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| 1 | Long-term antiviral efficacy of entecavir and liver histology improvement in Chinese patients with hepatitis B virus-related cirrhosis显示文摘AIM: To evaluate the clinical outcomes of 240-wk treatment with entecavir(0.5 mg) in Chinese nucleosidenaive patients with cirrhosis.METHODS: A total of 204 nucleoside-naive patients with compensated(n = 96) or decompensated(n = 108) hepatitis B virus(HBV)-induced cirrhosis at the Department of Gastroenterology of the China-Japan Union Hospital(Jilin University, Changchun, China) who were treated with entecavir(0.5 mg) for 240 wk were enrolled in this study. Liver biopsy samples obtained from 38 patients prior to treatment(baseline) and at week 240 were evaluated by different independent histopathologists. Efficacy assessments included the proportions of patients who achieved an HBV DNA level < 500 copies/m L, the association of interleukin-28 B genetic variation with antivirus therapy, clinical outcomes, and histologic improvement. Changes in liver disease severity were analyzed, and liver histologic evaluation was performed in 38 patients with paired biopsies. Student t tests were used to compare the means of continuous variables between the groups, and the proportions of patients who achieved the endpoints were compared using the χ2 test.RESULTS: At week 240, 87.5% of the patients with compensated cirrhosis and 92.6% of the patients with decompensated cirrhosis achieved a HBV DNA level < 500 copies/m L. Three patients had genotypic entecavir resistance within the 240-wk period. No significant association was observed between virologic response and interleukin-28 genotype(CT, 88.2% vs CC, 90.6%). The proportion of patients with Child-Pughclass A disease was significantly increased at week 240(68%) from the baseline(47%; P < 0.01). The proportion of patients with Child-Pugh class B disease was significantly decreased at week 240(25%) from the baseline(39%; P = 0.02). In the patients with paired liver biopsies, the mean reduction in the Knodell necroinflammatory score from the baseline was 3.58 ± 1.03 points(7.11 ± 1.80 vs 3.53 ± 1.35, P < 0.01). The mean reduction in Ishak fibrosis score from the baseline was 1.26 ± 0.64 points(5.58 ± 0.50 vs 4.32 ± 0.81, P < 0.01).CONCLUSION: Entecavir is an effective treatment option for patients with HBV-related compensated or decompensated cirrhosis that can result in sustained virologic suppression and histologic improvement. | Yan Xu Yong-Gui Zhang Xu Wang Wen-Qian Qi Shao-You Qin Zhen-Hua Liu Jian Jiao Jiang-Bin Wang | 2015 | World Journal of Gastroenterology2015，21，25： | 50 |
| 2 | De novo combined lamivudine and adefovir dipivoxil therapy vs entecavir monotherapy for hepatitis B virus-related decompensated cirrhosis显示文摘AIM:To compare efficacy of combined lamivudine(LAM)and adefovir dipivoxil(ADV)therapy with that of entecavir(ETV)monotherapy for hepatitis B virus(HBV)-related decompensated liver cirrhosis.METHODS:A total of 120 na ve patients with HBVrelated decompensated cirrhosis participated in this study.Sixty patients were treated with combined LAM and ADV therapy(LAM+ADV group),while the other60 were treated with ETV monotherapy(ETV group)for two years.Tests for liver and kidney function,alpha-fetoprotein,HBV serum markers,HBV DNA load,prothrombin time(PT),and ultrasonography or computed tomography scan of the liver were performed every1 to 3 mo.Repeated measure ANOVA and theχ2test were performed to compare the efficacy,side effects,and the cumulative survival rates at 48 and 96 wk.RESULTS:Forty-five patients in each group were observed for 96 wk.No significant differences in HBV DNA negative rates and alanine aminotransferase(ALT)normalization rates at weeks 48(χ2=2.12 and 2.88)and96(χ2=3.21 and 3.24)between the two groups were observed.Hepatitis B e antigen seroconversion rate in the LAM+ADV group at week 96 was significantly higher in the ETV group(43.5%vs 36.4%,χ2=4.09,P<0.05).Viral breakthrough occurred in 2 cases(4.4%)by week 48 and in 3 cases(6.7%)by week 96 in the LAM+ADV group,and no viral mutation was detected.In the ETV group,viral breakthrough occurred in 1 case(2.2%)at the end of week 96.An increase in albumin(F=18.9 and 17.3),decrease in total bilirubin and in ALT(F=16.5,17.1 and 23.7,24.8),reduced PT(F=22.7 and 24.5),and improved Child-Turcotte-Pugh and the model for end-stage liver disease scores(F=18.5,17.8,and 24.2,23.8)were observed in both groups.The cumulative rates of mortality and liver transplantation were 16.7%(10/60)and 18.3%(11/60)in the LAM+ADV and ETV groups,respectively.CONCLUSION:Both LAM+ADV combination therapy and ETV monotherapy can effectively inhibit HBV replication,improve liver function,and decrease mortality. | Jiang-Shan Lian Lin-Yan Zeng Jian-Yang Chen Hong-Yu Jia Yi-Min Zhang Dai-Rong Xiang Liang Yu Jian-Hua Hu Ying-Feng Lu Ling Zheng Lan-Juan Li Yi-Da Yang | 2013 | World Journal of Gastroenterology2013，19，37： | 36 |
