Posthepatitic Cirrhosis Research Articles

The expression of VEGF and cyclin D1/EGFR in common primary liver carcinomas in Egypt: an immunohistochemical study.

The most common types of primary malignant liver tumours are hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA). Treatment options for patients who are inoperable/advanced, or recurring are challenging. Cyclin D1, epidermal growth factor (EGFR) and vascular endothelial growth factor (VEGR) are common carcinogenic proteins that have potential therapeutic targets in various cancers. They have been implicated in the development of HCC and CCA. In this study, we aimed to evaluate the oncogenic function expression of cyclin D1, EGFR and VEGF in HCC and CCA of Egyptian patients. This could help to validate their therapeutic potential. Tumour cases were selected from 82 cases of primary liver carcinomas, with 58 cases being from HCC and 24 cases from CCA compared to 51 non-tumour adjacent liver cases and 18 from normal liver tissue. The immunohistochemical study of cyclin D1, EGFR and VEGR was conducted. Cyclin D1, EGFR and VEGF are overexpressed in HCC and CCA as compared to the control group (p < 0.001). Cyclin D1 was related to well-differentiated grade and early pathologic stage in HCC (p = 0.016 and p = 0.042, respectively). The well-differentiated grade showed significantly higher VEGF levels (p = 0.04). In the CCA group, however, EGFR was strongly related to high tumour size (p = 0.047). EGFR and VEGF were overexpressed in HCC raised in the non-cirrhotic liver compared to those developed in post-hepatitic liver cirrhosis (p = 0.003 and p = 0.014). Cyclin D1, EGFR and VEGF shared significant overexpression in HCC and CCA. EGFR and VEGF may play an oncogenic function in the development of HCC in non-cirrhotic liver. Furthermore, cyclin D1 and VEGF may play a good prognostic function in HCC, but EGFR may play a bad prognostic role in CCA.

The decreased risk of hepatocellular carcinoma in hepatitis B virus-related cirrhotic portal hypertension patients after laparoscopic splenectomy and azygoportal disconnection.

Posthepatitic cirrhosis is one of the leading risk factors for hepatocellular carcinoma (HCC) worldwide, among which hepatitis B cirrhosis is the dominant one. This study explored whether laparoscopic splenectomy and azygoportal disconnection (LSD) can reduce the risk of HCC among patients with hepatitis B virus (HBV)-related cirrhotic portal hypertension (CPH). A total of 383 patients with HBV-related CPH diagnosed as gastroesophageal variceal bleeding and secondary hypersplenism were identified in our hepatobiliary pancreatic center between April 2012 and April 2022, and conducted an 11-year retrospective follow-up. We used inverse probability of treatment weighting (IPTW) to correct for potential confounders, weighted Kaplan-Meier curves, and logistic regression to estimate survival and risk differences. Patients were divided into two groups based on treatment method: LSD (n = 230) and endoscopic therapy (ET; n = 153) groups. Whether it was processed through IPTW or not, LSD group showed a higher survival benefit than ET group according to Kaplan-Meier analysis (P < 0.001). The incidence density of HCC was higher in the ET group compared to LSD group at the end of follow-up [32.1/1000 vs 8.0/1000 person-years; Rate ratio: 3.998, 95% confidence intervals (CI) 1.928-8.293]. Additionally, in logistic regression analyses weighted by IPTW, LSD was an independent protective predictor of HCC incidence compared to ET (odds ratio 0.516, 95% CI 0.343-0.776; P = 0.002). Considering the ability of LSD to improve postoperative survival and prevent HCC in HBV-related CPH patients with gastroesophageal variceal bleeding and secondary hypersplenism, it is worth promoting in the context of the shortage of liver donors.

