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

2017 No. 8

Display Method:
Editorial
Establishment of a clinical research collaborative network for clinical cure of hepatitis B and prevention of mother-to-child transmission
Yin XueRu, Hou JinLin
2017, 33(8): 1409-1414. DOI: 10.3969/j.issn.1001-5256.2017.08.001
Abstract:
Chronic hepatitis B virus infection is a great threat to public health around the world. National, Asian-Pacific, or global clinical research collaborative network plays an important role in exploring new therapeutic strategies and biological markers and preventing mother-to-child transmission of hepatitis B. We believe that such network may help to realize a future without hepatitis B.
Challenges and strategies of antiviral therapy for chronic hepatitis B-how to achieve the maximization of clinical cure?
Wang WeiJing, Xie Qing
2017, 33(8): 1415-1418. DOI: 10.3969/j.issn.1001-5256.2017.08.002
Abstract:
Hepatitis B virus infection is still a major public health issue in the world, and antiviral therapy is the key therapeutic regimen to delay disease progression and improve outcome in patients with chronic hepatitis B ( CHB) . Various international guidelines recommend nucleos ( t) ide analogues ( NAs) and long-acting interferon as the first-line antiviral therapy. However, long-term administration of NAs has the disadvantages of long course of treatment, low HBeAg seroconversion rate, extremely low HBsAg clearance or seroconversion rate, low safety, and drug resistance. Therefore, it is an important issue to increase the seroconversion rates of HBeAg and HBsAg in treatment-experienced patients and realize clinical cure in the treatment of CHB. In recent years, many global randomized clinical trials including OSST, Switch, and ARES have shown that a combination of NAs and PEG-IFN or sequential therapy with NAs and PEG-IFN can increase the seroconversion rates of HBeAg and HBsAg in CHB patients and realize clinical cure, which provides a new direction for NAs in the treatment of CHB patients.
Therapeutic guidelines
Diagnosis, management, and treatment of hepatocellular carcinoma (V2017)
National Health and Family Planning Commission of the People’s Republic of China;
2017, 33(8): 1419-1431. DOI: 10.3969/j.issn.1001-5256.2017.08.003
Abstract(5724) PDF (2567KB)(3691)
Abstract:
Recommendations of the Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update
Han Bing, Qi XingShun, Jia JiDong
2017, 33(8): 1432-1434. DOI: 10.3969/j.issn.1001-5256.2017.08.004
Abstract:
An excerpt of international therapeutic guidelines for patients with HCV-related extrahepatic disorders: a multidisciplinary expert statement (2017)
Zhou Yun, Zheng XuYang, Jia ZhanSheng
2017, 33(8): 1435-1439. DOI: 10.3969/j.issn.1001-5256.2017.08.005
Abstract:
An excerpt of BSG guidelines on the management of common bile duct stones (2017)
Yan Wei, Zheng LiLing, Yu Hong, Cao JianBiao
2017, 33(8): 1440-1447. DOI: 10.3969/j.issn.1001-5256.2017.08.006
Abstract:
An excerpt of Asia-Pacific consensus guidelines for endoscopic management of benign biliary strictures (2017)
Zheng Xiao, Sun BoYi, Hu Bing
2017, 33(8): 1448-1453. DOI: 10.3969/j.issn.1001-5256.2017.08.007
Abstract:
Discussions by experts
Long-term follow-up cohort of hepatitis B in China: current status and perspectives
Hu XiaoYun, Sun Jian
2017, 33(8): 1454-1457. DOI: 10.3969/j.issn.1001-5256.2017.08.008
Abstract:
Hepatitis B virus ( HBV) infection is a global public health issue, especially in the Asian-Pacific region. At present, entecavir, tenofovir, and pegylated interferon are the first-line antiviral drugs recommended by related guidelines for the prevention and treatment of hepatitis B; however, different national/regional policies, economic level, coverage of health insurance, and medical level have caused the difference in antiviral regimens. Therefore, we have established a long-term follow-up cohort of hepatitis B to evaluate the efficacy of different treatment regimens, in order to improve the cure rate of hepatitis B and reduce the incidence rates of liver cirrhosis, liver cancer, and end-stage liver disease. Real-world data from cohort study help to understand the differences between guidelines and clinical practice, provide a reference for HBV guidelines, and balance clinical effect and cost-effectiveness.
Establishment and application of in vitro and in vivo models of hepatitis B virus infection
Wang BaoJu, Zhu Bin, Guo WeiNa, Yang DongLiang
2017, 33(8): 1458-1464. DOI: 10.3969/j.issn.1001-5256.2017.08.009
Abstract:
Hepatitis B is still an important infectious disease which threatens human health, and current antiviral therapy, including interferon and nucleos ( t) ide analogues, cannot cure chronic hepatitis B. Therefore, it is urgent to explore the detail mechanisms of HBV replication and pathogenesis, identify new therapeutic targets, and develop new drugs or treatment regimens, which relies on the development of suitable models for HBV infection and replication. Species restriction and tissue tropism of HBV have limited the development of models for HBV infection and replication. With the support by National Science and Technology Major Project for Infectious Diseases, the researchers in China have developed a series of cellular and animal models for HBV. This article reviews these models with reference to recent research advances in China and foreign countries.
Association of exosomes with viral infection and hepatitis B virus-related liver diseases
Jia XiaoFang, Chu QiaoFang, Yuan ZhengHong
2017, 33(8): 1465-1470. DOI: 10.3969/j.issn.1001-5256.2017.08.010
Abstract:
Hepatitis B virus ( HBV) infection causes pathological changes of the liver, including liver inflammation, hepatocyte necrosis, and even liver fibrosis, and promotes the progression from chronic hepatitis to liver cirrhosis and liver cancer, but related mechanisms remain unclear. The mechanism for the interaction between hepatocytes infected by HBV and uninfected hepatocytes/host immune system might be exosomes-mediated cell-cell communication in liver microenvironment. Many studies have demonstrated that viral infection can regulate the production of exosomes and affect their composition, and viral microRNAs, proteins, and even the entire virion can be incorporated into the exosomes, which can affect the immune recognition of viruses or regulate the function of adjacent cells. This article elaborates on the production and composition of exosomes and their roles in viral infection, as well as the research advances in the association between exosomes and HBV infection.
Original articles_Viral hepatitis
Clinical effect of telbivudine in treatment of pregnant women with hepatitis B virus infection and a low-level increase in alanine aminotransferase
Zhu YunXia, Wang Ming, Chen Yu, Bian Qian, Zou HuaiBin, Zhuo XiuPing, Meng Jun, Zhang ShiBin
2017, 33(8): 1471-1474. DOI: 10.3969/j.issn.1001-5256.2017.08.011
Abstract:
Objective To investigate the clinical effect of antiviral therapy with telbivudine antiviral therapy in parturients with hepatitis B virus ( HBV) infection and a special immune status in pregnancy. Methods A retrospective analysis was performed for the clinical data of67 HBsAg-positive chronic hepatitis B ( CHB) patients with HBV DNA > 106IU/ml who were examined and gave birth in Beijing You An Hospital, Capital Medical University, from January 2014 to October 2015. According to the level of alanine aminotransferase ( ALT) , the patients were divided into ALT < 2 × upper limit of normal ( ULN) group ( 29 patients, group A) , ALT ≥2 × ULN group with antiviral therapy ( 20 patients, group B) , and low-level ALT increase group without antiviral therapy ( 18 patients, group C) . The patients in groups A and B were given antiviral therapy with telbivudine after 12 weeks of pregnancy. The three groups were observed in terms of the levels of HBV markers HBsAg and HBeAg, liver biochemical parameters, adverse drug reactions, and neonatal birth defects. An analysis of variance was used for comparison of continuous data between multiple groups, the chi-square test was used for comparison of categorical data between multiple groups, and the Fisher's exact test was used when the data did not meet the conditions for the chi-square test. Results There were no significant differences between the three groups in normalization rate of liver function and the change in HBsAg level at the time of delivery ( both P > 0. 05) . The proportions of patients who achieved a ≥3 log reduction in HBV DNA level at the time of delivery were 44. 8%, 85. 0%, and 16. 7%, respectively, in the three groups, and the proportions of patients who achieved a ≥50% reduction in HBeAg were 41. 4%, 70. 0%, and 11. 1%, respectively; there were significant differences between the three groups for the two indices ( χ2=19. 85 and 14. 74, both P < 0. 001) . Conclusion The right timing of antiviral therapy for pregnant women with a low-level increase in ALT can effectively reduce the risk of mother-to-child transmission.
Value of HBsAg level in dynamic monitoring of disease progression in patients with chronic HBV infection
Bao Teng, Hu QingGang, Ye Jun, Tao Ben, Gao YuFeng
2017, 33(8): 1475-1478. DOI: 10.3969/j.issn.1001-5256.2017.08.012
Abstract:
Objective To investigate the clinical value of HBsAg level in dynamic monitoring of disease progression in patients with chronic HBV infection. Methods A retrospective analysis was performed for the clinical data of 1107 patients with different clinical stages of chronic HBV infection who had not received antiviral therapy at the time of hospitalization in The Second Affiliated Hospital of Anhui Medical University from May 2011 to December 2015, and according to the disease status, they were divided into HBeAg-positive chronic hepatitis B ( CHB) group ( n = 356) , HBeAg-negative CHB group ( n = 264) , compensated liver cirrhosis group ( LC-C group, n = 116) , decompensated liver cirrhosis group ( LC-D group, n = 201) , and primary liver cancer ( PLC) group ( n = 170) . These groups were compared in terms of HBsAg expression and the association between HBsAg and clinical features. An analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between any two groups; the t-test was used for comparison of continuous data between two groups. The chi-square test was used for comparison of categorical data between these groups. Pearson correlation analysis was also performed. Results There were significant differences in serum HBsAg and HBV DNA level between the HBeAg-positive CHB group, HBeAg-negative CHB group, LC-C group, LC-D group, and PLC group ( F =100. 45 and 86. 26, both P < 0. 001) . The HBeAg-positive CHB group ( n = 502) had significantly higher levels of HBsAg and HBV DNA than the HBeAg-negative CHB group ( n = 605) ( t = 16. 67 and 16. 22, both P < 0. 001) . There were significant differences in HBsAg and HBV DNA levels between the HBeAg-positive CHB group, LC-C group, LC-D group, and PLC group ( F = 42. 92 and 27. 38, both P <0. 001) , as well as between the HBeAg-negative CHB group, LC-C group, LC-D group, and PLC group ( F = 6. 04 and 4. 10, both P <0. 05) . HBV DNA level was significantly different across patients with different HBsAg levels ( < 1000 IU/ml, 1000-20 000 IU/ml, and> 20 000 IU/ml) ( F = 189. 51, P < 0. 001) . In the HBeAg-positive CHB group, HBeAg-negative CHB group, LC-C group, and LC-D group, serum HBsAg level was positively correlated with HBV DNA level ( r = 0. 554, 0. 501, 0. 320, and 0. 432, all P < 0. 001) .Conclusion HBsAg level gradually decreases with disease progression and is closely associated with HBV DNA level. Dynamic monitoring of HBsAg level helps to evaluate disease progression after HBV infection.
Liver biopsy results of chronic HBV carriers aged above 40 years: an analysis of 442 cases
Sun HaiYing, Wang YaJun, Wang Ming, Zhang ShuQin, Lyu ShengJun, Chen Hui
2017, 33(8): 1479-1482. DOI: 10.3969/j.issn.1001-5256.2017.08.013
Abstract:

