Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 30
Filtrar
1.
Dis Markers ; 2020: 8814841, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33381244

RESUMO

Background: Acute-on-chronic liver failure (ACLF) is a clinical syndrome characterized by acute deterioration of liver function and high short-term mortality. Clusterin, with biological functions similar to small heat shock proteins, can protect cells from apoptosis induced by various stressors. The aim of this study was to detect the level of serum clusterin in hepatitis B virus- (HBV-) related ACLF and to assess the predictive value of clusterin for the short-term prognosis of HBV-ACLF. Methods: We detected serum clusterin by ELISA in 108 HBV-ACLF patients, 63 HBV-non-ACLF patients, and 44 normal controls. Results: Serum clusterin was markedly lower in HBV-ACLF patients (median, 51.09 µg/mL) than in HBV-non-ACLF patients (median, 188.56 µg/mL) and normal controls (median, 213.45 µg/mL; all P < 0.05). Nonsurviving HBV-ACLF patients who died within 90 days had much lower clusterin levels than did surviving patients, especially those who died within 28 days (nonsurvival group vs. survival group: 39.82 ± 19.34 vs. 72.26 ± 43.52, P < 0.001; survival time ≤ 28 vs. survival time > 28: median 28.39 vs. 43.22, P = 0.013). The results showed that for identifying HBV-ACLF, the sensitivity of clusterin (93.7%) was similar to the sensitivities of the international normalized ratio (INR; 94.4%) and total bilirubin (TBIL; 94.8%), but its specificity (90.7%) was higher than that of prothrombin activity (PTA; 65.8%) and TBIL (69.8%) and was similar to INR (88.9%). As the concentration of clusterin increased, the mortality of HBV-ACLF patients decreased significantly from 59.3% to 7.0%. Clusterin had better ability for predicting the prognosis of HBV-ACLF patients than did the model for end-stage liver disease (MELD) score and the chronic liver failure consortium (CLIF-C) ACLF score (MELD vs. clusterin: P = 0.012; CLIF-C ACLF vs. clusterin: P = 0.031). Conclusion: Serum clusterin is a potential biomarker for HBV-ACLF which can be used to assess clinical severity and the short-term prognosis of patients with this disease and may help clinicians identify HBV-ACLF with greater specificity and improved prognostic accuracy than existing prognostic markers.

2.
Onco Targets Ther ; 13: 11421-11431, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33192075

RESUMO

Background: Individuals with hepatocellular carcinoma (HCC) are at risk of tumor recurrence after surgical resection, which affects their survival. The aim of the present study was to establish a model for predicting tumor progression in patients with HCC. Methods: To develop and validate the efficacy of a novel prognostic model, a retrospective cohort with HCC (n = 1005) at Beijing Ditan Hospital was enrolled from January 2008 and June 2017. Furthermore, a prospective cohort (n = 77) was recruited to validate the association between thyroid-stimulating hormone (TSH) levels and tumor progression in patients with HCC. Results: The model used in predicting the progression of HCC included four variables (namely, Barcelona Clinic Liver Cancer [BCLC] stage, presence of portal vein tumor thrombus, alpha-fetoprotein level, and TSH level). The AUROC of the 1-year progression-free survival (PFS) model was 0.755 and 0.753 in the deriving cohort and validation cohort, respectively, and these values were significantly higher than those of the Child-Pugh score, Model for End-stage Liver Disease (MELD), tumor-lymph node-metastasis (TNM) staging system, Okuda classification, and CLIP score. A simple assessment using a nomogram showed the 1-year PFS rate of patients with HCC. In the prospective cohort, the KM curve showed that the high TSH level group had a shorter PFS than the low TSH level (p = 0.001). Conclusion: The prognostic model of HCC progression was superior to other well-known classical tumor scoring systems. A high TSH level was correlated to poor outcome, particularly those with advanced HCC.

