2013 No. 11

Hepatocellular adenoma: new understandings of molecular pathology and novel model of clinical diagnosis and therapy

Liu HaiPing, Cong WenMing

2013, 29(11): 801-804. DOI: 10.3969/j.issn.1001-5256.2013.11.001

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Hepatocellular adenoma ( HCA) is the most common benign hepatocellular tumor, and its causes remain unclear. In Western countries, HCA is usually seen in the women of reproductive age who have a history of long- term use of oral contraceptives ( OCs) . In the latest 2010 WHO Histological Classification of Hepatobiliary Tumors, which is mainly based on the research results in European countries, it is proposed that HCA is classified into four molecular subtypes, i. e., type I: HNF1α- inactivated HCA; type II: β- catenin- activated HCA; type III: inflammatory HCA; type IV: unclassified HCA. The research progress in the molecular pathology of HCA in foreign countries is reviewed. In addition, the main results of a recent study of 189 patients with HCA who underwent hepatectomy in our hospital are outlined. It was shown that 70% of HCA patients were middle- aged men, and 50% were overweight or obese; even female patients seldom had a history of long- term use of OCs. The gene sequencing showed that the mutational hotspots and frequency of HNF1α in this group of HCA patients were significantly different from those reported in European countries, and no β- catenin and gp130 mutations were found.Therefore, based on the above results, it is considered that the population and pathogenesis of HCA are different in China than in European countries. In light of the reports of malignant transformation of HCA in literature, a feasibility study is conducted to assess the risk of malignant transformation of HCA by detecting the microsatellite instability or loss of heterozygosity, which may provide a molecular pathological basis for developing individualized treatment strategies.

A brief discussion on pathogenesis of primary biliary cirrhosis

Wang WeiBin, Zhu YouFu

2013, 29(11): 805-809. DOI: 10.3969/j.issn.1001-5256.2013.11.002

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The pathogenesis of primary biliary cirrhosis ( PBC) is unknown. Researchers have found that monozygotic twins have a higher concordance rate for PBC than dizygotic twins, and the phenomenon of familial aggregation and the results of genome- wide association studies also demonstrate the importance of genetic factors in the pathogenesis of PBC. The epidemiological investigations and animal model experiments show that xenobiotics and infectious molecules may play a role in the pathogenesis of PBC by molecular mimicry. The appearance of highly specific serum antimitochondrial antibodies and autoreactive T cells suggests a possible autoimmune pathogenesis of PBC. The histopathological features of PBC are inflammation in the portal area and immune- mediated intrahepatic bile duct destruction. The pathogenesis of PBC is summarized from the aspects of genetic factors, environmental exposure, autoimmune response, and liver pathology, and the importance of immune imbalance is emphasized.

Genetic variation and significance of hepatitis B surface antigen

Zhang ZhenHua, Deng WanYu, Lu MengJi, Yang DongLiang

2013, 29(11): 810-815. DOI: 10.3969/j.issn.1001-5256.2013.11.003

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Hepatitis B virus ( HBV) is prone to genetic variation because there is reverse transcription in the process of HBV replication.The gene mutation of hepatitis B surface antigen may affect clinical diagnosis of HBV infection, viral replication, and vaccine effect. The current research and existing problems are discussed from the following aspects: the mechanism and biological and clinical significance of S gene mutation. Most previous studies focused on S gene alone, so S gene should be considered as part of HBV DNA in the future research on S gene mutation.

Targeted therapy of liver fibrosis on the horizon

Chen PingSheng, Liu Jing

2013, 29(11): 816-819. DOI: 10.3969/j.issn.1001-5256.2013.11.004

Abstract(2867)

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Over the past few years, significant advances have occurred in the targeted therapy of liver fibrosis. However, it is still a big challenge to deliver drugs to target cells and exert desirable therapeutic effect. The research on targeted therapy of liver fibrosis, including the types of target cells and target molecules and their selection rules, the general rules and methods for carrier selection and modification, and the evaluation of treatment outcomes and toxic or side effects, is reviewed. It is pointed out that liver fibrosis is a complex pathological process involving multiple cells, cytokines, and signaling pathways, so selecting suitable therapeutic target is the key to targeted therapy, and proper development of targeted delivery system is the guarantee for successful treatment.

