Table of Content

31 May 2022, Volume 27 Issue 5

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Liver Failure

Analysis on the long-term survival status and clinical characteristics of patients with acute-on-chronic liver failure

KANG Wei-wei, TIAN Hui, FENG Li-li, LIU Li-wei, XU Man-man, KONG Ming, ZOU Zheng-sheng, DUAN Zhong-ping, CHEN Yu

2022, 27(5):  516-520. 

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Objective To investigate the long-term survival status of patients with acute-on-chronic liver failure (ACLF). Methods This was a retrospective cohort study. A total of 167 patients diagnosed as ACLF were enrolled. The survival status and laboratory examination results at 3 months and 1 year after follow-up were recorded, and the changes of short-term and long-term survival status were observed. The long-term prognosis of ACLF patients (≥24 weeks) was divided into 5 grades: Grade I was an ideal outcome: without cirrhosis; Grade II was a satisfactory outcome: compensatory cirrhosis, manifested as reversible or long-term compensatory cirrhosis; Grade III was an acceptable outcome: decompensated cirrhosis, manifested as decompensated cirrhosis or chronic liver failure; Grade IV was the survival outcome after transplantation; Grade V was the death outcome. Results A total of 167 patients with ACLF were enrolled, with a median age of 45 years (39, 53) and 136 cases (81.4%) were male. The etiology of 123 cases (73.7%) was chronic hepatitis B virus (HBV) infection which was the main cause, and the other 44 cases were caused by other diseases. At baseline, 68 cases (40.7%) without liver cirrhosis, and 99 cases (59.3%) with liver cirrhosis. Three months after liver transplantation, 16 cases (9.6%) survived and 56 cases (33.5%) died. At 1 year after liver transplantation, 15 cases (9.0%) survived and 67 cases (40.1%) died. After a 3 months follow-up among the 68 patients without liver cirrhosis, 11 patients (16.2%) still without liver cirrhosis, 23 cases (33.8%) with compensated cirrhosis, 14 cases (20.6%) with decompensated cirrhosis, 5 cases (7.4%) survived after liver transplantation, and 15 cases (22.1%) died. Continue the follow-up to 1 year, among the 11 patients without cirrhosis at 3 months, 8 of which were still in non-cirrhotic state, 1 of which developed compensated cirrhosis and 2 of which developed decompensated cirrhosis; among the 23 patients with compensatory cirrhosis at 3 months, 15 of which without liver cirrhosis, 5 of which still with compensatory cirrhosis, and 3 of which developed decompensated cirrhosis; among the 14 patients with decompensated cirrhosis at 3 months, 3 of which without liver cirrhosis, 9 of which with compensated cirrhosis and 2 of which still with decompensated cirrhosis. Among the 5 patients who survived after liver transplantation at 3 months, 1 patient died. After a 3 months follow-up among the 99 patients with liver cirrhosis, all of them still with liver cirrhosis 14 patients (14.1%) with compensated cirrhosis, 33 patients (33.3%) with decompensated cirrhosis, 11 patients (11.1%) survived after liver transplantation and 41 patients (41.1%) died. Continue the follow-up to 1 year, among the 14 patients with compensatory cirrhosis at 3 months, 11 of which still with compensatory cirrhosis and 3 of which developed decompensated cirrhosis; among the 33 patients with decompensated cirrhosis at 3 months, 13 of which with compensatory cirrhosis, 10 of which still with decompensated cirrhosis, 1 of which survived after liver transplantation and 9 of which died after liver transplantation. Among the 11 patients who survived after liver transplantation at 3 months, 1 patient died. Conclusion The short-term and long-term survival status of patients with ACLF is uncertain, which requires close follow-up and active treatment. The ACLF patients without cirrhosis at baseline have a longer survival time and a better survival state after active treatment.

Establishment of a nomogram for predicting infection in patients with liver failure

SHI Dong-yang, FU Qian-qian, XIAO Ling-yan, YANG Kai, ZHENG Yi-shan

2022, 27(5):  521-525. 

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Objective To establish a visual nomogram with predicting value for infection in patients with liver failure. Methods The patients with liver failure admitted to our hospital from January 2014 to December 2019 were collected and they were divided into infected group and non-infected group. The clinical data of patients were collected and analyzed by univariate and multivariate logistic regression analysis. Based on the screened independent risk factors, R language software was used to visualize the logistic regression (LR) model to obtain the nomogram, and the distinguishing ability and consistency ability of the model was evaluated through internal verification. Results Univariate analysis showed that the average ages of infected group and non-infected group were (44±13) and (49±14) respectively, (t=-3.273, P=0.001). There were 59 and 19 patients with liver cirrhosis in infected group (39.3%) and non-infected group (17.6%) respectively, χ²=13.46, P<0.001; There were 105 (70%) and 49 (48%) patients with hepatic encephalopathy in infected group and non-infected group respectively, χ²=4.341, P=0.037; There were 87 (58%) and 20 (19.6%) patients with ascites in infected group and non-infected group, χ²=36.63, P<0.001. There were 39 (26%) and 4 (3.92%) patients with hepatorenal syndrome in infected group and non-infected group, χ²=20.91, P<0.001; APACHEII score in infected group and non-infected group were (19.8±5.30) and (16.6±5.24) respectively, t=-4.8, P<0.001. The white blood cell (WBC) count in infected group and non-infected group were 9.56 (6.37-14.6) ×10⁹/L and 7.25 (5.77-10.7) ×10⁹/L, Z=-2.807, P<0.001. The alanine aminotransferase level in infected group and non-infected group were 309 (64-773) U/L and 554 (182-1039) U/L, Z=-2.577, P=0.01. The albumin level in infected group and non-infected group were (31.3±5.2) g/L and (33.1±5.0) g/L, t=2.657, P=0.008. The cholinesterase level in infected group and non-infected group were 2916 (2196-4123) U/L and 3966 (2840-4883) U/L, Z=-3.767, P<0.001. The serum potassium of the infected group and non-infected group were 3.98 (3.51-4.34) mmol/Land 4.27 (3.72-4.54) mmol/L, t=-2.675, P=0.007. The serum ions of infected group and non-infected group were (26.9±11.2) mmol/L and (31.7±12.3) mmol/L, t=-3.196, P=0.002. The creatinine of infected group and non-infected group were 71 (52-108) μmol/L and 57.5 (45.8-75.3) μmol/L, Z=-3.676, P<0.001. There were statistically significant differences in above indexes between the 2 groups. Multivariate logistic regression analysis showed that ascites (OR=4.90, 95%CI: 2.51~9.56), hepatic encephalopathy stage 4 (OR=8.41, 95%CI: 2.18 ~ 32.4), hepatorenal syndrome (OR=3.77, 95%CI: 1.18-12.1) and APACHEII score (OR=1.08, 95%CI: 1.02-1.15) were independent risk factors for infection in patients with liver failure (P<0.05). The consistency index (C-index) of the nomogram model predicting infection in patients with liver failure was 0.803. The calibration curve showed that the average absolute error between the predicted result and the actual result of the nomogram model was 0.038, and the receiver operator characteristic (ROC) curve shows that the area under the curve was 0.812 (95%CI: 0.760 ~ 0.864). Conclusion Ascites, hepatic encephalopathy, hepatorenal syndrome and higher APACHEII scores are independent risk factors for infection in patients with liver failure. The nomogram model based on these 4 risk factors can accurately predict the probability of infection in patients with liver failure.

