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Table of Content

    30 June 2021, Volume 26 Issue 6
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    Liver Fibrosis & Cirrhosis
    The relationship between sustained virological response and re-bleeding risk of chronic hepatitis C patients after endoscopic management of gastroesophageal varices
    HUANG Xiao-quan, WU Ling, JIANG Si-yu, LI Feng, CHEN Shi-yao
    2021, 26(6):  597-601. 
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    Objective To investigate the impact of sustained virological response (SVR) on the re-bleeding risk of chronic hepatitis C patients after endoscopic management of gastroesophageal varices bleeding (GVB).Methods A total of 49 patients admitted to Zhongshan Hospital, Fudan University with HCV related GVB were included in this study. They were divided into SVR group (N=26 patients) and non-SVR group (N=23 patients) according to their serum HCV RNA levels detected at the time of primary endoscopic therapy for GVB by esophageal variceal ligation (EVL) combined with histoacryl injection (HI). The occurances of re-bleeding and other complications of cirrhosis, and the survival rates of these patients in three years after endoscopic treatment were follow-up.Results Kaplan-Meier survival analysis showed that there were no significant differences in the cumulative rebleeding-free rates at 1-year, 2-year and 3-year between the SVR group and the non-SVR group, the same went for the cumulative survival rates between these two groups. The results of Multivariate analysis showed that the clearance of HCV did not influence the efficacy of endoscopic management of HCV-related GVB. The endoscopic treatment of EVL plus HI is an independent protective factor against re-bleeding in HCV-related cirrhotic patients with GVB.Conclusion The clearance of HCV RNA did not influence the efficacy of endoscopic management of HCV-related GVB. EVL plus HI can be the optimal treatment selection in these patients.
    Sarcopenia may predict the occurrence of hepatic encephalopathy in patients with liver cirrhosis after transjugular intrahepatic portosystemic shunt
    YU Rui, SUN Qian, SHI Qiang-wei, WANG Chun-feng, YAO Jian-ning, ZHANG Lian-feng
    2021, 26(6):  602-605. 
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    Objective To investigate the predictive value of sarcopenia on the occurrence of hepatic encephalopathy (HE) in patients with liver cirrhosis after transjugular intrahepatic portosystemic shunt (TIPSS).Methods A retrospective analysis of 301 patients who underwent TIPSS therapy from January 2015 to August 2019 were enrolled in these study. The skeletal muscle areas of the patients at the L3 level were measured by CT images and were analyzed by software to define sarcopenia. Risk factors for HE were analyzed by binary logistic regression.Results Among patients with liver cirrhosis who underwent TIPPS, the incidence of sarcopenia was 63.8%. Age (OR:1.088, 95%CI:1.024-1.156), MELD score (OR:1.004, 95%CI:1.003-1.005), HE history (OR:1.922, 95%CI: 1.487-2.357) and sarcopenia (OR: 2.745, 95%CI: 2.311-2.902) were independent risk factors for postoperative HE.Conclusion The incidence of sarcopenia in cirrhotic patients underwent TIPSS is relatively high. Sarcopenia may predict the occurrence of HE in liver cirrhotic patients after TIPSS surgery. Caution should be taken on such patients.
    Viral Hepatitis
    A real-world study on the treatment of chronic hepatitis C patients with Sofosbuvir/Velpatasvir
    FENG Qian-chang, ZHANG Chun-lan, LI Ling-hua, ZHANG Jian-zhen, XU Min, Cai Wei-ping
    2021, 26(6):  606-610. 
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    Objective To evaluate the efficacy and safety of Sofosbuvir/Velpatasvir (SOF/VEL) treatment on patients with chronic hepatitis C (CHC).Methods Forty-eight CHC patients who had received SOF/VEL treatment for 12 weeks and followed-up for 12 weeks were retrospectively analyzed. Sustained virological response (SVR) and drug-drug interactions (DDI) in these patients were observed during the 12-week’s follow-up period after drug withdrawal.Results Of the 48 patients, 24 patients (50%) were HCV genotype 6a,14 (29.2%) were genotype 3a, 5 (10.4%) were genotype 1b, 4 (8.3%) were genotype 3b and 1 (2.1%) was genotype 2a. Four (8.3%) of the 8 patients (16.7%) with liver cirrhosis were HCV genotype 6a, 2 (4.2%) were genotype 3a, 2 (4.2%) were genotype 1b. The negative conversion rate of serum HCV RNA was 39.6％ (19/48), 72.9％ (35/48), 93.8％ (45/48), 100.0％ (48/48) and 100.0％ (48/48) respectively at 1, 2, 4, 8 and 12 weeks of therapy. The overall SVR12 was 95.8% (46/48). The normalization rates of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was 97.9% (47/48) and 95.8 (46/48) at 12 weeks of therapy, and 93.8% (45/48) and 95.8 (46/48) at the 12-week’s follow-up period after drug withdrawal. Two patients whose estimated glomerular filtration rate (eGFR) less than 90 mL·min-1·1.73 m2 at baseline had completed the treatment without adjustment of SOF/VEL dosage; One patient who had a decreased eGFR at 8, 12 weeks therapy had completed the treatment without adjustment of SOF/VEL dosage, and the eGFR level returned to normal at the 12-week’s follow-up period after drug withdrawal. Among the 48 patients with CHC, 16 cases were complicated with other diseases, accounting for 33.3%. Among these 16 cases, 10 patients had combined medication, 3 cases with 1, 4 cases with 2, 1 case with 3 , 1 case with 7, 1 case with 9 kinds of drugs, without occurring DDI during their treatments.Conclusion CHC patients who received SOF/VEL treatment had a very high SVR12 and biochemical responses, and the therapy is safe.