Farnesoid X receptor in chronic liver diseases: an immunohistochemical study

ABSTRACT Chronic hepatitis C virus (HCV) related liver diseases are still an ongoing cause of hepatic failure despite the effective role of direct-acting anti-viral agents. Farnesoid X receptor (FXR) agonists have a potential therapeutic effect on the management of chronic liver diseases (CLD). However, data regarding FXR protein expression in human CLDs are limited and conflicting. We aimed to assess the immunohistochemical expression of FXR in HCV-related chronic hepatitis and cirrhosis in comparison with metabolic-associated fatty liver disease (MAFLD) and normal liver tissue. The expression of FXR was low both in hepatocytes and bile ducts of HCV-related chronic hepatitis and cirrhosis (p = .001, respectively). In addition, a significantly low expression of FXR was observed in HCV-related hepatitis and cirrhosis groups compared to MAFLD in hepatocytes (p < .001, for both) and bile ducts (p = .004 and p = .018). FXR expression in HCV-related cirrhosis was significantly associated with compensated liver function (p = .032) and low inflammatory activity (p = .022). FXR expression decreases in HCV-related CLDs. There was some evidence that FXR expression could protect against post-hepatitis cirrhosis.

Accurate Identification and Virulence Detection of Aeromonas: a Single-Center Retrospective Study on the Clinical Features and Outcomes Associated with Aeromonas Bacteremia in Southwestern China.

In this study, Aeromonas spp. were re-identified, and the clinical aspects associated with Aeromonas bacteremia, as well as drug resistance and virulence genes, were elucidated. A total of 188 isolates were classified into 7 Aeromonas spp. using housekeeping gene sequencing, which was the standard to assess the accuracy of the VITEK MALDI-TOF system and the VITEK2 Compact system. The VITEK MS system and housekeeping gene sequencing had a 39.89% clear coincidence rate, whereas the VITEK2 Compact system and the standard had a 2.13% coincidence rate. Aeromonas bacteremia was associated with septic shock, hematologic malignancy, and post-hepatitic cirrhosis. Hematological malignancy, hypoproteinemia, systemic steroid use, central venous catheterization, and virulence genes act and ast were linked to poor outcomes. Aeromonas bacteremia had a 37.5% mortality rate; however, differences in mortality rates among Aeromonas spp. were observed. According to the broth microdilution method, over 90% of isolates were sensitive to most antimicrobials, except ceftriaxone (83.33%) and imipenem (83.33%). Polymerase chain reaction and DNA sequencing verified the presence of drug resistance genes; blaCphA was detected in 3 isolates, while blaNDM-1 was found in one isolate. In summary, common methods for identifying Aeromonas spp. are ineffective. Immunocompromised patients have a higher risk of infection and mortality. Furthermore, carbapenem resistance is a serious problem.

Assessment of renal artery resistive index as a predictor of esophageal varices and its bleeding risk in post-hepatitic cirrhosis

Background Bleeding from rupture esophageal varices (EV) is a major and life-threatening complication of liver cirrhosis (LC). Early detection of EV and prediction of its bleeding risk is important. Objective To assess and evaluate the resistive index (RI) of the renal artery (RA) by Doppler in various stages of portal hypertensive manifestations of LC, and their values for detection of EV and its bleeding. Patients and methods The study included 90 patients, comprising 75 patients with confirmed diagnosis of LC, classified into the following groups: group 1 included 25 patients with EV and having history of variceal bleeding episodes, group 2 included 25 patients with EV and having no variceal bleeding episodes history, and group 3 included 25 patients without EV; in addition, 15 noncirrhotic controls were included as group 4. All patients were subjected to history taking, clinical examination, laboratory investigations, calculation of some important noninvasive indices (CHILD, FIB 4, and APRI) in cirrhotic groups, abdominal ultrasonography, renal Doppler, and upper gastrointestinal endoscopy. Results RA RI served as a predictor of the presence as well as bleeding risk of EV. LT RA RI revealed that a cutoff value of 0.70 has a sensitivity of 90% and a specificity of 76% to predict EV. Moreover, LT RA RI revealed that a cutoff value of 0.70 has a sensitivity of 92% and a specificity of 40% to predict EV bleeding. RT RA RI revealed that a cutoff value of 0.70 has a sensitivity of 80% and a specificity of 76% to predict EV. In addition, RT RA RI revealed that a cutoff value of 0.70 has a sensitivity of 88% and a specificity of 52% to predict EV bleeding. Conclusion RI of the RA may help in predictions of EV and its bleeding risk. LRA RI was more sensitive for prediction of EV bleeding.

