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Objective To investigate the epidemiological features and antiviral response of patients with genotype 6 chronic hepatitis C (CHC) in Guangxi, China. Methods A total of 97 patients with genotype 6 CHC who were admitted to The First Affiliated Hospital of Guangxi Medical University from December 2012 to December 2020 were enrolled, among whom 62 patients were given antiviral therapy. The 62 patients receiving antiviral therapy were divided into interferon group with 22 patients and direct-acting antiviral agent (DAA) group with 40 patients. Related data were collected, including general demographic data, HCV RNA, liver function, routine blood test results, and renal function. The chi-square test was used for comparison of categorical data between groups. Results Among the 97 patients, there were 69 male patients (71.1%) and 28 female patients (28.9%), with a mean age of 41.97±10.12 years, and the patients aged 30-40 years accounted for 47.4% (46/97). Of all 97 patients, 95 (97.9%) had genotype 6a, 1 had genotype 6e, and 1 had genotype 6xa. Among the 65 patients with a definite route of infection, 41 (63.1%) had intravenous drug use, 14 had medical-related operations, 9 had blood transfusion, and 4 had sexual contact as the route of infection. For the interferon group, the rapid virologic response (RVR) rate at week 4 was 81.8% (18/22), the rate of undetectable virus at the time of drug withdrawal (Epoint) was 86.4% (19/22), the rate of sustained virologic response at 12 weeks after drug withdrawal (SVR12) was 81.8%, and the rate of sustained virological response at 24 weeks after drug withdrawal (SVR24) was 81.8%; 1 patient in this group experienced recurrence. All 40 patients in the DAA group were previously untreated patients (33 patients without liver cirrhosis and 7 patients with compensated liver cirrhosis), with an overall RVR rate of 87.5%(35/40), an Epoint rate of 100%, and an SVR12 rate of 100%, and there was no treatment failure or recurrence. Although different DAA regimens had different RVR rates, they all had a SVR12 rate of 100%. The patients with compensated liver cirrhosis and other diseases had a SVR12 rate of 100%. Conclusion Intravenous drug addiction is the main route of infection for patients with genotype 6 CHC in Guangxi, and CHC is more common in men, with genotype 6a as the main subtype. DAA treatment has a higher virologic response rate than interferon treatment, with an SVR12 rate of 100%. There is no significant difference in SVR12 rate between the patients with compensated liver cirrhosis and those without liver cirrhosis.
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Objective To investigate the efficacy of entecavir (ETV) versus tenofovir disoproxil fumarate (TDF) and the treatment measures for poor response in previously untreated chronic hepatitis B (CHB) patients with high viral load. Methods A total of 165 CHB patients who received antiviral therapy and met the inclusion criteria in Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, from June 2016 to July 2021 were enrolled. The patients enrolled had a baseline HBV DNA level of > 6lg copies/ml and were previously untreated CHB patients who had used ETV or TDF for 48 weeks, and quantitative real-time PCR was used to measure HBV DNA. Virologic response rate was calculated after 48 weeks of treatment; a logistic regression analysis was used to investigate the influencing factors for the response of HBV DNA 40 U/L) at baseline, 89.2% (107/120) achieved an HBV DNA load of 30 years (77.8% vs 47.2%, 85.2% vs 66.7%). For the patients who did not achieve complete virologic response (HBV DNA ≥100 copies/mL) after 48 weeks of treatment, 87.9% (29/33) achieved complete virologic response after the original treatment regimen was prolonged for 48 weeks, and 100% (9/9) of the patients achieved complete virologic response after switching to or adding the first-line nucleos(t)ide analogues (NUCs) without cross-resistance sites with the original regimen for another 48 weeks. Conclusion The patients aged > 30 years should receive antiviral therapy as early as possible, regardless of viral load and ALT level, especially those with a family history of liver cirrhosis or hepatocellular carcinoma; the patients aged ≤30 years who have a normal ALT level and a high viral load should consider initiating antiviral therapy after providing informed consent. For the patients with poor response after 48 weeks of treatment, first-line NUCs without cross-resistance sites with the original regimen should be switched to or added in time.
