Objective?To evaluate the effectiveness and safety of Gansu for chronic hepatitis B. Methods?We searched The Cochrane Central Register of Controlled Trials (CCTR), PubMed, EMbase, CBM, CNKI, VIP, and Wanfang databases up to Dce. 2009. The methodological quality assessment and data extraction of the included studies were conducted by two reviewers independently according to the inclusion and exclusion criteria. Meta-analyses were performed for homogeneous studies using RevMan 4.2.10 software. Results?A total of 14 studies involving 1 755 patients met the inclusion criteria. Of which, 12 studies did not report randomization method, and the other two studies reported inadequate methods of randomization. None of the studies enforced allocation concealment and performed blinding. We conducted subgroup analyses based on the outcome measures and interventions. The results of meta-analyses showed: (1) In terms of reducing ALT, Gansu + conventional therapy was superior to conventional therapy alone. (2) In terms of the HBsAg seroconversion rate, no significant difference was found between the two groups. (3) In terms of the HBeAg, no significant difference was found between the two groups at 3 months’ follow-up. (4) In terms of the HBV-DNA, Gansu + conventional therapy was superior to conventional therapy alone at 3 and 6 months’ follow-up, but theses differences were not found between Gansu + Lamivudine/ Adefovir and Lamivudine/ Adefovir alone. In terms of reducing the index of hepatic fibrosis, Gansu + conventional therapy was superior to conventional therapy alone. Conclusion?Gansu might be effective in normalizing ALT levels, clearing HBV DNA, achieving virus seroconversion and improving hepatic fibrosis, without any serious adverse effects. However, because the overall effects cannot be pooled for analysis, more evidence is needed to support this finding.
ObjectiveTo summarize the research status of the relationship between hepatitis B virus X protein (HBx), hepatitis B virus (HBV) genotypes and hepatocellular carcinoma (HCC) at home and abroad, and to prospect its clinical significance.MethodThe literatures about HBx, HBV genotypes and HCC were reviewed.ResultsThere was a close relationship between HBx and the occurrence, development, migration and metastasis of HCC. There was a certain association between HBV genotypes and HCC, but the specific mechanism had not been clarified.ConclusionsHBx and HBV genotypes play an important role in the occurrence and development of HCC. With the further study of molecular mechanism, it will promote the diagnosis and treatment of hepatitis B, liver cirrhosis and liver cancer, and provide more individualized intervention for clinical workers.
ObjectivesTo systematically review the efficacy and safety of pegylated interferon α-2a (Peg-IFNα-2a) combined with entecavir (ETV) versus Peg-IFNα-2a alone in treatment of HBeAg-positive chronic hepatitis B (CHB) patients.MethodsThe Cochrane Library, PubMed, Web of Science, EMbase, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on Peg-IFNα-2a combined with ETV for HBeAg-positive CHB from inception to March, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 12 RCTs involving 1 130 patients were included. The results of meta-analysis showed that: compared with Peg-IFNα-2a monotherapy, Peg-IFNα-2a combined with ETV could improve the rate of serum HBV-DNA clearance (RR=2.55, 95%CI 1.83 to 3.55, P<0.000 01), ALT normalization (RR=2.37, 95%CI 1.76 to 3.20, P<0.000 01) and HBeAg seroconversion (RR=2.88, 95%CI 1.18 to 7.03, P=0.02) after 12 weeks of treatment. Additionally, it could improve the rate of serum HBV-DNA clearance (RR=2.10, 95%CI 1.74 to 2.53, P<0.000 01), AST normalization (RR=1.87, 95%CI 1.15 to 3.04, P=0.01), ALT normalization (RR=1.70, 95%CI 1.46 to 1.99, P<0.000 01), serum HBeAg clearance (RR=2.14, 95%CI 1.62 to 2.83, P<0.000 01), HBeAg seroconversion (RR=2.51, 95%CI 1.65 to 3.82, P<0.000 01) and serum HBsAg clearance (RR=2.78, 95%CI 1.06 to 7.31, P=0.04) after 24 weeks of treatment. It could also improve the rate of serum HBV-DNA clearance (RR=1.63, 95%CI 1.32 to 2.02, P<0.000 01), AST normalization (RR=2.75, 95%CI 1.82 to 4.16, P<0.000 01), ALT normalization (RR=1.47, 95%CI 1.33 to 1.63, P<0.000 01), serum HBeAg clearance (RR=1.65, 95%CI 1.42 to 1.91, P<0.000 01), HBeAg seroconversion (RR=1.91, 95%CI 1.51 to 2.41, P<0.000 01) and serum HBsAg clearance (RR=1.57, 95%CI 1.07 to 2.31, P=0.02) after 48 weeks of treatment. There was no statistically significance of adverse reactions in groups.ConclusionsCurrent evidence shows that Peg-IFNα-2a combined with ETV is superior to Peg-IFNα-2a monotherapy in the treatment of HBeAg-positive CHB, and does not increase the incidence of adverse reactions. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.
