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Table of Content

    31 March 2022, Volume 27 Issue 3
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    Liver Cancer
    Efficacy and safety of TACE combined with anti-angiogenic drugs and PD-1 inhibitors in the treatment of intermediate/advanced HCC
    DING Xiao-peng, TIE Jun, YU Jia-hao, REN Peng-wei, XUAN Guo-yun, MA Shuo-yi, GUO Chang-cun, HAN Ying, ZHOU Xin-min
    2022, 27(3):  277-280. 
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    Objective To analyze the efficacy and safety of transarterial chemoembolization (TACE) combined with anti-angiogenic drugs and programmed death receptor-1 (PD-1) inhibitors in the treatment of intermediate/advanced hepatocellular carcinoma (HCC).Methods Patients treated with TACE + anti-angiogenic drugs + PD-1 inhibitors who were hospitalized in Department of Gastroenterology in Xijing hospital from June 2018 to October 2020 were enrolled. The basic clinical characteristics, objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and related adverse reactions (AEs) of the patients were collected to explore the efficacy and safety of combined treatment.Results A total of 35 patients were enrolled. At the end of follow-up, 17 patients (48.6%) had died and 18 patients (51.4%) were still alive. The median PFS was 8.9 months (95%CI: 6.3-11.6) and the median OS was 16.1 months (95%CI: 11.4-20.9). The overall ORR was 60.0% and the disease control rate (DCR) was 85.7%. Among the 35 patients who received treatment, 9 patients (25.7%) had adverse reactions (AEs) above grade two. The adverse reactions improved after reducing the dosage and/or receiving symptomatic treatment.Conclusion Combination therapy has a certain therapeutic effect on patients with intermediate/advanced HCC, and the adverse reactions are relatively controllable.    
    Efficacy of bevacizumab combined with TACE in the treatment of advanced hepatocellular carcinoma
    LI Long, ZHENG Zhen-dong, DU Cheng, LIU Bo-na
    2022, 27(3):  281-283. 
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    Objective To evaluate the safety and efficacy of bevacizumab combined with transcatheter arterial chemoembolization (TACE) versus TACE monotherapy in the treatment of advanced hepatocellular carcinoma (HCC).Methods One hundred patients with advanced HCC admitted to our hospital from January 2018 to November 2019 were enrolled. They were divided into the combined group and the TACE group according to the treatment method. There were 50 cases in each group. The objective response rate (ORR) and tumor control rate (DCR) of 2 groups were compared. The levels of alpha fetoprotein (AFP) before and after treatment, the half-year survival rate, 18-month survival rate and median survival time between the 2 groups were compared.Results After 3 courses of treatment, enhanced magnetic resonance imaging (MRI) showed that the ORR of combination group and TACE group were 70.0% and 35.00% respectively, the difference was statistically significant (χ2=4.856, P=0.025); DCR of combination group and TACE group were 84.00% and 68.00% respectively, the difference was statistically significant (χ2=3.256, P=0.034). The AFP level of 2 groups decreased significantly after 3 courses of treatment, the AFP levels before and after treatment were significantly different in each group (P<0.05), and the AFP levels between the 2 groups were not significantly different (P>0.05). The half-year and 18-month survival rates of combined group were 90% and 50% respectively, which were significantly higher than those of TACE group, and the differences were statistically significant (χ2=4.726, P=0.032 and χ2=4.115, P=0.041, respectively). Kaplan-Meier analysis showed that the median survival time of patients in combined group and TACE group were 18 and 9 months, and the difference was statistically significant (χ2=7.012, P=0.007). The position of the survival curve of combination group was higher than that of TACE group, suggesting that the clinical efficacy of combined treatment was better.Conclusion The clinical efficacy of bevacizumab combined with TACE is better than TACE monotherapy in the treatment of advanced HCC, and the combined therapy can effectively improve the survival rate.
    Relationship between Glypican-3 expression level and tumor biological behavior in hepatocellular carcinoma tissues
    CHANG Li-xian, LIU Chun-yun, XIE Pian
    2022, 27(3):  284-287. 
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    Objective To guide the early diagnosis and treatment of hepatocellular carcinoma (HCC) through investigating the relationship between phosphatidylinositol proteoglycan 3 (GPC3) expression and malignant biological behavior of HCC.Methods The clinical data of 77 patients with HCC admitted to our hospital from December 2017 to August 2020 were retrospectively analyzed. All specimens were obtained from intraoperative pathologically resected tissues, HCC specimens were resected from the primary lesion, pericarcinomatous tissue was resected from the cancer adjacent liver tissues which was 5 cm away from the primary lesion, and normal liver tissue confirmed by pathology was resected from more than 5 cm away from the primary lesion. The GPC3 expression situations of different liver tissues were compared and the correlation between them and malignan biological behavior of HCC cells was analyzed [proliferation genes including: silent information regulator 6 (SIRT6), forkhead box P2 (FOXP2), hypoxia-inducible factor-1α (HIF-1α); hepatocyte apoptosis-related factors: phosphatidylinositol-3-kinase (PI3K), cysteine-containing aspartate protein hydrolase 3 (caspase-3), and serine threonine protein kinase (Akt)].Results The positive expression rates of GPC3 in HCC tissues, pericarcinomatous tissue normal tissues were 98.70% (76/77), 89.61% (69/77) and 2.60% (2/77) respectively, and the difference was statistically significant (χ2=275.074, P<0.001). The positive rate of GPC3 in normal liver tissues was significantly lower than that in pericarcinomatous tissue, (Z=10.421, P=0.004) and HCC tissues (Z=11.645, P<0.001). There was no significant difference of S100A2 expression grade among the different tissues (Z=6.839, P<0.001). Compared with pericarcinomatous tissue, the expression levels of GPC3, STC2, FOXP2, HIF-1α, SIRT6, PI3K, caspase-3 and Akt were higher in HCC tissues, the differences were statistically significant (P<0.05). Bivariate Pearson linear correlation test showed that GPC3 expressed in HCC tissues was positively associated with malignant biological behavior of cancer cells (proliferation genes: SIRT6, FOXP, HIF-1α; apoptosis-related factors: PI3K,caspase-3, Akt) (r>0, P<0.05).Conclusion There is a close relationship between GPC3 expression in HCC tissues and the biological behavior of cancer cells. GPC3 can be considered as a new target for HCC treatment, aimed at guiding the therapy of patients with HCC and improve prognosis.
