2020 No. 3

Combination of medicine and pharmacy assists for precise prevention and control of drug-induced liver injury

Xiao XiaoHe

2020, 36(3): 489-490. DOI: 10.3969/j.issn.1001-5256.2020.03.001

Abstract(1120)

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Abstract:
Drug-induced liver injury( DILI) is not only a hot topic in the field of liver diseases around the world,but also a major concern in the field of global drug safety at present. Due to a lack of specific indices,the misdiagnosis rate of DILI is high and there may be important issues in drug safety. DILI caused by Chinese herbal medicine has complex etiologies,with difficulties in clinical diagnosis,prevention,and control. Therefore,clinicians should cooperate with pharmaceutical experts to establish the strategies and methods for objective identification of DILI,clarify the causal relationship between drug and liver injury in order to realize the precise diagnosis of DILI. The etiology and pathogenesis about susceptible population,risk substance of drugs and rational usage of DILI should be clarified to manage DILI. Also,the research on liver injury induced by Chinese herbal medicine should be further emphasized and strengthened to guarantee the drug safety in clinical practice,and to promote the healthy development of traditional Chinese medicine.

Detection of the risk signals of drug-induced liver injury: Challenges and advances

Jing Jing, He TingTing, Wang RuiLin, Zhang Fan, Niu Ming, Guo YuMing, Zhu Yun, Xiao XiaoHe, Wang JiaBo

2020, 36(3): 491-496. DOI: 10.3969/j.issn.1001-5256.2020.03.002

Abstract(488)

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Early detection and effective monitoring of the risk signals of drug-induced liver injury( DILI) are of great importance in the prevention and management of DILI in clinical practice. However,the lack of high sensitivity and strong specificity in the detection of risk signals brings great challenges to the identification and monitoring of risk signals and causes difficulties in establishing the strategies for the prevention and control of DILI. This article analyzes the challenges in the identification of DILI risk signals,summarizes the applicability and limitations of risk signals based on commonly used indices in early recognition,prediction,and early warning of DILI,proposes an identification and monitoring model for DILI risk signals based on specific biomarkers,and elaborates on their potential clinical values,so as to provide a scientific basis for developing targeted strategies for the prevention and control of the risk of DILI.

The pathogenesis,diagnosis,and treatment of drug-induced liver injury with extrahepatic adverse drug reactions

Hou JunXing, Yan FenQin, Yu YueCheng

2020, 36(3): 497-500. DOI: 10.3969/j.issn.1001-5256.2020.03.003

Abstract(1185)

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Abstract:
Drug-induced liver injury( DILI) with extrahepatic adverse drug reaction( EHADR) is the injury of extrahepatic organs which is caused by the same drug inducing liver injury and may occur simultaneously or successively with DILI,such as the skin,gastrointestinal tract,blood system,cardiovascular system,and bone and joint system,and it should be taken seriously in clinical practice. DILI with EHADR is not rare,and its pathogenesis may be associated with various factors including the physicochemical properties,distribution,metabolism,excretion,biological activity,and immunological properties of drugs,host genetic background,and underlying diseases. The diagnosis and treatment of DILI with EHADR is more challenging than that of DILI alone.

Recent research advances in chronicity of drug-induced liver injury

Huang Ang, Sun Ying, Zou ZhengSheng

2020, 36(3): 501-504. DOI: 10.3969/j.issn.1001-5256.2020.03.004

Abstract(1177)

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Abstract:
Although drug-induced liver injury( DILI) is often an acute process,about 20% of the patients may progress to chronic DILI.Chronic DILI has a long course of disease and there is still no effective treatment. With the development and clinical application of new drugs and the wide application of herbal and dietary supplements,the incidence rate of DILI chronicity gradually increases. This article overviews the latest research advances in DILI chronicity from the aspects of the epidemiology,risk factors,clinical manifestations,diagnosis,and treatment of DILI,so as to gain a comprehensive understanding of chronic DILI.

Updated key points of the 2019 EASL guidelines for drug-induced liver injury and its practice in China

Yu Hong, Kang Hong, Chen Jun

2020, 36(3): 505-508. DOI: 10.3969/j.issn.1001-5256.2020.03.005

Abstract(1302)

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Abstract:
To further understand the 2019 EASL Guidelines for drug-induced liver injury( DILI),this article outlined the updated key points of the guidelines and analyzed these points with reference to the reality of China,including the type of DILI,DILI induced by herbs and dietary supplements,prospective versus retrospective studies,diagnosis and causality assessment,risk factors,special phenotypes of DILI,management of DILI induced by immune checkpoint inhibitors,indication for the withdrawal of antitubercular agents,new biomarkers for DILI under clinical research,and therapeutic drugs for DILI. It is pointed out that the new version of the EASL guidelines redefined the diagnosis of acute and chronic DILI,provided detailed management strategies for DILI induced by immune checkpoint inhibitors and criteria for the withdrawal of antitubercular agents,and summarized several special phenotypes of DILI,with an emphasis on DILI induced by herbs and dietary supplements. Therefore,these guidelines have a good reference value for the diagnosis and treatment of DILI in China.

Research advances in drug-induced liver injury

Yang Xue, Tu RongFang, Yang JinHui

2020, 36(3): 509-513. DOI: 10.3969/j.issn.1001-5256.2020.03.006

Abstract(1504)

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Abstract:
Drug-induced liver injury( DILI) has a complex pathogenesis and obvious individual difference. Early diagnosis and treatment of DILI may achieve good prognosis,but due to a lack of specific clinical symptoms,most cases cannot be identified in the early stage. If no timely treatment is given,DILI may progress to irreversible liver failure with a high mortality rate,and there are no effective therapies for advanced DILI except liver transplantation. Therefore,early diagnosis and treatment are of great importance for patients with DILI. This article summarizes the recent research advances in DILI,including suspected drugs,risk factors,pathogenesis,pathological features,clinical types and manifestations,diagnostic criteria and evaluation,and network database,in order to provide a basis for early diagnosis,clinical typing,treatment guidance,and prognostic evaluation of DILI.

Expert consensus on multidisciplinary diagnosis and treatment of precancerous lesions of hepatocellular carcinoma( 2020 edition)

Chinese Journal of Hepatology, Liver Cancer Study Group, Chinese Society of Hepatology, Chinese Medical Association

2020, 36(3): 514-518. DOI: 10.3969/j.issn.1001-5256.2020.03.007

Abstract(846)

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Hepatocellular carcinoma( HCC) currently holds the second position for cause of cancer-related deaths in China. Most of the pathogenic characteristics of HCC in China follow the tri-step model of hepatitis B-cirrhosis-liver cancer. The screening of precancerous lesions of stomach cancer,colorectal cancer and cervical cancer has achieved remarkable results for the diagnosis and treatment of malignant tumors. Dysplastic nodules in the state of cirrhosis have strong potential for malignant changes,especially high-grade dysplastic nodules,have extremely high canceration rate. This expert consensus is based on the research results and clinical experience of foreign and native experts of this field. Furthermore,this consensus summarizes and defines high-grade dysplastic nodules of the liver as precancerous lesions of HCC through multidisciplinary collaboration in terms of conception,screening,diagnosis,treatment and follow-up,with the aim to reduce the HCC incidence and improve the overall therapeutic effect of HCC in China.

Expert consensus on hepatobiliary specific contrast agent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced MRI scanning scheme

International Communication Group, Imaging Technology Society of Chinese Medical Association

2020, 36(3): 519-521. DOI: 10.3969/j.issn.1001-5256.2020.03.008

Abstract(1421)

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Abstract:
Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid( Gd-EOB-DTPA) is a hepatobiliary-specific magnetic resonance imaging( MRI) contrast agent and has been widely used in clinical practice. With reference to the expert consensus and references in China and foreign countries,the experts in China obtained plenty of scan experience in clinical practice,optimized,supplemented,and refined the scan regimen of Gd-EOB-DTPA-enhanced MRI,and thus reached a consensus on intended population,contrast agent injection,scan regimen,and quality control,in order to standardize the regimen of Gd-EOB-DTPA-enhanced MRI and help with imaging diagnosis and the development of clinical treatment strategies.

An excerpt of guidance for design and endpoints of clinical trials in chronic hepatitis B-Report from the 2019 EASL-AASLD HBV Treatment Endpoints Conference

Deng Rui, Sun Jian

2020, 36(3): 522-526. DOI: 10.3969/j.issn.1001-5256.2020.03.009

Abstract(373)

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An excerpt of alcohol associated liver disease 2020: A clinical practice guideline by the Italian Association for the Study of the Liver (AISF)

Wu YanYan, Chen LiGang, Qi XingShun

2020, 36(3): 527-528. DOI: 10.3969/j.issn.1001-5256.2020.03.010

Abstract(394)

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An excerpt of ACG clinical guideline: Disorders of the hepatic and mesenteric circulation (2020)

Xu ShiXue, Yang Ling, Qi XingShun

2020, 36(3): 529-531. DOI: 10.3969/j.issn.1001-5256.2020.03.011

Abstract(332)

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Compliance with antiviral therapy in patients with chronic hepatitis B

Lin ShunWei, Zhou ShuDong, Gao YanHui, Li YuePing, Jia WeiDong, Liang YingFang, Yang Yi

2020, 36(3): 532-535. DOI: 10.3969/j.issn.1001-5256.2020.03.012

Abstract(1126)

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Abstract:
Objective To investigate the medication compliance in patients with chronic hepatitis B and related influencing factors. Methods A retrospective cohort study was conducted for 3732 patients with chronic hepatitis B who were treated in the outpatient service of Guangzhou Eighth People's Hospital from January 1,2011 to December 31,2016,and related clinical data were collected from the hospital's information system,including demographic features,information of the physician in charge,medication information,and examination data. According to the medication possession ratio( MPR),the patients were divided into good compliance group with 2346 patients and poor compliance group with 1386 patients. The chi-square test was used to compare demographic features,diagnosis,and treatment between the two groups,and the two-level robust Poisson regression model was used to analyze influencing factors. Results The patients with chronic hepatitis B had an MPR of 0. 789 ± 0. 269,and 62. 86% of the patients with good compliance had an MPR of > 0. 8. The multivariate analysis showed that method of payment,time of treatment,physician's professional title,and pattern of medication were the influencing factors for compliance( all P < 0. 05). After the control of the other covariants,the proportion of patients with good compliance among the patients covered by medical insurance was 0. 119 times higher than that among the self-paying patients. The proportion of patients with good compliance tended to decrease in general,and the proportion of patients with good compliance in the 2th-5th years was15. 3%,22. 7%,21. 5%,and 34. 1%,respectively,lower than that in the first year. The proportion of patients with good compliance among the patients under the charge of an associate chief physician was 0. 249 times higher than that among the patients under the charge of an attending physician or a resident. The proportion of patients with good compliance among the patients receiving telbivudine was 0. 120 times higher than that among the patients taking entecavir. Conclusion Medication compliance of patients with chronic hepatitis B is closely associated with medical insurance,time of treatment,professional title of the physician in charge,and pattern of medication. The patients without medical insurance should be encouraged to purchase medical insurance. It is important to strengthen health education among patients with chronic hepatitis B and promote them to follow the guidelines for the treatment of chronic hepatitis B.

