Progression of Type C Chronic Hepatitis to Liver Cirrhosis and Hepatocellular Carcinoma—Its Relationship to Alcohol Drinking and the Age of Transfusion

Alcohol drinking has been reported to be an important factor that modulates the development and prognosis of chronic hepatitis B; however, little is known about an interrelationship between alcohol intake and the progression of chronic hepatitis C to liver cirrhosis (LC) and hepatocellular carcinoma (HCC). We attempted to clarify this interrelationship in patients with hepatitis C and history of blood transfusion. Thirty LC and 85 HCC patients were enrolled. In patients with LC, no significant correlation was observed between the amount of alcohol intake and the period from transfusion to diagnosis. The period from transfusion to diagnosis in HCC patients with alcohol intake ≥46 g/day and < 46 g/day were 26 ± 6 and 31 ± 9 years, respectively, resulting in a significant difference ( p < 0.05). The period from transfusion to diagnosis of LC and/or HCC showed significant negative correlation with the age of transfusion ( r = 0.82, Y = -0.67 X + 48.0, p < 0.01; r = 0.76, Y = -0.70 X + 54.1, p < 0.001, respectively). This correlation was also observed in patients with HCC, regardless of the amount of alcohol intake. In conclusion, these data suggest that alcohol drinking might be an important factor that promotes an occurrence of HCC in patients with hepatitis C, and that hepatitis C virus infection in the elderly promotes development of liver disease via LC to HCC.     

脾栓塞对肝硬化患者外周血T淋巴细胞亚群的影响

目的 :研究部分脾栓塞治疗脾功能亢进对肝硬化患者T淋巴细胞亚群的影响。方法 :57例肝硬化并脾功能亢进患者 ,32例采用部分脾栓塞治疗 ,2 5例采用脾全切治疗 ,1 5例正常人作为对照 ,比较两组治疗前后外周血T淋巴细胞亚群的变化。结果 :肝硬化患者外周血T淋巴细胞 (CD3+ )、T辅助 /诱导淋巴细胞亚群 (CD4+ )、T辅助淋巴细胞 /T抑制淋巴细胞亚群 (CD4+ /CD8+ )明显低于正常人 (P <0 .0 1 ) ;脾栓塞组治疗前后CD3+ 、CD4+ 、CD8+ 、CD4+ /CD8+ 无明显差异 (P >0 .0 5) ;脾全切组治疗后CD3+ 、CD4+ 、CD4+ /CD8+ 均较治疗前及部分脾栓塞组治疗后明显降低 (P <0 .0 1 )。结论 :肝硬化患者外周血CD3+ 、CD4+ 、CD4+ /CD8+ 降低 ,部分脾栓塞治疗脾功能亢进 ,对肝硬化患者外周血T淋巴细胞亚群无明显影响 ,显著优于脾全切治疗     

拉米夫定治疗失代偿期乙型肝炎肝硬化的随机对照研究

目的：用随机对照临床试验研究拉米夫定对失代偿期乙型肝炎后肝硬化患者生存率、肝功能生化指标、并发症及乙肝病毒学的影响。方法：107例患者随机分为治疗组（n=59)和对照组（n=48)。治疗组服用拉米夫定每日100毫克，对照组服用复方益肝灵每次四年，每日三次。结果：治疗组中位随访时间96周（17－161周），对照组为93周（12－160周），52周时治疗组HBV DNA转阴率78．7％（37／47），伴血清白蛋白显著升高，胆红素和谷丙转氨酶下降，P＜0．05。治疗组两年生存率为75．70％，对照组40．48％，P＜0．05。原发性肝癌发生率分别为8．5％和22．9％，P＜0．05。治疗组52周后11例（29．7％）HBV DNA转阳性，肝功能下降。结论：拉米夫定能改善乙型肝炎肝硬化失代偿期患者的肝功能，延长生存期，但长期疗效有限，应寻求更有效的治疗措施。     

Diagnosing clinical subsets of autoimmune liver diseases based on a multivariable model