    Application value of multi-modal ultrasound imaging in screening high risk population of liver cancer
    CHEN Jun-yao, LI Cai-yang, GUAN Hong-yong
    2022, 27(3):  288-291. 
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    Objective To investigate the application value of multi-modal ultrasound imaging technology in screening high-risk population of liver cancer.Methods Two hundred patients with high risk of liver cancer admitted to our hospital from January 2020 to February 2021 were selected, and all of them underwent ultrasound elastography and contrast-enhanced ultrasound. Pathological results were used as the gold standard to analyze the diagnostic value of ultrasound elastography, contrast-enhanced ultrasound and the combination of the 2 in liver cancer.Results Thirty-six cases were diagnosed as liver cancer based on pathological results, and the incidence of liver cancer was 18.00%. The accuracy rates of ultrasound elastography and contrast-enhanced ultrasound in diagnosing liver cancer were both 86.00%, which were significantly lower than that of the combination of the 2 methods (94.00%) (χ2=7.111, P<0.05). The sensitivity of ultrasound elastography and contrast-enhanced ultrasound in diagnosing liver cancer were 63.89% and 69.44% respectively, which were significantly lower than that of the combination of the 2 methods (91.67%) (χ2=8.036, 5.675, P<0.05); the specificity of ultrasound elastography and contrast-enhanced ultrasound were 90.85% and 89.63 respectively, which were significantly lower than that of the combination method (96.34%) (χ2=4.121, 5.658, P<0.05); the positive predictive values of ultrasound elastography and contrast-enhanced ultrasound were 60.53% and 59.52%, which were significantly lower than than that of the combination method (84.62%) (χ2=5.631, 6.262, P<0.05); the negative predictive values of ultrasound elastography and contrast-enhanced ultrasound were 91.98% and 93.04%, which were significantly lower than than that of the combination method (98.14%) (χ2=6.511, 4.940, P<0.05).Conclusion The population with high risk of liver cancer is more likely to develop liver cancer. The multi-modal ultrasound imaging technology has a high diagnostic value in screening high-risk population of liver cancer, and can improve the accuracy, sensitivity and specificity of screening.
    Clinical value of imaging features and quantitative parameters of CEUS in differentiating hepatic inflammatory pseudotumor from intrahepatic cholangiocarcinoma
    ZHU Ting, LIN Li-ping, WEI Yu-ya
    2022, 27(3):  292-295. 
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    Objective To investigate the value of imaging characteristics and quantitative parameters of contrast-enhanced ultrasound (CEUS) in differentiating hepatic inflammatory pseudotumor (IPT) from intrahepatic cholangiocarcinoma (ICC).Methods Fifty-seven patients with ICC admitted to our hospital from April 2016 to July 2021 were selected into ICC group, and 32 patients with IPT were selected into IPT group. Most patients were confirmed by surgery or needle biopsy. All patients underwent CEUS examination at admission. Imaging features (dynamic enhancement mode, enhancement mode in arterial phase, enhancement degree in arterial phase) and quantitative parameters (arrival time of contrast agent, peak time, iso-enhancement time, start fading time) of CEUS were observed in 2 groups. Receiver operator characteristic (ROC) curve was used to analyze the value of peak time, iso-enhancement time and fading time in predicting ICC.Results The CEUS pattern of 35.09% patients in ICC group was swift enhancement and simultaneous expurgation, significantly lower than that in IPT group (68.75%), (P<0.05). The proportions of peripheral ring enhancement, heterogeneous enhancement and homogeneous enhancement in ICC group were 31.58%, 54.39% and 14.04%, respectively, and those in IPT group were 18.75%, 40.63% and 40.63%, respectively, the differences were statistically significant (P<0.05). The peak time, iso-enhancement time and fading time of ICC group were 26.56 ± 6.53, 33.53 ± 7.25, 48.12 ± 9.12s respectively, which were significantly higher than those of IPT group (22.93 ± 7.26, 27.53 ± 7.46, 41.75 ± 9.55s), and the differences were statistically significant (P<0.05). According to ROC analysis, the area under curve of peak time, iso-enhancement time and fading time in predicting ICC were 0.877, 0.925 and 0.924, respectively, with P<0.05.Conclusion Imaging features and quantitative parameters of CEUS have a certain value in differentiating ICC from IPT.