    A predictive analysis for the treatment necessity of HBeAg negative, HBV DNA positive patients with chronic hepatitis B viral infection
    LIU Hong-bo, SHAN Hong, WANG Ning
    2021, 26(6):  611-613. 
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    Objective To study on the predictive index for the treatment necessity of HBeAg negative HBV DNA positive patients with chronic hepatitis B (CHB) viral infection.Methods 108 patients were divided into treatment group and follow-up group according to their liver pathology. Patients in the treatment group had significant hepatic inflammation (> grade 2) or fibrosis (>grade 2) under pathological examination, and patients in the follow-up group had less severe histological changes. Age, gender, family history of HBV infection, quantitative level of HBsAg, and HBV DNA load were included in single factor analysis for the treatment necessity. Logistic multivariate regression analysis was carried out on the statistically significant variables. The cut-off values of the independent risk factors were defined by receiver operating characteristic (ROC).Results Among the 108 cases of HBeAg negative HBV DNA positive patients with chronic HBV infection, 29 (26.7%) reached the criteria of treatment. Age and family history of HBV infection are independent risk factors for the treatment necessity. The cutoff value of risk age was 35.5 years old.Conclusion HBeAg negative HBV DNA positive patients with chronic HBV infection may also require treatment, with age older than 35.5 years and family history of HBV infection as independent predictors for the necessity.
    Clinical efficacy of tenofovir treatment on entecavir-resistance or poor-responsive chronic hepatitis B patients
    HU Xia, ZHOU Yue-jin, LU Cheng-hong, PAN Hua-jiang, WANG Kai-jian
    2021, 26(6):  614-616. 
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    Objective To investigate the clinical efficacy of Tenofovir dipivoxil (TDF) treatment on chronic hepatitis B patients with entecavir (ETV) resistance or poor-responsiveness.Methods Seventy chronic hepatitis B (CHB) patients collected from the 906th Hospital of Chinese PLA between March 2016 and April 2019 were enrolled in this retrospective case-control study. The patients were all poor responsiveness to initial ETV treatment. They were further divided into ETV poor-responsive group (group A, N=36) and ETV-resistance group (group B, N=44). All patients were shifted to TDF treatment alone for 48 weeks. The undetectable rate of HBV DNA, the alteration of liver and kidney function indexes, the incidence of adverse drug reactions were recorded and compared between these two groups after 12 weeks, 24 weeks, and 48 weeks of TDF treatment.Results (1) There was no significantly difference in gender, average age and average length between these two groups(P>0.05)(2)The undetectable rate of HBV DNA at 12 weeks in group A was 66.66%, which was significantly higher than that of 40.90% in group B (χ2=5.27, P=0.028<0.05). The undetectable rate of HBV DNA at 24 weeks and 48 weeks after TDF treatment in group A were 83.33%, and 94.44%, respectively, which were higher than those of 72.72%, and 86.36% in group B but didn’t reach significance (χ2=1.27,χ2=1.43; all P= 0.21:P>0.05)(3)Comparison of liver function recovery rate: at 12 weeks, the recovery rate in group A was 75.00% (12/16), which was significantly higher than that of 33.33% in group B: (8/24) (χ2=6.67,P=0.019<0.05). There were no significant differences between these two groups at weeks 24 and weeks 48 (P>0.05) (4) Adverse reactions: there were two cases had gastrointestinal reactions such as nausea and vomiting, and one case had a slight decrease in blood phosphorus. No obvious renal damage was observed in these patients within one year.Conclusion Significant antiviral efficacy and complete virus control can be achieved by TDF treatment in a short period of time. The treatment is efficient for ETV-resistance and poor-responsive patients for controlling viral replication, and delaying the progression and evolution of the disease.
    An analysis of the characteristics and the prognostic impact factors of liver failure caused by drug withdrawal in chronic hepatitis B patients
    DUAN Xing-gang, LIU Li, LIU Liang-ting, WANG Ying-tian, FAN Qun-xiong
    2021, 26(6):  617-620. 
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    Objective To investigate the characteristics of liver failure caused by discontinuation of antiviral drugs in chronic hepatitis B (CHB) patients and analysis the impact factors affecting prognosis.Methods One hundred and six chronic hepatitis B patients who were admitted to Shiyan People's Hospital from January 2015 to January 2020 were enrolled in this study. They were all suffered from liver failure due to withdrawal of anti-viral drugs. Based on their survival situation at the 12th week, they were divided into survival group (N=47 cases) and death group (N=59 cases). The baseline data, treatment plan, biochemical indicators, viral load and other clinical data of both groups of patients were collected. The clinical characteristics of these two groups of patients were compared and analyzed for the impact factors affecting prognosis. T-test was used to compare the measurement data of the normal distribution; Mann-Whitney U test was used to compare the measurement data of the skewed distribution; χ2 test was used to compare the counting data; Logistic regression was used to analyze the impact factors affecting prognosis.Results The incidence of cirrhosis in the death group was 88.14% (52/59), which was significantly higher than that of 18.75% (9/48) in the survival group (P<0.05). The levels of albumin, γ-transglutaminase and cholinesterase in the survival group were significantly higher than those in the death group. The total bilirubin, prothrombin time, international normalized ratio, and model for end-stage liver disease (MELD) score in the survival group were significantly lower than those in the death group (P<0.05). The grades of acute-on-chronic liver failure (ACLF) classification between these two groups were significantly different (P<0.05). Logistic regression was used to analyze the impact factors affecting prognosis. The result indicated that higher ACLF grades and liver cirrhosis are independent predictors of poor prognosis.Conclusion CHB patients with liver cirrhosis have a higher risk of liver failure after discontinuation of anti-viral drugs. The patients have a higher mortality rate once progress to liver failure. Meanwhile, the clinical outcome of the CHB patients with liver failure due to discontinuation of anti-viral drugs is associated with the severity grade of ACLF classification and whether the patient has cirrhosis.
