Table of Content

29 February 2016, Volume 21 Issue 2

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Orginal Articles

The prognostic value of serum M30-antigen levels in patients with HBV-related acute-on-chronic liver failure

CHEN Rong, CAO Zhu-jun, WANG Yun, XIANG Xiao-gang, AN Bao-yan, XIE Qing, WANG Hui, GUO Qing

2016, 21(2):  85-88. 

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Objective To investigate the apoptotic level of hepatocytes in patients with chronic hepatitis B virus (HBV) infection at different stages, and to evaluate its prognostic value on HBV-related acute-on-chronic liver failure (HBV-ACLF). Methods A prospective study was carried out in 174 patients including 40 chronic hepatitis B (CHB), 40 HBV-related liver cirrhosis (HBV-LC), 54 HBV-ACLF patients and 40 healthy controls (HC). HBV-ACLF group were followed up for 3 months and classified into survival and death group. Apoptotic levels of hepatocytes were measured by detecting keratin-18 associated caspase-cleaved fragment, M30-antigen. Results Serum M30-antigen levels in CHB, HBV-LC and HBV-ACLF were 145.24 [interquartile range (IQR 86.31-206.39) U/L, 213.42 (IQR 147.30-391.28) U/L and 762.67 (IQR 492.45-1395.24) U/L respectively, which were significantly (P<0.01) higher than those in HC group [60.34 (IQR 50.58-67.64)U/L]. Moreover, serum M30-antigen levels were gradually elevated as disease severity increased, reaching to peek in HBV-ACLF group, which was significantly higher (P<0.01) than those in CHB and HBV-LC group. M30-antigen level was significantly positively correlated with alanine aminotransferase (ALT), aspartate transaminase (AST), total bilirubin (TBil), prothrombin time (PT), international normalized ratio (INR) and HBV-DNA (all P<0.01), while reversely correlated with albumin (P<0.01). More importantly, serum levels of M30-antigen in the death group [1175.18 (IQR 756.57-3224.94) U/L] were significantly (P<0.01) higher than those in the survival group [491.39 (IQR 264.23-657.17) U/L]. Receiver operating characteristic (ROC) curve analysis demonstrated that serum M30-antigen could well predict 3-month outcome of HBV-ACLF patients, as the area under the curve (AUROC) was 0.86 (95% CI 0.75-0.96, P<0.01). Conclusion Hepatocyte apoptosis is closely associated with the disease severity of chronic HBV infection and markedly elevated in patients with HBV-ACLF. Hepatocytes apoptosis biomarker, M30-antigen, might be a potential indicator for the early prognosis of HBV-ACLF.

Frequency of Th17 and Treg in HBV-related acute-on-chronic liver failure and its clinical value

KAN Yan-ting, GAN Jian-he, SUN Wei, FENG Ting-ting

2016, 21(2):  89-91. 

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Objective To investigate the frequency of peripheral Th17, Treg and Th17/Treg in patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF), and its correlation with disease progression and prognosis. Methods Seventy-four cases were enrolled, including 33 HBV-ACLF cases (HBV-ACLF group), 30 chronic hepatitis B cases (CHB group) and 11 healthy cases (control group). The frequency of Th17 and Treg cells and surface antigen quantity in peripheral blood were detected in three groups with flow cytometry technique, respectively. Correlation analysis between changes of Th17 and Treg frequency in the HBV-related ACLF cases and total bilirubin (TBiL), alanine aminotransferase (ALT) and prothrombin time (PT) was performed. Results Frequency of Th17, Treg cells and proportion of Th17/Treg were higher in HBV-ACLF patients than those in CHB and control group (P<0.05), respectively. In HBV-ACLF group, frequency of Th17 in dead patients were higher than that in survivors; frequency of Th17 and Th17/Treg were positively correlated with PT, ALT and AST (P<0.05) with no significant correlation with TBiL. Additionally, Th17/Treg was also positively correlated with alpha fetoprotein (AFP) (P<0.05). Conclusion There were different degrees of immune dysfunction in HBV-ACLF patients. Frequency of Th17 and Th17/Treg were associated with disease progression. Higher frequency of Th17 predicted worse prognosis, which revealed it might be important indicators for those patients.