Liver assessment using Gd-EOB-DTPA-enhanced magnetic resonance imaging in primary biliary cholangitis patients.

To evaluate the feasibility of utilizing gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for the assessment of Child-Pugh class and for differentiating between patients with primary biliary cholangitis (PBC) and posthepatitic cirrhosis. 45 PBC patients and 45 posthepatitic cirrhosis patients were enrolled and Gd-EOB-DTPA-enhanced MRI was applied. The average relative signal enhancement (RE) of the liver and average contrast to noise ratio (CNR) of common bile duct at 4, 20, and 50 min between different Child-Pugh classes of PBC patients were compared. The RE and CNR in all timepoints in patients with the same Child-Pugh class were compared between PBC patients and posthepatitic cirrhosis patients. The RE of liver and CNR of common bile duct at 4, 20, and 50min was significantly different between all Child-Pugh classes of PBC patients. There were also no significant differences in the RE of liver and CNR of common bile duct in all timepoints between patients with PBC and posthepatitic cirrhosis in the same Child-Pugh class. Gd-EOB-DTPA-enhanced MRI is feasible for liver function assessment in PBC patients. However, the ability of this modality in differentiating liver cirrhosis of different etiologies requires further investigation.

Risk index for early infections following living donor liver transplantation.

IntroductionPost-operative infections in patients undergoing living donor liver transplantation (LDLT) are a major cause of morbidity and mortality. This study aims to develop a practical and efficient prognostic index for early identification and possible prediction of post-transplant infections using risk factors identified by multivariate analysis.Material and methodsOne hundred patients with post-hepatitic cirrhosis, HCV positive, genotype 4, Child B/C or MELD score 13-25 undergoing LDLT were included. All potential predictors of infection were analyzed by backward logistic regression. Cut-off values were obtained from ROC curve analysis. Significant predictors were combined into a risk index, which was further tested and compared by ROC curve analysis.ResultsPost-operative infection was associated with a significantly higher mortality (50.7% vs. 33.3%). Total leucocyte count, total bilirubin, early biliary complications, fever and C-reactive protein were found to be independent predictors of early infectious complications after LDLT. The risk index predicted infection with the highest sensitivity and specificity as compared with each predictor on its own (AUC = 0.91, 95% CI: 0.830–0.955, p < 0.0001).ConclusionsThe use of a combined risk index for early diagnosis of post-operative infections can efficiently identify high risk patients.

Expressions of MiR-132 in patients with chronic hepatitis B, posthepatitic cirrhosis and hepatitis B virus-related hepatocellular carcinoma.

To explore the expressions of miR-132 in patients with chronic hepatitis B, posthepatitic cirrhosis and hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), and to investigate its possible mechanism affecting the function of the body. Among 125 patients with HBV, there were 44 cases of chronic hepatitis, 42 cases of liver cirrhosis and 39 cases of liver cancer. Their liver function and HBV-deoxyribonucleic acid (HBV-DNA) viral load as well as the expressions of micro ribonucleic acid-132 (miR-132), phosphoinositide 3-kinase (PI3K), phosphorylated-protein kinase B (p-Akt) and hepatitis B X protein (HBx), were detected. There were significant differences in some liver function indexes and the HBV-DNA level among the three groups of patients (p < 0.05). The HBV-DNA level was 6.91 Lg copies/mL in the liver cancer group and 5.34 Lg copies/mL in the chronic hepatitis B group. Differences in the expression level of miR-132 among the three groups were notable (p < 0.05), but this expression level had a negative correlation with the HBV-DNA level. The expressions of PI3K and p-Akt proteins and messenger ribonucleic acids (mRNAs) were markedly different among the three groups (p < 0.05). HBx was expressed in the three groups of patients, and liver cancer patients with the highest expression degree of HBx accounted for 46%. Differences in the expression of miR-132 among the three groups are evident, which may be associated with differences in liver function, the HBV-DNA level, HBx and the expressions of PI3K and p-Akt proteins to a certain degree.

