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Table of Content

    30 June 2022, Volume 27 Issue 6
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    Liver Cancer
    Clinical features and prognosis of hepatitis C-associated hepatocellular carcinoma
    SHI Dong-mei, XIANG Xiao-gang, ZHAO Gang-de, WANG Xiao-lin
    2022, 27(6):  628-633. 
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    Objective To investigate the clinical characteristics of hepatitis C (HCV) associated hepatocellular carcinoma (HCC) and the effect of antiviral therapy on the prognosis of HCC.Methods The clinical data of 115 patients with HCV-related HCC hospitalized in our hospital from January 2011 to December 2020 were retrospectively analyzed. The patients were divided into untreated group (UCHC), treatment failure group (TF) and sustained virologic response group (SVR) according to antiviral treatment. The clinical characteristics and the effect of direct antiviral agent (DAA) on prognosis of the 3 groups were compared.Results Among 115 patients, 72 (62.6%) were male and 43 (37.4%) were female. The age ranged from 36 to 84 years old (62.6±7.1). The main route of transmission was blood transfusion or related blood products (57.4%), followed by drug use (11.3%). Genotype 1 59.1%, genotype 2 14.8%, genotype 3 14.8%, genotype 6 5.2%, 6.1% undetected. There was no significant difference in age, gender, blood transfusion history, genotype 1, white blood cell (WBC) count, hemoglobin (Hb) and total bilirubin (TBil) levels among the 3 groups at the time of HCC (P > 0.05). The proportion of cirrhosis decompensation, proportion of HBsAg negative and anti-HBc-IgG positive patients, alanine transaminase (ALT), aspartate transaminase (AST) and alpha fetoprotein (AFP) levels in SVR group were lower than those in TF group and UCHC group, with statistical significance (P<0.05). The levels of platelet (PLT), albumin (Alb) and epidermal growth factor receptor (eGFR) in SVR group were higher than those in TF group and UCHC group, with statistical significance (P<0.05). The incidence of portal vein cancer thrombus was 18.9% in SVR group, which was significantly lower than 36.4% in TF group and 30.4% in UCHC group (P<0.01). During the 2-year follow-up, the disease progression in SVR group was 10.3%, which was significantly lower than that in TF group (54.5%) and UCHC group (43.5%), with statistical significance (P<0.001). Further analysis showed that the disease progression rates within 9 months of patients who completed DAA treatment in TF group and UCHC group were 42.9% and 20.0%, significantly lower than those of patients who did not use DAA (75.0% and 61.5%), with statistical significance (P<0.01). The 2-year mortality in SVR group was 6.9%, which was lower than that in TF group and UCHC group (36.4% and 17.4%, P<0.05).Conclusion This study suggests that it is necessary for patients with HCV-associated HCC to get DAA antiviral therapy, which is helpful to improve the therapeutic effect, as well as reduce the metastasis and deterioration of HCC.
    Clinicopathological features and prognosis of hepatocellular carcinoma in children and adolescents
    SUN Wen-bo, DU Chun-hai
    2022, 27(6):  634-636. 
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    Objective To investigate the clinicopathological features and prognosis of hepatocellular carcinoma (HCC) in children and adolescents.Methods Thirty-two children and adolescents with HCC (27 males and 5 females) admitted to our hospital from January 2013 to December 2016 were ecrolled, with an average age of 14 (8, 16). Fifteen cases (46.9%) were diagnosed by ultrasound-guided liver biopsy, 12 cases (37.5%) were diagnosed by surgical biopsy, 5 cases (15.6%) were diagnosed by computed tomography (CT) and alpha fetoprotein (AFP). The survival rate was calculated and the clinilcal data was compared among patients with different clinical data. T test or Kruskal-Wallis H test was used to compare measurement data; Chi-square test was used to compare counting data. The survival rate was compared by Log-Rank test.Results Among 32 children and adolescents with HCC, 22 cases with hepatits B virus (HBV) infection and 10 cases without HBV infection. According to the clinical data of the 2 groups, the average ages of HBV positive group and HBV negative group were 15 (10, 16) years and 11 (8, 15) years, with statistical significance (Z=7.905, P<0.05). Thirteen cases (59.1%) with liver cirrhosis in HBV positive group and 2 cases (20.0%) with liver cirrhosis in HBV negative group, and the difference was statistically significant (χ2=4.219, P<0.05). The albumin (Alb) level and platelet (PLT) count in HBV positive group [37 (35, 40) g/l, 208 (170, 286)×109/l] were significant lower than those in HBV negative group [43 (39, 46) g/l, 314 (245, 360)×109/l], and the difference was statistically significant (Z=-5.012, -10.523, P<0.05). The median survival time of all subjects was 6 (4, 10) months, among which the 1-year, 3-year and 5-year survival rates were 34.4% (11/32), 15.6% (5/32) and 6.3% (2/32), respectively. Surgical resection, transcatheter arterial chemoembolization (TACE) and conservative treatment were performed in 14, 7 and 11 cases respectively, and the median survival time was 28 (10, 42) months, 5 (2, 8) months and 4 (1, 6) months, the differences were statistically significant (P<0.05). The 1-year survival rates of HBV positive group and HBV negative group were 56.3% (5/22) and 60.0% (6/10), with statistical significance (χ2=-4.234, P<0.05). The 1-year survival rates of patients with and without portal vein invasion were 22.7% (9/11) and 12.5% (2/16), with statistical significance (χ2=12.974, P<0.05). The 1-year survival rates of patients with and without distant metastasis were 100% (8/8) and 12.5% (3/24), with statistical significance (χ2=20.364, P<0.05). In view of the small number of cases involved, the differences of 3-year and 5-year survival rates were not analzed in this study.Conclusion HBV infection is still the most common cause for HCC in children and adolescents, and it is more likely to occur with cirrhosis. HCC in children and adolescents is highly malignant and progresses rapidly, inducing low surgical resection rate and poor prognosis. It is of vital importance to strengthen the screening of HCC as well as take active treatment for HBV infection in high-risk groups of children and adolescents.
