AIM: To assess the prevalence of the two mutations, C282Y and H63D of HFE gene, in healthy subjects, patients with chronic hepatitis C (CHC), and patients with nonalcoholic fatty liver disease (NAFLD) in Taiwan and to...AIM: To assess the prevalence of the two mutations, C282Y and H63D of HFE gene, in healthy subjects, patients with chronic hepatitis C (CHC), and patients with nonalcoholic fatty liver disease (NAFLD) in Taiwan and to explore the contribution of the HFE mutation on serum iron stores in CHC and NAFLD groups.METHODS: We examined C282Y and H63D mutations of HFE gene in 125 healthy subjects, 29 patients with CHC,and 33 patients with NAFLD. The serum iron markers,including ferritin, iron, and total iron binding capacity (TIBC),were assessed in all patients.RESULTS: All of the healthy subjects and patients were free from C282Y mutation. The prevalence of H63D heterozygosity was 4/125 (3.20%) in healthy subjects, 2/29(6.90%) in CHC group, and 1/33 (3.03%) in NAFLD group.The healthy subjects showed no significant difference in the prevalence of H63D mutation as compared with the CHC or NAFLD group. Increased serum iron store was found in 34.48% of CHC patients and 36.36% of NAFLD patients.In three patients of H63D heterozygosity, only one CHC patient had increased serum iron store. There was no significant difference in the prevalence of HFE mutations between patients with increased serum iron store and those without in CHC or NAFLD group.CONCLUSION: The HFE mutations may not contribute to iron accumulation in the CHC or NAFLD group even when serum iron overload is observed in more than one-third of these patients in Taiwan.展开更多
AIM To evaluate the impact of cytochrome P450 2C19(CYP2C19) and interleukin-1β(IL-1β) polymorphisms on the efficacy of Helicobacter pylori(H. pylori) eradication by using rabeprazole-based hybrid therapy.METHODS A t...AIM To evaluate the impact of cytochrome P450 2C19(CYP2C19) and interleukin-1β(IL-1β) polymorphisms on the efficacy of Helicobacter pylori(H. pylori) eradication by using rabeprazole-based hybrid therapy.METHODS A total of 88 H. pylori-infected patients were recruited to receive 14-d of hybrid therapy from March 2013 to May 2014. Three patients were excluded from analysis because of incomplete compliance. Either a follow-up endoscopy or 13 C-urea test was performed to determine the results of H. pylori eradication therapy. The genotypes of CYP2C19 and IL-1β were analyzed to investigate the impact on treatment effect. RESULTS The total eradication rate of H. pylori was 92.94%(79/85). According to the CYP2C19 genotypes, the rates of H. pylori eradication were 89.19% in extensive metabolizers(EM) and 95.83% in non-EM. The H.pylori eradication rates regarding the IL-1β genotypes were 92.59% in the normal acid secretion group and 93.10% in the low acid secretion group. After multivariable logistic regression analysis, both the genotypes of CYP2C19 and IL-1β had no significant influences on the eradication rates of H. pylori.CONCLUSION The CYP2C19 and IL-1β polymorphisms are not significantly independent factors of H.pylori eradication using rabeprazole-based hybrid therapy.展开更多
AIM： To evaluate the association among hepatic fibrosis, serum iron indices, and hepatic iron stores in patients with Chronic Hepatitis C （CHC）. METHODS： Thirty-two CHC patients were included in our study. The his...AIM： To evaluate the association among hepatic fibrosis, serum iron indices, and hepatic iron stores in patients with Chronic Hepatitis C （CHC）. METHODS： Thirty-two CHC patients were included in our study. The histological degree of fibrosis and inflammation activity was assessed according to the Metavir system. The serum iron indices including ferritin, iron and transferrin saturation were measured. Hepatic iron deposition was graded by Perls＇ stain. RESULTS： The CHC patients with severe hepatic fibrosis （n = 16） were significantly older than CHC patients with mild fibrosis （n = 16） （P = 0.024）. The serum iron indices, increased serum iron store and positive hepatic iron stain were not significantly different between the two groups. In multivariate logistic regression analysis, the age at biopsy was an independent predictor of severe hepatic fibrosis （Odds ratio = 1.312; P = 0.035）. The positive hepatic iron stain was significantly associated with the values of alanine aminotransferase （ALT） （P = 0.017）, ferritin （P = 0.008）, serum iron （P = 0.019） and transferrin saturation （P = 0.003）. The ferritin level showed significant correlation with the value ofALT （r = 0.531; P = 0.003）, iron （r = 0.467; P = 0.011） and transferrin saturation （r = 0.556; P = 0.002）. CONCLUSION： Our findings suggest that the severity of hepatitis C virus （HCV）-related liver injury is associated with patient age at biopsy. Both serum iron indices and hepatic iron deposition show correlation with serum indices of chronic liver disease but are not related to grade and stage of liver histology.展开更多
