Chinese Hepatolgy

The effect of somatostatin on QT interval of liver cirrhotic patients with gastroesophageal variceal bleeding

DU Yu-jun, CHEN Jun-lian, CHEN Li, FENG Xiao-xia

2021, 26(7): 724-726.

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Objective To explore the effect of somatostatin on QT interval and heart rate of liver cirrhotic patients with gastroesophageal variceal bleeding. Methods A total of 56 cirrhotic patients with gastroesophageal variceal bleeding who were treated with somatostatin were included as the bleeding group; In addition, 56 cirrhotic patients hospitalized in the same period of time whose age, gender, Child-Turcotte-Pugh score matched with the bleeding group were selected as the control group. Patients in the bleeding group were subjected to electrocardiogram examination and the QTc interval and heart rate were measured before using somatostatin and after hemostasis. In addition, the heart rate was continually recorded after hemostasis with a prolonged usage of somatostatin for 24 hours. Results Before somatostatin treatment in 56 patients in the bleeding group, 23 patients (41.1%) had prolonged QT interval, and the average time to hemostasis was (50.00±14.63) hours. The number of patients with prolonged QT interval after hemostasis was 12 (21.4%), which was significantly less than that of before the treatment (P=0.025). In the control group, 21 of 56 cases (37.5%) had prolonged QT interval on admission, and 19 cases (33.9%) after an average of (51.12±2.16) hours of control treatment. There was no significant difference in the control group before and after the observation period of time (P>0.05). When admitted to the hospital, the average QTc interval of 56 patients in the bleeding group was (464.29±25.09) milliseconds (ms). After using somatostatin for hemostasis, the average QTc interval was shortened to (443.54±21.19) ms, which showed statistically significant difference before and after somatostatin treatment (P<0.001). The QTc interval of the control group was (463.25±22.79) ms at admission. After a control treatment of (51.12±2.16) hours, the average QTc interval was (458.48±21.91) ms, which were not different with that of at admission (P>0.05). In the bleeding group, the average heart rate during hemostasis was (64.63±10.02) beats/min, and (57.68±9.13) beats/min after continuing somatostatin treatment for 24 hours, which showed a significantly difference with the treatment (P<0.001). Conclusion Liver cirrhotic patients with gastroesophageal variceal bleeding have a high incidence of prolonged QT interval. Somatostatin treatment restores the QT interval to normal and slows down the patient's heart rate. In patients with liver cirrhosis, somatostatin may play a positive role in preventing and treating malignant arrhythmias caused by prolonged QT interval.

A study of using high-density lipoprotein cholesterol to predict the prognosis of patients with liver cirrhosis

YU Chen-yan, GAO Jing-wen, YIN Min-yue, WU Ai-rong, ZHU Jin-zhou, LIU Xiao-lin

2021, 26(7): 727-731.

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Objective To investigate the predictive value of high density lipoprotein cholesterol (HDL-C) for the prognosis of patients with non-cholestatic cirrhosis. Methods 684 patients with liver cirrhosis who met the inclusion criteria in the first affiliated hospital of Soochow University from January 2017 to December 2020 were enrolled in this study. The results of blood routine, biochemical routine, coagulation routine tests and other related auxiliary examination on the first day of admission were collected. the Model for end-stage liver disease (MELD) score, MELD-Na score and Integration of albumin-bilirubin (ALBI) score were calculated and the performance of HDL-C and other scores to predict the prognosis of patients with cirrhosis were compared. Results Within the 684 patients with liver cirrhosis, 94 patients died and 590 survived during hospitalization. The level of HDL-C in death group was 0.3 (0.1-0.7) mmol/L, which is significantly lower than that in non-death group 0.9 (0.6-1.2) mmol /L (U=12 869.0, P<0.001). Multivariate logistic regression analysis showed that an increased age, white blood cell count, and creatinine level and the decreased HDL-C level were risk factors for poor prognosis of liver cirrhosis (P<0.05). The receiver operating characteristic curves (AUROC) of HDL-C level, MELD score, MELD-Na score and ALBI score were 0.768 (95 % CI: 0.768-0.819), 0.751 ( 95 % CI: 0.691-0.810), 0.747 ( 95 % CI: 0.686-0.807) and 0.715 (95 % CI: 0.659-0.770), respectively. The AUROC of HDL-C combined with MELD score was 0.803 (95% CI: 0.753-0.852), and the sensitivity and specificity were 74.5% and 74.2%, respectively. Conclusion HDL-C is a powerful predictor for the prognosis of patients with cirrhosis and the predictive ability of HDL-C combined with MELD score was significantly higher than that of single index.