    The evaluation value of contrast-enhanced ultrasound on blood supply in patients with primary liver cancer after microwave ablation
    ZHOU Cheng-xiang, LIU Ya-bin, SU Hong, JIANG Yi-xiang, LIN Hai-yan
    2022, 27(6):  637-639. 
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    Objective To investigate the evaluation value of contrast-enhanced ultrasound (CEUS) on blood supply in patients with primary liver cancer (PLC) after microwave ablation (MWA).Methods Sixty-six patients with PLC who underwent MWA in our hospital were selected, with a total of 72 lesions. Patients underwent digital subtraction angiography (DSA), enhanced X-ray computed tomography (CT) and CEUS at 1 month after operation. The blood supply of the lesions in the 3 groups was recorded, the angiographic result of DSA was regarded as the gold standard. Consistency analysis was used to evaluate the diagnostic value of enhanced CT and CEUS.Results There was blood supply in the lesion after MWA. The angiographic result of DSA showed that there was not blood supply in 13 lesions and there was blood supply in 59 lesions. Enhanced CT showed that there was not blood supply in 18 lesions and there was blood supply in 54 lesions. The angiographic result of CEUS showed that there was not blood supply in 13 lesions and there was blood supply in 59 lesions. According to the consistency analysis, 54 of 72 lesions were positive by enhanced CT, with a sensitivity of 0.915, a specificity of 1.000, an accuracy of 0.931 and a kappa of 0.796. By consistency analysis, 59 of 72 lesions were positive by CEUS, with a sensitivity of 1.000, a specificity of 1.000, an accuracy of 1.000 and a kappa of 1.000.Conclusion CEUS has a higher accuracy in evaluating blood supply of lesions in PLC patients after MWA, which is worthy of clinical promotion.
    Risk factors of moderate and severe pain in patients with hepatocellular carcinoma after radiofrequency ablation
    LIU Min-qiang, ZHA Xiao-liang, HUANG Xiang-rong, WU Qiang, HE Ren-liang
    2022, 27(6):  640-643. 
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    Objective To investigate risk factors of moderate and severe pain in patients with hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA).Methods One hundred and two patients with HCC who underwent computed tomography (CT)-guided percutaneous RFA under general anesthesia were enrolled. According to the visual analog scale (VAS) within 24 hours after operation, patients were divided into moderate and severe pain group (VAS ≥ 3 points) and non moderate/severe pain group (VAS < 3 points). Clinical data of the patients including gender, age, American Society of Anesthesiologists (ASA[A1]) classification, history of cirrhosis and liver surgery, preoperative pain, tumor size, tumor location, distance between tumor and liver capsule, tumor number, ablation number, ablation time and operation time were collected. Multivariate logistic regression analysis was performed to screen the risk factors for moderate and severe pain after operation.Results Fifty-six patients (54.9%) had moderate or severe pain within 24 hours after operation. Compared with the non moderate/severe pain group, the proportion of preoperative pain, tumor size > 1.5cm and ablation time > 12min in the moderate and severe pain group were higher (P<0.05). Multivariate logistic regression analysis showed that tumor focus > 1.5 cm and ablation time > 12 min were independent risk factors of moderate and severe pain in HCC patients after RFA (P<0.05).Conclusion Tumor size > 1.5 cm or RFA time > 12 min are positively related to the occurrence of moderate and severe pain in HCC patients after operation. Prompt analgesic treatment after RFA should be paid more attention to.
    Clinical value of T2WI sequence images and multi-slice spiral CT multi-phase scanning in differential diagnosis between nodules and small hepatocellular carcinoma in patients with liver cirrhosis
    SONG Wen-yue, GENG Cheng-jun, JIANG Kai
    2022, 27(6):  644-646. 
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    Objective To investigate the clinical value of magnetic resonance imaging (MRI) T2 weighted imaging (T2WI) and multiphase 64 slice spiral computed tomography (64-MDCT) in the differential diagnosis between nodules and small hepatocellular carcinoma (HCC) in patients with liver cirrhosis.Methods Seventy-six cirrhotic patients with nodular or small HCC admitted to our hospital from March 2018 to March 2021 were enrolled. All the subjects underwent MRI T2WI scan and multiphase 64-MDCT scan before operation. Taking the Results of postoperative histopathology as the gold standard, the diagnostic value the 2 Methods was evaluated by consistency analysis.Results The Results of postoperative pathological examination showed that there were 46 patients with small HCC and 30 patients with cirrhotic nodules.The Results of MRI T2WI showed that there were 43 patients with small HCC and 33 patients with cirrhotic nodules (including 13 cases of liver cirrhosis with degenerative nodules and 20 cases of liver cirrhosis with regenerative nodules).The Results of multiphase 64-MDCT showed that there were 39 patients with small HCC and 37 patients with cirrhotic nodules. The consistency analysis showed that the sensitivity and specificity of MRI T2WI in the diagnosis of small HCC were 0.891 and 0.933, respectively. The sensitivity and specificity of multiphase 64-MDCT were 0.804 and 0.933, respectively. The sensitivity and specificity of combined diagnosis were 0.935 and 0.967, respectively.Conclusion MRI T2WI and multiphase 64-MDCT can be used in the differential diagnosis of nodules and small HCC in patients with liver cirrhosis, and the combined examination has higher sensitivity and specificity.