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Objective:To compare the similarities and differences of clinical characteristics of human immunodeficiency virus (HIV)-negative and HIV-positive patients with talaromycosis marneffei (TSM).Methods:The clinical data of 175 inpatients diagnosed with TSM in First Affiliated Hospital of Guangxi Medical University from May 2012 to April 2019 were retrospectively analyzed. The patients were divided into HIV-positive group and HIV-negative group according to the results of HIV confirmation test. The clinical manifestations, laboratory examination indicators (white blood cell count, hemoglobin, albumin, CD4 + T lymphocyte count and C-reactive protein (CRP)) between the two groups were compared. Mann-Whitney U test and chi-square test were used for statistical analysis. Results:Among 175 TSM patients, 85 were HIV-positive and 90 were HIV-negative patients. The main clinical manifestations of fever and lymphadenopathy in the HIV-positive group and HIV-negative group were 71 (83.53%) cases and 73 (81.11%) cases, 50 (58.82%) cases and 47 (52.22%) cases, respectively, and there were both no statistical differences ( χ2=0.175 and 0.771, respectively, both P>0.05), while respiratory symptoms, weight loss and subcutaneous masses were 62 (72.94%) cases and 81 (90.00%) cases, 73 (85.88%) cases and 56 (62.22%) cases, one (1.18%) case and 16 (17.78%) cases, respectively, the differences were all statistically significant ( χ2=8.514, 12.630 and 13.737, respectively, all P<0.01). Hemoglobin in HIV-positive group and HIV-negative group were 90.50 (77.00, 113.95) g/L and 88.65 (72.85, 99.93) g/L, respectively. The difference was statistically significant ( Z=2.023, P=0.043). The ratios of albumin<30 g/L, CRP>10 mg/L in the two groups were 69.41%(59/85) and 60.00%(54/90), 94.37%(67/71) and 94.19%(81/86), respectively, and the differences were both not statistically significant ( χ2=1.693 and 0, respectively, both P>0.05). The ratios of cases with white blood cell counts >10×10 9/L and CD4 + T lymphocyte count<50/μL in the positive and negative groups were 3.53%(3/85) and 81.11%(73/90), 80.77%(63/78) and 1.75%(1/57), respectively, the differences were both statistically significant ( χ2=107.095 and 82.467, respectively, both P<0.01). Conclusions:In TSM patients, HIV-negative with subcutaneous masses, and increased white blood cell counts are common. Decreased body weight and CD4 + T lymphocyte count<50/μL in HIV-positive patients are more common than HIV-negative patients.
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ObjectiveTo investigate the incidence rate of resistance-associated variants (RAVs) in the non-structural protein 5B (NS5B) region in patients with hepatitis C virus (HCV) genotype 1b (GT1b) infection in Guangxi, China, as well as its difference between male and female patients. MethodsA total of 60 previously untreated patients with HCV GT1b infection who were admitted to The First Affiliated Hospital of Guangxi Medical University from April 2016 to September 2018 were enrolled. Their baseline serum samples were collected. The NS5B region fragments were amplified by nested PCR and gene sequencing was performed, and then the sequencing results were compared with standard strains in GeneBank. The t-test was used for comparison of age, HCV RNA, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) between male and female patients, and the Fisher′s exact test was used for comparison of mutation rate of drug-resistance sites. ResultsOf all 60 patients, 55 obtained the complete sequence information of the NS5B region, and the incidence rate of RAVs in the NS5B region was 96.3%. C316 (94.5%), A338 (70.9%), and T19 (74.5%) were the main mutation sites, and multisite mutations such as C316+T19 and C316+T19+A338 were observed. There was no significant difference in the incidence rate of RAVs between male patients and female patients ［95.8% (23/24) vs 96.8% (30/31), P=1.000］. ConclusionPatients with HCV GT1b infection in Guangxi have a high incidence rate of RAVs in the NS5B region, with both single-site and multisite mutations. There is no significant difference in the incidence rate of RAVs between male and female patients.