A comparison between two animal models of liver cirrhosis and portal hypertension

HU Dou-dou, REN Wan-lei, QIU Sha, JIANG Xiang-jun

2021, 26(7): 732-736.

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Objective To establish and evaluate two rat models of portal hypertension induced by carbon tetrachloride (CCl₄) and bile duct ligation (BDL). Methods 12 rats were randomly divided into CCl₄-induced liver injured group and a control group (N=6 in each group). Another 12 rats were divided into a BDL model group and a sham operation group (N=6 in each group). Portal pressures were measured and the liver and spleen tissue samples were taken at 4w, 8w, and 12w after the treatments. Rats in the model groups were compared with relative control groups and analyzed for general conditions, portal pressure, gross specimen changes, pathological morphologies, body mass, liver wet weight, and spleen wet weight. Normal distributed data are expressed as “mean±standard deviation”, and t test is used for the comparison between two groups. Results The major changes of livers in the CCl₄ model group were liver lobular deformation and adhesion. Fibrous septa and pseudolobules were observed as the pathological manifestation of liver parenchyma. In BDL model group, the shape of the liver lobes was still preserved, the livers were dark brown, and bile duct hyperplasia was the major pathological manifestation. In terms of the formation of portal hypertension, the portal pressure of rats in CCl₄ model group showed a gradual increase and significantly higher than that of the control group at 8w and 12w of CCl₄ treatment (P<0.05). The portal pressure of rats in BDL model group showed a short-term rapid increase, and significantly higher than those of the sham operation group at 4w, 8w, and 12w after BDL (P<0.05). Among the body mass, liver wet weight, and spleen wet weight, the increase of spleen wet weight is in consistent with that of portal pressure. The spleen weight of the rats of CCl₄ model group also gradually increased. The spleen weight of rats in the BDL model group was significantly higher than that of the sham operation group at 4w, and statistically different from those in the sham operation group at 8w and 12w after BDL (P<0.05). Conclusion There were differences in the formation of portal hypertension between two rat models of portal hypertension induced by carbon tetrachloride (CCl₄) and bile duct ligation (BDL). The study provides an experimental basis for further understanding of portal hypertension.

A proteomics study on the mechanism and signaling pathways for the activation of hepatic stellate cells by serum from liver fibrotic rats

LI Min-hang, CAI Bi-lian, JIANG Yun-xia, LUO Wei-sheng

2021, 26(7): 737-741.

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Objective To study on the possible mechanism for the activation of hepatic stellate cells (HSCs) by serum from liver fibrotic rats in vitro. Methods Whole proteins of HSCs were extracted after 14 days incubation of the cells with serum from fibrotic or normal rats. The proteins were then analyzed by a label free method. The differentially expressed proteins were analyzed based on Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG)databases. Results A total of 221 differential proteins were identified between two cellular preparations. These proteins were mainly located in Organelles and membranes, and could perform molecular functions such as catalytic activity and cellular function regulation. They were involved in 26 biological processes such as metabolism and biological regulation. KEGG enrichment analysis showed that these proteins were mainly involved in steroid and cholesterol metabolisms. Conclusion The abnormal expressions of cadherin-2, fibronectin, Notch 1 and Notch 2 proteins are highly correlated with the activation of HSC. These results suggest that these proteins may be the targets of HSC activation, and that the extracellular matrix and Notch signaling pathways are highly correlated with HSC activation.

