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.

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.

Clinical features of acute hepatitis E super-infections on chronic hepatitis B

AIM To examine the clinical features and risk factors for adverse outcomes in chronic hepatitis B(CHB) superimposed with hepatitis E virus(HEV).METHODS This retrospective cohort study included 228 patients with acute HEV infection(showing clinical acute hepatitis symptomology and positivity for anti-HEV immunoglobulin M) with underlying CHB(confirmed by positivity for hepatitis B surface antigen and/or hepatitis B virus(HBV) DNA over 6 mo) who had been admitted to the Shanghai Public Health Clinical Center, which represents the regional tertiary hospital for infectious diseases in Shanghai city, China. Data for adverse outcomes were collected, and included severe liver diseases(defined as liver failure and/or acute liver decompensation) and liver-related mortality. Logistic regression modeling was performed to determine the risk factors for adverse outcomes.RESULTS The symptoms caused by superimposed acute hepatitis E(AHE) were much more severe in cirrhotic patients(n = 94) than in non-cirrhotic patients(n = 134), as evidenced by significantly higher liver complications(77.7% vs 28.4%, P < 0.001) and mortality rate(21.3% vs 7.5%, P = 0.002). Most of the cirrhotic patients(n = 85, 90.4%) had no prior decompensation. Among the non-cirrhotic patients, superimposed AHE caused progressively more severe diseases that corresponded with the CHB disease stages, from immune tolerant to immune reactivation phases. Few risk factors were identified in the cirrhotic patients, but risk factors for non-cirrhotic patients were found to be intermediate HBV DNA levels(OR: 5.1, P = 0.012), alcohol consumption(OR: 6.4, P = 0.020), and underlying diabetes(OR: 7.5, P = 0.003) and kidney diseases(OR: 12.7, P = 0.005). Only 28.7% of the cirrhotic patients and 9.0% of the non-cirrhotic patients had received anti-HBV therapy previously and, in all cases, the efficacy had been suboptimal. CONCLUSION CHB-related cirrhosis and intermediate HBV DNA level were associated with severe disease in superinfected patients, and successful antiviral treatment might counter this outcome.

核苷(酸)类似物治疗代偿期乙型肝炎肝硬化患者血清HBV RNA水平变化及临床意义

目的探讨核苷(酸)类似物[nucleos(t)ide analogues,NAs]治疗代偿期乙型肝炎肝硬化患者过程中患者血清HBV RNA水平变化及临床意义。方法选择2012年7月至2014年6月首都医科大学附属北京地坛医院接受NAs治疗的51例代偿期乙型肝炎肝硬化的患者为研究对象,分别检测治疗前及治疗182周时丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、乙型肝炎病毒表面抗原(hepatitis B virus surface antigen,HBsAg)、乙型肝炎病毒e抗原(hepatitis B virus e antigen,HBeAg)、乙型肝炎病毒e抗体(hepatitis B virus e antibody,HBeAb)、HBVDNA及血清HBVRNA水平,采用Spearman相关分析血清HBV RNA水平与ALT、HBsAg、HBV DNA水平的相关性。结果(1)接受NAs治疗182周时,血清ALT(中位数:19.7 U/L vs 58.1 U/L)、AST(中位数:20.9 U/L vs 47.0 U/L)及HBs Ag(3.13±0.43 log10IU/ml vs 3.38±0.40 log10IU/ml)水平较基线显著降低,差异有统计学意义(P均<0.05),HBV DNA阴转率为93.62%(44/47)。(2)接受NAs治疗182周时血清HBV RNA水平与基线差异无统计学意义[(3.86±1.07)log10IU/ml vs(4.22±1.28)log10IU/ml;t=1.56,P=0.13]。(3)治疗182周时,HBe Ag未阴转组与阴转组(中位数:3.2 log10IU/ml vs 3.5 log10IU/ml)、HBe Ag未发生血清学转换组与发生转换组(中位数:3.2 log10IU/ml vs 3.5 log10IU/ml)间血清HBV RNA水平差异均无统计学意义(P均>0.05)。(4)患者基线血清HBV RNA与ALT、HBs Ag、HBV DNA水平均无相关性(r=0.14,P=0.36;r=0.05,P=0.75;r=0.05,P=0.77)。结论血清HBV RNA水平变化在代偿期乙型肝炎肝硬化患者NAs抗病毒治疗效果评估及预测方面无明显意义。

