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  • 中国科技核心期刊
  • 中国科技论文统计源期刊
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2024 Vol. 27, No. 6 Published:10 November 2024
Hepatitis in animal
Mechanism of histone deacetylase inhibitor ACY1215 in inhibition of LPS/D-galactosamine-induced acute liver failure in mice
Zhang Xiaoya, Shi Chunxia, Guo Jin, et al
2024, 27(6):  812-815.  doi:10.3969/j.issn.1672-5069.2024.06.004
Abstract ( 66 )   PDF (1588KB) ( 104 )  
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Objective This experiment was conducted to explore the mechanism of protective roles of histone deacetylase (HDAC) inhibitor ACY1215 in inhibition of acute liver failure (ALF). Methods Thirty mice were randomly divided into control, model and ACY1215-intervened groups, with 10 animals in each. ALF model was established by combination of lipopolysaccharide and D-aminogalactose intraperitoneal injection, and early intraperitoneal ACY1215 injection was carried out as intervention. Histopathological examination was performed. Hepatic expression of malate dehydrogenase 1 (MDH1),isocitrate dehydrogenase (IDH1),and fructose-2,6-bisphosphatase 2 (PFKFB2) as well as interleukin-1β (IL-1β) and IL-18 were detected by Western blot. Results Histopathological examination demonstrated the ALF model was successfully established, and ACY1215 intervention greatly ameliorate liver injuries; serum ALT, AST and total bilirubin levels in the model group were (3743.5±655.9)U/L, (2539.4±488.1)U/L and (89.56±7.2)μmol/L, significantly higher than [(34.5±7.6)U/L, (32.3±9.3)U/L and (6.2±2.4)μmol/L, respectively, P < 0.05] in the control, while ACY1215 intervention greatly decreased those parameters, e.g., (951.5±328.9)U/L, (475.3±131.24)U/L and (38.41±9.5)μmol/L (P<0.05); hepatic expression of MDH1 and IDH1 in the model was obviously weaker, that of PFKFB2, IL-18 and IL-1β was greatly intensified as compared to in the control, while in ACY1215-intervende group, the expression of MDH1 and IDH1 intensified, and PFKFB2, IL-18 and IL-1β weakened compared to in the model group. Conclusion The histone deacetylase inhibitor, ACY1215, could have a protective effects on mice with ALF, the mechanism by which it exert might be related to regulation of energy metabolism enzymes.
Down-regulation of hepatic SREBP1 and PPAR-γ expression by naringin in mice with high-fat diet-induced NAFLD
Jia Jihui, Zhang Yizhi, Lin Jing, et al
2024, 27(6):  816-819.  doi:10.3969/j.issn.1672-5069.2024.06.005
Abstract ( 83 )   PDF (1684KB) ( 96 )  
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Objective The purpose of this experiment was to investigate effects of naringin (Nar) on lipid metabolism in mice with high-fat diet (HFD) induced non-alcoholic fatty liver diseases (NAFLD). Methods Twenty-four C57BL/6J mice were randomly divided into control, model and HFD/Nar-intervention groups, with eight mice in each group. The model of NAFLD was established by HFD intake, and the intervention was carried out by naringin gavage at dose of 100 mg.kg-1 for four weeks. Drug intervention with differential gene enrichment pathways was determined by transcriptome sequencing. Hepatic lipid metabolism related genes and their protein expression were detected by qPCR and Western blot. Results Body mass of mice in model group increased by 57.8% (P<0.01) as compared with in the control, while in naringin-intervention group, it decreased by 13.5% (P<0.01); hepatic TG and TC levels in the model were (3.5±0.4)mmol/g protein and (3.1±0.5)mmol/g protein, both much higher than [(1.0±0.3)mmol/g protein and (0.8±0.1)mmol/g protein, P<0.01] in the control, while in HFD/Nar-intervention group, they significantly decreased to [(2.1±0.4)mmol/g protein and (1.11±0.3)mmol/g protein, P<0.05]; KEGG enrichment analysis by transcriptome sequencing showed obvious impacts of naringin on nine pathways related to lipid metabolism, presenting with hepatic sterol regulatory element binding protein 1 (SREBP1), peroxisome proliferator-activated receptor-γ (PPAR-γ), thrombospondin receptor (CD36) and liver-type fatty acid-binding protein 1 (FABP1) down-regulation(P<0.05), and PPAR-α and recombinant carnitine palmitoyltransferase 1A (CPT-1A) up-regulation(P<0.05). Conclusion Naringin could significantly ameliorate hepatic lipid deposition, the mechanisms by which it work might be related to regulation of some gene expression and inhibit lipid uptake and synthesis, and accelerate fatty acid oxidation.
Improvement of liver fibrosis in patients with chronic hepatitis B after tenofovir alafenamide fumarate antiviral and herbal medicine anti-fibrotic therapy
Zhang Tianting, Xu Jing, Jiang Zhengwei, et al
2024, 27(6):  820-823.  doi:10.3969/j.issn.1672-5069.2024.06.006
Abstract ( 116 )   PDF (888KB) ( 117 )  
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Objective The aim of this study was to investigate efficacy of tenofovir alafenamide fumarate (TAF) and Ganshuang granules, a herbal medicine compound, combination in the treatment of patients with chronic hepatitis B (CHB). Methods 76 patients with CHB were enrolled in our hospital between January 2020 and December 2023, and were randomly divided into control (n=38) and observation group (n=38). They were treated with TAF or TAF and herbal medicine combination for 48 weeks. Serum HBV DNA load was assayed by real-time fluorescence quantitative PCR, and serum HBeAg level was detected by chemiluminescence immunoassay. TCM syndromes scores were evaluated according to the Guidelines for the Traditional Chinese Medicine Diagnosis and Treatment of Chronic Hepatitis B (2018 Edition). Fibrosis index based on four factors (FIB-4) was obtained and liver stiffness measurement (LSM) was detected by transient elastography. Serum transforming growth factor-β1 (TGF-β), matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels were determined by ELISA. Results By end of 48 week treatment, ALT normalization rate in the observation group was 94.7%, much higher than 78.9%(P<0.05) in the control; scores of distending pain at hypochondrium, yellow and greasy tongue coating, poor appetite and nausea and yellow urine in the observation group were(0.9±0.1), (1.0±0.2), (0.9±0.1) and (0.7±0.1), all much lower than [(1.3±0.2), (1.3±0.2), (1.2±0.2) and (0.9±0.2), all P<0.05] in the control; FIB-4 score, LSM, serum TGF-β1 and TIMP-1 levels were (1.8±0.3), (7.0±0.6)kPa, (21.4±5.4)ng/mL and (119.3±19.5)ng/mL, all significantly lower than [(2.2±0.4), (9.7±1.1)kPa, (39.1±6.1)ng/mL and (168.9±22.3)ng/mL, respectively, P<0.05], while serum MMP-1 level was (9.8±1.2)ng/mL, significantly higher than [(7.1±1.0)ng/mL, P<0.05] in the control group. Conclusion Combination of TAF and Ganshuang granules in the treatment of patients with CHB could significantly reduce TCM syndrome scores, improve liver function and relieve liver fibrosis.
Viral hepatitis
Combination of tenofovir alafenamide and PEG-IFNα-2b in treatment of patients with chronic hepatitis B
Zhang Li, Feng Xixuan, Liu Fei, et al
2024, 27(6):  824-827.  doi:10.3969/j.issn.1672-5069.2024.06.007
Abstract ( 61 )   PDF (894KB) ( 45 )  
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Objective The aim of this study was to investigate antiviral efficacy of tenofovir alafenamide (TAF) and peginterferon interferon α-2b (PEG-IFNα-2b) combination in treatment of patients with chronic hepatitis B (CHB). Methods A total of 122 patients with CHB were enrolled in our hospital between March 2021 and March 2023, and were randomly divided into control (n=61) and observation (n=61) group, receiving TAF or TAF and PEG-IFNα-2b combination for antiviral therapy for 48 weeks. Serum HBV DNA loads were detected by real-time fluorescence quantitative PCR, serum HBeAg and HBsAg levels were assayed by electrochemiluminescence, and serum Toll-like receptor 4 (TLR4) and interleukin-35 (IL-35) levels were determined by ELISA. Results By end of 24-week and 48 week treatment, serum HBeAg levels in the combination group were(195.3±36.4)IU/ml and (180.6±25.9)IU/ml, both significantly lower than [(236.1±42.5)IU/ml and (217.5±33.8)IU/ml, P<0.05], and serum HBsAg levels were (925.1±226.9)IU/ml and (816.2±175.3)IU/ml, significantly lower than [(1028.4±251.5)IU/ml and (921.7±226.8)IU/ml, P<0.05] in TAF-treated patients; serum HBeAg negativity rates was 21.3% and 29.5%, both significantly higher than 3.3% and 6.6%(P<0.05) in TAF group; serum TLR4 levels were (68.6±17.4)pg/mL and (41.4±15.9)pg/mL, both much lower than [(90.1±20.5)pg/mL and (73.5±18.2)pg/mL, respectively, P<0.05], and serum IL-35 levels were (127.9±25.5)pg/mL and (73.5±18.6)pg/mL, both much lower than [(191.4±30.6)pg/mL and (102.7±26.1)pg/mL, respectively, P<0.05] in TAF group. Conclusion TAF and PEG-IFNα-2b combination in treatment of patients with CHB is efficacious, with a satisfactory serumHBeAg negativity, which might be related to reduced expressions of TLR4 and IL-35 and needs further investigation.
Tenofovir amibufenamide in re-treatment of patients with chronic hepatitis B and low-level viremia
He Zhenwen, Xu Gang, Meng Hua, et al
2024, 27(6):  828-831.  doi:10.3969/j.issn.1672-5069.2024.06.008
Abstract ( 73 )   PDF (891KB) ( 28 )  
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Objective The aim of this study was to investigate clinical antiviral efficacy of tenofovir amibufenamide (TMF) and entecavir (ETV) in the treatment of patients with chronic hepatitis B (CHB) and low-level viremia (LLV). Methods 79 patients with CHB were encountered in our hospital between April 2021 and April 2023, and all met enrollment criteria, e.g., receiving nucleos(t)ide analogues (NAs), including lamivudine, adefovir and ETV antiviral treatment for 4 to 22(12.1±3.6)yrs and having LLV (21 to 1999 IU/mL). Patients were divided into control (n=39) and observation (n=40) groups, receiving ETV or TMF treatment for 12 months. Serum HBV DNA loads were detected by high-sensitive real-time fluorescence quantitative PCR, serum HBsAg and HBeAg were assayed by chemiluminescence immunoassay, and routine blood and biochemical parameters were determined to obtain fibrosis-4 index (FIB-4) and estimated glomerular filtration rate (eGFR). Liver stiffness measurement (LSM) was detected by Fibroscan. Peripheral blood T lymphocyte subsets were measured by flow cytometry. Results By end of 48-week treatment, serum ALT and AST levels in the observation group were(30.2±4.0)U/L and (31.8±6.2)U/L, both not significantly different compared to [(30.9±3.6)U/L and (33.7±7.0)U/L, respectively] in the control (P>0.05), while serum HBV DNA loads was 25(14.8, 51.9)IU/mL, much lower than [223.8(87.2, 327.5)IU/mL, P<0.05] in the control; LSM, FIB-4 and eGFR were (7.0±0.8)kPa, (1.9±0.3) and (104.9±10.3)mL/min/1.73m2, not significantly different as compared to [(7.1±0.9)kPa, (1.8±0.3) and (105.1±11.2)mL/min/1.73m2, respectively, P>0.05] in the control; percentages of peripheral blood CD3+, CD4+, CD8+ cells and CD4+/CD8+ cell ratio were (66.9±6.9)%, (37.5±4.9)%, (24.0±2.5)% and (1.5±0.3), not significantly different compared to [(67.4±7.3)%, (38.8±4.6)%, (23.6±2.7)% and (1.6±0.4), respectively, P>0.05] in the control group. Conclusion TMF treatment could relatively radically inhibit HBV DNA replication in CHB patients with LLV, and long-term benefit needs further clinical investigation.
Assessment of significant liver fibrosis by visual instantaneous elastography and acoustic palpation elastography in patients with chronic hepatitis B
Zhou Jun, Zhang Zhongxin, Xu Haiyan
2024, 27(6):  832-835.  doi:10.3969/j.issn.1672-5069.2024.06.009
Abstract ( 59 )   PDF (884KB) ( 80 )  
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Objective This study was conducted to investigate the assessment of significant liver fibrosis (SLF) by visual instantaneous elastography (VIE) and acoustic palpation elastography (APE) in patients with chronic hepatitis B (CHB). Methods 121 patients with CHB were encountered in our hospital between October 2020 and October 2022, and all patients underwent liver biopsies for liver fibrosis staging and ultrasonography for liver stiffness measurement (LSM). The area under the receiver operating characteristic curve (AUROC) was drawn to reveal the diagnostic performance of LSM for predicting the SLF. Results Out of the 121 patients with CHB, the liver histo-pathological examination showed SLF in 95 cases, and non-significant liver fibrosis (NSLF) in 26 cases; the LSMvie and LSMape, serum aspartate aminotransferase and alanine aminotransferase levels in patients with SLF were (9.3±3.0)kPa,(9.3±3.1)kPa, (127.5±33.4)U/L and (137.8±38.8)U/L, all significantly higher than [(5.9±1.4)kPa, (6.0±1.5)kPa, (98.6±25.8)U/L and (90.5±28.7)U/L, respectively,P<0.05], while the blood platelet count was (125.8±41.5)×109/L, much lower than [(192.3±51.7)×109/L, P<0.05] in patients with NSLF; the sensitivity, specificity, accuracy, positive predictive value and negative predictive value by VIE in predicting SLF in patients with CHB were 95.8%, 88.5%, 94.2%, 96.8% and 85.2%, not significantly different as compared to 94.7%, 84.6%, 92.6%, 95.7% and 81.5% by APE (P>0.05). Conclusion The diagnostic accuracies of VIE and APE in predicting SLF in patients with CHB are both great, which might be useful in clinical practice, and warrants further investigation.
Serumv on Willebrand factor and soluble vascular cell adhesion molecule-1 level changes in patients with hepatitis C viral infection
Zhu Zhonghua, Hu Junxian, Li Yan
2024, 27(6):  836-839.  doi:10.3969/j.issn.1672-5069.2024.06.010
Abstract ( 48 )   PDF (895KB) ( 26 )  
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Objective This study was aimed to investigate serum von Willebrand factor (vWF) and soluble vascular cell adhesion molecule-1 (VACM-1) level changes in patients with hepatitis C viral infection. Methods 38 patients with chronic hepatitis C (CHC) and 38 patients with hepatitis C-induced liver cirrhosis (LC) were enrolled in our hospital between June 2020 and December 2022, and all received sofosbuvir, daclatasvir and ribavirin combination therapy for 12 weeks. Serum HCV RNA loads were detected by RT-PCR, and serum vWF, VACM-1 and interleukin-6 levels were assayed by ELISA. Results The rapid virological response, end treatment of virological response and sustained virological response rates in patient with LC were 81.5%,89.5% and 97.4%, not significantly different as compared to 89.5%, 92.1%and 100.0%in patients with CHC (P>0.05); at the end of antiviral therapy, the white blood cell count and platelet count in patients with LC were(4.7±0.9)×109/L and (139.5±42.1)×109/L, much lower than [(6.8±2.2)×109/L and (275.6±65.3)×109/L, P<0.05], while the FIB-4 and APRI scores were (2.8±1.6) and (0.6±0.3), much higher than [(0.7±0.9) and (0.2±0.1), respectively, P<0.05] in patients with CHC; serum vWF and sVCAM-1 levels in patients with LC were (134.3±44.3)ng/mL and (36.6±14.9)ng/mL, significantly higher than [(103.9±33.0)ng/mL and (18.7±8.9)ng/mL, respectively, P<0.05] in patients with CHC. Conclusion The application of DAAs in treating patients with HCV infection is efficacious, which might improve endothelial function, and needs further study.
Antiviral efficacy of dalatavir and asulivir combination in the treatment of naïve patients with chronic hepatitis C with genotype 1b infection
Zhang Keli, Tong Jing, Li Changping
2024, 27(6):  840-843.  doi:10.3969/j.issn.1672-5069.2024.06.011
Abstract ( 52 )   PDF (895KB) ( 31 )  
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Objective The aim of this study was to investigate the clinical antiviral efficacy of dalatavir (DCV) and asulivir (ASV) combination in the treatment of naïve patients with chronic hepatitis C (CHC) with genotype 1b infection. Methods 53 naïve patients with CHC and genotype 1b infection were enrolled in our hospital between October 2019 and October 2021, and all of them received the combination regimen of DCV and ASV therapy for 24 weeks, and were followed-up for 24 weeks. Serum HCV RNA loads, blood biochemical indexes and liver fibrosis index levels were detected. The drug resistance-related mutations of NS5A were detected by direct sequencing. Results At week 1, 2, 4, 8, 12 and 24 treatment, and at the end of 24 week follow-up, serum HCV RNA loss rates in the 53 patients with CHC were 3.7%, 9.4%, 43.3%, 69.8%, 83.0%, 94.3% and 94.3%, and serum HCV RNA loads were (5.8±0.1)lg IU/ml, (5.3±0.6)lg IU/ml, (3.5±0.5)lg IU/ml, (2.2±0.6)lg IU/ml, (1.0±0.2)lg IU/ml, (0.7±0.5)lg IU/ml and (0.7±0.4)lg IU/ml, all significantly lower than [(6.1±0.4)lg IU/ml, P<0.05] at baseline; at treatment week 24 and at the end of follow-up, serum AST levels were (22.7±11.4)U/L and (20.9±9.9)U/L, both significantly lower than [(63.5±6.6)U/L, P<0.05], and serum ALT levels were (19.3±10.7)U/L and (19.2±8.5)U/L, both significantly lower than [(80.2±65.3)U/L, P<0.05] at baseline; there were no obvious changes as respect to estimated glomerular filtration rate and blood routines during the treatment; at the end of treatment and follow-up, serum liver fibrosis indexes, such as Pc-III, HA and IV-c levels decreased greatly (P<0.05); the drug resistance-related mutations of NS5A was found in 3 cases (5.6%), out of which, the L31Y and Y93H simultaneous mutation in one case, and Y93H mutation in two cases. Conclusion The combination of DAC and ASV in treatment of naïve patients with CHC with genotype 1b infection is definitely efficacious, without renal function injury, while the NS5A mutations needs further investigation.
