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

2018 No. 9

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Editorial
More attention to hotspots and difficulties in research on liver failure
Wang YuMing, Zhao XueLan
2018, 34(9): 1819-1823. DOI: 10.3969/j.issn.1001-5256.2018.09.001
Abstract:
There are many hot and difficult points in the diagnosis and treatment of liver failure, and controversies still exist both at home and abroad. In the Western countries, the diagnosis of acute liver failure (ALF) does not depend on history of chronic liver disease. In Asian-Pacific region, including China, it is believed that the basis of chronic liver disease is an important factor determining disease characteristics. Etiological treatment is believed to be very important in the treatment of ALF. It has been confirmed that the application of NAC can significantly improve the overall survival rate of ALF induced by drug-induced liver injury. However, some scholars believe that the use of long-course NAC can not increase patients' benefits, which still needs further confirmation. For indications of HBV-ALF antiviral therapy, HBV DNA is not required to be positive in any guidelines except the guidelines in China. Although patients with HCV-related cirrhosis can achieve high SVR rate with DAA antiviral therapy, the clinical safety profile of various DAA treatments should be fully evaluated. Prophylactic use of antibiotics may be beneficial in patients with liver failure, but there is also an argument for lacking of evidence. Empirical antimicrobial therapy should be formulated according to the specific situation and non-antibiotic treatment can be tried to prevent infection including probiotics, gastrointestinal motility regulators, simvastatin, etc. It has been found that immunomodulators play an important role in the treatment of liver failure, but the timing, indications, dosage, course of treatment, specificity and adaptability of different liver injuries remain further clinical research. In conclusion, clinical experts should apply guidelines and consensus flexibly and rationally, and conduct in depth research based on specific situations as well as the guidelines and consensus, so as to improve the level of diagnosis and treatment of liver failure.
Discussions by experts
Research advances in acute liver failure
Jiang Hong, Bai XueFan
2018, 34(9): 1824-1831. DOI: 10.3969/j.issn.1001-5256.2018.09.002
Abstract:
Acute liver failure (ALF) is a syndrome characterized by rapid onset, rapid progression, and poor prognosis. Although much progress has been achieved in the etiology and pathogenesis of ALF and emergency liver transplantation and comprehensive treatment have significantly increased the treatment success rate, there are still many difficult issues in clinical practice. This article reviews the research advances in the classification, etiology, main clinical types, prognostic scoring system, and treatment of ALF in recent years.
Precision medicine and treatment strategies for liver failure
Zhu Bing, Xin ShaoJie, You ShaoLi
2018, 34(9): 1832-1835. DOI: 10.3969/j.issn.1001-5256.2018.09.003
Abstract:
Liver failure is one of the most serious diseases in clinical practice and has a low treatment success rate. The concept of precision medicine provides more enlightenment for the treatment of liver failure. An accurate understanding of the scientific connotation of precision medicine and the application of advanced techniques can improve the accurate diagnosis of liver failure. This article elaborates on the search for new treatment targets, blockade of hepatocyte necrosis, and the application of genetic technology to realize accurate medication and individualized biotherapy for liver failure. It is pointed out that the accurate diagnosis and treatment of liver failure can improve the level of treatment.
Advances in research hotspots in liver failure complicated by acute kidney injury
Zhuang Yan, Xie Qing
2018, 34(9): 1836-1841. DOI: 10.3969/j.issn.1001-5256.2018.09.004
Abstract:
Acute kidney injury (AKI) is defined as a sharp drop in glomerular filtration rate (GFR) and a rapid increase in serum creatinine and is one of the most serious complications of liver failure. Early diagnosis and treatment play a vital role in reducing the mortality and improving the prognosis of liver failure. This article elaborates on the research advances in the diagnostic criteria, pathogenesis, biomarkers, clinical features, and treatment of AKI and points out that constant modification of the definition and staging of AKI and research and development of efficient biomarkers for AKI are future research directions.
Hotspots and difficulties in the diagnosis and treatment of liver failure with infection
Chen Guang, Chen Tao, Ning Qin
2018, 34(9): 1842-1846. DOI: 10.3969/j.issn.1001-5256.2018.09.005
Abstract:
Liver failure is a serious liver damage caused by a variety of factors, and infection is one of the most common complications in the development and progression of liver failure. Liver failure patients with infection have a significant increase in mortality, which is a difficult clinical event for physicians. At present, there are no sufficient clinical data on the diagnosis and treatment of liver failure with infection, and there is also a lack of guidelines for clinical diagnosis and treatment in China and foreign countries. This article summarizes the difficulties and hotspots in the prevalence, pathophysiology, diagnosis, and treatment of liver failure with infection, in order to provide guidance for clinical diagnosis and treatment and directions for further clinical research.
Advances in the application of artificial liver in liver failure
Wang XiaoXiao, Huang JianRong
2018, 34(9): 1847-1854. DOI: 10.3969/j.issn.1001-5256.2018.09.006
Abstract:
Liver failure is a serious stage in the development of various liver diseases, with rapid progression, critical conditions, and a high mortality rate. Artificial liver can eliminate toxic substances in the body, supplement essential substances, and create opportunities for hepatocyte regeneration and liver function recovery, and in addition, it can also prolong the waiting time for liver transplantation and thus acts as a bridge to liver transplantation. However, the wide application of artificial liver is facing many difficulties nowadays, such as shortage of blood sources, difficulties in cell sources, a lack of satisfactory effects, and high costs, and therefore, artificial liver treatment needs innovation and improvement. New non-bioartificial liver systems developed in recent years, such as double plasma molecular absorption system, molecular absorbent recirculating system, continuous albumin purification system, and plasma diafiltration, can help to achieve a good clinical outcome and meanwhile reduce the amount of plasma used and minimize side effects. Biological artificial liver and hybrid artificial liver systems have the functions of specific detoxification, biosynthesis, and transformation and thus have great potential in clinical application, which is limited by cell source, cell culture, and bioreactor. This article elaborates on the current status and advances in the application of artificial liver in the treatment of liver failure and provides research directions for the development of artificial liver.
Therapeutic guidelines
Ni QianQian, Wu HuiMin, Hua Jing
2018, 34(9): 1873-1876. DOI: 10.3969/j.issn.1001-5256.2018.09.009
Abstract:
Sun MengYing, Tang ShanHong, Ceng WeiZheng
2018, 34(9): 1877-1878. DOI: 10.3969/j.issn.1001-5256.2018.09.010
Abstract:
Original articles_Viral hepatitis
Value of serum hepatitis B virus core-related antigen in predicting the treatment outcome of HBeAg-positive chronic hepatitis B patients treated with pegylated interferon-α
Wang Qing, Xu ZhiQiang, Liu RuiXia, Fu JuanJuan, Li Li, Pan XiuCheng
2018, 34(9): 1879-1883. DOI: 10.3969/j.issn.1001-5256.2018.09.011
Abstract:
Objective To investigate the value of hepatitis B virus core-related antigen (HBcrAg) in predicting the treatment outcome of HBeAg-positive chronic hepatitis B (CHB) patients treated with pegylated interferon-α (PEG-IFNα) . Methods A total of 79 HBeAg-positive CHB patients who were treated with PEG-IFNα in Department of Infectious Diseases in The Affiliated Hospital of Xuzhou Medical University from May 2012 to June 2015 were enrolled. The course of treatment was 48 weeks, and the patients were followed up for at least 24 weeks after treatment. HBcrAg, HBV serum markers, HBV DNA, and alanine aminotransferase (ALT) level were measured before treatment and at weeks 12, 24, and 48 of treatment. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups; a Pearson correlation analysis was performed to investigate correlation; a binary logistic regression analysis was used to identify the influencing factors for complete response; the receiver operating characteristic (ROC) curve was used to investigate the value of HBcrAg in predicting complete response. Results Among the 79 HBeAg-positive CHB patients who were treated with PEG-IFNα antiviral therapy and then followed up for 24 weeks, 35 achieved complete response. Compared with the non-response group, the response group had a significantly lower baseline HBs Ag level (P = 0. 008) , HBeAg level (P < 0. 001) , and HBcrAg level (P = 0. 002) . Baseline HBcrAg was positively correlated with HBV DNA (r = 0. 325, P =0. 003) , HBs Ag level (r = 0. 468, P < 0. 001) , and HBeAg level (r = 0. 695, P < 0. 001) and was not correlated with ALT level. Serum HBcrAg tended to decrease during treatment, and at week 12 of treatment, the response group had a significantly greater reduction in HBcrAg level compared with the non-response group (Z =-2. 653, P = 0. 008) . HBcrAg level at week 12 of treatment was an independent risk factor for complete response (odds ratio = 5. 510, 95% confidence interval: 1. 656-18. 326, P < 0. 05) . The optimal cut-off value of serum HBcrAg was 6. 45 log10 U/ml, and the area under the ROC curve was 0. 845. Conclusion HBcrAg is correlated with HBs Ag, HBeAg, and HBV DNA before PEG-IFNα antiviral therapy. Serum HBcrAg level at week 12 of treatment can be used to predict complete response after PEG-IFNα treatment.
Establishment and application of a database for hepatitis C virus NS3/4A protease inhibitors and their drug resistance data
Xie Lei, Hao Pei, Wu RuiHong, Li QingChao, Niu JunQi, Zhong Jing
2018, 34(9): 1884-1890. DOI: 10.3969/j.issn.1001-5256.2018.09.012
Abstract(2048) PDF (738KB)(333)
Abstract:
Objective To establish a database for direct-acting antiviral agents (DAAs) targeting hepatitis C virus (HCV) NS3/4 A protease and related resistance-associated variants, and to investigate its application in drug resistance analysis. Methods The published data and information of anti-NS3/4 A DAAs and related drug resistance data were collected and mined. The in vitro data of viral drug-resistant mutations and resistance-associated variants identified in clinical treatment were entered into the database, and a statistical analysis was performed based on the type of drugs, HCV genotypes, positions of drug-resistant mutations, and type of substituted amino acids. Some of the results were available for online query on a website. Then the database was used to perform a multi-data analysis of the drug resistance of genotype 3 HCV, a well-known difficult-to-treat viral genotype. Results A database for anti-NS3/4 A DAAs and their drug resistance data was established and some data were available for online query on a website (http://www. biosino. org/hcv/) . This database consisted of the following four parts, with over ten thousands of pieces of information: the information of DAAs; the in vitro drug-resistance data of viral strains with different genotypes containing drug-resistant mutations; the prevalence of pre-existing resistance-associated variants and their detection rates in patients with treatment failure; the three-dimensional structures of the DAA-NS3/4 A protease complex.This database was used to analyze drug resistance of all genotypes of HCV, and it was found that anti-NS3/4 A DAAs had the poorest therapeutic effect in patients with genotype 3 HCV. Although the third-generation anti-NS3/4 A DAAs had a good antiviral effect in patients with wild-type genotype 3 HCV, drug-resistant mutations might occur. Conclusion This database is the first one in China for anti-NS3/4 A DAAs and their drug-resistance data and provides an important resource of information and guidance for research on drug resistance and clinical treatment of HCV.
Original articles_Liver fibrosis and liver cirrhosis
Efficiency of FibroTouch in evaluating liver fibrosis degree in nonalcoholic fatty liver disease patients with different levels of body mass index
Leng XueJun, Yan XueBing
2018, 34(9): 1891-1895. DOI: 10.3969/j.issn.1001-5256.2018.09.013
Abstract:

Objective To investigate the efficiency of Fibro Touch noninvasive liver stiffness measurement (LSM) in evaluating liver fibrosis degree in nonalcoholic fatty liver disease (NAFLD) patients with different levels of body mass index (BMI) . Methods A total of 238 NAFLD patients who were admitted to The Affiliated Hospital of Xuzhou Medical University from June 2015 to January 2018 and underwent liver biopsy were enrolled in this study, and according to BMI, they were divided into group A (BMI < 24) , group B (24≤BMI < 28) , and group C (BMI≥28) . Fibro Touch was performed within one week after liver biopsy, and fasting blood samples were collected on the same day. The fibrosis indices were calculated. The efficiency of LSM in evaluating fibrosis degree was analyzed in all groups, and the correlation of LSM with related serological fibrosis indices was analyzed. The receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was used to evaluate the diagnostic value of LSM and serum markers. A one-way analysis of variance and the SNK-q test were used to investigate the differences in related indices between NAFLD patients with varying fibrosis degrees, and the Kruskal-Wallis H test was used for comparison of non-normally distributed data. The Spearman's rank correlation analysis was used to investigate the correlation between LSM and other indices. Results In group A, B, or C, there was a significant difference in LSM between the NAFLD patients with different fibrosis degrees (F = 18. 543, 22. 985, and 5. 904, P < 0. 001, P < 0. 001, and P = 0. 004) . In the NAFLD patients with progressive liver fibrosis, there was a significant difference in LSM between the patients with different levels of BMI (F = 3. 899, P = 0. 026) . LSM was correlated with Hui score, Forns index, fibrosis-4, and NAFLD fibrosis score (r = 0. 459, 0. 388, 0. 427, and 0. 422, all P < 0. 001) . LSM had the highest efficiency in the diagnosis of progressive liver fibrosis in NAFLD patients, with an AUC of 0. 870, a specificity of 86%, and a sensitivity of 70%. Conclusion Fibro Touch has good value in evaluating the liver fibrosis degree of NAFLD patients, and BMI may affect the result of LSM. LSM is well correlated with other diagnostic indices for liver fibrosis and holds promise for clinical application.

