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Table of Content

    28 February 2021, Volume 26 Issue 2
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    Liver Failure
    Clinical characteristics and prognosis of hepatitis B-related acute liver failure
    LAI Man, LIU Hai-xia
    2021, 26(2):  118-120. 
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    Objective To study on the clinical characteristics and prognosis factors of hepatitis B-related acute liver failure.Methods A total of 14 cases with hepatitis B-related Acute Liver Failure (ALF) were collected from January 2010 to January 2020. They were divided into the survival group and the dead group based on their outcomes. Their clinical features and laboratory examinations were collected and analyzed by SPSS statistic software. Results Within the 14 cases of Hepatitis B-related ALF, 7 (50%) patients were cure and 7 (50%) patients died. The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total Bilirubin (TBIL) and HBV DNA did not differ obviously between these two groups at admission. However, there were significant difference in blood ammonia (NH3) level, grades of hepatic encephalopathy, and prothrombin time activity (PTA) (P<0.05).Conclusion Acute hepatitis B-related acute liver failure is one of the rare critical clinical conditions, which have the features of acute onset, quick progression and high mortality. The degree of hepatic encephalopathy, high serum ammonia level and decreased PTA at admission may indicate a poor prognosis.
    A clinical analysis of 121 cases of HIV/AIDS patients complicated with acute-on-chronic liver failure
    RUAN Jun,YIN Heng, KOU Guo-xian, YANG Rui-xi, YANG Cheng-bin
    2021, 26(2):  121-124. 
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    Objective To analyze the clinical characteristics of human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) patients complicated with acute-on-chronic liver failure (ACLF), for improving standardized diagnosis and treatment of these conditions.Methods The clinical data of 121 HIV/AIDS patients complicated with ACLF were retrospectively analyzed. Results Among the 121 HIV/AIDS patients with ACLF, 93 cases (76.9%) were middle-aged males, and 85 cases (70.2%) were from rural areas. HIV infection was mainly transmitted through heterosexual contact in 71 cases (58.7%), and through intravenous drug abuse in 48 cases (39.7%). Sixty-seven cases (55.4%) of ACLF were caused by hepatitis C virus (HCV) infection and 61 cases (50.4%) were due to hepatitis B virus (HBV) infection. Ninety-five cases (78.5%) were C-type in clinical classification. Fifty-two cases (42.9%) was in advanced stage. The common clinical manifestations of these patients including jaundice in 121 cases (100.0%), fatigue and anorexia in 109 cases (90.1%), nausea and oil aversion in 101 cases (83.5%), abdominal distension in 97 cases (80.2%), abdominal pain in 82 cases (67.8%), hypoalbuminemia (ALB＜25 g/L) in 78 cases (64.5%), and hematemesis or hematochezia in 65 cases (53.7%). Complications of ACLF that occurred in these patients including ascites in 89 cases (73.6%), electrolyte disturbance in 83 cases (68.6%), spontaneous peritonitis in 81 cases (66.9%), pulmonary infection in 77 cases (63.6%), sepsis in 69 cases (57.0%), upper gastrointestinal bleeding in 62 cases (51.2%). In laboratory examination, alanine aminotransferase (ALT) and total bilirubin (TBIL) levels in liver function test significantly increased, and international normalized ratio (INR) in coagulation function elongated. Meanwhile, the level of procalcitonin and the total number of leukocyte in peripheral blood elevated. The CD4+T lymphocyte count (＜200/μL) was found to significantly decrease in 51 cases (42.1%) and HIV viral load (＞1000 copies/mL) was high in 59 cases (48.8%). The results of abdominal color ultrasound examination were varied without specificity.Conclusion The phenomenon of HIV/AIDS patients complicated with ACLF in Liangshan prefecture is prominent, with individual features in different clinical stages. It is essential to further strengthen the early monitoring and intervention of abnormal liver function in HIV/AIDS patients.
    Beclin1 and miRNA-130a expression correlated with the prognosis of patients with HBV-related acute-on-chronic liver failure
    CHEN Chong-gao, FU Hou-xuan, WANG Xiao-zhi, XIE Hui-zhong
    2021, 26(2):  125-127. 
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    Objective To explore the correlation between the autophagy-related protein (Beclin1) and miRNA-130a and the prognosis of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (HBV-ACLF).Methods The clinical data of 132 HBV-ACLF patients were retrospectively analyzed. They were divided into a survival group (65 cases) and a death group (67 cases) according to the survival status after admission for 6 months. 62 healthy people were selected as the normal control group during the same period of time. Serum Beclin1 and miRNA-130a levels were detected in all people in three groups. Receiver operating characteristics (ROC) curves were used to analyze the diagnostic value of these two parameters for HBV-ACLF patients. Results The serum level of Beclin1 in the death group was significantly higher than that in the survival group and the normal control group (P<0.05), and the serum level of Beclin1 in the survival group was significantly higher than the normal control group (P<0.05). Similarly, the expression of serum miRNA-130a in the death group and survival group was significantly higher than that in the normal control group (P<0.05). However, the expression of serum miRNA-130a in the death group was significantly lower than that in the survival group (P<0.05). According to ROC curve analysis, it was found that Beclin1 and mirna-130a had certain diagnostic value for the prognosis of HBV-ACLF patients. The area under the curve (AUC) was 0.811 and 0.836, the sensitivity was 0.791 and 0.851, and the specificity was 0.800 and 0.815, respectively.Conclusion Serum Beclin1 and miRNA-130a are closely associated with the prognosis of HBV-ACLF patients, which should be further investigated in clinical practice.