Hepatitis B and liver transplantation: Molecular and clinical features that influence recurrence and outcome

Hepatitis B virus(HBV) continues to be a major cause of morbidity and mortality worldwide. It is estimated that about 350 million people throughout the world are chronically infected with HBV. Some of these people will develop hepatic cirrhosis with decompensation and/or hepatocellular carcinoma. For such patients, liver transplantation may be the only hope for cure or real improvement in quality and quantity of life. Formerly, due to rapidity of recurrence of HBV infection after liver transplantation, usually rapidly progressive, liver transplantation was considered to be contraindicated. This changed dramatically following the demonstration that hepatitis B immune globulin(HBIG), could prevent recurrent HBV infection. HBIG has been the standard of care for the past two decades or so. Recently, with the advent of highly active inhibitors of the ribose nucleic acid polymerase of HBV(entecavir, tenofovir), there has been growing evidence that HBIG needs to be given for shorter lengths of time; indeed, it may no longer be necessary at all. In this review, we describe genetic variants of HBV and past, present, and future prophylaxis of HBV infection during and after liver transplantation. We have reviewed the extant medical literature on the subject of infection with the HBV, placing particular emphasis upon the prevention and treatment of recurrent HBV during and after liver transplantation. For the review, we searched PubMed for all papers on the subject of "hepatitis B virus AND liver transplantation". We describe some of the more clinically relevant and important genetic variations in the HBV. We also describe current practices at our medical centers, provide a summary and analysis of comparative costs for alternative strategies for prevention of recurrent HBV, and pose important still unanswered questions that are in need of answers during the next decade or two. We conclude that it is now rational and cost-effective to decrease and, perhaps, cease altogether, the routine use of HBIG during and following liver transplantation for HBV infection. Here we propose an individualized prophylaxis regimen, based on an integrated approach and risk-assessment.

Clinical factors associated with hepatitis B screening andvaccination in high-risk adults

BACKGROUND Hepatitis B virus is a viral infection that can lead to acute and/or chronic liver disease, and hepatocellular carcinoma(HCC). Hepatitis B vaccination is 95% effective in preventing infection and the development of chronic liver disease and HCC due to hepatitis B. In 2011, the Centers for Disease Control updated their guidelines recommending that adults at high-risk for hepatitis B infection be vaccinated against hepatitis B including those with diabetes mellitus(DM). We hypothesize that adults at high-risk for hepatitis B infection are not being adequately screened and/or vaccinated for hepatitis B in a large urban healthcare system.AIM To investigate clinical factors associated with Hepatitis B screening and vaccination in patients at high-risk for Hepatitis B infection.METHODS We conducted a retrospective review of 999 patients presenting at a large urban healthcare system from 2012-2017 at high-risk for hepatitis B infection. Patients were considered high-risk for hepatitis B infection based on hepatitis B practice recommendations from the Center for Disease Control. Medical history including hepatitis B serology, concomitant medical diagnoses, demographics, insurance status and social history were extracted from electronic health records.Multivariate logistic regression was used to identify clinical risk factors independently associated with hepatitis B screening and vaccination.RESULTS Among the 999 patients, 556(55.7%) patients were screened for hepatitis B. Of those who were screened, only 242(43.5%) patients were vaccinated against hepatitis B. Multivariate regression analysis revealed end-stage renal disease[odds ratio(OR): 5.122; 2.766-9.483], alcoholic hepatitis(OR: 3.064; 1.020-9.206),and cirrhosis or end-stage liver disease(OR: 1.909; 1.095-3.329); all P < 0.05 were associated with hepatitis B screening, while age(OR: 0.785; 0.680-0.906),insurance status(0.690; 0.558-0.854), history of DM(OR: 0.518; 0.364-0.737), and human immunodeficiency virus(OR: 0.443; 0.273-0.718); all P < 0.05 were instead not associated with hepatitis B screening. Of the adults vaccinated for hepatitis B,multivariate regression analysis revealed age(OR: 0.755; 0.650-0.878) and DM were not associated with hepatitis B vaccination(OR: 0.620; 0.409-0.941) both P <0.05.CONCLUSION Patients at high-risk for hepatitis B are not being adequately screened and/or vaccinated. Improvements in hepatitis B vaccination should be strongly encouraged by all healthcare systems.