Liver Fibrosis & Cirrhosis

Risk factors of rebleeding after endoscopic treatment for esophagogastric varices in liver cirrhosis patients

FANG Qing-qing, CHEN Ying, CHEN Wei, JIAN You-rong, LI Yu, ZHU Zi-hua, SHEN Dan Jie, CHEN Shi-yao, LI Feng

2022, 27(5):  526-530. 

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Objective To investigate the rebleeding rate and the risk factors of rebleeding after endoscopic treatment for esophagogastric varices in liver cirrhosis patients. Methods Retrospective analysis the clinical data of patients who with liver cirrhosis and accept esophageal variceal ligation and/or gastric variceal obliteration treatment for the first time from June 2018 to June 2021, and hospitalized in the Department of Gastroenterology of Minhang Hospital, Fudan University. According to whether there was bleeding during the follow-up period after treatment, they were divided into bleeding group and non bleeding group. The clinical features, laboratory results, imaging findings, hemodynamic parameters and endoscopic treatment were compared between the two groups. Cox regression model was used to explore the independent risk factors of bleeding after endoscopic treatment of varices. Results A total of 75 patients were included, of which 15 (20%) had bleeding during the follow-up after treatment. Compared with the non bleeding group, 14 of the 54 patients who with gastrointestinal bleeding before endoscopic treatment had bleeding after treatment, the bleeding rate was 25.93%, P=0.04. There were 24 cases complicated with portal vein thrombosis, while 8 cases were bleeding after treatment, the bleeding rate was 33.33%, P=0.048. In 35 cases of cirrhosis after hepatitis B, 11 cases had bleeding after treatment, the bleeding rate was 31.43%, P=0.021. And 24 cases of child a, 4 cases of bleeding after treatment, 47 cases of Child B, 8 cases of bleeding after treatment, 4 cases of child C, 3 cases of bleeding after treatment, P=0.018. Gastrointestinal bleeding occurred before endoscopic treatment, the portal vein thrombosis, cirrhosis after hepatitis B and Child-Pugh are risk factors for bleeding after endoscopic treatment, the difference between the two groups was statistically significant. Cox regression analysis showed that Child-Pugh grade (95%CI=1.273～12.879, HR=4.0487, P=0.018) was an independent risk factor for bleeding during follow-up after endoscopic treatment of varices. Conclusion Child Pugh grade is an independent risk factor for bleeding after endoscopic treatment in patients with liver cirrhosis and esophagogastric varices. Endoscopic treatment for gastroesophageal varices in patients who with poor liver function should be cautious.

Analysis on the influencing factors of gallbladder wall thickening in Wilson's disease-associated cirrhosis

LI Qi, ZENG A-juan, DING Hui-guo, LI Lei

2022, 27(5):  531-535. 

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Objective To investigate influencing factors of gallbladder wall thickening in patients with Wilson's disease (WD) -associated cirrhosis. Methods A total of 82 patients with WD admitted to our hospital were retrospectively enrolled and they were divided into 3 groups: WD-associated compensated cirrhosis group, WD-associated decompensated cirrhosis group and WD without cirrhosis group. Risk factors for gallbladder wall thickening were analyzed. Results Cholecystopathy was common in patients with WD, especially in patients with WD-associated cirrhosis. Compared to the patients with WD-associated compensated cirrhosis, the rates of gallbladder wall thickening (88.23% vs 42.86%, χ²=25.441, P<0.001), cholecystitis (74.29% vs 64.29%, χ²=10.319, P<0.05) and hydrocholecystis (51.43% vs 21.43%, χ²=9.111, P<0.05) were higher in patients with WD-associated decompensated cirrhosis. Course of disease, total bilirubin, direct bilirubin, serum albumin, cholinesterase, high-density lipoprotein-cholesterol, gallbladder wall roughness and hydrocholecystis were significantly associated with gallbladder wall thickening in patients with WD-associated cirrhosis. Multivariate analysis revealed that inside diameter of portal vein and Child-Pugh C were independently risk factors for gallbladder wall thickening in WD-associated cirrhosis. Conclusion Gallbladder wall thickening is common in patients with WD-associated cirrhosis. Inside diameter of portal vein and Child-Pugh C could be independent risk factors for the development of gallbladder wall thickening.

Changes of serum TIMP-1, MMP-2 and GP73 levels in patients with hepatitis B cirrhosis treated with entecavir

LIU Wen-yan, MA Shi-he, HUANG Gui, CHEN Chong, ZHENG Yi-bin

2022, 27(5):  536-539. 

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Objective To investigate the changes of serum tissue inhibitor of metalloproteinase-1 (TIMP-1), matrix metalloproteinase-2 (MMP-2) and golgi protein 73 (GP73) levels in patients with hepatitis B cirrhosis treated with entecavir. Methods Seventy-six patients with hepatitis B cirrhosis admitted to our hospital from June 2019 to May 2020 were enrolled, and they were randomly divided into control group and study group, with 38 cases in each group. The control group was treated with routine treatment, and the observe group was added with entecavir treatment. The levels of total bilirubin (TBil), albumin (Alb), international normalized ratio (INR), serum TIMP-1, serum MMP-2, serum GP73 and imaging indexes were compared between the 2 groups. The clinical efficacy and adverse reactions of the 2 groups were compared. Results After 3, 6, 12 months of treatment, TBil of study group were (30.1±5.3) μmol/L, (27.6±4.8) μmol/L, (22.4±4.2) μmol/L, respectively. The Alb level of study group at 3, 6, 12 months after treatment were (28.5±3.7) g/L, (32.6±4.5) g/L, (39.4±5.2) g/L, which were significantly higher than those of control group [(23.7±3.5) g/L, (29.1±4.2) g/L, (34.2±4.3) g/L] (TBil: t=3.518, 2.288, 46.80; INR: t=4.359, 4.258, 4.052; all P<0.05). The INR of study group at 3, 6, 12 months after treatment were (1.4±0.1), (1.2±0.1), (1.1±0.0), which were significantly lower than those of control group [(1.5±0.1), (1.3±0.1), (1.2±0.1)] (t=5.810, 3.505, 4.751, all P<0.05). After 3, 6, 12 months of treatment, the serum TIMP-1 of study group were (295.4±45.7) ng/mL, (262.3±40.2) ng/mL, (234.2±32.8) ng/mL, the serum MMP-2 level of study group were (726.5±66.3) ng/mL, (683.2±59.7) ng/mL, (601.4±52.6) ng/mL, the serum GP73 level of study group were (73.1±9.5) ng/mL, (54.1±7.8) ng/mL, (35.4±6.3) ng/mL, which were significantly lower than those in control group [TIMP-1: (317.2±50.1) ng/mL, (281.4±42.7) ng/mL, (251.8±39.2) ng/mL, MMP-2: (759.8±69.3) ng/mL, (711.4±57.2) ng/mL, (631.8±55.2) ng/mL, GP73: (82.8±10.7) ng/mL, (62.4±8.1) ng/mL, (50.7±7.6) ng/mL](TIMP-1: t=2.164, 2.008, 2.123, MMP-2: t=2.140, 2.103, 2.458, GP73: t=4.179, 4.550, 9.554, all P<0.05). After 3, 6, 12 months of treatment, the liver hardness of study group (17.6±4.1) kPa, (14.1±3.6) kPa, (13.1±3.2) kPa was significantly lower than that of the control group [(19.8±4.3) kPa, (15.8±3.9) kPa, (14.6±3.7) kPa] (t=2.283, 2.091, 2.142, all P<0.05). After 6, 12 months later treatment, the spleen thickness of the study group [(41.6±3.2) mm, (40.5±2.6) mm] was lower than that of control group [(43.7±3.1) mm, (41.9±2.7) mm] (t=2.906, 2.302, all P<0.05). Conclusion Entecavir can improve the liver function, reduce the liver hardness value, spleen thickness and regulate the serum TIMP-1, MMP-2, GP73 levels in patients with hepatitis B cirrhosis.