    Viral Hepatitis
    Analysis of gender disparity of viral markers and liver function indicators in chronic hepatitis B patients
    FANG Zhong, WANG Cong, HUANG Yu-xian, CHEN Liang, ZHANG Yi
    2021, 26(2):  128-130. 
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    Objective To clarify the sex disparity of chronic hepatitis B in seum viral markers and liver function parameters.Methods Clinical informations from 155 chronic hepatitis B (CHB) patients were analyzed in this retrospective study. HBeAg or HBeAb, HBsAb, HBcAb and HBV DNA in different genders were compared between the cases with and those without HBeAg seroconversion. The relationship between HBsAg levels and liver injury Indicators including alanine aminotransferase (ALT), aspartate aminotransferase (AST) and glutamyl transpeptidase (GGT), and other serological markers such as total bilirubin (TB), albumin (ALB), globin (GLB), prothrombin time (PT), international normalized ratio (INR) and platelet count (PLT). Results In HBeAg-negative patients, the serum levels of HBsAg and HBV DNA in males were significantly higher than in females. When analysis the correlation of these clinical indicators with HBsAg, it was found that HBsAg positively correlated with HBV DNA in males and in HBeAg positive females. In addition, there are a negative correlation between HBsAg and TB, PT or AST in HBeAg positive males.Conclusion Gender disparity is not only presented in viral markers, but also in other serological indicators in CHB patients.
    The correlation between CYP2E1 and CYP1A1 genotypes with the susceptibility of HBV infection in northern Guangzhou people
    HONG Xiao-lv, XU Pei-yan, PAN Xiao-ping
    2021, 26(2):  131-135. 
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    Objective To analyze the association between CYP2E1 and CYP1A1 genotypes with the susceptibility of HBV infection in northern Guangzhou people.Methods 150 patients with HBV infection were enrolled as the experimental group and 150 healthy cases were selected as the control group. The polymorphisms of rs3813867 and rs2031920 in CYP2E1 gene, and rs4646421 and rs2198843 in CYP1A1 gene were detected in all people by snapshot. The frequencies of the distributions of the genotypes were compared between these two groups. Clinical data of alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyl transpeptidase (GGT), total bilirubin (T-Bil), alpha fetoprotein (AFP) and HBV DNA were collected and analyzed for their relationship with significance mutation genotypes. Results Hardy-Weinberg equilibrium was found in both groups (P>0.05).The frequencies of rs4646421 and rs2198843 genotypes of CYP1A1 gene in experimental group were not significantly different between two groups (P>0.05), the frequencies of rs3813867 and rs4646421 genotypes of CYPE1 gene in experimental group were significantly different between two groups (P<0.05); At rs3813867 locus, the risk of hepatitis in individuals with CC genotype was 5.59 times higher than those with GG genotype. At rs2031920 locus, the risk of developing hepatitis in individuals with TT genotype was 3.57 times higher than those with CC genotype,but the frequencies of rs3813867 and rs4646421 genotypes in CYPE1 gene had no significant difference among all clinical indicators (all P>0.05).Conclusion Rs3813867 and rs4646421 of CYPE1 gene but not rs4646421 and rs2198843 in CYP1A1 gene were associated with the susceptibility of HBV infection in northern Guangzhou people.
    Efficacy of propofenofovir combined with fosinopril in the treatment of hepatitis B-related IgA nephropathy
    LAI Hua-mei, WANG Jun, WANG Hong
    2021, 26(2):  136-139. 
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    Objective To compare the treatment effects of propofenofovir combined with fosinopril and entecavir combined with fosinopril on patients with hepatitis B-related IgA nephropathy.Methods Seventy-two patients with hepatitis B-related IgA nephropathy were enrolled in this study, They were divided into two groups based on which treatment regime of antiviral drugs they received. Thirty-five patients in group A were treated with propofol combined with fosinopril, while 37 patients in Group B was treated with entecavir combined with fosinopril. The therapeutic effects were compared at 12 and 24 weeks after treatments. Results In the initial comparison between the two groups, there was no significant difference in gender, average age, 24-hour urine protein quantity, serum albumin, proportion of urine occult blood, systolic blood pressure, diastolic blood pressure, urinary protein creatinine ratio, urea nitrogen, serum creatinine (SCR), LG HBV DNA quantitation. After 12 weeks of treatment, 24-hour urine protein (0.45±0.15 vs. 0.69±0.17, t=-6.208, P<0.01), serum albumin (t=2.799, P<0.01), and the proportion of patients with positive HBV DNA (20% vs. 43.2%, χ2 = 4.470, P<0.01) in group B patients were significantly higher than those in group A (P<0.01). Similarly, there was no significant difference in systolic blood pressure, diastolic blood pressure, SCR, urinary occult blood (> 2 +) and urea nitrogen, Lee grade III and above in group A and group B patients at their baselineeline levels. After 24 weeks of treatment, 24-hour urinary protein quantitation (0.13±0.06, vs 0.23±0.08, t=-5.565, P<0.01), serum albumin (t=4.673, P<0.01), systolic blood (t=-5.704, P<0.01), systolic blood pressure (t=-5.704, P<0.01), diastolic blood pressure (t=-2.657, P=0.010), SCR (69.76±22.00, 84.08±18.76,t=-2.986, P<0.01), proportion of patients with positive LG HBV DNA quantitation (8.6% vs 27%, 27%, 27%, 27%, χ2=-4.141, P=0.042), proportion of patients with Lee grade III and above (8.6% vs 29.7%, χ2=3.878, P=0.049) were significant different between the two groups.Conclusion Compared with entecavir combined with fosinopril in the treatment of hepatitis B-related IgA nephropathy, propofenofovir combined with fosinopril has better consequence in reducing urine protein and controlling blood pressure of patients. It is necessary to further extend the follow-up time to confirm the long-term treatment effect.
