Table of Content

31 July 2020, Volume 25 Issue 7

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A comparative study of predictive models for acute liver failure in drug-induced liver injury

YANG Rui-yuan, LIU Li-wei, LUO Juan, LI Ke-xin, TIAN Qiu-ju, WANG Yan, ZHAO Xin-yan, JIA Ji-dong

2020, 25(7):  671-675. 

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Objective To compare the efficacy of different models in the prediction of acute liver failure in drug-induced liver injury (DILI) patients. Methods We conducted a retrospective cohort study of patients diagnosed with DILI from 2014 to 2018. Data of liver biochemical tests of these DILI patients were collected and acute liver failure (ALF) cases were identified among those fulfilled the criterion of Hy's law, new Hy's law and Robles model, respectively. The sensitivity, specificity, positive predictive and negative predictive value were calculated, respectively. Results A total of 298 patients were enrolled, with an average age of 54.7 ± 14.7 years, including 211 female patients (70.8%). Most cases of DILI were hepatocellular injury (77.2%), followed by mixed injury (16.4%) and cholestatic injury (6.4%). Among all the patients, 13 (4.4%) cases progressed to ALF, 5 (1.7%) underwent liver transplantation or died of liver-related events. In this study, 161 DILI patients met the criterion of Hy’s law, 5.8% of them progressed to ALF, 208 cases met the criterion of new Hy’s law, 5.6% progressed to ALF, while 73 cases met the criterion of Robles model and 15.1% developed ALF. DILI patients fulfilled the Robles model had the highest risk of developing ALF, with the sensitivity of 84.6%, the specificity of 78.2%, and the positive predictive value of 99.1%. DILI patients who met the criterion of Robles model had significantly lower rate of liver biochemical normalization at 1, 3 and 12 months compared with DILI patients who did not (P<0.05). Conclusion When applied at DILI recognition, the Robles model provides the best specificity and positive predictive value in the prediction of ALF development, and most accurately predicts the normalization rate of liver biochemical indices within 1 year.

Application of glucocorticosteroid in drug induced liver injury

LI Wen-ting, YANG Liang, HE Hong-liang, ZHAO Zong-hao, LI Yi

2020, 25(7):  676-678. 

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Objective To investigate the indication and timing of glucocorticosteroid (GC) therapy for drug induced liver injury(DILI). Methods This study retrospectively analyzed the demographic characteristics, etiology and clinical manifestations of 33 patients with DILI in our hospital from 2018 to 2020. Patients were divided into 2 groups, 21 patients in control group received routine medical treatment, 12 patients in treatment group were given GC combined with routine medical treatment. The results of laboratory test including liver function were analyzed. Furthermore, the effective rate and side effects were also observed during the treatment. Results GC significantly improved the effective rate of therapy for DILI, especially severe liver injury. There was no rebound of liver function while tapering GC or GC related side effects during the treatment. Conclusion It is safe and efficient to use GC in early stage of DILI.

Vanin-1 as a marker for early evaluation of acetaminophen induced acute liver injury

ZHEN Li-ying

2020, 25(7):  679-681. 

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Objective To investigate the expression and evaluation value of vanin-1 in acute liver injury induced by acetaminophen (APAP). Methods We established the acute liver injury model of mice induced by APAP. The rats were randomly divided into control group and experimental groups treated with various concentrations of APAP (100, 200, 300 mg/kg). The serum alanine aminotransferase (ALT) level, vanin-1 level in serum and in liver were detected. Parallel contrast was conducted between vanin-1 and ALT to analyze the correlation, and to evaluated the value of vanin-1 in the early evaluation of APAP-induced acute liver injury in mice. Results (1) At 12 hours (12h) after the establishment of the model, compared with the control group, serum ALT levels in the APAP treatment groups were significantly higher (P<0.05), which was dose-dependent. (2) At 12h, the expression levels of vanin-1 in serum and liver tissue in the APAP treatment groups were significantly higher than those in the control group (P<0.05), which was dose-dependent. (3) In the early evaluation of acute liver injury, vanin-1 mRNA was correlated with ALT (R>0.9). (4) Compared with ALT, vanin-1 is more sensitive in acute liver injury. Conclusion Vanin-1 is expected to be a marker for the early evaluation of acute liver injury induced by APAP, which needs further research.

Clinical and imaging analysis of intrahepatic biliary cystadenocarcinoma

LIU Yuan, AN Wei-min, REN Hong-wei, LI Yong-wu, LIU Chang-chun, DONG Jing-hui

2020, 25(7):  682-685. 

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Objective To analyze the clinical and imaging features of intrahepatic biliary cystadenocarcinoma (IBC). Methods The clinical data of 10 patients with IBC hospitalized in our hospital from October 2010 to December 2019 were analyzed retrospectively. The main complaints, clinical manifestations, laboratory examination and imaging features were summarized. Results In 10 patients with IBC, abdominal pain and abdominal distension were the main symptoms. There were 5 cases with no increased tumor markers, 3 cases with increased cancer antigen (CA) 125, 4 cases with increased CA199, 2 cases with increased carcinoembryonic antigen (CEA), and 1 case with increased CA724. Computed tomography (CT) or magnetic resonance (MR) showed cystic solid lesions with a long diameter of 1.50 cm-11.10 cm in 8 cases, mild to obvious intrahepatic bile duct dilatation around the lesions in 7 cases, wall nodules in 7 cases, irregular separation and septal enhancement in 6 cases, and progressive enhancement in 8 cases. Lymph node metastasis was found in 4 patients. And multiple metastases were found on MR and CT in 1 patient 1 year after operation. Conclusion IBC is more common in middle-aged and elderly women. The main clinical manifestations are abdominal pain and abdominal distention. Some patients may have elevated CA199 and CA125. The imaging findings are characterized with cystic solid masses with clear boundaries, sometimes with wall nodules, bile duct dilatation, irregular separation and progressive enhancement. Metastasis can occur in some patients, and the treatment should be complete surgical resection.

