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    30 September 2021, Volume 26 Issue 9
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    Drug Induced Liver Injury
    Analysis of clinical and pathological characteristics of liver injury induced by Chinese and western medicine based on integrated evidence chain
    HE Ting-ting, WANG Li-ping, REN Lu-tong, CUI Yan-fei, BAI Zhao-fang, GUO Yu-ming, GONG Man, WANG Rui-lin
    2021, 26(9):  962-967. 
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    Objective To analyze the clinical and pathological features of liver injury caused by Chinese and western medicine. Methods The general situation, clinical classification, medication history, laboratory indicators and pathological characteristics of liver puncture of in patients with drug-induced liver injury ( DILI ) admitted to our hospital from January 2015 to December 2020 were retrospectively analyzed. Results There were 102 patients with DILI, 27 males and 75 females, with an average age of (47±13) years. There were 187 patients with herb-induced liver injury ( HILI ), including 50 males and 137 females, with an average age of (49±11) years. There was no statistically significant difference between two groups in gender, age, body mass index (BMI), allergic history and drinking history. Both DILI and HILI were hepatocellular injury type, the numbers were 139 (74.3%) and 83 (81.4%), respectively. The levels of initial alkaline phosphatase (ALP) 171.0 (139.0, 242.0) U/L and total bilirubin (TBil) 96.6 (33.0, 209.9) umol/L of HILI group were higher than those of DILI group [initial ALP 150.0 (110.8, 246.8) U/L, initial TBil 73.9 (20.2, 148.3) umol/L], which was statistical significance (P<0.05). The levels of initial alanine aminotransferase (ALT) 895.0 (491.0, 1312.0) U/L and initial ALP 161.0 (125.0, 200.0) U/L of hepatocellular injury type in HILI group were higher than those in DILI group [initial ALT 541.0 (236.0, 1032.0) U/L, initial ALP 142.0 (107.0, 195.0) U/L], which was statistical significance (P<0.05). The levels of initial ALT 278.3±111.9 U/L, initial ALP 296.0 (202.0, 501.5) U/L, initial gamma-glutamyltransferase (GGT) 563.9±304.9 U/Land creatinine (Cr) 89.0 (64.5, 101.5) umol/Lof mixed injury type in DILI group were higher than those in HILI group [initial ALT 199.4±62.3 U/L, initial ALP 222.0 (167.5, 248.0) U/L, initial GGT 198.1±119.4 U/L, Cr 62.0 (54.0, 77.5) umol/L], which was statistical significance (P<0.05). In DILI group, the first suspected drugs inducing liver injury was antipyretic and analgesic, followed by drugs for thyroid diseases. Chinese medicines inducing HILI were mainly used in health care, skin disease, digestive system disease, bone and joint disease, etc. Compared to hepatocellular injury HILI, necrosis of liver cells, phagocytic pigment granules Kupffer cells, cholestasis in hepatocytes and / or the bile duct more likely occurred in hepatocellular injury DILI, which was statistical significance (P<0.05). Conclusion Hepatocyte injury is the main type of both DILI and HILI. Although the levels of initial ALT and ALP of DILI are lower than those of HILI, the pathological manifestations of liver injury is more severe in DILI.
    ROC curve analysis and comparative study of hepatobiliary biochemical indexes of drug-induced cholestasis
    REN Jing-Jing, ZHANG Li-xiang, HAN Zi-yan
    2021, 26(9):  968-971. 
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    Objective To investigate the characteristics and diagnostic value of hepatobiliary biochemical indexes of drug-induced cholestasis. Methods A total of 135 inpatients with drug-induced liver injury (DILI), bile duct stones (CBDS) or primary biliary cholangitis (PBC) admitted to our hospital from January 2012 to July were included. They were randomly divided into 3 groups.. A series of assay indexes were recorded, including total bile acid (TBA), total bilirubin (TBil), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP), 5-nucleotidase (5'-NT), alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Normality test, one-way analysis of variance, rank sum test, chi-square test and receiver operating characteristic (ROC) curve analysis were performed through SPSS software. Results TBA level of DILI group was significantly higher than those of PBC and CBDS group (P<0.05). TBil level of DILI group was significantly higher than that of PBC group (P<0.05). However, there was no statistical difference of TBil level between DILI group and CBDS group (P>0.05). GGT level of DILI group was significantly lower than those of CBDS and PBC group (P<0.05). The 5'-NT level of DILI group was significantly lower than that of CBDS group (P<0.05). However, there was no statistical difference of 5'-NT level between DILI and PBC group (P>0.05). There was no statistical difference in ALP level among three groups (P>0.05). The ROC curve of the DILI group showed that the area under the curve (AUC) of TBA level was 0.990, P=0.000, the cut-off value was 120.2μmol/L, and its sensitivity and specificity were 97.4% and 100%, respectively. The AUC of ALP : GGT ratio of DILI group was 0.930, P=0.000, the cut-off value was 0.74 (1∶1.35), its sensitivity and specificity were 89.5% and 89.5%, respectively. The AUC of TBil level in DILI group was 0.751, P=0.000, its cut-off value was 171.62μmol/L, its sensitivity and specificity were 100% and 55.8%, respectively. There was no significant difference in ROC curve analysis of ALP, 5'-NT and GGT levels of the DILI group. Conclusion Among different kinds of cholestasis, TBA level of drug-induced cholestasis is the highest and GGT level of drug-inducedI is the lowest, which may be a typical manifestation. Secondly, 5'-NT level of drug-induced cholestasis is significantly lower than that of CBDS, but similar to that of PBC. There is no statistical difference in ALP level among different kinds of cholestasis. The cut-off value of TBA level and ALP/ GGT ratio perform especially well in diagnosing drug-induced cholestasis,and showing excellent sensitivity and specificity.
