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Table of Content

    30 September 2020, Volume 25 Issue 9
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    Liver Cancer
    Prognosis analysis of liver transplantation for patients with hepatocellular carcinoma using different criteria
    ZHANG Da-li, ZHOU Xia, FENG Dan-ni, HE Xi, WANG Hong-bo, GAO Yin-jie, SUN Yan-ling, ZHANG Li-juan, LIU Zhen-wen, LIU Hong-ling
    2020, 25(9):  915-918. 
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    Objective To compare the prognosis of orthotopic liver transplantation (OLT) under three different criteria in a cohort of cirrhotic patients with hepatocellular carcinoma ( HCC). Methods A total of 391 HCC patients with OLT were enrolled in this retrospective cohort study. They were received OLT under three different criteria, i.e., Milan, “Up-to-seven” and Hangzhou. Cox proportional hazard regression analysis, Kaplan analysis and log-rank test were performed to compare the patients' recurrent rates and outcomes after OLT. P value <0.05 was considered significant. Results Compared to the patients with OLT under Milan criteria, the OLT patients exceeded Milan but within “Up-to-seven” criteria has similar recurrence rate (13.8% vs 21.8%, P=0.17) and disease-free survival (DFS) (10.93±0.3 years vs 9.5±0.7 years, P=0.14), whereas the OLT patients who exceeded “Up-to-seven” but within Hangzhou criteria had significant difference in tumor recurrence (13.8% vs 33.8%, P<0.01), HCC-related death (4.9% vs 23%, P<0.01) and long-term survival (12.2±0.23years vs 9.1±0.79 years, P<0.01). Conclusion The overall survival (OS) and DFS after OLT in HCC patients who exceed Milan but within “Up-to-seven” criteria were excellent,thus they should be offered the option of OLT.
    An Analysis on the efficacy of combination therapy with argon-helium knife cryoablation and transcatheter hepatic arterial chemoembolization for unoperable patients with advanced liver cancers
    LI Rui, SHI Qin-sheng
    2020, 25(9):  919-921. 
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    Objective To investigate the efficacy of combination therapy with argon-helium knife cryoablation and transcatheter hepatic arterial chemoembolization (TACE) for upoperable patients with advanced liver cancers. Methods One hundred and forty-four cases of unoperable patients with advanced liver cancers were selected in this study. They were divided into the observation group and the control group by random number table method, with 72 cases in each group. The control group was treated with TACE, and the observation group was treated with argon-helium cryoablation on the basis of TACE. The clinical efficacy, survival rate after treatment and the overall incidence of adverse reactions were compared between these two groups. Results The total effective rate of the observation group was significantly higher than that of the control group (77.78% vs 54.17%, P<0.05). Compared by Log-Rank test the survival rates between these two groups were not significantly different (P>0.05). The total incidence of adverse reactions in the observation group was 12.50%, which has no significant difference when compared with 8.33% in the control group (P>0.05). Conclusion The combination therapy with argon-helium cryoablation and TACE are effective and safety for the treatment of unoperable patients with advanced liver cancers, thus it is worth of clinical application.
    Long term efficacy of a decade after radiofrequency ablation for patients with hepatocellular carcinoma
    CHEN Hui, ZUO Lin-lin, LI Mu-song, LIU Meng
    2020, 25(9):  922-925. 
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    Objective To investigate the long-term efficacy of a decade after radiofrequency ablation (RFA) for patients with hepatocellular carcinoma (HCC). Methods Two hundred and ten patients with HCC underwent RFA treatment were enrolled in this study. The patients were followed up for ten to twelve years after surgery, and the treatment efficacy and outcome of RFA were recorded. According to the clinical experience and literature, 12 relevant factors that may affect the therapeutic efficacy of RFA were selected, and the differences in survival curves of each subgroup were analyzed. The factors with differences in survival curves were incorporated into COX regression model to analyze the independent factors affecting the 10-year long-term survival of patients treated with RFA for hepatocellular carcinoma. Results The first complete ablation rate was 89.05% among 210 patients. No serious complications occurred after the operation. Most patients were discharged within 1 week after surgery. At the end of the follow-up, a total of 144 patients died and 32 patients relapsed; Univariate analysis suggested that the tumor number, tumor diameter, safe margin of ablation, whether the tumor is adjacent to a large blood vessel, the Child-Pugh classification, the first ablation effect, PLT, AFP, and BCLC grade were all associated with 10-year survival of HCC patients after RFA (P<0.05); COX multivariate analysis showed that tumor number, tumor diameter, ablation safety margin, and Chind-Pugh classification were independent factors affecting the 10-year survival of patients with hepatocellular carcinoma after RFA. Conclusion RFA has the advantages of minimal invasive and high efficiency in the treatment of hepatocellular carcinoma, while the long term efficacy is affected by the tumor number, tumor size, ablation safety boundary and child Pugh classification of liver function, so the treatment plan should be selected based on the patients' condition.
    The value of cone beam computed tomography in the transcatheter arterial chemoembolization therapy for primary and metastatic liver cancers
    YAO Huan, LIANG Chun-rui, HE Xiang-ling, ZHANG Jing, LIN Hong-li, ZHONG Hong-yi, WANG Fan, YANG Lin
    2020, 25(9):  926-929. 
