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

2018 No. 1

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Editorial
Molecular basis of hepatic fibrosis and current status of its diagnosis and treatment
Li Yan, Lu LunGen
2018, 34(1): 12-15. DOI: 10.3969/j.issn.1001-5256.2018.01.001
Abstract:
During the process of acute or chronic liver injury, hepatic stellate cells interact with various types of cells such as hepatic parenchymal cells, Kupffer cells, and liver sinusoidal endothelial cells to mediate extracellular matrix deposition and sinusoid capillarization and thus initiate the process of hepatic fibrosis. The nature of hepatic fibrosis is repair response after liver injury. Liver biopsy is regarded as the gold standard for the diagnosis of hepatic fibrosis; however, it is generally associated with the risk of bleeding and even death. Noninvasive diagnostic methods for liver fibrosis mainly include serum biomarkers, imaging techniques, and predictive statistical model, but such methods cannot completely replace liver biopsy. At present, the treatment of hepatic fibrosis focuses on the research and development of new drugs targeting primary disease, hepatic stellate cells, or balance of extracellular matrix synthesis/degradation. The research on the molecular mechanism of hepatic fibrosis provides a solid theoretical basis for exploring the treatment of hepatic fibrosis.
Discussions by experts
The critical importance of diagnosing and treating liver fibrosis
Guo JinSheng
2018, 34(1): 16-19. DOI: 10.3969/j.issn.1001-5256.2018.01.002
Abstract:
Liver fibrosis is the scar repairing reaction in response to chronic liver injury due to various etiologies. It has been considered as the early and reversible stage of liver cirrhosis. This article points out the distinction between liver fibrosis and cirrhosis, introduces the current staging system of chronic liver diseases, and recent progress in diagnosing and evaluating liver fibrosis, as well as the medical treatment.The critical importance of diagnosing and treating liver fibrosis in preventing liver diseases progression into decompensated liver cirrhosis is emphasized.
Clinical application of quantitative assessment of liver fibrosis based on pathology and imaging technology
He ZhiYing, Wang BingQiong, You Hong
2018, 34(1): 20-23. DOI: 10.3969/j.issn.1001-5256.2018.01.003
Abstract:
Liver fibrosis/cirrhosis is a common pathological outcome of chronic hepatic diseases, and an accurate assessment of the degree of liver fibrosis has an important reference value in a definite diagnosis, treatment decision-making, clinical outcome monitoring, and prognostic evaluation. Two quantitative assessment techniques are widely used at present: the quantitative assessment technique based on liver biopsy is the gold standard for identifying the exact liver fibrosis stage and evaluating the progression and reversion of liver fibrosis; the noninvasive quantitative assessment technique based on imaging technology plays an important role in dynamic monitoring and prognostic prediction of liver fibrosis due to its repeatability. This article summarizes the development and application of these two quantitative assessment techniques to provide guidance for clinical practice.
The natural history and clinical features of nonalcoholic fatty liver disease-related cirrhosis
Zhang XiaXia, Xu HongTuan, Xu YouQing
2018, 34(1): 24-26. DOI: 10.3969/j.issn.1001-5256.2018.01.004
Abstract:
Nonalcoholic fatty liver disease ( NAFLD) is a type of metabolic liver injury closely associated with insulin resistance and genetic susceptibility and includes nonalcoholic simple fatty liver, nonalcoholic steatohepatitis, liver cirrhosis, and hepatocellular carcinoma. It has become an important public health issue nowadays. This article elaborates on the unique natural history of NAFLD and the clinical features of NAFLD-related cirrhosis. Further research on the progression of NAFLD-related cirrhosis is needed in the future to prevent the progression to liver cirrhosis, reduce liver-related death events, and relieve the economic burden for public health.
Association between liver vascular lesions and liver cirrhosis
Ning HuiBin, Shang Jia
2018, 34(1): 27-30. DOI: 10.3969/j.issn.1001-5256.2018.01.005
Abstract:
Many factors can cause liver fibrosis and cirrhosis in clinical practice, and liver cirrhosis caused by liver vascular lesions often has insidious progression. Due to a lack of knowledge in clinicians and limited diagnostic and treatment techniques, patients often have poor prognosis. The liver vascular system has a unique structure, and patients with different locations and extents of lesion have different clinical manifestations and outcomes. Correct diagnosis and differentiation of liver cirrhosis caused by different types of liver vascular lesions is an important and difficult issue and needs careful attention in clinical practice. This article summarizes the association of portal vein lesion, hepatic vein lesion, hepatic sinusoid lesion, and hepatic artery lesion with liver cirrhosis. A deep understanding of the clinical manifestations, pathological features, and key points in differential diagnosis of these lesions helps with correct diagnosis and treatment of such disease.
Road map of the diagnosis and treatment of intractable ascites based on guidelines for the diagnosis and treatment of cirrhotic ascites and related complications
Ding HuiGuo
2018, 34(1): 31-34. DOI: 10.3969/j.issn.1001-5256.2018.01.006
Abstract:
Guidelines for the diagnosis and treatment of cirrhotic ascites and related complications put forward the new criteria for the diagnosis and treatment of intractable cirrhotic ascites, and spontaneous bacterial peritonitis is a common cause of intractable cirrhotic ascites. About 50% -89% of patients with intractable cirrhotic ascites have a significant response to terlipressin ( 2-8 mg/d) , midodrine hydrochloride ( 22. 5 mg/d) , and tolvaptan ( 7. 5-15 mg/d) . Intravenous albumin supplementation ( 8 g/1000 ml ascites) has a similar therapeutic effect as terlipressin ( 3 mg) in preventing posterior circulation dysfunction after large-volume paracentesis. Patients with a poor response to medication or those who need frequent large-volume paracentesis ( more than three times per week) or frequent hospitalization ( more than three times per month) should be evaluated for liver transplantation or transjugular intrahepatic portosystemic shunt. α-Crystal rifaximin may become a new strategy for preventing complications of liver cirrhosis by regulating the intestine-microbe-liver axis. Therefore, it is of great significance to explore the“road map”of the diagnosis and treatment of intractable cirrhotic ascites that is suitable for the clinical practice in China.
Academic contention
The medical laboratory issues about recommendation on uniform cutoff values of “normal” ALT in the ACG guidelines
Yu Qian, Pan BoShen
2018, 34(1): 35-38. DOI: 10.3969/j.issn.1001-5256.2018.01.007
Abstract:
In the recent American clinical guidelines dealing with laboratory tests for evaluation of liver disease, the American College of Gastroenterology ( ACG) recommends ALT upper reference limits of 33 U/L for males and 25 U/L for females respectively, and that individuals with ALT above these“normal”cutoffs should be further investigated. Considering the differences between laboratory assays measuring ALT in our country, the standardization of methods and the consistency of results can not be completely ensured. The uniform “normal”range of ALT recommended by the ACG guidelines is largely based on findings from foreign studies and may not be suitable to Chinese population. On the other hand, reference upper/lower limits should not simply be equated with clinical decision thresholds. However, due to improper application of the related concepts of the above medical laboratory issues, simply recommending the uniform reference range of the ALT may lead to overdiagnosis and unnecessary follow-up examinations.
Therapeutic guidelines
An excerpt of recommendations on the use of magnetic resonance imaging in PSC - A position statement from the International PSC Study Group (2017)
Zhu YiZhou, Wang Ying, Zhu Chang, Xu XiaoRong
2018, 34(1): 39-43. DOI: 10.3969/j.issn.1001-5256.2018.01.008
Abstract:

An excerpt of ACR appropriateness criteria chronic liver disease (2017)


Zhou XinMiao, Liu ZhangChun, Zhou Wei, Qi XingShun
2018, 34(1): 44-45. DOI: 10.3969/j.issn.1001-5256.2018.01.009
Abstract:
An excerpt of diagnosis and management of paediatric autoimmune liver disease: ESPGHAN Hepatology Committee position statement (2017)
Wang FuChuan, Zhang Min
2018, 34(1): 46-52. DOI: 10.3969/j.issn.1001-5256.2018.01.010
Abstract:
Original articles_Viral hepatitis
Impact of pegylated interferon versus conventional interferon on the change in peripheral CD4+CD25highT cells in patients with chronic hepatitis B
Wang HaiYan, Zhu Li, Wang YinLing, Zhu YuePing, Zhu XiaoYan, Chai XiaoZhe, Qian Feng, Li Ming, Zhu ChuanWu
2018, 34(1): 53-57. DOI: 10.3969/j.issn.1001-5256.2018.01.011
Abstract:

