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

2019 Vol. 35, No. 11

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Editorial
Development and innovation of liver transplantation in China
Shen ZhongYang
2019, 35(11): 2377-2385. DOI: 10.3969/j.issn.1001-5256.2019.11.001
Abstract:
After 20 years of rapid development,liver transplantation in China has become an important part of this field in the world. In response to hepatitis B-associated liver disease and liver cancer,China has issued the guidelines and standards for liver transplantation in line with our own national conditions and has thus further expanded the number of liver transplantation recipients. At the same time,the improvement in science and technology has effectively promoted the continuous innovation of the surgical techniques of liver transplantation in China,and China has become one of the leading countries in the fields of laparoscopic donor surgery,xenogeneic liver transplantation,non-ischemic liver transplantation,and living donor liver transplantation. At present,donor shortage remains one of the important factors that limit the development of liver transplantation in China. The organ donation work in China has a long way to go. There is still a long way to go for organ donation in China.
Discussions by experts
Tasks and strategies for the prevention and treatment of middle-and long-term complications after liver transplantation
Liu YiHe, Zheng Hong, Shen ZhongYang
2019, 35(11): 2386-2390. DOI: 10.3969/j.issn.1001-5256.2019.11.002
Abstract:
With the continuous improvement of liver transplantation techniques and the innovation of related disciplines,great changes have been observed in the etiology and clinical outcome of middle-and long-term complications after liver transplantation,and thus related prevention and treatment strategies are worthy of exploration and adjustment. In recent years,breakthroughs have been made in the prevention and treatment of post-transplantation complications including the recurrence of hepatitis,but standardized diagnosis and treatment should be strengthened in order to maximize the benefits of recipients. So far,the prevention and treatment of middle-and long-term complications with unknown pathogenesis and complicated causes after liver transplantation still rely on the long-term monitoring,prevention,and control of related risk factors. The main tasks of long-term management of liver transplantation recipients is to maintain the function of transplanted liver,control the recurrence of primary diseases,prevent and treat the new-onset diseases,and continue to treat the concomitant diseases before surgery. This article elaborates on the tasks and strategies for the prevention and treatment of middle-and long-term complications after liver transplantation.
Risk factors for tumor recurrence after liver transplantation for hepatocellular carcinoma and related control strategies
Zheng WeiPing, Shen ZhongYang
2019, 35(11): 2391-2395. DOI: 10.3969/j.issn.1001-5256.2019.11.003
Abstract:
Tumor recurrence after liver transplantation for hepatocellular carcinoma is the main cause of significant reductions in the survival rates of patients and grafts. Risk factors for tumor recurrence after liver transplantation include pathological and biological features,factors associated with the recipient,factors associated with the donor and donor liver,and surgery-related factors. Immunosuppression regimen and various adjuvant therapies may help to prevent tumor recurrence. For patients undergoing liver transplantation for hepatocellular carcinoma,further studies are needed to investigate early identification of risk factors for tumor recurrence and related comprehensive prevention and treatment measures.
An analysis of related issues in long-term survival in children after liver transplantation
Lu YeFeng, Xia Qiang, Qiu BiJun, Feng MingXuan, Wan Ping
2019, 35(11): 2396-2401. DOI: 10.3969/j.issn.1001-5256.2019.11.004
Abstract:
Liver transplantation is a mature treatment for children with end-stage liver disease. With the development of surgical techniques,immunosuppressive therapy,and infection monitoring in recent years,there have been significant increases in the survival rates of patients and liver transplants,helping children to achieve long-term survival. Meanwhile,several issues have emerged,such as viral infection,complications,new-onset tumors,quality of life,and self-management. Therefore,this article reviews related issues in long-term survival in children after liver transplantation from the two aspects of medical treatment and nursing and provides several regimens for reference,so as to provide a basis for long-term high-quality survival in children after liver transplantation. Here,these issues are reviewed.
Research advances in immune tolerance in children receiving liver transplantation
Wang Kai, Gao Wei
2019, 35(11): 2402-2407. DOI: 10.3969/j.issn.1001-5256.2019.11.005
Abstract:
Compared with adult recipients,pediatric liver transplantation recipients have urgent needs for immune tolerance,with a higher probability of successful realization of immune tolerance. However at present,there is still a lack of effective experimental regimens,immune monitoring methods,and graft histological evaluation after long-term discontinuation of immunosuppressive agents in clinical practice,which results in the fact that immune tolerance stays in the theoretic stage and is not effectively implemented in clinical practice. This article reviews the advances and difficulties in immune tolerance in pediatric liver transplantation recipients in recent years,in order to provide help for operational immune tolerance in future.
Guidelines
Expert recommendations on standardized diagnosis and treatment for fatty liver disease (2019 revised edition)
Committee of Hepatology, Chinese Research Hospital Association, Fatty Liver Expert Committee, Chinese Medical Doctor Association, National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, National Workshop on Liver and Metabolism, Chinese Society of Endocrinology, Chinese Medical Association
2019, 35(11): 2426-2430. DOI: 10.3969/j.issn.1001-5256.2019.11.007
Abstract(1092) PDF (244KB)(857)
Abstract:

Nonalcoholic fatty liver disease( NAFLD) is the most common liver disease in China. To provide evidence-based and updated practical recommendations for clinician,this expert recommendations have updated the diagnosis and treatment of NAFLD in five aspects as follows:( 1) the framework of NAFLD treatment centre or clinic;( 2) screening and evaluation: who should be screened,initial evaluation items,non-invasive assessment of steatohepatitis and advanced fibrosis,when to obtain a liver biopsy in patients with NAFLD,and other metabolic disorders and cardiovascular risk assessment;( 3) managements of patient with NAFLD: lifestyle intervention( dietary,exercise and weight loss),drug treating metabolic co-morbidities such as hyperlipidemia,type 2 diabetes mellitus and hypertension,and steatohepatitis and fibrosis;( 4) management of special populations with NAFLD: children,pregnant or lactating women,patients co-existence with alcoholic liver disease,chronic HBV and/or HCV infection,and autoimmune disorders;( 5) monitoring and follow-up. This consensus aims to modify the optimizing management process and guide physicians make correct and reasonable decisions in the diagnosis and treatment for patients with NAFLD.

Guidelines for the diagnosis and treatment of hepatoblastoma (2019)
Compilation and Examination Expert Group for Guidelines for the diagnosis and treatment of hepatoblastoma (2019)
2019, 35(11): 2431-2434. DOI: 10.3969/j.issn.1001-5256.2019.11.008
Abstract:
Expert recommendation for operational norms of laparoscopic radical resection of perihilar cholangiocarcinoma
The Expert Group on Operational Norms of Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma, Editorial Board of Chinese Journal of Surgery
2019, 35(11): 2441-2446. DOI: 10.3969/j.issn.1001-5256.2019.11.010
Abstract:

Radical resection is the only curable treatment for perihilar cholangiocarcinoma. With the continuous renewal of laparoscopic instruments and the continuous improvement of technology,laparoscopic radical resection of perihilar cholangiocarcinoma has been gradually carried out in China,and its feasibility and safety have been recognized by some domestic peers. In order to standardize clinical diagnosis and treatment behavior,ensure patients receive safe and standardized treatment and improve prognosis,so that the operation can be standardized application and development. Based on the principles of treatment of perihilar cholangiocarcinoma and the corresponding technical norms of laparoscopic operation,the Expert Group on Operational Norms of Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma and Editorial Board of Chinese Journal of Surgery have organized relevant domestic expels to formulate expert recommendations for laparoscopic radical resection of perihilar cholangiocarcinoma,so as to facilitate clinical practice and standardized application.

