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

2019 Vol. 35, No. 4

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Editorial
The era of the reversal of liver fibrosis and cirrhosis: Current status and challenges
Wang BingQiong, Sun YaMeng, You Hong
2019, 35(4): 705-708. DOI: 10.3969/j.issn.1001-5256.2019.04.001
Abstract:
An increasing number of clinical studies have shown that effective etiological therapy might achieve the reversal of liver fibrosis/early cirrhosis. An accurate assessment of fibrosis reversal is of great importance for treatment decision-making and prognosis prediction. At present, the“gold standard”for the histological evaluation of liver fibrosis/cirrhosis reversal remains to be perfected, and there is still a controversy over the noninvasive assessment of fibrosis reversal. Long-term cohort studies are needed to observe whether it can improve clinical hard endpoint, and the clinical effect of new anti-fibrotic drugs needs to be further confirmed.
Discussions by experts
Histological assessment of reversal of liver fibrosis and cirrhosis
Zheng YongJian, Wang Yan
2019, 35(4): 709-713. DOI: 10.3969/j.issn.1001-5256.2019.04.002
Abstract:
Liver fibrogenesis is a common pathway of pathological progression of chronic liver injuries. The diagnosis of liver fibrosis provides an important basis for treatment decision-making and prognostic evaluation of chronic liver diseases. With the rapid development of therapeutics, many new clinical issues have emerged, which requires new techniques for the diagnosis of liver fibrosis. At present, histological assessment remains the most reliable method for a definite diagnosis of liver fibrosis and cirrhosis. With reference to related clinical articles and data, this article analyzes the clinical value and research directions of histological assessment in chronic liver disease management and diagnosis of liver fibrosis/cirrhosis and its reversal.
Serological assessment of the reversal of liver fibrosis and cirrhosis
Liu TianHui
2019, 35(4): 714-719. DOI: 10.3969/j.issn.1001-5256.2019.04.003
Abstract:
Liver fibrosis/cirrhosis is the common pathological process of most chronic liver diseases. Many studies have confirmed that a certain degree of the reversal of liver fibrosis or cirrhosis can be achieved after effective treatment. How to use simple serological markers to evaluate the reversal of liver fibrosis and cirrhosis is a research hotspot at present. This article summarizes the current status of the research on serological markers for the reversal of liver fibrosis and cirrhosis.
Radiological evaluation of the reversal of liver fibrosis and cirrhosis
Chen YongPeng, Liang XieEr
2019, 35(4): 720-723. DOI: 10.3969/j.issn.1001-5256.2019.04.004
Abstract:
Noninvasive methods for the evaluation of liver fibrosis have been widely validated with liver biopsy as the gold standard. This article elaborates on the application of various imaging methods in the evaluation of liver fibrosis and their prospects in evaluating the reversal of liver fibrosis. Transient elastography is the main imaging method for evaluating the reversal of liver fibrosis and can show the improvement in liver fibrosis via liver stiffness measurement, but the association between the reduction in liver stiffness measurement and the improvement of liver fibrosis remains unclear.
Clinical assessment of the reversal of liver cirrhosis: “Point of return”
Zhao WenShan, Xie Wen
2019, 35(4): 724-727. DOI: 10.3969/j.issn.1001-5256.2019.04.005
Abstract:
Nowadays, many clinical studies have demonstrated that some patients can achieve the reversal of liver cirrhosis. Therefore, the methods for accurate assessment of whether the reversal of liver cirrhosis can be achieved and when it is achieved have become the hotspots in clinical research. This helps with the specific evaluation of therapeutic outcome, the adjustment of treatment regimen, and the prediction of prognosis. This article introduces the application of various indices after the reversal of liver cirrhosis due to different etiologies from the aspects of noninvasive models and liver biopsy, in order to search for the methods that can accurately reflect the features of reversal.
Advances in the understanding and treatment of liver fibrosis in traditional Chinese medicine
Liu ChengHai, Zhao ZhiMin, Lyu Jing
2019, 35(4): 728-733. DOI: 10.3969/j.issn.1001-5256.2019.04.006
Abstract:
Liver fibrosis is commonly seen in various chronic liver diseases. In history, traditional Chinese medicine ( TCM) clinical practice based on syndrome differentiation and treatment formed unique experience in the diagnosis and treatment of liver fibrosis; in recent years, studies based on experimental exploration and evidence-based medicine have formed effective Chinese patent drugs and experienced prescriptions for the treatment of liver fibrosis, as well as integrated traditional Chinese and Western medicine regimens. With the improvement in the quality of TCM drugs and the development of related clinical studies, new TCM drugs with stable quality and marked clinical effect will be launched for the treatment of liver fibrosis, so as to meet the clinical needs of patients with chronic liver diseases and promote the modern and international development of TCM.
Academic contention
Effect of entecavir versus tenofovir disoproxil fumarate antiviral therapy in reducing the risk of hepatocellular carcinoma in patients with chronic hepatitis B: Reflections on a Korean retrospective study
Hong ShengZhen, Xu Jie
2019, 35(4): 734-736. DOI: 10.3969/j.issn.1001-5256.2019.04.007
Abstract:
Recently, Choi et al. published a real-world study in JAMA Oncology, which showed that there was a significant difference between the entecavir group and the tenofovir disoproxil fumarate group in reducing the risk of hepatocellular carcinoma ( HCC) in chronic hepatitis B ( CHB) patients. This result is inconsistent with the common point of view in antiviral therapy for CHB and has aroused a heated discussion in the academic world. The editorial simultaneously published in JAMA Oncology pointed out that the study by Choi et al. has certain clinical significance, but there are still many confounding factors which need to be further clarified, and therefore, the regimen of antiviral therapy for CHB patients cannot be changed based on this result. With reference to this result, this article analyzes the key influencing factors for the risk of HCC in CHB patients receiving long-term antiviral therapy with NAs.
Therapeutic guidelines
Chinese expert consensus on multidisciplinary diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus ( 2018)
Chinese Society of Liver Cancer, Chinese Medical Doctor Association
2019, 35(4): 737-743. DOI: 10.3969/j.issn.1001-5256.2019.04.008
Abstract:
Clinical practice guidelines for the interventional treatment of advanced pancreatic carcinoma (on trial) (3rd edition)
Committee of Interventional MedicineCancer Foundation of China;Committee of Interventional Medicine and BioengineeringChinese Society of Interventional Physicians;
2019, 35(4): 744-754. DOI: 10.3969/j.issn.1001-5256.2019.04.009
Abstract:
An excerpt of AISF position paper on HCV in immunocompromised patients (2018)
Hao DaAng, Liu Ye, Shen ShanShan, Yan XueBing
2019, 35(4): 755-761. DOI: 10.3969/j.issn.1001-5256.2019.04.010
Abstract:
An excerpt of management of hepatitis C virus infection in patients with chronic kidney disease: position statement of the joint committee of Italian association for the study of the liver (AISF), Italian society of internal medicine (SIMI), Italian society of infectious and tropical disease (SIMIT) and Italian society of nephrology (SIN)
Han Chao, Dou XiaoGuang
2019, 35(4): 762-765. DOI: 10.3969/j.issn.1001-5256.2019.04.011
Abstract:
An excerpt of hepatocellular carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up (2018)
Lyu JiaYu, Han Tao
2019, 35(4): 766-768. DOI: 10.3969/j.issn.1001-5256.2019.04.012
Abstract:
Original articles_Viral hepatitis
Clinical significance of the measurement of peripheral blood Epstein-Barr virus load in patients with HBV infection
Ran RuoXi, Xiao MengYao, Li AnLing, Liu SongMei
2019, 35(4): 769-773. DOI: 10.3969/j.issn.1001-5256.2019.04.013
Abstract:

Objective To investigate the clinical significance of co-infection with hepatitis B virus ( HBV) and Epstein-Barr virus ( EBV) in HBV-related liver diseases such as chronic hepatitis B ( CHB) , liver cirrhosis, and hepatocellular carcinoma ( HCC) . Methods A retrospective analysis was performed for the clinical data of 487 patients with HBV infection who were diagnosed in Zhongnan Hospital of Wuhan University from May 2016 to August 2018, among whom 194 ( 39. 8%) had co-infection with HBV and EBV. The patients were divided into groups according to the copy number of EBV DNA ( > 400 IU/ml) , Child-Pugh class ( Child-Pugh class A, B, and C) , and progression of liver disease ( CHB, liver cirrhosis, and HCC) , and related indices were compared between groups. The t-test was used for comparison of normally distributed 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. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups, and the Dunn-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 patients with CHB had a significantly higher copy number of HBV-DNA than those with liver cirrhosis or HCC ( t = 2. 417 and 3. 258, P = 0. 017 and 0. 001) , while the patients with HCC tended to have a higher copy number of EBV DNA than those with CHB or liver cirrhosis, but there was no significant difference between the three groups ( F = 1. 161, P = 0. 315) . After adjustment for liver function based on Child-Pugh class, the HCC patients with Child-Pugh class A liver function had a significantly higher copy number of EBV DNA than the CHB patients and the patients with liver cirrhosis ( t = 2. 062 and 2. 615, P = 0. 041 and 0. 010) , the liver cirrhosis patients with Child-Pugh class C liver function had a significantly higher copy number of EBV DNA than the CHB patients ( t = 2. 647, P = 0. 012) . ALT/AST, globulin, and lymphocyte percentage were specific clinical indices for co-infection with HBV and EBV. Conclusion There is an increase in EBV load in HCC patients, and both EBV and HBV are involved in the progression of liver diseases. Dynamic quantification of EBV DNA in patients with HBV infection has a certain significance in early intervention of the progression of liver diseases.