Objective To assess the efficacy and safety of Chinese medicinal herbs for asymptomatic hepatitis B virus(HBV) infection. Data Source The trials registers of the Cochrane Hepato-Biliary Group, the Cochrane Library and the Cochrane Complementary Medicine Field were searched in combination with MEDLINE, EMBASE, and handsearches of Chinese journals and conference proceedings. Data Selection Randomized clinical trials with 3 months follow-up comparing Chinese medicinal herbs versus placebo, no intervention, non-specific treatment, or interferon treatment for asymptomatic HBV carriers were included. No language and blinding limitations were applied. Data Extraction Data were extracted independently by two reviewers. The methodological quality of trials was assessed by the Jadad-scale plus allocation concealment. Results Three randomized clinical trials (307 patients) with low methodological quality following patients for three months or more after the end of treatment were included. Herbal compound Jianpi Wenshen recipe showed significant effects on clearance of HBV markers compared to interferon: relative risk 2.40 (95 % CI 1.01 to 5.72) for clearance of serum HBsAg, and 2.54 (1.13 to 5.70) for seroconversion of HBeAg to anti-HBe. Phyllanthus amarus and Astragalus membranaceus showed no significant antiviral effect compared with placebo. Analysis of pooling eight randomized clinical trials with less than three months follow-up did not show a significant benefit of Chinese medicinal herbs on viral markers. No serious adverse event was observed. Conclusions There is insufficient evidence for treatment of asymptomatic HBVcarriers using Chinese medicinal herbs due to the low quality of the trials. Further randomized, double blind, placebo-controlled trials are needed.
目的 探討乙型肝炎病毒（HBV）表面抗原（HBsAg）陽性肝硬化患者血清中HBV前S1抗原(前S1抗原)、HBV e抗原（HBeAg）及HBV核酸定量檢測（HBV DNA）相關性。 方法 2008年7月－2011年5月對97例HBsAg陽性肝硬化住院患者和50份HBsAg陰性的健康體檢者血清進行前S1抗原、HBV血清標志物檢測及實時熒光定量PCR檢測HBV DNA結果進行分析。 結果 97份HBsAg陽性肝硬化患者血清中，前S1抗原、HBeAg及HBV DNA陽性率分別為53.6%（52/97）、22.7%（22/97）及61.8%（60/97）。22例HBeAg陽性血清中，前S1抗原陽性18例（81.8%）， HBV DNA陽性20例（90.9%)。75例HBeAg陰性血清中，前S1抗原陽性34例（45.3%），HBV DNA陽性40例（53.3%），兩者的前S1抗原與HBV DNA結果間都具有很好的相關性。HBV DNA含量與前S1抗原及HBeAg陽性結果顯示：HBsAg陽性的肝硬化患者血清中HBV DNA陰性率為38.1%（含量＜103 copies/mL），而陽性檢出率HBV DNA含量主要集中在103～105 copies/mL，占81.7%（49/60），HBV DNA含量＞105 copies/mL占18.3%（11/60）。 結論 HBsAg陽性的肝硬化患者血清中主要以HBV非HBeAg陽性血清學模式為主，HBV DNA陽性檢出率的含量主要集中在103～105 copies/mL。前S1抗原在HBeAg陽性血清中與其含有HBsAg病毒及HBeAg陽性患者具有很好的相關性，而在HBeAg陰性血清中存在著差異。