    Liver Fibrosis & Cirrhosis
    Application of right heart contrast echocardiography in the evaluation of intrapulmonary shunt in patients with liver cirrhosis
    PAN Guo-dong, HOU Fei, ZHANG Yao, LIU Yu-feng, WANG Xiao-jing, LIU Yao, DUAN Ying, WANG Yan-bin, LI Wei, HAO Yi-wei, XIONG Hao-feng
    2021, 26(9):  972-976. 
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    Objective To investigate the application value of right heart contrast echocardiography in the evaluation of intrapulmonary shunt in patients with liver cirrhosis. Methods One hundred and eigthy-six inpatients with liver cirrhosis admitted to our hospital from July 2019 to September 2019 underwent the right heart contrast echocardiography, and vitamin B6 and sodium bicarbonate were used as contrast agents. The adverse reactions during the inspection were recorded. The dynamic images were collected. The image with the most densest area of microbubble in left atrium of patients with intrapulmonary shunt was analyzed, and the amount of microbubbles was semi-quantitatively analyzed to evaluate the existence of intrapulmonary vascular shunt. The right-heart contrast echocardiography and clinical data of patients with intrapulmonary shunt were analyzed to evaluate the high-risk factors. Results Among the 186 patients, 125 were males (67.2%) and 61 were females (32.8%), patients mean age ranged from 26 to 70 years old (53.4±9.9 years old). All patients had a good tolerance, and only 2 patients felt slight pain at the injection site, with no effect on the experiment. No adverse events occurred. 4 cases (2.15%) with a large volume of shunt, 6 cases with a medium volume of shunt (3.22%), 38 cases (20.43%) with a small volume of shunt, and 138 cases (74.19%) with no intrapulmonary shunt. Compared to the patients with a small volume of shunt, the appearance of microbubbles in the left atrium was earlier in patients with a large volume of shunt after contrast agents were injected. Further analysis showed that the Spearman correlation coefficient between the volume of the pulmonary shunt and the degree of cirrhosis in patients with liver cirrhosis was 0.463, which was a positive correlation. The volume of the intrapulmonary shunt became larger as the Child-Pugh grade of liver cirrhosis got higher. Conclusion The vitamin B6 and sodium bicarbonate mixed liquors can be a safe and effective contrast agent used in patients with liver cirrhosis for right-heart contrast echocardiography. The volume of intrapulmonary shunt is closely related to the severity of hepatic cirrhosis in patients with liver cirrhosis.
    The characteristics of fibrosis stage and its correlation with platelet in patients with low level HBsAg
    XU Fang, ZHANG Hai-quan, ZHAO Jia-qiang
    2021, 26(9):  977-979. 
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    Objective To investigate the characteristics of fibrosis stage in chronic hepatitis B (CHB) patients with low level of hepatitis B surface antigen (HBsAg) and its correlation with platelet (PLT) count. Methods One hundred and thirty-six CHB patients with low HBsAg admitted to our hospital from April 2018 to April 2020 were included. They were divided into S1 group (n=28), S2 group (n=37), S3 group (n=40), and S4 group (n=31) according to the stage of liver fibrosis. At baseline, the PLT, type Ⅲ collagen (PC-Ⅲ), collagen type Ⅳ collagen (C Ⅳ), hyaluronic acid (HA), and laminin (LN) were detected in all patients.The stage of liver fibrosis was evaluated. The levels of PC, PC-Ⅲ, C Ⅳ, HA and LN of the four groups were compared, Spearman coefficient test was used to analyze the correlation between PLT level and PC-Ⅲ, C Ⅳ, HA and LN in CHB patients with low level of HBsAg. Results PLT levels of S1 group, S2 group, S3 group and S4 group were (220.7±85.4) × 109/L, (169.2±66.4) × 109/L, (135.7±52.6) × 109/L, and (104.5±40.1) × 109/L, respectively. The PLT level of the four groups from the highest to the lowest was in order as follows: S1 group, S2 group, S3 group, S4 group. The difference was statistically significant (P<0.05). Serum levels of PC-Ⅲ, C Ⅳ, HA, and LN of S1 group were (95.5±34.3) μg/mL, (61.2±15.7) μg/mL, (84.3±25.6) ng/mL, (88.4±15.4) ng/mL, respectively; of S2 group were (130.5±48.6) μg/mL, (79.3±20.4) μg/mL, (115.3±30.6) ng/mL, (102.8±22.8); of S3 group were (166.4±62.7) μg/mL, (90.4±25.3) μg/mL, (155.5±45.1) ng/mL, (115.6±29.3) ng/mL and of S4 group were (223.7±80.9) μg/mL, (105.5±31.9) μg/mL, (224.3±79.3) ng/mL, (226.3±34) ng/mL. The indicators of the four groups from the lowest to the highest was in order as follows: S1 group, S2 group, S3 group, S4 group, and the difference was statistically significant (P<0.05). Correlation analysis showed that serum PLT level was negatively correlated with the levels of PC-Ⅲ, C Ⅳ, HA and LN in CHB patients with low levels of HBsAg, r=0.584, 0.521, 0.499, 0.544, respectively, P<0.05. Conclusion When the serum PLT level decreases significantly, the levels of serum PC-Ⅲ, C Ⅳ, HA and LN rise obviously in CHB patients with low level of HBsAg, suggesting the close relationship between the level of HBsAg and PLT, which may help to evaluate liver histological damage.
