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

2016 No. 2

Display Method:
Editorial
Work-up for diagnosis and treatment of liver cirrhosis: convention and development
Tang ChengWei
2016, 32(2): 201-202. DOI: 10.3969/j.issn.1001-5256.2016.02.001
Abstract:

Liver cirrhosis is one of the most important public health issues in China. The etiological treatment for patients with decompensated liver cirrhosis to delay progression has always been the practical and effective classical strategy. High- quality or creative methods for diagnosis and treatment come from ordinary and careful work. Portal hypertension is in nature a vascular disease,and relief of pressure in the portal system in time is the key to prevention of disease progression and various severe complications. The therapeutic decision should be made on the basis of a comprehensive understanding of portal hypertension,and minimally invasive techniques are important methods for such strategies.

Therapeutic guidelines
Interpretation of guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension
Ding HuiGuo, Xu XiaoYuan, Ling HuEnQiang, Jia JiDong
2016, 32(2): 220-222. DOI: 10.3969/j.issn.1001-5256.2016.02.003
Abstract:
An excerpt of New 2015 AASLD guidelines for treatment of chronic hepatitis B
Xu Ying, Wang WeiBin, Li ZhanDong, Wu YaoBo, Sun Jian
2016, 32(2): 223-229. DOI: 10.3969/j.issn.1001-5256.2016.02.004
Abstract:
Discussions by experts
Retrospects and prospects of transjugular intrahepatic portosystemic shunt in China
Niu Meng, Sun Jun, Xu Ke, Zhong HongShan
2016, 32(2): 230-233. DOI: 10.3969/j.issn.1001-5256.2016.02.005
Abstract:
In recent years,transjugular intrahepatic portosystemic shunt( TIPS) has been gradually applied and widely accepted in China,and the technical standards,indications,and contraindications of this technique have also been established gradually. The invention of covered stents successfully solved the issue of a high rate of shunt occlusion seen in bare stents,and thus TIPS is greatly developed. Unfortunately,since most clinical studies were published before the invention of covered stents,the clinical effect of TIPS cannot represent the current status in this field. With the development of this technique,the indications for TIPS are gradually expanded,and as a country with many patients in need of TIPS,high- quality multicenter randomized controlled clinical trials are urgently needed in China. TIPS has been accepted in the treatment of various complications of portal hypertension and hepatic vascular diseases and will enjoy a promising future.
Advances in transjugular intrahepatic portosystemic shunt and its application in treatment of cirrhotic portal hypertension
Xiao JiangQiang, ZhuGe YuZheng
2016, 32(2): 234-237. DOI: 10.3969/j.issn.1001-5256.2016.02.006
Abstract:

In recent years,with the development in basic research and clinical application,the success rate of transjugular intrahepatic portosystemic shunt( TIPS) has been increased significantly,and stent restenosis rate and the incidence of postoperative hepatic encephalopathy have been controlled. With reference to the authors' clinical practice and hot topics of conferences at home and abroad,this article introduces the advances in TIPS- related techniques and their application in liver cirrhosis,including TIPS puncture technique,TIPS stent,TIPS- related hepatic encephalopathy and its prevention and treatment,TIPS indications and contraindications,the issues solved by TIPS in liver cirrhosis,and the advantages and disadvantages of TIPS in the treatment of esophagogastric variceal bleeding compared with other therapeutic methods,in order to make contributions to the development of TIPS and bring more benefits to patients with liver cirrhosis.

Prevention and treatment of complications after transjugular intrahepatic portosystemic shunt
Xue Hui, Li PeiJie, Li WeiZhi, Su JingWen, Huang Jin
2016, 32(2): 238-241. DOI: 10.3969/j.issn.1001-5256.2016.02.007
Abstract:
The application of transjugular intrahepatic portosystemic shunt( TIPS) in the treatment of cirrhotic portal hypertension has been widely accepted both at home and abroad. This article focuses on the fatal complications of TIPS( including intraperitoneal bleeding and acute pulmonary embolism),shunt failure,and recurrent portosystemic hepatic encephalopathy,and elaborates on the reasons for such conditions and related preventive measures,in order to improve the accuracy and safety of intraoperative puncture,reduce common complications such as shunt failure and hepatic encephalopathy,and improve the clinical effect of TIPS in the treatment of cirrhotic portal hypertension.
Individualized treatment of liver cirrhosis and esophageal and gastric varices from the perspective of Baveno Ⅳ
Zhang ChunQing, Li Jing
2016, 32(2): 242-244. DOI: 10.3969/j.issn.1001-5256.2016.02.008
Abstract:
The therapeutic methods for portal hypertension have been greatly developed,including surgical operation,endoscopic injection of sclerosing agents,endoscopic variceal ligation,tissue adhesive embolization,and radioactive intervention,and have significantly reduced the fatality of portal hypertension. Focusing on the risk assessment and individualized management of portal hypertension,Baveno IV emphasizes patient stratification and individualized treatment. Based on Baveno IV consensus,this article briefly introduces hepatic venous pressure gradient and liver function reserve,as well as the application of characteristic parameters such as“gastro- renal shunt”in the development and prevention of variceal bleeding.
Research advances in non-cirrhotic portal hypertension
Zhang BoJing, Han GuoHong, Fan DaiMing
2016, 32(2): 245-249. DOI: 10.3969/j.issn.1001-5256.2016.02.009
Abstract:
Although liver cirrhosis is the most common cause of portal hypertension( PH),about 20% of PH cases are caused by non- cirrhotic reasons,which are referred to as non- cirrhotic portal hypertension( NCPH),with a high incidence rate in developing countries.NCPH is a group of heterogeneous hepatic vascular diseases,including idiopathic portal hypertension( IPH) and extrahepatic portal vein obstruction( EHPVO),as well as the rare diseases in clinical practice such as Budd- Chiari syndrome,congenital hepatic fibrosis,and nodular regenerative hyperplasia. The patients with NCPH usually have the symptoms of portal hypertension,such as recurrent variceal bleeding and splenomegaly,but liver function is well preserved in these patients. At present,the diagnosis of NCPH lacks a universally accepted standard and remains a challenge. In clinical practice,the method of exclusion is usually applied for the diagnosis of HCPH,and liver biopsy is performed when necessary to make a confirmed diagnosis. This paper introduces the pathogenesis and pathological manifestations of IPH and EHPVO,as well as the selection of diagnostic methods and therapeutic strategies. If upper gastrointestinal bleeding can be effectively controlled,NCPH is considered to have a relatively good prognosis.
Current status and perspectives of surgical treatment of portal hypertension
Yang Zhen
2016, 32(2): 250-253. DOI: 10.3969/j.issn.1001-5256.2016.02.010
Abstract:
The surgical treatment of portal hypertension once guided the development of modern surgery. In the past 10- 20 years,the non-surgical therapies including drugs to screen and control esophagogastric variceal bleeding,endoscopic variceal ligation,and transjugular intrahepatic portosystemic shunt have been widely applied in clinical practice. Surgical treatment is only applicable to those patients who do not respond to endoscopic treatment and have Child- Pugh class A liver function. At present,the following three surgeries have been universally acknowledged: distal splenorenal shunt,extensive pericardial devascularization combined with splenectomy,and two- stage transthoracic transabdominal combined devascularization. Due to a lack of liver donors in China,liver transplantation cannot be widely applied. Laparoscopic splenectomy and laparoscopic splenectomy combined with pericardial devascularization are great challenges for patients with cirrhotic portal hypertension. The author thinks that the surgical treatment of portal hypertension should collaborate with non- surgical therapies to develop individualized treatment regimens for patients with liver cirrhosis and non- cirrhotic portal hypertension.
Original articles_Portal hypertension
Effect of antiviral therapy on prognosis of patients with decompensated hepatitis B cirrhosis undergoing transjugular intrahepatic portosystemic shunt
Lin Jing, Wei Bo, Wu Hao, Tong Huan, Tang ChengWei
2016, 32(2): 254-258. DOI: 10.3969/j.issn.1001-5256.2016.02.011
Abstract:

Objective To investigate the effect of antiviral therapy on the prognosis of patients with decompensated hepatitis B cirrhosis who underwent transjugular intrahepatic portosystemic shunt( TIPS). Methods The clinical data of 110 patients with decompensated hepatitis B cirrhosis who underwent TIPS to prevent variceal rebleeding from January 2008 to December 2011 were analyzed retrospectively,and based on whether they used antiviral drugs or not,these patients were divided into TIPS- antiviral drug group( 58 patients) and TIPS group( 52patients). The t- test or Wilcoxon rank sum test was applied for comparison of continuous data between the two groups,and the chi- square test was applied for comparison of categorical data between the two groups. The Kaplan- Meier survival analysis and log- rank test were performed to analyze the cumulative survival rate,rebleeding rate,stent patency rate,and incidence of hepatocellular carcinoma( HCC). Results The 1-,3-,and 5- year cumulative survival rates after TIPS in the TIPS- antiviral drug group versus the TIPS group were 93. 1%vs 88. 5%,86. 1% vs 64. 9%,and 77. 7% vs 59. 7%,respectively,and the TIPS- antiviral drug group had a significantly higher cumulative survival rate than the TIPS group( χ2= 6. 833,P = 0. 009). In the TIPS- antiviral drug group,the virologic response rate increased with the prolonged time of antiviral therapy. The cumulative variceal rebleeding rate,stent patency rate,and incidence of HCC showed no significant differences between the two groups( all P > 0. 05). Conclusion Antiviral therapy can improve the survival rate of patients with decompensated hepatitis B cirrhosis after TIPS.

Therapeutic effect and safety of transjugular intrahepatic portosystemic shunt in patients with primary biliary cirrhosis and portal hypertension
Zhang Wei, ZhuGe YuZheng, Zhang Ming, He QiBin, Zhang Feng, Wang Yi, Zou XiaoPing
2016, 32(2): 259-263. DOI: 10.3969/j.issn.1001-5256.2016.02.012
Abstract:

Objective To investigate the short- term effect and safety of transjugular intrahepatic portosystemic shunt( TIPS) in the treatment of decompensated primary biliary cirrhosis( PBC). Methods The clinical data of 26 patients with decompensated PBC who received TIPS in Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2009 to May 2015 were analyzed retrospectively.The indicators including portal venous pressure,liver function,and survival before and after TIPS during 1 year of follow up were compared.The Friedman test was applied as the rank sum test for multiple related samples,the Wilcoxon test was applied as the paired rank sum test,and the Kaplan- Meier curve was applied for survival analysis. Results All patients had significantly reduced mean portal pressure after TIPS( 1911( 16. 35- 22. 05) mm Hg vs 27. 93( 25. 26- 30. 87) mm Hg; Z =- 4. 199,P < 0. 001). Within 3 months after TIPS,the patients showed significant increases in total bilirubin,Model for End- Stage Liver Disease score,and bile acid( χ2= 26. 000,18. 429,and16. 353,all P < 0. 001). The most common postoperative complication was pyrexia,which had an incidence rate of 80. 77%( 21 /26),followed by hepatic encephalopathy,with an incidence rate of 19. 23%( 7 /26). The survival rates at 6 and 12 months after surgery were both92. 3%( 24 /26). Conclusions TIPS has good short- to medium- term effect and safety in the treatment of decompensated PBC,and its long- term effect still needs to be proved.

Comparative clinical analysis of three surgical methods in patients with cirrhotic portal hypertension complicated by upper gastrointestinal bleeding
Wen JianSheng, Yue Kun, Wu ZhiQun, Lu HongJuan
2016, 32(2): 264-268. DOI: 10.3969/j.issn.1001-5256.2016.02.013
Abstract:

Objective To compare the effects of transjugular intrahepatic portosystemic shunt( TIPS),percutaneous transhepatic variceal embolization( PTVE),and TIPS combined with gastric coronary vein embolization( GCVE) in patients with cirrhotic portal hypertension complicated by upper gastrointestinal bleeding. Methods A total of 167 patients with cirrhotic portal hypertension complicated by upper gastrointestinal bleeding who underwent surgical treatment in Tongchuan Mining Bureau Central Hospital from January 2012 to October 2014 were analyzed retrospectively and divided into TIPS group( 56 patients),PTVE group( 53 patients),and TIPS- GCVE group( 58 patients) according to the difference in surgical method. The time of operation,time to postoperative recovery,hospital costs,postoperative improvement in gastrointestinal varices,incidence of rebleeding,incidence of hepatic encephalopathy,ascites elimination rate,indices related to the portal vein( diameter of the portal vein,portal vein velocity,portal venous pressure),and liver function parameters( ALT,AST,TBil,and Alb) were compared between the three groups. Comparison of continuous data between these groups was made by analysis of variance,and pairwise comparison was made by SNK- q test; comparison of categorical data between these groups was made by chis- quare test.Results There were significant differences in the time of operation,hospital costs,incidence of postoperative rebleeding,and incidence of postoperative hepatic encephalopathy between the three groups( F = 13. 85 and 12. 53,respectively,χ2= 7. 132 and 6. 368,respectively,all P < 0. 05). The hospital costs showed a significant difference between the TIPS group and the PTVE group( q = 2. 84,P < 0. 05); there were significant differences in the time of operation,hospital costs,incidence of postoperative rebleeding,and incidence of postoperative hepatic encephalopathy between the TIPS group and the TIPS- GCVE group( q = 3. 99 and 2. 58,respectively,χ2= 7. 396 and 6. 183,respectively,all P < 0. 05); there were significant differences in the time of operation,hospital costs,incidence of postoperative rebleeding,and incidence of postoperative hepatic encephalopathy between the PTVE group and the TIPS- GCVE group( q = 4. 53 and 3. 99,respectively,χ2=7. 534 and 5. 461,respectively,all P < 0. 05). Conclusion Although TIPS- GCVE has longer time of operation and higher hospital costs than TIPS and PTVE,it can significantly reduce the incidence of postoperative rebleeding and hepatic encephalopathy.

Association between serum ascites albumin gradient and esophagogastric variceal bleeding in patients with liver cirrhosis: a Meta-analysis
Zhang Hui, Xu YouQing
2016, 32(2): 269-274. DOI: 10.3969/j.issn.1001-5256.2016.02.014
Abstract:

Objective To investigate the association between serum ascites albumin gradient( SAAG) and esophagogastric variceal bleeding in patients with liver cirrhosis. Methods The databases Pub Med,Embase,the Cochrane Library,Wanfang Data,VIP,and CNKI were searched to obtain Chinese articles on SAAG and esophagogastric variceal bleeding in patients with liver cirrhosis published between January 2001 and June 2015,and each article should include a bleeding group and a non- bleeding group. Strengthening the reporting of observational studies in epidemiology( STROBE) was used as a reference to evaluate the quality of articles. The mean ± standard deviation( SD) of SAAG in bleeding groups and non- bleeding groups were pooled and analyzed. The Meta- Analyst software was used to calculate standardized mean differences( SMD) of SAAG between bleeding groups and non- bleeding groups and perform the meta- analysis. The chi- square test was applied for comparison of categorical data between groups. Results Thirteen articles met the inclusion criteria. SAAG was( 22. 54 ± 4. 69) g / L in bleeding groups and( 15. 91 ± 4. 20) g / L in non- bleeding groups. The test for heterogeneity showed significant heterogeneity( Q = 100. 735,I2=89. 065,P < 0. 001),and the bleeding groups had a significantly higher SAAG than the non- bleeding groups( SMD = 1. 970,95% CI: 1. 425- 2. 515,P < 0. 001). According to the SAAG level,the patients were divided into the group with a SAAG of < 15 g / L,the group with a SAAG of ≥15 g / L and ≤19. 9 g / L,and the group with a SAAG of ≥20 g / L,and with the increasing SAAG,the proportion of patients experiencing variceal bleeding increased significantly( χ2= 111. 702,P < 0. 001). Conclusions SAAG is closely associated with esophagogastric variceal bleeding in patients with liver cirrhosis,and the bleeding groups have a higher SAAG than the non- bleeding groups. SAAG may be applied as a valuable indicator to predict esophagogastric variceal bleeding in patients with liver cirrhosis.