Dynamic changes of intrahepatic T cell receptor repertoires before and after nucleos(t)ide analogues treatment in patients with chronic hepatitis B

WU Hong-kai, DENG Hao-hui, GONG Ming-xing, GAO Hong-bo, WANG Zhan-hui, YU Le-cheng

2021, 26(7): 742-746.

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Objective To investigate the dynamic changes of intrahepatic T cell receptor (TCR) repertoires before and after nucleos(t)ide analogues (NUCs) antiviral therapy in chronic hepatitis B (CHB) patients. Methods A total of ten CHB patients with tebivudine (LDT) based therapy were subdivided to two groups on HBeAg status after 104 treatment. The TCRβ complementarity determining region 3 (CDR3) of liver biopsies before and after 2-year NUCs treatment was analyzed by high-throughput sequencing. The TCR repertoire profiles and their correlations with serological parameters were analyzed. Results After LDT-based treatment for 104 weeks, the diversity of intrahepatic TCR repertoires in patients with HBeAg seroconversion decreased significantly on the number of unique VJ combinations (151.0 比 71.0, P=0.043), CDR3 clonotypes (223.0 比 109.0, P=0.043), and the values of normalized Shannon diversity entropy (0.58 比 0.17, P=0.045). The decline of HBsAg levels in these patients was positively correlated with the elevation of ablated clonetype frequency (r=0.9, P=0.037). Conclusion NUCs antiviral therapy may induce changes of intrahepatic TCR repertoires. T cell clone expansion plays an important role in HBeAg seroconversion, suggesting that oral antiviral therapy combined with immunotherapy may be more conducive to the control of HBV.

A correlation analysis between pregenomic RNA and different serological indexes of hepatitis B virus in chronic hepatitis B patients

ZHANG Ming-yue, CAO Ming, WANG Kai-xiang, CHEN Jie

2021, 26(7): 747-749.

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Objective The aim of this study was to investigate the correlation between pregenomic RNA (pgRNA) and different serological indexes of Hepatitis B Virus (HBV) in chronic hepatitis B (CHB)patients. Methods The clinical samples of 332 CHB patients were collected from Baoding Hospital of Infectious Diseases. Real-time fluorescence quantitative PCR method was used to measure the copy numbers of HBV pgRNA. The correlation between pgRNA levels and serological indexes of HBV and some other clinical data were analyzed. Results It was found that the HBV-DNA viral load was correlated with the levels of HBV-pgRNA and HBV-large surface protein(HBV-LP)(r=0.715 2 and 0.378 0, respectively,P<0.000 1). The HBV-pgRNA level were correlated with HBV-LP(R=0.336 7, P<0.000 1). In HBeAg positive patients, the average copy numbers of serum HBV-DNA and HBV-pgRNA were at higher levels, whereas the quantitative levels of serum HBV-LP were relatively low, and the serum HBV-pgRNA load was correlated with HBsAg level. In HBeAg negative patients, the average copy numbers of HBV-pgRNA were close to that of HBV-DNA, but the detection rate of pgRNA was higher than that of HBV-DNA. A weaker correlation was found between the serum HBV-pgRNA and HBsAg in the HBeAg negative patients, and between serum HBcAb and HBV-pgRNA. Conclusion Quantitative detection of serum HBV-pgRNA level can serve as an auxiliary detected parameter as other serological markers to provide guidance for safely withdrawal of anti-HBV drugs.

An analysis of the influencing factors for histological progression in 96 cases of chronic hepatitis B virus-infected patients with normal alanine aminotransferase level

CAO Xin, DENG Hao-hui, XIAO Yan-hua, YU Wei-hua, CHEN Yan-qing

2021, 26(7): 750-753.