Efficacy and safety of sofosbuvir and dacatavir combination in the treatment of patients with end-stage renal disease and concomitant chronic hepatitis C
Qiao Jin, Zhao Yan, Dou Zhihua
2024, 27(6):  844-847.  doi:10.3969/j.issn.1672-5069.2024.06.012
Abstract ( 46 )   PDF (884KB) ( 69 )  
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Objective The aim of this study was to investigate efficacy and safety of sofosbuvir and dacatavir combination in the treatment of patients with end-stage renal disease (ESRD) and concomitant chronic hepatitis C (CHC). Methods 42 CHC patients with ESRD were encountered in our hospital between May 2020 and May 2022, and all underwent maintenance hemodialysis. DAAs regimen was carried out by sorfosbuvir and dacatavir combination for all patients for 12 weeks and followed-up for 12 months. HCV genotypes was conducted by Simmonds gene typing. Rapid virological response (RVR), end of treatment virological response (ETVR), sustained virologic response six month (SVR6) and SVR12 were recorded. Results Genotypes infected in our series were 1b in 22 cases, 2a in 9 cases, 2b in 6 cases and 3 in 5 cases; except for SVR6 and SVR12 were 80.0% in patients with genotype 3 infection, the RVR, ETVR and SVR6 and SVR12 were all 100.0%(P>0.05) in patients with other three HCV genotype infection; by end of 12 month follow-up, serum ALT level in 42 patients with CHC was 23(20, 38)U/L, AST was 21(17, 35)U/L, both significantly lower than [61(42, 92)U/L and 59(45, 83)U/L, respectively, P<0.05] at baseline, while peripheral blood platelet count was 155(130, 194)×109/L, and estimated glomerular filtration rate (eGFR) was 14.9(12.5,17.3)ml/min×1.73 m2, both significantly higher than [122(98, 141)×109/L and 9.3(8.0, 11.5)ml/min×1.73m2, respectively, P<0.05] at baseline; there were no significant differences as respect to serum creatinine and urea levels before and after antiviral treatment (P>0.05); during direct antiviral agent (DAA) therapy, incidence of eight adverse events, including nausea, fatigue, itching, anorexia, hyperkalemia, hypoglycemia, hypertension and joint pain occurred in 55 episodes. Conclusion Application of DAA in dealing with patients with ESRD and complicated CHC have a satisfactory efficacy and safety, which warrants further clinical investigation.
Serum HCV RNA detection by NucliSens miniMag and QIAamp system
Li Liang, Duan Lixiang, Sun Xiaohong
2024, 27(6):  848-851.  doi:10.3969/j.issn.1672-5069.2024.06.013
Abstract ( 54 )   PDF (942KB) ( 25 )  
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Objective The purpose of this study was to compare performance of NucliSens miniMag system and QIAamp Viral RNA Mini Kit in detecting serum HCV RNA loads. Methods 103 serum samples with anti-HCV positive were collected in our hospital between June 2021 and June 2023, and serum RNA was extracted by NucliSens miniMag system or QIAamp Viral RNA Mini Kit, respectively. Serum HCV RNA loads were detected by real-time fluorescence quantitative RT-PCR. Repetition and sensitivity were assessed. Results Of 103 anti-HCV positive serum samples, serum HCV RNA positive rates by NucliSens miniMag system and QIAamp system were 86.4% and 82.5% (P>0.05); serum HCV RNA load by NucliSens miniMag system was (5.4±1.2) lg IU/mL, much higher than (5.0±1.6)lg IU/mL by QIAamp kit (t=2.078, P=0.039); coefficient of variation of lowest and highest serum HCV RNA loads by NucliSens miniMag system were 2.4% and 2.2%, much superior to 4.7% and 4.5% by QIAamp kit; lowest serum HCV RNA load by NucliSens miniMag system detection was 2.8×10-6 lg IU/mL, much sensitive than 3.5×10-6 lg IU/mL by QIAamp kit. Conclusion Efficacy of serum HCV RNA assay by NucliSens miniMag system is satisfactory, which could help clinicians diagnose patients with chronic hepatitis C.
Autoimmune liver diseases
Serum IL-6, IL-8 and IL-10 levels and their impact on response to steroid therapy in patients with autoimmune hepatitis
Chen Rongrong, Jiang Lili, Cao Lihua
2024, 27(6):  852-855.  doi:10.3969/j.issn.1672-5069.2024.06.014
Abstract ( 65 )   PDF (1008KB) ( 19 )  
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Objective The aim of this study was to investigate serum interleukin-6 (IL-6), IL-8 and IL-10 level changes and their impact on response to steroid therapy in patients with autoimmune hepatitis (AIH). Methods 60 patients with AIH and 60 healthy individuals were recruited in our hospital between January 2020 and December 2023, and all patients received prednisone treatment for six months. Serum IL-6, IL-8 and IL-10 levels were measured by chemiluminescence method. Performance for predicting response to therapy was analyzed by using receiver operating characteristic (ROC) curves. Results At admission, serum IL-6 and IL-8 levels in patients with AIH were (7.5±2.5)pg/mL and (70.2±26.7)pg/mL, both significantly higher than [(4.8±1.4)pg/mL and (42.4±13.2)pg/mL, respectively, P<0.05], while serum IL-10 levels was (4.2±1.1)pg/mL, much lower than [(7.3±2.6)pg/mL, P<0.05] in healthy individuals; by end of six month treatment, serum IL-6 and IL-8 levels obviously decreased and serum IL-10 level increased (P<0.05) in patients with AIH; 56.7% of patients with AIH in our series responded, while 43.3% of them didn’t completely responded to steroid therapy; at presentation, serum IL-6 and IL-8 levels in responders were (4.9±1.4)pg/mL and (47.4±15.2)pg/mL, both significantly lower than [(9.9±2.8)pg/mL and (108.3±28.7)pg/mL, respectively, P<0.05], while serum IL-10 level was (6.9±1.9)pg/mL, much higher than [(2.7±1.6)pg/mL, P<0.05] in non-responders; ROC analysis showed that AUC was 0.816, with sensitivity of 100.0% and specificity of 50.0%, when serum IL-6, IL-8 and IL-10 (≤4.8 pg/mL, ≤48.0 pg/mL and >6.8 pg/mL as cut-off-value, respectively) combination in predicting response to steroid therapy. Conclusion Serum IL-6, IL-8 and IL-10 levels in patients with AIH change abnormally, which might be involved in pathogenesis of the disease, and impact response to immunosuppression therapy.
Single nucleotide polymorphism of Rs3184504 in SH2B3 gene in patients with autoimmune liver disease
Chen Datong, Yue Zhanyi, Zhang Xiaopeng
2024, 27(6):  856-859.  doi:10.3969/j.issn.1672-5069.2024.06.015
Abstract ( 77 )   PDF (891KB) ( 42 )  
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Objective The aim of this study was to explore implication of single nucleotide polymorphism (SNP) of Rs3184504 loci in SH2B adaptor protein 3 (SH2B3) gene in patients with autoimmune liver diseases (AILD). Methods 58 patients with autoimmune hepatitis (AIH), 62 patients with primary biliary cholangitis (PBC) and 60 healthy persons were recruited in our hospital between June 2017 and October 2023, and SNP of blood SH2B3 gene at Rs3184504 locus were detected by PCR. The correlation between Rs3184504 SNP of SH2B3 gene and morbidity risk of AILD was analyzed by Logistic regression analysis. Results Proportions of TT genotype and allele T of SH2B3 gene at Rs3184504 locus in patients with AIH were 53.4% and 66.4%, and they were 54.8% and 69.4% in patients with PBC, all significantly higher than 16.7% and 26.7% (P<0.05), while proportions of CC genotype of SH2B3 gene at Rs3184504 locus in patients with AIH and PBC were 20.7% and 16.1%, both significantly lower than 63.3%(P<0.05) in healthy individuals; Logistic regression analysis showed morbidity risk of AIH significantly increased 2.529 times (OR=2.529, P<0.05) in patients with TT genotype of SH2B3 gene Rs3184504 locus, relatively compared to those carrying CC genotype, and morbidity risk of PBC increased 2.812 times(OR=2.812, P<0.05) in patients with CT genotype of SH2B3 gene Rs3184504 locus and it increased 2.370 times(OR=2.370, P<0.05) in patients with TT genotype, relatively compared to those carrying CC genotype. Conclusion Morbidity risk of AILD is related to SNP changes of SH2B3 gene at Rs3184504 locus, TT is susceptibility genotype of AIH, CT and TT are susceptible genotypes of PBC and risk of AILD is higher in individuals with T allele.
Mendelian randomization unveils causal relationship between cholelithiasis and primary sclerosing cholangitis
Gao Menghan, Chen Lanlan, Zhang Yuning
2024, 27(6):  860-865.  doi:10.3969/j.issn.1672-5069.2024.06.016
Abstract ( 70 )   PDF (1345KB) ( 89 )  
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Objective The aim of this study was to explore causal relationship between cholelithiasis and primary sclerosing cholangitis (PSC). Methods Materials of patients with PSC were retrieved from International PSC Genetics Research Group (IPSCSG) and Finnish Biobank (FinnGen R10), and Mendelian randomization (MR) analysis was conducted by integrating summary data of published genome-wide association studies. Genetic instruments closely associated with cholelithiasis were extracted, and then causal relationship between cholelithiasis and PSC was estimated by using inverse-variance weighted (IVW) and weighted median (WM) methods. Finally, reverse MR was applied to assess whether PSC could lead to altered risk of cholelithiasis. Results Forward MR analysis found that genetic susceptibility to cholelithiasis could increase the risk of PSC (ORIVW: 1.379, 95%CI: 1.052-1.807, P=0.020; ORWM: 1.450, 95%CI: 1.014-2.074, P=0.042), and this result was validated in the FinnGen (ORIVW: 1.989, 95%CI: 1.517-2.610, P=6.76×10-7; ORWM: 1.931, 95%CI: 1.302-2.865, P=0.001); reverse MR analysis found that genetically-predicted PSC did not alter the risk of cholelithiasis (ORIVW: 1.008, 95%CI: 0.991-1.024, P=0.356). Conclusion This MR study find cholelithiasis is an important risk factor for occurrence of PSC, and the reverse causality is not established.
Serum macrophage migration inhibitory factor and interleukin-21 levels in patients with autoimmune hepatitis
Gao Yu, Yang Lei, Hu Guangming, et al
2024, 27(6):  866-869.  doi:10.3969/j.issn.1672-5069.2024.06.017
Abstract ( 55 )   PDF (888KB) ( 35 )  
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Objective The aim of this study was to investigate implication of serum macrophage migration inhibitory factor (MIF) and interleukin-21 (IL-21) level changes in patients with autoimmune hepatitis (AIH). Methods 61 consecutive patients with AIH were encountered in our hospital between December 2017 and November 2022, and all received standardized immunosuppressive therapy by prednisone and azathioprine combination. Liver biopsies were performed and serum MIF and IL-21 levels were assayed by ELISA at presentation. Results Serum MIF and IL-21 levels in 17 patients with clinically determined severe liver injury were (2.5±0.9)μg/L and (321.5±34.2)pg/mL, both much higher than [(1.5±0.5)μg/L and (174.7±20.5)pg/mL, respectively, P<0.05] in 44 patients with mild to moderate liver injury; serum MIF and IL-21 levels in 26 patients with histo-pathologicall proved G3-G4 inflammatory activity were (2.6±1.1)μg/L and (332.9±35.4)pg/mL, both much higher than [(1.5±0.6)μg/L and(170.8±25.4)pg/mL, respectively, P<0.05] in 35 patients with G1-G2 inflammatory activity; of our series, 54 patients (88.5%) responded biochemically to standardized immunosuppressive therapy, and serum MIF and IL-2 levels in 19 patients responded late after six months were(2.9±1.5)μg/L and (334.5±40.6)pg/mL, significantly higher than [(1.5±0.3)μg/L and (194.8±19.5)pg/mL, respectively, P<0.05] in 22 patients who responded less than six months or [(0.9±0.2)μg/L and (100.6±9.2)pg/mL, respectively, P<0.05] in 23 patients who responded less than three months. Conclusion Serum MIF and IL-21 levels in patients with AIH elevate, which might influence liver injury and response to immunosuppressive therapy, and warrants further investigation.
Drug-induced liver injuries
Clinical features of patients with drug-induced liver injury: Analysis of 230 cases
Li Jing, He Haibin, Li Chunting, et al
2024, 27(6):  870-873.  doi:10.3969/j.issn.1672-5069.2024.06.018
Abstract ( 68 )   PDF (1239KB) ( 40 )  
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Objective The aim of this study was to summarize clinical feature of patients with drug-induced liver injury (DILI) in order to improve clinical management. Methods 230 patients with DILI were encountered in our hospital between March 2020 and March 2023, and the demographic data, clinical manifestations, and clinical tests were retrospectively reviewed and summarized. Serum antinuclear antibody (ANA) was assayed by Western blot, and serum IgG and IgM were detected routinely. Results Of 230 patients with DILI, obesity accounted for 45.7%, diabetes type 2 for 37.8% and hyperlipidemia for 43.5%; as for underlying diseases, infection accounted for 23.5%, cardiovascular diseases for 17.0% and tumor for 13.0%; patients with hepatocellular injury accounted for 61.7%, cholestatic injury for 24.4% and mixed type for 13.9%; one single alleged medicines accounted for 58.3%, double for 22.6%, trible for 13.0% and quadruplex for 6.1%; mild to moderate liver injury accounted for 58.7% and severe for 41.3%; serum IgM and IgG levels were normal, and serum ANA positive for 27.5%; all patients in our series recovered without death. Conclusion Patients with DILI in our series is relatively young, inappropriate medication might be involved in pathogenesis and the prognosis is good.
Liver failure
Trends in outcomes of patients with liver failure in our hospital over the past ten years
Xu Manman, Yang Yanrong, Li Shanshan, et al
2024, 27(6):  874-877.  doi:10.3969/j.issn.1672-5069.2024.06.019
Abstract ( 62 )   PDF (1099KB) ( 79 )  
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Objective The aim of this study was to analyze the change trends of discharge mode of hospitalized patients with liver failure over the last ten years. Methods The clinical materials of patients with liver failure, including acute liver failure (ALF), subacute liver failure (SALF), and acute-on-chronic liver failure (ACLF) and chronic liver failure (CLF), admitted to Beijing You'an Hospital between 2012 and 2021 was retrospectively collected, and analyzed. Results A total of 8512 patients with liver failure were hospitalized, of them, 5789 patients were enrolled as 2723 patients were ruled out based on exlusion criteria, with the mean age of (50.31 ± 13.49) year old, 28.7% of female, and mean hospital stay of 19.46 ± 15.19 days; the ACLF accounted for 47.3%, CLF for 42.0%, SALF for 7.9% and ALF for 2.9%; in terms of the way of discharging, the ordered accounted for 57.6%, non-ordered for 27.5%, and dead for 15.0%; the in-hospital mortality of ALF, CLF, ACLF and SALF were 52.2%, 14.2%,13.7% and 11.4%; the longitudinal analysis showed that in ALF patients, the percentage of doctor's order for discharge did not significantly changed, with in-hospital mortality fluctuating between 31.2% and 70.0%; in SALF, the percentage of discharge by medical advice increased from 55.6% to 70.8% year by year, and the in-hospital mortality decreased from 25.9% to 8.3% (P<0.001); in patients with ACLF, the proportion of discharge by medical orders increased from 47.9% to 59.7% (z=1.9677, P=0.049); in CLF patients, the proportion of patients discharged by medical order also increased from 55.8% to 75.2% (P<0.05), while the in-hospital mortality rate showed a downward trend from 20.9% to 9.3% (P<0.05) year by year. Conclusion The prognosis of patients with liver failure in our hospital has improved greatly over the past ten years, especially the discharging way by medical advice in patients with SALF, ACLF and CLF has increased year by year, but the in-hospital mortality of patients with ALF is still at a high level, so new diagnosis and treatment strategies need to be further explored.
Factors impacting prognosis of patients with acute-on-chronic hepatitis B liver failure complicated by hospital-acquired pneumonia
Qiu Zhongqiong, Lin Jianhui, Weng Yanyan, et al
2024, 27(6):  878-881.  doi:10.3969/j.issn.1672-5069.2024.06.020
Abstract ( 59 )   PDF (896KB) ( 110 )  
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Objective The aim of this study was to analyze influencing factors of patients with acute-on-chronic hepatitis B liver failure (HBV-ACLF) complicated by hospital-acquired pneumonia (HAP). Methods A total of 101 patients with HBV-ACLF and HAP were encountered in our hospital between January 2018 and December 2022, and all received comprehensive internal medical and liver-supporting treatment. Sputum culture and bacteria characterization were routinely performed. Univariate and multivariate Logistic regression analysis was applied to analyze independent risk factors influencing prognosis. Results Of 101 patients with HBV-ACLF and HAP, sputum obtained positive results in 76 cases (75.3%), and out of them, Gram positive pathogenic bacteria strain was found in 30 cases (39.5%), Gram negative in 11 cases (14.5%) and fungus in 35 cases (46.1%); 50 patients (49.5%) died and 51 patients (50.5%) survived during (44.7±24.4)day hospital stay; ages, plasma lactate level, model of end-stage liver disease score, percentages of concomitant spontaneous bacterial peritonitis (SBP) and gastrointestinal bleeding (GIB) in dead patients were(57.3±12.1)yr, (2.7±2.1)mmol/L, (27.5±6.9)point, 66.0% and 42.0%, all much higher than [(50±12.8)yr, (1.6±0.8)mmol/L, (22.5±7.3)point, 31.4% and 5.9%, respectively, P<0.05] in survivals; multivariate Logistic regression analysis showed that age (OR=1.054, 95%CI:1.005-1.110), plasma lactate level (OR=2.339, 95%CI:1.255-5.031), concomitant SBP(OR=6.784, 95%CI:2.139-25.206) and GIB (OR=18.504, 95%CI:3.973-122.636) were the independent risk factors impacting prognosis (P<0.05). Conclusion The patients with HBV-ACLF and HAP have a poor prognosis, clinicians should pay more attention to those who are elderly and with more than one complications, and take an appropriate measures in time to improve the outcomes.
