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

2019 Vol. 35, No. 3

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Editorial
What's new in alcoholic hepatitis
Gao Bin, Vijay H.Shah
2019, 35(3): 465-468. DOI: 10.3969/j.issn.1001-5256.2019.03.001
Abstract:

Alcoholic hepatitis is an important type of alcohol-associated liver disease characterized by acute liver inflammation caused by pro-longed heavy alcohol use. In the present article, the pathogenesis, clinical characteristics, diagnosis, current therapies and future treatmentstrategies of alcoholic hepatitis are summarized and reviewed in order to help the hepatologists to better understand this kind of disease in clini-cal practice.

Importance of the clinical research on alcoholic hepatitis
Wang BingYuan
2019, 35(3): 469-471. DOI: 10.3969/j.issn.1001-5256.2019.03.002
Abstract:

Alcoholic hepatitis ( AH) is a non-infectious inflammatory injury of the liver and often occurs on the basis of chronic liver dis-ease including fatty liver disease and liver cirrhosis. Acute exacerbation of liver disease due to heavy drinking within a short period of time isa severe manifestation of AH. The prognosis of AH depends on treatment timing and methods, and liver function can quickly recover or rap-idly deteriorate into multiple organ failure. Many clinicians lack the experience in early identification and timely treatment of AH, due to alack of typical clinical manifestations and specific auxiliary examinations, which affects clinical treatment, delays treatment, and exposessome AH patients to the risk of death. Therefore, it is imperative to conduct more clinical studies on AH, summarize real-world data, anddevelop expert consensus.

Discussions by experts
Influence of drinking on progression of chronic hepatitis B and outcome of antiviral therapy
Liu Chen, Xing HuiChun, Cheng Jun, Yang Song
2019, 35(3): 472-475. DOI: 10.3969/j.issn.1001-5256.2019.03.003
Abstract:
HBV can interact with alcohol in various ways to cause liver damage. Heavy drinking can accelerate the progression of chronichepatitis B and lead to a poorer prognosis; meanwhile, it can also affect the outcome and compliance in patients receiving antiviral therapy.The epidemiology of drinking in patients with chronic hepatitis B in China remains unclear, and further studies are needed to clarify themechanism of interaction between alcohol and HBV. Drinking management should be strengthened in patients with chronic hepatitis B inclinical practice, in order to alleviate liver injury induced by alcohol.
Clinical diagnosis of alcoholic hepatitis
Zou ZhengSheng
2019, 35(3): 476-477. DOI: 10.3969/j.issn.1001-5256.2019.03.004
Abstract:
Based on the significant differences in definition, clinical features, and prognosis between alcoholic hepatitis ( AH) and severeAH, it is recommended to classify AH into mild and severe AH. As for the disease spectrum of hospitalized patients with alcoholic liver dis-ease, most patients have liver cirrhosis, and about 15% have mild or severe AH. Alcoholic liver failure belongs to the category of severeAH. Severe AH is a clinical diagnosis, while alcoholic steatohepatitis is a pathological diagnosis. The clinical diagnostic criteria for severeAH tend to be consistent in European and the United States of America, but the Chinese guideline released in 2018 is not consistent with theguidelines from western countries.
Alcoholic liver disease with nonalcoholic fatty liver disease and obesity
Cao HaiXia, Fan JianGao
2019, 35(3): 478-480. DOI: 10.3969/j.issn.1001-5256.2019.03.005
Abstract:

For a long time, researchers and clinicians have strictly divided fatty liver diseases into alcoholic and non-alcoholic fatty liverdisease. When one was diagnosed as alcoholic liver disease, the effects of non-alcoholic factors, including obesity, diabetes or metabolicsyndrome, on liver diseases have been neglected. Conversely, when the patient was diagnosed as non-alcoholic fatty liver disease, the im-pacts of alcohol drinking are usually ignored. In the new era, physicians and scientific researchers need to pay more attention to the dual fac-tors of alcohol and obesity, which often exist together and affect liver disease progression. This article elaborates on the clinical features of fat-ty liver disease in the new era from the aspects of changes in the clinical features of alcoholic liver disease, disease pattern of nonalcoholicfatty liver disease with drinking, and differential diagnosis of alcoholic and nonalcoholic fatty liver diseases.

Intestinal microflora and alcoholic liver disease
Li Wei, Xing HuiChun
2019, 35(3): 481-484. DOI: 10.3969/j.issn.1001-5256.2019.03.006
Abstract:

Normal intestinal microflora and microecology are essential for normal physiological functions in human body. Intestinal microfloraimbalance is often observed in patients with alcoholic liver disease and manifests as abnormal number and constituent ratio of intestinal micro-flora, dysfunction of intestinal mucosal barrier, bacterial translocation, and intestinal endotoxemia, and it plays an important role in the de-velopment and progression of alcoholic liver disease. In addition, intestinal microflora also has influence on alcohol metabolism. Probiotics orfecal microbiota transplantation can regulate intestinal microflora and may play an active role in the treatment of alcoholic liver disease. Fur-ther studies are needed to discuss the standardized use of microecologics, dose selection, dosage form, and course of treatment during theprevention and treatment of alcoholic liver disease.

Application status and future prospect of the Gao-Binge model in alcoholic liver disease
Zhou Ke, Wang Hua
2019, 35(3): 485-488. DOI: 10.3969/j.issn.1001-5256.2019.03.007
Abstract:

The pathogenesis of alcoholic liver disease remains unclear, mainly due to the lack of accurate animal models in experiments.Many different animal models have been established to mimic alcoholic liver disease in patients, which have both advantages and disadvanta-ges. Among these models, the Gao-Binge model is widely used in the experiments because it highly mimics the drinking pattern in patients.It is more persuasive that the pathogenesis and therapeutic drugs have been examined in the Gao-Bingemodel. Although there are some lim-its in the Gao-Binge model, it is no doubt that this model has high value and future prospect in the study of alcoholic liver disease becauseof short duration time, low cost and good repeatability. Finally, the Gao-Binge model has also been used to study alcohol-induced damageto other organs such as the heart, pancreas, adipose tissue etc.

Academic contention
Severe alcoholic hepatitis and acute-on-chronic liver failure
Sun FuRong, Wang BingYuan
2019, 35(3): 489-493. DOI: 10.3969/j.issn.1001-5256.2019.03.008
Abstract:

Rapid progression or aggravation of jaundice, coagulation abnormalities and liver-related complications in patients with alcoholichepatitis indicates that they may develop severe alcoholic hepatitis. Some of these patients can progress acute-on-chronic liver failure withacute insults, such as infection and binge drinking and binge, showing as acute decompensation, organ failure and high 28-day mortalityrate. Early identification and effective intervention can improve the prognosis of acute-on-chronic liver failure. Intestinal barrier dysfunc-tion and liver-gut axis imbalance play an important role in the development of severe alcoholic hepatitis and acute-on-chronic liver fail-ure. It is important to improve the basic nutritional status of patients. Effective drug therapies are limited in improving the condition andprognosis of acute-on-chronic liver failure. Early liver transplantation can bring great benefits to these patients.

