Posthepatitic Cirrhosis Research Articles

Evaluation of gastric fundic and oesophageal varices by 64-row multidetector computed tomography before and after transjugular intrahepatic portosystemic shunt with concurrent left gastric vein embolization

To determine the utility of 64-row multidetector computed tomography (MDCT) in assessing the changes of gastric fundic and oesophageal varices before and after transjugular intrahepatic portosystemic shunt (TIPS) with concurrent left gastric vein embolization. Twenty-eight consecutive patients with gastric fundic and oesophageal varices resulted from posthepatitic cirrhosis, clinically confirmed with endoscopy, were enrolled into our study. All the patients underwent thoracicoabdominal triphasic enhancement scans with 64-row MDCT 2 weeks before TIPS along with embolizing left gastric vein, and 6 months after the therapy. Before and after the therapy, the varices shown on multiplanar reconstruction (MPR) were compared by Fisher's exact test to evaluate the changes. Gastric fundic and oesophageal varices were shown in 26 patients (92.9%) and 25 (89.3%) on MPR before the therapy, respectively. After the therapy, these varices diminished markedly, and were illustrated in six (21.4%) and 10 patients (35.7%), respectively (all P<0.05). As for the main inflowing vessel of the varices (left gastric vein), it was illustrated in 28 patients (100.0%) on preoperative CT-MPR. After the embolization, the left gastric vein had been completely occluded on postoperative CT-MPR. Significant eradication of gastric fundic and oesophageal varices on follow-up CT-MPR portography can be considered to assess the changes of gastric fundic and oesophageal varices before and after TIPS with concurrent left gastric vein embolization, and 64-row MDCT can be an effective modality to evaluate the changes.

Randomized trial comparing human albumin and hydroxyethyl starch 6% as plasma expanders for treatment of patients with liver cirrhosis and tense ascites following large volume paracentesis

Background and study aims Cirrhosis is the commonest cause of ascites accounting for almost 85% of all cases. Approximately 10% of patients with cirrhosis develop diuretic-resistant tense ascites that requires other therapeutic interventions. Large-volume paracentesis with plasma expander infusion, mainly albumin, has been used for the management of ascites in cirrhotic patients. We aimed at investigating whether human albumin can be substituted by a less expensive plasma expander, hydroxyethyl starch 6% following paracentesis. Patients and methods One-hundred and thirty-five patients (60% with cirrhosis and schistosomal periportal fibrosis combined, 26.7% with posthepatitic cirrhosis and 13.3% with schistosomal periportal fibrosis) with tense ascites were randomized to treatment by one-session of a nearly-total paracentesis plus intravenous human albumin (68 patients) or hydroxyethyl starch 6% (67 patients). These were given at a dose of 8 g/l of ascitic fluid removed. The two groups were compared for incidence of complications, recurrence of massive ascites after hospital dismissal and survival rate. Results Both groups showed no significant changes in renal or hepatic function or serum electrolytes. The incidence of complications following paracentesis was similar in both groups. The number of readmissions during follow up and causes of readmission and survival were also comparable. The effect of paracentesis on the effective intravascular volume was indirectly assessed by plasma renin activity and plasma aldosterone concentration before treatment, 2 and 6 days after treatment. None of the mean values of these changed significantly in the two groups after paracentesis. Postparacentesis transient hypotension was observed more in the hydroxyethyl starch 6% group than in those treated with albumin (23.9% versus 8.8%, p = 0.018). Conclusions Hydroxyethyl starch 6% is safe and as effective as human albumin in protecting patients treated with nearly-total paracentesis from developing renal and electrolyte complications. Transient hypotension following paracentesis was, however, commoner in the hydroxyethyl starch group.

Serum profile of Th17-related cytokines in patients with primary biliary cirrhosis

Objective:To observe the serum profile of Th17-related cytokines(IL-1β,IL-6,IL-17A,IL-23,and TGF-β)in patients with primary biliary cirrhosis,so as to study the role of Th17 cells in the pathogenesis of primary biliary cirrhosis(PBC).Methods:Seventy-eight patients with PBC,30 patients with HBV-related posthepatitic cirrhosis(PHC),and 60 healthy controls(HC)were enrolled in this study.The serum levels of above five Th17-related cytokines were determined by enzyme-linked immunosorbent assay(ELISA).Results:The levels of IL-1β,IL-6,IL-17A,and IL-23 in PBC group were significantly higher than those in HC group(P0.05);the levels of TGF-β were comparable between the PBC group and HC group.The levels of IL-1β,IL-6,and TGF-β were significantly lower and IL-17A,IL-23 were significantly higher in the PBC group compared with those in the PHC group(P0.05).Conclusion:Our findings indicate that PBC patients are in a status of chronic inflammation.Th17 subset may play an important role in the development and progression of PBC.