3.
Trials ; 21(1): 708, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787905

RESUMO

BACKGROUND: Nucleos(t)ide analogues (NAs) are the first-line option against chronic hepatitis B (CHB). NAs produce potent suppression of viral replication with a small chance of HBsAg seroclearance and a high risk of virological relapse after discontinuation. The combined therapy of NAs plus traditional Chinese medicine (TCM) is widely accepted and has been recognized as a prospective alternative approach in China. Based on preliminary works, this study was designed to observe the therapeutic effect of TCM plus entecavir (ETV) against HBeAg-positive chronic hepatitis B with respect to reducing the recurrence risk after NA withdrawal. METHODS/DESIGN: The study is a nationwide, multicenter, double-blind, randomized, placebo-controlled trial with a duration of 120 weeks. A total of 18 hospitals and 490 eligible Chinese HBeAg-positive CHB patients will be enrolled and randomly allocated into the experimental group and control group in a 1:1 ratio. Patients in the experimental group will be prescribed TCM formulae (Tiaogan-BuXu-Jiedu granules) plus ETV 0.5 mg per day for consolidation therapy for 96 weeks. Patients in the control group will be prescribed TCM granule placebo plus ETV 0.5 mg per day for the same course. After consolidation therapy, all patients will discontinue their trial drugs and be closely monitored over the next 24 weeks. Once clinical recurrence (CR) occurs, ETV treatment will be restarted. The primary outcome is the cumulative rate of CR at the end of this trial. CONCLUSION: This study is the first of its kind to observe therapeutic effects with respect to reducing recurrence after NA withdrawals after unified integrative consolidation therapy in the CHB population. TRIAL REGISTRATION: Chinese Clinical Trial Registry No. ChiCTR1900021232 . Registered on February 2, 2019.

4.
Open Forum Infect Dis ; 7(5): ofaa169, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32490031

RESUMO

Background: There is currently a lack of nonspecific laboratory indicators as a quantitative standard to distinguish between the 2019 coronavirus disease (COVID-19) and an influenza A or B virus infection. Thus, the aim of this study was to establish a nomogram to detect COVID-19. Methods: A nomogram was established using data collected from 457 patients (181 with COVID-19 and 276 with influenza A or B infection) in China. The nomogram used age, lymphocyte percentage, and monocyte count to differentiate COVID-19 from influenza. Results: Our nomogram predicted probabilities of COVID-19 with an area under the receiver operating characteristic curve of 0.913 (95% confidence interval [CI], 0.883-0.937), greater than that of the lymphocyte:monocyte ratio (0.849; 95% CI, 0.812-0.880; P = .0007), lymphocyte percentage (0.808; 95% CI, 0.768-0.843; P < .0001), monocyte count (0.780; 95% CI, 0.739-0.817; P < .0001), or age (0.656; 95% CI, 0.610-0.699; P < .0001). The predicted probability conformed to the real observation outcomes of COVID-19, according to the calibration curves. Conclusions: We found that age, lymphocyte percentage, and monocyte count are risk factors for the early-stage prediction of patients infected with the 2019 novel coronavirus. As such, our research provides a useful test for doctors to differentiate COVID-19 from influenza.

5.
Oncol Lett ; 19(4): 3249-3257, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32256820

RESUMO

Portal vein tumor thrombus (PVTT) promotes distant metastasis of hepatocellular carcinoma (HCC), which increases the mortality of patients with HCC and PVTT. The aim of the present study was to develop an early risk warning system for distant metastasis of hepatitis B virus (HBV)-associated primary HCC (HBV-HCC) with PVTT. Data from 346 patients (263 and 83 in the modeling and validation cohorts, respectively) who had received primary diagnoses of HBV-HCC and PVTT between January 2012 and June 2015 at Beijing Ditan Hospital (Beijing, China) were retrospectively examined. In the modeling cohort, univariate and multivariate logistic regression analyses were conducted to determine the factors that were significantly associated with distant metastasis. Furthermore, an early risk warning model for distant metastasis was proposed and validated through receiver operating characteristic curve analysis in the validation cohort. The results revealed that neutrophil to lymphocyte ratios of ≥2.31, red blood cell counts of ≥4.07×1012 cells/l, C-reactive protein levels of ≥7.02 mg/l, aspartate aminotransferase levels of ≥118.5 U/l and tumor thrombus site (at branch) were significantly positively associated with distant metastasis of HBV-HCC with PVTT (P<0.05; odds ratio >1.000). A formula for predicting distant metastasis was obtained with an accuracy of ~70%. The results of the present study may allow for the early prediction of distant metastasis and facilitate the administration of appropriate treatment to improve the outcomes and prognosis of patients with intermediate to advanced HCC.