Predictive value of HBcrAg for lamivudine resistance in patients with chronic hepatitis B

Liu Cheng, Mu YongPing, Yang ZongGuo, Chen XiaoRong, Lu YunFei, Xu QingNian

2013, 29(11): 820-823. DOI: 10.3969/j.issn.1001-5256.2013.11.005

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Objective To evaluate the predictive value of hepatitis B virus ( HBV) core- related antigen ( HBcrAg) for the lamivudine ( LAM) resistance in patients with chronic hepatitis B. Methods Forty- three patients with previously untreated chronic hepatitis B who were treated in the inpatient department and outpatient department from January 2009 to December 2011 were enrolled. These patients received treatment with LAM for at least 6 months and were then followed up for at least 6 months. They were divided into resistance group ( n= 21) and non- resistance group ( n = 22) according to the HBV DNA sequencing results during follow up. ALT, HBsAg, HBeAg, HBcrAg, and HBV DNA levels at different time points were measured. Comparison of continuous data between the two groups was made by independent- samples t test, and Mann- Whitney U test was used if heterogeneity of variance was identified; categorical data were analyzed by chi- square test; correlations were determined by Spearman analysis; the influential factors were determined by logistic regression analysis. Results Before treatment with LAM, there was a significant positive correlation between the HBcrAg and HBV DNA levels in peripheral blood ( Spearman correlation coefficient r = 0. 863, P < 0. 001) . After the initiation of LAM therapy, both HBcrAg and HBV DNA levels decreased, and the decrease in HBcrAg level was significantly slower and smaller than that in HBV DNA level. The logistic regression analysis showed that HBcrAg level at the end of follow- up might be an influential factor for LAM resistance ( P < 0. 01) . HBcrAg had a high predictive value for LAM resistance, with an area under the ROC curve of 0. 872 ( P < 0. 001) . Conclusion There is a significant positive correlation between HBcrAg and HBV DNA levels in peripheral blood before LAM administration, and the HBcrAg level at the end of follow-up has a high predictive value for LAM resistance in patients with chronic hepatitis B.

Efficacy and safety of pegylated interferon in patients with chronic hepatitis C in China: meta- analysis

Wang TingTing, Jiang YingAn, Yang LiHua, Zhou ZhenDong

2013, 29(11): 824-827. DOI: 10.3969/j.issn.1001-5256.2013.10.006

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Objective To evaluate the efficacy and safety of pegylated interferon in patients with chronic hepatitis C in China. Methods A search was performed using the Cochrane Central Register of Controlled Trials ( Cochrane Library, Issue 11, 2012) , OVID EBM Reviews, CNKI, and Wanfang database to identify relevant case- control studies of pegylated interferon therapy for chronic hepatitis C in China that were published from January 2002 to December 31, 2012. We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta- analysis using the Cochrane Collaboration's RevMan 5. 0 software. Results Eleven case- control studies involving 1106 patients with chronic hepatitis C were included. All included studies had a mean score of 1. 7 on the modified Jadad scale. The meta- analysis showed that the sustained virological response rate of patients was significantly higher in pegylated interferon group than in control group ( RR = 0. 49, 95% CI = 0. 43- 0. 57, P < 0. 001) . There was one study indicating a higher rate of adverse reactions in the experimental group, but other studies revealed no significantly higher rate of adverse reactions in the experimental group compared with control group; relevant meta- analysis was not performed due to the small number of patients who developed adverse reactions in both groups. Conclusion Proper use of pegylated interferon combined with ribavirin has good therapeutic efficacy in patients with chronic hepatitis C. However, its safety should be verified by more high- quality randomized controlled trials due to the limits of quantity and quality of included studies.

