52例HBeAg阴性HBV相关性肝细胞癌患者的临床分析

目的通过对HBeAg阴性慢性乙型肝炎进展为肝癌（HCC）患者的临床资料进行回顾性分析,探讨该病的发生规律和临床特征。方法对本院收治的52例HBeAg阴性HCC患者的性别、年龄、生化学指标、HBV DNA载量、免疫学状态以及服药情况等进行综合分析并进行统计学处理。结果52例HBeAg阴性HCC患者的血清HBV DNA分布：＜103拷贝/ml者18例（34.63%）,103～105拷贝/ml者22例（42.30%）,＞105拷贝/ml者12例（23.07%）。血清HBV DNA载量愈高的患者肝损伤愈重。抗-HBe （-）/抗-HBe（＋）和抗-HBs（-）/抗-HBs（＋）不同血清HBV DNA的分布无相关性,HCC的发生与抗-HBe和抗-HBs是否出现无关。经抗病毒药物治疗的HCC发生例数显著低于未使用过药物者,提示抗病毒药物能降低或延缓HCC的发生。结论对于HBeAg阴性慢性乙型肝炎患者,尤其是有重症化和肝硬化病理基础、年龄偏大的患者,其HBeAg转阴可能是在药物作用下实现的自然血清学转换伴HBV DNA水平下降至正常,甚至有患者出现HBSAg阴转;也可能是病毒发生变异所致;此两类患者均应警惕HCC的发生。     

丙型肝炎病毒及其与肝细胞癌的关系

肝细胞癌（HCC）在世界范围内是一种常见肿瘤，各种研究显示HCC高发生率的主要原因是病毒性肝炎演变成肝硬变及HCC，乙型肝炎病毒（HBV）在HCC病因学中的重要作用已经肯定，而在西方国家仅25％－50％的HCC患者呈现HBSAg阳性。1989年Choo等[1]首先用分子克隆方法分离出了丙型肝炎病毒（HCV），随着血清检测HCV抗体、逆转录聚合酶链反应（RT－PCR）检测HCV基因方法在各实验室的逐渐开展，慢性HCV感染与各种慢性肝病，特别是与原发性HCC的关系日益引起人们关注。1丙型肝炎病毒HCV是一种含有类脂质、有包膜的单股正链RNA病…     

干扰素治疗慢性乙型肝炎伴发白癜风一例

干扰素具有抗病毒、抗肿瘤和免疫调节作用,是治疗病毒感染性疾病、恶性肿瘤的有效药物,为目前治疗慢性乙型病毒性肝炎的主要药物,但在重视其治疗作用的同时亦应注意干扰素可能引起的严重不良反应,现报告应用干扰素治疗慢性乙型肝炎伴发白癜风1例。     

伴随的慢性肝炎状态严重影响肝细胞癌肝切除后的复发率

肝细胞癌（HCC）切除后的复发与多中心癌灶的存在有关，其中伴随的慢性肝炎也是一重要因素。在1983～1994年期间日本Nara大学医院曾为140例HCC患者施行了肝切除术，除外非治愈性切除和术后门个）J内死于并发症的病例，仅对余下的110例进行分析，计男89例，女对倒，平均592岁（29～79岁），乙型肝炎表面抗原（HBS）阳性25％，丙型肝炎病毒阳性率69％。无癌肿部分的肝组织病理状态分为慢性迁延性肝炎（CPH）、慢性活动性肝炎（CAH）和肝硬化。在随访期间每3月测肝功能、甲胎蛋白和无线生素K蛋白质（PIVK－11），胸片、B超扫描、CT扫…     

乙型肝炎病毒A1762T/G1764A突变与原发性肝细胞癌的关系

目的：对原发性肝细胞癌（HCC）、慢性乙型病毒性肝炎（CHB）及肝硬化（LV）患者肝组织中乙型肝炎病毒（hepatitis B virus,HBV）X基因基本核心启动子区（BCP）常见变异位点A1762T/G1764A进行检测分析,以探讨HBVX基因A1762T/G1764A变异与HCC发生发展的关系。方法：采用聚合酶链反应（PCR）方法检测67例患者（包括37例HCC,35例非HCC患者）肝组织中HBV X基因,并对PCR产物进行基因测序分析。结果：HCC组患者A1762T/G1764A突变率为85.7%（30/35）,非HCC组患者（包括CHB及LV）A1762T/G1764A突变率为40.6%（13/32）,HCC组双突变率明显高于非HCC组（P〈0.001）。结论：HBVA1762T/G1764A突变在HCC发生发展中可能起重要作用。     