6.
Gut Liver ; 14(2): 232-247, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31158948

RESUMO

Background/Aims: Studies have shown that nucleos(t)ide analogue (NA) treatment can reduce the risk of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients, but it is unclear which NA is most effective. We performed a meta-analysis and systematic review comparing the efficacies of NAs in CHB patients. Methods: We searched literature databases for randomized controlled trials (RCTs) and observational studies that analyzed the hepatic biochemical response, virological response, seroconversion rate, drug resistance rate, and HCC incidence rate in CHB patients treated with NAs. Meta-analyses were performed with RevMan and Stata/SE software. Results: Twelve cohort studies and one RCT were selected, in which entecavir (ETV), lamivudine (LAM), telbivudine (LdT), and/or tenofovir disoproxil fumarate (TDF) were evaluated in CHB patients. The meta-analysis showed that ETV was superior to LAM with regard to the HCC incidence (p<0.001), biochemical response (p=0.001), virological response (p=0.02), and drug resistance (p<0.001), and ETV was superior to LdT with regard to the virological response (p<0.001) and drug resistance (p<0.001). We found no significant difference between ETV and TDF with regard to the HCC incidence (p=0.08), biochemical response (p=0.39), virological response (p=0.31), serological conversion (p=0.38), or drug resistance (p=0.95). NA-treated patients with pre-existing cirrhosis had a 5.49 times greater incidence of HCC than those without cirrhosis (p<0.001). Conclusions: ETV or TDF should be used for long-term first-line monotherapy in CHB patients according to the current guidelines. Standardized protocols are needed for future studies of ETV and TDF to facilitate conclusive comparisons. Patients with cirrhosis are at significantly elevated risk for HCC, despite the benefits of NA treatment.

7.
Cancer Immunol Immunother ; 68(12): 2041-2054, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31720814

RESUMO

Hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC) is usually considered an inflammation-related cancer associated with chronic inflammation triggered by exposure to HBV and tumor antigens. T-cell exhaustion is implicated in immunosuppression of chronic infections and tumors. Although immunotherapies that enhance immune responses by targeting programmed cell death-1(PD-1)/PD-L1 are being applied to malignancies, these treatments have shown limited response rates, suggesting that additional inhibitory receptors are also involved in T-cell exhaustion and tumor outcome. Here, we analyzed peripheral blood samples and found that coexpression of PD-1 and T-cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif (ITIM) domain (TIGIT) was significantly upregulated on CD4+ and CD8+ T cells from patients with HBV-HCC compared with those from patients with chronic HBV or HBV-liver cirrhosis. Additionally, PD-1+ TIGIT+ CD8+ T-cell populations were elevated in patients with advanced stage and progressed HBV-HCC. Importantly, PD-1+ TIGIT+ CD8+ T-cell populations were negatively correlated with overall survival rate and progression-free survival rates. Moreover, we showed that PD-1+ TIGIT+ CD8+ T cells exhibit features of exhausted T cells, as manifested by excessive activation, high expression of other inhibitory receptors, high susceptibility to apoptosis, decreased capacity for cytokine secretion, and patterns of transcription factor expression consistent with exhaustion. In conclusion, PD-1+ TIGIT+ CD8+ T-cell populations are associated with accelerated disease progression and poor outcomes in HBV-HCC, which might not only have important clinical implications for prognosis but also provide a rationale for new targets in immunotherapy.


Assuntos
Linfócitos T CD8-Positivos/imunologia , Carcinoma Hepatocelular/imunologia , Vírus da Hepatite B/fisiologia , Hepatite B/imunologia , Neoplasias Hepáticas/imunologia , Adulto , Carcinogênese , Carcinoma Hepatocelular/mortalidade , Senescência Celular/genética , Feminino , Regulação Neoplásica da Expressão Gênica , Hepatite B/mortalidade , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Receptor de Morte Celular Programada 1/metabolismo , Estudos Prospectivos , Receptores Imunológicos/metabolismo , Análise de Sobrevida
8.
J Cancer ; 10(18): 4237-4244, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413742

RESUMO

Background and Aims: Although previous studies suggested that female patients who underwent curative resection in early-stage hepatocellular carcinoma (HCC) had better survival rates than male patients, it is unclear whether females in different HCC stages actually have survival advantage. This study aimed to investigate whether gender differences in the Barcelona Clinic Liver Cancer (BCLC) classification system contributed to different survival outcomes in hepatitis B virus (HBV)-related HCC. Methods: A retrospective analysis was performed of 1,753 patients diagnosed with HBV-related HCC between January 2008 and June 2017 at the Beijing Ditan hospital. The BCLC stages were classified into BCLC stage 0-B and BCLC stage C-D groups. Factors determining overall survival (OS) and progression-free survival (PFS) were analyzed via univariate and multivariate analysis using the Kaplan-Meier method and Cox proportional-hazards regression models. Results: The cohort consisted of 1,202 BCLC stage 0-B and 551 BCLC stage C-D HBV-related HCC patients. Gender was identified to be an independent risk factor for OS (HR = 0.617; 95% CI, 0.426-0.895; p = 0.011) and PFS (HR = 0.728; 95% CI, 0.558-0.950; p = 0.019) in BCLC stage 0-B HBV-related HCC patients. With respect to OS and PFS, there were significant differences between female and male patients only in BCLC stage 0-B, but not in BCLC stage C-D. The OS and PFS in BCLC stage 0-B for female patients was significantly greater than that for male patients (p = 0.0103, p = 0.0112). Tumor multiplicity and size were independent risk factors for female patients in BCLC stage 0-B, whereas tumor multiplicity, tumor size, HBV-DNA, hemoglobin, total bilirubin, and alpha-fetoprotein levels were independent risk factors for male patients in BCLC stage 0-B. Conclusions: Different outcomes in OS or PFS with respect to gender only exist in BCLC stage 0-B HBV-related HCC patients. Female patients have a better outcome than male patients in BCLC stage 0-B.