Genotypes of HCV in hepatitis C patients of Han nationality in Gansu, China

Peng XueBin, Mao XiaoRong, Chen Hong

2013, 29(11): 828-831. DOI: 10.3969/j.issn.1001-5256.2013.11.007

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Objective To investigate the genotypes of hepatitis C virus ( HCV) among the hepatitis C patients of Han nationality in Gansu, China, as well as their possible routes of transmission and relationship with clinical indices. Methods The complete data regarding hepatitis C, including sex, age, possible routes of transmission, HCV RNA level, and biochemical parameters, were collected from 220 hepatitis C patients of Han nationality in Gansu. Continuous data were analyzed by t test and rank sum test; categorical data were analyzed by chi-square test; multivariate logistic regression analysis was used to investigate the relationship between HCV genotypes and clinical indices. Results HCV genotype 1b was detected in 84 ( 38%) of all patients, and genotype 2a in 136 ( 62%) of these patients. The univariate analysis of 11 factors including age, sex, route of transmission, HCV RNA, alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , total bilirubin ( TBil) , indirect bilirubin ( IBil) , direct bilirubin ( DBil) , alanine phosphatase ( ALP) , and gamma- glutamyl transpeptidase ( GGT) showed that the route of transmission, ALT, and HCV RNA were correlated with HCV genotypes ( χ2= 23. 947, P < 0. 001; Z=- 3. 349, P = 0. 001; t =- 2. 325, P = 0. 021) , but age, sex, AST, TBil, IBbil, DBil, ALP, and GGT were not correlated with HCV genotypes ( P > 0. 05) . The multivariate logistic regression analysis showed that the above three factors were correlated with HCV genotypes ( χ2= 3. 993, P = 0. 046; χ2= 9. 308, P = 0. 002; χ2= 11. 652, P = 0. 001) . The number of genotype 2a patients was larger than that of genotype 1b patients among patients with high HCV RNA levels ( ≥106 IU / ml) and those with high ALT levels ( > 49 U / L) . HCV genotype 1b was more likely to be transmitted by blood transfusion and oral treatment compared with other routes. Conclusion Genotype 1b and genotype 2a are the main genotypes of HCV among the hepatitis C patients of Han nationality in Gansu, and genotype 2a is more common.Genotype 2a patients are more prone to high HCV RNA level and liver damage. In Gansu, HCV is transmitted mainly by blood transfusion, followed by oral treatment, and genotype 1b is more likely than genotype 2a to be transmitted by the two routes.

Relationship between hepatitis C virus genotypes and viral load in Chenzhou, China

Gu Bin, Huang HuiQin, Hou XiaoLan, Ning Feng, Zhang Yan, Li Lu

2013, 29(11): 832-834. DOI: 10.3969/j.issn.1001-5256.2013.11.008

Abstract(2994)

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Objective To investigate the epidemiological characteristics of hepatitis C and the genotypes of hepatitis C virus ( HCV) in Chenzhou, Hunan Province, China, and to analyze the difference in HCV RNA load between genotype 1 patients and non- genotype 1 patients. Methods Sixty hepatitis C patients with positive HCV RNA, who were from Chenzhou and received initial treatment in our hospital from March 2012 to March 2013, were included in the study. HCV RNA load and HCV genotypes were determined, and these patients were divided into genotype 1 group and non- genotype 1 group. The two groups were compared in terms of viral load. Continuous data were analyzed by t test if they were normally distributed and by rank sum test if they were not normally distributed. Results Among the 60 patients, 7 HCV genotypes were found, i. e., 1b, 3b, 6a, 3a, 2a, 2a + 3a, and 5a. Genotype 1b was the most frequent genotype, found in 25 cases ( 41. 6%) , followed by 3b and 6a ( 11 cases, 18. 3% for each) , 3a ( 6 cases, 10%) , 2a ( 4 cases, 6. 6%) , 2a +3a ( 2 cases, 3. 3%) , and 5a ( 1 case, 1. 7%) . In the genotype 1 group, 1 case had an HCV RNA level of ≤104IU / ml, 4 cases had HCV RNA levels of 104-105IU / ml, 10 cases had HCV RNA levels of 105- 106IU / ml, and 10 cases had HCV RNA levels of 106- 107IU / ml. In the non- genotype 1 group, 1 case had an HCV RNA level of ≤104IU / ml, 6 cases had HCV RNA levels of 104- 105IU / ml, 18 cases had HCV RNA levels of 105- 106IU / ml, 8 cases had HCV RNA levels of 106- 107IU / ml, and 2 cases had HCV RNA levels of ≥108IU / ml. There was no significant difference in HCV RNA load between the two groups ( Z =- 0. 302, P = 0. 763) . Conclusion In Chenzhou, genotype 1b is the major HCV genotype, followed by 3b and 6a, and other genotypes include 3a, 2a, 5a, and 2a /3a. The HCV RNA load shows no significant difference between genotype 1 patients and non- genotype 1 patients.

