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

2018 No. 5

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Original articles_Liver fibrosis and liver cirrhosis
Value of serum alpha-fetoprotein in predicting liver fibrosis in patients with chronic hepatitis B
Cheng WanQiu, Guan ShiHe, Zhang Hao, Yang Kai, Chen ZhiDong, Shao XuanXuan
2018, 34(5): 1015-1019. DOI: 10.3969/j.issn.1001-5256.2018.05.018
Abstract:
Objective To investigate the correlation between serum alpha-fetoprotein ( AFP) and classification of liver fibrosis in patients with chronic hepatitis B ( CHB) , as well as the value of serum AFP in predicting liver fibrosis in CHB patients. Methods A total of 286 patients with a confirmed diagnosis of CHB who were hospitalized in our hospital from May 2015 to May 2017 were enrolled, and 150 healthy adults who underwent physical examination at the Physical Examination Center in our hospital from March 2016 to June 2017 and had qualified results were enrolled as healthy control group. Liver biopsy was performed for CHB patients, and related hematological parameters were measured, including platelet count ( PLT) , alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , total bilirubin ( TBil) , albumin ( Alb) , globulin ( GLB) , alkaline phosphatase ( ALP) , gamma-glutamyl transpeptidase ( γ-GGT) , AFP, HBV DNA, and hepatitis B surface antigen ( HBs Ag) . The independent samples t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for non-normally distributed continuous data between groups; a Spearman correlation analysis was used to investigate the correlation between AFP and clinical indices; the receiver operating characteristic ( ROC) curve was used to evaluate the sensitivity and specificity of serum AFP level in predicting liver fibrosis. Results Of all 286 CHB patients, 19 had S0 liver fibrosis, 156 had S1 liver fibrosis, 52 had S2 liver fibrosis, 39 had S3 liver fibrosis, and 20 had S4 liver fibrosis; the Spearman correlation analysis showed that serum AFP level was positively correlated with the classification of liver fibrosis ( r = 0. 373, P < 0. 000 1) . There was a significant difference in serum AFP level between the CHB group and the healthy control group [2. 89 ( 1. 87-5. 59) ng/ml vs 2. 11 ( 1. 21-3. 10) ng/ml, P = 0. 0027]. There was also a significant difference in serum AFP level between the CHB patients with insignificant liver fibrosis and those with significant liver fibrosis [2. 51 ( 1. 70-3. 81) ng/ml vs 4. 17 ( 2. 42-14. 06) ng/ml, P = 0. 0069]. In CHB patients, serum AFP level was positively correlated with ALT ( r = 0. 393, P < 0. 000 1) , AST ( r = 0. 419, P < 0. 000 1) , and HBV DNA ( r = 0. 231, P < 0. 05) . There was no significant correlation between AFP level and HBs Ag ( r = 0. 154, P > 0. 05) . The correlation analysis showed that serum AFP level was positively correlated with aspartate aminotransferase-to-platelet ratio index in CHB patients ( r =0. 342, P < 0. 000 1) . The ROC curve was used to investigate the value of serum AFP level in predicting liver fibrosis, and the results showed that at the cut-off value of 3. 8 ng/ml, serum AFP level had a specificity of 84. 92%, a sensitivity of 37. 41%, and an area under the ROC curve of 0. 674 ( P < 0. 0001) , with a 95% confidence interval of 2. 03-8. 00 ng/ml. Conclusion In CHB patients, serum AFP level increases with the increase in liver fibrosis grade, and therefore, it has a good clinical value in evaluating significant liver fibrosis.
Association of HBV precore/core promoter variants with the degree of liver fibrosis in patients with HBeAg-positive chronic hepatitis B
Shi HaiYan, Li LiYa, He HaoLan, Liu HuiYuan, Chen ZhiMin, Chen WeiLie, Liao BaoLin
2018, 34(5): 1020-1024. DOI: 10.3969/j.issn.1001-5256.2018.05.019
Abstract:
Objective To investigate the association of hepatitis B virus ( HBV) precore/core promoter variants with liver pathological changes in patients with HBe Ag-positive chronic hepatitis B ( CHB) . Methods A total of 148 HBe Ag-positive CHB patients who were hospitalized in Guangzhou Eighth People's Hospital from April 2012 to December 2013, underwent liver biopsy, and had stored frozen serum samples were enrolled. Serum DAN was extracted and then nested PCR was used for the multiplication and sequencing of the HBV precore/core promoter region. The Mann-Whitney U test was used for comparison of continuous data with heterogeneity of variance between two groups, and the chi-square test was used for comparison of categorical data between two groups; a logistic regression analysis was performed to identify the parameters associated with marked liver fibrosis. Results Of all patients, 116 ( 78. 4%) were found to have marked liver fibrosis ( ≥S2) by liver biopsy. Among the patients with ALT ≤upper limit of normal, 10 ( 58. 8%) had marked liver fibrosis; 11. 8% had T1753 V mutation, 35. 3% had A1762 T/G1764 A mutation, and 5. 9% had G1896 A mutation. The univariate logistic regression analysis showed that HBV A1762 T/G1764 A and G1896 A mutations were significantly associated with marked liver fibrosis ( P < 0. 05) , while age, sex, HBV genotype, and other HBV mutations were not associated with marked liver fibrosis. The multivariate logistic regression analysis showed that HBV A1762 T/G1764 A mutation ( odds ratio [OR]= 7. 098, P < 0. 001) and G1896 A mutation ( OR = 16. 816, P = 0. 007) were independently associated with marked liver fibrosis. Conclusion HBV precore/core promoter variants can be used as the risk factors for marked liver fibrosis in HBe Ag-positive CHB patients.
Original articles_Liver neoplasms
Clinical effect and safety of percutaneous radiofrequency ablation versus microwave ablation in treatment of hepatocellular carcinoma:a Meta-analysis
Yan JinZhu, Weng Hong, Zhang Chao, Wang Yuan, Yang Jian, Peng XinYu
2018, 34(5): 1025-1032. DOI: 10.3969/j.issn.1001-5256.2018.05.020
Abstract:
Objective To investigate the clinical effect and safety of percutaneous radiofrequency ablation ( RFA) versus microwave ablation ( MWA) in the treatment of hepatocellular carcinoma ( HCC) using the meta-analysis and trial sequential analysis ( TSA) . Methods Pub Med, The Cochrane Library ( Issue 6, 2017) , EMbase, CNKI, VIP, CBM, and Wanfang Data were searched for randomized controlled trials ( RCTs) and cohort studies about RFA versus MWA in the treatment HCC published up to June 2017. Two reviewers independently screened the articles, extracted data, and evaluated their quality. Rev Man 5. 3 was used for the meta-analysis, and TSA v0. 9 Beta was used for TSA. Results A total of 6 RCTs and 11 cohort studies were included, with 1782 patients in total. The meta-analysis showed that there were no significant differences between RFA and MWA in complete ablation rate ( odds ratio [OR]= 0. 88, 95% confidence interval [CI]: 0. 63-1. 22, P = 0. 44) , overall local recurrence rate ( OR = 1. 2, 95% CI: 0. 90-1. 59, P = 0. 21) , and 1-and 3-year overall survival rates ( 1-year: OR = 0. 72, 95% CI: 0. 45-1. 14, P = 0. 16; 3-year: OR = 1. 13, 95% CI: 0. 85-1. 50, P = 0. 41) .The subgroup analysis showed that in patients with a tumor diameter of ≤3 cm or 3-5 cm, there were no significant differences in complete ablation rate and local recurrence rate between RFA and MWA, while the MWA group had a significantly shorter ablation time than the RFA group ( MD = 8. 08, 95% CI: 4. 79-11. 37, P < 0. 001) . As for the incidence rate of adverse events, the MWA group had significantly higher incidence rates of liver pain and postoperative pyrexia than the RFA group ( P = 0. 02 and P < 0. 01) . TSA was performed for complete ablation rate, local recurrence rate, and 3-year survival rate, and the results showed that more studies were needed to support this evidence. Conclusion RFA and MWA have a similar clinical effect in the treatment of HCC, and compared with RFA, MWA has a shorter time of operation and a higher incidence rate of complications.
Risk factors for infectious complications in primary liver cancer
Liu HongJin, Bao ChunMei, Bai WenLin, Li YinYin, Rong GuangHua, Lu YinYing, Chen Yan, Liu Ze, Cheng JiaMin, Ceng Zhen
2018, 34(5): 1033-1037. DOI: 10.3969/j.issn.1001-5256.2018.05.021
Abstract:
Objective To investigate the risk factors for infectious complications in patients with primary liver cancer. Methods A retrospective analysis was performed for the clinical data of 3034 patients with primary liver cancer who were admitted to 302 Hospital of PLA from February 2016 to February 2017, and among these patients, 297 experienced infectious complications and 2737 did not experience infectious complications; 153 patients with infectious complications were enrolled as infection group, and 46 without infectious complications were enrolled as non-infection group. There were 133 male and 20 female patients aged 34-75 years ( mean 56. 41 ± 6. 69 years) in the infection group, and 37 male and 9 female patients aged 47-74 years ( mean 57. 52 ± 11. 12 years) in the non-infection group. The association between possible risk factors and infectious complications in patients with primary liver cancer was analyzed. The t test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank sum test was used for comparison of continuous data with skewed distribution between two groups. The chi-square test was used for univariate analysis, and the multivariate logistic regression analysis was used for multivariate analysis. Results The multivariate logistic regression analysis showed that age ≤60 years ( OR = 5. 048, P <0. 001) , long course of hepatitis B and liver cancer ( OR = 2. 446, P = 0. 035, OR = 0. 433, P = 0. 016) , high HBV DNA ( OR = 2. 618, P =0. 005) , high white blood cell count ( OR = 1. 170, P = 0. 001) , high levels of alpha-fetoprotein ( AFP) ( OR = 0. 470, P = 0. 032) , alkaline phosphatase ( OR = 1. 004, P = 0. 004) , and gamma-glutamyl transpeptidase ( OR = 1. 004, P = 0. 006) , high Child-Pugh score ( OR = 0. 167, P = 0. 004) , low albumin ( OR = 0. 999, P < 0. 001) and cholinesterase ( OR = 0. 834, P < 0. 001) , long prothrombin time ( OR = 1. 299, P = 0. 007) , large maximum tumor diameter ( OR = 0. 389, P < 0. 005) , and presence of portal vein tumor thrombus ( OR =2. 378, P = 0. 018) were independent risk factors for infection in patients with primary liver cancer and HBV infection ( all P < 0. 05) . Conclusion Infection in patients with primary liver cancer is associated with risk factors including age of onset, course of hepatitis B and liver cancer, tumor diameter, portal vein tumor thrombus, HBV DNA and AFP levels, and liver function, which should be taken seriously in clinical practice. Active measures should be adopted to reduce infectious complications.
