Recompensation of complications in patients with hepatitis B virus-related decompensated cirrhosis treated with entecavir antiviral therapy / 中华肝脏病杂志

Objective: To analyze the occurrence of recompensation conditions in patients with chronic hepatitis B virus-related decompensated cirrhosis after entecavir antiviral therapy. Methods: Patients with hepatitis B virus-related decompensated cirrhosis with ascites as the initial manifestation were prospectively enrolled. Patients who received entecavir treatment for 120 weeks and were followed up every 24 weeks (including clinical endpoint events, hematological and imaging indicators, and others) were calculated for recompensation rates according to the Baveno VII criteria. Measurement data were compared using the Student t-test or Mann-Whitney U test between groups. Categorical data were compared by the χ (2) test or Fisher's exact probability method between groups. Results: 283 of the 320 enrolled cases completed the 120-week follow-up, and 92.2% (261/283) achieved a virological response (HBV DNA 20 IU/ml). Child-Pugh and MELD scores were significantly improved after treatment (8.33 ± 1.90 vs. 5.77 ± 1.37, t = 12.70, P < 0.001; 13.37 ± 4.44 vs. 10.45 ± 4.58, t = 5.963, P < 0.001). During the 120-week follow-up period, 14 cases died, two received liver transplants, 19 developed hepatocellular cancer, 11 developed gastroesophageal variceal bleeding, and four developed hepatic encephalopathy. 60.4% (171/283) (no decompensation events occurred for 12 months) and 56.2% (159/283) (no decompensation events occurred for 12 months and improved liver function) of the patients had achieved clinical recompensation within 120 weeks. Patients with baseline MELD scores > 15 after active antiviral therapy achieved higher recompensation than patients with baseline MELD scores ≤15 [50/74 (67.6%) vs. 109/209 (52.2%), χ (2) = 5.275, P = 0.029]. Conclusion: Antiviral therapy can significantly improve the prognosis of patients with hepatitis B virus-related decompensated cirrhosis. The majority of patients (56.2%) had achieved recompensation. Patients with severe disease did not have a lower probability of recompensation at baseline than other patients.

Assessment of efficacy and safety of daclatasvir, sofusbuvirand ribavirin regimen for 12 weeks as compared to daclatasvir and sofusbuvir combination regimen for 24 weeks in decompensated cirrhotic patients due to hepatitis C virus genotype 3 infection

Background: Assessment of efficacy and safety of daclatasvir+sofosbuvir+ribavirin (DCV+SOF+RBV) for 12 weeks as compare to daclatasvir and sofusbuvirfor 24 weeks in decompensated cirrhotic patients due to hepatitis C virus (HCV) genotype 3 infection. Methods: An observational, prospective, COHORTstudy over 1 year, in decompensated cirrhosis due to G3-HCV infected adult patients. Treatment was a combination of sofosbuvir 400 mg/day+daclatasvir 60 mg/day, with or without a weight-adjusted dosing of ribavirin for 12 or 24 weeks. The primary efficacyendpoint was sustained virologic response rates 12 weeks after therapy (SVR 12). The primary safety endpoint was treatment withdrawal rates secondary to severe adverse events. Results: The32 patients were screened and 2 were excluded, one patient due toassociated HBV+, one patient due to severe anemia. 30 patients were randomized. All 30 randomized patients were divided into two groups. Group 1 was given SOF+DCV+RBV for 12 weeks while group 2 patients were given SOF+DCV for 24 weeks. 81.8% of the participants in the group1 achieved SVR 12. The 90.9% of the participants in the group 2 achieved SVR12 (p=1). No other patient or treatment basal variables influenced the treatment effectiveness. No patient treatment withdrawal secondary to severe adverse events was observed. Conclusions: Both the regimen SOF+DCV with or without RBV are highly efficacious and safe. Addition of RBV can reduce the treatment duration to 12 weeks, and it will further improve compliance and more convenient for the patients.

