2018 No. 7

Immunotherapy for hepatocellular carcinoma

Ren ZhengGang

2018, 34(7): 1371-1373. DOI: 10.3969/j.issn.1001-5256.2018.07.001

Abstract(2129)

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Abstract:
In the past 10 years, the progress in systemic therapy for hepatocellular carcinoma ( HCC) is attributed to the application of molecular target therapy and the improvement in immunotherapy. The immunosuppressive microenvironment of HCC enables HCC cells to avoid attack by the immune system, which is also an important reason for the progression of HCC. Improving immune killing of HCC and correcting immunosuppressive conditions are important strategies for immunotherapy for HCC. Tumor vaccine therapy based on HCC specific antigen, genetically engineered T lymphocytes, and basic research and bench-to-bedside translation of immune checkpoint inhibitors have significantly improved the outcome of immunotherapy. Further studies should be performed for immunotherapy combined with other antitumor therapies such as local ablation, molecular targeted therapy, and tumor vaccine therapy.

Progress in the prevention and treatment of HBV-related hepatocellular carcinoma

Dong Jing, Jiang JiaJi

2018, 34(7): 1374-1377. DOI: 10.3969/j.issn.1001-5256.2018.07.002

Abstract(2662)

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Hepatitis B virus ( HBV) -related hepatocellular carcinoma ( HCC) accounts for 63. 9% of all HCC cases in mainland China.HBV leads to the development or recurrence of HCC in a direct or indirect way. Theoretically, anti-HBV therapy can reduce or delay the development of HCC. There has been convincing evidence that nucleos ( t) ide analogues ( NAs) can reduce the development of HCC, and recent studies showed that pegylated interferon ( PEG-IFN) is superior to NAs in secondary prevention; data showed that NAs are effective in reducing the cumulative recurrence rate of HCC after curative surgery, and the application of IFN can extend the overall survival of patients. Secondary/tertiary prevention of HBV-related HCC should focus on the following two points: ( 1) pay attention to the rational use of IFN/PEG-IFN in patients with chronic hepatitis B; ( 2) take HBV DNA < 20 IU/ml and HBs Ag < 1000 IU/ml as the long-term targets of control. In the antiviral era, two types of antiviral drugs should be applied individually to minimize the incidence and recurrence of HCC.

Value of Gd-EOB-DPTA in the diagnosis of hepatocellular carcinoma

Li RuoKun, Yan FuHua, Li Ke

2018, 34(7): 1378-1381. DOI: 10.3969/j.issn.1001-5256.2018.07.003

Abstract(2037)

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Abstract:
Gd-EOB-DPTA is a hepatocyte-specific contrast agent with the function of double-contrast imaging. It can reflect the blood supply of lesions via dynamic enhancement imaging and show the change in the expression of molecular receptors on hepatocyte membrane via hepatobiliary phase imaging. Gd-EOB-DPTA can reflect the multistep process of hepatocarcinogenesis from multiple dimensions, improve detection of hypovascular hepatocellular carcinoma ( HCC) and small HCC, display cirrhotic nodules with high-risk malignant transformation, and therefore, it has been recommended as a noninvasive tool for HCC diagnosis in China and international HCC clinical practice guidelines. This article reviews the recent advances of Gd-EOB-DTPA in the diagnosis of HCC.

Clinical predictive models for individualized treatment of hepatocellular carcinoma

Wang Kui, Zou QiFei, Shen Feng, Li Zheng, Wei WenXin, Xia Yong, Li Jun, Yan ZhenLin

2018, 34(7): 1382-1386. DOI: 10.3969/j.issn.1001-5256.2018.07.004

Abstract(2537)

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Hepatocellular carcinoma ( HCC) is one of the most common malignant tumors in China and has high incidence and mortality rates. HCC is often accompanied by hepatitis and liver cirrhosis, and therefore, there is high demand for precise treatment based on disease stage, tumor location, and liver function. Various diagnostic and treatment methods used in clinical practice have a certain therapeutic effect on HCC, and the issue of effective prognostic analysis and selection of individualized treatment regimen needs to be solved urgently. There are many predictive systems for the prognosis of HCC, among which nomogram can better help with the individualized analysis of HCC patients and has thus attracted more and more attention. At present, various nomographic predictive models have been established for different types of HCC; such models integrate some clinical and pathological indices, such as tumor markers, liver function, HBV indices, and microvascular tumor thrombus, and then risk score is calculated for each patient to predict prognosis. Meanwhile, clinicians can select the appropriate therapeutic method and postoperative anti-recurrence treatment based on the level of risk to achieve the goal of individualized treatment.

Advances in molecular targeted therapy for hepatocellular carcinoma

Chen WanYong, Ren Ning

2018, 34(7): 1387-1394. DOI: 10.3969/j.issn.1001-5256.2018.07.005

Abstract(2326)

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Abstract:
At present, the main treatment methods for hepatocellular carcinoma ( HCC) include surgery, chemotherapy, and radiotherapy.With the development of molecular biological techniques, the field of molecular targeted therapy is developing rapidly. The design of targeted drugs based on some specific sites in the signaling pathways involved in the development and progression of HCC has become a new research hotspot. This article elaborates on the pathways involved in the development and progression of HCC and targeted drugs for treatment.

Value of common laboratory parameters in predicting the prognosis of hepatocellular carcinoma

Wen XiaJie, Yao MingJie, Zhang Ling, Lu FengMin

2018, 34(7): 1395-1398. DOI: 10.3969/j.issn.1001-5256.2018.07.006

Abstract(2488)

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Patients with hepatocellular carcinoma ( HCC) often have underlying liver diseases, and unlike other types of cancer, the features of HCC and residual liver function may affect patient survival after surgery. In order to help clinicians identify patients who can benefit from radical hepatectomy, this article summarizes common laboratory parameters which have guiding significance for the prognosis of HCC patients, with reference to preliminary laboratory studies and literature review. This article particularly introduces prealbumin, a serological marker which reflects liver synthetic function, and as an independent prognostic factor for HCC patients after surgery, prealbumin is integrated into the traditional Child-Pugh classification system to develop a modified liver function scoring system, which can accurately predict the prognosis of patients undergoing radical hepatectomy. This scoring system may help clinicians select HCC patients suitable for surgery.

Prevalence of primary liver cancer in Eastern countries and related influencing factors

Zhang MingYuan, Niu JunQi

2018, 34(7): 1399-1402. DOI: 10.3969/j.issn.1001-5256.2018.07.007

Abstract(2417)

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Primary liver cancer is a serious disease which threatens human health, and Eastern countries have a high prevalence rate of primary liver cancer. Data from the World Health Organization show that in recent years, the incidence rate of liver cancer tends to decrease in most Eastern countries, and hepatitis B vaccination, application of antiviral drugs for hepatitis B and C, and reduced aflatoxin contamination are the main reasons for the reduction in the incidence rate of liver cancer. The incidence rates of alcoholic and nonalcoholic fatty liver disease are gradually increasing year by year, which should be taken seriously as a risk factor for liver cancer.

