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Table of Content

    31 August 2021, Volume 26 Issue 8
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    Viral Hepatitis
    Analysis of risk factors of hepatitis B virus reactivation during immunosuppressive therapy——A new model establishment
    FAN Wen-han, LIANG Xue-song, CHEN Yi, LIAO Wei, LI Cheng-zhong
    2021, 26(8):  843-846. 
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    Objective To investigate the risk factors of hepatitis B virus reactivation (HBVr) in HBsAg positive or anti-HBc positive chronic hepatitis B (CHB) patients after treated with immunosuppressants or chemotherapy drugs.Methods HBsAg positive CHB patients and HBsAg negative but anti-HBc positive CHB patients who received immunosuppressive therapy were retrospectively analyzed, the number of the patients was 238. According to the follow-up results, they were divided into HBVr group and non-HBVr group.The risk factors of HBVr were analyzed.Results The average age of 238 patients was 49 ± 14 years old, including 134 males (36.3%) and 33 HBVr patients (13.87%). Logistic regression model showed that there were significant differences between the two groups in whether received antiviral therapy (OR=0.022,95%Cl: 0.001～0.34), (P<0.001), baseline level of HBV DNA (OR=15.352,95%Cl:3.809～86.160), (P<0.001) and chemotherapy regimen (OR=0.361,95%Cl:0.068～1.929), (P=0.023), which were independent risk factors of HBVr. According to the results of variable screening, the regression equation for predicting the risk of HBVr was established as follows: -4.78×antiviral intervention (yes=1, no=0)+2.731×HBV DNA (≥104=1, <104=0)+3.272×chemotherapy regimen (A=3, B=2, C=1)+3.355, and the corresponding scoring system was also established.Conclusion HBVr is related to whether patients received antiviral therapy, the baseline level of HBV DNA and the choice of chemotherapy regimen. The new model will be helpful in predicting the risk of HBVr.
    Comparison of mutation rate of HBV S protein between genotype B and C in HBeAg negative chronic hepatitis B patients
    ZHANG Xiao-ying, GU Chao, MA Dao-liang, ZHANG Jue, Gao Yue-qiu, SUN Xue-hua
    2021, 26(8):  847-850. 
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    Objective To investigate the association between hepatitis B virus (HBV) genotype and S protein mutations and to provide a theoretical basis for analyzing the role of viral genotype in the prognosis of disease.Methods Ninty-nine HBeAg negative chronic hepatitis B (CHB) patients admitted to our hospital from January 2019 to October 2019 were enrolled in this study, the number of genotype B and genotype C were 50 and 49, respectively. DNA sequencing was used to detect the gene sequence of HBV S protein. Differences between categorical variables were analyzed by Chi-square test and Continuity Correction. Non-parametric test (Mann-Whitney U) was used for analyzing non-normal distribution data.Results The mutation rate of S protein in genotype C group was significantly higher that of the genotype B group (87.76% vs.66.00% , χ2=6.567, P=0.010), furthermore, the mutation sites were distributed randomly, mutation rates in both major hydrophilic region (MHR) and outside the MHR of genotype C were higher than that of genotype B (38.78% vs.18.00%, χ2=5.266, P=0.022; 85.71% vs.56.00%, χ2=10.550, P=0.001 respectively). In addition, statistical differences were also found in the “a”determinant (32.65% vs.12.00% , χ2=6.107, P=0.013) located in MHR and immune epitopes (69.39% vs.40.00% , χ2=8.620, P=0.003) and nonimmune epitopes (53.06% vs.30.00%, χ2=5.424, P=0.020) of cytotoxic T lymphocytes + T-helper cell (CTL + Th ) located outside the MHR between the genotype C and B.Conclusion Genotype C was more prone to HBV S protein mutations than genotype B among HBeAg negative CHB patients.
    Liver Cancer
    Expression and significance of folate metabolic pathway genes in hepatocellular carcinoma——A bioinformatics analysis
    SUN Wen-wen, ZHANG Ling-yun
    2021, 26(8):  851-856. 
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    Objective To explore the expression level, prognostic value and relationship with immune microenvironment of folate metabolic pathway key genes (FMGs) in hepatocellular carcinoma (HCC) through bioinformatics analysis.Methods The expression levels of FMGs (MTR, MTHFR, MTHFD1, MTHFD2, SHMT1 and SHMT2) in HCC were analyzed by Oncomine and GEPIA. The relationship between FMGs and clinical prognosis was assessed by Kaplan-Meier survival curve. The genetic changes of FMGs were observed by cBioPortal. The interaction network of FMGs was constructed by STRING and GeneMANIA. The relationship of FMGs and immune infiltratimh cells was analyzed by TIMER database.Results Oncomine and GEPIA online analysis showed that the relative mRNA expression levels of MTR and MTHFD2 in HCC were 2 and 1.6 folder higher than those in normal liver tissues (P<0.05). cBioPortal analysis revealed that genetic changes of FMGs in HCC included gene amplification, deletion mutation and missense mutation. Kaplan-Meier survival analysis demonstrated that the high mRNA expression level of MTHFR was significantly associated with poor prognosis [hazard ratio (HR)=1.49, P=0.04], while the high expression levels of MTHFD1 and SHMT1 were significantly associated with favorable prognosis (HR=0.63, P=0.008 9 and HR=0.52, P=0.00031). TIMER analysis suggestted that MTHFR and MTHFD2 were postively correlated with the infiltration of diverse immune cells, including B cells, CD8+ T cells, CD4+ T cells, macrophages, neutrophils, and dendritic cells.Conclusion FMGs is significantly correlated with the clinical prognosis of HCC patients and infiltration of immune cells, it is also a potential therapeutic target and a prognostic biomarker of HCC.
