Prognosis of hepatic cirrhosis patients with esophageal or gastric variceal hemorrhage: multivariate analysis

Objective: To study the effect of bacterial infection, use of antibiotics, active bleeding at endoscopy, and the severity of liver disease as prognostic factors in hepatic cirrhotic patients during the first 5 days after the episode of esophageal or gastric variceal hemor- rhage. Methods: Seventy-six hepatic cirrhosis patients with esophageal or gastric variceal bleeding were enrolled. Bleeding was managed in a standardized protocol u- sing octreotide and vasopressin in sclerotherapy or band ligation for active bleeding at endoscopy. The screening protocol for bacterial infection consisted of chest radiograph; blood, urine and ascitic fluid cul- tures; the severity of liver disease shown by Child- Pugh score. Results: Active bleeding was observed at endoscopy in 40 patients (53%). Failure to control bleeding Within 5 days occurred in 36 patients (45%). Empir- ical antibiotic treatment was used in 53 patients (67%), whereas bacterial infections were documen- ted in 43 patients (57%). Multivariate analysis showed that proven bacterial infection (P<0.01) or antibiotic use (P<0.05) as well as active bleeding at endoscopy (P<0.01) and Child-Pugh score (P< 0.01) were independent prognostic factors of failure to control bleeding. Conclusion: Bacterial infection is associated with fai- lure to control esophageal or gastric variceal bleeding in hepatic cirrhotic patients.

Changes in Hydrogen Sulfide in Rats with Hepatic Cirrhosis in Different Stages

This study aimed to observe changes in the hydrogen sulfide（H_2S） system in the blood and liver tissue of rats with hepatic cirrhosis at different stages by studying the effect of H_2S on the course of hyperdynamic circulation in rats with hepatic cirrhosis. H_2S concentration in the blood from the portal vein and inferior vena cava of hepatic cirrhosis rat model induced with carbon tetrachloride was detected on the 15 th, 30 th, and 52 nd day. The expression of cystathionine β-synthase（CBS） and cystathionine γ-lyase（CSE） protein, and CBS and CSE mRNA in the liver was detected by immunohistochemistry and reverse transcriptase polymerase chain reaction（RT-PCR）, respectively. The results indicated that H_2S concentration in the blood from the portal vein and inferior vena cava of rats with hepatic cirrhosis was significantly lower than that in the control group. H_2S was gradually decreased with the development of the disease and significantly lower in the blood from portal vein than in the blood of inferior vena cava at the mid-stage and the late stage groups. The expression levels of CBS and CSE protein, and CBS and CSE mR NA in the livers with hepatic cirrhosis at different stages were all higher than those in the control group, and the expression gradually increased with the development of the disease. The expression of CBS was lower than CSE in the same stages. The results indicated that the CSE mRNA was expressed predominantly in the cirrhosis groups as compared with CBS mRNA. Among experimental rats, the H_2S system has an important effect on the occurrence and development of hyperdynamic circulation in rats with hepatic cirrhosis. This finding adds to the literature by demonstrating that H_2S protects vascular remodelling in the liver, and that CSE is indispensable in this process.

Effects of Lactobacillus paracasei N1115 on gut microbial imbalance and liver function in patients with hepatitis B-related cirrhosis

