Table of Content

30 June 2020, Volume 25 Issue 6

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Liver Injury

Clinical study of two diagnostic criteria for chronic drug-induced liver injury

WANG Li-ping, HE Ting-ting, ZHU Yun, WANG Zhong-xia, WANG Li-fu, SUN Yong-qiang, JING Jing, XU Wen-tao, YU Si-miao, SANG Xiu-xiu, TIAN Miao, REN Yue-bo, CUI Yan-fei, WANG Rui-lin

2020, 25(6):  569-572. 

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Objective To evaluate the applicability of 2 different diagnostic criteria for chronic drug-induced liver injury (DILI) in China and the predictive value of total bilirubin (TBil) and alkaline phosphatase (ALP) at the second month after the onset of DILI.Methods A total of 73 cases of chronic DILI admitted to our hospital from January 2015 to June 2018 were enrolled. The patients were assessed by 6-month and 12-month diagnostic criteria, respectively. The diagnostic results of the 2 criteria were compared. The predictive value of TBil and ALP at the second month after the onset of DILI was analyzed.Results According to the 6-month diagnostic criterion, 65 cases were in accordance with the diagnosis of chronic DILI, and 8 cases were not. The best predictive threshold of TBil at the second month was 33.65 umol/L, with a sensitivity of 88% and a specificity of 61%. The level of ALP at the second month had no predictive value. According to the 12-month diagnostic criterion, 51 cases were in accordance with the diagnosis of chronic DILI, 22 cases were not. The levels of TBil and ALP at the second month both had no predictive value. Between the 2 criteria, there were significant differences (P<0.05). The detection rate of 6-month criterion was higher than that of 12-month criterion, and 43 patients met the 2 criteria at the same time.Conclusion At the second month after the onset of DILI, the predictive value of TBil was higher than that of ALP. According to the standard definition of chronic DILI, in consideration of diagnostic efficacy and the situation of DILI in China, it is suggested to refer to the 6-month diagnostic criterion for treatment and 12-month diagnostic criterion for diagnosis.

Liver Cancer

The clinical and pathological significance of mitochondrial pyruvate carriers in hepatocellular carcinoma

MA Xiang-ming, HOU Jing-yue, FU Qing-jiang, CAO Li-ying.

2020, 25(6):  573-577. 

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Objective Mitochondrial pyruvate carrier (MPC) plays an important pathophysiological role in the metabolism of tumor cells. However, there are few studies about the effects of MPC in the development of malignant tumors, especially hepatocellular carcinoma (HCC). The aim of this study was to analyze the correlation between the expression of MPC in HCC and the levels of clinicopathological parameters, and to evaluate the predictive value of MPC for recurrence and prognosis of HCC after operation.Methods MPC1 and MPC2 protein expression levels in 85 cases of carcinoma and adjacent tissue specimens were detected by immunohistochemistry. The relative expression levels of MPC1 and MPC2 were calculated by Image-Pro Plus software. The correlation between the protein expressions of MPC1 and MPC2 and the levels of clinical pathological parameters was analyzed between patients grouped according to the relative expressions of MPC1 and MPC2. Kaplain-Meier survival analysis was used to analyze the correlation between the protein expression of MPC and the recurrence, prognosis of patients with HCC. Cox regression models were established to determine independent risk factors for recurrence of HCC after operation.Results In paraffin-embedded specimens, the protein expressions of MPC1 and MPC2 in tumor tissues were significantly lower than those in adjacent tissues. There was no significant correlation between MPC1, MPC2 levels and clinical pathological parameters (P>0.05). In patients with lower expression of MPC1, the recurrence rate (P=0.000) was higher and the overall survival time (P=0.001) was shorter. However, the expression level of MPC2 was not correlated with recurrence rate (P=0.254) or overall survival (P=0.452). The decreased expression of MPC1 protein (P=0.000) and microvascular invasion (P=0.017) were independent risk factors for postoperative recurrence of HCC. Univariate and multivariate analyses showed that MPC2 was not associated with postoperative recurrence (P=0.230).Conclusion The absence or reduced activity of MPC1 and MPC2 protein in HCC is widespread. And the expression of MPC1 protein is associated with postoperative recurrence and prognosis of HCC, which can be used as a new biomarkers for clinical prognosis prediction and risk stratification in postoperative patients with HCC.