Background Diagnosing autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis, and other autoimmune liver diseases remains an imperfect process. We need a more accurate, evidence-based diagnostic system. Methods We conducted a national survey and identified 988 cases of liver disease which did not satisfy the inclusion criteria for any liver disease of known etiology. We expected these cases to include autoimmune liver disease (AILD) and its variant forms. We selected 269 prototype cases for which histological re-evaluation of liver biopsy by independent expert hepatopathologists and the original diagnosis coincided. We did a multiple logistic regression analysis to determine explanatory variables that would distinguish cases of AIH and PBC from those of non-AIH and non-PBC, respectively. We constructed a multivariable diagnostic formula that gave AIH and PBC disease probabilities and validated it in a study of an additional 371 cases (validation group). Results Based on the results of the statistical analysis, we selected three laboratory tests and four histological features as independent variables correlated to the diagnosis of both AIH and PBC. For the validation group, assuming that the original diagnosis was correct, the sensitivity and specificity for AIH were 86.3% and 92.4%, respectively. For PBC the sensitivity and specificity were 82.5% and 63.7%, respectively. A detailed analysis of inconsistent cases showed that the diagnosis based on the formula had given the correct diagnosis, for either AIH or PBC, except for 5 cases (1.3%) in which disease probability was low for both. Conclusions A seven-variable formula based on three laboratory tests and four histological features gives significant information for the diagnosis of AILD.     

Endoscopic management of gastric variceal bleeding with cyanoacrylate glue injection: safety and efficacy in a Canadian population

BACKGROUND:

Gastric variceal bleeding (GVB) is a major cause of morbidity and mortality among patients with portal hypertension. Endoscopic band ligation and standard sclerotherapy have been used but have significant limitations. Decompression through transjugular intrahepatic portosystemic shunt insertion has been shown to be effective. Gastric variceal injection therapy with a commercially available cyanoacrylate glue is less invasive than transjugular intrahepatic portosystemic shunt insertion and has recently been shown to be effective for acute hemostasis.

OBJECTIVE:

To assess the immediate and long-term outcomes of cyanoacrylate glue injection therapy for GVB.

METHODS:

A retrospective chart review was conducted to identify patients treated with cyanoacrylate injection for GVB at two tertiary care hospitals over a period of six years. The outcomes assessed included complications, acute hemostasis, rebleeding rate and all-cause mortality.

RESULTS:

Thirty-seven patients (60% men) underwent cyanoacrylate glue injections for GVB. The median follow-up period was 14 months and included 29 patients (eight were lost to follow-up). Initial hemostasis was achieved in 35 patients (95%). No significant complications from cyanoacrylate injection were observed. Early rebleeding was rare (8%) and late rebleeding occurred in only 28% of patients. The all-cause mortality rate was 28.6% during the median follow-up period.

CONCLUSION:

The data suggest that cyanoacrylate injection therapy is safe and effective for the prevention of short- and long-term bleeding from gastric varices. Furthermore, although these patients had significant comorbid disease, survival in the follow-up time period was greater than 70%.     

急诊胃镜对肝硬化非食管胃底静脉曲张破裂出血的诊疗价值

目的 探讨急诊胃镜对肝硬化非食管胃底静脉曲张破裂出血(non-esophageal variceal bleeding, NEVB)的诊疗价值.方法 回顾2003年1月～2008年1月我院肝硬化上消化道出血患者采取急诊胃镜检查130例,快速尿素酶试验和14C呼气试验(14C-UBT)检测幽门螺杆菌(Helicobacter pylori,H.pylori)感染情况,分析总结其中45例非食管胃底静脉曲张破裂出血临床诊治情况.结果 127例得到了确诊,确诊率为97.7%,其中非食管胃底静脉曲张破裂出血45例,占34.6%,以门脉高压性胃病(portal hypertensive gastropathy,PHG)和肝源性溃疡(hepatogenic ulcer, HU)居多.内镜下止血治疗14例,肝硬化并食管胃底静脉破裂出血者(EVB)H.pylori阳性率(38.8%)低于非食管胃底静脉破裂出血者(42.2%),但两者之间差异无统计学意义(P＞0.05),根除H.pylori者再次出血率低.结论 对肝硬化合并上消化道出血患者,最好行急诊胃镜检查,其诊断率高;非食管胃底静脉曲张破裂出血给予内镜下止血及内科治疗,效果确切,同时根除H.pylori有助于预防再次出血.     

Haemodynamic and renal effects of tadalafil in patients with cirrhosis

A recent report introduced the phosphodiesterase-5 inhibition by vardenafil as a novel treatment of portal hypertension in patients with cirrhosis.In the herein presented"letter to the editor",the administration of tadalafil did not influence portal haemodynamics but impaired systemic haemodynamics in patients with cirrhosis.Our observations concur with the results of a report in a previous issue of World Journal of Gastroenterology(October 2008).Moreover,tadalafil adversely affected renal function in patients with decompensated liver disease.     

