Abstract: Liver cirrhosis is the end stage of various chronic liver diseases. Early diagnosis and staging of liver cirrhosis, as well as effective disease assessment, are of great clinical significance. The application of liver biopsy, serological testing, and radiological examination in the clinical diagnosis of liver cirrhosis and the research advances in evaluation of liver reserve function, complications, and prognosis are reviewed. It is pointed out that with the development of molecular biological and imaging techniques, the accuracy and specificity of noninvasive diagnosis will be increased, and the disease assessment system will be improved.
Abstract: The necessity and feasibility of antiviral therapy in patients with liver cirrhosis have caught much attention. By summarizing the relevant guidelines /consensus statements and evidence- based medicine data in recent years, the advances in indications, strategies, drug options, and benefit /risk in antiviral therapy for hepatitis B virus (HBV) - and hepatitis C virus (HCV) - related cirrhosis are reviewed. The data reveal that for both HBV- and HCV- related cirrhosis, successful treatment may suppress viral replication, improve patients' conditions, delay disease progression, prolong survival, reduce complications, and create better conditions for surgical and minimally invasive operations for hepatocellular carcinoma. Because of the good safety of nucleos (t) ide analogues (NA) , it is recommended that patients with HBV- related cirrhosis (including those in decompensation stage and with complications) should receive NA as soon as possible. As interferon may cause many adverse reactions, antiviral therapy for HCV- related cirrhosis becomes more difficult than that for HBV- related cirrhosis. Careful selection of indications is necessary. Standardization of the strategies for antiviral therapy is important in the treatment of liver cirrhosis.
Abstract: Ascites is an important indicator of poor prognosis of liver cirrhosis. Although several guidelines and consensus statements on the management of ascites have been published in the past years, there are still a lot of controversial problems in this regard. The current controversial problems and difficulties in the management of ascites, such as the timing of sodium supplementation or sodium restriction, the selection of diuretics, the application value of aquaretics, the strategy of albumin administration after large- volume paracentesis, and the indications and efficacy of transjugular intrahepatic portosystemic shunt, are reviewed. It is pointed out that further studies on these problems with evidence- based medicine means will enhance the diagnosis and treatment of cirrhotic ascites and improve patients' prognosis.
Abstract: The progression of liver fibrosis directly affects treatment options and prognosis. Early diagnosis and classification of liver fibrosis and dynamic monitoring are clinically needed. Noninvasive diagnostic techniques can avoid or reduce liver biopsy to enable early identification of liver fibrosis and to dynamically monitor the progression of fibrosis. But various limitations have restricted its application. Noninvasive diagnostic techniques, such as liver transient elastography using the different probe mode, controlled attenuation parameter, spleen stiffness measurement, ultrasound- based transient elastography for the early prediction of hepatic fibrosis, and risk assessment of hepatitis B virus-related hepatocellular carcinoma, have been applied in clinical studies. In order to better understand and apply these diagnostic models, the progress in clinical studies of noninvasive diagnosis of liver fibrosis, as well as the limitations, is reviewed.
Abstract: Portal pressure assessment is a necessary means to diagnose portal hypertension. Currently, hepatic venous pressure gradient is considered as the diagnostic gold standard for portal hypertension. However, invasiveness is one of its most critical limitations. Therefore, a noninvasive, easy, and accurate measurement of portal pressure is of significant clinical value. The current noninvasive approaches to evaluate portal pressure, including CT portography, MR portography, Doppler ultrasonography, serum markers, and liver transient elastography, are summarized. Besides, a novel noninvasive portal pressure measurement technique based on the three- dimensional (3D) blood vessel model is introduced. It is pointed out that this method allows direct noninvasive measurement of portal pressure and establishment of 3D blood vessel model, as well as the diagnosis of portal hypertension based on directly simulated pressure indicators. However, this technique is being clinically tested, and its diagnostic accuracy needs to be further confirmed by large- sample clinical trials.
