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

2015 No. 1

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Editorial
Traditional Chinese medicine treatment of liver diseases
Wang RongBing
2015, 31(1): 2-6. DOI: 10.3969/j.issn.1001-5256.2015.01.001
Abstract:
Traditional Chinese medicine(TCM) treatment of liver diseases is derived from the regulation of liver function including storing blood and governing the free flow of qi,in which functional systems such as modern digestion,endocrine,and the gut-liver axis are involved,and is established on modern hepatic physiology,pathology,and etiology.To objectively reveal the characteristics and advantages of modern TCM treatment of liver diseases,we analyzed the clinical and research situation of TCM therapy for liver diseases in the last decade and collected major achievements that have been applied in clinical treatment of diseases,published in core journals,and confirmed by major scientific research programs.The results showed TCM combined with antiviral therapy can improve the clinical outcomes of chronic hepatitis B.TCM can help HBV carriers prevent disease progression.Integrated traditional Chinese and Western medicine therapy for acute-on-chronic liver failure can block the deterioration induced by endotoxin.TCM has been widely applied in protecting the liver through nonspecific anti-inflammation,alleviating hepatic fibrosis,and preventing non-alcoholic fatty liver.TCM plays an important role in treating some currently untreatable liver diseases.Therefore,it is our common responsibility to inherit and develop effective principle-method-recipe-medicines and create a better medical care system.
Therapeutic guidelines
Chinese consensus on the medical diagnosis and treatment of chronic cholecystitis and gallstones (2014, Shanghai)
Editorial Board of Chinese Journal of Digestion
2015, 31(1): 7-11. DOI: 10.3969/j.issn.1001-5256.2015.01.002
Abstract(3726) PDF (1558KB)(1073)
Abstract:
Diagnosis and treatment of cholangiocarcinoma: surgical expert consensus  
Chinese Chapter of International Hepato-Pancreato-Biliary Association,Hepatic Surgery Group, Chinese Society of Surgery, Chinese Medical Association
2015, 31(1): 12-16. DOI: 10.3969/j.issn.1001-5256.2015.01.003
Abstract(3215) PDF (1685KB)(1228)
Abstract:
Recommendations of ACG clinical guideline: the diagnosis and management of focal liver lesions
Zhu Peng, Chen Zhan, Wang YuMing
2015, 31(1): 21-24. DOI: 10.3969/j.issn.1001-5256.2015.01.005
Abstract:
Expert interpretation of the “KASL Clinical Practice Guidelines: Management of hepatitis C”
Ding Yang, Dou XiaoGuang
2015, 31(1): 25-29. DOI: 10.3969/j.issn.1001-5256.2015.01.006
Abstract:
Interpretation of the practice guidelines for alcoholic liver disease by EASL in 2012 and AASLD in 2010
Chang BinXia, Sun Ying, Teng GuangJu, Zhang Wei, Zhao Jun, Zou ZhengSheng, Li BaoSen
2015, 31(1): 30-34. DOI: 10.3969/j.issn.1001-5256.2015.01.007
Abstract:
Discussions by experts
Strategy for traditional Chinese medicine prevention and treatment of chronic hepatitis B
Gao YueQiu
2015, 31(1): 35-37. DOI: 10.3969/j.issn.1001-5256.2015.01.008
Abstract:

Abundant experience has been accumulated when it comes to the traditional Chinese medicine(TCM) prevention and treatment of chronic hepatitis B(CHB).However,there still exist some deficiencies such as insufficient randomized controlled trials(RCTs) and lack of attention to objective indices for therapeutic evaluation.Therefore,future clinical prevention and treatment should be tied closely to the research progress in the immune pathogenesis of CHB and give full play to the characteristics and advantages of TCM in modulating the functional status(including immunity) of human body.Moreover,clinical and translational research on the TCM regulation of immune response in CHB should be carried out to further improve clinical therapeutic effect.In addition,biochemistry,virology,and pathology should be applied actively in place of outcomes while paying attention to the symptoms of patients in an effort to improve the objectivity of therapeutic evaluation when summarizing clinical practice experience.Furthermore,RCTs should be employed as much as possible to enhance global recognition of the therapeutic effect of TCM treatment.And there is no doubt that bringing the advantages of integrated traditional Chinese and Western medicine therapy into full play will benefit a huge number of patients.

Progress and prospect of diagnosis and treatment of hepatic fibrosis by integrated traditional Chinese and Western medicine therapy
Wang XianBo, Sun Le
2015, 31(1): 38-41. DOI: 10.3969/j.issn.1001-5256.2015.01.009
Abstract:

In recent years,non-invasive methods for assessment of hepatic fibrosis have attracted more and more attention,and the application of non-invasive diagnostic techniques such as serum markers and transient elastography(Fibro Scan) for hepatic fibrosis is reviewed.Anti-fibrosis treatments should integrate etiological treatment,anti-inflammatory and liver-protecting therapy,and inhibiting the synthesis of extracellular matrix and degrading excessively deposited extracellular matrix.Antiviral treatment is the basis for resisting hepatic fibrosis due to chronic viral hepatitis.In this aspect,traditional Chinese medicine(TCM) has advantages in inhibiting the synthesis of extracellular matrix and degrading excessively deposited extracellular matrix,because it effects on multiple links,at multiple levels,and against multiple targets.So integrated traditional Chinese and Western medicine therapy is a promising treatment strategy.However,the benefit of integrative therapy against hepatic fibrosis still needs to be supported by rigorously designed,multicenter,large-sample clinical studies,and the mechanism of anti-fibrosis TCM treatment deserves further studies.

Clinical research progress in integrated traditional Chinese and Western medicine therapy for HBV-related liver failure
Li Jun
2015, 31(1): 42-47. DOI: 10.3969/j.issn.1001-5256.2015.01.010
Abstract:
Currently,hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF) and chronic liver failure(CLF) are the main clinical types of liver failure.This disease has complex,changeable,and accompanying syndromes,so the treatment is very difficult.In recent years,some progress has been made in the etiology and pathogenesis of liver failure,associated traditional Chinese medicine syndromes,and integrated traditional Chinese and Western medicine therapy.Consensus has gradually been reached on the etiology and pathogenesis of liver failure,which can be summarized as " dampness,heat,toxin,stasis,and deficiency".Evidence-based medicine is emphasized in the clinical study,which should be conducted in combination with Chinese conditions.Integrated traditional Chinese and Western medicine therapy for individualized intervention can effectively control complications,reduce the mortality of patients with liver failure,relive the clinical symptoms,and improve their quality of life.The preliminary mechanism has been revealed in regulating immunity and effectively controlling endotoxemia.
Study on TCM syndromes of liver failure and yang-supporting therapy
Mao DeWen, Tang Nong, Wang Na, Wang Sha, Long FuLi, Yi MinMing
2015, 31(1): 48-51. DOI: 10.3969/j.issn.1001-5256.2015.01.011
Abstract:
This paper reviews traditional Chinese medicine(TCM) physicians' understanding of liver failure including its TCM causes,mechanisms,positions,and syndrome differentiation in various dynasties.The results suggest that modern researchers agree with ancient physicians on these aspects of liver failure.Based on achievements of ancient TCM physicians,modern researchers have further developed and improved their understanding of TCM causes,mechanisms,positions,and syndrome differentiation of liver failure.Moreover,this paper discusses the treatment of chronic liver failure with yang-supporting therapy,which provides a novel perspective and method for treating chronic liver failure.
Progress in integrated traditional Chinese and Western medicine diagnosis and treatment for advanced schistosomiasis
Wu Liang, Tian DeYing
2015, 31(1): 52-57. DOI: 10.3969/j.issn.1001-5256.2015.01.012
Abstract:
Schistosomiasis is a dangerous infectious disease,and advanced schistosomiasis is a serious harm to people' s lives and health.Anthelmintic treatment alone cannot effectively prevent the development and progression of advanced schistosomiasis,especially liver fibrosis.This article introduces the pathogenesis,clinical manifestations,and integrated traditional Chinese and Western medicine therapy for advanced schistosomiasis.It is pointed out that integrated traditional Chinese and Western medicine therapy is an effective approach to the control of disease progression in patients with liver fibrosis.
Original articles_Integrated traditional and western medicine on hepatopancteatobiliary disease
Effect of kidney-tonifying and spleen-strengthening prescription on PD-1 and PD-L1 expression in HBeAg-positive chronic hepatitis B patients with slightly increased ALT levels
Zhou ZhenHua, Sun XueHua, Li Man, Zhu XiaoJun, Jin ShuGen, Zhang Xin, Gao YaTing, Gao YueQiu
2015, 31(1): 58-62. DOI: 10.3969/j.issn.1001-5256.2015.01.013
Abstract:

Objective To study the effect of kidney-tonifying and spleen-strengthening prescription(KTSSP) on the expression of programmed death-1(PD-1) and programmed death-ligand 1(PD-L1) in HBe Ag-positive chronic hepatitis B(CHB) patients with slightly increased alanine aminotransferase(ALT) levels.Methods This study included 32 HBe Ag-positive CHB patients with slightly increased ALT levels who were admitted to Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from September1,2010 to December 31,2013.These cases were divided into treatment group and control group using the randomized controlled method.Peripheral blood mononuclear cells were separated,and the expression levels of PD-1 on peripheral blood T lymphocytes and PD-L1 on dendritic cells were measured before and after treatment by flow cytometry.Comparison of continuous data between groups was made by independent-samples t test,while comparison of categorical data between groups was made by chi-square test.Results After treatment,the treatment group had a significantly reduced percentage of peripheral blood CD4+T cells with PD-1 expression(P < 0.01) and a significantly reduced mean fluorescence intensity(MFI) of PD-1 expression on CD4 + T cells(P < 0.05); there were significant differences in the percentage of CD 4+T cells with PD-1 expression and the MFI of PD-1 expression between the treatment group and control group(both P<0.05).After treatment,the treatment group had a significantly reduced percentage of peripheral blood CD8+T cells with PD-1 expression(P < 0.01) and a significantly reduced MFI of PD-1 expression on CD8+T cells(P < 0.01); there were significant differences in the percentage of CD8+T cells with PD-1 expression and the MFI of PD-1 expression between the two groups(both P < 0.05).After treatment,the treatment group had a significantly reduced MFI of PD-L1 expression on dendritic cells(P < 0.05) and myeloid dendritic cells(P < 0.01); there were no significant differences in the expression levels of PD-L1 on dendritic cells and myeloid dendritic cells between the two groups(both P >0.05).Conclusion For HBe Ag-positive CHB patients,KTSSP can reduce the expression levels of PD-1 on peripheral blood CD4+T and CD8+T cells and PD-L1 on dendritic cells and myeloid dendritic cells,which is associated with its clinical efficacy.

Efficacy of glycyrrhizin in patients with chronic severe hepatitis B:a meta-analysis
Mao HaiYing, Kang Tao, Yao Ling, Chen Qin
2015, 31(1): 63-67. DOI: 10.3969/j.issn.1001-5256.2015.01.014
Abstract:

Objective To systematically evaluate the efficacy and safety of glycyrrhizin in patients with chronic severe hepatitis B.Methods Literature published from January 1990 to July 2014 were searched in databases including Pub Med,Cochrane Library,CBMdisc,CNKI,VIP,and Wanfang Data.The randomized controlled trials comparing the efficacy of glycyrrhizin combined with internal comprehensive therapy versus internal comprehensive therapy alone in patients with chronic severe hepatitis B were included in the analysis.The methodological quality of included trials was independently assessed and the data were extracted.Meta-analysis was carried out with Review Manager Software 5.1,and the heterogeneity,sensitivity,and bias of the analysis were evaluated.Results Seven randomized controlled trials involving298 patients in the test group and 294 in the control group were included in the analysis.The results of meta-analysis showed that glycyrrhizin combined with internal comprehensive therapy was remarkably more effective than internal comprehensive therapy alone,indicated by significantly reduced mortality rate [relative risk(RR) = 0.56,95% confidenceinterval(CI) :0.42 ~ 0.76,P < 0.01],significantly decreased level of total bilirubin(TBil) [mean difference(MD) =-92.56,95% CI:-122.92 ~-62.20,P < 0.01],and significantly higher prothrombin activity(PTA) [mean difference(MD) = 11.14,95% CI:5.40 ~ 16.87,P < 0.01].No severe adverse reactions were found in all patients.Conclusion Glycyrrhizin can significantly reduce the mortality and improve TBil and PTA in patients with chronic severe hepatitis B.

Clinical efficacy of traditional Chinese medicine/herbal decoction combined with ursodeoxycholic acid for primary biliary cirrhosis:a meta-analysis
Du Ying, Fang Lei
2015, 31(1): 68-73. DOI: 10.3969/j.issn.1001-5256.2015.01.015
Abstract:

Objective To systematically evaluate the efficacy of traditional Chinese medicine / herbal decoction combined with ursodeoxycholic acid(UDCA) in the treatment of primary biliary cirrhosis(PBC),and to provide a reference for clinical medication.Methods Literature published before July 31,2014 was searched in databases as follows:Cochrane Library,Pub Med,China National Knowledge Infrastructure(CNKI),Chinese Scientific Journals Full-text Database(VIP),Chinese Biomedical Literature Database(CBM),and Wanfang Data.The randomized controlled trials(RCTs) comparing the efficacy of traditional Chinese medicine / herbal decoction combined with UDCA versus UDCA alone in PBC patients were included in the analysis.The methodological quality of included trials was assessed and the data were extracted,followed by meta-analysis using Rev Man 5.0 software.Results A total of 12 RCTs were included,involving 681 patients with 346 in the test group and 335 in the control group.The results of meta-analysis showed that,after 6 months of treatment,the overall response rate,improvement rate,and biochemical indices of liver function(ALT,ALP,GGT,and TBil) and hepatic fibrosis in the test group were significantly improved compared with those in the control group(all P < 0.05).There were no significant differences between the two groups in the immunological indices such as Ig A,Ig G,anti-mitochondrial antibody(AMA),and AMA M2 subtype(all P > 0.05).Conclusion Traditional Chinese medicine / herbal decoction combined with UDCA markedly improves the indices of hepatocellular necrosis and cholestasis,degree of hepatic fibrosis,and clinical symptoms in PBC patients after 6 months of treatment,but leads to no significant improvement in immunological indices.Due to the limited number of included RCTs and patients through systematic evaluation,and the presence of selection bias and publication bias,more double-blind randomized controlled trials with large sample size,multicenter involvement,and high quality are required to provide convincing evidence.

Clinical efficacy of Zisheng pills in treatment of adverse reactions in patients with primary hepatocellular carcinoma after transcatheter arterial chemoembolization
Liu XiaPing, Tao Yu, Wu ChunMing, Chen YongPing
2015, 31(1): 74-77. DOI: 10.3969/j.issn.1001-5256.2015.01.016
Abstract:

Objective To investigate the clinical efficacy of Zisheng pills in the treatment of adverse reactions in patients with primary hepatocellular carcinoma(HCC) after transcatheter arterial chemoembolization(TACE).Methods This study included 72 patients with liver cancer hospitalized in the Department of Liver Diseases and Department of Oncology,Wenzhou Hospital of Traditional Chinese Medicine,from June 2011 to May 2014.These cases were randomly divided into treatment group(n = 37) and control group(n = 35).All the patients were treated with TACE,as well as conventional symptomatic and supportive treatment.In addition,the treatment group was given Zisheng pills(one bag) three times a day for at least three consecutive months.Comparison of categorical data was made by chi-square test,while comparison of continuous data(expressed as mean ± SD) was made by t test.Survival comparison was made by Kaplan-Meier method and log-rank test.Results After the first TACE,there were significant differences in poor appetite and abdominal distension between the treatment group and the control group(P < 0.05); significant differences were also observed in CD3+and CD4+T lymphocytes between the two groups(P < 0.05).After the second TACE,there were significant differences in postoperative fatigue,poor appetite,and abdominal distension,as well as postoperative Karnofsky score,between the treatment group and the control group(P < 0.05); significant differences were also found in CD3+,CD4+,and CD8+T lymphocytes and CD4+/ CD8+ratio between the two groups(P < 0.05).The median survival time showed no significant differences between the treatment group and the control group(82 vs 74 weeks,P > 0.05),but the 2-year overall survival rate was significantly higher in the treatment group than in the control group(43.2% vs 20%,P < 0.05).Conclusion Zisheng pills have good clinical efficacy in the treatment of adverse reactions in liver cancer patients after TACE,and it can improve the symptoms and quality of life,regulate peripheral blood T lymphocyte subsets,and increase the 2-year overall survival rate.

Efficacy of Chaowei Zhikangyin in treatment of rat model of non-alcoholic fatty liver disease
Xiong Yan, Zhang ZhiJuan, Liu Peng, Wang Ya
2015, 31(1): 78-81. DOI: 10.3969/j.issn.1001-5256.2015.01.017
Abstract:

Objective To observe the efficacy of Chaowei Zhikangyin in the treatment of the rat model of non-alcoholic fatty liver disease(NAFLD).Methods A rat model of NAFLD was established by feeding 50 Sprague-Dawley rats with high-fat diet for 6 weeks and was confirmed by liver pathological examination.Then,the model rats were randomly divided into five groups:low-,medium-,and high-dose Chaowei Zhikangyin groups(given Chaowei Zhikangyin by gavage),Kezhi capsule treatment group(given a suspension of Kezhi capsules),and model group(orally given distilled water).In addition,control rats were fed with normal diet and then treated with distilled water.Six weeks later,the liver function,blood lipids,liver lipids,and liver histology were examined.Results All Chaowei Zhikangyin groups were superior to the model group in terms of alanine aminotransferase,aspartate aminotransferase,total cholesterol(TC),and triglyceride(TG) in serum and TC and TG in liver tissues(P < 0.05),but there were no significant differences between these Chaowei Zhikangyin groups and Kezhi capsule treatment group(P > 0.05).Different degrees of liver inflammation was observed in the model group and Chaowei Zhikangyin groups; however,the Chaowei Zhikangyin groups and Kezhi capsule treatment group had reduced liver inflammation compared with the model group(P < 0.05),and the Kezhi capsule treatment group showed a significantly more improvement than these Chaowei Zhikangyin groups(P < 0.05).Conclusion Chaowei Zhikangyin can improve liver function,reduce blood lipids,and inhibit liver inflammation in rats with NAFLD,and it has comparable efficacy to Kezhi capsules.This therapy can be used for treating NAFLD.

Original articles_Fatty liver
An epidemiological survey of prevalence and risk factors for fatty liver disease in adults residing in Yan'an,China
Qiao LiNa, Dai GuangRong, Zhang Jin, Shen Ni
2015, 31(1): 82-87. DOI: 10.3969/j.issn.1001-5256.2015.01.018
Abstract:

Objective To investigate the prevalence and major risk factors for fatty liver disease among adult residents in Yan'an,Shanxi Province,China.Methods The study enrolled healthy adults who had physical examination with complete clinical records in our hospital from February 2011 to March 2013.All participants underwent anthropometric measurement(height,weight,and blood pressure),biochemical and immunological tests(liver and renal function; blood glucose,lipids,and uric acid [UA]; viral markers),and ultrasound examination.Data analysis was performed using the t test,χ2test,and logistic regression analysis.Results A total of 6236 adult residents participated in the survey,who accounted for approximately 3.76 /1000 of the total population in Yan'an.There were 3532 males and 2704 females,with a mean age of 49.27 ± 12.93 years.Fatty liver disease was detected with ultrasound examination in 1602 participants(25.68%),among whom alcoholic,suspected alcoholic,and nonalcoholic forms accounted for 4.55%,7.08%,and 88.37%,respectively.The fatty liver group had a significantly higher prevalence of obesity,hypertension,hyperuricemia,higher-than-normal fasting serum glucose(FSG) level,diabetes mellitus,and dyslipidemia than the non-fatty-liver group(P < 0.001).Multiple regression analysis showed that age,gender(male),drinking,waist circumference,body mass index,high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),triglyceride(TG),UA,FSG,diabetes mellitus,and hypertension were influential factors for fatty liver disease,of which HDL-C was a protective factor.Compared with the normal FSG group,the impaired fasting glycaemia and diabetes groups were at an increased risk for fatty liver disease by 1.584-and 2.638-fold,respectively(P < 0.001).The risk increased by1.627-,1.796-,9.544-fold,respectively,in the overweight,grade I obesity,and grade Ⅱobesity groups versus the normal weight group(P< 0.001),by 1.638-and 3.648-fold in the moderate and heavy drinking groups versus the non-drinking group(P < 0.001),and by17.672-fold in the obesity plus drinking group versus the non-obesity or drinking group(P < 0.001).Moreover,the elevated systolic blood pressure,diastolic blood pressure,UA,TG,total cholesterol,and LDL-C groups and the reduced HDL-C group were at a significantly greater risk for fatty liver disease than the normal group,showing 1.835-,1.768-,1.821-,4.524-,1.569-,1.824-,and2.724-fold differences,respectively(P < 0.05).Abnormal TG and HDL-C levels were associated with the most significantly increased risk.Conclusion There is a high prevalence of fatty liver disease(mainly in a nonalcoholic form) among adult residents in Yan'an.Gender,age,obesity,drinking,disorder of glucose metabolism,hyperuricemia,hypertension,and hyperlipidemia are the major risk factors for this disease in the study area.

Original articles_Biliary diseases
Expression and significance of UCP-2 in rats with obstructive jaundice and bile flow restoration
Wen Nuan, Zhu YiXiang, Lu: RenGeng, Kang JiangHui, Han HongJun, Xu HanBin
2015, 31(1): 88-92. DOI: 10.3969/j.issn.1001-5256.2015.01.019
Abstract:

Objective To investigate the expression and significance of uncoupling protein 2(UCP-2) in rats with obstructive jaundice and bile flow restoration,and to explore the molecular mechanisms of metabolic disorders and oxidative damage caused by obstructive jaundice.Methods Thirty-six healthy male Wistar rats were randomly divided into six groups:sham-operation group(group A),obstructive jaundice for one week(group B),obstructive jaundice for two weeks(group C),obstructive jaundice for one week followed by recanalization for one week(group D),obstructive jaundice for ten days followed by recanalization for one week(group E),and obstructive jaundice for two weeks followed by recanalization for one week(group F).The serum levels of alanine aminotransferase(ALT),direct bilirubin(DBil),and total bilirubin(TBil) were measured.Morphological changes in hepatic tissues were observed under a light microscope.Expression of UCP-2 mRNA in hepatic tissues was assessed by RT-PCR.Results After induction of obstructive jaundice,the serum levels of ALT,DBil,and TBil in groups B and C were significantly elevated compared with those in group A(P < 0.05),and group C had even higher serum levels compared with group B(P < 0.05).Hepatic tissues of group B and C displayed pathological changes,including swelling of hepatocytes,infiltration of inflammatory cells,and bile duct hyperplasia in the portal area.Piecemeal necrosis of liver cells was observed in group C,which was accompanied by more serious pathological changes and increased proliferation of bile ducts and fibrous tissues.Compared with group A,groups B and C showed increased expression of UCP-2 mRNA in hepatic tissues(P < 0.05),and the increase was more prominent in group C(P < 0.05).After restoration of bile flow,the serum levels of ALT,DBil,and TBil in groups D,E and F decreased to varying degrees,and liver morphology tended to be normal.Expression of UCP-2 mRNA in group D was significantly higher than that in group B(P < 0.05),but lower than that in groups E and F(P < 0.05).Group F had significantly lower expression of UCP-2 mRNA than group C(P < 0.05).No significant difference in UCP-2 expression was observed between groups E and F(P > 0.05).Conclusion Expression of UCP-2mRNA in liver is upregulated with the induction of obstructive jaundice,and the level of expression is positively correlated with the duration of obstruction.With early relief of obstruction via bile flow restoration,active regeneration of hepatic tissues occurs,leading to temporary increase in UCP-2 expression.However,with prolonged obstruction,extensive liver damage prevents active regeneration of hepatic tissues,which results in slightly decreased expression of UCP-2.These results indicate that upregulation of UCP-2 may be one of the major mechanisms of metabolic disorders after obstructive jaundice.

Original articles_Hepatopancreatobiliary tumor
Diagnostic value of combined determination of DNA ploidy level and miRNA-21 expression in ascites cells for hepatocellular carcinoma
Xiao ZuoHan, Meng Gang, Wang LiZhi, Sun WenJin
2015, 31(1): 93-98. DOI: 10.3969/j.issn.1001-5256.2015.01.020
Abstract:

Objective To evaluate the diagnostic value of combined determination of DNA ploidy level and microRNA-21(miRNA-21)expression in ascites cells for hepatocellular carcinoma(HCC).Methods A total of 117 patients with ascites admitted to our hospital from January 1,2012 to January 1,2014 were enrolled.The patients with a confirmed diagnosis of HCC were assigned to experimental group(n= 48),and those without HCC to control group(n = 69).The risk factors for HCC were compared between the two groups.Logistic regression analysis was used to extract independent sensitive indicators.The receiver operating characteristic(ROC) curve for each indicator was drawn,and the area under the ROC curve(AUC) and Youden index(YI) were calculated.Results Univariate analysis revealed significant differences between the two groups in sex(male ratio),smoking history,positive rate of HBV,proportion of suspected positive cases based on upper abdominal CT,Karnofsky Performance Scale score,alanine aminotransferase,alpha-fetoprotein(AFP),abnormal prothrombin(APT),α-L-fucosidase,miRNA-21 expression in ascites cells,and the positive rate of DNA aneuploidy in ascites cells(all P < 0.05).Logistic regression analysis showed that smoking history,AFP,APT,miRNA-21 expression in ascites cells,and the positive rate of DNA aneuploidy in ascites cells were sensitive indicators for the diagnosis of HCC.The AUCs of miRNA-21 expression and positive rate of DNA aneuploidy were 0.742 and 0.801,respectively; the AUC and YI of combined use of smoking history,AFP,and APT were0.852 and 0.5992,respectively,while the AUC and YI increased to 0.869 and 0.6222,respectively,if including miRNA-21 expression and positive rate of DNA aneuploidy in combined determination.Conclusion DNA aneuploidy and miRNA-21 in ascites cells are independent risk factors for HCC.The two indicators have good diagnostic values when used separately,and they show increased diagnostic values when used in combination with other parameters(smoking history,AFP,and APT).Combined determination of these indicators has great clinical significance for the early diagnosis of HCC and is a good complement to the current HCC diagnosis system.

Clinical effect of transcatheter arterial chemoembolization combined with argon-helium cryoablation in patients with advanced unresectable primary hepatocellular carcinoma
Ni MingLi
2015, 31(1): 99-102. DOI: 10.3969/j.issn.1001-5256.2015.01.021
Abstract:

Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE) combined with argon-helium cryoablation in patients with advanced unresectable primary hepatocellular carcinoma(HCC).Methods TACE was performed in 35 patients with primary HCC who were admitted to our hospital from May 2008 to June 2010.After 2-3 weeks of treatment,the patients received argon-helium cryoablation,followed by a second TACE in 1-2 weeks.The short-term efficacy after treatment was evaluated and the long-term survival was studied by follow-up.Comparison between two groups was made by t test,and survival was analyzed using the Kaplan-Meier survival curves.Results The clinical outcomes of all 35 patients were evaluated.Complete response was observed in 7 patients,partial response in 21 patients,stable disease in 4 patients,and progressive disease in 3 patients.The overall response rate was 80.00%,and the disease control rate was 91.43%.The 2-and 3-year survival rates were 45.6% and 39.4%,respectively.The level of alpha-fetoprotein AFP in patients after the treatment(206.2 ± 48.6 μg / L) was significantly lower than that before the treatment(837.6 ±216.7 μg / L)(t = 2.673,P < 0.05).Conclusion TACE combined with argon-helium cryoablation is a reliable therapeutic approach in treating advanced unresectable primary HCC,and the advantages include minimal invasion,fast recovery,and few complications.

Original articles_Others
Diagnosis and treatment of pyogenic liver abscess in elderly patients by multislice CT
Wang YuLin, Hu RongKui, Zong Min
2015, 31(1): 103-106. DOI: 10.3969/j.issn.1001-5256.2015.01.022
Abstract:

Objective To review the multislice computed tomography(MSCT) characteristics and treatment of pyogenic liver abscess in elderly patients.Methods A retrospective analysis was performed on the clinical data of 42 elderly patients who were diagnosed with pyogenic liver abscess in our hospital from March 2001 to February 2014.The MSCT characteristics and clinical treatment of this disease were reviewed.Comparison between two groups was made by t test.Results Among the 42 patients,37 had the liver abscess in the right lobe,and 5 in the left lobe; 33 had single lesions,and 9 had grid-or honeycomb-like lesions.MSCT scan showed that all lesions had a lower density compared with normal hepatic tissues,and the CT values were approximately 6-40 Hu.In the arterial phase,39 patients had lesions with peripheral rim enhancement,and 3 had no edge enhancement.Conservative treatment was given to 15 patients,among whom the diameter of abscess was 3.7 ± 2.1 cm,the duration of fever was 11.7 ± 4.1 d,and the average hospital stay was 22.6 ± 5.3 d.Percutaneous drainage was performed in 27 patients,among whom the diameter of abscess was 6.3 ± 2.8 cm,the duration of fever was 7.1 ± 2.2 d,and the average hospital stay was 13.7 ± 3.1 d.There were significant differences in the diameter of abscess,the duration of fever,and the length of hospital stay between the two groups(P = 0.021,0.026,and 0.006,respectively).Conclusion MSCT can accurately reveal the location and morphology of abscess,and correct diagnosis can be made in combination with the patient's medical history.Drainage guided by ultrasound or CT is an effective,minimally invasive,and safe treatment for controlling fever and promoting fast recovery in the elderly.

Brief reports
Efficacy of low-dose interferon α-1b combined with ribavirin and thymosin α1 versus standard treatment for chronic hepatitis C: a comparative study 
Sun JianMin
2015, 31(1): 107-109. DOI: 10.3969/j.issn.1001-5256.2015.01.023
Abstract:
Case reports
Liver damage induced by Polygonum multiflorum powder: a report of 2 cases 
Liu MiaoMiao, Pan LiuLan, Wei YuTong, Xiao HeJun, Duan LiWei
2015, 31(1): 110-111. DOI: 10.3969/j.issn.1001-5256.2015.01.024
Abstract:
A case of primary leiomyosarcoma of the liver and literature review 
Liu ChunHua, Li QingYan, Guan Shan, Wang SiKui
2015, 31(1): 112-114. DOI: 10.3969/j.issn.1001-5256.2015.01.025
Abstract:
Reviews
HCV culture system and its application in antiviral research on Chinese herb extracts in vitro
Li JingTao, Chang ZhanJie, Xi Qi, Liu YaZhu, Song ChunRong, Nan Ran, Li RiXiang, Wei HaiLiang, Yan ShuGuang
2015, 31(1): 115-117. DOI: 10.3969/j.issn.1001-5256.2015.01.026
Abstract:
Many studies have shown that Chinese herb extracts could treat patients who suffer hepatitis C.However,the clinical efficacy is limited due to the use of traditional Chinese medicine(TCM) compounds.Because each drug contains multiple active substances,some of which may even act against each other in vivo,it is hard to clarify the mechanism of treatment.The current research on pseudotyped hepatitis C virus(HCV),replicon,and cell culture system is summarized,and the advances in antiviral research on the monomers or active components of Chinese herbs in vitro based on HCV RNA models are reviewed,thus providing new ideas for TCM treatment of hepatitis C.
Research advances in traditional Chinese medicine combined with interventional therapy for hepatocellular carcinoma
Liu Yang, Li GuiYing, Zhao XiangXuan, Lu ZaiMing, Guo QiYong
2015, 31(1): 118-122. DOI: 10.3969/j.issn.1001-5256.2015.01.027
Abstract:
Interventional therapy has become the first choice of non-surgical treatment for hepatocellular carcinoma(HCC) due to its advantages such as little trauma and marked local effect.However,the clinical efficiency is less than expected.One of the possibilities is the resistance of cancer cells to anti-cancer drugs.Increasing attention has been paid to the combination of traditional Chinese medicine(TCM) and interventional therapy in HCC treatment.This paper reviews the progress in TCM combined with interventional therapy for HCC at animal experiment and clinical study levels in recent ten years.It is pointed out that the combination therapy with TCM and intervention for HCC has a unique advantage.
New progress in development of animal models of hepatitis C virus infection
Zhu Ting, Nie QingHe
2015, 31(1): 123-126. DOI: 10.3969/j.issn.1001-5256.2015.01.028
Abstract:
An animal model of hepatitis C virus(HCV) infection involves the use of an animal to build the model for simulating the whole process of HCV infection in humans.Establishing an ideal animal model for HCV infection is conducive to study on the pathogenesis of chronic hepatitis C,including virus-host interactions,viral variability,and host immune response patterns.Additionally,it provides a more effective technical strategy for screening antiviral drugs and developing preventive vaccines.This article summarizes well-known animal models of HCV infection,such as those established in chimpanzees,tree shrews,and mice.The advantages and drawbacks of each kind of animal models are analyzed.In recent years,the establishment of small animal models,particularly those in transgenic mice,has opened up a new field in the development of animal models of HCV infection,which will be the hotspot and emphasis of relevant animal model studies.
Relationship between intestinal microflora imbalance and nonalcoholic fatty liver disease
Ma RuiJuan, Wu Jing, Zhou YongNing
2015, 31(1): 127-129. DOI: 10.3969/j.issn.1001-5256.2015.01.029
Abstract:
The intestinal microecosystem is composed of natural microflora,intestinal epithelial cells,and intestinal mucosal immune system.Nonalcoholic fatty liver disease(NAFLD) is a metabolic stress-induced liver injury associated with insulin resistance and genetic susceptibility.In recent years,there has been increasing evidence showing the involvement of imbalanced intestinal microflora in the pathogenesis of NAFLD.Overgrowth of intestinal microflora,increased permeability of intestinal mucosa,intestinal endotoxemia,and production of inflammatory cytokines play important roles in the development of NAFLD.Further studies on the relationship between intestinal microflora imbalance and the pathogenesis of NAFLD may shed light on the treatment and prevention of NAFLD.
Molecular targeted therapy for hepatocellular carcinoma
Shen YiNan, Lu JunHua
2015, 31(1): 130-134. DOI: 10.3969/j.issn.1001-5256.2015.01.030
Abstract:
Hepatocellular carcinoma(HCC) is the most common malignancy in the liver,for which surgical operation remains the primary treatment.However,the surgical treatment is associated with low resection rate and high recurrence rate,which drive studies on the molecule mechanism of initiation,metastasis,and invasion of HCC,in order to develop more effective early diagnosis and treatment methods.By reviewing related literature,this article summarizes the major signaling pathways related to HCC,such as the PI3 K / AKT / m TOR signaling pathway,RAS / RAF / MEK / ERK signaling pathway,and VEGF / VEGFR,PDGFR,and FGFR signaling pathway.New advances in the corresponding molecular targeted therapy for HCC are described,and the perspectives on future direction of relevant research are discussed.
Research progress in prediction of clinical outcome in patients with liver failure
Tang ShanHong, Zeng WeiZheng, Jiang MingDe, Fan QuanShui
2015, 31(1): 135-138. DOI: 10.3969/j.issn.1001-5256.2015.01.031
Abstract:
Liver failure is a clinical syndrome with severe disorders of liver cells for biosynthesis,detoxication,excretion,and biological transformation,which presents with coagulation disorders,jaundice,hepatic encephalopathy,and ascites.Liver failure progresses rapidly,so the prediction of clinical outcome is significant for the diagnosis and treatment.In recent years,there have been numerous reports on the prediction of clinical outcome in patients with liver failure.The study and application of serological and comprehensive models are reviewed,which provides a reference for the rational therapy for liver failure patients.
Main applications of diffusion-weighted magnetic resonance imaging in liver diseases
Chen Juan, Yin HuaBin
2015, 31(1): 139-142. DOI: 10.3969/j.issn.1001-5256.2015.01.032
Abstract:

Liver failure is a clinical syndrome with severe disorders of liver cells for biosynthesis,detoxication,excretion,and biological transformation,which presents with coagulation disorders,jaundice,hepatic encephalopathy,and ascites.Liver failure progresses rapidly,so the prediction of clinical outcome is significant for the diagnosis and treatment.In recent years,there have been numerous reports on the prediction of clinical outcome in patients with liver failure.The study and application of serological and comprehensive models are reviewed,which provides a reference for the rational therapy for liver failure patients.