Comparison of ultrasonographic characteristics between haptic neuroendocrine neoplasm and hepatocellular carcinoma

ZHOU Yan-ke, WANG Jing-min, TIAN Jing, LI Qian

2020, 25(7):  686-688. 

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Objective To compare the ultrasonographic characteristics between hepatic neuroendocrine neoplasm (hNEN) and hepatocellular carcinoma. Methods Twenty-two patients with hNEN treated in our department from February 2017 to August 2019 were selected, including 14 males and 8 females, 1 case of primary hNEN and 21 cases of metastatic hNEN, with an average age of (50.6 ± 10.0) years. The primary sites of metastatic hNEN included pancreas (n = 8), stomach (n = 5), small intestine (n = 4), colorectal (n = 3) and lung (n = 1). During the same period, 30 patients with hepatocellular carcinoma were randomly selected, including 23 males and 7 females, 26 cases of primary hepatocellular carcinoma and 4 cases of metastatic hepatocellular carcinoma, with an average age of (52.2 ± 7.9) years. The measurement data were expressed as (±s), compared with t-test, and the count data were expressed as (%) and compared with chi-square test. Results Using conventional ultrasound, there were significant differences in the average number of lesions, boundary, internal echo, echotexture and posterior echo attenuation between hNEN and hepatocellular carcinoma (P<0.05). There was no significant difference in lesion location, size and blood flow signal (P > 0.05). Using contrast-enhanced ultrasound, there were significant differences in the initial enhancement washout time, enhancement duration and washout rate between hNEN and hepatocellular carcinoma (P<0.05). There was no significant difference in initial enhancement time, enhancement rate, enhancement pattern and enhancement degree (P > 0.05). Conclusion Both conventional ultrasound and contrast-enhanced ultrasonography can effectively show the difference between hNEN and hepatocellular carcinoma, which were helpful to the differentiation of the 2 kinds of lesions in clinical practice.

MiR-425 regulates proliferation, migration and invasion of hepatocellular carcinoma cells by targeting PTPRN2

CHEN Ning, NIU Yao-fei, YOU Hang-biao, ZHAN Wei-li, WU He-wen

2020, 25(7):  689-692. 

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Objective To investigate the effect of microRNA (miR)-425 on the proliferation, migration and invasion of hepatocellular carcinoma cells, and the molecular mechanism. Methods The expression level of miR-425 in hepatocellular carcinoma cell lines (HepG2, SMMC-7721 and MHCC-97H) and normal hepatic cell line (HL-7702) was detected using reverse transcription-quantitative polymerase chain reaction. We predicted the target genes of miR-425 by bioinformatics analysis, and confirmed that protein tyrosine phosphatase, receptor type, N polypeptide 2 (PTPRN2) was directly targeted by miR-425 through dual luciferase reporter assay. The expression level of PTPRN2 protein was examined by western blotting. The effect of miR-425 and PTPRN2 on the proliferation, migration and invasion of hepatocellular carcinoma cells was tested by MTT assay and Transwell assay, respectively. Results The relative expressions of miR-425 in hepatocellular carcinoma cell lines were 2.01 ± 0.13, 3.97 ± 0.24 and 9.14 ± 0.26, which were higher than 1.00 ± 0.03 in normal hepatic cell line (P<0.005). Inhibiting the expression of miR-425 by transfecting miR-425 inhibitor could significantly suppress the proliferation, migration and invasion of hepatocellular carcinoma cells. The luciferase reporter assay showed that miR-425 could reduce the activity of luciferase in wild-type vectors (0.99 ± 0.09 vs 0.40 ± 0.03, P<0.05). But there was no statistically significant difference in mutant vectors (1.00 ± 0.05 vs 0.93 ± 0.07, P>0.05). Knockdown of PTPRN2 could reverse the inhibitory effect of miR-425 inhibitor on the proliferation, migration and invasion of hepatocellular carcinoma cells. Conclusion MiR-425 promotes the proliferation, migration and invasion of hepatocellular carcinoma cells by targeting PTPRN2.

Comparison of ultrasound-guided percutaneous radiofrequency ablation and surgical resection in the treatment of hepatocellular carcinoma of caudate lobe

LI Qi, LIU Chun-cheng, GAO Hai-de, ZHANG Hao, LI Xun-hai

2020, 25(7):  693-694. 

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Objective Comparison of ultrasound-guided percutaneous radiofrequency ablation and surgical resection in the treatment of hepatocellular carcinoma of caudate lobe. Methods Thirty-four patients with caudate lobe hepatocellular carcinoma admitted to hospital from January 2005 to January 2015 were included, including 12 patients who underwent ultrasound-guided percutaneous radiofrequency ablation (ablation group), including 10 males and 2 females. The age was (56.7±6.8) years old; There were 22 patients who underwent surgical resection (operation group), including 15 males and 7 females, aged (57.9±10.2) years. The measurement data are expressed as (x ±s), the t-test is analyzed, the counting data is expressed as absolute value, and the chi-square test is used for analysis. Kaplan-Meier method was used for survival analysis. Log Rank test was used to compare the survival curve, and Breslow test was used to test the cross of survival curve. Results The operative time of the ablation group was (50.6±15.4) min, and the intraoperative bleeding volume was (22.8 ±9.6) ml;. The intraoperative bleeding time of the patients in the ablation group was (178.4±35.2) min, and the intraoperative bleeding volume was (402.8±98.4) ml;. There were significant differences in operation time and intraoperative bleeding between the two groups (P<0.05). In the ablation group, the tumor recurrence rates at 1, 2 and 3 years after operation were 8.3% (1 case), 25.0% (3 cases) and 41.7% (5 cases), respectively. The 1 -, 2-and 3-year overall survival rates were 91.6% (1112), 83.3% (10) and 66.7% (8), respectively. In the operation group, the tumor recurrence rates at 1, 2 and 3 years after operation were 9.1% (2 cases), 27.3% (6 cases) and 40.9% (9 cases), respectively. The 1 -, 2-and 3-year overall survival rates were 90.9% (2022), 77.3% (17/22) and 68.2% (15/22), respectively. There was no significant difference in tumor recurrence rate and overall survival rate between the two groups (P>0.05). The incidence of complications was 16.7% (2) in the ablation group and 31.8% (7/22) in the operation group (P<0.05). Conclusion Ultrasound-guided percutaneous radiofrequency ablation is similar to surgical resection in the treatment of caudate lobe hepatocellular carcinoma. At the same time, it can reduce the trauma of patients and reduce the incidence of perioperative complications.

