ObjectiveTo explore the influence of paternal serum HBV-DNA load levels and pregnant women's HBsAb on vertical transmission of hepatitis B virus (HBV) from HBsAg positive fathers to infants in order to provide effective methods for paternal-fetal ventrical transmission of HBV prevention. MethodsUsing HBsAg and HBV-DNA as indicators to screen pregnant women and their husbands after gained consent, 121 families with HBVM negative or only HBsAb positive and HBV-DNA negative pregnant women, HBsAg positive husbands and their newborns were selected. In this case-control study, according to neonatal cord blood HBV-DNA detection, 23 newborns with cord blood HBV-DNA positive were selected as cases, 98 newborns as controls. ResultsThe positive rate of neonatal cord blood HBV-DNA was 19.0% (23/121); and there was dose-response relationship between paternal serum HBV-DNA load levels and neonatal cord blood HBV-DNA positive (trend χ2=60.108, P=0.000). The analysis of ROC curve showed that paternal serum HBV-DNA load level (106 copies/mL) is a better demarcation point to forecast the occurrence of vertical transmission of HBV from HBsAg positive fathers to infants, because there was a better sensitivity and specificity during forecast; and HBsAb negative pregnant women's were statistically significant (χ2=12.399, P=0.000). There was no significant difference at the positive rate of neonatal cord blood HBV-DNA between the case group and control group when paternal serum HBV-DNA load levels exceed 107 copies/mL (P > 0.05). ConclusionPaternal serum HBV-DNA load levels and HBsAb negative pregnant women are the risk factors of vertical transmission of HBV from HBsAg positive father to infants. Paternal serum HBV-DNA load level (106 copies/mL) is an appropriate index of the occurrence of vertical transmission.
ObjectiveTo systematically review the combination of entecavir and interferon-α (IFN-α) in treating hepatitis B compared to entecavir alone. MethodsPubMed, EMbase, The Cochrane Library (Issue 12, 2013), Web of Science, CBM, CNKI, WanFang Data and VIP were searched for the randomized controlled trials (RCTs) on entecavir and interferon-α (IFN-α) in treating hepatitis B from inception to December 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2.5. ResultsA total of 7 RCTs were finally included involving 543 cases. The results of meta-analysis revealed that, compared to entecavir alone, 24-week combined therapy was more effective in improving negative conversion rates of serum HBV-DNA (OR=2.93, 95%CI 1.79 to 4.79, P < 0.000 1), conversion rates of HBeAg (OR=2.36, 95%CI 1.35 to 4.14, P=0.003), and recovery rates of ALT (OR=2.73, 95%CI 1.73 to 4.32, P < 0.000 1). No statistical significance was found in terms of side effects. ConclusionCurrent evidence shows that combination of entecavir and IFN-α is more effective than entecavir alone in treating hepatitis B. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies.
Hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) has the characteristics of rapid progress and high mortality. Artificial liver support system (ALSS) is far superior to standard drug therapy in the treatment of such patients, and is widely used in emergency. ALSS is the use of external mechanical or biological devices to replace a part of the damaged liver function, divided into bioartificial, non-bioartificial liver and a combination of the two. At present, there is no unified sensitive prognostic index and recognized prognostic model for HBV-ACLF in artificial liver treatment. This paper reviews the research progress of prognosis evaluation of ALSS in the treatment of HBV-ACLF, in order to provide reference for clinicians and researchers
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.