BACKGROUND Hepatitis B cirrhosis(HBC)is a chronic disease characterized by irreversible diffuse liver damage and aggravated by intestinal microbial imbalance and metabolic dysfunction.Although the relationship between certain single probiotics and HBC has been explored,the impact of the complex ready-to-eat Lactobacillus paracasei N1115(LP N1115)supplement on patients with HBC has not been determined.AIM To compare the changes in the microbiota,inflammatory factor levels,and liver function before and after probiotic treatment in HBC patients.METHODS This study included 160 HBC patients diagnosed at the General Hospital of Ningxia Medical University between October 2018 and December 2020.Patients were randomly divided into an intervention group that received LP N1115 supplementation and routine treatment and a control group that received routine treatment only.Fecal samples were collected at the onset and conclusion of the 12-wk intervention period.The structure of the intestinal microbiota and the levels of serological indicators,such as liver function and inflammatory factors,were assessed.RESULTS Following LP N1115 intervention,the intestinal microbial diversity significantly increased in the intervention group(P<0.05),and the structure of the intestinal microbiota was characterized by an increase in the proportions of probiotic microbes and a reduction in harmful bacteria.Additionally,the intervention group demonstrated notable improvements in liver function indices and significantly lower levels of inflammatory factors(P<0.05).CONCLUSION LP N1115 is a promising treatment for ameliorating intestinal microbial imbalance in HBC patients by modulating the structure of the intestinal microbiota,improving liver function,and reducing inflammatory factor levels.

Impact of Nursing Interventions Based on Self- Efficacy Theory on HAMA and HAMD Scores in Patients with Hepatitis B Cirrhosis

Objective:To explore the effect of nursing interventions based on self-efficacy theory guidance on psychological stress indicators in patients with hepatitis B cirrhosis.Methods:70 patients with hepatitis B cirrhosis from October 2023 to May 2024 were selected and grouped by random number table.The observation group received nursing intervention based on self-efficacy theory,while the control group received routine nursing.The differences in psychological stress indicators,self-efficacy indicators,and nursing satisfaction were compared between the two groups.Results:Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HAMD)scores of the observation group were significantly lower than those of the control group(P<0.05);Chronic Disease Self-Efficacy Scale(CDSES)scores of the observation group were significantly higher than those of the control group(P<0.05);and nursing satisfaction scores of the observation group were significantly higher than those of the control group(P<0.05).Conclusion:Hepatitis B cirrhosis patients receiving nursing care based on self-efficacy theory can stimulate patients'self-efficacy,calm their emotions,and their overall satisfaction is high.

Hepatic myelopathy:Morphology of the thoracic and lumbar cord in liver cirrhosis and non-cirrhosis corpses and comparison of neuron functional protein

The current study demonstrated that injury of the spinal cord lateral funiculus occurs in liver cirrhosis. This study sought to compare the morphology of the thoracic and lumbar cord, the expression of functional proteins, and changes in vessels between liver cirrhosis and non-cirrhosis corpses. Results showed that in the liver cirrhosis group, the hepatic vein expanded, the gastrointestinal tract was full of coagulated blood, blood-stasis was easily seen in the veniplex of the vertebral canal and the lumbar spinal cord, and the cell bodies of the anterior horn in the thoracic and lumbar cord were smaller than those in non-cirrhosis corpses. In addition, nerve cells shrank, Nissl bodies were concentrated with obscured nuclei, and neurofilament and synapsin containing cell bodies of the anterior horn and white matter decreased in the liver cirrhosis group. These experimental findings indicate that abnormal circulation of the spinal cord, resulting from hemodynamic change of cirrhotic portal hypertension, may be the most significant cause of hepatic myelopathy.

Clinical efficacy of antiviral therapy in patients with hepatitis Brelated cirrhosis after transjugular intrahepatic portosystemic shunt