Objective To investigate the impact of pegylated interferon alpha-2 a ( PEG-IFNα-2 a) versus conventional interferon alpha-2 b ( IFNα-2 b) on the change in peripheral CD4+CD25high T cells in patients with chronic hepatitis B ( CHB) . Methods A total of 72 HBeAg-positive CHB patients who received interferon antiviral therapy in the Fifth People' s Hospital of Suzhou from June 2012 to June 2015 were enrolled, and according to the therapy selected by the patient, these patients were divided into PEG-IFNα-2 a group with 40 patients and IFNα-2 b group with 32 patients. The course of the interferon antiviral therapy was one year at least. The anticoagulant peripheral venous blood samples were collected before treatment and at month 12 of treatment. Another 30 healthy individuals were enrolled as controls. Flow cytometry was used to measure the percentage of peripheral CD4+CD25high T cells. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two independent samples; the Wilcoxon rank-sum test was used for comparison of paired data. The chi-square test or Fisher's exact test was used for comparison of categorical data between groups. Results At month 12 of treatment, there were 26 valid cases in the IFNα-2 b group and 32 valid cases in the PEG-IFNα-2 a group. There were no significant differences between the two groups in normalization rate of alanine aminotransferase, HBeAg seroconversion rate, and HBV DNA clearance rate ( P > 0. 05, P = 0. 05, P = 0. 47) . Before treatment, the IFNα-2 b group and the PEG-IFNα-2 a group had a significantly higher median percentage of peripheral CD4+CD25high T cells than the healthy control group ( U = 235. 5 and 238. 0, both P < 0. 05) . The PEG-IFNα-2 a group had a significant reduction in the median percentage of peripheral CD4+CD25high T cells at month 12 of interferon therapy ( Z =-2. 515, P = 0. 012) . As for the patients who achieved seroconversion of HBeAg, the IFNα-2 b group and the PEG-IFNα-2 a group had a significant reduction in peripheral CD4+CD25high T cells ( U = 121. 0 and 204. 5, both P < 0. 05) , while there was no significant difference between these two groups ( P > 0. 05) ; there was also no significant difference between these two groups and the healthy control group ( both P > 0. 05) . Conclusion Interferon antiviral therapy can reduce the percentage of peripheral CD4+CD25high T cells, and compared with IFNα-2 b, PEG-IFNα-2 a has a stronger effect in downregulating CD4+CD25high T cells; however, in patients who achieve seroconversion of HBeAg, PEG-IFNα-2 a and IFNα-2 b have a similar effect in downregulating CD4+CD25high T cells.

Expression features of follicular helper T cells in peripheral blood in patients with chronic hepatitis B
Wang Yan, Huang YouYing, Ma Yan, Guo Feng, Wang XiaoBo, Wang XiaoZhong
2018, 34(1): 58-62. DOI: 10.3969/j.issn.1001-5256.2018.01.012
Abstract:

Objective To investigate the expression features of follicular helper T ( Tfh) cells in peripheral blood in patients with chronic hepatitis B ( CHB) . Methods A total of 53 CHB patients who were admitted to Department of Hepatology in Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University from March 2016 to March 2017 were enrolled. Fasting venous blood samples were collected in the morning, and flow cytometry was used to measure Tfh and its subsets in peripheral blood. A total of 48 healthy individuals were enrolled as controls. The independent samples t-test was used for comparison of normally distributed continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the LSD-t test was used for further comparison between any 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 or Fisher' s exact test was used for comparison of categorical data between groups. A Pearson correlation analysis was performed to investigate correlation. Results The CHB group had significant higher percentages of CD4+ICOS+, CD4+CXCR5+, and CD4+ICOS+CXCR5+Tfh cells than the control group ( Z =-4. 319, P < 0. 001; t = 3. 742, P < 0. 001; t = 15. 948, P < 0. 001) . There were no significant differences in the percentages of CD4+ICOS+, CD4+CXCR5+, and CD4+ICOS+CXCR5+Tfh cells between the CHB patients with different immune stages, i. e., low-level replication, immune tolerance, and immune clearance ( all P > 0. 05) . CD4+ICOS+CXCR5+was not correlated with HBs Ag quantitation or HBV DNA. Conclusion Tfh cells are involved in the immune response mediated by hepatitis B virus, and they exert an anti-HBV effect by regulating humoral immune response.

Clinical value of Golgi protein 73 and hyaluronic acid in diagnosis of the progression of hepatitis B virus-related chronic liver diseases
Zhang LiJun, Liu MingJun, Wang Shuai, Wang Lin, Wang RuKun, Hou HuaBin, Sun GuiRong, Zhang NaNa, Liu LinJie
2018, 34(1): 63-67. DOI: 10.3969/j.issn.1001-5256.2018.01.013
Abstract:
Objective To investigate the clinical value of Golgi protein 73 ( GP73) and hyaluronic acid ( HA) in the diagnosis of the progression of hepatitis B virus ( HBV) -related chronic liver diseases. Methods A total of 142 patients who visited The Affiliated Hospital of Qingdao University from December 2016 to April 2017 were enrolled, and among these patients, 36 had hepatocellular carcinoma ( HCC) with liver cirrhosis, 66 had hepatitis B cirrhosis, and 40 had chronic hepatitis B ( CHB) . A total of 30 healthy subjects who underwent physical examination during the same period of time were enrolled as control group. ELISA was used to measure the serum level of GP73, and chemiluminescence was used to measure the level of HA. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Mann-Whitney U test was used for further comparison between any two groups. The receiver operating characteristic ( ROC) curve was used to analyze the diagnostic value of GP73 and HA measured alone or in combination. The Z test was used for comparison of area under the ROC curve ( AUC) , and the chi-square test was used for comparison of sex ratio, sensitivity, and specificity. Results The CHB group, liver cirrhosis group, and HCC group had significantly higher serum levels of GP73 and HA than the control group ( all P < 0. 05) . The liver cirrhosis group and the HCC group had significantly higher serum levels of GP73 and HA than the CHB group ( U = 677, 637, 291, and 193, all P < 0. 05) . In the liver cirrhosis group, the patients with decompensated liver cirrhosis had significantly higher serum levels of GP73 and HA than those with compensated liver cirrhosis ( U = 171 and 212, both P < 0. 05) . As for CHB patients, combined measurement of GP73 and HA had significantly higher AUC and sensitivity than GP73 measured alone ( AUC: 0. 950 vs 0. 790, Z = 2. 32, P < 0. 05; sensitivity: 91. 70% vs 72. 20% , χ2= 5. 14, P < 0. 05) . In the diagnosis of liver cirrhosis, GP73 had a significantly higher sensitivity than HA ( 87. 90% vs 69. 70% , χ2= 6. 05, P < 0. 05) , and compared with HA measured alone, combined measurement of GP73 and HA had a significant reduction in specificity ( 62. 30% vs 86. 80% , χ2= 14. 60, P < 0. 05) and a significant increase in sensitivity ( 93. 90% vs 69. 70% , χ2= 11. 80, P < 0. 05) . In the diagnosis of decompensated liver cirrhosis, combined measurement of GP73 and HA a significantly higher sensitivity than HA measured alone ( 83. 80% vs 67. 60% , χ2= 4. 17, P < 0. 05) . GP73, HA, and alpha-fetoprotein ( AFP) had an AUC of 0. 549, 0. 525, and 0. 807, respectively, in the diagnosis of HCC, and GP73 and HA had a lower diagnostic value than AFP ( Z = 3. 49 and 3. 80, both P < 0. 05) . Conclusion GP73 and HA can help with the monitoring of the progression of HBV-related chronic liver diseases. Combined measurement of GP73 and HA has an important clinical value in the diagnosis of liver cirrhosis and decompensated liver cirrhosis.
Signal mining and analysis of the adverse drug reaction of digestive dysfunction caused by the new anti-HCV drug sofosbuvir
Kou GuoXian, Wang Yu, Guo Jun, Liu Qian
2018, 34(1): 68-72. DOI: 10.3969/j.issn.1001-5256.2018.01.014
Abstract:

Objective To investigate the safety of a new anti-HCV drug, sofosbuvir, through mining the adverse drug reaction ( ADR) signals of digestive dysfunction caused by this drug. Methods The reporting odds ratio ( ROR) was used for mining the ADR signals of digestive dysfunction caused by sofosbuvir from 2014 to the first quarter of 2016 in the American Adverse Event Reporting system, and the distribution of signals among patients with different sexes, ages, and doses was analyzed. The chi-square test was used for comparison of categorical data between groups. Results A total of 17 ADR signals were detected, among which 15 were not included in the package insert.Among these signals, gastric variceal bleeding had the highest ROR value of 58. 41, followed by esophageal variceal bleeding ( 47. 92) , gastric varices ( 20. 02) , esophageal varices ( 17. 60) , and ascites ( 14. 92) , and all ADR signals had low intensity. There was a significant difference in the distribution of these signals between patients with different sexes ( P < 0. 001) , ages ( P = 0. 009) , or doses ( P = 0. 002) .Conclusion Mining and analysis of ADR signals of digestive dysfunction caused by sofosbuvir can provide a reference for a comprehensive and systematic evaluation of the safety of target system.