    Viral Hepatitis
    Analysis on epidemiological and clinical characteristics of 186 sporadic hepatits E cases
    CHEN Tu-fen, ZHANG Bo, ZHANG Yan, WAN Mei-ping, ZHENG Ning
    2022, 27(3):  296-301. 
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    Objective To investigate the epidemiological characteristics, clinical features and prognosis of sporadic hepatitis E (HE).Methods The clinical data of 186 patients with sporadic HE were retrospectively analyzed. According to age, all the patients were divided into elderly group ( ≥ 60 years old) and non-elderly group ( < 60 years old). According to etiology, they were divided into super infection group and simple infection group. The clinical characteristics, laboratory examination and treatment outcome were compared between each group.Results Before treatment, the total bilirubin (TBiL) level, creatinine (Cr) level, TBiL peak value, international normalized ratio (INR) peak value, Cr peak value, incidence of skin pruritus, incidence of complications (especially urinary tract infection, spontaneous peritonitis, hypoproteinemia, hepatic encephalopathy), incidence of combined diseases, length of hospital stay and course of disease of elderly group were higher than those of non-elderly group ( P<0.05). While the levels of alanine transaminase (ALT) albumin (ALB), ALT peak, ALB valley, and the incidence of fever of elderly group were lower than those of non-elderly group ( P<0.05). After treatment, the levels of alkline phosphatase (AKP), and HYPERLINK "http://www.youdao.com/w/prothrombin time/" /l "keyfrom=E2Ctranslation" prothrombin time (PT) in non-elderly group decreased more significantly (P<0.05). And there was no significant difference in the incidence rate of liver failure, cure improvement and mortality between the 2 groups (P>0.05). Before treatment, the TBiL level, PT, INR, incidence of complications (especially spontaneous peritonitis) and incidence of acute on chronic liver failure of super infection group were higher than those of simple infection group (P<0.05). After treatment, PT of simple infection group decreased more obviously than super infection group (P<0.05), while there was no significant difference in clinical symptoms, complications rate, cure improvement rate, mortality, length of hospital stay and course of disease between the 2 groups (P>0.05).Conclusion Patients in super infection group and elderly group are more prone to hyperbilirubinemia, hypoproteinemia and coagulation dysfunction. They are more likely to be attacked by liver failure and a variety of complications, with a longer hospital stay and a poor prognosis. The content above suggests that age and super infection are main factors affecting the prognosis.
    A study on the relationship between serum HBV pgRNA, HBV DNA and HBeAg levels in patients with chronic hepatitis B
    LU Yan-ling, LI Xiao-hong, CHEN Hai-tao
    2022, 27(3):  302-304. 
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    Objective To study on the relationship between the levels of pregenomic RNA of hepatitis B virus (HBV pgRNA), DNA of hepatitis B virus (HBV DNA) and e antigen of hepatitis B (HBeAg) in patients with chronic hepatitis B (CHB).Methods A total of 72 CHB patients admitted from June 2018 to June 2021 were selected as the studied subjects, and the sample value/critical value (S/CO) was used as the result of HBeAg. Patients with 1<S/CO≤5 were included in the low-concentration group (n=16 cases). Patients with 5<S/CO≤10 were included in the medium-concentration group (n=35 cases). Patients with S/CO>10 were included in the high-concentration group (n=21 cases). The levels of HBV pgRNA, HBV DNA and HBeAg in three groups of patients were quantitatively detected, and the correlations between HBV pgRNA, HBV DNA and HBeAg was analyzed.Results The levels of HBV pgRNA in three groups of patients were (5.85±0.64) copies/mL, (7.12±0.38) copies/mL, (7.75±0.59) copies/mL, respectively. The HBV DNA levels were (5.34±0.49) copies/mL, (7.16±0.62) copies/mL, (9.35±0.54) copies/mL, respectively. The levels of HBV pgRNA and HBV DNA in these three groups were low concentration grouP<medium concentration grouP<high concentration group, P<0.05. Correlation analysis showed that HBV pgRNA was positively correlated with HBeAg (r=0.566, P=0.002), and HBV DNA was positively correlated with HBeAg (r=0.496, P=0.005).Conclusion With the increase of HBeAg level, HBV pgRNA and HBV DNA levels gradually increased. The serum HBV pgRNA and HBV DNA levels of CHB patients were positively correlated with HBeAg levels. Clinical diagnosis of HBV infection and replication and the condition of CHB patients could be more accurate by combining these three indicators.
    The relationship between ANRIL and miR-122 expression in patients with occult hepatitis B viral infection
    LI Xiang, WANG Yan-bai, WANG Yin-feng, HUANG Xue-lan
    2022, 27(3):  305-310. 