Therapeutic guidelines
Guidelines for clinical diagnosis and treatment of acute-on-chronic liver failure in traditional Chinese  medicine
China Association of Chinese Medicine
2019, 35(3): 494-503. DOI: 10.3969/j.issn.1001-5256.2019.03.009
Abstract:
Expert consensus of percutaneous transhepatic biliary drainage and stent implantation in treatment of obstructive jaundice(2018 Edition)
The Society of Interventional Therapy, China Anti-Cancer Association
2019, 35(3): 504-508. DOI: 10.3969/j.issn.1001-5256.2019.03.010
Abstract:
An excerpt of AGA clinical practice update:Surgical risk assessment and perioperative management in cirrhosis (2018)
Chou Sai, Zhao GuoDong
2019, 35(3): 509-513. DOI: 10.3969/j.issn.1001-5256.2019.03.011
Abstract:
An excerpt of endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) guideline - updated 2018
Li JiaSu, Li WanTong, Liu Feng, Li ZhaoShen
2019, 35(3): 514-517. DOI: 10.3969/j.issn.1001-5256.2019.03.012
Abstract:
Original articles_Viral hepatitis
Association of APOBEC3B copy number variation with the prognosis of hepatitis B virus infection
Xie PengFei, Gao YuFeng, Li Xu
2019, 35(3): 518-521. DOI: 10.3969/j.issn.1001-5256.2019.03.013
Abstract:
Objective To investigate the difference in the distribution frequency of APOBEC3 B copy number variations ( CNVs) betweenpatients with different outcomes after hepatitis B virus ( HBV) infection and the role of APOBEC3 B CNVs in clinical outcome. MethodsA total of 296 patients with acute self-limiting recovery after HBV infection and 819 patients with different stages of chronic HBV infectionwho visited The First Affiliated Hospital of Anhui Medical University from January 2016 to December 2017 were enrolled as acute self limitingrecovery group and chronic HBV infection group, respectively, and their peripheral blood samples were collected. Among the 819 patientswith chronic HBV injection, 444 had chronic hepatitis B ( CHB) , 252 had liver cirrhosis ( LC) , and 123 had hepatocellular carcinoma ( HCC) . The AccuCopy method was used to measure APOBEC3 B CNVs in peripheral blood, and related clinical data were collected for allpatients. The chi-square test was used for comparison of distribution frequency of APOBEC3 B CNVs between groups. Results For acuteor chronic outcome after chronic HBV infection, the acute self limiting recovery group had a significantly lower proportion of patients with re-duced or deleted APOBEC3 B CNVs than the chronic HBV infection group ( 46. 96% vs 58. 00%, P = 0. 001 1) . For disease progression af-ter chronic HBV infection, the HCC group had the highest proportion of patients with deleted APOBEC3 B CNVs of 22. 76%, followed by theLC group ( 14. 29%) and the CHB group ( 11. 04%) , and there was a significant difference between the three groups ( χ2= 11. 85, P =0. 019) . In the chronic HBV infection group, there was no significant difference in the distribution frequency of APOBEC3 B CNVs betweenthe patients with positive E-antigen and those with negative E-antigen ( χ2= 0. 639, P = 0. 727) . Conclusion APOBEC3 B CNV is asso-ciated with the outcome of chronic HBV infection, and reduced and deleted APOBEC3 B CNV is a genetic susceptibility factor for chronicityand progression of HBV infection.
Association of blood lipids and albumin-bilirubin index with disease progression in patients with chronic hepatitis B virus infection
Cao WenJun, Wang TongTong, Gao YuFeng, Zou GuiZhou
2019, 35(3): 522-525. DOI: 10.3969/j.issn.1001-5256.2019.03.014
Abstract:
Objective To investigate the value of blood lipid indices and albumin-bilirubin index ( ALBI) in evaluating the progression ofchronic hepatitis B virus ( HBV) infection. Methods A total of 184 patients with chronic HBV infection who visited The Second AffiliatedHospital of Anhui Medical University from June 2016 to June 2017 were enrolled, and according to the stage of the disease, they were divid-ed into ASC group ( 74 HBV carriers) , CHB group ( 70 patients with chronic hepatitis B) , and LC group ( 40 patients with compensated cir-rhosis) . A total of 50 healthy individuals were enrolled as health control ( HC) group. Blood lipid indices and liver function parameters weremeasured, and the changes in blood lipid indices and ALBI during the progression of chronic HBV infection were analyzed. A one-way a-nalysis of variance was used for comparison of continuous data between multiple groups, and the Dunnett method was used for further compar-ison between two groups; the chi-square test was used for comparison of categorical data between groups; Pearson correlation analysis wasused to investigate correlation. Results There were significant differences between the ASC, CHB, LC, and HC groups in blood lipid indi-ces of cholesterol ( CHO) , high-density lipoprotein cholesterol ( HDL-C) , low-density lipoprotein cholesterol ( LDL-C) , apolipopro-tein A ( APOA) , and apolipoprotein B ( F = 12. 075, 19. 559, 6. 554, 9. 392, and 5. 458, all P < 0. 001) , and the LC group had signifi-cantly greater reductions in the above indices compared with the other three groups ( all P < 0. 05) . There was a significant difference in AL-BI between the four groups ( F = 49. 225, P < 0. 001) ; the LC group had a significantly higher ALBI than the other three groups ( all P <0. 05) , and the ASC and CHB groups had a significantly higher ALBI than the HC group ( both P < 0. 05) . CHO, HDL-C, LDL-C, andAPOA were negatively correlated with ALBI ( all P < 0. 05) , among which CHO and HDL-C had the strongest correlation with ALBI ( r =-0. 310 and-0. 266, both P < 0. 001) . Conclusion In patients with chronic HBV infection, blood lipid indices and ALBI can reflectthe degree of liver function damage, especially in patients with liver cirrhosis.
Clinical effect and safety of sofosbuvir-ledipasvir regimen in treatment of patients with HCV genotype 6a chronic hepatitis C
Li Wei, Kang Yi, Ding GangQiang, Shang Jia, Zhou YuanPing
2019, 35(3): 526-529. DOI: 10.3969/j.issn.1001-5256.2019.03.015
Abstract:
Objective To investigate the clinical effect and safety of sofosbuvir ( SOF) -ledipasvir ( LDV) in the treatment of patients withHCV genotype 6 a chronic hepatitis C ( CHC) . Methods A total of 63 patients with HCV genotype 6 a CHC who visited Department of In-fectious Diseases, Henan Provincial People's Hospital and Nanfang Hospital, from October 2014 to December 2016 were enrolled in thisprospective observational study. They were divided into SOF-LDV group ( treated with SOF-LDV for 12 weeks) and PR group ( treatedwith pegylated interferon combined with ribavirin for 24 weeks) . HCV RNA was measured during treatment and follow-up, and virologicresponse was evaluated. The chi-square test was used for comparison of categorical data between two groups, and the Mann-Whitney Utest was used for comparison of continuous data between two groups. Results There were no significant differences between the PR groupand the SOF-LDV group in rapid virologic response rate ( 85. 3% vs 100%, P > 0. 05) and virologic response rate at the end of treatment ( 94. 1% vs 100%, P > 0. 05) . The SOF-LDV group had a significantly higher sustained virologic response rate than the PR group ( 96.4% vs 73. 5%, χ2= 4. 38, P = 0. 036) . The PR group had a significantly higher incidence rate of adverse events than the SOF-LDV group ( χ2= 7. 54, P = 0. 006) . During follow-up, one patient with liver cirrhosis in the SOF-LDV group developed small hepatocellular carcino-ma, while no patient in the PR group developed liver cancer at the end of follow-up. Conclusion SOF-LDV for 12 weeks is safe and ef-fective in the treatment of HCV genotype 6 a CHC, but liver cancer should be closely monitored in patients with liver cirrhosis.
Original articles_Liver neoplasms
Value of Barcelona Clinic Liver Cancer staging system versus Hong Kong Liver Cancer staging system in predicting the prognosis of patients with hepatocellular carcinoma
Chen Chuang, Long PeiYun, Chen Jie, Wang Pan, Huang QingYun, Zang YouYa, Deng GuoYu, Lin DongYi, Wang ZongYu
2019, 35(3): 530-534. DOI: 10.3969/j.issn.1001-5256.2019.03.016
Abstract:
Objective To investigate the value of Barcelona Clinic Liver Cancer ( BCLC) staging system versus Hong Kong Liver Cancer ( HKLC) staging system in predicting the prognosis of patients with hepatocellular carcinoma ( HCC) . Methods A retrospective analysiswas performed for the clinical data of 436 previously untreated patients with HCC who were admitted to The Affiliated Tumor Hospital ofGuangxi Medical University from July 2008 to July 2013, and the staging score was determined according to the HKLC and BCLC staging sys-tems. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used to compare the cumulative survival ratebetween the patients with different HKLC or BCLC stages. The Cox proportional hazards model was used to calculate the likelihood ratios ( LR χ2) of the two systems. The area under the receiver operating characteristic curve ( AUC) and C-index were used to analyze the dis-criminability and trend of the HKLC and BCLC staging systems. Results There was a significant difference in survival rate between the pa-tients with adjacent HKLC stages ( all P < 0. 05) , and there was also a significant difference in survival rate between all patients with adja-cent BCLC stages ( all P < 0. 001) , except between those with stage 0 and stage A HCC. The Cox proportional hazards model showed that theHKLC system ( LR χ2= 131. 14) had a better homogeneity than the BCLC system ( LR χ2= 100. 69) . The C-index of the BCLC and HKLCsystems was 0. 703 ( 95% confidence interval [CI]: 0. 675-0. 731) and 0. 720 ( 95% CI: 0. 692-0. 748) , respectively, and there was asignificant difference in C-index between the two systems ( P < 0. 001) . There was a significant difference in the AUC of 1-year cumula-tive survival rate between the BCLC system and the HKLC system [0. 783 ( 95% CI: 0. 745-0. 821) vs 0. 811 ( 95% CI: 0. 774-0. 849) , P = 0. 026]. Conclusion Both BCLC and HKLC staging systems have a good value in predicting the prognosis of HCC patients, but the HKLC staging system has a higher value than the BCLC staging system.
Prognosis and staging system analysis of hepatocellular carcinoma patients with negative serum alpha-fetoprotein
Ye YingJian, Liu Bo, Chen Wei, Li QiongXia
2019, 35(3): 535-541. DOI: 10.3969/j.issn.1001-5256.2019.03.017
Abstract:
Objective To investigate the effect of negative expression of serum alpha-fetoprotein ( AFP) ( < 20 ng/L) on the prognosisand staging of patients with hepatocellular carcinoma ( HCC) , the risk factors for postoperative survival rate of AFP-negative patients, andthe best scoring system for clinical outcome evaluation. Methods A retrospective analysis was performed for the clinical data of 188 patientswith HCC who underwent surgical resection in Xiangyang First People's Hospital Affiliated to Hubei Medical College from January 2012 toDecember 2017, among whom 127 had positive AFP ( AFP-positive group) and 61 had negative AFP ( AFP-negative group) . The twogroups were compared in terms of tumor-related factors, surgery-related factors, and other clinical data. The t-test was used for compari-son of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally dis-tributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier survival curve was used to calculate overall survival rate and relapse-free survival rate, and the log-rank test was used for compari-son of survival between two groups. The Cox proportional hazards model was used for univariate and multivariate analyses to identify the riskfactors for survival rate in the AFP-negative group and to evaluate the value of TNM system, Barcelona Clinic Liver Cancer ( BCLC) sys-tem, Cancer of the Liver Italian Program ( CLIP) score, Chinese staging ( CS) system, Japan Integrated Staging ( JIS) score, and Okudastaging system in judging postoperative survival of the AFP-negative group. Results Of all 188 HCC patients, 61 ( 32. 45%) had negative AFP. Moreover, compared with the AFP-positive patients, the AFP-negative patients tended to have a more complete capsule ( χ2=7. 234, P = 0. 007) , a better pathological stage ( χ2= 6. 698, P = 0. 01) , a higher survival rate ( χ2= 9. 580, P = 0. 002) , and a lower recurrence rate ( χ2= 8. 407, P = 0. 004) . Child-Pugh class B HCC ( hazard ratio [HR]= 1. 711, 95% confidence interval [CI]: 1. 073 ~39. 921, P = 0. 001) , a high level of bilirubin ( HR = 1. 044, 95% CI: 1. 006-1. 083, P = 0. 021) , and absence of tumor capsule ( HR =7. 025, 95% CI: 1. 319-37. 401, P = 0. 022) were independent risk factors for a reduced overall survival rate in the AFP-negative group.Tumor diameter > 3 cm ( HR = 4. 172, 95% CI: 1. 271-13. 691, P = 0. 019) , absence of tumor capsule ( HR = 8. 901, 95% CI: 2. 352-33. 693, P = 0. 001) , and vascular invasion ( HR = 0. 043, 95% CI: 0. 003-0. 584, P = 0. 018) were risk factors for an increased recurrence rate of tumor in the AFP-negative group. The univariate analysis showed that among these six staging systems, the TNM and BCLC staging systems were significantly associated with overall survival rate and relapse-free survival rate ( P < 0. 05) and the CS system was only significantly associated with overall survival rate ( P < 0. 05) ; the multivariate analysis showed that only the BCLC stating system was significantly associated with overall survival rate ( HR = 0. 124, 95% CI: 0. 038-0. 401, P < 0. 01) and that the TNM staging system ( HR =0. 339, 95% CI: 0. 158-0. 952, P = 0. 039) and the BCLC staging system ( HR = 0. 177, 95% CI: 0. 058-0. 539, P = 0. 002) were significantly associated with relapse-free survival rate. Conclusion AFP-negative patients often have good liver reserve function and biological behavior and high survival rate and relapse-free survival rate. Among the above six staging systems, only the BCLC staging system is significantly associated with both overall survival rate and relapse-free survival rate after surgery, and therefore, it is the best system for evaluating postoperative survival and prognosis in AFP-negative patients.
Change in serum level of abnormal prothrombin after microwave ablation for hepatocellular carcinoma and its clinical significance
Sun Yu, Zhang HongHai, Yuan ChunWang, Li Cong, Hu CaiXia, Cui ShiChang, Zhang YongHong, Zheng JiaSheng
2019, 35(3): 542-546. DOI: 10.3969/j.issn.1001-5256.2019.03.018
Abstract:
Objective To investigate the changes in serum levels of des-γ-carboxy-prothrombin ( DCP) and alpha-fetoprotein ( AFP) after microwave ablation in patients with hepatocellular carcinoma ( HCC) , to monitor the recurrence of HCC, and to investigate the associa-tion of serum DCP and AFP levels with the recurrence of HCC. Methods A total of 76 patients who were hospitalized and treated in BeijingYouAn Hospital, Capital Medical University, from December 2015 to February 2018 and were diagnosed with HCC by liver biopsy were en-rolled. The serum levels of DCP and AFP were measured before and after microwave ablation and at the time of recurrence. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H testwas used for comparison between three groups; the Spearman correlation analysis was used to investigate correlation. Results At 1 week af-ter microwave ablation, the HCC patients had significant reductions in the serum levels of DCP and AFP ( Z = 6. 854 and 6. 246, both P <0. 01) , which further decreased at 1 month after microwave ablation ( DCP: Z = 11. 639 and 4. 786, both P < 0. 01; AFP: Z = 10. 058 and3. 812, both P < 0. 01) . Of all 76 HCC patients, 59 experienced recurrence, and the serum levels of DCP and AFP at the time of recurrencewere significantly higher than the levels at 1 week and 1 month after microwave ablation ( DCP: Z =-4. 671 and-8. 521, both P < 0. 01;AFP: Z =-3. 423 and-6. 311, both P < 0. 01) . Before microwave ablation, the recurrence group had significantly higher serum levels ofDCP and AFP than the non-recurrence group ( Z =-3. 010 and-2. 387, P = 0. 003 or P = 0. 017) ; at 1 month after microwave ablation, the recurrence group had a significantly higher serum level of DCP than the non-recurrence group ( Z =-3. 498, P < 0. 001) . In the re-currence group, the patients with extrahepatic distant metastasis or vascular invasion had a significantly higher serum level of DCP than thosewith intrahepatic recurrence alone before and at 1 month after microwave ablation ( χ2= 23. 597 and 18. 228, both P < 0. 01) . Correlation a-nalysis showed that in HCC patients with recurrence, serum DCP level before and at 1 month after microwave ablation was negatively correlated with time to recurrence ( r =-0. 500 and-0. 651, both P < 0. 01) . Conclusion Monitoring of serum DCP level before and after microwave ablation in HCC patients helps to judge the clinical effect of microwave ablation and predict recurrence and prognosis.
Expression and clinical significance of protein kinase CK2β in hepatocellular carcinoma
Liang RunWei, Fan ZhengJun, Huang Juan, Sun Tao, Yu ZuQi
2019, 35(3): 547-552. DOI: 10.3969/j.issn.1001-5256.2019.03.019
Abstract:
Objective To investigate the expression and clinical significance of protein kinase CK2β in hepatocellular carcinoma ( HCC) tissue and the association of CK2β expression with patient prognosis. Methods HCC tissue and adjacent tissue samples were collected from127 HCC patients Who were diagnosed in Department of Hepatopancreatobiliary Surgery, The first Affiliated Hospital of Zhengzhou Universi-ty from Januany 2012 to June 2013, and immunohistochemistry was used to measure the expression of CK2β. The association of CK2β ex-pression with clinical features of HCC patients was analyzed. A total of 20 HCC tissue samples, 20 adjacent tissue samples, 20 cirrhotic tis-sue samples, and 20 normal liver tissue samples were collected from March to June 2018 in our hospital, and Western blot and real-timePCR were used to measure the protein and mRNA expression of CK2β in these tissue samples. A one-way analysis of variance was used forcomparison of means between multiple groups, and Bonferroni test was used for further comparison between two groups; the chi-square testwas used for comparison of categorical data between groups. The Mann-Whitney U test or the Kruskal-Wallis H test was used to investi-gate the association of CK2β expression with clinical features. The Kaplan-Meier method was used for survival analysis, and the log-ranktest was used for comparison between groups. Results Western blot and real-time PCR showed that the expression rate of CK2β in HCCtissue was significantly higher than that in adjacent tissue, cirrhotic tissue, and normal liver tissue ( P < 0. 05) ; there was no significantdifference in the expression of CK2β between adjacent tissue and cirrhotic tissue ( P > 0. 05) , and the expression of CK2β in adjacent tissueand cirrhotic tissue was significantly higher than that in normal liver tissue ( P < 0. 05) . Immunohistochemical staining showed that there wasa significant difference in the positive rate of CK2β between HCC tissue and adjacent tissue in the 127 HCC patients ( 85. 8% vs 63. 0%, P < 0. 001) . There was a significant difference in CK2β expression distribution between HCC patients with different ages ( Z =-2. 277, P = 0. 023) , presence or absence of liver cirrhosis ( Z =-2. 144, P = 0. 032) , different tumor sizes ( Z =-2. 289, P = 0. 004) , or differ-ent Edmondson-Steiner pathological grades ( χ2= 8. 210, P = 0. 016) . The Kaplan-Meier survival curve analysis showed that the stronglypositive CK2β expression group had a significantly shorter postoperative survival time than the moderately positive, weakly positive, and neg-ative CK2β expression groups ( all P < 0. 001) . Conclusion CK2β may be involved in the development and progression of HCC, and itspositive expression is associated with the prognosis of HCC patients.
Expression and significance of the ABAT gene in hepatocellular carcinoma:An analysis based on data mining
Zhang YuPeng, Wang Fan, Chen PengFei, Liu Shi, Liu Lan, Chang Ying, Zhao Qiu
2019, 35(3): 553-558. DOI: 10.3969/j.issn.1001-5256.2019.03.020
Abstract:
Objective To investigate the expression and significance of the ABAT gene in hepatocellular carcinoma ( HCC) using relateddatabases. Methods The Oncomine database and GEPIA were used to analyze the expression of ABAT in HCC tissue. GEPIA was used toinvestigate the correlation of ABAT mRNA with the survival time and pathological stage of HCC patients. The MethHC database was used toanalyze the methylation level of ABAT promoter region. The String database was used to analyze the network of proteins interacting withABAT protein. The Human Protein Atlas was used to analyze the expression of ABAT protein in HCC tissue and the influence of the proteinexpression of ABAT on prognosis. Results The mRNA expression of ABAT in HCC tissue was significantly lower than that in normal livertissue; patients with lower mRNA expression tended to have a poorer prognosis ( log-rank, P = 0. 002 1) and a higher degree of malignancy ( P = 0. 002 34) . The protein expression of ABAT in HCC tissue was significantly lower than that in normal liver tissue, and patients withlower protein expression tended to have a poorer prognosis ( log-rank, P = 2. 14 × 10-3) . The methylation level of ABAT promoter region inHCC tissue was significantly higher than that in normal liver tissue ( P < 0. 005) . The proteins interacting with ABAT included ALDH1 A3, ALDH9 A1, ALDH3 A2, GAD1, and GAD2, which might be involved in cell functions such as cell apoptosis, redox, and neurotransmittersecretion. Conclusion Data mining of tumor gene databases shows that there are low levels of mRNA and protein expression of ABAT inHCC tissue, which is associated with patient's survival time. At present, database mining can provide a reference for the diagnosis andprognosis evaluation of HCC and a theoretical basis for tumor research in the future.
Original articles_Biliary diseases
Clinical effect of percutaneous transhepatic cholangial drainage combined with biliary stent implantation in treatment of high malignant obstructive jaundice and the influencing factors for prognosis
Chen WeiWei, Huang Kun, Liu Rui, Liu ChengLi
2019, 35(3): 559-564. DOI: 10.3969/j.issn.1001-5256.2019.03.021
Abstract:

Objective To investigate the clinical effect of percutaneous transhepatic cholangial drainage ( PTCD) combined with biliarystent implantation in the treatment of high malignant obstructive jaundice ( MOJ) and the risk factors for survival time. Methods A retro-spective analysis was performed for the clinical data of 92 patients with high MOJ who were admitted to Department of Hepatobiliary Surgeryin Air Force General Hospital, PLA, from June 2015 to June 2017. The t-test was used for comparison of normally distributed continuousdata between two groups; an analysis of variance was used for comparison between multiple groups, and the SNK-q test was used for furthercomparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data betweentwo groups. The chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic ( ROC) curve was used to determine the optimal cut-off values of influencing factors for survival time; the patients were divided into groups accord-ing to the optimal cut-off values, and the Kaplan-Meier method was used for survival analysis. The multivariate Cox proportional hazardsmodel was used to identify the independent influencing factors for survival time. Results All patients were followed up for a median time of6 months ( range 1-10 months) . A total of 56 patients died and 36 survived during follow-up, with a median survival time of 6 months, asurvival rate of 39. 1% at the end of follow-up, and a half-year survival rate of 44. 6%. Of all 92 patients, 14 experienced postoperativecomplications, resulting in an incidence rate of complications of 15. 2%. At 3 days and 1 week after surgery, there were significant reduc-tions in total bilirubin ( TBil) , direct bilirubin, alanine aminotransferase ( ALT) , and aspartate aminotransferase ( F = 206. 264, 106. 161, 86. 332, and 166. 857, all P < 0. 05) . The ROC Curve was used to analyze the data, TBil had a sensitivity of 95. 12% and a specificity of46. 15% at the optimal cut-off value of 112. 9 μmol/L; ALT had a sensitivity of 92. 68% and a specificity of 31. 58% at the optimal cut-off value of 210 U/L; albumin had a sensitivity of 68. 29% and a specificity of 58. 33% at the optimal cut-off value of 35. 7 g/L; red blood cell count had a sensitivity of 60. 98% and a specificity of 69. 23% at the optimal cut-off value of 3. 56 × 1012/L. Child-Pugh class, TBil, and ALT showed a significant difference in predicting overall survival ( all P < 0. 05) . The multivariate Cox proportional hazards model showed that Child-Pugh class C was an independent influencing factor for survival time after PTCD combined with biliary stent implantation. Conclusion PTCD combined with biliary stent implantation has a good clinical effect in the treatment of patients with MOJ, but preoperative liver function has a great impact on survival time. Therefore, liver function should be observed dynamically to guide clinical treatment, in order to prolong the survival time of such patients.

