HBV-related Chronic Liver Disease Research Articles

STING modulates HBV-related acute-on-chronic liver failure by mediating autophagy and macrophage polarization

Background & AimsHBV-related acute-on-chronic liver failure (HBV-ACLF) is a severe acute liver injury secondary to HBV-related chronic liver disease (with or without cirrhosis) and is characterized by a high short-term mortality rate. Presently, there is a paucity of experimental models that specifically focus on HBV-ACLF based on chronic hepatitis B. Therefore, this study aimed to establish an experimental mouse model of HBV-ACLF using chronic hepatitis B (CHB) as a basis and investigate the impact of STING activation on the disease. MethodsTo simulate HBV-ACLF conditions, a model was constructed by combining chronic HBV replication (caudal vein high-pressure hydrodynamic injection of pAAV/HBV1.2 plasmid) and acute hepatic insult (intraperitoneal injection of Acetaminophen (APAP)). Then, model mice were administered either a STING agonist or STING inhibitor. Liver injury, STING pathway, autophagy flux, and macrophage polarization were assessed to elucidate the potential role of STING. ResultsThe mouse model developed chronic hepatitis B and acute liver injury, partially reflecting features of clinical HBV-ACLF based on CHB. STING activation, autophagy, and macrophage polarization were found to be involved in the disease process. During the early stage (6 h) of the STING agonist treatment group, the STING pathway was activated, autophagy flux was up-regulated, and liver inflammation and injury were alleviated. Contrastingly, at the late stage of STING agonist treatment (24 h, 48 h), macrophages were polarized to the M1 phenotype, exacerbating liver inflammatory infiltration and injury. However, treatment with a STING covalent inhibitor reversed these effects. ConclusionsSting-induced autophagy exerts a protective effect on liver injury during the early stage. However, in later stages, STING may aggravate liver injury by shifting liver macrophage polarization to the M1 phenotype, thereby enhancing the inflammatory response.

Characterization of mutations in hepatitis B virus DNA isolated from Japanese HBsAg-positive blood donors in 2021 and 2022

Missense mutations in certain small envelope proteins diminish the efficacy of antibodies. Consequently, tracking the incidence and types of vaccine-escape mutations (VEMs) was crucial both before and after the introduction of universal hepatitis B vaccination in Japan in 2016. In this study, we isolated hepatitis B virus (HBV) DNA from 58 of 169 hepatitis B surface antigen (HBsAg)-positive blood samples from Japanese blood donors and determined the nucleotide sequence encoding the small envelope protein. DNA from six (10%) of the samples had VEMs, but no missense mutations, such as G145R, were detected. Complete HBV genome sequences were obtained from 29 of the 58 samples; the viral genotype was A1 in one (3%), A2 in three (10%), B1 in nine (31%), B2 in five (17%), B4 in one (3%), and C2 in 10 (34%) samples. Tenofovir-resistance mutations were detected in two (7%) samples. In addition, several core promoter mutations, such as 1762A>T and 1764G>A, and a precore nonsense mutation, 1986G>A, which are risk factors for HBV-related chronic liver disease, were detected. These findings provide a baseline for future research and highlight the importance of ongoing monitoring of VEMs and drug resistance mutations in HBV DNA from HBsAg-positive blood donors without HBV antibodies.

Technical Challenges in Simultaneous Living Donor Liver Transplantation and Domino Orthotopic Liver Transplantation

Liver transplantation is the ideal treatment of choice for Familial amyloid polyneuropathy (FAP). It is known that during transplantation surgery, this explant liver which will be removed from amyloid patient can be used as a domino graft for another suitable recipient. Even after successful results of domino liver transplantation in deceased donation setting this procedure is always seen with a fear of putting both the recipients at risk due to technical challenge. With living donor as the liver donor for the amyloid patient, the challenges faced are even higher. Only few centres have done similar surgeries and there are no standard guidelines for the same. The anatomical prerequisites, technique, and indications of domino orthotopic liver transplant (D-OLT) in live donation settling are still evolving. We here report a case of live donor liver transplant from a 38 year old with a Right lobe graft for a 40 year old with FAP along with D-OLT for a 52 year old with HBV related decompensated chronic liver disease with HCC. We have described the technical challenges and learnings in our first case which is one of few cases done in the Indian Subcontinent.