| 3 | Acute kidney injury in acute-on-chronic liver failure is different from in decompensated cirrhosis显示文摘AIM To evaluate the differences in acute kidney injury(AKI) between acute-on-chronic liver failure(ACLF) and decompensated cirrhosis(DC) patients. METHODS During the period from December 2015 to July 2017, 280 patients with hepatitis B virus(HBV)-related ACLF(HBV-ACLF) and 132 patients with HBV-related DC(HBV-DC) who were admitted to our center were recruited consecutively into an observational study. Urine specimens were collected from all subjects and the levels of five urinary tubular injury biomarkers were detected,including neutrophil gelatinase-associated lipocalin(NGAL), interleukin-18(IL-18), liver-type fatty acid binding protein(L-FABP), cystatin C(CysC), and kidney injury molecule-1(KIM-1). Simultaneously, the patient demographics, occurrence and progression of AKI, and response to terlipressin therapy were recorded. All patients were followed up for 3 mo or until death after enrollment. RESULTS AKI occurred in 71 and 28 of HBV-ACLF and HBV-DC patients, respectively(25.4% vs 21.2%, P = 0.358). Among all patients, the levels of four urinary biomarkers(NGAL, CysC, L-FABP, IL-18) were significantly elevated in patients with HBV-ACLF and AKI(ACLF-AKI), compared with that in patients with HBV-DC and AKI(DC-AKI) or those without AKI. There was a higher proportion of patients with AKI progression in ACLF-AKI patients than in DC-AKI patients(49.3% vs 17.9%, P = 0.013). Fortythree patients with ACLF-AKI and 19 patients with DC-AKI were treated with terlipressin. The response rate of ACLFAKI patients was significantly lower than that of patients with DC-AKI(32.6% vs 57.9%, P = 0.018). Furthermore, patients with ACLF-AKI had the lowest 90 d survival rates among all groups(P < 0.001).CONCLUSION AKI in ACLF patients is more likely associated with structural kidney injury, and is more progressive, with a poorer response to terlipressin treatment and a worse prognosis than that in DC patients. | Qun-Qun Jiang Mei-Fang Han Ke Ma Guang Chen Xiao-Yang Wan Semvua Bukheti Kilonzo Wen-Yu Wu Yong-Li Wang Jie You Qin Ning | 2018 | World Journal of Gastroenterology2018，24，21： | 25 |
| 4 | Antiviral drug resistance increases hepatocellular carcinoma:A prospective decompensated cirrhosis cohort study显示文摘AIM:To study the clinical outcome of antiviral therapy in hepatitis B-related decompensated cirrhotic patients.METHODS:Three hundred and twelve patients with decompensated hepatitis B cirrhosis were evaluated in a prospective cohort.With two years of follow-up,198patients in the group receiving antiviral therapy with nucleos(t)ide analogues and 39 patients in the control group without antiviral treatment were analysed.RESULTS:Among the antiviral treatment patients,162had a complete virological response(CVR),and 36 were drug-resistant(DR).The two-year cumulative incidence of hepatocellular carcinoma(HCC)in the DR patients(30.6%)was significantly higher than that in both the CVR patients(4.3%)and the control group(10.3%)(P<0.001).Among the DR patients in particular,the incidence of HCC was 55.6%(5/9)in those who failed rescue therapy,which was extremely high.The rtA181T mutation was closely associated with rescue therapy failure(P=0.006).The Child-Pugh scores of the CVR group were significantly decreased compared with the baseline(8.9±2.3 vs 6.0±1.3,P=0.043).CONCLUSION:This study showed that antiviral drug resistance increased the risk of HCC in decompensated hepatitis B-related cirrhotic patients,especially in those who failed rescue therapy. | Lei Li Wei Liu Yu-Han Chen Chun-Lei Fan Pei-Ling Dong Fei-Li Wei Bing Li De-Xi Chen Hui-Guo Ding | 2013 | World Journal of Gastroenterology2013，19，45： | 20 |
| 5 | Effects of entecavir and lamivudine for hepatitis B decompensated cirrhosis: Meta-analysis显示文摘AIM:To compare the effects of entecavir(ETV)and lamivudine(LAM)for the treatment of hepatitis B decompensated cirrhosis using a meta-analysis.METHODS:We conducted a literature search for all eligible studies published prior to May 30,2013 using PUBMED,MEDLINE,EMBASE,the China National Knowledge Infrastructure(CNKI),the VIP database,the Wanfang database and the Cochrane Controlled Trial Register.Randomized controlled trials(RCTs)comparing ETV with LAM for the treatment of hepatitis B decompensated cirrhosis were included.The data were analyzed with Review Manager Software 5.0.2.We used RR as an effect measure,and reported its95%CI.The meta-analysis was performed using either a fixed-effect or random-effect model,based on the absence or presence of significant