9.
Gastroenterol Rep (Oxf) ; 7(4): 250-257, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31413831

RESUMO

Background: Post-operative recurrence rates are high for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). This study aimed to explore the factors associated with post-operative 1-year recurrence rate in patients with HBV-related HCC who had a single small primary tumor (≤3 cm in diameter). Methods: This was a retrospective study of 203 (training cohort) and 64 (validation cohort) patients newly diagnosed with HBV-related HCC who had a single small primary tumor. The first year of post-operative follow-up was examined. Factors potentially associated with HCC recurrence were identified using Cox regression analyses. A model was constructed based on the factors identified and the prognostic value of the model was evaluated using receiver operating characteristic (ROC) curve analysis and calculation of the area under the ROC curve (AUC). Results: A history of alcoholism and serum levels of α-fetoprotein, total protein and γ-glutamyl transpeptidase (GGT) were independently associated with 1-year recurrence rate after surgery. A predictive model based on these four factors had an AUC of 0.711 (95% confidence interval, 0.643-0.772) in the training cohort and 0.727 (95% confidence interval, 0.601-0.831) in the validation cohort. The 1-year recurrence rate was significantly lower in the low-risk group than in the high-risk group in both the training cohort (17.0% vs. 49.5%, P < 0.001) and the validation cohort (43.2% vs. 74.1%, P = 0.031). Conclusion: A history of alcoholism and serum levels of α-fetoprotein, total protein and γ-glutamyl transpeptidase were independently associated with post-operative 1-year recurrence rate in patients with HBV-related HCC who had a single small primary tumor (≤3 cm in diameter).

10.
Phytomedicine ; 62: 152930, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31128485

RESUMO

BACKGROUND: Many patients with hepatocellular carcinoma (HCC) in Asian countries seek adjuvant therapy with traditional Chinese medicine (TCM). This study aims to explore the benefits of TCM therapy in the long-term survival of patients with hepatocellular carcinoma in China. PATIENTS AND METHODS: In total, 3483 patients with HCC admitted to the Beijing Ditan Hospital of Capital Medical University were enrolled in this study. We used 1:1 frequency matching by sex, age, diagnosis time, Barcelona Clinic Liver Cancer staging, and type of treatments to compare the TCM users (n = 526) and non-TCM users (n = 526). A Cox multivariate regression model was employed to evaluate the effects of TCM therapy on the HR value and Kaplan-Meier survival curve for mortality risk in HCC patients. A log-rank test was performed to analyze the effect of TCM therapy on the survival time of HCC patients. RESULTS: The Cox multivariate analysis indicated that TCM therapy was an independent protective factor for 5-year survival in patients with HCC (adjusted HR = 0.46, 95% CI 0.40-0.52, p < 0.0001). The Kaplan-Meier curve also showed that after PS matching, TCM users had a higher overall survival rate and a higher progression-free survival rate than non-TCM users. TCM users, regardless of the classification of etiology, tumor stage, liver function level, or type of treatment, all benefited significantly from TCM therapy. In addition, it was found that the most commonly used Chinese patent medications are Fufang Banmao Capsule, Huaier Granule, and Jinlong Capsule. CONCLUSION: Using traditional Chinese medications as adjuvant therapy can probably prolong median survival time and improve the overall survival among patients with HCC. Further scientific studies and clinical trials are needed to examine the efficiency and safety.


Assuntos
Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/mortalidade , Medicamentos de Ervas Chinesas/uso terapêutico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/mortalidade , Idoso , Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/patologia , China , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/patologia , Masculino , Medicina Tradicional Chinesa , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida
11.
Oncol Lett ; 17(1): 119-126, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30655746

RESUMO

The development of minimally invasive treatment over the last two decades has had a great impact on hepatitis B virus (HBV)-associated primary liver cancer. The model for end-stage liver disease (MELD) score is the optimal evaluated parameter for mortality in patients with end-stage liver disease. However, the association between MELD score and minimally invasive treatment with regard to the mortality of patients with HBV-associated hepatocellular carcinoma (HCC) with a portal vein tumor thrombus (PVTT) remains unclear. In the present study, a total of 173 patients who had been diagnosed with HBV-associated HCC and PVTT in the Beijing Ditan Hospital (Beijing, China), between January 2012 and January 2015, were screened. Follow-up was performed to observe the survival time and collect information on the demographic characteristics and associated clinical indicators present in the cohort. The patient's age, sex, laboratory parameters and the use of minimally invasive treatment were analyzed with SPSS 20.0 software. Independent risk factors for mortality were screened by Cox regression analysis. Logistic regression indicated that there was an interaction between the MELD score and minimally invasive treatment. In addition, a MELD score ≤17.85 was associated with a lower mortality rate subsequent to minimally invasive treatment.

