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Table of Content

    31 October 2022, Volume 27 Issue 10
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    Liver Cancer
    Therapeutic effect of Cyberknife in the treatment for abdominal lymph node metastases of primary hepatocellular carcinoma
    XIAO Chong-juan, ZHANG Tao, SUN Jing, FAN Yu-ze, DUAN Xue-zhang, HE Wei-ping
    2022, 27(10):  1069-1072. 
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    Objective To investigate the effect and safety of CyberKnife stereotactic radiotherapy in the treatment for abdominal lymph node metastases of primary hepatocellular carcinoma (PHCC). Methods Thirty-seven patients with abdominal lymph node metastases of PHCC who underwent CyberKnife radiotherapy in our hospital from January 2015 to September 2017 were enrolled. The total dose of CyberKnife radiotherapy ranged from 40Gy to 63Gy. The single dose ranged from 5Gy to 10Gy, divided into 4-10 fractions. Short-term therapeutic effect was assessed by Modified Response Evaluation Criteria in Solid Tumors. Long-term therapeutic effect was assessed by 1, 2, and 3-year overall survival rates and local control rates. The Kaplan-Meier method was used to calculate cumulative survival rate and local control rate. The log-rank test was used for the comparison of overall survival time between groups. Results The patients were followed up for 2-58 months, with an average of 14 months. Among all 37 patients, 8 (21.62%) achieved complete remission, 24 (64.86%) achieved partial remission, 4 (10.81%) achieved a stable condition, and 1 (2.70%) experienced disease progression. The effective rate was 86.48%, and the disease control rate was 97.29%. The 1, 2 and 3-year overall survival rates were 61.8%, 39.4% and 22.1%, respectively; The 1, 2 and 3- year local control rates were 86.0%, 80.3% and 63.1%, respectively; The median overall survival time was 16.0 months (range from 2 to 58 months). Among the 19 patients with abdominal pain or lower back pain, 12 (63.2%) achieved alleviation of pain symptoms after 3 times of treatment, 14 (73.7%) achieved complete remission at the end of treatment. Survival rate of patients with a total dose of ≥45 Gy treated with CyberKnife radiotherapy was significantly higher than that of patients with a total dose of <45 Gy, and there was significant difference between the 2 groups (P=0.000). The survival rate of patients without pain symptoms was significantly higher than that of patients with pain symptoms, and the difference was statistically significant (P=0.004). The incidence of gastrointestinal toxicities in Grade I and Ⅱ were 13.5％(5／37), no case appeared Grade III or above adverse events. Conclusion CyberKnife is safe and effective in the treatment of abdominal lymph node metastases of PHCC. CyberKnife stereotactic radiotherapy can effectively improve the survival rate and the local control rate, with less adverse reaction.
    CT in the diagnosis of primary clear cell carcinoma of the liver
    LU Li-jun, GUO Jian-wei, CHEN Jing-xin, ZHANG Ming
    2022, 27(10):  1073-1075. 
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    Objective To investigate the spiral computed tomography (CT) imaging features of primary clear cell carcinoma of liver (PCCCL). Methods The clinical and CT imaging data of 7 patients with PCCCL confirmed by pathology were collected and retrospectively analyzed. All the 7 cases underwent plain and dynamic enhanced CT scan. Results All the 7 cases of PCCCL were single lesions. Among them, 6 lesions located in the right lobe of liver, 1 lesion located in left lobe of liver. The diameter of tumor ranged from4 to 14 cm, with an average of 5.3 cm. Uneven low density and necrosis could be observed in 7 cases, and 2 cases with lipogenesis. There were 5 cases with clear boundary and pseudo-capsule, 2 cases with unclear boundary. Dynamic contrast-enhanced CT scans showed nonuniform enhancement in 7 cases. Enhancement in arterial phase and low density in venous phase were observed in 3 cases. Slight enhancement in arterial phase and continuous enhancement presented high density in venous phase were observed in 2 cases. The imaging of 2 cases showed nodular marked enhancement in arterial phase, progressive enhancement in venous phase and delayed phase, the extent of nodular enhancement gradually expanded. Conclusion There are some certain features in plain CT scan imaging of PCCCL, and the untypical enhancement features are related to the proportion of clear cell in the tumor. The characteristics of CT is valuable for the accurate diagnosis of PCCCL.
