Objective To assess the efficacy and safety of Chinese medicinal herbs for asymptomatic hepatitis B virus(HBV) infection. Data Source The trials registers of the Cochrane Hepato-Biliary Group, the Cochrane Library and the Cochrane Complementary Medicine Field were searched in combination with MEDLINE, EMBASE, and handsearches of Chinese journals and conference proceedings. Data Selection Randomized clinical trials with 3 months follow-up comparing Chinese medicinal herbs versus placebo, no intervention, non-specific treatment, or interferon treatment for asymptomatic HBV carriers were included. No language and blinding limitations were applied. Data Extraction Data were extracted independently by two reviewers. The methodological quality of trials was assessed by the Jadad-scale plus allocation concealment. Results Three randomized clinical trials (307 patients) with low methodological quality following patients for three months or more after the end of treatment were included. Herbal compound Jianpi Wenshen recipe showed significant effects on clearance of HBV markers compared to interferon: relative risk 2.40 (95 % CI 1.01 to 5.72) for clearance of serum HBsAg, and 2.54 (1.13 to 5.70) for seroconversion of HBeAg to anti-HBe. Phyllanthus amarus and Astragalus membranaceus showed no significant antiviral effect compared with placebo. Analysis of pooling eight randomized clinical trials with less than three months follow-up did not show a significant benefit of Chinese medicinal herbs on viral markers. No serious adverse event was observed. Conclusions There is insufficient evidence for treatment of asymptomatic HBVcarriers using Chinese medicinal herbs due to the low quality of the trials. Further randomized, double blind, placebo-controlled trials are needed.
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 探讨乙型肝炎病毒（HBV）表面抗原（HBsAg）阳性肝硬化患者血清中HBV前S1抗原(前S1抗原)、HBV e抗原（HBeAg）及HBV核酸定量检测（HBV DNA）相关性。 方法 2008年7月－2011年5月对97例HBsAg阳性肝硬化住院患者和50份HBsAg阴性的健康体检者血清进行前S1抗原、HBV血清标志物检测及实时荧光定量PCR检测HBV DNA结果进行分析。 结果 97份HBsAg阳性肝硬化患者血清中，前S1抗原、HBeAg及HBV DNA阳性率分别为53.6%（52/97）、22.7%（22/97）及61.8%（60/97）。22例HBeAg阳性血清中，前S1抗原阳性18例（81.8%）， HBV DNA阳性20例（90.9%)。75例HBeAg阴性血清中，前S1抗原阳性34例（45.3%），HBV DNA阳性40例（53.3%），两者的前S1抗原与HBV DNA结果间都具有很好的相关性。HBV DNA含量与前S1抗原及HBeAg阳性结果显示：HBsAg阳性的肝硬化患者血清中HBV DNA阴性率为38.1%（含量＜103 copies/mL），而阳性检出率HBV DNA含量主要集中在103～105 copies/mL，占81.7%（49/60），HBV DNA含量＞105 copies/mL占18.3%（11/60）。 结论 HBsAg阳性的肝硬化患者血清中主要以HBV非HBeAg阳性血清学模式为主，HBV DNA阳性检出率的含量主要集中在103～105 copies/mL。前S1抗原在HBeAg阳性血清中与其含有HBsAg病毒及HBeAg阳性患者具有很好的相关性，而在HBeAg阴性血清中存在着差异。Objective To study the correlation among Pre-S1 antigen, HBeAg and HBV DNA results in patients with HBsAg-positive liver cirrhosis. Methods We retrospectively analyzed the serum pre-S1-antigen, HBV serum markers and real-time quantitative PCR HBV DNA results in 97 patients with HBsAg-positive liver cirrhosis and 50 HBsAg-negative healthy volunteers in our hospital from July 2008 to May 2011. Results Among the 97 samples of HBsAg-positive liver cirrhosis patients’ serum, the positive rates of Pre-S1 antigen, HBeAg and HBV DNA were 53.6% (52/97), 22.7% (22/97) and 61.8% (60/97), respectively. In the 22 samples of HBeAg-positive serum, the number of positive pre-S1 antigen and HBV DNA was 18 (81.8%) and 20, respectively. In the 75 samples of negative HBeAg serum, the number of positive pre-S1 antigen and HBV DNA was 34 (45.3%) and 40 (53.3%) respectively. The pre-S1 antigen was correlated well with HBV DNA results in both the two groups. HBV DNA level, pre-S1 antigen and HBeAg-positive results showed that the serum HBV DNA negative rate of HBsAg-positive patients with cirrhosis was 38.1% (＜103 copies/mL), while the positive rate of HBV DNA level was mainly concentrated at 103~105 copies/mL, accounting for 81.7% (49/60), and HBV DNA level over 105 copies/mLaccounted for only 18.3% (11/60). Conclusions HBsAg-positive patients with cirrhosis mainly have a serum non-HBeAg-positive HBV serology pattern, and HBV DNA positive rate of the content is mainly concentrated at 103~105 copies/mL. There is a good correlation between pre-S1 antigen in HBeAg-positive serum and patients with HBsAg virus or positive HBeAg, while for Pre-S1 antigen in HBeAg-negative serum, it is quite different.
