2016 No. 7

Abstract:
At present,long- acting interferon combined with ribavirin is still a major therapeutic method for hepatitis C in China,and precision medicine can help cure more patients with hepatitis C. This article briefly introduces the diagnosis and treatment of hepatitis in China and the importance of the strategy of virologic response- guided therapy( RGT),and analyzes the influencing factors for the achievement of sustained virologic response. HCV RNA quantitation is the foundation of RGT strategy,and HCV RNA quantitation with a high specificity performed at crucial time points during treatment helps to evaluate response accurately,realize the individualized treatment of hepatitis C,and improve the cure rate of hepatitis C.

Prognostic evaluation of primary biliary cirrhosis and its value in guiding therapeutic regimens

Huang ChunYang, Liu YanMin

2016, 32(7): 1266-1272. DOI: 10.3969/j.issn.1001-5256.2016.07.009

Abstract(2225)

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Abstract:
Prognostic evaluation of patients with primary biliary cirrhosis( PBC) and how to improve the prognosis have attracted much attention. Further therapeutic regimens for PBC patients with poor prognosis has become the direction of clinical and scientific studies. This article summarizes the association between baseline indices and prognosis and prognostic evaluation of patients undergoing ursodeoxycholic acid( UDCA) treatment,introduces the current status of UDCA combined with budesonide,fibrates,and obeticholic acid for patients with poor response to UDCA and the drugs being developed,and analyzes the influencing factors for prognosis and efficacy of UDCA. It is pointed out that prognosis and efficacy should be evaluated before and during UDCA treatment,and that therapeutic regimens should be adjusted in time to improve prognosis.

Endoscopic ultrasound and multi-slice spiral CT portal venography in diagnosis and treatment of portal hypertension

Lu Wei, Zhou Li, Li Shuang

2016, 32(7): 1273-1276. DOI: 10.3969/j.issn.1001-5256.2016.07.010

Abstract(2074)

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Abstract:
At present,endoscopic ultrasound and multi- slice spiral CT portal venography are effective methods to assess the portal vein and collateral circulation. Endoscopic ultrasound can clearly show the blood vessels inside and outside the esophageal wall and in surrounding tissues,as well as the image of perforating branches,but it is still an invasive procedure. Multi- slice spiral CT portal venography can show the arrangement and architecture of the portal vein and its collaterals completely,but it cannot detect the submucosal veins with a small diameter ideally. These two methods have their own advantages and can give a systematic and complete evaluation of portal hypertension,which plays an important role in individualized treatment and management.

Clinical application of combined vascular resection and reconstruction in surgical treatment of hilar cholangiocarcinoma

Chen ZhiYu, Bie Ping

2016, 32(7): 1277-1279. DOI: 10.3969/j.issn.1001-5256.2016.07.011

Abstract(1927)

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Abstract:
The surgical treatment of hilar cholangiocarcinoma is one of the most challenging routine surgeries in the field of hepatobiliary surgery,and vascular invasion is an important reason for the low rate of radical resection in hilar cholangiocarcinoma. Currently,it is universally acknowledged that resection and reconstruction of the portal vein invaded is a key factor in improving R0 resection rate and long- term survival rate in patients with hilar cholangiocarcinoma. However,whether to perform resection and reconstruction after invasion of hepatic artery is still controversial. With reference to published literature and clinical practice in our center,this article introduces the application and prospects of combined vascular resection and reconstruction in the surgical treatment of hilar cholangiocarcinoma and points out that with the development of computer- assisted surgery and summarization of more and more case data,indications and long- term efficacy of combined vascular resection and reconstruction in the treatment of hilar cholangiocarcinoma await further investigation and research.

Application of endoscopic ultrasonography in diagnosis of pancreatic cancer and related research advances

He Qiang, Xu YouQing

2016, 32(7): 1280-1282. DOI: 10.3969/j.issn.1001-5256.2016.07.012

Abstract(432)

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Abstract:
At present,traditional imaging techniques for the diagnosis of early- stage pancreatic cancer lack enough sensitivity,and therefore,early diagnosis of pancreatic cancer is still the biggest challenge in precision medicine around the world. Based on a large amount of clinical practice and the development of related techniques,endoscopic ultrasonography( EUS) gradually shows its advantages in the diagnosis of pancreatic cancer,especially early diagnosis. This article reviews the application of EUS in the early diagnosis of pancreatic cancer and related research advances.

Criteria for withdrawal of nucleos( t) ide analogues and their clinical significance in treatment of chronic hepatitis B

Chen HeMin, Shao GuoHui

2016, 32(7): 1283-1286. DOI: 10.3969/j.issn.1001-5256.2016.07.013

Abstract(2834)

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Abstract:
Objective To investigate the association of virologic relapse after withdrawal of nucleos( t) ide analogues( NAs) with HBs Ag quantitation and HBV DNA load at withdrawal in patients with chronic hepatitis B( CHB). Methods A total of 205 CHB patients who were treated with NAs in the outpatient service of Jining Infectious Diseases Hospital from January 2010 to June 2014,met the criteria for drug withdrawal in Guidelines for Prevention and Treatment of Chronic Hepatitis B( version 2010),and planned to stop the drugs were enrolled.HBs Ag and HBV DNA load were measured before drug withdrawal,and COBAS Taq Man 480 Ⅱ PCR was performed for patients with HBV DNA < 103 IU / ml to measure highly sensitive HBV DNA load. The patients were followed up for 1 year after drug withdrawal and HBV DNA > 103 IU / ml was defined as virologic relapse. The chi- square test and Fisher' s exact test were used for comparison of categorical data between groups. Results At 1 year after drug withdrawal,the overall virologic relapse rate in all CHB patients was 65. 9%( 135 /205),and 20%( 41 /205) had HBV DNA >103 IU / ml. In the patients with HBs Ag quantitation ≤100 IU / ml or >100 IU / ml,the virologic relapse rate was23. 9%( 11 /46) and 78. 0%( 124 /159),respectively,with a significant difference between the two groups( χ2= 46. 4,P < 0. 000 1). In the patients with highly sensitive HBV DNA load < 20 IU / ml or ≥20 IU / ml,the virologic relapse rate was 56. 4%( 62 /110) and 76. 8%( 73/95),respectively,with a significant difference between the two groups( χ2= 9. 5,P = 0. 002). The patients with HBs Ag quantitation ≤100IU / ml and highly sensitive HBV DNA load < 20 IU / ml had a relapse rate of 14. 3%( 5 /35),and the other patients had a relapse rate of76. 5%( 130 /170); the relapse rate showed a significant difference between the two groups( χ2= 49. 9,P <0. 000 1). Conclusion After the patients meet the criteria for drug withdrawal in Guidelines for Prevention and Treatment of Chronic Hepatitis B( version 2010) and stop the antiviral therapy,the relapse of CHB is associated with HBs Ag quantitation and HBV DNA load at withdrawal. With reference to HBs Ag quantitation and / or highly sensitive HBV DNA load as the criteria for withdrawal of antiviral therapy,such as HBs Ag quantitation ≤100 IU / ml and highly sensitive HBV DNA load < 20 IU / ml,patients can achieve the safest drug withdrawal.

Establishment of a predictive model for early virologic response in previously untreated chronic hepatitis B patients treated with telbivudine

Huang ShuiWen, Liu BaoRong, Chen MingSheng, Lin Chun, Zhou Rui, Yang HuiAn, Jiang XiaoYan, Pan Chen, Li DongLiang

2016, 32(7): 1287-1291. DOI: 10.3969/j.issn.1001-5256.2016.07.014

Abstract(2238)

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Abstract:
Objective To investigate the establishment of a predictive model for early virologic response in previously untreated chronic hepatitis B( CHB) patients treated with telbivudine,since early virologic response can predict the long- term efficacy of nucleotide analogues.Methods A total of 135 CHB patients who visited Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2007 to August 2014 were enrolled and treated with telbivudine( 600 mg qd) for at least 24 weeks. Follow- up was performed once every 2 weeks,and the patients' baseline data and data measured during treatment were recorded. 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 the Cox proportional hazards regression model was used to analyze the influencing factors for early virologic response and establish the predictive model. Results The patients without a family history of hepatitis B virus( HBV) infection( P = 0. 000 3) and with high baseline levels of total bilirubin( TBil)( P = 0. 002 6)and aspartate aminotransferase( AST)( P = 0. 007 4) and a low HBV DNA load( P = 0. 002 3) tended to show early virologic response.The predictive model was established based on these variables,and the risk score( R) of CHB patients was calculated. The CHB patients with R > 0. 85 were more likely to achieve early virologic response. Conclusion The model established based on the four variables of family history,baseline TBil level,baseline AST level,and HBV DNA level can well predict early virologic response in previously untreated CHB patients treated with telbivudine.