Effects of different anti- HIV therapies on progression of hepatitis C in HCV / HIV- coinfected patients

Sun HongQing, Huang Qin, Shen Fang, Wu Min, Zhou XiaoMing, Cai WeiPing, Hu YunWen

2013, 29(11): 835-838. DOI: 10.3969/j.issn.1001-5256.2013.11.009

Abstract(2957)

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Objective To investigate the effect of protease inhibitors ( PIs) - or non- nucleoside reverse transcriptase inhibitors ( NNRTIs) - based therapy on the progression of hepatitis C in patients with hepatitis C virus ( HCV) / human immunodeficiency virus ( HIV) coinfection. Methods A total of 273 patients initially diagnosed with HCV / HIV coinfection were enrolled and divided into PIs group ( n = 135) and NNRTIs group ( n = 138) to receive PIs- based therapy and NNRTIs- based therapy, respectively, for one year. Laboratory indices, such as HCV RNA, aspartate aminotransferase ( AST) , alanine aminotransferase ( ALT) , total bilirubin ( TBil) , albumin ( Alb) , laminin ( LN) , cholyglycine ( CG) , type III procollagen ( PCIII) , type IV collagen ( CIV) , prothrombin activity ( PTA) , and cholinesterase ( CHE) , were quantified before and after treatment. The obtained data were analyzed using SPSS 11. 5 software; enumeration data were analyzed using the Kolmogorov- Smirnov test, and non- normal data were analyzed using the Mann- Whitney U test. Results After the end of treatment, PTA, CHE, TBil, Alb, ALT, AST, CG, and LN levels were significantly higher in NNRTIs group than in PIs [PTA: 77% ( 67%-109%) vs 68% ( 56%-91%) ; CHE: 6717. 00 U/L ( 5951. 00-7622. 00 U/L) vs 5862. 00 U/L ( 4392. 00- 8539. 25 U/L) ;TBil: 10. 95 μmol / L ( 8. 10- 14. 32 μmol / L) vs 8. 60 μmol / L ( 8. 00- 9. 50 μmol / L) ; Alb: 43. 90 mmol / L ( 39. 65- 48. 20 mmol / L) vs 38. 90 mmol / L ( 36. 00- 45. 00 mmol / L) ; ALT: 52. 50 U / L ( 30. 00- 93. 50 U / L) vs 36. 20 U / L ( 30. 30- 40. 40 U / L) ; AST: 49. 00U /L ( 33. 00- 80. 00 U / L) vs 31. 30 U / L ( 29. 70- 38. 70 U / L) ; CG: 16. 78 μg / ml ( 3. 26- 29. 32 μg / ml) vs 3. 26 μg / ml ( 1. 02-6. 88 μg / ml) ; LN: 34. 40 ng / ml ( 16. 71- 46. 54 ng / ml) vs 34. 05 ng / ml ( 33. 42- 64. 33 ng / ml) ; P < 0. 01 or P < 0. 05]. Conclusion NNRTIs- based therapy can accelerate the progression of hepatitis C in HCV / HIV- coinfected patients.

Therapeutic effect of autologous bone marrow stem cell transplantation through portal vein or hepatic artery in treatment of decompensated liver cirrhosis: a comparative study