Technical guidelines for clinical evaluation of liver injury induced by traditional Chinese medicine

State Drug Administration

2018, 34(7): 1403-1409. DOI: 10.3969/j.issn.1001-5256.2018.07.008

Abstract(1898)

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An excerpt of EASL clinical practice guidelines on hepatitis E virus infection 2018

Li Yan, Tang ShanHong

2018, 34(7): 1410-1414. DOI: 10.3969/j.issn.1001-5256.2018.07.009

Abstract(1844)

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An excerpt of EASL clinical practice guidelines: Management of alcohol-related liver disease (2018)

Song Yang, Zhou Fei, Chen LiGang

2018, 34(7): 1415-1419. DOI: 10.3969/j.issn.1001-5256.2018.07.010

Abstract(171)

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Comparison and interpretation of Chinese, American, and European guidelines on alcoholic liver diseases

Yang Song, Xing HuiChun, Cheng Jun

2018, 34(7): 1420-1422. DOI: 10.3969/j.issn.1001-5256.2018.07.011

Abstract(1808)

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Clinical features of HBV-related liver failure associated with recurrence after withdrawal of nucleos ( t) ide analogues and influencing factors for prognosis

Li XiaoLou, Zhuo HaiYan, Liu ZhiQiang, Chen RuanQin, Chen Li

2018, 34(7): 1423-1427. DOI: 10.3969/j.issn.1001-5256.2018.07.012

Abstract(2138)

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Objective To investigate the clinical features of chronic hepatitis B ( CHB) patients progressing to liver failure due to recurrence after withdrawal of nucleos ( t) ide analogues and influencing factors for prognosis. Methods A retrospective analysis was performed for the clinical data of 40 patients with liver failure due to recurrence after drug withdrawal who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2014 to December 2017, including general information, antiviral therapy, and biochemical and virological data. According to the treatment outcome at week 12, the patients were divided into survival group with 18 patients and death group with 22 patients, and clinical features were compared between the two groups. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between groups. The chi-square test was used for comparison of categorical data between groups. The logistic regression analysis was performed to identify the influencing factors for recurrence and progression to liver failure after drug withdrawal. Results There were no significant differences between the death group and the survival group in median time of antiviral therapy and time from drug withdrawal to recurrence ( P > 0. 05) , and the death group had a significantly higher proportion of patients with liver cirrhosis than the survival group ( 81. 8% vs 27. 8%, χ2= 11. 831, P = 0. 001) . Compared with the death group, the survival group had significantly higher levels of albumin ( t = 2. 302) , gamma-glutamyl transpeptidase ( Z =-3. 671) , and cholinesterase ( Z =-2. 134) and significantly lower total bilirubin ( Z =-4. 241) , prothrombin time ( t =-2. 727) , international normalized ratio ( t =-2. 343) , and Model for End-Stage Liver Disease score ( t =-3. 909) ( all P < 0. 05) . There was a significant difference in acute-on-chronic liver failure ( ACLF) grade between the two groups ( χ2= 18. 425, P < 0. 001) . The logistic regression analysis showed that ACLF grade ( odds ratio [OR] = 9. 865, 95% confidence interval [CI]: 1. 455-67. 370, P = 0. 020) and liver cirrhosis ( OR = 9. 988, 95% CI: 2. 048-48. 709, P = 0. 004) were independent risk factors for the prognosis of liver failure due to recurrence after drug withdrawal. Conclusion Liver failure due to recurrence after drug withdrawal has a high mortality rate, and its prognosis is not associated with antiviral regimen, course of treatment, or virological parameters. Patients with liver cirrhosis and a higher liver failure grade tend to have poorer prognosis. Patients with liver cirrhosis have a high risk after drug withdrawal and should take the medicine for a long time or even for the whole life.

Association of N-glycosylation mutation of HBV envelope protein with the development and prognosis of acute-on-chronic liver failure in patients with chronic hepatitis B

Chen Jie, Yao MingQi, Wei FeiLi, Xu JinFeng, Guo LeLe, Yang HaiXia, Li Ming, Zhang Jing

2018, 34(7): 1428-1431. DOI: 10.3969/j.issn.1001-5256.2018.07.013

Abstract(2248)

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Abstract:
Objective To investigate the association of N-glycosylation mutation of HBV envelope protein with the development of acute-on-chronic liver failure ( ACLF) in patients with chronic hepatitis B ( CHB) . Methods A total of 90 patients with HBV-ACLF were enrolled, and 60 patients with CHB were enrolled as control group. Nested PCR was used for the multiplication and sequencing of HBV S region, and the association of N-glycosylation of HBV envelope protein with the development ACLF was analyzed, as well as the association of N-glycosylation of HBV envelope protein with the severity and 90-day survival rate of ACLF. Results A total of 51 CHB patients ( 85. 0%) and 79 HBV-ACLF patients ( 87. 8%) were included in analysis. Among the CHB patients, 33 ( 64. 7%) had Asn-59 N-glycosylation and 21 ( 41. 2%) had Asn-4 N-glycosylation, while among the HBV-ACLF patients, 16 ( 20. 3%) had Asn-59 N-glycosylation and 14 ( 17. 7%) had Asn-4 N-glycosylation; there were significant differences in the numbers of cases of Asn-59 and Asn-4 N-glycosylation between the two groups ( P < 0. 001, and P = 0. 003) . There were no significant differences in liver function, HBV DNA, Model for End-Stage Liver Disease score, and 90-day survival rate between the ACLF patients with Asn-59 and Asn-4 N-glycosylation and those without such glycosylation ( P > 0. 05) . Conclusion The reduction in Asn-59 and Asn-4 N-glycosylation induced by HBV envelope protein variation may be associated with the development of ACLF.

Influence of daclatasvir hydrochloride combined with asunaprevir on renal function in patients with compensated hepatitis C cirrhosis

Liang ZhiJun, Wang SuNa

2018, 34(7): 1432-1435. DOI: 10.3969/j.issn.1001-5256.2018.07.014

Abstract(2025)

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Objective To investigate the influence of daclatasvir hydrochloride combined with asunaprevir on renal function in patients with compensated hepatitis C cirrhosis. Methods A total of 44 previously untreated patients with compensated hepatitis C cirrhosis caused by hepatitis C virus genotype 1 b infection who visited Department of Infectious Diseases in Tangdu Hospital, Fourth Military Medical University, from May 2017 to September 2017 were enrolled. All patients were given oral daclatasvir hydrochloride ( 60 mg, once a day) combined with asunaprevir ( 100 mg, twice a day) as the antiviral therapy, and the course of treatment was 24 weeks. The changes in HCV RNA clearance rate, alanine aminotransferase ( ALT) normalization rate, blood urea nitrogen, creatinine, and estimated glomerular filtration rate ( eGFR) were measured from baseline to weeks 4 and 24 of treatment were observed, and eGFR was calculated using the Modification of Diet In Renal Disease ( MDRD) and Chronic Kidney Disease Epidemiology Collaboration ( CKD-EPI) equations. The chi-squared test was used for comparison of normally distributed continuous data between groups, and the SNK-q test was used for further comparison between two groups. Results At week 24 of treatment, the HCV RNA clearance rate was 100% ( 44/44) and the ALT normalization was 97. 50% ( 39/40) . There was a significant increase in blood urea nitrogen from baseline ( 4. 43 ± 1. 09 mmol/L) to week 24 of treatment ( 4. 91 ± 1. 41 mmol/L) ( q = 2. 322, P = 0. 025) , while there was no significant change in creatinine from baseline to week 4 or 24 of treatment ( both P> 0. 05) . There was no significant change in eGFR calculated using either MDRD or CKD-EPI equation from baseline to week 4 or 24 of treatment ( both P > 0. 05) . As for the 14 patients with a baseline eGFR of < 90 ml/min/1. 73 m2 calculated using the MDRD equation, they had a significant increase in eGFR from baseline ( 82. 81 ± 7. 16 ml/min/1. 73 m2) to week 24 of treatment ( 89. 65 ± 15. 85 ml/min/1. 73 m2) ( q = 2. 303, P = 0. 038) . Conclusion Daclatasvir hydrochloride combined with asunaprevir has no significant influence on renal function in patients with compensated hepatitis C cirrhosis, and there is a need for more studies with a large sample size.

Correlation between serum selenium level and degree of liver cirrhosis in Enshi, Hubei Province, China

Zheng XiaoLi, He JianHua, Xiang XingChao, Zhou XiangYu, Lei Lei

2018, 34(7): 1436-1439. DOI: 10.3969/j.issn.1001-5256.2018.07.015

Abstract(1805)

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Objective To investigate the serum selenium level in patients with cirrhosis in Enshi, Hubei Province, China. Methods A total of 90 patients with cirrhosis who were treated in The Central Hospital of Enshi Autonomous Prefecture from January 2016 to June 2017 were enrolled as liver cirrhosis group and further divided into Child-Pugh class A, B, and C subgroups; 60 healthy volunteers who underwent physical examination were enrolled as control group. Serum selenium level and hepatic fibrosis indices were measured. The t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison of continuous data between multiple groups, and the SNK-q test was used for further comparison between two groups. The Spearman correlation test was used to investigate the correlation between serum selenium level and degree of liver cirrhosis. Results Compared with the control group, the liver cirrhosis group had a significant reduction in serum selenium level and significant increases in hyaluronic acid ( HA) , procollagen type Ⅲ ( PCⅢ) , type Ⅳ collagen ( Ⅳ-C) , and laminin ( LN) ( t = 7. 246, 9. 759, 4. 790, 8. 671, and 5. 908, all P < 0. 05) . There was a progressive reduction in serum selenium level and progressive increases in HA, PCⅢ, Ⅳ-C, and LN with increasing Child-Pugh class ( F =13. 524, 53. 903, 21. 490, 52. 495, and 19. 530, all P < 0. 05) . Serum selenium is negatively correlated with HA, PCⅢ, Ⅳ-C, LN, and Child-Pugh class ( r =-0. 361, -0. 519, -0. 448, -0. 354, and-0. 602, all P < 0. 05) . Conclusion Patients with cirrhosis have a significantly lower serum selenium level than the normal population in Enshi, but further clinical studies are needed to determine whether selenium supplementation can improve the prognosis of cirrhosis.