    A study on the applycation of carvedilol combined with endoscopic selective varices devascularization in the treatment for esophageal and gastric varices bleeding
    LI Mei-lin ,YAO Shang-zhi, WANG Dong, JU Feng, WANG Xiao-wei
    2021, 26(9):  980-983. 
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    Objective To evaluate the clinical efficacy and safety of endoscopic selective varices devascularization (ESVD) combined with oral carvedilol in the treatment for patients with esophageal and gastric varices bleeding (EGVB). Methods A retrospective analysis was performed on 40 cirrhosis patients with EGVB. According to different methods of treatment, 22 patients were selected into ESVD group, and 18 patients were selected into carvedilol combined ESVD group, respectively. The rate of rebleeding, mortality, endoscopic improvement rate and the incidence of complications were compared between two groups. Results The rebleeding rates within 2 weeks after treatment of ESVD group and combined treatment group were 36.4% (8/22) and 11.1% (2/18), respectively, which was no significant difference (P>0.05). The rebleeding rate within 6 months after treatment of combined treatment group was 22.2% (4/18), which was significantly lower than that of ESVD group (54.5%, 12/22) (P<0.05). The rates of hemorrhage-related death within 6 months after surgery in ESVD group and combined treatment group were 9.1% (1/22) and 5.6% (1/18), respectively, and the overall mortality were 9.1% (1/22) and 5.6% (1/18), respectively, which was no statistically significant (P>0.05). One month after treatment, endoscopic improvement rates of ESVD group and combined treatment group were 59.1% (13/22) and 88.8% (16/18) respectively, which was statistically significant (P<0.05). Six months after treatment, endoscopic improvement rates of ESVD group and combined treatment group were 54.5% (12/22) and 88.8% (16/18) respectively, which was statistically significant (P<0.05). No serious complication occurred in both groups during the follow-up period. Conclusion The efficacy and safety of ESVD combined with oral carvedilol are more available in the treatment for patients with EGVB, which is worthy clinical promotion.
    Feasibility of endoscopic submucosal dissection of benign esophageal tumors in patients with hepatitis B virus-related cirrhosis
    CHEN Yan-lei, CAI Yong-guo
    2021, 26(9):  984-986. 
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    Objective To analyze the feasibility of endoscopic submucosal dissection (ESD) of benign esophageal tumors in patients with hepatitis B virus-related cirrhosis. Methods The hospital medical record management system between January 2010 and June 2020 was reviewed. One hundred and seventy-four patients of benign esophageal tumors treated with ESD were included, with an average age of (53.2±10.5). The numbers of male and female were 92 and 82, respectively. Thirty-four patients with hepatitis B virus-related cirrhosis were selected as the cirrhosis group, and 140 patients without hepatitis B virus-related cirrhosis were selected as the non-cirrhosis group. The differences of measurement data were analyzed through the t-test or Kruskal-Wallis H test, and the differences of enumeration data were analyzed through the chi-square test. Results The Child-Pugh score of cirrhosis group and non-cirrhosis group were 7 (5, 12) and 0 (0, 0), respectively, the difference was statistically significant (P<0.05). The platelet count of cirrhosis group [152 (110, 318) × 109/L] was significantly lower than that of non-cirrhosis group [245 (142, 330) ×109/L, P<0.05], while international normalized ratio (INR) of cirrhosis group [1.2 (1.0, 1.8)] was significantly higher than that of non-cirrhosis group [1.0 (0.9, 1.3), P<0.05]. In addition, there was no significant difference in age, sex, white blood cell (WBC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin and albumin between the two groups. There was no significant difference in the diameter of esophageal benign tumor, esophageal leiomyoma, tumor location, ESD operation time and the number of complete tumor resection between the two groups. But there were 6 (17.6%) and 5 (3.6%) cases had postoperative bleeding in liver cirrhosis group and non-cirrhosis group, respectively, and the difference was statistically significant (P<0.05). Five cases of postoperative bleeding in cirrhosis group were combined with esophageal varices. Esophageal perforation or death related to ESD was not occurred in both groups. Conclusion ESD is safe and effective in the treatment of benign esophageal tumors in patients with hepatitis B virus-related cirrhosis, especially in patients without severe liver cirrhosis complications.
    Quantitatively predicting the prognosis of schistosomal sirrhotic patients with CT perfusion related parameters
    ZHANG Bi-quan, MA Yu-hang
    2021, 26(9):  987-989. 