Wang Fang, Kou JunFeng, Yun ShengHao, Cai GuoFang, Wang KeJing, Yang XingKun

2013, 29(11): 844-847. DOI: 10.3969/j.issn.1001-5256.2013.11.011

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Objective To conduct a comparative study on the therapeutic effect and safety of autologous bone marrow stem cell transplantation through the portal vein or hepatic artery in the treatment of decompensated liver cirrhosis. Methods A retrospective analysis was performed on the clinical data of 50 patients with decompensated liver cirrhosis who were hospitalized from December 2006 to May 2012. In addition to basic treatment, 25 of these patients underwent ultrasound- guided percutaneous liver puncture and autologous bone marrow stem cell transplantation through the portal vein ( portal vein group) , and the rest underwent radiology- guided femoral artery catheterization and autologous bone marrow stem cell transplantation through the proper hepatic artery ( hepatic artery group) . There were no significant differences in baseline conditions between the two groups. At 2, 4, and 8 weeks after operation, alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , total bilirubin ( TBil) , and albumin ( Alb) levels and prothrombin time activity ( PTA) were measured, and improvements in symptoms and adverse events were evaluated.Comparisons between the two groups were made by independent- samples t test; comparisons between values before and after treatment were made by paired t test; categorical data were analyzed by chi- square test. Results Twenty- two cases ( 88. 0%) of the portal vein group showed significant improvements in fatigue and poor appetite, versus 21 cases ( 84. 0%) of the hepatic artery group ( P > 0. 05) . At 8 weeks after operation, the portal vein group and hepatic artery group had serum Alb levels of 34. 4 ± 7. 8 g / L and 33. 8 ± 8. 0 g / L, significantly higher than the values before operation ( 27. 1 ± 8. 9 g / L and 26. 8 ± 9. 6 g / L) ( P < 0. 05 for both) , but there was no significant difference between the two groups ( P > 0. 05) ;the two groups had PTAs of 58. 0% ± 13. 1% and 56. 9% ± 12. 8%, significantly higher than the values before operation ( 45. 5% ± 12. 3%and 47. 0% ± 11. 6%) ( P < 0. 05 for both) , but there was no significant difference between the two groups ( P > 0. 05) . The treatment led to no significant changes in ALT, AST, and TBil levels in either group ( P > 0. 05 for all) . The portal vein group and hepatic artery group had alpha- fetoprotein levels of 10. 3 ± 5. 9 ng / ml and 8. 9 ± 4. 3 ng / ml at 8 weeks after operation, without significant difference between the two groups ( P >0.05) . No severe adverse reactions or complications occurred in either group. Conclusion Autologous bone marrow stem cell transplantation through the portal vein or hepatic artery is safe and effective in the treatment of decompensated liver cirrhosis, and there is no significant difference in therapeutic effect between the two procedures.

Effect of autologous bone marrow- derived mesenchymal stem cells on portal hemodynamics in patients with liver cirrhosis

Shang JianZhong, Ma LongFei, Ma HongWei, Zhao QiuFang, Zhao LinHua, Li XiaoFei, Fan YanFeng, Zhang SuE

2013, 29(11): 848-851. DOI: 10.3969/j.issn.1001-5256.2013.10.012

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Objective To observe the effect of autologous bone marrow- derived mesenchymal stem cells ( BMMSCs) on the portal hemodynamics in patients with hepatitis B virus ( HBV) - related decompensated cirrhosis. Methods Forty- six patients with HBV- related decompensated cirrhosis, who were admitted to the hospital from February 2011 to January 2012, were divided into treatment group ( n = 23) and control group ( n = 23) . There were no significant differences in sex, age, diagnosis, biochemical parameters, and imaging findings between the two groups. All patients provided informed consent prior to treatment. Both groups received antiviral, liver- protecting, and diuretic treatment. In addition, in the treatment group, bone marrow ( 200 ml) was drawn from each patient, BMMSCs were isolated, purified, and cultured, and the cultured cells were processed into cell suspension ( 10 ml) ; the cell suspension was injected into the liver via the hepatic artery. After 8 and 12 weeks of treatment, the changes in portal hemodynamic parameters were evaluated. The obtained data were analyzed using SPSS 13. 0 software; the paired t test was used for within- group comparisons. Results After 8 and 12 weeks of treatment, in the treatment group, the diameter of portal vein ( DPV) was significantly decreased to 13. 26 ± 1. 31 mm ( t = 2. 290, P < 0. 05) and 12. 83 ±1. 38 mm ( t = 3. 421, P < 0. 01) , and the diameter of splenic vein ( DSV) was significantly decreased to 8. 39 ± 1. 38 mm ( t = 2. 079, P <0. 05) and 8. 02 ± 1. 24 mm ( t = 2. 787, P < 0. 01) ; compared with the control group, the treatment group had significantly lower DPV ( t =2. 382, P < 0. 05; t = 2. 602, P < 0. 05) and DSV ( t = 3. 236, P < 0. 01; t = 4. 185, P < 0. 01) . After 8 and 12 weeks of treatment, in the treatment group, the portal vein maximum velocity ( PVX) was significantly increased to 20. 72 ± 4. 63 cm / s ( t = 2. 833, P < 0. 01) and20. 58 ± 3. 46 cm / s ( t = 3. 198, P < 0. 01) ; compared with the control group, the treatment group had significantly higher PVX ( t = 2. 530, P < 0. 05; t = 3. 123, P < 0. 01) . Conclusion Autologous BMMSCs can significantly improve the portal hemodynamics in patients with HBV- related decompensated cirrhosis.

