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ObjectiveTo investigate the effect of sustained virologic response on disease progression and the development of hepatocellular carcinoma (HCC) in patients with compensated hepatitis B cirrhosis receiving antiviral therapy with nucleos(t)ide analogues (NAs). MethodsA total of 542 patients with compensated hepatitis B cirrhosis who attended Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 1 to December 31, 2013, received antiviral therapy, and were followed up for more than 5 years were enrolled, and according to the status of virologic response during follow-up, they were divided into a sustained virologic response cohort with 496 cases and a non-sustained virologic response cohort with 46 cases. With disease progression as the outcome event, general information and examination data were collected during the 5-year follow-up period. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed; relative risk and 95% confidence interval (CI) were used to investigate the degree of correlation of factors measured with the progression of liver cirrhosis. The life-table method was used to calculate the 1-, 3-, and 5-year progression-free survival rates, and the Kaplan-Meier method was used to plot survival curves; the log-rank test was used for univariate analysis, and the Cox regression model was used for multivariate regression analysis. ResultsFor the 542 patients, the mean progression-free survival time was 62.50 months (95% CI: 61.01-63.92), and the 1-, 3-, and 5-year progression-free survival rates were 94%, 82%, and 71%, respectively. The sustained virologic response cohort had a significantly longer mean progression-free survival time than the non-sustained virologic response cohort ［63.10 months (95% CI: 61.65-64.55) vs 55.95 months (95% CI: 50.19-61.71), χ2=12.058, P=0.001］. Compared with the non-sustained virologic response cohort, the sustained virologic response cohort had significantly lower 5-year cumulative incidence rate of HCC than (20.6% vs 34.8%, χ2=5.759, P=0.016) and 5-year cumulative incidence rate of decompensated cirrhosis (5.0% vs 15.2%, χ2=8.239, P=0.004). Virologic response was an independent risk factor for disease progression (hazard ratio=232, 95% CI: 1.45-3.72). ConclusionSustained virologic response can reduce the incidence rates of complications and HCC, improve long-term prognosis, and prolong survival time in patients with compensated hepatitis B cirrhosis.
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Portal hypertension refers to a series of clinical manifestations caused by elevated pressure of the portal vein system, which can cause portal hypertension by causing portal venous obstruction and / or increased blood flow. A typical clinical manifestation in patients with decompensated cirrhosis is portal hypertension. A severe complication of portal hypertension is esophagogastric varices bleeding, refractory ascites, and hepatic encephalopathy. The effective reduction of portal pressure can reduce the incidence of complications, improve the prognosis and reduce the mortality. At present, the commonly used clinical methods for reducing portal hypertension include drug therapy, minimally invasive interventions, surgical treatment, and liver transplantation. This article reviews the current status of integrated traditional Chinese and Western medicine for portal hypertension.
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Abundant experience has been accumulated when it comes to the traditional Chinese medicine (TCM)prevention and treatment of chronic hepatitis B (CHB).However,there still exist some deficiencies such as insufficient randomized controlled trials (RCTs)and lack of attention to objective indices for therapeutic evaluation.Therefore,future clinical prevention and treatment should be tied closely to the re-search progress in the immune pathogenesis of CHB and give full play to the characteristics and advantages of TCM in modulating the func-tional status (including immunity)of human body.Moreover,clinical and translational research on the TCM regulation of immune response in CHB should be carried out to further improve clinical therapeutic effect.In addition,biochemistry,virology,and pathology should be ap-plied actively in place of outcomes while paying attention to the symptoms of patients in an effort to improve the objectivity of therapeutic e-valuation when summarizing clinical practice experience.Furthermore,RCTs should be employed as much as possible to enhance global rec-ognition of the therapeutic effect of TCM treatment.And there is no doubt that bringing the advantages of integrated traditional Chinese and Western medicine therapy into full play will benefit a huge number of patients.