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    Objective To study on the value of computed tomography (CT) perfusion parameters in quantitatively predicting the prognosis of schistosomal cirrhotic patients. Methods Eighty-four patients with schistosomal cirrhosis who had underwent 64-slice spiral CT perfusion scanning of liver were enrolled in this study. According to patients' prognosis they were divided into a death group (30 cases) and a survival group (54 cases), The CT liver perfusion imaging parameters, hepatic blood volume (BV), hepatic blood flow (BF), average contrast agent through time (determined by MTT) and hepatic arterial fraction (HAF), hepatic artery perfusion (HAP) of these two groups of patients were compared. Receiver-operating characteristic (ROC) curve was applied to evaluate the predictive efficacy of these parameters for the prognosis of the schistosomal cirrhotic patients. Results The BV and BF of the death group were significantly lower than those of the survival group (P<0.05), and the MTT, HAF, and HAP were significantly higher than those of the survival group (P<0.05). CT perfusion imaging parameters BV, BF, MTT, HAF, HAP had a certain predictive efficacy on the prognosis of patients with schistosomal cirrhosis, the area under the curve was 0.660, 0.637, 0.765, 0.674, 0.721, respectively. Conclusion CT liver perfusion imaging parameters BV, BF, MTT, HAF, HAP have important predictive value for the prognosis of patients with schistosomal cirrhosis, which should be taken adequate clinical attention.
    Viral Hepatitis
    Predicting liver-related events in chronic hepatitis B patients by the measurement of liver stiffness with two-dimensional shear wave elastography
    ZHU Dong-ming, DING Jie
    2021, 26(9):  990-993. 
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    Objective To evaluate the predictive value of liver stiffness measurement (LSM) with two-dimensional shear wave elastography (2D-SWE) for liver related events (LREs) in chronic hepatitis B (CHB) patients. Methods A total of 476 CHB patients were selected from May 2014 to October 2020, They were divided into a LREs group (n=68) and a non-LREs group (n=408) according to whether the patient developed LREs. LREs are defined as liver decompensation, hepatocellular carcinoma and/or liver-related death. Univariate and multivariate analysis were performed to determine the independent predictive factors related to the occurrence of LREs in CHB patients, ROC curve was drawn and the diagnostic cutoff point was taken at the maximum Jordan index. The diagnostic index were calculated. Results The age of LREs group and non-LREs group was(57.6±7.4)and (49.3±9.2) years, respectively, and there was significant difference between these two groups (P<0.05). The numbers of patients of Child-Pugh A, B and C grades were 2 cases (2.9%), 20 cases (29.4%) and 46 cases (67.6%) in LREs group, and 146 cases (35.8%), 221 cases (54.2%) and 41 cases (10.0%) respectively in non-LREs group. The difference was statistically significant (P<0.05). The levels of ALT, AST, PLT and HBeAg in LREs group were(68.5±79.6)IU/L,(56.1±63.6)IU/L,(112.8±48.0)×109/L,49 cases(72.0%),respectively, which were significantly higher than those in non-LREs group [(144.1±126.0) IU/L, (132.8±130.5) IU/L, (165.4±56.4)×109/L, 208 cases (51.0%), respectively,all P<0.05]. LSM, APRI and FIB-4 in LREs group were (26.6±10.7) kPa, (1.0±0.4) and (2.1±1.3), respectively,which were significantly higher than those in non-LREs group [(16.4±11.8)kPa, (0.5±0.2) and (1.2±0.2), respectively, all P<0.05]. The above variants were included in multivariate analysis, and the results showed that Child-Pugh grade, LSM, APRI and FIB-4 were independent predictors of LREs in CHB patients. The AUC value of LSM (0.88) for the diagnosis of LREs in CHB patients by 2D-SWE was significantly higher than those of APRI (0.74) and FIB-4 (0.78) (P<0.05). When triply combined these parameters, the diagnostic sensitivity, specificity and accuracy were 89.7% (61/68), 94.8% (387/408) and 94.1% (448/476), respectively. Conclusion 2D-SWE measurement of LSM can effectively predict the occurrence of LREs in CHB patients. When combined with APRI and FIB-4, the diagnostic efficiency is further improved, which has value of clinical application.
    Risk factors for liver failure-related death in chronic hepatitis B patients
    CHEN Jiao-yan, CHEN Bin, CAO Dong-rong, ZHU Man-ran, JIAO Zhi-yong, QIN Yong-jun, XIA Ming-xin
    2021, 26(9):  994-997. 
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    Objective To explore the risk factors that affect the survival of chronic hepatitis B (CHB) patients complicated with liver failure. Methods The clinical data of 140 CHB patients complicated with liver failure were retrospectively analyzed. The patients were divided into a survival group (clinical symptoms improved after treatment, n=77) and a death group (death after treatment, n=63) according to whether they survived after comprehensive medical treatment. The clinical data of these two groups of patients were compared. Single and multivariate logistic regression analyses were used to identify the risk factors that affect the survival of CHB patients complicated with liver failure. Results The result of univariate analysis showed that the course of disease, blood ammonia level, CTP score, MELD score, blood sodium level, age, alkaline phosphatase level, transaminase level, serum bilirubin level, prothrombin time, the occurrence of encephalopathy, hepatorenal syndrome, and gastrointestinal hemorrhage were the factors that impact on the survival of CHB patients with liver failure (all P<0.05). Further multi-variate analysis showed that advanced age, high levels of alkaline phosphatase, transaminase, serum bilirubin, prolonged prothrombin time, the occurrences of hepatic encephalopathy, hepatorenal syndrome, and gastrointestinal hemorrhage are independent risk factors for the survival of CHB patients with liver failure (OR=1.347, 1.029, 1.654, 1.352, 1.274, 0.081, 16.415, 0.937, respectively,all P<0.05). Conclusion Old age, high levels of alkaline phosphatase, transaminase, serum total bilirubin, and prolonged prothrombin time, the occurrences of hepatic encephalopathy, hepatorenal syndrome, and gastrointestinal hemorrhage are risk factors that impact on the survival of CHB patients with liver failure.