Application value of quantitative assessment of iodine concentration by CT energy spectral imaging in differential diagnosis of hepatacellular carcinoma

GAN Zhen-ning, MA Meng-xue, YAN Xiao-juan

2020, 25(7):  695-698. 

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Objective To study the application value of quantitative assessment of iodine concentration by computed tomography (CT) energy spectrum imaging in the differential diagnosis of hepatocellular carcinoma (HCC) and hypervascular hepatic metastases (HVHM). Methods A total of 141 patients with malignant liver tumors admitted to our hospital from August 2015 to August 2019 were enrolled. They were divided into group A (HVHM, 60 cases) and group B (HCC, 81 cases) according to pathological types. All patients underwent spectral CT scanning. The normalized iodine (water) concentration in arterial phase and portal phase, the ratio of iodine concentration between lesions and normal liver tissue, water (iodine) concentration, slope of energy spectral curve and iodine concentration difference between venous and arterial phase were compared between the 2 groups. And the efficacy of the quantitative parameters above in differential diagnosis of HCC and HVHM was analyzed. Results The values of normalized iodine (water) concentration, the ratio of iodine concentration between lesions and normal liver tissue, and the slope of energy spectral curve in group A were significantly higher than those in group B (P<0.05). The normalized iodine (water) concentration value in the portal phase, the ratio of iodine concentration between the lesions and normal liver tissue in the portal phase, and the slope of the energy spectral curve in the portal phase were all effective in the differential diagnosis of HCC and HVHM, and the area under the curve was 0.746, 0.778 and 0.802, respectively. Conclusion There are significant differences in quantitative parameters of spectral CT imaging, which provides an important reference for the differential diagnosis of HCC and HVHM.

Evaluation of the application of dual-energy iodine and magnetic resonance diffusion-weighted imaging in the interventional transcatheter arterial chemoembolization therapy against primary liver cancer

DENG Yong, XIAO Xiao-yan

2020, 25(7):  699-701. 

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Objective To evaluate the clinical application of dual-energy iodine and magnetic resonance diffusion-weighted imaging (DWI) in the evaluation of interventional transcatheter arterial chemoembolization (TACE) therapy against primary liver cancer. Methods 106 patients with liver cancer diagnosed in Jianghan Oilfield General Hospital from January 2017 to October 2018 were enrolled. The upper abdominal magnetic resonance DWI and dual energy scan were performed in all patients before and after TACE therapy. The apparent dispersion coefficient (ADC) values of preoperative and postoperative lesions were measured. The ADC values were transferred to the Liver VNC post-processing software to evaluate the positive detection rate of the lesions. Results The ADC values of the liver cancer tissues after TACE therapy were significantly higher than those before operation (P<0.05). The ADC values of the lesions were highest at 15 days after surgery, which was in line with the peak time of tumor cells necrosis. The ADC values decreased after 28d post operation. 102 lesions were confirmed by digital subtraction angiography (DSA), and the positive detection rate of the lesion was 97.17%. Both the positive detection rate and the sensitivity were high. Conclusion Dual-energy iodine in combine with magnetic resonance DWI can effectively evaluate the survival and necrosis of liver cancer after interventional TACE therapy, avoid the interference of iodized oil artifacts, and detect intrahepatic lesions, which has important significance for guiding further treatment.

Study on the influencing factors of HBV reactivation after precise radiotherapy for primary liver cancer

WANG Xiao, ZHOU Xi-jian, GU Pei

2020, 25(7):  702-704. 

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Objective Objective To explore the influencing factors of reactivation of hepatitis B virus (HBV) after precise radiotherapy for primary liver cancer (PLC). Methods From May 2016 to may 2019, 138 PLC patients in our hospital received precise radiotherapy.The tumor diameter, child-pugh grade of liver function, HBV DNA and other general data of patients were counted to analyze the occurrence of HBV reactivation after precise radiotherapy, and multivariate Logistic regression was used to analyze the independent influencing factors of HBV reactivation after precise radiotherapy in patients with PLC. Results All 138 PLC patients received precise radiotherapy, and 34 (24.6%) had HBV reactivation, including 6 (4.3%) at 4 weeks after precise radiotherapy, 16 (11.6%) at 8 weeks, and 12 (8.7%) at 12 weeks, all of which were included in the HBV reactivation group;104 patients (75.4%) did not experience HBV reactivation and were included in the HBV inactive group.The proportion of child-pugh grade B in the HBV reactivation group was 58.8%, significantly higher than 14.4% in the non-activated group (P<0.05);The proportion of serum HBV DNA > 1.0×10⁴ copies /ml in the HBV reactivation group was 50.0%, significantly higher than 6.7% in the non-activated group (P<0.05).Multivariate Logistic regression analysis showed that child-pugh grade (OR=1.129, 95%CI=1.004~1.270) and serum HBV DNA (OR=1.146, 95%CI=1.028~1.278) were independent influencing factors for HBV reactivation in PLC patients after accurate radiotherapy (P<0.05). Conclusion The reactivation of HBV in PLC patients after precise radiotherapy is closely related to the child Pugh grade of liver and the level of HBV DNA in serum, which should be paid more attention in clinical practice.

Study on the risk factors of hepatolithiasis developing intrahepatic cholangiocarcinoma

NIU Teng-teng, ZHANG Gong-xian, CHEN Bao-hua, WANG Zhen

2020, 25(7):  705-708. 

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Objective To explore the risk factors for the progression of hepatolithiasis to intrahepatic cholangiocarcinoma (ICC). Methods 150 patients with hepatolithiasis admitted to our hospital from November 2017 to November 2019 were included. The clinical data of the patients were collected and divided into ICC group and non ICC group according to their progress to ICC. By comparing the clinical characteristics of the two groups, the logistic regression model was used to analyze the multiple factors that lead to ICC. Results Of the 150 participants, 39 (26.00%) developed ICC and 111 (74.00%) did not. In ICC group, the history of choledochojejunostomy, the course of cirrhosis, hepatolithiasis ≥ 10 years, the proportion of diabetes was significantly higher than that in non ICC group, while the proportion of complete stone removal was significantly lower than that in non ICC group (P<0.05).Logistic regression model showed that the history of choledochojejunostomy, cirrhosis, the course of hepatolithiasis ≥ 10 years, diabetes mellitus were the risk factors for the progression of hepatolithiasis to ICC (P<0.05), and the complete removal of stones was the protective factor to prevent the progression to ICC (P<0.05). Conclusion The progression of hepatolithiasis to ICC is related to a variety of factors, including the history of choledochojejunostomy, cirrhosis, the course of hepatolithiasis, diabetes, and thorough removal of stones can reduce the risk of ICC.

Diagnostic efficacies of serum adrenomedullin and urinary thromboxane B2 in patients with decompensated cirrhosis complicated with acute renal injury

LIU Xiao, HU Yan, SUN Yan-jun

2020, 25(7):  709-713. 

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Objective To investigate the diagnostic efficacies of serum adrenomedullin (ADM) and urinary thromboxane B2 (TXB2) in decompensated cirrhosis patients complicated with acute renal injury (ARI). Methods 78 patients with decompensated cirrhosis admitted to Dongfeng Hospital affiliated to Hubei University of Medicine from January 2016 to December 2018 were enrolled in this study. They were divided into non-AKI group (38 cases) and AKI group (40 cases). The general clinical data and the serum ADM, serum creatinine (Scr), and urinary TXB2 levels between these two groups were compared. The correlation between ADM and TXB2 and other clinical indicators were analyzed. The risk factors of AKI in decompensated cirrhosis patients were analyzed by logistic regression. The ROC curve was used to evaluate the diagnostic efficacies of ADM and TXB2. Results There was no difference in age [(51.19±8.62) years vs (54.06±7.57) years], gender (male/female, 21/17 vs 26/14), course of disease [(6.71±1.49) years vs (6.42±0.84) years], child Pugh grade (A/B/C grade, 10/13/15 vs 3/16/21) and MELD score (5-6/7-9/ ≥10, 8/12/18 vs 10/13/17) between non AKI group and AKI Group (P>0.05). The albumin content in AKI group was lower than that in non-AKI group [(26.95±4.68)g/L vs (35.21±6.72)g/L] (P<0.05). The contents of urea nitrogen [(14.35±2.09) mmol/L vs (5.93±0.61) mmol/L], total bilirubin [(47.19±2.44) μmol/L vs (25.94±3.60)μmol/L], Scr[(125.38±14.37)μmol/L vs (72.84±4.84)μmol/L], ADM [(328.24±45.06)pg/mL vs (176.29±24.35)pg/mL], and TXB2 [(1885.40±243.51)pg/mL vs (1107.69±104.24)pg/mL] in AKI group were higher than those in non-AKI group (P<0.05). The ADM content in serum was negatively correlated with albumin (r=-0.753, P<0.05), whereas positively correlated with urea nitrogen, total bilirubin and Scr (r=0.851, 0.492, 0.695, respectively, P<0.05). The TXB2 content in urine was negatively correlated with albumin (r=-0.516, P<0.05), whereas positively correlated with urea nitrogen, total bilirubin and Scr (r=0.641, 0.430, 0.510, respectively, P<0.05). Scr (OR=2.357, 95%CI:1.247-4.457), ADM (OR=3.458, 95%CI:1.195-10.004) and urine TXB2 (OR=3.315, 95%CI:2.175-5.052) had certain value for the diagnosis of decompensated cirrhosis complicated with AKI (P<0.05). The area under ROC curve (AUC) of Scr, ADM and TXB2 in the diagnosis of decompensated cirrhosis with AKI was 0.757, 0.905 and 0.880, respectively. The sensitivity and specificity of ADM were the highest ( 85.16% and 87.19%, respectively). Conclusion The levels of serum ADM and urinary TXB2 in patients with decompensated cirrhosis complicated with AKI are higher than those in patients without AKI. Detecting serum ADM and urinary TXB2 levels is helpful for early diagnosis of AKI in patients with decompensated cirrhosis, which is worth of widely clinical application.

Risk factors for the colonization of Candida Albicans in patients with liver cirrhosis

LIU Da-da, LIANG Dong, ZHU Xiao-hong, ZHANG Yan, DONG Xiao-feng, WANG Quan-chu

2020, 25(7):  714-716. 

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Objective To investigate the colonization of Candida albicans in patients with liver cirrhosis and the risk factors. Methods 103 patients with liver cirrhosis in the observation group and 103 healthy physical examinees in the control group who visited 988 Hospital of the People's Liberation Army from March 2016 to January 2019 were enrolled. Specimens of feces and sputum were collected separately from both groups for microbial culture to observe the colonization levels of various types of fungi in the specimens. The risk factors of Candida albicans infection in liver cirrhotic patients were further analyzed by logistic regression analysis. Results The distribution ratios of Candida albicans in the feces and sputum of the observation group were significantly higher than the control group (P<0.05). In the observation group, the distribution ratios of Candida albicans in feces and sputum were significantly higher than those of Candida glabrata, Candida krusei and other fungi (P<0.05). Logistic regression analysis showed that hospitalization days ≥14 d, Child-Pugh of grade B or C and serum albumin ≤25 g/L were risk factors for Candida albicans infection (P<0.05). Conclusion Candida albicans is the main fungus colonized in the digestive tract and respiratory tract of cirrhotic patients with fungal infection. Hospitalization days ≥14 d, Child-Pugh grade B or C and serum albumin ≤25 g/L are risk factors for the infection. Countermeasures should be taken to improve the prognosis of the patients.

The value of regular endoscopy as a follow-up treatment after successful primary hemostasis of esophageal variceal hemorrhage in liver cirrhotic patients

WANG Pei-zheng, ZHANG Wei, WANG Wei, ZHAO Song

2020, 25(7):  717-720. 

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Objective To study on the value of regular endoscopy as a follow-up treatment after successful primary hemostasis of esophageal variceal (EV) hemorrhage in liver cirrhotic patients. Methods From January 2016 to December 2017, 146 patients with EV hemorrhage due to liver cirrhosis who were successfully treated by endoscopy for the first time in Pingdingshan First People's Hospital were enrolled in this study. They were randomly divided into two groups with 73 cases in each group. The follow-up treatment plan for the observation group was regular endoscopic treatment, while the control group was followed-up with conservative treatment. The remission of varicose vein under regular endoscopic treatment in the observation group were investigated. The recurrence, rebleeding, death due to EV, the occurrence of gastric varicose vein bleeding and related complications in the control and obseration groups were compared. Results The remission rate of EV in the observation group was 100.0% after 2 to 3 times treatment by regular endoscopy, which was significantly higher than 45.2% after the first treatment (P<0.05); There was no significant difference in the elimination rate of gastric varices between the observation group and the control group (P>0.05). There was no significant difference in recurrence rate, rebleeding rate and mortality rate of EV between the two groups within 1 month (P>0.05); During 12 and 20 months of follow-up, EV recurrence rates in the observation group were 15.1% and 20.5%, respectively, which were significantly lower than 41.1% and 72.6% in the control group (P<0.05); rebleeding rates in the observation group were 4.1% and 13.7%, respectively, which were significantly lower than 32.9% and 56.2% in the control group (P<0.05); mortality rates were 0 and 4.1%, respectively, which were significantly lower than 8.2% and 20.5% in the control group (P<0.05). The incidence of gastric varicose bleeding in the observation group was 0, which is significantly lower than 19.2% in the control group (P<0.05); There was no significant difference between these two groups as for the incidences of upper abdominal discomfort, gastrointestinal ulcer, fever and post-sternal pain (P>0.05). Conclusion Regular endoscopy has an important application value in the follow-up of the EV bleeding patients after successful primary endoscopic treatment, which effectively reduces EV degree, eliminates gastric varicose veins, reduces rebleeding rate and mortality with good security.

The application of quantitative magnetic resonance imaging texture analysis in the differentiation between regenerative nodules and small liver cancer in cirrhotic liver

LI Peng, GUO Zhong-jie, YANG Xu, ZHAO Hong-bo, LIANG Hao-ran

2020, 25(7):  721-723. 

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Objective To study on the application value of quantitative magnetic resonance imaging (MRI) texture analysis in the differentiation between regenerative nodules and small liver cancer in cirrhotic liver. Methods The clinical data of 44 cirrhotic patients with liver nodules who admitted to our hospital from April 2017 to April 2018 were retrospectively analyzed. They were divided into small liver cancer group(N=25)and regenerative nodule group(N=19). MRI examination had been performed on in both groups of patients and the differences of MRI texture parameter energy, contrast, correlation, deficit distance and entropy between these two groups were compared. Moreover, Receiver operating characteristic curve (ROC) analysis was performed on the parameters that had differences to clarify their efficiencies in predicting small liver cancer. Results The energy and correlation of MRI texture parameters in the small liver cancer group were significantly lower than those in the regeneration nodule group, whereas the entropy was significantly higher in the small liver cancer group. The area under the ROC curve predicted by energy, correlation and entropy for small liver cancer was 0.939, 0.761 and 0.892, respectively. Conclusion The quantitative analysis of MRI texture is of high accuracy in the recognition of malignant changes of cirrhotic nodules, which has clinical application value in the differentiation between cirrhotic regenerated nodules and small liver cancer.

Prediction of esophageal variceal bleeding in patients with hepatic cirrhosis by different non-invasive markers

HUANG Xian-guang, LI Song-hu, HUANG Mei-ting, WU Guang-yao, ZHANG Fu, CEN Xiao-hong

2020, 25(7):  724-728. 

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Objective To investigate the efficiency of different non-invasive markers in predicting esophageal variceal bleeding (EVB) in liver cirrhotic patients. Methods From January 2016 to February 2019, 86 patients with cirrhosis who underwent CT and upper gastrointestinal endoscopy examinations within six months were included. The diagnostic performances of instantaneous elastography (FibroScan), aspartate aminotransferase (AST) to alanine aminotransferase (ALT), AST to platelet ratio index (APRI), platelet count and spleen diameter (PL/SD), fibrosis index-4 (FIB-4), fibrosis index and King’s score were assessed by the receiver operating characteristic curve (ROC curve). Results Twenty one of the 86 cirrhotic patients had EVB (24.4%). Compared with non-EVB group, hemoglobin in the patients of EVB group decreased significantly (P<0.05), whereas liver stiffness measured by Fibroscan increased significantly (P<0.05). ROC analysis showed that FibroScan stiffness had the highest specificity (75.3%), PPV (51.3%), AUC (0.70) and accuracy (70.2%) in predicting EVB. Logistic regression analysis showed that there was a significant correlation between EVB and Fibroscan stiffness (OR = 1.57; 95%CI: 1.15-2.14), while other non-invasive markers (fibrosis index, King score, APRI, PL/SD and AST/ALT) did not significantly correlate with EVB. Conclusion Liver stiffness measured by FibroScan is the most reliable predictor of EVB in patients with liver cirrhosis. Despite the low diagnostic accuracy, liver stiffness is the most efficient non-invasive marker which may be used as an initial screening tool for EVB.

In vitro study on the inhibitory effect of propranolol on hepatic stellate cells activation via PDGFR/Akt pathway

LEI Cai-hong, ZHANG Yi

2020, 25(7):  729-731. 

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Objective To explore the inhibitory effect of propranolol on hepatic stellate cells (HSCs) activation in vitro via PDGFR/Akt pathway. Methods HSCs were studied as an in vitro model. The cells were divided into control group, saline group, and treatment groups A, B, and C. Cells in the control group was cultured under normal condition without special intervention. Cells in the saline group was treated with physiological saline vehicle. Cells in the three treatment groups A, B and C were treated with different concentrations of propranolol (10 μmol/L, 50 μmol/L, 100 μmol/L, respectively) for 24 h. The cells were then collected, and the morphological changes of each group were observed. The proliferation and apoptosis of HSCs were investigated. The protein concentration of types I and III collagen, MMP-2 and TNF-α, vascular endothelial growth factor (VEGF) and platelet-derived factor (PDGF) in different groups of cells were compared. Results (1) The morphology of HSCs in the control group and the saline group did not change significantly, whereas the cells in the propranolol treated A, B and C groups showed decreased cell density, poor adherence, and enhanced cell-to-cell connection. The changes were more obvious with the increase of propranolol concentration. (2) there was no significant change in the cells proliferation and apoptosis between the saline group and the control group (P>0.05), and the proliferation of cells in the treatment groups A, B and C dose-dependently decreased. The increase of apoptosis was significantly different from that of the control group (P<0.05). (3) The concentrations of types I and III collagen were not significantly different between the cells in the saline group when compared with the control group (P>0.05), whereas the concentrations of types I and III collagen in A, B and C groups were dose dependently lower than those in the control group (P<0.05). (4) There was no significant difference in MMP-2 and TNF-α levels between the saline group and the control group (P>0.05), whereas the levels of MMP-2 and TNF-α in A, B and C groups were dose-dependently lower than the control group (P<0.05). (5) The levels of VEGF and PDGF in the saline group were not significantly different from the control group (P>0.05). The levels of VEGF and PDGF in A, B and C groups were dose-dependently decreased when compared with the control group (P<0.05). Conclusion Propranolol inhibits the proliferation of HSCs and promote the cells apoptosis. It also reduces the expression of types I and III collagen in HSCs, which may have great significance in delaying the progression of liver cirrhosis.

Study on changes of brain functional connectivity of bilateral precuneus and other brain regions in patients with minimal hepatic encephalopathy based on resting-state fMRI

ZHANG Hai-jun, ZHANG Hong-juan

2020, 25(7):  732-735. 

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Objective To investigate the changes of brain functional connectivity of bilateral precuneus and other brain regions in patients with minimal hepatic encephalopathy based on resting-state fMRI. Methods 95 patients with hepatic encephalopathy (observation group) and 95 cases of physical examinees (control group) in our hospital from May 2016 to March 2019 were selected. All the selected subjects underwent fMRI. The changes of functional connectivity of bilateral precuneus and other brain regions were observed. The blood ammonia level, number connection test (NCT) and digit symbol test (DS) results were observed, and their correlation with disrupted functional connectivity was determined by spearman correlation analysis. Results The blood ammonia level and digital connection test results of the observation group were higher than those of the control group, and the digit symbol test results were lower than the control group (P<0.05). The brain functional connectivity of left precuneus with left inferior parietal lobule, right superior frontal gyrus, left insula, and left middle cingulate gyrus in the observation group was lower than those of the control group, while the brain functional connectivity of left precuneus with left superior frontal gyrus was higher than that of the control group (P<0.05). The brain functional connectivity of right precuneus with right supramarginal gyrus, right temporal pole, bilateral frontal lobe, medial cingulum cortex and left superior temporal gyrus in the observation group was lower than those of the control group, while the brain functional connectivity of right precuneus with left posterior cingulate gyrus was higher than that of the control group (P<0.05). Conclusion Abnormal resting-state functional connectivity of bilateral precuneus and multiple brain regions are demonstrated in patients with minimal hepatic encephalopathy, which may be the mechanism of endogenous neurological impairment of minimal hepatic encephalopathy.

The correlation and consistency of two methods for HBV RNA detection in chronic hepatitis B patients with or without nucleoside/nucleotide analogues treatment

WANG Xue-gang, ZHANG Xin-zhi, YANG Shu, GAN Su-qin, LIU Shi, HAO Kun-yan, ZHOU Bin, YU Yue-cheng

2020, 25(7):  736-742. 

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Objective To compare Race method and Sansure method in HBV RNA quantification in naive and treated patients with chronic hepatitis B (CHB). Methods Clinical datas were collected from patients who were followed up in the outpatient department of Nanfang Hospital. RACE method and Sansure method were used to detect patients' serum HBV RNA levels. The correlation and consistency of the two assays were analyzed. Results A total of 101 patients were enrolled, including 62 patients who received nucleoside/nucleotide analogues (NAs) treatment and 39 patients who did not receive any NAs treatment (i.e., na?ve patients). There were significant differences in HBsAg and HBV DNA levels between the treated and untreated groups. There were statistically differences in serum HBV RNA levels in the two groups. Detectable serum HBV RNA was seen in more patients in RACE group than in Sansure group, as well as higher mean levels of serum HBV RNA (3.16 lg copies/mL vs 2.53 lg copies/mL). There was no significant correlation between HBV DNA levels and HBV RNA levels in the treatment group (RACE R²= 0.4406, Sansure R²= 0.5081); while in the untreated group, there has significant correlation between the two methods (Race R²= 0.8448, Sansure R²= 0.8667). RACE and Sansure were significantly correlated in detectable HBV RNA levels (R²= 0.93498740, P<0.001). In addition, Bland-Altman analysis showed that the 95% of agreement of the two HBV RNA detection methods was relatively narrow (-1.789~0.22 lg copies /mL in the treatment group,and -2.25~0.53 lg copies /mL in the untreated group). If RACE method was used as the baseline, the deviation of Sansure method was -0.78 lg 拷贝/mL in the treatment group and -0.86 lg 拷贝/mL in the untreated group. Linear regression equation: Y (Sansure) =0.918 9X (RACE)-0.3754. Conclusion The correlation between the two methods is significant and can be calculated by linear regression equation; Both the two HBV RNA detection methods can effectively make up for the deficiency of serum HBV DNA detection in guiding the clinical diagnosis and treatment of CHB.

Clinical significance of surface antigen of hepatitis B virus quantification in patients with hepatitis B cirrhosis related primary liver cancer

XUE Hong-li, BAI Jin, SHAN Hong, QIN Li-li

2020, 25(7):  743-745. 

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Objective To explore the clinical significance of surface antigen of hepatitis B virus quantification in patients with hepatitis B cirrhosis or with liver cirrhosis complicated with hepatocellular carcinoma(HCC) for early diagnosis of HBV related HCC. Methods 54 patients with hepatocellular carcinoma complicated by hepatitis B cirrhosis were enrolled into observation group, as well as 72 patients with simple hepatitis B cirrhosis were enrolled into control group. The serum HBsAg levels and HBV DNA loads were compared between the two groups. Results The serum HBsAg and HBV DNA in observation group were significantly decreased compared with that in control group(P<0.001). Conclusion The serum HBsAg were decreased in the course of Hepatitis B cirrhosis into hepatocellular carcinoma. The quantification of HBsAg was a predictor of hepatocarcinogenesis with clinical significance of early diagnosis.

Comparison of clinical efficacy and safety of interferon α-2b combined with adefovir dipivoxil or entecavir in the treatment of drug-resistant e-antigen-positive hepatitis B

SHANIYA·Niyazi, KEBINUER·Tuerxun, PAN Ke-jun, SUN Xiao-feng

2020, 25(7):  746-748. 

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Objective To compare the clinical efficacy and safety of interferon α-2b combined with adefovir dipivoxil or entecavir in the treatment of drug-resistant e-antigen positive hepatitis B. Methods 86 patients with drug-resistant e-antigen positive hepatitis B were admitted from the First Affiliated Hospital of Xinjiang Medical University from October 2016 to January 2018. The patients were divided into two groups by random number table. The patients treated with interferonα-2b combined with adefovir dipivoxil were divided into group A and those treated with interferonα-2b combined with entecavir were divided into group B. After 24, 48 weeks of treatment and 24 weeks of follow-up, the therapeutic responses (virological and biochemical responses), serological indicators (HBeAg seroconversion and negative HBeAg, HBsAg and HBV DNA) and drug safety were compared between the two groups. Results After 24, 48 weeks of treatment and 24 weeks of follow-up, the serological conversion of HBAg in group B was better than that in group A (P < 0.05). The treatment response, HBeAg negative, HBsAg negative, HBV DNA negative and adverse reactions during treatment in the two groups have no significant (P > 0.05). Conclusion Interferonα-2b combined with adefovir dipivoxil or entecavir is effective in the treatment of drug-resistant hepatitis B with e antigen positive. Among them, the combination therapy of entecavir can significantly improve the serological conversion of HBeAg in patients with higher application value.

Predictive value of different scoring systems for the risk of acute on chronic liver failure in patients with chronic hepatitis B

HOU Qiao-mei, GAO Chan, JIANG Shan-shan

2020, 25(7):  749-751. 

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Objective To study the predictive value of different scoring systems for the risk of chronic hepatitis B patients with acute on chronic liver failure. Methods The clinical data of 94 patients with chronic hepatitis B and acute on chronic liver failure were selected and divided into the early group, the middle group and the late group according to the stages of liver failure. In addition, 30 patients with severe chronic hepatitis B admitted to our hospital at the same time were selected and set as the group without liver failure. After admission, all patients were evaluated by end-stage renal disease model (MELD), serum sodium concentration MELD integrated model(MELD-Na), end-stage renal disease model and serum sodium ratio (MESO), iMELD model scoring system (iMELD), sequential organ liver failure evaluation model (SOFA) before treatment. In addition, the ROC curve was used to analyze the value of five scores in predicting chronic hepatitis B patients with acute on chronic liver failure. Results In comparison of the five scores, there was a significant difference between the late group, the middle group, the early group and the non-liver failure group (P<0.05). According to ROC analysis, the area under the curve of predicting chronic hepatitis B patients with acute on chronic liver failure was 0.938, 0.976, 0.960, 0.902 and 0.903 respectively, and the sensitivity of MELD, MELD Na and iMELD to predict chronic hepatitis B patients with acute on chronic liver failure (0.989, 0.947, 0.968) was higher than that of MESO and SOFA (0.670, 0.809). Conclusion ROC curve has confirmed that MELD, MELD-Na, iMELD, MESO and SOFA scores can help in the early diagnosis of chronic hepatitis B and acute on chronic liver failure.

Analysis of influencing factors of poor response on treatment of autoimmune hepatitis

GUO Feng-cai, WU Jian-ming, WEI Zheng

2020, 25(7):  752-754. 