BACKGROUND As a country with a high burden of hepatitis B,China has about 86 million cases of hepatitis B virus infection,ranking the first in the world.Currently,there are about 390000 deaths due to hepatitis B-related complications such as liver cirrhosis and liver cancer every year.Consequently,how to control portal hypertension,improve liver functional reserve,and reduce the incidence of hepatic failure and liver cancer in such patients is the focus of current clinical attention.Previous clinical study in our center suggested that at 24 mo after transjugular intrahepatic portosystemic shunt(TIPS),the liver functional reserve of patients with hepatitis B cirrhosis was better than that of patients with alcoholinduced and immune cirrhosis,which may be related to the effective etiological treatment.AIM To investigate the clinical efficacy of three first-line antiviral drugs recommended by the guidelines of prevention and treatment for chronic hepatitis B in China(2019)in the treatment of patients with hepatitis B-related cirrhosis who had received a TIPS.METHODS The clinical data of 137 patients with hepatitis B-related cirrhosis with portal hypertension after receiving TIPS at our centre between March 2016 and December 2020 were analysed retrospectively.According to different anti-viral drugs,the patients were divided into entecavir(ETV)(n=70),tenofovir alafenamide fumarate(TAF)(n=32),and tenofovir disoproxil fumarate(TDF)(n=35)groups.The cumulative incidence of hepatic encephalopathy and hepatocellular carcinoma,survival,and changes in hepatic reserve function and glomerular filtration rate in patients treated with different antiviral drugs within 24 mo after surgery were investigated.RESULTS At 24 mo after surgery,the Child-Pugh score in the TAF group(6.97±0.86)was lower than that in the TDF(7.49±0.82;t=-2.52,P=0.014)and ETV groups(7.64±1.17;t=-2.92,P=0.004).The model for end-stage liver disease score in the TAF group at 24 mo after surgery was 9.72±1.5,which was lower than that in the TDF(10.74±2.33;t=-2.09,P=0.040)and ETV groups(10.97±2.17;t=-2.93,P=0.004).At 24 mo after surgery,the estimated glomerular filtration rate(eGFR)in the TAF group(104.41±12.54)was higher than that in the TDF(93.54±8.97)and ETV groups(89.96±9.86)(F=21.57,P<0.001).CONCLUSION At 24 mo after surgery,compared with TDF and ETV,TAF has significant advantages in the improvement of liver functional reserve and eGFR.

Adjuvant hepatic chemotherapy after resection of solitary hepatocellular carcinoma associated with hepatitis B virus cirrhosis

BACKGROUND: Although resection is the major treatment for patients with hepatocellular carcinoma ( HCC), the high intrahepatic recurrence remains a cardinal cause of death. This study was undertaken to evaluate the effect of hepatic arterial infusion chemotherapy on the survival and recurrence of HCC patients with hepatitis B virus ( HBV) cirrhosis after resection. METHODS: Twenty-eight patients who had undergone placement of a hepatic arterial pump at the time of liver wedge resection for HCC from 1998 through 2004 were reviewed retrospectively. These patients aged 23-71 years had HBV cirrhosis (Child-Pugh class A or B). They were given floxuridine(FUDR) (250 mg), doxorubicin (10 mg) and mitomycin C (4 mg) alternatively every 2 or 3 days through arterial pumps for 8 cycles each year in the first two years after resection. Meanwhile, traditional Chinese herbal medicine was prescribed to the patients. When the leucocyte count was as low as 3 x 109/L or asparate aminotransferase (AST) level was significantly increased, the regimen of chemotherapy was delayed for the normalization of leucocyte count and AST level (below 80 U/L). RESULTS: Of the 28 patients, 23 received 8 or 16 cycles of the set regimen of chemotherapy. These patients are alive with no evidence of recurrence. Among them, 5,7, and 11 patients are alive beyond 5 years, 3 years, and 1 year respectively. In the remaining 5 patients, 3 who had had a HCC 10 cm or more in diameter showed tumor recurrence within 1 year, in whom, 8 cycles of chemotherapy were not completed because of their low leucocyte count (<3 × 109/L) and poor liver function. One patient who had received 8 cycles of chemotherapy demonstrated recurrence at 16 months after resection. One patient who had received 16 cycles of chemotherapy had intrahepatic recurrence at 58 months after surgery. No recurrence was observed in 17 patients who had received 16 cycles of chemotherapy. CONCLUSION: Adjuvant hepatic arterial chemotherapy may be feasible to improve the survival of patients after resection of solitary HCC associated with HBV cirrhosis.

