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Table of Content

    25 January 2020, Volume 25 Issue 1
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    Original Articles
    Changes of thromboelastograms and routine coagulation parameters in patients with acute-on-chronic liver failure and thrombocytopenia
    YUAN Hong-xiang, ZHANG Qiu-yun, LOU Jin-li, YU Yan-hua, ZHAO Yan
    2020, 25(1):  20-23. 
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    Objective To investigate the changes of coagulation function in patients with acute-on-chronic liver failure (ACLF) and thrombocytopenia. Methods One hundred and forty-five cases of patients with ACLF and thrombocytopenia were divided into 4 groups, including group A (39 cases with the platelet numbers ≥ 100×109/L), group B (41 cases with the platelet numbers between [50-99]×109/L), group C (34 cases with the platelet numbers between [30-49]×109/L) and group D (31 cases with the platelet numbers ≤ 29×109/L). The coagulation function was evaluated using thromboelastography (TEG) and routine coagulation tests, and compared among the groups. Results Compared with patients of ACLF with platelet number ≥ 100×109/L, prothrombin time activity (PTA) were significantly lower, and international normalized ratio (INR) were significantly higher in patients with platelet number < 100×109/L, the difference was statistically significant (P<0.05). The levels of PTA and INR were 31.80 ± 7.02 and 2.43 ± 0.61 in group A, 27.44 ± 10.15 and 2.79 ± 0.92 in group B, 27.85 ± 9.33 and 2.69 ± 0.72 in group C, 25.25 ± 6.50 and 3.05 ± 1.46 in group D, respectively. Compared with group A, group B and C had no significant difference in levels of prothrombin time and activated partial thromboplastin time, yet group D had significant difference. In the TEG, there were significant differences in the reaction time, speed of clot formation (k), α angle, maximal amplitude (MA) and coagulation index (CI) between group A and D (P<0.05), significant differences in values of k, α angle, MA and CI between group A and C (P<0.05), and significant differences in value of CI between group A and B (P<0.05). Conclusion The coagulation function of ACLF patients is prone to abnormality. The TEG can evaluate the coagulation function and fibrinolysis status of patients well, which is important for diagnosis and treatment of coagulation disorder in patients.
    Clinical characteristics and factors influencing 6-month prognosis of 150 patients with hepatitis-associated aplastic anemia
    YU Xuan, LI Wen-hua, AN Dong-ying, WANG Yi-fan
    2020, 25(1):  24-27. 
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    Objective In order to investigate the clinical characteristics of 150 cases of hepatitis-associated aplastic anemia (HAAA) and the factors influencing 6-month prognosis of them. Methods Retrospective analysis was carried out in 150 patients with HAAA admitted to our hospital from November 2016 to November 2018. All patients were treated with supportive and immunosuppressive therapy. The clinical features and efficacy of 6-month treatment were observed. Multivariate logistic regression analysis was used to analyze the independent factors influencing HAAA patients′ outcomes after 6 months of treatment. Results Among 150 HAAA patients, 80.00% were males, 90.00% were younger than 25 years old. The onset internal from hepatitis to aplastic anemia (AA) was (42.50 ± 10.35) days, the interval between the onset and treatment of AA was (17.72 ± 4.10) days, and 78.00% of AA occurred during or after the recovery stage of hepatitis. Among these patients, 5.33% were diagnosed as hepatitis A, 7.33% as hepatitis B, 2.00% as hepatitis C, 5.33% as hepatitis E, and 80.00% as unidentified hepatitis. As for AA, 48.00% were diagnosed as severe AA (SAA), 38.67% as very severe AA (VSAA), and 13.33% as non-severe AA. Within 3 months of AA, 70.00% patients showed clinical symptoms of infection. The effective rate of 150 HAAA patients receiving 6-month supportive and immunosuppressive therapy was 56.67%, of which partial response accounted for 33.33%, and complete response 23.33%. Multivariate logistic regression analysis showed that gender, severity of AA, serum total bilirubin (TBil) level during hepatitis, and the proportion of mature monocytes in bone marrow were independent factors influencing the prognosis of HAAA patients after 6 months of treatment (P<0.05). Conclusion HAAA mostly occurs in young male patients, with unidentified hepatitis, mainly manifested as SAA and VSAA. The risk of early infection in HAAA is high. The prognosis is poor, which is related to gender, severity of AA, serum TBIL level in hepatitis, and the proportion of mature monocytes in bone marrow.
    Relationship between serum adenosine deaminase level and inflammatory activity of liver tissue in patients with autoimmune hepatitis
    CAO Hui, DING Ming, ZHAO Kai
    2020, 25(1):  28-30. 