Objective To observe the histological changes of the liver in chronic HBV carriers aged above 40 years. Methods A total of442 chronic HBV carriers aged above 40 years who underwent liver biopsy in Hepatology Hospital of Jilin Province from August 2012 to August 2015 were enrolled. Liver tissue samples were collected from all patients using ultrasound-guided rapid puncture, and the proportion of patients with grade ≥G2S2 liver fibrosis or liver cirrhosis was calculated. The association of medical history of HBV infection, liver function, body mass index ( BMI) and Fibro Scan with histological changes of the liver was analyzed. The t-test was used for comparison of continuous data between groups, relative risk ( RR) was used to analyze risk factors, and a Kappa analysis was used for consistency test. Results Of all 442 chronic HBV carriers aged ≥40 years, 56. 56% had grade ≥G2S2 liver fibrosis and 20. 14% had liver cirrhosis. The length of the medical history of HBV infection and BMI were correlated with the degree of liver fibrosis, and medical history > 10 years ( OR= 64. 06, 95% CI: 33. 72-121. 69, P < 0. 001) and BMI ≥24 ( OR = 6. 93, 95% CI: 4. 64-10. 35, P < 0. 001) were risk factors for liver fibrosis and cirrhosis. There were significant differences between grade < G2S2 liver fibrosis patients and grade ≥G2S2 liver fibrosis patients in the levels of alanine aminotransferase, aspartate aminotransferase, adenosine deaminase, gamma-glutamyl transpeptidase, alkaline phosphatase, and prealbumin ( t = 40. 00, 2. 16, 25. 35, 47. 73, 12. 62, and 13. 38, all P < 0. 05) . The consistency analysis of Fibro Scan and liver biopsy in the diagnosis of liver cirrhosis showed a Kappa value of 0. 76, suggesting that there was a good diagnostic consistency between these two methods. Conclusion Monitoring and management of chronic HBV carriers aged above 40 years should be taken seriously in clinical practice, and liver biopsy should be performed as soon as possible for those with ALT > 30 U/L and marked liver fibrosis suggested by Fibro Scan.