Relationship between quality of life and basic syndromes of traditional Chinese medicine in patients with posthepatitic cirrhosis

To investigate the main factors influencing the quality of life and the relationship between quality of life and basic syndromes of traditional Chinese medicine (TCM) in patients with post hepatitic cirrhosis. The outcomes of revised Short Form-36 Health Survey (SF-36) Questionnaire in 108 patients with post hepatitic cirrhosis and the normal control population were assessed, and the related clinical information including gender, age, body mass index (BMI), course of disease, basic syndromes of disease and main laboratory parameters were collected. The data were analyzed by t-test, analysis of variance (ANOVA) and stepwise regression analysis. The Cronbachs alpha coefficient of the revised SF-36 questionnaire was 0.773, indicating good consistency within the items. The outcomes of revised SF-36 and the scores of physical function, role physical, bodily pain, mental health, and social function in the patients with post hepatitic cirrhosis were significantly lower than those in the normal control population (P<0.01). Correlation analysis showed that there was a correlation between basic TCM syndromes and scores of physical function, mental health, role emotion, vitality, and general health. Stepwise regression analysis indicated that basic TCM syndromes, aspartate aminotransferase, total bilirubin, albumin, and prothrombin time played major role in the quality of life in the patients with post hepatitic cirrhosis, and the values of regression coefficient were 0.262, -0.297 8, -0.483 9, -0.483 9, -0.512 3, -0.571 9 respectively. The quality of life in the patients with post hepatitic cirrhosis is significantly decreased. The revised SF-36 with basic TCM syndrome items is more objective and has certain clinical practical value on measurement of quality of life in patients with post hepatitic cirrhosis.

Monocyte-platelet aggregates and platelet micro-particles in patients with post-hepatitic liver cirrhosis

Introduction Monocytes are the cells that play a crucial role in the pathogenesis of liver damage and liver cirrhosis (LC), and as platelets, by connecting hemostasis and inflammatory processes, participate in pathogenesis of chronic liver diseases, we aimed to investigate the presence of monocyte-platelet aggregates and platelet micro-particles (PMPs) and their role in LC. Patients and methods The study included 60 patients with post-hepatitic LC and 20 healthy controls. Activated monocytes (CD11b, HLA-DR, CD14, CD16), monocyte-platelet aggregates (CD41/CD14), activated platelets (CD41/CD62) and PMPs were analyzed by flow cytometry. Their relations to the clinical and laboratory data were assessed in the studied group. Results Patients with LC had higher levels of activated platelets, activated monocytes and monocyte-platelet aggregations as compared to healthy controls. PMPs percentage showed no significant differences between patients and controls but significantly increased in both patients with no bleeding and patients with splenomegaly compared to patients without. All studied markers showed no significant differences between patients with thrombocytopenia and those with normal platelet counts and also between patients with different disease stages. Positive correlations between monocyte-platelet aggregates and both activated platelets and monocytes were demonstrated. There were significant negative correlations between PMPs and both age and prothrombin time among patients. Conclusions The stage of post-hepatitic LC is not the only factor that affects the level of activated platelets, activated monocytes and monocyte-platelet aggregates. PMPs have no influence on thrombocytopenia but may have the potential to influence the progression of clotting activity in LC.

Immunologic Characterization of Posthepatitis Cirrhosis Caused by HBV and HCV Infection

No specific treatment can reverse the liver injury in cirrhosis. This study aims to characterize immune status and correlations between cirrhosis induced by HBV and HCV. Phenotypes of peripheral blood lymphocyte subsets (T, NK, regulatory T cells) and Th cytokine secretion were analyzed using flow cytometry in 42 HBV-cirrhotic and 40 HCV-cirrhotic patients. Cirrhotic patients had a lower proportion of CD3+CD8+T cells and NK cells, while the proportion of CD3+CD4+T cells and Treg cells were higher than those of healthy controls. The levels of Th2 cytokine (IL-6) in cirrhotic patients were increased, while only the Th1 cytokine (IFN-γ) increased in HBV-cirrhotic patients. These findings show that there is no difference between the cirrhotic groups except in the IFN-γ level. In cirrhosis, defects in innate, adaptive immune cells are likely regardless of which virus is involved. A cytokine imbalance may play a role in the development of posthepatitic cirrhosis.