Hospital profit and deficit of medical costs in patients with acute-on-chronic liver failure based on DRG payment reform
Wu Yu, Han Yuxing, Xu Manman, et al
2024, 27(6):  882-886.  doi:10.3969/j.issn.1672-5069.2024.06.021
Abstract ( 77 )   PDF (1013KB) ( 112 )  
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Objective The purpose of this study was to analyze hospitalization costs of patients with acute-on-chronic liver failure (ACLF) under background of diagnosis-related groups (DRG) payment system with aim of providing reference for optimization of DRG payment reform. Methods Patients with ACLF were encountered in Beijing You'an Hospital, Capital Medical University between March 2022 and December 2023, clinical materials were retrieved from HIS, cost data bank and medical insurance (MI) bank, and age-adjusted Charlson comorbidity index (aCCI) was calculated. Results 377 MI-paid patients with ACLF were encountered and 147 enrolled after exclusion, male 120, female 27, with median ages of 56.0(43.5, 64.0)yr, hospital stay of 17.0(12.0, 26.5)days, aCCI of 5.0(4.0, 6.0), medical costs of 38(25, 67) thousand yuan and 2 (2, 3) thousand yuan daily, hospital fatality of 37.4%, and medical deficit rate of 53.7%; medical deficits occurred in 30% HS11 group and 49.1% HS15 group, both with mean deficits of 2 thousand yuan; patients underwent artificial liver supporting system (ALSS) therapy were assigned to HJ1 group, and 78.9% of HJ11 group cost more medical burden than MI payment, with average deficit of 100.3 thousand yuan; deficit occurred in 90.9% of HJ13 group, with average deficit of 30.5 thousand yuan; medical material costs in HJ11 group and HJ13 group accounted for 17.5% and 21.0%, both much higher than 3.8% in HS11 group or 3.0%in HS15 group(P<0.001); median hospital stay in HS11 group and HS15 group with medical surplus were 12.0 days, while hospital stays were 28.0 days and 18.5 days in those with medical deficit P<0.001); patients in HJ11 group with medical deficit were much younger and the aCCI even lower than in those with medical surplus (P<0.05). Conclusion Under implementation of DRG payment reform, patients with ACLF in most DRG-assigned groups cost medical deficits, especially in those with ASLL therapy. We recommend the hospital stay should be enrolled for DRG cost, and appropriately increase payment criteria.
Liver cirrhosis
FibroTouch and virtual touch tissue quantification parameters in evaluating liver fibrosis in patients with schistosomiasis-induced liver disease
Tang Min, Zeng Li, Yang Xinrong
2024, 27(6):  887-890.  doi:10.3969/j.issn.1672-5069.2024.06.022
Abstract ( 56 )   PDF (922KB) ( 41 )  
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Objective The aim of this study was to explore clinical efficacy ofFibroTouchand virtual touch tissue quantification (VTQ) parameters in evaluating liver fibrosis in patients with schistosomiasis-induced liver disease (SILD). Methods 58 patients withSILDwere enrolled in our hospital between February 2019 and February 2023, and they all received etiological, liver-protecting and symptomatic supporting treatment. After recovery, FibroTouch was used to detect liver stiffness measurement (LSM), and VTQ was applied to detect liver shear wave velocity (SWV). Liver biopsy was performed to evaluate liver fibrosis staging, and receiver-operating characteristic curve (ROC) was adopted to analyze diagnostic performance of FibroTouch and VTQ parameters in predicting significant liver fibrosis (SLF). Results Of 58 patients with SILD, liver histo-pathological examination showed liver fibrosis S0 stage in 7 cases (12.1%), S1 stage in 15 cases (25.9%), S2 stage in 16 cases (27.6%), S3 stage in 12 cases (20.7%) and S4 stage in 8 cases (13.8%); LSM and SWV in patients with S4 liver fibrosis were (17.4±2.0)kPa and (1.9±0.2)m/s, both significantly greater than [(15.7±3.4)kPa and (1.7±0.3)m/s,P<0.05] in patients with S3 or [(12.4±2.8)kPa and (1.5±0.4)m/s, P<0.05] in those with S2 or [(8.7±2.0)kPa and (1.3±0.3)m/s, P<0.05] in S1 or [(5.8±0.9)kPa and (1.1±0.2)m/s,P<0.05] in S0; ROC analysis showed that AUCwas 0.937, with sensitivity of 87.5% and specificity of 90.0%, when LSM and SWV combination (with 12.8 kPa and 1.5 m/s as cut-off-value, respectivley) in predicting SLF in patients with SILD. Conclusion Combination of LSM and SWV in predicting SLF in patients with SILD really has certain clinical diagnostic efficacy, which might help guide clinicians to make intervention early.
Influencing factors of infections in patients with hepatitis B-induced liver cirrhosis and acute-on-chronic liver failure
Dong Xu, Qin Yanghua, Liao Wei, et al
2024, 27(6):  891-894.  doi:10.3969/j.issn.1672-5069.2024.06.023
Abstract ( 61 )   PDF (960KB) ( 77 )  
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Objective The aim of this study was to investigate influencing factors of infections in patients with hepatitis B-induced liver cirrhosis (LC) and acute-on-chronic liver failure (ACLF). Methods 323 patients with hepatitis B-induced LC, 124 patients with ACLF type A (with underlying chronic hepatitis B) and 184 patients with ACLF type B (with underlying compensated LC) were encountered in our hospital during last eight years. Multivariate Logistics regression analysis was applied for influencing factors of infections, and Kaplan-Meier curves were used for 90-day survival analysis. Results Incidences of infections in patients with LC, with ACLF type A and ACLF type B were 31.0%, 32.1% and 44.0%, with spontaneous bacterial peritonitis more common; age older, serum albumin level decreased, total serum bilirubin (TSB) level and prothrombin time international standardized ratio increased, incidence of hepatic encephalopathy and gastrointestinal hemorrhage (GIH) increased in patients with infections no matter in which groups(P<0.05); Logistics regression analysis showed that age, TSB, and GIH were all the independent risk factors for infections, while serum albumin level was a protective one; fatality rate in patients with LC was 16.0%, not significantly different compared to 15.2% in those without infection(P>0.05), while they were 57.5% in those with ACLF type A and 65.4% in with ACLF type B, both significantly higher than 14.3% and 27.2% (P<0.05) in patients without infections; survival curve analysis showed that survival rate in HBV-ACLF type A patients without infection was 5.713 times higher than in patients with infection, and survival rate in HBV-ACLF type B patients without infection was 3.364 times higher than in those with infection. Conclusion Patients with HBV-induce LC and ACLF have higher risk of infection, and we should take risk factors into consideration in clinical practice, which might improve outcomes of them.
Prevalence of nutrition and sarcopenia in patients with hepatitis B-induced liver cirrhosis
Wei Wei, Chu Limin, Wang Chao, et al
2024, 27(6):  895-898.  doi:10.3969/j.issn.1672-5069.2024.06.024
Abstract ( 60 )   PDF (882KB) ( 29 )  
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Objective The aim of this study was to investigate prevalence of nutrition and sarcopenia in patients with hepatitis B-induced liver cirrhosis (LC). Methods 156 patients with hepatitis B-induced LC were encountered in our hospital between January 2019 and December 2023, subjective global assessment (SGA) was applied to screen nutritional risk, and sarcopenia was diagnosed based on criteria proposed out by Asian Working Group for Sarcopenia 2019 (AWGS2019). Multivariate Logistic regression analysis was used to predict risk factors for sarcopenia. Results Of 156 patients in our series, incidence of malnutrition was 59.0% and incidence of sarcopenia was 29.5%, and they were 20.5% and 7.7% in 39 patients with Child-Pugh class A, 50.0% and 25.0% in 48 patients with class B and 87.0% and 44.9% in 69 patients with class C, significantly different among them (P<0.05); age, basic mass index (BMI), serum albumin level and SGA score in 46 patients with sarcopenia were (64.1±12.5)yr, (19.3±2.2)kg/m2, (24.1±3.9)g/L and (21.3±3.4) points, significantly different as compared to [(54.7±11.2)yr, (23.9±3.0) kg/m2, ((34.3±4.8)g/L and (28.7±4.0)point, all P<0.05] in 110 patients without sarcopenia; multivariate Logistic regression analysis showed that BMI(OR=0.683), serum albumin level (OR=0.631) and SGA score (OR=0.653) were all risk factors for occurrence of sarcopenia in patients with LC (P<0.05). Conclusion Malnutrition is common in patients with hepatitis B-induced LC, and the risk of sarcopenia is also relatively high. Clinicians should take these incidents into consideration and deal with as early as possible.
Assessment of stent function by color Doppler ultrasonography in patients with liver cirrhosis and portal hypertension after transjugular intrahepatic portosystemic shunt
Chen Siyan, Guo Daoning, Zou Xiaopan, et al
2024, 27(6):  899-902.  doi:10.3969/j.issn.1672-5069.2024.06.025
Abstract ( 72 )   PDF (1631KB) ( 44 )  
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Objective The aim of this study was to investigate assessment of stent function by color Doppler ultrasonography in patients with liver cirrhosis (LC) and portal hypertension (PH) after transjugular intrahepatic portosystemic shunt (TIPS). Methods 136 patients with LC were enrolled in our hospital between January 2020 and December 2022, and PH was defined as hepatic venous pressure gradient (HVPG)≥10 mmHg. Color Doppler ultrasonography was used to measure portal vein blood flow velocity (Vpv), portal vein diameter (Dpv) and portal vein blood flow (Qpv), and receiver operating characteristic (ROC) curve was applied to evaluate diagnostic efficacy of portal vein hemodynamic indicator combination in predicting PH. TIPS was performed routinely, and postoperative stent functions was assessed by color Doppler ultrasonography and digital subtraction angiography (DSA). Results Of 136 patients with LC in our series, PH was found in 62 cases(45.6%) based on HVPG measurement and 52 of them received TIPS; Vpv in patients with LC and PH was (13.1±2.3)cm/s, much lower than [(15.9±3.2)cm/s, P<0.05], while Dpv and Qpv were (1.3±0.3)cm and (626.8±106.8)mL/min, both much higher than [(1.1±0.2)cm and (499.9±97.2)mL/min, P<0.05] in cirrhotics without PH, and portal hemodynamic indicators restored to almost normal and showing no significant differences as compared to those in patients without PH [(16.2±2.5)cm/s, (1.1±0.2)cm and (502.1±99.4)mL/min, respectively, P<0.05]; ROC analysis showed that the AUC was 0.902(95%CI:0.849-0.955,P<0.05), with sensitivity (Se) of 79.0%, specificity (Sp) of 83.8%, when combination of Vpv, Dpv and Qpv in predicting PH; by end of one year follow-up in 52 patients after TIPS, DSA found stent dysfunction in 8 cases (15.4%), and consistency of ultrasonography was satisfactory (Kappa=0.680, P<0.05), with Se of 87.5%, Sp of 90.9%, and accuracy of 90.4%. Conclusion Color Doppler ultrasound has a good application in identifying stent dysfunction after TIPS in patients with LC and PH.
Clinical efficacy of endoscopic variceal ligation and intravinous octreotide and esomeprazole infusion in the treatment of patients with liver cirrhosis and esophagogastric variceal bleeding
Ma Li, Gu Zhongsheng, Li Xiang
2024, 27(6):  903-906.  doi:10.3969/j.issn.1672-5069.2024.06.026
Abstract ( 53 )   PDF (894KB) ( 34 )  
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Objective The aim of this study was to investigate clinical efficacy of endoscopic variceal ligation (EVL) and intravinous octreotide and esomeprazole infusion in the treatment of patients with liver cirrhosis (LC)and esophagogastric variceal bleeding(EVB). Methods 99 patients with LC and EVB were admitted to our hospital between December 2020 and December 2022, and were randomly divided into observation (n=49) and control group (n=50). All patients received EVL and intrvinous esomeprazole infusion, and those in the observation were additionally given intravenous octreotide bumping for 7 days. Serum nitric oxide (NO), endothelin (ET) and angiotensinⅡ (ATⅡ) levels were assayed. Portal vein diameter (PVD), portal vein flow (PVF), splenic vein diameter (SVD) and splenic vein flow (SVF) were detected by ultrasonography. Results Two and two patients didn’t survive emergent bleeding in both groups; of survivals, hemostasis rates at 24 h, 48 h and 72 h in the observation group were 66.0%, 95.7%and 100.0%, not significantly different compared to 62.5%, 85.4%and 100.0%(P>0.05)in the control; after treatment, PVD, PVF and SVF in the observation were(10.5±1.6)mm,(252.4±42.6)mL/min and(526.3±68.9)mL/min, all significantly lower than [(12.1±1.4)mm, (304.5±41.6)mL/minand (611.4±64.5)mL/min, respectively, P<0.05] in the control; serum NO level in the observation was (73.2±7.6) mol/L, much higher than [(64.9±7.4) mol/L, P<0.05], while serum ET and ATⅡ levels were (90.2±9.3)ng/L and (3.0±0.5)pg/mL, much lower than [(104.8±11.4)ng/L and (4.1±0.6)pg/mL, P<0.05] in the control group; one year of follow-up after treatment, re-bleeding rates in the observation and control groups were not much statistically significantly different (10.6%vs. 12.5%,P>0.05). Conclusion EVL and octreotide and esomeprazole combination in dealing urgently with patients with EVB has a satisfactory hemostasis efficacy, which might improve liver hemodynamicsand serum vascular activity.
Hepatoma
Enhanced MRI manifestation feature in differential diagnosis of ICC and HCC: A single center study
Zeng Wang, Cai Xiaoman, Ge Shang
2024, 27(6):  907-910.  doi:10.3969/j.issn.1672-5069.2024.06.027
Abstract ( 48 )   PDF (1758KB) ( 26 )  
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Objective The purpose of this study was to summarize the enhanced magnetic resonance imaging (MRI) feature in differential diagnosis of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC). Methods 120 patients with primary liver cancer (PLC) were encountered in our hospital between December 2019 and July 2023, and there all underwent enhanced MR scan before hepatectomy. The enhancement MR feature included arterial phase reinforcement characteristics, dynamic reinforcement patterns, abnormal blood perfusion, target sign at hepatobiliary phase, lesion signal form, distal bile duct dilation, and lesion capsule. The receiver operating characteristic curve (ROC) was applied to evaluate the differential diagnostic performance of MRI scanning. Results Out of the 120 patients with PLC, the histo-pathological examination diagnosed ICC in 23 cases and HCC in 97 cases; the percentages of edge of lesion enhancement at arterial phase, gradually dynamic enhancement mode, hepatobiliary target and distal bile duct dilatation in ICC lesions were 69.6%,56.5%, 65.2% and 39.1%, all significantly higher than 44.3%, 17.5%,9.3% and 3.1%, while the percentage of lesion envelope was 4.3%, much lower than 45.4%(P<0.05) in HCC lesions; based on comprehensive features, the MRI diagnosed ICC in 31 cases and HCC in 89 cases, with the sensitivity of 78.3%, the specificity of 86.6%, the positive predicting value of 58.1% and negative predicting value of 94.4%. Conclusion The enhanced MRI scanning could provide the clues for differentiating the ICC and HCC before surgery, which might help the clinicians make an appropriate management plans.
Gd-EOB-DTPA-enhanced MRI scan in diagnosis of patients with hepatocellular carcinoma
Danba Yuzhen, Cheng Pan
2024, 27(6):  911-914.  doi:10.3969/j.issn.1672-5069.2024.06.028
Abstract ( 59 )   PDF (1062KB) ( 24 )  
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Objective The aim of this study was to investigate diagnostic performance of MRI scan based on liver imaging report and data system (LI-RADS) in diagnosis of patients with hepatocellular carcinoma (HCC). Methods 100 patients with intra-hepatic space-occupying lesions (IH-SOL) were encountered in our hospital between June 2021 and July 2023, all underwent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) MR scan, and lesions were classified based on LI-RADS v2018. The main MRI features of HCC included non-circular arterial phase hyperintense (APHE), rapid clearance and enhanced capsule, and the possible auxiliary signs considered as malignant included non-enhanced capsules, mosaic structures, nodules, fat inside lesions, hemorrhage, halo enhancement, fat deficiency in lesions, iron deficiency, limited diffusion of DWI and mild and moderate T2 high signals. Results Liver histo-pathological examination showed HCC in 79 cases, including 92 lesions, dysplasia nodule (DN) in 14 cases, including 22 lesions and cirrhotic regenerative nodule (RN) in 7 cases, including 11 lesions; incidences of acyclic APHE, rapid clearance and enhanced capsule in HCC lesions were 82.6%, 80.4% and 33.7%, all much higher than 45.4%, 45.4% and 9.1% (P<0.05) in DN lesions or 36.4%, 45.4% and 0.0% (P<0.05) in RN lesions; as for auxiliary signs of HCCs lesions, the incidences of DWI diffusion limitation, mild to moderate T2 hyper-intensity, low signal at transitional phase and low signal at hepatobiliary phase were 85.9%, 88.0%, 84.8% and 91.3%, all much higher than 59.1%, 63.6%, 45.4% and 63.6% (P<0.05) in DN lesions or 45.4%, 54.5%, 45.4% and 54.5% (P<0.05) in RN lesions; the sensitivity by main and auxiliary signs in predicting HCC for LR-4/5 lesions was 95.6%, much higher than 79.3%(P<0.05) by main signs alone, while there were no significant differences as respect to specificity (51.5% vs. 42.4%) or accuracy(84.0% vs. 72.0%) by MRI main or main and auxiliary sign combination (P>0.05). Conclusion The diagnostic efficacy of MRI LI-RADS in differentiating malignant and benign IH-SOL is satisfactory, which might help clinicians make correct diagnosis early and make an appropriate measures for good outcomes.