Research progress on perioperative sarcopenia in liver transplantation / 中华临床营养杂志

Liver transplantation is the ultimate treatment for end-stage liver diseases such as decompensated cirrhosis and severe hepatitis, but with the sarcopenia incidence of up to 43.4%. Sarcopenia can significantly increase postoperative complications, prolong hospital stay, shorten postoperative survival and seriously affect patient prognosis. At present, sarcopenia is mainly evaluated by calculating the skeletal muscle measurement at the level of third lumbar vertebra on preoperative abdominal computed tomography images. Existing studies have demonstrated that the protein synthesis rate is reduced due to insufficient nutrient intake and metabolic disorder in liver transplantation patients. The identified liver-muscle axis mediators (e.g., hyperammonemia, low growth hormone and testosterone, endotoxemia), potential mediators (e.g., fibroblast growth factor 21) and gut microbiota play an important role in liver transplantation related sarcopenia. This paper reviewed the latest progress on the studies of perioperative sarcopenia in liver transplantation. Combining clinical practice, it is believed that combined therapy of rational nutrition and hormone supplementation, individualized resistance training and liver-muscle axis mediator pathway blockade, together with enhancement of clinicians' recognition of sarcopenia, may ameliorate or even reverse sarcopenia, effectively reduce perioperative complications and improve long-term prognosis of patients.

Analysis of quality of life and influencing factors of decompensated cirrhosis patients with intestinal obstruction / 国际外科学杂志

Objective To explore the life quality of decompensated cirrhosis complicated with intestinal obstruction patients and analyze its influencing factors,and provide basis for clinical intervention.Methods In Affiliated People's Hospital of Hubei University of Medicine,a retrospective collection of 39 patients with decompensated cirrhosis complicated with intestinal obstruction from August 2018 to August 2019 were included in the observation group,including 25 males and 14 females,aged (52.34 ±2.64) years old,ranging from 39 to 64 years old.A total of 42 patients with decompensated cirrhosis not complicated with intestinal obstruction were selected as the control group by random number table method in simple random sampling,including 30 males and 12 females,aged (51.34 ± 3.45),ranging from 37 to 68 years old.The patients in the two groups were investigated by using the chronic liver disease patient quality of life scale-chronic liver disease questionnaire.The abdominal symptoms,fatigue,systemic symptoms,activity,emotion,anxiety,and the total score of quality of life of the patients in the two groups were compared,and the influencing factors were analyzed.Among them,measurement data of normal distribution were expressed as (Mean ± SD),and comparison between groups was evaluated by t test;Comparison of count data was evaluated by chi-square test.Factors affecting quality of life were analyzed by multiple linear regression.Results The scores of abdominal symptoms,fatigue,systemic symptoms,activity,emotion,anxiety and the total score of the observation group were (5.58 ± 1.79),(4.23 ± 1.74),(4.93 ± 1.39),(5.36 ± 1.36),(4.74 ± 1.05),(4.26 ± 1.25),(31.06 ± 6.53),respectively.The scores of the control group were(6.27 ± 1.12),(5.47 ± 1.26),(6.14 ± 0.78),(5.88 ± 0.93),(5.45 ± 0.82),(4.96 ± 0.94),(33.79 ± 4.01),respectively.The difference between the two groups was statistically significant (P ＜ 0.05).Multiple linear regression results showed that disease course,child-pugh classification of liver function,discomfort symptoms such as abdominal pain,abdominal distension and fatigue,nutrition status,gender,age,medical expenses payment method,family per capita monthly income and anxiety were influencing factors.Conclusions Decompensated cirrhosis complicated with intestinal obstruction patients life quality is lower than decompensated cirrhosis not complicated with intestinal obstruction patients,and the influencing factors include disease-related factors and non-disease-related factors.Medical staff should give patients corresponding intervention according to their conditions to improve the quality of life of patients as much as possible.