Anesthetic effect and adverse reactions of propofol in painless gastrointestinal endoscopy in patients with different Child-Pugh classification of liver cirrhosis

Gao Fang, Chang Yue, Li Hai

2018, 34(7): 1440-1444. DOI: 10.3969/j.issn.1001-5256.2018.07.016

Abstract(1929)

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Objective To investigate the anesthetic effect and adverse reactions of propofol in painless gastrointestinal endoscopy in patients with varying degrees of liver cirrhosis. Methods A total of 342 patients with liver cirrhosis who underwent gastrointestinal endoscopy under propofol anesthesia in The Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces from February 2015 to August2017 were enrolled. According to the Child-Pugh class before surgery, the patients were divided into Child-Pugh A Group ( n = 224) , Child-Pugh B group ( n = 94) , and Child-Pugh C Group ( n = 24) . The three groups were compared in terms of anesthetic effect and adverse reactions. An analysis of variance was used for comparison of continuous data between multiple groups, and the SNK-q test was used for further comparison between any two groups; the chi-square test or the Kruskal-Wallis H rank sum test was used for comparison of categorical data between multiple groups, and a Ridit analysis was used for further comparison between any two groups. Results Compared with the Child-Pugh A group and the Child-Pugh B group, the Child-Pugh C group had a significantly smaller amount of propofol used ( F =4. 401, P = 0. 017) and a significantly shorter time of loss of consciousness ( F = 9. 440, P = 0. 001) . No patient experienced adverse reactions such as allergy to propofol, propofol infusion syndrome, and convulsion-like reactions. There were no significant differences in the incidence rates of pain at the injection site, arrhythmia, and respiratory depression between the three groups ( all P > 0. 05) . There was a significant difference in the reduction in blood pressure between the three groups ( H = 3. 795, P < 0. 001) , and the Child-Pugh B group had significantly lower blood pressure than the other two groups ( both P < 0. 05) . Conclusion Propofol has a safe anesthetic effect in painless gastrointestinal endoscopy in patients with varying degrees of liver cirrhosis and does not have serious adverse effects. Patients with poorer liver function tend to have a smaller amount of propofol used, and the change in blood pressure should be taken seriously during surgery.

Risk factors for early rebleeding after first-time endoscopic variceal ligation

Cui CanCan, Li DanDan, Li ZhangFeng, Yan ZhenKun, Wang LiQiang, Sun Chen, Zhang Ke, Zhang Bin

2018, 34(7): 1445-1451. DOI: 10.3969/j.issn.1001-5256.2018.07.017

Abstract(2304)

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Objective To investigate the effect of endoscopic variceal ligation ( EVL) for the first time on liver function in patients with liver cirrhosis and the risk factors for early rebleeding after surgery. Methods A retrospective analysis was performed for the clinical data of 125 cirrhotic patients with esophageal varices who underwent EVL in China-Japan Union Hospital of Jilin University from December 2013 to December 2016. They were divided into different groups according to Child-Pugh score. Liver function was observed before EVL and at 1 week after EVL. The features of patients who experienced early rebleeding after EVL were analyzed. The t-test was used for comparison of normally distributed continuous data between two groups, and a one-way analysis of variance was used for comparison between multiple groups; the Wilcoxon test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test was used for comparison of categorical data between groups. The Cox regression model was used to analyze the risk factors for postoperative bleeding, the Kaplan-Meier curve was used to analyze the association of observation indices with postoperative bleeding, and the log-rank test was used for difference analysis. Results There were no significant differences in liver function parameters between the patients with different Child-Pugh classes before and after EVL ( all P > 0. 05) . Of all 125 patients, 11 experienced early rebleeding, resulting in an early rebleeding rate of8. 8%. The univariate Cox regression analysis showed that there were significant differences in hemoglobin, prothrombin time ( PT) , aspartate aminotransferase, total bilirubin, albumin, the presence or absence of portal vein thrombosis, amount of ascites, and liver function classification between the patients with bleeding and those without ( all P < 0. 05) . The multivariate Cox regression analysis showed that Child-Pugh class C ( hazard ratio [HR]= 6. 363, 95% confidence interval [CI]: 1. 629-26. 580, P = 0. 021) , amount of ascites ( small: HR = 6. 581, 95% CI: 1. 060-66. 681, P = 0. 046; middle/large: HR = 8. 447, 95% CI: 1. 763-11. 641, P = 0. 022) , long PT before surgery ( HR =1. 146, 95% CI: 1. 039-1. 264, P = 0. 006) , and the presence of portal vein thrombosis ( HR = 9. 691, 95% CI: 1. 185-19. 281, P = 0. 034) were independent risk factors for early rebleeding after EVL. The Kaplan-Meier curve analysis was performed for the results of the multivariate Cox regression analysis, and the results showed that Child-Pugh class C ( χ2= 3. 972, P = 0. 046) , presence of ascites ( χ2= 20. 916, P <0. 001) , prolonged PT ( χ2= 21. 302, P < 0. 001) , and presence of portal vein thrombosis ( χ2= 10. 608, P = 0. 001) were risk factors for early rebleeding after EVL. Conclusion EVL does not cause damage to patients' liver function within a short period of time and is safe and effective. Liver function should be corrected, the amount of ascites should be reduced, and coagulation function should be improved before surgery to reduce the incidence rate of early rebleeding after EVL.

Clinical effect of selective transcatheter arterial embolization combined with CT-guided microwave ablation in treatment of hepatic hemangioma

Lu NingNing, Wang HaiYan, Gao WenFeng, Zhang YongHong, Zheng JiaSheng

2018, 34(7): 1452-1455. DOI: 10.3969/j.issn.1001-5256.2018.07.018

Abstract(1626)

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Objective To investigate the clinical effect and safety of selective transcatheter arterial embolization ( TAE) combined with CT-guided microwave ablation in the treatment of hepatic hemangioma, and to provide a reference for the selection of treatment methods for hepatic hemangioma. Methods A retrospective analysis was performed for the clinical data of 29 patients with hepatic hemangioma who underwent selective TAE combined with CT-guided microwave ablation in Beijing You An hospital from January 2012 to December 2016. The complications of ablation, complete ablation rate, change in the size of hemangioma, and improvement in clinical symptoms were observed to evaluate the clinical effect and safety of this treatment regimen. The t-test was used for the comparison of continuous data between groups.Results A total of 29 patients with 31 lesions of hepatic hemangioma were treated. Eleven patients experienced the complications of ablation, among whom two experienced pyrexia alone, three experienced abdominal pain, two experienced pyrexia and abdominal pain, two experienced hemoglobinuria alone, one experienced hemoglobinuria and slight subcapsular bleeding, and one experienced bile tumor and abdominal pain, and these patients were cured after symptomatic treatment. The incidence rate of complications was 37. 93% ( 11/29) , and no patient experienced severe complications or death. The patients were followed up till three months after surgery, and the clinical symptoms completely disappeared after ablation. According to the results of contrast-enhanced computed tomography or magnetic resonance imaging, there was a significant reduction in the mean diameter of the 31 hepatic hemangiomas after surgery ( 4. 44 ± 1. 39 cm vs 6. 58 ± 1. 25 cm, t =14. 02, P < 0. 01) , and the mean residual rate of the lesions of hepatic hemangioma was ( 66. 6 ± 12. 5) %. Of all patients, 27 ( 93. 1%) achieved complete ablation and 2 ( 6. 9%) had incomplete ablation, and since these two patients had complete remission of clinical symptoms and follow-up at 6 months after surgery showed no progressive enlargement of hepatic hemangioma, ablation was not performed again. Conclusion Selective TAE combined with CT-guided microwave ablation has a good clinical effect and high safety in the treatment of hepatic hemangioma, and therefore, it is a minimally invasive surgery holding promise for clinical application.