Original articles_Liver fibrosis and liver cirrhosis
Clinical effect of probiotics in treatment of liver cirrhosis: a Meta-analysis
Sun YuanPei, Guo XiaoXia
2018, 34(1): 73-79. DOI: 10.3969/j.issn.1001-5256.2018.01.015
Abstract:

Objective To investigate the clinical effect of probiotics in the treatment of liver cirrhosis through a systematic review. Methods PubMed, Embase, Cochrane Library, Chinese Scientific Journal Full-Text Database, VIP, and Wanfang Data were searched for randomized controlled trials ( RCTs) of probiotics for the treatment of liver cirrhosis. Rev Man 5. 3 software was used for the meta-analysis of the articles screened out. Rate difference ( RD) and its 95% confidence interval ( 95% CI) were used as effect size indicators for binary variables; weighted mean difference ( WMD) was used for evaluating continuous variables with the same unit, and standardized mean difference ( SMD) and its 95% CI were used for evaluating continuous variables with different units. Funnel plots were used to analyze publication bias.Results A total of 15 RCTs which met the inclusion criteria were included, and there were 1411 patients with liver cirrhosis in total ( 726 in treatment group and 685 in control group) . Compared with the control group, the treatment group had significant improvements in overall response rate ( RD = 0. 28, 95% CI: 0. 22-0. 34, P < 0. 001) and biochemical parameters for liver function including alanine aminotransferase ( SMD =-0. 90, 95% CI:-1. 14 to-0. 66, P < 0. 001) , total bilirubin ( WMD =-15. 99, 95% CI:-26. 42 to-5. 57, P <0. 001) , albumin ( SMD = 0. 66, 95% CI: 0. 40-0. 93, P < 0. 001) , endotoxin ( SMD =-1. 13, 95% CI:-2. 11 to-0. 15, P <0. 001) , and blood ammonia ( WMD =-15. 86, 95% CI:-21. 54 to-10. 18, P < 0. 001) . Conclusion Probiotics can significantly improve liver function in patients with liver cirrhosis, effectively inhibit the progression of liver cirrhosis, reduce the risk of complications including hepatic encephalopathy, and increase overall response rate and have good tolerability.

Clinical value of acoustic radiation force impulse in quantitative prediction of the degree of esophageal varices in patients with liver cirrhosis
Chen Min, Zhang DaKun, Gao YueJuan, Li Meng, Wang RuiFang, Zhang WenHui
2018, 34(1): 80-83. DOI: 10.3969/j.issn.1001-5256.2018.01.016
Abstract:

Objective To investigate the clinical value of acoustic radiation force impulse ( ARFI) in quantitative prediction of the degree of esophageal varices in patients with cirrhotic portal hypertension. Methods A total of 116 patients with liver cirrhosis who were admitted to 302 Hospital of PLA from October 2014 to February 2016 were enrolled. ARFI was used to measure real-time liver and spleen stiffness for all patients. With the degree of esophageal varices determined by gastroscopy as the gold standard for diagnosis, these patients were divided into non-varices group ( EV0, 16 patients) , mild varices group ( EV1, 39 patients) , moderate varices group ( EV2, 26 patients) , and severe varices group ( EV3, 35 patients) . The receiver operating characteristic ( ROC) curve was used to analyze the clinical value of liver/spleen ARFI in predicting the degree of esophageal varices. An analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the least significant difference Mann-Whitney U test was used for further comparison between any two groups; the chi-square test was used for comparison of categorical data between groups. The Spearman correlation analysis was used to investigate the correlation between the stiffness measured by ARFI and the degree of esophageal varices. Results The ARFI value of the spleen was 2. 54 ± 0. 34 m/s for EV0 patients, 3. 05 ± 0. 34 m/s for EV1 patients, 3. 48 ± 0. 50 m/s for EV2 patients, and 3. 69 ± 0. 33 m/s for EV3 patients ( χ2= 60. 121, P < 0. 001) . The ARFI value of the spleen was positively correlated with the grade of esophageal varices ( r =0. 713, P < 0. 001) . The areas under the ROC curve for the ARFI value of the spleen in the diagnosis of ≥EV1, ≥EV2, or EV3 esophageal varices were 0. 93, 0. 88, and 0. 83, respectively. There was no significant difference in the ARFI value of the liver between groups ( P =0. 085) , and the ARFI value of the liver was not correlated with the degree of esophageal varices ( P = 0. 245) . Conclusion The ARFI value of the spleen helps to achieve accurate quantitative prediction of the degree of esophageal varices in patients with cirrhotic portal hypertension and holds promise for clinical application.

Association of platelet count, fibrosis-4, and aspartate aminotransferase-to-platelet ratio index with the development and severity of esophageal varices in patients with liver cirrhosis
Wang Bao, Niu JunQi
2018, 34(1): 84-88. DOI: 10.3969/j.issn.1001-5256.2018.01.017
Abstract:

Objective To investigate the clinical value of platelet count ( PLT) , fibrosis-4 ( FIB-4) , and aspartate aminotransferase-to-platelet ratio index ( APRI) in predicting the development and classification of esophageal varices ( EVs) . Methods A retrospective analysis was performed for the clinical data of 163 patients with liver cirrhosis who visited Department of Hepatology in The First Hospital of Jilin University from January 2012 to December 2015. All patients underwent upper gastrointestinal endoscopy within one week after admission. According to PLT, the patients were divided into PLT ≤50 × 109/L group with 27 patients, PLT 50 × 109/L-≤100 × 109/L group with 84 patients, PLT 100 × 109/L-≤150 × 109/L group with 26 patients, and PLT > 150 × 109/L group with 26 patients. The Child-Pugh score, FIB-4, and APRI were recorded, and the association of PLT, FIB-4, and APRI with EVs was analyzed. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the LSD-t test was used for further comparison between any two groups; the Kruskall-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Dunn-Bonferroni test was used for further comparison between any two groups. The chi-square test was used for comparison of categorical data between groups, and the Fisher's test was used for the data which did not meet the conditions of the chi-square test. Spearman rank correlation was used to investigate the correlation of PLT, FIB-4, and APRI with EVs. The receiver operating characteristic ( ROC) curve and the area under the ROC curve ( AUC) were used to evaluate the values of PLT, FIB-4, and APRI in the diagnosis of EVs. Results Of all 163 patients with liver cirrhosis, 114 developed EVs and 49 did not experience EVs. There was a significant difference in the incidence rate of EVs between the cirrhotic patients with different PLTs ( χ2= 27. 36, P < 0. 001) . Compared with those with PLT≤150 × 109/L, the cirrhotic patients with PLT > 150 × 109/L had a significantly lower proportion of patients with EVs ( 34. 6% vs 76. 6% , P < 0. 001) or severe EVs ( 3. 8% vs 46. 7% , P < 0. 001) . There were significant differences in FIB-4 and APRI between the patients with different PLTs ( χ2= 102. 58 and 57. 02, both P < 0. 001) . PLT was negatively correlated with the degree of EVs ( r =-0. 491, P < 0. 001) , and FIB-4 and APRI were positively correlated with the degree of EVs ( r = 0. 460 and 0. 325, both P<0. 651="" 676="" 732="" 739="" 742="" 763="" .="" plt="" had="" an="" auc="" of="" 0.="" and="" accuracy="" 75.="" in="" predicting="" the="" presence="" or="" absence="" while="" fib-4="" 71.="" apri="" 72.="" 69.="" severe="" 67.="" 66.="" conclusion="" cirrhotic="" patients="" with="">150 × 109/L have a significant reduction in the risk of EVs or severe EVs. PLT, FIB-4, and APRI are correlated with the degree of EVs in cirrhotic patients, but they cannot fully replace gastroscopy.

Risk factors for glue extrusion bleeding after endoscopic therapy for esophagogastric variceal bleeding
Ma JiaLi, Li Ping, Wei HongShan, Zhou YuLing, Liang XiuXia, Hu JuLong, Ai ZhengLin, Chen Xu
2018, 34(1): 89-91. DOI: 10.3969/j.issn.1001-5256.2018.01.018
Abstract:

Objective To investigate the risk factors for glue extrusion bleeding after endoscopic tissue adhesive injection for the treatment of esophagogastric variceal bleeding. Methods A total of 416 patients with liver cirrhosis complicated by esophagogastric variceal bleeding or a past history of bleeding who were admitted to Beijing Ditan Hospital, Capital Medical University, from October 2008 to January 2016 were enrolled. A retrospective analysis was performed for their clinical data, including sex, age, etiology, routine blood test results, hepatic and renal function, electrolytes, blood lipids, coagulation, diameter of the portal vein, anteroposterior diameter of the spleen, Child-Pugh score, and volume of tissue adhesive injection. The t-test was used for comparison of continuous data between groups, and a multivariate logistic regression analysis was also performed. Results Of all patients, 59 experienced glue extrusion bleeding, resulting in an incidence rate of 14. 18% . The univariate analysis showed that there were significant differences in total bilirubin, direct bilirubin, total bile acid, Child-Pugh score, and volume of tissue adhesive injection between the patients with glue extrusion bleeding and those without ( t = 2. 54, 2. 85, 2. 35, 1. 03, and 4. 38, all P < 0. 05) . The multivariate logistic regression analysis showed that Child-Pugh score ( odds ratio[OR]= 2. 714, 95% confidence interval[CI]1. 600-4. 850, P = 0. 009) and volume of tissue adhesive injection ( OR = 2. 925, 95% CI 1. 762-5. 124, P = 0. 008) were independent risk factors for glue extrusion bleeding. Conclusion Patients with higher Child-Pugh score and volume of tissue adhesive injection tend to have a higher risk of glue extrusion bleeding.