Image quality and diagnostic efficacy of dual-source CT dual-energy TNC technique in patients with hepatocellular carcinoma
Yang Jiaxin, Yang Zijun, Chen Wei
2024, 27(6):  915-918.  doi:10.3969/j.issn.1672-5069.2024.06.029
Abstract ( 61 )   PDF (1148KB) ( 25 )  
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Objective The purpose of this study was to investigate the image quality and diagnostic efficacy of dual-source CT dual-energy true non-contrast enhanced (TNC) technique in patients with hepatocellular carcinoma(HCC). Methods 85 patients with intrahepatic space-occupying lesions were admitted to our hospital between January 2020 and January 2023, and all underwent dual-source CT dual-energy enhanced scanning to obtain the TNC and virtual non-contrast enhanced (VNC) imaging, signal to noise ratio (SNR) and contrast noise ratio (CNR). The imaging quality was subjectively evaluated by five scores. Results Out of the 85 patients with intrahepatic space-occupying lesions, the histopathological examination diagnose HCC in 48 cases, focal nodular hyperplasia (FNH) in 23 cases and hepatic hemangioma (HH) in 14 cases; the standard deviation (SD) of CT value of the hepatic lesion/right erector spinalis muscle at same level and the radiation dose in TNC-showed HCC foci were(7.9±1.8)HU and (5.9±0.6)mSv, both significantly greater than [(6.7±1.3)HU and (3.6±0.7)mSv, respectively, P<0.05] showed by VNC, while the SNR was (5.4±1.6), much smaller than [(6.5±1.7), P<0.05] showed by VNC; all the SD and the radiation dose in HCC, FNH and HH foci by TNC imaging were significantly greater than by VNC imaging(P<0.05), while the SNR was much lower than by VNC imaging (P<0.05); the CT values of HCC lesions by both TNC and VNC were greater than in FNH or HH foci (P<0.05); the subjective image quality score of HCC lesions by TNC was superior to by VNC imaging (P<0.05); the sensitivity, specificity and accuracy of TNC imaging in diagnosing HCC were 89.6%, 91.9% and 90.6%, much superior to 72.9%, 78.4% and 75.3%, respectively (P<0.05) by VNC imaging. Conclusion In dual-source CT dual-energy enhanced scan, although TNC images have higher radiation dose, the quality of TNC images is higher than that of VNC images, and the accuracy of TNC images in diagnosing hepatocellular carcinoma is higher, which has certain guiding value for clinical diagnosis of hepatocellular carcinoma.
Diagnostic efficacy of CT dynamic enhancement scan in patients with liver cirrhosis and intrahepatic space-occupying lesions
Deng Na, Zheng Yufeng, Liu Xuhong, et al
2024, 27(6):  919-922.  doi:10.3969/j.issn.1672-5069.2024.06.030
Abstract ( 64 )   PDF (1294KB) ( 23 )  
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Objective The aim of this study was to investigate diagnostic efficacy of CT dynamic enhancement scan in patients with liver cirrhosis and intrahepatic space-occupying lesions (SOL). Methods 120 patients with intrahepatic SOL were encountered in our hospital between February 2018 and May 2023, and all underwent CT dynamic enhancement scan. Golden diagnosis was based on histo-pathological examination by fine needle aspiration biopsies or post-operational tissues. Results Pathological diagnosis included hepatocellular carcinoma (HCC) in 84 cases (70.0%)and focal proliferative nodules (FPN) in 36 cases(30.0%) in our series; in lesions of HCC, percentage of intensified enhancement at arterial phase was 100.0%, equal enhancement at portal phase was 56.0% and low enhancement at delayed phase was 97.6%, while in lesions of FPN, the percentages of equal enhancement at arterial, portal and delayed phases were 88.9%, 94.4% and 100.0%; of the 120 cirrhotics with intrahepatic SOL, CT scan diagnosed primary liver cancer in 83 cases (69.2%) and FPN in 37 cases (30.8%), with sensitivity, specificity, accuracy, negative predictive value and positive predictive value of 96.4%, 94.4%, 95.8%, 91.9% and 97.6%, respectively (Kappa=0.902). Conclusion The feature of intrahepatic SOL showing by CT dynamic enhancement scan at different phases could help clinicians make a correct diagnosis, and deal with it appropriately.
Remimazolam and low-dose of propofol in induction of general anesthesia in patients with primary liver cancer undergoing hepatectomy
Tao Qiaojian, Zhong Huagen, Zhou Shaorong, et al
2024, 27(6):  923-926.  doi:10.3969/j.issn.1672-5069.2024.06.031
Abstract ( 51 )   PDF (890KB) ( 27 )  
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Objective The aim of this study was to investigate remimazolam and low-dose of propofol combination in induction of general anesthesia in patients with primary liver cancer (PLC) undergoing hepatectomy. Methods 80 patients with PLC were encountered in our hospital between January 2020 and January 2024, and all underwent hepatectomy. For induction of anesthesia, we assigned patients into group A (n=40), receiving combination agents, and group B (n=40), receiving remimazolam and low-dose of propofol, intravenously. All patients received routine anesthesia maintenance. Before anesthesia induction (T0), after anesthesia induction (T1), at intubation (T2) and at end of surgery (T3), sedation and postoperative cognitive function were evaluated by using Riker sedation/anxiety scale (SAS) and mini mental state examination (MMSE) scale. Results There was no significant differences in eye-opening time, extubation time and post-anesthesia care unit stay between the two groups (P>0.05); by T2, mean arterial pressure and heart rate in group B were(80.1±7.5)mmHg and (71.9±8.1)beats/min, both significantly lower than [(84.5±8.3)mmHg and (76.7±8.0)beats/min, respectively, P<0.05] in group A; by 1 min, 5 min and 10 min after removal of tracheal catheter, SAS scores in group B were (3.2±0.4)points, (3.6±0.5)points and (3.7±0.6)points, all significantly lower than [(3.9±0.7)points, (4.2±0.8)points and (4.5±0.9)points, respectively, P<0.05] in group A; by 6 hours after operation, MMSE score in group B was (25.7±3.0)points, much higher than [(22.5±2.1)points, P<0.05] in group A; post-operationally, adverse effect in group B was 2.5%, much lower than 17.5%(P<0.05) in group A. Conclusion Combination of remimazolam and low-dose of propofol in induction of general anesthesia in patients with PLC undergoing hepatectomy could maintain hemodynamic stability, improve sedation and cognitive function restoration.
Short-term and long-term efficacy of patients with primary liver cancer after hepatic arterial chemoembolization and radiofrequency ablation combination therapy
Wu Wenhua, Cai Zhifang, Li Yaping, et al
2024, 27(6):  927-930.  doi:10.3969/j.issn.1672-5069.2024.06.032
Abstract ( 64 )   PDF (1522KB) ( 117 )  
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Objective The purpose of this study was to investigate short-term and long-term efficacy of patients with primary liver cancer (PLC) after hepatic arterial chemoembolization (TACE) and radiofrequency ablation (RFA) combination therapy. Methods A total of 92 patients with PLC were encountered in our hospital between January 2016 and March 2018, and were randomly divided into control group (n=46) and observation group (n=46), receiving TACE or TACE and RFA combination treatment. All patients were followed-up for three years. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin-2(IL-2), IL-6 and tumor necrosis factor-α(TNF-α) levels were detected. Results Short-term efficacy (complete and partial remission) in the observation group was 82.6%, much higher than 58.7%(P<0.05) in the control; by end of one year after treatmenyt, serum hs-CRP, IL-6 and TNF-α levels in 44 survivals in the observation group were(5.1±2.0)ng/L, (97.3±12.2)ng/L and (47.8±5.8)pg/mL, significantly lower than [(8.2±1.6)ng/L, (110.3±15.5)ng/L and (53.5±6.8)pg/mL, respectively, P<0.05], while serum IL-2 level was (3.4±0.4)ng/L, significantly higher than [(3.0±0.5)ng/L, P<0.05] in 38 survivals in the control group; one-year, two-year and three-year survival rates in the observation group were 95.7%, 84.8% and 78.3%, all much higher than 82.6%, 65.2% and 54.4%(P<0.05) in the control. Conclusion Application of TACE and RFA combination in the treatment of patients with PLC is efficacious, with a satisfactory short-term and long-term survivals, which might improve body immune functions.
Liver abscess
MRI and DWI feature in patients with atypical hepatic abscess
Ma Ziyao, Wang Chao, Zhao Jue, et al
2024, 27(6):  931-934.  doi:10.3969/j.issn.1672-5069.2024.06.033
Abstract ( 56 )   PDF (1226KB) ( 21 )  
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Objective The aim of this study was to explore imaging feature of atypical hepatic abscess (AHA) for early diagnosis. Methods 42 patients with AHA and 42 patients with intrahepatic metastatic tumor (IMT) were encountered in our hospital between January 2019 and January 2024, and all underwent MRI and diffusion-weighted imaging (DWI) scan. Plain and enhanced scan signals, DWI signals, enhancement features at arterial phase, apparent diffusion coefficient (ADC) and relative ADC (rADC) of solid part in lesion margin were compared between the two groups. Results Proportion of target-like high signals by DWI in AHA lesions was significantly lower than that in IMT lesions (64.3% vs. 90.5%(P<0.05); proportions of margin enhancement at arterial phase and uneven enhancement at portal vein phase and at equilibrium phase in AHA lesions were 45.2%, 71.4% and 23.8%, significantly lower than 76.2%, 100.0% and 88.1% (P<0.05) in the IMT lesions; proportions of significant enhancement and continuity interruption at arterial phase were 9.5% and 0.0%, significantly lower than 88.1% and 73.8% (P<0.05) in IMT lesions; ADC and rADC of solid parts at AHA lesion margin were (1.8±0.4) ×10-3mm2/s and (0.7±0.2) ×10-3mm2/s, both significantly higher than [(1.0±0.2) ×10-3mm2/s and (0.4±0.1) ×10-3mm2/s, P<0.05] at IMT lesions. Conclusion AHA lesions at routine MRI and DWI scan has a unique feature, by which clinicians might differentiate it from IMT lesions.
Clinical feature of patients with bacterial liver abscess and concurrent underlying type 2 diabetes mellitus
Yi Fenxiu, Yi Fenjin, Lou Zhonglei
2024, 27(6):  935-938.  doi:10.3969/j.issn.1672-5069.2024.06.034
Abstract ( 56 )   PDF (885KB) ( 21 )  
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Objective The aim of this study was to summarize the clinical feature of patients with bacterial liver abscess (BLA) and concurrent underlying type 2 diabetes mellitus(T2DM). Methods 102 consecutive patients with BLA, of which, with concurrent underlying T2DM in 41 cases, were encountered in our hospital between May 2021 and October 2023, and all received antibiotics and intra-purulent cavity catheterization and pus drainage. Blood and/or pus bacterial culture and identification were conducted. Serum interleukin-6 (IL-6),C-reactive protein (CRP), procalcitonin (PCT), amyloid A (SAA) and D-dimer (D-D) levels were detected. Results Concurrent blood hypertension and pulmonary infections in patients with BLA and T2DM were 51.2% and 36.6%, both significantly higher than 18.0% and 8.2% (P<0.05) in those with BLA without T2DM; serum IL-6, CRP, PCT and SAA levels in patients with BLA and T2DM were 344.3(155.0, 511.9)pg/ml, 180.9(82.1, 270.7)mg/L, 8.6(5.7, 10.6)μg/L and 19.3(14.2, 25.5)mg/L, all significantly higher than [195.5(136.6, 274.1)pg/ml,124.8(52.5,190.4)mg/L, 2.2(1.4, 2.7)μg/L and 14.5(12.6, 20.1)mg/L, respectively, P<0.05] in those with BLA; Klebsiella Pneumoniae infection rate in patients with BLA and T2DM was 78.0%, much higher than 57.4%(P<0.05) in patients with BLA; catheterization for pus drainage and antibiotics therapy in patients with BLA and T2DM lasted for 6(3,10)d and 13(5, 20)d, both much longer than [4(2, 8)d and 10(4, 16)d,P<0.05] in patients with BLA; all but one patient (2.4%) with BLA and T2DM who died recovered. Conclusion Pulmonary and Klebsiella pneumoniae infection is more common in patients with BLA and concurrent underlying T2DM, and antibiotics and intra-purulent cavity catheterization for pus drainage is efficacious with a satisfactory outcomes.
Cholelithiasis
One-year follow-up of patients with complex hepatolithiasis after laparoscopic precision liver segment resection under CT three-dimensional visualization technology guidance
Tang Hao, Song Wenyuan, Cheng Qianli, et al
2024, 27(6):  939-942.  doi:10.3969/j.issn.1672-5069.2024.06.035
Abstract ( 56 )   PDF (883KB) ( 39 )  
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Objective The aim of this study was to observe the efficacy of laparoscopic precision liver segment resection under CT three-dimensional visualization technology guidance in the treatment of patients with complex hepatolithiasis. Methods 63 patients with complex hepatolithiasis were encountered in our hospital between January 2016 and December 2022, were divided into observation and control groups, and all patients underwent segmental hepatectomy and fiberoptic cholangioscopy. In the observation group, the CT three-dimensional visualization technology was applied to personally reveal, design operation plan and mimic the operation pre-operationally. All patients were followed-up for one year. Results The surgical time, intraoperative blood loss and hospital stay after operation in the observation group were 101.8(96.4,117.6)min, (25.9±6.7)mL and (9.6±1.5)d, all significantly shorter or less than [121.3(98.5,135.4)min, (37.7±15.9)mL and (11.9±2.7)d, respectively, P<0.05] in the control, while there was no significant difference as respect to recovery of intestinal functions in the two groups [(2.6±0.3)d vs. (2.8±0.6)d, P>0.05]; post-operationally, total serum bilirubin, albumin and ALP levels in the observation group were (15.6±8.4)μmol/L, (35.6±2.3)g/L and (78.1±21.2)U/L, all not significantly different compared to [(17.1±1.4)μmol/L, (36.8±2.7)g/L and (99.2±21.3)U/L, P>0.05] in the control; the incidence of complications, such as incision infection, biliary bleeding, biliary injury and biliary leakage in the observation was 16.1%, much lower than 53.1%(P<0.05) in the control; two weeks after surgery, the imaging showed that the stone clearance rate in the observation group was 96.8%, much higher than 75.0%(P<0.05) in the control, and at the end of one-year follow-up, the imaging demonstrated that the stone recurrence rate in the observation group was 3.2%, much lower than 18.8%(P<0.05) in the control group. Conclusion The laparoscopic precision liver segment resection under CT three-dimensional visualization technology guidance in the treatment of patients with complex hepatolithiasis is efficacious, which could improve stone clearance rate, with less complications and low stone recurrence, and warrants further clinical exploration.
Application of serratus anterior plane block and posterior rectus sheath block under general anesthesia in patients undergoing intrahepatic bile duct stone removal
Han Yang, Zhang Lili, Wang Yufeng, et al
2024, 27(6):  943-946.  doi:10.3969/j.issn.1672-5069.2024.06.036
Abstract ( 46 )   PDF (887KB) ( 34 )  
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Objective The aim of this study was to investigate application of serratus anterior plane block and posterior rectus sheath block under general anesthesia in patients undergoing intrahepatic bile duct stone (IHS) removal. Methods 60 patients with HIS were encountered in our hospital between April 2020 and January 2024, and all underwent surgery operation for removal of the stones under general anesthesia. For analgesia, patients were divided into control (n=28), receiving thoracic paravertebral nerve block, and observation (n=32), receiving serratus anterior plane block and posterior rectus sheath block. Post-anesthesia care unit (PACU) stay and other operation parameters were recorded, Ramsay sedation scores, resting and motion visual analogue scale (VAS) scores, and quality of recovery-40 questionnaire (QoR-40) were assessed. Results PACU stay in the observation was (35.1±2.0)min, much shorter than [(40.3±2.1)min,P<0.05] in the control; by 2 and 24 hours after operation, resting VAS scores in the observation were(2.9±1.4)points and (2.5±1.1)points, both significantly lower than [(3.7±1.7)points and (3.3±1.4)points, respectively, P<0.05], and motion VAS scores were (3.7±1.6)points and (2.9±1.5)points, both significantly lower than [(4.4±1.5)points and (3.6±1.4)points, P<0.05] in the control; pain perception, physical comfort and postoperative QoR-40 score in the observation were (35.3±1.2)points, (52.8±2.3)points and (175.0±8.0)points, all significantly higher than [(28.4±1.5)points, (45.8±2.8) points and (165.1±9.7)points, respectively, P<0.05] in the control. Conclusion In patients with HIS undergoing surgery operation for removal of stones under general anesthesia, serratus anterior plane block and posterior rectus sheath block have a satisfactory analgesic effects, and improve quality of recovery.
Comparison of laparoscopic transcystic common bile duct exploration and laparoscopic common bile duct exploration in dealing with patients with gallbladder stones and extrahepatic bile duct stones
Zhou Hongfei, Jia Zheng, Gu Hong
2024, 27(6):  947-950.  doi:10.3969/j.issn.1672-5069.2024.06.037
Abstract ( 79 )   PDF (888KB) ( 107 )  
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Objective The aim of this study was to compare efficacy of laparoscopic transcystic common bile duct exploration (LTCBDE) andlaparoscopic common bile duct exploration (LCBDE) in dealing with patients with gallbladder stones (GS) and extrahepatic bile duct stones(EBDS). Methods A total of 168 patients with GS and EBDS were enrolled in our hospital between January 2022 and January 2024, and we assigned them to LCBDE in 123 cases in control groupand to LTCBDE in 45 cases in observation group. Serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) levels were detected by ELISA, and blood biochemical parameters were routinely assayed. Results Operation time, intra-operational bleeding, anal exhaust time, post-operationalhospital stay and medical cost in the observation group were(104.4±34.2)min,(29.9±11.2)ml, (22.3±10.1)h, (6.5±2.9)d and (14000±600)yuan, all significantly shorter or less tan [(149.9±37.4)min, (43.6±16.3)ml, (28.4±9.6)h, (9.2±2.4)d and (18000±700)yuan, respectively, P<0.05] in the control; total stone clearance was obtained in the two groups; three days after operation, serum TNF-α and IL-6 levels in the observation group were(32.5±5.9)ng/L and (25.4±7.1)pg/L, both significantly lower than [(40.3±6.8)ng/L and (35.6±6.4)pg/L, respectively, P<0.05] in the control; post-operationally, incidences of biliary leakage, biliary tract infection, abdominalinfection, biliary tract hemorrhage and acute pancreatitis in the observation were 0.0%, 2.2%, 2.2%, 0.0% and 0.0%, all not significantly different compared to 2.4%, 0.0%, 4.1%, 1.6%and 2.4% in the control group (P>0.05). Conclusion Both LCBDE and LTCBDE have good efficacy for stone clearance in patients with GS and EBDS, and we recommend LTCBDE for good postoperative recovery and less economic costs.