Risk factors for vascular invasion of primary liver cancer
Chang XiuJuan, Lu YinYing, Rong GuangHua, Liu Ze, Chen Yan, Xu GuiLin, Gao XuDong, Lou Min, Wang ChunPing, Yang YongPing, Ceng Zhen
2018, 34(5): 1038-1041. DOI: 10.3969/j.issn.1001-5256.2018.05.022
Abstract:
Objective To investigate the risk factors for vascular invasion of primary liver cancer ( PLC) . Methods A retrospective analysis was performed for the clinical data of 211 patients with liver cancer who were hospitalized in 302 Hospital of PLA from January 2013 to June 2014. The logistic regression model fitting was used for the data of 133 patients, and the data of the other 78 patients was used for the verification of this model. Univariate and multivariate logistic regression analyses were used to identify the influencing factors for vascular invasion of PLC; the logistic regression model was established and the receiver operating characteristic ( ROC) curve was plotted to determine the optimal cut-off value of this model. Results The univariate logistic regression analysis showed that tumor diameter ( odds ratio [OR]= 1. 594, 95% confidence interval [CI]: 1. 376-1. 846, P = 0) , neutrophil-lymphocyte ratio ( NLR) ( OR = 2. 783, 95% CI: 1. 847-4. 195, P = 0) , platelet-to-lymphocyte ratio ( PLR) ( OR = 1. 016, 95% CI: 1. 008-1. 024, P = 0) , fibrinogen ( Fb) ( OR = 2. 295, 95% CI: 1. 608-3. 274, P = 0) , and lymph node metastasis ( OR = 11. 664, 95% CI: 3. 744-36. 338, P = 0) were risk factors for vascular invasion of PLC; the multivariate logistic regression analysis showed that tumor diameter ( OR = 1. 506, 95% CI: 1. 250-1. 815, P =0) , PLR ( OR = 1. 499, 95% CI: 0. 173-0. 998, P = 0. 022) , NLR ( OR = 2. 491, 95% CI: 1. 411-4. 397, P = 0. 002) , and Fb ( OR = 1. 486, 95% CI: 1. 008-2. 193, P = 0. 046) were used for regression model fitting. The area under the ROC curve was 0. 927 ( 95% CI: 0. 881-0. 973) , and the ROC curve showed that the model had the highest sensitivity of 92. 9%, the highest specificity of86. 5%, and a prediction accuracy rate of 82. 79%. Conclusion The regression equation containing tumor diameter, PLR, NLR, and Fb established in this study has a high prediction accuracy of vascular invasion of PLC and provides a reference for early warning of vascular invasion of PLC.
Ultrasound features of hepatic inflammatory myofibroblastic tumor:a report of 4 cases
Shen Peng, Tang ShaoShan
2018, 34(5): 1042-1045. DOI: 10.3969/j.issn.1001-5256.2018.05.023
Abstract:
Objective To investigate the ultrasound features of hepatic inflammatory myofibroblastic tumor ( HIMT) . Methods A retrospective analysis was performed for the ultrasound features of 4 patients who visit Shengjing Hospital from February 2007 to July 2017 with pathologically confirmed HIMT, including the location, size, boundary, morphology, internal echo, and blood flow of lesions. Results The patients were aged 2-69 years and there were 2 male and 2 female patients. All 4 patients had single tumor with a maximum diameter of 3. 4-21. 2 cm. Two patients had clear boundaries and two had unclear boundaries. Two patients had solid tumor with inhomogeneous low echo and 2 had mixed cystic and solid type; color Doppler flow imaging found blood flow signal in tumor in all patients. Conclusion Ultrasound can clearly reveal the size, internal echo, and blood flow of HIMT, but the ultrasound images of HIMT lack specificity. Pathological examination is still needed for a confirmed diagnosis.
Original articles_Biliary diseases
Value of preoperative and postoperative carbohydrate antigen 19-9 levels in predicting prognosis and early recurrence in patients with hilar cholangiocarcinoma
Cha YuFeng, He XiaoHu, Tian Mian, Gao Jun, Wang Gang
2018, 34(5): 1046-1051. DOI: 10.3969/j.issn.1001-5256.2018.05.024
Abstract:
Objective To investigate the value of preoperative and postoperative carbohydrate antigen 19-9 ( CA19-9) levels in predicting the prognosis and early recurrence of patients with hilar cholangiocarcinoma ( HCCA) . Methods A total of 80 patients with HCCA who underwent radical resection in The Second Affiliated Hospital of Shaanxi University of Chinese Medicine from January 2001 to December2013 were enrolled. According to their medical records and examination results, the clinical data including age and sex were recorded. Electrochemical luminescence was used to measure the serum level of CA19-9. The cut-off points of preoperative and postoperative CA19-9 levels in predicting the survival rate of HCCA patients were divided into ≤100 U/ml and > 100 U/ml groups, ≤150 U/ml and > 150 U/ml groups, ≤200 U/ml and > 200 U/ml groups, and ≤400 U/ml and > 400 U/ml groups. The Kaplan-Meier method was used to compare the survival rate between CA19-9 ≤150 U/ml group and CA19-9 > 150 U/ml group, as well as between increased CA19-9 group, ≤50% reduction in CA19-9 group, and > 50% reduction in CA19-9 group. Univariate and multivariate non-conditional logistic regression analyses were used to analyze the association of preoperative and postoperative CA19-9 levels with clinical data. 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 There was a significant difference in the prediction of survival time of HCCA patients undergoing radical resection between the cut-off points of preoperative CA19-9 of 100, 150, 200, and 400 U/ml ( t = 2. 85, 3. 66, 2. 84, and 2. 55, P < 0. 05) , as well as between the cut-off points of postoperative CA19-9 of 100, 150, 200, and 400 U/ml ( t = 3. 06, 4. 55, 3. 08, and 5. 15, P < 0. 05) . The Kaplan-Meier survival analysis showed that the HCCA patients undergoing radical resection with a preoperative CA19-9 level of ≤150 U/ml had a significantly higher survival rate than those with a preoperative CA19-9 level of > 150 U/ml ( P < 0. 05) ; the HCCA patients undergoing radical resection with a postoperative CA19-9 level of ≤150 U/ml had a significantly higher survival rate than those with a postoperative CA19-9 level of > 150 U/ml ( P < 0. 05) . The HCCA patients who underwent radical resection and had an increase in CA19-9 after surgery had a significantly higher survival rate than those who had a ≤50% or > 50% reduction in CA19-9 after surgery ( both P < 0. 05) .The univariate and multivariate analyses showed that in HCCA patients undergoing radical resection, the preoperative CA19-9 level was associated with lymph node metastasis and early recurrence ( both P < 0. 05) and the postoperative CA19-9 level was associated with early recurrence ( P < 0. 05) . Conclusion Preoperative and postoperative CA19-9 levels can be used to predict survival and early recurrence of patients with resectable HCCA. An increase in CA19-9 level after surgery may cause early recurrence and poor survival outcome in patients with HCCA.
Case reports
Traditional Chinese medicine treatment of methotrexate-induced liver injury with liver cirrhosis:a case report
Chen Xi, Lu Lu, Gu HongTu, Sun MingYu
2018, 34(5): 1080-1082. DOI: 10.3969/j.issn.1001-5256.2018.05.030
Abstract:
Intraductal papillary neoplasm of bile ducts with focal cancer infiltration:a case report
Liu ShouLing, Zhang JianWei, Wu Hao, Zhou JianPeng, Wei Feng, Wang GuangYi
2018, 34(5): 1083-1085. DOI: 10.3969/j.issn.1001-5256.2018.05.031
Abstract:
Roxithromycin-induced autoimmune hepatitis:a case report
Sheng JianHui, Sun Li, Tan HuiYing, Tan YouWen
2018, 34(5): 1086-1087. DOI: 10.3969/j.issn.1001-5256.2018.05.032
Abstract:
Systemic lupus erythematosus with primary biliary cholangitis:a case report
Wei LiNa, Song Jie, Ma JingTing, Zhao Rui, Wang WuDong, Li DongFu
2018, 34(5): 1088-1090. DOI: 10.3969/j.issn.1001-5256.2018.05.033
Abstract:
A case of liver injury due to intravenous injection of amiodarone
Zhang WenYing, Xu Yan, Shu Bing
2018, 34(5): 1091-1093. DOI: 10.3969/j.issn.1001-5256.2018.05.034
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IgG4-associated sclerosing cholangitis misdiagnosed as hilar cholangiocarcinoma:a case report
Xie QianKun, Shi XiaoJu, Hu YueLei, Chai WenGang, Lu: GuoYue
2018, 34(5): 1094-1095. DOI: 10.3969/j.issn.1001-5256.2018.05.035
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Incisional pyogenic granuloma with hyaline change after biliary exploration:a case report
Xie ZhiQin, Wang TaoLi, Chen Xun, Li HongXia, Tang CaiXi, Zhu ZeMin
2018, 34(5): 1096-1097. DOI: 10.3969/j.issn.1001-5256.2018.05.036
Abstract:
Reviews
Development and prospects of pathological classification systems for chronic hepatitis
Chen YangYi, Liu ChengHai
2018, 34(5): 1098-1102. DOI: 10.3969/j.issn.1001-5256.2018.05.037
Abstract:
Liver pathology is the gold standard for the diagnosis of chronic hepatitis. Although there are many effective noninvasive diagnostic methods, liver pathology is still the most direct and reliable method for evaluating inflammation and fibrosis in patients with chronic hepatitis.The classification system for liver pathology has been also constantly changing, so as to provide more accurate information of grading and staging and to guide clinical and scientific research. This article reviews the development of classification systems for liver pathology, the basic criteria and disadvantages of each major classification system, and the prospects of pathological classification systems for chronic hepatitis.
Research advances in the role of OX40/OX40L in the immune pathogenesis of chronic hepatitis
Qin Wei, Zhao CaiYan, Yang Zhao, Zhu SuPing, Li MuSong, Huo YuLing
2018, 34(5): 1103-1106. DOI: 10.3969/j.issn.1001-5256.2018.05.038
Abstract:

The development and progression of chronic hepatitis are closely associated with the immune function of human body, and T cells play an important role in this process. Costimulatory molecules OX40/OX40 L are involved in the activation of T cells. This article reviews the molecular features of OX40/OX40 L, the mechanism of action of OX40/OX40 L in immune regulation, and the association between OX40/OX40 L and chronic liver diseases.

Application of Viatorr covered stent in transjugular intrahepatic portosystemic shunt
Ding ZhiFeng, Yin ShiWu
2018, 34(5): 1107-1110. DOI: 10.3969/j.issn.1001-5256.2018.05.039
Abstract:

Transjugular intrahepatic portosystemic shunt ( TIPS) has been widely used in the treatment of the complications of portal hypertension, and in recent years, with a deepened understanding of TIPS, covered stents have been further developed and applied in clinical practice, among which a special stent for TIPS, Viatorr covered stent, has become a focus of attention. This article reviews the application and effect of Viatorr stent and points out that Viatorr stent can establish intrahepatic shunt and thus significantly improve shunt patency rate.Meanwhile, it can reduce the risk of repeated intervention and rebleeding without increasing the incidence rate of hepatic encephalopathy and improve patients' quality of life.

Advances in the effect of B-type natriuretic peptide and its significance in patients with cirrhotic cardiomyopathy
Wang YaJie, Chen LiPing, Shang ZhiYin, Yang JingMao, Ai YingChun, Cheng JiLin
2018, 34(5): 1111-1114. DOI: 10.3969/j.issn.1001-5256.2018.05.040
Abstract:

Cirrhotic patients often have an increased cardiac load and impaired myocardial systolic and diastolic functions, which further cause abnormal myocardial structure, and such patients may develop the symptoms of heart failure under stress, which is called cirrhotic cardiomyopathy ( CCM) . This disease attracts little attention due to its insidious onset. B-type natriuretic peptide ( BNP) is secreted by cardiomyocytes and can sensitively reflect the change in ventricular function, and it is widely used in the pathogenesis, treatment, and prognosis of cardiovascular diseases. BNP plays an important role in the diagnosis and treatment of respiratory and renal diseases, and meanwhile, recent studies have shown a significant increase in BNP in cirrhotic patients, which is closely associated with the severity of cirrhotic ascites, varices, and liver dysfunction. BNP can also reveal myocardial injury when there are no obvious symptoms of CCM. This article reviews the expression of BNP and its significance in patients with CCM.

The mechanism of chenodeoxycholic acid and its derivatives in hepatobiliary tumor
Qi Fei, Tang YingMei
2018, 34(5): 1115-1118. DOI: 10.3969/j.issn.1001-5256.2018.05.041
Abstract:

Chenodeoxycholic acid ( CDCA) is a primary bile acid and is involved in the digestion, transportation, and absorption of nutriments in the hepatobiliary system. Farnesoid X receptor ( FXR) is a member of the nuclear receptor superfamily. In vivo and in vitro studies have demonstrated that CDCA is the natural ligand for FXR and involved in many cell signaling pathways, and it can inhibit the proliferation and induce the apoptosis of hepatobiliary tumor cells. This article reviews the association between CDCA and hepatobiliary tumor.