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Objective To evaluate the prevalence and risk factors of metabolic syndrome among hepatitis C patients in Chinese Han population .Methods This was a multicenter ,cross-sectional study . A total of 997 Chinese Han patients with hepatitis C virus (HCV) infection were enrolled .Demographic data ,anthropometric data and clinical parameters related to metabolic syndrome were collected .Statistical analysis was performed by t-test (normal distribution) or Mann-Whitney U two-sample test (non-normal distribution) and χ test .Binary logistic regression analyses were used to determine the parameters significantly related to metabolic syndrome .Results Among the 997 patients ,170 (17 .1%) patients were diagnosed with metabolic syndrome .Binary logistic regression showed that genotype 2 (OR＝1 .594 ;95% CI :1 .045－2 .431 , P＝ 0 .030) ,older age (OR＝ 1 .040 ;95% CI :1 .022 －1 .058 , P＜ 0 .01) , overweight (OR＝3 .876 ;95% CI :2 .593－5 .792 ,P＜0 .01) ,fatty liver history (OR＝2 .106 ;95% CI : 1 .384－3 .204 ,P＝0 .001) ,homeostasis model assessment insulin (HOMA-IR) (OR＝1 .263 ;95% CI :1 .118－1 .427 , P＜0 .01) ,fasting insulin (OR＝0 .949 ;95% CI :0 .915 －0 .985 , P＝0 .006) ,lower serum albumin level (OR＝0 .957 ;95% CI :0 .915 －1 .000 , P＝0 .049) and higher γ-GT level (OR＝1 .004 ;95% CI :1 .000 －1 .008 , P＝ 0 .0041 ) were all significantly associated with the presence of metabolic syndrome .Conclusions Hepatitis C patients with genotype 2 ,older age ,overweight ,fatty liver history ,higher HOMA-IR ,lower fasting insulin level ,lower serum albumin level or higher γ-GT level should be screened for metabolic syndrome .
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Objective To observe the incidence of spontaneous clearance of hepatitis B virus (HBV) DNA in chronic hepatitis B (CHB) patients ,and to investigate the related factors of the spontaneous clearance of HBV DNA and to determine the time to start antiviral therapy .Methods Patients who met the inclusion criteria were recruited from the follow-up cohort of chronic HBV infection from January 2008 to August 2017 for observation .The liver function including alanine aminotransferase (ALT) levels ,HBV DNA load and serum markers of HBV were measured at baseline ,month 1 ,month 3 and month 6 of follow-up . Evaluation index included cumulative HBV DNA negative conversion rate and cumulative HBeAg negative conversion rate .Multivariable analysis was used to analyze the factors associated with the spontaneous clearance of HBV DNA .Results A total of 116 patients were recruited in this study .All the patients showed ALT level elevation at baseline .Without antiviral treatment ,the cumulative HBV DNA negative conversion rate was 12 .9％ after 6-month observation .HBeAg negative conversion rate was 22 .5％ .Multivariable analysis showed that patients without a family history of HBV infection ,baseline ALT level >3 times the upper limit of normal (ULN) and HBV DNA level <6 lg copies/mL had higher cumulative HBV DNA spontaneous clearance rate .HBV DNA negative conversion rate in patients whomet all the above three conditions was up to 75％ .Conclusions In CHB patients and ALT level elevation for the first time , some patients could achieve spontaneous clearance of HBV DNA without antiviral therapy .Patients without a family history of HBV infection ,baseline ALT level >3 ULN and HBV DNA level <6 lg copies/mL have higher rate of cumulative HBV DNA spontaneous clearance .