    Correlation between preoperative NLR level and liver failure after hepatectomy in patients with primary hepatic carcinoma
    ZHU Yi, ZHAO Ping, LI Jie-zhen, RAN Bo
    2021, 26(8):  857-860. 
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    Objective To analyze the relationship between preoperative neutrophil/lymphocyte ratio (NLR) and liver failure after hepatectomy in patients with primary hepatic carcinoma, and to guide the future prediction and prevention of liver failure after hepatectomy in patients with primary hepatic carcinoma.Methods A retrospective analysis was conducted. Two hundred and seventy-four patients with primary hepatic carcinoma who underwent hepatectomy treatment and were followed up postoperatively in our hospital from March 2017 to November 2019 were collected as liver cancer group, 67 patients with pathologically confirmed benign liver tumors were collected as control group. The levels of neutrophils (NE), lymphocytes (LY) and NLR of the two groups were detected and compared before operation; the patients of liver cancer group were divided into liver failure group and non-hepatic failure group according to whether liver failure occurred after hepatectomy, comparing the levels of NE, LY and NLR of the two groups before the operation to analyze the influence of the preoperative NLR level on the occurrence of liver failure after hepatectomy, and the receiver operator characteristic (ROC) curve was conducted to analyze the predictive value of preoperative NLR levels on the risk of liver failure after hepatectomy.Results The levels of NE and NLR before operation in the liver cancer group were statistically significant higher than those in the control group, and the LY level was lower than that in the control group (P<0.05). Liver failure occurred in 32 patients of the liver cancer group after hepatectomy, the incidence rate was 11.68%; the levels of NE and NLR before operation of liver failure group were higher than those of the non-hepatic failure group, and the LY level was lower than that of the non-hepatic failure group, the difference was statistically significant (P<0.05). The binary logistic regression analysis showed that NLR overexpression before surgery was an influencing factor for the occurrence of liver failure after hepatectomy in patients with primary hepatic carcinoma (OR>1, P<0.05); ROC curve was conducted and the area under the curve (AUC) of the preoperative NLR level predicting the occurrence of liver failure after hepatectomy was: 0.812 > 0.80, the predictive value was ideal.Conclusion The NLR level of patients with primary hepatic carcinoma is generally high, which may indicate the risk of liver failure after surgery. The preoperative NLR level can be a clinical risk factor to predict the occurrence risk of liver failure in patients with primary hepatic carcinoma after hepatectomy, and guide early risk assessment, prevention and treatment.
    The value of multimodal imaging quantitative parameters in the differential diagnosis of small hepatocellular carcinoma and dysplastic nodules on the background of cirrhosis
    WANG Kai-le, JIN Xian-de, WANG Zhen, ZHANG Xin, ZHOU Jie
    2021, 26(8):  861-865. 
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    Objective To explore the value of multimodal imaging quantitative parameters in the differential diagnosis of small hepatocellular carcinoma (SHCC) and dysplastic nodules (DN) on the background of cirrhosis.Methods Eighty patients with cirrhosis and focal space-occupying lesions were divided into SHCC group (46 cases, SHCC) and nodule group (34 cases, DN) according to their pathological diagnosis. Preoperative CT, contrast-enhanced ultrasound (CEUS) and MRI examinations were conducted in both groups of patients. The imaging characteristics of lesions and quantitative parameters were compared between the two groups of patients.Results As shown by CT, the blood flow (BF) (170.37±58.49 vs 143.45±55.24), blood volume (BV) (16.51±5.89 vs 13.12±4.03), mean transit time (MIT) (9.39±2.58 vs 8.12±2.37), surface permeability (PS) (49.30±15.16 vs 42.71±13.28), and hepatic artery fraction (HAF) (59.34±13.70 vs 46.35±11.38) were different between the SHCC group and the nodule group (all P<0.01). As shown by CEUS, the arrival time (AT) (15.23±3.64s vs 19.11±3.08s), time to peak (TTP) (29.63±9.68s vs 62.37±13.65s), peak intensity (PI) (65.19±7.64 vs 55.29±6.81), regional blood volume (RBV) in arterial phase (3367.5±751.7 vs 1458.2±709.8), regional blood flow (RBF) in arterial phase (64.3±18.9 vs 48.2±13.1), regional blood volume (RBV) in delay phase (473.2±155.1 vs 736.5±295) between the SHCC group and the nodule group were also different (all P<0.01). MRI shown that the apparent diffusion coefficient (ADC) {(0.78±0.17)×10-3 mm2/s vs 1.35±0.39)×10-3 mm2/s}, pure diffusion coefficient (D) {(0.89±0.21)×10-3 mm2/s vs (1.17±0.25)×10-3 mm2/s}, pseudo diffusion coefficient (D*) {(45.14±10.12)×10-3 mm2/s vs (81.56±15.41)×10-3 mm2/s} were also different between the SHCC group and the nodule group (all P<0.01). The detection rates of SHCC and DN on the background of cirrhosis by CT in combination with CUES or with MRI was 93.48% and 94.12%, respectively, which were significantly higher than those of by themselves alone (P<0.05).Conclusion The quantitative parameters of CT, CEUS and MRI can reflect tumor pathophysiology and hemodynamic changes to certain extents. However, single detection still has limitation to distinct SHCC and DN on the background of cirrhosis. The combinations of multiple imaging parameters improve the diagnostic accuracy and reliability.
