Table of Content

31 May 2020, Volume 25 Issue 5

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Viral Hepatitis

The real-word big data can be used to evaluate the HBsAg positive rate and immunity effects in children

SHAN Shan, LI Min, TIAN Yong-qian, KONG Yuan-yuan, YOU Hong, JIA Ji-dong

2020, 25(5):  472-475. 

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Objective To better understand HBV infection status and the immunity effects of hepatitis B in the National Immunization Program in real-world clinical practice.Methods Data were retrieved from the SuValue database (including 63 tertiary and secondary hospitals across China) from January 2006 to July 2017. The positive rates of surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core anti-body (anti-HBc) were analyzed and compared with the results of the national seroepidemiological survey of hepatitis B in 2006 and 2014. Results A total of 2 311 221 participants were included in this study, including 919 908 men and 1 391 313 women. From 2006 to 2007, the overall positive rates of HBsAg, HBeAg and anti-HBc declined from 17.4%, 7.1%, 32.9% to 5.9%, 2.3%, 24.2%, whereas the positive rate of anti-HBs increased from 47.6% to 56.4%. Interestingly, the HBsAg positive rate in the groups of 1-4 years and 5-14 years in 2006 (1.4% and 9.1%) and 2014 (0.4% and 0.9%) were close to that in the national seroepidemiological survey of hepatitis B conducted in 2006 (0.96% and 10.6%) and 2014 ( 0.3% and 0.9%, P<0.05).Conclusion The big data from real-world clinical practice can be used to monitor the HBsAg positive rate and evaluate the immunity effect of hepatitis B vaccine in the National Immunization Program those younger than 15 years old.

Liver Cancer

Risk prediction model of liver dysfunction after liver resection for HCC

WANG Shuo, XU Yu-bin

2020, 25(5):  476-479. 

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Objective To study the risk factors for liver dysfunction after liver resection for hepatocellular carcinoma (HCC).Methods The clinical data of 198 HCC patients admitted to our hospital from April 2017 to July 2019 who received hepatectomy were retrospectively analyzed. The retention rate of indocyanine green at 15 minutes (ICG-R15), serum albumin (ALB) before surgery, and postoperative liver function were recorded. Multivariate logistic regression was used to analyze the independent risk factors for liver dysfunction after liver resection for HCC. Results All the 198 patients underwent hepatectomy successfully, and 60 patients (30.30%) had hepatic dysfunction after operation. Multivariate logistic regression analysis showed that ALB [odd ratio (OR)=1.752, 95% confidence interval (CI) = 1.113-2.758], ICG-R15 (OR=1.136, 95% CI = 1.026-1.258), hepatic portal occlusion time (OR=1.129, 95% CI = 1.002-1.272), resected liver volume (OR=2.118, 95% CI = 1.070-4.192), and operation time (OR=1.007, 95% CI = 1.001-1.013) were independent risk factors for postoperative liver dysfunction (P<0.05).Conclusion Liver dysfunction after liver resection for HCC is associated with high preoperative ICG-R15, low serum ALB level, long time of hepatic portal occlusion and operation, and large resected liver volume.

The value of indocyanine green clearance measurement in predicting liver function in patients undergoing anatomical hepatectomy

DAI Bing, ZHANG Lin-jiao, LIU Chi, YANG Qi, LV Xin-yuan, WANG Lei

2020, 25(5):  480-482. 

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Objective To predict the liver function after anatomical hepatectomy by measuring the clearance rate of indocyanine green (ICG).Methods From September 2016 to September 2019, 68 patients who underwent anatomical hepatectomy, including 51 males and 17 females, with an average age of (49.8±10.2) years, were enrolled in our study. All patients underwent ICG clearance test and were pathologically diagnosed as primary hepatocellular carcinoma. The measurement data were expressed as (±s) and analyzed by t-test. Pearson correlation analysis was used to investigate the correlation between ICG retention rate at 15 minutes (ICG-R15) and observational data. Logistic regression model was used to identify the independent risk factors for postoperative liver insufficiency. Results The patients were divided into 2 groups: normal liver function group (n = 52) and liver insufficiency group (n = 16). There was no significant difference in age, platelet, total bilirubin, alanine aminotransferase, aspartate aminotransferase, prealbumin, prothrombin time international normalized ratio, operation time and preoperative ICG-R15 between the 2 groups. There were significant differences in intraoperative blood loss, intraoperative ICG-R15 and resected liver volume (P<0.05). Intraoperative ICG-R15 was significantly higher than preoperative ICG-R15 [(14.5±7.0)%, (6.8±5.5)%, P<0.05]. Pearson correlation analysis suggested that preoperative ICG-R15, intraoperative bleeding and resected liver volume had significant correlation with intraoperative ICG-R15 (correlation coefficients were 0.49, 0.72 and 0.60, respectively, P<0.05). Logistic regression analysis suggested that intraoperative ICG-R15 and resected liver volume were independent risk factors for liver insufficiency after anatomical hepatectomy, while preoperative ICG-R15 and intraoperative bleeding were not.Conclusion ICG clearance rate measurement is helpful to predict the state of liver function after anatomical hepatectomy. Intraoperative ICG-R15 is an independent risk factor for postoperative liver insufficiency.