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Objective To investigate the influencing factors for significant histological pathological progression in chronic hepatitis B virus (HBV) infected patients with normal alanine aminotransferase (ALT) level. Methods The clinical data of 96 patients with chronic HBV infection who were admitted to the hospital and underwent liver biopsies from June 2018 to December 2020 were retrospectively analyzed. They were divided into the observation group and the control group according to their pathological changes. The measurement data between these two groups were analyzed by t-test. The counting data were analyzed by chi square test. The influencing factors for significant histological changes (G≥2 or S≥2) were analyzed by logistic regression. Results Among these 96 patients, 42 cases (43.8%) were in the observation group (G8 2 or S 2) and 54 cases (56.2%) were in the control group (G<1 or S<1). Age(P=0.041),gender (P=0.034),family history of liver cirrhosis/HCC (P=0.039),HBeAg quantitative values (P=0.043) were the independent influencing factors for significant liver pathological changes (G≥2 or Sp2) in patients with normal ALT and chronic HBV infection (P<0.05). Conclusion For chronic HBV infected patients with normal ALT, age,gender,family history of liver cirrhosis/HCC and HBeAg quantitation were the influencing factors for significant changes in liver pathologies in these patients. These factors can also be used as important reference factors for starting antiviral therapy.

Relationship between the degree of liver fibrosis and mRNA levels of TLR2 and TLR4 in patients with chronic hepatitis C

JIA Guo-chang, LIU Chun-jiang, LIU Dong-po, KE Jin, GUO Jing-chao

2021, 26(7): 754-756.

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Objective To investigate the relationship between the degree of liver fibrosis and messenger RNA (mRNA) levels of toll-like receptor 2 (TLR2) and toll-like receptor 4 (TLR4) in patients with chronic hepatitis C (CHC). Methods From January 2019 to December 2019, 185 patients with CHC treated in our hospital were enrolled as CHC group. Another 185 healthy individuals who underwent physical examination in our hospital during the same period were enrolled as control group. The mRNA levels of TLR2 and TLR4 were compared between the 2 groups. According to the degree of liver fibrosis, CHC patients were divided into F1 subgroup (n=35), F2 subgroup (n=63), F3 subgroup (n=58) and F4 subgroup (n=29). The levels of TLR2 mRNA and TLR4 mRNA were compared among the subgroups. Spearman's correlation coefficient was used to analyze the correlation between the degree of liver fibrosis and mRNA levels of TLR2 and TLR4. Results The levels of TLR2 mRNA and TLR4 mRNA in CHC group were significantly higher than those in control group (P<0.05). The levels of TLR2 mRNA and TLR4 mRNA were statistically different among subgroups with different degree of liver fibrosis (F1 subgrouP<F2 subgrouP<F3 subgrouP<F4 subgroup, P<0.05). Correlation analysis showed that the expression of TLR2 mRNA and TLR4 mRNA was positively correlated with the degree of liver fibrosis in CHC patients (P<0.05). Conclusion The levels of TLR2 mRNA and TLR4 mRNA increase with the progression of liver fibrosis in CHC patients.

The relationship between the expression of LncRNA-MEG3 and clinicopathological features, prognosis of patients with primary liver cancer

HOU Ya-ping, ZHANG Xiao-jing, LI Ting

2021, 26(7): 757-760.

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Objective To detect the expression of long non-coding RNA maternally expressed gene 3 (LncRNA-MEG3) in serum of patients with primary liver cancer, and to explore the correlation between the expression level and the prognosis of patients with primary liver cancer. Methods From April 2015 to November 2016, 68 patients with primary liver cancer in our hospital were selected as the primary liver cancer group, and 70 healthy people who had routine physical examination in our hospital were selected as the control group. The expression level of serum LncRNA-MEG3 was detected by quantitative real-time polymerase chain reaction. The relationship between the serum expression level of LncRNA-MEG3 and the clinicopathological characteristics of primary liver cancer was analyzed. The influence of serum LncRNA-MEG3 expression level on the prognosis of patients with primary liver cancer was evaluated by Kaplan-Meier curve. The prognostic factors of patients with primary liver cancer were analyzed by Cox regression analysis. Results The serum expression level of LncRNA-MEG3 in the primary liver cancer group was significantly lower than that in the control group (P<0.05). The serum expression of LncRNA-MEG3 in patients with primary liver cancer had close relationship with clinical stage, differentiation degree and cirrhosis (P<0.05), but no relationship with gender, age or tumor diameter (P>0.05). The 3-year survival rate in the low expression group of serum LncRNA-MEG3 was significantly lower than that in the high expression group (P<0.05). Cox regression analysis showed that low expression of LncRNA-MEG3 and clinical stage were independent risk factors for the prognosis of patients with primary liver cancer (HR=2.500, 95% CI: 1.624-3.849; HR=2.024, 95% CI: 1.307-3.135). Conclusion The serum expression level of LncRNA-MEG3 is significantly decreased in patients with primary liver cancer, and it is closely related to the clinical stage, differentiation degree, liver cirrhosis and prognosis of patients. It suggests that LncRNA-MEG3 may be a potential index for the disease assessment and the prognosis prediction of primary liver cancer.