    The association of baseline vitamin D level with the virological response of tenofovir treatment on chronic hepatitis B patients
    LI Xuan, ZHANG Li-na, WANG Song, WANG Fang, NIE Guang, HE Qing
    2021, 26(6):  621-624. 
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    Objective To investigate the association of baseline serum vitamin D level with the 24-week virological response of tenofovir treatment on chronic hepatitis B patients.Methods A total of 115 patients who were hospitalized in the department of liver diseases of the third people’s hospital of Shenzhen from November 2017 to November 2019, and met the inclusion criteria were enrolled in this study. Baseline clinical data were collected including demographic information, virological indicators, blood routines, Liver function, blood coagulation function and serum vitamin D level. According to the quantitative results of hepatitis B viral load at 24 weeks of treatment, the patients were divided into positive and negative groups. The relationship between vitamin D level and virological response was analyzed by logistic multivariate analysis. Gender, HBeAg status and HBV DNA level were used as the stratified factors.Results The baseline serum 25(OH)D level of the positive group was significantly lower than that of the negative group (P=0.002). Multivariate analysis showed that the 24-week HBV DNA negative conversion rate gradually increased with an increase of baseline 25 (OH)D level. In the subgroup analysis, the 24-week HBV DNA negative conversion rate all increased with the increase of baseline 25 (OH)D level.Conclusion The level of 25(OH)D is an independent factor associated with the 24-week virological response of tenofovir treatment on chronic hepatitis B patients.
    Liver Cancer
    The effect of microvascular invasion on recurrence of hepatocellular carcinoma after radical resection
    DI Liang, ZHAO Xiao-fei, DING Jing
    2021, 26(6):  625-627. 
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    Objective To evaluate the effect of microvascular invasion (MVI) on recurrence of hepatocellular carcinoma (HCC) after radical resection.Methods There were 104 patients (72 males and 32 females) diagnosed with HCC by pathology after radical resection in our hospital from January 2014 to December 2018, with an average age of (52.3 ± 9.0) years. According to prognosis, the patients were divided into recurrence group and non-recurrence group. Univariate analysis was used to figure out factors with significant differences between the 2 groups, and multivariate logistic regression analysis was used to analyze the predictive factors of recurrence in HCC patients.Results There were 46 HCC patients in recurrence group and 58 in non-recurrence group. There were statistical differences in sex compositions, the incidence of > 5 cm tumor, the rates of alpha fetoprotein (AFP) > 400 μg/L and total bilirubin (TBil) > 17 mol/l, and the incidence of MVI between 2 groups (all P<0.05). Specifically, there were 40 (87.0%) and 32 (55.2%) cases of male (Z=12.166), 27 cases (58.7%) and 14 cases (24.1%) with tumor diameter > 5 cm (Z=12.829), 16 cases (34.8%) and 5 cases (8.6%) with AFP > 400 μg/L (Z=10.896), 17 cases (37.0%) and 10 cases (17.2%) with TBIL > 17 mol/L(Z=5.188), 29 cases (63.0%) and 13 cases (22.4%) of MVI (Z=17.590) in recurrence and non-recurrence groups, respectively. The age, liver cirrhosis, alanine aminotransferase > 40 U/L, albumin > 35 g/L, HBsAg and HBeAg were also significantly different between the 2 groups (P>0.05). The multivariate logistic regression model showed that tumor diameter > 5 cm, AFP > 400 μg/L and MVI were independent risk factors for recurrence of HCC.Conclusion Tumor diameter, AFP level and MVI are independent predictors for recurrence in HCC patients after radical resection, and can be used as evaluation indicators for postoperative treatment.
    Effect of apatinib on angiogenic factors of patients with advanced unresectable hepatocellular carcinoma after transarterial chemoembolization
    ZHAO Kai, XUE Jin-feng, XUE Peng-fei, CHANG Peng
    2021, 26(6):  628-631. 
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    Objective To observe the effect of apatinib on the levels of angiogenic factors in patients with advanced unresectable liver cancer after transcarterial chemoembolization (TACE).Methods Seventy-eight patients with advanced liver cancer in our hospital from March 2018 to March 2020 were selected as the research objects and randomly divided into combination group (39 cases) and TACE group (39 cases). The TACE group was treated with TACE, and the combination group was treated with apatinib and TACE. The clinical effects of the 2 groups were compared, and the levels of vascular endothelial growth factor (VEGF), alpha fetoprotein (AFP) and caspase-8 were compared before and after treatment.Results After treatment, compared with TACE group (43.59%), the total effective rate of combination group (66.67%) was significantly higher (P<0.05). The levels of VEGF before treatment were (229.36 ± 23.85) pg/mL and (228.61 ± 24.16) pg/mL in 2 groups, respectively, with no significant difference (P>0.05). Eight weeks after treatment, the VEGF levels were (135.16 ± 12.82) pg/mL and (162.17 ± 15.25) pg/mL, respectively, which were significantly lower than those before treatment, and the level in combination group was lower (P<0.05). The levels of AFP before treatment were (462.79 ± 22.16) ng/mL and (468.25 ± 22.81) ng/mL in 2 groups, respectively, with no significant difference (P>0.05). Eight weeks after treatment, the levels of AFP were (84.16 ± 12.47) ng/mL and (139.62 ± 13.85) ng/mL, respectively, which were significantly lower than those before treatment, and the level in combined group were lower (P<0.05). The levels of caspase-8 before treatment were (81.37 ± 11.28) pg/mL and (82.15 ± 11.67) pg/mL in 2 groups, respectively, with no significant difference (P>0.05). Eight weeks after treatment, caspase-8 levels were (104.92 ± 13.46) pg/mL and (95.74 ± 12.84) pg/mL, respectively, which were significantly higher than those before treatment, and the level in combination group was higher (P<0.05).Conclusion Apatinib has a good effect on patients with unresectable advanced liver cancer after TACE. It can improve the levels of VEGF, AFP, and caspace-8, which is worthy promoting.