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    Objective To explore the value of cone beam computed tomography (DynaCT) in transcatheter arterial chemoembolization (TACE) therapy for patients with primary or metastatic liver cancers. Methods One hundred and fifty-three patients with primary or metastatic liver cancers that received TACE surgery were studied. All patients were examined by spiral CT before operation, and DynaCT and digital subtraction angiography (DSA) during operation. The detection rates of common spiral computed tomography (CT), DSA and DynaCT for the focus of cancers, and the detection rates of DSA and DynaCT on the blood supply arterys of the focus of cancers was compared. The consistency between DSA and DynaCT in evaluating TACE embolization efficacy and actual embolization efficacy was analyzed. Results One hundred and fifty-eight tumor lesions were detected before operation, while 264 lesions were detected during DSA, and 427 lesions were detected during DynaCT. The average number of lesions detected by general spiral CT was significantly lower than that by DSA and DynaCT (P<0.001), and the average number of lesions detected by DSA was significantly lower than that by DynaCT (P<0.001). The detection rate of DSA for the arteries supplying the lesions was 56.44%, which was significantly lower than 87.12% of DynaCT (P<0.001). DynaCT performed embolization on 427 lesions, and 408 lesions (95.55%) were consistent with the actual embolization effect; DSA was used to evaluate the embolization effect of 264 lesions, and 205 lesions (77.65%) were consistent with the actual embolization effect. The consistency between the efficacy of TACE embolization evaluated by DSA and the efficacy of actual embolization was significantly lower than that of DynaCT (P<0.001). Conclusion DynaCT has important clinical application value in TACE therapy for liver cancers.
    A mechanism study on Sorafenib resistance mediated by NRF2/PI3K pathway with a human hepatoma cell line
    DUAN Jun-wei, NI Wen
    2020, 25(9):  930-932. 
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    Objective To investigate the involvement of NRF2/PI3K signaling pathway in sorafenib resistance with a liver cancer cell line SMMC-7721. Methods A SMMC-7721 drug-resistant cell line SMMC-7721-SR was first established by screening under ascendant concentrations of sorafinib. The cells were then transfected with NRF2 siRNA and treated with 10 μmol/L sorafenib for 48 h. Cells viability was detected by CCK-8 method. Apoptosis was detected by flow cytometry. The protein levels of NRF2, Keap1, ARE, p-PI3K and p-Akt were detected by Western blot. The mRNA levels of NRF2, Keap1, ARE, PI3K and Akt gene expression were detected by Real-Time quantitative PCR. Results Sorafenib significantly reduced the survival rate and promoted the apoptosis of SMMC-7721 cells (P<0.05). The promoting effect of Sorafenib on the cells apoptosis was more significant in SMMC-7721 cells when compared to the SMMC-77211-SR cells (P<0.05). The expression of NRF2 mRNA and protein in SMMC-7721-SR cells was significantly higher than that in SMMC-7721 cells, and the levels of Keap1, ARE, p-PI3K and p-Akt protein were significantly higher in SMMC-7721-SR cells (P<0.05). Sorafenib significantly upregulated NRF2 protein and mRNA expression in SMMC-7721 cells (P<0.05). After inhibiting the expression of NRF2 mRNA by specific siRNA, the survival rate of SMMC-7721-SR cells was significantly decreased, and the apoptosis rate was significantly increased, accompanied by decreases in the levels of Keap1, ARE, p-PI3K and p-Akt protein and mRNA expression in the cells after sorafenib treatment (P<0.05). Conclusion Sorafenib induces drug resistance in SMMC-7721 cells via activating NRF2. Inhibition of NRF2 may reverse the sorafenib resistance in SMMC-7721 cells.
    Effects of S-TACE combined with apatinib on tumor vascular factors, liver function and prognosis in patients with advanced primary liver cancer
    XU Xin-bao,YIN Jie, JI Hao-ming, QIAN Li
    2020, 25(9):  933-936. 
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    Objective To investigate the efficacy and safety of super-selective hepatic arterial chemoembolization (S-TACE) combined with apatinib in patients with advanced primary liver cancer (HCC). Methods In recent years, 72 patients with advanced HCC were divided into two groups. The control group was treated with S-TACE, and the observation group was treated with S-TACE combined with apatinib. The changes of tumor vascular inflammatory factors, liver function, therapeutic effect and safety indexes in the two groups were observed. Results Before treatment, the levels of tumor vascular factors such as VEGFR2, mmp-9 and caspase-8, as well as the levels of liver function indexes such as AFP-L3,ALT ,and LDH in the two groups were not statistically significant (P>0.05). After the treatment, the levels of tumor vascular factors and liver function indexes in the observation group were improved compared with those in the control group, which was statistically significant (P<0.05). The ORR and DCR in the observation group were higher than those in the control group, while MTTP and MOS were higher than those in the control group, which was statistically significant (P<0.05). There was no significant difference in the postembolization syndrome between the two groups (P>0.05). The adverse drug reactions in the observation group were higher than those in the control group, which was statistically significant (P>0.05). Conclusion For patients with advanced HCC, S-TACE combined with apatinib therapy can inhibit tumor angiogenesis, improve liver function, improve clinical benefit rate and provide high safety.
    Viral Hepatitis
    The efficacy of short-term treatment with Peg-interferon α for inactive hepatitis B surface antigen carriers with extremely low HBsAg levels
    ZHAO Hai-dong, CHEN Ling-feng, LIN Qiao-xin, LI Yi-fang
    2020, 25(9):  937-939. 