Clinical manifestations of portal vein thrombosis and related risk factors in patients with liver cirrhosis
Zhou RenHua, Li Peng, Zhang YanTing, Yang Hua, Yang ShaoQi
2016, 32(2): 275-278. DOI: 10.3969/j.issn.1001-5256.2016.02.015
Abstract:

Objective To investigate the clinical manifestations of portal vein thrombosis( PVT) and related risk factors in patients with liver cirrhosis. Methods A total of 541 patients with liver cirrhosis who were admitted to the General Hospital of Ningxia Medical University from April 2008 to April 2015 were included in the study; 76 patients with PVT were enrolled in the study group,and another 76 patients without PVT matched for sex,age,and Child- Pugh class were enrolled in the control group. The clinical data and related indicators were analyzed and compared between the two groups. The t- test was applied for comparison of continuous data between groups,the chi- square test was applied for comparison of categorical data between groups,and the unconditional logistic regression model was used to determine the independent risk factors for PVT in liver cirrhosis. Results In the patients with liver cirrhosis and PVT,42. 1%( 32 /76) had an insidious onset and 57. 9%( 44 /76) had obvious clinical manifestations. Most patients had Child- Pugh class B and C cirrhosis. There were significant differences between the two groups in platelet count,blood glucose,percentage of neutrophils,severe esophageal and gastric varices,plasma D- dimer,portal vein width,and thickness of the spleen( all P < 0. 05). The unconditional logistic regression model analysis showed that percentage of neutrophils( OR = 1. 044,P = 0. 040),plasma D- dimer( OR = 0. 091,P = 0. 000),portal vein width( OR =0. 030,P = 0. 008),and thickness of the spleen( OR = 0. 427,P = 0. 003) were the influencing factors for PVT. Conclusion PVT may have an insidious onset in patients with liver cirrhosis,or have different clinical manifestations. Cirrhotic PVT usually occurs in patients with advanced liver cirrhosis,and plasma D- dimer,portal vein width,thickness of the spleen,and percentage of neutrophils are the independent influencing factors for PVT in patients with liver cirrhosis.