Coronary-renal shunt combined with splenectomy for selective variceal decompression

Instruction: Selective shuns for gastroesophageal varices including distal splenorenal shunt and coronary-caval shunt may not solve the problems of the giant spleen with serious hypersplenism or deep location of the left gastric vein behind the pancreas. A new selective shunt procedure should be explored. Methods: Coronary-renal shunt combined with splenectomy was performed on 16 patients with gastroesophageal varices and serious hypersplenism due to posthepatitic cirrhosis. The patients had the dilated left gastric vein entering the splenic vein by preoperative CT angiorgraphic evaluation. After splenectomy, the proximal part of the splenic vein with a length of 3-5cm and the left gastric vein were freed from the pancreas. The freed splenic vein was divided at the distal side with the proximal orifice anasomosed to the left renal vein. Ligation or division between sutures was applied to the splenic vein between portal vein and left gastric vein. The right gastric and gastro-epiploic vessiles were divided to occlude the back flow from the portal vein. Results: There were no operative motality and no procedure-relative complications. Post-operative CT and endoscopy showed the shunts were patent with reduced or obliterative varices in all sixteen patients. There were no recurrent variceal haemorrhage nor encephalopathy by 6-36 months' follow-up. Conclusion: This procedure can reach the aim of selective variceal decompression when splenectomy is required. Keywords: portal hypertension; coronary-renal shunt; selective variceal decompression; splenectomy

Correlation of liver function with intestinal flora, vitamin deficiency and IL-17A in patients with liver cirrhosis.

The aim of this study was to investigate the correlation of liver function, intestinal flora, vitamin D and interleukin-17A (IL-17A) levels in patients with liver cirrhosis. A total of 52 patients diagnosed with posthepatitic cirrhosis and admitted into Yantai Infectious Disease Hospital (Yantai, China) from January to December in 2012 (liver cirrhosis group), and 52 patients with chronic hepatitis B (hepatitis group), and 40 healthy volunteers receiving physical examination in the hospital (normal control group) were selected into the study. The liver function, hepatitis B virus (HBV) deoxyribonucleic acid (DNA) level, intestinal flora distribution, vitamin D and IL-17A levels of all patients were detected, and the correlation among them was analyzed via Pearson's analysis. The number of Enterobacteriaceae, Enterococcus, Staphylococcus aureus and Saccharomyces in hepatitis and liver cirrhosis groups was significantly greater than in the normal control group (P<0.05), but the number of Lactobacillus, Bacteroides, Bifidobacterium and Clostridium was significantly decreased (P<0.05); the serum IL-17A levels in hepatitis and liver cirrhosis were obviously higher than that in the normal control group (P<0.05), but the serum vitamin D 25(OH) D and 1,25(OH)2D levels were obviously lower than that in the normal control group (P<0.05). In patients with liver cirrhosis, Enterobacteriaceae was positively correlated with prothrombin time (PT), Enterococcus was positively correlated with alanine aminotransferase and aspartate aminotransferase (AST) levels, Bifidobacterium was negatively correlated with AST, alkline phosphatase (AKP) and HBV DNA levels, and Bacteroides was negatively correlated with AST level and PT. There was a significant negative correlation between serum IL-17A and total bilirubin in patients with liver cirrhosis, and 25(OH) D was negatively correlated with AST, AKP and HBV DNA levels. In patients with liver cirrhosis, there was significant positive correlation between Enterococcus and IL-17A, and between Lactobacillus and 25(OH)D, but other bacteria were not obviously associated with IL-17A and vitamin D. Intestinal flora imbalance, vitamin D deficiency and IL-17A imbalance play an important role in the evolution of liver cirrhosis.

