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

2017 No. 5

Display Method:
Editorial
Improving the diagnosis and treatment of hepatobiliary & pancreatic diseases based on clinical evidence of advantages of integrated traditional Chinese and Western medicine
Liu Ping
2017, 33(5): 805-807. DOI: 10.3969/j.issn.1001-5256.2017.05.001
Abstract:
This issue of Journal of Clinical Hepatology focuses on integrated traditional Chinese and Western medicine and has invited the experts who are engaged in the diagnosis and treatment of hepatobiliary & pancreatic diseases using integrated traditional Chinese and Western medicine.With reference to their clinical practice of diagnosis and treatment and related studies, the special topics introduce how to give full play to the advantages of both traditional Chinese and Western medicine to improve patients' benefits and related developmental issues and show the perspectives of the development of integrated traditional Chinese and Western medicine.
Therapeutic guidelines
An excerpt of The International Liver Transplant Society (ILTS) living donor liver transplant recipient guideline(2016)
Zhou Xia, Yao Hong, Liu HongLing
2017, 33(5): 808-812. DOI: 10.3969/j.issn.1001-5256.2017.05.002
Abstract:
An excerpt of American Gastroenterological Association Institute guidelines for the diagnosis and management of acute liver failure(2017)
Chen Jing, Su HaiBin
2017, 33(5): 813-815. DOI: 10.3969/j.issn.1001-5256.2017.05.003
Abstract:
An excerpt of laparoscopic surgery for pancreatic neoplasms: the European Association for Endoscopic Surgery clinical consensus conference(2017)
Zheng SuLi, Zhang TaiPing
2017, 33(5): 816-819. DOI: 10.3969/j.issn.1001-5256.2017.05.004
Abstract:
The Australasian Hepatology Association consensus guidelines for the provision of adherence support to patients with hepatitis C on direct acting antivirals
Rao HuiYing, Wei Lai
2017, 33(5): 820-824. DOI: 10.3969/j.issn.1001-5256.2017.05.005
Abstract:
Discussions by experts
An exploration of therapeutic evaluation of traditional Chinese medicine in treatment of hepatic fibrosis
Xu LieMing
2017, 33(5): 825-828. DOI: 10.3969/j.issn.1001-5256.2017.05.006
Abstract:
China has become one of the leading counties in the world to treat hepatic fibrosis with Chinese patent drugs.The therapeutic effect of traditional Chinese medicine (TCM) should be evaluated from the aspects of short-term therapeutic effect, long-term therapeutic effect, and effect of relief of symptoms.This article introduces the results of our exploration of the application of liver stiffness measurement to evaluate therapeutic effect, five-year survival rate to assess long-term therapeutic effect, and a “TCM syndrome scale” to evaluate effect of relief of symptoms, suggesting that the Chinese patent drug Fuzheng Huayu capsules/tablets have a marked clinical effect in the treatment of hepatic fibrosis.It is recommended to use serological diagnostic models, conduct prospective studies with long-term follow-up, and analyze the samples and data accumulated over a long period of time, in order to perfect the methods for evaluating the outcome of hepatic fibrosis.
Epidemic features, major causes, and diagnostic evaluation of herb-induced liver injury
Liu ChengHai, Zhu ChunWu
2017, 33(5): 829-832. DOI: 10.3969/j.issn.1001-5256.2017.05.007
Abstract:
With the wide application of Chinese herbal medicine around the world and the continuous perfection of adverse drug reaction monitoring system, herb-induced liver injury (HILI) has attracted more and more attention, but its actual incidence remains unknown.As is reported in the literature, its constituent ratio ranged from 20% to 30% and there are many clinical types, among which hepatocellular injury is the most common type.There are many causes of HILI, including pharmaceutical factors, factors associated with the human body, lack of preclinical evaluation, and unreasonable clinical application.Currently it is difficult to make a diagnosis of HILI, and tracing the source of Chinese herbal medicine may play an important role in the diagnosis of this disease.Liver injury induced by Chinese herbal medicine should be taken seriously and active diagnosis and effective prevention and treatment should be performed.
Clinical research advances in traditional Chinese medicine in treatment of icteric hepatitis
Guo QiYu, Chen JianNeng, Zheng RuiDan
2017, 33(5): 833-837. DOI: 10.3969/j.issn.1001-5256.2017.05.008
Abstract:
The pathogenesis of icteric hepatitis is that pathogenic dampness blocks the middle energizer or blood stasis blocks the bile duct, so that the bile is not excreted normally and moves to the skin surface, which makes the skin yellow.Traditional Chinese medicine (TCM) has unique advantages in the prevention and treatment of icteric hepatitis.This article systematically introduces the etiology and pathogenesis of icteric hepatitis and the TCM syndrome differentiation therapy for icteric hepatitis, in order to provide a reference for the clinical treatment of icteric hepatitis and the improvement in its prognosis.
Integrated traditional Chinese and Western medicine therapy for acute and chronic cholecystitis
Zhang JingZhe, Yu Kui
2017, 33(5): 838-842. DOI: 10.3969/j.issn.1001-5256.2017.05.009
Abstract:
Acute and chronic cholecystitis is often complicated by gallstones.With the rapid development of modern surgery, especially the renovation in surgical concepts, techniques, and methods represented by noninvasive surgery, surgery becomes the most important method for the treatment of such disease.However, surgical treatment is also limited by different disease stages, disease onset status, and individual factors.As an indispensible part of the whole treatment system for such disease, non-surgical treatments, especially integrated traditional Chinese and Western medicine therapy, still have unique advantages.This article briefly summarizes the history of the treatment of acute and chronic cholecystitis and related hot topics and controversies, as well as the concepts and methods of integrated traditional Chinese and Western medicine therapy.
Current status and perspectives of integrated traditional Chinese and Western medicine therapy for pancreatitis
Cui NaiQiang, Cui YunFeng, Zhang ShuKun
2017, 33(5): 843-848. DOI: 10.3969/j.issn.1001-5256.2017.05.010
Abstract:
Integrated traditional Chinese and Western medicine therapy for pancreatitis has been used since the 1960s.According to the clinical manifestations and traditional Chinese medicine (TCM) syndrome differentiation of pancreatitis, pancreatitis was named “true heart pain with cold limbs caused by spleen disease”.Syndrome differentiation of acute pancreatitis and treatment with modified Dachaihu decoction achieved good clinical effects.After the 1990 s, the research focus of pancreatitis research was shifted to severe acute pancreatitis (SAP) .The clinical course of SAP was divided into three phases, and different therapeutic regimens were given.Clinical studies achieved good therapeutic effects in terms of cure rate and fatality rate.After 2000, integrated traditional Chinese and Western medicine therapy for chronic pancreatitis has been promoted systemically, and the cooperation between traditional Chinese medicine, endoscopic techniques, and operative treatment helps to significantly improve pain control, nutritional status, and incidence of complications.
Original articles_Viral hepatitis
Clinical effect of entecavir in treatment of chronic hepatitis B complicated by hepatic steatosis
Wu YanQin, Shen LiJun, Yu JiHong, Sun YuShan
2017, 33(5): 849-852. DOI: 10.3969/j.issn.1001-5256.2017.05.011
Abstract:

Objective To investigate the effect of antiviral therapy with entecavir in the treatment of chronic hepatitis B (CHB) complicated by hepatic steatosis.Methods A total of 164 HBe Ag-positive CHB patients who visited Bazhou People's Hospital from June 2014 to June2015 were enrolled, and according to the percentage of hepatocytes with steatosis in the hepatic lobules in all hepatocytes, they were divided into control group (<5% 43="" 89="" of="" hepatocytes="" with="" group="" a="" and="" b="">30% of hepatocytes with steatosis, 32 patients) .All patients were treated with entecavir.The serum virological parameters and liver function parameters were measured before treatment and at weeks 24 and 48 of treatment.A one-way analysis of variance was used for comparison of continuous data between groups, and the Bonferroni method was used for comparison between any two groups;the chi-square test was used for comparison of categorical data between groups.Results Hepatic steatosis did not affect the virologic response at week 24 of entecavir treatment (P>0.05) .However at week 48 of entecavir treatment, compared with the control group, group B had significantly lower HBe Ag clearance rate (34.4% vs 60.2%, P=0.012) and HBV DNA clearance rate (40.6% vs 67.4%, P=0.008) .At weeks 24 and 48 of entecavir treatment, compared with the control group, groups A and B had a significantly lower alanine aminotransferase normalization rate than the control group (group A:P=0.013 and 0.001;group B:P=0.001 and P<0.001) and significantly higher levels of aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase (group A:P24<0.001, P24=0.031, and P24=0.001, P48<0.001, P48=0.021, and P48<0.001;group B:P24<0.001, P24=0.028, and P24=0.001, P48<0.001, P48=0.017, P48<0.001) .conclusion="" a="" percentage="" of="" hepatocytes="" with="" steatosis="">30% is associated with the reduction in virologic response at week48 of entecavir treatment.Hepatic steatosis affects the biochemical response in CHB patients at weeks 24 and 48 of entecavir treatment.

Economic burden of inpatients with hepatitis B virus infection-related diseases and its impact on family financial status in Qidong, Jiangsu Province, China
Yao HongYu, Wang YuTing, Tang HongPing, Huang HuiYao, Zhang HongJian, Sha ChunXia, Shi JuFang, Dai Min, Chen TaoYang, Qu ChunFeng
2017, 33(5): 853-859. DOI: 10.3969/j.issn.1001-5256.2017.05.012
Abstract:

Objective To investigate the economic burden of inpatients with hepatitis B virus (HBV) infection-related diseases (including primary liver cancer, hepatitis B cirrhosis, and chronic hepatitis B) and its impact on family financial status in Qidong, Jiangsu Province, China.Methods Cluster random sampling was used to select consecutive cases of HBV infection-related diseases who were hospitalized in The People's Hospital of Qidong and Qidong Hospital for Infectious Diseases from May 1, 2014 to March 31, 2015.A questionnaire survey was performed to collect their demographic data, clinical data, direct medical costs within the past three years, direct non-medical costs, loss of income due to missed work, and the impact of disease on family financial status.The Wilcoxon rank sum test or the Kruskal-Wallis H rank sum test was used to analyze the impact of various factors on economic burden, such as clinical stage, age, sex, educational level, occupation, type of medical insurance, and family income.The chi-square test or Fisher's exact test was used to analyze the difference in family economic pressure caused by different disease types after HBV infection.Results The total costs of primary liver cancer, hepatitis B cirrhosis, and chronic hepatitis B within the past three years were 94001 yuan, 63421 yuan, and 39360 yuan, respectively, and direct medical costs accounted for 84.7%, 83.6%, and 89.9%, respectively.The self-paid costs within the past one year accounted for99.6%, 59.4%, and 16.7%, respectively, of the annual family income.There was a significant difference in the proportion of patients with great economic pressure between the three groups (38.7% vs 43.1% vs 11.3%, χ2=30.066, P<0.001) .There were also significant differences in the number of missed working days and loss of income due to missed work (7903 yuan vs 6280 yuan vs 2600 yuan, χ2=68.601, P<0.001) .Conclusion HBV infection-related diseases bring considerable burden to inpatients and their families, and the economic burden increases with a longer course of disease and more serious conditions.With the progression of chronic hepatitis B to hepatitis B cirrhosis and primary liver cancer, diseases impose greater economic pressure on families, and patients themselves and their relatives may suffer from greater loss of income due to missed work.Prevention and control of HBV infection has great social and economic benefits.

Original articles_Liver fibrosis and liver cirrhosis
Risk factors for HBV-related liver cirrhosis complicated by acute upper gastrointestinal bleeding
Yu ZhiRui, Wei GuoXi, Liu QiChang, Jin PeiMin
2017, 33(5): 860-863. DOI: 10.3969/j.issn.1001-5256.2017.05.013
Abstract:

Objective To investigate the risk factors for HBV-related liver cirrhosis complicated by acute upper gastrointestinal bleeding (AUGIB) .Methods A total of 58 patients with HBV-related liver cirrhosis complicated by AUGIB who were hospitalized in our hospital from January to December, 2011 were enrolled as study group, and 100 patients with HBV-related liver cirrhosis who did not experience upper gastrointestinal bleeding during the same period of time were enrolled as control group.Their general clinical data were collected.The t-test was used for comparison of continuous data between groups, the chi-square test was used for comparison of categorical data between groups, the multivariate Cox regression model was used to analyze the risk factors, and the life table method was used to analyze 1-, 2-, and 3-year cumulative survival rates and plot survival curves.Results The 1-, 2-, and 3-year cumulative survival rates in the patients with HBV-related liver cirrhosis complicated by AUGIB were 72.2%, 51.9%, and 35.2%, respectively, with a median survival time of 24.7 months.The univariate analysis showed that AUGIB was associated with bleeding history (χ2=7.128, P=0.008) , course of disease (t=8.283, P<0.001) , bad eating habits (χ2=7.612, P=0.006) , Child-Pugh class (χ2=6.045, P=0.049) , degree of esophageal varices (χ2=46.241, P<0.001) , gastric varices (χ2=14.211, P<0.001) , and portal hypertension (χ2=6.846, P=0.009) .The multivariate Cox regression analysis revealed that course of disease (RR=0.745, 95% CI:0.824-0.967, P=0.026) , bad eating habits (RR=1.426, 95% CI:1.033-2.582, P=0.032) , Child-Pugh class (RR=2.032, 95% CI:1.05-2.34, P=0.036) , degree of esophageal varices (RR=0.796, 95% CI:1.23-3.37, P=0.015) , degree of gastric varices (RR=0.825, 95% CI:2.46-3.92, P=0.043) , and portal hypertension (RR=0.983, 95% CI:1.26-3.75, P=0.007) were independent risk factors for the prognosis of patients with HBV-related liver cirrhosis complicated by AUGIB.Conclusion Course of disease, bad eating habits, Child-Pugh class, degree of esophageal varices, degree of gastric varices, and portal hypertension are independent risk factors for the prognosis of patients with HBV-related liver cirrhosis complicated by AUGIB.These factors should be taken seriously by clinical physicians to improve patients' prognosis.

