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

2020 Vol. 36, No. 4

Display Method:
Editorial
Current status and perspectives of autoimmune hepatitis
Wang QiXia, Ma Xiong
2020, 36(4): 721-723. DOI: 10.3969/j.issn.1001-5256.2020.04.001
Abstract:
Autoimmune hepatitis( AIH) is an autoimmune liver disease induced by environmental factors in individuals with genetic susceptibility,with the main features of positive serum autoantibody,hypergammaglobulinemia,elevated transaminases,and interface hepatitis.The pathogenesis of AIH remains unknown,high heterogeneity is observed in clinical diagnosis and treatment,and thus it is of great importance to establish individualized precise diagnosis and treatment. Therefore,this article reviews the research advances and difficult issues in this field.
Discussions by experts
Diagnosis and differential diagnosis of autoimmune hepatitis
Cui NaNa, Wang QiXia
2020, 36(4): 724-727. DOI: 10.3969/j.issn.1001-5256.2020.04.002
Abstract:
Autoimmune hepatitis( AIH) is a chronic persistent liver inflammatory disease associated with autoimmune response. AIH is commonly seen in women,and those without intervention may progress to liver cirrhosis and liver cancer. The main histological feature of AIH is moderate to severe interfacial hepatitis with lymphocyte-plasma cell infiltration. The clinical manifestations of AIH have obvious heterogeneity,and it is difficult to differentiate AIH from other liver diseases with similar clinical,biochemical,serological,and histological features. Misdiagnosis may seriously affect the prognosis of patients. This article reviews the key points in the diagnosis and differential diagnosis of AIH,hoping to provide help for clinical diagnosis and treatment.
Liver histopathological diagnosis of autoimmune hepatitis
Miao Qi, Chen XiaoYu
2020, 36(4): 728-730. DOI: 10.3969/j.issn.1001-5256.2020.04.003
Abstract:
Autoimmune hepatitis may have various liver histopathological manifestations,with interface hepatitis with lymphoplasmacytic infiltration,rosette formation,and emperipolesis as relatively characteristic manifestations,but they are not specific. The above histological manifestations should be combined with clinical data to exclude hepatitis caused by other reasons. This article mainly elaborates on the characteristic histological manifestations of AIH and the histological manifestations of special types of AIH and discusses the value of histology in the diagnosis and differential diagnosis of AIH.
Advances in the diagnosis and treatment of pediatric autoimmune hepatitis
Zhang XueYuan, Wang JianShe
2020, 36(4): 731-736. DOI: 10.3969/j.issn.1001-5256.2020.04.004
Abstract:
Autoimmune hepatitis( AIH) is a progressive inflammatory liver disease,and the incidence rate of pediatric AIH is gradually increasing in recent years. AIH can be classified into AIH-1( with positive antinuclear antibody and/or smooth muscle antibody and/or anti-soluble liver antigen antibody) and AIH-2( with positive liver-kidney microsomal type 1 antibody and/or anti-liver cytosol type 1 antibody),among which AIH-2 is mainly seen in children. Positive autoantibodies are rare in healthy children,and thus the requirements for autoantibody titer in the diagnosis of pediatric AIH are lower than the criteria for adults. Pediatric AIH progresses more rapidly than adult AIH,and treatment should be started immediately after confirmed diagnosis. Scoring systems for the diagnosis of AIH in adults are not applicable to pediatric patients and cannot be used to differentiate AIH from autoimmune sclerosing cholangitis.
Standard therapy and potential therapeutic targets for autoimmune hepatitis
Wang Rui, Wang QiXia, Ma Xiong
2020, 36(4): 737-742. DOI: 10.3969/j.issn.1001-5256.2020.04.005
Abstract:
Autoimmune hepatitis( AIH) is a liver inflammatory disease mediated by autoimmune response and may progress to liver failure and liver cirrhosis without treatment. The goal of AIH treatment is to achieve biochemical remission and histological remission. Currently immunosuppressant therapy is the standard therapy for AIH,i. e.,prednisone/prednisolone alone or combined with azathioprine. For the patients who do not tolerate or have poor response to the standard therapy,second-line treatment regimen,including mycophenolate mofetil,can be considered. Recent studies have shown that various factors participate in the development and progression of AIH,such as immune function,gut microbiota,vitamin D,and mental state,which may become the potential therapeutic targets for AIH. This article reviews related studies on the standard therapies for AIH and highlights the potential therapeutic targets for AIH treatment.