Objective To study the correlation among Pre-S1 antigen, HBeAg and HBV DNA results in patients with HBsAg-positive liver cirrhosis. Methods We retrospectively analyzed the serum pre-S1-antigen, HBV serum markers and real-time quantitative PCR HBV DNA results in 97 patients with HBsAg-positive liver cirrhosis and 50 HBsAg-negative healthy volunteers in our hospital from July 2008 to May 2011. Results Among the 97 samples of HBsAg-positive liver cirrhosis patients’ serum, the positive rates of Pre-S1 antigen, HBeAg and HBV DNA were 53.6% (52/97), 22.7% (22/97) and 61.8% (60/97), respectively. In the 22 samples of HBeAg-positive serum, the number of positive pre-S1 antigen and HBV DNA was 18 (81.8%) and 20, respectively. In the 75 samples of negative HBeAg serum, the number of positive pre-S1 antigen and HBV DNA was 34 (45.3%) and 40 (53.3%) respectively. The pre-S1 antigen was correlated well with HBV DNA results in both the two groups. HBV DNA level, pre-S1 antigen and HBeAg-positive results showed that the serum HBV DNA negative rate of HBsAg-positive patients with cirrhosis was 38.1% (＜103 copies/mL), while the positive rate of HBV DNA level was mainly concentrated at 103~105 copies/mL, accounting for 81.7% (49/60), and HBV DNA level over 105 copies/mLaccounted for only 18.3% (11/60). Conclusions HBsAg-positive patients with cirrhosis mainly have a serum non-HBeAg-positive HBV serology pattern, and HBV DNA positive rate of the content is mainly concentrated at 103~105 copies/mL. There is a good correlation between pre-S1 antigen in HBeAg-positive serum and patients with HBsAg virus or positive HBeAg, while for Pre-S1 antigen in HBeAg-negative serum, it is quite different.
Ｆｒｏｍ １９９０ ｔｏ １９９３， ｗｅ ｃａｒｒｉｅｄ ｏｎ ａ ｓｅｒｏｅｐｉｄｅｍｉｏｌｏｇｉｃａｌ ｓｕｒｖｅｙ ｏｎ ｈｅｐａｔｉｔｉｓ Ｂ ｖｉｒｕｓ （ＨＢＶ） ｉｎｆｅｃｔｉｏｎ ｏｆ ５２９７ ｇｅｎｅｒａｌ ｓｕｒｇｉｃａｌ ｐａｔｉｅｎｔｓ． Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈａｔ ｔｈｅ ｐｏｓｉｔｉｖｅ ｒａｔｅｓ ｏｆ ＨＢｓＡｇ， ａｎｔｉＨＢｓ ａｎｄ ａｎｔｉＨＢｃ ｗｅｒｅ １９．４％ 、３５．９％ ａｎｄ ４１．１％ｒｅｓｐｅｃｔｉｖｅｌｙ， ａｎｄ ｔｈｅ ｏｖｅｒａｌｌ ｒａｔｅ ｏｆ ＨＢＶ ｉｎｆｅｃｔｉｏｎ ｗａｓ ７０．５％， ｗｈｉｃｈ ｗａｓ ｍｕｃｈ ｈｉｇｈｅｒ ｔｈａｎ ｔｈａｔ ｏｆ ｔｈｅ ｇｅｎｅｒａｌ ｐｏｐｕｌａｔｉｏｎ． Ｉｎ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｈｅｐａｔｏｂｉｌｉａｒｙ ｏｒ ｐａｎｃｒｅａｔｉｃ ｄｉｓｅａｓｅｓ， ｔｈｅ ＨＢｓＡｇ， ａｎｔｉＨＢｃ ａｎｄ ｔｈｅ ｏｖｅｒａｌｌ ｒａｔｅ ｏｆ ＨＢＶ ｉｎｆｅｃｔｉｏｎ ｗｅｒｅ ３４．２％、５６．１％、８０．３％ｒｅｓｐｅｃｔｉｖｅｌｙ， ｗｈｉｃｈ ｗｅｒｅ ｈｉｇｈｅｒ ｔｈａｎ ｔｈｏｓｅ ｏｆ ｏｔｈｅｒ ｇｅｎｅｒａｌ ｓｕｒｇｉｃａｌ ｐａｔｉｅｎｔｓ．
肝臟移植作為終末期肝病的治療，自上個世紀80年代在歐美國家獲得公認以來，已在世界各國得到迅速開展。我國自90年代后期以來，在全國掀起了第二個肝移植的熱潮，迄今已完成1 000余例肝移植，在圍手術期處理、手術技術、介入放射、移植免疫、抗感染治療等各個方面均獲得豐富的經驗，我國肝移植的效果及長期生存率亦逐步趕上國際先進水平。總的來講，適合進行肝移植的病種可分為良性及惡性肝病，鑒于惡性肝病行肝移植后復發率高，長期生存率低，因而其作為肝移植的指征長期以來存在爭議，而良性終末期肝病則是肝移植的主要指征。我院自1999年2月以來連續施行肝移植114例，其中良性肝病為69例，占60.5%。本文僅針對良性肝病肝移植的一些特點談談我們的經驗和體會。
Objective To explore the effectiveness of passive immunization of fetus via mother on preventing the transmission of HBV from mother to infant. Methods A prospective randomized controlled study was designed. Fifty-two HBeAg positive pregnant women were randomly allocated to two groups, of which 28 women were allocated to trial group, and injected with 200 IU of hepatitis B immune globulin (HBIG) for 1 injection at the 28th, 32nd and 36th weeks of pregnancy respectively, 24 women allocated to control group were given no injection of HBIG. The samples of cord blood from the newborns in two groups were collected and tested for