Original articles_Liver fibrosis and liver cirrhosis
Value of aspartate aminotransferase-to-platelet ratio index in diagnosis and prediction of liver fibrosis degree in patients with chronic hepatitis B
Wu FangXiong, Gao BaoHua, Niu ChunYan, Sun Juan, Wang Wen, Zhu Lin, Luo JianMei, Zheng JianYun
2017, 33(8): 1483-1486. DOI: 10.3969/j.issn.1001-5256.2017.08.014
Abstract:
Objective To investigate the value of aspartate aminotransferase-to-platelet ratio index ( APRI) in the diagnosis and prediction of liver fibrosis degree in patients with chronic hepatitis B ( CHB) . Methods A total of 69 treatment-na6 ve CHB patients who were diagnosed in The First Affiliated Hospital of Xi'an Medical University from January 2014 to December 2016 were enrolled, and among these patients, 37 had positive HBeAg and 32 had negative HBeAg. Liver biopsy was performed, and a histopathological method was used to evaluate liver inflammation and fibrosis degree. APRI was calculated, the receiver operating characteristic ( ROC) curve was plotted, and the correlation between APRI and liver fibrosis degree was analyzed. The independent samples t-test was used for normally distributed continuous data between two groups, the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. The chi-square test was used for comparison of categorical data between groups. Results The HBeAg-negative group had a significantly higher APRI than the HBeAg-positive group[0. 890 ( 0. 370-3. 000) vs 0. 520 ( 0. 355-0. 652) , Z =-2. 024, P = 0. 025], and there was a significant difference in APRI between patients with different liver fibrosis degrees ( χ2= 10. 004, P = 0. 040) . The cut-off value of APRI for predicting severe liver fibrosis ( ≥F2) was 1. 06, and the area under the ROC curve was 0. 673 ( 95% CI: 0. 426-0. 920) . Conclusion APRI has a good value in the diagnosis and prediction of liver fibrosis degree and stage in patients with CHB.
Value of fibrosis-4 index in diagnosis of liver fibrosis in autoimmune hepatitis
Zhou GuiQin, Zhong QiHua, Wang RongBing, Dong XiaoDong, Li Bin, Yang Li, Wang XianBo
2017, 33(8): 1487-1491. DOI: 10.3969/j.issn.1001-5256.2017.08.015
Abstract:
Objective To investigate the value of the noninvasive diagnostic model of liver fibrosis fibrosis-4 ( FIB-4) index in the diagnosis of liver fibrosis in autoimmune hepatitis ( AIH) through an analysis of the clinical data of AIH patients. Methods A retrospective analysis was performed for the clinical data of 71 AIH patients who were hospitalized in Beijing Ditan Hospital, Capital Medical University from January 2010 to December 2015 and underwent liver biopsy, including age, alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , and platelet count ( PLT) . FIB-4 index was calculated and its correlation with pathological staging of liver fibrosis was analyzed, as well as the specificity and sensitivity of FIB-4 index in the diagnosis of liver fibrosis in AIH patients. The Kruskal-Wallis H test was used for comparison of continuous data between groups. Spearman correlation analysis was also performed. The receiver operating characteristic ( ROC) curve was plotted and the area under the ROC curve ( AUC) was analyzed. Results There was a significant difference in FIB-4 index between patients with different stages of liver fibrosis ( χ2= 10. 134, P = 0. 038) , but there were no significant differences in age, ALT, AST, and PLT between these patients ( all P > 0. 05) . FIB-4 index was positively correlated with fibrosis degree and increased with the increase in fibrosis degree ( rs= 0. 338, P = 0. 004) , while PLT was negatively correlated with fibrosis degree ( rs=-0. 305, P =0. 010) . In the diagnosis of S≥1, S≥2, and S≥3 liver fibrosis in AIH, FIB-4 index had AUCs of 0. 603 ( P = 0. 408) , 0. 698 ( P =0. 004) , and 0. 704 ( P = 0. 049) , respectively. FIB-4 had relatively low sensitivity and specificity for the diagnosis of S≥1 liver cirrhosis, but had a relatively high sensitivy for the diagnosis of S≥2 liver cirrhosis ( 77. 4%) and S≥3 liver fibrosis ( 88. 9%) . Conclusion FIB-4 index does not have a significant value in evaluating liver fibrosis in patients without liver fibrosis or with mild liver fibrosis, while it has a high value in the diagnosis of marked ( S≥2) and severe ( S≥3) liver fibrosis. It has better results in the diagnosis of severe liver fibrosis than marked liver fibrosis.
Original articles_Liver neoplasms
CT diagnosis and differentiation of nodular/mass-type hepatic lymphoma
Du XiaoFeng, Ma ZhouPeng, Lin GuanSheng, He Hui, Tang YaRong, Wu JianMing
2017, 33(8): 1492-1496. DOI: 10.3969/j.issn.1001-5256.2017.08.016
Abstract:
Objective To investigate the CT findings of nodular/mass-type hepatic lymphoma, and to improve its diagnostic level. Methods A retrospective analysis was performed for the CT findings of 6 patients with nodular/mass-type hepatic lymphoma confirmed by pathology or clinical treatment who were diagnosed and treated in Integrated Traditional Chinese and Western Medical Hospital of Jinshan District and Cixi Hospital Affiliated to Wenzhou Medical University from December 2008 to April 2016. The CT findings were closely observed in terms of tumor location, number, morphology, size, boundary, and features of density, features of dynamic enhancement, changes in internal and surrounding structures, and the presence or absence of dropsy and lymph node enlargement in the body surface, the abdominal cavity, or the retroperitoneal part. Results Of all patients, 2 had primary lymphoma manifesting as a solitary nodule in the liver and 4 had secondary lymphoma, among whom 1 had a solitary nodule and 3 had multiple nodules and masses with different sizes. There were 15 lesions in total, and the maximum diameter ranged from 17 to 108 mm. Five lesions had clear boundaries and 1 had obscure boundary. CT scan showed that 4 patients had homogeneous low-density lesions ( mean CT value = 29. 8-41. 4 Hu) , and 2 had inhomogeneous low-density lesions, with low density in the peripheral region ( mean CT value = 26. 7-39. 6 Hu) and patchy low-density areas in the central region ( mean CT value = 16. 5-27. 8 Hu) . Contrast-enhanced CT scan in arterial phase and portal venous phase showed that all 6 patients had mild-to-moderate continuous enhancement, which was weaker than normal liver tissues, with relatively obvious enhancement in portal venous phase ( mean CT value = 45. 6-63. 9 Hu) . There was a reduction in enhancement in delay phase with low density. Of all patients, 4had homogeneous enhancement, and 2 had inhomogeneous-density lesions on plain CT scan, with peripheral enhancement and patchy non-enhanced areas in the central region. Five patients had“vessel floating sign”inside the tumor. Calcification was not seen in any patient.Of all patients, 2 had slight local broadening of the upstream bile duct, 4 had superficial and abdominal cavity/retroperitoneal lymph node enlargement, and 1 had secondary lymphoma with spleen invasion. Conclusion Although nodular/mass-type hepatic lymphoma is rare, it has its own features. CT has a high value in the diagnosis and differentiation of this disease.
Lamivudine antiviral treatment after radical surgery prolongs disease-free survival of patients with hepatitis B virus-related liver cancer
Ding Tao, Wei Jian, He XuDong
2017, 33(8): 1497-1501. DOI: 10.3969/j.issn.1001-5256.2017.08.017
Abstract:
Objective To investigate whether lamivudine antiviral treatment after radical surgery can prolong disease-free survival of patients with hepatitis B virus-related liver cancer. Methods A total of 120 patients with hepatitis B virus-related liver cancer who underwent conventional radical surgery in Dongfeng Hospital Affiliated to Hubei Medical College from March 2014 to March 2016 were enrolled, and among these patients, 60 were given conventional treatment ( group A) and 60 were given lamivudine antiviral treatment ( group B) .ELISA was used to measure serum HBV DNA level. 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 Kaplan-Meier method was used to compare disease-free survival rate and recurrence rate between groups, and the Spearman method was used to investigate the correlation between serum HBV DNA level and survival time. Results According to the results of the 3-year follow-up, 71 patients ( 59. 17%) died ( group A: 46 patients died of tumor and 4 died of hepatic encephalopathy; group B: 20 died of tumor and 1 died of hepatic encephalopathy) . Compared with group A, group B had significantly lower recurrence rate ( 48. 33% vs 90. 00%, χ2= 16. 98, P < 0. 001) and mortality rate within 3 years ( 35. 00%vs 83. 33%, χ2= 10. 34, P < 0. 001) . Group B had significantly higher mean disease-free survival time and 1-, 2-, and 3-year disease-free survival rates than group A ( t = 9. 82, χ2= 7. 87, 11. 43, and 7. 98, all P < 0. 001) . After surgery, group B had a significantly lower serum HBV DNA load than group A [ ( 0. 008 1 ± 0. 003 2) × 105copies/ml vs ( 0. 014 3 ± 0. 008 9) × 105copies/ml, t = 18. 54, P< 0. 001]. In group A, there were significant differences in 1-, 2-, and 3-year disease-free survival rates between patients with serum HBV DNA load ≥1. 0 × 105copies/ml and those with serum HBV DNA load < 1. 0 × 105copies/ml ( χ2= 8. 57, P < 0. 05) , and further analysis showed that there were significant differences in 1-, 2-, and 3-year disease-free survival rates ( χ2= 4. 36, 5. 36, and 9. 53, P< 0. 05) ; in group B, there were no significant differences in 1-, 2-, and 3-year disease-free survival rates between these two groups of patients ( P > 0. 05) . Serum HBV DNA expression was positively correlated with patients' survival time ( r = 0. 67, P < 0. 001) . Conclusion Lamivudine antiviral therapy after radical surgery can effectively reduce serum HBV DNA level, and helps to prolong the disease-free survival time of patients with hepatitis B virus-related liver cancer.
Expression of microRNA-222 in hepatocellular carcinoma tissue and its clinical significance
Zhang ZhuQing, Lu ShuMing, Wang HuaLi, Xu MengYao, Li ChunYan, Xin Yue, Zhao JunJun
2017, 33(8): 1502-1505. DOI: 10.3969/j.issn.1001-5256.2017.08.018
Abstract:
Objective To investigate the expression of microRNA-222 ( miRNA-222) in hepatocellular carcinoma ( HCC) tissue and its clinical significance. Methods A total of 103 HCC tissue samples were collected from the patients who underwent surgical resection in Dalian Central Hospital and The First Affiliated Hospital of Dalian Medical University from January 2012 to December 2014. Quantitative real-time PCR was used to measure the expression of miRNA-222 in HCC tissues, adjacent cirrhotic tissues, and distal liver tissues, and the association between miRNA-222 expression and the clinicopathological features of HCC was analyzed. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the Dunnett's T3 test was used for further comparison between any two groups; the t-test was used for comparison between two groups. Results There was a significant difference in the expression of miRNA-222 between HCC tissues, adjacent cirrhotic tissues, and distal liver tissues ( F = 27. 167, P < 0. 001) ; the HCC tissues had significantly higher relative expression of miRNA-222 than the adjacent cirrhotic tissues ( 4. 543 ± 2. 029 vs 3. 072 ± 0. 844, P < 0. 01) and the distal liver tissues ( 4. 543 ± 2. 029 vs 1. 559 ± 0. 695, P < 0. 01) , and the adjacent cirrhotic tissues had significantly higher relative expression of miRNA-222 than the distal liver tissues ( P < 0. 01) . The expression of miRNA-222 was significantly associated with tumor size, degree of tumor differentiation, tumor thrombus in the portal vein, and invasion/metastasis ( t = 7. 256, 9. 900, 2. 345, and 4. 225, all P < 0. 05) , while it was not associated with sex, age, the presence of viral hepatitis, or increased alpha-fetoprotein level ( all P > 0. 05) . Conclusion The expression of miRNA-222 is abnormally upregulated in HCC tissue, and miRNA-222 measurement may help to evaluate the clinical progression and prognosis of HCC.