    The study of cellular immune function and its clinical significance in patients with liver cancer combined with liver cirrhosis and hypersplenism
    JIA Zhe, ZHANG Ke, HUANG Rong-hai, HE Rong, LU Yan, JIANG Li
    2021, 26(6):  632-637. 
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    Objective To investigate the difference of cellular immune function between liver cancer patients complicated with liver cirrhosis and hypersplenism and healthy people, and its significance for clinical evaluation and treatment.Methods Twenty-seven liver cancer patients complicated with liver cirrhosis were selected. The cellular immune function of peripheral blood, liver and spleen tissues detected by flow cytometry and immunohistochemistry were compared between patients and healthy cases. The correlation of the immune indexes between peripheral blood and liver and spleen tissues in patients was analyzed.Results Compared with healthy controls, in the peripheral blood of the patients, the percentage of CD4+ T lymphocytes and the ratio of CD4+ to CD8+ T cells were lower, and the percentage of CD8+ T lymphocytes was higher. Besides, the cellular immune function in the liver and spleen tissues of these patients was poorer compared with healthy population.Conclusion The cellular immune of liver cancer patients complicated with liver cirrhosis and hypersplenism is dysfunctional.
    Clinical value of hyperthermic intraperitoneal chemoperfusion in tumor recurrence after rupture and bleeding of hilar cholangiocarcinoma
    LUO Liang-tao, LI Chun-guang, LIU Wen-ming
    2021, 26(6):  638-641. 
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    Objective To investigate the clinical value of hyperthermic intraperitoneal chemoperfusion (HIPEC) in tumor recurrence after rupture and bleeding of hilar cholangiocarcinoma (HCCA).Methods A total of 84 patients with rupture and bleeding of HCCA admitted to our hospital from January 2017 to December 2018 were selected and randomly divided into experimental group and control group, with 42 cases in each. The experimental group underwent radical resection combined with HIPEC, and the control group underwent radical resection. The basic data, postoperative hospital stay, complications, tumor-free survival, and overall survival of the 2 groups were compared. Cox multivariate analysis was used to analyze independent risk factors for prognosis.Results There was no significant difference in the time of postoperative hospital stay, the incidence of seroperitoneum, or the incidence of pleural effusion between the 2 groups (P>0.05). The average tumor-free survival time of experimental group was significantly higher than that of control group (P<0.05). The 6-month, 12-month and 18-month tumor-free survival rate and overall survival rate of experimental group were significantly higher than those of control group (P<0.05). Cox regression model analysis indicated that histological classification and HIPEC were independent risk factors for postoperative tumor-free survival time and overall survival time (P<0.05).Conclusion In rupture and bleeding of HCCA, HIPEC combined with radical resection can reduce the risk of tumor recurrence, prolong the tumor-free survival period and improve the long-term prognosis under the premise of safety. It is worthy of clinical promotion.
    Clinical characteristics of 21 liver cancer patients complicated with cerebral infarction
    YANG Qing-xi, SU Ji-liang, SUN Zhong-wen, LIU Yuan-xun, HU Wen-juan
    2021, 26(6):  642-645. 
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    Objective To investigate the clinical characteristics of liver cancer patients complicated with cerebral infarction.Methods Twenty-one patients with liver cancer and cerebral infarction, and 120 patients with liver cancer admitted to our hospital between February 2018 and June 2020 were enrolled in our retrospective study as cerebral infarction group and control group. Univariate and logistic analyses were used to analyze the clinical characteristics of liver cancer complicated with cerebral infarction, and the influencing factors for cerebral infarction in patients with liver cancer.Results The ratio of lymph node metastasis, the levels of platelet, carcinoembryonic antigen (CEA), alpha fetoprotein (AFP) and D-Dimer (D-D) in cerebral infarction group were higher than those in control group (χ2/t=7.64, 9.71, 14.41, 45.43, 20.11, all P<0.05). Multivariate logistic regression analysis showed that platelet, AFP and D-D were independent risk factors for cerebral infarction in patients with liver cancer (OR=4.104, 4.076, 4.987, all P<0.05). In cerebral infarction group, the number of patients complicated with hypertension, diabetes and hyperlipidemia were 7 (33.3%), 5 (23.8%) and 6 (28.6%), respectively. There were 7 cases (33.3%) with single lesion, 14 cases (66.7%) with ≥ 2 arterial regions, 13 cases (61.9%) with small lesions, 6 cases (28.6%) with moderate lesions, and 2 cases (9.5%) with large lesions. The numbers of cases with elevated levels of platelet, AFP and D-D were 17 (81.0%), 13 (61.9%) and 16 (76.2%), respectively.Conclusion The increased levels of platelet, AFP and D-D were the independent risk factors for cerebral infraction in patients liver cancer. The clinical characteristics of 21 patients with liver cancer and cerebral infraction were non-traditional stroke risk factors, 2 or more arterial lesions, small lesions and elevated levels of platelet, AFP and D-D.
    A study about the potential influencing factors for short-term mortality risk of metastatic liver cancer complicated with hepatic encephalopathy
    LI Fei-long, ZHANG Zi-qian
    2021, 26(6):  646-649. 