heterogeneity.Two reviewers assessed the risk of bias and extracted data independently and in duplicate.The analysis was executed using the main outcome parameters including hepatitis B virus(HBV)DNA undetectability,HBV DNA level,hepatitis B e antigen(HBeAg)seroconversion,alanine aminotransferase(ALT)level,albumin level,total bilirubin(TBIL)level,prothrombin time activity(PTA)level,Child-Turcotte-Pugh(CTP)score,mortality,drugresistance,and adverse reactions.Meta-analysis of the included trials and subgroup analyses were conducted to examine the association between pre-specified characteristics and the therapeutic effects of the two agents.RESULTS:Thirteen eligible trials(873 patients in total)were included and evaluated for methodological quality and heterogeneity.Of these studies,all had baseline comparability,12 of them reported baseline values of the two treatment groups in detail.Following various treatment durations(12,24,36,48 and>48 wk),both ETV and LAM significantly reduced HBV DNA level,however,reductions were greater in the ETV group(MD=-0.66,95%CI:-0.83-0.50,P<0.00001),(MD=-0.93,95%CI:-1.36-0.51,P<0.0001),(MD=-1.4,95%CI:-1.78-1.01,P<0.00001),(MD=-1.18,95%CI:-1.90-0.46,P=0.001),(MD=-0.14,95%CI:-0.17-0.11,P<0.00001,respectively).At 12,24 and48 wk of treatment,ETV had a significant effect on the rate of HBV DNA undetectability(RR=1.55,95%CI:1.22-1.99,P=0.0004),(RR=1.25,95%CI:1.13-1.38,P<0.0001),(RR=1.2,95%CI:1.10-1.32,P<0.0001,respectively).Although HBeAg seroconversion in the ETV group was more pronounced than that in the LAM group at 24 wk(27.90%vs 26.19%)and 48 wk(31.52%vs 25.00%)of treatment,there was no statistically significant difference between them(RR=1.49,95%CI:0.98-2.28,P=0.07),(RR=1.27,95%CI:0.98-1.65,P=0.07,respectively).Following various treatment durations,both the ETV group and the LAM group showed significantly improved liver function(ALT,AIB,TBIL,PTA and CTP levels)and reduced mortality(ETV 6.37%,LAM 7.89%).The effects in the ETV group(0.33%)were statistically lower than those in the LAM group(14.33%)regarding the rate of drug-resistance(RR=0.1,95%CI:0.04-0.24,P≤0.00001).In addition,no severe adverse reactions were observed in the two treatment groups.CONCLUSION:ETV and LAM significantly improved liver function and reduced mortality.Both drugs produced similar serological responses,and were safe and well tolerated.However,ETV resulted in a better virological response and lower drug-resistance,but is more expensive. | Xiao-Guang Ye Qi-Min Su | 2013 | World Journal of Gastroenterology2013，19，39： | 18 |
| 6 | Bone marrow-derived mesenchymal stem cell therapy for decompensated liver cirrhosis:A meta-analysis显示文摘AIM:To assess the efficacy and safety of bone marrow-derived mesenchymal stem cell(BM-MSC) in the treatment of decompensated liver cirrhosis.METHODS:The search terms 'bone marrow stem cell' 'chronic liver disease' 'transfusion' and 'injection' were used in the Cochrane Library,Med-Line(Pub-Med) and Embase without any limitations with respect to publication date or language. Journals were also handsearched and experts in the field were contacted. The studies which used BM-MSC in the treatment of any chronic liver disease were included. Comprehensive Review Manager and Meta-Analyst software were used for statistical analysis. Publication bias was evaluated using Begg's test.RESULTS:Out of 78 studies identified,five studies were included in the final analysis.The studies were conducted in China,Iran,Egypt and Brazil.Analysis of pooled data of two controlled studies by Review Manager showed that the mean decline in scores for the model for end-stage liver disease(MELD)was-1.23[95%CI:-2.45-(-0.01)],-1.87[95%CI:-3.16-(-0.58)],-2.01[95%CI:-3.35-(-0.68)]at 2,4 and 24 wk,respectively after transfusion.Meta-analysis of the 5studies showed that the mean improvement in albumin levels was-0.28,2.60,5.28,4.39 g/L at the end of 8,16,24,and 48 wk,respectively,after transfusion.MELD scores,alanine aminotransferase,total bilirubin levels and prothrombin times improved to some extent.BMMSC injections resulted in no serious adverse events or complications.CONCLUSION:BM-MSC infusion in the treatment of decompensated liver cirrhosis improved liver function.At the end of year 1,there were no serious side effects or complications. | Xing-Nan Pan Lian-Qiu Zheng Xiao-Huan Lai | 2014 | World Journal of Gastroenterology2014，20，38： | 17 |