Abstract: The establishment and perfection of the assessment system for chronic liver diseases have a guiding significance for clinical diagnosis and treatment. Hepatic venous pressure gradient (HVPG) is of great significance in the progression of chronic liver diseases, and it is the only pathophysiological index for treatment independent of etiology. The current methods for evaluation of chronic liver diseases are simply described, and the application of HVPG in evaluation of chronic liver diseases is systematically summarized, including predicting the severity of liver cirrhosis, variceal bleeding risk and outcome of portal hypertension, development of cirrhotic ascites, efficacy of drugs for reducing portal hypertension and antiviral drugs, and postoperative outcome of liver cancer. It is thought that HVPG measurement plays an important role in the assessment of the progression and prognosis of chronic liver diseases and is an effective predictor of outcome.
Abstract: Objective To investigate the diagnostic value of real- time tissue elastography (RTE) in evaluating liver fibrosis in patients with chronic hepatitis B (CHB) . Methods Eighty- six patients with CHB, who visited Beijing Tiantan Hospital and Beijing You'an Hospital from March to August, 2013, were grouped according to the pathological stages of liver fibrosis. They were examined by RTE, biochemical tests, and liver biopsy. Then, liver fibrosis index ( LFI) and aspartate aminotransferase- to- platelet ratio index ( APRI) were calculated. Comparison between groups was made by one- way analysis of variance, followed by LSD t- test for multiple comparisons. The correlation between LFI and pathological stage of liver fibrosis was analyzed by Spearman correlation test. The sensitivity and specificity of LFI for the diagnosis of liver fibrosis were calculated. Regarding S≥2 (significant liver fibrosis) and S≥4 (early liver cirrhosis) as the positive standards, the receiver operating characteristic (ROC) curve was drawn and compared with APRI. Results LFI differed significantly across the groups (P = 0. 000) , except the comparison between S0 and S1 (P = 0. 298) . LFI was significantly correlated with pathological stage (r = 0. 831, P < 0. 001) . The areas under the ROC curve of LFI in diagnosing significant liver fibrosis and early liver cirrhosis were0. 873 (P < 0. 001) and 0. 923 (P = 0. 002) , respectively; the diagnostic thresholds were 2. 74 and 3. 61, respectively; the sensitivity and specificity were 0. 766 /0. 872 and 0. 833 /0. 878, respectively. LFI was significantly superior to APRI. Conclusion RTE has high diagnostic values for significant liver fibrosis and early liver cirrhosis and is an important noninvasive diagnostic method for liver fibrosis in patients with CHB.
Abstract: Objective To evaluate the value of transient elastography (FibroScan, FS) in predicting hepatic fibrosis in patients with HBeAg- negative chronic hepatitis B (CHB) . Methods One hundred and four patients with HBeAg- negative CHB, who were diagnosed and treated in Hubei Hospital of Traditional Chinese Medicine from June 2011 to May 2013, were enrolled in this study. All patients underwent FS for liver stiffness measurement before liver biopsy. Statistical analysis was applied to compare liver stiffness (kPa) with fibrosis stage (determined by liver biopsy) . The receiver operating characteristic ( ROC) curve of FS was constructed, and the area under the ROC curve (AUC) was calculated to analyze the accuracy of live stiffness in predicting significant fibrosis and cirrhosis. Comparison between groups was made by Kruskal- Wallis H test, followed by Mann- Whitney U test for multiple comparisons. The correlation between two variables was analyzed by Spearman rank and Pearson correlation test. Results Liver stiffness gradually rose as the degree of hepatic fibrosis increased, with significant differences between groups (P < 0. 01 or P < 0. 05) . Liver stiffness was positively correlated with the stage of hepatic fibrosis (r =0.810, P <0.01) . The AUC of liver stiffness for detecting liver cirrhosis was 0.956; the cut-off value for diagnosing liver cirrhosis was13. 1 kPa; the sensitivity was 92. 7%, and the specificity was 80%. Conclusion FS is a promising noninvasive method for the assessment of hepatic fibrosis in patients with HBeAg- negative CHB; particularly, it has high accuracy in the diagnosis of liver cirrhosis. FS combined with direct or indirect markers may play an important role in differential diagnosis and efficacy evaluation in patients with hepatic fibrosis.