Original articles_Liver fibrosis and liver cirrhosis
Expression of serum EBV-miR-BART13-3p and its diagnostic value in patients with chronic hepatitis B liver fibrosis in Qinghai, China
Li PingYing, Yang YongGeng, Li Juan, Shen YouXiu, Ma YingCai, Lu LunGen
2019, 35(4): 774-779. DOI: 10.3969/j.issn.1001-5256.2019.04.014
Abstract:
Objective To investigate the difference in the expression of serum EBV-miR-BART13-3 p between chronic hepatitis B ( CHB) patients with different liver fibrosis stages in Qinghai, China and the value of serum EBV-miR-BART13-3 p in the diagnosis of CHB liver fibrosis. Methods A total of 100 patients with CHB liver fibrosis who were admitted to Department of Gastroenterology, Qinghai Provincial People's Hospital, from July 2015 to March 2017 were enrolled, and according to fibrosis stage ( F0-F4) determined by liver transient elastography ( FibroTouch) , they were divided into F0-F2 group with 36 patients, F2-F4 group with 44 patients, and liver cirrhosis group with 20 patients. A total of 20 normal individuals who underwent physical examination were enrolled as control group. Real-time PCR was used to measure serum EBV-miR-BART13-3 p, and the expression of serum EBV-miR-BART13-3 p was compared between groups. A one-way ANOVA was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups. A bivariate correlation analysis was used to investigate the correlation between serum EBV-miR-BART13-3 p and liver stiffness measurement ( LSM) , and the receiver operating characteristic ( ROC) curve was used to investigate the value of serum EBV-miR-BART13-3 p and liver fibrosis indices [procollagen type Ⅲ ( PCⅢ) and hyaluronic acid ( HA) ] in the diagnosis of CHB liver fibrosis.Results The F0-F2 group, the F2-F4 group, and the liver cirrhosis group had significantly higher expression of serum EBV-miR-BART13-3 p than the control group ( 8. 91 ± 2. 33/14. 89 ± 4. 24/36. 56 ± 4. 24 vs 1. 01 ± 0. 57, F = 219. 42, P < 0. 001) . Serum EBV-miR-BART13-3 p had an area under the ROC curve ( AUC) of 0. 970, a sensitivity of 96. 9%, and a specificity of 88. 9% at the cut-off value of 10. 10; PⅢ had an AUC of 0. 632, a sensitivity of 31. 3%, and a specificity of 100% at the cut-off value of 47. 58 ng/ml; HA had an AUC of 0. 670, a sensitivity of 81. 3%, and a specificity of 55. 6% at the cut-off value of 85. 52 ng/ml. Serum EBV-miR-BART13-3 p was positively correlated with LSM ( r = 0. 797, P < 0. 001) . For the patients with the same stage of CHB liver fibrosis, there was no significant difference in the expression of serum EBV-miR-BART13-3 p between the patients in different ethnic groups or living at different altitudes in Qinghai ( all P > 0. 05) . Conclusion The expression of serum EBV-miR-BART13-3 p is gradually increasing with the progression of CHB liver fibrosis in Qinghai. Serum EBV-miR-BART13-3 p has a high value in the diagnosis of CHB liver fibrosis.Ethnic background and altitude have no marked influence on the expression of serum EBV-miR-BART13-3 p.
Clinical effect of Liqi Jianpi prescription in preventing hemorrhage within one year in patients with hepatitis B cirrhosis and severe esophageal and gastric varices
Hou YiXin, Yang ZhiYun, Yang YuYing, Jiang YuYong, Wang XianBo
2019, 35(4): 780-784. DOI: 10.3969/j.issn.1001-5256.2019.04.015
Abstract:
Objective To investigate the effect of Liqi Jianpi prescription on the risk of hemorrhage within one year in patients with hepatitis B cirrhosis and severe esophageal and gastric varices. Methods The patients who were hospitalized in Beijing Ditan Hospital from January2010 to August 2017 and were diagnosed with hepatitis B cirrhosis and esophageal and gastric varices were enrolled and divided into treatment group and control group. All patients were given conventional treatment, and the patients in the treatment group were given oral Liqi Jianpi decoction in addition to the conventional treatment. The incidence of upper gastrointestinal bleeding within one year was observed, and liver function, gastroscopy findings, and Child-Pugh class were observed before and after treatment. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. Results There was a significant difference in the rate of esophagogastric variceal bleeding within one year between the treatment group and the control group ( 19. 2%vs 38. 5%, χ2= 4. 112, P = 0. 038) . The treatment group had a significant change in serum albumin level after treatment ( t = 0. 934, P <0. 05) , and there was a significant difference in serum albumin level between the two groups after treatment ( t = 2. 928, P < 0. 05) . In the treatment group, portal vein width decreased significantly from 14. 1 ± 2. 7 mm before treatment to 12. 2 ± 2. 4 mm after treatment ( t =2. 829, P < 0. 01) ; in the control group, portal vein width was 14. 6 ± 2. 8 mm before treatment and 14. 3 ± 2. 5 mm after treatment ( t =0. 718, P < 0. 05) . After treatment, the treatment group had a significantly smaller portal vein width than the control group ( t = 1. 715, P <0. 05) . In the treatment group, the number of patients with red color sign decreased significantly from 20 before treatment to 9 after treatment ( χ2= 0. 884, P = 0. 08) ; after treatment, the degree of esophageal and gastric varices was alleviated, and the number of patients with severe varices decreased from 52 before treatment to 38 after treatment ( χ2= 0. 982, P = 0. 038) . Conclusion In patients with hepatitis B cirrhosis and severe esophageal and gastric varices, Liqi Jianpi prescription can reduce the incidence rate of upper gastrointestinal bleeding within one year, improve liver function, reduce portal vein width, and improve the degree of esophageal and gastric varices.