    Liver Fibrosis & Cirrhosis
    A prospective cohort study on the clinical characteristics and risk factors of long-term prognosis in patients with decompensated cirrhosis due to different etiologies
    DU Jing-yuan, YAN Hua-dong
    2021, 26(2):  140-146. 
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    Objective To study on the clinical characteristics and risk factors of long-term prognosis of patients with decompensated cirrhosis due to different etiologies.Methods Six hundred and forty-three patients with decompensated cirrhosis were prospectively enrolled in this study. Clinical data and laboratory indicators were collected in all patients for identifying the etiologies of liver diseases. The relationship between different etiologies with long-term prognosis were compared and the impact factors for long-term prognosis were analyzed by COX survival. Results Of the 643 patients with decompensated cirrhosis, 235 died in 2 years and the mortality was 36.5%. The 2-year mortality rate of HBV related cirrhosis, hepatitis B combined with alcoholic cirrhosis, alcoholic cirrhosis, other etiologies, and cryptogenic cirrhosis was 28.7% 45.0% 40.2% 42.7% and 53.2%, respectively (P value <0.05). Compared with HBV-related cirrhosis, patients with alcoholic cirrhosis were older, male predominant, and higher in 2-year mortality. The cirrhotic patients with unknown etiologies were the oldest, female in majority, with higher incidence of bacterial infection, and the worst long-term prognosis. Univariate COX regression analysis shown that age, mean arterial pressure (MAP), diabetes, previous decompensation, etiology, ascites, upper gastrointestinal bleeding, bacterial infection, hepatic encephalopathy, aspartate aminotransferase (AST), albumin (ALB), total Bilirubin (TBIL), International normalized ratio (INR), serum sodium, white blood cell count (WBC), creatinine (Cr), platelet count (PLT) and the prognostic models were associated with the 2-year mortality. By multivariate COX regression analysis it was found that age, etiology, serum sodium, platelet, albumin and Model for end-stage liver disease (MELD) score were independent risk factors of 2-year mortality in decompensated cirrhosis.Conclusion Patients with HBV related decompensated cirrhosis have the best whereas those with cryptogenic cirrhosis have the worst long-term prognosis. Age, etiology, serum sodium level, platelet count, albumin level, and MELD score are independent risk factors for the long-term prognosis in patients with decompensated cirrhosis.
    The clinical significance of liver reserve function for evaluating the severity of esophageal and gastric varices in patients with liver cirrhosis
    WANG Yu, DONG Chun-ling, YU Yi-li, GU Hong-tu, ZHAO Chang-qing, MU Yong-ping, YUAN Ji-li, LV Jing, TAO Yan-yan, LIU Cheng-hai
    2021, 26(2):  147-150. 