Recommendations for diagnosis and treatment of alcohol-related liver diseases: 2019 practice guidance from the American Association for the Study of Liver Diseases
Li ZhiGuo, Zhu Shun, Li Shuo, Ye YongAn
2019, 35(11): 2447-2448. DOI: 10.3969/j.issn.1001-5256.2019.11.011
Abstract:
Original articles_Viral hepatitis
Change in the level of T-cell receptor rearrangement excision circles after antiviral therapy in patients with chronic hepatitis B
Xiong Fang, Ma YanPin, Bao XuLi, Lu: Jun
2019, 35(11): 2449-2452. DOI: 10.3969/j.issn.1001-5256.2019.11.012
Abstract:
Objective To investigate the change in the level of T-cell receptor rearrangement excision circles( TREC) after antiviral therapy with thymopentin( TP5) and entecavir( ETV) in HBeAg-positive chronic hepatitis B( CHB) patients. Methods A total of 30 HBeAg-positive CHB patients who were diagnosed and treated in Beijing YouAn Hospital,Capital Medical University,from October 2014 to September 2016 were enrolled. All patients were given ETV combined with TP5 for 48 weeks. Real-time PCR was used to measure the level of TREC in peripheral blood mononuclear cells( PBMCs),and the change in TREC after treatment was analyzed. The correlation of TREC level with HBV DNA,HBeAg,and HBsAg was analyzed. The t-test was used for comparison of continuous data between two groups,and a Spearman correlation analysis was used to investigate the correlation between two indices. Results After the combined treatment for 48 weeks,24 patients achieved virologic response,and 3 achieved HBeAg clearance. The level of TREC significantly increased from 6. 03 ± 1. 71 copies/103 PBMCs before treatment to 10. 61 ± 2. 08 copies/103 PBMCs after treatment( t = 9. 32,P < 0. 000 1). The patients in the virologic response group had a significant increase in the level of TREC after treatment( 11. 21 ± 1. 71 copies/103 PBMCs vs5. 79 ± 1. 84 copies/103 PBMCs,t = 10. 57,P < 0. 000 1),while those in the non-virologic response group had no significant change in the level of TREC after treatment( 8. 21 ± 2. 08 copies/103 PBMCs vs 7. 03 ± 0. 28 copies/103 PBMCs,t = 1. 38,P = 0. 20). Before treatment,there was no significant difference in the level of TREC in PBMCs between the virologic response group and the non-virologic response group( P > 0. 05),while after treatment,the virologic response group had a significantly higher level of TREC than the non-virologic response group( t = 3. 69,P = 0. 001). A bivariate Spearman correlation analysis was performed for the levels of TREC,HBsAg,and HBeAg,HBV DNA load,and the degree of reductions from baseline to 48 weeks of treatment,and no statistical significance was found.Conclusion TP5 combined with ETV can increase thymic output function in HBeAg-positive CHB patients.
Value of cystatin C in the diagnosis of early renal injury in patients with viral hepatitis
Zhu YaGe, Wang Jing, Liu JinFeng, He YingLi
2019, 35(11): 2453-2455. DOI: 10.3969/j.issn.1001-5256.2019.11.013
Abstract:
Objective To investigate the value of serum cystatin C( Cys C) in the diagnosis of early renal injury in patients with viral hepatitis. Methods A retrospective analysis was performed for the clinical data of 270 patients with chronic hepatitis B virus( HBV) or hepatitis C virus( HCV) infection. According to the fibrosis degree determined by FibroScan,the patients were divided into non-significant liver fibrosis group( F0-F2),significant liver fibrosis group( F2-F3),progressive liver fibrosis group( F3-F4),and liver cirrhosis group( >F4). The four groups were compared in terms of urea nitrogen,creatinine,Cys C,and estimated glomerular filtration rate( e GFR). The t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups. A Pearson correlation analysis was used to investigate correlation. Results Among the 270 patients,200 had HBV infection and 70 had chronic HCV infection. There were significant differences in e GFR and Cys C between the four groups( F = 2. 714 and 3. 081,P = 0. 032 and 0. 017). Further comparison between two groups showed that the liver cirrhosis group had a significantly lower eGFR than the non-significant liver fibrosis group( 99. 61 ± 6. 92 ml·min-1·1. 73 m-2 vs 105. 32 ± 1. 86 ml·min-1·1. 73 m-2,t = 2. 655,P = 0. 008); compared with the non-significant liver fibrosis group,the other three groups had significant increases in the serum level of Cys C( significant liver fibrosis group: 1. 01 ± 0. 08 mg/L vs 0. 84± 0. 03 mg/L,t =-2. 218,P = 0. 028; progressive liver fibrosis group: 1. 02 ± 0. 04 mg/L vs 0. 84 ± 0. 03 mg/L,t =-4. 218,P < 0. 001;liver cirrhosis group: 1. 07 ± 0. 05 mg/L vs 0. 84 ± 0. 03 mg/L,t =-4. 675,P < 0. 001). For the patients with HBV or HCV infection,the patients with liver cirrhosis had a significantly higher serum level of Cys C than those without significant liver fibrosis( patients with HBV infection: 1. 06 ± 0. 36 mg/L vs 0. 84 ± 0. 13 mg/L,t =-3. 192,P = 0. 003; patients with HCV infection: 1. 04 ± 0. 22 mg/L vs 0. 86 ± 0.15 mg/L,t =-2. 318,P = 0. 029). Liver stiffness measurement was positively correlated with the serum level of Cys C( r = 0. 247,P = 0.003),while there was no correlation between liver stiffness measurement and eGFR( r =-0. 002,P = 0. 975). Conclusion Cys C can be used for the diagnosis of early renal injury in patients with viral hepatitis,and regular monitoring of Cys C level has a positive significance in the prevention and treatment of hepatorenal syndrome in such patients.
Clinical features of hepatitis C patients with failure or recurrence after treatment with pegylated interferon-α combined with ribavirin and the clinical effect of direct-acting antiviral agents
Zhang YaoDi, Zhang YueRong, Wang Hui, Lin Yan, Zhou Ning, Wu LiYang, Wei ShiFang, Li XiangLin
2019, 35(11): 2456-2460. DOI: 10.3969/j.issn.1001-5256.2019.11.014
Abstract:
Objective To investigate the clinical features of patients with failure or recurrence after treatment with PEG-IFN combined with ribavirin( PR regimen) in the real world and the clinical effect of different direct-acting antiviral agent( DAA) regimens in such patients. Methods A retrospective analysis was performed for the clinical data of 106 patients with chronic hepatitis C or hepatitis C-related compensated liver cirrhosis who attended the outpatient service or were hospitalized in The First Peoples' s Hospital of Lanzhou from March2014 to January 2018,and these patients experienced failure or recurrence after the treatment with the standard PR regimen. There were 54 male and 52 female patients. According to the response to PR treatment,the patients were divided into failure group with 13 patients,recurrence group with 51 patients,and sustained virologic response group with 42 patients. All patients underwent IL-28 B rs12979860/rs8099917 detection,baseline biochemical examination,Cobas HCV RNA test,and viral genotyping,and these results were compared between groups. The clinical outcomes of patients with failure or recurrence after PR treatment were observed after the treatment with different DAA regimens. The chi-square test was used for comparison of categorical data between groups; a one-way analysis of variance was used for comparison between multiple groups. Results The failure group and the recurrence group had a significantly higher age than the sustained virologic response group( F = 14. 05,P < 0. 001). Among the patients in the failure group,86. 4% had viral genotype 1 b,while among those in the recurrence group,72. 5% had viral genotype 2 a,and there was a significant difference between the three groups( χ2=17. 269,P = 0. 002). Among the patients in the failure group,92. 3% had a baseline HCV RNA level of ≥106 IU/L,and the failure group had a significantly higher proportion of such patients than the recurrence group and the sustained virologic response group( χ2= 10. 407,P =0. 005). There were no significant differences in sex and liver cirrhosis between the three groups( all P > 0. 05). Among the patients with primary treatment failure,100% patients had the non-protective genotype of IL-28 B rs12979860 CT/TT,and 92. 3% had the non-protective genotype of IL-28 B rs8099917 TG/GG; among the patients with recurrence,84. 3% patients had the non-protective genotype of IL-28 B rs12979860 CT/TT,and 86. 3% had the non-protective genotype of IL-28 B rs8099917 TG/GG; among the patients in the sustained virologic response group,85. 7% gad genotype CC at IL-28 B rs12979860 and 88. 1% had genotype TT at IL-28 B rs8099917.There were significant differences in the constituent ratios of rs12979860 and rs8099917 gene polymorphisms between the three groups( χ2= 57. 263 and 59. 651,both P < 0. 001). The patients with failure or recurrence after PR treatment achieved a sustained virologic response rate of 100% after the treatment with three different DAA regimens based on sofosbuvir. Conclusion Viral genotype and non-protective genotypes at IL-28 B rs12979860 and rs8099917 are influencing factors for failure and recurrence after PR treatment. The three different DAA regimens based on sofosbuvir achieves a sustained virologic response rate of 100% and has good safety in patients with failure or recurrence after PR treatment,which is not affected by the factors including IL-28 B single nucleotide polymorphism and viral replication level in the host.