Original articles_Viral hepatitis
Effects of nucleos(t) ide analogues on estimated glomerular filtration rate and serum creatinine level in patients with chronic hepatitis B
Xu Yong, Feng JiHong
2016, 32(2): 279-283. DOI: 10.3969/j.issn.1001-5256.2016.02.016
Abstract:
Objective To investigate the effects of nucleos( t) ide analogues( NAs) on the estimated glomerular filtration rate( e GFR) and serum creatinine( Scr) in patients with chronic hepatitis B( CHB). Methods A total of 184 patients with CHB who visited and were hospitalized in the Second Affiliated Hospital of Dalian Medical University from September 2010 to September 2014 were enrolled and divided into adefovir( ADV) group( 58 patients),telbivudine( LDT) group( 62 patients),and entecavir( ETV) group( 64 patients),according to the NAs administered. The course of treatment was 104 weeks for all groups. The changes in e GFR and Scr level in each group after treatment were evaluated. The chi- square test was applied for comparison of categorical data between groups; the Wilcoxon rank sum test was applied for comparison of continuous data before and after treatment within one group,and Kruskal- Wallis H rank sum test was applied for comparison between groups. Results In the ETV group,there were no significant changes in Scr and e GFR after 52 and 104 weeks of treatment( all P > 0. 05); in the ADV group,there was a significant increase in Scr level and a significant reduction in e GFR after 52 and 104 weeks of treatment( Z =- 3. 020,- 3. 456,- 4. 623,and- 4. 831,P = 0. 018,0. 008,0. 004,and < 0. 001,respectively); in the LDT group,there was a significant reduction in Scr level and a significant increase in e GFR after 52 and 104 weeks of treatment( Z =-5. 596,- 5. 687,- 5. 335,and- 5. 162,P = 0. 007,0. 003,0. 002,and < 0. 001,respectively). After 104 weeks of treatment,the distribution of e GFR showed a significant difference between the ADV group and the LDT group( χ2= 21. 039,P < 0. 001); in the LDT group,77. 78%( 7 /9) of all the patients achieved e GFR ≥90 ml·min- 1·1. 73 m- 2,and in the ADV group,23. 81%( 10 /42) of all the patients achieved e GFR < 90 ml·min- 1·1.73 m- 2. Conclusion During the treatment,LDT can increase e GFR and improve renal function significantly,while ADV may reduce e GFR,with potential nephrotoxicity. During the treatment for patients with CHB,e GFR may reflect renal injury much earlier than Scr. The mechanisms of action of LDT in increasing e GFR and protecting renal function await further investigation.
Original articles_Liver fibrosis and liver cirrhosis
Effect of somatostatin combined with pantoprazole in treatment of liver cirrhosis with upper gastrointestinal hemorrhage
Gao ChengGuang, Xie Feng, Feng YaDong
2016, 32(2): 284-287. DOI: 10.3969/j.issn.1001-5256.2016.02.017
Abstract:
Objective To investigate the effect of somatostatin( SS) combined with pantoprazole in the treatment of liver cirrhosis with upper gastrointestinal hemorrhage( UGIH). Methods A total of 70 patients with liver cirrhosis and UGIH who were admitted to Jiangyan Hospital of Traditional Chinese Medicine from January 2011 to August 2015 were enrolled and randomized into combination group and control group,with 35 patients in each group. After admission,the patients in both groups were given conventional basic treatment; the patients in the combination group were given SS combined with pantoprazole,and those in the control group were given SS alone. The treatment outcome,time to hemostasis,volume of blood transfusion,48- hour rebleeding rate,length of hospital stay,and adverse events before and after treatment were observed and compared between the two groups. The t- test was applied for comparison of continuous data between groups,the chi- square test was applied for comparison of categorical data between groups,and the Wilcoxon rank sun test was applied for comparison of ranked data between groups. Results The combination group had a significantly better treatment outcome compared with the control group,with overall response rates of 94. 3% and 62. 9%,respectively( χ2= 10. 27,P < 0. 05); the marked response rate was60. 0% in the combination group and 34. 3% in the control group,and showed no significant difference between the two groups( χ2= 2. 80,P > 0. 05); the combination group had a significantly shorter time to hemostasis,a significantly lower volume of blood transfusion,and a significantly shorter length of hospital stay compared with the control group( t = 9. 036,6. 419,and 4. 186,all P < 0. 05); the combination group had a lower 48- hour rebleeding rate than the control group,but the 48- hour rebleeding rate showed no significant difference between the two groups( χ2= 0. 22,P > 0. 05); the incidence rate of adverse events was similar between the two groups and showed no significant difference( χ2= 0. 16,P > 0. 05),and the adverse events in both groups were mild. Conclusion SS combined with pantoprazole has better efficacy than SS alone in the treatment of liver cirrhosis with UGIH. Patients treated with SS combined with pantoprazole have a short time to hemostasis,a low volume of blood transfusion,a low rebleeding rate,and a short length of hospital stay,with no serious adverse events during treatment. The combination therapy is an effective treatment of liver cirrhosis with UGIH.
Risk factors for antibiotic prophylaxis failure in patients with liver cirrhosis and upper gastrointestinal bleeding
Li XiaoLou, Chen MingSheng, Gan QiaoRong, Jiang XiaoYan, Chen Li
2016, 32(2): 288-291. DOI: 10.3969/j.issn.1001-5256.2016.02.018
Abstract:
Objective To investigate the risk factors for antibiotic prophylaxis failure in patients with liver cirrhosis and upper gastrointestinal bleeding. Methods Eighty- two patients with liver cirrhosis and upper gastrointestinal bleeding who were admitted to our hospital from January 2011 to June 2014 were analyzed retrospectively. All patients received third- generation cephalosporins as the antibiotic prophylaxis for 7 days. The therapeutic effect of prophylaxis within two weeks was analyzed,and the clinical features were compared between prophylaxis response group and non- response group. The t- test or Mann- Whitney U test was applied for comparison of continuous data between groups,the chi- square test was applied for comparison of categorical data between groups,and the logistic regression analysis was applied to determine the risk factors for antibiotic prophylaxis failure. Results A total of 38 patients( 46. 4%) developed secondary infection.There were significant differences in prothrombin time,proportion of patients admitted to the intensive care unit( ICU),duration of ICU stay,proportion of patients who received deep venipuncture,Child- Pugh classification,and Child- Pugh score between the prophylaxis response group and non- response group( P < 0. 05). Child- Pugh classification( OR = 2. 455,95% CI: 1. 01- 5. 97,P = 0. 048) and admission to the ICU( OR = 4. 12,95% CI: 1. 32- 12. 83,P = 0. 015) were the independent risk factors for antibiotic prophylaxis failure.Conclusion Antibiotic prophylaxis with third- generation cephalosporins has a high failure rate,and admission to the ICU and a high Child- Pugh classification are the independent risk factors for antibiotic prophylaxis failure.
Efficacy of entecavir combined with alprostadil in treatment of hepatitis B-related cirrhotic ascites
Li HuiLi, Lu XueFeng, Li Na
2016, 32(2): 292-295. DOI: 10.3969/j.issn.1001-5256.2016.02.019
Abstract:
Objective To investigate the efficacy of entecavir combined with alprostadil in the treatment of hepatitis B- related cirrhotic ascites. Methods A total of 100 patients with hepatitis B- related cirrhotic ascites who were admitted to Dezhou Hospital of Traditional Chinese Medicine from May 2012 to February 2014 were selected and randomly divided into treatment group and control group,with 50 patients in each group. The patients in both groups received the liver- protecting treatment,diuretic treatment,and intermittent supplementation of albumin( Alb). Additionally,the patients in the treatment group received oral entecavir 0. 5 mg once a day,combined with intravenous infusion of alprostadil 20 μg + 5% glucose injection 100 ml once a day,and those in the observation group only received oral entecavir 0. 5 mg once a day. The patients were hospitalized and treated for 4 weeks. Ascites regression,changes in the levels of alanine aminotransferase( ALT),total bilirubin( TBil),Alb,blood urea nitrogen( BUN),creatinine( Cr),and hepatitis B virus( HBV) DNA,and prothrombin activity( PTA) were observed in both groups. After discharge,the patients in both groups continued to take oral entecavir 0. 5 mg once a day,and the long- term therapeutic effect was observed through follow- up for 3 months. The t- test was applied for comparison of continuous data between groups,and the chi- square test was applied for comparison of categorical data between groups. Results The patients in both groups had varying degrees of reduction in the amount of ascites after treatment,and the treatment group had a significantly higher overall response rate than the control group( χ2= 6. 018,P < 0. 05). The patients in both groups had varying degrees of improvement in each index of liver and renal function( ALT,TBil,Alb,BUN,and Cr) and PTA after treatment; the treatment group had a better treatment outcome than the control group,and there were significant differences in each index after treatment between the treatment group and the control group( t = 7. 567,6. 875,- 4. 782,6. 786,8. 542,and 8. 976,all P < 0. 01). The patients in both groups had varying degrees of reduction in HBV DNA level after treatment( t = 8. 976 and 5. 758,both P < 0. 01),but HBV DNA level showed no significant difference between the two groups after treatment( P > 0. 05). The patients were followed up for 3 months after discharge,and the treatment group had a better treatment outcome than the control group in terms of stabilization of liver and renal function and recurrence of ascites. Conclusion Entecavir combined with alprostadil has a good therapeutic effect in hepatitis B- related cirrhotic ascites,as well as a good long- term effect,and is worthy of clinical application. Entecavir monotherapy does not improve renal function significantly,but can improve liver function significantly.
Clinical features of male patients with alcoholic liver cirrhosis or hepatitis B cirrhosis complicated by abnormal glucose metabolism
Zhang WenJie, Chen QiDan, Wan Yu, Deng Hui
2016, 32(2): 296-300. DOI: 10.3969/j.issn.1001-5256.2016.02.020
Abstract:
Objective To investigate the clinical features of male patients with alcoholic liver cirrhosis( ALC) or hepatitis B cirrhosis( HBC) complicated by abnormal glucose metabolism. Methods A total of 287 patients with liver cirrhosis who were admitted to Guangzhou Panyu Central Hospital from January 2008 to September 2013 were selected. Among these patients,74 had ALC and were all male,including 54 with abnormal glucose metabolism; the other 213 had HBC,including 97 with abnormal glucose metabolism( 69 male patients and28 female patients). A controlled study was performed for the clinical data of ALC and HBC patients with abnormal glucose metabolism,to investigate the association of patients' clinical manifestations with the indices for laboratory examination,insulin resistance index,incidence rate of abnormal glucose metabolism,and Child- Pugh class. The t- test was applied for comparison of continuous data between groups,the chi- square test was applied for comparison of categorical data between groups,and the Spearman rank correlation was applied for correlation analysis. Results Compared with HBC patients,ALC patients had significantly higher incidence rates of abnormal glucose metabolism( 73. 0% vs 32. 4%),hepatogenous diabetes( 35. 1% vs 14. 6%),fasting hypoglycemia( 27. 0% vs 10. 3%),and impaired glucose tolerance( 31. 1% vs 14. 1%)( χ2= 4. 371,3. 274,4. 784,and 1. 633,all P < 0. 05). The Spearman correlation analysis showed that in ALC and HBC patients,the incidence rate of abnormal glucose metabolism was positively correlated with Child- Pugh class( rs= 0. 41,P <0. 05). Compared with the HBC patients with abnormal glucose metabolism,the ALC patients with abnormal glucose metabolism had a significantly higher incidence rate of Child- Pugh class A( χ2= 7. 520,P = 0. 001),and a significantly lower incidence rate of Child- Pugh class C( χ2= 6. 542,P = 0. 003). There were significant differences in the incidence rates of dim complexion,telangiectasia of the face,spider angioma,hepatomegaly,hepatorenal syndrome,malnutrition,ascites,jaundice,hepatic encephalopathy,spontaneous bacterial peritonitis,and upper gastrointestinal bleeding between the ALC and HBC patients with abnormal glucose metabolism( χ2= 3. 785,2. 651,1. 974,3. 316,3. 771,5. 843,7. 251,5. 214,5. 778,2. 966,and 6. 312,all P < 0. 05). Compared with the HBC patients with abnormal glucose metabolism,the ALC patients with abnormal glucose metabolism had significantly higher levels of aspartate aminotransferase and total bilirubin,a significantly greater mean corpuscular volume,a significantly higher level of gamma- glutamyl transpeptidase,and a significantly lower level of albumin( t = 4. 775,7. 887,5. 143,6. 124,and 5. 210,all P < 0. 05). There were significant differences in the fasting blood glucose level,insulin level 2 hours after meal,and insulin resistance index between the ALC and HBC patients with abnormal glucose metabolism( t = 2. 770,6. 331,and 3. 770,all P < 0. 05). Conclusion The male patients with ALC or HBC gradually develop abnormal glucose metabolism with the deterioration of liver function,with individual etiology and features of liver cirrhosis,and the manifestations of abnormal glucose metabolism are not obvious. Related examinations should be performed for these male patients with liver cirrhosis of various causes,to confirm the existence of abnormal glucose metabolism.
Short-term efficacy of splenectomy versus partial splenic embolization for liver cirrhosis and hypersplenism: a Meta-analysis
He HaiGuan, Shen YiNan, Pang ShuJie, Yang Tian, Lu JunHua
2016, 32(2): 301-306. DOI: 10.3969/j.issn.1001-5256.2016.02.021
Abstract:
Objective To systematically evaluate the therapeutic effects of partial splenic embolization( PSE) and splenectomy for liver cirrhosis and hypersplenism. Methods The Medline,Embase,Web of Science,CNKI,Wanfang Data,and VIP were searched to collect the articles on PSE and splenectomy for liver cirrhosis and hypersplenism published between January 1,2005 and May 30,2015. The inclusion of articles was performed by two investigators independently,and after quality assessment and data extraction,Rev Man 5. 3 was applied for the Meta- analysis. Results A total of 10 control studies involving 638 patients were included. The results of the pooled analysis of 4 studies showed that the peripheral platelet counthad a significant difference between the PSE group and the splenectomy group at 1 week after surgery( WMD =- 65. 71,95% CI:- 120. 24 to- 11. 18,P = 0. 02),but showed no significant difference at 1 month after surgery( WMD =0. 68,95% CI:- 8. 16- 9. 52,P = 0. 88). The results of the pooled analysis of 2 studies showed that at 1 month after surgery,the PSE group had a significantly higher number of natural killer cells than the splenectomy group( WMD = 6. 03,95% CI: 3. 80- 8. 26,P < 0. 001),but there was no difference in this number at 1 year after surgery between the two groups( WMD = 3. 60,95% CI: 1. 25- 5. 96,P = 0. 003).The results of the pooled analysis of 3 studies showed that the PSE group had a significantly shorter hospital stay than the splenectomy group( WMD =-2. 52,95% CI:-3. 36 to-1. 67,P <0. 001). Conclusion Compared with the splenectomy group,the short- term increase in platelet count after surgery is alleviated in the PSE group,while there is no significant difference in long- term platelet count; PSE has significant advantages in maintaining the reserve function of immune system,shortening the length of hospital stay,and reducing complications in postoperative patients.
Effect of adiponectin on hepatic stellate cell contraction induced by endothelin-1 and its mechanism of action
Li Nan, Liu YingDi, Guo MingZhou, Liang Hao
2016, 32(2): 307-311. DOI: 10.3969/j.issn.1001-5256.2016.02.022
Abstract:
Objective To observe the effect of exogenous adiponectin on hepatic stellate cell( HSC) contraction induced by endothelin- 1( ET- 1),and to investigate the possible mechanism of action of adiponectin in this process. Methods Collagen lattice was applied to observe the effects of adiponectin( 0. 25,0. 5 μg / ml) alone and adiponectin( 0. 5 μg / ml) combined with nitro- L- arginine methyl ester( L- NAME) on the contraction of HSC- T6 cells induced by ET- 1. Quantitative real- time PCR and Western blot were applied to measure the mRNA and protein expression levels of ET- 1 in HSC- T6 cells after the action of adiponectin( 0. 5 μg / ml),and enzyme- linked immunosorbent assay was applied to measure the protein expression level of ET- 1 in HSC- T6 cell culture medium after the action of adiponectin( 0. 5 μg / ml). Quantitative real- time PCR and Western blot were also applied to measure the mRNA and protein expression levels of inducible nitric oxide synthase( i NOS) in HSC- T6 cells after the combined action of adiponectin( 0. 25,0. 5 μg / ml) and ET- 1,as well as the protein expression levels of AMPK,p- AMPK,Akt,and p- Akt in HSC- T6 cells. Analysis of variance was applied for comparison of continuous data between groups and pairwise comparision between any two groups was made by Dunnett test. Results The collagen lattice experiments showed that compared with the blank control group,the ET- 1 group had a significantly reduced gel area [( 24. 8 ± 7. 3) % vs( 71. 9± 4. 1) %,P < 0. 01]; after the treatment with adiponectin( 0. 5 μg / ml),the contraction induced by ET- 1 was significantly inhibited in the ET- 1 group [( 52. 7 ± 20. 6) % vs( 24. 8 ± 7. 3) %,P < 0. 05]; L- NAME( 5 mmol / L) partially counteracted the inhibitory effect of adiponectin( P > 0. 05). Adiponectin( 0. 5 μg / ml) inhibited the mRNA and protein expression levels of ET- 1 in HSC- T6 cells( P < 0. 05)and the protein expression level of ET- 1 in cell supernatants; after L- NAME was added,the above inhibitory effect of adiponectin was partially reversed. The mRNA expression of i NOS was detected in HSC- T6 cells,and the mRNA expression level of i NOS was significantly reduced after ET- 1 was added( P < 0. 01); after addition of ET- 1 and adiponectin,the mRNA expression level of i NOS was significantly increased compared with the ET- 1 group,and tended to increase with the increasing concentration of adiponectin; the protein expression level of i NOS had a similar trend. At 24 hours after ET- 1 treatment,the expression level of p- AMPK in HSC- T6 cells decreased significantly,and after adiponectin was added,the expression level of p- AMPK increased significantly with the increasing concentration of adiponectin; at 24 hours after ET- 1 treatment,the expression level of p- Akt in HSC- T6 cells increased significantly,and after adiponectin was added,the expression level of p- Akt decreased gradually with the reduction in the concentration of adiponectin. Conclusion Adiponectin can inhibit the HSC contraction induced by ET- 1,and its mechanism of action is to activate AMPK,increase the synthesis of nitric oxide,reduce the synthesis and secretion of ET- 1,and block the Akt signaling pathway. The inhibitory effect of adiponectin on HSC contraction may be one of its anti- fibrosis mechanisms.
Original articles_Liver neoplasms
Accuracy of Fibro Scan for diagnosis of primary liver cancer: a Meta-analysis
Li Mi, Nie QingHe
2016, 32(2): 312-316. DOI: 10.3969/j.issn.1001-5256.2016.02.023
Abstract:
Objective To investigate the accuracy of liver stiffness( LS) measured by Fibro Scan in the diagnosis of primary liver cancer through a meta- analysis. Methods The databases of Pub Med,Embase,CBM,CMCI,VIP,and CNKI were searched,and a manual search was performed for related journals,to collect the articles on LS measured by Fibro Scan in the diagnosis of primary liver cancer published from January 2003 to June 2015. QUADAS was applied for quality evaluation and data extraction,and Meta Disc 1. 4 software was applied for the Meta- analysis. Results A total of 6 English articles which met the inclusion criteria were included. The tests for heterogeneity showed no threshold effect,but the presence of heterogeneity caused by other reasons. In the articles included,the cut- off value for LS in the diagnosis of primary liver cancer was 11- 53. 7 k Pa,and the pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio,with their respective 95% confidence intervals,were 0. 66( 0. 61- 0. 71),0. 78( 0. 76- 0. 79),3. 19( 2. 39- 4. 25),0. 45( 0. 30- 0. 66),and 8. 63( 4. 34- 17. 18),respectively. The area under the summary receiver operating characteristic curve was 0. 8268,and the Q index was 0. 7597. Conclusion LS measured by Fibro Scan has good accuracy in the diagnosis of primary liver cancer,and holds promise for clinical application.
Effects of two methods for hepatic vascular occlusion in resection of giant hepatic hemangioma
Zhang HuaAn, Zhou XiaoFang
2016, 32(2): 317-319. DOI: 10.3969/j.issn.1001-5256.2016.02.024
Abstract:
Objective To evaluate the clinical effects of two methods for hepatic vascular occlusion in resection of giant hepatic hemangioma. Methods A total of 20 patients with giant hepatic hemangioma who were hospitalized in Tianmen Hospital of Traditional Chinese Medicine from January 2008 to December 2014 were divided into group A and group B,with 10 patients in each group. Pringle maneuver was applied for group A,and Pringle maneuver combined with inferior vena cava( IVC) clamping was applied for group B. The time of operation,time of portal triad clamping,intraoperative blood loss,blood transfusion rate,and indices for postoperative liver function were compared between the two groups. The t- test was applied for comparison of continuous data,and Fisher's exact test was applied for comparison of categorical data. Results The two groups showed no significant differences in time of operation and time of portal triad clamping( P > 0. 05),and compared with those in group A,the patients in group B had significantly less intraoperative blood loss and significantly lower volume and rate of blood transfusion( P < 0. 05). Compared with those in group A,the patients in group B had significantly lower levels of aspartate transaminase,alanine transaminase,and total bilirubin on the third and seventh days after surgery( all P < 0. 05). However,the incidence of postoperative complications showed no significant differences between the two groups( P > 0. 05). Conclusion The method of IVC clamping combined with Pringle maneuver can reduce intraoperative blood loss and is beneficial to the recovery of postoperative liver function,and thus it is worthy of clinical promotion and application.
Original articles_Pancreatic diseases
Effect of continuous blood purification in treatment of patients with severe acute pancreatitis and multiple organ dysfunction syndrome
Zhang Yong, Zeng WeiZheng, Wang YunXia, Weng Min, Zheng ShuMei, Jiang MingDe
2016, 32(2): 320-323. DOI: 10.3969/j.issn.1001-5256.2016.02.025
Abstract:

Objective To observe the effect of continuous blood purification( CBP) on serum inflammatory mediators in patients with severe acute pancreatitis( SAP) and multiple organ dysfunction syndrome( MODS). Methods Sixty- five SAP patients with MODS who were treated in General Hospital of Chengdu Command Area of Chinese PLA from April 2008 to December 2013 were enrolled and divided into two groups. The 33 patients in the control group received comprehensive internal medicine treatment,and the 32 patients in the treatment group received comprehensive internal medicine treatment and CBP. Changes in APACHE II score,MODS score,and the serum levels of tumor necrosis factor α( TNFα),C- reactive protein( CRP),interleukin 6( IL- 6),IL- 18,platelet- activating factor( PAF),and nitric oxide( NO) after treatment were observed. Independent- samples t test was applied for comparison of continuous data between the two groups,and paired t test was applied for before- after comparison within the same group; chi- squared test was applied for comparison of categorical data between the two groups. Results In both groups,APACHE II score,MODS score,and the serum levels of TNFα,CRP,IL- 6,IL- 18,PAF,and NO decreased significantly after treatment( all P < 0. 05),and the treatment group had significantly greater decreases in these values than the control group( all P < 0. 001); the survival rates in the treatment group and the control group were 90. 6%( 29 /32)and 78. 8%( 26 /33),respectively,with no significant difference between the two groups( χ2= 1. 749,P = 0. 186). Conclusion In SAP patients with MODS,CBP can effectively clear the serum inflammatory mediators to block systemic inflammatory response and improve organ function,and,therefore,it is an effective method to treat SAP.

