Comparison Of Clinical Characteristics Between HBeAg-negative And HBeAg-positive Patients With Cirrhosis And Forecast Research Of EV

[Background]Liver cirrhosis is a common disease globally. But there is no precise data to reflect the morbility of liver cirrhosis for each country and region till now. In addition, no exact statistics is available in our countries. In 2001, Huber reported that the death rate in German is 500 to 800 per 100 thousand people. In 2005,Naveau reported that the death rate in France is 200 to 330 per 100 thousand people. Liver cirrhosis is a common disease in our country which accounted for 4.3% to 14.2% of the total internal medicine hospitalizations. The cause of liver cirrhosis is complicated and mulfactorial which is related with the difference of geography, environment, race and living habit. Alcoholic cirrhosis is a common phenomenon in Northern America and Western Europe, with prevalence of 50%-90%. And many investigations show that the main reason for the liver cirrhosis in our country is viral hepatitis, mainly chronic hepatitis B. With the change of living habit,the cause of liver cirrhosis is changing too. The prevalence of alcoholic cirrhosis is increasing year by year. The biochemical, serological and histological characteristics and the therapy are quite different in liver cirrhosis patients with different causes. So it is important to investigate the etiology of cirrhosis in China which can influence the diagnosis and therapy.The percentage of HBeAg negative hepatitis B is rising in these years. Among the chronic hepatitis b patients in Asia, HBeAg negative is 19% in Japan, 21% in Chinese mainland, 20% in Taiwan, 11% in Hongkong and 16% in India.There are significant differences of clinical and virological profile and the response to the anti-virus therapy between HBeAg positive and HBeAg negative chronic hepatitis B patients. The levels of HBV DNA, ALT and HBsAg quantitation are significantly lower in HBeAg-negative patients compared with HBeAg-positive patients. The age of onset is higher and the liver histological lesion is more severe in HBeAg-negative patients than those in HBeAg positive patients..There are many reportswhich compared the characteristics between HbeAg negative and positive chronic hepatitis b. but there is little report about the difference of clinical manifestation, biochemical index, virology profile, incidence of complications, CTP and the response to the anti-virus therapy in patients with liver cirrhosis in China...Upper gastrointestinal bleeding is the most frequent complication of liver cirrhosis. And variceal bleeding (EVB) is the main cause of death (43.2% -80%). There are many parameters to predict oesophageal varies based on the different clinical report But there are some common limitations including the accuracy and the risks of some tests . So it is important to find some feasible and safe indexs to predict oesophageal varies to increase the survival rate. Part 1Etiological analysis of liver cirrhosis and Comparison of clinical characteristics between HBeAg-negative and HBeAg-positive patients with liver cirrhosisOBJECTIVETo analyze the causes of liver cirrhosis and investigate the clinical characteristics of HBeAg- negative and HBeAg-positive liver cirrhosis patients through cross-sectional retrospective analysis.METHODSA total of 599 hospitalized liver cirrhosis patients were included in this study. The etiology of patients with liver cirrhosis were investigated. The serum ALT values, HBV DNA levels , PLT levels , ages and CTP score were analyzed and compared between HBeAg-negative and HBeAg-positive patients.RESULTSFive hundreds and fifty seven (93.0%) liver cirrhosis patients were caused by viral hepatitis, mainly by the infection of hepatitis B virus. The numbers of HBeAg-negative and HBeAg-positive liver cirrhosis patients are 306 (62.3%) and 185 (37.7%), respectively. In general, patients are older in HBeAg-negative group than that in HBeAg-positive group. However, Serum ALT and HBV DNA levels are higher in HBeAg-positive group than those in HBeAg-negative group. There is no significant difference of CTP socres between the two groups.CONCLUSIONSThe major cause of liver cirrhosis is viral hepatitis, especially hepatitis B. The rate of HBeAg-negative liver cirrhosis patients is higher than that of HBeAg-positive ones in Chinese patients. The severity of liver diseases was not different between HBeAg-negative liver cirrhosis patients and HBeAg-positive liver cirrhosis patients.Part 2forecast research of EV with Hepatitis B Virus-Related CirrhosisOBJECTIVETo screen non-invasive indexes and establish a diagnosis model for screening and predicting EV.METHODSTwo hundreds and three HBV-C patients were retrospectively investigated. Patients'hematologies serum biochemical index, scores of ultrasonic examination were statistically analyzed. A novel model was established by stepwise logistic regression analysis.RESULTSPatients' age, liver ultrasonic score, spleen thickness between ribs, alanine aminotransferase, albumin and ratio of blood platelet/spleen thickness were correlated with EV stages significantly, and also statistically different between patients with mild and significant EV. Other related indexes included diameter of portal vein, spleen length below ribs, blood platelet, prothrombin time,γ-glutamyltransferase, aspartate aminotransferase and white blood cell. Logistic regression analysis showed that age, liver ultrasonic score and spleen thickness were predictors for EV stages. Area under receiver operation curve of Model was 0.799. EV index (EVI) of -0.42 for model was suitable for screening, with specificity 73.5%, sensitivity 80.2%. Nearly 27% of patients' EVI were lower than -1.31, with 87.0% negative predictive value (NPV), no severe EV in missed diagnosis patients . About 29.1% of patients' EVI were upper than 0.45, with positive predictive value 78%, and 13.6% without EV in misdiagnosis patients. With single spleen thickness predicted, about one third patients would be free from endoscopy. Patients with spleen thickness lower than 39mm predicted EV with NPV 90.2%, and only 2.4% patients with severe EV. Nearly 90% of patients with spleen thickness upper than 54mm were confirmed with different degree of EV.CONCLUSIONSModel consisted of age, liver ultrasonic scores and spleen thickness effectively screened and predicted EV stages. Most patients with spleen thickness lower than 39mm could be excluded from EV.