    MST1 and MST2 in Hippo signaling pathway were critical in stemness maintenance and self-renewal of hepatocellular carcinoma stem cells
    LV Shao-dong, WEI Yong-peng, WANG Zhuo, YUAN Jian-yong, LU Jun-hua
    2021, 26(8):  866-870. 
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    Objective To investigate the role of MST1 and MST2 expressed in Hippo signaling pathway in stemness maintenance and self-renewal of liver cancer stem cells.Methods Quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry were conducted to detect the expression levels of MST1 and MST2 in hepatocellular carcinoma (HCC) tissue samples. qRT-PCR and western blot were used to detect the expression levels of MST1 and MST2 in HCC cell lines. CD90+, CD105+ and CD133+ SMMC-7721 cells were selected by flow cytometry. Stem cell marker levels were measured by qRT-PCR and western blot. The expression of MST1 and MST2 were knocked down by shRNA. The formation of mammospheres was observed by microscopy.Results MST1 and MST2 were significantly highly expressed in HCC tissue samples and HCC cells. CD90+, the mammosphere-forming ability in CD105+ and CD133+ SMMC-7721 cells were significantly enhanced. The phosphorylation levels of AMPK increased remarkably, and the expression levels of OCT-4 and Nanog were upregulated to 2.56 ± 0.21, 2.32 ± 0.11. Knocking down MST1 or MST2 could reduce the mammosphere-forming ability of CD90+, CD105+, and CD133+ SMMC-7721 cells. And the phosphorylation levels of AMPK were attenuated. The expression levels of OCT-4 and Nanog were down-regulated to 0.48 ± 0.0 and 0.26 ± 0.08 after knocking down the MST1. The expression levels of OCT-4 and Nanog were down-regulated to 0.35 ± 0.06 and 0.42 ± 0.03 after knocking down the MST2.Conclusion There is an important biological significance of MST1 and MST2 in the stemness maintenance and self-renewal of HCC stem cells.
    miR-548a-5p regulates the apoptosis of hepatocellular carcinoma cell line HepG2 by targeting HMBOX1
    YUAN Yi-ran, CHEN Long, ZHANG Zhen
    2021, 26(8):  871-873. 
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    Objective To investigate the potential mechanism of mir-548a-5p regulating the apoptosis of hepatocellular carcinoma (HCC) cell line HepG2.Methods MiR-548a-5p mimics and miR-548a-5p inhibitor were used to overexpress and knockdown miR-548a-5p and the apoptosis levels of HepG2 were detected. Potential substrates of miR-548a-5p were detected by miRDB online analysis and luciferase reporting system. The siRNA and PCDNA3.1 vector were used to overexpress substrates and the apoptosis level of HepG2 was detected.Results After overexpressing miR-548a-5p, the apoptosis level of HepG2 decreased, and the expression level of HMBOX1, a potential target of miR-548a-5p, decreased significantly. On the contrary, after knocking down miR-548a-5p, the apoptosis level of HepG2 increased, and the expression of HMBOX1 increased significantly (P<0.05). Luciferase reporter system showed that miR-548a-5p targeted the 3-terminal non-coding region of HMBOX1. After knocking down HMBOX1, the apoptosis level of HepG2 decreased significantly, and vice versa (P<0.05).Conclusion MiR-548a-5p inhibits the translation of HMBOX1 by targeting the 3-terminal non-coding region of HMBOX1 mRNA, thereby inhibiting the apoptosis of HepG2 of HCC cells.
    Liver Fibrosis & Cirrhosis
    The value of LSPS score in evaluating the short-term prognosis of patients with alcoholic cirrhosis complicated with esophageal gastric variceal bleeding
    ZHOU Jia-mei, BAN Zhi-chao, ZHANG Xiao-juan, LI Yan, ZHANG Yong-hua, WANG Ming-lei, WANG Hui-zhe, ZHANG Xin
    2021, 26(8):  874-878. 
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    Objective To explore the value of liver stiffness-spleen diameter-to-platelet ratio score (LSPS) in evaluating the short-term prognosis of patients with alcoholic cirrhosis complicated with esophageal gastric variceal bleeding (EGVB).Methods A total of 90 patients with alcoholic cirrhosis and EGVB who were hospitalized in Second Central Hospital of Baoding from May 2017 to May 2018 were retrospectively analyzed. According to whether the patients suffered from rebleeding within 4 weeks, they were divided into bleeding group (25 cases) and non-bleeding group (65 cases). The general clinical data, blood routine, liver and kidney functions, coagulation function indexes were observed and compared. The liver hardness, portal vein and spleen diameter of the two groups were measured and LSPS were calculated. The difference between these two groups was analyzed by single factor analysis, followed by Logistic regression analysis to identify the risk factors of rebleeding. In addition, the predictive value of LSPS score for short-term rebleeding in patients with alcoholic cirrhosis complicated with EGVB was evaluated by receiver operating characteristic curve (ROC).Results The bleeding volume, the diameter of portal vein, the diameter of spleen, the hardness of liver, the proportion of liver function Child-Pugh grade C, and LSPS in the bleeding group were significantly higher than those in the non-bleeding group (P<0.05). Logistic regression analysis showed that the increases of the diameter of portal vein, the diameter of spleen, the hardness of liver and LSPS were the risk factors for the recurrence of bleeding in a short period of time. In addition, ROC curve showed that the predictive value of LSPS (AUC=0.960) for short-term rebleeding was significantly higher than those of portal vein diameter (AUC=0.822), spleen diameter (AUC=0.866) and liver hardness value (AUC=0.860), the cutoff value was 4.447, and the corresponding sensitivity and specificity were 88.00% and 92.30%, respectively.Conclusion The diameter of portal vein, the diameter of spleen, the hardness of liver and LSPS can affect the short-term prognosis of patients, and LSPS has a higher predictive value for the short-term rebleeding in patients with alcoholic cirrhosis and EGVB.