Abstract: Objective To compare the diagnostic values of FibroScan and FibroTouch for liver fibrosis. Methods A total of 962 patients who visited Department of Hepatology, The First Hospital of Jilin University from September 2013 to March 2014 were enrolled. FibroScan and FibroTouch were performed among these patients. Thirty- three cases underwent liver biopsy, and Aspartate aminotransferase- to-platelet ratio index (APRI) was calculated in 66 patients (chronic hepatitis B (CHB) : 53 cases; chronic hepatitis C (CHC) : 13 cases) .Spearman rank correlation test was used to analyze the correlation between the results measured by FibroScan and FibroTouch. The diagnostic values of FibroScan and FibroTouch for liver fibrosis were analyzed and compared by receiver operating characteristic (ROC) curve. Results The analysis of liver stiffness measured by FibroScan and FibroTouch among all patients showed that the correlation coefficient between FibroScan and FibroTouch was 0. 866 (P < 0. 05, n = 962) . FibroScan and FibroTouch were significantly correlated with APRI (r = 0. 58 and0. 63, P < 0. 05, n = 66) and pathological stage determined by liver biopsy (r = 0. 67 and 0. 74, P < 0. 05, n = 33) . Among patients with CHB, for the diagnosis of APRI ≥2 (liver cirrhosis) , the areas under the ROC curve (AUCs) of FibroScan and FibroTouch were 0. 761 vs0. 728 (P = 0. 61) ; among patients with CHC, for the diagnosis of APRI ≥1 (liver cirrhosis) , the AUCs of FibroScan and FibroTouch were0. 810 vs 0. 893 (P = 0. 38) . For pathological stages ≥S1, ≥S2, ≥S3, and ≥S4, the AUCs of FibroScan and FibroTouch were 0. 830 vs0. 889 (P = 0. 15) , 0. 841 vs 0. 835 (P = 0. 90) , 0. 888 vs 0. 920 (P = 0. 43) , and 0. 964 vs 0. 979 (P = 0. 45) , respectively. Conclusion FibroScan and FibroTouch have comparable diagnostic values for liver fibrosis. However, the number of cases undergoing liver biopsy in this study was relatively small, and investigation of more cases is needed to make further confirmation.
Abstract: Objective To observe the changes in degree of varices, red signs, and portal hypertensive gastropathy in liver cirrhosis patients with esophageal variceal bleeding (EVB) after endoscopic variceal ligation ( EVL) , endoscopic injection sclerotherapy ( EIS) , and tissue adhesive injection (TAI) . Methods A retrospective analysis was performed on 75 patients with EVB, who were initially treated with EVL, EIS, or TAI in our hospital from September 2011 to September 2013. At 2- 4 weeks after operation, gastroscopy was performed to evaluate the changes in the number and diameter of varices, red signs, and portal hypertensive gastropathy. Within- group comparison was made by paired t test, and comparison of rates was made by chi- square test. Results The number and diameter of varices decreased significantly after endoscopic therapy (3. 08 ± 0. 96 vs 3. 75 ± 0. 60, t = 5. 26, P < 0. 05; 1. 05 ± 0. 46 cm vs 1. 49 ± 0. 26 cm, t = 9. 84, P < 0. 05) .The rate of red signs also decreased significantly after operation (26. 67% vs 57. 33%, χ2= 14. 48, P < 0. 05) . However, the rate of portal hypertensive gastropathy decreased nonsignificantly after treatment (70. 67% vs 72. 00%, χ2= 0. 03, P > 0. 05) . Conclusion EVL, EIS, and TAI are effective and safe in liver cirrhosis patients with EVB.