Predictive factors for mortality in patients with alcoholic cirrhosis

Xie YanDi, Feng Bo, Gao Yan, Wei Lai

2013, 29(11): 852-857. DOI: 10.3969/j.issn.1001-5256.2013.10.013

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Objective To describe the clinical characteristics of alcoholic cirrhosis ( AC) , analyze the relationship of alcohol intake with development of AC, and compare the predictive values of biochemical parameters, complications, Child- Turcotte- Pugh ( CTP) score, Model for End- Stage Liver Disease ( MELD) score, and Discriminant Function ( DF) score for in- hospital mortality or mortality within 3months after discharge in patients with AC. Methods A retrospective statistical analysis was performed on the clinical data of 159 patients with a discharge diagnosis of AC, who were hospitalized in the Department of Hepatology from January 2000 to December 2011. Their medical records and baseline information were collected. The logistic regression analysis was used to analyze the risk factors for mortality. Three prediction models for mortality from AC were established, and the predictive capacities of the models were compared using receiver operating characteristic ( ROC) curves. Results ( 1) The risk factors for AC included an alcohol intake higher than 80 g / d ( OR = 2. 807, P <0. 05) and more than 10 years of alcohol use ( OR = 3. 429, P < 0. 028) . ( 2) Model 1 consisted of serum creatinine, white blood cell count, international normalized ratio, and number of complications, which was defined as the number of complications such as gastrointestinal hemorrhage, infection, hepatic encephalopathy, and hepatocellular carcinoma. Model 2 consisted of MELD score. Model 3 consisted of number of complications and MELD score. In predicting in- hospital mortality, Model 1, Model 2, and Model 3 had areas under the ROC curve ( AUCs) of 0. 950 ( P < 0. 001) , 0. 886 ( P < 0. 001) , and 0. 911 ( P < 0. 001) , respectively. In predicting mortality within 3 months after discharge, Model 1, Model 2, and Model 3 had AUCs of 0. 867 ( P < 0. 001) , 0. 878 ( P < 0. 001) , and 0. 893 ( P < 0. 001) , respectively. Conclusion The risk of AC rises as the alcohol intake and years of alcohol use increase. As to the predictive values for mortality in patients with AC, MELD score is better than CTP and DF scores, and Model 1 and Model 3 have good predictive capacities.

Species of pathogens and drug selection in liver cirrhosis patients with sepsis

Zhang Lan, Cui EnBo, Bao ChunMei, Zhang JuLing, Wang Huan, Chen SuMing, Zhang ChengLong, Mao YuanLi, Qu Fen

2013, 29(11): 858-862. DOI: 10.3969/j.issn.1001-5256.2013.11.014

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Objective To identify the species of pathogens in liver cirrhosis patients with sepsis and screen out the effective antibiotics, and to provide a basis for effective clinical antimicrobial therapy. Methods Blood samples were collected from liver cirrhosis patients with suspected bloodstream infections and were then injected into the blood culture bottles at the bedside. Blood was cultured using the BacT / Alert3D system. The isolated strains were identified by the Vitec II or API system ( BioMerieux, France) . Drug susceptibility tests were performed by Kirby- Bauer method. The pathogens and effective drugs in recent 10 years were analyzed. Results A total of 8543 strains of pathogens were isolated from various samples in recent 10 years, and 2065 ( 24. 2%) of them were detected from cultured blood, including1233 ( 59. 7%) Gram- negative bacillus strains, 787 ( 38. 1%) Gram- positive coccus strains, 28 ( 1. 4%) fungal strains, and 17 ( 0. 8%) other pathogenic strains. The drug sensitivity tests showed that Gram- negative bacteria had relatively low resistance to meropenem ( 7. 46%) , imipenem ( 6. 49%) , and amikacin ( 5. 27%) , extended spectrum beta- lactamase ( ESBL) - producing strains were more resistant to beta- lactam antibiotics except carbapenems and cefmetazole than ESBL- negative strains, and Gram- positive bacteria were100% sensitive to vancomycin and teicoplanin. Conclusion Gram- negative bacteria are the main pathogens of bloodstream infections in liver cirrhosis patients in our hospital. The pathogens are characterized by diversity and high resistance to many antibiotics. In clinical practice, antimicrobial drugs should be properly used according to the species and drug sensitivity of pathogens, so as to improve the cure rate, and the changing trends in the species and drug sensitivity of pathogens need to be continuously monitored.