Diagnostic value of serum YKL-40 for liver fibrosis stage: A meta-analysis
Zhang YanFang, Yang FuNing, Che YuanYuan, Huang Jing
2018, 34(9): 1896-1900. DOI: 10.3969/j.issn.1001-5256.2018.09.014
Abstract(1871) PDF (417KB)(359)
Abstract:
Objective To explore the diagnostic value of serum YKL-40 for liver fibrosis stage, and to provide a reference for noninvasive diagnosis of liver fibrosis in patients with chronic liver disease. Methods We searched Pub Med, EMBASE, the Cochrane Library, Web of Science, and CNKI for studies on the clinical value of YKL-40 in the diagnosis of liver fibrosis or cirrhosis. The quality of studies was evaluated using the QUADAS-2 tool to assess the risk of bias. Comprehensive quantitative evaluation of the included studies was performed using Stata 12. 0. The source of heterogeneity was analyzed, and the forest plot and summary receiver operating curve (SROC) were generated. Results A total of nine studies involving 1592 patients were included in the meta-analysis; six studies were conducted on significant fibrosis (≥F2) , and seven studies were conducted on progressive fibrosis (≥F3) . In the diagnosis of significant fibrosis (≥F2) , YKL-40 had pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, odds ratio, and area under the SROC (AUC) of0. 78 (95% confidence interval [CI]: 0. 69-0. 85) , 0. 53 (95% CI: 0. 33-0. 72) , 1. 7 (95% CI: 1. 0-2. 7) , 0. 41 (95% CI: 0. 21-0. 76) , 4 (95% CI: 1-13) , and 0. 76 (95% CI: 0. 72-0. 80) , respectively. In the diagnosis of progressive fibrosis (≥F3) , YKL-40 had pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, odds ratio, and AUC of 0. 83 (95% CI: 0. 76-0. 89) , 0. 72 (95% CI: 0. 62-0. 80) , 3. 0 (95% CI: 2. 0-4. 4) , 0. 23 (95% CI: 0. 14-0. 37) , 13 (95% CI: 5-30) , and 0. 85 (95% CI: 0. 82-0. 88) , respectively. Conclusion The diagnostic value of serum YKL-40 for significant and progressive liver fibrosis is limited, so it may not be a new, effective serum marker for the staging of liver fibrosis.
Level of high-mobility group box 1 in patients with chronic hepatitis B and liver cirrhosis and its clinical significance
Yang XinYing, Kang FuBiao, Ye LiHong, Dai ErHei, Sun DianXing
2018, 34(9): 1901-1904. DOI: 10.3969/j.issn.1001-5256.2018.09.015
Abstract:
Objective To investigate the correlation of serum high-mobility group box 1 (HMGB1) level with hepatic inflammatory activity, liver fibrosis degree, and liver function parameters in chronic hepatitis B patients. Methods A total of 73 patients with chronic hepatitis B and liver cirrhosis were enrolled as subjects. Liver biopsy was performed to determine inflammatory activity and liver fibrosis degree, liver function parameters and serum HMGB1 level were measured, and the correlation between HMGB1 level and other indices was analyzed. The t-test was used for comparison between two groups, and a linear correlation analysis was performed to investigate the correlation between two indices. Results The patients with chronic hepatitis B and liver cirrhosis had a significantly higher HMGB1 level than the healthy control group (29. 46 ± 7. 54 ng/ml vs 16. 86 ± 3. 48 ng/ml, t = 5. 668, P < 0. 01) . The G3-G4 group had a significantly higher HMGB1 level than the G1-G2 group (t = 4. 441, P < 0. 01) , while there was no significant difference in HMGB1 level between the S1-S2 group and the S3-S4 group (t = 0. 658, P > 0. 05) . Serum HMGB1 level was positively correlated with alanine aminotransferase (r = 0. 256 6, P = 0. 028 4) and aspartate aminotransferase (r = 0. 471 9, P < 0. 000 1) , while it was not correlated with albumin or total bilirubin (both P > 0. 05) . Conclusion Serum HMGB1 level is closely correlated with hepatic inflammatory activity.
Original articles_Liver neoplasms
Clinical effects of different treatment regimens for Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma and influencing factors for prognosis
Lu DongLing, Zhu YuPing, Ou Jie, Mao SuFei, Wu GuoBin, He JianBo, Huang Shan, Chen Chuang
2018, 34(9): 1905-1910. DOI: 10.3969/j.issn.1001-5256.2018.09.016
Abstract:
Objective To investigate the clinical effects of different treatment regimens for Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) and influencing factors for prognosis. Methods A retrospective analysis was performed for the clinical data of 91 patients with BCLC stage C HCC who were diagnosed and treated in The Affiliated Tumor Hospital of Guangxi Medical University from January 2005 to December 2012. According to the treatment regimen, these patients were divided into transarterial chemoembolization (TACE) group with 20 patients, TACE + sorafenib group with 18 patients, TACE + ablation group with 17 patients, surgery + TACE group with 20 patients, and surgery + TACE + ablation group with 16 patients. The patients were followed up to record survival and death time, and survival time was compared between groups. The chi-square test was used for comparison of categorical data between groups, and an analysis of variance was used for comparison of continuous data between groups. The Kaplan-Meier method was used to plot overall survival curves, and the log-rank test was used for comparison of cumulative survival rates. The Cox regression model was used for univariate and multivariate analyses. Results A total of 91 HCC patients were enrolled, and follow-up ended on November 1, 2016, with a follow-up rate of 100%. The univariate analysis showed that age, extrahepatic metastasis, tumor type, maximum tumor diameter, and treatment regimen were influencing factors for the prognosis of BCLC stage C HCC (all P < 0. 05) , and the multivariate analysis showed that age (P =0. 019) , maximum tumor diameter (P = 0. 018) , extrahepatic metastasis (P = 0. 026) , and treatment regimen (P = 0. 006) were independent influencing factors for the prognosis of HCC. There was a significant difference in overall survival between groups (χ2= 22. 841, P < 0. 001) . The surgery + TACE + ablation group had a significantly longer overall survival time than the other four groups (all P < 0. 05) ;the TACE + ablation group had a significantly longer overall survival time than the TACE group and the TACE + sorafenib group (P < 0. 05) ;the surgery + TACE group had a significantly longer overall survival time than the TACE group and the TACE + sorafenib group (P < 0. 05) .Conclusion Age, maximum tumor diameter, extrahepatic metastasis, and treatment regimen are independent influencing factors for the prognosis of BCLC stage C HCC. Surgical treatment should be selected for resectable stage C HCC, and TACE should be performed after surgery to prevent recurrence. TACE or ablation should be performed after recurrence, and surgical resection can be performed again when possible. TACE combined with ablation should be performed for unresectable stage C HCC, and the advantages of these two treatment methods can improve overall survival time.
Influencing factors for microvascular invasion in patients with single hepatocellular carcinoma and their prognosis
Hu YueLei, Sun DaWei, Luo FeiXiang, Liu Huan, Lu: GuoYue
2018, 34(9): 1911-1916. DOI: 10.3969/j.issn.1001-5256.2018.09.017
Abstract:
Objective To investigate the influencing factors for microvascular invasion (MVI) in patients with single hepatocellular carcinoma (SHCC) and their prognosis. Methods A retrospective analysis was performed for the clinical data of 138 patients with SHCC who were admitted to The First Hospital of Jilin University from January 2012 to December 2014 and underwent radical hepatectomy. The receiver operating characteristic curve was plotted based on neutrophil, platelet count (PLT) , fibrinogen, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, fibrinogen-albumin ratio, and presence or absence of MVI. The logistic regression model was used for univariate and multivariate analyses, and odds ratio (OR) and 95% confidence interval (CI) were used to evaluate association. The Kaplan-Meier method was used to calculate disease-free survival rate and plot survival curves of patients with or without MVI, and the log-rank test was used for survival analysis. Results The univariate analysis showed that sex (OR = 0. 400, 95% CI: 0. 162-0. 985, P = 0. 046) , tumor diameter (OR =5. 902, 95% CI: 2. 813-12. 382, P < 0. 001) , alpha-fetoprotein (AFP) (OR = 2. 635, 95% CI: 1. 286-5. 398, P = 0. 008) , neutrophil (OR = 3. 019, 95% CI: 1. 353-6. 736, P = 0. 007) , PLT (OR = 2. 255, 95% CI: 1. 116-4. 555, P = 0. 023) , fibrinogen (OR =3. 483, 95% CI: 1. 687-7. 190, P = 0. 001) , gamma-glutamyl transferase (OR = 2. 115, 95% CI: 1. 069-4. 182, P = 0. 031) , neutrophil-lymphocyte ratio (OR = 3. 662, 95% CI: 1. 803-7. 436, P < 0. 001) , platelet-lymphocyte ratio (OR = 3. 734, 95% CI: 1. 649-8. 455, P = 0. 002) , and fibrinogen-albumin ratio (OR = 3. 014, 95% CI: 1. 497-6. 070, P = 0. 002) were associated with MVI in patients with SHCC. The multivariate analysis indicated that tumor diameter (OR = 5. 423, 95% CI: 2. 555-11. 511, P < 0. 001) and AFP (OR = 2. 195, 95% CI: 1. 010-4. 774, P = 0. 047) were independent factors for MVI. The prognostic analysis showed that the 1-and3-year disease-free survival rates were 66. 4% and 52. 8%, respectively, in patients with MVI and 90. 6% and 71. 5%, respectively, in patients without MVI, and there were significant differences between these two groups of patients (χ2= 10. 929 and 4. 043, both P < 0. 05) .There was also a significant difference in disease-free survival curve between the two groups (χ2= 7. 860, P < 0. 05) . Conclusion Tumor diameter and preoperative AFP level are independent factors for MVI in patients with SHCC, and SHCC patients with MVI tend to have poor prognosis.
A cost-effectiveness analysis of Gd-EOB-DTPA contrast-enhanced magnetic resonance imaging versus ultrasound in hepatocellular carcinoma screening
Chen QiPing, Lin Su, Shi ZhenShan, Zhu YueYong, Li YouBing
2018, 34(9): 1917-1920. DOI: 10.3969/j.issn.1001-5256.2018.09.018
Abstract:
Objective To investigate the cost-effectiveness ratio of Gd-EOB-DTPA contrast-enhanced magnetic resonance imaging (EMRI) versus ultrasound in liver cancer screening for the high-risk population. Methods The Tree Age Pro 2011 software was used to establish a decision-tree model. A mathematical model was used to simulate the costs and benefits of EMRI or ultrasound screening every 6 months in patients with liver cirrhosis, and the cost-effectiveness ratios under different screening models were calculated. Results The EMRI group had a mean cost of liver cancer screening of 2050. 2 RMB each person each time and mean benefits of 0. 11 YLG, while the ultrasound group had a mean cost of 262. 6 RMB and mean benefits of 0. 02 YLG. When the incidence rate of liver cancer was 17. 8%, the EMRI group had a similar cost-effectiveness ratio as the ultrasound group, and the cost of 1 YLG was 11445 RMB; EMRI tended to have a lower cost and a better effect in screening with the increase in the incidence rate of liver cancer. The cost-effectiveness ratio of EMRI gradually decreased with the reduction in its price, and its effect in screening gradually increased with the reduction in price. Conclusion The cost-effectiveness of liver cancer screening is closely related to the incidence rate of liver cancer and the price of screening. EMRI has a good cost-effectiveness ratio in screening when the risk of liver cancer is higher than 17. 8%.
Original articles_Others
Clinical effect of endoscopic application of tissue adhesive and ligation in treatment of esophagogastric variceal bleeding in children: An analysis of 16 cases
Peng YiQiu, Wang YongJun
2018, 34(9): 1921-1924. DOI: 10.3969/j.issn.1001-5256.2018.09.019
Abstract:

Objective To investigate the clinical effect of endoscopic application of tissue adhesive and ligation in the treatment of esophagogastric variceal bleeding in children. Methods A retrospective analysis was performed for the clinical data of 16 children who underwent endoscopic treatment due to esophagogastric variceal bleeding from May 2010 to May 2017. Preoperative conditions and physiological indices and postoperative hemostasis rate, rebleeding rate, complications, and further treatment. Results The mean age of these children was 8. 50± 4. 97 years. Of all children, 5 had esophageal varices alone, among whom 1 had moderate (GII) type and 4 had severe (GIII) type, and11 had esophageal varices complicated by gastric varices, among whom 6 had GOV1 type (1 complicated by GI type, 3 complicated by GII type, and 2 complicated by GIII type) and 5 had GOV2 type (2 complicated by GII type and 3 complicated by GIII type) . There were a total of 50 varicose veins in these 16 children, with a mean number of 4 veins (range 1-5) in each child, and ligation was performed for 70 sites in total, with a mean number of 5 sites (range 0-8) in each child. Tissue adhesive injection was performed for 9 children at a total of15 sites, and 20 ml of tissue adhesive was used in total, with 2. 22 ml for each child and 1. 33 ml for each site. The hemostasis rate immediately after endoscopic therapy was 100%, and the rebleeding rate was 6. 25% (1/16) within 3 months and 12. 5% (2/16) after 3 months.The follow-up time ranged from 3 months to 7 years, and during follow-up, 4 children underwent liver transplantation and 1 underwent endoscopic treatment again due to bleeding. No obvious complications were observed. Conclusion In the treatment of esophagogastric variceal bleeding in children, endoscopic application of tissue adhesive and ligation has a marked hemostatic effect and few complications and provides valuable time for long-term treatment.

An investigation of the prevalence rate of nonalcoholic fatty liver disease in the population undergoing physical examination in Haikou, China
Ruan JianWen, Gao LiJuan, Liang XiongFei, Jiang MeiLian, Wang YaJiao, Chen ChaoYang
2018, 34(9): 1925-1928. DOI: 10.3969/j.issn.1001-5256.2018.09.020
Abstract:

Objective To investigate the prevalence of nonalcoholic fatty liver disease (NAFLD) in Haikou, China and the association of NAFLD with metabolic syndrome (MS) and its components. Methods A total of 18771 persons who underwent physical examination in Haikou People's Hospital from September 2016 to August 2017 were enrolled. Body height, body weight, blood pressure, fasting plasma glucose, blood lipids, and liver function parameters were measured, and ultrasound examination was performed for the liver. The prevalence rate of NAFLD was calculated, and the association of NAFLD with MS and its components was 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 Of all18771 persons, 5715 had NAFLD, resulting in a prevalence rate of 30. 45%; the prevalence rate of NAFLD was 41. 74% in men and17. 22% in women. Men aged 45-59 years had the highest prevalence rate of NAFLD, and women aged ≥45 years had the highest prevalence rate. Men had a significantly higher prevalence rate of moderate NAFLD than women (8. 10% vs 1. 19%, χ2= 476. 1, P < 0. 001) .Men with obesity and overweight had a higher prevalence rate of NAFLD, and women with obesity had a higher prevalence rate; in both men and women, there was a significant difference in the prevalence rate of NAFLD between groups with different levels of body mass index (BMI) (χ2= 2111, 1917, all P < 0. 001) . NAFLD patients had significantly higher BMI, blood pressure, fasting plasma glucose, triglyceride, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transpeptidase than non-NAFLD patients (t = 41. 276, 32. 339, 31. 487, 12. 185, 9. 716, 38. 382, 26. 350, 25. 291, and 15. 008, all P < 0. 001) . Conclusion There is a high prevalence rate of NAFLD in people undergoing physical examination in Haikou, and men tend to have a higher prevalence rate than women. NAFLD is closely associated with MS and its components.

