2020 No. 1

Current status and perspectives of integrated traditional Chinese and Western medicine therapy for hepatobiliary and pancreatic diseases

Jiang ShiLi, Liu Ping

2020, 36(1): 10-13. DOI: 10.3969/j.issn.1001-5256.2020.01.001

Abstract(1154)

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Abstract:
Integrated traditional Chinese and Western medicine therapy is important feature and advantage of clinical medicine in China.This article reviews the recent advances in the clinical and basic research on hepatobiliary and pancreatic diseases,with a focus on the common diseases such as liver fibrosis,nonalcoholic fatty liver disease,chronic cholecystitis and cholelithiasis,and critical diseases including severe pancreatitis,liver cirrhosis,and pancreatic cancer. We hope to objectively reflect the understanding of hepatobiliary and pancreatic diseases in traditional Chinese medicine,the current status and development trend of integrated traditional Chinese and Western medicine therapy,and existing problems,in order to provide a reference for further improvement of clinical therapeutic level.

Gut microecology: An important target of traditional Chinese medicine in the treatment of nonalcoholic fatty liver disease

Li HongShan, Hu YiYang

2020, 36(1): 14-18. DOI: 10.3969/j.issn.1001-5256.2020.01.002

Abstract(1256)

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Gut microecology plays an important role in the pathogenesis of nonalcoholic fatty liver disease. With reference to the research on traditional Chinese medicine in regulating gut microecology and treating nonalcoholic fatty liver disease,this article systematically elaborates on the association of nonalcoholic fatty liver disease with intestinal flora,gut bacterial metabolites,and gut barrier function and points out that the regulation of gut microecology and the maintenance of intestinal homeostasis are important measures for traditional Chinese medicine in the treatment of nonalcoholic fatty liver disease.

Prediction of acute-on-chronic liver failure and integrated traditional Chinese and Western medicine therapy

Wang XianBo, Zhang Qun, Gao FangYuan

2020, 36(1): 19-25. DOI: 10.3969/j.issn.1001-5256.2020.01.003

Abstract(1223)

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Acute-on-chronic liver failure(ACLF) is a reversible and complex clinical syndrome caused by various factors in patients with pre-existing chronic liver diseases,with the clinical features of acute liver function decompensation and high short-term mortality rate.ACLF has a complex pathogenesis,rapid progression,and a dangerous prognosis,and early and accurate prediction of prognosis is of vital importance. At present,there is still no ideal therapy for ACLF,and in recent years,integrated traditional Chinese and Western medicine therapy has achieved a certain effect in the treatment of this disease. This article reviews the advances in prognostic evaluation and integrated traditional Chinese and Western medicine therapy for ACLF,in order to provide guidance to prognostic evaluation of ACLF and selection of the regimens of integrated traditional Chinese and Western medicine therapy.

Biochemical response and integrated traditional Chinese and Western medicine therapy for primary biliary cholangitis

Wang XiaoJing, Liu Yao, Wang XianBo

2020, 36(1): 26-30. DOI: 10.3969/j.issn.1001-5256.2020.01.004

Abstract(1255)

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Primary biliary cholangitis(PBC) is an immune-mediated chronic and progressive intrahepatic cholestasis disease. Treatment with ursodeoxycholic acid(UDCA) can significantly improve the prognosis of patients with PBC,but some patients still have poor response to UDCA,which is the main risk factor for disease progression. Several evaluation models and scoring systems based on biochemical response have been applied to screen out patients with poor response in clinical practice. Integrated traditional Chinese and Western medicine therapy for PBC has certain advantages in improving the symptoms,liver biochemistry,fibrosis indices,and biochemical response rate of PBC patients and thus holds promise for clinical application; however,further improvement is needed for experimental design and efficacy evaluation.

Minimally invasive integrated traditional Chinese and Western medicine therapy for hepatolithiasis based on the SELECT concept

Shang Dong, Zhang GuiXin, Zhang QingKai

2020, 36(1): 31-35. DOI: 10.3969/j.issn.1001-5256.2020.01.005

Abstract(1318)

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Hepatolithiasis is difficult to treat in clinical practice and has high recurrence rate and incidence rate of complications,improper diagnosis and treatment can easily lead to hepatic insufficiency,and thus it has become one of the difficult problems to be solved in clinical practice. With the improvement of medical equipment and the wide application of various minimally invasive endoscopic techniques,most patients with hepatolithiasis can receive effective treatment. Traditional Chinese medicine therapy can prevent the recurrence of calculi and promote patients' recovery during the perioperative period. Based on the SELECT(Spyglass,ERCP,Laparoscopy,EUS,Choledochoscopy,Traditional Chinese Medicine) concept,minimally invasive treatment with a combination of various endoscopies should be selected according to the type and clinical features of hepatolithiasis and integrated traditional Chinese and Western medicine therapy should be given in the perioperative period to realize the minimally invasive,diversified,and individualized integrated traditional Chinese and Western medicine therapy for hepatolithiasis.

An excerpt of screening for hepatitis B virus infection in pregnant women: US Preventive Services Task Force reaffirmation recommendation statement (2019)

Wang XiaoXiao, Song AiXin, Chen XinYue

2020, 36(1): 44-46. DOI: 10.3969/j.issn.1001-5256.2020.01.008

Abstract(235)

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An excerpt of screening for pancreatic cancer: US Preventive Services Task Force reaffirmation recommendation statement (2019)

Jiang Qi, Zhou Wei, Zou DuoWu, Li ZhaoShen

2020, 36(1): 47-49. DOI: 10.3969/j.issn.1001-5256.2020.01.009

Abstract(410)

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An excerpt of radiation therapy for pancreatic cancer: Executive summary of an ASTRO clinical practice guideline (2019)

Liu YueChen, Gu MengYu, Cheng Yu, Yang GuiYuan

2020, 36(1): 50-52. DOI: 10.3969/j.issn.1001-5256.2020.01.010

Abstract(207)

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An excerpt of ACG clinical guideline: Hereditary hemochromatosis (2019)

Luo Min, Liu YiHan, Deng ZeBin, Yang BinYi, Liu NingYuan, Huo JiRong

2020, 36(1): 53-56. DOI: 10.3969/j.issn.1001-5256.2020.01.011

Abstract(262)

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Interpretation of expert consensus on application of choledochoscope in diagnosis and treatment of hepatolithiasis (2019 edition)

Guo Peng, Bie Ping

2020, 36(1): 57-58. DOI: 10.3969/j.issn.1001-5256.2020.01.012

Abstract(389)

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Comments on “2019 Chinese practice guideline for the prevention and treatment of hepatitis B virus mother-to-child transmission”

Zhou YiHua, Li Tong, Zhuang Hui

2020, 36(1): 59-61. DOI: 10.3969/j.issn.1001-5256.2020.01.013

Abstract(408)

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Recently,the Society of Infectious Diseases of Chinese Medical Association and Chinese GRADE Center jointly released the“2019 Chinese practice guideline for the prevention and treatment of hepatitis B virus mother-to-child transmission”. We concerned several issues in the Guideline,including the improper citation of some references,no recommendations for some key strategies for the prevention of hepatitis B virus mother-to-child transmission,insufficient or even lack of evidence for some recommendations and others. Based on the principle of academic contention,we present in this article our comments on the Guideline to discuss these issues with the Guideline's authors and readers.

Response to the article of “comments on 2019 Chinese practice for the prevention and treatment of hepatitis B virus mother-to-child transmission”

Liu JinFeng, Chen TianYan, Chen YaoLong, Zhao YingRen

2020, 36(1): 62-64. DOI: 10.3969/j.issn.1001-5256.2020.01.014

Abstract(237)

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Change in the expression of peripheral blood lymphocyte subsets during disease progression in patients with chronic hepatitis B virus infection

Weng FengWu, Guo LiYing, Li QiuWei, Li Li, Zhao LiCong, Sun XiaoXue, Yin MeiJun, Jia JianWei

2020, 36(1): 65-69. DOI: 10.3969/j.issn.1001-5256.2020.01.015

Abstract(1122)

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Objective To investigate the change in the expression of peripheral blood lymphocyte subsets during disease progression in patients with chronic hepatitis B virus(HBV) infection. Methods A total of 132 patients with chronic HBV infection who were hospitalized in Tianjin Second People's Hospital from January 2018 to April 2019 were enrolled,and among these patients,47 had chronic hepatitis B,44 had hepatitis B cirrhosis(cirrhosis group),and 41 had hepatitis B cirrhosis-related primary liver cancer(liver cancer group). A total of 42 healthy individuals who underwent physical examination during the same period of time were enrolled as control group. Flow cytometry was used to measure the accurate counts of peripheral blood lymphocyte subsets,and the expression of peripheral blood lymphocyte subsets was compared between the four groups. A Welch analysis of variance was used for comparison of normally distributed continuous data with heterogeneity of variance between groups,and the Games-Howell test was used for further comparison between two groups. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups. The chi-square test was used for comparison of categorical data between groups. A Spearman correlation analysis was used to investigate correlation. Results Compared with the control group and the chronic hepatitis B group,the cirrhosis group and the liver cancer group had significant reductions in the numbers of CD3+and CD4+T cells(all P < 0. 05). Compared with the control group,the liver cancer group had a significant reduction in the number of CD8+T cells(P < 0. 05); compared with the chronic hepatitis B group,the cirrhosis group and the liver cancer group had a significant reduction in the number of CD8+T cells(both P < 0. 05). Compared with the control group and the chronic hepatitis B group,the cirrhosis group and the liver cancer group had a significant reduction in the number of CD19+B cells(all P < 0. 05). Compared with the control group,the cirrhosis group and the liver cancer group had a significant reduction in the number of CD16+CD56+natural killer(NK) cells(both P < 0. 05); compared with the chronic hepatitis B group,the liver cancer group had a significant reduction in the number of CD16+CD56+NK cells(P < 0. 05). In the four groups,disease progression was negatively correlated with peripheral blood CD3+T cells,CD4+T cells,CD8+T cells,CD19+B cells,and CD16+CD56+NK cells(r =-0. 414,-0. 503,-0. 269,-0. 435,and-0. 402,all P < 0. 01).Conclusion In patients with chronic HBV infection,immune status changes with disease progression. Accurate counting of peripheral blood lymphocyte subsets can reflect the immune status of the body and can thus be used as a reference for evaluating clinical evolution,treatment outcome,and prognosis of chronic HBV infection.