HBeAg and HBV-DNA by ELISA and FQ-PCR. Results The rates of HBeAg positive in the newborns were 21.4% in trial group, 79.2% in control group. There was statistically significant difference between two groups ( χ2=17.26, Plt;0.01, RR=0.27). The rates of HBV-DNA positive in newborns were 25.0% in trial group, 83.3% in control group, showing statistically significant difference between the two groups (χ2=17.62, Plt;0.01, RR=0.30). In the trial group, there were 21 newborns with HBV-DNA negative, 7 with HBV-DNA positive. HBV-DNA quantities were significantly lower in 7 newborns than in their mothers (T=28, P=0.02, Wilcoxon test). Conclusions Multiple injections of HBIG to pregnant women with HBeAg positive before labor could greatly reduce mother-infant transmission of HBV.
ObjectiveTo investigate the influence of strengthening intervention on antiviral treatment compliance for cirrhosis patients following chronic hepatitis B. MethodsOne hundred patients with cirrhosis following chronic hepatitis B undergoing antiviral treatment between January 2007 and January 2009 were randomly divided into intervention group and control group with 50 patients in each group.Patients in the control group received routine care.For patients in the intervention group,besides routine care,strengthening education on the disease,medication guide,and weekly telephone follow-up after discharge were also added.On the time points of 6,12,18,24,30,36 months after patients were discharged,we followed them up with self-designed questionnaire,and compared the two groups of patients on the rates of fully complying with doctors,not fully complying with doctors and completely not complying with doctors.And the reasons were also analyzed. ResultsEighteen months after being discharged,the two groups had no significant difference in the rate of complying with doctors (P>0.05),while the difference was significant 24,30,36 months after leaving the hospital (P<0.05).The reasons were not following the doctors were mainly high cost and unsatisfying treatment effect.In the control group,the reasons also included lack of knowledge about the disease and lack of guidance and supervision. ConclusionThrough strengthening nursing intervention,patients'treatment compliance can be improved significantly.
Objective To investigate the current situation of randomized controlled trials or clinical controlled trial (RCT/CCT) on chronic hepatitis B and whether to offer reliable evidence for clinical practice in China. Methods RCT/CCT identified from six Chinese clinical journals were searched manually and assessed according to international standard of evidence-based medicine. Results 308 issues containing 212 therapeutic articles and 88 RCT/CCT on chronic hepatitis B were identified and analyzed. Conclusion the quantity and quality of RCT/CCT of chronic hepatitis B did not meet the need of clinical practice.