国产恩替卡韦对HBeAg阳性代偿期乙肝肝硬化患者HBV复制的抑制效果、血清球蛋白及补体C3、C4的影响研究

目的:探讨国产恩替卡韦(ETV)对乙型肝炎E抗原(HBeAg)阳性代偿期乙肝肝硬化患者乙型肝炎病毒(HBV)复制的抑制效果、血清球蛋白和补体C3、C4的影响。方法:按数表法将80例血清HBeAg阳性代偿期乙肝肝硬化患者随机分为EVT组和阿德福韦酯(ADV)组,每组各40例。常规对症治疗基础上,EVT组给予恩替卡韦治疗,ADV组给予阿德福韦酯治疗,两组均持续治疗48周。观察两组患者治疗后外周血中乙肝病毒脱氧核糖核酸(HBV-DNA)载量、HBV-DNA转阴率、HBeAg转阴率情况,并检测血清免疫球蛋白IgG、IgA、IgM和补体C3、C4水平,记录两组药物副反应发生率。结果:治疗48周后,两组患者HBV-DNA载量均较治疗前显著下降(P<0.05),EVT组HBV-DNA载量(2.20±0.64)LgIU/mL低于ADV组的(2.92±0.86)LgIU/mL,EVT组HBV-DNA载量降低值(3.46±0.98)LgIU/mL高于ADV组的(2.95±1.01)LgIU/mL,差异有统计学意义(P<0.05),EVT组HBV-DNA转阴率95%、HBeAg转阴率67.5%均高于ADV组的77.5%、40%,差异有统计学意义(P<0.05)。治疗48周后,两组血清IgG、IgA、IgM水平均明显下降,补体C3、C4水平均明显升高,差异有统计学意义(P<0.05),EVT组血清IgG(13.22±2.91)g/L、IgA(3.39±1.01)g/L、IgM(1.56±0.28)g/L低于ADV组的(15.34±2.95)g/L、(4.00±1.07)g/L、(1.75±0.31)g/L,EVT组补体C3(1.19±0.33)mg/L、C4(0.28±0.08)mg/L高于ADV组的(0.95±0.18)mg/L、(0.24±0.07)mg/L,差异有统计学意义(均P<0.05)。两组药副反应主要包括胃肠道反应、疲乏、肝区不适、失眠和谷丙转氨酶(ALT)异常升高,组间比较差异无统计学意义(P>0.05)。结论:HBeAg阳性代偿期乙肝肝硬化患者给予EVT抗病毒治疗能显著抑制HBV复制,降低血清IgG、IgA、IgM和提高补体C3、C4水平,对促进体液免疫功能恢复和改善预后具有重要作用。

动态MELD评分有助于预测HBV相关慢加急性肝衰竭预后

目的探讨在判断HBV相关慢加急性肝衰竭(HBV-related acute-on-chronic liver failure,HBV-ACLF)患者预后方面,终末期肝病模型(model for end-stage liver disease,MELD)评分的动态变化是否优于基线MELD评分。方法前瞻性收集2009—2011年在我国4家医院住院治疗的HBV-ACLF患者的临床资料,包括临床表现、实验室检查及转归等,研究MELD评分动态变化与转归的关系。结果①纳入的82例90 d病死率为37.80%。死亡组患者基线MELD评分为(25.50±4.77)分,与存活组[(23.72±4.68)分]相比,差异无统计学意义(P=0.101)。但是从入组第7天开始,死亡组MELD评分逐渐升高,存活组MELD评分逐渐下降,此后各时间点2组MELD评分相比差异均有统计学意义。②低危组(基线MELD评分≤23分者)从第14天开始,存活患者MELD评分显著低于死亡患者[(16.04±4.00)分vs(29.39±12.30)分,P<0.05],高危组(基线MELD评分>23分者)从第7天开始,存活患者MELD评分显著低于死亡患者[(22.38±4.91)分vs(28.92±6.76)分,P=0.001],并且随着时间推移,差距逐渐增加。结论判断HBV-ACLF的预后应在基线MELD评分基础上,注意其动态变化,这将有助于提高预测的准确性。