Circulating microRNA in the early diagnosis of hepatitis B associated liver cancer

Objective To screen the differentially expressed microRNA (miRNA, miR) in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) and analyze the biological information to provide a possibility for early humoral diagnosis and therapy. Methods Human gene expression microarray technology was used to analyze the miRNA differential expression profiles in post-hepatitis B liver cancer, post-hepatitis cirrhosis and healthy volunteers. GO analysis and KEGG pathway biological analysis were performed. Results We identified 17 differential miRNAs in the HBV-related HCC blood samples and 20 differential miRNAs in hepatitis B xirrhosis blood samples compared to healthy controla. There were also 4 down-regulated and 6 up-regulated miRNAs in HCC samples compared to the hepatitis B cirrhosis samples. The expression of hsa-miR-6127, hsa-miR-6879-5p, and hsa-miR-6510-5p was significantly increased in HCC, but reduced in healthy and cirrhotic groups. And it was confirmed that miRNAs participated in angiogenesis, host immunity and multiple signaling pathways of hepatitis B-related HCC. Conclusion Hepatitis B-associated liver cancer has significantly different expression profiles of miRNAs in healthy adults and cirrhosis, involving in the functional classification and signal transduction pathways. Analysis of these differences can faciliate the early diagnosis and therapy of HCC. Key words: Carcinoma, hepatocellular; MicroRNA; Bioinformatics; Hepatitis B Virus

Impact of Enterobacteriaceae bacteremia on survival in patients with hepatorenal failure.

Enterobacteriaceae are now the predominant pathogens isolated in patients with liver cell failure associated with bloodstream infections. We conducted a retrospective cohort study of patients who were admitted for the diagnosis of hepatorenal failure (HRF) between June 1999 and May 2008 to investigate the risk factors of Enterobacteriaceae bacteremia (EB). EB was defined as the isolation of an EB species from at least one blood culture within three months following diagnosis of HRF. Variables were collected from the medical records and analyzed in relation to EB. Twenty-four (32.5%) of the 73 patients developed EB. The origin of EB was abdominal in 21% of the patients, urinary in 12.5%, pulmonary in 16.5%, and primary in the remaining patients (50%). Two-thirds of EB occurred within 10 days following the development of HRF. The main pathogens were Escherichia coli (44%), Enterobacter species (20%) and Klebsiella pneumoniae (22%). Eighteen patients (75%) with EB died. Variables significantly associated with EB after multivariate analysis were a model for end-stage liver disease score >20 [odds ratio (OR): 2.84, P <0.02], posthepatitis B liver cirrhosis (OR: 4.72, P <0.05), posthepatitis C liver cirrhosis (OR: 3.48, P <0.05), and initial level of serum creatinine on admission to intensive care unit (OR: 2.56, P <0.02). EB is a frequent and severe complication of HRF. Patients with posthepatitis cirrhosis B and C, higher serum creatinine, and severe liver cell failure score have a high risk of developing EB.

