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Context and objectives As the global epidemic of obesity and metabolic syndrome progresses, the coexistence of fatty liver disease in patients with chronic viral hepatitis B (VHB) becomes significant. The objective of this work was to determine the frequency of hepatic steatosis assessed by Fibroscan/CAP (Controlled Attenuation Parameter) in patients with chronic VHB in Côte d'Ivoire. Methods. The study included 83 patients with chronic VHB. These were black patients who had performed a Fibroscan/CAP during the recruitment period and were willing to participate in the study. Patients with significant alcohol consumption, a secondary cause of hepatic steatosis, another liver disease regardless of the etiology associated with VHB were not included. Results. The frequency of hepatic steatosis in chronic HBV carriers assessed by CAP in our study population was 48.19 %, including 24.10 % of severe steatosis. Obesity was statistically correlated with the presence of steatosis in our patients. Patients who had steatosis on ultrasound were 5 times more likely to have steatosis on CAP. Significant fibrosis was insignificantly associated with steatosis. Conclusion. The frequency of fatty liver disease detected by fibroscan/CAP is high in patients with chronic VHB.
Contexte et objectifs Avec la progression de l'épidémie mondiale d'obésité et du syndrome métabolique, la coexistence d'une stéatose hépatique chez les patients porteurs d'une hépatite virale B chronique devient non négligeable. L'objectif de ce travail était de déterminer la fréquence de la stéatose hépatique chez les patients porteurs d'une hépatite virale B (HVB) chronique. Méthodes. Il s'agissait d'une série des cas de HVB de race noire, ayant réalisé un Fibroscan/CAP pendant la période du recrutement et consentants à participer à l'étude. Les patients ayant une consommation d'alcool significative, une cause secondaire de stéatose hépatique, une autre hépatopathie quelle que soit l'étiologie associée à l'hépatite B n'ont pas été inclus. Résultats. Quatre-vingt-trois patients porteurs d'une HVB ont été inclus. La fréquence de la stéatose hépatique chez les porteurs du VHB chronique était de 48,19 % dont 24,10 % de stéatose sévère. L'obésité était statistiquement corrélée à la présence d'une stéatose chez nos patients. Les patients qui avaient une stéatose à l'échographie étaient 5 fois plus à risque d'avoir une stéatose au CAP. La fibrose significative était associée de façon non significative à la stéatose. Conclusion : Près de la moitié des patients porteurs d'une hépatite virale B chronique présente une stéatose hépatique.
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Humans , Male , Female , Fatty LiverABSTRACT
Objective@#To investigate the correlation between serum chemokine CXCL13 (CXCL-13), interleukin-1beta (IL-1beta), interleukin-6 (IL-6) levels and liver function damage and hepatitis B virus replication in patients with chronic hepatitis B (CHB).@*Methods@#Eighty patients with CHB who were treated in Jiyuan People′s Hospital of Henan Province from January 2016 to December 2018 were selected as the study subjects. According to the severity of the disease, the patients were divided into mild group (34 cases), moderate group (26 cases) and severe group (20 cases). Eighty healthy people in the same period were selected as control group, and the serum levels of CXCL-13, IL-1β and IL-6 were detected and compared. Spearman correlation analysis was used to analyze the relation between CXCL-13, IL-1β, IL-6 and ALT, AST, HBV-DNA.@*Results@#The levels of ALT, AST, serum CXCL-13, IL-1β and IL-6 in patients with CHB were significantly higher than those in control group (P=0.000 for all comparisons); the levels of ALT, AST, HBV DNA and serum CXCL-13, IL-1β and IL-6 in patients with CHB were significantly higher than those in control group (P=0.000 for all the comparisons). Serum CXCL-13, IL-1β, IL-6 were positively correlated with ALT and AST (P=0.000, P=0.006, P=0.003, P=0.000, P=0.000, P=0.001), CXCL-13 level was positively correlated with HBV DNA (P=0.014), IL-1β and IL-6 were not correlated with HBV DNA. There were positive correlations among CXCL-13, IL-1β and IL-6 (P=0.012, P=0.019, P=0.008).@*Conclusions@#Serum CXCL-13 and IL-1β, IL-6 were closely related to the degree of liver function damage and disease progression in CHB patients. The level of CXCL-13 is positively correlated with the amount of hepatitis B virus. Therefore, close monitoring of serum CXCL-13, IL-1β and IL-6 in CHB patients is of clinical reference value for judging the patient′s condition.