Original articles_Liver fibrosis and liver cirrhosis
Correlation of the levels of angiotensin Ⅱ and angiotensin (1-7) with the degree of chronic hepatitis B liver fibrosis
Yu Chong, Gu YuLing, Li Min, Gu ErLi
2019, 35(11): 2461-2465. DOI: 10.3969/j.issn.1001-5256.2019.11.015
Abstract:
Objective To investigate the differences in the plasma levels of angiotensin Ⅱ( Ang Ⅱ) and angiotensin( 1-7) [Ang( 1-7) ]in different stages among patients with chronic hepatitis B( CHB) liver fibrosis and their significance in the pathogenesis of liver fibrosis.Methods A prospective study was performed. A total of 86 patients with hepatitis B virus( HBV) infection who attended our hospital from March 2017 to March 2019 were enrolled and divided into CHB group( group A) with 25 patients,compensated hepatitis B cirrhosis group( group B) with 31 patients,and decompensated hepatitis B cirrhosis group( group C) with 30 patients. The double-antibody sandwich method was used to measure the plasma levels of Ang Ⅱ and Ang( 1-7),and FibroTouch scan was used for liver stiffness measurement( LSM). 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 two groups; the chi-square test was used for comparison of categorical data between groups. A binary linear correlation analysis was used to investigate the correlation of the plasma levels of Ang Ⅱ and Ang( 1-7) with LSM; a Spearman rank correlation analysis was used to investigate the correlation of the plasma levels of Ang Ⅱ and Ang( 1-7) with the progression of CHB liver fibrosis; a logistic regression analysis was used to evaluate the value of Ang Ⅱ,Ang( 1-7),and LSM in predicting hepatitis B cirrhosis. Results With the progression of liver fibrosis from group A to group C,there was a significant increase in course of disease( 5. 2 ± 1. 3 years vs 7. 8 ± 1. 6 years vs 10. 1 ± 1. 5 years,F = 4. 266,P = 0. 002),a significant reduction in the proportion of patients receiving antiviral therapy( 76. 00% vs 64. 52% vs 53. 33%,χ2= 5. 544,P < 0. 001),significant increases in Ang II( 51. 01 ±8. 68 pg/ml vs 74. 38 ± 10. 05 pg/ml vs 102. 78 ± 13. 22 pg/ml,F = 520. 260,P < 0. 001),Ang II/Ang( 1-7) ratio( 1. 06 ± 0. 41 vs2. 32 ± 0. 23 vs 5. 82 ± 1. 24,F = 18. 860,P < 0. 001),and LSM( 6. 85 ± 1. 26 kP a vs 18. 25 ± 3. 22 kP a vs 26. 84 ± 7. 57 kP a,F = 93. 260,P <0. 001),and a significant reduction in Ang( 1-7)( 45. 93 ± 10. 24 pg/ml vs 31. 52 ± 9. 62 pg/ml vs 16. 55 ± 9. 48 pg/ml,F = 209. 860,P <0. 001). Ang II and Ang II/Ang( 1-7) ratio were positively correlated with LSM( r = 0. 623 and 0. 813,both P < 0. 01),while Ang( 1-7) was negatively correlated with LSM( r =-0. 677,P < 0. 01). Ang II,Ang II/Ang( 1-7) ratio,and LSM gradually increased with the progression of liver fibrosis( r = 0. 639,0. 886,and 0. 712,all P < 0. 01),while Ang( 1-7) was negatively correlated with the progression of liver fibrosis( r =-0. 653,P < 0. 01). Ang II/Ang( 1-7) ratio and LSM had an early warning effect for liver cirrhosis in patients with HBV infection( odds ratio = 1. 884 and 2. 015,both P < 0. 01). Conclusion In patients with HBV infection,there are gradual increases in Ang II and Ang II/Ang( 1-7) ratio and a gradual reduction in Ang( 1-7) with the aggravation of liver fibrosis. Dynamic monitoring of the plasma levels of Ang II and Ang( 1-7) can provide a reference for real-time assessment of liver fibrosis and decision-making in clinical diagnosis and treatment.
Value of serum liver fibrosis markers in the diagnosis of liver fibrosis
Zhang Yu, Tang ShiXiao
2019, 35(11): 2466-2471. DOI: 10.3969/j.issn.1001-5256.2019.11.016
Abstract:
Objective To investigate the value of the four serum liver fibrosis markers,i. e.,procollagen Ⅲ( PCⅢ),type Ⅳ collagen( C-Ⅳ),hyaluronic acid( HA),and laminin( LN),in the diagnosis of liver fibrosis. Methods A retrospective analysis was performed for the clinical data of 155 patients with liver cirrhosis,42 patients with liver cirrhosis and primary hepatic carcinoma( PHC),and 150 patients with chronic hepatitis who were admitted to The First Affiliated Hospital of Southwest Medical University from April 2018 to April2019,and 73 healthy individuals who underwent physical examination were also enrolled. The serum levels of the above four markers were measured for all subjects and were compared between groups. The receiver operating characteristic( ROC) curve was plotted to compare the diagnostic efficiency of these four markers. The t-test was used for normally distributed continuous data between two groups; the Kruskal-Wallis H rank sum test was used for comparison of non-normally distributed continuous data between multiple groups,and the Wilcoxon rank-sum test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. Results The patients with liver cirrhosis and the patients with liver cirrhosis and PHC had significantly higher serum levels and positive rates of the four markers than the patients with chronic hepatitis and the healthy subjects( all P < 0. 05). while there were no significant differences in the levels and positive rates of PCⅢ,C-Ⅳ,and HA between the patients with liver cirrhosis and the patients with liver cirrhosis and PHC( all P > 0. 05). Although the patients with liver cirrhosis and PHC had a significantly higher serum level of LN than those with liver cirrhosis( P < 0. 05),there was no significant difference in the positive rate of LN between the two groups( P > 0. 05). The patients with alcoholic cirrhosis had significantly higher serum levels of PCⅢ and C-Ⅳ than those with viral cirrhosis,viral-alcoholic cirrhosis,or autoimmune cirrhosis( all P < 0. 05),the patients with autoimmune cirrhosis,alcoholic cirrhosis,or viral-alcoholic cirrhosis had a significantly higher serum level of HA than those with viral cirrhosis( all P < 0. 05),and the patients with viral-alcoholic cirrhosis,viral cirrhosis,or alcoholic cirrhosis had a significantly higher serum level of LN than those autoimmune( all P < 0. 05). The patients with chronic hepatitis of different etiologies had significantly lower serum levels and positive rates of these four markers than those with liver cirrhosis( all P < 0. 05),and the patients with severe viral hepatitis had significantly higher positive rates of the four markers than the other patients( all P < 0. 05). PC Ⅲ,C-IV,HA,LN,and the combination of these four markers had an area under the ROC curve of 0. 836,0. 832,0. 895,0. 808,and 0. 901,respectively,in the diagnosis of liver cirrhosis. HA had a significantly larger area under the ROC curve than PCⅢ,C-Ⅳ,and LN( all P < 0. 05),while there was no significant difference between HA and the combination of these four markers( P >0. 05). Conclusion HA has a high diagnostic efficiency in liver fibrosis.
Establishment of a predictive model of death within 30 days for patients with liver cirrhosis and bacterial ascites
Huang YunYi, Wang XianBo
2019, 35(11): 2472-2477. DOI: 10.3969/j.issn.1001-5256.2019.11.017
Abstract:
Objective To investigate the risk factors for death within 30 days in patients with liver cirrhosis and bacterial ascites,and to establish a predictive model of death within 30 days. Methods A retrospective analysis was performed for the clinical data of 86 patients with liver cirrhosis and bacterial ascites who were admitted to Beijing Ditan Hospital,Capital Medical University,from January 2012 to April 2018.The patients were followed up for 30 days,and according to their prognosis,they were divided into survival group with 73 patients and death group with 13 patients. 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 was used for comparison of categorical data between groups. A logistic regression analysis was used to investigate the influencing factors for death within 30 days in patients with liver cirrhosis and bacterial ascites,and a predictive model was established based on these influencing factors. The area under the receiver operating characteristic curve was used to evaluate the predictive value of each independent influencing factor and the predictive model. Results The multivariate logistic regression analysis showed that there were significant differences between the survival group and the death group in ascites albumin( odds ratio [OR]= 0. 615,95% confidence interval [CI]: 0. 424-0. 893,P = 0. 011),neutrophil-to-lymphocyte ratio( NLR)( OR =1. 170,95% CI: 1. 011-1. 354,P = 0. 035),and Model for End-Stage Liver Disease( MELD) score( OR = 1. 341,95%CI: 1. 111-1. 618,P = 0. 002). A scoring model was established based on the results of the multivariate analysis to predict death within 30 days in patients with liver cirrhosis and bacterial ascites,and based on this model,the patients were divided into high-risk group with death within 30 days( score ≥2 points) and low-risk group with death within 30 days( score < 2 points). There was a significant difference in mortality rate with 30 days between the two groups( 60. 0% vs 5. 6%,P < 0. 001). Conclusion Ascites albumin ≤3. 5 g/L,NLR ≥6. 5,and MELD score ≥20 are independent risk factors for death within 30 days in patients with liver cirrhosis and bacterial ascites. The predictive model established on this basis can effectively evaluate the population at high risk of death within 30 days.