Abnormal expressions of Krüppel-like factors in progression of hepatocellular carcinoma
Wang Lingling, Yao Min, Yao Dengfu
2024, 27(6):  953-956.  doi:10.3969/j.issn.1672-5069.2024.06.039
Abstract ( 69 )   PDF (907KB) ( 122 )  
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The mechanisms of hepatocarcinogenesis have not been fully elucidated. Krüppel-like factors (KLFs), the largest family of zinc finger protein (ZFP) transcription factors in humans, have recently been found to play a promoting or inhibiting role in hepatocellular carcinoma (HCC) progression. Basic and clinical studies have shown that part of KLFs might be used as molecular markers for diagnosis and for predicting prognosis of patients with HCC. It is also possible as a molecular targets for gene therapy. This article reviews the tissue distribution, expressing features and clinical application of HCC-related KLFs.
Lipid metabolic reprogramming in the carcinogenesis of patients with hepatocellular carcinoma
Li Xiaobin, Liu Bowen, Hu shiping
2024, 27(6):  957-960.  doi:10.3969/j.issn.1672-5069.2024.06.040
Abstract ( 97 )   PDF (933KB) ( 138 )  
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Hepatocellular carcinoma (HCC) has complex biological characteristics, highly heterogeneous property and immunosuppressive tumor microenvironment. HCC carries a dismal prognosis. Metabolic reprogramming (MR) is one of the most important features of tumor cells and the lipid metabolism has been an important mechanism underlying HCC growth and metastasis. In this article, we review the roles of common lipid and its metabolism-related molecules in carcinogenesis of HCC and provides new targets for therapy of HCC.
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    Comparative study on the clinical efficacy of lorazepam and oxazepam in treatment of patients with alcoholic liver diseases and alcohol withdrawal syndrome
    Liu Lixia, Lin Yingyuan, Li Huamin, et al
    Journal of Practical Hepatology    2021, 24 (5): 709-712.   DOI: 10.3969/j.issn.1672-5069.2021.05.026
    Abstract1562)      PDF(pc) (850KB)(311)      
    Objective This clinical trial aimed to compare the efficacy of lorazepam and oxazepam in treatment of patients with alcoholic liver diseases (ALD) and alcohol withdrawal syndrome (AWS). Methods A total of 127 patients with ALD and AWS were enrolled in our hospital between November 2017 and November 2020, and were randomly divided into control (n=63) and observation group (n=64), receiving lorazepam and oxazepam, respectively, for seven days. The scores of alcohol withdrawal syndrome scale (AWSS) and self-rating anxiety scale (SAS) score were evaluated. Serum hyaluronic acid (HA), laminin (LN), type III procollagen N-terminal peptide (PC-III) and type-IV collagen (IV-C) were detected by ELISA. Results At the end of 7 day treatment, the efficient rate in observation group was 96.9%, significantly higher than 81.0% in the control (P<0.05); at presentation, the AWSS and SAS, serum alanine transaminase (ALT), aspartate aminotransferase (AST), glutamyl transpeptidase (GGT),total bilirubin (TBIL) and alkaline phosphatase (ALP) as well as HA, LN, PC-Ⅲ and IV-C levels were not significantly different between the two groups(P>0.05); after treatment, the AWSS and SAS in observation were (9.5±2.4) and (30.8±6.4), significantly different as compared to in the control; serum ALT, AST, GGT, TBIL and ALP levels were (30.5±8.1)U/L, (71.6±15.3)U/L, (466.1±22.7)U/L, (23.5±6.5)μmol/L and (82.3±12.4)U/L, all much lower than in the control; serum HA, PC-Ⅲ and IV-C levels were (116.8±18.3)μg/L,(123.1±12.3)μg /L and (80.2±11.6)μg /L, significantly lower than in the control. Conclusion The clinical efficacy of oxazepam is good in treatment of ALD patients with complicated AWS, which could improve clinical symptom and anxiety relieving.
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    Improvement of liver function tests by silibinin and polyene phosphatidylcholine combination therapy in patients with anti-tuberculosis drugs-induced liver injury
    Mo Junqiao, Lin Jing, Yang Li
    Journal of Practical Hepatology    2023, 26 (5): 666-669.   DOI: 10.3969/j.issn.1672-5069.2023.05.016
    Abstract1130)      PDF(pc) (851KB)(314)      
    Objective The aim of this study was to observe the efficacy of silibinin and polyene phosphatidylcholine combination therapy in patients with anti-tuberculosis drugs-induced liver injury (DILI). Methods 118 patients with pulmonary tuberculosis were encountered in our hospital between June 2018 and June 2021, and all received standardized anti-tuberculosis treatment by 2HRS( E) Z /4HR for six months. During the process, 63 patients were found having DILI, and were randomly divided into control (n=30) and observation (n=33) groups, receiving polyene phosphatidylcholine or silibinin capsule and polyene phosphatidylcholine combination therapy until the anti-tuberculosis regimen ended. Serum interleukin-2 (IL-2), IL-6, IL-1β and tumor necrosis factor-α (TNF-α) levels were detected by ELISA, serum superoxide dismutase (SOD) was detected by radioimmunoassay and serum reduced glutathione (GSH) and malondialdehyde (MDA) levels were assayed by biochemical colorimetry. Results After treatment, serum ALT, AST and GGT levels in the observation group were (32.8±6.1)U/L, (41.2±8.3)U/L and (36.1±6.5)U/L, all significantly lower than [(48.6±8.4)U/L, (53.8±9.2)U/L and (53.8±9.6)U/L, respectively, P<0.05] in the control; serum IL-6, IL-1β and TNF-α levels in the observation were (6.3±1.0)ng/L, (11.0±2.3)μg/L and (6.8±1.5)ng/L, all much lower than [(9.5±1.2)ng/L, (19.2±3.6)μg/L and (9.9±1.3)ng/L, respectively, P<0.05] in the control, while there was no significant difference respect to serum IL-2 levels in the two groups (P>0.05); serum SOD and GSH levels in the observation group were (597.3±71.6)U/L and(7.6±1.5)μmol/L, both significantly higher than [(542.8±68.2)U/L and (6.2±1.3)μmol/L, P<0.05], while serum MDA level was (4.0±0.7)nmol/L, much lower than [(5.8±0.9)nmol/L, P<0.05] in the control. Conclusion The administration of silibinin capsule and polyene phosphatidylcholine combination in treatment of patients with pulmonary tuberculosis during anti-tuberculosis therapy could protect the liver function test normal, and maintain the accomplishment of anti-tuberculosis treatment, which might be related to the relieving inflammation and oxidative stress response.
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    Short-term observation of entecavir and magnesium isoglycyrrhizinate in treatment of patients with chronic hepatitis B
    Huang Junrong, Wu Changru, Wu Jianlin
    Journal of Practical Hepatology    2022, 25 (3): 327-330.   DOI: 10.3969/j.issn.1672-5069.2022.03.006
    Abstract941)      PDF(pc) (839KB)(214)      
    Objective The purpose of this study was to observe the application of entecavir and magnesium isoglycyrrhizinate combination in the treatment of patients with chronic hepatitis B (CHB). Methods A total of 98 patients with CHB were enrolled in our hospital between January 2019 and February 2020, and were randomly divided into control (n=49) and observation group (n=49), receiving entecavir or entecavir and magnesium isoglycyrrhizinate combination therapy for 48 weeks. Serum hyaluronan (HA), laminin (LN), type-IV collagen (CIV) and type-III procollagen (PIIIP) levels were detected by radioimmunoassay. Serum interleukin 2 (IL-2), interleukin 4 (IL-4), interleukin 10 (IL-10) and tumor necrosis factor α (TNF-α) levels were detected by ELISA. The peripheral blood T lymphocyte subsets were detected by flow cytometry. Results At the end of 48 week observation, serum ALT normalization rate in the observation group was 87.8%, significantly higher than 71.4%(P<0.05) in the control; serum ALT and AST levels in the combination group were (32.3±6.9)U/L and (38.3±4.7)U/L, both significantly lower than [(47.5±7.6)U/L and (52.9±5.1)U/L, respectively, P<0.05] in the control; serum HA and PⅢP levels were (90.6±9.5)ng/mL and (141.6±32.6)ng/mL, both significantly lower than [(126.8±14.6)ng/mL and (168.2±29.9)ng/mL, respectively, P<0.05] in the control; serum IL-4 and TNF-α levels were (48.8±7.9)ng/L and (11.3±1.9)ng/L, significantly lower than [(62.6±8.8)ng/L and (18.5±1.7)ng/L, respectively, P<0.05], while serum IL-10 level was (19.2±2.5)ng/L, significantly higher than [(12.7±3.4)ng/L, P<0.05] in the control; the percentage of peripheral blood CD4+ cells and the ratio of CD4+/CD8+ cells were (43.5±5.5)% and (1.6±0.2), both significantly higher than [(38.4±4.7)% and(1.4±0.4), respectively, P<0.05] in the control group. Conclusion The application of entecavir and magnesium isoglycyrrhizinate combination in the treatment of patients with CHB could effectively improve liver function test normal, inhibit the process of liver fibrosis, which might be related to the inhibition of inflammatory reaction and modulation of immune system.
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    Auxiliary treatment of a herbal compound, Ganshuang granule, with entecavir for patients with chronic hepatitis B
    Guo Xiaoling, Zhang Yaowu, Li Mengtao, et al.
    Journal of Practical Hepatology    2023, 26 (3): 340-343.   DOI: 10.3969/j.issn.1672-5069.2023.03.010
    Abstract937)      PDF(pc) (819KB)(224)      
    Objective The purpose of this clinical trial was to investigate the auxiliary treatment of a herbal compound, Ganshuang granule, with entecavir for patients with chronic hepatitis B (CHB). Methods 60 patients with CHB were enrolled in our hospital between January 2019 and January 2021, and were randomly divided into control and observation groups, with 30 cases in each. The patients in the control group received entecavir, and those in the observation were treated with entecavir and a herbal compound, Ganshuang granule, for 48 weeks. The AST to platelet ratio index (APRI), fibrosis 4 score (FIB-4) were obtained, and the liver stiffness measurement (LSM) was determined by FibroTouch scan. Serum interleukin-6(IL-6), transforming growth factor-beta (TGF-β), platelet-derived growth factor (PDGF) and C-reactive protein (CRP) levels were assayed by ELISA. Results At the end of 48 week treatment, serum ALT and AST levels in the observation group were significantly lower than in the control group (P<0.05); serum HBV DNA loss in the two groups were both 100.0%, and serum HBeAg negative rates were both 0.0% (P>0.05); the APRI, FIB-4 and LSM in the observation group were (1.02±0.23), (4.38±0.77) and (7.73±1.53), all significantly lower than [(1.30±0.33), (5.26±0.85) and (9.68±2.02), respectively, P<0.05] in the control; serum IL-6, TGF-β, PDGF and CRP levels in the observation were much lower than in the control (P<0.05). Conclusion The auxiliary treatment of Ganshuang granule at base of entecavir antiviral therapy could significantly improve biochemical response in patients with CHB, which might be related to the anti-fibrotic effect and inhibition of body inflammatory reaction of the herbal compound.
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    Short-term efficacy of dapagliflozin and liraglutide combination in treatment of patients with non-alcoholic fatty liver disease and diabetes mellitus type 2
    Sun Zheng, Wang Xiaoye, Yuan Jing, et al.
    Journal of Practical Hepatology    2022, 25 (6): 796-799.   DOI: 10.3969/j.issn.1672-5069.2022.06.010
    Abstract865)      PDF(pc) (827KB)(710)      
    Objective The aim of this study was to investigate the short-term efficacy of dapagliflozin and liraglutide combination in treatment of patients with non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus type 2(T2MD). Methods 60 patients with NAFLD and T2MD were admitted to our hospital between September 2017 and October 2020, and were randomly divided into control and observation group, with 30 cases in each group. All the patients were supervised for routine lifestyle intervention and oral metformin administration for blood glucose control. In addition, the patients in the control group were treated with liraglutide intravenouly, and those in the observation group were treated with dapagliflozin and liraglutide combination. The regimen lasted for 3 months. The fasting plasma glucose (FPG), 2 hour-postprandial plasma glucose (2h PG) and glycated hemoglobin (HbA1c) as well as serum triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) levels were routinely obtained. Serum fasting insulin(Fins) and 2 h Ins levels were assayed, and the HOMA-IR was calculated. The controlled attenuation parameter (CAP) of livers was detected by FibroTouch. Results At the end of 3 month observation, the FPG, 2hPG and HbA1 levels in the observation group were(5.8±0.7)mmol/L, (6.9±0.8)mmol/L and (6.3±0.9)%, all significantly lower than [(6.6±0.6)mmol/L,(7.7±0.7)mmol/L and (7.2±1.0)%, respectively, P<0.05] in the control group; serum Fins, 2hIns and HOMA-IR levels were (9.8±1.2)mIU/L, (20.2±1.7)mIU/L and (2.6±0.4)%, significantly lower than [(11.9±1.1)mmol/L, (24.8±1.6) mmol/L and (3.2±0.5)%, respectively, P<0.05] in the control; serum TG level was (2.6±0.4) mmol/L, significantly lower than [(3.0±0.3)mmol/L, P<0.05], while serum HDL-C level was (1.6±0.2) mmol/L, significantly higher than [(1.2±0.3)mmol/L, P<0.05] in the control; the CAP was (249.2±7.5)dB/m, also significantly lower than [(264.7±8.6)dB/m, P<0.05] in the control; serum AST level was (39.9±3.8)U/L, significantly lower than [(44.9±4.2)U/L, P<0.05] in the control. Conclusion The application of dapagliflozin and liraglutide combination is efficacious in the treatment of patients with NAFLD and T2MD, which could effectively reduce blood glucose and lipid levels, improve liver function tests back to normal, with the ability of alleviation of insulin resistance.
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    Clinical features of patients with benign recurrent intrahepatic cholestasis: a report of three cases
    Wang Fu, Wang Haoqi, Zhou Yi, et al
    Journal of Practical Hepatology    2023, 26 (1): 47-50.   DOI: 10.3969/j.issn.1672-5069.2023.01.013
    Abstract807)      PDF(pc) (841KB)(198)      
    Objective The aim of this study was to summarize the clinical features of patients with benign recurrent intrahepatic cholestasis (BRIC). Methods The clinical manifestations, laboratory tests, imaging, pathological examinations, and genetic analysis in three patients with BRIC in Zhongshan Hospital, Fudan University, were retrospectively reviewed. Results The three patients were all male and their initial onset ages were below 20 year old; the common symptoms of the patients were jaundice and pruritus, and two of them also experienced abdominal distension, irregular defecation, and appetite loss; serum total bilirubin, direct bilirubin, ALP and TBA levels increased significantly, while serum GGT, ALT and AST levels stayed normal or increased slightly during the disease attack duration; no abnormal intrahepatic and extrahepatic bile ducts were found in magnetic resonance cholangiopancreatography (MRCP) examination, but obvious cholestasis of hepatocytes and capillary bile duct embolism were observed in liver histopathology; the ATP8B1 gene mutation sites with functional prediction of "potentially harmful" or "likely pathogenic" in pathogenic classification were all detected in three patients; all patients were excluded from other known causes of cholestasis, and the disease was recurrent, but with self-limiting. Conclusion The BRIC is rarely reported and its pathogenesis remains unclear currently. The clinical diagnosis might be made based on clinical manifestations, ancillary tests, and pathological findings after excluding other common causes of liver damage. For patients with high suspicion of BRIC, the genetic tests should be performed as early as possible to clarify the diagnosis and guide the management.
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    Clinical efficacy of PD-1 inhibitor and lenvatinib in the treatment of elderly patients with advanced primary liver cancer
    Peng Yu, Li Haitao, Yang Wenli, et al
    Journal of Practical Hepatology    2023, 26 (1): 112-115.   DOI: 10.3969/j.issn.1672-5069.2023.01.029
    Abstract721)      PDF(pc) (913KB)(344)      
    Objective The aim of this study was to explore the clinical efficacy of programmed cell death protein-1 (PD-1) inhibitor and lenvatinib in the treatment of elderly patients with advanced primary liver(PLC). Methods 56 patients with advanced PLC were admitted to our hospital between February, 2017 and February, 2020, and were divided into control (n=28) and observation group (n=28), receiving lenvatinib or PD-1 inhibitor, tirelizhu, and lenvatinib combination therapy. The peripheral blood lymphocyte subsets, CD4+ cell surface PD-1 and cytotoxic T-lymphocyte antigen 4 (CTLA-4) were detected by FCA. Serum acidic fibroblast growth factor (aFGF), basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) levels were detected by ELISA. Results At the end of three month treatment, there were no significant differences as respect to the objective remission rate (42.9% vs. 25.0%) and local control rate(78.6% vs. 64.3%, P>0.05); the percentages of CD3+, CD4+ and CD8+ cells in the combination treatment group were much higher than, while the CD4+/CD8+ cell ratio, as well as the cell PD-1 and CTLA-4 expression were much lower than in the control (P<0.05); serum aFGF, bFGF and VEGF levels in the observation group were (4.1±0.8)pg/L, (5.1±1.0)pg/L and (13.5±2.7)ng/ml, all significantly lower than [(5.3±0.9)pg/L, (6.1±0.8)pg/L and (18.6±3.1)ng/ml, respectively, P<0.05] in the control; at the end of two-year follow-up, there was no significant difference respect to the progression free survival (10.7% vs. 21.4%, P>0.05) between the two groups, while the overall survival in the observation group was 60.7%, much higher than 25.0% (P<0.05) in the control. Conclusion The strategy of PD-1 inhibitor and lenvatinib combination in the treatment of elderly patients with advanced PLC could improve immune functions and prognosis, which needs further investigation.