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Objective To evaluate the kidney safety of tenofovir (TDF) as a first-line antiretroviral drug in patients with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) and to analyze the risk factors for TDF nephrotoxicity.Methods Clinical data of treatment-naive adult HIV/AIDS patients were retrospectively collected from Longtan Hospital,Guangxi from September 2010 to June 2013.The estimated glomerular filtration rates (eGFR) between adults HIV/AIDS patients who maintained antiretroviral therapy (TDF/Lamivudine[3TC]/Efavirenz[EFV] and AZT/3TC/EFV groups) for one year or more were compared.The incidences of chronic kidney disease (CKD) and renal insufficiency were compared between the two groups.The categorical variables were described with the percentage (％) and compared with the chi-square test.Normal distribution data were described with mean±standard deviation and compared with Student t test.Non-normal distribution data were described with M (P25,P75) and compared with nonparametric test.The Cox hazard model was used to determine the risk factors for CKD in uni-and multivariate analyses.Results Among 441 patients enrolled in this study,232 were in TDF group,while 209 in AZT group.At baseline,the median age was 42 (32,51) years;the median weight was 55 (50,60) kg;the mean time of follow-up was (18.5±5.0)months.Eighty-three patients (18.8％) suffered from mild renal dysfunction.During the course of 24-month treatment,eGFR level in TDF group was lower than that in AZT group,with statistical significant difference (all P＜0.05).The cumulative incidences of renal hypofunction in the TDF group and AZT group were 18.8％ and 5.8％,respectively.The difference between the two groups was statistically significant (x2 =8.017,P=0.001).The cumulative incidences of CKD in the TDF and AZT groups were 3.4％ and 0.0％,respectively,with statistically significant difference (x2 =4.544,P =0.022).Age (HR=1.148,P＜0.01),the baseline eGFR (HR=4.193,P=0.002) were independent risk factors for renal toxicity.The subgroup analysis of TDF group of age ＜40,40-49,50-59,≥60 years old showed that the cumulative incidences of CKD in the four subgroups were 0,1.9％,5.4％ and 11.1％,respectively.The difference among groups was statistically significant (x2 =10.627,P =0.014).Conclusions As the first-line antiretroviral therapy,TDF can cause renal insufficiency in patients with HIV/AIDS,but the incidence of CKD is low.Age and the baseline eGFR are the independent risk factors for TDF-induced renal toxicity.The CKD incidence is significantly elevated among patients over 50 years old who exposed to TDF,especially in patients over 60 years old.
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Objective@#Hepatitis B surface antigen (HBsAg) loss is seldom achieved with nucleos(t)ide analog (NA) therapy in chronic hepatitis B patients but may be enhanced by switching to finite pegylated-interferon (Peg-IFN) alfa-2a. We assessed HBsAg loss with 48- and 96-week Peg-IFN alfa-2a in chronic hepatitis B patients with partial response to a previous NA.@*Methods@#Hepatitis B e antigen (HBeAg)-positive patients who achieved HBeAg loss and hepatitis B virus DNA < 200 IU/mL with previous adefovir, lamivudine or entecavir treatment were randomized 1:1 to receive Peg-IFN alfa-2a for 48 (n = 153) or 96 weeks (n = 150). The primary endpoint of this study was HBsAg loss at end of treatment. The ClinicalTrials.gov identifier is NCT01464281.@*Results@#At the end of 48 and 96 weeks' treatment, 14.4% (22/153) and 20.7% (31/150) of patients, respectively, who switched from NA to Peg-IFN alfa-2a cleared HBsAg. Rates were similar irrespective of prior NA or baseline HBeAg seroconversion. Among those who cleared HBsAg by the end of 48 and 96 weeks' treatment, 77.8% (14/18) and 71.4% (20/28), respectively, sustained HBsAg loss for a further 48 weeks. Baseline HBsAg < 1 500 IU/mL and week 24 HBsAg < 200 IU/mL were associated with the highest rates of HBsAg loss at the end of both 48- and 96-week treatment (51.4% and 58.7%, respectively). Importantly, extending treatment from 48 to 96 weeks enabled 48.3% (14/29) more patients to achieve HBsAg loss.@*Conclusion@#Patients on long-term NA who are unlikely to meet therapeutic goals can achieve high rates of HBsAg loss by switching to Peg-IFN alfa-2a. HBsAg loss rates may be improved for some patients by extending treatment from 48 to 96 weeks, although the differences in our study cohort were not statistically significant. Baseline and on-treatment HBsAg may predict HBsAg loss with Peg-IFN alfa-2a.