Clinical effect of laparoscopic radical resection in treatment of type Ⅳ hilar cholangiocarcinoma
Xu Jian, Zhang Wei, Wu ZhangKang, Wu Guo, Li JingDong
2019, 35(3): 565-569. DOI: 10.3969/j.issn.1001-5256.2019.03.022
Abstract:

Objective To investigate the feasibility and safety of laparoscopic radical resection in the treatment of type IV hilar cholangio-carcinoma. Methods A retrospective analysis was performed for the clinical data of 4 patients who were admitted to the Affiliated Hospitalof Chuanbei Medical College from July 2015 to September 2018, underwent laparoscopic radical resection, and were diagnosed with type IVhilar cholangiocarcinoma based on postoperative pathology. There were 2 female and 2 male patients aged 53-65 years, with a mean age of59. 4 years. All patients had varying degrees of jaundice before surgery and were given symptomatic treatment including liver-protectingtreatment, jaundice clearance, and nutritional support. Two patients underwent percutaneous transhepatic biliary drainage before surgery toalleviate jaundice. Results All 4 patients underwent a successful laparoscopic surgery, among whom 3 underwent left hemihepatectomy +total caudate lobe resection + lymph node dissection + choledochoenterostomy, and 1 underwent extensive right hemihepatectomy + total cau-date lobe resection + lymph node dissection + choledochoenterostomy. Time of operation was 5. 5-8. 5 hours, and intraoperative blood lossranged from 200 to 750 ml, with 400 ml intraoperative blood transfusion in 1 patient. After surgery, 1 patient had bile leakage and was im-proved and discharged after conservative continuous drainage; 1 patient had massive ascites and was discharged after liver-protecting anddiuretic treatment; no perioperative complication was observed in the other 2 patients. The patients were followed up for 3-24 months aftersurgery; 1 patient developed intrahepatic metastasis at 11 months after surgery and had survived with tumor for 4 months after interventionaltherapy. Conclusion With adequate preoperative assessment, strict control of surgical indications, skilled laparoscopic technique, andstandardized operation, laparoscopic radical resection is feasible and safe in the treatment of type IV hilar cholangiocarcinoma. R0 resectionis an important prognostic factor.