    Viral Hepatitis
    Predictive value of serum HBV RNA on relapse in patients with chronic hepatitis B after withdrawal of antiviral therapy: a meta-analysis
    ZHANG Qi, WANG Yu-yan, QIN Bo
    2022, 27(6):  647-651. 
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    Objective To investigate the predictive value of serum hepatitis B virus (HBV) RNA on relapse in patients with chronic hepatitis B (CHB) after withdrawal of antiviral therapy, and to screen a new biomarker for safely drug withdrawl.Methods PubMed, Embase, Web of science, Cochrane library and https://clinicaltrials.gov/ were used to search for relevant English articles published from 2016-2020. Manual searching was also conducted. The articles were screened according to the inclusion and exclusion criteria. Data extraction and quality assessment were also performed in the involved articles. Revman 5.3 software was used for meta-analysis.Results Compared with HBV RNA-negative patients, serum HBV RNA-positive patients had a higher risk of clinical relapse after drug withdrawal (RR=2.98, 95%CI=1.55~5.72, P=0.001).Conclusion Serum HBV RNA is an important assistant biomarker for predicting clinical relapse after drug withdrawal in patients with CHB. And the predicting value of serum HBV RNA on HBV recurrence after drug withdrawl deserves further investigation.
    Imaging characteristics of MSCT and blood biochemical indexes in patients with hepatitis B complicated with periportal effusion
    YE Fei, YE Jian-fei, CHEN Xue-fei
    2022, 27(6):  652-654. 
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    Objective To investigate the imaging features of multi-slice spiral computed tomography (MSCT) and blood biochemical indexes in patients with hepatitis B complicated with periportal effusion.Methods A total of 80 patients with chronic hepatitis B (CHB) admitted to our hospital from January 2018 to January 2021 were selected as the study subjects. All patients underwent MSCT examination. Patients were divided into observation group (51 cases with periportal effusion) and control group (29 cases without periportal effusion) according to the Results of MSCT. The MSCT manifestations of CHB patients with periportal effusion were observed. The blood biochemical indexes of glutamyl transpeptidase (GGT), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were compared between 2 groups.Results According to the Results of MSCT examination in observation group, effusion can be observed in the surrounding area of liver portal vein trunk and branches during portal venous phase. Low density shadow could be observed in the surrounding area of portal vein trunk and branches. The MSCT features of effusion around the portal vein were that: when scanning direction was parallel to the level and portal vein, the imaging feature was tramline sign, when the scanning plane was perpendicular to the portal vein, the imaging feature was target sign. The levels of GGT, AST and ALT in the observation group [(218.94 ± 36.52) U/L, (192.04 ± 31.75) U/L and (288.49 ± 52.74) U/L] were significantly higher than those in the control group [(174.58 ± 28.75) U/L, (158.62 ± 22.68) U/L and (229.37 ± 46.52) U/L], (P<0.05).Conclusion The imaging features of MSCT in CHB patients combined with periportal effusion were tramline sign or target signs. The degree of liver function injury in CHB patients with periportal effusion was higher than that in patients without portal effusion.
    A new index for early diagnosis of acute hepatitis B: quantitative log value of anti-HBc-IgM/DNA
    ZhAO Wei, CHen Yan-qing, JI Yuan-yuan, CHENG Lin, ZHOU Hai-dong, GUO Chang-feng
    2022, 27(6):  655-657. 
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    Objective To distinguish acute hepatitis B (AHB) from chronic hepatitis B(CHB),and to diagnose AHB at the earliest time.Methods One hundred and thirty-two cases of AHB and 277 cases of CHB were collected and compared for identifying differential indexes between these two groups. Receiver operating characteristic (ROC) curve analysis was performed to obtain the maximum index in area under the curve (AUC) and calculate the sensitivity and specificity for diagnosing AHB.Results (1)The quantitative value of anti-HBc-IgM/DNA log within 48 hours after admission in AHB group was 5.18(0.03-13.65),which was significantly higher than those of 0.04(0.01-3.48) in CHB group (P=0.000). (2)The sensitivity and specificity of quantitative value of anti-HBc-IgM/DNA log in the diagnosis of AHB is 95.45% and 97.47%.The best Youden index is 0.929, the AUC is 0.991,and the cutoff value was 1.025. When simplified to 1, the sensitivity and specificity remained unchanged. (3)Compared with the traditional index anti-HBc-IgM, the AUC difference of anti-HBc-IgM/DNA log in the diagnosis ofAHB is statistically significant (P=0.001).Conclusion The quantitative log value of anti-HBc-IgM/DNA within 48 hours after admission can serve as a new index for early diagnosis of AHB. AHB can be considered when the log value is more than or equal to 1.
    Liver Fibrosis & Cirrhosis
    The characteristics and risk factors of hepatic encephalopathy after emergent TIPS operation in patients with bleeding from esophageal and gastric varices
    LIU Yi, ZHOU Zi-zhong, LIU Gang, XU Hai-rong
    2022, 27(6):  658-661. 
