Table of Content

28 February 2019, Volume 24 Issue 2

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Original Articles

Difference in clinicopathological features of congenital biliary atresia children with and without Kasai procedure: a comparative study in 58 cases

ZHAO Xin-yan, LUO Wen-ping, LIU Li-wei, WEI Lin, HE En-hui , JIA Ji-dong, SUN Li-ying, ZHU Zhi-jun

2019, 24(2):  126-129. 

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Objective To investigate clinicopathological features of congenital biliary atresia (BA) children with or without Kasai procedure for improving the understanding and diagnostic accuracy of BA.Methods The clinical data of BA patients who were hospitalized in Beijing Friendship Hospital from January 2017 to October 2018 were retrospectively analyzed.Results Fifty-eight qualified cases were enrolled in this study. Among all the patients, 14 cases (24.1%) didn’t have Kasai procedure (non-Kasai group), and 44 cases (75.9%) underwent Kasai procedure (Kasai group) previously. Medium age was 6.5 (6.0, 8.0) months in non-Kasai group and 12.0 (8.0, 36.0) months in Kasai group, which showed significantly difference (P<0.001). Ratio of male to female was 1∶1.2. Total bilirubin level and model for end-stage liver disease score in Kasai group were significantly lower than those in non-Kasai group, respectively [51.89 (17.40, 222.13) vs. 334.90 (274.89, 506.52), P<0.001; 15.44 ± 8.31 vs. 21.24 ± 6.02, P=0.019]. In Kasai group, pathological features of acute cholestasis such as hepatocellular cholestasis, bile plugs in bile capillary and cholestasis in Kupffer cells, were significantly improved. Moreover, ductular reactions and bile plugs in bile ductules were reduced, and widths of fibrous septa were narrower.Conclusion The main differences of clinicopathological features in BA patients pre- and post- Kasai would contribute to a better understanding and improvement in diagnostic accuracy of this disease.

The prognostic value of peripheral blood neutrophil-to-lymphocyte ratio in acute-on-chronic liver failure

GUAN Jing, XU Yu-min, XIAN Yong-chao, HUANG Cheng-jun, LAI Rong-tao, WANG Xiao-lin, XIE Jing-dong, CAI Wei, XIE Qing

2019, 24(2):  130-132. 

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Objective To investigate the predictive value of neutrophil-to-lymphocyte ratio (NLR) on the progression and clinical outcome of acute-on-chronic liver failure (ACLF).Methods The clinical data of 174 cases of ACLF from 2013 to 2017 in the Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. According to clinical outcome, patients were divided into the survival group and the death group. NLR was compared between the 2 groups. Continuous data were analyzed using univariate analysis and t-test, and categorical data were analyzed using ?2-test. Univariate and multivariate logistic regression analyses were applied to investigate the factors related to disease progression.Results NLR of the survival group (2.45±1.16) was significantly lower than that of the death group (5.55±3.60), which increased gradually with increased mortality. NLR and prothrombin time were the main affecting factors for disease progression (P<0.001). There was a significant difference in baseline NLRs between the survival group and death group (2.45±1.16 vs. 5.55±3.60, P<0.001).Conclusion Peripheral blood NLR can predict early death risk in patients with ACLF.

The efficiency of serum GP73 combined with AST for diagnosing liver inflammation in patients with chronic hepatitis B

WANG chun-yan¹, HAN Ping², JI Dong¹, Ma Li-jun³, WANG jing-jing¹, SHAO Qing¹, CHEN Guo-feng¹

2019, 24(2):  133-137. 

