中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

2013 No. 9

Display Method:
Editorial
Acute- on- chronic liver failure: from pathophysiology to clinical practice
Li JunFeng, Duan ZhongPing
2013, 29(9): 641-644. DOI: 10.3969/j.issn.1001-5256.2013.09.001
Abstract:
Acute- on- chronic liver failure ( ACLF) is a clinical syndrome with rapid liver function decompensation as a result of chronic liver disease. As a clinical entity characterized by rapid progression, requirement for multiple organ support therapy, and a short- and medium- term mortality up to more than 50%, it has received wide attention in the past decade. Due to its complex pathogenesis, no consensus has been reached on the definition of ACLF. Therefore, starting with our current understanding of this disease, we reviewed how ACLF came to be increasingly recognized in the medical community and what differences exist in the understanding of the ACLF concept between China and other countries, analyzed important pathophysiological changes and characteristics of ACLF, and proposed new therapeutic concepts and methods based on the pathophysiology. Taken together, under the guidance of the pathophysiology of the disease, clinical management of ACLF will achieve better therapeutic effect and prognosis in future.
Therapeutic guidelines
Introduction to the revised American Association for the Study of Liver Diseases practice guideline management of adult patients with ascites due to cirrhosis 2012
Zhu Peng, Wang YuMing
2013, 29(9): 645-646. DOI: 10.3969/j.issn.1001-5256.2013.09.002
Abstract(4128) PDF (554KB)(1061)
Abstract:
Recommendations of management of adult patients with ascites due to cirrhosis: update 2012
Yang Li, Gao YanHang, Niu JunQi
2013, 29(9): 647-648. DOI: 10.3969/j.issn.1001-5256.2013.09.003
Abstract(3695) PDF (1176KB)(1063)
Abstract:
Paying attention to nutritional management of hepatic encephalopathy in patients with liver cirrhosis:  introduction to ISHEN consensus
Wang MaoRong
2013, 29(9): 649-651. DOI: 10.3969/j.issn.1001-5256.2013.09.004
Abstract:
Recommendation for the standardization of diagnosis and treatment of fatty liver disease
Expert Committee on the Diagnosis and Management of Fatty Liver Disease, Chinese Medical Association
2013, 29(9): 652-655. DOI: 10.3969/j.issn.1001-5256.2013.09.005
Abstract(3837) PDF (1207KB)(1007)
Abstract:
Discussions by experts
Progress in technology and clinical application of non- bioartificial liver support system
Liu XiaoHui, Guo HaiQing, Zhang Jing, Duan ZhongPing
2013, 29(9): 661-665. DOI: 10.3969/j.issn.1001-5256.2013.09.007
Abstract:
Several types of non- bioartificial liver support systems are now widely used in the treatment of severe hepatitis and liver failure, which are life- threatening diseases, but no consensus has been reached regarding its efficacy. The designs and results of high- level studies for evaluating the therapeutic effects of 6 common types of non- bioartificial liver are reviewed; considering the pathophysiological characteristics of liver failure and the mechanism of artificial liver, analysis and horizontal comparison are performed on the effectiveness of non- bioartificial liver, and the advantages and disadvantages of artificial liver and its indications are pointed out. In addition, the safety and strategy of clinical application of non- bioartificial liver, as well as the future demand and development in technical and clinical research in this field, are summarized.
Clinical implications of laboratory tests in liver failure and evaluation of new laboratory indices for liver failure
Nie QingHe
2013, 29(9): 666-669. DOI: 10.3969/j.issn.1001-5256.2013.09.008
Abstract:
As liver failure is associated with a complex etiology, complicated clinical types, a wide range of complications, rapid progression, and varied clinical interventions, it is difficult to use a single laboratory index to accurately evaluate the degree of liver function damage and accurately predict the prognosis of liver failure. With the recent emergence of a variety of novel biomarkers and biochemical indices for assessment of the prognosis of liver failure, extensive research work is needed to study how to combine these new indices with classic liver function tests and biochemical indices for prediction of the prognosis of liver failure. This effort will help to refine the existing scoring system and biomarkers for severity assessment and prognosis prediction of liver failure.
Investigation of artificial liver support system combined with stem cell transplantation in treatment of liver failure
He HongLiang, Li JianGuo, Gao ZhiLiang
2013, 29(9): 670-673. DOI: 10.3969/j.issn.1001-5256.2013.09.009
Abstract:
Currently, the main treatment strategies for liver failure include comprehensive medical treatment, artificial liver support system treatment, liver transplantation, and stem cell transplantation. In recent years, major progress has been made in liver failure treatment with artificial liver support system and stem cell transplantation. Non- bioartificial liver treatments commonly seen in the clinical setting, as well as the cell source, cell culture method, bioreactor, and clinical application of bioartificial liver, are reviewed. The mechanism and clinical application of stem cell therapy for liver failure are discussed. In view of the unsatisfactory clinical effect of artificial liver or stem cells alone in the treatment of liver failure, the feasibility of combination therapy with artificial liver and stem cells for liver failure is proposed.
Risk factors, diagnostic criteria, and drug discontinuation criteria for drug- induced liver injury
Yu Zheng, Jia JiDong
2013, 29(9): 674-677. DOI: 10.3969/j.issn.1001-5256.2013.09.010
Abstract:
Drug- induced liver injury ( DILI) is the liver injury caused by drugs or their metabolites, which is the common cause of live failure. Currently, there is still a lack of effective predictors and diagnostic and therapeutic methods for DILI. To gives an introduction to DILI from the aspects of risk factors, diagnostic criteria, causality assessment, etc. To understand the latest research progress in DILI can make for timely identification of patients susceptible to DILI; proper use of causality assessment can help standardize the diagnosis and treatment of DILI.
Original articles_Liver failure and liver support system
Determination of serum M30 and M65 levels and its clinical significance in patients with HBV- related acute- on-chronic liver failure
Zhu Bing, You ShaoLi, Wan ZhiHong, Liu HongLing, Rong YiHui, Zang Hong, Zhang AiMin, Xin ShaoJie
2013, 29(9): 678-680. DOI: 10.3969/j.issn.1001-5256.2013.09.011
Abstract:

Objective To determine the serum M30 and M65 levels in patients with HBV- related acute- on- chronic liver failure ( ACLF) and to investigate their association with this disease. Methods Thirty- one patients with HBV- related ACLF ( 20 cases with response to treatment and 11 cases without response to treatment) , 20 patients with chronic hepatitis B ( CHB) , and 10 healthy controls were enrolled in the study. Serum M65 and M30 levels were measured by enzyme- linked immunosorbent assay. Analysis of variance was used for comparison among groups; q- test was used for pairwise comparison. Results The serum M30 and M65 levels of ACLF patients ( 508. 65 ±340. 16 and 768. 75 ± 290. 02 U / L) were significantly higher than those of CHB patients ( 212. 27 ± 91. 33 and 384. 40 ± 134. 46 U / L) and healthy controls ( 94. 12 ± 17. 64 and 121. 99 ± 29. 25 U / L) ( P < 0. 05 for all comparisons) . In the ACLF patients, the serum level of M30was positively correlated with that of M65 ( r = 0. 78, P < 0. 05) ; no significant differences were seen between the cases with response to treatment and those without response to treatment in serum M30 and M65 levels ( 572. 38 ± 349. 45 vs 436. 14 ± 285. 59 U / L, P = 0. 29; 817. 25± 307. 66 vs 703. 90 ± 221. 37 U / L, P = 0. 31) . Conclusion Serum levels of M30 and M65 are sensitive indicators for the necrosis and apoptosis of hepatocytes. Significant increases in serum M30 and M65 levels are observed in patients with HBV- related ACLF.

Fatality and adverse event rates of prostaglandin E in treating acute liver failure: a meta- analysis
Chen XiaoHong, Wu ZongYing, Wang YiPing, Ceng Chao, Pan Tao
2013, 29(9): 681-684. DOI: 10.3969/j.issn.1001-5256.2013.09.012
Abstract:

Objective To evaluate the fatality and adverse event rates of prostaglandin E ( PGE) versus placebo in treating acute liver failure ( ALF) . Methods A search was performed using Cochrane Library, MEDLINE, EMBASE, VIP, CNKI, CBM, and other electronic databases to select randomized controlled trials ( RCTs) for comparing PGE and placebo in treating ALP published up to April 2012. There were no limits to language and publication. Data extraction and quality evaluation were performed independently by two researchers for the RCTs meeting inclusion criteria; a meta- analysis was performed with RevMan 5. 1 software, and the GRADE system was used to grade the quality of evidence and strength of recommendation. Results Two RCTs involving 59 cases met the inclusion criteria. Compared with the placebo, PGE could not reduce the fatality rate ( RR = 0. 99; 95% CI: 0. 62- 1. 57; P = 0. 96) , as demonstrated by the meta- analysis.Both interventions caused slightly adverse events, but no incidence rate was reported. Based on the GRADE system, the quality of evidence was low ( 2C) , and the strength of recommendation was weak. Conclusion PGE cannot reduce the fatality of ALF, according to the systematic review. Large- scale, high- quality basic and clinical researches should be performed to confirm the conclusion because the systematic review is secondary study, the literature included has low quality of evidence, and there may be bias in review.

Preliminary investigation of hybrid bioartificial liver support system in treatment of HBV- related acute- on- chronic liver failure
You ShaoLi, Liu HongLing, Rong YiHui, Zhu Bing, Zang Hong, Liu WanShu, Wan ZhiHong, Mao PanYong, Xin ShaoJie
2013, 29(9): 685-688. DOI: 10.3969/j.issn.1001-5256.2013.09.013
Abstract:

Objective To construct a hybrid bioartificial liver support system and to investigate its safety and efficacy in patients with hepatitis B virus ( HBV) - related acute- on- chronic liver failure ( ACLF) . Methods A hollow fiber bioreactor was constructed using cultured HepG2 cells transfected with human augmenter of liver regeneration gene. Patients with HBV- related ACLF who were hospitalized in our hospital from May2009 to August 2011 were randomly divided into treatment group ( n = 10) and control group ( n = 10) . The treatment group was treated using the hybrid bioartificial liver support system, while the control group was treated with conventional plasma exchange. Comparison of means between the two groups was made by independent- samples t test, and comparison of variables before and after treatment was made by paired t test. Results Of the 10 patients in treatment group, 7 had improvement in clinical symptoms and were discharged, 1 died of hepatic encephalopathy, 1 died of hepatorenal syndrome, and 1 died of liver failure after discharge. Of the 10 patients in control group, 5 survived, 1 underwent liver transplantation, and 4 died of liver failure. Before treatment, the treatment group and control group had model for end- stage liver disease ( MELD) scores of 24. 26± 2. 54 and 24. 71 ± 2. 79, respectively, without significant difference between the two groups ( t = 1. 971, P = 0. 064) . The treatment group had MELD scores of 21. 71 ± 2. 92, 22. 10 ± 4. 46, and 19. 90 ± 5. 43 after 3 days, 1 week, and 4 weeks, respectively, of treatment. At the end of one-year follow- up, the mean serum alpha- fetoprotein levels were 14. 24 ng / ml in treatment group and 11. 32 ng / ml in control group, and no space- occupying lesions in the liver were found through abdominal ultrasound. Conclusion The constructed hybrid bioartificial liver support system is effective and safe in the treatment of HBV- related ACLF.

Original articles_Liver fibrosis and liver cirrhosis
Therapeutic effect of telbivudine combined with Fuzheng Huayu tablets in treatment of liver fibrosis in chronic hepatitis B: a report of 60 cases
Dong XiaoPing
2013, 29(9): 689-691. DOI: 10.3969/j.issn.1001-5256.2013.09.014
Abstract:
Objective To investigate the therapeutic effect of telbivudine combined with Fuzheng Huayu tablets in the treatment of liver fibrosis in chronic hepatitis B ( CHB) . Methods A total of 120 patients with CHB, who were admitted to our hospital from July 2011 to November 2012, were randomly divided into treatment group ( n = 60) and control group ( n = 60) . All patients received antiviral and liver-protecting therapy with telbivudine; meanwhile, the treatment group was given Fuzheng Huayu tablets as an addition for 6 months. The liver function, four indices for liver fibrosis, and patient' s symptoms and signs were evaluated. The enumeration data were analyzed by chi-square test, and the measurement data were analyzed by t- test. Results After 6 months of treatment, the treatment group showed normalized aspartate aminotransferase ( AST) , albumin / globulin ratio ( A / G) , and total bilirubin ( TBil) as well as decreased alanine aminotransferase ( ALT) , and there were significant differences between the treatment group and control group in AST ( 33. 1 ± 15. 5 vs 39. 5 ± 18. 4, t = 2. 060, P < 0. 05) , A / G ( 1. 78 ± 0. 41 vs 1. 64 ± 0. 32, t = 2. 085, P < 0. 05) , TBil ( 13. 8 ± 6. 6 vs 17. 9 ± 8. 3, t = 3. 172, P <0. 05) , and ALT ( 55. 3 ± 23. 4 vs 64. 7 ± 27. 6, t = 2. 012, P < 0. 05) ; also, the treatment group showed significant improvements in hyaluronic acid ( HA) , laminin ( LN) , type Ⅲ procollagen peptide ( PⅢP) , and type Ⅳ collagen ( Ⅳ- C) , and there were significant differences between the treatment group and control group in HA ( 107. 7 ± 82. 3 vs 141. 6 ± 91. 4, t = 2. 155, P < 0. 05) , LN ( 125. 4 ± 73. 2 vs154. 9 ± 76. 5, t = 2. 135, P < 0. 05) , PⅢP ( 0. 61 ± 0. 56 vs 0. 96 ± 0. 44, t = 3. 266, P < 0. 05) , and IV- C ( 90. 6 ± 78. 3 vs 134. 3 ±67. 9, t = 3. 807, P < 0. 05) . In addition, the treatment group had alleviated lassitude, improved appetite, and palliated abdominal distension, demonstrating significant differences compared with the control group ( 71. 7% vs 53. 3%, P < 0. 05; 83. 3% vs 65. 0%, P < 0. 05;80. 0% vs 58. 3%, P < 0. 05) . Conclusion When used along with Fuzheng Huayu tablets, telbivudine has better performances in relieving symptoms, improving liver function, and reducing liver fibrosis in CHB patients with liver fibrosis.
Original articles_Biliary diseases
Causes and countermeasures of delayed hemobilia after endoscopic retrograde cholangiopancreatography
Wang JiHeng, Gao Ge, Shi JiuJian
2013, 29(9): 692-694. DOI: 10.3969/j.issn.1001-5256.2013.09.015
Abstract:
Objective To investigate the cause and treatment of delayed hemobilia after endoscopic retrograde cholangiopancreatography ( ERCP) . Methods A retrospective analysis was performed on the complications in 1007 patients after ERCP, and the 7 cases of delayed hemobilia were subjected to analysis of time of onset of bleeding, spectrum of disease, blood volume, and treatment process. Results All the bleeding patients had cholangitis. The bleeding occurred at 24 hours to 2 weeks after ERCP, with a small to medium volume of blood ( ≤1000 ml) . The conservative medical treatment produced a good outcome in these bleeding patients. Conclusion Delayed hemobilia after ERCP is rare and has a good prognosis following conservative medical treatment.
Original articles_Liver neoplasms
Therapeutic strategy for spontaneous rupture of primary hepatocellular carcinoma: report of 30 cases
Wang YuanXi, Li ZhiWei, Zheng Yu, Chen Jin, Tuo QingHua
2013, 29(9): 695-697. DOI: 10.3969/j.issn.1001-5256.2013.09.016
Abstract:

Objective To investigate the therapeutic strategy for spontaneous rupture of hepatocellular carcinoma ( HCC) . Methods A retrospective analysis was performed on the clinical data of 30 patients with HCC rupture hospitalized at our hospital from January 2008 to December2011, including nine patients treated by primary surgical tumor resection and 21 patients treated with emergency transcatheter arterial chemoembolization ( TACE) . Of the latter group, 10 patients underwent surgical tumor resection after TACE and the other 11 patients were treated with TACE alone. Treatment outcomes were evaluated and compared. Categorical data were compared using the chi- square test or Fisher's test. Results The success rate of hemostasis was 100% in the 21 patients treated with TACE, of whom 10 patients received tumor resection within 2- 5 weeks after TACE and HCC was confirmed by postoperative pathology. No peritoneal metastasis was noted three months after surgery. One- year survival rate was 70% ( 7 /10) . Of the nine patients treated by primary surgical tumor resection, two died during the perioperative period and five developed peritoneal or port- site metastasis within three months, and one- year survival rate was 44. 4% ( 4 /9) . For the 11 cases treated with TACE alone, one- year survival rate was 27. 3% ( 3 /11) . Conclusion TACE combined with surgical tumor resection is the preferred emergency treatment for spontaneous rupture of primary HCC. It can significantly increase the success rate of rescuing patients with HCC rupture and tumor resection rate, significantly decrease peritoneal metastasis rate, and prolong the survival of the patients.

Clinical significance of α- fetoprotein in initial diagnosis of primary hepatic cancer
Zhao ChunHua, Zhou WenFeng, Chen WeiHua, Xi Zhen, Zhang ChunMei
2013, 29(9): 698-701. DOI: 10.3969/j.issn.1001-5256.2013.09.017
Abstract:

Objective To investigate the value ofα- fetoprotein ( AFP) in the initial diagnosis of primary hepatic cancer ( PHC) . Methods A retrospective analysis was performed on the initial AFP measurement results and imaging findings of 177 patients who had relatively complete clinical data and had a confirmed diagnosis of PHC; 98 patients with chronic hepatitis B ( CHB) and 82 patients with post- hepatitis B cirrhosis ( PHBC) , who were admitted to our department in 2011, were enrolled as controls. The obtained data were subjected to statistical analysis using SAS software; the enumeration data were subjected to chi- square test. Results In the initial examination for the 177PHC patients, 93 ( 52. 54%) had a serum AFP level not lower than 400 ng / ml, 38 ( 21. 47%) had a serum AFP level between 20 ng / ml and 400 ng / ml, and 46 ( 25. 99%) had a normal serum AFP level; the abnormal rate of AFP level was 74. 01%, which was significantly higher than those of CHB group ( χ2= 106. 07, P < 0. 001) and PHBC group ( χ2= 67. 82, P < 0. 001) . Among the 177 PHC patients, 63 ( 35. 59%) had a serum AFP level lower than 400 ng/ml in the course of disease. The serum AFP level was significantly lower in patients with a tumor diameter not larger than 3 cm than in those with a tumor diameter larger than 5 cm ( χ2= 8. 62, P < 0. 005) . In the initial examination, serum AFP level yielded a significantly lower correct diagnosis rate than B- mode ultrasound ( χ2= 30. 39, P < 0. 000) and computed tomography ( χ2= 84. 83, P < 0. 000) . Conclusion The abnormal rate of AFP level is higher in PHC patients than in those with CHB and PHBC during initial examination, and the higher the serum AFP level, the higher its diagnostic value. There is a certain relationship between serum AFP level and tumor size. Attention should also be paid to those with negative results of AFP detection. Dynamic monitoring of AFP level combined with imaging examination is helpful for early and correct diagnosis.

Peroxisome proliferator- activated receptor gamma inhibits liver cancer proliferation and metastasis in vitro
Shen Bo, Nie YuQiang
2013, 29(9): 702-706. DOI: 10.3969/j.issn.1001-5256.2013.09.018
Abstract:

Objective To investigate the inhibitory effect of peroxisome proliferator- activated receptor gamma ( PPARγ) on the development, progression, invasion, and metastasis of liver cancer cells. Methods Hepatocellular carcinoma ( HCC) MHCC97L cells were randomly assigned to be transfected with Ad- PPARγ or Ad- LacZ ( control) . The cells were also exposed to PPARγ agonist rosiglitazone. Cell proliferation, apoptosis, migration, and invasive ability were evaluated using MTS assay, flow cytometry, wound healing test, and transwell invasion assay. Multiple comparisons of means between groups were conducted using one- way analysis of variance with Bonferroni correction; the means of two groups were compared using the t test. Results Ad- PPARγ transfection resulted in higher expression of PPARγprotein in HCC cells compared with control cells, which suppressed cell proliferation ( P < 0. 01) , induced cell apoptosis ( P < 0. 01) , and suppressed cell migration and invasion. Moreover, the invasiveness of HCC cells transfected with Ad- PPARγ was reduced by 20% ~ 60%.Rosiglitazone enhanced the inhibitory effect of Ad- PPARγ on the growth and migration of HCC cells. Conclusion PPARγ exerts an inhibitory effect on the proliferative, invasive, and metastatic potential of HCC cells in vitro. This study sheds new light on the search for potential markers and gene therapies for liver cancer.