目的：建立能表达乙肝病毒（hepatitis B virus,HBV）preS2S抗原蛋白的荷瘤小鼠模型，为研究HBV核酸疫苗的体内CTL应答及免疫治疗作用提供简便易行的研究模型。 方法：以免疫印迹法验证SP2/0-S2S细胞中有HBV preS2S抗原的稳定表达，将SP2/0-S2S细胞种植到BALB/c小鼠胁部皮下（荷瘤），观察能否生长成瘤，以及成瘤的时间、肿瘤大小和荷瘤后小鼠的生存时间；以免疫组织化学法检测小鼠肿瘤组织HBV preS2S抗原的表达。以不表达preS2S抗原蛋白的SP2/0-CMV细胞荷瘤小鼠作为阴性对照。结果：荷瘤后3天～1周，SP2/0-S2S细胞可在小鼠皮下形成实体肿瘤，成瘤率为100%，肿瘤细胞中有preS2S抗原表达，荷瘤后小鼠的平均生存时间为16±1天；与不表达preS2S抗原蛋白的SP2/0-CMV细胞荷瘤小鼠相比，成瘤率、成瘤时间、肿瘤大小及生存时间差异。结论：建立了能表达HBV preS2S抗原蛋白的荷瘤小鼠模型，可用于HBV核酸疫苗的体内CTL应答及免疫治疗作用的实验研究。同时也建立了不表达preS2S抗原蛋白的荷瘤小鼠模型，可用作阴性对照。
Objective To explore the relationship between the HBsAg positive patients suffering from hepatocellular carcinoma (HCC) and HBV DNA genotype. Methods By using PCR type-specific primers combined with sequencing of genotype, we analyzed the genotype of HBV DNA in the serum of 500 patients with positive HBsAg in our hospital. Among them, 150 cases suffered from HCC. Results Genotype B and C were both predominant genotypes in HBsAg positive patients. But in HCC group, the rate of genotype C was 65.33% （98/150）, which was significantly higher than that in non-HCC group (88/350, 25.14%), while genotype B, in contrast, was 28.67% （43/150） and 68.86% （241/350）， χ2=75.45， Plt;0.05. The distribution of HBV DNA genotype B or genotype C in different gender or different age groups were not statistically significantly different in cases of HCC (Pgt;0.05). Conclusion Genotype C of HBV DNA is more common in patients with HCC, and maybe there is relationship between genotype C and the occurrence of HCC.
Objective To investigate the prevention of HBV reinfection in the perioperative period of liver transplantation on HBV-related diseases． Methods Published papers were collected and reviewed． Results HBV-related diseases were the main indications of liver transplantation．The prevention for HBV reinfection affects the survivals remarkably. Nowadays, a lot of medication have been used in the prevention of HBV reinfection， and the therapeutic regimens were different from each other. Conclusion Liver transplantation is an effective treatment for HBV-related disease． Appropriate prevention of HBV reinfection in the perioperative period of liver transplantation is important for the survivals of patients．
Ｆｒｏｍ １９９０ ｔｏ １９９３， ｗｅ ｃａｒｒｉｅｄ ｏｎ ａ ｓｅｒｏｅｐｉｄｅｍｉｏｌｏｇｉｃａｌ ｓｕｒｖｅｙ ｏｎ ｈｅｐａｔｉｔｉｓ Ｂ ｖｉｒｕｓ （ＨＢＶ） ｉｎｆｅｃｔｉｏｎ ｏｆ ５２９７ ｇｅｎｅｒａｌ ｓｕｒｇｉｃａｌ ｐａｔｉｅｎｔｓ． Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈａｔ ｔｈｅ ｐｏｓｉｔｉｖｅ ｒａｔｅｓ ｏｆ ＨＢｓＡｇ， ａｎｔｉＨＢｓ ａｎｄ ａｎｔｉＨＢｃ ｗｅｒｅ １９．４％ 、３５．９％ ａｎｄ ４１．１％ｒｅｓｐｅｃｔｉｖｅｌｙ， ａｎｄ ｔｈｅ ｏｖｅｒａｌｌ ｒａｔｅ ｏｆ ＨＢＶ ｉｎｆｅｃｔｉｏｎ ｗａｓ ７０．５％， ｗｈｉｃｈ ｗａｓ ｍｕｃｈ ｈｉｇｈｅｒ ｔｈａｎ ｔｈａｔ ｏｆ ｔｈｅ ｇｅｎｅｒａｌ ｐｏｐｕｌａｔｉｏｎ． Ｉｎ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｈｅｐａｔｏｂｉｌｉａｒｙ ｏｒ ｐａｎｃｒｅａｔｉｃ ｄｉｓｅａｓｅｓ， ｔｈｅ ＨＢｓＡｇ， ａｎｔｉＨＢｃ ａｎｄ ｔｈｅ ｏｖｅｒａｌｌ ｒａｔｅ ｏｆ ＨＢＶ ｉｎｆｅｃｔｉｏｎ ｗｅｒｅ ３４．２％、５６．１％、８０．３％ｒｅｓｐｅｃｔｉｖｅｌｙ， ｗｈｉｃｈ ｗｅｒｅ ｈｉｇｈｅｒ ｔｈａｎ ｔｈｏｓｅ ｏｆ ｏｔｈｅｒ ｇｅｎｅｒａｌ ｓｕｒｇｉｃａｌ ｐａｔｉｅｎｔｓ．
Objective To evaluate the effectiveness of combination therapy with lamivudine (LAM) and hepatitis B immunoglobulin (HBIG) versus LAM monotherapy in prevention of hepatitis B virus recurrence after liver transplantation. Methods Databases including MEDLINE (Ovid), PubMed, EMbase, Cochrane Central Register of Controlled Trials (CENTRAL), CBM, VIP, and CNKI were searched up to Dec. 2008. Clinical trials including randomized controlled, non-randomized concurrent-control and case-control studies about combination therapy with HBIG and LAM versus LAM monotherapy in prevention of hepatitis B virus recurrence after liver transplantation were screened. Trial