Objective To explore the relationship between the level of serum ferritin (SF) and liver damage in patients with chronic hepatitis B (CHB). Methods The concentration of serum ferritin of 98 patients with CHB from July to October 2014 was measured, and then correlation analysis was performed to analyze the correlation between SF and such indexes as serum tumor marker α-fetoprotein, biochemical markers [alanine amino transferase (ALT), aspartate amino transferase (AST), total protein (TP), albumin and total bilirubin (TBIL)], and hepatitis B serum markers (hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B e antigen, hepatitis B e antibody, and hepatitis B core antigen). Serum hepatitis B virus DNA (HBV-DNA) viral load was also tested, and then the discrepancy of SF levels in the high and low viral load groups was analyzed. Results The average concentration of the abnormally elevated SF was (878.69±837.98) ng/mL. The SF mean difference between low-load HBV-DNA and high-load HBV-DNA was statistically significant (P < 0.05). Serum ferritin levels were independently and positively correlated with ALT, AST, and TBIL (P < 0.01) and inversely correlated with TP and albumin (P < 0.01). Conclusion The rise of SF is associated with liver damage, which can reflect the state of inflammation of patients with CHB.
【摘要】 目的 分析慢性乙肝患者血清生化、血常规、血清病毒载量及乙型肝炎标志物与肝组织炎症分级、纤维化分期的相关性,以找到有较好相关性的临床指标；通过肝活检证实临床诊断与病理诊断的符合情况,探讨肝活检的重要性及价值。方法 对2007年6月—2009年8月在传染科行肝穿刺活检的359例慢性乙型肝炎患者的血清丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、总胆红素(TB)、白蛋白(ALB)、球蛋白(GLB)等指标,白细胞(WBC)、血小板(PLT)等指标,凝血酶原时间(PT),血清HBV DNA定量及乙肝标志物的不同状态与肝穿病理分级、分期的相关性进行分析；统计慢性乙肝患者临床诊断与病理诊断的符合情况。结果 肝组织炎症分级及纤维化分期之间有一定相关性(Plt;0.05)；血清ALT、AST、ALB、GLB、PT有助于判断肝组织炎症程度(Plt;0.05)；ALB、GLB、WBC、PLT、PT对肝组织纤维化程度的评估有意义(Plt;0.05)；HBV DNA复制水平与肝组织炎症及纤维化无关(Pgt;0.05),但存在负相关的趋势；纤维化程度高的患者HBeAg阴性组较HBeAg阳性组更多(Plt;0.05)。慢性乙型肝炎患者临床与病理诊断总符合率为56.3％。结论 动态监测慢性乙肝患者肝功能、血常规、凝血常规在一定程度上有助于判断疾病的程度,但要确诊肝组织炎症分级及纤维化分期,肝组织病理活检是必需的。
Objective To evaluate the efficacy and safety of genus Phyllanthus for chronic HBV infection. Design a systematic review of randomized clinical trials. Methods Randomized trials comparing genus Phyllanthus versus placebo, no intervention, general non-specific treatment, other herbal medicine, or interferon treatment for chronic HBV infection were identified by electronic and manual searches. Trials of Phyllanthus herb plus interferon versus interferon alone were also included. No blinding and language limitations were applied. The methodological quality of trials was assesses, by the Jadadscale plus allocation concealment. Results Twenty-two randomized trials (n=1 947) were identified. The methodological quality was high in five double blind trials and rest was low. The combined results showed that Phyllanthus species had positive effect on clearance of serum HBsAg (relative risk 5.64, 95%C1 1.85 to 17.21) compared with placebo or no intervention. There was no significant difference on clearance of serum HBsAg, HBeAg and HBV DNA between Phyllanthus and interferon. Phyllanthus species were better than non-specific treatment or other herbal medicines on clearance of serum HBeAg, HBeAg, HBV DNA, and liver enzyme normalization. Analyses showed a better effect of the Phyllanthus plus interferon combination on clearance of serum (1.56, 1.06 to 2.32) and HBV DNA (1.52, 1.05 to 2.21) than interferon alone. No serious adverse events were reported. Conclusions Based on the review Phyllanthus species may have positive effect on antiviral activity and liver biochemistry in chronic HBV infection. However, the evidence is not b due to the general low methodological quality and the variations of the herb. Further large trials are needed.
