Long-term lamivudine for chronic hepatitis B and cirrhosis: A real-life cohort study

AIM: To investigate clinical outcomes of chronic hepatitis B(CHB) and liver cirrhosis(LC) patients under whole-course management with lamivudine(LAM). METHODS: This was a retrospective-prospective cohort study based on two nonrandom cohorts of Chinese patients(LAM group and history control group). Two hundred thirty-eight patients with LAM treatment for at least 12 mo under whole-course management were included in the LAM group. The management measures included regular follow-up and timely adjustment of the therapeutic regimen according to drug-resistance and relapse. Two hundred thirtyeight patients with CHB or LC without any antiviral treatment and with follow-up over 12 mo were included in the history control group. The LAM and control group patients were 1:1 matched by propensity score method to ensure both patients were similar in general datum,sex,age,E antigen,and diagnosis. The incidence rates of endpoint events [LC,hepatocellular carcinoma(HCC),and death] were compared between the LAM and control groups.RESULTS: Hepatitis B virus-DNA < 1000 copies per m L rate and rate of alanine transaminase < 1.3 of theupper normal limit in LAM and control groups were 89.1% vs 18.5%(P < 0.05) and 89.8% vs 31.1%(P < 0.05),respectively. Viral breakthrough occurred in 77 patients(32.4%); the one-,three-,and fiveyear cumulative rates were 6.8%,33.1%,and 41.3%,respectively. In total,44.5%(106/238) of patients had once stopped LAM,and 63(59.4%) of them developed virologic relapse; the relapse rate of patients with and without reaching Asian Pacific Association for the Study of the Liver endpoint criteria were 52.4% and 69.8%,respectively. Six CHB patients in the LAM group developed LC compared to 47 patients in the control group; the three-,and five-year cumulative rates of CHB at baseline of LAM were lower than those of the control group: 0.7% vs 12.0% and 1.8% vs 23.8%(P < 0.01),respectively. The incidence of HCC in CHB at baseline of LAM was lower than that of the control group; the three-,and five-year cumulative rates were 0% vs 3.2% and 1.1% vs 3.2%(P = 0.05),respectively. The incidence of HCC in LC at baseline of LAM was lower than that of the control group: 9.8%(5/51) vs 25.0%(12/48),and the three-,and five-year cumulative rates were 4.5% vs 20.7% and 8.1% vs 37.5%(P < 0.01),respectively. The mortality rate in the LAM group was lower than the control group. CONCLUSION: Standardized long-term LAM treatment in combination with comprehensive management can reduce the incidence rates of LC and HCC as well as hepatitis B virus-related deaths.

建设项目财务评价指标的进一步研究

通过对净现值和内部收益率两个指标的研究 ,提出一种新的财务评价指标———综合内部收益率CIRR ,并对其进行了推导求证 ,新的指标能够更全面、更科学的反映项目的可行性。

补肾益气疏肝凉血活血方对乙肝肝纤维化患者免疫功能的影响

目的了解补肾益气疏肝凉血方对乙肝肝纤维化患者免疫功能的影响。方法３８例乙肝肝纤维化患者以补肾益气疏肝凉血活血法辨证治疗，观察其对循环免疫复合物（ＣＩＣ）、血清透明质酸（ＨＡ）的影响。结果随着ＣＩＣ含量的降低，血清ＨＡ亦同步下降。结论该法抗肝纤维化的作用，与具有减轻免疫损伤作用有关。

Shunting branch of portal vein and stent position predict survival after transjugular intrahepatic portosystemic shunt

AIM: To evaluate the effect of the shunting branch of the portal vein (PV) (left or right) and the initial stent position (optimal or suboptimal) of a transjugular intrahepatic portosystemic shunt (TIPS).