Case reports
Case of subacute liver failure due to hyperthyroidism
Jing Jing, Luo ShengQiang, Gong Man, Sun YongQiang, Zhang Fan, Zhang Ning, Wu Xin, Liu HongHong
2013, 29(9): 707-708. DOI: 10.3969/j.issn.1001-5256.2013.09.019
Abstract:
Discontinuation of immunosuppressive therapy after liver transplantation: an analysis of one case
Lu: GuoYue, Wang ChuanLei, Sun XiaoDong, Qiu Wei, Du XiaoHong, Zhang Wei, Wang GuangYi
2013, 29(9): 709-710. DOI: 10.3969/j.issn.1001-5256.2013.09.020
Abstract:
Reviews
Research advances in oxidative stress and mitochondrial permeability transition in liver failure
Wang KeFei, Zhu YueKe, Meng QingHua
2013, 29(9): 711-714. DOI: 10.3969/j.issn.1001-5256.2013.09.021
Abstract(2639) PDF (688KB)(615)
Abstract:
Major treatment options for liver failure include clinical medical treatment, and prevention of complications) , artificial liver, liver transplantation, and stem cell transplantation. While these means are known to have produced favorable outcomes, some patients died due to acute and severe onset of disease or treatment delays. Oxidative stress has emerged as a research hotspot in recent years and antioxidant treatment has been drawing increasing attention. Outlines research developments in recent years and reviews the association of oxidative stress injury and mitochondrial permeability transition pore ( MPTP) with liver failure, in an effort to shed light on the importance of oxidative stress in the pathogenesis of liver failure and offer a theoretical basis and ideas for antioxidant therapy in the future.
Clinical utility of hepatic venous pressure gradient for predicting outcome and guiding treatment of cirrhosis and portal hypertension
Cao XunXun, Lu LunGen
2013, 29(9): 715-718. DOI: 10.3969/j.issn.1001-5256.2013.09.022
Abstract(3340) PDF (815KB)(670)
Abstract:
Measurement of the hepatic venous pressure gradient ( HVPG) remains the most commonly used method to assess portal hypertension ( clinically defined as above the normal range of 1- 5 mm Hg) . HVPG measurement can also serve as a predictor of variceal bleeding ( increased risk associated with >10-12 mm Hg) and as a prognostic indicator by which treating physicians may design appropriate therapeutic strategies for primary and secondary prophylaxis. The current treatments aim to reduce the HVPG to < 12 mm Hg or achieve a 20%reduction from baseline, both of which are associated with significantly lower risk of variceal bleeding and rebleeding. For primary prevention, non- selective beta- blockers, such as propranolol, are currently used; however, rebleeding incidence remains high and is frequently treated by a combination of drugs, including the non- selective beta- blockers, and endoscopic management, such as transjugular intrahepatic portosystemic shunting, endoscopic sclerotherapy, and endoscopic band ligation. We discuss the current HVPG measurement methods as well as the clinical applications, detailing its potential as a prognostic indicator of variceal bleeding and rebleeding in various liver conditions, such as cirrhosis, and in response to treatment.
Advances in treatment of primary biliary cirrhosis
Qin Hua, Bai ShiShan
2013, 29(9): 719-721. DOI: 10.3969/j.issn.1001-5256.2013.09.023
Abstract(2319) PDF (589KB)(630)
Abstract:
Primary biliary cirrhosis ( PBC) is a chronic progressive intrahepatic cholestatic disease of unknown cause, and its incidence is increasing year by year. The main therapies for PBC include ursodeoxycholic acid for cholestasis, glucocorticoid or immunosuppressant for abnormal immune response, and symptomatic treatment for complications; liver transplantation is suitable for end- stage cases. With continuous development and clinical application of new drugs, this paper reviews the latest global advances in the treatment of PBC over the last 5years. However, further study is needed to identify the radical treatment with fewest adverse effects.