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

2017 No. 9

Display Method:
Editorial
Hotspots in clinical management of severe liver diseases
Lu: JiaYu, Han Tao
2017, 33(9): 1617-1620. DOI: 10.3969/j.issn.1001-5256.2017.09.001
Abstract:
Severe liver diseases such as liver failure and acute decompensated cirrhosis have critical conditions and high mortality rates, and the prognosis of such patients is closely associated with early warning, timely dynamic assessment, and comprehensive and effective therapy.The patients require a series of effective clinical management measures for elimination of causative factors, organ support, and prevention and treatment of complications. Medical treatment-artificial liver-liver transplantation is an important modality for severe liver diseases. Granulocyte colony-stimulating factor, stem cell therapy, and bioartificial liver have a promising future, while there are still controversies over non-selective β-blocker. This article reviews the hotspots in the clinical management of severe liver diseases.
Therapeutic guidelines
Expert consensus on TCM diagnosis and treatment of ascites due to cirrhosis (2017)
Branch of Gastrointestinal Diseases, China Association of Chinese Medicine
2017, 33(9): 1621-1626. DOI: 10.3969/j.issn.1001-5256.2017.09.002
Abstract:
Expert consensus on diagnosis and treatment of pyrrolidine alkaloids-related sinusoidal obstruction syndrome (2017, Nanjing)
Cooperative Group for Hepatic and Gall Diseases, Chinese Society of Gastroenterology, Chinese Medical Association
2017, 33(9): 1627-1637. DOI: 10.3969/j.issn.1001-5256.2017.09.003
Abstract:
Radiofrequency ablation in the treatment of hepatic hemangiomas-consensus of experts in China
Gao Jun, Fan RuiFang, Yang JiaYin, Cui Yan, Ji JianSong, Ma KuanSheng, Li XiaoLong, Zhang Long, Xu ChongLiang, Kong XinLiang, Ke Shan, Ding XueMei, Wang ShaoHong, Song JingJing, Zhai Bo, Ning ChunMin, Guo ShiGang, Xin ZongHai, Dong YongHong, Lu Jun, Zhu HuaQiang, Sun WenBing
2017, 33(9): 1638-1645. DOI: 10.3969/j.issn.1001-5256.2017.09.004
Abstract:
Expert consensus on the optimization of perioperative management of liver transplantation for severe hepatitis by enhanced recovery after surgery
Study Group of Transplantation Immunology, Society of Organ Transplantation, Chinese Medical Doctor Association, Study Group of Surgery, Chinese Society of Surgery, Chinese Medical Association, Society of Organ Transplantation, Guangdong Medical Doctor Association
2017, 33(9): 1646-1654. DOI: 10.3969/j.issn.1001-5256.2017.09.005
Abstract:

In order to apply the concept of enhanced recovery after surgery ( ERAS) in the optimization of perioperative management of liver transplantation for severe hepatitis, reduce complications, and promote patients'fast recovery, Study Group of Transplantation Immunology, Society of Organ Transplantation, Chinese Medical Doctor Association, Study Group of Surgery, Chinese Society of Surgery, Chinese Medical Association, and Society of Organ Transplantation, Guangdong Medical Doctor Association have developed Expert consensus on the optimization of perioperative management of liver transplantation for severe hepatitis by enhanced recovery after surgery. This consensus summarizes the clinical experience in each transplantation center from the perspective of the role of ERAS in the optimization of preoperative, intraoperative, and postoperative treatment strategies for liver transplantation for severe hepatitis and puts forward related expert consensus, in order to provide a reference for clinical optimization of perioperative management of liver transplantation for severe hepatitis.

An interpretation of diagnosis, management, and treatment of hepatocellular carcinoma (V2017)
Li Zhao, Zhu JiYe
2017, 33(9): 1655-1657. DOI: 10.3969/j.issn.1001-5256.2017.09.006
Abstract:
An excerpt of International Liver Transplant Society consensus statement on hepatitis C management in liver transplant candidates (2017)
Zhang DaLi, Liu HongLing
2017, 33(9): 1658-1662. DOI: 10.3969/j.issn.1001-5256.2017.09.007
Abstract:
An excerpt of hepatitis B and pregnancy (Society of Obstetricians and Gynaecologists of Canada, 2017)
Liu HuiMin, Xiang YuanCui, Li HaoRan, Wang YaLi, Ji Mei, Zhong XiaoZhu
2017, 33(9): 1663-1667. DOI: 10.3969/j.issn.1001-5256.2017.09.008
Abstract:
Recommendations for United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (2017)
Qi WenLei, Wu XinMin, Zhang JianWei, Ye JunFeng, Wang GuangYi
2017, 33(9): 1668-1676. DOI: 10.3969/j.issn.1001-5256.2017.09.009
Abstract:
Discussions by experts
Immunotherapy for acute-on-chronic liver failure
Han Ying, Cui LiNa, Guo GuanYa
2017, 33(9): 1677-1682. DOI: 10.3969/j.issn.1001-5256.2017.09.010
Abstract:
Inflammatory response and immune dysfunction play important roles in the progression of acute-on-chronic liver failure ( ACLF) and may lead to systemic inflammatory response syndrome. Excessive inflammatory and immune response may result in increased susceptibility to infection and finally lead to multiple organ dysfunction syndrome ( MODS) . Elimination of liver injury and correction of immune dysfunction can prevent sepsis and/or MODS and improve patients'survival. Up to now, immunotherapy for ACLF has not been recommended in related guidelines. However, as an important pathophysiological change of ACLF and a key event closely associated with incidence rate and mortality rate, persistent activation of hepatic and systemic inflammatory response and immune cell dysfunction urges us to consider immunoregulatory treatment, in order to block and reverse disease progression. This article introduces potential immunoregulatory drugs for the treatment of ACLF, including albumin, glucocorticoids, granulocyte colony-stimulating factor, artificial liver support system, and mesenchymal stem cell transplantation, and discusses some promising targets for immunotherapy.
Timing of glucocorticoid therapy for liver failure
Meng QingHua
2017, 33(9): 1683-1686. DOI: 10.3969/j.issn.1001-5256.2017.09.011
Abstract:
There are still controversies over the use of glucocorticoids in the treatment of liver failure, and current guidelines for liver failure recommend that glucocorticoids should be used with great caution. However, some latest studies have shown that the use of glucocorticoid therapy in the early stage of liver failure can bring more benefits to patients. Age, disease progression rate and severity, and complications of liver failure may affect the treatment outcome. Further studies are still needed for the selection of right patients, drugs and dose, and treatment timing.
Coping with shortage of plasma-The new therapeutic pattern of non-bioartificial liver
Li Shuang, Chen Yu
2017, 33(9): 1687-1692. DOI: 10.3969/j.issn.1001-5256.2017.09.012
Abstract:
With the increase in patients with liver failure, the artificial liver support system is facing great opportunities and challenges. Although artificial liver has achieved remarkable results in the treatment of patients with liver failure, non-bioartificial liver techniques commonly used in China, mainly plasma exchange, are facing the issue of limited plasma supply. This article focuses on plasma exchange and discusses how to deal with the shortage of plasma in non-bioartificial liver treatment from various aspects, in order to provide a reference for clinical physicians.