Effect of Pien Tze Huang on bile excretion and its analgesic effect in experimental animals
Li JunFeng, Ren Feng, Ding Mei, Liu Shuang, Chen ZhiLiang, Chen Yu, Duan ZhongPing
2019, 35(3): 570-573. DOI: 10.3969/j.issn.1001-5256.2019.03.023
Abstract:

Objective To investigate the effect of Pien Tze Huang on bile excretion and its analgesic effect in experimental animals. Meth-ods A total of 30 guinea pigs were randomly divided into Pien Tze Huang group, ursodeoxycholic acid group, and control group. Accordingto body mass, the three groups were treated with Pien Tze Huang ( 140 mg/kg) , ursodeoxycholic acid ( 22. 5 mg/kg) , and normal saline, respectively, by gavage for 4 consecutive days. Then bile drainage was performed to measure the volume of bile secretion and the change inbile composition. Related liver function parameters were also measured. A total of 30 mice were randomly divided into Pien Tze Huang group ( 360 mg/kg) , ursodeoxycholic acid group ( 120 mg/kg) , and control group. At one hour after the last administration, the mice were givenintraperitoneal injection of 0. 6% glacial acetic acid ( 0. 15 ml/10 g) , and the writhing test was performed to observe the analgesic effect ofPien Tze Huang. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least signifi-cant difference t-test was used for further comparison between two groups. Results Compared with the control group, the Pien Tze Huanggroup and the ursodeoxycholic acid group had a significant increase in the volume of bile secretion ( P = 0. 039 and 0. 009) . There were nosignificant differences between the three groups in cholesterol, bilirubin, total bile acid, and phospholipid in bile ( all P > 0. 05) and liverfunction parameters ( alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, total bilirubin, direct biliru-bin, indirect bilirubin, and total bile acid) ( all P > 0. 05) . Compared with the control group, the Pien Tze Huang group had a significantreduction in the number of writhing times ( P < 0. 001) , suggesting that Pien Tze Huang had a marked analgesic effect. Conclusion Ani-mal experiments show that Pien Tze Huang has marked choleretic and analgesic effects, which provides theoretical and data support for theclinical application of Pien Tze Huang.

Original articles_Others
Clinical features of liver injury induced by antitumor drugs:An analysis of 56 cases
Zhang HuiJuan, Shi ZuXuan, Zhao LanFang, Gao TianHui, Li Jian
2019, 35(3): 574-578. DOI: 10.3969/j.issn.1001-5256.2019.03.024
Abstract:

Objective To investigate the clinical features of drug-induced liver injury ( DILI) caused by antitumor drugs during the treat-ment of malignant tumors. Methods A retrospective analysis was performed for the clinical data of 56 patients who were diagnosed with ma-lignant tumors in Henan Provincial People's Hospital from January 2015 to December 2016 and experienced DILI during the treatment withantitumor drugs, including sex, age, type of primary tumor, hepatotropic virus infection, liver function, type of chemotherapeutics, onsettime of liver injury, application of liver-protecting drugs, and outcome of liver injury. Results Among the 56 patients with DILI caused byantitumor drugs, 30 ( 53. 6%) had hepatocellular injury, and 45 ( 80. 4%) had mild liver injury. FOLFOX, GP/DP, and CHOP were themost common regimens for DILI, and of all 56 patients, 50 ( 89. 3%) had DILI caused by multiple drugs. Platinum-based drugs, anti-microtubule agents, and alkylating agents were the common drugs causing DILI. Of all 56 patients, 35 ( 62. 5%) developed DILI within 1-2 weeks after medication. Conclusion DILI caused by antitumor drugs mainly has a mild degree and hepatocellular injury type is the mostcommon clinical type. Platinum-based antitumor drugs and related chemotherapeutic regimens are the most common drugs for DILI. A com-bination of multiple antitumor drugs is more likely to cause DILI, and patients with such DILI often have a good prognosis.

Drug-induced liver injury in children:An analysis of medication and clinical features
Zhang YanFang, Guo YuMing, Niu Ming, Ge FeiLin, Jing Jing, Zhu Yun, Zhu ShiShu, Han ZiXin, Wang JiaBo, Liu ShiJing, Xiao XiaoHe
2019, 35(3): 579-584. DOI: 10.3969/j.issn.1001-5256.2019.03.025
Abstract:

Objective To investigate the drugs responsible for drug-induced liver injury ( DILI) in children and related risk factors, andto provide a reference for safe drug use in children in clinical practice. Methods A retrospective analysis was performed for the clinical da-ta of 187 children with DILI, aged 0-14 years, who were treated in The Fifth Medical Center of Chinese PLA General Hospital from January2008 to December 2017, including medication history, biochemical parameters, symptoms/signs, and clinical outcome. Based on the meth-od of integrated evidence chain, 127 children with medication information were divided into Western medicine-induced DILI group ( West-ern medicine group with 75 children) , traditional Chinese medicine ( TCM) -induced DILI group ( TCM group with 15 children) , and thegroup with DILI induced by Western medicine and TCM ( TCM-Western medicine group with 37 children) . The reason for medication, medication time, latency of DILI, and drug classification were compared between groups. The Kruskal-Wallis H test was used for compari-son of continuous data with skewed distribution between multiple groups, and the Nemenyi test was used for further comparison between twogroups; the chi-square test was used for comparison of categorical data between groups. Results Of all 187 children with DILI, 116 ( 62%) had severe liver injury or above, among whom 3 underwent liver transplantation and 1 died, and 45 ( 24%) developed chronicity.In the Western medicine group and the TCM-Western medicine group, major suspected drugs for DILI were antibiotics, antipyretics, anal-gesics, and anti-inflammatory drugs, which accounted for 42%, 30%, 56%, and 31%, respectively. In the TCM group, the most com-mon TCM drugs for DILI were those used to treat skin diseases, which accounted for 47% and were mainly the preparations of Fallopia multi-flora ( 33%) . There were significant differences between the three groups in medication time ( H = 11. 658, P = 0. 003) and latency ( H =10. 945, P = 0. 004) , and the TCM group had significantly longer medication time and latency than the other two groups ( all P < 0. 05) .Conclusion Most children with DILI have serious conditions. The risk of liver injury due to medication in children should be taken serious-ly, and particular emphasis should be placed on the risk of liver injury caused by antibiotics, antipyretics, analgesics, and anti-inflamma-tory drugs and long-term use of some TCM drugs for skin diseases.