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    Objective HBsAg loss represents clinical cure of hepatitis B. The aim of the present study was to investigate the HBsAg loss rate in inactive hepatitis B surface antigen carriers (IHCs) with extremely low HBsAg levels after peg-interferon α-2b (Peg-IFNα) short-term treatment. Methods Thirty-eight cases of IHCs were included in this study. They were treatment-nave and the average baseline HBsAg level were less than 15 IU/mL. According to the patients' willingness, they were divided into Peg-IFNα treatment group (N=12 cases) or control group (N=26 cases). The Peg-IFNα treatment group was subcutaneously injected with 180 μg/week of Peg-IFNα-2b for 24 weeks. The control group were followed up without treatment for a median of 55.7 (25.3±79.2) weeks. SPSS 25.0 software was used for statistical analysis., Chi-square test was used to compare the difference in HBsAg loss rate and HBsAg seroconversion rate between the two groups. Logistic regression was used to analyze the correlation between baseline characteristics, Peg-IFNα treatment and HBsAg loss. Results At 24 weeks, 83.3% (N=10) IHCs in the Peg-IFNα treatment group achieved HBsAg loss and 41.6% (N=5) IHCs achieved HBsAg seroconversion. 7.7% (N=2) IHCs in the control group had HBsAg loss and HBsAg seroconversion rate was 0. The HBsAg loss rate and HBsAg seroconversion rate in Peg-IFNα treatment group were statistically higher than that of the control group (P<0.05). By univariate analysis it was found that Peg-IFNα treatment significantly increased HBsAg clearance of IHCs (OR=60.00, 95% CI: 7.39 - 487.14). Conclusion Peg-IFNα short-term treatment for IHCs with extremely low HBsAg levels may significantly improve HBsAg loss rate and HBsAg seroconversion rate.
    A study on the impact of vitamin D deficiency in patients with hepatitis B
    GAO Wen, YANG Xue, DOU Ai-hua, HUI Wei, LIU Mei, XU Bin, DUAN Zhong-ping
    2020, 25(9):  940-942. 
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    Objective To investigate the impact of vitamin D deficiency on the clinical parameters of patients with chronic hepatitis B (CHB), liver cirrhosis and hepatocellular carcinoma (HCC). Methods Ninety-one hepatitis B patients including 14 cases of CHB, 44 cases of cirrhosis, 33 cases of HCC and 13 healthy controls were collected in this study. Vitamin D was determined by liquid chromatography-mass spectrometry with isotope dilution. Parameters such as T lymphocyte subsets, liver function and virological indexes were detected simultaneously. Univariate and multivariate analyses were performed to analysis the association between vitamin D levels and the clinical parameters. Results The prevalence of vitamin D deficiency (defined as < 20 ng/mL) in the patients with liver cancer (96.97%) and cirrhosis (93.18%) was higher than that in the healthy controls (76.92%) and the patients with chronic hepatitis B (77.83%). The content of vitamin D in the healthy controls was 16.38±5.53 ng/mL, 15.06±4.91 ng/mL in the patients with chronic hepatitis B, 11.85±2.66 ng/mL in the patients with liver cirrhosis and 10.59±3.06 ng/mL in the patients with liver cancer. The Vitamin D levels were not different in these four groups in different seasons (P> 0.05). The vitamin D levels between the healthy control and the chronic hepatitis B groups, or between the cirrhosis and HCC groups were not different (P> 0.05). However, there was a significant difference in the vitamin D levels of the cirrhosis and HCC patients when compared with the healthy controls and the chronic hepatitis B patients (P<0.05), indicating that vitamin D levels were decreased in association with hepatitis B progression. There were also correlation between the Vitamin D levels with the clinical parameters of lymphocyte, hemoglobin, platelet, PTA, albumin, prealbumin, cholinesterase, T lymphocyte subsets (CD3+, CD3+ CD8+, CD45+), suggesting that vitamin D was associated with the synthesis and immune function of the livers. Conclusion Most of the patients with chronic hepatitis B viral infection have vitamin D deficiency. Vitamin D may be involved in regulating immune function of hepatitis B patients, and its deficiency is associated with the clinical progression. These results may provide insight for the research and treatment of CHB.
    Influence of intrahepatic cholestasis on liver stiffness measurement value
    YAN Hua, ZHENG Li-min, YANG Xiao-hong
    2020, 25(9):  943-945. 
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    Objective To investigate the significance of transient elastography in disease monitoring and treatment evaluation of intrahepatic cholestasis (IHC). Methods A total of 56 IHC patients, who were admitted to our hospital from April 2017 to June 2019, including 21 males and 35 females, aged (38.4±7.5) years, were enrolled. IHC diagnosis conforms to alkaline phosphatase >1.5 times the upper limit of normal value, gamma-glutamyltranspeptidase >3 times the upper limit of normal value, and imaging showing no bile duct dilatation. Measurement data [median (25th percentile, 75th percentile)] were analyzed by Kruskal-Wallis H test, and counting data (%) were analyzed by chi-square test. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency. Results IHC etiology includes 22 cases (39.3%) of autoimmune hepatitis, 12 cases (21.4%) of primary sclerosing cholangitis, 8 cases (14.3%) of drug induction, 6 cases (10.7%) of primary biliary cirrhosis and 8 cases (14.3%) of other causes (overlap syndrome, hepatolenticular degeneration, Budd-Chiari syndrome, EB virus infection and lymphoma). According to METAVIR score, the numbers of IHC patients with fibrosis stage (F) 0, F1, F2, F3 and F4 were 5 cases (8.9%), 9 cases (16.1%), 15 cases (26.8%), 11 cases (19.6%) and 16 cases (28.5%) before treatment, respectively, 14 cases (25.0%), 11 cases (19.6%), 9 cases (16.1%), 6 cases (10.7%) and 16 cases (28.5%) after treatment, respectively (P<0.05). The cut-off value, sensitivity, specificity and area under the ROC curve (AUC) of liver stiffness measurement (LSM) for IHC patients with METAVIR ≥F2 were 6.8 kPa, 98%, 50% and 0.77, respectively. The cut-off value, sensitivity, specificity and AUC for METAVIR ≥F3 were 9.2 kPa, 88%, 83% and 0.90, respectively. The cut-off value, sensitivity, specificity and AUC for F4 were 13.5 kPa, 91%, 98% and 0.93, respectively. The LSM value of IHC patients was [12.8 (9.0, 24.2)] kPa before treatment and [9.6 (5.2, 18.1)] kPa after treatment, with statistical difference (P<0.05). Conclusion Transient elastography is an effective method to evaluate the degree of liver fibrosis, disease severity and therapeutic response in patients with IHC, which has sufficient diagnostic value.
    The analysis of clinical characteristics of transfusion and non transfusion chronic hepatitis C virus infection
    WANG Fei, HU Jing, WANG Yi-ming
    2020, 25(9):  946-947. 
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    Objective To study the clinical characteristics of transfusion and non transfusion chronic hepatitis C virus (HCV) infection. Methods The clinical dataes of 84 patients with HCV infection were analyzed retrospectively,which accorded to the principle of parallel control trial.There were 42 cases were infected by blood transfusion among them, which was the observation group.The other 42 cases were non blood transfusion HCV infection, which was the control group.The basic demographic dataes and pathological characteristics of the two groups were compared, and the clinical characteristics of the patients with HCV infection were recorded. Results The age of patients in the observation group was significantly higher than that in the control group,the difference was statistically significant (P<0.05).There were no significant difference in gender, BMI, occupation and education between the two groups (P>0.05).The course of disease in the observation group was longer than that in the control group,the difference was statistically significant (P<0.05).There was significant difference in the distribution of HCV genotypes between the two groups (P<0.05).There was no significant difference in HCV load between the two groups (P>0.05). Conclusion There are significant differences in genotype distribution among patients with different routes of HCV infection.The patients who infected by blood transfusion has longer course of disease and the age is older.
    Liver Fibrosis & Cirrhosis
    Analysis of the incidence and prognosis of spontaneous portosystemic shunt in patients with cirrhosis
    WANG Tao, LI Mu-song, HAN Qiu-ran, LI Cai-hong, SUN Jing-wei
    2020, 25(9):  948-951. 
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    Objective To investigate the incidence and prognosis of spontaneous portosystemic shunt in patients with cirrhosis. Methods A total of 220 patients with cirrhosis complicated with portal hypertension admitted to our hospital from June 2017 to November 2018 were selected. All patients received the transjugular intrahepatic portosystemic shunt (TIPS), and patients with spontaneous portosystemic shunt received the coil, angiosclerotic agent or Amplatzer occlude. The incidence rate of spontaneous portosystemic shunt was recorded. The death and postoperative complications were also recorded during the postoperative 1-year follow-up. Results The incidence rate of spontaneous portosystemic shunt was 38.64% (85/220). In patients with spontaneous portosystemic shunt, the postoperative 1-year cumulative incidence rates of hepatic encephalopathy, ascites and upper gastrointestinal hemorrhage were 32.41%, 36.47% and 23.53%, respectively. The stent patency rate decreased to 78.82% 1 year after operation. The postoperative 1-year mortality had no significant difference between patients with and without spontaneous portosystemic shunt (P> 0.05). The postoperative 1-year cumulative incidence of hepatic encephalopathy of patients with spontaneous portosystemic shunt had no difference with that of patients without spontaneous portosystemic shunt (32.41% vs 21.48%, P> 0.05). The history of hepatic encephalopathy was an independent risk factor for hepatic encephalopathy within 1 year after TIPS (P<0.05). Conclusion In this study, the incidence of spontaneous portosystemic shunt in cirrhotic patients with portal hypertension was 38.64%. TIPS combined with occlusion can effectively reduce portal pressure. Moreover, the incidence of hepatic encephalopathy within 1 year after operation is related to the history of hepatic encephalopathy before operation.
    The application value of TIPS combined with GCVE in the treatment of portal hypertension complicated with massive upper gastrointestinal hemorrhage
    WANG Ning, LIN Fang-ming, LV Ming
    2020, 25(9):  952-954. 
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    Objective To study the clinical value of transjugular intrahepatic portosystemic shunt (TIPS) and gastric coronary vein embolization (GCVE) in the treatment of portal hypertension with massive upper gastrointestinal hemorrhage. Methods Seventy-four patients with portal hypertension and massive upper gastrointestinal hemorrhage in our hospital were selected as study subjects. There were 37 cases undergoing TIPS and GCVE in the observation group, and 37 cases treated with splenectomy and pericardial devascularization in the control group. The postoperative complications were compared between the 2 groups. The international normalized ratio (INR), serum albumin, total bilirubin (TBIL) and fibrinogen (Fib) levels before and after operation were compared between the 2 groups. The postoperative thrombosis and 1-year rebleeding rate were recorded. Results There were no significant differences in the levels of albumin, INR, TBIL and Fib between the 2 groups(P> 0.05). There were no significant differences in the incidences of postoperative ascites, postoperative pain, incision infection and lung infection between the 2 groups (P> 0.05). There were significant differences in the incidence of postoperative hepatic encephalopathy and 1-year rebleeding rate between the 2 groups (P < 0.05). In the observation group, there was significant difference in the incidence of hepatic encephalopathy among patients with different liver function grades after operation (P<0.05). Conclusion The TIPS combined with GCVE has similar efficacy to splenectomy plus pericardial devascularization in the treatment of portal hypertension with massive upper gastrointestinal hemorrhage. The 1-year rebleeding rate after TIPS combined with GCVE is lower, but the risk of postoperative hepatic encephalopathy is higher.
    Risk factors for cirrhotic cardiomyopathy in patients with hepatitis B-associated cirrhosis
    WU Wen-jie, JIANG Li-ping, WANG Hong-yan, CHEN Ruan-qin, CHEN Ming-sheng
    2020, 25(9):  955-958. 
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    Objective To investigate the influencing factors of cirrhotic cardiomyopathy (CCM) in patients with hepatitis B-associated cirrhosis and to prevent CCM as soon as possible. Methods With strict inclusion and exclusion criteria, 45 hepatitis B-associated cirrhosis patients complicated with CCM who were hospitalized in our hospital from February 2013 to July 2015 were selected as the case group, and 100 patients without CCM in the same period were selected as the control group. A case-control study was conducted. Independent-sample t test was used to analyze the measurement data obeying normal distribution, Mann-Whitney U test was used to analyze the measurement data with non-normal distribution, χ2 test was used to analyze the counting data, and multivariate logistic regression analysis was used to evaluate the effect of various factors on CCM in hepatitis B-associated cirrhosis patients. Results The Child-Pugh grade [odds ratio (OR)=3.794, 95% confidence interval (CI): 1.320~10.901], the model for end-stage liver disease (MELD) score (OR=1.218, 95% CI: 1.107~1.341), age (OR=1.079, 95% CI: 1.034~1.125) and hemoglobin (Hb) (OR=0.978, 95% CI: 0.962~0.994) were statistically significant variables affecting the development of CCM in patients with hepatitis B-associated cirrhosis. Conclusion Child-Pugh grade, MELD score, Hb and age are independent risk factors for CCM in hepatitis B-associated cirrhosis patients.
    Other Liver Diseases
    Clinical analysis of 30 patients with hepatic tuberculosis
    WANG Xiao-juan, LIANG Shu-hui, LIU Qing
    2020, 25(9):  959-960. 
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    Objective To summarize the clinical characteristics, examinations and diagnosis of hepatic tuberculosis. Methods The clinical data of patients with hepatic tuberculosis treated in our hospital from January 2000 to January 2020 were retrospectively analyzed. Results Among the 30 patients with hepatic tuberculosis, there were 24 cases with fever, 19 cases with obscure pain in the right upper abdomen, 21 cases with abdominal distension, and 22 cases with weight loss of 3-7 kg. Laboratory examinations showed 17 cases with anemia, 9 cases with decreased leukocyte, 11 cases with increased leukocyte, 20 cases with increased erythrocyte sedimentation, 14 cases with increased adenosine deaminase and 11 cases with increased lactate dehydrogenase. There were 18 T cell spot test positive cases and 13 purified protein derivative skin test positive cases. Liver function test indicated that all patients had different degrees of liver dysfunction. Imaging examinations showed various types of intrahepatic lesions. In the 30 patients, there were 23 cases pathologically diagnosed by ultrasound-guided liver biopsy, and 2 cases pathologically diagnosed by surgery. Conclusion Hepatic tuberculosis has diverse clinical manifestations, with lack of specific diagnostic laboratory indicators. Therefore, its diagnosis needs comprehensive analysis. Imaging combined with liver histopathological examination is the main method to diagnose hepatic tuberculosis.
    Prognostic analysis of neonatal intrahepatic cholestasis caused by citrin deficiency
    LI Jing, XIONG Li-jing, DU Li-na, JIANG Mao-lin, YANG Jing, XIE Xiao-li
    2020, 25(9):  961-964. 
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    Objective To investigate the clinical and laboratory features, gene mutations and prognosis of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD). Methods Six NICCD patients diagnosed by gene detection from January 2017 to December 2019 in our department were enrolled. Clinical data of these patients were collected and analyzed. Results The average birth weight of the 6 patients was 2.95 kg, and all of them experienced disease onset in infant period. The chief complaints were repeated jaundice (4/6), growth retardation (1/6) and abdominal distension (1/6). Laboratory data showed that all the 6 patients had increased aspartate aminotransferase, γ-glutamyl transferase, alkaline phosphatase, total bilirubin, direct bilirubin and total bile acid. Most had increased alanine aminotransferase (3/6), increased lactic acid (2/2), increased alphafetoprotein (3/3), decreased albumin (1/6) and prolonged activated partial thromboplastin time (2/4). Mutations were found in SLC25A13 gene, which included c.852-855del, c.615+5G>A, c.1177+1G>A, IVS16ins3kb, c.1362C>G, 1210G>T, and c.1660-c.1661insGAGATTACAGGTGGCTGCCCGGG. After feeding with lactose-free and medium-chain triglyceride-rich formula, liver function improved 24 days later and normalized completely within 1 year in 5 of the infants. Another case had cirrhosis, ascites and liver failure, accompanied by infection at first visit and finally gave up treatment. The average follow-up age was 1 year and 9 months. All of them had the preference for a high protein and high fat diet. Conclusion NICCD should be taken into account in the etiology of infant cholestasis. Early visit and early genetic testing are helpful in early diagnosis. Most Children with NICCD have good prognosis after diet intervention, and long-term follow-up is required.
    Clinicopathological characteristics of patients with overlapping syndrome of autoimmune hepatitis and primary biliary cholangitis
    ZHANG Mei-qin, SHEN Lan-chao, CHEN Guo-feng, LV Chun
    2020, 25(9):  965-967. 
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    Objective The serum biochemical indexes, autoantibodies and liver histopathological manifestations of patients with autoimmune hepatitis (AIH)- primary biliary cholangitis (PBC) overlap syndrome were recorded, and the clinical pathological characteristics of these patients were analyzed. Methods From June 2016 to June 2019, 78 clinically diagnosed autoimmune liver disease (AILD) patients in our department were selected, including 32 AIH patients (AIH group), 24 PBC patients (PBC group)and 22 patients with AIH-PBC overlap syndrome (AIH-PBC group). The measurement data are expressed as (±s) and the comparison between groups is analyzed by t test. Counting data are expressed as percentages, and chi-square test is used for comparison between groups. Results ALP in AIH-PBC group [(412.4±226.4) U/L] was significantly higher than that in AIH group [(108.2±68.1) U/L](P<0.05). GGT in AIH-PBC group [(430.5±152.8) U/L] was significantly higher than that in AIH group [(118.7±65.2) U/L] (P<0.05). IgM in AIH-PBC group [(5.2±1.7) g/L] was significantly higher than that in AIH group [(2.5±0.8) g/L](P<0.05). ALT in AIH-PBC group [(182.6±68.1) U/L] was significantly higher than that in PBC group [(98.7±45.7) U/L]. AST in AIH-PBC group [(174.9±70.2) U/L] was significantly higher than that in PBC group [(104.6±52.4) U/L]; IgG in AIH-PBC group [(19.5±6.6) g/L] was significantly higher than that in PBC group [(15.2±1.9) g/L]. AMA expression in patients in AIH-PBC group(72.7%) was significantly higher than that in AIH group (0%) (P<0.05). The expression of AMA M2 in patients (100%) in AIH-PBC group (100%) was significantly higher than that in AIH group (0%) (P<0.05). SMA expression in AIH-PBC group (72.7%) was significantly higher than that in PBC group (16.7%)(P<0.05). ANA expression in patients (90.9%) in AIH-PBC group was significantly higher than that in PBC group (12.5%) (P<0.05). Conclusion Serum biochemical indexes, autoantibodies and liver biopsy pathological manifestations of patients in AIH-PBC group have the characteristics of AIH and PBC diseases, while the differences in serum biochemical indexes and autoantibody detection levels can be used as the basis for distinguishing AIH-PBC overlap syndrome.
    Clinical study of ERCP combined with praziquantel in the treatment of hepatic fluke infection complicated with biliary obstruction
    DENG Yan, WU Fan, CHEN Lu-bin, LI Ning-ning, KOU Wei-wei, WANG Yun
    2020, 25(9):  968-971. 
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    Objective To investigate the clinical effect of ERCP combined with praziquantel in the treatment of hepatic fluke infection complicated with biliary obstruction. Methods The clinical data of 33 patients with liver fluke disease complicated with biliary obstruction admitted to our hospital from January 2016 to January 2018 were retrospectively analyzed at the same time as the clinical data of 33 patients with liver fluke infection and biliary obstruction previously admitted to our hospital. Among them, 33 cases received ERCP combined with praziquantel treatment, 33 cases received ERCP surgery, and all patients received anti-tremoria treatment after admission. Compare the data of surgical success rate and postoperative complications, length of hospital stay, hospital expenses of the two groups, compare the alanine aminotransferase(ALT), gamma-GGTP (gamma glutamyl transpeptidase) (GGT), total bilirubin (TBIL) and alkaline phosphatase (ALP) levels before and after treatment in the two groups. In addition, statistics on the occurrence of adverse reactions after ERCP surgery combined with praziquantel. Results There was no significant difference between the two groups in effective rate, length of stay and cost of stay (P>.05). Before treatment, there was no significant difference in ALT, GGT, ALP and TBil between the two groups (P>0.05). After treatment, the levels of ALT, GGT, ALP and TBil decreased in the two groups, but there was no significant difference between the two groups (P>0.05). After treatment, the levels of ALT, GGT, ALP and TBil in the two groups showed a downward trend, and the intra-group comparison difference was significantly lower than that before treatment, with statistically significant differences (P<0.05). There was no significant difference in the total incidence of postoperative complications between the two groups (P>.05). Headache, dizziness and tachycardia occurred in 1 case after ERCP combined with praziquantel, and no obvious adverse reactions were observed in ERCP group. Headache and dizziness were mild reactions, which were relieved by themselves without special treatment. Tachycardia improved after symptomatic treatment. Conclusion ERCP combined with praziquantel for the treatment of liver fluke infection complicated with biliary tract obstruction is safe and effective, which can eliminate the biliary tract obstruction and kill the liver fluke at the same time, and can improve the liver function of patients, which is worthy of clinical application.
    Effect of Liraglutide on ERS in T2DM and NAFLD patients and its clinic efficacy
    GAO Lan, LIU Hai-wei, LIN Lu, CHEN Kai-ning
    2020, 25(9):  972-974. 
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    Objective To detect the effect of Liraglutide on endoplasmic reticulum stress (ERS) in type 2 diabetes mellitus(T2DM) and non-alcoholic fatty liver disease(NAFLD) patients and analyze its clinic efficacy. Methods A total of 144 patients were enrolled in this study. Who were divided into: control group(n=72) and observation group(n=72). The control group was given metformin(0.5 g/time, 2 times/d for 12 weeks). The observation group was given Liraglutide (0.6 mg/d for 1 weeks, 1.2 mg/d for 11 weeks ). CHOP, ATF6, and GRP78 mRNA expression was detected by realtime PCR. The clinical efficacy and adverse reactions rate was compared. Results After treatment, the expression of FBG, 2hPBG, HbA1c, HOMA-IR, TG, TC, and LDL-C was significantly lower in observation group than that in control group (P<0.05). The 2-△△Ct values of CHOP, ATF6, and GRP78 was significantly lower in observation group than that in control group (P<0.05). The clinic effective rate in observation group was 81.9%(59/72), which was lower than that of 62.5%(45/72) in control group (P<0.05). The adverse reactions rate was 2.8%(2/72) in control group and 4.2%(3/72) in observation group. There was no significant difference between the two groups (P>0.05). Conclusion Liraglutide can inhibit ERS to decrease blood glucose and lipid in T2DM combined with NAFLD patients, with effectively clinical efficacy and safety.