Case-control study of thrombocytopenia in liver transplant recipients with alcoholic cirrhosis

FENG Dan-ni, ZHANG Da-li, HE Xi, ZHANG Li-juan, ZHOU Shuang-nan, GAO Yin-jie, LIU Hong-ling

2022, 27(5):  540-542. 

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Objective To investigate whether pre-liver transplantation (LT) low low-density lipoprotein (LDL) level and pre-LT large spleen size were the risk factors for thrombocytopenia after LT. Methods A total of 81 patients who underwent LT for alcoholic cirrhosis in our hospital from April 2015 to November 2018 were enrolled. Patients with thrombocytopenia after LT were screened. Patients with platelet (PLT) level less than 100 × 10⁹/L and more than 100 × 109/L in 1 year after LT were selected into case group and control group, respectively. The influence of pre-LT LDL level and spleen size on post-LT PLT level was recorded. The averages of the 2 groups were compared by t test and non-parametric test. Logistic regression was used to analyze risk factors. Results Finally, 38 liver recipients met the inclusion criteria were enrolled. In the first year after LT, the PLT level of 9 patients decreased (case group), with the median of 86.0 (76.0, 89.0) ×10⁹/L, while 29 cases with normal PLT level (control group), with the median of 129.0 (118.0, 166.0) ×10⁹/L. Compared with control group, patients in case group had significant lower pre-LT PLT level (35±5.47×10⁹/L, 47(35, 61)×10⁹/L, respectively, Z=-2.04, P=0.041), lower pre-LT LDL level (0.86(0.82,1.29) mmol/L, 1.53(1.3, 2.34) mmol/L, Z=-2.68, P=0.006) and larger spleen size (6130±806.9 mm², 4410(3288, 5278.5) mm², Z=-2.05, P=0.041). Logistic regression analysis showed that lower pre-LT LDL level (OR=0.089, 95%CI: 0.012 - 0.675, P=0.019)) and large spleen size (OR=1.001, 95% CI: 1.000-1.001,P=0.024) were risk factors for thrombocytopenia after LT. Conclusion Low pre-LT LDL level and splenomegaly may induce thrombocytopenia after LT.

Liver Cancer

Features and diagnostic value of contrast-enhanced ultrasound in patients with solid liver nodules ≤2 cm

ZHOU Cheng-xiang, ZHAO Lin, SU Hong, LIN Hai-yan, MA Li-wen

2022, 27(5):  543-546. 

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Objective To analyze the features and diagnostic value of contrast-enhanced ultrasound in patients with solid liver nodules ≤ 2 cm. Methods 140 patients with solid liver nodules ≤ 2 cm in diameter treated in the hospital were enrolled between June 2018 and December 2020. Conventional ultrasound and contrast-enhanced ultrasound were performed on patients. Results Among 156 lesions, pathological examination showed there were 87 benign lesions, including 28 hemangiomas, 42 regenerative nodules, 5 steatosis, 10 inflammatory necrosis and 2 spiroma. And there were 69 malignant lesions of 20 atypical hyperplasias and 49 small hepatocellular carcinomas (SHCC). Among the hepatocellular carcinomas, there were 23 lesions of high differentiation, 15 moderate differentiation, 6 poor differentiation, 2 clear cell carcinomas, 1 bile duct cystadenocarcinoma, and 2 primary hepatic large cell neuroendocrine carcinomas. With pathological examination as the gold standard, 78 benign cases and 78 malignant cases were diagnosed by conventional ultrasound, and 85 benign cases and 71 malignant cases were diagnosed by contrast-enhanced ultrasound. The Kappa value, correctness, sensitivity, specificity, positive predictive value and negative predictive value were 0.527, 76.3%, 73.6%, 79.7%, 85.0%, and 70.5% of conventional ultrasound diagnosis, and were 0.896, 94.9%, 94.3%, 95.7%, 96.5%, and 93.0% of contrast-enhanced ultrasound. Ultrasound examination results displayed 42 lesions of very low to low echoes, 76 of medium to high echoes and 38 of mixed echoes. Among the 156 lesions, 36 lesions showed rapid enhancement in the arterial phase and fast in and fast out in the portal vein phase, 38 showed fast in but no out until the delayed phase, and 5 showed fast in and slow out until the delayed phase, 27 showed slow in but no out, 1 showed equal enhancement-out in portal vein phase or delayed phase after equal enhancement in the arterial phase, 34 showed equal enhancement in arterial phase, portal vein phase and delayed phase, 16 lesions showed no enhancement in the arterial phase, portal vein phase and delayed phase. The initial increase time of contrast-enhanced ultrasound for benign lesions was (14.5±2.9) s, which was significantly longer than [(11.2±2.8) s, P<0.05] for malignant lesions, and the peak time with (22.9±6.7) s was significantly longer than [(20.6±6.2) s, P<0.05] of malignant lesions, and half time of descent with (169.4±42.6) s was significantly longer than [(66.9±30.4) s, P<0.05] of malignant lesions. Conclusion Contrast-enhanced ultrasound can dynamically monitor the liver tissue microcirculation perfusion in real time, facilitate the observation of the microvascular structure of parenchymal tissues, and help judge the nature of the lesion. Its advantages can better make up for the deficiencies of conventional ultrasound and effectively improve the diagnostic accuracy rate.

The differential diagnosis of hepatic alveolar echinococcosis with intrahepatic cholangiocarcinoma by conventional and contrast-enhanced ultrasound

WA Zeng-cheng, DU Ting, XU Hui-qing, QIAO Zhi-zhong

2022, 27(5):  547-549. 