Current status and recent progress of second-line drugs for autoimmune hepatitis
Hu ZhiChao, Fan XiaoLi, Shen Yi, Yang Li
2018, 34(5): 1119-1122. DOI: 10.3969/j.issn.1001-5256.2018.05.042
Abstract:

Autoimmune hepatitis ( AIH) is an immune-mediated liver parenchymal inflammation with hepatocytes as target cells. Second-line drugs can be used for patients who have suboptimal response or intolerance to the standard treatment of AIH. This article reviews the research advances in second-line drugs for AIH.

Current status of research on liver failure after liver cancer resection
Tang DeSheng, Li FuJun
2018, 34(5): 1123-1127. DOI: 10.3969/j.issn.1001-5256.2018.05.043
Abstract:

Liver failure is one of the most serious complications after liver cancer resection. Hemodynamic changes, bile salt imbalance, and impaired immune function can cause liver failure after liver cancer resection, and related risk factors include patient, liver, and surgical conditions. This article summarizes the causes and influencing factors for liver failure after liver cancer resection and points out that prophylactic measures before surgery, expansion of remnant liver volume, adjustment of hemodynamic imbalance of the liver, and optimization of perioperative treatment help to reduce the incidence rate of liver failure after liver cancer resection and improve the prognosis and long-term survival of such patients.

Association between intestinal dysbacteriosis and liver diseases
Hou Jing, Lu Yue, Zhang DeKai
2018, 34(5): 1128-1132. DOI: 10.3969/j.issn.1001-5256.2018.05.044
Abstract(2780) PDF (102KB)(560)
Abstract:

At present, studies have confirmed the closely relationship between liver diseases and intestinal flora, and regulation of intestinal flora has a certain effect on the progression and therapeutic outcome of liver diseases. With reference to the influencing mechanism of intestinal dysbacteriosis on liver diseases such as alcoholic liver disease, non-alcoholic liver disease, and acute liver injury, this article reviews the research advances in China and foreign countries and summarizes the complications of decompensated liver diseases, such as hepatic encephalopathy and spontaneous bacterial peritonitis, in order to provide new strategies for the treatment of liver diseases in future.

Research advances in the pathogenesis and surgical treatment of gallbladder carcinoma
Zhang FuBo, Zhang YaMin
2018, 34(5): 1133-1136. DOI: 10.3969/j.issn.1001-5256.2018.05.045
Abstract:

Gallbladder carcinoma ( GBC) is often obscured by some benign diseases in clinical practice and thus unsuspected GBC tends to occur. As for etiology, long-term stimulation by gallstones, gallbladder polyps larger than 1 cm, gallbladder adenoma, and adenomyomatosis of the gallbladder are closely associated with GBC. In the aspect of molecular biology, long non-coding RNA, microRNA, surface growth factor receptor, and some membrane proteins are involved in the development and progression of GBC, which may provide a reference for clinical practice. It is of great importance to perform intraoperative and postoperative surgical management of GBC, which is related to patients' survival. Patients with highly suspected or proven GBC should be converted to open surgery after disease assessment, in order to avoid reoperation. Reoperation should be performed for patients with unsuspected GBC found by postoperative pathological examination, in order to avoid tumor progression and metastasis.