Association between serum level of interleukin-17 and HBsAg clearance in patients with HBsAg-negative chronic hepatitis B

Cao ZhenHuan, Liu YaLi, Ma LiNa, Lu JunFeng, Jin Yi, He ZhiMin, Zheng YanHong, Chen XinYue

2016, 32(7): 1292-1295. DOI: 10.3969/j.issn.1001-5256.2016.07.015

Abstract(2173)

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Abstract:
Objective To investigate the association between HBsAg clearance and serum level of interleukin- 17( IL- 17) in HBeAg-negative chronic hepatitis B( CHB) patients treated by pegylated interferon( PEG- IFN). Methods A total of 13 HBeAg- negative CHB patients who visited Beijing You An Hospital from January 2012 to January 2015 were enrolled. After the 24- week treatment with PEG-IFN,6 achieved HBsAg clearance( R group) and 7 did not achieve HBsAg clearance( NR group). The Luminex technology was used to measure the serum level of IL- 17 at baseline and weeks 12 and 24 of treatment. Ten healthy controls and 6 patients with acute hepatitis B( AHB) were enrolled and serum level of IL- 17 was measured. An analysis of variance was used for comparison of continuous data between multiple groups,and the SNK- qtest was used for further pairwise comparison; the t- test was used for comparison of continuous data between any two groups; the chi- square test was used for comparison of categorical data between groups. Results The AHB group had the highest serum level of IL- 17 at baseline,followed by the CHB group and healthy control group,and the serum level of IL- 17 at baseline showed significant differences between the three groups( P < 0. 05). After the PEG- IFN treatment for 24 weeks,HBeAg- negative CHB patients showed a significant reduction in serum level of IL- 17( P = 0. 044). R group had a significantly higher serum level of IL- 17 than NR group and showed a significant reduction in the serum level of IL- 17 after PEG- IFN treatment,while NR group showed no significant increase or reduction in the serum level of IL- 17. Conclusion In the PEG- IFN treatment for HBeAg- negative CHB patients,a high serum level of IL- 17 at baseline and a significant reduction in serum level of IL- 17 helps with HBsAg clearance.

Effect and safety of bilirubin serum adsorption in treatment of patients with chronic severe hepatitis B

Wang QingHai, Luo KaiZhong, Tian Yi

2016, 32(7): 1296-1299. DOI: 10.3969/j.issn.1001-5256.2016.07.016

Abstract(2302)

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Objective To investigate the effect and safety of bilirubin serum adsorption( BSA) in the treatment of patients with chronic severe hepatitis B. Methods A prospective study was performed for 40 patients with chronic severe hepatitis B[prothrombin activity( PTA)> 25%] who were hospitalized in The Second Xiangya Hospital of Central South University from January 1,2014 to December 31,2015,and all the patients were given BSA. The results of routine blood test [white blood cell( WBC) count,red blood cell( RBC) count,hemoglobin( Hb),and platelet( PLT) count],coagulation function [prothrombin time( PT),activated partial thromboplastin time( APTT),and fibrinogen( Fib) ],liver function [total bilirubin( TBil),direct bilirubin( DBil),total bile acid( TBA),albumin( Alb),and globulin( Glb) ],and electrolytes( K+,Na+,Cl-,and Ca2+) were collected before treatment and at 1 week after treatment. Blood pressure,breath,heart rate,and oxygen saturation were observed and recorded before,during,and after treatment,and the presence or absence of symptoms such as fear of cold,pyrexia,dizziness,chest distress,and abdominal pain was observed. The t- test was used for comparison of continuous data between groups. Results All the patients had good tolerance of the treatment,and clinical symptoms were improved after treatment. TBil,DBil,and TBA showed significant reductions,Alb,Glb,and Fib showed slight reductions,and PT and APTT were significantly prolonged( t = 21. 254,22. 395,7. 821,6. 986,7. 580,9. 852,10. 705,and 5. 528,all P < 0. 001). After treatment,Ca2+level was significantly reduced and WBC count increased significantly( t = 6. 924 and 9. 852,both P < 0. 001). At the 1- week follow- up,Alb,Glb,Fib,PT,APTT,Ca2+level,and WBC count almost returned to the same levels before treatment,and TBil,DBil,and TBA showed varying degrees of increases compared with the values after treatment,but remained lower than the values before treatment. Of all the40 patients,12( 30%) experienced adverse events,among whom 3( 7. 5%) experienced fear of cold( or chills),3( 7. 5%) experienced reduced blood pressure,2( 5. 0%) experienced reduced heart rate,1( 2. 5%) experienced nausea and vomit,1( 2. 5%) experienced abdominal pain,and 1( 2. 5%) experienced cold sweat. Conclusion BSA therapy is safe and effective in the treatment of patients with chronic severe hepatitis B and PTA > 25% and has transient effects on patients' coagulation function,serum calcium,and WBC count.

Efficacy of low-dose glucocorticoids in treatment of HBV-related acute-on-chronic liver failure

Qiu Bo, Zhu Ling, Wang TangMing, Yan ShiChun, Zhang JianMing, Xie ZhiAn, Liu XingYu

2016, 32(7): 1300-1304. DOI: 10.3969/j.issn.1001-5256.2016.07.017

Abstract(2237)

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Abstract:
Objective To investigate the efficacy and safety of low- dose glucocorticoids in the treatment of HBV- related acute- on-chronic liver failure( HBV- ACLF). Methods A total of 118 patients with HBV- ACLF who were treated in Center for Liver Disease Treatment in the Fourth People's Hospital of Panzhihua from January 2012 to October 2015 were enrolled and randomly divided into treatment group and control group,with 59 patients in each group. All the patients were given antiviral therapy with entecavir and conventional liver-protecting and symptomatic treatment,and the patients in the treatment group were given intravenous drip of low- dose hydrocortisone sodium succinate( 25 mg / d) in addition. The clinical manifestations,biochemical parameters for liver function,adverse events,length of hospital stay,and hospital costs were recorded for all patients. The t- test was used for comparison of continuous data between groups,the paired t- test was used for comparison of continuous data within groups,and the chi- square test or Fisher's exact test was used for comparison of categorical data between groups. Results At the end of the course of the treatment,the treatment group showed significantly better improvements in the biochemical parameters for liver function( alanine aminotransferase,aspartate aminotransferase,total bilirubin,albumin,cholinesterase,and prothrombin activity) compared with the control group( all P < 0. 001). The treatment group had a significantly shorter length of hospital stay and significantly lower hospital costs than the control group( length of hospital stay: 48. 0 ± 9. 2 d vs 74. 0 ± 16. 4 d,t = 4. 34,P < 0. 01; hospital costs: 7974. 5 ± 853. 7 RMB / person vs 12 432. 7 ± 1263. 1 RMB / person,t = 22. 46,P < 0. 01). No patients in the treatment group experienced adverse events related to hydrocortisone sodium succinate. Conclusion In the treatment of HBV- ACLF,low- dose hydrocortisone sodium succinate can eliminate jaundice,alleviate conditions,and improve the prognosis. Meanwhile,it can also shorten the length of hospital stay and reduce hospital costs. This drug has good safety and holds promise for further clinical research.

Familial aggregation and clinical prognosis of hepatitis B virus infection in Guangzhou,China

Ye JunZhao, Wu YanQin, Li Rui, Li ShaoFeng, Zhong BiHui

2016, 32(7): 1305-1309. DOI: 10.3969/j.issn.1001-5256.2016.07.018

Abstract(1995)

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Objective To investigate the characteristics of familial aggregation and prognosis of chronic hepatitis B( CHB) in Guangzhou,China,where there is a high prevalence of hepatitis B virus( HBV) infection. Methods The CHB patients who were treated in Outpatient Department of Hepatitis in the First Affiliated Hospital of Sun Yat- sen University from January 2009 to April 2016 were enrolled. The basic demographic features,relatives' HBV markers,patients' HBV indices,liver biochemical parameters,and findings on liver color Doppler ultrasound,computed tomography( CT),and magnetic resonance imaging( MRI) were analyzed. Familial aggregation was defined as at least two relatives diagnosed with chronic HBV infection,and the clinical features were compared between the groups with and without familial aggregation. The t- test was used for comparison of normally distributed continuous data between groups,and the Wilcoxon rank sum test was used for non- normally distributed continuous data between groups. The chi- square test or Fisher' s exact test was used for comparison of categorical data between groups. The univariate logistic regression was used to analyze familial aggregation and the risk factors for HBV infection,liver cirrhosis,and liver cancer in offspring. Results A total of 1096 CHB patients with a clear family history were enrolled; among these patients,569 had a positive family history,resulting in a rate of familial aggregation of 51. 9%. According to their age,the patients were stratified into groups of 16- 30 years,31- 45 years,and > 46 years. The proportions of patients diagnosed with liver cirrhosis across the three age stratifications in the groups with and without familial aggregation were 2. 1% /11. 5% /35. 6% and 2. 7% /5. 7% /38. 5%,respectively. The group with familial aggregation had a significantly higher proportion of patients aged 31- 45 years who were diagnosed with liver cirrhosis than the group without familial aggregation( χ2= 5. 71,P = 0. 02). The familial aggregation pattern was dominated by infection between siblings( 30. 2%) and mother- children infection( 34. 4%). Maternal and paternal infection( OR = 8. 18,95% CI: 5. 24-12. 75),maternal infection alone( OR = 4. 60,95% CI: 3. 69- 5. 74),and paternal infection alone( OR = 2. 77,95% CI: 2. 11- 3. 63)were associated with HBV infection in offspring. Familial aggregation pattern was not the risk factor for the development of liver cirrhosis in patients( P > 0. 05),while maternal and paternal infection( OR = 8. 5,P < 0. 01) was the risk factor for the development of liver cancer.Conclusion CHB infection shows high familial aggregation in Guangzhou,and the patients with a positive family history of CHB may progress to liver cirrhosis early.