12.
Drug Des Devel Ther ; 13: 221-230, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30643388

RESUMO

A systematic review and meta-analysis of previous randomized controlled trials of traditional Chinese medicine (TCM) supporting Qi and enriching blood in the treatment of cancer related anemia (CRA) in patients not receiving chemoradiotherapy were conducted. A total of 13 randomized controlled trials were included. Compared with the control group, better improvement was found for the level of hemoglobin (mean difference=4.57, 95% CI [1.38, 7.76], P=0.005) and overall therapeutic effect (risk ratio [RR]=1.31, 95% CI [1.18, 1.46], P<0.000) in the TCM groups. The incidence of related adverse events was not increased in the TCM groups (RR=0.54, 95% CI [0.29, 0.99], P=0.05). However, due to the relatively low quality and the small sample sizes of the included studies, the results should be interpreted with a degree of caution. Nevertheless, TCM with the role of supporting Qi and enriching blood may be a safe and effective treatment for CRA in patients not receiving chemoradiotherapy and might be considered as an alternative treatment to conventional western medicine including iron supplements and erythropoietin.


Assuntos
Anemia/tratamento farmacológico , Medicamentos de Ervas Chinesas/farmacologia , Medicamentos de Ervas Chinesas/uso terapêutico , Medicina Tradicional Chinesa , Neoplasias/sangue , Neoplasias/tratamento farmacológico , Qi , Anemia/sangue , Anemia/complicações , Medicamentos de Ervas Chinesas/química , Humanos , Neoplasias/complicações
13.
Medicine (Baltimore) ; 97(49): e13536, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30544459

RESUMO

Macroscopic vascular invasion cannot be properly predicted in advance in hepatocellular carcinoma patients based on clinical characteristics and imaging features.To develop a predictive scoring model of macroscopic vascular invasion in hepatocellular carcinoma patients after transcatheter arterial chemoembolization combined with radiofrequency ablation based on specific laboratory and tumor indicators.A predictive scoring model, which estimates the incidence of macroscopic vascular invasion at 1-year follow-up, was constructed based on a derivation cohort of 324 patients with hepatocellular carcinoma; a validation cohort of 120 patients was prospectively included. The prognostic value of the scoring model was determined by concordance index, time-dependent receiver operating characteristics, and calibration curves.Cox multivariate analysis of the derivation cohort identified prothrombin time, aspartate aminotransferase, and Barcelona clinic liver cancer (BCLC) staging as independent predictive factors of macroscopic vascular invasion. The areas under the receiver operating characteristic curves of the predictive scoring model were 0.832 and 0.785 in the derivation and validation cohorts, respectively, and the calibration curves fitted well. Kaplan-Meier analysis showed that the incidence of macroscopic vascular invasion was significantly higher in the high-risk group (score 0-2) than in the low-risk group (score 3-4) in both the derivation and validation cohorts (P < .0001 and P = .0008, respectively).The predictive scoring model enables the accurate prediction of macroscopic vascular invasion incidence 1 year in advance in hepatocellular carcinoma patients who undergo transcatheter arterial chemoembolization combined with radiofrequency ablation.


Assuntos
Carcinoma Hepatocelular/diagnóstico , Neoplasias Hepáticas/diagnóstico , Invasividade Neoplásica/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/fisiopatologia , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Feminino , Seguimentos , Humanos , Incidência , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/fisiopatologia , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Prognóstico , Ablação por Radiofrequência , Medição de Risco
14.
Lipids Health Dis ; 17(1): 248, 2018 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-30400953