Features of intestinal microbiota in hepatitis B cirrhosis patients with amassment or tympanites type of liver-kidney Yin deficiency syndrome: A comparative analysis
Cai WenJun, Luan YuTing, Liu ChengHai, Jiang ShiLi, Zhao ZhangQing, Gu HongTu, Yuan JiLi, Xing Feng, Zhou Yang, Lu: Jing, Mu YongPing
2019, 35(4): 785-789. DOI: 10.3969/j.issn.1001-5256.2019.04.016
Abstract:
Objective To investigate the distribution of intestinal microbiota in hepatitis B cirrhosis patients with amassment or tympanites type of liver-kidney Yin deficiency syndrome through a comparative analysis.Methods A total of 21 hepatitis B cirrhosis patients with amassment type of liver-kidney Yin deficiency syndrome (without ascites) and 15 hepatitis B cirrhosis patients with tympanites type of liver-kidney Yin deficiency syndrome (with ascites) who were treated in Department of Liver Cirrhosis, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, from October to December, 2016 were enrolled as amassment group and tympanites group, respectively.Stool samples were collected, and DNA was extracted and sequenced by 16S rRNA sequencing technology.The Wilcoxon rank-sum test was used for comparison of categorical data;The Mann-Whitney U test was used for comparison of continuous data between groups.The ADE 4 software package of R package (v.2.15.3) was used for principal component analysis, and the abundance of operational taxonomic units (OTUs) in each sample was used to determine whether the amassment and tympanites types of liver-kidney Yin deficiency syndrome could be distinguished.Multiple hypothesis tests were used for comparison of relative abundance of each species between groups and were adjusted by Benjamini and Hochberg false discovery rate (FDR) , and Pfdr<0.05 was considered statistically significant.Results Compared with the amassment group at the phylum level, the tympanites group had a significant increase in the abundance of Proteobacteria (Pfdr=0.009) and a significant reduction in the abundance of Bacteroidetes (Pfdr=0.048) , as well as slight reductions in the abundance of Actinobacteria (Pfdr>0.05) and Firmicutes (Pfdr>0.05) .Compared with the amassment group at the genus level, the tympanites group had significant increases in the abundance of Enterobacter (Pfdr=0.035) and Escherichia-Shigella (Pfdr=0.007) of the Proteobacteria phylum, as well as significant reductions in the abundance of Bifidobacterium (Pfdr=0.009) and Actinomyces (Pfdr=0.04) of the Acfinobacteria phylum and the abundance of Lachnospira (Pfdr=0.003) , Butyrivibrio (Pfdr=0.009) , Pseudobutyrivibrio (Pfdr=0.041) , Roseburia (Pfdr=0.049) , and Faecalibacterium (Pfdr=0.021) of the Firmicutes phylum.Conclusion Compared with the hepatitis B cirrhosis patients with amassment type of liver-kidney Yin deficiency syndrome, the patients with tympanites type have significant reductions in probiotic bacteria and significant increases in conditioned pathogens in intestinal microbiota, suggesting that in hepatitis B cirrhosis patients with tympanites type of liver-kidney Yin deficiency syndrome, besides liver-kidney nourishing therapy, stomach/intestine-cleansing therapy should also be adopted to regulate the imbalance of intestinal microbiota.
Value of neutrophil-lymphocyte ratio in predicting the prognosis of patients with decompensated cirrhosis
Liang LiMin, Xu HeXiang, Zheng JiShun, Zhang YuanYuan
2019, 35(4): 790-795. DOI: 10.3969/j.issn.1001-5256.2019.04.017
Abstract:
Objective To investigate the value of neutrophil-lymphocyte ratio ( NLR) in predicting the prognosis of patients with decompensated cirrhosis. Methods A retrospective analysis was performed for the clinical data of 173 patients who were diagnosed with decompensated cirrhosis in The Third Affiliated Hospital of Anhui Medical University from January 2013 to December 2016, including sex, age, etiology, medical history, and first laboratory examination after admission. With death as the outcome event, these patients were divided into survival group and death group according to the outcome of the disease at 1-year follow-up. The influencing factors for prognosis were analyzed, and the value of NLR in predicting the prognosis of patients with decompensated cirrhosis were evaluated. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A Spearman correlation analysis was performed to investigate the correlation between two variables. A univariate Cox analysis was performed for related variables, and the multivariate Cox proportional hazards model was used to identify independent influencing factors.The receiver operating characteristic ( ROC) curve was plotted and the area under the ROC curve ( AUC) was calculated; the optimal cut-off value was determined according to the optimal Youden index. The Kaplan-Meier survival analysis was performed to compare the 1-year survival rate of patients with different NLR values, and the log-rank test was used for comparison. Results Of all 173 patients, 50 died and 123 survived within the 1-year follow-up. The death group had significantly higher NLR, Child-Turcotte-Pugh ( CTP) score, and Model for End-Stage Liver Disease ( MELD) score than the survival group ( U = 4660. 0, 4994. 5, and t =-9. 209, all P < 0. 001) .NLR was positively correlated with CTP score and MELD score ( r = 0. 363 and 0. 410, both P < 0. 001) . The optimal cut-off values of NLR and MELD score in predicting 1-year prognosis were 3. 52 and 14. 26, respectively, with AUCs of 0. 758 and 0. 854, respectively;the combination of NLR and MELD score had an increased AUC of 0. 863. The survival analysis showed that the high-NLR group ( NLR≥3. 52) had a significantly lower survival rate than the low-NLR group ( NLR < 3. 52) ( χ2= 36. 602, P < 0. 001) . The multivariate Cox regression analysis showed that NLR≥3. 52 was an independent risk factor for death within 1 year. Conclusion NLR has a good value in predicting the 1-year prognosis of patients with decompensated cirrhosis.
Correlation between serum CA125 level and severity of liver dysfunction in patients with liver cirrhosis: A Meta-analysis
Shao CuiPing, Xu YouQing
2019, 35(4): 796-800. DOI: 10.3969/j.issn.1001-5256.2019.04.018
Abstract:
Objective To investigate the correlation between serum CA125 level and the severity of liver dysfunction in patients with liver cirrhosis. Methods Wanfang Data, CNKI, CBM, and VIP were searched for Chinese articles on the correlation between serum CA125 level and the severity of liver dysfunction in patients with liver cirrhosis published from January, 2008 to October, 2018, with a liver cirrhosis group and a normal control group in each article. Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE) was used for quality assessment. The mean and standard deviation of CA125 in liver cirrhosis group, healthy control group, and liver cirrhosis groups with different Child-Pugh classes were analyzed. Meta-Analyst software was used to calculate the standardized mean deviation ( SMD) of CA125 in each group and perform the meta-analysis. A heterogeneity analysis was performed for the studies included in this study; a random effects model was used in case of significant heterogeneity, while a fixed effect model was used in case of insignificant heterogeneity. A one-way analysis of variance was used for comparison of continuous data between multiple groups. Results A total of 15 articles were included in this study. The meta-analysis showed that the liver cirrhosis group had a significantly higher serum CA125 level than the healthy control group ( 181. 18 ± 110. 76 U/ml vs 15. 10 ± 7. 15 U/ml, SMD = 2. 28, 95% confidence interval: 1. 81-2. 76, P < 0. 001) . The level of CA125 increased significantly with the increase in Child-Pugh class ( F = 15. 704, P < 0. 001) . Conclusion Serum CA125 level is correlated with the severity of liver dysfunction in patients with liver cirrhosis and thus has a certain value in evaluating the severity of liver dysfunction and predicting prognosis.
Effect of propranolol on hemodynamics and its clinical significance in patients with portal hypertension
Xu Hui, Zhang Feng, Zhang Ming, Zhu GeYuZheng
2019, 35(4): 801-807. DOI: 10.3969/j.issn.1001-5256.2019.04.019
Abstract:
Objective To investigate whether short-term oral administration of propranolol can induce hemodynamic response in patients with liver cirrhosis and esophageal and gastric varices, as well as the clinical significance of such response in the prevention of esophagogastric variceal bleeding ( EGVB) . Methods A total of 42 cirrhotic patients with esophageal and gastric varices who were treated in Department of Gastroenterology in Affiliated Drum Tower Hospital of Nanjing University Medical School from March 2015 to October 2016 were enrolled. Hepatic venous pressure gradient ( HVPG) was measured before and after 7 days of oral administration of propranolol. The patients who completed these two HVPG measurements were followed up until the development of EGVB. Hemodynamic response was defined as a reduction in HVPG by at least 20% or an absolute value of HVPG of ≤12 mm Hg. The paired samples t-test and the chi-square test were used to compare the change in HVPG after propranolol administration and the incidence of EGVB between responders and non-responders.A regression analysis was used to identify the independent risk factors for EGVB. Results A total of 32 patients were included in the final analysis, with an overall response rate of 43. 75% ( 14 responders and 18 non-responders) , and the overall HVPG value decreased from18. 3 ± 5. 0 mm Hg to 15. 0 ± 4. 9 mm Hg ( t = 4. 640, P < 0. 001) . There were no significant differences in age, sex, etiology, liver function, and baseline HVPG between the responders and the non-responders ( all P > 0. 05) , and the responders had a significantly higher HVPG value at the second time of measurement than the non-responders ( 11. 5 ± 3. 5 mm Hg vs 17. 7 ± 5. 0 mm Hg, t = 5. 470, P <0. 001) . During the 3-year follow-up, 8 patients developed EGVB, and the responders had a significantly lower incidence rate of EGVB than the non-responders ( χ2= 8. 529, P = 0. 004) . The multivariate Cox regression analysis showed that a past history of bleeding ( hazard ratio [HR]= 12. 917, 95% confidence interval [CI]: 1. 861-89. 648, P = 0. 010) and HVPG value at the second time of measurement ( HR = 1. 481, 95% CI: 1. 102-1. 990, P = 0. 009) were independent risk factors for EGVB. Conclusion The rate of hemodynamic response in cirrhotic patients with esophageal and gastric varices is 43. 75% after short-term oral administration of propranolol. Responders have a significantly lower risk of EGVB than non-responders. Patients with a past history of bleeding or a high HVPG value at the second time of measurement have an increased risk of bleeding.