Analysis of quality of life and influencing factors of decompensated cirrhosis patients with intestinal obstruction / 国际外科学杂志

Objective@#To explore the life quality of decompensated cirrhosis complicated with intestinal obstruction patients and analyze its influencing factors, and provide basis for clinical intervention.@*Methods@#In Affiliated People′s Hospital of Hubei University of Medicine, a retrospective collection of 39 patients with decompensated cirrhosis complicated with intestinal obstruction from August 2018 to August 2019 were included in the observation group, including 25 males and 14 females, aged (52.34±2.64) years old, ranging from 39 to 64 years old. A total of 42 patients with decompensated cirrhosis not complicated with intestinal obstruction were selected as the control group by random number table method in simple random sampling, including 30 males and 12 females, aged (51.34±3.45), ranging from 37 to 68 years old. The patients in the two groups were investigated by using the chronic liver disease patient quality of life scale- chronic liver disease questionnaire. The abdominal symptoms, fatigue, systemic symptoms, activity, emotion, anxiety, and the total score of quality of life of the patients in the two groups were compared, and the influencing factors were analyzed. Among them, measurement data of normal distribution were expressed as (Mean±SD), and comparison between groups was evaluated by t test; Comparison of count data was evaluated by chi- square test. Factors affecting quality of life were analyzed by multiple linear regression.@*Results@#The scores of abdominal symptoms, fatigue, systemic symptoms, activity, emotion, anxiety and the total score of the observation group were (5.58±1.79), (4.23±1.74), (4.93±1.39), (5.36±1.36), (4.74±1.05), (4.26±1.25), (31.06±6.53), respectively. The scores of the control group were(6.27±1.12), (5.47±1.26), (6.14±0.78), (5.88±0.93), (5.45±0.82), (4.96±0.94), (33.79±4.01), respectively. The difference between the two groups was statistically significant (P< 0.05). Multiple linear regression results showed that disease course, child-pugh classification of liver function, discomfort symptoms such as abdominal pain, abdominal distension and fatigue, nutrition status, gender, age, medical expenses payment method, family per capita monthly income and anxiety were influencing factors.@*Conclusions@#Decompensated cirrhosis complicated with intestinal obstruction patients life quality is lower than decompensated cirrhosis not complicated with intestinal obstruction patients, and the influencing factors include disease-related factors and non-disease-related factors. Medical staff should give patients corresponding intervention according to their conditions to improve the quality of life of patients as much as possible.

Effects of preemptive analgesia by nalbuphine combined with flurbiprofen on pain and platelet activity in patients with decompensated cirrhosis / 吉林大学学报(医学版)

Objective: To observe the influence of preemptive analgesia by nalbuphine combined with flurbiprofen in the platelet activity indexes of the patients with decompensated cirrhosis, and to explore its quality of analgesia in the patients with decompensated cirrhosis. Methods: A total of 120 patients with decompensated cirrhosis were randomly divided into combination group (40 cases, given nalbuphine combined with flurbiprofen before anesthesia), nalbuphine group (40 cases, given nalbuphine before anesthesia) and flurbiprofen group (40 cases, given flurbiprofen before anesthesia). The postoperative patient-controlled intravenous analgesia (PCIA) was carried out with sufentanil in all the patients. The indexes of visual analog score (VAS), PCIA compression number, sufentanil consumption, Ramsay score, thrombelastogram (TEG) indexes (R value, K value, a angle, MA value and CI value) and the maximum aggregation rate by arachidonic acid (MARAA) and β-endorphin (β-EP) level, recovery time, and agitation occurrence rate of the patients in various groups were recorded 12 h and 24 h after operation. Results: The indexes of VAS, PCIA compression number, sufentanil consumption and 3-EP level of the patients in combination group were lower than those in the other groups 12 and 24 h after operation (P0. 05). The Ramsay scores of the patients in three groups had no differences at 12 and 24 h after operation (P>0. 05). Compared with nalbuphine group, the R values and K values of the patients in combination group and flurbiprofen group at 12 and 24 h after operation were increased (P 0. 05). The recovery time of the patients among three groups had no significant difference (F=2. 054, P=0. 102). The agitation occurrence rate during recovery period of the patients in case group was the highest (F=5. 624, P= 0. 001), and there was no significant difference in the agitation occurrence rate during recovery period of the patiens between nalbuphine group and flurbiprofen group (χ2 =3. 020, P=0. 091). Conclusion: Combination of nalbuphine and flurbiprofen in the patients with decompensated cirrhosis before analgesia can improve the quality of postoperative analgesia and can' t inhibit the activity of platelet obviously.