Effects of probiotic therapy on hepatic encephalopathy in patients with liver cirrhosis:an updated meta-analysis of six randomized controlled trials

BACKGROUND： Liver cirrhotic patients with hepatic encephalopathy have poor prognosis. Probiotics alter the intestinal microbiota and reduce the production of ammonia. We conducted a meta-analysis about the role of probiotics on liver cirrhotic patients with hepatic encephalopathy.DATA SOURCES： We collected the relevant literatures up to February 21, 2014 from databases of PubMed, EMBASE and the Cochrane Central Register of Controlled Trials. A statistical analysis was conducted by RevMan 5.2 and STATA 12.0 software.RESULTS： Six randomized controlled trials involving 496 liver cirrhotic patients were included. The results showed that probiotic therapy significantly reduced the development of overt hepatic encephalopathy（OR [95% CI]： 0.42 [0.26, 0.70],P=0.0007）. However, probiotics did not affect mortality, levels of serum ammonia and constipation（mortality： OR [95% CI]：0.73 [0.38, 1.41], P=0.35; serum ammonia： WMD [95% CI]：-3.67 [-15.71, 8.37], P=0.55; constipation： OR [95% CI]： 0.67 [0.29,1.56], P=0.35）.CONCLUSION： Probiotics decrease overt hepatic encephalopathy in patients with liver cirrhosis.

Correlation Between NLRP3 Inflammasome and GP73 Levels and Hepatitis B Cirrhosis with Esophageal Varices Rupture

Objective:To investigate the correlation between NOD-like receptor family protein 3(NLRP3)inflammasome and Golgi protein 73(GP73)levels and hepatitis B cirrhosis with esophageal varices(EV)rupture.Methods:The subjects of this study were 145 patients with hepatitis B cirrhosis and varices who were treated in our hospital in recent years.Endoscopic examination was performed on the patients.The patients were divided into two groups according to whether there was EV rupture:rupture group and non-rupture group.The correlation between plasma NLRP3 and GP73 levels and hepatitis B cirrhosis with EV rupture was analyzed.Results:Through observation,comparing the levels of NLRP3 and GP73 between the two groups,the levels of NLRP3 and GP73 were significantly higher in the rupture group than in the non-rupture group(P<0.05).Logistic regression analysis showed that NLRP3 and GP73 levels and Child-Pugh classification were related risk factors of hepatitis B cirrhosis with EV rupture.Conclusion:NLRP3 inflammasome and GP73 levels are closely related to hepatitis B cirrhosis with EV rupture.The corresponding evaluation aids in predicting EV rupture and bleeding in patients with hepatitis B cirrhosis.

Network meta-analysis of the compensatory effect of different Chinese herbal compounds combined with Entecavir in the treatment of hepatitis B cirrhosis