Interventional effect of mangiferin on carbon tetrachloride-induced hepatic fibrosis in mice
Wang Hu, Cheng Yujia, Wang Li, Liao Yifeng, Cao Jiang
2019, 35(4): 808-812. DOI: 10.3969/j.issn.1001-5256.2019.04.020
Abstract:

ObjectiveTo investigate the interventional effect of mangiferin on carbon tetrachloride (CCl4)-induced hepatic fibrosis in mice and the potential mechanism. MethodsA total of 45 male C57BL/6 mice were randomly divided into three groups: normal control group (NC group), liver fibrosis model group (CCl4 group), and mangiferin pretreatment group (CCl4+M group), with 15 mice in each group. An automatic biochemical analyzer was used to measure the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST); HE staining and Masson staining were performed to observe liver pathological changes; ELISA was used to measure the serum levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNFα); Western Blot was used to measure the protein expression of α-smooth muscle actin (α-SMA), nuclear factor-kappa B (NF-κB), IL-1β, p62, and microtubule-associated protein 1 light chain 3 (LC3) in the liver; quantitative real-time PCR was used to measure the mRNA expression of type I collagen (Col-I) and α-SMA in the liver. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. ResultsHE staining and Masson staining showed a low proportion of mice with hepatocyte degeneration and necrosis and a significant reduction in collagen fibers in the CCl4+M group. Compared with the CCl4 group, the CCl4+M group had significant reductions in the serum levels of ALT and AST (both P<001). ELISA showed that compared with the CCl4 group, the CCl4+M group had significant reductions in the serum levels of IL-1β, IL-6, and TNF-α (all P<0.01). Western Blot showed that compared with the CCl4 group, the CCl4+M group had significant reductions in the protein expression of α-SMA, NF-κB, IL-1β, and LC3-II/I in the liver (P<0.01, P<0.05, P<0.01, and P<0.05) and a significant increase in the protein expression of p62 (P<0.05). Quantitative real-time PCR showed that compared with the CCl4 group, the CCl4+M group had significant reductions in the mRNA expression of Col-I and α-SMA (P<0.05 and P<0.01). ConclusionMangiferin can alleviate CCl4-induced hepatic fibrosis in mice, possibly by reducing inflammation to protect liver function and inhibiting autophagy to reduce the activation of hepatic stellate cells.


Original articles_Liver neoplasms
Clinical effect of ablation in treatment of needle tract implantation after radiofrequency ablation for primary liver cancer
Lu NingNing, Wang HaiYan, Zhang YingHua, Sun Bin, Zhang YongHong, Cui XiongWei, Zheng JiaSheng
2019, 35(4): 813-817. DOI: 10.3969/j.issn.1001-5256.2019.04.021
Abstract:
Objective To investigate the risk factors for needle tract implantation after radiofrequency ablation for primary liver cancer and the clinical effect of ablation. Methods A retrospective analysis was performed for the clinical data of 4 patients with needle tract implantation after radiofrequency ablation for primary liver cancer who underwent ablation therapy in Center of Interventional Oncology and Liver Diseases, Beijing You An Hospital, from January 2017 to October 2018. Risk factors, the clinical effect of ablation, and complications were analyzed.Results All four patients had intrahepatic tumor lesions located near the Glisson's capsule, and among these patients, two had poorly differentiated hepatocellular carcinoma ( HCC) , one had moderately differentiated HCC, and one had well-differentiated HCC. The time from radiofrequency ablation to needle tract implantation ranged from 3. 6 to 14. 3 months, and all four patients had a single lesion of needle tract implantation, which was located at the anterior abdominal wall in three patients and at the right abdominal wall in one patient. Of all patients, three underwent argon-helium cryoablation, and one underwent radiofrequency ablation. Two patients experienced pyrexia and transient aggravation of pain after surgery, and the symptoms were relieved after symptomatic treatment. No serious complication was observed. Contrast-enhanced computed tomography performed at one month after surgery showed complete ablation of metastatic lesion in three patients, with no recurrence after follow-up for 2-19 months. One patient was found to have local residual lesion, with marked relief of pain, and no enlargement of the residual lesion was observed after follow-up for 3 months. All patients had significant reductions in serum alpha-fetoprotein and abnormal prothrombin at one month after surgery. Conclusion Ablation therapy, especially argon-helium cryoablation, has a good clinical effect in the treatment of needle tract implantation at the abdominal wall, with the advantages of few complications and good tolerability. Therefore, it is a good choice for patients who cannot tolerate surgical operation or are unwilling to undergo surgical operation.
Clinical effect of transcatheter arterial chemoembolization combined with radiofrequency ablation in treatment of Barcelona Clinical Liver Cancer stage B primary liver cancer and influencing factors for prognosis
Sun Yu, Zhang HongHai, Sheng ShouPeng, Li Cong, Yuan ChunWang, Cui ShiChang, Hu CaiXia, Liu BoJun, Li XingMing, Zhang YongHong, Zheng JiaSheng
2019, 35(4): 818-824. DOI: 10.3969/j.issn.1001-5256.2019.04.022
Abstract:
Objective To investigate the clinical effect of transcatheter arterial chemoembolization ( TACE) combined with radiofrequency ablation ( RFA) in the treatment of Barcelona Clinical Liver Cancer ( BCLC) stage B primary liver cancer and influencing factors for prognosis. Methods A total of 154 patients with BCLC stage B primary liver cancer who were admitted to Beijing YouAn Hospital, Capital Medical University, from January 2007 to January 2012 and underwent TACE combined with RFA were enrolled. Baseline laboratory data and imaging findings were collected for all patients, and all patients were followed up by the outpatient service, hospitalization, or telephone. The Kaplan-Meier method was used to plot survival curves and the log-rank test was used for the analysis of survival curves. The indicators with P < 0. 05 in the univariate analysis were included in multivariate Cox regression analysis. Results The 154 patients with BCLC stage B liver cancer had a median survival time of 37 months and the 1-, 2-, 3-, and 5-year survival rates were 82. 5%, 59. 7%, 50. 6%, and 36. 1%, respectively. The patients were divided into B1, B2, B3, and B4 groups according to the BCLC substage, and the B1 group had a significantly higher survival rate than the B2, B3, and B4 groups ( χ2= 16. 881, P = 0. 001) . The patients with complete ablation at one month after RFA, an age of < 60 years, an alpha-fetoprotein ( AFP) level of < 400 ng/ml, a cholinesterase ( ChE) level of ≥4000 U/L, a total bilirubin ( TBil) level of ≤21 μmol/L, a Child-Pugh class A disease, a number of tumors of ≤3, or a maximum tumor diameter of < 3 cm had a significantly higher survival rate than those with incomplete ablation ( χ2= 173. 002, P < 0. 001) , an age of ≥60 years ( χ2= 6. 336, P = 0. 012) , an AFP level of ≥400 ng/ml ( χ2= 10. 765, P = 0. 001) , a ChE level of < 4000 U/L ( χ2= 6. 933, P =0. 008) , a TBil level of > 21 μmol/L ( χ2= 4. 624, P = 0. 032) , a Child-Pugh class B disease ( χ2= 5. 570, P = 0. 018) , a number of tumors of > 3 ( χ2= 6. 761, P = 0. 009) , or a maximum tumor diameter of > 5 cm ( χ2= 7. 430, P = 0. 024) . The multivariate Cox regression analysis showed that ablation assessment ( odds ratio [OR]= 21. 950, 95% confidence interval [CI]: 11. 817-40. 772, P < 0. 001) , Child-Pugh class ( OR = 2. 190, 95% CI: 1. 329-3. 609, P = 0. 002) , AFP level ( OR = 1. 760, 95% CI: 1. 122-2. 760, P = 0. 014) , and BCLC B substage ( OR = 2. 178, 95% CI: 1. 284-3. 694, P = 0. 004) were influencing factors for survival time after RFA in patients with BCLC stage B liver cancer. Conclusion TACE combined with RFA is safe and effective in the treatment of BCLC stage B liver cancer.Incomplete ablation, a AFP level of ≥400 ng/ml, Child-Pugh class B, and late substage of BCLC stage B are independent risk factors for survival time after RFA in patients with BCLC stage B liver cancer.
