Table of Content

31 December 2016, Volume 21 Issue 12

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Several issues regarding prevention of mother-to-child transmission of hepatitis B virus

Chinese Journal of Hepatology, Journal of Clinical Hepatology, and Chinese Hepatology

2016, 21(12):  1013-1015. 

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Mother-to-child transmission (MTCT) is the major route of transmission of hepatitis B virus (HBV), especially areas withhigh prevalence rates. Injection of hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine for infants at birth, followed by completevaccination, can prevent HBV transmission to infants in 95% of HBsAg-positive mothers. However, immunoprophylaxis failure is still observed in 5%~10% infants born to mothers with high-level viremia. It has been demonstrated that nucleos(t) ide analogues for pregnant women with a high viral load in late pregnancy as antiviral therapy can further reduce MTCT of HBV. This article discusses the criteria of antiviral therapy for the prevention of MTCT, including the threshold of HBV DNA level in pregnant women, time of the start of treatment, time of drug withdrawal, type of drugs, and inoculation route of hepatitis B vaccine.

Original Articles

Research on life quality in patients with nonalcoholic fatty liver diseases

TAO Ye-ting, YAN Shi-yan, CHEN Guang-yu, PAN Qin, CHEN Yuan-wen, FAN Jian-gao

2016, 21(12):  1017-1022. 

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Objective To discuss the association between nonalcoholic fatty liver disease (NAFLD) and health-related quality of life (HRQoL). Methods Three hundred and nineteen adults who had physical examinations and sixty-four patients with liver diseases except NAFLD (89.1% were chronic hepatitis B, CHB) were enrolled. Measurements of controlled attenuation parameter (CAP), liver stiffness measurement (LSM), and serum transaminase were performed for NAFLD screening. HRQoL were assessed by short form health survey (SF-36). Results In NALFD group, scores of physical function (PF) (90.22±12.83), role-physical (RP) (84.41±28.05), general health (GH) (65.67±19.75) and vitality (VT) (75.00±15.69) were significantly lower than those in healthy control group (84.90±14.34, 75.63±34.20, 55.02±18.73 and 69.82±15.32, all P<0.05), but not obviously different from those in non-NALFD liver disease group (82.58±19.07, 56.64±43.47, 52.06±19.42 and 66.02±19.80, all P>0.05). There was a statistically significant decreasing tendency in PF (90.22±12.83 vs 83.41±15.25 vs 86.10±13.51), GH (65.67±19.75 vs 55.03±20.60 vs 55.00±17.16) and VT scores (75.00±15.69 vs 69.77±14.84 vs 69.86±15.76) from healthy control group to mild hepatic steatosis group, to moderate and severe hepatic steatosis group (all P<0.05). Additionally, PF (87.33±13.84 vs 86.40±15.58 vs 77.73±12.51), RP (79.27±32.18 vs 76.75±35.94 vs 60.23±37.53), body pain (BP) (80.31±20.01 vs 76.61±20.07 vs 66.59±25.01), GH (59.63±19.78 vs 55.61±20.40 vs 47.82±20.72) and VT scores (72.77±15.16 vs 70.96±15.60 vs 63.86±19.27) showed significantly downward trends from fibrosis-free group to fibrosis group, and to cirrhosis group (all P<0.05). In NAFLD patients, obesity group had significantly lower scores in VT (73.06±14.69 vs 68.33±15.42) and health transition (HT) (47.58±17.94 vs 41.11±20.59) than non-obesity group (P<0.05). Compared with normal aminotransferase group, elevated aminotransferase group had significantly lower scores in GH and VT (59.82±20.72 vs 52.84±18.59, 73.18±16.26 vs 68.36±14.59, all P<0.05). Conclusion Similar to non-NAFLD liver disease patients that mainly composed of CHB, NAFLD patients showed a severe impairment in HRQoL.

Clinical features of alcoholic liver failure

QIAO Yan, LV Sa, LI Chen, LIU Wan-shu, WANG Hai-bo, TIAN Hua, GUO Cong, YOU Shao-li, ZHU Bing, LI Jin

2016, 21(12):  1023-1026. 