中医药治疗乙型肝炎肝硬化失代偿期研究进展

乙型肝炎病毒感染是肝硬化发生的最主要原因,疾病发展至失代偿期时患者的生存率极低,是肝病患者死亡的主要原因之一。目前临床上单纯的西医治疗未能提高整体疗效,而中医药对乙型肝炎肝硬化失代偿期的防治逐渐展现出显著优势,其临床经验丰富,且不良反应少,有效改善患者的症状和提高生活质量。基于此,通过查阅国内外相关文献,结合古今学者对乙型肝炎肝硬化失代偿期的认识,归纳分析乙型肝炎肝硬化失代偿期的病理生理过程、病因病机、中医辨证论治及中医内治和外治的防治理念,为进一步推动乙型肝炎肝硬化失代偿期的中医药治疗提供参考及新思路。

柴胡疏肝散联合抗病毒药物治疗CBD相关性代偿期肝硬化的观察

目的:观察柴胡疏肝散加减联合阿德福韦酯、拉米夫定治疗乙型肝炎相关性代偿期肝硬化的临床疗效及用药安全性。方法:将本院2011年4月至2013年4月肝病科收治的60例乙型肝炎相关性代偿期肝硬化患者纳入研究,根据入院先后顺序将60例患者分为ADV+LAM组,以及中西结合组,每组各30例,其中DV+LAM组在使用拉米夫定联合阿德福韦,中西结合组在ADV+LAM组方案基础上加用柴胡疏肝散方,2组均接受为期48周的治疗。观察治疗48周患者的并发症及肝细胞癌的发生情况,同时记录HBV DNA浓度、肝功能指标变化情况及超声检查结果。结果:1)经过48周的治疗及随访,10例患者发生并发症或肝细胞癌,占16.67%。其中ADV+LAM组7例(腹水3例,肝细胞癌1例,食管静脉曲张2例,肝性脑病1例),中西结合组1例(食管静脉曲张1例)。2组发生并发症或肝细胞癌发生率比较P=0.02时我们利用Logistic回归分析后得出:年龄、性别不是肝硬化并发症或肝细胞癌独立危险因子(P均>0.05),而HBe Ag状况、HBVDNA载量均是肝硬化并发症或肝细胞癌独立危险因子(P均<0.05)。2)治疗12周、24周、36周、48周时ADV+LAM组HBV DNA转阴率分别为50.5%、57.3%、64.9%、87.6%,而中西医结合组HBV DNA转阴率分别为50.8%、59.7%、85.7%、96.4%,2组治疗第12周及24周时HBV DNA转阴率无统计学意义(P1=0.34,t1=4.24;P2=0.25,t2=4.92)。治疗第36周及48周2组HBV DNA转阴率比较有统计学意义(P3=0.03,t1=5.91;P4=0.02,t2=5.92)。3)治疗48周后,中西医结合组血清丙氨酸氨基转移酶(ALT)、天门冬氨酸转移酶(AST)、血尿素氮(BUN)、肌酐(Cr)、血清白蛋白(ALB)、总胆红素(TBIL)改善最为明显。2组不良反应发生率比较P=0.032,所有患者对症处理后症状消失,未出现肾功能不全患者。结论:柴胡疏肝散通过抑制HBV病毒复制,从而达到部分逆转肝硬化的发展,临床建议推广运用。

乙型肝炎后肝硬化失代偿期患者次均住院费用新灰色关联与结构变动分析

目的了解某院乙型肝炎后肝硬化失代偿期患者次均住院费用内部构成及变化,为降低患者医疗负担、优化住院费用结构及控制医药费用增长提供参考。方法选取广东省某三级甲等医院2018年1月至2023年8月期间7459例次乙型肝炎后肝硬化失代偿期患者的住院费用明细,运用新灰色关联与结构变动分析法对患者各细项费用的关联度、变动度及贡献率等指标进行统计分析。结果2018—2021年该院乙型肝炎后肝硬化失代偿期患者次均住院费用逐年增长,年均增长7.01%;2022年和2023年出现下降,较上年分别下降7.64%和8.04%。次均住院费用构成比前4位是药品费、诊断费、耗材费、治疗费。次均住院费用关联度最大的是药品费(0.915),其次是诊断费(0.909)和耗材费(0.770)。结构贡献率前3位是药品费(43.27%)、诊断费(19.12%)、耗材费(17.91%),3者累计结构变动贡献率超过80%。结论药品费、诊断费和耗材费是影响住院费用的主要因素,是降低患者住院费用的重点;需进一步调整优化住院费用结构,体现医务人员劳动技术价值,降低患者医疗费用负担。