| 7 | Clinical impact of microbiome in patients with decompensated cirrhosis显示文摘Cirrhosis is an increasing cause of morbidity and mortality. Recent studies are trying to clarify the role of microbiome in clinical exacerbation of patients with decompensated cirrhosis. Nowadays, it is accepted that patients with cirrhosis have altered salivary and enteric microbiome, characterized by the presence of dysbiosis. This altered microbiome along with small bowel bacterial overgrowth, through translocation across the gut, is associated with the development of decompensating complications. Studies have analyzed the correlation of certain bacterial families with the development of hepatic encephalopathy in cirrhotics. In general, stool and saliva dysbiosis with reduction of autochthonous bacteria in patients with cirrhosis incites changes in bacterial defenses and higher risk for bacterial infections, such as spontaneous bacterial peritonitis, and sepsis. Gut microbiome has even been associated with oncogenic pathways and under circumstances might promote the development of hepatocarcinogenesis. Lately, the existence of the oral-gutliver axis has been related with the development of decompensating events. This link between the liver and the oral cavity could be via the gut through impaired intestinal permeability that allows direct translocation of bacteria from the oral cavity to the systemic circulation. Overall, the contribution of the microbiome to pathogenesis becomes more pronounced with progressive disease and therefore may represent an important therapeutic target in the management of cirrhosis. | Theodora Oikonomou George V Papatheodoridis Michael Samarkos Ioannis Goulis Evangelos Cholongitas | 2018 | World Journal of Gastroenterology2018，24，34： | 16 |
| 8 | Scoring systems for prediction of mortality in decompensated liver cirrhosis: A meta-analysis of test accuracy显示文摘AIM To compare the accuracy of the scoring systems ChildTurcotte-Pugh(CTP), Model for End-stage Liver Disease score(MELD), MELD-Na, and MELD to Serum Sodium ratio(MESO) to predict the mortality in decompensated liver cirrhosis.METHODS The PubMed, Web of Science, Cochrane Library, EMBASE, and Ovid databases were systematically searched from inception to September 2018 for relevant articles, and we evaluated the quality of the included studies. The accuracy of scoring systems was analyzed with Stata 12 and MetaDiSc 1.4.RESULTS Sixteen studies involving 2337 patients were included. The pooled areas under the summary receiver operating characteristic curves(AUROCs) of CTP, MELD, MELD-Na, and MESO to predict mortality were 0.81,0.78, 0.85, and 0.86, respectively. Within 3 mo, the AUROCs of CTP, MELD, and MELD-Na in predicting mortality were 0.78, 0.76, and 0.89, respectively. The AUROCs of CTP, MELD, and MELD-Na at 3 mo were 0.86, 0.78, and 0.86, respectively. The AUROCs of CTP, MELD, and MELD-Na at 6 mo were 0.91, 0.83, and 0.90, respectively. The AUROCs of CTP, MELD, and MELDNa at 12 mo were 0.72, 0.75 and 0.84, respectively. In cirrhotic patients with bleeding, the AUROCs of CTP and MELD were 0.76 and 0.88, respectively.CONCLUSION MESO has the highest AUROC in all assessed scoring systems. Considering the different time points, MELDNa has good accuracy in predicting the mortality of decompensated liver cirrhosis. Compared to CTP, MELD is better in predicting variceal bleeding. | Shi-Lan Wu Yi-Xiang Zheng Zheng-Wen Tian Meng-Shi Chen Hong-Zhuan Tan | 2018 | World Journal of Clinical Cases2018，6，15： | 12 |
| 9 | Long term outcome of antiviral therapy in patients with hepatitis B associated decompensated cirrhosis显示文摘AIM To investigate survival rate and incidence of hepatocellular carcinoma(HCC) in patients with decompensated cirrhosis in the antiviral era.METHODS We used the Korean Health Insurance Review and Assessment. Korea's health insurance system is a public single-payer system. The study population consisted of 286871 patients who were prescribed hepatitis B antiviral therapy for the first time between 2007 and 2014 in accordance with the insurance guidelines.Overall, 48365 antiviral treatment-na?ve patients treated between 2008 and 2009 were included, and each had a follow-up period ≥ 5 years. Data were analyzed for the 1 st decompensated chronic hepatitis B(CHB) and treatment-na?ve patients(n = 7166). RESULTS The mean patient age was 43.5 years. The annual mortality rates were 2.4%-19.1%, and 5-year cumulative mortality rate was 32.6% in 1^(st) decompensated CHB treatment-na?ve subjects. But the annual mortality rates sharply decreased to 3.4%(2.4%-4.9%, 2-5 year) after one year of antiviral treatment. Incidence of HCC at first year was 14.3%, the annual incidence of HCC decreased to 2.5%(1.8%-3.7%, 2-5 year) after one year. 5-year cumulative incidence of HCC was 24.1%. Recurrence rate of decompensated event was 46.9% at first year, but the annual incidence of second decompensation events in decompensated CHB treatment-na?ve patients was 3.4%(2.1%-5.4%, 2-5 year) after one year antiviral treatment. 5-year cumulative recurrence rate of decompensated events was 60.6%. Meanwhile, 5-year cumulative mortality rate was 3.1%, and 5-year cumulative incidence of HCC was 11.5% in compensated CHB treatment-na?ve patients.CONCLUSION Long term outcome of decompensated cirrhosis treated with antiviral agent improved much, and incidence of hepatocellular carcinoma and mortality sharply decreased after one year treatment. | Young-Cheol Ju Dae-Won Jun Jun Choi Waqar Khalid Saeed Hyo-Young Lee Hyun-Woo Oh | 2018 | World Journal of Gastroenterology2018，24，40： | 8 |