selection and data extraction were conducted by two reviewers independently. Meta-analysis was performed using RevMan 5.0.18 software. Results Eleven non-randomized concurrent-control studies involving 1 421 patients (1 035 patients in combination therapy group, and 386 patients in LAM monotherapy group) were included. The results of meta-analyses showed: Compared with LAM monotherapy group, the risks of hepatitis B virus recurrence, YMDD mutation, and death associated with HBV recurrence were significantly reduced by 73% (RR=0.27, 95%CI 0.20 to 0.37, Plt;0.000 01), 72% (RR=0.28, 95%CI 0.15 to 0.53, P=0.000 01), and 79% (RR=0.21, 95%CI 0.09 to 0.49, P=0.000 3) respectively in combination therapy group after liver transplantation; overall survival rates of both recipients and grafts in combination therapy group were similar to LAM monotherapy group (RR=1.03, 95%CI 0.95 to 1.11, P=0.51; RR=1.04, 95%CI 0.97 to 1.12, P=0.26). Conclusion Current evidence indicates that compared with LAM monotherapy, combination therapy with LAM and HBIG could reduce the risks of hepatitis B virus recurrence, YMDD mutation, and death associated with HBV recurrence after liver transplantation.
Objective To evaluate the efficacy and safety of antiviral drugs for hepatitis B with YMDD motif variant. Methods We electronically searched MEDLINE (1989-April, 2004), EMBASE (1989-April, 2004), CBMdisc (expand) (1989-April, 2004), and handsearched unpublished Chinese conference proceedings. Randomized and quasi-randomized trials in patients with chronic hepatitis B with YMDD motif variant correlative to lamivudine were collected. Two reviewers extracted the data and assessed the quality of literature independently. The data were then analyzed by RevMan 4.2 software. Results Five studies involving 6 trials and 284 patients were included. According to the results of meta-analysis, antiviral therapy with adefovir plus lamivudine showed significantly better effects on the clearance of serum HBV-DNA and HBeAg and normalization of ALT than that of lamivudine alone (RR 16.61, 95%CI 2.29 to 120.71; RR 6.66, 95%CI 1.23 to 35.88 and RR 6.26, 95%CI 2.29 to 17.12 respectively); also, oxymatrine plus thymothin showed obviously better effects on the clearance of serum HBV-DNA and HBeAg (RR 2.96, 95%CI 1.26 to 6.93 and RR 2.51, 95%CI 1.05 to 5.98 respectively).But adefovir alone showed no better effects on clearance of serum HBV-DNA and HBeAg than that of lamivudine alone (RR 11.00, 95%CI 0.65 to 186.02 and RR 7.00, 95%CI 0.39 to 126.92 respectively); interferon plus lamivudine showed no better effects on the clearance of serum HBV-DNA, HBeAg and the normalization of ALT (RR 3.50, 95%CI 0.90 to 13.58; RR 4.90, 95%CI 0.70 to 35.10 and RR 2.80, 95%CI 0.91 to 8.12 respectively). Chinese herbs plus lamivudine showed no better effects on the clearance of serum HBV-DNA (RR 1.16, 95%CI 0.89 to 1.51). There were no significant side effects in the groups, except flu like symptom in the interferon group, slight kidney impairment in the adefovir group, and aggravation of rare cases in lamivudine group. Conclusions Antiviral therapy with adefovir plus lamivudine, or oxymatrine plus thymothin, shows better effects than with lamivudine alone in terms of antiviral therapy and clinical outcome improvement. However, the evidence is too weak to draw a definite conclusion in this systematic review. Larger sample size and rigorously designed randomized, double blind, placebo control trials are required for future study.