[Efficacy and safety of Kuhuang injection in treating viral hepatitis： systematic review and Meta-analysis of randomized controlled trials].

To systematically evaluate the effectiveness and safety of Kuhuang injection in treating viral hepatitis. Eight electronic databases and clinic trials were searched to collect randomized controlled trials for the effect of Kuhuang injection in the treatment of viral hepatitis. According to the Cochrane Handbook 5.1, two independent reviewers screened out the literatures, extracted data and assessed the quality of thestudies included. RevMan5.3 software was used for the data analysis. A total of 32 articles were included, involving 3 188 patients, including male 1 951 cases (61.2%), female 859 cases (26.9%), and 378 cases of unknown sex (11.9%). All the clinical studies showed a low quality. Due to the complication of diseases and difficulty in intervention measures, most trails were classified by the condition of diseases, and then a descriptive analysis was made. The results showed that the test group was better than the control group in total efficiency of treating severe icteric viral hepatitis, and the test group was advantageous over the control group in jaundice removal and liver function recovery rate in treating icteric hepatitis. In the Meta-analysis on the RCTs for icteric viral hepatitis, the total efficiency of Kuhuang injection + comprehensive treatment group was higher than that of the comprehensive treatment group （RR=1.35, 95%CI=[1.10,1.66], P=0.61）. In addition, when Kuhuang injection was dripped too fast, patients had such adverse reactionsas dizziness, palpitation, nausea, vomiting and skin rash, which could be relieved at a lower dripping speed.Based on the existing evidences, Kuhuang injection had a certain effect in treating viral hepatitis. Most clinic trails did not include viral hepatitis etiology, clinical classification and diversified intervention measures, which resulted in a high clinical heterogeneity and poor comparability between trails. Besides, most trials had a low methodological quality, which affected the authenticity of the results. Therefore, more high-quality, multi-center, large-sample, randomized double-blind controlled trialsarerequired to prove the evidences.

Association between hepatitis B co-infection and elevated liver stiffness among HIV-infected adults in Lusaka, Zambia.

OBJECTIVE: To describe liver disease epidemiology among HIV-infected individuals in Zambia. METHODS: We recruited HIV-infected adults (≥18 years) at antiretroviral therapy initiation at two facilities in Lusaka. Using vibration controlled transient elastography, we assessed liver stiffness, a surrogate for fibrosis/cirrhosis, and analysed liver stiffness measurements (LSM) according to established thresholds (>7.0 kPa for significant fibrosis and >11.0 kPa for cirrhosis). All participants underwent standardised screening for potential causes of liver disease including chronic hepatitis B (HBV) and C virus co-infection, herbal medicine, and alcohol use. We used multivariable logistic regression to identify factors associated with elevated liver stiffness. RESULTS: Among 798 HIV-infected patients, 651 had a valid LSM (median age, 34 years; 53% female). HBV co-infection (12%) and alcohol use disorders (41%) were common and hepatitis C virus co-infection (<1%) was rare. According to LSM, 75 (12%) had significant fibrosis and 13 (2%) had cirrhosis. In multivariable analysis, HBV co-infection as well as male sex, increased age and WHO clinical stage 3 or 4 were independently associated with LSM >7.0 kPa (all P < 0.05). HBV co-infection was the only independent risk factor for LSM >11.0 kPa. Among HIV-HBV patients, those with elevated ALT and HBV viral load were more likely to have significant liver fibrosis than patients with normal markers of HBV activity. CONCLUSIONS: HBV co-infection was the most important risk factor for liver fibrosis and cirrhosis and should be diagnosed early in HIV care to optimise treatment outcomes.

Evolución bioquímica y respuesta histológica de pacientes con hepatitis C bajo tratamiento antiviral / Biochemical evolution and histological response of patients with hepatitis C undergoing antiviral therapy

Fundamento: la hepatitis C es uno de los principales problemas de salud a nivel mundial y la indicación másfrecuente de transplante hepático en muchos países. Objetivo: determinar la evolución bioquímica y respuesta histológica de pacientes con hepatitis crónica tipo C bajo tratamiento con Interferón alfa 2b recombinante y ribavirina atendidos en consultaprovincial de Hepatología. Métodos: estudio observacional y descriptivo, en 31 pacientes portadores del virus de la hepatitis C, remitidos a la consulta deHepatología Provincial de Cienfuegos en el Hospital Universitario Dr Gustavo Aldereguía Lima, entre enero de 2007 y junio de 2009; y tratados con interferon alfa 2b recombinante más ribavirina. Se estudiaron las variables: edad, sexo, posible vía de infección, valores séricos de alanito aminotransferasa, evaluaciónbioquímica (al concluir el tratamiento y al finalizar el seguimiento) y respuesta histológica. Para la evaluación de la actividad histológica de las lesiones hepáticas crónicas se empleó el índice de Knodell. Para comparar los resultados (respuesta bioquímica y la respuesta histológica) antes y después del tratamiento se empleó la Prueba de los Signos. Resultados: El sexo femenino predominó en la muestra (58,1 por ciento). La edad promediofue de 45,5±11,6 años. La vía posible de trasmisión no se pudo identificar en 51,6 por ciento de los pacientes. Eltratamiento quirúrgico fue identificado como vía de infección en el 22,6 por ciento, seguido del tratamiento parenteral reiterado (16,1 por ciento). Conclusión: al finalizar el tratamiento se obtuvo un mayor porcentaje de respuesta en cuanto a la evolución bioquímica y a la respuesta histológica(AU)

Background: Hepatitis C is a major health problem worldwide and the most common indicator for the need of a liver transplantation in many countries. Objective: To determine the biochemical evolution and the histological response of patients with chronic hepatitis C who were treated with ribavirin and recombinant interferon alfa-2b in the provincial Hepatology consultation. Methods: A descriptive observational study was conducted. It included 31 patients who presented the hepatitis C virus and were treated in the Hepatology consultation of the Provincial General University Hospital of Cienfuegos Dr Aldereguía Gustavo Lima from January 2007 to June 2009. These patients were administered with ribavirin and recombinant interferon alfa-2b. Variables such as age, sex, possible route of infection, aminotransferase alanine serum, biochemical evaluation (after treatment and after follow-up) and histological response were included. In order to assess the histological activity of chronic liver injuries Knodell Index was used. In order to compare the results (biochemical and histological response) before and after treatment the Sign Test was used. Results: Women were predominant in the sample group (58.1 percent). The average age was 45.5 ± 11.6 years. The possible route of transmission could not be identified in 51.6 percent of patients, while surgical treatment was identified as the route of infection in 22.6 percent of the cases, followed by repeated parenteral treatment in 16.1 percent of them. Conclusion: By the end of treatment there was a higher response rate in terms of biochemical changes and histological response(AU)

De-jaundice of Severe Jaundice Hepatitis with TCM Preserving Enema / 浙江中医药大学学报

[Objective] To observe the de-jaundice of severe jaundice hepatitis with TCM enema.[Method] 87 cases of chronic virus hepatitis with hyperbilirubinemia were randomly divided into 2 groups,the treatment group treated with TCM preserving enema and routine combination of TCM and western medicine which could protect liver and decrease enzyme and de-jaundice.The control one used only the later,observed for 6 weeks.[Result] The reduction of total bilirubin of the treatment group was larger than control group,P