乙型肝炎肝硬化患者肝性脑病形成诱因及不同分期血清甲状腺激素、S100B水平情况

目的探讨乙型病毒性肝炎(乙型肝炎)肝硬化患者肝性脑病(HE)形成诱因及不同临床分期血清甲状腺激素、S100B水平情况。方法选取2014年1月至2016年1月期间收治的乙型肝炎肝硬化患者186例,对其进行回顾性分析,根据诊断是否合并HE分为HE患者组(95例)和非HE患者组(91例)。比较2组血清甲状腺激素[血清总甲状腺素(T4)和总三碘甲状腺素(T3)]水平及血清S100B水平;对HE患者根据West-Haven分级标准进行临床分期,分析其诱因构成,并对不同临床分期时T3、T4及S100B水平进行比较。结果 HE患者组T3、T4水平明显低于非HE患者组,血清S100B水平明显高于非HE患者组(均P<0.000 1)。HE患者临床分期:Ⅰ期26例,Ⅱ期34例,Ⅲ期18例,Ⅳ期17例;HE形成诱因:乙型肝炎病毒感染37例(38.94%),乙型肝炎患者高蛋白摄入过量12例(12.63%),镇静药物使用4例(4.21%),其他因素(水电解质紊乱6例、饮酒3例、腹泻3例、不明原因3例)15例(15.78%),多种诱因合并(2个及以上因素)27例(28.42%);随着HE分期的上升,患者的T3、T4水平呈下降趋势,血清S100B水平呈上升趋势(均P<0.001)。结论随着肝硬化HE病变程度的进展,血清甲状腺激素水平和血清S100B的测定有助于评估乙型肝炎肝硬化HE的严重程度。

疏肝实脾丸联合恩替卡韦治疗乙肝肝硬化代偿期肝郁脾虚证的临床效果研究

目的 探究疏肝实脾丸联合恩替卡韦治疗乙型肝炎(乙肝)肝硬化代偿期肝郁脾虚证的临床治疗效果、不良反应发生情况及对患者肝功能指标的影响。方法 60例乙肝肝硬化代偿期肝郁脾虚证患者,随机分成对照组与研究组,每组30例。对照组单用恩替卡韦治疗,研究组接受疏肝实脾丸联合恩替卡韦治疗。比较两组治疗效果、肝功能指标[总胆红素(TBil)、天门冬氨酸氨基转移酶(AST)、白蛋白(ALB)]及不良反应发生情况。结果 研究组的临床治疗总有效率96.7%高于对照组的70.0%(P<0.05)。治疗后,研究组的TBil(18.0±3.5)μmol/L、AST(32.4±4.2)U/L均低于对照组的(21.9±4.2)μmol/L、(40.5±6.9)U/L,ALB(42.7±5.0)g/L高于对照组的(36.9±6.0)g/L(P<0.05)。研究组的不良反应发生率3.3%低于对照组的23.3%(P<0.05)。结论 在乙肝肝硬化代偿期肝郁脾虚证治疗过程中,疏肝实脾丸联合恩替卡韦治疗可以有效优化各项肝功能指标,降低不良反应的发生率,提高临床治疗安全性,效果显著。

通络化癥膏外敷辅治乙型肝炎肝硬化代偿期临床观察

目的:观察通络化癥膏外敷辅治乙型肝炎肝硬化代偿期的疗效。方法:66例随机分为两组各33例,两组均用替诺福韦、保肝降酶治疗,治疗组加用通络化癥膏外敷。结果:治疗6个月后观察组肝功能指标、肝纤维化指标均比对照组低而凝血功能指标比对照组短(P<0.05)。观察组HBeAg及HBV-DNA转阴率比对照组高(P<0.05)。观察组不良反应发生率与对照组比较差异无统计学意义(P>0.05)。结论:通络化癥膏外敷辅治乙型肝炎肝硬化代偿期可提高疗效。