| 10 | Predictors of fifty days in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis显示文摘AIM: To determine the predictors of 50 d in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis(SBP).METHODS: Two hundred and eighteen patients admitted to an intensive care unit in a tertiary care hospital between June 2013 and June 2014 with the diagnosis of SBP(during hospitalization) and cirrhosis were retrospectively analysed. SBP was diagnosed by abdominal paracentesis in the presence of polymorphonuclear cell count ≥ 250 cells/mm3 in the peritoneal fluid. Student's t test, multivariate logistic regression, cox proportional hazard ratio(HR), receiver operating characteristics(ROC) curves and Kaplan-Meier survival analysis were utilized for statistical analysis. Predictive abilities of several variables identified by multivariate analysis were compared using the area under ROC curve. P < 0.05 were considered statistical significant. RESULTS: The 50 d in-hospital mortality rate attributable to SBP is 43.11%(n = 94). Median survival duration for those who died was 9 d. In univariate analysis acute kidney injury(AKI), hepatic encephalopathy, septic shock, serum bilirubin, international normalized ratio, aspartate transaminase, and model for end-stage liver disease- sodium(MELD-Na) were significantly associated with in- hospital mortality in patients with SBP(P ≤ 0.001). Multivariate coxproportional regression analysis showed AKI(HR = 2.16, 95%CI: 1.36-3.42, P = 0.001) septic shock(HR = 1.73, 95%CI: 1.05-2.83, P = 0.029) MELD-Na(HR = 1.06, 95%CI: 1.02-1.09, P ≤ 0.001) was significantly associated with 50 d in-hospital mortality. The prognostic accuracy for AKI, MELD-Na and septic shock was 77%, 74% and 71% respectively associated with 50 d inhospital mortality in SBP patients.CONCLUSION: AKI, MELD-Na and septic shock were predictors of 50 d in-hospital mortality in decompensated cirrhosis patients with SBP. | Chinmaya Kumar Bal Ripu Daman Vikram Bhatia | 2016 | World Journal of Hepatology2016，8，12： | 5 |
| 11 | Efficacy and safety of autologous stem cell transplantation for decompensated liver cirrhosis:A retrospective cohort study显示文摘AIM To evaluate the long-term efficacy and safety of autologous stem cell transplantation(SCT) for decompensated liver cirrhosis.METHODS Consecutive patients with decompensated liver cirrhosis were included and assigned into the SCT group and non-transplantation(non-SCT) group according to whether they received SCT treatment. Patients werefollowed up for ten years. The long-term survival rate and incidence of hepatocellular carcinoma(HCC) were compared between groups. | Ming-Fang Wang You-Bing Li Xiao-Juan Gao Hao-Yang Zhang Su Lin Yue-Yong Zhu | 2018 | World Journal of Stem Cells2018，10，10： | 4 |
| 12 | Efficacy of tolvaptan in patients with refractory ascites in a clinical setting显示文摘AIM: To elucidate the efficacies of tolvaptan(TLV) as a treatment for refractory ascites compared with conventional treatment. METHODS: We retrospectively enrolled 120 refractory ascites patients between January 1, 2009 and September 31, 2014. Sixty patients were treated with oral TLV at a starting dose of 3.75 mg/d in addition to sodium restriction(> 7 g/d), albumin infusion(10-20 g/wk), and standard diuretic therapy(20-60 mg/d furosemide and 25-50 mg/d spironolactone) and 60 patients with large volume paracentesis in addition to sodium restriction(less than 7 g/d), albumin infusion(10-20 g/wk), and standard diuretic therapy(20-120 mg/d furosemide and 25-150 mg/d spironolactone). Patient demographics and laboratory data, including liver function, were not matched due to the small number of patients. Continuous variables were analyzed by unpaired t-test or paired t-test. Fisher's exact test was applied in cases comparing two nominal variables. We analyzed factors affecting clinical outcomes using receiver operating characteristic curves and multivariate regression analysis. We also used multivariate Cox's proportional hazard regression analysis to elucidate the risk factors that contributed to the increased incidence of ascites.RESULTS: TLV was effective in 38(63.3%) patients. The best cut-off values for urine output and reduced urine osmolality as measures of refractory ascites improvement were > 1800 mL within the first 24 h and > 30%, respectively. Multivariate regression analysis indicated that > 25% reduced urine