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    28 February 2023, Volume 28 Issue 2
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    Liver Failure
    Clinical characteristics and prognosis of patients with autoimmune hepatitis -induced acute on chronic liver failure
    XU Tian-jiao, TIAN Hua, YOU Shao-li, ZHU Bing, LV Sa
    2023, 28(2):  157-161. 
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    Objective To investigate the clinical characteristics and prognosis of autoimmune hepatitis acute on chronic liver failure (AIH-ACLF). Methods The clinical characteristics of 36 patients with AIH-ACLF treated in our hospital from January 2016 to December 2020 were retrospectively analyzed. According to the prognosis, patients were divided into improvement group and ineffective group, and the data between the 2 groups were compared. T test and rank sum test were used to analyze the data of classified variables, Logistic regression was used for multivariate analysis. Results Among the 36 cases, 32 were female (88.89%) and the average age was 52.29 ± 16.27 years. All the cases were AIH type 1 and had never received corticosteroid therapy before, 86.1% of patients combined with liver cirrhosis. The total improvement rate was 27.8% (10 cases), and 2 cases were treated with liver transplantation. Ascitic fluid (34 cases, 94.4%) and hepatic encephalopathy (HE) (20 cases, 55.6%) were the most common complications. Compared with the ineffective group, the prothrombin activity (PTA) in the improved group was higher [32.80 (26.25～37.70)% vs 22.95 (14.86～35.25)%, P=0.044]; the total bilirubin (TBil) (171.03±69.19μmol/L vs 261.23±131.00μmol/L, P=0.012), model for end-stage liver disease (MELD) score [19.00 (17.75～23.50) vs 29.50 (24.25～34.25), P<0.001)] and the incidence of HE (20% vs 69.2%, P=0.011) was lower. The proportion of patients treated with corticosteroid therapy was high (80.0% vs 26.9%, P=0.007). Corticosteroid therapy and MELD score were independent risk factors for prognosis of AIH-ACLF. Fifteen patients (41.2%) received corticosteroid therapy, and 8 of them improved. The interval time from diagnosis to corticosteroid therapy and MELD scores of improved patients were lower. Conclusion The prognosis of patients with AIH-ACLF is poor, corticosteroid therapy and MELD score are independent risk factors for prognosis. Early corticosteroid therapy are essential for improving the prognosis of patients with AIH-ACLF.
    Analysis on etiology and clinical outcome of 76 children with acute liver failure
    JIN Jian-guo, HUA Qing
    2023, 28(2):  162-164. 
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    Objective To investigate the etiology and clinical outcome of 76 children with acute liver failure (ALF). Methods A total of 76 children (43 males and 33 females) with ALF admitted to our hospital from January 2010 to January 2021 were included, with an average age of 1 month to 12 years. All the objects were followed up regularly and death group according to the clinical outcome. The etiology of ALF children were collected, and the clinical data of survival group and death group were compared and analyzed by multiple-factor analysis. Results The etiology of 31 (40.8%) cases was unclear and etiology of 45 (59.2%) cases was definite. Among the latter, 14 cases were drug-induced injury (18.4%), 11 cases were infectious diseases (15.8%), 9 cases were anatomical abnormalities (congenital dysplasia of blood vessels or biliary tract) (14.5%), 7 cases were hereditary metabolic diseases (9.2%), 3 cases were autoimmune diseases (3.9%) and 1 case was neoplastic diseases (1.3%). Among the 76 children with ALF, 44 cases survived and 32 cases died, respectively. Compared with clinical data, the alanine transaminase (ALT) and aspartate aminotransferase (AST) [1108 (504, 3114) U/L and 1226 (808, 3225) U/L] in the survival group were significantly higher than those in the death group [526 (204, 915) U/L and 717 (470,1948) U/L, Z=27.402, 24.153, P<0.05]. In the survival group, the albumin (Alb), total bilirubin (TBil), direct bilirubin (DBil) and blood ammonia of survival group [33.2 (30.2, 38.4) g/L, 61.2 (26.5, 182.4) μmol/L, 38.0 (12.9, 114.8) μmol/L and 80.0 (60.5, 101.7) μmol/L] were significantly different from those in death group [28.7 (26.0, 31.4) g/L、152.9(70.6, 288.0) μmol/L, 87.6 (41.6, 158.2) μmol/L and 109.5 (85.5, 146.6) μmol/L], P<0.05. The survival group plotting time PT and international normalized ratio (INR) were 24.2(21.0, 29.8) s and 2.1(1.8, 2.8), which was significantly different from the death group [38.4(24.4, 52.5) s and 3.3(2.3, 6.6)] (Z=-20.197, -21.158, P<0.05). PELD score of survival group [20.2 (18.4, 32.0) points] was significantly higher than that of death group [30.8 (24.6, 39.0) points, Z=-22.278, P<0.05]. Taking the ALT, AST, Alb, TBil, DBil, blood ammonia, PT, INR and PELD score as independent variables, and the clinical outcome was taken as dependent variable (assigned 0 = survival, 1 = death), and the logistic regression analysis was conducted. The results indicated that TBil and PELD scores were independent risk factors of death in the clinical outcome of children with ALF (P<0.05). Conclusion The mortality of children with ALF is high, and the common causes are drug-induced damage, infectious diseases, anatomical abnormalities (congenital dysplasia of blood vessels or biliary tract), genetic metabolic diseases, autoimmune diseases and neoplastic diseases. The increase of TBil and PELD scores in children with ALF indicates poor prognosis.
