Adult ; Esophageal and Gastric Varices ; drug therapy ; etiology ; physiopathology ; Esophagus ; physiopathology ; Female ; Humans ; Isosorbide Dinitrate ; analogs & derivatives ; therapeutic use ; Liver Cirrhosis ; complications ; physiopathology ; Male ; Manometry ; Vasodilator Agents ; therapeutic use

Hyperdynamic circulation in patients with liver cirrhosis is characterized by increased cardiac output and heart rate, and decreased systemic vascular resistance with low arterial blood pressure and currently focused on understanding the pathogenesis because of possibility of developing novel treatment modality. Basically, these hemodynamic alternations arise from portal hypertension. Portosystemic collaterals develop to counterbalance the increased intrahepatic vascular resistance to portal blood flow and induce an increase in venous return to heart. Increased shear stress in vascular endothelial cell related high blood flow by portosystemic shunting contributes to this up-regulation of eNOS resulting in NO overproduction. Additionally, bypassing through portosystemic collaterals and escaping degradation of over-produced circulating vasodilators in the diseased liver can promote the peripheral arterial vasodilation. Vasodilation of the systemic and splanchnic circulations lead to a reduced systemic vascular resistance, and increased cardiac output and splanchnic blood flow. Furthermore, neurohumoral vasoconstrictive systems including systemic nervous system, rennin angiotensin aldosterone system, and vasopressin are intensively activated secondary to vasodilation. However, hyperdynamic circulation would be more aggravated by the activated vasoconstrictive systems. With the progression of the cirrhotic process, hyperdynamic alternations can be more profound due to hyporesponsiveness to vasoconstrictors and increased shunt formation in conjunction with autonomic neuropathy. Eventually, splanchnic arterial vasodilation results in an increase portal venous inflow, maintaining the elevated portal venous pressure. Hyperdynamic circulation is intimately involved in portal hypertension with liver cirrhosis, therefore it is reasonable to have an interest in complete understanding of the pathogenensis of hyperdynamic circulation to develop novel treatment modality.
Blood Circulation/*physiology ; Blood Flow Velocity/physiology ; Humans ; Hypertension, Portal/etiology/*physiopathology ; Liver/blood supply/physiopathology ; Liver Cirrhosis/drug therapy/etiology/*physiopathology ; Nitric Oxide/metabolism ; Nitric Oxide Synthase Type III/metabolism ; Vasodilation

OBJECTIVETo observe the influence of Fuzheng Huayu Tablet on mental state and social activity of patients with post-hepatitis B liver cirrhosis (LC-HB).

METHODSAdopting grouped randomized double-blinded control method, 180 LC-HB patients in 3 research centers were distributed to 2 groups, the treated group and the control group, 90 in each group. Patients in the treated group were administered with FZHYT; while those in the control group treated with conventional therapy combined with placebo, the course for all patients were 6 months. Their mental state and social activity were evaluated before treatment, after 3 months' treatment and at terminal of the 6-month therapeutic course by estimating with Zung self-rating anxiety scale (SAS), self-rating depression scale (SDS) and social deficit screening scale (SDSS). Additionally, the basic demographic materials, liver function, cirrhosis index, hepatic and splenic images, blood coagulation function, etc. in the patients were tested and compared as well.

RESULTSAs compared with before treatment, the normal rate of SAS and SDS scores increased and the social deficit rate decreased in the treated group significantly after treatment, showing statistical significance (P<0.05 or P<0.01); while in the control group, change was only shown in the social deficit (P<0.01), inter-group comparisons after treatment showed significant differences in all the three indexes (P<0.05 or P<0.01). Additionally, after treatment, levels of liver function, cirrhosis, blood coagulation function and splenomegaly in the treated group were all improved significantly P<0.05 or P<0.01), and the improvements were better than those in the control group (P<0.01) in levels of total bilirubin (TBIL), albumin (ALB), type IV collagen (IV-C), prothrombin time (PT), prothrombin activity (PTA).

CONCLUSIONMost patients of LC-HB have mental disturbance and social activity deficit, which could definitely be improved by intervention with Chinese FZHYT.