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    Objective To explore the application value of antisense noncoding RNA in cyclin kinase inhibitor 4 locus (ANRIL) and microRNA-122 (miR-122) in the differential diagnosis of occult hepatitis B virus (HBV) infection.Methods Twenty patients with occult hepatitis B admitted from February 2019 to January 2021 were selected as occult hepatitis B group. Eighty patients with chronic hepatitis B hospitalized at the same period of time were selected as chronic hepatitis B group. Eighty healthy people were enrolled as the healthy control group. Serum samples were collected from all groups of people. The serum levels of ANRIL and miR-122 were detected by real-time fluorescence quantitative PCR (qRT-PCR). The serum HBV DNA load was detected by PCR in combination with fluorescence probe in vitro. The levels of serum total bilirubin (TBil), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected by automatic biochemical analyzer. The correlations between serum levels of ANRIL, miR-122, and TBIL, ALT, AST, and HBV DNA load in patients with occult hepatitis B were analyzed. The values of serum ANRIL and miR-122 in differential diagnosis of occult hepatitis B was analyzed. The influencing factors of occult hepatitis B were analyzed.Results The levels of TBIL, ALT, and AST in chronic hepatitis B group [(42.94±7.85) mol/L, (236.48±40.76) U/L, and (193.26±45.78) U/L, respectively] were higher than those in occult hepatitis B group [(25.64±6.35) mol/L, (32.74±7.15) U/L, and (29.36±7.24) U/L, respectively] and healthy control group [(22.46±4.68) mol/L, (26.95±7.03) U/L, and (19.46±6.13)U/L, respectively]. HBV DNA load in chronic hepatitis B group was higher than that in occult hepatitis B group [(6 243.58±1 006.74) vs (3.95±1.09)]. The miR-122 level in chronic hepatitis B group (0.43±0.12) was lower than that in occult hepatitis B group (0.69±0.21) and healthy control group (1.02±0.23) (P<0.05). The serum ANRIL level of occult hepatitis B group (1.53±0.37) was higher than that of healthy control group (1.01±0.21), and the miR-122 level was lower than that of healthy control group (P<0.05). Serum ANRIL was negatively correlated with miR-122 in patients with occult hepatitis B (r=-0.597, P<0.05), and ANRIL (miR-122) was positively (negatively) correlated with TBIL, ALT, AST and HBV DNA load (P<0.05). The area under the curve (AUC) of serum ANRIL, miR-122 and their combination in the differential diagnosis of occult hepatitis B was 0.901, 0.887 and 0.941, respectively; the specificity was 91.2%, 73.8% and 96.3%, respectively; and the sensitivity was 85.0%, 95.0% and 90.0%, respectively. ANRIL was an independent risk factor for occult hepatitis B (P<0.05), while miR-122 was a protective factor for occult hepatitis B (P<0.05).Conclusion The expression level of ANRIL is increased and the expression level of miR-122 is decreased in patients with occult hepatitis B. Both of them have good specificity and sensitivity in the differential diagnosis of occult hepatitis B.
    Exploring the strategy for eliminating hepatitis C based on current cognition of general practitioners
    HE Na, HAO Shuai, HAO Rong, FENG Gong, KONG Fan-jiao, REN Zhuo-xu, XU Mei-qi, ZHANG Sheng-li
    2022, 27(3):  311-315. 
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    Objective To explore the eliminating strategy by analyzing the status quo for the diagnosis and treatment of hepatitis C and the grassroots recognition of general medical doctors, in order to facilitate WHO strategies for eliminating hepatitis C by 2030.Methods 1. Patients with hepatitis C treated in the hospital were followed-up by phone directly and the status quo for the diagnosis and treatment were analyzed; 2. The status quo for the cognition of hepatitis C in grassroots generals was obtained by an approach of questionnaire survey.Results 1. Among the 480 patients who were followed-up, 215 cases were lost of follow-up. Fifteen cases didn't know the disease; 29 cases had taken high imitation drug for treatment. 2. 16.38% of the general practitioners didn't understand that hepatitis C was a curable disease; 18.12% of the general practitioners didn't know the latest treatment options for hepatitis C; 20.91% of the general practitioners didn't know that DAA drugs had been included in the national medical insurance catalog; 16.37% of the doctors didn't know the strategic goal of “2030 elimination of hepatitis C as a threat of public health”.Conclusion To enhance the cognitive ability of grassroots on hepatitis C, to improve the academic cognition rate of general medical doctors and community residents, and to actively carry out hepatitis C knowledge tours are important strategies for promoting the micro-elimination of hepatitis C at grassroots level.
    An evaluation on different methods for detecting low-level hepatitis C virus
    YANG Xiao-jiao, YU Jin-hong
    2022, 27(3):  316-320. 
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    Objective Contradictory results in testing anti-hepatitis C virus antibody by chemiluminescence immunoassays (CLIAS) are very common, especially in the cases of low-level anti-HCV. The aim of this study was to explore the diagnostic values of various methods of single detection for low-level anti-HCV and to analyze their effectiveness.Methods A total of 84 serum samples were assessed for HCV via chemiluminescence microparticle immunoassay(CMIA), Enzyme-linked immunosorbent assay (ELISA), electro chemiluminescence immunoassay (ECLIA), recombinant immunoblot assay (RIBA) and Polymerase Chain Reaction (PCR) assay.Results Of the 31 samples with an anti-HCV S/CO ratio between 0.40-10.0 as tested by Architect, 45.16% were indeterminate, 25.81% were positive, and 29.03% were negative according to RIBA. Furthermore, 2 out of 19 samples were related with RF, IgG or IgA. Areas under the ROC in ECLIA, CMIA, HCV-Ag and HCV-RNA were 1.000, 0.997, 0.753 and 0.679, respectively, and their cut-offs were 15.85 COI, 3.31 S/CO, 3.32 fmol/l and 3.94E+03 copies/ml, respectively. The HCV Ag test showed a strong correlation between the logarithmic values of HCV-RNA and HCV-Ag (R=0.91, P<0.001). Of the positive RIBA samples, 97.5% presented reactivity for Core or NS3 antigens on nitrocellulose immunoblot test strips, while only 37.5% presented reactivity for NS4-1 or NS5 antigens and only 2.5% for NS4-2.Conclusion Two methods are required for testing Low-level anti-HCV to improve the diagnostic accuracy, and reference values of 15.85 COI (ECLIA) and 3.31 S/CO (CMIA) are recommended. To some extent, HCV-Ag may be assayed instead of HCV RNA.
