Short Term Efficacy of Entecavir in the Treatment of Decompensated Chronic Hepatitis B Cirrhosis

Objective:To explore the effect of entecavir on patients with decompensated chronic hepatitis B cirrhosis.Methods:From October 2007 to December 2019,100 patients with decompensated chronic hepatitis B cirrhosis who were treated in our hospital were selected to carry out this study.The clinical data of the patients were analyzed.According to whether entecavir treatment was carried out,100 patients were divided into two groups,50 cases in the control group and 50 cases in the observation group.The control group was treated with conventional drugs,and the observation group was treated with entecavir.Liver function indexes,liver fibrosis indexes,HBV-DNA negative conversion rate and incidence of adverse reactions were compared between the two groups.Results:Compared with the control group,the liver function indexes of the observation group were lower,P<0.05;Compared with the control group,the observation group was better,P<0.05;The negative rate of HBV-DNA in the observation group was lower than that in the control group(P<0.05);There was no difference in the incidence of adverse reactions between the two groups,P>0.05.Conclusion:Entecavir can not only improve the liver function,but also enhance the shortterm treatment effect,without increasing adverse reactions,and has high safety,which is worthy of recommendation.

De novo combination therapy with lamivudine and adefovir dipivoxil in chronic hepatitis B patients

AIM:To investigate the appropriate time for combination therapy in HBeAg positive chronic hepatitis B(CHB) patients with decompensated cirrhosis.METHODS:Thirty HBeAg positive CHB patients with decompensated cirrhosis were enrolled in the study.All of the patients were given 48 wk combination therapy with lamivudine(LAM) and adefovir dipivoxil(ADV) .Briefly,10 patients were given the de novo combination therapy with LAM and ADV,whereas the other 20 patients received ADV in addition to LAM after hepatitis B virus(HBV) genetic mutation.RESULTS:Serum alanine aminotransferase and total bilirubin were both improved in the two groups at 4,12,24 and 48 wk after treatment.Serum albumin was also improved at 24 and 48 wk after combination therapy in both groups.The serum HBV DNA level wasstill detectable in every patient in the two groups at 4 and 12 wk after combination treatment.However,in the de novo combination group,serum HBV DNA levels in 4(40%) and 9(90%) patients was decreased to below 1×10 3 copies/mL at 24 and 48 wk after the combination treatment,respectively.In parallel,serum HBV DNA levels in 2(20%) and 8(40%) patients in the add-on combination group became undetectable at 24 and 48 wk after combination treatment,respectively.Furthermore,6(60%) patients in the de novo combination group achieved HBeAg seroconversion after 48 wk treatment,whereas only 4(20%) patients in the add-on combination group achieved seroconversion.Child-Pugh score of patients in the de novo combination group was better than that of patients in the add-on combination group after 48 wk treatment.Moreover,patients in the de novo combination group had a significantly decreased serum creatinine level and elevated red blood cell counts.CONCLUSION:De novo combination therapy with LAM and ADV was better than add-on combination therapy in terms of Child-Pugh score,virus inhibition and renal function.

Acute-on-chronic liver failure：recent update

Acute on chronic liver failure（ACLF） was first described in 1995 as a clinical syndrome distinct to classic acute decompensation.Characterized by complications of decompensation,ACLF occurs on a background of chronic liver dysfunction and is associated with high rates of organ failure and significant short-term mortality estimated between45%and 90%.Despite the clinical relevance of the condition,it still remains largely undefined with continued disagreement regarding its precise etiological factors,clinical course,prognostic criteria and management pathways.It is concerning that,despite our relative lack of understanding of the condition,the burden of ACLF among cirrhotic patients remains significant with an estimated prevalence of 30.9%.This paper highlights our current understanding of ACLF,including its etiology,diagnostic and prognostic criteria and pathophysiology.It is evident that further refinement of the ACLF classification system is required in order to detect high-risk patients and improve short-term mortality rates.The field of metabolomics certainly warrants investigation to enhance diagnostic and prognostic parameters,while the use of granulocyte-colony stimulating factor is a promising future therapeutic intervention for patients with ACLF.

Is P2/MS score valuable for prediction in HBV-related variceal bleeding?

Objective:To determine the predictive value of P2/MS in patients with chronic HBV-related cirrhosis, and to predict high-risk esophageal varices, and obtain a cut-off value.Methods:A total of 412 patients with HBV-related cirrhosis who were admitted to our hospital between August 2014 and August 2017 were retrospectively evaluated. A diagnosis of cirrhosis was made with standard laboratory, radiological and physical examination findings. According to these evaluations, esophageal varices were classified as small, medium and large. For all obtained data, P2/MS was calculated. Two threshold values (P2/MS<11 and P2/MS>25) were considered in predicting the presence of high-risk EVs during recording. And the optimal cut-off value of the P2/MS index was determined for high-risk esophageal varices in patients with chronic viral hepatitis B.Results:A total of 375 patients who met the inclusion criteria were included in the study. When the P2/MS index was compared with other noninvasive tests, the mean and median P2/MS scores were respectively 54.17 and 33.25. The P2/MS value of the patients without esophageal varices was higher than that of the patients with esophageal varices. When these results were evaluated, the higher the score, the lower the risk of varices. We obtained a positive predictive value of 93.80% [95%CI(80.20-98.70)] when the cut-off value of P2/MS was taken as <11, and obtained a negative predictive value of 94.30% [95%CI(86.20-98.20%)] when the cut-off value of P2/MS was taken as >25.Conclusions:We could predict the patients with high-risk esophageal varices within this group at a extremely good rate. We also compared the results of this test with other non-invasive tests and achieved successful results. We have shown that P2/MS can be used in order to optimally select patients for endoscopic screening and prevent all of the expensive and unnecessary procedures safely.

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.