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

2017 No. 7

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Editorial
Challenges in precise treatment for primary liver cancer based on gene mutation
Zhou HuaBang, Hu HePing
2017, 33(7): 1209-1210. DOI: 10.3969/j.issn.1001-5256.2017.07.001
Abstract:
Gene mutation is the molecular basis of the pathogenesis of primary liver cancer, and precise treatment based on gene mutation is an important direction for the treatment of liver cancer in future.This article introduces the current status, complexity, and prospects and future directions of precise treatment for liver cancer from the aspects of complex gene mutations in liver cancer, level of mutation detection, and limitations of clinical trials.It is pointed out that there are many challenges in precise treatment for liver cancer, but precise treatment still has a promising future.
Value of contrast-enhanced ultrasound in early diagnosis of liver cancer and radiofrequency ablation treatment
Chen MinHua, Wu Wei
2017, 33(7): 1211-1213. DOI: 10.3969/j.issn.1001-5256.2017.07.002
Abstract:
Early identification and effective treatment of hepatocellular carcinoma plays an important role in improving survival rate.The establishment of simple and effective procedures for early diagnosis, census methods, and effective minimally invasive treatment is an important project in China to improve the diagnosis and treatment level of liver cancer.Contrast-enhanced ultrasound plays an important role in the early diagnosis of liver cancer and radiofrequency ablation treatment.This article describes how contrast-enhanced ultrasound helps with the identification of small hepatocellular carcinoma and degree of tumor differentiation in patients with liver cirrhosis, as well as the differential diagnosis of hyperplasia/canceration and precancerous lesion.It also introduces the important role of contrast-enhanced ultrasound in standard radiofrequency ablation and development of therapeutic regimens and strategies and clarifies that it can be used before, during, and after radiofrequency ablation treatment.
Therapeutic guidelines
Management algorithm for interrupting mother-to-child transmission of hepatitis B
Chinese Foundation for Hepatitis Prevention and Control; Chinese Society of Infectious Diseases, Chinese Medical Association; Chinese Society of Hepatology, Chinese Medical Association
2017, 33(7): 1214-1217. DOI: 10.3969/j.issn.1001-5256.2017.07.003
Abstract(4349) PDF (1941KB)(1136)
Abstract:
Expert consensus on transjugular intrahepatic portosystemic shunt
Interventional Group, Chinese Society of Radiology, Chinese Medical Association
2017, 33(7): 1218-1228. DOI: 10.3969/j.issn.1001-5256.2017.07.004
Abstract:
Expert consensus on the classification of subtype in Budd-Chiari syndrome
Expert committee on Vane Cava Obstruction, Specialized Committee of Endovascology, Chinese Medical Doctor Association
2017, 33(7): 1229-1235. DOI: 10.3969/j.issn.1001-5256.2017.07.005
Abstract:

From 2012 to 2015 the Department of Interventional Radiology of the Affiliated Hospital of Xuzhou Medical University undertook the clinical special research subject” Study on the standardization of interventional diagnosis and treatment of Budd-Chiari syndrome” (No.BL2012021) , a program supported by the Department of Science and Technology of Jiangsu Province.Based on the clinical results of three years research and the scientific summary of the experience from more than 2150 cases accumulated in more than 20 years, the Department of Interventional Radiology of the Affiliated Hospital of Xuzhou Medical University presided over a demonstration meeting about “the standardization of interventional diagnosis and treatment of Budd-Chiari syndrome” on January 14, 2016 in Xuzhou City of Jiangsu Province, China.The scholars from the Expert Committee on Vena Cava Obstruction of Specialized Committee of Endovascology, Chinese Medical Doctor Association, as well as the experts from the related medical fields, including interventional radiology, vascular surgery, pathology and diagnostic imaging, who have been engaged in the study of Budd-Chiari syndrome, attended the meeting, and in the meeting the participants made a full and thorough discussion on the classification and subtypes of Budd-Chiari syndrome.The scholars and experts have unanimously reached a consensus on the subtype definition of Budd-Chiari syndrome:the Budd Chiari syndrome is suggested to be classified into the hepatic vein occlusion subtype, the inferior vena cava occlusion subtype and mixed occlusion subtype, including 10 subtype entities in total.The hepatic vein occlusion subtype includes membranous occlusion of hepatic vein/accessory hepatic vein, segmental occlusion of hepatic vein, extensive occlusion of hepatic vein, and hepatic vein occlusion associated with thrombus formation.The inferior vena cava occlusion subtype includes inferior vena cava membranous occlusion with hole in membrane, inferior vena cava membranous occlusion, segmental occlusion of inferior vena cava, and inferior vena cava occlusion with thrombus formation.The mixed occlusion subtype includes occlusion of hepatic vein and inferior vane cava, and occlusion of hepatic vein and inferior vane cava associated with thrombus formation.

Consensus on the clinical nutritional intervention for patients with chronic liver diseases
Beijing Medical Association, Committee of Parenteral and Enteral Nutrition;Expert Panel on Consensus on the parenteral and Enteral Nutritional and the Dietary Intervention for Patients with Chronic Liver Diseases
2017, 33(7): 1236-1245. DOI: 10.3969/j.issn.1001-5256.2017.07.006
Abstract(4318) PDF (1566KB)(1143)
Abstract:

Liver is the most important metabolic organ in the human body.The varying nutrient metabolism and malnutrition (undernutrition) occur in people with chronic liver diseases.Malnutrition and chronic liver damage are reciprocal causation, leading to form a vicious spiral.Whether nutritional support for patients with chronic liver disease (compensated or decompensated cirrhosis, acute on chronic liver failure and chronic liver failure) can play a role in improving the outcome is the focus of our attention.In recent years, there is still lack of large sample, high quality clinical reports in this field.Based on systematic review of major literatures and clinical practice of chronic liver disease in our country, this consensus would provide references for physicians, nurses, dietitians and pharmacists in clinical work related to chronic liver disease.