Influence of alcohol consumption on liver function and rebleeding in alcoholic cirrhotic patients with esophageal and gastric varices
Ma JiaLi, He LingLing, Li Ping, Jiang Yu, Hu JuLong, Zhou YuLing, Liang XiuXia, Wei HongShan
2019, 35(11): 2478-2482. DOI: 10.3969/j.issn.1001-5256.2019.11.018
Abstract:
Objective To investigate the influence of alcohol consumption on liver function and prognosis in alcoholic cirrhotic patients.Methods A total of 211 alcoholic cirrhotic patients with gastroesophageal variceal bleeding who underwent endoscopic treatment in Beijing Ditan Hospital,Capital Medical University,from September to December,2018 were enrolled,and among these patients,there were 208 male and 3 female patients,with a mean follow-up time of 45 months( range 2-110 months). The association of alcohol consumption with liver parameters was analyzed. According to the presence or absence of gastroesophageal variceal rebleeding,the patients were divided into early rebleeding group,delayed rebleeding group,and non-rebleeding group,and the three groups were compared in terms of liver parameters and alcohol consumption. The t-test was used for comparison of normally distributed continuous data between groups,and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Spearman rank correlation test was used for correlation analysis. Results Duration of drinking was correlated with creatinine( r = 0. 142,P = 0. 039) and direct bilirubin( DBil)( r =-0. 137,P = 0. 047),and daily alcohol consumption was correlated with DBil( r = 0. 144,P = 0. 037) and prealbumin( r =-0. 190,P = 0. 009),while there was no correlation between total alcohol consumption and indicators for liver injury. There were significant differences between the early rebleeding group and the delayed rebleeding group in white blood cell count( WBC)( t =-2. 355,P = 0. 020),neutrophils( t' =-2. 602,P = 0. 010),hemoglobin( t = 2. 247,P = 0. 026),mean corpuscular volume( t =-2. 073,P = 0. 040),alanine aminotransferase( Z =-1. 985,P =0. 047),international normalized ratio( Z =-2. 397,P = 0. 017),spleen thickness( Z =-2. 542,P = 0. 011),Child-Pugh score( t' =-2. 364,P = 0. 020),and Child-Pugh grade( Z =-2. 485,P = 0. 013). The non-rebleeding group had significantly lower WBC ( Z =-2. 276,P = 0. 017) and neutrophils( Z =-2. 375,P = 0. 018) than the rebleeding group,and the early and delayed rebleeding groups had a significantly shorter duration of drinking than the non-rebleeding group( Z =-2. 522,P = 0. 012). The logistic regression analysis showed that neutrophils was a risk factor for variceal rebleeding( odds ratio = 1. 152,95% confidence interval: 1. 017-1. 300,P =0. 026). Conclusion No dose-response relationship is found between alcohol consumption and liver injury in this study,and alcohol consumption may not have a marked effect on variceal rebleeding.
Effect of Hic-5 gene knockout on NF-κB/p65 expression and CCl4-induced liver fibrosis degree in mice
Yang DaYin, Du YiChao, Tan Peng, Chen Hao, Qian BaoLin, Wang AnKang, Huang ShiYao, Fu WenGuang, Xia XianMing
2019, 35(11): 2483-2488. DOI: 10.3969/j.issn.1001-5256.2019.11.019
Abstract:

Objective To investigate the effect of Hic-5 gene knockout on NF-κB/p65 expression and liver fibrosis. Methods Ten wild-type male C57 BL/6 mice were randomly divided into wild-type control group( WT-Control group with 5 mice) and wild-type experimental group( WT-CCl4 group with 5 mice),and ten male C57 BL/6 mice with Hic-5 gene knockout were randomly divided into Hic-5 knockout control group( Hic-5 KO-Control group with 5 mice) and Hic-5 knockout experimental group( Hic-5 KO-CCl4 group with5 mice). The serum levels of alanine aminotransferase( ALT) and aspartate aminotransferase( AST) were measured. Picrosirius red staining was used to observe collagen deposition in liver tissue. Immunohistochemistry was used to measure the expression of alpha-smooth muscle actin( α-SMA) and p65 protein,and real-time quantitative PCR was used to measure the mRNA expression of α-SMA,collagen1,and p65 in liver tissue. The primary hepatic stellate cells of mice were isolated and stimulated with different concentrations of TGF-β1,and then real-time quantitative PCR was used to measure the mRNA expression of α-SMA,collagen 1,and p65 in primary hepatic stellate cells. 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 two groups. Results Picrosirius red staining showed that compared with the WT-CCl4 group,the Hic-5 KO-CCl4 group had a significant reduction in collagen fibers in liver tissue( P < 0. 001). Measurement of serum ALT and AST showed that there were significant differences in ALT and AST between the WT-Control group,the WT-CCl4 group,the Hic-5 KO-Control group,and the Hic-5 KO-CCl4 group( F = 22. 85 and 25. 15,both P < 0. 001),and the Hic-5 KO-CCl4 group had significantly lower serum levels of ALT and AST than the WT-CCl4 group( both P < 0. 05). Immunohistochemistry showed that there were significant differences in the expression levels of α-SMA and p65 protein in liver tissue between the WT-Control group,the WT-CCl4 group,the Hic-5 KO-Control group,and the Hic-5 KO-CCl4 group( F = 207. 10 and 98. 16,both P < 0. 001),and the Hic-5 KO-CCl4 group had significantly lower expression of α-SMA and p65 protein in liver tissue than the WT-CCl4 group( both P < 0. 01).The results of real-time quantitative PCR showed that there were significant differences in the relative mR NA expression of α-SMA,collagen 1,and p65 in liver tissue between the WT-Control group,the WT-CCl4 group,the Hic-5 KO-Control group,and the Hic-5 KO-CCl4 group( F = 41. 62,13. 93,and 98. 16,all P < 0. 001),and the Hic-5 KO-CCl4 group had significantly lower relative mR NA expression of α-SMA,collagen 1,and p65 in liver tissue than the WT-CCl4 group( all P < 0. 05). After the primary hepatic stellate cells were stimulated by TGF-β1 at concentrations of 0,5,and 10 ng/ml,there were significant differences in the relative mR NA expression ofα-SMA,collagen 1,and p65 between the WT 0 ng/ml group,the WT 5 ng/ml group,the WT 10 ng/ml group,the KO 0 ng/ml group,the KO 5 ng/ml group,and the KO 10 ng/ml group( F = 53. 9,75. 82,and 52. 41,all P < 0. 001),and the Hic-5 KO group had significantly lower relative mR NA expression of α-SMA,collagen 1,and p65 than the WT group( all P < 0. 01). Conclusion Hic-5 knockout inhibits NF-κB/p65 expression and hepatic stellate cell activation and alleviates CCl4-induced liver fibrosis.

Original articles_Liver neoplasms
Efficacy and safety of microsphere transarterid chemoembolization combined with radiotherapy versus microsphere transarterial chemoembolization alone in treatment of patients with unresectable liver cancer
Ma MingYuan, Lin GangYi, Cai ZongYang, Luo HeSan, Wu ShengXi
2019, 35(11): 2489-2494. DOI: 10.3969/j.issn.1001-5256.2019.11.020
Abstract:
Objective To investigate the efficacy and safety of microsphere transarterial chemoembolization( TACE) combined with radiotherapy in the treatment of patients with unresectable liver cancer. Methods A total of 68 patients with unresectable liver cancer were enrolled in Shantou central hospital from January 2016 to October 2018,among whom there were 65 male and 3 female patients,with a median age of 55 years( range 36-75 years). These patients were randomly divided into microsphere TACE group with 34 patients and microsphere TACE combined with radiotherapy group( combined group with 34 patients). The two groups were compared in terms of short-term response rate,progression-free survival( PFS) rate,overall survival( OS) rate,and adverse events to evaluate safety. The chi-square test was used for comparison of categorical data between groups,and the Kaplan-Meier method and the log-rank test were used for comparison of PFS and OS rates. Results Up to the last follow-up on April 30,2019,all patients completed treatment as planned and the median follow-up time was 15. 2 months. A total of 25 deaths were observed. The objective response rate was 50. 0% in the microsphere TACE group and 76. 5% in the combined group,and the combined group had a significantly better short-term response than the microsphere TACE group( χ2= 7. 995,P = 0. 046). For the microsphere TACE group,the 6-,12-,18-,and 24-month OS and PFS rates were 94. 1%/76. 5%,69. 0%/47. 1%,51. 3%/23. 9%,and 30. 9%/9. 6%,respectively,and for the combined group,the 6-,12-,18-,and 24-month OS and PFS rates were 100%/93. 7%,87. 8%/81. 1%,75. 1%/52. 9%,and 58. 2%/44. 1%,respectively; the combined group had significantly better PFS and OS time than the microsphere TACE group( χ2= 9. 027 and 4. 288,P = 0. 002 7 and 0. 038). There was a low incidence rate of adverse events in the two groups,and no treatment-related death was observed. Conclusion Compared with microsphere TACE alone,microsphere TACE combined with radiotherapy significantly improves short-term response and long-term survival in patients with unresectable liver cancer and thus provides a more effective and safer treatment for such patients.
