HBeAg与乙型肝炎相关性肝细胞癌关系的临床观察

目的研究HBeAg阴性与HBeAg阳性的乙型肝炎相关性原发性肝癌患者生化指标和病毒相关因素的差异,并探讨其临床意义。方法回顾性分析华西第一附属医院2009年1月～2010年11月以来住院的合并HBV感染原发性肝癌患者220例,分为HBeAg阳性与HBeAg阴性两组。探讨两组甲胎蛋白(AFP)水平、肝功能水平,HBV DNA定量、肝组织学指标的差异。结果HBeAg阳性原发性肝癌195例,占总数的89%;HBeAg阴性原发性肝癌25例,占总数的11%;HBeAg阳性组HBVDNA定量对数均值显著高于HBeAg阴性组(t=2.01,P<0.05);HBeAg阴性组肝纤维化分期为4期的比例为40%,明显高于HBeAg阳性组21%(χ2=9.5,P=0.049)。两组在AFP,肝功能等指标上差异无统计学意义。结论 HBeAg阳性原发性肝癌发生率高于阴性者。同HBeAg阳性原发性肝癌相比,HBeAg阴性肝癌患者肝组织学损害程度较重,合并肝硬化更为常见,预后更差。HBeAg阴性患者并发肝细胞癌,早期漏诊率高于阳性者。     

乙型肝炎病毒相关肝细胞癌的多学科合作诊断与治疗

原发性肝细胞癌(HCC) 主要发生在慢性肝病或肝硬化的基础之上,与乙型肝炎病毒(HBV) 和丙型肝炎病毒 (HCV) 感染密切相关。多学科合作诊疗模式是近年来在临床上兴起的诊断和治疗复杂疾病的理想模式,特别是对于 一种疾病有多器官损害表现,或一种疾病有多种治疗方法的疾病帮助更大。本期专题笔谈“HBV 相关HCC 的多学 科合作诊断与治疗”将从内科医生在HCC 多学科诊疗模式中的作用、HCC 的分子靶向治疗进展、HBV 相关HCC 抗病毒治疗的作用及与预后关系、索拉非尼治疗中晚期HCC 的临床分析等方面进行系列讨论。     

HBV相关肝细胞癌患者乙型肝炎病毒基因分型

目的了解HBV相关肝细胞癌患者乙型肝炎病毒基因型别及分布特点。方法采用聚合酶链式反应结合TaqmanMGB探针技术对70例HCC患者和57例CHB患者进行HBV基因分型检测和分析。结果HCC患者中C基因型占74．29％,B基因型占24．29％％,BC基因型占5．71％。HCC患者c基因型所占比例显著高于CHB患者（P〈0．05）。HCC（40～50）岁年龄组和50岁以上年龄组患者中B基因型分别占16．67％、28．57％;C基因型分别占83．33％、68．57％,两年龄组患者B、c基因型分布均无明显差异（P均〉0．05）。HCCB、C基因型患者的血清HBeAg阳性率、HBeAb阳性率、e系统（HBeAgHBeAb）阴性率及HBVDNA水平差异均无显著性（P均〉0．05）。结论南京地区HBV相关HCC患者HBV基因型以C型为主,其次为B型,少量为BC混合型。HCC患者的基因型与发病年龄之间无明显相关性。HCCB、C基因型患者的HBeAg表达状态以及HBVDNA复制水平均无明显差异。     