Diagnostic value of serum lipase combined with Ranson or BISAP scoring system in assessment of severity of acute pancreatitis
Chen DongLai, Liao ZhenHai, Lin ShunQuan
2016, 32(2): 324-328. DOI: 10.3969/j.issn.1001-5256.2016.02.026
Abstract:
Objective To investigate the diagnostic value of serum lipase combined with the Ranson or BISAP scoring system in the assessment of severity of acute pancreatitis. Methods A total of 314 patients with acute pancreatitis who were admitted to The Second People' s Hospital of Huidong County from February 2012 to February 2015 were selected and divided into mild acute acute pancreatitis( MAP) group( 202 patients) and severe acute pancreatitis( SAP) group( 112 patients). Serum lipase determination,Ranson scoring,BISAP scoring,serum lipase determination combined with Ranson scoring,and serum lipase determination combined with BISAP scoring were performed for all the patients. The t- test was applied for comparison of continuous data between groups,the chi- square test was applied for comparison of categorical data between groups,and the Z test was applied for the comparison of area under the receiver operating characteristic curve( AUC) and Youden index between different methods. Results The patients with SAP had significantly higher serum lipase level,Ranson score,and BISAP score than those with MAP( t = 14. 89,11. 89,and 5. 12,P = 0. 003,0. 007,and 0. 037). As for the AUCs for the prediction of organ failure,pancreatic necrosis,and death,serum lipase determination combined with the BISAP scoring system had significantly higher AUCs than the BISAP scoring system( Z = 7. 54,7. 11,and 7. 57,P = 0. 033,0. 031,and 0. 030),serum lipase determination combined with the Ranson scoring system had significantly higher AUCs than the Ranson scoring system( Z = 5. 23,5. 78,and 6. 18,P =0. 037,0. 034,and 0. 032),and serum lipase determination combined with the BISAP scoring system had significantly higher AUCs than serum lipase determination combined with the Ranson scoring system( Z = 13. 55,8. 33,and 7. 66,P = 0. 005,0. 029,and 0. 031). As for Youden index for the prediction of organ failure,pancreatic necrosis,and death,serum lipase determination combined with the Ranson scoring system had a significantly higher Youden index than the Ranson scoring system( Z = 5. 17,6. 89,and 7. 35,P = 0. 038,0. 032,and 0. 027),serum lipase determination combined with the BISAP scoring system had a significantly higher Youden index than the BISAP scoring system( Z = 7. 54,7. 22,and 9. 57,P = 0. 030,0. 031,and 0. 025),and serum lipase determination combined with the BISAP scoring system had a significantly higher Youden index than serum lipase determination combined with the Ranson scoring system( Z =10. 11,10. 23,and 13. 24,P = 0. 020,0. 019,and 0. 010). Conclusion Compared with the Ranson scoring system or BISAP scoring system alone,serum lipase determination combined with the Ranson or BISAP scoring system is more accurate in the assessment of severity of acute pancreatitis,and serum lipase determination combined with the BISAP scoring system has a higher sensitivity and a greater diagnostic value in clinical practice.
Changes in serum levels of M30,M65,and IL-17 and their clinical significance in patients with acute pancreatitis
Hao TingTing, Ma XiaoPeng, Wen YanLi, Dai GuangRong, Feng YiChao, Zhang Li
2016, 32(2): 329-332. DOI: 10.3969/j.issn.1001-5256.2016.02.027
Abstract:
Objective To investigate the changes in serum levels of M30,M65,and interleukin- 17( IL- 17) and their clinical significance in patients with acute pancreatitis. Methods A total of 126 patients with acute pancreatitis who were admitted to our hospital from December 2009 to December 2013 were selected,and according to clinical diagnosis,they were divided into mild acute pancreatitis group( 82 patients) and severe acute pancreatitis group( 44 patients). A total of 107 healthy subjects who underwent physical examination during the same period of time were enrolled as the control group. On days 1,2,and 4,the serum levels of M30,M65,and IL- 17 were measured,and M30 / M65 ratio was calculated. Comparison of coutinous data between multiple groups was made by ANOVA and pairwise comparison between any two groups was made by SNK- q test,comparison between two groups was made by independent- sample t test,while comparison of categorical data by chisquare test. Results On days 1,2,and 4,the severe acute pancreatitis group and mild acute pancreatitis group had significantly higher serum levels of M30,M65,and IL- 17( P < 0. 05),and a significantly lower M30 / M65 ratio( P <0. 001),as compared with the healthy controls. On days 1,2,and 4,the severe acute pancreatitis group had significantly higher serum levels of M30 and M65 than the mild acute pancreatitis group( P < 0. 001); on day 1,the severe acute pancreatitis group had a significantly lower M30 / M65 ratio than the mild acute pancreatitis group( P < 0. 001); the serum level of IL- 17 showed no significant difference between the two groups( P > 0. 05). M65 and IL- 17 had high sensitivity and specificity in the diagnosis of acute pancreatitis. Conclusion The serum levels of M65 and IL- 17 and M30 / M65 ratio at 24 hours after the attack of acute pancreatitis can be used as the serological biomarkers for early evaluation of the severity of acute pancreatitis.
Effect of Blumgart anastomosis in prevention and treatment of pancreatic fistula after pancreaticoduodenectomy
Pan Chao, Xi PengCheng, Shi ZuoLiang, Bian JianMin, Yang KunXing, Liu ZiJun, Ni ShaoZhong, Yang ShiYong, Shi KaiWang
2016, 32(2): 333-336. DOI: 10.3969/j.issn.1001-5256.2016.02.028
Abstract:
Objective To investigate the effect of Blumgart anastomosis( BA) on pancreatic fistula( PF) and other complications after pancreaticoduodenectomy. Methods The clinical data of 190 patients who underwent pancreaticoduodenectomy in our hospital from January2005 to December 2011 were analyzed retrospectively. The patients were divided into three groups,with 55 patients in the BA group,65 patients in the duct- to- mucosa anastomosis group,and 70 patients in the invaginated pancreaticojejunostomy group. The incidence rates of PF and other complications after different methods of anastomosis were compared. The chi- square test was applied for comparison of the incidence of complications between groups. Results No deaths occurred during surgery. The incidence rate of postoperative complications was48. 4%( 92 /190),and that of PF was 20. 5%( 39 /190),with 5. 5%( 3 /55) in the BA group,20%( 13 /65) in the duct- to- mucosa anastomosis group,and 32. 9%( 23 /70) in the invaginated pancreaticojejunostomy group. In the pancreatic duct with a diameter of < 3mm,the incidence rate of PF showed a significant difference between the three groups( χ2= 6. 089,P < 0. 05),while in the pancreatic duct with a diameter of ≥3 mm,there was no significant difference in PF between the three groups( χ2= 5. 436,P < 0. 05). Conclusion BA is a safe,simple,and time- saving technique and can reduce the incidence of PF,which is worthy of clinical application.
Expression and roles of poly(ADP-ribose) polymerase-1 and caspase-3 in pancreatic cancer and adjacent tissues
Pu Jing, Li Xun, Zhu Jun, Bai ZhongTian, Yan Jun
2016, 32(2): 337-341. DOI: 10.3969/j.issn.1001-5256.2016.02.029
Abstract:
Objective To investigate the protein expression of poly( ADP- ribose) polymerase- 1( PARP- 1) and caspase- 3 in pancreatic cancer and adjacent tissues. Methods A total of 66 cancer tissue samples and 113 samples of adjacent tissues were collected from the patients who underwent surgical treatment with a confirmed diagnosis of pancreatic cancer by postoperative pathological examinations in The First Hospital of Lanzhou University from January 2013 to June 2014,and immunohistochemical examinations were performed to measure the expression of PARP- 1 and caspase- 3 in these samples. The chi- square test was applied for comparison of categorical data between groups. Results Of all the 66 samples of pancreatic cancer,53 had varying degrees of PARP- 1 expression,with a positive rate of80. 3%; of all the 133 samples of adjacent tissues,39 had PARP- 1 expression,with a positive rate of 34. 5%; the expression of PARP-1 in the samples of pancreatic cancer was significantly higher than that in the samples of adjacent tissues( χ2= 34. 79,P < 0. 01). The expression of PARP- 1 in moderately and poorly differentiated samples of pancreatic cancer( 18 /25,72%; 10 /14,71. 4%) was significantly higher than that in highly differentiated samples( 3 /14,21. 4%)( χ2= 10. 76,P < 0. 01). Of all the 66 samples of pancreatic cancer,47 had varying degrees of caspase- 3 expression,with a positive rate of 71. 2%; of all the 133 samples of adjacent tissues,71 had caspase-3 expression,with a positive rate of 62. 8%. The expression of caspase- 3 in highly differentiated samples of pancreatic cancer( 11 /18,61. 1%) was significantly higher than that in moderately and poorly differentiated samples( 4 /20,20%; 0 /9,0)( χ2= 11. 44,P < 0. 01).Conclusion The expression level of PARP- 1 in the samples of pancreatic cancer is significantly higher than that in the samples of adjacent tissues,and the strong positive rate of PARP- 1 increases with the decrease in the degree of differentiation; the expression of caspase- 3 is similar between pancreatic cancer and adjacent tissues,and the strong positive rate of caspase- 3 decreases with the decrease in the degree of differentiation. The expression levels of PARP- 1 and caspase- 3 may be related to the development and progression of pancreatic cancer.
Original articles_Others
Clinical effect of plasma exchange combined with hemofiltration in patients with subacute liver failure induced by antitubercular agents
Hou HuanRong, Shang Jia, Kang Yi, Li YuKui, Ceng YanLi, Ding GangQiang, Mao ZhongShan, Xiao ErHui
2016, 32(2): 342-346. DOI: 10.3969/j.issn.1001-5256.2016.02.030
Abstract:

Objective To investigate the clinical effect of plasma exchange( PE) combined with hemofiltration( HF) in the treatment of subacute liver failure( SALF) induced by antitubercular agents. Methods A total of 58 patients with SALF induced by antitubercular agents who visited Henan Provincial People's Hospital from July 2009 to January 2015 were collected and divided into PE treatment group( 27patients) and PE- HF combined treatment group( 31 patients) according to different therapeutic methods. The changes in clinical symptoms and signs,liver function,renal function,electrolytes,and coagulation function after treatment were investigated and compared between the two groups,and the incidence of adverse events and 6- month survival rate were observed in both groups. The t- test was applied for comparison of continuous data between groups,and the chi- square test was applied for comparison of categorical data between groups. Results After treatment,both PE treatment group and PE- HF combined treatment group had significant reductions in the levels of ALT,AST,TBil,GGT,and ALP,as well as a significant increase in prothrombin activity( PTA)( t = 2. 871,2. 986,2. 905,2. 063,4. 028,- 2. 591,2. 940,2. 935,2. 940,2. 918,4. 981,and- 2. 933,all P < 0. 05); the PE- HF combined treatment group had significantly greater reductions in ALT,AST,TBil,GGT,and ALP and a significantly greater increase in PTA,as compared with the PE treatment group( t =- 2. 891,-2. 784,- 2. 194,- 3. 014,- 0. 294,and- 3. 907,all P < 0. 05). In the PE treatment group,the response rates to correct high urea( UREA),high creatinine( Cr),hypokalemia,hyponatremia,hypochloridemia,and hypocalcemia were 80. 00%,60. 00%,81. 82%,78. 57%,88. 89%,and 75. 00%,respectively; in the PE- HF combined treatment group,these response rates were 85. 71%,87. 50%,85. 71%,92. 31%,92. 31%,and 86. 67%,respectively; there were significant differences in these response rates between the two groups( χ2= 9. 603,11. 302,9. 543,13. 987,9. 493,and 9. 502,all P < 0. 05). The PE treatment group had an overall response rate of88. 89% and a mean hospital stay of 36. 36 days,while the PE- HF combined treatment group had an overall response rate of 96. 77% and a mean hospital stay of 26. 03 days; the incidence rates of adverse events in these two groups were 5. 06% and 7. 06%,respectively. Conclusion As for the treatment of SALF induced by antitubercular agents,compared with PE treatment alone,PE combined with HF can significantly relieve patients' clinical symptoms and signs,improve liver function,correct electrolyte disturbance,improve renal function,increase overall response rate,and reduce the mean hospital stay,and has a lower incidence rate of adverse events. Therefore,it is an effective and safe therapeutic method.

Case reports
Isolated duodenal variceal bleeding caused by liver cirrhosis: a report of one case
Liu LiLi, An Yang, Hu Yue, Hua Rui, Pan Yu, Niu JunQi
2016, 32(2): 347-348. DOI: 10.3969/j.issn.1001-5256.2016.02.031
Abstract:
Liver cirrhosis complicated by retroperitoneal variceal bleeding: a report of one case
Xiao Xue, Wang Jing, Liu Hui, Yan Yan
2016, 32(2): 349-350. DOI: 10.3969/j.issn.1001-5256.2016.02.032
Abstract:
Hepatic angioleiomyoma: a report of one case and literature review
Lai LongXiang, Su Juan, Hao FaTao, Liu ShanShan, Duan LiuXin, Liu QuanDa
2016, 32(2): 351-353. DOI: 10.3969/j.issn.1001-5256.2016.02.033
Abstract:
Reviews
Treatment and prevention strategies to complications of transjugular intrahepatic portosystemic shunt
Tuo Lin, Tang ShanHong, Zeng WeiZheng, Wu XiaoLing
2016, 32(2): 354-357. DOI: 10.3969/j.issn.1001-5256.2016.02.034
Abstract:

Transjugular intrahepatic portosystemic shunt( TIPS) can effectively reduce portal hypertension,prevent recurrent esophagogastric variceal bleeding,and relieve intractable ascites. TIPS involves vessel puncture,expansion of puncture tract within the liver parenchyma,and stent implantation,and may cause various complications. The effective prevention and treatment of TIPS- related complications have become a new direction for research in TIPS. This article reviews the intraoperative and postoperative complications of TIPS and related preventive and treatment strategies.