Original articles_Liver neoplasms
Value of transforming growth factor-β1 in diagnosis of primary liver cancer:a meta-analysis
Mo XiaoLi, Liu Jie, Zhu JiaYu, Chen Chuang, Ou Jie, Mao SuFei
2017, 33(5): 864-868. DOI: 10.3969/j.issn.1001-5256.2017.05.014
Abstract:

Objective To investigate the value of transforming growth factor-β1 (TGFβ1) in the diagnosis of primary liver cancer using a meta-analysis.Methods Pub Med, EMBASE, Cochrane Library, CBM, CNKI, Wanfang Data, and VIP were searched for articles on TGFβ1 in the diagnosis of primary liver cancer published up to June 30, 2016.The Overview Quality Assessment Questionnaire was used to evaluate the quality of articles screened out.Stata 13.0 software was used for the analysis of diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio, the summary receiver operating characteristic (SROC) curve was plotted, and publication bias was tested.The confidence level was expressed as 95% confidence interval (95% CI) .The Q test and I2 test were used for testing heterogeneity, and a subgroup analysis was also performed.Results A total of 16 articles were included, with 1124 patients in liver cancer group and 1443 patients in control group.The sensitivity was 0.68 (95% CI:0.52-0.80) and the specificity was 0.85 (95% CI:0.74-0.92) .The diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio were 11.75 (95% CI:6.18-22.36) , 4.6 (95% CI:2.7-7.9) , and0.38 (95% CI:0.26-0.56) , respectively.The area under the SROC curve was 0.84 (95% CI:0.80-0.87) .The subgroup analysis showed that compared with immunohistochemistry, ELISA had higher positive likelihood ratio and diagnostic odds ratio and a larger area under the SROC curve, as well as a lower negative likelihood ratio.There was heterogeneity among the articles included, and the main sources of heterogeneity were different underlying liver diseases in patients, different types of diseases in non-primary liver cancer group (including benign control group and normal control group) , and difference in experimental design.The Deeks funnel plot showed no significant publication bias.Conclusion TGFβ1 has high sensitivity and specificity in the diagnosis of liver cancer and may become an auxiliary index for the diagnosis of liver cancer.

Correlation between mRNA expression of heat shock protein in tumor tissue and tumor stage in patients with HBV-related hepatocellular carcinoma
Xu QingNian, Lu YunFei, Tang BoZong, Chen XiaoRong, Yang ZongGuo
2017, 33(5): 869-874. DOI: 10.3969/j.issn.1001-5256.2017.05.015
Abstract:

Objective To investigate the correlation between mRNA expression of heat shock protein (HSP) and tumor stage in patients with HBV-related hepatocellular carcinoma (HCC) .Methods The GSE14520 data set was downloaded from gene expression omnibus in the website of the National Center of Biotechnology Information.A total of 25 HSP genes were obtained from the GSE14520 data, and after the comparison with the clinical data downloaded from the database, 220 HCC patients with mRNA expression of HSP and corresponding clinical data were enrolled.The mRNA expression of HSP in tumor tissues was measured, the TNM stage and Barcelona Clinic Liver Cancer (BCLC) stage were determined for each patient, and a correlation analysis was performed.The Kruskal-Wallis H non-parametric test was used for comparison between multiple groups, and univariate and multivariate logistic regression analyses were used to investigate the correlation between HSP and HCC tumor stage.Results With the increase in TNM stage, the expression of HSPA12 A, HSPA5, HSP90AA1, and HSPA13 gradually increased (all P<0.05) , while the expression of HSP90AA1 gradually increased with the increase in BCLC stage (P<0.05) .HSPA4L (OR=1.019, P=0.005) , HSPA12A (OR=1.077, P=0.026) , and HSP90AA1 (OR=1.001, P=0.002) were risk factors for TNM stage.HSPA9 was negatively correlated with TNM stage (OR=0.995, P=0.011) .HSPH1 (OR=1.005, P=0.041) , HSPA1B (OR=1.002, P=0.048) , and HSPA5 (OR=1.000, P=0.001) were risk factors for BCLC stage, and HSPA9 was negatively correlated with BCLC stage (OR=0.995, P=0.005) .Conclusion There is a certain correlation between HSPs and tumor stage in HCC patients.

Influence of specific down-regulation of LKB1 expression on invasion and migration of hepatoma cells
Sha Liang, He JianBo, Li KeZhi, Chen Chuang, Huang Shan, Zhao YinNong, Lian Fang, Wu GuoBin
2017, 33(5): 875-879. DOI: 10.3969/j.issn.1001-5256.2017.05.016
Abstract:

Objective To investigate the influence of specific down-regulation of LKB1 expression on invasion and migration of the hepatoma cell line SK-hep-1.Methods Quantitative real-time PCR (RT-PCR) and Western blot were used to measure the expression of LKB1 in the human hepatoma cell line SK-hep-1 and normal hepatocytes (HL7702) .LKB1 specific double-strand small interfering RNA was designed, synthesized, and then transfected into the human hepatoma cell line SK-hep-1 with high expression of LKB1 to silence the expression of LKB1 gene.A negative control (NC) group was established.RT-PCR and Western blot were used to measure the changes in the mRNA and protein expression of LKB1.Cell Counting Kit-8 was used to measure the proliferative capacity of hepatoma cells.In vitro Transwell chamber invasion and migration assays were used to observe the influence of LKB1 gene silencing on invasion and migration of the human hepatoma cell line SK-hep-1.The t-test was used for comparison of continuous data between two groups;a one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between any two groups.Results Compared with normal human hepatocytes (HL7702) , SK-hep-1 cells had significantly higher mRNA and protein expression of LKB1 (both P<0.05) .Compared with the NC group, the siLKB1-1 treatment group had significant reductions in the mRNA and protein expression of LKB1 in SK-hep-1 cells (both P<0.05) .Compared with the NC group, the siLKB1-1 treatment group had a significantly higher cell proliferation rate and significant increases in invasion and migration (1.393 ±0.022 vs 1.1284±0.032, t=15.313, P<0.001;147±19 vs 83±21, t=14.879, P<0.001;113±13 vs 75±17, t=8.791, P<0.001) .Conclusion LKB1 may be involved in inhibiting the proliferation, invasion, and migration of hepatoma cells and can affect the prognosis of patients with liver cancer.

Original articles_Biliary diseases
Association between metabolic syndrome and gallstones
Zhou BingBing, Wang XueMei, Zhang Qian, Xu ShiYi, Dan ZhongYan, Lai YaXin, Wang HaoYu
2017, 33(5): 880-882. DOI: 10.3969/j.issn.1001-5256.2017.05.017
Abstract:

Objective To investigate the association of metabolic syndrome and its components with gallstones and the factors for the development of gallstones.Methods A total of 445 community residents, who were followed up by Department of Endocrinology in The First Affiliated Hospital of China Medical University from January to June, 2015, were enrolled as study subjects and were divided into metabolic syndrome group with 220 patients and non-metabolic syndrome group with 225 patients.A questionnaire survey, physical examination, and blood test were performed for these patients to obtain the data on sex, age, body height, body weight, waist circumference, blood pressure, and blood biochemical parameters[fasting blood glucose, triglyceride (TG) , and high-density lipoprotein (HDL) ].The chi-square test was used for comparison of categorical data between two groups, the t-test was used for comparison of continuous data between groups, and a multivariate logistic regression analysis was used to identify independent risk factors for the development of gallstones.Results Of all patients, 49 (11.01%) had gallstones, among whom 38 (17.27%) were in the metabolic syndrome group and 11 (4.89%) were in the non-metabolic syndrome group;the metabolic syndrome group had a significant increase in the prevalence rate of gallstones (χ2=17.409, P<0.001) .The multivariate logistic regression analysis showed that increased waist circumference (OR=1.088, P<0.001) , increased TG level (OR=1.209, P=0.038) , and reduced HDL level (OR=0.329, P=0.014) were independent risk factors for gallstones.Conclusion Increased waist circumference, increased TG level, and reduced HDL level may be independent risk factors for the development of gallstones.

Clinical effect of laparoscopic cholecystectomy combined with laparoscopic choledocholithotomy T-tube drainage in treatment of gallbladder and common bile duct stones
Tan ZhanHai, Zhu GuangHui, Chen JianRong, Zhou LianMing, Yang Zhi, Zhang JiFa, Zhang XueLi, Dan YuanZhou
2017, 33(5): 883-887. DOI: 10.3969/j.issn.1001-5256.2017.05.018
Abstract:

Objectives To investigate the clinical effect of laparoscopic cholecystectomy (LC) combined with laparoscopic choledocholithotomy T-tube drainage (LCHTD) in the treatment of gallbladder and common bile duct stones.Methods A retrospective analysis was performed for 117 patients with gallbladder and common bile duct stones who underwent surgical treatment in The Central Hospital of Fengxian District from January 2013 to January 2016, and among these patients, 57 underwent LC + LCHTD (LC + LCHTD group) and 60 underwent open cholecystectomy (OC) combined with open choledocholithotomy T-tube drainage (OCHTD) (OC + OCHTD group) .The time of operation, intraoperative blood loss, length of hospital stay, hospital costs, and incidence of postoperative complications were compared between the two groups, as well as the changes in related biochemical parameters after surgery.A repeated measures analysis of variance was used for comparison of values measured at different time points, 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 There was no significant difference in the time of operation between the LC + LCHTD group and the OC + OCHTD group (P>0.05) .Compared with the OC + OCHTD group, the LC +LCHTD group had significantly lower intraoperative blood loss, postoperative fasting time, and length of postoperative hospital stay (t=11.765, 2.978, and 5.876, all P<0.05) , a significantly lower visual analogue scale pain score at 24 hours and 3 and 7 days after surgery (t=2.403, 3.205, and 2.032, all P<0.05) , and significantly higher total hospital costs (t=5.664, P<0.001) .The LC + LCHTD group had a significantly lower incidence rate of total complications than the OC + OCHTD group (χ2=4.173, P<0.05) , and the OC +OCHTD group had a significantly greater reduction in albumin than the LC + LCHTD group (t=10.766, P<0.05) .Conclusion In the treatment gallbladder and common bile duct stones, the patients treated with LC + LCHTD have less surgical trauma and postoperative complications, a shorter length of hospital stay, and faster postoperative rehabilitation, compared with those treated with OC + OCHTD.

Clinical effect of laparoscopic versus open cholecystectomy in treatment of patients with portal hypertension complicated by gallstones
Zhao Bin, Qing XiaoSong, Lai Zhao
2017, 33(5): 888-891. DOI: 10.3969/j.issn.1001-5256.2017.05.019
Abstract:

Objective To investigate the safety and feasibility of laparoscopic cholecystectomy (LC) in the treatment of portal hypertension complicated by gallstones.Methods A retrospective analysis was performed for the clinical data of 96 patients with portal hypertension complicated by gallstones who underwent surgical treatment in The Fourth People' s Hospital of Zigong from January 2012 to June 2016.These patients were divided into laparoscopic group with 50 patients who underwent LC and open group with 46 patients who underwent open cholecystectomy.The surgical conditions and changes in liver function after surgery were compared between the two groups.An analysis of variance with repeated measures was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for comparison between two groups;the t-test was used for comparison between two groups.The chi-square test was used for comparison of categorical data between groups.Results No deaths occurred during the perioperative period and no patient was converted to open surgery in the laparoscopic group.Compared with the open group, the laparoscopic group had significantly lower time of operation, intraoperative blood loss, length of hospital stay, hospital costs, and incidence rate of postoperative complications (t=2.075, 7.389, 4.839, and 3.809, χ2=4.697, all P<0.05) .Both groups had increased or reduced serum levels of alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , total bilirubin (TBil) , and albumin (Alb) at 1 day after surgery, which gradually returned to preoperative levels at 3 or 7 day after surgery.The laparoscopic group had significant changes in the serum levels of ALT, AST, and Alb (F=201.85, 185.55, and 4.570, all P<0.01) , while the open group had significant changes in the serum levels of ALT, AST, TBil, and Alb (F=597.84, 373.10, 5.617, and 10.429, all P<0.01) .There were significant increases in the serum levels of ALT and AST 1 day after surgery in the laparoscopic group and at 1 and 3 days after surgery in the open group (all P<0.05) , and at 1 and 3 days after surgery, the laparoscopic group had significantly lower serum levels of ALT and AST than the open group (t=12.537, 18.370, 9.548 and 15.118, both P<0.01) .At 1 day after surgery, the open group had a significant increase in the serum level of TBil (P<0.05) and a higher serum level of TBil than the laparoscopic group (t=2.547, P=0.013) .There were significant reductions in the serum level of Alb at 1 day after surgery in the laparoscopic group and at 1 and 3 days after surgery in the open groups (all P<0.05) , and at 1 day after surgery, the laparoscopic group had a significantly higher serum level of Alb than the open group (t=2.291, P=0.024) .Conclusion LC is safe and feasible in the treatment of portal hypertension complicated by gallstones, and compared with open cholecystectomy, it has the advantages of a minimally invasive surgery and causes less liver damage.

A safety analysis of day-surgery laparoscopic cholecystectomy for elderly patients aged above 65 years with biliary tract diseases
Cao JunNing, Zhao SenFeng, Li XiangJun, Liu Bo
2017, 33(5): 892-895. DOI: 10.3969/j.issn.1001-5256.2017.05.020
Abstract:

Objective To investigate the safety of day-surgery laparoscopic cholecystectomy (LC/DS) in elderly patients.Methods The clinical data were collected from 4764 patients who underwent LC/DS in PLA General Hospital from November 2009 to July 2015, and a retrospective analysis was performed for the general data, time of operation, intraoperative blood loss, length of postoperative hospital stay, satisfaction rate, reason for delayed discharge, rate of delayed discharge caused by psychological factors, rate of delayed discharge caused by abdominal drainage tube placement, incidence of complications, rate of conversion to laparotomy, readmission rate with 30 days after discharge, and mortality rate of elderly patients (≥65 years) .The clinical data of elderly patients were compared with those of non-elderly patients.The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Results A total of 710 elderly patients and 4054 non-elderly patients underwent LC/DS, and no patients died.There were significant differences between these two groups in the time of operation [57.5 (41.8-74.3) min vs 54.0 (40.0-70.0) min, Z=-2.715, P=0.007], intraoperative blood loss [10.0 (5.0-20.0) ml vs 5.0 (0-10.0) ml, Z=-8.604, P<0.001], length of postoperative hospital stay [1.0 (1.0-1.0) d vs 1.0 (1.0-1.0) d, Z=-3.778, P<0.001], overall rate of delayed discharge (20.3% vs 14.8%, χ2=13.637, P<0.001) , rate of delayed discharge caused by psychosocial factors (8.6% vs 6.5%, χ2=4.220, P=0.040) , and rate of delayed discharge caused by abdominal drainage tube placement (4.4% vs 2.0%, χ2=13.909, P<0.001) .There were no significant differences between the two groups in the incidence of complications (6.5% vs 5.9%, χ2=0.334, P=0.563) , rate of conversion to laparotomy (0.8% vs 0.4%, χ2=2.119, P=0.145) , and readmission rate within 30 days after discharge (0.7% vs 0.5%, χ2=0.190, P=0.663) .Conclusion Elderly patients undergoing LC/DS have comparable risks of complications, conversion to laparotomy, and readmission to non-elderly patients, which suggests that LC/DS is safe and feasible.