乙型肝炎病毒基本核心启动子和前C区突变与肝硬化肝细胞癌和非肝硬化肝细胞癌发生的关系

目的 研究慢性HBV感染者抗病毒治疗前HBV基本核心启动子(BCP)和前C区突变与肝细胞癌发生的关系.方法 收集2003年1月至2010年12月浙江省上虞市人民医院感染疾病科门诊和住院收治的慢性HBV感染患者,其中慢性乙型肝炎166例(对照),肝硬化肝细胞癌患者158例和非肝硬化肝细胞癌患者57例,采用PCR扩增后直接测序法检测HBV BCP和前C区突变,同时确定基因型.数据采用x2检验及Logistic回归分析.结果 患者以HBV基因B型为主,其中慢性乙型肝炎有124例,肝硬化肝细胞癌有126例,非肝硬化肝细胞癌有50例.以慢性乙型肝炎患者作为对照组,在单变量分析中BCP V1753突变(x2=7.927,P=0.005)、BCP T1762/A1764双突变(x2=12.796,P＜0.01)、前C区A1896突变(x2=6.890,P=0.009)和前C区A1899突变(x2=11.850,P=0.001)与肝硬化肝细胞癌的发生有关;前C区A1896突变(x2 =27.310,P＜0.01)和前C区A1899突变(x2=7.575,P=0.006)与非肝硬化肝细胞癌的发生有关.多因素Logistic回归分析发现,在HBeAg阳性患者中,BCP T1762/A1764双突变(wald=6.180,P=0.016,OR=8.883)和前C区A1899突变(wald=10.279,P=0.001,OR=7.475)是肝硬化肝细胞癌发生的危险因素;前C区A1896突变(wald=4.324,P=0.038,OR=4.439)和前C区A1899突变(wald=4.850,P=0.028,OR=6.010)是非肝硬化肝细胞癌发生的危险因素.在HBeAg阴性患者中,仅前C区A1896突变(wald=15.448,P＜0.01,OR=12.128)是非肝硬化肝细胞癌发生的危险因素.结论 BCP T1762/A1764双突变与HBeAg阳性患者的肝硬化肝细胞癌发生有关,前C区A1896突变与HBeAg阳性和阴性患者的非肝硬化肝细胞癌发生有关,前C区A1899突变与HBeAg阳性患者的肝硬化肝细胞癌和非肝硬化肝细胞癌发生有关.     

乙型肝炎病毒相关性肝细胞癌预测模型的优化北大核心CSCD

目的优化已建立的HBV相关性肝细胞癌（HCC）预测模型（REACH—B评分模型）。方法收集2004年10月1日至2014年5月1日于福建医科大学附属第一医院肝病中心初次入院、HBsAg阳性超过半年的患者,分为HCC组和对照组（非HCC组）,回顾性收集相关指标,进行评分评估。用受试者工作特征曲线判断各模型预测价值。结果预测3年HBV相关性HCC发生,共纳入627例患者,其中HCC组151例,对照组476例。REACHB评分模型预测3年HCC发生的曲线下面积（Auc）为0．78（95％CI：0．74～0．82）,敏感度为73．00％,特异度为78．70％。联合甲胎蛋白（AFP）建立R—AFP评分模型,对3年HCC发生的AUC升至0．80（95％CI：0．76～0．83,Z=2．50,P=0．01）,敏感度为71．03％,特异度为79．13％。联合甲胎蛋白异质体3与AFP之比（AFP—L3％）建立R—AFP—L3％评分模型,对3年HCC发生的AUC进一步升至0．83（95％CI：0．80～0．87,Z=2．45,P=0．01）,敏感度为75．01％,特异度为79．32％。预测5年HBV相关性HCC发生,共纳人159例患者,其中HCC组65例,对照组94例。REACH—B评分模型预测5年HCC发生的AUC为0．79（95％CI：0．72～0．87）,敏感度为73．60％,特异度为75．43％。R-AFP评分模型对5年HCC发生的预测价值AUC升至0．84（95％CI：0．77～0．90,Z=2．70,P=0．006）,敏感度为83．12％,特异度为77．89％。结论联合AFP及AFP—L3％能优化REACHB评分模型对3年和5年HBV相关性HCC发生的预测价值。     

乙型肝炎病毒相关性肝细胞癌预测模型的验证

目的 验证已建立的乙型肝炎病毒相关性肝细胞癌预测模型(REACH-B评分模型及CU-HCC评分模型). 方法 收集2004年10月1日至2014年5月1日初次人院、HBsAg阳性超过半年的患者,分为病例组(肝癌组)和对照组(非肝癌组),回顾性收集3年前及5年前相关指标,进行评分评估.据资料不同采用t检验、秩和检验、x2检验或受试者工作特征曲线进行统计学分析.结果 共627例患者纳入3年乙型肝炎病毒相关性肝细胞癌预测REACH-B评分模型验证,其中病例组151例,对照组476例.REACH-B评分模型预测3年肝癌发生的曲线下面积为0.78,敏感度为73.00％,特异度为78.70％.男性并ALT≥45 U/L患者应用REACH-B评分模型对3年肝细胞癌发生的预测价值曲线下面积分别为0.89,敏感度为87.09％,特异度为83.86％.共159例患者纳入5年乙型肝炎病毒相关性肝细胞癌预测REACH-B评分模型及CU-HCC评分模型验证,其中病例组65例,对照组94例.REACH-B评分模型预测5年肝癌发生的曲线下面积为0.79,敏感度为73.60％,特异度为75.43％.CU-HCC评分模型预测5年肝癌发生的曲线下面积为0.76,敏感度为78.40％,特异度为77.40％. 结论 REACH-B评分模型和CU-HCC评分模型均可适用本地区人群;男性并ALT≥45 U/L患者应用REACH-B评分模型对3年乙型肝炎病毒相关性肝细胞癌发生有较高的预测价值.     

