Objective To evaluate the effect and safety of Yinzhihuang injection for icteric viral hepatitis. Methods We searched MEDLINE (1966 to 2005), The Cochrane Library (Issue1, 2005), CBMdisk (1978 to 2004), CMCC (1994 to 2005), CMAC (1994 to 2005), CNKI (1994 to 2005), VIP (1989 to 2004). Data were extracted by two reviewers using a designed extraction form. The quality of included trials was critically assessed. RevMan 4.2.7 was used for data analysis. Results Four randomized controlled trials were included. It showed that Yinzhihuang injection could abate jaundice better than or the same as controlled western medicine in patients with hepatitis (WMD 19.70, 95%CI 32.69 to 6.71 and WMD 1.27, 95%CI 3.08 to 0.54, respectively), but less than S-adeanosyl methionine in patients with chronic hepatitis (WMD 106.00, 95%CI 189.05 to 22.95). There may be a dose-effect relationship in Yinzhihuang injection, higher doses had better effect (WMD 11.50, 95%CI 16.53 to 6.47). No fatal side effects were reported.Conclusions It is noted that Yinzhihuang injection can abate jaundice of icteric viral hepatitis. Due to low statistical power and high risk of selection bias, performance bias and measurement bias of the included trials, these conclusions need to be treated cautiously.
【Abstract】ObjectiveTo investigate the relationship of magnetic resonance diffusion-weighted imaging (DWI) to histology in the patients of chronic viral hepatitis. MethodsThirty-five patients of chronic viral hepatitis who received liver biopsy and 10 healthy volunteers were included in this study. All of them underwent DWI on a 3.0T MRI device. Apparent diffusion coefficient (ADC) of the liver were measured respectively when b value were set as 100, 400, 600 and 800 s/mm2. Biopsy specimens were scored for fibrosis and necroinflammation according to the Knodell histology activity index (HAI). ResultsWhen b value was set as 800 s/mm2, statistical difference was showed between the fibrosis group and the nonfibrosis group, statistical difference was also shown among the different degrees of necroinflammation and fibrosis. ConclusionDWI is a valuable method for grading and staging of chronic viral hepatitis.
At present, the most commonly used nucleoside (acid) anaog (NAs) treatment regimen in clinical practice cannot completely cure chronic viral hepatitis B (CHB). However, although the polyethylene glycol interferon treatment regimen is superior to the NAs regimen in terms of immune mechanism, it has the disadvantage of low hepatitis B virus DNA response rate. In recent years, the cure of CHB is being studied all over the world. Various mechanisms and drug targets are being explored, and diversified therapeutic strategies are also being used. Clinical cure of hepatitis B is possible, but it is still in the early stage, and many potential drugs and better therapeutic strategies are still being tested. This article mainly reviews the latest progress in the treatment of CHB based on the recent research achievements in direct antiviral drugs and host immunotherapy as well as the research progress in combination therapy.
【Abstract】Objective To investigate the CT manifestations of chronic virus hepatitis B. Methods According to the inclusion and exclusion criteria, the clinical data and laboratory information of 120 patients with chronic virus hepatitis B were reviewed retrospectively. All patients underwent standardized contrast-enhanced spiral CT dual-phase scanning of the upper abdomen. The changes of the liver, bile duct, spleen, portal venous system, lymph node of the upper abdomen, peritoneal cavity and pleural cavity were observed and noted. Results CT manifestations of chronic virus hepatitis B were as follows: ①changes of the configuration and shape of the liver, ② changes of the density of the liver, ③intrahepatic perivascular lucency, ④thickening of gallbladder wall and edema of the gallbladder fossa, ⑤splenomegaly, ⑥enlargement of abdominal lymph nodes, ⑦ascites, ⑧abnormalities related to portal hypertension (collateral circulation), and ⑨secondary thoracic changes (pleural and pericardial effusion). Conclusion Chronic virus hepatitis B can demonstrate several abnormal findings involving the liver, gallbladder, lymph nodes, spleen, etc on contrast-enhanced CT scanning.
Objective To evaluate the quality of studies assessing the value of serum hyaluronic acid in the diagnosis of liver fibrosis, to analyze the sources of bias and variation, and to estimate the accuracy of serum hyaluronic acid in diagnosing early liver cirrhosis and liver fibrosis in patients with chronic viral hepatitis.Methods We searched MEDLINE (1966 to June 2006), EMbase (1974 to June 2006), CBMdisc (1978 to April 2005), CNKI (2005 to June 2006) and VIP (2005 to June 2006) for studies assessing the diagnostic value of serum hyaluronic acid for liver fibrosis in patients with chronic viral hepatitis. We checked the references in the reports of included studies. QUADAS items were used for quality assessment. Meta-disc software was used to analyze sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic test odds ratio for the pooled analysis and heterogeneity test. DPS2005 software was used to draw SROC curves for those without heterogeneity. Results In total 24 studies were included: 12 published in Chinese and 12 published in English. Results of the pooled analysis showed that, as for radioimmunoassay (RIA), the pooled LR+ of the studies involving the diagnosis of liver cirrhosis and the differentiation of absent/present liver fibrosis were 7.029 and 3.608; and the pooled LR- were 0.198 and 0.319, respectively. As for enzyme-linked immunosorbent assay (ELISA), the pooled LR+ of the studies involving the diagnosis of liver cirrhosis, the differentiation of mild/severe and absent/present liver fibrosis were 6.093, 9.806 and 4.308; and the pooled LR- were 0.354, 0.347 and 0.563, respectively. Conclusion The biases identified from the 24 studies are mainly due to reference standard review bias. By both RIA and ELISA methods, serum hyaluronic acid has a sound value in diagnosing live cirrhosis. Its value in differentiating absent/present liver fibrosis is also acceptable. However, its value in differentiating mild/severe liver fibrosis needs to be further studied.