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Hepatitis B virus (HBV) covalently closed circular DNA (cccDNA) in infected hepatocytes is the main cause of off-therapy viral rebound. The half-life of cccDNA is only 33-50 days, so the conversion of newly synthesized rcDNA to cccDNA in the nucleus is essential for the maintenance of cccDNA pool in infected hepatocytes. Though not directly targeting the existing cccDNA, current nucleos(t)ide analogues (NAs) may exhaust the cccDNA reservoir by blocking the rcDNA formation. Indeed, a prolonged consolidation therapy post loss of serum HBV DNA can achieve sustained remission and thus safe drug discontinuation in a small proportion of chronic hepatitis B (CHB) patients. In recent studies, we and others have demonstrated that it is the serum HBV RNA that reflects the cccDNA activity in infected hepatocytes, particularly among the patients on NAs. Here we suggest that instead of measuring serum HBV DNA only, simultaneous measurement of both viral DNA and RNA would improve the accuracy to reflect the cccDNA activity; therefore, the virological response should be redefined as consistent loss (less than the lower limit of detection) of both serum HBV DNA and RNA, which indicates the safety of drug discontinuation. Accumulating evidence has suggested that for the CHB patients with lower serum HBsAg, switch-to or add-on pegylated interferon (Peg-IFN) treatment would result in loss of serum HBsAg in a relatively large proportion of CHB patients. Since serum HBV RNA is an ideal biomarker to reflect the intrahepatic cccDNA activity, for the patients with a serum HBsAg level lower than 1 500 IU/ml after long-term NAs treatment, the serum HBV RNA should be measured. If serum HBV RNA is detected, peg-IFN should be added on; if serum HBV RNA is not detected, NAs treatment should be switched to peg-IFN treatment. We believe the therapy based on serum HBV RNA would make the functional cure of CHB (serum HBsAg loss or even conversion to anti-HBs) more efficient.
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Objective To investigate the epidemiological characteristics and therapeutic strategies of patients infected with hepatitis C virus (HCV)genotype 6 in Guangxi area.Methods Serum samples were collected from 150 patients with serologic HCV RNA positive in Guangxi, China. Reverse transcription nested polymerase chain reaction (PCR)was employed to amplify HCV NS5B fragments and the DNA products were sequenced.The sequences obtained were compared with the sequences deposited in GenBank to construct a phylogenetic tree.Among the patients who accomplished 48-week treatment of interferon plus ribavirin and 24-week follow-up after stopping medication,10 cases were infected with genotype 6a and 28 cases with genotype 1 HCV.The virological responses were evaluated at week 4,week 12,week 24 of treatment and week 24 after the end of the treatment.Results Among all recruited 150 cases,21 (14.0%)cases were HCV genotype 6 including two subtypes 6a (n = 20 )and 6d (n = 1 ). Genotype 6 HCV mainly affected intravenous drug users, especially with age of ≤ 40 years old. Phylogenetic tree showed that there was very close evolutionary distance between HCV 6 strains of Guangxi and Hongkong,China strains (Y12083,DQ 480515)and Vietnam strain (EU246930).All of 10 HCV genotype 6a patients who completed 48 weeks of antiviral therapy achieved sustained virological response (SVR).The rate of SVR was higher than that of genotype 1 patients,but without statistically different significance (10/10 vs 75 .0%,P >0.05).Conclusion HCV genotype 6 in Guangxi area mainly affects young intravenous drug users with age of ≤ 40 years old,which has high homology with Hongkong,China and Vietnam standard strains.Patients with HCV 6 genotype infection treated with interferon plus ribavirin for 48 weeks usually achieve favorable SVR.
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Objective To evaluate the correlation of the baseline clinical and laboratory test index with death,and to discuss the independent risk factors for long-term prognosis in elderly HIV/ AIDS patients who had accepted highly active antiretroviral therapy (HAART).Methods 1671 cases of HIV/AIDS patients were included in retrospective cohort study,divided into death group (183 cases) and non-death group (1488 cases) according to HIV/AIDS related death event,and followed up for 2 days to 120 months,an average of 427 days.Results During the period of followup,the proportion of male (12.45％) was higher than that of women (6.9％) in death group(x2 =10.42,P＜0.01).The mortality ratio of the WHO stage Ⅲ and Ⅳ was higher than that of the WHO stage Ⅰ and Ⅱ (x2 =18.67,P＜0.01).The mortality ratio was significantly higher in HIV/AIDS patients with baseline CD4+ T lymphocyte cell ＜100 cells/mm3 than ＞100 cells/mm3 (x2 =52.59,P＜0.01).The platelet (PLT),hemoglobin (HB),and blood glucose levels were lower in death group than in non-death group (P ＜ 0.05),but serum creatinine (SCR) and AST (aspartate aminotransferase) levels were higher than that in the non-death group (P＜0.05).There was no significantly differences between the death group and the non-death group in the index of white blood cell (WBC),blood urea nitrogen (BUN),total cholesterol (CH),triglyceride (TG),alanine aminotransferase (ALT) and total bilirubin (TB) levels (all P＞ 0.05).Multiple logistic regression analysis revealed that the WHO stage (OR=0.777,95％ CI:0.612～0.987,P＜0.05) and the baseline level of CD4+ T lymphocytes cell (OR=1.345,95％ CI:1.089～1.662,P＜0.01) were independent risk factors for long-term outcomes in elderly HIV/AIDS patients.Conclusions The WHO stage and baseline CD4+ T lymphocyte cell level are the independent risk factors for long-term prognosis in HIV/AIDS patients over 60 years of age.Early discovery and early beginning HAART can effectively improve the prognosis of elderly HIV/AIDS patients.