乙型肝炎病毒相关性肝细胞癌中分泌型卷曲相关蛋白基因甲基化分析

目的 研究HBV相关性肝细胞癌(HCC)中分泌型卷曲相关蛋白(SFRP)1、SFRP2基冈甲基化状态及其与肝细胞癌发牛发展的关系.方法 利用甲基化特异性聚合酶链反应(MSP)法检测45例肝细胞癌患者术中取得癌组织、癌旁组织及6例胆囊结石或肝脏血管瘤患者正常肝组织中SFRP1、SFRP2基因的甲基化状态.数据行X2检验、Fisher's 确切概率法统计分析.结果 在45例HCC患者中,癌组织和癌旁组织中SFRP1基因的甲基化率分别占62.2%和35.6%(X2=6.403,P＜0.05);SFRP2基因的甲基化率分别占51.1%和28.9%(X2=4.630,P＜0.05);6例正常肝组织均未检测到甲基化.癌组织中SFRPI与SFRP2基因甲基化在性别、年龄、HBV血清标志物、癌旁组织类型、有无转移和病理分级等因素之间差异均无统计学意义(P＞0.05),癌组织中SFRP1与SFRP2基因异常甲基化具有线性相关性(r=0.381,P=0.01).结论 SFRP1和SFRP2基因甲基化在HBV相关性HCC中是个频发事件,将来有可能作为一种预测HCC形成的分子生物学标志物.     

体内与转染细胞中乙型肝炎病毒株复制特性的相关性

目的 比较不同乙型肝炎病毒（HBV）株在体内及转染细胞中复制特性是否相符。方法 以核酸杂交定量和聚合酶链反应-酶联免疫吸附试验（PCR-ELISA）测定5例孕妇血清中HBVDNA含量,并测定乙型肝炎表面抗原（HBsAg)和乙型肝炎e抗原（HBeAg)含量,分别克隆血清中的HBV基因组转染细胞,检测培养上清液中HBsAg和HBeAg表达水平,并以Southern印迹及核酸杂交检测转染细胞内、外HBVDNA复制水平。结果 转染细胞内、外HBVDNA复制水平与相应血清HBVDNA量呈正相关趋势,转染细胞表达的病毒抗原水平与相应血清中病毒抗原含量也呈正相关趋势。结论 感染者血清中HBVDNA和病毒抗原的含量与毒株在细胞中复制和抗原表达水平有相符趋势。HBV不同毒株在转染细胞中的复制可基本反映体内毒株的复制特性。     

人乙型肝炎免疫球蛋白定量清除新生儿乙型肝炎病毒表面抗原的研究

目的 根据新生儿出生时HBsAg和HBV DNA的载量,调整人乙型肝炎免疫球蛋白使用量,以期更有效地阻断HBV的母婴传播. 方法 收集出生2h内静脉血HBsAg阳性新生儿资料125例.分为研究组64例,对照组61例,研究组根据新生儿出生时HBsAg感染量调整乙型肝炎免疫球蛋白使用量,与对照组比较新生儿12个月龄以上治疗效果.计量资料采用非正态分布采用秩和检验,计数资料采用x2检验.结果 2组新生儿出生时HBsAg和HBV DNA检测值的差异均无统计学意义(p 值均＞0.05).研究组出生HBV感染新生几64例,12月龄以上成功清除HBsAg者53例,成功清除率为82.8％,感染11例(1.2％).对照组出生HBV感染新生儿61例,12月龄以上成功清除HBsAg者35例,成功清除率为57.4％,感染26例(3.1％).2组出生HBV感染新生儿12个月龄以上清除HBsAg效果比较,x2=9.696,P＜0.05,差异有统计学意义.结论 根据新生儿的HBsAg感染量调整使用乙型肝炎免疫球蛋白,可提高乙型肝炎母婴传播的阻断成功率.     