Bioartificial liver and liver transplantation: new modalities for the treatment of liver failure
Ding YiTao
2017, 33(9): 1693-1698. DOI: 10.3969/j.issn.1001-5256.2017.09.013
Abstract:
The main features of liver failure are extensive necrosis of hepatocytes, rapid disease progression, and poor prognosis, and at present, there are no effective drugs and methods for the treatment of liver failure. This article summarizes four treatment methods for liver failure, i. e., medical treatment, cell transplantation, liver transplantation, and artificial liver support therapy, and elaborates on the existing treatment methods. The current medical treatment regimen should be optimized; cell transplantation has not been used in clinical practice; liver transplantation is the most effective method, but it is limited by donor liver shortage and high costs; artificial liver can effectively remove toxic substances in human body. Therefore, this article puts forward artificial liver as a transition for liver transplantation; artificial liver can buy time for liver regeneration or liver transplantation and prolong patients'survival time and thus has a promising future. The new treatment modality of bioartificial liver combined with liver transplantation may bring good news to patients with liver failure.
Malnutrition assessment and nutrition support therapy for end-stage liver disease
Zhu Bin, Zou CongCong, Zheng Xin
2017, 33(9): 1699-1706. DOI: 10.3969/j.issn.1001-5256.2017.09.014
Abstract:
Malnutrition is a common complication in patients with end-stage liver disease and is associated with patients'clinical prognosis and quality of life, but it has not been taken seriously by clinical physicians. This article elaborates on the pathogenesis of malnutrition in patients with end-stage liver disease and introduces the latest research advances in malnutrition assessment and nutrition support therapy for end-stage liver disease in China and foreign countries. Early nutrition support therapy for patients with end-stage liver disease may help to improve their comprehensive clinical outcome.
Original articles_Viral hepatitis
Clinical effect and short-term safety of telbivudine in blocking mother-to-child transmission of HBV
Pan YuChen, Wang Chong, Wen SiMin, Wang Chuan, Kong Fei, Niu JunQi, Jiang Jing
2017, 33(9): 1707-1712. DOI: 10.3969/j.issn.1001-5256.2017.09.015
Abstract:
Objective To evaluate the clinical effect and short-term safety of telbivudine administered in late pregnancy for blocking mother-to-child transmission of HBV in pregnant women with high HBV DNA load. Methods Pregnant women with positive HBsAg and HBe Ag and HBV DNA ≥2 × 106 IU/ml who underwent blockade of mother-to-child transmission in The First Hospital of Jilin University from July 2012 to June 2015 were enrolled. These patients were informed of current methods for blocking mother-to-child transmission of hepatitis B, and according to their own will, they were divided into active/passive immunization + telbivudine ( telbivudine group) and active/passive immunization group ( immunization group) . The patients in the telbivudine group were given oral telbivudine ( 600 mg, once a day) from week 32 of pregnancy to delivery, and those in the immunization group were not given antiviral therapy. The infants in both groups were given 20 μg hepatitis B vaccine combined with 100 IU hepatitis B immunoglobulin after birth. Positive HBsAg in infants at an age of 7months was defined as failed blockade of mother-to-child transmission. The t-test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank sun test was used for comparison of non-normally distributed continuous data between groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. Results A total of 447 pregnant women were enrolled, and there were 81 pregnant women in the telbivudine group and 366 women in the immunization group. Compared with the immunization group, the telbivudine group had a significantly higher mean age ( 28. 8 ± 3. 3 years vs 27. 6 ± 3. 8 years, t =-2. 55, P = 0. 01) and a significantly higher proportion of pregnant women with HBV DNA load > 108 IU/ml ( 82. 7% vs 61. 5%, χ2=13. 21, P < 0. 001) . There were no significant differences in alanine aminotransferase level, delivery mode, and feeding pattern between the two groups ( all P > 0. 05) . No infants in the telbivudine group had positive HBsAg at an age of 7 months, while among the 370 infants in the immunization group, 21 had positive HBsAg; there was a significant difference in positive rate between the two groups ( 0 vs 5. 7%, P =0. 02) . No women experienced eclampsia, premature rupture of membranes, or postpartum bleeding, and there were no significant differences between the two groups of infants in premature birth rate, body length, body weight, and Apgar score ( all P > 0. 05) . Conclusion In addition to active and passive immunization for neonates, antiviral therapy for pregnant women with a high viral load in late pregnancy can significantly improve the blocking rate of mother-to-child transmission of HBV and achieve no mother-to-child transmission of hepatitis B, and the neonates have good short-term safety.
Correlation between serum ferritin level and antiviral effect of pegylated interferon in chronic hepatitis C patients with genotype 1b
You ChunFang, Zhou LiMin, Deng Wei
2017, 33(9): 1713-1716. DOI: 10.3969/j.issn.1001-5256.2017.09.016
Abstract:
Objective To investigate the correlation between serum ferritin ( SF) level and antiviral effect of pegylated interferon-α-2a ( Peg-IFNα-2a) in chronic hepatitis C ( CHC) patients. Methods A total of 85 CHC patients who were admitted to The First People's Hospital of Zigong from November 2013 to July 2014 were enrolled and treated with subcutaneous injection of Peg-IFNα-2a 180 μg once a week combined with oral ribavirin 10-15 mg·kg-1·d-1. The course of treatment was 48 weeks and the patients were followed up for 24 weeks after the treatment ended. SF was measured at week 0, and HCV RNA was measured at weeks 0, 4, 12, 24, 48, and 72 to evaluate therapeutic outcome. According to the therapeutic outcome, the patients were divided into rapid virologic response ( RVR) group, early virologic response ( EVR) group, sustained virologic response ( SVR) group, no response group ( NR group) , and recurrence group; according to the SF level, the patients were divided into high-SF group ( ≥400 ng/ml) and low-SF group ( < 400 ng/ml) . An analysis of variance was used for comparison of continuous data between groups, and SNK-q test was used for comparison between any two groups; the chi-square test was used for comparison of categorical data between groups, and Spearman rank correlation was used for correlation analysis. Results Of all patients, 36 ( 42. 35%) achieved RVR, 70 ( 82. 35%) achieved EVR, 68 ( 80. 00%) achieved SVR, 15 ( 17. 65%) had no response, and 2 ( 2. 35%) experienced recurrence. The NR group and recurrence group had a significant increase in SF level, and the NR group had a significantly higher SF level than RVR group ( 1489. 15 ± 278. 21 ng/ml vs 398. 12 ± 252. 45 ng/ml, q = 10. 826, P < 0. 01) , EVR group ( 1489. 15 ± 278. 21 ng/ml vs 514. 85 ± 275. 64 ng/ml, q = 10. 151, P < 0. 01) , and SVR group ( 1489. 15 ± 278. 21 ng/ml vs486. 45 ± 251. 60 ng/ml, q = 10. 614, P < 0. 01) . SF level was negatively correlated with the therapeutic effect of PEG-IFN ( rs=-0. 688, P< 0. 001) . Compared with the high-SF group, the low-SF group had a significantly higher proportion of patients who achieved RVR ( 85. 29% vs13. 73%, P < 0. 001) , EVR ( 100% vs 70. 59%, P < 0. 001) , or SVR ( 100% vs 66. 67%, P < 0. 001) and a significantly lower proportion of patients who had no response ( 0 vs 29. 41%, P < 0. 001) . Conclusion In CHC patients, SF level before treatment is correlated with the antiviral effect of PEG-IFN, suggesting that SF level can predict the antiviral effect of PEG-IFN in CHC patients.