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    Serum CA125,CA199,AFP,CEA in patients with cirrhosis and primary liver cancer
    Dai Weiwei, Liu Zhengxin, Xu Baohong
    JOURNAL OF PRACTICAL HEPATOLOGY    2017, 20 (1): 81-84.   DOI: 10.3969/j.issn.1672-5069.2017.01.021
    Abstract702)      PDF(pc) (715KB)(784)      
    Objective To investigate the changes of serum carbohydrate antigen(CA)125,CA199, alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) in patients with live cirrhosis and primary liver cancer(PLC). Methods Serum levels of CA125,CA199,AFP and CEA in 440 individuals were detected by ELISA,including 223 patients with liver cirrhosis,97 patients with PLC and 120 healthy persons. Results The levels of CA125 in patients with liver cirrhosis and PLC were (261.64±32.47) U/ml and (265.80±30.44 ) U/ml, CA199 were (25.73±3.39) U/ml and (30.54±3.29) U/ml,CEA were (4.03±0.36) ng/ml and (3.87±0.21) ng/ml,much higher than those[(21.25±7.66) U/ml,(18.57±8.11) U/ml and (3.08±1.05) ng/ml,P<0.05] in healthy persons;serum AFP levels in patients with PLC were(20000.00±453.07) ng/ml,much higher than[(7.52±2.01) ng/ml,P<0.05] in patients with liver cirrhosis;The levels of CA125(474.52±59.80) U/ml],CA199 [(27.80±5.94) U/ml] and CEA [(5.80±0.63) ng/ml] in patients with liver cirrhosis of class C were significantly higher than those of class A [(55.65±8.82) U/ml,(18.81±0.46) U/ml and (3.20±0.10) ng/ml,respectively,P<0.05];The levels of CA125[(385.16±36.09) U/ml],CA199[(26.55±2.87) U/ml],AFP[(13.63±1.82) ng/ml] and CEA [(4.85±0.39) ng/ml] in patients with cirrhotic ascites were higher than those without ascites[(62.75±15.45) U/ml,(19.58±0.75) U/ml,(9.39±1.26) ng/ml and (3.54±0.16) ng/ml,P<0.05];The levels of CA125 [(318.48±48.80)U/ml] and CA199 [(26.63±3.22)U/ml] in patients with alcoholic liver cirrhosis were higher than those in patients with viral cirrhosis [(215.77±26.26)U/ml and(19.06±0.64)U/ml,P<0.05] or in patients with primary biliary cirrhosis [(129.73±28.55)U/ml and(18.00±0.00) U/ml,P<0.05];The level of AFP [(56.41±26.75)ng/ml] in patients with viral cirrhosis was higher than[(5.44±0.30) ng/ml or(7.35±1.47) ng/ml,respectively,P<0.05],while the CEA level[(3.53±0.17) ng/ml] was lower than [(5.19±0.35) ng/ml or(5.73±0.98) ng/ml,P<0.05] in patients with alcoholic liver cirrhosis or primary biliary cirrhosis. Conclusion The serum levels of CA125,CA199,AFP and CEA in patients with liver cirrhosis and PLC were different. The serum levels of CA125,CA199,AFP and CEA in patients with liver cirrhosis were associated with Child-Pugh scores,ascites and etiology.
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    Early antiviral efficacy of tenofovir amibufenamide in treatment of naïve patients with chronic hepatitis B
    Zhang Danlei, Xu Jing
    Journal of Practical Hepatology    2023, 26 (3): 336-339.   DOI: 10.3969/j.issn.1672-5069.2023.03.009
    Abstract695)      PDF(pc) (821KB)(153)      
    Objective The aim of this study was to investigate the early efficacy of tenofovir amibufenamide (TMF) in the treatment of naïve patients with chronic hepatitis B (CHB). Methods A total of 90 naïve patients with CHB were recruited in the First Affiliated Hospital, China University of Science and Technology between January 2020 and March 2022, and were divided into observation (n=50) and control group (n=40), receiving TMF or tenofovir disoproxil fumarate (TDF) treatment for 48 weeks. Serum alanine transaminase (ALT), HBV DNA loads, HBeAg and HBsAg levels were detected routinely. Results At 12, 24, 36 and 48 weeks of treatment, serum ALT levels in the observation group were 38.0(25.0,55.0)U/L, 31.5(23.8,35.0)U/L, 29.5(22.8,35.0) U/L and 26.0(21.8,34.0)U/L, all not significantly different compared to 38.5(25.0,60.0)U/L, 30.0(22.0,44.0)U/L, 31.0(22.8,44.5)U/L and 28.0(19.8,42.0)U/L (P>0. 05), serum HBV DNA loads were 0(0, 3)lgIU/ml, 0(0, 0.5)lgIU/ml, 0(0, 0)lgIU/ml and 0(0, 0)lgIU/ml, not significantly different compared to 2(0, 3)lgIU/ml, 0(0, 2)lgIU/ml, 0(0, 1.5)lgIU/ml and 0(0,0)lgIU/ml (P >0.05) in the control; serum HBV DNA loss were 58%, 76%, 78% and 88%, not significantly different compared to 45%, 65%, 75% and 85%(P >0.05) in the control; at 12, 24 and 36 week treatment, serum ALT normalization rates in the observation group were 56%, 80% and 92%, all not significantly different compared to 55%, 70% and 65%(P >0.05) , while at the end of treatment 48 week, serum ALT normalization rate in the observation group was 100.0%, much higher than 72.5%(P<0.01) in the control; during the period of antiviral regimen, there was no obvious untoward effects in the two groups. Conclusion The antiviral performance of TMF in the treatment of naïve patients with CHB is as efficacious as of TDF, while the long-term efficacy and its impact on renal functions needs further clinical investigation.
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    Multi-slice spiral CT features of patients with gallbladder adenomyosis different from with gallbladder cancer
    Yang Fan, Wang Jian, Wen Zhi
    Journal of Practical Hepatology    2022, 25 (1): 140-143.   DOI: 10.3969/j.issn.1672-5069.2022.01.035
    Abstract688)      PDF(pc) (3720KB)(202)      
    Objective The aim of this study was to summarize the imaging features of multi-slice spiral CT (MSCT) in patients with gallbladder adenomyosis and in patients with gallbladder carcinoma. Methods 113 patients with gallbladder adenomyosis and 78 with gallbladder carcinoma were enrolled in our hospital between September 2015 and September 2020, and all patients underwent MSCT and ultrasonography. The histophthological examination was performed after surgery. Results The consistency of diagnosis by MSCT based on postoperative histopathological examination (Kappa=0.749) was stronger than that by ultrasonography (Kappa=0.577); the accuracy rate by MSCT scan in the diagnosis of patients with gallbladder adenomyosis was higher than that by ultrasonography(88.0% vs. 79.6%, P<0.05); the diagnosis of special, local gallbladder adenomyosis, by MSCT was also higher than that by ultrasonography (97.1% vs. 82.9%, P<0.05); the CT scan showed that the percentages of smooth gallbladder walls, RAS sinus display and clear boundary between liver and gallbladder in patients with gallbladder adenomyosis were 36.3%, 36.3% and 69.0%, all significantly higher than 9.0%, 6.4% and 38.5% in patients with gallbladder carcinoma (P<0.05). Conclusion The diagnostic accuracy of patients with gallbladder adenomyosis by MSCT is relatively high, and its imaging feature might help discriminate gallbladder adenomyosis from cancer.
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    Guidelines of prevention and treatment for nonalcoholic fatty liver disease:a 2018 update
    National Workshop on Fatty Liver, Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association; Fatty Liver Expert Committee, Chinese Medical Doctor Association
    JOURNAL OF PRACTICAL HEPATOLOGY    2018, 21 (2): 177-186.   DOI: 10.3969/j.issn.1672-5069.2018.02.007
    Abstract672)      PDF(pc) (841KB)(2440)      
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    Report of serious liver injury induced by acitretin in a patient with psoriasis and literature review
    Li Chen, Liu Hongling, Liu Wanshu
    JOURNAL OF PRACTICAL HEPATOLOGY    2014, 17 (4): 416-418.   DOI: 10.3969/j.issn.1672-5069.2014.04.023
    Abstract652)      PDF(pc) (670KB)(1096)      
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    Guidelines for the prevention and treatment of metabolic dysfunction-associated (non-alcoholic) fatty liver disease(Version 2024)
    Chinese Society of Hepatology, Chinese Medical Association
    Journal of Practical Hepatology    2024, 27 (4): 494-510.  
    Abstract647)      PDF(pc) (3936KB)(760)      
    The Chinese Society of Hepatology of the Chinese Medical Association invited relevantexperts to revise and update the Guideline of Prevention and Treatment of Nonalcoholic Fatty Liver Disease(2018Version) and renamed it as (Version 2024) Guideline for the Prevention and Treatment of MetabolicDysfunction-associated (non-alcoholic) Fatty Liver Disease. Herein, the guiding recommendations on clinicalissues such as screening and monitoring, diagnosis and evaluation, treatment and follow-up of metabolicdysfunction-associated fatty liver disease are put forward.
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    Intestinal flora changes in patients with hepatitis B-induced liver cirrhosis after entecavir and glycyrrhizin combination treatment
    Ji Minyou, Li Chao, Zhao Xingzhong, et al
    Journal of Practical Hepatology    2021, 24 (5): 641-644.   DOI: 10.3969/j.issn.1672-5069.2021.05.009
    Abstract642)      PDF(pc) (852KB)(231)      
    Objective The aim of this study was to investigate the clinical predicting value of serum ascites albumin gradient (SAAG) on esophageal variceal bleeding (EVB) risk in patients with decompensated hepatitis B cirrhosis. Methods 84 patients with decompensated hepatitis B cirrhosis were admitted to our hospital between April 2017 and October 2019, and the SAAG and modified SAAG werecalculated. The Logistic multivariate analysis was used to analyze the independent impacting factors on EVB in patients with decompensatedhepatitis B cirrhosis. The receiver operating characteristic curve (ROC) was drawn and the area under the ROC (AUROC) was calculated to predict the EVB risk. Results 18 out of our series had, and 66 patients had not EVB during six-month followed-up period; the percentage of male cases older than 65 yr in patients with EBV was 72.2%,greatly older than in patients without EBV (43.9%,P<0.05); serum albumin level in patients with EVB was (35.8±2.7)g/L, significantly lower than , blood platelet count was (52.3±10.7)×109/L, significantly lower than , the APTT was (45.8±5.9)s, significantly longer than ,the SAAG was (18.7±5.1), significantly higher than , and the modified SAAG was (9.2±2.4), significantly higher than in patients without EVB; the spleen thickness was (5.2±1.3)cm, significantly higher than , and the portal vein blood flow velocity was (15.2±2.9) cm/s, significantly slower than in patients without EVB; the multivariate Logistic analysis showed that serum albumin level (OR=0.435, 95%CI=0.287-0.659), ascites albumin level(OR=1.845, 95%CI=1.063-3.202), the APTT(OR=1.469,95%CI=1.272-1.697), the MELD score (OR=3.285, 95%CI=1.697-6.359) and the modified SAAG(OR=2.917, 95%CI=1.337-6.364) were the independent impacting factors for EVB in patients with decompensated hepatitis B cirrhosis(P<0.05); the AUCs of modified SAAG and MELD score for predicting EVB were 0.827 and 0.791, respectively, and theirsensitivities were 0.889 and 0.787, and the specificities were 0.636 and 0.612, respectively. Conclusion The application of SAAG is helpful to predict the risk of EVB in patients with decompensated hepatitis B cirrhosis, and worth further clinical investigation.
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    Clinical characteristics of patients with Dengue fever: A report of 70 cases
    Wang Qian, Li Wenli, Wang Bing, et al.
    Journal of Practical Hepatology    2022, 25 (5): 645-648.   DOI: 10.3969/j.issn.1672-5069.2022.05.010
    Abstract638)      PDF(pc) (816KB)(124)      
    Objective The aim of this study was to summarize the clinical features of patients with Dengue fever (DF), especially in those with liver injuries. Methods 70 patients with DF were encountered in our hospital from January to December 2020, and were carefully managed by supporting treatment. The patients with liver injuries were dealt with liver-protecting medicines. The clinical feature, including blood and biochemical parameters was collected. Results Out of 70 patients with DF, the main symptoms included fever, arthralgia, rash, abdominal pain, diarrhea, respiratory and urinary tract infections, and the leukopenia in 34 cases, thrombocytopenia in 35 cases and abnormal liver function tests in 33 cases; the hospital stay in 33 patients with liver injuries was (7.1±2.2) d, significantly longer than [(5.8±2.0), P<0.05] in 37 patients without liver injuries; all the 70 patients recovered; there was no significant difference as respect to peripheral white blood cell counts between patients with and without liver injuries (P>0.05), while the platelet counts in patients with liver injuries was (105.0±48.6)×109/L, significantly lower than [(156.2±88.7)×109/L, P<0.05] in those without liver injuries; serum ALT, AST, GGT, C-reactive protein and MB isoenzyme of creatine kinase levels slightly increased in patients with liver injuries and the outcomes was good. Conclusions The patients with Dengue fever could have complicated slight liver injuries, and the liver-protecting management could improve the recovery.
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    Guidelines of prevention and treatment for alcoholic liver disease:a 2018 update
    National Workshop on Fatty Liver, Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association; Fatty Liver Expert Committee, Chinese Medical Doctor Association
    JOURNAL OF PRACTICAL HEPATOLOGY    2018, 21 (2): 170-176.   DOI: 10.3969/j.issn.1672-5069.2018.02.006
    Abstract629)      PDF(pc) (735KB)(698)      
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    Preliminary study on the efficacy of combination of tenofovir and Anluo Huaxian pill in the treatment of patients with HBeAg-negative chronic hepatitis B
    Zhao Xieshan, Wu Chunrong, Wang Chunfeng, et al
    Journal of Practical Hepatology    2019, 22 (5): 644-647.   DOI: 10.3969/j.issn.1672-5069.2019.05.008
    Abstract608)      PDF(pc) (817KB)(230)      
    Objective The aim of this study was to investigate the efficacy of of combination of tenofovir and Anluo Huaxian pill,a herbal medicine,in the treatment of patients with HBeAg-negative chronic hepatitis B (CHB). Methods A total of 68 patients with HBeAg-negative CHB were recruited in our hospital bwtween March 2015 and May 2017,and were divided randomly into two groups,with 34 patients in each. The patients in the control group were treated with tenofovir orally and those in the observation were treated with combination of tenofovir and Anluo Huaxian pill for 48 weeks. Serum interleukin(IL)-6,IL-2,and tumor necrosis factor-α(TNF-α) by enzyme-linked immunosorbent assay,and serum type III procollagen(PC-III),hyaluronic acid (HA),laminin (LN) and type IV collagen (IV-C) were detected by radioimmunoassay. Results At the end of 48 w treatment,serum HA,LN,IV-C,and PC-III levels in the combination group were(94.5±31.5) ng/ml,(113.2±51.6) ng/ml, (72.4±20.3) g/L and (102.4±19.6) g/L,significantly lower than [(121.6±37.5) ng/ml,(132.5±53.8) ng/ml,(94.6 ±22.1) μg/L and(134.7±21.5) g/L,respectively,P<0.05] in the control;serum IL-2 level was (173.6±28.3) ng/L, significantly higher than [(145.7±26.4) ng/L,P<0.05], while serum IL- 6 and TNF-α levels were (94.5±16.2) pg/ml and(26.6±6.8) pg/ml,significantly lower than [(112.6±17.8) pg/ml and(35.7±8.3) pg/ml,respectively,P<0.05] in the control;serum HBV DNA loss were 91.2% and 88.2% in the two groups(P<0.05) and serum ALT normalization rates in the two groups were 94.1% and 94.1%. Conclusion The administration of tenofovir and Anluo Huaxian pills is effective in the treatment of patients with HBeAg-negative CHB, which might alleviate liver fibrosis and reduce intrahepatic inflammation.
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    Very short-term efficacy of silybin meglumine and Danning tablet combination in treatment of patients with alcoholic hepatitis
    Lu Yongyu, Liu Changjiang, Huang Shuai.
    Journal of Practical Hepatology    2020, 23 (5): 662-665.   DOI: 10.3969/j.issn.1672-5069.2020.05.015
    Abstract605)      PDF(pc) (847KB)(473)      
    Objective The aim of this study was to investigate the short-term efficacy of silybin meglumine and Danning tablet, a herbal medicine, combination in treatment of patients with alcoholic hepatitis (AH). Methods 146 consecutive patients with AH were recruited in our hospital between March 2017 and June 2019, and were randomly divided into control group (n=73) and observation group (n=73). The patients in the control group were given Danning tablets, and those in the observation group were treated with silybin meglumine and Danning combination for 3 months. Serum superoxide dismutase (SOD), alondialdehyde (MDA) and free fatty acid (FFA) were detected. Results Serum total cholesterol (TC) level in the combination group was (4.9±0.7)mmol/L, significantly lower than 【(5.5±1.2)mmol/L, P<0.05】, and high density lipoprotein cholesterol (HDL-C) was (1.3±0.9)mmol/L, much higher than 【(1.0±0.5)mmol/L, P<0.05】 in the control, and serum triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) levels in the two groups were not significantly different 【(1.7±0.3)mmol/L vs. (1.7±0.7)mmol/L and (3.2±0.4)mmol/L vs. (3.4±0.7)mmol/L, respectively, P>0.05】; serum alanine aminotransferase level was (35.9±7.7)U/L, serum aspartate aminotransferase level was (39.5±6.3)U/L, serum glutamyl transpeptidase level was (123.8±6.6)U/L, and serum alkaline phosphatase level was (57.3±12.5)U/L, all significantly lower than those in the control [(63.5±9.2)U/L,(65.5±7.8)U/L,(145.7±7.2)U/L and (78.4±13.1)U/L, respectively, P<0.05】; serum SOD level was (132.9±19.3)nmol/L, much higher than 【(105.5±12.6)nmol/L, P<0.05】, serum MDA level was (9.5±2.3)nmol/L, significantly lower than 【(14.4±3.6)nmol/L, P<0.05】, and serum FFA level was (24.3±3.1)nmol/L, much lower than 【(30.2±3.3)nmol/L, P<0.05】 in the control. Conclusion The administration of silybin meglumine and a herbal medicine combination in treatment of patients with AH might in short-term ameliorate blood lipid metabolism, inhibit oxidative stress and improve liver functions, which needs further multi-central investigations.