Objective:To evaluate the efficacy and safety of different Chinese herbal compounds combined with Entecavir in the treatment of hepatitis B cirrhosis during the compensatory period by using mesh meta-analysis.Methods:PubMed,CNKI,Wanfang and VIP databases were searched by computer,and the retrieval time was from the establishment of each database to October 5,2022.According to inclusion and exclusion criteria,literature search was conducted independently by two researchers.RevMan5.4.1 software provided by Cochrane was used for evaluation,and Stata16.0 software was used for statistical analysis.Results:A total of 34 RCTs were included,involving 16 TCM compounds and 1543 patients.The results of network meta-analysis showed that ALT indexes of liver function were listed as Yiqi Jiedu Tongluo Method>Luoshugan Tablet>Anluo Huaxian Wan>Qishenrugan Capsule>Qingganhuaji Decoction>Ganshuang Granules>Compound Biejia Rugan Tablet>Rougan Sanjie Decoction>Shugan Jianpi Decoction>Shenqi Fuzheng Huayu Decoction>Peituhua Decoction>Shugan Jianpi Huoxu prescription>Rhubarb Zhezhan Capsule combined with Entecavir treatment respectively;The order of HA index of liver fibrosis was Heluo Shugan Tablet>Shugan Jianpi Huoxui prescription>Anluo Huaxian Wan>Compound Biejia Ruangan Tablet>Rougan Sanjie Decoction>Ganshuang Granules>Danji Huoxui Decoction>Yiqi Jiedu Tongluo Method>Rhubarb Zhezhe Capsule>Fuzheng Huayu Table>Shugan Jianpi Decoction>Rougan Huayu Decoction>Peitu Huayu Decoction>Qingganhuaji Prescription>Shenqi Fuzheng Huayu prescription combined with Entecavir respectively;In order of adverse reactions from best to worst,Shuganjianpi Decoction,Qishenrugangan Capsule,Ganshuang Granules,Peituhuazhi Decoction,compound Biejiruganpian,and He Shugan Pian combined with entecavir,respectively;The effective rate of treatment was listed as Ganshuang Granules>Compound Biejia Ruangan Tablets>uoshugan Tablets>Rougansanjie Decoction>Rhubarb Zhezhe Capsules>Yiqi Jiedu Tongluo Method>Qingganhuaji prescription>Anluo Huaxia Wan>Shugan Jianpi Decoction>Fuzheng Huayu tablets>Peituhuazhi Decoction>Shenqi Fuzheng Huayu prescription combined with Entecavir respectively.Conclusion:Entecavir combined with supplementing qi and detoxifying and dredging collages is the best method to recover ALT index of liver function during the compensation period for hepatitis B cirrhosis;Entecavir combination and Luoshugan tablet were the best treatment for HA index of hepatic fibrosis;Entecavir combined with Shuganjianpi Decoction was the best treatment for adverse reactions;The best treatment efficiency was Entecavir combined with Ganshuang granules.

Analysis of Serum Cys-C,TBA,and Routine Blood Parameters of Patients with Hepatitis B-Related Decompensated Cirrhosis

Objective:To study the levels of serum cystatin C(Cys-C),total bile acid(TBA),and other routine blood parameters on patients with decompensated hepatitis B cirrhosis.Methods:Study group 1 consisted of 30 patients with hepatitis B-related decompensated cirrhosis,and study group 2 consisted of 30 patients with hepatitis B;while the control group consisted of 30 healthy people who underwent physical examination.The blood parameters were used to evaluate the clinical treatment effect of patients.Results:The TBA,Cys-C,alanine transaminase(ALT),total bilirubin(TBIL),aspartate aminotransferase(AST),and international normalized ratio(INR)in study group 1 were significantly higher than those of study group 2 and the control group;while the platelet count(PLT),hemoglobin(Hb),albumin(ALB),and estimated glomerular filtration rate(eGFR)were significantly lower in the study group 1 compared to the control group and study group 2(P<0.05).The Cys-C,PLT,TBA,AST,TBIL,and INR of patients in study group 1 who were successfully treated were significantly lower than the patients who were not successfully treated(P<0.05).Conclusion:Serum Cys-C,TBA,and routine blood parameters are useful in predicting the condition and the prognosis of patients of hepatitis B-related decompensated cirrhosis.

Relationship between the expression of IP-10 and IP-10 mRNA in peripheral blood and HBV DNA level in patients with cirrhosis