Original articles_Liver fibrosis and liver cirrhosis
Value of real-time shear wave elastography in evaluating classification of liver fibrosis: a Meta-analysis
Wu Yue, Huang LiPing
2017, 33(9): 1717-1721. DOI: 10.3969/j.issn.1001-5256.2017.09.017
Abstract:
Objective To investigate the diagnostic value of real-time shear wave elastography ( SWE) technique in evaluating classification of liver fibrosis. Methods Pub Med, CNKI, CBM, VIP, and Wanfang Data were searched for Chinese and English articles on SWE for evaluating classification of liver fibrosis published from January 2010 to December 2016, and these articles were screened and evaluated.Meta-disc 1. 4 software was used for the meta-analysis of the data in the articles included. Results A total of 11 English articles were included, with 1560 cases in total. In the ≥F2 group, SWE had a pooled sensitivity of 0. 85 ( 95% confidence interval [CI]: 0. 82-0. 87) , a specificity of 0. 79 ( 95% CI: 0. 76-0. 82) , and a diagnostic odds ratio ( DOR) of 30. 81 ( 95% CI: 16. 55-57. 34) . In the ≥F3 group, SWE had a pooled sensitivity of 0. 87 ( 95% CI: 0. 84-0. 91) , a specificity of 0. 84 ( 95% CI: 0. 82-0. 87) , and a DOR of 41. 45 ( 95%CI: 18. 25-94. 45) . In the F4 group, SWE had a pooled sensitivity of 0. 88 ( 95% CI: 0. 83-0. 91) , a specificity of 0. 91 ( 95% CI: 0. 89-0. 92) , and a DOR of 67. 18 ( 95% CI: 30. 03-150. 31) . The areas under the receiver operating characteristic curve for these three groups were 0. 914 7, 0. 922 3, and 0. 952 0, respectively. Conclusion SWE has a high diagnostic value in evaluating the classification of liver fibrosis and can be used to determine liver fibrosis stage in clinical practice.
Influencing factors for esophageal stenosis caused by sclerotherapy for esophageal varices
Wang ZhenBiao, Wu YanJing, Zhang YueNing, Li Peng
2017, 33(9): 1722-1724. DOI: 10.3969/j.issn.1001-5256.2017.09.018
Abstract:
Objective To investigate the influencing factors for esophageal stenosis caused by sclerotherapy for esophageal varices. Methods A retrospective analysis was performed for the clinical data of 17 patients with esophageal stenosis caused by sclerotherapy for esophageal varices who were treated in Beijing You'an Hospital from February 2011 to December 2016, and 17 patients who were given sclerotherapy for esophageal varices and did not experience esophageal stenosis were enrolled as control group. The two groups were compared in terms of dose of sclerosing agent, number of treatments, injection site, and other related factors. 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 esophageal stenosis group had a significantly lower number of treatments with sclerosing agent than the control group ( 3. 11 ± 0. 90 vs 5. 12 ± 2. 11, t =-3. 267, P = 0. 003) . Compared with the control group, the esophageal stenosis group had significantly higher total dose of sclerosing agent ( 36. 12 ± 3. 55 ml vs 28. 36 ± 5. 08 ml, t = 4. 046, P < 0. 001) and dose of sclerosing agent for last injection ( 19. 13 ± 4. 19 ml vs 12. 46 ±2. 61 ml, t = 4. 179, P < 0. 001) , and the injection sites were close to each other or located on the same plane. Repeated sclerotherapy caused esophageal stenosis in case of improper operation. Conclusion It is of great clinical significance to properly determine injection dose, site, and number of injections and avoid overlap between ulcers, in order to prevent esophageal stenosis after sclerotherapy for esophageal varices.
Original articles_Liver neoplasms
Multi-slice spiral CT and magnetic resonance imaging features of hepatic focal nodular hyperplasia and their pathological basis
Wu ZhenDong, Chen Lin, Yang Kai, Sun ZongQiong
2017, 33(9): 1725-1728. DOI: 10.3969/j.issn.1001-5256.2017.09.019
Abstract:
Objective To investigate the multi-slice spiral CT ( MSCT) and magnetic resonance imaging ( MRI) features of hepatic focal nodular hyperplasia ( FNH) and their pathological basis, and to improve the accuracy of diagnostic imaging. Methods A retrospective analysis was performed for the MSCT and MRI findings of 40 patients with pathologically confirmed hepatic FNH who were admitted to Wuxi Fourth People's Hospital, Affiliated Hospital of Jiangnan University, from January 2010 to December 2016. Results Of all the 30 patients who underwent MSCT, 24 showed low-density lesions on plain scan, among whom 18 had irregular lower-density shadow ( scar) in the central areas of lesions and 6 had slightly higher density ( fatty liver disease) ; as was shown by the contrast-enhanced scan, all lesions had intense enhancement in the arterial phase with even or uneven density, as well as slightly higher or equal density in the portal venous phase, and 18 patients had delayed enhancement in central low-density lesions or a reduction in the size of such lesions. MRI was performed for 40 patients, and plain scan showed that the lesions were slightly hypointense on T1WI and slightly hyperintense on T2WI and DWI, and 32 patients had star-like, striped, or mottled low signals in lesions. All lesions except scars showed intense enhancement in the arterial phase, slight hyperintensity or isointensity in the portal venous phase, and isointensity in the delayed phase. Of all 40 patients, 32 had hypointensity and delayed enhancement in lesions or a reduction in the size of such lesions, 4 had incomplete ring enhancement around the lesions in the portal venous phase and the delayed phase, and 28 had blood vessels around or inside the lesions. Conclusion MSCT and MRI are specific and accurate in the diagnosis of hepatic FNH, and a combination of these two methods can improve the diagnostic rate of hepatic FNH.
