Effect of treatment with direct-acting antiviral agents on the prognosis of extrahepatic diseases in patients with hepatitis C / 临床肝胆病杂志

The prognosis of patients with hepatitis C virus infection depends not only on liver lesions， but also on extrahepatic sequelae. Direct-acting antiviral agents （DAAs）， as the first-line drugs in the treatment of hepatitis C， have helped more and more patients achieve sustained virologic response and clinical cure， but its effect on the prognosis of extrahepatic diseases remains unclear. This article reviews the effect of DAAs treatment on the prognosis of extrahepatic diseases in patients with hepatitis C and points out that long-term follow-up monitoring is still required for patients with hepatitis C after cure.

Clinical analysis of 17 cases of Kala-azar in Yangquan City, Shanxi Province / 中华地方病学杂志

Objective:To explore the epidemic characteristics, clinical features and therapeutic effects of Kala-azar in Yangquan City, Shanxi Province in recent years, and to improve the cognition of Kala-azar.Methods:The clinical data of 17 adult cases of Kala-azar in Yangquan City, Shanxi Province in 2018 and 2019 were collected by retrospective analysis method, the epidemiological characteristics, clinical diagnosis and first diagnosis, clinical manifestations, laboratory and imaging examination, treatment and prognosis of the patients were sorted and analyzed.Results:All 17 patients were from Yangquan City, Shanxi Province, including 15 males and 2 females. The main clinical manifestations were long-term irregular fever (17 cases), anemia (13 cases) and splenomegaly (16 cases). The main manifestations of blood routine included decreased white blood cell count (14 cases), anemia (13 cases), and decreased platelet count (10 cases). The positive rate of rk39 immunochromatographic strip test was 100.00% (14/14). Nine patients underwent bone marrow puncture smear examination, 7 patients were positive for Leishman-Donovan bodies. All patients were treated with sodium pentavalent antimony gluconate (hereinafter referred to as antimonials) for 10 days, the cure rate was 88.24% (15/17), and recurrence rate was 11.76% (2/17).Conclusions:The clinical manifestations of Kala-azar are not typical, and it is easy to be misdiagnosed. Early examination of bone marrow puncture smear and serum antibody should be carried out for suspected patients. Antimonials is still a safe and effective drug for treating Kala-azar.

Efficacy of precision therapy with direct-acting antiviral drugs for patients with chronic HCV genotype 1b infection / 中华临床感染病杂志

Objective To evaluate the efficacy of precision therapy with direct-acting antiviral drugs (DAAs) for patients with chronic HCV gene type 1b infection.Methods One hundred and thirteen patients with chronic HCV genotype 1b infection admitted in the Department of Infectious Diseases of First Hospital of Shanxi Medical University from January 2018 to July 2019 were enrolled,including 89 patients with chronic hepatitis and 24 patients with cirrhosis.Different DAAs therapeutic schedule were taken based on liver function, kidney function, complication and treatment costs.Seventy-two patients were treated with pan-genotype drugs, including 43 patients treated with Sofosbuvir and Velpatasvir (SOF+VEL), 13 treated with Sofosbuvir and Ribavirin ( SOF +RBV), and 16 treated with Sofosbuvir and Daclatasvir ( SOF +DCV).Forty one patients were treated with specific genotype DAAs , including 15 treated with Ombitasvir and Dasabuvir (OBV+DSV), and 26 treated with Elbasvir and Grazoprevir tablets (EBR+GZR).Pair t test and Chi-square test were used to compare virological response rate , the liver function and the adverse reactions were observed.Results The super-rapid virological response (SRVR) rate with DAAs treatment at 1 week was 88.5%(100／113),and the rapid virological response ( RVR) at 4 weeks of treatment was 98.2%(111／113).There was no significant differences in SRVR and RVR among the patients treated with five treatment regimens (χ2 ＝5.95 and 1.04,P＞0.05), all the patients obtained complete early virological response (CEVR) at 12 weeks and sustained virological response ( SVR12) at 12 weeks after treatment. Besides, there were no significant differences in SRVR and RVR between pan-genotype and gene-specific drugs (χ2 ＝0.03 and 0.17, P＞0.05),both CEVR and SVR12 reached 100% in all patients.The liver transaminase levels were improved in patients undergoing pan-genotype or gene-specific drugs treatment. Mild adverse reactions were observed in 5 cases, hemolysis occurred in 1 patient and it was cured after replacement of drugs.Conclusion Both pan-genotype and specific genotypes of DAAs can achieve high virological response rates.Genotypic testing should be performed before antiviral therapy , in order to accurately select treatment options and to save costs.