An excerpt of medical management of severe alcoholic hepatitis: expert review from the clinical practice updates committee of the AGA institute (2017)
Zhu Ping, Han Tao
2017, 33(7): 1246-1248. DOI: 10.3969/j.issn.1001-5256.2017.07.007
Abstract:
ACR appropriateness criteria resectable pancreatic cancer
Qi Bing, Shang Dong
2017, 33(7): 1249-1254. DOI: 10.3969/j.issn.1001-5256.2017.07.008
Abstract:
An excerpt of 2016 consensus recommendations of the Korean Society of Abdominal Radiology about diagnosis of hepatocellular carcinoma with Gadoxetic Acid-enhanced MRI
Han Bing, Zhou Wei, Han Lei, Liu ZhangChun, Qi XingShun
2017, 33(7): 1255-1256. DOI: 10.3969/j.issn.1001-5256.2017.07.009
Abstract:
Discussions by experts
Advances in early screening and diagnosis of hepatocellular carcinoma
Lu LunGen
2017, 33(7): 1257-1261. DOI: 10.3969/j.issn.1001-5256.2017.07.010
Abstract:
Hepatocellular carcinoma (HCC) is a malignant tumor with the second highest mortality rate in China, and annual deaths account for 51% of all deaths in the world.HCC brings heavy burdens to the society and medical care in China.Early diagnosis is one of the most important methods for preventing HCC and improving survival rate of HCC patients, and the development of simple, convenient, and quick diagnostic methods is a direction for current research.Methods for the early diagnosis of HCC mainly include imaging diagnosis and measurements of protein markers and molecular markers.Alpha-fetoprotein (AFP) has an important value in the early diagnosis of HCC.One Step AFP test helps the patients to measure AFP at home by themselves and realize the regular monitoring of AFP level, which supports the early diagnosis of HCC and creates a new approach for early screening and diagnosis of HCC.
Serological diagnosis of hepatocellular carcinoma:challenges and opportunities
Lu FengMin
2017, 33(7): 1262-1265. DOI: 10.3969/j.issn.1001-5256.2017.07.011
Abstract:
Serological markers have the features of noninvasiveness and simple operation and thus have become a research hotspot in the diagnosis of hepatocellular carcinoma.This article briefly introduces the role of the conventional serological marker alpha-fetoprotein (AFP) in assisting the diagnosis and predicting the prognosis of HBV-related liver cancer, as well as the clinical value of new markers such as alpha-fetoprotein-L3 and abnormal prothrombin/des-γ-carboxy prothrombin.Based on literature review, the possibility of serum Golgi protein 73 used for laboratory auxiliary diagnosis of hepatocellular carcinoma has been denied.The results of the author's experiment suggest that serum GP73 measurement can be used as a laboratory diagnostic index for progressive liver fibrosis and liver cirrhosis.
Advances in imaging diagnosis of liver cancer
Zhang ChunYu, Fu Yu, Li XiaoDong, Li YongRui, Zhang HuiMao
2017, 33(7): 1266-1269. DOI: 10.3969/j.issn.1001-5256.2017.07.012
Abstract:
Liver biopsy is the gold standard for the diagnosis of primary liver cancer, but it is an invasive examination.At present, imaging has become the preferred method for the diagnosis of liver cancer.This article summarizes new imaging methods and techniques for the diagnosis and evaluation of primary liver cancer, including contrast-enhanced ultrasound, CT perfusion imaging, diffusion-weighted imaging-intravoxel incoherent motion, IDEAL IQ sequence, dynamic contrast-enhanced MRI, and hepatocyte-specific contrast-enhanced imaging, and points out that diagnostic imaging can not only evaluate the degree of tumor differentiation, blood supply and perfusion, and invasiveness of lesions, but also predict the prognosis and evaluate liver function.Therefore, it can provide a reference for clinical diagnosis and treatment.
Antiviral therapy for hepatitis virus-related hepatocellular carcinoma:current status and challenges
Dong Jing, Jiang JiaJi
2017, 33(7): 1270-1273. DOI: 10.3969/j.issn.1001-5256.2017.07.013
Abstract:
The incidence rate of hepatocellular carcinoma (HCC) is increasing around the world and tends to decrease in East Asia and several regions in China;however, China still has higher incidence rate and mortality rate of HCC than most countries.Studies have shown that long-term antiviral therapy can inhibit HBV replication to a very low level or help patients with HCV infection achieve sustained virologic response, which can further reduce the incidence rate of virus-related HCC.New evidence suggests that compared with nucleos (t) ide analogues, PEG-IFNα has a better effect of secondary prevention.Studies also indicate that interferons play an important role in tertiary prevention of virus-related HCC.This article reviews the epidemiological studies on virus-related HCC in recent years and the role of antiviral therapy in second and tertiary prevention and points out that adequate and effective antiviral therapy is the basis for preventing the development and recurrence of HCC.
Original articles_Viral hepatitis
Clinical value of hemoglobin and its association with hepatocyte steatosis in chronic hepatitis B patients
Wang Peng, Zhang ZhiQiao, Lu: GuoTao, Wang GongSui, Chen XiaoQiao, Ming Lang, Zheng Chong, Chen LeWu, Xie QiuLi, He JieXiong, Huang Yong
2017, 33(7): 1274-1279. DOI: 10.3969/j.issn.1001-5256.2017.07.014
Abstract:
Objective To investigate the clinical value of hemoglobin and its association with hepatocyte steatosis in chronic hepatitis B (CHB) patients.Methods A retrospective analysis was performed for the clinical and pathological data of 1580 CHB patients who were hospitalized in The First People's Hospital of Shunde from January 2006 to December 2014 and underwent liver biopsy, among whom 216 (13.67%) had hepatocyte steatosis (hepatocyte steatosis group) and 1364 had no hepatocyte steatosis (non-hepatocyte steatosis group) .The patients were divided into groups 1, 2, and 3 according to hemoglobin level, and the clinical and pathological features were analyzed and compared between the three groups.The t-test was used for comparison of continuous data between group;a one-way analysis of variance was used for comparision between multiple groups.The Mann-Whitney U test was used for ranked data between groups.The Kruskal-wallis H test was used for ranked data between multiple groups;the chi-square test was used for comparison of categorical data between groups.Spearman correlation analysis was also performed to determine the correlation between two variables.Univariate logistic regression analysis and multivariate stepwise regression analysis were used to identify the influencing factors for hepatocyte steatosis.Results Body mass index (BMI) , systolic pressure, diastolic pressure, uric acid, total cholesterol, low-density lipoprotein, and HBV DNA load increased with the increase in hemoglobin level (F=12.718, 3.024, 4.026, 4.624, 38.276, 28.108, 7.358, all P<0.05) .The incidence rates of hepatocyte steatosis in groups 1, 2, and 3 were 7.59%, 11.76%, and 21.67%, respectively (χ2=44.23, P<0.05) .Hemoglobin was positively correlated with hepatic steatosis (rs=0.211, P<0.001) .The multivariate logistic regression analysis showed that hemoglobin (odds ratio [OR]=1.066, P<0.05) , BMI (OR=1.576, P<0.05) , age (OR=1.041, P<0.05) , sex (OR=0.261, P<0.05) , aspartate aminotransferase (OR=0.987, P<0.05) , triglyceride (OR=1.690, P<0.05) , and uric acid (OR=1.006, P<0.05) were independent influencing factors for hepatocyte steatosis in CHB patients.The area under the receiver operating characteristic curve was 0.852 (95% confidence interval [CI]:0.811-0.893, P<0.01) for BMI, 0.701 (95% CI:0.662-0.740, P<0.01) for low-density lipoprotein, 0.694 (95% CI:0.653-0.734, P<0.01) for triglyceride, 0.689 (95% CI:0.650-0.728, P<0.01) for total cholesterol, 0.675 (95% CI:0.637-0.714, P<0.01) for hemoglobin, 0.654 (95% CI:0.617-0.691, P<0.01) for age, 0.619 (95%CI:0.575-0.662, P<0.01) for uric acid, and 0.612 (95% CI:0.569-0.655, P<0.01) for blood glucose.Conclusion CHB patients with a high hemoglobin level tend to develop hepatocyte steatosis, and hemoglobin may be an independent influencing factor for hepatocyte steatosis in CHB patients.A high hemoglobin level has a certain value in predicting hepatocyte steatosis and awaits further research.
Establishment and functional evaluation of DC-CIK co-culture system with combined loading of HBsAg and HBcAg
Wang ShaoYang, Lin TaoFa, Zhu LingLing, Xie LiPing
2017, 33(7): 1280-1283. DOI: 10.3969/j.issn.1001-5256.2017.07.015
Abstract:
Objective To investigate the function of cytokine-induced killer cell (CIK) after co-culture of dendritic cells (DC) and CIK loaded with different HBV antigens.Methods A total of 13 patients with chronic hepatitis B (CHB) who visited Fuzhou General Hospital of Nanjing Military Area Command from January 2015 to June 2016 were enrolled.Peripheral blood mononuclear cells (PBMCs) were isolated from 13 CHB patients, and DC and CIK were cultured and divided into CIK culture group, DC+CIK co-culture group, DC+CIK +HBsAg co-culture group, DC+CIK+HBcAg co-culture group, and DC+CIK+HBsAg+HBcAg co-culture group.Then ELISPOT assay was performed to measure the ability of CIK to produce pegylated interferonγ (IFNγ) , and HepG2.2.15 cells were used as target cells to measure the killing function of CIK.A one-way analysis of variance was used for comparison of continuous date between groups, and the least significant difference t-test was used for further comparison between any two groups.Results There was a significant difference in IFNγ level between different CIK test groups (F=29.84, P<0.001) , and the DC+CIK+HBsAg+HBcAg group had the highest IFNγlevel.There was a significant difference in CIK killing rate between groups (F=14.77, P<0.001) , and the DC+CIK+HBsAg+HBcAg group had the highest CIK killing rate.Conclusion DC-CIK co-culture with combined loading of HBsAg and HBcAg may be an effective cell system for the treatment of CHB.
Original articles_Liver fibrosis and liver cirrhosis
Comparison of the abilities of five scoring systems to predict short-term and medium-term death risks in patients with decompensated cirrhosis
Fan XiaoLi, Wen MaoYao, Shen Yi, Yang Li
2017, 33(7): 1284-1290. DOI: 10.3969/j.issn.1001-5256.2017.07.016
Abstract:
Objective To compare the abilities of Child-Turcotte-Pugh (CTP) score, Model for End-Stage Liver Disease (MELD) , MELD combined with serum sodium concentration (MELD-Na) , integrated MELD (iMELD) , and MELD to SNa ratio (MESO) to predict short-term and medium-term death risks in patients with decompensated cirrhosis at months 3 and 12.Methods The records of 269 patients with decompensated cirrhosis in Department of Gastroenterology, West China Hospital, Sichuan University from January 1 to December31, 2014 were retrospectively analyzed.The CTP, MELD, MELD-Na, iMELD, and MESO scores were evaluated for these patients within48 hours after admission and these patients were followed up for at least 12 months.The predictive abilities of these five scoring systems were evaluated by the area under the receiver operating characteristic curve (AUC) at months 3 and 12.Comparison of continuous data was conducted using t test (for data with normal distribution and homogeneity of variance) or Mann-Whitney U test (for data with non-normal distribution) , while comparison of categorical data was conducted using χ2 test.Meanwhile, logistic regression analysis, Hosmer-Lemeshow goodness-of-fit test, and Kaplan-Meier survival analysis were performed.Results Twenty-five (9.29%) and thirty-eight (14.13%) of all patients died within 3 months and 12 months, respectively.There were significant differences between the patients who died and survived within 12 months in total bilirubin, creatinine, urea, albumin, white blood cell count, prothrombin time, international normalized ratio, serum sodium, the presence or absence of hepatic encephalopathy on admission, degree of ascites, the CTP, MELD, MELD-Na, iMELD, and MESO scores on admission, history of hepatic encephalopathy, and treatments for these factors after discharge (all P<0.05) .The multivariate logistic regression analysis revealed that all five scores were independent prognostic factors for the patients (odds ratios:CTP=2.020, MELD=1.252, MELD-Na=1.088, iMELD=1.114, MESO=1.368;all P<0.01) .At month 3, CTP score had the highest AUC (0.823) , followed by MESO (0.796) , MELD (0.789) , MELD-Na (0.775) , and iMELD (0.770) scores.At month 12, the AUC values for CTP, MELD, MELD-Na, iMELD, and MESO were 0.834, 0.798, 0777, 0.801, and 0.804, respectively.Therefore, CTP score was best in predicting the death risks within 3 and 12 months.The Kaplan-Meier curves showed that these five scoring methods clearly distinguished 12-month cumulative survival rates for these patients (all P<0.05) .Conclusion CTP score, MELD score, and three MELD-related scores can reliably predict both short-term and medium-term death risks in patients with decompensated cirrhosis.Moreover, CTP score may have a better ability to predict death risks in patients with decompensated cirrhosis in China.
Original articles_Liver neoplasms
Value of combined detection of AFP, CA19-9, and CEA in early diagnosis of primary liver cancer
Li JiaYan, Song JinYun, Wang JianFang, Wu XuPing
2017, 33(7): 1291-1295. DOI: 10.3969/j.issn.1001-5256.2017.07.017
Abstract:
Objective To investigate the value of combined measurement of alpha-fetoprotein (AFP) , carbohydrate antigen 19-9 (CA19-9) , and carcinoembryonic antigen (CEA) in the early diagnosis of primary liver cancer.Methods A total of 248 patients who visited the outpatient service or were hospitalized in The Second Hospital of Nanjing from October 2014 to December 2016 were enrolled and divided into primary liver cancer group with 88 patients and non-tumor liver disease group with 160 patients.A total of 130 healthy subjects who underwent physical examination were enrolled as normal control group.The Roche cobas e 411 analyzer was used to measure the serum levels of the tumor markers AFP, CA19-9, and CEA, and the sensitivities and specificities of these markers or a combination of them were analyzed.Beckman Coulter AU5800 was used to measure biochemical parameters for liver function, and Biotek ELX808 was used to measure hepatitis B virus markers and HCV antibody.The receiver operating characteristic (ROC) curve was used to analyze the results of measurements of serum AFP, CA19-9, and CEA alone or in combination in patients with primary liver cancer.A one-way analysis of variance was used for comparison of continuous data between multiple groups and the SNK-q test was used for further comparison between two groups;the t-test was used for comparison of continuous data between two groups.The chi-square test was used for comparison of categorical data between groups.The Spearman correlation analysis was also performed.Results In the primary liver cancer group and the non-tumor liver disease group, the patients with abnormal liver function had significantly higher levels of AFP and CA19-9 than those with normal liver function (primary liver cancer group:t=35.64 and 3.38, both P<0.05;non-tumor liver disease group:t=12.51 and 8.19, both P<0.05) .Among the patients with normal liver function, the primary liver cancer group had a significantly higher level of CEA than the non-tumor liver disease group and the normal control group (all P<0.05) .Among the patients with abnormal liver function, the primary liver cancer group had significantly higher levels of AFP, CA19-9, and CEA than the non-tumor liver disease group and the normal control group (all P<0.05) .The serum levels of AFP, CA19-9, and CEA increased with the increase in Child-Pugh class.Among the patients with abnormal liver function in the primary liver cancer group, Child-Pugh class B patients had significant increases in the levels of AFP, CA19-9, and CEA compared with Child-Pugh class A patients, and Child-Pugh class C patients had significant increases compared with Child-Pugh class B patients (all P<0.05) .Among the patients with abnormal liver function in the non-tumor liver disease group, Child-Pugh class B patients had significant increases in the levels of AFP and CA19-9 compared with Child-Pugh class A patients, and Child-Pugh class C patients had significant increases compared with Child-Pugh class B patients (all P<0.05) ;Child-Pugh class C patients had a significant increase in the level of CEA than Child-Pugh class A/B patients (P<0.05) .The primary liver cancer group had significantly higher positive rates of AFP, CA19-9, and CEA than the non-tumor liver disease group and the normal control group (all P<0.05) , and the positive rates of these tumor markers were significantly higher when measured in combination than when measured alone (all P<0.05) .In the primary liver cancer group, a combination of the three tumor markers had a sensitivity of 86.36% and a specificity of 92.35%, while AFP, CA19-9, and CEA measured alone had sensitivities of 71.59%, 52.27%, and 39.77%, respectively.In the patients with primary liver cancer, the areas under the ROC curve for serum AFP, CA19-9, CEA, and a combination of them were 0.776, 0.704, 0.681, and0.817, respectively.AFP was positively correlated with gamma-glutamyl transpeptidase in the primary liver cancer group (r=0.54, P=0.04) and was positively correlated with indirect bilirubin (IBil) in the normal control group (r=0.50, P=0.01) .In the primary liver cancer group, CA19-9 was positively correlated with alanine aminotransferase (ALT) , direct bilirubin (DBil) , IBil, total bilirubin (TBil) , and total bile acid (TBA) (r=0.58, 0.63, 0.61, 0.65, and 0.58, all P<0.05) , and in the non-tumor liver disease group, CA19-9 was positively correlated with ALT, alkaline phosphatase (ALP) , DBil, IBil, TBil, and TBA (r=0.51, 0.63, 0.66, 0.64, 0.70, and 0.59, all P<0.05) .Conclusion AFP can well reflect liver injury, but it may yield false-negative results in the diagnosis of primary liver cancer.A mild increase in CEA does not strongly indicate primary cancer.CA19-9 is easily influenced by the factors including ALP and bilirubin and has a high false-positive rate.Combined measurement of AFP, CA19-9, and CEA can improve the sensitivity of the diagnosis of primary liver cancer and is better than single measurement of AFP, CA19-9, or CEA.Therefore, it provides a strong basis for early diagnosis and treatment.
Short-and long-term efficacy of transarterial chemoembolization versus liver resection in treatment of patients with Barcelona stage B multiple hepatocellular carcinoma
Li Xin
2017, 33(7): 1296-1300. DOI: 10.3969/j.issn.1001-5256.2017.07.018
Abstract:
Objective To investigate the short-and long-term efficacy of transarterial chemoembolization (TACE) versus liver resection in the treatment of patients with Barcelona Clinic Liver Cancer (BCLC) stage B multiple hepatocellular carcinoma (HCC) .Methods A retrospective analysis was performed for the clinical data of 80 patients with BCLC stage B multiple HCC who were treated from June 2010 to June 2011, and among these patients, 49 underwent liver resection (LR group) and 31 underwent TACE (TACE group) .The postoperative complications, changes in liver function parameters, survival time, and 1-, 3-, and 5-year survival rates 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.The Kaplan-Meier curve was used for survival analysis, The log-rank test was used for conparison between two groups.Results At 1 week after surgery, the LR group and the TACE group had significant increases in total bilirubin, alanine aminotransferase (ALT) , and aspartate aminotransferase (AST) (LR group:t=3.181, 2.181, and 2.955, P=0.002, 0.032, and 0.004;TACE group:t=3.109, 3.965, and 4.519, P=0.003, P<0.001, and P<0.001) , and after surgery, the LR group had significantly lower levels of AST and ALT than the TACE group (t=2.094 and 2.111, P=0.040 and 0.038) .Compared with the TACE group, the LR group had significantly higher 1-, 3-, and 5-year survival rates (75.51%/51.02%/40.82% vs 61.29%/22.58%/9.68%, all P<0.05) and significantly longer median survival time (36.3 months vs 26.5 months, P<0.05) .The LR group had a significantly lower recurrence rate than the TACE group (30.61% vs 67.74%, χ2=10.576, P=0.001) .Conclusion Liver resection has a better effect in the treatment of patients with BCLC stage B multiple HCC than TACE and can improve overall survival and prolong survival time.
Shortening liver cancer screening interval may improve the prognosis of patients with hepatitis B cirrhosis-related hepatocellular carcinoma
Li Peng, Ding HuiGuo, Xu Hui, Zhang ShiBin, Zhang YueNing, Wang ZhenBiao, Wu YanJing, Yu HaiBin
2017, 33(7): 1301-1304. DOI: 10.3969/j.issn.1001-5256.2017.07.019
Abstract:
Objective To investigate the influence of shortening liver cancer screening interval on the detection of early-stage hepatocellular carcinoma (HCC) in patients with hepatitis B cirrhosis and their prognosis, as well as proper screening schemes for such patients at a high risk of HCC.Methods A total of 310 patients with hepatitis B cirrhosis who were diagnosed and treated in Department of Gastroenterology and Hepatology, Beijing You An Hospital, from January 2007 to January 2008 were enrolled, and according to the screening interval, they were divided into 3-month screening group (group A) with 78 patients and 6-month screening group (group B) with 232 patients.The screening items included serum alpha-fetoprotein and ultrasound and the patients were followed up for 5 years.The patients with HCC screened out were followed up to the endpoint (death or December 31, 2016) .The detection of HCC and prognosis were compared between the two groups.The t-test was used for comparison of continuous data between groups, the chi-square test or Fisher's exact test was used for comparison of categorical data between groups, and the Kaplan-Meier method was used for survival analysis.Results At the end of the5-year follow-up, 73 patients were diagnosed with HCC, with 21 in group A and 52 in group B.Group A had a significantly higher proportion of patients with early-stage HCC (Barcelona Clinic Liver Cancer stage A) than group B [66.7% (14/21) vs 15.4% (8/52) , χ2=18.685, P<0.001].Group A also had a significantly higher proportion of patients who underwent radical surgery than group B (76.2% vs 36.5%, χ2=9.424, P=0.002) .The patients with HCC were followed up to the endpoint, and compared with group B, group A had a significantly longer cumulative survival time (66.4 ± 8.0 months vs 38.1 ± 4.5 months, t=4.295, P=0.038) and a significantly higher cumulative survival rate [71.4% (15/21) vs 46.2% (24/52) , χ2=3.840, P=0.043].Conclusion For patients with hepatitis B cirrhosis, a 3-month screening interval can increase the early detection rate of HCC, bring the opportunity of radical treatment for these patients, and prolong their survival time.
Influence of neutrophil-lymphocyte ratio on prognosis of liver cancer:a meta-analysis
Liu Jian, Gao ChiDan, Zhang LiXin, Quan Gang, Zhang YuShun, Li JingDong
2017, 33(7): 1305-1309. DOI: 10.3969/j.issn.1001-5256.2017.07.020
Abstract:
Objective To investigate the association between neutrophil-lymphocyte ratio (NLR) and prognosis of liver cancer.Methods Pub Med, Embase and Cochrane Library, CBM, VIP, Wanfang Data were searched for Chinese and English articles on the association between NLR and prognosis of liver cancer published up to October 2016.Review Manager 5.3 was used for statistical analysis of data in these articles, and funnel plots were used to evaluate publication bias.Results A total of 12 studies which met the inclusion criteria were included, with 3325 liver cancer patients in total.The meta-analysis showed that liver cancer patients with an increased NLR had significant reductions in overall survival time (hazard ratio [HR]=1.56, 95% confidence interval [95% CI]:1.46-1.66, P<0.001) , disease-free survival (HR=1.57, 95% CI:1.23-2.00, P<0.001) , and recurrence-free survival (HR=1.54, 95% CI:1.36-1.74, P<0.001) .Conclusion Liver cancer patients with an increased NLR tend to have poor prognosis, and NLR should be taken seriously in clinical practice to provide timely prognostic evaluation and rational treatment for liver cancer patients.
Expression features and prognostic significance of Yes-associated protein in hepatocellular carcinoma and cholangiocellular carcinoma
Wang Chun, Wu Hao, Liu Yan, Ding Xiong, Li ZeMin
2017, 33(7): 1310-1315. DOI: 10.3969/j.issn.1001-5256.2017.07.021
Abstract:
Objective To investigate the expression of Yes-associated protein (YAP) in hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CC) and its association with clinical prognosis.Methods Samples were collected from 190 patients who were treated in The Second Hospital Affiliated to Chongqing Medical University from July 2004 to July 2009, among whom 110 had HCC and 80 had CC.The difference in YAP expression and its association were analyzed in both groups, and patients' prognosis was compared between the two groups.The chi-square test was used to investigate the association between YAP expression and clinicopathological features of HCC and CC, and the Kaplan-Meier method and the log-rank test were used to assess tumor-free survival rate and overall survival rate.A univariate Cox regression analysis was used to evaluate the influence of YAP expression on the prognosis of patients with HCC and CC.Results The CC group had higher expression of YAP than the HCC group (68.7% vs 56.3%, P=0.036) .High YAP expression in HCC and CC was significantly associated with tumor size (P<0.001 and P=0.024) , alpha fetoprotein (P=0.009 and 0.034) , liver cirrhosis (P=0.032 and 0.006) , vascular invasion (P=0.011 and 0.028) , and intrahepatic metastasis (P=0.049 and 0.030) .In both groups, the patients with high YAP expression had significantly lower tumor-free survival rate and overall survival rate than those with low YAP expression (all P<0.05) .Multivariate analysis showed that high YAP expression is an adverse prognostic factor for tumor-free survival and overall survival in both groups (all P<0.05) .Conclusion High YAP expression is frequently found in patients with HCC and CC, and high YAP expression is associated with low survival rate.
Original articles_Biliary diseases
High-risk factors for cholangitis after endoscopic sphincterotomy
Zhang Yu
2017, 33(7): 1316-1319. DOI: 10.3969/j.issn.1001-5256.2017.07.022
Abstract:
Objective To investigate the high-risk factors for cholangitis after endoscopic sphincterotomy (EST) , and to provide a reference for clinical prevention and treatment.Methods A total of 196 patients who underwent EST in our hospital from June 2013 to January2016 were enrolled, among whom 31 experienced cholangitis after EST (infection group) and 165 had no cholangitis (control group) .Related factors were analyzed for both groups.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 non-conditional logistic regression analysis was performed for variables with statistical significance.Results The univariate analysis showed that there were significant differences between the two groups in the past history of biliary tract surgery [8 (25.81%) vs 10 (6.06%) , χ2=12.200, P=0.000 5], number of common bile duct stones (2.8 ± 0.5 vs 2.2 ± 0.6, t=5.234, P=0.000 5) , gallstones complicated by cholecystitis [8 (25.81%) vs 13 (7.88%) , χ2=6.994, P=0.000 4], intrahepatic bile duct stones [6 (19.35%) vs 8 (4.85%) , χ2=8.280, P=0.004 0], time of operation (35.6 ± 5.8 min vs 27.1± 6.2 min, t=7.072, P=0.000 4) , presence or absence of lithotripsy [10 (32.26%) vs 15 (9.09%) , χ2=10.591, P=0.000 1], postoperative pneumobilia [12 (60.00%) vs 16 (21.82%) , χ2=17.940, P=0.000 2], and duration of the use of antibiotics (3.6 ± 0.7 d vs4.5 ± 0.8 d, t=5.854, P=0.000 6) .The multivariate non-conditional logistic regression analysis showed that past history of biliary tract surgery [OR (95% CI) =1.962 (1.156-3.658) , P=0.024], number of common bile duct stones [OR (95% CI) =2.632 (1.366-5.013) , P=0.021], intrahepatic bile duct stones [OR (95% CI) =2.976 (1.482-5.536) , P=0.024], time of operation [OR (95%CI) =4.859 (2.513-8.622) , P=0.006], postoperative pneumobilia [OR (95% CI) =5.326 (2.633-10.524) , P=0.005 ], and duration of the use of antibiotics [OR (95% CI) =0.565 (0.263-0.895) , P=0.009] were independent risk factors for cholangitis after EST.Conclusion Positive intervention of related risk factors for cholangitis after EST has important clinical significance in the prevention of cholangitis after EST.
Original articles_Others
Clinical features of acute-on-chronic liver failure induced by withdrawal of nucleos (t) ide analogues
Hu GaoFei, Li XiaoPeng, Wu ZhenPing, Mei Qing, Li Dan, Zhang WenYuan, Yu TingTing, Cheng Na, Zhang LunLi
2017, 33(7): 1320-1323. DOI: 10.3969/j.issn.1001-5256.2017.07.023
Abstract:

Objective To investigate the clinical features of patients with hepatitis B virus-related acute-on-chronic liver failure (ACLF) induced by the withdrawal of nucleos (t) ide analogues (NAs) .Methods A retrospective analysis was performed for the clinical data of 865 patients who were admitted to The First Affiliated Hospital of Nanchang University from June 2014 to October 2016 and diagnosed with ACLF.Among these patients, 137 experienced ACLF induced by drug withdrawal (withdrawal group) and 728 experienced ACLF not induced by drug withdrawal (non-withdrawal group) .The type of antiviral drugs, duration of standard antiviral therapy, withdrawal way, time from withdrawal to the development of liver failure, monitoring after withdrawal, underlying liver diseases, and 30-day mortality after progression to ACLF were recorded in detail.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 Of all the 728 patients in the non-withdrawal group, 389 were cured or improved and 339 died or had no response.Of all the 137 patients in the withdrawal group, 69 had chronic viral hepatitis, among whom 40 were cured or improved and 29 died or had no response;68 had liver cirrhosis, among whom 16 were cured or improved and 52 died or had no response;there was a significant difference (χ2=16.81, P<0.001) 6="" 16="" 25="" 32="" 33="" 37="" 47="" 79="" 137="" .of="" all="" the="" patients="" in="" withdrawal="" before="" used="" adefovir="" lamivudine="" combined="" with="" and="" entecavir.of="" when="" they="" developed="" had="" a="" duration="" of="" drug="" 6-12="">12 months.Conclusion Improper withdrawal of NAs can easily induce ACLF.The changes in virologic parameters, liver function parameters, and liver imaging findings should be closely monitored for patients with hepatitis B within 6 months after withdrawal.Underlying liver diseases determine the development and prognosis of ACLF after withdrawal, and long-term standard antiviral therapy is of great importance in patients with liver cirrhosis.