Value of serum PIVKA-Ⅱ, alpha-fetoprotein, and ferritin in assisting the diagnosis of HBV-related hepatocellular carcinoma
Wen Jun, Li Jia, Wang ChunYan, Ma Ying
2017, 33(9): 1729-1733. DOI: 10.3969/j.issn.1001-5256.2017.09.020
Abstract:
Objective To investigate the value of serum PIVKA-Ⅱ, alpha-fetoprotein ( AFP) , and ferritin ( FER) measured alone or in combination in assisting the diagnosis of HBV-related hepatocellular carcinoma ( HCC) . Methods A total of 40 patients with hepatitis B virus ( HBV) -related HCC, 41 patients with liver cirrhosis after hepatitis B, 44 patients with chronic hepatitis B ( CHB) , and 36 controls who underwent physical examination were enrolled. Their serum samples were collected and the serum levels of PIVKA-Ⅱ, AFP, and FER were measured. The area under the ROC curve ( AUC) , sensitivity, and specificity of PIVKA-Ⅱ, AFP, and FER measured alone or in combination in the diagnosis of HBV-related HCC were analyzed. The non-parametric Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups, and the Mann-Whitney U test was used for further comparison between two groups. A binary logistic stepwise regression analysis was used to determine the new variable pre of predicted probability of combined measurement of these three indices. Results There were significant differences in the serum levels of AFP and PIVKA-Ⅱ between the liver cirrhosis group, CHB group, HBV-related HCC group, and healthy control group ( χ2= 51. 446 and 59. 613, both P < 0. 001) . The HBV-related HCC group had a significantly higher serum level of AFP than the liver cirrhosis group, CHB group, and healthy control group ( Z =-4. 609, -6. 026, and-6. 031, all P < 0. 001) , and the liver cirrhosis group also had a significantly higher serum level of AFP than the healthy control group ( Z =-2. 30, P = 0. 021) . The HBV-related HCC group had a significantly higher serum level of PIVKA-Ⅱ than the liver cirrhosis group, CHB group, and healthy control group ( Z =-6. 080, -6. 595, and-5. 608, all P < 0. 001) , and the CHB group had a significantly higher serum level of PIVKA-Ⅱ than the healthy control group ( Z =-2. 153, P = 0. 031) . The HBV-related HCC group had a significantly higher serum level of FER than the CHB group ( Z =-2. 177, P = 0. 029) . When measured alone, AFP had the highest sensitivity in the diagnosis of HBV-related HCC ( 79. 49%) , and FER had the highest specificity ( 94. 28%) . When any two of these indices were measured, PIVKA-Ⅱ/AFP had the highest sensitivity ( 89. 74%) , and FER + AFP and FER + PIVKA-Ⅱ had a high specificity ( 97. 14%) . FER/AFP/PIVKA had a sensitivity of 92. 31% and the combined measurement of FER, AFP, and PIVKA-Ⅱhad a specificity of 97. 14%. Conclusion Combined measurement of PIVKA-Ⅱ, AFP, and FER can improve the sensitivity and specificity of single measurement. Serum PIVKA-Ⅱ and AFP have a high clinical value in the diagnosis of HCC; single measurement can well assist the diagnosis, and combined measurement does not increase the diagnostic rate.
Prognostic value of preoperative platelet-to-lymphocyte ratio in patients with hepatocellular carcinoma: a Meta-analysis
Li ZhiBin, Xiao DongSheng, Song Wei
2017, 33(9): 1734-1739. DOI: 10.3969/j.issn.1001-5256.2017.09.021
Abstract:
Objective To systematically investigate the prognostic value of preoperative platelet-to-lymphocyte ratio ( PLR) in patients with hepatocellular carcinoma ( HCC) . Methods Medline, EMBASE, Cochrane Library, CNKI, CBM, VIP, and Wanfang Data were searched for studies assessing the association between preoperative PLR and prognosis of HCC published up to January 2017. Two reviewers independently screened the articles according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality, and then a meta-analysis was performed using Rev Man 5. 3 software. The chi-square test was used for the analysis of heterogeneity between studies. Results A total of 18 articles with 4193 patients were included. The meta-analysis showed that compared with those with low PLR, patients with high PLR had significantly lower overall survival ( OS) rate ( hazard ratio [HR]= 1. 74, 95% confidence interval[CI]1. 42-2. 14, P < 0. 001) and disease-free survival rate or relapse-free survival rate ( HR = 1. 76, 95% CI: 1. 56-1. 98, P <0. 001) . The subgroup analysis revealed that patients with high PLR had significantly shorter OS than those with low PLR, regardless of race ( Asian or Caucasian) , treatment method ( surgery, chemotherapy, or multimodality therapy) , sample size ( ≥200 or < 200) , cut-off value of PLR ( ≥150 or < 150) , and NOS score ( ≥7 or < 7) ( all P < 0. 05) . Conclusion High preoperative PLR is closely associated with poor prognosis of HCC patients, suggesting that PLR might be a prognostic factor in HCC patients.
A preliminary analysis of composition and structure of intestinal microbiota in patients with liver cirrhosis or hepatocellular carcinoma
Zhou LengXiao, Han Tao, Liu BaoWen, Gao YingTang, Han HaiYan
2017, 33(9): 1740-1744. DOI: 10.3969/j.issn.1001-5256.2017.09.022
Abstract:
Objective To investigate the differences in intestinal microbiota between patients with liver cirrhosis and those with hepatocellular carcinoma ( HCC) complicated by liver cirrhosis, as well as the association between the change in intestinal microbiota and the development of HCC. Methods A total of 35 patients with chronic liver diseases who were hospitalized in Department of Hepatology in Tianjin Third Central Hospital from December 2015 to May 2016 were enrolled, among whom 20 patients had liver cirrhosis ( liver cirrhosis group) and 15 had HCC complicated by liver cirrhosis ( HCC group) . Fecal samples were collected from all patients, total bacterial DNA was extracted, and Roche 454 sequencing was used to determine the sequence of the V3-V6 viable regions of 16 S r DNA. A bioinformatics analysis was also performed ( species taxonomy, abundance analysis, and diversity analysis) . The t-test was used for comparison of continuous data between groups, and the Mann-Whitney U test was used for comparison of categorical data between groups. Results The mean number of operational taxonomic units ( OTUs) in the samples from the 20 liver cirrhosis patients was 306. 50 ±163. 76, and that in the samples from the 15 HCC patients was 357. 24± 168. 85; there were no significant differences in the number of OTUs and alpha diversity between the two groups of patients ( both P >0. 05) . The bacteria in fecal samples included Actinobacteria, Bacteroidetes, Firmicutes, and Proteobacteria. Genus-species and composition analyses showed that there was a significant difference in relative abundance of various bacteria in the intestine between the liver cirrhosis group and the HCC group, and compared with the HCC group, the liver cirrhosis group had significant increases in the proportions of Actinobacteria ( 0. 21% vs 0. 06%, U =89. 000, P =0. 043) , Bifidobacterium ( 0. 16% vs 0. 04%, U =90. 000, P =0. 046) , and Clostridium ( 0. 13% vs 0. 08%, U = 90. 000, P = 0. 046) and significant reductions in the proportions of Rikenellaceae ( 0. 58% vs 2. 30%, U = 82. 000, P = 0. 023) and Christenellaceae ( 0. 01% vs 0. 08%, U = 84. 500, P = 0. 028) . Conclusion There are significant differences in the composition of intestinal microbiota between patients with liver cirrhosis and those with HCC complicated by liver cirrhosis, while the specific mech anisms of the interaction between the differences and HCC with liver cirrhosis remained unclear.
