Table of Content

30 April 2018, Volume 23 Issue 4

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Original Articles

The effects of nucleos(t)ide analogues treatment on prognosis of patients with chronic hepatitis B-related hepatocellular carcinoma

AN Bao-yan, WANG Yun, XIANG Xiao-gang, CHEN Li-wen, CAO Zhu-jun, YAN Lei, DING Ye-zhou, TANG Wei-liang, LIN Lan-yi, ZHU Chuan-wu, XIE Qing, WANG Hui

2018, 23(4):  294-296. 

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Objective To investigate effect of nucleos(t)ide analogues (NA) treatment on prognosis of patients with chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC). Methods A total of 532 patients with CHB-related HCC in Shanghai Ruijin Hospital from January 2008 to November 2015 were retrospectively analyzed, whose baseline characteristics, NA treatment condition, Barcelona Clinic Liver Cancer (BCLC) scores and liver function were recorded. Patients were divided into three groups, including sustained NA treatment group, post-HCC NA treatment group and NA treatment-naïve group. Prognosis of the three groups was analyzed and compared. Results In NA treatment-naïve group, average levels of serum alpha fetoprotein, alanine aminotransferase, aspartate aminotransferase and direct bilirubin were 3.4-fold (223.3 ng/mL vs. 64.77 ng/mL, P<0.01), 1.4-fold (44 U/L vs. 32 U/L, P<0.01), 1.5-fold (54 U/L vs. 35 U/L, P<0.01) and 1.4-fold (5.4 ng/mL vs. 4 ng/mL, P<0.05) of those in NA treatment group, respectively. According to the BCLC staging system, proportion of patients with stage A or B in NA treatment group (72.03%) was higher than that in NA treatment-naïve group (46.38%). During the follow-up, survival in sustained NA treatment group was significantly longer than that in post-HCC NA treatment group or NA treatment-naïve group (P<0.05). Conclusion NA treatment for CHB-related HCC patients may alleviate disease severity and prolong life survival.

Influence of liver function on the outcomes and prognosis of acute kidney injury in liver cirrhosis and liver failure patients

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

2018, 23(4):  297-301. 

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Objective To investigate the influence of liver function on the outcomes and prognosis of acute kidney injury (AKI) in liver cirrhosis or liver failure patients and analyze the related factors. Methods Clinical data of 157 AKI patients with decompensated liver cirrhosis or liver failure in the Department of Infectious Diseases in our hospital from March 2016 to June 2017 was retrospectively analyzed. Stratified analysis based on liver function and AKI stage was applied to evaluate the influence of liver function on treatment efficiency, outcomes and prognosis of AKI. Logistic regression analysis was used to analyze factors related to outcomes and prognosis of AKI. Results There were 157 patients with AKI (73 decompensated liver cirrhosis and 84 liver failure patients) during hospitalization, 75.1% of whom met the diagnostic criteria of hepatorenal syndrome (HRS) (2007). Model for end-stage liver disease (MELD) score (t=-13.05, P=0.000), AKI staging (χ²=12.80, P=0.002), AKI treatment response (χ²=25.06, P=0.000), progression of AKI (χ²=26.01, P=0.000) and prognosis (χ²=47.69, P=0.000) were significantly different between liver cirrhosis group and liver failure group. Logistic regression multivariate analysis showed that AKI staging (OR=0.079, P=0.000) and MELD score (OR=1.073, P=0.002) were the main influencing factors for AKI outcomes. Furthermore, AKI outcomes (OR=22.753, P=0.000) and MELD score (OR=0.823, P=0.000) were the main influencing factors for prognosis. Conclusion The 2015 International Club of Ascites (ICA) updated guideline increases diagnostic sensitivity, but intense attention should be paid to the effect of primary liver disease and liver function on treatment efficiency, outcomes and prognosis of AKI, especially in patients with liver failure. Early diagnosis and active intervention under close observation may improve AKI outcomes and prognosis.

