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World Journal of Stem Cells 2018年第10期10卷 138-145页

作者： Ming-Fang Wang You-Bing Li Xiao-Juan Gao Hao-Yang Zhang Su Lin Yue-Yong Zhu Liver Center the First Affiliated HospitalFujian Medical UniversityFuzhou 350005Fujian ProvinceChina Fujian Provincial Governmental Hospital Fuzhou 350001Fujian ProvinceChina School of Biological Sciences the University of Hong KongHong KongChina

AIM To evaluate the long-term efficacy and safety of autologous stem cell transplantation(SCT) for decompensated liver *** Consecutive patients with decompensated liver cirrhosis were included and assigned into the SCT group and non-transplantation(non-SCT) group according to whether they received SCT treatment. Patients werefollowed up for ten years. The long-term survival rate and incidence of hepatocellular carcinoma(HCC) were compared between groups.

关键词： decompensated liver cirrhosis Stem cell transplantation Hepatocellular carcinoma Propensity score matching

Acute kidney injury in acute-on-chronic liver failure is different from in decompensated cirrhosis

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World Journal of Gastroenterology 2018年第21期24卷 2300-2310页

作者： Qun-Qun Jiang Mei-Fang Han Ke Ma Guang Chen Xiao-Yang Wan Semvua Bukheti Kilonzo Wen-Yu Wu Yong-Li Wang Jie You Qin Ning Department and Institute of Infectious Disease Tongji HospitalTongji Medical CollegeHuazhong University of Science and Technology

AIM To evaluate the differences in acute kidney injury(AKI) between acute-on-chronic liver failure(ACLF) and decompensated cirrhosis(DC) patients. METHODS During the period from December 2015 to July 2017, 280 patients with hepatitis B virus(HBV)-related ACLF(HBV-ACLF) and 132 patients with HBV-related DC(HBV-DC) who were admitted to our center were recruited consecutively into an observational study. Urine specimens were collected from all subjects and the levels of five urinary tubular injury biomarkers were detected,including neutrophil gelatinase-associated lipocalin(NGAL), interleukin-18(IL-18), liver-type fatty acid binding protein(L-FABP), cystatin C(CysC), and kidney injury molecule-1(KIM-1). Simultaneously, the patient demographics, occurrence and progression of AKI, and response to terlipressin therapy were recorded. All patients were followed up for 3 mo or until death after enrollment. RESULTS AKI occurred in 71 and 28 of HBV-ACLF and HBV-DC patients, respectively(25.4% vs 21.2%, P = 0.358). Among all patients, the levels of four urinary biomarkers(NGAL, CysC, L-FABP, IL-18) were significantly elevated in patients with HBV-ACLF and AKI(ACLF-AKI), compared with that in patients with HBV-DC and AKI(DC-AKI) or those without AKI. There was a higher proportion of patients with AKI progression in ACLF-AKI patients than in DC-AKI patients(49.3% vs 17.9%, P = 0.013). Fortythree patients with ACLF-AKI and 19 patients with DC-AKI were treated with terlipressin. The response rate of ACLFAKI patients was significantly lower than that of patients with DC-AKI(32.6% vs 57.9%, P = 0.018). Furthermore, patients with ACLF-AKI had the lowest 90 d survival rates among all groups(P < 0.001).CONCLUSION AKI in ACLF patients is more likely associated with structural kidney injury, and is more progressive, with a poorer response to terlipressin treatment and a worse prognosis than that in DC patients.