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    Objective To explore the clinical value of liver reserve function and portal vein diameter (PVD) in predicting the severity of esophageal gastric varices (EGV) in patients with liver cirrhosis.Methods The clinical data of 151 patients with liver cirrhosis were retrospectively analyzed. All patients underwent gastroendoscopic examination. They were then divided into no or mild esophageal varices group, and moderate or severe esophageal varices group referred to the "Trial Scheme for Endoscopic Diagnosis and Treatment of Gastrointestinal Varicose Veins and Bleeding (2009)", "Baveno Ⅵ Consensus (2015)", "Central Hypertension Esophageal Varicose Hemorrhage Guidelines for Prevention and Treatment (2015). The relationship between the degree of EGV and Indocyanine green elimination rate (ICG-K) and Indocyanine green retention test (ICG-R15) was analyzed. Measurement data that conformed to the normal distribution were expressed as mean±standard deviation ($\bar{x}$±s), and the comparison between two groups was performed with T test or analysis of variance. Median and interquartile intervals were used for measurement data that didn’t meet the normal distribution [M (P25 ~ P75)], and the comparison between two groups was performed with the rank sum test. The comparison of count data between groups was performed using the χ2 test, and those who did not meet the χ2 test conditions used Fisher's exact test. Factor analysis was performed using a binary logistic regression model, and OR values of risk factors and 95% of OR values were calculated. Results Among the indexes related to liver reserve function with no or mild EGV, ICG-R15, PVD, Chid-Pugh-score, model for end-stage liver disease (MELD) score, total bilirubin (Tbil), prothrombin time (PT), and international normalized ratio (INR) were lower than those in the moderate or severe EGV group. ICG-K value, The EHBF, Alb, PLT, and APRI scores of no or mild EGV group were greater than those of moderate or severe EGV group, and the difference between the two groups was statistically significant (P<0.05). Among them, ICG-K, ICG-R15, PVD, Chid-Pugh-scores are independent risk factors for moderate or severe esophageal and gastric varicose veins and the EGV severity is positively correlated (OR values ??are 0.003, 1.111, 1.591, 4.669, P values (Both <0.05). The AUC for predicting no or mild EGV and moderate or severe EGV is 0.116, 0.877, 0.773, 0.746, respectively. Further analysis of ICG-R15's diagnostic cutoff value for the diagnosis of moderate or severe EGV is 19.650%, and its sensitivity The specificities were 0.729 and 0.955, respectively.Conclusion Liver reserve function, namely ICG-K, ICG-R15, Chid-Pugh score and PVD are independent risk factors for moderate or severe EGV. ICG-R15 has good diagnostic value for predicting the grade of moderate or severe EGV. It can therefore be used as a supplementary reference for further invasive gastroscopic evaluation.
    Analysis of prognostic factors for hepatorenal syndrome in patients with liver cirrhosis
    HAO Sha-sha, YAO Jia, YUAN Li-li
    2021, 26(2):  151-154. 
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    Objective To investigate the prognostic factors for hepatorenal syndrome (HRS) in patients with cirrhosis.Methods Ninety-seventy HRS patients admitted to our hospital from January 2019 to December 2019 were divided into a survival group and a death group. Multivariate logistic regression was used to analyze the factors affecting the 28-day prognosis of patients. Results HRS survival rate during hospitalization was 24.74%. The alanine aminotransferase, serum total bilirubin, total bile acid, and the model of end-stage liver disease (MELD) score in the death group were 56.00 (31.60, 114.00) IU/L, 141.51 (51.20, 328.93) μmol/L, 67.21 (28.40, 133.76) μmol/L and 27.00 (20.00, 34.00), respectively, significantly different from 38.00 (21.00, 56.00) IU/L, 45.30 (20.11, 75.00) μmol / L, 27.86 (17.26, 42.10) μmol/L and 18.00 (15.50, 24.50) in the survival group (P<0.05). HRS classification, infection, MELD score and hepatic encephalopathy were related to prognosis (P<0.05). Multivariate logistic regression showed that infection (OR=5.291, P=0.048), MELD score (OR=1.105, P=0.017) and hepatic encephalopathy (OR=0.066, P=0.000) were independent factors affecting prognosis. Furthermore, the receiver operating characteristic curve of MELD score for predicting death showed that the cut-off value of MELD score was 26.50 (P=0.001).Conclusion By analyzing the data of 97 patients, many common clinical indicators are related to the prognosis of HRS. Controlling infection, improving liver and kidney function and preventing hepatic encephalopathy play the crucial roles in improving the prognosis of HRS.
    Factors influencing prognosis for cirrhotic patients with esophagogastric variceal bleeding within 1 year after endoscopic variceal ligation
    ZHANG Sheng-yan, HUANG Hong-chun, WANG Xiu-min
    2021, 26(2):  155-158. 
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    Objective To study factors influencing prognosis for cirrhotic patients with esophagogastric variceal bleeding within 1 year after endoscopic variceal ligation (EVL).Methods Three hundred and twenty-four cirrhotic patients with esophagogastric variceal bleeding receiving EVL from November 2017 to December 2018 were followed up for at least 1 year. Readmission for hemorrhage and death were regarded as poor prognosis. The multivariate logistic regression analysis was used to define factors influencing prognosis of patients, and a nomogram was developed to predict poor prognosis. Results All the patients were followed up for 12 to 25 months. Forty-six patients with poor prognosis were enrolled as observation group, the other 278 patients as control group. The incidence of poor prognosis was 14.2%. In observation group, there were 5, 10 and 31 patients classified as Child-Pugh grade A, B and C. In control group, there were 103, 120 and 55 patients classified as Child-Pugh grade A, B and C. The average diameter of varicose veins was (1.1±0.4) cm in observation group, and (0.8±0.5) cm in control group. There were significant differences in Child-Pugh grade and varicose vein diameter between the 2 groups (P<0.05). The hemoglobin of (78.6±10.0) g/L in observation group, was significantly lower than (85.4±8.9) g/L in control group (P<0.05). The total bilirubin (TBil) and γ-glutamyltranspeptidase were (42.8±4.9) μmol/L and (76.4±24.1) U/L in observation group, significantly higher than (27.3±5.2) μmol/L and (37.9±14.8) U/L in control group (P<0.05). The Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease score and model for end-stage liver disease includes serum sodium (MELD-Na) score were (9.4±2.3), (10.8±2.2) and (11.2±2.5) in observation group, significantly higher than (7.8±3.1), (8.7±3.0) and (9.6±2.4) in control group (P<0.05). The multivariate logistic regression analysis showed that Child-Pugh grade [odds ratio (OR)=2.181, 95% confidence interval (CI): 1.475-3.225], TBil (OR=1.789, 95%CI: 1.241-2.579), CTP score (OR=2.518, 95%CI: 1.763-3.596) and MELD-Na score (OR=1.484, 95%CI: 1.084-2.032) were risk factors for poor prognosis in cirrhotic patients with esophagogastric variceal bleeding (P<0.05). The concordance index of nomogram to predict poor prognosis was 0.630.Conclusion The prognosis in cirrhotic patients with esophageal variceal bleeding within 1 year after EVL is related to liver function and MELD-Na score. The nomogram has high accuracy in predicting prognosis.