BACKGROUND Cytomegalovirus(CMV)infection is usually subclinical and asymptomatic in the healthy population,whereas severe complications occur in immunocompromised patients.CASE SUMMARY In this case report,we described...BACKGROUND Cytomegalovirus(CMV)infection is usually subclinical and asymptomatic in the healthy population,whereas severe complications occur in immunocompromised patients.CASE SUMMARY In this case report,we described a rare case of acute CMV hepatitis in a 35-yearold male immunocompetent patient who presented with a history of week-long intermittent fever with nonspecific constitutional symptoms.Acute hepatitis was suspected according to the initial serological tests.After ruling out other etiologies,including viral hepatitis A,B,C,drug,alcohol,autoimmune,and Wilson disease,acute CMV hepatitis was diagnosed based on positive CMV IgM and DNA quantitative tests.Because there was no any local acute hepatitis E reported in Taiwan,so hepatitis E was not checked.The patient recovered both clinically and serologically with symptomatic management and without antiviral therapy within 12 days from the onset of symptom.CONCLUSION In conclusion,a diagnosis of CMV infection should be considered when nonspecific prodromal symptoms occur in acute hepatitis with an uncertain etiology.Antiviral therapy should not be used in immunocompetent patient who had no decompensation of the liver,such as this patient.Widely available noninvasive tests for CMV can facilitate early diagnosis if used appropriately.Harm–benefit analysis is essential before using antiviral therapy in immunocompetent patients.展开更多
Hepatocellular carcinoma(HCC),especially hepatitis B virus(HBV)-related,remains a major cause of cancerrelated mortality worldwide.Unless there is early detection with curative treatment,the 5-year survival rate of ad...Hepatocellular carcinoma(HCC),especially hepatitis B virus(HBV)-related,remains a major cause of cancerrelated mortality worldwide.Unless there is early detection with curative treatment,the 5-year survival rate of advanced HCC is less than 15%.The preventive strategies for HBV-related HCC are thus urgently needed to reduce the global burden of this disastrous cancer.Primary prevention involves the avoidance of viral infection through hepatitis B vaccination and interruption of viral transmission from patients with chronic HBV infection.Universal neonatal hepatitis B vaccination program has successfully reduced the prevalence of HBV carriage rate as well as HCC incidence in vaccinated cohorts.However,HBV elimination is still difficult to achieve.Regarding secondary prevention,long-term treatment with nucleos(t)ide analogues has been proven to reduce the risk of HBV-related HCC.Individual risk stratification and a periodic HCC surveillance in these patients could facilitate early HCC diagnosis.Finally,tertiary prevention can also be achieved by life-long treatment with NAs to reduce the risk of HCC recurrence after curative treatment of primary HCC.Challenges ahead include the fact that HBV is not yet curable by current antiviral agents.Combination therapy with direct anti-HBV agents and host-targeting immunomodulatory agents is under active development.In addition,HCC risk cannot be eliminated even in patients with HBsAg seroclearance or functional cure.Therefore,HCC surveillance is strongly recommended for every patient with chronic HBV infection.展开更多
文摘AIM: To assess the prevalence of the two mutations, C282Y and H63D of HFE gene, in healthy subjects, patients with chronic hepatitis C (CHC), and patients with nonalcoholic fatty liver disease (NAFLD) in Taiwan and to explore the contribution of the HFE mutation on serum iron stores in CHC and NAFLD groups.METHODS: We examined C282Y and H63D mutations of HFE gene in 125 healthy subjects, 29 patients with CHC,and 33 patients with NAFLD. The serum iron markers,including ferritin, iron, and total iron binding capacity (TIBC),were assessed in all patients.RESULTS: All of the healthy subjects and patients were free from C282Y mutation. The prevalence of H63D heterozygosity was 4/125 (3.20%) in healthy subjects, 2/29(6.90%) in CHC group, and 1/33 (3.03%) in NAFLD group.The healthy subjects showed no significant difference in the prevalence of H63D mutation as compared with the CHC or NAFLD group. Increased serum iron store was found in 34.48% of CHC patients and 36.36% of NAFLD patients.In three patients of H63D heterozygosity, only one CHC patient had increased serum iron store. There was no significant difference in the prevalence of HFE mutations between patients with increased serum iron store and those without in CHC or NAFLD group.CONCLUSION: The HFE mutations may not contribute to iron accumulation in the CHC or NAFLD group even when serum iron overload is observed in more than one-third of these patients in Taiwan.
文摘AIM To evaluate the impact of cytochrome P450 2C19(CYP2C19) and interleukin-1β(IL-1β) polymorphisms on the efficacy of Helicobacter pylori(H. pylori) eradication by using rabeprazole-based hybrid therapy.METHODS A total of 88 H. pylori-infected patients were recruited to receive 14-d of hybrid therapy from March 2013 to May 2014. Three patients were excluded from analysis because of incomplete compliance. Either a follow-up endoscopy or 13 C-urea test was performed to determine the results of H. pylori eradication therapy. The genotypes of CYP2C19 and IL-1β were analyzed to investigate the impact on treatment effect. RESULTS The total eradication rate of H. pylori was 92.94%(79/85). According to the CYP2C19 genotypes, the rates of H. pylori eradication were 89.19% in extensive metabolizers(EM) and 95.83% in non-EM. The H.pylori eradication rates regarding the IL-1β genotypes were 92.59% in the normal acid secretion group and 93.10% in the low acid secretion group. After multivariable logistic regression analysis, both the genotypes of CYP2C19 and IL-1β had no significant influences on the eradication rates of H. pylori.CONCLUSION The CYP2C19 and IL-1β polymorphisms are not significantly independent factors of H.pylori eradication using rabeprazole-based hybrid therapy.
