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

2015 No. 7

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Editorial
Research advances in non- alcoholic fatty liver disease: a review of current status and prospect
Fan JianGao
2015, 31(7): 999-1001. DOI: 10.3969/j.issn.1001-5256.2015.07.001
Abstract:

Non- alcoholic fatty liver disease( NAFLD) affects more and more people. There are a lot of studies on the pathogenesis,diagnosis,and treatment of this disease,but controversies still exist. This article aims to highlight the latest advances and challenges in the clinical studies on NAFLD,so as to help the physicians to make the best management decisions for patients with NAFLD.

Therapeutic guidelines
Interpretation of 2015 WHO guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection: comparison antiviral treatment of chronic hepatitis B
Dai MingJia, Leng XueJun, Yan XueBing
2015, 31(7): 1004-1007. DOI: 10.3969/j.issn.1001-5256.2015.07.003
Abstract:
EASL recommendations on treatment of hepatitis C 2015
Rao HuiYing, Wei Lai
2015, 31(7): 1008-1017. DOI: 10.3969/j.issn.1001-5256.2015.07.004
Abstract:
Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites
Wang Shuai, Hu DaRong
2015, 31(7): 1018-1022. DOI: 10.3969/j.issn.1001-5256.2015.07.005
Abstract:
2015 Standards of Practice Committee of the American Society for Gaserointestinal Endoscopy guideline: the role of ERCP in benign diseases of the biliary tract
Chen Gang, Liu Hong, Li Li
2015, 31(7): 1023-1026. DOI: 10.3969/j.issn.1001-5256.2015.07.006
Abstract:
2015 The Japanese Society of Gastroenterology of Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis
Chang BinXia, Zou ZhengSheng, Li BaoSen, Wang Hua, Gao Bin
2015, 31(7): 1027-1030. DOI: 10.3969/j.issn.1001-5256.2015.07.007
Abstract:
2014 Korean Liver Cancer Study Group-National Cancer Center Korea practice guideline for the management of hepatocellular carcinoma: an excerpt of recommendations
Zhao JianCheng, Qi XingShun, Guo XiaoZhong
2015, 31(7): 1031-1033. DOI: 10.3969/j.issn.1001-5256.2015.07.008
Abstract:
Discussions by experts
Hepatitis C virus related fatty liver
Zhang Yu, Cheng Jun
2015, 31(7): 1034-1037. DOI: 10.3969/j.issn.1001-5256.2015.07.009
Abstract:

Liver steatosis is a prominent pathological feature of chronic hepatitis C( CHC). Increased lipid uptake and lipid synthesis and decreased lipid secretion and lipid degradation are all involved in the pathogenesis of steatosis induced by hepatitis C virus( HCV) infection.In this paper,the association between HCV infection and liver steatosis is expounded. It is pointed out that the CHC patients with genotype3 HCV infection have a higher incidence rate of liver steatosis than those with other genotypes,and studies have shown that it is closely related to the direct action of HCV. And for CHC patients with other genotypes,liver steatosis is mostly associated with metabolic disorder. Liver steatosis not only accelerates the process of chronic viral hepatitis,but also directly affects patients' response to antiviral therapy. The association between HCV infection and liver steatosis and the mechanism still need to be confirmed by further studies.

Application of lipid- regulating drugs in non- alcoholic fatty liver disease
Cui RuiBing, Yan Ming
2015, 31(7): 1038-1041. DOI: 10.3969/j.issn.1001-5256.2015.07.010
Abstract:
Non- alcoholic fatty liver disease( NAFLD) is a clinical syndrome which is characterized by diffuse fatty degeneration of hepatocytes without excessive use of alcohol,and it is one of the most common causes of abnormal liver function and chronic liver disease. Although the etiology and pathogenesis of NAFLD have not been well defined,the pathological basis of NAFLD is fatty degeneration of hepatocytes. On the one hand,the lipid- regulating drugs can reduce blood lipids to decrease liver fat deposition; on the other hand,they can promote lipid accumulation in the liver to increase liver injury. So there is still controversy that if the lipid- regulating drugs can be used for treating NAFLD. In this paper,the application and progression of four lipid- regulating drugs,statins,fibrates,probucol,and ezetimibe,in NAFLD are briefly described.
Role of gut microbiota regulation in traditional Chinese medicine treatment of non- alcoholic fatty liver disease
Tian HuaJie, Feng Qin, Hu YiYang
2015, 31(7): 1042-1045. DOI: 10.3969/j.issn.1001-5256.2015.07.011
Abstract:
Based on recent studies which have shown that gut microbiota plays an important role in the pathogenesis of non- alcoholic fatty liver disease( NAFLD),the article elaborates on the relationship of NAFLD with intestinal endotoxemia,short- chain fatty acids,bile acid metabolism,and endogenous ethanol. By illustrating the author's research progress in the relationship between traditional Chinese medicine( TCM) regulation of gut microbiota and NAFLD treatment,the article proposes that this approach is not only a clinical practice of TCM in the modern era,it may also become a new strategy in the treatment of NAFLD.
Research advances in association between non- alcoholic fatty liver disease and cardiovascular disease
Li Qiang, Zhuo QiBin, Chen Liang, Huang YuXian
2015, 31(7): 1046-1049. DOI: 10.3969/j.issn.1001-5256.2015.07.012
Abstract:
Non- alcoholic fatty liver disease( NAFLD) has become the most common cause of chronic liver disease in developed countries.The obvious association between NAFLD and cardiovascular disease( CVD) has been proved by a series of retrospective and prospective studies in recent years. It is indicated that NAFLD could result in CVD by increasing carotid intima thickness and arterial wall stiffness and causing endothelial dysfunction,coronary artery calcification,left ventricular remodeling,and left ventricular diastolic dysfunction. As an independent risk factor,NAFLD could promote the development and progression of CVD,which,correspondingly,is the main cause of death in NAFLD patients. Therefore,risk assessment for CVD in NAFLD patients is so important that the disease progression could be delayed by lifestyle modification and pharmacotherapy. Then the mortality related to CVD may be reduced and the overall prognosis of NAFLD patients would be improved.
Roles of abnormal lipid metabolism in pathogenesis of non- alcoholic fatty liver disease
Lu Ran, Hong TianPei
2015, 31(7): 1050-1054. DOI: 10.3969/j.issn.1001-5256.2015.07.013
Abstract:
The prevalence of non- alcoholic fatty liver disease( NAFLD) keeps rising worldwide along with the increasing prevalence of metabolic diseases such as obesity,type 2 diabetes,and dyslipidemia. Although most NAFLD patients present with simple steatosis of hepatocytes,some patients progress to non- alcoholic steatohepatitis,liver cirrhosis,and even cancer. In the Western world,NAFLD is the most common cause of elevated liver enzymes,and hence there has been a growing interest in this disease. Given that fat deposition in the liver is the hallmark of NAFLD,we review the roles and the underlying mechanism of disturbed lipid metabolism in the development of NAFLD and suggest that more insights into the pathogenesis of NAFLD will help develop targeted strategies for the prevention and treatment of this disease.
Research advances in genetic susceptibility to non- alcoholic fatty liver disease
Yuan Chen, Cheng YuTing, Jiang Man, Lu LinLin, Xin YongNing, Xuan ShiYing
2015, 31(7): 1055-1058. DOI: 10.3969/j.issn.1001-5256.2015.07.014
Abstract:
Non- alcoholic fatty liver disease( NAFLD) is one of the most common liver diseases,with complicated etiology and pathogenesis. As a heredity- environment- metabolism- stress disease,the genetic factors play an important role in the pathogenesis of NAFLD. In order to identify the role of genetic factors in the pathogenesis of NAFLD and to find out new clinical therapeutic targets,the present review summarizes the susceptibility genes of NAFLD,especially those identified by genome- wide association study,including the genes of patatin- like phospholipase domain- containing 3,leptin receptor,adiponectin,and tumor necrosis factor- ɑ.
Original articles_Nonalcoholic fatty liver disease
Analysis of correlation between serum 25- hydroxyvitamin D level and nonalcoholic fatty liver disease
Cai Wen, Dong ZhengHui, Wang ShuXia, Yang XiaoPing, Yao Hua
2015, 31(7): 1059-1062. DOI: 10.3969/j.issn.1001-5256.2015.07.015
Abstract:

Objective To analyze the correlation between serum 25- hydroxyvitamin D level and nonalcoholic fatty liver disease( NAFLD),and to provide a clinical basis for the prevention and treatment of NAFLD. Methods From March to October,2014,200 Uyghur patients and 200 Han patients with NAFLD in our hospital were enrolled into NAFLD group,while an equal number of healthy Uyghurs and Hans were used as controls. For all subjects,questionnaire survey,physical examination,abdominal ultrasound examination,and blood biochemical examination were performed,and serum 25- hydroxyvitamin D level was determined using enzyme- linked immunosorbent assay. The relationship between 25- hydroxyvitamin D and NAFLD was analyzed by Spearman correlation analysis and multivariate logistic regression analysis. Results Serum 25- hydroxyvitamin D levels in the NAFLD group were significantly lower than those in the control group for both Uyghurs and Hans( P < 0. 05),and serum 25- hydroxyvitamin D level was negatively correlated with NAFLD( rHan=- 0. 212,rUyghur=- 0. 220,P < 0. 01). The results of multivariate logistic regression analysis showed that the rising serum 25- hydroxyvitamin D level was a protective factor for NAFLD( ORHan= 0. 894,PHan= 0. 015; ORUyghur= 0. 897,PUyghur= 0. 025). Conclusion Serum 25- hydroxyvitamin D level is closely associated with NAFLD in Uyghurs and Hans.

Prevalence and clinical features of hepatic steatosis in patients with chronic hepatitis B
Zhang ZhiQiao, Wang GongSui, Kang KaiFu, Wu GuoBiao, Wang Peng
2015, 31(7): 1063-1067. DOI: 10.3969/j.issn.1001-5256.2015.07.016
Abstract:

Objective To analyze the prevalence and clinical features of hepatic steatosis in patients with chronic hepatitis B. Methods The clinical data of patients with chronic hepatitis B who were hospitalized at the Department of Infectious Diseases,the First People's Hospital of Shunde,Guangdong,China,from January 2006 to December 2014,were retrospectively collected for analysis and comparison of clinical and pathological indicators. The patients were divided into fatty liver group and non- fatty liver group depending on the presence or absence of fatty liver. Continuous data of the two groups were compared using the t test and categorical data were compared using the χ2test. If data were not normally distributed,comparisons were made using the Mann- Whitney U test. Results The incidence of fatty liver increased with age( P < 0. 05) and peaked at an age of ≥45 years in both groups. Fatty liver was more likely to occur in men than in women below 30 years and between 30 and 44 years( P < 0. 05). Diabetes,abnormal levels of cholesterol,triglycerides,low- density lipoprotein,and uric acid,and a history of alcohol consumption were significantly more frequent in the fatty liver group than in the non- fatty liver group( P < 0.05). Levels of body mass index,gamma- glutamyl transpeptidase,albumin,blood urea nitrogen,creatinine,uric acid,glucose,total cholesterol,triglycerides,low- density lipoprotein,apolipoprotein A,apolipoprotein B,aspartate aminotransferase were significantly different between the two groups( P < 0. 05). Inflammation and fibrosis were significantly milder in the fatty liver group compared with the non- fatty liver group( P < 0. 05). Patients in the non- fatty liver group were more likely to be complicated by grade 3 liver inflammation and stage 3fibrosis( P = 0. 001 and P = 0. 015). Conclusion Fatty liver patients are more likely to present with glucose and lipid metabolism disorder. Hepatic steatosis is not significantly correlated with HBe Ag,but may be somewhat associated with HBV DNA,inflammation grade and fibrosis stage. Further studies are needed to establish their connections..

Clinical efficacy of Liuweiwuling tablets in treatment of non- alcoholic fatty liver disease: a meta- analysis
Zhou LiJun
2015, 31(7): 1068-1072. DOI: 10.3969/j.issn.1001-5256.2015.07.017
Abstract:

Objective To systematically evaluate the clinical efficacy of Liuweiwuling tablets in the treatment of non- alcoholic fatty liver disease( NAFLD),and to provide an evidence- based medicine basis for its clinical application. Methods Literature about Liuweiwuling tablets in the treatment of NAFLD published up to January 30,2015 was searched for in Cochrane Library,CNKI,Wanfang Data,and Pub Med. And the randomized controlled trials( RCTs) of Liuweiwuling tablets combined with conventional therapy( experimental group)versus conventional therapy( control group) for NAFLD were included in the analysis. The quality of included studies was assessed,and the data were extracted. And then they were subjected to meta- analysis using Rev Man 5. 2 to analyze the improvements in alanine aminotransferase( ALT),aspartate aminotransferase( AST),gamma- glutamyl transpeptidase( GGT),triglyceride( TG),clinical overall response rate,and imaging indices. Results A total of six RCTs were included in the analysis,involving 228 cases in the experimental group and205 cases in the control group. The analysis results showed that the experimental group had significantly reduced levels of ALT,AST,GGT,and TG compared with the control group( standardized mean difference [SMD] =- 1. 29,95% confidence interval [CI]:- 1. 69 ~- 0. 89,P < 0. 01; SMD =- 1. 15,95% CI:- 1. 85 ~- 0. 45,P < 0. 01; SMD =- 1. 47,95% CI:- 1. 68 ~- 1. 25,P < 0. 01; SMD =- 0. 48,95% CI:- 0. 60 ~- 0. 35,P < 0. 01). The experimental group had significantly higher clinical overall response rate and better improvements in imaging indices than the control group( relative risk [RR]= 1. 48,95% CI: 1. 29- 1. 70,P < 0. 01; RR = 1. 43,95%CI: 1. 21- 1. 68,P < 0. 01). Conclusion For patients with NAFLD,Liuweiwuling tablets combined with conventional therapy can significantly improve the liver function,reduce the blood lipid level,and increase the clinical overall response rate. However,since the quality of included literature is low,the reliability of the current meta- analysis conclusions should be further verified.

Fatty liver and light manual labor: an epidemiological survey in Tianjin by controlled attenuation parameter
Li Hai, Liu ChunCheng, Wang YuLin, Hou Rui, Gao HongJun, Niu HaiYan, Xia ShiHai, Zhu LiMin
2015, 31(7): 1073-1077. DOI: 10.3969/j.issn.1001-5256.2015.07.018
Abstract:

Objective To investigate the incidence and possible related factors for fatty liver among workers engaged in light manual labor in Tianjin,China. Methods Among 800 healthy workers engaged in light manual labor randomly selected from a company in Tianjin,a total of 602 healthy workers completed physical examination and data collection. The content of fat and liver stiffness were determined by controlled attenuation parameter( CAP) using Fibro Scan,and the disease history,body mass,height,blood pressure,and living habits in all subjects were investigated. The possible related factors for different degrees of fatty liver were analyzed. Between- group comparison of continuous data was performed using the Kruskal- Wallis H test,and comparison of categorical data was performed using χ2test with row × column tables. Pairwise comparison was performed using χ2segmentation method,and the agreement between CAP and color ultrasound was analyzed using the Kappa coefficient. Results Among the 602 subjects,there were 180( 29. 9%),195( 32. 3%),and 227( 37. 7%) subjects with severe fatty liver,moderate fatty liver,and no fatty liver,respectively. There were significant differences in age,body mass index,waist- hip ratio,smoking,drinking,history of diabetes,and family history between the above three groups according to CAP( P <0. 05 for all). With higher sensitivity,CAP achieved a significantly higher detection rate of fatty liver than traditional color ultrasound( 62. 3% vs 44. 0%,P = 0. 000). The agreement between two methods was poor( Kappa value < 0. 4). Conclusion Among the so-called“healthy people”engaged in light manual labor,the incidence of fatty liver has exceeded 60%,which is associated with body mass index,waist- hip ratio,bad living habits,history of diabetes,and family history of fatty liver. CAP can noninvasively detect fatty liver with higher sensitivity and less time; however,its clinical significance needs further studies.

Changes in intestinal flora in nonalcoholic fatty liver disease: their correlation with insulin resistance index,tumor necrosis factor- α,and interleukin- 6
Zhang QiuNan, Xiao Ying, Miao RuiXin, Zhang YaQing, Zhu Ying
2015, 31(7): 1078-1081. DOI: 10.3969/j.issn.1001-5256.2015.07.019
Abstract:

Objective To explore the changes in intestinal flora in patients with nonalcoholic fatty liver disease( NAFLD) and their correlation with homeostatic model assessment- insulin resistance( HOMA- IR) index,serum tumor necrosis factor- α( TNFα),and interleukin- 6( IL- 6). Methods Eighty- two patients with NAFLD who were diagnosed and treated in the Department of Gastroenterology in our hospital from January 2013 to September 2014 were enrolled into NAFLD group. Sixty healthy physical examinees were used as controls.Fresh feces and fasting serum of all subjects were collected to calculate intestinal colonization resistance( B / E value) and HOMA- IR. The serum levels of TNFα and IL- 6 were determined by enzyme- linked immunosorbent assay. The correlation of B / E value with HOMA- IR,TNFα,and IL- 6 was analyzed. Between- group comparison of continuous data was performed by t test,and multiple- group comparison was performed by analysis of variance. Correlation analysis was made by Pearson correlation analysis. Results Compared with the control group,the NAFLD group had significantly decreased numbers of bifidobacteria and lactobacilli,significantly increased numbers of Enterobacteriaceae and Enterococcus,and a significantly lower B / E value( all P < 0. 01). Moreover,the NAFLD group had significantly higher levels of serum alanine aminotransferase,aspartate aminotransferase,triglycerides,fasting plasma glucose,fasting serum insulin,HOMA-IR,TNFα,and IL- 6 than the control group( all P < 0. 01). Correlation analyses showed that B / E value was significantly negatively correlated with HOMA- IR,TNFα,and serum IL- 6( r =- 0. 872,P < 0. 01; r =- 0. 461,P < 0. 01; r =- 0. 523,P < 0. 01). Conclusion The changes in intestinal flora are closely related to changes in HOMA- IR and levels of TNFα and IL- 6 in patients with NAFLD,which suggest that the above factors may influence and interact with each other,contributing to the development and progression of NAFLD.

Association between AGTR1 gene polymorphism and risk of nonalcoholic fatty liver disease
Liu Yang, Jiang Man, Chen LiZhen, Du ShuiXian, Xin YongNing, Xuan ShiYing
2015, 31(7): 1082-1087. DOI: 10.3969/j.issn.1001-5256.2015.07.020
Abstract:

Objective To investigate the association between type 1 angiotensin II receptor( AGTR1) rs3772622 polymorphism and nonalcoholic fatty liver disease( NAFLD) and the interaction between the locus and patatin- like phospholipase domain- containing protein 3( PNPLA3) rs738409 polymorphism. Methods A total of 241 patients who were diagnosed with NAFLD by B- mode ultrasound in Qingdao Municipal Hospital from September 2013 to September 2014 and 205 healthy controls were included. AGTR1 rs3772622 and PNPLA3rs738409 were determined by polymerase chain reaction and a genotyping method. A statistical analysis was performed on allele frequency,genotype frequency,and clinical / biochemical data of the two loci. According to different data types,t test and Pearson chi- square test were separately performed. The variant genotypes of AGTR1 rs3772622 and PNPLA3 rs738409 for risk of NAFLD were analyzed by Logistic regression analysis. The interactions between AGTR1 rs3772622 and PNPLA3 rs738409 were investigated by generalized multifactor dimensionality reduction. Results No significant differences were found between the NAFLD group and the control group as regards to the distribution of genotypes and alleles of AGTR1 rs3772622( P > 0. 05). Compared with the wild type,the AGTR1 rs3772622 variant did not significantly increase the risk of NAFLD( P > 0. 05) and the variant carriers of PNPLA3 rs738409 had a 2. 09- fold increase in the risk of NAFLD [odds ratio( OR) = 2. 09,95% confidence interval( CI) : 1. 35- 3. 23,P = 0. 001]. The combination of AGTR1 rs3772622 and PNPLA3rs738409 significantly increased the risk of NAFLD( OR = 3. 60,95% CI: 1. 50- 6. 23,P < 0. 001). There were significant differences in alanine aminotransferase and aspartate aminotransferase between the single variant carriers of PNPLA3 rs738409 and the carriers of the two variants( both P < 0. 05). Conclusion The polymorphism of AGTR1 rs3772622 is not associated with the development and progression of NAFLD in Chinese population,but the AGTR1 rs3772622 variant can increase the risk of NAFLD in variant carriers of PNPLA3 rs738409.

Association between PPARγ gene rs3856806 polymorphism and nonalcoholic fatty liver disease
Xu Xin, Jiang Man, Li JiangWen, Dong QuanYong, Lin ZhongHua, Chu LeiLei, Xin YongNing, Xuan ShiYing
2015, 31(7): 1088-1091. DOI: 10.3969/j.issn.1001-5256.2015.07.021
Abstract:

Objective To investigate the association between PPARγ gene rs3856806 polymorphism and nonalcoholic fatty liver disease( NAFLD). Methods The blood samples of 189 patients who were diagnosed with NAFLD by B- ultrasound and 184 healthy normal subjects were collected to determine the genotypes of PPARγ gene rs3856806 by improved multiple ligase detection reaction. Comparison of categorical data between the two groups was made by Pearson chi- square test,and comparison of continuous data was made by t test. And the logistic regression analysis was used for calculating odds ratio( OR) and 95% confidence interval( 95% CI). Results The NAFLD group had significantly higher body weight,waist circumference,hip circumference,and levels of alanine aminotransferase,aspartate aminotransferase,gamma- glutamyl transpeptidase,glucose,triglyceride,total cholesterol,and low- density lipoprotein than the control group( P<0. 05). However,the NAFLD group had a significantly lower level of high- density lipoprotein than the control group( P < 0. 01). There were no significant differences in the allele and genotype frequencies of rs3856806 between the two groups( P >0. 05). The patients with rs3856806 T allele showed higher risk of developing NAFLD than those with C allele( OR = 1. 068,95% CI: 0. 748- 1. 525,P > 0. 05).The unconditional logistic regression analysis showed that the patients with TT / TC genotypes had higher risk of developing NAFLD than those with CC genotype( OR = 1. 077,95% CI: 0. 706- 1. 643,P > 0. 05). Conclusion PPARγ gene rs3856806 polymorphism is not significantly associated with NAFLD.

Association between GCKR gene rs780094( C > T) polymorphism and non- alcoholic fatty liver disease in Han population in Qingdao,China
Dong QuanYong, Xu Xin, Li JiangWen, Jiang Man, Lin ZhongHua, Chu LeiLei, Xin YongNing, Xuan ShiYing
2015, 31(7): 1092-1095. DOI: 10.3969/j.issn.1001-5256.2015.07.022
Abstract:

Objective To investigate the association between glucokinase regulatory protein( GCKR) gene rs780094( C > T) polymorphism and non- alcoholic fatty liver disease( NAFLD) in the Han population in Qingdao,China. Methods A case- control study was conducted in 180 patients with NAFLD and 172 healthy controls. Blood samples were collected from all the subjects and were genotyped for rs780094 by polymerase chain reaction and DNA sequencing method. Genotype and allele frequencies were compared between the control and case groups. Results No significant differences between the two groups were observed in both genotype and allele frequencies( both P > 0. 05).The variant GCKR rs780094 T allele did not significantly increase the risk of NAFLD( OR = 1. 068,95% CI: 0. 748- 1. 525,P = 0. 719)compared with the C allele. Logistic regression model analysis adjusted for confounding factors exhibited that the TT + CT genotype of GCKR rs780094 did not significantly increase the risk of NAFLD relative to the CC genotype( P > 0. 05). Conclusion GCKR rs780094 T allele may be not associated with the increased risk of NAFLD in the Han population in Qingdao.

Original articles_Biliary diseases
Risk factors for complications after laparoscopic cholecystectomy in elderly patients aged over 60
Wang Jun
2015, 31(7): 1096-1098. DOI: 10.3969/j.issn.1001-5256.2015.07.023
Abstract:

Objective To explore the risk factors for complications after laparoscopic cholecystectomy in elderly patients. Methods Three hundred and forty elderly patients who underwent laparoscopic cholecystectomy at our hospital from July 2005 to July 2014 were enrolled.Basic information and clinical history of the patients were collected and recorded retrospectively. The patients were followed up for three months after surgery and treatment outcomes and complications were observed. The patients were divided into complication group and complication- free group,and the risk factors for complications were analyzed. Results Univariate analysis showed that old age,emergency operation,intraoperative blood loss ≥50 ml,gallbladder adhesion,Calot' s triangle adhesion,and history of diabetes mellitus put patients at higher risk of complications after laparoscopic cholecystectomy( P < 0. 05). Multivariate analysis showed that old age,operation properties,gallbladder adhesion,Calot's triangle adhesion,and history of diabetes mellitus were risk factors for complications in elderly patients who underwent laparoscopic cholecystectomy( P < 0. 05). Conclusion Age,operative approach,gallbladder adhesion,Calot's triangle adhesion,and history of diabetes mellitus are risk factors for complications in elderly patients who undergo laparoscopic cholecystectomy.

Expression of Grb2,MMP- 3,and MMP- 9 in cholangiocarcinoma and its significance
Zhao TingKuan, Li ChunYan, Yang Yong, Liu Jing, Guo HuaXiong
2015, 31(7): 1099-1102. DOI: 10.3969/j.issn.1001-5256.2015.07.024
Abstract:

Objective To investigate the expression of growth factor receptor- bound protein- 2( Grb2),matrix metalloproteinase- 3( MMP- 3),and MMP- 9 in cholangiocarcinoma and its significance. Methods The expression of Grb2,MMP- 3,and MMP- 9 in cholangiocarcinoma tissues of 47 cases and normal tissues was measured using immunohistochemistry,and the correlations of Grb2 expression with clinical pathology and MMP- 3 and MMP- 9 expression were analyzed. Comparison of continuous data was made using t test,and the correlation of Grb2 expression with MMP- 3 and MMP- 9 expression was analyzed using the multivariate linear regression model. Results The expression of Grb2 in cholangiocarcinoma tissues was significantly higher than that in normal bile duct tissues( t = 5. 935,P < 0. 001);the expression of Grb2 in cholangiocarcinoma tissues and normal bile duct tissues showed no significant correlation with age,sex,and differentiation level; the expression of Grb2 in cholangiocarcinoma tissues with lymph node or distant metastasis was significantly higher than that in cholangiocarcinoma tissues without metastasis( t = 3. 882,P = 0. 003). The expression of Grb2 was positively correlated with the expression of MMP- 3 and MMP- 9( r2= 0. 3667,P = 0. 018; r2= 0. 5133,P = 0. 007). Conclusion The expression of Grb2 in cholangiocarcinoma tissues is higher than that in normal bile duct tissues,and it is closely related to the invasion and metastasis of carcinoma. Further study shows that the expression of Grb2 is positively correlated with the expression of MMP- 3 and MMP- 9.

Original articles_Others
Dietary intake of selenium and serum selenium in patients with chronic hepatitis B,liver cirrhosis and acute- on-chronic liver failure
Zhao Juan, Li Juan, Yu HongWei, Meng QingHua
2015, 31(7): 1103-1106. DOI: 10.3969/j.issn.1001-5256.2015.07.025
Abstract:

Objective To analyse dietary intake of selenium and serum selenium levels in patients with different types of chronic liver diseases,and to explore the relationship between selenium and severity of liver diseases. Methods Seventy- four patients admitted to Beijing You An Hospital from August 2008 to October 2014,as well as 16 healthy persons as healthy control( HC) group,were recruited in this study.Based on liver disease types,these patients were divided into chronic hepatitis( CH) group( n = 23),liver cirrhosis( LC) group( n = 27),and acute- on- chronic liver failure( ACLF) group( n = 24). Dietary intake of selenium was calculated on admission by dietary assessment software,and serum selenium levels were measured by inductively coupled plasma- atomic emission spectroscopy. Comparison of continuous data between groups was made by one- way ANOVA; comparison of categorical data between groups was made by χ2test; the correlation between variables was determined by Pearson correlation analysis. Results The dietary selenium intake in the HC group was 45. 45 ± 18. 10 μg.Compared with the HC group,the CH group,LC group,and ACLF group had insufficient dietary intake of selenium( 37. 69 ± 11. 30 μg,32. 65 ± 13. 55 μg,and 28. 95 ± 13. 30 μg,respectively). Dietary selenium intake gradually decreased with the progression of liver disease.Compared with the HC group,the LC group and ACLF group had significantly lower dietary selenium intake( P = 0. 004 and 0. 000,respectively). Serum selenium in the HC group was 0. 17 ± 0. 04 μg / ml. Compared with the HC group,the CH group,LC group,and ACLF group had significantly lower serum selenium levels( 0. 12 ± 0. 05 μg / ml,P = 0. 007; 0. 11 ± 0. 06 μg / ml,P = 0. 000; 0. 13 ± 0. 05 μg /ml,P = 0. 015). Serum selenium in the LC group was reduced most among these groups. Furthermore,serum selenium was significantly associated with prealbumin level,white blood cell count,and platelet count( r = 0. 229,P = 0. 030; r = 0. 213,P = 0. 044; r = 0. 255,P =0. 015). Conclusion With the progression of liver disease,serum selenium and dietary intake of selenium decrease gradually. It is meaningful to monitor and provide supplementary selenium in patients with chronic liver diseases during clinical practice.

Comparison of efficacy between sodium morrhuate and lauromacrogol as sclerosing agents in treatment of hepatic cyst
Tan ZuYun, Guo YaBing
2015, 31(7): 1107-1109. DOI: 10.3969/j.issn.1001-5256.2015.07.026
Abstract:

Objective To compare the efficacy of sodium morrhuate versus lauromacrogol in the treatment of hepatic cyst. Methods Seventy- four patients with hepatic cyst who were admitted to our hospital from January 2009 to May 2013 were enrolled as subjects and divided into two groups. After the cystic fluid was drained by percutaneous liver biopsy,sodium morrhuate solution was injected into the cystic cavity for adhesion and sclerosis in 46 patients in group A,and lauromacrogol solution was injected in 28 patients in group B. The incidence rates of pain in patients during and after surgery were compared between the two groups. The follow- up comparison of hepatic cyst recurrence rates within one year after surgery was performed between the two groups. Between- group comparison was performed by χ2test. Results Five patients( 10. 87%) in group A and two patients( 7. 14%) in group B had recurrence within one year after treatment. There was no significant difference in recurrence rate between the two groups( χ2= 0. 283,P > 0. 05). The incidence of pain in group A was significantly higher than that in group B( χ2= 5. 258,P < 0. 05). Conclusion With the same efficacy as sodium morrhuate in the treatment of hepatic cyst,lauromacrogol can be routinely used as a sclerosing agent due to its mild side effects.

Correlation between liver damage degree and clinical manifestations in patients with pulmonary tuberculosis after chemotherapy
Sun Ying, Li RunPu, Wang XiaoJie
2015, 31(7): 1110-1113. DOI: 10.3969/j.issn.1001-5256.2015.07.027
Abstract:

Objective To explore the correlation between the degree of liver damage and clinical manifestations in patients with pulmonary tuberculosis after chemotherapy. Methods This study included 3620 new smear- positive pulmonary tuberculosis patients treated with first- line anti- tuberculosis drug in the Second Central Hospital of Baoding from January 2008 to January 2014,and the follow- up study was carried out to observe medication use and side effects of anti- tuberculosis drug treatment. Comparison of categorical data was made by chisquare test. Results A total of 1225 patients( 33. 8%) exhibited clinical manifestations related to liver injury. The most common clinical manifestation was nausea and vomiting( 72. 9%),followed by fatigue( 37. 8%),rash( 31. 5%),abdominal distension and diarrhea( 28. 1%),fever( 14. 2%),anorexia( 3. 8%),and other manifestations( 2. 0%). The nausea and vomiting usually first appeared and were followed by abdominal distension and diarrhea. Of all patients,243 cases( 6. 7%) suffered from liver damage and 109 cases( 3. 0%)had moderate to severe liver damage. Of the patients with clinical manifestations,171 cases( 14. 0%) had liver damage and 74 cases( 6. 0%) suffered from moderate to severe liver damage. Compared with the patients without clinical manifestations,the relative risks of liver damage and moderate to severe liver damage were 4. 643 [95% confidence interval( CI) = 3. 035- 4. 856]and 4. 134( 95% CI = 2. 817-4. 351),respectively,in the patients with clinical manifestations. The patients with fatigue,nausea and vomiting,rash,abdominal distension and diarrhea,anorexia,and other manifestations had higher risk of liver damage and moderate to severe liver damage than those without clinical manifestations( P < 0. 05) and the patients with anorexia showed the highest risk. Conclusion One third of patients with pulmonary tuberculosis have liver injury- related clinical manifestations after chemotherapy. Patients with fatigue,nausea and vomiting,rash,abdominal distension and diarrhea,anorexia,and other manifestations are more susceptible to liver damage and moderate to severe liver damage.

Ganshuang granules protect mouse liver from chronic injury induced by CCl4 via autophagy
Sun HaiQing, Wang XiaoQi, Shi HongBo, Lou JinLi, Chen Yu, Duan ZhongPing
2015, 31(7): 1114-1119. DOI: 10.3969/j.issn.1001-5256.2015.07.028
Abstract:

Objective To investigate the role and action mechanism of Ganshuang granules in the protection against CCl4- induced chronic liver injury in mice via autophagy,and to provide a basis for its clinical application. Methods We established a chronic liver injury model in mice by intraperitoneal injection of CCl4,and a cell model of liver damage in cell line HL- 7702 induced by CCl4 in vitro. The animals were divided into three groups,Ganshuang granule intervention group,normal control group,and CCl4 group without receiving Ganshuang granules. In addition,we exposed the cells to 3- methyladenine( 3- MA),an autophagy inhibitor,and observed the effects of Ganshuang granules on cell apoptosis. Liver tissue injury was evaluated by HE staining; serum alanine aminotransferase( ALT) and aspartate aminotransferase( AST) levels were determined by biochemical assays. Autophagy was assessed by immunofluorescence staining and Western blotting. Liver apoptosis was analyzed by flow cytometry and Annexin V / PI double staining. Comparisons between groups were performed using analysis of variance. Results HE staining showed that liver tissue injury was significantly milder in the Ganshuang granule intervention group than in the CCl4 group. Serum ALT and AST levels were significantly differences between Ganshuang granule intervention group,normal control group,and CCl4group( F = 15. 76、13. 35,P < 0. 05). Both in vivo and in vitro tests showed that autophagy increased significantly in cells treated with Ganshuang granules than in cells exposed to CCl4 alone,while apoptosis was significantly reduced in the former.The administration of 3- MA weakened the protective effect of Ganshuang granules and increased apoptosis. Flow cytometry showed that apoptosises were significiantly differences between five groups( F = 25. 637,P < 0. 01). Conclusion Ganshuang granules have protective effects against chronic liver injury by inhibiting apoptosis,possibly through enhanced autophagy.

Clinical characteristics of multiple ERCP procedures in elderly patients aged over 80
Wang JiHeng, Su XiMing, Gao Ge, He YuQi
2015, 31(7): 1120-1122. DOI: 10.3969/j.issn.1001-5256.2015.07.029
Abstract:

Objective To analyze the clinical characteristics of patients aged equal to or more than 80 years receiving multiple endoscopic retrograde cholangiopancreatography( ERCP) procedures and to evaluate the safety and efficacy of ERCP. Methods The clinical data were collected and retrospectively reviewed for patients aged 80 years or older who were admitted to the Gastroenterology Department of Beijing Army General Hospital and underwent ERCP at least twice from July 2010 to December 2014. Results Sixty patients( male 33,female 27)underwent 146 times of ERCP in total,among which 2 times were performed in 47 patients,3 times in 5 patients,4 times in 5 patients,5times in 2 patients,and 7 times in 1 patient. Postoperative events included hemorrhea after endoscopic sphincterotomy in 2 cases,post- ERCP acute pancreatitis in 1 case,and death within 3 weeks after ERCP in 2 cases due to chronic obstructive pulmonary disease. Conclusion Recurrent common bile duct stones and prolonged survival time of malignant tumor patients are the main reasons for repeated ERCP in elderly patients. As a whole,ERCP shows good safety and efficacy and improves the prognosis in elderly patients with biliopancreatic disorders.

Brief reports
Analysis of high-risk groups and predictive factors for hepatic steatosis in patients with chronic hepatitis B
Zhang ZhiQiao, Wang GongSui, Kang KaiFu, Wu GuoBiao, Wang Peng
2015, 31(7): 1123-1125. DOI: 10.3969/j.issn.1001-5256.2015.07.030
Abstract:
Case reports
Hepatitis E-associated pure red cell aplasia: a report of one case
Hao KunYan, Yu LeCheng, Gao Lei, Yang RuiNing, He ZhangLun, Wang MaoRong
2015, 31(7): 1126-1127. DOI: 10.3969/j.issn.1001-5256.2015.07.031
Abstract:
Severe liver damages induced by Huolisu oral liquid taken with euthyrox: a report of two cases
Zhao JianXue, Lu WeiTing, Liu ManTian, Guo HaiYan, Gu LuJuan, Che JunYong, Liu LiNa
2015, 31(7): 1128-1129. DOI: 10.3969/j.issn.1001-5256.2015.07.032
Abstract:
One case of acute liver damage induced by Yasmin
Kong WenLi, Yang YiLiang, Peng ShanShan, Hu Yue, Pan Yu, Hua Rui
2015, 31(7): 1130-1131. DOI: 10.3969/j.issn.1001-5256.2015.07.033
Abstract:
Hepatic veno-occlusive disease induced by Gynura segetum: a report of two cases
Peng ShanShan, Cui YuanYuan, Kong WenLi, Qi LingXia, Jin MeiShan, Pan Yu, Hua Rui
2015, 31(7): 1132-1134. DOI: 10.3969/j.issn.1001-5256.2015.07.034
Abstract:
Reviews
Research advances in treatment of non-alcoholic fatty liver disease
Li Qiang, Zhuo QiBin, Chen Liang, Huang YuXian
2015, 31(7): 1135-1139. DOI: 10.3969/j.issn.1001-5256.2015.07.035
Abstract:

Non- alcoholic fatty liver disease( NAFLD) affects up to a third of the population in developed countries. Between 10% and30% of patients with NAFLD have non- alcoholic steatohepatitis( NASH). There are metabolic risk factors common to both NAFLD and cardiovascular disease,so patients with NASH have an increased risk of liver- related and cardiovascular death. This articles reviews the most recent advances in the management of NAFLD in five main areas: lifestyle modification,weight loss treatment,therapy for metabolic syndrome,insulin sensitizer and antioxidant pharmacotherapy,and management of end- stage liver disease. It is pointed out that clinicians need to pay more attention to metabolic syndrome in the diagnosis and treatment of NAFLD.

Research advances in fatty donor liver in liver transplantation
Cao HaiYang, Wu XiaoFeng, Lin DongDong
2015, 31(7): 1140-1143. DOI: 10.3969/j.issn.1001-5256.2015.07.036
Abstract:

Fatty donor liver is a common pathological change in liver transplantation and directly affects the postoperative recovery. This article reviews the research progress in fatty donor liver from the following aspects: pathological characteristics,assessment criteria,impact on postoperative recovery,and intervention,so as to discuss how to use fatty donor liver safely and efficiently in liver transplantation.

Research advances in adiponectin actions in nonalcoholic fatty liver disease
Fei XinYing, Shen Zhen, Wang JianGang, Chen YanSheng, Liu WenTao
2015, 31(7): 1144-1146. DOI: 10.3969/j.issn.1001-5256.2015.07.037
Abstract:

The incidence of nonalcoholic fatty liver disease( NAFLD) is increasing worldwide and the age of onset gradually gets younger.However,specific therapeutic interventions are lacking. The exact mechanism of NAFLD has not yet been well elucidated. Recent studies indicate that adiponectin( APN) is an adipokine with anti- inflammatory activity and is considered a hepatic protector,which plays a central role in the pathogenesis of NAFLD. Research on APN actions in NAFLD is popular around the world. This article summarizes the mechanism of APN actions in NAFLD,briefly describes the relationship of APN with nonalcoholic steatohepatitis and NAFLD- related hepatic fibrosis,and reviews related clinical studies. It is suggested that APN holds promise as a novel therapeutic target in the treatment of NAFLD and further research into the signaling pathway of APN would lead to a better understanding of its action mechanism and can provide a novel strategy for the treatment of NAFLD.

Research advances in innate immunity mechanism of nonalcoholic fatty liver disease
Zhai QingQing, Zhou ZhenHua, Wang WeiJian, Sun XueHua, Zhu XiaoJun, Zhang Xin, Li Man, Gao YueQiu
2015, 31(7): 1147-1152. DOI: 10.3969/j.issn.1001-5256.2015.07.038
Abstract:

The pathogenesis and progression of nonalcoholic fatty liver disease( NAFLD) are closely associated with the activation of the innate immune system. This article reviews how various types of immune cells,Toll- like receptors,and their downstream signaling pathways are involved in insulin resistance and mediate oxidative stress,inflammation,and fibrosis in the liver. Reduction or elimination of dendritic cells delays inflammatory responses and fibrosis in the liver. A decrease in natural killer T cells induces lipid accumulation at the stage of simple steatosis,but alleviates fibrosis at the inflammation stage. The m TOR signaling pathways for insulin and amino acids suppresses autophagy through short- term or long- term regulation,which leads to endoplasmic reticulum stress and altered insulin resistance,thereby modulating the development and progression of NAFLD. The research on the mechanisms by which traditional Chinese medicine offers therapeutic benefits for NAFLD increasingly focuses on the potential role of immunity.

Role of Toll-like receptors in development and progression of nonalcoholic fatty liver disease
Chen Jie, Zhang Jing, He QiuShui
2015, 31(7): 1153-1155. DOI: 10.3969/j.issn.1001-5256.2015.07.039
Abstract:

The pathogenesis of nonalcoholic fatty liver disease( NAFLD) remains unclear. Many studies have shown that Toll- like receptors are involved in the development and progression of NAFLD,especially nonalcoholic steatohepatitis. This article reviews the role of Toll- like receptors in the pathogenesis of NAFLD from three aspects: interactions between Toll- like receptors and inflammatory factors,interactions between Toll- like receptors and free fatty acids,and Toll- like receptor gene polymorphism.

Research progress in role of myosin light chain kinase in pathogenesis of nonalcoholic fatty liver disease
Li ChunMiao, Zhuang LiWei
2015, 31(7): 1156-1159. DOI: 10.3969/j.issn.1001-5256.2015.07.040
Abstract(2547) PDF (213KB)(474)
Abstract:

Myosin light chain kinase( MLCK) is a key enzyme involved in intestinal mucosal mechanical barrier and plays an important role in the pathogenesis of nonalcoholic fatty liver disease( NAFLD). This article describes the " two- hit theory" for NAFLD and gut- derived endotoxin which plays a major role in the pathogenesis of NAFLD,the relationship between endotoxin,MLCK,and NAFLD,and the impact of MLCK inhibitor ML- 7 on the intestinal barrier. MLCK inhibitor ML- 7 may hinder and delay the development and progression of NAFLD,providing a novel clinical idea for the early prevention of NAFLD.

Role of Ghrelin  in development and progression of nonalcoholic fatty liver disease
Xu Jia, Ma JingTing, Li DongFu
2015, 31(7): 1160-1162. DOI: 10.3969/j.issn.1001-5256.2015.07.041
Abstract:

The incidence of nonalcoholic fatty liver disease( NAFLD) has been increasing in China year by year,and NAFLD has become the second most common liver disease after viral hepatitis. Its development is closely associated with insulin resistance and oxidative stress and NAFLD is one of the important components of metabolic syndrome. Ghrelin is a newly discovered endogenous ligand for growth hormone secretagogue and has broad biological functions. Ghrelin not only affects the metabolic process of glucose and lipids,but also plays an important role in the development and progression of NAFLD. In this review,the role of endogenous Ghrelin expression in the development and progression of NAFLD is briefly summarized and the Ghrelin regulation in the development and progression of NAFLD is pointed out,which will provide new approaches to the clinical treatment of NAFLD.

Gene polymorphisms in non-alcoholic fatty liver disease: a review of research progress
Zhu DuanQuan, Wu Hao, Gong JianPing
2015, 31(7): 1163-1167. DOI: 10.3969/j.issn.1001-5256.2015.07.042
Abstract:

Non- alcoholic fatty liver disease( NAFLD) is considered one of the most common chronic liver diseases throughout the world.The incidence of NAFLD is closely associated with ethnicity,nationality,family,and region. In recent years,the association between NAFLD and gene has grown to be paid more attention. It is of great significance for inhibiting the prevalence of fatty liver disease to understand NAFLD and the gene polymorphisms associated with its pathogenesis. In this review,we summarize the gene polymorphisms associated with glucose metabolism,fatty acid metabolism,and oxidative stress in the pathogenic mechanisms of NAFLD and point out that NAFLD is a genetic- environment- metabolic stress disorder.

Research advances in cell models of hepatitis B virus
Wu Jiang, Zhou ZhenHua, Sun XueHua, Zhu XiaoJun, Li Man, Zhang Xin, Gao YueQiu
2015, 31(7): 1168-1172. DOI: 10.3969/j.issn.1001-5256.2015.07.043
Abstract(2156) PDF (1537KB)(1058)
Abstract:

Hepatitis B virus( HBV) infection has become the main cause of hepatocellular carcinoma. A series of cell models for HBV infection are established to lay a good foundation for the research on the pathogenesis and treatment of HBV. In this review,we summarize culture models for a single type of cells,co- culture models for multiple types of cells,and other animal models,which are mainly for HBV transfection and infection. We also discuss the methods of cell model construction for HBV infection and their virological characteristics. It provides reliable evidence of models for scientific interpretation of advantages of traditional Chinese medicine in the prevention and treatment of chronic hepatitis B.

Risk factors for portal vein thrombosis following splenectomy in patients with liver cirrhosis
Yang ZhengMao, Zhang LingYi
2015, 31(7): 1173-1175. DOI: 10.3969/j.issn.1001-5256.2015.07.044
Abstract:

Portal vein thrombosis( PVT) develops in some patients with liver cirrhosis and may aggravate portal hypertension. The risk factors for PVT have not yet been completely clarified. Splenectomy might increase the risk of developing PVT,which may progress to a life-threatening complication after splenectomy if not diagnosed promptly and treated properly. In this review,we discuss the recent findings concerning the risk factors for PVT after splenectomy. It is pointed out that splenectomy is the major cause of PVT developed in patients with liver cirrhosis.

Application of tumor necrosis factor antagonists in hepatic disease treatment
Chi ZhaoChun, Geng ZhangXin
2015, 31(7): 1176-1179. DOI: 10.3969/j.issn.1001-5256.2015.07.045
Abstract:

All tumor necrosis factor( TNF) antagonists are associated with hepatotoxicity and thus induce liver injury,commonly manifested as hepatitis B virus and hepatitis C virus reactivation,acute hepatitis,drug- induced liver disease,cholestasis,serum liver enzyme activity elevation,and even acute liver failure. Hence,the application of TNF antagonists in hepatic disease treatment remains controversial. This review summarizes currently available data on the mechanism and application of TNF antagonists in hepatic disease treatment. Although TNF antagonists have been applied for many years,large randomized controlled trials are still recommended to assess its efficacy and safety and to achieve a consensus.