Discussions by experts
Clinical value of anti-HBc quantification for chronic HBV infection
Hou FengQin, Wang GuiQiang
2018, 34(5): 915-918. DOI: 10.3969/j.issn.1001-5256.2018.05.001
Abstract:
As the achivement of a major project during the 12 th Five-year Plan Period in China, the technique of anti-HBc quantification has been approved for commercial use and holds promise for wide application in clinical practice. Chinese scholars have explored the clinical significance of anti-HBc in various aspects and found that it has great values in the assessment of natural course of chronic hepatitis B virus ( HBV) infection and the baseline prediction of antiviral therapy. Studies have shown that anti-HBc is significantly positively correlated with alanine aminotransferase ( ALT) and significantly associated with liver inflammation. In chronic HBV infection patients with a normal ALT level, anti-HBc can be used instead as an indicator, with great significance for the development of therapeutic strategy in such patients.
New strategies for clinical cure and Institute of hepatitis B:viral suppression combined with immune modulation and its road map
Wu Di, Huang Da, Ning Qin
2018, 34(5): 919-925. DOI: 10.3969/j.issn.1001-5256.2018.05.002
Abstract:
Chronic hepatitis B virus ( HBV) infection remains a major global health issue. At present, nucleos ( t) ide analogues ( NAs) and interferon ( IFN) or pegylated interferon ( PEG-IFN) are used as the antiviral therapy. NA therapy is generally safe and well tolerated, but it has a high virological recurrence rate after drug withdrawal and a long course of treatment which may require lifelong medication. PEG-IFN therapy has the advantages of relatively shorter course of treatment, longer response, and lower rate of resistance; however, only some patients can achieve sustained response to IFN, and IFN has a high rate of adverse events, which limits the wide application of IFN in clinical practice. Since HBV covalently closed circular DNA and the integrated HBV genome stably exist in the nuclei of infected hepatocytes, it is difficult to achieve the elimination ( complete cure) of HBV. The ideal endpoint of antiviral therapy for chronic hepatitis B recommended by most guidelines is the sustained disappearance of HBs Ag, with or without HBs Ab seroconversion ( functional cure) . Theoretically, a combination of antiviral agents with different anti-HBV mechanisms, including the drugs for viral suppression and immune modulation, is a promising strategy for the treatment of chronic hepatitis B. Latest studies have demonstrated that compared with NA alone, NA given concurrently or sequentially with PEG-IFN has certain advantages in virologic and serological response. Our articles published in Journal of Hepatology in 2015 and Journal of Infectious Diseases in December 2017 introduce the research advances in treatment strategies for chronic hepatitis B and put forward our thoughts on clinical cure of chronic hepatitis B and related clinical routes, with reference to research findings in China and foreign countries. This article provides some updated information.
Antiviral therapeutic strategies for chronic hepatitis B patients with a normal alanine aminotransferase level
Ding Yang, Dou XiaoGuang
2018, 34(5): 926-929. DOI: 10.3969/j.issn.1001-5256.2018.05.003
Abstract:
Alanine aminotransferase ( ALT) is one of the most sensitive biochemical parameters used to reflect the degree of liver injury. It is generally believed that patients with hepatitis B virus ( HBV) infection and a normal ALT level are in the immune tolerance state, and no antiviral therapy is required in patients without liver inflammation or those with mild liver inflammation. However, these patients are not always in the immune tolerance state, and the disease can insidiously progress to chronic hepatitis B ( CHB) , liver cirrhosis, and even hepatocellular carcinoma. Therefore, antiviral therapy for CHB patients with normal ALT has always been a hot topic of clinical research. This article elaborates on the association between ALT and liver inflammation in CHB patients and the timing of antiviral therapy for CHB patients with normal ALT.
Individualized treatment with pegylated interferon-α for chronic hepatitis B
Wan MoBin
2018, 34(5): 930-933. DOI: 10.3969/j.issn.1001-5256.2018.05.004
Abstract:
Antiviral therapy is the basic treatment of chronic hepatitis B, and pegylated interferon-α is one of the first-line treatment drugs. At present, several consensuses have been reached on individualized treatment with pegylated interferon-α, which is playing an important role in clinical practice. New clinical demands appear along with the clinical application of pegylated interferon-α. With reference to relevant literature and personal clinical experience, this article elaborates on some knowledge of individualized treatment with pegylated interferon-α for chronic hepatitis B.
Clinical significance of serum HBV RNA measurement in chronic hepatitis B patients
Lu FengMin, Dou XiaoGuang, Zhang WenHong, Wang FuSheng
2018, 34(5): 934-938. DOI: 10.3969/j.issn.1001-5256.2018.05.005
Abstract:
In the era of antiviral therapy with potent nucleos ( t) ide analogues ( NAs) , serum HBV DNA is reduced to a level below the lower limit of detection in most chronic hepatitis B ( CHB) patients, but the loss of serum HBV DNA only indicates that reverse transcription of virus is effectively inhibited and cannot truly reflect the transcriptional activity of covalently closed circular DNA ( ccc DNA) in hepatocytes.In addition, some patients, although with almost depleted or residual, silent ccc DNA in liver tissue, were still positive for serum HBs Ag after long-term treatment due to the integration of HBV DNA fragments. How to truly evaluate the presence and transcriptional activity of ccc DNA in hepatocytes is still a problem that needs to be solved urgently. Serum HBV RNA comes from ccc DNA transcript in liver tissue and is released into blood circulation as virus-like HBV RNA particles, since it is not effectively transformed to rc DNA. Therefore, in patients receiving the treatment with NAs, serum HBV RNA can qualitatively reflect the transcriptional activity of ccc DNA in liver tissue. At present, most scholars think it is hard to achieve " complete cure" of CHB with current therapies. Therefore, we put forward a ladder-like improvement pattern from " partial cure" to " para-functional cure" and " clinical cure" ( or " functional cure") . " Partial cure" based on the elimination or silence of ccc DNA and persistently negative HBV RNA should be used to predict the risk of recurrence or virological rebound after drug withdrawal, and a low serum level of HBs Ag combined with these two criteria should be used as the criteria for " quasi-clinical cure".The clinical significance of serum HBV RNA measurement needs to be addressed in multi-cohort clinical trails and/or improved in the real world studies.
Original articles_Viral hepatitis
Clinical effect of pegylated interferon α-2a in treatment of previously untreated HBeAg-positive chronic hepatitis B patients and related predictive factors
Lou Xin, Gao YuFeng, Ye Jun, Wang YinQiu, Guan ZiShu, Zou GuiZhou
2018, 34(5): 995-1000. DOI: 10.3969/j.issn.1001-5256.2018.05.014
Abstract:
Objective To investigate the clinical effect of pegylated interferon α-2 a ( PEG-IFNα-2 a) in the treatment of previously untreated HBeAg-positive chronic hepatitis B ( CHB) patients and related predictive factors. Methods A retrospective analysis was performed for 111 previously untreated HBeAg-positive CHB patients who were treated with PEG-IFNα-2 a in Department of Hepatology in the Second Affiliated Hospital of Anhui Medical University from January 2011 to June 2015. The patients were followed up for serum HBs Ag quantitation, HBeAg quantitation, HBV DNA quantitation, and alanine aminotransferase ( ALT) level at baseline and at weeks 12, 24, and48 of treatment. At week 48 of treatment, of all 111 patients, 35 achieved HBeAg seroconversion ( 48-week seroconversion group) and 76 did not achieve such seroconversion ( 48-week non-seroconversion group) . The independent samples t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic ( ROC) curve was used to evaluate the efficiency of related indices in predicting treatment outcomes, and the area under the ROC curve ( AUC) was compared to evaluate the predictive value of each index. The dichotomous logistic regression model was used to evaluate the influence of independent variables on HBeAg seroconversion. Results There was a significant difference in HBeAg level between the two groups before treatment ( t =-3. 361, P < 0. 05) . At week 12 of treatment, there were significant differences between the two groups in HBs Ag quantitation ( t =-3. 225, P < 0. 05) , reduction in HBs Ag ( Z =-2. 202, P < 0. 05) , HBeAg quantitation ( Z =-5. 025, P < 0. 05) , reduction in HBeAg ( Z =-3. 569, P < 0. 05) , HBV DNA quantitation ( Z =-3. 261, P < 0. 05) , and reduction in HBV DNA ( t = 2. 202, P < 0. 05) .At week 24 of treatment, there were significant differences between the two groups in HBs Ag quantitation ( t =-3. 222, P < 0. 05) , reduction in HBs Ag ( Z =-1. 860, P < 0. 05) , HBeAg quantitation ( Z =-5. 951, P < 0. 05) , reduction in HBeAg ( t = 5. 514, P < 0. 05) , HBV DNA quantitation ( Z =-2. 311, P < 0. 05) , and ALT level ( Z =-2. 234, P < 0. 05) . HBeAg quantitation at week 24 had a high predictive value ( AUC = 0. 88, P < 0. 001) , with a sensitivity of 94. 03%, a specificity of 64. 52%, a positive predictive value of85. 10%, and a negative predictive value of 83. 30% at a cut-off value of 0. 18 log10 S/CO. In addition, HBeAg quantitation at week 12 and reduction in HBeAg at week 24 had a good predictive value ( AUC = 0. 81 and 0. 80, respectively) . Baseline HBeAg < 2. 91 log10 S/CO ( odds ratio [OR]= 10. 086, 95% confidence interval [CI]: 1. 64-61. 93, P = 0. 013) , ALT < 1. 45 × upper limit of normal ( ULN) at week 24 ( OR = 5. 228, 95% CI: 1. 27-21. 45, P = 0. 022) , and reduction in HBeAg > 1. 5 log10 S/CO at week 24 ( OR = 5. 780, 95%CI: 1. 38-24. 25, P = 0. 016) were independent predictive factors for HBeAg seroconversion at week 48. Conclusion Baseline HBeAg level, HBs Ag/HBeAg/HBV DNA levels and reductions at week 12 of treatment, HBs Ag/HBeAg levels and reductions at week 24 of treatment, and HBV DNA and ALT levels at the same time points have a certain value in predicting HBeAg seroconversion at week 48.
Association between HBsAg clearance and serum level of granulocyte-macrophage colony stimulating factor in inactive HBsAg carriers receiving pegylated interferon alpha-2a
Cao ZhenHuan, Lu JunFeng, Wu YaLi, Zheng YanHong, Chen XinYue
2018, 34(5): 1001-1004. DOI: 10.3969/j.issn.1001-5256.2018.05.015
Abstract:
Objective To investigate the association between HBs Ag clearance and serum level of granulocyte-macrophage colony stimulating factor ( GM-CSF) in inactive HBs Ag carriers receiving pegylated interferon ( PEG-IFN) alpha-2 a. Methods A total of 20 inactive HBs Ag carriers who visited Beijing You An Hospital, Capital Medical University, from January 2013 to January 2016 were enrolled, and after 24 weeks of PEG-IFN alpha-2 a treatment, 13 achieved HBs Ag clearance ( R group) and 7 did not achieve HBs Ag clearance ( NR group) . The Luminex technique was used to measure the serum level of GM-CSF at baseline and at weeks 12 and 24 of treatment. The serum level of GM-CSF was also measured for 11 healthy controls ( HC group) . The t-test or an analysis of variance was used for comparison of continuous data between groups, and the Bonferroni test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. Results The R and NR groups had a significantly higher serum GM-CSF level than the HC group ( 42. 63 ±11. 24 pg/ml and 46. 77 ± 10. 52 pg/ml vs 11. 97 ± 3. 85 pg/ml) , and there was a significant difference between the three groups ( F = 4. 482, P = 0. 02) . At weeks 12 and 24 of PEG-IFNα-2 a treatment, the R group had a significantly higher serum GM-CSF level than the NR group ( t = 22. 422 and 17. 782, both P < 0. 05) . In the R group, the serum GM-CSF level was 42. 63 ± 11. 25 pg/ml at baseline, significantly increased to 83. 31 ± 14. 20 pg/ml at week 12 of treatment, and then significantly decreased to 32. 34 ± 8. 06 pg/ml at week 24 of treatment ( F =7. 655, P =0. 002) . In the NR group, the serum GM-CSF level was 46. 77 ± 10. 52 pg/ml at baseline and significantly decreased to25. 90 ± 7. 06 pg/ml at week 12 of treatment and 9. 43 ± 2. 45 pg/ml at week 24 of treatment ( F = 5. 264, P = 0. 016) . Conclusion In inactive HBs Ag carriers receiving PEG-IFN alpha-2 a treatment, the increase in serum GM-CSF level may indicate HBs Ag clearance.
Value of aspartate aminotransferase-to-platelet ratio index in judging the indication for antiviral therapy in patients with chronic HBV infection and alanine aminotransferase less than two times of upper limit of normal
Chen Chen, Zhai YuFeng, Zhang HuaiHong
2018, 34(5): 1005-1010. DOI: 10.3969/j.issn.1001-5256.2018.05.016
Abstract:

Objective To investigate the value of aspartate aminotransferase-to-platelet ratio index ( APRI) in judging the indication for antiviral therapy [liver inflammation grade ( G) ≥2 or fibrosis stage ( S) ≥2] in patients with chronic HBV infection and alanine aminotransferase ( ALT) < 2 × upper limit of normal ( ULN) . Methods A retrospective analysis was performed for the clinical data of 207 patients with chronic HBV infection and ALT < 2 × ULN who were admitted to Nanyang Central Hospital from January 2015 to June 2017, and according to liver inflammation grade and fibrosis stage, these patients were divided into G < 2 + S < 2 group with 87 patients and G≥2 or S≥2 group with 120 patients. The results of liver biopsy and laboratory examination were recorded, and APRI was calculated. The Spearman correlation analysis was performed to investigate the correlation of APRI with liver inflammation grade and fibrosis stage. The area under the receiver operating characteristic curve ( AUC) was used to investigate the value of ALT, aspartate aminotransferase ( AST) , platelet count ( PLT) , and APRI in judging the indication for antiviral therapy in patients with ALT < 2 × ULN. The t-test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Results APRI was positively correlated with liver inflammation grade and fibrosis stage ( r = 0. 661 and 0. 597, P<0. 001) . Among ALT, AST, PLT, and APRI, APRI had the highest value in judging the indication for antiviral therapy, with AUCs of0. 913 in the G≥2 or S≥2 group, 0. 882 in the G≥2 group, and 0. 881 in the S≥2 group. APRI had an AUC of 0. 913 ( 95% confidence interval: 0. 871-0. 954) in predicting the indication in the G≥2 or S≥2 group at the optimal cut-off value of 0. 5324; when APRI was ≥0. 5324, the patients had marked liver histological changes, i. e., G≥2 or S≥2, which met the indication for antiviral therapy. APRI had a sensitivity of 87. 50%, a specificity of 89. 66%, a positive predictive value of 92. 11%, and a negative predictive value of 83. 87%. Conclusion For patients with chronic HBV infection and ALT < 2 × ULN, APRI has a good value in evaluating liver pathological changes and judging the timing of antiviral therapy and can reduce the frequency of invasive assessment of histological changes via liver biopsy.

Effect of thymosin α1 on the function of CD4+CD25+CD127dim/- regulatory T cells in chronic hepatitis B patients
Li Yu, Tian Ying, Yang XiaoMei, Cao NingJia, Li Zhu, Zhang Hong, Zhang XianJiao
2018, 34(5): 1011-1014. DOI: 10.3969/j.issn.1001-5256.2018.05.017
Abstract:
Objective To investigate the effect of thymosin α1 therapy on the function of CD4+CD25+CD127dim/-regulatory T ( Treg) cells in chronic hepatitis B ( CHB) patients. Methods A total of 67 CHB patients who were admitted to Department of Infectious Diseases in Shaanxi Provincial People's Hospital from December 2016 to July 2017 were enrolled, among whom 38 patients received entecavir antiviral therapy ( control group) and 29 received entecavir combined with thymosin α1 for injection ( treatment group) . Peripheral blood mononucleated cells were isolated before and after treatment, and flow cytometry was used to measure the percentage of CD4+CD25+CD127dim/-Treg cells. CD4+CD25+CD127dim/-Treg cells were purified and co-cultured with autologous CD4+CD25-T cells. CCK-8 assay was used to measure cell proliferation, and ELISA was used to measure the levels of cytokines. The t-test was used for comparison of related indices between the two groups, the chi-square test was used for comparison of categorical data. Results In the control group, the percentage of CD4+CD25+CD127dim/-Treg cells was significantly reduced from 12. 32% ± 1. 22% at baseline to 8. 85% ± 2. 18% after 12 weeks of treatment ( t = 4. 579, P = 0. 0005) , while in the treatment group, this value was significantly reduced from 13. 71% ± 2. 32% at baseline to 9.26% ± 2. 30% after 12 weeks of treatment ( t = 4. 803, P = 0. 0003) . The measurement of cytokines was performed for 17 patients in the control group and 21 in the treatment group. After 12 weeks of treatment, the control group showed no significant changes in cell proliferation and levels of cytokines in the co-culture system of Treg and CD4+CD25-T cells; the treatment group had a significant increase in cell count in the co-culture system [ ( 3. 66 ± 0. 95) × 106 vs ( 2. 07 ± 0. 51) × 106, t = 5. 709, P < 0. 0001], as well as significant reductions in the levels of inhibitory cytokines interleukin-10 ( 41. 40 ± 11. 89 pg/ml vs 56. 53 ± 27. 85 pg/ml, t = 2. 639, P = 0. 019) and interleukin-35 ( 122. 9 ± 9. 98 pg/ml vs 130. 0 ± 15. 98 pg/ml, t = 2. 459, P = 0. 028) and significant increases in the levels of antiviral cytokines interferon-α ( 297. 5 ± 83. 56 pg/ml vs 235. 6 ± 67. 72 pg/ml, t = 2. 603, P = 0. 017) and interferon-γ ( 5. 83 ± 0. 85 pg/ml vs 4. 39 ± 0. 95 pg/ml, t = 4. 659, P = 0. 0004) . Conclusion Thymosin α1 can inhibit the level and immunosuppressive function of CD4+CD25+CD127dim/-Treg cells in CHB patients and improve their immune function.
Guidelines of prevention and treatment for alcoholic liver disease:a 2018 update
Fatty Liver Expert Committee,Chinese Medical Doctor Association, National Workshop on Fatty Liver and Alcoholic Liver Disease,Chinese Society of Hepatology,Chinese Medical Association
2018, 34(5): 939-946. DOI: 10.3969/j.issn.1001-5256.2018.05.006
Abstract(1312) PDF (335KB)(2004)
Abstract:
Guidelines of prevention and treatment for nonalcoholic fatty liver disease: A 2018 update
National Workshop on Fatty Liver and Alcoholic Liver Disease,Chinese Society of Hepatology,Chinese Medical Association, Fatty Liver Expert Committee,Chinese Medical Doctor Association
2018, 34(5): 947-957. DOI: 10.3969/j.issn.1001-5256.2018.05.007
Abstract(2340) PDF (422KB)(2526)
Abstract:
An expert consensus for the management of chronic hepatitis B in Asian Americans(2018)
He CaiNi, Lu JingYi, Liu YiHao, Liu Yang, Ji FanPu
2018, 34(5): 958-965. DOI: 10.3969/j.issn.1001-5256.2018.05.008
Abstract:
Updated key points and clinical pathway for NCCN clinical practice guidelines in oncology: hepatobiliary cancers (Version 1.2018)
Li JuDong, Xu XinFei, Yu JiongJie, Xing Hao, Wu MengChao, Yang Tian
2018, 34(5): 966-977. DOI: 10.3969/j.issn.1001-5256.2018.05.009
Abstract:
An excerpt of American Gastroenterological Association Institute Guideline on initial management of acute pancreatitis (2018)
Zhou Xin, Yang GuiYuan, Qian ZhuYin
2018, 34(5): 978-981. DOI: 10.3969/j.issn.1001-5256.2018.05.010
Abstract(432) PDF (188KB)(1167)
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An excerpt of management of acute pancreatitis in the pediatric population: a clinical report from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee(2018)
Yan YanYan, Xie XinBao, Wang JianShe
2018, 34(5): 982-986. DOI: 10.3969/j.issn.1001-5256.2018.05.011
Abstract:
An excerpt of the NICE guidelines on pancreatic cancer in adults: diagnosis and management
Chen Yin, Yang GuiYuan, Qian ZhuYin
2018, 34(5): 987-990. DOI: 10.3969/j.issn.1001-5256.2018.05.012
Abstract:
An excerpt of ACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts (2018)
Xie ZhiQin, Zhu ZeMin, Guo ZiYi, Liu ZhiYong, Tang CaiXi
2018, 34(5): 991-994. DOI: 10.3969/j.issn.1001-5256.2018.05.013
Abstract:
Influence of duration of plasma diafiltration on therapeutic outcome of liver failure
Yang XianShan, Zhou Li, Li Lu, Li Shuang, Kong Ming, Li ShanShan, Zou HuaiBin, Xu ManMan
2018, 34(5): 1052-1054. DOI: 10.3969/j.issn.1001-5256.2018.05.025
Abstract:
Objective To investigate the influence of different durations of plasma diafiltration ( PDF) on liver function in patients with liver failure and rebound of liver function after treatment. Methods A total of 101 patients with liver failure who were admitted to Beijing You An Hospital, Capital Medical University, from January 2015 to December 2016 were enrolled, and according to the duration of treatment, these patients were divided into 4-hour group with 77 patients and 6-hour group with 24 patients. All patients were given artificial extracorporeal liver support therapy in addition to the medical treatment. The two groups were observed in terms of the reductions in alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , total bilirubin ( TBil) , and direct bilirubin ( DBil) after treatment and the rebound of ALT, AST, TBil, and DBil at 24 and 72 hours after treatment. 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 All patients had stable hemodynamics during treatment and no patient experienced adverse events. Some patients complained of staying in bed for a long time and feeling weak. The 6-hour group had a significantly higher intolerance rate than the 4-hour group [41. 7% ( 10/24) vs 6. 5% ( 5/77) , χ2= 17. 90, P < 0. 01].There were no significant differences in the reductions in ALT, AST, TBil, and DBil after PDF treatment between the two groups ( t = 2. 53, -4. 48, -1. 52, and-0. 47, all P > 0. 05) . There were also no significant differences between the two groups in the degrees of rebound of ALT, AST, TBil, and DBil at 24 and 72 hours after treatment ( 24 hours: t =-0. 236, -1. 251, -1. 251, and 0. 943, all P > 0. 05;72 hours: t =-0. 700, 0. 596, -1. 530, and 1. 837, all P > 0. 05) . Conclusion PDF treatment with different durations has similar effect and safety. Therefore, 4-hour PDF can be applied in clinical practice to improve patients' tolerance.
Value of continuous monitoring of ICG-R15 in assessing hepatic insufficiency after partial hepatectomy
Luo YuJun, Zhang YaMin, Yang Long, Li Yan, Liu ZiRong
2018, 34(5): 1055-1059. DOI: 10.3969/j.issn.1001-5256.2018.05.026
Abstract:
Objective To investigate the value of indocyanine green retention rate at 15 minutes ( ICG-R15) immediately and at 3 and 5 days after partial hepatectomy in assessing the incidence of postoperative hepatic insufficiency. Methods This prospective study included70 patients with hepatocellular carcinoma who underwent partial hepatectomy from November 2016 to May 2017 in the First Central Hospital of Tianjin. The relationship between preoperative and postoperative ICG-R15 and postoperative hepatic insufficiency was analyzed, and the difference between the preoperative and postoperative continuous monitoring of ICG-R15 in assessing the incidence of postoperative hepatic insufficiency was also analyzed. Comparison of categorical data was made by chi-square test. Continuous data were compared using two-independent-samples t test. The area under the receiver operating characteristic curve ( AUC) was used to determine the accuracy of preoperative and postoperative ICG-R15 in assessing the incidence of postoperative hepatic insufficiency. Results Of the 70 patients, 14 ( 20%) had postoperative hepatic insufficiency, and the other patients had good recovery of liver function. The means of ICG-R15 before operation and immediately and at 3 and 5 days after operation were 5. 73% ± 4. 31%, 12. 36% ± 7. 41%, 11. 51% ± 8. 76%, and 9. 60%± 7. 00%, respectively, in the patients with good recovery of liver function, and were 18. 02% ± 13. 48%, 32. 54% ± 18. 67%, 34. 73%± 18. 49%, and 25. 34% ± 11. 49%, respectively, in the patients with postoperative hepatic insufficiency, with significant differences between the two groups of patients ( t = 3. 368, 3. 966, 4. 571, and 4. 901, all P < 0. 05) . The incidence rates of postoperative hepatic insufficiency were 11. 10%, 20. 0%, and 100%, respectively, in patients with ICG-R15 < 10%, 10% < ICG-R15 < 20%, and ICG-R15 >20% preoperatively, were 0, 18. 2%, and 62. 5%, respectively, in patients with ICG-R15 < 10%, 10% < ICG-R15 < 20%, and ICG-R15 > 20% immediately after operation, were 6. 3%, 11. 1%, and 50. 0%, respectively, in patients with ICG-R15 < 10%, 10% 20% at 3 days after operation, and were 5. 3%, 12. 5%, and 62. 5%, respectively, in patients with ICG-R15 < 10%, 10% < ICG-R15 < 20%, and ICG-R15 > 20% at 5 days after operation; the incidence of postoperative hepatic insufficiency increased significantly as ICG-R15 increased ( χ2= 22. 374, 28. 024, 14. 810, and 21. 159, all P < 0. 001) . There were significant differences in the incidence of postoperative hepatic insufficiency between any two of the groups with ICG-R15 < 10%, 10% < ICG-R15< 20%, and ICG-R15 > 20% preoperatively ( all P < 0. 001) , and between any two of the groups with ICG-R15 < 10%, 10% < ICG-R15 < 20%, and ICG-R15 > 20% ( except ICG-R15 < 10% and 10% < ICG-R15 < 20% groups) before operation and at 3 and 5 days after operation ( all P < 0. 05) . The AUCs ( confidence intervals) of ICG-R15 before operation and immediately and at 3 and 5 days after operation were 0. 790 ( 0. 676-0. 878) , 0. 857 ( 0. 752-0. 929) , 0. 855 ( 0. 750-0. 927) , and 0. 870 ( 0. 768-0. 938) , respectively, and the postoperative ICG-R15 values had a significantly larger AUC than the preoperative ICG-R15 ( all P < 0. 05) . Conclusion Postoperative continuous monitoring of ICG-R15 is more accurate than preoperative ICG-R15 in assessing the incidence of hepatic insufficiency among liver cancer patients after partial hepatectomy, and can guide clinicians to provide early clinical intervention.