Objective To compare lamivudine monotherapy versus lamivudine-thymosin alpha-1 combination therapy for HBeAg positive chronic hepatitis B. Methods We searched CENTRAL (Issue 4, 2008), PubMed (up to December 2008), the Chinese Biomedical database (CBM, up to December 2008), and CNKI (up to December 2008). We also scanned references of all included studies and pertinent reviews. Quality assessment and data extraction were conducted by two reviewers independently. Meta-analyses were conducted using RevMan 5.0. Results We identified 23 trials involving 1 488 patients. According to the results of meta-analyses, the HBeAg seroconversion rate of the combination therapy group was higher than that of the monotherapy group, both at the end of the treatment and the one year follow-up (RR=2.89, 95%CI 2.40 to 3.48; RR=4.99, 95%CI 2.99 to 8.31); and there were also significant differences between the two groups for secondary outcomes including HBV-DNA negative, ALT normalization, etc.. There was no significant difference between the two groups in adverse reaction. Conclusion Lamivudine-thymosin alpha-1 combination therapy might be more effective than lamivudine monotherapy for HBeAg positive chronic hepatitis B. However, the results should be interpreted with caution because of the low quality of the included studies. High-quality, large scale randomized controlled trials are needed to further prove the results.
ObjectiveTo explore expressions of the metaherin (MTDH) mRNA and its protein in hepatitis B related hepatocellular carcinoma tissues and its clinical significance. MethodsSeventy two tissues of patients with hepa-titis B related hepatocellular carcinoma who were treated in Affiliated Taihe Hospital of Hubei Medical University from Jul. 2012 to Oct. 2013 were collected retrospectively. Quantitative PCR (Q-PCR) and Western blot methods were used to detect the expression levels of MTDH mRNA and its protein in 10 cases of hepatitis B related hepatocellular carcinoma tissues and pericarcinoma tissues. Besides, immunohistochemistry was used to determine the expression of MTDH protein in 72 cases of hepatocellular carcinoma tissues, then the relationship of expression of MTDH protein and clinico-pathological features was explored. ResultsThe expression levels of MTDH mRNA and its protein in hepatocellular carcinoma tissues were both higher than those of pericarcinoma tissues (8.50±0.84 vs. 4.55±0.81, t=10.797, P=0.000; 0.65± 0.24 vs. 0.25±0.16,t=6.375, P=0.013). The MTDH protein was positively expressed in 42 cases (58.3%) and negatively expressed in 30 cases (41.7%) of hepatocellular carcinoma tissues. The results of logistic regression showed that,MTHD protein was up-regulated in patients with category Ⅲ of Edmondson grade (OR=4.783, 95% CI:2.663-11.918, P=0.020), microvascular invasion (OR=37.790, 95% CI:2.227-99.434, P=0.005), and lymph node metastasis (OR=7.332, 95% CI:3.325-30.669, P=0.023). ConclusionExpressions of MTDH mRNA and its protein are both higher in hepatitis B related hepatocellular carcinoma tissue, which are correlated with poor prognosis.
ObjectiveTo investigate the efficacy of lamivudine combined with low-dose hepatitis B immune globulin to prevent HBV reinfection after liver transplantation. MethodsThe clinical data of 76 cases of HBV-related liver disease after liver transplantation using lamivudine combined with low-dose hepatitis B immune globulin to prevent HBV re-infection were retrospectively analyzed, and the HBV re-infection risk factors were analyzed. ResultsSeventy-six patients' HBsAg became negative after liver transplantation, HBV re-infect in 9 cases.The re-infection rate was 9.2% (7/76) and 11.8% (9/76), respectively, in 1-year and 2-year after liver transplantation. ConclusionsLamivudine combined with low-dose hepatitis B immune globulin after liver transplantation can be effective preventing re-infection with HBV.HBeAg positive and HBV-DNA positive before liver transplantation is risk factors of HBV re-infection.
