Effects of alcohol consumption on viral hepatitis B and C

The liver is the main target organ for hepatitis viruses and the vital organ for alcohol metabolism. These two factors of viral hepatitis and alcohol abuse in combination can exert dual harmful actions, leading to enhanced damage to the liver. Epidemiological studies have revealed a higher prevalence of hepatitis C virus (HCV) infection among alcoholics than the general population. The interaction of alcohol with viral hepatitis [e.g., hepatitis B virus (HBV), HCV] and the underlying mechanisms are not fully understood. The effects of alcohol on viral hepatitis include promoted viral replication, weakened immune response, and increased oxidative stress. Clinically, alcohol abuse is correlated with an increased risk of developing end-stage liver cirrhosis and hepatocellular carcinoma in patients with chronic hepatitis B and C, suggesting that the combination of alcohol and HBV/HCV lead to more severe liver damage. The influence of mild to moderate alcohol drinking on the HBV-induced liver fibrosis, cirrhosis, and hepatocellular carcinoma among patients infected with HBV remains unclear. Unlike HBV infected patients, no safe level of alcohol intake has been established for patients with HCV. Even light to moderate alcohol use can exert a synergistic effect with viral hepatitis, leading to the rapid progression of liver disease. Furthermore, interferon-based therapy is less effective in alcohol drinkers than in control patients, even after abstinence from alcohol for a period of time. Therefore, abstaining from alcohol is highly recommended to protect the liver, especially in individuals with HBV/HCV infection, to improve the clinical efficacy of antiviral treatment and prevent the rapid progression of chronic viral hepatitis.     

慢性乙型肝炎和乙肝性肝硬化病人生命质量的研究

目的　研究慢性乙型肝炎和乙肝性肝硬化对病人生命质量影响。方法　应用生命质量普适性量表SF 3 6,对慢性乙型肝炎及乙肝性肝硬化病人和健康对照进行测试比较。结果　与健康对照比较 ,轻度慢性乙肝在SF 3 6的 4个领域分数显著降低 ;中度慢性乙肝和ChildA级乙肝性肝硬化 7个领域分数显著降低。与轻度慢性乙肝比较 ,中度慢性乙肝在 6个领域分数显著降低 ;ChildA级乙肝性肝硬化在 5个领域分数显著降低。ChildB级乙肝性肝硬化与其它组比较 ,所有领域分数均显著降低 (P <0 .0 5 )。结论　慢性乙型肝炎和乙肝性肝硬化病人生命质量在精神和躯体健康方面都有显著降低。SF 3 6能较好地评价慢性乙型肝炎和乙肝性肝硬化病人生命质量     

Preventive strategies in chronic liver disease: part I. Alcohol, vaccines, toxic medications and supplements, diet and exercise.

Chronic liver disease is the 10th leading cause of death in the United States. Hepatitis C virus infection is the most frequent cause of chronic liver disease and the most common indication for liver transplantation. Preventive care can significantly reduce the progression of liver disease. Alcohol and hepatitis C virus are synergistic in hastening the development of cirrhosis; therefore, patients with hepatitis C infection should abstain from alcohol use. Because superinfection with hepatitis A or B virus can lead to liver failure, vaccination is recommended. Potentially hepatotoxic medications should be used with caution in patients with chronic liver disease. In general, nonsteroidal anti-inflammatory drugs should be avoided; acetaminophen in a dosage below 2 g per day is the safest choice. Many herbal remedies are potentially hepatotoxic, and only milk thistle can be used safely in patients who have chronic liver disease. Weight reduction and exercise can improve liver function in patients with fatty liver.     