Study on serum levels of Th17/ Treg cytokines in HBV-related acute-on-chronic liver failure patients

SHI Wen-juan, JIA Jin-tang, LI Cai-dong, WANG Hui-fen

2016, 21(2):  92-94. 

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Objective To investigate the expression levels of Th17/Treg cytokines in HBV-related acute-on-chronic liver failure (HBV-ACLF) patients and its clinical significance. Methods Ninety-five patients admitted in Lanzhou Second People's Hospital from December 2010 to December 2013 were enrolled, including 33 HBV-ACLF patients (HBV-ACLF group), 42 chronic hepatitis B patients (CHB group) and 20 healthy people (HC group). Enzyme-linked immune-sorbent assay (ELISA) was applied to detect the levels of IL-17 and IL-35 among groups, respectively. Meanwhile, measurement of liver function parameters was carried out. Results Levels of IL-17 and IL-35 in both HBV-ACLF group (137.47±60.81 and 242.39±81.80 pg/mL) and CHB group (121.63±57.25 and 212.05±123.98 pg/mL) were higher than those in HC group (16.37±8.47 and 33.6±24.63 pg/mL) (t=6.496, 6.136, 5.857 and 5.441, P<0.01), respectively. There were no significant differences in IL-17 and IL-35 levels between HBV-ACLF group and CHB group (t=0.987 and 1.034, P>0.05). Conclusion High expression levels of IL-17 and IL-35 might be associated with occurrence of HBV-ACLF.

Clinical study of autologous bone marrow mesenchymal stem cells transplantation through proper hepatic artery for decompensated cirrhosis patients

ZHENG Sheng, YANG Juan, LIU Qiong, LOU Wei-xin

2016, 21(2):  95-99. 

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Objective To investigate the clinical therapeutic effect and safety of autologous bone marrow mesenchymal stem cells (BMSC) transplantation through proper hepatic artery in patients with decompensated liver cirrhosis. Methods Eighty-four patients with decompensated liver cirrhosis, which admitted in Department of Liver Diseases of the No.533 Hospital of People's Liberation Army from 2012 Jun to 2013 Jun, were randomly divided into transplantation group (n=36) and control group (n=48). Patients in control group received routine treatment, while patients in transplantation group received additional autologous BMSC transplantation through proper hepatic artery. Alanine aminotransferase (ALT), albumin (Alb), total bilirubin (TBil), prothrombin time (PT) and model for end stage liver disease (MELD) were evaluated in both groups during follow-up at week 4, 12, 24 and 48, respectively. Comparison of liver function at different time after therapy between two groups carried out by independent t test , F test and LSD test. Incidence of hepatocellular carcinoma (HCC) and mortality were analyzed by χ2 test. Results Four weeks after treatment, there were 15 cases (41.7%) ascites subsiding, 21 cases (58.3%) abdominal distention disappearing and 13 cases (36.1%) edema of lower limbs relieving in transplantation group, while there were 15 cases (31.3%), 20 cases (41.7%) and 11 case (22.9%) in control group, respectively, which revealed statistically significant differences (P<0.05). In transplantation group at week 4, 12, 24, 48, there were significant improvements in ALT, Alb, TBiL, PT and MELD (F=6.172, 9.795, 10.961, 11.198, 19.652, P=0.000, respectively) than those at baseline. In control group, some parameters, including ALT, Alb and TBiL, had significant improvement (F=5.594, 13.664, 12.612, P=0.000, respectively), while other parameters, including PT and MELD, did not changed before and after therapy. At week 48, ALT, Alb, TBiL, PT and MELD showed significant differences between transplantation and control groups (t=5.477, 8.830, 6.371, 11.362, 9.426, P<0.05, respectively). No significant differences were observed in incidence of HCC and mortality (χ²=4.815、6.286, P<0.05, respectively). Additionally, no severe adverse effects occured in patients during and after transplantation. Conclusion Autologous BMSC transplantation through proper hepatic artery for decompensated liver cirrhosis is a safe and effective therapy, which could be a bridging or a complementary treatment.

Efficacy and prognosis of terlipressin for hepatorenal syndrome and its related factors

YIN Wei, LI Cheng-zhong

2016, 21(2):  100-104. 