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Objective To analyze the differential diagnosis of hepatic alveolar echinococcosis (HAE) and intrahepatic cholangiocarcinoma (ICC) by conventional ultrasound (CU) and contrast-enhanced ultrasound (CEUS). Methods From January 2017 to June 2021, 42 cases of HAE (31 males and 11 females, average age 55.7±12.2 years), and fifty-six ICC patients (37 males and 19 females, average age 38.8±14.0 years) were enrolled in this study. The performance of CU and CEUS and their combination in the diagnosis of HAE and ICC were compared by drawing receiver operating characteristic (ROC) curve and calculating the area Under the Curve (AUC). Results There were 34 cases (80.9%) and 8 cases (19.1%) of HAE, and 30 cases (53.6%) and 26 cases (46.4%) of ICC were found in the right lobe and left lobe of the livers, respectively, with statistical significant difference (χ²=7.941, P<0.05). 7 cases (16.7%), 29 cases (69.0%) and 6 cases (14.3%) of HAE patients, and 6 cases (10.7%), 18 cases (32.1%) and 32 cases (57.1%) of ICC patients were shown high, mixed and low echo lesions, respectively, the difference was statistically significant (χ²=18.825, P<0.05). Biliary dilatation was found in 2 cases (4.8%) of HAE and 16 cases (28.6%) of ICC patients, with statistical significance (P<0.05). There were 9 cases (21.4%) and 1 case (1.8%) of pseudo-cyst (χ²=10.106), and 20 cases (47.6%) and 0 cases (0) with calcification (χ²=33.504) in the HAE and ICC patients, respectively, the difference was all statistically significant (P<0.05). There were 27 cases (64.3%), 7 cases (16.7%) and 8 cases (19.0%) in HAE patients, and 46 cases (82.1%), 8 cases (14.3%) and 2 cases (3.6%) in ICC patients with high, equal and low echoic arterial phase, respectively, with statistically significant difference (χ²=-6.750, P<0.05). 36 cases (85.7%), 4 cases (9.5%), 2 cases (4.8%) and 1 case (2.4%) of HAE, and 6 cases (10.7%), 26 cases (46.4%), 13 cases (23.2%),and 11 cases (19.6%) of ICC patients had annular, heterogeneous, eccentric and centripetal enhancement, respectively, with statistically significant difference (χ²=53.172, P<0.05). There were 1 case (2.4%), 13 cases(30.9%)and 28 cases(66.7%)of HAE, and 0 cases (0), 1 case (1.8%) and 55 cases (98.2%) of ICC patients with high, equal and low echoic venous phase, respectively, the difference was statistically significant (χ²=18.445, P<0.05). 1 case (2.4%), 11 cases (26.2%) and 30 cases (71.4%) of HAE patients, and 0 cases (0), 2 cases (3.6%) and 54 cases (96.4%) of ICC patients with high, equal and low echoic delay, respectively, the difference was statistically significant (χ²=12.340, P<0.05). The peak time, fast-forward and fast-out of HAE patients were (192.7±46.2) s and 10 cases (23.8%), which was significantly different from those of (32.5±9.2)s and 41 cases (73.2%) in ICC patients (t=40.018, -14.125, P<0.05). The AUC value of diagnosing HAE by a combination of CU and CEUS was significantly higher than those by CU and CEUS alone (P< 0.05). Conclusion HAE and ICC can be accurately distinguished based on their typical characteristics of CU and CEUS.

Viral Hepatitis

The incidence and risk factors of HBV reactivation in breast cancer patients during chemotherapy

WANG Lu, YANG Yang, SU Yi, SUN Tao, ZHANG Hong-juan

2022, 27(5):  550-552. 

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Objective To explore the incidence and risk factors of hepatitis B virus (HBV) reactivation in breast cancer (BC) patients during chemotherapy. Methods From May 2012 to December 2018, 236 BC patients with HBV infection were collected, They were all female patients, with an average age of (48.6±11.0) years. According to whether HBV reactivation occurred during chemotherapy, the patients were divided into a reactivation group and a non-reactivation group. The severity of liver injury in HBV reactivated BC patients was referred to WHO grading standard., T test, chi-square test or rank sum test were used for statistical comparisons based on the data types; Multivariate analysis was used to explore the independent risk factors of HBV reactivation in BC patients. Results In 236 cases of BC patients with HBV infection, 44 cases were reactivated with an incidence rate of 18.6%. Comparing the clinical data of patients in reactivation group and non-reactivation group, the age of reactivation group and non-reactivation group was (43.8±13.2) years and (50.2±9.4) years, with statistically significant difference (t=-7.894, P<0.05). There were 40 cases (90.9%) and 85 cases (44.3%) of HBV-DNA positive patients at baseline in the reactivation group and the non-reactivation group, respectively, with statistical significance (χ²=31.255, P<0.05). There were 18 cases (40.9%) and 11 cases (5.7%) in reactivation group and non-reactivation group, and the difference was statistically significant (χ²=41.104, P< 0.05). The levels of baseline and post-chemotherapeutic ALT, AST, and TBil in the reactivation group were (37.5±5.6) U/L and (64.4±9.5) U/L, (36.0±5.2) U/L and (55.2±7.6) U/L, and (12.3±3.2) μmol/L and (18.4±3.8)μmol/L, respectively, which were significantly different with those of (21.4±3.5) U/L and (42.4±7.8) U/L, (19.2±3.0) U/L and (38.7±6.8) U/L, and (10.7±2.0) μmol/L and (14.6±2.6)μmol/L of the non-reactivation group (t=12.035, 15.022, 18.642, 9.258, 6.028, P< 0.05). Taking the above-mentioned difference data as independent variables and whether HBV-infected BC patients have virus reactivation as dependent variables, the results of multivariate analysis suggested that baseline HBV-DNA positive, discontinuation of antiviral drug, baseline ALT and baseline AST were independent risk factors for HBV reactivation in HBV-infected BC patients (P<0.05). The liver injuries grading I, II, III, and IV in the reactivation group were 3 cases (6.8%), 11 cases (25.0%), 7 cases (15.9%), and 2 cases (4.5%), respectively, which were significantly different with those of 22 cases (11.4%), 13 cases (6.8%), 0(0) and 0(0), in patients of non-reactivation group (χ²=22.069, P<0.05). Conclusion The incidence of virus reactivation during chemotherapy in BC patients with HBV-infection is high. it is necessary to pay attention to the alteration of HBV-DNA and liver function in these patients, and instruct the patients to regularly taking antiviral drugs.

Effect of comorbid type 2 diabetes mellitus on the antiviral response of interferon combined with ribavirin in patients with chronic hepatitis C

HU Chun-xia,YANG Jiao-nan, ZHANG Feng-xiao, HU Jing-hua

2022, 27(5):  553-556. 

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Objective To explore the effect of comorbid type 2 diabetes mellitus (T2DM) on the antiviral response of interferon combined with ribavirin in the treatment of chronic hepatitis C (CHC) patients. Methods 78 CHC patients with T2DM (study group) and 53 patients with CHC alone (control group) were diagnosed and treated between March 2017 and June 2019. All patients were treated with interferon in combination with ribavirin for 48 weeks and followed up for 24 weeks after the treatment. Indexes of liver and pancreatic islet functions were tested before and after the treatment. The antiviral responses of the two groups of patients were compared, and drug safety was evaluated. Results The liver function indexes of both groups were significantly improved after treatment. There was no statistically significant difference in the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (TBIL) between the two groups (P>0.05). The fasting blood glucose (FPG) level of the study group was (5.82±1.03) mmol/L, and the insulin resistance index (HOMA-IR) was (2.43±0.40) after treatment, which was higher than those of (5.24±0.91) mol/L and (1.91±0.34) respectively in the control group, the difference was statistically significant (P<0.05). There was no significant difference in rapid virological response (RVR) and early virological response (EVR) between the two groups of patients after treatment (P>0.05). However, the virological response at the end of treatment (ETVR) and sustained virological response (SVR) of the study group were 52.56% and 46.15%, respectively, which were lower than those of 71.70% and 66.04% in the control group, the difference was statistically significant (P<0.05). The incidence of total adverse drug reactions of the study group and the control group during the treatment period were 8.97% and 7.55%, respectively, without statistically difference (P>0.05). Conclusion Antiviral therapy with Interferon in combination with ribavirin can improve liver and pancreatic islet functions in CHC patients with good safety, but comorbid T2DM may affect the virological response of the antiviral theatment.

Effect of nonalcoholic fatty liver disease on antiviral treatment response of children and adolescents with chronic hepatitis B

WANG Xiao-wei, SUN Jing, WANG Dong

2022, 27(5):  557-560. 