Reduced post‐operative neutrophil activation in liver transplant recipients suffering from post‐hepatitic cirrhosis

It has been supposed that liver transplant recipients with hepatitis C virus infection have a higher incidence of infectious complications after transplantation. This study was designed to investigate whether neutrophil function is immediately affected by liver transplantation. Biochemical values, plasma levels of myeloperoxidase (MPO), hydrogen peroxide production of neutrophils and neutrophil-platelet complexes were analyzed in 32 patients who underwent liver transplantation and 20 healthy volunteers. MPO levels were significantly increased 24 h after reperfusion. In post-hepatitic patients levels were significantly lower three d up to one wk post-transplant than in patients due to other liver diseases. One wk post-operatively the respiratory burst activity following N-formyl-methionyl-leucylphenylalanine (fMLP) or (tumor necrosis factor-alpha) TNF-alpha/fMLP stimulation was depressed in post-hepatitic recipients. Respiratory burst stimulated with phorbol 12-myristate 13-acetate in these patients was increased one wk after transplantation. One d after transplantation the neutrophil-platelet complexes decreased significantly throughout the post-operative period. The results of this study suggest a reduced post-operative neutrophil activation in liver transplant recipients suffering from post-hepatitic cirrhosis compared to cirrhosis due to other causes. We hypothesized that neutrophil dysfunction in those patients depends on the underlying disease with an increased susceptibility to bacterial or fungal infections.

Reversibility of posttransplantation diabetes mellitus following liver transplantation

Background: It has been supposed that liver transplant recipients with hepatitis C virus infection have a higher incidence of infectious complications after transplantation. This study was designed to investigate whether neutrophil function is immediately affected by liver transplantation. Methods: Biochemical values, plasma levels of myeloperoxidase (MPO), hydrogen peroxide production of neutrophils and neutrophil-platelet complexes were analyzed in 32 patients who underwent liver transplantation and 20 healthy volunteers. Results: MPO levels were significantly increased 24 h after reperfusion. In post-hepatitic patients levels were significantly lower three d up to one wk post-transplant than in patients due to other liver diseases. One wk post-operatively the respiratory burst activity following N-formylmethionyl- leucylphenylalanine (fMLP) or (tumor necrosis factor-alpha) TNF-alpha/ fMLP stimulation was depressed in post-hepatitic recipients. Respiratory burst stimulated with phorbol 12-myristate 13-acetate in these patients was increased one wk after transplantation. One d after transplantation the neutrophil-platelet complexes decreased significantly throughout the post-operative period. Conclusions: The results of this study suggest a reduced post-operative neutrophil activation in liver transplant recipients suffering from post-hepatitic cirrhosis compared to cirrhosis due to other causes. We hypothesized that neutrophil dysfunction in those patients depends on the underlying disease with an increased susceptibility to bacterial or fungal infections.

Endoscopic Therapy of Biliary Fistulas After Complex Liver Resections

Background: The role and efficacy of endoscopy in the treatment of biliary fistulas of the common bile duct are well documented. On the contrary, results of endoscopic procedures for fistulas arising from peripheral bile ducts after liver resections are poorly studied, although more complex hepatectomies are increasingly performed in oncologic surgery. We analyzed retrospectively the results of these procedures. Patients and Methods: 32 patients (men: 19) aged 10-74 years were included. 13 patients had a right hepatectomy, 2 a left hepatectomy, 2 a single segmentectomy, 6 had more than a single segmentectomy, and 9 had a bi-partition liver transplantation (cystic fibrosis, post hepatitis cirrhosis and HCC) .