Features of KIR gene polymorphisms in unpaid blood donors with occult hepatitis B infection

Zhang Tao, Mao Wei, Wang DongFang, Jiang YuLin, Yang DanRong, Yin Dan, Yang Hu, Ou YangXiongYan, Tan QianQian

2020, 36(1): 70-75. DOI: 10.3969/j.issn.1001-5256.2020.01.016

Abstract(1028)

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Objective To investigate the KIR gene polymorphisms and their features in unpaid blood donors with occult hepatitis B infection(OBI). Methods A total of 105 unpaid blood donors with OBI were screened out from the unpaid blood donors in Chongqing Blood Center from 2016 to 2019. Peripheral blood samples were collected for DNA extraction and KIR genotyping. KIR genotype ID and haplotype were determined based on a comparative analysis of the KIR genotype database published on the international allele website. Genotype frequency was calculated according to the equation of genotype frequency( F) = ,in which f represented the proportion of a phenotype of KIR gene. The chi-square test was used for comparison of categorical data between groups. Results All 105 OBI blood donors had the KIR genes 2 DL4,3 DL2,3 DL3,and pseudogene 3 DP1. The KIR genes 2 DL1,2 DL3,3 DL1,2 DS4,and pseudogene 2 DP1 had an F value of > 70%,among which the KIR gene 2 DS4 with exon 5 deletion had an F value of 26. 32%. The KIR genes with low frequency(< 30%)were 2 DL2,2 DL5,2 DS1,2 DS2,2 DS3,2 DS5,and 3 DS1. Compared with the Han population in Chongqing,Hebei,and Jiangsu and the Tibetan population in Lasa,the OBI blood donors had a significantly lower frequency of the KIR 2 DL3 gene(χ~2= 9. 598,12. 236,13. 719,and 10. 974,all P < 0. 05). There were significant differences in the frequencies of 2 DL2,2 DL5,2 DS2,and 2 DS3 between the OBI blood donors and the Uyghur population in Urumqi(χ~2= 16. 215,6. 981,19. 498,and 11. 819,all P < 0. 05). There were significant differences in the frequencies of 2 DL2,2 DS1,2 DS2,2 DS3,and 2 DS4 between the OBI blood donors and the Caucasians(χ~2= 22. 477,3. 877,34. 937,6. 909,and 4. 271,all P < 0. 05). Compared with the Han population in Chongqing,the OBI blood donors had a significant increase in the frequency of KIR 2 DS4* del(χ~2= 12. 911,P < 0. 05). Compared with the population with chronic HBV infection,the OBIblood donors had significant reductions in the frequencies of 2 DS2 and 2 DS3(χ~2= 13. 005 and 8. 289,P < 0. 05) and significant increases in the frequencies of 2 DS4 and 3 DL1(χ~2= 10. 032 and 3. 865,P < 0. 05). Compared with the population with ankylosing spondylitis,the OBI blood donors had significant reductions in the frequencies of 2 DL3 and 2 DS3(χ~2= 7. 851 and 16. 504,P < 0. 05). Compared with the gays with HIV-AIDS,the OBI blood donors had significant increases in the frequencies of 2 DS4 and 3 DL1(χ~2= 15. 491 and 4. 475,P <0. 05). There were significant differences in the frequencies of 2 DL1,2 DL2,2 DL3,2 DL4,2 DL5,2 DS4,3 DL2,3 DL3,and 2 DP1 between the OBI blood donors and the population with sporadic acute hepatitis E(χ~2= 4. 448,30. 934,17. 942,15. 638,4. 227,13. 802,32. 667,35. 653,and 36. 566,P < 0. 05). A total of 21 KIR genotypes were found,among which genotype AA1 had the highest frequency of 49. 52%,followed by genotype Bx2(18. 1%). Conclusion OBI blood donors have unique features of KIR gene polymorphisms. KIR2 DL3 is a potential protective gene for OBI,while KIR 2 DS4 * del is a potential susceptibility gene for OBI.

Effect of interferon-α and thymopentin on the mRNA expression of APOBEC3A and APOBEC3B in HepG2.2.15 cells

Xiong Fang, Gao Yao, Ma YanPin, Yu LeLe, Tan BingQin, Bao XuLi, Lu: Jun

2020, 36(1): 76-79. DOI: 10.3969/j.issn.1001-5256.2020.01.017

Abstract(1016)

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Objective To investigate the effect of synergistic intervention of interferonα(IFNα) and thymopentin(TP5) on the mRNA expression of apolipoprotein B mRNA editing enzyme,catalytic polypeptide-like 3 A(APOBEC3 A) and apolipoprotein B mRNA editing enzyme,catalytic polypeptide-like 3 B(APOBEC3 B) in HepG2. 2. 15 cells. Methods HepG2. 2. 15 cells were divided into blank control group,IFNα treatment group,TP5 treatment group,and IFNα + TP5 treatment group,and at 12,24,48,and 72 hours of treatment,quantitative real-time PCR was used to measure the mRNA expression of APOBEC3 A and APOBEC3 B in HepG2. 2. 15 cells. An analysis of variance was used for comparison of continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups. Results Compared with the blank control group,the IFNα treatment group and the IFNα + TP5 treatment group had a significant increase in the mRNA expression of APOBEC3 A at 12,24,48,and 72 hours of treatment(all P < 0. 001). Compared with the IFNα treatment group,the IFNα + TP5 treatment group had a significant increase in the mRNA expression of APOBEC3 A at these four time points(all P < 0. 001). TP5 treatment had no significant influence on the mRNA expression of APOBEC3 A at each time point(all P > 0. 05). There was no significant difference in the mRNA expression of APOBEC3 B between the blank control group and the treatment groups(all P > 0. 05). Conclusion IFNα combined with TP5 can significantly upregulate the mRNA expression of APOBEC3 A in HepG2. 2. 15 cells.

Clinical efficacy and safety of sofosbuvir tablets combined with ribavirin in treatment of treatment-nave patients with genotype 2 chronic hepatitis C virus infection

Song GuangJun, Rao HuiYing, Li GuangMing, Guo XiaoLin, Jia ZhanSheng, Zhang MingXiang, Jia JiDong, Jiang XiangJun, Zheng SuJun, Zhao YingRen, Shang Jia, Yang XingXiang, Cai DaChuan, Nan YueMin, Wang FuSheng, Mao Qing, Xie Yao, Qin Hong, Wei Lai

2020, 36(1): 80-83. DOI: 10.3969/j.issn.1001-5256.2020.01.018

Abstract(1486)

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Objective To investigate the clinical efficacy and safety of sofosbuvir combined with ribavirin in the treatment of treatment-naive patients with genotype 2 chronic hepatitis C virus(HCV) infection. Methods Treatment-naive patients with genotype 2 HCV infection were screened in sixteen research centers of China. All patients received sofosbuvir(400 mg/tablet,1 tablet/d) combined with ribavirin(1000 mg/d for patients with a body weight of < 75 kg and 1200 mg/d for those with a body weight of ≥75 kg) for 12 weeks and were followed up for 12 weeks after drug withdrawal. The primary outcome measure was sustained virologic response at week 12 of follow-up,and the secondary outcome measures included the proportion of patients with HCV RNA below the lower limit of quantitation at weeks 2,4,8,and 12 of treatment and after 4 weeks of drug withdrawal,virological rebound rate at weeks 4,8,and 12 of treatment,and recurrence rate at weeks 4 and 12 of follow-up. Adverse events were observed during treatment to evaluate drug safety. Results A total of 136 subjects were enrolled,among whom 121 had no liver cirrhosis and 15 had compensated liver cirrhosis. The sustained virologic response(SVR) ratewas 92. 6%(95% confidence interval: 88. 3%-97. 0%) after 12 weeks of drug withdrawal. At week 8 of treatment,1 patient experienced virological rebound; after 4 weeks of drug withdrawal,8 patients experienced virological rebound; after 12 weeks of drug withdrawal,10 patients experienced virological rebound. Among the 136 subjects,128(94. 1%) reported 549 cases of treatment-emergent adverse events,among which 243 cases were associated with sofosbuvir and/or ribavirin and were reported in 99 subjects(72. 8%). No adverse events leading to the adjustment or discontinuation of sofosbuvir were observed. A total of 7 serious adverse events were reported in 6 patients(4. 4%),among which only one(a low echo area in the liver with unknown nature) was considered possibly associated with sofosbuvir and/or ribavirin. No adverse events leading to study discontinuation or death were observed. Conclusion Sofosbuvir combined with ribavirin can achieve a high SVR rate in treatment-na6 ve patients with genotype 2 chronic HCV infection,with mild adverse reactions and acceptable safety profile.