    Liver Failure
    Clinical characteristics of liver failure patients with or without HIV/AIDS
    TIAN Ze-min, TIAN Chong
    2022, 27(3):  321-324. 
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    Objective To investigate the clinical characteristics of liver failure patients with or without Human Immunodeficiency Viral infection/Acquired Immune Deficiency Syndrome (HIV/AIDS).Methods A retrospective review of 47 cases of liver failure patients with HIV /AIDS (group 1) and 108 cases of liver failure patients without HIV/AIDS (group 2) collected from January 2017 to August 2020 was performed by analyzing their general data, etiologies, classifications, laboratory examination, complications and prognosis.Results The liver failure patients in both groups were mainly middle-aged men. There were no significant differences in gender, age and length of stay between two groups of patients (P>0.05). The most common etiology was hepatitis virus, accounting for 59.57% (28 cases) and 71.30% (77 cases) in group 1 and group 2 of patients, respectively, followed by drug that accounting for 38.30% (18 cases) and 22.22% (24 cases), respectively. The highest proportion of liver failure was caused by HBV, accounting for 57.45% (27 cases) and 69.44% (75 cases) respectively. It was mainly acute(subacute)-on-chronic according to clinical classification, accounting for 70.21% (33 cases) and 65.74% (71 cases), respectively. The highest incidence of complications was infection, accounting for 70.21% (33 cases) and 56.48% (61 cases), respectively. The infections were mainly due to peritonitis and pneumonia, accounting for 66.67% (22 cases) and 68.85% (42 cases), and 42.42% (14 cases) and 40.98% (25 cases), respectively. There were significant differences in fungal infection rate (16 cases, 34.04% vs 4 cases, 3.70%), regular treatment of HBV (10 cases, 21.28% vs 9 cases, 8.33%), ineffectiveness/mortality ratio (30 cases, 63.83% vs 45 cases, 41.67%), the proportion of drug factors in etiology (18 cases, 38.30% vs 24 cases, 22.22%), incidence of hepatic encephalopathy (14 cases, 29.79% vs 15 cases,13.89%) as well as the levels of SCRP (40.23 mg/L vs 17.60 mg/L), PCT (1.00 ng/mL vs 0.79 ng/mL), PT (28.20 s vs 23.75 s), INR (2.37 vs 1.99), ALB (25.72 g/L vs 28.89 g/L), CHE (2074.64 U/L vs 2810.79 U/L), CD4 (186.76 cells/uL vs 390.24 cells/uL) between groups (P<0.05).Conclusion Liver failure patients with HIV/AIDS have more severe liver damage, deficiency in liver synthesis function, and higher rate of ineffective treatment and deaths.
    Correlation between the ratio of PA/TB, serum level of AFP and the efficacy and prognosis of sequential plasma exchange with DPMAS in HBV-ACLF patients
    HUANG Fu-tong, LIN Yong-mei, LU Chang-chun, HE Ying, RAO Ke-meng
    2022, 27(3):  325-329. 
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    Objective To investigate the correlation between the ratio of pre-albumin to total bilirubin (PA/TB) and serum level of alpha-fetoprotein (AFP) and the efficacy and prognosis of sequential plasma exchange with dual plasma molecular adsorption system (DPMAS) in patients with hepatitis B related acute on chronic live failure (HBV-ACLF).Methods Sixty HBV-ACLF patients who underwent sequential plasma exchange with DPMAS were selected. Before and after the treatment, venous blood was collected to detect serum pre-albumin (PA), total bilirubin (TBil) and AFP, and PA/TB ratio was calculated. After 90 days of follow-up post treatment, the factors affecting the death of HBV-ACLF patients within 90 days and the value of PA/TB ratio and AFP in predicting death within 90 days of HBV-ACLF patients were analyzed.Results Within all the 60 patients that had accomplished the treatment of sequential plasma exchange with DPMAS, 25 cases improved, 35 cases did not improve, 39 cases died and 21 cases survived during the follow-up. After the treatment, serum TBIL level decreased (P<0.05), while PA, PA/TB ratio and AFP increased (P<0.05). The serum levels of PA, AFP and PA/TB in the improved group were (215.21±4.02)g/L,(220.12±7.95)ng/mL, and(38.05±1.54)respectively,which were higher than (204.92±5.06)g/L, (179.20±10.05) ng/mL, and (33.34±2.05) respectively, in the non-improved group (P<0.05). The serum TBil level was(4.51±0.36)mg/dl in the improved group, which was lower than(7.42±0.77)mg/dL in the non-improved group (P<0.05). Serum TBIL level in the death group was(7.15±0.69)mg/dL which was higher than(4.46±0.30)mg/dL in the survival group (P<0.05). Serum AFP and PA levels, ratio of PA/TB in the death group were (206.03±6.12)g/L,(183.83±15.21)ng/mL, and(32.94±1.39) respectively, which were lower than(215.12±3.26)g/L,(219.32±8.52)ng/mL, and(39.68±0.30)respectively, in the survival group (P<0.05). Hepatic encephalopathy, low AFP and low PA/TB ratio were the risk factors for death in HBV-ACLF patients within 90 days (P<0.05). The area under the curve (AUC) of the combined PA/TB ratio and AFP in predicting HBV-ACLF death within 90 days was 0.920, which was higher than that of PA/TB ratio (AUC=0.688) and AFP (AUC=0.685) alone (P<0.05).Conclusion Decreased PA/TB ratio and serum level of AFP are associated with poor efficacy and poor prognosis after sequential plasma exchange with DPMAs in HBV-ACLF patients, which can be used as prognostic evaluating markers of HBV-ACLF patients.