Original articles_Biliary diseases
Clinical effect of laparoscopic left lateral hepatectomy in treatment of intrahepatic bile duct stones
Ling XinJian, Wang DongShu
2017, 33(8): 1506-1509. DOI: 10.3969/j.issn.1001-5256.2017.08.019
Abstract:
Objective To investigate the surgical method, safety, and clinical effect of laparoscopic left lateral hepatectomy in the treatment of intrahepatic bile duct stones. Methods A total of 30 patients with intrahepatic bile duct stones who were admitted to our hospital from January 2015 to December 2016 were enrolled, and according to the surgical procedure, these patients were divided into conventional group ( 15 patients) and laparoscopic group ( 15 patients) . The patients in the conventional group were treated with open left lateral hepatectomy, and those in the laparoscopic group were treated with minimally invasive laparoscopic left lateral hepatectomy. Surgical indices were observed, and postoperative complications and liver function parameters were compared between the two groups. The t-test was used for comparison of normally distributed continuous data, and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data. The chi-square test was used for comparison of categorical data. Results The laparoscopic group had significant reductions in the time to passage of gas by anus ( 1. 02 ± 0. 51 d vs 1. 98 ± 0. 36 d, t = 5. 956, P < 0. 001) and length of postoperative hospital stay ( 8. 83 ±0. 81 d vs 11. 83 ± 0. 42 d, t = 5. 830, P < 0. 001) compared with the conventional group. Compared with the conventional group, the laparoscopic group had a significantly lower alanine aminotransferase level ( 125. 8 ± 91. 9 U/L vs 214. 1 ± 99. 6 U/L, t = 2. 52, P = 0. 02) and a significantly higher serum albumin level ( 33. 2 ± 3. 7 g/L vs 28. 9 ± 4. 3 g/L, t = 2. 94, P = 0. 01) at 5 days after surgery. Conclusion Compared with conventional open surgery, laparoscopic left lateral hepatectomy has the features of little trauma, rapid postoperative recovery, and little influence on liver function in the treatment of intrahepatic bile duct stones and has a marked clinical effect. Therefore, it holds promise for clinical application.
Clinical effect of laparoscopic surgery in treatment of common bile duct stones after subtotal gastrectomy
Lei Ting
2017, 33(8): 1510-1513. DOI: 10.3969/j.issn.1001-5256.2017.08.020
Abstract:
Objective To investigate the safety and feasibility of laparoscopic surgery in the treatment of common bile duct stones after subtotal gastrectomy. Methods A retrospective analysis was performed for the clinical data of 46 patients with gallstones and common bile duct stones after subtotal gastrectomy who underwent surgical treatment in Luoyang Central Hospital Affiliated to Zhengzhou University from January 2010 to October 2016. Among these patients, 25 underwent laparoscopic cholecystectomy + common bile duct exploration ( laparoscopic group) , and 21 underwent open cholecystectomy + common bile duct exploration ( open group) . The surgical conditions and postoperative complications were compared between the two groups. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results No patients died during the perioperative period and 2 patients ( 8. 0%) in the laparoscopic group were converted to open surgery. There were significant differences between the laparoscopic group and the open group in time to ambulation after surgery ( 1. 2 ± 0. 6 d vs 2. 4 ± 1. 2 d, t = 4. 395, P < 0. 001) , time to passage of gas by anus after surgery ( 1. 8 ± 0. 5 d vs 2. 8 ± 0. 8 d, t = 5. 168, P < 0. 001) , and length of postoperative hospital stay ( 5. 2 ± 1. 1 d vs 7. 5 ± 2. 3 d, t = 4. 439, P < 0. 001) . There were no significant differences between the two groups in time of operation, intraoperative blood loss, hospital costs, T tube placement, and rate of residual stones ( all P > 0. 05) . After surgery, 2 patients ( 8. 0%) in the laparoscopic group and3 ( 14. 3%) in the open group experienced complications, and there was no significant difference between the two groups ( P = 0. 495) .Conclusion Laparoscopic surgery is safe and feasible in the treatment of common bile duct stones after subtotal gastrectomy and has the advantages of minimally invasive surgery.
Original articles_Pancreatic diseases
Clinicopathological features of pancreatic mucinous cystic neoplasm and influencing factors for its malignancy
Hou LiYan, Jia RuJiang, Wang XiuChao, Lan ChunGen, Yin QingChen
2017, 33(8): 1514-1517. DOI: 10.3969/j.issn.1001-5256.2017.08.021
Abstract:
Objective To investigate the clinicopathological features of pancreatic mucinous cystic neoplasm ( MCN) and influencing factors for benign and malignant MCN. Methods A retrospective analysis was performed for the clinical data of 43 patients with pathologically confirmed pancreatic MCN who were treated from January 2013 to December 2015, and according to the results of pathological diagnosis, the patients were divided into benign group ( mucinous cystadenoma and pancreatic MCN with low/middle-grade dysplasia) and malignant group ( MCN with high-grade dysplasia and MCN with invasive carcinoma) . The clinicopathological features and radiological features were summarized, and the risk factors for malignant transformation of pancreatic MCN were analyzed. 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, and a multivariate logistic regression analysis was used to identify risk factors. Results There were 14 male and 29 female patients aged 22-81 years ( median 58. 53 years) . Of all patients, 30 ( 69. 8%) had clinical symptoms. The maximum tumor diameter was 4. 8 cm ( range 1. 2-16cm) . Of all patients, 18 ( 41. 9%) had MCN in the head of the pancreas, 3 ( 7. 0%) had MCN in the neck of the pancreas, 20 ( 46. 5%) had MCN in the body and tail of the pancreas, and 2 ( 4. 6%) had multiple MCNs. There were significant differences between the two groups in age, tumor nature, tumor location, texture, tumor markers, heterogeneous enhancement of the cyst wall, heterogeneous enhancement of solid components, and cyst wall thickness > 0. 2 cm ( all P < 0. 05) . The multivariate logistic regression analysis showed that age and increased tumor markers were independent predictive factors for malignant pancreatic MCN ( both P < 0. 05) . Conclusion Age, tumor nature, tumor location, texture, increased tumor markers, heterogeneous enhancement of the cyst wall, heterogeneous enhancement of solid components, and cyst wall thickness > 0. 2 cm are important features of malignant pancreatic MCN, and age and increased tumor markers are risk factors for malignant pancreatic MCN.
Risk factors for hypertriglyceridemia-induced acute pancreatitis
Hu WeiLin
2017, 33(8): 1518-1521. DOI: 10.3969/j.issn.1001-5256.2017.08.022
Abstract:
Objective To investigate the risk factors for hypertriglyceridemia-induced acute pancreatitis, and to provide a reference for clinical prevention and treatment. Methods A total of 42 patients with hypertriglyceridemia-induced acute pancreatitis who were admitted to The People's Hospital of Guang'an from January 2014 to June 2016 were enrolled as study group, and 42 patients with non-hypertriglyceridemia-induced acute pancreatitis ( biliary or alcoholic) were enrolled as control group. The two groups were compared in terms of sex, age, fatty liver, body mass index ( BMI) , type 2 diabetes, hyperlipidemia, family history of hyperlipidemia, serum triglyceride, serum cholesterol, low-density lipoprotein ( LDL) , high-density lipoprotein ( HDL) , whole blood low-shear viscosity, and D-dimer concentration at the time when they visited the hospital. 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. A multivariate non-conditional logistic regression analysis was performed for the statistically significant variables identified in the univariate analysis. Results The univariate analysis showed that there were significant differences between the two groups in sex, fatty liver, BMI, type 2 diabetes, hyperlipidemia, family history of hyperlipidemia, serum triglyceride level, whole blood low-shear viscosity, whole blood high-shear viscosity, and D-dimer concentration ( all P < 0. 05) . The multivariate non-conditional logistic regression analysis showed that type 2 diabetes ( odds ratio [OR]= 2. 206, 95% confidence interval[95% CI]: 1. 125-4. 263, P = 0. 024) , serum triglyceride level ( OR = 5. 253, 95% CI: 2. 502-9. 568, P = 0. 001) , BMI ( OR =3. 812, 95% CI: 1. 896-7. 529, P = 0. 011) , fatty liver ( OR = 4. 255, 95% CI: 2. 185-8. 236, P = 0. 009) , and D-dimer concentration ( OR = 6. 258, 95% CI: 3. 526-11. 653, P = 0. 006) were independent risk factors for hypertriglyceridemia-induced acute pancreatitis. Conclusion It is of great clinical significance to provide intervention for risk factors for hypertriglyceridemia-induced acute pancreatitis and minimize its incidence rate.
Predictive value of combined measurement of D-dimer, fibrinogen, and peripheral blood leukocyte count for severity of acute pancreatitis
Hu QingMei, Niu ChunYan
2017, 33(8): 1522-1526. DOI: 10.3969/j.issn.1001-5256.2017.08.023
Abstract:
Objective To explore the predictive value of combined measurement of D-dimer ( D-D) , fibrinogen ( FIB) , and peripheral blood leukocyte count ( PBLC) for the severity of acute pancreatitis ( AP) . Methods We collected the clinical data of 134 hospitalized patients who were diagnosed with AP in the General Hospital of Ningxia Medical University from January 2014 to January 2016. These patients were divided into mild acute pancreatitis ( MAP) group ( n = 72) and severe acute pancreatitis ( SAP) group ( n = 62) . Also, these patients were divided into hyperlipidemic acute pancreatitis ( HAP) group ( n = 43) and biliogenic acute pancreatitis ( BAP) group ( n = 91) . The initial measurements of D-D, FIB, and PBLC for the patients who were admitted to the hospital within 24 hours of onset and received no treatment before admission were collected. The t test was used for comparison of normally distributed continuous data, while the Mann-Whitney U test was used for non-normally distributed continuous data. The chi-square test was used for comparison of categorical data. In addition, the Spearman correlation test and Pearson correlation test were used for correlation analyses. The receiver operating characteristic ( ROC) curve was used to analyze the predictive values of D-D, FIB, and PBLC for the severity of AP. Results Compared with the MAP group, the SAP group had significantly increased D-D and FIB levels in peripheral blood ( Z =-3. 171, P = 0. 002; t =-2. 339, P =0. 021) . Compared with the HAP group, the BAP group had a significantly higher D-D level ( Z =-4. 178, P < 0. 001) , an insignificantly higher FIB level ( P > 0. 05) , and a significantly lower PBLC ( t = 2. 466, P = 0. 015) . The areas under the ROC curve ( AUCs) of D-D, FIB, and PBLC were 0. 659, 0. 611, and 0. 591, respectively, and D-D had a higher value than FIB and PBLC in predicting the severity of SAP. The AUC of a combination of D-D, FIB, and PBLC was 0. 712. Plasma D-D and FIB levels were positively correlated with the severity of AP ( r = 0. 275 and 0. 192, P = 0. 001 and 0. 026) . Conclusions D-D, FIB, and PBLC are important for early judgment of the severity of AP, and a combination of the three markers has greater significance.
Original articles_Others
Clinical features of 181 patients with cholestatic autoimmune hepatitis
Lyu Sa, You ShaoLi, Tian Hua, Song FangJiao, Liu WanShu, Wang HaiBo, Li Chen, Liu LiMin, Zhu Bing
2017, 33(8): 1527-1531. DOI: 10.3969/j.issn.1001-5256.2017.08.024
Abstract:

Objective To investigate the clinical features of patients with cholestatic autoimmune hepatitis ( AIH) and their prognosis after corticosteroid therapy. Methods The patients with AIH, autoimmune hepatitis-liver cirrhosis ( AIH-LC) , or autoimmune hepatitis-liver failure ( AIH-LF) who were hospitalized in 302 Hospital of PLA from January 2014 to December 2015 were enrolled, and a retrospective analysis was performed for the clinical data of the patients with cholestatic AIH who met the inclusion criteria. The improvement rate of patients receiving corticosteroid therapy and reasons why corticosteroid therapy was not applied were analyzed. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H test was used for non-normally distributed continuous data between multiple groups; the chi-square test was used for comparison of categorical data between groups. Results A total of 181 patients with cholestatic AIH were enrolled, with 15 patients in AIH group, 142 in AIH-LC group, and 24 in AIH-LF group. The male/female ratio was 1 ∶ 11. 1. Type-1 AIH patients with positive anti-nuclear antibody and/or anti-smooth muscle antibody accounted for 96. 7% ( 175/181) . Most patients with cholestatic AIH had liver cirrhosis ( 78. 5%) . There were significant differences between the three groups in age, albumin, prothrombin time activity, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase and total bilirubin ( F = 3. 836, 13. 271, and 41. 819, χ2= 29. 153, 22. 759, 8. 826, and 26. 942, all P <0. 05) . The 181 patients with cholestatic AIH achieved an overall improvement rate of 36. 5%, and the AIH group had the highest improvement rate ( 66. 7%) . Of all patients, 35 ( 19. 3%) received corticosteroid therapy, and these patients had a significantly higher improvement rate than those who did not receive corticosteroid therapy ( 57. 1% vs 31. 5%, χ2= 8. 009, P = 0. 005) . Infection, ascites, and gastrointestinal bleeding were main reasons for the absence of corticosteroid therapy. Conclusion Cholestatic AIH is commonly seen in female patients, and most of patients with cholestatic AIH have liver cirrhosis or type-1 AIH. Corticosteroid therapy is an effective method, but its application is limited by infection, ascites, and gastrointestinal bleeding.

