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    31 March 2021, Volume 26 Issue 3
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    The association between antinuclear antibody titers with the clinical features and prognosis of drug induced liver injury
    WANG Yan, WANG Yu, WANG Lan, TIAN Qiu-ju, YANG Rui-yuan, LI Ke-xin, LIU Li-wei, LU Yi-da, WANG Xiao-ming, WANG Yu, OU Xiao-juan, JIA Ji-dong, ZHAO Xin-yan
    2021, 26(3):  237-242. 
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    Objective To study the clinical characteristics and outcomes of patients with drug-induced liver injury (DILI) and different titers of antinuclear antibodies (ANA). Methods The clinical and prognostic data of DILI patients who were hospitalized in Liver Research Center, Beijing Friendship Hospital, Capital Medical University from January 2009 to January 2019 were collected. They were divided into ANA negative, titers of 1:80, 1:160 and ≥ 1:320 groups. The clinical manifestations, laboratory indexes, and prognosis among each group were compared. ANOVA test, Kruskal Wallis H test was used for continuous variables. Chi Square test was used for categorical variables. Bonferroni correction was used for multiple comparisons. P<0.05 was statistically significant. Results A total of 602 patients was enrolled, with 177 in ANA negative group, 281 in ANA 1:80 group, 99 in ANA 1:160 group, and 45 cases in ANA ≥ 1:320 group. The majority of patients were female (76.8%-87.9%), and the median age was 56.0 years old. There was no significant difference in the peak value of alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), glutamyl transpeptidase (GGT) and total bilirubin (TBIL) among these four groups of patients. However, with the increase of ANA titer, serum albumin (Alb) (37.2 ± 5.5g/L, 36.5 ± 5.0 g/L, 36.2 ± 5.1 g/L, 34.6 ± 4.9 g/L in these four groups, respectively, P=0.030) and prothrombin activity (PTA) (86.1 ± 22.9%, 82.5 ± 23.5%, 78.6 ± 24.1%, 75.7 ± 27.4%, P=0.016) significantly decreased, whereas serum globulin (GLB) (27.5 ± 4.6 g/L, 29.5 ± 5.2 g/L, 29.2 ± 5.8 g/L, 32.3 ± 6.4 g/L, P<0.001) and Immunoglobulin G (IgG) [1240.0 (1080.0, 1420.0)mg/dL, 1380.0 (1140.0, 1670.0) mg/dL, 1440.0 (1180.0, 1840.0) mg/dL, 1740.0 (1380.0, 2110.0) mg/dL, P=0.001] significantly increased. The proportion of connective tissue diseases increased successively along with the increased titers of ANA (0.6%, 2.8%, 5.0%, 13.3%, respectively, P<0.001). The hospitalization time also significantly prolonged, which were 11.0 (8.0, 14.0) days, 11.0 (8.0, 14.0) days, 12.0 (9.0, 15.0) days and 15.0 (10.0, 20.0) days, respectively (P<0.001). The proportion of normalization of liver biochemical indexes decreased, whereas the proportion of progression of chronicity, cirrhosis, death or liver transplantation significantly increased (P=0.006). Conclusion Higher ANA titer in DILI patients is associated with an increase of connective tissue diseases, prolonged hospitalization time, impaired liver synthetic function, worsened immune function, less normalization of liver biochemical indexes. It is also related to significant progression of chronicity, cirrhosis, death or liver transplantation. Our data suggests that the higher titer of ANA, the worse of outcomes of DILI patients, which warrant clinical awareness.
    Analysis of 162 cases of drug-induced liver injury
    WANG Tao, WANG Xue-wei, JIANG Yuan-ye, CAO Qin, JI Guang
    2021, 26(3):  243-246. 
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    Objective To explore the medication situation and clinical characteristics of patients with drug-induced liver injury (DILI), to provide auxiliary judgment for clinicians. Methods The general information of 162 patients with DILI admitted in our hospital from 2018 to 2019 was collected, and clinical data including drugs previously used, clinical characteristics, laboratory data, and statistical analysis. Results Of the 162 patients with DILI, 60 were male (37%) and 102 were female (63%), with the majority in the 40-80 age group, accounting for 141(87%). Among the drugs that caused DILI, we found that Chinese patent medicines and Chinese medicine decoctions occupied the first place, among which Shouwu, Tripterygium wilfordii, Zongzi, Gukang capsules, and Xianling Guzhen capsules were the majority. Antitumor drugs and tuberculosis drugs were mostly used. Among 162 patients, fatigue was the most common in 117 cases (72.2%), followed by anorexia in 86 cases (53.1%) and urinary yellow in 67 cases (41.4%). Hepatocyte injury type was the most common type of DILI, and grade 1 liver injury was the most, accounting for 112 cases (69.1%). The differences in ALT, AST, ALP, and γ-GT levels among the three types of hepatocyte injury, cholestasis, and mixed types were statistically significant [318.50 (177.50-724.00)U/L vs 117.50 (67.00-231.50)U/L vs 321.00 (187.75-747.75)U/L, P=0.000; 223.50 (118.75-490.75)U/L vs 132.50 (69.00-206.75)U/L vs 224.00 (123.94-670.00)U/L, P=0.043; 190.00 (122.00-281.75)U/L vs 289.50 (263.00-507.00)U/L vs 347.00 (249.00-560.5)U/L, P=0.000; 164.50 (89.50-242.25)U/L vs 309.00 (143.50-506.00)U/L vs 283.00 (191.50-574.00)U/L, P=0.000]. In addition, the ALT, AST, APK, TB, and length of hospital stay of DILI patients caused by Chinese medicine were significantly higher than those of western medicine group [423.00 (238.00-728.50)U/L vs 190.00 (97.00-311.00)U/L, P=0.000; 345.00 (151.25-613.75)U/L vs 139.00 (82.65-223.00)U/L, P=0.000; 274.50 (207.75-355.25)U/L vs 220.00 (126.00-306.00)U/L, P=0.009; 66.5 (19.25-114.75)μmol/L vs 17.00 (11.00-33.00)μmol/L, P=0.000; 20 (15-24.75) vs 13.00 (9.00-17.00), P=0.000]. Conclusion DILI was more common in middle-aged and elderly women; and fatigue was the most obvious clinical manifestation of DILI patients. Whether it was herbal medicine or western medicine-mediated DILI, liver cell injury types were mostly; compared with western medicine, traditional Chinese medicine could cause liver damage more.