Clinicopathological features of hepatocellular lymphoepithelioma- like carcinoma: case report and review of the literature

Li GuiMei, Yang ZhiHui, Gao Hong, Yin ZhengJin

2013, 29(11): 871-873. DOI: 10.3969/j.issn.1001-5256.2013.11.017

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The research in liver tissue pathology of chronic HBV infection patients

Shang DanHe, Chen YanPing, Li ChunYan

2013, 29(11): 874-877. DOI: 10.3969/j.issn.1001-5256.2013.11.018

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Histopathological examination of the liver is the most direct method for evaluating the pathological changes of the liver in patients with chronic hepatitis B virus ( HBV) infection. Generally, the patients with chronic HBV infection who show normal or slightly elevated serum alanine transaminase ( ALT) levels ( < 2 × ULN) are considered to have mild hepatic fibrosis or inflammation. However, in recent years, many scholars have found that some patients with serum ALT levels below 2 × ULN have severe pathological changes. The relationship between clinical features and pathological changes of the liver in patients with chronic HBV infection is reviewed, and the pathological and clinical features of chronic HBV infection patients with serum ALT levels below 2 × ULN are understood systematically. Age, sex, HBeAg status, HBV DNA level, and ALT level are considered to have certain relationship with these features. Monitoring of these factors is helpful for comprehensive evaluation of pathological changes of the liver in patients with chronic HBV infection.

Research progress in role of augmenter of liver regeneration in the liver

Shi HongBo, Duan ZhongPing

2013, 29(11): 878-881. DOI: 10.3969/j.issn.1001-5256.2013.11.019

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Recent studies have found that augmenter of liver regeneration ( ALR) not only promotes liver regeneration and protects the liver from damage, but may also play an important role in the formation and development of the liver. The recent progress in research on the biological function and action mechanism of ALR in the liver is reviewed, and the application of ALR in the diagnosis and treatment of liver diseases is summarized. It is suggested that ALR may regulate hepatocyte apoptosis through the mitochondrial pathway to promote liver repair and regeneration. In the future, ALR may be used as a candidate for evaluating liver regeneration and prognosis in patients with liver failure.ALR holds promise as an effective medicine for treating severe liver disease and liver failure.

Relationship between laboratory parameters and liver pathology in patients with nonalcoholic steatohepatitis

Chang BinXia, Teng GuangJu, Sun Ying, Zhao Jun, Zhang Wei, Huo DanDan, Zheng RuiDan, Zou ZhengSheng, Li BaoSen

2013, 29(11): 839-843. DOI: 10.3969/j.issn.1001-5256.2013.11.010

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Objective To investigate the relationship between laboratory parameters and pathological features of the liver in patients with nonalcoholic steatohepatitis ( NASH) and to provide some information for the diagnosis and prognosis of NASH. Methods A retrospective analysis was performed on the clinical data of 206 patients with a histological diagnosis of NASH who were admitted to our hospital from May2008 to December 2011. Laboratory parameters such as alanine aminotransferase ( ALT) and aspartate aminotransferase ( AST) and liver pathology were analyzed statistically. The data on varying degrees of steatosis, inflammation, and fibrosis of the liver were analyzed using the independent- samples t test or one- way analysis of variance, and correlations were determined by Spearman analysis. Results There were significant differences in ALT, AST, and lactate dehydrogenase ( LDH) between patient groups with different degrees of steatosis, inflammation, or fibrosis ( P < 0. 05 for all) , significant differences in white blood cell ( WBC) and alanine phosphatase ( ALP) between patients groups with different degrees of steatosis or fibrosis ( P < 0. 05 for all) , and significant differences in mean corpuscular volume ( MCV) , platelet ( PLT) , albumin ( Alb) , cholinesterase ( CHE) , gamma globulin electrophoresis ( γ- EP) , and glucose ( Glu) between patient groups with different degrees of steatosis ( P < 0. 05 for all) . Correlations existed between the degrees of steatosis and inflammation, between the degrees of steatosis and fibrosis, and between the degrees of inflammation and fibrosis ( r = 0. 261, P < 0. 05; r = 0. 561, P < 0. 05; r =0. 353, P < 0. 05) . Conclusion ALT, AST, and LDH are significantly correlated with the degrees of steatosis, inflammation, and fibrosis, WBC and ALP are significantly correlated with the degrees of steatosis and fibrosis, and MCV, PLT, Alb, CHE, γ- EP, and Glu are significantly correlated with the degree of steatosis.