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Objective To analyze the influence of nonalcoholic fatty liver disease (NAFLD) on antiviral treatment response of children and adolescents with chronic hepatitis B (CHB). Methods From March 2013 to April 2019, there were 316 children and adolescents with CHB were enro[jg1]lled in this study. Within them, 76 patients including 63 males and 13 females had NAFLD, with an average age of 6.6 (3.0, 15.5) years. Another 238 patients including 182 male and 56 female only had CHB, with an average age of 6.0 (3.0, 13.5) years old. The CHB patients were divided into CHB with NAFLD group and CHB alone group according to whether they were complicated with NAFLD or not. Measurement data were expressed as mean±standard deviation (±s) and analyzed with T test. Counting data were expressed as percentage (%) and analyzed with Chi square test. Results The BMI of CHB with NAFLD group [21.6 (19.7, 24.4) kg/m²] was significantly higher than that of CHB alone group [19.6(17.5, 22.0) kg/m²] (P<0.05). The ratio of liver and spleen CT values in CHB with NAFLD group were 1.1(0.9, 1.2), which were significantly higher than those of 0.6(0.5, 0.8) in CHB alone group (t=-11.635, P<0.05). The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC) and total glycerol (TG), pre-albumin, and fibrinogen in CHB alone group were 87 (51, 142) U/L, 68 (45, 110) U/L, 3.6 (3.2, 4.1) mmol/L and 0.9(0.7, 1.1)mmol/L, 26.7(24.1,29.2)g/L、152(138,185)mg/L及2.7(2.4,3.3)g/L, respectively, which were significantly lower than those of 98(58, 172) U/L, 82 (48, 140) U/L, 4.8(3.4, 5.8)mmol/L,1.4(0.9, 1.9)mmol/L,23.8(22.0,26.4)g/L,140(120,167)mg/L,and 2.4(1.9,2.8)g/L in CHB with NAFLD group [t=4.370, 6.517, 8.610, 12.005, P<0.05)]. After 24 weeks antiviral treatment, the HBV-DNA seroconversion rates in the CHB with NAFLD group and CHB alone group were 217 cases (91.1%) and 53 cases (69.7%), respectively, with significant difference (P<0.05).There was no significant difference between the HBV-DNA seroconversion rates of these two groups after 12 weeks antiviral treatment. In addition, the ALT and AST normalization rates of CHB alone group at 12 and 24 weeks were 138 cases (58.0%) and 154 cases(64.7%), and 166 cases (69.7%) and 180 cases (75.6%), respectively, which were significantly higher than those of 30 cases (38.55) and 32 cases(41.0%), and 41 cases (53.9%) and 44 cases (57.9%) of the CHB with NAFLD group, respectively, with statistical significant difference (P<0.05). The HBV DNA responsive rate of antiviral treatment for 24 weeks in CHB alone group (238 cases, 100%)were significantly higher than that of CHB with NAFLD group(61 cases,80.2%)(P<0.05). When comparing the anti-viral treatment responsive and non-responsive CHB patients with NAFLD, the ratio of liver and spleen CT values, TC, ALT, AST and HBV DNA of the responsive patients were 0.7(0.5, 0.8), 3.0(2.3, 3.7)mmol/L, 42(28, 74)U/L and 44(28, 78) U/L, respectively,which were significantly different with those of [0.5(0.4, 0.6), 3.8(3.2, 5.0)mmol/L, 64(37, 92)U/L, 70(28, 98)U/L and 7.3(6.3, 8.5)log10 copies/ml in the non-response patients (t=-4.440, 6.746, 13.082, 15.146, 9.320, P<0.05)]. Conclusion The presence of NAFLD in children and adolescent CHB patients may affect their biochemical responsiveness and viral clearance to anti-viral treatment.

Other Liver Diseases

Clinical and pathological characteristics of progressive familiar intrahepatic cholestasis: a report of 19 cases

LIU Xiao-ju, WU Li-na, LIU Li-wei, LIU Jin-xiang, ZHU Zi-jun, SUN Li-ying, ZHAO Xin-yan

2022, 27(5):  561-565. 

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Objective To compare the clinical features, transporters and genotypes of PFIC types 1, 2 and 3. Methods From 2014 to 2018, PFIC patients were diagnosed in Beijing Friendship Hospital, Capital Medical University. The clinical, biochemical, pathological and genetic sequencing results were collected. Results 19 patients met the diagnostic criteria for PFIC. The mean age was 10.6 ± 22.7 months, 52% were male. 3 cases were type 1 (15.7%), 13 cases were type 2 (68.4%), 3 cases were type 3 (15.7%). There were 15 cases (78.9%) with onset within 1 year, 12 cases (63.1%) received liver transplantation. The onset of PFIC type 2 was the earliest (2.9 ± 3.37 months). Type 3 had the latest onset (48 ± 39.1 months) and the least hepatic impairment. The most common clinical manifestations were splenomegaly in 84.2% (16/19), jaundice in 78.9% (15/19), ascites in 52.6% (10/19), pruritus in 52.6% (10/19), portal hypertension in 47.3% (9/19), hepatomegaly, portal systemic shunt and gallbladder secondary changes in 42.1% (8/19). As compared to non-cirrhotic patients, direct bilirubin [ 270.6 (59.9, 390.3) vs 79.1 (10.4, 96.5)μmol/L, > 3-fold, P=0.02], indirect bilirubin[236.4(54.9,319.5)vs 65.6(11.6,85.5)μmol/L,>4-fold,P=0.041]prothrombin time [ (22.24 ± 9.93) vs (13.83 ± 2.93)s, P=0.034] and international normalized ratio [ 1.7 (1.2, 2.4) vs 1.1 (1.0, 1.3), P=0.034] were significantly higher in patients with cirrhosis. Alkaline phosphatase [ (417.2 ± 240.3) vs (214.5 ± 58.34)U/L, approximately 2-fold, P=0.049] and leukocytes [(12.1 ± 9.7 ) vs(4.14 ± 3.56)×10⁹/L, > 2-fold, P=0.049] were significantly elevated in the normal GGT group compared to the elevated GGT group. From the perspective of liver pathology, type 1 the degree of cholestasis was the most severe, without BSEP, MDR3 and MRP2 protein loss. Decreased or complete loss of BSEP protein in type 2; MDR3 protein is completely absent in type 3 with minimal cholestasis. Conclusion The results of this study showed that PFIC 3 had mild clinical severity and GGT was significantly increased, which could be used as an important clue to differentiate the types of PFIC. In addition, gene sequencing and loss of the corresponding transporter in liver histology suggest their role for PFIC diagnosis and classification.

An analysis for the diagnostic?significance of clinical manifestation, autoantibodies and liver pathology of 84 patients with primary biliary cholangitis

CHENG Ya-jiao, LU Guan-zhu, WANG Yu-huan, BAO Yu-jie, XU Jie, YUAN Xiao-ling

2022, 27(5):  566-569. 

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Objective To analyze the clinical features, autoantibodies and the diagnostic significance of liver histopathology of primary biliary cholangitis (PBC), in order to improve the understanding of this disease. Methods The clinical characteristics, results of autoantibody tests and liver histopathological examination of 84 patients diagnosed with PBC or PBC-AIH overlap syndrome were analyzed. Results Among the 84 patients, the male to female ratio was 1:4.6, and the average age was (55.54±11.10) years. Among the common clinical symptoms, the incidence of skin pruritus in AMA-M2-positive patients (27.3%) is higher than that in AMA-M2-negative patients (3.4%), with statistical difference (χ²=6.990, P=0.008). The results of autoantibody tests indicated that the positive rates of AMA-M2, p210 and Sp100 were 65.5%, 23.8%, and 16.7%, respectively. Among 52 patients who underwent liver biopsies, 23 each of AMA-M2 positive and AMA-M2 negative patients have histopathologically confirmed PBC. Compared with the AMA-M2 positive patients, the AMA-M2 negative patients had more cases with significant fibrosis (i.e., PBC stage III, 7.3% vs 24.1%, χ²=4.746, P=0.042). Conclusion AMA positive has high sensitivity and specificity for the diagnosis of PBC. However, AMA-M2 negative PBC is also common in Chinese patients. Although the combination of Sp100 and gp210 tests can improve the diagnostic rate of PBC patients, the diagnosis was still easy to be missed or delayed. Histopathological examination to achieve early diagnosis and treatment is also important for improving the patient's prognosis and life qualities.