A bioinformatics analysis of the microRNA-mRNA differential expression network for alcoholic hepatitis
Zhang XiuZhi, Li NingNing, Liu XiaoLi, Kang ChunYan, Zhang JinZhong
2019, 35(3): 585-591. DOI: 10.3969/j.issn.1001-5256.2019.03.026
Abstract:

Objective To establish a microRNA-mRNA differential expression network for alcoholic hepatitis ( AH) , and to investigatenew targets for the diagnosis and treatment of AH. Methods Differentially expressed microRNAs and mRNAs between AH patients and nor-mal controls were screened out. Related software including TargetScan, DIANA, MIRDB, PICTAR, and miRWalk 2. 0 was used to searchfor the target genes of differentially expressed microRNA, and a key microRNA-mRNA network was established using the differentially ex-pressed mRNAs that changed in an opposite way to microRNA. The Database for Annotation, Visualization and Integrated Discovery wasused for the gene ontology ( GO) and Kyoto Encyclopedia of Genes and Genome ( KEGG) analyses of target genes. The GCBI online soft-ware ( www. gcbi. com. cn) was used for enrichment analysis of target genes and core network establishment. The GeneMANIA database inCytoscape software ( genemania. org) was used to perform a protein-protein interaction analysis of key target genes. The above three meth-ods were compared in terms of the search for key pathways involved in the development of AH. Results A key microRNA-mRNA networkwas established with 5 differentially expressed microRNAs including hsa-mir-21-5 p, hsa-mir-148 a-3 p, and hsa-mir-30 e-5 pand 51 target genes including collagen type IV alpha 1 chain ( COL4 A1) , thrombospondin-2 ( THBS2) , and integrin alpha 6 ( IGTA6) . Aprotein-protein interaction network of key target genes was established. The GO analysis and various pathway analyses showed that the PI3 K-Akt pathway and local adhesion were closely associated with AH. Conclusion During the development of AH, there are complex interac-tions between the related proteins of key target genes. COL4 A1 and THBS2 may promote the development of AH by activating ITGA6 to regu-late the PI3 K-Akt pathway and the process of local adhesion. The establishment of the microRNA-mRNA network reveals the key links inthe development of AH and highlights the focus of research. The discovery of the genes associated with the PI3 K-Akt pathway in AH is ex-pected to provide new targets for the diagnosis and treatment of AH.

Effect of human liver-derived stem cells in prevention and treatment of alcoholic fatty liver disease in mice
Bi YanZhen, Zhang QiuSheng, Fan Zeng, Yang YongHong, Zhang XiaoBei, Wang QuanQuan, Wang QuanYi, Wang YiBo, Duan ZhongPing, Chen Yu, Shu ZhenFeng, Si ChuanPing, Hong Feng
2019, 35(3): 592-595. DOI: 10.3969/j.issn.1001-5256.2019.03.027
Abstract:

Objective To investigate the effect of intraperitoneal transplantation of human liver-derived stem cells in the prevention and treatment of alcoholic fatty liver disease in mice. Methods A total of 30 male C57 BL/6 mice were randomly divided into blank control group ( group N) , model control group ( group M) , and stem cell transplantation group ( group S) . The mice in group N were fed a normal diet, and those in the other two groups were fed Lieber-DeCarli alcohol liquid diet; at the same time, the mice in group S were given intraperitoneal transplantation of human liver-derived stem cells twice a week. After six weeks of intervention, body weight and liver index were measured, and the serum levels of alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , total bilirubin ( TBil) , total cholesterol ( TC) , triglyceride ( TG) , high-density lipoprotein cholesterol ( HDL-C) , and low-density lipoprotein cholesterol ( LDL-C) were also measured. The levels of TG and non-esterified fatty acid ( NEFA) in the liver were measured, and liver pathological examination and oil red O staining of the liver were performed. One-way ANOVA was used for comparison of continuous data between multiple groups, and the SNK-q test was used for further comparison between two groups. Results There were significant differences in the serum levels of ALT, AST, TG, TC, and HDL-C and the content of TG and NEFA in the liver between the three groups ( F = 66. 94, 7. 15, 8. 02, 18. 64, 3. 86, 23. 14 and 30. 49, all P < 0. 05) , Compared with group N, group M showed significant increases in levels of ALT, AST, and TG in serum and levels of TG and NEFA in liver tissue ( all P < 0. 05) . Group S had significantly lower levels of ALT, AST, and TG in serum and levels of TG and NEFA in liver tissue than group M ( all P < 0. 05) . Liver HE staining and oil red O staining showed that group S had a significantly lower degree of liver steatosis than group M. Conclusion Intraperitoneal transplantation of human liver-derived stem cells has a marked effect in the prevention and treatment of alcoholic fatty liver disease in mice.

Clinical effect of intervention with Gandouling tablets in the perioperative period of splenectomy in patients with Wilson's disease accompanied by splenomegaly and hypersplenism
Ma ShouLiang, Yang WenMing, Han Hui, Wang YanXin, Dong Ting, Sheng YuQin
2019, 35(3): 596-599. DOI: 10.3969/j.issn.1001-5256.2019.03.028
Abstract:

Objective To investigate the clinical effect of perioperative Gandouling intervention in patients with Wilson's disease ( WD) complicated by splenomegaly and hypersplenism and the changes in related indices. Methods A total of 60 WD patients with splenomegalyand hypersplenism who were hospitalized in Encephalopathy Center, The First Affiliated Hospital of Anhui University of Chinese Medicine, from July 2016 to July 2018 were enrolled and randomly divided into control group and treatment group, with 30 patients in each group. Thepatients in the control group were given conventional Western medicine treatment including decoppering for 4 courses ( each course of treatmentwas 8 days) , followed by splenectomy and conventional decoppering at the end of week 1 after surgery for 2 courses; the patients in the treat-ment group were given Gandouling in addition to the treatment in the control group. Clinical outcome and changes in 24-hour urinary copper, peripheral hemogram, liver function parameters, and portal venous flow indices were observed. The two independent samples t-test was usedfor comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between twogroups. Results The treatment group had a significantly higher overall response rate than the control group [90% ( 27/30) vs 60% ( 18/30) , χ2= 4. 43, P = 0. 03]. Compared with the control group at the end of two courses of treatment after surgery, the treatment group had sig-nificantly lower 24-hour urinary copper ( t = 41. 07, P < 0. 05) and levels of alanine aminotransferase and aspartate aminotransferase ( t = 7. 29 and 6. 13, both P < 0. 01) and significantly higher levels of red blood cell count, platelet count, and hemoglobin ( t =-5. 49, -3. 43, and-3. 53, all P < 0. 01) . At the end of two courses of treatment after surgery, both groups had a reduction in portal venousflow, and the treatment group had a significantly greater improvement in portal venous flow than the control group ( t = 12. 05, P < 0. 01) .Conclusion Gandouling can improve the clinical outcome of WD patients with splenomegaly and hypersplenism after splenectomy.

Case reports
Hepatitis C virus-associated Waldenstrom macroglobulinemia and cryoglobulinemia: A case report
Yu XiaoYuan, Xin Qi, Liu YingMin, Jin FengYan
2019, 35(3): 600-601. DOI: 10.3969/j.issn.1001-5256.2019.03.029
Abstract:
Primary hepatic follicular dendritic cell sarcoma: A case report
Wang ShouQian, Abudureyimu Tuerhong, Wang ShuPeng, Tang ChaoHui, Wang YingChao
2019, 35(3): 602-604. DOI: 10.3969/j.issn.1001-5256.2019.03.030
Abstract:
Primary hepatic angiosarcoma in the elderly: A case report and literature review
Zhang XueWen, Dai ChaoLiu
2019, 35(3): 605-607. DOI: 10.3969/j.issn.1001-5256.2019.03.031
Abstract:
A case of primary hepatic angiosarcoma with splenic metastasis and rupture
Zhu XiXun, Li ZhiWei, Zheng Yu
2019, 35(3): 608-610. DOI: 10.3969/j.issn.1001-5256.2019.03.032
Abstract:
A case of spontaneous portosystemic shunt with hepatic encephalopathy
Hu WenYan, Rao ChunYan, Liu HuaBao, Wang YaNan
2019, 35(3): 611-612. DOI: 10.3969/j.issn.1001-5256.2019.03.033
Abstract:
Invasive Klebsiella pneumoniae liver abscess syndrome:A report of two cases and literature review
Li Jing, Zhao JieMin, Tang YiQian, Zhao Xin
2019, 35(3): 613-616. DOI: 10.3969/j.issn.1001-5256.2019.03.034
Abstract:
Acute renal failure caused by Viridans streptococci-associated liver abscess:A case report
Zhang ShuZe, Yu ZeYuan, Ren YanXian, Wang KeShen, Yang HanTeng, Jiao ZuoYi
2019, 35(3): 617-618. DOI: 10.3969/j.issn.1001-5256.2019.03.035
Abstract:
Percutaneous transhepatic multi-tube drainage combined with carbapenem antibiotics in treatment of multiple liver abscesses in AIDS:A case report
Yang Yang, Peng FengHui, Jia Feng, Liu YaHui, Ji Bo
2019, 35(3): 619-620. DOI: 10.3969/j.issn.1001-5256.2019.03.036
Abstract:
A case of neuroendocrine tumor of the ampulla of Vater
ABUDUREYIMU Tuerhong, Deng Yu, Wang Kun, Liu Kai, Liu YaHui
2019, 35(3): 621-622. DOI: 10.3969/j.issn.1001-5256.2019.03.037
Abstract:
Three cases of peritoneal mesothelioma
Liu XiaoWen, Zhong YanPing, Liu PeiYan, Gao YanHang
2019, 35(3): 623-626. DOI: 10.3969/j.issn.1001-5256.2019.03.038
Abstract:
Reviews
Research advances in the pathogenesis and diagnosis/treatment of muscle injury after treatment with nucleos (t) ide analogues in patients with chronic hepatitis B
Yuan Ling, Ceng BaiMei, Lin ShiDe
2019, 35(3): 627-630. DOI: 10.3969/j.issn.1001-5256.2019.03.039
Abstract:
With the wide application of nucleos ( t) ide analogues ( NAs) in antiviral therapy for chronic hepatitis B ( CHB) , the side effectsof NAs after long-term use have attracted more and more attention from clinicians and patients. In recent years, an increasing number ofstudies have reported muscle injury in CHB patients treated with NAs, and we have gained a deeper understanding of the incidence rate, pathogenesis, and treatment of muscle injury. This article reviews the incidence rate, related factors, clinical manifestations, pathogenesis, management, and prevention and treatment of muscle injury associated with NAs.
Research advances in epidemiology, pathogenesis, and diagnosis and treatment of hepatitis D virus infection
Wang Yu, Chen XiaoHua, Zhao ZhiMin, Huang Kai, Liu ChengHai
2019, 35(3): 631-634. DOI: 10.3969/j.issn.1001-5256.2019.03.040
Abstract:
Hepatitis B virus ( HBV) /hepatitis D virus ( HDV) co-infection can accelerate the progression of liver diseases, but due to thelimitations of the detection methods for HDV RNA, the epidemiology of HDV remains unclear. Further studies are needed to investigate thepathogenesis of HBV/HDV co-infection caused by HDV and related treatment methods. By reviewing the epidemiological features of HDV, HDV-specific immunity, genotype, and pathogenesis in China and other countries and summarizing HDV detection methods and treatmentmethods, this article shows that current detection methods for HDV infection have low sensitivity and specificity, with a lack of standardizeddetection methods. Exploration of new HDV detection methods will help to develop new and effective anti-HDV drugs, which has great sig-nificance in improving the outcome of HDV infection.
Advances in the application of transient elastography in noninvasive diagnosis of liver fibrosis
Luo WenPing, Ma Hong, Wang Yu
2019, 35(3): 635-639. DOI: 10.3969/j.issn.1001-5256.2019.03.041
Abstract:
Liver biopsy is the most sensitive and specific method for the diagnosis and staging of liver fibrosis, but its invasiveness and limi-tations have promoted the wide application of noninvasive evaluation methods for liver fibrosis in clinical practice in recent years. Variousstudies have proved the diagnostic efficiency of transient elastography ( TE) in chronic liver diseases of various etiologies, such as viral hepa-titis, nonalcoholic fatty liver disease, alcoholic liver disease, and autoimmune liver disease, especially in liver fibrosis and liver cirrhosis, and therefore, it has been incorporated into clinical practice guidelines in many countries. However, the diagnostic efficiency of TE in liverfibrosis is affected by several factors including aminotransferases, bilirubin, liver inflammation, and steatosis. Several noninvasive methodsshould be used in combination based on etiology to improve diagnostic accuracy.
Mechanism of the activation of hepatic stellate cells:An exploration of new diagnostic markers and therapeutic targets for liver fibrosis
Jiang Na, Ping Jian, Xu LieMing
2019, 35(3): 640-643. DOI: 10.3969/j.issn.1001-5256.2019.03.042
Abstract:
Liver fibrosis has a complex pathogenesis, and at present, the research mainly focuses on hepatic stellate cells ( HSC) . Many stim-ulating factors and regulatory pathways have been found to promote the activation of HSC. This article reviews the recent research findings onseveral major cytokines and peroxisome proliferator-activated receptor γ and research hotspots in recent years, including the association of mi-croRNAs, long non-coding RNA, and exosomes with HSC activation. This article also introduces potential targets for the treatment of liver fi-brosis and new markers for noninvasive diagnosis of liver diseases and proposes that chemical drugs or traditional Chinese medicine compoundswhich act on the targets of HSC activation can be formulated, in order to make a breakthrough in the therapeutics of liver fibrosis.
Role and mechanism of action of adipocytokines in the progression of liver fibrosis
Huo XinMei, Huang HuiFang
2019, 35(3): 644-647. DOI: 10.3969/j.issn.1001-5256.2019.03.043
Abstract:
Liver fibrosis is an essential stage in the development and progression of liver cirrhosis, and uncontrolled liver fibrosis may even-tually lead to liver cirrhosis and/or hepatocellular carcinoma. Liver fibrosis is a dynamic process regulated by many factors. An increasingnumber of evidence has shown that adipokines transmit dynamic functions in the liver and are involved in the regulation of liver fibrosis. Thisarticle reviews the research on major adipocytokines ( adiponectin and leptin) involved in liver fibrosis and the recent advances in the mecha-nism of action of these adipocytokines in liver fibrosis.
Application of reverse ligation in treatment of gastroesophageal varices
Li HongYan, Tang TongYu
2019, 35(3): 648-650. DOI: 10.3969/j.issn.1001-5256.2019.03.044
Abstract:
As one of the complications of liver cirrhosis, esophageal and gastric varices will seriously threaten patient's life once it rupturesand causes bleeding. At present, endoscopic treatment has become the first-line treatment for this disease. As for gastroesophageal varices, conventional esophageal ligation cannot deal with the varicose veins under the cardia and has a high risk of postoperative recurrence. In re-cent years, reverse ligation, as an effective method for the treatment of gastroesophageal varices, is safe and effective in the treatment of vari-ces and has a similar clinical effect as other endoscopic techniques. This article elaborates on the clinical features and treatment of gastroe-sophageal varices and advantages, limitations, and improvements of reverse ligation.
Risk factors, early screening, and preventing strategy for hepatitis B-related hepatocellular carcinoma
Li Mi, Nie QingHe, Han Man, Ju Di
2019, 35(3): 651-655. DOI: 10.3969/j.issn.1001-5256.2019.03.045
Abstract:
Hepatocellular carcinoma ( HCC) is a leading cause of cancer-related death worldwide and hepatitis B virus ( HBV) infection isone of most important risk factors for HCC. The development of HBV-related HCC involves a complex interaction between host and virus, and related risk factors include HBV viral load, HBeAg, and host susceptibility. Screening methods for HCC include radiological examina-tion such as ultrasound and serological markers such as α-fetoprotein, and protein induced by vitamin K antagonist-II and alpha-fetopro-tein ( AFP) variants may help with the diagnosis of AFP-negative HCC. Appropriate measures such as HBV vaccination and antiviral thera-py can help to prevent HCC. The long-term goal of antiviral therapy for chronic hepatitis B is to reduce complications such as liver cirrhosisand HCC. nucleos ( t) ide analogues can effectively inhibit replication of virus, but they cannot eradicate covalently closed circular DNA inthe nucleus of hepatocytes. There is still an urgent need for a cure for hepatitis B. This article reviews the epidemiology, risk factors, screening methods, and preventive strategies for HBV-related HCC.
Biological function and regulatory mechanism of epithelial-mesenchymal transition-related long non-coding RNAs in liver cancer
Wang Yuan, Guo Tao, Li JingHua, Zhao JiSen, Zhou YuanLong, Yang JiHong
2019, 35(3): 656-660. DOI: 10.3969/j.issn.1001-5256.2019.03.046
Abstract:
Liver cancer has a high degree of malignancy, and many oncogenes and tumor suppressor genes play an important regulatory rolein the development and progression of liver cancer. Epithelial-mesenchymal transition ( EMT) is a biological process in which epithelialcells transform into mesenchymal cells, which can increase the migration and invasion abilities of tumor cells. Long non-coding RNAs ( ln-cRNAs) can regulate EMT process in various ways. This article reviews the research advances in the main biological functions and regulatorymechanisms of EMT-related lncRNAs in liver cancer.
Spleen-strengthening and dampness-removing therapy exerts a therapeutic effect on nonalcoholic fatty liver disease by regulating hepatic MTP promoter methylation
Liu Tao, Xu QiuLing
2019, 35(3): 661-664. DOI: 10.3969/j.issn.1001-5256.2019.03.047
Abstract:

Nonalcoholic fatty liver disease ( NAFLD) is the most common risk factor for diabetes mellitus and cerebrovascular and cardiovascu-lar diseases. The prevalence of NAFLD is increasing rapidly with the improvement in living. Microsome triglyceride transfer protein ( MTP) isa key enzyme for outward transport of liver lipids, and the increase in MTP promoter methylation is an important factor for liver lipid depositionin NAFLD. Traditional Chinese medicine believes that“spleen Qi transfers essence”, and the lipid transport function of MTP may be one of themanifestations of“spleen Qi transfers essence”. Clinical studies have shown that the spleen-strengthening and dampness-removing principleis of great importance in the treatment of NAFLD. By reviewing related articles, this article points out that the spleen-strengthening anddampness-removing therapy can improve NAFLD by regulating MTP promoter methylation, increasing the level of hepatic MTP, promoting theoutflow of liver lipids, and alleviating lipid deposition.

Role of intestinal dysbacteriosis in the pathogenesis of acute-on-chronic hepatitis B liver failure
Chen MuXing, Wang ShaoYang
2019, 35(3): 665-668. DOI: 10.3969/j.issn.1001-5256.2019.03.048
Abstract:
Acute-on-chronic liver failure is a clinical syndrome with acute exacerbation on the basis of chronic liver disease and cancause severe liver injury and dysfunctions of liver synthesis, detoxification, metabolism, and biotransformation. Intestinal dysbacteriosis is animportant factor for the acceleration of liver failure. Therefore, it is important to prevent or delay the progression of liver failure by improvingintestinal dysbacteriosis and liver function.
Association between high-mobility group box B1 and hepatic ischemia-reperfusion injury
Gao WeiDong, Feng ZanJie, Peng CiJun, Li Yang, Wu Bo, Geng Xin
2019, 35(3): 669-671. DOI: 10.3969/j.issn.1001-5256.2019.03.049
Abstract:
High-mobility group box B1 ( HMGB1) is a DNA-binding protein widely distributed in eukaryotic cells. When tissue damageoccurs, HMGB1 acts as an endogenous risk signal to activate the body's immune system and mediate aseptic inflammatory response. Currentresearch findings have shown that HMGB1 plays a key role in hepatic ischemia-reperfusion injury. This article summarizes the recent re-search advances in the proinflammatory role of HMGB1 in hepatic ischemia-reperfusion and HMGB1 as a target for the treatment of hepaticischemia-reperfusion injury.
Function and mechanism of action of the PD-1/PD-L1 pathway in liver diseases
Pan SiYu, Wang ZhiXin, ZHOU Ying, Wang Tao, Yin Jie, Wang Qiang, Fan HaiNing
2019, 35(3): 672-676. DOI: 10.3969/j.issn.1001-5256.2019.03.050
Abstract:
Programmed death-1 ( PD-1) is an important immunosuppressive molecule which interacts with its ligand programmed death-ligand 1 ( PD-L1) and plays an important role in central/peripheral immune tolerance, transplantation immunity, tumor immune escape, and autoimmune disease. At present, there is still no systematic understanding of the role of the PD-1/PD-L1 pathway in the developmentand progression of liver diseases. This article summarizes related studies on the role of the PD-1/PD-L1 pathway in the progression of liverdiseases and reviews the immunoregulatory function of the PD-1/PD-L1 pathway and its role in liver diseases. It is pointed out that thePD-1/PD-L1 pathway is involved in immunoregulatory function of the liver and plays an important role in the development and progressionof liver inflammation, autoimmune liver diseases, viral liver diseases, tumor immune escape, transplantation rejection reaction, induced im-mune response, and autoimmune tolerance. Intervention of the PD-1/PD-L1 pathway may provide new strategies and directions for theprevention and treatment of liver disease.
Clinical and pathological features of primary biliary cholangitis with negative anti-mitochondrial antibody
Liu HongLi, Yang YongFeng
2019, 35(3): 677-680. DOI: 10.3969/j.issn.1001-5256.2019.03.051
Abstract:

Anti-mitochondrial antibody ( AMA) is a typical serum marker for primary biliary cholangitis ( PBC) , and the diagnosis ofAMA-negative PBC may easily be neglected in clinical practice. This article analyzes the differences in epidemiology, clinical and patho-logical features, and treatment outcome between AMA-negative and AMA-positive PBC and points out that there are significant differencesbetween them in the symptom of pruritus, immunoglobulin M, and severity of bile duct injury. For patients with a clinical diagnosis of AMA-negative PBC, immunofluorescence assay combined with immunological detection should be performed to exclude the false-negative resultof AMA, and a confirmed diagnosis can be made with reference to the manifestation of cholestasis, positive results of anti-sp100, anti-gp210, and anti-ANA antibodies, and typical hyperactive cholangitis based on pathological examination. Differential diagnosis of this dis-ease with other types of bile duct injury or absence of bile duct should be taken seriously in clinical practice.

Nonsurgical treatment of malignant biliary obstructive diseases
Yin JingYang, Yang Kang
2019, 35(3): 681-685. DOI: 10.3969/j.issn.1001-5256.2019.03.052
Abstract:
Malignant biliary obstructive diseases are caused by various primary or metastatic malignancies of the liver, the biliary tract, andthe pancreas, with major clinical manifestations of obstructive jaundice, liver impairment, and cholangitis. Early diagnosis of such patients isdifficult, and most patients are in an advanced stage at the time of diagnosis and lose the opportunity for surgical resection. Nonsurgical treat-ment techniques including biliary drainage and biliary stent implantation play an important role in palliative treatment of patients with unre-sectable malignant biliary obstructive diseases. The application of new techniques, such as biliary radiofrequency ablation, intraductalbrachytherapy, and photodynamic therapy, further promotes the improvement in the effect of nonsurgical treatment methods including biliarydrainage. With the help of related research advances, these techniques can be applied in clinical practice in a standardized way.
Influence of common bile duct stones and juxta-papillary duodenal diverticula on endoscopic retrograde cholangiopancreatography and related coping strategies
Wan QianQian, Jin Jing, Li Jun
2019, 35(3): 686-689. DOI: 10.3969/j.issn.1001-5256.2019.03.053
Abstract:

Juxta-papillary duodenal diverticula ( JPD) may easily cause biliary and pancreatic diseases. JPD changes papillary positionand shape and increases the difficulties in endoscopic retrograde cholangiopancreatography ( ERCP) intubation and stone removal, and itmay also cause a series of complications. With reference to related articles in China and foreign countries, this article briefly describes thetyping and development of JPD and its association with biliary and pancreatic diseases, analyzes the influence of common bile duct stones andJPD on ERCP, and summarizes related coping strategies, in order to provide suggestions and bases for clinical diagnosis and treatment.

Reconsideration of indications for gallbladder-preserving cholecystolithotomy and preventive measures for postoperative recurrence of gallstones
Li YanFei, Du QianCheng, Zhang MengZhao, Mei XuePeng, Chen YiChong, Zhou Ying, Fan HaiNing
2019, 35(3): 690-695. DOI: 10.3969/j.issn.1001-5256.2019.03.054
Abstract:
Choledochoscopic minimally invasive gallbladder-preserving cholecystolithotomy is a surgical method for preserving the gallblad-der in the treatment of gallstones, and recurrence of gallstones is a hot topic for gallbladder-preserving cholecystolithotomy. The postopera-tive recurrence rate of gallstones can be reduced by selecting appropriate surgical indications and adopting effective preventive measures aftersurgery. This article reviews the indications for minimally invasive gallbladder-preserving cholecystolithotomy and postoperative preventivemeasures for the recurrence of gallstones, in order to better understand the influencing factors for recurrence and provide guidance for thetreatment of gallstones by minimally invasive gallbladder-preserving cholecystolithotomy.