    Establishment of a cell line supporting the gene expression and replication of hepatitis B virus-genotype C
    LI Rui-ming, YANG Yan, ZENG Xian-huang, MENG Zhong-ji
    2021, 26(9):  998-1002. 
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    Objective To establish a novel cell line supporting the gene expression and replication of hepatitis B virus (HBV)-genotype C, and provide a new cell model for antiviral research. Methods HBV DNA was extracted from the serum of hepatitis B patients. Full-length of HBV genome was amplified by polymerase chain reaction (PCR). The circularized HBV full-length genome was generated by Sap I restriction enzyme cleavage and T4 ligase ligation, and was used as a template to amplify 0.2 copies of HBV genome (nt1402-nt1989) and one copy of HBV (nt1402-nt3215-nt1407), respectively. The two HBV DNA PCR products were cloned into pcDNA3(-)-EGFP-△CMV vector to obtain a p1.2×HBV-EGFP plasmid, followed by sequencing verification. The recombinant plasmid was transfected into HepG2 cells with lipofectamine 2000. Positive clones were selected by culturing the cells in the presence of G418 (700μg/ml) for 2-3 weeks. The levels of HBsAg, HBeAg, and HBV DNA in the cell culture supernatants were detected by ELISA and real-time PCR, respectively; The intracellular HBV replication intermediates were detected by Southern blotting, and the intracellular HBsAg and HBcAg were detected by immunofluorescence. Results A novel cell line, namely HepG2X15, was established for supporting the replication of HBV DNA -genotype C that derived from clinical isolates. It was evidenced that high levels of HBsAg, HBeAg, and HBV DNA were detectable in the culture supernatant, and intracellular HBV replication intermediates, HBsAg, and HBcAg were detectable in the cells. Compared with HepG2.2.15 cell line, HepG2X15 cells secrete higher levels of HBsAg and HBV virions into the culture supernatant. Conclusion A novel cell line HepG2X15 supporting the replication of HBV- genotype C was successfully established, with high production of HBsAg, HBeAg, and HBV virions, and intracellular HBV replication intermediates. It can be used for screening of anti-HBV drug and for investigating the mechanisms of anti-HBV drug resistance.
    Liver Cancer
    Application of three-dimensional CT reconstruction in the evaluation of tumor volume of hepatocellular carcinoma before hepatectomy
    GUO Zhi-ben, TANG Wen-cai, LI Xiao-hua, TANG Fu-qiang, ZHANG Wei-lan
    2021, 26(9):  1003-1006. 
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    Objective To evaluate the application of computed tomography (CT) three-dimensional reconstruction in the assessment of tumor volume before resecting primary liver cancer (PLC). Methods One hundred and twenty patients with PLC who were treated with laparoscopic liver resection from January 2015 to January 2020 were enrolled in these study. According to different preoperative evaluation methods, they were divided into a control group (with two-dimensional CT, 60 cases) and an observation group (with CT three-dimensional reconstruction, 60 cases). The operation condition including the estimated lesion volume, actual lesion volume, estimated resection liver volume, actual resection volume, residual liver volume, operation time, hospitalization time, intraoperative blood loss and postoperative complications were compared between these two groups of patients. The postoperative parameters of liver function including alanine aminotransaminase (ALT), total bilirubin (TBIL), aspertate aminotransferase (AST) levels were also analyzed. Results All patients in these two groups were successfully completed laparoscopic hepatectomy, with no case of death or conversion to open surgery. The volume of pre-resected liver and the actual volume of resected liver in the observation group were significantly lower than those in the control group (P<0.05), and the remaining liver volume was significantly larger than that of the control group (P<0.05). There was no significant difference in the estimated and actual volume of the lesion between these two groups (P>0.05), so as to the pre-resected liver volume and the actual resected liver volume (P>0.05). However, the pre-resection liver volume in the control group was significantly larger than the actual resection liver volume (P<0.05). The hospitalization time of the observation group was significantly shorter, and the intraoperative blood loss was significantly less than those of the control group (all P<0.05). There was no significant difference between these two groups in terms of the operation time and the incidence of postoperative complications (P>0.05) . At 7 days after operation, the liver function indexes of the observation group were significantly lower than those before operation (P<0.05), and significantly lower than those of the control group (P<0.05). Conclusion Compared with traditional CT imaging technology, CT three-dimensional reconstruction can provide a more accurate preoperative assessment for tumor volume before surgery, thus reducing intraoperative bleeding and shortening the patient’s hospital stay.
    Serum GP73 and hepcidin levels are corelated with the prognosis of hepatitis B-related liver cancer patients
    CHEN Chao, YAO Ling, QIU Bang-dong, WANG Xiao-yan
    2021, 26(9):  1007-1010. 