Hot spots and difficult issues in treatment of chronic hepatitis B / 中华临床感染病杂志

Chronic hepatitis B (CHB) is a serious disease threatening the health and even life of people, at present antiviral therapy is the key approach to alter the disease outcome.The treatment objectives are to maximize the long-term inhibition of viral replication ; to reduce the inflammatory necrosis of hepatocytes and hepatic fibrosis ; to decompensate the cirrhosis ; to avoid the occurrence of liver failure , hepatocellular carcinoma and other complications ; thereby to improve the quality of life and prolong the survival of patients.The clinical cure should be pursued as far as possible ; however, most of CHB patients can not meet the standard of drug withdrawal and achieve clinical cure.This article reviews the current hot spots and difficult issues in the treatment of CHB.

Evaluation of training course of hepatic disease in grass roots clinical hepatic physicians in some poverty-stricken counties in Shanxi and Shaanxi provinces / 中华流行病学杂志

Objective To understand the awareness of hepatic disease related knowledge among hepatic physicians in poverty-stricken counties in China,assess the effectiveness of training and provide a reference for the training in the future.Methods The training was conducted in 90 clinical hepatic physicians selected from county hospitals in poverty-stricken counties (or cities) in Shanxi and Shaanxi provinces.An examination was conducted before the training,immediately after the training and at 5th month after the training,respectively.One-way analysis of variance and x2 test were conducted to evaluate the score and the correct rate.Results The knowledge score was (42.96± 14.02) before the training,(62.86 ± 13.28) immediately after the training and (59.03 ± 17.92) at 5thmonth after the training,and the differences were significant.After the training,the awareness of all aspects of related knowledge was improved,the difference was significant compared to knowledge score before training,and at 5th month after the training,the difference was still significant.Conclusion After the training,the awareness of liver disease related knowledge of clinical hepatic physicians in poverty-stricken counties (cities) in Shanxi and Shaanxi provinces was improved,and the improvement could be maintained for nearly halfa year.

Evaluation of training course of hepatic disease in grass roots clinical hepatic physicians in some poverty-stricken counties in Shanxi and Shaanxi provinces / 中华流行病学杂志

Objective To understand the awareness of hepatic disease related knowledge among hepatic physicians in poverty-stricken counties in China,assess the effectiveness of training and provide a reference for the training in the future.Methods The training was conducted in 90 clinical hepatic physicians selected from county hospitals in poverty-stricken counties (or cities) in Shanxi and Shaanxi provinces.An examination was conducted before the training,immediately after the training and at 5th month after the training,respectively.One-way analysis of variance and x2 test were conducted to evaluate the score and the correct rate.Results The knowledge score was (42.96± 14.02) before the training,(62.86 ± 13.28) immediately after the training and (59.03 ± 17.92) at 5thmonth after the training,and the differences were significant.After the training,the awareness of all aspects of related knowledge was improved,the difference was significant compared to knowledge score before training,and at 5th month after the training,the difference was still significant.Conclusion After the training,the awareness of liver disease related knowledge of clinical hepatic physicians in poverty-stricken counties (cities) in Shanxi and Shaanxi provinces was improved,and the improvement could be maintained for nearly halfa year.

Diagnosis strategies for intrahepatic cholangiocarcinoma / 临床肝胆病杂志

Intrahepatic cholangiocarcinoma is an uncommon malignant tumor,and its incidence has been increasing in the recent 30 years. Since patients have no specific clinical manifestations in early stage,the diagnosis of this disease is often very difficult,with a low rate of radical resection in late stage and poor prognosis.Therefore,as for patients with intrahepatic cholangiocarcinoma,early screening and diag-nosis is of vital importance.Imaging examination is an important method for the diagnosis of intrahepatic cholangiocarcinoma,and when com-bined with laboratory markers and pathological examination,it can increase diagnostic rate and reduce the rate of missed diagnosis.It is im-portant in clinical practice to select reasonable methods based on the patient′s actual condition.