RESUMO

BACKGROUND: The liver plays an important role in the metabolism of lipid and lipoprotein. Dyslipidemia has been demonstrated to be related with several cancers, but the association between serum lipid and hepatocellular carcinoma (HCC) in the absence of cirrhosis remains unclear. METHODS: A total of 2528 patients with HCC at the Beijing Ditan Hospital between February 2008 and December 2017 were retrospectively included in the study. We identified 200 patients with HCC without cirrhosis by histopathology, imaging, endoscopic findings, and laboratory tests. Multivariate regression analysis was performed to determine the independent characteristics associated with HCC without cirrhosis and its prognosis. RESULTS: In the logistics regression analysis, compared to patients with HCC with cirrhosis, patients with HCC without cirrhosis were more likely to have elevated triglyceride (TG) levels (OR = 2.66; 95% CI, 1.18-6.01; P = 0.019). The Kaplan-Meier analysis revealed that a lower TG level was a risk factor regardless of the presence of cirrhosis. The results of the Cox proportional hazard regression analysis showed that a decreased TG level was significantly related to a worse overall survival (HR = 0.51; 95% CI, 0.29-0.89; P = 0.017). CONCLUSION: Serum TG level may be an independent factor to predict the prognosis of patients with HCC in the absence of cirrhosis.


Assuntos
Carcinoma Hepatocelular/diagnóstico , Neoplasias Hepáticas/diagnóstico , Triglicerídeos/sangue , Adulto , Idoso , Carcinoma Hepatocelular/sangue , China , Feminino , Humanos , Estimativa de Kaplan-Meier , Cirrose Hepática , Neoplasias Hepáticas/sangue , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Fatores de Risco
15.
Oncol Lett ; 14(6): 7691-7698, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29250171

RESUMO

Previous studies have revealed that the deregulation of circulating miRNAs is associated with liver cirrhosis. The present study aimed to identify reliable candidate biomarkers to improve the early detection of liver cirrhosis. An integrated analysis of expression profiles of microRNAs (miRNAs/miRs) and mRNAs in liver cirrhosis tissues from the GEO database was performed. Next, the regulatory targets of the differentially expressed miRNAs in liver cirrhosis tissues were predicted. In addition, a regulatory network of miRNA-target genes was constructed. A total of 4 eligible mRNA expression profiling studies and 2 miRNA expression profiling studies met the inclusion criteria, and were thus included. A total of 48 differentially expressed miRNAs and 1,773 differentially expressed genes were identified in liver cirrhosis tissues compared with normal tissues. There were 240 miRNA-target pairs whose expression was negatively correlated. In the miRNA-target regulatory network, overexpression of miR-21 and miR-199a-3p was suggested to be closely associated with the progression of liver cirrhosis. In addition, functional enrichment analysis of the target genes indicated that cell cycle was the most significantly enriched pathway, and the dysregulation of leukemia inhibitory factor, cancerous inhibitor of protein phosphatase 2A and retinoblastoma-associated protein 1 clearly suggested their importance in the development of liver cirrhosis. We hypothesized that miR-21 and miR-199a-3p may be promising non-invasive diagnostic biomarkers for the early diagnosis of liver cirrhosis. The miRNA-target regulatory network may provide additional insight into the current data regarding the role of miRNAs in liver cirrhosis.

16.
Dis Markers ; 2017: 7075935, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28396612

RESUMO

Aim. To determine whether nucleot(s)ide analogs therapy has survival benefit for patients with HBV-related HCC after unresectable treatment. Method. A systematic search was conducted through seven electronic databases including PubMed, OVID, EMBASE, Cochrane Databases, Elsevier, Wiley Online Library, and BMJ Best Practice. All studies comparing NA combined with unresectable treatment versus unresectable treatment alone were considered for inclusion. The primary outcome was the overall survival (OS) after unresectable treatment for patients with HBV-related HCC. The secondary outcome was the progression-free survival (PFS). Results were expressed as hazard ratio (HR) for survival with 95% confidence intervals. Results. We included six studies with 994 patients: 409 patients in nucleot(s)ide analogs therapy group and 585 patients without antiviral therapy in control group. There were significant improvements for the overall survival (HR = 0.57; 95% CI = 0.47-0.70; p < 0.001) and progression-free survival (HR = 0.84; 95% CI = 0.71-0.99; p = 0.034) in the NA-treated group compared with the control group. Funnel plot showed that there was no significant publication bias in these studies. When it comes to antiviral drugs and operation method, it also showed benefit in NA-treated group. At the same time, overall mortality as well as mortality secondary to liver failure in NA-treated group was obviously lesser. Sensitivity analyses confirmed the robustness of the results. Conclusions. Nucleot(s)ide analogs therapy after unresectable treatment has potential beneficial effects in terms of overall survival and progression-free survival. NA therapy should be considered in clinical practice.