Effect of arsenic trioxide chemotherapy on survival time in liver cancer patients undergoing liver transplantation
Ji JunSong, Chen Ting, Wang Hui, Wang ChenYi, Zhu XinYing, Yin Hao, Fu ZhiRen
2017, 33(9): 1745-1748. DOI: 10.3969/j.issn.1001-5256.2017.09.023
Abstract:
Objective To investigate whether arsenic trioxide preventive chemotherapy can prolong the survival time of patients with primary liver cancer undergoing liver transplantation. Methods A retrospective analysis was performed for the clinical data of the patients who underwent liver transplantation in Department of Liver Transplantation in Changzheng Hospital from January to December, 2015, and among these patients, 35 ( observation group) received the chemotherapeutic regimen of epirubicin D1 + 5-fluorouracil ( D1-5) and 35 ( control group) received the chemotherapeutic regimen of arsenic trioxide ( D1-14) . Hematological examinations were performed at the beginning and ending of each cycle of treatment, including routine blood test, hepatic and renal function, and tumor markers, and drug side-effects were observed. Chest CT, liver CT, or MRI was performed at the beginning of every two cycles to record tumor recurrence, survival, and death time. The chi-square test was used for comparison of categorical data between groups, the Kaplan-Meier method was used to plot survival curves, and the log-rank test was used to compare survival curves between groups. Results In the observation group, 3 patients experienced a transient increase in alanine aminotransferase after the last chemotherapy; 30 patients experienced the symptoms of water-sodium retention including mild edema in the face and lower limbs in the late stage of treatment, which were improved after diuretic treatment or at the end of treatment. In the control group, 24 patients experienced varying degrees of gastrointestinal reactions such as poor appetite, nausea, and vomiting, which were improved at the end of chemotherapy. The control group had a 1-year survival rate of 85. 7% ( 30/35) , a 2-year survival rate of 47. 4% ( 18/35) , and a 3-year survival rate of 22. 9% ( 8/35) , and the observation group had a 1-year survival rate of 91. 4% ( 32/35) , a 2-year survival rate of 83. 9% ( 26/31) , and a 3-year survival rate of 57. 1% ( 12/21) . There was no significant difference in 1-year survival rate between the two groups ( χ2= 2. 258, P < 0. 05) , and the observation group had significantly higher 2-and 3-year survival rates than the control group ( χ2= 7. 786 and 6. 720, both P < 0. 05) . Survival curves also showed that the observation group had significantly higher 2-and 3-year survival rates than the control group ( χ2= 6. 573, P < 0. 05) . Conclusion Arsenic trioxide has been used for a long time, and with modern and scientific administration, it can improve the survival time of patients with liver cancer undergoing liver transplantation.
Original articles_Biliary diseases
Effect of preoperative biliary drainage on complications and short-term mortality after pancreaticoduodenectomy: a Meta-analysis
He XueRong, Zhang BaoHua, Gong JianPing
2017, 33(9): 1749-1753. DOI: 10.3969/j.issn.1001-5256.2017.09.024
Abstract:
Objective To investigate the effect of preoperative biliary drainage ( PBD) on complications and short-term mortality after pancreaticoduodenectomy ( PD) . Methods Related databases such as Pub Med, Embase, and the Cochrane Library, as well as main gastroenterological journals in the US, were searched for the articles on the effect of PBD on PD published from January 1, 2010 to January 1, 2017. Reviews Manager 5. 3 software was used for the statistical analysis of the incidence rates of total complications, infection, and anastomotic fistula and short-term mortality rate after surgery. Results Eight articles involving 2687 patients were included in the meta-analysis. These patients were divided into PBD group and non-PBD group according to whether they underwent PBD before PD. There was no significant difference in short-term mortality rate between the PBD group and the non-PBD group ( odds ratio [OR]= 1. 19, 95% confidence interval [CI]: 0. 79-1. 80, P = 0. 41) . Compared with non-PBD group, the PBD group had significantly higher incidence rates of total postoperative complications ( OR = 1. 95, 95% CI: 1. 24-3. 06, P = 0. 004) and postoperative infection ( OR = 2. 37, 95% CI: 1. 45-3. 87, P = 0. 000 5) . There was no significant difference in the incidence rate of postoperative anastomotic leak between the two groups ( OR =1. 43, 95% CI: 0. 95-2. 14, P = 0. 09) . Conclusion PBD does not bring benefits to patients'prognosis after surgery and it may increase the incidence rates of total postoperative complications and postoperative infection. Therefore, PBD is not recommended as conventional preoperative treatment for PD.
Risk factors for infectious complications after hepatectomy in patients with intrahepatic bile duct stones
Wang XinWei, Zhao ZongGang
2017, 33(9): 1754-1757. DOI: 10.3969/j.issn.1001-5256.2017.09.025
Abstract:
Objective To investigate the risk factors for infectious complications after hepatectomy in patients with intrahepatic bile duct stones. Methods A retrospective analysis was performed for the clinical data of 168 patients with intrahepatic bile duct stones who underwent hepatectomy in The Fifth People's Hospital of Ji'nan from January 2010 to December 2016. A univariate analysis was performed for potential risk factors for infectious complications after hepatectomy, and the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed for the factors with statistical significance. Results Of all patients, 31 ( 18. 5%) experienced infectious complications after surgery. No patient underwent reoperation and all patients were cured. The univariate analysis showed that age, preoperative albumin level, biliary cirrhosis, interval between surgery and acute cholangitis ( ISAC) , extent of hepatectomy, and choledochoenterostomy were influencing factors for postoperative infectious complications ( χ2= 5. 407, 4. 263, 11. 633, 6. 023, 5. 000, and 5. 815, all P < 0. 05) . The multivariate analysis showed that biliary cirrhosis ( odds ratio [OR]= 3. 028, 95% confidence interval [CI]: 1. 791-5. 121, P = 0. 002) , ISAC < 4 weeks ( OR = 1. 539, 95% CI: 1. 010-2. 345, P = 0. 046) , and choledochoenterostomy ( OR = 2. 389, 95% CI: 1. 261-4. 527, P = 0. 028) were independent risk factors for infectious complications after hepatectomy in patients with intrahepatic bile duct stones. Conclusion Patients with intrahepatic bile duct stones, particularly those with biliary cirrhosis, ISAC < 4 weeks, and choledochoenterostomy, have a high risk of developing infectious complications after hepatectomy. Control and improvement of these factors may help with the early prevention of postoperative infectious complications.