    Liver Fibrosis/Cirrhosis
    The changes and correlation between oral and intestinal microflora in patients with liver cirrhosis
    REN Hai-xia, YAN Hua-nan, NIU Shu-li, LI Bo, AN Kai, GUO Yong-ze, ZHANG Hong-wei
    2022, 27(3):  330-333. 
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    Objective To compare the differences between oral and intestinal microflora in patients with liver cirrhosis by 16S rRNA gene sequencing, and to analyze the association between them.Methods A total of 19 patients clinically diagnosed as liver cirrhosis were selected as the cirrhosis group (HS group), and 19 healthy volunteers were selected during the same period of time as the healthy group (HC). Fecal and saliva samples were collected from both groups of people. DNAs were extracted and 16S rRNA V3-V4 region gene sequencing were performed on the collected samples. The obtained high-quality data was compared with the Greengene database. The differences of oral and intestinal microflora between these two groups were further analyzed.Results Venn diagram showed that although there were some differences between oral and intestinal species, there also existed same species. At the phylum level, the abundance of Proteobacteria in HS group was significantly higher, whereas the abundance of Bacteroidetes was lower than that in HC group (all P<0.05). At the genus level, the abundance of Lachnospira in HS group was significantly lower, whereas the abundance of Escherichia and Veillonella were significantly higher than that in HC group (all P<0.05); As for the oral microflora at the phylum level, the abundance of Firmicutes in HS group was significantly higher, whereas the abundance of Proteobacteria was significantly lower than that in HC group (all P<0.05). At the genus level, the abundance of Veillonella and Leptotrichia was significantly higher, whereas the abundance of Haemophilus was significantly lower than that of HC group (all P<0.05). Alpha diversity analysis showed that the diversity and richness of oral and intestinal flora were decreased in patients with cirrhosis. Beta diversity results showed that there was significant difference between oral and intestinal microflora, and the difference between individuals of intestinal microflora was greater than that of oral microflora.Conclusion The oral and intestinal microflora composition of liver cirrhotic patients is very different, although there exists some common species. There was a significant increase in opportunistic bacteria and a significant decrease in beneficial bacteria in the oral and intestinal microflora of cirrhotic patients.
    Other Liver Diseases
    A 10-year's survey analysis of the clinical features of pyogenic liver abscess disease in hospital
    SHANG Da-bao, WU Bo-ming, ZHANG Jin-ming, TANG Wei-liang, ZHAO Gang-de, LI Zi-qiang, LU Jie, XIE Qing, SHI Dong-mei, XIANG Xiao-gang
    2022, 27(3):  334-336. 
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    Objective To investigate the changes in disease characteristics of patients with pyogenic liver abscess (PLA) hospitalized in Ruijin Hospital of Shanghai Jiaotong University School of Medicine in the latest 10 years.Methods To retrospectively analyze the clinical data of 106 patients with PLA who were hospitalized in the Department of infectious diseases, Ruijin Hospital from March 2010 to October 2020.Results The incidence of PLA has increased in recent years, and the disease predominantly affects male patients, with a peak age range of 50-80 years. Among all the affected individuals, 80%-90% had elevated neutrophils with acute C-reactive protein elevation, and more than half of the patients developed anemia with reduced albumin and prolonged erythrocyte sedimentation rate. Among the common clinical features, fever and chills occurred in nearly 90% of cases, general malaise in 50%, and right upper abdominal pain in 25%. 45 patients had positive pus cultures or blood cultures, and 5 patients (11.1%) were identified by second-generation sequencing, of which 33 were positive for Klebsiella pneumoniae (29 pus cultures and 4 blood cultures), accounting for 64.7% of culture-positive organisms, followed by 6 cases of Escherichia coli (5 pus cultures and 1 blood culture), accounting for 11.8%. 89 patients were combined with one or more underlying diseases, of which diabetes mellitus accounted for 57 cases (64.0%), and 11 cases (12.4%) have transcatheter arterial chemoembolization (TACE).Conclusion Diabetes mellitus is the main underlying disease of PLA, and cases caused by interventional operation of liver including TACE is rising annually. Klebsiella pneumoniae is the main causative agent of PLA. The second-generation sequencing technique has its advantages. Appropriate antibacterial drugs should be selected according to the pathogenic and pharmacological characteristics in the treatment.
