中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

2014 No. 1

Display Method:
Editorial
Current development of liver transplantation in China
Zheng ShuSen, Yu Jun, Zhang Wu
2014, 30(1): 2-4. DOI: 10.3969/j.issn.1001-5256.2014.01.001
Abstract:

As the only effective way for the treatment of end- stage liver disease, liver transplantation has been developed rapidly in China over recent years. The latest developments of liver transplantation in China are reviewed, including establishment of selection criteria for the liver cancer recipients of liver transplantation——Hangzhou Criteria; latest application of salvage liver transplantation and downstaging therapy in liver transplantation for liver cancer; progress in liver transplantation combined with artificial liver support system for treatment of severe acute liver failure; breakthrough in technology innovation of living donor liver transplantation and organ donation and transplantation after cardiac death in China. Facing the problem of organ shortage, a scientific and standardized organ donation system should be established in line with the national conditions of China, so as to benefit the people and further improve the reputation of China in the international organ transplant community.

Therapeutic guidelines
Recommendations of long-term medical management of the pediatric patient after liver transplantation: 2013 Practice Guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation
Zhu Peng, Wang YuMing
2014, 30(1): 5-6. DOI: 10.3969/j.issn.1001-5256.2014.01.002
Abstract:
Discussions by experts
Prevention and management of recurrence and metastasis of hepatocellular carcinoma after liver transplantation
Ji Ru, Dou KeFeng, Xu Hui
2014, 30(1): 7-10. DOI: 10.3969/j.issn.1001-5256.2014.01.003
Abstract:
Hepatocellular carcinoma ( HCC) is still a prevalent gastrointestinal cancer. Liver transplantation ( LT) is one of the main means in the comprehensive treatment of HCC because it radically removes the tumor. However, tumor recurrence and metastasis after LT remain the main obstacles to long- term survival. In recent years, substantial progress has been made in the diagnosis and treatment of HCC thanks to the technological improvement and experience accumulation worldwide. The HCC indications for LT, prediction of HCC recurrence and metastasis, perioperative management in LT, and comprehensive treatment of recurrent HCC after LT are reviewed.
Clinical progress in donation after cardiac death liver transplantation in China
Lu: GuoYue, Qiu Wei
2014, 30(1): 11-13. DOI: 10.3969/j.issn.1001-5256.2014.01.004
Abstract:
Liver transplantation is an important treatment for end- stage liver disease, but donor shortage is becoming increasingly apparent, so donation after cardiac death ( DCD) , which is suitable for the national conditions of China and consistent with international standards, is an important measure for easing the organ shortage at the present stage. The tortuous development process of international DCD liver transplantation, including the definition and classification, ethical principles, indications, acquisition program, donation cases, and clinical results, is reviewed. It is considered that DCD donor liver is a solution to current donor shortage in liver transplantation in China. With the development of DCD liver transplantation, it will become an important part of liver transplantation in China.
Features of HCV recurrence in patients with HCV- related cirrhosis after liver transplantation and its antiviral and immunomodulatory therapies
Jiao Jian, Wang JiangBin
2014, 30(1): 14-17. DOI: 10.3969/j.issn.1001-5256.2014.01.005
Abstract:
The best choice of treatment for patients with HCV- related cirrhosis may be liver transplantation once liver decompensation occurs. Immunoregulatory drugs, especially immunosuppressants, may be a main causative factor for accelerated HCV recurrence after liver transplantation. How to control HCV infection while reducing graft rejection is a meaningful problem that needs to be solved. The current antiviral and immunomodulatory therapies after HCV- related liver transplantation are summarized. Analysis showed that proper immunosuppression and antiviral therapy in patients with HCV- related cirrhosis after liver transplantation are of great significance for preventing HCV recurrence, prolonging graft survival, and improving prognosis. Sudden change in immunosuppressive therapy, such as rapid withdrawal or changing the dose or type of immunosuppressant, may lead to HCV recurrence. Slow progressive reduction in steroid hormone and maintenance treatment with azathioprine may be beneficial.
Original articles_Liver transplantation
Prognos is of living donor liver transplantation performed during different periods in infants with biliary atresia: a single- center experience with 101 cases
Hua XiangWei, Xia Qiang, Zhang JianJun, Li QiGen, Xu Ning, Chen XiaoSong, Zhang Ming, Xue Feng, Han LongZhi, Wang Xin, Xia Lei, Luo Yi, Shen CongHuan, Xing TianYu, Xi ZhiFeng
2014, 30(1): 18-22. DOI: 10.3969/j.issn.1001-5256.2014.01.006
Abstract:

Objective To compared the prognosis between infants with biliary atresia ( BA) who underwent living donor liver transplantation ( LDLT) during 2006- 2009 and 2010- 2012 in the Department of Liver Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine and to evaluate the prognos is of LDLT performed during different periods. Methods A retrospective analysis was performed on the clinical data of 101 infants with BA who underwent LDLT from October 2006 to December 2012. These patients were divided into 2006- 2009 group and 2010- 2012 group according to the year the procedure was performed. The two groups were compared in terms of preoperative general data, intraoperative status, and treatment outcome. The Kaplan- Meier method was used for survival analysis; measurement data were analyzed by t test, and enumeration data were analyzed by Fisher exact probability test and chi- square test. Results The preoperative general data showed no significant difference between the two groups. Compared with the 2006- 2009 group, the 2010- 2012 group had significantly less intraoperative blood loss ( t = 2. 05, P = 0. 04) , a significantly shorter cold ischemia time of donor liver ( t = 3. 25, P < 0. 01) , and significantly lower incidence of postoperative biliary complications ( χ2= 4. 27, P = 0. 04) , pulmonary infection ( χ2= 4. 47, P = 0. 03) , and acute rejection ( P = 0. 03) . The 2010- 2012 group had significantly improved survival compared with the 2006- 2009 group; the 1 and 2 year cumulative survival rates for the 2010- 2012 group were 88. 4% and 88. 4%, respectively, versus 84. 4% and 75% for the 2006- 2009 group. Conclusion The development of surgical techniques, improvement in perioperative management, and standardized follow- up can significantly increase the success rate of surgery and survival rate and reduce postoperative complications in BA patients.

Rationality analysis of delivery method for hepatitis B immune globulin in patients with chronic HBV infection after liver transplantation
Wei XianYi, Wei Hong
2014, 30(1): 23-26. DOI: 10.3969/j.issn.1001-5256.2014.01.01-007
Abstract:

Objective To analyze the rationality of delivery method for hepatitis B immune globulin ( HBIG) in patients with chronic hepatitis B virus ( HBV) infection after liver transplantation and to investigate the guiding principle for medication. Methods Forty- four cases of hepatitis B- related liver transplantation who participated in the phase IV clinical trial of HBIG for intravenous injection from August 2008 to December 2010 were analyzed. These patients were divided into severe liver disease group, liver cancer group, and liver cirrhosis group. The positive rates of HBV DNA and HBeAg were compared between groups by chi- square test. The HBV DNA level was compared by analysis of variance. The correlation between blood concentration and half- life of HBIG at different doses and dosing intervals was analyzed by Pearson's correlation test. The titer of anti- HBs at one week after operation was compared between HBeAg- negative group and HBeAg-positive group and between high- HBV DNA group and low- HBV DNA group by t test. Cases of reinfection were also monitored. Results There were no significant differences in the positive rates of HBV DNA and HBeAg between the severe liver disease group, liver cancer group, and liver cirrhosis group ( χ2= 4. 871, P = 0. 088; χ2= 1. 079, P = 0. 583) . No significant differences in mean HBV DNA level were found between these groups ( F = 0. 895, P = 0. 418) . The Pearson's correlation analysis revealed a significant negative correlation between the blood concentration and half- life of HBIG ( r = 0. 988, P = 0. 012) . The tier of anti- HBs showed no significant differences between HBeAg- negative group and HBeAg- positive group and between high- HBV DNA group and low- HBV DNA group one week after operation ( t = 1. 757, P = 0. 087) . No cases of reinfection were found during the observation period. Conclusion It is necessary to give HBIG 4000 IU during operation and 2000 IU daily for 6 days after operation, and the dose should be increased appropriately when the patients have relatively high viral load in serum. For the patients whose serological markers of hepatitis B become negative, the antibody level can be maintained at about 100 IU / L until the next administration if 600 IU of HBIG is given once a month by intramuscular injection.

Antiviral therapy for recurrent hepatitis C after liver transplantation and its effect on liver fibrosis
Zhou ShuangNan, Sun YanLing, Zhang Min, Liu ZhenWen, Gao YinJie, Xiang Yi, Zhou Xia, Tang RuJia, He Xi, Su HaiBin
2014, 30(1): 27-29. DOI: 10.3969/j.issn.1001-5256.2014.01.008
Abstract:

Objective To perform antiviral therapy in patients with recurrent hepatitis C after liver transplantation and to study the efficacy of antiviral therapy and its effect on the progression of liver fibrosis. Methods Twenty- three patients with recurrent hepatitis C after liver transplantation who were admitted to our hospital from June 2005 to December 2012 were treated with interferon plus ribavirin. Virological response, adverse reactions, and liver pathology were observed before and after treatment. Enumeration data were expressed as number of cases and constituent ratio; comparison of anti- fibrotic effect between the groups with different responses to antiviral therapy was made by rank sum test. Results Twelve patients discontinued treatment due to adverse reactions. Eighteen patients achieved end- of- treatment virological response ( ETVR) ; 6 of the 18 patients achieved sustained virological response ( SVR) , and 12 relapsed after treatment. Nineteen patients underwent liver biopsy before and after treatment. In the SVR group, liver fibrosis was improved in 3 cases, stable in 1 case, and worse in 0 case; in the relapse group, liver fibrosis was improved in 2 cases, stable in 3 cases, and worse in 5 cases; in the patients without response, liver fibrosis was improved in 0 case, stable in 1 case, and worse in 4 cases. There were significant differences in anti- fibrotic effect between the three groups ( χ2= 7. 330, P = 0. 026) . Conclusion SVR rate is low in patients who receive antiviral therapy for recurrent hepatitis C after liver transplantation. Effective antiviral therapy can delay the progression of liver fibrosis, and patients with SVR have the most improvement in liver fibrosis.

Original articles_Viral hepatitis
Epidemiological features and serological changes in sporadic acute hepatitis B among adults: an analysis of 202 cases
Zheng DongChun, Nie YuanXia, Liang HaiLin, Hu YueLin, Cheng Xiao, Feng XiaoXia, Chen YongPing
2014, 30(1): 30-33. DOI: 10.3969/j.issn.1001-5256.2014.01.009
Abstract:
Objective To investigate the epidemiological features and serological changes in sporadic acute hepatitis B ( AHB) among adults. Methods A total of 202 adult patients with AHB were selected as subjects. The epidemiological data of patients were collected, and follow- up was regularly performed for 48 weeks to monitor alanine aminotransferase ( ALT) , total bilirubin ( TBil) , hepatitis B virus ( HBV) DNA, and serological markers of HBV ( HBV- Ms) . Categorical data were analyzed by nonparametric rank sum test; comparison of continuous data between groups was made by independent- samples t test; correlation analysis was performed by Pearson test. Results Among AHB patients, there were more males than females; the mean age was 42. 99 ± 7. 31 years. Of all cases, 29. 20% developed the disease by micro blood transmission, 17. 33% by heterosexual transmission, and 48. 02% by unknown route of transmission. Only 49. 01% of the patients were positive for HBV DNA when visiting the hospital. The HBV DNA- positive group had a serum ALT level of 1973. 2 ± 445. 3 U / L, and the HBV DNA- negative group had a serum ALT level of 1500. 3 ± 287. 7 U / L, without significant difference between the two groups ( t = 1. 852, P > 0. 05) . The HBV DNA- positive group had a serum TBil level of 118. 40 ± 37. 33 μmol / L, and the HBV DNA- negative group had a serum TBil level of 81. 06 ± 23. 24 μmol / L, with significant difference between the two groups ( t = 2. 765, P < 0. 01) . Eight patterns of HBV- Ms were found in the patients who first visited the hospital; in the most frequent pattern, which was seen in 39. 11% of patients, HBsAg, HBeAg, anti- HBc, and anti- HBc IgM were detected, and in the second most frequent pattern, which was seen in 29. 27% of patients, HBsAg, anti- HBe, anti- HBc, and anti- HBc IgM were detected. The monitoring of HBV- Ms in 99 AHB patients who had complete data showed that the negative conversion rate of HBsAg was 97. 98%, and the average negative conversion time was 2. 5 weeks; the cumulative positive conversion rate of anti- HBs was 83. 84%; the negative conversion rate of HBeAg among HBeAg-positive patients was 100%, and all showed negative conversion within 4 weeks of onset; the positive conversion rate of anti- HBe was 80. 81%in the 48- week follow- up; serum anti- HBc remained detectable. In the acute phase, the 202 patients had HBsAg levels below 200 ng / ml, and the HBsAg level was inversely proportional to the negative conversion time of HBsAg. Conclusion Micro blood transmission and sexual transmission have become the main routes of transmission for sporadic AHB among adults. Rapid HBV DNA clearance and rapid seroconversion of HBsAg and HBeAg are the characteristics of sporadic AHB among adults. The HBsAg level in acute phase is helpful for determining the outcome of AHB. In this study, 2 cases were finally converted into chronic HBV infection.
Original articles_Liver fibrosis and liver cirrhosis
Analysis of noninvasive predictive indices of esophageal varices in patients with posthepatitic cirrhosis
Liu WenNa, Li Rong, Xie YuanYuan, Dai GuangRong
2014, 30(1): 34-38. DOI: 10.3969/j.issn.1001-5256.2014.01.010
Abstract:
Objective To investigate the clinical significance of noninvasive predictive indices of esophageal varices ( EV) in patients with posthepatitic cirrhosis. Methods Sixty- four patients with posthepatitic cirrhosis, who were hospitalized in the Affiliated Hospital of Yan'an University from February 2011 to January 2013, were enrolled in this study. All patients underwent gastroscopy to evaluate EV. The diameter of portal vein ( PV) , spleen length ( SL) , spleen thickness ( ST) , and degree of ascites were determined by abdominal ultrasound, and the spleen index ( SI) was calculated. Prothrombin time ( PT) , serum albumin ( Alb) , etc., were measured by laboratory testing. Liver function was assessed by Child- Pugh classification. The correlation between each index and EV or severe EV was analyzed based on area under the receiver operating characteristic curve. For normally distributed data, comparison of means between groups was made by one- way analysis of variance; for non- normally distributed data, comparison between groups was made by Kruskal- Wallis H test; correlation analysis was performed by Kendall's rank correlation test. Results Among the 64 patients, 48 ( 75%) had various degrees of EV, including 14 mild cases, 12 moderate cases, and 22 severe cases. There were significant differences in SI, Model for End- Stage Liver Disease ( MELD) score, MELD- Na score between the patients with EV and those without EV ( P < 0. 05) . PV and SI showed significant differences between the mild cases and severe cases ( P < 0. 05) ; SI showed significant differences between the mild cases and moderate cases and between the moderate cases and severe cases ( P < 0. 05 for both) . Alb showed significant difference only between the patients without EV and severe cases ( P < 0. 01) . No significant difference in PT was found between each two patient groups ( P > 0. 05) . As the severity of EV increases, PV, SI, MELD score, and MELD- Na score tended to increase, Alb showeda downward trend, and PT demonstrated no significant changes. The degree of EV was positively correlated with Child- Pugh score ( t = 0. 483, P < 0. 05) , and there was no correlation between the degrees of ascites and EV ( P > 0. 05) . When SI was higher than 58. 96 cm2, its sensitivity, specificity, positive predictive value, and negative predictive value for EV were 91. 7%, 100. 0%, 100. 0%, and 80. 1%, respectively. When SI was higher than 70. 56 cm2, its sensitivity, specificity, positive predictive value, and negative predictive value for EV were 86. 4%, 90. 5%, 96. 5%, and 68. 9%, respectively. Conclusion There is a certain correlation between degree of EV and Child-Pugh score. PV, Alb, SI, MELD score, and MELD- Na score have predictive values for EV, and SI may be used as a sensitive noninvasive predictive index for EV and severe EV in patients with posthepatitic cirrhosis.
Original articles_Hepatopancreatobiliary tumor
Prognostic factors in patients with hepatitis B- related primary liver cancer treated with transcatheter arterial chemoembolization
Yin Hao, Xiao Lin, Zhan XinYu, Zhang ZeGao, Lu XiaoBo, Zhang YueXin
2014, 30(1): 50-54. DOI: 10.3969/j.issn.1001-5256.2014.01.011
Abstract:

Objective To analyze the prognostic factors in patients with hepatitis B- related primary liver cancer treated with transcatheter arterial chemoembolization ( TACE) and to provide a basis for properly selecting indications and treatment regimen in clinical practice. Methods A total of 140 patients with hepatitis B- related primary liver cancer, who underwent TACE in our hospital from January to December 2010, were enrolled in this study. Follow- up was continued until December 2011 to observe the patients' survival within 12 months after treatment. The Kaplan- Meier method and log- rank ( Mantel- Cox) test were used for univariate and multivariate analyses to identify the prognostic factors in patients with hepatitis B- related primary liver cancer treated with TACE. Results The univariate analysis showed that age, portal vein metastasis, peritoneal metastasis, pleural metastasis, Child- Pugh classification, bilirubin, alanine aminotransferase, number of interventional therapies, and antiviral therapy were prognostic factors in patients with hepatitis B- related primary liver cancer treated with TACE. There was significant difference in 12- month survival curve between patients treated with TACE plus antiviral therapy and those who did not receive antiviral therapy ( P < 0. 05) . The multivariate analysis showed that portal vein metastasis ( P = 0. 004) , peritoneal metastasis ( P = 0. 009) , bilirubin level ( P = 0. 017) , antiviral therapy ( P = 0. 000) , and number of TACE therapies ( P = 0. 000) were prognostic factors in patients with hepatitis B- related primary liver cancer treated with TACE. Conclusion Portal vein metastasis, peritoneal metastasis, and bilirubin level may be independent risk factors in patients with hepatitis B- related primary liver cancer treated with TACE, and antiviral therapy and number of interventional therapies may be protective factors for these patients.

Clinical effect of transcatheter arterial chemoembolization combined with tegafur, gimeracil, and oteracil potassium in treatment of advanced hepatocellular carcinoma
Zhang Cheng, Chen ChangNan, Lin YunXiao, Su MingJun, Pan QiZuo, Chen ChanJuan, Rong TingJie, Xie Feng
2014, 30(1): 55-57. DOI: 10.3969/j.issn.1001-5256.2014.01.012
Abstract:

Objective To evaluate the clinical effect of transcatheter arterial chemoembolization ( TACE) alone or combined with tegafur, gimeracil, and oteracil potassium ( S- 1) in the treatment of advanced hepatocellular carcinoma ( HCC) . Methods Sixty patients with unresectable advanced HCC, who were admitted to our hospital from August 2009 to October 2010, were randomly divided into treatment group ( n =30) and control group ( n =30) . The treatment group was treated with TACE combined with oral S-1, and the control group with TACE alone. The response rates, disease control rates, survival rates, and adverse reactions of both groups were evaluated. Categorical data were analyzed by chi- square test; survival analysis was performed by Log- rank test. Results Compared with the control group, the treatment group had a significantly higher response rate ( 63. 3% vs 33. 3%, χ2= 5. 406, P = 0. 020) , a significantly higher disease control rate ( 86. 7% vs 43. 3%, χ2= 12. 308, P = 0. 000) , a significantly higher 1- year survival rate ( 77. 3% vs 51. 5%, χ2= 4. 593, P = 0. 032) , and a significantly higher 2- year survival rate ( 34. 8% vs 10. 4%, χ2= 4. 812, P = 0. 028) . Mild adverse reactions ( grade Ⅰ or Ⅱ) were seen in the two groups, including nausea, vomiting, diarrhea, and bone marrow suppression. These adverse reactions could be reduced by symptomatic treatment and showed no significant differences between the two groups ( P > 0. 05) . Conclusion The combination therapy with S- 1 plus TACE is effective in the treatment of advanced HCC and is worth further study.

Original articles_Biliary diseases
Surgical treatment of cholangiolithiasis with cavernous transformation of the portal vein: a review and analysis of 18 cases
Tang CaiXi, Zhao ZhiJian, Feng Bin, Yang KaiQing
2014, 30(1): 39-41. DOI: 10.3969/j.issn.1001-5256.2014.01.013
Abstract:
Objective To analyze the clinical features of cholangiolithiasis with cavernous transformation of the portal vein ( CTPV) and to investigate the surgical treatment of this disease. Methods A retrospective analysis was performed on the clinical data of 18 patients with cholangiolithiasis with CTPV who were admitted to our hospital from January 2009 to December 2012; the clinical data included treatment method, surgical approach, time of operation, blood loss during operation, complications, and stone clearance rate. Results No death was seen in these cases. Eight cases underwent endoscopic retrograde cholangiopancreatography, and 3 cases underwent stone removal through the porta hepatis. The time of operation was 2. 9- 5. 4 h ( mean, 3. 8 h) . The blood loss during operation was 150- 2630 ml ( mean, 430 ml) . The rate of residual stones was 11%. Conclusion For patients with cholangiolithiasis who have a history of chronic liver diseases and who have undergone biliary tract surgery several times, especially those with recurrent biliary tract infection, examination should be carried out to detect CTPV, and individualized therapy should be determined before operation according to imaging data, liver function, and general condition. It is better to remove all stones using a choledochoscope during operation, and ultrasound- assisted hepalobectomy can be performed if necessary to remove intrahepatic stones.
Original articles_Pancreatic diseases
Spleen- preserving laparoscopic distal pancreatectomy: a report of 12 cases from a single institution
Qiu FuNan, Wu JiaYi, Tian YiFeng, Lai ZhiDe, Zhou SongQiang, Yan MaoLin, Chen Zhong, Wang YaoDong
2014, 30(1): 42-45. DOI: 10.3969/j.issn.1001-5256.2014.01.014
Abstract:
Objective To investigate the safety, feasibility, and operation skills of spleen- preserving laparoscopic distal pancreatectomy ( SPLDP) in the treatment of tumors in the body and tail of the pancreas. Methods A retrospective analysis was performed on the medical records of 12 patients who underwent SPLDP at Fujian Provincial Hospital from October 2008 to December 2012; 11 cases had the spleen preserved by Kimura method, and the other one had the spleen preserved by Warshaw method. Results All patients successfully underwent SPLDP without conversion to laparotomy. The mean operative time was 172. 5 min ( 120- 240 min) ; the mean intraoperative blood loss was 191. 7 ml ( 50- 400 ml) ; the mean postoperative length of hospital stay was 9. 5 days ( 4- 25 days) . Three patients had grade B pancreatic fistula after operation and were cured after adequate drainage. After operation, solid pseudopapillary tumor of the pancreas was pathologically confirmed in 4 cases, pancreatic neuroendocrine carcinoma in 2 cases, pancreatic islet cell tumor in 2 cases, pancreatic pseudocyst in 2 cases, and pancreatic cystadenoma in 2 cases. The duration of postoperative follow- up was 6- 51 months, and no diabetes and tumor recurrence were detected. Conclusion SPLDP is safe and feasible in the treatment of benign and low- grade malignant tumors in the body and tail of the pancreas.
Clinical analysis of relationship between gallstone morphology and biliary pancreatitis
Zhang Peng, Yu CongHui
2014, 30(1): 46-49. DOI: 10.3969/j.issn.1001-5256.2014.01.015
Abstract:
Objective To investigate the relationship between gallstone morphology and acute pancreatitis. Methods A total of 110 patients with biliary pancreatitis, who were admitted to our hospital from February 2011 to February 2013, were selected as pancreatitis group, while 110 patients with gallstones were selected as non- pancreatitis group. The sizes, number, shapes, and textures of gallstones were compared between the two groups, and the relationship between gallstone morphology and pancreatitis was analyzed. Comparison between groups was made by chi- square test. Results There were significant differences in the sizes, number, and shapes of gallstones between the pancreatitis group and non- pancreatitis group ( χ2= 41. 146, 27. 150, and 13. 839, P < 0. 01 for all comparisons) . Stone texture also showed significant difference between the two groups ( χ2= 8. 000, P < 0. 05) . Of the patients with mild acute pancreatitis, 66. 36% had gallstone sizes of < 3 mm, and 17. 89% had gallstone sizes of 3- 10 mm; of the patients with severe acute pancreatitis, 86. 67% had gallstone sizes of < 3 mm, and 13. 33% had gallstone sizes of 3- 10 mm. Conclusion Among the patients with gallstones, those who have small, multiple, soft, and brittle stones have an increased incidence of pancreatitis; the decrease in stone sizes leads to an increasing trend in the severity of pancreatitis.
Original articles_Others
Analysis of endotoxin and endothelin-1 levels in patients with type 1 hepatorenal syndrome
Gao BaoXiu, Nie Xin, He Yong, Yang ZhengBing, Luo TongXing, Song HaoLan, Li GuiXing
2014, 30(1): 58-61. DOI: 10.3969/j.issn.1001-5256.2014.01.016
Abstract:

Objective To analyze the clinical data, laboratory parameters, infection rate, and serum procalcitonin ( PCT) and ET- 1 levels of patients with cirrhotic ascites and type 1 hepatorenal syndrome ( HRS) and to investigate the roles of endotoxin and ET- 1 in the development of HRS. Methods Between January 2009 and October 2012, 56 inpatients with cirrhotic ascites and type 1 HRS ( HRS group) and 60 inpatients with cirrhotic ascites who had normal renal function ( non- HRS group) were included in the study. Their general data, causes of liver cirrhosis, infection rates and types, Child- Pugh classification, systemic inflammatory response syndrome ( SIRS) score, and mean arterial pressure ( MAP) were recorded; blood samples were collected to evaluate liver and renal function and measure serum electrolyte, PCT, and ET- 1 levels. The clinical data and laboratory parameters were compared between the two groups. Categorical data were analyzed by chi-square test; comparison of normally distributed continuous data between the two groups was made by independent- samples t test, and comparison of non- normally distributed continuous data between the two groups was made by Wilcoxon rank sum test. Results The infection rate of HRS group ( 75. 0%) was significantly higher than that of non- HRS group ( 28. 4%) ( χ2= 11. 91, P < 0. 05) . The PCT and ET- 1 levels and SIRS score of HRS group [8. 72 ( 3. 14, 31. 68) ng / L, 13. 04 ± 2. 82 pg / ml, and 2. 1 ± 1. 1]were significantly higher than those of non-HRS group [0. 11 ( 0. 04, 0. 45) ng / L, 5. 76 ± 1. 68 pg / ml, and 0. 6 ± 0. 6] ( P < 0. 05) . In addition, the HRS group had significantly higher serum urea, creatine, cystatin C, and K levels than the non- HRS group ( P < 0. 05) , while the HRS group had significantly lower Na and Cl levels than the non- HRS group ( P < 0. 05) . There were no significant differences in ALT and AST levels between the two groups ( P > 0. 05) . Conclusion Endotoxin causes elevated expression of ET- 1, and ET- 1 induces renal perfusion deficiency by intense renal vasoconstriction, thus leading to type 1 HRS. Endotoxin and ET- 1 are closely associated with the development of type 1 HRS.

ROC analysis of prognostic factors in Chinese patients with primary biliary cirrhosis
Zhao DanTong, Liao HuiYu, Liu YanMin, Huang ChunYang, Zhang HaiPing, Sun LiMei, Ma YinXue, Zhao Yan, Yan HuiPing
2014, 30(1): 62-66. DOI: 10.3969/j.issn.1001-5256.2014.01.017
Abstract:

Objective To investigate and assess prognostic factors for survival in patients with primary biliary cirrhosis ( PBC) by receiver operating characteristics ( ROC) curves and Kaplan- Meier methods. Methods A total of 155 patients were identified and followed. Terminal events were death and / or liver transplantation. The optimal thresholds for continuous variables were established by ROC curves and cumulative proportions of patients developing an event were estimated using the Kaplan- Meier method. Results During a median follow- up period of 50 months ( range: 6- 316) , 36 patients died or underwent liver transplantation. Age 55 years or older, Total Bilirubin ( TBil) > 1. 8mg / dl, serum IgG > 17. 2 g / L, and Mayo risk score ( MRS) > 6. 11 were associated with mortality. With four markers in series test, their sensitivity was 99. 18%, specificity was 5. 56%, the total coincidence rate was 79. 23%; With four markers in parallel test, their sensitivity was 100%, specificity was 24. 51%, the total coincidence rate was 40. 77%. Age 55 years or older ( P = 0. 001) , TBil > 1. 8mg / dl ( P = 0. 005) , serum IgG > 17. 2 g / L ( P = 0. 001) , and MRS > 6. 11 ( P < 0. 000 1) were significantly associated with mortality. Conclusion Age 55 years or older, TBil > 1. 8mg / dL, serum IgG > 17. 2 g / L, and MRS > 6. 11 might predict survival for PBC patients with liver cirrhosis.

Case reports
One case of liver transplantation for liver failure due to adult- onset Still's disease
Wang GuangYi, Shi XiaoJu, Jiang Chao, Sun XiaoDong, Qiu Wei, Lu: GuoYue
2014, 30(1): 67-68. DOI: 10.3969/j.issn.1001-5256.2014.01.018
Abstract:
Efficacy and safety of interferon plus ribavirin in elderly patients with chronic hepatitis C: report of 4 cases
Cai ShaoPing, Zhang WenJin, He WeiPing, Fan ZhenPing, Ji YingJie
2014, 30(1): 69-71. DOI: 10.3969/j.issn.1001-5256.2014.01.019
Abstract:
One case of nephrotic syndrome complicated by decompensated hepatitis C cirrhosis treated with hormone and interferon
Liu YuanYuan, Guo XiaoLin, Jin JingLan
2014, 30(1): 72-73. DOI: 10.3969/j.issn.1001-5256.2014.01.020
Abstract:
One case of hepatic cirrhosis with tuberculous pleurisy
Li ZePeng, Zhao PengTao, Chi XiaoLing, Xiao HuanMing, Xie YuBao
2014, 30(1): 74-74. DOI: 10.3969/j.issn.1001-5256.2014.01.021
Abstract:
Reviews
Incidence and prevention of liver transplantation- related cardiovascular complications
Li JiangBin, Du XiLin, Dong Rui, Yin JiKai, Lu JianGuo
2014, 30(1): 75-77. DOI: 10.3969/j.issn.1001-5256.2014.01.022
Abstract:
Liver transplantation is an effective treatment for acute liver failure, decompensated cirrhosis, hepatocellular carcinoma, and other end- stage liver diseases. In recent years, with the improvements in patients' understanding of medical technology and their requirement for postoperative quality of life, liver transplantation has become a common surgery in clinical practice. The causes and preventive methods for liver transplantation- related cardiovascular complications are reviewed from the aspects before, during, and after liver transplantation, aiming at a better understanding and guidance for clinical liver transplantation.
Role of hepatitis B virus X protein in development and progression of primary liver cancer
Liao Kai, Zhang LeiDa
2014, 30(1): 78-81. DOI: 10.3969/j.issn.1001-5256.2014.01.023
Abstract:
Hepatitis B virus ( HBV) X protein ( HBx) is a multifunctional protein encoded by HBV X gene. It plays a regulatory role in gene transcription, cell signal transduction, cell proliferation and transformation, cell cycle, and cell apoptosis. Currently, HBx is considered to play an important role in the development and progression of HBV- related hepatocellular carcinoma ( HCC) . The relationship of HBx with oncogene, antioncogene, cell proliferation, cell apoptosis, invasion and metastasis of liver cancer, and liver cancer stem cells is presented, and the role of HBx in the development and progression of HCC is reviewed.
Effects of sex hormones on stem cells and stem cell therapy for liver fibrosis
Yan XiaoMing, Xiao Ping, Zhang LiTing, Fang XueQin, Luo JingYi, Li JunFeng
2014, 30(1): 82-85. DOI: 10.3969/j.issn.1001-5256.2014.01.024
Abstract:
Substantial progress has been made in the stem cell therapy for liver fibrosis. However, the therapeutic effect is limited by decreased self- renewal of stem cells during migration. Therefore, to improve the self- renewal of stem cells after transplantation is urgent and essential for the successful application of stem cells in clinical practice. Current studies have shown that sex hormones have an impact on the self- renewal of stem cells. The effects of estrogens and androgens on the self- renewal of various stem cells and the functional differences between the stem cells from persons of different sexes are reviewed. Moreover, the effect of sex hormones on stem cell therapy for liver fibrosis is discussed. It is considered that sex hormones have significant theoretical and clinical values for improving the self- renewal of stem cells and selecting appropriate stem cells in the stem cell therapy for liver fibrosis.
Significance of factor V Leiden mutation in Budd- Chiari syndrome and portal vein thrombosis
Hu FengRong, Gao Fan, Yang Qing, Qi XingShun
2014, 30(1): 86-89. DOI: 10.3969/j.issn.1001-5256.2014.01.025
Abstract:
Budd- Chiari syndrome and portal vein thrombosis are two rare vascular disorders of the liver and may be complicated by severe diseases like liver failure and portal hypertension. Studies have shown that factor V Leiden ( FVL) mutation is an important risk factor for both Budd- Chiari syndrome and portal vein thrombosis in Western countries. However, FVL mutation is rarely observed in Chinese patients with Budd- Chiari syndrome. The significance of FVL mutation in the pathogenesis of Budd- Chiari syndrome and portal vein thrombosis is reviewed. It is suggested that prospective studies regarding the prevalence of FVL mutation in Chinese patients with portal vein thrombosis are warranted to judge the necessity of screening for FVL mutation.