Current status of research on overlap syndrome of autoimmune liver disease
Ni Ping, Fan XiaoLi, Yang Li
2020, 36(4): 743-748. DOI: 10.3969/j.issn.1001-5256.2020.04.006
Abstract:
Autoimmune liver diseases mainly include primary biliary cholangitis( PBC),autoimmune hepatitis( AIH),and primary sclerosing cholangitis. Simultaneous or successive occurrence of the features of any two of the above diseases is called overlap syndrome,among which PBC-AIH overlap syndrome is the most common type. Overlap syndrome can progress rapidly to liver cirrhosis and liver failure without timely treatment. This article summarizes the research advances in overlap syndrome of autoimmune liver disease in recent years.
Research advances in autoantibodies in autoimmune hepatitis
Zhang HaiPing, Yan HuiPing
2020, 36(4): 749-753. DOI: 10.3969/j.issn.1001-5256.2020.04.007
Abstract:
Autoantibodies have an important value in the diagnosis,typing,and differential diagnosis of autoimmune hepatitis( AIH); however,the autoantibodies of AIH lack specificity and have various types and inconsistent results,which brings confusions to clinical diagnosis.With reference to the literature data and the author's clinical experience,this article reviews the application value and research advances in the main autoantibodies in AIH and introduces the recommendations for autoantibody detection methods in related guidelines.
Guidelines
The protocol for prevention,diagnosis and treatment of liver injury in coronavirus disease 2019
China Digestion Association, Chinese Medical Doctor Association; Chinese Society of Hepatology, Chinese Medical Association
2020, 36(4): 754-757. DOI: 10.3969/j.issn.1001-5256.2020.04.008
Abstract:
An excerpt of diagnosis and management of autoimmune hepatitis in adults and children: 2019 practice guidance and guidelines from the American Association for the study of liver diseases
Cui NaNa, Wang QiXia, Ma Xiong
2020, 36(4): 758-763. DOI: 10.3969/j.issn.1001-5256.2020.04.009
Abstract:
An excerpt of international consensus guidelines for surgery and the timing of intervention in chronic pancreatitis (2019)
Wu YanYan, Tang YuFu, Xin Lei, Qi XingShun
2020, 36(4): 764-765. DOI: 10.3969/j.issn.1001-5256.2020.04.010
Abstract:
An excerpt of ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) guideline (2019)
Tang Jian, Li JiaSu, Liu Feng, Li ZhaoShen
2020, 36(4): 766-771. DOI: 10.3969/j.issn.1001-5256.2020.04.011
Abstract:
Coronavirus disease 2019 and hepatobiliary & pancreatic diseases
Features of liver injury in patients with coronavirus disease 2019 in Bozhou,China
Li GuangMing, Pan Xin
2020, 36(4): 772-774. DOI: 10.3969/j.issn.1001-5256.2020.04.012
Abstract:

Objective To investigate the condition of liver injury in different populations of patients with coronavirus disease 2019( COVID-2019),and to further understand the pathogenic characteristics of COVID-2019. Methods A total of 28 patients with COVID-2019 and liver injury who were admitted to the designated hospitals for COVID-2019 in Bozhou,China from February 1 to 12,2020 were enrolled,and they were divided into male group( n = 15) and female group( n = 13) according to sex or young group( n = 10) and middle-aged and elderly group( n = 17) according to age. The levels of alanine aminotransferase( ALT),aspartate aminotransferase( AST),gamma-glutamyl transpeptidase( GGT),alkaline phosphatase( ALP),and lactate dehydrogenase( LDH) were measured on admission. The Wilcoxon rank-sum test was used for comparison of continuous data between two groups,the Fisher exact test was used for comparison of categorical data between two groups. Results Varying degrees of liver injury were observed in the 28 patients. There were no significant differences in the levels of ALT,AST,GGT,ALP,and LDH between the male group and the female group and between the young group and the middle-aged and elderly group( all P > 0. 05). There was no significant difference in abnormal rate of ALT,AST,GGT and LDH between male group and female group( all P > 0. 05); There was no significant difference in abnormal rate of ALT,AST,GGT between the young group and the middle-aged and elderly group( all P > 0. 05); there was a significant difference in abnormal rate of LDH between the young group and the middle-aged and elderly group( P < 0. 05). Conclusion Patients with COVID-2019 may experience different degrees of liver injury with the development of the disease,middle-aged and elderly patients tend to develop liver injury. There was no significant correlation with gender and age in mild and general patients. Therefore,liver function should be monitored in patients with COVID-2019,and the treatment method should be selected carefully to prevent liver injury.