丙型病毒性肝炎供者器官在实体器官移植中的应用现状与展望

丙型病毒性肝炎供者器官作为一种边缘性器官已经被应用于实体器官移植中,在有效缓解器官短缺现况的同时,也面临着一些挑战,如丙型肝炎病毒（HCV）传播。但随着直接抗病毒药物的出现和应用,丙型病毒性肝炎的治愈逐渐成为现实,这也为丙型病毒性肝炎患者成为器官移植供者奠定了基础。目前,在抗病毒药物的辅助治疗下,丙型病毒性肝炎供者实体器官移植取得了一定的疗效。因此,本文总结丙型病毒性肝炎供者肾脏、心脏、肺脏及肝脏等移植的研究现状,就丙型病毒性肝炎供者在实体器官移植中的应用情况及抗病毒药物辅助治疗的安全有效性做一综述,探究丙型病毒性肝炎供者在实体器官移植中可行性,以期为扩大器官移植供体池提供参考,减少终末期疾病患者器官移植的等待时间。     

防治肝移植术后病毒性肝炎复发的现状与展望

<正>肝移植术后病毒性肝炎的复发可导致移植物失功,影响受者长期存活率[1]。因此,预防复发及复发后进行有效的抗病毒治疗至关重要。近年来乙型肝炎、丙型肝炎、戊型肝炎的治疗有了显著改善,现就肝移植术后抗病毒治疗进展及前景评述如下。1乙型病毒性肝炎乙型肝炎病毒(HBV)感染是一个全球性的公共健康问题,每年约78万人死于急性或慢性HBV感染。肝移植是治疗乙肝相关性终末期肝病唯一有     

慢性病毒性肝炎患者干扰素α治疗不良反应临床处理专家共识

干扰素α（IFN-α）广泛应用于慢性乙型肝炎（CHB）和慢性丙型肝炎（CHC）的抗病毒治疗,但存在较多不良反应,常见的不良反应有流感样症状、外周血细胞和血小板计数下降、内分泌和代谢性疾病、消化道症状和神经精神异常等[1-5],发生率见表1。少数患者可引起严重不良反应,如间质性肺炎、自身免疫性溶血或严重精神性疾病等。正确处理IFN-α治疗中的不良反应可提高患者依从性,从而有效提高IFN-α疗效。发生严重不良反应者常需停止治疗,以保证患者的安全。为进一步规范并优化慢性病毒性肝炎患者IFN-α不良反应的管理和治疗,《中华实验和临床感染病杂志（电子版）》、《中国肝脏病杂志（电子版）》及《Infection International （Electronic Edition）》编辑部组织国内部分专家对相关资料进行整理与分析,形成《慢性病毒性肝炎患者干扰素α治疗不良反应临床处理专家共识》（以下简称共识）。本《共识》是基于目前该领域的最新成果,遵照循证医学原则编写,可作为慢性病毒性肝炎患者干扰素α不良反应临床处理的指导。随着相关临床证据的不断积累,专家委员会将对《共识》内容进行持续更新。相应证据及推荐等级见表2。     

胆固醇代谢在肝细胞癌发生发展中的作用研究进展

肝细胞癌(HCC)是常见的恶性实体瘤,其发病率高,预后差。尽管病毒性肝炎仍是HCC的最主要病因,近年来随着生活水平的提高和膳食习惯的改变,非酒精性脂肪性肝病正成为HCC不可忽视的病因。新近研究表明,胆固醇代谢紊乱在HCC的发生、发展中扮演着重要的角色。采用各种方法干预胆固醇代谢紊乱,能够有效的预防和治疗HCC。本文通过...     

现代医学4P模式与替比夫定临床应用

随着现代医学不断进步，21世纪医学管理模式已经由预防、预测、个体化的“3P”（prevention，prediction，personalization）模式进入包括患者参与（participation）在内的“4P”模式，意味着现代医学已从技术至上走向人文关怀。这种现代医学模式的转变对于慢性疾病的防治具有更为重要的意义。慢性乙型肝炎在我国发病率高，预后不良，是危及健康的重要疾病。抗病毒治疗是预防、延缓和阻止慢性乙型肝炎进展的根本治疗方法，而且需要长期维持治疗。替比夫定是目前慢性乙型肝炎抗病毒治疗的主要药物之一，以下就现代医学的4P模式与替比夫定的临床应用谈谈粗浅的认识和看法。     

Treatment of hepatocellular carcinoma: with special emphasis on liver transplantation

A variety of therapeutic options have been developed over the past 25 years for the treatment of hepatocellular carcinoma. With advances in antiviral treatment for hepatitis viruses and improvements in surgical techniques, adult-to-adult living-donor liver transplantation has been increasingly carried out in Japan over the past 6 years. The Japanese national health insurance system began to cover adult-to-adult living-donor transplantation from January 2004, which is expected to increase the number of such surgeries. In this review, various therapeutic modalities for the treatment of hepatocellular carcinoma are discussed, with special emphasis on hepatic resection and liver transplantation.     