    Mechanism of METTL14 promoting liver fibrosis
    ZHANG Jun-pei, CHEN Yin, SHEN Dan-jie, LIU Hai-ling, TIAN Yi, CHEN Shi-yao
    2021, 26(2):  159-161. 
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    Objective To study the effect of methyltransferase?like 14 (METTL14) on the proliferation and activation of hepatic stellate cells (HSCs).Methods The expression of METTL14 in transforming growth factor beta 1 (TGF-β1) treated HSCs was detected by quantitative reverse transcription polymerase chain reaction (RT-qPCR). In HSCs with overexpression of METTL14, the abilities of proliferation and migration were analyzed by MTT assay and transwell migration assay, and the expression of collagen type I (COL I) and alphas-smooth muscle actin (α-SMA) was analyzed by RT-qPCR and Western blot. Results The expression of METTL14 in HSCs was up-regulated to about 2.8-fold after co-cultivation with TGF-β1. The absorbance of HSCs after 48 hours in culture of co-culture group (0.730±0.047) was significantly higher than that of control group (0.533±0.022, P<0.05). And the number of migrating cells (186±42.75) was also significantly larger than that of control group (97±7.00, P<0.05). RT-qPCR showed that the relative expression levels of COLI and α-SMA in cells with overexpression of METTL14 (2.48±0.31, 3.36±0.43) were significantly higher than those in control group (1.00±0.26, 1.00±0.24, both P<0.05). Western blot showed that the protein expression levels of COLI and α-SMA in co-culture group were also significantly higher than those in control group.Conclusion METTL14 promotes hepatic fibrosis by enhancing the proliferation and activation of hepatic stellate cells.
    Liver Cancer
    The value of diffusion-weighted imaging for evaluating short-term efficacy of cyber knife in the treatment of small hepatocellular carcinoma
    YU Hai-long, SHI Fang-fang, CAI Jian-ming, ZHANG Jian-zeng, HU Hai-dong, ZHENG Zeng, DONG Jing-hui
    2021, 26(2):  162-166. 
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    Objective To investigate the value of diffusion-weighted imaging (DWI) for evaluating short-term efficacy of cyber knife in the treatment of small hepatocellular carcinoma.Methods Twenty-three patients (24 lesions) diagnosed with small hepatocellular carcinoma in our hospital from February 2017 to December 2017 were enrolled. All the 23 patients underwent non-enhanced magnetic resonance imaging (MRI) scans and DWI scans of the liver before cyber knife, 1 month, 3 months and 6-12 months after cyber knife; as well as dynamic contrast-enhanced MRI scans of the liver before treatment, 3 months and 6-12 months after treatment. According to the modified response evaluation criteria in solid tumors, the complete necrosis and residual activity of tumor 6-12 months after cyber knife were assessed. The apparent diffusion coefficient (ADC) values of residual active tissue, necrosis in tumor and normal liver tissue at different times were measured. Paired t test was used to compare ADC values of tumor necrosis lesions and normal liver tissues before and after treatment, and receiver operating characteristic (ROC) curve was used to evaluate the efficacy of ADC values in predicting complete tumor necrosis after treatment. Results Among the 24 lesions, 23 lesions were completely necrotic, and active tissues were found in 1 lesion after treatment. The ADC values of the completely necrotic tumor tissues 1 month and 3 months after treatment were higher than that before treatment, with statistical difference (P<0.05). There were no statistically significant differences in ADC of normal liver tissue 1 month or 3 months after treatment compared with that before treatment (P>0.05). The area under the ROC curve of ADC value for predicting the complete necrosis in tumor tissues after cyber knife was 0.830. And the cut-off value of ADC was 1.29×10-3 mm2/s, with sensitivity of 85.7% and specificity of 47.6%.Conclusion The ADC value helps to distinguish the necrotic component from the active component of small hepatocellular carcinoma 1 month after cyber knife, and can be used to evaluate the short-term efficacy of cyber knife in small hepatocellular carcinoma.
    A comparative study of radiofrequency ablation and microwave ablation combined with radiotherapy in the treatment of primary hepatocellular carcinoma with portal vein tumor thrombus
    LIN Chuan, WANG Qiu, YOU Xin
    2021, 26(2):  167-170. 