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    Objective To investigate the characteristics and risk factors of hepatic encephalopathy after emergent transjugular intrahepatic portosystemic shunt (TIPS) operation in patients with bleeding from esophageal and gastric varices (EGV).Methods The clinical data of 102 patients with liver cirrhosis accompanied by rupture of EGV who were admitted to the Third People’s Hospital of Zigong City from July 2015 to July 2020 and treated with TIPS within 72h were retrospectively analyzed. The patients were followed-up for 6 months. They were divided into 42 cases of hepatic encephalopathy (HE) group and 60 cases of non-hepatic encephalopathy (non-HE) group according to whether they occurred HE after operation. The baseline data and biochemical indicators of patients before TIPS surgery were collected and compared, followed by univariate and multivariate Logistic regression analysis for the risk factors of HE after TIPS.Results There were a total of 102 subjects enrolled in this study. Within them, 42 occurred HE, with 20 cases (47.62%) of grade 0~1, 11 cases of grade 2 (26.19%), 7 cases of grade 3 (16.675), and 5 cases of grade 4 (11.90%). The Results of univariate analysis showed that coagulation time, MELD score and HVPG in patients with EGV hemorrhage were associated with HE after TIPS (P<0.05). Multivariate logistic regression analysis showed that MELD score (OR=3.50, 95%CI: 1.70～7.10), HVPG (OR=3.90, 95%CI: 1.58～9.67) were independent risk factors for HE after TIPS operation in patients with ruptured EGV (P<0.05).Conclusion The incidence of HE after emergency TIPS is higher in patients with EGV bleeding. Among them, MELD score and HVPG are independent risk factors for HE after TIPS. Therefore, preoperative MELD score and HVPG can predict the risk of postoperative HE.
    The prognostic value of PALBI in combination with AMIS65 scoring system in liver cirrhotic patients with acute upper gastrointestinal bleeding
    DONG Qi-gang, XU Jun
    2022, 27(6):  662-667. 
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    Objective To explore the prognostic value of PALBI combined with AMIS65 scoring system in cirrhotic patients with acute upper gastrointestinal bleeding.Methods A total of 230 patients with cirrhosis complicated with acute upper gastrointestinal bleeding admitted from September 2017 to March 2021 were selected. According to 30 days’ survival status after admission the patients were divided into a survival group (N=201) and a death group (N=29). Epidemiological data including age and sex, and laboratory examination Results including routine blood test, hepatic and renal function, and coagulation function were collected and compared, The scores of PALBI and AMIS65 on admission were calculated and compared between the two groups. Single factor analysis and logistic regression analysis based on partial maximum likelihood estimation were used to determine the independent influencing factors of prognosis, and the receiver operating characteristic (ROC) curve was used to evaluate the value of individual and combined detection in predicting death.Results Prothrombin time (21.64 ± 2.97 vs 20.12 ± 2.68, t=2.816, P=0.005), total bilirubin (34.76 ± 2.78 vs 26.87 ± 3.02, t=13.277, P<0.001), international standardized ratio (1.55 ± 0.21 vs 1.33 ± 0.38, t=4.649, P<0.001), PALBI score (-1.43 ± 0.31 vs -1.94 ± 0.26, t = 9.629, P<0.001) and AMIS65 scores (3.45 ± 0.58 vs 2.09 ± 0.41, t=12.195, P<0.001) in the death group were significantly higher than those of the survival group. Albumin (27.54 ± 6.01 vs 31.98 ± 5.01, t=4.346, P<0.001) and platelet count (71.99 ± 18.23 vs 83.56 ± 24.25,t=1.829, P=0.049) and Child-Pugh grade A ratio (3.45% vs 33.83%, χ2 = 26.117, P<0.001) in the death group were significantly lower than those in the survival group. Logistic regression analysis showed that PALBI score (OR=1.597, 95%CI: 1.597~2.449) and AMIS65 score (OR=2.162, 95%CI: 1.499~3.357) were independent factors affecting the prognosis of acute upper digestive tract bleeding in cirrhosis, and the equation was logit (P)=-0.541+0.682XPALBI score +0.771XAMIS65 score. ROC curve analysis showed that PALBI score alone predicted the optimal critical value was -1.69 score, with a corresponding sensitivity of 79.31%, specificity of 80.60%, and AUC of 0.801 (95%CI: 0.750~0.852). The predictive optimal critical value of AMIS65 score alone was 2.73 score, with a corresponding sensitivity of 65.52%, specificity of 62.69%, and AUC of 0.760 (95%CI: 0.707~0.812). The sensitivity, specificity and AUC corresponding to the optimal truncation value of regression combined detection were 96.55%, 95.52% and 0.975 (95%CI: 0.924~0.986) respectively, and the sensitivity, specificity and AUC of combined prediction were significantly higher than those of PALBI score and AMIS65 score alone (P<0.05), which showed certain predictive value.Conclusion PALBI score and AMIS65 score were independent factors affecting the prognosis of acute upper digestive tract in cirrhosis, and regression analysis combined with detection had higher predictive value.
    Differential analysis of clinical manifestation and prognosis between simple cirrhosis and cirrhosis with hepatogenic diabetes
    LI Shuang-qi, MENG Lian-xin, WEI Su-yu, WANG Xi-sheng, JI Hong-yun, WU Na
    2022, 27(6):  668-671. 