    Significance of NGAL-based model in early diagnosis and differential diagnosis of acute kidney injury in cirrhotic patients
    YIN Wei, LI Cheng-zhong
    2021, 26(3):  247-251. 
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    Objective To clarify the significance of early detection of neutrophil gelatinase-associated lipocalin (NGAL) in the diagnosis of acute kidney injury (AKI) in cirrhotic patients and the significance of NGAL-based model in differentiating the types of AKI. Methods A total of 804 patients with decompensated cirrhosis were included in the study. 213 patients (26.5%) were hospitalized with AKI or had AKI at admission. Once AKI occurred, the patients were diagnosed and treated according to the new ICA(International-Club of Ascites)-AKI guidelines. Blood aldosterone and angiotensin Ⅱ levels of the patients in the lying position in the morning were detected within 24 hours after the diagnosis of AKI. Urine NGAL (uNGAL) level was detected in the supernatant of centrifuged morning urine. The significance of NGAL in the diagnosis of AKI was evaluated and data were collected to develop an early differential diagnosis system. Results The uNGAL of cirrhotic patients with AKI was higher than that of decompensated cirrhotic patients without AKI (t=11.439, P=0.000); the levels of uNGAL were significantly different within pre-azotemia (PRA,323.08±106.93), hepatorenal syndrome (HRS,486.27±164.67) and acute tubular necrosis patients(ATN,882.43±440.92 ng/mL) (F=48.774,P=0.000). After further stratification with AKI stage, uNGAL was found to be meaningful in differentiating AKI above stage 2,especially ATN. The threshold determined by Yoden index under receiver operating characteristic curve(ROC)is 522.72ng/mL (sensitivity: 0.938, specificity: 0.655).The threshold of 621.73ng/mL (sensitivity: 0.750, specificity: 0.800) showed a higher sensitivity and was more fit for clinical requirement. The expression levels of aldosterone and angiotensin II were different in different types of AKI (P=0.000), but the intergroup analysis and multivariate analysis showed little significance for differentiating HRS from ATN. Conclusion As a new marker, uNGAL is useful for diagnosing AKI in cirrhotic patients. Early detection of uNGAL is of greater significance for differentiating ATN-type AKI.
    Influencing factors and etiological characteristics of bloodstream infection in patients with liver cirrhosis
    WANG Hua-qiang, XIE Fang, SHENG Yun-feng, ZHENG Wen-kai, LI Ping
    2021, 26(3):  252-254. 
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    Objective To investigate the influencing factors, etiological distribution and drug resistance of bloodstream infection in patients with liver cirrhosis. Methods The data of 87 patients with liver cirrhosis who had bloodstream infection were retrospectively analyzed. The general data of a parallel hospitalized patients with cirrhosis who didn't get bloodstream infection during the same period of time were also collected as the control group. The comorbidities,history of invasive treatments, the distribution of pathogens and drug resistance of bloodstream infections in these patients were analyzed. Results Seventy-three of the 87 (83.9%) cirrhotic patients with bloodstream infection were in decompensate stage. Patients in bloodstream infection group were complicated with diseases such as diabetes (21.8%), peritoneal effusion (71.3%), hepatic encephalopathy (20.7%) and gastrointestinal bleeding (24.1%) and invasive procedures such as intravenous indwelling catheter (14.9%), indwelling catheter (16.1%) and abdominal puncture (58.6%), while the incidence of these complications in the control group were 11.9%, 36.8%, 9.0%, 9.6%, 8.3%, 3.8% and 21.5%, respectively. The proportion of patients developing complications in the infection group was significantly higher than that in the control group (All P<0.05). A total of 87 pathogenic bacteria were cultured out, including 59 Gram-negative bacteria (67.8%), which were mainly Escherichia coli (24.1%), Klebsiella pneumoniae (21.8%), and Pseudomonas aeruginosa (5.7%), etc. The resistance rates to ampicillin were 81%, 100% and 80%, respectively; and the sensitivity to imipenem is 100%. Twenty-eight strains (32.2%) were Gram-positive bacteria, which were mainly Staphylococcus aureus (10.3%), Streptococcus (8.0%) and Staphylococcus epidermidis (6.9%). They were all (100%) sensitive to vancomycin, tigecycline and linezolid. Conclusion Bloodstream infections are more common in patients with decompensated cirrhosis, which is closely related to their own comorbidities and invasive procedures. The pathogens of bloodstream infection are mainly Gram-negative bacteria, and antibacterial drugs such as cefoperazone/sulbactam, piperacillin / tazobactam, imipenem can be used as the first empirical medication.
    Comparison of the efficacy between shear wave elastrography and serum fibrosis indexes in non-invasive evaluation of hepatic fibrosis in chronic hepatitis B patients
    ZHANG Rong-rong, ZHOU Jing, ZHAO Peng, ZHU Li-yao, ZHANG Xin, YE Xiao-hang
    2021, 26(3):  255-258. 