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    Role of bile acids in cholestatic liver injury
    He Shengfu, Wang Yuqin
    Journal of Practical Hepatology    2020, 23 (6): 919-922.   DOI: 10.3969/j.issn.1672-5069.2020.06.041
    Abstract595)      PDF(pc) (865KB)(711)      
    Objective Bile acid(BA) is synthesized in the liver and is the major component of bile. BAs accumulates in serum and liver when BAs secretion is impaired, which is followed by liver injury. The molecular mechanism of cholestasis has been extensively studied, however, it remains controversial. Recent studies showed that BAs might induce hepatocyte injury under pathological conditions, and the mechanism involved inflammatory response induced by stressed hepatocytes. In this article, we reviewed recent advances in the pathogenesis of liver injury induced by BAs and we focused on how BAs induce the activation of inflammatory cytokines that further induce the aggregation of immune cells. Based on these pathogenesis, we tentatively point out a number of novel treatments for cholestatic liver damage.
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    Clinical efficacy of tenofovir and Fuzhenghuayu capsule in treatment of patients with chronic hepatitis B liver cirrhosis
    Ye Xiaoting,Sun Qingfeng,Fu Rongquan, et al
    Journal of Practical Hepatology    2021, 24 (1): 143-144.   DOI: 10.3969/j.issn.1672-5069.2021.01.037
    Abstract584)      PDF(pc) (764KB)(199)      
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    Prevention and treatment of cirrhotics with esophagus and gastric varices bleeding
    Sun Ruonan, Zhang Chunqing
    Journal of Practical Hepatology    2021, 24 (4): 607-610.   DOI: 10.3969/j.issn.1672-5069.2021.04.039
    Abstract559)      PDF(pc) (854KB)(605)      
    Objective Esophageal and gastric varices bleeding (EGVB) is a common complications of liver cirrhosis, with a high mortality rate. Therefore, the prevention and treatment of EGVB is very important for patients with liver cirrhosis. Internal medicine, endoscopic management, interventional and surgical operation are all important approaches for the prevention and treatment of EGVB, which greatly improves the survival rate of cirrhotic patients. In this paper, we reviewed the current progress of primary prevention, emergent hemostasis and secondary prevention of patients with different types of esophageal and gastric varices.
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    Comparison of response toPEG-IFNα-2a or PEG-IFNα-2b in patients with chronic hepatitis B
    Lin Jinxiang, Yang Keli
    Journal of Practical Hepatology    2021, 24 (1): 27-30.   DOI: 10.3969/j.issn.1672-5069.2021.01.008
    Abstract554)      PDF(pc) (812KB)(680)      
    Objective The aim of this study was to compare the antiviral response to pegylated interferon-α (PEG-IFNα-2a) or PEG-IFNα-2b in patients with chronic hepatitis B (CHB). Methods 74 patients with CHB were enrolled in our hospital between July 2016 and May 2018, and were randomly divided into group A (n=37) and group B (n=37). The patients in group A were treated with PEG-IFNα-2a, and those in group B were treated with PEG-IFNα-2b. The antiviral therapy lasted for 48 w, and all patients were followed-up for 24 weeks. Results At the end of 12 w, 24 w and 48 w treatment and 24 w followed-up, serum alanine aminotransaminase (ALT) normalization rates in goup A were 29.7%, 35.1%, 83.8% and 75.7%, all not significantly different as compared to 27.0%, 29.7%, 86.5% and 78.4%, respectively, (P>0.05) in group B; serum HBV DNA loss were 59.5%, 73.0%, 78.4% and 75.7%, all not significantly different as compared to 45.9%, 51.4%, 81.1% and 75.7%, respectively, (P>0.05) in group B; serum HBeAg negative rates were 33.3%, 36.7%, 36.7% and 40.5%, all not significantly different as compared to 29.2%, 29.2%, 33.3% and 35.1%, respectively, (P>0.05) in group B; during the treatment, the incidences of flu-like symptoms and abnormal thyroid functions in the two groups were the same, and the incidences of thrombocytopenia and granulocytopenia in group A were 40.0% and 76.6%, both notsignificantly different as compared to 37.8% and 75.7% in group B (P>0.05).Conclusion At present, both PEG-IFNα-2a and PEG-IFNα-2b could be selected for the treatment of patients with CHB, and the surveillance of untoward effects is pivotally important for the regimen going and the achievement of antiviral therapy.
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    Evaluation of reliability and validity of self-rating anxiety scale and self-rating depression scale in patients with liver cirrhosis
    Tian Yindi, Wang Yikai, Li Jing, et al.
    JOURNAL OF PRACTICAL HEPATOLOGY    2019, 22 (1): 105-108.   DOI: 10.3969/j.issn.1672-5069.2019.01.028
    Abstract554)      PDF(pc) (932KB)(1079)      
    Objective This study was designed to evaluate of reliability and validity of self-rating anxiety scale(SAS) and self-rating depression scale(SDS) in patients with liver cirrhosis. Methods A total of 138 patients with liver cirrhosis were enrolled in this study. The reliability and validity of the two scales was evaluated by Cronbach’s α co-efficient,intraclass correlation co-efficient (ICC),Kaiser-Meyer-Olkin (KMO) score and Bartlett’s test of sphericity(BTS). Results The prevalence of anxiety and depression in this series were 38.2% and 63.1%,respectively;SAS scale’ Cronbach's α coefficient was 0.777 and SDS scale’ was 0.782, indicating better homogeneity reliability; Twenty items of SAS and SDS scales were analyzed by exploratory factors to construct validity and four main factors were extracted from the SAS scale that showed the variances ratio were 15.4%,14.9%,10.6% and 10.2%,respectively,and four factors accounted for 51.1% of the total variance of accumulated explanation;Five main factors were extracted from SDS scales that showed the variance ratio were 14.0%,12.6%,11.9%,10.3% and 8.4%,respectively,with 57.4% of the total variance;The re-measurement analysis of SAS and SDS scale’s items found that the two measurements were highly correlated with each other (P<0.001). Conclusion SAS and SDS scales have a better reliability and validity in the investigation of psychological and mental impairment in patients with liver cirrhosis.
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    Diagnosis and treatment of hepatocellular jaundice
    Yang Min, Lu Mingqin
    JOURNAL OF PRACTICAL HEPATOLOGY    2018, 21 (2): 160-162.   DOI: 10.3969/j.issn.1672-5069.2018.02.003
    Abstract535)      PDF(pc) (439KB)(1039)      
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    Effect and underlying mechanism of curcumin on oleic acid-induced steatosis of HepG2 cells in vitro
    Wu Pengbo, Song Qi, Yu Yuanjie, et al.
    Journal of Practical Hepatology    2020, 23 (3): 324-327.   DOI: 10.3969/j.issn.1672-5069.2020.03.006
    Abstract527)      PDF(pc) (2483KB)(921)      
    Objective The aim of this experiment was to explore the effect and underlying mechanism of curcumin on oleic acid-induced steatosis of HepG2 cells in vitro. Methods HepG2 cells were treated with or without 1 mmol/L oleic acid (OA) to establish nonalcoholic fatty liver disease (NAFLD) cell model. The HepG2 cells were divided into four groups, e.g. control (con), steatosis model (OA) , curcumin control and curcumin-intervened groups. Bodipy493/503 staining was used to detect the distribution of lipid droplets in the HepG2 cells. The ultrastructure of mitochondria was examined by transmission electron microscopy. Reactive oxygen species (ROS) levels were detected by DCFH-DA. The TNF-α and IL-6 levels in the supernatants were measured by a commercial kit. The apoptosis was determined by Hoechst 33258 staining. Western blott was applied to determine the expression of Bcl-2, Bax, mCytc, NF-κB, and Caspase-3/9 proteins. Results Compared with in the control cells, the cells treated with OA showed significantly increased lipid droplets accumulation, while the cells treated with curcumin showed reduced lipid droplets accumulation; the mitochondrial damage including mitochondrial swelling and vesiculation in OA group was more obvious than that in control group, while the mitochondrial damage treated by curcumin was significantly improved; the TNF-α and IL-6 levels in OA group were much higher than that in the control group , while they decreased greatly in curcumin-inervened group ; the ROS levels was (52.24±5.11)% in OA group, significantly higher than (6.71±2.31)% in the control group, while it decreased to (37.44±7.21)% in curcumin-treated group (P<0.05); the apoptosis rate in OA group was (12.12±0.72)%, significantly higher than (2.04±0.57)% in the control group, while it decreased significantly in curcumin-treated group ; the expressions of Bax, NF-κB and cleaved-Caspase-3/9 intensified, and Bcl-2 and mCytc decreased greatly in OA group as compare to those in the control, while the expressions of Bax, NF-κB and Caspase-3/9 decreased, and Cytc and Bcl-2 increased (P<0.05) in curcumin-intervened group. Conclusion Curcumin effectively prevent oleic acid-induced steatosis in HepG2 cells, which might be related to the alleviation of inflammatory reaction, oxidative stress and inhibition of apoptosis.
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    Efficacy and safety of glecaprevir/pibrentasvir therapy in the treatment of patients with chronic hepatitis C and genotype 1b infection
    Hu Chunxia, Yang Jiaonan, Zhang Fengxiao et al
    Journal of Practical Hepatology    2022, 25 (3): 359-362.   DOI: 10.3969/j.issn.1672-5069.2022.03.014
    Abstract523)      PDF(pc) (843KB)(144)      
    Objective The aim of this study was to investigate the efficacy and safety of glecaprevir/pibrentasvir therapy in the treatment of patients with chronic hepatitis C (CHC) and genotype 1b infection. Methods A total of 138 patients with CHC and genotype 1b infection were admitted to the our hospital between July 2019 and August 2020, and were randomly divided into DAA-treated group, receiving glecaprevir/pibrentasvir treatment in 69 cases, and PR-treated group, receiving pegylated interferon alpha-2b and ribavirin combination treatment in another 69 cases. The regimen lasted for 12 weeks in both groups. The biochemical, hematology and virologic parameters were routinely detected. Results At the end of the treatment, serum aspartate aminotransferase and alanine aminotransferase levels in DAA-treated patients were (35.2±6.2)U/L and (30.7±5.4)U/L, both significantly lower than [(48.4±6.9)U/L and (45.4±6.1)U/L, respectively, P<0.05] in PR-treated patients; the rapid virologic response, virologic response at end of treatment and sustained virologic response in DAA-treated patients were 78.3%, 95.7% and 95.7%, all significantly higher than 65.2%, 76.8% and 76.8%(P<0.05) in PR-treated patients; during the treatment, the white blood cell counts and platelet counts in PR-treated patients were (3.4±1.4)×109/L and (110.7±30.8)×109/L, both significantly lower than [(6.3±1.3)×109/L and (208.3±30.2)×109/L, P<0.05] in DAA-treated patients; the incidence of untoward effects in patients receiving DAA treatment was 5.8%, very significantly lower than 84.1%(P<0.001) in patients receiving PR treatment. Conclusion The administration of glecaprevir/pibrentasvir in treating patients with genotype 1b-infected CHC is efficacious and safe with promising virologic response and low side effects, which warrants further clinical investigation.
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    Efficacy of bifidobacterium triple viable capsuleand metformin in treatment of patients with nonalcoholic fatty liver disease
    Chen Jinyu, Guo Xiaoxia, Zhong Xiaoni
    Journal of Practical Hepatology    2021, 24 (1): 63-66.   DOI: 10.3969/j.issn.1672-5069.2021.01.017
    Abstract515)      PDF(pc) (818KB)(231)      
    Objective The aim of this study was to investigate the therapeutic efficacy of bifidobacterium triple viable capsule and metformin in the treatment of patients with nonalcoholic fatty liver disease (NAFLD) and the changes of blood dark incubation of insulin receptor substrate 1(IRS1), IRS2 and glucose transporter -4(GLUT4) mRNA. Methods 70 patients with NAFLD were enrolled in our hospital between June 2018 and December 2019,and were randomly divided into control (n=35) and observation (n=35), receiving metformin hydrochloride or bifidobacterium triple viable capsules at base of metformin for three months. Peripheral blood IRS1, IRS2 and GLUT4mRNA were assayed by RT-PCR, and serum highly sensitive c-reactive protein (hs-CRP), interleukin -6 (IL-6) and IL-10 levels were also detected. Results At the end of three month treatment, the total fatty liver improvement rate in the observation group was 91.4%, which was significantly higher than that in the control group (68.6%, P<0.05); serum aspartate aminotransferase (AST) level in the observation group was (23.9±9.7) U/L, significantly lower than that in the control group , serum alanine aminotransferase (ALT) level was (45.5±12.3) U/L, much lower than that in the control group , and serum glutamyltranspeptidase (GGT) level was (66.9±11.9) U/L, significantly lower than that in the control group ; blood IRS1 mRNA was (2.1±0.2), which was much higher than that in the control group , peripheral blood IRS2 mRNA level was (2.3±0.4), which was significantly higher than that in the control group , and peripheral blood GLUT4 mRNA level was (2.5±0.4), which was also significantly higher than that in the control group ; serum hs-CRP level was (3.4±0.7) mg/L, significantly lower than that in the control group , serum interleukin-6(IL-6) level was (26.9±7.4)ng/L, significantly lower than that in the control group , and serum IL-10 level was (46.5±12.8)ng/L, significantly lower than that in the control group .Conclusion The combination of bifidobacterium triple viable capsule and metformin in treatment of patients with NAFLD could effectively improve the hepatic steatosis, which might be related to the elevation of peripheral blood IRS1, IRS2 and GLUT4 and inhibition of serum inflammatory factors.
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    Conventionaland contrast-enhanced ultrasonography manifestations of intrahepatic cholangiocarcinoma
    Chen Jiaojiao, He Nian’an, Fang Jing, et al
    Journal of Practical Hepatology    2021, 24 (2): 272-275.   DOI: 10.3969/j.issn.1672-5069.2021.02.031
    Abstract511)      PDF(pc) (3530KB)(415)      
    Objective The aim of this study was to summarize the conventional and contrast-enhanced ultrasonography (CEUS)manifestations of intrahepatic cholangiocarcinoma (ICC).Methods 52 patients with ICC were recruited in our hospital, and all underwent conventional and CEUS check-up.Results The gray-scale ultrasonography showed than the tumors presented with uniform hypoechoic in 23 cases (44.2%, uneven hypoechoic in 22 cases (42.3%), slightly hyperechoic and hyperechoic in 7(13.5%); the color Doppler flow imaging showed that the blood supply of lesions was in grade 0 in 11 cases (21.2%), in grade 1 in 9 cases (17.3%), in grade 2 in 28 cases (53.8%), and in grade 3 in 4 cases(7.7%); out of 51 eligible cases of ICC, the CEUS demonstrated that the enhancement performance in arterial phase was in typeⅠ, e.g. rapid overall uniform enhancement, in 10 cases (19.6%), and in type Ⅱ, e.g. rapid uneven enhancement, in 41 cases (80.4%), out of which, in subtype Ⅱa, the overall uneven enhancement, in 19 cases (37.3%), in subtype Ⅱb, the dendritic enhancement, in 9 (17.6%), in subtype Ⅱc, thick-walled irregular ring-like enhancement, in 6 (11.8%), and in subtype Ⅱd, ring-like and dendritic enhancement, in 7 (13.7%).Conclusion ICCs have some CEUS characteristic features, which might help for the early diagnosis.
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    Committee of Hepatology, Chinese Research Hospital Association; Fatty Liver Expert Committee, Chinese Medical Doctor Association
    National Workshop on Fatty Liver, Alcoholic Liver Disease, Chinese Society of Hepatology; National Workshop on Liver, Metabolism, Chinese Society of Endocrinology, Chinese Medical Association
    Journal of Practical Hepatology    2019, 22 (6): 787-792.   DOI: 10.3760/cma.j.issn.1007-3418.2019.10.005
    Abstract508)      PDF(pc) (737KB)(877)      
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    Clinical efficacy of entecavir combined with live bifidobacterium and lactobacillus tablets in the treatment of hepatitis B patients with decompensated liver cirrhosis
    Li Bo, Deng Cunliang
    JOURNAL OF PRACTICAL HEPATOLOGY    2018, 21 (5): 669-672.   DOI: 10.3969/j.issn.1672-5069.2018.05.004
    Abstract508)      PDF(pc) (444KB)(358)      
    Objective To investigate the clinical efficacy of entecavir combined with live bifidobacterium and lactobacillus tablets in the treatment of B patients with decompensated liver cirrhosis. Methods 120 patients with hepatitis B induced decompensated liver cirrhosis in the Affiliated Hospital of the Southwest Medical University between Jan. 2015 and Aug. 2017 were randomly divided into control and observation groups. The patients in the control group were administrated entecavir and patients in the observation group were administrated entecavir and live bifidobacterium and lactobacillus tablets. The index of liver function,hepatic fibrosis,HBV DNA and the rate of spontaneous bacterial peritonitis were compared between the two groups. Results At the end of 12 weeks,serum levels of ALT and TBIL in combination treatment group were(70.2±6.2) U/L and(16.3±4.2) μmol/L,both significantly lower than (76.2±9.6) U/L and (26.3±5.2) μmol/L in the control group(P<0.05);serum level of ALB in the treatment group was (32.5±4.2) g/L,significantly higher than(30.2±5.3)g/L in the control group(P<0.05);at the end of 24 weeks,serum levels of ALT and TBIL in the treatment group were (12.2±3.2) U/L and(6.2±1.3) μmol/L,both significantly lower than (26.4±3.2)U/L and (11.2±3.2) μmol/L in the control group (P<0.05);serum level of ALB in the treatment group was (37.8±2.3) g/L,significantly higher than (34.4±4.2) g/L in the control group (P<0.05);serum LN and C- IV were (65.2±15.1)ng/ml and (85.5±8.5)ng/ml,much lower than【(75.3±10.3)ng/ml and (96.2±10.3)ng/ml in the control,respectively,P<0.05】;serum HBV DNA level was (1.0±0.1)lg copies/ml,no significantly different as compared to (1.7±0.3) lg copies/ml in the control (P>0.05),and serum HBV DNA negativity rate was 100.0%,also no significantly different as compared to 90.0% in the control(P>0.05);at the end of 12 w and 24 w,the SBP occurred in 5(8.3%) and in 2(3.3%),significantly lower than in 10(16.7%) and in 8(13.3% in the control (P<0.05);at the end of 24 w,3(5%) died in the combination group,much lower than 10(16.7%) in the control(P<0.05). Conclusion Entecavir combined with live bifidobacterium and lactobacillus tablets has a good clinical efficacy in treatment of hepatitis B patients with decompensated liver cirrhosis,which is worth further investigation.