肝爽颗粒、富马酸替诺福韦二吡呋酯联合方案在改善代偿期乙型肝炎肝硬化患者肝功能及减轻肝纤维化程度中的应用价值

目的:分析肝爽颗粒联合富马酸替诺福韦二吡呋酯治疗代偿期乙型肝炎肝硬化的效果及其对肝功能、肝纤维化程度的影响.方法:择取2020年10月至2022年10月期间就诊于我院的94例代偿期乙型肝炎肝硬化患者作为研究对象,随机分两组.基础组47例给予富马酸替诺福韦二吡呋酯治疗,实验组48例在此基础上增加肝爽颗粒.6 m后,对比两组患者临床疗效、肝功能、肝纤维化程度、不良反应.结果:实验组总有效率高于基础组(P<0.05);治疗后,实验组丙氨酸转移酶(Alanine transferase,ALT)、天门冬氨酸转移酶(Aspartate transferase,AST)、总胆红素(Total bilirubin,TBIL)水平均低于基础组(P<0.05);治疗后,实验组透明质酸(Hyaluronic acid,HA)、Ⅲ型前胶原(TypeⅢprocollagen,PcⅢ)、Ⅳ型胶原(TypeⅣprocollagen,Ⅳ-C)、层粘蛋白(laminin,LN)水平均低于基础组(P<0.05);两组不良反应发生率无显著差异.结论:肝爽颗粒联合富马酸替诺福韦二吡呋酯能够有效保护代偿期乙型肝炎肝硬化患者肝功能,改善肝纤维化程度,提高治疗效果,且安全性高.

多b值弥散加权成像对乙肝肝硬化分级的诊断价值探讨

目的探讨乙肝肝硬化患者不同肝叶磁共振弥散加权成像不同b值对肝硬化Child-Pugh分级的诊断价值。方法收集72例乙肝肝硬化患者和23例健康志愿者,其中肝硬化患者按Child-Pugh评分系统分为A、B、C三组分别为22例、26例和24例,均行肝脏MR-DWI扫描,设定不同的弥散敏感系数(b值)分别为0s/mm2、400s/mm2、600s/mm2、800s/mm2,测定每个受试者不同b值下肝脏各叶的ADC值。分别统计各b值肝左外叶、肝左内叶、肝右叶和肝尾状叶的ADC值,分析不同肝叶ADC值与Child-Pugh分级的相关性,使用ROC曲线评估肝叶ADC值对肝硬化分级的诊断效能。结果在不同b值下,肝硬化组肝脏ADC值均低于正常对照组,且各肝叶ADC值与肝硬化Child-Pugh分级均呈负相关(P<0.05)。结论 DWI可以对乙肝肝硬化进行定量检查,有助于临床早期无创伤性评估肝硬化分级。

RPR、ALBI和APRI对HBV相关肝硬化的诊断价值

目的探讨天门冬氨酸氨基转移酶与血小板计数比值(APRI)、清蛋白与总胆红素比值(ALBI)、红细胞分布宽度与血小板计数比值(RPR)对HBV相关肝硬化不同分期的诊断价值。方法收集2016年9月至2019年9月于湖北省鄂州市中心医院就诊的64例HBV相关肝硬化患者(LC组),30例慢性乙型肝炎患者(CHB组)和50例体检健康者(对照组)的临床及实验室检查资料,并将肝硬化患者64例分为代偿期(CC组)27例和失代偿期(DC组)37例。比较不同组RPR、ALBI和APRI,并绘制受试者工作特征曲线(ROC曲线)比较各指标对肝硬化不同分期的诊断效能。结果RPR、ALBI和APRI与肝硬化进展均呈正相关(均P<0.05),其预测肝硬化的ROC曲线下面积分别为0.932(95%CI 0.878~0.967)、0.853(95%CI 0.784~0.906)和0.782(95%CI 0.705~0.846)。RPR预测肝硬化的曲线下面积均高于APRI(均P<0.05)。亚组分析显示,RPR对CC组肝硬化的诊断效能明显优于ALBI和APRI。结论RPR是预测CHB患者早期肝硬化的可靠指标,且优于ALBI和APRI。