Expression of nuclear factor-kappa B and inducible nitric oxide synthase in peripheral blood mononucleated cells and immune status in patients with different stages of chronic hepatitis B

Huang Jin, Zhang MeiQuan, He DaoXing

2020, 36(3): 536-540. DOI: 10.3969/j.issn.1001-5256.2020.03.013

Abstract(1060)

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Abstract:
Objective To investigate the expression of nuclear factor-kappa B( NF-κB) and inducible nitric oxide synthase( iNOS) in peripheral blood mononucleated cells( PBMCs) of patients with different stages of chronic hepatitis B( CHB),as well as the changes in natural killer( NK),T,and B lymphocytes in each stage. Methods A total of 80 patients with CHB-related diseases who were admitted to Nanping First Hospital Affiliated to Fujian Medical University from October 2017 to January 2019 were enrolled and divided into four groups according to disease stage: hepatitis group,liver failure group,liver cirrhosis group,and liver cancer group,with 20 patients in each group,and ten healthy volunteers were enrolled as control group. Flow cytometry was used to measure total lymphocyte count as well as the counts of lymphocyte subsets in peripheral blood in all five groups,Western blot was used to measure the protein expression of NF-κB and iNOS in PBMCs,and the nitrate reductase method and ELISA were used to measure the serum levels of nitric oxide( NO) and interleukin-6( IL-6). A one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups. Results Compared with the control group,the hepatitis group,the liver failure group,the liver cancer group,and the liver cirrhosis group had a significant reduction in total lymphocyte count( all P < 0. 05),and compared with the hepatitis group,the liver failure group,the liver cancer group,and the liver cirrhosis group had a significant reduction in total lymphocyte count( all P < 0. 05). The liver failure group,the liver cancer group,and the liver cirrhosis group had a significant reduction in CD3+T cells compared with the control group and the hepatitis group( all P < 0. 05),as well as a significant reduction in CD4+T cells compared with the hepatitis group( all P < 0. 05); the liver failure group had a significant increase in CD8+T cells compared with the liver cancer group,the liver cirrhosis group,and the control group( all P < 0. 05); the liver failure group had a significant reduction in CD4+/CD8+compared with the control group,the hepatitis group,the liver cirrhosis group,and the liver cancer group( all P < 0. 05); the liver failure group and the liver cirrhosis group had a significant increase in CD3-CD19+B cells compared with the hepatitis group and the control group( all P < 0.05); the liver failure group and the liver cancer group had a significant reduction in CD16+CD56+NK cells compared with the hepatitis group and the control group( all P < 0. 05). The liver cirrhosis group,the liver failure group,and the liver cancer group had significant increases in the protein expression of NF-κB and iNOS compared with the hepatitis group and the control group( all P < 0. 05). Compared with the control group,the liver failure group,the liver cancer group,the liver cirrhosis group,and the hepatitis group had significant increases in the serum levels of NO and IL-6( all P < 0. 05). Conclusion There are certain differences in immune status between patients with different stages of HBV infection,and NF-κB-iNOS-NO may be involved in the immune response of HBV-related diseases.

Value of Fibroscan combined with GPR,APRI,NFS or FIB-4 for progressive liver fibrosis in patients with chronic hepatitis B and nonalcoholic fatty liver disease

Gong Hang, Li LiangPing

2020, 36(3): 541-545. DOI: 10.3969/j.issn.1001-5256.2020.03.014

Abstract(1652)

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Objective To investigate the diagnostic value of FibroScan,gamma-glutamyl transpeptidase-to-platelet ratio( GPR),aspartate aminotransferase-to-platelet ratio index( APRI),nonalcoholic fatty liver disease( NAFLD) fibrosis score( NFS),and fibrosis-4( FIB-4) used alone or FibroScan combined with GPR,APRI,NFS,or FIB-4 for progressive liver fibrosis in patients with chronic hepatitis B( CHB) and NAFLD. Methods A total of 92 patients who underwent liver biopsy in Sichuan Provincial People's Hospital from November 2014 to August 2018 and were diagnosed with CHB and NAFLD were enrolled. Based on the SAF scoring system for liver biopsy,these patients were divided into mild-to-moderate liver fibrosis( F1 + F2) group with 69 patients and progressive liver fibrosis( F3) group with 23 patients. FibroScan was used to obtain liver stiffness measurement( LSM),and GPR,APRI,NFS,and FIB-4 were calculated based on clinical indices. The Mann-Whitney U test was used for comparison of continuous data between two groups. Spearman rank correlation was used for correlation analysis. A multivariate binary logistic regression analysis( forward stepwise regression) was used to construct combined predictive factors. The receiver operating characteristic( ROC) curve was plotted,and the area under the ROC curve( AUC) was calculated,and Delong method was used to compare the AUC to evaluate the early-warning value of each noninvasive diagnostic method used alone or in combination in the diagnosis of CHB and progressive liver fibrosis. Results The mild-to-moderate liver fibrosis group had significantly lower values of FibroScan,GPR,APRI,NFS,and FIB-4 than the progressive liver fibrosis group( Z =-4. 910,-3. 425,-3. 837,-3. 873,and-3. 990,all P < 0. 05). The correlation analysis showed that FibroScan,GPR,APRI,NFS,and FIB-4 were positively correlated with the pathological staging of liver fibrosis( r = 0. 518,0. 361,0. 405,0. 407,and 0. 418,P < 0. 05). FibroScan,GPR,APRI,NFS,and FIB-4 used alone had a certain clinical value in the diagnosis of progressive liver fibrosis( AUC = 0. 844,0. 740,0. 770,0. 771,and 0. 779,all P < 0. 001),while FibroScan was not superior to GPR,APRI,NFS,and FIB-4( P > 0. 05). FibroScan combined with GPR,APRI,NFS,or FIB-4 had a significantly higher AUC than GPR,APRI,NFS,or FIB-4 used alone in the diagnosis of progressive liver fibrosis( Z = 1. 977,2. 076,2. 361,and 2. 206,all P < 0. 05). FibroScan combined with these four indices had an AUC of 0. 896( 95% confidence interval: 0. 813-0. 950). Conclusion FibroScan,GPR,APRI,NFS,and FIB-4 have a certain clinical value in the diagnosis of progressive liver fibrosis,and FibroScan combined with GPR,APRI,NFS,or FIB-4 has higher efficiency than GPR,APRI,NFS,or FIB-4 used alone in the diagnosis of progressive liver fibrosis,among which FibroScan combined with NFS or FIB-4 may have the best clinical value.

Clinical value of transient elastography,aspartate aminotransferase-to-platelet ratio index,and fibrosis-4 in the diagnosis of liver fibrosis in children with biliary atresia

Chen WeiTing, Li ShuangJie

2020, 36(3): 546-550. DOI: 10.3969/j.issn.1001-5256.2020.03.015

Abstract(1267)

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Objective To investigate the value of liver stiffness measurement( LSM) by transient elastography,aspartate aminotransferase-to-platelet ratio index( APRI),and fibrosis-4( FIB-4) in the diagnosis of liver fibrosis in children with biliary atresia. Methods A total of 110 children with biliary atresia who underwent Kasai operation in Department of Neonatal Surgery,Hunan Children's Hospital,from January 1,2016 to December 31,2018 were enrolled. Liver biopsy specimens and related clinical data were collected,including routine blood test results,liver function,and transient elastography results. The chi-square test was used for comparison of categorical data between groups. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data. MedCalc software was used to plot the receiver operating characteristic( ROC) curve,and the ROC curve was used to evaluate the diagnostic efficiency of LSM,APRI,and FIB-4 in evaluating the degree of liver fibrosis. The Spearman correlation analysis was also performed. Results The ROC curve analysis showed that in the diagnosis of biliary atresia with marked liver fibrosis( F≥2),LSM had an area under the ROC curve( AUC) of 0. 874( 95% confidence interval [CI]: 0. 778-0. 970) at the cut-off value of 9. 250 kPa,APRI had an AUC of 0. 636( 95% CI: 0. 362-0. 911) at the cut-off value of 0. 680,and FIB-4 had an AUC of 0. 622( 95% CI: 0. 363-0. 880) at the cut-off value of 0. 047; in the diagnosis of biliary atresia with progressive liver fibrosis( F≥3),LSM,APRI,and FIB-4 had an AUC of 0. 781( 95% CI: 0. 689-0. 873),0. 519( 95% CI: 0. 401-0. 636),and 0. 506( 95% CI: 0. 389-0. 623),respectively,at the cut-off value of 10. 75 k Pa,0. 70,and 0. 05,respectively; in the diagnosis of biliary atresia with liver cirrhosis( F≥4),LSM,APRI,and FIB-4 had an AUC of0. 855( 95% CI: 0. 769-0. 942),0. 701( 95% CI: 0. 599-0. 803),and 0. 717( 95% CI: 0. 609-0. 825),respectively,at the cut-off value of 11. 85 kPa,0. 82,and 0. 09,respectively. The correlation analysis showed that LSM was positively correlated with aspartate aminotransferase level( r = 0. 258,P = 0. 007) and was negatively correlated with platelet count( r =-0. 248,P = 0. 009). Conclusion Transient elastography has a high accuracy in determining the grade of liver fibrosis in children with biliary atresia,with a higher clinical value than APRI and FIB-4 in evaluating the degree of liver fibrosis.