Challenges and countermeasures for diagnosis and treatment work in hepatobiliary surgery in the epidemic of novel coronavirus pneumonia
Tan YunHua, Li JianBo, Shang YangYang, Zhang Tao, Zheng MingYou
2020, 36(4): 775-777. DOI: 10.3969/j.issn.1001-5256.2020.04.013
Abstract:

The epidemic of coronavirus disease 2019( COVID-19) has become a severe and complicated situation. As of February 23,2020,there have been more than 77,038 confirmed cases of new coronavirus infection nationwide. COVID-19 is highly infectious and has a long incubation period and a variety of clinical manifestations,which has a great impact on society and economy and also seriously affects the daily operation of hepatobiliary surgery. This article discusses and recommends the medical protection measures required for outpatient,ward,and operation of hepatobiliary surgery,in order to reduce the risk of nosocomial infection in hepatobiliary surgery during the COVID-19 epidemic.

Original articles_Viral hepatitis
Liver histological changes and clinical features in chronic hepatitis B with normal or mildly elevated alanine aminotransferase
Ji LinXiu, Yang XingXiang
2020, 36(4): 778-782. DOI: 10.3969/j.issn.1001-5256.2020.04.014
Abstract:
Objective To investigate the association between liver histological changes and clinical indices in chronic hepatitis B( CHB)patients with normal or mildly elevated alanine aminotransferase( ALT),and to provide a basis for guiding antiviral therapy. Methods A retrospective analysis was performed for the clinical data of 903 CHB patients who underwent liver biopsy in Sichuan Provincial People's Hospital from October 2011 to August 2018. The association of sex,age,serum HBeAg status,serum ALT,and HBV DNA level with liver inflammation activity and fibrosis degree was analyzed in CHB patients with an ALT level of < 2 × upper limit of normal( ULN). The chi-square test was used for comparison of categorical data between two groups. Results The liver inflammatory activity ranged from G1 to G4 in 903 CHB patients,among whom 67. 6% had G2 inflammation and 831( 92. 0%) had G≥2 inflammation; the fibrosis stage ranged from S0 to S4 in all patients,among whom 78. 2% had S1 fibrosis and 159( 17. 6%) had S≥2 fibrosis. Male patients had significantly higher liver inflammatory activity and fibrosis stage than the female patients( χ2= 6. 120 and 15. 098,both P < 0. 05). Among the patients with ALT < 1 × ULN,1 × ULN≤ALT < 1. 5 × ULN,and ALT≥1. 5 × ULN,91. 2%,92. 1%,and 94. 8%,respectively,had marked( G≥2)liver inflammation and necrosis,which showed a significant difference between the three groups( χ2= 28. 125,P < 0. 05); among the three groups of patients,12. 7%,22. 9%,and 24. 4%,respectively,had marked( S≥2) liver fibrosis,which showed a significant difference between the three groups( χ2= 18. 004,P < 0. 05). Liver inflammatory activity and fibrosis degree aggravated with the increase in the age of CHB patients( χ2= 65. 768 and 56. 056,both P < 0. 05) and the reduction in serum HBV DNA level( χ2= 21. 712 and 29. 461,both P <0. 05). The HBeAg-negative patients had significantly higher liver inflammatory activity and fibrosis stage than the HBeAg-positive patients( χ2= 30. 798 and 26. 380,both P < 0. 05). Among the HBeAg-positive and HBeAg-negative patients with an age of ≥30 years and 1. 5 × ULN ≤ ALT < 2 × ULN,100%( 40/40) and 97. 8%( 45/46),respectively,had marked liver inflammation and necrosis.Conclusion Most CHB patients with normal or mildly elevated ALT have marked liver inflammation and varying degrees of liver fibrosis,especially male patients aged ≥30 years. It is recommended to perform liver histopathological examination to assess the indication for antiviral therapy and avoid delay in treatment.
