Association between KIR Genes and Efficacy of Treatment of HBeAg-Positive Chronic Hepatitis B Patients with Entecavir.

Entecavir (ETV) is commonly used to treat chronic hepatitis B (CHB) in China. However, certain percentages of e-Antigen (HBeAg) positive CHB patients do not respond to ETV therapy. OBJECTIVE: To investigate whether the killer immunoglobulin-like receptor (KIR) genes were associated with seroconversion in HBeAg positive CHB responder patients treated with ETV. METHODS: Polymerase chain reaction with sequence-specific primers (PCR-SSP) method was performed to genotype KIR genes in 200 healthy controls and 198 HBeAg-positive CHB patients which 59 were defined as the complete response group (CRG) to the treatment with ETV and 139 were defined as null or partial response group (NPRG). RESULTS: The frequencies of KIR2DS2 and KIR2DS3 were significantly higher (P=0.030, OR=1.57，95%CI=2.36-1.05 and P=0.018, OR=1.773，95%CI=2.77-1.13, respectively), while, the frequencies of KIR2DL3, KIR2DS1 and KIR3DS1 were significantly lower (P=0.038, OR=0.525, 95%CI=0.96-0.29,and P=0.031, OR=0.640, 95%CI =0.95-0.43, and P=0.035, OR=0.641, 95%CI=0.96-0.43, respectively) in HBeAg-positive CHB patients than those in healthy controls. The frequency of KIR2DS3 gene was significantly higher in NPRG than that in CRG (P=0.018, OR=0.402, 95%CI=0.83-0.20). The frequencies of KIR2DL3 and KIR3DS1 genes were significantly higher in CRG than those in NPRG (P=0.019, OR=3.625, 95%CI=10.83-1.21 and P=0.041, OR=1.949, 95%CI=3.65-1.04, respectively). CONCLUSION: Patients with KIR2DS3 might have negative responses to anti-HBV therapy with ETV and patients with KIR2DL3 and KIR3DS1 might have advantage in the therapy with ETV.

[Multiple organ damage in patients dying from acute decompensated heart failure].

OBJECTIVE: To detect the occurring and developing patterns of multiple organ damage in patients dying from acute decompensated heart failure (ADHF). METHODS: The clinical data of 30 hospitalized patients of ADHF were analyzed. The dying causes included renal, hepatic, respiratory dysfunctions, infection and anemia. All patients received continuous cardiac rhythm monitoring. Their renal, hepatic and respiratory function, infection and anemia were evaluated at admission and during the last 24 hours pre-death respectively. And the results were compared. RESULTS: There were 19 males and 11 females. The average age was (55±22) years old. Among them, 7 cases were of NYHA class III and 23 cases NYHA class IV at admission. The causes of heart failure included valvular heart disease (n=17), dilated cardiomyopathy (n=6), ischemic cardiomyopathy (n=4), valvular heart disease and previous cardiac infarction (n=2) and restrictive cardiomyopathy (n=1). From admission to death, the average hospitalization duration was (8.8±7.4) days. Eleven cases suffered from sudden cardiac death due to lethal arrhythmias including ventricular tachycardia, ventricular fibrillation and sinus arrest. Another 19 cases had no lethal arrhythmias, but they suffered cardiac shock eventually. Among all 30 cases, there were 15 cases with pulmonary infection, 13 cases with hepatic dysfunction, 6 cases with renal dysfunction, 7 cases with respiratory failure, 7 cases with anemia and 15 cases with multiple organ damage at admission. However, the pre-death values increased to 26 (87%, P<0.01), 19 (63%, P<0.05), 24 (80%, P<0.01), 20 (67%, P<0.01), 9 (30%, P>0.05) and 29 (97%, P<0.01) respectively. CONCLUSION: Multiple organ damage evolves and worsens to result in death in ADHF patients.