Assuntos
Antivirais/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Vírus da Hepatite B/efeitos dos fármacos , Hepatite B Crônica/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Adenina/análogos & derivados , Adenina/uso terapêutico , Arabinofuranosiluracila/análogos & derivados , Arabinofuranosiluracila/uso terapêutico , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/mortalidade , Guanina/análogos & derivados , Guanina/uso terapêutico , Vírus da Hepatite B/crescimento & desenvolvimento , Vírus da Hepatite B/patogenicidade , Hepatite B Crônica/complicações , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/mortalidade , Humanos , Lamivudina/uso terapêutico , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/mortalidade , Organofosfonatos/uso terapêutico , Estudos Retrospectivos , Análise de Sobrevida , Telbivudina , Tenofovir/uso terapêutico , Timidina/análogos & derivados , Timidina/uso terapêutico
17.
J Diabetes Res ; 2017: 3819502, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28154829

RESUMO

Aim. To establish a new score model to predict risk of death in patients with hepatocellular carcinoma and type 2 diabetes mellitus. Methods. This was a retrospective study of 147 patients with hepatocellular carcinoma and type 2 diabetes mellitus who came to Beijing Ditan Hospital between October 2008 and June 2013. Univariate and multivariate logistic regression analysis was performed to obtain the independent factors associated with death risk. A new score model was devised according to these factors. Results. A prediction score model composed of HbA1c, NLR, age, and CTP class was devised, which ranged from 0 to 7. AUROC of the score was 0.853 (P < 0.001, 95% CI: 0.791-0.915). Scores 0-2, 3-4, and 5-7 identified patients as low-, medium-, and high-risk categories. The cumulative survival rate was 93.6%, 83.0%, and 74.5% in the low-risk group in 1, 2, and 3 years, while it was 64.0%, 46.0%, and 26.0% in the medium-risk group, whereas it was 24.0%, 12.0%, and 6.0% in the high-risk group, respectively. The cumulative survival rate was significantly higher in the low-risk group than that in the medium-risk group and high-risk group (P < 0.001). Conclusion. The HbA1c-based score model can be used to predict death risk in patients with hepatocellular carcinoma and type 2 diabetes mellitus.


Assuntos
Carcinoma Hepatocelular/mortalidade , Diabetes Mellitus Tipo 2/mortalidade , Hemoglobina A Glicada/análise , Neoplasias Hepáticas/mortalidade , Idoso , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/complicações , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/complicações , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Prognóstico , Estudos Retrospectivos , Risco , Medição de Risco , Taxa de Sobrevida
18.
Eur J Gastroenterol Hepatol ; 29(6): 669-678, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28195876

RESUMO

AIM: The CANONIC study proposed the Chronic Liver Failure Consortium acute-on-chronic liver failure (CLIF-C ACLF) prognostic model at the European Association for the Study of the Liver-CLIF diagnosis. This study aimed to develop and validate a prognostic model for predicting the short-term mortality of hepatitis B virus (HBV) ACLF as defined by the Asia-Pacific Association for the Study of the Liver. PATIENTS AND METHODS: A retrospective cohort of 381 HBV ACLF patients and a prospective cohort of 192 patients were included in this study. Independent predictors of disease progression were determined using univariate and multivariate Cox proportional hazard regression analysis, and a regression model for predicting prognosis was established. Patient survival was estimated by Kaplan-Meier analysis and subsequently compared by log-rank tests. The area under the receiver operating characteristic curve was used to compare the performance of various current prognostic models. RESULTS: Our model was constructed with five independent risk factors: hepatic encephalopathy, international normalized ratio, neutrophil-lymphocyte ratio, age, and total bilirubin, termed as the HINAT ACLF model, which showed the strongest predictive values compared with CLIF-C ACLF, CLIF-C Organ Failure, Sequential Organ Failure Assessment, CLIF-Sequential Organ Failure Assessment, Model for End-stage Liver Disease, Model for End-stage Liver Disease-sodium, and Child-Turcotte-Pugh scores; this model reduced the corresponding prediction error rates at 28 and 90 days by 16.4-54.5% after ACLF diagnosis in both the derivation cohort and the validation cohorts. CONCLUSION: The HINAT ACLF model can accurately predict the short-term mortality of patients with HBV ACLF as defined by Asia-Pacific Association for the Study of the Liver.


Assuntos
Insuficiência Hepática Crônica Agudizada/diagnóstico , Insuficiência Hepática Crônica Agudizada/mortalidade , Técnicas de Apoio para a Decisão , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/mortalidade , Insuficiência Hepática Crônica Agudizada/virologia , Adulto , Área Sob a Curva , Distribuição de Qui-Quadrado , Feminino , Hepatite B Crônica/virologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Escores de Disfunção Orgânica , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
19.
PLoS One ; 12(2): e0170605, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28231294