Independent predictive factors for significant liver histological changes in patients with HBe Ag-positive high-viral-load chronic HBV infection and a normal alanine aminotransferase level

Li Qiang, Huang YuXian, Chen Liang

2016, 32(7): 1310-1314. DOI: 10.3969/j.issn.1001-5256.2016.07.019

Abstract(1740)

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Objective To investigate the independent predictive factors for significant liver histological changes( SLHCs) in patients with HBe Ag- positive high- viral- load chronic hepatitis B virus( HBV) infection and a normal alanine aminotransferase( ALT) level. Methods A retrospective analysis was performed on the clinical data of 116 previously untreated patients with HBe Ag- positive high- viral-load( HBV DNA≥105copies / ml) chronic HBV infection and a normal ALT level( < 50 U/L) who were hospitalized in Shanghai Public Health Clinical Center Affiliated to Fudan University from June 2013 to August 2015. The definition of SLHCs was inflammation ≥G2 and /or fibrosis≥S2. The t- test or Mann- Whitney U rank sum test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. Univariate and multivariate regression analyses were used to determine independent predictive factors for SLHCs. Results Of all the 116 patients,47( 40. 5%) had SLHCs. The multivariate analysis showed that age( OR = 2. 828,P < 0. 05),ALT( OR = 1. 011,P < 0. 05),and gamma- glutamyl transpeptidase( GGT)( OR = 1. 089,P< 0. 05) were independent predictors for SLHCs in patients with HBe Ag- positive high- viral- load chronic HBV infection and a normal ALT level. The patients aged ≤30 years had a significantly lower incidence rate of SLHCs than those aged > 30 years( 21. 6% vs 49. 4%,χ2= 6. 42,P = 0. 015),the patients with ALT ≤30 U/L had a significantly lower incidence rate of SLHCs than those with 30 U/L < ALT≤50 U/L( 17. 6% vs 50. 0%,χ2= 19. 86,P < 0. 001),and the patients with GGT≤40 U/L had a significantly lower incidence rate of SLHCs than those with GGT > 40 U/L( 28. 8% vs 66. 7%,χ2= 28. 63,P < 0. 001). Conclusion In patients with HBe Ag- positive high-viral- load chronic HBV infection and a normal ALT level,those with an age of > 30 years,ALT > 30 U/L,and GGT > 40 U/L tend to develop SLHCs and need liver biopsy.

Influence of Notch signaling pathway on interleukin-22 secreted by CD4~+T cells in patients with hepatitis B

Wang Wei, Zhao RongRong, Yang XiaoFei, Huang ZhangXing, Lian JianQi, Wang JiuPing, Zhang Ye

2016, 32(7): 1315-1318. DOI: 10.3969/j.issn.1001-5256.2016.07.020

Abstract(1627)

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Objective To investigate the influence of Notch signaling pathway inhibition on interleukin- 22( IL- 22) secreted by CD4~+T cells in patients with hepatitis B,and to elaborate on the role of the Notch- IL- 22 signaling pathway in the pathogenesis of hepatitis B.Methods A total of 45 previously untreated patients with hepatitis B who visited and were hospitalized in Tangdu Hospital from July 2013 to December 2014 were enrolled,and among these patients,13 had acute hepatitis B( AHB) and 32 had chronic hepatitis B( CHB). Another20 healthy volunteers were enrolled as normal control( NC) group. CD4~+T cells were isolated,and quantitative real- time PCR was used to measure the mRNA expression of Notch1 and Notch2. CD4~+T cells were stimulated by anti- CD3 antibody or HBV core peptide library and the Notch signaling pathway inhibitor DAPT was added. Quantitative real- time PCR was used to measure the mRNA expression of IL-22 in cells,and ELISA was used to measure the level of IL- 22 secretory protein in supernatant. The Kruskal- Wallis H test was used for statistical analysis of data between groups,and the Dunn's multiple test was used for data comparison between any two groups. Results The mRNA expression of Notch1 in CD4~+T cells in CHB patients was about 2 times that in NCs( Z = 7. 708,P = 0. 018),and the mRNA expression of Notch2 in AHB and CHB patients was more than 10 times that in NCs( Z = 9. 643 and 12. 90,both P < 0. 000 1). Inhibition of the Notch signaling pathway did not influence the mRNA expression of IL- 22 in cultured CD4~+T cells,but significantly reduced the secretion of non- specific IL- 22 in NCs( Z = 5. 068,P = 0. 015),AHB patients( Z = 5. 203,P = 0. 016),and CHB patients( Z = 2. 892,P = 0. 047). Conclusion Inhibition of the Notch signaling pathway can block IL- 22 secretion by non- specific CD4~+T cells,suggesting that the Notch- IL- 22 signaling pathway may promote non- specific inflammatory response in HBV infection.

Correlation between routine blood test results and antiviral effect in patients with refractory chronic hepatitis C treated with pegylated interferon-α

Chen XiaoYun, Zheng YanHong, Jin Yi, Yu HaiBin, Ma LiNa, Chen XinYue

2016, 32(7): 1319-1322. DOI: 10.3969/j.issn.1001-5256.2016.07.021

Abstract(1655)

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Objective To investigate the correlation between the changes in routine blood test results and antiviral effect in patients with refractory chronic hepatitis C receiving standard treatment. Methods A total of 63 previously untreated patients with refractory chronic hepatitis C who visited Beijing You An Hospital,Capital Medical University,from September 2011 to December 2012 were enrolled. The patients were treated with pegylated interferon- α- 2a 180 μg / week and ribavirin( RBV) for 48 weeks. HCV RNA measurement and routine blood tests were performed at baseline and weeks 4,12,and 24 of treatment to analyze the correlation between routine blood test results and antiviral effect. According to the status of sustained virologic response( SVR),the patients were divided into SVR group and n SVR group. 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 simple linear correlation analysis was performed. Results Of the 63 patients,three were lost to follow- up,and the other 60 patients completed the antiviral therapy and 24- week follow- up; among the 60 patients,46 achieved SVR,resulting in an SVR rate of76. 7%. Compared with the n SVR group,the SVR group showed lower absolute lymphocyte count( LYPH),white blood cell count( WBC),and absolute neutrophil count( NUET),and the three indicators were significantly different between the two groups at 12 weeks( t = 3. 398,2. 766,and 2. 037,all P < 0. 05); WBC and NUET still showed significant differences between the two groups at 24 weeks( t = 2. 559 and 2. 151,both P < 0. 05). In addition,at week 4 of treatment,the SVR group showed significantly greater reductions in these three indicators from baseline compared with the n SVR group,LYPH showed significant different between the two groups( t = 2. 26,P =0. 03). At weeks 4 and 12 of treatment,LYPH,WBC,and NEUT were positively correlated with the reduction in HCV RNA( r = 0. 36,0. 45,0. 37,0. 47,0. 61,and 0. 33,all P < 0. 05). Conclusion The reductions in LYPH,WBC,and NEUT can be used as predictive indicators for antiviral effect in patients with refractory chronic hepatitis C.

