2013 No. 12

Strengthening research on relationship between metabolic syndrome and chronic liver disease

Fan JianGao, Zhu ChanYan

2013, 29(12): 881-884. DOI: 10.3969/j.issn.1001-5256.2013.12.001

Abstract(2042)

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Metabolic syndrome is becoming a global epidemic disease, and it has been an important cause or risk factor for chronic liver disease in China. Recently, many studies have shown that metabolic syndrome is not only the important cause or risk factor for non-alcoholic fatty liver disease, but also closely associated with increased incidence of cirrhosis and liver cancer in patients with alcoholic liver disease, chronic hepatitis B and C, and cryptogenic liver disease. Moreover, chronic liver disease patients with metabolic syndrome have a significantly increased risk of type 2 diabetes and arteriosclerotic cardiovascular disease. These results suggest that hepatologists should pay more attention to the clinical research on the relationship between metabolic syndrome and liver disease and its management.

Relationship between metabolic syndrome and chronic hepatitis C

Yan Jie, Xie Wen

2013, 29(12): 887-889. DOI: 10.3969/j.issn.1001-5256.2013.12.003

Abstract(2933)

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Metabolic syndrome is closely associated with chronic hepatitis C. On one hand, hepatitis C virus plays an important role in the pathogenesis of metabolic syndrome. On the other hand, metabolic syndrome can affect the response of chronic hepatitis C to antiviral therapy. The relationship between metabolic syndrome and chronic hepatitis C is reviewed to improve the clinicians' awareness of this problem and the treatment outcome of chronic hepatitis C.

Progress in treatment of nonalcoholic fatty liver disease

Shi JunPing, Xun YunHao

2013, 29(12): 890-893. DOI: 10.3969/j.issn.1001-5256.2013.12.004

Abstract(2982)

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The incidence of nonalcoholic fatty liver disease ( NAFLD) increases with the prevalence of obesity, but specific treatment for this disease is lacking. First, the possible clinical benefits from different strategies of lifestyle modification, as well as the methods for improving intervention effect and existing problems, are reviewed. Second, the indications for bariatric surgery and the main research directions are briefly presented. Finally, several promising drugs including vitamin E, farnesoid X receptor agonist, intestinal probiotics, polyunsaturated fatty acids, glucagon-like peptide-1 receptor agonist, and pentoxifylline are elaborated on. The currently acquired clinical evidence and progress in basic research suggest that lifestyle modification is the basis for treatment in all patients with NAFLD, but better schemes are needed to improve the intervention effect; bariatric surgery is one of the effective therapies for NAFLD patients with morbid obesity who have no relevant contraindications; drug treatment should be selectively applied to the population with a confirmed diagnosis of NAFLD.

Research advances in quantitative evaluation of liver fat in patients with nonalcoholic fatty liver disease

Wang Zi, Hu DaoYu

2013, 29(12): 894-896. DOI: 10.3969/j.issn.1001-5256.2013.12.005

Abstract(3248)

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In recent years, numerous researches have been done on quantification of the liver fat in patients with nonalcoholic fatty liver disease ( NAFLD) using noninvasive techniques, particularly by magnetic resonance imaging ( MRI) . Various MR methods for quantifying liver fat in NAFLD patients have been developed in recent 10 years. The advantages and disadvantages of these methods, including MR spectroscopy and MR imaging, are described and summarized. IDEAL-IQ and MRI-estimated proton density fat fraction help to achieve precise quantitative evaluation of liver fat, providing basis and reference for further research on quantification of liver fat in NAFLD patients.

Research progress in role of iron overload in non- alcoholic fatty liver disease

Li GuangMing, Fan JianGao

2013, 29(12): 897-900. DOI: 10.3969/j.issn.1001-5256.2013.12.006

Abstract(3133)

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Iron overload is an important research focus in non-alcoholic fatty liver disease ( NAFLD) . The relationship between iron overload and NAFLD is summarized from the assessment method for iron overload, relationship between iron load and hemochromatosis gene mutations, incidence of iron load in NAFLD, and relationship between iron load and progression of NAFLD; the action mechanism of iron overload in the progression of NAFLD is reviewed from the causes of iron overload, relationship between iron overload and lipid metabolism, and relationship between type of iron deposition and liver damage; the significance of iron overload in the diagnosis and treatment of NAFLD is discussed from iron overload as a new marker of risk stratification and potential therapeutic target in NAFLD. It is currently considered that iron overload, whether the cause or result of NAFLD progression, will promote the progression of NAFLD once it occurs; as a new marker of risk stratification and potential therapeutic target in NAFLD, iron load is worthy of further study.

