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

2016 No. 9

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Editorial
A new understanding of etiological treatment in patients with severe viral hepatitis
Wang YuMing
2016, 32(9): 1637-1643. DOI: 10.3969/j.issn.1001-5256.2016.09.002
Abstract:

Severe viral hepatitis has a various etiology,which varies greatly among different regions. Hepatitis B and hepatitis C are commonly seen in China. It has been proved that antiviral therapy has great significance in HBV- related severe liver disease,and they often need long- term or lifetime medication. The selection of drugs should consider potency,low resistance,and safety. Patients with renal insufficiency should use nucleoside analogues with a note of caution. As for patients with HBV infection who plan to use or have already used immunosuppressants,antiviral therapy is of vital importance. Current studies support the therapeutic regimen with direct- acting antiviral agents in patients with severe hepatitis complicated by chronic renal disease. This therapy has achieved a satisfactory effect,but such patients tend to have a higher recurrence rate than general patients. Therefore,more large- scale clinical studies which last for a longer time are needed for validation. In conclusion,effective antiviral therapy should be given with reference to detailed condition,so as to improve the survival rates in patients with severe viral liver disease.

Therapeutic guidelines
Updated key points and clinical pathway for NCCN clinical practice guidelines in oncology: hepatobiliary cancers(Version2.2016)
Zhu Peng, Wang YuMing
2016, 32(9): 1644-1652. DOI: 10.3969/j.issn.1001-5256.2016.09.003
Abstract(2186) PDF (898KB)(541)
Abstract:
An excerpt of KASL clinical practice guidelines: management of chronic hepatitis B (2016)
Li Juan, Xu BaiGuo, Han Tao
2016, 32(9): 1653-1658. DOI: 10.3969/j.issn.1001-5256.2016.09.004
Abstract:
An excerpt of the Japanese Society of Gastroenterology of evidence-based clinical practice guidelines for liver cirrhosis(2015)
Zhang Hong, Han Jing, Zhang XiaoLan
2016, 32(9): 1659-1663. DOI: 10.3969/j.issn.1001-5256.2016.09.005
Abstract:
National Cancer Centre Singapore consensus guidelines for hepatocellular carcinoma(2016)
Zhang Hao, Tian She, Jiang JianXin
2016, 32(9): 1664-1667. DOI: 10.3969/j.issn.1001-5256.2016.09.006
Abstract:
Discussions by experts
Current status of liver failure treatment
Ma Zhen, Wu Yun
2016, 32(9): 1668-1672. DOI: 10.3969/j.issn.1001-5256.2016.09.007
Abstract:

Liver failure is severe liver injury caused by various factors. This article summarizes currently used therapeutic methods for liver failure,and the universally acknowledged therapeutic methods include intensive care and supportive care,etiological treatment,regulation of immune function,prevention and treatment of various complications,supportive treatment with artificial liver,and liver transplantation. It is pointed out that the treatment of liver failure should focus on the multimodality therapy of internal medicine- artificial liver- liver transplantation,and that early diagnosis and treatment should be emphasized in clinical practice. The multimodality therapy should be developed according to the etiology,and complications should be actively prevented and treated. A multidisciplinary team should be established to develop individualized diagnosis and treatment regiments,so as to reduce the mortality rate and improve patients' clinical outcome.

Disease assessment and prognosis of liver failure
Zhang Jing, Zhou XinMin
2016, 32(9): 1673-1677. DOI: 10.3969/j.issn.1001-5256.2016.09.008
Abstract:
Liver failure has a high fatality rate and greatly threatens human health. Liver transplantation can effectively reduce the fatality rate. However,the problems such as donor shortage and allograft rejection limit the wide application of liver transplantation. An accurate early assessment helps to evaluate patients' condition and optimize therapeutic strategies. At present,commonly used systems for prognostic evaluation include the King's College Hospital,MELD,integrated MELD,Child- Pugh score,CLIF- SOFA,CLIF- C ACLFS,and D- MELD,and each system has its own advantages and disadvantages. Among these systems,the MELD scoring system is the most commonly used one,and the D- MELD scoring system is the most innovative one,which can be used for patients on the waiting list for liver transplantation. This article elaborates on the characteristics and predictive value of each scoring system in clinical practice.
Research advances in clinical diagnosis,prognostic evaluation,and treatment of liver failure
Lin Feng
2016, 32(9): 1678-1683. DOI: 10.3969/j.issn.1001-5256.2016.09.009
Abstract:
Liver failure usually has rapid progression and poor prognosis and is one of the major causes of death in patients with severe hepatitis. This article describes the clinical diagnosis,prognostic evaluation,and therapeutic methods of liver failure and points out that the different opinions on the diagnosis of liver failure in China and foreign countries tend to reach a consensus. The Model for End- Stage Liver Disease score is commonly used in the evaluation of severity and prognosis of liver failure. With long- time efforts,multimodality therapy in internal medicine combined with artificial extracorporeal liver support therapy can significantly improve the survival rate of patients with liver failure. Stem cell treatment is a new method for the treatment of liver failure in clinical practice and has promising prospects.
Definition,pathophysiology,and clinical management of acute-on-chronic liver failure
Liu HaiXia, Zhu YueKe, Meng QingHua
2016, 32(9): 1684-1687. DOI: 10.3969/j.issn.1001-5256.2016.09.010
Abstract:
Acute- on- chronic liver failure( ACLF) is defined as rapid deterioration of liver function under acute attack in patients with chronic liver disease and is associated with an extremely high mortality. Since the basis of liver disease and potential pathogenic factors for acute injury are different in Chinese and Western medicine,the diagnosis remains controversial. However,there is a consensus on the fact that the condition of ACLF can be reversed,and early diagnosis and reasonable treatment can improve prognosis. This article introduces the pathophysiology of ACLF from the aspects of risk factors,predisposing factors,response after injury,and organ failure and elaborates on the reasonable management measures to improve patients' survival rate.
Advances in diagnosis and treatment of patients with acute-on-chronic liver failure complicated by acute kidney injury
Li XiaoPeng, Wu ZhenPing, Zhang LunLi, Li Ming
2016, 32(9): 1688-1693. DOI: 10.3969/j.issn.1001-5256.2016.09.011
Abstract:
Acute- on- chronic liver failure( ACLF) is the most common type of liver failure in China,and it has complicated clinical manifestations and high mortality. When the patients experience ACLF complicated by acute kidney injury( AKI),they tend to have a prolonged length of hospital stay and a high risk of multiple organ failure,which always suggests poor prognosis. This article briefly describes the advances in the definition,causative factors,prognostic evaluation,diagnostic markers,and treatment of ACLF complicated by AKI. It is pointed out that early identification,diagnosis,and intervention of AKI helps to reverse kidney injury and avoid the development of severe AKI.
Diagnosis and treatment of invasive fungal diseases in patients with severe liver diseases
Zang Hong, Xin ShaoJie
2016, 32(9): 1694-1698. DOI: 10.3969/j.issn.1001-5256.2016.09.012
Abstract:

Invasive fungal diseases( IFDs) are an important factor affecting the prognosis of patients with severe liver diseases,and their early diagnosis remains a challenge for clinicians. The four most commonly seen IFDs are candidiasis,aspergillosis,cryptococcosis,and pneumocystis pneumonia. We should pay attention to the risk of developing IFDs in patients with severe liver diseases during clinical management. Particularly,early diagnosis and proper treatment of IFDs are important in high- risk patients. These are vital to improving the prognosis of patients with severe liver diseases.