Analysis of the difference between solitary necrotic nodule of the liver and single metastatic liver cancer in contrast-enhanced ultrasound

LI Jing, ZHANG Ming-zhi, LIU Jia-kai, SHI Bo, LUO Li

2020, 25(5):  483-485. 

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Objective Contrast-enhanced ultrasound (CEUS) was used to investigate the difference of diagnostic performance between solitary necrotic nodule of the liver (SNNL) and single metastatic liver cancer (SMHC).Methods The patients pathologically diagnosed SNNL or SMHC by ultrasound-guided puncture biopsy or operation, who underwent CEUS for liver during hospitalization in the second Affiliated Hospital of Chengdu Medical College and West China Hospital of Sichuan University from January 2014 to December 2018 were enrolled. The measurement data were expressed as (±s), analyzed by t-test. And the counting data were expressed as absolute numbers, analyzed by chi-square test. Results A total of 31 patients were enrolled in the study, including 14 males and 17 females, with an average age of (52.6±7.9) years. There were 6 patients with SNNL and 25 patients with SMHC. The average age of patients with SNNL was significantly lower than that of patients with SMHC [(43.8±7.2) years, (59.7±11.2) years, P<0.05]. In SNNL group, there were 5 cases with clear lesion boundary and 1 case with fuzzy lesion boundary. In SMHC group, there were 8 cases with clear lesion boundary and 17 cases with fuzzy lesion boundary. There was significant difference between the 2 groups (P<0.05). In arterial phase, the thickness of the highly-enhanced peripheral ring was between 1.1 and 4.8 mm, with an average of (2.4±0.8) mm in SNNL group, and was between 3.3 and 9.2 mm, with an average of (5.1±1.3) mm in SMHC group. There was significant difference in the thickness of the highly-enhanced peripheral ring between the 2 groups (P<0.05). In SNNL group, there was no significant difference between area without enhancement in delayed and arterial phases [(6.1±4.2) cm, (8.0±6.5) cm, P>0.05]. However, in SMHC group, there was significant difference between area without enhancement in delayed and arterial phases [(6.3±2.9) cm, (2.8±3.6) cm, P<0.05].Conclusion CEUS is helpful to distinguish SNNL from SMHC, with differences in the thickness of highly-enhanced ring around the lesion in arterial phase and the range of non-enhancement area in delayed phase.

Fibrosis & Cirrhosis

Correlation between 25 hydroxyvitamin D level and liver cirrhosis of different etiologies

HU Chen-bo, YAN Rong-mei, JIN Hong-hui, HUO Yong-kang, LI Zhong-ping

2020, 25(5):  486-490. 