Research advances in portal hypertensive gastropathy
Huang Guan, Dai ShuLong, Yang KunXing, Wang XiaoPing
2016, 32(2): 358-360. DOI: 10.3969/j.issn.1001-5256.2016.02.035
Abstract:
Portal hypertensive gastropathy( PHG) is a disease caused by cirrhotic( or non- cirrhotic) portal hypertension,with a typical feature of snake- skin appearance of the gastric mucosa under endoscope. Many studies have shown that portal hypertension is a necessary condition for the development and progression of PHG. PHG is often complicated by acute or chronic upper gastrointestinal bleeding,which may be the direct reason for patients to visit the hospital. Therefore,the study of the diagnosis and treatment of PHG is very important in clinical practice. This article reviews the research advances in the pathogenesis,classification,diagnosis,and treatment of PHG.
Research advances in association between regulatory T cells and hepatitis B virus infection
He JunNan, Zhao ShouSong
2016, 32(2): 361-365. DOI: 10.3969/j.issn.1001-5256.2016.02.036
Abstract:
Regulatory T cells are a subset of T cells,and can inhibit the body's immune response and induce immune tolerance,which has become one of the hot topics in the field of immunological research in recent years. Regulatory T cell dysfunction and the change in the number of regulatory T cells are closely associated with the progression and treatment of autoimmune diseases,infectious diseases,tumor immune tolerance,transplant rejection,and allergic diseases. This article summarizes the surface markers and immunological mechanism of regulatory T cells,as well as the association of regulatory T cells with the pathogenesis of hepatitis B and antiviral therapy.
Research advances in hepatitis B virus-associated glomerulonephritis
An Shuang, Zhang Rui, Yang WenXuan, Zhou HongJie, Zhang ZeTian, Yang YiLiang, Guo XiaoLin
2016, 32(2): 366-369. DOI: 10.3969/j.issn.1001-5256.2016.02.037
Abstract:
Hepatitis B virus- associated glomerulonephritis( HBV- GN) is the most common extrahepatic injury induced by chronic hepatitis B virus( HBV) infection,which has been taken seriously by scholars in recent years. This article summarizes the research advances in related risk factors for HBV- GN,pathogenesis,and treatment. Since the diagnostic rate of HBV- GN is low and the sample size is small at present,there is still much space for research in this field. More clinical trials with good quality are needed in the future to investigate the therapeutic regimens for this disease.
Current studies of novel drugs against hepatitis B virus in clinical trials
Li Qiang, Huang YuXian, Chen Liang
2016, 32(2): 370-373. DOI: 10.3969/j.issn.1001-5256.2016.02.038
Abstract:
Chronic hepatitis B( CHB) is one of the major causes of liver cirrhosis and hepatocellular carcinoma. Interferon and nucleos( t)ide analogues can control disease progression. However,they cause very low HBs Ag clearance or seroconversion rates and relapse in most patients after treatment withdrawal. In recent years,the further understanding of the interaction between hepatitis B virus( HBV) and host gives birth to a large number of novel drugs that hold promise for successful cure of CHB. This paper reviews several novel drugs against HBV in phase Ⅰ,Ⅱ,or Ⅲ clinical trials,and points out that these novel drugs against HBV have preliminarily indicated a bright future.
Research advances in methods for determination of tumor boundary in hepatectomy
Wang JinWei, Zhang YaMin
2016, 32(2): 374-377. DOI: 10.3969/j.issn.1001-5256.2016.02.039
Abstract:
With the in- depth understanding of liver physiology,oncology,and anatomy,as well as the development of imaging technology and surgical equipment,hepatectomy has become more precise. Determination of tumor boundary during surgery has a great significance in realizing precise hepatectomy. Various methods for determination of tumor boundary during hepatectomy have been summarized and compared here,as well as their own advantages and disadvantages,with a focus on the detection methods which have not been widely used in clinical practice but have promising prospects,such as indocyanine green- mediated near- infrared light detection and navigation technique and near- infrared molecular imaging technique mediated by nano- molecular probes. Combined application of various examination techniques will become an inevitable trend of development in liver surgeries in the future.
Research advances in non-hormonal therapies for autoimmune hepatitis
Zhong QiHua, Zhou GuiQin, Wang XianBo, Wang XiaoJing, Wang RongBing, Sun FengXia
2016, 32(2): 378-381. DOI: 10.3969/j.issn.1001-5256.2016.02.040
Abstract:
Autoimmune hepatitis is a chronic progressive inflammatory disease of the liver,which is mediated by the abnormal autoimmune response. Immunosuppressive therapy is the major therapeutic method for this disease,and liver transplantation can be performed for patients in the advanced stage. At present,the internationally acknowledged standard therapeutic method is prednisone or prednisone combined with azathioprine. Most patients can achieve clinical remission,but the recurrence rate is high and some patients fail to respond to the treatment.This article briefly reviews the therapies except corticosteroid therapy and substitutive therapy after treatment failure,introduces the application of integrated traditional Chinese and Western medicine therapy for autoimmune hepatitis,and points out that non- hormonal therapies are the new directions for the treatment of autoimmune hepatitis,which still needs to be further investigated.
Research advances in the pathogenesis of drug-induced liver injury
Xu Xin, Ji LiSha, Lu LinLin, Chen LiLi, Xin YongNing, Xuan ShiYing
2016, 32(2): 382-385. DOI: 10.3969/j.issn.1001-5256.2016.02.041
Abstract:
In recent years,with an increasing number of drug types and unreasonable drug use,the incidence and mortality of drug- induced liver injury( DILI) have been increasing. The pathogenesis of DILI is complex,and may involve liver injury caused by the direct effect of drugs,immune- mediated liver injury,mitochondrial injury,and bile duct injury,etc. This article investigates the pathogenesis and its important role in the prevention and treatment of DILI,and reviews the research advances in the pathogenesis of DILI.
Advances in clinical research on liver disease during pregnancy
Liu MiaoMiao, Jia ShengNan, Zhang Qian, Xiao HeJun, Pan LiuLan
2016, 32(2): 386-389. DOI: 10.3969/j.issn.1001-5256.2016.02.042
Abstract:
Liver disease during pregnancy is substantially different from common liver diseases,and it is very important to raise the awareness of such disease and improve the diagnostic level. The literature on liver disease during pregnancy published in recent years is reviewed in this article,and the research advances in the pathogenesis,diagnosis,and treatment of liver disease during pregnancy are summarized.
Role of ADAMTS13 in diagnosis and pathogenesis of liver diseases
Xu ShanShan, Chen YaLi, Zhang Jing
2016, 32(2): 390-392. DOI: 10.3969/j.issn.1001-5256.2016.02.043
Abstract:
Recent studies have demonstrated that coagulation function and liver microcirculation disturbance are important in the development and progression of liver diseases. ADAMTS13,also known as von Willebrand factor- cleaving protease,is a metalloproteinase produced by hepatic stellate cells,with major functions to cleave the von Willebrand factor multimers produced by vascular endothelial cells,regulate the adhesive capacity of platelets,and influence the body' s coagulation function and microcirculation. The important role of ADAMTS13 in the pathophysiological processes of various severe liver diseases such as liver cirrhosis,severe alcoholic hepatitis,hepatic veno-occlusive disease after stem cell transplantation,and liver graft dysfunction is reviewed in this paper,and its association with the severity of liver diseases is clarified. Plasma ADAMTS13 is involved in the development and progression of various liver diseases,and measurement of its level and activity can help the diagnosis and differential diagnosis of liver diseases.
Research progress in association between interleukin-23 and liver diseases
Bao SuXia, Zheng JianMing, Shi GuangFeng
2016, 32(2): 393-396. DOI: 10.3969/j.issn.1001-5256.2016.02.044
Abstract:
Interleukin 23( IL- 23) is a recently discovered cytokine,and growing evidence suggests that IL- 23 plays an important role in the development and progression of autoimmune diseases and inflammatory diseases. In recent years,certain research advances in association between IL- 23 and liver diseases have been achieved at home and abroad. General features and biological characteristics of IL- 23 are described,and its role in the development and progression of diseases such as hepatitis B,hepatitis C,and hepatocellular carcinoma is reviewed here,so that clinicians will have a deeper understanding of the effect of IL- 23 in liver diseases and provide optimized therapies for patients with liver diseases.
The role of hepatocyte nuclear factor 4 alpha in development and progression of liver diseases
Yang JinLian, Wang Yan
2016, 32(2): 397-403. DOI: 10.3969/j.issn.1001-5256.2016.02.045
Abstract(1265) PDF (915KB)(399)
Abstract:
Hepatocyte nuclear factor 4 alpha( HNF4α),a member of the nuclear receptor superfamily,has a high expression level in mature hepatocytes. HNF4α can regulate hepatocyte- specific gene expression at a transcriptional level,promote hepatocyte development and differentiation,participate in establishment and maintenance of hepatocyte polarity,and enhance the synthetic,metabolic,and detoxifying functions of the liver. Through inhibiting the activation of hepatic stellate cells,reversing epithelial- mesenchymal transition,and inhibiting the proliferation,invasion,and metastasis of hepatoma cells,HNF4α may be involved in the development and progression of various liver diseases including liver fibrosis,liver cirrhosis,and hepatocellular carcinoma. This paper elaborates on the biological functions of HNF4α,and summarizes and analyzes the research advances in the mechanisms of action of HNF4α in the pathological process of liver diseases,in order to provide references for further investigation of the potential targeted therapies for liver diseases.
Conference overviews
A summary of 2015 academic conference of Tianjin Society of Integrated Traditional Chinese and Western Medicine  for Liver Diseases
Zhang Qing, Li Hai, Xiang XiaoHui, Lu Wei, Chen Xin, Xia ShiHai
2016, 32(2): 404-405. DOI: 10.3969/j.issn.1001-5256.2016.02.046
Abstract: