Clinical features of acute-on-chronic liver failure induced by withdrawal of nucleos (t) ide analogues

Hu GaoFei; Li XiaoPeng; Wu ZhenPing; Mei Qing; Li Dan; Zhang WenYuan; Yu TingTing; Cheng Na; Zhang LunLi

doi:10.3969/j.issn.1001-5256.2017.07.023

Issue 7

Jul. 2017

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > Journal of Clinical Hepatology > 2017 > 33(7): 1320-1323

PDF( 226 KB)

Clinical features of acute-on-chronic liver failure induced by withdrawal of nucleos (t) ide analogues

DOI: 10.3969/j.issn.1001-5256.2017.07.023

Department of Infectious Diseases, The First Affiliated Hospital of Nanchang University & Jiangxi Key Laboratory of Liver Regenerative Medicine

Research funding:

Received Date: 2017-01-16
Published Date: 2017-07-20

Abstract

Abstract

Objective To investigate the clinical features of patients with hepatitis B virus-related acute-on-chronic liver failure (ACLF) induced by the withdrawal of nucleos (t) ide analogues (NAs) .Methods A retrospective analysis was performed for the clinical data of 865 patients who were admitted to The First Affiliated Hospital of Nanchang University from June 2014 to October 2016 and diagnosed with ACLF.Among these patients, 137 experienced ACLF induced by drug withdrawal (withdrawal group) and 728 experienced ACLF not induced by drug withdrawal (non-withdrawal group) .The type of antiviral drugs, duration of standard antiviral therapy, withdrawal way, time from withdrawal to the development of liver failure, monitoring after withdrawal, underlying liver diseases, and 30-day mortality after progression to ACLF were recorded in detail.The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Results Of all the 728 patients in the non-withdrawal group, 389 were cured or improved and 339 died or had no response.Of all the 137 patients in the withdrawal group, 69 had chronic viral hepatitis, among whom 40 were cured or improved and 29 died or had no response;68 had liver cirrhosis, among whom 16 were cured or improved and 52 died or had no response;there was a significant difference (χ2=16.81, P<0.001) 6="" 16="" 25="" 32="" 33="" 37="" 47="" 79="" 137="" .of="" all="" the="" patients="" in="" withdrawal="" before="" used="" adefovir="" lamivudine="" combined="" with="" and="" entecavir.of="" when="" they="" developed="" had="" a="" duration="" of="" drug="" 6-12="">12 months.Conclusion Improper withdrawal of NAs can easily induce ACLF.The changes in virologic parameters, liver function parameters, and liver imaging findings should be closely monitored for patients with hepatitis B within 6 months after withdrawal.Underlying liver diseases determine the development and prognosis of ACLF after withdrawal, and long-term standard antiviral therapy is of great importance in patients with liver cirrhosis.
- liver failure,
- hepatitis B virus,
- nucleosides,
- nucleotides

FullText(HTML)

References(17)

References

[1]Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:a 2015 update[J].J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[2]ZHAN DA, LIU H, CHEN XJ, et al.The clinical efficacy of telbivudine and adefovir ester combination therapy of hepatitis B patients with high viral loads[J].Int J Virol, 2016, 23 (1) :17-19. (in Chinese) 詹东昂, 刘华, 陈秀记, 等.替比夫定联用阿德福韦酯在高病毒载量乙肝患者中的应用效果[J].国际病毒学杂志, 2016, 23 (1) :17-19.

[3]ZHANG Y, YU YS, TANG ZH, et al.Clinical study of entecavir combined with kushenin improving the Th1/Th2 imbalance in patients with HBe Ag-positive chronic hepatitis B[J].Chin J Clin Pharmacol Ther, 2016, 21 (10) :1168-1172. (in Chinese) 张毅, 余永胜, 汤正好, 等.恩替卡韦联合苦参素改善HBe Ag阳性慢性乙型肝炎患者Th1/Th2失平衡临床研究[J].中国临床药理学与治疗学, 2016, 21 (10) :1168-1172.

[4] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, CMA;Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, CMA.Guideline for diagnosis and treatment of liver failure (2012 version) [J].Chin J Clin Infect Dis, 2012, 5 (6) :321-327. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝治疗组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南 (2012年版) [J].中华临床感染病杂志, 2012, 5 (6) :321-327.

[5]FENG H, HE GP.The study of the compliance of patients with chronic hepatitis B and influence factors[J].Chin J Nurs, 2005, 40 (12) :891-894. (in Chinese) 冯辉, 何国平.慢性乙型病毒性肝炎患者治疗依从性及其影响因素分析[J].中华护理杂志, 2005, 40 (12) :891-894.