Risk genes for the development of chronic hepatitis B cirrhosis assessed by prediction analysis of microarrays

Xiao ChunYang, Li QinKai, Yu JingXia, Liu Ting, Lu LunGen, Xu MingYi

2016, 32(7): 1323-1329. DOI: 10.3969/j.issn.1001-5256.2016.07.022

Abstract(1935)

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Objective To investigate the risk genes for predicting the development of chronic hepatitis B( CHB) cirrhosis using gene chip technology. Methods A total of 40 CHB patients who visited Shanghai First People's Hospital from April 2008 to December 2010 were enrolled as a clinical cohort and were divided into S0,S1,S2,S3,and S4 groups,with 8 patients in each group. Liver biopsy was performed to determine fibrosis stage with the Scheuer pathological score as the criteria,and clinical data and liver tissue samples were reserved. The Human Affymetrix Gene Chip was used to establish the gene expression profiles of liver tissues in CHB patients,and the significance analysis of microarrays( SAM) and prediction analysis of microarrays( PAM) were used to screen out the risk genomes for predicting the development of CHB cirrhosis. Quantitative real- time PCR was used to measure the mRNA expression of risk genes in liver tissue. The chi- square test was used for comparison of categorical data. The t- test and a one- way analysis of variance were used for comparison of normally distributed continuous data,and SNK- q test was used for further comparison between any two groups; the Mann- Whitney U rank sum test was used for comparison of non- normally distributed continuous data. Results A total of 1674 differentially expressed genes were screened out by Affymetrix Gene Chip. A cluster analysis of these genes showed that gene expression showed differences between groups with different fibrosis stages,which suggested that the gene expression profile was well consistent with fibrosis stage. Four different classification methods were used for analysis,and 87 significant genes were screened out by SAM and 14 “high- risk”genes were screened out by PAM. The quantitative real- time PCR showed the expression of 6 risk genes( CD24,CXCL6,EHF,ITGBL1,LUM,and SOX9) differed significantly between groups S0,S1- 3,and S4( P < 0. 05),and the S1- 3 and S4 groups showed significantly upregulated expression of these genes compared with the S0 group( all P < 0. 05). Conclusion The 6 high- risk factors screened out and verified by gene chip technology help to predict the probability of developing liver cirrhosis in CHB patients and can be used as the diagnostic genes for predicting hepatitis B cirrhosis.

Effect of decoy receptor 3 gene on hepatocyte apoptosis

Pan LiuLan, Jia ShengNan, Ma JingTing, Tai JingHua, Jin ZhenJing

2016, 32(7): 1330-1333. DOI: 10.3969/j.issn.1001-5256.2016.07.023

Abstract(2064)

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Objective To investigate the effect of decoy receptor 3( DcR3) gene on hepatocyte apoptosis,as well as the possible mechanism of action of DcR3 in this process. Methods The human liver cell lines were cultured in vitro,and p EF1α- DcR3 transfection group,p EF1α- IRES transfection group,and negative control group were established. The p EF1α- IRES- DsRed- Express2- DcR3 eukaryotic expression vector was constructed and transfected into human liver cell lines for 36 hours. qRT- PCR was used to measure the mRNA expression of DcR3,Fas ligand( Fas L),α- smooth muscle actin( α- SMA),and transforming growth factor- β1( TGF- β1),Western blot was used to measure the change in the protein expression of DcR3,and flow cytometry was used to measure apoptosis. An analysis of variance was used for comparison of continuous data between groups,and the least significant difference t- test was used for comparison between any two groups. Results After human liver cell lines were transfected with p EF1α- DcR3 for 36 hours,the p EF1α- DcR3 transfection group showed significant increases in the mRNA and protein expression of DcR3 compared with the p EF1α- IRES transfection group and negative control group( F = 33 169. 5and 141. 54,all P < 0. 01). Compared with the other two groups,the p EF1α- DcR3 transfection group showed significant reductions in the mRNA expression of Fas L,α- SMA,and TGF- β1( F = 269 451. 8,20 790. 4,and 8067. 8,all P < 0. 01),which suggested that DcR3 inhibited the expression of Fas L,α- SMA,and TGF- β1. Compared with the p EF1α- IRES transfection group and negative control group,the p EF1α- DcR3 transfection group showed a significant reduction in apoptosis rate( F = 558. 63,all P < 0. 01). Conclusion DcR3 can inhibit hepatocyte apoptosis and downregulate the mRNA expression of Fas L,α- SMA,and TGF- β1.

Risk factors for postoperative pulmonary infection in patients with primary liver cancer

Ai YeQing, Zhang ChengHua, Liu HuiFang

2016, 32(7): 1334-1337. DOI: 10.3969/j.issn.1001-5256.2016.07.024

Abstract(2158)

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Objective To investigate the risk factors for postoperative pulmonary infection in patients with primary liver cancer through a retrospective analysis,and to provide a reference for appropriate preventive measures in clinical treatment. Methods A total of 286 patients with liver cancer who visited Department of Hepatology,180 Hospital of PLA,from May 2011 to December 2015 were enrolled,and according to the presence or absence of postoperative pulmonary infection,these patients were divided into infection group( 36 patients) and non-infection group( 250 patients). The factors for postoperative pulmonary infection were analyzed. 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 logistic multivariate regression analysis was used to analyze the risk factors for postoperative pulmonary infection. Results The univariate analysis showed that age distribution,smoking history,diabetes,intraoperative blood transfusion volume,and the indwelling time of abdominal drainage tube showed significant differences between the two groups( all P < 0. 05). The multivariate analysis showed that smoking history,diabetes,intraoperative blood transfusion volume,and the indwelling time of abdominal drainage tube were independent risk factors for postoperative pulmonary infection in patients with primary liver cancer( all P < 0. 05). Among the anesthesia- related factors,application of single- use medical devices and perioperative antibacterial agents significantly reduced the incidence rate of postoperative pulmonary infection( both P < 0. 05).Conclusion Smoking history,diabetes,intraoperative blood transfusion volume,the indwelling time of abdominal drainage tube,no use of single- use medical devices during anesthesia,and no use of perioperative antibacterial agents are risk factors for postoperative pulmonary infection in patients with primary liver cancer. Corresponding preventative and treatment methods can effectively prevent the development of postoperative pulmonary infection.

Value of contrast-enhanced ultrasound in differential diagnosis of single metastatic liver cancer and solitary necrotic nodule of the liver

Li Jing, Tang ShaoShan, Yu HongWei

2016, 32(7): 1338-1341. DOI: 10.3969/j.issn.1001-5256.2016.07.025

Abstract(2081)

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Abstract:
Objective To investigate the value of contrast- enhanced ultrasound( CEUS) in the differential diagnosis of single metastatic hepatic carcinoma( MHC) and solitary necrotic nodule of the liver( SNNL). Methods A retrospective analysis was performed for 12 patients with single MHC and 16 patients with SNNL who showed circular enhancement in arterial phase on CEUS. Age,size of lesion,and findings of two- dimensional gray- scale ultrasound and CEUS were compared between the two groups. The two- independent- samples t-test was used for comparison between groups,and the paired t- test was used for comparison within each group. Results The MHC group had a significantly higher mean age than the SNNL group( 60. 2 ± 11. 3 years vs 41. 0 ± 9. 1 years,t = 4. 970,P < 0. 001). The mean diameter of lesion was 2. 86 ± 1. 22 cm in the MHC group and 2. 97 ± 0. 96 cm in the SNNL group,and showed no significant difference between the two groups( t =- 0. 269,P = 0. 790). In the MHC group,the lesions had complex and uneven echoes and blurred boundaries,while in the SNNL group,most lesions were in the right lobe and were hypoechoic with clear boundaries. No blood flow signals were detected on CDFI in these two groups. Both groups had circular enhancement around the lesions in arterial phase on CEUS,and the mean thickness showed a significant difference between the MHC group and the SNNL group( 5. 00 ± 1. 69 mm vs 2. 37 ± 0. 87 mm,t = 5. 374,P < 0. 001). In the MHC group,the area in lesions without enhancement in delayed phase was significantly larger than that in arterial phase( t =- 4. 508,P =0. 001),while in the SNNL group,the area in lesions without enhancement showed no significant difference between delayed phase and arterial phase( t =- 0. 449,P = 0. 660). Conclusion The thickness of circular enhancement in arterial phase on CEUS and the presence or absence of the enlargement in the area without enhancement contributes to the differential diagnosis of single MHC and SNNL.

Syndrome differentiation-based treatment of primary liver cancer developed by Professor Qian Ying: an analysis of experience

Li JingYing, Li XiuHui, Zhang Yin, Gou ChunYan, Li Li

2016, 32(7): 1342-1344. DOI: 10.3969/j.issn.1001-5256.2016.07.026

Abstract(1959)

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Objective To investigate the traditional Chinese herbs and core prescriptions commonly used by Professor Qian Ying in the syndrome differentiation- based treatment of primary liver cancer,and to guide clinical medication. Methods A retrospective analysis was performed for the clinical data of the patients diagnosed and treated by Professor Qian Ying. A descriptive analysis was performed to analyze Professor Qian Ying's clinical medication and prescriptions in the treatment of primary liver cancer,and the complex network and clustering with point mutual information were used to analyze the complex association between multiple traditional Chinese herbs. Results A total of111 patients with primary liver cancer were enrolled. There were 287 visits,287 prescriptions,and 132 traditional Chinese herbs in total.The core herbs used by Professor Qian Ying were Visci herba,raw Astragalus membranaceus,Salvia miltiorrhiza,Oldenlandia diffusa,and Polygoni Orientalis Fructus,and this result was consistent with the composition of Huqi powder developed by Professor Qian Ying. The prescriptions commonly used included Huqi powder,Shengmai decoction,and Xiaoyao powder. Conclusion Salvia miltiorrhiza is the special herb used by Professor Qian Ying in the treatment of primary liver cancer and Huqi powder developed by Professor Qian Ying is the commonly used prescription.