Liver Failure

Predictive value of CLIF-SOFA score for organ failure in patients with HBV-ACLF

MA Wan-su, ZHAO Lin, LI Hong-sheng

2020, 25(6):  578-581. 

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Objective To investigate the value of chronic liver failure sequential organ failure assessment (CLIF-SOFA) score in predicting organ failure in patients with hepatitis B virus associated acute-on-chronic liver failure (HBV-ACLF).Methods A total of 100 HBV-ACLF patients admitted to our hospital from August 2016 to August 2019 were divided into organ failure group and non-organ failure group according to the condition of organ involvement. The CLIF-SOFA scores were compared between the 2 groups. The receiver operator characteristic (ROC) curve was used to analyze the predictive value of CLIF-SOFA scores for organ failure. On the day of admission, 2 mL of fasting venous blood was collected. The levels of total bilirubin (TBil), total cholesterol (TC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alpha fetoprotein (AFP) and leukocyte count (WBC) were measured. Correlation between CLIF-SOFA score and serum indexes were analyzed by Pearson correlation coefficient.Results Of the 100 cases, 21 (21.00%) had no organ failure and 79 (79.00%) had organ failure. The organ failure group had higher CLIF-SOFA score (6.19±1.04) than the non-organ failure group (4.17±1.01) (P<0.05). The area under the ROC curve of CLIF-SOFA score was 0.808 (standard error = 0.053, P=0.000, 95% confidence interval = 0.705-0.911). Serum TBil and WBC in organ failure group [(384.64±15.89) μmol/L, (7.94±1.56) × 10⁹/L] were significantly higher than those in non-organ failure group [(189.48±17.84) μmol/L, (6.21±1.75) × 10⁹/L] (P<0.05). TC, ALT and AST in organ failure group [(1.76±0.34) mmol/L, (384.50±96.76) U/L, (328.91±91.12) U/L] were significantly lower than those in non-organ failure group [(2.32±0.83) mmol/L , (645.41±124.64) U/L, (552.32±114.76) U/L] (P<0.05). The CLIF-SOFA score of HBV-ACLF patients with organ failure was positively correlated with serum TBil and WBC (r=0.616, 0.824, P<0.05), and negatively correlated with ALT and AST (r=-0.742, -0.574, P<0.05).Conclusion CLIF-SOFA score can predict organ failure in patients with HBV-ACLF, which is related to TBil, WBC, ALT and AST.

Predictive value of combined detection of serum p62 and LC3-II for short-term prognosis of patients with hepatitis B virus related acute-on-chronic liver failure

LIU Tie-feng, XU Shu-ni, WU Shan-shan

2020, 25(6):  582-584. 