Clinical effect of Jinlong capsules combined with Western medicine treatment in treatment of primary liver cancer:A Meta-analysis
Shi Ke, Wang XiaoJing, Wang XianBo
2019, 35(11): 2495-2501. DOI: 10.3969/j.issn.1001-5256.2019.11.021
Abstract:
Objective To investigate the clinical effect and adverse events of Jinlong capsules combined with Western medicine treatment in the treatment of advanced primary liver cancer. Methods PubMed,The Cochrane library,CNKI,Wanfang Data,CBM,and VIP were searched for randomized controlled trials( RCTs) on Jinlong capsules combined with Western medicine treatment in the treatment of advanced primary liver cancer published up to May 2019. The patients treated with Jinlong capsules combined with Western medicine treatment were enrolled as intervention group,and those treated with Western medicine treatment alone were enrolled as control group. Data extraction and quality assessment were performed,and RevMan 5. 3 was used to perform the Meta-analysis with a fixed or random effects model.Results A total of 26 RCTs were included,with a total of 2318 patients( 1175 patients in the intervention group and 1143 patients in the control group). The results of the Meta-analysis showed that compared with Western medicine treatment alone,Jinlong capsules combined with Western medicine treatment had significant increases in response rate( relative risk [RR] = 1. 36,95% confidence interval [CI]:1. 25-1. 49,P < 0. 001),1-year survival rate( RR = 1. 29,95% CI: 1. 14-1. 47,P < 0. 001),Karnofsky Performance Scale score( RR = 1. 37,95% CI: 1. 19-1. 59,P < 0. 001),peripheral blood CD3+T lymphocytes( mean difference [MD]= 11. 18,95% CI: 2. 68-19. 68,P = 0. 01),CD4+T lymphocytes( MD = 6. 43,95% CI: 3. 82-9. 05,P < 0. 001),and CD4+/CD8+ratio( MD = 0. 31,95% CI: 0. 26-0. 36,P < 0. 001),as well as significant reductions in rate of progression( RR = 0. 41,95% CI: 0. 29-0. 57,P < 0. 001),rate of leucopenia( RR = 0. 65,95% CI: 0. 57-0. 75,P < 0. 001),incidence rate of gastrointestinal reactions( RR = 0. 72,95% CI: 0. 59-0. 88,P= 0. 001),and peripheral blood CD8+T lymphocytes( MD =-4. 68,95% CI:-5. 84 to-3. 51,P < 0. 001). Conclusion Jinlong capsules combined with Western medicine treatment has a marked clinical effect in the treatment of advanced primary liver cancer with few adverse events and thus holds promise for clinical application.
Value of conventional ultrasonography and contrast-enhanced ultrasound in the differential diagnosis of intrahepatic cholangiocellular carcinoma and hepatocellular carcinoma: An analysis based on the logistic regression model
Ye XianJun, Hu Lei, He NianAn, Wei Mei, Liu Xiao, Liu WenBin
2019, 35(11): 2502-2507. DOI: 10.3969/j.issn.1001-5256.2019.11.022
Abstract:
Objective To investigate the value of conventional ultrasonography( US) and contrast-enhanced ultrasound( CEUS) in the differential diagnosis of intrahepatic cholangiocellular carcinoma( ICC) and hepatocellular carcinoma( HCC) by establishing a logistic regression model with the variables of US features and CEUS enhancement pattern( circumferential ring enhancement). Methods A retrospective analysis was performed for the US and CEUS features of 55 ICC patients and 42 HCC patients,and the results of surgical pathology or biopsy were used as the golden standard for diagnosis. A logistic regression analysis was used to evaluate the value of four US features,lesion echo,blood supply type,bile duct dilatation,and circumferential ring enhancement of CEUS,in the differential diagnosis of ICC and HCC. The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. A binary logistic regression analysis was performed for the factors with statistical significance in univariate analysis. Likelihood ratio was used to evaluate the fitting of the whole model,and the feature with the highest likelihood ratio in the qualitative diagnosis of ICC was screened out. The receiver operating characteristic( ROC) curve was plotted for the logistic regression model in the qualitative diagnosis of ICC,and the area under the ROC curve( AUC) was calculated. Results There were significant differences between the two groups in lesion echo( χ2= 4. 813,P < 0. 05),blood supply type( χ2= 10. 222,P < 0. 01),bile duct dilatation( χ2= 40. 669,P < 0. 01),and circumferential ring enhancement of CEUS( χ2= 8. 180,P < 0. 01),and these four features had a sensitivity of 58. 15%,72. 73%,67. 27%,and 69. 09%,respectively,and a specificity of 64. 29%,59. 52%,66. 4%,and 95. 24%,respectively,all P < 0. 05,in the differential diagnosis of ICC and HCC. Type of lesion echo,blood supply,circumferential ring enhancement of CEUS,and presence or absence of bile duct dilatation had an odds ratio of 3. 556,4. 107,4. 223,and 5. 776,respectively. The binary logistic regression equation was Logistic( P) =-2. 761 + 1.272 X1 + 1. 430 X2 + 1. 538 X3 + 1. 743 X4. The likelihood-ratio test of this model showed a significant difference in this regression equation( χ2= 94. 691,P < 0. 001). In the qualitative diagnosis of ICC,this regression equation had a sensitivity of 74. 3%,a specificity of 82. 2%,and an AUC of 0. 856. There was a significant difference in time to peak between the two groups( t = 8. 497,P < 0. 01). Conclusion The logistic regression model and CEUS qualitative analysis can improve the qualitative diagnosis of ICC.
Expression of FAM134B in liver cancer and its association with prognosis: An analysis based on data mining
Zhong LanHai, Ma DanDan, Zhang ZhiYong, Zhang Yi, Cai Xun
2019, 35(11): 2508-2512. DOI: 10.3969/j.issn.1001-5256.2019.11.023
Abstract:
Objective To investigate the expression of FAM134 B in liver cancer and its association with clinicopathological features and prognosis. Methods Data mining was performed for Oncomine,Human Protein Atlas,TCGA,and Kaplan Meier-Plotter databases to analyze the expression of FAM134 B in liver cancer,and the association of the expression of FAM134 B with clinicopathological characteristics and prognosis was analyzed. The chi-square test was used for comparison of categorical data between groups,and the Kaplan-Meier method was used to investigate the association between FAM134 B expression and prognosis of liver cancer. Results As for normal tissue,the highest expression level of FAM134 B was found in the kidney,and the expression of FAM134 B in the liver ranked 9 th; as for tumor tissue,the highest expression of FAM134 B was found in renal cancer,and the expression of FAM134 B in liver cancer ranked 11 th. A total of 147 studies found a significant difference in FAM134 B expression,and there was a significant difference in FAM134 B expression between various tumors. FAM134 B expression in liver cancer tissue was lower than that in normal liver tissue. FAM134 B protein was localized in the endoplasmic reticulum,and its expression was associated with age of onset of liver cancer patients,liver cirrhosis,alpha-fetoprotein,race,and degree of tumor differentiation( all P < 0. 05). FAM134 B expression was associated with the overall survival rate of liver cancer patients( hazard ratio [HR]= 0. 67,95% confidence interval[CI]: 0. 47-0. 95,P = 0. 026) and had significant influence on the prognosis of the Asian population( HR = 0. 40,95% CI: 0. 22-0. 74,P = 0. 003),while it had no significant influence on the prognosis of the Caucasian population( HR = 0. 65,95% CI: 0. 40-1. 05,P = 0. 076). Conclusion There is a significant difference in the expression of FAM134 B between tumors,with a low expression in liver cancer. FAM134 B protein is localized in the endoplasmic reticulum,and its low expression is associated with several malignant phenotypes of liver cancer and the low overall survival rate.
Expression and significance of the LONP1 gene in hepatocellular carcinoma
Zhang Yan, Xiang XiaoXing, Wang CuiMei
2019, 35(11): 2513-2516. DOI: 10.3969/j.issn.1001-5256.2019.11.024
Abstract:
Objective To investigate the expression and clinical significance of the LONP1 gene in hepatocellular carcinoma( HCC).Methods A total of 90 patients with pathologically confirmed HCC from January 2010 to September 2011 were enrolled,and the microarrays for their HCC tissue and adjacent tissue samples were provided by Shanghai Xinchao Biological Co.,Ltd. According to the level of positive expression of LONP1 in HCC tissue,the patients were divided into weak positive group with 33 patients,positive group with 24 patients,and strong positive group with 33 patients. Immunohistochemistry was used to measure the expression of LONP1 in HCC and adjacent tissue samples,and its association with the clinicopathological features of HCC was analyzed. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The Kaplan-Meier method and the log-rank test were used for survival analysis,and the Cox proportional-hazards regression model was used to investigate risk factors. Results The positive expression rate of LONP1 protein in HCC tissue was significantly higher than that in the adjacent tissue( 100% vs 8. 9%,χ2= 152. 308,P < 0. 001). The expression of LONP1 protein was associated with presence or absence of tumor capsule,presence or absence of liver cirrhosis,clinical stage,and pathological grade( all P < 0. 05). There was a significant difference in median survival time between the weak positive group,the positive group,and the strong positive group( 40. 545 months vs 28. 545 months vs 19. 428 months,χ2= 32. 058,P < 0. 001). In HCC patients,median survival time was correlated with the expression of LONP1 protein,pathological grade,and clinical stage( all P < 0. 05). The multivariate Cox analysis showed that with the weak positive expression of LONP1 protein as a reference,positive expression of LONP1 protein( hazard ratio [HR]= 0. 109,95% confidence interval [CI]: 0. 034-0. 349,P < 0. 001) and strong positive expression of LONP1 protein( HR =0. 448,95% CI: 0. 219-0. 918,P = 0. 028) were independent influencing factors for the survival of HCC patients. Conclusion The expression level of LONP1 in HCC tissue is significantly higher than that in adjacent tissue,and the patients with high expression of LONP1 have a significantly shorter survival time than those with low expression.