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Abundant experience has been accumulated when it comes to the traditional Chinese medicine (TCM) prevention and treatment of chronic hepatitis B (CHB). However, there still exist some deficiencies such as insufficient randomized controlled trials (RCTs) and lack of attention to objective indices for therapeutic evaluation. Therefore, future clinical prevention and treatment should be tied closely to the research progress in the immune pathogenesis of CHB and give full play to the characteristics and advantages of TCM in modulating the functional status (including immunity) of human body. Moreover, clinical and translational research on the TCM regulation of immune response in CHB should be carried out to further improve clinical therapeutic effect. In addition, biochemistry, virology, and pathology should be applied actively in place of outcomes while paying attention to the symptoms of patients in an effort to improve the objectivity of therapeutic evaluation when summarizing clinical practice experience. Furthermore, RCTs should be employed as much as possible to enhance global recognition of the therapeutic effect of TCM treatment. And there is no doubt that bringing the advantages of integrated traditional Chinese and Western medicine therapy into full play will benefit a huge number of patients.
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Background: Chronic hepatitis C is one of the major causes of end-stage liver disease with a high incidence rate, amounting to a grave and serious problem of public health. Currently, interferon-based (with or without ribavirin) antiviral therapy has limited use due to its stringent indications, possible contraindications and side effects. Traditional Chinese medicine (TCM) may have advantages in the prevention and treatment of chronic hepatitis C and it is of significant value to discover the advantages. Through this research, a safe and effective treatment protocol of TCM or integrated TCM and Western medicine for chronic hepatitis C can be formed. To this end, during China's Eleventh Five-Year Plan, special research projects on acquired immune deficiency syndrome (AIDS), viral hepatitis and the other major infectious diseases were established. Our studies on chronic hepatitis C constitute one of the major special research topics. Methods and design: Clinical information of patients with chronic hepatitis C will be first collected in a large, multicenter epidemiological survey. Positive symptoms will be analyzed by rapid cluster analysis, principal constituent analysis and factor analysis, and syndrome types will be diagnosed based on expert advice. Concurrently, a large, multicenter, randomized, parallel-group prospective study will be launched based on evidence-based medical principles to evaluate the effects and safety of the treatment protocol for chronic hepatitis C. The evaluated indexes will include the normalization rate of liver function, virological improvement and quality of life improvement for the short-term efficacy and the incidence of liver cirrhosis and (or) primary liver cancer and mortality for the long-term efficacy. Discussion: This study will investigate the TCM syndrome differentiation norms and the syndrome distribution rules of chronic hepatitis C and evaluate the efficacy and safety of a treatment protocol for chronic hepatitis C based on TCM theory or combined treatment of TCM and Western medicine. The study results will be helpful to developing a TCM treatment program for chronic hepatitis C. Trial registration: The research program was registered in the Chinese Clinical Trial Registry in English and Chinese in January 2010. Registration number: ChiCTR-TRC-10000770.
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OBJECTIVE: A method based on dubious condition of information entropy was introduced and applied to discuss a complexity problem in the analysis of correlation between traditional Chinese medicine (TCM) syndrome and season. METHODS: Eight hundred and seventy one cases of chronic virus hepatitis B (hepatitis B) with TCM clinical data were analyzed by information entropy method. RESULTS: It was found that hepatitis B with Yin deficiency of liver and kidney happened more often in summer than in other seasons. CONCLUSION: It is inferred that the difference of seasons may influence the variation of TCM syndromes.
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AIM: To explore the treatment of subclinical hepatic encephalopathy(SHE) by traditional Chinese medicine. METHODS: Sixty patients with SHE were randomized into two groups: treatment group with 30 cases treated by Qingkai Granule and control group with another 30 cases treated by lactulose.They were all treated for two weeks.The evoked potentials(Eps) were measured,moreover,number connection test(NCT) and digit symbol test(DST) were conducted. RESULTS: In treatment group,the period for NCT was shorter and the DST also improved apparently;peak latency(PL) and interpeak latency(IPL) of SEP and AEPs were shorter to different degrees,with significant differences among groups. CONCLUSION: Qingkai Granule acts to effectively increase the learning,memory and space cognitive capacities in patients,and improves the nerve electrophysiology in patients.