关键词： decompensated cirrhosis Acute-on-chronic liver failure Acute kidney injury Biomarker Etiology Treatment Prognosis

Scoring systems for prediction of mortality in decompensated liver cirrhosis: A meta-analysis of test accuracy

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World Journal of Clinical Cases 2018年第15期6卷 995-1006页

作者： Shi-Lan Wu Yi-Xiang Zheng Zheng-Wen Tian Meng-Shi Chen Hong-Zhuan Tan Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University Department of Infectious Diseases Xiangya Hospital Central South University

AIM To compare the accuracy of the scoring systems ChildTurcotte-Pugh(CTP), Model for End-stage Liver Disease score(MELD), MELD-Na, and MELD to Serum Sodium ratio(MESO) to predict the mortality in decompensated liver *** The PubMed, Web of Science, Cochrane Library, EMBASE, and Ovid databases were systematically searched from inception to September 2018 for relevant articles, and we evaluated the quality of the included studies. The accuracy of scoring systems was analyzed with Stata 12 and MetaDiSc *** Sixteen studies involving 2337 patients were included. The pooled areas under the summary receiver operating characteristic curves(AUROCs) of CTP, MELD, MELD-Na, and MESO to predict mortality were 0.81,0.78, 0.85, and 0.86, respectively. Within 3 mo, the AUROCs of CTP, MELD, and MELD-Na in predicting mortality were 0.78, 0.76, and 0.89, respectively. The AUROCs of CTP, MELD, and MELD-Na at 3 mo were 0.86, 0.78, and 0.86, respectively. The AUROCs of CTP, MELD, and MELD-Na at 6 mo were 0.91, 0.83, and 0.90, respectively. The AUROCs of CTP, MELD, and MELDNa at 12 mo were 0.72, 0.75 and 0.84, respectively. In cirrhotic patients with bleeding, the AUROCs of CTP and MELD were 0.76 and 0.88, *** MESO has the highest AUROC in all assessed scoring systems. Considering the different time points, MELDNa has good accuracy in predicting the mortality of decompensated liver cirrhosis. Compared to CTP, MELD is better in predicting variceal bleeding.

关键词： Liver cirrhosis decompensated Mortality Accuracy Meta-analysis

De novo combined lamivudine and adefovir dipivoxil therapy vs entecavir monotherapy for hepatitis B virus-related decompensated cirrhosis

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World Journal of Gastroenterology 2013年第37期19卷 6278-6283页

作者： Jiang-Shan Lian Lin-Yan Zeng Jian-Yang Chen Hong-Yu Jia Yi-Min Zhang Dai-Rong Xiang Liang Yu Jian-Hua Hu Ying-Feng Lu Ling Zheng Lan-Juan Li Yi-Da Yang State Key Laboratory for Diagnosis and Treatment of Infectious Diseases the FirstAffiliated HospitalZhejiang University School of Medicine

AIM:To compare efficacy of combined lamivudine(LAM)and adefovir dipivoxil(ADV)therapy with that of entecavir(ETV)monotherapy for hepatitis B virus(HBV)-related decompensated liver ***:A total of 120 na ve patients with HBVrelated decompensated cirrhosis participated in this *** patients were treated with combined LAM and ADV therapy(LAM+ADV group),while the other60 were treated with ETV monotherapy(ETV group)for two *** for liver and kidney function,alpha-fetoprotein,HBV serum markers,HBV DNA load,prothrombin time(PT),and ultrasonography or computed tomography scan of the liver were performed every1 to 3 *** measure ANOVA and theχ2test were performed to compare the efficacy,side effects,and the cumulative survival rates at 48 and 96 ***:Forty-five patients in each group were observed for 96 *** significant differences in HBV DNA negative rates and alanine aminotransferase(ALT)normalization rates at weeks 48(χ2=2.12 and 2.88)and96(χ2=3.21 and 3.24)between the two groups were *** B e antigen seroconversion rate in the LAM+ADV group at week 96 was significantly higher in the ETV group(43.5%vs 36.4%,χ2=4.09,P<0.05).Viral breakthrough occurred in 2 cases(4.4%)by week 48 and in 3 cases(6.7%)by week 96 in the LAM+ADV group,and no viral mutation was *** the ETV group,viral breakthrough occurred in 1 case(2.2%)at the end of week *** increase in albumin(F=18.9 and 17.3),decrease in total bilirubin and in ALT(F=16.5,17.1 and 23.7,24.8),reduced PT(F=22.7 and 24.5),and improved Child-Turcotte-Pugh and the model for end-stage liver disease scores(F=18.5,17.8,and 24.2,23.8)were observed in both *** cumulative rates of mortality and liver transplantation were 16.7%(10/60)and 18.3%(11/60)in the LAM+ADV and ETV groups,***:Both LAM+ADV combination therapy and ETV monotherapy can effectively inhibit HBV replication,improve liver function,and decrease mortality.