A preliminary investigation and feature analysis of non-alcoholic fatty liver and nonalcoholic steatohepatitis in employees in an IT company
Li XiuChi, Ruan GaiQing, LYU JiaEn, Sun MoQian, Wang MingMing
2017, 33(7): 1324-1327. DOI: 10.3969/j.issn.1001-5256.2017.07.024
Abstract:

Objective To investigate the incidence rates and features of non-alcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH) , and to provide a theoretical basis for health management and development of intervention and preventive measures in the health management department.Methods Physical examination reports in 2016 were obtained from a large IT company to analyze the incidence rates of NAFL and NASH in different age and sex groups, as well as the correlation with the indices including overweight (or obesity) , triglyceride, fasting blood glucose, blood uric acid, and blood pressure.The chi-square test was used for comparison of rates.Results In all employees, the incidence rates of NAFL and NASH were 4.51% and 17.64%, respectively, and the overall incidence rate of these two diseases was 22.15%.The NAFL-NASH group had significantly higher incidence rates of overweight (or obesity) (91.20% vs 12.68%, χ2=7571.9, P<0.001) , hyperlipidemia (95.06% vs 9.27%, χ2=9373.8, P<0.001) , and hyperuricemia (40.02% vs 10.51%, χ2=1591.90, P<0.001) than the non-NAFL-NASH group.Compared with female employees, male employees had significantly higher incidence rates of NAFL (6.78% vs 1.81%, χ2=190.35, P<0.001) and NASH (25.04% vs 5.06%, χ2=991.90, P<0.001) , as well as significantly higher incidence rates of overweight (or obesity) (40.90% vs 12.97%, χ2=1319.10, P<0.001) , hyperlipidemia (36.00% vs 16.07%, χ2=696.22, P<0.001) , hyperglycemia (2.17% vs 0.64%, χ2=53.82, P<0.01) , hyperuricemia (26.76%vs 1.69%, χ2=1581.10, P<0.001) , and hypertension (6.21% vs 1.22%, χ2=170.94, P<0.001) .Compared with those aged<35 years, the employees aged ≥35 years had significantly higher incidence rates of NAFL (8.13% vs 4.47%, χ2=41.56, P<0.001) and NASH (21.73% vs 16.76%, χ2=24.72, P<0.001) , as well as significantly higher incidence rates of hyperglycemia (2.79% vs1.43%, χ2=17.26, P<0.001) and hypertension (6.33% vs 4.03%, χ2=18.56, P<0.001) while="" there="" were="" no="" significant="" differences="" in="" the="" incidence="" rates="" of="" overweight="" or="" and="" high="" uric="" acid="" between="" these="" two="" groups="" all="" p="">0.05) .Conclusion Although IT employees are young, there is no significant reduction in the incidence rate of nonalcoholic fatty liver disease.The development of NAFL and NASH has the clinical features of overweight (or obesity) , hyperlipidemia, and hyperuricemia, which are commonly seen in male patients.Older employees have higher incidence rates of NAFL, NASH, hyperglycemia, and hypertension than younger employees.