BACKGROUND: Post-hepatitic cirrhosis is regarded as common and severe form of liver damage. Interferon gamma-inducible protein 10 (IP-10), a member of the non-ELR (glutamic-leucine-arginine) motif CXC chemokine family, has recently been shown to recruit and activate specific subsets of leukocytes to sites of inflammation or an immune response during the development of hepatic cirrhosis. However, the effects of IP-10 and IP-10 mRNA on inflammatory infiltration at local sites and in the peripheral blood of patients with post-hepatitic cirrhosis as well as their relationship with viral load are still poorly defined. This study aimed to detect the relationship between the expression of IP-10 in serum, IP-10 mRNA in peripheral blood mononuclear cells (PBMCs), and the levels of HBV DNA in the serum of patients, and to explore their role in the pathogenesis of cirrhosis. METHODS: Typical patients with cirrhosis after HBV infection were selected, and their serum IP-10 concentrations were evaluated with ELISA, the content of IP-10 mRNA in PBMCs was measured by real-time PCR, and the load of HBV DNA in serum and PBMCs was assessed by semi-quantitative analysis of gel imaging. RESULTS: The levels of IP-10 in serum and IP-10 mRNA in PBMCs of patients with cirrhosis were 299.9 +/- 77.2 pg/ml and 0.7500 +/- 0.1495, respectively. They were higher than those of controls (P<0.05) and also increased in the HBV DNA(+) groups (P<0.05, P<0.01) to 343.0 +/- 80.3 pg/ml and 0.8465 +/- 0.1528, respectively. The levels of IP-10 in serum and IP-10 mRNA in PBMCs were clearly correlated with the load of HBV DNA (P<0.01). CONCLUSIONS: The levels of IP-10 and IP-10 mRNA in the peripheral blood of patients with cirrhosis increase are closely correlated with the load of HBV DNA in serum, and play a key role in the progression of post-hepatitic cirrhosis. (Hepatobiliary Pancreat Dis Int 2010; 9: 280-286)

Salviae miltiorrhizae ameliorates cirrhosis and portal hypertension by inhibiting nitric oxide in cirrhotic rats

OBJECTIVE: To determine the effect of Salviae miltiorrhizae on cirrhosis and portal hyperiension by inhibiting nitric oxide synthase type Ⅱ (NOSⅡ) in rats. METHODS: Real time RT-PCR was used to detect the expression of NOSII mRNA. The enzymatic activity of nitric oxide synthase and the circulating levels of nitric oxide (NO), systemic and portal hemodynamics, and quantification of cirrhosis were measured with highly sensitive methods. Traditional Chinese medicine was utilized to treat cirrhotic rats and the function of NO was evaluated. Double-blind method was applied in the experiment constantly. RESULTS: The concentration of NO increased markedly at all stages of cirrhosis, and so did the enzymatic activity of NOS, antl the iNOSmRNA expressed greatly. Meanwhile the portal-venous-pressure (PVP), portal-venous-now (PVF) increased significantly. NO, Nos and iNOSmHNA were positively correlated to the quanlity of hepatic fihrosis. Salviae Miltiorrhizae significantly inhibited NO production and inhibited the expression of iNOSmRNA. CONCLUSIONS: The increased hepatic expression of NoSIⅡ is one of the important factors causing cirrhosis and portal hypertension. Salviae Miltiorrhizae significantly ameliorates cirrhosis and portal hypertension.

Nutritional Support Treatment for Severe Chronic Hepatitis and Posthepatitic Cirrhosis

The therapeutic effectiveness of nutritional support in the treatment of severe chronic hepatitis and posthepatitic cirrhosis was evaluated. 143 patients with severe chronic hepatitis and 83 with posthepatitic cirrhosis were evaluated with SGA for assessing the nutritional status before the treatment. Patients with severe chronic hepatitis were divided into three groups： group A subject to enteral nutrition （EN） and parenteral nutrition （PN）, group B subject to comprehensive treatment （CT） ＋PN; group C subject to CT＋EN. The patients with posthepatitic cirrhosis were divided in- to two groups： group D receiving CT and group E receiving CT＋ PN ＋ EN. The function of liver and kidney and nutritional status were monitored to assess the therapy in 6 weeks. The results showed before treatment, over 90% patients had moderate to severe malnutrition. After nutritional support, the liver function （ALT, T-bil） and nutritional status （TP, TC） in group A was improved significantly as compared with that in groups B and C （P〈0.05）. Compared with group D, the values of TP and Alb were increased significantly in group E （P〈0. 05）, but the levels of ALT, AST and T-bil had no obvious change. It was suggested that most patients with severe chronic hepatitis or posthepatitic cirrhosis had malnutrition to varying degrees. The nutritional support treatment could obviously improve the nutritional status of these patients, and was helpful to ameliorate the liver function of the patients with severe chronic hepatitis. Among the methods of nutritional support treatment, PN combined with EN had the best effectiveness.