Efficacy of Yunnan white medicinal powder combined with somatostatin and pantoprazole in treatment of liver cirrhosis complicated by upper gastrointestinal bleeding and its effect on inflammatory factors
Zhao JingFeng, Liu Qun, Wang XiuYan, Zhang Yang, Liang LiWei, Gan Yu
2018, 34(1): 92-96. DOI: 10.3969/j.issn.1001-5256.2018.01.019
Abstract:

Objective To investigate the efficacy of Yunnan white medicinal powder combined with somatostatin and pantoprazole in the treatment of liver cirrhosis complicated by upper gastrointestinal bleeding and its effect on inflammatory factors. Methods A total of 150 patients with liver cirrhosis complicated by upper gastrointestinal bleeding who were admitted to Shenyang 242 Hospital from April 2016 to March 2017 were enrolled and randomly divided into observation group and control group, with 75 patients in each group. The patients in the control group were given somatostatin for injection + pantoprazole sodium for injection, and those in the observation group were given Yunnan white medicinal powder in addition to the treatment for the control group. The two groups were observed and compared in terms of clinical outcome, blood transfusion volume, time to hemostasis, length of hospital stay, and change in hemoglobin, as well as the changes in the serum levels of high-sensitivity C-reactive protein ( hs-CRP) and interleukin-6 ( IL-6) after treatment. 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, and the Ridit analysis and the u test were used for ranked data of clinical outcome. Results Compared with the control group, the observation group had a significantly lower blood transfusion volume and significantly shorter time to hemostasis and length of hospital stay ( t = 6. 357, 7. 360, and 4. 469, all P < 0. 01) , as well as a significantly higher level of hemoglobin after treatment ( t = 4. 042, P < 0. 01) . The observation group had a significantly higher overall response rate than the control group ( 96. 00% vs 85. 33% , u = 2. 564, P < 0. 05) . Both groups had significant reductions in the serum levels of hs-CRP and IL-6 after treatment ( t = 14. 240, 6. 943, 35. 277, and 17. 764, all P < 0. 01) , and the observation group had a significantly higher level of hs-CRP and IL-6 than the control group after treatment ( t = 7. 984 and 18. 946, both P < 0. 01) . Conclusion Yunnan white medicinal powder combined with somatostatin and pantoprazole has a marked clinical effect in the treatment of liver cirrhosis complicated by upper gastrointestinal bleeding and can reduce blood transfusion volume, shorten the time to hemostasis and length of hospital stay, and reduce the serum levels of hs-CRP and IL-6.

Clinical effect of octreotide combined with an increased amount of fluid infusion in treatment of intractable cirrhotic ascites
Ge HongYan, Li PeiXia, Zhang YangYang, Wang LiLi, Wei YaoLing
2018, 34(1): 97-100. DOI: 10.3969/j.issn.1001-5256.2018.01.020
Abstract:

Objective To investigate the clinical effect of octreotide combined with an increased amount of fluid infusion in the treatment of intractable cirrhotic ascites, and to provide new thoughts for clinical diagnosis and treatment. Methods A total of 65 patients with intractable cirrhotic ascites who visited Affiliated Hospital of Inner Mongolia University for The Nationalities from February 2016 to May 2017 were enrolled and randomly divided into control group with 31 patients and observation group with 34 patients. The patients in the control group were given conventional treatment, and those in the observation group were given continuous pumping of octreotide 0. 6 mg once every 12 hours for 3 days, followed by intramuscular injection of octreotide 0. 2 mg once every 8 hours for 7-10 consecutive days, and an increased amount of fluid infusion, in addition to the conventional treatment. Symptomatic treatment was given based on patients' symptoms and tolerance. Vital signs, abdominal circumference, body weight, and time to ascites regression were observed during treatment, and the length of hospital stay and incidence rate of complications were analyzed. 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 Compared with the control group, the observation group had significantly shorter time to ascites regression ( 6. 13 ± 1. 25 d vs 11. 61 ± 1. 34 d, t =-4. 06, P < 0. 001) and length of hospital stay ( 10. 01 ± 1. 46 d vs 16. 10 ± 1. 57 d, t =-7. 65, P < 0. 001) , as well as significantly greater average daily reductions in abdominal circumference ( 4. 01 ± 0. 75 cm vs 2. 42 ± 0. 35 cm, t = 4. 69, P < 0. 001) and body weight ( 1. 67 ± 0. 42 kg vs 0. 97 ± 0. 54 kg, t = 4. 58, P < 0. 001) . The observation group had significantly lower incidence rates of upper gastrointestinal bleeding and electrolyte disturbance than the control group ( upper gastrointestinal bleeding: 5. 88% vs 32. 26% , χ2= 7. 49, P < 0. 05; electrolyte disturbance: 8. 82% vs 38. 71% , χ2= 8. 56, P < 0. 05) . Conclusion In addition to the conventional treatment of intractable ascites, octreotide combined with an increased amount of fluid infusion can promote spontaneous dieresis, significantly reduce the amount of ascites, shorten the time to ascites regression, reduce complications, and improve patients' conditions.

Value of combined measurement of serum cystatin C and urinary neutrophil gelatinase-associated lipocalin in diagnosis of acute kidney injury secondary to cirrhotic ascites
Lei Lei, Li LiangPing, Zhang Hu
2018, 34(1): 101-105. DOI: 10.3969/j.issn.1001-5256.2018.01.021
Abstract:

Objective To investigate the value of combined measurement of serum cystatin C ( Cys C) and urinary neutrophil gelatinase-associated lipocalin ( NGAL) in the diagnosis of AKI secondary to cirrhotic ascites. Methods A total of 105 patients with cirrhotic ascites who were admitted to Sichuan Provincial People's Hospital from January 2015 to June 2016 were enrolled and divided into AKI group with 56 patients and non-AKI group with 49 patients. Meanwhile, 40 healthy persons who underwent physical examination were enrolled as controls. The indices including serum Cys C, urinary NGAL, serum creatinine ( Scr) , and glomerular filtration rate ( GFR) were observed. The 105 patients with cirrhotic ascites were divided into subgroups according to Child-Pugh class, and the changes in serum Cys C, urinary NGAL, Scr, and GFR were compared between these subgroups. The independent samples 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 SNK-q test was used for further comparison between any two groups. The chi-square test was used for comparison of categorical data between groups, and a Pearson correlation analysis was also performed. Results There were significant differences in the levels of serum Cys C and urinary NGAL between the AKI group and the non-AKI group, as well as between the AKI group and the healthy control group ( all P < 0. 01) . AKI stage was determined for all AKI patients, and the AKI patients with a higher stage had significantly higher levels of serum Cys C and urinary NGAL than those with a lower stage ( all P < 0. 05) . Of all 56 AKI patients, 11 ( 19. 6% ) died; the patients who died had significantly higher levels of serum Cys C and urinary NGAL than those who survived ( t =-7. 742 and-3. 209, both P < 0. 01) . The correlation analysis showed that the levels of serum Cys C and urinary NGAL were negatively correlated with GFR ( r =-0. 915 and-0. 793, both P < 0. 01) . The levels of serum Cys C and urinary NGAL increased significantly and GFR decreased significantly with the increase in Child-Pugh class ( all P <0. 05) . Conclusion Combined measurement of serum Cys C and urinary NGAL can be used for the early diagnosis of AKI secondary to cirrhotic ascites and the evaluation of the severity and prognosis of AKI.

Predictive factors for portal vein thrombosis after splenectomy in cirrhotic patients with portal hypertension
Mou SiYu, Yang Zhe, Wu LiQun, Qiu Xuan, Guo JiaMing
2018, 34(1): 106-111. DOI: 10.3969/j.issn.1001-5256.2018.01.022
Abstract:

Objective To investigate the cause of portal vein thrombosis ( PVT) after esophagogastric devascularization and splenectomy in cirrhotic patients with portal hypertension ( PH) . Methods A retrospective analysis was performed for the clinical data of 123 patients who were admitted to The Affiliated Hospital of Qingdao University from January, 2012 to August, 2016 and underwent esophagogastric devascularization and splenectomy, and according to the presence or absence of PVT after surgery, these patients were divided into PVT group and non-PVT group. 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. The logistic regression model was used for multivariate analysis, and the area under the curve ( AUC) was used to compare the predictive value of influencing factors. Results Of all patients, 37 experienced PVT after esophagogastric devascularization and splenectomy, resulting in an incidence rate of 30. 08% . The univariate analysis of the PVT group and the non-PVT group showed that there were significant differences between the two groups in preoperative body mass index ( BMI) ( t = 2. 291, P < 0. 05) , Model for End-Stage Liver Disease ( MELD) score ( t = 1. 852, P < 0. 05) , portal vein diameter ( t = 1. 982, P < 0. 05) , splenic vein diameter ( t = 2. 582, P < 0. 05) , superior mesenteric vein diameter ( t = 2. 186, P < 0. 05) , flow rate of the splenic vein ( t = 2. 109, P < 0. 05) , and method for the resection of the splenic pedicle ( χ2= 4. 505, P < 0. 05) . As for Child-Pugh class A patients, there were significant differences between the PVT group and the non-PVT group in splenic vein diameter, superior mesenteric vein diameter, portal vein diameter, and preoperative BMI ( t = 2. 347, 2. 654, 2. 312, and 2. 187, all P < 0. 05) . The multivariate logistic regression analysis showed that BMI ( odds ratio [OR]= 0. 859, 95% confidence interval [CI]: 0. 750-0. 983, P = 0. 027) , splenic vein diameter ( OR = 1. 191, 95% CI:1. 035-1. 370, P = 0. 015) , flow rate of the splenic vein ( OR = 1. 125, 95% CI: 1. 004-1. 262, P = 0. 043) , superior mesenteric vein diameter ( OR = 1. 202, 95% CI: 1. 001-1. 444, P = 0. 048) , and primary splenic pedicle resection ( OR = 2. 815, 95% CI: 1. 056-7. 503, P = 0. 039) were independent risk factors for PVT after surgery. Preoperative BMI < 22. 54 kg/m2 ( sensitivity 75. 9% and specificity 58. 3% ) or preoperative splenic vein diameter > 11. 5 mm ( sensitivity 72. 7% and specificity 62. 9% ) suggested a higher risk of PVT after esophagogastric devascularization and splenectomy. Conclusion Preoperative splenic vein diameter and BMI are associated with PVT after surgery, and monitoring of these two indices helps to predict PVT in the early stage.

Screening for differentially expressed proteins in patients with liver cirrhosis complicated by portal vein thrombosis
Xiong JingPing, Peng YuanYuan, Zhang YueXin
2018, 34(1): 112-117. DOI: 10.3969/j.issn.1001-5256.2018.01.023
Abstract:

Objective To investigate the differentially expressed serum proteins in patients with liver cirrhosis complicated by portal vein thrombosis ( PVT) . Methods Serum samples were collected from 45 patients with liver cirrhosis who were hospitalized in Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, from November 2015 to November 2016, and among these patients, 22 had PVT and 23 had no PVT. Isobaric tags for relative and absolute quantitation ( i TRAQ) combined with chromatography and mass spectrometry were used to screen out the differentially expressed serum proteins, and a bioinformatics analysis was performed for the differentially expressed proteins. 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. The Fisher's exact test was used to compare the distribution of GO terms or KEGG pathways in the target protein set or total protein set, in order to evaluate the significance level of protein enrichment of a GO term or KEGG pathway. Results A total of 800 proteins were screened out, among which 86 were differentially expressed, including 32 upregulated proteins ( ratio ≥1. 2, P < 0. 05) and 54 downregulated proteins ( ratio ≤0. 83, P < 0. 05) . Among these proteins, 14 were associated with cellular component, 22 were involved in biochemical processes, and 10 were associated with molecular function. The KEGG analysis showed that there were significant differences in 18 proteins in 5 metabolic and signaling pathways between the liver cirrhosis-PVT group and liver cirrhosis group. These 5 metabolic and signaling pathways were associated with fat digestion and absorption, platelet activation, metabolism of glyoxylic acid and dicarboxylic acid, osteoclast differentiation, and axon guidance. Conclusion i TRAQ combined with chromatography and mass spectrometry can effectively screen out the differentially expressed serum proteins, among which GP5, FGA, and FGG may be potential biological markers for PVT in patients with liver cirrhosis and are worthy of further research.

Effect of TNF-like weak inducer of apoptosis and its receptor on migration of hepatic stellate cells
Su Min, Zhang Wei, Zhu ChengKai, Zhang Feng, Zhu GeYuZheng
2018, 34(1): 118-121. DOI: 10.3969/j.issn.1001-5256.2018.01.024
Abstract:

Objective To investigate the effect of TNF-like weak inducer of apoptosis ( TWAEK) and its receptor fibroblast growth factor-inducible 14 ( Fn14) on the migration of hepatic stellate cells and the possible mechanism. Methods The human hepatic stellate cell line LX-2 cells were treated with TWEAK or Fn14 specific small interfering RNA ( Fn14 siRNA) + TWEAK. Transwell chamber was used to observe the migration of hepatic stellate cells, and real-time PCR and Western blot were used to measure the expression of matrix metalloproteinase-9 ( MMP9) . The independent samples 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 two groups. Results Compared with normal LX-2 cells, the TWEAK group had a significant increase in the migration of LX-2 cells ( 105 ± 8 vs 164 ± 17, t = 5. 287, P < 0. 01) , and compared with the negative control group, the Fn14 siRNA + TWEAK group had a significant reduction in the number of migrated cells ( 122 ± 9 vs 58 ± 7, t = 9. 836, P < 0. 01) . When LX-2 cells were treated with TWEAK, the mRNA and protein expression of MMP9 increased in a time-dependent manner ( both P < 0. 05) , while the Fn14 siRNA +TWEAK group had significant reductions in the mRNA and protein expression of MMP9 compared with the TWEAK group ( t = 5. 358, P <0. 01) . Conclusion TWEAK and its receptor Fn14 can promote the migration of hepatic stellate cells by upregulating MMP9, and blockade of this pathway may become a potential target for the treatment of liver fibrosis.

Role of phosphatase and tensin homolog deleted on chromosome ten in a rat model of carbon tetrachloride-induced liver fibrosis and the effect of qi-tonifying and blood-activating prescription
Niu XueMin, Wang BaoYu, Wang Yang, Zhao Wen, Fu Na, Zhao SuXian, Du JingHua, Wang RongQi, Zhang YuGuo, Nan YueMin
2018, 34(1): 122-128. DOI: 10.3969/j.issn.1001-5256.2018.01.025
Abstract:

Objective To investigate the role of phosphatase and tensin homology deleted on chromosome ten ( PTEN) in a rat model of carbon tetrachloride ( CCl4) -induced liver fibrosis and the molecular mechanism of action of qi-tonifying and blood-activating prescription in regulating PTEN and inhibiting liver fibrosis. Methods A total of 27 male Wistar rats were randomly divided into three groups, with 9 rats in each group. The rats in liver fibrosis group were treated with CCl4 to establish a model of liver fibrosis, and those in qi-tonifying and blood-activating prescription group were also treated with CCl4 to establish a model and then given a self-made qi-tonifying and blood-activating prescription containing Astragalus membranaceus, Salvia miltiorrhiza, and poria. The rats in the control group were given intraperitoneally injected olive oil. HE staining, Masson staining, and immunohistochemical staining of collagen type I alpha 1 ( Col1 A1) and collagen type Ⅳ ( Col4) were performed to observe the degree of liver fibrosis and collagen deposition; qRT-PCR, immunohistochemistry, and Western blot were used to measure the expression of transforming growth factor-β1 ( TGF-β1) , PTEN, and downstream genes AKT, mTOR, and p70 S6 K. A one-way 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. Results In the liver fibrosis group, liver pathology showed perisinusoidal fibrosis and fibrous tissue proliferation, collagen deposition, and formation of fibrous septum in the portal area; compared with the control group, the liver fibrosis group had significant increases in the mRNA and protein expression of TGF-β1, a significant reduction in the expression of PTEN, and significant increases in the mRNA and phosphorylated protein expression of AKT, mTOR, and p70 S6 K ( all P < 0. 01) . The qi-tonifying and blood-activating prescription group had a marked improvement in liver fibrosis; compared with the liver fibrosis group, the qi-tonifying and blood-activating prescription group had a significant increase in the expression of PTEN ( P < 0. 01) , significantly inhibited mRNA and protein expression of TGF-β1 ( both P < 0. 05) , and significant reductions in the mRNA and phosphorylated protein expression of AKT, mTOR, and p70 S6 K ( all P < 0. 05) . Conclusion Qi-tonifying and blood-activating prescription can prevent and reverse liver fibrosis, possibly by regulating the expression of PTEN and its downstream signal factors.