ObjectiveTo explore the predictive value of serum prothrombin induced by vitamin K absence-Ⅱ (PIVKA-Ⅱ) detection for the biological characteristics of hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC).MethodsThis retrospective study included 394 patients with HBV-related HCC who were newly diagnosed and treated with surgical resection in West China Hospital of Sichuan University between June 2017 and December 2018. Their clinical information such as tumor size, tumor number, tumor cell differentiation, presence of microvascular invasion (MVI), distant metastasis, and portal vein tumor thrombus was collected from the medical record. The laboratory test results of patients during diagnosis and before surgery were collected, including alpha-fetoprotein (AFP), PIVKA-Ⅱ, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (γ-GGT), etc., and the relationships between PIVKA-Ⅱ levels and tumor biological characteristics were analyzed. Non-normal continuous variables were presented as medium (lower quartile, upper quartile).ResultsCompared with the patients with low HCC serum PIVKA-Ⅱ levels (≤40 mAU/mL), patients with high serum PIVKA-Ⅱ levels (>40 mAU/mL) had larger tumor diameters [5.00 (3.00, 9.00) vs. 2.50 (1.63, 4.95) cm, P<0.001], more severe Barcelona Clinic Liver Cancer (BCLC) stage (P<0.001), and higher AFP [186.05 (6.86, 1 210.00) vs. 17.83 (4.33, 231.95) ng/mL, P<0.001], ALT [38.00 (26.00, 66.25) vs. 32.00 (22.00, 51.00) U/L, P=0.018], AST [42.00 (30.00, 76.00) vs. 34.00 (25.50, 48.25) U/L, P<0.001], and γ-GGT [71.00 (39.00, 165.50) vs. 55.50 (25.00, 93.00) U/L, P=0.005], and were more likely to form portal vein tumor thrombi (16.61% vs. 3.75%, P=0.003) and MVI (43.67% vs. 11.11%, P<0.001). In BCLC stage 0 HCC patients, the positive rate of PIVKA-Ⅱ was only 51.35%. Multivariate logistic regression analysis showed that PIVKA-Ⅱ>40 mAU/mL was an independent predictor of MVI [odds ratio=6.588, 95% confidence interval (CI) (1.645, 26.383), P=0.008]. The area under receiver operating characteristic curve of PIVKA-Ⅱ level predicting MVI was 0.761 [95%CI (0.693, 0.830)], with a sensitivity of 66.22% and a specificity of 79.06%.ConclusionIn HBV-related HCC patients, high PIVKA-Ⅱ is associated with the poor biological characteristics of tumor, and is an independent risk factor for tumor MVI.
ObjectiveTo systematically review the efficacy and safety of interferon-alpha (IFN-α) combined with enticavir (ETV) for treatment-naïve chronic hepatitis B (CHB) patients, so as to provide references for clinical practice. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 7, 2015), Web of Science, WanFang Data, CNKI, CBM and VIP from inception to July 20th, 2015, to collect randomized controlled trials (RCTs) about IFN-α combined with ETV versus IFN-α or ETV monotherapy for treatment-naïve CHB patients. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 RCTs involving 964 patients were included. The results of meta-analysis showed that:For HBV-DNA loss rate, HBeAg loss rate and HBeAg seroconversion rate, there were no significant differences between the combination therapy group and the monotherapy group at 12-week of treatment, but the combination therapy group was significantly superior to the monotherapy group at 24-and 48-week of treatment except that there was no significant difference between the combination therapy group and the IFN-α monotherapy group in HBeAg seroconversion at 48-week of treatment. For rate of ALT normalization, the combination therapy group was superior to the IFN-α monotherapy group at 12-and 24-week of treatment, but there were no significant differences between the combination therapy group and the ETV monotherapy group at 12-, 24-, and 48-week of treatment. For safety, no pooled analysis was performed because different outcomes were reported by included studies. ConclusionIFN-α combined with ETV is superior to IFN-α or ETV monotherapy in decreasing viral load, and promoting HBeAg loss and HBeAg seroconversion for treatment-naïve CHB patients, but the evidence of safety is insufficient. Due to the limited quantity and quality of included studies, the aforementioned conclusions still need to be further verified by conducting more large-scale, high quality RCTs.
Objective To assess the efficacy of telbivudine in the treatment of chronic hepatitis B (CHB). Methods Randomized controlled trials (RCTs) of telbivudine therapy vs. lamivudine therapy in both Chinese and English were retrieved from seven electronic databases with a cut-off date in February 2010, including PubMed, EMbase, VIP, CBM, CNKI, and The Cochrane library. The meta-analyses and evaluation on methodology quality were performed for the included studies. Results Two RCTs as Grade-A study were included. The meta-analyses showed that telbivudine was superior to lamivudine in aspects of therapeutic response (RR=1.28, 95%CI 1.10 to 1.48, P=0.001), ALT normalization (RR=1.12, 95%CI 1.01 to 1.23, P=0.02), and PCR-negative HBV DNA or below the lower limit (RR=1.44, 95%CI 1.36 to 1.53, Plt;0.000 01), primary treatment failure (OR=0.28, 95%CI 0.18, to 0.43, Plt;0.000 01), viral breakthrough (OR=0.38, 95%CI 0.32 to 0.47, Plt;0.000 01) and viral resistance (OR=0.44, 95%CI 0.36 to 0.55, Plt;0.000 01). Conclusion Based on the current clinical evidence, telbivudine demonstrates superiority in comparison with lamivudine on all direct measures of antiviral efficacy for CHB. Because of the short follow-up duration and the small sample size of the included studies, it is expected to further discuss the long-term efficacy.