Interest of SAAG in Etiological Diagnosis of Ascites in African Black

Purpose: To show the interest of the serum-ascites concentration gradient in albumin (SAAG) in the etiological diagnosis of ascites in African black. Materiel and Methods: This was a monocentric observational and analytical study performed on patients over 15 years old and hospitalized in the Hepato-Gastroenterology department of Cocody from January 1st, 2010 to March 31st, 2017 for ascites. The cytology and chemistry of the ascites fluid and the protidogram were performed. The main outcome measure was the prediction of portal hypertension (PHT) or non-portal hypertension related causes of ascites from SAAG. Results: The hospital prevalence of ascites was 11%. There were 82 women (46.9%) and 93 men (53.1%) with a sex ratio (M/F) of 1.1. SAAG was low in 68.6% of cases and high in 31.4% of cases. The most common etiologies were post-viral cirrhosis (74%), HCC (16.60%) and peritoneal tuberculosis (13.7%) respectively. In the case of high SAAG, 91% of ascites related to PHT were observed, but also 77.5% of a low SAAG corresponded to ascites related to PHT (p = 0.024) with Se = 35% Sp = 84% and accuracy = 44%. All patients with peritoneal tuberculosis had a SAAG low of less than 1.1 g/dl significantly (p = 0.002). SAAG had a diagnostic performance of 89% in peritoneal tuberculosis at the cutoff value of ?1.24 g/dl (AUROC = 0.91, Se = 96%, Sp = 86%) while in post viral hepatitis cirrhosis at a threshold of 0.58 g/dl the diagnostic performance was 60% (AUROC = 0.69, Se = 53%, Sp = 79%). Conclusion: The simple technical SAAG, allowing to distinguish the ascites linked to the PHT and the ascites not bound to the PHT, can be used like a method of diagnosis of the etiologies of the ascites especially in the peritoneal tuberculosis in the African countries low income.

Validation of the AFP model as a predictor of HCC recurrence in patients with viral hepatitis-related cirrhosis who had received a liver transplant for HCC

The AFP model was shown to be superior to the Milan criteria for predicting hepatocellular carcinoma (HCC) recurrence after liver transplantation in a French population. Our aim was to test the AFP model in a non-French, post-hepatitic cirrhosis-based population of HCC candidates. 574 patients transplanted for HCC in four Italian centers were studied. AFP score was assessed at the last evaluation before liver transplantation (LT). Probabilities of recurrence and survival were estimated by the log-rank test or competing risk analysis and compared according to the AFP model. 24.7% patients were beyond Milan criteria. HCC complicated hepatitis C virus (HCV) and hepatitis B virus (HBV) cirrhosis in 58.7% and 24% of the cases, respectively. Five-year probabilities of recurrence differed according to AFP score ⩽2 vs. >2 in the whole population (13.2±1.8% vs. 49.8±8.7%, p<0.001, HR=4.98), in patients within Milan criteria (12.8±2.0% vs. 32.4±12.1%, p=0.009, HR=3.51), beyond Milan criteria (14.9±4.2% vs. 58.9±11.5%, p<0.001, HR=4.26), HCV patients (14.9±2.5% vs. 67.6±14.7%, p<0.001, HR=6.56) and HBV patients (11.6±3.4% vs. 34.3±12.5%, p=0.012, HR=3.49). By net reclassification improvement analysis AFP score significantly improved prediction of non-recurrence compared to Milan criteria. Overall five-year survival rates according to AFP score ⩽2 or >2 were 71.7±2.2% vs. 42.2±8.3% (p<0.001, HR=2.14). The AFP model identifies HCC candidates at low risk of recurrence, otherwise excluded by Milan criteria in a population with a predominance of post-hepatitic-related HCC. The AFP score can be proposed for selection of HCC candidates in programs with a high proportion of viral/HCV-related cirrhosis. Selection criteria for liver transplantation of patients affected with hepatocellular carcinoma (HCC) are based on the Milan criteria, which have been shown to be too restrictive, precluding access to liver transplantation for some patients who might be cured by this operation. Recently, a French group of researchers developed a new selection model called the AFP model, or AFP score, allowing some patients with HCC not meeting Milan criteria to be transplanted with excellent results. In the present work, the AFP score was tested in a population of non-French patients transplanted for HCC occurring mainly on post-hepatitic (HCV or HBV) cirrhosis. The results confirm that in this specific population, as in the original French population of patients, the AFP model better selects patients with HCC eligible for transplantation, compared to Milan criteria. We conclude that the AFP score, which has been officially adopted by the French organization for Organ Sharing for HCC patients, can also be implemented in countries with an important burden of HCC occurring on post-hepatitic cirrhosis.