Determination and clinical significance of plasma matrix metalloproteinase in patients with hepatocellular carcinoma
Zhang HongHai, Sun Yu, Liu Fang, Xie Li, Qiao LuXin, Chen DeXi, Yin JiMing
2019, 35(4): 825-829. DOI: 10.3969/j.issn.1001-5256.2019.04.023
Abstract:
Objective To investigate the expression of matrix metalloproteinases ( MMPs) in patients with hepatocellular carcinoma ( HCC) and its association with clinicopathological features. Methods A total of 131 patients who were hospitalized and treated in Beijing YouAn hospital from October 2015 to May 2018 were enrolled, and among these patients, 35 had hepatitis B cirrhosis and 96 had HCC. A total of20 healthy controls who underwent physical examination at the outpatient service during the same period of time were enrolled as healthy control group. Suspension phase chip technology was used to measure the plasma levels of MMP-1, MMP-2, MMP-7, MMP-9, and MMP-10 before treatment. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between three groups; the Spearman correlation analysis was performed to investigate correlation. Results The HCC group had a plasma level of MMP-1 of 8134. 84 ( 6147. 94-11 148. 47) pg/ml and a plasma level of MMP-7 of 6541. 58 ( 3906. 63-9033. 12) pg/ml, which were significantly higher than the plasma levels of MMP-1 and MMP-7 in the hepatitis B cirrhosis group and the healthy control group ( χ2= 23. 521 and 66. 112, both P < 0. 001) . The HCC group had a plasma level of MMP-2 of 103 774. 45 ( 90 485. 91-123 673. 90) pg/ml, which was significantly higher than that in the healthy control group ( P< 0. 05) . The patients with a tumor diameter of ≥5 cm, distant metastasis, portal venous invasion, clinical stage Ⅲ/Ⅳ, or Edmondson-Steiner ( ES) grade Ⅲ/Ⅳ had a significantly higher plasma level of MMP-1 than those with a tumor diameter of < 5 cm ( Z =-7. 313, P< 0. 001) , without distant metastasis ( Z =-6. 569, P < 0. 001) , without portal venous invasion ( Z =-6. 051, P < 0. 001) , with clinical stage Ⅰ/Ⅱ ( Z =-5. 844, P < 0. 001) , or with ES grade Ⅰ/Ⅱ ( Z =-7. 423, P < 0. 001) . The patients with distant metastasis, portal venous invasion, clinical stage Ⅲ/Ⅳ, or ES grade Ⅲ/Ⅳ had a significantly higher plasma level of MMP-7 than those without distant metastasis ( Z =-3. 454, P = 0. 001) , without portal venous invasion ( Z =-3. 846, P < 0. 001) , with clinical stage Ⅰ/Ⅱ ( Z =-2. 285, P= 0. 022) , or with ES grade Ⅰ/Ⅱ ( Z =-3. 287, P = 0. 001) . Conclusion The expression of MMP-1 and MMP-7 in HCC patients is associated with HCC metastasis, portal venous invasion, clinical stage, and pathological grade and can help to evaluate the severity and prognosis of tumor invasion in HCC patients.
Original articles_Pancreatic diseases
Clinical features of severe acute hypertriglyceridemic pancreatitis
Tang YongFeng, Tang GuoDou, Liang ZhiHai, Tan MengBin, Huang HuaLi, Tan MinZhen
2019, 35(4): 830-834. DOI: 10.3969/j.issn.1001-5256.2019.04.024
Abstract:
Objective To investigate the clinical features of severe acute hypertriglyceridemic pancreatitis ( HTGP) . Methods A retrospective analysis was performed for the clinical data of 179 patients with moderate severe pancreatitis ( MSAP) or severe acute pancreatitis ( SAP) who were admitted to The First Affiliated Hospital of Guangxi Medical University from January 2013 to June 2016. According to the etiology, these patients were divided into severe biliogenic acute pancreatitis ( biliogenic AP) group with 68 patients, severe alcoholic acute pancreatitis ( alcoholic AP) group with 39 patients, severe acute HTGP group with 45 patients, and severe acute pancreatitis group with other causes ( other group) with 27 patients. Related data of the patients with clear causes in the former three groups were recorded, including demographic data, blood triglyceride ( TG) level on the first day of admission, cause, pancreatic necrosis, systemic complications [acute respiratory distress syndrome ( ARDS) , acute renal injury, hypotension, and disseminated intravascular coagulation ( DIC) ], and related clinical outcomes ( admission to the intensive care unit, length of hospital stay, and mortality rate) . In order to investigate the influence of TG concentration on the prognosis of AP patients, the patients were divided into normal blood lipid group with 82 patients, mild dyslipidemia group with 52 patients, moderate dyslipidemia group with 28 patients, and severe dyslipidemia group with 17 patients, according to the TG level on the first day of admission, and the incidence rates of systemic complications, pancreatic necrosis, and clinical outcomes were analyzed. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, the chi-square test was used for comparison of categorical data between groups, and the Spearman rank correlation test was used for correlation analysis. Results Biliary tract disease remained the leading cause of SAP ( 38%) , followed by hypertriglyceridemia ( 25%) . As for systemic complications, the HTGP group had a significantly higher incidence rate of ARDS than the biliogenic AP group and the alcoholic AP group ( P = 0. 014 and0. 022) . In the groups with different TG levels, the incidence rates of ARDS and acute renal injury were positively correlated with TG level ( r = 0. 966 and 0. 982, P = 0. 004 and 0. 019) . Conclusion The HTGP group has a higher incidence rate of ARDS than the biliogenic AP group and the alcoholic AP group, and the risk of ARDS and acute renal injury tends to increase with the increasing TG level.
Original articles_Others
Risk factors for the coexistence of inflammatory bowel disease and nonalcoholic fatty liver disease: A Meta-analysis
Feng Gong, He Na, Mi Man, Li XuePing, Liu ManLing, Fan LiPing, Niu ChunYan
2019, 35(4): 835-839. DOI: 10.3969/j.issn.1001-5256.2019.04.025
Abstract:

Objective To investigate whether glucocorticoids, anti-tumor necrosis factor ( anti-TNF) drugs, and a past history of surgical treatment of inflammatory bowel disease ( IBD) are the risk factors for the coexistence of IBD and nonalcoholic fatty liver disease ( NAFLD) . Methods PubMed, Embase, Cochrane Library, Wanfang Data, CNKI, and VIP were searched for clinical trials of the coexistence of IBD and NAFLD published up to October 2018. The articles included were summarized and quality assessment was performed according to inclusion and exclusion criteria. RevMan 5. 2 was used for data processing; the random effects model was used for data with heterogeneity, and the fixed effect model was used for data with homogeneity. Results A total of 7 articles were included, with 1645 patients.The meta-analysis showed that glucocorticoids might not be a risk factor for the coexistence of IBD and NAFLD ( odds ratio ( OR) = 1. 19, 95% confidence interval ( CI) : 0. 90-1. 57, P = 0. 23) ; anti-TNF drugs were not a risk factor for the coexistence of IBD and NAFLD ( OR = 0. 86, 95% CI: 0. 65-1. 13, P = 0. 27) ; a past history of surgical treatment of IBD was a risk factor for the coexistence of IBD and NAFLD ( OR = 1. 50, 95% CI: 1. 09-2. 05, P = 0. 01) . Conclusion Glucocorticoids and anti-TNF drugs for the treatment of IBD may not increase the incidence rate of the coexistence of IBD and NAFLD, while surgical treatment for IBD may increase this incidence rate.