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    Objective To analyze the potential influencing factors for short-term mortality risk of metastatic liver cancer complicated with hepatic encephalopathy.Methods A total of 125 patients with metastatic hepatocellular carcinoma complicated with hepatic encephalopathy admitted to our hospital from January 2017 to December 2019 were enrolled as the research subject. They were divided into survival group and death group according to the prognosis. The clinical data of the 2 groups were analyzed to summarize the risk factors of prognosis.Results There were statistical differences in Child-Pugh score and liver encephalopathy classification between survival group and death group (P<0.05). And there was no statistical difference in liver cancer classification, tumor diameter, or tumor location between 2 groups (P>0.05). The levels of prothrombin time, blood urea nitrogen, and cholinesterase were significantly different between 2 groups (P<0.05). There was no significant difference in the levels of alanine transaminase, glutamic oxalacetic transaminase, blood ammonia, or blood sodium (P>0.05). There was statistical difference in the incidence of liver cancer complicated with cirrhosis and the number of comorbidities (P<0.05). There was no statistical difference in the incidences of portal vein thrombosis, extrahepatic metastasis, or abdominal lymph node metastasis (P>0.05). Multivariate logistic regression analysis indicated that cancer comorbidities ≥ 3, Ⅲ or Ⅳ stage of hepatic encephalopathy and Child-Pugh grade C were independent risk factors for short-term mortality of metastatic liver cancer complicated with hepatic encephalopathy (P<0.05).Conclusion There are many independent risk factors for short-term mortality of metastatic liver cancer with hepatic encephalopathy. Such patients need close monitoring and intervention to reduce the risk of death and to improve the prognosis.
    Other Liver Diseases
    Clinical and imaging features of gallbladder carcinoma
    CAO Li-jun, LI Wei, YU Hai-long, CAI Jian-ming, DONG Jing-hui, LV xiao-yan
    2021, 26(6):  650-654. 
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    Objective To analyze the clinical and imaging features of gallbladder carcinoma and to improve the diagnostic level.Methods The clinical and imaging data of 89 patients with gallbladder diseases diagnosed and treated in our hospital were retrospectively analyzed, including 34 cases of gallbladder carcinoma and 55 cases of benign gallbladder lesions. The serological indexes and imaging characteristics were compared between the 2 groups.Results Serological indexes including carbohydrate antigen 12-5 (CA12-5) (P=0.03), carbohydrate antigen 19-9 (CA19-9) (P=0.04), lactate dehydrogenase (P<0.01) and carcinoembryonic antigen (CEA) (P=0.00) were statistically different between benign and malignant gallbladder diseases. As for imaging characteristics, gallbladder lesion classification (P<0.01), lesion thickness (P=0.01), arterial phase enhancement amplitude (P<0.01), mucosal line integrity (P=0.03), enlarged lymph nodes (P=0.00), biliary obstruction (P=0.02) and apparent diffusion coefficient (ADC) value (P<0.01) were significantly different. Binary logistic regression analysis showed that there were significant differences in the mucosal line integrity (OR=345.35), biliary obstruction (OR=282.43) and ADC value (OR=0.001) between benign and malignant gallbladder diseases.Conclusion The integrity of mucosal line, biliary obstruction and ADC value are valuable in the diagnosis of gallbladder carcinoma, with better diagnostic efficiency combined with the levels of serum CA12-5, CA19-9, lactate dehydrogenase and CEA.
    Investigation on medication adherence and quality of life of liver transplant recipients in a hospital in Shanghai during the outbreak of novel coronavirus pneumonia
    JIA Li-yan, JING Yi-lei, ZHANG Qian, LV Xiao-ying, WU Xin-rui, MA Fang-hui, LIU Wen-qiong, XUE Feng, ZHU Yan-bo
    2021, 26(6):  655-660. 
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    Objective To investigate the medication adherence and quality of life in adult liver transplant (LT) recipients during the epidemic of 2019 novel coronavirus pneumonia (COVID-19) in China and to provide guidance for health management of LT recipients in the face of public health emergencies.Methods A cross-sectional survey was conducted among 183 cases of adult LT recipients followed up in our hospital from 17th to 21st February 2020. The questionnaire consisted of self-designed general data questionnaire, the Basel Assessment of Adherence Immunosuppressive Medications Scale (BAASIS) and post-liver transplant quality of life (pLTQ). The data was analyzed to investigate the medication adherence and quality of life of LT recipients during the COVID-19 pandemic, and the influencing factors were analyzed by multiple linear regression analysis.Results One hundred and eighty samples were included in the analysis. ① The BAASIS score of medication adherence was (5.25 ± 2.26) points, and the pLTQ score of quality of life was (146.51 ± 29.73) point. Among all the recipients, 57.22% were with good medication adherence.② The independent influencing factors of the medication adherence in LT recipients included “unemployment after surgery” (b'=-0.192, P=0.008), “long survival time” (b'=0.188, P=0.009), and “minority nationality” (b'=0.186, P=0.010). ③ The independent influencing factors of life quality in LT recipients included “poor sleep quality” (b'=-0.252, P=0.000), “high monthly per capita income” (b'=0.212, P=0.003), “long survival time” (b'=0.177, P=0.009), and “unemployment after the surgery” (b'=-0.150, P=0.036).Conclusion The medication adherence of LT recipients was better during the COVID-19 pandemic than normal period, and the quality of life was not significantly affected. However, employment after operation, long survival time and minority nationality played negative effects on patients’ medication adherence. And poor sleep quality, low income, short survival time, and unemployment after operation played negative effects on patients’ quality of life. Patients with these features need more attention, targeted guidance and nursing intervention.