Clinical features of patients with Barcelona Clinic Liver Cancer stage C primary liver cancer and related prognostic factors: An analysis of 140 cases

Guo XiaoDi, Sun ShaSha, Li WenDong, Shen YanJun, Sun Wei, Ding XiaoYan, Chen JingLong

2018, 34(7): 1456-1461. DOI: 10.3969/j.issn.1001-5256.2018.07.019

Abstract(2307)

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Objective To investigate the clinical features of patients with Barcelona Clinic Liver Cancer ( BCLC) stage C primary liver cancer ( PLC) and related prognostic factors. Methods A retrospective analysis was performed for the clinical data of 140 patients with BCLC stage C PLC who were admitted to Beijing Ditan Hospital, Capital Medical University, from October 2008 to December 2015. The Kaplan-Meier method was used for survival analysis, and the log-rank test was used for univariate analysis. The multivariate Cox proportional hazards model was used to analyze prognostic factors according to forward stepwise regression based on maximum likelihood estimation. Results Most of the 140 patients were male, and the male/female ratio was 6∶ 1. The three most common initial symptoms of PLC were abdominal pain or liver area pain, weakness, and abdominal distension. The median survival time was 6 months, and the median follow-up time was 10 months ( 1-80 months) . The 1-year survival rate of these patients was 22. 14%. The univariate analysis showed that Child-Pugh class, the type of portal vein tumor thrombus, tumor number, tumor morphology, tumor diameter, aspartate aminotransferase/alanine aminotransferase ( AST/ALT) ratio, and use or non-use of transcatheter arterial chemoembolization ( TACE) were associated with prognosis ( χ2= 6. 215, 19. 609, 8. 849, 11. 122, 11. 571, 7. 438, 30. 511, and 10. 690, all P < 0. 05) . The multivariate analysis showed that Child-Pugh class ( odds ratio [OR]= 1. 524, 95% confidence interval [CI]: 1. 011-2. 297, P = 0. 044) , tumor diameter ( OR = 1. 803, 95%CI: 1. 097-2. 964, P = 0. 020) , and AST/ALT ratio ( OR = 1. 769, 95% CI: 1. 301-2. 406, P < 0. 001) were independent risk factors for the prognosis of advanced PLC, while the use of TACE was a protective factor ( OR = 0. 598, 95% CI: 0. 363-0. 985, P = 0. 043) .Conclusion Advanced PLC has poor prognosis and short median survival time. A more accurate survival benefit analysis should be performed based on adverse prognostic factors to guide the selection of therapeutic paradigms in clinical practice. Increased AST/ALT ratio should also be taken seriously.

Clinical effect of sequential therapy with transarterial chemoembolization and bipolar-needle radiofrequency ablation in treatment of hepatocellular carcinoma in high-risk locations

Liang HongYuan, Guo QiYong, Mao XiaoNan, Sun Wei, Zhao Gang, Wang XiHai, Liu Zhen, Wen Feng, Lu ZaiMing

2018, 34(7): 1462-1469. DOI: 10.3969/j.issn.1001-5256.2018.07.020

Abstract(2086)

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Objective To investigate the clinical effect of sequential therapy with transarterial chemoembolization ( TACE) and bipolar-needle radiofrequency ablation ( RFA) in the treatment of hepatocellular carcinoma ( HCC) in high-risk locations. Methods A total of 35 previously untreated patients with HCC in high-risk locations who visited Shengjing Hospital of China Medical University from January 2014 to June 2015 were enrolled. They were given TACE for 15-60 days, followed by CT-guided bipolar-needle FRA. The patients were followed up for 2-36 months after surgery, and the clinical outcomes were evaluated. The t-test was used for comparison of continuous data between groups, and the chi-square test or Fisher's exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used for survival analysis. Results A total of 35 HCC patients with 40 lesions were enrolled and given the sequential therapy with TACE and bipolar-needle RFA, and the technical success rate was 100%. The lesions with a maximum diameter of ≤3 cm achieved a complete ablation rate of 100% ( 28/28) , and those with a maximum diameter of > 3 cm achieved a complete ablation rate of66. 7% ( 8/12) ; there was a significant difference between these two groups ( P = 0. 005) . The patients were followed up to June 2017; the median survival time was 27. 6 months, and the 1-and 2-year survival rates were 94. 3% and 65. 7%, respectively. The lesions close to the capsule had a higher complete ablation rate than those in other locations ( 95% vs 85%, P > 0. 05) , as well as a lower incidence rate of complications ( 15% vs 35%, P > 0. 05) . There was a significant difference in mean ablation time between the lesions with > 50% lipiodol deposition and those with < 50% lipiodol deposition ( 24. 2 ± 6. 7 min vs 30. 1 ± 10. 2 min, t = 2. 163, P = 0. 037) . No patients experienced serious complications; mild complications included slight subcapsular hemorrhage in three patients, slight abdominal hemorrhage in one patient, subcutaneous hematoma in one patient, mild pneumothorax with slight abdominal hemorrhage in one patient, mild pneumothorax in two patients, and mild hemothorax in two patients, and all these complications were relieved after conservative treatment. Conclusion Sequential therapy with TACE and CT-guided bipolar-needle RFA is safe and effective in patients with HCC in high-risk locations, and may have a better therapeutic effect on subcapsular lesions than on the lesions in other high-risk locations.

Clinical value of serum PIVKA-Ⅱ in diagnosis of HBV-related hepatocellular carcinoma

Zhang Ying, Yan XueBing

2018, 34(7): 1470-1474. DOI: 10.3969/j.issn.1001-5256.2018.07.021

Abstract(2388)

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Abstract:
Objective To evaluate the clinical value of serum protein induced by vitamin K absence or antagonist-Ⅱ ( PIVKA-Ⅱ) and alpha-fetoprotein ( AFP) , alone or in combination, in the diagnosis of hepatitis B virus ( HBV) -related hepatocellular carcinoma ( HCC) . Methods A total of 450 patients with HBV infection, who underwent serological tests in the Department of Infectious Diseases, The Affiliated Hospital of Xuzhou Medical University, from February 2016 to June 2017, were enrolled in our hospital, including 200 patients with HBV-related HCC ( 80 surgically treated cases) , 143 patients with hepatitis B cirrhosis, 65 patients with severe chronic hepatitis B ( CHB) , and 42 CHB patients with liver failure. The serum levels of PIVKA-Ⅱ and AFP were compared between the four groups. An analysis of variance was used to compare normally distributed continuous data between multiple groups; the Kruskal-Wallis H test was used to compare non-normally distributed continuous data between multiple groups, and the Mann-Whitney U test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. A binary stepwise logistic regression was used to obtain a new variable as a combination of PIVKA-Ⅱ and AFP. The receiver operating characteristic ( ROC) curve was used to calculate the area under the ROC curve ( AUC) of AFP and PIVKA-Ⅱ, alone or in combination, in the diagnosis of HBV-related HCC, and the De Long test was used for comparison of AUC between these variables. Results The HBV-related HCC patients had significantly higher PIVKA-Ⅱ and AFP levels than other groups ( Z =-9. 432, -6. 369, -2. 158, -13. 202, -9. 609, and-7. 584, all P< 0. 05) . The PIVKA-Ⅱ levels of the patients with severe CHB and CHB patients with liver failure were significantly higher than that of the patients with hepatitis B cirrhosis ( Z =-2. 977 and-2. 308, both P < 0. 05) . The HBV-related HCC patients showed significant reductions in AFP and PIVKA-Ⅱ levels within 5-7 days after surgical treatment ( Z =-96. 892 and-76. 997, both P < 0. 05) . In the diagnosis of HBV-related HCC, PIVKA-Ⅱ had 84. 0% sensitivity and 86. 4% specificity, and AFP had 81. 5% sensitivity and 50. 4%specificity. The AUCs of AFP, PIVKA-Ⅱ, and a combination of AFP and PIVKA-Ⅱ in the diagnosis of HBV-related HCC were0. 757, 0. 905, and 0. 912, respectively; there were significant differences in AUC between PIVKA-Ⅱ and AFP ( Z = 6. 048, P < 0. 001) and between AFP and a combination of AFP and PIVKA-Ⅱ ( Z = 7. 814, P < 0. 001) . A combination of AFP and PIVKA-Ⅱ had the highest diagnostic efficiency for HBV-related HCC. Conclusion Serum PIVKA-II has a better diagnostic value for HBV-related HCC than AFP, and a combination of the two can increase the detection rate of HCC and reduce the rate of misdiagnosis.