Influence of low-level lead exposure on liver function and blood lipids in rats with nonalcoholic fatty liver disease
Zhu WeiMei, Wang XiuFang, Yang HaiQing, Yang HongLing, Li XueZhang, Pan Yue
2019, 35(4): 840-845. DOI: 10.3969/j.issn.1001-5256.2019.04.026
Abstract:

Objective To investigate the influence of low-lead high-fat diet on liver function and blood lipids in rats with nonalcoholic fatty liver disease ( NAFLD) , as well as the expression of sterol regulatory element-binding protein-1 c ( SREBP-1 c) , fatty acid synthase ( FAS) , and acetyl-CoA carboxylase α ( ACCα) in the liver from the aspect of the fatty acid synthesis pathway. Methods A total of 40 clean male Sprague-Dawley rats were given adaptive feeding for 14 days and were then randomly divided into normal group, low-lead exposure group, high-fat diet group, and low-lead high-fat diet group, with 10 rats in each group. The rats were sacrificed after 8 weeks of feeding with the corresponding diet, and serum and liver samples were collected to measure blood lead, liver function, blood lipids, and liver pathology. Western blot and RT-PCR were used to measure the protein and mRNA expression of SREBP-1 c, FAS, and ACCα involved in fatty acid synthesis. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. Results There were marked liver pathological changes after exposure. The sections from the normal group and the low-lead exposure group had a smooth surface and evenly distributed nuclei, without marked adipocyte infiltration or inflammatory response; the sections from the low-lead high-fat diet group and the high-fat diet group had marked fatty infiltration and inflammatory cell infiltration, and those from the low-lead high-fat diet group had larger fat vacuoles. There were significant differences in blood lead and liver lead between groups ( F = 37. 792 and 21. 458, both P < 0. 001) , and the low-lead exposure group and the low-lead high-fat diet group had significantly higher levels than the normal group ( all P < 0. 05) . There were significant differences in aspartate aminotransferase ( AST) , alanine aminotransferase ( ALT) , high-density lipoprotein cholesterol ( HDL-C) , and low-density lipoprotein cholesterol ( LDL-C) between groups ( F = 35. 791, 24. 422, 37. 287, and 42. 371, all P <0. 001) , and the low-lead exposure group, the high-fat diet group, and the low-lead high-fat diet group had significantly higher AST, ALT, LDL-C, and HDL-C than the normal group ( all P < 0. 05) . Western blot and RT-PCR showed consistent protein and mRNA expression features of SREBP-1 c, FAS, and ACCα, and there were significant differences in the protein and mRNA expression of REBP-1 c, FAS, and ACCα between groups ( protein expression: F = 21. 864, 22. 358, and 57. 761, all P < 0. 001; mRNA expression: F =34. 652, 22. 964, and 42. 384, all P < 0. 001) . Compared with the normal group and the low-lead exposure group, the high-fat diet group and the low-lead high-fat diet group had significant increases in the protein and mRNA expression of SREBP-1 c, FAS, and ACCαin the liver ( all P < 0. 05) . Conclusion Low-lead exposure can aggravate liver function and dyslipidemia in NAFLD rats, possibly by regulating the expression of SREBP-1 c, FAS, and ACCα.

Mild hypothermia exerts a protective effect against hepatic ischemia-reperfusion injury in rats by activating the PI3K/Akt signaling pathway
Liu Jian, Li Li, Wang XiaoChuan, Zhang ShengNing, Li LaiBang, Mang YuanYi, Gao Yang, Chen YongLin, Ren Gang, Li Wang
2019, 35(4): 846-851. DOI: 10.3969/j.issn.1001-5256.2019.04.027
Abstract:

Objective To investigate the protective mechanism of mild hypothermia pretreatment against hepatic ischemia-reperfusion injury in rats. Methods A total of 40 male Sprague-Dawley rats were randomly divided into sham-operation group ( Sham group) , hepatic ischemia-reperfusion injury group ( HIRI group) , mild hypothermia group ( MH group) , and mild hypothermia + LY294002 group ( MH +LY group) , with 10 rats in each group. Serum and liver tissue samples were collected at 3, 6, 12, and 24 hours of hepatic ischemia-reperfusion. Western blotting was used to measure the protein expression of phosphoinositide 3-kinase ( PI3 K) , phosphorylated PI3 K ( p-PI3 K) , protein kinase-B ( Akt) , and phosphorylated Akt ( p-Akt, Ser308) in liver tissue. TUNEL and Western blotting were used to measure cell apoptosis and expression of apoptosis-related proteins in liver tissue. ELISA was used to measure the levels of superoxide dismutase ( SOD) , glutathione peroxidase ( GSH-Px) , and malondialdehyde ( MDA) in liver tissue. An automatic biochemical analyzer was used to measure the activities of alanine aminotransferase ( ALT) and aspartate aminotransferase ( AST) in serum. A one-way analysis of variance was used for comparison between multiple groups, and the SNK-q test was used for further comparison between two groups.Results The HIRI group had significantly lower relative expression levels of p-PI3 K and p-Akt than the Sham group ( q = 5. 217 and5. 456, both P < 0. 01) , and the MH group had significantly higher relative expression levels of p-PI3 K and p-Akt in liver tissue than the HIRI group ( q = 10. 434 and 14. 116, both P < 0. 01) . At 3, 6, 12, and 24 hours of hepatic ischemia-reperfusion, the HIRI group, the MH group, and the MH + LY group had significantly higher activities of AST and ALT in serum than the Sham group ( all P < 0. 001) .TUNEL staining showed that the HIRI group had a significantly higher proportion of apoptotic cells in liver tissue than the Sham group ( 42. 25% ± 3. 50% vs 3. 21% ± 0. 5%, q = 10. 187, P < 0. 01) . Compared with the HIRI group, the MH group had a significant reduction in the proportion of apoptotic cells ( q = 7. 784, P < 0. 01) , while there was no significant difference in the proportion of apoptotic cells between the HIRI group and the MH + LY group ( 42. 25% ± 3. 50% vs 38. 19% ± 2. 8%, q = 1. 059, P > 0. 05) . Western blotting showed that compared with the Sham group, the HIRI group had a significant reduction in the expression of the anti-apoptotic protein Bcl-2 ( q =2. 101, P < 0. 05) and significant increases in the expression of the pro-apoptotic proteins Bax, Fas, and Fasl ( q = 11. 016、4. 735, and10. 201, all P < 0. 01) , and the regulatory effect of HIRI on apoptotic-related proteins was downregulated by mild hypothermia treatment.According to the results of oxidative indices, the HIRI group, the MH group, and the MH + LY group had significantly lower expression of SOD and GSH-Px and significantly higher expression of MDA in liver tissue than the Sham group ( all P < 0. 05) ; compared with the HIRI group, the MH group had significantly higher expression of SOD and GSH-Px ( q = 2. 894 and 2. 731, both P < 0. 05) and significantly lower expression of MDA ( q = 5. 888, P < 0. 05) in liver tissue. In addition, mild hypothermia + LY294002 treatment significantly reduced the regulatory effect on the expression of SOD, MDA, and GSH-Px in liver tissue in the MH group ( q = 2. 999, 2. 944, and 2. 620, all P < 0. 05) . Conclusion MH exerts a protective effect against HIRI in rats, possibly by activating the PI3 K/Akt pathway to downregulate hepatocyte apoptosis and enhance antioxidant capacity in vivo.