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Objective To observe the efficacy and prognosis of terlipressin treatment in patients with hepatorenal syndrome (HRS), and to investigate its related factors and clinical significance. Methods Data of hospitalized patients with HRS from January 2012 to December 2014 in Changhai hospital before and after terlipressin treatment was collected for analysis of the efficacy and prognosis. Univariate analysis was used to screen related factors according to varied efficacy and prognosis of HRS treated with terlipressin, analysis results of which were verified by logistic regression and receiver operating characteristic (ROC) curve analysis. Results Ninety-six HRS cases treated with terlipressin were enrolled. Among those patients, overall effectiveness was 43.8% with efficiency rate as 32.8% for HRS type I patients and efficiency rate as 65.6% for HRS type II patients. Furthermore, model for end stage liver disease Na (MELD-Na) score, baseline creatinine clearance rate (CCr) and infection incidence were related factors for efficacy of terlipressin treatment. MELD-Na score, total bilirubin (TBil) and efficacy of terlipressin treatment were related factors of prognosis. Conclusion Terlipressin has a satisfactorily curative effect on HRS treatment, efficacy and prognosis of which were associated with basis liver function before terlipressin treatment. Terlipressin should be applied as early as possible. However, efficacy may be poor in patients with higher MELD-Na score.

The noninvasive diagnostic models for primary biliary cirrhosis

MA Jiali, LI Ping, ZHANG Fukui, ZHOU Yuling, LIANG Xiuxia, AI Zhenglin

2016, 21(2):  105-106. 

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Objective To verify the noninvasive diagnostic models of liver fibrosis in primary biliary cirrhosis (PBC), and to assess its diagnostic value on histologic staging. Methods Diagnostic value of the models on histologic staging was assessed by the receiver operating characteristic curve (AUC). Results The noninvasive diagnostic models had different levels of diagnostic values, especially H index, Forns Score and RPR, which could predict advanced fibrosis (stage III-IV) with an area under the receiver operating characteristic curve (AUROC) of 0.851, 0.811 and 0.843, respectively. Conclusion The noninvasive models of H index, Forns Score and RPR, which were consisting of laboratory markers, could help accurately identify early (stage I-II) and advanced (stage III-IV) liver fibrosis in patients with PBC.

The impacts of KPNA2 gene silencing on the proliferation and invasion of human hepatocarcinoma cell lines SMMC7721 and Bel7404

WANG Tao, MA Si-cong, QI Xing-xing, TANG Xiao-yin, CUI Dan, WANG Zhi, CHI Jia-chang, LI Ping, ZHAI Bo

2016, 21(2):  107-110. 

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Objective To observe the impacts of Karyopherin α-2 (KPNA2) gene silencing on proliferation and invasion of human hepatocarcinoma cell lines SMMC7721 and Bel7404. Methods Human hepatocarcinoma cell lines SMMC7721 and Bel7404 were transiently transfected with KPNA2 siRNA through adoption of LipofectaminTM 2000. Protein immunoblotting was performed to detect KPNA2 protein expression in transfected cells at 48 hours after transfection. MTT assay was carried out to assess proliferative capability of gene silencing cells, and Transwell assay was used to evaluate their invasion ability. Results Relative mRNA level of KPNA2 in control group of SMMC7721 and Bel7404 was higher than that in siRNA-transfected group (1.02±0.13 vs. 0.37±0.07, t=10.78, P<0.01; 1.05±0.1 vs. 70.36±0.06, t=9.38, P<0.01, respectively). Relative protein level in control group was higher than that in transfected group (0.96±0.10 vs. 0.42±0.05, t=11.83, P<0.01; 0.93±0.09 vs. 0.48±0.06, t=10.19, P<0.01, respectively). Proliferative capacity of control groups was stronger than that in transfected groups at 24h, 48h and 72h respectively, which revealed statistically significant differences (P<0.05). Invasive capacity in control group was more powerful than that in siRNA-transected group (126.20±21.61 vs. 51.13±10.2, t=7.68, P<0.01; 125.124±8.04 vs. 55.20 ±18.54, t=8.48, P<0.01, respectively ). Conclusion KPNA2 gene silencing could adjust the proliferative capacity and invasive ability of human hepatocarcinoma cell lines SMMC7721 and Bel7404.