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Objective To investigate theapplication value of combined detection of serum autophagy-associated proteins [p62 and microtubule-associated protein 1 light chain 3-II (LC3-II)] in predicting short-term prognosis of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF).Methods A total of 78 HBV-ACLF patients (ACLF group) admitted to our hospital from September 2016 to September 2018 were enrolled. And 42 healthy people who underwent physical examination in the same period were enrolled as control group. Fasting venous blood in the morning of both groups was collected. Total bilirubin, creatinine and international normalized ratio were measured. The scores of the model for end-stage liver disease (MELD) were calculated. Enzyme-linked immunosorbent assay was applied to measure levels of serum p62 and LC3-II. The clinical outcomes within 3 months after admission were recorded. The receiver operating characteristic (ROC) curves were applied to evaluate predicting efficiency of serum p62 and LC3-II for prognosis of HBV-ACLF patients.Results The level of serum LC3-II in ACLF group was significantly higher than that in control group [(68.35±16.07) ng/ml vs (37.96±11.50) ng/ml], while p62 level was lower than that in control group [(2.30±1.45) ng/ml vs (4.63±2.38) ng/ml] (P< 0.05). The results of Pearson correlation analysis showed that serum p62 was negatively correlated with MELD score (r=-0.383, P< 0.05), while serum LC3-II was positively correlated with MELD score (r=0.458, P< 0.05). ROC curves confirmed that optimal cut-off values of p62 and LC3-II for predicting short-term prognosis of HBV-ACLF patients were 1.51 ng/ml and 80.74 ng/ml, respectively. The area under the ROC curve (AUC) of their combined prediction was greater than that of p62 or LC3-II alone [0.813 (95% confidence interval: 0.710-0.892) vs 0.727 (95% confidence interval: 0.616-0.821), 0.736 (95% confidence interval: 0.626-0.828)] (P< 0.05). There was no significant difference in AUC between p62 and LC3-II for predicting prognosis of HBV-ACLF (P>0.05).Conclusion There is certain value of serum p62 and LC3-II in predicting short-term prognosis of patients with HBV-ACLF. The combined detection has better predictive value.

Other Liver Diseases

Clinical characteristics and diagnosis of citrin deficiency with intrahepatic cholestasis

ZHU Ping, ZHAO Jie, CHENG Xue-lian, Li De-liang, ZHANG Wei-ye

2020, 25(6):  585-587. 

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Objective To explore the clinical characteristics and diagnosis of citrin deficiency with intrahepatic cholestasis (NICCD).Methods Thirty cases of citrin deficiency with NICCD children admitted to our hospital from July 2018 to July 2019 were selected as the case group, and 30 cases of normal newborns delivered in our hospital in the same period were selected as the normal group.The serum GGT, ALT, ALP and AST were compared between the two groups. The levels of TSH, FT4, IGF-1 and GH were measured at the same time.ROC was drawn to analyze the diagnostic value of liver function and endocrine index for citrin deficiency and NICCD.Results The serum GGT, ALT, ALP and AST contents of the case group were (460.38 ± 126.46) U/L, (254.49 ± 75.54) U/L, (424.59 ± 102.48) U/L, (301.93 ± 84.46) U/L, respectively Higher than the normal group (297.52 ± 89.38) U/L, (129.05 ± 33.56) U/L, (283.19 ± 56.52) U/L, (123.53 ± 62.38) U/L (all P<0.05).The case group serum IGF-1 [(34.65 ± 6.48) ng/mL] was significantly lower than the normal group [(164.36 ± 29.96) ng/mL](P<0.05).The case group GH [(18.35 ± 5.37) ng/mL] was significantly higher than the normal group [(2.01 ± 0.78) ng/mL] (P<0.05).The AUC of serum GGT, ALT, ALP, AST, IGF-1, and GH contents to diagnose Citrin deficiency with NICCD was 0.694, 0.764, 0.752, 0.782, 0.794, 0.791, respectively.Conclusion Compared with normal infants, citrin deficiency with NICCD infants have obvious liver function and endocrine abnormalities, among which serum GGT, alt, ALP, AST, IGF-1, GH can be used as an important index to diagnose the disease.

Analysis of clinical characteristics and curative effect of autoimmune hepatitis in children

NA Xi, WANG Wei, HE Jian-qing

2020, 25(6):  588-590. 

