Comparison of four prognostic models and a new Logistic regression model to predict short-term prognosis of acute-on-chronic hepatitis B liver failure / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute-on-chronic hepatitis B liver failure (ACLF-HBV) is a clinically severe disease associated with major life-threatening complications including hepatic encephalopathy and hepatorenal syndrome. The aim of this study was to evaluate the short-term prognostic predictability of the model for end-stage liver disease (MELD), MELD-based indices, and their dynamic changes in patients with ACLF-HBV, and to establish a new model for predicting the prognosis of ACLF-HBV.</p><p><b>METHODS</b>A total of 172 patients with ACLF-HBV who stayed in the hospital for more than 2 weeks were retrospectively recruited. The predictive accuracy of MELD, MELD-based indices, and their dynamic change (D) were compared using the area under the receiver operating characteristic curve method. The associations between mortality and patient characteristics were studied by univariate and multivariate analyses.</p><p><b>RESULTS</b>The 3-month mortality was 43.6%. The largest concordance (c) statistic predicting 3-month mortality was the MELD score at the end of 2 weeks of admission (0.8), followed by the MELD: sodium ratio (MESO) (0.796) and integrated MELD (iMELD) (0.758) scores, DMELD (0.752), DMESO (0.729), and MELD plus sodium (MELD-Na) (0.728) scores. In multivariate Logistic regression analysis, the independent factors predicting prognosis were hepatic encephalopathy (OR = 3.466), serum creatinine, international normalized ratio (INR), and total bilirubin at the end of 2 weeks of admission (OR = 10.302, 6.063, 5.208, respectively), and cholinesterase on admission (OR = 0.255). This regression model had a greater prognostic value (c = 0.85, 95%CI 0.791 - 0.909) compared to the MELD score at the end of 2 weeks of admission (Z = 4.9851, P = 0.0256).</p><p><b>CONCLUSIONS</b>MELD score at the end of 2 weeks of admission is a useful predictor for 3-month mortality in ACLF-HBV patients. Hepatic encephalopathy, serum creatinine, international normalized ratio, and total bilirubin at the end of 2 weeks of admission and cholinesterase on admission are independent predictors of 3-month mortality.</p>

The study on frequency distribution of regulatory T cells and its functional markers in peripheral blood of chronic hepatitis B / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To explore the role of treg cells and its functional markers in pathogenesis of chronic hepatitis B, and the correlation with disease progression.</p><p><b>METHODS</b>20 cases of healthy control people,53 cases of chronic hepatitis B patients and 24 cases of liver cirrhosis patients were enrolled into the groups. Detecting the frequencies of CD4+ CD25+ Fox3+ cells, CD4+ CD25+ CD127(low) cells, CD39+ treg cells and CTLA-4+ treg cells in treg cells by flow cytometry. Clinical parameters were investigated in the same time.</p><p><b>RESULTS</b>The frequencies of treg cells, CD4+ CD25+ CD127(low) cells and CD39+ treg cells were significant different among healthy control group, CHB group and LC group (P < 0.01). The frequencies of treg cells, CD4+ CD25+ CD127(low) cells and CD39+ treg cells were significantly different in moderate-severe CHB group compared with mild CHB group (P < 0.05, P < 0.05, P < 0.01). In CHB group the frequencies of CD4+ CD25+ Foxp3+ cells were positively correlated with ALT (r = 0. 289, P < 0.05) and AST (r = 0.302, P < 0.05), the frequencies of CD4+ CD25+ Foxp3+ cells had a significant positive correlation with the frequencies of CD4+ CD25+ CD127(low) cells (r = 0.478, P < 0.01).</p><p><b>CONCLUSION</b>The frequencies of treg cells and its functional markers probably had a dynamic tendency in the process of chronic hepatitis B and were closely related with the change of liver function parameters. CD39+ treg cells may be a group of functional treg cells, which indicated that CD39 be a sensitive marker to react treg cells function. In some sense, CD4+ CD25+ CD127(low) cells frequency could represent treg cell frequency.</p>