    Effect of S-adenosyl-L-methionine in patients with primary biliary cholangitis treated with ursodeoxycholic acid
    DU Xiao-fei, CHEN Jie, REN Shan, ZHANG Xiao-dan, HUANG Chun-yang, SHAN Jing
    2021, 26(6):  661-663. 
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    Objective To investigate the effect of S-Adenosyl-L-Methionine (SAMe) supplementation on liver biochemistry and liver stiffness measurement (LSM) value in patients with primary biliary cholangitis (PBC), treated with Ursodeoxycholic acid (UDCA).Methods The all 50 patients with PBC were enrolled and divided into two groups randomly and averagely. They had received UDCA treatment. The patients in observation group additionally had been treated with SAMe in the dose of 1000 mg daily over a period of 24 weeks. SAMe had been injected intravenously for two weeks and then orally treated. Liver function and LSM were measured before treatment, 6 months after treatment and 1 year after treatment.Results The therapeutic effect was judged by Ehime standard after 6 months’ treatment. There were 23 cases had response in observation group (92.0%), significantly higher than that in the control group (17 cases, 68.0%, P=0.034). The therapeutic effect was judged by Barcelona standard after 1 year treatment. There were 20 cases had response in the treatment group (80.0%), which was higher than that in the control group (17 cases, 68.0%), but the difference was not statistically significant (P=0.333). 6 months and 1 year after treatment, LSM value in observation group was [(6.6±2.5)kPa, (6.8±3.0) kPa], which was lower than that in control group [(6.8±3.0)kPa, (7.4±2.7) kPa], but the difference was not statistically significant as well. There were no serious adverse reactions in both groups.Conclusion Our study demonstrates a positive effect of adding SAMe to UDCA in patients with PBC in near future.
    Clinical and pathological features of acute autoimmune hepatitis
    NIE Hong, SONG Jie, SHI Niu
    2021, 26(6):  664-666. 
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    Objective Analysis of clinical and pathological features of autoimmune hepatitis (AIH) patients of acute onset.Methods A total of 74 patients with AIH, aged (53.4 ± 11.3) years, were selected between May 2010 and November 2010. Among them, 28 patients with AIH of acute onset (acute group), the diagnosis should be in accordance with at least one of the following items: total bilirubin (TBil) ≥ 85.5 μmol/L, ALT (AST) ≥ 10 × normal limit, and 46 cases of non-acute onset (non-acute group). (±s) or [M(P25, P75)] represented measurement data, t-test or Kruskal-Wallis H test were used; (%) represented counting data, chi-square test were used.Results There were significant differences in TBil, ALT, AST, PT, INR, IgG, antinuclear antibody (ANA) and the degree of liver fibrosis between acute group and non-acute group of AIH (P<0.05). There was no significant difference in age, sex, WBC, PLT, anti-smooth muscle antibody (ASMA), anti-liver soluble antigen antibody (anti-SLA), anti-liver and kidney microsomal antibody (anti-LKM), anti-neutrophil cytoplasmic antibody (ANCA) and hepatitis inflammatory activity between the two groups (P>0.05). There were significant differences in jaundice, anorexia, yellow urine and oil weariness between acute group and non-acute group in AIH patients (P<0.05), but there was no significant difference in fatigue, ascites, abdominal pain, weight loss, lower limb edema and joint pain between the two groups (P>0.05).Conclusion In clinical practice, the number of AIH cases of acute onset is not uncommon, and it is difficult to identify these patients only through IAIHG score. Compared with non-acute AIH, there are significant differences in liver transaminase, coagulation index and degree of liver fibrosis in acute patients, which will help to distinguish them. In the clinical manifestations, jaundice, anorexia, yellow urine and oil-weariness are more significant in AIH of acute onset, which will help clinicians to find out in the early stage.
    Functional characteristics of CD4+CD25+ regulatory T cells in the peripheral blood of NAFLD patients with insulin resistance
    LV Xiao-yu, WANG Zhong-jing
    2021, 26(6):  667-669. 
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    Objective To investigate the functional characteristics of CD4+CD25+ regulatory T cells (Treg) in peripheral blood of insulin resistance (IR) patients with nonalcoholic fatty liver disease (NAFLD).Methods 30 cases of NAFLD combined with IR (group ①), 30 cases of NAFLD (group ②) and 20 healthy individuals (group ③) in our hospital from January 2017 to December 2019 were enrolled. Routine laboratory indexes, HOMA-IR levels and peripheral blood CD4+CD25+Treg levels were detected. According to the average value of HOMA-IR in group ①, they were further divided into high IR group and low IR group, and the levels of CD4+CD25+ Treg in peripheral blood of the two groups were compared.Results AST, ALT, TC, TG levels of group ① and group ② had no significant difference (P>0.05), while were higher than those of group ③ (P<0.05). Among three groups, HOMA-IR level was the highest in group ①, followed by group ② and group ③(P<0.05), meanwhile, the CD4+CD25+Treg level was the lowest in group ①, followed by group ② and group ③ (P<0.05). CD4+CD25+Treg level in high IR group was significantly lower than that in the low IR group (P<0.05).Conclusion The number of CD4+CD25+Treg in peripheral blood of NAFLD patients is decreased and the immune function is abnormal, while IR will aggravate the reduction of CD4+CD25+Treg, so it is of positive significance to adjust the living habits of patients to alleviate IR in patients with NAFLD.
    The value of serum miR-221 and prolactin levels in the early diagnosis of non-alcoholic fatty liver disease in the elderly
    TANG Gai-xiang, LI Ya, ZHANG Xu
    2021, 26(6):  670-673. 