Abstract: Objective To investigate the relationship of serum Th1 /Th2 cytokine levels with liver function and their clinical significance in patients with alcoholic liver cirrhosis (ALC) . Methods Thirty- four ALC patients, 13 patients with viral liver cirrhosis ( VLC) , and 17healthy controls were included in the study. Serum levels of Th1 cytokines (tumor necrosis factor (TNF) α, interferon (IFN) γ, and interleukin (IL) - 12) and Th2 cytokines (IL- 10, IL- 4, IL- 6, and IL- 13) were measured by cytometric bead array, and their correlations with Child- Pugh classification, model of end- stage liver disease (MELD) score, and biochemical parameters of liver function were analyzed. Comparison between multiple groups was made by Kruskal- Wallis H test, and comparison between two groups was made by Mann-Whitney U test. Correlation analysis was performed by Spearman rank test. Results The Th1 ( TNFα and IFNγ) /Th2 ( IL- 10, IL- 4, and IL- 13) cytokine levels in ALC group were significantly lower than those in healthy control group ( P < 0. 05) , and these indices decreased nonsignificantly as the Child- Pugh class increased. Compared with VLC patients, ALC patients had significantly increased Th1 /Th2 cytokine levels except IL- 4 level (P < 0. 05) . In ALC patients, TNFα, IL- 10, and IL- 13 levels were positively correlated with prothrombin time activity (P < 0. 05) but negatively correlated with total bilirubin and MELD score (P < 0. 05) ; especially, the levels of IL-10, IL- 13, IL- 4, TNFα, and IFNγ were negatively correlated with daily alcohol consumption (P < 0. 05) . Conclusion The expression of Th1 /Th2 cytokines is significantly reduced in ALC patients and is correlated with alcohol intake and liver function damage. Monitoring serum Th1 /Th2 cytokine levels in ALC patients is helpful for clinical treatment and prognostic evaluation.
Abstract: Objective To observe the therapeutic efficacy and safety of adefovir dipivoxil (ADV) alone versus combined with lamivudine (LAM) in the treatment of LAM- resistant HBeAg- positive chronic hepatitis B (CHB) . Methods Forty patients with LAM- resistant HBeAg- positive CHB were randomly assigned to monotherapy group (n = 20) and combination therapy group (n = 20) . The monotherapy group received ADV alone, while the combination therapy group received ADV combined with LAM. After 24 and 48 weeks of treatment, serum HBV DNA level, undetectable HBV DNA rate, HBeAg loss rate, alanine aminotransferase ( ALT) normalization rate, adverse reactions, and drug resistance were assessed. The two groups were compared by t- test for continuous data and chi- square test for categorical data. Results There were no significant differences in sex, age, and pretreatment levels of serum HBV DNA and ALT between the two groups (P > 0. 05) . After 48 weeks of treatment, serum undetectable HBV DNA rate and ALT normalization rate for the combination therapy group were 90% and 95%, respectively, significantly higher than those for the monotherapy group (60% and 65%) (P < 0. 05) ; there was no significant difference in HBeAg loss rate between the combination therapy group and monotherapy group (45% vs 35%, χ2= 0. 417, P =0. 519) . Conclusion ADV alone or combined with LAM has good clinical efficacy in the treatment of LAM- resistant HBeAg- positive CHB. However, the combination therapy can increase undetectable HBV DNA rate and ALT normalization rate and has good safety, and it holds promise for clinical application.
Abstract: Objective To evaluate the efficacy of lamivudine and thymosin alpha- 1 combination therapy in the treatment of HBeAg- positive chronic hepatitis B (CHB) by meta- analysis. Methods Randomized controlled trials (RCTs) of lamivudine and thymosin alpha- 1combination therapy in treatment of HBeAg- positive CHB (follow- up for at least 24 weeks) , from January 1998 to date, were identified by searching Cochrane Library, PubMed, EMBASE, EBSCO, CNKI, Wanfang Data, and CQVIP. Lamivudine monotherapy RCTs were searched for in the same way as control tests. Efficacy was measured by odds ratio. Meta- analysis was carried out with RevMan 5. 2 software. Results Nine RCTs involving 600 patients were included, with 320 cases in the combination therapy group and 280 in the control group. At the end of follow- up, the combination therapy group had significantly higher serum ALT recovery rate, HBV- DNA negative conversion rate, HBeAg negative conversion rate, and HBeAg seroconversion rate than the control group ( P < 0. 01 for all) , with pooled odds ratios (95% confidence intervals) of 4. 84 (3. 28, 7. 16) , 2. 09 (1. 45, 3. 01) , 5. 32 (3. 35, 8. 46) , and 6. 22 (3. 78, 10. 25) , respectively. Conclusion Lamivudine and thymosin alpha- 1 combination therapy is more likely to achieve sustained response rate than lamivudine monotherapy for HBeAg- positive CHB. More RCTs of high quality and large scale are required to verify this conclusion.