Original articles_Biliary diseases
Association between fasting blood glucose and the risk of cholelithiasis
Liang MingYang, Wei YaoChen, Wang YiMing, Cui HaoZhe, Sun MiaoMiao, Liu SiQing, Cao LiYing
2019, 35(11): 2517-2522. DOI: 10.3969/j.issn.1001-5256.2019.11.025
Abstract:
Objective To investigate the association between fasting blood glucose and the risk of cholelithiasis. Methods A total of87513 individuals who underwent fasting blood glucose test and liver/biliary ultrasound in health examination in Kailuan from 2006 to 2007 were enrolled as subjects,and according to the results of blood glucose test,the subjects were divided into normal blood glucose group with73456 subjects,impaired fasting blood glucose group with 7165 subjects,and diabetic group with 6892 subjects. The log-rank test was used to compare the cumulative incidence rate of cholelithiasis between groups; the Cox proportional hazards model was used to analyze the influence of different levels of fasting blood glucose on new-onset cholelithiasis and calculate hazard ratio( HR) and 95% confidence interval( CI); a stratified analysis was used to compare the risk of cholelithiasis between the individuals with different levels of fasting blood glucose in the groups with different sexes,blood lipid levels,and levels of body mass index( BMI). A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups. The chi-square test was used for comparison of categorical data between groups. Results There was a significant difference in the cumulative incidence rate of cholelithiasis between the normal blood glucose group,the impaired fasting blood glucose group,and the diabetic group( 10. 91% vs 12. 17% vs 18. 86%,χ2= 27. 94,P < 0. 05). After the continuous adjustment for the other factors in the Cox proportional hazards model analysis,compared with the normal blood glucose group,the impaired fasting blood glucose group had a risk of new-onset cholelithiasis of 0. 97( 95% CI: 0. 85-1. 11,P = 0. 587),and the diabetic group had a risk of new-onset cholelithiasis of 1. 15( 95% CI: 1. 01-1. 30,P = 0. 019). The stratified analysis showed that diabetes was a risk factor for new-onset cholelithiasis in male individuals( HR = 1. 16,95% CI: 1. 01-1. 33,P = 0. 043),individuals with normal blood lipids( HR = 1. 22,95% CI: 1. 01-1. 49,P = 0. 044),and individuals with overweight based on BMI( HR = 1. 16,95% CI:1. 01-1. 35,P = 0. 048). Conclusion Diabetes can increase the risk of cholelithiasis. Diabetes is an independent risk factor for cholelithiasis in men,individuals with normal blood lipids,and individuals with overweight based on BMI.
Clinicopathological features of Caroli's disease: An analysis of 5 cases
Li Li, Yao JingJing, Yang JiangHui, Yin HongFang
2019, 35(11): 2523-2527. DOI: 10.3969/j.issn.1001-5256.2019.11.026
Abstract:
Objective To investigate the clinical features,pathological features,differential diagnosis,and prognosis of Caroli's disease( CD). Methods A retrospective analysis was performed for the clinicopathological data of 5 parents with CD who were treated in Beijing Tsinghua Chang Gung Hospital from January 2014 to May 2019,and a literature review was also performed. Results There were 3 male and2 female patients,with a mean age of 20 years. All of them attended the hospital due to the presence of intermittent upper abdominal pain,and among these patients,4 had pyrexia,2 had splenomegaly and portal hypertension,1 had gallstones,4 had bilateral renal cysts,and 4 had abnormal hepatic function. Imaging examination showed varying degrees of cystic dilatation of the intrahepatic bile ducts which communicated with the biliary tree,and fibrous bands were observed in these cysts. Pathological examination showed intrahepatic bile duct dilatation with fibrous tissue proliferation and chronic inflammatory cell infiltration on the bile duct wall,and fibrovascular bundles were observed in the bile duct cavity. In addition,fibrosis and proliferation of the portal area and abnormal small bile ducts were observed in type Ⅱ CD. Conclusion CD is often seen in children and adolescents,and its clinical manifestations lack specificity. A confirmed diagnosis of CD relies on imaging and pathological examinations. Histopathological features of this disease include cystic dilatation of the intrahepatic bile ducts communicating with the biliary tree and the bands consisting of fibrous tissue and vessels in these cysts.
Original articles_Pancreatic diseases
Clinical and prognostic features of acute alcoholic pancreatitis
Jiang Xin, Xu Huan, Yan YongFeng, Zhong Rui, Luo XuJuan, Shi XiaoMin, Wang Min, Peng Yan, Tang XiaoWei
2019, 35(11): 2528-2532. DOI: 10.3969/j.issn.1001-5256.2019.11.027
Abstract:
Objective To investigate the clinical and prognostic features of acute alcoholic pancreatitis. Methods A total of 467 patients with incipient acute pancreatitis( AP) who were admitted to The Affiliated Hospital of Southwest Medical University from July 2013 to July2018 were enrolled as subjects,and among these patients,182 with alcoholic AP were enrolled as alcoholic group and 285 with biliary AP were enrolled as biliary group. The two groups were compared in terms of the clinical features such as age,sex,laboratory markers,disease grade,complications,and prognostic indices. The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups,and the Mann-Whitney U test was used for comparison of ranked data between two groups. Results Compared with the biliary group,the alcoholic group had significantly higher constituent ratio of male patients( 74. 2% vs 48. 1%,χ2= 31. 124,P < 0. 001) and proportion of patients with fatty liver disease( 34. 1% vs 24. 9%,χ2= 4. 569,P = 0. 033). The biliary group had a significantly higher proportion of patients with hypertension than the alcoholic group( 23. 5% vs 15. 4%,χ2= 4. 524,P = 0. 033). Compared with the biliary group,the alcoholic group had significantly higher levels of creatinine and triglyceride( Z =-4. 828,t = 7. 916,both P < 0. 001),proportion of patients with severe AP( 34. 6% vs 15. 1%,Z =-4. 787,P < 0. 001),and CTSI score( 4. 6 ± 1. 7 vs 4. 2 ± 1. 5,t = 2. 672,P = 0. 008). Compared with the biliary group,the alcoholic group had significantly higher probabilities of acute peripancreatic fluid accumulation( 61. 0% vs 49. 8%,χ2=5. 045,P < 0. 05),pancreatic pseudocyst( 11. 5% vs 4. 2%,χ2= 8. 881,P < 0. 05),infectious pancreatic necrosis( 37. 9% vs 19. 6%,χ2= 18. 899,P < 0. 05),and renal failure( 19. 2% vs 8. 4%,χ2= 11. 758,P < 0. 05). Compared with the biliary group,the alcoholic group had significantly longer time to intestinal function recovery,time to relief of abdominal pain,and length of hospital stay( t =-4. 078,-3. 357,and-2. 527,all P < 0. 05). There was a significant difference in mortality rate between the alcoholic group and the biliary group( 7. 1% vs 3. 2%,χ2= 3. 929,P = 0. 047). Conclusion Compared with the biliary group,the alcoholic group has a higher risk of complications,worse clinical manifestations,and a higher mortality rate. Therefore,alcohol abstinence education should be performed for this population,especially men,in order to reduce adverse outcomes.