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    Objective To explore the changes of Golgi protein 73 (GP73) and hepcidin (Hepc) levels in the serum of hepatitis B-related liver cancer patients and their correlation with the patients’ prognosis. Methods Ninety-eight patients with hepatitis B-related liver cancer admitted between September 2017 to September 2018 were enrolled in this study as the research group. Ninety-two healthy examined people during the same time period were collected as the control group. Serum GP73 and Hepc levels were compared between the research and the control groups, and between the death and survival patients with hepatitis B-related liver cancer. Logistic regression analysis was performed to identify the risk factors affecting the patients’ survival. Receiver operating characteristic curve (ROC) was drawn for analyzing the efficacy of serum GP73 and Hepc levels in predicting the prognosis of patients with hepatitis B-related liver cancer. Results Serum GP73 and Hepc levels in the study group were (204.7±10.3) ng/mL and (128.3±12.6) μg/L, respectively, which were significantly higher than those in the control group [(38.1±6.7) ng/mL and (77.9±9.5) μg/ L, respectively] (P<0.05). After 2 years of follow-up, the mortality of patients with hepatitis B-related liver cancer was 28.4%. The serum GP73 and Hepc levels of dead patients were (261.6±12.7) ng/mL and (165.8±13.2) μg/L,respectively, which were significantly higher than those of surviving patients [(182.5±5.9) ng/mL and (113.1±10.4) μg/L, respectively] (P<0.05). Logistic multivariate analysis showed that TNM stage III-IV, high serum levels of GP73 and Hepc were all independent risk factors affecting the survival of patients with hepatitis B-related liver cancer (OR=2.570, 1.984, 2.121, all P<0.05). ROC analysis showed that the best cut-off points of serum GP73 and Hepc levels for predicting death of hepatitis B-related liver cancer patients were 25.3 ng/mL and 130.0 μg/L, respectively. The sensitivity were 70.4%, 88.9%, and the specificity were 89.7%, 72.1%, respectively. The area under the curve (AUC) were 0.887 (95%CI: 0.805~0.943) and 0.883 (95%CI: 0.801~0.940). Conclusion Serum GP73 and Hepc levels in patients with hepatitis B-related liver cancer are abnormally elevated. TNM stages III to IV, high levels of GP73 and Hepc are independent risk factors that affect the survival of patients with hepatitis B-related liver cancer.
    circPDSS1 regulates the invasion, migration and apoptosis of hepatocellular carcinoma cells by targeting miR-1298
    LI Min, WU Xing-gui, ZHU Jun-hua
    2021, 26(9):  1011-1015. 
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    Objective To investigate the effect of circular RNA PDSS1 (circPDSS1) on apoptosis, migration and invasion of liver cancer cells and its mechanism. Methods The expression of circPDSS1 and miR-1298 in liver cancer tissues and adjacent tissues were detected by real-time fluorescence quantitative PCR (RT-qPCR). Dual luciferase reporter gene experiment and RT-qPCR were used to confirm the targeted regulation of circPDSS1 on miR-1298. CircPDSS1 small interfering RNA (si-circPDSS1), miR-1298 mimics, si-circPDSS1+ miR-1298 inhibitor (anti-miR-1298) were transfected into liver cancer cell MHCC97H, respectively. Apoptosis was detected by flow cytometry, and cell migration and invasion were detected by transwell assays. Results Compared with adjacent tissues, the expression of circPDSS1 in liver cancer tissues was significantly increased (3.41±0.33 vs 1.00±0.06), while the expression of miR-1298 was significantly reduced (0.42±0.04 vs 1.00±0.07, P<0.05). circPDSS1 targeted and negatively regulated miR-1298 expression. After inhibiting the expression of circPDSS1, the apoptosis rate of MHCC97H cells was significantly increased (22.71±2.19% vs 6.02±0.05%), while the number of migrating (55.72±4.78 vs 101.86±9.65) and invasive (41.24±3.80 vs 85.71±7.57) cells were significantly decreased (P<0.05). After overexpression of miR-1298, the apoptosis rate of MHCC97H cells was significantly increased (18.67±1.06% vs 7.08±0.69%), while the cell numbers of migrating (61.11±5.54 vs 107.15±10.96) and invading (50.05±4.22 vs 88.57±7.96) were significantly decreased (P<0.05). Compared with the inhibition of circPDSS1, the apoptosis rate (11.68±1.24% vs 23.31±2.84%) of MHCC97H after the inhibition of miR-1298 and circPDSS1 was significantly decreased, while the cell numbers of migrating (86.59±7.44 vs 54.59±4.78) and invading (76.01±6.33 vs 39.91±3.73) were significantly increased (P<0.05). Conclusion Inhibiting the expression of circPDSS1 can reduce the migration and invasion ability of liver cancer cells and induce apoptosis. The mechanism is related to the targeted regulation of miR-1298.
    Other Liver Diseases
    Analysis of the etiology and prognosis of portal vein thrombosis in patients after liver transplantation
    LI Li-xin, LI Zhi-jie, BAI Ying, LIU Hong-ling, LI Hong-ling, REN Min-juan, AN Zi-rui, LIU Zhen-wen, WANG Hong-bo
    2021, 26(9):  1016-1018. 
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    Objective To investigate the etiology and prognosis of portal vein thrombosis(PVT) after liver transplantation(LTx). Methods The clinical data of 401 orthotopic liver transplantation patients in our center were reviewed and the etiology of PVT after LTx was analyzed. Results The incidence of PVT was 3.7% (15/401) in 15 LTx patients, including 9 males and 6 females, with an average age of 50.8 years (35-63 years). There were 9 cases of hepatitis B cirrhosis, 1 case of hepatitis C cirrhosis, 1 case of hepatitis B-C overlapping infection cirrhosis, 2 cases of autoimmune hepatitis cirrhosis, 1 case of hepatic lenticular degeneration, and 1 case of alcoholic cirrhosis.Among the 15 patients with PVT, 12 cases had preoperative thrombosis(80%), 4 cases had splenectomy or splenic embolization operation history(26.7%), and 3 cases had portal-luminal shunt(20%).After effective treatment, the thrombosis was significantly relieved. Conclusion PVT is a rare vascular complication after LTx. Color Doppler Ultrasonography is the first choice and effective method for monitoring portal vein complications. Early detection and individualized treatment can achieve safe and effective efficacy.