Association between the expression of centromere protein F and prognosis in patients with hepatocellular carcinoma:An analysis using GEO database

Fan Bin, Zhang Yong, Li JinMao, Liu Tao, Zhang JiaYao

2018, 34(7): 1475-1480. DOI: 10.3969/j.issn.1001-5256.2018.07.022

Abstract(2921)

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Abstract:
Objective To investigate the association of the expression of centromere protein F ( CENPF) with clinical features and prognosis in patients with hepatocellular carcinoma ( HCC) . Methods The online tool Oncomine was used to measure the expression of CENPF in HCC tissue and normal liver tissue. Related chip data ( GSE14520) were downloaded from the GEO database of National Center for Biotechnology Information. The gene expression profile and related clinical data of 215 HCC tissue samples were collected, and these samples were divided into low CENPF expression group with 107 samples and high CENPF expression group with 108 samples. The expression of CENPF and related clinical information were analyzed. The t-test was used for comparison of continuous data between groups; the chi-square test was used for comparison of categorical data between groups; the log-rank ( Mantel-Cox) test was used for survival analysis; the Cox proportional hazards model was used for univariate and multivariate analyses of survival data. Results The datasets demonstrated that HCC tissue samples had a significantly higher expression level of CENPF than normal liver tissue samples ( t = 12. 217, P < 0. 001) . The expression level of CENPF was associated with alpha-fetoprotein ( AFP) level, tumor size, TNM stage, and metastasis risk ( χ2= 6. 463, 4. 338, 7. 951, and 17. 331, all P < 0. 05) . The survival analysis showed that the patients with high CENPF expression had a significantly poorer prognosis than those with low CENPF expression ( hazard ratio = 1. 92, 95% confidence interval: 1. 24-2. 96, P = 0. 005) . The univariate Cox analysis showed that the prognosis of HCC patients was associated with AFP level, tumor diameter, liver cirrhosis, tumor stage, metastasis risk, and CENPF expression ( all P < 0. 05) ; the multivariate Cox analysis showed that liver cirrhosis, tumor stage, and high CENPF expression were independent risk factors for the prognosis of HCC patients ( all P < 0. 05) . Conclusion High CENPF expression is associated with the progression of HCC, and CENPF might be used as a potential prognostic biomarker for HCC patients.

ECHS1, epidermal growth factor, and low-glucose conditions promote the invasion and metastasis of hepatocellular carcinoma cells

Lu JiaZhen, Xu WenJuan, Cai YiLing, Ao ShaoJun, Ding RongRong, Zhang MingQing

2018, 34(7): 1481-1486. DOI: 10.3969/j.issn.1001-5256.2018.07.023

Abstract(2520)

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Abstract:
Objective To investigate the expression of key enzymes associated with energy metabolism in hepatocellular carcinoma ( HCC) tissue, as well as the roles of short-chain enoyl-CoA hydratase 1 ( ECHS1) , AMP-activated protein kinase ( AMPK) , fatty acid synthase ( FAS) , acetyl-CoA carboxylase ( ACC) , and low-glucose conditions in the development and progression of HCC. Methods A total of 32 HCC patients who underwent surgical resection in 175 Hospital of PLA from June 2015 to June 2016 were enrolled. HCC tissue and adjacent tissue samples were collected, and immunohistochemistry was used to measure the expression of key enzymes associated with energy metabolism in HCC tissue samples with different degrees of tumor differentiation and adjacent tissues, including FAS, ACC, and AMPK.Two groups of hepatoma cells were established. Hepatoma Huh7-plv and HepG2-PU6 cells transfected with blank control plasmids were established as control group, and hepatoma cells transfected with small interfering RNA ( siRNA) ( Huh7-siECHS1 and HepG2-siECHS1 cells) were established as experimental group. A Transwell chamber assay was used to observe the effect of ECHS1, low-glucose condition, and EGF on the invasion ability of hepatoma cells. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results Immunohistochemistry showed that compared with the adjacent tissue samples, the HCC tissue samples had a significant higher proportion of ACC-or AMPKβ-positive cells ( ACC-positive cells:21/11 vs 7/25, χ2= 12. 44, P < 0. 05; AMPKβ-positive cells: 31/1 vs 26/6, χ2= 4. 68, P < 0. 05) . The Transwell chamber assay showed that compared with the corresponding hepatoma cells treated by ECHS1 interference ( Huh7-siECHS1-N, HepG2-siECHS1-N, Huh7-siECHS1-N-EGF, and HepG2-siECHS1-N-EGF) , the hepatoma cells cultured under normal conditions ( Huh7-plv-N and HepG2-PU6-N) and with the addition of EGF ( Huh7-plv-N-EGF and HepG2-PU6-N-EGF) had a significantly higher number of invasive cells ( t = 6. 93, 6. 51, 7. 55, and 4. 93, all P < 0. 05) ; compared with the corresponding hepatoma cells treated by ECHS1 interference ( Huh7-siECHS1-LowGlu, HepG2-siECHS1-LowGlu, Huh7-siECHS1-LowGlu-EGF, and HepG2-siECHS1-LowGlu-EGF) , the hepatoma cells cultured under low-glucose conditions ( Huh7-plv-LowGlu and HepG2-PU6-LowGlu) and with the addition of EGF ( Huh7-plv-LowGlu-EGF and HepG2-PU6-LowGlu-EGF) had a significantly higher number of invasive cells ( t= 9. 52, 5. 80, 20. 52, and 8. 80, all P < 0. 05) . Under different conditions, hepatoma Huh7 and HepG2 cells had a significant reduction in invasion ability after ECHS1 interference. Compared with the hepatoma cells cultured under normal conditions ( Huh7-plv-N and HepG2-PU6-N) , the hepatoma cells cultured with the addition of EGF ( Huh7-plv-N-EGF and HepG2-PU6-N-EGF) had a significant increase in the number of cells passing through the Transwell chamber ( t = 4. 44 and 3. 17, both P < 0. 05) . Compared with the hepatoma cells cultured under normal conditions, the hepatoma cells cultured under low-glucose conditions ( Huh7-plv-LowGlu and HepG2-PU6-LowGlu) had an increase in the number of invasive cells ( both P > 0. 05) . Conclusion ECHS1 and EGF can significantly enhance the invasion and metastasis of hepatoma cells, and low-glucose conditions can also promote the invasion of hepatoma cells.