Effect of CLCVP during complex laparoscopic hepatectomy on perioperative indicators and prognosis in patients with hepatocellular carcinoma

LV Fa-kai, WANG Deng-ji, XIE Yu-hui, ZHANG Yu

2021, 26(7): 761-764.

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Objective To investigate the influence of controlled low central venous pressure (CLCVP) in complex laparoscopic hepatectomy on perioperative indicators and prognosis of liver cancer patients. Methods A total of 124 patients with primary liver cancer (PLC) admitted to our hospital from May 2018 to May 2019 were included in the study. They were divided into an observation group and a control group according to the random number table, with 62 patients in each group. The control group underwent complex laparoscopic hepatectomy, and the observation group underwent CLCVP added to complex laparoscopic hepatectomy. The perioperative clinical indicators (operation time, intraoperative blood loss, intraoperative blood transfusion, portal block time and hospital stay) and incidence of postoperative complications were compared between the 2 groups. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine (SCr), and blood urea nitrogen (BUN) levels were compared before and after surgery in the 2 groups. Moreover, the patients in both groups were followed up for 1 year after operation, and the 1-year postoperative survival rate was calculated. Results All the perioperative indexes in the observation group were better than those in the control group (P<0.05). There was no significant difference in the levels of ALT, AST, SCr, BUN before operation, or the levels of SCr and BUN 3 and 7 days after operation between the 2 groups (P>0.05). The levels of ALT and AST in the observation group were significantly lower than those in the control group before operation, 3 and 7 days after operation (P<0.05). There was no significant difference in the incidence of postoperative complications between the 2 groups (9.68% vs 6.45%, P>0.05). With no cases lost during the 1-year follow-up, there was no statistical difference in the 1-year postoperative survival rate between the 2 groups (82.26% vs 80.65%, P>0.05). Conclusion CLCVP during complex laparoscopic hepatectomy shortens the operation time and hospital stay, reduces intraoperative blood loss, and has no adverse effect on the complications and prognosis of patients with primary liver cancer.

Correlation between ABO blood type and risk of liver cancer: a meta-analyses

AI Jun, ZHANG Jia-juan, ZHENG Wen-kai, LI Ping

2021, 26(7): 765-769.

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Objective To evaluate the correlation between ABO blood type and liver cancer from the perspective of evidence-based medicine. Methods A total of 26 case-control studies at home and abroad were included. RevMan 5.3 statistical software was used to conduct the meta analyses on the correlation between ABO blood type and liver cancer. Results There was no significant correlation between blood type and the risk of liver cancer (all P>0.05). In the subgroup analysis, blood type A was positively related to liver cancer in foreign, male and chronic liver disease populations (RR=1.16, 95% CI 1.02-1.32; RR=1.10, 95% CI 1.02-1.19; RR=1.13, 95% CI 1.04-1.22). Whereas, blood type O was negatively correlated with the occurrence of liver cancer in foreign, male and chronic liver disease populations (RR=0.85, 95% CI 0.78-0.91; RR=0.83, 95% CI 0.71-0.95; RR=0.87, 95% CI 0.80-0.96). Conclusion ABO blood type is not significantly related to the occurrence of liver cancer, but there is a relationship between ABO blood type and the occurrence of liver cancer in different populations.