Correlation between polymorphisms in the human leukocyte antigen-DQB1 alleles and hepatitis B with primary hepatocellular carcinoma / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the correlation between polymorphisms in human leukocyte antigen (HLA)-DQB 1 and primary liver cancer (PLC) with hepatitis B virus (HBV) and to search for susceptibility and resistance genes related to PLC with HBV.</p><p><b>METHODS</b>One hundred and eighteen patients with HBV-related liver cancer were enrolled from the First Hospital of Shanxi Medical University. Patients were stratified by family history of hepatitis B (39 with; 79 without) and HBV DNA positivity (60 positive, ≥1*10(3) IU/mL; 58 negative, <1*10(3) IU/mL). The HLA-DQB 1 genotype was determined by PCR and direct nucleotide sequence analysis genotyping. Allele frequencies were calculated by the direct counting method. Betweengroup comparisons were carried out with the Chi-square test or Mann-Whitney U test.</p><p><b>RESULTS</b>The allele frequencies of HLA-DQBl*0202 and HLA-DQBl*0301 were significantly higher in patients with hepatocellular carcinoma (HCC) than the control group (1 1.8% and 29.3% vs. 7.6% and 21.1%; U=2.43 and 3.09, P<0.05, RR=1.581 and 1.477). The allele frequencies of HLA-DQB1*0202 and HLADQB 1*0301 were significantly higher in patients with HCC and familial history of hepatitis B than in the normal population (14.1% and 29.5% vs. 7.6% and 21.1%; U=3.76 and 3.16, P less than 0.05, RR=1.928 and 1.495). The allele frequency of HLA-DQB 1*0301 was significantly higher in the HBV DNA positive group than in the HBV DNA negative group (35.0% vs. 23.3%; x2=5.543, P less than 0.05, RR=1.775), while the frequency of HLA-DQB1*0302 was significantly lower in the HBV DNA positive group than in the HBV DNA negative group (10.9% vs. 14.7%; x2=4.604, P<0.05, RR=0.229).</p><p><b>CONCLUSIONS</b>The HLA-DQB 1 *0202 and HLA-DQB 1*0301 alleles may represent susceptibility for PLC with hepatitis B as well as for familial hepatitis B liver cancer. The HLA-DQB 1*0301 allele may support replication of HBV DNA, facilitating progression to liver cancer. The HLA-DQB1*0302 allele may inhibit replication of HBV DNA and reduce the incidence of liver cancer.</p>

Familial Hepatits B Virus Genotypes and Clinical Prognosis / 中华医院感染学杂志

OBJECTIVE To investigate the distribution of familial hepatitis B virus (HBV) genotypes and analyze the relationship between genotypes and clinical outcome. METHODS A total of 136 cases of familial hepatitis B were involved in this study,including 25 cases of asymptomatiec HBV carriers (ASC),85 cases of chronic hepatits B (CHB),24 cases of liver cirrhosis (LC) and 4 cases of hepatocellular carcinoma (HCC). Nested polymerase chain reaction-restriction fragment length polymorphism (ntPCR-RFLP)was used to identify the genotypes of HBV. RESULTS There were 124 cases with hepatitis genotype C,7 cases with genotypes B+C mixed,3 cases with genotype B and 2 cases that did not conformed to be any of genotypes from A to H. Genotype C in the HCC was predominant genotype (100%),next in the LC(96%),CHB (95.3%) and ASC(66.7%).Compared with genotype C,genotypes B and B+C only existed in ASC and CHB,the proportion was 9.5% vs 23.8% and 1.2% vs 2.3%,respectively. There were no other HBV genotypes from A to H seen in familial hepatitis B in Shanxi province. CONCLUSIONS HBV genotype C is the major one in familial hepatitis B in Shanxi. There are a few genotypes B and B+C existed. Genotype C induces a relatively bad prognosis.