Five Decades of HBV Infection in Italy: A Continuous Challenge.

In Italy, Hepatitis B virus (HBV) infection has been characterized by several changes over the last five decades. In 2019, the incidence of acute HBV among subjects targeted by the vaccination campaign was 0 cases in the age group 0-14 years and 0.1/100,000 in the age group 15-24. Nowadays, the burden of different stages of HBV-related chronic liver diseases is minimal. Intravenous drug use is no longer a risk factor (O.R. 0.7; 95% C.I. 0.5-1.02) for acquiring acute HBV; the proportion of cases reporting this exposure fell from 29.8% to 3.3% over the last two decades. The key public health intervention has been the compulsory vaccination campaign started in 1991 for infants 3 months old and 1-2 years old (the latter group for the first 12 years of the campaign). Moreover, non-immunogenic factors and the availability of effective oral antiviral drugs have played and continue to play a prominent role. The potential availability of new oral antiviral drugs with the inherent ability to eliminate the genomic HBV reservoirs may represent a further crucial step in the elimination of the virus in people that are already infected.

Metabolic biomarkers significantly enhance the prediction of HBV-related ACLF occurrence and outcomes

Acute-on-chronic liver failure (ACLF) is a clinical syndrome of high short-term mortality in patients with chronic liver disease. Chronic hepatitis B is the main cause of ACLF (HBV-ACLF) in China and other Asian countries. To improve disease management and survival for ACLF patients, we aimed to discover novel biomarkers to enhance HBV-ACLF diagnosis and prognosis. We performed a metabolomics profiling of 1,024 plasma samples collected from HBV-related chronic liver disease patients with acute exacerbation at hospital admission in a multi-year and multi-center prospective study (367 ACLF and 657 non-ACLF). The samples were randomly separated into equal halves as a discovery set and a validation set. We identified metabolites associated with 90-day mortality in the ACLF group and the progression to ACLF within 28 days in the non-ACLF group (pre-ACLF) using statistical analysis and machine learning. We developed diagnostic algorithms in the discovery set and used these to assess the findings in the validation set. ACLF significantly altered the serum metabolome, particularly in membrane lipid metabolism, steroid hormones, oxidative stress pathways, and energy metabolism. Numerous metabolites were significantly associated with 90-day mortality in the ACLF group and/or pre-ACLF in the non-ACLF group. We developed algorithms for the prediction of ACLF 90-day mortality (area under curve, AUC: 0.87 and 0.83 for the discovery set and validation set, respectively) and the diagnosis of pre-ACLF (AUC: 0.94 and 0.88 for the discovery set and validation set, respectively). To translate our discoveries into practical clinical tests, we developed targeted assays using liquid chromatography mass spectrometry (LCMS). Based on novel metabolite biomarkers, we established HBV-ACLF tests with higher accuracy than existing methods. Acute-on-chronic liver failure (ACLF) is a clinical syndrome of high short-term mortality affecting 25% of hospitalized cirrhosis patients. Chronic hepatitis B (HBV) is the main etiology of ACLF in China and other Asian counties. There is currently no effective therapy. Early diagnosis and accurate prognosis for disease management are critical for improving clinical outcomes for ACLF patients. Based on novel metabolite biomarkers, we developed liquid chromatography mass spectrometry (LCMS) tests with improved accuracy for the early diagnosis and prognosis of HBV-ACLF. The LCMS tests can be implemented in clinical labs and used by physicians to triage HBV-ACLF patients for treatment options and proactive disease management. NCT02457637 and NCT03641872.

Detection of hepatitis-B virus genotype B among patients with HBV-related chronic liver disease by using nested polymerase chain reaction

Aim: To detect the genotype B of Hepatitis-B virus in patients seropositively for HbsAg in Al-Dewayia city, Iraq.Methods: Sera from 30 patients with HBV-related chronic liver disease were tested for HBV genotype B using Nested Polymerase Chain reaction toward two sets of type specific primers of HBV genome.Results: The genotype B was detected in (6/30) samples at (20%) of tested sera, where the PCR product was 281bp, which encode to untranslated region (UTR) specific region of HBV genome.Conclusion: The Nested Polymerase Chain reaction is a simple method and easy to use, especially in our country where not all of the reported genotypes until now detected, and the present study established that the common genotype of HBV was B.