Bi-monthly hepatic arterial infusion chemotherapy as a novel strategy for advanced hepatocellular carcinoma in decompensated cirrhotic patients

BACKGROUND AND AIMS: We previously reported the comparable efficacy of bi-monthly hepatic arterial infusion chemotherapy (B-HAIC) to that of sorafenib chemotherapy for the treatment of advanced hepatocellular carcinoma (aHCC) in patients with compensated cirrhosis. In this study, we demonstrate the efficacy of B-HAIC in patients with decompensated cirrhosis.METHODS: Forty-five patients with aHCC refractory to transcatheter arterial chemo-embolization (TACE) were treated with B-HAIC and were divided into two groups according to hepatic functional reserve (Child-Pugh grade). Overall survival period, treatment response, and adverse events in each group were analyzed.RESULTS: Efficacy and disease control rates in the Child-Pugh B group (n=24; 21% and 71%, respectively) were not significantly impaired compared the Child-Pugh A group (n=21; 38% and 67%, respectively). Median survival time and survival rate at 12 months in the Child-Pugh B group were 422 days and 58.3%, respectively, whereas those in the Child-Pugh A group were 567 days and 70.8%, respectively. Importantly, the hepatic functional reserve of patients did not worsen in either group during the treatment period. Furthermore, the occurrence rate of adverse events leading to discontinuation of anti-tumor treatment was not significantly increased in the Child-Pugh B group.CONCLUSIONS: Given the preservation of hepatic functional reserve afforded by B-HAIC chemotherapy in patients with decompensated cirrhosis, B-HAIC might be an acceptable alternative strategy for aHCC patients who do not respond to TACE.

Research progress on antiviral therapy in severe hepatic impairment patients and special population with HCV infection / 中华临床感染病杂志

The research and development of direct-acting antiviral agents (DAAs) for hepatitis C achieved significant results in the last decade .DAAs is highly effective in treatment of hepatitic C patients with convenience and safety , and the sustained virological response of DAAs is over 90％, which will greatly contribute to achieving the WHO's goal of eliminating hepatitis C by 2030.The European Association for the Study of the Liver (EASL), American Association for the Study of Liver Diseases (AASLD) and WHO all updated guidelines for diagnosis and treatment of hepatitis C in 2018, which will play a positive role for the management of hepatitis C globally .This article reviews the related guidelines and literature on prevention and treatment of hepatitis C , and summarizes the advantages of antiviral therapy for severe hepatic impairment patients and special population with HCV infection .

Clinical study of entecavir and adefovir dipivoxil in the treatment of decompensated cirrhosis of hepatitis B / 中国生化药物杂志

Objective To investigate the clinical efficacy of entecavir and adefovir dipivoxil in the treatment of decompensated cirrhosis with hepatitis B virus. Methods 100 cases of decompensated cirrhosis of hepatitis B in our hospital (February 2015 to October 2016) were randomly divided into control group and experimental group, each with 50 cases. The control group was treated with adefovir dipivoxil, and the experimental group was treated with entecavir and adefovir dipivoxil. The clinical symptoms of the two groups were compared and analyzed. Results After treatment, the level of ALT in the experimental group was (46.20±3.21) U/L, and the level of AST was (52.40±3.90) U/L.The level of ALT in the control group was (70.43±10.90) U/L, and the level of AST was (70.33±9.19)U/L, and the two groups had statistical significance (P＜0.05). The negative rate of HBV-DNA in the experimental group was 76.0%, which was significantly higher than that in the control group (58.0%), and there was statistical difference (P＜0.05). The negative rate of HBeAg in the two groups was 22.0% and 24.0% respectively, and there was no significant difference. Conclusion Entecavir and adefovir dipivoxil in the treatment of hepatitis B liver cirrhosis patients clinical effect is ideal,can significantly improve the liver function, improve clinical symptoms, high safety, has clinical significance.