Distribution and clinical significance of HBV genotypes in patients with HBV infection in 30 regions of China / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To explore the distribution and clinical significance of HBV genotypes in patients with HBV infection in China.</p><p><b>METHOD</b>Serum samples were collected from 2922 patients with HBV infection. HBV genotyping was performed with type-specific primers polymerase chain reaction, and the virological and biochemical markers were detected, which differences in the genotypes distribution between various regions and liver function and virological markers between various HBV genotyping were analyzed.</p><p><b>RESULT</b>The genotype B, C, B + C, D of 2922 patients with HBV infection accounted for 15.9%, 83.5%, 0.41%, 0.21% respectively. In Northern China, genotype C was most prevalent, accounting for 90% of all cases, while it was less common in Southern China; genotype C was present in Zhejiang and Jiangsu provinces, but genotype B was comparatively more common in Guangdong, Hunan, Hubei, and Jiangxi provinces. B, C genotype HBV infection patients in the sex difference was not statistically significant; B genotypes compared with C genotype HBV infection patients, the average age of is less (P < 0.001); HBeAg positive rate of C genotype HBV infection patients are higher than that of B genotype (P = 0.023); Viral load of genotype C HBV infection patients is higher than that of genotype B (P = 0.038); Cholinesterase and Albumin levels of genotype C HBV infection patients are lower than that of genotype B (P values were 0.016, <0.001).</p><p><b>CONCLUSION</b>There were HBV genotype B, C, B + C and D in Chinese patients with HBV infection, with genotype B and C being the major ones. Mainly in northern regions of genotype C, C genotype significantly reduced the southern region, some of the southern region dominated by B genotype. Genotype C HBV infection patients are older, and their HBeAg-positive rate is higher, and their liver damage is more severe, but their viral load is less.</p>

Research of PD-1 expression in CD8+ T cell of peripheral blood with HBV-associated acute-on-chronic liver failure / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To analyze PD-1 expression in CD8 + T cell of Peripheral blood with HBV-associated acute-on-chronic liver failure and effect on CD8+ T cell.</p><p><b>METHODS</b>We selected 60 patients with HBV-ACLF and collected their peripheral blood. We analyzed the expressions of PD-1, CD95, perforin, granzyme A, granzyme B, CD107a on CD8+ T lymphocytes and the expression of PD-L1 on monocytes peripheral blood by using flow cytometry. 15 liver cirrhosis patients( LC) and 15 healthy individuals( HC) are control groups.</p><p><b>RESULT</b>PD-1 expression was (1) The PD-1 expression in HBV-ACLF patients was significantly elevated compared with those in HC and lower in improved group than that in invalid group and death group (P < 0.05) and increased from prophase, metaphase to advanced stage (P < 0.05). Moreover, (2) PD-L1 expression on monocytes was positively correlated with disease progression. (P < 0.05). (3) Both PD-1 and CD95 expressions were higher in dead group than those in improved and non-improved groups. Perforin, granzymes and CD107a expressions on CD8+ T cells significantly increased in dead group compared with those in improved and non-improved groups (P < 0.05). However, PD-1 expressions on these cells were lower, compared with normal persons.</p><p><b>CONCLUSIONS</b>The expression of PD-1 and PD-L1 in HBV-ACLF patients was positively correlated with disease progression. The elevated PD-1 expression promoted apoptosis of CD8+ T cells. For HBV-ACLF patients, the PD-1 expression on effector CD8+ T cells was lower than those in other CD8+ T cells, which maybe accounted for the failure to controlling immune injury in liver.</p>

Association between HBV genotype and chronic/severe liver disease with HBV infection in Chinese patients / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To explore the association between HBV genotype and chronic/severe liver disease with HBV infection in Chinese patients.</p><p><b>METHODS</b>Serum samples were collected from 2922 patients with HBV infection. HBV genotyping was performed with type-specific primers polymerase chain reaction, and the virological and biochemical markers were detected, which differences in the genotypes between various clinical types of HBV infection and liver function and virological markers between various HBV genotyping were analyzed.</p><p><b>RESULTS</b>The genotype B, C, BC combinations, D of 2922 patients with HBV infection accounted for 15.9%, 83.5%, 0.41%, 0.21% respectively. The ratio of genotype B in acute hepatitis group was higher (P = 0.003), which the ratio of genotype C in the cirrhosis group and the hepatocellular carcinoma group was higher (P = 0.000, 0.000). The difference in ratio of genotype C was not statistically significant between acute-on-chronic liver failure group and chronic hepatitis group. HBeAg-positive rate, viral load and liver function markers of B, C genotype group in acute hepatitis group and chronic hepatitis group were not significant different. HBeAg-positive rates of genotype C in acute-on-chronic liver failure group, cirrhosis group, hepatocellular carcinoma group were higher than that of genotype B (P = 0.000, 0.024, 0.003). Viral load of genotype C in hepatocellular carcinoma group was higher than that of genotype B (P = 0.025). Cholinesterase levels of genotype C in the acute-on-chronic liver failure group and the hepatocellular carcinoma group was lower than that of genotype B (P = 0.0004, 0.02).</p><p><b>CONCLUSION</b>There were HBV genotype B, C, B/C combinations and D in Chinese patients with HBV infection, with genotype B and C being the major ones. Compared with HBV genotype B, genotype C in Chinese patients with HBV infection was more likely to chronic infection, evolved to cirrhosis and hepatocellular carcinoma, but genotype difference was not observed in occurrence of acute-on-chronic liver failure. Genotype was not significant effect in acute and chronic hepatitis B, but HBeAg-positive rate/viral load was higher and liver damage was more severe in severe and end-stage genotype C HBV infection patients.</p>