Clinical significance of the change in plasma D-dimer in patients with hepatitis B cirrhosis

Xu Jing, Ji Dong, Wang ChunYan, Fu YiMing, Chen SongHai, Li ZhongBin, Chen GuoFeng

2020, 36(3): 551-555. DOI: 10.3969/j.issn.1001-5256.2020.03.016

Abstract(1454)

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Objective To investigate the correlation between plasma D-dimer level and severity of hepatitis B cirrhosis and its value in the diagnosis of portal vein thrombosis( PVT). Methods A retrospective analysis was performed for the clinical data of 500 patients with hepatitis B cirrhosis who were hospitalized in The Fifth Medical Center of Chinese PLA General Hospital from January to December,2018,and according to the plasma level of D-dimer,they were divided into normal group with 217 patients and elevated group with 283 patients. The correlations of plasma D-dimer level with Child-Pugh class and Model for End-Stage Liver Disease( MELD) score were compared between the two groups. 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 Kruskal-Wallis H test was used for multiple groups comparison and further pairwise comparison. The chi-square test was used for comparison of categorical data between two groups. A Spearman correlation analysis was used to investigate correlation. The receiver operating characteristic( ROC) curve was used to evaluate the early warning performance of D-dimer level for PVT in patients with hepatitis B cirrhosis. Results There were significant differences between the two groups in D-dimer level,alanine aminotransferase,aspartate aminotransferase,total bilirubin,albumin,Child-Pugh class,MELD score,and incidence rate of PVT( all P < 0. 05). The correlation analysis showed that plasma D-dimer level was positively correlated with Child-Pugh class and MELD score in both groups( r = 0. 463,0. 455,0. 214,and 0. 756,all P <0. 05). A total of 50 patients with hepatitis B cirrhosis were found to have PVT; the patients with PVT had a significantly higher D-dimer level that those without PVT [1. 96( 0. 82-4. 91) mg/L vs 0. 61( 0. 19-1. 54) mg/L,Z =-6. 02,P < 0. 001]. The ROC curve analysis showed that D-dimer level had an area under the ROC curve of 0. 758( 95% confidence interval: 0. 719-0. 796) at the optimal cut-off value of 0. 76 mg/L. Conclusion Plasma D-dimer level is correlated with the severity of hepatitis B cirrhosis and can be used to predict the prognosis of patients with hepatitis B cirrhosis. The possibility of PVT should be considered in patients with an elevated D-dimer level.

Gastroscopic manifestations of portal hypertensive gastropathy in liver cirrhosis and related factors

Wang WenSheng, Zhu GuangXi, Wen LiangZhi, Chen DongFeng

2020, 36(3): 556-560. DOI: 10.3969/j.issn.1001-5256.2020.03.017

Abstract(1280)

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Objective To investigate the gastroscopic manifestations of gastric mucosa in portal hypertensive gastropathy( PHG) and the association of PHG with gastroesophageal varices,ulcers,and liver cirrhosis complications. Methods A retrospective analysis was performed for the clinical data of 867 patients with liver cirrhosis who were treated in Daping Hospital of Army Medical University from August 2012 to June 2018,and the incidence rates of gastroesophageal varices,PHG,and ulcers were recorded. Meanwhile,the data of spontaneous bacterial peritonitis( SBP),hepatic encephalopathy( HE),and hepatocellular carcinoma( HCC) were collected. The chi-square test was used for comparison of categorical data between groups,and a Spearman correlation analysis was also performed. Results The incidence rate of PHG in the patients with liver cirrhosis reached 66. 2%( 574/867),and gastric mucosa abnormalities in mild PHG were mainly red-spot lesions( 68. 6%) and snakeskin( 56. 8%),while diffuse erythema( 76. 5%) was the main gastric mucosa abnormality in severe PHG.There was a significant difference in the incidence rate of PHG between the patients with different severities of esophageal varices( χ2=304. 712,P < 0. 05),and the severity of PHG increased with the aggravation of esophageal varices( r = 0. 515,P < 0. 05). There was a significant difference in the incidence rate of PHG between the patients with different severities of gastric varices( χ2= 81. 004,P < 0. 05),and the severity of PHG was positively correlated with that of gastric varices( r = 0. 292,P < 0. 05). There was a significant difference in the incidence rate of PHG between the patients with varices at different locations( χ2= 41. 361,P < 0. 05); the patients with gastric varices alone had the lowest incidence rate of PHG( 34. 8%) and only had mild PHG,and those with gastroesophageal varices had the highest incidence rate of PHG( 85. 6%). Among the patients without PHG,71( 24. 2%) were hospitalized due to hematemesis and/or tarry stool,and among the 574 patients with PHG,316( 55. 1%) were hospitalized,and there was a significant difference between the two groups( χ2=74. 562,P < 0. 05). Conclusion Patients with different severities of PHG have different features of gastric mucosa abnormalities. The development and severity of PHG are closely associated with the severity of gastroesophageal varices and are important causes of gastrointestinal bleeding in liver cirrhosis. PHG should be treated and prevented to reduce the risk and complications of gastrointestinal bleeding.

Clinical value of acoustic radiation force impulse elastography in predicting esophageal variceal bleeding in liver cirrhosis

Zhang DaKun, Chen Min, Zhang WenHui, Wang RuiFang, Shi XiaoJuan

2020, 36(3): 561-564. DOI: 10.3969/j.issn.1001-5256.2020.03.018

Abstract(1061)

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Objective To investigate the clinical value of acoustic radiation force impulse( ARFI) elastography in predicting esophageal variceal bleeding in patients with liver cirrhosis. Methods A retrospective analysis was performed for the clinical data of 271 patients with liver cirrhosis who attended the Fifth Medical Center of Chinese PLA General Hospital from October 2014 to May 2017,and ARFI elastography was performed for all patients to measure the elasticity of the liver and the spleen. According to the presence or absence of esophageal variceal bleeding,the patients were divided into bleeding group and non-bleeding group,and related indices were compared between the two groups. The receiver operating characteristic( ROC) curve was used to evaluate the value of ARFI elasticity in the diagnosis of esophageal variceal bleeding in liver cirrhosis. 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. Results The bleeding group had a significantly higher ARFI elasticity of the spleen than the non-bleeding group [3. 89( 3. 49-4. 11) m/s vs 3. 46( 2. 93-3. 80) m/s,Z =-4. 941,P < 0. 001],and there was no significant difference in the ARFI elasticity of the liver between the bleeding group and the non-bleeding group [2. 08( 1. 57-2. 74)m/s vs 1. 98( 1. 49-2. 70) m/s,Z =-1. 025,P = 0. 305]. The areas under the ROC curve for ARFI elasticity values of the spleen and the liver were 0. 714 and 0. 544,respectively,in predicting esophageal variceal bleeding in patients with liver cirrhosis( P = 0. 002 5). At the cut-off value of 3. 71 m/s,the ARFI elasticity of the spleen had a sensitivity of 0. 68 and a specificity of 0. 69 in predicting esophageal variceal bleeding. Conclusion The ARFI elasticity value of the spleen has a better value than that of the liver in predicting the risk of esophageal variceal bleeding and thus holds promise for clinical application.

Clinical effect of emergency gastroscopic ligation,sclerotherapy,and tissue adhesive injection in treatment of esophagogastric junctional variceal bleeding

Ding PengPeng, Zhang WenHui, Qi XiaoBao, Lu Zheng, Wang YanLing, Han JingJing, Chen JianHong, Guo ChunMei, Liu Hong

2020, 36(3): 565-568. DOI: 10.3969/j.issn.1001-5256.2020.03.019

Abstract(1557)

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Abstract:
Objective To investigate the clinical effect of endoscopic variceal ligation( EVL),endoscopic injection sclerotherapy( EIS),and tissue adhesive injection in the treatment of esophagogastric junctional variceal bleeding,and to provide a reference for reasonable selection of different hemostasis methods. Methods A total of 1264 patients with liver cirrhosis and esophagogastric junctional variceal bleeding who underwent emergency gastroscopic hemostasis in Beijing Shijitan Hospital and The Fifth Medical Center of Chinese PLA General Hospital from June 2017 to June 2019 were enrolled and divided into EVL,EIS,HI groups based on the method of emergency gastroscopic hemostasis. These groups were compared in terms of success rate of operation,success rate of hemostasis,early rebleeding rate,and postoperative complications. The patients were also divided into groups based on bleeding site,and the success rates of different hemostasis methods at different sites were compared. An analysis of variance was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. Results The success rate of EIS and tissue adhesive injection was significantly higher than that of EVL,and the success rate of EIS was significantly higher than that of tissue adhesive injection( χ2= 75. 01,P < 0. 05). Tissue adhesive injection had a significantly higher success rate of hemostasis than EVL and EIS( χ2= 9. 885,P < 0. 05). There was no significant difference in early rebleeding rate between groups( χ2= 0. 29,P = 0. 865). The patients undergoing EVL had a significantly higher incidence rate of aspiration and pneumonia than those undergoing EIS or tissue adhesive injection( χ2= 19. 08,P < 0. 05); the patients undergoing tissue adhesive injection had a significantly higher proportion of patients with postoperative pyrexia than those undergoing EVL or EIS( χ2= 23. 94,P < 0. 05); the patients undergoing EVL or tissue adhesive injection had a significantly higher incidence rate of postoperative retrosternal discomfort than those undergoing EIS( χ2= 19. 56,P < 0. 05). EIS and EVL had a high success rate of hemostasis for the bleeding sites at 1-5 cm above the esophagogastric junction( EGJ); EIS and tissue adhesive injection had a similar success rate of hemostasis for the bleeding sites from 1 cm above the EGJ to 2 cm below the EGJ; tissue adhesive injection had a high success rate of hemostasis for the bleeding sites at 2-5 cm below the EGJ. Conclusion EVL,EIS,and tissue adhesive injection are effective methods for the treatment of esophagogastric junctional variceal bleeding,and the selection of hemostasis method based on the location of bleeding site can improve the outcome of hemostasis.