HBeAg状态及乙型肝炎病毒载量对慢性重型乙型肝炎预后的影响

目的 探讨HBeAg状态及HBV DNA载量对慢性重型乙型肝炎预后的影响.方法 回顾分析2002年1月至2007年12月在南方医科大学南方医院住院的慢性重型乙型肝炎患者406例,研究HBeAg状态、HBV DNA载量对疾病预后的影响.计量资料采用t检验,率的比较采用X2检验.结果 406例重型肝炎患者中,HBeAg阳性208例,占51.2%,HBeAg阴性198例,占48.8%.HBeAg阳性组与HBeAg阴性组比较,两组间男女构成比、TBil峰值及平均凝血酶原活动度谷值差异均无统计学意义;HBeAg阴性组平均年龄(46.7±12.8)岁,显著高于HBeAg阳性组(38.3±13.5)岁(t=6.43,P＜0.01);HBeAg阴性组肝硬化患者占67.7%,亦显著高于HBeAg阳性组的45.7%(X2=19.97,P＜0.01);HBeAg阴性组好转率为32.3%,显著低于HBeAg阳性组的44.7%(X2=6.56,P＜0.05).在208例HBeAg阳性与198例HBeAg阴性患者中,均显示随着HBV DNA载量的升高,其好转率下降,呈显著负相关(X2=22.98,X2=26.04;均P＜0.01).结论 HBeAg阴性重型乙型肝炎较HBeAg阳性者预后差;无论HBeAg状态如何,HBV DNA载量越高,其预后越差.     

Analysis of Risk Factors for Hepatocellular Carcinoma in Patients With HBs Antigen- and Anti-HCV Antibody-Negative Alcoholic Cirrhosis: Clinical Significance of Prior Hepatitis B Virus Infection

Background: The hepatitis B virus (HBV) or hepatitis C virus (HCV) markers frequently are detected in alcoholic patients with hepatocellular carcinoma (HCC). However, risk factors for the development of HCC in patients with HBs antigen (Ag)- and anti-HCV antibody (anti-HCV)-negative alcoholic cirrhosis have not been clearly documented. The present study was conducted to elucidate the occurrence rates of HCC in HBs Ag- and anti-HCV-negative male alcoholic cirrhosis and to assess the risk factors for hepatocellular carcinogenesis.
Method: We prospectively studied 91 consecutive patients with HBs Ag- and anti-HCV-negative alcoholic cirrhosis for 0.5 to 12.5 years (median 5.9 years). Potential risk factors assessed for liver carcinogenesis included the following six variables: age, total alcohol intake, association of continuing alcohol intake after diagnosis, indocyanine green retention rate at 15 min, anti-HB core antibodies (anti-HBc), and association of diabetes mellitus.
Results: Cumulative occurrence rates of HCC were 6.4%, 18.9%, and 28.7% at the end of the 5th, 7th and 10th years, respectively. When classified by anti-HBc, the occurrence rates of HCC in 31 patients with anti-HBc and 60 patients without anti-HBc were 15.6% and 2.9% at the 5th year, 28.4% and 13.5% at the 7th year, and 40.4% and 22.1% at the 10th year, respectively. The occurrence rates of HCC were also significantly related to the cumulative alcohol intake. Cox proportional hazard model identified that cumulative alcohol intake ( p = 0.0047) and positive anti-HBc antibodies ( p = 0.0598) were independently associated with the occurrence rates of HCC.
Conclusion: These epidemiologic results suggest that heavy cumulative alcohol intake and prior exposure to HBV infection are risk factors for the development of HCC in patients with HBs Ag- and anti-HCV-negative alcoholic cirrhosis.     

Low Serum Hepatitis B Surface Antigen Level Predicts Compensated Cirrhosis Caused by Chronic Hepatitis B in HBeAg Positive Patients in East China

Backgrounds:

Serum hepatitis B surface antigen (HBsAg) levels are associated with fibrosis in patients with chronic hepatitis B (CHB) infection.

Objectives:

The aim of our study was to evaluate serum HBsAg level as a biomarker for compensated cirrhosis in hepatitis B e antigen (HBeAg) positive CHB patients.