Clinical effect of transumbilical single-port laparoscopic cholecystectomy versus conventional three-trocar laparoscopic cholecystectomy with three holes: a comparative analysis
Li Qi, Wu HaiBin
2017, 33(9): 1758-1761. DOI: 10.3969/j.issn.1001-5256.2017.09.026
Abstract:
Objective To investigate the clinical effect of transumbilical single-port laparoscopic cholecystectomy versus conventional three-trocar conventional laparoscopic cholecystectomy. Methods A total of 62 patients with gallstones or gallbladder polyps who were admitted to Yan'an People's Hospital from January 2015 to December 2016 were enrolled, and according to the admission number, these patients were divided into three-trocar group with 32 patients treated with laparoscopic cholecystectomy with three holes and single-port group with 30 patients treated with single-port laparoscopic cholecystectomy. The two groups were compared in terms of time of operation, intraoperative blood loss, abdominal wall beauty score, Visual Analogue Scale ( VAS) score before surgery and at 1 and 3 days after surgery, application of analgesics, levels of liver function parameters alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , and alkaline phosphatase ( ALP) before surgery and at 24 hours after surgery, hospital costs, and complications during the 1-month follow-up. The t-test was used for comparison of continuous data between groups, and the matched t-test was used for comparison before and after treatment. The chi-square test was used for comparison of categorical data between groups. Results Compared with the three-trocar group, the single-port group had a significantly higher abdominal wall beauty score after treatment ( 4. 89 ± 0. 10 vs 3. 15 ± 0. 34, t = 4. 910, P = 0. 039) , a significantly shorter length of postoperative hospital stay ( 2. 58 ± 0. 53 d vs 4. 35 ± 0. 24 d, t =-5. 459, P = 0. 032) , a significantly longer time of operation ( 78. 15 ± 4. 21 min vs 50. 84 ± 5. 12 min, t = 4. 455, P = 0. 047) , a significantly lower VAS score at 1 and 3 days after surgery ( at 1 day after surgery: 4. 72 ± 0. 58 vs 6. 37 ± 0. 45, t =-7. 060, P < 0. 001; at 3 days after surgery: 3. 24 ± 0. 83 vs 5. 45 ± 0. 94, t =-4. 644, P < 0. 001) , and a significantly lower proportion of patients who used analgesics ( 20. 0% vs 37. 5%, χ2= 6. 768, P = 0. 009) .Both groups had significant increases in the levels of ALT, AST, and ALP after surgery, and the single-port group had significantly lower levels than the three-trocar group ( all P < 0. 001) . During the 1-month follow-up, there was no significant difference in the incidence rate of complications between the two groups ( P > 0. 05) . Conclusion Transumbilical sing-port laparoscopic cholecystectomy has small surgical trauma and invisible scars after surgery. Patients feel little pain and are satisfied with the appearance of skin at the surgical site.This surgical procedure does not increase complications and has little influence on liver function. It needs a longer time of operation compared with three-trocar laparoscopic cholecystectomy.
Original articles_Pancreatic diseases
Clinical effect of laparoscopic internal drainage in treatment of pancreatic pseudocyst
Wan JingLei, Shi YaoPu, Wang Bin, Gong ZhiWen, Yang Hang, Yang YongSheng
2017, 33(9): 1762-1765. DOI: 10.3969/j.issn.1001-5256.2017.09.027
Abstract:
Objective To investigate the clinical effect of laparoscopic internal drainage of pancreatic pseudocyst ( LIDP) versus open surgical internal drainage of pancreatic pseudocyst ( OSIDP) and the feasibility, safety, and superiority of LIDP. Methods A retrospective analysis was performed for the clinical data of 46 patients with pancreatic pseudocyst ( PPC) who underwent internal drainage in China-Japan Union Hospital of Jilin University and The Second Hospital of Jilin University from June 2011 to August 2016, and among these patients, 22 underwent LIDP ( LIDP group) and 24 underwent OSIDP ( OSIDP group) . The two groups were compared in terms of preoperative general status ( sex, age, and size of the cyst) , intraoperative conditions ( time of operation and intraoperative blood loss) , and postoperative conditions ( time to first flatus, time to first meal, length of postoperative hospital stay, hospital cost, and complications) . The t-test was used for comparison of normally distributed continuous data with homogeneity of variance between groups, and the t'test was used for continuous data with heterogeneity of variance; the Pearson chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. Results There were significant differences between the two groups in intraoperative blood loss ( 87. 72 ± 24. 48 ml vs 103. 75 ±26. 83 ml, P < 0. 05) , time to first flatus after surgery ( 3. 00 ± 1. 02 d vs 3. 79 ± 1. 10 d, t =-2. 517, P = 0. 016) , time to first meal after surgery ( 3. 09 ± 0. 97 d vs 3. 87 ± 0. 99 d, t =-2. 705, P = 0. 010) , length of postoperative hospital stay ( 4. 90 ± 1. 54 d vs 8. 66 ± 3. 71 d, t =-4. 548, P < 0. 001) , and hospital cost ( 43 402. 06 ± 6424. 47 yuan vs 37 668. 45 ± 11 249. 01 yuan, t = 2. 097, P = 0. 042) . Of all 22 patients in the LIDP group, 2 ( 9. 09%) experienced the postoperative complication of biochemical leakage; of all 24 patients in the OSIDP group, 4 ( 16. 67%) experienced postoperative complications ( 2 patients with biochemical leakage and 2 with grade B pancreatic fistula) , among whom 2 patients were complicated by bleeding. Conclusion LIDP has the advantages of small trauma, clear visual field, low intraoperative blood loss, fast postoperative recovery, short length of hospital stay, and low incidence of complications. Compared with OSIDP, LIDP does not increase the time of operation, but it leads to a significant increase in average hospital cost. This surgical procedure is simple and easy and does not have high requirements for surgical equipment, and therefore, it holds promise for clinical application.
Original articles_Others
Clinical features of alcoholic liver disease: a clinical analysis of 206 cases
Gao GuangFu, Zhang ShuFeng, Wang ZhangWu, Gao HongWei
2017, 33(9): 1766-1768. DOI: 10.3969/j.issn.1001-5256.2017.09.028
Abstract:

Objective To investigate the clinical features of alcoholic liver disease, and to provide a theoretical basis for the development of control strategy for this disease. Methods The clinical data of 206 patients with alcoholic liver disease who were admitted to The Fifth Affiliated Hospital of Zhengzhou University from January 2011 to December 2016 were collected. The different types of alcoholic liver disease were analyzed, as well as the proportion of patients with alcoholic liver disease among all patients with liver diseases and its change trend from 2011 to 2016. The age distribution characteristics of patients with different types of alcoholic liver disease were analyzed, and the types of alcoholic liver disease in 2011-2013 were compared with those in 2014-2016. The chi-square test was used for comparison of categorical data between groups. Results The patients with alcoholic cirrhosis accounted for 69. 90% ( 144/206) , followed by those with alcoholic hepatitis ( 19. 42%) . The proportion of patients with alcoholic liver disease among all patients with liver diseases gradually increased from 2011 to 2016. Of all patients with alcoholic liver disease, the patients aged 40-60 years accounted for 66. 99% ( 138/206) . Patients aged 40-60 years had the highest incidence rate of alcoholic fatty liver disease, and those aged > 60 years had a significantly lower incidence rate than the other patients ( χ2= 8. 16, P = 0. 01) . Of all the patients aged 40-60 years, 18. 84% ( 26/138) had alcoholic hepatitis, 68. 84% ( 95/138) had alcoholic cirrhosis, and 5. 07% ( 7/138) had alcoholic acute-on-chronic liver failure. Among the patients with alcoholic liver disease who were admitted from 2014 to 2016, 73. 20% had alcoholic cirrhosis, which was significantly higher than the proportion of patients with alcoholic cirrhosis ( 60. 38%) from 2011 to 2013 ( χ2= 9. 24, P < 0. 05) . Conclusion Alcoholic liver disease is commonly seen in patients aged40-60 years. Early diagnosis of alcoholic liver disease should be enhanced in clinical practice to delay or reverse liver fibrosis and cirrhosis.