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    Objective To compare the efficacy between shear wave elastrography (SWE) and serological fibrosis markers in non-invasive evaluation of hepatic fibrosis in patients with chronic hepatitis B (CHB). Methods 74 patients (44 males and 30 females) with CHB were admitted to our hospital from January 2018 to March 2020, with an average age of (40.2±7.8) years. The measurement data were analyzed by t-test and the counting data were analyzed by chi-square test. Univariate and multivariate Logistic regression analysis were performed to determine the independent predictors of significant liver fibrosis in patients with CHB. To construct the Receiver operating characteristic (ROC) curve of shear wave velocity (SWV) and serological fibrosis indexes for diagnosing significant hepatic fibrosis in patients with CHB. The area under the curve (AUC), sensitivity and specificity were calculated. The maximum Jordan index was taken as the cutoff point for each diagnostic index. Results Hepatic fibrosis was graded by Scheuer score system. S0 and S1 stages were defined as non-significant hepatic fibrosis (non-significant fibrotic group), and S2, S3 and S4 stages were defined as significant hepatic fibrosis (significant fibrotic group). Among 74 CHB patients, 7 cases were in S0 stage of liver fibrosis, 18 cases were in S1 stage, 27 cases were in S2 stage, 11 cases in S3 stage and 11 cases in S4 stage. The average age of the non-significant fibrotic group was (37.2±6.0) years, which was younger than that of the significant fibrotic group [(42.9±9.6) years, P<0.05]. The levels of ALT, ALP, GGT, total cholesterol, PLT, RDW and INR in the non-significant fibrotic group were (42.4±7.9)U/L, (102.4±22.2)U/L, (42.3±11.4)U/L, (3.8±1.0)mg/dL, (182.6±40.8)×109/L, (13.8±0.9)% and (1.0±0.2), respectively, which were significantly different with those of the control group [58.3±18.2)U/L, (131.5±28.5)U/L, (80.2±16.3)U/L, (5.5±1.4)mg/dL, (92.4±32.4)×109/L, (11.6±1.8)% and (1.2±0.3)], (P<0.05). The SWV in non-significant fibrotic group was (1.44±0.22)m/s, which was significantly lower than that in the significant fibrotic group [(1.92±0.38) m/s, P<0.05]. The serological fibrosis indexes HA, C-IV, APRI, FIB-4, Forns score and RPR in the non-significant group were (70.2±12.6)ng/mL, (63.4±21.5)ng/mL, (0.3±0.2), (0.8±0.3), (-0.6±0.5) and (0.08±0.02), respectively, which were significantly different with the control group [(55.9±30.8)ng/ml, (42.8±18.9)ng/mL, (0.7±0.5), (1.3±0.4), (0.4±0.8) and (0.11±0.02)] (P<0.05). Multivariate Logistic regression analysis was carried out with the existence of significant liver fibrosis in patients with CHB as dependent variables and the above significant differences as independent variables. GGT, HA, C-IV, PLT, SWV, FIB-4, APRI, FIB-4, Forns score and RPR were independent predictors of significant liver fibrosis. When evaluating significant hepatic fibrosis, the AUC values of SWE were significantly higher than those of APRI, FIB-4, Forns, FibroIndex, RPR, HA and C-IV, respectively. Conclusion SWE is a reliable and non-invasive method for evaluating hepatic fibrosis in patients with CHB. The diagnostic performance of SWE is superior to serological fibrosis indexes such as HA, C-IV, APRI, FIB-4, Forns score and RPR.
    An analysis for the risk factors of post-operative complications in patients with liver cirrhosis after endoscopic retrograde cholangiopancreatography
    CHEN Xu-feng, XU Ya-feng, ZHOU Zhi-hua, XIANG Zheng-guo, TANG Xiao-long, YANG Sheng-lan, ZHENG Yang
    2021, 26(3):  259-261. 
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    Objective To analyze the risk factors of post-operative complications in patients with liver cirrhosis after endoscopic retrograde cholangiopancreatography (ERCP), and to provide guidance for the prevention of these complications. Methods The clinical data of 96 cases of liver cirrhotic patients that had received ERCP were retrospectively analyzed. The patients were divided into with complication group and without complication group according to whether they presented postoperative complications. Single and multi-factor analysis were performed in the cirrhotic patients to identify the risk factors for post-operative complications after ERCP treatment. Results Within the 96 cirrhotic patients that had received ERCP, 18 patients(18.75%)presented postoperative complications. The preliminary single-factor analysis showed that esophageal varices, ascites, history of sphincter of Oddi dysfunction (SOD), repeated intubation, cholangiopancreatography, and pre-cut were the risk factors of post-operative complications after ERCP (P<0.05). The result of Logistic regression analysis showed that esophageal varices, ascites, history of SOD, repeated intubation, cholangiopancreatography, and pre-cut were the risk factors of developing complications after ERCP in the patients with liver cirrhosis (OR>1, P<0.05). Conclusion Esophageal varices, ascites, history of SOD, repeated intubation, cholangiopancreatography, and pre-cut increase the risk of complications of ERCP in liver cirrhotic patients. Patients with these risk factors should therefore obtain active intervention to improve the prognosis after ERCP.
    Current status for the treatment of primary liver cancer and an exploration of multidisciplinary team model
    DONG Xiao-feng, YANG Ying-hao, ZHANG Yan, WANG Jian-bin, ZHU Xiao-hong, LIU Da-da, LIANG Dong
    2021, 26(3):  262-265. 
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    Objective To discuss the necessity of multidisciplinary team (MDT) model for the treatment of hepatocellular carcinoma (HCC). Methods The clinical data of HCC patients admitted to our hospital from January 2010 to January 2018 were collected and retrospectively analyzed. Results The treatment of HCC in our hospital was mainly based on surgical resection and transcatheter arterial chemoembolization (TACE). Among the patients who underwent surgical resection, some of them were operated with extended surgical indications. In the patients who received TACE therapy, some had single and smaller lesions without obtaining surgical treatment and showed an exponential decline in numbers for retreatment. Conclusion Surgical resection and TACE therapy belong to the surgical and internal medical systems separately. Due to a limitation in the knowledge systems, the specialists tend to predominately select and only focus on the HCC treatment with their own specialty, while lacking of knowledge and experience for the treatment methods in other disciplines. This exists in current practice of HCC treatment. In order to integrate the advantages of various treatment regimes and apply optimized treatment on HCC patients, it is necessary to carry out organized and systematic multidisciplinary comprehensive treatment.