Patients and Methods:

Two-hundred and one HBeAg-positive Chinese CHB patients with or without cirrhosis were enrolled in this retrospective study. Cirrhosis was diagnosed based on liver biopsy. Furthermore, patients with decompensated cirrhosis were excluded. A statistical analysis was performed regarding the association between serum HBsAg level and compensated cirrhosis.

Results:

Patients with compensated cirrhosis had a significantly lower mean serum HBsAg level compared to those without cirrhosis (3.27 Log₁₀ IU/mL VS 4.17 Log₁₀ IU/mL, P < 0.001). Furthermore, examining the correlation with compensated cirrhosis revealed that lower level of serum HBsAg was a significant factor in multivariate analysis. The area under the receiver operating characteristics curve of serum HBsAg was 0.856 for compensated cirrhosis. A positive predictive value of 66.2% and negative predictive value of 90.7% were obtained with a cut-off value of < 3.60 Log₁₀ IU/mL (4000 IU/mL) of serum HBsAg. Moreover, the rate of compensated cirrhosis increased to 75.0% after combining with APRI > 2.

Conclusions:

In HBeAg positive CHB patients, low serum HBsAg level is a useful predictor of compensated cirrhosis.     

Roles of Alcohol, Hepatitis Virus Infection, and Gender in the Development of Hepatocellular Carcinoma in Patients with Liver Cirrhosis

To assess the interaction of alcohol, hepatitis C virus (HCV), and hepatitis B virus (HBV) infection in hepatocarcinogenesis, we prospectively observed 449 patients with liver cirrhosis (LC) who presented to our outpatient clinics in 1 month; 164 patients with habitual drinking [alcoholic liver-liver cirrhosis (AL-LC)] who had taken ≥72 g alcohol/day (HCV-positive 81 cases: HCV + AL; HCV-negative 83 cases: AL); 176 patients with HCV infection, but without alcohol intake; 34 patients with HBV infection; 6 patients with HCV and HBV coinfection; and 82 patients with liver diseases from other etiologies, such as primary biliary cirrhosis. In the HCV group, the cumulative occurrence rate of hepatocellular carcinoma (HCC) was 9%, 18%, and 23% in the first, second, and third years, respectively. In the HCV + AL group, that was 13%, 17%, and 28%, respectively. There was no difference in the HCC occurrence rate between the two groups. In the AL group, the cumulative HCC occurrence rate was only 1% during the observation period of 3 years. The occurrence rate was significantly lower in the AL group, compared with the HCV and the HCV + AL groups. In the HBV group, the cumulative occurrence rate of HCC during the observation period of 3 years was 17%, which was similar to that of the HBV + AL group, 14%. We also examined some other variables that might be related to the development of HCC. The cumulative occurrence rate of HCC in male patients was 31%, whereas that was 18% in female patients. In the HCV group, there was a significant increase of HCC occurrence rate in male patients. In contrast, no difference was observed in the HCC occurrence rate between male and female patients in the HBV group. The present study suggests that alcohol alone may not be an independent risk factor for HCC, nor does it accelerate HCC development in LC patients with HCV and HBV infection during the prospective observation of 3 years.     

肝癌和癌周双份肝组织的HBVDNA整合状况

本文对30例肝癌患者的肝组织进行研究,从其中24例HBsAg(+)病人检出HBVDNA整合者21例,其中癌组织有整合者18例,癌周组织有整合者15例,双份组织均有整合者13例。6例HBsAg(-)者的1例癌周组织也检出HBVDNA整合。杂交带分析发现,不同病例和同一例肝内不同组织整合带数目和电泳位置不一致。23例癌周肝组织有明显的碎屑坏死,这可能与整合、癌变有关。     

Hepatitis B Virus Core Promoter Mutations in Patients With Chronic Hepatitis B and Hepatocellular Carcinoma in Bucharest,Romania

Background:

Accurate and personalized molecular virological diagnosis of hepatitis B virus (HBV) infection is crucial for individualized selection of patients for antiviral therapy in Romania.

Objectives:

We aimed to investigate HBV mutations in Romanian patients with chronic HBV infection, also to match HBV genotypes with HBV mutations identified and clinical outcomes.