Application of a modified diagnostic scale in diagnosis of acute drug-induced liver injury
Chou LiXia, Fan ZuoPeng, Liu Ying, Liang Shan, Nie Wei, Lin Wei, Liu YiRong, Zhang Jing, Hu ZhongJie
2017, 33(7): 1328-1331. DOI: 10.3969/j.issn.1001-5256.2017.07.025
Abstract:

Objective To investigate the application of a modified diagnostic scale in the diagnosis of acute drug-induced liver injury (DILI) .Methods A total of 82 patients with acute DILI who were treated in Beijing You An Hospital, Capital Medical University from January 2011 to December 2015 were enrolled, among whom 52 were enrolled in DILI group and 30 were enrolled in non-DILI group.On the basis of Roussel Uclaf Causality Assessment Method (RUCAM) scale and with reference to Digestive Disease Week Japan scale, three parameters, i.e., “report of liver injury induced by single Chinese materia medica or Chinese patent medicine”, “eosinophil count”, and “drug lymphocyte stimulation test based on Cell Counting Kit-8”, were added to establish a modified diagnostic scale.The RUCAM scale and the modified diagnostic scale were used to evaluate each suspected drug to verify the sensitivity and specificity of this new scale in the diagnosis of DILI.The chi-square test was used for comparison of categorical data between groups.Results There were 75 suspected drugs in the DILI group and 41 suspected drugs in the non-DILI group.Compared with the RUCAM scale, the modified diagnostic scale increased the number of drugs evaluated as “highly probable” and “probable” from 74.7% to 94.7% (χ2=11.554, P=0.001) in the DILI group.In the non-DILI group, only 2 drugs (4.9%) were changed from“possible”to“probable”, and the other drugs were maintained as “possible”, “unlikely”, or“excluded”;the specificity of diagnosis was reduced from 100% to 95.1% (χ2=0.512, P=0.474) .Conclusion Compared with the RUCAM scale, this modified diagnostic scale has an increased sensitivity and a reduced specificity of diagnosis and needs to be further validated in clinical practice.

Erythropoietic protoporphyria with jaundice as the main manifestation:a clinical, pathological, and genetic analysis of 4 cases
Li XiaoQing, Shi Jie, Lai YaMin, Zhang BoWei, Wu LiNa, Zhu LiMing, Zhang Tao, Qian JiaMing
2017, 33(7): 1332-1335. DOI: 10.3969/j.issn.1001-5256.2017.07.026
Abstract:

Objective To investigate the clinical, pathological, and genetic features of erythropoietic protoporphyria, and to enhance the knowledge of liver involvement in this disease.Methods A retrospective analysis was performed for the clinical data of 4 patients with erythropoietic protoporphyria with jaundice as the main manifestation who were hospitalized in Peking Union Medical College Hospital from July 2011 to September 2014, including clinical features, liver pathology, and gene mutations.Results All the children had an acute/subacute onset, with intrahepatic cholestatic jaundice as the main clinical feature.The liver function test showed gamma-glutamyl transpeptidase 425-1152 U/L, alkaline phosphatase 196-356 U/L, total bilirubin 287-485 μmol/L, and direct bilirubin 216-394 μmol/L.All the patients experienced typical skin pain, erythema, and blisters after sunshine in their childhood.Further examinations showed free erythrocyte protoporphyrin 49.8-113.1 μg/g Hb, liver pathological examination showed“Maltese”cross under a polarizing microscope, and mutations at different loci of FECH gene were detected.Conclusion For patients with intrahepatic cholestatic liver disease with typical painful erythema after sunshine, the possibility of erythropoietic protoporphyria should be considered.Skin/liver pathology, erythrocyte protoporphyrin, and FECH gene detection help with the diagnosis of this disease.