The diagnostic value of low-frequency ultrasound combined with high-frequency ultrasound in hyperplastic of the gallbladder

Cheng Lin, Mei Yong

2016, 32(7): 1345-1347. DOI: 10.3969/j.issn.1001-5256.2016.07.027

Abstract(1503)

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Abstract:
Objective To explore the clinical value of low- and high- frequency ultrasound in the diagnosis of benign lesions of the gallbladder.Methods A retrospective analysis was performed in 110 outpatients with pathologically confirmed benign lesions of the gallbladder in our hospital from January 2015 to January 2016. All patients were examined with low- frequency ultrasound,and the results were recorded. Then,they were examined with a combination of low- and high- frequency ultrasound,and the results were recorded. The rate of agreement with pathological diagnosis was compared between the two examination methods. The chi- square test was used for comparison of categorical data between groups. Results In the 110 patients,83 had the low- frequency ultrasound results in accordance with pathological diagnosis; 102 had the low- and high-frequency ultrasound results in accordance with pathological diagnosis,consisting of 70 cases of polypoid lesions of the gallbladder( 68. 63%) and32 cases of adenomyomatosis of the gallbladder( 31. 37%). Eight( 7. 3%) of the 110 patients were misdiagnosed by the combined examination.The rate of agreement with pathological diagnosis of the combined examination( 92. 73%) was significantly higher than that of low- frequency ultrasound( 75. 45%)( χ2= 12. 666,P = 0. 001). Conclusions A combination of low- and high- frequency ultrasound helps increase the diagnostic rate for benign lesions of the gallbladder.

Experience in clinical diagnosis and treatment of patients aged >65 years with acute calculous cholecystitis

Guo Xin, Lu: XiaoHui, Shi DongLi, Li NingYu, Chen LuBin

2016, 32(7): 1348-1350. DOI: 10.3969/j.issn.1001-5256.2016.07.028

Abstract(2231)

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Objective To investigate the features and methods of clinical diagnosis and treatment of elderly patients with acute calculous cholecystitis. Methods A retrospective analysis was performed for the clinical data of elderly patients who were diagnosed with acute calculous cholecystitis in 451 Hospital of PLA from June 2012 to June 2015. After admission,all patients received fasting treatment,electrocardiographic monitoring,anti- infective therapy,and maintenance of body fluid balance and stable blood pressure and glucose. According to patients condition choose laparoscopic cholecystectomy open cholecystectomy,open cholecystectomy and common bile duct exploration. Results A total of 129 patients were enrolled; among these patients,119 had acute calculous cholecystitis,2 had gallstones with adenomatous hyperplasia of the gallbladder mucosa,6 had pyogenic cholecystitis,and 2 had gallbladder gangrene. Among the patients enrolled,52 were complicated by at least one internal disease. Among them,67 underwent emergency surgery since there were no significant improvements in symptoms,and 62 showed relief of symptoms and underwent surgical treatment at other times. Of all patients,108 underwent laparoscopic cholecystectomy,9 underwent laparoscopy and were converted to open cholecystectomy,and 9 underwent open cholecystectomy and common bile duct exploration. All the surgeries were successful and all the patients were cured and discharged. There were no deaths. Conclusion Elderly patients with acute calculous cholecystitis are in a critical condition and often complicated by various internal diseases. Laparoscopic cholecystectomy is the most commonly used therapeutic method. Clinicians should be fully prepared before surgery,take the perioperative management seriously,and accurately judge the surgical indications and timing.

Recurrence after gallbladder-preserving cholecystolithotomy for sand-like and non-sand-like gallstones: a comparative analysis

Chen Zhi, Zhang HongYi, Xu XinBao, Liu ChengLi, Li XinHui

2016, 32(7): 1351-1353. DOI: 10.3969/j.issn.1001-5256.2016.07.029

Abstract(3060)

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Objective To investigate the recurrence at 1- 3 years after laparoscopic cholecystolithotomy in patients with sand- like and non-sand- like gallstones. Methods A retrospective analysis was performed for the clinical data of 155 patients with gallstones who underwent gallbladder- preserving cholecystolithotomy in Air Force General Hospital,PLA from October 2012 to December 2014,and these patients were divided into sand- like stone group( 29 patients) and non- sand- like stone group( 126 patients). The recurrence of stones was observed at1- 3 years after surgery. 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 time of operation showed a significant difference between the sand- like stone group and the non- sand- like stone group( 126. 13 ± 20. 52 min vs 75. 64 ± 16. 58 min,t = 7. 709,P < 0. 001). At 1- 3 years after surgery,6 patients in the sand- like stone group and 8 in the non- sand- like stone group experienced recurrence,and the 2- and 3- year recurrence rates showed significant differences between the two groups( 2- year recurrence rate: 20. 69% vs 6. 35%,χ2= 4. 284,P =0. 038; 3- year recurrence rate: 20. 69% vs 6. 35%,χ2= 4. 284,P = 0. 038). Conclusion The patients with sand- like gallstones have a significantly higher recurrence rate and a significantly longer time of operation than those with non- sand- like gallstones,and therefore,they should avoid gallbladder- preserving cholecystolithotomy.

Diagnosis,treatment,and outcome of Mirizzi syndrome in the perioperative period of laparoscopic cholecystectomy

Chen LuBin, Lu: XiaoHui, Guo Xin

2016, 32(7): 1354-1356. DOI: 10.3969/j.issn.1001-5256.2016.07.030

Abstract(2118)

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Objective To investigate the diagnosis,treatment,and outcome of Mirizzi syndrome in patients undergoing laparoscopic cholecystectomy( LC). Methods A retrospective analysis was performed on the clinical data of 32 patients who underwent LC in the 451 Hospital of PLA from December 2006 to December 2014 and experienced Mirizzi syndrome during the perioperative period. Intraoperative diagnosis,selection of surgical procedures,and evaluation of treatment outcome were summarized. Results Among these patients with Mirizzi syndrome,8 were diagnosed before surgery and 24 were diagnosed during LC. According to the Csendes classification,23 patients had type Ⅰ,7 had type Ⅱ,1 had type Ⅲ,and 1 had type Ⅳ Mirizzi syndrome. A total of 30 patients completed LC,and they all had type I or Ⅱ Mirizzi syndrome. One patient with type Ⅱ disease underwent LC and common bile duct exploration. Two patients with type Ⅲ or Ⅳ disease were converted to open surgery; the type Ⅲ patient underwent bile duct end- to- end anastomosis,and the type Ⅳ patient underwent choledochoenterostomy. Conclusion Mirizzi syndrome is difficult to diagnose,and ultrasonography is the preferred method of examination. A combination of magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can improve preoperative diagnostic rate. Most cases of type Ⅰ and Ⅱ Mirizzi syndrome can be treated by LC. Open surgery should be considered for type Ⅲ and Ⅳ cases to avoid biliary tract injury.

Clinical application of selective intraoperative cholangiography in biliary system surgery

Wu ErBin, Zhang JinWei

2016, 32(7): 1357-1359. DOI: 10.3969/j.issn.1001-5256.2016.07.031

Abstract(2113)

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Objective To investigate the value of selective intraoperative cholangiography( IOC) in biliary system surgery. Methods A retrospective analysis was performed on the clinical data and follow- up data of 112 patients who were hospitalized in The First People's Hospital of Pingdingshan and underwent selective IOC from May 2010 to May 2015. Another 84 patients who met the criteria for selective IOC but underwent no IOC or failed IOC were enrolled as controls. The clinical data and follow- up data 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 In the selective IOC group,82 patients underwent laparoscopic IOC( 19 were converted to open surgery after IOC) and 30 underwent open IOC; 40 patients had positive results on IOC,among whom 24 had biliary calculi,4 had biliary stricture,1had space- occupying lesions at the lower end of bile duct,5 had bile duct injury,and 6 had negative bile duct exploration. In the control group,53 patients underwent intraoperative bile duct exploration,among whom 26 had biliary calculi,2 had inflammatory stricture at the lower end of bile duct,and 25 had negative results. The negative exploration rate showed a significant difference between the selective IOC group and the control group [15. 00%( 6 /40) vs 47. 17%( 25 /53),χ2= 10. 616,P = 0. 001]. In the selective IOC group,1 patient( 0. 89%) experienced postoperative bile leakage caused by bile duct injury,which was noticed during the surgery and treated with bile duct repair and T- tube drainage,and the patient was cured 2 weeks later. In the control group,7 patients( 8. 33%) experienced postoperative bile duct injury and required reoperation or endoscopic treatment. The incidence rate of bile duct injury showed a significant difference between the two groups( χ2= 6. 787,P = 0. 009). Within half a year after surgery,2 patients( 1. 79%) in the selective IOC group and 12 patients( 14. 29%) in the control group experienced biliary calculi,and the incidence rate of biliary calculi showed a significant difference between the two groups( χ2= 11. 308,P = 0. 001). Conclusion Selective IOC can effectively reduce unnecessary bile duct exploration,the probability of bile duct injury,and the incidence of postoperative residual calculi,identify bile duct injury as early as possible during surgery,reduce the probability of reoperation,relieve pain,and reduce costs; therefore,it helps with bile duct exploration.