Objective To investigate the association of cholecystectomy with non- alcoholic fatty liver. Methods The 110 adults treated by cholecystectomy, who underwent physical examination in the Third Affiliated Hospital of Southern Medical University from January 2011to December 2013, were included in the study. None of the subjects had a history of viral hepatitis and alcohol abuse. All subjects underwent CT scanning and measurement of serum triglyceride and cholesterol levels to confirm the diagnosis of non- alcoholic fatty liver. Results Among the 110 subjects, 42 (38. 18%) had non- alcoholic fatty liver, including 28 males (45. 90%) and 14 females (28. 59%) ; 78 (70.91%) had increased blood lipids, and 32 (29.09%) had normal blood lipids. Conclusion Cholecystectomy may be a risk factor for NAFLD.
Abstract: Objective To investigate the clinical experience of laparoscopic cholecystectomy (LC) for acute cholecystitis. Methods A retrospective analysis was performed on the clinical records of 216 patients with acute cholecystitis who underwent LC in Qingpu Branch of Zhongshan Hospital, Fudan University from January 2010 to January 2013. LC was performed under intubation general anaesthesia, with three holes conventionally and four holes if necessary. After operation, the drainage tube was placed for 1- 3 d, and antibiotics were administered for 3-5 d. The time of operation, length of postoperative hospital stay, and incidence of postoperative complications were determined. All patients were followed up for at least 0. 5 year after operation. Results LC was successfully performed in 188 (87. 0%) of all patients; 28 (13. 0%) of all patients were converted to open surgery. The mean time of operation was 62. 00 ± 11. 27 min; the mean length of hospital stay was 4. 60± 2. 16 d; the incidence of postoperative complications was 2. 3% (5 /216) . All patients were cured and discharged. During follow- up, no patients developed other complications and all recovered well. Conclusion LC is safe and feasible in the treatment of acute cholecystitis. Correct manipulation of the Calot's triangle and proper abdominal drainage are the key to successful operation.
Abstract: Objective To investigate the approach to laparoscopic cholecystectomy (LC) in the treatment of complicated gallbladder disease. Methods A retrospective analysis was performed on the clinical data of 81 patients with complicated gallbladder disease admitted to the Department of General Surgery in our hospital from August 2007 to November 2013, including 66 cases of acute cholecystitis, 14 cases of atrophic cholecystitis, and 1 case of Mirizzi syndrome. All laparoscopic operations were completed using the aspirating dissector and ultrasonic knife and lasted for 1. 5- 3 h. Results LC was successfully completed in 79 cases. One case had common hepatic duct injury during operation, which was treated by laparoscopic suture repair; one case had intraoperative bleeding and was converted to laparotomy; one case was suspected of having Mirizzi syndrome before operation and was converted to laparotomy after the syndrome was confirmed during operation.Conclusion Laparoscopic cholecystectomy is safe and feasible in the treatment of complicated gallbladder disease. The key to successful treatment is preoperative evaluation of this disease, intraoperative use of aspirating dissector and ultrasonic knife for dissecting the Calot triangle, antegrade resection combined with retrograde resection, and total resection combined with partial resection, which can effectively avoid intraoperative hemorrhage and bile duct injury.
Abstract: Objective To observe the efficacy of duodenoscopic treatment of biliary ascariasis while preserving the function of the duodenal sphincter and to explore the feasibility of this technique as the preferred method for treatment of biliary ascariasis. Methods A retrospective analysis was performed on the clinical data of 69 patients with biliary ascariasis who received duodenoscopic treatment while preserving the function of the duodenal sphincter in our department from 2007 to 2013. Results All the 69 patients with biliary ascariasis not only preserved the function of the duodenal sphincter, but also had the biliary ascarids successfully removed. The patients were discharged 2- 3 days later and then received conventional helminthic treatment. No patients developed complications such as acute pancreatitis, bleeding, and perforation. Conclusion Duodenoscopic treatment of biliary ascariasis while preserving the function of the duodenal sphincter is safe and effective and causes fewer surgical complications, so it should be considered as the preferred method for treatment of biliary ascariasis.