Clinical study of entecavir and adefovir dipivoxil in the treatment of decompensated cirrhosis of hepatitis B / 中国生化药物杂志

Objective To investigate the clinical efficacy of entecavir and adefovir dipivoxil in the treatment of decompensated cirrhosis with hepatitis B virus. Methods 100 cases of decompensated cirrhosis of hepatitis B in our hospital (February 2015 to October 2016) were randomly divided into control group and experimental group, each with 50 cases. The control group was treated with adefovir dipivoxil, and the experimental group was treated with entecavir and adefovir dipivoxil. The clinical symptoms of the two groups were compared and analyzed. Results After treatment, the level of ALT in the experimental group was (46.20±3.21) U/L, and the level of AST was (52.40±3.90) U/L.The level of ALT in the control group was (70.43±10.90) U/L, and the level of AST was (70.33±9.19)U/L, and the two groups had statistical significance (P＜0.05). The negative rate of HBV-DNA in the experimental group was 76.0%, which was significantly higher than that in the control group (58.0%), and there was statistical difference (P＜0.05). The negative rate of HBeAg in the two groups was 22.0% and 24.0% respectively, and there was no significant difference. Conclusion Entecavir and adefovir dipivoxil in the treatment of hepatitis B liver cirrhosis patients clinical effect is ideal,can significantly improve the liver function, improve clinical symptoms, high safety, has clinical significance.

Analysis of Medical Use and Costs Related to the Management of Liver Cirrhosis Using National Patients Sample Data

BACKGROUND: Liver cirrhosis causes substantial socio-economic burden and is one of the major severe liver diseases in Korea. Nonetheless, there is only a few studies that analyzes disease burden of liver cirrhosis in Korea. Such study must be carried out due to its increasing need from the invention of new drugs for chronic hepatitis and demand for cost-effectiveness analyses. METHODS: Patient sample data with ensured representativeness was analyzed retrospectively to compare the medical costs and uses for patients with compensated cirrhosis and decompensated cirrhosis. Patient claims data that include K74 and K703 from the year of 2014 were selected. Within the selected data, decompensated cirrhosis patient was identified if complications such as ascites (R18), encephalopathy (B190), hepatic failure (K72), peritonitis (K65), or esophageal varices (I85) were included, and they were compared to compensated cirrhosis patients. RESULTS: 6,565 patients were included in the analysis. The average cost per patient was 6,471,020 (SD 8,848,899) KRW and 2,173,203 (4,220,942) KRW for decompensated cirrhosis and compensated cirrhosis, respectively. For inpatients, the average hospitalized days was 38.0 (56.4) days and 27.2 (57.2) days for decompensated cirrhosis and compensated cirrhosis, respectively. For outpatients, the average number of visits was 8.7 (9.1) days and 5.3 (7.5) days for compensated cirrhosis and decompensated cirrhosis, respectively. CONCLUSION: Compared to compensated cirrhosis patients, decompensated cirrhosis patients had higher costs, especially for hospitalization, injection, examination, and drugs administrated within medical institutions.

Clinical study on optimization scheme of autologous bone marrow stem cell transplantation for decompensated cirrhosis / 中国生化药物杂志

Objective To compare the therapeutic effects of bone marrow stem treatment by different bone marrow mobilization,distinct separation methods or cell suspension density, and to explore the optimal treatment plan of autologous bone marrow stem cell transplantation for decompensated cirrhosis.Methods Twenty three patients with decompensated cirrhosis were studied.100 ~200 mL bone marrow from each patient was harvested in aseptic condition, after isolation and purification by density gradient centrifugation,the stem cells were obtained and transplanted into the liver via hepatic artery.The serum glutamic acid alanine aminotransferase (ALT), albumin (ALB), prothrombin time (PT) and total bilirubin (TBIL) were checked before and l, 2, 3 months after therapy respectively,changes in these indicators of each group were compared by different bone marrow mobilization, distinct separation methods, or cell suspension density.Results After transplantation, levels of albumin increased significantly 1, 2, 3 months after treatment compared with baseline(P<0.05).Patients in bone marrow mobilization group obtained higher stem cell density (P<0.05), which had no significant difference in improving liver function ( ALT, TBIL, ALB, PT) compared with non-bone marrow mobilization group.Patients using the kit significantly improved their albumin (3 months after treatment, P<0.05), which had no significant difference in improving liver function (ALT, TBIL, ALB, PT) compared with using ordinary lymphocyte isolation method group.There was no significant difference in improving liver function ( ALT, TBIL, ALB, PT) between lower magnitude stem cell density group(≤1 ×1010/L) and higher magnitude stem cell density group(1 ×1010/L).Conclusion The treatment for decompensated cirrhosis by transplantation of autologous bone nlarrow stem cells is safe and effective, which can significantly increase the level of albumin in patients with decompensated cirrhosis.Preoperative bone marrow mobilization can increase the rate of stem cells obtained, and the method using the kit improves the leves of protein respectively.They are helpful to improve the efficacy.