Case reports
HBV reactivation in patients with IgG4-related sclerosing cholangitis after liver transplantation: A case report
Fang YiNa, Dong KaiHui, Chen QingLing, Wei QianQian, Yu ChengNan, Kui YiWen, Mao MiaoMiao, Wen XiaoYu, Jin QingLong
2019, 35(4): 852-853. DOI: 10.3969/j.issn.1001-5256.2019.04.028
Abstract:
A case of jaundice of unknown origin
Gao LuHua, Nie QingHe, Zhao XiTai
2019, 35(4): 854-857. DOI: 10.3969/j.issn.1001-5256.2019.04.029
Abstract:
Small-for-size syndrome in hepatic alveolar echinococcosis treated by ex vivo liver resection and autotransplantation: A case report 
Ye HaiWen, Zhou Ying, Lu Qian, Zhang LingQiang, Deng Yong, Xu XiaoLei, Li XiaoWen, Jia Fan, Wang HaiJiu, Fan HaiNing
2019, 35(4): 858-860. DOI: 10.3969/j.issn.1001-5256.2019.04.030
Abstract:
A case of eosinophilia secondary to infection with Clonorchis sinensis and Ascaris lumbricoides
Wang HaiXia, Cai YanJun, Li WanYu, Mei QiTeng, Qi Yue
2019, 35(4): 861-862. DOI: 10.3969/j.issn.1001-5256.2019.04.031
Abstract:
Collision carcinoma of the common  bile duct composed of neuroendocrine small cell carcinoma and high-grade  adenocarcinoma: A case report
Liu Zhao, Zhang YaMeng, Wang BaoSheng
2019, 35(4): 863-865. DOI: 10.3969/j.issn.1001-5256.2019.04.032
Abstract:
A case of primary liposarcoma of the pancreas
Zhang JianWei, Ji JingWei, Xing MingXuan, Wang GuangYi, Du XiaoHong
2019, 35(4): 866-867. DOI: 10.3969/j.issn.1001-5256.2019.04.033
Abstract:
VHL syndrome with multiple pancreatic cysts and fourth ventricle hemangioblastoma: A case report
Zhuang ChunYu, Chen XiaoJing, Chen JiaCheng, Zhou KaiLun
2019, 35(4): 868-869. DOI: 10.3969/j.issn.1001-5256.2019.04.034
Abstract:
A case of adenosquamous carcinoma of the ampulla of Vater
Abudureyimu Tuerhong, Wang Kun, Liu Kai, Liu YaHui
2019, 35(4): 870-871. DOI: 10.3969/j.issn.1001-5256.2019.04.035
Abstract:
Infectious mononucleosis with polyserous effusions: A case report
Ji TongTong, Zhu WenYan, Lu HaiYing, Yu YanYan
2019, 35(4): 872-873. DOI: 10.3969/j.issn.1001-5256.2019.04.036
Abstract:
Reviews
Association between chronic hepatitis B and nonalcoholic fatty liver disease and pathogenesis of chronic hepatitis B with nonalcoholic fatty liver disease
Huang BeiBei, Li Lei
2019, 35(4): 874-878. DOI: 10.3969/j.issn.1001-5256.2019.04.037
Abstract:
At present, hepatitis B virus ( HBV) infection is one of the leading causes of liver cirrhosis and liver cancer. With the development of the society, the improvement in living standards, and the change in lifestyle, nonalcoholic fatty liver disease ( NAFLD) has gradually replaced hepatitis B and becomes the most important chronic liver disease in China. Due to the large number of patients with chronic HBV infection, the number of patients with chronic HBV infection and NAFLD has been increasing year by year, which has become an important feature of liver disease spectrum in China. Therefore, the interaction between NAFLD and chronic hepatitis B ( CHB) has attracted more and more attention. This article reviews the interaction between CHB and NAFLD and the pathogenesis of CHB with NAFLD.
Association between HBeAg-negative chronic hepatitis B and pre C/BCP mutation
Dai HaiMei, Wei Jia
2019, 35(4): 879-882. DOI: 10.3969/j.issn.1001-5256.2019.04.038
Abstract:
Studies on the HBV gene have shown that HBeAg-negative chronic hepatitis B ( CHB) is associated with gene mutations in the pre-C ( preC) and basic core promoter ( BCP) region of HBV DNA, and it is pointed out that the mutation in the preC/BCP region can affect the expression of serum HBeAg and is closely associated with the low replication of HBV DNA in the body, the progression of diseases, and the response to antiviral therapy, which makes the treatment of CHB more complicated. This article reviews the current status of the treatment of HBeAg-negative CHB, structure and mutation of HBV preC/BCP region, and the influence of mutation on the progression of HBeAg-negative CHB and the effect of antiviral therapy for hepatitis B.
Research advances in Th1/Th2 balance and fibrotic diseases
Huang Hui, Zhou Yang, Ping Jian, Xu LieMing
2019, 35(4): 883-886. DOI: 10.3969/j.issn.1001-5256.2019.04.039
Abstract:
Body immunity is closely associated with the pathogenesis of fibrotic diseases. In CD4+ T lymphocyte subsets, T helper 1 ( Th1) /T helper 2 ( Th2) balance plays an important regulatory role in the development and progression of many diseases. This article describes the association of Th1/Th2 balance with liver fibrosis, pulmonary fibrosis, and renal fibrosis. It is believed that in addition to the measurement of single cytokines, further studies are needed to clarify the specific association between T helper cells and other cells and related mechanisms.
Influence of intestinal dysbacteriosis on liver cirrhosis
Li YunPeng, Wang XinHong, Zhang DeKai
2019, 35(4): 887-890. DOI: 10.3969/j.issn.1001-5256.2019.04.040
Abstract:
Liver cirrhosis is a progressive chronic liver disease due to one or more causes, with diffuse fibrosis in liver tissue, pseudolobules, and regenerative nodules as major histological features. Once liver cirrhosis enters the decompensated stage, the liver and several other organs are injured, which can hardly be recovered or reversed. This article introduces the process of Toll-like receptors in recognizing the changes in intestinal flora and the influence of this process on the development and progression of liver cirrhosis, as well as the protective effect of bile acid against liver cirrhosis by regulating intestinal flora. This article also reviews the advances in delaying liver cirrhosis after the treatment of intestinal dysbacteriosis and points out that the treatment of intestinal dysbacteriosis may become the major direction of liver cirrhosis treatment in future.
Assessment and clinical management of sarcopenia in patients with liver cirrhosis
Han Fang, Han Tao, Liang Jing
2019, 35(4): 891-894. DOI: 10.3969/j.issn.1001-5256.2019.04.041
Abstract:
As the disease progresses, there is a significant change in the body composition of patients with liver cirrhosis, and sarcopenia is one of the common complications in liver cirrhosis, especially in decompensated cirrhosis. About 30%-70% of patients with liver cirrhosis have sarcopenia, which greatly affects patients' survival and is closely associated with the development of hepatic encephalopathy. Sarcopenia may also increase the risk of infection. Sarcopenia and muscle fatty degeneration can be used as poor prognostic indicators of hepatocellular carcinoma and may increase the risk of recurrence of liver cancer. This article reviews the research advances in the definition of sarcopenia, the association of sarcopenia with liver cirrhosis, and assessment and clinical management of sarcopenia.
Application and management of autologous bone marrow stem cells in treatment of liver cirrhosis
Wang Deng, Sun Hang, Wu ChuanXin
2019, 35(4): 895-898. DOI: 10.3969/j.issn.1001-5256.2019.04.042
Abstract:
Liver transplantation is considered the best method for the treatment of liver cirrhosis, but its clinical application is limited by the shortage of liver donors, high costs, and immunological rejection. In recent years, bone marrow stem cells ( BMSCs) has shown great prospects in the treatment of liver cirrhosis. Recent clinical studies have shown that BMSC therapy is a safe and effective treatment method for liver cirrhosis, but its mechanism remains unclear, and there are various treatment regimens. This article reviews the mechanism of BMSCs in the treatment of liver cirrhosis, route of BMSC delivery, indices for therapeutic effect evaluation, and dose of BMSCs.