Patients and Methods:

This was a cross-sectional study. A total of 484 Romanian patients with chronic HBV infection and hepatocellular carcinoma (HCC) were investigated. This was performed in Fundeni Clinical Institute, Bucharest, Romania during January 2005 to August 2010. HBsAg positive patients with chronic HBV infection admitted to Fundeni Clinical Institute were randomly enrolled in the study. Analysis was performed in the Centre for Immunogenetics and Virology, Fundeni Clinical Institute, Bucharest, Romania. Indirect diagnosis was performed with enhanced chemiluminescence method using Architect i2000SR and HBV-DNA was quantified with COBAS TaqMan HBV PCR. Direct sequencing of the PCR-products was performed with the PCR-product sequencing kit. HBV genotyping was performed with INNO-LiPA DR Amplification and INNO-LiPA HBV precore-core.

Results:

We detected two HBV genotypes; A (8.1%) and D (60.5%), and a mixture of genotypes A and D (31.4%) (P < 0.001). Basal core promoter (BCP) A1762T/G1764A and precore (PC) G1896A mutations were detected in these Romanian patients with chronic HBV infection. HBV chronic carriers had mainly genotype D (54.4%) and HBV WT (64.0%). BCP A1762T, G1764A and PC G1896A were significantly associated with HCC-tissue HBV sequencing (75.3%) (P < 0.001). PC G1896A alone was detected in HCC-serum HBV sequencing group (66.7%).

Conclusions:

Genotype D was the main genotype detected in Romanian patients with chronic HBV infection. Genotype D presented both BCP and PC mutations more frequently.     

Safety and Efficacy of Transcatheter Arterial Chemoemboliazation in the Real-Life Management of Unresectable Hepatocellular Carcinoma

Background

Trans-arterial chemoembolization (TACE) is associated with better survival in BCLC-stage B patients with hepatocellular carcinoma (HCC) and Child-Pugh A whereas in Child-Pugh B there is no definite evidence of benefit.

Objectives

To assess the safety and efficacy of TACE during routine clinical practice in a consecutive Greek cohort of patients with unrespectable HCC.

Patients and Methods

Seventy one patients enrolled for this study (mean follow-up:24.6 months). 100 mg cisplatin, 50 mg doxorubicin and 10 ml lipiodol as well as embolic materials were used. CT-scans and blood tests were obtained prior and post-TACE. Kaplan–Meier method and Cox proportional hazard model were used to evaluate survival and factors affecting survival.

Results

Survival at 1-year, 2-years, 3-years and 5-years was 73.2%, 45.4%, 33.2% and 14.9% respectively. Procedure-related mortality was 1.4%. Multivariate analysis showed lesion diameter, Child-Pugh classification, alcohol abuse, tumor response and AFP prior TACE as independent prognostic factors of survival. Patients diagnosed during surveillance had significantly better survival rates compared to those diagnosed after development of symptoms (HR = 0.58, 95%CI: 0.33-1.01, P < 0.05).

Conclusions

TACE is safe and efficient for unrespectable HCC. Alcohol abuse, tumor burden, response criteria, Child-Pugh and AFP prior to the session were identified as independent predictors of survival whereas, adherence to surveillance programs resulted in significantly better survival in these patients.     

Clinical Characteristics of Patients with Hepatocellular Carcinoma in a Middle Eastern Population

Background

Hepatocellular carcinoma (HCC) is one of the leading causes of death in Saudi male patients. Local clinical and demographic data of this disease are scarce.

Objectives

We sought to describe the clinical characteristics and outcomes of patients from two tertiary care centers in Saudi Arabia.

Patients and Methods

Data were collected for all patients diagnosed to have hepatocellular carcinoma between June 2003 and July 2008 who had been registered in a special research database (the Saudi Observatory Liver Disease Registry (SOLID)). Data were extracted from SOLID for clinical, biochemical, radiologic parameters and outcome.