Role of therapeutic endoscopic retrograde cholangiopancreatography in treatment of pancreaticobiliary diseases

Jiang ShengJun, Wang YongGuang, Li QiMei, Liu Ji, Tao LingYun, Jin Hui, Liu XiaoJing

2016, 32(7): 1360-1363. DOI: 10.3969/j.issn.1001-5256.2016.07.032

Abstract(2101)

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Objective To investigate the effect of therapeutic endoscopic retrograde cholangiopancreatography( ERCP) on liver function and treatment outcome in patients with pancreaticobiliary diseases. Methods A total of 397 patients with pancreaticobiliary diseases who underwent ERCP with an electronic duodenoscope in Beijing Chuiyangliu Hospital from January 2005 to July 2015,were enrolled. According to the type of disease,they were divided into benign obstruction group( 109 patients),malignant obstruction group( 47 patients),pancreatitis group( 27 patients),foreign body obstruction group( 127 patients),simple cholangitis group( 19 patients),biliary fistula group( 15patients),juxta- ampullary duodenal diverticula group( 29 patients),and liver transplantation group( 24 patients). Liver function parameters including alanine aminotransferase( ALT),aspartate aminotransferase( AST),alkaline phosphatase( ALP),γ- glutamyl transpeptidase( GGT),and total bilirubin( TBil) were measured at 1 day before ERCP and at 4 weeks after ERCP. The therapeutic effect was evaluated at 1 month after ERCP. The paired t- test was used for comparison of continuous data before and after treatment within one group,an analysis of variance was used for comparison between multiple groups,and the chi- square test was used for comparison of categorical data between groups. Results After ERCP,all the patients showed significant improvements in ALT,AST,ALP,GGT,and TBil,suggesting that ERCP significantly improved the subjects' liver function( all P < 0. 05). The evaluation of therapeutic effect showed that after ERCP,all the groups showed significant remission of symptoms; all the patients in the simple cholangitis group were cured,while those in the liver transplantation group and malignant obstruction group only achieved certain improvements. Conclusion Therapeutic ERCP can significantly improve the patients' liver function. However,as for patients with liver transplantation and pancreaticobiliary tumors,laparoscopic surgery should be performed in combination with ERCP.

Value of serum carbohydrate antigens 19-9 and 24-2 in diagnosis of benign and malignant biliary tract diseases

Cui DaPeng, Zhang YingChun, Gao ShuQuan, Han Lei, Zhang YiJun, Zhao LiJuan, Liu ZhenXian, Yang He

2016, 32(7): 1364-1367. DOI: 10.3969/j.issn.1001-5256.2016.07.033

Abstract(2353)

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Objective To investigate the value of serum carbohydrate antigen 19- 9( CA19- 9) and carbohydrate antigen 24- 2( CA24-2) in the diagnosis of benign and malignant biliary tract diseases. Methods A total of 214 patients with biliary tract diseases who were hospitalized in Department of Gastroenterology and Department of General Surgery in the First Hospital Affiliated to Hebei North University from January 2012 to October 2015 were enrolled,and according to the nature of lesions,they were divided into benign lesion group( 162 patients) and malignant lesion group( 52 patients). The healthy people who underwent physical examination during the same period of time in the Physical Examination Center were enrolled as normal control group( 40 persons). Peripheral venous blood was collected for all subjects in a fasting state,and the serum levels of total bilirubin( TBil),direct bilirubin( DBil),and indirect bilirubin( IBil) were measured. Radioimmunoassay was used to measure the serum levels of CA19- 9 and CA24- 2. The Kruskal- Wallis H test was used for comparison of continuous data between multiple groups,and the Wilcoxon rank sum test was used for further comparison between any two groups; the chi-square test was used for comparison of categorical data between groups; Pearson correlation analysis was also performed. Results Compared with the normal control group,the benign lesion group and the malignant lesion group showed significant increases in the serum levels of TBil and CA19- 9( all P < 0. 01). Compared with the benign lesion group,the malignant lesion group showed significant increases in the serum levels of CA19- 9 and CA24- 2( all P < 0. 01). The serum levels of CA19- 9 and CA24- 2 were not associated with tumor location in cholangiocarcinoma,but they were associated with the degree of tumor differentiation( χ2= 6. 860 and 9. 010,all P < 0. 05). The combined measurementof CA 1 9- 9 and CA 2 4- 2 had a sensitivity of 8 8. 5 % and a specificity of 8 2. 1 % in the diagnosis of cholangiocarcinoma,which were significantly higher than the sensitivity and specificity of CA19- 9 or CA24- 2 measurement( all P < 0. 01). In the patients with benign biliary tract diseases and cholangiocarcinoma,serum CA19- 9 was positively correlated with serum TBil( r = 0. 634 and 0. 346,both P < 0. 05),and the benign lesion group had a significantly greater correlation between serum CA19- 9 and serum TBil than the malignant lesion group. Conclusion Combined measurement of CA19- 9 and CA24- 2 has clinical significance in early diagnosis of cholangiocarcinoma.

Influencing factors for the length of hospital stay in patients with drug-induced liver injury

Du ShuiXian, Lu LinLin, Xin YongNing, Liu Yang, Yuan Chen, Gu JiuLian, Xuan ShiYing

2016, 32(7): 1368-1372. DOI: 10.3969/j.issn.1001-5256.2016.07.034

Abstract(2167)

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Objective To investigate the influencing factors for the length of hospital stay in patients with drug- induced liver injury( DILI),and to guide clinical practice,reduce the pressure of hospitalization,and reduce the patients' economic burden. Methods The clinical data of the patients with DILI who were hospitalized in Qingdao Municipal Hospital from January 2012 to December 2014 were collected,including age,sex,primary disease,medication history,routine blood test,liver function parameters,DILI type,medication,and prognosis.The Spearman rank correlation,Wilcoxon rank sum test,and Kruskal- Wallis H rank sum test were used to analyze the influencing factors for the length of hospital stay. A multivariate linear regression analysis was performed for the factors with statistical significance determined by the univariate analysis. Results The clinical data of 191 patients with DILI were collected. Among these patients,there were 114 male and 77 female patients aged 11- 84 years( mean 50. 83 ± 2. 72 years),and the mean hospital stay was 14 days( range 4- 41 days). Patient's age,the highest levels of alanine aminotransferase( ALT) / alkaline phosphatase( ALP) / total bilirubin( TBil),and the lowest level of prothrombin activity( PTA) were positively correlated with the length of hospital stay( rs= 0. 388,0. 247,0. 172,0. 487,and 0. 120,all P < 0. 05). The presence or absence of the histories of underlying liver disease,hypertension,malignant tumors,tuberculosis,and hyperthyroidism,use of different suspected drugs,therapies for DILI,and DILI types were the influencing factors for the length of hospital stay in patients with DILI( all P < 0. 05). The multivariate linear regression analysis showed that age,the histories of underlying liver disease and malignant tumors,traditional Chinese medicine,antipyretic and analgesic drugs,the highest levels of ALT / ALP / TBil,the lowest level of PTA,therapies for DILI,and DILI types were independent risk factors for the length of hospital stay in patients with DILI( all P < 0. 05).Conclusion Age,the histories of underlying liver disease and malignant tumors,traditional Chinese medicine,antipyretic and analgesic drugs,the highest levels of ALT / ALP / TBil,the lowest level of PTA,therapies for DILI,and DILI types are influencing factors for the length of hospital stay in patients with DILI. Regulation of the influencing factors for the length of hospital stay during clinical diagnosis and treatment can reduce hospital costs and plays an important role in reducing healthcare burden.