Evaluation of entire gastric fundic and esophageal varices secondary to posthepatitic cirrhosis: portal venography using 64-row MDCT

There are no reports regarding entire gastric fundic and esophageal varices evaluated with 64-row multidetector CT (MDCT). We attempt to clarify the feasibility of portal venography with this scanner in evaluation of these varices. A total of 33 patients, with clinically confirmed gastric fundic and esophageal varices secondary to posthepatitic cirrhosis, underwent thoracicoabdominal triphasic enhancement scans using 64-row MDCT along with conventional angiographic portography. CT portography and conventional portography were compared by statistical agreement to determine whether CT maximum intensity projection (CT-MIP) portography is useful in evaluation of entire gastric fundic and esophageal varices. CT-MIP portography demonstrated gastric fundic and esophageal varices, and the inflowing and outflowing vessels of the varices. Gastric fundic varices were shown in 32 cases (97.0%), and esophageal varices were in 27 (81.8%). The inflowing vessels including the left gastric vein and posterior gastric vein/short gastric vein were illustrated in 31 (94.0%) and 17 (51.5%) cases, respectively. The outflowing vessels including the azygos vein, hemiazygos vein, and gastro-renal shunts were seen in 30 (90.9%), 8 (24.2%), and 12 (36.4%) cases, respectively. Findings of CT-MIP portography and conventional angiographic portography were in close agreement (Kappa value ranged from 0.621 to 1.000). CT-MIP venography with 64-row MDCT could be considered as a method for detecting entire gastric fundic and esophageal varices developed from posthepatitic cirrhosis.

Posthepatitic cirrhosis with primary hypothyroidism: a report of one case

Posthepatitic cirrhosis with primary hypothyroidism: a report of one case

Classification and modeling of traditional Chinese medicine syndromes in patients with posthepatitic cirrhosis by partial least-squares

Classification and modeling of traditional Chinese medicine syndromes in patients with posthepatitic cirrhosis by partial least-squares

Traditional Chinese medicine diagnosis and evaluation of the clinical effect in post-hepatitic cirrhosis based on fuzzy analysis

In view of the problem of traditional Chinese medicine (TCM) diagnosis, fuzzy comprehensive evaluation is introduced to the diagnosis and evaluation of the clinical effect of hepatitis. A new diagnosis and evaluation model of the TCM clinical effect standard was presented. The old disputed evaluation model by subjective analysis can be displaced by this objective method in its evaluation system. The foundation of this method is the fuzzy diagnosis model. This method has been realized to diagnose hepatitis and its values in practice has been validated through examples of clinical syndromes of post-hepatitic cirrhosis.

Role of the peritoneopleural pressure gradient in the genesis of hepatic hydrothorax. An isotopic study

Hepatic hydrothorax is defined as the development of significant pleural effusion in a patient with cirrhosis without primary pulmonary or cardiac disease. This complication is seen in 4-10% of patients with cirrhosis. The pleural effusion is a result of a direct passage of ascitic fluid into the pleural cavity through a defect in the diaphragm. We report two patients with posthepatitis cirrhosis presenting with a significant pleural effusion. The peritoneopleural communication was demonstrated by peritoneal scintigraphy. The role of the peritoneopleural pressure gradient is discussed.

Primary biliary cirrhosis and osteoporosis: a case-control study

Osteoporosis is a common complication of chronic liver disease, from cholestatic disorders to autoimmune, alcoholic, and posthepatitic cirrhosis. Osteoporosis appears more striking in patients with primary biliary cirrhosis (PBC) because the disease usually affects elderly women, who are naturally prone to osteoporosis. Our aims were (1) to compare the prevalence of osteoporosis (T-score <-2.5 SD) between PBC patients and a group of age-and sex-matched controls consisting of healthy subjects from the general population; and (2) to identify the main risk factors for the development of bone loss. Thirty-three women with PBC (mean age, 47.3 +/- 10.4 years) and 66 healthy subjects were enrolled in the study. Bone mineral density (BMD) was assessed at the lumbar spine by dual-photon X-ray absorptiometry. Bone metabolism was evaluated by measuring serum calcium corrected for serum albumin, 25-hydroxyvitamin D (25-OH vit D), parathyroid hormone, and osteocalcin. Vertebral fractures were analyzed using vertebral fracture assessment (VFA). The mean T-score was lower in the PBC group compared to healthy controls, with a significant statistical difference (-2.39 +/- 0.93 and -1.47 +/- 0.99 in lumbar spine and total hip, respectively, in the PBC group versus -0.99 +/- 0.51 and -0.56 +/- 1.14 in healthy controls (P < 0.001). The prevalence of osteoporosis was 51.5% in the PBC group versus 22.7% in healthy controls with a statistically significant difference (P = 0.004). BMD of the PBC group was significantly correlated positively with body mass index (BMI) and 25-OH vit D, and negatively with menopausal status, duration of disease, and parathyroid hormone (PTH) levels. Vertebral fractures were present in 9% of the patients. We found that osteoporosis is more prevalent in women with PBC than in the general population. BMI, menopausal status, duration of the disease, and vitamin D deficiency are the main risk factors for osteoporosis in this liver disease.