Updated Treatment Guidelines for Chronic Hepatitis B

Chronic hepatitis B virus (HBV) infection is a major cause of liver cirrhosis and hepatocellular carcinoma in Korea. While the prevalence of HBV infection is gradually declining in Korea, 3 of the population still suffers from HBV-related chronic liver diseases. In this review, we summarize the updated clinical guidelines for management of chronic HBV, as revised by the Korean Association for the Study of the Liver in 2022.

Predicting the survival benefit of liver transplantation in HBV-related acute-on-chronic liver failure: an observational cohort study

Liver transplantation (LT) is an effective therapy for acute-on-chronic liver failure (ACLF) but is limited by organ shortages. We aimed to identify an appropriate score for predicting the survival benefit of LT in HBV-related ACLF patients. Hospitalized patients with acute deterioration of HBV-related chronic liver disease (n=4577) from the Chinese Group on the Study of Severe Hepatitis B (COSSH) open cohort were enrolled to evaluate the performance of five commonly used scores for predicting the prognosis and transplant survival benefit. The survival benefit rate was calculated to reflect the extended rate of the expected lifetime with vs. without LT. In total, 368 HBV-ACLF patients received LT. They showed significantly higher 1-year survival than those on the waitlist in both the entire HBV-ACLF cohort (77.2%/52.3%, p<0.001) and the propensity score matching cohort (77.2%/27.6%, p<0.001). The area under the receiver operating characteristic curve (AUROC) showed that the COSSH-ACLF II score performed best (AUROC 0.849) at identifying the 1-year risk of death on the waitlist and best (AUROC 0.864) at predicting 1-year outcome post-LT (COSSH-ACLFs/CLIF-C ACLFs/MELDs/MELD-Nas: AUROC 0.835/0.825/0.796/0.781; all p<0.05). The C-indexes confirmed the high predictive value of COSSH-ACLF IIs. Survival benefit rate analyses showed that patients with COSSH-ACLF IIs 7-10 had a higher 1-year survival benefit rate from LT (39.2%-64.3%) than those with score <7 or >10. These results were prospectively validated. COSSH-ACLF IIs identified the risk of death on the waitlist and accurately predicted post-LT mortalityand survival benefit for HBV-ACLF. Patients with COSSH-ACLF IIs 7-10 derived a higher net survival benefit from LT. This study was supported by the National Natural Science Foundation of China (No. 81830073, No. 81771196) and the National Special Support Program for High-Level Personnel Recruitment (Ten-thousand Talents Program).

A Lower HCC Incidence in Chronic HBV-Infected Patients Recovered from Acute-on-Chronic Liver Failure: A Prospective Cohort Study.

Activation of chronic hepatitis B virus (HBV) infection is an important cause of acute-on-chronic liver failure (ACLF). However, the effect of HBV-ACLF episode on hepatocellular carcinoma (HCC) occurrence remains largely unknown. A total of 769 HBV-ACLF patients and 2114 HBV-related chronic liver disease (HBV-CLD) patients diagnosed between August 1998 and December 2011 were enrolled in this prospective cohort study. Of the HBV-CLD patients, 380 received lifetime antiviral treatment with nucleos(t)ide analogues. Propensity score matching was applied to reduce baseline differences between HBV-ACLF and HBV-CLD cohorts. The survival rate of HBV-ACLF patients was 53.6%, 50.3%, 47.8%, and 46.2% at 90-day, 1-year, 5-year, and 10-year, respectively. The cumulative incidence of HCC was lower in HBV-ACLF cohort with 369 eligible patients survived for >90 days than in HBV-CLD cohort with the 380 patients (5.77/1,000 vs. 9.78/1,000 person-years, p = 0.0497). HBV-ACLF episode decreased HCC risk regardless of liver cirrhosis, and in patients without family history of HCC. Multivariate Cox analyses indicated that male, increasing age, liver cirrhosis, and platelet count (≤100 × 109/L) increased, whereas HBV-ACLF episode decreased, HCC risk independently. In the propensity score-matched cohorts, HBV-ACLF episode reduced HCC incidence (10.20/1,000 vs. 4.66/1,000 person-years, p = 0.0326). The area under curve of nomogram was 0.812 for 3-year HCC probability. HBV-ACLF episode decreases HCC occurrence in chronic HBV patients. Older age and liver cirrhosis independently increased HCC occurrence. A nomogram-enrolled episode of ACLF reliably predicts the occurrence of HCC.