Blood Coagulation ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Hepatitis B ; complications ; drug therapy ; physiopathology ; Humans ; Liver Cirrhosis ; drug therapy ; etiology ; physiopathology ; psychology ; Liver Function Tests ; Patient Dropouts ; Social Behavior ; Tablets

OBJECTIVETo investigate the action of nitric oxide (NO) on testicular dysfunction in cirrhotic rats.

METHODSCirrhotic rats were induced by bile duct ligation (BDL). Concentration of NO in the serum and homogenates of the testicular tissue in biliary cirrhotic rats, L-NAME rats, and sham operated rats were measured by assay of nitrate reductase. Concentrations of testosterone in the serum of 3 groups were measured by radioimmunoassay. Sperm density and percent of motive sperm in the epididymis of the rats were determined.

RESULTSConcentrations of NO in the serum and homogenates of the testicular tissue of cirrhotic rats were significantly greater than those of sham operated rats (4.165 micromol/L 1.162 micromol/L, and 1.305 micromol/g 0.087 micromol/g vs 0.535 micromol/L 0.237 micromol/L and 0.720 micromol/g 0.063 micromol/g). Concentrations of testosterone in the serum, the sperm density and percent of motive sperm in the epididymis were significantly lower in cirrhotic rats than sham operated rats (0.049mug/L 0.020 microgram/L, 16.46% 4.84%, and 86.89 10(6)/ml 33.17 10(6)/ml vs 2.680 microgram/L 0.403 microgram/L, 62.45% 9.21%, and 299.43 10(6)/ml 53.85 10(6)/ml). By contrast, the administration of a low dose of L-NAME (0.5 mg/kg per day) for one week to cirrhotic rats was associated with a significant reduction in concentration of NO (1.975 micromol/L 0.406 micromol/L and 0.950 micromol/g 0.057 micromol/g) and a significant increase in concentration of testosterone in the serum, the sperm density and percent of motive sperm in the epididymis (0.993 microgram/L 0.179 microgram/L, 33.85% 4.93%, and 188.94 10(6)/ml 38.34 10(6)/ml).

CONCLUSIONSNO is associated with testicular dysfunction in cirrhosis. The testicular dysfunction induced by cirrhosis can obtain improvement by using low dose of L-NAME.

Animals ; Liver ; parasitology ; Liver Cirrhosis, Experimental ; pathology ; physiopathology ; Male ; NG-Nitroarginine Methyl Ester ; therapeutic use ; Nitric Oxide ; physiology ; Rats ; Rats, Sprague-Dawley ; Testicular Diseases ; drug therapy ; etiology ; Testis ; drug effects ; pathology ; physiopathology ; Testosterone ; blood

OBJECTIVETo study the clinical therapeutic effects and safety of Fufang Biejia Ruangan tablet (FBRt) in patients with chronic hepatitis B complicated with hepatic fibrosis.

METHODSTotally 420 patients were randomly divided into two groups, FBRt group (300 cases) were treated with Fufang Biejia Ruangan tablets and control group (120 cases) were treated with He Luo Shu Gan capsule, the patients in both groups were treated for 6 months.

RESULTSThe cure rate and total effective rate of FBRt group were significantly higher than those of control group (55.67 percent and 81.67 percent vs. 15.8 percent and 60.00 percent, P less than 0.01).

CONCLUSIONFufang Biejia Ruangan tablet could alleviate clinical symptoms and hepatic fibrosis. Fufang Biejia Ruangan tablet is effective and safe in treatment of patients with chronic hepatitis B complicated with liver fibrosis.