    Correlation between peripheral blood NK cell levels and liver fibrosis in chronic hepatitis B patients
    LI Lan-ya, WU Guang, TU Tao, ZHANG Li
    2021, 26(8):  879-882. 
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    Objective To investigate the correlation between the levels of natural killer cells (NK) in peripheral blood and liver fibrosis in chronic hepatitis B (CHB) patients, in order to provide guidance for the risk assessment and intervention of liver fibrosis.Methods A total of 83 CHB patients collected from March 2017 to February 2020 were studied. They were detected for their peripheral blood NK cell levels and evaluated the occurrence of histological liver fibrosis according to the Scheuer scoring system. The patients were divided into a liver fibrosis group (S1 stage-S4 stage) and a control group (S0 stage), Single and multi-factor logistic regression analyses were performed to analyze the influencing factors associated with liver fibrosis. Receiver operating characteristic curve (ROC) was drawn to evaluate the predictive value of peripheral blood NK cell level on liver fibrosis.Results Fifty-seven of the 83 (68.67%) CHB patients had liver fibrosis. The baseline data of the liver fibrosis group and the control group including gender, age, body mass index, course of disease, family history, smoking history, and drinking history were not different (P>0.05). However, the level of peripheral blood NK cells in patients of the liver fibrosis group was significantly lower than that of the control group (P<0.05). Low expression of NK cells in peripheral blood was found to be an influencing factor associated with liver fibrosis (OR>1, P<0.05).The Area Under Curve (AUC) of peripheral blood NK cell level for predicting the risk of liver fibrosis in CHB patients was 0.842, which had certain predictive value.Conclusion Low expression of NK cells in peripheral blood may be related to the progression of CHB and affect the occurrence of liver fibrosis. Early detection of peripheral blood NK cell levels may have a positive significance for predicting the fibrosis risk and improving the prognosis of CHB patients after early intervention.
    The application of real-time shear wave elastography combined with serum HA and APRI index in the evaluation of fibrosis degree in patients with chronic hepatitis B
    WEI Yu-ya, ZHU Ting, TANG Wen-jing, FANG Jing
    2021, 26(8):  883-886. 
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    Objective To study the application value of real-time shear wave elastography (SWE) combined with serum hyaluronic acid (HA) and aspartate aminotransferase and platelet ratio index (APRI)in the evaluation of fibrosis degree in patients with chronic hepatitis B.Methods There were 116 cases of clinical dataes with chronic hepatitis B from June 2018 to June 2020,all patients underwent liver biopsy,the grade of liver fibrosis was recorded.All patients were examined by SWE and the elastic modulus was recorded.The serum hyaluronic acid (HA) was detected by radioimmunoassay,the APRI index was calculated.The accuracy of elastic modulus, serum HA and APRI in evaluating liver fibrosis were analyzed.Results There were 48 cases of S0-S1, 32 cases of S2, 20 cases of S3 and 16 cases of S4.There were significant differences in four groups of patients with different degrees of liver fibrosis in elastic modulus [(7.2±2.4)kPa,(8.9±3.0)kPa,(13.6±5.3),(18.7±6.5)kPa,P<0.05],serum HA[(139.1±72.8)μg/L,(337.6±115.2)μg/L,(416.2±136.5)μg/L,(584.2±162.6)μg/L,P<0.05],APRI[(0.4±0.2),(0.7±0.3),(0.9±0.4),(1.1±0.5),P<0.05].The re-ceiver operative characteristic curve(ROC) analysis showed that modulus of elasticity (AUC=0.765, 95% CI=0.642-0.889), serum HA (AUC = 0.797, 95% CI = 0.680-0.913) and APRI (AUC=0.732, 95% CI=0.599-0.866) had high application value in judging liver fibrosis ≥ S2 stage.The multiple stepwise regression analysis showed that the elastic modulus, serum HA and APRI were closely related to the degree of liver fibrosis in patients with chronic hepatitis B (P<0.05).The sensitivity and specificity of elastic modulus value + HA + APRI of combined diagnosis predicts liver fibrosis ≥ S2 stage were 60.1% and 90.5% respectively,the sensitivity and specificity of elastic modulus value+HA+APRI in predicting liver fibrosis ≥ S2 stage were 92.5% and 66.5%, respectively.Conclusion The SWE combined with serum HA and APRI index has high accuracy in evaluating the degree of liver fibrosis in patients with chronic hepatitis B.