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Objective To investigate the correlation between serum 25 hydroxyvitamin D [25(OH)D] level and cirrhosis.Methods Thirty patients with chronic hepatitis B (CHB) and 61 patients with liver cirrhosis of different etiologies (28 with hepatitis B-related liver cirrhosis, 5 with alcoholic liver cirrhosis, 11 with hepatitis C overlapping alcoholic liver cirrhosis, 17 with occult liver cirrhosis) were enrolled, including 28 patients in compensated stage and 33 patients in decompensated stage. All the patients were divided into 3 groups: CHB group, compensated liver cirrhosis group and decompensated liver cirrhosis group. The biochemical indexes of the 3 groups were analyzed and compared. The 25(OH)D level in cirrhosis of different etiologies was analyzed and compared. Pearson/Spearman correlation analysis was used to analyze the correlation between 25(OH)D levels and variables in cirrhosis. Binomial logistic regression analysis was used to evaluate the risk factors for 25(OH)D deficiency in cirrhosis. Results 1.There were significant differences in age, serum total bilirubin, serum alanine aminotransferase, serum albumin (ALB), serum creatinine, serum potassium, serum sodium, serum calcium and 25(OH)D among the 3 groups (P<0.05). The level of 25(OH)D in CHB group was higher than that in compensated cirrhosis and decompensated cirrhosis groups (25.22 ng/mL, 18.05 ng/mL, 15.46 ng/mL,P<0.01). 2.Among 61 cases of liver cirrhosis, 56 cases (91.8%) had 25(OH)D insufficiency/deficiency, including 28 (45.9%) in hepatitis B-related cirrhosis group, 5 (8.2%) in alcoholic cirrhosis group, 11 (18.0%) in mixed cirrhosis group, and 17 (27.9%) in occult cirrhosis group. And there was no significant difference in 25(OH)D level among 4 groups (P>0.05). 3. Pearson/Spearman correlation analysis showed that 25(OH)D was positively correlated with ALB (r=0.46, P<0.001) and blood potassium (r=0.34, P<0.01), but negatively correlated with international normalized ratio (r=-0.30, P<0.022). 4.Multivariate binomial logistic regression analysis showed that ALB was a risk factor for 25(OH)D deficiency in patients with liver cirrhosis (P<0.05).Conclusion Vitamin D insufficiency/deficiency is very common in patients with liver cirrhosis, and aggravate with the progress of liver disease, which has nothing to do with the etiology of liver cirrhosis. ALB is a risk factor for 25(OH)D deficiency in patients with liver cirrhosis.

Other Liver diseases

The clinical characteristics of 11 cases of systemic lupus erythematosus with non primary biliary cirrhosis

WANG Juan-juan, SHI Hong-ying, ZHENG Shi-tan

2020, 25(5):  491-493. 

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Objective To investigate the clinical characteristics of systemic lupus erythematosus with non primary biliary cirrhosis.Methods Retrospectively assessed 11 cases diagnosed as systemic lupus erythematosus with non primary biliary cirrhosis between January 2013 and January 2019 at the Second Affiliated Hospital of Fujian Medical University. Results They were all female with median age of 57-year-old and their condition were all severe;7 cases were first diagnosed as SLE because of discovery of cirrhosis,with 3 of them passing away 1 day after living hospital and 1 passing away after 1 year.2 patients with hepatic encephalopathy,renal insufficiency,high bilirubin,largely elevated CA125 and CA199 had a rapid deterioration of illness and died in a short time.Only 3 cases of them were stable,1 case with a history of SLE before having regular treatment of SLE and 1 case diagnosed as hepatitis B infection accepting regular antiviral treatment.Conclusion Female were more seen in SLE with non biliary cirrhosis and the condition were usually severe.These patients had a bad prognosis as a whole. A large majority of people were first diagnosed as SLE because of cirrhosis,and often they had worse prognosis.Hepatic encephalopathy,renal insufficiency,high bilirubin,largely elevated CA125 and CA199 may suggest a bad result.Accepting regular treatment of SLE with a SLE history and antiviral treatment with a definite hepatitis B virus infection may improve the prognosis.

Analysis of clinical features of 140 infants with biliary atresia

CHEN Min-xia, LI Xu-fang, XU Yi, YE Jia-wei, YANG Hua-mei, FANG Chun-xiao, WANG Yan-ling, TAN Li-mei

2020, 25(5):  494-497. 

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Objective To investigate the clinical features of infants with biliary atresia (BA),improve the recognition of BA by pediatricians and the early diagnosis rate.Methods One hundred and forty children with BA confirmed by surgical cholangiography were chosen from Guangzhou Women and children's medical center in recent three years. The general clinical data, laboratory examination and imaging examination results of them were analyzed retrospectively. Results Most of the 140 cases were term infants with normal birth weight. The medium age of onset was 3.0(3.0,5.0)days, the medium initial visit time was 15.0(5.0,42.0)days. The first time of liver function examination was (47.23±22.09) days, and the time of operation diagnosis was (73.86±20.99) days. Only 36.43% of the patients discharged typical clay colored stool, 92.86% of them had hepatomegaly and hardened texture. Only 50.71% of the patients with GGT≥300 U·L^-1. After treatment, GGT of children with GGT<300 U·L^-1 increased significantly (P<0.05). Sixty-five 46.43% of BA patients were complicated with cytomegalovirus infection. The positive rate of hepatobiliary-ultrasound and MRCP to diagnose BA were 89.28%(125/140) and 70.73%(87/123) respectively.Conclusion BA is common in term infants. The liver function for the children whose jaundice is delayed or repeated should be checked as early as possible. During the diagnosis and treatment process, attention should be paid to liver and spleen examination, and dynamic observation should be made for children with atypical stool and GGT<300 U·L^-1. Hepatobiliary ultrasound combined with MRCP can improve the diagnosis rate.