    CT features of microvascular invasion and recurrence of small hepatocellular carcinoma under the background of liver cirrhosis
    CHEN Xiao-ping, HU Wei-jie, WANG Ting-ting
    2022, 27(10):  1076-1079. 
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    Objective To investigate the computed tomography (CT) manifestations of microvascular invasion (MVI) and recurrence of small hepatocellular carcinoma (sHCC) under the background of liver cirrhosis. Methods Seventy-two patients with sHCC and cirrhosis admitted to our hospital from June 2015 to June 2018 were selected as the research objects. Patients were divided into a MVI group (n=32) and a non-MVI group (n=40) according to the presence of MVI. All objects were followed up for 3 years after operation, and were divided into a recurrence group (n=19) and a non-recurrence group (n=53) according to the recurrence of sHCC. CT examination was performed before surgery. The results of CT examination between MVI group and non-MVI group were compared. The results of CT examination between recurrence group and non-recurrence group were also compared. Results The proportions of patients with complete capsule, defective capsule and no envelop in MVI group were 28.13%, 46.86% and 25.00%, respectively, while those in non-MVI group were 62.50%, 27.50% and 10.00%, respectively. The differences between the 2 groups were statistically significant (P<0.05). The proportions of patients with enhanced and smooth tumor margins were 78.13%, 34.38% in MVI group, and 42.50%, 77.50% in non-MVI group, respectively. The differences between the 2 groups were statistically significant (P<0.05). The proportions of complete capsule, defective capsule and no envelop in the recurrence group were 21.43%, 46.43% and 32.14%, and those in the non-recurrence group were 63.64%, 29.55% and 6.82%. The differences between the 2 groups were statistically significant (P<0.05). The proportions of patients with enhanced and smooth tumor margins were 92.86%, 32.14% in the recurrence group, and 36.36%, 75.00% in the non-recurrence group, respectively. The differences between the 2 groups were statistically significant (P<0.05). Conclusion Preoperative CT examination has high predictive value for MVI and recurrence of sHCC in patients with cirrhosis.
    The therapeutic effect of carrelizumab or sintilimab combined with lenvatinib in the treatment of liver cancer and the influence on tumor markers
    YANG Jian-qi, CAO Wen-miao, WU Yin-xia, YIN Ting, XING En-ming
    2022, 27(10):  1080-1083. 
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    Objective To investigate the therapeutic effect of carrelizumab or sintilimab combined with lenvatinib in the treatment of liver cancer and its influence on tumor markers. Methods Ninety-five patients with primary liver cancer admitted to our hospital from June 2018 to June 2021 were selected as the research objects. According to the treatment method, the patients were divided into lenvatinib group (lenvatinib, 33 cases), carrelizumab group (carrelizumab combined with lenvatinib, 30 cases), and sintilimab group (sintilimab combined with lenvatinib, 32 cases). The clinical therapeutic efficacy, side effects, liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil)] and tumor markers [alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), α-L-fucosidase (AFU), carbohydrate antigen 199 (CA199)] among the 3 groups after treatment were compared. Results The clinical efficacy of carrelizumab group and sintilimab group were significantly higher than lenvatinib group (P<0.05). The levels of ALT, AST and TBil in the 3 groups were all significantly decreased after treatment, the liver function of carrelizumab group and sintilimab group were significantly lower than lenvatinib group (P<0.05). The levels of AFP, CEA, AFU, and CA199 in the 3 groups were significantly decreased after treatment, the tumor markers levels of carrelizumab group and sintilimab group were significantly lower than lenvatinib group (P<0.05). There was no significant difference in side effects among the 3 groups (P>0.05). Conclusion Carrelizumab or sintilimab combined with lenvatinib in the treatment of liver cancer can effectively improve the therapeutic efficacy and liver function, reduce the levels of tumor markers, with good safety.
    Contrast-enhanced ultrasound in predicting complete remission of hepatocellular carcinoma after transcatheter arterial chemoembolization
    GAO Xin-xuan, ZHEN Yan-hua, LI Hui-xia
    2022, 27(10):  1084-1087. 