    Clinical analysis of 23 cases of end-stage primary biliary cirrhosis
    ZHANG Li-li, HU Jian-hua, JIN Hua, XU Hui
    2022, 27(3):  337-340. 
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    Objective To summarize the clinical and laboratory findings of patients with end-stage primary biliary cirrhosis (PBC).Methods A retrospective summary and analysis of the laboratory examination results of 23 patients with end-stage PBC diagnosed in Beijing You'an Hospital affiliated to Capital Medical University, from January 2018 to December 2020.Results Among the 23 patients with end-stage PBC, the incidence of jaundice was 100%, and there were 18 cases (78.26%) with splenomegaly and thick spleen. The anemia was mainly mild to moderate anemia, and the hemoglobin of patients was 90-120 g/L, accounted for 43.39%, patients with hemoglobin of 60-90 g/L accounted for 47.83%. Patients with increased ALP accounted for 47.82%, and with increased γ-GT accounted for 8.70%. ALT (56.13±119.05) U/L, AST (92.04 ±124.46) U/L were considered to be a mild to moderate increase, and the degree of index rise and fall had no obvious correlation with the severity of the disease. Total cholesterol was (2.07±0.57) mmol/L, triglyceride was (0.99±0.54) mmol/L, and the degree of dyslipidemia of patients with end-stage PBC was significantly different from patients with early PBC.Conclusion Part of the laboratory indicators of patients with end-stage PBC are different from those of common PBC patients, the condition is more serious and the prognosis is worse.
    Clinical characteristics and mutation analysis of 5 pedigrees with Wilson's Disease
    CHENG Qi-qi, YANG Li-xia, WANG Liang, SUN Jun, LIANG Jia-yuan, GE Shan-fei
    2022, 27(3):  341-346. 
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    Objective To understand the mutation characteristics and clinical characteristics of ATP7B gene of pedigrees with hepatolenticular degeneration (HLD), which is also called Wilson's Disease (WD), and to explore the relationship between mutation and the pathogenesis of WD.Methods Peripheral blood samples from 5 members of pedigrees with the WD were collected, genomic DNA was extracted, then we analysed the clinical manifestations and mutations.Results All patients in the 5 pedigrees showed liver damage of varying degrees, and even some patients developed liver failure, but no neurological symptoms occurred. Most patients had K-F ring and with decreased serum ceruloplasmin. ATP7B gene detection showed that all the five probands were caused by multiple mutations, while the parents of the probands only carried a single pathogenic mutation gene. Seven pathogenic mutations were detected, including five missense mutations, one nonsense mutations and one insertion mutation, in which c.3087_3088insT (p.G1030Wfs*39) was a new insertion mutation. In addition, 10 single nucleotide polymorphisms were detected. One pre symptomatic patient was diagnosed by family genetic testing.Conclusion In this study, most patients with WD show liver damage, but the clinical symptoms and ages of onset are different. Compound heterozygous mutation is the most popular mutation form of ATP7B, and a novel pathogenic mutation has been identified. Gene sequencing analysis is helpful for rapid diagnosis of pre symptomatic patients in pedigrees with WD.
    Analysis of pathological and clinical features of 128 cases of unexplained liver damage
    DU Ting, YANG Yan, YANG Wen-jun, JIN Jing, SHENG Hui-ping
    2022, 27(3):  347-351. 
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    Objective The etiology and clinical characteristics of 128 patients with unexplained liver damage were analyzed.Methods From February 2016 to May 2020, 128 patients with unexplained liver dysfunction were selected as the subjects. The etiology was determined by noninvasive examination and liver biopsy combined with pathological results and clinical characteristics.Results According to the pathological results from liver biopsy, there were 115 patients that the causes of liver damage were identified, among them, 56 cases (43.8%) were autoimmune liver disease, 44 cases (34.4%) were nonalcoholic fatty liver disease and 15 cases (11.7%) were drug-induced liver damage, 2 cases (1.6%) were diagnosed with herpesvirus infectious hepatitis by non-hepatitis virus detection and liver histology, 3 cases (2.3%) were diagnosed as Gibert syndrome by gene detection and liver histology. The remaining 8 patients (6.3%) still could not determine the etiology through the above examination.Conclusion In patients with unexplained liver damage, autoimmune liver disease and non-alcoholic fatty liver disease are the main causes, followed by drug-induced liver damage. For patients with abnormal liver function who cannot determine the etiology, special tests such as gene detection or non-hepatitis virus detection can be considered, combined with pathological examination of liver tissue and clinical data of patients for comprehensive analysis, which provides reference for clinical diagnosis and treatment.
    Perivascular epithelioid cell tumor in liver: a clinicopathological analysis
    ZHOU Bing, KANG Yu-bin, WANG Jie
    2022, 27(3):  352-354. 