Effect of UHRF1 gene silencing on the progression of pancreatic adenocarcinoma cells
Yan Ping, Wang Qing, Liu Yu, Wu Yan, He Shuai, Chen Xia
2019, 35(11): 2533-2536. DOI: 10.3969/j.issn.1001-5256.2019.11.028
Abstract:
Objective To investigate the effect of UHRF1 gene silencing on the progression of pancreatic adenocarcinoma( PAAD) cells.Methods A total of 30 patients with PAAD who underwent pancreaticoduodenectomy in Department of Hepatobiliary Surgery,Leshan People's Hospital,from July to December,2018,were enrolled,and the non-necrotic PAAD tissue and the adjacent tissue were resected as samples.Semi-quantitative RT-PCR and Western blot were used to measure the mRNA and protein expression of UHRF1 in these samples. After the short-hairpin RNA( sh RNA) plasmid vectors were constructed for the targeted silencing of the UHRF1 gene and were transfected into PAAD cells by the lentivirus infection method,MTT assay was used to evaluate cell proliferation,and Western blot was used to measure the expression of UHRF1,Bax,and Bcl-2. 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 of continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups. Results The expression of UHRF1 in PAAD tissue was significantly higher than that in adjacent tissue( t =18. 131,P <0. 001). Compared with the UHRF1 group,the UHRF1-sh RNA group had a significant reduction in the protein expression of UHRF1 in PAAD cells( t = 3. 882,P = 0. 023),with inhibited cell proliferation at 12 and 36 hours after transfection( t = 4. 365 and19. 042,P = 0. 005 and P < 0. 001). Compared with the adjacent tissue group and the UHRF1 group,the UHRF1-sh RNA group had a significant increase in the expression of the pro-apoptotic protein Bax( F = 862. 366,P < 0. 001) and a significant reduction in the expression of the anti-apoptotic protein Bcl-2( F = 170. 167,P < 0. 001),suggesting that UHRF1 gene silencing had a pro-apoptotic effect. Conclusion The expression of the UHRF1 gene is significantly upregulated in PAAD tissue,and UHRF1 gene silencing can inhibit the growth of PAAD tissue,possibly by inducing tumor cell apoptosis. UHRF1 may be a new molecular target for the treatment of PAAD.
Original articles_Others
Clinical features of diabetic patients with bacterial liver abscess and different levels of glycosylated hemoglobin
Wang WeiZhao, Zhu QinLing, Xiang XiaoXing, Ma Li, Ju MengXian, Jin XiaoLong, Wang YongChao, Han WeiWei, Xu QingCheng
2019, 35(11): 2537-2541. DOI: 10.3969/j.issn.1001-5256.2019.11.029
Abstract:

Objective To investigate the clinical features of diabetic patients with bacterial liver abscess and different levels of glycosylated hemoglobin( Hb Alc). Methods A total of 118 adult diabetic patients with bacterial liver abscess who were admitted to our hospital from December 2014 to December 2018 were enrolled,and according to the level of Hb Alc,they were divided into well-controlled group with 32 patients,fairly-controlled group with 31 patients,and poorly-controlled group with 55 patients. The three groups were compared in terms of general data,clinical manifestations,laboratory results,complications,and pathogen test results. 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 two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. Results There were significant differences in mean age and length of hospital stay between the three groups( F = 2. 933 and 3. 310,both P < 0. 05). Compared with the other two groups,the poorly-controlled group had a significantly younger mean age of onset( P = 0. 016) and a significantly longer length of hospital stay( P = 0. 044). Hypertension was the most common underlying disease in diabetic patients with liver abscess,followed by biliary tract diseases and cerebral infarction,and there was a significant difference in cerebral infarction between the three groups( χ2= 6. 135,P =0. 037). Compared with the well-controlled group,the poorly-controlled group had significantly fewer and less typical signs of abdominal tenderness( χ2= 6. 178,P = 0. 046),and compared with the other two groups,the poorly-controlled group tended to have a significant increase in C-reactive protein( χ2= 5. 985,P = 0. 049) and were more likely to develop sepsis( χ2= 6. 247,P = 0. 044). Conclusion For diabetic patients with bacterial liver abscess,the patients with a poorly controlled Hb Alc level often have a young age of onset,a long length of hospital stay,and atypical clinical signs and are likely to develop sepsis,which may lead to insufficient attention in clinical practice,delay diagnosis and treatment,and even endanger life,and therefore,such patients should be taken seriously in clinical practice.

Case reports
Histological reversal after treatment of drug-induced cirrhosis with Yiqi Liangxue TCM combined with Fuzheng Huayu Capsule: A case report
Wang Yu, Lu: Jing, Liu ChengHai
2019, 35(11): 2542-2544. DOI: 10.3969/j.issn.1001-5256.2019.11.030
Abstract:
Suspected seventh-day syndrome after liver transplantation for liver cancer: A case report
Jia Fan, Li Ang, Chen Hong, Lu Qian
2019, 35(11): 2545-2546. DOI: 10.3969/j.issn.1001-5256.2019.11.031
Abstract:
Ganglioneuroma in the hepatic hilar region: A case report
Fan YeHui, Ji JingWei, Wang XiaoLei, Zhang ShiLiang, Zhang RuoYan, Qiu Wei, Wang GuangYi, Wu Hao
2019, 35(11): 2547-2548. DOI: 10.3969/j.issn.1001-5256.2019.11.032
Abstract:
Hepatolenticular degeneration with MTHFR gene mutation: A case report
Li Ning, Zhang Xin, Li Rui, Jiao Lin
2019, 35(11): 2549-2550. DOI: 10.3969/j.issn.1001-5256.2019.11.033
Abstract:
Biliary neuroendocrine carcinoma: A case report
Yi Dan, Wang ShuPeng, Dong ShanShan, Ren XueKang, Niu ChunYuan, Liu SongYang
2019, 35(11): 2551-2552. DOI: 10.3969/j.issn.1001-5256.2019.11.034
Abstract:
Ligamentum teres hepatis hemorrhage after laparoscopic cholecystectomy: A case report
Ji JingWei, Liu Zhi, Xing MingXuan, Qi Jun, Du XiaoHong, Wang GuangYi
2019, 35(11): 2553-2554. DOI: 10.3969/j.issn.1001-5256.2019.11.035
Abstract:
A case of spontaneous splenic artery aneurysm rupture
Liao TingHai, Yang Fan, Li GuoWei, Feng Yu, Yang DaGang, Yuan HongTao
2019, 35(11): 2555-2556. DOI: 10.3969/j.issn.1001-5256.2019.11.036
Abstract:
Reviews
Vertical transmission of hepatitis B virus: Modes and blocking strategies
Zhao Fei, Liu Fei, Wang ZhongFeng, Li HaiJun, Xu HongMei
2019, 35(11): 2557-2560. DOI: 10.3969/j.issn.1001-5256.2019.11.037
Abstract:
Mother-to-child vertical transmission is the main mode of transmission of chronic hepatitis B in China. The probability of failure in blocking vertical transmission is about 10% in pregnant mothers with a high viral load,and therefore,correct management of hepatitis B virus( HBV) is of great importance during pregnancy. In addition,viral treatment during pregnancy should take into account the risk of vertical transmission,the health of pregnant women,and the safety of fetus,and each treatment method or prevention option needs to be carefully evaluated. Reasonable antiviral methods,drug selection,and drug withdrawal time can reduce the probability of mother-to-child transmission. This article summarizes the modes of mother-to-child vertical transmission of chronic hepatitis B and related blocking strategies,so as to provide a reference for improving the blocking rate of vertical transmission of HBV.
Association between hepatitis B virus infection and bile acid
Li Shuo, Li ZhiGuo, Ye YongAn
2019, 35(11): 2561-2564. DOI: 10.3969/j.issn.1001-5256.2019.11.038
Abstract:
Hepatitis B virus( HBV) infection is closely associated with bile acid. Recent studies have shown that HBV infection is involved in the regulation of bile acid metabolism through bile acid transporters and mediation of liver injury,and bile acid changes HBV biosynthesis through FXR. This article reviews the research advances in the association between HBV infection and bile acid and the role of bile acid in the diagnosis and treatment of HBV-related liver diseases,so as to provide new ideas for the clinical diagnosis and treatment of HBV infection.
Role of intestinal flora-mediated immune response in chronic hepatitis B virus infection
Gao Hui, Liu ShouSheng, Zhao ZhenZhen, Xin YongNing
2019, 35(11): 2565-2568. DOI: 10.3969/j.issn.1001-5256.2019.11.039
Abstract:
Hepatitis B virus( HBV) infection can cause acute or chronic liver injury. Chronic hepatitis B( CHB)-related liver cirrhosis and hepatocellular carcinoma usually lead to an increase in mortality,and their pathogenesis may be associated with immune response. Intestinal flora plays an important role in host metabolism and immune regulation,and the studies on“gut-liver axis”and intestinal flora have shown that the structural change of intestinal flora,bacterial translocation,and related immunologic injury may affect the development and progression of liver inflammation on the basis of CHB. This article summarizes and discusses the immunological role of intestinal flora in CHB and explores the potential treatment methods for HBV infection based on intestinal flora.
Immunotherapy for chronic hepatitis B
Wu XiaoMin, Tong QiaoYun, Liu Wei
2019, 35(11): 2569-2572. DOI: 10.3969/j.issn.1001-5256.2019.11.040
Abstract:
Although current direct anti-hepatitis B virus( HBV) drugs have good effects in controlling viral replication and limiting the progression to liver cirrhosis,there is still a long way to go in the treatment of chronic hepatitis B( CHB). Immune tolerance and immune dysfunction may be the two most important immunopathogenic factors. With reference to the development of new strategies and new drugs for anti-HBV immunotherapy and the latest research findings around the world,this article reviews the research advances in immunotherapy for CHB in recent years.