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Objective To investigate the clinical features and prognosis of patients with alcoholic liver failure. Methods A total of 456 patients diagnosed of alcoholic liver failure from January 2010 to May 2015 in our hospital were enrolled, and the clinical features and prognosis were retrospectively analyzed. Comparisons of clinic characteristics and prognosis between the 456 patients and another 394 patients with HBV related acute-on-chronic liver failure (HBV-related ACLF) during the same period were carried out. Results These alcoholic liver failure patients, including 98.25% males and 1.75% females, were with an average age of 47.68 ± 9.35 ranging from 18 to 86 years old. Patients aging from 40 to 60 accounted for the majority (69.74%). The proportion of alcoholic liver failure was increasing yearly, and alcoholic liver failure had become the second predominant cause of liver failure. Comparing with HBV-related ACLF patients, patients with alcoholic liver failure showed significantly lower model for end stage liver disease (MELD) score, hospital stay and levels of albumin(Alb), hemoglobin(Hb), blood platelet (PLT) and cholinesterase (CHE) in patients with alcoholic liver failure were significantly lower, respectively (P=0.000). However, there were no significant difference between the two groups in age, total bilirubin (TBil) and direct/ total bilirubin (D/T), respectively (P=0.201, 0.094 and 0.567).Besides, the hospital mortality rate was higher in alcoholic liver failure group than that in HBV-related ACLF group (P=0.006). Conclusion Hospitalization rates for alcoholic liver failure is on rise year by year, and those patients mainly aging 40~60 years old with relatively poor prognosis.

Retrospective clinical analysis of the treatment efficacy of ursodeoxycholic acid in chronic drug-induced liver injury

GAO De-Yong, LIU Liang-Ming, LI Guo-Xia, WANG Ying-Ying, WANG Yan-Yan, XU Guo-Rong, WU Jian-Qing, XIA Li-Ping

2016, 21(12):  1027-1029. 

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Objective To investigate the treatment efficacy of ursodeoxycholic acid (UDCA) in chronic drug-induced liver injury (DILI) and its histopathology characteristics. Methods In the retrospective analysis, 49 cases were divided into treatment group who received UDCA (750 mg/d) combined with basic therapy, and control group who received only the basic therapy. Therapeutic efficacy and liver function indicators were observed at month 3 and 6. Cure rates in the 2 groups were evaluated at month 6, and liver biopsies were conducted in patients who failed to response to the therapy for evaluating the histopathology progress. Results In treatment group, mean levels of total bilirubin (TBil), alkaline phosphatase (ALP), and gamma-glutamyl transpeptidase (GGT) were 56.17 μmol/L and 19.42 μmol/L, 129.64 U/L and 72.79 U/L, 101 U/L and 71 U/L at month 3 and 6, respectively, which were significantly lower than that in control group (P<0.05). However, alanine aminotransferase (ALT) level showed no significantly difference between the 2 groups (P>0.05). Treatment group showed significantly higher therapeutic efficacy than control group at month 3 (P<0.05), but not at month 6 (P>0.05). Nevertheless, the non-response rate in treatment group (8.7%) was obviously lower than that in control group at month 6 (23.1%) (P<0.05). The histopathology appeared to be portal area inflammation accompanied with hepatocyte adipose degeneration in treatment group, while portal bile duct hyperplasia, hepatic steatosis and hepatocyte cholestasis in control group. Conclusion UDCA could effectively improve liver function and reduce inflammation and cholestasis in patients with chronic DILI, and then increases the cure rate and postpones the histopathology progress of liver tissue.

Evaluation of right ventricular myocardial function in patients with liver cirrhosis using 3D speckle tracking imaging

QIAN Rong, XIONG Ai-min, YANG Wei-zhong, WANG Xiu-mei, LIU Ping, LIU Wen-jie, CHEN Ting-ting, ZHOU Zhu, XIE Yan-chun, KE Jing-jing, LI Jing, XU Xiao-ting, YANG Jun

2016, 21(12):  1030-1032. 

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Objective To investigate the application value of three-dimensional speckle tracking imaging (3D-STI) in evaluating myocardial function of right ventricle in patients with liver cirrhosis. Methods Forty-seven patients with liver cirrhosis were divided into group A, B and C according to Child-pugh score, and 30 healthy volunteers were enrolled as control group. 3D-STI was applied to analyze general area strain (GAS), area strain (AS) and area strain dyssynchrony index (ASDI) of all myocardial segments in different groups. Right ventricular ejection fraction (RVEF) were measured by echocardiography in all groups. Results There was no significant difference in all indexes between group A and control group. In terms of some myocardial segments, group B showed high levels of GAS, AS and ASDI than control group and group A (P<0.05), but no significant difference in RVEF than control group. Group C showed significantly lower levels of GAS, AS and RVEF than control group and group A (both P<0.05), but higher level of ASDI (P<0.05). Conclusion Liver cirrhosis could lead to myocardial damages of right ventricle, which could be effectively assessed by STI in different stages of liver cirrhosis.