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

2016 No. 8

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Therapeutic guidelines
EASL clinical practice guidelines on the management of benign liver tumors (2016)
Huang Cheng, Sun HuiChuan
2016, 32(8): 1439-1445. DOI: 10.3969/j.issn.1001-5256.2016.08.001
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Recommendations for EASL cinical pactice guidelines on the prevention, diagnosis and therapy of gallstones (2016)
Ye JunFeng, Wu XinMin, Zhang BoZhuo, Qi WenLei, Wang GuangYi
2016, 32(8): 1446-1449. DOI: 10.3969/j.issn.1001-5256.2016.08.002
Abstract(227) PDF (181KB)(1100)
Abstract:
An excerpt of EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease(2016)
Chang BinXia, Li BaoSen, Zou ZhengSheng
2016, 32(8): 1450-1454. DOI: 10.3969/j.issn.1001-5256.2016.08.003
Abstract:
An excerpt of  the International Liver Transplant Society guidelines on living liver donation(2016)
Zhou Xia, Liu HongLing
2016, 32(8): 1455-1457. DOI: 10.3969/j.issn.1001-5256.2016.08.004
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Updated key points and clinical pathway for NCCN clinical practice guidelines: pancreatic adenocarcinoma (Version1. 2016)
Li XiaoQing, Qian JiaMing
2016, 32(8): 1458-1462. DOI: 10.3969/j.issn.1001-5256.2016.08.005
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Discussions by experts
Common mutations of hepatitis B virus and their clinical significance
Hu AiRong, Hu Ting
2016, 32(8): 1463-1467. DOI: 10.3969/j.issn.1001-5256.2016.08.006
Abstract:
Hepatitis B virus( HBV) tends to mutate easily due to its special structure and life cycle. Mutation changes the biological behavior of HBV and its sensitivity to antiviral drugs and even affects therapeutic effect and accelerate disease progression. The point mutations are commonly see in the pre- S / S open reading frame( ORF),which may be associated with immune escape and occult HBV infection. The G1896 A mutation is often observed in the pre- C / C- ORF and is associated with the development of HBe Ag- negative chronic hepatitis B( CHB),hepatocellular carcinoma( HCC),and severe chronic hepatitis( liver failure). The mutations in P- ORF mainly occur in the reverse transcriptase( RT) domain and are closely related to the resistance to nucleos( t) ide analogues. The A1762 T and G1764 A mutations occur in the basal core promoter( BCP),which overlaps with X- ORF,and may be associated with HBe Ag- negative CHB,HCC,and severe chronic hepatitis( liver failure). Clarification of the association between these mutations and diseases helps to develop tailor- made diagnostic and therapeutic regimens for patients with HBV infection.
Alternative methods for diagnosis of esophageal varices in patients with liver cirrhosis
Deng Han, Qi XingShun, Zhu Qiang, Guo XiaoZhong
2016, 32(8): 1468-1473. DOI: 10.3969/j.issn.1001-5256.2016.08.007
Abstract:
Esophageal variceal bleeding is one of the most serious complications of liver cirrhosis. Upper gastrointestinal endoscopy( UGE)is the gold standard for the diagnosis of esophageal varices,but it is invasive. Recently,several studies have reported some alternative methods for the diagnosis of esophageal varices,including serological model,ultrasound parameters,liver and spleen stiffness measurement,esophageal capsule endoscopy,nuclear magnetic resonance,and computed tomography. This article reviews the accuracy of these methods in the diagnosis of esophageal varices and their clinical significance. Ultrasound parameters( splenoportal index,congestion index of the portal vein,and platelet count / spleen diameter ratio),spleen stiffness measurement,computed tomography,and esophageal capsule endoscopy are accurate in the diagnosis of esophageal varices,and therefore,they can be applied in clinical practice and the application of UGE should be reduced.
Reconsideration of the clinical value of anatomical hepatectomy in surgical resection of liver cancer
Zhang YaMin
2016, 32(8): 1474-1476. DOI: 10.3969/j.issn.1001-5256.2016.08.008
Abstract:
The surgical resection of liver cancer consists of anatomical and non- anatomical resection,and controversy still exists over the application of these two procedures in clinical practice. This article introduces the technical points of anatomical and non- anatomical hepatectomy and analyzes the effect of anatomical hepatectomy on disease- free survival rate and overall survival rate,as well as the application of non- anatomical hepatectomy in liver cancer patients with underlying liver disease. The mechanism of recurrence after hepatectomy for liver cancer is also discussed. At last,this article summarizes the safety of anatomical hepatectomy and the advantages of non- anatomical hepatectomy and laparoscopic hepatectomy. As for liver cancer patients with liver cirrhosis,selection of the method for surgical resection of liver cancer should be based on a comprehensive evaluation of liver function and tumor condition.
Research advances in radiological examination for nonalcoholic fatty liver disease
Ye JunZhao, Zhong BiHui
2016, 32(8): 1477-1482. DOI: 10.3969/j.issn.1001-5256.2016.08.009
Abstract:
There is a high prevalence of nonalcoholic fatty liver disease( NAFLD) around the world,and early diagnosis and evaluation of liver fatty degeneration and fibrosis degree play important roles in the early treatment and prognostic evaluation of patients with NAFLD. This article reviews the principles,diagnostic accuracy,influencing factors,and practicability of various imaging techniques applied in liver fat quantification and fibrosis prediction. Studies have shown that radiological fat quantitative diagnosis based on ultrasound and magnetic resonance and liver fibrosis evaluation based on elastography have a high level of accuracy and promising prospects; however,such techniques lack standard cut- off values and operating procedures which may provide a reference for clinical application.
Several issues regarding evaluation of renal injury and renal insufficiency in patients with liver disease
Hao KunYan, Yu YueCheng
2016, 32(8): 1483-1487. DOI: 10.3969/j.issn.1001-5256.2016.08.010
Abstract:

In patients with liver disease such as viral hepatitis and liver cirrhosis,renal injury and renal insufficiency can be generally classified as acute kidney injury( AKI),chronic kidney disease,and acute- on- chronic nephropathy. AKI can be classified as stage 1( risk stage),stage 2( injury stage),and stage 3( failure stage). Traditionally hepatorenal syndrome is classified as types Ⅰ and Ⅱ,and in recent years,type Ⅲ hepatorenal syndrome with organic renal injury has been proposed. Hepatorenal disorder( HRD) is used to describe any renal disease which occurs in patients with liver cirrhosis. At present,sensitive and accurate biochemical parameters used to evaluate renal function in patients with liver disease in clinical practice include estimated glomerular filtration rate,increase in serum creatinine within unit time,and serum cystatin C level,and urinary microalbumin level also plays an important role in the early diagnosis of nephropathy. Causes of liver disease,severity,complications including infection,nutritional status,therapeutic drugs,and underlying nephropathy may be associated with renal injury and renal insufficiency in patients with liver disease and should be differentiated.

Biochemical parameters in diagnosis of cholestatic liver disease
Sun FengXia, Sui JingLi, Li Pan, Wang Man, Wu Fang, Li XiaoLing
2016, 32(8): 1488-1490. DOI: 10.3969/j.issn.1001-5256.2016.08.011
Abstract:
Although guidelines and expert consensuses have been published on the diagnosis and treatment of cholestatic liver disease recently in China and the rest of the world,many problems still exist in the biochemical standard for the diagnosis of cholestasis; for example,there are substantially different diagnostic criteria for cholestasis of various causes. This brings confusion to clinical doctors and is not good for research. This article analyzes common parameters in cholestasis and points out the problems in diagnosis. It is recommended to organize in- depth discussions and set standard for the diagnosis of cholestasis,in order to provide a more reliable basis for clinical research on cholestasis.
Research advances in treatment of primary biliary cholangitis
Li YanMei, Wang QiXia, Ma Xiong
2016, 32(8): 1491-1496. DOI: 10.3969/j.issn.1001-5256.2016.08.012
Abstract:
Primary biliary cholangitis( PBC) is an autoimmune liver disease mainly involving intrahepatic interlobular bile ducts and can progress to liver fibrosis,cirrhosis,and even liver failure. At present,the only drug approved for the treatment of PBC is ursodeoxycholic acid( UDCA),but up to 40% of PBC patients have suboptimal response to UDCA,and the risk of related complications is increased. Nowadays,other drugs and treatment methods,such as fibrates,glucocorticoids,immunosuppressants,obeticholic acid,biological agents,and mesenchymal stem cells,have been gradually applied in clinical practice and have brought the hope for the treatment of these patients.
Original articles_Viral hepatitis
Effect of protein acetylation on hepatitis B virus replication
Jia XiaoFang, Zhang XiaoNan, Wu Ao, Zhang LiJun, Yuan ZhengHong
2016, 32(8): 1497-1501. DOI: 10.3969/j.issn.1001-5256.2016.08.013
Abstract:

Objective To investigate the effect of protein acetylation in host cells on the replication of hepatitis B virus( HBV) in hepatocytes,since HBV infection greatly threatens human health and the acetylation of encoding proteins in infected cells plays an important role in HBV replication and infection. Methods The deacetylase inhibitors trichostatin A( TSA) and nicotinamide( NAM) were used to stimulate HBV replication in Hep G2. 2. 15 and Hep AD38 cells,and the HBV replication markers were measured. The pan- acetylysin protein and Ac- H3 were examined by Western Blot. Results The stimulation of cells with TSA and NAM increased the overall acetylation level of proteins in cells,and the acetylation level increased in a time- and dose- dependent manner. In the Hep G2. 2. 15 and Hep AD38 cells,stimulation with TSA and NAM reduced HBs Ag level in the supernatant of cell culture and increased HBV DNA level in a time- and dose- dependent manner,while HBe Ag in the supernatant of cell culture and DNA in cells did not change significantly. Conclusion Acetylation of host proteins may be involved in and affect HBV replication in cells,and further analysis and determination of host proteins whose acetylation affects HBV replication in cells help to learn more about the regulation of HBV replication and provide new thoughts for the development of specific antiviral strategies.

Original articles_Liver fibrosis and liver cirrhosis
Clinical effect of Dahuang Zhechong capsules combined with entecavir in treatment of chronic hepatitis B patients with liver fibrosis
Xie YongCai, Hu GuoXin, Peng YanZhong, Zheng Jie, Li YinPing
2016, 32(8): 1502-1507. DOI: 10.3969/j.issn.1001-5256.2016.08.014
Abstract:

Objective To investigate the clinical effect of Dahuang Zhechong capsules combined with entecavir in the treatment of chronic hepatitis B( CHB) patients with liver fibrosis. Methods A total of 100 CHB patients with liver fibrosis who visited or were hospitalized in Shenzhen Hospital of Peking University from October 2014 to January 2016 were enrolled and randomly divided into Western medicine group and combined treatment group,with 50 patients in each group. The patients in the Western medicine group were given entecavir,and those in the combined treatment group were given Dahuang Zhechong capsules in addition to entecavir. The course of the treatment was 48 weeks.The changes in liver function,HBV DNA load,four serum parameters of liver fibrosis,liver stiffness,and aspartate aminotransferase- to-platelet ratio index( APRI) / Fibro Index were observed in both groups. The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results Both groups showed significant reductions in serum levels of aspartate aminotransferase( AST),alanine aminotransferase( ALT),and HBV DNA load after 48 weeks of treatment( all P < 0. 05). After treatment,the four serum parameters of liver fibrosis all returned to normal after treatment,and the serum levels of hyaluronic acid,type Ⅲ precollagen,and type IV collagen showed significant differences between the two groups( all P < 0. 05),and the portal vein diameter,thickness of the spleen,liver stiffness and APRI / Fibro Index also showed significant differences between the two groups( both P < 0. 05). The combined treatment group had a significantly higher overall response rate than the Western medicine group( 92. 0%vs 72. 0%,χ2= 6. 775,P = 0. 009). Conclusion Dahuang Zhechong capsules combined with entecavir have a better effect in the treatment of CHB patients with liver fibrosis compared with entecavir alone.

The predictive values of three noninvasive indices in diagnosis of liver fibrosis in patients with chronic hepatitis B: a comparative study
Zhuang XiaoFang, Ma Yan, Wang XiaoZhong, Wang Yan, Guo Feng, Wang XiaoBo
2016, 32(8): 1508-1512. DOI: 10.3969/j.issn.1001-5256.2016.08.015
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Objective To investigate the values of Fibro Touch,FIB- 4 index,and aspartate aminotransferase- to- platelet ratio index( APRI) in the diagnosis of liver fibrosis in patients with chronic hepatitis B( CHB). Methods A total of 148 patients with CHB who visited Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region and underwent liver biopsy from September 2013 to May2015 were enrolled and divided into groups according to fibrosis stage. All the patients underwent blood biochemical examination,routine blood tests,and Fibro Touch measurement. Then FIB- 4 and APRI were calculated,and liver stiffness was recorded. The receiver operating characteristic( ROC) curve was used to calculate the area under the ROC curve( AUC) and determine the cut- off value,sensitivity,and specificity. Chi- square test was used for comparison between two groups,and the Pearson rank correlation analysis was also performed. Results Fibro Touch,APRI,and FIB- 4 were well correlated with fibrosis stage( r = 0. 628,0. 486,and 0. 482,respectively,all P < 0. 01).In the marked liver fibrosis( ≥S2) group and liver cirrhosis( S4) group,Fibro Touch had the best diagnostic performance,with AUCs of 0. 84 and 0. 93,respectively,followed by APRI,which had AUCs of 0. 79 and 0. 87,respectively; FIB- 4 index had the worst diagnostic performance,with AUCs of 0. 77 and 0. 84,respectively. In patients with a fibrosis stage of ≥S2 or S4,Fibro Touch had a better diagnostic value than APRI and FIB- 4( Z = 21. 589,P < 0. 001; Z = 18. 896,P < 0. 001; Z = 11. 192,P = 0. 001; Z = 16. 891,P < 0. 001),and APRI had a better diagnostic value than FIB- 4( Z = 46. 918,P < 0. 001; Z = 35. 334,P < 0. 001). Conclusion Fibro Touch can accurately evaluate the presence of liver fibrosis and fibrosis degree and help most patients avoid invasive liver biopsy.
Fibro Scan in diagnosis of liver fibrosis in patients with different chronic liver diseases: a comparative analysis
Lu HaiYing, Liu LingFeng, Xu XiaoYuan, Yu YanYan, Wu ChiHong
2016, 32(8): 1513-1517. DOI: 10.3969/j.issn.1001-5256.2016.08.016
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Objective To investigate the similarities and differences of Fibro Scan in the diagnosis of liver fibrosis in patients with different chronic liver diseases. Methods The clinical data of 516 patients with chronic liver diseases who visited Peking University First Hospital from October 2012 to January 2015 were collected,and according to the cause of disease,these patients were divided into chronic hepatitis B( CHB) group( 305 patients),chronic hepatitis C( CHC) group( 117 patients),and primary biliary cirrhosis( PBC) group( 94 patients). The routine blood test results,liver function,Fibro Scan( FS) value,and abdominal ultrasound findings were recorded. The patients in each group were further divided into subgroups with FS value < 7. 3 k Pa,7. 3 k Pa ≤FS value < 15 k Pa,or FS value ≥15 k Pa.The Kruskal- Wallis H test was used for comparison of continuous data and categorical data between multiple groups,and the Mann- Whitney U test was used for comparison between any two groups. The multiple linear regression was used to analyze the correlation of FS value with age,sex,body mass index( BMI),routine blood test results,liver function,and ultrasound parameters. Results In the CHB group,sex,hemoglobin,aspartate aminotransferase( AST),albumin,alkaline phosphatase( ALP),total bilirubin( TBil),BMI,diameter of the portal vein,and ascites were the independent influencing factors for FS value( all P < 0. 05); in the CHC group,platelet count,alanine aminotransferase( ALT),ALP,gamma- glutamyl transpeptidase( GGT),total bile acid,smoothness of liver surface,diameter of the portal vein,and ascites were the independent influencing factors for FS value( all P < 0. 05); in the PBC group,TBil,total bile acid,and ascites were the independent influencing factors for FS value( all P < 0. 05). Most indicators showed significant differences between CHB and CHC patients with different FS values( all P < 0. 05). In the PBC group,only ALT( Z =- 2. 121,P = 0. 034),AST( Z =- 3. 027,P =0. 002),and spleen length( Z =- 2. 496,P = 0. 013) showed significant differences between the FS value < 7. 3 k Pa subgroup and the7. 3 k Pa ≤FS value < 15 k Pa subgroup; platelet count( Z =- 2. 289,P = 0. 022),albumin( Z =- 2. 185,P = 0. 029),TBil( Z =- 2. 642,P = 0. 008),spleen thickness( Z =- 3. 317,P = 0. 001),spleen length( Z =- 2. 010,P = 0. 044),and diameter of the splenic vein( Z =- 2. 296,P = 0. 022) showed significant differences between the 7. 3 k Pa ≤FS value < 15 k Pa subgroup and the FS value ≥15 k Pa subgroup. Conclusion Different factors affect the FS value in patients with different causes. Total bile acid and TBil are important influencing factors for FS value in PBC patients,while liver function greatly influences FS value in CHB and CHC patients,suggesting that the threshold values for Fibro Scan in the diagnosis of liver fibrosis should be set independently for different causes of disease.
Efficacy of Jiawei Jianpi Bushen prescription in treatment of liver fibrosis and its role in regulating Treg/Th17 balance
Pan Kai, Zhao Qiang, Tao YanYan, Chen GaoFeng, Liu ChengHai
2016, 32(8): 1518-1524. DOI: 10.3969/j.issn.1001-5256.2016.08.017
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Objective To investigate the therapeutic effect of Jiawei Jianpi Bushen prescription in liver fibrosis in rats and its effect on regulatory T( Treg) cells and T helper 17( Th17) cells. Methods A total of 32 male Wistar rats were randomly divided into normal group,model group,Jianpi Bushen prescription group,and Jiawei Jianpi Bushen prescription group. The model was established by subcutaneous injection of CCl4. The administration groups were given Jianpi Bushen decoction and Jiawei Jianpi Bushen decoction since week 4 and sacrificed at the end of week 8. The serum markers of liver function were measured,the status of liver inflammation and fibrosis was observed,and the protein and mRNA expression of Fox3 and interleukin- 17( IL- 17) and serum levels of interleukin- 4( IL- 4) and IL- 17 were also observed. An analysis of variance was used for comparison of continueus data between multiple groups,the LSD t- test was used for comparison of countinuous data between two groups; the Ridit test was used for comparison of ranked data. Results Compared with the normal group,the model group showed significant increases in total bile acid( TBA),alkaline phosphatase( ALP),total bilirubin( TBil),alanine aminotransferase( ALT),and aspartate aminotransferase( AST)( all P < 0. 05),as well as significant collagen deposition in the liver and significantly increased expression of α- smooth muscle actin( α- SMA)( both P < 0. 05). Compared with the model group,the Jianpi Bushen decoction group showed significant reductions in serum ALP,TBA,TBil,and ALT( all P < 0. 05); the Jiawei Jianpi Bushen decoction group showed significant reductions in serum ALP,TBA,TBil,ALT,and AST( all P < 0. 05); the administration groups showed significant reductions in collagen deposition in the liver and expression of α- SMA( all P < 0. 05). Compared with the Jianpi Bushen decoction group,the Jiawei Jianpi Bushen decoction group had significantly reduced TBA,ALT,and AST( all P < 0. 05). Compared with the normal group,the model group showed significant increases in the protein and mRNA expression of IL- 17 in the liver tissue and a significant increase in the mRNA expression ratio of IL- 17 to Foxp3( all P < 0. 05),a significant increase in serum IL- 17 level,and significant reductions in serum levels of IL- 4 and IL- 17( all P < 0. 05). Compared with the model group,the administration groups showed significant reductions in the protein and mRNA expression of IL- 17 in the liver tissue and a significant reduction in the mRNA expression ratio of IL- 17 to Foxp3( all P < 0. 05),a significant reduction in serum IL- 17 level,and significant increases in serum levels of IL- 4 and IL- 17( all P <0. 05). Conclusion Jiawei Jianpi Bushen prescription has improved efficacy in the treatment of liver fibrosis,and its mechanism of action may be associated with the regulation of Treg / Th17 imbalance.
Clinical efficacy of entecavir in HBeAg-negative chronic hepatitis B with compensated cirrhosis
Han BenLi
2016, 32(8): 1525-1528. DOI: 10.3969/j.issn.1001-5256.2016.08.018
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Objective To investigate the clinical efficacy of 96- week entecavir( ETV) treatment for HBe Ag- negative chronic hepatitis B patients with compensated cirrhosis,as well as its effect on patients with different HBV DNA loads. Methods A total of 118 chronic hepatitis B patients with compensated cirrhosis who visited Xiangyang Hospital of Traditional Chinese Medicine from January 2009 to June 2013 were enrolled and all had Child- Pugh class A cirrhosis. According to HBV DNA load,these patients were divided into high- load group( group A,HBV DNA≥105copies / ml) and low- load group( group B,HBV DNA < 105 copies / ml). All the patients were treated with ETV 0. 5 mg / d for 96 weeks. Child- Pugh score was used to evaluate liver function before and after treatment,and the changes in alanine aminotransferase( ALT),albumin( Alb),and total bilirubin( TBil) after treatment were observed. Hyaluronic acid( HA),α2- macroglobulin,and liver stiffness measurement( LSM) were used to evaluate liver fibrosis. The t- test was used for comparison between groups,and a repeated- measures analysis of variance was used for comparison within one group and between groups at different time points. Chisquare test was applied for comparison of categorical data between the two groups. Results The two groups showed significant reductions in ALT,Alb,and TBil at weeks12 and 24 of treatment( all P < 0. 05),and the ALT normalization rate and HBV DNA clearance rate at weeks 24 and 48 of treatment showed significantly differences between the two groups( χ2= 9. 241,6. 428,11. 134,5. 139,all P < 0. 05). Both groups showed significant reductions in HA,α2- macroglobulin,and LSM after treatment( t = 2. 648,1. 921,4. 018,3. 166,2. 136,3. 461,all P < 0. 05). The incidence rates of complications such as variceal bleeding,ascites,and hepatocellular carcinoma showed no significant differences between the two groups( all P > 0.05). Conclusion In HBe Ag- negative chronic hepatitis B patients with compensated cirrhosis,ETV can significantly improve liver function,slow down the process of liver fibrosis and cirrhosis,and effectively reduce long- term complications.
Long-term therapeutic effect of transjugular intrahepatic portosystemic shunt in patients with intractable cirrhotic ascites and prognostic factors
Ju Wei, Zhang BoJing, Han GuoHong
2016, 32(8): 1529-1533. DOI: 10.3969/j.issn.1001-5256.2016.08.019
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Objective To investigate the long- term therapeutic effect of transjugular intrahepatic portosystemic shunt( TIPS) in patients with intractable cirrhotic ascites and prognostic factors. Methods A retrospective analysis was performed for the clinical data of 57 patients with intractable cirrhotic ascites who were received TIPS in our hospital from January 2009 to June 2014. Regular telephone follow- up was performed in all patients. Laboratory testing results and abdominal ultrasound and CT findings were examined. The improvement in ascites and survival were evaluated. The χ2test was applied for comparison of categorical data between groups. The Kaplan- Meier method was used to calculate the cumulative probability of survival and other cumulative probabilities,the log- rank test was used for survival difference analysis,the Cox regression model was used to analyze prognostic factors,and the receiver operating characteristic curve( ROC) and the area under the curve( AUC) were used to determine the optimal cut- off values of prognostic factors. Results The 1- year ascites remission rate after TIPS was93%,and the 1- and 2- year survival rates were 60% and 43%,respectively. The multivariate Cox regression analysis showed that Child-Pugh score( HR = 268,95% CI: 1. 009- 1. 594,P = 0. 042) and urea nitrogen( HR = 1. 143,95% CI: 1. 034- 1. 264,P = 0. 009,) were predictive factors for 1- year survival rate after TIPS in patients with intractable cirrhotic ascites. The area under the ROC curve of Child-Pugh score was 0. 699( P = 0. 011,95% CI: 0. 558- 0. 840),and the optimal cut- off value of Child- Pugh score was 8,with a sensitivity of75% and a specificity of 67%. The Kaplan- Meier survival analysis demonstrated that the 1- year survival rates of patients with Child- Pugh scores of ≤8 and > 8 were 82% and 38%,respectively( χ2= 10. 888,P = 0. 001). Conclusion TIPS is safe and effective in the treatment of intractable ascites,and Child- Pugh score ≤8 is a predictive factor for 1- year survival rate in such patients.
Significance of serum ischemia-modified albumin level in evaluating liver function in patients with liver cirrhosis of various causes
Chen ChengLiang, Song Wei, Meng XiuNa, Tian Xing, Jiao Jian
2016, 32(8): 1534-1537. DOI: 10.3969/j.issn.1001-5256.2016.08.020
Abstract:
Objective To investigate the differences in serum levels of ischemia- modified albumin( IMA) and IMA / albumin ratio( IMAR) in patients with liver cirrhosis of various causes,as well as the significance of IMA measurement and IMAR in evaluating liver function. Methods A total of 456 patients with liver cirrhosis who were admitted to China- Japan Union Hospital of Jilin University from February 2012 to February 2014 were enrolled. The patients underwent liver function evaluation,and according to the serum albumin( Alb) level,they were divided into normal Alb group( 152 patients) and reduced Alb group( 304 patients). According to the cause of the disease,the patients were further divided into hepatitis B virus( HBV) group,hepatitis C virus( HCV) group,and alcoholic cirrhosis group,and healthy subjects were enrolled as controls. The serum IMA level was measured for all patients with liver cirrhosis,IMAR was calculated,and the correlations of IMA and IMAR with liver function parameters and Child- Pugh score were analyzed. An analysis of variance was used for comparison of coutinuous data between groups,and the least significant difference t- test was used for further comparision between any two groups; the chi- square test was used for comparison of categorical data between group and the Spearman rank correlation was used to analyze the correlation of IMA、IMAR、Child- Puch score. Results Compared with the healthy controls,the patients with liver cirrhosis showed significant increases in the serum IMA level and IMAR( all P < 0. 05),and the cirrhotic patients with hypoproteinemia had significantly higher serum IMA level and IMAR than those without hypoproteinemia( all P < 0. 05). In addition,the patients with alcoholic cirrhosis had significantly higher serum IMA level and IMAR than those with HBV- or HCV- associated liver cirrhosis( F = 6. 765,8. 276; P < 0. 01).The serum IMA level was correlated with Alb,total bilirubin( TBil),international normalized ratio( INR),and cholinesterase( CHE)( r =- 0. 510,0. 731,0. 327,- 0. 679; all P < 0. 05). IMAR was correlated with TBil,INR,and CHE( r = 0. 488,0. 327,- 0. 896; all P <0. 05). The serum IMA level and IMAR were positively correlated with Child- Pugh score( r =- 0. 801,0. 899; all P < 0. 05). Conclusion Patients with liver cirrhosis experience a reduced Alb function before the development of hypoproteinemia,and serum IMA level and IMAR differ significantly between the patients with liver cirrhosis of various causes.
Original articles_Liver neoplasms
Epidemiological and clinical features of primary liver cancer: an analysis of 236 patients
Zhao RongRong, Deng YongDong, Yuan Hong
2016, 32(8): 1538-1542. DOI: 10.3969/j.issn.1001-5256.2016.08.021
Abstract:
Objective To investigate the epidemiological and clinical features of patients with primary liver cancer( PLC). Methods A retrospective analysis was performed for the clinical data of 236 patients with complete information who were admitted to The First Hospital of Lanzhou University and diagnosed with PLC for the first time form August 2012 to August 2014,and their epidemiological and clinical features were analyzed. The chi- square test was used for comparison of categorical data between groups. Results Among the 236 PLC patients,there were 198 male patients( 83. 9%) and 38 female patients( 16. 1%),and the patients aged 41- 60 years has the highest incidence rate( 58. 5%,138 /236). Nineteen patients had a family history of liver cancer,28 had a history of heavy drinking,34 were complicated by type 2 diabetes,and 44 were complicated by hypertension. Among these patients,232( 98. 3%) developed PLC on the basis of chronic liver disease,and 4( 1. 7%) had no chronic liver disease. There were 207 patients( 87. 7%) with chronic HBV infection,and most of them had HBe Ag- negative infection. Fourteen patients( 5. 9%) had chronic HCV infection,5( 2. 1%) had HBV / HCV co- infection,and 6( 2. 5%) had chronic alcoholic hepatitis. Among the 212 patients with HBV infection,51( 24. 1%) had HBe Ag- positive chronic hepatitis B,and 95( 44. 8%) had HBe Ag- negative chronic hepatitis B; there was significant difference in HBV DNA level between the two groups( χ2= 40. 687,Ρ = 0. 001). Among all the PLC patients,104 had an alpha- fetoprotein( AFP) level of > 400 IU / ml,48 had an AFP level of 200- 400 IU / ml,and 84 had an AFP level of < 200 IU / ml; 154( 62. 3%) had a single lesion,and 72( 30. 5%) had multiple lesions; most( 72. 7%) of patients with a single lesion had the single lesion in the right lobe,and the proportions of patients with multiple lesions in the right lobe and in both lobes accounted for 58. 3% and 41. 7%,respectively. Among the 80 PLC patients with pathological results,most( 85%) had hepatocellular carcinoma. Conclusion PLC has certain distribution patterns in sex,age of onset,family history of liver cancer,etiology,tumor position,number of tumors,and pathological histology. The factors involved in the development and progression of PLC need in- depth investigation,in order to develop good control strategies. Moreover,the association of PLC with chronic metabolic diseases such as diabetes and hypertension awaits further investigation.
Synergistic effect of interventing insulin-like growth factor-Ⅰ receptor activation combined with anti-cancer drugs in inhibiting the proliferation of hepatocellular carcinoma cells
Cai Yin, Yao Min, Wang Li, Dong ZhiZhen, Gu JuanJuan, Yan XiaoDi, Qiu LiWei, Yao DengFu
2016, 32(8): 1543-1548. DOI: 10.3969/j.issn.1001-5256.2016.08.022
Abstract:
Objective To investigate the intervention of gene transcription of insulin- like growth factor- Ⅰ receptor( IGF- ⅠR) and its synergistic effect with anti- cancer drugs in inhibiting the proliferation of hepatocellular carcinoma( HCC) cells. Methods The HBV-positive HCC PLC / PRF /5 and HBV- negative Bel- 7404 cells were transfected with the efficient plasmid p GPU6 / GFP / Neo- IGF- ⅠR-shRNA. Fluorescent quantitative RT- PCR and Western blot were used to measure mRNA and protein expression,the Cell Counting Kit-8 was used to analyze cell proliferation,and flow cytometry and Annexin- V- PE /7- ADD were used to analyze cell cycle and apoptosis.The t- test was used for comparison of continuous data between groups,the Fisher's exact test was used for comparison of categorical data between groups. Results The efficiency of IGF-ⅠR shRNA transfection was 71% in HCC PLC / PRF /5 cells and 90% in Bel- 7404 cells,and both cells showed reductions in the mRNA and protein expression of IGF- ⅠR. The intervention group showed a significant inhibition compared with the negative control group,and the 72- hour inhibition rates of Bel- 7404 cells and PLC / PRF /5 cells showed significant differences between the two groups( inhibition rates of Bel- 7404 cells: 61. 5% ± 1. 7% vs 11. 2% ± 0. 9%,t = 5. 493,P < 0. 05; inhibition rates of PLC / PRF /5 cells: 63. 9% ± 3. 9% vs 9. 5% ± 1. 1%,t = 19. 244,P < 0. 001). The intervention group showed a significantly higher apoptosis rate of Bel- 7404 cells than the blank control group( 35. 96% vs 12. 16%,P < 0. 001) and the negative control group( 35. 96% vs 9. 43%,P < 0. 001),as well as a significantly higher apoptosis rate of PLC/PRF/5 cells than the blank control group( 44. 84% vs 6. 62%,P < 0. 001) and the negative control group( 44. 84% vs 4. 02%,P < 0. 001). The co- intervention group showed significantly higher percentages of Bel- 7404 cells and PLC / PRF /5 cells in G0/ G1 phase than the negative control group( 59. 0% ± 1. 3%vs 48. 4% ± 0. 8%,t = 12. 032,P < 0. 001; 65. 4% ± 0. 5% vs 53. 5% ± 0. 7%,t = 22. 789,P < 0. 001). The co- intervention group showed significantly lower expression of cyclin D1 in Bel- 7404 cells and PLC / PRF /5 cells than the negative control group( 59. 6% ± 4. 7%vs 90. 0% ± 3. 4%,t = 7. 389,P < 0. 05; 39. 9% ± 0. 5% vs 90. 2% ± 14. 6%,t = 4. 876,P < 0. 05). The OD value of Bel- 7404 cells and PLC / PRF /5 cells showed a significant difference between the intervention group and the negative control group when the sorafenib concentration was 0,2. 5,5,10,and 20 nmol / L and the oxaliplatin concentration was 0,5,10,20,and 40 μmol / L( all P < 0. 05). Conclusion The downregulation of IGF-ⅠR gene transcription has the synergistic effect of inhibiting HCC cell proliferation and improving drug susceptibility.
Expression and clinical significance of astrocyte elevated gene-1,β-catenin,and cyclin D1 in hepatocellular carcinoma
Yu Ying, Luo XinHua, Cheng MingLiang, Cheng YunJuan
2016, 32(8): 1549-1552. DOI: 10.3969/j.issn.1001-5256.2016.08.023
Abstract:
Objective To investigate the expression and clinical significance of astrocyte elevated gene- 1( AEG- 1),β- catenin,and cyclin D1 in hepatocellular carcinoma( HCC) tissues. Methods A total of 40 HCC samples and 40 samples of corresponding para- carcinoma tissues from the patients with pathologically confirmed HCC who underwent surgery in The People's Hospital of Guizhou from July 2013 to December 2014 were randomly selected,and 8 samples of normal liver tissues were selected as controls. The immunohistochemistry SP was used to measure the protein expression of AEG- 1,β- catenin,and cyclin D1 in HCC tissues,corresponding para- carcinoma tissues,and normal liver tissues,and the correlation between their expression and HCC clinicopathological characteristics was analyzed. The chi- square test or Fisher's exact test was used for comparison of categorical data between groups,and the Spearman rank correlation was used to analyze the correlation of AEG- 1 with β- catenin,and cyclin D1 in HCC. Results HCC tissues and para- carcinoma tissues showed significantly higher protein expression of AEG- 1,β- catenin,and cyclin D1 than normal liver tissues( χ2= 7. 840,4. 274,8. 817,4. 274,9. 919,and 4. 850,P = 0. 005,0. 039,0. 003,0. 039,0. 002,and 0. 028). The positive expression of AEG- 1,β- catenin,and cyclin D1 showed no significant differences across the patients with different sexes,ages,HBs Ag status,or tumor sizes( all P > 0. 05),but showed significant differences across the patients with different degrees of pathological differentiation,TNM stages for liver cancer,and metastases( all P < 0. 05). The correlation analysis showed that the protein expression of AEG- 1 was positively correlated with that of β- catenin and cyclin D1( r = 0. 420 and 0. 741,both P < 0. 01). Conclusion AEG- 1,β- catenin,and cyclin D1 may play vital roles in the development and progression of HCC. AEG- 1 may up- regulate the expression and activity of cyclin D1 and β- catenin and thus promote the development and metastasis of HCC. A combined measurement of AEG- 1,β- catenin,and cyclin D1 can be used as an important parameter for HCC gene therapy and prognostic evaluation.
Original articles_Biliary diseases
Predictive value of serum CA19-9 in predicting acute cholangitis in patients with obstructive jaundice
Pan YaJun, Sun ShaoFu
2016, 32(8): 1553-1556. DOI: 10.3969/j.issn.1001-5256.2016.08.024
Abstract:
Objective To investigate the predictive factors for acute cholangitis in patients with obstructive jaundice. Methods A retrospective analysis was performed for the clinical data of 358 patients with common bile duct stones and obstructive jaundice who were treated in The Fourth People's Hospital of Haikou from October 2010 to October 2015. According to the presence or absence of acute cholangitis,the patients were divided into acute cholangitis group( n = 223) and obstructive jaundice group( n = 135). Age,sex,and comorbidities were compared between the two groups,and the association between abnormalities in serum tumor markers and liver function parameters and the development of acute cholangitis was examined. The parameters with statistical significance were used to establish the receiver operating characteristic( ROC) curves,and their sensitivity and specificity in the diagnosis of acute cholangitis were evaluated. The t test and χ2test were applied for comparison of continuous data and categorical data between groups,respectively. Results The acute cholangitis group had significantly higher serum levels of CA19- 9 and CA12- 5 than the obstructive jaundice group( serum level of CA19- 9: 82. 33 ± 23. 01 k U / L vs 36. 75 ± 12. 58 k U / L,t = 11. 028,P < 0. 05; serum level of CA125: 30. 21 ± 9. 59 k U / L vs 18. 62 ± 5. 27 k U / L,t = 8. 597,P <0. 05). The analysis of the ROC curves showed that the areas under the ROC curve for serum CA19- 9 and CA12- 5 were 0. 891 and0. 705,respectively,and the corresponding cut- off values for the highest diagnostic accuracy were 61. 01 k U / L and 22. 56 k U / L,respectively,with sensitivities of 82. 1% and 77. 6% and specificities of 79. 8% and 69. 5%. Conclusion Increased serum CA19- 9 level has a great value in predicting acute cholangitis in patients with common bile duct stones and obstructive jaundice.
Original articles_Others
Clinical efficacy of Qinggan Huashi Huoxue decoction combined with liver-protecting and enzyme-lowering drugs in treatment of alcoholic liver disease
Yao ZhiShan, Liu DingDing, Yun Xiang
2016, 32(8): 1557-1561. DOI: 10.3969/j.issn.1001-5256.2016.08.025
Abstract:

Objective To investigate the clinical efficacy and safety of Qinggan Huashi Huoxue decoction combined with liver- protecting and enzyme- lowering drugs in the treatment of alcoholic liver disease( ALD). Methods A total of 175 ALD patients who were admitted to The Second People's Hospital of Tangshan from January 2012 to December 2015 were enrolled and randomly divided into treatment group( 87patients) and control group( 88 patients). The patients in the control group were asked to quit smoking and were given nutritional support and medications including polyene phosphatidylcholine,reduced glutathione,magnesium isoglycyrrhizinate,and ursodeoxycholic acid capsules,and those in the treatment group were given the self- made traditional Chinese medicine Qinggan Huashi Huoxue decoction in addition to the therapeutic regimen for the control group. During the three courses of treatment( 12 weeks),the patients' clinical symptoms and signs were observed,liver function [alanine aminotransferase( ALT),aspartate aminotransferase( AST),gamma- glutamyl transpeptidase( GGT),albumin( Alb),and total bilirubin( TBil) ]and blood lipids [total cholesterol( TC),triglyceride( TG),high- density lipoprotein( HDL),and low- density lipoprotein( LDL) ] were performed regularly,the results of routine blood tests and abdominal ultrasound findings were recorded regularly,and adverse events which occurred during treatment were recorded. The independent samples t- test was used for comparison of continuous data between groups,an analysis of variance with repeated measures was used to compare the differences at each time point between the two groups,and the chi- square test was used for comparison of categorical data between groups. Results After treatment,all patients achieved varying degrees of improvements in clinical symptoms and signs,which showed significant differences between the two groups at weeks 4,8,and 12 of treatment( t = 14. 390,10. 487,and 13. 547,all P < 0. 05). The liver function parameters in the two groups showed varying degrees of improvements at weeks 4,8,and 12 of treatment,and ALT,AST,and GGT showed significant differences between the two groups at weeks 4,8,and 12 of treatment( F = 21. 050,8. 108,and 12. 038,all P < 0. 01). In the control group,HDL showed a significant change after treatment( t = 3. 101,P < 0. 05),and in the treatment group,HDL and LDL showed significant changes after treatment( t = 6. 818 and 2. 532,both P < 0. 05). After treatment,HDL showed a significant difference between the two groups( t = 2. 784,P < 0. 05). The overall response rate also showed a significant difference between the control group and the treatment group( 53. 4% vs 82. 8%,χ2= 28. 74,P < 0. 001). No patient experienced significant adverse events during treatment. Conclusion Qinggan Huashi Huoxue decoction combined with liver- protecting and enzyme- lowering drugs can improve the clinical outcome of ALD patients and holds promise for clinical application.

Application of drug lymphocyte stimulation test using cell counting kit-8 assay in diagnosis of acute drug-induced liver injury
Fan ZuoPeng, Liang Shan, Nie Wei, Chou LiXia, Chen Jie, Zhang Jing, Jin RongHua, Hu ZhongJie
2016, 32(8): 1562-1565. DOI: 10.3969/j.issn.1001-5256.2016.08.026
Abstract:

Objective To develop a novel drug lymphocyte stimulation test( DLST) using cell counting kit- 8( CCK- 8) assay,and to investigate its application in the diagnosis of acute drug- induced liver injury( DILI). Methods The patients with acute DILI who were admitted to Beijing You An Hospital from January 2011 to December 2014 were screened,and the suspected drugs for liver injury were collected. The patients' peripheral blood mononuclear cells( PBMCs) were isolated,cultured in vitro,and then incubated with the suspected drugs. The CCK- 8 assay was used to measure the proliferation of lymphocytes. A positive control group was established for each experiment and was stimulated by phytohemagglutinin. Meanwhile,PBMCs from healthy subjects were enrolled as the negative control group,and were exposed to the same drugs and measured simultaneously. The results of DLST were introduced into the Roussel Uclaf Causality Assessment Method( RUCAM) scoring system to assess their effects on the sensitivity of the diagnosis of acute DILI. The chi- square test was used for comparison of categorical data between groups. Results Preliminary experiments were performed to determine the experimental conditions of DLST based on CCK- 8 assay. A total of 61 patients with acute DILI were enrolled. DLST based on CCK- 8 assay was completed in 52 patients who received a total of 75 drugs,and the results were identified to be reliable in 48 patients with 70 drugs. A total of 19 patients with22 drugs achieved positive results of DLST,with positive rates of patients and drugs being 39. 6% and 31. 4%,respectively,and a specificity of 93. 8%. Thirteen( 38. 2%) out of 34 traditional Chinese medicines and 9( 25%) out of 36 Western medicines achieved positive results of DLST,and the median stimulation index was 2. 29( 1. 81- 14. 20). After the results of DLST were introduced into the RUCAM scoring system,the proportion of drugs assessed as“highly probable”or “probable”were increased from 74. 7% to 92. 0%( χ2= 8. 112,P =0. 004). Conclusion CCK- 8 assay can be used to perform DLST,and the introduction of DLST results into the RUCAM scoring system can significantly improve the sensitivity of RUCAM in the diagnosis of DILI. Compared with the conventional DLST,DLST based on CCK-8 has the advantages of few requirements for laboratories,a simple and timesaving procedure,and low costs,and can be further used and verified in clinical practice.

Hepatocyte autophagy model established by physical method
Zhu XueMin, Meng QingHua
2016, 32(8): 1566-1570. DOI: 10.3969/j.issn.1001-5256.2016.08.027
Abstract:

Objective To establish the autophagy model of normal human liver cell line 7702 induced by hypoxia and starvation,and to lay a foundation for further studies on the influence of autophagy on liver function. Methods The 7702 cells were selected and incubated with95% air and 5% CO2 at a temperature of 37 ℃( normal control group). The Binder three- gas incubator was used,with a temperature of37 ℃,a CO2 concentration of 5%,and an O2 concentration of 0. 3% to provide a hypoxic environment,and the serum- free DMEM was used to induce starvation. These cells were divided into 6-,12-,18-,and 24- hour hypoxia- starvation groups. Western blot was used to measure the protein expression of Beclin 1,Atg5,and LC3 in the normal control group and experimental groups,RT- q PCR was used to measure the mRNA expression of Beclin 1 and Atg5 in each group,and after transfection of LC3 plasmid,immunofluorescence assay was used to observe autophagy in each group. An analysis of variance was used for comparison of continuous data between groups,and the least significant difference t- test was used for further comparison between any two groups; the chi- square test was used for comparison of categorical data between groups. Results The 6- hour hypoxia- starvation groups had higher protein expression of Beclin 1,Atg5,and LC3 than the normal control group or other treated groups. Compared with all the other groups,the 6- hour hypoxia- starvation group showed significantly increased mRNA expression of Beclin 1 and Atg5,as well as significantly greater increases in the mRNA expression of Beclin 1and Atg5( all P < 0. 05). The hypoxia- starvation groups had significantly lower numbers of autophagosomes than the normal control group,and the 6- hour hypoxia- starvation group had the highest number of autophagosomes( all P < 0. 05). Conclusion Hypoxia and starvation established by physical methods can successfully induce hepatocyte autophagy,which is the most remarkable at 6 hours of hypoxia and starvation.

Characteristics of gene mutation in Chinese patients with hereditary hemochromatosis
Lu: TingXia, Zhang Wei, Li XiaoJin, Xu AnJian, Zhao XinYan, Ou XiaoJuan, Huang Jian
2016, 32(8): 1571-1574. DOI: 10.3969/j.issn.1001-5256.2016.08.028
Abstract:

Objective To investigate the characteristics of gene mutation in Chinese patients with hereditary hemochromatosis( HH).Methods A total of 9 patients with HH who visited Beijing Friendship Hospital,Capital Medical University from January 2013 to December2015 were enrolled. The genomic DNA was extracted,and PCR amplification and Sanger sequencing were performed for all the exons of four genotypes of HH,i. e.,HFE( type Ⅰ),HJV( type ⅡA),HAMP( type ⅡB),TFR2( type Ⅲ),and SLC40A1( type Ⅳ) to analyze gene mutations. A total of 50 healthy subjects were enrolled as control group to analyze the prevalence of identified gene mutations in a healthy population. Results Of all patients,2 had H63 D mutation of HFE gene in type Ⅰ HH,1 had E3 D mutation of HJV gene in typeⅡA HH,2 had I238 M mutation of TFR2 gene in type Ⅲ HH,and 1 had IVS 3 + 10 del GTT splice mutation of SLC40A1 gene in type ⅣHH. No patients had C282 Y mutation of HFE gene in type Ⅰ HH which was commonly seen in European and American populations. Five patients had no missense mutation or splice mutation. In addition,it was found in a family that a HH patient had E3 D mutation of HJV gene,H63 D mutation of HFE gene,and I238 M mutation of TFR2 gene,but the healthy brother and sister carrying two of these mutations did not had the phenotype of HH. Conclusion HH gene mutations vary significantly across patients of different races,and non- HFE- HH is dominant in the Chinese population. There may be HH genes which are different from known genes,and further investigation is needed.

Brief reports
Neuroendocrine neoplasm of the bile duct: a clinical analysis of 5 cases
Gao Yan, Lin ShuCui, Wang YiQian, Zhang TianHao, Li WenChao, Cao JingYu
2016, 32(8): 1575-1577. DOI: 10.3969/j.issn.1001-5256.2016.08.029
Abstract:
Case reports
Clinical cure of chronic hepatitis B: a case report
Zhang ZeTian, Ji HuiFan, Chen Shuai, Li Xu, Yang WenXuan, Zhang GuoShan, Guo XiaoLin
2016, 32(8): 1578-1579. DOI: 10.3969/j.issn.1001-5256.2016.08.030
Abstract:
A case of acute coinfection with HBV and HCV
Dong Bing, Zhang PingPing, Zhao PeiDong, Jin YongSheng, Xu GuangHua
2016, 32(8): 1580-1581. DOI: 10.3969/j.issn.1001-5256.2016.08.031
Abstract:
Liver failure due to chronic hepatitis C with hyperthyroidism: a case report
Wang Wei, Lu WeiNa, Yao ChunFu, Shao ShiXiang, Gao HengBo
2016, 32(8): 1582-1583. DOI: 10.3969/j.issn.1001-5256.2016.08.032
Abstract(1464) PDF (131KB)(407)
Abstract:
Hepatic cirrhosis with Wernicke encephalopathy: a case report
He LiLi, Ning XiuJing, Guo XiaoLin, Ji HuiFan
2016, 32(8): 1584-1585. DOI: 10.3969/j.issn.1001-5256.2016.08.033
Abstract:
A case of primary hepatic carcinoid tumor
Fan WenHai, Zhao ZhengBin, Wang FeiFei, Chen QingFeng
2016, 32(8): 1586-1587. DOI: 10.3969/j.issn.1001-5256.2016.08.034
Abstract:
One case of primary amyloidosis
Yao Wei, Mi ShaoPing, Wang XiaoDong, Wang EnCheng, Liu JuRong, Li Bo, Wang Jing
2016, 32(8): 1588-1589. DOI: 10.3969/j.issn.1001-5256.2016.08.035
Abstract:
Successful treatment of adult-onset Still' s disease complicated by acute severe hepatic lesion and hemophagocytic syndrome: a case report
Xu Fang, Hou Jie, Zhang Yu, Qin JunJie
2016, 32(8): 1590-1591. DOI: 10.3969/j.issn.1001-5256.2016.08.036
Abstract:
Langerhans cell histiocytosis with hepatic lesion as the first symptom in children: a case report and literature review
Ou YangWenXian, Tang Lian, Cao Min, Chen WeiJian, Jiang Tao, Kang Zhen, Li ShuangJie
2016, 32(8): 1592-1595. DOI: 10.3969/j.issn.1001-5256.2016.08.037
Abstract:
Portal hypertension as the main clinical manifestations of myelofibrosis with acute cholecystitis: a case report
Li Xu, Guo XiaoLin, Ji HuiFan, Gao PuJun
2016, 32(8): 1596-1597. DOI: 10.3969/j.issn.1001-5256.2016.08.038
Abstract:
A case of clear cell renal cell carcinoma with pancreatic metastases
Ma YuTeng, Chen YuGuo, Liu ShuHan, Zhou JianPeng, Wang GuangYi, Wei Feng
2016, 32(8): 1598-1599. DOI: 10.3969/j.issn.1001-5256.2016.08.039
Abstract:
Reviews
Regulatory effect of interleukin-10 on natural killer cells in patients with chronic hepatitis B
Zhou Liang, Li XiaoYan, Huang YueHua
2016, 32(8): 1600-1603. DOI: 10.3969/j.issn.1001-5256.2016.08.040
Abstract:
At present,it is very difficult to cure chronic hepatitis B( CHB) with current therapeutic methods. Natural killer( NK) cells are an important part of innate immunity and play an important role in immune surveillance and early anti- infectious immune process. Interleukin- 10( IL- 10) is a multifunctional negative regulatory factor and is involved in the biological regulation of immune cells and inflammatory cells. This article introduces the features and functions of IL- 10 and NK cells,the association of CHB with IL- 10 and NK cells,and the value of IL- 10 and NK cells in the treatment of CHB,and points out that in CHB,IL- 10 exerts a negative regulatory effect on NK cells. Further investigations are needed to confirm whether the antiviral function of NK cells can be enhanced through blocking the regulatory effect of IL- 10 on NK cells,and whether liver immunopathology induced by activation of NK cells can be avoided at the same time.
Value of spleen stiffness measured by noninvasive method in evaluating the severity of cirrhotic portal hypertension
Wu LingZhi, Cui XiangHua, Jia JiDong
2016, 32(8): 1604-1607. DOI: 10.3969/j.issn.1001-5256.2016.08.041
Abstract:
Cirrhotic portal hypertension can lead to serious complications including esophageal variceal bleeding. Hepatic venous pressure gradient( HVPG) and upper gastrointestinal endoscopy can be used to evaluate the severity of portal hypertension and predict the risk of bleeding. However,both methods are invasive,which limits their clinical practice. Therefore,noninvasive techniques for the evaluation of portal hypertension will have certain advantages in clinical practice. This article introduces the noninvasive methods for the measurement of spleen stiffness,including transient elastography,acoustic radiation force impulse,real- time tissue elastography,and magnetic resonance elastography,as well as the value of these methods in evaluation of portal hypertension and influencing factors. It is pointed out that the difference in the diagnostic efficiency of spleen stiffness measured by these methods in portal hypertension needs to be verified by further studies.
Research advances in liver cirrhosis complicated by portal vein thrombosis
Kang FuLai, Zhang YueXin
2016, 32(8): 1608-1612. DOI: 10.3969/j.issn.1001-5256.2016.08.042
Abstract:
Portal vein thrombosis( PVT) is a common complication in patients with liver cirrhosis. The development of PVT in patients with liver cirrhosis has not been taken seriously emphasis by clinicians,and there are few related studies. Up to now,no consensus has been reached on the diagnosis and treatment of liver cirrhosis complicated by PVT. In recent years,with the improvement in clinical diagnosis and treatment techniques and increasing knowledge of this disease,the influence of PVT on the course of disease in patients with liver cirrhosis has been taken seriously. This article investigates the development and progression,diagnosis,prevention,and related therapeutic methods of PVT in patients with liver cirrhosis.
Formation of collateral circulation in patients with cirrhotic portal hypertension and its clinical significance
Tang ShanHong, Zeng WeiZheng, Wu XiaoLing, Ren Juan, Lin Wei, Jiang MingDe
2016, 32(8): 1613-1616. DOI: 10.3969/j.issn.1001-5256.2016.08.043
Abstract:

Portal hypertension is a common clinical disease and brings a series of complications including the formation of gastrointestinal varicose veins,ascites,hepatic encephalopathy,and abdominal varicose veins. Most of these complications are related to the opening of collateral circulation after the increase in portal venous pressure. On one hand,collateral circulation helps to alleviate the high portal venous pressure,and on the other hand,it brings related complications to patients. This article reviews recent reports and studies on collateral circulation related to portal hypertension,in order to increase our knowledge of collateral circulation in portal hypertension and improve clinical diagnosis and treatment of such disease.

Role of vitamin D and vitamin D receptor in evaluation and treatment of liver cirrhosis
Zhu BingHua, Xu LieMing
2016, 32(8): 1617-1621. DOI: 10.3969/j.issn.1001-5256.2016.08.044
Abstract:
Vitamin D is mainly produced in the liver,and chronic liver injury caused by various reasons will affect the metabolism of vitamin D,lead to vitamin D deficiency,and accelerate disease progression. Recent studies have confirmed that in patients with liver cirrhosis,the degree of vitamin D deficiency is closely associated with the severity and complications of liver cirrhosis. This article introduces the role of vitamin D and vitamin D receptor in the evaluation and treatment of liver cirrhosis and points out that vitamin D helps to evaluate the severity of liver cirrhosis and may become a new point and an important drug for the treatment of liver cirrhosis.
Role of intestinal flora in the development and progression of spontaneous bacterial peritonitis
Luan YuTing, Cai WenJun, Xu Ying, Liu Ping, Mu YongPing
2016, 32(8): 1622-1625. DOI: 10.3969/j.issn.1001-5256.2016.08.045
Abstract:
Spontaneous bacterial peritonitis( SBP) is a major complication of liver cirrhosis. In recent years,with the development of biotechnology,such as high- throughput sequencing and intestinal metagenomics,the role of intestinal flora in liver diseases has been taken more and more seriously. Bacterial translocation,especially the translocation of Gram- negative enteric bacilli,is involved in the development and progression of SBP. This article briefly describes the factors related to the development and progression of SBP and the important role of intestinal flora in SBP. The improvement in biotechnology clarifies the role of intestinal flora in diseases,and restoration of balanced intestinal flora may become a new method for the prevention and treatment of SBP.
Role of T-helper cell 17 in the development and progression of hepatocellular carcinoma
Zhang FeiFei, Chen Hui, Lyu Jun
2016, 32(8): 1626-1629. DOI: 10.3969/j.issn.1001-5256.2016.08.046
Abstract:

Hepatocellular carcinoma( HCC) is one of the most common malignant tumors in the world. How to improve cure rate and reduce recurrence and metastasis of HCC have always been hot topics in research. T- helper cell 17( Th17),an important subset of CD4+T-helper cells,plays a critical role in infection,autoimmune response,and tumor microenvironment. This article introduces the discovery of Th17 and related cytokines,summarizes its mechanisms of action and clinical significance in the development and progression of HCC,and provides some clues for new targets in the treatment of HCC and prognosis prediction.

Expression of programmed death-ligand 1 in hepatocellular carcinoma and its clinical significance
Yang Liu, Zhu XiLing, Li Gong
2016, 32(8): 1630-1634. DOI: 10.3969/j.issn.1001-5256.2016.08.047
Abstract:
In recent years,the immunotherapy based on the blocking of programmed death- 1( PD- 1) / programmed death- ligand 1( PD- L1)pathway has achieved encouraging progress in the treatment of malignant tumors such as melanoma and lung cancer. More and more studies have focused on its role in hepatocellular carcinoma( HCC). This article introduces the mechanism of action of PD- 1 / PD- L1,expression of PD- L1 in HCC tissues,and its basic and clinical research in the treatment of HCC,and points out that PD- L1 plays an important role in tumor immune escape and is expected to become an independent index for evaluating the prognosis of HCC. The discovery of PD- 1 / PD- L1 pathway provides a new target for immunotherapy for HCC.