Risk factors forEnterobacteriaceaebacteremia after liver transplantation

Enterobacteriaceae are now the predominant pathogens isolated in bloodstream infections complicating orthotopic liver transplantation (OLT). We conducted a retrospective cohort study of patients who underwent OLT in a University hospital between 01/01/1997 and 31/03/2003 to investigate the risk factors of Enterobacteriaceae bacteremia (EB) after OLT. EB was defined as the isolation of an Enterobacteriaceae species from at least one blood culture within 3 months following OLT. Pre-, per- and postoperative variables were collected from the medical records and analyzed in relation to EB. Forty (12.5%) of the 320 patients developed EB. The origin of EB was abdominal in 32% of the patients, urinary in 18%, pulmonary in 10%, and primary in the remaining 40% of the patients. Two-thirds of EB occurred within 1 month following OLT. The main pathogens were Escherichia coli (42%), Enterobacter cloacae (17%) and Klebsiella pneumoniae (17%). Susceptibility rates varied from 82.5% for ciprofloxacin to 95% for amikacin. Fourteen patients (35%) with EB died. Variables significantly associated with EB after multivariate analysis were a MELD score >20 (OR: 2.79 [1.24-6.30], P=0.013), transplantation for posthepatitic B (OR: 4.47 [1.67-11.98], P=0.03) or posthepatitic C (OR: 3.79 [1.59-9.01], P=0.03) cirrhosis, a positive bile culture (OR: 3.47 [1.19-10.13], P=0.023) and return to surgery (including retransplantation) (OR: 2.72 [1.32-5.58], P=0.006). EB is a frequent and severe complication following OLT. Patients grafted for a posthepatitic cirrhosis, with a severe pretransplantation status, with a positive bile culture and those undergoing reoperation have a high risk of developing EB.

Schwangerschaft nach Lebertransplantation und unter Immunsuppression mit Ciclosporin

Orthotopic liver transplantation had been performed in 1983 in a now 40-year-old woman in the terminal stage of posthepatitis liver cirrhosis with recurrent oesophageal bleedings and precoma from complete liver-cell failure. She became pregnant in 1988 while under immunosuppression with cyclosporin (2.1-2.7 mg/kg body-weight) and prednisolone (5 or 7.5 mg daily in rotation). Pregnancy proceeded without complication and there were no side effects from cyclosporin. After premature membrane rupture in the 39th week of pregnancy uterine inertia developed during oxytocin stimulation of contractions, and caesarean section was performed. The female infant was normally developed without any malformations. Liver, kidney and adrenal functions were normal, as was haemopoiesis. But possible late sequelae of cyclosporin treatment in the child cannot as yet be assessed because of the short follow-up.

Zwillingsschwangerschaft nach Lebertransplantation

Orthotopic liver transplantation was performed in a 29-year-old woman because of increasing decompensation of HBs-antigen positive post-hepatitic cirrhosis. Postoperatively she developed a mild rejection reaction and diabetes mellitus. Thirteen months after the transplant she conceived twins. This high risk pregnancy was complicated by a febrile viral infection with purulent tracheobronchitis at 9 weeks and a threatened abortion at 11 weeks. At 33 weeks there was a sudden drop in haemoglobin due to a minor uterine rupture which necessitated cesarean section. The female infants--of development in keeping with the dates--showed no clinical or ultrasound evidence of any malformations. Apart from initial difficulties--asphyxia (second twin), fluctuating glucose and calcium levels, an episode of neonatal jaundice which required phototherapy, reluctance to suck and hypotonia--the further development of both twins proceeded normally. The maternal diabetes disappeared after delivery, HBs-antigen remained negative and the HBs-antibody titre rose. The patient has remained in good condition, both mentally and physically.