    Application of FibroScan technique combined with serum osteocalcin in postmenopausal women with nonalcoholic fatty liver disease
    ZHANG Jin, ZHANG Hai
    2020, 25(9):  975-977. 
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    Objective The purpose of this study was to evaluate the degree of hepatic steatosis in postmenopausal women with nonalcoholic fatty liver disease (NAFLD) by measuring hepatic fat decay by FibroScan and serum osteocalcin (OC). Methods From Jan. 2016 to Mar. 20, 2016 postmenopausal women with NAFLD were admitted and their age was (45.0±8.2) years old. NAFLD was based on the guidelines for diagnosis and treatment of non-alcoholic Fatty liver Disease (revised in 2010). The Spearman correlation coefficient is used to evaluate the correlation, the ROC curve is drawn to evaluate the diagnostic efficiency, and the diagnostic cutoff point is determined when the Jordan index reaches its maximum. Results Among the postmenopausal women with NAFLD, there were 27 cases of stage S0, 46 cases of stage S1, 35 cases of stage S2 and 18 cases of stage S3. The CAP values of FibroScan in each stage were (208.4±32.6) dB/m, (221.5±40.4) dB/m, (265.4±37.1) dB/m, (311.5±50.4) dB/m, respectively, and the serum OC values in each stage were (23.1±2.4) ng/ml, (21.8±2.9) ng/ml, (20.4±1.8) ng/ml, (18.2±2.0) ng/ml, respectively. Correlation analysis showed that the stage of hepatic steatosis in postmenopausal women with NAFLD was positively correlated with CAP (r=0.38, P<0.05), but negatively correlated with serum OC (r=0.27, P<0.05). The AUROC, cut-off point, sensitivity and specificity of serum OC in the diagnosis of hepatic steatosis in postmenopausal women with NAFLD were 0.84,20.9 ng/mL, 84.8% and 83.6%, respectively. AUROC, cut-off point, sensitivity and specificity were 0.85, 255.8dB/m, 76.0% and 90.4%, respectively. After combined diagnosis, the AUROC, sensitivity and specificity were 0.90,88.2% and 92.6%, respectively. Conclusion The measurement of serum OC and FibroScan is of high value in the diagnosis of hepatic steatosis in postmenopausal women with NAFLD, and the diagnostic efficiency is further improved after the combined diagnosis of CAP and CAP.
    Quantitative detection of fatty liver in children by real-time shear wave elastography
    HE Mei-qing, HAN Lei, PENG Jian-mei, GAO Yan-hua, REN Yuan, GUAN Xiang-ping, WANG Juan
    2020, 25(9):  978-981. 
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    Objective To study the value of real-time shear wave elastography (SWE) in quantitative detection of nonalcoholic fatty liver disease (NAFLD) in children. Methods 96 children with NAFLD admitted to our hospital from January 2019 to September 2019 were selected as the observation group, and 124 normal children as the control group. The Young's modulus of liver was measured by SWE technique.Young's modulus and serum alanine aminotransferase and glutamic oxaloacetic aminotransferase levels were compared between the two groups. The relationship between Young's modulus and severity of NAFLD and liver function indexes was analyzed, and the predictive value of Young's modulus for children's NAFLD was judged. Results The young's modulus of the observation group was significantly lower than that of the control group (P<0.05), and the serum GPT and GST were significantly higher than that of the control group (P<0.05).Serum alanine aminotransferase and glutamic oxaloacetic aminotransferase were positively correlated with Young's modulus in children with NAFLD (r=0.322, 0.467, P= 0.000, 0.000).Among 96 cases of NAFLD, 32 cases were mild NAFLD, 31 cases were moderate NAFLD and 33 cases were severe NAFLD.The young's modulus of mild NAFLD was significantly higher than that of moderate NAFLD and severe NAFLD (P<0.05), and the young's modulus of moderate NAFLD was significantly higher than that of severe NAFLD (P<0.05).Young's modulus has a certain predictive value for children's NAFLD, and the area under the curve is 0.895. Conclusion SWE plays an important role in assessing the severity of NAFLD and its lesions in children, and can be used for early screening of NAFLD in children.
    Effects of intrahepatic cholestasis of pregnancy on liver function, inflammatory cytokines and fetal outcome
    ZHANG Yan-wei, YANG Rui, YUE Xin, HAN Guo-rong, WANG Gen-ju
    2020, 25(9):  982-985. 
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    Objective To investigate the effects of intrahepatic cholestasis of pregnancy (ICP) on liver function, inflammatory cytokines and fetal outcomes. Methods Between August 2014 and August 2019, there were 96 patients with ICP (ICP group), with an average of (29.5±1.3) years old. ICP accorded with the Diagnostic criteria of ICP in Obstetrics and Gynecology (7th edition). Another 100 patients with normal pregnancy were selected in the same period (control group). There was no significant difference in age, pregnancy and cesarean section between the two groups (P>0.05). T-test comparison of measurement data and χ2 test comparison of counting data. Results Serum bile acid (TBA), ALT and AST in ICP group were (35.9±5.8) μmol/l, (70.7±6.1) u/l and (86.0±7.9) u/l, which were significantly different from those in control group (4.7±1.1) μmol/l, (16.0±4.1) u/l and (14.6±4.2) u/l, respectively) (P<0.05). Hs-CRP, IL-6 and TNF-α in ICP group were (13.5±0.6)mg/L/l, (0.7±0.1) ng/l and (142.0±7.9)ng/L/l, which were significantly different from those in control group (8.4±0.4) mg/l, (0.4±0.1) ng/l and (82.6±5.2) ng/l, respectively) (P<0.05). The neonatal weight, gestational week, Apgar score at 1 minute of birth, amniotic fluid turbidity, intrauterine distress and neonatal jaundice in ICP group were (2860.4±30.5) g, (36.2±1.2) weeks, (8.2±0.3) minutes, 33 cases (34.4%), 12 cases (12.5%) and 28 cases (29.2%), Compared with the control group [3205.8±40.2)g, (38.6±1.2) weeks, (9.4±0.4) minutes, 7 cases (7.0%), 4 cases (4.0%) and 8 cases (8.0%)] there was significant difference (P<0.05). Conclusion ICP patients have abnormal liver function and higher inflammatory cytokines than normal patients. compared with normal patients, ICP patients have a higher incidence of fetal adverse outcome, which should be paid more attention to in clinic.