Characteristics and clinical significance of peripheral follicular cytotoxic T cells in patients experiencing acute rejection after liver transplantation
Zhang Ke, Yang Fan, Sun YanLing, Liu ZhenWen, Wang FuSheng, Shi Ming
2017, 33(7): 1336-1339. DOI: 10.3969/j.issn.1001-5256.2017.07.027
Abstract:

Objective To investigate the expression characteristics of peripheral follicular cytotoxic T (Tfc) cells in patients undergoing liver transplantation and their significance in acute rejection.Methods A total of 36 patients who underwent liver transplantation in Liver Transplantation Research Center in 302 Hospital of PLA from December 2015 to February 2017 were enrolled, and among these patients, 11 experienced acute rejection (AR group) and 25 did not experience acute rejection (NAR group) .A confirmed diagnosis of acute rejection was made by pathological diagnosis.Another 20 healthy volunteers in Physical Examination Center were enrolled as controls (HC group) .Flow cytometry was used to investigate the characteristics of Tfc in peripheral blood and its correlation with total B lymphocytes, juvenile B lymphocytes, memory B lymphocytes, plasma cells, and liver function parameters.The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the Mann-Whitney U test was used for further comparison between any two groups;Spearman rank correlation was used for correlation analysis.Results The AR group had a significantly higher frequency of Tfc in peripheral blood than the NAR group (U=60, P=0.008) and the HC group (U=2, P<0.001) , and the NAR group had a significantly higher frequency of Tfc than the HC group (U=40, P<0.001) .The frequency of Tfc was positively correlated with total B lymphocytes and juvenile B lymphocytes (r=0.665 and 0.462, both P<0.001) , negatively correlated with memory B lymphocytes and plasma cells (r=-0.453, P=0.001) , and positively correlated with serum gamma-glutamyl transpeptidase level (r=0.371, P=0.026) .Conclusion There is an increase in the frequency of peripheral Tfc in patients who experience acute rejection after liver transplantation, which is correlated with B lymphocytes and hepatic bile duct injury.Tfc may be involved in acute rejection after liver transplantation.