Objective By means of evidence-based clinical practice, to find more effective treatment for a hepatitis B related nephritis patient with renal failure. Methods The following databases as Up to Date (May 2011), The Cochrane Library (Issue 5, 2011), PubMed (1978 to 2011) and CNKI (1978 to 2011) were searched to identify systematic reviews and randomized controlled trials (RCTs) of treating hepatitis B related nephritis with glucocorticoid, immunosuppressor or antiviral therapies, and the quality of collected clinical evidence was evaluated by using GRADEpro software. Results The glucocorticoid or combined immunosuppressors was not recommended for existing adverse effects and not acting on the remission of hepatitis B related nephritis and reduction of proteinuria. However, the antiviral therapy used alone was recommended for acting on the remission of hepatitis B related nephritis and the reduction of proteinuria. In view of adverse effects and expensive price of interferon, the nucleoside analogue antiviral agent was suggested. Considering the renal toxicity of adefovir and tenofovir, and possible drug-resistance of lamivudine, the entecavir (0.5 mg qd) was finally selected with patient’s agreement, and the supporting therapies such as lowering blood pressure, and protecting the kidney and liver were adopted continually. After one month treatment, 24-hour urinary protein got reduced, serum albumin got increased, kidney function got stable, and hepatitis B virus DNA quantity got reduced. Conclusion For treating hepatitis B related nephritis with kidney failure, entacavir can reduce 24-hour urinary protein, raise serum albumin, stabilize kidney function and reduce hepatitis B virus DNA in a short term, but its long-term efficacy still requires further studies.
Drugs may induce hepatitis B virus (HBV) reactivation (HBV-R). Here we have reviewed the definition and harm of HBV-R, the risk drugs and their underlying mechanism, the influence factors, as well as the early intervention measures. It is shown that multiple drugs, including chemotherapy drugs, immunotherapy drugs, directly acting antivirals, cell therapy, etc., can induce HBV-R by affecting host immunity or directly activating HBV transcription factors. HBV-R could cause severe liver damage, even interruption of treatment of original diseases, affecting the prognosis of patients. Through precisely identifying risk drugs, monitoring the influence factors, and prescribing preventive anti-HBV regimen if necessary, the incidence of HBV-R can be significantly reduced. It is also suggested that clinical physicians should not only pay attention to the early identification and intervention of HBV-R, but also further study the mechanism of HBV-R in depth, especially the underlying mechanism between host, HBV and risk factors. This will help to promote the discovery of more valuable markers for risk prediction and targets for early intervention, and to further reduce the risk of HBV-R and improve the prognosis of patients.
ObjectiveTo systematically evaluate the association between human leukocyte antigen DQ (HLA-DQ) gene rs2856718A>G, rs9275572A>G polymorphisms and the risk of chronic hepatitis B. MethodsPubMed, EMbase, CBM, WanFang Data, CNKI and VIP databases were systematically searched from inception to April 2015 to collect case-control studies about HLA-DQ gene polymorphisms and the risk of chronic hepatitis B. 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, and Stata 12.0 software was used for sensitivity and publication bias analysis. ResultsA total of 6 papers involving 8 case-control studies were included, which involved 3 690 cases and 6 267 controls. The results of meta-analysis showed that:the rs2856718A>G polymorphism was associated with the decreased risk of chronic hepatitis B (AG+GG vs. AA:OR=0.63, 95%CI 0.51 to 0.78, P=0.000; GG vs. AG+AA:OR=0.69, 95%CI 0.61 to 0.79, P=0.000; GG vs. AA:OR=0.56, 95%CI 0.48 to 0.64, P=0.000; GA vs. AA:OR=0.64, 95%CI 0.47 to 0.88, P=0.006; G vs. A:OR=0.74, 95%CI 0.68 to 0.79, P=0.000). The rs9275572A>G polymorphism was not associated with the risk of chronic hepatitis B (AG+GG vs. AA:OR=1.11, 95%CI 0.55 to 2.23, P=0.770; GG vs. AG+AA:OR=1.10, 95%CI 0.84 to 1.45, P=0.500; GG vs. AA:OR=1.14, 95%CI 0.54 to 2.41, P=0.730; AG vs. AA:OR=1.06, 95%CI 0.56 to 2.02, P=0.860; G vs. A:OR=1.11, 95%CI 0.83 to 1.48, P=0.490). ConclusionHLA-DQ gene rs2856718 A>G polymorphism is significantly associated with decreased risk of chronic hepatitis B, but the rs9271319 A>G polymorphism is not associated with the risk of chronic hepatitis B.