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    Objective To compare the effect of radiofrequency ablation and microwave ablation combined with radiotherapy on primary hepatocellular carcinoma with portal vein tumor thrombus.Methods One hundred patients who had primary hepatocellular carcinoma with portal vein tumor thrombus treated in Yibin secong people's hospital and West China Hospital from November 2016 to November 2017 were randomly divided into a radiofrequency ablation group and a microwave ablation group. The radiofrequency ablation group was treated with radiofrequency ablation combined with radiotherapy, while the microwave ablation group was treated with microwave ablation combined with radiotherapy. The ablation points and time of 2 groups were recorded. The levels of glutamyl transpeptidase (γ-GT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), hyaluronidase (HA), laminin (LN), type Ⅲ procollagen (PC Ⅲ), fibrinogen (FIB) and T lymphocyte subsets, prothrombin time (PT) and activated partial thromboplastin time (APTT) were detected. The therapeutic effects and adverse reactions were compared. Results The ablation time of microwave ablation group was shorter than that of radiofrequency ablation group (P<0.05). After treatment, the levels of γ-GT, ALT, AST, HA, LN and PC Ⅲ in the microwave ablation group were lower than those in the radiofrequency ablation group, PT and APTT were shorter than those in the radiofrequency ablation group, and the level of FIB was higher than that in the radiofrequency ablation group (P<0.05). After treatment, the levels of CD3+ and CD4+ in the microwave ablation group were higher than those in the radiofrequency ablation group, and the level of CD8+ was lower than that in the radio frequency ablation group (P<0.05). The total effective rate of microwave ablation group was higher than that of radiofrequency ablation group (P<0.05). The complication rate of microwave ablation group was slightly lower than that of radiofrequency ablation group, but there was no significant difference between the 2 groups (P>0.05).Conclusion Microwave ablation combined with radiotherapy can improve the liver function, coagulation function, immune function and liver fibrosis in the patients with primary hepatocellular carcinoma and portal vein tumor thrombus.
    The relation of peripheral blood levels of T lymphocyte subsets and NK cell to recurrence and metastasis in patients with primary liver cancer after operation
    HE Qing, LI Yang, JIANG Li-hang, DENG Pan-pan, LIU Wei, LIAO Yu-fei
    2021, 26(2):  171-174. 
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    Objective To analyze the correlation of peripheral blood levels of T lymphocyte subsets and natural killer (NK) cell with recurrence and metastasis in primary liver cancer patients after operation.Methods The retrospective analysis was performed. Fifty-eight patients with primary liver cancer undergoing hepatectomy in our hospital from March 2017 to March 2019 were enrolled. All patients were divided into a recurrence and metastasis group (21 cases) and a non-recurrence and metastasis group (37 cases) according to postoperative follow-up. The peripheral blood of patients was collected, and the levels of T lymphocyte subsets and NK cell of the 2 groups were detected and compared. The regression analysis was performed to analyze the correlation of each index with recurrence and metastasis. Results The levels of CD3+, CD3+/CD4+, NK cell in recurrence and metastasis group were lower than those in non-recurrence and metastasis group, and the level of CD3+/CD8+ in recurrence and metastasis group was higher than that in non-recurrence and metastasis group (P<0.05). CD3+ level had no relation to postoperative recurrence and metastasis in patients with primary liver cancer. The levels of CD3+/CD4+, CD3+/CD8+ and NK cell may be the influencing factors for recurrence and metastasis (P<0.05).Conclusion Patients with primary liver cancer have immune dysfunction in different degrees. The immune dysfunction may be related to the postoperative recurrence and metastasis, which deserves clinical attention.
    The value of gamma-glutamyl transpeptidase to platelet ratio index in predicting acute liver function deterioration after transarterial chemoembolization
    MEI Bao-fu, DENG Zhi-feng, ZHENG Lan, LIN Dui-xian
    2021, 26(2):  175-178. 
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    Objective To investigate the value of gamma-glutamyl transpeptidase to platelet ratio index (GPRI) in predicting acute liver function deterioration (ALFD) in patients with primary liver cancer after transarterial chemoembolization (TACE).Methods The clinical data of 141 primary liver cancer patients treated with TACE in our hospital from June 2015 to December 2019 were retrospectively analyzed. The patients were divided into ALFD group and control group. The t test and χ2 test were used to compare the clinical data between 2 groups. The predictive value of Child-Pugh score and GPRI was assessed by receiver operating characteristic (ROC) curve. Results The Child-Pugh score and GPRI of ALFD group were significantly higher than those of control group. The area under the ROC curve (AUC) and cut-off value of Child-Pugh score were 0.774 and 6. The AUC of GPRI were 0.784 and 2.02. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Child-Pugh score were 58.8%, 88.8%, 60.6%, 87.0% and 80.8%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of GPRI were 73.5%, 78.5%, 52.1%, 90.3% and 77.9%, respectively. GPRI > 2.02 was risk factor for ALFD.Conclusion GPRI is valuable in predicting ALFD after TACE. It is safe to receive TACE when pre-operation GPRI ≤ 2.02, which is helpful for evaluating the risk of ALFD in Child-Pugh B patients.
    The research of the expression of HCV RNA and core protein in the tissues of HCV-related hepatocellular carcinoma with bile duct tumor thrombus
    ZHANG Bo, ZHANG Yu-fen
    2021, 26(2):  179-181. 