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Objective To explore the application value of real-time shear wave elastography (SWE) technique in diagnosing and staging of chronic viral hepatitis B and hepatic fibrosis and to establish Young's modulus reference range for diagnosing and staging of hepatic fibrosis.Methods Forty-eight patients with chronic hepatitis B and fifty-eight healthy adults were enrolled and their Young's modulus values of S5 and S6 segments of liver were measured.Histopathologic examination was performed on 48 patients with chronic hepatitis B.Comparative analysis was conducted between the pathological findings and Young's modulus values,by means of which Young's modulus reference range for diagnosis and staging of hepatic fibrosis was obtained.Results There was significant difference in Young's modulus values of S5 and S6 segments of liver between chronic hepatitis B group and the normal control group (P＜0.05).Young's modulus values of S5 and S6 segments of liver in chronic hepatitis B group were (11.7 ± 2.9) kPa and (12.1 ± 3.2) kPa respectively,which were significantly higher than those in the normal control group,(5.7 ± 1.1) kPa and (5.8 ± 1.3) kPa respectively.Significant differences of Young's modulus values were detected in every staging of hepatic fibrosis (P＜0.05).S5 segment of liver Young's modulus values in S0-S4 stages were (5.8 ± 2.2) kPa,(7.3 ± 1.9) kPa,(10.3 ± 2.8) kPa,(10.3 ± 2.8) kPa,and (25.3 ± 3.6) kPa,respectively.S6 segment of liver Young's modulus values in S0-S4 stages were (5.7 ± 2.3) kPa,(9.2±2.1) kPa,(10.5±2.1) kPa,(14.7±4.5) kPa,and (26.1 ±2.1) kPa,respectively.Young's modulus value of the liver rose with the increase of S stage.Conclusion SWE technique can establish the Young's modulus reference range for hepatic fibrosis stage.Besides,it features high sensitivity,specificity and accuracy.
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Objective To observe the clinical curative effect of combination of traditional Chinese and western medicine for treatment of patients with hepatitis B virus (HBV) related acute-on-chronic (subacute) liver failure (ACLF). Methods A prospective randomized controlled trial was conducted; 66 cases of HBV-ACLF patients were randomly divided into two groups: a test group (44 cases) and a control group (22 cases). Conventional western medicine treatment was given to both groups; the patients in test group additionally received the traditional Chinese medicine (TCM) in accord to the principles of differentiation of syndromes in TCM, in cases with damp-heat and blood stasis syndrome with yellow appearance, Liangxue Jiedu Huayu decoction (Paeoniae Radix Rubra 60 - 150 g, Artemisiae Scopariae Herba 30 - 90 g, Gardeniae Fructus 9 - 12 g, Hedyotis diffusa Willd 20 - 30 g, Salviae Miltiorrhizae Radix et Rhizoma 30 g, Atractylodis Macrocephalae Rhizoma 30 g, Rubiae Radix et Rhizoma 30 - 45 g, Siegesbeckiae Herba 30 - 45 g, Bletillae Rhizoma 15 g ) was given, in cases with Qi deficiency and blood stasis with yellow appearance, Yiqi Jiedu Huayu decoction (Astragali Radix Preparata Cum Melle 30 g, Pseudostellariae Radix 15 g, Artemisiae Scopariae Herba 30 - 60 g, Polygoni Cuspidati Rhizoma et Radix 15 - 30 g, Salviae Miltiorrhizae Radix et Rhizoma 30 g, Aconiti Lateralis Radix Preparata 10 - 15 g, Atractylodis Macrocephalae Rhizoma 30 g, Rubiae Radix et Rhizoma 30 - 45 g, Siegesbeckiae Herba 30 - 45 g, Gigeriae Galli Endothelium Corneum 20 g) was given, the dosage in both groups being 1 dose daily, one dose was prepared to a water decoction 250 - 300 mL which was divided into two parts, one part taken twice a day; the control group received only western medicine treatment. After 2 weeks of treatment, the clinical comprehensive curative effect, the syndrome score