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    Objective To investigate clinicopathologic characteristics, diagnosis and differential diagnosis and prognosis of perivascular epithelioid cell tumor (PEComa) of liver.Methods The clinical and pathological features of 3 cases with liver PEComa were analyzed by histopathological and immunohistochemical testing. Clinical and follow-up information was obtained. The published relevant literatures were reviewed.Results All 3 patients were females, aged from 39 to 60 years. The most common symptoms were cough with sputum and exertional dyspnea; 2 case was asymptomatic and 1 case with bellyache. Microscopically, the boundary between tumor and normal liver tissue was clear, the epithelioid tumor cells were solid lamellar or nested arrangement, the cytoplasm was eosinophilic or translucent, abundant vascular network and fat vacuoles were found in the stroma. Immunohistochemically, the tumor cells were positive for Vim, HMB45, Melan-A and SMA. The average follow-up was 37 months, no tumor recurrence or metastasis was found.Conclusion PEComa of liver is rare and the clinical symptoms are atypical, definite diagnosis depends on characteristic histological morphology and immunohistochemical findings.
    Changes of fat controlled attenuation parameter and liver stiffness measurement in patients with nonalcoholic fatty liver disease complicated with type 2 diabetes mellitus
    WEI Jian-dong, GOU Xiao-jun, CHEN Yuan-zhuo, SHI Wei
    2022, 27(3):  355-357. 
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    Objective To explore the changes of liver fat controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) in patients with nonalcoholic fatty liver disease(NAFLD) complicated with type 2 diabetes mellitus (T2DM), and to provide clinical basis for early NAFLD screening of diabetic patients.Methods From January 2018 to December 2020, 128 patients with T2DM (58 males and 70 females) were reviewed, with age of (52.6±8.2) years. The diagnosis of NAFLD and T2DM was in line with the guidelines, and the patients with T2DM were divided into NAFLD group and single T2DM group according to whether they were complicated with NAFLD. T test was used for measurement data, and Chi-square test was used for counting data.Results There were 44 cases and 84 cases in NAFLD group and single T2DM group in 128 patients with T2DM. Comparative data showed that ALT, AST, TG, LDL, FBG, FINS and HbA1c in NAFLD group were (86.3±10.5) U/L, (82.9±8.3) U/L, (2.5±0.7) mmol/L, (4.4±1.3) mmol/L, (9.6±1.2) mmol/L, (5.2±1.5) uIU/uL and (8.4±0.9)%, compared with single T2DM group [(38.2±4.8) U/L, (39.7±3.8) U/L, (1.6±0.5) mmol/L, (2.3±0.8) mmol/L, (7.2±1.0) mmol/L, (3.6±1.1) uIU/uL and (6.9±0.8)%], the difference was statistically significant (P<0.05). The LSM of NAFLD group and single T2DM group were (9.3±2.4) kPa and (5.7±1.1) kPa, with statistical significance difference (P<0.05). The levels of CAP in NAFLD group and single T2DM group were (224.2±36.4) dB/m and (121.4±24.9)dB/m, with statistical significance difference (P<0.05). According to the degree of hepatic steatosis, it could be divided into Grade 0 to Grade 3 (G0-G3). In T2DM patients with NAFLD, there were 7 patients with G0, 14 with G1, 13 with G2, 10 with G3. The CAP values of G2 and G3 were significantly higher than those of G0 and G1 respectively (P<0.05), while the CAP values of G3 were significantly higher than those of G2 (P<0.05). According to the degree of liver fibrosis, it could be divided into F0 to F4. In T2DM patients with NAFLD, there were 6 patients with F0, 11 with F1, 13 with F2, 8 with F3, 6 with F4. LSM values in F3 and F4 were significantly higher than those in F0, F1 and F2 (P<0.05).Conclusion There is an obvious correlation between T2DM and NAFLD. Early screening of T2DM and NAFLD has a positive impact on the treatment and prognosis of the disease.
    Clinical characteristics of intrahepatic cholestasis in patients with Sjogren's syndrome
    ZHONG Yan-dan, YU Hai-ying, PENG Shan-shan, GE Ting-qiu, DING Qiao-yun, CAO Xing-guo, YANG Yong-feng
    2022, 27(3):  358-360. 
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    Objective To study the relationship between intrahepatic cholestasis in patients with Sjogren's syndrome (SS) and primary biliary cholangitis (PBC).Methods 32 SS patients with chronic intrahepatic cholestasis were divided into two groups according to whether anti-myocardial antibody (AMA)/AMA-M2 was positive or not. The clinical characteristics, laboratory examination and liver pathology of the two groups were compared.Results The clinical conditions of 32 patients were good, including 18 cases of fatigue (56%), 6 cases of pruritus (19%), 8 cases of abdominal distension (25%), 8 cases of splenomegaly (25%), and no patient had liver failure. There was no significant difference in TBIL [(62.4 ± 41.1) μmol/L, (59.6 ± 53.2) μmol/L], ALP [(324.6 ± 230.2) U/L, (305.4 ± 198.8) U/l] and GGT [(298.5 ± 203.2) U/L, (287.9 ± 194.2) U/L] (t=0.561, P=0.546; t=0.647, P=0.449; t=0.736, P=0.485). There was no significant difference between the two groups (χ2=0.029, P=0.985). All patients underwent liver biopsy. The liver biopsy results of all patients in AMA/AMA-M2 positive group were consistent with PBC. In the AMA/AMA-M2 negative group, the liver biopsy results of 9 patients were consistent with PBC, and the liver biopsy results of the remaining 2 patients showed nonspecific inflammation. The stage of PBC in the two groups was mostly in stage I or stage II.Conclusion Clinically, for SS patients with intrahepatic cholestasis, whether AMA is positive or not, liver biopsy should be considered to further determine whether PBC is accompanied.