Comparison of contrast-enhanced ultrasonography between primary and metastatic neuroendocrine tumors of the liver

WANG Wen-qing

2020, 25(5):  498-500. 

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Objective The contrast-enhanced ultrasonographic findings of primary hepatic neuroendocrine neoplasm (PHNEN) and metastatic neuroendocrine neoplasm (MHNEN) were compared.Methods A retrospective analysis was made of 26 patients with hepatic neuroendocrine neoplasm treated in our hospital from January 2008 to July 2019, including 26 patients with contrast-enhanced ultrasonography. There were 22 patients with MHNEN, 12 males and 10 females, aged (50.6±9.4) years, and 4 patients with PHNEN, including 2 males and 2 females, aged (53.1±14.2) years. The measurement data are expressed as (±s), compared by t-test, the counting data are expressed as percentages, and compared by chi-square test. Results The primary sites of tumors in 22 patients with MHNEN included pancreas (n=9), stomach (n=4), gallbladder (n=4), small intestine (n=2), colon and rectum (n=2) and lung (n=1). A total of 28 lesions were found with a diameter of 1.5×12.8 cm. The average value was (4. 2±3. 6) cm. 16 lesions showed high or slightly high echo, 12 lesions showed slightly low or low echo, 11 lesions had clear boundary, 14 lesions had unclear boundary, 3 lesions had unclear boundary, and 15 lesions had blood flow signal. A total of 7 lesions were found in 4 patients with PHNEN, with a diameter of 1.8 to 17.4 cm, with an average of (7.2±5.5) cm. 5 lesions showed high or slightly high echo, 2 lesions showed slightly low or low echo, 4 lesions had clear boundary, 2 lesions had unclear boundary, 1 lesion had unclear boundary, and 2 lesions had blood flow signal. There was significant difference in lesion diameter between MHNEN and PHNEN patients (P<0.05). There was no significant difference in the beginning enhancement time, the beginning regression time, the enhancement duration, the enhancement speed, the regression speed, the enhancement form and the enhancement shape between MHNEN and PHNEN patients (P>0.05).Conclusion MHNEN and PHNEN are characteristic in ultrasonography and contrast-enhanced ultrasonography, mainly in the mode of overall enhancement and 'fast forward and fast retrogression'. They are of clinical value in the diagnosis of neuroendocrine neoplasm, but it is necessary to further compare the differences of ultrasonographic findings between MHNEN and PHNEN in the future.

Study on risk factors of chronic liver graft-versus-host disease after hematopoietic stem cell transplantation

LI Jing, CHEN Fang-fang, LI Wen-bin, ZHANG Wen-jie

2020, 25(5):  501-504. 

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Objective To study the risk factors of chronic graft-versus-host disease (cGVHD) in liver after hematopoietic stem cell transplantation (HSCT).Methods 149 patients with HSCT admitted to our hospital from April 2014 to April 2019 were enrolled in this study and retrospectively analyzed.General data of the patients were collected and postoperative liver cGVHD incidence was analyzed. Multivariate Logistic regression analysis was used to analyze the independent influencing factors of postoperative liver cGVHD complicated with HSCT. Results Among 149 patients with HSCT, 40 patients had postoperative liver cGVHD, accounting for 26.85%; Liver cGVHD did not occur in 109 patients, accounting for 73.15%.Multivariate logistic regression analysis showed that the use of ATG (OR=0.235, 95%CI=0.113～0.490) and early onset of aGVHD (OR=2.089, 95%CI=1.020～4.279) were independent influencing factors of liver cGVHD after HSCT (P<0.05).Conclusion The occurrence of hepatic cGVHD after HSCT is related to the occurrence of cGVHD in the early stage of transplantation, and the use of ATG in the early prevention of GVHD can reduce the incidence.