Serum ferritin diagnosis and prediction of hepatitis B virus-related acute-on-chronic liver failure.

Early diagnosis and prediction of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is important to reduce mortality. This study aimed to assess the diagnostic and predictive value of serum ferritin (SF) in HBV-ACLF patients. Clinical data from 1905 hospitalized patients with acute deterioration of HBV-related chronic liver diseases were analyzed to explore the association between SF and ACLF. A co-expression network based on transcriptomics data for 20 HBV-ACLF patients was constructed to investigate biological processes related to ferritin. Of 1270 patients in the derivation group, 440 and 830 were diagnosed with and without ACLF, respectively, based on Chinese Group on the Study of Severe Hepatitis B-ACLF criteria. SF levels showed high diagnostic accuracy (area under the receiver operating characteristic [AUROC]: 0.820) for ACLF at admission. In patients with ACLF, SF was associated with liver and coagulation failure. In patients without ACLF, SF predicted risk for 28-day progression to ACLF (AUROC: 0.808). A validation group of 635 patients confirmed the above results. Moreover, SF was significantly associated with the immune response based on transcriptomics analysis.SF is a potential diagnostic and predictive marker for HBV-ACLF and might play a crucial role in immune disorders in HBV-ACLF.

Predicting the Onset of Hepatitis B Virus–Related Acute-on-Chronic Liver Failure

Acute-on-chronic liver failure (ACLF) is a life-threatening syndrome with rapid progression. This study aimed to develop and validate a prognostic score to predict the onset of ACLF in hepatitis B virus (HBV) etiology. The prospective clinical data of 1373 patients with acute deterioration of HBV-related chronic liver disease were used to identify clinical characteristics and develop a prognostic score for the onset of ACLF. Of the patients assessed using the Chinese Group on the Study of Severe Hepatitis B (COSSH)-ACLF criteria, 903 patients with non-ACLF at admission (1 received transplantation at 5 days) were stratified: 71 with progression to ACLF and 831 without progression to ACLF at 7 days. Four predictors (total bilirubin, international normalized ratio, alanine aminotransferase, and ferritin) were associated significantly with ACLF onset at 7 days. The COSSH-onset-ACLF score was constituted as follows: (0.101× ln [alanine aminotransferase]+ 0.819× ln [total bilirubin]+ 2.820× ln [international normalized ratio]+ 0.016× ln [ferritin]). The C-indexes of the new score for 7-/14-/28-day onset (0.928/0.925/0.913) were significantly higher than those of 5 other scores (Chronic Liver Failure Consortium ACLF development score/Model for End-stage Liver Disease score/Model for End-stage Liver Disease sodium score/COSSH-ACLF score/Chronic liver failure Consortium ACLF score; all P < .001). The improvement in predictive errors, time-dependent receiver operating characteristic, probability density function evaluation, and calibration curves of the new score showed the highest predictive value for ACLF onset at 7/14/28 days. Risk stratification of the new score showed 2 strata with high and low risk (≥6.3/<6.3) of ACLF onset. The external validation group further confirmed the earlier results. A new prognostic score based on 4 predictors can accurately predict the 7-/14-/28-day onset of ACLF in patients with acute deterioration of HBV-related chronic liver disease and might be used to guide clinical management.