    The value of using contrast-enhanced ultrasound in combination with blood γ-GT level to evaluate the efficacy of transcatheter arterial chemoembolization therapy for patients with primary hepatic carcinoma
    LI Cong-hui, LUO Hong-ying, WANG Jian-jun, KUANG Xue-jun, BAO Yong-hui
    2021, 26(3):  266-269. 
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    Objective To analyze the value of using contrast-enhanced ultrasound (CEUS) in combination with blood γ-glutamyltransferase (γ-GT) level to evaluate the efficacy of transcatheter arterial chemoembolization (TACE) therapy for patients with primary hepatocellular carcinoma (PHC). Methods Eighty PHC patients who underwent TACE interventional therapy were selected. CEUS was performed in all patients before and after TACE. Blood γ-GT level was detected before TACE and at 7d, 28d and 2 months after the surgery. The value of combine CEUS examination with blood γ-GT level to evaluate the efficacy of TACE on PHC patients was analyzed. Results CEUS examination was performed in 80 patients with PHC before TACE. A total of 109 lesions were found, showing mild and diffuse enhancement. At 2 months after TACE, CEUS re-examination showed that 37 lesions in 35 patients were completely destroyed, and 72 lesions in 45 patients were residual tumors. At 7d after surgery, the blood γ-GT level in PHC patients was significantly increased compared with that of before surgery (P<0.05), and the γ-GT level at 28d after surgery was significantly decreased compared with those of before surgery, and 7d after surgery (P<0.05). The γ-GT level at 2 months after surgery was significantly lower than that of before surgery and those of 7d and 28d after surgery (P<0.05). The sensitivity, positive predictive value, negative predictive value and diagnostic coincidence rate of the combined detection for the diagnosis of PHC were higher than those of γ-GT detection (P<0.05), and there were no statistical differences when compared with those of CEUS examination (P>0.05). Conclusion CEUS examination can accurately diagnose residual lesions in patients with PHC after TACE. The combination of CEUS with blood γ-GT level increase the sensitivity for diagnosing PHC, and reduce the misdiagnosis and missed diagnosis rates. It has certain application value for evaluating the efficacy of TACE therapy for PHC patients.
    Diagnostic value of fibrinogen/prealbumin ratio and γ-glutamyl transpeptidase/platelet ratio in alpha-fetoprotein-negative hepatocellular carcinoma
    WANG Wei, LI Hui-yan, LIU Hua
    2021, 26(3):  270-272. 
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    Objective To evaluate the value of fibrinogen/prealbumin ratio (FPR) and γ-glutamyl transpeptidase/platelet ratio (GPR) in alpha-fetoprotein-negative hepatocellular carcinoma (AFP-N HCC). Methods From March 2018 to March 2020, there were 80 AFP-N HCC patients (58 males and 22 females) with an average age of (50.2 ± 9.8) years, and 100 patients undergoing physical examination (60 males and 40 females) with an average age of (49.8 ± 6.2) years enrolled in the study. The independent predictive factors of AFP-N HCC were analyzed by Logistic regression. Cut-off points for diagnosing AFP-N HCC were determined by receiver operating characteristic (ROC) curve, and the diagnostic efficiency was calculated. Results There were significant differences in platelet, hemoglobin, fibrinogen, phosphatidic acid, alanine transaminase (ALT), aspartate transaminase, total bilirubin, gamma-glutamyl transpeptidase, FPR and GPR between AFP-N HCC group and healthy group (P<0.05). Logistic regression analysis showed that ALT, FPR and GPR were independent factors for AFP-N HCC (P<0.05). The cut-off value of FPR for diagnosing AFP-N HCC was 11.60, with area under the curve (AUC) [95% confidence interval (CI)] of 0.94 (0.90-0.96), sensitivity of 86.5%, and specificity of 88.4%. The cut-off value of GPR for diagnosing AFP-N HCC was 0.21, with AUC (95% CI) of 0.89 (0.85-0.92), sensitivity of 68.4% and specificity of 94.8%. Combining FPR and GPR, the AUC (95% CI), sensitivity and specificity were 0.97 (0.95-0.99), 91.0% and 96.2%, respectively. Conclusion FPR and GPR can be used for the diagnosis of AFP-N HCC. The combination of FPR and GPR has better diagnostic value.
    Gd-EOB-DTPA MRI combined with contrast-enhanced ultrasound in the diagnosis of hepatocellular carcinoma (< 2cm) on the background of liver cirrhosis
    CHEN Yu-feng, ZHU Ze-yuan, CHENG Ying, QI Liang
    2021, 26(3):  273-275. 
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    Objective To analyze the clinical value of Gd-EOB-DTPA enhanced magnetic resonance imaging (Gd-EOB-DTPA MRI) combined with contrast-enhanced ultrasound (CEUS) in the diagnosis of < 2 cm hepatocellular carcinoma, so-called small hepatocellular carcinoma (SHCC), on the background of liver cirrhosis. Methods Fifty-two patients (36 males and 16 females) with focal hepatic nodules (< 2 cm) having high risk of HCC with an average age of (58.6 ± 9.0) years from January 2015 to December 2019 were analyzed retrospectively. All patients had undergone Gd-EOB-DTPA MRI and CEUS. Chi-square test was used to compare the data between SHCC and dysplastic nodules (DN); receiver operating characteristic curve (ROC) curve was used to evaluate the diagnostic efficiency of Gd-EOB-DTPA MRI and CEUS. Results There were 70 nodules in 52 patients, 54 nodules diagnosed as SHCC, 16 as DN. SHCC and DN were significantly different in T1 weighted imaging (T1WI), T2 weighted imaging (T2WI), arterial phase hyperenhancement, hepatobiliary phase, diffusion weighted imaging (DWI) of MRI and arterial phase hyperenhancement of CEUS (P<0.05). The area under the ROC curve of CEUS arterial phase hyperenhancement, Gd-EOB-DTPA MRI hepatobiliary phase low signal and DWI high signal for diagnosing SHCC were higher than that of Gd-EOB-DTPA MRI T1WI low signal, T2WI high signal and arterial phase hyperenhancement, respectively (P<0.05). For diagnosing SHCC, arterial phase hyperenhancement of CEUS combined with low signal intensity in hepatobiliary phase and high signal intensity in DWI of Gd-EOB-DTPA MRI had sensitivity of 95.5%, specificity of 96.3% and accuracy of 96.2%. Conclusion Arterial phase hyperenhancement of CEUS combined with low signal intensity in hepatobiliary phase and high signal intensity in DWI of Gd-EOB-DTPA MRI helps to improve the diagnostic efficiency of SHCC on the background of liver cirrhosis.