关键词： Chronic hepatitis B decompensated liver cirrhosis Lamivudine Adefovir dipivoxil Combination therapy Entecavir

Effects of entecavir and lamivudine for hepatitis B decompensated cirrhosis: Meta-analysis

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World Journal of Gastroenterology 2013年第39期19卷 6665-6678页

作者： Xiao-Guang Ye Qi-Min Su Department of Infectious Diseases the SecondAffiliated Hospital of Guangzhou Medical University

AIM:To compare the effects of entecavir(ETV)and lamivudine(LAM)for the treatment of hepatitis B decompensated cirrhosis using a ***:We conducted a literature search for all eligible studies published prior to May 30,2013 using PUBMED,MEDLINE,EMBASE,the China National Knowledge Infrastructure(CNKI),the VIP database,the Wanfang database and the Cochrane Controlled Trial *** controlled trials(RCTs)comparing ETV with LAM for the treatment of hepatitis B decompensated cirrhosis were *** data were analyzed with Review Manager Software *** used RR as an effect measure,and reported its95%*** meta-analysis was performed using either a fixed-effect or random-effect model,based on the absence or presence of significant *** reviewers assessed the risk of bias and extracted data independently and in *** analysis was executed using the main outcome parameters including hepatitis B virus(HBV)DNA undetectability,HBV DNA level,hepatitis B e antigen(HBeAg)seroconversion,alanine aminotransferase(ALT)level,albumin level,total bilirubin(TBIL)level,prothrombin time activity(PTA)level,Child-Turcotte-Pugh(CTP)score,mortality,drugresistance,and adverse ***-analysis of the included trials and subgroup analyses were conducted to examine the association between pre-specified characteristics and the therapeutic effects of the two ***:Thirteen eligible trials(873 patients in total)were included and evaluated for methodological quality and *** these studies,all had baseline comparability,12 of them reported baseline values of the two treatment groups in *** various treatment durations(12,24,36,48 and>48 wk),both ETV and LAM significantly reduced HBV DNA level,however,reductions were greater in the ETV group(MD=-0.66,95%CI:-0.83-0.50,P<0.00001),(MD=-0.93,95%CI:-1.36-0.51,P<0.0001),(MD=-1.4,95%CI:-1.78-1.01,P<0.00001),(MD=-1.18,95%CI:-1.90-0.46,P=0.001),(MD=-0.14,95%CI:-0.17-0.

关键词： Hepatitis B decompensated cirrhosis Entecavir Lamivudine Randomized controlled trial Metaanalysis.

Clinical impact of microbiome in patients with decompensated cirrhosis

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World Journal of Gastroenterology 2018年第34期24卷 3813-3820页

作者： Theodora Oikonomou George V Papatheodoridis Michael Samarkos Ioannis Goulis Evangelos Cholongitas Fourth Department of Internal Medicine Hippokration General Hospital Medical School of Aristotle University of Thessaloniki Academic Department of Gastroenterology Laiko General Hospital Medical School of National and Kapodistrian University of Athens First Department of Internal Medicine Laiko General Hospital Medical School of National and Kapodistrian University of Athens

Cirrhosis is an increasing cause of morbidity and mortality. Recent studies are trying to clarify the role of microbiome in clinical exacerbation of patients with decompensated cirrhosis. Nowadays, it is accepted that patients with cirrhosis have altered salivary and enteric microbiome, characterized by the presence of dysbiosis. This altered microbiome along with small bowel bacterial overgrowth, through translocation across the gut, is associated with the development of decompensating complications. Studies have analyzed the correlation of certain bacterial families with the development of hepatic encephalopathy in cirrhotics. In general, stool and saliva dysbiosis with reduction of autochthonous bacteria in patients with cirrhosis incites changes in bacterial defenses and higher risk for bacterial infections, such as spontaneous bacterial peritonitis, and sepsis. Gut microbiome has even been associated with oncogenic pathways and under circumstances might promote the development of hepatocarcinogenesis. Lately, the existence of the oral-gutliver axis has been related with the development of decompensating events. This link between the liver and the oral cavity could be via the gut through impaired intestinal permeability that allows direct translocation of bacteria from the oral cavity to the systemic circulation. Overall, the contribution of the microbiome to pathogenesis becomes more pronounced with progressive disease and therefore may represent an important therapeutic target in the management of cirrhosis.