Fecal Microbiota Transplantation Slows the Progression of HBV-Related Liver Diseases and Induces Virologic Response in Patients with HBV Infection

Aims: Healthy gut microbiome plays a crucial role in the treatment of Hepatitis B Virus (HBV) infection and chronic liver disease. Based on existing studies, we aimed to explore the difference in the efficacy of Fecal Microbiota Transplantation (FMT) in patients with different stages of HBV-related chronic liver disease. Methods: In this study, 10 HBV patients with HBeAg-negative infection, 8 patients with Chronic Hepatitis B (CHB) infection, and 8 patients with hepatitis B cirrhosis Child-Pugh score A, 9 patients with hepatitis B cirrhosis Child-Pugh score B/C were treated with FMT. Results: Our results demonstrated that continuous FMT treatment improved liver function, controlled the replication of HBV-DNA, enhanced the intestinal mucosal barrier function, relieve the degree of liver fibrosis and postponed the progression of HBV-related chronic liver disease. The result of 16S ribosomal RNA (rRNA) sequencing indicated that the individual genus and composition of the bacteria in the feces of patients gradually approached the structure seen in case of the feces of healthy donors; the number of specific Operational Taxonomic Units (OTUs) in the stool samples of patients gradually decreased. Conclusion: Our study further confirmed that FMT could be a novel and effective treatment strategy for patients with chronic HBV infection.

From the Editor’s desk…

From the Editor’s desk…

Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure

Early determination of the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is important to guide clinical management and decrease mortality. The aim of this study was to develop a new simplified prognostic score to accurately predict outcomes in patients with HBV-ACLF. Prospective clinical data from 2,409 hospitalized patients with acute deterioration of HBV-related chronic liver disease were used to develop a new prognostic score that was validated in an external group. A total of 954 enrolled patients with HBV-ACLF were diagnosed based on the Chinese Group on the Study of Severe Hepatitis B-ACLF (COSSH-ACLF) criteria. Six predictive factors were significantly related to 28-day mortality and constituted a new prognostic score (=1.649×ln(international normalized ratio)+0.457×hepatic encephalopathy score+0.425×ln(neutrophil)+0.396×ln(total bilirubin)+0.576×ln(serum urea)+0.033×age). The C-indices of the new score for 28-/90-day mortality (0.826/0.809) were significantly higher than those of 4 other scores (COSSH-ACLF, 0.793/0.784; CLIF-C ACLF, 0.792/0.770; MELD, 0.731/0.727; MELD-Na, 0.730/0.726; all p <0.05). The prediction error rates of the new score for 28-day mortality were significantly lower than those of the 4 other scores: COSSH-ACLF (15.9%), CLIF-C ACLF (16.3%), MELD (35.3%) and MELD-Na (35.6%). The probability density function evaluation and risk stratification of the new score also showed the highest predictive values for mortality. These results were then validated in an external cohort. A new prognostic score based on 6 predictors, without an assessment of organ failure, can accurately predict short-term mortality in patients with HBV-ACLF and might be used to guide clinical management. Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a complex syndrome that is associated with a high short-term mortality rate. We developed a simplified prognostic score for patients suffering from this condition based on a prospective multicentre cohort. This new score had better predictive ability than 4 other commonly used scores.

Impaired antibacterial response of liver sinusoidal Vγ9+Vδ2+ T cells in patients with chronic liver disease

ObjectiveThe liver acts as a frontline barrier against diverse gut-derived pathogens, and the sinusoid is the primary site of liver immune surveillance. However, little is known about liver sinusoidal immune...

The signature of HBV-related liver disease in peripheral blood mononuclear cell DNA methylation