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    Objective To compare the clinical manifestations and prognosis of liver cirrhosis patients with simple cirrhosis and those with hepatogenic diabetes (HD), to explore the influence of blood glucose level on the prognosis of the disease, and to summarize the experience of treatment and nursing.Methods The clinical data of 82 patients with hepatic cirrhosis from January 2019 to January 2020 were analyzed retrospectively. Within them, patients with simple cirrhosis were grouped as the control group, and patients combined with hepatogenic diabetes (HD) cirrhosis were grouped as the observation group. They were compared with the differences in sex, age of admission, length of hospital-stay, course of disease, liver function classification, body mass index (BMI) and laboratory indexes, and analyzed the differences in the occurrence of complications, mortality rate and readmission rate after discharge. Logistic regression analysis was applied to identify the risk factors of hepatogenic diabetes mellitus and its adverse clinical manifestations.Results There were significant differences between the admission age, length of stay, course of disease and distribution of liver function of patients with simple cirrhosis and those with HD cirrhosis (P<0.05). There was no significant difference between the two groups in sex, etiology, BMI, hypersensitive-C-reactive protein (hs-CRP), Low-density lipoprotein and other clinical indexes (P>0.05). The follow-up time was 1 year and no death happened in both groups. There was 1 re-hospitalized case in control Group and 8 re-hospitalized cases in HD Group. The incidence of pulmonary infection in HD Group (35%) was significantly higher than that in control group (14.28%) (P<0.05). There was no significant difference between these two groups in the incidence of other complications (P>0.05). The Results of Logistic regression analysis showed that the course of disease and Child-Pugh grade C were risk factors of HD complication in liver cirrhosis (P<0.05).Conclusion There were significant differences in admission age, length of stay, course of disease and liver function between simple cirrhosis group and cirrhosis with HD group, the course of disease and the liver function of Child Pugh grade C were risk factors of liver cirrhosis complicated with hepatogenic diabetes. Cirrhotic patients with HD had higher risk of adverse clinical manifestations than those without.
    Liver Failure
    Incidence, risk factors and clinical prognosis of upper gastrointestinal hemorrhage in patients with acute-on-chronic liver failure
    ZHANG Xia, ZHAO Zi-yu, LI Min
    2022, 27(6):  672-674. 
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    Objective To analyze the incidence, risk factors and clinical outcome of upper gastrointestinal bleeding (UGH) in patients with acute-on-chronic liver failure (ACLF), so as to understand the mechanism of the disease and provide guidance for early clinical intervention.Methods From February 2016 to February 2021, there were 312 patients with ACLF (190 males and 122 females) were enrolled in this study with an average age of (54.1±11.0) years. According to the appearance of UGH, they were divided into UGH group (n=117, 37.5%) and non-UGH group (n=195). UGH is defined as hematemesis, black stool or UGH observed under electronic gastroscope. T-test and Chi-square test was used for statistical comparison according to the types of data; Multivariate analysis was applied to explore the independent risk factors of UGH in ACLF patients. The survival rate was compared by Log-Rank test.Results Fifty-two cases (44.4%) in UGH group and 14 cases (7.2%) in non-UGH group has previous UGH history (P<0.05). Twelve cases (10.2%) in UGH group and 5 cases (2.6%) in non-UGH group had infection (P<0.05). Fifty-six cases (47.8%) in UGH group and 47 cases (24.1%) in non-UGH group had ascites (P<0.05). Six cases (5.1%) in UGH group and 7 cases (3.6%) in non-UGH group had hepatic encephalopathy (P<0.05). The MELD scores of UGH group and non-UGH group were (19.0±6.5) points and (11.6±5.3) points, respectively, with statistically significant difference (P<0.05). The levels of hemoglobin (Hb), total bilirubin (TBil), alanine aminotransferase (ALT), Aspartate aminotransferase (AST), international normalized ratio (INR) and serum sodium in UGH group were (84.8±13.4) g/L, (52.3±9.8) μmol/L, (82.5±17.0) U/L, (73.3±15.2) U/L, (1.4±0.2) and (132.2±6.6) mmol/L, respectively, which were significantly different when compared with those of [(106.4±16.1) g/L, (24.5±5.6) μmol/L, (58.4±11.6) U/L, (46.2±8.9) U/L, (1.0±0.2) and (140.6±7.6) mmol/L, respectively, in non-UGH group (P<0.05). The above-mentioned difference data were then taken as independent variables for multivariate analysis for the risk factors of UGH in ACLF patients. The Results suggested that previous UGH history, MELD score and INR were independent predictors of bleeding in HBV-ACLF patients (P<0.05). All patients were followed up for 3 months, and the endpoint was ACLF-related death. The 28-day and 90-day survival rates of UGH group (66.7% and 40.2%) were significantly lower than those of non-UGH group (87.7% and 77.9%) (all P<0.05).Conclusion The clinical prognosis of ACLF patients complicated with UGH is poor. In clinical practice, attention should be paid to patient’s with past UGH history and poor coagulation state. Early clinical intervention should be taken to avoid the occurrence of UGH.
    Clinical features and prognostic analysis of pulmonary infection in patients with acute-on-chronic liver failure
    DONG Jie, SUN Meng-ying, ZHOU Xiao-lei, YANG Qing
    2022, 27(6):  675-678. 
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    Objective To analyze the clinical characteristics and prognostic factors of HBV-related chronic acute liver failure patients with lung infection.Methods A total of 75 HBV-related chronic acute liver failure (HBV-ACLF) patients who were admitted to our hospital from March 2018 to January 2019 were selected and divided into the lung infection group (lung infection, LI) according to whether they had pulmonary infection. ) 37 cases in the group and 38 cases in the no lung infection (NLI) group. Collect and analyze the complications of the two groups of patients, check the six biochemical indicators of cholesterol, serum sodium, alpha-fetoprotein, albumin, PTA, and C-reactive protein in the two groups, use the Child-Pugh score to assess the prognosis of the patients, and analyze the two The correlation between biochemical indicators and prognosis of patients in the group.Results Compared with the NLI group, the incidence of coagulation dysfunction, upper gastrointestinal hemorrhage, hepatic encephalopathy, and hepatorenal syndrome in the LI group increased significantly, and the difference was statistically significant (P<0.05), while the incidence of ascites was higher There is no statistical difference. Serum biochemical index Results showed that compared with patients without lung infection, the expression levels of serum cholesterol, serum sodium, alpha-fetoprotein, albumin, and PTA in patients with lung infection decreased, while CRP and PCT were significantly increased. The difference was statistically significant (P<0.05). The Child-Pugh score Results showed that the average Child-Pugh score of the non-pulmonary infection group was 5.3±0.43 points, and the score of the combined lung infection group was 8.6±3.3 points. There was a significant difference between the two (P<0.01). The Results of Spearman correlation analysis showed that Child-Pugh score was positively correlated with CRP and PCT content, and the correlation was statistically significant (P<0.0001). Child-Pugh scores are negatively correlated with cholesterol, serum sodium, alpha-fetoprotein, albumin and PTA, and the correlations are statistically significant (cholesterol P<0.05, serum sodium, alpha-fetoprotein, albumin and PTAP<0.0001).Conclusion Pulmonary infection in patients with chronic acute liver failure can aggravate the symptoms and affect the prognosis of the patients. The expression of cholesterol, serum sodium, serum albumin, C-reactive protein, PTA, alpha-fetoprotein and PCT may affect the combination of HBV-ACLF An important factor for the prognosis of patients with lung infection.