The diagnostic value of serum Cat S level in patients with primary biliary cholangitis

GAO Lin-lin, KONG Mi-cai, FENG Wei-hua

2022, 27(5):  570-572. 

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Objective To investigate the changes and diagnostic value of serum cathepsin S (Cat S) level in patients with primary biliary cholangitis (PBC). Methods A total of 135 patients with PBC and hepatitis B (HBV) who were admitted from June 2017 to October 2020 were selected and denoted as PBC group (75 cases) and HBV group (60 cases), respectively. The serum levels of total Cat S, pro-Cat S and active-Cat S were compared between the two groups of patients. Pearson correlation analysis was used to explore the correlation between serum Cat S and alkaline phosphatase (ALP), glutamyl transpeptidase (GGT), immunoglobulin G (IgG) and immunoglobulin M (IgM) in PBC patients. Rreceiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was used to evaluate the diagnostic value of serum Cat S for PBC. Results The levels of ALP, GGT, IgG and IgM in the PBC group were (258.76±82.56) U/L, (258.76±82.56) U/L, (258.76±82.56) g/L, and (258.76±82.56) g/L, respectively,which were all higher than those of [(187.52±64.38), (215.33±76.21), (8.32±2.45), (2.53±1.05)] in the HBV group (t=14.310, 9.713, 8.016; all P<0.05). Similarly,serum levels of total Cat S, pro-Cat S and active-Cat S in the PBC group were (14.85±4.52) pg/L, (8.53±3.61) pg/L, and (6.32±1.87) pg/L, respectively, which were higher than those of [(5.26±2.85) pg/L, (3.82±1.15) pg/L, (1.44±0.75) pg/L] in the HBV group (t=5.481, 8.078, 10.098, 6.668; all P<0.05). Serum total Cat S level in PBC patients was positively correlated with ALP, GGT, IgG and IgM (r=0.625, 0.581, 0.681, 0.582, P<0.05). Concordancely, serum pro-Cat S level was positively correlated with ALP, GGT, IgG and IgM (r=0.764, 0.676, 0.753, 0.603, P<0.05). By ROC analysis it was shown that the best cut-off points for the diagnosis of PBC by serum total Cat S, pro-Cat S and active-Cat S were 8.79 pg/L, 5.88 pg/L, 3.16 pg/L, and the AUCs were 0.887, 0.644, 0.658, respectively. Conclusion The level of serum Cat S in patients with PBC is abnormally increased, and its diagnostic efficiency for PBC is high. Serum level of Cat S can be used as an important reference index for the diagnosis of PBC.

MRI proton density and fat fraction in non-obese NAFLD patients with different liver histological characteristics

WANG Tie-gang, LI Xiao-ming, ZHU Dan-yang

2022, 27(5):  573-575. 

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Objective To compare the clinical data of non-obese nonalcoholic fatty liver disease (NAFLD) patients with those of chronic hepatitis B (CHB) patients, and analyze the performance of magnetic resonance imaging-estimated proton density fat fraction (MRI-PDFF) of non-obese NAFLD patients with different liver histological features such as the degrees of steatosis and inflammation, and the stages of liver fibrosis. Methods A total of 74 non-obese NAFLD patients (40 males and 34 females) aged (42.3±11.4) years from January 2019 to July 2021 were collected. There were 92 patients with CHB (64 males and 28 females) with an average age of (38.1±10.3) years. The diagnosis of non-obese NAFLD and CHB meet the standard criteria. The clinical data of non-obese NAFLD patients were compared with CHB patients. The associations between MRI-PDFF manifestations with different liver histological features were analyzed. Results There were 29 cases (39.2%) and 11 cases (12.0%) of hypertension in non-obese NAFLD and CHB patients, respectively, with statistical significance (χ²=16.629, P<0.05). The levels of total triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) in non-obese NAFLD patients were (2.4±1.0) mmol/L, (5.3±1.4) mmol/L, (3.5±0.9) mmol/L and (1.0±0.4) mmol/L, respectively, which were significantly higher than those of [(1.2±0.6) mmol/L, (4.0±1.0) mmol/L, (2.3±0.6) mmol/L and (1.5±0.6) mmol/L in CHB patients (t=10.502, 4.104, 4.230, -5.018, P<0.05). The MRI-PDFF of non-obese NAFLD and CHB patients were (16.5±5.2)% and (3.8±1.1)%, respectively, with statistical significance (t=22.428, P<0.05). For the degrees of hepatic steatosis of the non-obese NAFLD patients, 10 cases were in S0, 25 cases were in S1, 28 cases were in S2 and 11 cases were in S3. The MRI-PDFF of each degree of hepatic steatosis was (3.3±1.5)%, (9.2±3.3)%, (16.2±5.0)% and (21.4±6.4)%, respectively, with statistical significance (t=12.234, P<0.05). However, there was no significant difference in MRI-PDFF among patients with different liver inflammatory degrees and liver fibrosis stages (P>0.05). Conclusion With the increased severity of liver steatosis in non-obese NAFLD patients, The MRI-PDFF significantly increase which is helpful to quantitatively evaluate liver fat content and improve the diagnosis.

Observation on the recovery process of refractory bacterial liver abscess patients undergoing radiofrequency ablation at different time

DONG Xiao-ping, CHEN Xin-ju

2022, 27(5):  576-579. 