Value of duplex Doppler ultrasonography in non-invasive assessment of children with chronic liver disease

AIM:To investigate the value of duplex Doppler ultrasonography (US) in the assessment of the hemodynamics of the portal and hepatic veins in a cohort of children with chronic liver disease (CLD) and to detect any relationship between the US changes,etiology and severity (or stage) of CLD. METHODS:We prospectively enrolled 25 children with biopsy-proven CLD. Thirteen had cirrhosis (aged 8.9 ± 2.0 years) and 12 had chronic hepatitis (aged 9.3 ± 2.3 years). Gray scale and color-coded duplex Doppler US were performed for all,as well as 30 healthy age and sex-matched controls. Findings were correlated with clinical,laboratory and histopathological characteristics. RESULTS:Prominent caudate lobe was detected in 100% of cirrhotics,but none of the chronic hepatitis or controls. Thickened lesser omentum and loss of the triphasic waveform of the hepatic vein were present in 69.2% and 53.8% of cirrhotics vs 33.3% and 8.3% of chronic hepatitis respectively. Portal vein flow velocity was significantly lower (P < 0.0001) and the congestion index was significantly higher (P < 0.005) in both patient groups compared to controls. Child-Pugh’s staging showed a positive correlation with both abnormal hepatic vein waveform and direction of portal blood flow; and a negative correlation with both hepatic and portal vein flow velocities. No correlation with the etiology of CLD could be detected. CONCLUSION:Duplex Doppler added to grayscale US can detect significant morphologic and portal hemodynamic changes that correlate with the severity (stage) of CLD,but not with etiology.     

Evaluation of quantitative portal venous, hepatic arterial, and total hepatic tissue blood flow using xenon CT in alcoholic liver cirrhosis-comparison with liver cirrhosis related to hepatitis C virus and nonalcoholic steatohepatitis

Background/Aims: Xenon computed tomography (Xe-CT) is a noninvasive method of quantifying and visualizing tissue blood flow (TBF). For the liver, Xe-CT allows separate measurement of hepatic arterial and portal venous TBF. The present study evaluated the usefulness of Xe-CT as a noninvasive diagnostic procedure for measuring hepatic TBF in alcoholic liver cirrhosis (AL-LC), compared with liver cirrhosis related to nonalcoholic steatohepatitis (NASH), (NASH-LC), and hepatitis C virus (HCV), (C-LC). Methods: Xe-CT was performed on 22 patients with AL-LC, 7 patients with NASH-LC, and 24 patients with C-LC. Severity of LC was classified according to Child-Pugh classification. Correlations between hepatic TBF, Child-Pugh classification, and indocyanin green retention (ICG) rate after 15 minutes (ICG15R) were examined. Correlations of hepatic TBF in Child-Pugh class A to AL-LC, NASH-LC, and C-LC were also examined. Results: Portal venous TBF (PVTBF) displayed a significant negative correlation with Child-Pugh score and ICG15R (r = −0.432, p < 0.01, r = −0.442, p < 0.01, respectively). Moreover, ICG15R displayed a significant positive correlation with Child-Pugh score (r = 0.661, p < 0.001). Meanwhile, mean PVTBF and total hepatic TBF (THTBF) was significantly lower in AL-LC than in C-LC (p < 0.05). Mean PVTBF was significantly lower in Child-Pugh class A to AL-LC and NASH-LC than in that to C-LC (p < 0.05). Similarly, mean THTBF was significantly lower in Child-Pugh class A to NASH-LC than in that to C-LC (p < 0.05). Conclusions: Measurement of hepatic TBF using Xe-CT is useful as a noninvasive, objective method of assessing the state of the liver in chronic liver disease.     

补中益气汤加味治疗肝硬化腹水体会

目的：探讨补中益气汤对治疗肝硬化腹水的临床体会。方法：64例患有肝硬化腹水的患者,均符合综合性诊断标准。利用中医的辨证论治,因病施治。结果：接受治疗的患者中,治愈10例,好转48例,无效6例,总有效率为93．75％。结论：临床运用补中益气汤治疗肝硬化腹水具有良好效果。