An epidemiological survey of alcoholic liver disease among staff of Yanchang Oilfield
Li QianNan, Chang JianBo, Bai YanXia, Wan Yan, Bi JianHong, Dai GuangRong
2017, 33(9): 1769-1773. DOI: 10.3969/j.issn.1001-5256.2017.09.029
Abstract:

Objective To investigate the prevalence of alcoholic liver disease ( ALD) among the staff of Yanchang Oilfield and related risk factors. Methods The physical examination data were collected from the staff of Yanchang Oilfield in June 2016, and all the staff underwent anthropometric measurement ( body height, body weight, and blood pressure) , laboratory examinations ( routine blood test, liver function, blood lipids, blood glucose, and viral markers) , and upper abdominal ultrasound and completed the questionnaire. The chi-square test was used for comparison of categorical data between groups, and logistic regression was used for multivariate analysis. Results A total of 6723 employees participated in the study, among whom 397 had ALD, and the prevalence rate of ALD was 5. 91%. Compared with female staff, male staff had significantly higher drinking rate ( 65. 07% vs 15. 75%, χ2= 1107. 48, P < 0. 001) and prevalence rate of ALD ( 7. 20% vs 1. 11%, χ2= 75. 34, P < 0. 001) . Male population was the major group for alcohol consumption. There was a significant difference in the prevalence rate of ALD between the staff with different degrees of education ( χ2= 86. 598, P < 0. 001) . The obese group had a significantly higher prevalence rate of ALD than the non-obese group ( 17. 70% vs 9. 27%, χ2= 40. 698, P < 0. 001) . With the increases in drinking volume and drinking years, the prevalence rate of ALD gradually increased, and there was a significant difference in the prevalence rate of ALD between the staff with different daily drinking volumes and drinking years ( χ2= 1147. 428 and 116. 542, both P <0. 001) . With the increase in daily drinking volume, the abnormal rates of gamma-glutamyl transpeptidase ( GGT) , alanine aminotransferase, and aspartate aminotransferase ( AST) gradually increased ( χ2= 250. 013, 199. 027, and 151. 459, all P < 0. 001) ; with the increase in drinking years, the abnormal rates of GGT and AST gradually increased, with a significant increase in the abnormal rate of GGT ( χ2= 27. 158, P < 0. 001) . There were significant differences between the drinking group and the control group in the abnormal rates of liver function, blood pressure, blood lipids, body mass index, and mean corpuscular volume ( χ2= 51. 272, 9. 988, 316. 430, 80. 675, and 13.570, all P < 0. 05) . The multivariate analysis showed that age, male sex, obesity, daily drinking volume, drinking pattern, degree of education, GGT, AST, and mean corpuscular volume were closely associated with the development of ALD ( all P < 0. 05) . Conclusion There is a high prevalence rate of ALD among the staff of Yanchang Oilfield. Sex, age, degree of education, drinking volume, drinking pattern, and obesity are major influencing factors for ALD in adults in this region.

Expression of hepcidin and interleukin-6 and their correlation in liver inflammation process in a rat model of nonalcoholic fatty liver disease
Zhao Rui, Li Juan, Wang Liang, Kong Yin, Ding Jie, Wang JuanXia, Li GuangMing, Zhang LingYi
2017, 33(9): 1774-1777. DOI: 10.3969/j.issn.1001-5256.2017.09.030
Abstract:

Objective To investigate the changes in the expression of hepcidin ( Hepc) and interleukin-6 ( IL-6) in liver inflammation process in a rat model of nonalcoholic fatty liver disease ( NAFLD) . Methods The rats were given high-fat emulsion by gavage to establish the model of NAFLD ( group M) and normal rats were given normal saline by gavage as controls ( group C) . Liver tissue samples were collected from these rats, and immunohistochemistry was used to measure the expression of Hepc and IL-6 in liver tissue in group M at 4, 8, and 12weeks ( M4, M8, and M12groups) and in group C at 12 weeks ( C12group) . The NAFLD activity score ( NAS) was assessed for both groups.The expression of Hepc and IL-6 in liver tissue was measured, and NAS was calculated. A one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for comparison between two groups. Pearson correlation analysis was also performed. Results Over the course of treatment, the M4, M8, and M12 groups had gradual increases in the expression of Hepc and IL-6, and there were significant differences between these groups and the C12group ( Hepc: 0. 372 ± 0. 216/1. 213 ± 0. 193/2. 390± 0. 192 vs 0. 166 ± 0. 192, all P < 0. 05; IL-6: 0. 499 ± 0. 218/1. 290 ± 0. 210/2. 644 ± 0. 441 vs 0. 240 ± 0. 109, all P < 0. 05) . In group M, the expression of Hepc was positively correlated with that of IL-6 ( r = 0. 944, P < 0. 05) , and the expression Hepc and IL-6 was positively correlated with NAS ( r = 0. 927 and 0. 907, both P < 0. 001) . Conclusion Based on the results of this preliminary study, liver inflammation process in NAFLD can upregulate the expression of Hepc and IL-6 in liver tissue, and Hepc is significantly correlated with the inflammatory factor IL-6. Further studies are needed to investigate the roles of Hepc and IL-6 in predicting the progression of NAFLD.

Case reports
A case of post-hepatitis B cirrhosis complicated by hepatic myelopathy
Guo FengChang, Fu Xing, Zheng RuiQi, Hu YuLin
2017, 33(9): 1778-1779. DOI: 10.3969/j.issn.1001-5256.2017.09.031
Abstract:
A case of liver cirrhosis with hepatocellular adenoma
Qi ChuanWang, Sun Zhe
2017, 33(9): 1780-1781. DOI: 10.3969/j.issn.1001-5256.2017.09.032
Abstract:
Primary malignant melanoma of the gallbladder: a case report
Chen ShanPeng, Wang ZhiXiang, Zhang XiaoDi, Wei ZhiLi, Tian Wei
2017, 33(9): 1782-1783. DOI: 10.3969/j.issn.1001-5256.2017.09.033
Abstract:
IgG4-negative autoimmune pancreatitis: a report of 2 cases and literature review
Yang JianLin, Ji HuiFan, Han Fei, Guo XiaoLin
2017, 33(9): 1784-1786. DOI: 10.3969/j.issn.1001-5256.2017.09.034
Abstract:
A case of splenic littoral cell angioma
Jia Feng, Jin Kai, Liu XiangLiang, Yu SongYan, Liu YaHui
2017, 33(9): 1787-1788. DOI: 10.3969/j.issn.1001-5256.2017.09.035
Abstract:
Reviews
Current status of medical reimbursement for chronic hepatitis B and related countermeasures: an investigation in 333 prefecture-level cities
Wu JinXin, Lei Chuang, Hou JinLin
2017, 33(9): 1789-1793. DOI: 10.3969/j.issn.1001-5256.2017.09.036
Abstract:
An investigation of the special policies for chronic diseases in medical insurance for urban employees and residents has been conducted in 333 prefecture-level cities in China, and the results showed that 78% of all cities included chronic hepatitis B ( CHB) in medical reimbursement for urban employees and 57% included CHB in medical reimbursement for urban residents. However, there are still some issues to be resolved, such as inconsistent descriptions of the diagnosis of CHB-related diseases, inconsistent diagnostic criteria, lack of standardization of reimbursement process, infringement of patient privacy, and inadequate dose prescribed for CHB patients in the outpatient service. Therefore, we suggested that the Ministry of Human Resources and Social Security should introduce unified policies to include CHB in medical reimbursement, unify disease name and diagnostic criteria, standardize the reimbursement process for CHB, and increase the prescribed dose.