Research advances in noninvasive diagnosis of nonalcoholic steatohepatitis

Yang Shuo, Lu: Dong, Xu YouQing

2013, 29(12): 901-904. DOI: 10.3969/j.issn.1001-5256.2013.12.007

Abstract(2922)

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Nonalcoholic steatohepatitis ( NASH) is a key stage in the progression of nonalcoholic fatty liver disease. Now liver biopsy is the gold standard for diagnosing NASH, but it cannot be widely used due to its invasiveness and potential hazards. Therefore, searching for noninvasive diagnostic methods for NASH with relatively high sensitivity and specificity is a hotspot of current research. The examination methods closely related to noninvasive diagnosis of NASH, such as serological tests for CK-18, TGF-β1, APRI, etc. and imaging examinations including ultrasound, TE, and MRE, are summarized. It is found that each method has advantages and disadvantages, suggesting that joint use of two or more examination methods may be the research direction for noninvasive diagnosis of NASH.

Update on diagnosis and treatment of Wilson disease in China

Yang Xu

2013, 29(12): 905-908. DOI: 10.3969/j.issn.1001-5256.2013.12.008

Abstract(283)

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Wilson disease ( WD) is a rare and treatable genetic disease that is found worldwide. The latest progress and author's experience in this field are described, and some notable clinical issues concerning this disease in China are discussed. Many studies have shown that in recent years, the number and age range of WD cases have increased, and more and more liver-type and atypical cases have been identified; WD is difficult to diagnose, and misdiagnosed cases are commonly seen. Heightened alertness is the key to the prevention of misdiagnosis, and laboratory testing is an indispensible basis for diagnosis of this disease. Kayser-Fleischer ring, ceruloplasmin, urinary copper, hepatic copper, and genetic testing are of great significance for the diagnosis of WD. Hepatic copper has the highest specificity and sensitivity for WD, reaching 95%, and genetic testing has a specificity of 100% and a sensitivity of 60%-85% for WD. Patients suspected of WD should undergo systemic copper metabolic examination. Diagnostic criteria should be strictly followed, and WD can be diagnosed if the total score is not lower than 4; diagnosis cannot be based on a single test. Once the diagnosis is confirmed, therapy is started regardless of the severity of disease. Severe cases are not encouraged to discontinue therapy due to the side effects of drugs. Fulminating cases should receive rapid decopper treatment as soon as possible. Liver transplantation may be considered for patients with acute or chronic liver failure unresponsive to medical therapy. Overall, patients who receive adequate care for WD have a good long-term prognosis. We need to recognize the new characteristics of this disease and improve the diagnosis and treatment of WD in China.

Relationship between HBV DNA and HBeAg in serum and HBcAg and inflammation grade in liver tissue among patients with chronic hepatitis B

Liu XingXiang, Li GuiZhen, Xu YunFang, Zhang Jing

2013, 29(12): 919-921. DOI: 10.3969/j.issn.1001-5256.2013.12.011

Abstract(2883)

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Objective To investigate the relationship between HBV DNA and HBeAg in serum and HBcAg and inflammation grade in liver tissue among chronic hepatitis B ( CHB) patients. Methods A retrospective analysis was performed on 250 CHB patients who underwent liver biopsy. These patients were divided into three groups according to serum levels of HBV DNA: group A ( < 3 log10IU / ml, n = 45) , group B ( 3-6 log10IU / ml, n = 138) , and group C ( > 6 log10IU / ml, n = 67) , and they were also divided into HBeAg-positive group ( n= 142) and HBeAg-negative group ( n = 108) . The positive rate of HBcAg and inflammation grade in liver tissue were compared between groups, and correlations were analyzed. Comparisons of rates were made by chi-square test and Fisher's exact test; correlations were determined by linear correlation analysis. Results There were significant differences in positive rate of HBcAg between groups A, B, and C ( χ2= 11. 1, P = 0. 05) , and serum HBV DNA level was positively correlated with the positive rate of HBcAg in liver tissue ( r = 0. 75, P =0. 001) . There were no significant differences in inflammation grade between groups A, B, and C ( χ2= 13. 3, P = 0. 075) , and no correlation was found between serum HBV DNA level and inflammation grade in liver tissue ( r = 0. 04, P = 0. 325) . There was significant difference in positive rate of HBcAg between the HBeAg-positive group and HBeAg-negative group ( χ2= 6. 64, P = 0. 01) , and the presence or absence of HBeAg in serum was positively correlated with the positive rate of HBcAg in liver tissue ( r = 0. 56, P = 0. 001) . There was no significant difference in inflammation grade between the HBeAg-positive group and HBeAg-negative group ( χ2= 8. 43, P = 0. 065) , and no correlation was found between the presence or absence of HBeAg in serum and inflammation grade in liver tissue ( r = 0. 06, P = 0. 415) .Conclusion The expression of HBcAg in liver tissue can better reflect HBV replication in the liver among CHB patients. When HBV markers cannot be detected in the serum of patients, liver biopsy can be used to detect HBcAg in liver tissue and assess HBV replication.

Effect of pegylated interferon α-2a combined with thymosin α1 on quality of life in patients with chronic hepatitis B

Lu JianGuo

2013, 29(12): 922-925. DOI: 10.3969/j.issn.1001-5256.2013.12.012

Abstract(3075)

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Objective To investigate the effect of pegylated interferonα-2a ( PEG-IFN α-2a) combined with thymosin α1 ( Tα1) on the quality of life ( QOL) in patients with chronic hepatitis B ( CHB) . Methods A total of 148 patients with CHB who were admitted to our department from October 2008 to October 2012 were selected and randomly divided into observation group ( n = 74) and control group ( n =74) . The control group was treated with PEG-IFN α-2a, while the observation group was treated with PEG-IFN α-2a plus Tα1. The hepatitis B virus ( HBV) DNA load, QOL, Chronic Liver Disease Questionnaire scores, and adverse reactions were compared between the two groups at months 3, 6, and 12 of treatment. Comparisons between groups were made by independent-samples t test; comparisons between variables before and after treatment were made by paired t test; categorical data were analyzed by chi-square test. Results Compared with the control group, the observation group had significantly higher decrease in HBV DNA load and virological response rate at months 3 ( t = 2. 281, P = 0. 02; χ2= 3. 950, P = 0. 04) , 6 ( t = 3. 237, P = 0. 00; χ2= 4. 022, P = 0. 04) , and 12 ( t = 3. 197, P = 0. 00;χ2= 4. 028, P = 0. 04) , significantly higher overall QOL, physiological, social relation, fatigue, and anxiety scores at month 6 ( t = 2. 039-3. 472, P < 0. 05) , and significantly higher overall QOL, general health status, physiological, psychological, social relation, fatigue, systemic symptom, activity, anxiety, and environment scores at month 12 ( t = 2. 020-3. 201, P < 0. 05) . Conclusion PEG-IFN α-2a combined with Tα1 can improve immunity and antiviral ability and promote HBV clearance in the treatment of CHB, thus leading to the improvement in patients' QOL. This therapy holds promise for clinical application.

Diagnosis and treatment of hepatolenticular degeneration in adult patients with primary liver diseases

Fan ZhenPing, Zhang HaiYan, Cai ShaoPing, Ji YingJie, Shi XueMin, Zhang WenJin

2013, 29(12): 940-942. DOI: 10.3969/j.issn.1001-5256.2013.12.017

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One case of primary hepatic amyloidosis characterized by jaundice

Bao XuLi, Tian Zhou, Chen QingFeng, Li Li, Zhang Lei, Lu: Jun

2013, 29(12): 943-944. DOI: 10.3969/j.issn.1001-5256.2013.12.018

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Long- term misdiagnosis of Dubin- Johnson syndrome: a report of one case

Liu QiLin, Xin GuiJie, Gao PuJun, Wang ZhongFeng, Sha XiuJuan

2013, 29(12): 945-946. DOI: 10.3969/j.issn.1001-5256.2013.12.019

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Research advances in gene polymorphisms in nonalcoholic fatty liver disease

Niu TongHong, Zhang Mei, Jiang Man, Xin YongNing, Xuan ShiYing

2013, 29(12): 947-951. DOI: 10.3969/j.issn.1001-5256.2013.12.020

Abstract(2712)

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The incidence of non-alcoholic fatty liver disease ( NAFLD) is rising worldwide. Investigation of genes involved in the pathogenesis of NAFLD is significant for improving treatment regimen and prognosis. Differences in prevalence of NAFLD between races suggest genetic contribution in this disease. PNPLA3 and apoC-III genes, which have become research hotspots in recent years, play important roles in the regulation of lipid metabolism. Studies have established an association of PNPLA3 gene variant ( rs738409[G], encoding I148M) and two single nucleotide polymorphisms (-455T > C [rs2854116]and-482C > T [rs285417]) in the insulin response element in the apoC-III promoter region with NAFLD. The previous research achievements are summarized to conclude that PNPLA3 can be used as an independent predictor of the incidence of NAFLD. However, no consensus has been reached regarding apoC-III among the studies worldwide, and the relevant research in China is still in the primary stage. New ideas are explored for future research on the pathogenesis of NAFLD.

Pathogenesis and risk factors of cholesterol gallstones in patients with non- alcoholic fatty liver disease

Chen YongFang, Wu ZhanJun

2013, 29(12): 952-955. DOI: 10.3969/j.issn.1001-5256.2013.12.021

Abstract(2917)

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Epidemiological investigation suggests that the incidence of gallstones, particularly cholesterol gallstones, is high among patients with non-alcoholic fatty liver disease ( NAFLD) . NAFLD and gallstones are closely related to the diseases such as obesity, diabetes, and hyperlipidemia, so both NAFLD and gallstones are considered the manifestations of metabolic syndrome ( MS) . Many studies both at home and abroad are reviewed to investigate the pathogenesis and risk factors of cholesterol gallstones in patients with NAFLD. It is thought that the pathogenesis may be related to insulin resistance, leptin resistance, small intestinal bacterial overgrowth, etc., and age, sex, obesity, dyslipidemia, and pathoglycemia are risk factors. Understanding the pathogenesis and risk factors of cholesterol gallstones in patients with NAFLD is of great significance for the prevention and treatment of NAFLD, gallstones, and MS.

Role and action mechanism of 8-iso-PGF2α in traumatic liver diseases

Hou ShanShan, Zhang XiaoRui, Zhao YuanHong

2013, 29(12): 956-958. DOI: 10.3969/j.issn.1001-5256.2013.12.022

Abstract(3283)

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Oxidative stress caused by reactive oxygen species changes the function of biofilm mainly by initiating membrane lipid peroxidation and causes varying degrees of liver damage along with a series of cytokines. As the specific product of lipid peroxidation, 8-iso-PGF2α has strong bioactivity and is currently considered the gold indicator for evaluating oxidative stress and lipid peroxidation damage. The relationship between traumatic liver diseases and lipid peroxidation is summarized; 8-iso-PGF2α is recommended as a sensitive indicator of peroxidative damage in liver diseases, and its potential use in liver diseases is preliminarily discussed.

Role of sphincter of Oddi dysfunction in formation of biliary calculi

Su Yang, Wu ShuoDong, Tian Yu, Fan Ying, Yu Hong

2013, 29(12): 959-961. DOI: 10.3969/j.issn.1001-5256.2013.11.023

Abstract(2721)

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Sphincter of Oddi dysfunction plays an important role in the development and progression of biliary and pancreatic diseases.Sphincter of Oddi dysfunction can be classified into two categories: anatomical abnormality and functional disorder. Studies have found that sphincter of Oddi dysfunction is closely associated with duodenal-biliary reflux and formation of biliary calculi. The classification of sphincter of Oddi dysfunction and its relationship with formation of biliary calculi are reviewed and summarized. It is thought that intervention and regulation for Sphincter of Oddi dysfunction may be of great significance in guiding the prevention and treatment of cholelithiasis.

Leng Fang, Sun JiaBang

2013, 29(12): 885-886. DOI: 10.3969/j.issn.1001-5256.2013.12.002

Abstract(140)

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Association between NNMT gene polymorphism and nonalcoholic steatohepatitis

Xiao JianXin, Chen Lei

2013, 29(12): 909-913. DOI: 10.3969/j.issn.1001-5256.2013.12.009

Abstract(2662)

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Objective To investigate the association between nicotinamide N-methyltransferase ( NNMT) gene rs694539 variant and nonalcoholic steatohepatitis ( NASH) . Methods A total of 76 NASH patients who visited or were hospitalized in our hospital from January 2010 to June 2013, as well as 160 healthy volunteers matched with the patients for race, age, and sex, were included in the study. NNMT gene polymorphism was detected by polymerase chain reaction-restriction fragment length polymorphism. The genotype and allele frequencies were compared by chi-square test, and comparison of means between two groups was made by t test. The association between NNMT genotypes and NASH was evaluated using odds ratio ( OR) calculated by unconditional logistic regression model, as well as its 95% confidence interval ( CI) . Results NNMT gene rs694539 variant was found to be significantly associated with NASH. GG genotype was a protective factor against NASH ( OR = 0. 57, 95% CI = 0. 33-0. 98; χ2= 4. 13; P = 0. 04) , while AA genotype was a risk factor for NASH ( OR =2. 55, 95% CI = 1. 10-5. 88; χ2= 5. 02; P = 0. 03) . The NASH patients had significantly lower serum homocysteine ( Hcy) levels than the healthy controls ( 12. 97 ± 1. 65 vs 13. 52 ± 1. 72 μmol / L, P = 0. 02) . The logistic regression analysis showed that A allele ( OR = 3. 79, 95% CI = 1. 21-11. 89; P = 0. 02) and alanine aminotransferase ( ALT) ( OR = 1. 08, 95% CI = 1. 05-1. 11; P = 0. 00) were risk factors for NASH after adjustment for sex, aspartate aminotransferase, ALT, body mass index, triglyceride, total cholesterol, and Hcy. Conclusion NNMT gene rs694539 variant is a genetic risk factor for developing NASH.

Relationship between nonalcoholic fatty liver disease and adipocyte fatty acid- binding protein

Zhou XiaoLi, He LanJie

2013, 29(12): 914-918. DOI: 10.3969/j.issn.1001-5256.2013.12.010

Abstract(270)

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Objective To investigate the relationship between nonalcoholic fatty liver disease ( NAFLD) and serum level of adipocyte fatty acid-binding protein ( AFABP) . Methods A total of 160 patients who underwent physical examination in the Affiliated Hospital of Ningxia Medical University from July to November 2010 were included in our study. These subjects were divided into two groups according to the diagnostic criteria for NAFLD formulated by the Chinese Medical Association: control group ( n = 71) and NAFLD group ( n = 89) . The two groups were compared with respect to general condition, body mass index ( BMI) , blood pressure, AFABP, serum insulin, and other serological indices. The relationship of serum AFABP with NAFLD and other metabolic parameters was analyzed using the Spearman linear correlation coefficient. Comparison of measurement data was made by t test and rank sum test; comparison of enumeration data was made by chi-square test. Results There were more males than females in the NAFLD group. Compared with the control group, the NAFLD group had higher BMI and levels of blood glucose, triglyceride ( TG) , aspartate aminotransferase ( AST) , alanine aminotransferase ( ALT) , and uric acid and lower high-density lipoprotein ( HDL) level; in addition, the NAFLD group had significantly higher serum AFABP and insulin levels and homeostasis model assessment-estimated insulin resistance ( HOMA-IR) . The Spearman correlation analysis showed that serum AFABP was positively correlated with NAFLD, BMI, HOMA-IR, serum insulin, blood glucose, TG, ALT, AST, and uric acid but negatively correlated with HDL. After adjustment for sex, age, and BMI, serum AFABP was positively correlated with NAFLD, HOMA-IR, serum insulin, blood glucose, TG, ALT, and uric acid, but had no significant correlation with HDL and AST. Conclusion Serum AFABP is closely associated with NAFLD and may be an independent plasma marker of this disease. AFABP plays a causative role in the pathogenesis of NAFLD.

Clinical features of primary biliary cirrhosis: a clinical analysis of 70 cases

Lu WeiTing, Jiang XingHuo, Guo HaiYan, Zhao JianXue

2013, 29(12): 926-928. DOI: 10.3969/j.issn.1001-5256.2013.12.013

Abstract(2819)

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Objective To investigate the clinical features of patients with primary biliary cirrhosis ( PBC) . Methods A retrospective analysis was performed on the clinical data of 70 inpatients diagnosed with PBC from January 2008 to March 2013. The initial symptoms, liver function, and antimitochondrial antibody ( AMA) subtypes ( M2, M4, and M9) of patients, as well as the pathological results of 3 cases, were recorded. The increases in alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , alanine phosphatase ( ALP) , and gamma-glutamyl transpeptidase ( GGT) were analyzed by Wilcoxon rank sum test. Results Of all patients, 84. 3% were females; the mean age was 59. 2 ± 8. 7 years. The main clinical manifestations included weakness ( 25. 7%) , itching ( 24. 3%) , discomfort in the upper right abdominal quadrant ( 18. 6%) , and abdominal distension ( 18. 6%) . Abnormal liver function was mainly characterized by significant increases in GGT ( 324. 5 ± 250. 4 U / L) and ALP ( 381. 1 ± 259. 0 U / L) . The number of patients with more than 5-fold increase in GGT was significantly higher than the numbers of patients with more than 5-fold increases in ALT, AST, and ALP ( u =-5. 861, P = 0. 000;u =-4. 036, P = 0. 000; u =-4. 445, P = 0. 000) . The numbers of patients with more than 2-fold increases in AST and ALP were significantly higher than the number of patients with more than 2-fold increase in ALT ( u =-4. 405, P = 0. 000; u =-3. 625, P = 0. 000) .Among all patients, 87. 1% were positive for antimitochondrial M2 antibody ( AM2A) , 31. 4% were positive for AM4A, and 11. 4% were positive for AM9A. Conclusion PBC, more common in females, is the chronic liver damage characterized by significant increases in GGT and ALP. Detection of AMA subtypes ( M2, M4and M9) is valuable for confirming the diagnosis of PBC.

Clinical efficacy of cyclophosphamide in treatment of primary sclerosing cholangitis

Cheng Peng, Yao JianNing, Wang ChunFeng

2013, 29(12): 929-931. DOI: 10.3969/j.issn.1001-5256.2013.12.014

Abstract(2819)

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Objective To investigate the clinical efficacy of cyclophosphamide in the treatment of primary sclerosing cholangitis ( PSC) .Methods Twenty-four patients with PSC who received treatment in the department of gastroenterology in our hospital from January 2004 to December 2012 were selected as subjects and divided into observation group ( n = 13) and control group ( n = 11) . The control group was treated with ursodesoxycholic acid, while the observation group with ursodesoxycholic acid plus cyclophosphamide. After four weeks of treatment, clinical outcome, changes in serum bilirubin levels, and adverse reactions were compared between the two groups. Categorical data were analyzed by Fisher exact probability test, and continuous data by independent-samples t test and paired-samples t test. Results Compared with the control group, the observation group had a significantly higher response rate ( 84. 62% vs 45. 45%, P = 0. 0489) , significantly more improvements in serum total and direct bilirubin levels ( t = 12. 45, P < 0. 001; t = 5. 60, P < 0. 001) , and a nonsignificantly higher incidence of adverse reactions ( 23. 08% vs 18. 18%, P = 0. 741) . Conclusion Cyclophosphamide has significant clinical efficacy and tolerable incidence of adverse events in the treatment of PSC, so it is worthy of application in clinical treatment.

Clinical application of absorbable clips in hepatectomy

Zhu Yu, Zhang Wei

2013, 29(12): 932-935. DOI: 10.3969/j.issn.1001-5256.2013.12.015

Abstract(2870)

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Objective To evaluate the feasibility of application of absorbable clips in hepatectomy for reducing intraoperative bleeding, operation time, and postoperative complications. Methods A retrospective analysis was performed on the clinical data of 315 patients who underwent hepatectomy in the department of hepatobiliary surgery from January 2010 to July 2012. These patients were divided into observation group ( n = 149) , among whom absorbable clips were used in hepatectomy, and control group ( n = 166) , among whom the conventional surgical approach was used. Intraoperative bleeding, operation time, bile leakage, surgical site infection, liver failure, material and hospitalization expenses, and reoperation due to active bleeding at surgical wound were evaluated. Continuous data were analyzed by t test, and categorical data were analyzed by chi-square analysis and Fisher's exact test. Results The intraoperative bleeding was significantly less in the observation group than in the control group ( 344. 59 ± 116. 78 vs 582. 90 ± 216. 17 ml, t = 11. 95, P < 0. 05) . The operation time was significantly shorter in the observation group than in the control group ( 205. 56 ± 45. 72 vs 270. 84 ± 33. 87 min, t = 14. 47, P < 0. 05) . The material expenses were significantly more in the observation group than in the control group ( 2849. 36 ± 84. 75 vs 567. 27 ± 56. 38 yuan, t =16. 21, P < 0. 05) , but there was no significant difference in hospitalization expenses between the observation group and control group ( 39 344. 52 ±521. 21 vs 38 872. 43 ±426. 05 yuan, t =0, P >0. 05) . After operation, bile leakage was found in one case in the observation group and 9 cases in the control group ( χ2= 5. 765, P < 0. 05) ; surgical site infection was found in 2 cases in the observation group and in 15 cases in the control group ( χ2= 9. 104, P < 0. 05) ; liver failure was found in 2 cases in the observation group and in 11 cases in the control group ( χ2= 5. 541, P < 0. 05) . No one underwent reoperation in the observation group, versus 6 cases in the control group ( χ2=7. 91, P < 0. 05) Conclusion The application of absorbable clips in hepatectomy can reduce intraoperative bleeding, operation time, and postoperative complications.

Clinical features of sinusoidal obstruction syndrome: an analysis of 35 cases and literature review

Zhang YanTing, Li Shuang, Zhou DongHui, Li Jun

2013, 29(12): 936-939. DOI: 10.3969/j.issn.1001-5256.2013.12.016

Abstract(2848)

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Objective To summarize the clinical features, diagnosis, and treatment of sinusoidal obstruction syndrome ( SOS) and review relevant literature and to improve the clinical diagnosis of this disease. Methods A retrospective analysis was performed on the medical histories, clinical manifestations, laboratory results, imaging findings, liver histopathology, treatments, and prognosis of 35 patients with SOS who were hospitalized at the First Affiliated Hospital of Nanjing Medical University from August 2008 to May 2013. Results Of all patients, 31 ( 88. 6%) had taken Gynura segetum, 2 had received other traditional Chinese medicines, and 2 had undergone allogeneic hematopoietic stem cell transplantation. The main symptoms included abdominal distention ( 100%) , ascites ( 91. 4%) , hepatalgia ( 62. 9%) , and jaundice ( 48. 6%) , as well as varying degrees of liver function damage. Ultrasound examination revealed unclear or thinner hepatic veins and slower or no blood flow. CT scans showed map-like heterogeneous enhancement in the liver. Pathological examination demonstrated local sinusoidal congestion, steatosis of some hepatocytes, hemorrhage in some liver tissue, and massive chronic inflammatory cell infiltration in the liver tissue and portal area. After treatment, 15 cases ( 42. 9%) showed improvement, and 20 cases ( 57. 1%) showed no response and were discharged. Conclusion Taking Gynura segetum is still the main cause of SOS in China. Early diagnosis and timely use of drugs for improving hepatic microcirculation and glucocorticoids are effective in improving the prognosis of SOS.

2013, 29(12): 962-966. DOI: 肝胆病杂志 2013,29(12),962-966

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2013, 29(12): 968-985. DOI: 肝胆病杂志 2013,29(12),968-985

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2013 No. 12

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2013 No. 12

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