Table of Content

31 March 2018, Volume 23 Issue 3

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Original Articles

Therapeutic response and prognosis under the new criteria (ICA2015) of acute kidney injury in cirrhosis patients and influencing factors.

YIN Wei, LI Cheng-zhong, ZOU Duo-wu

2018, 23(3):  201-205. 

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Objective To investigate the treatment response and prognosis of the new diagnostic criteria of cirrhosis with acute kidney injury (AKI) in cirrhosis patients (International Club of Ascites 2015, ICA2015), and to analyze the related factors.Methods There were 220 patients with decompensated liver cirrhosis patients in our hospital from July 2016 to June 2017 enrolled in the retrospective study. Clinical dataduring hospitalization were collected for assessing treatment efficacy and short-term prognosis. Risk factors for AKI and its prognosis were analyzed with logistic regression and receiver operating characteristic (ROC) curve.Results Incidence of concurrent AKI during hospitalization was 27.7% in 220 decompensated liver cirrhosis patients. Thirty-nine patients were in AKI stage 1, among whom 94.9% had therapeutic response, 84.6% had good prognosis and 5.1% had AKI recurrence after discharge. Nineteen patients were in AKI stage 2, among hom 84.2% had therapeutic response, 63.2%had good prognosis and 10.5% had AKI recurrence after discharge. Three patients were in AKI stage 3, among whom 1 had complete response, but all died during hospitalization or within 3 monthsdischarge. Factors for concurrent AKI in cirrhosis patients were MELD score, baseline serum creatinine, and infection status. Factors for prognosis of cirrhosis patients with AKI were total bilirubin (TB), albumin, international normalized ratio and AKI treatment response. However, the prognosis in decompensated cirrhosis patients was only related to TB, alanine aminotransferase and number of complications. Conclusion Compared to old ICA guideline, increased diagnostic sensitivity, higher proportion of therapeutic response and prognosis improved from ICA2015 are observed in AKI patients with cirrhosis. Though there are still many problems in ICA2015.

Analysis of risk factors for portal vein thrombosis in liver cirrhosis patients

XIONG Jing-ping, LIU Hai-ying, ZHANG Yue-xin

2018, 23(3):  206-209. 

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Objective To investigate clinical characteristics of liver cirrhosis patients with portal vein thrombosis (PVT) and the related risk factors.Methods Clinical data of 218 patients with liver cirrhosis from June 2013 to June 2017 in our hospital were retrospectively analyzed, including 109 cases with PVT and 109 cases without PVT. General information, clinical manifestations, complications, laboratory examinations and imaging data were analyzed. Measurement data were compared by t-test and enumeration data were by chi-square test. Unconditional logistic regression model was applied for analyzing independent risk factors of PVT in liver cirrhosis patients.Results There were no differences in age, gender, nation, smoking, etiology, white blood cell count, platelet count, prothrombin time, international normalized ratio, activated partial prothrombin, fibrinogen, creatinine, cystatin C, total bilirubin, direct bilirubin, alanine aminotransferase, gamma glutamyl transpeptidase, alkaline phosphatase, length of spleen and width of splenic vein between PVT group and non-PVT group. However, Child-Pugh score (χ²=20.293, P=0.0001), splenectomy (χ²=11.869, P=0.001), the width of portal vein (t=3.125, P=0.002), width of spleen (t=2.283, P=0.024), hemoglobin (t=-3.751, P=0.000), albumin (t=-3.924, P=0.000), D-dimer (t=5.861, P=0.000) and fibrin degradation products (t=3.110, P=0.002) were significantly different between PVT group and non-PVT group. Occurrence of diarrhea, hepatic encephalopathy and hepatorenal syndrome showed no significant difference between two groups (P>0.05), but abdominal pain (χ²=4.598, P=0.032), fever (χ²=7.72, P=0.005), upper gastrointestinal bleeding (χ²=18.435, P=0.0001) and spontaneous peritonitis (χ²=16.987, P=0.000) were significantly different between two groups (P<0.05).Conclusion D-dimer, width of portal vein, Child-Pugh score and splenectomy are independent risk factors for PVT in liver cirrhosis patients (OR=0.686, 0.161, 3.193 and 9.515; P=0.0001, 0.007, 0.021 and 0.007, respectively). PVT in liver cirrhosis patients would aggravate clinical symptoms and increase incidence of complications.

Diagnostic value of MR for portal cavernoma cholangiopathy in patients with hepatitis B virus-related cirrhosis

WANG Wei-wei, AN Wei-min, DONG Jing-hui, REN Hong-wei, ZHANG Jian-zeng

2018, 23(3):  210-213. 

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Objective To investigate the diagnostic value of MR for portal cavernoma cholangiopathy (PCC) in patients with hepatitis B virus (HBV) -related cirrhosis.Methods Dynamic contrast-enhanced MR imaging for 33 patients clinically diagnosed of HBV-related cirrhosis with PCC from 2010 to 2016 in our hospital were retrospectively analyzed. MR signs including bile duct dilatation, terminal biliary strictures, marginal vascular dilatation and others were observed.Results All the 33 cases showed wavy bile duct dilation and irregular biliary wall, including 3 cases with tumor-like bile duct wall thickening. Among these patients, 7 cases showed involvement of intrahepatic bile duct in left lobe, 4 cases showed involvement of intrahepatic bile duct in right lobe, 14 cases showed involvement of intrahepatic bile duct in both lobes and 8 cases showed involvement of both intrahepatic and extrahepatic bile ducts. Marginal vasculars of common bile duct (CBD) were tortuous in all cases. Furthermore, 21 cases showed terminal biliary strictures and 12 cases showed obstruction, with homogeneously delayed reinforcement mass in 4 cases and portal vein embolus in 8 cases.Conclusion MR imaging plays an important role in diagnosis of PCC patients with HBV-related cirrhosis, which is characterized by bile duct dilatation, tortuous marginal vascular of CBD and homogeneously delayed reinforcement mass in terminal bile duct.

The role of RIPK3-mediated necroptosis in patients with HBV-related acute-on-chronic liver failure

CHEN Li-wen, YAN Lei, CAO Zhu-jun, DING Ye-zhou, LIU Ke-hui, LIN Lan-yi, LAI Rong-tao, XIE Qing, WANG Hui

2018, 23(3):  214-216. 

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Objective To investigate the role of RIPK3-mediated necroptosis in patients with HBV-related acute-on-chronic liver failure.Methods Total 140 subjects were recruited, including 40 patients with HBV related acute-on-chronic liver failure (HBV-ACLF), 40 patients with HBV-related liver cirrhosis (HBV-LC), 40 chronic hepatitis B patients (CHB), and 20 heathy controls. Serum RIPK3 levels were measured, and the correlation between ALT/AST with serum RIPK3 levels were analyzed.Results Serum RIPK3 levels in all patients with liver diseases [30.94 (0.00, 459.10) pg/mL], including HBV-ACLF, HBV-LC and CHB, were significantly higher than that in healthy controls [0.00 (0.00, 0.00) pg/mL] (P<0.0001). Moreover, serum RIPK3 levels gradually elevated as the severity of liver desease increased, especially in HBV-ACLF group [870.35 (337.80, 1426.97) pg/mL]. Significant positive correlation was found between serum RIPK3 and ALT levels (r=0.5804, P<0.0001), AST levels (r=0.8114, P<0.0001), TBIL (r=0.5388, P<0.0001), PT (r=0.5690, P<0.0001), as well as INR (r=0.5724, P<0.0001) in patients with liver disease.Conclusion Necroptosis, mediated by RIPK3, plays a significant role in HBV-ACLF.

Characteristics of hypoxia model induced by cobalt chloride in human hepatic sinusoidal endothelial cells

ZHANG Feng, WANG Qing-lan, LIU Cheng-hai, TAO Yan-yan

2018, 23(3):  217-220. 

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Objective To investigate the characteristics of hypoxia model induced by cobalt chloride (CoCl₂) in human hepatic sinusoidal endothelial cells (HHSEC).Methods HHSEC were incubated with different concentrations of CoCl₂ (0～800 μM) for 24 h, in which cell viability was measured with counting kit-8 (CCK8) assay. Cell migration was detected by transwell assay after stimulating HHSEC with 50～200 μM CoCl₂. Matrigel lumen formation assay was used to detect cell lumen formation. Expressions of cell hypoxia inducible factor -1α (HIF-1α), von Willebrand factor (vWF) and vascular endothelial growth factor (VEGF) protein were detected by western blot. HIF-1α nuclear translocation was observed by immunofluorescence staining. Results Compared with control group, cell viability and cell migration of HHSEC were significantly increased, with a rich and airtight tubular structure formed in low concentration of 50～200 μM CoCl₂ group. Expressions of HIF-1α, vWF and VEGF in HHSEC were increased in 50 μM and 200 μM CoCl₂ group than those in the control group. Furthermore, expressions of HIF-1α and vWF in 200μM CoCl₂ group were higher than those in 50 μM CoCl₂ group.Conclusion Low levels of 50 μM and 200 μM CoCl₂ may induce HHSEC hypoxia and angiogenesis through promoting the expression and nuclear translocation of HIF-1α.