Chinese Hepatolgy

Baseline platelet as an independent predictor for clinical outcome after antiviral therapy in compensated HBV-related cirrhosis patients

WU Xiao-ning, ZHANG Wei, ZHOU Jia-ling, WANG Lin, SUN Ya-meng, MENG Tong-tong, GUAN Qiu-shuang, WANG Bing-qiong, CHEN Shu-yan, SHI Yi-wen, WANG Xiao-ming, YOU Hong, OU Xiao-juan, JIA Ji-dong

2018, 23(7): 576-579.

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Objective To investigate baseline indicators which could be predictors for liver-related events (LRE) after antiviral therapy in compensated hepatitis B virus (HBV) -related cirrhosis patients. Methods A prospective cohort of compensated HBV-related liver cirrhosis patients were followed up for observation of LRE. According to whether LRE occurred or not, patients were divided into LRE group and non-LRE group. Results A total of 106 patients with compensated HBV-related cirrhosis were recruited and followed up for 3 years. There were 18 patients (17.0%) developing LRE after 3-year follow-up, whose baseline platelet counts were lower than those in patients without LRE (P<0.05). The Cox proportional hazards model showed that baseline platelet was an independent predictor for LRE. Furthermore, the platelet counts increased more dramatically in patients without LRE than those in patients with LRE after antiviral treatment (P<0.05). HBV DNA decreased significantly in both groups after treatment, without significant difference between 2 groups. Conclusion Baseline platelet is an independent predictor for LRE in patients with compensated HBV-related cirrhosis who received antiviral therapy.

MRI features of solitary necrotic nodule in liver

SHI Fang-fang, HU Hai-dong, ZHENG Zeng, AN Wei-min

2018, 23(7): 580-582.

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Objective To investigate the features and differential diagnosis of liver solitary necrotic nodules (SNNs) in both plain and dynamic contrast-enhanced magnetic resonance imaging (MRI) scan in order to improve the diagnosis of SNN. Methods Thirty-four patients with biopsy confirmed SNN from 2012 to 2017 in our hospital were analyzed retrospectively. The lesions in both plain and enhanced MRI scan were evaluated. Results A total of 34 lesions were found, whose maximum diameter ranged from 0.7 to 4.9 cm. There were 7 lesions distributed in the left lobe, 24 in the right lobe and 3 in the tail lobe. In diffusion weighted imaging (DWI), 7 lesions showed hypointense signals, 8 showed isointense signals, and 19 showed hyperintense signals. On T1WI, 25 lesions showed slightly hypointense signals, 6 showed isointense signals, and 3 showed lightly hyperintense signals. On T2WI, 19 lesions showed slightly hypointense signals, 9 showed isointense signals, and 5 showed slightly hyperintense signals. The dynamic contrast-enhanced scan of 28 lesions showed no enhancement inside nodules but peripherally circular enhancement with clear edge in the portal phase and delayed phase. However, 3 lesions showed no enhancement in all phases. Besides, the other 3 lesions show mild patchy enhancement in arterial phase, and peripheral enhancement with separation-like enhancement in the delayed phase. Conclusion The characteristic features of SNNs in dynamic contrast-enhanced MRI scan are peripherally circular enhancement with clear edge, which is valuable in the diagnosis of SNN.

Clinical characteristics of HBeAg-positive chronic hepatitis B patients developed telbivudine resistance

JIN Kun, LIU Qiu-xia, WANG Lei

2018, 23(7): 583-586.

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Objective To investigate clinical characteristics of hepatitis B e antigen (HBeAg) -positive chronic hepatitis B (CHB) patients developed telbivudine resistance. Methods Clinical data of HBeAg-positive CHB patients receiving telbivudine monotherapy at baseline, during treatment and at virological breakthrough was analyzed for investigating clinical characteristics of telbivudine resistance. Results The median time of virological breakthrough occurrence in patients developed telbivudine resistance was 78 weeks. Levels of serum hepatitis B virus (HBV) DNA and alanine aminotransferase (ALT) were significantly lower in patients at virological breakthrough than that at baseline. There was a significant difference in HBV DNA levels between patients with single-site and multiple-site drug resistance mutations when virological breakthrough occurred (u=315.50, P=0.03). Eight drug resistance mutation sites and 11 combination patterns were detected, all containing M204I site mutation. Between telbivudine-resistant group and control group, there were statistically significant differences in age, gender, baseline levels of HBeAg and ALT. Rates of HBV DNA undetectable, HBeAg loss and HBeAg seroconversion in telbivudine-resistant group were significantly lower than those in control group at week 12 and week 24, respectively. Conclusion Patients of older age, male gender, lower baseline levels of HBeAg and ALT were predisposed to develop telbivudine resistance. However, patients who achieved virological and serological response in the early stages are unlikely to develop telbivudine resistance.