Analysis the relationship of HBV BCP A1762T/G1764A double mutation with HBV related acute on chronic liver failure / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To analysis the relationship between HBV BCP A1762T/G1764A double mutation with acute on chronic liver failure (ACLF).</p><p><b>METHODS</b>HBV BCP A1762T/G1764A double mutation was detected in 166 HBV chronic infection patients by nested PCR and direct DNA sequencing. The mutation rate was compared among the patients with different disease course.</p><p><b>RESULTS</b>Among 166 patients, 45 patients, 45 patients, 49 patients and 27 patients were diagnosed as chronic hepatitis B (CHB), liver cirrhosis (LC), ACLF and hepatocellular carcinoma (HCC), respectively. A1762T/G1764A double mutation rate was 40.0% (18/45), 84.4% (38/45), 73.5% (36/49) and 92.6% (25/27) respectively in different groups. However, A1762T/G1764A double mutation rate has no difference between ACLF based on CHB and LC (P = 0.502) and between patients with HBeAg positive and negative (P = 0.735). HBV DNA level (log) of patients with A1762T/G1764A double mutation was 5.68 +/- 1.36, lower than but having no significant statistic difference compared to patients without the double mutation (6.14 +/- 1.81, P = 0.075).</p><p><b>CONCLUSION</b>A1762T/G1764A double mutation has a close relationship with the progress of HBV-infection diseases, but is not specific to patients with ACLF. And patients with BCP double mutation have similar HBV DNA levels and HBeAg status with patients without the double mutation.</p>

Lamivudine and entecavir significantly improved the prognosis of early-to-mid stage hepatitis B related acute on chronic liver failure / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To clinically study the antiviral effects of lamivudine and entecavir on patients with early-to-mid stage Hepatitis B related acute on chronic liver failure (HBV-ACLF). METHODS; A prospective, randomized, open and parallel controlled clinical trial was designed to observe the antiviral effects of nucleoside analogues on patients with early-to-mid stage HBV-ACLF. Three groups were set for controlled study, i. e. basic treatment group, lamivudine plus basic treatment group and entecavir plus basic treatment group.</p><p><b>RESULTS</b>One month after treatment, the improvement rates of lamivudine group and entecavir group were 58.85% and 59.15% respectively, significantly higher than that of basic treatment group which was 34.84% (Chi(2) = 9.8323, P = 0.043). By the end of six months, the cumulative survival rates of patients with the antiviral treatments, i.e., lamivudine, entecavir, were 65.8%, 60.1%, significantly higher than that (42%) without the antiviral treatment (P = 0.045, P = 0.04 respectively). The cumulative survival rate in patients with a MELD score < 30 was higher than that with a MELD score over 30 (Chi(2) = 3.920, P = 0.048). For the patients with pretreatment HBV DNA > or = 10(7), the cumulative survival rate in patients with entecavir treatments group was higher than that of patients in basic treatment group (Chi(2) = 5. 014 P= 0.025). According to the Ordinal Regression analysis, antiviral therapy by using either lamivudine or entecavia could significantly increase the improvement rate of patients with early-to-mid stage HBV-ACLF. But severe complications, including hepatorenal syndrome, electrolyte imbalance and hepatic encephalopathy, medical history of liver cirrhosis, and pretreatment HBV DNA > or = 10(7) had significant impacts on prognosis of this group patients.</p><p><b>CONCLUSIONS</b>Antiviral therapy by using either lamivudine or entecavia could significantly increase the survival rate of patients with early-to-mid stage HBV-ACLF.</p>