恩替卡韦对乙肝肝硬化代偿期患者HBV-DNA水平及肝功能的影响分析

目的探究恩替卡韦对乙肝肝硬化代偿期患者乙型肝炎病毒DNA(HBV-DNA)水平及肝功能的改善作用效果,为恩替卡韦的合理应用提供指导建议。方法随机选取本院2016年11月至2018年9月收治的乙肝肝硬化代偿期患者100例为研究对象,根据治疗方法的不同将其分为A组、B组,各50例。A组患者采取阿德福韦酯片治疗,B组患者采取恩替卡韦治疗,比较两组治疗效果。结果治疗后,B组患者总有效率(96.00%)高于A组(80.00%),对比差异具有统计学意义(P<0.05);B组患者HBV-DNA水平低于A组,对比差异具有统计学意义(P<0.05);B组患者肝功能各项指标水平改善程度高于A组,对比差异具有统计学意义(P<0.05)。结论对乙肝肝硬化代偿期患者予以恩替卡韦治疗,疗效确切,利于降低患者HBV-DNA水平及促进患者肝功能的恢复,值得优选。

RDW、MELD及ALBI对乙肝肝硬化失代偿期并肝功能衰竭患者短期预后的预测

目的探讨红细胞分布宽度(red cell distribution width,RDW)、终末期肝病模型(model for end-stage liver disease,MELD)、白蛋白-胆红素指数(albumin-bilirubin index,ALBI)对乙肝肝硬化失代偿期并肝功能衰竭患者短期预后的预测价值。方法回顾性分析2019年1月至2020年12月徐州医科大学附属医院住院治疗的282例乙肝肝硬化失代偿期并肝功能衰竭患者的临床资料及实验室检查。依据患者出院后随访90 d内生存情况分为生存组(170例)和死亡组(112例),计算两组MELD及ALBI,并比较MELD、ALBI、RDW等水平,绘制ROC曲线评价各指标对于患者短期预后的评估价值,计算出最佳截断值。采用Logistic回归分析随访期间出现死亡的独立危险因素。结果生存组胆碱酯酶(cholinesterase,CHE)、血清白蛋白(albumin,ALB)水平均高于死亡组(P<0.05)。死亡组谷丙转氨酶(alanine aminotransferase,ALT)、总胆红素(total bilirubin,TBIL)、凝血酶原时间(prothrombin time,PT)、国际标准化比值(international normalized ratio,INR)、RDW、MELD及ABLI水平均高于生存组患者(P<0.05)。死亡组并发症发生率明显高于生存组患者(P<0.05)。ROC曲线显示,RDW、MELD、ALBI对于评估预后对应的曲线下面积分别为0.82、0.88、0.92(P<0.05)。多因素Logistics回归结果显示,RDW、MELD及ALBI是乙肝肝硬化失代偿期并肝功能衰竭患者死亡的独立危险因素。结论乙肝肝硬化失代偿期并肝功能衰竭患者的病死率高,并发症发生率高,RDW、MELD及ALBI对其短期预后的评估存在一定的价值,且是患者死亡的独立危险因素。

FibroScan对预测乙肝肝硬化预后的价值临床研究

目的评价FibroScan对预测乙肝肝硬化预后的临床价值研究。方法选择2018年1月—2019年6月我院收治的80例无肝硬化患者(A组)及80例肝硬化患者(B组),采用FibroScan、肝组织学、肝功能、血常规检测和肝脏B超、电子胃镜检查,观察对比两组患者的肝功能、血常规主要指标及FS值,比较不同肝纤维化分期和食管胃静脉曲张程度患者的FS值,分析影响肝硬化患者FS值的因素,分析FS值、血小板计数、凝血酶原时间和门静脉宽度预测发生食管胃静脉曲张程度的诊断效能。结果A组的AST、ALT、WBC、HGB、PLT均高于B组(P<0.05),PT、FS值和门静脉宽度低于B组(P<0.05);A组肝纤维化Ⅰ、Ⅱ级患者的FS值均与0级患者相比有差异(P<0.05),Ⅱ级患者的FS值较Ⅰ级患者存在差异(P<0.05);B组食管胃静脉曲张中、重度患者的FS值均较轻度患者存在差异(P<0.05),重度患者的FS值较中度患者存在差异(P<0.05);PT与FS值呈正相关(P<0.05);PLT、PT+门静脉宽度+FS值对肝硬化发生食管胃静脉曲张程度的诊断效能最高。结论乙肝肝硬化患者的FS值与乙肝非肝硬化患者比较具有明显区别,PLT、PT+门静脉宽度+FS值三者联合检测对预测食管胃静脉曲张程度具有较好的诊断价值,故FibroScan应成为预测乙肝肝硬化预后的新指标。