    Liver Fibrosis & Cirrhosis
    Analysis of related factors of hemorrhage after anticoagulant therapy for femoral vein catheter-related thrombosis in patients with end-stage liver disease
    PENG Jing-han, HUANG De-liang, YU Hong, CHEN Jun
    2023, 28(2):  165-170. 
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    Objective To investigate the efficacy of anticoagulant therapy for femoral vein catheter-related thrombosis in patients with end-stage liver disease (ESLD) and the risk factors of bleeding after treatment. To provide effective scientific basis for anticoagulant therapy for deep venous thrombosis in patients with ESLD. Methods The data of 62 inpatients with ESLD and femoral vein catheter-related thrombosis in our hospital from January 2019 to May 2021 were collected. Clinical general data and laboratory indexes of patients with bleeding and non-bleeding after anticoagulation therapy were analyzed retrospectively; investigating factors associated with the time from anticoagulation to thrombus disappearance. Results A total of 62 patients were enrolled, including 15 cases (24.2%) in bleeding group and 47 cases (75.8%) in non-bleeding group. There were significant differences in total anticoagulation time 8.0 (4.0,22.0) vs 21.0 (9.0,42.0) days and FT4 14.6 (13.4,17.3) vs 18.0 (14.7,21.4) pmol/L between bleeding group and non-bleeding group (P＜0.05). The result of multiple linear regression showed that the time from anticoagulation to thrombus disappearance was significantly correlated to creatinine (Cr) and anticoagulant drugs (low molecular weight heparin, rivaroxaban, low molecular weight heparin + rivaroxaban or other drugs), (P＜0.05). Conclusion There is no significant difference between the choice of anticoagulant drugs (low molecular weight heparin, rivaroxaban or low molecular weight heparin + rivaroxaban) and curative effect in the treatment of bleeding complications in ESLD patients with catheter-related deep vein thrombosis. FT4 may be correlated with anticoagulant bleeding, while Cr is negatively correlated with the time from anticoagulant to thrombus disappearance. Before anticoagulation, it is necessary to pay attention to Objective indexes such as FT4 and Cr, which can predict the time of anticoagulation bleeding and thrombus disappearance.
    Liver Fibrosis & Cirrhosis
    Application of noninvasive liver fibrosis score in predicting the severity of esophageal and gastric varices in patients with cirrhosis
    LI Wen-ting, DANG Tong, WANG Jing, WANG Hai-ying
    2023, 28(2):  171-174. 
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    Objective Esophageal variceal bleeding is a complication in patients with portal . The aim of the study was to investigate the clinical value of noninvasive model in predicting the severity of esophageal and gastric varices in patients with cirrhosis. Methods The clinical data of 86 patients admitted to our hospital from May 2020 to January 2021 were collected, including laboratory examination, imaging and gastroscopy results. The severity of esophageal varices was evaluated according to gastroscopy. The predictive value of noninvasive liver fiber scores including aspartate aminotransferase/platelet ratio index (APRI), r-gamma-glutamyl transpeptidase-to-platelet ratio (GPR), fibrosis index based on the four factors (FIB-4), S-index, aspartate transaminase-to-alanine transaminase ratio (AAR) and gamma-glutamyl 1 transpeptitiase-platelet ratio (GAPRI) were compared, and the receiver operator characteristic (ROC) curve conducted. Results The area under the ROC curve of APRI, GPR, FIB-4, S-index, AAR, GAPRI were 0.646, 0.637, 0.634, 0.632, 0.566, 0.636 respectively, and the diagnostic value of APRI was the highest. The specificity of APRI, GPR, FIB-4, S-index, AAR, GAPRI were 56.72%, 89.47%, 36.84%, 73.68%, 57.89%, 89.47%, the specificity of GPR and APRI was the highest. The sensitivity of APRI, GPR, FIB-4, S-index, AAR, GAPRI were 56.72%, 40.30%, 91.04%, 55.22%, 61.19%, 40.30% respectively, sensitivity of APRI was the highest. Platelets, alanine transaminase (ALT), and RDW in mild esophageal varices group were 114.47 ± 50.715, 34.74 ± 15.818, 16.889 ± 2.2521, respectively, while those in severe esophageal varices group were 95.79 ± 42.272, 42.52 ± 24.971, 15.849 ± 2.6023, there was no statistical difference between the two groups (P>0.05). There was no significant difference of APRI, FIB-4, S-index, GAPRI, GPR, and AAR between mild esophageal varices group and severe group [0.637 (0.409, 0.895), 0.637 (0.409, 0.895), 3.562 (2.166, 6.155), 0.435 (0.211, 0.984), and 43.81 (26.829, 64)] vs [901 (0.524,1.407), 0.901 (0.524,1.407), 4.5 (3.335,6.991), 0.891 (0.327,1.778) 61 (29.126144.444), 1.017 (0.485,2.407), 1.48251 ± 0.720318], (P>0.05). Conclusion APRI, GPR, GAPRI and S-index may have a certain predictive value for the severity of esophageal variceal hemorrhage in patients with liver cirrhosis, and the predictive value APRI maybe higher.
    Thalidomide treatment ameliorates hepatopulmonary syndrome in rats with biliary cirrhosis
    JIANG Li-ping, JIANG Xiao-yan, WANG Hong-yan, WU Wen-jie, OU Yang, CHEN Ming-sheng
    2023, 28(2):  175-180. 