Construction of the eukaryotic expression vectors of interleukin-12 and granulocyte-macrophage colony-stimulating factor and their expression in hepatoma cells

Shao Xue, Ma JingTing, Song Jie, Zhang Qian, Zhang ChuanHui, Wang WuDong, Wu Meng, Pan LiuLan

2018, 34(7): 1487-1491. DOI: 10.3969/j.issn.1001-5256.2018.07.024

Abstract(2055)

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Objective To construct the eukaryotic expression vectors of interleukin-12 ( IL-12) and granulocyte-macrophage colony-stimulating factor ( GM-CSF) , PBI-CMV3-IL-12 and PBI-CMV3-GM-CSF, and the expression of IL-12 and GM-CSF in hepatoma cells after H22 hepatoma cells are transfected with such vectors. Methods The Trizol method was used to extract total liver RNA from mice, which was then reversely transcribed into c DNA. The coding sequences of IL-12 and GM-CSF were obtained by amplification using specific primers containing Bam HI and Hind III restriction sites. Double enzyme digestion was performed for the products and PBI-CMV3 empty vectors, and then the digested products were transformed into DH5α after being recycled by gel extraction kit and connected by T4 DNA ligase. Monoclonal bacterial colonies were selected and plasmid extraction, enzyme digestion, and DNA sequencing were performed for the identification of the expression vector constructed. The constructed plasmids were divided into empty vector group, PBI-CMV3-IL-12 group, PBI-CMV3-GM-CSF group, and co-transfection group. These plasmids were transfected into H22 hepatoma cells, and quantitative real-time PCR and Western blot were used to measure the mRNA and protein expression of IL-12 and GM-CSF in cells. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the Dunnett's T3 method was used for further comparison between two groups. Results The eukaryotic expression vectors, PBI-CMV3-IL-12 and PBI-CMV3-GM-CSF, were successfully constructed. Quantitative real-time PCR showed that there were significant differences in the mRNA expression of IL-12 and GM-CSF between the four groups ( F = 522 and 163, both P < 0. 001) . Compared with the empty vector group, the PBI-CMV3-IL-12 group and the co-transfection group had a significant increase in the mRNA expression of IL-12 ( both P < 0. 05) . Compared with the empty vector group, the PBI-CMV3-GM-CSF group and the co-transfection group had a significant increase in the mRNA expression of GM-CSF ( both P < 0. 05) . Western blot showed that the interest protein could bind to antibody and produce a specific band in the membrane, and an analysis of band size and gray value showed that the protein expression of IL-12 and GM-CSF had a similar trend as the mRNA expression of IL-12 and GM-CSF. Conclusion The eukaryotic expression vectors of IL-12 and GM-CSF are successfully constructed, and they are highly expressed in H22 hepatoma cells.

Specific magnetic resonance imaging of vascular endothelial growth factor-C targeted molecular probe and its clinical significance in a rat model of hepatocellular carcinoma

Pan Qi, Luo ChunHai, Ma WanLing, Qu YuanFei, Wang JianRu, Chen Lin

2018, 34(7): 1492-1496. DOI: 10.3969/j.issn.1001-5256.2018.07.025

Abstract(1992)

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Objective To investigate the magnetic resonance ( MR) imaging features of the targeted molecular probe with vascular endothelial growth factor-C ( VEGF-C) antibody and superparamagnetic iron oxide ( USPIO) , VEGF-C-USPIO, in a rat model of hepatocellular carcinoma ( HCC) and its clinical significance. Methods The induction method was used to establish a rat model of in situ HCC, and30 Sprague-Dawley rats were randomly divided into experimental group with 20 rats and control group with 10 rats. The rats in the experimental group were treated with tail vein injection of the targeted molecular probe VEGF-C-USPIO, and those in the control group were treated with tail vein injection of the non-targeted probe USPIO. MR scanning was performed before injection and at 1 hour after injection;the intensity of T2 WI signal in liver tumor and adjacent liver tissue was measured; contrast-to-noise ratio ( CNR) was calculated, and the two groups were compared in terms of CNR before and after enhancement. Liver tissue was collected after scanning, and HE staining was performed to clarify the pathological type of liver cancer in rats; Prussian blue staining was performed to analyze the content of iron in tumor cells; immunohistochemical staining was performed to investigate the expression of VEGF-C in liver cancer tissue. The independent samples t-test was used for comparison between the experimental group and the control group, and the paired samples t-test was used for comparison within each group after the injection of contrast agent. Results Cancer was successfully induced in all 30 rats; the pathological diagnosis was HCC, and the tumor formation rate was 100%. The experimental group had a significant change in CNR at 1 hour after the injection of the targeted contrast agent VEGF-C-USPIO ( 2. 11 ± 0. 23 vs 3. 47 ± 0. 45, t =-13. 15, P < 0. 001) , while the control group had no significant change in CNR at 1 hour after the injection of the non-targeted contrast agent USPIO ( 3. 51 ± 0. 14 vs 3. 82 ± 0. 61, t =-1. 40, P = 0. 192) ; there was a significant difference in CNR between the two groups after injection ( t = 17. 60, P < 0. 001) . HE staining performed for liver tissue samples showed a pathological type of HCC; immunohistochemical staining showed that VEGF-C was mainly expressed in the membrane and cytoplasm of hepatoma cells; Prussian blue staining showed that compared with the control group, the experimental group had a significant increase in iron particles in tumor tissue. Conclusion The synthesized targeted molecular probe VEGF-C-USPIO has a good active targeting effect on a rat model of HCC and can realize the specific imaging of HCC through the change in MR signal intensity. Therefore, it provides an imaging basis for the early diagnosis of HCC.

Value of direct peroral cholangioscopy combined with laser lithotripsy in treatment of patients with difficult common bile duct stones

Chen XiaoQin, Liu XiongChang, Yang JunJie, Zhang QiYong, Liu TianRang

2018, 34(7): 1497-1501. DOI: 10.3969/j.issn.1001-5256.2018.07.026

Abstract(1894)

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Objective To investigate the clinical effect of direct peroral cholangioscopy combined with laser lithotripsy in the treatment of difficult bile duct stones. Methods A total of 21 patients with difficult bile duct stones who underwent cholecystolithotomy under endoscopic retrograde cholangiopancreatography in Lanzhou First People's Hospital from October 2014 to October 2017 were enrolled. All patients were treated with small endoscopic sphincterotomy, and balloons with a size of 10-15 mm were selected based on the maximum diameter ( or maximum diameter + 2 mm) of stones to perform balloon dilatation. The carunculae minor or the juxta-diverticulum papillae were cut open and then dilated, and those which could not be cut open were directly dilated with balloons. The criterion for papillary dilatation was that a 10 mm balloon could pass the papillary opening smoothly. The ultrafine endoscope was inserted into the common bile duct via the papillary opening, laser lithotripsy was conducted under the direct view, a specially designed basket was used to remove the stones, and the common bile duct was rinsed repeatedly. Results The ultrafine endoscope successfully entered the common bile duct and found the stones, with a success rate of 100%. Of all patients, 16 ( 66. 7%) underwent direct insertion, 5 ( 23. 8%) underwent insertion assisted by guide wire, and 2 ( 9. 5%) underwent insertion assisted by outer casing. The mean insertion time was 4. 9 ± 2. 9 minutes. The success rate of lithotripsy was 81. 0%, and 4 patients ( 19%) experienced failed lithotripsy. There were no serious complications or surgery-related deaths during the treatment. One patient ( 4. 8%) experienced fever, right upper abdominal pain and tenderness, and increases in leukocytes and procalcitonin after surgery and was improved after the treatment with antibiotics for biliary tract infection. One patient ( 4. 8%) experienced moderate postoperative pancreatitis and was improved after conservative treatment. Conclusion Direct peroral cholangioscopy is a safe and effective technique for the diagnosis and treatment of difficult common bile duct stones. In particular, its combination with laser lithotripsy shows great advantages.

Clinical effect of primary suture versus T-tube drainage in laparoscopic choledocholithotomy: A meta-analysis

Zhou Ze, Wang GuoTai, Yang XingWu

2018, 34(7): 1502-1507. DOI: 10.3969/j.issn.1001-5256.2018.07.027

Abstract(2360)

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Objective To investigate the clinical effect, adaptability, and advantages/disadvantages of primary suture versus T-tube drainage in laparoscopic common bile duct exploration ( LCBDE) , and to provide reliable evidence for clinical treatment. Methods Pub Med, OVID, WOS, EMBASE, Chinese Scientific Journal Full-Text Database, Wanfang Data, and VIP were searched for articles published from January 1, 2005 to December 31, 2016. The articles were screened according to inclusion and exclusion criteria, and Rev Man5. 3 software was used for meta-analysis. Results A total of 12 articles were included, with 1222 patients in total, among whom 616 were given primary suture ( observation group) and 606 were given T-tube drainage ( control group) . There were significant differences between primary suture and T-tube drainage in time of operation ( weighted mean difference [WMD] =-10. 79, 95% confidence interval [CI]:-13. 55 to-8. 03, P < 0. 001) , length of postoperative hospital stay ( WMD =-4. 16, 95% CI:-4. 84 to-3. 48, P < 0. 001) , time to first flatus ( WMD =-8. 39, 95% CI:-12. 50 to-4. 27, P < 0. 001) , biliary drainage time ( WMD =-27. 06, 95% CI:-51. 08 to-3. 04, P = 0. 03) , and incidence rate of bile leakage ( odds ratio = 0. 47, 95% CI: 0. 27-0. 82, P = 0. 008) . Conclusion Primary suture in LCBDE is safe and effective and has significant advantages over T-tube drainage. Therefore, it holds promise for clinical application.