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    Objective To investigate contrast-enhanced ultrasound (CEUS) in predicting the clinical remission of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods A total of 46 patients (40 males and 6 females) who underwent CEUS after TACE from June 2019 to July 2021 were enrolled, with an average of 56 (41, 68) years. The efficacy of TACE was recorded according to the evaluation criteria of efficacy (RECIST), in which no blood flow or enhancement signal in the focus was defined as complete remission (CR), and the rest were non-CR. The general data of CR and non-CR cases were compared. The risk factors affecting the remission of lesions after TACE in HCC patients were analyzed, and evaluate the diagnostic value of CEUS. Results A total of 46 lesions were observed in 46 HCC cases, including 16 cases of CR (CR group) and 30 cases of non-CR (non-CR group). The tumor diameter of CR group was 2.5 (1.5, 4.0) cm, which was significantly smaller than that of non-CR group [4.5 (3.0, 6.5) cm, Z=11.028, P<0.05]. The proportions of arterial phase enhancement and annular enhancement in CR group were 7 cases (43.8%) and 2 cases (12.5%), which were significantly different from those in non-CR group [26 cases (86.7%) and 17 cases (56.7%)], the differences were statistically significant (χ2=-9.480, χ2=-8.496, P<0.05). The thickness of annular enhancement in CR group was 0.0 (0.0,0.0) cm, which was significantly lower than that in non-CR group [0.3 (0.0, 0.7) cm, Z=-9.004, P<0.05]. Tumor diameter, arterial enhancement, annular enhancement and annular enhancement thickness were taken as independent variables, remission of HCC patients after TACE treatment was taken as dependent variable (assigned 0 = CR, 1= no CR). The results of logistic regression indicated that tumor diameter, annular enhancement and annular enhancement thickness were independent predictors for incomplete remission in HCC patients after TACE treatment (P<0.05). Taking the results of digital subtraction angiography (DSA) or liver biopsy as the gold standard, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS in diagnosing CR were 81.2% (13/16), 93.3% (28/30), 89.1% (41/46) and 86.7% (13/15), respectively. Conclusion CEUS can be used to predict the CR of HCC patients after TACE. Tumor diameter, annular enhancement and annular enhancement thickness are independent risk factors.
    The value of preoperative ultrasonic microflow grading in predicting microvascular invasion of hepatocellular carcinoma
    MA Guo-jie, FANG Jing-jing, YANG Xian-kui, HE Xiao
    2022, 27(10):  1088-1091. 
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    Objective To investigate the value of preoperative ultrasonic microflow grading in predicting microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC). Methods A total of 138 HCC patients were admitted to our hospital between August 2018 and August 2021. They were divided into MVI group (60 cases) and MVI group (78 cases) according to the pathological results. Serum alpha-fetoprotein (AFP) level was detected by immunofluorescence method before surgery. At the same time, ultrasound microflow imaging and contrast imaging were performed to record the tumor size, microflow grade, microflow distribution, tumor edge morphology, peritumor enhancement and other imaging characteristics. The independent predictive factors of MVI were analyzed, and the predictive efficacy of serum AFP level combined with imaging characteristics of MVI was investigated. Results The proportion of serum AFP level ≥400 μg/L in MVI group was 28.3%, which was significantly higher than that of 12.8% in MVI group (P<0.05); The proportions of tumor size >5 cm, grade Ⅲ microflow grade, unsmooth tumor margin and peritumoral enhancement in MVI group were 58.3%, 40.0%, 83.3% and 51.7%, respectively, which were significantly higher than those of 34.6%, 20.5%, 51.3% and 17.9% in MVI group (P<0.05). Serum AFP level, tumor size, micro-blood flow grade, unsmooth tumor margin and peritumoral enhancement were independent predictors of MVI in HCC patients (P<0.05). The area under curve (AUC), sensitivity, specificity and accuracy of serum AFP level combined with imaging features (including tumor size, microflow grading, tumor margin unsmoothness and peritumoral enhancement) in predicting MVI were 0.954, 93.3%, 97.4% and 95.7%, respectively. Conclusion In addition to serum AFP level, unsmooth tumor margin, tumor size and peri-tumor strength, preoperative ultrasonic microflow grade was also an independent predictor of MVI in HCC patients. The prediction efficiency could be further improved by a combination of the above indicators.