    Liver Failure
    Risk factors of post-operative liver failure in hepatectomized patients due to hepatic hemangioma
    WANG Guo-feng, JIA Yu-qing, WANG Hong-bo
    2021, 26(8):  887-891. 
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    Objective To observe the occurrence of liver failure in patients with hepatic hemangioma after hepatectomy and analyze the risk factors.Methods A total of 96 patients with hepatic hemangioma who underwent hepatectomy in Department of General Surgery, Yangzhou Friendship Hospital from March 2019 to January 2020 were selected in this study. The occurrence of postoperative liver failure in all patients were observed. A baseline data survey form was designed and used for recording the patient’s information. Single and multivariant analyses were performed to identify the risk factors associated with post-hepatectomy liver failure.Results Nine of the 96 patients (9.38%) with hepatic hemangioma had liver failure after hepatectomy. Single and multivariant regression analyses showed that large tumor size, low platelet count, and high intraoperative blood loss were the risk factors of liver failure after hepatectomy (OR>1, P<0.05).Conclusion Hepatic hemangioma patients have the risk of liver failure after hepatectomy, which may be related to the large tumor size, low platelet count, and high intraoperative blood loss. Clinical attention should be paid to reasonable intervention after hepatectomy in patients with hepatic hemangioma with the above-mentioned risk factors of liver failure for improving their prognosis.
    A comparison between the effects of antibiotic de-escalation therapy and empirical treatment on HBV-related acute-on-chronic liver failure patients complicated with spontaneous bacterial peritonitis
    HAN Xian-zhi, ZHANG Shu-feng, GAO Guang-fu, ZHU Hai-yang, GAO Hong-wei, SUN Hui-qing
    2021, 26(8):  892-894. 
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    Objective To study on the effect of antibiotic de-escalation therapy and empirical treatment on HBV-related acute-on-chronic liver failure (HBV-ACLF) patients complicated with spontaneous bacterial peritonitis (SBP).Methods A total of 104 patients with HBV-ACLF and SBP from April 2014 to April 2020 were enrolled in this study. They were divided into an observation group and a control group by random number table method, with 52 cases in each group. The observation group was treated with antibiotic de-escalation and further divided into effective and non-effective subgroups, while the control group was treated with empirical antibiotic therapy. The ascites bacterial culture results were recorded and the therapeutic effects of these groups were compared. Factors associated with the treatment effect were analyzed.Results There was significant difference between the observation and control groups in overall efficacy after 2 weeks’ treatment (P<0.05). The incidence of hepatic encephalopathy and refractory ascites in the observation group were significantly lower than those of the control group ((13 vs 23 cases, and 11 vs 21 cases, respectively) (P<0.05). In patients of the observation group, the international normalized ratio (INR), levels of aspartate aminotransferase (AST) and alanine transferase (ALT), the model for end stage liver disease (MELD) score of effectively treated patients were significantly lower than those of non-effective patients (P<0.05). By multivariate logistic regression analysis it was showed that the hepatic encephalopathy (95%CI=1.154～9.328, P=0.026, OR=3.281), hepatorenal syndrome (95%CI=1.522～4.087, P=0.000, OR=2.494), international normalized ratio (INR) (95%CI=1.375～2.603, P=0.000, OR=1.892), model for end-stage liver disease (MELD)(95%CI=1.054-3.630, P=0.033, OR=1.956) were independent factors influencing the treatment effect on patients with HBV-ACLF and SBP.Conclusion Antibiotic de-escalation regimen for the treatment of HBV-ACLF combined with SBP is more effective than conventional empirical antibiotic therapy. This efficacy is further associated with factors such as INR, MELD and hepatic encephalopathy.
    Other Liver Diseases
    Clinical characteristics of 15 patients with drug-induced liver and kidney injuries
    FU Shuang-nan, HE Ting-ting, ZHANG Ning, ZHOU Chao, ZHANG Jing-jing, WANG Xuan, LI Xin, SUN Zhi-hua, LIU Peng-cheng, GONG Man
    2021, 26(8):  895-898. 
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    Objective To analyze the clinical manifestations, laboratory tests and other clinical features of acute drug-induced liver and kidney injuries.Methods The clinical data of patients with acute DILI and AKI admitted to the Fifth Medical Center of PLA General Hospital from January 1, 2011 to December 31, 2019 were retrospectively analyzed, and the clinical characteristics were discussed.Results Among the 15 patients, 9 were female, 8 were ≥60 years old, with an average age of 64.88±10.30 years old. The most common clinical manifestations were anorexia (10 cases), followed by fatigue (9 cases) and yellow urine (8 cases). The main clinical classification is hepatocyte type (46.67%). The degree of liver damage was all grade 3 and above, and the main type of kidney damage was stage 1 (60%). Ascites was the most common complication.Conclusion Acute DILI with AKI is mainly seen in the elderly. The clinical classification of acute DILI with AKI is mainly hepatocyte type,and the degree of liver damage is severe. The appearance of complications affects the patients’ prognosis.
    A comparison of liver function recovery between interventional embolization and open abdominal surgery for the treatment of grades III and IV liver trauma
    CHEN Jun, TIAN tian, JIANG Hui-zhen, XU Wang
    2021, 26(8):  899-902. 