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    Objective To investigate the relationship between serum adenosine deaminase (ADA) level and hepatic inflammatory activity in patients with autoimmune hepatitis (AIH). Methods Forty-six patients with AIH treated in our department from June 2015 to January 2019 were included. The inclusion criteria of AIH were based on the consensus on the diagnosis and treatment of autoimmune hepatitis developed by the Chinese Society of Hepatology, Chinese Medical Association in 2015. The measurement data of normal distribution were presented as mean ± standard deviation, and compared by t-test. The measurement data of non-normal distribution were presented as median (percentage 25, percentage 75), and compared by Kruskal-Wallis H test. The count data were presented as absolute value, and compared by chi-square test. And the correlation between the level of serum ADA and the grade of inflammation in liver tissue was analyzed by Spearman correlation coefficient. The diagnostic efficacy of serum ADA level in liver inflammation was evaluated by receiver operator characteristic curve (ROC curve). Results There were 46 patients with AIH, including 17 males and 29 females, with an average age of (43.3 ± 11.8) years. There were 2 cases of Grade (G) 0, 5 cases of G1, 11 cases of G2, 16 cases of G3 and 12 cases of G4. There were significant differences in ADA levels among AIH patients in G0 [11.8 (10.2, 15.2) U/L], G1 [13.4 (10.8, 16.7) U/L], G2 [17.4 (12.8, 20.4) U/L], G3 [22.7 (17.6, 28.7) U/L] and G4 [23.8 (18.1, 29.6) U/L] (P<0.05). Spearman correlation analysis showed that the level of serum ADA was positively correlated with the grade of inflammation in liver tissue (r=0.72, P<0.05). The cut-off value in diagnosis of mild inflammation in liver tissue and the areas under ROC curve (AUC) were 13.2 U/L and 0.72. The cut-off value and AUC in diagnosis of moderate inflammation were 16.8 U/L and 0.76. And the cut-off value and AUC in diagnosis of severe inflammation were 23.4 U/L and 0.88. Conclusion The level of serum ADA is positively correlated with the inflammatory activity of liver tissue in patients with AIH, which has ideal diagnostic value for severe inflammation of liver tissue, and can be used as a potential serological index to predict the inflammatory activity of liver tissue in patients with AIH.
    Analysis of etiology and clinical characteristics of drug-induced liver injury in children
    TIAN Chun-li, LIANG Ke-feng, ZHAO Yu
    2020, 25(1):  31-33. 
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    Objective To analyze the causes and clinical characteristics of the children with drug-induced liver injury (DILI) in our hospital. Methods A total of 41 patients with DILI under 14 years in our hospital from January 2008 to June 2019 were included, by searching the medical records management system. The diagnosis was established according to DILI standard proposed in 2004. Danan regimen was adopted in the clinical classification of DILI. The measurement data of normal distribution are presented as mean ± standard deviation, the measurement data of non-normal distribution are presented as median (percentage 25, percentage 75), and the count data are presented as percentage. Results Among the patients included, 24 were male (58.5%) and 17 were female (41.5%). The average age was (8.3 ± 3.5) years, ranging from 5 months to 14 years. Among them, 3 were under 1 year (7.3%), 4 were 1 to 3 years old (9.8%), 16 were 4 to 9 years old (39.0%), and 18 were 10 to 14 years old (43.9%). The alanine aminotransferase was 925 (458, 1655) U/L, the aspartate aminotransferase was 525 (175, 1284) U/L, the alkaline phosphatase was 325 (248, 486) U/L, and the total bile acid was 108 (28, 198) mol/L. A total of 14 patients underwent liver biopsy, among whom 9 cases (64.3%) were diagnosed as hepatocellular injury, 2 cases (14.3%) as cholestatic injury and 3 cases (21.4%) as mixed type. The drugs causing DILI included antibacterial drugs (16, 39.0%), Chinese patent medicines or Chinese medicine preparations (13, 31.7%), chemotherapeutic or immunosuppressive drugs (6, 14.6%), anti-tuberculosis drugs (2, 4.9%), antipyretic analgesics and psychotropic drugs (4, 9.8%). Furthermore, antibacterial drugs included macrolides (9, 22.0%), penicillins (4, 9.7%) and cephalosporins (3, 7.3%). And clinical symptoms of these DILI patients included fatigue (23, 56.1%), loss of appetite (31, 75.6%), nausea (16, 39.0%), icteric skin or dark urine (11, 26.8%), vomiting (7, 17.1%), and pruritus or rash (6, 14.6%). Conclusion DILI in children can occur in different ages, and the main drugs leading to the disease are antibiotics, traditional Chinese medicine, chemotherapeutic and immunosuppressive drugs. In the future, these drugs should be appropriately used in children with caution.