Study on the correlation between antithrombin III activity and short-term prognosis of acute-on-chronic liver failure patients treated with artificial liver support system

MAO Yan-qun, ZHOU Xue-shi, WANG Xia, SU Ting-ting, DU He-juan, GUO Xiao-ye, ZHOU Ling-xiao, QIU Yuan-wang

2021, 26(7): 770-775.

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Objective To analyze the correlation of antithrombin III (AT-III) activity with short-term efficacy and prognosis of acute-on-chronic liver failure (ACLF) patients treated with artificial liver support system. Methods A retrospective analysis was performed in 236 ACLF patients treated with artificial liver support system in our hospital from January 1, 2012 to June 30, 2019. The blood routine, liver function, international normalized ratio (INR), and AT-Ⅲ activity were recorded, and the model for end-stage liver disease (MELD) score was calculated at the time of admission. The 30-day efficacy and 90-day survival rate of artificial liver support were evaluated. The t-test and rank sum test were used for measurement data, and the chi-square test was used for count data. The influential factors for the efficacy of artificial liver and patient outcome were analyzed by Logistic regression. Results Artificial liver support was effective in 139 patients, and 63 patients died during the 90-day follow-up. Regression analysis showed that AT-Ⅲ activity (OR=1.118, 95% CI 1.082-1.156, P=0.000) was an independent factor affecting the efficacy of artificial liver. Total bilirubin (OR=1.008, 95% CI 1.004-1.012, P=0.000), INR (OR=1.109, 95% CI 1.076-1.505, P=0.025), AT-Ⅲ activity (OR=0.911, 95% CI 0.881-0.943, P=0.000), and MELD score (OR=1.090, 95% CI 1.052-1.115, P=0.034) were independent factors affecting the 90-day survival of ACLF patients. Conclusion The short-term efficacy of artificial liver support system and short-term prognosis of ACLF was correlated with AT-Ⅲ activity.

The role of ulinastatin in the treatment of acute-on-chronic liver failure: a retrospective cohort study

ZHANG Xiu-cui, LI Ming-long, HANG Xiao-feng, WEI Bo

2021, 26(7): 776-778.

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Objective To investigate the efficacy of ulinastatin in the treatment of acute-on-chronic liver failure (ACLF). Methods Ninty patients with ACLF admitted to our hospital from January 2015 to December 2016 were enrolled in our single-center retrospective cohort study. The patients were divided into control group (treated with routine therapy) and experimental group (treated with ulinastatin added to routine therapy). There was no significant difference in demographics between the 2 groups. Results The therapeutic efficacy in the experimental group was significantly better than the control group (70% vs 45%, P=0.025), and the mortality rate was lower than the control group (27.6% vs 51.9%, P=0.0487). The incidence of spontaneous bacterial peritonitis was significantly lower in the experimental group (26.67% vs 50.00%, P=0.0346), while the rates of other complications had no statistical difference (P>0.05). Conclusion Ulinastatin added to routine therapy can improve the prognosis and reduce the incidence of spontaneous bacterial peritonitis in ACLF patients. Further prospective studies are warranted to verify the efficacy of ulinastatin in the treatment of liver failure.

Clinical study of the effect of cytochrome P450 on the application of tacrolimus in liver transplantation recipients

ZHOU Xia, TANG Ru-jia, HE Xi, GAO Yin-jie, Yao Hong, LIU Zhen-wen, WANG Hong-bo, LIU Hong-ling

2021, 26(7): 779-782.