Effects of silencing glypican- 3 gene transcription on proliferation and apoptosis of hepatoma cells

Tai BoJun, Yao Min, Gu Xing, Shi Yun, Yu DanDan, Chen Jie, Zheng WenJie, Yao DengFu, Lu ShaoLin

2013, 29(11): 863-866. DOI: 10.3969/j.issn.1001-5256.2013.10.015

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Objective To investigate the effects of silencing glypican-3 ( GPC-3) gene transcription by shRNA on the proliferation and apoptosis of hepatoma cells. Methods GPC- 3- shRNA was inserted into pGPU6 / GFP/ Neo vector, and HepG2 cells were transfected with the vector.The mRNA and protein expression of GPC- 3 was measured by fluorescence quantitative PCR and Western blot; the proliferation of HepG2 cells was evaluated by MTT assay; the cell cycle and apoptosis of HepG2 cells were analyzed by flow cytometry, Annexin- V- PE /7- AAD staining, and apoptotic DNA ladder kit. Results After the HepG2 cells were transfected with GPC- 3- shRNA, the GPC- 3 mRNA silencing rate was up to 89. 3%, in accordance with the down- regulation of GPC- 3 protein; the proliferation inhibition rate of HepG2 cells was as high as 71. 1%; the HepG2 cells were arrested in G1 phase, and the apoptosis rate of HepG2 cells reached 65. 6%. Conclusion Silencing GPC- 3 gene transcription by shRNA can significantly inhibit the proliferation and promote the apoptosis of hepatoma cells.

Roles of indocyanine green clearance test and 13C- methacetin breath test in assessing liver function in acute liver injury: a comparative study

Mao JingYi, Li Xin, Wang Chen, Xu YouQing

2013, 29(11): 867-870. DOI: 10.3969/j.issn.1001-5256.2013.11.016

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Abstract:
Objective To conduct a comparative study of indocyanine green ( ICG) clearance test and13C- methacetin breath test (13C- MBT) in assessing the liver function in acute liver injury. Methods Forty- eight male Sprague- Dawley rats were randomly divided into control group and 6, 12, 24, 48, and 72 h model groups. The rats in control group were intraperitoneally injected with saline, while the rats in model groups were intraperitoneally injected with D- galactosamine ( 450 mg / kg) to establish an acute liver injury model. The pathological score of liver tissue, ICG retention rate at 15 minutes ( ICG R15) , and parameters of13C- MBT, such as duration to peak of13CO2delta over baseline ( DOB) curve ( T max) , maximum metabolization velocity ( MV max) , cumulative excretion at 120 min ( CUM120) , and maximum DOB ( DOB max) were monitored.Comparison between groups was made by one- way analysis of variance; pairwise comparison of means between samples was made by SNK- q test;correlation between two variables was analyzed by Pearson's correlation test. Results Compared with the control group, all model groups showed significantly increased pathological scores ( P < 0. 05) and significantly decreased MV max, CUM120, and DOB max ( P <0.05) . Pathological score was positively correlated with T max ( r =0.593, P <0.05) and negatively correlated with MV max, CUM120, and DOB max ( r =-0.731, -0.618, and-0.592, P < 0. 05 for all) . Compared with the control group, the 12, 24, and 48 h model groups had significantly increased ICG R15 ( P < 0. 05) , but there was no significant difference in ICG R15 between the 6, 12 h model group and control group ( P > 0. 05) . Conclusion Both13C- MBT and ICG clearance test can be used as the effective tools for monitoring the liver function in acute liver injury.13C- MBT is more sensitive than ICG clearance test in the early diagnosis of acute liver injury.

2013 No. 11

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International Database

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2013 No. 11

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International Database

New media cluster

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Hepatobiliary College

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