Current status and perspectives of the treatment of hepatocellular carcinoma with portal vein tumor thrombus
Zhang XueWen, Dai ChaoLiu
2019, 35(4): 899-904. DOI: 10.3969/j.issn.1001-5256.2019.04.043
Abstract:
Portal vein tumor thrombus is one of the most common complications of advanced hepatocellular carcinoma and greatly affects the treatment and prognosis of such patients. With the development and advances in surgical treatment methods, local interventional treatment, radiation therapy, targeted drug therapy, and immunotherapy in recent years, advanced hepatocellular carcinoma with portal vein tumor thrombus is no longer a dilemma in clinical treatment. Both single and combined treatments have achieved good clinical effects. This article reviews the current status, difficulties, and future treatment methods for advanced liver cancer with portal vein tumor thrombus.
Features and clinical significance of nutritional metabolism in patients with primary liver cancer
Zhao WenHao, Liu XueLian, Li HongWei, Wang Xu, Liu XiangLiang, Li Wei
2019, 35(4): 905-907. DOI: 10.3969/j.issn.1001-5256.2019.04.044
Abstract:
Nutritional metabolism is closely associated with the treatment of tumors and is an important research field in China and foreign countries. On the one hand, the use of nutrient metabolism pathway molecules as therapeutic targets has become a new direction in the field of biomedical research; on the other hand, poor nutritional status in patients with tumors will lead to the fact that the patients cannot be treated or have severe adverse reactions or poor prognosis, and thus it has always been a hot research topic. The liver is a metabolic organ, and the metabolism of liver tumors is different from that of tumors in other parts. Therefore, the research on nutritional metabolism in patients with liver cancer is of particular importance. This article elaborates on the changes in the metabolism of glucose, lipids, proteins, and amino acids and related molecular mechanisms in patients with primary liver cancer, in order to provide thoughts for selecting nutrient metabolism pathways in patients with liver cancer, identifying specific markers for liver cancer, and solving the issue of nutritional support during treatment and provide a reference for the research on nutritional metabolism of liver cancer.
Current status of the research and development of new formulations and drugs for cystic echinococcosis
Yin Jie, Fan HaiNing, Wen Hao, Wang HaiJiu, Zhang LingQiang, Pang MingQuan, Gu XianBo, Wang Tao, Pan SiYu
2019, 35(4): 908-912. DOI: 10.3969/j.issn.1001-5256.2019.04.045
Abstract:
Cystic echinococcosis ( CE) is a zoonotic parasitic disease caused by Echinococcus granulosus infection and can involve the organs in the whole body. Surgery is the primary method for the treatment of CE. With the development of related techniques, precision operation, and no-tumor operation standards, more and more patients are able to receive surgical treatment, but there are still many patients who can only receive drug conservative treatment. However, there are limited drugs for the treatment of CE at present, and only benzimidazole has a definite therapeutic effect. This article reviews the research advances in the pharmacotherapy for CE in China and foreign countries, so as to provide a reference for drug research and development and clinical drug use.
Liver microcirculation disturbance in nonalcoholic fatty liver disease
Liu YaJuan, Li LiangPing
2019, 35(4): 913-916. DOI: 10.3969/j.issn.1001-5256.2019.04.046
Abstract:
At present, the pathogenesis of nonalcoholic fatty liver disease ( NAFLD) is not completely clear, but hepatic microcirculation perfusion is an important feature of disease progression, in which lipid accumulation in hepatocytes is the key to microvascular injury. This article introduces the function, structure, and neuromodulation of normal microcirculation, with a focus on the mechanism of liver microcirculation disturbance and the changes in cellular molecules and imaging findings due to such disturbance. Therefore, clarification of liver microcirculation disturbance can provide new insights into the pathophysiology of NAFLD, and optimized noninvasive diagnostic methods may help to identify high-risk populations and patients in the early stage of nonalcoholic steatohepatitis.
Advances in the treatment of nonalcoholic fatty liver disease in children
Li ZeSheng, Wu Jie
2019, 35(4): 917-920. DOI: 10.3969/j.issn.1001-5256.2019.04.047
Abstract:
Nonalcoholic fatty liver disease ( NAFLD) refers to a syndrome of a series of lesions such as simple fatty liver disease, nonalcoholic steatohepatitis, liver fibrosis, and even liver cirrhosis. With the improvement of living standards, there is an increasing number of children with obesity, and the detection rate of NAFLD also tends to increase. Major treatment methods for children with NAFLD include the changes in diet and lifestyle and medication. The article reviews the advances in the treatment of NAFLD in children in recent years.
Diagnosis and treatment of inherited metabolic liver disease
Zhang YaNan, Xu Ying, Jiang Chang, Gao YanHang
2019, 35(4): 921-924. DOI: 10.3969/j.issn.1001-5256.2019.04.048
Abstract:
The liver is the key place for most metabolic pathways, so it is often involved earliest and has the most severe injury, and liver injury of some inherited metabolic diseases may develop into liver cirrhosis and even malignant tumors of the liver and tended to have poor prognosis. Inherited metabolic liver disease often has complicated clinical manifestations, and the limitations of conventional diagnostic and therapeutic methods are difficult issues for clinical physicians. With the development of cellular and molecular biology techniques, new diagnostic and therapeutic methods, such as gene detection, gene therapy, and stem cell transplantation, have been gradually applied in clinical practice, bringing hope to patients with refractory diseases. This article reviews the recent advances in the diagnosis and treatment of inherited metabolic liver diseases commonly seen in clinical practice, such as hepatolenticular degeneration, hereditary hemochromatosis, glycogen storage disease, ɑ1-antitrypsin deficiency, hereditary hyperbilirubinemia, and hereditary cholestasis.
Recent advances in drug-induced liver injury: Potential mechanisms, pathological features, and biomarkers
Geng WenJing, Liu Hui, Ding HuiGuo
2019, 35(4): 925-929. DOI: 10.3969/j.issn.1001-5256.2019.04.049
Abstract:
Drug-induced liver injury ( DILI) is one of the main causes of acute liver failure, black box warnings, and drug withdrawal from the market, and it is also a major concern in public health, drug research and development, and the pharmaceutical industry. However, a lack of specific diagnostic markers for DILI makes the diagnosis of this disease a major challenge for clinicians. This article summarizes the recent advances in DILI research, including potential mechanisms, pathological features, biomarkers, and in vitro methods, in order to provide a reference for clinical and pathological diagnosis and prognostic evaluation of DILI.
Association between nuclear factor-erythroid 2-related factor-2 antioxidant pathway and liver diseases
He GuoNa, Shen FengJun
2019, 35(4): 930-933. DOI: 10.3969/j.issn.1001-5256.2019.04.050
Abstract:
Nuclear factor-erythroid 2-related factor-2 ( Nrf2) is an important transcription factor for cells to resist oxidative stress. It interacts with antioxidant response elements to induce the expression of downstream protective phase II detoxification enzymes and antioxidant enzymes and thus exerts a protective effect on cells. Oxidative stress is the common pathogenesis of many liver diseases, and the Nrf2-ARE antioxidant pathway is an important anti-oxidative stress pathway in vivo. It can induce the expression of downstream target genes and thus plays an important role in the development, progression, and prevention of liver diseases. This article briefly describes the mechanism of action of the Nrf2 antioxidant pathway in the development and progression of liver diseases and points out that Nrf2 may be a potential target for the prevention or treatment of liver diseases.
Current status of research on bile duct lesions and related liver diseases
Xu JiaMin, Tang YingMei
2019, 35(4): 934-936. DOI: 10.3969/j.issn.1001-5256.2019.04.051
Abstract:
The bile duct is the channel for bile transport in the liver, and the lining epithelial cells in the bile duct have functional and morphological heterogeneity and are the target of various bile duct diseases. In addition to bile metabolism and secretion, biliary epithelial cells are also involved in tissue damage and repair. Biliary epithelial cells have an immune barrier function and can secrete different proinflammatory factors and chemokines. Under the stimulation of endogenous and exogenous factors, biliary epithelial cells present immune reactivity and initiate immune response in the host. This article reviews the current status of research on bile duct lesions and related liver diseases.