Study on the Correlation of Plasma NO, ET-1 and ALT in the Patients with Chronic Hepatitis and Cirrhosis

The levels of plasma nitric oxide (NO), endothelin 1 (ET 1) and ALT in the patients with chronic hepatitis B and active cirrhosis and the correlation among them were observed and analyzed. NO 3 ˉ was restored by using cadmium column assay and NO 2 ˉ measured by heavy nitrogen assay. The primitive NO 3 ˉ and total restored NO 2 ˉ(NO 3 ˉ/ NO 2 ˉ) in plasma of the patients with chronic hepatitis and cirrhosis. Plasma ET 1 and ALT levels were determined by using radioimmunological assay and Lai's assay, respectively. Compared with normal control group, the plasma levels of NO 2 ˉ/NO 3 ˉ and ET 1 in the patients with chronic active hepatitis and active cirrhosis were significantly increased ( P <0.05-0.01). There was a positive correlation between NO and ALT, and ET 1 and ALT in the patients with chronic active hepatitis and active cirrhosis respectively. It was suggested that elevation of both NO and ET 1 levels were closely related with injury severity of liver function.

Tetrandrine Ameliorates Cirrhosis and Portal Hypertension by Inhibiting Nitric Oxide in Cirrhotic Rats

To examine the role and effect of nitric oxide synthase type Ⅱ(NOSⅡ) in cirrhotic rats, expression of NOSⅡ mRNA was detected by real time RT-PCR. The enzymatic activity of nitric oxide synthase and the circulating levels of NO, systemic and portal hemodynamics and quantification of cirrhosis were measured. Chinese traditional medicine was used to treat cirrhotic rats and the effect of NO was evaluated. Double-blind method was used in experiment. Our results showed the concentration of NO and the enzymatic activity of NOS increased markedly at all stages of cirrhosis and iNOSmRNA was strongly expressed. Meanwhile, the portal-venous-pressure (PVP) and portal-venous-flow (PVF) were significantly increased. NO, NOS and iNOSmRNA were positively correlated to the degree of hepatic fibrosis. Tetrandrine significantly inhibited NO production and the expression of iNOSmRNA. Our results suggested that increased hepatic expression of NOSⅡ is one of the important factors causing cirrhosis and portal hypertension. Tetrandrine can significantly ameliorate cirrhosis and portal hypertension.

Serum and ascites levels of macrophage migration inhibitory factor, TNF-α and IL-6 in patients with chronic virus hepatitis B and hepatitis cirrhosis

Objective: To study the potential role of macrophage migration inhibitory factor (MIF), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the development of chronic virus hepatitis B (CH) and hepatitis cirrhosis (HC). Methods: The serum concentrations of MIF, TNF-α and IL-6 in 18 patients with chronic virus hepatitis B and in 14 patients with hepatitis cirrhosis without as- citic fluid, and the serum and ascites cytokine con- centrations in 22 HC patients with ascitic fluid were detected by enzyme linked immunity sorbed assay. Results: The cytokine concentrations of the patients were significantly higher than those of the controls. The serum levels of MIF, TNF-α and IL-6 of the 22 patients with ascitic fluid were higer than those of 14 HC patients without ascites. In the 18 patients with CH, the serum cytokine concentrations were the low- est. The serum cytokine concentrations of the 22 HC patients with ascites were significantly higher than those of the 14 HC patients without ascites (P< 0. 01). Their serum cytokine concentrations were sig- nificantly higher than those in the 18 patients with CH (P<0. 01). The concentration of IL-6 in ascites was the highest among all the groups. The serum le- vels of MIF, TNF-α and IL-6 are correlated with al- anine aminotransferase (ALT) in the patients with CH, but not in those with HC with or without asci- tes. Conclusions: These results indicated that MIF, TNF- α and IL-6 may participate in the pathological process of CH and cirrhosis, that IL-6 seems to play an important role in ascites formation, and that se- rum levels of MIF, TNF-α and IL-6 appear to reflect the severity of tissue injury in HBV disease.