Risk factors for liver injury in patients with acquired immunodeficiency syndrome treated with nevirapine

Liu Pei, Gao ShiCheng

2016, 32(7): 1373-1377. DOI: 10.3969/j.issn.1001-5256.2016.07.035

Abstract(2065)

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Objective To investigate the risk factors for hypersensitivity- associated liver injury induced by the combined antiretroviral therapy( c- ART) including nevirapine( NVP) in patients with acquired immunodeficiency syndrome. Methods The clinical data and blood samples of 132 patients who received the combined therapy including NVP in Zhongnan Hospital of Wuhan University from June 2008 to October 2015 were collected,and PCR- SSP was used to determine the genotypes of human leukocyte antigen( HLA) DRB1 and HLA-Cw. The patients who experienced hypersensitivity- associated liver injury induced by NVP within 6 weeks of c- ART were enrolled in the liver injury group( 41 patients),and those who did not experience liver injury were enrolled in the control group( 91 patients). The risk factors for liver injury induced by NVP hypersensitivity were analyzed. 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. The univariate logistic regression method was used to analyze the risk factors for liver injury associated with NVP hypersensitivity,and the variables with P < 0. 10 were included in the multivariate logistic regression model to perform stepwise regression analysis. The Spearman correlation coefficient was used to analyze the correlation between the number of CD4 cells and alanine aminotransferase( ALT) level in patients experiencing hypersensitivity- associated liver injury. Results The results of the multivariate logistic regression analysis showed that male sex( OR = 12. 297,95% CI: 2. 467- 61. 300,P = 0. 002),a high CD4 cell count at baseline( OR = 1. 010,95% CI: 1. 001- 1. 018,P = 0. 022),HCV co- infection( OR = 10. 598,95%CI: 1. 411- 79. 613,P = 0. 022),and a HLA- Cw*03 carrier( OR = 34. 119,95% CI: 5. 543- 210. 023,P < 0. 001) were risk factors for liver injury associated with NVP hypersensitivity. In the patients with HCV co- infection or a high CD4 cell count( ≥200 / μl) or carrying HLA- Cw*03 allele,male patients had a significantly higher incidence rate of liver injury than female patients( 63. 9% vs 11. 6%,χ2= 23. 390,P < 0. 001). Baseline CD4 cell count was positively correlated with ALT level( r = 0. 583,P < 0. 001). Conclusion Male patients infected with human immunodeficiency virus who are co- infected with HCV and have a high CD4 cell count at baseline should avoid using NVP.The value of HLA- Cw*03 gene screening in predicting hepatotoxicity associated with NVP hypersensitivity awaits further investigation.

Clinical features and risk factors for patients with liver failure complicated by invasive pulmonary aspergillosis

Xiao ErHui, Ning HuiBin, Kang Yi, Cao YongGe, Wei JunFeng, Shang Jia

2016, 32(7): 1378-1381. DOI: 10.3969/j.issn.1001-5256.2016.07.036

Abstract(2493)

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Objective To investigate the clinical features and risk factors for patients with liver failure complicated by invasive pulmonary aspergillosis( IPA),and to provide a reference for clinical diagnosis and treatment. Methods The clinical data of 477 patients with liver failure who were diagnosed and treated in Henan Provincial People's Hospital from January 2010 to December 2014 were collected,and the clinical features,laboratory markers,and results of imaging examinations of patients with IPA were retrospectively analyzed. Another 49 patients with liver failure who were hospitalized within the same period,had similar ages,and were not complicated by pulmonary infection were randomly selected as controls. The independent samples t- test was used for comparison of continuous data between groups,the chi-square test or Fisher's exact test were used for comparison of categorical data between groups,and multivariate logistic regression analysis was performed to analyze the risk factors for liver failure complicated by IPA. Results Among the 447 patients with liver failure,43( 9. 6%) were complicated by IPA. Age( P = 0. 023),hepatic encephalopathy( P = 0. 021),long- term use of broad- spectrum antibiotics( P = 0.007),use of hormone( P = 0. 016),and deep venous catheterization( P < 0. 001) were independent risk factors for the development of IPA. Clinical manifestations of liver failure patients with IPA lacked specificity. Lung CT scan showed multiple nodules,masses,and wedge- shaped consolidation near the pleura in both lungs,but typical halo sign and air crescent sign were rarely seen. Among the 35 patients who received antifungal therapy,30 were improved or cured,3 died of digestive tract bleeding,2 clied of plumonary infection,and all the other patients who did not receive therapy also died. Conclusion Patients with liver failure have various risk factors for the development of IPA,and the clinical manifestations are not typical,with high incidence and fatality rates. Early detection and treatment is the key to improving survival rates.

Clinical features of HIV/AIDS patients with digestive diseases

Yin Fei, Zhou WeiHong

2016, 32(7): 1382-1387. DOI: 10.3969/j.issn.1001-5256.2016.07.037

Abstract(1894)

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Objective To analyze the clinical data of patients admitted with an initial diagnosis of digestive diseases who have human immunodeficiency virus( HIV) / acquired immune deficiency syndrome( AIDS),and to guide clinical diagnosis. Methods The clinical data of HIV / AIDS patients who were hospitalized due to digestive system symptoms from January 1,2013 to December 31,2014 were collected,including epidemiological data,clinical symptoms and signs,auxiliary examinations,and complications. The features of each parameter were observed. 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 A total of 95 HIV / AIDS patients with digestive diseases were enrolled,and the male / female ratio was1. 4∶ 1. Among these patients,57( 60%) were aged 30- 50 years,85( 89. 47%) were Yi people,and 86( 90. 53%) were farmers. Of all patients,46( 48. 42%) were infected via sexual transmission and 44( 46. 32%) were infected via intravenous drug use. In these patients,common clinical symptoms included abdominal pain( 71. 58%),pyrexia( 43. 16%),and diarrhea( 17. 89%),and common signs included ascites( 28. 42%),superficial lymphadenectasis( 21. 05%),and hepatosplenomegaly( 16. 84%). The auxiliary examination showed a significant increase in globulin. The proportion of patients with opportunistic infection reached 83. 16%,mainly lung and digestive tract infections. Among the patients who underwent gastroscopy,31. 58% had mycotic esophagitis. Chronic non- atrophic gastritis,electrolyte disturbance,and intestinal obstruction were commonly seen in patients with noninfectious complications. Of all HIV / AIDS patients,54. 74%( 52 /95) were complicated by HBV and / or HCV infection,and the liver function parameters globulin,total bilirubin,aspartate aminotransferase,alanine aminotransferase,and A / G showed significant differences between these patients and the patients with HIV infection alone( all P < 0. 01). Conclusion HIV infection should be highly suspected in patients who visit the department of gastroenterology due to abdominal pain and diarrhea,have clinical manifestations of ascites,superficial lymphadenectasis,and hepatosplenomegaly,and are complicated by opportunistic infection in the lungs and digestive tract,especially those with histories of drug use and unprotected sex. Meanwhile,HBV and / or HCV infection may aggravate patients' condition and should be taken seriously.

Influence of extracellular signal-regulated kinase 1/2 pathway inhibitor PD98059 on proliferation and killing function of γδT cells cultured in vitro

Sun LeiQing, Xu Jing, Chen YongQiang, Zheng Lu, Lu: XiaoTing, Liu JunQuan, Chen FuXing, Zhou ZhongHai

2016, 32(7): 1388-1391. DOI: 10.3969/j.issn.1001-5256.2016.07.038

Abstract(2059)

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Objective To investigate the effect of extracellular signal- regulated kinase 1/2( ERK1/2) pathway inhibitor PD98059 on the proliferation and killing function of γδT cells cultured in vitro. Methods Mononuclear cells were separated from peripheral blood in healthy subjects and placed in RPMI 1640 complete medium containing zoledronic acid and interleukin- 2 to obtain γδT cells through induction and culture. The ERK1/2 specific inhibitor PD98059 was used to block the ERK1/2 signaling pathway in γδT cells,and the proliferation of γδT cells was measured by cell counting,and the killing function of γδT cells was measured by CCK- 8 method. Flow cytometry was used to measure the expression of granzyme B and perforin in γδT cells. The t- test was used for comparison of continuous data between groups. Results After 10 days of culture,the purity of γδT cells reached 87. 94% ± 2. 36%. The number of γδT cells treated with PD98059 was significantly lower than that of control cells [( 6. 74 ± 0. 36) × 105/ ml vs( 9. 42 ± 0. 31) × 105/ ml,t =- 12. 708,P < 0. 001]. Compared with the control cells,those treated with PD98059 had significantly higher positive expression rates of granzyme B and perforin( granzyme B:48. 89% ± 1. 31% vs 41. 58% ± 1. 58%,t = 7. 582,P < 0. 001; perforin: 65. 92% ± 3. 29% vs 33. 49% ± 2. 83%,t = 15. 478,P < 0. 001) and a significantly higher killing rate of Hep G2 cells( 69. 28% ± 4. 96% vs 48. 34% ± 3. 01%,t = 11. 201,P < 0. 001). Conclusion The ERK1/2specific inhibitor PD98059 can inhibit the proliferation of γδT cells,but it can enhance the in vitro killing function of γδT cells.