Original articles_Liver fibrosis and liver cirrhosis
Etiologies and clinical features of liver cirrhosis in Lanzhou,China
Shen ZiXiong, Li Min, Zhang JiMing, Li JinZhou, Gou HaiYan, Wang YiXuan
2020, 36(4): 783-787. DOI: 10.3969/j.issn.1001-5256.2020.04.015
Abstract:
Objective To investigate the etiologies and clinical features of patients with liver cirrhosis in Lanzhou,China and the risk factors for liver cirrhosis with primary liver cancer. Methods A retrospective analysis was performed for the medical records of 3496 patients with liver cirrhosis who were diagnosed and treated in Department of Infectious Diseases,The First Hospital of Lanzhou University,from April 2015 to April 2018,including sex,age,family history,past history,personal history,etiology,clinical manifestation,complication,and laboratory examination. The chi-square test was used for comparison of categorical data between groups,and the multivariate logistic regression analysis was used to investigate the risk factors for liver cirrhosis with liver cancer. Results Among the 3496 patients with liver cirrhosis,2209( 63. 19%) had hepatitis B,among whom 2032 patients had complete HBe Ag data,with 807( 39. 71%) HBe Ag-positive patients and 1225( 60. 29%) HBe Ag-negative patients; among these 2209 patients,2207 had HBV DNA data,among whom 1567( 71. 00%) had positive HBV DNA. There were 309 patients( 8. 84%) with hepatitis C,144 patients( 4. 12%) with autoimmune hepatitis,133 patients( 3. 80%)with primary biliary cholangitis,93 patients( 2. 66%) with alcoholic cirrhosis,and 447 patients( 12. 79%) with cryptogenic cirrhosis. Major clinical manifestations included splenomegaly and/or hemocytopenia in 2299 patients( 65. 76%),ascites in 1760 patients( 50. 34%),esophageal varices in 1647 patients( 47. 11%),gastric varices in 1386 patients( 39. 66%),and jaundice in 754 patients( 21. 57%). The main complications included primary liver cancer in 937 patients( 26. 80%),gastrointestinal bleeding in 822 cases( 23. 51%),infection in 697 patients( 19. 94%) [mainly pulmonary infection in 487 patients( 13. 93%) ],and hepatic encephalopathy in 261 patients( 7. 47%). The patients with hepatitis B cirrhosis had a significantly higher incidence rate of primary liver cancer than those with alcoholic hepatitis cirrhosis( χ2= 26. 854,P < 0. 001); the patients with alcoholic cirrhosis had a significantly higher incidence rate of gastrointestinal bleeding than those with hepatitis B cirrhosis( χ2= 5. 031,P = 0. 025); the patients with hepatitis B cirrhosis had a significantly lower incidence rate of hepatic encephalopathy than those with alcoholic cirrhosis( χ2= 40. 903,P < 0. 001). Among the patients with a confirmed diagnosis of primary liver cancer,73. 22% had positive alpha-fetoprotein( AFP) and 26. 78% had negative AFP. Age( odds ratio [OR]= 1. 025,95% confidence interval[CI]: 1. 017-1. 034,P <0. 05),male sex( OR =2. 701,95% CI: 2. 168-3. 365,P <0. 05),positive HBV DNA( OR =1. 361,95% CI:1. 123-1. 649,P < 0. 05),hypertension( OR = 2. 372,95% CI: 1. 845-3. 050,P < 0. 05),and a family history of liver cancer( OR =2. 261,95% CI: 1. 255-4. 075,P < 0. 05) were risk factors for primary liver cancer in patients with liver cirrhosis. Conclusion Hepatitis B is the main etiology of liver cirrhosis in Lanzhou,followed by hepatitis C and autoimmune liver disease. The main clinical manifestations are splenomegaly and/or hemocytopenia,and the main complication is primary liver cancer. Active antiviral therapy and prevention of hypertension may help to reduce the risk of primary liver cancer in patients with liver cirrhosis.
Original articles_Liver neoplasms
Clinical value of serum Glycan-Test in the diagnosis of hepatitis B virus-related hepatocellular carcinoma
Zhang LiLi, Jin ZiZheng, Liu Ning, Zhao YanMing, Tong Xuan, Zhao Yan, Lou JinLi
2020, 36(4): 788-791. DOI: 10.3969/j.issn.1001-5256.2020.04.016
Abstract:
Objective To investigate the clinical value of the oligosaccharide chain detection kit Glycan-Test( G-Test,fluorescent capillary electrophoresis) in assisting the diagnosis of hepatitis B virus( HBV)-related hepatocellular carcinoma( HCC). Methods A total of310 serum samples were collected from the patients who attended Beijing YouAn Hospital from August 2017 to June 2018,among which there were 170 samples of HBV-related HCC( HCC group),50 samples of hepatitis B cirrhosis( liver cirrhosis group),85 samples of chronic hepatitis B( hepatitis group),and 5 samples of other malignant tumors of visceral organs. The relative concentration of serum oligosaccharide chain was measured,and the sensitivity,specificity,overall coincidence rate,positive predictive value,and negative predictive value of G-Test in clinical diagnosis were calculated and analyzed. A methodological comparison was performed for G-Test and serum alpha-fetoprotein( AFP). The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups,and the Dunn's multiple comparison test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between two groups. The receiver operating characteristic( ROC) curve was used to evaluate diagnostic efficiency,and the logistic regression model was used to establish a combined diagnostic model of G-Test and AFP. The Z test was used for comparsion of area under ROC curve. Results The HCC group had a significantly higher level of G-Test than the hepatitis group [6. 