    Predictive value of human immunodeficiency virus infection on prognosis pyogenic of liver abscess
    DING Rui, WANG Qi, LIU Li-gai, ZHAO Wen-shan, XIE Wen
    2021, 26(9):  1019-1023. 
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    Objective To analyze the clinical characteristics of pyogenic liver abscess (PLA) in patients infected with human immunodeficiency virus (HIV), and to evaluate the predictive value of HIV infection on the prognosis of PLA. Methods We performed a single-center retrospective study of 139 patients with PLA in Beijing Ditan Hospital, Capital Medical University from January 2016 to December 2019. Differences were compared among patients with /without HIV infection. Risk factors for poor prognosis of patients with PLA within 30 days were evaluated. Results Patients with HIV infection had a poor outcome than patients without HIV infection (P=0.023). The positive rates of bacteria culture were 18.2% (22/121) in blood and 24.7% (24/97) in pus. Klebsiella pneumoniae accounted for 12.5% (1/8) in HIV group and 92.1% (35/38) in non-HIV group, respectively (P<0.001). Logistic regression analysis showed that older age (OR=1.048, 95% CI: 1.010-1.087, P=0.012), HIV infection (OR=4.264, 95% CI: 1.647-11.041, P=0.003), multiple abscesses (OR=3.157,95% CI: 1.265-7.882, P=0.014), and increased total bilirubin (OR=1.027,95% CI: 1.003-1.051, P=0.025) were independent risk factors for poor prognosis in PLA patients. Conclusion It seems that HIV infection can predict the short-term prognosis of PLA in clinical practice.
    Relationship between liver injury related indexes and severity of acute severe pancreatitis and NLR ratio
    DONG Qing-lian, LI Zhen-ping
    2021, 26(9):  1024-1026. 
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    Objective To study the relationship between liver injury related indexes and severity of acute severe pancreatitis and neutrophil lymphocyte ratio (NLR). Methods 90 patients with severe acute pancreatitis who were treated in our hospital from October 2018 to October 2020 were included in the study, and they were divided into moderate severe acute pancreatitis (MSAP) group and severe acute pancreatitis (SAP) group according to the severity of the disease, with 45 cases in each group. The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), glutamyl transpeptidase (GGT), total bilirubin (TBIL), absolute value of neutrophils, absolute value of lymphocytes and NLR were compared between the two groups. Spearman coefficient was used to analyze the correlation between the severity of severe acute pancreatitis and ALT, AST, TBIL, neutrophil absolute value, NLR. Results The levels of ALT, AST and TBIL in SAP group were significantly higher than those in MSAP group [(112.46±21.18) U/L vs (84.77±14.56) U/L, (87.46±11.57) U/L vs (67.16±9.16) U/L, (42.38±14.18) μmol/L vs (34.58±17.89) μmol/L]. The difference was significant (P<0.05). The absolute value and NLR of neutrophils in SAP group were significantly higher than those in MSAP group [(9.27±1.07)×109/L vs (8.41±1.34)×109/L, (8.41±2.48) vs (6.18±1.04)]. The difference was obvious (P<0.05). The severity of severe acute pancreatitis was positively correlated with ALT, AST, TBIL, neutrophil absolute value and NLR (P<0.05). Conclusion Liver injury related indicators and NLR can be used to predict the severity of severe acute pancreatitis, and there is a significant correlation between them.
    Correlation analysis of IL-10, TGF - β and their mRNA levels with liver function indexes in patients with severe acute pancreatitis complicated with liver injury
    JIAO Fang-fang, ZHANG Wei, WU Yun-zhen
    2021, 26(9):  1027-1030. 
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    Objective To analyze the correlation between the levels of interleukin-10 (IL-10), transforming growth factor - β (TGFβ) and its transcripts (mRNA) and liver function indexes in patients with severe acute pancreatitis (SAP) complicated with liver injury. Methods 60 SAP patients who were diagnosed and treated in our hospital from October 2018 to October 2020 were included in this trial. According to whether they had liver injury or not, they were divided into combined group (with liver injury) and sap (without liver injury) group, with 30 cases in each group, in addition, 30 healthy volunteers who came to our hospital for physical examination during the same period were included for a controlled study, and the control group was included.The levels of IL-10, TGFβ, IL-10 mRNA, TGFβ mRNA and liver function indexes [alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), glutamyl transpeptidase (GGT), total bilirubin (TBil)] of the three groups at admission were compared, and the correlation was analyzed by Spearman coefficient. Results The levels of IL-10 and IL-10 mRNA in the combined group were higher than those in the sap group and the control group[(56.74±4.24),(47.58±6.74) vs(39.85±4.36)ng/mL;(1.14±0.21),(0.75±0.14)vs(0.61±0.11)], The levels of TGF - β and TGF - β mRNA in the combined group were significantly higher than those in SAP group and control group[(72.04±8.61)vs(67.54±7.14),(65.38±6.71)ng/L; (0.47±0.08)vs(0.41±0.05),(0.40±0.04)], There was significant difference (P<0.05).The levels of AST, ALT, TBil, GGT and ALP in the combined group were significantly higher than those in SAP group and control group[(85.42±10.24)vs(34.24±5.64),(32.15±5.16)U/L;(79.46±10.41)vs(35.15±4.26),(33.41±4.18)U/L;(40.15±5.42)vs(35.41±4.34),(33.28±4.08)μmol/L,(61.04±7.18)vs(56.34±5.48)U/L,(54.23±4.35)U/L;(116.54±18.41)vs(104.64±12.36),(102.58±11.85)U/L],There was significant difference (P<0.05).The levels of IL-10, IL-10 mRNA, TGFβ and TGF - β mRNA were positively correlated with AST,ALT, GGT, ALP and TBil in SAP patients with liver injury (P<0.05). Conclusion The levels of interleukin-10 (IL-10), transforming growth factor β (TGFβ) and their transcripts (mRNA) were significantly correlated with liver function in SAP patients with liver injury.