Treatment of gastric varices by endoscopic sclerotherapy using butyl cyanoacrylate: 10 yearsʼ experience of 635 cases

Gastric varices (GV) are life-threatening for patients with portal hypertension. Endoscopic injection with butyl cyanoacrylate (BC), the mainstay of the therapy for GV, has been reported to be effective for hemostasis of bleeding varices, but its efficacy in the obliteration of GV and impact on the survival of patients still needs clarification. Here we summarized our experience of 10 years' practice to evaluate the efficacy and safety of endoscopic therapy using BC for GV patients. From January 1997 to April 2006, GV cases treated with endoscopic injection using BC were collected. The "sandwich method" and the "modified sandwich method" were used to inject BC intravascularly. Retrograde analysis was made on the data of treatment and follow-up. A total of 635 GV cases treated with endoscopic injection using BC were collected, most of them (90.2%) suffered from post-hepatitis cirrhosis. Emergency hemostasis was achieved in 139 out of 146 sessions (95.2%). Complications occurred in 32 cases (5.2%), including hemorrhage due to early expulsion of tissue glue (3.1%), septicemia (1%) and ectopic thrombosis (0.5%), such as spleen infarction. Endoscopic follow-up in 503 patients showed complete disappearance (76.9%), collapse (17.3%) or remnants (5.8%) of gastric varices. A total of 550 patients were followed up clinically for 3 to 115 months. Of these patients, 44 had recurrent bleeding (8.0%) and 44 died from hepatic failure, recurrent bleeding, hepatic carcinoma or other causes. The longest survival was 115 months, with a median survival of 25 months. Survival rates at 1, 2, 3, 4 and 5 year were 95%, 92%, 90%, 83% and 81%, respectively. Endoscopic sclerotherapy with BC is effective for the hemostasis of bleeding GV, as well as obliteration of GV which contributes to less rebleeding and better survival. The modified sandwich method may be useful to minimize ectopic embolism, which we speculated to result from excess iodized oil.

Energy metabolism in patients with chronic viral hepatitis and posthepatitic cirrhosis

目的 了解慢性肝炎(慢肝)与肝炎后肝硬化(肝硬化)患者的物质能量代谢与摄入特点,以有效指导营养治疗.方法 采用间接测热法对60例慢肝(慢肝组)和60例肝硬化患者(肝硬化组)的静息能量消耗水平进行测定,分别与Harris-Benedict公式计算的基础能量消耗和膳食调查计算的食物能量摄入进行比较;分析静息能量消耗与营养评价指标的相关性.结果 肝硬化组的静息能量消耗(77±21)kJ·kg-1·d-1,低于基础能量消耗(95±16)kJ·kg-1·d-1(t=-6.49,P＜0.01),能量摄入(102±33)kJ·kg-1·d-1,是静息能量消耗的1.42±0.61倍,其中蛋白质摄入(0.84±0.31)g·kg-1·d-1,是静息蛋白质消耗[(1.11±0.42)g·kg-1·d-1]的0.85±0.52倍,呈负氮平衡(-6.29±4.62);慢肝组的静息能量消耗[(93±18)kJ·kg-1·d-1]与基础能量消耗[(98±8)kJ·kg-1·d-1]比较,差异无统计学意义(P＞0.05),能量摄入为(127±34)kJ·kg-1·d-1,是静息能量消耗的1.41±0.43倍,其中蛋白质摄入(1.02±0.29)g·kg-1·d-1,是静息蛋白质消耗(0.87±0.34)g·kg-1·d-1的1.31±0.61倍,呈负氮平衡(-2.02±4.07);与慢肝组比较,肝硬化组的静息能量消耗、能量及三大能量营养素摄入量、血清白蛋白和前白蛋白水平均显著低下(P＜0.01),体重下降明显(P＜0.01),负氮平衡严重(P＜0.01);肝硬化组的能量摄入与静息能量消耗和基础能量消耗的比值呈正相关(P＜0.05),血清前白蛋白与蛋白质氧化率呈负相关(P＜0.05).结论 肝硬化患者的静息能量消耗呈低代谢状态;负氮平衡是慢肝与肝硬化患者的共同营养问题;早期预防慢性肝病患者的营养不良能够改善其远期预后。