Adolescent ; Adult ; Aged ; Alanine Transaminase ; blood ; Hepatitis B, Chronic ; complications ; drug therapy ; pathology ; Humans ; Liver ; pathology ; physiopathology ; Liver Cirrhosis ; drug therapy ; etiology ; pathology ; Medicine, Chinese Traditional ; Middle Aged ; Tablets

OBJECTIVE: To evaluate the efficacy of combination therapy of lamivudine (LAM) and adefovir dipivoxyl (ADV) for patients with hepatitis B-induced decompensated cirrhosis. METHODS: A total of 81 patients were randomly divided into a combination group and an ADV group over 48 week treatment course. The combination group were treated with LAM (100 mg/d) plus ADV (10 mg/d), and the ADV group with ADV (10 mg/d ) for 48 weeks. All patients received hepatic function support and symptomatic treatment. The levels of HBV DNA, liver function, Child-Pugh scores and HBV DNA indicators were observed before and after the treatment. RESULTS: At week 4, the mean reduction of HBV DNA was 1.83 lgIU/mL, 17.9% of the patients achieved undetectable HBV DNA and 28.2% showed normal ALT in the combination group. The counterpart in the ADV group was 0.96 lgIU/mL, 5.3% and 10.5%. At week 4, 12, 24 and 48, the differences in the mean reduction of HBV DNA, undetectable HBV DNA and ALT normalization were statistically significant between the 2 groups. The difference in HBeAg negative conversion rates and HBeAg seroconversion at week 24 and 48 was not significant. CONCLUSION The combination therapy results in HBV suppression and improved liver function and Child-Pugh score. The combination treatment has an advantage over ADV due to low drug resistance rate and good tolerance.
Adenine ; administration & dosage ; analogs & derivatives ; Adult ; Antiviral Agents ; therapeutic use ; Drug Therapy, Combination ; End Stage Liver Disease ; drug therapy ; etiology ; Female ; Hepatitis B, Chronic ; complications ; Humans ; Lamivudine ; administration & dosage ; Liver Cirrhosis ; drug therapy ; etiology ; physiopathology ; Male ; Middle Aged ; Organophosphonates ; administration & dosage

BACKGROUND/AIMS: This prospective study aimed to determine if Doppler ultrasonography can be representative of hepatic venous pressure gradient (HVPG) in assessing the severity of portal hypertension and response to drug reducing portal pressure. METHODS: The HVPG and the parameters of Doppler ultrasonography including portal venous velocity (PVV) and splenic venous velocity, the pulsatility and resistive index of hepatic, splenic and renal arteries were measured in 105 patients with liver cirrhosis. In 31 patients the changes of hepatic venous pressure gradient and portal venous velocity after administration of terlipressin were evaluated. The patients who showed a reduction in HVPG of more than 20% of the baseline were defined as responders to terlipressin. RESULTS: Any Doppler ultrasonographc parameters did not correlate with HVPG. Both HVPG and PVV showed a highly significant reduction after the administration of terlipressin(-28.3 +/- 3.9%, -31.2 +/- 2.2% respectively). However, PVV decreased significantly not only in responders(31.7 +/- 2.4%) but also in nonresponders(29.5 +/- 6.1%). CONCLUSION: Doppler ultrasonography can not be representative of HVPG in assessing the severity of portal hypertension and response to drug reducing portal pressure in liver cirrhosis.
Antihypertensive Agents/therapeutic use ; Blood Flow Velocity ; Comparative Study ; English Abstract ; Female ; *Hepatic Veins ; Human ; Hypertension, Portal/drug therapy/etiology/physiopathology/*ultrasonography ; Liver Cirrhosis/*complications ; Lypressin/*analogs & derivatives/therapeutic use ; Male ; Middle Aged ; Prospective Studies ; *Ultrasonography, Doppler ; *Venous Pressure

OBJECTIVETo observe the effect of Xuefu Zhuyu decoction (XZD) on the chronic hepatitis B caused liver fibrosis (CHBLF) and the portal hemodynamics.

METHODSSixty patients with CHBLF were randomly divided into two groups, the 28 patients in the treated group were treated with oral intake of XZD and conventional liver protective treatment, the 32 patients in the control group were treated with conventional liver protective treatment alone, the therapeutic course for both groups was 3 months. Serum liver fibrosis criteria and portal dynamical criteria were observed before and after treatment.