    Non-operative risk factors for postoperative delirium in patients undergoing hepatectomy: a meta-analysis
    ZHOU Jing, LIU Yu-jiao, GAO Yuan, HAO Gu
    2021, 26(9):  1031-1035. 
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    Objective To evaluate non-operative risk factors for postoperative delirium in patients undergoing hepatectomy by Meta-analysis. Methods CNKI, Wanfang, CBM, VIP, PubMed and Embase databases were searched for studies on factors affecting the occurrence of postoperative delirium in patients undergoing hepatectomy from the establishment date of databases to May 7, 2020. And the extracted data were merged and analyzed by using Revman 5.3 software. Results A total of 5 articles and 1181 patients were included. Age: The age in the delirium group was older than that in the non-delirium group with statistical difference (WMD=7.76,95% CI:4.81-10.71, P<0.05). Nutritional indicators: The body mass index (BMI) and albumin level in delirium group were lower than those in non-delirium group with statistical differences (BMI: WMD=-1.19, 95% CI: -2.00--0.39; albumin: WMD=-0.32, 95% CI: -0.42--0.23, P<0.05). Bad life style: There were no statistical differences in incidences of postoperative delirium when comparing smoking group and non-smoking group (OR=0.55,95% CI:0.11-2.78, P>0.05). And there were no statistical differences in incidences of postoperative delirium when comparing alcohol abuse group and non-alcohol abuse group (OR=0.95,95% CI:0.60-1.49, P>0.05). Complications: The incidence of postoperative delirium in the group with pulmonary disease was higher than that in the group without pulmonary disease (OR=3.37, 95% CI: 1.76-6.46, P<0.05). There was were no statistical differences in the incidences of postoperative delirium between the diabetic group and the non-diabetic group, the cardiovascular disease group and the non-cardiovascular disease group (diabetes: OR=0.81, 95% CI: 0.52-1.27, P>0.05; cardiovascular disease: OR=0.98, 95% CI: 0.49-1.94, P>0.05). Sedative drugs: The incidence of postoperative delirium in the group with use of sedative drugs was higher than that in the group without use of sedative drugs (OR=4.31, 95% CI: 2.37-7.81, P<0.05). Conclusion Advanced age, low BMI, lower albumin level, with pulmonary disease and use of sedative drugs are risk factors for postoperative delirium in patients undergoing hepatectomy. For patients undergoing hepatectomy who have the above risk factors, we should pay attention to the occurrence of postoperative delirium, strengthen nutritional support and try to avoid the use of sedative drugs.
    Changes and clinical significance of liver function in premature infants with different gestational ages and newborns with different birth weights
    ZHU Li-Jia, MA Xiao-dan, DUAN Jiang, LI Meng, HUANG Yong-kun
    2021, 26(9):  1036-1040. 
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    Objective To explore clinical value of alanine amino transferase (ALT), preAlbumin (PAB), Albumin (Alb), alkaline phosphatase (ALP), g-glutamyl transferase (gamma-glutamyl transferase, GGT) and total bile acid (TBA) in the treatment of premature infants with different gestational ages and newborns with different birth weights. Methods The changes of ALT, PAB, Alb, ALP, GGT, TBA in 204 premature infants of different gestational ages and 206 newborns of different birth weights before and after treatment were retrospectively analyzed. We compared and analyzed the differences of various biochemical indicators in different gestational age preterm infants and different birth weight newborns. Results 1. Alb and PAB in late, middle, very preterm infants groups, and normal, low, very low birth weight newborns groups were higher than those before treatment, and the changes were the most statistically significant (P<0.05). With the recovery and improvement of liver function after treatment, ALT, GGT and TBA reduced. 2. Inter group differences: The younger the gestational age and the lighter the birth weight, the ability of liver to synthesize Alb, PAB, ALT, ALP, GGT and TBA were also different between groups of premature infants with different gestational ages and newborns with different birth weights respectively. Conclusion 1. In different gestational ages premature infants and different birth weight newborns after treatment, Alb and PAB increased significantly, and ALT and GGT decreased significantly. Alb and PAB have the most significant changes. Alb and PAB can be used as important indicators for monitoring liver function. 2. With the younger the gestational age and the lighter the weight, the liver function is easily affected, and its synthesis capacity, reserve and excretion capacity are worse.