Efficacy and safety of sofosbuvir / daclatasvir with ribavirin in the treatment of hepatitis C cirrhosis: a real-world study

LIU Li, LI Jun-yi, DU Ying-rong, LIU Chun-yun, LI Wei-kun, WANG Hui, LI Hui-min, CHANG Li-xian, QI Yan-wei

2018, 23(7): 587-590.

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Objective To observe the efficacy and safety of sofosbuvir / daclatasvir with ribavirin in the treatment of hepatitis C cirrhosis. Methods From May 2016 to May 2017 in our hospital, there were 129 patients with hepatitis C cirrhosis receiving 12-week sofosbuvir / daclatasvir with ribavirin therapy. Patients were followed up for 12 weeks after antiviral treatment, and sustained virologic response at week 12 post-treatment (SVR12), biochemical response, improvement of hepatic fibrosis and adverse reactions during treatment were observed. Results HCV RNA of the 129 patients was (5.9±1.33) lgIU/mL at baseline and (1.67±1.24) lgIU/mL after 2-week treatment. Among the patients, HCV RNA was undetectable in 75.78% patients after 2-week treatment and in 93.44% patients after 12-week treatment. FibroScan measurement of the patients was (17.57±9.86) at baseline and decreased to (8.32±1.47) at week 12 (t=15.852, P=0.000). Serum levels of total bilirubin (TBil), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were significantly decreased at week 2 compared to those at baseline, respectively (t=2.408, P=0.017; t=11.054, P=0.000; t=12.227, P=0.000). Besides, biochemical response reached 100%. Multivariate regression analysis of 6 patients without SVR12 showed that retreatment was an independent predictor. No serious adverse reactions occurred with fatigue and headache being the main adverse reactions. Conclusion The patients with hepatitis C cirrhosis who received sofosbuvir / daclatasvir with ribavirin therapy achieved very high SVR12 rate, high biochemical response rate and significant improvement of liver fibrosis with good safety.

Effects of short chain fatty acids on metabolism of glucose and lipid in obese mice induced by high fat diet

LIU Qian, CHENG Chen, XIN Xin, HU Yi-yang, FENG Qin

2018, 23(7): 591-595.

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Objective To observe the effects of short chain fatty acids (SCFAs) on metabolism of glucose and lipid in obese mice induced by high fat diet (HFD), and to investigate the possible mechanisms from the perspective of intestinal epithelial barrier function. Methods Forty C57BL/6J mice were equally randomly divided into normal diet (ND) group, HFD model group, SCFAs treatment (HFD+SCFAs) group and lactulose (LA) treatment (HFD+LA) group. Mice were fed a HFD for 14 weeks, and treated with corresponding drugs or distilled water since week 10. After 4-week treatment, mice were sacrificed for observing body weight, food intake, liver weight, ratio of liver weight to body weight, morphology and diameter of adipocytes after epididymis, fasting plasma glucose (FBG), fasting serum insulin (FINS), homeostatic model assessment insulin resistance (HOMA-IR), serum triglyceride (TG), serum cholesterol (TC), low density lipoprotein, hepatic TG, serum alanine aminotransferase, aspartate aminotransferase, and hepatic and colonic tissue pathological changes. Results The body weight, liver weight, ratio of liver weight to body weight, FBG, FSI, HOMA-IR, serum TG, serum TC and hepatic TG in HFD+SCFAs group were significantly lower than those in the HFD group (P<0.01). SCFAs was superior to LA in reducing FSI, HOMA-IR, serum TG, serum TC, and hepatic TG (P<0.01 or P<0.05). Moreover, hepatic steatosis, inflammation and ballooning were significantly improved in HFD+SCFAs group than those in HFD group, and disease activity score was decreased (P<0.01). SCFAs intervention could significantly improve colonic pathology, including colonic epithelial damage, glandular disorder and inflammatory cell infiltration induced by HFD. Conclusion SCFAs can effectively reduce body weight, improve the metabolism of glucose and lipid and decrease hepatic fat deposition in obese mice induced by HFD. Reducing intestinal inflammatory response and enhancing intestinal epithelial barrier function maybe one of the possible mechanisms.

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