Effect of different direct-acting antivirals on the clinical outcome of genotype 1b chronic hepatitis C and compensated hepatitis C cirrhosis

Hou YiHui, Liu TengFei, Zhao XiaoQing, Zhang LiaoYun

2020, 36(1): 84-87. DOI: 10.3969/j.issn.1001-5256.2020.01.019

Abstract(1227)

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Objective To investigate the effect of different direct-acting antivirals(DAAs) on the clinical outcome of genotype 1 b chronic hepatitis C(CHC) and compensated liver cirrhosis(CLC). Methods A total of 115 patients with genotype 1 b CHC and CLC who were treated in Department of Infectious Diseases in The First Hospital of Shanxi Medical University from January to December,2018 were enrolled as subjects,among whom there were 91 patients with CHC and 24 patients with CLC. All patients were given antiviral therapy with DAAs according to their conditions. Among the patients with CHC,28 were treated with sofosbuvir and velpatasvir(SOF + VEL),21 were treated with elbasvir and grazoprevir tablets(EBR + GZR),16 were treated with ombitasvir and dasabuvir(OBV + DSV),13 were treated with sofosbuvir and daclatasvir(SOF + DCV),and 13 were treated with sofosbuvir and ribavirin(SOF + RBV); among the 24 patients with CLC,15 were treated with sofosbuvir and velpatasvir(SOF + VEL),4 were treated with elbasvir and grazoprevir tablets(EBR + GZR),and5 were treated with sofosbuvir and daclatasvir(SOF + DCV). The two groups were compared in terms of normalization rate of liver function and virologic response rate,and adverse drug reactions were observed. 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 Of all patients,90. 4% achieved super-rapid virologic response at 1 week of treatment,98. 2% achieved rapid virologic response at week 4 of treatment,100% achieved complete early virologic response at week 12 of treatment,and 100% achieved sustained virologic response at week 12 after the end of treatment.There was no significant difference in HCV RNA seroconversion rate between the patients receiving different antiviral treatment regimens at weeks 1 and 4 of treatment(χ2= 2. 83 and 0. 07,P > 0. 05). All antiviral treatment regimens significantly improved the liver function of patients,and there was no significant difference in clinical outcome between different groups(χ2= 0. 83 and 1. 23,P > 0. 05). Both groups had no significant increase or reduction in renal function parameters after 12 weeks of the treatment with DAAs(t = 1. 32 and 0. 56,P >0. 05). There was a low incidence rate of adverse events,with two cases of nausea(1. 74%) and one case each of dizziness,palpitation,rash,and hemolysis(0. 87%). Conclusion In patients with genotype 1 b disease,DAA antiviral regimens selected based on their conditions can achieve good virologic response rate,with significant improvement in liver function and a low incidence rate of adverse events.

Epidemiological features of positive anti-HCV among the HIV-infected population in Guangxi,China

Chen Xu, Su MingHua, Jiang JianNing, Liu ZhiHong, Wei Qi, Wu FeiFei, Zhou Yi, Teng ChunLing

2020, 36(1): 88-93. DOI: 10.3969/j.issn.1001-5256.2020.01.020

Abstract(1182)

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Objective To investigate the epidemiological status and features of anti-HCV positive rate among the HIV-infected population in Guangxi,China. Methods The patients from Guangxi who attended 7 hospitals in Guangxi form 2010 to 2016 and were confirmed with positive HIV antibody were enrolled as subjects. Their demographic data,anti-HCV test results,and route of HIV-HCV coinfection were collected. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups,and the Bonferroni method was used for multiple comparisons of sample rates. Since dependent variables were binary variables,the binary univariate and multivariate logistic regression analyses were performed. Results A total of 6154 patients with positive HIV antibody were enrolled,among whom 409(6. 65%; 95% confidence interval [CI]: 6. 03%-7. 27%) had positive HCV antibody. Male patients had a significantly higher anti-HCV positive rate than female patients(7. 97% vs 3. 57%,χ2= 29. 294,P < 0. 01). The age group of 18-44 years had the highest anti-HCV positive rate of 10. 47%,followed by the age group of 45-59 years(5. 44%),and these two groups had a significantly higher positive rate than the other age groups based on pairwise comparison(all P < 0. 01). Intravenous drug users had the highest anti-HCV positive rate of 75. 12%,followed by the intravenous drug users with sexual contact(70. 00%),and the patients with these two routes of infection had a significantly higher anti-HCV positive rate than those with other routes(all P < 0. 01). In the patients with positive HIV and HCV antibodies,intravenous drug users accounted for a higher proportion than the patients with other routes of infection; 72. 30% of the male patients were intravenous drug users,while 57. 58% of the female patients were infected via sexual transmission,and there was a significant difference in the distribution of the routes of infection between the male and female patients(P < 0. 01). The age group of 18-44 years had the highest proportion of intravenous drug users(71. 58%),followed by the age group of 45-59 years(63. 27%),and these twogroups had a significantly higher proportion than the other age groups based on pairwise comparison(all P < 0. 01). The age group of 60-80 years had a significantly higher proportion of patients with sexual transmission than the other age groups based on pairwise comparison(all P < 0. 01). The logistic regression analysis showed that for the patients with HIV infection,the risk of intravenous drug use and HCV infection was 60. 385 times(95% CI: 7. 909-461. 017) that of the other routes of infection,and the risk of intravenous drug use + sexual contact and HCV infection was 46. 667 times(95% CI: 4. 144-525. 501) that of the other routes of infection(P < 0. 01). Conclusion The anti-HCV positive rate remains high among the patients with HIV infection in Guangxi,and male patients have a higher anti-HCV positive rate than female patients. Young individuals have a higher anti-HCV positive rate than the other age groups. Among the male population and the young and middle-aged population,intravenous drug use is the main route of HIV/HCV infection,while in the female population and the elderly population,sexual contact is the main route of infection. Intravenous drug use is an independent risk factor for HIV-HCV coinfection.

Full-length sequencing and baseline resistance-associated substitution of hepatitis C virus subtype 3b

Huang JieTing, Xu Ru, Liao Qiao, Wang Min, Dan ZhenGang, You QingZhu, Rong Xia, Fu YongShui

2020, 36(1): 94-97. DOI: 10.3969/j.issn.1001-5256.2020.01.021

Abstract(1099)

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Objective To investigate the application of next-generation sequencing(NGS) in determining the full-length sequence and baseline resistance-associated substitution(RAS) of hepatitis C virus(HCV) subtype 3 b. Methods Nucleic acid was extracted from plasma of a HCV RNA-positive blood donor,and after sequence-independent amplification,a sequencing library was constructed and NGS was performed using Illumina Hiseq. Bioinformatics methods were used to analyze full-length HCV sequence,viral genotype,and baseline RAS to direct-acting antivirals(DAAs). Results A total of 8. 4 Gb data with more than 56 million reads were obtained. The full-length HCV sequence was obtained by bioinformatics analysis,with an average sequencing depth of 488 007 and a genotype of 3 b subtype. A total of 12 RASs were identified in HCV amino acid sequence,i. e.,Y56 H,Q80 K,Q80 R,and A156 G located in NS3,M28 G,Q/A30 G,Q/A30 K,L31 F,L31 M,and Y93 H located in NS5 A,and S282 T and V321 A located in NS5 B,among which Q/A30 K and L31 M located in NS5 A had high frequencies of 99. 16% and 98. 37%,respectively,while the other 10 RASs had low frequencies of < 0. 5%.Conclusion NGS can be used to determine the full-length sequence and genotype of HCV subtype 3 b and identify baseline RASs,which has great significance in the epidemiological study of HCV subtype 3 b and the development of DAA treatment regimens.

Value of hepatitis E virus nucleic acid,antigen,and antibodies in the diagnosis of hepatitis E virus infection

Li XiaoHe, Wang JiangHua, Ji Ying, Liu Yan, Zhu Ling, Jia YuYuan, Wang ZhenYu, Shi YiJun, Zhang HaiYing, Rao HuiYing

2020, 36(1): 98-101. DOI: 10.3969/j.issn.1001-5256.2020.01.022

Abstract(1218)

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Objective To investigate the role of hepatitis E virus nucleic acid(HEV RNA),hepatitis E virus antigen(HEV Ag),hepatitis E virus antibodies(HEV IgM antibody and HEV IgG antibody) in the clinical diagnosis of hepatitis E virus infection. Methods A total of13 992 specimens,for which the detection of HEV IgM antibody and HEV IgG antibody were performed in Peking University People's Hospital,were collected,among which 1924 had positive HEV IgM antibody or HEV IgG antibody. Quantitative real-time PCR was used to determine HEV RNA and HEV genotype,and enzyme-linked immunosorbent assay was used to detect HEV Ag,HEV IgM antibody,and HEV IgG antibody and measure the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),and direct bilirubin(DBil). The non-parametric rank sum Mann-Whitney U test was used for comparison of continuous data between groups. Results Among the 1924 specimens with positive HEV IgM antibody or HEV IgG antibody,152(7. 9%) had positive HEV IgM antibody,1897(98. 6%) had positive HEV IgG antibody,62(3. 2%) had positive HEV RNA,and 55(2. 9%) had positive HEV Ag. Among the 152 specimens with positive HEV IgM antibody,62(40. 8%) had positive HEV RNA,and 55(36. 2%) had positive HEV Ag,and among the 62 specimens with positive HEV RNA,55(88. 7%) had positive HEV Ag. The HEV RNA-positive group with 62 specimens had significantly higher levels of ALT,AST,TBil,and DBil than the HEV RNA-negative group with 90 specimens(Z =-7. 609,-6. 942,-5. 815,and-6. 130,all P < 0. 001),and the HEV Ag-positive group with 55 specimens had significantly higher levels of ALT,AST,TBil,and DBil than the HEV Ag-negative group with 97 specimens(Z =-6. 413,-5. 786,-5. 199,and-5. 545,all P < 0. 001). Nested PCR amplification and sequencing showed that in the HEV RNA-positive group with 62 specimens,58 had positive HEV RNA and 4 had negative HEV RNA. The high level of positive HEV IgG antibody significantly reduced the S/CO value of HEV Ag detection and even yielded a negative result.Conclusion Compared with HEV antibodies,HEV Ag can improve the diagnostic level of hepatitis E and has certain clinical significance.High levels of aminotransferases or bilirubin can help with the diagnosis of hepatitis E. The high level of HEV IgG antibody may reduce the detection value of HEV Ag,and attention should be paid to HEV IgG antibody value when HEV Ag is negative.