46( 5. 73-7. 07) vs 3. 38( 2. 85-4. 18),H =107. 9,P <0. 001]and the liver cirrhosis group[6. 46( 5. 73-7. 07) vs 3. 99( 3. 13-5. 21),H = 104. 2,P < 0. 001].The HCC group had a significantly higher AFP level than the hepatitis group [0. 77( 0. 45-1. 77) log10 ng/ml vs 0. 58( 0. 41-0. 89) log10 ng/ml,H = 33. 65,P = 0. 025]. G-Test had a sensitivity of 83. 53%,a specificity of 74. 29%,an overall coincidence rate of 79. 36%,a positive predictive value of 79. 78%,and a negative predictive value of 78. 79%. G-Test alone had a significantly larger AUC than AFP alone( 0. 846 vs 0. 611,Z = 5. 795,P < 0. 001),and G-Test combined with AFP had an AUC of 0. 870,which was significantly larger than that of G-Test alone( Z = 2. 523,P = 0. 012) or AFP alone( Z = 6. 943,P < 0. 001). There were significant differences in the detection rates of G-Test and AFP between the early-stage group and the advanced group( χ2= 26. 441、38. 379,all P < 0. 001). At the negative cut-off values of < 20, < 200,and < 400 ng/ml for AFP,G-Test had a detection rate of 86. 24%,85. 93%,and 85. 31%,respectively,in HCC patients with negative AFP. Conclusion G-Test has good sensitivity and specificity and a certain clinical value in assisting the diagnosis of HCC,and G-Test combined with AFP has better diagnostic efficiency.
Clinical effect of surgical resection versus radiofrequency ablation in treatment of multiple liver cancer in different liver segments meeting the Milan criteria
Wang Ning, Zheng JinLi, Jiang Li
2020, 36(4): 792-797. DOI: 10.3969/j.issn.1001-5256.2020.04.017
Abstract:
Objective To investigate the treatment methods for multiple liver cancer in different liver segments meeting the Milan criteria.Methods A retrospective analysis was performed for the clinical data of patients with multiple liver cancer in different liver segments meeting the Milan criteria who underwent surgical resection or radiofrequency ablation in Department of Hepatic Surgery and Liver Transplantation Center,West China Hospital,from February 2009 to February 2013. A totle of 158 patients were divided into surgical resection group( n =110) and radiofrequency ablation group( n = 48),and the clinical effect of these two methods was compared. The chi-square test or the Fisher exact test was used for comparison of categorical data between two groups; the t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the Kaplan-Meier method was used to analyze overall survival rate and disease-free survival rate,and the log-rank test was used for comparison of survival rates; the receiver operating characteristic( ROC) curve was used to investigate the association of degree of tumor differentiation with microvascular invasion. Results There was no significant difference in prognosis between the surgical resection group and the radiofrequency ablation group( 1-,3-,and 5-year overall survival rates: 94. 5%/55. 2%/28. 8% vs 83. 3%/50. 0%/26. 5%,χ2= 1. 161,P = 0. 281; 1-,3-,and 5-year disease-free survival rates: 86. 4%/42. 5%/21. 9% vs 79. 2%/37. 5%/11. 0%,χ2= 1. 771,P = 0. 183). There was a significant difference in prognosis between the patients without microvascular invasion and those with microvascular invasion( 1-,3-,and 5-year overall survival rates: 94. 6%/59. 1%/31. 8% vs 94. 1%/33. 1%/10. 1%,χ2= 4. 250,P = 0. 039; 1-,3-,and 5-year disease-free survival rates: 87. 1%/48. 1%/25. 0% vs 82. 4%/17. 6%/6. 1%,χ2= 8. 120,P = 0. 004). There was a significant difference in prognosis between the patients with poorly differentiated liver cancer and those with non-poorly differentiated liver cancer( 1-,3-,and 5-year overall survival rates: 91. 2%/33. 7%/4. 1% vs 96. 1%/64. 5%/39. 0%,χ2= 19. 092,P < 0. 001; 1-,3-,and 5-year disease-free survival rates: 79. 4%/10. 3%/3. 2% vs 89. 5%/56. 6%/31. 4%,χ2= 25. 973,P < 0. 001). There were no significant differences between the patients with en bloc resection and those with separate local resection in 1-,3-,and 5-year overall survival rates( 93. 7%/57. 7%/29. 8% vs 93. 3%/38. 9%/23. 3%,χ2= 1. 282,P = 0. 257) and 1-,3-,and 5-year disease-free survival rates( 85. 3%/46. 0%/23. 7% vs 86. 7%/26. 7/10. 0%,χ2= 1. 706,P =0. 191). There was no significant difference in postoperative complications between the surgical resection group and the radiofrequency ablation group( χ2= 3. 088,P = 0. 079),and no patient died within 30 days after surgery. Conclusion Surgical resection and radiofrequency ablation have a similar effect in the treatment of multiple liver cancer in different liver segments meeting the Milan criteria. En bloc resection and separate local resection have a similar clinical effect in patients undergoing surgical resection. Microvascular invasion of tumor and degree of tumor differentiation may affect the prognosis of such patients.