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    Efficacy and safety of tauroursodeoxycholic acid and ursodeoxycholic acid combination in the treatment of patients with nonalcoholic fatty liver disease:a Meta-analysis
    Xing Xin, Wei Zhongcao, Zhou mimi, et al.
    Journal of Practical Hepatology    2019, 22 (6): 852-855.   DOI: 10.3969/j.issn.1672-5069.2019.06.019
    Abstract505)      PDF(pc) (920KB)(495)      
    Objective To systematically evaluate the efficacy and safety of tauroursodeoxycholic acid and ursodeoxycholic acid combination in the treatment of patients with nonalcoholic fatty liver disease (NAFLD). Methods We searched CNKI,VIP,WanFang Data,CBM,PubMed,The Cochrane Library,EMbase database and retrieved randomized controlled trials (RCT) on the observation of tauro ursodesoxycholic acid and ursodeoxycholic acid combination in the treatment of patients with NAFLD since inception of database. Meta analysis was performed by using RevMan 5.3 software. Results A total of 682 NAFLD patients were included in 6 RCT studies,and 342 in the observation group were treated by tauro ursodesoxy cholic acid and polyene phosphatidyl choline,and 340 in the control group were treated by ursodeoxycholic acid and polyene phosphatidyl choline combination. The Results showed that the overall effective rate [RR=1.10,95%CI(1.03,1.18),P=0.004],serum ALT reduction [MD=13.34,95%CI(12.20,14.48),P<0.00001],AST reduction [MD=11.29,95%CI(5.85,16.72),P<0.0001], GGT reduction [MD=22.54,95%CI(20.75,24.33),P<0.00001],TG reduction[MD=0.48,95%CI(0.25,0.70),P<0.0001],LDL-C reduction [MD=0.67,95%CI(0.51,0.83),P<0.00001] and BMI reduction [MD=1.57,95%CI(1.29, 1.84),P<0.00001] as well s HDL-C elevation [MD=0.23,95%CI(0.18,0.27),P<0.00001] in the observation group in the treatment of patients with NAFLD were significantly superior to those in the control group; however,there was no significant difference between the two groups as respect to serum TC reduction [MD=0.30,95%CI(-0.03,0.64),P=0.08] and the incidence of adverse reactions [RR=1.00,95%CI(0.41, 2.47),P=1.00];the improvement of hepatic steatosis was also not significantly different between the two groups [RR=2.2,95%CI(0.97,4.98),P=0.06]. Conclusion The efficacy of tauro ursodesoxy cholic acid combined with polyene phosphatidyl choline in the treatment of patients with NAFLD is good based on the domestic studies,which might be at a low level observations.
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    Short-term observation ofglicladine and insulin aspart 50 in the treatment of patients with non-alcoholic fatty liver diseases and hepatogenic diabetes
    Zhang Yan, Xia Wenfang, Jin Jin, et al
    Journal of Practical Hepatology    2021, 24 (2): 240-243.   DOI: 10.3969/j.issn.1672-5069.2021.02.023
    Abstract495)      PDF(pc) (860KB)(252)      
    Objective The aim of this study was to analyze the short-term efficacy of glicladine and insulin aspart 50 in the treatment of patients with non-alcoholic fatty liver diseases (NAFLD) and hepatogenic diabetes and to monitor the changes of homeostasis model assessment for insulin resistance (HOMA-IR) and index of β-cell function in homeostasis model assessment (HOMA-β).Methods 98 patients with NAFLD and hepatogenic diabetes were admitted to our hospital between January 2017 and December 2019 were randomly divided into control group (n=49) and observation group (n=49). The patients in the control group were treated with insulin aspart 50, while those in the observation group were treated with glicladine at the basis of insulin aspart 50. The regimen in both groups lasted for 12 weeks. The fasting blood glucose (FBG) , postprandial 2 hour blood glucose (2 h PG) and serum hemoglobin A1c (HbAlc) level were detected, and the HOMA-IR and HOMA-β were calculated. Serum liver function indexes were detected by automatic biochemical analyzer.Results At the end of 12 week treatment, the FPG level in observation group was (6.3±3.9) mmol/l, significantly lower than [ (7.8 ±1.2) mmol/l, P<0.05] in the control, the 2 h PG level was (8.4±2.6) mmol/l, significantly lower than [(11.5±2.8) mmol/l, P<0.05] in the control, and the HbAlc level was (7.1±1.6)%, significantly lower than [(8.3±1.9)%, P<0.05] in the control; the HOMA-IR in the observation group was (1.5±0.2) , significantly lower than [(2.4±03), P<0.05] in the control, while the HOMA-β was (42.9±8.7), significantly higher than [(33.5±7.2), P<0.05] in the control; serum alanine aminotransferase (ALT) level in the observation group was (53.9±13.7) U/L, significantly lower than [(72.2±19.6) U/L, P<0.05] in the control, and serum aspartate aminotransferase (AST) level was (22.1±6.3) U/L, significantly lower than [(46.4±6.9) U/L, P<0.05] in the control; Serum albumin, total bilirubin and glutamyl transpeptidase levels in the two groups were not significantly different before and after treatment (P>0.05).Conclusion The administration of glicladine and insulin aspart 50 in the treatment of patients with NAFLD and hepatogenic diabetes could significantly improve the blood sugar level recovery, which might related to the improvement of islet β cell functions and reduction of HOMA-IR.
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    Models of nonalcoholic fatty liver disease
    Zhang Yizhi, Zhang Xiaohui, Chen Yu
    Journal of Practical Hepatology    2021, 24 (5): 761-764.   DOI: 10.3969/j.issn.1672-5069.2021.05.039
    Abstract495)      PDF(pc) (860KB)(989)      
    Objective The incidence rate of nonalcoholic fatty liver disease (NAFLD) is increasing. It might progress to the end-stage liver disease. However, there is still no specific treatment for this entity. Therefore, the establishment of representative animal models reflecting disease characteristics has become especially important. Although there are many different disease models, there is still a lack of NAFLD model which could cover the whole spectrum of this entity in human. In this paper, we reviewed the current progress on NAFLD model, focusing on animal model, 2D cell model, 3D liver model and their advantages and disadvantages.
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    Combination of ursodeoxycholic acid and prednisone and azathioprine in the treatment of patients with autoimmune hepatitis
    Nie Liu, Peng Hanming, Liao Dongliang
    Journal of Practical Hepatology    2021, 24 (2): 224-227.   DOI: 10.3969/j.issn.1672-5069.2021.02.019
    Abstract484)      PDF(pc) (858KB)(332)      
    Objective The aim of this study was to observe the efficacy of combination of ursodeoxycholic acid (UDCA) and prednisone and azathioprine in the treatment of patients with autoimmune hepatitis (AIH).Methods 120 AIH patients were recruited in the Department of Gastroenterology in our hospital between February 2017 and December 2019, and were randomly divided into control and observation groups with 60 cases in each group. The patients in the control received prednisone and azathioprine, while those in the observation group received UDCA at base of prednisone and azathioprine therapy. The regimen lasted for 21 months. Serum complement 3 (C3), C4, as well as immunoglobulin were detected.Results At the end of the treatment, serum alanine aminotransferase level in the observation group was (55.2±6.9)U/L, significantly lower than 【(91.2±12.8)U/L, P<0.05】, serum aspartate aminotransferase level was (59.7±7.5)U/L, significantly lower than 【(101.5±13.5)U/L, P<0.05】, serum alkaline phosphatase level was (122.4±15.7)U/L, much lower than 【(138.9±15.2)U/L, P<0.05】, and serum glutamyl transpeptidase level was (120.7±10.1)U/L, significantly lower than 【(161.5±20.7)U/L, P<0.05】 in the control; serum C3 level in the observation was (0.6±0.1)g/L, significantly lower than 【(0.8±0.2)g/L,P<0.05】, and serum C4 level was (0.1±0.1)g/L, significantly lower than 【(0.2±0.1)g/L, P<0.05】 in the control; serum IgG level in the observation group was (12.5±2.0)g/L, significantly lower than 【(20.4±2.7)g/L, P<0.05】, and serum IgM level was (2.7±0.9)g/L, significantly lower than 【(3.4±1.1)g/L, P<0.05】 in the control.Conclusion The administration of ursodeoxycholic acid at base of prednisolone and azathioprine combination in the treatment of patients with AIH could effectively reduce serum C3 and C4 levels, improve immune functions and alleviate liver injury, which needs further investigation.
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    Cross-talk between Notch and LPS-TLR4-NF-κB inflammatory signaling pathways in LPS-activated HepG2 cells
    Zhang Ying, Wang Hongyan, Chi Cheng, et al
    JOURNAL OF PRACTICAL HEPATOLOGY    2019, 22 (4): 470-473.   DOI: 10.3969/j.issn.1672-5069.2019.04.005
    Abstract484)      PDF(pc) (571KB)(823)      
    Objective To investigate the interaction between Notch and LPS-LPS-Toll like receptor-4(TLR4)-NF-κB inflammatory signaling pathways in HepG2 cells stimulated with lipopolysaccharide (LPS).Methods HepG2 cells were cultured with LPS and cell RNAs were extracted,and Notch signaling pathway receptors and their ligands mRNA were detected by quantitative reverse transcription polymerase chain reaction. Western blot analysis was used to detect Notch intracellular domain(NICD) and NF-κB protein expression levels after the γ-secreting enzyme inhibitor (DAPT),LPS or combination of LPS and DAPT activation,respectively.Results After LPS activation of HepG2 cells,the mRNA level of Notch 1 was 2.25 times(P<0.001),Jag 1 was 2.47 times(P<0.001),NOTCH 3 was 0.0700 times (P>0.05),Jag 2 was 0.420 times (P>0.05),and Dll 4 was 0.947 times (P<0.01) increased,while NOTCH 2 was 0.857 times(P<0.01),NOTCH 4 was 0.283 times(P>0.05),Dll 1 was 0.750 times(P<0.01),and Dll 3 was 0.393 times(P>0.05) decreased;the expression of NICD and NF-κB proteins in LPS-intervened cells increased obviously,while those in DAPT-intervened cells decreased greatly as compared to those in the control. Conclusion Our findings reveals that the interaction might be going on between Notch and TLR4-NF-κB signaling pathways in HepG2 cells stimulated by LPS. The inhibition of Notch signaling pathway could significantly alleviate the inflammatory response caused by LPS-TLR4.
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    Up-regulation of lipid metabolism related genes in liver tissues of mice with nonalcoholic fatty liver diseases
    Zhang Meng, Chen Yi, Liu Jiao, et al
    Journal of Practical Hepatology    2020, 23 (2): 163-166.   DOI: 10.3969/j.issn.1672-5069.2020.02.004
    Abstract477)      PDF(pc) (1674KB)(835)      
    Objective The aim of this experiment was to investigate the changes of lipid metabolism related genes in liver tissues of mice with nonalcoholic fatty liver diseases (NAFLD). Methods A NAFLD model was established in ten mice by feeding high-fat diet. The histopathological changes of the liver tissues were observed. Blood total cholesterol (TCH) and triglycerides (TG) levels were detected, and sterol regulatory element-binding proteins (SREBPs), acetyl coenzyme carboxylase (ACC) and fatty acid synthase (FAS) mRNA were detected by reverse transcription-polymerase chain reaction. Results The steatosis of liver cells was found in mice in NAFLD model group; blood TG and TCH levels in NAFLD model group were (0.63±0.13) mmol/L and (7.23±0.7) mmol/L, significantly higher than [(0.28± 0.06) mmol/L and (2.78±0.6) mmol/L, P<0.001] in ten mice in the control; at the end of 24 w experiment, hepatic FAS and SREBP-1 mRNA in NAFLD mice were (3.9±1.1) and (1.8±0.7), significantly higher than 【(1.0±0.3) and (1.0±0.4), FAS: t = 6.231, P<0.001; SREBP-1: t = 2.431, P =0.035】, while the ACC mRNA was (1.2±0.5), not significantly different as compared to 【(1.0±0.4), t = 0.765, P =0.462】 in the control. Conclusion The lipid metabolism related genes in liver tissue of mice with NAFLD are significantly up-regulated, which might play a pivotal role in the pathogenesis of NAFLD.
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    Preliminary study of the efficacy of entecavir combined with silybin neglumine amine in treatment of patients with chronic hepatitis B and NAFLD
    Li Xu
    JOURNAL OF PRACTICAL HEPATOLOGY    2017, 20 (6): 676-679.   DOI: 10.3969/j.issn.1672-5069.2017.06.010
    Abstract473)      PDF(pc) (269KB)(185)      
    Objective To observe the efficacy of entecavir combined with silybin meglumine amine in treatment of patients with chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD). Methods 80 patients with CHB and NAFLD in our hospital were enrolled between January 2015 and January 2016 in this study. Patients were randomly divided into control group and observation group with 40 cases in each group. The patients in control group was treated with entecavir alone and in observation group was given entecavir combined with silybin meglumine amine. The regimen continued in both groups,and we assessed the efficacy at the end of six month treatment. Results At the end of six month treatment,serum alanine aminotransferase and aspartate amonotransferase levels in observation group were significantly lower than those in the control group[(64.3±27.9) U/L vs. (83.7±26.0) U/L,and (42.0±24.5) U/L vs. (57.6±26.6) U/L,respectively,P<0.05 for both];serum levels of PCⅢ,Ⅳ-C,LN and HA in observation group were lower than those in the control group [(106.0±54.5) ng/L vs. (147.6±76.6) ng/L,(69.23±21.24) ng/L vs. (86.74±21.30) ng/L,(119.2±61.2) ng/L vs. (212.7±100.3) ng/L,and (119.2±71.2) ng/L vs. (205.7±91.3) ng/L,respectively,P<0.05 for all];there were no differences as respect to serum HBV DNA and HBsAg levels between the two groups [(2.3±0.9) Ig IU /ml vs. (2.7±1.0) Ig IU /ml,and (4458.0±945.5) S/CO vs. (4744.0±1256.5) S/CO,respectively,P<0.05 for both]. Conclusion The combination of entecavir and silybin meglumine amine is effective in improving liver enzymes and serum indexs of hepatic fibrosis in patients with CHB and NAFLD,but we don’t find any benefit on serum HBsAg eradication by this regimen.
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    Diagnostic efficacy of FibroTouchR by measuring fat attenuation index in detecting liver steatosis in patients with non-alcoholic fatty liver diseases
    Yang Shuo, Lyu Dong, Wang Tianyi, Zhang Longyou, Xu Youqing
    JOURNAL OF PRACTICAL HEPATOLOGY    2016, 19 (1): 50-54.   DOI: 10.3969/j.issn.1672-5069.2016.01.013
    Abstract470)      PDF(pc) (2229KB)(825)      
    Objective To evaluate the diagnostic value of FibroTouch® by fat attenuation index(FAI) in patients with non-alcoholic fatty liver diseases(NAFLD). Methods A total of 86 patients with NAFLD and 90 healthy persons were recruited in this study. NAFLD group was divided into mild,moderate and severe liver steatosis based on B-ultrasonography. Two independent sample t-test was used to compare body mass index (BMI),FAI and liver stiffness were obtained by FibroTouch® between NAFLD group and healthy control. One-way analysis of variance was used to compare above parameters among mild,moderate and severe liver steatosis. Pearson correlation was used to analyze the relationship between FAI and BMI or liver stiffness. Receiver operating characteristic(ROC) curves were plotted,and the areas under the curves(AUC) were calculated. The cut-off values were defined by maximizing the sum of sensitivity and specificity(maximum Youden index). Results Between control group and NAFLD group,BMI were [(22.9±2.1) kg/m2 and (27.8±3.4) kg/m2,P<0.001],FAI were [(215.1±16.3) db/m and (263.0±25.1) db/m,P<0.001],liver stiffness were [(5.1±1.1) Kpa and (8.8±5.7) Kpa,P<0.001];Among mild(n=43),moderate(n=28),severe(n=15) liver steatosis,FAI showed significant difference [(244.0±9.9) db/m,(273.8±9.7) db/m and(301.9±20.1) db/m,P<0.001];FAI showed positive correlation with BMI (r=0.741,P<0.001) and liver stiffness (r=0.442,P<0.001);AUC of normal vs. mild,mild vs. moderate, and moderate vs. severe were(0.935,0.986,and 0.969,respectively,P<0.001);The cut-off values for mild, moderate,and severe liver steatosis were 237 db/m(sensitivity 96.7%, specificity 86.4%),259 db/m (se. 97.7%, sp. 92.9%),and 286 db/m( se. 96.4%,sp. 93.3%),respectively. Conclusion FAI shows advantages in diagnosing NAFLD,and has a promising diagnostic potential for grading liver steatosis in patients with NAFLD.
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    Dynamic enhanced CT manifestation of liver metastases in patients with colorectal cancer
    Jiang Haitao, Zhang Yanmei, Fan Lu
    JOURNAL OF PRACTICAL HEPATOLOGY    2018, 21 (1): 125-126.   DOI: 10.3969/j.issn.1672-5069.2018.01.034
    Abstract469)      PDF(pc) (871KB)(568)      
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    Analysis of plasma exchange and continuous blood purification in treatment of patients with hepatitis B liver failure
    Yang Xiaoling, Zhou Qiang, Zheng Chunhua, et al
    JOURNAL OF PRACTICAL HEPATOLOGY    2018, 21 (3): 469-470.   DOI: 10.3969/j.issn.1672-5069.2018.03.042
    Abstract459)      PDF(pc) (880KB)(505)      
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