Association between hematobilia and primary disease after therapeutic endoscopic retrograde cholangiopancreatography
Wang QunRu, Zhang Yong, Mou Dong, Chen BeiJin, Ni Hua, Gao Hui
2017, 33(5): 896-898. DOI: 10.3969/j.issn.1001-5256.2017.05.021
Abstract:

Objective To investigate the difference in the risk of hematobilia after therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with different primary diseases.Methods A retrospective analysis was performed for the clinical data of 685 patients with pancreaticobiliary diseases who underwent therapeutic ERCP in General Hospital of Chengdu Military Region from June 2013 to June 2016.According to the presence or absence of hematobilia after ERCP, they were divided into bleeding group (29 patients) and non-bleeding group (656 patients) .The association between primary disease and the risk of bleeding was evaluated.The chi-square test was used for comparison of categorical data between groups, and the independent samples t-test was used for comparison of continuous data between groups.Results The overall incidence rate of hematobilia after ERCP was 4.2% (29/685) , and among these patients, 21 had early bleeding and 8 had delayed bleeding.The bleeding group had a significantly higher incidence rate of hypertension than the non-bleeding group (65.5% vs 25.6%, χ2=22.286, P<0.001) 2="5.356," .compared="" with="" the="" non-bleeding="" bleeding="" group="" had="" significantly="" higher="" proportions="" of="" patients="" impacted="" ampullar="" stones="" vs="" p="" cholangiocarcinoma="" pancreatic="" cancer="" and="" carcinoma="" .there="" were="" no="" significant="" differences="" between="" two="" groups="" in="" common="" bile="" duct="" acute="" pyogenic="" biliary="" inflammatory="" stenosis="" after="" surgery="" all="">0.05) .Conclusion Patients with impacted ampullar stones or malignant pancreaticobiliary diseases have a high risk of hematobilia after ERCP and should be given adequate preoperative preparation, effective intraoperative hemostasis, and strengthened postoperative prevention.

Protective effect of prostaglandin E1 pretreatment against liver ischemia-reperfusion injury in rats with cholestasis
Xu Feng, Liu XiaoLin, Wang Chao, Dai ChaoLiu
2017, 33(5): 899-904. DOI: 10.3969/j.issn.1001-5256.2017.05.022
Abstract:

Objective To investigate the protective mechanism of prostaglandin E1 (PGE1) against liver ischemia-reperfusion injury in rats with cholestasis.Methods A total of 36 male Wistar rats were randomly divided into PGE1 group (PGE group) and normal saline group (NS group) .The rats in the PGE group were treated with continuous pump of PGE1 (0.5 μg/kg/min) from 15 minutes before liver ischemia to 60 minutes of reperfusion, and those in the NS group were given normal saline of the same volume.Common bile duct ligation was performed to establish a rat model of cholestasis.Seven days later, Pringle maneuver was used to perform hepatic inflow occlusion for 15 minutes, and serum levels of enzymes and bilirubin were measured at 1, 6, and 24 hours of reperfusion, as well as the levels of myeloperoxidase (MPO) , tumor necrosis factor α (TNFα) , Bcl-2, Bax, and human heat shock protein 70 (HSP70) and histopathological changes.Results At 1, 6, and 24 hours of reperfusion, there were no significant differences in total bilirubin and direct bilirubin between the two groups (both P>0.05) , and the PGE group had significantly lower levels of alanine aminotransferase, aspartate aminotransferase, MPO, and TNFα than the NS group (all P<0.05) .At 1, 6, and 24 hours of reperfusion, compared with the NS group, the PGE group had a significantly higher level of Bcl-2 and a significantly lower level of Bax (both P<0.05) .At 1 and 6 hours of reperfusion, the PGE group had significantly higher mRNA expression of HSP70 than the NS group (P<0.05) 24="" and="" at="" hours="" of="" there="" was="" no="" significant="" difference="" in="" mrna="" expression="" hsp70="" between="" the="" two="" groups="" p="">0.05) .Compared with the NS group, the PGE group had a lower degree of liver injury, which manifested as reduced hepatocyte swelling and necrosis, clear structures of the hepatic cords and the hepatic sinusoids, regular arrangement of hepatic cords, and widened hepatic sinusoids.Conclusion PGE1 protects the liver with cholestasis against ischemia-reperfusion injury by reducing neutrophil infiltration and Bax expression and upregulating the expression of HSP70 and Bcl-2.

Clinical effect of Pien Tze Huang in treatment of guinea pigs with cholecystitis induced by lithocholic acid given by gavage
Ren CaiYuan, Ren Feng, Li JunFeng, Ding Mei, Chen Yu, Duan ZhongPing, Zhang HuanHu
2017, 33(5): 905-908. DOI: 10.3969/j.issn.1001-5256.2017.05.023
Abstract:

Objective To investigate the clinical effect of traditional Chinese medicine Pien Tze Huang in the treatment of guinea pigs with cholecystitis.Methods A total of 80 guinea pigs (40 males and 40 females) were randomly divided into blank control group (10 guinea pigs treated with PBS at the same dose as that in model group) , cholecystitis model group (20 guinea pigs treated with lithocholic acid given by gavage) , Pien Tze Huang group (30 guinea pigs treated with Pien Tze Huang by gavage in addition to the treatment in the cholecystitis model group) , and ursodeoxycholic acid group (20 guinea pigs treated with ursodeoxycholic acid in addition to the treatment in the cholecystitis model group) .All groups were observed in terms of symptoms, pathological damage of the gallbladder, and liver function [the levels of alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , total bilirubin (TBil) , direct bilirubin (DBil) , indirect bilirubin (IBil) , and total bile acid (TBA) ].The two-independent-samples t test was used for comparison of continuous data between groups;a one-way analysis of variance was used for comparison between multiple groups and the least significant difference t-test was used for comparison between any two groups.P<0.05 was considered statistically significant.Results Compared with the model group, the Pien Tze Huang group had significantly better conditions with smooth hair, a good mental state, and good food consumption, and no guinea pigs died after 15 days.As was shown by ultrasound and rheography, compared with the model group, the Pien Tze Huang group had basically normal morphology of the gallbladder and significant reductions in sagittal diameter of the gallbladder (14.92±1.36 mm vs 16.51±0.65 mm, P<0.05) , transverse diameter of the gallbladder (21.25±1.61 mm vs 23.93±0.84 mm, P<0.05) , and gallbladder wall thickness (0.75± 0.049 mm vs 0.90±0.03 mm, P<0.05) .HE staining showed that Pien Tze Huang significantly improved the pathological damage of the gallbladder.Compared with the model group, the Pien Tze Huang group had significant reductions in ALT (316.50±264.50 U/L vs684.71±87.73 U/L, P<0.05) , AST (88.78±16.69 U/L vs 180.2±84.40 U/L, P<0.05) , TBil (0.18±0.10) μmol/L vs 1.43 ±0.90 μmol/L, P<0.05) , DBil (0.06±0.05 μmol/L vs 0.23±0.07 μmol/L, P<0.05) , IBil (0.12±0.06 μmol/L vs 1.20±0.55μmol/L, P<0.05) , and TBA (42.40±40.57 μmol/L vs 271.42±148.94 μmol/L, P<0.05) .Conclusion Pien Tze Huang can significantly improve the symptoms, pathological damage of the gallbladder, and liver function in guinea pigs with cholecystitis.

Expression of trophoblast cell-surface antigen 2, phosphorylated extracellular signal-regulated kinase 1/2, and cyclin D1 in gallbladder carcinoma tissue and related clinical significance
Li XinXing, Teng ShiFeng, Xu Kai, Zhang YanYan, Zhang WeiGang, Zhang XianWen, Yao Jun, Yao HouShan, Huang Xin, Hu ZhiQian
2017, 33(5): 909-914. DOI: 10.3969/j.issn.1001-5256.2017.05.024
Abstract:

Objective To investigate the expression of human trophoblast cell-surface antigen 2 (TROP2) , phosphorylated extracellular signal-regulated kinase 1/2 (p-ERK1/2) , and cyclin D1 in gallbladder carcinoma tissue and their correlation with clinicopathological parameters, as well as their association with the prognosis of patients with gallbladder carcinoma.Methods A total of 88 patients who were diagnosed with gallbladder carcinoma in Changzheng Hospital, Second Military Medical University, from June 2005 to June 2010 were enrolled, and their pathological specimens were obtained.Immunohistochemistry was used to measure the expression of TROP2, p-ERK1/2, and cyclin D1 in 88 gallbladder carcinoma tissue samples and 15 adjacent tissue samples.The chi-square test was used for comparison of categorical data between groups, and the Spearman method was used to investigate the correlation between any two parameters of TROP2, p-ERK1/2, and cyclin D1;univariate and multivariate Cox regression analyses were used to analyze the influencing factors for the prognosis of patients with gallbladder carcinoma;the Kaplan-Meier method was used to plot their survival curves.Results The positive rates of TROP2, p-ERK1/2, and cyclin D1 in gallbladder cancer tissue were 74.30%, 58.40%, and 55.30%, respectively, significantly higher than those in adjacent tissue (5.42%, 35.67% and 39.87%, respectively) (P<0.05) .The expression of TROP2, p-ERK1/2, and cyclin D1 was associated with gallstones, tumor diameter, degree of tumor differentiation, vascular and perineural invasion, lymph node metastasis, surgical procedure, and TNM stage (χ2=4.300 ~ 53.315, all P<0.05) .The expression of TROP2 was positively correlated with that of p-ERK1/2 and cyclin D1 (rs=0.402 and 0.742, both P<0.001) , and the expression of p-ERK1/2 was also positively correlated with that of cyclin D1 (rs=0.242, P=0.023) .The multivariate survival analysis showed that positive expression of TROP2 had a significant influence on 3-year survival rate (RR=2.412, 95% CI:1.186 ~ 5.126, P=0.010) .Conclusion High expression of TROP2 may be an important reason for malignant progression of gallbladder carcinoma, and highly expressed TROP2 may mediate the high expression of p-ERK1/2 and cyclin D1, resulting in the malignant progression of gallbladder carcinoma.Positive expression of TROP2 is an independent risk factor for the prognosis of patients with gallbladder carcinoma and may be an effective target for clinical intervention.

Original articles_Pancreatic diseases
Risk factors for recurrence after surgery for biliary pancreatitis
Li RenLi, Zhou Qing
2017, 33(5): 915-918. DOI: 10.3969/j.issn.1001-5256.2017.05.025
Abstract:

Objective To investigate the risk factors for recurrence after surgery for biliary pancreatitis.Methods A total of 284 patients with biliary pancreatitis who were treated in The Fourth Hospital of PLA from January 2008 to December 2014 were followed up, and the risk factors for postoperative recurrence were analyzed.The chi-square test was used for categorical data, and the unconditional logistic regression model was used for multivariate analysis.Results The follow-up period ranged from 6 to 27 months (mean 36.4 ± 8.4 months) .Of all patients, 27 experienced recurrence, and the recurrence rate was 9.51%.The univariate analysis showed that postoperative recurrence was associated with a family history of gallstone disease, high-fat diet, sand-like stones, intrahepatic bile duct stones, biliopancreatic duct opening stenosis, and diverticulum around the ampullar region (χ2=8.721, 5.979, 8.641, 15.996, 33.833, and 27.203, all P<0.05) .The multivariate logistic analysis showed that high-fat diet (OR=2.296, P=0.012) , biliopancreatic duct opening stenosis (OR=2.280, P=0.007) , and diverticulum around the ampullar region (OR=2.522, P=0.009) were independent risk factors for recurrence after surgery for biliary pancreatitis.Conclusion Biliary pancreatitis patients with high-fat diet, biliopancreatic duct opening stenosis, or diverticulum around the ampullar region tend to experience recurrence after surgery.Intervention and close follow-up should be performed for these patients to prevent recurrence.

A systematic analysis of the application of diagnostic criteria for drug-induced liver injury in China based on the literature
Zhang Dong, Zhang Tao, Wu YuNan, Sun KeWei
2017, 33(5): 919-923. DOI: 10.3969/j.issn.1001-5256.2017.05.026
Abstract:

Objective To investigate the application of diagnostic criteria for drug-induced liver injury in China.Methods CNKI, VIP, and Wanfang Data were searched for articles published from 1990 to 2015, and the diagnostic criteria in the articles were recorded to investigate the current application of diagnostic criteria for drug-induced liver injury.Results A total of 609 articles were included, with 410 articles of case studies and 199 case reports.A total of 15 types of diagnostic criteria were used in China, and only 13.4% of these articles used the causality assessment method recommended by the international community.In 46% of the cases reported in the articles, a diagnosis was made based on clinical symptoms and exclusion of common causes of liver injury.Conclusion There are many diagnostic criteria for drug-induced liver injury in China, and the diagnosis is subjective and lacks rigor.

Clinical features of different types of drug-induced liver injury and their association with liver histological changes
Xu CengLi, Gao Min, Guo ChunXia, Xing MinDan, Li Jia
2017, 33(5): 924-927. DOI: 10.3969/j.issn.1001-5256.2017.05.027
Abstract:

Objective To investigate the clinical features of patients with different clinical types of drug-induced liver injury (DILI) , as well as the association between clinical type and pathological type.Methods A total of 289 patients with DILI who were admitted to Tianjin Second People's Hospital from January 2014 to January 2016 were enrolled, and according to the“R value”calculated based on biochemical parameters, they were divided into hepatocellular injury type group, cholestasis type group, and mixed type group.Medications and biochemical parameters were summarized and the liver histological changes in patients undergoing biopsy were observed to investigate the consistency between pathological type and clinical type.The non-parametric Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and a one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups.The chi-square test was used for comparison of categorical data between groups.Results According to the calculated“R value”, of all patients, 181 (62.63%) had hepatocellular injury type, 55 (19.03%) had cholestasis type, and 53 (18.34%) had mixed type.Most of the drugs that caused liver injury were traditional Chinese medicine (48.79%) .A total of 152 patients underwent biopsy, and according to the histological changes, 43 (28.29%) had hepatocellular injury type, 8 (5.26%) had cholestasis type, and 101 (66.45%) had mixed type;among these patients, the calculation of the “R value”showed that 95 (62.50%) had hepatocellular injury type, 29 (19.08%) had cholestasis type, and 28 (18.42%) had mixed type.There was a poor consistency between pathological type and clinical type (κ=0.229, P<0.05) .Conclusion Traditional Chinese medicine is the main cause of DILI.There is a poor consistency between clinical type and pathological type of DILI, and the most common pathological type is mixed type.Therefore, the criteria for clinical typing await further improvement.

Clinical effect of linagliptin combined with insulin aspart 50 in treatment of hepatogenous diabetes
Yang Shuo, Jiang XiaoDi
2017, 33(5): 928-931. DOI: 10.3969/j.issn.1001-5256.2017.05.028
Abstract:

Objective To investigate the clinical effect and safety of linagliptin combined with insulin aspart 50 in the treatment of hepatogenous diabetes (HD) .Methods A total of 57 patients with HD who visited The People's Hospital of Liaoning Province from October 2014 to February 2016 were enrolled and randomly divided into insulin aspart 50 group (group A, 28 patients) and linagliptin combined with insulin aspart 50 group (group B, 29 patients) .The two groups were compared in terms of blood glucose, insulin, C-peptide, glucose disposition index (DI) , glycosylated hemoglobin A1c (Hb A1c) , glucagon, and daily insulin dose at baseline and after 12 weeks of treatment.The adverse events including hypoglycemia were observed.The paired t-test was used for comparison of continuous data within one group, and the independent-samples t test was used for comparison of continuous data between groups;the chi-square test was used for comparison of categorical data between groups.Results After 12 weeks of treatment, both groups had significant reductions in blood glucose at four time points (t=5.357-21.380, all P<0.05) and significant increases in the insulin level at 30, 60, and 120 minutes (t=2.222-6.491, all P<0.05) .Compared with group A, group B had significantly lower levels of Hb A1 c and glucagon, daily insulin dose, and blood glucose and insulin levels at 30, 60, and 120 minutes (t=3.136-15.096, all P<0.05) , as well as significantly higher DI and levels of C-peptide at four time points (t=2.994-10.813, all P<0.05) .Group A had a significantly higher incidence rate of hypoglycemia than group B (28.6% vs 3.4%, χ2=5.005, P<0.05) .Conclusion Linagliptin combined with insulin aspart 50 can effectively control blood glucose in patients with HD and has good safety.

Effect of Huatan Qushi Huoxue prescription on the ADPN/AMPK/ACC signaling pathway in rats with nonalcoholic steatohepatitis
Zhao WenXia, Yan Le, Shao MingYi, Zhang LiHui
2017, 33(5): 932-936. DOI: 10.3969/j.issn.1001-5256.2017.05.029
Abstract:

Objective To investigate the effect of Huatan Qushi Huoxue prescription on the adiponectin (ADPN) /adenosine monophosphate-activated protein kinase (AMPK) /acetyl-Co A carboxylase (ACC) signaling pathway in rats with nonalcoholic steatohepatitis (NASH) .Methods A total of 72 male Sprague-Dawley rats were randomly divided into blank group, model group, control group, and high-, middle-, and low-dose Huatan Qushi Huoxue prescription groups.All rats except those in the blank group were given high-fat diet combined with intraperitoneal injection of tetracycline to establish a rat model of NASH.At week 2 after model establishment, the Huatan Qushi Huoxue prescription groups were treated with high-, middle-, and low-dose Huatan Qushi Huoxue prescription, and polyene phosphatidylcholine (Yishanfu) capsules were given as control.At the end of the experiment, the content of free fatty acid (FFA) in liver homogenate was measured, and ELISA and RT-q PCR were used to measure the protein and mRNA expression of ADPN, adiponectin receptor-2 (AdipoR2) , AMPK, ACC, and carnitine palmitoyltransferase-1 (CPT-1) in liver tissue.An analysis of variance was used for comparison of data between multiple groups;the least significant difference t-test was used for comparison of data with homogeneity of variance between two groups, and the Dunnett's T3 method was used for comparison of data with heterogeneity of variance.Results Compared with the control group, the high-dose group had significant reductions in FFA level in liver homogenate (229.07±46.62 μmol/gprot vs 382.75 ±30.93 μmol/gprot, P<0.01) and mRNA and protein expression of ACC in liver tissue (mRNA:1.66±0.04 vs 2.40±0.37, P<0.01;protein:512.20±60.70 pg/g vs 756.72±61.21 pg/g, P<0.01) , as well as significant increases in the mRNA and protein expression of ADPN (mRNA:1.53±0.31 vs 0.75±0.11, P<0.01;protein:22.23±2.75 μg/g vs 14.01±2.17 μg/g, P<0.01) , AdipoR2 (mRNA:1.38±0.33 vs 0.61±0.09, P<0.01;protein:128.41±10.46 ng/g vs 94.62±6.88 ng/g, P<0.01) , AMPK (mRNA:1.43±0.39 vs 0.78±0.04, P<0.01;protein:1353.79±59.52 μg/g vs 1107.19±56.78 μg/g, P<0.01) , and CPT-1 (mRNA:1.39±0.31 vs 0.52±0.04, P<0.01;protein:175.54±9.91 U/g vs 128.74±12.74 U/g, P<0.01) .Conclusion Huatan Qushi Huoxue prescription can effectively activate the ADPN/AMPK/ACC signaling pathway, which may affect the β oxidation and synthesis of fatty acids and reduce fat deposition in hepatocytes.

Case reports
Misdiagnosis of peritoneal pseudomyxoma as cirrhotic ascites: a report of 2 cases 
Shen XiaoXu, Wu YaYun
2017, 33(5): 937-939. DOI: 10.3969/j.issn.1001-5256.2017.05.030
Abstract(2296) PDF (1557KB)(1091)
Abstract:
Hereditary hemorrhagic telangiectasia with liver cirrhosis: a case report
Fu QiLin, Huang Fu, Tang YingHui, Yu Yue, Li FenPing
2017, 33(5): 940-942. DOI: 10.3969/j.issn.1001-5256.2017.05.031
Abstract:
Liver transplantation for liver failure caused by alcoholic cirrhosis complicated by portal ductopathy: a case report 
Wang Yao, Sun Ying, Xu XiJing, Sun XiaoDong, Lu: GuoYue, Wen XiaoYu, Jin QingLong
2017, 33(5): 943-945. DOI: 10.3969/j.issn.1001-5256.2017.05.032
Abstract:
Caroli disease with nephronophthisis: a case report and literature review
Ou YangYuQing, Lu HaiYing, Xu XiaoYuan
2017, 33(5): 946-948. DOI: 10.3969/j.issn.1001-5256.2017.05.033
Abstract:
Reviews
Research advances in immune tolerance in chronic hepatitis B virus infection
Wu FengPing, Dang ShuangSuo
2017, 33(5): 949-953. DOI: 10.3969/j.issn.1001-5256.2017.05.034
Abstract:

Immune tolerance refers to the specific non-response or negative response of T and B lymphocytes to antigens.According to the period of formation, immune tolerance can be classified into central tolerance and peripheral tolerance.Immune tolerance to hepatitis B virus (HBV) after HBV infection is considered a major cause of chronic HBV infection.This article briefly reviews the roles of HBe Ag, functional defects of dendritic cells, low response of cytotoxic T lymphocytes, T helper cells and cytokines, variations of HBV genotype and genome, and host gene polymorphisms in the development of immune tolerance in chronic HBV infection, as well as related research advances.

Research advances in signaling pathways involved in the development of hepatic fibrosis
Peng Qin, Zhao ShenJun, Li Wu
2017, 33(5): 954-958. DOI: 10.3969/j.issn.1001-5256.2017.05.035
Abstract:
Liver fibrosis is a pathological process for the liver to repair various chronic liver injuries and may eventually progress to liver cirrhosis, liver failure, or even liver cancer.Therefore, early intervention and treatment of liver fibrosis is of particular importance.This article summarizes the latest research advances in the roles of TGF-β/Smad signaling pathway, Notch signaling pathway, Wnt signaling pathway, Hedgehog signaling pathway, and integrin signaling pathway in the pathogenesis of liver fibrosis and points out that these signaling pathways play an extremely important role in the development and progression of liver fibrosis and may provide new directions for the treatment of liver fibrosis
Evaluation of stent function after transjugular intrahepatic portosystemic shunt using color Doppler and contrast-enhanced ultrasound
Lu ChunYu, Tang ShaoShan
2017, 33(5): 959-962. DOI: 10.3969/j.issn.1001-5256.2017.05.036
Abstract:
At present, transjugular intrahepatic portosystemic shunt (TIPS) is an effective procedure widely used in the clinical treatment of portal hypertension.The blood stream in the portal vein can be directly shunted into the hepatic vein through the inserted stent, which helps to reduce portal vein pressure.TIPS provides treatment opportunities for the patients with advanced portal hypertension complicated by intractable ascites and gastroesophageal variceal bleeding and those who are waiting for transplantation or cannot tolerate surgery.The key to success of TIPS is to maintain stent patency after placement, and therefore, post-TIPS monitoring is of vital importance.As a noninvasive, cheap, practical, and repeatable procedure, ultrasound has an important value in post-TIPS monitoring.This article summarizes the role of color Doppler and contrast-enhanced ultrasound in evaluating stent function after TIPS.
Significance of serological markers in diagnosis of nonalcoholic fatty liver disease
Wan Yan, Chang JianBo, Bai YanXia, Li QianNan, Dai GuangRong
2017, 33(5): 963-968. DOI: 10.3969/j.issn.1001-5256.2017.05.037
Abstract:
In recent years, the incidence rate of fatty liver tends to increase markedly, and liver biopsy is the gold standard for the diagnosis of fatty liver, but it has some inevitable shortcomings.At present, there lacks a convenient, cheap, and accurate noninvasive diagnostic method for clinical practice.This article reviews the significance of various serological markers in the diagnosis of nonalcoholic fatty liver disease (NAFLD) and points out that liver enzyme, aspartate aminotransferase/alanine aminotransferase ratio, serum ferritin, serum selenium, uric acid, high fasting insulin level, retinol-binding protein-4, cytokeratin-18, PNPLA3 gene, and TM6SF2 gene have great significance in the diagnosis of NAFLD.There are still controversies over the value of interleukin-28 B in the diagnosis of NAFLD, and more clinical trials are needed.We believe that in the near future, a combination of various serum markers may become an accurate noninvasive method for the diagnosis of NAFLD and the assessment of the degree of liver fatty degeneration and fibrosis.
Complications of radiofrequency ablation for liver cancer in high-risk locations and their prevention
Zhang JunChao, Lin Su, Zhu YueYong
2017, 33(5): 969-973. DOI: 10.3969/j.issn.1001-5256.2017.05.038
Abstract:
Radiofrequency ablation (RFA) is one of the most important methods for the treatment of liver cancer and has the advantages of small trauma, simple operation, and repeatability.However, for tumors in high-risk locations within 5 mm of the first and second branches of the hepatic portal vein, near the hepatic vein, the inferior vena cava, or the gallbladder, within 5 mm of the intestinal tract, under the Glisson's capsule, and in the diaphragm, RFA has the issues of a low complete ablation rate, a high local recurrence rate, and serious complications.This article introduces the complications of RFA for liver cancer in high-risk locations and their prevention and points out that with the promotion of individualized and standardized RFA, liver cancer in these high-risk locations is no longer a contradiction for RFA.
Current research status of precancerous dysplastic nodules in hepatocellular carcinoma
Jiao JunZhe, Li JingTao, Yan ShuGuang, Wei HaiLiang, Ju Di, Song YiJun, Chang ZhanJie
2017, 33(5): 974-978. DOI: 10.3969/j.issn.1001-5256.2017.05.039
Abstract:

Dysplastic nodule (DN) is an important stage for precancerous hepatocellular carcinoma (HCC) lesions progressing to HCC and has a very high risk of canceration.According to the difference in atypia, DN is classified into low-grade DN (LGDN) and high-grade DN (HGDN) .This article summarizes the pathological features, radiological features, and biomarkers of LGDN and HGDN, briefly describes the risk of the canceration of DN into HCC, and points out that it is necessary to enhance the knowledge of DN, the precancerous HCC lesions, in clinical physicians.DN screening to identify nodules with a high risk of canceration and related intervention help to prevent the development of HCC.

Research advances in the identification of clinical biomarkers for liver diseases using metabolomics based on ultra-performance liquid chromatography-mass spectrometry
Zhou Xuan, Lai Yong
2017, 33(5): 979-984. DOI: 10.3969/j.issn.1001-5256.2017.05.040
Abstract:

The biomarkers currently known for the early diagnosis of liver diseases often have poor sensitivities and specificities, and thus it is very important to find new biomarkers with high sensitivities and specificities for the early diagnosis of liver diseases.The emerging metabolomics technology has been widely used and may help to achieve this goal.This article reviews the research advances in the role of metabolomics based on ultra-performance liquid chromatography-mass spectrometry in the identification of biomarkers for liver diseases and emphasizes its significance in the early diagnosis, treatment, and prognosis evaluation of liver diseases.

Application of statins in prevention and treatment of liver diseases
Liu Lu, Han Tao, Zhou LengXiao
2017, 33(5): 985-989. DOI: 10.3969/j.issn.1001-5256.2017.05.041
Abstract:

Statins are widely used as important lipid-lowering drugs, and studies have proven the safety of statins in patients with liver diseases.In recent years, there have been more and more studies on the effects of statins in the prevention and treatment of hepatitis C, fatty liver disease, liver cirrhosis, and hepatocellular carcinoma.Studies have shown that besides the lipid-lowering effect, statins also have various other effects, including anti-inflammatory effect, immune regulation, anti-proliferation, and antioxidant effect, and they can also improve vascular endothelial function and inhibit platelet aggregation.Their roles in the prevention and treatment of liver diseases await further research.

Diagnosis and treatment of hepatic alveolar echinococcosis
Fang Dan, Chen ZheYu
2017, 33(5): 990-993. DOI: 10.3969/j.issn.1001-5256.2017.05.042
Abstract:

Alveolar echinococcus can be found in various organs of the body, with the liver as the most common organ.This article briefly elaborates on the diagnosis and treatment of hepatic alveolar echinococcosis.The diagnosis of this disease includes epidemic areas, serology, ultrasound, imaging examination, and pathological diagnosis, and its treatment includes radical hepatectomy, palliative hepatectomy, liver transplantation, high-intensity focused ultrasound, radiofrequency ablation, ultrasound-or CT-guided percutaneous biliary drainage, and pharmacotherapy.Regular screening, early diagnosis, and a combination of prevention and treatment should be performed for the high-risk population in epidemic areas to improve prognosis and prolong survival time.

Research advances in adult hepatic progenitor cells
Li Fei, Ma ZhenZeng, Lu LunGen
2017, 33(5): 994-997. DOI: 10.3969/j.issn.1001-5256.2017.05.043
Abstract:

The liver has a strong regenerative capacity, and in case of acute injury, the proliferation of mature hepatocytes helps to complete liver regeneration.However, in case of chronic injury, the proliferative capacity of mature hepatocytes is damaged or exhausted, and the activation, proliferation, and differentiation of hepatic progenitor cells are involved in liver regeneration.This article summarizes the characteristics and origins of hepatic progenitor cells, their role in tissue repair after liver injury and development of liver cancer, and potentials and problems of cell transplantation in the treatment of liver diseases.It is pointed out that an understanding of the biological characteristics of hepatic progenitor cells, their role in liver injury and liver cancer, and related pathogenesis helps with the treatment of liver diseases.

Novel therapeutic targets for primary biliary cholangitis
Chen RongBin, Wu XueMing, Wu Ying, Yao DingKang
2017, 33(5): 998-1002. DOI: 10.3969/j.issn.1001-5256.2017.05.044
Abstract:
Primary biliary cholangitis (PBC) is a chronic autoimmune-mediated liver disease manifesting as progressive cholestasis and non-purulent inflammation in small-and medium-sized intrahepatic bile ducts.It finally progresses to liver cirrhosis and liver cancer and greatly threatens patient's life.Studies have found that ursodeoxycholic acid (UDCA) can treat PBC effectively.There is a constant increase in the proportion of patients with poor response to UDCA who have undergone transplantation or died, and therefore, new therapeutic regimens should be developed as soon as possible.It is necessary to develop new drugs which act on the key processes of disease progression, such as the "upstream" immune response, the "midstream" bile duct injury, and the "downstream" fibrotic process.Combination treatment with drugs targeting different pathways is a trend for future development.This article summarizes current potential therapeutic regimens for PBC and assesses the challenges in the treatment of PBC.