论文快速发表网

社科类论文科技类论文医学类论文管理类论文教育类论文农林类论文新闻类论文建筑类论文文艺类论文法学类论文

EI Compendex Source List（2022年1月） EI Compendex Source List（2020年1月） EI Compendex Source List（2019年5月） EI Compendex Source List（2018年9月） EI Compendex Source List（2018年5月） EI Compendex Source List（2018年1月）中国科学引文数据库来源期刊列 CSSCI(2017-2018)及扩展期刊目录 2017年4月7日EI检索目录（最新） 2017年3月EI检索目录最新公布北大中文核心期刊目录 SCI期刊（含影响因子）

本站服务项目浅谈青年教师如何开展教科研大学青年教师如何处理教学和科

论文范文

Reduced Incidence and Better Liver Disease Outcomes among Chronic HCV Infected Patients Who Consume C 时间:2018-09-26 22:19   来源:未知   作者:admin   点击: 次 Abstract:Background and Aim. The effect of cannabis use on chronic liver disease (CLD) from Hepatitis C Virus (HCV) infection, the most common cause of CLD, has been controversial. Here, we investigated the impact of cannabis use on the prevalence of CLD among HCV infected individuals. Methods. We analyzed hospital discharge records of adults (age ≥ 18 years) with a positive HCV diagnosis. We evaluated records from 2007 to 2014 of the Nationwide Inpatient Sample (NIS). We excluded records with other causes of chronic liver diseases (alcohol, hemochromatosis, NAFLD, PBC, HBV, etc.). Of the 188,333 records, we matched cannabis users to nonusers on 1:1 ratio (4,728:4,728), using a propensity-based matching system, with a stringent algorithm. We then used conditional regression models with generalized estimating equations to measure the adjusted prevalence rate ratio (aPRR) for having liver cirrhosis (and its complications), carcinoma, mortality, discharge disposition, and the adjusted mean ratio (aMR) of total hospital cost and length of stay (LOS) [SAS 9.4]. Results. Our study revealed that cannabis users (CUs) had decreased prevalence of liver cirrhosis (aPRR: 0.81[0.72-0.91]), unfavorable discharge disposition (0.87[0.78-0.96]), and lower total health care cost ($39,642[36,220-43,387] versus $45,566[$42,244-$49,150]), compared to noncannabis users (NCUs). However, there was no difference among CUs and NCUs on the incidence of liver carcinoma (0.79[0.55-1.13]), in-hospital mortality (0.84[0.60-1.17]), and LOS (5.58[5.10-6.09] versus 5.66[5.25-6.01]). Among CUs, dependent cannabis use was associated with lower prevalence of liver cirrhosis, compared to nondependent use (0.62[0.41-0.93]). Conclusions. Our findings suggest that cannabis use is associated with decreased incidence of liver cirrhosis, but no change in mortality nor LOS among HCV patients. These novel observations warrant further molecular mechanistic studies.
1. Introduction
   Globally chronic Hepatitis C Infection (HCV), followed by alcoholic and nonalcoholic-fatty liver diseases (ALD and NAFLD), represents the most common cause of chronic liver disease (CLD) that can progress to liver fibrosis and hepatic cellular carcinoma (HCC) [1]. In the United States of America (USA), HCV imposes significant financial and utilization burden on the healthcare system [2]. Fortunately, with recent advances in HCV therapy using direct-acting antivirals (DAA) [3], sustained virologic response (SVR) has been achieved in about 95% of infected individuals [4], resulting in gradual decline in the burden of HCV [1]. However, the remaining 5% with uncontrolled SVR might still progress to CLD. Furthermore, individuals who develop resistance to or do not have access to DAA such as individuals with modest incomes or from less developed countries are more likely to still suffer from CLD [5, 6].
   Cannabis, the most commonly used illicit drug [7], has been shown to modulate inflammatory and fibrotic processes in the liver in preclinical studies [8, 9]. These preclinical observations have additionally been confirmed by recent population studies on ALD and NAFLD [10, 11]. However, the relationship between cannabis use and HCV has been controversial and remains unclear. While earlier studies suggested that cannabis use resulted in increased steatosis, fibrosis, and worsening of HCV disease [12–14], recent observations are now advancing that cannabis use has no effect on HCV disease progression [15–17]. A recent reports even revealed that cannabis use was associated with reduced steatosis in HCV infected individuals [18]. However, most of these studies had significant limitations given that evaluations were made from a single center. Further, these studies were limited in size and lacked diversity in study individuals. Additionally, these studies often included subjects with other chronic liver diseases, which might impact the effects of cannabis on HCV disease study outcomes. Interestingly, a recent study revealed that cannabidiol (CBD), the main nonpsychoactive agent in cannabis, induced cell death in approximately 85% of HCV infected cells in vitro, similar to interferon alpha-2b treatment [19].