ABSTRACT
In 2022, Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association, organized domestic experts to update the guideline for the prevention and treatment of hepatitis C from the aspects of epidemiology, population screening and prevention, laboratory testing, simplification of diagnostic processes and treatment regimens, and antiviral therapy for special populations. This article aims to interpret the treatment of special populations not specifically mentioned in the new guideline, including pregnant women and patients with hepatocellular carcinoma, as well as other issues that need to be solved, in order to provide a reference for clinicians in practical work.
ABSTRACT
In 2010,studies found that achievement of sustained virologic response after treatment in patients with chronic HCV infection meant cure;the overall cure rate of interferon combined with ribavirin around the world was about 60％,and the result of real-world study in China was 71.1％.In 2013,the US took the lead in launching the direct-acting antiviral agents (DAAs) for HCV,and the cure rate was increased to almost 100％.However,recent studies have found that the incidence of hepatocellular carcinoma (HCC) tends to increase after the application of DAAs,and there are still controversies over whether DAAs are the major cause of this phenomenon.In our opinion,this phenomenon is caused by the fact that the indications for DAAs cover more end-stage hepatitis C patients who are intrinsically the high-risk population of HCC;however,it cannot be excluded that DAAs may lead to the change in the body's antitumor immune status.Studies are needed in the future to examine this issue at the molecular level.
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Objective To investigate the risk factors and predictive model for the occurrence of post-sustained virologic response (SVR)hepatocellular carcinoma in chronic hepatitis C (CHC)patients. Methods A total of 203 CHC patients hospitalized at the First Affiliated Hospital of Zhengzhou University from January 2006 to December 2014 who received antiviral therapy and achieved SVR were collected,including 11 post-SVR HCC cases.Risk factors for post-SVR HCC were estimated by Cox′s proportional hazards regression model.Cutoff value predicting risk of post-SVR HCC was determined by receiver operating characteristic curve.Results In Cox′s model,the risk of post-SVR HCC increased by 9.4-fold in patients with initial diagnosis as compensated cirrhosis compared to those with initial diagnosis as CHC.Increase in post-SVR albumin by per 1 g/L was associated with reduced risk by 20% for the occurrence of post-SVR HCC.Cut-off value of post-SVR albumin for the prediction of HCC was determined as ≤ 36.0 g/L with an area under the curve (AUC)of 0.809.A predictive model for post-SVR HCC was created based on initial diagnosis as compensated cirrhosis and post-SVR albumin ≤36.0 g/L with an AUC of 0.871 .The sensitivity,specificity and negative predictive value of the model were 0. 818,0.896 and 0.989,respectively.Conclusions Initial diagnosis as compensated cirrhosis combines with post-SVR albumin ≤36.0 g/L are risk factors for post-SVR HCC with ideal prediction value for the occurrence of post-SVR HCC in CHC patients.
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Objective To investigate the expression of PD-1 on CD4 +and CD8 + T cells in patients with HBeAg-positive chronic hepatitis B(CHB)treated with telbivudine.Methods Fifty-six HBeAg-positive CHB patients admitted in the First Affiliated Hospital of Zhengzhou University during January 201 3 and June 201 4 were enrolled in this study.The expression of PD-1 on CD4 +and CD8 + T cells was detected with flow cytometry at baseline,24,48 and 72 wks after telbivudine treatment.The relationship of PD-1 expression with alanine aminotransferase (ALT)level,HBeAg seroconversion and HBV DNA loads was analyzed.t test and completely random variance analysis were used to analyze the data.Results The PD-1 expression on CD4 + and CD8 + T cells at baseline was higher in patients with low ALT levels compared to those with high ALT levels(t =1 2.20 and 9.69,both P <0.01 ),while higher levels of PD-1 expression was also observed in patients with high HBV DNA load (≥5 lgIU /mL)compared to those with low HBV DNA load (t =4.39 and 4.85,both P <0.01 ).PD-1 levels on CD4 + and CD8 + T cells presented a declining trend after telbivudine treatment(F =6.98 and 8.97,both P <0.01 ),PD-1 expression in patients with HBeAg seroconversion showed lower levels compared with baseline values (t =1 8.45 and 1 8.01 ,both P <0.01 ). Conclusion In HBeAg-positive CHB patients,the expression of PD-1 on CD4 + and CD8 + T lymphocytes shows a decreasing trend during the treatment with telbivudine,indicating that antiviral therapy may alleviate the immunosuppression in these patients.
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Objective To investigate the expectation values of dental esthetics during the orthodontic treatment in adolescents with malocclusion.Methods 14～18 year-old adolescents with malocclusion were randomly divided into the treatment group (30 cases) and the control group (21 group) for a prospective study with a period of 1.5 years (0,0.5,1.0,1.5 year respectively),esthetics components of index of orthodontic treatment need (IOTN-AC) and self-made sheet for expectation values of dental esthetics were used to evaluate the values during the follow-up.Results During the follow-up,the IOTN-AC values in the treatment group were decreasing,conversely,the values in the control group were increasing,the expectation values of dental esthetics were increasing in both of the two groups,the differences above were significantly.Conclusions Expectation values of dental esthetics were higher during the follow-up in both of the treatment and untreatment cases,so the dentists and the nurses should encourage the consolidation therapy in treatment cases,and persuade the untreatment cases for orthodontic therapy in order to improve their psychological needs.