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Objective To explore the factors influencing poor response on treatment of autoimmune hepatitis (AIH). Methods The clinical data of 78 patients with AIH admitted to our hospital from January 2012 to October 2019 were analyzed retrospectively. All patients were divided into good response group (n = 54) and poor response group (n = 24) according to the response after treatment.To compare the differences between the two groups in basic data (gender, age), clinical symptoms (whether there is fatigue, nausea, jaundice, poor appetite, abdominal pain), serum indexes (ANA, AMA, alt, AST, TBIL, ALP), we will find that there are different information lines and using multi factor logistic. C regression analysis to explore the risk factors of poor response after AIH treatment. Results Patients with fatigue, nausea and jaundice in the poor response group accounted for 75.00%, 79.16%, 83.33%, 79.17% and 75.00% of those with positive ANA and AMA antibodies, which were significantly higher than those in the good response group (25.00%, 20.83%, 16.67%, 20.83% and 25.00%, all P<0.05).The results of multivariate logistic regression analysis showed that patients with AIH had symptoms of asthenia, nausea and jaundice. The high expression of ALP was a risk factor for poor response after treatment, all of which were P<0.05. Conclusion Patients with poor response to AIH often have symptoms of asthenia, nausea and jaundice, and ALP in serum shows high expression, which are risk factors for poor response on treatment.

Effects of alteration of intestinal flora on the incidence of non-alcoholic fatty liver disease in obese children

ZHANG Li-wen, REN Ming-xing, XUE Guo-chang, SHEN Lin-na, XIA Xue-xia, SONG Yue-juan, XIA Huan

2020, 25(7):  755-758. 

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Objective To observes the incidence of alteration of intestinal flora and non-alcoholic fatty liver disease in obese children, and to analyze the effect of alteration of intestinal flora on the incidence of non-alcoholic fatty liver disease in obese children. Methods 541 obese children in the outpatient of hospital from March 2017 to June 2019 were selected as obese group, and 112 children who received regular physical examination and were confirmed to be non-obese and had no other serious complications during the same period were selected as control group. The general situations questionnaire was designed, and the general situations of the research subjects were asked and recorded. All children underwent intestinal flora examination. The incidence of alteration of intestinal flora and non-alcoholic fatty liver disease in obese group and control group were compared, and the relationship between alteration of intestinal flora and non-alcoholic fatty liver disease in obese children was analyzed. Results The body mass index (BMI) and waist circumference in obese group were [(29.17±1.11)kg/m², (81.21±5.54)cm], which were higher than those in control group (P<0.05); Compared with control group, the detected number of enteric bacilli and enterococcus colony in obese group was [(8.62±1.33), (7.49±1.11)], which was higher, and the detected number of other colonies was lower; The detection rate of alteration of intestinal flora and non-alcoholic fatty liver diseasewas (18.67%, 9.43%), which was high (P<0.05); The alteration of intestinal flora was positively correlated with the incidence of non-alcoholic fatty liver disease (r=0.673, P<0.05); The detection rate of non-alcoholic fatty liver disease in obese children with alteration of intestinal flora was (41.58%), which was higher than that in normal people (P<0.05); The alteration of intestinal flora was the risk factor for non-alcoholic fatty liver disease in obese children (OR=34.090, P<0.05). Conclusion Obese children are often associated with alteration of intestinal flora, which is closely related to the occurrence of non-alcoholic fatty liver disease. Alteration of intestinal flora may be the risk factor for the occurrence of non-alcoholic fatty liver disease in obese children, and it should be paid clinical attention to detect and intervene as soon as possible.

Pathological observation of congenital cholangiectasis with liver injury in children

LIU Yong-hong, HE Jin-ping, MA Shun-mao

2020, 25(7):  759-761. 

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Objective To study the pathological basis of congenital biliary dilatation (CBD) with liver injury in children. Methods 138 cases of CBD with liver injury admitted to our hospital from May 2014 to May 2019 were included as the research object, and a retrospective analysis was carried out.According to the age of the children, the children were divided into group A (72 cases aged from 1 month to 3 years) and group B (66 cases aged from 4 to 16 years).The clinical characteristics of the two groups were analyzed, and the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), alkaline phosphatase (AKP), gamma-glutamyltransferase (GGT), albumin (ALB) were compared. The levels of serum amylase, urine amylase, bile amylase, platelet count, leukocyte count and hemoglobin were observed. Results In group A, cystic dilatation of common bile duct was dominant, cyst diameter was larger, most distal cysts were strictured and atresia, and cysts were accompanied by protein embolus, calculi, hepatomegaly and cholestasis;Group B was dominated by spindle dilatation, with most of the cysts opening at the distal end and relatively small cyst diameter, a few cysts with obvious stenosis and atresia at the distal end, and a few with large liver and obvious cholestasis.The incidence of jaundice and pottery stool in group A was 68.1% and 72.2% respectively, which was significantly higher than that in group B (18.2% and 15.2% (P<0.05), and the incidence of abdominal pain was 38.9%, which was significantly lower than that in group B (95.5% (P<0.05);The incidence of fever, abdominal distension, vomiting, abdominal mass and hepatosplenomegaly in group A was not significantly different from that in group B (P>0.05).ALT, AST, TBIL, DBIL, AKP, GGT in group A were significantly higher than those in group B (P<0.05), while IBIL and ALB were not significantly different from group B (P>0.05).White blood cell count in group A was significantly higher than that in group B (P<0.05), and bile amylase was significantly lower than that in group B (P<0.05), and there were no statistically significant differences in blood amylase, urine amylase, hemoglobin and RBC count between groups B (P>05). Conclusion Children with CBD at different ages have different clinical manifestations, accompanied by different degrees of liver injury. Biliary obstruction and cholestasis are the pathological basis of liver injury in children, which should be paid enough attention to clinically.