Association between single nucleotide polymorphism of low-density lipoprotein receptor and nonalcoholic fatty liver disease
Yue HaiYan, Liu ShouSheng, Wang Cong, Gu JiuLian, Xin YongNing, Xuan ShiYing
2018, 34(9): 1929-1935. DOI: 10.3969/j.issn.1001-5256.2018.09.021
Abstract:

Objective To investigate the association between gene polymorphisms of low-density lipoprotein receptor (LDL-R) and nonalcoholic fatty liver disease (NAFLD) and the effect of LDL-R gene polymorphisms on serum lipid levels in the Chinese Han population.Methods A total of 216 NAFLD patients who visited Qingdao Municipal Hospital from October 2015 to July 2017 and 135 healthy subjects were enrolled. PCR and mass spectrometry were used to determine the genotypes of the rs1433099 and rs2738464 loci of LDL-R. The biochemical methods were used to measure the changes in blood lipid levels and liver enzymes. The Hardy-Weinberg (H-W) equilibrium was used to test the group representativeness of samples, and the chi-square test was used to test whether the distribution of genotypes was in accordance with the H-W equilibrium. The direct counting method was used to determine genotype and allele frequencies; the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups; the t-test and wilcoxon rank sum test were used for comparison of continuous data between groups; the association of rs1433099 and rs2738464 polymorphisms with the relative risk of NAFLD was expressed as odds ratio (OR) and its 95% confidence interval (CI) , and the binary logistic regression model was used for calculation. Results There was no significant difference between the NAFLD group and the healthy control group in allele and genotype frequencies of LDL-R rs1433099 and rs2738464 (all P > 0. 05) . There were also no significant differences between the two groups in blood lipid levels, liver enzymes, and body mass index (BMI) (all P > 0. 05) . In the NAFLD group, the healthy control group, and all subjects, there were no significant differences in general clinical features, including blood lipid levels, BMI, blood pressure, and liver enzymes, between the subjects carrying rs1433099 T and rs2738464 G and those who did not carry such alleles (all P > 0. 05) . Conclusion The polymorphisms of LDL-R rs1433099 and rs2738464 do not affect blood lipid levels. This study demonstrates for the first time that the polymorphisms of LDL-R rs1433099 and rs2738464 are not associated with the risk of NAFLD in the Chinese Han population.

Mechanism of action of blueberry combined with probiotics in improving nonalcoholic fatty liver disease by affecting the JAK1/STAT3/BAX signaling pathway regulated by interleukin-22
Zhu JuanJuan, Cheng MingLiang, Zhao XueKe, Mu Mao
2018, 34(9): 1936-1944. DOI: 10.3969/j.issn.1001-5256.2018.09.022
Abstract:

Objective To investigate the effect of blueberry combined with probiotics on the JAK1/STAT3/BAX signaling pathway regulated by interleukin-22 (IL-22) and their mechanism of action in improving nonalcoholic fatty liver disease (NAFLD) . Methods A total of40 clean Sprague-Dawley rats were divided into normal control group (CG group) , IL-22 siRNA-negative control group (IL-22 SI-NC group) , IL-22 siRNA group (IL-22 SI group) , IL-22 siRNA-negative control + blueberry-probiotics group (IL-22 SI-NC + BPG group) , and IL-22 siRNA + blueberry-probiotics group (IL-22 SI + BPG group) . The rats in the CG group were given 100% normal diet, and the rats in all the other groups were given compound high-fat diet to establish a rat model of fatty liver and were then given the injection of IL-22 siRNA-negative control lentivirus or IL-22 siRNA lentivirus at the abdominal liver area (blind puncture) every other day for 12 weeks in total. The liver was harvested to confirm whether the model was established successfully or not and the effect of siRNA, and then the above groups were given normal diet and blueberry-probiotics solution by gavage. The rats were observed for 8 weeks. One-way analysis of variance was used for comparison between multiple groups; the SNK test (q test) was used for further pairwise comparisons of data with homogeneity of variance, while the Tamhane' s test (q' test) was used for the data with heterogeneity of variance. Results Compared with the IL-22 SI-NC group, the IL-22 SI group had significant increases in alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , total cholesterol (TC) , triglyceride (TG) , and low-density lipoprotein (LDL) (all P < 0. 01) , a significant reduction in high-density lipoprotein (HDL) (P < 0. 01) , significant reductions in the mRNA and protein expression of IL-22, JAK1, and STAT3 (all P < 0. 01) , and a significant increase in the expression of Bcl-2-associated X protein (BAX) (P < 0. 01) . Compared with the IL-22 SI-NC group, the IL-22 SI-NC + BPG group had significant reductions in ALT, AST, TC, TG, and LDL (all P < 0. 01) , a significant increase in HDL (P < 0. 01) , significant increases in the mRNA and protein expression of IL-22, JAK1, and STAT3 (all P <0. 01) , and a significant reduction in BAX (P < 0. 01) . Compared with the IL-22 SI group, the IL-22 SI + BPG group had significant reductions in ALT, AST, TC, TG, and LDL (all P < 0. 05) , a significant increase in HDL (P < 0. 05) , significant increases in the mRNA and protein expression of IL-22, JAK1, and STAT3 (all P < 0. 05) , and a significant reduction in BAX (P < 0. 05) . Conclusion Blueberry combined with probiotics can antagonize hepatocyte fatty degeneration accelerated by IL-22 siRNA to a certain degree and increase the expression of IL-22, indicating that IL-22 may be a key factor for blueberry combined with probiotics in improving NAFLD. It is speculated that blueberry combined with probiotics can enhance the expression of IL-22, activate the JAK1/STAT3 signaling pathway to inhibit the expression of the downstream apoptotic factor BAX, reduce hepatocyte apoptosis, increase cholesterol metabolism, reduce lipid deposition, and thus improve NAFLD. Therefore, it is considered an adjuvant therapeutic regimen for NAFLD.