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    Objective To investigate the value of serum miR-221 and prolactin levels in the early diagnosis of elderly non-alcoholic fatty liver disease.Methods We recruited 65 elderly patients diagnosed with nonalcoholic fatty liver disease (NAFLD) by liver biopsy from January 2019 to December 2019 in our hospital, including 40 patients in the simple non-alcoholic fatty liver (SNAFL) 25 cases in the group and non-alcoholic steatohepatitis (NASH) group and recruited 30 healthy elderly who applied for physical examination as control. We quantified the relative expression level and PRL level of miR-221 in the serum of the research subjects, and analyze the diagnostic efficacy through the receiver operating characteristic curve. Results The relative expression levels of miR-221 were from high to low in NASH group, SNAFL group, and control group. The P value of each group was <0.001. From high to low, the PRL levels were in control group, SNAFL group, NASH group (all P<0.05). The AUC values of miR-221 and PRL for the diagnosis of NAFLD were 0.795 and 0.880, respectively, and the P values were both <0.001. The sensitivity, specificity, positive predictive value, negative predictive value, and Youden index of PRL for the diagnosis of NAFLD were 83.3%, 87.7%, 91.9%, 75.8%, and 0.71, respectively, and the diagnostic efficacy was better than miR-221. The AUC values of miR-221 and PRL for the diagnosis of SNAFL and NASH were 0.862 and 0.710 respectively, and the P values were both <0.001. The sensitivity, specificity, positive predictive value, negative predictive value, and Yoden index of miR-221 for the diagnosis of SNAFL and NASH were 76.0%, 85.0%, 85.0%, 76.0%, and 0.61, respectively, and the diagnostic efficacy was better than PRL.Conclusion Serum miR-221 and prolactin levels have good diagnostic efficacy for elderly patients with NAFLD, and prolactin is superior to miR-221 in distinguishing patients with NAFLD from normal people, and miR-221 is superior to prolactin in distinguishing SNAFL from NASH patients.
    Analysis of factors affecting long-term prognosis of patients with drug-induced liver injury
    CAI Tao, SUN Lan-zhen, LAN Xiao-hong
    2021, 26(6):  674-676. 
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    Objective To analyze the clinical data of patients with drug-induced liver injury (DILI) and explore the prognostic factors of DILI patients.Methods A total of 126 patients with DILI in hospital from January 2016 to June 2020 were selected. The diagnosis of DILI was in accordance with the guidelines for the diagnosis and treatment of DILI. According to the condition, the patients were divided into remission group and uncured group. The measurement data were expressed as (±s) and analyzed by t-test, count data were expressed as (%) and chi-square test was used, univariate and multivariate Logistic regression analysis were performed to determine the independent predictive factors affecting the prognosis of patients with DILI.Results Of the 126 patients with DILI, 92 patients were treated with remission (remission group) and 34 patients with uncured treatment (uncured group). Univariate analysis of the clinical data of patients in remission group and uncured group showed that the age of remission group was (43.7±9.6) years, and that of uncured group was (51.6±10.3) years. There was significant difference between the two groups (Z=5.192, P<0.05). The ALT, AST and INR in remission group were (94.2±40.5) u/l, (108.8±35.2) u/l and (1.9±1.1), which were significantly lower than those in uncured group [(350.4±204.8) u/l, (320.1±92.1) and (1.2±0.3), Z=14.829、12.028、10.914,P<0.05]. In the remission group, there were 66 cases of western medicine (71.7%), 9 cases of traditional Chinese medicine / proprietary Chinese medicine (9.8%), 17 cases of combined use (18.5%). And in the uncured group, there were 14 cases of western medicine (41.2%), 8 cases of traditional Chinese medicine / proprietary Chinese medicine (23.5%) and 12 cases of combined use (35.3%). The difference was statistically significant (Z=26.278, P< 0.05). Age, ALT, AST, INR and the type of drugs were set as independent variables, and the prognostic status of patients with DILI was set as dependent variables (assignment 0 = remission, 1 = not cured). The results of multivariate analysis showed that INR and the type of drugs were independent predictors of prognosis in patients with DILI.Conclusion INR and the type of drugs are independent predictive factors affecting the prognosis of patients with DILI. In the process of clinical drug use, attention should be paid to the use of type of drugs.
    Analysis of etiology and clinical features of 431 cases of neonatal jaundice
    ZHANG Jie, LI Zhen, WU Fang, LI Ya-chun
    2021, 26(6):  677-679. 
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    Objective To investigate the etiology and clinical characteristics of neonatal jaundice.Methods The clinical data of 431 neonates with jaundice in our hospital were analyzed, and the clinical etiology, high risk factors and the clinical characteristics of the condition of jaundice were analyzed statistically by comparing the correlation of the risk factors.Results There were 172 infectious cases (39.91%) , 84 hemolysis cases (19.49%), 49 cases with perinatal hypoxia and scalp hematoma (11.37%), 22 delayed defecation cases (5.10%), 4 cases with polycythemia (0.70%), and 73 cases with unknown jaundice (16.94%). Among the high risk factors, there were 80 neonatus whose mother with gestational diabetes (18.56%), 45 whose mother with hypothyroidism (10.44%), 34 with neonatal hypoproteinemia (7.89%), and 17 with neonatal hypoglycemia (3.94%). There was no significant deference in transaminase between the infection group and the non-infection group.Conclusion Infection, hemolysis and perinatal factors are the main causes of neonatal jaundice in our hospital.
    Analysis of etiology and clinical features of infantile cholestatic hepatopathy
    CHEN Qiong, MEI Hong, GAO Yuan, XU Ping-ping, CHEN chen, WU Yu-ping
    2021, 26(6):  680-683. 