目的:观察α干扰素治疗HBeAg(+)慢性乙型肝炎患者过程中病毒学及血清学动态变化情况,通过早期疗效预测终末疗效。方法:观察144例HBeAg(+)慢性乙型肝炎患者经α干扰素治疗24WK及随访24WK 过程中HBV-DNA以及HBeAg变化情况.结果:经α干扰素治疗12、24、48WK时,HBV-DNA下降到可检测值以下病例数分别为32、32、31例;同期HBeAg发生血清转换病例数分别为16、17、21例。结论:干扰素治疗12WK时患者病毒学及血清学结果可早期预测终末疗效。
【摘要】 目的 观察阿德福韦酯联合拉米夫定治疗阿德福韦酯治疗48周后应答不佳，HBeAg阳性慢性乙型肝炎的疗效和安全性。 方法 选择2006年1月-2010年12月间阿德福韦酯治疗48周后乙型肝炎病毒 DNAgt;104 copies/mL的26例慢性乙型肝炎患者，给与拉米夫定（100 mg，1次/d）联合治疗。观察治疗12周，24周时的应答情况。 结果 所有纳入26例患者在联合拉米夫定优化治疗24周后，无论是病毒学应答还是血清学应答都获得显著的改善，无一例患者观察到有耐药以及药物不良反应发生。 结论 联合拉米夫定是对阿德福韦酯应答不佳慢性乙型肝炎患者安全有效的干预策略之一。【Abstract】 Objective To observe the effect and safety of adefovir dipivoxil (ADV) combined with lamnivudine (LAM) in treating HBeAg-positive chronic hepatitis B (CHB) patients with poor response to ADV monotherapy for 48 weeks. Methods Twenty-six HBeAg-positive CHB patients received initial treatment of ADV from January 2006 to December 2010, and their serum HBV-DNA still maintained over or equal to 1.0×104 copies/mL after 48 weeks. These patients received the optimized treatment of ADV (10 mg, one time per day) combined with LAM (100 mg, one time per day). Patients′ responses to the treatment at the 12th and 24th week were observed. Results Compared with baseline, ADV plus LAM had an improved response rate of virological response, biochemical response and HBeAg/HBeAb seroconversion. No LAM-resistant or ADV-resistant mutations were detected. In all the 26 patients, no adverse reactions were observed. Conclusion Optimized therapy combining LAM and ADV can be a good choice for patients with hepatitis B who have a poor response to ADV monotherapy.
ObjectiveTo study the value of hepatitis B virus surface antigen (HBsAg) in the evaluation of antiviral efficacy and its influencing factors under a complex population background resulting from various nationalities in Xinjiang. MethodsWe retrospectively analyzed patients with chronic hepatitis B (CHB) admitted and administrated with nucleot(s)ide analogues (NAs) for the first time in Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region from January 2012 to August 2013. The biological, virological, and serological responses were analyzed as well as the possible factors related to HBsAg levels and its reduction levels. ResultsThere were 63 CHB patients enrolled. After 48 weeks' treatment, all patients achieved biological response, and 59 of them achieved complete virological response in spite of 4 patients with partial response. In all the 30 hepatitis B virus e antigen (HBeAg) positive patients, 5 achieved HBeAg seroconversion. After correlation and regression analysis, it turned out that the history (P=0.033) and HBeAg levels at week 48 (P<0.001) were independent impact factors for HBsAg level at week 48. And the reduction degree of HBsAg at week 48 was influenced by HBsAg at week 48. In 21 patients counting to week 72 maintaining biological response, 18 achieved complete virological response. Unfortunately, all 8 HBeAg positive patients encountered no HBeAg loss or seroconversion. After correlation and regression analysis, it turned out that HBsAg level at week 72 was influenced by HBsAg at week 48 (r=0.700, P<0.001). And the decline degree of HBsAg at week 72 was related to baseline HBsAg level. ConclusionSatisfactory efficacy can be achieved via NAs treatment in CHB patients. But when HBsAg is used separately as an indicator for therapeutic efficacy, we should be aware that intrahepatic covalently closed circular DNA (cccDNA) is not only the impact factor of HBsAg variation, the history, the variations of HBeAg and HBsAg itself during the treatment should also be considered.