[6]SHOUVAL D, LAI CL, CHANG TT, et al.Relapse of hepatitis B in HBe Ag-negative chronic hepatitis B patients who discontinued successful entecavir treatment:the case for continuous antiviral therapy[J].J Hepatol, 2008, 50 (2) :289-295.

[7]HADZIYANNIS SJ, TASSOPOULOS NC, HEATHCOTE EJ, et al.Long-term therapy with adefovirdipivoxil for HBe Ag-negative chronic hepatitis B[J].N Eng J Med, 2005, 352 (26) :2673-2681.

[8]LIU XY, CHEN J, XIAO L, et al.Clinical features of HBV-associated acute-on-chronic liver failure induced by discontinuation of nucleoside analogues[J].J Clin Hepatol, 2016, 32 (9) :1766-1769. (in Chinese) 刘晓燕, 陈婧, 肖珑, 等.停用核苷和核苷酸类药物诱发HBV相关慢加急性肝衰竭患者的临床特点分析[J].临床肝胆病杂志, 2016, 32 (9) :1766-1769.

[9] LI XP, LEI W, ZHANG LL, et al.The clinical significance of stop using nucleotide (acid) antiviral drugs ininduced factors of severe hepatitis[C].The 16th national congress of viral hepatitis and liver disease in China, 2013. (in Chinese) 李小鹏, 雷湾, 张伦理, 等.停用核苷 (酸) 类抗病毒药物在重型肝炎诱发因素中的临床意义[C].中华医学会第十六次全国病毒性肝炎及肝病学术会议论文汇编, 2013.

[10]PHILLIPS S, CHOKSHI S, RIVA A, et al.CD8 (+) T cell control of hepatitis B virus replication:direct comparison between cytolytic and noncytolyticfunctions[J].J Immunol, 2010, 184 (1) :287-295.

[11]BONI C, LACCABUE D, LAMPERTICO P, et al.Restored function of HBV-specific T cells afterlong-term effective therapy with nucleos (t) ide analogues[J].Gastroenterology, 2012, 143 (4) :963-973, e969.

[12]LIU BX, ZHANG LL, ZHANG WF.Changes of hepatitis B core antigen-specific cytotoxic T lymphocytes in chronic hepatitis B patients during antiviral treatment and relapse after withdrawal of treatment[J].Chin J Infect Dis, 2016, 34 (8) :480-484. (in Chinese) 刘碧霞, 张伦理, 张文峰.慢性乙型肝炎患者抗病毒治疗与停药复发后体内乙型肝炎核心抗原特异性T淋巴细胞变化[J].中华传染病杂志, 2016, 34 (8) :480-484.

[13]SEEGER C, MASON WS.Molecular biology of hepatitis B virus infection[J].Virology, 2015, 479-480:672-686.

[14]LIU BX, ZHANG LL, LI XP, et al.Curative effect of chronic hepatitis B second treatment with entecavir when non-standarded stopantiviral therapy[J].Guangdong Med J, 2015, 36 (8) :1263-1265. (in Chinese) 刘碧霞, 张伦理, 李小鹏, 等.慢性乙型肝炎不规范停用恩替卡韦复发后再次恩替卡韦治疗的效果[J].广东医学, 2015, 36 (8) :1263-1265.

[15]TSOCHATZIS EA, BOSCH J, BURRROUGHS AK.Liver cirrhosis[J].Lancet, 2014, 383 (9930) :1749-1761.

[16]WU GC, ZHOU WP, ZHAO YR, et al.A study on the long-term outcome of hepatitis B e antigen-negative chronic hepatitis B compared with that of hepatitis B e antigen-positive chronic hepatitis B[J].Chin J Infect Dis, 2007, 25 (3) :166-168. (in Chinese) 巫贵成, 周卫平, 赵有蓉, 等.乙型肝炎e抗原阴性和阳性慢性乙型肝炎患者临床转归的回顾性分析[J].中华传染病杂志, 2007, 25 (3) :166-168.

[17]KANG W, PARK JY.When to stop nucleos (t) ide analogues treatment for chronic hepatitis B?Durability of antiviral response[J].World J Gastroenterol, 2014, 20 (23) :7207-7212.