    Drug-Induced Liver Injury
    Clinical characteristics and outcome of patients with chronic drug-induced liver injury
    CHEN Hong, ZHAO Sha-sha, YANG Wan-jun
    2022, 27(6):  679-682. 
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    Objective To analyze the clinical characteristics of patients with chronic drug-induced liver injury (DILI) and to explore the impact of these clinical characteristics on the outcome of the disease.Methods 340 cases of chronic DILI patients from March 2018 to March 2021 in our hospital were selected. After treatment for 6 months, the patients were divided into poor prognosis group (n=102) and good prognosis group (n=38). The basic data, clinicopathological data and related indexes of liver function were compared between the two groups. The median values of ALT, AST, Alb, TBil and DBil were taken as the cut-off values, and the risk factors were analyzed by logistic regression.Results In 340 patients, there were more than a dozen different kinds of drugs causing chronic DILI, among which traditional Chinese medicine accounted for 31.18%, antipyretic and analgesic drugs accounted for 12.35%, antitumor drugs accounted for 11.76%, antibiotics accounted for 9.41%, followed by hormones, cardiovascular medication, health care products. In the poor prognosis group, age ≥ 60 years old, and the proportions of patients with cholestasis or mixed type were 57.84% and 63.74%, which were significantly higher than 41.60% and 37.82% in the good prognosis group. The levels of ALT, AST, ALP, TBil, DBil and GGT in the poor prognosis group were (524.58 ± 89.53) U/L, (408.45 ± 89.56) U/L, (192.42 ± 78.45) U/L, (43.25 ± 12.64) μmol/L, (32.58 ± 12.41) μmol/L, (148.52 ± 51.44) U/L, which in the good prognosis group were (329.75 ± 87.55) U/L, (272.41 ± 78.48) U/L, (176.52 ± 69.86) U/L, (32.15 ± 14.15) μmol/L, (28.47 ± 8.97) μmol/L, (139.45 ± 42.52) U/L, respectively. The levels of ALT, AST, TBil and DBil in the poor prognosis group were significantly higher than those in the good prognosis group. Alb level was (45.15 ± 15.42) g/L in the poor prognosis group, which was significantly lower than that in the good prognosis group (59.86 ± 17.45) g/L (P<0.05). Logistic analysis showed that Age ≥ 60 years, non-hepatocellular type, ALT≥435.40 U/L, AST≥325.24 U/L, Alb≤52.15 g/L, TBil≥38.53 μmol/L, DBil≥29.14 μmol/L were risk factors for poor prognosis of chronic DILI.Conclusion There are many drugs causing chronic DILI, and age, types of liver injury and liver biochemical indexes have a great relationship with the outcome of patients with chronic DILI. Patients’ liver function indexes should be closely monitored and intervention in time should be carried out to control the occurrence and development of DILI while using drugs prone to cause chronic DILI.
    Analysis of clinical characteristics of 170 patients with drug-induced liver injury
    ZHAO Jiao, XIAO Li
    2022, 27(6):  683-687. 
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    Objective To analyze the clinical characteristics of patients with drug-induced liver injury (DILI).Methods The clinical data of 170 DILI patients admitted to Taizhou People's Hospital from July 2015 to July 2020 were retrospectively analyzed. Multivariate logistic regression, Kruskal-Wallis H test and ROC-AUC were used to analyze the data.Results The age of 170 patients was (46.69±13.53) years old, of which 125 were female (73.5%). The top three suspicious drugs: 102 cases (60.0%) of Chinese herbal medicines (Polygonum multiflorum, Tripterygium wilfordii, Sedum tatarinowii, Panax notoginseng, Houttuynia cordata, Dandelion, Black bone vine, Leprosy grass, etc.) and dietary supplements (weight loss meal replacement agents, enzymes, vitamin complexes, weight loss agent), 28 cases (16.5%) of antibacterial drugs, and 14 cases (8.2%) of non-steroidal anti-inflammatory drugs. There were 118 cases (69.41%) of hepatocellular type, 29 cases (17.06%) of cholestatic type, and 23 cases (13.53%) of mixed injury type. A total of 18 patients underwent liver biopsy, and pathology basically were consistent with DILI diagnosis, but the consistency between the clinical types and pathological types was not ideal (K value=0.04<0.4). Age≥40 years old (P=0.025; OR=2.731; 95%CI: 1.134, 6.576), drinking (P=0.003; OR=5.348; 95%CI: 1.786, 16.234) and diabetes (P=0.01; OR=8.848; 95%CI: 1.699, 46.073) are independent risk factors for DILI. Two patients who took Sedum tatarinowii capsules for more than 1 month died.Conclusion DILI patients are mostly 41-60 years old and women. Chinese herbal medicine and dietary supplements are the main pathogenic factors of DILI. Hepatocellular type is the main clinical type of DILI. Liver biopsy is helpful for diagnosis, but it is not a necessary diagnostic method for DILI. Most patients have a good prognosis.