osmolality [odds ratio(OR) = 20.7; P < 0.01] and positive hepatitis C viral antibodies(OR = 5.93; P = 0.05) were positively correlated with an improvement of refractory ascites, while the total bilirubin level per 1.0 mg/dL(OR = 0.57;P = 0.02) was negatively correlated with improvement. In comparing the TLV group and controls, only the serum sodium level was significantly lower in the TLV group(133 mE q/L vs 136 mE q/L; P = 0.02). However, there were no significant differences in the other parameters between the two groups. The cumulative incidence rate was significantly higher in the control group with a median incidence time of 30 d in the TLV group and 20 d in the control group(P = 0.01). Cox hazard proportional multivariate analysis indicated that the use of TLV(OR = 0.58; P < 0.01), uncontrolled liver neoplasms(OR = 1.92; P < 0.01), total bilirubin level per 1.0 mg/dL(OR = 1.10; P < 0.01), and higher sodium level per 1.0 m Eq/L(OR = 0.94; P < 0.01) were independent factors that contributed to incidence. CONCLUSION: Administration of TLV results in better control of refractory ascites and reduced the incidence of additional invasive procedures or hospitalization compared with conventional ascites treatments. | Takamasa Ohki Koki Sato Tomoharu Yamada Mari Yamagami Daisaku Ito Koki Kawanishi Kentaro Kojima Michiharu Seki Nobuo Toda Kazumi Tagawa | 2015 | World Journal of Hepatology2015，7，12： | 4 |
| 13 | Collagen proportionate area of liver tissue determined by digital image analysis in patients with HBV-related decompensated cirrhosis显示文摘BACKGROUND: The accurate assessment of the degree of hepatic fibrosis plays a critical role in guiding the diagnosis, treatment and prognostic assessment of chronic liver diseases. Liver biopsy is currently the most reliable method to evaluate the severity of hepatic fibrosis. However, liver biopsy is an invasive procedure associated with morbidity and mortality, and has several limitations in patients with decompensated cirrhosis. There is no report on the collagen proportionate area (CPA) of liver tissue in the decompensated stage of cirrhosis. This study aimed to determine the CPA of resected liver tissue samples from patients with HBV-related decompensated cirrhosis using digital image analysis, and to analyze the relationship between the CPA and liver functional reserve. METHODS: Fifty-three resected liver tissue samples from liver transplant patients with chronic hepatitis B-induced decompensated cirrhosis were stained with Masson's trichrome, and the CPA in these samples was quantitatively determined using digital image analysis. The values of relevant liver function just before liver transplantation, the CPA in liver tissue, and their correlation were analyzed. RESULTS: The mean CPA at the decompensated stage of cirrhosis was 35.93±14.42% (11.24%-63.41%). The correlation coefficients of the CPA with a model for end-stage liver disease score, serum total bilirubin and international standard ratio of prothrombin B were 0.553, 0.519 and 0.533, respectively (P<0.001). With increasing CPA values, the three indices reflecting liver functional reserve also changed significantly.CONCLUSIONS: The degree of fibrosis may be correlated with the functional reserve. With the advancement of fibrosis, the liver functional reserve is attenuated accordingly. | Shi-Bin Xie, Chao Ma, Chao-Shuang Lin,Ying Zhang, Jian-Yun Zhu and Wei-Min Ke Department of Infectious Disease, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China | 2011 | Hepatobiliary & Pancreatic Diseases International2011，10，5： | 1 |
| 14 | Usefulness of portal vein pressure for predicting the effects of tolvaptan in cirrhotic patients显示文摘AIM: To elucidate influencing factors of treatment response, then tolvaptan has been approved in Japan for liquid retention.METHODS: We herein conducted this study to clarify the influencing factors in 40 patients with decompensated liver cirrhosis complicated by liquid retention. Tolvaptan was administered at a dosage of 7.5 mg once a day for patients with conventional diuretic-resistant hepatic edema for 7 d. At the initiation of tolvaptan, the estimated hepatic venous pressure gradient(HVPG) value which was estimated portal vein pressure was measured using hepatic venous catheterization. We analyzed the effects of tolvaptan and influencing factors associated with treatment response.RESULTS: Subjects comprised patients with a median age of 65(range, 40-82) years. According to the ChildPugh classification, class A was 3 patients, class B was 19, and class C was 18. Changes from the baseline in body weight were-1.0 kg(P = 2.04 × 10^(-6)) and-1.3 kg(P = 1.83 × 10^(-5)), respectively. The median HVPG value was 240(range, 105-580) mm H2 O. HVPG was only significant influencing factor of the weight loss