Value of neutrophil-lymphocyte ratio in evaluating the short-time prognosis of patients with acute-on-chronic liver failure
Wu DuJuan, Jin Lei, Gao YuFeng, Ye Jun, Xia GuoMei, Li Fang, Zou GuiZhou
2018, 34(9): 1945-1949. DOI: 10.3969/j.issn.1001-5256.2018.09.023
Abstract:

Objective To investigate the effect of neutrophil-lymphocyte ratio (NLR) on the 28-day prognosis of patients with HBV-associated acute-on-chronic liver failure (HBV-ACLF) . Methods A total of 100 patients with HBV-ACLF who were admitted to The Second Affiliated Hospital of Anhui Medical University from January 2015 to December 2016 were enrolled, and according to their prognosis on day 28, they were divided into death group and survival group. The data on sex, age, laboratory markers, Model for End-Stage Liver Disease (MELD) score, and clinical complications were collected for univariate analysis. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups. The Chi-square test was used for comparison of categorical data between two groups. Binary logistic regression was used for multivariate analysis. Pearson correlation analysis was used to investigate the correlation between MELD score and NLR. The receiver operating characteristic (ROC) curve was used to analyze the value of indices in predicting the prognosis of HBV-ACLF. Results The analysis of 100 patients with HBV-ACLF showed that there were significant differences between the survival group and the death group in age, albumin, alanine transaminase, serum creatinine, white blood cell count, neutrophil count, lymphocyte count, monocyte count, international normalized ratio, total bilirubin, NLR, and MELD score (all P < 0. 05) . The survival group had lower incidence rates of hepatic encephalopathy, hemorrhage, ascites, and infection than the death group, but there were no significant differences between the two groups (all P > 0. 05) . The binary logistic regression analysis showed that NLR and MELD score were independent predictive factors for 28-day mortality in HBV-ACLF patients (P < 0. 001 and P = 0. 022) , and NLR was positively correlated with MELD score (r = 0. 264, P = 0. 008) . The ROC curve analysis showed that NLR had a significantly larger area under the ROC curve than MELD score (0. 889 vs 0.728, P =0.026 7) . Conclusion NLR is an independent predictive factor for the short-term prognosis of HBV-ACLF patients.

Value of MELD combined with serum sodium concentration in predicting the short-term outcome of patients with HBV-related acute-on-chronic liver failure in China: A meta-analysis
Zhang Hui, Jia Lei, Yao ShiWei, Cui PeiLin, Xu YouQing
2018, 34(9): 1950-1955. DOI: 10.3969/j.issn.1001-5256.2018.09.024
Abstract:

Objective To investigate the value of MELD combined with serum sodium concentration (MELD-Na) in predicting the short-term outcome of patients with HBV-related acute-on-chronic liver failure (ACLF) in China. Methods Pub Med, Embase, CNKI, VIP, and Wanfang Data were searched for related articles in English and Chinese published from January 2006 to March 2018. The second version of Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of each article. The presence or absence of threshold effect was examined. According to the presence or absence of heterogeneity, a random effect model or a fixed effect model was used for pooling sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (DOR) . The receiver operating characteristic (ROC) curve was plotted and the area under the ROC curve (AUC) was calculated. The Deek's funnel plot asymmetry test was used to investigate the presence or absence of publication bias. Results A total of eight studies were included, with a total of 1386 patients, among whom there were 1173 (84. 6%) male patients. The mean age of the patients included in these studies ranged from 41. 3 to 46. 9 years. The tests for heterogeneity showed significant heterogeneity between studies and a random effect model was used for pooling. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and DOR were 0. 67 (95% confidence interval [CI]: 0. 59-0. 75) , 0. 77 (95% CI: 0. 63-0. 87) , 2. 89 (95% CI: 1. 84-4. 54) , 0. 43 (95% CI: 0. 35-0. 52) , and 7. 32 (95% CI: 4. 33-12. 40) , respectively. The AUC was 0. 75 (95 CI: 0. 72-0. 79) . The Deek's funnel plot asymmetry test showed no significant publication bias. Conclusion MELD-Na score has a certain value in predicting the short-term outcome of patients with HBV-related ACLF in China.

Association of perforin and granzyme B with liver injury induced by infectious mononucleosis in Children
Jiang Tao, Li LiPing, Yi SiSi, Ou YangWenXian, Tan YanFang, Li ShuangJie
2018, 34(9): 1956-1959. DOI: 10.3969/j.issn.1001-5256.2018.09.025
Abstract:

Objective To investigate the changes in peripheral blood mononuclear cells [CD8+T lymphocytes and natural killer (NK) cells] and levels of perforin and granzyme B in these cells in children with infectious mononucleosis (IM) , as well as their clinical significance in liver injury. Methods A total of 60 children who met the diagnostic criteria for IM were enrolled, and 30 healthy children were enrolled as control group. With the help of cell surface markers and cytokine staining, flow cytometry was performed to analyze CD8+T lymphocytes, NK cells, and the expression of perforin and granzyme B. The t-test was used for comparison of continuous data between groups;a one-way analysis of variance was used for comparison between three groups, and the Dunnett-t test was used for further comparison between two groups. Results Among the 60 children with IM, the incidence rate of liver injury was 50% (30/60) ; 18 (60%) children had an alanine aminotransferase (ALT) level of < 200 IU/L, 10 (33. 3%) had an ALT level of ≥200 IU/L and < 400 IU/L, and 2 (6. 67%) had an ALT level of ≥400 IU/L. All children had normal liver functions after one month of treatment. Compared with the control group, the non-liver injury IM group and the liver injury IM group had significant increases in the expression of perforin and granzyme B in CD8+T lymphocytes (all P < 0. 05) . Compared with the non-liver injury subgroup of IM patients, the liver injury subgroup had a significantly higher percentage of CD8+T lymphocytes and significantly higher expression of perforin and granzyme B in NK cells (all P < 0. 05) . Conclusion There is a high incidence rate of liver injury in children with IM, mainly mild or moderate elevation of aminotransferases, which are self-limiting and can be returned to normal. High levels of perforin and granzyme B in NK cells and a high percentage of CD8+T lymphocytes are the cause of liver injury.

Effect of Compound Yindan Decoction on the expression of farnesoid X receptor and multidrug resistance-associated protein 3 in rats with acute intrahepatic cholestasis
Sui JingLi, Sun FengXia, Li XiaoLing, Zhang QiuXiang
2018, 34(9): 1960-1966. DOI: 10.3969/j.issn.1001-5256.2018.09.026
Abstract:

Objective To investigate the mechanism of action of Compound Yindan Decoction on acute intrahepatic cholestasis induced byα-naphthyl isothiocyanate (ANIT) in rats. Methods A total of 108 male Sprague-Dawley rats were randomly divided into normal control group, model group, high-, middle-, and low-dose traditional Chinese medicine (TCM) groups, and positive control group, with 18 rats in each group. According to the time of sampling, each group was divided into 24-hour, 48-hour, and 72-hour subgroups, with 6 rats in each subgroup. The model group, the TCM groups, and the positive control group were given a single dose of 2% ANIT (100 mg/kg/d) by gavage to establish the model, and the normal control group was given an equal volume of salad oil by gavage. At 2 hours after modeling, the high-, middle-, and low-dose TCM groups were given Compound Yindan Decoction 1 ml/100 g body weight once a day by gavage at a dose of 24. 48 g·kg-1·d-1, 12. 24 g·kg-1·d-1, and 6. 12 g·kg-1·d-1; the model group and the normal control group were given an equal volume of normal saline once a day by gavage; the positive control group was given ursodeoxycholic acid (UDCA) solution 1 ml/100 g body weight once a day by gavage at a dose of 67. 5 mg·kg-1·d-1. The rats were sacrificed at 24, 48, or 72 hours after modeling, and RT-q-PCR, Western blot, and immunohistochemistry were used to measure the expression of farnesoid X receptor (FXR) and multidrug resistance-associated protein 3 (MRP3) in liver tissue. A one-way analysis of variance was used for comparison between multiple groups, and LSD-t test was used for further comparison between two groups. Results According to the results of RT-q-PCR, compared with the normal control group at each time phase, the model group had a significant reduction in the mRNA expression of FXR (all P<0. 05) ; compared with the model group at each time phase, all the TCM groups and the UDCA group had a significant increase in the mRNA expression of FXR (all P < 0. 05) ; the high-dose TCM group had significantly higher mRNA expression of FXR than the middle-and low-dose TCM groups at each time phase (all P < 0. 05) . Compared with the normal control group at each time phase, the model group had a significant increase in the mRNA expression of MRP3 (all P < 0. 05) ; compared with the model group at each time phase, the UDCA group and all the TCM groups except the 24-hour low-dose TCM subgroup had a significant increase in the mRNA expression of MRP3 (all P <0. 05) ; the 48-and 72-hour high-dose TCM subgroups had significantly higher mRNA expression of MRP3 than the middle-and low-dose TCM groups (all P < 0. 05) . According to the results of immunohistochemistry, compared with the normal control group at each time phase, the model group had a significant reduction in the protein expression of FXR (all P < 0. 05) ; compared with the model group, the 24-hour high-, middle-, and low-dose TCM subgroups and the UDCA group at each time phase had a significant increase in the protein expression of FXR (all P < 0. 05) ; the high-dose TCM group had significantly higher protein expression of FXR than the middle-and low-dose TCM groups at each time phase (all P < 0. 05) . Compared with the normal control group at each time phase, the model group had a significant increase in the protein expression of MRP3 (all P < 0. 05) ; compared with the model group at each time phase, the UDCA group and all the TCM groups except the 24-hour low-dose TCM subgroup had a significant increase in the protein expression of MRP3 (all P <0. 05) ; the high-dose TCM group had significantly higher protein expression of MRP3 than the low-dose TCM group at each time phase and the 72-hour middle-dose TCM subgroup (all P < 0. 05) . According to the results of Western blot, compared with the normal control group at each time phase, the model group had a significant reduction in the protein expression of FXR (all P < 0. 05) ; compared with the model group at each time phase, the high-, middle-, and low-dose TCM groups and the UDCA group had a significant increase in the protein expression of FXR (all P < 0. 05) ; the high-dose TCM group had significantly higher protein expression of FXR than the middle-and low-dose TCM groups at each time phase (all P < 0. 05) . Compared with the normal control group at each time phase, the model group had a significant increase in the protein expression of MRP3 (all P < 0. 05) ; compared with the model group, the 48-and 72-hour middle-and high-dose TCM subgroups and the UDCA group had a significant increase in the protein expression of MRP3 (all P < 0. 05) ; at 48 and72 hours, the high-dose TCM group had significantly higher protein expression of MRP3 than the middle-and low-dose TCM groups (all P < 0. 05) . Conclusion Compound Yindan Decoction has a therapeutic effect on rats with acute intrahepatic cholestasis induced by ANIT through gavage, possibly by upregulating the mRNA and protein expression of FXR and MRP3.