基金Supported by grants from the Taipei Institute of Pathology, Taipei, Taiwan, China
文摘AIM： To evaluate the association among hepatic fibrosis, serum iron indices, and hepatic iron stores in patients with Chronic Hepatitis C （CHC）. METHODS： Thirty-two CHC patients were included in our study. The histological degree of fibrosis and inflammation activity was assessed according to the Metavir system. The serum iron indices including ferritin, iron and transferrin saturation were measured. Hepatic iron deposition was graded by Perls＇ stain. RESULTS： The CHC patients with severe hepatic fibrosis （n = 16） were significantly older than CHC patients with mild fibrosis （n = 16） （P = 0.024）. The serum iron indices, increased serum iron store and positive hepatic iron stain were not significantly different between the two groups. In multivariate logistic regression analysis, the age at biopsy was an independent predictor of severe hepatic fibrosis （Odds ratio = 1.312; P = 0.035）. The positive hepatic iron stain was significantly associated with the values of alanine aminotransferase （ALT） （P = 0.017）, ferritin （P = 0.008）, serum iron （P = 0.019） and transferrin saturation （P = 0.003）. The ferritin level showed significant correlation with the value ofALT （r = 0.531; P = 0.003）, iron （r = 0.467; P = 0.011） and transferrin saturation （r = 0.556; P = 0.002）. CONCLUSION： Our findings suggest that the severity of hepatitis C virus （HCV）-related liver injury is associated with patient age at biopsy. Both serum iron indices and hepatic iron deposition show correlation with serum indices of chronic liver disease but are not related to grade and stage of liver histology.
文摘BACKGROUND Cytomegalovirus(CMV)infection is usually subclinical and asymptomatic in the healthy population,whereas severe complications occur in immunocompromised patients.CASE SUMMARY In this case report,we described a rare case of acute CMV hepatitis in a 35-yearold male immunocompetent patient who presented with a history of week-long intermittent fever with nonspecific constitutional symptoms.Acute hepatitis was suspected according to the initial serological tests.After ruling out other etiologies,including viral hepatitis A,B,C,drug,alcohol,autoimmune,and Wilson disease,acute CMV hepatitis was diagnosed based on positive CMV IgM and DNA quantitative tests.Because there was no any local acute hepatitis E reported in Taiwan,so hepatitis E was not checked.The patient recovered both clinically and serologically with symptomatic management and without antiviral therapy within 12 days from the onset of symptom.CONCLUSION In conclusion,a diagnosis of CMV infection should be considered when nonspecific prodromal symptoms occur in acute hepatitis with an uncertain etiology.Antiviral therapy should not be used in immunocompetent patient who had no decompensation of the liver,such as this patient.Widely available noninvasive tests for CMV can facilitate early diagnosis if used appropriately.Harm–benefit analysis is essential before using antiviral therapy in immunocompetent patients.
基金supported by grants from the National Taiwan University Hospital,the Ministry of Health and Welfare,and the Ministry of Science and Technology,Executive Yuan,Taiwan.
文摘Hepatocellular carcinoma(HCC),especially hepatitis B virus(HBV)-related,remains a major cause of cancerrelated mortality worldwide.Unless there is early detection with curative treatment,the 5-year survival rate of advanced HCC is less than 15%.The preventive strategies for HBV-related HCC are thus urgently needed to reduce the global burden of this disastrous cancer.Primary prevention involves the avoidance of viral infection through hepatitis B vaccination and interruption of viral transmission from patients with chronic HBV infection.Universal neonatal hepatitis B vaccination program has successfully reduced the prevalence of HBV carriage rate as well as HCC incidence in vaccinated cohorts.However,HBV elimination is still difficult to achieve.Regarding secondary prevention,long-term treatment with nucleos(t)ide analogues has been proven to reduce the risk of HBV-related HCC.Individual risk stratification and a periodic HCC surveillance in these patients could facilitate early HCC diagnosis.Finally,tertiary prevention can also be achieved by life-long treatment with NAs to reduce the risk of HCC recurrence after curative treatment of primary HCC.Challenges ahead include the fact that HBV is not yet curable by current antiviral agents.Combination therapy with direct anti-HBV agents and host-targeting immunomodulatory agents is under active development.In addition,HCC risk cannot be eliminated even in patients with HBsAg seroclearance or functional cure.Therefore,HCC surveillance is strongly recommended for every patient with chronic HBV infection.