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Objective To observe the regularity of cytochrome P450 (CYP) polymorphism in liver transplantation patients and its influence on the application of tacrolimus. Methods From April 2016 to March 2019, 146 patients who received liver transplantation in our hospital and survived for more than 1 month were selected and randomly divided into experimental group and control group. The patients in control group routinely detected FK506, biochemical indicators and observed its clinical characteristics. On the basis of the above items, the patients in experimental group were tested for CYP3A4*1B and CYP3A5*3 gene single nucleotide polymorphisms. Results There were no significant differences in the FK506 level, C0/D value, renal damage, acute rejection, infection and mortality between the experiment and the control group. Among the 73 recipients in the experiment group, CYP3A4*1B were all wild-type. CYP3A5*3 detection type: 35 patients were found A/G wild type (46.1%); 33 cases G/G mutant type (43.4) %; 5 cases A/A mutant type (6.6%). The C0/D value in G/G mutation patients was significantly higher than that of A/G wild-type and A/A mutant patients (P=0.002, 0.007 and 0.034 at 3, 6 and 12 months after surgery).There was no significant difference in FK506 level between groups. The incidence of infection in patients with G/G mutation in the experiment group was significantly higher than that in A/G wild-type patients (χ²=7.066, P=0.008). Conclusion The CYP3A4*3 genotype is mainly wild type in China, and it has little effect on FK506 metabolism. The genetic polymorphism of CYP3A5*3 is closely related to the metabolism of tacrolimus, and variant patients may need a lower dose of tacrolimus to reach the target level and reduce the incidence of infection.

Expression of bile acid efflux transporters in liver tissue of jaundice patients after liver transplantation

ZHOU Li-na, Li Dong-liang, PAN Chen, LIN Chun, WU Hai-cong, ZHOU Xiao-lin

2021, 26(7): 783-787.

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Objective This case control study aimed to detect and analyze the expression of bile acid transporters BSEP, MRP2, MDR3 in liver tissues of patients with jaundice after liver transplantation, and to explore the role of bile acid metabolism in its generation and development. Methods In the case control study, 25 cases with jaundice and liver puncture after liver transplantation in Nanjing Military Area Command Fuzhou General hospital form 2006 to 2017 were selected. 18 cases with hepatic hemangioma were selected as control group. Clinic data and paraffin block of liver biopsy tissue were collected on all patients. The liver specimens were performed for histopathological and immunohistochemical examinations. Immunohistochemistry was performed to detect the expression of BSEP, MRP2 and MDR3 in the liver tissues of two groups. Semi-quantitative analysis was applied to compare the expression difference of the above bile acid transporters in liver tissues of control group, the liver transplantation group and the jaundice group after liver transplantation caused by various causes. Results The total expression level of BSEP, MRP2 and MDR3 in jaundice liver tissue after liver transplantation was lower than that of the control group (P<0.05), but there is a difference between different causes: only the expression of BSEP in the liver tissues with jaundice caused by rejection, viral factors and bile duct obstruction after liver transplantation was significantly lower than that in the control group (P<0.001, P=0.002, P=0.035). MRP2 expression in liver tissues with jaundice caused by viral factors was lower than that in the control group. The expression of MDR3 in the liver tissues with jaundice caused by post-transplantation rejection (P=0.001), ischemia-reperfusion injury (P=0.011), drug toxicants (P=0.047) and obstructive factors (P=0.01) was significantly higher than that in the control group. Conclusion The down-regulated of bile acid efflux proteins BSEP, MRP2 and MDR3 in the liver tissue of patients with jaundice after liver transplantation suggested that they may play an important role in the pathogenesis of cholestasis after liver transplantation, but the expression levels of above-mentioned proteins in patients with different etiologies are different.

The clinical characteristics of giant hepatic hemangioma and observation of the application value of different interventional embolization materials

ZHANG Jun-wei, HUANG Xu-dong, CAI Di, WANG Gui-hao

2021, 26(7): 788-791.