BackgroundHepatitis B virus (HBV)-related liver disease induces liver damage by hepatic immune and inflammatory response. The association between aberrant peripheral blood mononuclear cell (PBMC) DNA methylation and progression of liver disease and fibrosis remains unclear.ResultsHere we applied Infinium 450 K BeadChip investigating PBMC genome-wide methylation profiling of 48 HBV-related liver disease patients including 24 chronic hepatitis B (CHB), 14 compensated liver cirrhosis (LC), and 10 decompensated liver cirrhosis (DLC). In total, there were 7888 differentially methylated CpG sites (36.06% hypermethylation, 63.94% hypomethylation) correlate with liver disease progression. LC was difficult to be diagnosed, intermediating between CHB and DLC. We used least absolute shrinkage and selection operator (LASSO)-logistic regression method to perform a LC predictive model. The predicted probability (P) of having LC was estimated by the combined model: P = 1/(1 − e−x), where X = 11.52 − 2.82 × (if AST within the normal range − 0.19 × (percent methylation of cg05650055) − 0.21 × (percent methylation of cg17149911 ). Pyrosequencing validation and confusion matrix analysis was used for internal testing, area under receiver operating characteristic curve (AUROC) of model was 0.917 (95% CI, 0.80–0.977). On the fibrosis progress, there were 1705 genes in LC compared with CHB, whose differentially methylated CpG sites loading within the “promoter” regions (including TSS1500, TSS200, 5′UTR, and the 1st exon of genes) subject into the enrichment analysis using Ingenuity Pathway Analysis (IPA). There were 113 enriched immune-related pathways indicated that HBV-related liver fibrosis progression caused epigenetic reprogramming of the immune and inflammatory response.ConclusionsThese data support idea that development of HBV-related chronic liver disease is linked with robust and broad alteration of methylation in peripheral immune system. CpG methylation sites serve as relevant biomarker candidates to monitor and diagnose LC, providing new insight into the immune mechanisms understanding the progression of HBV-related liver fibrosis and cirrhosis.

Clinical characteristics and 28-d outcomes of bacterial infections in patients with hepatitis B virus-related acute-on-chronic liver failure.

BACKGROUNDAcute-on-chronic liver failure (ACLF), which includes hepatic and multiple extra-hepatic organ failure, is a severe emergency condition that has high mortality. ACLF can rapidly progress and requires an urgent assessment of condition and referral for liver transplantation. Bacterial infections (BIs) trigger ACLF and play pivotal roles in the deterioration of clinical course.AIMTo investigate the clinical characteristics and 28-d outcomes of first BIs either at admission or during hospitalization in patients with hepatitis B virus (HBV)-ACLF as defined by the Chinese Group on the Study of Severe Hepatitis B (COSSH).METHODSA total of 159 patients with HBV-ACLF and 40 patients with acute decompensation of HBV-related chronic liver disease combined with first BIs were selected for a retrospective analysis between October 2014 and March 2016. The characteristics of BIs, the 28-d transplant-free survival rates, and the independent predictors of the 28-d outcomes were evaluated.RESULTSA total of 194 episodes of BIs occurred in 159 patients with HBV-ACLF. Among the episodes, 13.4% were community-acquired, 46.4% were healthcare-associated, and 40.2% belonged to nosocomial BIs. Pneumonia (40.7%), spontaneous bacterial peritonitis (SBP) (34.5%), and bloodstream infection (BSI) (13.4%) were the most prevalent. As the ACLF grade increased, the incidence of SBP showed a downward trend (P = 0.021). Sixty-one strains of bacteria, including 83.6% Gram-negative bacteria and 29.5% multidrug-resistant organisms, were cultivated from 50 patients with ACLF. Escherichia coli (44.3%) and Klebsiella pneumoniae (23.0%) were the most common bacteria. As the ACLF grade increased, the 28-d transplant-free survival rates showed a downward trend (ACLF-1, 55.7%; ACLF-2, 29.3%; ACLF-3, 5.4%; P < 0.001). The independent predictors of the 28-d outcomes of patients with HBV-ACLF were COSSH-ACLF score (hazard ratio [HR] = 1.371), acute kidney injury (HR = 2.187), BSI (HR = 2.339), prothrombin activity (HR = 0.967), and invasive catheterization (HR = 2.173).CONCLUSIONFor patients with HBV-ACLF combined with first BIs, pneumonia is the most common form, and the incidence of SBP decreases with increasing ACLF grade. COSSH-ACLF score, acute kidney injury, BSI, prothrombin activity, and invasive catheterization are the independent predictors of 28-d outcomes.

Celiac Disease and Portal Hypertension: A Causal Association or Just a Coincidence?