关键词： Microbiome Dysbiosis Oral-gut-liver axis Hepatic encephalopathy decompensated cirrhosis Liver carcinoma

Antiviral drug resistance increases hepatocellular carcinoma:A prospective decompensated cirrhosis cohort study

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World Journal of Gastroenterology 2013年第45期19卷 8373-8381页

作者： Lei Li Wei Liu Yu-Han Chen Chun-Lei Fan Pei-Ling Dong Fei-Li Wei Bing Li De-Xi Chen Hui-Guo Ding Department of Gastroenterology and Hepatology Beijing You’an Hospital Affiliated with Capital Medical University Department of Internal Medicine Beijing Ji Shui Tan HospitalAffiliated with Peking University Viral Laboratory of Liver Diseases Research Institute Capital Medical University

AIM:To study the clinical outcome of antiviral therapy in hepatitis B-related decompensated cirrhotic ***:Three hundred and twelve patients with decompensated hepatitis B cirrhosis were evaluated in a prospective *** two years of follow-up,198patients in the group receiving antiviral therapy with nucleos(t)ide analogues and 39 patients in the control group without antiviral treatment were ***:Among the antiviral treatment patients,162had a complete virological response(CVR),and 36 were drug-resistant(DR).The two-year cumulative incidence of hepatocellular carcinoma(HCC)in the DR patients(30.6%)was significantly higher than that in both the CVR patients(4.3%)and the control group(10.3%)(Pdecompensated hepatitis B-related cirrhotic patients,especially in those who failed rescue therapy.

关键词： Hepatitis B decompensated cirrhosis Nucleos(t)ide analogues Hepatocellular carcinoma Drug resistance

Long term outcome of antiviral therapy in patients with hepatitis B associated decompensated cirrhosis

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World Journal of Gastroenterology 2018年第40期24卷 4606-4614页

作者： Young-Cheol Ju Dae-Won Jun Jun Choi Waqar Khalid Saeed Hyo-Young Lee Hyun-Woo Oh Department of Translational Medicine Graduate school of Biomedical Science and Engineering Hanyang University Department of Internal Medicine School of Medicine Hanyang University Department of Industrial Management Engineering Korea University

AIM To investigate survival rate and incidence of hepatocellular carcinoma(HCC) in patients with decompensated cirrhosis in the antiviral *** We used the Korean Health Insurance Review and Assessment. Korea's health insurance system is a public single-payer system. The study population consisted of 286871 patients who were prescribed hepatitis B antiviral therapy for the first time between 2007 and 2014 in accordance with the insurance ***, 48365 antiviral treatment-na?ve patients treated between 2008 and 2009 were included, and each had a follow-up period ≥ 5 years. Data were analyzed for the 1 st decompensated chronic hepatitis B(CHB) and treatment-na?ve patients(n = 7166). RESULTS The mean patient age was 43.5 years. The annual mortality rates were 2.4%-19.1%, and 5-year cumulative mortality rate was 32.6% in 1^(st) decompensated CHB treatment-na?ve subjects. But the annual mortality rates sharply decreased to 3.4%(2.4%-4.9%, 2-5 year) after one year of antiviral treatment. Incidence of HCC at first year was 14.3%, the annual incidence of HCC decreased to 2.5%(1.8%-3.7%, 2-5 year) after one year. 5-year cumulative incidence of HCC was 24.1%. Recurrence rate of decompensated event was 46.9% at first year, but the annual incidence of second decompensation events in decompensated CHB treatment-na?ve patients was 3.4%(2.1%-5.4%, 2-5 year) after one year antiviral treatment. 5-year cumulative recurrence rate of decompensated events was 60.6%. Meanwhile, 5-year cumulative mortality rate was 3.1%, and 5-year cumulative incidence of HCC was 11.5% in compensated CHB treatment-na?ve *** Long term outcome of decompensated cirrhosis treated with antiviral agent improved much, and incidence of hepatocellular carcinoma and mortality sharply decreased after one year treatment.

