Cryptogenic cirrhosis in the region where obesity is not prevalent

AIM： Recent studies have demonstrated that obesity is the common feature of cryptogenic cirrhosis （CC） and non-alcoholic steatohepatitis. However, there is little information on CC in the region where obesity is not prevalent, METHODS： The clinical features, and the liver-related morbidity and mortality of CC were analyzed in Japan where the prevalence of obesity is low. Among 652 cirrhotic patients, we identified 29 patients （4.4%） with CC. Of these, 24 CC patients who were followed up for more than 6 months were compared in a case-control study with age-, sex-, and Child-Pugh score-matched controls having cirrhosis of viral etiology. RESULTS： Obesity （BMI≥25 kg/m^2）, diabetes mellitus, and hypertriglyceridemia were more frequent, and the visceral fat area was larger in the CC patients than in the controls. The indices of insulin resistance were higher and the serum aminotransferase levels were lower in the CC patients than in the controls. Logistic regression analysis identified the elevated hemoglobin A1c, BMI ≥ 25 kg/m^2, and normal aminotransferase levels as independent predictors of CC. Kaplan-Meier analysis demonstrated lower occurrence of hepatocellular carcinoma and higher survival rate in the CC than in the controls in contrast to the similar cumulatlve probability of liverrelated morbidity between those groups.CONCLUSION： CC more frequently presents with the clinical features suggestive of non-alcoholic steatohepatitis compared with controls even in the region where obesity is not prevalent. The lower occurrence of hepatocellular carcinoma and higher survival rate may indicate an indolent clinical course in CC as compared with viral cirrhosis.

Liver Transplantation Outcomes of HBV-,HCV-,and Alcohol-induced Hepatocellular Carcinoma in the United States:Analysis of National Inpatient Samples

Objective Liver transplantation is a current treatment option for hepatocellular carcinoma(HCC).The United States National Inpatient Sample database was utilized to identify risk factors that influence the outcome of liver transplantation,including locoregional recurrence,distant metastasis,and in-hospital mortality,in HCC patients with concurrent hepatitis B infection,hepatitis C infection,or alcoholic cirrhosis.Methods This retrospective cohort study included HCC patients(n=2391)from the National Inpatient Sample database who underwent liver transplantation and were diagnosed with hepatitis B or C virus infection,co-infection with hepatitis B and C,or alcoholic cirrhosis of the liver between 2005 and 2014.Associations between HCC etiology and post-transplant outcomes were examined with multivariate analysis models.Results Liver cirrhosis was due to alcohol in 10.5%of patients,hepatitis B in 6.6%,hepatitis C in 10.8%,and combined hepatitis B and C infection in 24.3%.Distant metastasis was found in 16.7%of patients infected with hepatitis B and 9%of hepatitis C patients.Local recurrence of HCC was significantly more likely to occur in patients with hepatitis B than in those with alcohol-induced disease.Conclusion After liver transplantation,patients with hepatitis B infection have a higher risk of local recurrence and distant metastasis.Postoperative care and patient tracking are essential for liver transplant patients with hepatitis B infection.

Efficacy observation of Yiguanjian decoction combined adefovir Dipivoxil tablet in treating HBeAg negative chronic viral hepatitis B active compensated liver cirrhosis patients

Objective To explore clinical efficacy of Yiguanjian Decoction(YD)combined Adefovir Dipivoxil Tablet(ADT)in treating HBe Ag negative chronic viral hepatitis B(CVHB)active compensated liver cirrhosis(LC)patients.Methods Totally 68 HBe Ag negative CVHB active compensated LC patients initially treated were assigned to the treatment group and the control group

Diagnostic Efficacy and Possible Underlying Mechanisms of Noninvasive Clinical Markers in Hepatocellular Carcinoma

Background and Aims:In this study,we aimed to evaluate the diagnostic values of alpha-fetoprotein(AFP),soluble AXL(sAXL),des-γ-carboxy prothrombin(DCP),the aspartate aminotransferase-to-platelet ratio index(APRI),and the gamma-glutamyl transpeptidase-to-platelet ratio(GPR)in hepatocellular carcinoma(HCC)and the possible underlying mechanisms of the correlations between them.Methods:We collected serum samples from 190,128,and 75 patients with HCC,cirrhosis,and chronic viral hepatitis,and from 82 healthy subjects.Serum levels of AFP,sAXL,and DCP were determined,and APRI and GPR values were calculated.Receiver operating characteristic(ROC)curves were used to analyze the diagnostic value of single and combined biomarkers.Results:We detected significant differences between the HCC group and other groups regarding serum AFP,sAXL,DCP,and APRI levels.GPR significantly differed between the HCC group and other groups,except for the liver cirrhosis group.AFP,sAXL,DCP,APRI,and GPR had positive correlations with each other,and AFP showed a higher area under the curve(AUC)and Youden index values,while APRI and DCP showed the highest sensitivity and specificity.Also,when AFP was combined with sAXL,DCP,APRI,and GRP,the highest AUC(0.911)and a higher net reclassification improvement value were obtained compared with those obtained for the individual biomarkers.Conclusions:AFP,sAXL,DCP,APRI,and GPR are independent risk factors for HCC,and the diagnostic performance of AFP combined with sAXL,DCP,APRI,and GPR for HCC diagnosis was superior to that of the individual biomarkers.