Brief reports
Diagnosis and interventional therapy for Budd-Chiari syndrome secondary to hepatic venous obstruction
Yu Hong, Sun DianXing, Liang ZhiHui, Li HaiJun, Yang XinYing, Kang FuBiao
2017, 33(7): 1340-1341. DOI: 10.3969/j.issn.1001-5256.2017.07.028
Abstract:
Case reports
A case of adult huge undifferentiated sarcoma of the liver
Kou Kai, Sun DaWei, Liu Huan, Zhou JianPeng, Wang GuangYi, Lu: GuoYue
2017, 33(7): 1342-1343. DOI: 10.3969/j.issn.1001-5256.2017.07.029
Abstract:
Intractable hypokalemia caused by glycyrrhizinic acid preparations:a case report
Pang XiangJun, Zhao Na, Wang ShouQing, Xin GuiJie
2017, 33(7): 1344-1345. DOI: 10.3969/j.issn.1001-5256.2017.07.030
Abstract:
Common bile duct wall puncture and biopsy guided by endoscopic ultrasonography in diagnosis of common bile duct malignant tumor:a case report
Wen HongXu, Xue DiQiang, Du HongWei, Ming YuZhen
2017, 33(7): 1346-1348. DOI: 10.3969/j.issn.1001-5256.2017.07.031
Abstract:
Reviews
Research advances in influencing factors for the antiviral effect of nucleos (t) ide analogues
Wang LiLi, Liang YueDong
2017, 33(7): 1349-1353. DOI: 10.3969/j.issn.1001-5256.2017.07.032
Abstract:
Nucleos (t) ide analogues (NAs) have been widely used in clinical practice as first-line antiviral drugs.In recent years, many clinical studies have found that some patients cannot reach a satisfactory therapeutic outcome.This article introduces the antiviral indications and follow-up of chronic hepatitis B and summarizes the influence of baseline characteristics, HBV genotype, HBV mutation and drug resistance, patients' medication compliance, presence or absence of other diseases or viral infection, and serum vitamin D level on the antiviral effect of NAs.It is pointed out that appropriate timing for antiviral therapy, patient education before treatment, regular follow-up during treatment, and timely identification of comorbidities and drug resistance help to improve the antiviral effect of NAs and delay the progression of liver diseases.
Influence of maintained hemodialysis on viral load in patients with end-stage renal disease with HBV infection
Zhang HuiFang, Li YongGuo
2017, 33(7): 1354-1357. DOI: 10.3969/j.issn.1001-5256.2017.07.033
Abstract:
In the patients with end-stage renal disease (ESRD) with hepatitis B virus (HBV) infection who underwent hemodialysis, the viral load of HBV DNA is relatively low and stable.For this phenomenon, some studies suggest that hemodialysis can reduce the HBV DNA load.The mechanism, which remains unclear, may be as follows:when HBV DNA enters the dialysate through the dialysis membrane, it was adsorbed onto the dialysis membrane;some virus particles were destroyed, and antiviral substances were produced in the course of hemodialysis.At present, there is no consensus on the mechanism responsible for the influence of maintained hemodialysis on the viral load of HBV DNA.This article reviews the factors involved in the influence of maintained hemodialysis on the viral load in ESRD patients with HBV infection and the recent progress.
Research advances in radiofrequency ablation in treatment of hepatocellular carcinoma
Luo DanDong, Qiao AnYi
2017, 33(7): 1358-1361. DOI: 10.3969/j.issn.1001-5256.2017.07.034
Abstract:
Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related death in the world, and only 20% of HCC patients can undergo radical treatment.Radiofrequency ablation induces coagulative necrosis of cells via thermal energy, kills tumor cells, and makes it possible to cure HCC.Many clinical studies have confirmed that radiofrequency ablation provides good local control and has high safety, and therefore, it can be used to replace radical surgery.This article reviews the indications and therapeutic effect of radiofrequency ablation in the treatment of HCC, as well as its comparison with radical surgical resection and transarterial chemoembolization in terms of their therapeutic effects.It is pointed out that the treatment regimen should be selected based on the patient's individualized conditions.
Current status of treatment of liver cancer complicated by esophageal variceal bleeding
Peng Zhong, Qi XingShun, Guo XiaoZhong
2017, 33(7): 1362-1364. DOI: 10.3969/j.issn.1001-5256.2017.07.035
Abstract:
Esophageal variceal bleeding is a major complication of liver cancer and a major cause of death in patients with liver cancer.This article summarizes the current status of the treatment of liver cancer complicated by esophageal variceal bleeding, including drugs and endoscopic and interventional treatment, with an emphasis on treatment options for liver cancer complicated by esophageal variceal bleeding.
Clinical application of positron emission tomography/computed tomography in hepatocellular carcinoma and related research advances
Zhang ZeYu, Cheng HongYan
2017, 33(7): 1365-1368. DOI: doi:10.3969/j.issn.1001-5256.2017.07.036
Abstract:
Advances in the application of GPC3 in treatment of liver cancer
Ren ZhiZhong, Zhang YueWei
2017, 33(7): 1369-1372. DOI: 10.3969/j.issn.1001-5256.2017.07.037
Abstract:
Liver cancer is one of the most common malignant tumors in the world, and traditional liver cancer treatment methods have their own limitations.Glypican-3 (GPC3) is a cell-surface heparan sulfate proteoglycan and is involved in the regulation of individual development and cell proliferation and differentiation.It is also a hepatoma-specific carcinoembryonic antigen.The mechanism of action of GPC3 in the development and progression of liver cancer has become a hot research topic.GPC3 not only has a unique value in the diagnosis of liver cancer, but also plays an important role in the treatment of liver cancer.This article also introduces the application of GPC3-derived tumor vaccines, GPC3 antibodies, GPC3 gene therapy, and targeted therapy and brings new ideas for the treatment of liver cancer.
Role of cell apoptosis regulated by P53 in treatment of hepatocellular carcinoma
Gao Si, Zhao XiangXuan, Lu ZaiMing
2017, 33(7): 1373-1376. DOI: 10.3969/j.issn.1001-5256.2017.07.038
Abstract:
P53 abnormality or mutation is commonly seen in patients with hepatocellular carcinoma (HCC) , and therefore, restoration of P53 function has become a research hotspot in the treatment of HCC.This article reviews the association of P53 with Bcl-2 protein family, microRNA, TGFβ, HBV, HCV, and AKT and the role of P53 in regulating cell apoptosis, in order to provide clues for improving the therapeutic outcome of HCC.
Mechanism and significance of let-7 in diagnosis and treatment of hepatocellular carcinoma
Huo TingTing, Wang DongXu, Zhang MingZhi, Zhao Lei
2017, 33(7): 1377-1380. DOI: 10.3969/j.issn.1001-5256.2017.07.039
Abstract:
MicroRNA (miRNA) play important roles in post-transcriptional gene regulation.In recent years, miRNA has become a hot topic in the research on the development and progression of tumors, and gene targeting therapy for malignant tumors has achieved preliminary progress.As one of the first discovered miRNA, let-7 can regulate the cell cycle and angiogenesis and is involved in the proliferation, differentiation, and apoptosis of various tumor cells.Most members of the let-7 family can act as tumor suppressor gene and have low expression in various tumor tissues and high expression in the serum of patients with malignant tumors.Let-7 is closely associated with the invasion and drug resistance of hepatocellular carcinoma (HCC) .The studies above show that let-7 might become a new marker for the early diagnosis of HCC and provide new targets for the treatment of HCC.
Pathogenesis of hepatocellular carcinoma induced by HBV and HCV infection
Wang YueJiao, Song HaiYan, Xing LianJun, Ji Guang, Zheng PeiYong
2017, 33(7): 1381-1386. DOI: 10.3969/j.issn.1001-5256.2017.07.040
Abstract:
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide.Surgery is the preferred therapy for patients with small HCC;however, there still lack effective therapies for advanced HCC and postoperative recurrence and metastasis, leading to its high mortality.Persistent hepatitis virus infection, mainly hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, is the most important cause of HCC.Through various signal transduction mechanisms, hepatitis virus changes gene expression in hepatocytes, blocks or alters immune response, regulates the microenvironment in the liver, and thus promotes the development and progression of HCC.This article reviews the pathogenesis of HCC induced by HBV and HCV infection, in order to provide new approaches for the prevention and treatment of HCC.
Research advances in immune repertoire and high-throughput sequencing in primary biliary cholangitis
Zhao DanTong, Guo ChangLong, Yan HuiPing
2017, 33(7): 1387-1390. DOI: 10.3969/j.issn.1001-5256.2017.07.041
Abstract:
Primary biliary cholangitis (PBC) is an autoimmune liver disease with unclear pathogenesis.The amino acid composition and sequence in the complementarity-determining region 3 of T cell receptor (TCR) and B cell receptor (BCR) are highly diverse, which forms a large antigen recognition receptor repertoire, i.e., immune repertoire.In recent years, second-generation sequencing techniques combined with multiplex PCR or amplicon rescue multiplex PCR have been used to study the features of immune repertoire in PBC patients, and it has been found that PBC patients have clonal expansion of specific CD4~+T lymphocytes, clonal diversity of B lymphocytes, somatic hypermutation, and reduction in class switch, as well as increase in clonal diversity after treatment with ursodeoxycholic acid.These findings need to be confirmed by large-scale in vivo and in vitro studies and different immune repertoire research strategies.
Latest advances in diagnosis and treatment of occult common bile duct stones
Wang Chao, Xu Feng, Liu XiaoLin, Dai ChaoLiu
2017, 33(7): 1391-1396. DOI: 10.3969/j.issn.1001-5256.2017.07.042
Abstract:
Occult common bile duct stones have no clinical symptoms and if it is not diagnosed or treated in time, it can cause unexplained abdominal pain after cholecystectomy or serious complications such as biliary pancreatitis and acute cholangitis, which may threaten patients' lives.Proper diagnosis and treatment modalities can reduce postoperative complications, save medical resources, and reduce medical disputes.This article introduces the latest advances in the diagnosis and treatment of occult common bile duct stones, including the features and diagnostic efficacy of imaging examinations (abdominal ultrasound, computed tomography, magnetic resonance cholangiopancreatography (MRCP) , endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography (ERCP) , intraoperative cholangiography, intraoperative laparoscopic ultrasonography, intraductal ultrasonography, and intraoperative choledochoscopy) , as well as the effect of treatment modalities (endoscopic sphincterotomy (EST) , laparoscopic common bile duct exploration (LCBDE) , open common bile duct exploration, endoscopic papillary balloon dilatation, electrohydaulic lithotripsy, extracorporeal shockwave lithotripsy, litholysis, and laser lithotripsy) .It is pointed out that the diagnosis and treatment of occult common bile duct stones should be treated differently according to risk stratification.Endoscopic ultrasonography or MRCP should be performed for patients with moderate risks or above, and their results are critical to the choice of surgical procedure.For treatment modality, LCBDE or ERCP/EST should be selected according to patients' actual conditions.
Clinical application of hepatopancreatoduodenectomy in treatment of advanced gallbladder cancer
Zhang HaiWen, Wang Meng, Wang ChuanLei, Jie EnBo, Wang GuangYi
2017, 33(7): 1397-1399. DOI: 10.3969/j.issn.1001-5256.2017.07.043
Abstract:
Gallbladder cancer has many characteristics such as rapid progression, difficult early diagnosis, low R0 resection rate, and poor prognosis.In recent years, extended radical resections including hepatopancreatoduodenectomy (HPD) have been performed for patients with advanced gallbladder carcinoma that invades the common bile duct, duodenum, and portal vein, but with no distant metastasis in many large medical centers.This procedure can significantly increase the R0 resection rate and prolong the survival time of patients.But due to the high rate of complications and high mortality in the patients treated with HPD, many surgeons still have little confidence in this procedure.This article reviews the current application of HPD in advanced gallbladder cancer, related problems, complications, and surgical indications, and suggests that HPD can be selected according to strict surgical indications.