Stability of FibroTouch in determining liver stiffness measurement and controlled attenuation parameter

Zhao XiaoBo, Yu Jing, Zhang ZhenHua, Zou GuiZhou

2020, 36(1): 102-106. DOI: 10.3969/j.issn.1001-5256.2020.01.023

Abstract(1407)

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Abstract:
Objective To investigate the stability of FibroTouch(FT) in the determination of liver stiffness measurement(LSM) and controlled attenuation parameter(CAP). Methods A total of 309 patients with chronic hepatitis B virus(HBV) infection,nonalcoholic fatty liver disease(NAFLD),liver function abnormalities,or other diseases who underwent FT in the outpatient service of Department of Hepatology,The Second Affiliated Hospital of Anhui Medical University,were enrolled. FT was performed at three different measurement points for the same subject,and intraclass correlation coefficient(ICC) and the Bland-Altman method were used to evaluate the stability of measured values. The Kendall's W test and pie charts were used to evaluate the stability of diagnostic results. Results LSM and CAP values of the three different measurement points for the same subject had an ICC of > 0. 75 in different disease groups(all P < 0. 001),among which the chronic HBV infection group had the highest ICC of LSM of 0. 905,the other disease group had the highest ICC of CAP of 0. 805,the NAFLD group had the lowest ICC of LSM of 0. 785 and the lowest ICC of CAP of 0. 780. The Bland-Altman plots were generated for the three measurement points,and the dots within the limits of agreement accounted for about 95%. The diagnostic results of LSM and CAP staging of the three measurement points had a Kendall's W coefficient of 0. 825 and 0. 858,respectively(all P < 0. 001). The proportion of patients with consistency between the diagnostic results for F≥2 stage(LSM > 7. 3 k Pa) and mild(or more severe) fatty liver stage(CAP >240 dB/m) based on mean value of measurement points and all three measurement points was > 60%,while the proportion of patients with consistency between the diagnostic results based on mean value of measurement points and only one measurement point was < 10%. Conclusion The values and diagnostic results of FT measurement have good stability; however,in order to improve its stability in diagnosing F ≥2 stage and mild(or more severe) fatty liver,it is suggested to use the mean value of multiple measurement points for diagnosis.

Clinical application of hepatic venous pressure gradient measurement after esophagogastric variceal bleeding in guiding secondary prevention for patients with liver cirrhosis

Lu Zheng, Jin Bo, Zhang WenHui, Zhang JunHua, Chi ChunSheng, Wu LiBing, Yan LiPing, Liu Bo, Han JingJing, Ma XueMei, Wang YanLing, Han Jun, Yu XiaoLi, Wu Qin, Duan XueZhang, Li HanWei

2020, 36(1): 107-112. DOI: 10.3969/j.issn.1001-5256.2020.01.024

Abstract(1251)

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Abstract:
Objective To investigate the basis for the selection of secondary prevention with endoscopy or transjugular intrahepatic portosystemic shunt(TIPS) after esophagogastric variceal bleeding and the value of hepatic venous pressure gradient(HVPG) in clinical decision-making. Methods A retrospective analysis was performed for 148 patients who had an HVPG of above 12 mm Hg after esophagogastric variceal bleeding and received secondary prevention with endoscopy or TIPS in The Fifth Medical Center of Chinese PLA General Hospital from January 2016 to February 2018. According to related guidelines,HVPG > 18 mm Hg was a high-risk factor for esophagogastric variceal rebleeding,and the patients were divided into medium pressure group(HVPG 12-18 mm Hg) with 78 patients and high pressure group(HVPG > 18 mm Hg) with 70 patients. Clinical features and endoscopic findings were summarized for both groups. The patients were further divided into four groups with an HVPG of 12-16 mm Hg, > 16-18 mm Hg, > 18-20 mm Hg,and > 20 mm Hg,respectively,and the four groups were compared in terms of the safety and efficacy of secondary prevention,with focuses on rebleeding and prognosis. The two-independent-samples 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 Kruskal-Wallis H test was used for comparison of ranked data between groups. Results Before secondary prevention,there were no significant differences between the medium pressure group and the high pressure group in hemoglobin,platelet,albumin,bilirubin,creatinine,blood ammonia,prothrombin time,Child-Pugh score,and Model for End-Stage Liver Diseasescore,and the medium pressure group had a significantly higher proportion of patients with opening of collateral circulation than the high pressure group(67. 95% vs 50. 00%,χ2= 11. 250,P = 0. 004). There was no significant difference in the LDRf type of esophageal and gastric varices between the two groups. The high pressure group had a significantly higher proportion of patients who selected TIPS than the medium pressure group(28. 57% vs 10. 26%,χ2= 8. 067,P = 0. 005). After secondary prevention,the mean follow-up time was 28. 66 ±11. 20 months,and no serious complications were observed. No patients experienced the progression of liver cirrhosis,and there was an improvement in ascites. Rebleeding rate within 1 year after secondary prevention with endoscopy tended to increase with the increase in HVPG,and 41. 03% of the patients with HVPG > 20 mm Hg underwent the preventive treatment for the second time within 1 year. Secondary prevention with endoscopy had a good clinical effect in the patients with an HVPG of 12-16 mm Hg,with a rebleeding rate of 14. 63% within1 year. The patients with an HVPG of > 20 mm Hg who underwent secondary prevention with TIPS had a significantly lower rebleeding rate within 1 year than those who underwent secondary prevention with endoscopy(10% vs 34. 48%). Conclusion It is recommended to select secondary prevention for variceal bleeding based on HVPG,develop a follow-up plan for patients with different HVPG values after secondary prevention,and give individualized treatment.

Value of Child-Pugh score versus albumin-bilirubin grade in predicting the prognosis of unresectable hepatocellular carcinoma treated by transarterial chemoembolization

Wang ZheXuan, Wang EnXin, Xia DongDong, Bai Wei, Wang QiuHe, Yuan Jie, Li XiaoMei, Niu Jing, Guo WenGang, Li Kai, Yin ZhanXin, Han GuoHong

2020, 36(1): 113-117. DOI: 10.3969/j.issn.1001-5256.2020.01.025

Abstract(1360)

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Abstract:
Objective To investigate the ability of Child-Pugh score versus albumin-bilirubin(ALBI) grade in predicting the overall survival of hepatocellular carcinoma(HCC) patients with good liver function undergoing transarterial chemoembolization(TACE). Methods A retrospective analysis was performed for the clinical data of 185 patients with unresectable HCC who underwent TACE in Xijing Hospital of Digestive Diseases,Air Force Medical University,from January 2010 to December 2014,including epidemiological data(age,sex,and etiology),laboratory parameters(routine blood test results,hepatic and renal function,and coagulation function),and imaging data(tumor size and number). Overall survival time was calculated,and Child-Pugh score and ALBI grade were determined based on baseline data and laboratory results. Risk stratification was performed based on Child-Pugh score and ALBI grade,the Kaplan-Meier method was used to plot survival curves,and the log-rank test was used to compare overall survival. The Cox regression model was used to analyze risk factors.The time-dependent receiver operating characteristic(ROC) curve and C-index were used to compare the ability of Child-Pugh score and ALBI grade in predicting survival. Results According to Child-Pugh score,the patients with 5 points had a median survival time of25. 3 months(95% confidence interval [CI]: 20. 1-30. 5 months),and those with 6 points had a median survival time of 8. 6 months(95% CI: 7. 5-16. 9 months); there was a significant difference between them(P = 0. 002). According to ALBI grade,the patients with ALBI grade 1 had a median survival time of 29. 1 months(95% CI: 25. 9-32. 3 months),and those with ALBI grade 2 had a median survival time of 15. 1 months(95% CI: 12. 7-17. 6 months); there was a significant difference in survival tine between them(P < 0. 001).ECOG score,tumor size,number of tumors,alpha-fetoprotein,aspartate aminotransferase,albumin,total bilirubin,Child-Pugh score,and ALBI grade were associated with survival(all P < 0. 05). The three analytical models showed that after the adjustment for hazard ratio(HR) in the multivariate analysis,albumin(HR = 0. 93,95% CI: 0. 90-0. 97,P < 0. 001),bilirubin(HR = 1. 04,95% CI: 1. 02-1. 06,P < 0. 001),Child-Pugh score(HR = 1. 75,95% CI: 1. 18-2. 59,P = 0. 005),and ALBI grade(HR = 1. 82,95% CI: 1. 29-2. 59,P = 0. 001) independently predicted the overall survival of the patients. The time-dependent ROC curve analysis showed that the ability of Child-Pugh score in predicting survival tended to decrease over the time of observation,while the ability of ALBI grade remained relatively stable. These two systems had a similar ability in predicting survival within 12 months,while ALBI grade had a better ability than Child-Pugh score thereafter. Child-Pugh score had a slightly lower C-index than ALBI grade [0. 57(95% CI: 0. 53-0. 60) vs 0. 63(95% CI: 0. 57-0. 68) ]. Conclusion Both ALBI grade and Child-Pugh score can be used for prognostic stratification of HCC patients undergoing TACE alone,but ALBI grade has a better long-term predictive ability than Child-Pugh score.