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    Objective To investigate the mechanism of thalidomide in the treatment of hepatopulmonary syndrome (HPS). Methods Common bile duct ligation was used to induce HPS in rats. Four weeks after operation, experimental group was treated by thalidomide [100 mg/(kg·d)], control group was treated by distilled water [100 mg/(kg·d)] for 2 weeks. Biochemical, plasma and bronchoalveolar lavage fluid vascular endothelial growth factor (VEGF), TNF-α and blood gas analysis were performed in all rats. The rat liver was collected for histopathological examination, and the lung tissue was analyzed by real-time fluorescence quantitative PCR and western blot. In another parallel group, the results showed that the model was successful. Results After thalidomide treatment, the alveolar-arterial partial pressure of oxygen (A-aPO2) and the levels of serum VEGF and TNF-α were significantly decreased [A-aPO2 rank was 25.10 (10) in thalidomide group, 15.60 (10) in control group (P<0.001), 25.50 (10) in thalidomide group, 14.50 (10) in control group (P<0.001). serum TNF-α level was 25.50 (10) in thalidomide treatment group, and 12.60 (10) in control group (P<0.001)]. Meanwhile, thalidomide decreased lung VEGF, VEGF receptor 2 (VEGFR-2) mRNA [(VEGF model group vs. thalidomide group: 23.25 (10) vs. 15.10 (10); VEGFR-2 model group vs. thalidomide group: 22.40 (10) vs. 15.60 (10)] and protein [VEGF model group vs. thalidomide thalidomide group: 2.03±0.96 vs. 1.45±0.99; VEGFR-2 model group vs. thalidomide group: 21.50 (10) vs. 12.25 (10)] expression (all P<0.05). Conclusion Thalidomide can reduce Amura PO2 in choledochal ligation rats, suggesting that thalidomide can improve the HPS of experimental animal model. The mechanism may be related to the inhibition of TNF-α, to inhibit VEGF/VEGFR-2 pathway and reduce pulmonary angiogenesis.
    Liver Cancer
    Effect of Nucleos(t)ide analogues(NAs) therapy on the postoperative survival in patients with hepatitis B virus related hepatocellular carcinoma-a meta analysis
    LIU Yun-xiao, FU Yan, NIU Li-na, DOU Jing , WANG Xiao-zhong
    2023, 28(2):  181-188. 
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    Objective To investigate the effect of Nucleos(t)ide analogues (NAs) on postoperative survival and prognosis of patients with hepatitis B virus (HBV) related hepatocellular carcinoma (HCC). Methods PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, Wan fang, and Wei pu databases were used for searching, and the deadline was December 2021. Two reviewers screened the literatures independently according to the inclusion and exclusion criteria, then extracted and assessed the data. The meta-analysis was conducted through Stata16. Results A total of 25 studies including 6 randomized controlled trial (RCT) studies and 20 cohort studies were included. Among them, there was a two-stage longitudinal clinical study, which including both a RCT and a cohort study. Our meta-analysis showed that the overall survival (OS) and recurrence free survival (RFS) of the patients in the experimental treated by NAs and hepatic resection, were superior to the patients in control group treated by hepatic resection at the 1st, 3rd, 5th year. Conclusion Compared with the control group, the patients with HBV-HCC who were treated by NAs and hepatic resection could achieve a better OS and RFS.
    Retrospective cohort study on traditional chinese medicine dialectical treatment improving survival rate of patients with hepatocellular carcinoma after radical resection
    HE Zheng-yang, SHE Wei-ming
    2023, 28(2):  189-192. 
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    Objective To evaluate the influence of traditional chinese medicine dialectical treatment on the survival rate and disease-free survival rate of patients with hepatocellular carcinoma after radical resection by retrospective cohort study. Methods A total of 619 patients with hepatocellular carcinoma who were followed up for more than 5 years after radical operation in two third-class hospitals in Shanghai were enrolled. Those who received traditional chinese medicine dialectical treatment for more than 6 months after operation were assigned as the Chinese and western medicine cohort, otherwise, they were assigned as the western medicine cohort.The clinical data of patients were collected and analyzed. Results 1. The 1, 2, 3 and 5-year disease-free survival rates of patients in western medicine cohort were 70.00%, 54.86%, 48.65% and 38.92% respectively; The 1, 2, 3 and 5-year disease-free survival rates of Chinese and Western medicine patients were 82.33%, 69.08%, 59.44% and 40.03% respectively. Log-rank test showed that there was no significant difference between the two groups (P=0.300), while Breslow test showed that there was significant difference between the two groups (P=0.026). 2.The 1, 2, 3 and 5-year overall survival rates of patients in western medicine cohort were 88.92%, 80.27%, 76.49% and 65.68% respectively. The 1, 2, 3 and 5-year overall survival rates of Chinese and Western medicine patients were 99.20%, 96.79%, 91.79% and 75.50% respectively. Log-rank test showed that the difference between the two cohorts was statistically significant (P=0.002). 3. By subgroup analysis of Chinese and Western medicine cohort, it was found that the 5-year survival rate of high exposure group (≥12 months) was significantly better than that of high exposure group (≥6 months and < 12 months).81.46% and 47.73% respectively (P<0.001). Conclusion For the patients after radical resection of hepatocellular carcinoma, the survival rate and survival time of patients in the TCM-WM group treated with traditional chinese medicine dialectical treatment are higher and longer than those in the Western medicine group. Among them, those who have been treated with traditional chinese medicine dialectical treatment for a long time (≥12 months) have higher survival rate and longer survival time.Compared with the western medicine group, TCM-WM group have higher disease-free survival rate and longer disease-free survival time in short-term. The disease-free survival condition of the TCM-WM groups is better than that of the western medicine group before 60 months, while the disease-free survival condition of the two groups tends to be the same after 60 months.
