2015 No. 3

Quantitative assessment of liver fibrosis: invasive or non-invasive?

Liang XieEr, Wang Yan, Hou JinLin

2015, 31(3): 317-321. DOI: 10.3969/j.issn.1001-5256.2015.03.001

Abstract(387)

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Abstract:
Precise and quantitative assessment of the severity of liver fibrosis is of great value for confirming diagnosis,making treatment decision,monitoring treatment outcome,and determining prognosis. This paper analyzes the development and application of invasive and non- invasive quantitative assessment of histological liver fibrosis. From the first descriptive histological evaluation,the assessment of liver fibrosis based on invasive liver biopsy has been developed into semi- quantitative approaches. The fully- quantitative and objective assessment of histological liver fibrosis can overcome drawbacks of traditional semi- quantitative approaches including observer bias and sampling error. The non- invasive assessment of liver fibrosis not only overcomes drawbacks of liver biopsy including invasion and sampling error,but also holds promise for predicting the long- term outcome of disease,though its application in monitoring dynamic changes in liver fibrosis still needs to be confirmed by liver histological evaluation. Therefore,the non- invasive assessment of liver fibrosis cannot yet completely replace liver histological evaluation,but it can reduce the number of liver biopsies in patients with definitive diagnosis. The application of the non- invasive diagnostic method in monitoring dynamic changes in liver fibrosis needs to be validated at more clinical settings,and for the quantitative assessment of histological liver fibrosis,the correlation of clinical relevance between the results and the long- term outcomes needs to be systematically identified.

Guidelines for the management of chronic pancreatitis(2014)

Group of Pancreas Surgery, Chinese Society of Surgery, Chinese Medical Association

2015, 31(3): 322-326. DOI: 10.3969/j.issn.1001-5256.2015.03.002

Abstract(186)

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Guidelines for integrated traditional Chinese and Western medicine diagnosis and treatment of severe acute pancreatitis (2014, Tianjin)

General Surgery Committee, China Society of Integrated Traditional Chinese and Western Medicine

2015, 31(3): 327-331. DOI: 10.3969/j.issn.1001-5256.2015.03.003

Abstract(281)

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Clinical application of noninvasive diagnosis of liver fibrosis

Zhu ChuanLong, Wang Kun, Gao RenDao

2015, 31(3): 332-336. DOI: 10.3969/j.issn.1001-5256.2015.03.004

Abstract(2986)

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Hepatic fibrosis is the common outcome of chronic liver diseases of various causes. At present,liver biopsy is the “gold standard”for the diagnosis of liver fibrosis,but it has limitations and is invasive,which leads to the development of noninvasive assessment of liver fibrosis. The article mainly introduces the technology and application of noninvasive diagnosis of liver fibrosis from the aspects of clinical manifestation,serology,and radiology. It has pointed out the clinical value of these noninvasive diagnosis techniques,and it discusses the progress in clinical research and its limitations for noninvasive diagnosis of liver fibrosis.

Mechanisms and treatment of cholestasis- induced liver fibrosis

Zhang QiDi, Lu LunGen

2015, 31(3): 337-341. DOI: 10.3969/j.issn.1001-5256.2015.03.005

Abstract(3002)

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Any pathological state that causes disturbance in bile flow is called cholestasis. Liver fibrosis is a repair response to liver injury.Both cholestasis and liver fibrosis are pathological states in liver diseases. This paper briefly introduces cholestasis and liver fibrosis,and illustrates the mechanisms and therapeutic drugs for cholestasis- induced liver fibrosis. Further study is needed to prevent and treat cholestasis- induced liver fibrosis.

Study on pathogenesis of schistosomal liver fibrosis

Zhao Lei, Yang DongLiang

2015, 31(3): 342-344. DOI: 10.3969/j.issn.1001-5256.2015.03.006

Abstract(2894)

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The important pathological feature induced by schistosomiasis is liver fibrosis. Schistosome eggs release soluble egg antigen to form egg granuloma,which stimulates host inflammation,induces extracellular matrix deposition,and finally causes liver fibrosis. This process is tightly associated with hepatic stellate cells,T cells,and other cytokines. Deep understanding of cellular and molecular mechanisms of schistosomiasis- induced liver fibrosis will help to identify targets for drug development and clinical treatment,and bring new hope to patients with schistosomiasis- induced liver fibrosis.

Anti-viral therapy for chronic hepatitis B and cirrhosis: monotherapy or combination?

Shi YiWen, Wang Lin, You Hong

2015, 31(3): 345-348. DOI: 10.3969/j.issn.1001-5256.2015.03.007

Abstract(254)

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At present,the response rate of anti- viral therapy for chronic hepatitis B still needs to be increased. Therefore,combination therapy including nucleosides combined with nucleotides,as well as interferon combined with nucleosides and nucleotides,is being explored by many researchers. According to recent studies,monotherapy using potent nucleosides or nucleotides is the first choice for initial treatment of chronic hepatitis B,and tenofovir is an alternative choice for nucleosides- and nucleotides- resistant patients. Combination therapy using nucleosides and nucleotides is recommended for patients with high viral load and positive HBe Ag. Entecavir combined with tenofovir can be used for patients with a treatment history and even for those with multiple drug resistance. The long- term therapy with interferon can be used to achieve HBe Ag and HBs Ag seroconversion in patients already treated with nucleosides and nucleotides.

Early diagnosis and empiric therapy for cirrhosis associated with infection

Nan YueMin, Niu XueMin

2015, 31(3): 349-353. DOI: 10.3969/j.issn.1001-5256.2015.03.008

Abstract(3028)

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Infection is a frequent complication of cirrhosis,which often occurs in the lungs,chest,abdomen,biliary tract,urinary tract,soft tissue,and skin,and occasionally causes spontaneous bacteremia in patients. This paper reviews the risk factors and common types of infection in cirrhosis associated with infection,and the early diagnosis and symptomatic treatment of different types of infection. Moreover,this paper points out that cirrhosis associated with infection is a key factor for disease progression and the early diagnosis and treatment are essential for successful treatment. The third- generation cephalosporins are the first- line antibiotic agents. Drug- resistant bacteria should be treated with antibiotic compound containing β- lactamase inhibitors or carbapenems. Methicillin- resistant Staphylococcus aureus should be treated with glycopeptide antibiotics or combination therapies. Pulmonary mycoses are mainly treated with caspofungin or voriconazole. Antibiotics combined with supportive therapies including the administration of albumin can improve the treatment outcome and prognosis.

Therapeutic strategy for gastroesophageal variceal bleeding of portal hypertension

Tian XiangGuo, Zhang ChunQing

2015, 31(3): 354-356. DOI: 10.3969/j.issn.1001-5256.2015.03.009

Abstract(2987)

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Gastroesophageal variceal bleeding is a severe complication of portal hypertension. The prevention of gastroesophageal variceal bleeding and rebleeding remains an important goal in treating patients with liver cirrhosis. This article briefly describes the four stages of the prevention and treatment of gastroesophageal variceal bleeding due to portal hypertension and points out that the therapeutic strategy should be selected according to the clinical stage,hepatic venous pressure,and liver function classification of patients.

Diagnostic value of serum apolipoprotein B/A1 ratio for hepatic fibrosis(F≥2) in chronic hepatitis C patients

Lei ChengDuo, Li JunFeng, Zheng SuJun, Ren Yan, Zhao Jing, Zhang JingYun, Duan ZhongPing

2015, 31(3): 357-360. DOI: 10.3969/j.issn.1001-5256.2015.03.010

Abstract(288)

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Objective To investigate the relationship between serum apolipoprotein B / A1( APOB / APOA1) ratio and chronic hepatitis C( CHC)- related hepatic fibrosis,and to assess the ability of serum APOB/APOA1 ratio to identify significant hepatic fibrosis( ≥F2).Methods A total of 120 interferon treatment- na? ve CHC patients were selected from Dingxi,Gansu Province,China. Serum APOB,APOA1,and other clinical indicators of liver function were measured. Meanwhile,liver biopsies were performed,and the Metavir scoring system was employed to evaluate the stage of hepatic fibrosis. Continuous data were expressed as the mean ± standard deviation,and comparisons of the mean between groups were performed by t test. Categorical data were expressed as numerical value( percentage),and comparisons of the mean between groups were performed by Pearson χ2test. Correlation analysis was performed by Spearman's rank correlation analysis,and the receiver operating characteristic( ROC) curve was plotted. Results The APOB / APOA1 ratio was negatively correlated with the stage of liver fibrosis( r =- 0. 225,P = 0. 005). There was a significant difference in the APOB / APOA1 ratio between patients in the presence and absence of significant hepatic fibrosis( ≥ F2 vs F0- F1,P = 0. 015). Regarding the ability to distinguish CHC- related significant liver fibrosis,the ROC showed an area under the curve of APOB / APOA1 ratio up to 0. 63,with 93. 8% sensitivity and 30. 9%specificity. Conclusion There is an association between APOB / APOA1 ratio and the stage of CHC- related hepatic fibrosis. The APOB /APOA1 ratio has certain potential for identifying significant hepatic fibrosis in CHC patients.

Relationship between serum markers and severity of liver fibrosis in patients with chronic hepatitis D

Zhou Ying, Xiong HongPin, Chen Keng, Ping Qu, Liao BaoLin

2015, 31(3): 361-364. DOI: 10.3969/j.issn.1001-5256.2015.03.011

Abstract(2854)

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Objective To explore the relationship between levels of alanine aminotransferase( ALT),hepatitis B virus( HBV) DNA,and serum markers of fibrosis including hyaluronic acid( HA),laminin( LN),type Ⅲ procollagen peptide( PⅢP),and type Ⅳ collagen( CⅣ) and the severity of liver fibrosis in patients with chronic hepatitis D( CHD). Methods Twenty- eight patients with CHD who were inpatients in our hospital from March 2008 to January 2013 and had not received any antiviral treatment were enrolled as subjects. Serum levels of ALT,HBV DNA,and fibrosis markers( HA,LN,PIIIP,and CIV) in patients were determined,and the histopathological staging of liver fibrosis was measured by liver biopsy. Continuous data were expressed as mean ± standard deviation and compared of continuous data between the HBe Ag- positive group and the HBe Ag- negative group by t test,and comparison of categorical data was made by χ2test. Comparison between different fibrosis stages was made by the Kruskal- Wallis nonparametric test. Correlation analysis was made by the Spearman rank method. Results There were no significant differences in progression of liver fibrosis between the HBe Ag- positive group and the HBe Ag- negative group( χ2= 0. 129,P = 0. 720). There were significant differences in levels of HA and LN between groups with liver fibrosis stages 1,2,and ≥3( Z = 12. 035,P = 0. 002; Z = 8. 457,P = 0. 015). Levels of HA( 169. 4 ± 166. 3 ng / ml) and LN( 149. 2 ±85. 1 ng / ml) in the stage ≥3 group were significantly higher than those in the stage 1 group and the stage 2 group( P < 0. 05). There were no significant differences in levels of ALT,HBV DNA,PIIIP,and CIV between three groups. The severity of liver fibrosis was positively correlated with levels of HA,LN,PIIIP,and CIV( r = 0. 512,P = 0. 005; r = 0. 472,P = 0. 011; r = 0. 451,P = 0. 016; r = 0. 454,P =0. 015). Conclusion Levels of HA and LN can be used as serum markers to determine the severity of liver fibrosis in patients with CHD.

Clinical value of nucleotide analogues for treatment of hepatitis B-related decompensated cirrhosis

Zhang XueHua, Li ZhongPing

2015, 31(3): 365-369. DOI: 10.3969/j.issn.1001-5256.2015.03.012

Abstract(181)

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Objective To investigate the clinical value of nucleotide analogues for the treatment of hepatitis B- related decompensated cirrhosis. Methods A total of 97 inpatients with hepatitis B- induced decompensated cirrhosis were selected from the Department of Hepatology,Nanhua Hospital,Shanghai,China,from January 2007 to December 2013. There were 55 patients of the antiviral group and 42 patients of the non- antiviral group. Each group was subdivided into groups 1( hepatitis B- related cirrhosis) and 2( hepatitis B- related liver cancer). The antiviral group 2 was further divided into groups 2. 1( antiviral therapy before detection of liver cancer) and 2. 2( antiviral therapy after detection of liver cancer). According to the period of time for antiviral therapy,patients were divided into groups A( ≤24weeks),B( 24- 48 weeks),and C( > 48 weeks). Courses of hepatitis,cirrhosis,and cancer,as well as survival rate and complication incidence,were compared between groups. Continuous data were expressed as the mean ± standard deviation,for which pairwise comparisons were performed using t test and multiple comparisons were performed using one- way ANOVA. Categorical data were expressed as percentage,for which group comparisons were performed using χ2test. Results There were no significant differences between the antiviral and non- antiviral groups regarding course of hepatitis,complication incidence,and 7- year and 9- year survival rates( P > 0. 05). Significant differences existed between the above two groups in course of cirrhosis,53. 27 ± 58. 16 months vs 30. 76 ± 46. 70 months( P < 0. 05); and 3- year and 5- year survival rates,58. 2% and 36. 4% vs 33. 3% and 16. 7%( P < 0. 05). Additionally,course of liver cancer significantly differed between the antiviral groups 2. 1 and 2. 2,3. 93 ± 3. 39 months vs 21. 58 ± 23. 20 months( P < 0. 05). There were no significant differences between groups A,B,and C regarding course of hepatitis,complication incidence,and 9- year survival rate( P > 0. 05). The above three groups of patients showed significant differences in course of cirrhosis,32. 75 ± 61. 32 months vs 25. 86 ± 16. 40 months vs.74. 79 ± 55. 40 months( P < 0. 05); course of hepatitis B- related liver cancer,2. 55 ± 2. 72 months vs 10. 43 ± 7. 25 months vs 17. 71 ±24. 21 months( P < 0. 05); and 3- year,5- year,and 7- year survival rates,( 35. 0%,15. 0%,and 5. 0%) vs( 42. 9%,14. 3%,and14. 3%) vs( 78. 6%,60. 7%,and 35. 7%)( P < 0. 05). Conclusion Antiviral therapy for hepatitis B- related decompensated cirrhosis can prolong the survival time and increase the 3- year and 5- year survival rates in patients with liver cirrhosis and cancer. The curative effect becomes more significant with antiviral therapy over a longer period of time.

Diagnosis and treatment of primary bleeding from esophageal varices in cirrhotic patients from Yangzhou,China: an analysis of 80 cases

Zhou HongHua, Xiang XiaoXing, Zhang MiaoMiao

2015, 31(3): 370-373. DOI: 10.3969/j.issn.1001-5256.2015.03.013

Abstract(2898)

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Objective To investigate the diagnosis and treatment of primary bleeding from esophageal varices( EVB) in cirrhotic patients from Yangzhou,China. Methods A retrospective analysis was performed on 80 cirrhotic patients with primary BEV who were treated at the Department of Gastroenterology,Northern Jiangsu People's Hospital,Yangzhou,China,from January 2010 to December 2013. Categorical data were expressed as rate or constituent ratio and comparison of the rate was performed using χ2test. Results Primary BEV caused by hepatitis B- related cirrhosis accounted for the largest proportion of patients under study. Clinical application of Sengstaken- Blakemore tubes saved the life of patients' to the maximum degree,which provided time for the following treatment. The basic treatment included hemostasis,blood transfusion,antacids,and fluid infusion,and the late treatment mainly included endoscopic variceal ligation( EVL),endoscopic variceal sclerotherapy( EVS),EVL + EVS,surgery,and transjugular intrahepatic portosystemic shunt,among which EVL was most widely used. Changes in hematologic indicators during early bleeding were useful for guiding clinical treatment and evaluating the prognosis of patients. Conclusion Cirrhosis- related primary BEV has complex causes in patients from Yangzhou,for whom the treatment still needs to be further improved to reach the individualized level. Timely and correct treatment has great implications for improving the clinical effect and reducing the mortality. Early physical examination plays a pivotal role in the diagnosis and treatment of the disease.

Correlation study of spleen stiffness measured by Fibro Touch with esophageal and gastric varices in patients with liver cirrhosis

Wei YuTong, Jia ShengNan, Liu MiaoMiao, Xiao HeJun, Pan LiuLan

2015, 31(3): 374-377. DOI: 10.3969/j.issn.1001-5256.2015.03.014

Abstract(3351)

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Objective To explore the correlation of spleen stiffness measured by Fibro Scan with esophageal and gastric varices in patients with liver cirrhosis. Methods Spleen and liver stiffness was measured by Fibro Scan in 72 patients with liver cirrhosis who received gastroscopy in our hospital from December 2012 to December 2013. Categorical data were analyzed by χ2test,and continuous data were analyzed by t test. Pearson's correlation analysis was used to investigate the correlation between the degree of esophageal varices and spleen stiffness. Results With the increase in the Child- Pugh score in patients,the measurements of liver and spleen stiffness showed a rising trend. Correlation was found between the measurements of spleen and liver stiffness( r = 0. 367,P < 0. 05). The differences in measurements of spleen stiffness between patients with Child- Pugh classes A,B,and C were all significant( t = 5. 149,7. 231,and 6. 119,respectively; P =0. 031,0. 025,and 0. 037,respectively). The measurements of spleen and liver stiffness showed marked increases in patients with moderate and severe esophageal and gastric varices. The receiver operating characteristic( ROC) curve analysis showed that the area under the ROC curve,sensitivity,and specificity for spleen stiffness were significantly higher than those for liver stiffness and platelet count / spleen thickness. Conclusion The spleen stiffness measurement by Fibro Scan shows a good correlation with the esophageal and gastric varices in patients with liver cirrhosis. Fibro Scan is safe and noninvasive,and especially useful for those who are not suitable for gastroscopy.

Preliminary research on quantitative evaluation of carotid artery elasticity in patients with cirrhosis using ultrafast pulse wave velocity technique

Zhang Hong, Zhou Qi, Jiang Jue

2015, 31(3): 378-380. DOI: 10.3969/j.issn.1001-5256.2015.03.015

Abstract(2894)

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Objective To explore the value of ultrafast pulse wave velocity( UFPWV) technique in the quantitative evaluation of carotid artery elasticity in patients with cirrhosis. Methods Forty- three patients diagnosed clinically with cirrhosis in our hospital from September2013 to June 2014 were enrolled as subjects. Seventy- one healthy physical examinees within the same period were used as controls. The cirrhosis group matched the control group in terms of age and gender. The intima- media thickness( IMT) and elasticity parameters of the bilateral carotid arteries were measured by the UFPWV technique. The elasticity parameters included the pulse wave velocity at the beginning of the systole( PWVBS) and the pulse wave velocity at the end of the systole( PWVES). Comparisons of IMT and elasticity parameters between the two groups were made by t test,and the relationship between elasticity parameters and IMT in the cirrhosis group was analyzed using Pearson correlation. Results The carotid artery IMT,PWVBS,and PWVESin the cirrhosis group were significantly larger than those in the control group( t = 12. 233,P < 0. 001; t = 6. 388,P < 0. 001; t = 6. 681,P < 0. 001). In the cirrhosis group,PWVBSand PWVESwere positively correlated with IMT( r = 0. 248,P < 0. 001; r = 0. 383,P < 0. 001). Conclusion The carotid artery elasticity in patients with cirrhosis is lower than that in healthy people. The UFPWV technique can quickly measure the local PWVBSand PWVESof carotid artery in patients with cirrhosis,which provides a novel and convenient method to evaluate vascular elasticity in patients with cirrhosis.

Relationship between portal vein pressure and Fibro Scan score in cirrhotic patients with concomitant portal hypertension

Cheng XiaoFei, Liang XiongBo, Xiong XiaoQing, Tang YongLi, Chen Ping

2015, 31(3): 381-383. DOI: 10.3969/j.issn.1001-5256.2015.03.016

Abstract(2362)

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Objective To analyze the relationship between portal vein pressure and Fibro Scan score in patients with liver cirrhosis using color Doppler ultrasonography and transient elastography( Fibro Scan). Methods Totally 235 patients with liver cirrhosis were selected from the Second People's Hospital of Zhongshan,Guangdong Province,China,from March 2012 to March 2014,with 100 healthy individuals as controls. Color Doppler ultrasonography was performed to measure the portal vein diameter( PVD),mean portal vein velocity( PVVmean),and blood flow quantity of portal vein( PVQ). Portal vein pressure( Ppv) was calculated from the equation of Ppv = 1. 895 1 + 0. 001 1PVQ.Fibro Scan was also performed. Continuous data were expressed as the mean ± standard deviation. Group comparisons were performed by t test. The relationship between test parameters and Ppv was examined by correlation analysis. Results The PVD,PVQ,PVVmean,Ppv,and Fibro Scan score of cirrhotic patients with concomitant portal hypertension were 1. 42 ± 0. 12 cm,1238 ± 145. 23 ml / min,13. 25 ± 1. 56 cm / s,3. 28 ± 0. 17 k Pa,and 27. 81 ± 7. 52 k Pa,respectively,all of which were significantly higher than those in the control group( P <0. 05). Fibro Scan score and PVQ were positively correlated with Ppv in cirrhotic patients( r = 0. 52,P < 0. 001; r = 0. 61,P < 0. 001).Conclusion Fibro Scan score can be used as a reference indicator for noninvasive evaluation of portal hypertension.

Curative effect of peritoneal lavage in treatment of cirrhotic patients with spontaneous bacterial peritonitis

Yang ZhengMao, Shi WenJuan, Zhou Jian, Wang ZhaoXun

2015, 31(3): 384-386. DOI: 10.3969/j.issn.1001-5256.2015.03.017

Abstract(2316)

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Objective To investigate the value of peritoneal lavage in the treatment of cirrhotic patients with spontaneous bacterial peritonitis( SBP). Methods Eighty- six cirrhotic patients with SBP who were admitted to the Department of Infection in our hospital from February 2010 to February 2013 were selected and randomly divided into treatment group( n = 46) and control group( n = 40). The two groups were both treated with intravenous antibiotic therapy,therapeutic paracentesis,and intravenous plasma and albumin. Meanwhile,the treatment group received peritoneal lavage with warm saline,and intraperitoneal antibiotic administration. The curative effects were compared between the two groups. Categorical data were expressed as percentage and compared between the two groups by chi- square test. Results The response rate in the treatment group was significantly higher than that in the control group( 79. 09% vs 14. 50%,χ2= 7. 4836,P <0. 05). The case- fatality rate in the treatment group was significantly lower than that in the control group( 17. 39% vs 37. 50 %,χ2=4. 4159,P < 0. 05). Conclusion Peritoneal lavage is an effective method in the treatment of cirrhotic patients with SBP.

Value of five-stage prognostic system in predicting short-term outcome of patients with liver cirrhosis

Tian Yan, Hu NaiZhong

2015, 31(3): 387-391. DOI: 10.3969/j.issn.1001-5256.2015.03.018

Abstract(244)

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Objective To evaluate the clinical value of five- stage prognostic system in predicting the short- term outcome of patients with liver cirrhosis,and to compare it with the Child- Turcotte- Pugh( CTP) and Model of End- Stage Liver Disease( MELD) scores. Methods Two hundred and one hospitalized patients with liver cirrhosis in the Department of Gastroenterology in the First Affiliated Hospital of Anhui Medical University from January 2011 to January 2014 were enrolled in the study and followed up for at least six months. Patients were classified accorded to the five- stage prognostic system,and the mortality rate in each stage was measured. The receiver operating characteristic( ROC) curve and the area under the ROC curve( AUC) were used to assess the accuracy of the five- stage prognostic system in predicting the short- term death risk of cirrhotic patients,which was then compared with the CTP and MELD scores. Categorical data were analyzed by chi- square test. Comparison of AUC was made by normal distribution Z test. Spearman's correlation analysis was used to investigate the correlation of the five- stage prognostic system with the CTP and MELD scores. Results The study used the admission time as the starting point and the death of patients or study termination time as the endpoint. Among the 201 patients,50( 24. 9%) died within six months. Based on the five- stage prognostic system,the mortality rates for stages 1 to 5 were 0( 0 /11),0( 0 /18),4. 2%( 2 /48),16. 3%( 7 /43),and 50. 6%( 41 /81),respectively. In patients with decompensated cirrhosis( stages 3,4,and 5),the mortality increased with stage,and the differences in mortality between patients in stages 3 and 4,3 and 5,and 4 and 5 were all significant( χ2= 3. 89,35. 33,and13. 96,respectively; P = 0. 049,0. 000,and 0. 049,respectively). The AUC for the five- stage prognostic system,five- stage prognostic system combined with CTP and MELD score,and CTP score were 0. 820,0. 915,0. 888,and 0. 809,respectively( P < 0. 05). The five-stage prognostic system showed positive correlations with both CTP and MELD scores( r = 0. 772,P = 0. 000; r = 0. 479,P = 0. 000). Conclusion The five- stage prognostic system based on portal hypertension complications is effective in predicting the short- term outcome of patients with decompensated liver cirrhosis. A combination of the five- stage prognostic system and the CTP and MELD scores can accurately predict the outcome of patients with liver cirrhosis.

Relationship between intestinal dysbacteriosis and Child-Pugh classification in patients with cirrhosis

Huang XiaoYu, Li GangPing, Kou JiGuang, Li Lei, Xia XiuMei, Yang Ling, Hou XiaoHua

2015, 31(3): 392-395. DOI: 10.3969/j.issn.1001-5256.2015.03.019

Abstract(2165)

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Objective To evaluate the distribution of intestinal flora in patients with cirrhosis compared with healthy people and investigate the relationship between the distribution of intestinal flora and Child- Pugh classification of liver function,and to analyze the effect of probiotic treatment on the improvement of intestinal flora and liver biochemical indices in patients with cirrhosis. Methods Twenty- six patients with compensated cirrhosis( without ascites) and 22 with decompensated cirrhosis( with ascites) who were admitted to our hospital from February2014 to July 2014,as well as 21 healthy adult subjects,were randomly selected. Patients with cirrhosis were given probiotic( Bei Feida) treatment in addition to conventional therapy for 14 days. All patients signed informed consent forms. The distribution of intestinal flora,blood ammonia,serum alanine aminotransferase,serum albumin,and serum bilirubin levels were determined. Comparison of continuous data between the two and multiple groups was made by t test and analysis of variance,respectively,and comparison of categorical data was made by non-parametric test. Results All patients with cirrhosis had varying degrees of intestinal dysbacteriosis,predominantly due to significantly increased enterococci and enteric bacilli( P < 0. 01) and significantly reduced bifidobacteria( P < 0. 01). Dysbacteriosis was associated with liver function. Patients with Child- Pugh C cirrhosis had significantly more severe dysbacteriosis than patients with Child- Pugh A cirrhosis( P <0. 01). Probiotic treatment significantly improved liver biochemical indices,reduced blood ammonia,and increased intestinal bifidobacteria( P <0. 01). Probiotic treatment improved the Child- Pugh classification in patients with cirrhosis and had a more significant effect on cirrhotic patients with ascites( P < 0. 01). Conclusion Patients with cirrhosis have varying degrees of intestinal dysbacteriosis. Probiotic treatment can effectively relieve dysbacteriosis,improve biochemical indices,and reduce blood ammonia in patients with cirrhosis.

Analysis of risk factors for rebleeding after splenectomy and pericardial devascularization in treatment of portal hypertension due to liver cirrhosis

Zhang Lei, Yue Ping, Song XiaoJing, Yue Wei, Li Xun, Yuan Hong, Deng WanRong

2015, 31(3): 396-399. DOI: 10.3969/j.issn.1001-5256.2015.03.020

Abstract(2417)

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Objective To investigate the possible risk factors for rebleeding after splenectomy and pericardial devascularization in the treatment of portal hypertension due to liver cirrhosis,and to provide a certain basis for reducing the incidence of digestive tract re- hemorrhage for these patients. Methods A retrospective analysis was performed on 238 cirrhotic patients with portal hypertension who underwent splenectomy and pericardial devascularization in the First Hospital of Lanzhou University from December 2003 to December 2013. These patients were divided into postoperative rebleeding group( n = 32) and non- bleeding group( n = 206). Univariate analysis( t test or chi- square test) and multivariate logistic regression analysis were performed to investigate the risk factors for rebleeding after splenectomy and pericardial devascularization. Results Of the 32 patients with postoperative rebleeding,17 had esophagogastric variceal bleeding,11 had bleeding due to portal hypertensive gastropathy,and 4 had stress ulcer bleeding. The univariate analysis showed that there were significant differences between the two groups in the following factors: Child- Pugh classification of liver function,degree of liver cirrhosis evaluated intraoperatively,pathological changes of the gastric mucosa,platelet count,prothrombin time( PT),activated partial thromboplastin time( APTT),and presence of diabetes( all P <0. 05). The multivariate logistic regression analysis suggested that the significant independent influential factors for postoperative rebleeding were presence of diabetes,Child- Pugh classification of liver function,degree of liver cirrhosis evaluated intraoperatively,diffuse lesion of the gastric mucosa,PT,and APTT. Conclusion For cirrhotic patients with portal hypertension,the appropriate methods for managing these risk factors are of great clinical significance for preventing rebleeding after splenectomy and pericardial devascularization.

Cause analysis of early portal vein thrombosis after esophagogastric devascularization and splenectomy in cirrhotic patients with portal hypertension

Wu XiaoFeng, Fu Zhi, Liu ZhaoBo, Meng Jian, Li ChuanYun, Lin DongDong

2015, 31(3): 400-403. DOI: 10.3969/j.issn.1001-5256.2015.03.021

Abstract(2098)

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Objective To identify the causative factors for early portal vein thrombosis( EPVT) after esophagogastric devascularization and splenectomy( EGDS) in cirrhotic patients with portal hypertension. Methods A 3- month follow- up of a retrospective study was performed on 83 patients who received EGDS at our hospital from January 2012 to December 2013. The patients were assigned to thrombosis and control groups given the presence or absence of EPVT. Continuous and categorical data were compared between groups using t test and χ2test,respectively. Logistic regression models were adopted for multivariate analysis. Results EPVT occurred in 44 patients after EGDS,accounting for an incidence of 53. 01%. There were significant differences between the thrombosis and control groups in terms of preoperative portal vein diameter( P = 0. 014),postoperative portal vein diameter( P = 0. 017),spleen volume( P = 0. 013),and portal venous flow alteration( P = 0. 030); these four parameters were risk factors for EPVT after EGDS. Logistic regression analysis showed that portal venous flow alteration after surgery was an independent risk factor for EPVT( P = 0. 003); portal venous flow and pressure alterations after surgery,operation time,intraoperative bleeding,and maximum platelet count were unrelated to EPVT. Conclusion Hemodynamic factors impact EPVT after EGDS,for which individualized anticoagulant therapy is necessary.

Significance of molecular markers of prethrombotic state in monitoring portal vein thrombosis in patients with liver cirrhosis

Lu XiaoMin, Wang ZhenNing, Yang Jun

2015, 31(3): 404-406. DOI: 10.3969/j.issn.1001-5256.2015.03.022

Abstract(1840)

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Abstract:
Objective To investigate the levels of molecular markers of prethrombotic state in liver cirrhosis( LC) patients with portal vein thrombosis( PVT) and their significance. Methods Seventy- two LC patients who were admitted to our hospital from 2011 to 2013 were selected for analysis. Among the patients,thirty- two were diagnosed with PVT by computed tomography. The plasma levels of granular membrane protein- 140( GMP- 140),von Willebrand Factor antigen( v WF: Ag),thrombomodulin( TM),and D- dimer( DD) were measured by enzyme- linked immunosorbent assay. The data were analyzed using SPSS 11. 0. Continuous data were expressed as mean ±standard deviation and compared between the two groups by independent- samples t test. Results The concentrations of GMP- 140,TM,v WF: Ag,and DD in patients with PVT were significantly higher than those in patients without PVT( 20. 68 ± 1. 49 vs 13. 05 ± 0. 97 μg / L,P < 0. 05; 47. 24 ± 1. 36 vs 34. 05 ± 5. 03 μg / L,P < 0. 05; 194. 32% ± 7. 68% vs 136. 21% ± 3. 68%,P < 0. 05; 0. 86 ± 0. 12 vs 0. 42 ±0. 08 mg / L,P < 0. 05). The plasma levels of GMP- 140,TM,v WF: Ag,and DD in PVT patients with severe esophageal varices were significantly higher than those in patients with mild esophageal varices( 19. 68 ± 1. 29 vs 12. 05 ± 1. 07 μg / L,P < 0. 05; 45. 24 ± 1. 26 vs35. 05 ± 4. 83 μg / L,P < 0. 05; 196. 32% ± 6. 68% vs 141. 21% ± 3. 45 %,P < 0. 05; 0. 79 ± 0. 12 vs 0. 36 ± 0. 08 mg / L,P < 0. 05).The plasma levels of GMP- 140,TM,v WF: Ag,and DD in PVT patients with gastrointestinal bleeding were significantly higher than those in patients without gastrointestinal bleeding( 18. 98 ± 1. 18 vs 11. 98 ± 1. 12 μg / L,P < 0. 01; 46. 78 ± 1. 35 vs 36. 02 ± 4. 78 μg / L,P <0. 01; 197. 32% ± 6. 39% vs 138. 21% ± 4. 12 %,P < 0. 01; 0. 81 ± 0. 14 vs 0. 35 ± 0. 12 mg / L,P < 0. 01). Conclusion The levels of molecular markers of prethrombotic state can be used to monitor PVT in LC patients.

Analysis of pathogenic features of liver cirrhosis with spontaneous bacterial peritonitis

Zhang JuLing, Geng Wei, Cui EnBo, Yuan Yuan, Zhang ChengLong, Chen SuMing, Jia TianYe, Wang Huan, Bao ChunMei, Qu Fen

2015, 31(3): 407-412. DOI: 10.3969/j.issn.1001-5256.2015.03.023

Abstract(2374)

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Abstract:
Objective To analyze the pathogenic and drug resistance features,as well as laboratory indices,of spontaneous bacterial peritonitis( SBP) and to provide a basis for the early warning,rapid diagnosis,and timely treatment of the disease. Methods The clinical data and laboratory indices of 1340 patients diagnosed with SBP in 302 Hospital of PLA from January 2011 to December 2013 were retrospectively analyzed. The pathogenic spectrum and laboratory characteristics of SBP caused by different pathogenic bacteria were compared and the drug resistance features of the bacteria were also determined. Drug sensitivity results were analyzed with WHONET5 software,and statistical analysis was carried out with CHISS software. Comparison of continuous data was made by t test,and comparison of categorical data was made by chi- square test. Results Of the 1340 liver cirrhosis patients with SBP,591 cases( 44. 10%) were infected with gram- negative bacilli( G- b),746( 55. 67%) with gram- positive cocci( G+ C),one( 0. 07%) with fungi,and two( 0. 15%) with gram- positive bacilli( G+ b). Compared with G+ Cinfection,G- binfection involving other body parts had a significantly higher abnormality rate of laboratory indices including neutrophil,ascites white blood count( WBC),polymorphonuclear leukocyte( PMN),alanine aminotransferase( ALT),aspartate aminotransferase( AST),total bilirubin( TBil),exogenous prothrombin activity( PTA),and creatinine( Cr)( P < 0. 05). The positive rates of extended- spectrum beta- lactamase( ESBL) produced by Escherichia coli and Klebsiella pneumoniae were 40. 00% and36. 03%,respectively. The drug resistance rates of Acinetobacter baumannii to amikacin,sulfamethoxazole / trimethoprim,and imipenem were 42. 42%,57. 57%,and 57. 58%,respectively,while the drug resistance rates of Pseudomonas aeruginosa to cefoperazone and ticarcillin / clavulanic acid were 45. 45% and 36. 36%,respectively. The composition ratios of methicillin- resistant Staphylococcus aureus and methicillin- resistant coagulase- negative Staphylococcus were 43. 33% and 78. 09%,respectively,and their sensitivity rates to vancomycin and teicoplanin were 100%. Conclusion The pathogenic bacteria of SBP were mainly G+ Cand G- b,which show strong drug resistance. Auxiliary examinations for neutrophil,ascites WBC,ascites PMN,ALT,AST,TBil,PTA,and Cre can predict G- binfection,and antibiotics should be used in the treatment based on the types and drug resistance of pathogenic bacteria as well as the patients' conditions.

Clock drawing test in cognitive assessment for patients with hepatitis B cirrhosis

Sun YuMei, Zhou YingXia, Xing HuiChun, Lin KeKe

2015, 31(3): 413-417. DOI: 10.3969/j.issn.1001-5256.2015.03.024

Abstract(1994)

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Abstract:
Objective To explore the significance and potential influencing factors for the clock drawing test( CDT) in cognitive assessment for patients with hepatitis B cirrhosis. Methods Ninety- five Child- Turcotte- Pugh class A patients with hepatitis B cirrhosis,who were admitted to our hospital from June to December,2012,were enrolled as subjects. Ninety- five healthy volunteers were used as controls.CDT was conducted in the two groups to measure cognitive functions and investigate potential influencing factors. Results The medians of total scores of CDT1 and CDT2 were 17 and 26,respectively,in patients with hepatitis B cirrhosis,and 20 and 27,respectively,in the control group. The rank- sum test showed that the total score of CDT1 and the scores of the digital and pointer parts in CDT1 and CDT2 were all significantly lower in the cirrhosis group than in the control group( P < 0. 05). There were no significant differences in the total score of CDT2 and the scores of the anchor parts in CDT1 and CDT2 between the two groups. The Spearman correlation analysis indicated that the total score of CDT2 was negatively correlated with age( r =- 0. 262,P < 0. 05) and positively correlated with driving history( r = 0. 238,P <0. 05) in the control group; in the cirrhosis group,the total score of CDT1 was negatively correlated with abnormal direct bilirubin level( r =- 0. 203,P < 0. 05),and the total score of CDT2 was positively correlated with education,driving history,and antiviral therapy( r =0. 291,P < 0. 05; r = 0. 222,P < 0. 05; r = 0. 223,P < 0. 05). Conclusion The impairment in visual- spatial ability of patients with hepatitis B cirrhosis should be taken into account. CDT is helpful for the early detection of cognitive dysfunction in patients with cirrhosis.

Dynamic change of hepcidin in liver fibrosis induced by CCl4 among mice

Pang GuoJin, Chen ShuangJun, Zhao WeiHua, Liu TianHui, Wang Ping, You Hong, Cong Min

2015, 31(3): 418-423. DOI: 10.3969/j.issn.1001-5256.2015.03.025

Abstract(379)

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Objective To investigate the dynamic change of hepcidin in liver fibrosis induced by CCl4 among mice. Methods C57 BL /6mice were given CCl4 by intragastric administration to establish a liver fibrosis model. The degree of liver injury and fibrosis was evaluated by HE and Masson staining. Prussian blue staining was used to detect liver iron deposition in the progression of liver fibrosis. Primary hepatocytes,hepatic stellate cells,and Kupffer cells were isolated from C57 BL /6 mice by two- step in situ collagenase perfusion and density gradient centrifugation. The mRNA levels of tumor necrosis factor alpha( TNFα),interleukin- 6( IL- 6),interleukin- 1β( IL- 1β),and hepcidin were measured by quantitative real- time PCR( qRT- PCR). Continuous data were expressed as mean ± SD,and comparison of continuous data between the two groups was made by t test. Results The HE and Masson staining of liver tissues showed that the degree of liver fibrosis gradually increased as CCl4 was given,and hepatic fibrosis was reversed after the administration of CCl4 was stopped. Prussian blue staining showed that liver iron deposition increased as CCl4 was given; the area of liver iron deposition was significantly increased compared with that of the normal control group at week 4 of administration( t = 4. 772,P < 0. 05),but no significant increase was seen from week 4 to week 6; the area of liver iron deposition at week 6 was still higher than that of the normal control group( t = 10. 32,P < 0. 05);liver iron deposition decreased in the spontaneous reversal after the administration was stopped. The mRNA levels of TNFα,IL- 1β,and IL-6 assessed by qRT- PCR continuously increased in model mice,reaching the peak levels at week 6,and significant differences were observed between the model mice and normal controls( t = 4. 322,9. 707,and 5. 678,P < 0. 05 for all). The expression of hepcidin in the liver increased in the early stage of model establishment and reached the peak level at week 4,with a significant difference compared with that of the normal control group( t = 2. 590,P < 0. 05),but it was reduced in the spontaneous reversal. Conclusion Liver iron deposition increases gradually in the progression of liver fibrosis induced by CCl4 among mice. The expression of hepcidin in the liver is upregulated in the progression of liver fibrosis and is correlated with the expression of inflammatory cytokines.

Therapeutic effect of estradiol-pretreated human bone marrow mesenchymal stem cells on liver cirrhosis in mice

Yan XiaoMing, Zhang LiTing, Luo JingYi, Xiao Ping

2015, 31(3): 424-430. DOI: 10.3969/j.issn.1001-5256.2015.03.026

Abstract(2233)

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Objective To explore the effect of estradiol on human bone marrow mesenchymal stem cells( BMSCs) and the therapeutic effect of estradiol- pretreated BMSCs on liver cirrhosis in mice. Methods Third- passage BMSCs were divided into control( untreated with estradiol) and experimental groups( treated with different concentrations of estradiol); the effect of estradiol on the proliferative activity of BMSCs was measured by MTT assay. Apoptosis was induced by H2O2 in the control and experimental groups of BMSCs,with normal BMSCs as the blank group; the effect of estradiol on apoptosis in BMSCs was tested by trypan blue staining and quantitative real- time PCR of caspase- 3 mRNA. Forty- six normal male C57 BL mice were assigned to control,model,BMSC transplantation,and estradiol- pretreated BMSC transplantation groups. An animal model of liver cirrhosis was established by intraperitoneal injection of CCl4. At 12 weeks after CCl4 injection,estradiol- pretreated and untreated BMSCs were transplanted into mice through the tail vein. At 4 weeks after BMSC transplantation,blood samples were collected for serum alanine aminotransferase( ALT) and serum aspartate aminotransferase( AST) assays. The stage of liver fibrosis was determined by hematoxylin- eosin and Masson staining. Type I collagen( collagen I) expression was analyzed by RT- PCR. Normally distributed categorical data( with homogeneous variances) were analyzed using ANOVA,followed by pairwise comparisons using LSD test; non- normally distributed data( with heterogeneous variances) were analyzed using Mann- Whitney rank- sum test. Results All the experimental groups had higher proliferative activity than the control group( F = 730. 08,P = 0. 000). H2O2 promoted apoptosis in BMSCs,with lower apoptosis rate in the experimental groups than in the control group( F = 258. 34,P = 0. 000). Caspase- 3 mRNA expression was significantly different between the control and experimental groups( F = 50. 29,P = 0. 000). Additionally,there were significant differences in rats between the model,BMSC transplantation,and estradiol- pretreated BMSC transplantation groups in terms of ALT( P = 0. 000 for all),AST( P < 0. 05 for all),fiber ratio( P < 0. 05 for all),and collagen I mRNA expression( P < 0. 05 for all). Conclusion Estradiol promotes the proliferation and reduces H2O2- induced apoptosis in BMSCs. BMSCs can improve liver cirrhosis and their therapeutic effect is enhanced by estradiol pretreatment.

Clinical effects of hand-assisted laparoscopic vs open splenectomy combined with pericardial devascularization the treatment of portal hypertension in liver cirrhosis

Bao HanKang, Wei XiuLi

2015, 31(3): 431-433. DOI: 10.3969/j.issn.1001-5256.2015.03.027

Abstract(244)

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One case of hepatitis B cirrhosis complicated by rhabdomyolysis

Zhang DaLi, Zhang Min, Su HaiBin

2015, 31(3): 434-435. DOI: 10.3969/j.issn.1001-5256.2015.03.028

Abstract(2886)

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One case of spontaneous recanalization of acute portal vein thrombosis in patients with cirrhosis

Jiang HongLi, Zhang Rui, Hu YuLin, Xin GuiJie

2015, 31(3): 436-437. DOI: 10.3969/j.issn.1001-5256.2015.03.029

Abstract(2866)

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Alcoholic cirrhosis with localized hepatic fatty infiltration misdiagnosed as liver cancer: a report of one case and literature review

Tang ShanHong, Yang DeHui, Ceng WeiZheng, Wu XiaoLing, Wang Zhao, Zhou XiaoLei, Li HongYong, Chen HongChao, Fan QuanShui, Jiang MingDe

2015, 31(3): 438-440. DOI: 10.3969/j.issn.1001-5256.2015.03.030

Abstract(2821)

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One case of poikiloderma vasculare atrophicans with cirrhosis

Wang HongJie, Zhou JingJing, Sun Ying, Wen XiaoYu, Jin QingLong

2015, 31(3): 441-442. DOI: 10.3969/j.issn.1001-5256.2015.03.031

Abstract(2848)

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Treatment of hemoperitoneum following transjugular intrahepatic portosystemic shunt: a report of 4 cases and literature review

Hu WeiLin, Luo XiaoPing, Ling Ning, Shi XiaoFeng, Huang Ying, Yang YiXuan, Ceng WeiQun, He Hua, Zhang DaZhi

2015, 31(3): 443-446. DOI: 10.3969/j.issn.1001-5256.2015.03.032

Abstract(2735)

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Roles of Nrf2 and autophagy in liver fibrosis

Wang WeiHao, Xu WeiHua

2015, 31(3): 447-451. DOI: 10.3969/j.issn.1001-5256.2015.03.033

Abstract(2600)

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Liver fibrosis is an essential stage in the progression of chronic liver disease to liver cirrhosis,and its incidence is high in the world. The mechanism of liver fibrosis that involves many cytokines and signaling pathways is complicated and is understood by people more and more clearly. This review presents that nuclear factor- erythroid 2- related factor- 2( Nrf2)- mediated antioxidant response plays a critical role in suppressing the progression of liver fibrosis. In addition,autophagy is also an important and complex regulator of liver fibrosis in different pathways. The possible mechanism of interaction between Nrf2 and autophagy in liver fibrosis is also described in this review.Currently,the research combining Nrf2 and autophagy is considered the future direction for the study of liver fibrosis,providing a new idea for the treatment of liver fibrosis.

Signal transduction involved in activation of hepatic stellate cells

Ren ChangZhen, Hao LiSen

2015, 31(3): 452-456. DOI: 10.3969/j.issn.1001-5256.2015.03.034

Abstract(2877)

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Hepatic stellate cells( HSCs) are the source of fibre in the liver which can produce a large number of extracellular matrix via proliferation and activation,and this is the central link of hepatic fibrosis. Following further research on hepatic fibrosis,signal transduction involved in the activation of HSCs have been researched as a popular topic. This paper generalizes the main signaling transduction pathways involved in activation of HSCs and Hedgehog / Gli pathway,and introduces recent advances in related research. It is promising to make new breakthroughs in the prevention and treatment of hepatic fibrosis through in- depth study of these signaling pathways.

Role of Hedgehog signaling pathway in progression of non-alcoholic fatty liver fibrosis

An BaiQuan, Jiang Man, Xin YongNing, Jiang XiangJun, Liu ZhenSheng, Xuan ShiYing

2015, 31(3): 457-459. DOI: 10.3969/j.issn.1001-5256.2015.03.035

Abstract(2883)

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Obesity and related metabolic syndromes are prevalent on the global scale. Thus far,non- alcoholic fatty liver( NAFL) disease has caused wide attention from domestic and overseas scholars. NAFL cirrhosis is considered to be the central part and inevitable stage of liver cirrhosis developed from simple fatty liver and non- alcoholic steatohepatitis. The effect of Hedgehog signaling pathway on hepatocytes in the progression of NAFL fibrosis was elucidated and investigated by a population study. Results showed that abnormal activation of the Hedgehog signaling pathway promoted the progression of NAFL fibrosis. In- depth study on the Hedgehog signaling pathway may provide a new approach for the treatment of NAFL fibrosis.

Research progress in antiviral therapy for decompensated hepatitis B cirrhosis

Tu YanYun, Chen HaiYan, Liu XuDong

2015, 31(3): 460-464. DOI: 10.3969/j.issn.1001-5256.2015.03.036

Abstract(3207)

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Decompensated hepatitis B cirrhosis is one of the final outcomes of chronic hepatitis B and liver fibrosis. Extensive studies have demonstrated that antiviral therapy can slow disease progression,improve clinical outcomes,reduce complications,slow decompensated cirrhosis progression,and improve survival. At present,nucleoside and nucleotide analogues are the most common antiviral agents in the treatment of decompensated hepatitis B cirrhosis. This paper introduces effective antiviral agents against decompensated hepatitis B cirrhosis and discusses potential problems in antiviral treatment,suggesting that personalized medication should be achieved on the basis of standardized antiviral treatment in clinical practice.

Progress in treatment of liver cirrhosis

Zhang JingWen, Shi YongQuan, Han Ying

2015, 31(3): 465-468. DOI: 10.3969/j.issn.1001-5256.2015.03.037

Abstract(3623)

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Liver cirrhosis is a late- stage hepatic fibrosis,which results from various risk factors such as viruses,alcohol,fat,drugs and immunity,and genetic metabolism,leading to chronic liver damage. This paper reviews the etiological treatment and therapy for complications. It is pointed out that liver transplantation,which is currently the only effective approach to the treatment of liver cirrhosis,is limited by liver donor shortage and high cost. Stem cell therapy becomes a hot spot of research due to its huge potential for the treatment of liver cirrhosis. However,its mechanism remains unclear with many pending problems.

Research advances in role of carvedilol in management of cirrhotic portal hypertension: a review of clinical trials

Yang ChunJiao, Qi XingShun, Guo XiaoZhong

2015, 31(3): 469-471. DOI: 10.3969/j.issn.1001-5256.2015.03.038

Abstract(3325)

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The primary aim of preventing variceal bleeding in liver cirrhosis is to reduce portosystemic pressure gradient. Carvedilol is a non- selective beta blocker with selective inhibition of α- 1 receptor and blockage of calcium channel. This paper reviews the role of carvedilol in reducing hepatic venous pressure gradient and preventing variceal bleeding. Analysis has shown that carvedilol is superior to propranolol in reducing portosystemic pressure gradient. Carvedilol may be similar to propranolol or endoscopic ligation for the primary and secondary prevention of variceal bleeding. Further randomized controlled trials with a larger sample size are warranted to confirm these findings.

Diagnosis and treatment procedure for intractable liver ascites

Fan ZhiDong, You JinLi

2015, 31(3): 472-474. DOI: 10.3969/j.issn.1001-5256.2015.03.039

Abstract(2442)

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Ascites is a common complication of liver cirrhosis. Liver ascites may occur repeatedly,which increases the therapeutic difficulty. This paper reviews the definition of intractable liver ascites,general treatment measures,and current treatment of common complications such as spontaneous bacterial peritonitis and hepatorenal syndrome,as well as the advances in conventional,unconventional,and surgical treatment of intractable liver ascites. It is pointed out that abdominocentesis for excessive drainage and active preparation for liver transplantation are the preferred approach to the treatment of intractable liver ascites.

Progress in application of branched- chain amino acids in patients with liver cirrhosis

Lu: Zheng, Meng QingHua

2015, 31(3): 475-477. DOI: 10.3969/j.issn.1001-5256.2015.03.040

Abstract(2682)

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The metabolism of amino acids mainly takes place in the liver,and patients with liver cirrhosis may develop metabolic disorders of proteins,carbohydrates,fats,and amino acids,which in turn causes dysfunction of multiple organs and systems,as well as complications like hepatic encephalopathy,esophageal variceal bleeding,and ascites,resulting in high mortality. This paper summarizes the metabolic characteristics of amino acids and the application of branched- chain amino acids( BCAAs) in the treatment of liver cirrhosis,and it points out the significance of BCAAs in regulating serum aminogram,increasing the ratio of BCAAs to aromatic amino acids,preventing complications of liver cirrhosis,and improving the quality of life for patients with the disease.

Role of vascular biology in portal hypertension

Ren XiaoLi, Shi YongQuan, Han Ying

2015, 31(3): 478-481. DOI: 10.3969/j.issn.1001-5256.2015.03.041

Abstract(1915)

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The development of portal hypertension is associated with remarkable changes in the intra- and extra- hepatic vasculature. Thus far,in- depth research into vascular biology has furthered our understanding about the mechanism of dynamic vascular changes associated with portal hypertension. Advances in portal hypertension- related vascular biology are reviewed. Alterations in hepatic vascular cells and their signaling pathways are associated with increases in the intra- hepatic resistance,eventually resulting in the development of portal hypertension. Due to mesenteric arterial vasodilation,increased blood flow enters the portal vein and exacerbates portal hypertension. Better understanding of relevant mechanisms and targeted molecular pathways will provide new prospects for the treatment of portal hypertension.

2015 No. 3

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2015 No. 3

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