RESULTSComparison of the remarkable effective rate between the two groups showed significant difference. After treatment, in the treated group, all the serum criteria for liver fibrosis (HA, PCIII, LN) and criteria for portal trunk hemodynamics, such as mean velocity and quantity of blood flow were significantly improved (P < 0.05 or P < 0.01), as compared with those in the control group, the difference was also significant (P < 0.05 or P < 0.01).

CONCLUSIONXZD has definite therapeutic effect on chronic hepatitis B caused liver fibrosis.

Adolescent ; Adult ; Collagen Type III ; blood ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hemodynamics ; Hepatitis B, Chronic ; blood ; complications ; Humans ; Hyaluronic Acid ; blood ; Liver Cirrhosis ; blood ; drug therapy ; etiology ; Male ; Middle Aged ; Phytotherapy ; Portal Vein ; physiopathology

Animals ; Colon ; blood supply ; pathology ; Colonic Diseases ; drug therapy ; etiology ; physiopathology ; Hemodynamics ; Hepatic Veins ; pathology ; physiopathology ; Hypertension, Portal ; complications ; physiopathology ; Intestinal Mucosa ; blood supply ; drug effects ; pathology ; Liver Cirrhosis, Experimental ; complications ; Losartan ; administration & dosage ; therapeutic use ; Male ; Microscopy ; Portal Pressure ; drug effects ; Random Allocation ; Rats ; Rats, Wistar

OBJECTIVETo evaluate the efficacy of kushenin in treating patients with chronic hepatitis C after renal transplantation.

METHODSFifty-five patients were randomly assigned by lottery to the treatment group (29 cases) and control group (26 cases). The same immunosuppression therapy was given to all patients in both groups. Patients in the treatment group were treated with kushenin 0.6 g once a day, while those in the control group were treated with conventional liver protective agents such as vitamins. The treatment duration of both groups was 3 months. The incidences of serious hepatitis and acute rejection reaction, serum biochemistry parameters including indicators of liver and kidney functions, hepatic fibrosis index, and serum HCV-RNA were compared between the two groups.

RESULTS(1) The incidence of serious hepatitis in the treatment group and the control group was 3.45% (1/29 cases) and 11.54% (3/26 cases), respectively, which was insignificantly different between the two groups (P=0.335). (2) The incidence of acute rejection in the treatment group was 6.90% (2/29 cases) and that in the control group was 7.69% (2/26 cases), showing insignificant difference (P=0.335). (3) The differences in serum alanine aminotransferase (ALT), direct bilirubin (DBIL), hyaluronic acid (HA), propeptide collagen type III (PC III), laminin (LN), collagen type IV (Col IV) levels between the two groups were insignificant before transplantation (P>0.05), while the above-mentioned parameters in the treatment group were significantly lower than those in the control group after transplantation (P<0.05). The difference in serum creatinine (SCr) and endogenous creatinine clearance rate (CCr) between the two groups was insignificant before and after transplantation (P>0.05). (4) The negative conversion rate of HCV-RNA in the treatment group was 31.03% (9/29 cases), significantly higher than the value of 11.54% (3/26 cases) in the control group after transplantation (P<0.05). (5) The levels of serum ALT and DBIL in patients with HCV-RNA converted to negative were significantly lower than those with still-positive HCV-RNA (P<0.05).

CONCLUSIONSKushenin has a certain effect on inhibiting the proliferation of HCV, protecting liver cells, and anti-liver fibrosis. On the other hand, it has no obvious influence on renal allograft function. Thus, the drug is clinically safe and effective for use in treating patients with chronic hepatitis C after renal transplantation.

Adolescent ; Adult ; Antiviral Agents ; administration & dosage ; adverse effects ; therapeutic use ; China ; epidemiology ; Female ; Graft Rejection ; Hepacivirus ; genetics ; Hepatitis C, Chronic ; drug therapy ; epidemiology ; etiology ; physiopathology ; Humans ; Incidence ; Kidney Function Tests ; Kidney Transplantation ; adverse effects ; Liver Cirrhosis ; complications ; drug therapy ; Liver Function Tests ; Male ; Pterocarpans ; administration & dosage ; adverse effects ; therapeutic use ; RNA, Viral ; blood