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Objective Clinical characteristics and therapeutic effect of children with autoimmune hepatitis (AIH).Methods A total of 22 children (6 males and 14 females) with AIH admitted to our department from June 2014 to June 2019 were selected with an average age of (9.5 ±4.4) years. The treatment was prednisone 2 mg/kg/d (maximum dose 60 mg/d) 1 month after azathioprine treatment 2 mg/kg/d (maximum 100 mg/d). After 3 months of treatment, the hormone drug dose was gradually reduced until it stopped. The measurement data were expressed as (±s) or [M (P25, P75)], t-test or Kruskal-Wallis H test; the counting data were expressed as absolute numbers and compared by chi-square test.Results Among the 22 cases of AIH, 6 cases were acute course, 10 cases were subacute course and 6 cases were chronic course. 13 cases were AIH type I, 5 cases were AIH type II, 4 cases were unclassified. There was no significant difference among the three groups (P>0.05). GLO in patients with AIH type I [(35.2±9.8) g] was significantly higher than that in patients with AIH type II [(24.1±6.7) g, P<0.05]. The IgG of patients with AIH type I [(27.4±5.2) g] was significantly higher than that of patients with AIH type II [(19.7±4.4g) g, P<0.05], but there was no significant difference in ALT, AST and TBIL between the two types (P>0.05). The results of liver histology included interfacial hepatitis (n = 12), plasma cell or lymphocyte infiltration (n = 18), hepatic fibrosis (n = 22), rosette (n = 6) and bile duct lesion (n = 3). There was no significant difference in liver histological results among AIH I, AIH II and unclassified patients (P>0.05). All patients were followed up after treatment, 21 cases were effective, 6 cases were refractory and 11 cases were recurrent. there was no significant difference in the number of effective, refractory and recurrent cases between AIH type I, AIH type II and unclassified patients (P>0.05).Conclusion The clinical manifestations of AIH type I, II and unclassified children are various, and the laboratory indexes and liver histological results are more serious. Prednisone + azathioprine can effectively improve the condition of AIH patients, but the patients are prone to recurrence after treatment and need to adhere to the treatment.

The relationship between the type of blood supply and the efficacy of transcatheter arterial interventional therapy for hepatic hemangioma

YAO Yu, DAI Feng, XU Chun-yang

2020, 25(6):  591-594. 

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Objective To investigate the relationship between the type of blood supply and the efficacy of transcatheter arterial interventional therapy for hepatic hemangioma.Methods 128 patients with hepatic hemangioma admitted to our hospital from January 2017 to January 2019 were divided into three groups according to their blood supply. They were rich blood supply group (case number = 43), medium blood supply group (case number = 47), and deficient blood supply group (case number = 38).All patients underwent interventional therapy via hepatic artery embolization. The clinical effects of three groups were evaluated at 3 and 6 months after operation, and the reduction rates of tumors and arterial phase enhancement were recorded at 6 months after operation.The liver function indexes, including alanine aminotransferase (AAT), direct bilirubin (DB) and total bilirubin (TB), were compared before and 3, 7 and 14 days after operation in three groups, and the complications were analyzed.Results The total remission rates of the rich blood supply group and the medium blood supply group were [76.74% and 72.34%] respectively, which were significantly higher than those of the hypovascular group [47.37% (P<0.05)].The total remission rates of the blood supply group and the medium blood supply group were [72.09% and 63.83%] respectively, which were significantly higher than those of the hypovascular group [(39.47% (P<0.05)].The tumor shrinkage rates of the rich blood supply group and the medium blood supply group were [(55.62±10.05)%, (50.34±8.51)%], which were significantly higher than those of the poor blood supply group [(31.28±8.32)% (P<0.05)].The reduction rates of arterial phase enhancement in the rich blood supply group and the medium blood supply group were [(28.53±5.12)%, (23.64±4.87)%], which were significantly higher than those in the poor blood supply group [(17.29±5.23)% (P<0.05)].The serum levels of AAT, DBil and TBil at 3 and 7 days after operation in the three groups were higher than those before operation (P<0.05).The incidence of fever, nausea, vomiting, cholecystitis and upper abdominal pain in the rich blood supply group was [9.30%, 6.98%, 2.33%, 0.00% and 4.65%], respectively. There was no significant difference in complication rate among the three groups (P>0.05).Conclusion Compared with the patients without blood supply, the patients with rich blood supply and medium blood supply had better curative effect 3 or 6 months after transcatheter arterial embolization, and the reduction rate of tumor size and arterial phase enhancement was higher than that of the patients without blood supply. However, there was no significant difference in liver function and complications among the patients with different blood supply types.