    Consistency analysis of liver tumor volume between 3D reconstruction via 3D visualization technology and postoperative measurement
    CAI Ming-yue, JIANG Kai, XU Meng-lai, JIANG Jun-lin
    2021, 26(3):  276-280. 
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    Objective To investigate the consistency between the simulated operation via three-dimensional (3D) visualization technology and the actual operation of liver cancer. Methods Between August 2016 and August 2019, 144 patients with primary liver cancer in our hospital were treated by laparoscopic hepatectomy. All patients had undergone preoperative non-enhanced and contrast-enhanced spiral computed tomography (CT) of the upper abdomen. The original CT images were stored in digital imaging and communications in medicine format. The surgical plan was based on 3D images of liver reconstructed by 3D visualization technology. The actual hepatectomy and prognosis were analyzed, and the volume of tumor were compared between actual hepatectomy and 3D reconstruction. Results All of 144 patients underwent 3D reconstruction of liver and intrahepatic vessels successfully. Five patients underwent transarterial chemoembolization, because preoperative evaluation showed their intolerance to the operation with tumor invading inferior vena cava. The rest underwent hepatectomy successfully, including 74 cases of left lateral hepatic lobectomy, 5 cases of IV segmentectomy, 15 cases of VI segmentectomy, 15 cases of Ⅶ and Ⅷ segmentectomy, 5 cases of right hepatic lobectomy, 10 cases of left hepatic lobectomy and 15 cases of irregular hepatectomy. In the 139 patients, the total liver volume of (1 500.5 ± 447.9) mL, the virtual liver resection volume of (507.8 ± 184.4) mL, and the remnant to standard functional liver volume ratio of (64.0 ± 8.5) % were calculated by 3D visualization technology before operation. The actual tumor volume measured (523.0 ± 175.8) mL after operation. There was a positive correlation between virtual and actual volume of hepatectomy (r=0.949, P<0.001). After operation, 13 patients had complications, all of whom improved to be discharged after symptomatic treatment. No tumor recurrence or metastasis was found during 3-month follow-up. Conclusion The application of 3D reconstruction visualization technology in preoperative evaluation helps to predict the scope of liver resection accurately and to guide the formulation of surgical plan.
    The clinical significance of the expression of Twist in liver cancer tested by immunohistochemistry
    WEI Xiao-fang, OU Chuan-hua, LI Shao-long, MAO Xiao-ling
    2021, 26(3):  281-283. 
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    Objective To explore the clinical significance of the expression of Twist in liver cancer tested by immunohistochemistry. Methods There were 136 clinical specimens of primary hepatocellular carcinoma (HCC) tissues from January 2013 to January 2017 in our hospital analyzed in the study, 85 of which contained paracarcinomatous tissues (< 3 cm away from HCC). The expression levels of Twist in HCC tissues and paracarcinomatous tissues were detected by immunohistochemistry, and the relationship of Twist expression to clinicopathological parameters and prognosis of HCC patients was analyzed. Results The positive staining area of Twist protein was mainly located in cytoplasm, which was distributed in patches, nests or a diffuse manner as brownish yellow granules. The positive expression rate of Twist protein in cancer tissues was 66.2%, significantly higher than 5.9% in paracarcinomatous tissues (P<0.05). Among 136 cancer tissue samples, 90 were Twist protein positive and 46 were negative. In Twist positive group, the rates of pathologic stage Ⅲ ~ Ⅳ, TNM stage Ⅲ ~ Ⅳ, poorly differentiated tumor cells, incomplete capsule and vascular invasion were 45.6%, 46.7%, 46.7%, 41.1% and 35.6%, significantly higher than 23.9%, 28.3%, 26.1%, 19.6% and 17.4% in Twist negative group (P<0.05). There was no significant difference in age, sex, tumor size or serum alpha-fetoprotein level between Twist positive and negative groups (P>0.05). And 3-year survival rate was 57.8% in Twist positive group and 65.2% in negative group, with no significant difference between. Conclusion Twist overexpression may be closely related to the occurrence, development and prognosis of primary HCC. And Twist is expected to a therapeutic target for primary HCC, which deserves more attention in clinical practice.
    The effect of fluoxetine on proliferation and apoptosis of HepG2 cells and its mechanism
    LIU Xiao-hui, MA Li-xia, ZHANG Jing
    2021, 26(3):  284-286. 