The clinical advancement of hypersplenism caused by post-hepatitis cirrhosis

Post-hepatitis cirrhosis (PHC), which results from either hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, and its associated with hemodynamic changes may cause the spleen to become functionally hyperactive—a condition known as hypersplenism. Hypersplenism is associated with anemia, leukopenia, thrombocytopenia and splenomegaly. There are several effective methods to treat hypersplenism with the development of medical technology and the main purpose is the remission of hypersplenism, reducing the portal hypertension and decreasing the risk of hemorrhage. However, complete splenectomy or partial treatment of the hyperactive spleen is still controversial all over the world. This may be caused by the lack of the knowledge on the pathophysiological characteristics and clinical significance of treating hypersplenism. This review is a comprehensive discussion on the recent research which investigates hypersplenism caused by PHC. Key words: Cirrhosis; Hypersplenism; Pathophysiology; Treatment

Hypersplenism is correlated with increased risk of hepatocellular carcinoma in patients with post-hepatitis cirrhosis.

Several risk factors exist for hepatocellular carcinoma in patients with post-hepatitis cirrhosis (PHC), including hypersplenism. Splenectomy is a common but controversial procedure in the management of hypersplenism, but its impact on hepatocellular carcinoma (HCC) remains uncertain. We conducted a hospital-based study of PHC patients to identify potential risk factors, including a history of splenectomy, which has been associated with progression from PHC to HCC. From 2002 to 2012, 2678 patients developed hypersplenism secondary to PHC. Of these patients, 828 developed HCC and 1850 did not. Potential risk factors of HCC were determined by univariate and multivariate analyses to exclude confounding variables. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were determined for each factor. Many factors, such as liver function, platelet (PLT) counts, Child-Pugh class, and history of hepatitis, were associated with progression to HCC. PHC patients with hypersplenism who displayed elevated levels of alanine transaminase (ALT), aspartate transaminase (AST), γ-glutamyltransferase (GGT), ALK, phosphatase, and prolonged prothrombin time (PT) had a significantly increased risk of HCC. However, the patients who had splenectomy showed better liver function test results and less progression to HCC. In patients with PHC and hypersplenism, abnormal levels of ALT, AST, ALP, and GGT and prolonged PT are risk factors of HCC. Splenectomy, as the intervention method of hypersplenism, is performed less frequently in patients who developed HCC than in patients who did not develop HCC. Therefore, splenectomy may act as an independent factor that is significantly associated with HCC development.

Clinical efficacy of silybin combined with entecavir for treatment of patients with post-hepatitis cirrhosis

Clinical efficacy of silybin combined with entecavir for treatment of patients with post-hepatitis cirrhosis

Skin and soft tissue bacterial infections in cirrhotic patients with edema

Objective: The aim of this study was to determine the type, risk factors, and the causative organism of bacterial skin infections in cirrhotic patients with edema. Background: Bacterial infections are often associated with significant morbidity and mortality in cirrhosis. The common practice of outdoor barefoot walking and the associated risk of trauma may predispose cirrhotic patients to skin infection. Patients and methods: This study was conducted on 150 patients, of whom 35 cirrhotic patients served as the control group. Data, including the type, the site, risk factors, and the culture results of the skin or soft tissue infection present, were collected. Results: A unique criterion of this study was that in all the study participants in the cirrhotic group the infection was due to posthepatitic cirrhosis (hepatitis C virus, hepatitis B virus, or combined infection). History or evidence of trauma, uncontrolled diabetes, massive lower-limb edema, and a high BMI are major risk factors for developing skin or soft tissue infection. Cellulitis represents the most common type of infection, affecting mainly the lower limbs. Gram-negative organisms are the causative organisms in cirrhotic patients (17%), mainly Escherichia coli in 13% of the cases. Conclusion: Gram-negative bacteria may cause bullous cellulitis in patients with cirrhosis. Trauma, diabetes mellitus, and massive lower-limb edema are major risk factors for skin and soft tissue infections in cirrhotic patients.