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    Objective To study the clinical significance of the expression of hepatitis C virus (HCV) RNA and core protein in the tissues of hepatitis C virus (HCV)-related hepatocellular carcinoma.Methods Fifty-four patients of HCV-related hepatocellular carcinoma were included as the research subjects,the positive rates of HCV RNA and HCV core protein in the patients of HCV-related hepatocellular carcinoma of cancer tissue and paracancerous tissue were detected.The positive rates of HCV RNA and HCV core protein between cancer and adjacent tissues were compared,the positive rates of HCV RNA and HCV core protein in cancer tissues of patients with different stages and differentiation were compared. Results There was significant difference in the positive rate of HCV RNA between cancer tissue and adjacent tissue (P<0.05).There was significant difference in the positive rate of HCV core protein between cancer tissue and adjacent tissue (P<0.05).The distribution of HCV RNA positive rate and HCV core protein positive rate in the patients of HCV related hepatocellular carcinoma was consistent (Kappa value=0.951,P=0.000).The positive rate of HCV RNA was significantly different in different pathological stages (P<0.05).The positive rate of HCV RNA in different differentiated cancer tissues was significantly different (P<0.05).The positive rate of HCV core protein was significantly different in different stages (P<0.05).The positive rate of HCV core protein in different differentiated cancer tissues was significantly different (P<0.05).Conclusion The positive rate of HCV RNA and core protein are related to the occurrence of HCV-related hepatocellular carcinoma.It is helpful to the diagnosis and treatment of HCV-related hepatocellular carcinoma by monitoring the content of HCV RNA and core protein.
    Other Liver Diseases
    Clinical features of adult patients with chronic active Epstein-Barr virus infection
    SHI Dong-mei, LIU Yun-ye, WANG Wei-jing, XIANG Xiao-gang
    2021, 26(2):  182-186. 
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    Objective To investigat the clinical features of adult-onset chronic active Epstein-Barr virus infection(CAEBV)and to provide a basis for the diagnosis and treatment of CAEBV.Methods The clinical data of 41 adults with CAEBV from January 2008 to December 2019 was analyzed retrospectively, including onset, clinical manifestation, EBV DNA, EBV antibodies, cytokines, EBER in situ hybridization, treatment and follow-up results. Results Among the 41patients with CAEBV, the male to female ratio was 1.2∶1(22 males and 19 females), and the median age was 42 years(15-75 years). According to the analysis of the onset of the patients, 38 cases (92.7%), 36 cases (87.8%), 35 cases (85.4%) and 28 case (68.3%) of the patients presented intermittent fever, accompanied by lymph node enlargement, splenomegaly and hepatomegaly, with the most common involvement of the digestive, respiratory and blood systems. Life-threatening complications included 9 cases (21.9%) of hemophagocytic syndrome, 5 cases (12.2%) of liver failure, 4 cases (9.8%) of ARDS caused by interstitial pneumonia, and 3 cases (7.3%) of malignant lymphoma. The mean value of serum EBV DNA in 41 CAEBV patients was 104.3copy/ml. Eleven of the 41 cases (26.8%) died within 3 months. The platelet counts (53.3±29.2)×109/L vs(88.1±36.7)×109/L in death group was significantly lower than survival group (t=3.055, P ±0.01). At the same time serum TBil levels(141.4±78.5)μmol/L vs(61.3±34.4)μmol/L,AST(210.5±99.6)IU/L vs(78.8±89.2)IU/L,LDH(864.6±478.6)IU/L vs (445.2±337.5)IU/L,ferritin(1933.9±166.7)ng/mL vs(687.5±103.8)ng/mL, IL-2R(5 253.6± 736.4)U/L vs(1 989.0± 131.5)U/L,IL-10(486.1±125.7)pg/mL vs(151.2 ±232.5)pg/mL in death group were all significantly higher than survival group(t=-3.759、-3.542、-4.715、-6.672、-3.965 and -3.452,all P<0.01).Conclusion The study reveals that CAEBV in adult patients has a severe clinical course and prognosis is poor. Lower thrombocytopenia and higher TBil、AST、LDH、ferritin、IL-2R and IL-10 might potentially be risk factor for a poor prognosis. EBV loads should be measured and tissue should be stained on hybridization (EBER) if a patient presents with the known symptoms of CAEBV.
    The predictive value of serum A-FABP for diagnosis of NAFLD
    WEN Qian, WANG Xiao-ye, ZHAO Li, ZHANG Zhe, LI Wu-liang, ZHAO Shu-guang, TAO Mei
    2021, 26(2):  187-191. 