Objective To evaluate the efficacy of antiviral therapy in hepatocellular carcinoma (HCC) patients with high HBV DNA levels after radical resection. Methods A retrospective analysis was performed on the clinical data of 113 HCC patients with high HBV DNA levels who underwent radical resection from January 2007 to January 2010. These patients were divided into treatment group (n = 74) and control group (n = 39) . In addition to liver- protecting therapy and supportive care, antiviral therapy was given to the treatment group, but not in the control group. All patients were followed up after operation, and the two groups were compared in terms of HBV DNA level, tumor recurrence rate, and survival rate. Comparison between the two groups was made by t test or chi- square test; the Kaplan- Meier method was used to calculate postoperative survival rates, and the log- rank test was used for survival difference analysis. Results After operation, the treatment group had a continuously decreased HBV DNA level, which was significantly lower at 6, 12, and 24 months after operation than before operation (t = 14. 38, 18. 50, 16. 22, P < 0. 05) ; there were significant differences in HBV DNA levels at 6, 12, and 24 months after operation between the treatment group and control group ( t = 13. 19, 24. 20, 14. 15, P < 0. 05) . The 3- year disease- free survival (DFS) rate showed significant difference between the two groups after operation (P =0.029) . The 1-, 2-, and 3-year cumulative survival rates were 95. 95%, 85. 14%, and 75. 68%, respectively, in the treatment group and 87. 18%, 69. 23%, and 53. 85%, respectively, in the control group; the treatment group had a significantly higher 3- year cumulative survival rate than the control group (P = 0. 016) .Conclusion Antiviral therapy can increase 3- year DFS rate and prolong postoperative survival in HCC patients with high HBV DNA levels after radical resection. Thus, antiviral therapy should be performed early, regularly, and persistently in HCC patients with high HBV DNA levels.
Objective To investigate the value of combined detection of serum alpha- fetoprotein (AFP) and Golgi protein- 73 (GP73) in the diagnosis of hepatocellular carcinoma (HCC) and to provide a basis for early diagnosis and differential diagnosis of HCC. Methods A total of 408 patients hospitalized in Baoji Central Hospital from June 2012 to May 2013, as well as healthy persons who had normal test results in physical examination, were included in the study, and their specimens were collected. These patients were classified into HCC group (n =142) , chronic hepatitis group (n =156) , and liver cirrhosis group (n =110) . Serum levels of AFP and GP73 in the three groups were measured by electrochemiluminescence immunoassay and double- antibody sandwich enzyme- linked immunosorbent assay, respectively.Comparison of test results between groups was made by analysis of variance, and comparison of rates was made by chi- square test. The sensitivity and specificity of the two indicators for the diagnosis of HCC were calculated using MedCalc statistical software. Results The HCC group had significantly higher serum AFP and GP73 levels than the liver cirrhosis group and chronic hepatitis group ( P < 0. 05) ; the liver cirrhosis group had significantly higher serum AFP and GP73 levels than the chronic hepatitis group (P < 0. 05) . The sensitivity and specificity of the two indicators for the diagnosis of HCC were 95. 8% and 98. 6%, respectively, showing significant differences compared with those of each indicator alone (P < 0. 05) . Conclusion Combined detection of serum AFP and GP73 has high diagnostic value and clinical significance for HCC, and they can be used as indicators for early diagnosis and differential diagnosis of HCC.
Objective To study the features of Kawasaki disease (KD) with liver damage and investigate the possible related factors, and to improve the understanding of liver damage in KD patients. Methods The clinical data of 75 KD patients admitted from 2008 to 2013 were collected to retrospectively analyze the clinical features of liver damage, as well as routine blood test, C- reactive protein (CRP) , erythrocyte sedimentation rate (ESR) , liver function, and abdominal ultrasound. Categorical data were analyzed by chi- square test; continuous data were expressed as mean ± standard deviation; comparison between groups was made by t test and multivariate stepwise regression analysis. Results The incidence of abnormal alanine aminotransferase (ALT) level in 75 cases was 32%, and 79. 2% of these patients had a serum ALT level of less than 200 IU /L, including 3 patients with hepatomegaly, 1 patient with jaundice, and 1 patient with splenomegaly, which accounted for 12. 5%, 4. 2%, and 4. 2%, respectively, of patients with liver damage. CRP and ESR were not found to be related to liver damage (t = 1. 560, P = 0. 123; t = 1. 291, P = 0. 201) . There was significant difference in platelet count between patients with liver damage and controls (t =- 3. 228, P = 0. 003) . No significant difference in white blood cell (WBC) count increase was found between the liver damage group and control group, but simultaneous increase in WBC count and platelet count was significantly associated with an increased risk of liver damage (P < 0. 05) . Conclusion CRP and ESR are not found to be significantly related to the development of liver damage, but there is a close relationship between liver damage and abnormal platelet count. WBC count shows a certain relationship with liver damage. Clinicians should pay attention to these factors and take timely measures for intervention.