    Cost-effectiveness comparison of four treatment strategies for primary liver cancer
    LIU Er-li, LI Bo-qun, HUANG Ying-ting, CUI Hao, WANG Xiao-jun, ZHANG Hong-ying
    2023, 28(2):  193-199. 
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    Objective To compare the prognosis and cost of four treatment strategies for patients with primary liver cancer (PLC), so as to provide reference for patients to select treatment schemes. Methods The clinical data of 644 patients with PLC primarily diagnosed in Beijing You'an Hospital Affiliated to Capital Medical University from January 1, 2014 to December 31, 2018 were retrospectively analyzed. According to different treatment methods, they were divided into four groups: Hepatectomy (LR) group, transcatheter arterial chemoembolization (TACE) group, TACE combined with radiofrequency ablation (RFA) group, and symptomatic treatment group. The survival rate and prognostic risk factors of the four treatment schemes were compared, and the cost-effectiveness analysis was carried out. Results The 1- to 5- year overall survival rates of TACE combined with RFA group were significantly better than that of the other three groups (P<0.05) (LR group: 58.33%, 27.08%, 14.58%, 4.17%, 2.08%; TACE group: 71.23 %, 53.42%, 35.62%, 24.66%, 12.33%; TACE combined with RFA group: 75.30%, 58.43%, 45.48%, 29.22%, 17.17%; symptomatic treatment group: 28.89%, 15.56%, 0.00%, 0.00%, 0.00%, respectively). Treatment, BCLC stage, ascites and hepatic encephalopathy were independent prognostic factors affecting the overall survival rate. The average treatment costs of each time in the four groups were ￥72201.00±113067.69 in LR group, ￥37302.35±34759.82 in TACE group, ￥41163.46±36920.18 in TACE+RFA group, and ￥35968.44±25546.05 in symptomatic treatment group, which had no statistically significant diference (P<0.001). The 5-year survival rate of four treatment schemes was used as the effectiveness for cost-effectiveness analysis. Because no patients in the symptomatic treatment group survived to 5 years, the cost-effectiveness ratios of the other three treatment groups were as follows: LR group: 34712.02; TACE group: 3025.33; TACE+RFA group: 2397.41, and the difference was statistically significant (P<0.05). Conclusion In conclusion, the combination of TACE and RFA treatment had more advantages than LR, TACE and symptomatic treatments for PLC in improving survival rate and reducing costs.
    An analysis on the consistency between arterial phase diagnosis of contrast-enhanced ultrasound and pathological results of micro-hepatocellular carcinoma in the context of liver cirrhosis
    YIN Wei, FENG Yu-cheng, LUO Song-zhi, DAI Sheng-dao
    2023, 28(2):  200-202. 
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    Objective To analysis the significance of the arterial phase contrast-enhanced ultrasound (CEUS) in the diagnosis of micro-hepatocellular carcinoma in the context of liver cirrhosis. Methods 66 patients with liver nodules (totally 70 nodules) were included in the study from August 2016 to August 2021. All patients had background of liver cirrhosis. The nature of the lesions was confirmed by pathological examination, and the patients were divided into micro-liver cancer group (38 cases, 40 nodules) and non-malignant nodule group (28 cases, 30 nodules). Before pathological diagnosis, all patients underwent CEUS examination. The CEUS enhanced perfusion mode, descending branch halving time, enhancement peak time and continuous enhancement time of each lesion were observed, and the consistency between CEUS diagnosis of micro-hepatocellular carcinoma under the background of liver cirrhosis and pathological results was analyzed. Results The arterial phase of all lesions in micro-liver cancer group was high enhancement, and the portal vein phase was mainly low enhancement (32/40, 80.00%); In the non-malignant group, the arterial phase was mainly low enhancement (17/30, 56.67%), and the portal phase was mainly equal enhancement (22/30, 73.33%). The enhancement levels of arterial phase and portal vein phase between the two groups was significantly differenct (P<0.05). The descending branch halving time (84.68±18.20)s, peak enhancement time (22.65±8.84)s and continuous enhancement time (41.03±10.81)s in the micro- hepatocellular carcinoma group were lower than those in the non-malignant group [(115.03 ± 20.12)s, (30.59 ± 10.75)s, (84.54 ± 18.20)s] (P<0.05). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and kappa value of CEUS were 92.50%, 80.00%, 87.14%, 86.05%, 88.89% and 0.734 respectively. Conclusion The perfusion of minuscule liver nodules in the early stage of hepatocellular carcinoma is different from that of liver cirrhosis. CEUS has important value in the diagnosis of micro-liver cancer complicated with liver cirrhosis.
    Non-alcoholic Fatty Liver Disease
    The impact of weight loss on the severity of liver fibrosis and fatty liver in patients with chronic hepatitis B and/or non-alcoholic fatty liver disease
    LI Wan, HAN Yan-xia, XIE Shou-zhen, MA Ying-cai, YANG Yong-geng, LI Ping-ying
    2023, 28(2):  203-206. 