The clinical characteristics of hepatic failure with aspergillosis / 中华肝脏病杂志

<p><b>OBJECTIVES</b>To study the clinical characteristics of hepatic failure with aspergillosis.</p><p><b>METHODS</b>The data of hepatic failure patients with fungal infection hospitalized in our hospital form January 1985 to June 2006 were collected. This research mainly focused on the clinical characteristics of the patients co-infected with aspergillosis.</p><p><b>RESULTS</b>The occurrence of aspergillosis was 20.5% (104 cases) among 507 hepatic failure patients with fungal infection. Compared with other fungal infection in hepatic failure patients, the effective rate of antifungal therapy and the improvement rate of underlying disease were worse in patients with aspergillus infection (36.5% vs 57.8%, P = 0.000; 26.0% vs 36.7%, P = 0.049). Aspergillus fumigatus was the most common species among 108 fungal species. The species next to Aspergillus fumigatus were Aspergillus niger and Aspergillus flavus. The mainly infected organ was lung and its clinical manifestation was atypical. Liver function could be improved with effective anti-fungus therapy.</p><p><b>CONCLUSIONS</b>Diagnosis and treatment of aspergillosis is difficult in hepatic failure patients co-infected with aspergillosis. Early and effective antifungal therapy is helpful to the recovery of liver function in the hepatic failure patients suspected with aspergillosis co-infection.</p>

The short-term efficacy of nucleoside analogue on the treatment of acute-on-chronic liver failure / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To discuss the short-term efficacy of nucleoside analogue on the treatment of hepatitis B virus induced acute-on-chronic liver failure (HBV-ACLF).</p><p><b>METHODS</b>348 patients with HBV-ACLF in our hospital from January 2006 to June 2008 were selected. According to the stages of patient's condition and whether or not with nucleoside analogue administration, The patients were divided into early stage therapy group, early stage control group, middle stage therapy group and middle stage control group. Groups were compared on the basis of stages. The clinical data were analyzed using chisquare test and independent-Samples T Test.</p><p><b>RESULTS</b>After 2 weeks of therapy no significant difference found between the therapy group and the control group. the total bilirubin (TBil) and alanine transaminase (ALT) showed no significant difference between the middle stage therapy group and the control group in 4 weeks of therapy. However significant differences existed in the HBV DNA negative rate, PTA, the model for end-stage liver disease (MELD) score and the improvement rate between the two groups (P<0.05, P<0.01). Only the 4 week survival rate and HBV DNA negative rate showed significant difference in patients who received anti-virus therapy on the early stage as compared to the control group.</p><p><b>CONCLUSION</b>Anti-virus therapy with nucleoside analogue is an effective way for the treatment of those patients with HBV-ACLF and can increase the survival rate.</p>

Study on gene delivery via the bile duct to rat liver using naked DNA particles / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of gene delivery to the right lateral lobe of the rat liver via a branch of the bile duct using naked DNA.</p><p><b>METHODS</b>We evaluated regional gene delivery to the right lateral lobe of the rat liver via a branch of the bile duct, using naked DNA, including pGL3, pCMV beta and Cy3 labeled CMV beta.</p><p><b>RESULTS</b>Gene expression was observed in right lateral lobe of both the damaged and the normal rats liver. The gene delivery efficiency was similar in two groups (P > 0.05). Gene expression was found in the right lateral lobe of damaged and normal livers. Fluorescence was observed in the region of the portal triads, and occasionally, in the lobule.</p><p><b>CONCLUSION</b>Retrograde infusion of naked DNA via the bile duct is an effective way to deliver genes to in both damaged and normal rat liver.</p>