酒精性肝病患者健康相关生存质量研究

目的研究酒精性肝病患者健康相关生存质量及其与疾病严重程度的关系以及对比酒精性肝病与慢性乙型肝炎患者健康相关生存质量的差别。方法 2010年12月至2011年10月收治的70例男性酒精性肝病患者(非肝硬化组45例,肝硬化组25例),56例男性慢性乙型肝炎患者(非肝硬化组24例,肝硬化组32例)以及42例男性健康对照组受试者参与试验。所有受试者回答SF-36V2(中文版)量表,通过SF-36V2软件计算出:生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、精神健康共8个维度,以及躯体健康总评和精神健康总评。使用协方差分析对比健康对照组,酒精性肝病非肝硬化组,以及酒精性肝病肝硬化组健康相关生存质量;对比酒精性肝病与慢性乙型肝炎患者健康相关生存质量。结果和健康对照组相比,酒精性肝病患者随着疾病的加重,SF-36V2各维度评分明显降低(P<0.05)。酒精性肝病非肝硬化组患者较慢性乙型肝炎非肝硬化组患者仅生理功能、生理职能、活力、躯体健康总评四项评分轻度受损(P<0.05)。酒精性肝病肝硬化组与慢性乙型肝炎肝硬化组患者SF-36V2各维度评分相似(P>0.05)。结论酒精性肝病患者健康相关生存质量降低,且病情越重,健康相关生存质量越差。酒精性肝病患者健康相关生存质量与慢性乙型肝炎患者相似。     

血浆内毒素在肝炎患者中的表现

目的　探讨血浆内毒素在急、慢性肝炎和肝硬化患者的表现。方法　对慢性乙型肝炎患者 3 71例 ,急性甲型或戊型肝炎患者 79例和正常健康人 5 0例 ,用偶氮显色法检测血浆内毒素水平。绘制ROC曲线对肝炎患者数据的三分位进行分析 ,观察在急性肝炎、不同慢性肝炎和肝硬化患者间血浆内毒素水平的差异。结果　急性甲型或戊型肝炎、慢性乙型肝炎中度、重度及其肝硬化患者血浆内毒素水平较正常对照组、慢性乙型肝炎轻度水平显著增高 ,随病情发展 ,明显上升。相互间可以寻找判断限 ,予以区分。而且 ,所有肝炎患者内毒素结果以百分位数排列 ,用三分位观察时 ,有较好的差别。结论　对肝炎患者进行血浆内毒素测定 ,可以为临床提供有价值的信息     

拉米夫定治疗活动性乙型、丁型重叠感染肝炎肝硬化失代偿期临床观察

【目的】研究核苷类药物治疗失代偿期乙型、丁型重叠感染肝炎肝硬化48周的临床疗效。【方法】24例失代偿期乙型、丁型重叠感染肝炎肝硬化患者在内科综合治疗基础上口服拉米夫定100mg每日1次。疗程中监测患者生化学指标（ALT、AST、TBil、ALB）、凝血功能（凝血酶原时间PT）、HBsAg定量、child—push评分,B超门静脉宽度、门静脉峰值流速均有不同程度的改善。并观察有无不良反应的发生。【结果】24例患者各项指标得到明显改善,疗程中无明显不良反应发生。【结论】拉米夫定治疗失代偿期乙型、丁型重叠感染肝炎肝硬化患者有较好生化学指标改善、HBsAg下降及抗HBV病毒学应答,部分患者抗HDV病毒学应答。     

乙型肝炎肝硬化患者幽门螺杆菌感染与血氨水平的关系

目的:探讨乙型肝炎肝硬化患者幽门螺杆菌(Helicobacterpylori,Hp)感染与血氨的关系,为临床防治肝性脑病是否需要常规根除Hp提供理论依据。方法:收集86例乙肝肝硬化住院患者,分Hp(+)组和Hp(-)组,并选取同期住院的Hp阳性的胃溃疡或胃炎患者60例作为对照组。Hp(+)组以埃索美拉唑、克拉霉素及阿莫西林行Hp根治性治疗,分别检测各组的空腹血氨及Hp(+)组治疗前后血氨浓度变化。根据肝功能Child分级及食管静脉曲张程度进行分组,比较各组血氨水平。结果:Hp(+)组血氨浓度明显高于Hp(-)组,差异有显著性(P<0.01);Hp(+)组根除Hp后血氨浓度较治疗前明显下降,差异有显著性(P<0.005)。Hp(+)组中Child-PughB、C级血氨浓度明显高于A级,差异有显著性(P<0.01),Ⅰ°、Ⅱ°食管静脉曲张血氨水平Hp(+)组明显高于Hp(-)组,差异有显著性(P<0.05)。结论:Hp感染可使乙肝肝硬化患者血氨水平升高,根除Hp有助于预防和治疗乙肝肝硬化高氨血症。     