Effect of ghrelin O-acyltransferase inhibition by small interfering RNA on hepatocyte fatty degeneration and related mechanism of action
Zhang ShaoRen, Hu JingXian, Fan XiaoMing
2018, 34(5): 1060-1067. DOI: 10.3969/j.issn.1001-5256.2018.05.027
Abstract:
Objective To investigate the effect of inhibition of ghrelin O-acyltransferase ( GOAT) by small interfering RNA ( siRNA) on hepatocyte fatty degeneration and related mechanism of action. Methods Human LO2 hepatocytes were treated with free fatty acid ( FFA) to induce hepatocyte fatty degeneration. LO2 hepatocytes were treated with FFA and siRNA-GOAT alone or in combination and then divided into normal control ( NC) group ( treated with phosphate buffered saline alone) , siRNA-GOAT group ( treated with siRNA-GOAT at a final concentration of 10 nm) , FFA group ( treated with FFA at a final concentration of 1 mm) , and FFA + siRNA-GOAT group ( treated with FFA at a final concentration of 1 mm and siRNA-GOAT at a final concentration of 10 nm) . Oil red O staining was performed for hepatocytes to identify lipid droplets; the triglyceride ( TG) test kit was used to measure the lipid level in LO2 hepatocytes; Western blot, qRT-PCR, immunofluorescent staining, and electron microscopy were used to measure autophagy; ELISA and RT-PCR were used to measure the levels of tumor necrosis factor-α ( TNFα) and interleukin-6 ( IL-6) ; ELISA was used to measure the changes in the levels of mammalian target of rapamycin ( m TOR) , phosphorylated m TOR ( p-m TOR) , AMP-activated protein kinase ( AMPK) , and phosphorylated AMPK. A one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between any two groups. Results Compared with the FFA group, the FFA + siRNA-GOAT group had a significant reduction in the formation of lipid droplets and a significantly lower TG level ( P < 0. 001) . Compared with the FFA group, the FFA +siRNA-GOAT group had significant reductions in the protein and mRNA expression of TNFα and IL-6 ( all P < 0. 005) . The siRNA +GOAT group had significantly higher mRNA expression of LC3-II and Beclin-1 than the NC group ( all P < 0. 001) . The FFA + siRNA-GOAT group had significantly higher mRNA expression of LC3-II and Beclin-1 than the FFA group ( all P < 0. 001) . The siRNA + GOAT group had significantly higher protein expression of LC3-II and Beclin-1 than the NC group ( all P < 0. 05) . The FFA + siRNA-GOAT group had significantly higher protein expression of LC3-II and Beclin-1 than the FFA group ( all P < 0. 05) . Immunofluorescent staining showed that compared with the FFA group and the siRNA-GOAT group, the FFA + siRNA-GOAT group had a significant increase in the expression of endogenous LC3-II in LO2 hepatocytes. Electron microscopy showed that compared with the FFA group, the FFA + siRNA-GOAT group had a significant increase in the expression of autophagosome. After the LO2 hepatocytes were treated by autophagy inhibitors siRNA-ATG5 and 3-MA or an autophagy stimulant, rapamycin, there was a significant difference in TG level between the FFA + siRNA-ATG5 group and the FFA + siRNA-GOAT group ( P < 0. 001) , as well as between the FFA + 3-MA group and the FFA + rapamycin group ( P < 0. 001) . The FFA + siRNA-GOAT group had a significantly higher level of LC3-I/II than the FFA + siRNA-ATG5 group ( P <0. 05) , and the FFA + rapamycin group had a significantly higher level of LC3-I/II than the FFA + 3-MA group ( P < 0. 05) . Compared with the FFA group, the FFA + siRNA-GOAT group had significantly higher protein expression of p-AMPK ( P < 0. 05) and significantly lower protein expression of p-m TOR ( P < 0. 05) . Conclusion GOAT inhibition by siRNA can upregulate autophagy and alleviate hepatocyte fatty degeneration, possibly by regulating the AMPK/m TOR pathway.
Clinical features of acute schistosomiasis in China
Hu QinMing, Yang Zheng, Yuan Zhe, Yang ZhongMin
2018, 34(5): 1068-1074. DOI: 10.3969/j.issn.1001-5256.2018.05.028
Abstract:
Objective To investigate the clinical features of acute schistosomiasis in China, and to improve the understanding of this disease among clinicians. Methods CNKI was searched with “acute schistosomiasis”as a key word for Chinese articles published from January2000 to December 2016 to conduct a retrospective analysis of clinical studies on acute schistosomiasis in China. Results A total of 26 clinical studies with 1380 patients with acute schistosomiasis were included. Hubei had the highest number of patients ( 656 patients) , followed by Sichuan with 312 patients, Hunan with 154 patients, Anhui with 154 patients, Yunnan with 51 patients, Jiangxi with 24 patients, Jiangsu with 19 patients, and Zhejiang with 10 patients. Most of the patients were school-aged children and young adults. All patients had a clear contact history of infected water, and the onset time was mainly summer and autumn. Clinical features included pyrexia [1256 ( 91. 0%) ], diarrhea [766 ( 55. 5%) ], cough [650 ( 47. 1%) ], abdominal pain [538 ( 39. 0%) ], fear of cold [410 ( 29. 7% ], stool with blood and pus [309 ( 22. 4%) ], abdominal distension [182 ( 13. 2%) ], headache [50 ( 3. 6%) ], and cercarial dermatitis [48 ( 3. 5%) ]. Laboratory examination showed leukocytosis [885 ( 64. 1%) ] and eosinophilia [998 ( 72. 3%) ], microscopic examination of stool found Schistosoma eggs or blood fluke miracidia in 901 patients ( 65. 3%) , serum immunological detection showed positive results in 639 patients ( 46. 3%) , and ultrasound examination showed splenomegaly in 635 patients ( 46. 0%) . Conclusion Clinicians should consider the possibility of acute schistosomiasis for patients with a contact history of epidemic area who experience pyrexia, abdominal pain, and eosinophilia.
Mechanism of action of glutamine in portal hypertensive gastropathy in rats
Huang XiangJun, Wang YongHeng, Duan ShanShan, Li Lan, Sun GuoHui, Yang MeiYue, Leng DaYue, Zhang WenXing
2018, 34(5): 1075-1079. DOI: 10.3969/j.issn.1001-5256.2018.05.029
Abstract:
Objective To investigate the role and mechanism of action of glutamine in portal hypertension gastropathy ( PHG) in rats.Methods A total of 60 Sprague-Dawley rats were randomly divided into groups A ( sham-operation) , B ( sham-operation + glutamine) , C ( partial portal vein ligation) , and D ( partial portal vein ligation + glutamine) . A rat model of PHG was established by partial ligation of the main portal vein. Portal vein pressure ( PVP) , gastric injury index ( GI) , pathological integral ( PI) of the gastric mucosa, and liver morphological changes were measured after 2 weeks, and the plasma levels of alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , albumin ( Alb) , nitric oxide ( NO) , tumor necrosis factor-α ( TNFα) , and superoxide dismutase ( SOD) were also measured. The t-test was used for comparison of continuous data between two groups, an analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. Results There was a significant difference in PVP between groups A, B, C, and D ( 1. 17 ± 0. 15 k Pa vs 1. 21 ± 0. 19 k Pa vs 2. 65 ± 0. 16 k Pa vs 2. 18 ± 0. 22 k Pa, F = 4. 60, P < 0. 05) , and there were also significant differences between groups C/D and groups A/B ( P < 0. 05) . There were significant differences between groups C and D in GI ( 15. 52 ± 2. 05 vs 8. 26 ± 1. 23, t = 5. 84, P < 0. 05) and PI ( 7. 56 ± 1. 53 vs 3. 15 ± 1. 42, t = 7. 45, P < 0. 05) . There were no significant differences in ALT, AST, and Alb between the four groups ( all P > 0. 05) . There were significant differences between the four groups in TNFα ( 0. 56 ± 0. 11 ng/ml vs 0. 41 ± 0. 21 ng/ml vs 1. 35 ± 0. 26 ng/ml vs 0. 68 ± 0. 21 ng/ml, F = 5. 24, P < 0. 05) , NO ( 1. 63 ± 0. 15 μmol/gpro vs 1. 41 ± 0. 12 μmol/gpro vs 5. 52 ± 1. 06 μmol/gpro vs 2. 26 ± 0. 83μmol/gpro, F = 8. 40, P < 0. 05) , and SOD ( 148. 21 ± 6. 21 U/mg vs 154. 21 ± 5. 31 U/mg vs 74. 56 ± 4. 21 U/mg vs 135. 25 ± 4. 82 U/mg, F = 14. 78, P < 0. 05) . There were significant differences in TNFα, NO, and SOD between group C and groups A/B ( all P <0. 05) , as well as between groups C and D ( all P < 0. 05) . Conclusion PHG has various pathogenic factors. Glutamine can alleviate gastric mucosal edema and hemorrhage in rats with PHG and reduce the content of NO, TNFα, and SOD. Glutamine has a good antioxidant effect and thus helps with the treatment of PHG.