Pathogen distribution and drug resistance in liver cancer patients with liver abscess after transarterial chemoembolization or ablation

Cai MiaoTian, Liang LianChun

2020, 36(1): 118-122. DOI: 10.3969/j.issn.1001-5256.2020.01.026

Abstract(1100)

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Objective To investigate the pathogen distribution characteristics and drug resistance in patients with liver abscess after transarterial chemoembolization(TACE) or ablation for liver cancer,and to provide a basis for rational use of antibacterial agents in clinical practice. Methods A retrospective analysis was performed for the results of the strains isolated from liver pus and blood culture and drug sensitivity test of the liver cancer patients who were admitted to Beijing YouAn Hospital from January 2011 to December 2018 and developed liver abscess after TACE/ablation. The Chi-square test was used for comparison of categorical data between groups. Results A total of 49 patients were enrolled,with 15 in TACE group and 34 in ablation group. A total of 35 strains of pathogenic organisms were detected in the TACE group,and Gram-negative bacteria,Gram-positive bacteria,and fungi accounted for 54. 3%,40%,and 5. 7%,respectively; Klebsiella pneumoniae,Enterococcus faecium,and Pseudomonas aeruginosa were the main pathogenic bacteria isolated from liver pus culture,and Enterococcus faecalis,Escherichia coli,and Citrobacter were the main pathogenic bacteria isolated from blood culture. A total of 64 strains of pathogenic organisms were detected in the ablation group,and Gram-negative bacteria,Gram-positive bacteria,and fungi accounted for 59. 4%,39. 1%,and 1. 6%,respectively; Escherichia coli,Klebsiella pneumonia,and Enterococcus faecalis were the main pathogenic bacteria isolated from liver pus culture,and Klebsiella pneumoniae,Escherichia coli,and Enterococcus faecalis were the main pathogenic bacteria isolated from blood culture. Drug susceptibility results showed that in the strains of Klebsiella pneumoniae and Escherichia coli,the ESBL-producing strains accounted for 26. 3%(5/19) and 43. 8%(7/16),respectively,and the carbapenem-resistantstrains accounted for 10. 5%(2/19) and 12. 5%(2/16),respectively. Klebsiella pneumoniae had a drug resistance rate of ≤10. 5% to third-generation cephalosporins,quinolones,aminoglycosides,piperacillin/tazobactam,and carbapenems,and Escherichia coli had a drug resistance rate of 43. 8%-62. 5% to the tested cephalosporins,quinolones,and penicillins,18. 8% to piperacillin/tazobactam,and 12. 5%to carbapenems. In the strains of Enterococcus faecium and Enterococcus faecalis,the vancomycin-resistant strains accounted for 13. 3%(2/15) and 0,respectively,and the linezolid-resistant strains accounted for 13. 3%(2/15) and 28. 6%(2/7),respectively,while no teicoplanin-resistant strains were detected. Conclusion Klebsiella pneumoniae,Escherichia coli,Enterococcus faecium,and Enterococcus faecalis are the main pathogenic bacteria of liver abscess after TACE/ablation for liver cancer,and drugs should be selected based on drug susceptibility results to reduce drug-resistant strains.

Establishment and evaluation of a predictive model for short-time prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure

Hu Hui, Huang BeiBei, Ning Ling, Jiang ShouWei, Shen Qiang, Liu Lei, Li Lei

2020, 36(1): 123-127. DOI: 10.3969/j.issn.1001-5256.2020.01.027

Abstract(1128)

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Abstract:
Objective To investigate the predictive factors for short-term(12-week) survival and prognosis of patients with hepatitis B virus(HBV)-related acute-on-chronic liver failure(HBV-ACLF),and to establish a new predictive model. Methods Related clinical data were collected from 67 patients who were diagnosed with HBV-ACLF in The Affiliated Provincial Hospital of Anhui Medical University from April 2015 to August 2018,and according to their survival at 12-week follow-up after diagnosis,they were divided into survival group with 28 patients and death group with 39 patients. Their clinical data were collected,including sex,age,total bilirubin(TBil),international normalized ratio(INR),creatinine(Cr),serum sodium,platelet count(PLT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(Alb),serum cystatin C(CysC),and presence or absence of acute kidney injury(AKI). The t-test was used for comparison of normally distributed continuous data between two groups,and the Wilcoxon rank-sum test was used for comparison of continuous data with skewed distribution between two groups; the chi-square test was used for comparison of categorical data between groups; logistic regression was used to perform the factorial analysis and establish a predictive model; the receiver operator characteristic(ROC) curve was used to evaluate the predictive model,and the method by DeLong et al. was used to compare the area under the ROC curve(AUC). Results The death group had significantly higher age,TBil,INR,CysC,and Model for End-Stage Liver Disease(MELD) score than the survival group,and the patients with AKI had a significantly lower short-term survival rate than those without AKI(all P < 0. 05). TBil(odds ratio [OR]= 1. 013,95% confidence interval [CI]: 1. 003-1. 024,P = 0. 014),INR(OR = 6. 857,95%CI: 1. 449-32. 449,P = 0. 015),CysC(OR = 2. 826,95% CI: 1. 001-7. 983,P = 0. 050),and PLT(OR = 0. 982,95% CI: 0. 964-1. 000,P = 0. 048) were independent predictive factors for patient survival. A TICP model was established with the combination of TBil,INR,CysC,and PLT,and there was a significant difference in AUC between the TICP model and MELD score[0. 879(95% CI: 0. 776-0. 946) vs 0. 760(95% CI: 0. 644-0. 859),Z = 2. 708,P = 0. 007]. Compared with MELD score,the TICP model had significantly better accuracy(87. 05% vs 67. 16%),sensitivity(84. 62% vs 56. 41%),and Youden index(0. 70 vs 0. 42). Conclusion TBil,INR,CysC,and PLT are independent influencing factors for short-term prognosis of HBV-ACLF patients,and the TICP predictive model with the combination of these four indices has a good value in predicting the short-term survival and prognosis of HBV-ACLF patients.

Predisposing factors for acute-on-chronic liver failure and their influence on prognosis

Yang ShuJuan, Tian Zhen, He YingLi, Zhao YingRen, Zhang Jing, Lu: HengYi, Song HongBo

2020, 36(1): 128-131. DOI: 10.3969/j.issn.1001-5256.2020.01.028

Abstract(1119)

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Objective To investigate the prognosis of patients with acute-on-chronic liver failure(ACLF) caused by different predisposing factors and the change in these factors within the past 10 years. Methods A retrospective analysis was performed for the clinical data of 537 ACLF patients who were hospitalized and treated in The First Affiliated Hospital of Xi'an Jiantong University and Xi'an Eighth Hospital from January 2008 to December 2017,including age,sex,etiology,predisposing factors,and prognosis(improvement/death),and the 28-day mortality rate was calculated. The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. A Cox regression analysis was used to evaluate the influence of different predisposing factors on 28-day mortality rate. Results Among the 537 patients with ACLF,511(95. 16%) had HBV-related ACLF,3(0. 56%) had HCV-related ACLF,2(0. 37%) had alcoholic hepatitis-related liver failure,18(3. 35%) had an unclassified type,1(0. 19%) had overlapping infection of HBV and HCV,and 2(0. 37%) had ACLF associated with primary biliary cirrhosis. Among the 537 patients with ACLF,34. 8%had no predisposing factors,17. 1% did not receive standard treatment,16% had HBV-ACLF due to the withdrawal of nucleos(t) ide analogues(NAs),9. 7% had alcohol consumption,6. 9% had infections,3% had a history of surgery,and 3% had a history of medication causing liver injury. There was a significant difference in 28-day mortality rate between the patients without predisposing factors and those with the predisposing factor of surgery,infection,or withdrawal of NAs(χ2= 8. 553,11. 351,and 4. 274,all P < 0. 05). Surgery(hazard ratio[HR]=2. 132,95% confidence interval [CI]: 1. 240-3. 664,P = 0. 006) and infection(HR = 1. 942,95% CI: 1. 262-2. 989,P =0. 003) were independent risk factors for ACLF and death in patients with chronic liver diseases. As for the change in predisposing factors in the recent 10 years,the proportion of patients with drug-induced ACLF in the last five years was significantly higher than that in the first five years(χ2= 6. 365,P < 0. 05). Conclusion ACLF patients with the predisposing factors of surgery,infection,and withdrawal of NAs have a higher 28-day mortality rate than those without these predisposing factors. Surgery and infection are independent risk factors for death in patients with ACLF. There is an increase in the proportion of patients with drug-induced ACLF in the recent 5 years.

Clinical and pathological features of hepatomegaly of unknown origin: An analysis of 87 cases

Yu SiMiao, Cui YanFei, Tian Miao, Su PengYu, Zhang Ning, Zhu Yun, Wang LiFu, Sun YongQiang, Jing Jing, Sang XiuXiu, Xu WenTao, Wang LiPing, Wang RuiLin

2020, 36(1): 132-135. DOI: 10.3969/j.issn.1001-5256.2020.01.029

Abstract(1275)

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Objective To investigate the common etiology and clinical features of hepatomegaly of unknown origin. Methods A retrospective analysis was performed for the clinical data of 87 patients with hepatomegaly of unknown origin who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from January 2009 to December 2018,including sex,age,clinical symptoms,signs,and laboratory markers. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups and further comparison between two groups. For categorical variables,the chi-square test was used for comparison of categorical data between groups. Results Among the 87 patients,2(2. 30%) had unknown etiology,and 85(97. 70%) had a confirmed diagnosis based on pathology,among whom 18(20. 69%) had non-hepatotropic viral hepatitis,8(9. 20%) had chronic drug-induced liver injury,and 22(25. 29%) had glycogen storage disease. There were significant differences in age,sex,alanine aminotransferase,aspartate aminotransferase,white blood cell count,and platelet count between the non-hepatotropic viral hepatitis group,the chronic drug-induced liver injury group,and the glycogen storage disease group(χ2= 5. 80,10. 34,16. 85,18. 69,10. 02,12. 76,all P < 0. 05). According to the results of pathological examination,the patients with glycogen storage disease had typical plant cell-like arrangement with positive results of PAS staining; the patients with chronic drug-induced liver injury had disordered lobular structure and mixed inflammatory cell infiltration with a majority of polymorphonuclear leukocytes in the hepatic sinusoids; the patients with non-hepatotropic viral hepatitis mainly had liver parenchymal inflammation,disordered lobular structure,and pseudolobular structure in the early stage. Conclusion Hepatomegaly of unknown origin has complex etiologies,with inherited metabolic diseases as the most common cause,mainly glycogen storage diseases. Other causes such as non-hepatotropic viral hepatitis and chronic drug-induced liver injury arealso important causes of hepatomegaly of unknown origin.