Clinical features and prognosis of patients with primary biliary cholangitis complicated by hepatitis virus infection
Zhao DanTong, Yan HuiPing, Liu YanMin, Huang ChunYang, Zhang HaiPing, Zhao Yan, Liao HuiYu
2017, 33(8): 1532-1536. DOI: 10.3969/j.issn.1001-5256.2017.08.025
Abstract:

Objective To investigate the clinical features and prognosis of patients with primary biliary cholangitis ( PBC) complicated by hepatitis virus infection. Methods A total of 16 patients who were admitted to Beijing You An Hospital from October 2004 to October 2012 and diagnosed with PBC complicated by hepatitis virus infection were enrolled, among whom 7 had chronic hepatitis B virus infection, 3 had hepatitis C, 4 had hepatitis E, 1 had hepatitis B and hepatitis C, and 1 had hepatitis A. A total of 76 hospitalized patients with PBC alone were enrolled as controls. The two groups were compared in terms of clinical features, laboratory markers, and autoantibodies, and follow-up visits were performed to investigate prognostic features. The independent samples t-test was used for comparison of normally distributed continuous data, and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data; the chi-square test or Fisher's exact test was used for comparison of categorical data. The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used to compare survival rates between groups. Results Compared with the control group, the PBC-hepatitis virus infection group had significantly lower proportion of female patients ( χ2= 12. 22, P = 0. 002) , alkaline phosphatase ( U = 225. 00, P < 0. 001) , CHO ( U = 363. 50, P = 0. 036) , and Ig G level ( t = 2. 79, P = 0. 007) , and no patients in the PBC-hepatitis virus infection group experienced abdominal wall varices, upper gastrointestinal bleeding, or hepatic encephalopathy. The PBC-hepatitis virus infection group had various autoantibodies including anti-nuclear antibody, smooth muscle antibody, anti-parietal cell antibody ( APCA) , anti-liver specific protein antibody, and anti-myocardial antibody, as well as a significantly higher APCA positive rate than the control group ( 25% vs 3. 9%, χ2= 5. 608, P = 0. 016) . The median follow-up time was 49. 5 months ( 2-312 months) . The PBC-hepatitis virus infection group had a significantly lower incidence rate of adverse events than the control group ( 25. 0% vs 64. 5%, χ2= 8. 43, P = 0. 005) , and there were no significant differences between the two groups in cumulative survival rate and proportion of patients who did not experience any adverse event ( both P > 0. 05) . Conclusion Most patients with PBC complicated by hepatitis virus infection are in the early stage of PBC and have various nonspecific autoantibodies. Current study does not indicate that hepatitis virus infection has influence on the survival of PBC patients.

Clinical features and prognosis of AIDS complicated by drug-induced liver injury: an analysis of 119 cases
Yang JunYang, Qi TangKai, Zhang RenFang, Liu Li, Shen YinZhong, Ji YongJia, Lu HongZhou
2017, 33(8): 1537-1542. DOI: 10.3969/j.issn.1001-5256.2017.08.026
Abstract:

Objective To investigate the clinical features and prognosis of AIDS patients complicated by drug-induced liver injury ( DILI) . Methods A total of 119 patients who were diagnosed with AIDS in First Department of Infectious Diseases in Shanghai Public Health Clinical Center from January 2014 to December 2015 and met the diagnostic criteria for DILI were enrolled. The clinical data including medications, CD4~+T lymphocyte count, clinical manifestations, liver biochemical parameters, therapies, duration of liver injury, and prognosis were analyzed, and DILI type and classification were determined for all patients. The influence of DILI caused by different drugs on liver biochemical parameters was analyzed. The Wilcoxon rank sum test was used for comparison of continuous data between two groups and the Kruskal-Wallis H test was used for comparison between multiple groups; the chi-square test was used for comparison of categorical data between groups. Results The 58 patients who received highly active antiretroviral treatment ( HAART) had significantly higher grade of liver injury ( χ2= 15. 756, P < 0. 001) and levels of total bilirubin ( TBil) ( Z =-3. 466, P = 0. 010) and albumin ( Alb) ( Z =-1. 968, P = 0. 049) than the 61 patients who did not. Among the patients who had a clear cause of DILI, 8 had DILI caused by antifungal drugs, 41 had DILI caused by antibacterial drugs, 18 had DILI caused by antitubercular agents, and 24 had DILI caused by antiviral drugs; the patients with DILI caused by antitubercular agents had a significantly higher level of TBil than those with DILI caused by other three types of drugs ( H = 12. 804, P = 0. 005) , the patients with DILI caused by antibacterial drugs and antitubercular agents had a significantly lower level of Alb than those with DILI caused by the other two types of drugs ( H = 14. 236, P = 0. 003) , and the patients with DILI caused by antitubercular agents and antiviral drugs had a significantly higher grade of liver injury than those with DILI caused by the other two types of drugs ( χ2= 16. 373, P = 0. 008) . The hepatocellular injury-type patients had a shorter length of hospital stay ( χ2= 8. 046, P = 0. 045) .A high level of alkaline phosphatase and a low level of alanine aminotransferase indicated a longer length of hospital stay ( Z =-2. 943 and-2. 592, both P < 0. 05) . Conclusion AIDS patients are given various drugs and have a high incidence rate of DILI. HARRT can aggravate liver injury, but it does not significantly affect patients' prognosis. Liver function examination should be performed regularly during clinical medication to know the state of liver inflammation and reduce the incidence rate of DILI in AIDS patients.