    Correlation between blood oxygen saturation and abnormal liver function in patients with new coronavirus pneumonia
    REN Jian-feng, ZHANG Yu-ping, SHAO Jing, ZHANG Qi-sheng, GAO De-yong, WANG Xiao-jin
    2020, 25(9):  986-989. 
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    Objective To analyze the correlation between blood oxygen saturation and liver function abnormalities and clinical treatment in patients with COVID-19 novel coronavirus pneumonia. Methods Observe the incidence of abnormal liver function in 74 patients with confirmed COVID-19 new coronary pneumonia compared with mild/normal (46 cases) and severe/critical (28 cases) patients, as well as blood oxygen saturation and liver function biochemical indicators before and after treatment. Analyze the correlation between blood oxygen saturation and changes in biochemical indicators of liver function in patients as well. Results There were significant differences in oxygen saturation(96.52±1.68 VS 87.61±2.99), ALT(39.69±25.35 VS 57.25±37.89)、AST(61.00±17.66 VS 36.83±16.30)、LDH(61.00±17.66 VS 36.83±16.30) between mild/moderate and severe/critical patients (P<0.05);In the patients with abnormal liver function, blood oxygen saturation returned to normal after treatment, and liver function was restored to different degrees in both groups. ALT(66.82±21.65 VS 42.47±18.46)、AST (61.00±17.66 VS 36.83±16.30)、LDH(309.46±58.92 VS 218.38±45.12)of mild/normal patients, and ALT (93.54±21.06 VS 49.54±19.75), AST (57.93±14.22 VS 33.80±11.28)、LDH (329.79±54.78 VS 257.50±90.59) of severe/critical patients were significantly improved (P<0.05);In the correlation analysis with oxygen saturation, ALT, AST, r-GT and LDH were negatively correlated with oxygen saturation (P<0.05). Conclusion Low blood oxygen saturation in patients with new coronary pneumonia is closely related to abnormal liver function, and the restoration of blood oxygen saturation is helpful to improving liver function.
    Analysis of the effect of simvastatin on drug metabolic enzymes in liver based on Cocktail probe drug assay
    LI Song, CHEN Jun
    2020, 25(9):  990-993. 
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    Objective To analyze the effect of simvastatin on the activity of CYP450 in liver by using Cocktail probe drug method, and to provide reference for drug interaction research and promote rational drug use in clinic. Methods The specific probe substrates corresponding to the subtypes of CYP450 enzyme were selected and UPLC-MS was used to determine the drug concentration of the probe drug in plasma. The pharmacokinetic parameters were calculated by DAS 3.0. The effect of simvastatin on CYP450 activity was evaluated by comparing the pharmacokinetic parameters of probe substrates in blank control group and simvastatin group. Results Compared with the blank control group, the AUC of fenacetin in simvastatin group decreased, the AUC of tolbutamide, chlorzoxazone and testosterone increased, and the main pharmacokinetic parameters of omeprazole and metoprolol had no significant difference compared with the blank control group. Conclusion Simvastatin can induce the activity of CYP1A2 in rats, inhibit the activity of CYP2C9, CYP2E1 and CYP3A4, but has no significant effect on the activity of CYP2C19 and CYP2D6.
    A preliminary study on the molecular mechanism of microRNA-27a inhibiting lipid metabolism of hepatic stellate cells
    XU Zi-xin, LUO Xin, LUO Sheng-zheng, XU Ming-yi, LIN Ren-kun
    2020, 25(9):  994-997. 
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    Objective To investigate the molecular mechanism of microRNA27a inhibiting the lipid metabolism of hepatic stellate cell. Methods LX2 cells were stimulated by palmitic acid (PA), the expression level of miR-27a was tested by PCR; After Overexpression of miR-27a, lipid deposition of LX2 cells was tested by oil red staining.The mRNA expression of FAS and SCD1 was verified by qPCR. C57BL/6 mice were randomly divided into two group: high-fatty diet with CCL4 group(HFD+CCL4) and low fatty diet with CCL4 (LFD+CCL4). The pathological changes of liver tissues in mice were detected by hematoxylin eosin (HE) and Sirius red staining. Besides, qPCR was applied to detect the relative expression of microRNA27a and the mRNA expression of FAS and SCD1 in different group. Results Comparing with the control group,the expression of miR27a in LX2 cell in experimental group decreased after stimulated by PA; In the mouse model ,the expression of miR27a in HFD with CCL4 group also decreased, compared with LFD with CCL4 (P<0.05).Compared with blank control group, lipid deposition in LX2 cells of overexpressing miR-27 a was significantly reduced as well as the mRNA expression of FAS and SCD1, however, the expression of FAS and SCD1 in HFD with CCL4 group were increased (P<0.05). Conclusion MiR-27a can inhibit the lipid synthesis of hepatic stellate cells, reduce liver lipid deposition and delay the development of liver fatty change by inhibiting the expression of FAS and SCD1.This provides a new thought for the treatment of nonalchoholic fatty liver disease.