恩替卡韦治疗乙型肝炎肝硬化病毒耐药的临床观察

目的观察恩替卡韦治疗乙型肝炎肝硬化48周后的疗效及病毒耐药位点变异情况。方法收集近2年门诊或住院患者,其中恩替卡韦治疗乙型肝炎肝硬化患者19例,采用恩替卡韦0.5 mg/d治疗,同时阿德福韦治疗组(10mg/d)23例、替比夫定治疗组(600 mg/d)15例、拉米夫定治疗组(100 mg/d)14例,于治疗48周后观测其肝功能、Child-Pugh分级以及血清HBV DNA自基线下降的水平。结果治疗48周后各治疗组患者肝功能、Child-Pugh分级以及血清HBV DNA自基线下降的水平与治疗前比较均有显著性差异,而且恩替卡韦未出现耐药方面的相关表现。结论恩替卡韦能改善活动性乙型肝炎肝硬化肝功能,疗效与其他核苷类似物比较无显著性差异,但耐药方面表现较其他药物为优。     

肝癌及其他肝病患者血清脂蛋白（a）水平分析

目的检测肝病患者血清脂蛋白（a）[Lp（a）]的水平,分析在不同程度肝细胞损伤情况下的Lp（a）表达规律。方法采用透射比浊法测定36例肝癌患者、28例中度肝硬化患者、68例慢性肝炎患者及60名健康对照者的Lp（a）水平,并对不同程度肝炎患者进行分组分析。结果各组肝病患者的Lp（a）水平均低于健康对照组（P〈0．05）,而各肝病组间比较差异无统计学意义（P〉0．05）;慢性肝炎组轻、中、重度间比较,轻度和重度Lp（a）水平差异具有统计学意义（P〈0．05）。Lp（a）水平与年龄无明显相关性（r：0．055,P=0．439）,Lp（a）水平在不同性别人群中的表达无统计学意义（P〉0．05）。结论Lp（a）是肝脏损伤的间接指标,评价血清Lp（a）水平有助于评估肝脏疾病的肝功能,同时血清Lp（a）可作为临床判断肝细胞损害程度的指标之一。     

Chronic liver disease. The scope of causes and treatments.

Evaluation of chronic liver disease begins with a carefully taken history, thorough physical examination, and standard laboratory tests. Often, however, other studies are required, such as a viral hepatitis panel, serologic tests for autoimmune markers, tests for antimitochondrial antibodies, measurement of serum iron and ceruloplasmin levels, liver biopsy, and imaging studies of the extra-hepatic bile ducts. Medical treatment of chronic active hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis remains unsatisfactory. Early treatment of hemochromatosis and Wilson's disease can prevent cirrhosis and liver failure. Liver transplantation is now a viable procedure for patients with end-stage chronic liver disease.     

Peginterferon alpha/ribavirin combination therapy for the treatment of hepatitis C infection.

Chronic infection with the hepatitis C virus is widespread in the United States. This disease is associated with a progression of fibrosis of the liver leading to liver cirrhosis in as many as 20% of cases. The current standard of care for the treatment of chronic hepatitis C infection is combination therapy with pegylated interferon alpha plus ribavirin. In more than 50% of patients, this regimen has been shown to induce a sustained viral response, defined as undetectable hepatitis C viral ribonucleic acid (RNA) for 6 months after the end of treatment. Typically, patients are treated for 24 or 48 weeks. A number of possible adverse events are associated with combination therapy, and patient empowerment through supportive nursing care is critical to facilitating patient adherence to treatment. This article provides an update on information concerning the diagnosis and treatment of chronic hepatitis C infection. This information can be tailored to provide patient-focused assessment, education, and treatment.     

Importance of hepatitis vaccination in patients with chronic liver disease

Acute hepatitis A or B infection can be lethal in patients with chronic liver disease. Safe and effective vaccines are currently available to prevent hepatitis A and B. Despite wide availability of vaccines, most patients with chronic liver disease are not immunized, in part due to nonuniform and inconsistent current recommendations for this population. A better understanding of the importance of preventing acute hepatitis A and B in patients with chronic liver disease and a proactive approach to vaccination by primary care physicians can positively influence the outcome of patients with chronic liver disease.     