Relative Articles

[1]	Jinyuan TANG, Chenfenglin YANG, Dongle LIANG, Yuhao LUO. Role of exosomes in intrahepatic cholangiocarcinoma[J]. Journal of Clinical Hepatology, 2024, 40(1): 181-186. doi: 10.12449/JCH240130
[2]	Yuanpeng MAO, Zhe YU, Aqian SONG, Hongshan WEI. From viral hepatitis to hepatocellular carcinoma: The role of exosomal microRNAs[J]. Journal of Clinical Hepatology, 2023, 39(2): 439-443. doi: 10.3969/j.issn.1001-5256.2023.02.030
[3]	Shuyang ZHANG, Yanzhen BI, Shousheng LIU, Sheng LIU, Yongning XIN. Differentially expressed microRNAs in plasma exosomes from patients with chronic hepatitis B or hepatitis B virus-related acute-on-chronic liver failure: A bioinformatics analysis[J]. Journal of Clinical Hepatology, 2023, 39(8): 1848-1856. doi: 10.3969/j.issn.1001-5256.2023.08.013
[4]	Xuemei DING, Shilun WU, Wenbing SUN. Value of preoperative microRNA-192 in peripheral blood mononuclear cells in predicting microvascular invasion of solitary hepatocellular carcinoma[J]. Journal of Clinical Hepatology, 2021, 37(5): 1121-1125. doi: 10.3969/j.issn.1001-5256.2021.05.028
[5]	Sheng CHEN, Guoxiang CHEN, Zhongming HE, Shujie CHENG, Jisen ZHAO. Role of miRNA in the development and progression of cholangiocarcinoma[J]. Journal of Clinical Hepatology, 2021, 37(9): 2241-2245. doi: 10.3969/j.issn.1001-5256.2021.09.048
[6]	Xiuhong HUANG, Xiaoli XIE, Huiqing JIANG. Value of a microRNA risk score model in predicting the prognosis of hepatocellular carcinoma[J]. Journal of Clinical Hepatology, 2021, 37(5): 1110-1115. doi: 10.3969/j.issn.1001-5256.2021.05.026
[7]	Nannan QIAN, Lulu TANG, Taohua WEI, Yue YANG, Wenjie HAO, Wenming YANG. Role and mechanism of exosome non-coding RNA in liver fibrosis[J]. Journal of Clinical Hepatology, 2021, 37(10): 2429-2434. doi: 10.3969/j.issn.1001-5256.2021.10.036
[8]	Jianheng HAO, Zhencheng LI, Ying LIU, Yiwen HOU, Yan GAO, Yuchuan MIAO, Yang LIU, Huiqin HAO. A functional analysis of differentially expressed microRNAs involved in liver injury in mice with autoimmune hepatitis induced by concanavalin A[J]. Journal of Clinical Hepatology, 2021, 37(6): 1360-1367. doi: 10.3969/j.issn.1001-5256.2021.06.028
[9]	Yan JIAO, Ying ZHANG, Honglin SHI, Wang LU, Dexi CHEN, Yu CHEN, Hongbo SHI. A bioinformatics analysis of differentially expressed proteins in plasma exosome of acute-on-chronic liver failure patients with different prognoses[J]. Journal of Clinical Hepatology, 2021, 37(4): 834-840. doi: 10.3969/j.issn.1001-5256.2021.04.022
[10]	Yao YunTing, Zhou YuanZhong, Liu Jun. Role of exosomes in hepatocellular carcinoma[J]. Journal of Clinical Hepatology, 2020, 36(10): 2333-2339. doi: 10.3969/j.issn.1001-5256.2020.10.038
[11]	Wu JunYi, Lai ZhiDe, Tian YiFeng, Wang YaoDong. Expression and clinical significance of serum exosomal microRNA-221-3p in hepatocellular carcinoma[J]. Journal of Clinical Hepatology, 2020, 36(8): 1768-1772. doi: 10.3969/j.issn.1001-5256.2020.08.018
[12]	Zhang ShiWan, Yu XueQin, Chen Fang, Mei YiHan, Mei XiaoPing. Biological characteristics of exosome microRNA and its role in the development and progression of liver fibrosis[J]. Journal of Clinical Hepatology, 2020, 36(9): 2083-2086. doi: 10.3969/j.issn.1001-5256.2020.09.039
[13]	Jia XiaoFang, Chu QiaoFang, Yuan ZhengHong. Association of exosomes with viral infection and hepatitis B virus-related liver diseases[J]. Journal of Clinical Hepatology, 2017, 33(8): 1465-1470. doi: 10.3969/j.issn.1001-5256.2017.08.010
[14]	Zhang ZhuQing, Lu ShuMing, Wang HuaLi, Xu MengYao, Li ChunYan, Xin Yue, Zhao JunJun. Expression of microRNA-222 in hepatocellular carcinoma tissue and its clinical significance[J]. Journal of Clinical Hepatology, 2017, 33(8): 1502-1505. doi: 10.3969/j.issn.1001-5256.2017.08.018
[15]	Wu JunCheng, Xu MingYi. Research advances in the association between exosomes and liver diseases[J]. Journal of Clinical Hepatology, 2017, 33(9): 1815-1819. doi: 10.3969/j.issn.1001-5256.2017.09.042
[16]	Wang QingLan, Tao YanYan, Lu: Jing, Liu Ping, Liu ChengHai. Antifibrotic mechanism of Fuzheng Huayu prescription by regulation of the differential expression of microRNAs in mouse liver[J]. Journal of Clinical Hepatology, 2016, 32(3): 503-508. doi: 10.3969/j.issn.1001-5256.2016.03.022
[17]	Lin Kun, Ci DanWangJiu, Chang ZhiHui, Liu ZhaoYu. Clinical value of circulating micro RNAs in hepatic,biliary and pancreatic carcinomas[J]. Journal of Clinical Hepatology, 2015, 31(5): 790-795. doi: 10.3969/j.issn.1001-5256.2015.05.040
[18]	Li Qiang, Zhuo QiBin, Huang YuXian, Chen Liang. Diagnosis and treatment of hepatocellular carcinoma from a new perspective of miRNAs[J]. Journal of Clinical Hepatology, 2015, 31(6): 977-981. doi: 10.3969/j.issn.1001-5256.2015.06.037
[19]	Hu XueLing, Fan GongRen. Functional role of microRNAs in viral hepatitis infections[J]. Journal of Clinical Hepatology, 2012, 28(11): 877-880.
[20]	Shi WeiMin, Shen YuYing. Investigation on influences of the changes of endotoxin in the bile on hepatic injury[J]. Journal of Clinical Hepatology, 2007, 23(2): 105-106.