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Objective To study the clinical characteristics of patients with giant hepatic hemangioma and observation of the application value of different interventional embolization materials. Methods The clinical data of 84 patients with giant hepatic hemangioma from March 2017 to March 2020 were collected, all patients received color Doppler Flow Imaging (CDFI) examination and interventional embolization, the CDFI hemodynamic characteristics were recorded.84 patients were divided into observation group (n=48) and control group (n=36) according to the different embolization materials. The observation group was treated with pingyangmycin iodized oil embolization, and the control group was treated with bleomycin iodized oil embolization. The treatment effects of the two groups were compared, and the clinical effects of patients with different hemodynamic characteristics were recorded. Results The results of CDFI examination showed that there were 23 cases of high blood supply in the 84 patients, which accounting for 27.38%, the 47 cases of low blood supply type, which accounting for 55.95%, 14 cases of poor blood supply, which accounting for 16.67%. The tumor diameter in the observation group at 3 months after treatment was significantly lower than that in the control group, the difference was statistically significant (P<0.05). There was no statistically significant difference in hospitalization time, hospitalization expenses and incidence of adverse reactions between the two groups (P>0.05). The overall curative effect of patients in the high blood supply group was significantly better than that of the low blood supply group and the poor blood supply group, the difference was statistically significant (P<0.05). The results of receiver operator characteristic (ROC) analysis showed that the AUC of diameter of hepatic hemangioma for judging the effect of pingyangmycin iodized oil embolization was 0.743 (95% CI=0.559～0.657, SE=0.079, P=0.028), the sensitivity was 0.833, the specificity was 0.583, and the cutoff value was 13.21 cm. Conclusion The patients with giant hepatic hemangioma are mainly of high blood supply and low blood supply. The pingyangmycin iodized oil embolization material is better than bleomycin in the treatment of giant hepatic hemangioma, especially for the high blood supply and the tumor diameter less than 13.21 cm, and the effect was significant.

CT and MRI features of cystic papillary tumor of bile duct

SHEN Jin-dong, GENG Cheng-jun, YIN Hui-kang, LANG Wei-wei

2021, 26(7): 792-794.

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Objective To observe the CT and MRI features of cystic intraductal papillary neoplasms of the bile duct (IPNB). Methods 90 patients with cystic IPNB were retrospectively analyzed, another 90 patients with mucinous cystic tumor (MCN) were selected as MCN group. The clinical data and imaging features of the two groups were analyzed. At the same time, IPNB group was divided into invasive lesions (51 cases) and non-invasive lesions (39 cases) according to the pathological results. Results The proportion of mural nodules, bile duct communication and bile duct dilatation in IPNB group (63.33%, 51.11%, 100.00%) was significantly higher than that in MCN group (17.78%, 0.00%, 17.78%) (P<0.05). In IPNB group, the diameter of invasive lesions [(7.49±0.68) cm] was significantly higher than that of non-invasive lesions [(5.53±0.46) cm] (P<0.05). Conclusion In CT and MRI imaging features, mural nodules, bile duct communication and bile duct dilatation can be used as the basis for clinical diagnosis and differential diagnosis of cystic IPNB. In addition, the larger the diameter of cystic IPNB, the higher the possibility of invasive lesions.

Clinical characteristics of liver disease patients with positive anti SLA antibody

ZHONG Yan-dan, YU Hai-ying, GUO Yin-yan, DING Qiao-yun, CAO Xing-guo, PENG Shan-shan, YANG Yong-feng

2021, 26(7): 795-798.

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Objective Anti SLA antibody is a specific serological marker of AIH. This study retrospectively evaluated the detection rate of anti SLA in AIH and various liver diseases, and analyzed the clinical characteristics, IAIHG-AIH score, treatment response and outcome of patients with anti SLA positive AIH. Methods Serum anti SLA was detected in 853 patients with liver diseases of different etiology. The presence of anti SLA was detected by Western blot. We recorded the general characteristics and test results of the patients. Results Anti SLA was detected in 18 (2%) of 853 liver disease patients. There were 11 cases of AIH (61.1%), 3 cases of AIH / PBC (16.7%), 2 cases of PBC (11.1%), 1 case of HBV (5.6%) and 1 case of DILI (5.6%). The detection rate of anti SLA in AIH patients was 6%. 11 patients with anti SLA positive AIH received immunosuppressive therapy and developed biochemical remission, but 6 of them relapsed (5 recurred after drug withdrawal and 1 relapsed in remission stage). Conclusion The detection rate of anti SLA is very low, but it has high specificity for AIH. Further studies are needed to prove the clinical significance of anti SLA in AIH.

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