Effect of pharmacotherapy on decompensated liver function in children with hepatolenticular degeneration
Li ChunXia, Gong JingYu, Zhang MeiHong, Wang JianShe
2017, 33(8): 1543-1547. DOI: 10.3969/j.issn.1001-5256.2017.08.027
Abstract:

Objective To investigate the effect of pharmacotherapy on decompensated liver function in children with hepatolenticular degeneration. Methods Three children with“liver cirrhosis and decompensated liver function”as the onset of hepatolenticular degeneration who were admitted to Jinshan Hospital Affiliated to Fudan University from August 1, 2015 to August 1, 2016 were enrolled, and ATP7 B gene sequencing was performed to make a confirmed diagnosis. Clinical outcome was recorded. Results Compound heterozygous mutation of the ATP78 gene was detected in the three children. After comprehensive medical treatment, all children had improvements in hypoproteinemia and coagulation function, and two children had a reduced Child-Pugh score. Conclusion Hepatolenticular degeneration should be considered for children with unexplained abnormal liver function and even liver cirrhosis, and early diagnosis and timely pharmacotherapy can reduce the need for liver transplantation.

CT and MRI manifestations of liver fluke granuloma
Huang Lu, Lu LiJian
2017, 33(8): 1548-1551. DOI: 10.3969/j.issn.1001-5256.2017.08.028
Abstract:

Objective To investigate the CT and MRI manifestations and clinical features of liver fluke granuloma. Methods A retrospective analysis was performed for the clinical and imaging data of 5 patients with pathologically confirmed liver fluke granuloma who were hospitalized in The First Affiliated Hospital of Guangxi Medical University from January 2010 to September 2015. Results Liver fluke granuloma had slightly low density on CT plain scan, as well as a slightly low signal on T1 weighted images and a slightly higher signal on T2 weighted images of MRI plain scan. Three-phase contrast-enhanced CT scan showed delayed enhancement with mild dilatation of the intrahepatic bile duct, and normal vessels ran through the lesion. Conclusion Liver fluke granuloma is a rare disease in clinical practice. A history of eating raw fish, delayed enhancement on three-phase contrast-enhanced CT scan, and normal vessels running through the lesion all contribute to the diagnosis of liver fluke granulomas.

Effect of trefoil factor 3 on intestinal mucous barrier in rats with nonalcoholic steatohepatitis
Liang Kai, Kong WeiZong, Chen Juan, Wang YingChun
2017, 33(8): 1552-1557. DOI: 10.3969/j.issn.1001-5256.2017.08.029
Abstract:

Objective To investigate the change in intestinal mucous barrier in rats with nonalcoholic steatohepatitis ( NASH) , the effect of trefoil factor 3 ( TFF3) on intestinal mucous barrier in NASH rats, and the therapeutic effect of TFF3 on NASH. Methods A total of 60 clean male Sprague-Dawley rats were randomly divided into normal group, model group, and treatment group, with 20 rats in each group.The rats in the normal group were given normal diet, and those in the model group and the treatment group were given high-fat diet to induce NASH. The rats in the treatment group were given intraperitoneal injection of rh TFF3 at a dose of 1 ml·kg-1·d-1 ( a concentration of 0. 1 mg/ml) , and those in the normal group and the model group were given normal saline at a dose of 1 ml·kg-1·d-1; the course of treatment was 3 weeks for all groups. At the end of week 15, fluorescein isothiocyanate-labeled dextran was given by gavage to evaluate intestinal permeability, and after the rats were sacrificed, serum levels of aspartate aminotransferase ( AST) , alanine aminotransferase ( ALT) , total cholesterol ( TC) , triglyceride ( TG) , and endotoxin ( ET) and diamine oxidase ( DAO) activity were measured. HE staining was performed to observe the histopathological changes of the liver and the terminal ileum, PAS staining was performed to observe and count the goblet cells of the terminal ileum, immunohistochemistry was used to measure the expression of the tight junction protein Occludin and TFF3 in the terminal ileum, and quantitative real-time PCR was used to measure the mRNA transcription level of TFF3. 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 The model group had significant increases in serum levels of AST, ALT, TC, TG, and ET and DAO activity, and the treatment group had significant reductions compared with the model group ( all P < 0. 01) . The model group had a significant increase in NAFLD activity score compared with the normal group ( P < 0. 01) , and the treatment group had significant improvement in liver inflammation and a significant reduction in NAFLD activity score compared with the model group ( P < 0. 01) . The model group had cell necrosis, damage of the intestinal villi, and a significant reduction in goblet cells in the terminal ileum under a light microscope; in the treatment group, damage of the intestinal villi was repaired and there was an increase in goblet cells. The model group had a significant increase in intestinal permeability compared with the normal group, and the treatment group had a significant reduction compared with the model group ( both P < 0. 01) . The model group had a significant reduction in the expression of Occludin and TFF3, and the treatment group had a significant increase compared with the model group ( all P < 0. 01) . The model group had a downregulated TFF3 mRNA transcription level in the terminal ileum compared with the normal group, and the treatment group had an upregulated level compared with the model group ( both P < 0. 01) . Conclusion NASH rats have damaged goblet cells and mucous barrier dysfunction. TFF3 can repair the damaged terminal ileum, promote the regeneration of goblet cells and mucus secretion, restore intestinal barrier function, reduce intestinal permeability, and thus exert its therapeutic effect on NASH.