目的 观察茵陈柴平汤治疗重度慢性乙型肝炎的疗效及不良反应。 方法 2009年3月－2010年3月，选择采用茵陈柴平汤联合常规保肝药物治疗50例重度慢性乙型肝炎患者（治疗组），并与50例仅用常规保肝药物治疗的重度慢性乙型肝炎患者（对照组）进行比较，观察治疗2、4周时的临床症状、肝功能及凝血酶原活动度等指标的变化。 结果 治疗2、4周时，治疗组在肝功能及凝血酶原活动度等指标均有显著改善，无严重不良反应；4周时，治疗组的症状缓解率（84%）明显高于对照组（66%）；其总有效率（96%）亦高于对照组（80%）。 结论 茵陈柴平汤治疗重度慢性乙型肝炎具有较好的临床疗效，且无严重不良反应。
Objective To evaluate the effectiveness and safety of Gansu for chronic hepatitis B. Methods We searched The Cochrane Central Register of Controlled Trials (CCTR), PubMed, EMbase, CBM, CNKI, VIP, and Wanfang databases up to Dce. 2009. The methodological quality assessment and data extraction of the included studies were conducted by two reviewers independently according to the inclusion and exclusion criteria. Meta-analyses were performed for homogeneous studies using RevMan 4.2.10 software. Results A total of 14 studies involving 1 755 patients met the inclusion criteria. Of which, 12 studies did not report randomization method, and the other two studies reported inadequate methods of randomization. None of the studies enforced allocation concealment and performed blinding. We conducted subgroup analyses based on the outcome measures and interventions. The results of meta-analyses showed: (1) In terms of reducing ALT, Gansu + conventional therapy was superior to conventional therapy alone. (2) In terms of the HBsAg seroconversion rate, no significant difference was found between the two groups. (3) In terms of the HBeAg, no significant difference was found between the two groups at 3 months’ follow-up. (4) In terms of the HBV-DNA, Gansu + conventional therapy was superior to conventional therapy alone at 3 and 6 months’ follow-up, but theses differences were not found between Gansu + Lamivudine/ Adefovir and Lamivudine/ Adefovir alone. In terms of reducing the index of hepatic fibrosis, Gansu + conventional therapy was superior to conventional therapy alone. Conclusion Gansu might be effective in normalizing ALT levels, clearing HBV DNA, achieving virus seroconversion and improving hepatic fibrosis, without any serious adverse effects. However, because the overall effects cannot be pooled for analysis, more evidence is needed to support this finding.
Objective To compare adefovir monotherapy with adefovir-thymosin alpha-1 combination therapy for chronic hepatitis B. Methods We searched The Cochrane Library, MEDLINE, PubMed, the Chinese Biomedical Database (CBM), CNKI, Wanfang, and VIP databases up to February 2010 to identify randomized controlled trials (RCTs) comparing adefovir plus thymosin alpha-1 versus adefovir alone for chronic hepatitis B. We also scanned references of all included studies and pertinent reviews. The methodological quality assessment and data extraction were conducted by two reviewers independently according to the Cochrane Reviewer’s Handbook 5.0.2 . Meta-analyses were performed using RevMan 5.0 software. Results Eleven trials involving 895 patients were included. The results of meta-analyses shoued: the HBeAg seroconversion rate of the combination therapy group was higher than that of the monotherapy group, both at the sixth month and the twelfth month (RR=1.77, 95%CI 1.38 to 2.27; RR=1.74, 95%CI 1.44 to 2.10); and there were also significant differences between the two groups for secondary outcomes including HBV-DNA negative, ALT normalization, etc.Conclusion Adefovir-thymosin alpha-1 combination therapy might be more effective than adefovir monotherapy for chronic hepatitis B. Significant differences are even observed at the sixth month. However, the results should be interpreted with caution because of the low quality of the included studies. High-quality, large-scale RCTs are needed to further prove the results.
Objective To evaluate the effectiveness and safety of foscarnet sodium in the treatment of chronic hepatitis B. Methods We searched MEDLINE, EMbase, The Cochrane Library and CNKI from 1978 to June 2006. Randomized controlled trials of foscarnet sodium versus other drugs or no drugs in the treatment of chronic hepatitis B were identified. The quality of the included trials was evaluated by two reviewers independently. Meta-analysis was done using The Cochrane Collaboration’s RevMan 4.2.7. Results Seven studies (337 patients) were included; one compared foscarnet sodium versus interferon, and the other six compared foscarnet sodium versus no drugs. All the included studies were graded in terms of the quality of randomization, allocation concealment and blinding. All 7 studies were graded as level C. The meta-analysis showed that: ① foscarnet sodium was not significantly different from interferon in clinical efficacy, liver function, negative-conversion rate of virological markers and side effects. ② compared with the no drugs group, the negative-conversion rate of virological markers was significantly higher for the foscarnet sodium group, HBeAg (RR 6.20, 95%CI 1.76 to 21.79) and HBV-DNA (RR 4.13, 95%CI 1.32 to 12.86); but there were no significant differences in clinical efficacy, liver function and side effects. Conclusions Available evidence shows that: in the treatment of chronic hepatitis B the effectiveness and safety of foscarnet sodium are not significantly different from interferon, but only one trial is included in this review, so the evidence is weak. Compared with no drugs, foscarnet sodium significantly improves the negative-conversion rate of virological markers, but the evidence is insufficient to show whether foscarnet sodium could improve clinical efficacy and liver function, as well as reduce side effects.