Value of combined measurement of serum growth differentiation factor 15 and alpha-fetoprotein in the diagnosis of hepatitis B virus-related hepatocellular carcinoma

Li Huan, Chen JuanJuan, Zhu ChengLiang, Zhang PingAn

2020, 36(3): 569-572. DOI: 10.3969/j.issn.1001-5256.2020.03.020

Abstract(1044)

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Abstract:
Objective To investigate the clinical value of combined measurement of serum growth differentiation factor 15( GDF15) and alpha-fetoprotein( AFP) in the diagnosis of hepatocellular carcinoma( HCC) associated with hepatitis B virus( HBV) infection. Methods A total of 225 subjects who received treatment or underwent physical examination in Renmin Hospital of Wuhan University from March 1 to September 1,2019,were enrolled,among whom there were 97 patients with HCC caused by HBV infection( HCC group),41 patients with chronic hepatitis B( CHB group),and 87 healthy individuals( NC group),and the levels of GDF15 and AFP were measured for all three groups. The one-sample Kolmogorov-Smirnov test was used to determine whether the data were normally distributed or not; an analysis of variance was used for comparison of normally distributed data 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 data between multiple groups,and the Mann-Whitney U test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data. A binary logistic regression analysis was used to obtain the regression model of GDF15 and AFP; the receiver operating characteristic( ROC) curve was plotted for GDF15 and AFP used alone or in combination,and the area under the ROC curve( AUC),sensitivity,specificity,and Youden index were calculated. Results There were significant differences in the levels of GDF15 and AFP between the HCC group,the CHB group,and the NC group( χ2= 53. 77 and 119. 12,both P < 0. 01); the HCC group had a significantly higher level of GDF15 than the CHB group and the NC group( both P < 0. 01),the HCC group and the CHB group had a significantly higher level of AFP than the NC group,and the HCC group had a significantly higher level of AFP than the CHB group( all P < 0. 01). The ROC curve analysis showed that GDF15 alone had an AUC of 0. 752,a sensitivity of 74. 0%,and a specificity of 68. 3%,AFP alone had an AUC of 0. 660,a sensitivity of 45. 8%,and a specificity of 85. 4%,and GDF15 combined with AFP had an AUC of 0. 816,a sensitivity of 88. 4%,and a specificity of 68. 5%. Conclusion Combined measurement of GDF15 and AFP can improve the diagnostic efficiency for HBV-related HCC and has a high clinical value.

Efficacy and safety of laparoscopic versus open liver resection in treatment of colorectal cancer liver metastasis: A Meta-analysis

Gao BenJian, Luo Jia, Liu Ying, Yang XiaoLi, Su Song, Li Bo

2020, 36(3): 573-579. DOI: 10.3969/j.issn.1001-5256.2020.03.021

Abstract(1344)

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Abstract:
Objective To systematically evaluate the efficacy and safety of laparoscopic liver resection( LLR) versus open liver resection( OLR) in the treatment of colorectal cancer liver metastasis( CRLM). Methods Chinese databases( CNKI,Wanfang,and VIP) and English databases( PubMed,Cochrane Library,and Embase) were searched for controlled clinical trials on LLR versus OLR in the treatment of CRLM published up to June 2019. Chinese search words were colorectal cancer liver metastasis,laparoscopic liver resection,and open liver resection,and English search words were colorectal cancer,colorectal liver metastases,laparoscopic hepatectomy,laparoscopic liver resection,open hepatectomy,and open liver resection. Quality assessment and data extraction were performed for the studies included,and RevMan5. 3 software was used to perform the meta-analysis. Results A total of 23 studies were included,and there were 4204 patients in total,with 1558 patients in LLR group and 2646 in OLR group. The results of the meta-analysis showed that compared with the OLR group,the LLR group had significantly lower intraoperative blood loss( mean difference [MD]=-145. 48,95% confidence interval[CI]:-190. 96 to-100. 00,P < 0. 001),lower transfusion rate( odds ratio [OR]= 0. 41,95% CI: 0. 29-0. 60,P < 0. 001),lower incidence rate of postoperative complications( OR = 0. 55,95% CI: 0. 47-0. 65,P < 0. 001),and shorter length of postoperative hospital stay( MD =-2. 69,95% CI:-3. 29 to-2. 10,P < 0. 001). There were no significant differences between the two groups in time of operation,perioperative mortality rate,R0 resection rate,1-and 5-year overall survival rates,and disease-free survival rate( all P >0. 05). Conclusion LLR is safe and feasible in the treatment of CRLM and has better short-term efficacy than OLR,but more randomized controlled trials are needed for verification.

Expression and clinical significance of pseudogene DUXAP8 in liver cancer

Wang Chun, Ye MingLiang, Chen ZhiHang, Luo Jie, Hong YingHui, Zhao Qiu, Chang Ying

2020, 36(3): 580-586. DOI: 10.3969/j.issn.1001-5256.2020.03.022

Abstract(1003)

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Abstract:
Objective To investigate the expression,clinical significance,and potential mechanism of action of DUXAP8 in hepatocellular carcinoma. Methods The expression data of liver cancer and related clinical data published up to June 2019 were collected from TCGA database to screen out the differentially expressed long non-coding RNAs( lncRNAs) between liver cancer tissue and adjacent tissue which affected the prognosis of patients. The association of the expression level of DUXAP8 with clinicopathological features and prognosis was analyzed. Gene ontology( GO) and KEGG pathway enrichment analysis was used to investigate the biological functions and biological processes of DUXAP8-related genes. The STRING database and Cytoscape were used to analyze protein-protein interactions and screen out key genes,and then the expression levels of key genes and prognosis were analyzed and a literature search analysis was performed. The Wilcoxon signed-rank test and the Wilcoxon rank-sum test were used to compare the expression of DUXAP8 between liver cancer tissue and adjacent tissue,and the Wilcoxon rank-sum test was used to compare the expression of DUXAP8 between the patients with different clinicopathological features. The Kaplan-Meier method was used to plot survival curves and the log-rank test was used for survival comparison between groups; a Cox regression analysis was used to identify the influencing factors for prognosis. A Pearson correlation analysis was used to analyze DUXAP8-related genes. Results As for the matched and unmatched samples,there was a significant difference in the expression of DUXAP8 between liver cancer tissue and adjacent tissue( P < 0. 001),and the expression of DUXAP8 in liver cancer tissue was significantly higher than that in adjacent tissue. There was a significant difference in the expression of DUXAP8 between the patients with different ages or T stages( P < 0. 05),and the patients with an age of ≥60 years or a T stage of T3 or T4 tended to have higher expression of DUXAP8. The univariate analysis showed that clinical stage,T stage,and expression of DUXAP8 were associated with patients' overall survival( all P <0. 001),and the multivariate Cox regression analysis showed that an advanced clinical stage( hazard ratio [HR]= 1. 648,95% confidence interval [CI]: 1. 330-2. 709,P < 0. 001) and high expression of DUXAP8( HR = 1. 849,95% CI: 1. 262-2. 713,P < 0. 01) were independent risk factors for poor prognosis. The genes involved in the maintenance of tumor cell proliferation and cell cycle were enriched in the samples with high expression of DUXAP8. TOP2 A,KIF2 C,TTK,PLK1,CDCA8,CDC20,NCAPG,BUB1 B,BUB1,and CCNA2 were the Hub genes of DUXAP8-related genes and were mainly involved in the processes such as cell mitosis and cell cycle,and they were the factors for poor prognosis of patients with liver cancer( all P < 0. 05). Conclusion The high expression of DUXAP8 is a risk factor for poor prognosis in patients with liver cancer and DUXAP8 may promote the development and progression of liver cancer by affecting the processes of cell proliferation and cell cycle.

Regulatory effect of water extract of Jianpi Xiaoji prescription on autophagy of human liver cancer SMMC7721 cells

Han ZhiWei, Wang ZongYu, Ju JiaNi, Li KeZhi, Wu GuoBin, Lin DongYi, Chen Chuang

2020, 36(3): 587-591. DOI: 10.3969/j.issn.1001-5256.2020.03.023

Abstract(1032)

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Abstract:
Objective To investigate the anti-liver cancer mechanism of water extract of Jianpi Xiaoji prescription and its effect on cell autophagy flow and autophagy-related proteins. Methods SMMC7721 cells were treated with water extract of Jianpi Xiaoji prescription.CCK-8 assay was used to measure cell proliferation; flow cytometry was used to measure cell apoptosis rate; Western blot was used to measure the expression of the autophagy-related proteins Beclin1,LC3,and P62; the formation of autophagosomes and the fusion of autophagosomes and lysosomes were monitored. The independent samples t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups. Results The CCK-8 assay showed that cell proliferation was significantly inhibited at 24,48,72,and 96 hours after the drug was added,and there was a significant difference between the drug treatment group and the control group( t =28. 458,81. 093,85. 328,and 100. 158,all P < 0. 001). Flow cytometry showed that compared with the control group,the drug treatment group had a significant increase in the apoptosis of liver cancer SMMC7721 cells( t =-42. 629,P < 0. 001). Western Blot showed that compared with the control group,the drug treatment group had significantly downregulated expression of Beclin1 and significantly upregulated expression of the autophagy markers LC3-Ⅱ and P62. The flow of autophagosomes to autolysosomes was blocked in the drug treatment group,and there was a significant difference between the drug treatment group and the control group( F = 31. 155,P < 0. 001). Conclusion The water extract of Jianpi Xiaoji prescription can inhibit the proliferation of human liver cancer SMMC-7721 cells and promote apoptosis; meanwhile,it can upregulate the expression of Beclin1,downregulate the expression of LC3 and P62,and block the formation of autophagy flux.