Results

Data was available for 363 patients, the mean age of diagnosis was 66 years, 74% of patients were males, and Hepatitis C was the underlying cause of liver disease in 48%, while Hepatitis B in 29%. Most of the patients were diagnosed at an advanced stage, 53 % of patients had a CLIP score of 4 to 6 (advanced stage), 55% had large multi-nodular tumors and 16% had vascular invasion or extra-hepatic spread at the time of diagnosis. Most of the patients had decompensated cirrhosis; with child-pogh score B in 44% and C in 26% with presence of portal hypertension in 55%. Forty eight percent died during the study period. Predictors of poor survival in the univariate analysis were; presence of portal vein thrombosis (P = 0.03), portal hypertension (P < 0.0001), presence of ascites (P = 0.022), hepatic encephalopathy (P < 0.0001), advanced child-pough score (P < 0.0001), bilirubin > 22 (P < 0.0001) and INR > 1.2 (P = 0.02). On multivariate analysis, only the presence of portal hypertension, bilirubin > 22 and severe hepatic encephalopathy were significant with adjusted hazard ratio of 1.6 (95% CI; 1.04-2.47), 1.76 (95% CI; 1.12-2.8), and 3.18 (95% CI; 1.42-7.14) respectively.

Conclusions

The data from this cohort indicates that most of patients diagnosed with HCC present at late tumor and liver disease stages, when prognosis is usually dismal. Regular cancer surveillance in cirrhotic patients might change the outcomes. Further studies with results of treatment outcomes in this community are needed.     

Autologous Peripheral Blood Stem Cell Transplantation Improves Portal Hemodynamics in Patients with Hepatitis B Virus-related Decompensated Cirrhosis

Background:

Chronic hepatitis B virus (HBV) infection may eventually lead to decompensated liver cirrhosis, which is a terminal illness.

Objectives:

The aim of this study was to investigate the therapeutic efficacy of autologous peripheral blood stem cell (APBSC) transplantation to improve portal vein hemodynamics in patients with HBV-related decompensated cirrhosis.

Patients and Methods:

This prospective study included 68 hospitalized patients who were diagnosed with HBV-related decompensated cirrhosis. These patients were divided into two groups: the transplantation group included 33 patients, while the control group included 35. Both groups received conventional medical treatment simultaneously, and APBSC transplantation was performed on the patients in the transplantation group. We evaluated the effects of APBSC transplantation on postoperative liver function using the following indices: total bilirubin, serum prothrombin and albumin, spleen size, and portal vein hemodynamics. Postoperatively, all of the patients were followed up at 24, 36, and 48 weeks.

Results:

The transplantation group had no serious reactions. Compared with the control group, albumin and prothrombin activity in the transplantation group was significantly improved at 24, 36, and 48 weeks after the procedure, and spleen length and portal vein diameter were substantially reduced at 48 weeks. The velocity of peak portal vein blood flow and mean maximum portal vein blood flow were greatly increased in the APBSC transplantation group at 36 and 48 weeks, respectively; however, there was also decreased portal vein diameter, which reduced portal vein pressure in patients with HBV-related decompensated cirrhosis.

Conclusions:

APBSC transplantation greatly benefits HBV-linked decompensated cirrhosis patients and should be recommended in clinical practice.     

Differentially Expressed Proteins in Chronic Active Hepatitis,Cirrhosis, and HCC Related to HCV Infection in Comparison With HBV Infection: A proteomics study

Background

Hepatocellular carcinoma is a highly progressive cancer in the case of late diagnosis which is frequently associated with HBV and HCV viral infections.

Objectives

To identify differentially expressed serum proteins among three main stages of HCV infection and healthy individuals, and their comparisons with sera from patients with the same stage of HBV infection.

Patients and Methods

Two-dimensional polyacrylamide gel electrophoresis combined with liquid chromatography-tandem mass spectrometry was performed on 47 sera from healthy volunteers, those with chronic active hepatitis, cirrhosis and HCC patients associated with HBV and HCV infections.

Results

Among these, 62 spots were differentially expressed (≥ 1.5 fold; P < 0.05), of which 42 spots that corresponded to 15 proteins were identified by liquid chromatography-tandem mass spectrometry. CD5-like antigen (CD5L) was differentially expressed between cirrhosis and HCC patients with HCV infection. Leucine-rich α2-glycoprotein (LRG) and haptoglobin (HP) α2 isoforms differed in the HCC that was associated with either HCV or HBV infections.

Conclusions

CD5L might be a useful biomarker for early diagnosis of HCC in HCV cirrhotic patients. LRG and HP α2 isoforms could be potential markers for distinguishing viral HCC. Our results also further support the presence of varying molecules involved in hepatocarcinogenesis in HBV when compared with HCV infection.