Analysis of prognostic factors for patients with acute-on-chronic liver failure / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To analyze the prognostic factors for patients with acute-on-chronic liver failure, and to build a scoring system for assessment of the prognosis of liver failure.</p><p><b>METHODS</b>480 patients with acute-on-chronic liver failure in our hospital from January 2006 to June 2008 were enrolled in this study. The patients were divided into improved group and deteriorated group. The clinical data were analyzed by using chi square test, independent-Samples T Test and Binary logistic regression.</p><p><b>RESULTS</b>The factors that significantly affected the prognosis of Acute-on-chronic Liver Failure included age, hepatitis or liver cirrhosis, Staging, Hyponatremias, alpha-fetoprotein (AFP), the prothrombin time activity (PTA), total bilirubin (TBil), creatinine (Cr), albumin (ALB) and Hepatic encephalopathy, ascites, alimentary tract hemorrhage (P less than 0.05, P less than 0.01). PTA, Hyponatremias, hepatitis or liver cirrhosis, Hepatic encephalopathy and alimentary tract hemorrhage were independent risk factors of prognosis.</p><p><b>CONCLUSION</b>PTA, Hyponatremias, hepatitis or liver cirrhosis, Hepatic encephalopathy and alimentary tract hemorrhage are important to build a scoring system to assess the prognosis of Acute-on-chronic Liver Failure and may be useful to guide clinical treatment.</p>

Rescue of dendritic cells malfunction and loading with HBV proteins in patients with chronic hepatitis B in vitro / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To investigate dendritic cell (DC) malfunctions in patients with chronic hepatitis B (CHB) and try some means to restore the function in vitro.</p><p><b>METHODS</b>Twelve CHB patients and 10 healthy people were enrolled in the study. Phenotype analysis and allogeneic mixed lymphocyte reaction (AMLR) assay of DC from these subjects were made. Enzyme-linked ELISpot method for detecting IFN-gamma-producing CD8 (+) T cells were used to evaluate the efficacy of DC loaded in vitro with HBsAg or HBcAg.</p><p><b>RESULTS</b>DC from patients had a lower expression of co-stimulatory molecules and impaired AMLR capacity, but was restored partially by cytokine cocktail in vitro. Mature DC loaded with HBsAg or HBcAg showed a greater capacity for IFN-gamma-production than immature DC.</p><p><b>CONCLUSION</b>Malfunction of DC from CHB patients may be rescued by a cocktail of cytokines, and therapeutic DC vaccines loaded with HBV protein might be helpful to treat CHB patients.</p>

Relativity analysis of chronic hepatitis B virus genotype and clinical pathology / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To explore the relationship between chronic hepatitis B virus genotypes and clinical pathology.</p><p><b>METHODS</b>HBV genotype was determined in 92 cases with chronic hepatitis B patients and the relationship between HBV genotypes and clinical, serological and histological data of the patients was analyzed.</p><p><b>RESULTS</b>Sixteen cases were infected with HBV genotype B (17.4%), 71 with genotype C (77.2%), 3 with HBV classified as genotype B+C (3.2%) and in 2 (2.2%) cases HBV genotype was not confirmed. ALT level and HBV DNA load log value were (82.6+/-82) U/L, (84.7+/-71.5) U/L and (5.8+/-1.4), (5.9+/-1.5) respectively in genotypes B and C patients, in 8 cases of genotype C group liver cirrhosis was diagnosed, but no statistical significance was seen.</p><p><b>CONCLUSION</b>No significant differences in clinical, serological or histological data were detected between genotypes B and C patients.</p>

Construction of eukaryotic expression vector expressing hepatitis B virus HBsAg and EGFP fusion protein and establishment of stable transfected Chang Liver cell line / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To construct a eukaryotic expression vector for expressing hepatitis B virus (HBV) recombinant HBsAg-EGFP fusion protein and obtain a stable transfected Chang Liver cell line.</p><p><b>METHODS</b>The coding region of HBsAg gene of HBV was amplified by PCR and was digested by BamH I/EcoR I . This fragment was inserted into pEGFPN1 with T4 ligase and transformed E-coli TG1. The positive recombinant plasmid was selected, then the recombinant plasmid was transfected into Chang Liver cell by Lipofectamine 2000 cells containing stable transformants were selected by the ability of resistance to G418 and isolated with a limited dilution. The stable transfected cell line expressing high level HBsAg-EGFP fusion protein was obtained.</p><p><b>RESULTS</b>The eukaryotic expression vector named pEGFPN1-HBsAg was successfully constructed and the stable transfected Chang Liver cell line expressing pEGFPN1-HBsAg fusion protein was obtained.</p><p><b>CONCLUSION</b>The stable transfected Chang Liver cell line could express pEGFPN1-HBsAg fusion protein, could be used to screen the proteins differentially expressed in HBsAg expression Chang Liver cells, which brought some new clues for studying the potential molecular mechanism of HBsAg protein.</p>