肝硬化病原学分析和乙肝肝硬化中HBeAg阳性与阴性患者的临床特点比较

目的 通过大样本横断面回顾性调查，了解临床肝硬化患者病原组成及临床所见HBeAg(－)和HBeAg(＋)两类肝硬化患者临床相关因素的异同。 方法 对599例肝硬化患者的住院病历进行回顾性调查，分析肝硬化患者病因构成及占主要病因的乙肝肝硬化中的HBeAg(－)和HBeAg(＋)肝硬化组年龄、ALT、HBV DNA定量、CTP评分、PLT等指标的组内和组间差异。 结果 在肝硬化病因中以病毒性肝炎后肝硬化常见，有557例，占93.0％，其中又以乙肝肝硬化居多。在乙肝肝硬化中HBeAg (－)乙肝肝硬化306例，占62.3％；HBeAg(＋)肝硬化185例，占37.7％。HBeAg(＋)组ALT、HBV DNA总体上均高于HBeAg(－)组。HBeAg(－)组患者年龄明显高于HBeAg(＋)组。两组之间Child-Pugh，（CTP）积分无明显差异。 结论 目前我国临床所见肝硬化病例以病毒性肝炎感染后所致占绝大多数，乙肝肝硬化中又以HBeAg(－)者占多数。HBeAg(－) 与HBeAg(＋)肝硬化患者在病情轻重方面无明显差异，无论HBeAg是否阳性，病毒载量高时，抗病毒治疗及控制肝脏炎症能减轻病情恶化。     

强化干预对乙型肝炎肝硬化抗病毒治疗依从性的影响研究

目的探讨强化干预对乙型肝炎（乙肝）肝硬化抗病毒治疗依从性的影响。方法将2007年1月-2009年1月100例行抗病毒治疗的乙肝肝硬化患者随机分为干预组和对照组,每组各50例。对照组给予常规护理,干预组在常规护理的基础上,加强病情宣教、用药指导,并于出院后每周电话随访。在患者出院后的第6、12、18、24、30、36个月采用自行设计的乙肝肝硬化患者抗病毒治疗遵医行为调查问卷表进行随访,比较两组患者完全遵医、不完全遵医、完全不遵医的发生比例并分析其中的原因。结果出院后的18个月内两组依从性差异无统计学意义（P〉0．05）,而在第24、30、36个月时,两组依从性差异均有统计学意义（P〈0．05）。不遵医的原因主要为费用高和疗效不理想,在对照组患者用药依从性差的原因还有缺乏肝硬化疾病知识以及缺乏用药指导和监督。结论在抗病毒治疗过程中通过强化护理干预,患者的治疗依从性明显提高。     

Comparative characteristics of adenosine triphosphatase activity in the erythrocytes of patients with acute and chronic liver diseases, chronic cholecystitis and in HBs antigen carriers

A decrease in sodium, potassium and anion (HCO3)-activated erythrocyte ATPases is noted in patients with acute viral hepatitides A and B, chronic persisting hepatitis, liver cirrhosis, chronic cholecystitis and in HBs-antigen carriers, the reduction of HCO8-ATPase being more noticeable. A degree of expression of the above changes depends on the severity of a pathological process in the liver. The most serious changes are noted in liver cirrhosis. In this disease calcium ATPase activity is also on a decrease. Erythrocyte ATPase activity is lowered in chronic cholecystitis to a lesser degree. In patients with chronic persisting hepatitis and liver cirrhosis erythrocyte ATPase activity slightly increases, however it remains significantly lowered as compared to the control level. The determination of erythrocyte ATPase activity can be used for assessment of the status of patients with acute and chronic liver diseases.     

乙型肝炎病毒X抗原、X抗体检测的临床意义

目的了解乙型肝炎病毒X抗原(HBxAg)、X抗体(HBxAb)在乙型肝炎、肝硬化、肝癌患者血清中的表达情况,探讨HBxAg和HBxAb与上述疾病的相关性和临床意义。方法应用大肠埃希菌合成重组HBxAg,用该抗原免疫动物获得的HBxAb分别包被反应板以酶联免疫吸附试验(ELISA)检测患者(171例乙型肝炎、70例肝硬化和38例肝癌)血清中HBxAg和HBxAb。结果在乙型肝炎、肝硬化、肝癌患者血清中HBxAg和HBxAb阳性率分别为8.8%、18.6%、7.9%和10.5%、47.1%、34.2%,HBxAg在肝硬化患者中检出率较高(P<0.025);与乙型肝炎组比较,HBxAb阳性率在肝硬化和肝癌患者均有显著增高(P<0.005)。结论HBxAg在肝硬化患者检出率较高,而HBxAb则在乙型肝炎后的肝硬化和肝癌患者检出率较高,提示HBxAg和HBxAb可能参与肝组织的免疫病理性损伤过程。     

