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

2014 No. 6

Display Method:
Editorial
The challenges to hepatitis C research in era of direct antiviral agents
Zhong Jing, Tao WanYin
2014, 30(6): 481-484. DOI: 10.3969/j.issn.1001-5256.2014.06.001
Abstract:
Hepatitis C virus ( HCV) is an important human pathogen that causes chronic viral hepatitis worldwide. HCV infection, often persistent and asymptomatic, could lead to liver fibrosis /cirrhosis and hepatocellular carcinoma. The interferon /ribavirin therapy has been widely used for treating chronic hepatitis C, but it is not always effective and has strong side effects. The development of small- molecule direct antiviral agents ( DAA) has greatly improved the curing efficiency of chronic hepatitis C therapeutics and will likely replace the interferon- based therapy in the future. However, these developments do not necessarily suggest that the problems of chronic hepatitis C have been completely solved. The HCV research is still facing many challenges in this new DAA era.
Therapeutic guidelines
EASL recommendations on treatment of Hepatitis C 2014 (April 2014)
Liu HongHong, Luo ShengQiang
2014, 30(6): 1-6. DOI: 10.3969/j.issn.1001-5256.2014.06.026
Abstract:
Evaluation for liver transplantation in adults: 2013 Practice Guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation
Zhou Xia, Zhang Min
2014, 30(6): 7-9. DOI: 10.3969/j.issn.1001-5256.2014.06.027
Abstract:
Discussions by experts
Re- understanding of refractory hepatitis C: progress in antiviral therapy strategies for hepatitis C
Dou XiaoGuang, Ding Yang
2014, 30(6): 485-488. DOI: 10.3969/j.issn.1001-5256.2014.06.002
Abstract:
It has been nearly 20 years from the discovery of hepatitis C virus ( HCV) and clinical diagnosis of hepatitis C to antiviral therapy with interferon, and significant progress has been made. Substantial changes have taken place in both the concept and strategy for antiviral treatment of hepatitis C, with more and more direct- acting antiviral agents emerging in recent years; these changes are as follows: from the control of HCV to clinical cure, from a sustained virologic response ( SVR) rate around 30% with conventional interferon therapy to an SVR rate of 70%- 80% with standard therapy with pegylated interferon and ribavirin, and from evaluating the difficulty of treatment based on genotypes and viral load to determining the treatment strategy according to host IL28B genotypes and response patterns ( rapid virologic response and complete early virologic response) . The progress in antiviral therapy strategies for hepatitis C is systematically reviewed for re-understanding of refractory hepatitis C.
Diagnosis and treatment of acute hepatitis C
Zhao Ning, Li ZhiWei
2014, 30(6): 489-492. DOI: 10.3969/j.issn.1001-5256.2014.06.003
Abstract:
Acute hepatitis C is an acute infectious disease caused by hepatitis C virus. Accurate diagnosis and proper treatment are very important for preventing the progression of this disease. Recent research advances in acute hepatitis C, including the epidemiological and clinical features, diagnosis, and treatment of acute hepatitis C, are reviewed, in order to provide a basis for better understanding of acute hepatitis C and proper diagnosis and treatment of this disease among clinicians.
Recent progress in direct- acting antiviral agents for chronic hepatitis C
Li MinRan, Xu XiaoYuan
2014, 30(6): 493-495. DOI: 10.3969/j.issn.1001-5256.2014.06.004
Abstract:
The current standard treatment for hepatitis C virus ( HCV) infection is a combination of pegylated interferon ( PEG- IFN) and ribavirin. However, it remains incurable in some patients. In recent years, direct acting antiviral agents ( DAAs) that target specific HCV enzymes in HCV life cycle have been developed rapidly. A combination of PEG- IFN, ribavirin, and DAAs can increase the sustained virological response rate in patients with chronic hepatitis C ( CHC) . For patients who cannot use or tolerate interferon therapy, a combination of various DAAs has good efficacy. Therefore, DAAs bring new hope for the treatment of CHC.
Original articles_Viral hepatitis
Association between serum lipid levels and antiviral treatment outcome in patients with chronic hepatitis C
Shi Jia, Shen Zhen, Miao Hui, Yang ZongGuo, Xu QingNian, Lu YunFei, Lyu Ying, Chen XiaoRong
2014, 30(6): 496-500. DOI: 10.3969/j.issn.1001-5256.2014.06.005
Abstract:

Objective To investigate the association between serum lipid levels and antiviral treatment outcome in chronic hepatitis C ( CHC) patients. Methods A total of 171 treatment-naive CHC patients were included in the present retrospective study and received a standard therapy of pegylated interferon ( PEG- IFN) plus ribavirin. Serum levels of total cholesterol ( TC) , triglycerides ( TG) , low- density lipoprotein cholesterol ( LDL- C) , high- density lipoprotein cholesterol ( HDL- C) , apolipoprotein A ( apoA) , apolipoprotein B ( apoB) , and other vital indicators in laboratory were determined, and their relationships with treatment responses, hepatitis C virus ( HCV) genotypes, and therapy time points ( for non- 1b type, 0, 12, and 24 weeks; for 1b type, 0, 24, and 48 weeks) were analyzed. For normally distributed measurement data, values were expressed as mean ± SD, and statistical analysis was performed by t test and ANOVA; for non- normally distributed data, values were expressed as median and interquartile range, and statistical analysis was performed by rank sum test; for categorical variables, values were expressed as frequency ( constituent ratio) , and statistical analysis was performed by chi- square test. Univariate and multivariate logistic regression analyses were performed to determine prognostic factors. Results Among the 171 CHC patients receiving PEG- IFN plus ribavirin, 81. 87% achieved a sustained virological response ( SVR) , and 18. 13% did not; SVR patients showed significantly lower TG and apoB levels than non- SVR patients ( P < 0. 05) . Compared with patients infected with HCV- 1b and HCV- 6a, those with HCV- 3 infection had lower serum levels of TC, LDL- C, apoA, and apoB ( P < 0. 05) , while the opposite results were observed in terms of the levels of alanine aminotransferase and aspartate aminotransferase ( P < 0. 05) . In the SVR group, significant increases in TG and apoB were observed at the end of treatment process, while a significant decrease in HDL- C was also noted ( P <0. 05) . However, no significant changes in serum lipids were observed in non- SVR patients. The univariate logistic regression analysis revealed that SVR was closely related to the following factors: age ≤50 years, HCV genotype non- 1b, TG ≤3. 11 mmol /L, and apoB≤0. 63 g/L ( P <0.05) . The multivariate logistic regression analysis indicated that patients with CHC were more likely to achieve a SVR if they were ≤50 years old with a serum apoB level of ≤0. 63 g /L. Conclusion Serum lipid levels and age are closely related to the clinical outcome of CHC. Age ( ≤50 years) and serum apoB level ( ≤0. 63 g /L) are two independent predictors for SVR in CHC patients.

Effect of HCV on disease progression in patients with HIV /HCV coinfection
Liu JinHua, Zhao Yan, Sun HuanQin, Liu Ning, Qiao GuiFang, Wang ZiKang, Xu Jie, Li Ang, Zhang YongHong
2014, 30(6): 501-504. DOI: 10.3969/j.issn.1001-5256.2014.06.006
Abstract:
Objective To analyze the effect of hepatitis C virus ( HCV) on disease progression in patients with human immunodeficiency virus ( HIV) /HCV coinfection. Methods Twenty- nine patients with HIV /HCV coinfection and 20 patients with HIV infection alone, who visited Beijing YouAn hospital for follow- up in August 2012, were enrolled. The two groups of patients were matched for age, sex, time and route of HIV infection, and HIV subtypes. The liver function and fibrosis were evaluated by biochemical testing of peripheral blood and FibroScan. CD4+and CD8+T cell counts were determined by flow cytometry. Results The levels of alanine aminotransferase, aspartate aminotransferase, and total bilirubin for the HIV /HCV coinfection group were 76. 16 ± 81. 25 U /L, 87. 66 ± 71. 32 U /L, and 14. 21 ± 9. 56μmol/L, respectively, significantly higher than those for the HIV infection group ( 27. 74 ±20. 63 U/L, 45. 65 ±16. 95 U/L, and 10. 26 ±3. 22 μmol /L) ( P = 0. 004, 0. 005, and 0. 046) . Compared with the HIV infection group, the HIV /HCV coinfection group had a nonsignificantly increased liver stiffness ( t = 1. 889, P = 0. 080) , a significantly higher viral load ( 3. 66 ± 0. 97 lg copies /ml vs 3. 02 ± 0. 90 lg copies /ml, t = 2. 251, P = 0. 030) , significantly lower CD4+T cell count and CD4+/CD8+ratio ( 374. 25 ± 185. 48 cells /μl vs 496. 45 ±230. 98 cells /μl, P = 0. 048; 0. 33 ± 0. 17 vs 0. 46 ± 0. 27, P = 0. 043) , and a nonsignificantly higher incidence of AIDS ( 27. 59% vs5. 00%, P = 0. 063) . Conclusion HCV exacerbates liver damage, enhances HIV replication, increases the impairment of immune function in patients with HIV /HCV coinfection, so it can accelerate the disease progression in these patients.
Epidemiological features and disease spectrum of hepatitis C in Qinghai Province, China: analysis of 110 cases
Huang YanWu, Han FengJuan
2014, 30(6): 505-507. DOI: 10.3969/j.issn.1001-5256.2014.06.007
Abstract:
Objective To investigate the epidemiological features and disease spectrum of inpatients with hepatitis C in recent years and to provide reference for the control of hepatitis C. Methods A retrospective study of demography, epidemiology, and laboratory examination was performed in 110 hospitalized patients with hepatitis C. Results Of the 110 patients, 60 were male and 50 were female, with a male-to- female ratio of 1. 2: 1. The main transmission routes included blood product transfusion ( 33. 6%) , surgery ( 30. 0%) , intravenous drug use ( 14. 5%) , and sexual transmission ( 4. 5%) . The other 19 cases ( 17. 4%) were of unknown transmission route. The annual numbers of cases from 2008 to 2011 were 16, 18, 32, and 44, respectively. The genotype proportions in patients were as follows: 1b, 60. 7% ( 17 /28) ; 2a, 28. 6% ( 8 /28) ; 1b /2a mixed type, 7. 1% ( 2 /28) ; 3b, 3. 6% ( 1 /28) . Of all patients, 13. 6% ( 15 /110) were found with acute hepatitis C, 67. 3% ( 74 /110) with chronic hepatitis C, 19. 1% ( 21 /110) with liver cirrhosis, and 10. 9% ( 12 /110) with decompensated cirrhosis. Conclusion The incidence of HCV infection has been increasing year by year. The major HCV genotypes are 1b and2a. Hepatitis C is apt to develop into liver cirrhosis. It is necessary to reinforce monitoring and to carry out specific epidemiological study among the target population.
Changes in NK cells and regulatory T cells among patients with refractory chronic hepatitis C during antiviral treatment
Chen XiaoYun, Zhang YongHong, Ma LiNa, Jin Yi, Yu HaiBin, Zheng YanHong, Liu Ning, Liu JinHua, Wang Jian, Chen XinYue
2014, 30(6): 508-513. DOI: 10.3969/j.issn.1001-5256.2014.06.008
Abstract:
Objective To investigate the changes in NK cells and regulatory T ( Treg) cells among patients with refractory chronic hepatitis C ( CHC) during antiviral therapy and to analyze antiviral effect-related immunological factors. Methods A total of 41 patients with refractory CHC ( 30 treatment- naive patients and 11 treatment- unresponsive patients) and 11 healthy controls ( HC) were enrolled in this prospective open cohort study. Naive patients received pegylated interferon α- 2a ( Peg- IFN- α- 2a) 180 μg /week and ribavirin ( RBV) 10. 6- 15mg / kg /day for 48 weeks, while unresponsive patients received Peg- IFN- α- 2a 180 μg /week and RBV 15 mg /kg /day for 72 weeks. Blood cells and serum were dynamically collected to measure HCV RNA, liver function, NK cells and Treg cells and to analyze curative effect- related immunological factors. Continuous variables were analyzed by t- test or rank sum test, and discrete variables were analyzed by chi- square test. Results All patients finished antiviral treatment and 24- week follow- up survey. Seventeen naive patients ( 56. 7%) and 3 unresponsive patients ( 27. 2%) achieved a sustained virologic response ( SVR) . The 8 unresponsive patients without SVR were named response- free patients ( RFP) . At baseline, the percentage of NK cells in patients was lower than that in the HC group, while the percentage of Treg cells in patients was higher than that in the HC group. During antiviral therapy, in naive patients with SVR, the percentage of NK cells increased at week 24 of treatment, as compared with the baseline and week 4, and the percentage of Treg cells decreased at week 24, as compared with the baseline and week 4; In naive patients without SVR, the percentage of Treg cells increased at week 24, as compared with the baseline and week 4; no significant change in the percentage of NK cells or Treg cells was observed in unresponsive patients without SVR.Conclusion Decrease in NK cells and increase in Treg cells are related to chronic HCV infection. Dynamic changes in NK cells and Treg cells can predict the efficacy of antiviral therapy: the increase in NK cells and decrease in Treg cells, which are indicative of upregulation immune function and downregulation of immunosuppression, can be used for predicting SVR.
Relationship between IL- 28B polymorphisms and susceptibility to hepatitis C among Han population in Jiangsu Province, China
Tan GuoLei, Sun Mei, Wang JianFang, Wu XuPing
2014, 30(6): 514-517. DOI: 10.3969/j.issn.1001-5256.2014.06.009
Abstract:
Objective To investigate the association between interleukin- 28B ( IL- 28B) polymorphisms and susceptibility to hepatitis C among the Han population in Jiangsu Province, China. Methods A case- control study was conducted in 88 hepatitis C patients who visited the Second Hospital of Nanjing in 2011 and 100 healthy controls who underwent physical examination in the same hospital. PCR and direct sequencing were used to detect IL- 28B single- nucleotide polymorphisms ( SNPs) ( rs8099917, rs12979860, rs12980275, rs8113007, and rs12972991) . Genotypes and alleles were compared between the two groups. Statistical analysis was performed by Pearsonχ2test; the sample representativeness was evaluated according to the Hardy- Weinberg equilibrium. Results There were no significant differences in sex and age between the two groups ( P = 0. 92 and 0. 28) . The major genotypes at the five IL- 28B SNPs among subjects were TT, CC, AA, AA, and AA. No significant differences were observed between hepatitis C patients and healthy controls in the genotypes and alleles at these IL- 28B SNPs ( χ2= 0. 31, 0. 50, 0. 60, 0. 15, and 0. 07, P > 0. 05 for all; χ2= 0. 29, 0. 48, 0. 56, 0. 14, and 0. 07, P >0. 05 for all) . Conclusion IL- 28B SNPs ( rs8099917, rs12979860, rs12980275, rs8113007, and rs12972991) may not be associated with the susceptibility to hepatitis C among the Han population in Jiangsu Province.
Construction of lentiviral vector encoding CLEC4M and overexpression of CLEC4M in K- 562 cells
Wang YuanYuan, Nie QingHe, Zhu Ting
2014, 30(6): 518-521. DOI: 10.3969/j.issn.1001-5256.2014.06.010
Abstract:
Objective To construct the lentiviral vector encoding CLEC4M and prepare K- 562 cells with stable overexpression of CLEC4M. Methods The gene sequence of normal CLEC4M was cloned by reverse transcription PCR and then inserted into GV166 vector to construct GV166- CLEC4M lentiviral expression vector, and then lentiviral packaging was performed by transfection of 293T cells. The obtained lentiviral liquid was used to infect human leukemia cell line K- 562. Real- time PCR and Western blot were used to detect the overexpression of CLEC4M in K- 562 cells. Results Sequencing showed that the recombinant lentiviral expression plasmid GV166- CLEC4M was successfully constructed. Lentiviruses could efficiently infect K- 562 cells, according to real- time PCR. CLEC4M was successfully over- expressed in K- 562 cells at mRNA and protein levels. Conclusion The construction of lentiviral vector encoding CLEC4M lays a foundation for further study of CLEC4M gene involved in HCV entry into host cells.
Changes in serum levels of Th1 /Th2 cytokines in HBeAg- positive pregnant women with HBV infection after telbivudine treatment
Huang HongFei, He DengMing, Wu QuanXin, Li MaoShi, Zhu Peng, Wang YuMing
2014, 30(6): 522-526. DOI: 10.3969/j.issn.1001-5256.2014.06.011
Abstract:
Objective To evaluate the changes in serum levels of Th1 /Th2 cytokines in pregnant women with chronic hepatitis B virus ( HBV) infection after telbivudine treatment and to investigate the immune mechanism by which telbivudine blocks the mother- to- infant transmission of HBV. Methods Fifty- four HBeAg- positive pregnant women with chronic HBV infection were enrolled from April 2008 to September 2012, and they were divided into two groups based on their alanine aminotransferase ( ALT) levels: immune active group ( n =18) and immune tolerant group ( n = 36) . Telbivudine was administrated at a dose of 600 mg per day during the second or third trimester.Before treatment and prior to delivery, the serum levels of ALT, total bilirubin ( TBil) , HBV DNA, and HBV markers were routinely measured, and the levels of Th1 cytokines ( interleukin- 2 ( IL- 2) , interferon- γ ( IFNγ) ) and Th2 cytokines ( interleukin- 4 ( IL- 4) , interleukin- 6 ( IL- 6) ) were determined by enzyme- linked immunosorbent assay. SPSS 18. 0 was used for statistical analysis. Results After treatment, HBV DNA level was reduced significantly ( P < 0. 01) , while there were no significant changes in serum ALT and TBil and no HBeAg seroconversion. Compared with the healthy population, before treatment and prior to delivery, both treatment groups showed higher expression of IL- 2 ( healthy control < 4 pg /ml) and IFNγ ( healthy control < 15 pg /ml) but lower expression of IL- 4 ( healthy control< 10 pg /ml) and IL- 6 ( healthy control < 5 pg /ml) . Furthermore, there were no significant differences in IL- 2, IFNγ, IL- 4, and IL-6 levels between the two groups ( P > 0. 01) . Prior to delivery, IL- 4 level was elevated in immune active group ( P = 0. 014) , but within the limits of normal range, while IL- 2, IFNγ, and IL- 6 levels showed no significant changes ( P = 0. 182, 0. 259, and 0. 710, respectively) ; the levels of IL- 2, IFNγ, IL- 4, and IL- 6 in immune tolerant group showed no significant changes ( P = 0. 651, 0. 839, 0. 650, and 0. 542, respectively) . Conclusion Th1 cytokines are highly expressed while Th2 cytokines are lowly expressed in the second or third trimester among HBV- infected pregnant women. Short- term telbivudine treatment has limited influence on Th1 /Th2 balance in HBV- infected pregnant women, indicating that other mechanisms might be recruited for interfering with the mother- infant transmission of HBV.
Clinical significance of low- level HBV DNA replication and specific antibody expression in patients with HBV- related liver failure
Tian FangYuan, Dan Jing, Tang KuanYin, Cao WuKui
2014, 30(6): 527-530. DOI: 10.3969/j.issn.1001-5256.2014.06.012
Abstract:
Objective To investigate the influential factors and clinical significance of low- level hepatitis B virus ( HBV) DNA replication and specific antibody expression in patients with HBV- related liver failure. Methods A retrospective analysis was performed on the medical records of 391 patients with HBV- related liver failure and 394 patients with chronic hepatitis B ( CHB) hospitalized in the Tianjin Second People's Hospital from June 2008 to December 2013. The HBV DNA level was compared between patients with HBV- related liver failure and those with CHB, and the influential factors were analyzed. According to the expression of HBV serum markers ( HBV- Ms) , patients with liver failure were divided into specific antibody- positive group ( positive for anti- HBs, anti- HBe or anti- HBc) and specific antibody- negative group ( negative for anti- HBs, anti- HBe or anti- HBc) . The changes in HBV DNA level and survival were compared between the two groups. Between- group comparison was made by independent- samples t test or Mann- Whitney rank sum test, and comparison of enumeration data was made by chi- square test. Results The patients with HBV- related liver failure had a significantly lower HBV DNA level than the CHB patients ( Z =- 16. 469, P < 0. 05) . The levels of HBV DNA in HBeAg- positive and- negative patients with liver failure were significantly lower than those in patients with CHB ( Z1=- 11. 665, P < 0. 05; Z2=- 12. 853, P < 0. 05) . Of the391 patients with HBV- related liver failure, 29 ( 7. 42%) were specific antibody- positive, and 25 ( 86. 21%) of them died; 362 ( 92. 58%) were specific antibody-negative, and 157 ( 43.37%) of them died. There was a significant difference in mortality between the specific antibody- positive and specific antibody- negative groups ( P < 0. 05) . The specific antibody- positive group had a significantly lower HBV DNA level than the specific antibody- negative group ( Z =- 3. 594, P < 0. 05) . For either group, the HBV DNA level was significantly lower in HBeAg- negative patients than in HBeAg- positive patients ( Z = 7. 427 or 7. 513, P < 0. 05) . Conclusion HBV M expression and the body's immune status play a role in the progression of HBV- related liver failure. HBV DNA replication is at a low level in the immune clearance phase. Being positive for anti- HBs, anti- HBe, and anti- HBc suggest a super immune response to HBV, leading to rapid progression of disease and high mortality.
Study of HBV- X gene mutation among patients with HBV- related chronic hepatitis, liver cirrhosis, and primary liver cancer
Lei Man, He Song
2014, 30(6): 531-536. DOI: 10.3969/j.issn.1001-5256.2014.06.013
Abstract:
Objective To study the relationship between hepatocarcinogenesis and the mutation in X gene among patients with chronic hepatitis B virus ( HBV) infection, such as chronic hepatitis B ( CHB) , liver cirrhosis ( LC) and primary liver cancer ( PLC) . Methods The serum samples from 89 patients with chronic HBV infection who visited the Second Affiliated Hospital of Chongqing Medical University from2011 to 2013 were collected. PCR was used to amplify the X gene of HBV DNA extracted from the serum samples. After sequencing, the HBV- X genome was compared with those reported in GenBank to find the variable sites and variant forms. Chi- square and one- way ANOVA were used for the statistical analysis afterwards, whereas genotypes were determined by the genotyping tool of the National Center for Biotechnology Information. Results All patients were genotype B or C. Among HBeAg- positive patients, 46. 2% were genotype B, and53. 8% were genotype C; among HBeAg- negative patients, 81. 2% were genotype B, and 18. 8% were genotype C ( P = 0. 001) . PLC patients had a significantly higher risk of mutation in the basic core promoter ( BCP) region than the CHB and LC groups ( 69. 2% vs 34. 4%and 61. 3%, P < 0. 05) ; in addition, an evident T- base deficiency was observed at nt1821 site ( 88. 5% vs 53. 1% and 71%, P =0. 014) . Among CHB and LC patients, those with genotype C had a significantly higher risk of BCP double mutation than those with genotype B ( 61. 5% vs 15. 8%, P = 0. 007; 83. 3% vs 47. 4%, P = 0. 045) . The incidence of BCP double mutation was significantly higher in the low- viral load group ( ≤106copies /ml) than in the high- viral load group ( > 106copies /ml) ( 81. 3% vs 47. 9%, P = 0. 015) .Conclusion The BCP double mutation and T- base deficiency at nt1821 site may play important roles in the development of PLC.
Efficacy of magnesium isoglycyrrhizinate in treatment of hepatitis E with severe jaundice
Luo XiaoKe, Li XiaoLing, Yang LiMing, Wang XiaoHong
2014, 30(6): 537-539. DOI: 10.3969/j.issn.1001-5256.2014.06.014
Abstract:
Objective To observe and analyze the efficacy of magnesium isoglycyrrhizinate in the treatment of hepatitis E with severe jaundice. Methods Seventy- eight cases of hepatitis E with severe jaundice admitted from January 2009 to December 2012 were equally divided into treatment group ( n = 39) and control group ( n = 39) . Both groups were given polyene phosphatidylcholine, reduced glutathione, and Adenosine Disodiu for liver protection; additionally, magnesium isoglycyrrhizinate injection ( 150 mg) was given to the treatment group by intravenous drip once daily, while compound glycyrrhizin injection ( 120 mg) was given to the control group by intravenous drip once daily. The course of treatment was 6 weeks in the two groups. Patients were considered to show response to treatment if their serum levels of total bilirubin ( TBil) and alanine aminotransferase were < 85 μmol /L and < 160 U /L, respectively. Comparison of means between the two groups was made by independent- samples t test; before- after comparison within each group was made by paired t- test; comparison of enumeration data between the two groups was made by chi- square test. Results Both groups showed improvements after treatment. The treatment group had a significantly higher overall response rate than the control group ( 84. 6% vs 66. 7%, P < 0. 05) . After treatment, the treatment group had a serum TBil level of 68. 9 ± 40. 3 μmol /L, with significantly more improvement compared with the serum TBil level for control group ( 129. 1 ± 69. 3 μmol /L) ( F = 24. 658, χ2= 12, P < 0. 01; F = 36. 145, χ2= 15, P < 0. 01) . Conclusion Magnesium isoglycyrrhizinate has significant efficacy in the treatment of hepatitis E with severe jaundice. It shows a marked promotional effect on the proliferation of liver cells within a certain concentration range, accelerates jaundice disappearance, and has no obvious adverse effects.
Original articles_Liver fibrosis and liver cirrhosis
Analysis of risk factors for early rebleeding from esophageal and gastric varices in patients with liver cirrhosis
Yang Hua, Liu YunXia, Li Peng, Yang ShaoQi, Wang YuanZhen
2014, 30(6): 540-542. DOI: 10.3969/j.issn.1001-5256.2014.06.015
Abstract:

Objective To investigate the risk factors for early rebleeding from esophageal and gastric varices ( EGV) in patients with liver cirrhosis. Methods A total of 432 patients with liver cirrhosis who were admitted to Ningxia Medical University from January 2006 to December 2009 were included in the study. These patients were divided into control group ( n = 325) , who stopped bleeding after initial treatment, and study group ( n = 107) , who had rebleeding after initial treatment. The clinical and test data of the two groups were analyzed.Comparison of measurement data between the two groups was made by t test, while comparison of enumeration data was made by chi- square test; multiple comparison of constituent ratios was made. The univariate unconditional logistic regression model was used for analyzing the risk factors for rebleeding. Results There were significant differences in sex, smoking, hemoglobin ( Hb) level, white blood cell ( WBC) count, alanine aminotransferase level, aspartate aminotransferase level, and spleen thickness between the two groups ( P < 0. 05) . The univariate unconditional logistic regression analysis showed that percentage of neutrophils ( OR = 0. 976, P = 0. 034) , WBC count ( OR =1. 173, P = 0. 007) , portal vein width ( OR = 7. 530, P = 0. 001) , and Hb level ( OR = 1. 415, P = 0. 013) were positively correlated with rebleeding. Conclusion WBC count, percentage of neutrophils, Hb level, and portal vein width are positively correlated with rebleeding from EGV, and they are the risk factors for early rebleeding from EGV in patients with liver cirrhosis if their values are high.

Original articles_Biliary diseases
Diagnostic values of ultrasonography and CT for gallbladder adenomyomatosis: a comparative analysis
Zhang QinQin, Chen Fei, Qiu ShaoDong
2014, 30(6): 543-545. DOI: 10.3969/j.issn.1001-5256.2014.06.016
Abstract:
Objective To analyze the diagnostic values of ultrasonography and computed tomography ( CT) for gallbladder adenomyomatosis.Methods The ultrasound and CT findings of 28 cases of pathologically confirmed gallbladder adenomyomatosis in our hospital were retrospectively analyzed. The diagnostic values of the two imaging tools for gallbladder adenomyomatosis were analyzed with the pathological diagnosis as the gold standard. Comparison of rates was made by chi- square test; multiple comparisons of rates were made by partition of chi- square. Results Before operation, among the 28 patients, 15 were diagnosed with gallbladder adenomyomatosis by ultrasonography, and 9 were diagnosed by CT; the diagnostic rate of CT was 32. 14%, and the diagnostic rate of ultrasonography was 53. 57%. The chi- square test showed no difference between the diagnostic rates of ultrasonography and CT for gallbladder adenomyomatosis ( χ2=2. 63, P = 0. 10 >0. 05) . In addition, the statistical results showed no differences between the diagnostic rates of ultrasonography and CT for various types of gallbladder adenomyomatosis ( segmental type: χ2=0, P=0. 11 >0. 0125; diffuse type: χ2=2. 57, P =1. 00 > 0. 0125; focal type: χ2= 1. 42, P = 0. 23 > 0. 0125) . Conclusion CT and ultrasonography are two important imaging methods for the diagnosis of gallbladder adenomyomatosis. The detection rate of gallbladder adenomyomatosis can be increased through the combination of convex array probe and linear array probe in ultrasonography.
Clinical study of changes in intestinal permeability in patients with gallstones of different distribution and properties
Bai ShunYan, Xiao SiJie, Wei Na
2014, 30(6): 546-548. DOI: 10.3969/j.issn.1001-5256.2014.06.017
Abstract:
Objective To study the changes in intestinal permeability in patients with gallstones of different distribution and properties and to investigate the role of intestinal barrier function in gallstone formation. Methods A total of 108 patients with gallstones in our hospital in need of operation from March 2011 to March 2013 were enrolled in this study. Twenty healthy controls were also included. According to the distribution of gallstones, the subjects were separated into the following four groups: normal control group ( group A1) , gallbladder stone group ( group B1) , bile duct stone group ( group C1) , and combined group ( group D1) , in which gallbladder stones were complicated by bile duct stones. All patients underwent operation, and gallstones were collected for chemical analysis. According to the chemical properties of gallstones, the subjects were re-grouped as follows: normal control group ( group A2) , cholesterol stone group ( group B2) , pigment stone group ( group C2) , and mixed stone group ( group D2) , in which cholesterol stones were mixed with pigment stones. D- lactic acid level and diamine oxidase ( DAO) activity in plasma and mucosal tissue of the terminal ileum were measured by spectrophotometry. Differences were analysed by ANOVA and LSD t- test. Results Plasma D- lactic acid level and intestinal DAO activity showed no significant differences between groups A1, B1, C1, and D1 ( P > 0. 05) .Chemical analysis after surgery found 40 cases of cholesterol stones ( 37. 04%) , 52 cases of pigment stones ( 48. 15%) , and 16 cases of mixed stones ( 14. 8%) . Group C2 showed significantly different D- lactic acid level and DAO activity compared with B2 and A2 ( P < 0. 05) , but no differences from D2 ( P >0. 05) . Group B2 was found of no differences from A2 and D2 ( P >0. 05) . Conclusion Patients with pigment stones were all found of changes in intestinal permeability. The formation of pigment stones is related to impairment of intestinal barrier function. It is possible that impairment of intestinal barrier function plays a certain role in pigment stone formation.
Original articles_Pancreatic diseases
Early changes in hemorheological parameters and TXA2 and PGI2 levels among patients with severe acute pancreatitis
Liang Chao, Sha YingYing, Zhu XiaoMing, Wang XiongDa, Zhu YuHua, Zhao ZhenYu
2014, 30(6): 549-551. DOI: 10.3969/j.issn.1001-5256.2014.06.018
Abstract:
Objective To investigate the early changes in hemorheological parameters and thromboxane A2 ( TXA2) and prostacyclin ( PGI2) levels among patients with severe acute pancreatitis ( SAP) . Methods Thirty-two SAP patients hospitalized from January 2012 to September 2013 were selected as SAP group; 30 healthy controls were selected as normal control ( NC) group. Venous blood was collected after admission and before treatment. The hemorheological parameters and plasma levels of TXA2and PGI2were determined, and TXA2/PGI2ratio was calculated. Comparison between groups was made by t test. Results Compared with the NC group, the SAP group had a significantly lower erythrocyte deformation index ( t = 2. 185, P < 0. 05) , significantly higher whole blood viscosities at high-, middle-, and low- shear rates and plasma viscosity ( t = 2. 820, 2. 755, 2. 700, and 3. 622, P < 0. 05) , significantly higher whole blood reduced viscosities at high- and low- shear rates ( t = 3. 391 and 2. 018, P < 0. 05) , a significantly higher hematocrit ( t = 2. 980, P < 0. 05) , a significantly higher erythrocyte rigidity index ( t = 2. 209, P < 0. 05) , a significantly higher erythrocyte aggregation index ( t = 2. 004, P < 0. 05) , a significantly higher whole blood relative index at high shear rate ( t = 2. 630, P < 0. 05) , a significantly higher whole blood relative index at low shear rate ( t = 2. 440, P < 0. 05) , a significantly higher TXA2level ( t = 3. 256, P < 0. 05) , a significantly higher PGI2level ( t =2. 589, P < 0. 05) , and a significantly higher TXA2/PGI2ratio ( t = 2. 640, P < 0. 05) . Conclusion Hemorheological disorders and increased activity of vascular endothelial cells appear in the early stage in SAP.
Original articles_Hepatopancreatobiliary tumor
Clinical value of laparoscopic hepatectomy in liver cancer patients with cirrhosis
Xu JunHui, Ding YouMing, Wang Bin, Fang HanGang
2014, 30(6): 552-555. DOI: 10.3969/j.issn.1001-5256.2014.06.019
Abstract:

Objective To compare the perioperative outcomes of laparoscopic hepatectomy ( LH) versus open hepatectomy ( OH) for liver cancer patients with cirrhosis. Methods From September 2010 to June 2012, 78 liver cancer patients with cirrhosis hospitalized in Renmin Hospital affiliated to Wuhan University were considered for liver resection; among them, 32 patients were treated with LH, and 46 patients with OH. Intraoperative and postoperative conditions and tumor recurrence were compared between the two groups. Group t- test and paired t- test were used for measurement data, while chi- square test for enumeration data. Results The comparison of two groups indicated that the following indicators were significantly lower in the LH group than in the OH group: intraoperative blood loss ( t = 0. 057, P = 0. 040) , incidence of postoperative complications ( electrolyte imbalance, bile leakage, and ascites: t = 3. 001, 3. 241, and 4. 255, respectively, P< 0. 05 for all) , liver function on the first day after operation ( AST and ALT: t = 3. 427 and 3. 201, P = 0. 001 and 0. 002) , postoperative time to oral intake ( t = 3. 012, P = 0. 001) , length of hospital stay ( t = 2. 157, P = 0. 003) , and tumor recurrence ( t = 2. 751, P =0. 006) ; whereas, the operative time in LH group was significantly longer than that in OH group ( t = 3. 101, P = 0. 003) . Conclusion Compared with OH, LH has various advantages in liver cancer patients with cirrhosis, such as smaller abdominal incision, less intraoperative blood loss, lower incidence of postoperative ascites, decreased postoperative complications, shorter hospital stay, and lower incidence of tumor recurrence.

Changes in platelet parameters and their influential factors in cirrhotic patients with hepatocellular carcinoma
Ding ShengNan, Yang WeiMin, Niu JunQi
2014, 30(6): 556-559. DOI: 10.3969/j.issn.1001-5256.2014.06.020
Abstract:

Objective To analyze the changes in platelet parameters and their influential factors in cirrhotic patients with hepatocellular carcinoma ( HCC) . Methods The clinical data of 602 cirrhotic patients with HCC who were admitted to the First Hospital of Jilin University from January 2011 to December 2012, as well as 200 cirrhotic patients hospitalized during the same period, were collected. Statistical analysis was performed using SPSS 19. 0. Normally distributed continuous data were expressed as mean ± standard deviation; comparison between two groups was made by t test, and comparison between multiple groups was made by analysis of variance. Non- normally distributed data were expressed as median and interquartile range ( P25- P75) ; comparison between groups was made by rank sum test. Results Compared with the cirrhotic group, the HCC group had significantly higher platelet count ( PLT) and plateletcrit ( PCT) ( t = 5. 019, P = 0. 000;t = 5. 017, P = 0. 000) and a significantly lower mean platelet volume ( MPV) /PLT ( t = 5. 877, P = 0. 000) ; there were no significant differences in MPV and platelet distribution width between the two groups ( t =- 0. 942, P = 0. 347; t =- 1. 040, P = 0. 298) . The receiver operating characteristic ( ROC) analysis showed that the area under the ROC curve was 0. 636 for PLT, 0. 633 for PCT, and 0. 639 for MPV /PLT in the diagnosis of HCC in cirrhotic patients. Decreases in PLT and PCT were closely related to hepatitis C virus ( HCV) infection. Patients with Child- Pugh class A cirrhosis had significantly higher PLT and PCT than those with Child- Pugh class B and C cirrhosis ( P <0.01) ; patients with a maximum tumor diameter of ≥5 cm had significantly higher PLT and PCT than those with maximum tumor diameters of 2- 5 cm and ≤2 cm ( P < 0. 01) . Patients with Child- Pugh class A cirrhosis had a significantly lower MPV /PLT than those with Child- Pugh class B and C cirrhosis ( P < 0. 01) ; patients with a maximum tumor diameter of ≥5 cm had a significantly lower MPV /PLT than those with maximum tumor diameters of 2- 5 cm and ≤2 cm ( P < 0. 01) . Conclusion PLT, PCT, and MPV /PLT can be used in the auxiliary diagnosis of HCC in cirrhotic patients, which are related to HCV, Child- Pugh classification, and tumor size.

Original articles_Others
Diagnosis and treatment of hepatogenous diarrhea: an analysis of 62 cases
Bao SuXia, Sun ZhangYu, Zhou Yan, Zhang ZhiHao, Dun ShaoZhi, Wang YingYing, Chen Si, Yang XiaoYan
2014, 30(6): 560-562. DOI: 10.3969/j.issn.1001-5256.2014.06.021
Abstract:

Objective To investigate the pathogenesis, diagnostic keys, and treatment of hepatogenous diarrhea. Methods Sixty- two patients with hepatogenous diarrhea were assigned to three levels of treatment. Patients given level- one treatment received live combined Clostridium butyricum and Bifidobacterium powder for regulating intestinal flora; patients given level- two treatment received montmorillonite powder for constriction, adsorption, and stopping diarrhea and compound diphenoxylate for inhibiting intestinal peristalsis; patients given level- three treatment received somatostatin for reducing portal pressure. Total bilirubin, albumin, total bile acid, prothrombin time, platelet count, spleen thickness, spleen length, splenic vein width, and portal vein width, as well as routine stool test and stool culture, were measured before treatment, and the times of diarrhea and time of onset were determined before and after treatment. Measurement data were expressed as M ( P25- P75) , and statistical analysis was performed using the Spearman rank correlation coefficient. Results Hepatogenous diarrhea was mostly seen in patients with decompensated liver cirrhosis. The higher the Child- Pugh score, the severer the diarrhea and the higher the susceptibility to diarrhea. Hepatogenous diarrhea had no specific clinical manifestations. Mild or moderate diarrhea was treated mainly by improving liver function, regulating intestinal flora, and inhibiting intestinal peristalsis, while severe diarrhea mainly by reducing portal pressure. Conclusion The pathogenesis of hepatogenous diarrhea is complex, without specificity for the diagnosis. The key to therapy is to treat the primary liver disease, regulate intestinal flora, reduce portal pressure, and somatostatin shows good efficacy for severe diarrhea.

Clinical efficacy of magnesium isoglycyrrhizinate in treatment of liver injury among patients with obstructive jaundice after percutaneous transhepatic cholangiodrainage
Wang XiaoPeng, Su He, Tian HongWei, Zhang SuYu, Wu ZiYan, An YaLi, Ma YunTao
2014, 30(6): 563-566. DOI: 10.3969/j.issn.1001-5256.2014.06.022
Abstract:

Objective To evaluate the clinical efficacy and safety of magnesium isoglycyrrhizinate in the treatment of liver injury among patients with obstructive jaundice after percutaneous transhepatic cholangiodrainage ( PTCD) . Methods Sixty- two obstructive jaundice patients with liver injury after PTCD were randomly divided into treatment group ( n = 32) and control group ( n = 30) . All patients were given vitamin B6, vitamin C, and coenzyme complex by intravenous drip. At the same time, the treatment group was given magnesium isoglycyrrhizinate ( 100 mg) after PTCD for 7 days, while the control group was given reduced glutathione ( 1200 mg) for 7 days. After treatment, the improvements in serum alanine transaminase ( ALT) , aspartate aminotransferase ( AST) , albumin ( Alb) , γ- glutamyl transpeptidase ( GGT) , alkaline phosphatase ( ALP) , total bilirubin ( TBil) , direct bilirubin ( DBil) , tumor necrosis factor- α ( TNFα) , and nuclear factor- kappa B ( NF- κB) were evaluated. The adverse reactions associated with magnesium isoglycyrrhizinate were observed. Results After treatment, both groups showed significant decreases in serum TBil, DBil, ALT, AST, ALP, TNFα, and NF- κB ( P < 0. 05) , and the treatment group had significantly higher decreases in these indices ( P < 0. 05) . However, there were no significant improvements in Alb and GGT in either group after treatment, and the two indices showed no significant differences between the two groups ( P > 0. 05) . Conclusion Treated with magnesium isoglycyrrhizinate, obstructive jaundice patients with liver injury after PTCD can regain the liver function and recover from jaundice rapidly, and magnesium isoglycyrrhizinate has good efficacy and safety.

Case reports
One case of adult Still's disease with fever and jaundice as main clinical manifestations
Zhang Kai, Chen Hong, Lu MingXia, Wang FeiFei, Wan Hui, Zhang LiTing
2014, 30(6): 567-568. DOI: 10.3969/j.issn.1001-5256.2014.06.023
Abstract:
Reviews
Research progress in HBV /HCV co- infection
He Li, Hu Ping, Shen HuanJun, Zhang Ye, Huang ZhangXing
2014, 30(6): 569-572. DOI: 10.3969/j.issn.1001-5256.2014.06.024
Abstract:
Hepatitis B virus ( HBV) is a hepatotropic DNA virus; HBV DNA and special P protein are covered by capsid proteins to form core particles, which are then covered by lipoprotein to form complete virus particles. Hepatitis C virus ( HCV) , which belongs to the Flaviviridae family, is a single- stranded, positive- sense RNA. HBV and HCV are transmitted by parenteral route and may cause co- infection through the same route of transmission. The pathogenesis of HBV /HCV co- infection and its relationship with occult HBV infection, hepatocellular carcinoma, organ transplantation, and HBV vaccine are reviewed. Meanwhile, the treatment of co- infection is presented. It is shown that HBV and HCV interfere with each other in terms of virology and pathology.
Research progress in tumor- associated antigen antibodies for diagnosis of liver cancer
Wang WuChen, Zhou YongNing
2014, 30(6): 573-576. DOI: 10.3969/j.issn.1001-5256.2014.06.025
Abstract:
Liver cancer is one of the most common malignant tumors in the world. The mortality of patients with liver cancer remains high even with increasing progress in therapies. Early diagnosis is helpful for prolonging the survival of patients, so new biomarkers need to be explored for timely diagnosis and treatment of liver cancer. The present research focuses on tumor- associated antigens ( TAAs) and their corresponding autoantibodies as serological biomarkers of liver cancer. The production of autoantibodies and the TAAs and anti- TAAs currently found in the liver cancer tissue are summarized. In addition, it is pointed out that these newly found autoantibodies have relatively high sensitivity and specificity for the early diagnosis of liver cancer.