Value of MELD score, MELD-Na score, and King's College Hospital criteria in evaluating the prognosis of patients with acute liver failure of pregnancy

Han PuQing, Sun Yan

2018, 34(7): 1508-1513. DOI: 10.3969/j.issn.1001-5256.2018.07.028

Abstract(1852)

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Objective To investigate the value of the Model for End-Stage Liver Disease ( MELD) score, MELD combined with serum sodium concentration ( MELD-Na) score, and King's College Hospital ( KCH) criteria in evaluating the prognosis of patients with acute liver failure ( ALF) of pregnancy. Methods A total of 50 patients who were admitted to the Third Affiliated Hospital of Guangzhou Medical University from January 1, 2010 to June 30, 2017 with ALF of pregnancy as the initial diagnosis were enrolled, and according to prognosis, they were divided into death group and survival group. The patients were evaluated using the MELD score, MELD-Na score, and KCH criteria, and the association between these models and prognosis was analyzed. The t-test or Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic ( ROC) curve was plotted; the sensitivity, specificity, positive predictive value, and negative predictive value of each model were calculated; the area under the ROC curve ( AUC) was used to analyze the value of these three models in predicting the prognosis of patients with ALF of pregnancy. Results Of all 50 patients, 14 died and 36 survived, resulting in a mortality rate of 28. 0%. Compared with the survival group on admission, the death group had significant increases in MELD score ( 39. 66 ± 5. 17 vs 29. 63 ± 6. 19, t = 5. 36, P <0. 05) and MELD-Na score ( 43. 89 ± 9. 85 vs 31. 32 ± 7. 29, t = 4. 94, P < 0. 05) . On day 3 after admission, the death group had significantly higher MELD score and MELD-Na score than the survival group ( MELD score: 44. 24 ± 3. 96 vs 28. 74 ± 3. 84, t =-12. 68, P <0. 05; MELD-Na score: 46. 34 ± 5. 14 vs 32. 42 ± 4. 95, t =-8. 82, P < 0. 05) . There was no significant difference in mortality rate between the patients who met the KCH criteria and those who did not ( 8/25 vs 6/25, χ2= 0. 397, P = 0. 754) . The ROC curve analysis showed that baseline MELD score had an AUC of 0. 885 ( 95% confidence interval [CI]: 0. 781-0. 988, P < 0. 01) , a sensitivity of71. 4%, and a specificity of 94. 4%; MELD-Na score had an AUC of 0. 873 ( 95% CI: 0. 764-0. 982, P < 0. 01) , a sensitivity of78. 6%, and a specificity of 88. 9%; KCH criteria had an AUC of 0. 548 ( 95% CI: 0. 392-0. 670, P < 0. 05) , a sensitivity of 57. 1%, and a specificity of 52. 7%. Baseline MELD score and MELD-Na score were divided into groups according to the cut-off value of ROC curve, and the analysis showed that the mortality rate of patients increased with the increases in MELD score and MELD-Na score ( χ2=21. 337 and 17. 294, both P < 0. 001) . Conclusion MELD score, MELD-Na score, and KCH criteria can predict the prognosis of patients with ALF of pregnancy, and MELD score and MELD-Na score have a better clinical value than the KCH criteria.

Clonorchiasis complicated by multiple cholelithiasis and cholestatic cirrhosis misdiagnosed as Budd-Chiari syndrome: A case report

Xu YanLing, Zhao Xu, Guo XiaoLin, Ji HuiFan, Zhang Ying, Song XinYue, Wang JingYu, Sun XiaoFeng, Liu Kai, He RongHua, Gao PuJun

2018, 34(7): 1514-1516. DOI: 10.3969/j.issn.1001-5256.2018.07.029

Abstract(1848)

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Diagnosis and treatment of idiopathic portal hypertension: A case report

Li LiangTao, Wu Bo, Wang ShouQian, Wang YingChao

2018, 34(7): 1517-1519. DOI: 10.3969/j.issn.1001-5256.2018.07.030

Abstract(1935)

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A case of large hepatocellular carcinoma treated by transcatheter arterial chemoembolization combined with radiofrequency ablation

Liu BoZhi, Yuan ZhuHui, Li Wei

2018, 34(7): 1520-1522. DOI: 10.3969/j.issn.1001-5256.2018.07.031

Abstract(1717)

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Successful treatment and clinical cure of acute-on-chronic liver failure in third trimester of pregnancy: A case report

Wang YaPing, Shi YuMing, Xu Min, Yang Zhan, Li Jing, Chen Keng, Liu HuiYuan

2018, 34(7): 1523-1525. DOI: 10.3969/j.issn.1001-5256.2018.07.032

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Clinical effect of double plasma molecular absorption system in treatment of liver failure due to hyperthyroidism: A case report

Guo XiJu, Guo WeiBo, Zhang JiaChang, Lu YaJing, Yang Yan

2018, 34(7): 1526-1528. DOI: 10.3969/j.issn.1001-5256.2018.07.033

Abstract(1902)

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Autoimmune hepatitis with thrombotic thrombocytopenic purpura: A case report

Wu Yun, Yao ZhiShan, Wang Wei

2018, 34(7): 1529-1531. DOI: 10.3969/j.issn.1001-5256.2018.07.034

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A case of hepatic sinusoidal obstruction syndrome

Hu ZhiFeng, Yin ShiWu, Pan ShengQuan, Xiang TingMiao

2018, 34(7): 1532-1534. DOI: 10.3969/j.issn.1001-5256.2018.07.035

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A case of double gallbladder malformation with obstructive jaundice

Li HongHong, Zhao Ge, Xue JunJun, Ning YaWen, Guo HongYi, Li WenLong, Guo ChunLei

2018, 34(7): 1535-1537. DOI: 10.3969/j.issn.1001-5256.2018.07.036

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Research advances in extrahepatic manifestations of chronic hepatitis C virus infection

Liu JingWen, Hao YingXia, Gao GuangZhou

2018, 34(7): 1538-1542. DOI: 10.3969/j.issn.1001-5256.2018.07.037

Abstract(1343)

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As a hepato-and lymphotropic virus, hepatitis C virus ( HCV) not only infects hepatocytes, but also replicates in extrahepatic tissues and peripheral blood mononucleated cells. Chronic HCV infection is known to be associated with a wide variety of extrahepatic manifestations, such as hematological diseases ( mixed cryoglobulinemia and non-Hodgkin lymphoma) , dermatological diseases ( lichen planu and porphyria cutanea tarda) , endocrine disorders ( diabetes mellitus and thyroiditis) , rheumatic diseases ( arthritis and sicca syndrome) , and so on. This article reviews research advances in the extrahepatic manifestations of chronic HCV infection.

Analysis of reversal factors associated with liver fibrosis/cirrhosis in patients with chronic HBV infection after achieving virologic response

Yang Yan, Zhang Xin

2018, 34(7): 1543-1546. DOI: 10.3969/j.issn.1001-5256.2018.07.038

Abstract(1383)

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Chronic hepatitis B virus ( HBV) infection can lead to varying degrees of liver fibrosis, which is an important pathological basis of liver cirrhosis. The incidence of end-stage liver diseases such as liver cirrhosis and hepatocellular carcinoma can be reduced by controlling and even reversing liver fibrosis. After achieving virologic response ( VR) to long-term anti-HBV therapy, patients with chronic HBV infection have resolution of inflammation, varying degrees of reversal of liver fibrosis and even liver cirrhosis, or even complete recovery of normal liver structure, but the specific mechanism and influencing factors remain unclear. This article reviews the recent studies on the reversal of liver fibrosis/cirrhosis after achieving VR in patients with chronic HBV infection, and summarizes the influencing factors for reversal of liver fibrosis/cirrhosis in patients with chronic HBV infection after antiviral therapy, including age, sex, host factors, viral factors, therapeutic factors, and metabolic factors, but a lot of factors still await further investigation.