Original articles_Liver neoplasms
Value of Gd-EOB-DTPA-enhanced MRI in diagnosis of hepatocellular carcinoma
Sun Yu, Zhang Nan, Hou Jie, Ma XiangHong, Wang Wei, Yang BenQiang
2018, 34(1): 129-132. DOI: 10.3969/j.issn.1001-5256.2018.01.026
Abstract:

Objective To investigate the value of Gd-EOB-DTPA-enhanced MRI in the diagnosis of hepatocellular carcinoma ( HCC) .Methods A total of 40 patients with liver cirrhosis or suspected HCC who visited General Hospital of Shenyang Military Area Command from October 2016 to April 2017 were enrolled, and the data on three dynamic phases of Gd-EOB-DTPA-enhanced MRI ( arterial phase, portal venous phase, and delayed phase) , hepatobiliary phase ( delayed for 20 minutes) , and diffusion-weighted imaging ( DWI) ( b = 50, 400, and 1000 s/mm2) were collected. Two radiologists made a diagnosis and gave diagnostic confidence scores based on the presence or absence of hepatobiliary phase images. Postoperative pathology or clinical diagnosis was used as the criteria for assessing the diagnostic accuracy of HCC. The t-test was used for comparison of continuous data, and the chi-square test was used for comparison of categorical data.Results A total of 42 HCC lesions and 37 cirrhotic nodules were detected. There were significant differences between HCC lesions and cirrhotic nodules in signal intensity on hepatobiliary phase and DWI ( χ2= 64. 503 and 67. 855, both P < 0. 001) , as well as the apparent diffusion coefficient when the b-values of DWI were 400 s/mm2 and 1000 s/mm2 ( t = 62. 75 and 75. 36, both P < 0. 001) . There was a significant difference in diagnostic confidence score given by the radiologists between the images of three dynamic phases of Gd-EOB-DTPA-enhanced MRI and those of four dynamic phases ( including hepatobiliary phase) ( 3. 260 ± 0. 521 vs 4. 620 ± 0. 661, t = 10. 67, P <0. 001) . With postoperative pathology and clinical diagnosis as criteria, the images of three dynamic phases of Gd-EOB-DTPA-enhanced MRI had a significantly higher diagnostic accuracy for HCC than those of four dynamic phases ( including hepatobiliary phase) [76. 19% ( 32/42) vs 95. 24% ( 40/42) , χ2= 6. 222, P = 0. 013]. Conclusion Gd-EOB-DTPA-enhanced MRI may improve diagnostic accuracy and confidence for HCC and has an important clinical value.

Feasibility of i Flow color-coding technique in quantitative real-time measurement of hemodynamic changes after transarterial chemoembolization for hepatocellular carcinoma
Wang YuZhe, Yin HuaBin
2018, 34(1): 133-136. DOI: 10.3969/j.issn.1001-5256.2018.01.027
Abstract:

Objective To investigate the value of iFlow color-coding technique in quantitative real-time analysis of hemodynamic changes after transarterial chemoembolization ( TACE) for hepatocellular carcinoma ( HCC) . Methods A total of 31 patients who were diagnosed with HCC in Shanghai Fifth People's Hospital from December 2015 to January 2017 were enrolled. No patient underwent surgical operation or ablation. All patients underwent TACE with the same contrast agent, high-pressure injector parameters, and place of angiographic catheter. The iFlow technique was used to generate two-dimensional color-coded images and time-density curve ( TDC) before and after surgery and measure the opening of the angiographic catheter and the time to peak ( TTP) of the starting and ending points of the major tumor feeding arteries, as well as the ratio of the areas under the curve ( AUC) of TDC of tumor tissue and the opening of the angiographic catheter. The paired t-test was used for comparison of continuous data between groups. Results TTP of the major tumor feeding arteries was 4.64 ± 0. 49 s before TACE and 5. 97 ± 0. 84 s after TACE ( t = 11. 57, P < 0. 01) , and there was a significant difference in AUC between the tumor tissue and the opening of the angiographic catheter ( 0. 53 ± 0. 15 vs 0. 16 ± 0. 12, t = 25. 85, P < 0. 01) . There was no significant difference in TTP between the opening of the angiographic catheter and the major tumor feeding arteries before and after TACE ( P > 0. 05) .Before TACE, the TDC of tumor feeding arteries had a shape of“rapid increase-rapid reduction”with relatively high slope and peak value, while after TACE, the TDC had a shape of “increase-flat-reduction”with reductions in slope and peak value. Conclusion The iFlow technique can perform real-time measurement of TTP and TDC of the region of interest and helps with quantitative evaluation of hemodynamic changes in HCC. Therefore, it can provide objective quantitative indices for evaluating the degree of tumor embolism.

Clinical effect of transarterial chemoembolization combined with endovascular implantation of iodine-125 seeds in treatment of primary liver cancer complicated by portal vein tumor thrombus
Wang QiaoYu, Pan Jie, Zhou YuanMin
2018, 34(1): 137-141. DOI: 10.3969/j.issn.1001-5256.2018.01.028
Abstract:

Objective To investigate the clinical effect of transarterial chemoembolization ( TACE) combined with endovascular implantation of iodine-125 seeds in the treatment of primary liver cancer complicated by portal vein tumor thrombus ( PVTT) and its influence on liver function. Methods A retrospective analysis was performed for the clinical data of 96 patients with primary liver cancer complicated by PVTT who were admitted to Guangzhou No. 12 People's Hospital from January 2013 to December 2016. Among these patients, 52 were treated with TACE combined with endovascular implantation of iodine-125 seeds in the portal vein ( combination group) and 44 were treated with TACE alone ( control group) . The two groups were compared in terms of the outcome of tumor lesions and PVTT and the changes in related laboratory markers after treatment. 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 Compared with the control group, the combination group had significantly higher remission rates of tumor lesions ( 59. 62% vs 38. 64% , χ2= 4. 196, P = 0. 041) and PVTT ( 80. 77% vs 59. 09% , χ2=5. 421, P = 0. 020) . At 8 weeks after surgery, the combination group had significantly lower serum alpha-fetoprotein ( AFP) , diameter of the main portal vein, and platelet count ( PLT) and significantly higher serum levels of alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , and total bilirubin ( TBil) than the control group ( t = 3. 891, 3. 291, 2. 330, 3. 729, 3. 582, and 4. 126, all P <0. 05) ; both groups showed significant increases in serum levels of ALT, AST, and TBil ( all P < 0. 05) and significant reductions in PLT, serum AFP and diameter of the main portal vein ( all P < 0. 05) . Conclusion TACE combined with endovascular implantation of iodine-125 seeds in the portal vein has a better clinical effect than TACE alone in the treatment of primary liver cancer complicated by PVTT, but more attention should be paid to liver impairment during treatment.

Clinical effect on microwave coagulo-necrotic therapy combined with laparoscopic splenectomy in treatment of primary hepatocellular carcinoma complicated by hypersplenism
Liu ShuMin, Sun Qiu, Zhang MeiJu
2018, 34(1): 142-146. DOI: 10.3969/j.issn.1001-5256.2018.01.029
Abstract:
Objective To investigate the feasibility and safety of microwave coagulo-necrotic therapy ( MCN) combined with laparoscopic splenectomy ( LS) in the treatment of primary hepatocellular carcinoma ( PHC) complicated by hypersplenism. Methods A retrospective analysis was performed for the clinical data of 22 PHC patients with hypersplenism who were admitted to Baoji Municipal People' s Hospital from January 2008 to December 2012 and underwent MCN combined with LS. Their clinical data were collected, and postoperative complications and survival were observed. The t-test was used for comparison of continuous data, and the Kaplan-Meier method was used to plot cumulative survival curves. Results In MCN therapy, 5 patients underwent thoracotomy, 15 underwent laparotomy, and 2 underwent laparoscopic surgery; in LS treatment, 17 underwent hand-assisted LS and 5 underwent simple LS. The mean time of operation was ( 303. 24 ±56. 02) min, the mean blood loss volume was ( 146. 92 ± 60. 72) ml, and the mean weight of the resected spleen was ( 670. 42 ± 204. 54) g. Of all patients, 6 ( 27. 27% ) experienced postoperative recurrence, 5 ( 22. 73% ) experienced portal vein thrombosis, and 2 ( 9. 09% ) experienced pleural effusion. There was a significant increase in platelet count at 1 month after surgery [ ( 15. 72 ± 5. 47) ×104/μl vs ( 4. 43 ±1. 03) ×104/μl, t = 6. 83, P < 0. 001]. The 1-, 3-, and 5-year overall survival rates after surgery were 90. 91% , 68. 18% , and 59. 09% , respectively, and the 1-, 3-, and 5-year disease-free survival rates were 59. 09% , 13. 64% , and 13. 64% , respectively.Conclusion MCN combined with LS is safe, effective, and feasible in the treatment of PHC complicated by hypersplenism.
Original articles_Pancreatic diseases
Clinical features of acute pancreatitis of different etiologies
Wang BeiBei, Liao ShanYing, Ma Juan, Bu XiaoLing, Sha WeiHong
2018, 34(1): 147-151. DOI: 10.3969/j.issn.1001-5256.2018.01.030
Abstract:

Objective To investigate the clinical features of acute pancreatitis ( AP) of different etiologies. Methods A retrospective analysis was performed for the clinical data of 150 patients with AP who were admitted to Department of Gastroenterology, Guangdong General Hospital, from January 2014 to December 2015, and among these patients, 97 had biliary pancreatitis, 32 had hyperlipidemic pancreatitis, and 21 had alcoholic pancreatitis. The three groups were compared in terms of sex, age, comorbidities, laboratory examination, distribution of severity, complications, related scores, and length of hospital stay. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t-test was used for further comparison between any two groups. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Mann-Whitney U test was used for further comparison between any two groups. The chi-square test or Fisher' s exact test was used for comparison of categorical data between groups, and the Kruskal-Wallis H test was used for comparison of ranked data between groups. Results The biliary pancreatitis group had a significantly older age of onset than the other two groups, and most of the patients in this group were female, while most of the patients in the other two groups were male ( all P < 0. 05) . The biliary pancreatitis group had a significantly higher proportion of patients with heart disease or hypertension, while the hyperlipidemic pancreatitis group had a significantly higher proportion of patients with diabetes ( all P < 0. 05) . The biliary pancreatitis group had significantly higher levels of blood amylase, alanine aminotransferase, and aspartate aminotransferase and a significantly lower level of C-reaction protein on admission and at 72 hours after admission, compared with the other two groups ( all P < 0. 05) . The hyperlipidemic pancreatitis group had significantly higher levels of blood glucose, blood lipids ( triglyceride and cholesterol) , and glycosylated hemoglobin ( all P < 0. 05) . There was no significant difference in distribution of severity between the three groups ( P > 0. 05) . The biliary pancreatitis group had significantly lower incidence rate of acute fluid collection and MCTSI score than the other two groups ( both P < 0. 05) , and the alcoholic pancreatitis group had a significantly higher incidence rate of systemic infection than the other two groups ( P < 0. 05) . There was no significant difference in the length of hospital stay between the three groups ( P > 0. 05) . Conclusion The difference in the etiology of AP does not affect disease severity and prognosis. The etiology of AP can be identified as early as possible with reference to the features of demographics, comorbidities, and laboratory examination, and therefore, proper treatment can be given to improve patients' prognosis.

Clinical significance of abnormal liver function in determining the etiology and severity of acute pancreatitis
Zhao Qi, Wang Bing, Li ZhenFang, Fang ChunFang, Li Cong, Li SenLin
2018, 34(1): 152-156. DOI: 10.3969/j.issn.1001-5256.2018.01.031
Abstract(2833) PDF (1578KB)(1088)
Abstract:

Objective To investigate the association of liver function parameters with etiology and severity in patients with acute pancreatitis ( AP) complicated by liver injury, and to clarity the clinical significance of the change in liver function in determining the etiology and severity of AP. Methods A retrospective analysis was performed for the clinical data of 163 AP patients who were hospitalized in Liaocheng People's Hospital from January 2011 to March 2016, and according to the etiology, these patients were divided into biliary AP group with 85 patients and non-biliary AP group with 78 patients. According to the Balthazar CT grade, the patients were divided into mild acute pancreatitis ( MAP) group with 138 patients and severe acute pancreatitis ( SAP) group with 25 patients. Of all patients in the biliary AP group, 18 had biliary SAP and 67 had biliary MAP; of all patients in the non-biliary AP group, 7 had non-biliary SAP and 71 had non-biliary MAP. The groups were compared in terms of liver function parameters alanine aminotransferase ( ALP) , aspartate aminotransferase ( AST) , gamma-glutamyl transpeptidase ( GGT) , and alkaline phosphatase ( ALP) , and the change in liver function was observed on admission and at 48 and 96 hours after admission. The t-test was used for comparison of continuous data between two groups; an analysis of variance was used for comparison between three groups, and the SNK-q test was sued for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. Results In the patients with MAP, there were significant differences in the levels of ALT, AST, ALP, and GGT between the biliary AP group and the non-biliary AP group ( all P < 0. 05) ; in the patients with SAP, there were only significant differences in the levels of ALP and GGT between the biliary AP group and the non-biliary AP group ( both P<0. 05) . As for liver injury caused by biliary AP, there were significant reductions in the levels of ALT, AST, ALP, and GGT at 48-96 hours after admission ( all P < 0. 05) , while in the patients with non-biliary AP, there were no significant changes in these liver function parameters ( all P >0. 05) . Compared with the non-biliary AP group, the biliary AP group had a significantly higher incidence rate of an abnormal level of ALP, GGT, or ALP + GGT ( all P < 0. 05) . In the patients with AP caused by the same reason, there was no significant difference in liver function between SAP and MAP patients ( all P > 0. 05) . Conclusion Most patients with AP tend to have abnormal liver function, especially those with biliary AP. As for patients with MAP, abnormal liver function often indicates biliary AP; as for patients with SAP, ALT and AST have a low value in predicting etiology, while ALP and GGT are more sensitive, i. e., the increase in ALT and GGT indicates the possibility of biliary AP. When the change in liver function is monitored continuously, the patients with significant reductions in liver function parameters, especially the levels of ALT and AST, tend to have a higher possibility of biliary AP. The degree of liver injury, especially the activities of aminotransferases, is not associated with the severity of AP.

Clinical application of duodenum-preserving pancreatic head resection
Zhou SongQiang, Tian YiFeng, Lai ZhiDe, Qiu FuNan, Yan MaoLin, Wang YaoDong
2018, 34(1): 157-159. DOI: 10.3969/j.issn.1001-5256.2018.01.032
Abstract:

Objective To investigate the indications and therapeutic effect of duodenum-preserving pancreatic head resection ( DPPHR) .Methods A retrospective analysis was performed for the clinical data of 17 patients who underwent DPPHR in Fujian Provincial Hospital from January 2013 to February 2017. Among these patients, 6 had chronic pancreatitis with pancreatic duct stones, 2 had chronic pancreatitis with pancreatic pseudocyst, 3 had solid pseudopapillary tumor of the pancreatic head, 3 had intraductal papillary mucinous neoplasm, 2 had serous cystadenoma of the pancreatic head, and 1 had mucinous cystadenoma of the pancreatic head. Results The time of operation was 200-360 minutes ( mean 304. 0 ± 45. 3 minutes) , and the intraoperative blood loss was 50-500 ml ( mean 267. 5 ± 116. 1 ml) . No patient died in the perioperative period. After surgery, 5 experienced biochemical leak, 2 experienced grade B pancreatic fistula, no patient experienced grade C pancreatic fistula, and 1 experienced gastroplegia; all these patients were cured and discharged after conservative treatment. The length of postoperative hospital stay was 17-78 days ( mean 30. 8 ± 14. 3 days) . The 17 patients were followed up for 2 months to 4 years after surgery, and no patient experienced tumor recurrence, new-onset diabetes, dyspepsia, or common bile duct stenosis after surgery. Conclusion Besides ensuring the complete resection of tumor, DPPHR can reduce the incidence rate of surgical trauma and complications and shorten the time of operation and the length of hospital stay. Compared with pancreaticoduodenectomy, DPPHR can better preserve the endocrine and exocrine functions of the pancreas and improve patients' postoperative quality of life.

Expression of Sema4D and Ki67 in pancreatic carcinoma and its relationship with clinicopathological features
Jia RuJiang, Hou LiYan, Yin QingChen
2018, 34(1): 160-163. DOI: 10.3969/j.issn.1001-5256.2018.01.033
Abstract:

Objective To investigate the expression of Sema4 D and Ki67 in pancreatic carcinoma and its relationship with clinicopathological features. Methods The expression of Sema4 D and Ki67 in 40 pancreatic carcinoma tissues and 10 adjacent tissues was measured by immunohistochemistry, and its relationship with the clinicopathological features of pancreatic carcinoma was analyzed. Comparison of categorical data between two groups was made by chi-square test. Spearman's rank correlation analysis was used to identify the correlation between these variables. Results Sema4 D and Ki67 were detected in 19 ( 47. 5% ) and 18 ( 45. 0% ) , respectively, of the 40 pancreatic carcinoma tissues, with significantly higher positive rates than the adjacent tissues ( χ2= 10. 040 and 10. 000, P = 0. 020 and 0. 022) . The abnormal expression of Sema4 D and Ki67 differed significantly between patients with different tumor stages and between patients with and without lymph node metastasis ( χ2= 6. 352, 4. 912, 12. 031, and 6. 465, P = 0. 013, 0. 028, 0. 001, and 0. 025) . Sema4 D expression was positively correlated with Ki67 expression ( r = 0. 347, P = 0. 028) . Conclusion The expression of Sema4 D and Ki67 is elevated in pancreatic carcinoma compared with the adjacent tissue. Their expression is positively correlated with each other and is associated with tumor staging and lymph node metastasis.

