Hepatitis B Virus-related Decompensated Liver Cirrhosis: Effect Of Antiviral Therapy To Clinical Features

Background and objective:The joint action of multiple factors could accelerate the speed of chronic hepatitis B to decompensated cirrhosis or hepatocellular carcinoma,one of the most important factors is the active HBV replication.Therefore,effective treatment should be need to remove or suppress HBV replication,and decrease the occurrence of complications and increase the rate of survivirs.China is a developing country,many places of our country have low-income economy together with high endemicity of chronic hepatitis B virus(HBV)infection,and lacking of awareness of the disease,most of the infectors receive antiviral therapy after the oneset decompensation,thus delay the optimal timing treatment and affect the quality of the patients life and survivor rate.The present study aims at observing the clinical features of the oneset of decompensation,and analysis the effect of antiviral therapy on it,to manifest the importance of antiviral therapy in time.Methods:From January2012 to December 2015,a retrospective study involving HBV-related first time decompensated cirrhosis was performed in the Fu Jian Provincial Hospital,there were 56 patients,consisting with 31 males and 25 females.Our study aimed at assessing the clinical features and clinical events after the onset of decompensation.We divided the total patients into two groups according whether they have received antiviral therapy,treated group and untreated group.Results:(1)Clinical features:There was not statistically significant difference between the two groups in the various aspects of clinical manifestations(p>0.05).(2)Laboratory examinations:including ALB、PLT、ALT、AST、TBi L、PT.There was statistically significant difference between the two groups in ALB、ALT、AST、TBi L(respectively,P=0.002、0.014、0.003、0.008).(3)Child-Pugh class and Child-Pugh score:In the untreated group,5(12.82%)were Child-Pugh class A,21(53.85%)were Child-Pugh class B,13(33.33%)were Child-Pugh class C.In the treated group,10(58.82%)were Child-Pugh class A,5(29.41%)were Child-Pugh class B,2(11.77%)were Child-Pugh class C.It was statistically significant difference between the two groups(P=0.002).In Child-Pugh score,mean±SD of untreated group was higher than the treated group,It was statistically significant difference between the two groups(respectively,9.15±0.331vs7.11±0.44,P=0.001).(4)Virological parameters:In the untreated group,13(33.33%)were HBV DNA<1.0X103IU/ml,1(2.56%)was HBV DNA between 1.0X103IU/ml and 2.0X103IU/ml,25(64.11%)were HBV DNA>2.0X103IU/ml.In the treated group,11(64.71%)were HBV DNA<1.0X103IU/ml,1(5.88%)was HBV DNA between 1.0X103IU/ml and 2.0X103IU/ml,5(29.41%)were HBV DNA>2.0X103IU/ml.It was statistically significant difference between the two groups(P=0.02).(5)Serological indicators:In the untreated group,14(35.09%)were HBe Ag positive,25(64.10%)were HBe Ag negative.In the treated group,5(29.41%)were HBe Ag positive,12(70.58%)were HBe Ag negative.There was not statistically significant difference between the two groups(P=0.637).(6)Imageological examinations: In the untreated group,the most common results were splenomegaly(82.05%)、ascite(82.05%)、esophageal gastric varices(56.41%).In the treated group,the most common results were splenomegaly(88.24%)、esophageal gastric varices(64.71%)、portal hypertension(52.94%).It was statistically significant difference between the two groups in ascite(P=0.003).(7)Complications: In the untreated group,the predominant mode of initial decompensation was ascite(82.05%),followed by were upper gastrointestinal bleeding(61.54%)、cholelithiasis(35.09%)and jaundice(35.09%).In the treated group,the most common complications were upper gastrointestinal bleeding(64.71%)、ascite(47.06%)、cholelithiasis(17.65%).There were two patients had HE and HCC in the untreated group.Whereas,there was only one patient had HE,and no one had HCC in the treated group.It was statistically significant difference between the two groups in ascite and jaundice(respectively,P=0.003、0.045).Conclusion:Antiviral therapy may improve the incipient parameters(biochemical results,child-pugh class,child-pugh score and virological parameters)of HBV-related decompensated cirrhosis,and reduce the occurrence of ascites and jaundice.