Celiac disease (CD) has been linked to portal hypertension (PHT) of varied etiology, but the causality association has never been proved. We aim to study the prevalence of CD in patients of PHT of different etiology. A prospective observational study was conducted from June 2017 to December 2018 involving all the cases of PHT of varied etiology. Consecutive patients of PHT with chronic liver disease (CLD) of defined etiology like ethanol, viral hepatitis (B or C), Budd-Chiari syndrome (BCS), autoimmune-related cirrhosis, and cryptogenic CLD (cCLD)(group A) and those with noncirrhotic PHT (NCPHT), which included noncirrhotic portal fibrosis (NCPF) and extrahepatic portal vein obstruction (EHPVO) (group B), were screened for CD by IgA anti-tTG antibody followed by duodenal biopsy in serology-positive patients. Out of a total of 464 patients, group A constituted 382 patients, CLD related to ethanol (155), cCLD (147), hepatitis B (42), hepatitis C (21), autoimmune (10), and BCS (7), whereas 82 patients were in group B with NCPF (64) and EHPVO (18). Total 29 patients were diagnosed with CD in both groups, 17 in group A (4.5%) and 12 in group B (14.6%). In group A, 13 patients with cCLD, two with HBV-related CLD, one with BCS, and one with autoimmune-related CLD were concomitantly diagnosed as CD. In group B, CD was diagnosed in 12 patients of NCPF (11) and EHPVO (1). Liver histology showed chronic hepatitis in two patients and was normal in three patients. CD is common in PHT of different etiology, especially in cCLD, NCPH and autoimmune hepatitis; however, the etiological basis for this association is still to be defined. The likelihood of CD is higher in liver disease than the general population, and these patients should be screened for CD.

The role of IL22 polymorphisms on liver cirrhosis in patients with hepatitis B virus: A case control study.

Glycogen storage disease (GSD) type IX, characterized by liver enlargement and elevated aminotransferase levels, is the most frequent type of GSD. The global incidence of GSD type IXa is only about 1/100,000 individuals. Case reports of GSD type IX are rare in China. We present the first case report of GSD type IXa in Northeast China caused by mutation of PHKA2.An 11-year-old boy was referred to our hospital because of liver enlargement with consistently elevated transaminase levels over 6 months.Histopathological results following an ultrasound-guided liver biopsy confirmed a diagnosis of GSD. Further genetic testing showed that the patient had GSD type IXa caused by the c.133C>T mutation in PHAK2.We placed the patient on a high-protein and high-starch diet and provided hepatoprotective and supportive therapy.The patient's transaminase levels decreased significantly and were nearly normal at 10-month follow-up.This is the first reported case of GSD type IXa in Northeast China. We hope that the detailed and complete report of this case will provide a reference for the diagnosis of liver enlargement of unknown etiology in future clinical practice.

Evaluation of Health Related Quality of Life of Chronic Liver Disease Patients (Hbv &amp; Hcv Related)

Background: One of the leading causes of death and disability worldwide is viral hepatitis and Hepatitis B (HBV) &amp; Hepatitis C (HCV) constitute 90% of it. In chronic diseases it is more important to evaluate personal impact and disability caused by the disease. Objective: Purpose of this study was to assess the impact of HBV &amp;/or HCV related Chronic Liver Disease (CLD) on health related quality of life of patients, providing insight on present condition of the patients. Materials and methods: This observational study was conducted from June to July, 2018 a private chamber of Chattogram, Bangladesh. Convenience sampling method was used to collect data from 112 HBV &amp;/or HCV patients using EQ-5D-3L questionnaire. SPSS version 23 for windows was used for statistical analysis. Results: In our study, most of the patients could take proper care of themselves but almost one fourth complains some difficulty in walking (28.6%) and performing daily activities (25%). Whereas more than half of total participants had mild physical discomfort or pain (55.4%) and depressive or anxiety (51.8%) experiences in their life. We also found lower quality of life score (Mean 7.13, SD 1.531) in a scale of 5-15 with a comparatively higher well being score (Mean 72.23, SD 21.62) in scale of 0-100 among participants. It was also evident that vaccination status of the spouse were lower in patients with higher wellbeing perception. Conclusion: We tried to evaluate the HRQoL of HBV and HCV related CLD patients to mitigate the burden and provide equitable health care.&#x0D; JCMCTA 2019 ; 30 (1) : 31-35