Correlation of intestinal flora with serum glucagon-like peptide-1 level in patients with nonalcoholic fatty liver disease

Liu ZhiPing, Zhao ZhiWei, Zhang JinHua

2020, 36(1): 136-139. DOI: 10.3969/j.issn.1001-5256.2020.01.030

Abstract(1094)

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Objective To investigate the correlation of intestinal dysbacteriosis with serum glucagon-like peptide-1(GLP-1) level in patients with nonalcoholic fatty liver disease(NAFLD). Methods A total of 116 patients with NAFLD who attended Wuhan Hankou Hospital from January to December 2018,were enrolled as NAFLD group,and 96 healthy individuals who underwent physical examination in our hospital during the same period of time were enrolled as control group. Fresh feces samples were collected from all subjects and bacterial culture was performed; the change in intestinal flora was analyzed,and the Bifidobacterium-Escherichia coli(B/E) ratio was calculated to evaluate the colonization resistance of intestinal flora. The two groups were compared in terms of the changes in body mass index(BMI),triglyceride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),fasting plasma glucose(FPG),fasting insulin(FINS),Homeostasis Model Assessment of Insulin Resistance(HOMA-IR),serum GLP-1 level,number of intestinal bacteria,and B/E ratio. The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. Pearson correlation analysis and partial correlation analysis were performed. Results Compared with the control group,the NAFLD group had significantly higher levels of BMI(24. 76 ±2. 93 kg/m2 vs 22. 35 ± 2. 54 kg/m2,t = 6. 327,P < 0. 05),TG(1. 15 ± 0. 65 mmol/L vs 0. 93 ± 0. 62 mmol/L,t = 2. 504,P < 0. 05),TC(4. 06 ± 1. 02 mmol/L vs 3. 71 ± 1. 15 mmol/L,t = 2. 347,P < 0. 05),LDL-C(2. 76 ± 0. 93 mmol/L vs 2. 33 ± 0. 87 mmol/L,t =3. 450,P < 0. 05),FINS(15. 17 ± 7. 39 m IU/L vs 12. 74 ± 6. 81 m IU/L,t = 2. 469,P < 0. 05),HOMA-IR(2. 58 ± 1. 38 vs 2. 14 ±1. 25,t = 2. 411,P < 0. 05),Enterobacter(9. 56 ± 1. 85 log cfu/g vs 8. 38 ± 1. 92 log cfu/g,t = 4. 544,P < 0. 05),Enterococcus(8. 12 ±1. 47 log cfu/g vs 7. 66 ± 1. 54 log cfu/g,t = 2. 219,P < 0. 05),and Staphylococcus(7. 54 ± 1. 22 log cfu/g vs 7. 03 ± 1. 18 log cfu/g,t =3. 075,P < 0. 05),as well as significantly lower levels of serum GLP-1(6. 95 ± 2. 74 pmol/L vs 8. 06 ± 2. 86 pmol/L,t =-2. 878,P <0. 05),Bifidobacterium(8. 87 ± 1. 76 log cfu/g vs 9. 71 ± 1. 86 log cfu/g,t =-3. 371,P < 0. 05),Lactobacillus(8. 31 ± 1. 55 log cfu/g vs 8. 97 ± 1. 57 log cfu/g,t =-3. 068,P < 0. 05),Bacteroides(8. 66 ± 1. 21 log cfu/g vs 9. 23 ± 1. 34 log cfu/g,t =-3. 251,P <0. 05),and B/E ratio(0. 96 ± 0. 17 vs 1. 15 ± 0. 15,t =-8. 539,P < 0. 05). Serum GLP-1 level was positively correlated with B/E ratio(r = 0. 604,P < 0. 05) and was negatively correlated with BMI,TG,TC,LDL-C,and HOMA-IR(r =-0. 551,-0. 424,-0. 386,-0. 445,and-0. 503,all P < 0. 05). After the control for BMI,TG,TC,LDL-C,and HOMA-IR,serum GLP-1 level was still positively correlated with B/E ratio(r = 0. 576,P < 0. 05). Conclusion The reduction in serum GLP-1 level is correlated with intestinal dysbacteriosis in patients with NAFLD.

Establishment of a rat model of nonalcoholic steatohepatitis and histopathological changes of the pancreas and the kidney

Song QingLian, Tan YuE, Liu JingJing, Yuan BeiBei, Li Min, He LiQin, Dai GuangRong

2020, 36(1): 140-144. DOI: 10.3969/j.issn.1001-5256.2020.01.031

Abstract(931)

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Objective To establish a rat model of nonalcoholic steatohepatitis,and to investigate the histopathological changes of the extrahepatic organs of the pancreas and the kidney. Methods A total of 20 Sprague-Dawley rats were selected,among which 6 were randomly selected as the observation group(group B). The remaining 14 rats were paired into seven groups according to body weight,then a random number table was used to select 1 rat from each group and assign them into the experimental group(group C),and the remaining 7 rats were assigned to the control group(group A). The rats in groups B and C were given high-fat diet,while those in group A were given a normal diet. In group B,two rats each were killed at weeks 4,8,and 12 of the experiment,liver tissue was extracted for HE staining,and liver pathological sections were observed under a microscope to see whether steatohepatitis was achieved. The model was successfully established at the end of week 12. All rats in groups A and C were sacrificed,and the serological markers alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transpeptidase(GGT),triglyceride(TG),total cholesterol(TC),low-density lipoprotein(LDL),glucose(GLU),insulin(INS),and homeostasis model assessment of insulin resistance(HOMA-IR) were measured. HE staining was performed for liver tissue and pancreatic tissue to observe the changes in pancreatic acini and pancreatic islets. PAS staining was performed for kidney tissue,and immunohistochemical desmin-staining was performed to observe the expression of desmin in glomerular podocytes. The t-test was used for comparison of continuous data between two groups. Results Compared with group A,group C had significantly higher pathological score and serum levels of ALT,GGT,LDL,TG,TC,GLU,INS,and HOMA-IR(t = 4. 67,2. 83,2. 34,4. 58,4. 78,3. 00,2. 97,3. 80 and 4. 10,all P < 0. 05). Liver pathological changes were observed in the high-fat group from week 4 to week 12,i. e.,the lobular structure was gradually destroyed,the small fat vacuoles in the cytoplasm of the hepatocytes gradually developed into large fat vacuoles,and inflammatory cell infiltration gradually appeared in the portal area. Pancreatic pathological changes were observed in the high-fat group at the end of week 12,i. e.,apoptosis and atrophy of pancreatic acinar cells were observed,and no significant abnormalities were observed in pancreatic islet cells. Renal pathological changes were observed in the high-fat group at the end of week 12,i. e.,therewere significant increases in the substances with positive PAS staining results,the glomerular volume,and the thickness of the glomerular capillary basement membrane,with disordered arrangement of capillary loops,hyperplasia of the mesangial area,swelling of renal tubular epithelial cells,and stenosis of some lumens. Immunohistochemical staining showed an increase in the expression of desmin in glomerular podocytes in the high-fat group. Conclusion A rat model of nonalcoholic steatohepatitis is successfully established by high-fat diet.Nonalcoholic steatohepatitis in rats may lead to apoptosis and atrophy of pancreatic acinar cells,increase in glomerular volume,thickening of the capillary basement membrane,mesangial hyperplasia,and podocyte injury.

Clinical effect of extracorporeal membrane oxygenation in donor liver protection during donation after brain and cardiac death

Ding LiMin, Li XinZhang, Luo WenFeng, Yang XiaoGang, Huang XiaoMei, Xu ZhiDan

2020, 36(1): 145-148. DOI: 10.3969/j.issn.1001-5256.2020.01.032

Abstract(923)

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Objective To investigate the application of extracorporeal membrane oxygenation(ECMO) in donor liver protection during donation after death,and to summarize the preliminary experience in the application of ECMO in donor liver protection. Methods Clinical data were collected from liver transplantation donors/recipients who received ECMO during donation after brain and cardiac death(DBCD)and those who received conventional DBCD liver transplantation,and a comparative analysis was performed for donor liver protection and outcome of transplantation. The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. Results A total of 32 donors with similar general status and liver function were enrolled and divided into control group(conventional DBCD liver transplantation) and experimental group(DBCD liver transplantation with ECMO),with 16 donors in each group. A total of 32 liver transplantation recipients were divided into corresponding control group and experimental group,with 16 recipients in each group. There were significant differences between the donor control group and the donor experimental group in heart rate,systolic pressure,diastolic pressure,partial pressure of blood oxygen,lactate level,central venous pressure,total bilirubin(TBil),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)(t = 14. 121,-17. 817,-19. 187,-8. 927,4. 559,-3. 495,3. 357,4. 111,and 3. 553,all P < 0. 05). Compared with the recipient control group on day 7 after surgery,the recipient experimental group had significantly faster recovery of liver function after liver transplantation using the ECMO technique,and there were significant differences between the two groups in TBil,DBil,ALT,AST,alkaline phosphatase,and gamma-glutamyl transpeptidase(t =9. 309,4. 783,5. 067,2. 203,4. 774,and 5. 257,all P < 0. 05). The recipient experimental group had a significantly shorter length of hospital stay than the recipient control group(20. 87 ± 4. 98 d vs 12. 65 ± 2. 86 d,t = 5. 756,P < 0. 001). Conclusion Liver transplantation using the ECMO technique has a good clinical effect,and scientific and rational use of ECMO can effectively improve the quality of donor liver. Therefore,it plays an active role in organ donation after Chinese citizen death.