Clinical efficacy of adefovir dipivoxil in treatment of decompensated cirrhosis / 中国生化药物杂志

Objective To explore the clinical efficacy of adefovir dipivoxil in treatment of liver cirrhosis.Methods 45 cases with liver cirrhosis admitted in 302 Military Hospital of Chian in 2012 were randomly divided into experiment group(n=25)and control group(n=20).Experiment group was treated with adefovir dipivoxil,and control group was given traditional therapy.Two groups were treated for six months.Renal function,liver function and liver firosis were examined with every month,the recovery indexes of renal function between two groups were detected and compared after treatment, which was used to judge the clinical efficacy of adefovir dipivoxil. Results Before treatment,there were no significant differences in the thickness of spleen,serum indexes of portal vein,splenic vein and hepatic fibrosis between experiment group and control group.After treatment,the liver and spleen condition and liver fibrosis index including HA,LN,PCIII,IV-C in two groups were significantly improved by B ultrasound and serum detection,and the improvement degree of experimental group was significantly higher than control group(P<0.05).Conclusion Adefovir dipivoxil has better therapic efficacy in treatment of liver cirrhosis.

Efficacy comparison of lamivudine combined with adefovir dipivoxil de novo and entecavir monotherapy in treatment of patients with hepatitis B virus-related decompensated cirrhosis / 中国药学杂志

OBJECTIVE: To compare the efficacy of lamivudine (LAM) combined with adefovir dipivoxil (ADV) de novo and entecavir(LTV) monotherapy in treatment of patients with hepatitis B virus (HBV)-related decompensated cirrhosis for one year. METHODS: Sixty HBV-infected patients with decompensated cirrhosis treated with LAM combined with ADV de novo and 40 patients treated with ETV were enrolled. Liver and kidney function, HBVDNA, HBVM, AFP, US or CT scan of liver were tested every 1-3 month. The treatment efficacy was evaluated at month 12. RESULTS: By month 12, the HBV DNA negative rates in LAM combined with ADV de novo group (45 cases) and ETV monotherapy group (30 cases) were 51.1% and 60.0% respectively. There was no significant difference(P>0.05). The HBeAg negative rates in LAM + ADV group and ETV group were 30.4% and 26.7% respectively. There was no significant difference (P>0.05). The ALT normalization rates in two groups were similar. Viral breakthrough happened in 2 cases (4.4%) by month 12 in LAM + ADV group, and no viral resistance was observed, while viral breakthrough happened in 1 case (3.3%) by month 12 in ETV group. Improvement of liver function was obvious in both groups, for CTP and MELD scores decreased distinctly. The accumulative total mortality or liver transplantation rates were 9.4% and 8.7% respectively in LAM + ADV group and ETV group. No increase in blood creatinine above the upper normal limit was observed in both groups. CONCLUSION: Both of LAM combined with ADV de novo and ETV monotherapy are best choice in treatment of patients with HBV-related decompensated cirrhosis. They can inhibit HBV replication obviously, improve liver function and decrease mortality.

Management of Liver Cirrhosis / 대한내과학회지

Liver cirrhosis has distortion of the hepatic architecture and the formation of regenerative nodules due to progressive hepatic fibrosis. Treatment of underlying etiology can slow or reverse the progression of liver fibrosis. Early stage is characterized by asymptomatic phase, termed 'compensated cirrhosis' follwed by the development of complications of portal hypertension and/or liver dysfunction, termed 'decompensated cirrhosis'. The quality of life and survival of patients with cirrhosis can be improved by prevention and treatment of these complications. This review discuss the complication and its management in patients with liver cirrhosis.