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    Objective To study on the recovery of liver function in patients with grades III and IV liver trauma after interventional embolization or open abdominal surgical therapies.Methods 82 patients with grades III and IV liver trauma from May 2017 to November 2020 were included. They were divided into an observation group (40 cases, treated with hepatic interventional embolization) and a control group (42 cases, treated with laparotomy) according to different treatments that the patients had received. The postoperative liver function and complications were recorded in all patients, and the postoperative recovery was compared between the two groups.Results No death in the observation group but 2 cases of death in the control group happened after the treatments. The operation time and postoperative hospital stay of the observation group were significantly shorter than those of the control group (69.3±13.1 min vs 114.7±20.2 min, and 7.6±1.3 d vs 9.2±1.8 d, respectively)(t=12.010, 4.595; P<0.05). The amount of bleeding in the observation group was significantly less than that of the control group (165.0±45.8 mL vs 214.9±70.3 mL, t=3.788, P<0.05). The levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBil) and gamma glutamyl transferase (GGT) in patients of the observation group were significantly lower than those in the control group at one day (237.5±80.2 U/L, 298.7±98.5 U/L, 94.2±27.2 μmol/L and 103.2±21.4 U/L vs 280.2±69.6 U/L, 367.7±86.1 U/L, 117.3±20.2 μmol/L and 118.9±26.4 U/L; t=2.543, 3.336, 4.312 and 2.922, respectively; P<0.05), 3 days (104.4±54.3 U/L, 175.5±80.3U/L, 64.4±19.5 μmol/L and 90.6±16.3 U/L, vs 173.5±70.3 U/L, 245.8±98.5 U/L, 82.2±15.3 μmol/L and 107.7±26.3 U/L, t=4.920, 3.499, 4.542, and 3.495, respectively; P<0.05) and 5 days (90.6±36.5 U/L, 105.4±96.5 U/L, 57.9±17.6 μmol/L and 80.5±13.7 U/L, vs 138.2±33.6 U/L, 182.3±63.2 U/L, 75.7±20.1 μmol/L and 95.1±18.8 U/L, t=6.068, 4.216, 4.214, 3.969, respectively; P<0.05) after operation. There were significant differences in the incidence of postoperative abdominal bleeding (1 case vs 7 cases) and liver abscess (0 case vs 5 cases) between the observation group and the control group (χ2=5.000 and 5.333, respectively; P<0.05).Conclusion The transcatheter hepatic embolization therapy is effective and safe for the treatment of grades III and IV liver trauma. The early recovery of liver function after embolization therapy is better than that of open abdominal surgery.
    The value of magnetic resonance imaging in the diagnosis of primary biliary cholangitis and the evaluation of hepatic fibrosis
    ZHAO Hong-wei, ZHU Jia, ZHANG Guo-liang, BAI Xue-feng, HAN Fei, LIN Guang-yao
    2021, 26(8):  903-906. 
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    Objective To evaluate the MRI findings of primary biliary cholangitis patients with (PBC), and to explore the value of MRI in the diagnosis of PBC and the evaluation of liver fibrosis.Methods From Jan 2012 to Jan 2020, there were 42 patients with PBC (10 males and 32 females) with an average age of (52.9±9.8) years. T-test was used for measurement data, chi-square test was used for counting data, ROC curve was drawn, the best cut-off point for DWI diagnosis was determined, and the diagnosis of PBC staging by DWI was evaluated.Results According to Ludwig classification, there were seven cases of stage Ⅰ, twelve cases of stage Ⅱ, seventeen cases of stage Ⅲ and six cases of stage Ⅳ in patients with PBC. The MRI signs of the patients included diffuse hepatomegaly in 20 cases (47.6%), splenomegaly in 42 cases (100%), enlargement of portal vein lumen in 23 cases (54.8%), establishment of portosystemic collateral circulation in 4 cases (7.7%), ascites in 9 cases (21.4%), inhomogeneous signal intensity of hepatic parenchyma in 22 cases (52.4%), and T2-weighted high signal intensity around portal vein in 25 cases (59.5%). The periportal halo sign was found in 26 cases (61.9%), the number of intrahepatic bile ducts decreased in 24 cases (57.1%), and hilar lymph node enlargement in 24 cases (57.1%). Among the 26 PBC patients with periportal halo syndrome, there were two cases of stage Ⅰ (33.3%), four cases of stage Ⅱ (30.8%), fifteen cases of stage Ⅲ (83.3%) and five cases of stage Ⅳ (100%). Among the 24 patients with reduced number of intrahepatic bile ducts in PBC, there were zero cases in stage Ⅰ (0), four cases in stage Ⅱ (30.8%), fifteen cases in stage Ⅲ (83.3%) and five cases in stage Ⅳ (100%). There was significant difference in the number of cases in each stage (P<0.05), but no significant difference was found in other MRI signs (P>0.05). The average ADC values of patients with PBC were (1.12±0.04) ×10-3 mm/s2 in stage Ⅰ, (1.09±0.02)×10-3 mm/s2 in stage Ⅱ, (1.05±0.04)×10-3 mm/s2 in stage Ⅲ, and (1.01±0.03)×10-3 mm/s2 in stage IV, respectively. Comparing the average ADC value of each stage, there were significant differences between stage Ⅰ and stage Ⅲ, stage Ⅰ and stage Ⅳ, stage Ⅱ and stage Ⅳ (P< 0.05). The cutoff point, AUC (95%CI), sensitivity and specificity of DWI in patients with ≥stage Ⅱ PBC were 1.10× 10-3 mm/s2, 0.85 (0.78-0.89), 70.8% and 81.6%, respectively, and the cutoff point, AUC (95%CI), sensitivity and specificity in patients with ≥stage Ⅲ PBC were 1.06×10-3 mm/s2, 0.91 (0.85-0.94), 83.2% and 90.8%, respectively.Conclusion Periportal halo sign and decreased number of intrahepatic bile ducts are specific signs of MRI in patients with PBC. DWI can effectively diagnose patients with stage Ⅲ PBC. To sum up, MRI can be used as an effective non-invasive way to evaluate liver fibrosis in patients with PBC, and is helpful to evaluate the severity of PBC lesions.
    Analysis of predictors of poor response or intolerance in patients with autoimmune hepatitis after treatment
    XIAO Xuan, QIAN Jin-li, LI Ting
    2021, 26(8):  907-909. 
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    Objective To evaluate the predictors of poor response or intolerance in autoimmune hepatitis (AIH) patients after treatment.Methods A total of 92 patients (26 males and 66 females) with AIH between January 2012 and July 2020 were reviewed. Normal ALT and AST were defined as post-treatment response (response group), ALT and AST maintained at 2 times the normal upper limit of (ULN) (treatment response was not good) or > 2 times ULN (treatment intolerance) was defined as no response after treatment (non-response group). M (P25, P75) denotes metrological data and Kruskal-Wallis H test comparison; (%) represents counting data and chi-square test comparison; Logistic regression analysis explores the influencing factors of poor response or intolerance in AIH patients.Results There were 55 cases in response group and 37 cases in non-response group. The age of diagnosis of AIH, the progression of AIH and liver cirrhosis were significantly different between the two groups (P<0.05), but there was no significant difference in sex, acute onset, AIH recurrence and autoimmune diseases between the two groups (P>0.05). There were significant differences in ALT, AST, anti-smooth muscle antibody (SMA) and anti-liver specific cytoplasmic antigen type I antibody (LC-1) between response group and non-response group (P<0.05), but there was no significant difference in TBIL, albumin, IgG, antinuclear antibody (ANA), anti-liver soluble antigen antibody (anti-SLA), anti-liver and kidney microsomal antibody (anti-LKM) and anti-mitochondrial antibody (AMA) (P>0.05). The age of diagnosis of AIH, the progression of AIH, liver cirrhosis, ALT, AST, AMA and LC-1 were included in Logistic regression analysis. The results showed that the age of diagnosis of AIH and liver cirrhosis were independent risk factors for poor response or intolerance in patients with AIH.Conclusion Younger age at the time of diagnosis of AIH and the occurrence of cirrhosis in the disease stage are the risk factors of poor response or intolerance in patients with AIH after treatment.
    Changes and clinical value of serum P-LIP and ANGPTL4 in non-alcoholic fatty liver disease
    LIU Gang, XIONG Guo-wei, WANG Jiu
    2021, 26(8):  910-912. 
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    Objective To investigate the changes and clinical value of serum pancreatic lipase (P-LIP) and angiopoietin-like protein 4 (ANGPTL4) in non-alcoholic fatty liver disease (NAFLD).Methods A total of 128 NAFLD patients admitted to this hospital from February 2018 to October 2020 were selected as the study group, and 120 healthy patients who underwent physical examination in the hospital during the same time period were selected as the control group. The serum P-LIP and ANGPTL4 levels of the two groups of study subjects were compared. the NAFLD patients were divided into mild group (69 cases), moderate group (36 cases) and severe group (23 cases) based on abdominal ultrasound examination, and the different severity levels were compared Serum P-LIP and ANGPTL4 levels in NAFLD patients. Make receiver operating characteristic curve (ROC) to analyze the diagnostic efficacy of serum P-LIP, ANGPTL4 and their combination for NAFLD.Results The systolic blood pressure, diastolic blood pressure, alanine aminotransferase (ALT), aspartate aminotransferase (AST), phosphocreatine kinase (CK) and total cholesterol (TC) in the study group were significantly higher than those in the control group (t=5.375, 7.669, 17.110, 9.447, 12.644, 12.213, all P<0.05). The serum P-LIP level in the study group was (27.5±8.1) U/L, which was significantly lower than the control group (38.1±9.8) U/L (t=9.308, P<0.05), and the serum ANGPTL4 level in the study group was (172.7±75.3) ng/mL, which was significantly lower It was higher than the control group (145.3±65.4) ng/mL (t=3.051, P<0.05). The serum P-LIP and ANGPTL4 levels of NAFLD patients with different severity levels were statistically different (t=11.357, 7.518, P<0.05). The serum P-LIP of NAFLD patients in the severe group was significantly lower than that in the mild group and the moderate group (t=4.295, 2.467, P<0.05). Serum P-LIP of NAFLD patients in the severe group was significantly lower than that in the mild group (t=2.009, P<0.05); serum NGPTL4 in the severe group of NAFLD patients was significantly higher than that in the mild and moderate groups (t=4.417, 2.047, P<0.05), and serum ANGPTL4 in the moderate group of NAFLD patients was significantly higher than the mild group (t=2.332, P<0.05). ROC analysis showed that the best cut-off points for the diagnosis of NAFLD patients by serum P-LIP and ANGPTL4 were 33.6 U/L and 164.2 ng/mL, respectively. The specificity of the combination of the two was 96.7%, which was higher than that of serum P-LIP and ANGPTL4. The specificity of diagnosis alone (70.8%, 60.8%), the area under the curve (AUC) of the combined diagnosis of serum P-LIP and ANGPTL4 for NAFLD patients was 0.874, which was significantly higher than the AUC (0.718, 0.663) (Z=4.015, 4.042, P=0.003, 0.001), and the combination of serum P-LIP and ANGPTL4 showed good consistency between the diagnosis of NAFLD patients and the results of abdominal ultrasound examination (Kappa=0.715, P=0.008).Conclusion The combined detection of serum P-LIP and ANGPTL4 has a higher diagnosis of NAFLD and can be used as an important reference index for the diagnosis of NAFLD.
    Relationship between plasma acylation stimulating protein and obese nonalcoholic fatty liver disease
    LI Xiao-xiang, GU Xiao-dan, XU Wei-dong
    2021, 26(8):  913-916. 
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    Objective To investigate the relationship between plasma acylation stimulating protein (ASP) and obesity in obese patients with nonalcoholic fatty liver disease (NAFLD).Methods A total of 72 obese and non-obese NAFLD patients in our hospital from 2017 to 2019 were selected as the research objects, and 60 healthy people who passed the physical examination in the same period in our hospital were selected. The serum or plasma biochemical indexes of the three groups were compared, and the correlation between ASP and body mass index (BMI) in NAFLD patients was analyzed by Pearson.Results Compared with the control group, the levels of plasma ASP and other glucose and lipid metabolism in obese and non-obese NAFLD patients were significantly increased (P<0.01), while compared with non-obese NAFLD group, the level of ASP and other glycolipid metabolism indexes in obese NAFLD patients increased more significantly (P<0.01).Conclusion The content of ASP in plasma of obese NAFLD patients is higher, which may be related to obesity and blood lipid metabolism.
    Predictive value of aspartate aminotransferase to platelet ratio index in preterm infants with parenteral nutrition associated cholestasis
    CAI Si-ming, CEN Hong-xia, LIAO Zhao-mei, CHEN Jian-biao
    2021, 26(8):  917-919. 
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    Objective To explore the predictive value of aspartate aminotransferase to platelet ratio index(APRI) in preterm infants with parenteral nutrition associated cholestasis(PNAC).Methods A total of 132 extremely low birth weight preterm infants who received parenteral nutrition from March 2018 to February 2020 in our hospital were retrospectively analyzed. They were divided into PNAC group and non PNAC group. The levels of direct bilirubin (DB), aspartate aminotransferase (AST) and platelet (PLT) were recorded at 1, 2 and 3 weeks after parenteral nutrition treatment, and the APRI value was calculated.Results At the first week after parenteral nutrition treatment, APRI in PNAC group was significantly higher than that in non PNAC group (P<0.05), but DB, AST and PLT had no significant difference between the two groups (P>0.05). At the second week after parenteral nutrition treatment, APRI and DB in PNAC group were significantly higher than those in non PNAC group (P<0.01), and PLT was significantly lower than that in non PNAC group (P<0.05). AST had no significant difference between the two groups (P>0.05). At the third week after parenteral nutrition treatment, APRI, DB and AST in PNAC group were significantly higher than those in non PNAC group (P<0.05 and P<0.01), and PLT was significantly lower than that in non PNAC group (P<0.01). The AUC of APRI was 0.701, the cut-off value was 0.43, the sensitivity was 78.6%, and the specificity was 73.1%.Conclusion Early monitoring of APRI is beneficial to the early detection of PNAC.
    Correlation between serum glycocholic acid levels and adverse pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy
    XUE Kui, SHI Hui, WANG Wen-juan
    2021, 26(8):  920-923. 
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    Objective To investigate the correlation between the level of serum glycocholic acid and adverse pregnancy outcomes in patients with intrahepatic cholestasis (ICP) during pregnancy, so as to guide early intervention in future ICP patients and promote benign pregnancy outcomes.Methods From May 2017 to April 2020, 260 patients with ICP in the hospital were selected as the research objects. The pregnancy outcomes of the patients were counted and divided into a poor pregnancy outcome group and a control group. The serum levels of glycocholic acid in the two groups were detected and the influence and predictive value of serum glycocholic acid levels on adverse pregnancy outcomes in ICP patients were analyzed.Results Among the 260 ICP patients in this study, eighty-three patients had poor pregnancy outcomes, and the incidence of adverse pregnancy outcomes was 31.92%; the serum glycocholic acid level in the adverse pregnancy outcome group was higher than that of the control group, and the difference was statistically significant (P<0.05); compared other baseline data between groups, the difference was not statistically significant (P>0.05); after single logistic regression analysis and establishment of multiple regression model, the results of multivariate analysis showed that the high expression of serum glycocholic acid was the influencing factor of the adverse pregnancy outcome of ICP patients (OR>1, P<0.05); the ROC curve was drawn and found that the AUC of serum glycocholic acid levels used to predict adverse pregnancy outcomes in ICP patients was 0.868, which had certain predictive value. And when the cut-off of serum hepatic acid was 2.670μmol/L, the best predictive value could be obtained.Conclusion Patients with ICP are at high risk of adverse pregnancy outcomes. Overexpression of serum glycocholic acid level may be involved in the occurrence of adverse pregnancy outcomes in ICP patients. Early detection of serum glycocholic acid levels can predict pregnancy outcomes, and may be of positive significance for guiding the formulation of early intervention programs and improving pregnancy outcomes.