    Other Liver Diseases
    Intervention effect of isocalorie low carbohydrate high protein diet on nonalcoholic fatty liver disease
    WU Xiao-xi, WANG Tao, DU Sheng-nan, GAO Jing-jing, JIANG Yuan-ye, CAO Qin
    2022, 27(6):  688-692. 
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    Objective Ultra performance liquid chromatography tandem high resolution mass spectrometry (UPLC-Q-Orbitrap/MS) was used to explore the changes of serum metabolic markers in patients with NAFLD after 4 weeks of isocalorie low carbohydrate and high protein diet intervention. The purpose was to find more suitable dietary recommendations for NAFLD patients in China.Methods 23 patients with NAFLD from January 2019 to January 2020 in our hospital were selected as the research objects. They were intervened with isocalorie low carbohydrate and high protein diet for 4 weeks. Before and after the intervention, the serum biochemical and blood lipid of patients were detected routinely, and the metabonomics was conducted. The changes of serum metabolic markers before and after the intervention were analyzed.Results After 4 weeks of low-carbon diet intervention, the weight, BMI and waist circumference of the enrolled patients were significantly reduced compared with the previous, [74.00(70.75-80.00) kg vs 72.50(69.50-78.25) kg, Z=-3.083, P=0.002; 25.63(24.40-26.17) kg/m2 vs 24.87(24.27-26.15) kg/m2, Z=-3.389, P=0.001; 100.00(91.50-104.00) cm vs 98.00(94.50-100.00) cm, Z=-2.560, P= 0.010]. In terms of serum biochemistry, the patients’ ALT level were significantly lower than before [42.00(30.00-77.50) U/L vs 22.00(14.50-44.00) U/L, Z=-2.875, P=0.004], AKP, AST, GGT were decreased [87.00(81.00-99.50) U/L vs 78.00(61.00-96.00) U/L, Z=-2.282, P=0.023; 30.00(19.00-45.50) U/L vs 22.00(19.00-29.00) U/ L, Z=-2.273, P=0.023; 35.00(29.50-55.00) U/L vs 29.00(22.00-44.50) U/L, Z=-2.374, P=0.018]. In addition, the patients’ TC and GLU levels were significantly decreased (5.01±1.38 mmol/L vs 3.03±1.56 mmol/L, t=5.002, P=0.000; 5.40 (5.10-5.50) mmol/L vs 4.50 (4.20-4.80) mmol/L, Z=-3.788, P=0.000]. Serum metabonomics analysis found that the serum samples before and after the intervention could be completely separated, with significant differences. At the same time, 67 potential biomarkers were found, of which amino acid and phospholipid metabolism were the main ones.Conclusion In this study, the isocaloric low carbohydrate high protein diet can significantly reduce the body weight, BMI and waist circumference of patients with NAFLD, also improve the liver function, blood lipid and blood glucose of patients, and further through metabonomics, we find that the diet mainly affects the metabolism of amino acids and phospholipids.
    Expression of osteopontin in different pathological stages of primary biliary cholangitis
    WANG Yan-kun, MA Jun-ji
    2022, 27(6):  693-697. 
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    Objective To detect the expression of osteopontin (OPN) in liver tissues at different pathological stages of primary biliary cholangitis (PBC), and to explore the role of OPN in the PBC progression.Methods A retrospective analysis of the liver pathology of the Department of Pathology, Beijing You’an Hospital, Capital Medical University, from December 2013 to January 2020. HE, Masson and Gomori silver staining were combined to evaluate the pathological changes and fibrosis of PBC liver at different pathological stages. CK19, CK7 and OPN antibodies were used to study bile duct injury and OPN expression in PBC liver tissue. Nonparametric Spearman correlation was used to analyze the correlation between PBC pathological stage and OPN pathological score.Results A total of 70 PBC cases were included. The serum anti-mitochondrial antibody (AMA) was positive, including 10 males (14.29%), with an average age of (53 ± 9) years and 60 females (85.71%) , the average age was (51 ± 11) years old, and the ratio of female to male was 6:1. The patients with PBC pathological stages 1-4 were 18, 17, 18 and 17 respectively, and the average ages were (48 ± 12) years old, (48 ± 12) years old, (53 ± 9) years old and (56 ± 7) years old respectively. Compared with the average age of patients with PBC stage 1, the patients with stage 4 were older (P=0.026). With the progression of PBC, hepatic fibrosis and bile duct injury gradually aggravated. Compared with PBC pathological stage 1 (χ2=12.586, P<0.001) and stage 2 (χ2=21.394, P<0.001) and stage 4 (χ2=4.972, P=0.026), the rate of strong expression of OPN immunohistochemical score increased significantly in PBC pathological stage 3 (83.33%). OPN positive cells could be seen occasionally in stage 1 PBC portal area, but different from stage 1 PBC, the number of OPN positive cells in stage 2 to 4 PBC liver portal area increased significantly. Nonparametric Spearman correlation analysis showed that there was a certain correlation between PBC pathological stage and OPN pathological score (r=0.396, P=0.001).Conclusion After PBC developes into hepatic fibrosis, the expression of OPN in liver tissue increases significantly, and the high expression rate of OPN decreases after liver cirrhosis. The high expression of OPN not only indicates the aggravation of bile duct immune injury load, but also indicates the strong ability of liver tissue proliferation. The close combination of OPN and PBC pathological stage has important clinical value for evaluating the severity of the disease and predicting the prognosis of patients.