Research advances in targeted therapy for hepatocellular carcinoma
Huang Shen, Yang ChengLei, Zhang ZhiMing
2019, 35(11): 2573-2577. DOI: 10.3969/j.issn.1001-5256.2019.11.041
Abstract:
Hepatocellular carcinoma( HCC) is one of the most common malignant tumors. Due to the insidious onset,poor prognosis,and lack of specificity of HCC,most patients have reached the advanced stage at the time of diagnosis. Conventional treatment methods,such as surgical resection,liver transplantation,radiotherapy,and chemotherapy,have limited therapeutic effects and fail to bring significant benefits to patients. With the improvement of science and technology and medical level in recent years,targeted therapy drugs have gradually entered people's vision due to the breakthroughs in the treatment of HCC and thus bring new hope to patients with advanced HCC. Targeted drugs have attracted wide attention due to good molecular selectivity,targeted killing of tumor cells,and protection of normal tissue. This article reviews the research advances in targeted therapy for HCC.
Research advances in the risk factors for microvascular invasion in hepatocellular carcinoma
Bai Xue, Ma ZuoHong, Hao ZhiQiang, Fu XiBo, Jiao Ao, Shang Hai, Hua XiangDong
2019, 35(11): 2578-2581. DOI: 10.3969/j.issn.1001-5256.2019.11.042
Abstract:
Liver cancer is one of the most common malignant tumors in the world,and at present,China has the highest incidence rate of liver cancer. Liver cancer has an insidious onset,and patients often have no obvious symptoms in the early stage; however,due to the rapid progression of this disease,most patients have developed advanced tumors at the time of diagnosis,and about 10% of patients have microvascular invasion( MVI) at initial pathological diagnosis. Although continuous improvement and progress have been made in the treatment methods for liver cancer,there is no significant reduction in postoperative recurrence rate. Many studies support that MVI is one of the independent risk factors for liver cancer recurrence,and patients with MVI determined by pathological diagnosis often have poor prognosis. However,there is still a lack of preoperative evaluation methods for MVI. This article analyzes and integrates the studies on MVI in the past 3 to5 years,in order to provide a comprehensive understanding of the research advances in MVI.
Research advances in traditional Chinese medicine regulation of autophagy in treatment of liver cancer
Gu Huan, Bai ZhangChuan, Liu Liu, Cheng QiuLuo, Zhu Ying
2019, 35(11): 2582-2587. DOI: 10.3969/j.issn.1001-5256.2019.11.043
Abstract:
Autophagy has become a research hotspot in the prevention and treatment of tumor in recent years. With the help of the bidirectional regulatory effect of autophagy,it can not only provide energy and a stable internal environment for normal and tumor cells by clearing misfolded proteins and damaged organelles in cells,but also induce autophagic death of tumor cells. Traditional Chinese medicine has advantages over Western medicine in better mediating autophagy to inhibit tumor development and progression,with the features of low toxicity,multiple targets,and multiple pathways. With an increasing number of studies on autophagy in traditional Chinese medicine,this article reviews the research advances in the effect of traditional Chinese medicine in autophagy in liver cancer in the past 10 years and explores and analyzes existing problems,hoping to provide a reference and new ideas for subsequent research on liver cancer.
Research advances in the pathogenesis of nonalcoholic fatty liver disease
Jiang YuZi, Nie HongMing, Wang Rong
2019, 35(11): 2588-2591. DOI: 10.3969/j.issn.1001-5256.2019.11.044
Abstract:
Nonalcoholic fatty liver disease( NAFLD) is the leading cause of chronic liver dysfunction and has complex pathogenesis and progression. With in-depth studies in recent years,the theory of“two hits”has gradually been replaced by the theory of“multiple hits”. The theory of“multiple hits”including the neuroendocrine immune inflammatory network suggests that various factors participate in the progression of NAFLD,such as insulin resistance,adipose tissue dysfunction,mitochondrial dysfunction,endoplasmic reticulum stress,inflammatory activation,fatty acids,gut microbiota,iron overload,dietary factors,genetic factors,and epigenetic factors. With reference to the research advances in recent years,this article reviews the pathogenesis of NAFLD from the aspects of genetic and epigenetic factors,gut microbiota,intrahepatic immune cells,and aquaporin.
Advances in the clinical research on autoimmune liver disease with Sjgren's syndrome
Zhang Xia, Luo LiTing, Ma HeMing, Ren TianQi, Niu JunQi
2019, 35(11): 2592-2595. DOI: 10.3969/j.issn.1001-5256.2019.11.045
Abstract:
Autoimmune liver disease is a group of liver diseases caused by the disorder of the autoimmune system,and some patients may have the symptoms of dry mouth and dry eyes. Patients with autoimmune liver disease and Sjgren's syndrome are commonly seen in clinical practice. This article summarizes the research advances in the clinical manifestation,pathological features,key diagnosis/treatment points,and prognosis of autoimmune liver disease with Sjgren's syndrome.
Research advances in the diagnosis and treatment of acute-on-chronic liver failure with infection
Lu AiQi, Yang KeLi, Guan YuJuan
2019, 35(11): 2596-2599. DOI: 10.3969/j.issn.1001-5256.2019.11.046
Abstract:
Acute-on-chronic liver failure( ACLF) is a severe syndrome of liver diseases commonly seen in clinical practice and can lead to severe disorders and decompensation of liver synthesis,metabolism,detoxification,and biotransformation,as well as multiple organ failure and an extremely high short-term mortality rate. Infection can induce or aggravate the condition of ACLF and is an independent influencing factor for patient prognosis. This article describes the mechanism and characteristics of ACLF with infection,summarizes the common types and clinical features of infection,reviews the recommended anti-infective regimens,and emphasizes the importance of early prophylactic treatment. ACLF patients with infection tend to have critical conditions,and early diagnosis and empirical anti-infective treatment is the key to successful treatment.
Establishment and application value of a monosodium glutamate-rat-liver regeneration model
Li HanMin
2019, 35(11): 2600-2604. DOI: 10.3969/j.issn.1001-5256.2019.11.047
Abstract:
The establishment of an animal model of liver regeneration in a state of neuro-endocrine-immune network dysfunction is an urgent need to promote the research on the regulatory mechanism of liver regeneration. The monosodium glutamate( MSG)-rat-liver regeneration model is a composite model of liver regeneration which combines the MSG-rat model with the model of partial hepatectomy( PHx) or hepatotoxicity( for example,CCl4),and it is mainly used to investigate liver regeneration and its regulatory mechanism in the state of neuro-endocrine-immune network dysfunction,mechanisms and drug screening of liver-brain syndrome,and mechanisms of disease-syndrome combination and drug efficacy. Dysregulated liver regeneration process is observed in the MSG-rat-liver regeneration model established by the MSG-rat model and PHx,which is significantly different from the liver regeneration process in normal rats after major hepatectomy. The MSG-rat-liver regeneration model established by the MSG-rat model and hepatotoxicity has a significantly higher degree of liver fibrosis than normal rats with CCl4-induced liver fibrosis. The hypothalamic-pituitary-hepatic axis is an important mechanism of the influence of the external environment on liver regeneration,and the imbalance of epithelial-mesenchymal transition/mesenchymal-epithelial transition is an important mechanism of the influence of intrahepatic microenvironment on abnormal liver regeneration( liver fibrosis).The research on MSG-rat-liver regeneration model preliminarily reveals the efficacy and mechanism of traditional Chinese medicine in the prevention and treatment of liver and related diseases( including liver-brain syndrome) by influencing the neuro-endocrine-immune-liver regeneration regulatory network and promotes the research on the combination of diseases and syndromes. The establishment and application of the MSG-rat-liver regeneration model has important scientific significance and application value in further exploration of the complex mechanism of liver regeneration and the mechanism of traditional Chinese medicine in regulating liver regeneration.
Differences in the clinicopathological features of pancreatic head carcinoma arising from the dorsal pancreas and the ventral pancreas
Wang DaSong, Ye Hui
2019, 35(11): 2605-2608. DOI: 10.3969/j.issn.1001-5256.2019.11.048
Abstract:
The pancreas arises from the dorsal and ventral anlagen. The dorsal anlagen forms the cephalic part of the head of the pancreas,the neck of the pancreas,the body of the pancreas,and the tail of the pancreas,while the ventral anlagen forms the caudal part of the head of the pancreas and the uncinate process of the pancreas. There is a fusion plane between the dorsal pancreas and the ventral pancreas,which can be identified by immunohistochemical staining of pancreatic polypeptide. There are differences in local invasion,lymph node metastasis,neural invasion,and survival time between pancreatic head carcinoma arising from the dorsal pancreas and that arising from the ventral pancreas. This article reviews the differences in clinicopathological features between these two types of pancreatic head carcinoma.