Analysis of the medium-term curative effect of transjugular intrahepatic portosystemic shunt through jugular vein with covered Viatorr stent / 中华肝脏病杂志

Objective@#To investigate the medium-term curative effect of transjugular intrahepatic portosystemic shunt (TIPS) through jugular vein with covered Viatorr stent.@*Methods@#Data of 105 consecutive patients with covered Viatorr stent of our hospital was retrospectively analyzed. Follow-up was performed after surgery, and color Doppler was reviewed to evaluate the efficacy of TIPS.@*Results@#Transjugular intrahepatic shunt was successfully established in all patients. The pressure gradients of portal vein before and after operation were 22.33 ± 6.4 mmHg and 9.78 ± 4.9 mmHg, respectively,P< 0.01, and the difference was statistically significant. The follow-up period ranged from 12.7 to 15.6 months, with an average of 13.09 ± 1.4 month. Total bilirubin and coagulation time increased after operation, but there was no significant difference in total bilirubin and coagulation time at 1, 3, 6 and 12 months after operation. The patency rate of shunt was 100%, 99.05%, 99.05% and 99.05% at 1, 3, 6 and 12 months after operation. The incidence of hepatic encephalopathy was 34.2%, 29.5%, 19.1% and 14.3% respectively. The recurrence rate of symptoms was 0%.@*Conclusion@#Patients with cirrhotic portal hypertension who underwent TIPS with covered Viatorr stent had a lower rate of restenosis, improved liver function, and a lower incidence of severe hepatic encephalopathy. However, the long-term efficacy needs further observation.

Hepatitis C virus infection increases the incidence of intrahepatic cholangiocarcinoma: a Meta-analysis / 中华肝胆外科杂志

Objective A meta-analysis was conducted to evaluate the correlation between hepatitis C virus (HCV) infection and the incidence of intrahepatic cholangiocarcinoma (ICC).Methods EMBASE,MEDLINE,Web of Science,CNKI,Weipu and Wanfang databases were retrieved to identify eligible studies which were published between January 2000 and May 2015.Pooled odds ratios (OR) with 95％ confidence interval (95％ CI) were calculated using RevMAN 5.3.Results 14 case-control studies and 2 cohort studies were included in this study.As there was great heterogeneity among these 16 studies (Chi2 =53.18,df =15,I2 =72％,P ＜0.05),the random-effect model was employed.The combined risk estimates of all the studies showed a significant increase in ICC incidence with HCV infection (OR =3.96,95％ CI 2.63-5.95,P ＜ 0.05).The Begg funnel plot showed no evidence of publication bias.Conclusion HCV infection is related to an increased risk of ICC incidence.

Changes in HBsAg titer and HBV DNA load and their correlation in patients with chronic hepatitis B and HBV-related liver cirrhosis / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the changes in HBsAg titer and HBV DNA load and their correlation in patients with chronic hepatitis B (CHB) and HBV-related liver cirrhosis (HBV-LC).</p><p><b>METHODS</b>Forty-six patients with mild to moderate CHB (CHB-LM), 24 patients with severe CHB (CHB-S), and 28 patients with HBV-LC at admission, and 51 patients with HBV-LC at 4.08 ± 3.06 months during antiviral treatment were tested for serum HBsAg titer and HBV DNA load using Abbott chemiluminescence and fluorescence quantitative PCR, respectively.</p><p><b>RESULTS</b>The serum HBsAg titer and HBV DNA load gradually decreased with increased disease severity (from CHB-LM, CHB-S to HBV-LC; χ(2)=12.537 and 8.381, respectively, P<0.05). HBsAg titer and HBV DNA load were significantly higher in CHB-LM and CHB-S groups than in HBV-LC group (P<0.05), but comparable between CHB-LM and CHB-S groups (Z=-0.649 and 0.032, respectively, P>0.05). Among HBeAg-positive patients, HBsAg titer and HBV DNA load tended to decrease with increased disease severity (from CHB-LM, CHB-S to HBV-LC; χ(2)=6.146, P=0.046 and χ(2)=1.017, P>0.05; respectively), and CHB-LM group had significantly higher HBsAg titer than HBV-LC group (Z=-2.247, P=0.025). Among the HBeAg-negative patients, serum HBsAg and HBV DNA load gradually declined with the disease severity (χ(2)=8.660 and 13.581, respectively, P<0.05), and were obviously higher in CHB-LM and CHB-S groups than in HBV-LC group (P<0.05). Positive correlations were found between serum HBsAg and HBV DNA levels in CHB-LM (r=0.389, P=0.009) and HBV-LC groups (r=0.431, P=0.022), but not in CHB-S group (r=0.348, P=0.104). After antiviral therapy, the serum HBsAg titer was slightly decreased (Z=-1.050, P=0.294) while HBV DNA load markedly reduced (Z=-5.415, P<0.001), showing no correlation between them (r=0.241, P=0.111) or between the measurements before and after treatment (r=0.257, P=0.085).</p><p><b>CONCLUSION</b>Serum HBsAg titer and HBV DNA load decreases progressively from CHB-LM to CHB-S and HBV-LC in both HBeAg- positive and -negative patients. The serum HBsAg titer is positively correlated with HBV DNA load, but their levels are not consistently parallel.</p>

Analysis of risk factors of hepatitis B cirrhosis complicated with hepatic encephalopathy / 中国基层医药

Objective To investigate the hepatitis B liver cirrhosis complicated with hepatic encephalopathy (HE),relevant risk factors in the development of strategies for the prevention and treatment of the disease,and make for the clinical experience accumulation.Methods A retrospective analysis of 64 cases of liver cirrhosis patients complicated with HE,for the observation group.In addition,53 patients of hepatitis B cirrhosis without HE patients were selected as control group.The two groups of patients with objective physiological indicators were recorded and compared.Results (1) Compared with the control group,blood ammonia,serum total bilirubin,blood urea nitrogen level and infection,incidence of digestive tract hemorrhage of the study group increased,blood sodium,alanine amin otrans ferase,decrease the serum albumin level,the differences were statistically significant (t =3.0 8 5,5.5 2 8,x2 =9.174,7.126,t =4.102,4.337,8.675,5.323,all P ＜0.05).(2) For the patients in the study group,age,more than 3 kinds of incentives and C grade of liver function were the high risk factors of death.(3) In the cause of deaths in the study group,the infection was the most common,the incidence rate was 75.9%,the second above digestive rare tract hemorrhage,the incidence rate was 65.5%.Conclusion The elderly,the number of risk factors and severity of liver function are the occurrence and development of related risk factors of hepatitis B related cirrhosis with hepatic encephalopathy,to remove the incentive is the key of HE with prevention and treatment of hepatitis B cirrhosis.