    Differentiation ratio of peripheral blood T cells in patients with primary biliary cirrhosis complicated with systemic lupus erythematosus and its clinical significance
    ZHOU Yan-yan
    2022, 27(6):  698-702. 
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    Objective To investigate the differentiation ratio of peripheral blood T cells in patients with primary biliary cirrhosis (PBC) complicated with systemic lupus erythematosus (SLE) and its clinical significance.Methods Sixty patients with PBC complicated with SLE treated in our hospital from January 2018 to January 2021 were selected as the case group. In addition, healthy people who came to our hospital for physical examination in the same period were selected as the control group. The expression of T lymphocyte subsets in peripheral blood, mRNA expression of related inflammatory cytokines and secretion of Th1, Th2, Th17 cytokines in serum were compared between the two groups.Results The ratio of CD3+, CD4+, CD8+, CD16+, CD56+, Treg and CD4+/CD8+ in the case group were significantly lower than those in the control group [(67.84±9.56)% VS (74.85±8.95)%, (34.92±5.83)% VS (43.18±5.25)%, (18.39±1.58)% VS (21.83±1.24)%, (17.26±1.85)% VS (20.39±2.84)%, (3.15±1.23)% VS (4.82±1.42)%, (1.32±0.21)% VS (1.93±0.24)%, respectively, all P<0.05], and CD8+ was higher than that in the control group [(29.75±3.95)% VS (26.82±4.17)%, P<0.05]. The mRNA expressions of interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-17A (IL-17A) and interleukin-22 (IL-22) in the control group were higher than those in the control group [(0.637±0.014) VS (0.575±0.023), (0.735±0.133) VS (0.641±0.037), (0.952±0.007) VS (0.631±0.005), (0.634±0.025) VS (0.593±0.036), (0.753±0.038) VS (0.522±0.023), (0.722±0.026) VS (0.512±0.041), (0.683±0.047) VS (0.573±0.045), (0.933±0.019) VS (0.566±0.012), respectively], the difference was statistically significant (all P<0.05). The secretion levels of Th1 (IFN-γ, TNF-α, IL-2), Th2 (IL-4, IL-6, IL-10) and Th17 (IL-17A, IL-22) cytokines in the case group were significantly higher than those in the control group (P<0.05).Conclusion There are significant differences in peripheral blood T cell subsets between patients with PBC complicated with SLE and healthy subjects. There are different degrees of abnormal cellular immune regulation and immune dysfunction.
    The clinical efficacy of ursodeoxycholic acid in the treatment of infantile cholestatic hepatitis and its influence on serum inflammation indicators and intestinal flora
    LIU Xi, LIAO Shan, LIU Xiao-guai
    2022, 27(6):  703-707. 
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    Objective To explore the clinical value of ursodeoxycholic acid (UDCA) in infantile cholestatic hepatitis (ICH).Methods 186 infants with ICH were selected as observation objects and grouped by random number table method. The control group (93 cases) took oral preparations of live bifidobacteria, and the observation group (93 cases) took UDCA on the basis of the control group, for 2 weeks of treatment. The indicator changes of serum inflammation factors [Interleukin-4 (IL-4), IL-6, IL-10 and tumor necrosis factor-α (TNF-α)], liver function [alkaline plum phosphate (ALP), total bilirubin (TBil), alanine aminotransferase (ALT) and γ-glutamyl transpeptidase (GGT)], immunoregulatory factors and bile acid indicators [soluble vascular cell adhesive molecule-1 (sVCAM-1), conjugated bile acid (CBA) and cholyglycine (CG)], intestinal flora [Lactobacillus, Bifidobacteria, Escherichia coli, and the ratio of Bifidobacteria to Enterobacteria (B/E) value)] before and 2 weeks after the medication were observed, and clinical efficacy and safety were assessed.Results The expression levels of serum IL-4 and IL-10 increased, and the expression levels of IL-6 and TNF-α decreased (P<0.05) after 2 weeks of treatment. And the levels of IL-4 and IL-10 in the observation group were significantly higher than those in the control group (P<0.05), the levels of IL-6 and TNF-α in the observation group were significantly lower than those in the control group (P<0.05). The levels of ALP, ALT, TBil, GGT, sVCAM-1, CBA, and GG in the two groups of infants were reduced after 2 weeks (P<0.05), and the levels of ALP, ALT, TBil, GGT, sVCAM-1, CBA and GG in the observation group were significantly lower than those in the control group (P<0.05). The numbers of Bifidobacteria, Lactobacillus and B/E value increased in the two groups after two weeks of medication, and the numbers of Bifidobacteria, Lactobacillus and B/E value in the observation group were significantly higher than those of the control group (P<0.05). The numbers of Escherichia coli (E. coli) in the two groups after two weeks of medication decreased (P<0.05), but there was no significant change in the numbers of E. coli in the observation group compared with the control group after 2 weeks of treatment (P>0.05). The total effective rate of treatment in the observation group was 94.62%, which was significantly higher than 86.02% in the control group (χ2=4.230, P<0.05). The adverse reaction rate of the observation group was 6.45%, compared with 5.38% of the control group, there was no significant difference (χ2=0.103, P>0.05).Conclusion UDCA has outstanding efficacy in treating ICH, which can inhibit inflammation, promote the recovery of intestinal flora, and improve liver function. Its mechanism may be related to the regulation of sVCAM-1 and bile acid indicators, and it is safe to use.