Change in T helper 17 cell/regulatory T cell imbalance in rats with immunological liver injury

Xue Miao, Mao XiaoRong, Chen Hong

2020, 36(1): 149-152. DOI: 10.3969/j.issn.1001-5256.2020.01.033

Abstract(1016)

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Abstract:
Objective To investigate the methods for establishing a rat model of immunological liver injury and the change in T helper 17 cell(Th17)/regulatory T cell(Treg) imbalance in rats with immunological liver injury. Methods A total of 30 female Wistar rats were divided into acute immunological liver injury group(AC group),chronic immunological liver injury group(CC group),and healthy control group(HC group) using a random number table,with 10 rats in each group. The rats in the AC group and the CC group were given tail vein injection of α-galactosylceramide(α-GalCer) and concanavalin A(ConA) to establish a rat model,and those in the HC group were given injection of an equal volume of normal saline. The serum levels of alanine aminotransferase(ALT) and aspartate aminotransferase(AST)were measured after modeling,HE staining was used to observe liver pathological changes,and immunohistochemistry was used to measure the protein expression of Foxp3 and RORγt in the liver. Flow cytometry was used to measure the changes in the frequencies of Th17 and Treg cells in peripheral blood and spleen suspension,and Th17/Treg ratio was calculated. 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. Results Compared with the HC group,the AC group and the CC group had significant increases in the serum levels of ALT,AST,and total bilirubin and a significant reduction in the level of albumin(F = 14. 782,20. 765,16. 088,and 74. 181,all P < 0. 001). HE staining showed that compared with the HC group,the AC group and the CC group had the changes of acute and chronic hepatocyte injury. Compared with HC group,the AC group had significant increases in the frequency of Th17 cells,the protein expression of RORγt(all P < 0. 05),the frequency of Treg cells(P < 0. 05),and Th17/Treg ratio(P < 0. 05). Compared with the HC group,the CC group had significant increases in the frequencies of Th17 and Treg cells and a significant reduction in Th17/Treg ratio(all P < 0. 05). Conclusion Both α-GalCer and ConA can be used to successfully establish a model of immunological liver injury without deaths,and the changes in liver histology and serum biochemistry are consistent with acute and chronic immune hepatitis. Th17/Treg imbalance plays an important role in inflammatory response and tis-sue damage and is closely associated with immune status and disease progression.

Clinical effect of gemcitabine combined with high-intensity focused ultrasound in treatment of advanced pancreatic cancer: A Meta-analysis

Zi Li, Chen Kai, Liu GuangLin, Li RenLi, Xu Wei

2020, 36(1): 153-157. DOI: 10.3969/j.issn.1001-5256.2020.01.034

Abstract(1237)

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Abstract:
Objective To evaluate the clinical effect and safety of high-intensity focused ultrasound(HIFU) combined with gemcitabine in the treatment of advanced pancreatic cancer. Methods SCI,Cochrane Library,Embase,PubMed,Wanfang Data,CNKI,CBM,and VIP were searched for randomized controlled trials(RCTs) of HIFU combined with gemcitabine in the treatment of advanced pancreatic cancer,with the assistance of expanded search,and these RCTs were screened according to the inclusion criteria. Review Manager 5. 3 was used to perform the Meta-analysis. A fixed effects model was used for non-heterogeneous data; heterogeneity was explained by subgroup analysis based on intervention methods,and if it could not be explained by subgroup analysis,a random effects model was used. Relative risk(RR) and 95% confidence interval(CI) were used as evaluation indices,and funnel plots were generated based on the outcome measure involved in the highest number of studies. Results A total of 8 RCTs with 474 patients were included. The patients in the experimental group received gemcitabine-based chemotherapy and HIFU,and those in the control group received gemcitabine-based chemotherapy alone. Compared with the control group,the experimental group had significantly better results in 3-,6-,and 12-month survival rates(3-month: RR = 1. 07,95% CI: 1. 00-1. 14,P < 0. 05; 6-month: RR = 2. 19,95% CI: 1. 75-2. 75,P < 0. 05; 12-month: RR =2. 35,95% CI: 1. 07-5. 14,P < 0. 05),tumor control(RR = 1. 64,95% CI: 1. 21-2. 24,P = 0. 002),and pain control(RR = 3. 15,95% CI: 2. 45-4. 05,P < 0. 05). There were no significant differences between the two groups in the incidence rates of leukopenia(RR =1. 05,95% CI: 0. 85-1. 30,P > 0. 05),gastrointestinal reactions(RR = 0. 89,95% CI: 0. 56-1. 42,P > 0. 05),and liver injury(RR = 1. 29,95% CI: 0. 95-1. 75,P > 0. 05). Since the outcome measure of pain control was involved in the highest number of studies,funnel plots were generated and showed no significant risk of bias. Conclusion Compared with gemcitabine alone,HIFU combined with gemcitabine can increase patients' survival rate and improve their symptoms,with a similar incidence rate of adverse effects. Further studies are needed for this combined therapy.

Primary hepatic sarcomatous carcinoma misdiagnosed as liver abscess: A case report

Qian XiaoHui, Gao BingQiang, Wang WeiLin

2020, 36(1): 158-160. DOI: 10.3969/j.issn.1001-5256.2020.01.035

Abstract(960)

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A case of primary hepatic high-grade neuroendocrine carcinoma

Liu YuWei, Cui GuoZhen, Liu XiangLiang, Niu JunQi, Zhao HengJun

2020, 36(1): 161-163. DOI: 10.3969/j.issn.1001-5256.2020.01.036

Abstract(1025)

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A case of portal hypertension caused by paroxysmal nocturnal hemoglobinuria

Zhi YiXiao, Pang MengYuan, Tao Yu, Hua Rui

2020, 36(1): 164-165. DOI: 10.3969/j.issn.1001-5256.2020.01.037

Abstract(902)

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Lymphoma with liver failure as the first presentation: A report of two cases

Lai Man, Liu HaiXia, Zhu YueKe

2020, 36(1): 166-168. DOI: 10.3969/j.issn.1001-5256.2020.01.038

Abstract(979)

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Gastrointestinal bleeding induced by Caroli disease: A case report

Han Xi, Ding XiaoLing, Li XueMei, Zhang XiaoFei, Guo YingJun, Yang Yong, Chen DaZhi, Tian MingGuo, Ma ShouCheng, Hu ShengJuan

2020, 36(1): 169-170. DOI: 10.3969/j.issn.1001-5256.2020.01.039

Abstract(955)

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Splenic marginal zone lymphoma with pancytopenia as the first presentation: A case report

He Tao, Wang AnKang, Jiang Yu, Li Qiu, Fu WenGuang

2020, 36(1): 171-173. DOI: 10.3969/j.issn.1001-5256.2020.01.040

Abstract(907)

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Research advances in persistent hepatitis B virus infection and its mechanism

Chen Huan, Yang YanQing, Chu Jun, Zhang GuoYuan, Lin ShiDe

2020, 36(1): 174-177. DOI: 10.3969/j.issn.1001-5256.2020.01.041

Abstract(1049)

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Hepatitis B virus(HBV) belongs to the Hepadnaviridae family and can cause acute and chronic hepatitis,liver cirrhosis,and even liver cancer in humans. Current antiviral drugs cannot completely eliminate HBV in liver cells and thus it is difficult to achieve a curative effect. In recent years,the mechanism of persistent HBV infection has attracted wide attention,which mainly involves host and virus. This article elaborates on the research advances in persistent HBV infection from the aspect of virus,including covalently closed circular DNA,HBV particles,and HBV components.

Advances in the diagnosis and treatment of nonalcoholic fatty liver disease-related liver fibrosis

Zhu HongMei, Wang QinYing

2020, 36(1): 178-181. DOI: 10.3969/j.issn.1001-5256.2020.01.042

Abstract(1114)

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Nonalcoholic fatty liver disease(NAFLD) is becoming the most common chronic liver disease in the world. From the perspective of its disease spectrum,nonalcoholic steatohepatitis(NASH) is a form of disease progression and can progress to liver fibrosis,leading to NAFLD-related liver cirrhosis and liver cancer. NASH-related liver fibrosis is closely associated with prognosis,and effective measures are urgently needed for the diagnosis and intervention of disease progression. This article summarizes the research advances in the diagnosis and treatment of NAFLD-related liver fibrosis.

Risk factors for the formation of portal vein thrombosis in patients with liver cirrhosis

Ruan FangMing, Li BiMin

2020, 36(1): 182-185. DOI: 10.3969/j.issn.1001-5256.2020.01.043

Abstract(946)

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Portal vein thrombosis(PVT) is commonly seen in patients with liver cirrhosis. Patients with varices complicated by portal vein thrombosis are more likely to experience bleeding,with higher failure rate of hemostasis and rebleeding rate,and the patients receiving liver transplantation may have a poorer prognosis. There are various risk factors for portal vein thrombosis,such as severity of liver dysfunction,use of non-selective beta blockers,and portal vein blood flow velocity. This article reviews the risk factors for portal vein thrombosis in patients with liver cirrhosis,in order to further understand the mechanism and risk level of portal vein thrombosis.