Supplements(0)

Cited By

Cited by

Periodical cited type(9)

1.	张芸，蔡欣奕，丁靖诺，陆圣威，陈萃英，吴婷婷，张军利，赵卫峰. 寡糖链、甲胎蛋白对乙型肝炎病毒相关肝细胞癌风险筛查与诊断价值研究. 中国全科医学. 2024(15): 1855-1860 .
2.	杨晨，朱帆东，夏阳，楼天奇，张敏鸣，赵振华. MRI多模态影像组学鉴别肝细胞肝癌与肝富血供良性病变的应用价值. 放射学实践. 2023(05): 581-586 .
3.	唐宇雁，谢仕斌，朱建芸. 甲胎蛋白和甲胎蛋白异质体比率（AFP-L3%）对HBV相关早期肝细胞癌的诊断效能分析. 临床肝胆病杂志. 2023(11): 2607-2613 . 本站查看
4.	钟雪娇，郑腊梅，魏闯. 超声引导肋间神经阻滞用于腹腔镜肝部分切除术镇痛效果研究. 重庆医学. 2022(01): 45-49 .
5.	吴鸿淞，韦朋余，李登辉，杨振宇，杜锡林. 甲胎蛋白检测肝细胞肝癌的临床应用价值. 检验医学与临床. 2021(12): 1809-1811+1824 .
6.	叶秀娟. 血清AFP、CEA和CA125在原发性肝癌中的表达及其联合诊断价值分析. 吉林医学. 2021(09): 2234-2235 .
7.	朱学彤，王凯瑾，周琪，许建成. 长春地区成人血清甲胎蛋白、癌胚抗原参考区间适用性验证. 临床肝胆病杂志. 2020(02): 369-371 . 本站查看
8.	周宇辰，袁国盛，胡承光，刘俊维，任彦瑜，唐淬蓉，于乐成，杨定华. 降低AFP诊断阈值并联合检测DCP显著提高肝细胞癌的诊断率. 肝脏. 2019(05): 507-509+518 .
9.	李政霖，侯雪晶，漆栋梁，白建荣，杨艳慧，杨丽俊，杨忠霞. 血清学指标在原发性肝癌临床诊断中的应用价值. 国际流行病学传染病学杂志. 2019(06): 495-499 .

Other cited types(7)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Get Citation

PDF

XML

Article Metrics

Article views (577) PDF downloads(98)

Clinical features of acute-on-chronic liver failure induced by withdrawal of nucleos (t) ide analogues

DOI: 10.3969/j.issn.1001-5256.2017.07.023