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    Objective To investigate the effect of fluoxetine on proliferation and apoptosis of HepG2 cells and its mechanism. Methods We treated HepG2 cells with different concentrations of fluoxetine respectively for 24 hours. Flow cytometry was used to detect cell cycle of HepG2 cells treated with different concentrations of fluoxetine. In HepG2 cells treated with 12.5 μM fluoxetine for 0, 6, 12 and 24 hours, real-time polymerase chain reaction were used to detect the mRNA expressions of Bcl-2 and Bax, and Western bolt was used to detect the protein expressions of Bcl-2, Bax and caspase-3. Results It was showed that the cell percentages in G2/M phase were 9.63% ± 0.33%, 10.12% ± 0.86%, 19.68% ± 4.31% and 22.74% ± 2.46% after HepG2 cells treated with control, 5 μM, 10 μM and 12.5 μM of fluoxetine for 24 hours, respectively. And the cell percentages in G2/M phase in 10 μM and 12.5 μM groups were statistically different from that in control group (both P<0.05). The mRNA levels of Bcl-2 in HepG2 cells were gradually reduced as the time of incubating with 12.5μM fluoxetine increased (0, 6, 12 and 24 hours). The differences were statistically significant between the 0-hour group and other groups, respectively (all P<0.05). While there was no statistical difference in the Bax mRNA levels between control and other groups, respectively (all P>0.05). The protein expression level of Bcl-2 began to decrease after 12-hour incubation while the protein expression level of Bax was not significantly changed. The protein expression levels of Bax/Bcl-2 and caspase-3 began to increase after 12-hour incubation. Conclusion Through influencing HepG2 cell cycle, reducing the expression of anti-apoptotic protein Bcl-2 and activating caspase-3, fluoxetine can inhibit proliferation and induce apoptosis of HepG2 cells.
    Relationship of HBV genotypes and drug-resistant mutation sites to disease progression in patients with HBV-related chronic liver diseases
    LIU Li-guan, YE Qiao-xia, YAN Yan, YAN Yan-yan, HUANG Zhi-jie,ZHANG Xiao-man
    2021, 26(3):  287-290. 
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    Objective To explore the relationship of hepatitis B virus (HBV) genotypes and drug resistance mutation sites to disease progression in patients with HBV-related chronic liver diseases. Methods Two hundred and thirty patients with HBV-related chronic liver diseases treated with nucleos(t)ide analogues (NAs) were selected as study subjects. HBV genotypes and drug-resistant mutations within reverse transcriptase (RT) region were detected. Results Among the 230 patients with HBV-related chronic liver disease, 100 cases (43.47%) were found to have NA-resistant mutations, with lamivudine (LAM)/telbivudine (LdT) resistance being the most common (30.00%, 69/230), adefovir (ADV) resistance being the second (7.83%, 18/230), entecavir (ETV) resistance being the least (5.65%, 13/230), and there was statistically significant difference among them (χ2=67.392, P<0.001). Among the cases with LAM/LdT-resistant mutations, 55 were single-point mutant (79.71%), most being rtM204V/I mutations (17.39%, 40/230); 14 were multi-point mutant (20.29%), most being rtL180M+rtM204V/I mutations (5.65%, 13/230). Among the cases of ADV resistant mutations, most were single-point mutant (61.11%, 11/18), Rta181t mutations being the most prevalent (3.91%, 9/230). And all cases of ETV-resistant mutations were multi-point mutant, most being rtm204v/I+rta181t+rts202g/I mutations (3.04%, 7/230). In all the patients with HBV-related chronic liver diseases, HBV genotypes were B (70.43%, 162/230) and C (29.57%, 68/230), with no genotype A, D, E, F, G, H or J. There was significant difference in mutation rates of rt180 and rt181 between genotype B and C of HBV (χ2=11.545, P=0.001; χ2=4.845, P=0.028), no significant difference in rates of other mutations (P>0.05). The distribution of HBV genotypes was statistically different between chronic hepatitis B group and hepatitis B-related cirrhosis group (χ2=25.012, P<0.001). The rate of rt204 mutation was significantly different among chronic hepatitis B group, hepatitis B-related cirrhosis group and hepatitis B-related liver cancer group (P=0.015), and rates of other mutations were not (P>0.05). Conclusion The genotypes of HBV in this area are mainly B and C, and the detection rate of main resistant mutations against NAs is relatively high. The disease progression and resistant mutations in patients infected with HBV of different genotypes are different, and the rate of rt204 mutation is different in different disease stages. It is suggested that patient infected with HBV should be routinely tested for HBV genotypes and resistance against NAs for individualized treatment and improvement of disease progression.
    Analysis of clinical and pathological features of idiopathic non-cirrhotic portal hypertension
    WANG Qing-qing, PENG Yu-hui, TANG Yan-fang
    2021, 26(3):  291-295. 
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    Objective To compare the clinical parameters between idiopathic non-cirrhotic portal hypertension (INCPH) and virus hepatitis-related decompensated cirrhosis, and to analyze clinical and pathological features of INCPH. Methods Clinical data of 44 patients, including 23 patients with INCPH and 21 with virus hepatitis-related decompensated cirrhosis, were retrospectively analyzed. The clinical parameters were compared between the 2 groups, and the pathological characteristics of INCPH were investigated. Results The patients in INCPH group were younger (39.83 ± 15.38 years) and predominantly female (60.87%) , while the patients in decompensated cirrhosis group were older (53.33 ± 11.24 years) and predominantly male (80.95%), and the differences were statistically significant (P<0.05). The main symptom was gastrointestinal bleeding (39.13%) in INCPH group, and ascites (85.71%) in the other group (P<0.05). Red blood cell, platelet, prothrombin activity, albumin, cholinesterase in virus hepatitis-related decompensated cirrhosis group were significantly lower than those in INCPH group (P<0.05), while international normalized ratio, alanine transaminase, aspartate transaminase, total bilirubin, liver stiffness measurement and Child-Turcotte-Pugh score were significantly higher than those in INCPH group (P<0.05). And there was no significant difference in white blood cell or hemoglobin between the 2 groups (P>0.05). Compared with virus hepatitis-related decompensated cirrhosis group, INCPH group had thicker spleen, more portal vein structure disorder, more portal vein cavernous degeneration, and more collateral circulation, and the differences were statistically significant (P<0.05). However, there were no significant differences in portal vein diameter, splenic vein diameter, splenic vein diameter/portal vein diameter, incidence of splenomegaly, incidence of portal hypertensive gastropathy or degree of esophageal and gastric varices between the 2 groups (P>0.05). The liver histopathology of INCPH mainly showed that there was no obvious disorder of hepatocyte arrangement, formation of pseudo-lobe, or thrombosis in portal vein, and that there was venectasia of interlobular vein and central vein, expansion of portal area, dilation of liver sinuses, and watery degeneration of liver cells. Conclusion There were both differences and similarities in clinical manifestations, laboratory tests, and imaging indicators between INCPH and virus hepatitis-related decompensated cirrhosis, so the liver pathological examination is necessary for diagnosis.