HBV/HCV co-infection complicated by HBV-associated glomerulonephritis: a report of one case

Xue Liang

2016, 32(7): 1392-1393. DOI: 10.3969/j.issn.1001-5256.2016.07.039

Abstract(1940)

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One rare case of chronic active Epstein-Barr virus infection in adults

Jia ShengNan, Yang LanLan, Shao Xue, Liu SiQi, Jin ZhenJing

2016, 32(7): 1394-1395. DOI: 10.3969/j.issn.1001-5256.2016.07.040

Abstract(2357)

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Abstract:

Epithelioid hemangioendothelioma of the liver: a case report

Li Xu, Guo XiaoLin, Ji HuiFan, Li Xin, Gao PuJun

2016, 32(7): 1396-1397. DOI: 10.3969/j.issn.1001-5256.2016.07.041

Abstract(2246)

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Abstract:

New immunotherapeutic strategies for chronic hepatitis B

Liu Shi, Tang ShanHong, Zhong XiaoZhu

2016, 32(7): 1398-1402. DOI: 10.3969/j.issn.1001-5256.2016.07.042

Abstract(2376)

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Abstract:
Chronic hepatitis B( CHB) is one of the most important infectious diseases around the world. Currently,interferon and nucleos( t) ide analogues are the main drugs for CHB and have good therapeutic efficacy,but the ultimate goal of eliminating hepatitis B virus( HBV) in human body has not been achieved. Therefore,it is of vital importance to explore new therapeutic strategies and develop new drugs for CHB. Persistent HBV infection is closely associated with human body's immune status,and studies have shown that immunotherapy may help to cure CHB. With reference to CHB patients' immune status,this article reviews the research advances in new immunotherapeutic strategies including Toll- like receptor agonists,cell therapy,and therapeutic vaccines.

Research advances in determination of hepatitis B core antibody level

Wang Wei, Zhao ZhaoXia, Li YuXiao, Rong Jun, Gao PengBin, Zheng HuanWei, Zhao CaiYan

2016, 32(7): 1403-1405. DOI: 10.3969/j.issn.1001-5256.2016.07.043

Abstract(1870)

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Abstract:
With the development and application of the double antigen sandwich method for quantification of hepatitis B core antibody( HBcAb) in recent years,there is increasing knowledge of the ability of HBcAb to reflect the body's anti- viral capability. This article introduces the commonly used measurement methods for HBcAb and the new trends in HBcAb measurement and summarizes the association of serum HBcAb level with viral antigen and the body's immune response,as well as research advances in effective prediction of antiviral effect with baseline HBcAb measurement before antiviral therapy. It is also pointed out that the clinical application of HBcAb needs further investigation.

Association between hepatitis B virus pre-S/S gene variants and HBV-related liver diseases

Yao MingQi, Chen Jie, Zhang Jing

2016, 32(7): 1406-1408. DOI: 10.3969/j.issn.1001-5256.2016.07.044

Abstract(305)

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Abstract:
The pre- S/S gene variants of hepatitis B virus( HBV) cause various pathological and clinical outcomes. Occult hepatitis B,fulminant hepatitis or liver failure,HBs Ag- and HBs Ab- positive HBV infection,and primary liver cancer are all associated with HBV pre- S/S gene variants,which are involved in the development and progression of these HBV- related diseases. This article introduces the association between HBV pre- S/S gene variants and the development and progression of HBV- related liver diseases,reviews the results of related clinical and basic research,and emphasizes the controversial issues in current research,in order to provide clues for further studies.

Research advances in liver cirrhosis complicated by portal vein thrombosis

Wang WanQin, Wen MaoYao, Fan XiaoLi, Shen Yi, Yang XiaoXue, Yang Li

2016, 32(7): 1409-1412. DOI: 10.3969/j.issn.1001-5256.2016.07.045

Abstract(1496)

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Abstract:
Portal vein thrombosis( PVT) is a common complication of liver cirrhosis. This article reviews the research advances in liver cirrhosis complicated by PVT in recent years and points out that PVT is induced by the combined effect of various factors. Hemodynamic disorder is an important basis for the development of PVT. PVT can be classified into different types according to the degree of thromboembolism and the portal vein branches involved. At present,anticoagulant therapy and interventional therapy are commonly used in the treatment of PVT. The development of PVT may not promote the progression of liver cirrhosis,but it may affect the prognosis of patients with liver cirrhosis who receive liver transplantation.

Research advances in prevention and treatment of primary liver cancer with metabolic agents

Liu Yan, Ye Nan, Gong JianPing

2016, 32(7): 1413-1417. DOI: 10.3969/j.issn.1001-5256.2016.07.046

Abstract(2468)

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Abstract:
Recently,more and more studies have shown that the development and progression of primary liver cancer( hereinafter referred to as liver cancer) is closely associated with the metabolism in human body,and metabolic disturbance in human body increases the incidence and mortality of liver cancer. The prevention and treatment of liver cancer with drugs improving metabolism is a hot research topic nowadays.This article introduces three metabolic agents,S- Adenosylmethionine,metformin,and statins,which can be used for the prevention and treatment of liver cancer,as well as their association with the pathogenesis of liver cancer and possible mechanisms of action. The article points out that further studies are needed to investigate the association between metabolism and the pathogenesis of liver cancer,in order to find more metabolic agents for the prevention and treatment of liver cancer in future.

Application of tumor-associated antigens and their autoantibodies in early diagnosis of hepatocellular carcinoma

Wang Ting, Liu Mei, Dong Lei, Duan ZhongPing

2016, 32(7): 1418-1421. DOI: 10.3969/j.issn.1001-5256.2016.07.047

Abstract(2103)

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Abstract:
Early identification and diagnosis of hepatocellular carcinoma( HCC) is necessary for improving survival rates of HCC patients.Studies have shown that the abnormal proteins released by tumor cells,i. e.,the autoantibodies stimulated by tumor- associated antigens( TAAs),can be detected before a clinical diagnosis of HCC is made,and therefore,such proteins may become the new markers for the early diagnosis of HCC. This article reviews the application of several new autoantibodies to tumor- associated antigens in the diagnosis of HCC and points out that these autoantibodies have promising prospects and clinical significance in the early diagnosis of HCC.

Role of tumor-associated macrophages in development and progression of primary liver cancer

Chen Wei, Zhou Yun, Gong JianPing

2016, 32(7): 1422-1424. DOI: 10.3969/j.issn.1001-5256.2016.07.048

Abstract(2222)

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Abstract:
The relationship between inflammatory response and tumor has gained great attention in recent years. Tumor- associated macrophages( TAMs) play an important role in tumor growth,proliferation,metabolism,and metastasis. Many studies have confirmed that most TAMs have an M2 phenotype and can promote tumor growth,metabolism,metastasis,and angiogenesis in primary liver cancer. The transformation of M2 macrophages into M1 macrophages changes the biological manifestations of hepatoma cells,which may become a new therapeutic strategy for liver cancer. This article reviews the research advances in the association between TAMs and the progression of primary liver cancer,as well as possible therapeutic regimens.

Research advances in zebrafish as a model of liver cancer

Wang XinJuan

2016, 32(7): 1425-1428. DOI: 10.3969/j.issn.1001-5256.2016.07.049

Abstract(2645)

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Abstract:
The incidence rate of liver cancer tends to increase in recent years,and the molecular and pathogenic mechanisms of liver cancer should be further investigated to guarantee health. As an important model organism,zebrafish have highly conserved genes and grow fast.The early embryo of zebrafish is transparent,which helps with the real- time observation of the development process. Zebrafish are similar to humans in the composition,function,and signaling pathways of hepatocytes,as well as response to injury. In modern biological studies,zebrafish have been wildly used as the model of liver diseases. This article summarizes the research advances in the application of zebrafish as the model of liver cancer,and points out that the techniques for establishing the zebrafish model of liver cancer have become mature. With the constant development of experimental techniques,great achievements will be achieved in the field of liver cancer.

Research advances in sinusoidal obstruction syndrome

Li HaiNi, Zhang Min

2016, 32(7): 1429-1432. DOI: 10.3969/j.issn.1001-5256.2016.07.050

Abstract(2602)

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Abstract:
Sinusoidal obstruction syndrome( SOS) is a sinusoidal or small venous fibrous occlusive disease. This article reviews the research advances in the etiology,pathogenesis,clinical manifestations,auxiliary examinations,and treatment of SOS,and points out that the pathogenesis of SOS remains unknown and there are no specific therapeutic methods. How to identify SOS and provide intervention and treatment as early as possible becomes the hot research topic.

Research advances in differential diagnosis of benign and malignant ascites

Sun Juan, Niu ChunYan

2016, 32(7): 1433-1438. DOI: 10.3969/j.issn.1001-5256.2016.07.051

Abstract(3144)

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Abstract:
Differential diagnosis of benign and malignant ascites is of a great value in determining etiology,evaluating prognosis,and determining therapy regimens. There are many diagnostic methods for ascites,but up to now,no method can achieve high sensitivity and specificity and meet the requirements of clinical economics and feasibility at the same time. Therefore,searching for an ideal method for differential diagnosis of ascites has become an important topic of current research. This article describes the clinical value of diagnostic methods,such as molecular biological detection,cytological examination,combined determination of tumor markers,and routine tests,in the differential diagnosis of benign and malignant ascites,analyzes the diagnostic efficiency of related biomarkers,and points out that combined determination of various parameters has an increased value in the differential diagnosis of benign and malignant ascites.

2016 No. 7

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International Database

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2016 No. 7

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International Database

New media cluster

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Open access

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