Optimal duration of therapy in HBV-related cirrhosis

It is estimated that one-third of the world's population has been exposed to hepatitis B virus and that 300-400 million people have chronic hepatitis B. In areas of the world where hepatitis B infection is endemic, this chronic viral infection is a major cause of premature morbidity and mortality related to hepatocellular carcinoma (HCC) and complications of end-stage liver disease. Recent data from population-based studies suggest that the level of viral replication in chronic hepatitis B is an independent predictor of the future complications of the disease; patients with hepatitis B viral DNA titres >10(4) copies/mL (especially those with titres >10(5) copies) have a significantly greater risk of developing HCC and cirrhosis. There is also recent evidence that treatment with antiviral therapy in patients with chronic hepatitis B who have advanced hepatic fibrosis is associated with a reduction in the risk of decompensation of liver disease and HCC. Several new antiviral medications have been recently approved for the treatment of chronic hepatitis B. Several recent position statements and practice guidelines have recommended treatment of patients with chronic hepatitis B with oral antiviral medications. However, there remains some disagreement as to the threshold of viral load before treatment should be initiated and the optimal duration of therapy in patients with cirrhosis due to hepatitis B. This article describes the current recommendations regarding therapy in this group of patients and suggests some criteria for treatment of patients with chronic hepatitis B-related cirrhosis or advanced hepatic fibrosis.     

Serum hyaluronate and type III procollagen aminoterminal propeptide concentration in chronic liver disease. Relationship to cirrhosis and disease activity

To analyse the relationship between the presence of liver cirrhosis and hepatic inflammation and the serum concentrations of the aminoterminal propeptide of procollagen type III (P-III-NP) and of hyaluronic acid (HA) in chronic liver disease, we measured P-III-NP and HA concentrations in paired serum samples from 133 patients with various chronic liver diseases, from 22 patients with acute hepatitis and from 50 healthy age-matched controls. In 24 (of the 133) patients with autoimmune chronic liver disease, follow-up determination was performed during therapeutic treatment with immunosuppressive drugs. Compared with controls P-III-NP concentrations (medians) were significantly elevated in 65% of patients with chronic active hepatitis (P = 0.00097) and in 79% of patients with active liver cirrhosis (P = 0.0126) but not in patients with chronic persistent hepatitis (P = 0.06). Serum concentrations (medians) of HA were increased (P = 0.0058) in 32% of patients with chronic active hepatitis and in 91% of patients with active cirrhosis (P less than 6 x 10(-7)). The difference of HA serum concentrations but not that of P-III-NP serum concentrations in patients with chronic active hepatitis and in patients with active cirrhosis was statistically significant. HA and P-III-NP serum concentrations were significantly elevated in 22 patients with acute hepatitis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Interferon alfa-2a treatment for chronic hepatitis C without cirrhosis and its effects on the incidence of hepatocellular carcinoma

The aim of interferon treatment for chronic hepatitis C is eradication of the hepatitis C virus during the early stages of the disease to prevent progression to liver cirrhosis or hepatocellular carcinoma. However, the effects of interferon on preventing the development of hepatocellular carcinoma for chronic hepatitis C without cirrhosis remain obscure. We wished to study these effects. In this retrospective study, we followed up 66 patients with chronic hepatitis C who were treated with interferon alfa-2a (total dose 324 to 792 MIU) for an average period of 3 years after treatment. Of these 66 patients, 3 patients developed hepatocellular carcinoma during the follow-up period (range, 0.3 to 2.8 years; yearly incidence 1.5%). All 3 patients were among 27 patients who did not respond to interferon treatment. Of these 3 patients, 1 patient developed liver cirrhosis after interferon treatment, and the histologic staging of the remaining 2 patients before interferon treatment was F3, according to the new Inuyama classification. None of the 18 patients who were complete responders to interferon treatment or the 21 patients with incomplete responses developed hepatocellular carcinoma. Our results suggest that patients with chronic hepatitis C who have no response to interferon treatment and histologically advanced disease should be closely followed up after interferon treatment, although the mechanism of malignant transformation to hepatocellular carcinoma in patients with chronic hepatitis C virus infection is still obscure.