Objective To investigate the significance of serum cystatin C (CysC) level for the early diagnosis of acute kidney injury (AKI) in patients with acute- on- chronic liver failure (ACLF) . Methods Sixty patients with chronic hepatitis B- related ACLF and 60 patients with CHB, as well as 60 healthy controls, were included in the study. The ACLF patients were followed up until discharge, and serum samples were collected during hospital stay. Serum CysC level was measured by latex- enhanced immunoturbidimetric assay. The receiver operating characteristic (ROC) curves of serum CysC, creatinine (Cr) , and sodium levels for the diagnosis of AKI were drawn, and the areas under the ROC curves (AUCs) and optimal cut- off values were determined. For normally distributed measurement data, comparison between groups was made by one- way analysis of variance, and multiple comparisons were made by two- sided t test; otherwise, comparison between groups was made by Mann- Whitney U test. Enumeration data were analyzed by chi- square test. The Pearson correlation test was used for correlation analysis. The AUCs and optimal cut- off values were calculated by Medcal 12. 7. 1. 0. Results The serum CysC level in ACLF patients was 1050 ± 444 ng /ml, which was significantly higher than those in healthy controls (638 ± 275 ng /ml, P = 0. 016) and CHB patients (661 ± 225 ng /ml, P = 0. 028) ; for ACLF patients, serum CysC level was not significantly correlated with serum Cr level (r =0.311, P >0.05) , but showed a significant positive correlation with MELD score (r =0. 529, P <0. 01) . During hospital stay, 8 (13.3%) of ACLF patients developed AKI. The multivariate logistic regression analysis indicated that serum CysC level was the independent risk factor for AKI development in ACLF patients (OR = 1. 008, P = 0. 021) . The cut- off value of serum CysC level for the early diagnosis of AKI in ACLF patients was 1210 ng /ml. Conclusion Elevated serum CysC level may provide an early prediction of AKI development in ACLF patients with a normal serum Cr level during hospital stay.
Objective To summarize the complications of subclavian catheterization in severe hepatitis patients and to investigate clinical safety and treatment. Methods Five hundred and six cases of severe hepatitis, who underwent subclavian catheterization before non- bioartificial liver operation like double plasma molecular adsorption system, were enrolled. Intraoperative and postoperative adverse reactions were under close observation and recording. Results Of all patients, 492 (97. 2%) were punctured and catheterized successfully, and 38 (7.5%) developed complications, including local hematoma and bleeding at puncture sites (15 cases) , catheter infection (13 cases) , and catheterization into the subclavian artery (10 cases) . Conclusion Subclavian catheterization has a high success rate, and is sufficient to meet the need of clinical rescue and treatment. Most complications would not interfere with treatment outcome after proper disposal. Subclavian catheterization can be safely applied to severe hepatitis patients with coagulation disturbance.
Objective To investigate the clinical significance of late- onset abnormal elevation of transaminase after hepatectomy. Methods A retrospective analysis was performed on the clinical data of 15 patients with abnormal elevation of transaminase after partial hepatectomy, who were admitted to our center from March 2009 to March 2012. The clinical implication of different types of late- onset elevation of transaminase was analyzed. Comparison between groups was made by t test or chi- square test. Results There were two different populations with abnormal elevation of transaminase after operation. There were differences in time of postoperative transaminase elevation, duration of transaminase elevation, and peak level of transaminase between survival cases and death cases. Conclusion Abnormal elevation of transaminase after hepatectomy is not commonly seen in clinical practice. The patients with late- onset elevation of transaminase at 3- 5 d after operation have poor prognosis, which should be given enough attention.