    Clinical factors affecting liver failure in patients with HBV related hepatocellular carcinoma after hepatectomy
    ZHAO Zi-yu, WANG Ming-qiang, NIU Yao-fei
    2022, 27(10):  1092-1095. 
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    Objective To analyze the possible risk factors for acute liver failure (ALF) after hepatectomy in patients with hepatitis B virus (HBV) cirrhosis and hepatocellular carcinoma (HCC), and to prevent the occurrence of ALF after liver resection. Methods 61 patients with HCC after HBV cirrhosis in our hospital from June 2019 to June 2021 were selected. The occurrence of postoperative ALF was observed, the general clinical data of patients were recorded, and the possible risk factors were analyzed. Results Among 61 patients with HCC related to HBV cirrhosis, 10 cases with posthepatectomy liver failure (PHLF group), and 51 cases without PHLF (non-PHLF group). The age of PHLF group and non-PHLF group was (58.3 ± 4.9) years and (45.8 ± 5.6) years, and the difference was statistically significant(P<0.05). Child-Pugh grade A, B and C in PHLF group were 3 cases (30.0%), 7 cases (70.0%) and 0(0), while those in non-PHLF group were 36 cases (70.6%), 15 cases (29.4%) and 0(0), the difference was statistically significant(P<0.05). The tumor diameter, intraoperative blood loss and operation time in PHLF group were (9.3 ± 1.9)cm, (1235.89 ± 158.0)mL and (267.15 ± 59.5)min, which were significantly different from those in non-PHLF group [(6.2 ± 1.5)cm and (879.5 ± 105.3)mL and (223.12 ± 39.12)min],the difference was statistically significant(P<0.05). Irregular resection and lobectomy of liver in PHLF group were 3 cases (30.0%) and 7 cases (70.0%), while those in non-PHLF group were 41 cases (80.4%) and 10 cases (19.6%), the difference was statistically significant (P<0.05). Transcatheter arterial chemoembolization (TACE) was found in 1 case (10.0%) and 27 cases (52.9%) in PHLF group and non-PHLF group, and no TACE was found in 9 cases (90.0%) and 24 cases (47.1%) in PHLF group and non-PHLF group, the difference was statistically significant(P<0.05). Whether ALF occurred or not was taken as the dependent variable, and the independent variables were the statistically significant factors in the above univariate analysis. Logistic regression analysis was used. The results showed that age, Child-Pugh grade, tumor diameter, surgical resection range, intraoperative blood loss, intraoperative blood transfusion, preoperative TACE were related to the occurrence of PHLF (P<0.05). Conclusion ALF after hepatectomy in patients with HBV related HCC may be related to age, Child-Pugh grade, tumor diameter, surgical resection range, intraoperative blood loss and intraoperative blood transfusion. Preoperative TACE is a protective factor.
    Liver Fibrosis & Cirrhosis
    An analysis on the correlation between esophageal varices degree and clinical indexes of liver cirrhosis
    LV Ying, JIANG Shi-li, LV Jing, ZHAO Chang-qing, XING Feng, GU Hong-tu, YUAN Ji-li, LIU Cheng-hai, LIU Ping, MU Yong-ping
    2022, 27(10):  1096-1101. 
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    Objective To analyze the relationship between the degree of esophageal varices and laboratory indexes of patients with liver cirrhosis, so as to provide reference for clinical diagnosis and prognosis. Methods The clinical information of 175 patients who were diagnosed with liver cirrhosis and underwent gastroscopy in the department of liver cirrhosis of Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine from June 2016 to February 2018 were collected, The correlation between the degree of esophageal varices and laboratory test indexes of these patients were analyzed. Results (1) Compared with patients without esophageal varices (EV), the levels of red blood cell (RBC), hemoglobin (Hb), platelet (PLT), prealbumin (PA), cholinesterase activity (ChE), prothrombin activity (PTA) and fibrinogen (FIB) in the EV group were significantly decreased (P<0.05 or P<0.01); whereas the iver stiffness was significantly increased (22.95 ± 9.85 vs. 18.22 ± 7.94, t=-2.815, P=0.006). (2) With the increase of the degree of EV, the levels of RBC, Hb, PLT, PA and ChE were significantly different among the four groups that were without varices (G0), mild varices (G1), moderate varices (G2) and severe varices (G3) (P<0.05), and RBC, Hb, PLT, PA, ChE, PTA and FIB in G3 group were reduced significantly than those in G0 group (P<0.05 or P<0.01). Correlation analysis showed that the degrees of EV were negatively correlated with the levels of RBC, Hb, PLT, PA, ChE, PTA and FIB (R2 = 0.8292, R2 = 0.9219, R2 = 0.9312, R2 = 0.5064, R2 = 0.8409, R2 = 0.5547, R2 = 0.8504, respectively). (3) With the increase of the degrees of EV, the liver hardness value and CTP grade increased gradually. There were significant differences among the four groups (P<0.05), and the degrees of EV were positively correlated with the liver hardness values (R2 = 0.9133). Conclusion The degrees of EV in liver cirrhosis are not only related to liver hardness values and CTP scores, but also related to the levels of RBC, Hb, PLT, PA, ChE, PTA and FIB in peripheral blood, which is worthy of clinical attention and -further exploration.
    An analysis on the expression of serum Nrf2 and HO-1 in patients with chronic hepatitis B-related cirrhosis and different degrees of liver injury
    CHEN Ji-de, HE Ying, WANG Peng-sen, LI Jian, FENG Hua-guo
    2022, 27(10):  1102-1105. 
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    Objective To analyze the expression of serum nuclear factor E2 related factor 2 (Nrf2) and heme oxygenase (HO-1) in patients with chronic hepatitis B-related cirrhosis with different degrees of liver injuries. Methods 95 patients with chronic hepatitis B-related cirrhosis treated in the hospital from January 2019 to June 2020 were selected as the research subjects. The degree of liver injury (Child-Pugh grade) of all patients was evaluated at admission and divided into a mild group, a moderate group and a severe group. The patients were then investigated with a designed baseline data questionnaire. The baseline data of patients in these three groups were counted and compared, along with analyses on the association between serum Nrf2, HO-1 and the degrees of liver injuries in the patients. Results Among 95 patients with chronic hepatitis B-related cirrhosis after assessment, 29 were Child-Pugh grade A, 35 were Child-Pugh grade B, and 31 were Child-Pugh grade C. The levels of serum Nrf2 and HO-1 of patients in severe group were lower than those in moderate group and mild group, and the levels of serum Nrf2 and HO-1 of patients in moderate group were lower than those in mild group, the differences were statistically significant (P<0.05). There was no statistic significant difference in the baseline data of patients with chronic hepatitis B-related cirrhosis with different degrees of liver injuries (P>0.05). By Kendall’s tau-b correlation analysis, it was found that the degrees of liver injuries in patients with chronic hepatitis B cirrhosis was negatively correlated with the levels of serum Nrf2 and HO-1 (r<0, P<0.05). The results of multiple logistic regression analysis showed that the abnormal expression of serum Nrf2 and HO-1 may be related to the degrees of liver injuries in chronic hepatitis B cirrhosis (OR<1, P<0.05). Conclusion The abnormal low expression of serum Nrf2 and HO-1 at admission may be related to moderate and severe liver injuries in patients with chronic hepatitis B-related cirrhosis.
    The evaluation of liver stiffness and carotid elasticity by ultrasond in patients with chronic viral hepatitis
    SUN Xiang, ZHAO Xiao-yu, TAN Jie
    2022, 27(10):  1106-1109. 
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    Objective To explore the changes in shear wave velocity (SWV) and carotid elasticity parameters of Ultrosound in patients with chronic viral hepatitis, and analyze their relationship with the degree of liver fibrosis. Methods From January 2020 to February 2022, 117 patients with chronic hepatitis B (CHB group), 57 patients with chronic hepatitis C (CHC group) and 50 age and sex matched healthy people (control group) were enrolled in this study. Acoustic radiation force pulse imaging (ARFI) and carotid ultrasound were performed on the three groups of subjects, and shear wave velocity (SWV), carotid intima-media thickness (CIMT), pulse wave conduction velocity (PWV), dilation coefficient (DC), compliance coefficient (CC), stiffness parameters (α, β) and arterial pressure enhancement index (AIx) were recorded. Blood biochemical indexes, SWV and carotid elasticity parameters were compared among the three groups. Results The glycosylated hemoglobin (HbA1c), Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) in CHB group were (5.5±1.0)%, (46.5±8.5) U/L and (45.2±7.2) U/L, respectively, while those in CHC group were (6.7±1.7)% and (43.2±9.4) U/L. They were significantly higher than those of (5.2±0.5)%, (28.2±5.8) U/L and (23.8±5.7) in the control group U/L(P<0.05). The Alb and HDL in CHB group were (40.8±8.7) g/L and (1.0±0.3) mmol/L, while those in CHC group were (40.8±8.1) g/L and (0.9±0.3) mmol/L, which were significantly lower than those of (43.8±9.2)g/L and(1.2±0.4)mmol/L in the control group (P<0.05). SWV, CIMT, PWV, α, β and AIx in CHB group were (1.84±0.50) m/s, (0.63±0.15)mm, (6.70±1.16) m/s, (4.13±1.61), (8.42±3.15) and (3.08±0.46)%, and in CHC group were (1.86±0.36) m/s, (0.69±0.17)mm, (7.96±1.33) m/s, (5.77±2.22), (11.67±4.22) and (3.03±0.45)%, respectively, which were significantly higher than those of (1.03±0.10) m/s, (0.51±0.11)mm, (6.09±0.76) m/s, (3.03±0.63), (6.18±1.30) and (1.65±0.52)% in the control group (P<0.05). The DC and CC of CHB group were (0.020±0.009) 1/kPa, (1.05±0.34) mm2/kPa, while those of CHC group were (0.017±0.007) 1/kPa and (0.82±0.38) mm2/kPa, which were significantly lower than those of (0.032±0.010) 1/kPa, (1.29±0.20) mm2/kPa in the control group (P<0.05). The number of S0, S1, S2, S3 and S4 patients were 17 cases, 20 cases, 41 cases, 25 cases and 14 cases, respectively. SWV and CIMT in CHB patients with higher degree of liver fibrosis were significantly higher than those with lower degree of liver fibrosis (P<0.05). S0, S1, S2, S3 and S4 in patients with CHC were 11 cases, 12 cases, 11 cases, 14 cases and 9 cases, respectively. SWV and CIMT in patients with high degree of liver fibrosis were significantly higher than those with low degree of liver fibrosis (P<0.05). Conclusion In patients with CHB and CHC, not only the liver hardness increased significantly, but also the carotid elasticity parameters changed. Using ARFI technology and carotid ultrasound to evaluate the degree of liver fibrosis is helpful to monitor cardiovascular events in patients with CHB and CHC.
    Drug-Induced Liver Injury
    An analysis on the clinical characteristics of patients with drug-induced chronic liver failure
    ZHANG Li-li, ZHANG Run-shun, YAO Zi-ang, HU Jian-hua, LV Wen-liang
    2022, 27(10):  1110-1111. 
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    Objective To analysis the clinical and laboratory findings of patients with drug-induced chronic liver failure. Methods The laboratory test results of patients with drug-induced chronic liver failure who were hospitalized in Beijing You'an Hospital Affiliated to Capital Medical University from January 2018 to June 2021 were retrospectively analyzed. Results A total of 12 patients were included, with a male to female ratio of 1:11. All patients (100%) had jaundice, 10 patients (83.33%) had splenomegaly, 9 patients (75%) had ascites, and 4 patients had grade 3 ascites. There were 3 cases of grade 2 ascites and 1 case of hepatic encephalopathy (8.33%). 75% of the patients were accompanied by moderate to severe anemia, and the platelet counts of 12 patients were all below 100×109/L. The prothrombin times of all patients were prolonged by more than 3s, with INR higher than the upper limit of normal reference value. The bilirubin levels were elevated, especially DBil. The patient's ALT, AST, DBil, GGT ALP were (38.92±39.86) U/L, (78.08±73.58) U/L, (101.61±78.73) μmol/L, (37.42±34.28 ) U/L and (110.83±40.42) U/L, respectively. Conclusion The laboratory indicators and clinical characteristics of patients with drug-induced chronic liver failure have their own specialties The more serious the disease presents, and the worse of the prognosis.
    Hepatotoxic pyrrolizidine alkaloid detection accurately diagnosed HPA-HSOS
    SHAO You-lin, XIONG Ai-zhen, ZHANG Suo-cai, WU Jian-ming, MA Chun-ming, GUO Feng-cai, LIU Long-gen
    2022, 27(10):  1112-1115. 
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    Objective To investigate the feasibility of detecting hepatotoxic pyrrolizidine alkaloids (HPA) in patients’ ingestion in the diagnosis of HPA-hepatic sinusoidal obstruction syndrome (HSOS). Methods Clinical datas were collected from 1 patient taking Gynura Segetum Lour and 4 patients taking “Sanqi powder” or “Sanqi wine”. Acquity Ultra Performance LCTM-Micromass ZQ 2000(UPLC-MS) was used to determine the levels of six major hepatotoxic pyrrolizidine alkaloids, including seneciphylline, seneciphylline N-oxide, senecionine, senecionine N-oxide, seneciphyllinine and seneciphyllinine N-oxide. Results ① 4 patients were diagnosed with HPA-HSOS, and 1 patient was excluded from HPA-HSOS. ② HPA was found in roots, stems and leaves of Gynura Segetum, and the content of HPA was root > leaf > stem. Conclusion HPA-HSOS can be accurately diagnosed by detecting HPA in patients’ ingestion.
    Diagnostic value of serum M30 and M65 for liver inflammation in patients with drug-induced liver injury
    KAN Yan-ting, WU Wei-feng, YANG Yong-feng
    2022, 27(10):  1116-1119. 
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    Objective To determine the diagnostic value of serum M30 and M65 for liver inflammation in patients with drug-induced liver injury (DILI). Methods From June 2020 to June 2021, 37 patients with drug-induced liver injury were selected from the First Department of Hepatology, Nanjing Second Hospital. According to the degree of liver inflammation at admission, they were divided into mild-moderate group (24 cases) and severe group (15 cases), and 18 healthy people were selected as control group. Enzyme-linked immunosorbent assay was used to detect the difference of serum M30 and M65 levels between DILI patients and healthy controls, and the changes of serum M30 and M65 levels before and after treatment. Analyzing the correlation between serum M30 and M65 levels and liver function indexes, including alaninetransaminase (ALT), aspartatetransaminase (AST), gamma-glutamyl transferase (γ-GT), alkaline phosphatase (ALP). Results Serum M30 in mild-moderate group and severe group were (256.41 ± 50.61) U/L and (1116.69 ± 136.83) U/L respectively, and serum M65 in mild-moderate group and severe group were (1007.98 ± 291.15) U/L and (3963.68 ± 614.62) U/L respectively, both were higher than healthy control group (P<0.05). After treatment, there was no significant difference between M30 detected after liver inflammation recovery and healthy control group (P>0.05), but M65 was still higher than that of healthy control group (P<0.05). M65 was positively correlated with ALT (r=0.523, P<0.05), AST (r=0.512, P<0.05), γ-GT (r=0.434, P<0.05) and ALP (r=0.423, P<0.05). M30 was positively correlated with ALT (r=0.748, P<0.05) and AST (r=0.525, P<0.05). There is a positive correlation with γ-GT (r=0.325, P>0.05) and ALP (r=0.415, P>0.05), but there is no statistical difference. Conclusion Serum M30 and M65 levels are sensitive indicators to reflect hepatocyte necrosis and apoptosis in patients with DILI, which are related to liver inflammation and have certain clinical auxiliary value.
