Diagnostic Tests, Routine ; Humans ; Liver Cirrhosis ; diagnosis

Chronic hepatitis B infection is a very important health problem in China, which is carrying an enormous economic and social burdens. The major routs of chronic hepatitis B infection in China are mother-infant vertical transmission and early childhood horizontal transmission. After more than 10 years implementation of universal vaccination against hepatitis B in newborns and safety injection in health care settings, the prevalence of HBsAg in general population has decreased from 9.75% to around 7%. In China, patients with hepatitis are cared by either hepatologists or physicians of infectious diseases. The Chinese Society of Hepatology, and Chinese Society of Infectious Diseases jointly issued an evidence-based guideline on the prevention and treatment of chronic hepatitis B in 2005. This guideline concisely describes the virology, epidemiology, natural history and prevention, as well as diagnosis and management of chronic hepatitis B. It also highlights the importance of active viral replication in disease progression in chronic HBV infection and explicitly states the necessity of antiviral therapy in patient care. The cornerstone of anti-hepatitis B therapy is optimal use of interferons or nucleos(t)ide analogs in those patients with active viral replication and elevated serum transaminase levels. Through an independent continue medical educational agency, a panel of selected speakers were trained to give well-formatted talks on the key points of the guideline in over 60 major cities across China. This educational campaign among health care providers has greatly improved the awareness and the stand of care for antiviral therapy.

In China universal vaccination program against hepatitis B virus (HBV)in newborns has led to a dramatic decline in HBsAg prevalence from 9.75%in 1992 to 7.18%in 2006.However,it is estimated that there are still around 90 million patients with chronic HBV infection,including 20-30 million with chronic hepatitis B (CHB).As recommended therapies,interferons and nucleos(t)ide analogues can effectively suppress HBV replication and thereby halt the progression of liver disease.Unfortunately,the current standard of care could not cure CHB in most cases.Developing direct antiviral agents targeting the specific steps of HBV life cycle or immunotherapy against the key steps of immune response to HBV infection will ultimately enable us to cure CHB.Chinese hepatologists have published more and more papers on HBV prevention and management,with the aim of optimizing current modalities and exploring new therapies.Adopting the public health policy to improve the accessibility and affordability of preventive and therapeutic drugs and increase the coverage of vaccination and standardized treatment is the most effective means to reduce the enormous health and socioeconomic burden of HBV-related diseases.

In recent years,the basic research on liver fibrosis has been progressed rapidly.This article briefly reviews the cellular and molecular mechanisms of liver fibrosis,including the origin of myofibroblasts,immune regulation,autophagy,and epigenetic regulation,and introduces several new therapeutic targets.More and more evidences show that successful removal of causes is the most important antifibrotic therapy.At present,although the antifibrotic drugs acting on different targets have been emerging,most of them are still in the early stage of research and development,and well-designed clinical trials are needed to confirm their clinical efficacy.

Iron overload is a metabolic disorder characterized by excessive iron deposition in the liver,pancreas,heart,endocrine organs, etc.,resulting in structural damage and dysfunction.The liver is the primary organ for iron storage,and excessive iron deposition induces liver inflammation and fibrosis,which may progress to cirrhosis and even liver cancer,with a poor prognosis.Accurate evaluation and effec-tive treatment can reduce liver injury caused by iron overload and improve patients′survival.

Non-cirrhotic portal hypertension(NCPH)is a group of diseases that show evidences of portal hypertension but no cirrhosis is present.Common causes of NCPH include pre-sinusoidal portal lesions such as portal vein thrombosis,congenital liver fibrosis and idiopathic portal hypertension,and post-sinusoidal portal lesions.The major feature of this group of diseases is well preserved liver function in spite of prominent portal hypertensive manifestations such as esophageal varices/gastrointestinal bleeding and splenomegaly/hypersplenism.Careful differentiation from cirrhosis requires thorough clinical,radiological and pathological investigation.Preventing and control of variceal bleeding and hypersplenism through medical,endoscopic and interventional procedures yield good prognosis in most of the patients with NCPH.

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