Clinical Characteristics Analysis Of HBV-related Liver Failure And Its Association Studies With CCL3L1 Gene Copy Number Variation

Hepatitis B virus (HBV) infection has been a severe threat of public health worldwide. There has been two billion people infected by HBV out of the total 6 billion population of the world, including chronic HBV infection of 350 million people. One million people died of liver disease relating to HBV. China is a high occurrence area of HBV infection. According to the report publicized by the survey of national epidemiology, there has been 93 million people infected HBV in China. The features of HBV-related liver failure include a lot of complications in patients, difficulty of treatment and a high fatality rate. Therefore, a large sample investigation about the natural history and the clinical process of HBV-related liver failure is required.Acute kidney injury (AKI) is a clinical syndrome with high mortality in patients with HBV-related liver failure. However, there is no any study to report the exact incidence, clinical outcome of AKI in HBV-related liver failure. Therefore, we analyze the incidence, etiologies, clinical characteristics and prognostic factors of acute renal injury in HBV-related liver failure in our hospital. Then we could make earlier diagnosis and treatment, and the prognosis will be better.Some segregation analysis and twin studies strongly support the role of host genetic components in determining the chronicity of HBV infection. Therefore, it is necessary to study the susceptible mechanism of HBV-related liver failure to genome-wide abnormalities. Recently, the studies focus on the genome-wide study of association between copy number variations (CNVs) and diseases at the level of DNA structural variation. CNVs are the result of duplications, deletions, insertions, inversions and complex combinations of rearrangements, and is defined as a chromosomal segment that is 1 kb or larger in length, whose copy number varied in comparison to a reference genome. In recent studies, some CNVs have been well mapped, and scientists found that genomic regions containing CNVs may harbor important genes and gene regulatory elements, and may have considerable influence on the disease susceptibility. Herein, we attempt to find CNVs related to HBV-related liver failure at the level of genomic structure abnormalities, and analyze the clinical data of HBV-related liver failure patients, which may provide a new path to favor the diagnosis, treatment and prognosis of HBV-related liver failure.Main Results:1. Among the patients in our study, there were more males than females, and the highest morbidity was in the young and middle-aged people, famers and laborers comprised the largest proportion at 63.09%. A total of 463 patients (43.47%) had a family history of HBV-related liver failure and 56.66% of patients had a history of drinking alcohol. The patient's main clinical manifestations are hypodynamia, loss of appetite and abdominal distension.2. 654 cases (61.35%) were in agreement with the standard of acute-on-chronic liver failure.3. The prognoses of patients with HBV-related liver failure were related to ALT, AST, ALB, T.Bil, PTA, AFP, drinking alcohol, ascites, hepatorenal syndrome, infection and≥2 complications.4. The incidence of AKI in HBV-related liver failure is 21.2%. The most common causes of AKI are prerenal azotemia (volume-responsive prerenal AKI).5. The prognoses of patients with AKI in HBV-related liver failure were related to age, PTA, BUN, hepatic encephalopathy and haemorrhage of digestive tract.6. The carrier had no significant difference with healthy people (p>0.05). CCL3L1 copy number of patients with HBV-related liver failure was significantly lower than that of carrier and healthy people.Conclusion:1. The prognosis of HBV-related liver failure is related to inducement, complications, and the chemical risk factors that reflecting conditions.2. PTA and complications are independent factors.3. CCL3L1 average copy number in China was about 3.4. Age,BUN and hepatic encephalopathy are independent risk factors affecting prognosis of patients with AKI in HBV-related liver failure. 5. CCL3L1 copy number has a close relationship with the susceptibility to HBV-related liver failure.