慢性乙型肝炎、肝硬化患者血清瘦素测定及临床意义

目的:测定慢性乙型肝炎(CHB)、乙型肝炎后肝硬化(LC)患者血清瘦素水平,并探讨其异常变化的临床意义。方法:采用酶联免疫吸附试验(ELISA),测定79例CHB、77例LC患者的血清瘦素水平,同时检测76名正常人血清瘦素水平作为对照。结果:与正常对照组比较,CHB和LC患者,无论男女其血清瘦素水平均明显降低,且CHB患者瘦素水平明显低于LC患者。以上3组血清瘦素水平女性均高于男性。结论:CHB和LC患者,不论肝功能异常程度如何,其血清瘦素水平均低于正常人,其原因与肝脏受病毒感染损伤、肝脏功能异常明显相关。

Liver transplantation for alcoholic liver disease: Lessons learned and unresolved issues

The use of liver transplantation(LT) as a treatment for alcoholic liver disease(ALD) has been highly controversial since the beginning. The ever increasing shortage of organs has accentuated the low priority given to patients suffering from ALD, which is considered a "self-inflicted" condition. However, by improving the long-term survival rates, making them similar to those from other indications, and recognizing that alcoholism is a primary disease, ALD has become one of the most common indications for LT in Europe and North America, a situation thought unfathomable thirty years ago. Unfortunately, there are still many issues with the use of this procedure for ALD. There are significant relapse rates, and the consequences of excessive drinking after LT range from asymptomatic biochemical and histological abnormalities to graft failure and death. A minimum three-month period of sobriety is required for an improvement in liver function, thus making LT unnecessary, and to demonstrate the patient's commitment to the project, even though a longer abstinence period does not guarantee lower relapse rates after LT. Recent data have shown that LT is also effective for severe alcoholic hepatitis when the patient is unresponsive to corticosteroids therapy, with low relapse rates in highly selected patients, although these results must be confirmed before LT becomes a standard procedure in this setting. Finally, LT for ALD is accompanied by an increased risk of de novo solid organ cancer, skin cancer, and lymphoproliferative disorders, which has a large impact on the survival rates.

原发性胆汁性肝硬化50例临床分析

目的对50例原发性胆汁性肝硬化(PBC)患者的临床特征及病理特点进行回顾性研究,以提高对该病的认识。方法对临床/病理确诊为PBC患者的临床特征、各项生化指标和组织学特点进行总结。结果50例PBC患者中女性占88%(44/50),确诊时平均年龄44.9岁。最常见的临床症状为乏力(68%,34/50),其次为纳差(48%,24/50)、瘙痒(26%,13/50),最主要的体征包括黄疸(64%,32/50)、脾大(48%,24/50)、肝掌(28%,14/50)。患者血清碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(γ-GT)明显升高,但随着病程逐渐发展,这2项指标逐渐下降,到晚期下降明显。32例患者(64%)胆红素有不同程度的升高,大部分患者丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)表现为轻-中度升高。41例患者(80.2%)抗线粒体抗体(AMA)/AMA-M2亚型抗体阳性。共有32例患者行肝脏穿刺病理检查,其中87.5%为早期(Ⅰ、Ⅱ期),12.5%为晚期(Ⅲ、Ⅳ期)。结论PBC主要累及中老年女性,主要表现为乏力、纳差、瘙痒,早期血清ALP和γ-GT水平升高,AMA及AMA-M2亚型抗体阳性。PBC应尽早明确诊断并及时治疗。

联合检测血清酯酶和乳酸脱氢酶同功酶对原发性肝癌诊断价值的初步探讨

目的:研究使用同功酶临床诊断试剂盒(醋酸纤维素薄膜电泳法)联合检测血清酯酶(Es)同功酶和乳酸脱氢酶(LDH)同功酶对肝硬化和肝细胞癌(HCC)的诊断价值。方法:采用Es试剂盒和LDH试剂盒检测血清,原发性肝癌病人18例,失代偿期肝硬化病人40例,正常人40例。结果:HCC及肝硬化病人Es2带活性减弱甚至大多数消失,与正常对照相比差异有极显著性(P<0.01),而HCC病人LDH5带活性明显增强,与肝硬化及正常相比差异有显著性(P<0.05)。结论:检测血清Es对肝硬化和HCC的诊断有高度敏感性,结合检测血清LDH对肝硬化并发HCC的诊断具有重要的临床价值。