effect. When patients with body weight loss of 2 kg or greater from the baseline was defined as responders, receiver operating characteristic curve analysis showed that the optimal HVPG cutoff value was 190 mm H_2 O in predicting treatment response. The response rate was 87.5%(7/8) in patients with HVPG of 190 mm H2 O or less, whereas it was only 12.5%(2/16) in those with HVPG of greater than 190 mm H2O(P = 7.46 × 10^(-4)). We compared each characteristics factors between responders and non-responders. As a result, HVPG(P = 0.045) and serum hyaluronic acid(P = 0.017) were detected as useful factors.CONCLUSION: The present study suggests that tolvaptan in the treatment of liquid retention could be more effective for patients with lower portal vein pressure. | Ai Nakagawa Masanori Atsukawa Akihito Tsubota Chisa Kondo Tomomi Okubo Taeang Arai Norio Itokawa Yoshiyuki Narahara Katsuhiko Iwakiri | 2016 | World Journal of Gastroenterology2016，22，21： | 1 |
| 15 | Management of hepatitis C infection before and after liver transplantation显示文摘Chronic hepatitis C(CHC) is the most common indication for liver transplantation(LT). Aggressive treatment of hepatitis C virus(HCV) infection before cirrhosis development or decompensation may reduce LT need and risk of HCV recurrence post-LT. Factors associated with increased HCV risk or severity of recurrence include older age, immunosuppression, HCV genotype 1 and high viral load at LT. HCV recurrence post-LT leads to accelerated liver disease and cirrhosis development with reduced graft and patient survival. Currently, interferon(IFN)-based regimens can be used in dualagent regimens with ribavirin, in triple-agent antiviral strategies with direct-acting antivirals(e.g., protease inhibitors telaprevir or boceprevir), or before transplant in compensated patients to reduce HCV viral load to prevent or reduce the risk of post-LT recurrence and complications; they cannot be used in patients with decompensated cirrhosis. IFN-based regimens are used in less than half of HCV-infected patients waiting for LT due to extremely low efficacy and poor tolerability. However, antiviral therapy is indicated after LT in patients with histologically confirmed CHC despite tolerability issues. Improvements in side effect management have increased survival in patients achieving therapeutic targets. HCV treatment pre- and post-LT results in significant health care costs especially when lack of efficacy leads to disease worsening, although studies have shown sofosbuvir treatment before LT vs conventional post-LT dual antiviral is cost effective. The suboptimal efficacy and tolerability of IFN-based therapies, plus the significant economic burden, means the need for effective and well tolerated IFN-free antiHCV therapy for pre- and post-LT remains high. | Stefano Fagiuoli Roberto Ravasio Maria Grazia Lucà Anna Baldan Silvia Pecere Alessandro Vitale Luisa Pasulo | 2015 | World Journal of Gastroenterology2015，21，15： | 1 |
| 16 | Direct antiviral agent treatment of decompensated hepatitis C virus-induced liver cirrhosis显示文摘Recently, direct antiviral agents(DAAs) have been increasingly used for the treatment of chronic hepatitis C virus(HCV) infections, replacing interferon-based regimens that have severe adverse effects and low tolerability. The constant supply of new DAAs makes shorter treatment periods with enhanced safety possible. The efficacy of DAAs for treatment of compensated liver cirrhosis(LC) is not less than that for treatment of non-cirrhotic conditions. These clinical advantages have been useful in pre- and post-liver transplantation(LT) settings. Moreover, DAAs can be used to treat decompensated HCV-induced LC in elderly patients or those with severe complications otherwise having poor prognosis. Although encouraging clinical data are beginning to appear, the actual efficacy of DAAs for suppressing disease progression, allowing delisting for LT and, most importantly, improving prognosis of patients with decompensated HCV-LC remains unknown. Casecontrol studies to examine the short- or long-term effects of DAAs for treatment of decompensated HCV-LC are urgently need. | Shogo Ohkoshi Haruka Hirono Satoshi Yamagiwa | 2015 | World Journal of Gastrointestinal Pharmacology and Therapeutics2015，6，4： | 1 |