Original articles_Others
Detection rates of autoantibodies in patients with drug-induced liver injury and their clinical significance
Jiang HongLi, Qi YaBin, Zhang Rui, Hu YuLin
2018, 34(1): 164-167. DOI: 10.3969/j.issn.1001-5256.2018.01.034
Abstract:

Objective To investigate the detection rates of autoantibodies in patients with drug-induced liver injury ( DILI) and their clinical significance. Methods A total of 132 patients with DILI who were admitted to The First Hospital of Jilin University from January 2009 to December 2013 were enrolled, and 96 patients with chronic hepatitis B ( CHB) who were hospitalized during the same period of time were enrolled as controls. The patients were analyzed with respect to the detection rate of autoantibody, titers and types of autoantibodies, age, sex, type of drugs inducing liver injury, time of onset, biochemical parameters for liver function, and coagulation parameters. The chi-square test was used for comparison of categorical data between groups. Results In the patients with DILI, the detection rate of autoantibodies was 60. 6% ( 80/132) , and the detection rates of anti-nuclear antibody, anti-smooth muscle antibody, and anti-mitochondrial antibody were 56. 1% , 12. 9% , and 3. 0% , retrospectively; the antibody titer was mainly low titer and moderate titer. In patients with CHB, the detection rate of autoantibodies was 45. 8% ( 44/96) , which was significantly lower than the detection rate in the patients with DILI ( χ2= 4. 889, P = 0. 027) . In the patients with DILI, the detection rate of autoantibodies was not associated with sex, age, typing, or Child-Pugh class, while it was associated with medication time, and there was a significant difference in the positive rate of autoantibody between the patients with a medication time of > 1 month and those with a medication time of ≤1 month ( 68. 9% vs 40. 6% , χ2= 7. 963, P = 0. 004 8) . Conclusion A variety of autoantibodies can be detected in patients with DILI, mainly low-and moderate-titer autoantibodies, among which anti-nuclear antibody is the most common one. The detection rate of autoantibody increases with the increase in medication time.

Case reports
Antiviral therapy using sofosbuvir combined with ribavirin after transcatheter arterial chemoembolization for hepatitis C virus-related hepatocellular carcinoma with tumor thrombus in the right atrium: a case report
Li CuiCui, Ma JingTing, Zhou He, Hu RongRong, Wang Kai, Li DongFu
2018, 34(1): 168-171. DOI: 10.3969/j.issn.1001-5256.2018.01.035
Abstract:
Hepatic perivascular epithelioid cell tumor (PEComa): a case report and literature review
Gao WeiKe, Dai ChaoLiu
2018, 34(1): 172-176. DOI: 10.3969/j.issn.1001-5256.2018.01.036
Abstract:
Multiple metastases of malignant melanoma: a case report
Kui YiWen, Wen XiaoYu, Wang Yao, Xu XiJing, Jin QingLong
2018, 34(1): 177-178. DOI: 10.3969/j.issn.1001-5256.2018.01.037
Abstract:
A case report of benign recurrent intrahepatic cholestasis
Chai XiaoZhe, Zhu Wei, Luo XiangRong, Qian Feng, Zhu ChuanWu
2018, 34(1): 179-180. DOI: 10.3969/j.issn.1001-5256.2018.01.038
Abstract:
Reviews
Relationship between the Notch signaling pathway and the development and progression of liver fibrosis
Zhang Xu, Liu Ping, Mu YongPing
2018, 34(1): 181-183. DOI: 10.3969/j.issn.1001-5256.2018.01.039
Abstract:

The Notch signaling pathway mainly includes Notch receptors and ligands, transcription factors, and DNA binding proteins. It decides the way of cell proliferation, differentiation, and apoptosis. Recent studies have shown that the Notch signaling pathway plays an important role in the development and progression of liver fibrosis, and blocking or activating the Notch signaling pathway can influence the progression of liver fibrosis. This article reviews the research advances in the composition of the Notch signaling pathway, the mechanism by which it is activated, and its association with liver fibrosis.

Advances in the effect of carvedilol in prevention and treatment of esophageal variceal bleeding in patients with cirrhosis
Niu XiaoWei, Liu TongTing, Wei Zhi
2018, 34(1): 184-187. DOI: 10.3969/j.issn.1001-5256.2018.01.040
Abstract:

Carvedilol is a new non-selective beta blocker, and studies have proven that the effect of carvedilol in receptor blocking is 2-4 times that of propranolol. Carvedilol is widely used in the treatment of heart failure. However, there are still controversies over its effect in reducing portal pressure and preventing esophageal variceal bleeding. This article analyzes and compares the clinical application of carvedilol, propranolol, and endoscopic variceal ligation in the prevention and treatment of bleeding and summarizes the pharmacological action, clinical effect, dose, and adverse reactions of carvedilol. It is pointed out that carvedilol can significantly improve hemodynamic disorder caused by portal hypertension and thus may become a new drug for the prevention and treatment of esophageal variceal bleeding.

Anesthetic management strategies for patients with cirrhotic portal hypertension
Wang Lin, Xu JiPing, Liu Jing, Ma XianChun, Sun WenBing
2018, 34(1): 188-191. DOI: 10.3969/j.issn.1001-5256.2018.01.041
Abstract:

Patients with cirrhotic portal hypertension tend to develop multiple organ dysfunction and have special requirements for anesthetic management, which involves disorders in the metabolism of anesthetics, hyperdynamic circulation, perioperative hypoxemia, coagulation disorder, bleeding, thrombosis, and hepatic encephalopathy, and thus it becomes a difficult issue in the work of anesthesiologists. This article reviews the anesthetic management strategies for cirrhotic portal hypertension, in order to provide an effective reference for optimization of perioperative anesthetic management.

Research advances in the influence of hepatic stellate cells on precancerous lesions of liver cirrhosis and hepatocellular carcinoma via the TGFβ1-PI3K/AKT signaling pathway
Ju Di, Li JingTao, Han Man, Wei HaiLiang, Yan ShuGuang, Li Mi, Shi XiaoYan, Chang ZhanJie
2018, 34(1): 192-194. DOI: 10.3969/j.issn.1001-5256.2018.01.042
Abstract:

The malignant transformation of the precancerous lesions of liver cirrhosis and hepatocellular carcinoma ( HCC) leads to the formation of liver cancer. Hepatic stellate cells ( HSCs) play a role in the production of cells in precancerous lesions of HCC, the formation of hepatic fibrosis microenvironment, and the interaction between them via the TGFβ1-PI3 K/AKT signaling pathway. An understanding of the mechanism for the malignant transformation of the precancerous lesions of liver cirrhosis and HCC and the association between HSCs and the TGFβ1-PI3 K/AKT signaling pathway helps to investigate the pathogenesis of HCC. Regulation of HSCs or intervention of the TGFβ1-PI3 K/AKT signaling pathway can inhibit or reverse the progression of liver cirrhosis to HCC, which provides new thoughts and therapeutic targets for prevention and intervention of the development of HCC.

Current status of non-surgical local therapies for hepatocellular carcinoma originating from the caudate lobe and related research advances
Yao ChangYu, Du YingRui, Ke Shan, Gao Jun, Sun WenBing
2018, 34(1): 195-198. DOI: 10.3969/j.issn.1001-5256.2018.01.043
Abstract:

Hepatocellular carcinoma originating from the caudate lobe is a special type of hepatocellular carcinoma, and surgical resection is a conventional therapeutic method for this disease. However, the special anatomical position and complex structure of the caudate lobe make it difficult to perform surgical resection, especially laparoscopic resection. In the past decade, non-surgical local therapies, such as radiofrequency ablation, microwave ablation, transcatheter arterial chemoembolization, ethanol injection, and radiotherapy, are playing a more and more important role in the comprehensive treatment of hepatocellular carcinoma originating from the caudate lobe and have been recommended as the preferred treatment modality for patients with such disease who are not suitable for surgical resection. This article discusses the current status of non-surgical local therapies for hepatocellular carcinoma originating from the caudate lobe and related research advances.

Research advances in tumor markers for the diagnosis of hepatocellular carcinoma
Yang GuiMin, Zhao YunSheng, Wang ChunHua, Jin Liang
2018, 34(1): 199-203. DOI: 10.3969/j.issn.1001-5256.2018.01.044
Abstract:
Hepatocellular carcinoma ( HCC) is a malignant tumor with a high fatality rate in the world, and alpha-fetoprotein ( AFP) is the most commonly used tumor marker for HCC diagnosis. However, AFP does not have a satisfactory sensitivity or specificity and may lead to missed diagnosis when the tumor is small in the early stage of HCC. This article summarizes the clinical value of new tumor markers in the diagnosis, treatment monitoring, and prognosis judgment of HCC and analyzes the future prospects of the measurement of tumor markers for HCC. It is pointed out that combined determination of several tumor markers helps to improve the sensitivity and specificity of HCC diagnosis, and the screening and optimization of combined determination of tumor markers, noninvasive and efficient tumor markers, and individualized treatment are research hotspots in future.
A preliminary study of the pathogenesis of malnutrition in patients with hepatic alveolar echinococcosis
Ma Bao, Deng Yong, Wang ZhiXin, Wang HaiJiu, Fan HaiNing
2018, 34(1): 204-206. DOI: 10.3969/j.issn.1001-5256.2018.01.045
Abstract:

Hepatic echinococcosis has become a major threat to human health. Hepatic alveolar echinococcosis caused by Echinococcus multilocularis infection has the features of slow and insidious onset, a high probability of surgery, slow postoperative recovery, and many complications and thus does great harm to humans. Most of the patients with hepatic alveolar echinococcosis also have varying degrees of malnutrition on admission, which is closely associated with surgical tolerance, postoperative rehabilitation, and the development of complications.However, the pathogenesis of malnutrition in patients with hepatic alveolar echinococcosis remains unknown. This article elaborates on possible mechanisms and points out that malnutrition in such patients is a result of various factors and complex mechanisms.