Association of estrogen receptor α gene polymorphisms with hepatitis B cirrhosis

Cheng Na, Yang Jing

2020, 36(1): 186-189. DOI: 10.3969/j.issn.1001-5256.2020.01.044

Abstract(898)

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At present,hepatitis B cirrhosis still has a major impact on public health and national development. The development and progression of hepatitis B cirrhosis is associated with estrogen. Estrogen acts by binding to estrogen receptors,and the expression and functional status of estrogen receptors are affected by estrogen receptor gene polymorphisms. This article mainly introduces the structure and biological characteristics of estrogen and estrogen receptor α gene and their association with the pathogenesis of hepatitis B cirrhosis,and it is pointed out that the abnormal expression of estrogen may be associated with the development and progression of hepatitis B cirrhosis. However,due to the differences in genetic loci,environment,and location between studies,the results of the association of estrogen receptor α gene polymorphisms with hepatitis B cirrhosis may not be completely consistent.

Research advances in endoscopic treatment of esophageal and gastric varices

Cui MeiLan, Yan HuiMin, Zheng HuanWei

2020, 36(1): 190-193. DOI: 10.3969/j.issn.1001-5256.2020.01.045

Abstract(844)

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Gastroesophageal variceal bleeding is one of the most common and critical complications of liver cirrhosis,with high rebleeding and mortality rates. Esophageal and gastric varices is a special type of varices,and endoscopic treatment methods for this disease include endoscopic variceal sclerotherapy,endoscopic tissue adhesive injection,and combined sequential therapy,but there are still controversies over the selection of specific treatment method. This article reviews the recent research advances in the endoscopic treatment of esophageal and gastric varices in China and foreign countries.

Research advances in drug therapy for advanced primary liver cancer

Pan TingTing, Cui XiaoNan

2020, 36(1): 194-197. DOI: 10.3969/j.issn.1001-5256.2020.01.046

Abstract(965)

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Liver cancer is one of the most common malignant tumors at present and has high incidence and mortality rates. Most patients are in the advanced stage at the time of diagnosis and thus lose the opportunity for surgery and have poor prognosis. At this time,medical treatment focusing on drug therapy becomes an important method for the treatment of advanced liver cancer,including chemotherapy,targeted therapy,immunotherapy,traditional Chinese medicine treatment,and endocrine therapy. This article reviews the recent research advances in drug therapy for advanced liver cancer.

Research advances in omega-3 polyunsaturated fatty acids in treatment of nonalcoholic fatty liver disease

Guo YueCheng, Lu LunGen

2020, 36(1): 198-200. DOI: 10.3969/j.issn.1001-5256.2020.01.047

Abstract(870)

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With the changes in people's lifestyle and dietary structure,the incidence rate of nonalcoholic fatty liver disease(NAFLD) has been increasing year by year,and NAFLD has become a serious threat to human health. The treatment of NAFLD has always been a hot topic of basic and clinical research on liver diseases. In recent years,many studies have revealed that omega-3 polyunsaturated fatty acids(ω3-PUFA) can promote fatty acid oxidation,improve intestinal homeostasis,and thus improve lipid metabolism and liver inflammation,and therefore,more and more clinical studies have applied ω3-PUFA in the treatment of NAFLD. However,the mechanism of ω3-PUFA in the treatment of NAFLD is still unclear,and there are certain limitations in related clinical studies. This article mainly introduces the role of ω3-PUFA in NAFLD and the results of related clinical studies and further discusses the problems that need to be solved in ω3-PUFA for the treatment of NAFLD.

Association between nonalcoholic fatty liver disease and depression

Yang XuYao, Yu Di, Zhao JinHan, Chuan LiXue, Chang Jiang

2020, 36(1): 201-204. DOI: 10.3969/j.issn.1001-5256.2020.01.048

Abstract(926)

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At present,nonalcoholic fatty liver disease(NAFLD) has become one of the most common chronic liver diseases in the world.With the development of the bio-psycho-social medical model,the mental health problems of patients with NAFLD are gradually attracting more and more attention. In recent years,more and more studies have been conducted on the association between NAFLD and psychiatric diseases,especially depression. Studies have shown that there is a significant correlation between NAFLD and depression; however,the common pathophysiological mechanism of such correlation is still unclear and further studies are needed to determine their causal relationship and treatment. This article reviews the research advances in the association between NAFLD and depression,common pathophysiological mechanism,and treatment,so as to lay a foundation for further research on these two disease and help with their prevention and treatment in future clinical practice.

Formation mechanism of neutrophil extracellular traps and their role in liver diseases

Cao Lin, Li Qian, Ji LongShan, Gao YueQiu, Li Man

2020, 36(1): 205-207. DOI: 10.3969/j.issn.1001-5256.2020.01.049

Abstract(993)

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Neutrophil extracellular traps(NETs) have recently been found to be a new immune mechanism for neutrophils to kill pathogens.The main component of NETs is DNA,with granular proteins of different sizes attached to the surface. NETs play different roles in various liver diseases such as hepatic ischemia-reperfusion injury,chronic hepatitis B,liver cirrhosis,and liver cancer. This article reviews the formation mechanism,structure,and role of NETs in liver diseases.

Research advances in drug carrier systems targeting hepatic stellate cells

Huang XiaoLi, Liu YingYing, Cong Min

2020, 36(1): 208-212. DOI: 10.3969/j.issn.1001-5256.2020.01.050

Abstract(1100)

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Hepatic stellate cells(HSCs) are an important target for the treatment of liver fibrosis. Safe and effective targeted delivery of therapeutic agents to HSCs,improvement of drug therapeutic effect,and reduction of toxic and side effects of off-target drugs are important measures for the development of anti-liver fibrosis drugs. A number of protein markers are elevated in activated HSCs,and thus their ligands are used for the specific delivery of anti-fibrotic drugs. This article summarizes the research advances in the treatment of liver fibrosis by targeting HSCs from the aspects of the type of drug carriers and target receptors.

Current status of the research on portopulmonary hypertension

Yin Xin, Zhang Yu, Shao YueMing, Gao Hui, Qin TingTing, Wen XiaoYu

2020, 36(1): 213-217. DOI: 10.3969/j.issn.1001-5256.2020.01.051

Abstract(1061)

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Portopulmonary hypertension(POPH) refers to the increase in pulmonary artery pressure on the basis of portal hypertension,which may lead to progressive right ventricular failure and death with disease progression. POPH has a low incidence rate and is often neglected by clinicians due to a lack of symptoms or the presence of non-specific symptoms in the early stage. This article summarizes the research advances in the pathogenesis,diagnosis,and treatment of POPH in recent years,introduces the noninvasive detection methods currently available for POPH diagnosis,and explores the selection of appropriate treatment methods based on the severity and individualized conditions of patients with POPH,so as to improve the understanding of this disease among clinicians.

Latest advances in the treatment of hepatolenticular degeneration

Zhou SiMin, Guo LiPing, Cai WangFeng, Zhou Lu, Wang BangMao

2020, 36(1): 218-221. DOI: 10.3969/j.issn.1001-5256.2020.01.052

Abstract(1057)

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Hepatolenticular degeneration(HLD) is an autosomal recessive liver disease associated with copper metabolism disorders. Mutations in the ATP7 B gene on chromosome 13 result in impaired transmembrane transport of copper ions,which in turn leads to excessive deposition of copper in the liver,brain,cornea,kidney,and bone joints(mainly in the liver and the brain). Early diagnosis and treatment can significantly reduce tissue damage and improve the prognosis of patients. American Association for the Study of Liver Diseases issued the guidelines for the diagnosis and treatment of HLD in 2008,and the European Association for the Study of the Liver released such guidelines in 2012. This article summarizes the recent research advances in China and foreign countries to give an overview of the treatment of HLD.

Advances in drug therapy for primary biliary cholangitis

Hao Juan, Lu: Jing, Xing Feng, Yang QuanJun, Liu ChengHai

2020, 36(1): 222-226. DOI: 10.3969/j.issn.1001-5256.2020.01.053

Abstract(1285)

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Primary biliary cholangitis(PBC) is a cholestatic liver disease with unclear etiology and pathogenesis. Ursodeoxycholic acid and obeticholic acid are the therapeutic drugs for PBC approved by the US Food and Drug Administration,both of which have the effect of alleviating intrahepatic cholestasis. However,some patients still have poor biochemical response to them,and it is urgent to explore new therapeutic drugs or methods. Fibrates,immunosuppressants,and traditional Chinese medicine have a certain effect in the treatment of patients with PBC,but further studies are needed to analyze their clinical safety and mechanism of action.

Acute pancreatitis and epigenetic regulation mechanisms

Zhao XianLin, Zhu ShiFeng, Kang HongXin, Li Juan, Tang WenFu, Wan MeiHua

2020, 36(1): 227-230. DOI: 10.3969/j.issn.1001-5256.2020.01.054

Abstract(1064)

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Acute pancreatitis is a local pancreatic and systemic inflammatory disease due to various living and environmental factors,such as alcohol,gallstones,high lipids,and smoking,and its pathogenesis remains unclear. Studies have shown that epigenetic regulation mechanisms,such as DNA methylation,histone modification,and non-coding RNA,play an important role in the development and progression of acute pancreatitis. This article introduces the association between the common causes of acute pancreatitis(including alcohol,gallstones,high lipids,and smoking) and epigenetic regulation mechanisms,as well as the association between inflammatory response and epigenetic regulation mechanisms. The preliminary exploration of epigenetic regulation mechanisms in acute pancreatitis provides new thoughts for further understanding the development,progression,and treatment of acute pancreatitis.

2020 Vol. 36, No. 1

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2020 Vol. 36, No. 1

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International Database

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Open access

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