Role of DNA recognition receptors in pathogenic mechanism of hepatitis B
Huang Jing, Pang XiuQing, Xie DongYing
2017, 33(9): 1794-1797. DOI: 10.3969/j.issn.1001-5256.2017.09.037
Abstract:
As a global disease, hepatitis B still threatens human health. However, the pathogenesis of hepatitis caused by HBV remains unclear. The innate immune system in the liver can detect HBV infection and use every strategy to eliminate the virus. DNA recognition receptors play an important role in this process; they recognize HBV DNA or pgRNA in cytoplasm or nucleus, activate innate immunity through various signaling pathways to produce inflammatory cytokines and interferon, and finally exert their antiviral effect. This article summarizes the DNA recognition receptors involved in inflammation induced by HBV and HBV clearance, elaborates on their detailed pathways, and discusses the issues regarding the role of DNA recognition receptors in liver innate immunity induced by HBV and related perspectives.
Research advances in the sphingosine kinase signaling pathway in liver fibrosis
Sun Yue, Lan Tian, Guo Jiao
2017, 33(9): 1798-1801. DOI: 10.3969/j.issn.1001-5256.2017.09.038
Abstract:
Formation of liver fibrosis mainly involves activation of hepatic stellate cell and imbalance between synthesis and degradation of extracellular matrix. The sphingosine kinase ( Sph K) /sphingosine 1-phosphate ( S1P) /sphingosine 1-phosphate receptors ( S1PRs) signaling pathway plays an important role in the regulation of cell life activities including proliferation, migration, and inflammatory response.This article introduces the distribution and biological functions of Sph K, S1P, and S1PRs and elaborates on the research advances in mechanism of action of the Sph K/S1P/and S1PRs signaling pathway in liver fibrosis. Many studies have confirmed the important role of the Sph K/S1P/and S1PRs signaling pathway in liver fibrosis, and in-depth exploration helps to provide new thoughts for clinical treatment of liver fibrosis and development of new drug targets.
Research advances in predisposing factors for acute-on-chronic hepatitis B liver failure
Zheng Ying, Li YongGuo
2017, 33(9): 1802-1805. DOI: 10.3969/j.issn.1001-5256.2017.09.039
Abstract:
HBV is the cause of acute-on-chronic liver failure in most patients, and therefore, acute-on-chronic hepatitis B liver failure is one of the most challenging public health issues at present. Long-term administration of nucleos ( t) ide analogues, abuse of various drugs, and change in drinking habits caused by economic and cultural diversity contribute to the complex predisposing factors for acute-on-chronic hepatitis B liver failure. An analysis of these reasons can help to prevent the development of acute-on-chronic hepatitis B liver failure in the early stage and reduce mortality rate.
Value of serum cholinesterase in diagnosis/treatment and prognostic evaluation of liver diseases
Kong Jian, Xiang XiaoXing
2017, 33(9): 1806-1809. DOI: 10.3969/j.issn.1001-5256.2017.09.040
Abstract:
Serum cholinesterase ( ChE) is synthesized by hepatic parenchymal cells and is released into blood immediately after synthesis, and therefore, serum ChE can be used as an objective and sensitive indicator of liver function. Serum ChE has been used as an independent factor for the evaluation of liver function for a long time and can reflect the synthetic function of the liver and help to determine the severity of liver diseases. Combined measurement of serum ChE and serum prealbumin, total cholesterol, total bile acid, and prothrombin time has an important value in the diagnosis and treatment of liver diseases. At the same time, serum ChE combined with Child-Turcotte-Pugh score or MELD score can accurately evaluate liver reserve function, which may help with the prognostic evaluation of patients with liver diseases.
Research advances in the association between interleukin-17 and liver diseases
Yang PuJuan, Huang Yi, Liu HuaBao
2017, 33(9): 1810-1814. DOI: 10.3969/j.issn.1001-5256.2017.09.041
Abstract:
Interleukin-17 ( IL-17) is a proinflammatory factor produced by T helper 17 cells and can induce a variety of chemokines which participate in the body's immunoregulation and inflammatory response. IL-17 can activate various liver cells to produce inflammatory mediators and secrete proinflammatory factors and thus regulate liver inflammation. IL-17 is upregulated in many liver diseases, such as virus hepatitis, fatty liver disease, autoimmune liver diseases, and parasite infection in the liver, and it can promote the development and progression of liver cirrhosis and liver cancer and is associated with liver failure and rejection reaction in liver transplantation. This article reviews the research advances in the role of IL-17 in liver diseases.
Research advances in the association between exosomes and liver diseases
Wu JunCheng, Xu MingYi
2017, 33(9): 1815-1819. DOI: 10.3969/j.issn.1001-5256.2017.09.042
Abstract:
Exosomes are extracellular vesicles with a diameter of 30-100 nm formed during the processes of“endocytosis-fusion-exocytosis”. Exosomes can be released by various types of cells and may carry important biological molecules, such as lipids, proteins, and nucleic acids. They are also involved in signal transduction and exchange of substances between cells and can regulate the physiological and pathological processes in various systems. They also play an important role in liver diseases, including liver cancer, viral hepatitis, liver fibrosis, and alcoholic and non-alcoholic fatty liver disease. This article reviews the research advances in exosomes in liver diseases.
Research advances in animal models of obstructive jaundice
Luo WeiWei, Yu ShuiPing
2017, 33(9): 1820-1823. DOI: 10.3969/j.issn.1001-5256.2017.09.043
Abstract:
Obstructive jaundice is a common disease that greatly threatens human health. In order to better investigate the pathogenesis of obstructive jaundice, pathophysiological changes during disease progression, and treatment measures, the establishment of a stable animal model of obstructive jaundice becomes the basis for the research on various types of obstructive jaundice. This article elaborates on the advantages and disadvantages of the animal models of acute, progressive, chronic fluctuant, malignant, and reducible obstructive jaundice, as well as their application in clinical practice. These animal models have certain limitations in reflecting the development and progression of target disease. Most animal models are established by surgery or external physical and chemical damage, and there are still no mouse models of gene knockout or overexpression. Future research will focus on the stable animal models of chronic and progressive obstructive jaundice and special types of obstructive jaundice.