    Other Liver Diseases
    Analysis of collaborative research platform for aild prevention and trearment
    PENG Yun, LI Jian-hui, LU Bing
    2022, 27(10):  1120-1122. 
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    Objective To analyze how to establish a collaborative research platform of prevention and treatment for autoimmune liver disease (AILD) to manage AILD, reduce the risk of canceration in patients with AILD, improve the quality of life and prolong the life of patients. Methods The characteristics and advantages of the collaborative research platform of prevention and treatment for AILD, the electronic health records of AILD patients, the implementation and management of the platform team, the deficiencies and the improvement measures of the collaborative research platform were analyzed. The collaborative research platform of prevention and treatment of AILD focused on personnel training, forming an efficient, mutual assistance and comprehensive team, emphasizing the implementation of a collaborative research model centered on patients, AILD diagnosis and treatment. Results Since the implementation and management of the collaborative research platform of prevention and treatment for AILD, our department had treated 136 patients with liver disease in Changde for more than 2 years, including 49 patients diagnosed with AILD or overlap syndrome. Patients had already been in the middle and late disease stage admitted into our department. Patients had achieved clinical and biochemical index remission and prevented further progression to cirrhosis or liver failure after diagnosis and treatment from the collaborative research platform of prevention and treatment for AILD. The collaborative research platform combining AILD prevention and treatment holded more than 100 special lectures qriented by AILD and other liver diseases every year, distributed more than 2,000 health handbooks, hosted large-scale free clinic activities on World Hepatitis Day, helped AILD patients to register on the collaborative research platform and check the test results based on network, communicated with doctors to get illness information, save time and cost of unnecessary round-trip hospital consultation. In addition, patients could also actively participate in health lectures and communicate with doctor by telephone, which significantly improved the health management ability and the compliance of therapy of AILD patients. Conclusion The collaborative research platform of prevention and treatment of AILD provides patients best diagnosis and treatment based on the “many-to-one” service mode, which helps to improve the prognosis of AILD, improve the quality of life and reduce disease burden.
    Clinical characteristics and gene analysis of infants with genetic metabolic intrahepatic cholestasis in Nanning
    PANG Zhi-dong, YAN Yun-ying, XU Jiang-yan, QUE Yu-chen
    2022, 27(10):  1123-1128. 
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    Objective To investigate the clinical characteristics and gene mutation characteristics of infants with genetic metabolic intrahepatic cholestasis in Nanning. Methods A total of 116 infants with suspected genetic metabolic intrahepatic cholestasis in Nanning, who were treated in our hospital from January 2016 to December 2020, were collected as the research objects. The clinical data of all infants were collected. Target gene capture combined with high-throughput sequencing technology was used for gene detection, and Sanger was used for verification. Results (1) A total of 116 infants were included in this study, and there were 35 with gene mutation, including 11 of SLC25A13 gene mutation (31.43%), 8 of JAG1 gene mutation (22.86%), 7 of ABCB11 gene mutation (20.00%), 5 of HSD3B7 gene mutation (14.29%), 2 of CFTR gene mutation and 2 of AKR1D1 gene mutation (5.71%). (2) There were 11 of Citrin Protein deficiency (31.43%), 8 of Alagille syndrome (22.86%), 7 of progressive familial intrahepatic cholestasis of type 2 (20.00%), 4 of congenital bile acid synthesis disorder of type 1 (11.43%), 3 of congenital bile acid synthesis disorder of type 2 (8.57%), and 2 with cystic fibrosis (5.71%). (3) ALT level in infants of cholestasis with gene mutation was (244.85±70.64) U/L, which was significantly higher than those in infants of cholestasis without gene mutation (P<0.05), and there were no significant differences in gender, age of onset, age of treatment, weight, feeding pattern, yellow skin dyeing time, white earthen stool, AST, γ-GGT, ALP, TBA, TBil, TP, Alb, Glb, color Doppler ultrasound of liver, spleen and gallbladder (P>0.05). Conclusion The etiology of infants with intrahepatic cholestasis with gene mutation in Nanning is various and the clinical features are not significant. High throughput sequencing technology is of great value in the diagnosis of infants with intrahepatic cholestasis with suspected genetic metabolic diseases clinically.