Need for hepatocellular carcinoma screening before renal transplantation in HBs +, HBe +, western African

We report a case of fulminant hepatocellular carcinoma discovered 50 days after renal transplantation. The recipient was a young Senegalese, hepatitis B virus chronic carrier. The pre-transplant check-up was normal, and the tumor was latent until its dramatic expression. Progression of hepatitis B liver disease occurs in immuno-suppressed renal transplant recipients, which often leads to chronic active hepatitis, cirrhosis and hepatocellular carcinoma, with a high risk of death due to liver disease. The early discovery of the tumor in this patient emphasizes the necessity for complete hepatic screening before transplantation in african, hepatitis B virus chronic carrier recipients. Moreover, the accumulation of risk factors for hepatocellular carcinoma: hepatitis B virus, food mycotoxins (aflatoxin), parasitic infestation and immunosuppression with transplantation is stressed.     

Primary hepatic lymphoma in hepatitis C: case report and review of the literature.

Primary B-cell lymphoma of the liver is an extremely rare tumor. The higher incidence of hepatocellular carcinoma in hepatitis C is well known, but the relationship with lymphoma is unclear. An increased incidence has been reported in patients with chronic hepatitis C. Hepatitis C virus is known to be a lymphotropic virus. Mixed cryoglobulinemia, which is a benign lymphoproliferative disorder, has a definite association with hepatitis C. It is postulated that the virus may also induce a malignant transformation. We describe an unusual presentation of a case of asymptomatic left hepatic mass in a patient with hepatitis C with a preoperative diagnosis of hepatocellular carcinoma. He underwent a left lateral segmentectomy, and the pathologic examination revealed non-Hodgkin's lymphoma. The clinical features, radiologic investigations, and pathologic findings are presented. A review of the literature discussing clinical features, postulated pathogenetic mechanisms, and management options is also presented.     

Treating hepatitis C infection in liver transplant recipients.

Chronic infection with hepatitis C virus (HCV) is a growing problem worldwide, with up to 300 million individuals infected, and those with chronic infection are at risk for cirrhosis and hepatocellular carcinoma. HCV infection is the most common indication for liver transplantation in the United States and Europe. Unfortunately, although transplantation is effective for treating decompensated cirrhosis and limited hepatocellular carcinoma associated with hepatitis C, HCV reinfection is virtually the rule among transplant recipients. Reinfection of the graft is associated with more rapidly progressive disease, with a median time to cirrhosis of 8 to 10 yr. Unfortunately, treatment of chronic HCV in liver transplant recipients is suboptimal. Combination therapy with interferon (pegylated and nonpegylated forms) plus ribavirin appears to provide maximum benefits. Drug therapy is usually administered for recurrent disease. No prophylactic therapy is available. Preemptive regimens offer no distinctive advantages over treatments begun for recurrent disease. Overall, treatment is poorly tolerated, with frequent need for dose reductions, especially from cytopenias, and drug discontinuations in up to 50% of patients. Optimizing drug doses is important in maximizing sustained virological response rates. Future therapies may include ribavirin alternatives with lower rates of anemia, alternative interferons with lower rates of cytopenias, and new antiviral drugs that can be used alone or in combination with either interferon or ribavirin to enhance sustained virological response rates and improve tolerability. Liver Transpl 12:1192-1204, 2006. (c) 2006 AASLD.     

De novo hepatocellular carcinoma in a liver allograft associated with recurrent hepatitis B

Recurrent hepatocellular carcinoma is well described following liver transplantation. However, de novo hepatocellular carcinoma in the allograft is rare. We describe the clinical and pathological features of a case of de novo hepatocellular carcinoma arising in a cirrhotic allograft 9 years following transplantation for chronic hepatitis B.     

The extrahepatic manifestations of hepatitis B virus

Hepatitis B Virus (HBV) leads to a number of hepatic complications, from acute to chronic hepatitis, cirrhosis and hepatocellular carcinoma, is a well-established fact. Upcoming clinical research, over the years, associates numerous extrahepatic manifestations during the acute and chronic episodes of hepatitis B with significant morbidity and mortality. A causal relationship between HBV and serious autoimmune disorders has also been observed among certain susceptible vaccine recipients in a defined temporal period following immunization. The cause of these extrahepatic manifestations is generally believed to be immune mediated. The most commonly described include skin rash, arthritis, arthralgia, glomerulonephritis, polyarteritis nodosa, and papular acrodermatitis etc. The serum-sickness like "arthritis-dermatitis" prodrome has also been observed in approximately one-third of patients acquiring HBV infections. Skin manifestations of HBV infection typically present as palpable purpura reported to be caused by chronic HBV, although this association remains controversial. To consider the relationship between HBV and other clinically significant disorders as well as serious autoimmune disorders among certain vaccine recipients is the topic of this review. Variable factors that influence extrahepatic manifestation are discussed, including possible synergy between hepatitis B virus and the immune system.     