关键词： Hepatitis B Antiviral agent decompensated cirrhosis Mortality Hepatocellular carcinoma

Autologous bone marrow transplantation in decompensated liver: Systematic review and meta-analysis

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World Journal of Gastroenterology 2015年第28期21卷 8697-8710页

作者： Prasoon Pankaj Qi Zhang Xue-Li Bai Ting-Bo Liang Department of Hepatobiliary and Pancreatic Surgery the Second Affiliated Hospital Zhejiang University School of Medicine

AIM:To evaluate the efficacy of autologous bone marrow mononuclear cell transplantation in decompensated liver ***:Medline,EMBASE,PubMed,Science Direct,and the Cochrane Library were searched for relevant *** case-control studies were included along with randomized clinical *** was performed in line with recommendations from the Cochrane Collaboration software review *** was assessed using a randomeffects ***:Four randomized controlled trials and four retrospective studies were *** transplantation increased serum albumin level by 1.96 g/L(95%CI:0.74-3.17;P = 0.002],2.55 g/L(95%CI:0.32-4.79;P= 0.03),and 3.65 g/L(95%CI:0.76-6.54;P = 0.01)after 1,3,and 6 mo,*** who had undergone cell transplantation also had a lower level of total bilirubin[mean difference(MD):-1.37 mg/dL;95%CI:-2.68-(-0.06);P = 0.04]after 6 *** decreased after 1 year when compared to standard treatment(MD:-1.26;95%CI:-2.48-(-0.03);P =0.04].A temporary decrease in alanine transaminase and aspartate transaminase were significant in the cell transplantation ***,after 6 mo treatment,patients who had undergone cell transplantation had a slightly longer prothrombin time(MD:5.66 s,95%CI:0.04-11.28;P = 0.05).Changes in the model for endstage liver disease score and Child-Pugh score were not statistically ***:Autologous bone marrow transplantation showed some benefits in patients with decompensated liver ***,further studies are still needed to verify its role in clinical treatment for end-stage liver disease.

关键词： Autologous transplantation Bone marrow Cirrhosis decompensated liver disease

Direct antiviral agent treatment of decompensated hepatitis C virus-induced liver cirrhosis

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2015年第4期6卷 114-119页

作者： Shogo Ohkoshi Haruka Hirono Satoshi Yamagiwa Department of Internal Medicine School of Life Dentistry at Niigata the Nippon Dental University Division of Gastroenterology and Hepatology Graduate School of Medical and Dental Sciences Niigata University

Recently, direct antiviral agents(DAAs) have been increasingly used for the treatment of chronic hepatitis C virus(HCV) infections, replacing interferon-based regimens that have severe adverse effects and low tolerability. The constant supply of new DAAs makes shorter treatment periods with enhanced safety possible. The efficacy of DAAs for treatment of compensated liver cirrhosis(LC) is not less than that for treatment of non-cirrhotic conditions. These clinical advantages have been useful in pre- and post-liver transplantation(LT) settings. Moreover, DAAs can be used to treat decompensated HCV-induced LC in elderly patients or those with severe complications otherwise having poor prognosis. Although encouraging clinical data are beginning to appear, the actual efficacy of DAAs for suppressing disease progression, allowing delisting for LT and, most importantly, improving prognosis of patients with decompensated HCV-LC remains unknown. Casecontrol studies to examine the short- or long-term effects of DAAs for treatment of decompensated HCV-LC are urgently need.

关键词： decompensated liver cirrhosis Prognosis Direct ant