Sleep status investigation of patients with chronic hepatitis C

JIANG Ying-ying, BIAN Dan-dan, ZHOU Hai-yang, DUAN Shu-li, WANG Zhao, LIU Shuang, CHEN Yu, ZHENG Su-jun, DUAN Zhong-ping

2018, 23(4):  302-304. 

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Objective To investigate the sleep status in patients with chronic hepatitis C (CHC) in some areas of China. Methods From July 2015 to June 2016, questionnaires were applied to investigate the sleep status of CHC patients in 11 hospitals from northeast, northwest, northern, southwest, central and eastern China. Results A total of 378 valid questionnaires were collected. Insomnia rate in CHC patients reached 71%, including 63% with trouble falling asleep, 55% with trouble staying asleep and 56% with early morning awakening. Among these patients, 53% patients felt insomnia disturbing and 47% thought their life, work and study were affected by insomnia. There were only 14% patients taking sleeping pills. Rates of insomnia in the six areas were significantly different (P<0.01), which was 95.4% in northwest but only 50.0% in northern China. Conclusion Insomnia rate in CHC patients is much higher than that in general population (71% vs. 6%～30%), with most common insomnia type of trouble in falling asleep. Few patients take sleeping pills in spite of the effect that insomnia has on their life, work and study. Moreover, insomnia rate is negatively correlated with income level to a certain extent.

Serum thyroid hormones in acute on chronic liver failure patients and its correlation with prognosis

KAN Yan-ting, YANG Yong-feng

2018, 23(4):  305-306. 

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Objective To investigate the expression of serum thyroid hormones in acute on chronic liver failure (ACLF) patients and its correlation with prognosis. Methods Levels of serum free triiodothyronine (FT3), free thyroxin (FT4) and thyroid stimulating hormone (TSH) in ACLF patients (n=45) and chronic hepatitis B (CHB) patients (n=49) were detected and their effect on prognosis was analyzed. Results Compared with CHB patients, ACLF patients showed lower levels of FT3 (2.16±0.67 vs. 2.81±0.88, P<0.05) and TSH (0.87±0.82 vs. 2.74±2.33, P<0.05). In ACLF patients, serum TSH level in survivors was significant higher than that in non-survivors (1.12±1.09 vs. 0.58±0.49, P<0.05). Spearman correlation analysis showed that TSH level was negatively correlated with total bilirubin (TBil) and model for end-stage liver disease score (r=0.508 and r=0.467, both P<0.05). Moreover, FT3 was significantly negatively correlated with TBil (r=-0.399, P<0.05). Conclusion Expression of serum thyroid hormones could be an index for severity in ACLF patients and a valuable predictor for ACLF prognosis.

Correlation analysis between MR signal features and histopathological type in small hepatocellular carcinoma

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

2018, 23(4):  307-309. 

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Objective To investigate the correlation between magnetic resonance (MR) signal characteristics and histopathological classification of small hepatocellular carcinoma (HCC). Methods Twenty-one patients with single histopathological type were enrolled in the study, who were diagnosed of small HCC in our hospital from October 2009 to December 2017. Dynamic contrast- enhanced MR scan was performed in all cases within 1 month before operation. Patients were classified into 3 groups according to world health organization (WHO) pathological classification criteria, including pseudoglandular type (n=10), compact type (n=5) and trabecular type (n=6). Ratio of lesion signal value to adjacent liver background signal value was calculated and analyzed in T1 weighted imaginge (T1WI), T2 weighted imaginge (T2WI) and diffusion weighted imaging (DWI) and dynamic contrast- enhanced MR scan during arterial phase, portal phase and delayed phase, respectively. Results T2WI signal value in compact type was significantly different from that in pseudoglandular type (P<0.01) and trabecular type (P<0.05). T1WI signal value showed significant differences between pseudoglandular type and compact type (P<0.05). However, there was no significant difference in DWI sequence and dynamic contrast-enhanced scan among different histopathological types. Conclusion The signal values of MR T1WI and T2WI in small HCC are correlated with histopathological types.