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    Objective To explore the predictive value of serum adipocyte fatty acid-binding protein (A-FABP) for the diagnosis of non-alcoholic fatty liver disease (NAFLD).Methods Eighty-six cases of NAFLD (NAFLD group) patients and 86 healthy adults (control group) were enrollled. Age, gender, height, weight, BMI, waist circumference were assessed. The level of serum TC, TG, HDL-C, LDL-C, FPG, ALT, AST, γ-GT, UA, hsCRP, A-FABP, TNF-α were measured. The receiver operating characteristic curve (ROC curve) was plotted, the NAFLD threshold of A-FABP was calculated, the predictive efficacy was verified, and the correlation between A-FABP and TNF-α was analyzed. Results Compared with the control group, the height, weight, waist circumference, BMI, TG, TC, LDL-C, FPG, ALT, AST, γ-GT, UA, hsCRP, the level of serum A-FABP and TNF-α in the NAFLD group were increased(P<0.05), while HDL-C were decreased significantly (P<0.01). When the A-FABP cutoff value was 82.43 pg/mL, the diagnostic sensitivity of NAFLD was 97.7%, the specificity was 93.0%, the positive predictive value was 93.3%, the negative predictive value was 97.6%, the overall coincidence rate was 95.3%, and the consistency test statistic Kappa was 0.907. The spearman or pearson correlation analysis revealed that the A-FABP level was positively correlated with TNF-α, UA and BMI, while was negatively correlated with HDL-C (P<0.05). Multiple linear regression showed that TNF-α and UA were independent factors affecting A-FABP.Conclusion A-FABP play important roles in the liver function impairment and inflammatory response, and is a good serum predictor for NAFLD with a cutoff value of 82.43 pg/mL.
    Analysis of the relationship between basic diseases and prognosis of pyogenic liver abscess
    ZHANG Yan, CHEN Bei-fang, ZHU Xiao-hong, LIU Da-da, WANG Jian-bin, DONG Xiao-feng, LIANG Dong
    2021, 26(2):  192-194. 
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    Objective To analyze the relationship between basic diseases and prognosis in patients with pyogenic liver abscess (PLA).Methods One hundred and fifty-three patients with PLA admitted to the NO.988 Hospital of Joint Logistic Support Force from January 2015 to January 2020 were selected as the research objects. According to the associated basic diseases, they were divided into group A (diabetes group), group B (biliary group), group C (diabetes + biliary group) and group D (other factors) for retrospective study to understand the correlation between them and prognosis. Results Klebsiella pneumoniae and Gram-positive bacteria were the main pathogens in group A and group D, the focus was single and the prognosis was better; group B and group C were mainly E.coli due to biliary factors, the focus was often multiple and the prognosis was poor, the difference was statistically significant (P<0.05).Conclusion When PLA occurs, it is helpful to know the state of basic diseases in detail, to make treatment plan and to judge prognosis.
    The role of IL-6 in the pathogenesis of hepatopulmonary syndrome in rats
    WANG Li-guo, GUO Yue-ning, LIU Nan-nan
    2021, 26(2):  195-198. 
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    Objective To establish a rat model of hepatopulmonary syndrome(HPS), isolate and culture pulmonary endothelium, and elucidate the role and mechanism of IL-6 in the pathogenesis of hepatopulmonary syndrome in rats.Methods We established a rat model of Hepatopulmonary Syndrome, isolated and cultured rat lung Endothelium, and studied the effects of IL-6 on cell proliferation and related signaling pathways by PCR and Western blot. Results HPS rat model was established by common bile duct ligation. Liver cirrhosis and HPS were induced in 4~6 weeks. The manifestations of HPS were listlessness, yellowing of urine, bradykinesia, dyspnea, hypoxemia and increased concentration of plasma nitric oxide, ultrasound showed that the bile duct was dilated and the membrane of the liver was uneven. 6w rats were sacrificed to observe the formation of hepatic fibrous bands and the dilatation of hepatic pseudolobule and pulmonary microvessels; The expression of IL-6 in HPS was significantly higher than that in tumor necrosis factor-α, IL-8 and IL-1, P<0.05; The results showed that IL-6 could promote the proliferation of lung endothelium and inhibit the apoptosis of PMVECs induced by lipopolysaccharide (LPS), the main mechanism is through activating JAK2/STAT3 signal pathway.Conclusion IL-6 can activate JAK2/STAT3 signal transduction pathway, promote the proliferation of PMVECs, and then affect the occurrence of HPS.
    Establishment and management of biobank for unknown etiology liver disease
    SONG Jin-yun, ZHAO Hong-yu
    2021, 26(2):  199-201. 
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    Objective To explore the construction method of biobank, sample data management and quality control of stored samples.Methods Plasma, buffy coat and peripheral blood mononuclear cells (PBMC) samples from patients who were diagnosed as unknown etiology liver disease during July 2018 and June 2019 in the Second Hospital of Nanjing, Nanjing University of Chinese Medicine were harvested, coded and stored in -80 ℃ refrigerator or liquid nitrogen. The full-time staff of the biobank log in the system of Nanjing multi center biological sample database to input the clinical information and sample coding information of the donors. Samples were randomly selected for the extraction and identification of DNA and RNA. Results Up to June 2019, a total of 2 007 samples were collected, including 1 625 plasma samples, 333 buffy coat samples and 49 PBMCs samples. In addition, the quality of DNA and RNA of 5 buffy coat samples were detected. All random samples were in accordance with the quality standards of samples and could meet the requirements of the following studies.Conclusion A biobank of unknown etiology liver disease and standardized biobank operation and management procedures were established, which can provide experimental samples and detailed clinical data for further study of unknown etiology liver disease.