Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2019; 25(3): 378-387
Published online Jan 21, 2019. doi: 10.3748/wjg.v25.i3.378
Differential hepatic features presenting in Wilson disease-associated cirrhosis and hepatitis B-associated cirrhosis
Hao-Jie Zhong, Huan-Huan Sun, Lan-Feng Xue, Eileen M McGowan, Yu Chen
Hao-Jie Zhong, Lan-Feng Xue, Yu Chen, Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510000, Guangdong Province, China
Hao-Jie Zhong, Department of Gastroenterology, Guangdong Medical University, Zhanjiang 524000, Guangdong Province, China
Huan-Huan Sun, Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an 710000, Shaanxi Province, China
Eileen M McGowan, Faculty of Science, University of Technology Sydney, Sydney NSW 2007, Australia
Author contributions: Zhong HJ, Sun HH, and Chen Y contributed to study conception and design; Zhong HJ, Sun HH, Xue LF, McGowan EM, and Chen Y contributed to data acquisition, data analysis and interpretation, and writing of the article; Zhong HJ, McGowan EM, and Chen Y contributed to editing, reviewing, and final approval of the article.
Supported by the Science and Technology Planning Project of Guangdong Province, No. 2015A030302085 and No. 2016A020212022.
Institutional review board statement: The study was reviewed and approved by the Ethical Committee of the First Affiliated Hospital of Guangdong Pharmaceutical University (2018-72).
Informed consent statement: Informed consent was waived by the Ethical Committee of the First Affiliated Hospital of Guangdong Pharmaceutical University.
Conflict-of-interest statement: There are no conflicts of interest for any of the authors.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at yuchen@gdpu.edu.cn.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yu Chen, MD, PhD, Doctor, Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, No. 19, Nonglinxia Road, Guangzhou 510000, Guangdong Province, China. yuchen@gdpu.edu.cn
Telephone: 86-138-24462875 Fax: +86-020-61325957
Received: December 7, 2018
Peer-review started: December 9, 2018
First decision: December 28, 2018
Revised: January 3, 2019
Accepted: January 9, 2019
Article in press: January 9, 2019
Published online: January 21, 2019
Research background

Cirrhosis is a chronic late stage liver disease associated with hepatitis viruses, alcoholism, and metabolic disorders, such as Wilson disease (WD). As the etiology and onset age of WD-associated cirrhosis are different from those of other kinds of liver cirrhosis, WD-associated cirrhosis may involve a distinct liver injury pathogenesis.

Research motivation

We hypothesized that cirrhosis is not one disease and cirrhosis of different etiology may have differential clinical hepatic features.

Research objectives

To delineate the liver features between WD-associated cirrhosis and hepatitis B-associated cirrhosis in the Chinese population.

Research methods

We performed a cross-sectional study of 60 WD-associated cirrhosis and 56 hepatitis B-associated cirrhosis inpatients. We analyzed the liver fibrosis degree, liver function indices, and portal hypertension features between these two groups.

Research results

No inter-group differences were observed in the diagnostic liver fibrosis markers, however, clinical features clearly defined the origin of cirrhosis. Cirrhosis presenting in WD patients had worse liver function, lower incidence of hepatic encephalopathy, and lower portal vein diameter, compared to cirrhosis resulting from hepatitis B. They had decreased risks of progression from Child-Pugh grade A to B and of ascites. Conversely, WD-associated cirrhosis patients had a higher risk of splenomegaly, which was associated with a significantly increased risk of leukopenia and thrombocytopenia.

Research conclusions

WD-associated cirrhosis presents a higher risk of splenomegaly associated with leukopenia and thrombocytopenia, although revealing milder liver dysfunction and portal hypertension symptoms. These findings indicated that cirrhosis is not one disease and further classification for diagnosis and treatment options, dependent on origin, are needed.

Research perspectives

The higher risk of splenomegaly associated with leucopenia and thrombocytopenia in these younger, vulnerable WD patients with cirrhosis, suggests early and regular monitoring of associated blood disorders and infections to alleviate further clinical complications.