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Objective To investigate the correlation between serum Golgi protein 73 (GP73) and liver inflammation in patients with chronic hepatitis B (CHB), and to assess the diagnostic accuracy of the noninvasive model based on GP73 and aspartate aminotransferase (AST) for significant liver inflammation (inflammation grade ≥G2).Methods A total of 422 treatment-nave CHB patients were divided into group 1 [whose alanine aminotransferase (ALT) ＜ 2×upper limit of normal (ULN), n=220] and group 2 (whose ALT ≥ 2×ULN, n=200). GP73, AST, ALT and other biochemical indices were detected in all patients. Patients in group 1 were with liver biopsy (LB), and the correlation between GP73 and pathological inflammation of liver tissue was analyzed. The noninvasive diagnostic model was established using binary logistic regression analysis and the diagnostic efficacy of significant hepatic inflammation (≥G2) was evaluated using receiver-operating characteristic (ROC) curve.Results GP73 level of group 1 (median, 50.68 ng/mL) was significantly lower than that of group 2 (median, 110.6 ng/mL)(P<0.001). In group 1, 57 cases (25.7%) and 110 cases (49.5%) showed significant hepatic inflammation (≥G2) and fibrosis (fibrosis stage ≥S2), respectively. The GP73 level of the significant hepatic inflammatory group (≥G2) was higher than that of invisible hepatic inflammatory group (G0-G1) (P<0.001), which showed positive correlation with inflammation grades in group 1 (correlation coefficient=0.405, P<0.001). The efficiency of noninvasive diagnosis model based on GP73 combined with AST in the diagnosis of significant liver inflammation (≥G2) was better than separate application of GP73, ALT or AST. The area under the ROC curve of this model was 0.836, and its sensitivity and specificity were 75.44% and 80.61% (P<0.01), respectively. When the cut-off values were ≤2.88 and ≥ 4.2, 80.6% (175/222) treatment-nave CHB patients could use this noninvasive diagnosis model without resorting to LB.Conclusion Serum GP73 level is closely correlated with liver inflammation in CHB patients. The noninvasive diagnostic model of GP73 combined with AST can accurately predict significant liver inflammation. It can be used as an alternative for LB to determine whether patients with ALT less than 2ULN need antiviral therapy or not.

Relationships of GCLM, GCLC and GSTP1 gene polymorphisms in patients with anti-tuberculosis drug-induced liver injury

WANG Yun, BAO Jing

2019, 24(2):  138-142. 

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Objective To analyze the relationship of polymorphisms of glutamate cysteine ligase modifier (GCLM) subunit, glutamate cysteine ligase catalytic (GCLC) subunit and glutathione S transferase P1 (GSTP1) with acute anti-tuberculosis drug-induced liver injury (AADILI).Methods In our study, 92 cases with AADILI were enrolled as the study group and 86 cases without AADILI were enrolled as the control group. T-588C loci of GCLM gene, C-129T loci of GCLC gene and Ile105Val loci of GSTP1 gene were detected using polymerase chain reaction restriction fragment length polymorphism. Representativeness of genotype frequencies were verified using Hardy-Weinberg equilibrium. Factors related to the occurrence of AADILI were analyzed using Logistic method.Results There were single nucleotide polymorphisms (SNPs) at T-588C loci of GCLM gene, C-129T loci of GCLC gene and Ile105Val loci of GSTP1 gene, which were stable and in accordance with Hardy-Weinberg equilibrium. There were significant differences in genotype distributions of TT at GCLM T-588C loci, CC at GCLC C-129T loci and GG at GSTP1 Ile105Val loci between the 2 groups (P< 0.05). Genotypes of TT at GCLM T-588C loci, CC at GCLC C-129T loci and GG at GSTP1 Ile105Val loci were risk factors for AADILI.Conclusion The SNPs of GCLM T-588C, GCLC C-129T and GSTP1 Ile105Val genes are associated with AADILI susceptibility. TT at GCLM T-588C loci, CC at GCLC C-129T loci and GG at GSTP1 Ile105Val loci can increase the risk of AADILI.

CT and MR imaging features of hepatic neuroendocrine carcinoma

SHI Fang-fang, ZHENG Zeng, REN Hong-wei, AN Wei-min, DONG Jing-hui

2019, 24(2):  143-146. 

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Objective To study the computed tomography (CT) and magnetic resonance (MR) imaging features of hepatic neuroendocrine carcinoma (NEC) in order to improve its diagnostic level.Methods The CT and MR imaging materials of 37 patients diagnosed as hepatic NEC by pathology and immunohistochemistry were retrospectively analyzed.Results Primary hepatic NECs were often single. Plain CT usually showed hypo-intense or mixed hypo-intense, and patchy high signals inside were observed when complicated with hemorrhage. In the enhanced scan, carcinomas showed gradually enhanced density. The CT values of solid lesions in portal phase and equilibrium phase were slightly higher than those in arterial phase. Usually primary hepatic NECs showed homogeneous or slightly higher thick-ring signals on MR diffusion-weighted imaging (DWI), slightly hyper-intense on T2-weighted imaging (T2WI) with some hyper-intense cystic zones inside, and slightly hypo-intense on T1-weighted imaging (T1WI) with some slightly hyper-intense lesions. The enhanced MR imaging of lesions showed moderate homogeneous enhancement or marginal enhancement with large arteries visible in some lesions, and iso-intensity or slightly hypo-intensity in portal and delayed phases. Some lesions showed complete or incomplete pseudo-capsule, and surrounding portal vein and hepatic vein were compressed without tumor thrombus. Liver metastatic NECs were often multiple and large. Plain CT scan showed hypo-intense or slightly hypo-intense. Compared with liver parenchyma, the enhanced scan of metastatic NECs usually showed heterogeneous enhancement or mild to moderate marginal enhancement in arterial phase, and iso-intense or slightly hypo-intense signals in portal and equilibrium phases. Meanwhile, liver metastatic NECs showed marginal hyperintensity on MR DWI, slightly hyper-intense on T2WI and slightly hypo-intense on T1WI, with cystic necrosis areas appearing in most of the lesions. The enhanced MR imaging showed heterogeneous or marginal enhancement in arterial phase and "eccentric target ring sign" in most of the portal and delayed phases. Tumor thrombi were visible in some portal veins.Conclusion Hepatic NECs can be divided into primary and metastatic tumors, whose imaging features have certain characteristics. Combined with clinical data and immunochemistry, CT and MR imaging are helpful for the diagnosis of lesions.

Protective mechanism of miR-152 overexpression on acetaminophen-induced acute liver injury

ZHANG Hao-jie, LIN Chen-chen

2019, 24(2):  147-149. 

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Objective Overdose of acetaminophen (APAP) clinically could result in severe and fatal liver failure.The aim of this study was to investigate the molecular role of micro ribonucleic acid-152 (miR-152) in the pathogenesis of APAP-induced acute liver injury.Methods B6 mice were intraperitoneally injected with APAP to induce acute liver injury. In the experiment, mice were given miR-152 agomir, antagomir and corresponding negative controls 24 hours before APAP induction, respectively. Assays of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and histology were conducted to evaluate the degree of APAP-induced liver injury. The expression levels of miR-152 and inflammatory factors were measured using quantitative real time polymerase chain reaction.Results Compared with the control group, the expression level of miR-152 increased by 2 fold after induction of APAP treatment (P< 0.05). The overexpression of miR-152 in vivo alleviated acute liver injury caused by APAP overdose, showing lower levels of ALT (8295 ± 557.1 vs. 3995 ± 551.9, P< 0.05) and AST (8065 ± 1057 vs. 3623 ± 548.4, P< 0.05). However, silencing miR-152 had a detrimental effect during the injury process, which were with higher levels of ALT (6973 ± 649.6 vs. 11915 ± 555.5, P< 0.05) and AST (6130 ± 566.7 vs. 9415 ± 622.0, P< 0.05).Conclusion It was demonstrated that miR-152 alleviated APAP-induced acute liver injury, which suggesting potential therapeutic value of miR-152 mimics on treatment of this disorder clinically.