    CT and MR imaging characteristics of 11 cases with primary liver lymphoma
    RONG Xue-fei, CAI Jian-ming, DONG Jing-hui, LIU Yuan, REN Hong-wei
    2021, 26(3):  296-298. 
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    Objective To explore the CT and MRI imaging characteristics of patients with primary liver lymphoma and improve the diagnostic level of this disease. Methods A retrospective analysis was performed in the Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, from May 2012 to September 2019. Results In this group of 11 cases, 9 cases were with solitary lymphoma, and 1 with multiple lymphoma, CT plain scan showed low and uniform density, with clear boundary. MRI showed low signal on T1WI, high signal on T2WI, high signal on DWI. 6 cases showed homogeneous signal, enhanced scan showed mild enhancement. In 6 cases, there were vessels passing through the lesions without involvement, showing “floating vessels sign”. In 2 cases, there were annular enhancement around the lesions, showing “target sign”. In 2 cases, there were delayed enhancement of central scar. Conclusion The CT and MR images of primary liver lymphoma showed clear lesion boundaries, mainly uniform density/signal, characteristic “vascular floating sign” with uneven density/signal. The enhancement of “target sign” and patchy enhancement should be considered as the possibility of this disease.
    Analysis of the causes of liver disease in children under 14 years old
    YU Hai-ying, ZHONG Yan-dan, YANG Yong-feng, PENG Shan-shan, DING Qiao-yun,GUO Yin-yan,CAO Xing-guo
    2021, 26(3):  299-301. 
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    Objective To study the incidence and etiology of liver disease in children under 14 years old. Methods From January 2016 to December 2019, 676 outpatients and inpatients with liver disease in our hospital were collected and divided into six groups according to their ages. The incidence of liver disease in different age groups was analyzed, and the causes of 676 patients were analyzed. Results Among 676 cases, 554 cases were male (81.95%), 122 were female (18.05%), and the incidence rate was high in male. 199 cases were diagnosed as liver diseases in 3~6 years old group (27.96%), and the U value was 3.18 (P<0.01). There were 407 cases of chronic hepatitis B (60.21%), 74 cases of non-alcoholic fatty liver (10.95%), 36 cases of abnormal liver function (5.32%). There were 19 cases with drug-induced hepatitis (2.81%), 18 with CMV hepatitis (2.66%), 11 with chronic hepatitis C (1.63%), 8 with hepatitis A (1.18%), 6 with EBV hepatitis (0.88%), 3 with acute hepatitis B (0.44%) and 1 with hepatoblastoma (0.15%). After routine serological examination and imaging examination, 93 cases (13.76%) were still unclear about the cause of liver disease. After liver biopsy or / and related gene detection in 66 cases, there were 21 cases of Gilbert's syndrome (22.58%), 11 cases of hepatolenticular degeneration (11.83%), 9 cases of progressive muscular dystrophy (9.68%), 6 cases of autoimmune hepatitis (6.45%), 4 cases of glycogen accumulation (4.30%) and 3 cases of Dubin Johnson (6.45%) There were 2 cases of glucose-6-phosphate dehydrogenase deficiency, 2 cases of progressive familial cholestasis and 2 cases of Alagille syndrome, accounting for 2.15% respectively; there were 1 case of overlap syndrome, 1 case of sclerosing cholangitis, 1 case of rotor syndrome and 1 case of hereditary spherocytosis, accounting for 1.075% respectively. There were still 2 cases of unknown etiology. Conclusion There were many causes of liver disease in children under 14 years old, mainly chronic hepatitis B; and children with unexplained abnormal liver function; genetic metabolic abnormalities leading to liver disease was the main reason.
    Predictors of the risk of liver failure after hepatectomy in patients with hepatical alveolar echinococcosis
    ZHANG Lie, LI Yan-mao, CONG Shan
    2021, 26(3):  302-304. 
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    Objective To investigate the predictors of the risk of liver failure after hepatectomy in patients with hepatical alveolar echinococcosis. Methods A total of 159 patients with hepatical alveolar echinococcosis who underwent hepatectomy in our hospital from April 2017 to April 2020 were included in the study. The patients were divided into hepatic failure group (n=38) and non-hepatic failure group (n=121) according to whether liver failure occurred after surgery. We compared two groups of gender, age, living areas, ethnic minority, pathological changes, the standardized residual liver volume (SRLV), Child-Pugh, grading, focal diameter, operation time, intraoperative blood loss, then the statistically significant factors above were included in the logistic model and with quantitative assignment, whether with liver failure as the dependent variable (Yes = 1, No = 0), age, SRLV, Child-Pugh grade, operative time, intraoperative blood loss as the independent variable (X), in order to determine the risk factors of liver failure in patients with hepatical alveolar echinococcosis after hepatectomy. Finally, the accuracy of age, SRLV, Child-Pugh grade, operation time and intraoperative blood loss in predicting postoperative liver failure of such patients was analyzed by consistency. Results There was significant difference in gender, residential area, nationality, lesion site and lesion diameter between the two groups (P>0.05). In the liver failure group, the proportion of patients with age ≥ 65 years old, SRLV < 50%, Child-Pugh grade B-C, operation time ≥ 3 h, intraoperative blood loss ≥ 1000 mL were significantly higher than that in the non-liver failure group (P<0.05). Multiple Logistic regression analysis model confirmed that age ≥ 65 years old, SRLV < 50%, Child-Pugh grade B-C, operation time ≥ 3 h, and intraoperative blood loss ≥ 1000 mL were risk factors for liver failure after hepatectomy for patients with hepatical alveolar echinococcosis (P<0.05). Consistency analysis confirmed that age, SRLV, Child-Pugh grade, operative time and intraoperative blood loss could all be used to predict hepatic failure after hepatectomy for patients with hepatical alveolar echinococcosis. Conclusion Logistic model confirmed that the occurrence of liver failure after hepatectomy in patients with hepatical alveolar echinococcosis was closely related to age, SRLV, Child-Pugh grade, operation time, and intraoperative blood loss. Meanwhile, consistency analysis confirmed that the above factors could be used to predict postoperative liver failure in such patients, and the consistency was relatively high.