efficacy, and the changes of main indexes of liver function,cholinesterase (ChE), albumin (Alb), prothrombin activity (PTA) were observed in the two groups.Results The clinical total efficacy in the test group was significantly higher than that in the control group [75.0% (33/44) vs. 45.5% (10/22),P 0.05). After treatment, the alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil) and direct bilirubin (DBil) were all lower than those before treatment in both groups, while the ChE, Alb and PTA were higher than those before treatment, and the degree of changes was more significant in the test group [test group: ALT (U/L): 63.28±99.28 vs. 574.58±571.08, AST (U/L): 86.84±92.88 vs. 438.20±482.74, TBil (μmol/L): 161.90±178.34 vs. 269.46±95.10, DBil (μmol/L): 115.32±126.51 vs. 209.12±79.78, ChE (U/L): 4 239.14±1 505.00 vs. 3 341.49±1 609.40, Alb (g/L): 32.65±4.77 vs. 29.73±3.31, PTA: (69.69±44.92)% vs. (32.84±7.47)%; control group: ALT (U/L): 93.28±93.86 vs. 365.24±376.98, AST (U/L): 126.26±121.35 vs. 287.17±301.04, TBil (μmol/L): 226.80±187.38 vs. 281.02±103.73, DBil (μmol/L): 172.50±147.32 vs. 227.96±87.20, ChE (U/L): 4 484.66±1 886.53 vs. 3 918.77±1 417.77, Alb (g/L): 33.17±4.76 vs. 30.47±3.03, PTA: (63.80±36.80)% vs. (33.96±6.32)%,P < 0.05 orP < 0.01].Conclusion The combination of TCM and western medicine for treatment of HBV-ACLF can improve liver function, and the prognosis is superior to using western medicine treatment alone.
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Vitiligo universalis is an uncommon variant that is rarely seen. Interestingly, vitiligo universalis often accompanies systemic diseases such as endocrinopathies. A 43-year-old man presented with whole body depigmentation and poliosis affecting most of his scalp and body hair. He had undergone a liver transplant 2 years ago due to liver cirrhosis from a chronic hepatitis B infection and has been treated for diabetes mellitus for several years. Histopathology showed no melanocytes and an absence of epidermal pigmentation on the skin. We herein report a rare case of vitiligo universalis associated with chronic viral hepatitis B.
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Adult , Humans , Diabetes Mellitus , Hair , Hepatitis B , Hepatitis B, Chronic , Hepatitis, Chronic , Liver , Liver Cirrhosis , Melanocytes , Pigmentation , Scalp , Skin , Transplants , VitiligoABSTRACT
OBJECTIVE To survey the therapeutic effect of lamivudine alone or in combination with bicyclol on chronical viral hepatitis B.METHODS Ninety patients with chronic viral hepatitis B were divided into 3 groups: A,B and C.Patients of group A(n=30) were given each 100mg lamivudine po qd,and 25 mg(bicyclol) po,tid,and the course of treatment lasted 72 weeks.Patients of group B(n=30) were subjected to(lamivudine) treatment alone at the same dosage as that of patients in group A.Patients of group C(n=30) were treated with(conventional) hepatinica and symptomatic therapeutic measures,serving as controls.Changes in serum HBV DNA and liver functions and YMDD mutant were dynamically monitored.RESULTS At the end of the 24,48 and 72 weeks of treatment,the rates of sera to turn negative for HBV DNA were 90.0%,(86.7%,) and(83.3%),(respectively),in patients of group A,and 86.7%,83.3%,and 76.7%,respectively,in patients of group B.The rates of sera to turn negative for HBV DNA,in patients of groups A and B were significantly higher than those in patients of group C(P0.05);at the end of 72 weeks,the rates of YMDD mutant were 16.7% in group A and 36.7% in group B,the rates in group A were significantly higher than in group B((P
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0.05).Conclusion Coverage of medical insurance and effective antiviral therapy for the patients with CHB could affect their QOL.
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OBJECTIVE:To evaluate the economic burden of chronic hepatitis B(CHB)and its complications,and to e-valuate the benefits of treatment with interferon-?.METHODS:The components of the economic burden of disease included direct medical costs and non-medical costs as well as indirect economic loss per patient-year in patients with chronic hepatitis B virus infections,including chronic hepatitis B,compensated and decompensated cirrhosis,and hepatocellular carcinoma.Net cost savings due to treatment of CHB with interferon-?were estimated using clinical data from2therapeutic schemes used in hospital.RESULTS:For the patients at different stages of hepatopathy,the direct medical cost and economic burden per year were different:9000yuan,11362yuan(CHB);13865yuan,19412yuan(compensated cirehosis);25678yuan,36979yuan(decompensated cirrhosis);26501yuan,40264yuan(liver cancer),Compared with conrentional therapy against CHB,the direct medical cost and total cost were reduced following4months treatment of interferon-?after5-year follow-up.The reduced amounts were831yuan,2038yuan per person,respectively.The surrival rate rised by2.8%.CONCLUSION:CHB infections create a heavy economic burden on the society,as well as patients and their families.We have seen the potential cost-savings due to treatment with interferon-?.
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BACKGROUND/AIMS: The post-treatment relapse patterns and efficacy of lamivudine re-treatment for relapsed patients have not been clarified. The aims of this study were to evaluate the relapse patterns after discontinuing therapy and the effects of lamivudine re-treatment for relapsed patients after HBeAg seroconversion. METHODS: Therapy was discontinued after HBeAg seroconversion in 121 patients. Sixty-six patients were relapsed and included in this study. The duration of lamivudine re-treatment therapy was from 6-35 (mean: 16) months. Post-retreatment monitoring continued for 1-40 (mean: 8.9) months. RESULTS: Among the relapsed 66 patients, 50 (75.8%) had HBeAg reappearance while 16 (24.2%) remained HBeAg negative and anti-HBe positive. The cumulative relapse rates at 3, 6, 12 and 24 months were 27%, 47%, 60% and 66%, respectively. Forty-two relapsers received lamivudine re-treatment. Among them, 33 were HBeAg positive and 9 were HBeAg negative and anti-HBe positive, Response was achieved in 31 of the 42 patients (73.8%). The cumulative response rates at 6, 9 and 12 months were 62%, 69% and 72%, respectively. Six patients (14.3%) developed viral breakthrough. All patients were HBeAg positive chronic hepatitis B. The duration of lamivudine re-treatment was the only predictable factor for response of lamivudine re-treatment. Therapy was discontinued after response in 21 patients. Eleven patients were relapsed, including 6 who were HBeAg positive and 5 who were HBeAg negative. Predictive factors for post-retreatment relapse were age and the duration of additional lamivudine therapy after response. CONCLUSIONS: The response rate of lamivudine re-treatment was significantly higher than in initial lamivudine treatments. The breakthrough and relapse rates, however, were similar in both initial and retreated lamivudine therapy.
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Adult , Female , Humans , Male , Antiviral Agents/therapeutic use , Hepatitis B e Antigens/blood , Hepatitis B, Chronic/diagnosis , Lamivudine/therapeutic use , Recurrence , RetreatmentABSTRACT
BACKGROUND/AIMS: Long-term treatment with lamivudine causes breakthrough, but the clinical course after lamivudine breakthrough is not well known. The aims of this study were to evaluate the clinical course in lamivudine after breakthrough, and to identify predictive factors of breakthrough. METHODS: 124 patients with chronic hepatitis B infection, who represented viral breakthrough during lamivudine therapy, were included. The mean duration of lamivudine therapy and additional lamivudine therapy after breakthrough was 30.5 months and 12.5 months, respectively. RESULTS: The cumulative breakthrough rates at 12, 18, 24 and 36 months were 8, 24, 36 and 52%, respectively. After viral breakthrough, only 4 patients maintained normal ALT levels. 120 patients showed ALT elevation. The number of patients with ALT levels greater than 5 times, and greater than 10 times, the upper normal limit were 67 (56%) and 29 (24%), respectively. While still on lamivudine therapy after breakthrough, 98 patients presented ALT elevation. Only 22 had normalized ALT levels. Hepatic decompensation developed in 2 patients. HBeAg seroconversion after breakthrough occurred in 10 patients. The changing pattern of quantitative HBeAg levels during lamivudine therapy was the only predictive factor associated with viral breakthrough. The mean time of turning points in decrescendo-crescendo patterns of HBeAg levels during lamivudine therapy was earlier than viral breakthrough (9 months vs. 17 months). CONCLUSIONS: These results suggested that deterioration of hepatic function can usually be observed after breakthrough. The serial monitoring of serum quantitative HBeAg levels may allow an early recognition of viral breakthrough.
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Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , DNA, Viral/blood , English Abstract , Hepatitis B e Antigens/blood , Hepatitis B virus/isolation & purification , Hepatitis B, Chronic/drug therapy , Lamivudine/therapeutic use , Prognosis , Reverse Transcriptase Inhibitors/therapeutic useABSTRACT
BACKGROUND/AIMS: Lamivudine, an oral nucleoside analogue, effectively suppresses HBV replication and improves liver enzymes as well as liver histology. Long-term lamivudine therapy can induce the emergence of drug resistant HBV strains in some patients. The aim of this study was to evaluate the effects of lamivudine, the breakthrough rate, and the relapse rate of discontinuing therapy after HBeAg loss. METHODS: A total of 190 patients with HBeAg and HBV DNA positive showing abnormal serum levels of aminotransferases for at least 6 months received 100 mg of lamivudine once daily. The duration of lamivudine therapy was from 6-36 months (mean 14 months). Responder was defined as the ALT normalization with sustained suppression of HBV DNA and HBeAg loss. Therapy was to be stopped after HBeAg loss. Post-treatment monitoring continued for 1-21 months (mean 6 months). RESULTS: The cumulative HBeAg loss rates at 12 months and 18 months were 35% and 43%, respectively. Pretreatment serum HBeAg quantitation, and the duration of lamivudine therapy were independent predictive factors for HBeAg loss. The cumulative breakthrough rates at 18 and 24 months were 38% and 57%, respectively. Pretreatment HBV DNA level was the only predictable factor for breakthrough. Therapy was discontinued after HBeAg loss in 52 patients. Most episodes of relapse (15/16) occurred within 6 months after cessation of lamivudine. The cumulative relapse rates at 3 months and 6 months were 21% and 50%, respectively. A predictive factor for post-treatment relapse after HBeAg loss was the duration of lamivudine therapy. CONCLUSIONS: These results suggested the pretreatment quantitative HBeAg in serum and duration of lamivudine therapy are independent predictive factors for HBeAg loss. The HBeAg response of lamivudine-induced HBeAg loss was not durable after discontinuing therapy.
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Humans , DNA , Hepatitis B e Antigens , Hepatitis B virus , Hepatitis B , Hepatitis , Lamivudine , Liver Diseases , Liver , Recurrence , TransaminasesABSTRACT
Objective To explore the relationship among HBV load ,IFN-? and IL-4 in sera from patients with CHB.Methods Fluorescence quantitative PCR(FQ-PCR) was used to detect quantity of HBV DNA,and ELISA was used to determine contents of IFN-? and IL-4.According to HBV DNA quantity(copies/ml),the patients with chronic hepatitis B(CHB) were divided into high(≥10 7/ml),middle(10 6～10 5/ml) and low (
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To explore the changes in blood levels of lipopolysaccharide(LPS), lipopolysaccharide-binding protein(LBP),and soluble CD14 (sCD14), and their clinical significance in patients with severe chronic viral hepatitis B. blood levels of LPS were determined with chromogenic limulus amebocyte lysate assay, and LBP and sCD14 were assayed with ELISA in 24 patients of severe chronic viral hepatitis B. 10 normal subjects and 16 patients with chronic hepatitis B were also enrolled as controls. The results showed that the blood levels of LPS, LBP and sCD14 were significantly higher in patients with the early stage, midterm, late periods of severe chronic viral hepatitis B than in normal subjects and in those with chronic hepatitis B. The blood levels of LPS, LBP and sCD14 were also significantly higher in patients who died of severe chronic viral hepatitis B than in survivors of the same disease. It suggested that when patients with severe chronic viral hepatitis B were complicated by intestinal endotoxemia (IETM), the sensitivity of Kupffer cells to endotoxin was significantly increased, resulting in hepatocyte injury by TNF ?,even in the presence of very low endotoxin concentration .
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BACKGROUND/AIMS: This study was conducted to determine the effect of novel long-term maintenance treatment with lamivudine by gradual lengthening of the medication interval in patients with chronic active viral hepatitis B. METHOD: All patients were non-responder, relapsed or intolerable patients to previous interferon therapy. Patients were divided into a drug-interval changing study and a daily continual medication control group. Drug-interval changing protocol with gradual lengthening of the medication interval after conversion to undetectable HBV-DNA in serum and reduction of serum aminotransferase to normal level was monitored monthly. RESULTS: Before treatment, 15 patients of the drug-interval change group and 11 patients of the daily medication group were similar in laboratory and pathologic findings. Mean follow-up periods were 12.8 moths and 11.4 months respectively. HBeAg seroconversion rate was higher in patients in the daily medication group (86.7% vs. 40.0%, p<0.05). The odds of loss of HBeAg, development of anti-HBe, and suppression of HBV-DNA are about 11 times, 7 times, and 8 times higher in the drug-interval change group compared with the daily medication group, respectively (p<0.05). CONCLUSION: Drug-interval lengthening method was effective in long-term suppression of viral replication with low cost.
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Humans , Follow-Up Studies , Hepatitis B e Antigens , Hepatitis B , Hepatitis , Interferons , Lamivudine , MothsABSTRACT
BACKGROUND/AIMS: As one of biological modifiers of immune reaction, thymomodulin is known to be peptide derivatives of thyrnic acid. Lysate, and thymomodulin can stimulate antibody formations by increasmg the functions of B and T tymphocytes. Furthermore, GM-CSF and TNF can be released by thymomodulin resulting in relief from bone marrow suppression. And these actions of thymomodulin affer a new therapeutic modality in chronic diseases ot the liver as well as chronic hronchitis. Although interferons are frequently under trials for chronic viral hepatitis B. anothersome of side etTec ts and cost effectiveness is often refractory to be used. Herein, this study was intended to estimate the effectiveness and side effects of per oral thymomodulin. METHODS: Forty one patients with chronic viral hepatitis showing positivity of HBsAg over 6 months were treated with per oral thymomodulin (15mlAmg/ml, h vice daily, over 6 months), Clinical data of preand post-trial states were prospectively investigated. RESULTS: As a result, negative conversion of HBV DNA izvealed 20.6% out ol 34 patients showed HBsAg positivity. HBeAg was isappeared in 10.4 % among the 29 cases. Only two cases were shown the clearance of HBsAg. However. These data are statistically insignificant in comparison to the control group (p>0.05, chi-square test). The desirable effects were noticed as disappearance of acne in 5 cases, and amelioration of menstrual abnormalities in 3 cases. Undesirable side effects were only mild nausea in 3 cases, and indigestion in 2 cases. CONCLUSIONS: On thc basis of these data, it is suggested that oral thymomodulin is an easy and safe therapeutic approach in chronic viral hepatitis B but remains to be heralded by long-term clinical trials.
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Humans , Acne Vulgaris , Bone Marrow , Chronic Disease , Cost-Benefit Analysis , DNA , Dronabinol , Dyspepsia , Granulocyte-Macrophage Colony-Stimulating Factor , Hepatitis B e Antigens , Hepatitis B Surface Antigens , Hepatitis B , Hepatitis , Interferons , Liver , Nausea , Prospective StudiesABSTRACT
OBJECTIVE: To observe the effects of matrine and reduced glutathione on chronic viral hepatitis B. METHODS: 98 patients with chronic viral hepatitis B were randomly divided into treatment group (n=55) and control group (n=43). Both groups were treated with Diammonium glycyrrhizinate injection and Reduced glutathione injection. The treatment group was treated by Martine injection additionally. Their main clinical symptoms, signs were observed.The levels of TBIL, ALT, AST, ALP, GGT were examined.RESULTS: The clinical symptoms and the serum levels of TBIL, ALT, AST, ALP, GGT were significantly improved in the treatment group, as compared with the control group (P