Brief reports
A study of compliance in patients with HBeAg-negative chronic hepatitis B receiving entecavir treatment
Tao JunXiu, Li XiaoDong, Cao Ting, Xiao MingZhong, Wu HuiKun, Wu Deng, Ren Meng, Wang Ting, Bai LiYing
2017, 33(8): 1558-1560. DOI: 10.3969/j.issn.1001-5256.2017.08.030
Abstract:
Case reports
A case of hepatoblastoma with liver cirrhosis secondary to cytomegalovirus hepatitis
Sun LiYang, Liang Lei, Wang Zheng, Xing Hao, Wu MengChao, Yang Tian
2017, 33(8): 1561-1562. DOI: 10.3969/j.issn.1001-5256.2017.08.031
Abstract:
Endoscopic ultrasonography-guided pancreatic duct puncture combined with ERCP in treatment of pancreatic duct obstruction caused by chronic pancreatitis: a case report
Wen HongXu, Xue DiQiang, Du HongWei, Ming YuZhen
2017, 33(8): 1563-1564. DOI: 10.3969/j.issn.1001-5256.2017.08.032
Abstract:
A case of multiple splenic hemolymphangioma
Xing JianYing, Chen XiaoJing, Chen JiaCheng, Li Jiao, Wang Yun, Wang YuanYuan, Zhou KaiLun
2017, 33(8): 1565-1567. DOI: 10.3969/j.issn.1001-5256.2017.08.033
Abstract:
Reviews
Research advances in clinicopathological features of patients with chronic HBV infection and normal alanine aminotransferase level
Li YanPing, Li ChunYan, Chen YanPing
2017, 33(8): 1568-1571. DOI: 10.3969/j.issn.1001-5256.2017.08.034
Abstract:
It was generally considered that patients with chronic HBV infection and normal alanine aminotransferase ( ALT) level had no or mild liver pathological changes, but in recent years, a large number of studies have found that such patients may also have marked inflammation and fibrosis in the liver. This article discusses the association between clinical features and liver pathological features in patients with chronic HBV infection and normal ALT level and points out that age, sex, HBeAg status, HBV DNA load, ALT level, and liver stiffness measurement are associated with liver pathological changes. Monitoring of these clinical indices helps with early detection of liver pathological changes in patients with chronic HBV infection and normal ALT level.
Research advances in influencing factors for natural prognosis of patients with chronic HBV infection in immune tolerance phase
Gao HongYan, Liu Na, Li ChunXia, Lu RongZeng, Xu GuangHua
2017, 33(8): 1572-1575. DOI: 10.3969/j.issn.1001-5256.2017.08.035
Abstract:
In the natural history of chronic HBV infection, immune tolerance phase is the early stage of disease progression and plays a decisive role in disease monitoring and treatment. The latest CHB guidelines in China and foreign countries recommend regular follow-up for patients in immune tolerance phase, instead of antiviral therapy. Although patients with chronic HBV infection in immune tolerance phase tend to have a good prognosis, they may also have the risk of progression to end-stage liver diseases such as liver cirrhosis, hepatocellular carcinoma, and liver function decompensation. This article elaborates on the influencing factors for natural prognosis of patients with chronic HBV infection in immune tolerance phase and provides a theoretical basis for clinical judgment of patient' s conditions, determination of the most appropriate timing for the initiation of antiviral therapy, and individualized management.
Research advances in stem cell transplantation for the treatment of acute-on-chronic liver failure
Xiao XiaoXiao, Liang Rui
2017, 33(8): 1576-1580. DOI: 10.3969/j.issn.1001-5256.2017.08.036
Abstract:
Acute-on-chronic liver failure ( ACLF) is a critical disease in clinical practice and has a mortality rate as high as 80%. At present, there are still no ideal therapeutic measures for ACLF. Stem cell transplantation has unique advantages in the treatment of ACLF;however, there are still some issues regarding the research on stem cell transplantation, which limit its clinical application. This article elaborates on conventional treatment methods, source of stem cells, transplantation approach, and related issues, in order to provide help for further studies.
A new understanding of the pathogenesis of nonalcoholic fatty liver disease
Xin ShengLiang, Xu KeShu
2017, 33(8): 1581-1583. DOI: 10.3969/j.issn.1001-5256.2017.08.037
Abstract:
The incidence rate of nonalcoholic fatty liver disease ( NAFLD) has been increasing in China in recent years and has reached11%-15%. At present, the " multiple-hit" hypothesis is considered the main pathogenesis of NAFLD, yet the specific pathogenesis remains unknown. This article elaborates on the roles of carcinoembryonic antigen-related cell adhesion molecule 1 highly expressed in the liver, vitamin D/vitamin D receptor axis, and psychological factors in the development and progression of NAFLD, in order to provide new directions for the research on the pathogenesis of NAFLD in future.
Role of ceramide in development and progression of nonalcoholic fatty liver disease
Han HaiJing, Qi Xue, Niu ChunYan
2017, 33(8): 1584-1588. DOI: 10.3969/j.issn.1001-5256.2017.08.038
Abstract:
Nonalcoholic fatty liver disease ( NAFLD) is a clinicopathological syndrome caused by liver damage factors except alcohol and has the major feature of diffuse macrovesicular hepatocyte steatosis. The " two-hit " hypothesis can partly explain the pathogenesis of NAFLD. Recent studies have found that ceramide is a key molecular messenger involved in the development and progression of NAFLD, and as a sphingolipid, it is closely associated with the " two-hit" hypothesis. This article reviews the role of ceramide in NAFLD.
Pharmacotherapy for primary biliary cholangitis: basic concepts and research advances
Jin QianWen, Tu ChuanTao
2017, 33(8): 1589-1594. DOI: 10.3969/j.issn.1001-5256.2017.08.039
Abstract:
Primary biliary cholangitis ( PBC) is a chronic progressive cholestatic liver disease of unknown etiology characterized by highly specific anti-mitochondrial antibody in serum and immune-mediated non-pyogenic destructive infection in the small intrahepatic bile ducts, which can lead to portal inflammation and fibrosis and finally progress to liver cirrhosis and liver failure. At present, ursodeoxycholic acid ( UDCA) is the only drug approved for the treatment of PBC with a recommended dose of 13-15 mg·kg-1·d-1. There are significant improvements in the survival rate of patients achieving biochemical response after UDCA treatment. However, about 40% of PBC patients do not respond to UDCA, and such patients have a risk of disease progression and are in urgent need of other drugs. With reference to recent clinical studies and guidelines, this article summarizes the basic concepts and latest advances in pharmacotherapy for PBC, as well as the perspectives of new drugs in clinical trials, in order to bring new hopes to PBC patients with poor response to UDCA.
Research advances in association between Golgi protein 73 and liver diseases
Wei FengXian, Liu Zhao, Geng Jie, Su GuoHong, Chen Mo, Wang ManCai, Cao WeiJia, Zhang YouCheng
2017, 33(8): 1595-1598. DOI: 10.3969/j.issn.1001-5256.2017.08.040
Abstract:
Golgi protein 73 ( GP73) has a very low expression level in normal people, while it has a significantly higher expression level in patients with liver diseases and hepatocellular carcinoma ( HCC) , and therefore, it may become a new marker for HCC. This article introduces the distribution of GP73 in human body and definitions of different subtypes of GP73 and elaborates on its association with benign/malignant liver diseases and surgical operation based on the subtypes of GP73, as well as the application of GP73 in the differentiation of benign/malignant liver diseases. Since GP73 is closely associated with the development, progression, and prognosis of liver diseases, this article summarizes the latest advances in basic research, introduces the structural basis of fucosylated GP73 and proliferation, migration, and invasion of hepatoma cells and known signaling pathways, and lists the factors which affect the expression of GP73.
Research advances in sump syndrome
Xu Yu, Zhang XiaoDi, Wang ZhiXiang
2017, 33(8): 1599-1602. DOI: 10.3969/j.issn.1001-5256.2017.08.041
Abstract:
Sump syndrome is a rare complication of side-to-side choledochoduodenostomy ( CDD) and occasionally occurs after spontaneous gallbladder-bile duct-digestive tract fistula or end-to-side choledochojejunostomy. Before the development of minimally invasive surgery, conventional surgical operation used to be the most important treatment method. This article reviews the research advances in sump syndrome in recent years and points out that endoscopic retrograde cholangiopancreatography is the major diagnostic method for this disease, and endoscopic sphincterotomy combined with bile duct debridement is the most simple and effective measure for the treatment of sump syndrome. Meanwhile, this article briefly reviews sump syndrome with reference to related literature and clinical practice, in order to raise the awareness for sump syndrome.
Effect of pancreatic stellate cell activation regulated by microRNA on fibrosis of chronic pancreatitis
Zhu YiZhou, Zhu Chang, Zhou Shu, Liu Hua, Xu XiaoRong
2017, 33(8): 1603-1607. DOI: 10.3969/j.issn.1001-5256.2017.08.042
Abstract:
Chronic pancreatitis is a progressive chronic inflammatory disease and finally progresses to irreversible pancreatic fibrosis. The diagnosis and treatment of chronic pancreatitis is difficult and there are still no effective measures for delaying or reversing fibrosis. This article introduces the research advances in the role of microRNA ( miRNA) in the fibrosis of chronic pancreatitis and points out that pancreatic stellate cell activation is the key step in pancreatic fibrosis. Recent studies have demonstrated that miRNA regulates pancreatic stellate cell activation and participates in the fibrosis of chronic pancreatitis through altering gene expression and mediating signaling pathways and epithelial-mesenchymal transition, and miRNA may become a new target for the treatment of chronic pancreatitis.