    Value analysis of intrahepatic fat infiltration level detected by magnetic resonance spectroscopy in diagnosis of nonalcoholic fatty liver disease
    LIU Xiao-ling, RUAN Jun, ZHU Jing-song
    2021, 26(3):  305-308. 
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    Objective To explore the value of MR spectroscopy (MRS) in detecting intrahepatic fat infiltration (FF) in the diagnosis of nonalcoholic fatty liver disease (NAFLD). Methods Between December 2016 to December 2019, 138 patients with NAFLD in our hospital received routine CT examination. All patients underwent MRS examination within 3 days after CT examination to obtain FF value. MRS spectrum lines of NAFLD patients with different degrees were analyzed, FF values of NAFLD patients with different degrees were compared, and the correlation between FF values and NAFLD severity and CTliver/spleen was evaluated. Results 138 patients with NAFLD successfully completed MRS examination.The water peak and lip peak of MRS spectrum in all patients showed double peaks, and the other substances were close to the straight line;Among them, patients with mild and moderate NAFLD showed high anteropotential and low anteropotential, namely high water peak and low lip peak, while patients with severe NAFLD showed low anteropotential and high lip peak, namely low water peak and high lip peak.The FF value of patients with mild NAFLD was significantly lower than that of patients with moderate and severe NAFLD (P<0.05), and the FF value of patients with moderate NAFLD was significantly lower than that of patients with severe NAFLD (P<0.05).FF value was highly positively correlated with NAFLD severity (rank correlation coefficient rS=0.838, P<0.001).FF value in NAFLD patients was negatively correlated with CTliver/spleen (r=-0.920, P<0.001). Conclusion The detection of FF by MRS was of great significance to evaluate the severity of NAFLD and should be widely used in clinical practice.
    Effect of vitamin D supplementation on biochemical indexes and prognosis of infantile hepatitis syndrome
    LIU Zi-hui, SHI Jing, LI Jun-jun, OUYANG Zhen-rong, LEI Ye-fei
    2021, 26(3):  309-311. 
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    Objective To explore the effect of vitamin D supplementation on biochemical indexes and prognosis of infant hepatitis syndrome (IHS). Methods 112 children with IHS admitted to our hospital from November 2016 to November 2019 were divided into two groups according to the random number table method, 56 cases in each group, of which the control group was treated with routine treatment, and the observation group was supplemented with vitamin D on the basis of routine treatment, all of which lasted for 10 days. We observed clinical curative effect of two groups, and compared serum direct bilirubin (DBil), total bilirubin (TBil), glutamyl transpeptidase (γ-GT), alanine aminotransferase (ALT) level of two groups before and after treatment, serum 25-hydroxyl vitamin D3 [25 (OH) D3], monocyte nuclear factor kappa B (NF-κB) predominate, tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6) levels of two groups before and after treatment were analyzed, and we observed adverse reactions of two groups of children. Results The total effective rate of the observation group was 92.86%, which was significantly higher than 75.00% of the control group (P<0.05). The serum levels of DBil, TBil, γ-GT and ALT in the observation group were significantly lower than those before and after treatment in the control group (P<0.05). The serum 25 (OH) D3 in the observation group was significantly higher than that before and after treatment in the control group (P<0.05), and NF-κB, TNF-α, IL-6 were significantly lower than that before and after treatment in the control group (P<0.05). During the treatment period, there were no dysphoria, anorexia, nausea, fever, arrhythmia and other adverse reactions in all children in the two groups. Conclusion Vitamin D supplementation for children with IHS had definite effect, could effectively alleviate inflammatory reaction and liver injury, and with good safety, which should be paid enough attention in clinical practice.
    Effect of ultrasound combined with multi-slice spiral CT-guided puncture-aspiration or catheter drainage on inflammatory response in patients with bacterial liver abscess
    DONG Da, XU Bin, HU Jie-min, HAI Wei
    2021, 26(3):  312-315. 
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    Objective To observe the effect of ultrasound combined with multi-slice spiral CT-guided puncture-aspiration or catheter drainage on inflammatory response in patients with bacterial liver abscess. Methods 84 patients with bacterial liver abscess who admitted in the hospital from February 2017 to August 2019 were selected as subjects. All patients underwent ultrasound combined with multi-slice spiral CT-guided surgery, and they were divided into aspiration group and catheter drainage group according to the treatment methods, with 42 cases in each group. The curative effects of two groups were evaluated and compared. On admission, after the 3rd and 7rd day after surgery, the peripheral elbow venous blood of patients was collected, and the inflammatory response indexes [procalcitonin (PCT), C-reactive protein (CRP)] were detected after processing. The postoperative complications in each group were recorded. Results The results of rank sum test of ranked data showed that there was no statistical difference in the overall curative effects between aspiration group and catheter drainage group (P>0.05). The results of chi-square test showed that there was no statistical difference in the total effective rate between the two groups (P>0.05). After surgery for 3 d and 7 d, the levels of PCT and CRP in two groups were lower than those on admission (P<0.05). There was no statistical difference in the levels of PCT and CRP between two groups at each time after surgery (P>0.05). There were no severe postoperative complications in both groups. Conclusion After clarifying the indications for patients with bacterial liver abscess, ultrasound combined with multi-slice spiral CT-guided puncture drainage or aspiration therapy could alleviate inflammatory response and achieve better drainage effects, and have no complications, which was safe and reliable.