Idiopathic portal hypertension associated with POEMS syndrome mimicking liver cirrhosis in a patient with chronic HBV infection

Abstract Objective To study the mutual relationship between anti-HBx and IL-10, IL-12 or soluble Fas (sFas) in sera of patients with chronic HBV infection and to explore the importance of anti-HBx detection as well as its role in the development of chronic HBV infection. Methods Total of 90 cases with chronic HBV infection were randomly selected, including 10 of asymptomatic carriers (ASC), 28 of chronic hepatitis B (CHB), 26 of liver cirrhosis (LC) and 26 patients of hepatocellular carcinoma (HCC). Their clinical data and blood samples were collected, and serum was prepared and stored at -73℃. Anti-HBx was detected with an indirect ELISA established in our earlier research, and levels of IL-10, IL-12 and Fas were determined with commercial double-antibody sandwich ELISA kits. The mutual relationship between anti-HBx and IL-10, IL-12 or sFas in serum were analyzed with the software SPSS 20.0. Results All levels of IL-10, IL-12 and sFas in peripheral blood showed a rising trend with development of chronic HBV infection. The levels of IL-10 in ASC, CHB, LC and HCC groups were 13.93 ± 14.40 ng/L, 39.38 ± 20.77 ng/L, 69.06 ± 46.37 ng/L and 62.82 ± 23.42 ng/L, respectively, levels of IL-12 in the 4 groups were 15.64 ± 23.04 ng/L, 68.50 ± 23.14 ng/L, 76.83 ± 12.82 ng/L and 83.74 ± 24.88 ng/L, respectively, and levels of sFas were 58.17 ± 77.42 ng/L, 179.88 ± 104.36 ng/L, 249.22 ± 107.80 ng/L and 252.98 ± 87.65 ng/L, respectively. Twenty-seven out of 90 patients showed a positive result for anti-HBx detection, including 1 in ASC, 4 in CHB, 12 in LC and 10 in HCC group. The levels of IL-10, IL-12 and sFas were higher in anti-HBx positive group than in negative group. Statistical analysis demonstrated significant differences of IL-10 and IL-12 between the two groups (P < 0.05), but the differences of sFas had no statistical significance (P = 0.094). Conclusions Anti-HBx antibody is not protective, and is closely related to IL-10, IL-12 and sFas. It may be an important serum indicator for aggravation from chronic hepatitis B to liver cirrhosis or hepatocellular carcinoma in patients with chronic HBV infection.

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Screening for chronic hepatitis B and C in migrants from Afghanistan, Iran, Iraq, the former Soviet Republics, and Vietnam in the Arnhem region, The Netherlands

Epidemiology and Infection ◽

10.1017/s0950268813003415 ◽

2014 ◽

Vol 142 (10) ◽

pp. 2140-2146 ◽

Cited By ~ 23

Author(s):

C. RICHTER ◽

G. TER BEEST ◽

E. H. GISOLF ◽

P. VAN BENTUM ◽

C. WAEGEMAEKERS ◽

...

Keyword(s):

Liver Cirrhosis ◽

Hepatitis B ◽

Risk Groups ◽

Hbv Infection ◽

Chronic Hbv Infection ◽

Increased Risk ◽

Chronic Hbv ◽

First Generation Migrants ◽

Chronic Hcv ◽

Former Soviet Republics

SUMMARYMigrants born in hepatitis B virus (HBV) and hepatitis C virus (HCV) endemic countries are at increased risk of being infected with these viruses. The first symptoms may arise when liver damage has already occurred. The challenge is to identify these infections early, since effective treatment has become available. In 2011 we conducted a screening project in first-generation migrants (FGMs) born in Afghanistan, Iran, Iraq, the former Soviet Republics, and Vietnam and living in Arnhem and Rheden. All participants were offered free blood screening for HBV and HCV. In total 959 participants were tested, with the country of origin known for 927, equating to 28·7% of all registered FGMs from the chosen countries. Nineteen percent (n = 176) had serological signs of past or chronic HBV infection and 2·2% (n = 21) had chronic HBV infection. The highest prevalence of chronic HBV infection was found in the Vietnamese population (9·5%, n = 12). Chronic HCV was found in two persons from the former Soviet Republics and one from Vietnam. Twenty-four percent (n = 5) of the newly identified patients with chronic HBV and one of the three patients with chronic HCV received treatment. Three of the patients, two with HCV and one with HBV, already had liver cirrhosis. The highest (9·5%) HBV prevalence was found in FGMs from Vietnam, indicating a high need for focusing on that particular immigrant population in order to identify more people with silent HBV infection. The fact that three patients already had liver cirrhosis underlines the necessity of early identification of HBV and HCV infection in risk groups.

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HBsAg level as a predictor of disease activity in patients with chronic hepatitis B infection with delta-agent

Infekcionnye bolezni ◽

10.20953/1729-9225-2020-4-149-152 ◽

2020 ◽

Vol 18 (4) ◽

pp. 149-152

Author(s):

M.A. Abdukadyrova ◽

◽

S.M. Sharapov ◽

A.S. Khikmatullaeva ◽

◽

...

Keyword(s):

Liver Cirrhosis ◽

Chronic Hepatitis ◽

Hepatitis B ◽

Disease Activity ◽

Chronic Hepatitis B ◽

Hbv Dna ◽

Hbv Infection ◽

Hbsag Level ◽

Chronic Hbv Infection ◽

Chronic Hbv

We have conducted a pilot study to identify the association between the HBsAg level and activity of the pathological process in the liver, as well as possibility of quantitative assessment of HBsAg for monitoring chronic liver diseases caused by hepatitis B virus (HBV) and hepatitis D virus (HDV). Objective. To assess the possibility of using HBsAg levels as a predictor of disease activity and prognosis in patients with chronic HBV infection with delta-agent. Patients and methods. We analyzed serum specimens from 30 patients with HDV and HBV co-infection. Among 15 patients with chronic hepatitis B with delta-agent, there were 5 HBV DNA positive and 10 HBV DNA negative. Among patients with liver cirrhosis, HBV DNA was detected in 11 individuals, while 4 individuals had undetectable HBV DNA levels. Results. We found that mean HBsAg level in patients with chronic HBV infection and negative HBV DNA was 1.9 ± 0.56 IU/mL. Mean HBsAg level in patients with chronic HBV infection with delta-agent and positive HBV DNA was 4.3 ± 0.62 IU/mL (p < 0.05). High HBsAg levels correlated with elevated ALT in patients with chronic hepatitis B and delta-agent. Patients with liver cirrhosis caused by HDV had normal ALT levels, but elevated bilirubin concentrations regardless of HBV DNA presence and HBsAg level. Conclusion. High levels of HBsAg can be considered as a predictor of active disease in patients with chronic HBV infection with delta-agent and also a marker of transformation of chronic hepatitis B with delta-agent into liver cirrhosis. Key words: chronic hepatitis B with delta agent, liver cirrhosis, enzyme-linked immunosorbent assay, HBsAg levels, polymerase chain reaction

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Correlation Between Liver Cirrhosis and Risk of Cardiac Arrhythmias

Revista de Chimie ◽

10.37358/rc.18.6.6361 ◽

2018 ◽

Vol 69 (6) ◽

pp. 1527-1532

Author(s):

Veronica Calborean ◽

Silvia Alina Miscoci ◽

Octavian Istratoaie ◽

Oana Galceava ◽

Dragos Ovidiu Alexandru ◽

...

Keyword(s):

Atrial Fibrillation ◽

Liver Cirrhosis ◽

Cardiac Arrhythmias ◽

Hcv Infection ◽

Hbv Infection ◽

Alcoholic Liver Cirrhosis ◽

Chronic Hbv Infection ◽

Chronic Hcv Infection ◽

Chronic Hbv ◽

Chronic Hcv

There are few studies analyzing the correlation between liver cirrhosis and cardiac arrhythmias. Still, factors triggering cardiac arrhythmias occur in many instances in liver cirrhosis.We studied a cohort with patientsdiagnosed with liver cirrhosis hospitalized to Cardiology Department, to the County Hospital of Craiova, between January 2017 and January 2018. We wanted to study the frequency of cardiac arrhythmias at the patients diagnosed with liver cirrhosis and also to evaluate several associated factors.The frequency of cardiac arrhythmias in the presence of risk factors was analysed using x2 test and statistical models.We analized multiple variable including demographics and clinical and biochemical characteristics, frequency of type of arrhythmias and evaluation of the associated factors like diabetes mellitus, hypertension, hypercholesterolemia, hypertriglyceridemia ,hyper/hypokalemia and hyper/hyponatremia. From our group, after exclusion criteria, we have a total of 34 patients with alcoholic liver cirrhosis, 37 patients with chronic HCV infection and 36 patients with HBV infection. From 34 patients with alcoholic liver cirrhosis, 23 patients presented atrial fibrillation(67.65%), from 37 patients with chronic HCV infection 21 were diagnosed with atrial fibrillation(56.76%) and from the patients with HBV infection 19 patients were known with atrial fibrillation(52.78%).We have encounter atrial flutter at 2 patients (5.56%) with chronic HBV infection. Atrial extrasystole was found at 7 patients with chronic HBV infection (19.44%), 4 patients with chronic HCV infection (10.81%) and 1 patients with alcoholic liver cirrhosis (2.94%). Ventricular extrasystole was found at 12 patients with chronic HBV infection (33.33%), 3 patients with chronic HCV infection (8.11%) and 5 patients with alcoholic liver cirrhosis (14.71%).We have also correlate the arrhythmias with different biochemical variables from our cohort. In our study there were many association between hepatic cirrhosis and cardiac abnormalities, which is concordant to reports from literature. Compared to population without liver cirrhosis, the prevalence of arrhythmias was increased in our cohort.

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Association between liver cirrhosis and estimated glomerular filtration rates in patients with chronic HBV infection

Medicine ◽

10.1097/md.0000000000021387 ◽

2020 ◽

Vol 99 (33) ◽

pp. e21387

Author(s):

Dexin Wang ◽

Xiuping Yan ◽

Min Zhang ◽

Cuicui Ren ◽

Lili Wang ◽

...

Keyword(s):

Liver Cirrhosis ◽

Glomerular Filtration ◽

Hbv Infection ◽

Chronic Hbv Infection ◽

Chronic Hbv ◽

Estimated Glomerular Filtration Rates

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The Potential of Serum IFN-γ for Determining the Progression of Chronic Hepatitis B

The Indonesian Journal of Gastroenterology Hepatology and Digestive Endoscopy ◽

10.24871/2232021210-216 ◽

2022 ◽

Vol 22 (3) ◽

pp. 210-216

Author(s):

Tri Nugraha Susilawati ◽

Winda Rahayuningtyas ◽

Triyanta Yuli Pramana

Keyword(s):

Liver Cirrhosis ◽

Chronic Hepatitis ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Hbv Infection ◽

Provisional Diagnosis ◽

Chronic Hbv Infection ◽

Tnf Α ◽

Ifn Γ ◽

Chronic Hbv

Background: A persistent infection of hepatitis B virus (HBV) can cause liver cirrhosis and hepatocarcinoma even though the virus itself is non-cytopathic and does not cause cell injury. It has been asserted that liver injury in chronic HBV infection is attributed to the host immune system responding to HBV infection. Cytokines have a critical role in mediating immune responses to viral infection. This study aimed to determine the correlation between the levels of serum IFN-γ, IL-2, IL-17, and TNF- α with the progress of chronic HBV infection that was determined through provisional diagnosis, patient’s age, and the levels of serum transaminases.Method: Blood samples were collected from patients with chronic hepatitis B and the levels of serum IFN-γ, IL-2, IL-17, and TNF-α were measured by using ELISA. The correlation between each cytokine levels and the provisional diagnosis, patient’s age, and serum transaminases were analyzed by using the Spearman correlation test with a p value of 0.05 is considered as statistically significant.Results: A total of 47 samples were collected from patients with chronic hepatitis B (n=38), chronic hepatitis B with liver cirrhosis (n = 6), and chronic hepatitis B with hepatocellular carcinoma (nc = 3). A significant correlation was found between the levels of serum IFN-γ and aspartate aminotransferase (AST) (p = 0.04).Conclusion: The increase of serum IFN-γ and AST levels may highlight the importance of these particular cytokine and liver transaminase in the immune response to chronic HBV infection since IFN-γ is capable to induce apoptotic cell death which promotes AST release and facilitates liver injury.

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Levels and Significance of Serum Adiponectin in Patients with Chronic HBV Infection at Different Clinical Stages

E3S Web of Conferences ◽

10.1051/e3sconf/202018503008 ◽

2020 ◽

Vol 185 ◽

pp. 03008

Author(s):

Bei Liu

Keyword(s):

Liver Cirrhosis ◽

Clinical Laboratory ◽

High Serum ◽

Hbv Infection ◽

Control Group ◽

Chronic Hbv Infection ◽

Compensated Cirrhosis ◽

Significant Difference ◽

Clinical Stages ◽

Chronic Hbv

To analyze the serum APN levels of patients with chronic HBV infection in different clinical stages and their correlation with clinical laboratory examination indicators. A total of 120 HBV-infected patients are included in this study, including chronic HBV carriers, chronic hepatitis B (CHB) and compensated cirrhosis patients, 40 cases in each group, and 40 medical examinees as healthy controls. Compared with the healthy control group, the APN level in the chronic HBV infection group is significantly increased (p<0.05), and the APN level in the cirrhosis group is significantly increased compared with the other two groups (p<0.05). There is no significant difference between the chronic HBV carrier group and the CHB group. The ratio of people with high APN in the high DNA viral load group is higher (p = 0.002, χ2 = 9.143); the APN level of the liver cirrhosis group is significantly different from the non-cirrhosis group (P = 0.004, χ2 = 8.123). There is no significant correlation between APN level and ALT, AST and other indicators (P>, 0.05). High serum APN may be used as a marker for the diagnosis of HBV-infected liver cirrhosis.

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Recombinant Human Thrombopoietin Increases Platelet Numbers and Reduces the Risk of Bleeding Events in Thrombocytopenic Patients with Chronic Hepatitis B Virus Infection: A Multicenter Observational Study

Blood ◽

10.1182/blood-2018-99-116000 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 4990-4990

Author(s):

Wan-Yi Zhai ◽

Ru Feng ◽

Xiao-Lu Zhu ◽

Yun He ◽

Hai-Xia Fu ◽

...

Keyword(s):

Liver Cirrhosis ◽

Adverse Events ◽

Hbv Infection ◽

Bleeding Events ◽

Chronic Hbv Infection ◽

Platelet Counts ◽

Risk Of Bleeding ◽

B Virus ◽

Chronic Hbv ◽

Methods Of Treatment

Abstract Introduction Hepatitis B virus (HBV) is a widespread virus that severely affects people's health, especially in China. HBV has infected over 400 million people worldwide (Liaw YF et al, Lancet, 2009), of which 93 million are Chinese (Hou J.L. et al, 2015). People infected with hepatitis B virus may develop chronic HBV infection, leading to a high risk of liver cirrhosis or hepatocellular carcinoma. Thrombocytopenia can be observed in patients with chronic HBV infection, especially in patients with liver cirrhosis. Thrombocytopenia plays a key role in thrombin generation and possibly bleeding tendencies in patients with chronic HBV infection. Those patients are at a higher risk of bleeding comparing to the patients without thrombocytopenia, which may lead to a higher mortality. However, its pathogenesis is considered to be complicated and remains poorly understood. Currently, there are not many effective treatments for chronic HBV infection patients with concomitant thrombocytopenia. Moreover, due to the invasiveness of procedures or inadequate effectiveness, the current treatments still have limited applications. Recombinant human thrombopoietin (rh-TPO) can promote megakaryocyte development and platelet production, resulting in an elevation in platelet counts both in vitro and in vivo, though there is still no information available for its effect in chronic HBV infection patients with concomitant thrombocytopenia. Methods The aim of the study is to explore the effectiveness and safety of rh-TPO in the treatment of thrombocytopenia in patients with chronic HBV infection. This was a multicenter, observational study conducted in China between January 2003 and May 2018. Patients with chronic HBV infection (defined as seropositive for HBV surface antigen (HBsAg) for more than 6 months and/or had serum HBV DNA levels greater than 500 copies/ml) accompanied with thrombocytopenia (defined as a platelet count of <100 000 per cubic millimeter) were enrolled and divided into 2 groups by the occurrence of liver cirrhosis. Each patient received nucleoside analog (NA) alone treatment, or NA plus prednisone or NA plus rh-TPO treatment. Platelet counts, occurrence of bleeding events and adverse events were evaluated before and after treatment. Results Through our research, we have noticed that among patients with chronic HBV infection associated thrombocytopenia, patients with liver cirrhosis had significantly lower platelet counts compared to those without liver cirrhosis, especially in cirrhotic patients with splenomegaly. After treatment, patients treated with NA plus prednisone and patients treated with NA plus rh-TPO had significantly higher platelet count elevations than those treated with NA alone, respectively. Chronic HBV infection patients with liver cirrhosis reacted superior to both prednisone and rh-TPO treatment compared to patients without liver cirrhosis, especially in those without splenomegaly. During the observations before and after treatment, fewer bleeding events were observed in patients treated with rh-TPO or prednisone, compared to the NA alone group. No severe bleeding events occurred during the treatment. 22 variables considered relevant to the presence of bleeding events were tested using univariate analysis. The platelet counts, prothrombin time (PT), prothrombin activity (PTA) and methods of treatment were significantly associated with bleeding events. The platelet counts, and methods of treatment were risk factors associated with bleeding events in multivariate analysis. The adverse events among patients receiving different methods of treatment were mild and balanced. Liver function and HBV replication were not worsened after treatment. No severe adverse events were observed during the treatment with rh-TPO, and no patients stopped treatment due to adverse events during the observation. Conclusion Treatment with rh-TPO could elevate the platelet counts and reduce the risk of bleeding events in chronic HBV infection patients with thrombocytopenia. The treatment with rh-TPO was more effective in patients with liver cirrhosis, especially in those without splenomegaly. No severe adverse events were observed during rh-TPO treatment, proving the safety of rh-TPO in the use of treatment in chronic HBV infection associated thrombocytopenia. Disclosures No relevant conflicts of interest to declare.

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