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    Objective To analyze the etiological characteristics of infantile cholestatic hepatopathy (ICH).Methods Data of cases of jaundice in infants admitted to the Department of Gastroenterology of Children's Hospital from January 2014 to July 2018 were collected. Those meeting the ICH diagnostic criteria were enrolled, which was recommended by the American Academy of Pediatrics and was used as the inclusion criteria. The etiology and clinical characteristics of the enrolled cases were retrospectively analyzed.Results A total of 271 ICH patients met the inclusion criteria. Among them, there were 110 cases of infectious diseases, 19 cases of genetic metabolic diseases, 81 cases of structural abnormalities of the biliary tract, 3 cases of drug-related hepatitis, 12 cases of total parenteral nutrition associated cholestasis, 7 cases of congenital hypothyroidism, and 39 cases of unknown etiology. Among infectious diseases, the highest incidence was cytomegalovirus infection, with a total of 61 cases. Among the 19 cases of genetic metabolic diseases, 12 cases were caused by Citrin deficiency. Other etiology included Alagille syndrome in 4 cases, congenital carnitine deficiency in 2 cases, and progressive familial cholestasis in the liver in 1 case. In the disease that the structure of the biliary tract is abnormal, there were 55 cases of congenital biliary atresia which were diagnosed by cholangiography, 32 cases of Kasai surgery were performed for treatment, 17 cases of congenital choledochal cyst, 9 cases of biliary dysplasia.Conclusion On the one hand, in the infectious factor group, cytomegalovirus infection was the main factor. Blood biochemical examination showed that the bilirubin index had varying degrees of increase and the liver enzyme index had the slight rising. Diseases of the biliary tract system were mainly congenital biliary atresia, which was characterized by persistent jaundice that could not be subside, light yellow or terracotta stool and poor nutritional status in the infants. B ultrasound of gallbladder indicated abnormal morphology and poor systolic function and cirrhosis of different degrees. Some cases were relieved after Kasai operation. On the other hand, Citrin deficiency was the main factor in the genetic and metabolic factor group. The clinical features of this disease included jaundice, abdominal distension, growth retardation, abnormal coagulation phase and alpha-fetoprotein index. The etiology and pathogenesis of ICH were complex, and its diagnosis and treatment were very difficult.
    Study on the regulatory effect of hepatocellular derived liver precursor-like cells on macrophages
    PENG Yuan, ZHOU Xun, JING Hong-Shu, ZHU Xue-Jing, SHI Yao-Ping, WANG Tao, CUI Dan, SI Dong-Hua, YAN He-Xin, ZHAI Bo
    2021, 26(6):  684-687. 
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    Objective To investigate the effects of human hepatocellular derived liver precursor like cells (HEPLPCS) supernatant on macrophage subsets M1 and M2, respectively.Methods The primary liver cell line was purchased from Ziride liver, and the hepatocyte amplification and culture system (TEM) developed by the previous team was used to amplify and transdifferentiate the primary liver cells into liver precursor like cells (HEPLPCS) in vitro. During the culture process, the supernatant of the HEPLPCS was collected, and after centrifugation, the cells were frozen and stored for later use. Macrophages were derived from bone marrow of C57 mice (BMDM). After erythrocyte lysis treatment, mice M-CSF (40 ng/mL) was added for culture, and stimulated and induced for 7 days. Adherent macrophages were obtained for the experiment. Macrophages in the resting state were stimulated by LPS (100 ng/mL) to produce m1-type macrophages in the inflammatory state and IL-4(40 ng/mL) to produce M2-type macrophages with anti-inflammatory and tissue repair functions. On the basis of the directional induced macrophage polarization, the culture supernatant HepLPCs conditions with different polarization states of macrophages to jointly develop, collect the culture supernatant of different time points, cell RNA and protein, by flow cytometry quantitative PCR ELISA methods such as comprehensive evaluation HepLPCs culture supernatant on macrophages, the influence of different subgroup.Results M0 macrophages were obtained by inducing BMDM adherent by GM-CSF stimulation in mice. The purity of macrophages was identified by flow cytometry, and F4/80+ (total macrophage marker) expression accounted for 92.8%. Directionally induced macrophage polarization: LPS and IL-4 were used to stimulate the cells for six h, respectively, and the cells were harvested for flow test and qPCR test. F4/80+,CD11c+ expression accounted for 88.1%. F4/80+ , CD206+ expression accounted for 97.0%. After 6 hours of LPS stimulation, the expression of M1-related inflammatory genes were upregulated: IL6, IL1β, and iNOS were upregulated by 823.200±174.500 times, 8.389±0.029 times, and 24.650±1.196 times. After 6 hours of IL-4 stimulation, M2-related gene expression increased: CD206 expression was upregulated 114.000± 3.579 times, IL10 expression was upregulated 2.634±0.028 times, and Arg1 expression was upregulated 53.260±8.083 times.M1 type and M2 type macrophages were successfully induced. On this basis, the expression of polarization related genes in M1-type macrophages was down-regulated after co-culture with HEPLPCS-CM: IL6 expression was 346.300±20.810, IL1β expression was 11.290±0.10, iNOS expression was 169.800±9.711.The levels of IL6, IL1β and iNOS were 138.700±32.130pg/ (mL×105 cell), 0.710±0.019pg/ (mL×105 cell) and 0.095±0.001pg/ (mL×105 cell) respectively.The expression of polarization-related genes in M2 macrophages was upregulated: CD206 expression was 40.88±0.1768, IL10 expression was 22.2±0.1414, and Arg1 expression was 32.25±0.2121.IL10 secretion increased to 108.052±0.472 pg/ (mL×105 cell).Conclusion The conditional medium of HEPLPCS can inhibit the LPS-induced inflammatory activation of macrophages, significantly reduce the expression of genes and secreted proteins of inflammation-related factors, and promote the expression of repair type M2 macrophages induced by IL4 and increase the secretion of anti-inflammatory factor IL-10.