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Objective To observe the effect of radiofrequency ablation at different time on the recovery of refractory bacterial liver abscess. Methods A total of 88 patients with refractory bacterial liver abscess admitted to our hospital from January 2017 to January 2021 were selected. All the patients received radiofrequency ablation in our hospital, and were divided into group A and group B according to the different time between the onset of the disease and the treatment of radiofrequency ablation. The time from onset to radiofrequency ablation in group A (n=45) was ≤ 72 h, and that in group B (n=43) was > 72 h. Both groups returned to hospital for reexamination 3 months after surgery to evaluate the clinical efficacy of both groups. Blood samples were collected preoperatively and 3 months after operation, and tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) were detected by enzyme linked immunosorbent assay. Finally, the differences between the two groups in operative time, temperature normalization time, white blood cell count normalization time, length of hospital stay, hospitalization cost and incidence of postoperative complications during hospitalization were compared. Results There was no significant difference in total effective rate between the two groups (93.3% VS 93.0%, P>0.05). In group A, the operation time, temperature normalization time, white blood cell count normalization time, hospitalization time and hospitalization cost were (51.4±9.3) min, (3.5±0.8) d, (5.4±0.9) d, (7.8±1.5) d, (3.4±0.5) ten thousand yuan, respectively. In group B, those were (59.7±10.8) min, (4.9±1.4) d, (6.8±1.4) d, (9.2±2.0) d, (3.9±0.7) ten thousand yuan, respectively. The operation time, temperature normalization time, white blood cell count normalization time and hospitalization time of group A were significantly shorter than those of group B (P<0.05), and the hospitalization cost of group A was significantly less than that of group B (P<0.05). The preoperative levels of TNF-α, IL-6 and IL-8 in group A were (74.5±20.4) pg/mL, (192.4±40.5) pg/mL, and (90.4±15.6) pg/mL, respectively, and the postoperative levels of those were (42.1±12.7) pg/mL, (71.7±21.0) pg/mL, (54.1±11.3) pg/mL, respectively. The preoperative levels of TNF-α, IL-6 and IL-8 in group B were (75.0±20.9) pg/mL, (192.0±41.3) pg/mL, and (90.8±15.1) pg/mL, respectively, the postoperative levels were (42.8±13.0) pg/mL, (72.0±21.8) pg/mL, and (53.9±12.9) pg/mL, respectively. There was no significant difference in the preoperative levels of TNF-α, IL-6 and IL-8 between the two groups (P>0.05). Compared with preoperation, the levels of TNF-α, IL-6 and IL-8 in both groups were significantly decreased after operation (P<0.05). There was no significant difference in the total incidence of postoperative complications between the two groups (24.4% VS 23.3%, P>0.05). Conclusion Radiofrequency ablation is safe and effective in patients with refractory bacterial liver abscess. Compared with patients that the time from onset to radiofrequency ablation > 72 h, patients that the aforementioned time ≤ 72 h have advantages of faster postoperative recovery and less hospitalization cost after treatment.

Risk factors of complications after laparoscopic repair in patients with traumatic liver rupture

CHEN Zhi-qiang, YANG Qi, PENG Zheng, CHEN Yan-jun

2022, 27(5):  580-583. 

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Objective To study the risk factors of complications after laparoscopic repair in patients with traumatic liver rupture. Methods 102 patients with traumatic liver rupture in our hospital from April 2017 to October 2020 were collected as the research objects, all patients underwent laparoscopic repair, and the complications were recorded. The Logistic multivariate analysis was used to explore the risk factors of postoperative complications, the exponential equation was established and its application value in judging complications was analyzed. Results There were 38 cases with complications, the incidence rate was 37.25%. Among the 102 patients, there were 14 cases of postoperative infection, 12 cases of postoperative bile leakage, 8 cases of bleeding and 4 cases of liver abscess. The Logistic multivariate analysis showed that the time from injury to admission, blood loss, duration of hypotension and albumin (Alb) level were independent factors, which affected the postoperative complications (P<0.05). The exponential equation was established, which accorded to the results of the Logistic multifactor analysis: Y=0.603X₁+0.654X₂+0.471X₃+0.798X₄+0.899X₅ (X₁=time from injury to admission, X₂=blood loss, X₃=grade of liver rupture, X₄=duration of hypotension, X₅=Alb). Receiver operating characteristic (ROC) analysis showed that the area under curve (AUC) of postoperative complications judged by exponential equation was 0.796 (SE=0.066, 95%CI=0.666-0.926, P<0.001). Conclusion The incidence of complications after laparoscopic repair of traumatic liver rupture is high. The complications are related to the time from injury to admission, blood loss, grade of liver rupture, the duration of hypotension and Alb level.

Clinical characteristics and prognosis of patients with severe alcoholic hepatitis

LI Xiang-yang, TANG Quan-miao, WANG Lei

2022, 27(5):  584-587. 

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Objective To review the clinical data of severe alcoholic hepatitis (SAH) patients, and compare the clinical features, prognosis scores and short-term prognosis of non-SAH- acute-on-chronic liver failure (ACLF) and SAH-ACLF patients, so as to provide basis for SAH disease management, prognosis evaluation and treatment strategy formulation. Methods From January 2009 to October 2021, 112 patients with SAH [105 males and 7 females, aged (49.6±9.4) years] were collected. Patients with SAH were divided into non-SAH-ACLF group and SAH-ACLF group according to whether there was ACLF. We compared the clinical features, prognosis scores and 28-day and 90-day survival rates between patients in two groups. The measurement data of skewness distribution was expressed as [M (P₂₅, P₇₅)], and Mann-Whitney U test was adopted. The measurement data of normal distribution was expressed as (±s), and independent t test was adopted. Counting data were expressed as absolute numbers, which were compared by Chi-square test. The survival rate was compared by Log-Rank test. Results There were 82 and 30 patients without SAH-ACLF and with SAH-ACLF, respectively. According to the clinical characteristics, 9 cases (11.0%), 8 cases (9.7%), 19 cases (23.2%) and 27 cases (32.9%) of gastrointestinal bleeding, hepatic encephalopathy, infection and ascites in non-SAH-ACLF group, which were compared with SAH-ACLF group [8 cases (26.7%), 16 cases (53.3%), 17 cases (56.7%) and 20 cases (66.7%)], with statistical significance (χ²=-4.200, -24.733, -11.299, -10.267, P<0.05). White blood cells (WBC), total bilirubin (TBil), direct bilirubin (DBil), urea nitrogen (BUN) and creatinine (Scr) in patients without SAH-ACLF were 7.0 (4.6, 10.8) × 10⁹/L, 140.6 (98.4, 302.8) μmol/L, 82.0 (44.4, 172.5) μmol/L, 4.8 (3.1, 6.5) mmol/L and 58.4 (52.0, 76.5) μmol/L, compared with those in SAH-ACLF group [9.4 (6.5, 14.5) × 10⁹/L, 242.8 (186.0, 412.6) μmol/L, 162.5 (92.5, 231.8) μmol/L, 9.2 (4.0, 15.4) mmol/L and 91.4 (65.4, 220.6) μmol/L, with statistical significance (Z=-3.914, -10.126, -11.020, -10.104, -8.002, P<0.05). The prothrombin time (PT) and international normalized ratio (INR) of non-SAH-ACLF group were 20.2 (19.0, 23.6) s and 1.6 (1.5, 2.0), which were significantly higher than those of SAH-ACLF group [26.5 (21.5, 32.2) s and 2.2 (1.8, 2.0), Z=-3.802, -3.914, P<0.05]. The Maddrey discriminant function (MDF) score, model for end-stage liver disease (MELD) score, Age-bilirubin-INR-creatinine (ABIC) score, chronic liver failure-sequential organ failure (CLIF-SOFA) score, chronic liver failure-Consortium Organ Failure score (CLIF-C OFs) and CLIF-C ACLF score of non-SAH-ACLF patients were 52.0 (41.5, 68.4) points, 11.2 (9.0, 14.2) points, 7.4 (6.0, 9.0) points, (7.4. 9.0) points, 4.0 (3.0, 5.0) points, 8.0 (7.0, 9.0) points and 35.4 (30.2, 42.5) points, compared with those in SAH-ACLF group [82.0 (56.2, 108.0) points, 20.8 (15.5, 25.4) points, 8.8 (7.5, 10.6) points, 6.0 (5.0, 8.0) points, 10.0 (9.0, 11.0) points and 48.0 (40.0, 52.1) points], with statistical significance (Z=2.664, 6.508, 2.251, 2.610, 2.412, 5.268, P<0.05). The 28-day survival rates of non-SAH-ACLF and SAH-ACLF patients were 95.1% (78/82) and 70.0% (21/30), with statistical significance (χ²=11.511, P<0.05). The 90-day survival rates of non-SAH-ACLF and SAH-ACLF patients were 84.1% (69/82) and 46.7% (14/30), with statistical significance (χ²=16.079, P<0.05). Conclusion Compared with SAH patients without ACLF, complications, blood biochemical indexes and prognosis scores after ACLF are significantly worse than the former, and the short-term prognosis is obviously unsatisfactory, which needs to be paid attention to in clinical practice.