Case reports
A case of hepatolenticular degeneration with hepatocellular carcinoma
Li Xiang, Cai Jie, Xu YuWen, Yang Fen, Sun ALei, Weng YaLi
2018, 34(9): 1967-1971. DOI: 10.3969/j.issn.1001-5256.2018.09.027
Abstract:
A case of hepatic echinococcosis misdiagnosed as liver cancer
Wang ChuanLin, Chen Xing, Ji Min, Liu Jiao, Mei YiHan, Mei XiaoPing
2018, 34(9): 1972-1974. DOI: 10.3969/j.issn.1001-5256.2018.09.028
Abstract:
Erythropoietic protoporphyria with liver failure as the main manifestation: A case report
Cao LiLi, Dong Yi, Chu Fang, Wang LiMin, Zhang Min
2018, 34(9): 1975-1978. DOI: 10.3969/j.issn.1001-5256.2018.09.029
Abstract:
Clostridium perfringens liver abscess in patients with diabetes mellitus: A case report
Zhang ShuZe, Wang KeShen, Ren YanXian, Yu ZeYuan, Yang HanTeng, Jiao ZuoYi
2018, 34(9): 1979-1981. DOI: 10.3969/j.issn.1001-5256.2018.09.030
Abstract:
Imaging diagnosis of portal vein double branch malformation: A case report
Xu LiLi, Mu JingJing, Zhang Tong, Tong MingHui
2018, 34(9): 1982-1983. DOI: 10.3969/j.issn.1001-5256.2018.09.031
Abstract:
Traditional Chinese medicine treatment combined with olaparib for gallbladder cancer with DNA repair defects: A case report
Zhang Long, Wang Jie, Zhao YuanHong
2018, 34(9): 1984-1985. DOI: 10.3969/j.issn.1001-5256.2018.09.032
Abstract:
Reviews
Research advances in chronic hepatitis B complicated by nonalcoholic fatty liver disease
Cao Dan, Chen WenJing, Li YanPing, Chen YanPing
2018, 34(9): 1986-1989. DOI: 10.3969/j.issn.1001-5256.2018.09.033
Abstract:
Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease around the world, and chronic hepatitis B (CHB) complicated by NAFLD has also become more and more common and is taken seriously by clinical physicians. At present, there is no clear understanding of the clinical features and prognosis of CHB complicated by NAFLD. With reference to related literature on CHB complicated by NAFLD, this article reviews the research advances in the risk factors, biochemistry, virology, histology, and prognosis of CHB complicated by NAFLD. It is pointed out that age, male sex, and metabolic disorders are the risk factors for NAFLD in CHB patients, and patients with CHB complicated by NAFLD have a high risk of liver cirrhosis and hepatocellular carcinoma. However, the effect and mechanism of NAFLD on virus replication and clearance in CHB patients and the effect of HBV infection on the development of NAFLD remain unclear, which will be research hotspots in future.
Association between HBV A1762T/G1764A double nucleotide substitution and liver diseases
Lai Xin, Zhou TaiCheng, Wei Jia
2018, 34(9): 1990-1994. DOI: 10.3969/j.issn.1001-5256.2018.09.034
Abstract:
HBV A1762 T/G1764 A double nucleotide substitution (also called TA mutation) is relatively common in liver diseases. Hepatocyte nuclear factor 4 (HNF4) is one of liver-enriched transcription factors, and TA mutation is located in the binding region of HNF4 and HBV and plays an important regulatory role in HBV gene transcription and replication. Several studies have pointed out that TA mutation may aggravate liver diseases after HBV infection and increase the risk of chronic liver failure and liver cancer; however, it is still unclear how TA mutation can aggravate liver disease after HBV infection, and more studies are needed for clarification in the future. This article reviews the association between HBV A1762 T/G1764 A double nucleotide substitution and liver diseases.
Influence of HBV DNA load on surgical outcome of hepatitis B-associated liver cancer
Ye HaiWen, Deng Yong, Zhang LingQiang, Wang HaiJiu, Zhou Ying, Xu XiaoLei, Fan HaiNing
2018, 34(9): 1995-1998. DOI: 10.3969/j.issn.1001-5256.2018.09.035
Abstract:
HBV infection is highly prevalent in China, and patients with a high HBV-DNA load for a long time may progress to liver cirrhosis, which may lead to liver cancer. At present, surgery is still the main method for the treatment of hepatitis B-related liver cancer.Many studies have shown that HBV DNA load is an important influencing factor for the recovery of liver function after surgery, postoperative complications, recurrence of liver cancer, and the success of liver transplantation in patients with hepatitis B-related liver cancer. Its mechanism may be associated with high HBV DNA load and HBV reactivation. Maintaining a low HBV DNA load by antiviral therapy can improve the prognosis of patients with hepatitis B-related liver cancer. This article reviews the influence of HBV DNA load before and after surgery on the surgical outcome of hepatitis B-related liver cancer, in order to provide a reference for research on the treatment of patients with liver cancer.
Research advances in the structure and function of osteopontin and its effect in diagnosis and treatment of hepatocellular carcinoma
Wu Han, Li ZhenLi, Xing Hao, Wang MingDa, Wu MengChao, Yang Tian
2018, 34(9): 1999-2003. DOI: 10.3969/j.issn.1001-5256.2018.09.036
Abstract:
Osteopontin (OPN) is a widely distributed secretory protein and is involved in integrin-mediated cell signal transduction. It also plays an important role in the development, progression, and metastasis of hepatocellular carcinoma (HCC) . OPN plays a pivotal role in biomineralization and innate immunity, participates in tumor growth and angiogenesis by interacting with integrin, and induces the recurrence and metastasis of HCC via multiple signal transduction. Combined measurement of OPN and other tumor biomarkers can improve the sensitivity of early diagnosis of HCC. OPN inhibitors may serve as a new target for the treatment of HCC and can improve the sensitivity of chemotherapeutic drugs. This article summarizes the recent studies on OPN and introduces the biological function of OPN and its role in the progression and diagnosis and treatment of HCC.
Serological noninvasive diagnosis of nonalcoholic steatohepatitis
Hu Ying, Li LiangPing
2018, 34(9): 2004-2007. DOI: 10.3969/j.issn.1001-5256.2018.09.037
Abstract:
Nonalcoholic steatohepatitis is a progressive disease that can lead to hepatic fibrosis, liver cirrhosis, and liver cancer, and its early diagnosis is of great significance for delaying disease progression. In recent years, more and more serological markers and models have been found, and the application models based on the combination of various indicators have been updated; these models have a certain diagnostic efficiency for both nonalcoholic steatohepatitis and hepatic fibrosis. This article reviews the research on serological noninvasive diagnosis of nonalcoholic steatohepatitis and hepatic fibrosis.
Reconsideration of liver failure after liver cancer surgery
Xu XiaoLei, Wang ZhiXin, 周灜, Wang HaiJiu, Ye HaiWen, Wang Qiang, Fu ShiQiang, Fan HaiNing
2018, 34(9): 2008-2011. DOI: 10.3969/j.issn.1001-5256.2018.09.038
Abstract:
High mortality and incidence rate of complications after hepatectomy are closely associated with postoperative liver failure. Due to limited research on liver failure at present, no consensus has been reached on the definition of liver failure after hepatectomy. This article summarizes the definition, pathogenesis, risk factors, liver function assessment methods, and preventive measures of postoperative liver failure. It is pointed out that adequate preoperative assessment of liver function reserve, effective methods for bleeding control, shortening time of operation, preservation of functional liver tissue as much as possible, and timely and effective diagnosis/treatment and prevention during the perioperative period can reduce the incidence rate of liver failure, improve patient prognosis, and maximize the benefits of patients.
Research advances in the etiology of liver failure during pregnancy
Zhang BaoZhong, Zhou PengZhi
2018, 34(9): 2012-2016. DOI: 10.3969/j.issn.1001-5256.2018.09.039
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Liver failure during pregnancy is a serious liver injury caused by various pathogenic factors during pregnancy and is a critical disease that threatens the life of the mother and the fetus. The causes of liver failure during pregnancy are classified into viral factors, non-viral factors, pregnancy-specific factors, and unknown causes. This article describes the research advances in the incidence rates, deaths, and geographical distribution characteristics of liver failure during pregnancy of different etiologies and compares the clinical features of liver failure during pregnancy of different etiologies. It is pointed out that liver failure during pregnancy of different etiologies has entirely different treatment regimens and prognoses, and the etiological diagnosis has important guiding significance in the treatment of this disease. Further examination should be performed for critically ill pregnant women suspected of this disease to determine the etiology, and appropriate treatment should be given as early as possible.
Role of signal transduction and transcription factors STAT1 and STAT3 in the pathogenesis of hepatocellular carcinoma and liver failure
Gao MengDan, Zhang YongHong, Zhao Yan
2018, 34(9): 2017-2020. DOI: 10.3969/j.issn.1001-5256.2018.09.040
Abstract:
Hepatocellular carcinoma (HCC) and liver failure are common liver diseases in China and have extremely high incidence and mortality rates. Although there are many related studies, the detailed pathogenesis of these two diseases is still unknown. This article reviews the role of STAT1 and STAT3 phosphorylation proteins in the pathogenesis of HCC and liver failure, such as antiviral defense, acute phase response, liver injury, repair, inflammation, and transformation. A deep understanding of their role in the pathogenesis of HCC and liver failure and the development of related drugs with them as molecular targets play an important role in reducing mortality rate in clinical practice.
Rheumatic and skin manifestations associated with autoimmune liver diseases
Tian Hui
2018, 34(9): 2021-2026. DOI: 10.3969/j.issn.1001-5256.2018.09.041
Abstract:
Autoimmune liver diseases mainly include autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, and various types of overlap syndromes and are often associated with extrahepatic autoimmune diseases. However, few studies have described the association of autoimmune liver diseases with rheumatic disease and/or skin disease. For this purpose, this article reviews the rheumatic and skin manifestations associated with autoimmune liver diseases in detail and the clinical significance of non-specific antibodies. It is pointed out that individualized treatment should be given to patients with rheumatic disease and/or skin disease.
Current status and perspectives of laparoscopic pancreaticoduodenectomy
Chen ZhiCheng, Liu Jun
2018, 34(9): 2027-2032. DOI: 10.3969/j.issn.1001-5256.2018.09.042
Abstract:
Laparoscopic pancreaticoduodenectomy (LPD) is performed with the help of the laparoscopic technique and is considered the most complicated general surgical procedure. In the past 20 years, it has been developing slowly and has gradually gained recognition. Although some scholars have different points of view, we still expect the advantages of LPD. With reference to related articles in China and foreign countries, this article elaborates on the current status and future directions of LPD.