| 17 | Autologous bone marrow transplantation in decompensated liver: Systematic review and meta-analysis显示文摘AIM:To evaluate the efficacy of autologous bone marrow mononuclear cell transplantation in decompensated liver disease.METHODS:Medline,EMBASE,PubMed,Science Direct,and the Cochrane Library were searched for relevant studies.Retrospective case-control studies were included along with randomized clinical trials.Metaanalysis was performed in line with recommendations from the Cochrane Collaboration software review manager.Heterogeneity was assessed using a randomeffects model.RESULTS:Four randomized controlled trials and four retrospective studies were included.Cell transplantation increased serum albumin level by 1.96 g/L(95%CI:0.74-3.17;P = 0.002],2.55 g/L(95%CI:0.32-4.79;P= 0.03),and 3.65 g/L(95%CI:0.76-6.54;P = 0.01)after 1,3,and 6 mo,respectively.Patients who had undergone cell transplantation also had a lower level of total bilirubin[mean difference(MD):-1.37 mg/dL;95%CI:-2.68-(-0.06);P = 0.04]after 6 mo.This decreased after 1 year when compared to standard treatment(MD:-1.26;95%CI:-2.48-(-0.03);P =0.04].A temporary decrease in alanine transaminase and aspartate transaminase were significant in the cell transplantation group.However,after 6 mo treatment,patients who had undergone cell transplantation had a slightly longer prothrombin time(MD:5.66 s,95%CI:0.04-11.28;P = 0.05).Changes in the model for endstage liver disease score and Child-Pugh score were not statistically significant.CONCLUSION:Autologous bone marrow transplantation showed some benefits in patients with decompensated liver disease.However,further studies are still needed to verify its role in clinical treatment for end-stage liver disease. | Prasoon Pankaj Qi Zhang Xue-Li Bai Ting-Bo Liang | 2015 | World Journal of Gastroenterology2015，21，28： | 0 |
| 18 | Morbidity and prognosis of acute decompensated heart failure patients with preserved ejection fraction accompanied by myocardial injury显示文摘Objective To investigate the prognostic value of cardiactroponin I in acute decompensated heart failure( ADHF ) patients with preserved ejection fraction.Methods We included 326 consecutive ADHF patientswith preserved ejection fraction from January 2016 to January2017. Patients were divided into two groups basedon cardiac troponin I levels. Group A included patientswith elevated troponin I level (cTnI≥0. 04 ng /ml) andgroup B included patients with normal troponin I level(cTnI < 0. 04 ng /ml). BNP levels,length of hospitalstay,readmission rate,30-day and 180-day all-causemortality were compared between the two groups. Results(1) There were 185 patients ( 56. 7%) in thegroup A and 141 patients in the group B. (2) Male ratio(44. 9% vs 32. 6%,P < 0. 05),serum creatinine levelsat admission ([120. 6 ± 48. 2]μmmol /L vs [107. 4 ±51. 2]μmmol /L,P < 0. 05),BNP levels([846 ± 575]pg /ml vs [423 ± 387] pg /ml,P < 0. 05),30-day and180-day all-cause mortality (5. 4% vs 0. 7%,9. 2% vs2. 8%,P < 0. 05) were all significantly higher in groupA than in group B. | 张倩 | 2019 | China Medical Abstracts(Internal Medicine)2019，36，2： | 0 |
| 19 | Danshao Huaxian capsule in treatment of decompensated cirrhosis resulting from chronic hepatitis B显示文摘BACKGROUND: The prognosis of decompensated cirrhosis resulting from chronic hepatitis B is poor, and the benefits of treatment with interferon are ourweight serious sideeffects and the risk of fatal exacerbation of disease. Danshao Huaxian capsule rapidly reduces hepatitis B virus(HBV)-DNA in serum to undetectable levels. METHODS: A total of 35 patients with chronic hepatitis B and decompensated cirrhosis were treated with Danshao Huaxian 1.2g. po. tid daily. Before the treatment, HBVDNA in serum was positive in all patients. Ten patients had Child-Pugh class B and 25, class C hepatitis B. Seven patients underwent liver transplantation within 6 months of initial treatment. Of the 10 patients of class B, 5 died within 6 months, and the other 5 did not complete the treatment for some reasons; the 25 patients of class C were treated for at least 6 months (mean =19 months). RESULTS: In most of the 25 patients, liver function was improved slowly but markedly after 9 months of treatment, showing a decreased level of serum bilirubin from 67±13 to 30±4μmol/L (P<0.05, baseline vs.6 months), an increased level of serum albumin from 27±1 to 34±1 g/L(P<0.05) and a decreased level of Child-Pugh score from 10.3±0.4 to 7.5+0.5 (P<0.05). Three patients developed resistance to Danshao Huaxian because of a mutation in the YMDD motif, but liver function was not deteriorated. Inhibition of viral replication with Danshao Huaxian resulted in a significant improvement of liver function in patients with decompensated HBV cirrhosis, but the long-term results remain uncertain. CONCLUSION: Danshao Huaxian capsule is effective in inhibiting viral DNA replication in patients with decompensated cirrhosis and making clinical improvement. | Ming-Liang Cheng, Tong Lu, Yu-Mei Yao and Xiao-Xia Geng Department of Infectious Diseases, Affiliated Hospital of Guiyang Medical College, Guiyang 550004, China and Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA | 2006 | Hepatobiliary & Pancreatic Diseases International2006，5，1： | 0 |
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