RESUMO

BACKGROUND: The neutrophil-lymphocyte ratio (NLR) is a new prognostic predictor for patients with liver cancer. The association of NLR and T lymphocytes with the pathogenesis and progression of liver cancer is poorly understood. METHODS: Seventy-three patients with hepatitis B virus (HBV)-associated primary liver cancer (HBV-PLC), 50 patients with HBV-associated liver cirrhosis (HBV-LC) and 37 patients with chronic HBV infection (CHB) were prospectively enrolled from July 1, 2013 to February 28, 2014 in Beijing Ditan Hospital, Capital Medical University (Beijing, China). The NLR, proportions and concentrations of neutrophils and lymphocytes, concentration of subpopulations of lymphocytes, and the expression of CD31 (index for recent thymic output) and HLA-DR (index for activation of T lymphocytes) of T cells in the peripheral blood samples of the patients were assessed and statistically compared between different groups. RESULTS: The NLR was significantly increased from patients with CHB, those with HBV-LC to those with HBV-PLC (P<0.05), along with significant increase of neutrophils and decrease of lymphocytes in the same way (P<0.05). The concentrations of T lymphocytes, natural killer cells, B cells, CD4+ T cells and CD8+ T cells were decreased from patients with CHB, those with HBV-LC to those with HBV-PLC, and were significantly reduced in patients with HBV-PLC compared with those in patients with CHB (P<0.05). The CD31 and HLA-DR expression of naive CD4+ and CD8+ T cells was significantly decreased and increased, respectively in patients with HBV-PLC compared with that in patients with CHB. CONCLUSIONS: Elevated NLR, resulted from the increase of neutrophils and decrease of lymphocytes, is positively associated with the pathogenesis and progression of HBV-PLC. The reduced thymic output and hyperactivation of T lymphocytes may contribute to the decrease of T lymphocytes, which could be also related to the pathogenesis of HBV-PLC.


Assuntos
Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/sangue , Hepatite B Crônica/complicações , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/virologia , Neutrófilos/patologia , Linfócitos T/patologia , Adulto , Progressão da Doença , Feminino , Hepatite B Crônica/patologia , Hepatite B Crônica/virologia , Humanos , Contagem de Leucócitos , Cirrose Hepática/sangue , Cirrose Hepática/patologia , Cirrose Hepática/virologia , Neoplasias Hepáticas/patologia , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos/virologia , Prognóstico , Linfócitos T/virologia , Timo/patologia , Timo/virologia , Adulto Jovem
20.
Eur J Gastroenterol Hepatol ; 29(1): 1-9, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27749778

RESUMO

AIM: Hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) has significant morbidity and mortality. There is no standard approach for the management of HBV-related ACLF with nucleos(t)ide analogs. Our objective was to compare the short-term mortality between entecavir (ETV) and lamivudine (LAM) in patients with HBV-related ACLF. METHODS: We recruited 311 inpatients with HBV-related ACLF from December 2002 to January 2015. The patients were treated with ETV (n=143) or LAM (n=168). The primary endpoint was mortality rate at week 8. Virological and biochemical responses were also studied. RESULTS: By week 8, 53 (37.06%) patients in the ETV group and 57 (33.93%) patients in the LAM group died, and the two groups had similar mortality (P=0.414). Multivariate analysis showed that age, total bilirubin, international normalized ratio, and model for end-stage liver disease (MELD) score were independent factors for mortality at week 8. The best cut-off value of the MELD score was 24.5 for 8-week mortality. Twenty-nine of the 170 (17.06%) patients with MELD score less than 24.5 died at week 8, and the ETV and LAM groups had similar mortality (P=0.743). Eighty-one of the 141 (57.45%) patients with MELD score of at least 24.5 died at week 8 and the LAM group had lower mortality than the ETV group (P=0.018 at week 4; P=0.039 at week 8). Both groups showed similar virological and biochemical responses at 4 weeks. CONCLUSION: LAM reduces the 8-week mortality rate significantly in patients with HBV-related ACLF who had MELD score of at least 24.5.


Assuntos
Insuficiência Hepática Crônica Agudizada/tratamento farmacológico , Antivirais/uso terapêutico , Doença Hepática Terminal/tratamento farmacológico , Guanina/análogos & derivados , Hepatite B Crônica/tratamento farmacológico , Lamivudina/uso terapêutico , Insuficiência Hepática Crônica Agudizada/diagnóstico , Insuficiência Hepática Crônica Agudizada/mortalidade , Insuficiência Hepática Crônica Agudizada/virologia , Adulto , Antivirais/efeitos adversos , Técnicas de Apoio para a Decisão , Farmacorresistência Viral , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/mortalidade , Doença Hepática Terminal/virologia , Feminino , Guanina/efeitos adversos , Guanina/uso terapêutico , Hepatite B Crônica/complicações , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/mortalidade , Humanos , Estimativa de Kaplan-Meier , Lamivudina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA