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

2016 No. 11

Display Method:
Editorial
Antiviral therapy for chronic hepatitis B: current status and perspectives
Fan Rong, Sun Jian, Hou JinLin
2016, 32(11): 2029-2032. DOI: 10.3969/j.issn.1001-5256.2016.11.001
Abstract:

Chronic hepatitis B is an important public health issue in China. The drugs used as the antiviral therapy for hepatitis B are mainly interferons and nucleos( t) ide analogues. Although these drugs have realized persistent HBV inhibition in most patients,a large number of patients cannot achieve immune control and functional cure. It is believed that in the future,with the research and development of new target drugs,we will defeat HBV in the way we defeated HCV.

Therapeutic guidelines
An excerpt of guideline for the evaluation of cholestatic jaundice in infants: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) in 2016
Ma LinJie, Chen Gang, Hu ZongQiang
2016, 32(11): 2033-2035. DOI: 10.3969/j.issn.1001-5256.2016.11.002
Abstract:
An excerpt of non-alcoholic fatty liver disease (NAFLD): assessment and management (NICE guidelines in 2016) 
Liu Tao, Zhang Li, Fan JianGao, Ji Guang
2016, 32(11): 2036-2038. DOI: 10.3969/j.issn.1001-5256.2016.11.003
Abstract:
Discussions by experts
Diagnosis and treatment of hepatitis B virus infection complicated by metabolic syndrome
Liu Jing, Shi JunPing
2016, 32(11): 2039-2042. DOI: 10.3969/j.issn.1001-5256.2016.11.004
Abstract:

With the prevalence of obesity around the world,the incidence rate of hepatitis B virus( HBV) infection complicated by metabolic syndrome( MS) is increasing year by year,and such patients have become a special population in patients with chronic HBV infection. In recent years,the research on the features of this disease and diagnosis and treatment strategies has become a hot topic in the field of liver disease. MS not only increases the risk of liver fibrosis and cirrhosis in chronic hepatitis B( CHB) patients,but also reduces the response to antiviral therapy. Therefore,as for patients with HBV infection,especially CHB patients with suboptimal response to antiviral therapy,MS and its components should be considered. Screening and monitoring of liver cirrhosis should be performed for patients with HBV infection complicated by MS to guide the development of proper treatment regimens.

Advances in research and development of new drugs for antiviral therapy for chronic hepatitis B
Gao YanHang, Liu PeiYan, Gao PuJun
2016, 32(11): 2043-2049. DOI: 10.3969/j.issn.1001-5256.2016.11.005
Abstract:

Chronic hepatitis B virus( HBV) infection is one of the major disease burdens worldwide. At present,the antiviral therapy for hepatitis B includes interferons and nucleos( t) ide analogues. Current therapeutic regimens based on these drugs cannot significantly increase the proportion of patients with functional cure. With a better understanding of HBV replication cycle and specific virus- host cell interactions,this article summarizes and reviews the advances in the research and development of new drugs for HBV with a focus on different action targets during the above processes.

How to evaluate combination therapy using interferon and nucleos(t)ide analogues
Chen Lu, Xie Qing
2016, 32(11): 2050-2053. DOI: 10.3969/j.issn.1001-5256.2016.11.006
Abstract:

Chronic hepatitis B is still one of the most important chronic diseases in China because of its high relevance to liver cirrhosis and hepatic cell cancer( HCC). Currently,interferon and nucleos( t) ide analogues are two main treatments for chronic hepatitis B,but they have advantages and disadvantages. More investigations are needed to explore better ways for treating this disease,and combination therapy might be one of the options. This article analyzes the advances in various combination therapies and points out views about the selection of combination therapies and patients.

New considerations in antiviral therapy for special populations with chronic hepatitis B
Hu XiaoYun, Sun Jian, Peng Jie
2016, 32(11): 2054-2057. DOI: 10.3969/j.issn.1001-5256.2016.11.007
Abstract:

Increasing attentions have been paid to the antiviral therapy for special populations with chronic hepatitis B( CHB),including patients co- infected with HIV,HDV,or HCV,children and adolescents,pregnant women,patients with chronic kidney diseases,and patients who require chemotherapy or immunosuppressive therapy. The indications for antiviral therapy,drug selection and adjustment,and treatment course in special populations with CHB have become the hot topics of clinical research. In recent years,all guidelines for the prevention and treatment of CHB have provided a summary of key considerations in the standardized management of these populations. However,the strength of recommendations for antiviral therapy in these populations is not high. In order to obtain a strong medical evidence for antiviral therapy in these populations,we should standardize clinical management processes and carry out high- quality cohort studies based on the previous research.

Role of liver fibrosis assessment in decision-making and efficacy surveillance for antiviral therapy in patients with chronic hepatitis B
Liang XieEr, Chen YongPeng
2016, 32(11): 2058-2061. DOI: 10.3969/j.issn.1001-5256.2016.11.008
Abstract:

Liver fibrosis / cirrhosis is the outcome of the progression of chronic hepatitis B and is associated with liver events and long- term prognosis. Effective antiviral therapy can delay or even reverse disease progression. Therefore,assessment of liver fibrosis degree before and during treatment is of great importance in initiating antiviral therapy,developing therapeutic regimens,and monitoring antiviral effects and complications. The semi- quantitative histological scoring system is widely acknowledged in the assessment of liver fibrosis degree and is an important basis for the initiation of antiviral therapy for hepatitis B,as well as a method commonly used for efficacy surveillance. Morphological and structural quantitative methods provide objective histological assessment of liver fibrosis and may cover the shortage of conventional semi- quantitative scoring system. Non- invasive methods for the assessment of liver fibrosis may reduce but not completely substitute liver histological examinations; a consensus has not been reached on their cut- off values to make decisions to initiate antiviral therapy,but such non- invasive methods can provide rich information on therapeutic effect and long- term prognosis.

Research advances in primary biliary cholangitis
Duan WeiJia, Tian QiuJu, You Hong, Jia JiDong
2016, 32(11): 2062-2065. DOI: 10.3969/j.issn.1001-5256.2016.11.009
Abstract:

Primary biliary cholangitis is a chronic intrahepatic cholestatic liver disease and has increasing incidence and prevalence rates,as is reported in the literature. Examination of specific antibodies including serum anti- mitochondrial antibody subtype M2 and liver histopathological examination help to make a definite diagnosis of this disease. Ursodeoxycholic acid( UDCA) is often used for the treatment of this disease,but patients with an unsatisfactory biochemical response to UDCA tend to have rapid disease progression. At present,there are no effective treatment methods for such patients. The addition of budesonide,fenofibrate,bezafibrate,or obeticholic acid may be effective in these patients,but this needs to be verified by further clinical studies.

Original articles_Viral hepatitis
Clinical effect of 24-week TDF versus ADV sequential therapy in HBeAg-positive chronic hepatitis B patients with suboptimal response to 48-week pegylated interferon-α-2a treatment
Lu: Ying, Chen XiaoRong
2016, 32(11): 2066-2069. DOI: 10.3969/j.issn.1001-5256.2016.11.010
Abstract:

Objective To investigate the clinical effect of 24- week tenofovir disoproxil fumarate( TDF) sequential therapy in HBeAg- positive chronic hepatitis B( CHB) patients with suboptimal serological response to 48- week pegylated interferon- α- 2a( Peg- IFN- α- 2a) monotherapy. Methods A total of 21 patients who did not achieve HBeAg seroconversion after the 48- week Peg- IFN- α- 2a monotherapy at a dose of 180 μg / week were enrolled. Among these patients,11 were given TDF 300 mg / d in addition,the withdrawal of Peg- IFN- α- 2a after 12 weeks,and TDF monotherapy for 12 weeks; 10 were given sequential adefovir dipivoxil( ADV) monotherapy at a dose of 10 mg / d for 24 weeks. The indicators including HBV DNA,liver and renal function,and HBV serological markers were measured at weeks 12 and 24 of treatment,and the clinical outcome was compared between the two groups. The independent samples t- test was used for comparison of normally distributed continuous data between groups and the paired t- test was used for comparison of normally distributed continuous data within one group; the Mann- Whitney U test was used for comparison of non- normally distributed continuous data between groups. The Fisher's exact test was used for comparison of categorical data. Results At weeks 12 and 24 of treatment,there were no significant differences in HBs Ag and HBeAg levels between groups( both P > 0. 05). At week 24 of treatment,there was no significant difference in HBeAg seroconversion rate between the TDF group and the ADV group [18. 2%( 2 /11) vs 10. 0%( 1 /10),P > 0. 05]. At weeks 12 and 24 of treatment,the TDF group had significant reductions in HBeAg compared with baseline( 1. 75 ± 0. 59 log10 S / CO、1. 61 ± 0. 70 log10 S / CO vs1. 86 ± 0. 58 log10 S / CO,P = 0. 017 and 0. 027). At week 24 of treatment,the TDF group had a significantly lower alanine aminotransferase( ALT) level than the ADV group[21. 0( 15.0-27.0) U/L vs 33. 0( 21. 5-63. 5) U/L,P =0.046]. There were no significant differences in estimated glomerular filtration rate at weeks 12 and 24 of treatment between the two groups( both P > 0. 05). Conclusion As for CHB patients with suboptimal serological response to 48- week Peg- IFN- α- 2a monotherapy,addition of TDF for 12 weeks and then TDF monotherapy for 12 weeks helps to achieve greater reductions in serum ALT and HBeA g levels compared with sequential ADV therapy.

Clinical effect of entecavir combined with thymosin in treatment of HBe Ag-positive hepatitis B patients
Huang Ling, Ning HuiMing, Xu YanHua, Tang Qun, Ou Qiang
2016, 32(11): 2070-2074. DOI: 10.3969/j.issn.1001-5256.2016.11.011
Abstract:

Objective To investigate the clinical effect of entecavir( ETV) combined with thymosin in the treatment of HBe Ag- positive chronic hepatitis B( CHB) patients. Methods A total of 108 HBe Ag- positive CHB patients who were treated in Department of Infectious Diseases in our hospital from March 2012 to March 2015 were enrolled,and according to the parallel,single- blind,randomized controlled principles,the patients were divided into control group( 54 patients) and observation group( 54 patients). The patients in both groups were given comprehensive medical treatment; the patients in the control group were treated with ETV alone,and those in the observation group were treated with ETV combined with thymosin. The changes in liver function parameters,virological parameters,immune indices,and liver fibrosis indicators were compared between the two group. The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results After 48 weeks of treatment,there were significant differences between the observation group and the control group in the liver function parameters albumin / globulin ratio( 1. 73 ± 0. 57 vs 1. 50 ± 0. 51,t =2. 210,P < 0. 05),alanine aminotransferase( 42. 58 ± 14. 32 U / L vs 54. 26 ± 18. 78 U / L,t = 3. 634,P < 0. 05),aspartate aminotransferase( 35. 79 ± 10. 33 U / L vs 49. 97 ± 17. 84 U / L,t = 5. 055,P < 0. 05),and total bilirubin( 18. 89 ± 6. 02 μmol / L vs 25. 24 ± 9. 06μmol /L,t = 4. 290,P < 0. 05). After 48 weeks of treatment,there were significant differences between the observation group and the control group in the liver fibrosis indicators laminin( 65. 34 ± 11. 02 ng / ml vs 102. 57 ± 16. 41 ng / ml,t = 13. 840,P < 0. 001),hyaluronic acid( 91. 68 ± 11. 53 ng / ml vs 151. 23 ± 16. 71 ng / ml,t = 21. 555,P < 0. 001),type IV collagen( 81. 02 ± 12. 64 μg / ml vs 118. 47 ±18. 01 μg / ml,t = 12. 507,P < 0. 001),and procollagen III( 70. 44 ± 13. 06 μg / ml vs 91. 57 ± 17. 16 μg / ml,t = 7. 200,P < 0. 001). At weeks 12,24,and 48 of treatment,the observation group had significantly higher HBe Ag clearance rates than the control group( 29. 63% /46. 30% /57. 41% vs 12. 96% /22. 22% /25. 93%,χ2= 4. 475,6. 948,and 11. 009,all P < 0. 05). After 48 weeks of treatment,compared with the control group,the observation group had a significantly lower serum level of interleukin- 4( 2. 69 ± 1. 23 pg / ml vs 4. 38 ±1. 44 pg / ml,t = 6. 558,P < 0. 001) and a significantly higher level of interferonγ( 1. 82 ± 0. 89 pg / ml vs 1. 12 ± 0. 56 pg / ml,t = 4. 812,P < 0. 001). There was no significant difference in the incidence rate of adverse events between the observation group and the control group( 3. 70% vs 1. 85%,χ2= 0. 343,P = 0. 558). Conclusion In HBeA g- positive CHB patients,ETV combined with thymosin can promote the recovery of liver function,regulate immune function,improve HBeA g clearance rate,and inhibit the process of liver fibrosis.

An analysis of medication rule for HBeAg-positive chronic hepatitis B based on association rule and complex system entropy clustering
Jiao YunTao, Li XiaoKe, Yang XianZhao, Ye YongAn
2016, 32(11): 2075-2079. DOI: 10.3969/j.issn.1001-5256.2016.11.012
Abstract:
Objective To investigate the features of traditional Chinese medicine( TCM) and prescription rules in the treatment of HBeAg- positive chronic hepatitis B( CHB). Methods A systematic search was performed for the articles on the TCM diagnosis and treatment of HBeAg-positive CHB,the information of TCM diagnosis and treatment in medical records were extracted,and a database was established after data standardization. The Traditional Chinese Medicine Inheritance Support System was used to investigate the medication rule. Results A total of 100 articles with 135 medical records were included in this study. A total of 220 types of Chinese materia medica were used,among which Bupleurum chinense,Salvia miltiorrhiza,Radix Glycyrrhizae,Atractylodes macrocephala Koidz.,and Poria cocos were frequently used. As for the meridian entry of drugs,liver meridian,spleen meridian,and stomach meridian were commonly used. The analysis showed that the core drugs for HBeAg- positive CHB were Bupleurum chinense,Atractylodes macrocephala Koidz.,Radix Paeoniae Alba,Radix Curcumae,Salvia miltiorrhiza,Radix Glycyrrhizae,Poria cocos,Polygonum cuspidatum,Astragalus membranaceus,Herba Artemisiae Scopariae,and Hedyotis diffusa. A total of 20 core drug combinations were deduced based on complex system entropy clustering,and 10 new prescriptions were obtained using unsupervised entropy hierarchical clustering. Conclusion In this study,literature mining and inductive analysis show that the syndromes of stagnation of liver qi and spleen deficiency and liver and gallbladder damp- heat are common syndrome types of HBeAg- positive CHB. The medicine suits and prescriptions refined in this study can be used for reference in clinical practice.
Impact of nucleos(t)ide analogues on quality of life in patients with chronic hepatitis B
Zhong ChunXiu, Cai ShaoHang, Yin JunHua, Gao YuLin
2016, 32(11): 2080-2083. DOI: 10.3969/j.issn.1001-5256.2016.11.013
Abstract:

Objective To investigate the impact of treatment with nucleos( t) ide analogues on quality of life( Qo L) in patients with chronic hepatitis B( CHB),as well as proper nursing measures. Methods A total of 102 CHB patients who were treated in Department of Infectious Diseases,Nanfang Hospital,Southern Medical University from March 2010 to July 2014 were enrolled and divided into continuous treatment group( 54 patients) and drug withdrawal group( 48 patients). The 36- item short- form health survey( SF- 36) was used to measure Qo L. The patients in the treatment group were evaluated before treatment and at 96 weeks of treatment,and those in the drug withdrawal group were evaluated at the time of drug withdrawal and at 48 weeks after drug withdrawal. The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. The logistic regression analysis was performed for univariate and multivariate analyses. Results Compared with before treatment,the continuous treatment group had significant increases in the scores on the domains of physiological function,role physical,bodily pain,and general health after 96 weeks of antiviral therapy( physiological function: 94. 91 ± 7. 11 vs 92. 13 ± 10. 58,t =- 2. 924,P < 0. 05; role physical: 81. 94 ± 24. 96 vs71. 76 ± 34. 01,t =- 2. 623,P < 0. 05; bodily pain: 87. 72 ± 8. 64 vs 82. 85 ± 12. 88,t =- 3. 576,P < 0. 05; general health: 59. 63 ±14. 59 vs 53. 52 ± 16. 79,t =- 3. 786,P < 0. 05). As for psychological quality,the continuous treatment group had a significant increase in the subscale of mental health( 67. 30 ± 18. 94 vs 75. 56 ± 15. 53,t =- 3. 883,P < 0. 001),while there were no significant improvements in other subscales. At 48 weeks after drug withdrawal,the drug withdrawal group had significant increases in role physical( 84. 20 ± 18. 97 vs72. 49 ± 24. 38,t =- 2. 768,P < 0. 05),general health( 69. 28 ± 22. 94 vs 56. 41 ± 18. 27,t =- 3. 206,P < 0. 05),and mental health( 75. 02 ± 16. 03 vs68. 94 ± 14. 07,t =- 2. 078,P < 0. 05). The multivariate analysis showed that marital status was associated with the improvement in QoL after antiviral therapy( odds ratio = 11. 61,95% CI: 2. 28- 59. 00,P = 0. 003); the unmarried patients had better improvements in Qo L compared with the married ones,especially physiological function( t =- 2. 176,P = 0. 034),role physical( t =- 2. 173,P = 0. 034),and role emotional( t =- 2. 811,P = 0. 007). Conclusion Antiviral therapy can improve the Qo L and mental health of CHB patients. Effective psychological intervention is necessary for CHB patients,especially married CHB patients.

Clinical effect of entecavir in treatment of patients with chronic hepatitis B complicated by tuberculosis
Zhu DongLiang, Li DaoBo, Zhao ManZhi, Ma Ke, Song JianXin, Xu Dong
2016, 32(11): 2084-2087. DOI: 10.3969/j.issn.1001-5256.2016.11.014
Abstract:

Objective To investigate the clinical effect of entecavir in the treatment of patients with chronic hepatitis B( CHB) complicated by tuberculosis during anti- tuberculosis treatment. Methods A retrospective study was performed for the clinical data of 95 patients with CHB complicated by tuberculosis,and according to the application of entecavir antiviral therapy during anti- tuberculosis treatment,these patients were divided into treatment group and control group. The changes in clinical biochemical parameters and prognosis after treatment were compared between the two groups. The t- test or Mann- Whitney U test were used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results During the treatment,compared with the treatment group,the control group had significantly higher alanine aminotransferase [382. 7( 260. 7- 635. 9) U / L vs 143. 3( 97. 9-260. 4) U / L,Z =- 4. 225,P < 0. 001] and aspartate aminotransferase [280. 7( 197. 6- 461. 8) U / L vs 93. 8( 67. 3- 156. 9) U / L,Z =- 4. 637,P < 0. 001]and significant increases in total bilirubin [157. 4( 139. 7- 269. 6) μmol / L vs 106. 8( 88. 3- 187. 1) μmol / L,Z =- 2. 671,P = 0. 008] and the proportion of patients with jaundice( 63. 2% vs 34. 2%,χ2= 7. 650,P = 0. 007). Compared with the treatment group,the control group had a significantly prolonged prothrombin time( 22. 5 ± 15. 5 s vs 17. 3 ± 9. 7 s,t = 2. 553,P = 0. 012)and a significantly lower platelet count [( 131. 0 ± 69. 4) × 109/ L vs( 181. 7 ± 105. 6) × 109/ L,t = 2. 826,P = 0. 004] during treatment.Compared with the treatment group,the control group had significant increases in the proportions of patients with liver failure( 42. 1% vs15. 8%,χ2= 7. 306,P < 0. 001) and patients who were forced to stop all or part of antitubercular agents due to liver impairment during treatment( withdrawal of all antitubercular agents: 17. 5% vs 2. 6%,χ2= 4. 952,P = 0. 026; withdrawal of part of antitubercular agents: 68. 4%vs 15. 8%,χ2= 25. 330,P < 0. 001). Conclusion During the anti- tuberculosis treatment for patients with CHB complicated by tuberculosis,entecavir antiviral therapy can effectively reduce the incidence of liver injury during anti- tuberculosis treatment and ensure the effect and safety of anti- tuberculosis treatment; therefore,it holds promise for further clinical research.

Clinical effect of entecavir combined with antituberculosis therapy in patients with tuberculosis complicated by chronic HBV infection
Hong YouZhi, Huang JiShui, Hong WenCong, Jiang TaoYuan
2016, 32(11): 2088-2091. DOI: 10.3969/j.issn.1001-5256.2016.11.015
Abstract:

Objective To investigate the clinical effect of entecavir combined with antituberculosis therapy in patients with tuberculosis complicated by chronic HBV infection. Methods A total of 108 patients with tuberculosis complicated by chronic HBV infection were divided into entecavir group with 58 patients and control group with 50 patients. The patients in the entecavir group were given entecavir from1 month before antituberculosis therapy to the end of antituberculosis therapy,and those in the control group were given antitubercular agent alone. The incidence of liver injury and clinical symptoms,time to appearance of abnormal liver function,and time to liver function recovery were compared between the two groups. The two- independent- samples t test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results Compared with the control group,the entecavir group had significantly higher incidence rates of abnormal liver function( 29. 31% vs 64. 00%,χ2= 8. 475,P < 0. 05) and clinical symptoms of liver injury( 17. 24% vs 28. 00%,χ2= 5. 534,P < 0. 05). There were significant differences in the time to appearance of abnormal liver function( 25. 1 ± 10. 2 d vs 20. 1 ± 8. 9 d,t = 2. 675,P < 0. 05) and time to liver function recovery( 26. 5 ± 9. 8 d vs 32. 6 ±11. 2 d,t = 3. 778,P < 0. 05). Conclusion Entecavir can significantly reduce the incidence of liver injury caused by antituberculosis therapy,postpone the time to appearance of liver injury,and accelerate liver function recovery in patients with tuberculosis complicated by chronic HBV infection.

An investigation of clinical features of HBsAg and anti-HBs positive patients with chronic hepatitis B
Song JinYun, Wang JianFang, Wu XuPing, Huang Ling
2016, 32(11): 2092-2095. DOI: 10.3969/j.issn.1001-5256.2016.11.016
Abstract:
Objective To investigate the phenomenon of coexistence of HBsAg and anti- HBs and its clinical features,as well as related causes. Methods A total of 2260 persons who underwent physical examination in The Second Affiliated Hospital of Southeast University from February 2011 to February 2014 were enrolled,among whom 830 were diagnosed with chronic hepatitis B. Chemiluminescence microparticle immunoassay was used to screen out 188 patients with coexistence of HBsAg and anti- HBs,and these patients were divided into HBeAg positive group( 101 patients) and HBeAg negative group( 87 patients). Another 200 patients with positive HBsAg and negative anti-HBs were enrolled as controls,among whom 80 were in the HBeAg- positive group and 120 were in the HBeAg- negative group. HBV serological markers,liver function,and viral load were measured and analyzed with reference to clinical manifestations. The chi- square test was used for comparison of categorical data between groups. Results There were five patterns of HBV serological markers in patients with positive HBsAg and anti- HBs,among which positive HBsAg,anti- HBs,HBeAg,and anti- HBc and negative anti- HBe were the most common and accounted for 47. 9%( 90 /188). The overall abnormal rate of liver function parameters was 69. 1%( 130 /188),and the positive rate of HBV DNA was 56. 9%( 107 /188). The two groups with positive HBeAg had a high level of HBV DNA replication,and there was no significant difference in the positive rate of HBV DNA between positive HBsAg and anti- HBs group and control group( P > 0. 05).In the groups with negative HBeAg,there was a significant difference in the proportion of patients with HBV DNA quantitation of > 1 × 105 IU / ml between positive HBsAg and anti- HBs group and control group( P < 0. 05). The sequencing of the S region of HBV showed that among the 80 patients with positive HBsAg and anti- HBs,27 had variations in this region,and the mutation rate reached 33. 7%. The major variation sites in S region included P29 L,S61L,P62 L,I126T / S,Q129 N,M133K,F134 L,G145R / K,L175 S,and L186 H. Conclusion The patients with positive HBsA g and anti- HBs account for a certain proportion in patients with hepatitis B,and the major reason may be variation of viral strains. This situation does not indicate the improvement in disease,and the appearance of anti- HBs may not achieve complete and effective HBsA g clearance. There may be persistent replication of viral DNA,which needs to be taken seriously.
Clinical features of patients with acute exacerbation of chronic hepatitis B: an analysis of 74 cases
Ruan JianWen, Gao LiJuan, Su RuKai
2016, 32(11): 2096-2098. DOI: 10.3969/j.issn.1001-5256.2016.11.017
Abstract:
Objective To investigate the clinical features of patients with acute exacerbation of chronic hepatitis B,and to provide a basis of evidence- based medicine for the diagnosis and treatment of acute exacerbation of chronic hepatitis B. Methods A retrospective analysis was performed for the clinical data of 74 patients with acute exacerbation of chronic hepatitis B who were diagnosed in The People's Hospital of Haikou from January 2011 to October 2015. These patients were divided into HBe Ag positive group( 51 patients) and HBe Ag negative group( 23 patients). The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results The patients with acute onset of chronic hepatitis B had a level of alanine aminotransferase( ALT) of 523- 2940 U/L and were manifested as icteric hepatitis( 64 patients,86. 49%),and 65 patients( 87. 84%) were cured within4 weeks. There were no significant differences in baseline ALT,aspartate aminotransferase,and HBV DNA levels between the HBe Ag positive group and the HBe Ag negative group( all P > 0. 05),and the HBe Ag negative group had a significantly higher level of total bilirubin( TBil) than the HBe Ag positive group( 141. 1 ± 132. 9 μmol/L vs 80. 1 ± 68. 8μmol/L,t = 2. 745,P = 0. 007). Conclusion The acute exacerbation of chronic hepatitis B is similar to acute hepatitis B,and the patients with negative HBe Ag have a high level of TBil and severe hepatocyte injury.
Correlation between HBsAg,prothrombin time activity,and indocyanine green retention rate at 15 minutes in patients with HBeAg-positive chronic HBV infection
Fan WenHai, Zhao ZhengBin, Chen QingFeng, Zhang LiTing, Wang FeiFei, Wang Qiong, Wang Shan, Wei Xin
2016, 32(11): 2099-2102. DOI: 10.3969/j.issn.1001-5256.2016.11.018
Abstract:
Objective To investigate the correlation between HBsAg,prothrombin time activity( PTA),and indocyanine green retention rate at 15 minutes( ICG R15) in patients with HBeAg- positive chronic HBV infection. Methods A total of 92 patients with HBeAg- positive chronic HBV infection who were admitted to The First Hospital of Lanzhou University from December 2015 to April 2016 were enrolled and divided into chronic hepatitis B( CHB) group( 24 patients),compensated liver cirrhosis group( 38 patients),and decompensated liver cirrhosis group( 30 patients). Serum HBsAg quantitation,PTA test,and liver reserve function test( ICG R15)were performed for all patients. The chi- square test was used for comparison of categorical data between groups,an analysis of variance was used for comparison of continuous data between multiple groups,and a Pearson correlation analysis was also performed. Results There were significant differences between the three groups in serum HBsAg quantitation( 3. 82 ± 0. 43 log10 IU / ml vs 2. 88 ± 0. 36 log10 IU / ml vs 2. 60 ± 0. 27 log10 IU / ml,F = 25. 19,P < 0. 001),ICG R15( 7. 51% ± 3. 10% vs 9. 57% ± 8. 18% vs 24. 13% ± 14. 28%,F = 24. 00,P = 0. 001),and PTA( 81. 00% ± 17. 62% vs 83. 08% ± 9. 64% vs 62. 32% ± 16. 90%,F = 13. 42,P = 0. 009). The correlation analysis showed that PTA was negatively correlated with ICG R15 in all three groups( r =- 0. 948,- 0. 602,and- 0. 735,all P < 0. 01). In the compensated liver cirrhosis group and decompensated liver cirrhosis group,HBsAg was positively correlated with PTA( r = 0. 410 and 0. 473,both P < 0. 05) and negatively correlated with ICG R15( r =- 0. 427 and- 0. 768,P < 0. 01). Conclusion In HBeAg positive patients,there are certain correlations between HBsAg,PTA,and ICG R15,which,to a certain degree,reflects the liver reserve function in patients with chronic HBV infection.
HBV genotyping of 702 hepatitis B patients in Changchun,China and its clinical significance
Yuan Ye, Yu XueJiao, Lu NianHong, Zhang MingWei
2016, 32(11): 2103-2106. DOI: 10.3969/j.issn.1001-5256.2016.11.019
Abstract:
Objective To investigate the distribution of HBV genotypes in Changchun,China,as well as the association of genotypes with virus replication level,serum markers,and liver impairment and its clinical significance. Methods A total of 702 patients with HBV infection who visited The First Hospital of Jilin University from August 2013 to May 2016 were enrolled. Real- time PCR was used to determine HBV genotypes. HBV DNA load,serum markers,and liver function were measured,and the association between genotype and clinical test items was analyzed. The independent samples t- test was used for the comparison of means between groups,and the chi- square test was used for comparison of categorical data between groups. The Mann- Whitney U test was used to investigate the distribution of HBV genotypes in different diseases. Results Of all patients with HBV infection,664 underwent successful genotyping,among whom 484( 72. 9%) had genotype C,168( 25. 3%) had genotype B,and 12( 1. 8%) had genotype B + C. There were no differences in the distribution of HBV genotypes between patients with different sexes or ages. Compared with those with genotype B HBV infection,the patients with genotype C HBV infection had significantly higher HBV DNA load( 6. 68 ± 1. 20 log10 copies / ml vs 5. 15 ± 1. 37 log10 copies / ml,t = 13. 714,P < 0. 001) and HBsAg( +) + HBeAg( +) + anti- HBc( +)( χ2= 21. 687,P < 0. 001). There was no significant difference in HBsAg( +) + anti- HBe( +) + anti- HBc( +)between the two groups( χ2= 2. 124,P = 0. 145). The patients with genotype B had significantly higher levels of HBsAg and anti- HBe than those with genotype C( χ2= 28. 780,P < 0. 001). Compared with those with genotype B,the patients with genotype C had significantly higher levels of alanine aminotransferase( ALT) and aspartate aminotransferase( AST)( ALT: 307. 6 ± 113. 4 U / L vs 285. 8 ± 96. 2 U / L,t = 2. 229,P = 0. 026; AST: 211. 1 ± 96. 4 U / L vs 192. 7 ± 89. 2 U / L,t = 2. 172,P = 0. 030),as well as a significantly lower level of albumin( 37. 6 ± 9. 1 g/L vs 39. 9 ± 10. 6 g/L,t = 2. 701,P = 0. 007). Among the patients with genotype C HBV infection,264 progressed to chronic hepatitis,202 to liver cirrhosis,and 18 to liver cancer; among the patients with genotype B HBV infection,142 progressed to chronic hepatitis,20 to liver cirrhosis,and 6 to liver cancer. The patients with genotype C HBV infection had significantly greater liver injury compared with those with genotype B HBV infection( U = 28 894. 000,P < 0. 001). Conclusion Most of the patients with HBV infection in Changchun have genotype C,followed by genotype B. HBV genotype is not associated with sex or age. The patients with genotype C HBV infection have active HBV DNA replication and show greater association with the severity of liver injury compared with those with genotype B HBV infection.
Effect of hepatitis B virus rtA181T mutation on autophagy of Huh7 hepatoma cells
Shi JingRen, Guo XiangHua, Wang JieLin, Wang ShanShan, Qiao LuXin, Chen DeXi
2016, 32(11): 2107-2111. DOI: 10.3969/j.issn.1001-5256.2016.11.020
Abstract:
Objective To investigate the effect of reverse transcriptase A181T( rtA181T) mutation in hepatitis B virus( HBV) on autophagy of Huh7 hepatoma cells. Methods Huh7 hepatoma cells were transfected with wild- type( WT) 1. 3mer HBV plasmids( WT group),1. 3mer HBV rt A181 T mutant plasmids( 181 T group),or WT and rt A181 T mutant plasmids at a ratio of 1∶ 1( WT + 181 T group). Western blot and immunofluorescence assay were performed to measure the expression of intracellular HBV surface protein( HBs),and ELISA was used to measure the expression of extracellular HBs Ag. Western blot was used to measure the expression of endogenous autophagy- related proteins microtubule- associated light chain 3- II( LC3- Ⅱ) and P62,and Real time PCR was used to measure the mRNA expression of autophagy- related genes Atg5 and Beclin1. After transfection with green fluorescent protein- LC3,immunofluorescence assay was used to measure autophagy particles. An analysis of variance was used for comparison of continuous data between multiple groups and the LSD- t test was used for further comparison between any two groups. Results Immunofluorescence assay showed that there was expression of HBs in the 181 T group,WT group,and WT + 181 T group,and the 181 T group had significantly higher expression of intracellular HBs than the WT group and WT + 181 T group. The results of ELISA showed that there were significant differences in the level of HBs Ag in cell culture supernatant between the three groups( F = 66. 739,P < 0. 001),and the 181 T group had a significantly lower level of extracellular HBs Ag than the WT group and WT + 181 T group( 0. 111 ± 0. 056 vs 3. 157 ± 0. 490 /2. 240 ± 0. 797,both P < 0. 001). The WT group,181 T group,and WT + 181 T group all showed the aggregation of LC3- II autophagy particles; compared with the WT group and WT + 181 T group,the181 T group had significantly higher expression of LC3- II and significantly lower expression of P62( both P < 0. 05). The 181 T group had significantly higher mRNA expression of autophagy- related genes Atg5 and Beclin1 than the WT group and WT + 181 T group( P < 0. 05).
Original articles_Liver fibrosis and liver cirrhosis
Effect of transjugular intrahepatic portosystemic shunt combined with splenic artery embolization on hepatic hemodynamics and liver function in patients with liver cirrhosis
Liang XiaoHua, Zhang Feng, Zhu GeYuZheng
2016, 32(11): 2112-2117. DOI: 10.3969/j.issn.1001-5256.2016.11.021
Abstract:
Objective To investigate the effect of transjugular intrahepatic portosystemic shunt( TIPS) combined with splenic artery embolization( SAE) on hepatic hemodynamics,liver function,and prognosis in patients with liver cirrhosis. Methods A total of 24 patients who underwent TIPS in the Department of Gastroenterology in Drum Tower Hospital from September 2014 to June 2015 were enrolled and divided into TIPS group( 14 patients) and TIPS- SAE group( 10 patients) according to whether TIPS was used in combination with SAE. Color Doppler was used to measure the diameter,blood flow rate,and blood flow volume of the hepatic artery and portal vein before and after treatment; liver function parameters including alanine aminotransferase( ALT),aspartate aminotransferase( AST),and total bilirubin( TBil)were measured before and after surgery; the incidence of postoperative complications such as hepatic encephalopathy( HE) and splenic abscess was observed in the two groups. The Wilcoxon rank sum test was used for comparison of parameters before and after treatment within each group,and the Mann- Whitney U test was used for comparison of parameters between the two groups. Results At 5 days after surgery,the TIPS- SAE group showed significant increases in hepatic artery blood flow rate [200. 00( 168. 25- 224. 75) vs 91. 35( 76. 00-113. 25),Z = 2. 803,P = 0. 005],portal vein blood flow rate [60. 30( 49. 85- 75. 70) vs 28. 30( 21. 20- 30. 00),Z = 2. 666,P =0. 008 ],and hepatic artery blood flow volume [188. 00( 172. 00- 232. 00) vs 79. 10( 61. 15- 89. 75),Z = 2. 803,P = 0. 005],a significant reduction in portal vein pressure [29. 50( 24. 50- 34. 00) vs 38. 00( 34. 00- 41. 75),Z =- 2. 668,P = 0. 008],and significant increases in ALT [61. 30( 28. 55- 139. 60) vs 21. 10( 14. 00- 26. 95),Z = 2. 429,P = 0. 015],AST [43. 70( 22. 67- 106. 27) vs 23. 20( 20. 97- 36. 87),Z = 2. 599,P = 0. 009],and TBil [31. 75( 17. 95- 36. 92) vs 15. 35( 13. 10- 18. 62),Z = 2. 803,P = 0. 005]. The TIPS- SAE group showed a significantly higher level of AST at 30 days after surgery[49. 00( 12. 10 ~ 58. 35) U / L vs 23. 20( 20. 97 ~36. 87) U / L]( t = 2. 100,P = 0. 036). At 30 days after surgery,the TIPS group showed a significantly higher level of TBil than the TIPS-SAE group [35. 00( 24. 00- 51. 25) vs 18. 30( 12. 55- 31. 00),Z =- 2. 371,P = 0. 017]. At three month after surgery,one patient in the TIPS group developed HE( grade 2),and in the TIPS- SAE group,one patient experienced HE( grade 3) and 2 experienced splenic abscess. Conclusion After TIPS,hepatic artery infusion is significantly increased. SAE cannot further increase liver perfusion after TIPS;however,it may aggravate postoperative liver impairment within a short time and cannot improve the prognosis of patients.
Value of serum cancer antigen12-5 level in diagnosis of peritoneal effusion in patients with liver cirrhosis
Zhang Hui, Jia Lei, Lu: Dong, Xu YouQing
2016, 32(11): 2118-2120. DOI: 10.3969/j.issn.1001-5256.2016.11.022
Abstract:
Objective To investigate the value of serum cancer antigen 12- 5( CA12- 5) level in the diagnosis of peritoneal effusion in patients with liver cirrhosis. Methods A total of 142 patients with liver cirrhosis who were hospitalized at Beijing Tiantan hospital from January 2011 to December 2015 and met the inclusion criteria were enrolled. According to the presence or absence of peritoneal effusion,the patients were divided into peritoneal effusion group( 81 patients) and non- peritoneal effusion group( 61 patients). The two- independent-samples t test was used for comparison of normally distributed continuous data between groups,the Mann- Whitney U non- parametric test was used for comparison of non- normally distributed continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. A Spearman correlation analysis was used to investigate the correlation between serum CA12- 5 level and the degree of peritoneal effusion. Results The peritoneal effusion group had a significantly higher serum CA12- 5 level than the non- peritoneal effusion group [290. 00( 50. 82- 618. 4) U / ml vs 15. 39( 9. 77- 23. 04) U / ml,Z =- 8. 537,P < 0. 01]. Serum CA12- 5 level was positively correlated with the degree of peritoneal effusion( r = 0. 812,P < 0. 01) and had a high diagnostic value for peritoneal effusion( the area under the receiver operating characteristic curve was 0. 92). Serum CA12- 5 level had a sensitivity of 81. 5% and a specificity of 88. 5%at a cut- off value of 35. 00 U / ml. Conclusion Serum CA12- 5 level can help with the diagnosis and monitoring of peritoneal effusion.
Original articles_Liver neoplasms
Clinical effect of liver cancer resection combined with selective decongestive devascularization in treatment of primary liver cancer complicated by portal hypertension
Zheng GuiLong, Ding HaiHua, Ding ZhiQing, Deng XianRen, Xia JingBo, Li HongXin
2016, 32(11): 2121-2125. DOI: 10.3969/j.issn.1001-5256.2016.11.023
Abstract:
Objective To investigate the clinical effect of liver cancer resection combined with selective decongestive devascularization in the treatment of primary liver cancer complicated by portal hypertension. Methods A retrospective analysis was performed for the clinical data of 60 patients with primary liver cancer complicated by portal hypertension who were treated in The Second People's Hospital of Zhenjiang from March 2013 to February 2016. According to the surgical procedure,the patients were divided into group A( 32 patients) and group B( 28 patients). The patients in group A were given liver cancer resection combined with splenectomy,and those in group B were given liver cancer resection combined with selective decongestive devascularization. The patients' general status in the perioperative period were observed,and immune function parameters and liver function parameters were compared between the two groups before and after surgery,as well as the incidence of complications. The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results Compared with group A,group B had a significantly longer time of operation( 135. 27 ± 15. 13 min vs 118. 35 ± 12. 56 min,t =- 4. 733,P < 0. 001) and a significantly shorter length of hospital stay( 14.28 ± 2. 95 d vs 16. 37 ± 3. 42 d,t = 2. 516,P = 0. 007). At 1 month after surgery,group B had significantly higher levels of Ig G,Ig M,and Ig A than group A [( 14. 98 ± 3. 12) vs( 12. 51 ± 2. 75) 、( 2. 79 ± 1. 13) vs( 2. 25 ± 1. 02),( 2. 42 ± 0. 79) vs( 1. 87 ± 0. 82),t =- 3.260,- 1. 945,and- 2. 636,P < 0. 001, = 0. 028,and < 0. 005]. At 1 month after surgery,both groups showed significant increases in platelet count( t =- 89. 590 and- 20. 261,both P < 0. 001),and group A showed a significantly greater increase than group B [( 302. 46± 15. 08) × 109/ L vs( 80. 25 ± 5. 68) × 109/ L,t = 73. 481,P < 0. 001]. There were no significant differences in the incidence rates of postoperative complications between the two groups( 18. 75% vs 17. 86%,χ2= 0. 008,P = 0. 929). Conclusion Liver cancer resection combined with selective decongestive devascularization can improve liver function and maintain good immune function in patients,and therefore,it has an important clinical application value.
Influence of Forkhead box Q1 expression on therapeutic effect of transarterial chemoembolization after hepatocellular carcinoma surgery
Zhou YiLong, Chen Yuan, Zhang YiXin, Shao BingFeng, Zhang SuQing, Xu AiBing, He Song, Li YongJun, Tian SiYuan
2016, 32(11): 2126-2129. DOI: 10.3969/j.issn.1001-5256.2016.11.024
Abstract:
Objective To investigate the expression of Forkhead box Q1( FOXQ1) in the tissue of hepatocellular carcinoma( HCC),its influence on the prognosis of surgical resection combined with transarterial chemoembolization( TACE),and the value of FOXQ1 in evaluating the treatment outcome of HCC. Methods A total of 120 HCC patients who were admitted to The Affiliated Tumor Hospital of Nantong University from January 2004 to December 2007 were enrolled. Immunohistochemistry was used to measure the expression of FOXQ1 in HCC tissue,which was compared with patients' clinical features. The chi- square test was used for comparison of categorical data between groups,the Kaplan- Meier curve and log- rank test were used to analyze patients' disease- free survival( DFS) rates after surgery,and the Cox proportional hazards regression model was used for univariate and multivariate regression analyses. Results The results of immunohistochemistry showed that FOXQ1 had a dark- brown color in HCC tissue and was mainly expressed in tumor cytoplasm and nucleus. The univariate regression analysis showed that patients' DFS was affected by TNM stage( HR = 0. 347,95% CI: 0. 210- 0. 573,P < 0. 001),the number of tumors in the liver( HR = 0. 294,95% CI: 0. 176- 0. 490,P < 0. 001),HBV infection( HR = 0. 395,95% CI: 0. 222-0. 704,P = 0. 002),alpha- fetoprotein expression( HR = 0. 348,95% CI: 0. 207- 0. 586,P < 0. 001),presence or absence of liver cirrhosis( HR = 0. 414,95% CI: 0. 244- 0. 702,P = 0. 001),and high FOXQ1 expression level( HR = 1. 968,95% CI: 1. 171- 3. 308,P = 0. 011). Multivariate regression analysis showed that the patents' DFS was associated with TNM stage( HR = 0. 466,95% CI: 0. 248-0. 874,P = 0. 017),the number of tumors in the liver( HR = 0. 427,95% CI: 0. 216- 0. 844,P = 0. 014),and high FOXQ1 expression level( HR = 2. 896,95% CI: 1. 628- 5. 152,P < 0. 001). The patients with a high FOXQ1 expression level had a shorter DFS than those with a low FOXQ1 expression level( 18 months vs 26 months,χ2= 5. 006,P = 0. 025). Conclusion FOXQ1 can be used as a biomarker to evaluate the prognosis of HCC patients and the treatment outcome of HCC.
Original articles_Biliary diseases
Role of reproductive factors in female patients with primary biliary cholangitis
Chen Jing, Guo ZhangCun, Shi YongQuan, Zhou XinMin, He XiaoXia, Chen Yu, Wang Lu, Guo GuanYa, Han ZheYi, Han Ying
2016, 32(11): 2130-2133. DOI: 10.3969/j.issn.1001-5256.2016.11.025
Abstract:
Objective To investigate the role of productive factors in the development of primary biliary cholangitis( PBC). Methods A total of 273 female patients with a definite diagnosis of PBC who visited Xijing Hospital from October 2013 to August 2015 were enrolled. The patients with autoimmune hepatitis,primary sclerosing cholangitis overlap syndrome,and hepatic encephalopathy and those with incomplete data after telephone follow- up were excluded,and 54 female PBC patients who had female relatives were finally enrolled( PBC group).The female relatives who were less than 10 years older or younger than the patients were collected,and those with severe systemic diseases and incomplete data after telephone follow- up were excluded; finally 88 relatives were enrolled( relative group). The questionnaire for female reproductive factors in PBC was used to survey all these enrolled patients and collect data. The t- test was used for comparison of continuous data between groups,the chi- square test was used for comparison of categorical data between groups,and a multivariate logistic regression analysis was used for the analysis of dose- response relationship. Results The PBC group had a significantly higher number of births than the relative group( 2. 55 ± 1. 84 vs 1. 84 ± 0. 95,t = 2. 708,P = 0. 009). Furthermore,there was a significant dose- response pattern between the number of births and the development of PBC( P = 0. 002). Conclusion The number of births may be associated with the development of PBC in a dose- response manner. As for the female population susceptible to PBC,a reduction in the number of births may reduce the possibility of PBC.
Diagnosis of clonorchiasis during and after biliary tract surgery: a clinical analysis of 15 cases
Qi WenLei, Zhang RuoYan, Chai WenGang, Liu MingJiang, Du XiaoHong, Ye JunFeng
2016, 32(11): 2134-2137. DOI: 10.3969/j.issn.1001-5256.2016.11.026
Abstract:
Objective To investigate the clinical features of clonorchiasis diagnosed during biliary surgery,and to provide more comprehensive and effective information for the surgical treatment of clonorchiasis. Methods A retrospective analysis was performed for the clinical data of 15 patients who were diagnosed with clonorchiasis during and after biliary tract surgery in our department from January 2013 to January 2016,and their clinical features were summarized. Results All the 15 patients were male,among whom 5 once ate uncooked freshwater fish and shrimps. Of all patients,8 underwent laparoscopic bile duct exploration and 7 underwent endoscopic retrograde cholangiopancreatography( ERCP). Adult Clonorchis sinensis was found in intraoperative or postoperative drainage. All the patients achieved clearance of Clonorchis sinensis after regular anthelmintic treatment. Conclusion If bile duct exploration finds grey- black or bright- red melon seed-like floccules,clonorchiasis should be highly suspected. Intraoperative T- tube drainage is recommended,and if suspected Clonorchis sinensis is found after laparoscopic bile duct exploration and T- tube drainage or after ERCP and nasobiliary drainage,microbiological examination should be performed next. As for the patients with a definite diagnosis of clonorchiasis,they should not eat uncooked freshwater fish or shrimps and should be given regular anthelmintic treatment.
Value of cold laser combined with choledochoscopy in treatment of residual stones after biliary surgery
Jiang ZheLong, Pan Fan, Lu: LiZhi, Jiang Yi
2016, 32(11): 2138-2140. DOI: 10.3969/j.issn.1001-5256.2016.11.027
Abstract:
Objective To investigate the value of cold laser combined with choledochoscopy in the treatment of residual stones after biliary surgery. Methods A retrospective analysis was performed for the clinical data of 79 patients with residual stones after biliary surgery who were admitted to Fuzhou General Hospital of Nanjing Military Area Command from January 2015 to June 2016. All the patients underwent cold laser combined with choledochoscopy at 6 weeks after surgery. The cure rate and complications were observed. Results All the patients underwent successful lithotripsy,and the cure rate was 100%. Of all the patients,68 did not experience any postoperative complication,7 experienced abdominal distension,abdominal pain,and diarrhea,which achieved spontaneous remission after observation,and 4 experienced fear of cold and chill,which were improved after symptomatic treatment. No patients experienced serious complications,such as bile duct injury,biliary tract perforation,bile leakage,and hematobilia. Conclusion Cold laser combined with choledochoscopy has a good effect,a high level of safety,and good repeatability in the treatment of residual stones after biliary surgery; therefore,it holds promise for clinical application.
Application of fast track surgery strategy in perioperative period of primary suture of laparoscopic choledocholithotomy
Liu JinHeng, Wang YanTing, Yi Bin, Gao Yuan, Chen AnPing, Zhang ShengLong
2016, 32(11): 2141-2145. DOI: 10.3969/j.issn.1001-5256.2016.11.028
Abstract:
Objective To investigate the clinical application value of fast track surgery strategy( EARS) in the perioperative period of primary suture of laparoscopy in the treatment of common bile duct stones. Methods A total of 64 patients with gallstones complicated by common bile duct stones who were hospitalized in Department of Hepatobiliary Surgery in The Second People's Hospital of Chengdu from October2015 to February 2016 were enrolled,and according to the treatment in the perioperative period,the patients were divided into EARS group( 32 patients) and control group( 32 patients). Clinical indices and complications were compared between the two groups. The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups.Results Compared with the control group,the ERAS group had significantly shortened time of extraction of drainage tube( 1. 6 ± 0. 9 d vs2. 7 ± 1. 0 d,t =- 5. 675,P < 0. 01) and length of hospital stay( 5. 1 ± 1. 0 d vs 6. 8 ± 1. 1 d,t =- 5. 910,P < 0. 01),significantly shorter time to first ambulation( 1. 0 ± 0. 3 d vs 1. 6 ± 0. 7 d,t =- 4. 313,P < 0. 01) and time to intestinal functional recovery( 1. 1 ± 0. 4 d vs1. 8 ± 0. 6 d,t =- 4. 842,P < 0. 01),a significantly shortened time to stopping infusion after surgery( 3. 8 ± 1. 0 d vs 4. 9 ± 1. 2 d,t =- 3. 923,P < 0. 01),significantly reduced total hospital costs( 17 433. 5 ± 1411. 3 ten thousand yuan vs 26 651. 6 ± 2945. 8 ten thousand yuan,t =- 15. 942,P < 0. 001),a significantly lower proportion of patients who experienced pain after surgery [4( 12. 5%) vs 13( 40. 6%),χ2= 6. 490,P = 0. 011],and significantly lower levels of alanine aminotransferase( 105. 25 ± 35. 34 U / L vs 179. 00 ± 48. 64 U / L,t =- 5. 973,P < 0. 05) and total bilirubin( 50. 78 ± 12. 60 μmol / L vs 79. 70 ± 18. 56 μmol / L,t =- 7. 090,P < 0. 05) after surgery. Conclusion EARS is highly practical in the perioperative period of laparoscopic surgery and can promote patients' rapid recovery. Therefore,it holds promise for clinical application.
Original articles_Pancreatic diseases
Effect of angiotensin 1-7 on the TLR4/NF-κB pathway in cerulein-induced pancreatic acinar cells
Wang Yan, Cui LiJian, Xiao HongLi, Wang GuoXing, Yin ChengHong
2016, 32(11): 2146-2150. DOI: 10.3969/j.issn.1001-5256.2016.11.029
Abstract:
Objective To investigate the effect of angiotensin 1- 7 [Ang( 1- 7) ] on the TLR4 / NF- κB pathway in cerulein- stimulated pancreatic acinar AR42 J cells. Methods AR42 J cells were randomly divided into control group,model group( stimulated with 10 nmol / L cerulein),Ang( 1- 7) group( 10- 7,10- 6,and 10- 5mol / L Ang( 1- 7) + 10 nmol / L cerulein),and Ang( 1- 7) receptor inhibitor A779group( 10- 7,10- 6,and 10- 5mol / L A779 + 10 nmol / L cerulein). The control group was AR42 J cells with normal growth. The AR42 J cells in the model group were stimulated with 10 nmol / L cerulein and the cells were collected at 15 minutes,30 minutes,2 hours,6 hours,12 hours,and 24 hours after stimulation. The AR42 J cells in the Ang( 1- 7) group were treated with various concentrations of Ang( 1- 7) for30 minutes and then stimulated with cerulein for 12 hours,and then the cells were collected. The AR42 J cells in the A779 group were treated with various concentrations of A779 for 30 minutes and then stimulated with cerulein for 12 hours,and then the cells were collected. Immunofluorescence assay was used to determine the expression sites of TLR4 and NF- κB in AR42 J cells,and Western blot was used to measure the protein expression of TLR4 and NF- κB in AR42 J cells in each group. A one- way analysis of variance was used for comparison of continuous data between groups,and the least significant difference method was used for further comparison between any two groups. Results Both TLR4 and NF- κB were expressed in the cytoplasm of AR42 J cells. Compared with the control group,the model group showed significant increases in the expression of TLR4 at 30 minutes,2 hours,and 6 hours after modeling and a significant reduction at 12 hours after modeling( all P < 0. 05),as well as significant increases in the expression of NF- κB at 30 minutes,2 hours,6 hours,12 hours,and 24 hours after modeling( all P < 0. 05). The 10- 5mol / L Ang( 1- 7) group had significantly downregulated protein expression of TLR4 and NF- κB compared with the model group( 0. 570 ± 0. 046 vs 0. 893 ± 0. 057,0. 520 ± 0. 071 vs 0. 750 ± 0. 057,both P < 0. 05).The 10- 5mol / L A779 group had significantly upregulated protein expression of TLR4 and NF- κB compared with the model group( 0. 680± 0. 045 vs 0. 563 ± 0. 088,0. 617 ± 0. 071 vs 0. 453 ± 0. 054,both P < 0. 05). Conclusion In cerulein- stimulated AR42 J cells,Ang( 1- 7) can downregulate TLR4 and inhibit NF- κB activation.
Original articles_Others
Clinical effect of alprostadil combined with entecavir in treatment of HBV-related liver failure complicated by ascites
Ji HuiChun, Zhang ZhenJiang, Zhu Fang, Liu JunQuan, Liu QingDe, Pang Wei
2016, 32(11): 2151-2154. DOI: 10.3969/j.issn.1001-5256.2016.11.030
Abstract:

Objective To investigate the clinical effect of alprostadil combined with entecavir in the treatment of HBV- related liver failure complicated by ascites. Methods A total of 84 patients with HBV- related liver failure complicated by ascites who were hospitalized and treated in No. 97 Hospital of PLA from September 2011 to June 2014 were enrolled and randomly divided into treatment group( 42 patients)and control group( 42 patients). The patients in both groups were given conventional treatment for liver protection,jaundice clearance,diuresis,and albumin nutritional support. The patients in the control group were given entecavir in addition,while those in the treatment group were given alprostadil combined with entecavir in addition. The liver function parameters [total bilirubin( TBil),alanine aminotransferase( ALT),and aspartate aminotransferase( AST) ],prothrombin activity( PTA),HBV DNA load,clinical outcome,24- hour urine volume,and ascites regression before and after treatment were observed and recorded. The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results Both groups had significant changes in the liver function parameters( TBil,ALT,and AST),PTA,and HBV DNA load after treatment( all P < 0. 05). There were significant differences in TBil,ALT,AST,and PTA after treatment between the treatment group and the control group( TBil: 197. 4 ± 47. 6 μmol / L vs287. 5 ± 150. 6 μmol / L,t = 2. 30,P < 0. 05; ALT: 189. 4 ± 63. 8 U / L vs 263. 4 ± 79. 5 U / L,t = 2. 73,P < 0. 05; AST: 138. 7 ± 87. 5 U / L vs 250. 8 ± 90. 4 U / L,t = 3. 43,P < 0. 05; PTA: 63. 5% ± 17. 0% vs 45. 5% ± 15. 1%,t = 2. 60,P < 0. 05). The treatment group had significantly higher marked response rate and overall response rate concerning clinical outcome than the control group( marked response rate:40. 48% vs 28. 57%,χ2= 4. 32,P < 0. 05; overall response rate: 85. 71% vs 66. 67%,χ2= 4. 20,P < 0. 05). The treatment group also had significantly higher marked response rate and overall response rate concerning ascites regression than the control group( marked response rate: 47. 62% vs 23. 81%,χ2= 13. 20,P < 0. 05; overall response rate: 88. 10% vs 52. 38%,χ2= 12. 81,P < 0. 05). Conclusion In patients with severe hepatitis B complicated by ascites,alprostadil combined with entecavir has good clinical effect and safety and can effectively improve the prognosis. Therefore,it holds promise for clinical application.

Clinical value of indocyanine green retention rate in condition analysis and prognostic evaluation of patients with HBV-related acute-on-chronic liver failure
Liu JingHua, Liu Na, Liu ChenXi
2016, 32(11): 2155-2158. DOI: 10.3969/j.issn.1001-5256.2016.11.031
Abstract:

Objective To investigate the clinical value of indocyanine green retention rate at 15 min( ICG R15) in the condition analysis and prognostic evaluation of patients with acute- on- chronic liver failure( ACLF),and to provide a reference index for condition analysis and prognostic evaluation of patients with ACLF. Methods A total of 127 ACLF patients who were admitted to our hospital from August2013 to January 2016 were enrolled,and according to the clinical stage,they were divided into early- stage group,medium- stage group,and late- stage group. The ICG R15,Model for End- Stage Liver Disease( MELD) score,and prothrombin time( PT) were compared between the patients with different clinical stages. According to the prognosis at 90 days,the patients were divided into survival group and death group,and the above indicators were compared between the two groups. The clinical value of ICG R15 in condition analysis and prognostic evaluation was summarized. The independent samples t- test or a one- way analysis of variance was used for continuous data,the least significant difference method was used for comparison between any two groups,and the chi- square test was used for categorical data.Results Compared with the early- stage group,the medium- stage group and late- stage group had significantly higher ICG R15( 53. 96% ±10. 01% /54. 23% ± 9. 21% vs 44. 00% ± 9. 21%,P < 0. 05),PT( 26. 87 ± 6. 84 s /28. 43 ± 3. 61 s vs 19. 79 ± 2. 82 s,P < 0. 05),and MELD score( 31. 56 ± 4. 17 /32. 87 ± 3. 28 vs 24. 00 ± 3. 85,P < 0. 05). The death group had significantly higher ICG R15,PT,and MELD score than the survival group( ICG R15: 53. 91% ± 5. 83% vs 45. 03% ± 4. 33%,t = 9. 85,P < 0. 05; PT: 29. 85 ± 3. 52 s vs 21. 35 ± 3.18 s,t = 14. 20,P < 0. 05; MELD score: 33. 81 ± 4. 67 vs 25. 30 ± 4. 02,t = 10. 99,P < 0. 05). With an ICG R15 of 52%,a PT of 29 s,and a MELD score of 32 as cut- off values,there were significant differences in mortality rate between the patients with different levels of indicators( ICG R15: 22. 39% vs 64. 29%,χ2= 8. 831,P < 0. 05; PT: 25. 71% vs 61. 40%,χ2= 6. 263,P < 0. 05; MELD score: 21. 54% vs 62. 90%,χ2= 7. 583,P < 0. 05). Conclusion With the aggravation of the condition of ACLF and the reduction in prognosis,PT and MELD score increase gradually,and ICG R15 also increases. We can comprehensively evaluate patients' condition and clinical prognosis in an early stage based on the changes in the above indicators.

Guiding significance of Guideline for diagnosis and treatment of herb-induced liver injury in clinical diagnosis: a retrospective analysis
Zhu Yun, Wang RuiLin, Sun XueYing, Yu SiMiao, Jing Jing, Wang JiaBo, He TingTing, Huang YiXue, Wang LiPing, Sun YongQiang
2016, 32(11): 2159-2162. DOI: 10.3969/j.issn.1001-5256.2016.11.032
Abstract:

Objective To investigate the clinical guiding significance of Guideline for diagnosis and treatment of herb- induced liver injury in the diagnosis of herb- induced liver injury( HILI). Methods A retrospective analysis was performed for the clinical data of 595 hospitalized patients who were admitted to 302 Hospital of PLA from January 2009 to January 2014 and diagnosed with HILI according to HILI diagnostic strategies recommended by American College of Gastroenterology. The chi- square test was used for comparison of categorical data between groups. Results According to the Guideline for diagnosis and treatment of HILI,all 595 patients( 100%) were diagnosed with suspected HILI,234( 39. 3%) were diagnosed with clinical HILI,and 52( 8. 7%) were diagnosed with definite HILI. Among the patients with clinical and definite HILI,85. 0% and 94. 2%,respectively,had a clinical type of cell injury,and 52. 6% and 42. 3%,respectively,had a severe disease. There were no significant differences in prognosis between the patients with suspected,clinical,and definite HILI,and81. 5%,82. 5%,and 80. 8%,respectively,were cured. Conclusion Guideline for diagnosis and treatment of HILI can effectively guide the diagnosis of HILI,avoid misdiagnosis in clinical practice,and guarantee the safe application of Chinese herbal medicine. Its clinical guiding significance in the diagnosis of HILI awaits more prospective studies.

Clinical effect of matrine in treatment of rats with nonalcoholic steatohepatitis
Ai ZhengLin, Xie BuShan, Yao ShuKun
2016, 32(11): 2163-2166. DOI: 10.3969/j.issn.1001-5256.2016.11.033
Abstract:

Objective To investigate the antioxidant effect of matrine and its clinical effect in the treatment of rats with nonalcoholic steatohepatitis( NASH). Methods A total of 30 rats were randomly divided into three groups: control group,NASH group,and matrine group,with 10 in each. A high- fat diet was used to establish the rat model of NASH,and matrine was given by gavage for treatment at a dose of36 mg·kg- 1·d- 1. The changes in body weight and liver weight were observed in all rats. HE staining was used to observe the histopathological changes of the liver. The serum levels of alanine aminotransferase( ALT) and aspartate aminotransferase( AST) and the content of reduced glutathione( GSH),superoxide dismutase( SOD),and malondialdehyde( MDA) in liver tissue were measured. A one- way analysis of variance was used for the comparison between multiple groups,and the SNK- q test was used for further comparison between any two groups. Results Compared with the NASH group,the matrine group had significant reductions in the serum levels of ALT and AST( ALT:52. 0 ± 3. 0 U / L vs 41. 8 ± 3. 7 U / L,P < 0. 001; AST: 233. 6 ± 9. 4 U / L vs 170. 1 ± 1. 8 U / L,P < 0. 001). The matrine group showed marked improvement in the histopathological changes of the liver compared with the NASH group. Compared with the NASH group,the matrine group had significantly increased content of SOD and GSH in liver tissue( SOD: 17. 7 ± 2. 0 μg / mg vs 27. 0 ± 3. 6 μg / mg,P < 0. 001;GSH: 16. 5 ± 1. 6 U / mg vs 28. 5 ± 2. 1 U / mg,P < 0. 001) and significantly reduced content of MDA( 22. 9 ± 1. 9 nmol / mg vs 17. 8 ± 1. 8nmol / mg,P < 0. 001). Conclusion Matrine has an antioxidant effect and a marked clinical effect in the treatment of rats with NASH.

Case reports
Thrombotic cavernous transformation of the portal vein secondary to hepatitis B cirrhosis treated with warfarin: a case report
Yuan Wei, Zhang YuYi, Zhang ZhengGuo, Zou Ying, Wang JieFei, Qian ZhiPing
2016, 32(11): 2167-2168. DOI: 10.3969/j.issn.1001-5256.2016.11.034
Abstract:
A case of giant hepatoblastoma
Ma LinJie, Chen Xiao, Zou Long, Liu Hong, Hu ZongQiang, Bai JianHua, Chen Gang
2016, 32(11): 2169-2170. DOI: 10.3969/j.issn.1001-5256.2016.11.035
Abstract:
A case of ectopic pancreas in the gastric antrum misdiagnosed as hepatic cyst
Hao Qiao, Xue JianFeng, Tian XiangYong, Hu JunLong
2016, 32(11): 2171-2172. DOI: 10.3969/j.issn.1001-5256.2016.11.036
Abstract:
A case of hepatolenticular degeneration with mental disorder as initial symptomc
Cui YuanYuan, Yang YiLiang, Wang ShaSha, Hua Rui
2016, 32(11): 2173-2174. DOI: 10.3969/j.issn.1001-5256.2016.11.037
Abstract:
A case of hepatic alveolar echinococcosis
Wang ZhiWei, Li Qiang, Chai Chen
2016, 32(11): 2175-2176. DOI: 10.3969/j.issn.1001-5256.2016.11.038
Abstract:
A case of gallstones with gallbladder-stomach fistula and biliary ileus
Lin QianHuang, Xu Hui, Tang XiaoLong, Ding Zheng, Tang WenJun, Wu KaiKai, Xun JinLiang
2016, 32(11): 2177-2178. DOI: 10.3969/j.issn.1001-5256.2016.11.039
Abstract:
Infarct of spleen infarction after laparoscopic spleen-preserving distal pancreatectomy conservation of the splenic arteries and veins: a case  report
Zhao Lei, Zhang Ping, Shi XiaoJu, Zang MingCui, Wei Feng, Wang GuangYi
2016, 32(11): 2179-2181. DOI: 10.3969/j.issn.1001-5256.2016.11.040
Abstract:
Reviews
Research advances in tenofovir in treatment of chronic hepatitis B patients with drug resistance
Yan YueRong, Feng JiHong
2016, 32(11): 2182-2185. DOI: 10.3969/j.issn.1001-5256.2016.11.041
Abstract:
Currently,tenofovir is the first- line drug for the treatment of chronic hepatitis B. This article reviews the research advances in its therapeutic effects in patients who are resistant to lamivudine and adefovir dipivoxil,respond poorly to entecavir,or have multidrug resistance and introduces the results of the comparative study on the therapeutic effects of tenofovir monotherapy and combined treatment. It is pointed out that tenofovir has good safety and a good therapeutic effect in patients with drug resistance,including pregnant women; however,there are no significant differences in study results between tenofovir monotherapy and combined treatment.
Influence of interaction between endogenous miRNAs and hepatitis B virus in hepatocytes on hepatitis B virus transcription and related mechanisms
Qiu Hua, Sun XueHua, Zhou ZhenHua, Li Man, Zhang Xin, Gao YueQiu
2016, 32(11): 2186-2190. DOI: 10.3969/j.issn.1001-5256.2016.11.042
Abstract:
MicroRNAs( miRNAs) may be involved in the regulation of gene expression after transcription and play important roles in regulating hepatitis B virus( HBV) transcription and replication. This article summarizes the miRNAs with an anti- HBV effect in hepatocytes and4 regulatory mechanisms,as well as the mechanisms through which HBV affects the expression of endogenous miRNAs in hepatocytes via HBx and self- coding miRNAs and promotes replication. The analyses show that the interaction between endogenous miRNAs and HBV in hepatocytes forms a complex regulatory network,competes for the results of regulation,and determines the activity of HBV transcription and the trend of disease progression. In- depth studies on the mechanisms of the influence of interaction between endogenous miRNA and HBV in hepatocytes on HBV transcription have great significance in exploring new anti- HBV methods.
Mechanisms of hyponatremia in patients with decompensated liver cirrhosis treated with terlipressin and related treatment principles
You Jia, Jiang JiaJi
2016, 32(11): 2191-2194. DOI: 10.3969/j.issn.1001-5256.2016.11.043
Abstract:
Esophagogastric variceal bleeding and hepatorenal syndrome are common complications in patients with decompensated liver cirrhosis and portal hypertension. Terlipressin can lead to the constriction of visceral vessels,reduce portal venous pressure,and increase renal perfusion and is the first- line drug. In recent years,it has been reported that some patients experienced hyponatremia during the treatment with terlipressin. Since patients with liver cirrhosis tend to develop hyponatremia,the application of terlipressin may have an adverse effect on the management of serum sodium level in such patients. This article summarizes the incidence rate of hyponatremia during terlipressin treatment and related risk factors and introduces the pathogenesis of hyponatremia during terlipressin treatment in patients with decompensated liver cirrhosis and the treatment principles for hyponatremia. If the occurrence of hyponatremia can be controlled,terlipressin may be an effective drug for the treatment of portal hypertension.
Regulatory effect of transforming growth factor-β on activation of hepatic stellate cells
Zhao WeiHua, Wang YanHong, Cong Min
2016, 32(11): 2195-2198. DOI: 10.3969/j.issn.1001-5256.2016.11.044
Abstract:
In the process of liver fibrosis,transforming growth factor β( TGFβ) is considered an important regulatory factor for the activation of hepatic stellate cells( HSCs) and extracellular matrix production. Therefore,the therapeutic strategies targeted at the activation of HSCs and liver fibrosis induced by TGFβ are worthy of further research. This article reviews the role of TGFβ in the activation of HSCs,the regulatory effect of TGFβ,and the therapeutic strategies targeted at the activation of HSCs induced by TGFβ,so as to provide a theoretical basis and new thoughts for the clinical treatment of liver fibrosis.
Prevention of surgical site infection after liver cancer resection
Xu Feng, Tang Bin, Dai ChaoLiu, Wang Chao, Liu XiaoLin
2016, 32(11): 2199-2202. DOI: 10.3969/j.issn.1001-5256.2016.11.045
Abstract:
Surgical site infection( SSI) often increases the length of hospital stay,economic burden,and even mortality of patients undergoing liver cancer resection. Targeted preventive measures help to reduce SSI. This article introduces the preventive measures for SSI,including improvement of patients' physical condition( such as preoperative smoking cessation,blood sugar control,and improvement of nutrition and liver function),improvement of surgical procedure( such as skin disinfection,incision management,precise liver resection,laparoscopic hepatectomy,liver section management,abdominal cavity flushing,placement of drainage tube,and prevention of intestinal injury and bile leakage),and prophylactic use of antibiotics. It is pointed out that the development of SSI after liver cancer resection is the result of multiple risk factors,and that the keys to SSI prevention include strict control of surgical indications,accurate preoperative assessment,precise intraoperative operation,careful postoperative management,and rational use of antibiotics.
Diagnostic value of H19 gene in hepatocellular carcinoma
Wang ShiMei, Wu Xia, Kang Peng, Meng QingYang
2016, 32(11): 2203-2205. DOI: 10.3969/j.issn.1001-5256.2016.11.046
Abstract:
Recent studies have shown that some long non- coding RNAs( lncRNAs) are expressed abnormally in hepatocellular carcinoma( HCC) tissue,and the expression of H19 gene in lncRNAs in HCC tissue is significantly higher than that in normal tissue. After the knockout of H19 gene,the proliferative and invasive abilities of HCC are significantly reduced. This article briefly introduces lncRNAs and H19 gene,the detection method for lncRNAs,and the value of H19 in the diagnosis of HCC and points out that H19 may be used in a method for the diagnosis of HCC. Further studies on the expression of H19 in HCC and rapid,simple,and economic detection of lncRNAs including H19 play important roles in the diagnosis of HCC.
Expression and role of heat shock protein 70 in hepatocellular carcinoma
He ZeLing, Cao JianBiao, Fan GongRen
2016, 32(11): 2206-2209. DOI: 10.3969/j.issn.1001-5256.2016.11.047
Abstract:
Heat shock protein 70( HSP70) is expressed differently in hepatocellular carcinoma( HCC) tissues. Since its expression and regulatory mechanism remain unclear,whether HSP70 can help with the early diagnosis,treatment,and prognostic evaluation of HCC has become a hot research topic. This article reviews the source of HSP70 and its family,abnormal expression of HSP70 in HCC,and its association with treatment methods and prognostic evaluation of HCC,in order to provide a reference for clinical diagnosis and treatment of HCC.
Value of ultrasonic elastography in diagnosis of liver diseases
Zhang XiaoTong, Guo LiPing
2016, 32(11): 2210-2213. DOI: 10.3969/j.issn.1001-5256.2016.11.048
Abstract:
Ultrasonic elastography is a new technique of ultrasonic diagnosis and plays an important role in the diagnosis and monitoring of chronic liver diseases in recent years. This article introduces the principle and classification of ultrasonic elastography,as well as the application value of different techniques of ultrasonic elastography in liver diseases and related research advances. It is pointed out that ultrasonic elastography can analyze the stiffness of liver tissue qualitatively and quantitatively,which makes up for the shortage of traditional ultrasonic imaging and enriches diagnostic information. Therefore,ultrasonic elastography has an important clinical value and holds promise for wide clinical application.
Research advances in diagnosis and treatment of liver disease during pregnancy
Luo Huan, Huang WenXiang
2016, 32(11): 2214-2217. DOI: 10.3969/j.issn.1001-5256.2016.11.049
Abstract:
Liver disease during pregnancy is classified as pregnancy- specific liver disease and non- pregnancy- specific liver disease. The unique physicochemical status during pregnancy increases the burden of liver metabolism. Once liver injury occurs,it tends to be more serious and is closely associated with maternal and fetal outcome. If no diagnosis and treatment are given in time,pregnant women and parturients may experience more complications and the mortality rate of perinatal infants will also increase. This article reviews the latest research advances in the diagnosis and treatment of liver disease during pregnancy,in order to provide a reference for the diagnosis and treatment of liver disease during pregnancy in clinical practice.
Research advances in pathogenesis and management of fatigue in patients with primary biliary cirrhosis
Zhao Jian, Cao Jia, Yao DingKang
2016, 32(11): 2218-2221. DOI: 10.3969/j.issn.1001-5256.2016.11.050
Abstract:
Fatigue is one of the most common symptoms of primary biliary cirrhosis( PBC) and greatly affects patients' quality of life. The pathogenesis of fatigue in PBC remains unknown and there are no effective therapeutic methods. This article reviews the latest advances in the pathogenesis and treatment of fatigue in PBC. Studies have shown that the causes of fatigue in PBC include various central and peripheral factors,such as the changes in the brain,sleep disorders,depression,autonomic nervous dysfunction,and abnormal muscle metabolism.Modafinil does not have a definite therapeutic effect in fatigue in PBC. The causes and treatment of fatigue in PBC still need in- depth systematic studies.
Role of chymotrypsin C in development and progression of pancreatitis and pancreatic cancer
Liu ZeJie, Song YiLin, Li Hong, Feng YingMing, Su HaiChuan
2016, 32(11): 2222-2225. DOI: 10.3969/j.issn.1001-5256.2016.11.051
Abstract:
Chymotrypsin C( CTRC) is a trypsinogen synthesized by pancreatic acinar cells and secreted by pancreatic duct cells and belongs to the family of serine chymotrypsin. The main function of CTRC is to regulate the balance between activation and degradation of trypsin and maintain the structural and functional integrity of the pancreas. CTRC gene mutations can cause abnormal activation of trypsinogen and abnormal degradation of trypsin and then lead to the development of pancreatitis. The downregulation or absence of CTRC expression may be associated with the development and metastasis of pancreatic cancer. This article introduces the structure and biological function of CTRC and its mechanism of action in the development and progression of pancreatitis and pancreatic cancer.