A five-year analysis of HBV mutations in a multidrug-resistant patient with chronic hepatitis B / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate HBV mutations in reverse transcriptase (RT) gene and precore/basal core promoter (PC/BCP) regions in a chronic hepatitis B patient and to analyze the link between the mutations and drug resistance or HBeAg sero-conversion.</p><p><b>METHODS</b>Eighteen serum samples were collected from a chronic hepatitis B patient during his 14 hospitalizations from June 2002 to September 2007. HBV DNA was extracted and nested PCR was employed for amplification of target gene fragments. Direct sequencing of PCR products was performed followed by analysis with NTI software. The significance of the results was analyzed in combination with the clinical data of the patient.</p><p><b>RESULTS</b>Several mutations were identified in succession, including LAM-resistant mutations M204I/V and L180M+M204V, ETV-resistant mutation S202G, and HBeAg nonsense mutation G1896A. The results were in accordance with the disease progression of the patient.</p><p><b>CONCLUSION</b>Sequencing of HBV RT and PC/BCP regions is valuable for comprehensively checking the viral mutations and thus it is helpful in the surveillance of patients in clinics as a way for adopting reasonable antiviral therapy.</p>

Etiological analysis of 1977 patients with acute liver failure, subacute liver failure and acute-on-chronic liver failure / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the etiology of 1977 patients from northern China with acute (ALF), sub-acute (SALF) or acute-on-chronic liver (ACLF) failures.</p><p><b>METHOD</b>The age, gender, etiology, pathogenesis, and prognosis of the 1977 patients with liver failures were retrospectively analyzed.</p><p><b>RESULTS</b>Of the 1977 cases, the three most common causes of ALF were HEV (33.96%) or HBV (13.21%) infections or those caused by medicines (9.43%). The three predominant causes of SALF were medicines (31.53%), HEV (16.22%) or HBV (9.91%) infections, but those of the ACLF were HBV (90.29%) infection, alcoholic hepatopathy (2.65%), and HBV super infected with HEV (2.26%) infections. 90.09% (1781) patients were infected by hepatotropic viruses. Of these 1781 patients, the most common cause of their liver failures was HBV infection (92.93%). In these HBV infected patients, 77.10% were from 26 to 55 years old. From 2005 to 2007, there were 39 patients with alcoholic liver failure. In the past two years, there were 23 patients with drug induced liver failure. The improvement rate of the 1977 patients after their treatments was 35.56%. The improvement rate of HEV infected liver failure was higher than drug induced liver failure (P less than 0.05); no statistical significance was found between other groups (P more than 0.05).</p><p><b>CONCLUSION</b>Different types of liver failure have different predominant causes. HBV infection is the most common cause in our 1977 patients. In the past two years, the number of drug induced liver failures and alcoholic liver failures have been increasing.</p>

Use of bicyclol in treatment of chronic hepatitis B virus infection: a systematic review / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of bicyclol for chronic hepatitis B.</p><p><b>METHOD</b>The authors searched CBMDisk, CJFD (2000-2006), CJD-CD, PubMed (1966-2006) for randomized controlled trials (RCT) comparing bicyclol versus non-antiviral interventions, interferon alpha (IFN-a) and lamivudine for treatment of chronic hepatitis B. Two reviewers performed data extraction and quality assessment independently and discussed when there was different opinion. We analyzed the data with RevMan 4.2 software supplied by Cochrane Collabration.</p><p><b>RESULTS</b>Fourteen RCTs involving 1782 patients were included. ALT recovery rate of bicyclol group was 69.3 percent while that of the control group was 59.0 percent, the difference was statistical significant [RR 1.24, 95 percent CI (1.01, 1.52), P=0.04]. Loss of HBeAg in the bicyclol group (22.1 percent) was higher than that of the control group (13.5 percent) [RR 1.65, 95 percent CI (1.32, 2.06), P<0.00001]. No serious adverse events were reported.</p><p><b>CONCLUSION</b>Bicyclol might be beneficial to recovery of liver function and loss of serum HBV marker. However, more high quality clinical trials are needed for confirmation.</p>