Research advances in the role of coagulation factors in liver fibrosis

Li SuXin, Li LuHao, Dang XiaoWei

2018, 34(7): 1547-1550. DOI: 10.3969/j.issn.1001-5256.2018.07.039

Abstract(1248)

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Present studies on organ fibrosis including liver fibrosis show that coagulation factors and inflammatory response promote the progression of organ fibrosis, which makes people to be aware of the fact that the change in coagulation factors is not only a secondary event to liver fibrosis, and coagulation factors also play an important role in the development and progression of liver fibrosis. Recent studies have shown that most of the coagulation factors with thrombotic tendency promote liver fibrosis, while those with bleeding or hemolytic tendency inhibit liver fibrosis. Anticoagulant therapy can significantly improve or alleviate liver fibrosis, and therefore, it may provide a direction for the treatment of liver fibrosis in future. This article reviews the research advances in the role of coagulation factors in liver fibrosis.

Clinical effect of rifaximin in treatment of complications associated with liver cirrhosis

Lu: XinYue, Li Lei

2018, 34(7): 1551-1554. DOI: 10.3969/j.issn.1001-5256.2018.07.040

Abstract(1414)

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Patients with liver cirrhosis often die of complications, among which hepatic encephalopathy is the primary cause of death and upper gastrointestinal bleeding is the most common complication of liver cirrhosis. In recent years, with the continuous progress in the research on intestinal flora and inflammatory response in patients with liver cirrhosis, rifaximin, a selective oral antibacterial agent, has attracted more and more attention in China and foreign countries. This article analyzes the studies on rifaximin in the treatment of complications associated with liver cirrhosis, in order to provide reasonable suggestions for subsequent studies and clinical practice.

Current status of research on primary and secondary risk factors for esophagogastric variceal rebleeding in patients with liver cirrhosis

He Yang, Su YaRong, Han ZiYan

2018, 34(7): 1555-1559. DOI: 10.3969/j.issn.1001-5256.2018.07.041

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There are various risk factors for esophagogastric variceal bleeding ( EVB) in patients with liver cirrhosis, such as portal hypertension, thrombosis and blood coagulation in the ruptured blood vessel, sclerotic region or number of ligation points, internal environment, degree of risk of malnutrition, Child-Pugh class, the extent of varices, red color sign, severity of bleeding, and diameter of the portal vein.This article reviews the current status of research on risk factors for EVB in patients with liver cirrhosis and classifies such factors into primary and secondary risk factors, and it is pointed out that portal venous pressure, ability of rapid thrombosis in the ruptured blood vessel, presence or absence of emergency treatment, internal environment, degree of risk of malnutrition, and hepatic functional reserve are predominant risk factors for esophagogastric variceal rebleeding in patients with liver cirrhosis.

Role of immunosuppressive cells in the development and progression of hepatocellular carcinoma

Zang ChaoRan, Zhang YongHong

2018, 34(7): 1560-1564. DOI: 10.3969/j.issn.1001-5256.2018.07.042

Abstract(1546)

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Hepatocellular carcinoma ( HCC) is a major health problem around the world. The incidence rate of HCC is gradually increasing, but its early diagnostic rate remains at a low level. Most patients who present with apparent clinical symptoms have reached the advanced stage, which greatly influences the treatment outcome. In recent years, immunotherapy for HCC has attracted more and more attention, and the change in immune status during the development and progression of HCC has gradually become a research hotspot. This article elaborates on the role of immunosuppressive cells in the development and progression of HCC and points out that in-depth studies on immunosuppressive cells will provide a new direction for immunotherapy for HCC in clinical practice.

Research advances in glucocorticoids for the treatment of liver failure

Wang XiuFang, Feng GuoHe

2018, 34(7): 1565-1568. DOI: 10.3969/j.issn.1001-5256.2018.07.043

Abstract(1833)

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Abstract:
Glucocorticoids ( GCs) are widely used in the treatment of liver diseases accompanied by inflammation due to its strong anti-inflammatory and immunosuppressive effects, especially autoimmune hepatitis and cholestatic hepatitis. However, there are still controversies over the use of GCs in the treatment of liver failure among Chinese and foreign scholars. On the one hand, some scholars think that GCs can suppress immune function, cause immune dysfunction, induce bacterial and fungal infections, and thus increase mortality; on the other hand, some scholars believe that GCs can suppress immune response, reduce inflammatory response and hepatocyte necrosis, and thus protect hepatocytes and prolong survival. This article reviews the mechanism, opportune administration, and dosage of GCs in the treatment of liver failure, as well as the current status of the research on the application of GCs in liver failure of different etiologies and observation indices during application.

Research advances in autoimmune hepatitis and primary biliary cholangitis in 2017

Li ShuXiang, Duan WeiJia, Zhang Dong, You Hong, Jia JiDong

2018, 34(7): 1569-1572. DOI: 10.3969/j.issn.1001-5256.2018.07.044

Abstract(1977)

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Abstract:
Autoimmune liver diseases are a group of chronic liver injuries mediated by abnormal autoimmunity and mainly include autoimmune hepatitis ( AIH) , primary biliary cholangitis ( PBC) , and primary sclerosing cholangitis. With the continuous improvement in people's understanding of these diseases and the level of diagnosis and treatment, the incidence of autoimmune liver diseases is constantly increasing and such diseases have been taken more and more seriously by hepatologists. In 2017, new achievements have been made in the basic and clinical research on AIH and PBC, and this article reviews the research advances in these two diseases in 2017.

Association of regulatory T cells, T helper 17 cells, and change in their balance with autoimmune hepatitis

Ge KuanXue, Gao WeiHua, Xiang XiaoXing

2018, 34(7): 1573-1576. DOI: 10.3969/j.issn.1001-5256.2018.07.045

Abstract(1842)

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Abstract:
Autoimmune hepatitis ( AIH) is a chronic liver inflammatory disease, and its etiology and pathogenesis remain unclear. In recent years, abnormal immune regulation mechanism has become a research hotspot. Regulatory T ( Treg) cells and Th17 cells are two subsets of CD4+T cells and there are significant differences in function and differentiation between them. Treg/Th17 balance plays an important role in maintaining the stability of human immune system, and Treg/Th17 imbalance will cause abnormal immune response and then lead to autoimmune diseases. In-depth studies on the role of Treg and Th17 cells in the pathogenesis of AIH may provide new strategies for immunotherapy for this disease. This article reviews the change in Treg/Th17 balance in autoimmune hepatitis.

Progress in diagnosis and treatment of pyogenic liver abscess

Zhang ShunYi, Chen YueXiang

2018, 34(7): 1577-1580. DOI: 10.3969/j.issn.1001-5256.2018.07.046

Abstract(2430)

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Abstract:
Pyogenic liver abscess ( PLA) is a common hepatic infectious disease. Early, sufficient intravenous injection of sensitive antibiotics combined with percutaneous drainage has led to a decrease in the mortality of PLA in recent years. And clinicians can diagnose and locate the disease quickly with the help of imaging modalities. The changes in pathogens and their drug resistance have gradually become a new focus of research. This article analyzes the literature on PLA in recent years and, with reference to the authors' experience in clinical practice, reviews the diagnosis, etiology, and treatment of PLA.

Research advances in the diagnosis and treatment of serous microcystic adenoma of pancreas

Han Jie, Zhang YongSheng, Kong XinLiang, Sun WenBing

2018, 34(7): 1581-1584. DOI: 10.3969/j.issn.1001-5256.2018.07.047

Abstract(1785)

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Abstract:
Serous microcystic adenoma of pancreas ( SMAP) is a rare type of serous cystadenoma of the pancreas, and its major pathological features include the formation of many small sacs around the central stellate scar and glycogen-rich cubic epithelial cells with the same shape in the sacs. SMAP has a low incidence rate and misdiagnosis and mistreatment are commonly seen in clinical practice. This article describes the clinical features, pathological diagnosis, differential diagnosis, and treatment measures of SMAP, in order to further enhance the clinical diagnosis and treatment of SMAP.

2018 No. 7

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2018 No. 7

Previous Issue | Next Issue

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International Database

New media cluster

Media cluster

Open access

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