Effect of proteasome subunit beta type 4 on the proliferation and viability of human liver cancer SMMC7721 cells

Lu Qian, Cheng Xin, Xia ZhenGuo, Chen Zhong

2020, 36(3): 592-595. DOI: 10.3969/j.issn.1001-5256.2020.03.024

Abstract(927)

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Abstract:
Objective To investigate the effect of proteasome subunit beta type 4( PSMB4) on the proliferation and viability of human liver cancer SMMC7721 cells and its possible mechanisms. Methods The specific short-hairpin RNA( shRNA) technique was used to construct SMMC7721 cells with knockdown expression of PSMB4,and these cells were selected as experimental group. MTT assay and colony-forming assay were used to observe the change in cell proliferation,flow cytometry was used to measure the change in cell apoptosis rate,and Western blot was used to measure the change in the expression of related proteins. The independent samples t-test was used for comparison of continuous data between two groups. Results SMMC7721 cells with knockdown expression of PSMB4 were successfully constructed( shRNA1: t = 22. 67,P < 0. 0001; shRNA2: t = 30. 88,P < 0. 0001; shRNA3: t = 67. 82,P < 0. 0001). The MTT assay showed that the experimental group had a significantly lower OD490 value than the control group on day 4( 0. 4770 ± 0. 0135 vs 0. 3237 ± 0. 0127,t =8. 286,P = 0. 0012) and day 5( 0. 5893 ± 0. 0088 vs 0. 3847 ± 0. 0090,t = 16. 220,P < 0. 0001). The colony-forming assay showed a significant reduction in the number of cell colonies in the experimental group. Flow cytometry showed that compared with the control group,the experimental group had significantly higher early apoptosis rate( 5. 5570% ± 0. 2589% vs 3. 8870% ± 0. 3324%,t = 3. 964,P = 0. 0166),late apoptosis rate( 12. 6300% ± 0. 4198% vs 5. 3100% ± 0. 3062%,t = 14. 080,P = 0. 0001),and total apoptosis rate( 18. 1800% ± 0. 6785%vs 9. 1970% ± 0. 6313%,t = 9. 967,P = 0. 0006),as well as a significant reduction in the protein expression of nuclear factor-kappa B p65( 0. 8015 ±0. 0120 vs 0. 2841 ±0. 0110,t =31. 830,P <0. 0001) and a significant increase in the protein expression of nuclear factor-kappa B inhibitory protein α( 0. 4816 ± 0. 0112 vs 0. 6583 ± 0. 0142,t = 9. 774,P = 0. 0006). Conclusion Knockdown of PSMB4 expression may reduce the proliferation and viability of liver cancer SMMC7721 cells by inhibiting the NF-κB signaling pathway.

Liver histopathological features of patients with drug-induced liver injury due to Chinese herbal medicine or Western medicine: A comparative analysis of 50 cases

Luo Qiong, Zhu GeRui, Gu HongTu, Liu Kun, Chen GaoFeng, Xing Feng, Tao YanYan, Liu ChengHai

2020, 36(3): 596-601. DOI: 10.3969/j.issn.1001-5256.2020.03.025

Abstract(1335)

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Abstract:
Objective To compare the liver histopathological features of drug-induced liver injury( DILI) caused by Chinese herbal medicine( HM) and that caused by Western medicine( WM),and to investigate the pathological features of HM-DILI. Methods A total of50 patients with drug-induced liver injury( DILI) who were diagnosed and treated in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from March 2014 to June 2019. All the patients with DILI were enrolled and divided into HM-DILI group and WM-DILI group. A retrospective analysis was performed for the clinical features and the pathological features of the two groups,including the clinical type of DILI,severity of liver injury,and liver histopathological features,especially location and grade of liver inflammation,type and degree of steatosis,and iron deposition. The t test and Mann-Whitney U test was used for comparison of continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups; the Mann-Whitney U test was used for comparison of ranked data. Results Of all 50 patients,20( 40. 0%) had HM-DILI and 30( 60%) had WM-DILI. There were no significant differences in sex,age,course of disease,and biochemical parameters of liver function between the two groups( all P > 0. 05). The main clinical types of the two groups were hepatocellular injury type and the degree of injury which was mainly grade l,and there were no significant differences in the clinical type of DILI and the severity of liver injury between the two groups( both P > 0. 05). As for liver histopathological features,both groups had varying degrees of focal necrosis of hepatocytes,steatosis( microvesicular,macrovesicular,and mixed),and fibrous tissue proliferation at the portal area,and compared with the WM-DILI group,the HM-DILI group had significantly greater lymphocyte/plasma cell infiltration in the portal area( χ2= 3. 860,P < 0. 05) and iron deposition in Kupffer cells( χ2= 4. 787,P < 0. 05).Conclusion There are no significant differences in clinical manifestations between HM-DILI and WM-DILI,but patients with HM-DILI have more obvious inflammation in the portal area and iron deposition in Kupffer cells than those with WM-DILI.

Serum interferon-gamma-induced protein-10 level and gene polymorphism in patients with drug-induced liver injury accompanied by autoimmune phenomena

Ren Shan, Du XiaoFei, Huang YunLi, Huang ChunYang, Zhang XiaoDan, Dan Jing, Chen XinYue

2020, 36(3): 602-607. DOI: 10.3969/j.issn.1001-5256.2020.03.026

Abstract(1122)

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Objective To investigate the single nucleotide polymorphism( SNP) and serum expression of interferon-gamma-induced protein 10( IP-10) in patients with drug-induced liver injury accompanied by autoimmune phenomena( AI-DILI). Methods A total of 168 patients with drug-induced liver injury( DILI) who were diagnosed and treated in Beijing YouAn Hospital,Capital Medical University,from October 2016 to June 2019 were enrolled and divided into AI-DILI group( n = 72) and non-AI-DILI group( n = 96). The SNP of IP-10 rs56061981 locus was detected and the serum level of IP-10 was measured. The two groups were compared in terms of IP-10 level and SNP genotype,and their association with the development of AI-DILI was analyzed. Allele frequency was calculated based on genotype results,and the chi-square test was used for Hardy-Weinberg equilibrium analysis. The t-test and the Mann-Whitney U test were used for comparison between two groups; a repeated measures analysis of variance was used for comparison between different time points; the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The Pearson correlation analysis was used to investigate correlation. The receiver operating characteristic( ROC) curve was used to analyze the value of baseline IP-10 level in predicting AI-DILI. Results There was a significant difference in the positive rate of autoantibody between the AI-DILI group and the non-AI-DILI group( 91. 67% vs 12. 5%,χ2= 103. 8,P < 0. 05). Compared with the non-AI-DILI group,the AI-DILI group had significantly higher distribution frequency of CC genotype( 77. 78% vs 62. 50%,χ2= 4. 592,P = 0. 03) and frequency of C allele( 86. 11% vs 72. 92%,χ2= 4. 41,P = 0. 04). The AI-DILI group had a significantly higher baseline IL-10 level than the non-AI-DILI group( 627. 99 ± 198. 07 pg/ml vs 378. 13 ± 218. 45 pg/ml,t = 7. 34,P < 0. 05),and baseline IL-10 level was positively correlated with baseline aspartate aminotransferase level and AIH score( r = 0. 67 and 0. 79,both P < 0. 05). At the optimal cut-off value of 527. 03 pg/ml,baseline IP-10 level had a sensitivity of 0. 846,a specificity of 0. 867,and an area under the ROC curve of 0. 832 in predicting AI-DILI. CC genotype combined with a baseline IP-10 level of ≥527. 03 pg/ml had a positive predictive value of 92. 84% and a negative predictive value of 86. 33% in predicting the development of AI-DILI. Conclusion CC genotype of IP-10 rs56061981 is associated with the development of AI-DILI and affects the serum expression of IP-10,and the combination of CC genotype and IP-10 expression has a high value in predicting AI-DILI.

Protective effect of pinocembrin in a mouse model of liver injury induced by acetaminophen

Du YiChao, Zhang Hao, Zhong FuRui, Cheng HuanLi, Lai Li, Qian BaoLin, Tan Peng, Xia XianMing, Fu WenGuang

2020, 36(3): 608-611. DOI: 10.3969/j.issn.1001-5256.2020.03.027

Abstract(1307)

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Abstract:
Objective To investigate the protective effect of pinocembrin( PIN) in a mouse model of liver injury induced by acetaminophen( APAP). Methods A total of 50 healthy male C57BL/6 J mice were randomly divided into blank group,PIN( 50 mg/kg) group,APAP( 300 mg/kg) model group,PIN( 30 mg/kg) + APAP( 300 mg/kg) experimental group,and PIN( 50 mg/kg) + APAP( 300 mg/kg) experimental group,with 10 mice in each group. The mice in the blank group and the model group were given an equal volume of normal saline by gavage,and those in the PIN group and the PIN + APAP groups were given PIN by gavage once a day,for 7 consecutive days. At 2 hours after the last administration,the mice in the model group and the PIN + APAP groups were given intraperitoneal injection of APAP 300 mg/kg once,and those in the blank group and the PIN group were given intraperitoneal injection of an equal volume of normal saline. Serum samples were collected to measure the levels of alanine aminotransferase( ALT) and aspartate aminotransferase( AST); liver tissue homogenate was prepared to measure the biochemical parameters of malondialdehyde( MDA),superoxide dismutase( SOD),and glutathione( GSH);HE staining was used to observe liver histopathology. 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 Compared with the blank group,the APAP( 300 mg/kg) model group had significant increases in the activities of ALT and AST( P < 0. 01),suggesting that a model was successfully established,while the PIN( 30 mg/kg) + APAP( 300 mg/kg) group and the PIN( 50 mg/kg) + APAP( 300 mg/kg) group had significant reductions in the levels of ALT and AST( P < 0. 01). Compared with the blank group,the APAP( 300 mg/kg)model group had a significant increase in the level of MDA and significant reductions in SOD activity and GSH level in the liver( P < 0. 01);compared with the APAP( 300 mg/kg) model group,the PIN( 30 mg/kg) + APAP( 300 mg/kg) group and the PIN( 50 mg/kg) + APAP( 300 mg/kg) group had a significant reduction in the level of MDA and significant increases in SOD activity and GSH level in the liver( P <0. 05). Histopathological observation showed that PIN significantly improved liver injury caused by APAP and helped to maintain normal liver histomorphology. Conclusion PIN exerts a marked protective effect on liver injury induced by APAP,possibly by inhibiting oxidative stress in the liver.

Prevalence of nonalcoholic fatty liver disease in taxi drivers in Shenzhen,China

Huang HaiYan, Wei RongXin, He GuangYing, Ceng HuiYuan

2020, 36(3): 612-615. DOI: 10.3969/j.issn.1001-5256.2020.03.028

Abstract(985)

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Abstract:
Objective To investigate the prevalence of nonalcoholic fatty liver disease( NAFLD) and related abnormal indicators among taxi drivers in Shenzhen,China,and to provide a basis for scientific prevention and treatment of fatty liver disease. Methods A total of1752 taxi drivers who underwent physical examination in Shenzhen Longhua District People's Hospital from May 2018 to June 2019 were selected,and related indicators were measured,including body mass index( BMI),blood pressure,fasting plasma glucose( FPG),total cholesterol( TC),triglyceride( TG),high-density lipoprotein( HDL),low-density lipoprotein( LDL),alanine aminotransferase( ALT),aspartate aminotransferase( AST),and uric acid( UA). Liver ultrasound examination was also performed. The association between the prevalence rate of NAFLD and various biochemical parameters was analyzed. The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. Results The prevalence rate of NAFLD among the taxi drivers was 51. 66%( 905/1752),and male drivers had a significantly higher prevalence rate than female drivers[57. 94%( 770/1329) vs 31. 91%( 135/423),χ2= 9. 209,P = 0. 027]. The taxi drivers with NAFLD had significantly higher abnormal rates of BMI,blood lipids,blood pressure,FPG,and UA than those without NAFLD( χ2= 5. 894,7. 126,8. 045,8. 909,and 10. 373,P = 0. 047,0. 035,0. 030,0. 028,and 0. 018). The taxi drivers with a BMI of ≥28 kg/m2 had a significantly higher prevalence rate of NAFLD than those with a BMI of 24. 0-27. 9 kg/m2 or a BMI of < 24 kg/m2( male: χ2= 7. 904 and 18. 624,P = 0. 035 and 0. 008; female: χ2= 8. 613 and 31. 635,P = 0. 029 and 0. 006). The taxi drivers with working years of > 15 years had a significantly higher prevalence rate of NAFLD than those with working years of 11-15 years,5-10 years,and < 5 years( male: χ2= 9. 781,13. 546,and 18. 052,P = 0. 024,0. 012,and 0. 008; female: χ2= 7. 052,9. 847,and 12. 157,P = 0. 036,0. 023,and 0. 016). Conclusion There is a high prevalence rate of NAFLD among taxi drivers in Shenzhen,and male drivers have a higher prevalence rate than female drivers. The prevalence rate of NAFLD is associated with the abnormal rates of hyperlipidemia,obesity,hyperglycemia,and hyperuricemia and the working years in driving.

Clinical effect of surgery in treatment of calcified hepatic cystic echinococcosis

Gao Yu, Wu XiangWei, Liu GuiSheng, Lei Zhen

2020, 36(3): 616-619. DOI: 10.3969/j.issn.1001-5256.2020.03.029

Abstract(1029)

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Objective To investigate the clinical effect of surgery in the treatment of calcified hepatic cystic echinococcosis. Methods A retrospective analysis was performed for the clinical data of 16 patients with 20 calcified hepatic hydatid cysts who underwent surgical treatment( total pericystectomy,subtotal pericystectomy,and endocystectomy) in The First Affiliated Hospital of Shihezi University School of Medicine from November 2015 to February 2019. Results Of all 16 patients,1 underwent total pericystectomy,5 underwent endocystectomy,and 10 underwent subtotal pericystectomy. One patient experienced bile leakage after surgery since the cyst ruptured and entered the bile duct and there was a biliary fistula in the outer wall of the cyst before surgery,and the other patients had no residual cavity complications including residual cavity effusion and infection,bile leakage,or jaundice. There was no death and recurrence after operation. Conclusion Surgical treatment is necessary for non-stationary calcified hepatic cystic echinococcosis. Total pericystectomy is not suitable,while subtotal pericystectomy may be the preferred surgical method,especially when the calcified hepatic hydatid cyst is located near the porta hepatis or the intrahepatic and extrahepatic vessels and there is no obvious lacunae between the adventitia and the outer cyst. Endocystectomy can be selected when hepatic hydatid cyst ruptures.

Effect of the transforming growth factor-β1 signaling pathway in inducing the differentiation of hepatic progenitor cells

YUSUFUKADIER·Maimaitinijiati, AIMAITI·Yasen, Li WenDing, Ran Bo, TUERGANAILI.aji, Shao YingMei, Wen Hao

2020, 36(3): 620-623. DOI: 10.3969/j.issn.1001-5256.2020.03.030

Abstract(998)

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Objective To investigate the effect of the transforming growth factor-β1( TGF-β1) signaling pathway on the differentiation of hepatic progenitor cells( HPCs). Methods HPC-E14. 5 cells were cultured in vitro and immunofluorescent staining was performed for identification. The cells were divided into control group( HPCs),HPCs + TGF-β1 group,and HPCs + SB431542 group. The cells in the HPCs + TGF-β1 group were treated with exogenous TGF-β1,and those in the HPCs + SB431542 group were treated with the TGF-β1 receptor inhibitor SB431542; after 72 hours of treatment,qRT-PCR and Western blot were used to measure the mRNA and protein expression of the stem cell marker alpha-fetoprotein( AFP),the hepatocyte marker albumin( Alb),and the cholangiocyte marker cytokeratin 19( CK19),and periodic acid-Schiff staining was used to evaluate function after differentiation. A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the Dunnett's t-test was used for further comparison between two groups. Results The results of qRT-PCR showed that the control group had significantly higher mRNA expression of AFP than the other two groups( F = 128. 937,P < 0. 01),the HPCs + TGF-β1 group had significantly higher mRNA expression of CK19 than the other two groups( F =414. 467,P < 0. 01),and the HPCs + SB431542 group had the highest mRNA expression of Alb( F = 794. 929,P < 0. 01). The results of Western blot showed that the control group had significantly higher protein expression of AFP than the other two groups( F = 269. 000,P <0. 01),the HPCs + TGF-β1 group had significantly higher protein expression of CK19 than the other two groups( F = 93. 010,P < 0. 01),and the HPCs + SB431542 group had significantly higher protein expression of Alb than the other two groups( F = 1086. 000,P < 0. 01).Periodic acid-Schiff staining showed that the control group had a significantly smaller positive staining area than the other two groups( F =79. 251,P < 0. 05). Conclusion The TGF-β1 signaling pathway induces HPC differentiation into functional cholangiocytes; however,HPCs tend to differentiate into mature hepatocytes after the TGF-β1 signaling pathway is blocked. Such cholangiocytes and hepatocytes have the normal function of glycogen storage and synthesis and may participate in metabolic activities.

Prevalence of gallstones among university teachers and related risk factors: A multicenter study

Zhang Chi, Hu ShuLing, Sun Peng, Bai Ye, Wang YuTong, Zhang Ben, Gu DongQing, Wang Xin

2020, 36(3): 624-630. DOI: 10.3969/j.issn.1001-5256.2020.03.031

Abstract(1014)

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Abstract:
Objective To investigate the prevalence rate of gallstones among university teachers in Tianjin,China,and related risk factors.Methods Physical examination data were collected from the teachers from five universities who participated in physical examination in Physical Examination Center,Tianjin Medical University Cancer Institute and Hospital,in 2015,and abdominal ultrasound was used for the diagnosis of gallstones. The chi-square test was used for comparison of categorical data between groups. Univariate and multivariate logistic regression analyses were used to identify the risk factors for gallstones in the teachers from different universities,and a meta-analysis was used for the pooled analysis of prevalence rate and risk factors. Results A total of 8006 university teachers were enrolled,among whom 440 were diagnosed with gallstones,and the pooled prevalence rate of gallstones was 5. 5%. The meta-analysis showed that hypertension( odds ratio[OR]= 1. 67,95% confidence interval [CI]: 1. 32-2. 12,P <0. 001),fatty liver( OR =1. 39,95% CI: 1. 12-1. 72,P < 0. 001),kidney stones( OR = 1. 90,95% CI: 1. 15-3. 14,P = 0. 01),and high levels of hexokinase( OR = 1. 42,95% CI: 1. 03-1. 94,P = 0. 03),alanine aminotransferase( OR = 1. 32,95% CI: 1. 01-1. 73,P = 0. 04),and globulin( OR = 1. 74,95% CI: 1. 08-2. 79,P = 0. 02) were risk factors for gallstones. Conclusion There is a relatively low prevalence rate of gallstones among university teachers in Tianjin,and hypertension,fatty liver,kidney stones,and high levels of hexokinase,alanine aminotransferase,and globulin may be the risk factors for gallstones.

Value of serum apolipoprotein A1 versus apolipoprotein B-to-apolipoprotein A1 ratio in predicting severe acute pancreatitis

Zhong Rui, Xu Huan, Peng Yan, Yan YongFeng, Jiang Xin, Wang Min, Fu WenGuang, Tang XiaoWei

2020, 36(3): 631-635. DOI: 10.3969/j.issn.1001-5256.2020.03.032

Abstract(1357)

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Abstract:
Objective To investigate the blood lipid parameters for the early prediction of severe acute pancreatitis( SAP) and their predictive value. Methods A retrospective analysis was performed for the clinical data of 425 patients with acute pancreatitis( AP) who were admitted to The Affiliated Hospital of Southwest Medical University from January 2017 to January 2019,among whom there were 229 patients with mild acute pancreatitis( MAP),161 patients with moderate-severe acute pancreatitis( MSAP),and 35 patients with severe acute pancreatitis( SAP). Blood lipid levels were collected for all patients within the first 24 hours after admission. A one-way analysis of variance and the Kruskal-Wallis H test were used for comparison of continuous data between multiple groups. A logistic regression analysis was used for the variables with statistical significance determined by the univariate analysis. The Spearman correlation was used to investigate the correlation between data. The receiver operating characteristic( ROC) curve was used to evaluate the diagnostic efficiency of indices,and Med Calc software was used to investigate whether there was a significant difference in diagnostic efficiency. Results There were significant differences in apolipoprotein A1( ApoA1) and apolipoprotein B-to-apolipoprotein A1( Apo B/A1) ratio between the patients with different severities of acute pancreatitis( F = 46. 290,χ2= 9. 130,both P < 0. 05). Apo B/A1 ratio was positively correlated with Atlanta grade,Ranson score,MCTSI score,and BISAP score( r = 0. 296,0. 129,0. 303,and 0. 284,all P < 0. 05). ApoA1 was negatively correlated with Atlanta grade,Ranson score,MCTSI score,and BISAP score( r =-0. 407,-0. 176,-0. 338,and-0. 285,all P < 0. 05). Apo B/A1 ratio was an independent risk factor for SAP( odds ratio = 4. 493,95% confidence interval [CI]: 1. 399-14. 427,P = 0. 012),while ApoA1 was an independent protective factor for SAP( odds ratio = 0. 004,95% CI: 0-0. 034,P < 0. 001). Apo B/A1 ratio had an area under the ROC curve ( AUC) of 0. 763( 95% CI: 0. 675-0. 851,P <0. 001) in predicting SAP,and ApoA1 had an AUC of 0. 862( 95% CI: 0. 809-0. 916,P <0. 001) in predicting SAP,suggesting that ApoA1 had a higher diagnostic value( Z = 2. 183,P = 0. 029). Conclusion Both serum ApoB/A1 ratio and ApoA1 have a certain value in predicting SAP,and ApoA1 has a higher predictive value than ApoB/A1 ratio.

A bioinformatics analysis of acute pancreatitis based on gene expression microarray and drug screening

Dong XiaoPeng, Wang LiJuan, Zhao ChunLin, Zhang JianPing, Pan HaiBang, Yi JianFeng, Shi YuHong

2020, 36(3): 636-640. DOI: 10.3969/j.issn.1001-5256.2020.03.033

Abstract(1304)

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Objective To screen out differentially expressed genes( DEGs) and related candidate therapeutic drugs for acute pancreatitis( AP) using the bioinformatics method. Methods High-throughput microarray datasets( GSE109227 and GSE65146) associated with AP in mice were downloaded from gene expression omnibus,and GEO2 R was used to screen out DEGs. Database for Annotation,Visualization and Integrated Discovery was used to perform gene ontology and pathway enrichment analysis. Protein-protein interaction( PPI) was established in String database and visualized by Cytoscape,and then subnetwork modules and hub genes were screened out. The microRNAs associated with the hub genes were predicted and candidate drugs were screened out using Comparative Toxicogenomics Database( CTD).Results A total of 130 upregulated and 16 downregulated DEGs were screened out in the high-throughput microarray datasets GSE109227 and GSE65146. DEGs were mainly involved in the biological processes such as inflammatory response,neutrophil chemotaxis,tumor necrosis factor-mediated cellular response,and positive regulation of gene expression,and they were also involved in the signaling pathways of extracellular matrix-receptor interaction,regulation of actin cytoskeleton,leukocyte transendothelial migration,and focal adhesion. A total of 12 hub genes and 6 subnetwork modules were screened out in the PPI network. The microRNAs including miR-199 a-5 p and miR-1-3 p might regulate the post-transcriptional regulation of key genes. Genistein,resveratrol,and quercetin which were screened out from CTD database could reduce the expression of key genes. Conclusion Related genes screened out by the bioinformatics method may play an important role in the development of AP and can be used as the basis for drug screening.

Effect of triptolide on fibrosis in a mouse model of cerulean-induced chronic pancreatitis

Tan Peng, Chen Hao, Wang AnKang, Qian BaoLin, Huang ZhiWei, Shi Hao, Gao Lin, Fu WenGuang

2020, 36(3): 641-645. DOI: 10.3969/j.issn.1001-5256.2020.03.034

Abstract(1406)

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Objective To investigate the effect of triptolide on fibrosis in mice with cerulein-induced chronic pancreatitis( CP) based on the nuclear factor-kappa B( NF-κB)/interleukin-6( IL-6) signaling pathway. Methods A total of 15 male C57 BL/6 mice were randomly divided into control group( treated with normal saline),cerulein group( model mice with cerulein-induced CP),and triptolide group( induced by cerulean and treated with triptolide),with 5 mice in each group. Samples were collected for detection after 6 weeks. The weight of the pancreas was measured; HE staining,picrosirius red staining,and Masson staining were used to observe pancreatic histomorphology and collagen deposition; ELISA was used to measure the expression of IL-6 in serum; immunohistochemistry was used to measure the expression of alpha-smooth muscle actin( α-SMA) and NF-κB/p65; Western blot was used to measure the expression of NF-κB/p65,IL-6,and α-SMA. 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 significant differences between the three groups in the weight of the pancreas,IL-6 concentration,pathological score,picrosirius red staining results,Masson staining results,and mean optical density of positive α-SMA signal and positive NF-κB/p65 signal( F = 64. 87,15. 85,145. 33,141. 80,121. 77,250. 22,and 69. 22,all P < 0. 001). Compared with the cerulein group,the triptolide group had a significant increase in the weight of the pancreas and significant reductions in the expression of IL-6,pancreatic fibrosis,collagen deposition,and the expression of α-SMA and NF-κB/p65( all P < 0. 05). Western blotting showed that there were significant differences in the expression of NF-κB/p65,IL-6,andα-SMA between the three groups( F = 8. 86,6. 74,and 16. 23,all P < 0. 05),and compared with the cerulein group,the triptolide group had significantly lower expression of NF-κB/p65,IL-6,and α-SMA in the pancreatic tissue( all P < 0. 05). Conclusion Triptolide alleviates fibrosis in mice with cerulein-induced CP and inhibit the protein expression of NF-κB/p65 and IL-6.

Clinicopathological features of perivascular epithelioid cell tumor of the liver: An analysis of 4 cases

Sun Qi, Jin XinYao, Wang CaiYing, Yang YanLi

2020, 36(3): 646-648. DOI: 10.3969/j.issn.1001-5256.2020.03.035

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Infectious mononucleosis with hepatitis A: A case report

Lu: Jia, Zhao Gang, Sun XueHua, Gao YueQiu

2020, 36(3): 649-651. DOI: 10.3969/j.issn.1001-5256.2020.03.036

Abstract(808)

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Therapeutic effect of methylprednisolone in treatment of severe drug-induced liver injury with psoriasis: A case report

Lu ChaoXiu, Guo Xin, Yue DongJie, Wu FeiFei

2020, 36(3): 652-654. DOI: 10.3969/j.issn.1001-5256.2020.03.037

Abstract(944)

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A case of adult autosomal recessive polycystic kidney disease with polycystic liver disease

Li JiaLin, Chen Ming

2020, 36(3): 655-656. DOI: 10.3969/j.issn.1001-5256.2020.03.038

Abstract(834)

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Mixed adenoneuroendocrine carcinoma of the gallbladder with hepatic metastasis: A case report

Zhang CongQi, Wu Hao, Xing MingXuan, Wang Wu

2020, 36(3): 657-658. DOI: 10.3969/j.issn.1001-5256.2020.03.039

Abstract(927)

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Differences in hepatitis B vaccination strategies among children in China and foreign countries

Shen Jun, Zhao Chao

2020, 36(3): 659-661. DOI: 10.3969/j.issn.1001-5256.2020.03.040

Abstract(929)

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Hepatitis B is still one of the major infectious diseases in China,and hepatitis B vaccination is the most effective method to control the spread of hepatitis B. This article compares and summarizes the similarities and differences in hepatitis B vaccination for children in major authoritative documents from China and foreign countries,elaborates on the issues of hepatitis B vaccination in children with exposure to high risks and failure of vaccination and other issues associated with hepatitis B vaccination in children in China,so as to provide suggestions for clinical practice.

Role of microRNA in hepatitis B virus infection-related diseases

Liu LiLi, Su HeLing, Liu YongMing

2020, 36(3): 662-665. DOI: 10.3969/j.issn.1001-5256.2020.03.041

Abstract(777)

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MicroRNA( miRNA) plays an important role in viral diseases by regulating post-transcriptional gene expression. MiRNA can affect the replication and gene expression of hepatitis B virus( HBV) in host cells,while HBV can regulate the expression of host miRNA to provide a favorable environment for its own survival and replication. This miRNA-mediated relationship between HBV and host is an important basis for the pathogenesis of HBV infection-related diseases. This article reviews the research advances in the role of miRNA in HBV infection-related chronic hepatitis B,liver cirrhosis,and hepatocellular carcinoma.

Role of Wnt signal-mediated crosstalk between hepatic macrophages and hepatic progenitor cells in the development and repair of liver fibrosis

Jian Xun, Xu Ying, Liu Ping, Mu YongPing

2020, 36(3): 666-669. DOI: 10.3969/j.issn.1001-5256.2020.03.042

Abstract(918)

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Hepatic macrophages and hepatic progenitor cells play an important role in the development and repair of liver fibrosis. The polarized state of macrophages can affect the differentiation orientation of hepatic progenitor cells,and the Wnt signaling pathway may play a key role in the crosstalk between hepatic macrophages and hepatic progenitor cells. This article overviews the role of macrophages and hepatic progenitor cells and the mechanism of the crosstalk between them in the pathological state of liver fibrosis. It is pointed out that in-depth studies are needed to investigate the genome and phenotype of hepatic macrophages and clarify the mechanism of action of macrophages in regulating the differentiation of hepatic progenitor cells,in order to provide a basis for the treatment of liver fibrosis.

The role of devascularization in cirrhotic portal hypertension and related controversies

Xu Wei, Tu Bing

2020, 36(3): 670-672. DOI: 10.3969/j.issn.1001-5256.2020.03.043

Abstract(1011)

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Gastroesophageal variceal bleeding and hypersplenism caused by portal hypertension seriously threaten the life of patients with liver cirrhosis. At present,devascularization is still one of the important surgical procedures for the treatment of portal hypertension; however,the development of the treatment methods such as drugs,endoscopy,and interventional treatment has caused the controversies over the role,surgical indications,and surgical timing of devascularization in the treatment of portal hypertension,as well as whether splenectomy is needed. This article reviews the role of devascularization and related controversies and points out that devascularization is still irreplaceable. Individualized,comprehensive,and minimally invasive treatment regimens should be developed for portal hypertension,so as to bring maximum benefits to patients with minimal invasiveness.

The role of gut microbiota in the pathogenesis of portal hypertension

Zhang Qun, Wang XianBo

2020, 36(3): 673-676. DOI: 10.3969/j.issn.1001-5256.2020.03.044

Abstract(1027)

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Gut microbiota is the largest collection of commensal micro-organisms in the human body. Since the liver has unique anatomical location and vascular system,it is easily exposed to gut microbiota and their metabolites. Under normal conditions,the barrier function of the intestinal epithelium and the cleaning and detoxification function of the liver can prevent microorganisms or their products from entering the liver and systemic circulation. However,when the intestinal barrier function is damaged,a large number of bacterial products may enter the liver and systemic circulation and stimulate the body's immune and inflammatory responses,and such perturbations become prominent in liver cirrhosis and may increase the risk of clinically significant portal hypertension. This article summarizes the role of gut microbiota in the pathogenesis of portal hypertension and provides ideas for clinical treatment.

Mechanism of action of chemotherapy drugs in promoting liver injury

Fang Kai, Xu Jian, Xu Ke, Zhan YuePing

2020, 36(3): 677-679. DOI: 10.3969/j.issn.1001-5256.2020.03.045

Abstract(1243)

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Drugs are an important cause of liver injury,and according to statistics,about 1100 drugs may induce liver injury. Due to the difficulty in differential diagnosis,drug-related liver injury is still misjudged. As different drugs have different mechanisms of action in inducing liver injury and may cause different degrees of liver injury,targeted countermeasures should be adopted. There are fewer systematic reviews of liver injury caused by chemotherapy drugs. This article mainly introduces the hepatotoxic mechanisms of various chemotherapy drugs,elaborates on the degree of hepatotoxicity caused by chemotherapy drugs,summarizes the clinical manifestations of liver injury caused by chemotherapy drugs,and gives recommendations to clinical treatment.

Research advances in the role of macrophages in nonalcoholic fatty liver disease

Luo YuXin, Guo JinBo, Zhang XiaoLan

2020, 36(3): 680-683. DOI: 10.3969/j.issn.1001-5256.2020.03.046

Abstract(968)

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With the improvement of living standard,the incidence rate of nonalcoholic fatty liver disease( NAFLD) is gradually increasing year by year and its age of onset tends to become younger,but its pathogenesis remains unclear. Macrophages are important cells involved in the pathogenesis of NAFLD and have attracted great attention. This article elaborates on the origin and classification of liver macrophages,the role of macrophages in liver inflammation and related activation mechanism,and the drugs targeting macrophages,in order to provide a reference for the clinical treatment of NAFLD.

The role of liver sinusoidal endothelial cells in the progression of nonalcoholic fatty liver disease

Jiang Zhao, Ruan Bo

2020, 36(3): 684-686. DOI: 10.3969/j.issn.1001-5256.2020.03.047

Abstract(1141)

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Nonalcoholic fatty liver disease( NAFLD) is a clinical metabolic syndrome characterized by hepatic steatosis,inflammation,and fibrosis and has become a common chronic liver disease with great impact on public health. Liver sinusoidal endothelial cells( LSECs) are specialized vascular endothelium of liver tissue,and as an important vascular barrier,LSECs play an important role in regulating the absorption and metabolism of nutrients and substances from the blood of the intestines in hepatocytes. This article reviews the research advances in LSEC capillarization,vascular dysfunction,and its involvement in the regulation of liver inflammation,angiogenesis,and liver fibrosis during the development and progression of NAFLD.

Association between mitochondria and hepatocellular injury

Wei HaiLiang, Si MingMing, Guo Hui, Li JingTao, Li Qian, Yan ShuGuang, Ju Di

2020, 36(3): 687-689. DOI: 10.3969/j.issn.1001-5256.2020.03.048

Abstract(1613)

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The mitochondria in liver tissue not only provides energy for substance metabolism in hepatocytes,but also participates in hepatocellular injury and even apoptosis. It also plays an important role in several pathological processes closely associated with hepatocellular injury and apoptosis,such as hepatitis,hepatic fibrosis,precancerous lesion,and liver cancer. This article elaborates on the association between mitochondria and hepatocellular injury from the following aspects: the important role of the change in mitochondrial membrane permeability in hepatocellular injury,hepatocellular injury accelerated by ATP synthesis disorder and consumption,and the association of abnormal Ca2+ homeostasis in hepatocellular mitochondria with hepatocellular injury,in order to provide a theoretical basis for mitochondria-targeted prevention and treatment of chronic liver diseases due to hepatocellular injury.

Mechanism of action of intestinal flora in hepatic encephalopathy

Ji XiaoTong, He YunHan, Qi YingYuan, Yang XiaoHang

2020, 36(3): 690-692. DOI: 10.3969/j.issn.1001-5256.2020.03.049

Abstract(1005)

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Hepatic encephalopathy( HE) has various clinical symptoms,and its etiology and pathogenesis have not been fully understood.Recent studies have shown that the composition of intestinal flora is associated with the changes in the central nervous system in patients with HE. With reference to recent studies in China and foreign countries,this article analyzes and summarizes the regulatory mechanism of intestinal flora on HE through the liver-brain axis from the perspectives of microbiology,nervous system,and immunology,and it is pointed out that in-depth studies on the mechanism of action of intestinal flora are needed for the treatment of HE and can provide a clear basis for clinical diagnosis and treatment.

Association between end-stage liver disease and sarcopenia

Li DongCeng, Kong Ming, Chen Yu

2020, 36(3): 693-696. DOI: 10.3969/j.issn.1001-5256.2020.03.050

Abstract(924)

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End-stage liver disease is often accompanied by various complications,among which sarcopenia is a common complication in patients with end-stage liver disease and is often neglected by clinicians,and in fact,sarcopenia also affects the prognosis of patients with end-stage liver disease. This article elaborates on the definition,evaluation method,and diagnostic criteria for sarcopenia and the association of sarcopenia with various liver diseases. It is pointed out that further studies are needed to explore the role of sarcopenia in the development of liver diseases,so as to provide new ideas for the diagnosis and treatment of liver diseases.

Diagnosis and treatment of primary biliary cholangitis-autoimmune hepatitis overlap syndrome

Yang Ning, Liu YanSheng, Han Ying

2020, 36(3): 697-700. DOI: 10.3969/j.issn.1001-5256.2020.03.051

Abstract(1686)

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Autoimmune liver diseases( AILDs) include primary biliary cholangitis( PBC),autoimmune hepatitis( AIH),and primary sclerosing cholangitis. Some patients may have the features of two AILDs at initial diagnosis or during follow-up,which is usually referred to as“overlap syndrome”,among which PBC-AIH overlap is the most common type. Compared with those with PBC or AIH alone,the patients with PBC-AIH overlap syndrome tend to have higher incidence rates of portal hypertension,gastrointestinal bleeding,ascites,death,and liver transplantation,as well as more rapid disease progression,and therefore,early diagnosis and treatment is of great importance. This article reviews the recent advances in the diagnosis and treatment of PBC-AIH overlap syndrome.

Association between metabolic syndrome and gallstones

Bai JiDong, Xue RongQuan, Bai YongLe, Xia YiJun, Wang XiDong, Xi LongFu, Han XiaoYue, Han LiBo

2020, 36(3): 701-703. DOI: 10.3969/j.issn.1001-5256.2020.03.052

Abstract(1173)

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In recent years,more and more patients with metabolic syndrome also have gallstones,and gallstones may lead to life-threatening diseases such as acute cholecystitis,acute obstructive cholangitis,and pancreatitis. This article summarizes the association of obesity,hyperlipidemia,hyperglycemia,and hypertension in metabolic syndrome with gallstones and discusses related mechanisms,in order to provide guidance for the screening,diagnosis,treatment,and prevention of gallstones.

Controversies over the extent of surgical resection for hilar cholangiocarcinoma and research advances in diagnosis and treatment

Wang Hong, Yao XiaoXiao, Qiao ShiXing

2020, 36(3): 704-707. DOI: 10.3969/j.issn.1001-5256.2020.03.053

Abstract(982)

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Hilar cholangiocarcinoma( HCCA) is a common malignant tumor of the extrahepatic bile duct and has the features of special anatomical location,tumor growth along the bile duct,high degree of malignancy,and easy involvement of liver parenchyma. At present,the treatment methods for HCCA include surgical resection,non-surgical biliary drainage,neoadjuvant chemoradiotherapy,and photodynamic therapy,but surgical resection is still the preferred method. There are still controversies over the need for preoperative biliary drainage,portal vein thrombosis,and extent of surgical resection. This article elaborates on the research advances in the clinical typing of HCCA,preoperative examination and diagnosis,and treatment methods.

Biological role of hypoxic microenvironment in pancreatic cancer

Zhang Yu, Jiang JianXin

2020, 36(3): 708-712. DOI: 10.3969/j.issn.1001-5256.2020.03.054

Abstract(1209)

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Hypoxia caused by rapid growth of cancer cells and insufficient central blood supply is one of the characteristics of tumor microenvironment,especially in pancreatic cancer. An increasing number of studies have shown that hypoxia is closely associated with angiogenesis,metabolic reprogramming,tumor proliferation,and early invasion and metastasis of pancreatic cancer and can mediate tumor immune evasion by secreting a variety of active factors. In addition,as a key factor for the low cure rate of pancreatic cancer,drug resistance is also associated with hypoxia. Hypoxia is closely associated with the development and progression of pancreatic cancer and depends on hypoxia-inducible factor. This article summarizes the association between hypoxic microenvironment and pancreatic cancer and discusses the activation of related signaling pathways and molecular mechanisms,in order to provide clues for targeted therapy for hopoxic microenvironment in pancreatic cancer.

2020 Vol. 36, No. 3

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2020 Vol. 36, No. 3

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