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Objective To evaluate the efficacy and drug resistance profiles of nucleosides (NA) retreatment in NA experienced chronic hepatitis B (CHB) patients. Methods Totally 104 NA experienced CHB subjects were enrolled in this study.All these subjects had received at least 3 months NA monotherapy and stopped the treatment,and then received NA retreatment for at least one year.The subjects were divided into three groups according to the following criteria:reached the therapy endpoint of China guideline when they stopped NA-naive treatment (group A,n =39); did not reach the therapy endpoint when they stopped NA-naive treatment but hepatitis B virus (HBV) DNA＜1.0× 103 copy/mL (group B,n=33); and with HBV DNA＞1.0× 103 copy/mL (group C,n=32).The efficacy and drug resistance profiles of retreatment were compared among three groups. The effects of baseline alanine aminotransferase (ALT) levels,HBV DNA levels and HBeAg titers on the retreatment efficacies were analyzed. The mutations of HBV P gene were detected by nested polymerase chain reaction (PCR) and direct sequencing.The data were analyzd by Wilcoxon test and x2 test.Results The time to ALT normalization in patients with baseline ALT＜ 1.3 × upper limit normal (ULN) was shorter than that in patients with ALT≥1.3×ULN (2 months vs 4 months; Z=2.281,P=0.023).The time to virological response in patients with baseline HBV DNA＜5 lg copy/mL was shorter than that in patients with HBV DNA≥5 lg copy/mL (1 month vs 2 months; Z=2.054,P =0.040). The time to virological response and ALT normalization in baseline HBeAg negative were both shorter than those in patients with baseline HBeAg positive patents ( 1 month vs 3 months and 2 months vs 4.5 months,respectively; Z=2.580 and 2.304,respectively; both P＜0.05). The subjects in group A achieved virological response and HBeAg seroconversion after retreatment earlier compared to previous NA-naive therapy ([1.61 ± 1.76] months vs [3.48±4.066]months and [3.38 ± 3.34] months vs [9.92-11.22] months,respectively; Z=-2.854 and-1.094,respectively; both P＜0.05).The cumulative HBeAg seroconversion rate in group A was higher compared to those in group B and group C (80.0％ vs 36.8％ and 37.5％,respectively; x2 =4.368 and 5.100,respectively; both P＜0.05).Thirteen patients developed clinical resistance and four of them developed genotypic resistance proved by PCR direct sequencing.Among the patients retreated with the same regimen as previous in the C group,the cumulative resistance rate was highest compared to group A and B (44％ vs 9％ and 0,respectively; x2 =5.019 and 6.588,respectively;both P＜0.05).No resistance was detected in the 14 patients retreated with combined NA treatment without cross resistance.Conclusions For NA experienced CHB patients who fulfill the indication of antiviral therapy,the retreatment should be started as earlier as possible. Retreatment with NA combination without cross resistance can prevent (reduce) the risk of developing drug resistance.