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    Objective To evaluate the impact of weight loss to mitigate the progression of liver fibrosis and the accumulation of liver fat in chronic hepatitis B (CHB) and/or non-alcoholic fatty liver disease (NAFLD) patients. Methods The participants were divided into three groups: group A with CHB (52 cases), group B with NAFLD (58 cases), and group C with CHB concurrent with NAFLD (50 cases). Fibro-Touch was used to non-invasively detect the degree of liver fibrosis and fatty liver disease by measurement of liver stiffness (LSM) and controlled attenuation coefficient (CAP), The general liver function indicators and blood levels of lipids of these participants were tested before and after intervention. According to the guidance, the interventions on weight loss were conducted in three groups of cases for 6 months. The effectiveness of intervention was defined as a decrease in BMI for ≥2 kg/m2. Results The values of LSM and ALT in the effective group B decreased, and the values of LSM and ALT before weight loss in the effective group B were (9.8±1.9) kPa and (31.8±10.6) U/L, respectively. After six months of weight loss, the values of LSM and ALT in group B were (8.0±1.5) kPa and (31.8±10.6) U/L, respectively, and the differences were statistically significant (P values 0.002 and 0.001, respectively). The CAP value of the effective intervention group decreased significantly in the three groups. The CAP value of the group A before weight loss was (230.2±10.3) db/m, and the CAP after six months was (212.7±10.1) db/m, P=0.003. The CAP value of the group B before weight loss was (303.9±26.2) db/m. After six months, the CAP was (261.8±18.6) db/m, P=0.008. Before the weight loss in group C, the CAP was (289.7±31.6) db/m and after six months, the CAP was (250.1±21.6) db/m, P=0.016 (P<0.05). In the effective intervention group, before weight loss, TG and LDL-c in group A were (1.3±0.4) and (2.2±0.7) mmol/L, and after six months, TG and LDL-c in group A were (0.9±0.2) and (1.7±0.5) mmol/L. Before weight loss, TG and LDL-c of group B were (2.3±1.2) and (2.8±1.1) mmol/L, and after six months, TG and LDL-c of group B were (1.7±0.7) and (2.3±0.7) mmol/L. Before weight loss, TG and LDL-c of group C were (1.9±1.0) and (2.1±0.6) mmol/L, and after six months, TG and LDL-c of group C were (1.2±0.6) and (1.6±0.5) mmol/L, and blood lipid (TG and LDL-c) of the effective intervention group were decreased significantly (P<0.05). Conclusion Effective weight loss intervention can significantly alleviate the degree of liver steatosis in patients with NAFLD, improve liver fibrosis, and improve liver function and blood lipid indexes, further delaying the progression of such diseases. Effective weight loss intervention decreased liver steatosis in patients with CHB and NAFLD, improved the blood lipid index, of which the improvement of TG and LDL-c were more obvious.
    The association of PNPLA3 and FABP1 genes methylation with metabolism-related fatty liver disease
    ZHU Kai, YANG Lei, ZHOU Qing, MA Xue-er, LI Qin, HE Xiao-xuan, YANG Xue-xia, CAI Wen
    2023, 28(2):  207-213. 
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    Objective To investigate the prevalence of metabolic-associated fatty liver disease (MAFLD) in Urumqi, and to explore the association of the methylation of PNPLA3 and FABP1 genes with the incidence of MAFLD by comparing the methylation levels of PNPLA3 and FABP1 genes between MAFLD patients and normal people. Methods The clinical data of the population undergoing physical examination in the First Affiliated Hospital of Xinjiang Medical University from January to March 2022 were retrospectively analyzed. 15 patients with MAFLD were recruited as the case group, and 15 healthy people without previous history of liver diseases were matched at the same time as the control group. Methylation specific PCR (MSP) method was used to detect the methylation of PNPLA3 and FABP1 genes. Point-biserial correlation was used to analyze the correlation between clinical data and the genes expression. Results A total of 1081 cases (33.84%) in 3194 physical examination subjects were diagnosed as MAFLD, including 698 (64.57%) males, 383 (35.43%) females, and 424 cases (39.22%) with age of 40 to 50 years old, the differences were statistically significant (P<0.001). There were 2 cases (13.33%) in the case group and 10 cases (66.67%) in the control group had PNPLA3 gene hypermethylation, the difference was statistically significant (χ2=6.806, P=0.009). Similarly there were 5 cases (33.33%) in the case group and 12 cases (80.00%) in the control group had FABP1 gene hypermethylated status, the difference was statistically significant (χ2=4.887, P=0.027). The methylation status of PNPLA3 gene was negatively correlated with the levels of fasting blood glucose (FPG) (r=-0.385, P<0.05), triglyceride (TG)(r=-0.584, P<0.05), and high density lipoprotein (HDL-C)(r=0.651, P<0.001). The methylation status of FABP1 gene was negatively correlated with the serum levels of urea (UA) (r=0.407, P<0.05), FPG (r=0.416, P<0.05), TG (r=0.565, P<0.05), total cholesterol (TC) (r=0.515, P<0.05), aspertate aminotransferase (AST) (r=-0.416, P<0.05), alanine aminotransferase (ALT) (r=0.473, P<0.05), whereas positively correlated with the level of HDL-C (r=0.487, P<0.05). Conclusion The prevalence of MAFLD in Urumqi is the highest in China. The methylation status of PNPLA3 and FABP1 genes promoter region in blood cells of patients with MAFLD was significantly decreased, and was correlated with FPG, TG, TC, UA, AST, ALT, HDL-C and apolipoprotein B, which is one of the important mechanisms for the occurrence and development of MAFLD.