Retrospective study of liver failure complicated with bacterium and fungous infection / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To study clinic character of liver failure complicated with bacterium and fungous infection.</p><p><b>METHODS</b>The patients with liver failure complicated with bacterial and fungous infection who were treated in our hospital from January 1986 to June 2006 were studied. All patients had clinical manifestation and positive of bacterium. The data were statistical analysis.</p><p><b>RESULTS</b>507 patients diagnosed with fungous infection were found from January 1986 to June 2006 in which 132 patients were diagnosed with bacterial and fungous infection. There were 85 patients (64.39%) with chronic severe hepatitis and 40 patients (30.3%) with decompensation cirrhosis. Bacterial infection happened in 153 cases in which the rate of nosocomial infections was 54.90%. 204 bacterial strains were separated in which 143 strains (70.10%) were gram-negative bacterium and 61 (29.90%) strains were gram-positive bacterium. The main sites of bacterial infection were abdominal cavity (122 cases) and lung (30 cases). Fungous infection happened in 143 cases in which the rate of nosocomial infections was 86.71%. 155 fungous strains were separated in which 90 strains (58.06%) were Candida albicans, 17 strains (10.97%) were Aspergillus fumigatus and 25 (16.13%) strains were non-Candida albicans. The main sites of fouguns infection were lung (94 cases) and mouth (53 cases). 84 patients (63.64%) were ineffective and died after treatment.</p><p><b>CONCLUSION</b>The patients with decompensation cirrhosis and chronic severe liver hepatitis were easy to be infected by bacterial and fungous. the rate of fungous nosocomial infections is higher than that of bacterium. The prognosis is bad in patients who had secondary fungous infection.</p>

Changes of peripheral plasmacytoid dendritic cells and lymphocyte subsets in chronic hepatitis B patients treated with consensus interferon alpha / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the changes of peripheral plasmacytoid dendritic cells and lymphocyte subsets in patients with chronic hepatitis B (CHB) during consensus interferon (CIFN) treatment.</p><p><b>METHODS</b>Twenty-three patients with CHB were treated with CIFN for 24 weeks and followed up for another 24 weeks. Peripheral plasmacytoid dendritic cells and lymphocyte subsets were measured throughout the treatment and follow-up periods.</p><p><b>RESULTS</b>After CIFN treatment, 43.5% of the patients had virological and biochemical responses. The percentage and absolute number of peripheral plasmacytoid dendritic cells decreased significantly (P less than 0.05), the number of CD3+ cells, CD4+ T cells, B cells and the ratio of CD4+/CD8+ cells decreased also (P less than 0.05), but the number of CD8+ T cells and NK cells increased (P less than 0.05).</p><p><b>CONCLUSIONS</b>Consistent virological and biochemical responses can be seen in some patients with CHB virus infection after CIFN treatment, and the percentage and number of their peripheral plasmacytoid dendritic cells greatly decreased, but the number of CD8+ T cells and NK cells increased.</p>

Comparison and analysis of two international diagnostic criteria for the diagnosis of 230 cases with drug-induced liver injury / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To compare and analyze the accuracy of two diagnostic criteria of drug-induced liver injuries.</p><p><b>METHODS</b>230 cases of drug-induced liver injury diagnosed clinically in the 302 hospital of PLA were retrospectively studied. The drugs which induced liver injuries were summarized and analyzed. Danan's international consensus criteria and Maria's diagnostic scale were applied to diagnose these 230 cases again and then the differences of diagnostic results were analyzed and compared.</p><p><b>RESULTS</b>The drugs which induced liver injuries in the 230 patients were arranged in order of their usage frequencies: traditional Chinese herbs and the like, antibiotics, antipyretic analgesics, antituberculosis medicines, cardiovascular drugs, over-the-counter health stuff, psychopharmaceuticals, dermatological agents, drug for diabetes, tapazol, and others. Based on the 230 adult inpatients with drug-induced liver injury, according to Danan's international consensus criteria, 149 cases (64.8%), 71 (30.9%) and 10 (4.3%) were classified as drug-related, indeterminate and drug-unrelated respectively; according to Maria's diagnostic scale, not one was a definite drug-induced liver injury, 55 cases (23.9%) were probable, while 126 (54.8%), 33 (14.3%) and 16 (7.0%) were possible, unlikely and excluded respectively.</p><p><b>CONCLUSION</b>The accordance rate of Danan's international consensus criteria and clinical diagnosis was higher than that of Maria's diagnostic scale. Neverthelessìthe current diagnostic methods for drug-induced liver injury need to be revised for clinical practice.</p>