Pathology of liver tumours

The liver is an important site for both primary and metastatic tumours. In non-cirrhotic patients, the commonest hepatic presentation of malignant disease is metastasis from other sites, most commonly colon, lung, stomach, pancreas and breast. In patients with cirrhosis, hepatocellular carcinoma is the most likely cause of hepatic malignancy, and is a major cause of cancer death worldwide. The malignant cells of hepatocellular carcinoma show differentiation resembling hepatocytes. There is a strong link with chronic viral hepatitis and cirrhosis of any cause, although an unusual slow growing variant of hepatocellular carcinoma called fibrolamellar carcinoma does not show these associations. Cholangiocarcinoma is adenocarcinoma arising in a bile duct, and is usually of unknown cause although some cases are linked with chronic biliary inflammation or infection. Intrahepatic cholangiocarcinoma is increasingly often diagnosed, although definitive diagnosis requires clinical exclusion of a metastasis from elsewhere. There is a variety of benign liver tumours, often manifesting incidentally during investigations. Some have a risk of malignant progression (dysplastic nodules in cirrhotic liver, some hepatocellular adenomas), while others are notable mainly for mimicking more serious disease than for great intrinsic significance.     

Hepatocellular carcinoma and cholangiocarcinoma--different prognosis, pathogenesis and therapy

Primary liver cancer is one of the most common cancer worldwide. Beside hepatocellular carcinoma (HCC), accounting for more than 80%, cholangiocarcinoma (CC) is the second most frequent primary malignant epithelial liver tumor. Combined hepatocellular-cholangiocarcinoma (HCC/CC) is a rare form of liver cancer with a frequency of 1%. Both, hepatocellular carcinoma and cholangiocarcinoma, show a wide geographical variation with low-incidence areas in North America and Europe and high incidence areas in Africa and Asia. Whereas hepatocellular carcinomas develop by malignant transformation of hepatocytes, cholangiocarcinomas arise from the small intrahepatic bile duct epithelium. The UICC-TNM classification of malignant liver tumors is applied for both tumor entities. 70-80% of hepatocellular carcinoma occur in cirrhotic liver. In high incidence areas, such as Asia and Africa, HCC is strongly associated with chronic viral hepatitis B and C and liver cirrhosis. Nutritional factors, toxins and metabolic diseases contribute also to hepatocarcinogenesis. The etiology of cholangiocarcinoma remains unclear, most occur in absence of known etiological factors. But several risk factors including hepatolithiasis, liver fluke infection, and anatomical abnormalities associated with inflammation of the biliary tract have been described.     

Pathology of liver tumours

The liver is an important site for both primary and metastatic tumours. Hepatocellular carcinoma is a major cause of cancer death worldwide, and in patients with cirrhosis is the most likely cause of hepatic malignancy. In non-cirrhotic patients, the commonest hepatic presentation of malignant disease is metastasis from other sites, most commonly colon, lung, stomach, pancreas and breast. In hepatocellular carcinoma, the malignant cells show differentiation resembling hepatocytes. There is a strong link with chronic viral hepatitis and cirrhosis of any cause, although an unusual slow-growing variant of hepatocellular carcinoma called fibrolamellar carcinoma does not show these associations. Cholangiocarcinoma is adenocarcinoma arising in a bile duct, and is usually of unknown cause although some cases are linked with chronic biliary inflammation or infection. Intrahepatic cholangiocarcinoma is increasingly often diagnosed, although definitive diagnosis requires clinical exclusion of a metastasis from elsewhere. There is a variety of benign liver tumours, often manifesting incidentally during investigations. Some have a risk of malignant progression (dysplastic nodules in cirrhotic liver, some hepatocellular adenomas), while others are notable mainly for mimicking more serious disease than for great intrinsic significance.     

A Comparative Study of Antiviral Therapy After Resection of Hepatocellular Carcinoma in the Immune-Active Phase of Hepatitis B Virus Infection

Background  

The role of antiviral therapy for patients in the immune-active phase of hepatitis B virus (HBV) infection who underwent partial hepatectomy for hepatocellular carcinoma (HCC) is unknown.