Abstract: Bacteremia is a common complication in patients with liver cirrhosis, and its incidence rises as the severity of liver disease increases. Liver cirrhosis complicated by bacteremia will lead to poor prognosis. The research progress in liver cirrhosis complicated by bacteremia is reviewed from the following aspects: risk factors, diagnostic points, treatment methods, prevention, and prognosis. It is believed that early prevention and treatment of bacteremia have great significance for the prognosis of patients with liver cirrhosis.
Abstract: In patients with liver cirrhosis, variceal bleeding is a common fatal complication of portal hypertension. Varices are present in almost half of patients with cirrhosis at the time of diagnosis. Since transjugular intrahepatic portosystemic shunt (TIPS) was first applied clinically in 1988, the relevant information about TIPS has been continually updated and perfected by lots of clinical trials. The role of TIPS in the prevention and treatment of variceal bleeding in cirrhotic patients with portal hypertension, including primary prevention of variceal bleeding, treatment of acute variceal bleeding, and prevention of rebleeding, is reviewed. TIPS is an effective treatment for variceal bleeding in cirrhotic patients with portal hypertension. Along with the technical development, TIPS will be available for more and more patients and will play an increasingly important role in the prevention and treatment of variceal bleeding among cirrhotic patients with portal hypertension.
Abstract: Objective and accurate assessment of liver fibrosis in patients with chronic hepatitis B (CHB) helps to choose the correct therapeutic scheme and guide the clinical treatment. In recent years, the noninvasive diagnostic models for liver fibrosis have been constantly emerging, but no consensus has been reached in this regard. The research advances in noninvasive regression models for liver fibrosis in patients with CHB are reviewed according to different staging methods for liver fibrosis, and the existing models are analyzed in terms of problems and shortages.It is thought that further studies should be done to establish simpler, more effective models that have higher diagnostic values.
Abstract: Epithelial- mesenchymal transition (EMT) , which means the transformation of epithelial cells into mesenchymal cells under the influence of cytokines, leading to pathological changes in tissues. According to recent research findings, EMT plays an important role in organ fibrosis. Various types of EMT in the fibrosis of hepatobiliary system, as well as the characteristics of each stage and the disease progression, are described, which is of great significance for understanding the development, termination, and even reversion of EMT and fibrosis of hepatic and biliary epithelial cells.
Abstract: During the development and procession of liver fibrosis, peroxisome proliferator- activated receptor (PPAR) α and γ are in charge of the regulation of lipid metabolism, fatty acid metabolism, anti- liver fibrosis, etc., and are closely related to fat metabolism- related enzymes. As a key enzyme in fat metabolism, acyl- CoA synthetase long- chain family member 1 (ACSL1) is involved in lipid synthesis and catabolism and then causes lipid deposition and inflammation in the liver, so it directly or indirectly promotes hepatic fibrosis. The biological functions and roles of PPAR α and γ and ACSL1 are reviewed; the action mechanisms of PPAR α and γ in the transcriptional regulation of ACSL1 are briefly described; the regulatory effects of PPAR α and γ on ACSL1 and their effects on the progression of hepatic fibrosis are analyzed from the aspects of liver lipid metabolism and hepatic stellate cell activation. It is pointed out that in the liver PPAR α andγ are directly or indirectly involved in the progression of hepatic fibrosis by regulating ACSL1.
Abstract: With the progress in research on portal hypertension in recent years, portal hypertensive biliopathy (PHB) has attracted more and more attention. The pathophysiology and clinical manifestations of PHB, as well as the main methods for the diagnosis and treatment of this disease, are briefly described. The pathogenesis of PHB remains unclear, and it has been postulated that the external pressure of portal cavernoma and the ischemic stricture of the bile duct may play a role. Magnetic resonance cholangiopancreatography is the primary diagnostic tool for PHB. Currently, it is thought that asymptomatic PHB patients do not require any treatment, and symptomatic PHB patients should receive individualized treatment, which mainly included reducing portal pressure and relieving biliary obstruction. Transjugular intrahepatic portosystemic shunt has become the first- line therapy for symptomatic PHB. More research and practice are needed for further understanding of PHB.