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Objective To explore the influence factors on hepatitis B virus (HBV) relapse after nucleos(t)ide analogues (NA) withdrawal in the chronic hepatitis B (CHB) patients who met NA cessation criteria. Methods Eighty-one consecutive CHB patients were treated with NA, 38 with lamivudine (LAM), 25 with adefovir dipivoxil (ADV), 12 with entecavir (ETV), 6 with LAM +ADV. Among recruited patients, 40 were hepatitis B virus e antigen (HBeAg) positive, 41 were HBeAg negative, 67 of them were initial treatment, 14 were retreatment due to resistance to NA at baseline. The treatment was discontinued after meeting China therapeutic end-point criteria. HBV DNA, HBV serological markers, alanine aminotransferase (ALT) were measured respectively at baseline, every month before virological response, every 3 months after virological response, every month within first 6 months and every 2 months over 6 months after drugs withdrawal. Twelve probable influence factors on relapse which were sex, age, HBV family history, baseline HBV DNA,baseline HBeAg status, baseline ALT, virological response time, total duration of treatment, duration of additional treatment, the level of hepatitis B virus surface antigen (HBsAg) at cessation therapy,initial treatment or retreatment, drug category were analyzed with univariate, multivariate Cox regression modle and stratified analysis. The cumulative relapse was calculated by the Kaplan-Meier method. Results A total of 36 patients (44. 4%) relapsed within 1 year. Initial treatment or retreatment, HBV family history, virological response time, the level of HBsAg at cessation therapy were independent risk factors. The relapse rate of retreatment was higher than that of initial treatment (78.6% vs 37. 3% , χ2 = 7. 983, P = 0. 005) , those of patients with HBV family history higher than without family history (64. 5% vs 15.0%, χ2 =12. 096,P = 0.002), those of patients obtained virological response within 3 months lower than after 3 months(34. 0% vs 64. 3% , χ2 =6. 823,P=0. 009) , those of patients with HBsAg≤150 μg/L at cessation therapy lower than >150 μg/L(27. 6% vs 53. 8%, χ2=5. 199,P=0. 023). Conclusions Retreatment, HBV family history, later virological response and higher HBsAg level at cessation therapy are risk factors of relapse after NA withdrawal. Such patients should be treated with prolonged duration after meeting end-point criteria to strengthen the efficacy.
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Objective To investigate the relationship between CT signs of portal hypertension and histopathologic stage of chronic hepatic fibrosis and cirrhosis. Methods Tri-stage enhance volume CT scan of upper abdomen was performed in 84 participants, including 48 patients with hepatic fibrosis confirmed by liver pathologic biopsy which divided into S1 (12/48), S2 (14/48), S3 (9/48) and S4 (13/48),16 patients with typical cirrhosis, and 20 healthy subjects as a control group. Measured the caliber of left and right branch of portal vein, MPV, SV and SMV at MIP images respectively, observed the collateral circulation, ascites and the size of spleen and then studied comparatively these measured parameters of different histopathologic stage. One-Way ANOVA was performed in the comparison of the vascular diameter of portal system and the size of spleen(SNK was used in the comparison between the groups). x2 test ofR × Ctable was performed in the comparison of ascites and collateral circulation among groups, and the vessel of portal system which has the greatest impact on the pathological staging of hepatic fibrosis was investigated with Logistic regression analysis. Results The caliber of left branch of portal vein, right branch of portal vein. MPV. SV and SMV were (0.98±0.11). (1.00±0.12), (1.33±0.11). (0.75±0.10).(1.07±0. 12) em respctively, the size of spleen was (128. 55±30. 56) cm<'3>, and collateral circulation and ascites were not found in control group. SV enlarged gradually in test groups and showed S1 (0. 86±0. 12) cm, S2(0. 96±0. 11) cm, S3(1.07±0.08) cm, S4(1.09±0. 10) cm, typical cirrhosis (1.18±0. 19) cm respotively. The difference between each group of S1 to typical cirrhosis and control group was significant, and the same result was seen among S3 to S4, cirrhosis and S1 to S2. Logostic regression analysis showed that the standardized regression coefficient of SV was maximum (2. 719) and had statistical significance(P <0. 01). The incidence of collateral circulati on and ascites in patients with typical cirrhosiswas significant higher than that of normal liver and every stage of hepatic fibrosis (P < 0. 05). Conclusion CT scan may be helpful for the early detection of advanced hepatic fibrosis or early stage of liver cirrhosis for patients with chronic liver disease.