    An analysis on carotid intima-media thickness and carotid-femoral pulse wave velocity in patients with nonalcoholic fatty liver disease
    ZHAO Jian-hong, LI Hong-bin, CHENG Xiang-chao, GUO Yan-wei
    2023, 28(2):  214-217. 
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    Objective To evaluate the correlation between nonalcoholic fatty liver disease (NAFLD), subclinical atherosclerosis (SAS), carotid intima-media thickness (CIMT), and carotid-femoral pulse wave velocity (cfPWV) in patients with NAFLD. Methods From January 2019 to March 2021, there were 122 patients with NAFLD were enrolled in this study as the NAFLD group, with 78 males and 44 females, and an average age of 43.3±12.0 years old. At the same period of time, 120 healthy people were included as the control group. The clinical data of SAS, CIMT and cfPWV between the NAFLD patients and the healthy controls were compared. Results The body mass index (BMI) of NAFLD group and control group was (28.4±3.7) kg/m2 and (24.1±3.0) kg/m2, respectively, which had statistically significant difference (t=2.138, P<0.05). The waist circumference of NAFLD group and control group was (102.5±9.7) cm and (93.3±8.4) cm, respectively, with significant difference (t=2.498, P<0.05). The levels of ALT, AST, TG, TC, HDL and LDL in NAFLD group were (38.0±6.7) U/L, (35.3±6.4) U/L, (2.2±0.6) mmol/L, (5.1±0.9) mmol/L, (1.0±0.2) mmol/L, respectively, which were significantly different with those of (25.2±5.2) U/L, (22.8±4.8) U/L, (1.0±0.5) mmol/L, (4.6±0.8) mmol/L, (1.2±0.3) mmol/L and (2.4±0.5) mmol/L in the control group (P<0.05). The fasting insulin levels in NAFLD group and control group were (102.5±9.7) μU/mL and (93.3±8.4) μU/mL, respectively, with significant difference (t=4.712, 4.268, 3.849, 2.587, -2.181, 2.028, P<0.05). The HOMA-IR of NAFLD group and control group were (3.5±0.8) and (2.0±0.5), with significant difference (t=5.427, P<0.05). The right CIMT of NAFLD group and control group were (0.66±0.12) mm and (0.58±0.10) mm, respectively, the differences were statistically significant (t=4.442, P<0.05). The left CIMT of NAFLD group and control group were (0.65±0.11) mm and (0.58±0.09) mm, the difference was statistically significant (P<0.05). In NAFLD group, right CIMT>75th, right CIMT>0.9 mm, left CIMT>75th and left CIMT>0.9 mm were 95 cases (77.9%), 9 cases (7.4%), 98 cases (80.3%) and 11 cases (9.0%), respectively, compared with those of 62 cases (51.7%), 2 cases (1.7%), 69 cases (57.5%) and 3 cases (2.5%) in the control group, the differences were statistically significant (χ2=18.227, 4.547, 14.740, 4.713, P<0.05). In NAFLD group, cfPWV, cfPWV>10 m/s and cfPWV>90th were (10.4±2.8) m/s, 68 cases (55.7%) and 77 cases (63.1%), respectively, compared with those of (8.2±2.5) m/s, 28 cases(23.3%) and 32 cases in the control group, the differences were statistically significant (P<0.05). Conclusion CIMT and cfPWV in patients with NAFLD are significantly increased, and the patients are prone to develop SAS. It is necessary to treat the NAFLD patients as soon as possible, in order to prevent the progression of SAS and avoid the occurrence of cardiovascular events.
    Other Liver Diseases
    Diagnostic value of serum total bile acid in drug-induced cholestasis
    XU Shan-shan, SONG Jing-jing, QIU Li-xia, ZHANG Jing
    2023, 28(2):  218-221. 
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    Objective To investigate the diagnostic value of serum total bile acid (TBA) in drug-induced cholestasis(DRIC). Methods Clinical and pathological data of patients with drug-induced liver injury who were hospitalized in Beijing You'an Hospital, Capital Medical University from July 2013 to August 2019 were collected. Based on pathological manifestations, the enrolled patients were grouped as having cholestasis or no cholestasis, and the TBA levels of the two groups were compared. Results A total of 281 DILI patients were enrolled, including 127 (45.20%) in the non-cholestatic group(group A) and 154 (54.80%) in the cholestatic group(group B). Hepatocellular cholestasis (61.04%) was the main pathological manifestation of cholestasis according to the pathological changes. There were no significant differences in gender, age and clinical symptoms between the two groups. The serum TBA, TBil and DBil levels in group B were significantly higher compared to group A (all P<0.05), and the hospital stay was longer (P<0.05). Univariate analysis showed that the serum TBA, TBil and DBil levels in group B were significantly higher than those in group A. Multivariate analysis showed that TBA was an independent predictor of cholestasis in patients with DILI. With 99.70 μmol/L as the critical value, the area under curve (AUC) of TBA for predicting hepatic histological cholestasis was 0.603 (0.536-0.671) (P=0.003), and its sensitivity and specificity were 52.6% and 74.0%, respectively. When the serum TBA level≥20.1 μmol/L, the probability of cholestasis could be considered as 75%, and the sensitivity was greater than 76.6%. Conclusion Serum TBA, TBil and DBil are sensitive indexes for DRIC. Moreover, serum TBA can be diagnostically useful.
    Effects of Astragali Radix on acute drug-induced liver injury by regulating the expression of TRPM2
    ZHU Ge-rui, MA Yuan-yuan, WANG Fan, HUANG Kai, PENG Yuan, CHEN Gao-feng, LIU Cheng-hai, TAO Yan-yan
    2023, 28(2):  222-228. 
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    Objective To observe the mechanism of Astragali Radix (AR) regulating the expression of transient receptor potential melastatin 2(TRPM2) on acetaminophen(APAP)-induced acute liver injury(ALI). Methods In vivo experient: thirty-nine male mice were randomly divided into control group(n=7) and study groups(n=8 each). The study groups were divided into the following groups at random: the APAP model group, the low-dose AR group(50 mg/kg), the high-dose AR group(75 mg/kg) and the N-acetylcysteine (NAC) treatment group(100 mg/kg). Both of AR and NAC were administered daily through oral gavage once a day for 3 consecutive days. On the 4th day, the mice in the study groups were given 350 mg/kg APAP by gavage. After 12 h of APAP treatment, samples were collected. Blood was collected to detect the serum levels of ALT and AST; Liver tissue slices were subjected to hematoxylin and eosin(HE) staining for observing the pathological changes, while immunohistochemical staining was performed to observe the expression of myeloperoxidase (MPO) and TRPM2. In vitro experiment: The AML12 mouse hepatocyte line was cultured in vitro and was stimulated by APAP (0, 5, 10, 20 mM) for 12 or 24 h. After the optimal stimulation concentration and duration of action were screened out, RT-PCR and Western blot were used to dynamically measure TRPM2 in hepatocytes. The ALI cell model was established with 5 mM APAP and divided into control group, APAP model group, low-dose AR group(125 μg/mL), high-dose AR group(250 μg/mL) and NAC control group. Except the control group, the other groups were incubated with NAC for 24 h. The CCK-8 assay was used to measure the viability of hepatocytes. RT-PCR and Western blot were used to measure TRPM2 in hepatocytes. Results In vivo experiment, compared with the normal group, the levels of serum ALT and AST in the APAP model group significantly increased (P<0.01). The liver tissue showed severe destruction of liver tissue structure, massive/submassive necrosis of hepatocytes, and central venous congestion. Compared with the APAP model group, AR had obvious hepatoprotective effects, including lowering the levels of serum ALT and AST in model mice, alleviating the necrosis of hepatocytes and down-regulated the expression of MPO and TRPM2 in liver tissue. While the high-dose AR group had the same efficacy as NAC. In vitro experiment: 5 mM APAP incubation could significantly induce hepatocyte damage (F=25.408, P<0.01), and the expression of TRPM2 in hepatocytes increased with time; compared with the APAP model group, AR could increase the viability of hepatocytes and reduce the expression of TRPM2 in hepatocytes. Conclusion AR has a good protective effect on APAP drug-induced liver injury, which may be related to down-regulation of TRPM2 expression.
    Value of preoperative MELD score in evaluating postoperative complications and long-term prognosis of patients with hepatic echinococcosis
    YU Peng, DUAN Shao-bin
    2023, 28(2):  229-232. 
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    Objective To investigate the value of the preoperative MELD(model for end-stage liver disease) score in the evaluation of postoperative complications and long-term prognosis in patients with liver hydatid disease. Methods The preoperative MELD scores of various complications in patients with hepatic echinococcosis were compared. The five-year recurrence or death of all patients suffering from hepatic echinococcosis after operation was taken as the state variable and the preoperative MELD score was used as the test variable. The ROC analysis of the two was carried out to obtain the optimal cut-off values for predicting the postoperative survival of patients. The participants were divided into two groups. The general clinical data of patients between the two groups were compared, and the 5-year recurrence free survival rate and overall survival rate of postoperative patients between the two groups were compared by Kaplan-Meier survival analysis. Results In this study, 97 patients with hepatic echinococcosis, 66 males (68.0%) and 31 females (32.0%), aged 27-68 years, with an average age of (43.2 ± 12.6) were enrolled. Major complications included liver dysfunction in 35 (36.1%) cases , biliary fistula in 20 (20.6%) cases, pleural and peritoneal effusion in 32 (33.0%) cases and infection in 16 (16.5%) cases. The preoperative MELD score of patients with postoperative liver dysfunction (12.3 ± 3.1) was significantly higher than that of patients with normal liver function (6.2 ± 1.1) (t/χ2=11.236 / <0.001), ROC analysis showed that the area under the curve (AUC) of preoperative MELD score predicting the postoperative survival value of patients with hepatic hydatid disease was 0.832 (95% CI: 0.754 ~ 0.886), and the optimal cut-off value was 10.3. According to the optimal cut-off value of preoperative MELD score, patients were divided into two groups based on their MELD scores: group A, MELD score ≥ 10.3(n=39, 40.2%) and group B, MELD < 10.3(n=58, 59.8%). Kaplan Meier survival analysis showed that there was no significant difference in the 5-year recurrence- free survival rate of patients between the two groups (78.9%, 58.2%, 56.3% vs 100%, 76.9%, 65.5%, all P>0.05). The 1-year, 3-year and 5-year overall survival rate in group A was significantly lower than that in group B(100%, 75.6%, 63.4% vs 100%, 92.3%, 83.2%, all P<0.05). Conclusion The preoperative MELD score can accurately evaluate the risk of postoperative liver dysfunction and long-term overall survival rate of patients with hepatic echinococcosis.
    Comparative study of big five personality traits between living liver donors and healthy population
    LU Ying, WANG Yu-jia, LU Ye-feng, WU Yi-bo
    2023, 28(2):  233-237. 
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    Objective To survey the difference between living donor liver transplantation(LDLT) and healthy population by using the Big Five Inventory(BFI). Methods In this cross-sectional study, the questionnaire was developed on the basis of the 10-item Big Five Inventory(BFI-10). Results A total of 77 donors(23.4% male and 76.7% female) were recruited in this study. In addition, 1999 cases of healthy population(15.5% male and 84.5% female) served as controls. The scores of agreeableness(A) and conscientiousness(C) in the LDLT group were significantly higher compared to controls(7.70±1.49 vs 7.15±1.53, 7.83±1.44 vs 6.80±1.74, all P<0,01), and the scores of neuroticism(N) were lower in the LDLT group than in the control group(5.62±1.81 vs 6.09±1.60, P<0.05). Further analysis in the LDLT group indicated that there were significant differences in C personality on the payment manners for medical costs and extraversion(E) personality on debt-related decisions(all P<0.05). Conclusion The personality characteristics of donors are mostly C personality, which could impact the decision-making on the forms of payment for medical expenses. The factor of debt influenced the E personality of donors.
    Effects of plasma exchange combined with low-molecular-weight heparin sodium on coagulation, liver and kidney function and pregnancy outcomes in patients with acute fatty liver of pregnancy
    YUAN Xiao-li, WANG De-qin, XU Xiao-ying
    2023, 28(2):  238-241. 
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    Objective To investigate the efficacy and safety of plasma exchange (PE) combined with low-molecular-weight heparin sodium(LMWH) in the treatment of patients with acute fatty liver of pregnancy (AFLP). Methods A total of 55 AFLP patients admitted from January 2019 to December 2021 were divided into two groups. The control group was given PE and supportive treatment, and the observation group was additionally treated with LMWH. The changes of coagulation parameters, liver and renal function , pregnancy outcomes and adverse drug reactions of the two groups were observed. Results After 1 week of treatment, D-dimer and PT levels in the observation group were lower than controls (1.73±0.34)mg/ mL vs (1.91±0.42)mg/mL; (12.43±1.72)s vs (14.16±2.04)s, all P<0.05). The levels of FIB and PLT were higher in the observation group compared with the control group( (4.67±0.97)g/L vs (43.58±0.72)g/L; (118.29±9.81)×109/L vs (100.45±9.13)×109/L, all P<0.05). Serum ALT, TBIl, DBIl and Alb levels in the observation group were lower than in the control group(( 79.58±6.53)U/L vs (96.45±8.42)U/L; (82.34±7.71)μmol/L vs (97.52±8.65)μmol/L; (81.47±5.73)μmol/L vs (97.52±7.68)μmol/L, (34.82±3.78)g/L vs (32.67±3.72)g/L, all P<0.05 ). The observation group also showed significantly lower levels of Cr, UA and 24-hour urinary protein compared with the control group ((128.15±7.14)μmol/L vs (142.43±7.96)μmol/L; (227.64±11.42)μmol/Lvs (289.52±13.29)μmol/L; (2.54±0.32)g/24 h vs (2.83±0.38)g/24 h, all P<0.05). The incidences of severe birth asphyxia and DIC, postpartum hemorrhage, maternal and neonatal peripartum mortality and liver function recovery time in the observation group were significantly lower than controls(P<0.05). There was no difference in adverse reactions between the two groups (P>0.05). No serious adverse drug reactions occurred in the observation group. Conclusion PE combined with LMWH in the treatment of AFLP can improve the coagulation function, promote the recovery of liver and kidney function, result in better pregnancy outcomes, representing a safe option.
    Retrospective analysis of clinical features of liver dysfunction associated with varicella-zoster virus infection
    WANG Jian-bin, LIANG Dong
    2023, 28(2):  242-243. 
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    Objective To analyze the clinical characteristics and prognosis of abnormal liver function secondary to varicella(chickenpox), so as to provide clinical decision support. Methods The clinical data of the 330 patients with varicella who were treated in our hospital from January 2010 to January 2022 were collected, and the clinical characteristics of the patients with abnormal liver function secondary to varicella were analyzed. Results Liver injury occurred in 68 patients, with an incidence rate of 20.6%. The majority of cases were in the acute stage of varicella infection without obvious clinical symptoms. The main manifestations were mild elevation of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in which the changes of ALT levels were more obvious. Patients with ALT <100 U/L generally did not use drug intervention, while patients with ALT>100 U/L received oral liver-protective drugs, all patients with abnormal liver function were cured and no recurrence was observed. Conclusion Although the prevalence of liver function abnormalities is common in patients with varicella, its clinical symptoms, mainly characterized by mild liver damage, are not obvious and could be cured by appropriate liver protection treatment.