Impact of Fuzheng Huayu tablet on antiviral effect of entecavir in patients with hepatitis B cirrhosis

Background:Fuzheng Huayu tablet is a traditional Chinese medicine(TCM)used for the treatment of liver fibrosis and cirrhosis.However,whether the combination with Fuzheng Huayu tablet could affect the antiviral efflcacy of nucleos(t)ide remains a concern.The objective of this trial was to explore the impact of Fuzheng Huayu tablet on antiviral effect of entecavir in patients with hepatitis B cirrhosis.Methods:A prospective,randomized control trial was conducted.Patients with compensated hepatitis B cirrhosis were randomly divided into the treatment group(entecavir capsule plus Fuzheng Huayu tablet)and the control group(entecavir capsule plus simulant of Fuzheng Huayu),and followed up for 48 weeks.The dynamic changes of HBV DNA load,the rate of serological conversion of HBeAg,liver function,renal function and liver stiffness measurement(LSM)were monitored.The general clinical data and adverse events were also recorded.Results:There was no significant difference in the rate of virological response and cumulative virological response between the treatment group and the control group(P>0.05).After 48 weeks of treatment,the HBeAg seroconversion rate,biochemical response rate and LSM value were 21.05%and 4.76%(P=0.164),86.96%and 65.96%(P=0.017),9.5 kpa and 10.6 kpa(P=0.827)in the treatment group and the control group,respectively.No serious adverse events related to the study therapy occurred during the trial.Conclusions:The antiviral entecavir combined with Fuzheng Huayu tablet did not affect the antiviral efflcacy of entecavir,but could improve the rate of biochemical response,and had a tendency to improve the rate of serological conversion of HBeAg and liver fibrosis in patients with hepatitis B cirrhosis.Fuzheng Huayu tablet is clinically safe for patients with hepatitis B cirrhosis.

Alpha-fetoprotein screening in patients with hepatitis C-induced cirrhosis who achieved a sustained virologic response in the direct-acting antiviral agents era

To the Editor:Hepatocellular carcinoma (HCC) is the most common primary livertumorandthethirdcauseofcancer-relateddeathsworldwide. HCC is the consequence of malignant transformation of hepatocytes and mainly occurs in patients with cirrhosis. Hepatitis C virus (HCV) chronic infection is a leading cause of end-stage liver diseaseandHCCintheWesterncountries[1].Theapprovalof direct-acting antiviral agents (DAAs) for the treatment of HCV has revolutionized the management of the disease, as no absolute contraindication to treatment exists and sustained virological response

Hepatitis B cirrhosis combined with Budd-Chiari syndrome treated by liver transplantation:Case report and literature review

Objective:To summarize and analyze the clinical treatment experience of hepatitis B cirrhosis combined with Budd-Chiari syndrome.Methods:Data was obtained from a patient who were diagnosed with hepatitis B cirrhosis combined with Budd-Chiari syndrome.We retrospectively analyzed the clinical character of the patient.Results:The patient was diagnosed with Budd-Chiari syndrome incidentally during operation.so the patient underwent orthotopic liver transplanation,in which the liver and retrohepatic vena cava were resected,and recovered uneventfully.Conclusion:Orthotopic liver transplantation is not only an ideal treatment but also improves the prognosis of patients for hepatitis B cirrhosis combined with Budd-Chiari syndrome.