Mechanism of action of direct-acting antiviral agents in treatment of chronic hepatitis C
Wen XiaoYu, Niu JunQi
2016, 32(9): 1699-1705. DOI: 10.3969/j.issn.1001-5256.2016.09.013
Abstract:
With the development and launch of direct- acting antiviral agents( DAAs) in the world in recent years,therapeutic regimens for chronic hepatitis C are constantly evolving. DAAs will also be launched in China in the near future. DAAs mainly target at the non-structural proteins of HCV and can inhibit HCV RNA replication. This article introduces the targets,mechanism of action,and resistance characteristics of different DAAs,as well as their current research and development in China and the results of phase Ⅲ clinical studies,in order to provide a reference for combined therapeutic strategies with DAAs in the treatment for chronic hepatitis C.
Advances in Roussel Uclaf Causality Assessment Method for diagnosis of drug-induced liver injury and its comparison with structured expert opinion process
Yu YueCheng, Fan Ye
2016, 32(9): 1706-1713. DOI: 10.3969/j.issn.1001-5256.2016.09.014
Abstract:
Up to now,the diagnosis of drug- induced liver injury( DILI) still relies on the exclusive method,and the Roussel Uclaf Causality Assessment Method( RUCAM) is the most commonly used scale. Since the release of the first version of RUCAM scale in 1993,the second version was released in 2015,in which the definition and scoring criteria of each key element were revised appropriately and explained in detail. The Structured Expert Opinion Process( SEOP) was designed by the workgroup of DILI network prospective study,but since it is too complicated and time- and energy- consuming,its application in clinical practice is limited. This article introduces the research and development history and application method of RUCAM,as well as the modifications made in the 2015 version of RUCAM,and briefly compares the difference in bias between RUCAM and SEOP in the diagnosis of DILI. It is pointed out that both RUCAM and SEOP have marked interobserver and intraobserver variabilities,and therefore,it is necessary to explore a more objective,reproducible,accurate,and convenient strategy for the diagnosis of DILI.
Original articles_Viral hepatitis
Efficacy of telbivudine combined with adefovir dipivoxil and pegylated interferon combined with entecavir as antiviral therapy for chronic hepatitis B: a comparative analysis
Li Na, Gou Wei, Cui WeiLi
2016, 32(9): 1714-1716. DOI: 10.3969/j.issn.1001-5256.2016.09.015
Abstract:
Objective To investigate the efficacy of telbivudine combined with adefovir dipivoxil and PEG- IFN- α- 2a combined with entecavir as the antiviral therapy for HBe Ag- positive patients with chronic hepatitis B( CHB) and a high viral load. Methods A total of 80 previously untreated HBe Ag- positive CHB patients with a high viral load who were treated in The Sixth People's Hospital of Qingdao from November2012 to November 2015 were enrolled and randomly divided into two groups. The patients in group A were treated with telbivudine combined with adefovir dipivoxil,and those in group B were treated with PEG- IFN- α- 2a combined with entecavir. Biochemical and virologic response rates and seroconversion rate were observed at weeks 12,24,and 48 of administration. The drug resistance rate and incidence rates of adverse events were observed in both groups. The Chi- square test was applied for comparision of categorical data between the two groups,and the t- test was applied for comparision of continuous data between the two groups. Results Biochemical and virologic response rates at weeks 12,24,and 48 of administration showed no significant differences between the two groups. The seroconversion rates at weeks 12 and 24 of administration showed no significant differences between the two groups,while at week 48 of administration,group B had significantly higher HBe Ag clearance rate and seroconversion rate than group A( 45. 0% vs 67. 5%,22. 5% vs 45. 0%,χ2= 4. 114 3 and 4. 528 3,both P < 0. 05). Group B had significantly higher incidence rates of adverse events than group A. Conclusion Telbivudine combined with adefovir dipivoxil and PEG- IFN- α- 2a combined with entecavir can effectively inhibit the replication of high- load HBV DNA,delay disease progression,and realize HBe Ag seroconversion. However,the two regimens have their own advantages and disadvantages and should be selected according to clinical situation.
Clinical features of chronic HBV/HCV infection complicated by mild hepatic steatosis
He Jia, Li Wei, Li Kuan, Ning HuiBin, Liu JunPing, Mao ZhongShan, Shang Jia
2016, 32(9): 1717-1720. DOI: 10.3969/j.issn.1001-5256.2016.09.016
Abstract:
Objective To investigate the clinical features of previously untreated patients with chronic HBV/HCV infection complicated by mild hepatic steatosis. Methods A total of 111 previously untreated patients with chronic HBV/HCV infection who were hospitalized in Zhengzhou University People's Hospital from December 2014 to January 2016. Liver biopsy confirmed that all the patients had mild hepatic steatosis. Among these patients,65 had HBV infection and 46 had HCV infection. The changes in clinical indices such as liver function,blood lipid,blood glucose,and liver stiffness measurement( LSM) were compared between the two groups. The independent samples t- test or Wilcoxon two- sample 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 There were significant differences in LSM,aspartate aminotransferase( AST),gamma- glutamyl transpeptidase( GGT),plasma albumin( Alb),total cholesterol( TC),high- density lipoprotein cholesterol( HDL- C),low- density lipoprotein cholesterol( LDL- C),and platelet count( PLT) between the two groups( all P < 0. 05). According to liver inflammation grade and fibrosis stage,the patients were divided into G < 2/S < 2 group( 0,0- 1,1,1- 2) and G≥2/S≥2 group( 2,2- 3,3- 4,4). LSM showed significant differences across the groups with different liver inflammation grades and fibrosis stages( HBV infection: 6. 40( 5. 30 ~ 7. 70) vs 8. 30( 5. 90 ~ 11. 30),Z =- 2. 463,P = 0. 014; 6. 70( 5. 30 ~ 7. 80) vs 8. 30( 5. 70 ~ 11. 30),Z =- 2. 049,P = 0. 040。HCV infection: 7. 60( 6. 30 ~ 11. 50) vs 17. 50( 12. 00 ~ 26. 70),Z =- 3. 961,P < 0. 001; 7. 60( 5. 90 ~ 10. 20) vs 15. 50( 7. 50 ~ 21. 50),Z =- 3. 325,P = 0. 001). In the patients with chronic HCV infection,TC showed a significant difference between the groups with different fibrosis stages( 4. 28 ± 0. 85 vs 3. 82 ± 0. 68,t = 2. 045,P = 0. 047). Conclusion Compared with the previously untreated patients with chronic HBV infection complicated by mild hepatic steatosis,those with HCV infection complicated by mild hepatic steatosis have higher LSM,GGT,TC,and LDL- C,as well as lower Alb,PLT,AST,and HDL- C. In addition,the parameters associated with hepatic steatosis( BMI,GLU,fat attenuation parameter,blood lipid) are not positively correlated with disease progression.
Association of programmed cell death-1 gene polymorphisms with chronic hepatitis C virus infection and antiviral effect
Kong LingBo, Nan YueMin, Zhang YuGuo, Zhao SuXian, Wang RongQi, Fu Na, Di HaiLing, Su ShanShan
2016, 32(9): 1721-1724. DOI: 10.3969/j.issn.1001-5256.2016.09.017
Abstract:
Objective To investigate the association of single nucleotide polymorphisms( SNPs) of programmed cell death- 1( PD- 1)gene with chronic hepatitis C virus( HCV) infection and the effect of antiviral therapy with interferon combined with ribavirin. Methods A total of 228 patients with chronic hepatitis C( CHC) who were hospitalized in seven hospitals in Hebei Province,China from October 2010 to October 2012 were enrolled and treated with interferon combined with ribavirin as the individualized antiviral therapy. Eighty- one persons who underwent physical examination were enrolled as control group. The Taq Man probe method was used to detect PD- 1 gene polymorphisms. The distribution of alleles and genotypes at PD- 1. 1 and PD- 1. 3 were compared between the two groups,and the association between the SNPs of PD- 1. 1 and PD- 1. 3 and anti- HCV effect was analyzed. The chi- square test was used for the comparison of categorical data between groups. Results The CHC group showed significantly higher frequencies of T allele and TT genotype at PD- 1. 1 than the control group( 52. 41% vs 43. 21%,χ2= 4. 059,P = 0. 044; 28. 51% vs 14. 81%,χ2= 6. 469,P = 0. 039). The SNPs of PD- 1. 1 gene were not significantly associated with complete early virologic response or sustained virologic response( both P > 0. 05). Both groups had CC genotype at PD- 1. 3. Conclusion PD- 1. 1 T allele might be associated with chronic HCV infection,and patients carrying TT genotype have a high risk of chronic HCV infection. PD- 1. 1 polymorphism is not associated with virologic response to anti- HCV therapy.
Efficacy comparative of different laboratory test reagents for hepatitis C virus antibody
Guo FeiBo, Wu JunZhu
2016, 32(9): 1725-1728. DOI: 10.3969/j.issn.1001-5256.2016.09.018
Abstract:
Objective To investigate the effects of different laboratory test reagents for hepatitis C virus( HCV) antibody through a comparative analysis. Methods A total of 207 samples which tested positive by four anti- HCV screening reagents commonly used in the laboratories in China( Kehua,Xinchuang,Wantai,and Abbott) were included. HCV RNA nucleic acid amplification( NAT) was performed,and if NAT results were negative,recombinant immunoblot assay( RIBA) was performed for further confirmation. The test results of these four screening reagents were compared,and their S/CO values and true positive rates were analyzed. Results Of all the 205 samples testing positive by any one reagent,191( 93. 2%) tested positive by the four reagents,and 14( 6. 8%) were tested inconsistently by the four reagents. The positive predictive values of Xinchuang,Kehua,Wantai,and Abbott reagents were 88. 2%( 180/204),93. 8%( 180/192),91. 4%( 180/197),and 90. 0%( 180/200),respectively. The S/CO thresholds with a positive predictive value of ≥95% for Xinchuang,Kehua,Wantai,and Abbott reagents were 9. 0,4. 0,5. 0,and 7. 0,respectively. Conclusion Xinchuang,Kehua,Wantai,and Abbott reagents have significantly different S/CO thresholds with a positive predictive value of ≥95%,which are significantly different from those in other domestic laboratories. Each laboratory should establish an applicable S/CO threshold with a positive predictive value of ≥95%,in order to reduce the sample size for confirmatory test.
Effect of prohibitin on hepatitis C virus replication
Shi JuanJuan, Yang Ning, Zhang Xin, Wu FengPing, Li Mei, Gao Ning, Jia XiaoLi, Zhai Song, Dang ShuangSuo
2016, 32(9): 1729-1733. DOI: 10.3969/j.issn.1001-5256.2016.09.019
Abstract:
Objective To investigate the effect of prohibitin( PHB) on hepatitis C virus( HCV) replication. Methods Human hepatocarcinoma Huh- 7. 5 cells were transfected with the full- length genome HCV RNA in vitro to establish the full- length genome cell model of HCV,and the supernatants were collected 24,48,72,and 96 hours later to measure HCV copies. The indirect immunofluorescence assay was used to measure the expression of HCV core proteins,and a transmission electron microscope was used to observe the changes in the ultrastructure of HCV- infected Huh- 7. 5 cells and identify the full- length genome cell model of HCV. Quantitative real- time PCR and Western Blot were used to measure the expression of PHB in HCV- infected Huh- 7. 5 cells,and the RNA interference technique was used to measure the replication of HCV RNA. The t- test was used for comparison between groups. Results The results of identification showed that the HCV full- length genome cell model was successfully established. At 24 and 48 hours after Huh- 7. 5 cells were transfected with HCV RNA,the mRNA expression level of PHB was 13. 41 ± 1. 35 and 16. 45 ± 1. 76,respectively,which differed significantly from that in the control group( 1. 01 ± 0. 57 and 1. 01 ± 0. 87,t = 29. 540 and 31. 361,both P < 0. 01),and the 24- and 48- hour transfection groups showed a significantly higher expression level of PHB than the control group( both P < 0. 01). At 24 and 48 hours after Huh- 7. 5 cells were transfected with the RNA interference plasmids of PHB,the level of HCV RNA was 64. 32 ± 5. 49 and 84. 45 ± 7. 06,respectively,significantly higher than that in the control group( shRNA- control group; 10. 52 ± 1. 57 and 16. 34 ± 2. 97,t = 29. 538 and 25. 908,all P < 0. 01).Conclusion In HCV- infected Huh- 7. 5 cells,the increased expression of PHB is closely related to HCV RNA infection,and to a certain extent,PHB can inhibit the replication of HCV RNA.
Original articles_Liver fibrosis and liver cirrhosis
Effect of entecavir combined with Fuzheng Huayu capsules on inflammatory factors and fibrosis markers in patients with compensated chronic hepatitis B-related cirrhosis
Wang He, Wang QianJun, Sun FengBo, Zhang XinMing, Qi YuQin
2016, 32(9): 1734-1738. DOI: 10.3969/j.issn.1001-5256.2016.09.020
Abstract:
Objective To investigate the clinical effect of entecavir( ETV) combined with Fuzheng Huayu capsules in the treatment of patients with compensated chronic hepatitis B- related cirrhosis. Methods A total of 142 patients with compensated chronic hepatitis B- related cirrhosis who visited the Sixth People's Hospital Qingdao from January 2013 to December 2015 were randomly divided into treatment group and control group,with 71 patients in each group. Both groups were given conventional treatment such as liver- protecting and symptomatic treatment. The patients in the control group were given ETV 0. 5 mg/day,while those in the treatment group received oral administration of Fuzheng Huayu capsules 1. 5 g twice a day in addition to the treatment in the control group. Both groups were treated for 12 months. The changes in inflammatory factors and fibrosis markers were observed. 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 After the 12- month treatment,the treatment group and the control group showed no significant difference in the serum HBV DNA clearance rate [91. 5%( 65/71)vs 90. 1%( 64/71),P = 0. 771]. Compared with the control group,the treatment group showed significant reductions in serum hyaluronic acid,laminin,procollagen type III,collagen type IV,alanine aminotransferase,aspartate aminotransferase,liver stiffness measurement,tumor necrosis factor- α( TNF- α),interleukin- 6( IL- 6),interleukin- 8( IL- 8),and hypersensitive C- reactive protein( hs-CRP)( t = 16. 187,5. 343,13. 697,17. 121,7. 409,27. 371,7. 973,5. 471,7. 885,9. 057,8. 171,all P < 0. 001). Conclusion Compared with ETV alone,ETV combined with Fuzheng Huayu capsules exerts a better anti- fibrotic effect and can inhibit the release of TNF- α,IL- 6,IL- 8 and hs- CRP in patients with compensated chronic hepatitis B- related cirrhosis.
Value of indocyanine green test in evaluating liver reserve function in patients with hepatitis B cirrhosis
Lai RuiMin, Wang MingFang, Zhu YueYong
2016, 32(9): 1739-1742. DOI: 10.3969/j.issn.1001-5256.2016.09.021
Abstract:
Objective To evaluate liver reserve function in patients with hepatitis B cirrhosis using indocyanine green( ICG) clearance test,and to investigate the correlation of ICG clearance test with Child- Turcotte- Pugh( CTP) class and the Model for End- Stage Liver Disease( MELD) score in evaluating liver function. Methods A total of 127 patients with hepatitis B cirrhosis who were hospitalized in The First Affiliated Hospital of Fujian Medical University from January 2012 to January 2015 were enrolled. ICG clearance test was performed for all the patients,and the ICG plasma clearance( K value),effective liver blood flow( EHBF),and ICG retention at 15 minutes( ICG R15)were calculated. CTP class and MELD score were also determined. An analysis of variance was used for comparison between groups,the least significant difference t- test was used for comparison between any two groups,Spearman rank correlation was performed for correlation analysis,and the area under the receiver operating characteristic( ROC) curve was used to compare liver reserve function. Results Among all the patients with hepatitis B cirrhosis,63 had CTP class A,45 had CTP class B,and 19 had CTP class C hepatitis B cirrhosis. With the increasing CTP class,ICG R15 gradually increased,while EHBF and K value gradually decreased( F = 146. 96,91. 26 and 40. 94,P =0. 001,0. 003 and 0. 005). In the evaluation of liver function,ICG R15 was positively correlated with MELD score and CTP class( r = 0. 525 and 0. 838,both P < 0. 01) and was negatively correlated with EHBF and K value( r =- 0. 703 and- 0. 901,both P < 0. 01). The area under the ROC curve was 0. 85 for ICG R15 and 0. 65 for MELD score. Conclusion ICG test can accurately and dynamically reflect liver reserve function,and ICG R15 can evaluate liver reserve function better than CTP class and MELD score.
Clinical effect of laparoscopic splenectomy combined with esophagogastric devascularization in treatment of liver cirrhosis with portal hypertension
Tang HanQiu
2016, 32(9): 1743-1746. DOI: 10.3969/j.issn.1001-5256.2016.09.022
Abstract:
Objective To investigate the effect and safety of laparoscopic splenectomy( LS) combined with esophagogastric devascularization( ED) in the treatment of esophagogastric variceal bleeding and severe hypersplenism. Methods A retrospective analysis was performed for 68 patients with cirrhotic portal hypertension who visited The Central Hospital of Hanzhong from June 2012 to June 2013. The patients were divided into LS + ED group and open splenectomy( OS) + ED group,with 34 patients in each group. The clinical indices,complications,degree of gastric varices before and after surgery,and changes in Child- Pugh score for liver function were compared between the two groups. The t- test was used for comparison of continuous data between groups,and the chi- square test or the Fisher's exact test was used for comparison of categorical data between groups. Results The LS + ED group had a significantly lower postoperative drainage volume,significantly less intraoperative blood loss,a significantly shorter length of postoperative hospital stay,and a significantly shorter postoperative ventilation time than the OS + ED group( t =- 3. 144,- 2. 536,- 4. 151,and- 2. 671,P = 0. 003,0. 015,0. 001,and 0. 002),while the improvements in the degree of gastric varices and Child- Pugh score for liver function showed no significant differences between the two groups( both P > 0. 05). Conclusion LS combined with ED can significantly reduce intraoperative blood loss,postoperative drainage volume,time of passage of gas by anus after surgery,and length of postoperative hospital stay,and therefore,it is a safe,feasible,and effective method for the treatment of portal hypertension.
Original articles_Liver neoplasms
Elemene combined with transcatheter arterial chemoembolization in treatment of primary liver cancer: a meta-analysis
Ou ZhiTao, Zhan YuanJing, Huang ChunMing
2016, 32(9): 1747-1752. DOI: 10.3969/j.issn.1001-5256.2016.09.023
Abstract:

Objective To investigate the short- term efficacy,long- term efficacy,and adverse effects of elemene combined with transcatheter arterial chemoembolization( TACE) in the treatment of primary liver cancer( PLC). Methods Pub Med,EMBASE,Cochrane Library,Chinese Scientific Journal Full- Text Database,Wanfang Data,CBM,and VIP were searched by two reviewers using the same search strategy for clinical studies on elemene combined with TACE in the treatment of PLC. The Jadad quality scoring system was used to assess the quality of the studies included,and Review Manager 5. 2 software was used for the meta- analysis. Results A total of 9 articles involving487 patients were included. The results of the meta- analysis showed that compared with the TACE group,the elemene- TACE group showed significant increases in the response rate,disease control rate,and 12- and 24- month survival rates( response rate: RR = 1. 43,95% CI: 1. 23- 1. 67,P < 0. 001; disease control rate: RR = 1. 22,95% CI: 1. 11- 1. 32,P < 0. 001; 12- month survival rate: RR = 1. 68,95% CI: 1. 22- 2. 31,P = 0. 001; 24- month survival rate: RR = 2. 91,95% CI: 1. 44- 5. 87,P = 0. 003). As for the incidence of adverse events,the elemene- TACE group showed a significant reduction in the incidence rate of abdominal pain( RR = 0. 59,95% CI: 0. 36-0. 98,P = 0. 04). Conclusion Compared with TACE alone,elemene combined with TACE might improve response rate,disease control rate,and survival rates and reduce adverse events in patients with liver cancer.

Original articles_Biliary diseases
Value of endoscopic ultrasound and magnetic resonance cholangiopancreatography in diagnosis of obstructive jaundice
Jia Lei, Guo YuNing, Guo XiuLi, Wang TianYi, Lu: Dong, Xu YouQing
2016, 32(9): 1753-1755. DOI: 10.3969/j.issn.1001-5256.2016.09.024
Abstract:

Objective To investigate the value of endoscopic ultrasound( EUS) versus magnetic resonance cholangiopancreatography( MRCP) in the diagnosis of obstructive jaundice. Methods A total of 31 patients with obstructive jaundice who visited Beijing Tiantan Hospital,Capital Medical University,from January 2015 to March 2016 were enrolled,and all the patients underwent EUS and MRCP. The sensitivity,specificity,accuracy,and Youden index of EUS and MRCP in the diagnosis of obstructive jaundice were compared. Results Of all patients,16( 51. 61%) were diagnosed with common bile duct stones,1( 3. 23%) was diagnosed with ampullary tumor,6( 19. 35%)were diagnosed with duodenal papillary tumor,3( 9. 68%) were diagnosed with tumor of the head of the pancreas,2( 6. 45%) were diagnosed with bile duct tumor,2( 6. 45%) were diagnosed with bile duct inflammation,and 1 had no stones or space- occupying lesions observed by endoscopic retrograde cholangiopancreatography,EUS,or MRCP. The coincidence rate of EUS in the diagnosis of ampullary tumor,duodenal papillary tumor,and tumor of the head of the pancreas was 100%,and MRCP had a lower coincidence rate in the diagnosis of common bile duct stones and a lower overall coincidence rate of diagnosis than EUS( 81. 25%/76. 67% vs 93. 75%/90. 00%). In the diagnosis of obstructive jaundice,EUS and MRCP had sensitivities of 90. 00% and 76. 70%,specificities of 100%,accuracy rates of 90. 30% and77. 40%,and Youden indices of 0. 90 and 0. 77. Conclusion EUS has a higher value in the diagnosis of obstructive jaundice than MRCP.

Clinical experience in treatment of complex intrahepatic bile duct stones by regular hepatectomy
Wu Xiao, Xia Hao, Wu Jian, Zhang Ming
2016, 32(9): 1756-1759. DOI: 10.3969/j.issn.1001-5256.2016.09.025
Abstract:

Objective To investigate the clinical effect of regular hepatectomy in patients with complex intrahepatic bile duct stones. Methods A retrospective analysis was performed for the clinical data of 98 patients with complex intrahepatic bile duct stones who were treated in our hospital from January to December,2013. The distribution characteristics of intrahepatic bile duct stones,clinical manifestations,extent of operation,time of operation,complications,and surgical outcome were analyzed. Results All the 98 patients completed regular hepatectomy. Of all patients,37 underwent choledocholithotomy with T- tube drainage and segmental hepatectomy,6 underwent resection of the left lateral lobe of the liver,1 underwent left hemihepatectomy,7 underwent resection of a single hepatic segment in the right lobe of the liver combined with segmental hepatectomy,45 underwent combined segmental hepatectomy of the left and right lobes of the liver,and 2 underwent biliary- enteric basin anastomosis after hilar bile duct reconstruction. No patients died during the perioperative period. The mean time of operation was 65. 0 ± 5. 0 min,and the mean intraoperative blood loss was 83. 0 ± 6. 2 ml. No patients experienced residual stones after surgery. Of all patients,5( 5. 1%) experienced complications,among whom 3 experienced bile leakage and 2 experienced blood exudation on the surface of the wound in the liver; 3 patients were diagnosed with intrahepatic cholangiocarcinoma by postoperative pathological examination. All the patients for followed up for 5 years,and 11( 11. 2%) experienced recurrence of stones after surgery. Conclusion Regular hepatectomy is safe and effective in the treatment of complex intrahepatic bile duct stones,with few complications and a low recurrence rate of stones. Therefore,it holds promise for wide clinical application.

Operation skills of endoscopic retrograde cholangiopancreatography in pancreaticobiliary patients with periampullary duodenal diverticula
Zhuang DongHai, Zhang Kai
2016, 32(9): 1760-1762. DOI: 10.3969/j.issn.1001-5256.2016.09.026
Abstract:
Objective To investigate the operation skills of endoscopic retrograde cholangiopancreatography( ERCP) in patients with periampullary duodenal diverticula. Methods A retrospective analysis was performed for the clinical data of 867 patients with periampullary duodenal diverticula who underwent ERCP in Department of Hepatobiliary Endoscopy in Shandong Jiaotong Hospital from March 2013 to February 2015. The rate of successful intubation,therapeutic effect,and development of complications were analyzed. Results The rate of successful intubation was 99. 8%. Of all patients,793 underwent successful intubation with an incision knife,44 were treated with double guide wires and pancreatic duct stenting,3 underwent fixation of the papilla with hemostatic clips,25 underwent the pre- cut technique,and 2underwent failed intubation. There were 5 cases of pancreatitis,l case of perforation,l case of delayed bleeding,and all the patients were cured after conservative treatment. Conclusion When ERCP is used in the treatment of pancreaticobiliary diseases complicated by periampullary duodenal diverticula,the indications for ERCP and endoscopic sphincterotomy should be clarified. Targeted operation skills selected based on the features of the papilla help to improve the success rate and reduce complications,and therefore,it is a safe minimally invasive therapy.
Original articles_Pancreatic diseases
Diagnosis and treatment of hypertriglyceridemic pancreatitis in pregnancy
Gao NaNa
2016, 32(9): 1763-1765. DOI: 10.3969/j.issn.1001-5256.2016.09.027
Abstract:
Objective To investigate the clinical diagnosis and treatment of hypertriglyceridemic pancreatitis in pregnancy( HPP). Methods The clinical data of 29 patients with HPP who were admitted to Yulin Hospital of Traditional Chinese Medicine from June 2005 to June2015 were retrospectively analyzed. Results Of all the 29 patients,5( 17. 2%) were in the first trimester and 24( 82. 8%) were in the third trimester; among them,8( 27. 6%) had mild pancreatitis,14( 48. 3%) had moderate pancreatitis,and 7( 24. 1%) had severe pancreatitis. The patients had a mean serum triglyceride level of 15. 5 mmol/L. No pregnant women died; the mortality rate of the fetuses reached 17. 2%( 5/29),and all of the five cases were intrauterine fetal death. Conclusion Although the prevalence of HPP is low,its incidence rate is increasing gradually,and HPP is commonly seen in the third trimester. HPP is always associated with a high fetal mortality rate,and therefore,timely diagnosis and treatment should be provided to improve the prognosis of mother and fetus.
Original articles_Others
Clinical features of HBV-associated acute-on-chronic liver failure induced by discontinuation of nucleoside analogues
Liu XiaoYan, Chen Jing, Xiao Long, Tong JingJing, Guan ChongDan, Yan LiLong, Su HaiBin
2016, 32(9): 1766-1769. DOI: 10.3969/j.issn.1001-5256.2016.09.028
Abstract:

Objective To investigate the clinical features of patients with HBV- associated acute- on- chronic liver failure( HBV-ACLF) induced by the discontinuation of necleos( t) ide analogues. Methods A retrospective analysis was performed for 698 patients with a definite diagnosis of HBV- ACLF in The 302 Hospital of PLA from January 2014 to April 2016,and among these patients,150( discontinuation group) had acute- on- chronic liver failure( ACLF) induced by discontinuation,396( previously untreated group) had not received antiviral therapy when they developed this disease for the first time,and the other 152 patients with ACLF caused by other reasons were enrolled as controls. The causative factors,underlying diseases,family history,serum hepatitis B markers,prognosis,and initial onset were summarized,and the drugs used and discontinuation time were recorded for patients who stopped taking necleos( t) ide analogues. The chi-square test was used for the comparison of categorical data between groups. Results Among the 698 patients,355( 50. 86%) had a family history of chronic hepatitis B( CHB),and 93 patients( 62. 00%) in the discontinuation group had a family history of CHB. Among the 150 patients in the discontinuation group,27( 18. 00%) had an underlying disease of chronic hepatitis,among whom 12( 44. 44%) had a family history of CHB,which was significantly lower than the overall level( χ2= 2. 57,P = 0. 07); 123( 82. 00%) had an underlying disease of liver cirrhosis( compensated),among whom 81( 65. 85%) had a family history of CHB,which was significantly higher than the overall level( χ2= 48. 77,P < 0. 001). Of all the patients in the discontinuation group,77. 33%( 116/150) developed the disease within 1 year after discontinuation,and 21. 33%( 32/150) developed the disease during the second year after discontinuation. The HBe Ag- negative patients accounted for 47. 33%( 71/150). In the discontinuation group and previously untreated group,the patients with an underlying disease of chronic hepatitis showed a significantly higher cure and improvement rate than those with an underlying disease of liver cirrhosis( the discontinuation group: 88. 89% vs 53. 66%,χ2= 11. 450,P = 0. 001; the previously untreated group: 71. 79% vs 59. 50%,χ2= 5. 355,P =0. 021). Conclusion Discontinuation of necleos( t) ide analogues results in an increased proportion of patients with liver failure. Long-term antiviral therapy is very important,especially for patients with liver cirrhosis.

Decompensated liver disease complicated by acute stroke caused by multiple factors: a clinical analysis of 15 cases
Gou ChunYan, Li Li, Zhao DaWei, Li JingYing, Luo XiaoLan, Li XiuHui
2016, 32(9): 1770-1773. DOI: 10.3969/j.issn.1001-5256.2016.09.029
Abstract:

Objective To investigate the clinical features of patients with decompensated liver disease complicated by acute stroke. Methods A retrospective analysis was performed for the clinical data of 15 patients who were hospitalized in Beijing You'an Hospital,Capital Medical University and diagnosed with decompensated liver disease complicated by acute stroke from January 2011 to December 2015,including medical history,neurological manifestations,treatment,and prognostic features. Results Among the 15 patients,11 had acute hemorrhagic stroke( AHS),and 4 had acute ischemic stroke( AIS); among the 11 patients with AHS,4( 36. 36%) had hemorrhage caused by brain metastatic tumor of liver cancer( tumor- associated stroke),and 3( 27. 27%) were complicated by liver failure. Among the 15 patients,12( 80%) had disturbance of consciousness as the early neurological manifestation,and the confirmed diagnosis was made based on head CT findings; the treatment mainly included symptomatic support and rehabilitation training. The patients with AHS had poor prognosis.Four( 26. 67%) of the 15 AHS patients died,among these patients,2 had liver failure complicated by AHS,1 had liver cirrhosis complicated by AHS,and 1 had brain metastases complicated by AHS. Conclusion Patients with decompensated liver disease complicated by acute stroke tend to develop the manifestations of AHS,which may be related to a poor clotting mechanism and brain metastasis of liver cancer,and have poor prognosis. Head CT scan should be performed for patients with decompensated liver disease accompanied by neuropsychiatric abnormalities as early as possible to help with early diagnosis and timely treatment.

Association between serum preptin level and insulin resistance in patients with nonalcoholic fatty liver disease
Wang JinJun, Wang QinQin, Liu XinYan, Li YingMei, Xiong WuJun
2016, 32(9): 1774-1777. DOI: 10.3969/j.issn.1001-5256.2016.09.030
Abstract:

Objective To investigate the change in serum preptin level and its association with insulin resistance( IR) in patients with nonalcoholic fatty liver disease( NAFLD). Methods A total of 72 patients with NAFLD who visited the outpatient service or were hospitalized in Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine and Dongfang Hospital Affiliated to Tongji University from April to August,2014 were enrolled,and 53 normal controls( NCs) matched by age and sex were also enrolled. All the subjects underwent ultrasound examination,and according to the results of ultrasound examination,the patients were divided into mild,moderate,and severe NAFLD groups. The following parameters were measured: body height,body weight,systolic blood pressure,diastolic blood pressure,waist circumference,hip circumference,liver function parameters,blood lipids,high- sensitivity C- reactive protein,fasting blood glucose,fasting insulin( FINS),glycosylated hemoglobin,and serum preptin level. Body mass index( BMI),waist- hip ratio,and homeostasis model assessment of insulin resistance( HOMA- IR) were calculated. The two- independent- samples t test was used to compare means of continuous data between groups,comparison between group was made by analysis of variance,and multiple comparisons were made by SNK- q test; and the Pearson correlation coefficient method was used for correlation analysis; a multivariate linear regression analysis was used to identify the the correlations between preptin and variables,and a logistic regression analysis was used to identify the associations between variables and NAFLD. Results The NAFLD patients had a significant increase in the preptin level compared with the control group( 385. 54 ± 72. 78 pg/ml vs 303. 85 ± 57. 54 pg/ml,t =- 6. 76,P < 0. 001); the mild,moderate,and severe NAFLD groups showed gradual increases and significant differences in the preptin level( 328. 58 ± 53. 51 pg/ml,376. 71 ± 57. 77 pg/ml,and 449. 35 ± 56. 95 pg/ml,respectively,P < 0. 001).The Pearson correlation analysis showed that serum preptin level was positively correlated with BMI( r = 0. 475,P < 0. 001),HOMA- IR( r =0. 671,P < 0. 001),and FINS( r = 0. 763,P < 0. 001). The multivariate linear regression analysis showed that FINS and HOMA- IR were independent influencing factors for serum preptin level. The logistic regression analysis showed that preptin was closely associated with NAFLD. Conclusion Preptin is closely associated with the development of NAFLD and may be involved in the development and progression of NAFLD by affecting insulin resistance.

Effect of blueberry and probiotics on expression of PNPLA3 and SREBP-1c in rats with nonalcoholic fatty liver disease
Zhu JuanJuan, Zhou MingYu, Cheng MingLiang
2016, 32(9): 1778-1784. DOI: 10.3969/j.issn.1001-5256.2016.09.031
Abstract:

Objective To investigate the expression of patatin- like phospholipase domain- containing protein 3( PNPLA3) and sterol regulatory element- binding protein- 1c( SREBP- 1c) in the rat model of nonalcoholic fatty liver disease( NAFLD) treated by blueberry combined with probiotics,as well as its mechanism of action in NAFLD. Methods A total of 36 clean Sprague- Dawley rats were divided into normal group( NG),model group( MG),spontaneous recovery group( SRG),blueberry group( BG),probiotics group( PG),and blueberry- probiotics group( BPG). Tissue sections were prepared after the experiment ended to observe serological and histological changes and measure the mRNA and protein expression of PNPLA3 and SREBP- 1c. A one- way analysis of variance was used for comparison between multiple groups; the SNK- q test was used for data with homogeneity of variance,and the Tamhane's- T2 test was used for data with heterogeneity of variance. Results The six groups showed significant differences in liver index,serum alanine aminotransferase,total cholesterol,triglyceride,low- density lipoprotein,and high- density lipoprotein( F = 384. 908,188. 554,75. 523,94. 667,95. 235,and132. 586,all P < 0. 01). The NAFLD activity score also showed a significant difference between the six groups( F = 71. 896,P < 0. 01),and BPG showed a significantly greater reduction in the NAFLD activity score than MG,SRG,BG,and PG( all P < 0. 01). The six groups showed significant differences in the positive rates of PNPLA3 and SREBP- 1c in liver tissue( F = 175. 527 and 110. 504,both P < 0. 01),and BPG showed a significantly greater reduction in the positive rates of PNPLA3 and SREBP- 1C than MG,SRG,BG,and PG( all P <0. 01). The mRNA and protein expression of PNPLA3 and SREBP- 1c showed a significantly difference between the six groups.( F =375. 822,410. 379,288. 940,116. 054,all P < 0. 01). BPG showed significant reductions in the mRNA expression of PNPLA3 and SREBP- 1c compared with MG,SRG,BG,and PG( all P < 0. 01). Conclusion Blueberry combined with probiotics can effectively improve the structure of pathological tissues in NAFLD and reduce hepatocyte fatty degeneration. Its mechanism may be that the combination of blueberry and probiotics can reduce inflammation induced by inflammatory factors and downregulate the expression of SREBP- 1c,and thus weaken PNPLA3 gene transcription,enhance cholesterol metabolism,and reduce lipid deposition. Therefore,it can be applied as adjuvant therapy for NAFLD.

Case reports
Drug hypersensitivity syndrome with liver failure as the main clinical manifestation: a case report
Han DongXia, Li Juan, Meng QingHua
2016, 32(9): 1785-1786. DOI: 10.3969/j.issn.1001-5256.2016.09.032
Abstract:
A case of acute fulminant hepatitis B with HIV infection
Chen ChiChi, Chen XiaoRong, Lu YunFei
2016, 32(9): 1787-1788. DOI: 10.3969/j.issn.1001-5256.2016.09.033
Abstract:
A case of secondary hemochromatosis
Mou WenQian, Li ChunYan, Chen YanPing
2016, 32(9): 1789-1790. DOI: 10.3969/j.issn.1001-5256.2016.09.034
Abstract:
A case of primary systemic amyloidosis with hepatomegaly as the main manifestation
Fan ChunLei, Wang Zheng, Li Lei, Dong PeiLing, Ding HuiGuo
2016, 32(9): 1791-1793. DOI: 10.3969/j.issn.1001-5256.2016.09.035
Abstract:
Reviews
The role of fluoxetine in antiviral therapy for chronic hepatitis C
Qin Yuan, Zhang Ying, Zhao JieRu, Guo YongHong, Jia ZhanSheng
2016, 32(9): 1794-1796. DOI: 10.3969/j.issn.1001-5256.2016.09.036
Abstract:

More than 20% of chronic hepatitis C( CHC) patients receiving the antiviral therapy with interferonα( IFNα) experience depression,and fluoxetine is often used to alleviate this symptom. Fluoxetine has anti- inflammatory properties and can change the synthesis of liver lipids,but its influence on antiviral therapy for CHC and related mechanism remain unknown. Recent studies show that fluoxetine can inhibit hepatitis C virus( HCV) infection and reduce the production of reactive oxygen species( ROS) and lipid accumulation in Huh7. 5cells; in addition,it can promote the antiviral effect mediated by IFNα through activating STAT1 and JNK signaling pathways and thus reduce HCV viral load and the level of alanine aminotransferase in CHC patients. Fluoxetine elevates PPAR response element activity in CHC patients,and its inhibitory effect on HCV infection and lipid accumulation were partly reversed by antagonists including PPARβ/γ,suggesting that fluoxetine inhibits HCV infection,ROS production,and lipid accumulation through regulating PPARβ/γ and JNK/STAT pathways.

Research advances in indicators for early diagnosis of liver cirrhosis patients with renal impairment
Lu LiFang, Feng GuoHe
2016, 32(9): 1797-1800. DOI: 10.3969/j.issn.1001-5256.2016.09.037
Abstract:
The liver is closely associated with the kidney,and liver injury in various stages can cause various kidney diseases to varying degrees,which further lead to renal impairment. Such renal impairment in the early stage is often functional and can be reversed by drugs,otherwise it can progress to hepatorenal syndrome,cause acute renal failure,and even threaten human life. The indicators such as serum creatinine and urea nitrogen have a limited effect in the early diagnosis of renal impairment and cannot be used for early monitoring and diagnosis of liver cirrhosis patients with renal impairment. Therefore,early monitoring of liver cirrhosis patients with renal impairment has always been a hot topic in this field. This article summarizes the research advances in the indicators for early diagnosis of renal impairment.
Research advances in integrated traditional Chinese and Western medicine diagnosis and treatment of minimal hepatic encephalopathy
Sun RunFei, Wu Chao, Chen Xi, Sun MingYu
2016, 32(9): 1801-1805. DOI: 10.3969/j.issn.1001-5256.2016.09.038
Abstract:

Minimal hepatic encephalopathy( MHE) is a common complication in the progression of liver cirrhosis,and cando great harm to patients and the society. This disease has hidden clinical symptoms,and fine intelligence tests and nerve electrophysiological examination can find abnormalities in intelligence and mental status. If no treatment is given in time,MHE can easily progress to hepatic encephalopathy. Therefore,it is important to clarify the pathogenesis of MHE and give a definite diagnosis. MHE has a complex pathogenesis,and scholars at home and abroad have put forward various hypotheses based on in- depth studies. In recent years,great achievements have been made in traditional Chinese and Western medicine for the treatment of MHE. This article reviews resarch advances in the pathogenesis of MHE worldwide and achievements in the diagnosis and treatment of MHE based on traditional Chinese and Western medicine.

Current research status of mechanisms of the development and progression of liver fibrosis
Xu MingCui, Zhang Feng, Zhu GeYuZheng
2016, 32(9): 1806-1809. DOI: 10.3969/j.issn.1001-5256.2016.09.039
Abstract:

Liver fibrosis is the intermediate process in the progression of various chronic liver diseases to liver cirrhosis,and its serious complications affect the prognosis of patients with chronic liver diseases. However,so far,there remain no effective drugs for the treatment of liver fibrosis. This article investigates the development and progression of liver fibrosis from the aspects of signaling pathways and molecular mechanisms and briefly introduces the latest research advances in the roles of signaling pathways,including transforming growth factor- β/Smad pathway,platelet- derived growth factor pathway,leptin signaling pathway,and connective tissue growth factor pathway,chemokines,neuroendocrine factors,and angiogenesis in the development of liver fibrosis,so as to enhance the knowledge of the development of liver fibrosis and provide a theoretical basis for the research on molecular- targeted drugs based on the pathogenesis of liver fibrosis.

The role of MAPK signaling pathway in development/progression and treatment of liver cancer
Ci DanWangJiu, Lin Kun, Lu ZaiMing, Zhao XiangXuan, Wang XiaoMing
2016, 32(9): 1810-1813. DOI: 10.3969/j.issn.1001-5256.2016.09.040
Abstract:

Abnormal activation of the mitogen- activated protein kinase( MAPK) signaling pathway is closely associated with the development,progression,and metastasis of liver cancer. This article introduces the expression of MAPK proteins in liver cancer and its role in the proliferation,differentiation,and metastasis of liver cancer,and elaborates on the value of the MAPK signaling pathway in the treatment and prognostic evaluation of liver cancer. It is pointed out that the MAPK signaling pathway plays an important role in the development/progression and treatment of liver cancer and is a potential molecular target for the treatment and prognostic evaluation of liver cancer.

Role of uric acid in the development and progression of nonalcoholic fatty liver disease
Li ShaoFeng, Liao XianHua, Ye JunZhao, Zhong BiHui
2016, 32(9): 1814-1818. DOI: 10.3969/j.issn.1001-5256.2016.09.041
Abstract:
Abnormal uric acid metabolism is closely associated with the development and progression of nonalcoholic fatty liver disease( NAFLD). This article describes the relationship between uric acid and the prevalence and severity of NAFLD,and point out that uric acid metabolic disorders directly affect the development and progression of NAFLD through complicated pathways such as insulin resistance,oxidative stress,direct influence on the expression of lipid synthetase,and inflammatory response. Control of uric acid is expected to become one of the multimodality therapies for NAFLD.
Research advances in diagnosis and treatment of IgG4-associated autoimmune hepatitis
Shi XiaoDong, Wei Qi, Yu Min, Liu XingXing, Jia ZhiFang, Wang YueQi, Jiang ZhenYu
2016, 32(9): 1819-1821. DOI: 10.3969/j.issn.1001-5256.2016.09.042
Abstract:
Autoimmune hepatitis( AIH) is a chronic progressive inflammatory disease involving the liver parenchyma. In recent years,there have been more studies focusing on IgG4- associated diseases. Foreign scholars have found that patients with AIH also have IgG4- positive plasma cell infiltration in the liver,suggesting that IgG4 may be involved in the pathogenesis of AIH,and this disease is considered a special type of AIH and thus it is called IgG4- associated AIH( IgG4- AIH). This article reviews the research advances in the diagnosis and treatment of AIH and IgG4- AIH,so as to enhance clinical doctors' knowledge of such diseases.
Research progress in biomarkers of drug-induced liver injury
Guo Pei, Lu Wang, Yang WenXuan, Hu YuLin
2016, 32(9): 1822-1826. DOI: 10.3969/j.issn.1001-5256.2016.09.043
Abstract:

Drug- induced liver injury( DILI) is a major reason for the recall of marketed drugs and the failure of clinical trials. Detection of potential liver injury remains a challenge for clinical management and preclinical drug safety studies. Currently,serum levels of alanine aminotransferase and aspartate aminotransferase are the gold standards for evaluating liver injury. However,these biomarkers are nonspecific and insensitive,and often result in false- positive results. Therefore,researchers have never stopped searching for the biomarkers of DILI with high sensitivity and specificity. This review summarizes recent research progress in the biomarkers of DILI to better predict and diagnose DILI.

Research progress in the role of autophagy in liver regeneration
Han WeiJia, Shi HongBo, Chen Yu
2016, 32(9): 1827-1831. DOI: 10.3969/j.issn.1001-5256.2016.09.044
Abstract:

Autophagy is a pathway of intracellular degradation,in which autophagic vacuoles are formed to transport intracellular biomacromolecules and damaged organelles to lysosomes. Autophagy plays an important role in the maintenance of the dynamic balance of liver function. Abnormal liver cells can be eliminated by autophagy. This article reviews the close relationship of autophagy with the proliferation of liver cells,non- parenchymal liver cells,and hepatic stem cells. Analysis has shown that autophagy may restore the volume and function of the liver by promoting the proliferation of liver cells and hepatic stem cells,which can be stopped in time to prevent tumor development. Autophagy may promote the activation of non- parenchymal liver cells during liver dysfunction,which can inhibit the regeneration of liver cells,and,in the meantime,lead to the development and progression of liver fibrosis. When the tumor is being formed,autophagy plays an important role in the transformation of normal cells into cancer cells; malignant regeneration of liver cells is activated but not terminated in time.