Study on serum hormones and liver function in male patients with liver cirrhosis and gynecomastia

Objective To investigate the relationship between the mechanism of gynecomastia and serum hormone levels, as well as liver function in male patients with liver cirrhosis. Methods Forty-six male patients with liver cirrhosis and gynecomastia were collected as gynecomastia group from March 2013 to March 2014, and at the same period seventy male patients with liver cirrhosis but without gynecomastia were studied as non-gynecomastia group. The condition of mammogenesis and maximum of breast thickness were measured by bilateral breast ultrasound. Hormones including luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), estradiol (E2), progesterone (PRGE), and testosterone (T); liver function including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil) and serum albumin (Alb); blood coagulation function including prothrombin time (PT), platelet count (PLT) were examined and the Child-Pugh scores were calculated. t-test was performed for results comparison between gynecomastia group and non-gynecomastia groups. Chi-square test was used to compare the difference in drinking rate between two groups. The patients of gynecomastia group and non-gynecomastia group were further divided into Child-Pugh Grade A, B and C subgroups according to Child-Pugh scores and the patients of gynecomastia group were divided into subgroups according etiology such as posthepatitic cirrhosis, alcoholic liver cirrhosis and posthepatitic cirrhosis combined with alcoholc cirrhosis. Single factor analysis of variance was applied to compare the laboratory findings between subgroups, and least-significant difference mothod was used to further compared the differences between two subgroups. Results Among forty-six male patients with liver cirrhosis and gynecomastia, the mean thickness of breast was (7.56±2.84) mm.All the differences of TBil, Alb, PT and Child-Pugh score of Child-Pugh grade patient were statistically significant between gynecomastia group and no gynecomastia group ((96.72±75.86) μmol /L vs (60.57±54.00) μmol /L, (29.12±4.90) g/L vs (33.86±6.86) g/L, (19.06±4.76) s vs (15.54±2.57) s, 11.54±0.91 vs 10.33±0.57, respectively, t=2.79, -4.33, 4.58, 2.22, all P 0.05). PRL and E2/T ratio ((404.49±297.26) mU/L and 68.74±46.37) were higher than those of non-gynecomastia group ((279.77±111.57) mU/L and 13.60±11.55), and T was lower than that of non-gynecomastia group ((7.15±5.74) nmol/L vs (15.46±8.53) nmol/L), and the differences were statistically significant (t=2.72, 7.90、-6.27; all P 0.05). T level of gynecomastia group gradually decreased, and those of Child-Pugh B, C subgroup ((8.20±7.58) nmol/L and (4.18±3.76) nmol/L) were siginificantly lower than that of Child-Pugh A subgroup of non-gynecomastia group ((17.64±9.04) nmol/L, F=9.37, P<0.05). The E2/T levels of gynecomastic group gradually increased. There was significant difference in E2/T level between Child-Pugh C subgroup of gynecomastia group (105.49±94.42) and Child-Pugh A grade subgroup of non-gynecomastia group (11.38±9.60, F=12.57, P<0.05). Conclusions There are different degrees of sex hormone disorder in the serum of male patients with liver cirrhosis and gynecomastia which is more significant in PRL, T and E2/T.T and E2/T level are correlated with the degree of liver functional impairment.Gynecomastia in alcoholic liver cirrhosis is more severe than that of posthepatitic liver cirrhosis. Key words: Liver cirrhosis; Gynecomastia; Sex hormones; Ultrasonography, mammary

Progress in treatment of hypersplenism in patients with post-hepatitis cirrhosis

Progress in treatment of hypersplenism in patients with post-hepatitis cirrhosis