Study on the relationship between CT imaging findings and pathological types of hepatic angiomyolipoma

CHENG Wei-rong, XU pei-xia, YANG Hui-jing

2020, 25(6):  595-597. 

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Objective To investigate the relationship between CT imaging findings and pathological types of hepatic angiomyolipoma (HAML).Methods A total of 26 patients with HAML who underwent surgical treatment and confirmed by postoperative pathology from February 2014 to April 2019 were included in the study. There were 5 males and 21 females with an average age of (45.2 ±5.9) years. According to the research of Tsui and other scholars, the pathological classification of HAML was carried out.Results In 6 cases of hemangioma type, most of them existed abnormal blood vessels and smooth muscle cells, which contained adipose tissue components, but the amount was small. None fat density shadow was found in CT imaging the examination showed quasi-circular low density shadow in CT plain scan, continuous enhancement in CT enhancement scan, thick twisted vascular shadow and partial calcification in CT scan. In 4 cases of myoma type, a very small amount of adipose tissue components were found in routine pathology, especially in smooth muscle cells. None adipose tissue was found on CT in 2 patients, and a very small amount of adipose tissue was found in 2 patients on CT. The overall angioma type showed obvious enhancement in arterial phase, slightly higher density in venous phase and delayed phase in CT enhanced scan. In 7 cases of lipoma type, a large amount of adipose tissue components were found in routine pathology. On plain CT scan, there were multiple strips of reticular structure and diffuse density shadow of adipose tissue, while on enhanced CT, there were thick twisted blood vessels in adipose tissue. In 9 cases of mixed type, a variety of tissue components were found in routine pathology, including adipose tissue, distorted blood vessels and smooth muscle cells. The total content of adipose tissue was between 10% and 85%. On plain CT scan, diffuse soft tissue density shadow and adipose tissue density shadow were seen, and the two imaging manifestations were mixed. CT enhanced scan showed none enhancement in adipose tissue components, but obvious enhancement of soft tissue density in arterial phase.Conclusion CT imaging findings can effectively reflect the tissue composition and pathological features of HAML patients. It is valuable for the diagnosis of HAML and has important clinical significance.

The value of conventional ultrasound and contrast-enhanced ultrasound in diagnosis and differentiation of hepatic neuroendocrine tumors

Muhetajiang·Wubulihasimu, Guzainuer·A jimu, Mutalifu

2020, 25(6):  598-601. 

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Objective To study the application value of ultrasound and contrast-enhanced ultrasound in differential diagnosis of hepatic neuroendocrine tumors (HNET).Methods 128 patients with liver diseases were as the research objectors, 89 cases of hepatocellular carcinoma (HCC) were in the control group, 39 cases of HNET were in the observation group among them.Meanwhile, the image characteristics of conventional ultrasound and contrast-enhanced ultrasound were recorded, and the contrast-enhanced time was compared between the two groups.The imaging characteristics of MHNET and PHNET ultrasound and contrast-enhanced ultrasound were recorded, and the contrast-enhanced time of two groups of patients were compared.Results The ultrasonography showed that there were 12 cases of single focus in the observation group were lower than 68 cases in the control group, there were 19 cases of hyperechoic imaging, 8 cases of hypoechoic imaging, 28 cases of homogeneous imaging, the proportion were higher thanthose of the control group, the difference were statistically significant (P<0.05).The contrast-enhanced ultrasound showed that the capsule of the observation group was enhanced in 4 cases, the proportion was lower than that of the control group, the difference was statistically significant (P<0.05).The time of regression to isoenhancement and the time of hypoenhancement in the observation group were (31.64±6.38) s and (64.82±16.85) s respectively, which were significantly shorter than those of the control group (P<0.05).The maximum diameter of MHNET lesions were (4.47±1.89) cm, which were significantly lower than that of PHNET (P<0.05).Conclusion The ultrasound and contrast-enhanced ultrasound are helpful for screening of HNET, and it can provide basis for differential diagnosis between MHNET and PHNET.