Comparison of clinical features and prognosis between neonatal cytomegalovirus infection and hepatitis syndrome

LV Jing, GUO Jiu-chun

2022, 27(5):  588-592. 

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Objective To compare and analyze the clinical features and prognosis of neonatal cytomegalovirus (CMV) infection and infant hepatitis syndrome (IHS). Methods From January 2018 to December 2020, 58 newborns with simple CMV infection (CMV group), 58 with IHS (IHS group) were enrolled. Among the newborns with IHS, 17 IHS newborns with non-CMV infection were collected as NCMV-IHS group, 41 IHS newborns with CMV infection were selected as the CMV-IHS group, and 58 healthy newborns were selected as the normal control group (NC group). The general clinical data, clinical manifestations, serum CMV-IgM and urine CMV-DNA test results of each group were compared, the serum total bilirubin (TBIL), γ-glutamyl transpeptidase (γ-GT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin (Alb) levels of each group were detected and compared. Results The ratios of jaundice, lymphadenopathy, hepatomegaly and splenomegaly in the IHS group were 93.10%, 25.86%, 81.03%, and 70.69%, respectively, which were higher than 50.00%, 5.17%, 12.07%, and 10.34% in the CMV group (P<0.05), and the ratios of jaundice and splenomegaly in the CMV-IHS group were higher than those in the NCMV-IHS group (P<0.05). The positive rates of CMV-IgM and CMV-DNA in the IHS group were 36.21% and 70.69%, respectively, and those in the CMV group were 44.83% and 84.48%, which were significantly higher than the 1.72% and 1.72% in the NC group (P<0.05). The serum levels of TBIL, γ-GT, ALT and AST in CMV group and IHS group were higher than those in the NC group, and these in IHS group were higher than those in CMV group (P<0.05); serum level of Alb in IHS group was lower than that in the CMV group and NC group (P<0.05). The ALT of the CMV-IHS group was (127.85±36.79) U/L, significantly higher than (106.01±31.03) of the NCMV-IHS group, while the Alb was (34.93±3.02) g/L in the CMV-IHS group, which was lower than (39.19±3.59) g/L of the NCMV-IHS group (P<0.05). 58 cases (100.00%) and 57 cases (98.28%) in the CMV group and IHS group were cured and discharged. After 6 months of follow-up, 5 cases (12.50%) in the CMV-IHS group had IHS recurrence, there was no recurrence in the NCMV-IHS group, the difference between the two groups was statistically significant (P<0.05). Conclusion Simple CMV infection lacks typical symptoms, while IHS infants have the main clinical manifestations including jaundice, hepatosplenomegaly, and CMV infection can induce IHS. The overall prognosis of neonatal CMV and IHS is good, but CMV infection may increase the risk of IHS recurrence.

The study of serum TBA, ALP and coagulation function in sepsis patients with liver injury

WANG Jun-feng, ZHAO Liang, WANG Jun-jie, YANG Chun-qiu

2022, 27(5):  593-595. 

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Objective To observe the levels of serum total bile acid (TBA), alkaline phosphatase (ALP) and coagulation function in patients with sepsis induced liver injury. Methods From March 2018 to March 2021, 85 sepsis patients with liver injury were selected as the observation group, and patients with sepsis without liver damage were selected as the control group during the same period. On the day of enrollment, the levels of serum TBA, ALP, D-dimer, activated partial thromboplastin time (APTT), prothrombin time (PT), and fibrinogen (FIB) were detected in the two groups. Results The levels of TBA and ALP in the observation group were (94.37±15.62) μmol/L and (24.59±4.33) μmol/L, respectively. The levels of TBA and ALP in the control group were (82.35±13.28) μmol/L and (19.85±3.62) μmol/L, respectively. And the levels of TBA and ALP in the observation group were higher than those in the control group (P<0.05). The levels of D-dimer, APTT, PT and FIB in the observation group were (3164.25±526.73) ng/mL, (35.28±7.14) s, (15.38±4.92) s, and (4.15±0.96) g/L in the control group, respectively. The levels of APTT, PT and FIB were (1624.37±328.17) ng/mL, (31.96±5.52) s, (13.84±5.02) s, (3.36±1.18) g/L, respectively. The levels of D-dimer, APTT, PT, FIB in the observation group were higher than those in the control group (P<0.05). Conclusion Sepsis can lead to liver function damage, increase of TBA and ALP levels, and abnormal coagulation function.

The role and possible mechanism of FGF15/FGFR4 signal pathway in rifampicin-induced liver injury in mice

TU Qian-qian, WEI Xia, SONG Yu-lin

2022, 27(5):  596-599. 

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Objective This study was designed to explore the role and possible mechanism of Fibroblast Growth Factor 15 (FGF15)/Fibroblast Growth Gactor Receptor 4 (FGFR4) signal pathway in rifampicin-induced liver injury. Methods 28 C57BL6 mice were randomly divided into control group (n=7), model group (n=7), FGF15 group (n=7) and FGFR4 inhibitor (BLU9931) group (n=7). Except for the control group, rifampicin 200 mg·kg^-1·d^-1 was given to mice intragastrically for 7 days. Meanwhile, the BLU9931 group was given BLU9931 (10 mg·kg^-1) 6 hours before rifampicin was given and the FGF15 (0.1 mg·kg^-1·d^-1) was injected to FGF15 group intragastrically 1 hour after rifampicin was given. The mice were killed 7 days after the establishment of the model. Liver function indexes were detected by chemical method. Pathological changes of liver was observed by HE staining. Total cholesterol (TCHO), triglyceride (TG) and FGF15 in liver homogenate were detectded. Fibroblast growth factor receptor 4 (FGFR4), cholesterol 7α hydroxylase 1 (CYP7a1) and bile salts export pump (BSEP) protein expression levels in liver homogenate were measured by Western blot. Results Seurm total bilirubin (TBIL) in control group, model group, FGF15 group and BLU9931 group were respectively (2.63±0.51), (25.09±4.85), (19.57±3.72) and (39.53±7.14) μmol/L. Meanwhile, the levels of FGF15 in liver homogenate of these four groups were respectively (646.86±22.66), (580.40±11.30), (622.11±18.96) and (528.37±44.91) pg/g. The relative molecular expression levels of FGFR4 in liver tissues of these four groups were respectively (0.34±0.06), (0.16±0.02), (0.29±0.05) and (0.10±0.02). The relative molecular expression levels of CYP7a1 in liver tissues of these four groups were respectively (0.06±0.01), (0.38±0.06), (0.22±0.03) and (0.63±0.09), and the relative molecular expression levels of BSEP in liver tissues of these four groups were respectively (0.42±0.07), (0.26±0.04), (0.36±0.03) and (0.19±0.03). Compared with the control group, the difference of TBIL, FGF15, FGFR4, CYP7a1 and BSEP in the model group were significantly (all P<0.05). Compared with the model group, the difference of those factors in the FGF15 group were significantly (all P<0.05). Compared with the model group, the difference of those factors in the BLU9931 group were significantly (all P<0.05). Conclusion FGF15/FGFR4 signal pathway plays an important role in rifampicin-induced liver injury in mice, which may be related to the regulation of CYP7a1 and BSEP expression.