Effect of Aldo-keto reductase family 1 member B10 gene silencing on the proliferation and apoptosis of hepatocellular carcinoma cells
Qian RuiKun, Ma ZhangLin, Qiao Sen
2020, 36(4): 798-802. DOI: 10.3969/j.issn.1001-5256.2020.04.018
Abstract:
Objective To investigate the biological functions and related pathological mechanisms of Aldo-keto reductase family 1 member B10(AKR1 B10) in hepatocellular carcinoma(HCC).Methods The COLE database was used to analyze the mRNA expression of AKR1 B10 in normal liver cells and HCC cell lines.The UALCAN and Oncomine databases were used to analyze the mRNA expression of AKR1 B10 in HCC tissue and adjacent tissue.Western blot was used to investigate the difference in the protein expression of AKR1 B10 between HCC tissue and adjacent tissue.AKR1 B10 in HepG2 and Huh7 cells was knocked down by lentivirus,and the cells were divided into control group and AKR1 B10 knockdown group(which was further divided into shAKR1 B10 1# group and shAKR1 B10 2# group).AnnexinVAPC/PI double staining,colony formation assay,and the method of subcutaneous xenograft tumor were used to observe the apoptosis of HCC cells,colony formation,and the change in the volume of subcutaneous xenograft tumor after AKR1 B10 knockdown.The peroxide-sensitive fluorescent probe DCFH-DA and Western blot were used to measure the changes in ROS and related proteins,such as pATMser1981,γ-H2 AX,c-Caspase-3,and c-RARP in HCC cells.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 The CCLE database showed that the mRNA expression of AKR1 B10 in HCC cells was significantly higher than that in normal liver cells) the Oncomine database suggested that the mRNA expression of AKR1 B10 in HCC tissue was more than 10 times that in adjacent tissue) the UALCAN database showed that the AKR1 B10 gene was highly expressed in HCC tissue.For the six patients in this study,the expression of AKR1 B10 in HCC tissue was significantly higher than that in adjacent tissue.Compared with the control group,the AKR1 B10 knockdown group had a significant reduction in the colony formation ability of HCC cells(P <0.001) and a significant increase in apoptosis rate(P <0.001).Compared with the control group,the AKR1 B10 knockdown group had significant increases in ROS,the markers for DNA damage p-ATMser1981 and γ-H2 AX,and the indices for cell apoptosis c-Caspase-3 and c-RARP.In the BALB-c/Nude mouse model,compared with the control group,the AKR1 B10 knockdown group had a significant reduction in tumor volume since day 13 after allograft transplantation(P <0.05).Conclusion AKR1 B10 may be an effective therapeutic target for the treatment of HCC.
Effect of targeted regulation of the Wnt2 gene by microRNA( microRNA-21) on the proliferation and migration of HepG2 hepatoma cells
Wang ZeXin, Guan LiJun, Li JianMing, Wang ZhiChao, Xue MengRuo, Qin XiaoJun
2020, 36(4): 803-807. DOI: 10.3969/j.issn.1001-5256.2020.04.019
Abstract:
Objective To investigate the effect of targeted regulation of the Wnt2 gene by microRNA( miR-21) on the proliferation and migration of HepG2 hepatoma cells. Methods Quantitative real-time PCR was used to measure the mRNA expression of miR-21 in HepG2 hepatoma cells and normal liver cell line LO2. HepG2 cells were transfected with miR-21 inhibitor,and then the expression of miR-21 and cell proliferation,migration,and apoptosis were analyzed for the inhibitor group and the control group. The protein expression of Wnt2 was measured for the two groups,and dual-luciferase reporter assay was used to verify the association between miR-21 and the Wnt2 gene. The t-test was used for comparison of continuous data between groups. Results The relative expression of miR-21 in HepG2 cells was significantly higher than that in LO2 cells( 1. 978 ± 0. 035 vs 1. 586 ± 0. 022,t = 16. 424,P < 0. 05). After the transfection of miR-21 inhibitor,the inhibitor group had significantly lower expression of miR-21 than the control group( 0. 857 ± 0. 017 vs 1. 684 ± 0. 039,t= 33. 669,P < 0. 05). Compared with the control group after the transfection of miR-21 inhibitor,the inhibitor group had a significant reduction in the proliferation ability of HepG2 cells( P < 0. 05),a significantly lower number of cells passing through the Transwell chamber( 83. 72 ± 15. 06 vs 147. 85 ± 20. 64,t = 4. 347,P < 0. 05),and a significantly higher cell apoptosis rate( 25. 67% ± 3. 95% vs 10. 27%± 2. 14%,t = 5. 937,P < 0. 05). The inhibitor group had significantly lower relative expression of Wnt2 in HepG2 cells than the control group( 0. 862 ± 0. 127 vs 1. 306 ± 0. 218,t = 3. 048,P < 0. 05). TargetScan software showed that miR-21 inhibitor significantly inhibited the luciferase activity of the cells transfected with wild-type Wnt2-3'UTR plasmid( 0. 972 ± 0. 102 vs 0. 612 ± 0. 092,t = 4. 219,P <0. 05),while there was no effect on the luciferase activity of the cells transfected with mutant Wnt2-3' UTR plasmid( 0. 982 ± 0. 093 vs0. 911 ± 0. 128,t = 0. 972,P > 0. 05). Conclusion Inhibition of miR-21 expression can effectively inhibit the proliferation and migration of HepG2 cells,promote the apoptosis of HepG2 cells,and inhibit the over-activation of the Wnt signaling pathway,and therefore,it may become one of the potential target genes for liver cancer treatment.
Effect of hepatitis B x gene on the expression of major histocompatibility complex class I chain-related gene A-A5. 1,invasion,and migration of HepG2. 2. 15 cells
Li Pei, Liu Yu
2020, 36(4): 808-812. DOI: 10.3969/j.issn.1001-5256.2020.04.020
Abstract:
Objective To investigate the effect of hepatitis B x( HBx) gene on the expression of major histocompatibility complex class I chain-related gene A( MICA)-A5. 1,invasion,and migration of HepG2. 2. 15 cells. Methods HepG2. 2. 15 cells( HepG2 cells with the insertion and continuous expression of whole HBV genome) were cultured in vitro and were randomly divided into control group,HBx overexpression plasmid group,HBx empty plasmid group,HBx siRNA group,and HBx siRNA negative control group. After the transfection of plasmid or siRNA,CCK-8 assay was used to measure cell proliferation after 24 and 48 hours to screen out the appropriate duration of drug action; the Transwell invasion test and wound-healing assay were used to observe the changes in cell invasion and migration abilities;immunoblotting was used to measure the expression of HBx,MICA-A5. 1,and the marker proteins for epithelial-mesenchymal transition E-cadherin and vimentin; ELISA was used to measure the level of soluble MICA( s MICA) in cell culture medium. 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 control group after 24 hours,the HBx overexpression plasmid group had a significant increase in cell viability and the HBx siRNA group had a significant reduction in cell viability( q = 8. 268 and 4. 365,P < 0. 001 and 0. 036); compared with the control group after 48 hours,the HBx overexpression plasmid group had a significant increase in cell viability and the HBx siRNA group had a significant reduction in cell viability( q = 12. 680 and 7. 523,both P < 0. 001). Compared with the control group,the HBx overexpression plasmid group had significant increases in the protein expression of HBx,MICA,and vimentin in cells,the level of s MICA in cell culture medium,the number of migrating cells,and the number of cells out of the Transwell chamber,as well as a significant reduction in the expression of E-cadherin( q = 9. 427,6. 697,10. 500,5. 042,22. 740,15. 720,and 5. 258,all P < 0. 05); the HBx siRNA group had significant reductions in the protein expression of HBx,MICA,and vimentin in cells,the level of s MICA in cell culture medium,the number of migrating cells,and the number of cells out of the Transwell chamber,as well as a significant increase in the expression of E-cadherin( q = 8. 133,8. 828,7. 616,7. 673,5. 391,7. 694,and 6. 226,all P < 0. 05). Conclusion The HBx gene regulates theexpression of MICA-A5. 1 in HepG2. 2. 15 cells and the invasion and migration of HepG2. 2. 15 cells,and upregulation of the HBx gene can promote the expression of MICA-A5. 1 and enhance the invasion and migration abilities of HepG2. 2. 15 cells.
Original articles_Other liver diseases
Value of MELD、AARC、COSSH ccoring systems in evaluating the 90-day prognosis of hepatitis B virus-related acute-on-chronic liver failure
Zhang WenJia, Zhao LiJuan, Wu JiZhou
2020, 36(4): 813-817. DOI: 10.3969/j.issn.1001-5256.2020.04.021
Abstract:
Objective To investigate the value of Model for End-Stage Liver Disease( MELD),APASL-ACLF Research Consortium( AARC),and Chinese Group on the Study of Severe Hepatitis B( COSSH) scoring systems in evaluating the 90-day prognosis of hepatitis B virus-related acute-on-chronic liver failure( HBV-ACLF). Methods A retrospective analysis was performed for the clinical data of88 patients with HBV-ACLF who were hospitalized in Chaoyang Central Hospital from July 2017 to May 2019,and according to the follow-up results on day 90 after admission,the patients were divided into survival group with 35 patients and death group with 53 patients. The influencing factors for the 90-day prognosis of HBV-ACLF patients were analyzed; the above three scores were determined,and their predictive value was evaluated. The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A multivariate binary logistic regression analysis was used to investigate the influencing factors for the prognosis of HBV-ACLF. The receiver operating characteristic( ROC) curve was plotted,and the Z test was used for comparison of area under the ROC curve( AUC) between two scores. Results The univariate analysis showed that there were significant differences between the two groups in age,total bilirubin( TBil),white blood cell count,platelet count,uric acid,creatinine( Cr),prothrombin activity,serum sodium concentration( Na),international standardized ratio,arterial blood lactate,oxygenation index( PaO2/FiO2),complications( hepatic encephalopathy,pulmonary infection,upper gastrointestinal bleeding,and hepatorenal syndrome),MELD score,AARC score,and COSSH score( all P < 0. 05). The multivariate logistic regression analysis found that TBil( odds ratio [OR]= 0. 982,95%confidence interval [CI]: 0. 970-0. 995,P = 0. 006),Na( OR = 1. 168,95% CI: 1. 024-1. 332,P = 0. 021),Cr( OR = 0. 950,95%CI: 0. 906-0. 996,P = 0. 033),age( OR = 0. 910,95% CI: 0. 842-0. 983,P = 0. 016),and PaO2/FiO2( OR = 1. 058,95% CI: 1. 028-1. 089,P < 0. 001) were independent influencing factors for the 90-day prognosis of patients with HBV-ACLF. The ROC curve analysis showed that COSSH score had significantly higher AUC and Youden index than MELD score( 0. 937/0. 820 vs 0. 836/0. 574) and AARC score( 0. 937/0. 820 vs 0. 816/0. 497),and COSSH score had a significantly higher AUC than AARC score( Z = 3. 082,P < 0. 05).Conclusion These three scoring systems have a good value in evaluating the 90-day prognosis of HBV-ACLF patients,and COSSH score may have a higher value than the other two scores.
Safety and efficacy of transjugular intrahepatic portosystemic shunt in treatment of acute decompensated cirrhotic events in patients with acute-on-chronic liver failure
Guo Shuai, Han GuoHong
2020, 36(4): 818-822. DOI: 10.3969/j.issn.1001-5256.2020.04.022
Abstract:
Objective To investigate the safety and efficacy of transjugular intrahepatic portosystemic shunt( TIPS) in the treatment of acute decompensated cirrhotic events in patients with acute-on-chronic liver failure( ACLF). Methods A retrospective analysis was performed for the clinical data of 35 patients with ACLF and acute decompensated cirrhotic events who were hospitalized and underwent TIPS in Xijing Hospital of Digestive Diseases,Air Force Medical University,from June 2008 to December 2017,and 35 patients,matched by the propensity score at a ratio of 1∶ 1,who underwent medical treatment were enrolled. Related clinical,laboratory,and imaging data were collected. The t-test or the Mann-Whitney U test was used for comparison of continuous variables between two groups,and the chi-square test used for comparison of categorical data. A logistic regression model was used to investigate the risk factors for disease progression; the Kaplan-Meier method was used to estimate cumulative survival probability; the Cox regression model was used to determine the risk factors for survival,and a competing-risk model was used to compare the incidence rate of hepatic encephalopathy during follow-up. Results Among the patients who underwent TIPS,20 achieved disease improvement and 15 had stable conditions or experienced aggravation,while among the patients who received medical treatment,11 achieved disease improvement and 24 had stable conditions or experienced aggravation; the TIPS group had a significantly higher proportion of patients with improvement than the medical treatment group( χ2= 4. 69,P =0. 03). After the adjustment for sex and age in the logistic regression model,TIPS was more helpful for disease improvement than medical treatment( odds ratio = 3. 02,95% confidence interval [CI]: 0. 12-0. 91,P = 0. 03). The 28-and 180-day mortality rates were22. 9% and 42. 9%,respectively,in the TIPS group and 17. 1% and 68. 6%,respectively,in the medical treatment group,and the TIPS group had a significantly higher 180-day survival rate than the medical treatment group( χ2= 3. 92,P = 0. 048). The Cox multivariate analysis showed that serum total bilirubin was an independent risk factor for prognosis( hazard ratio = 1. 04,95% CI: 1. 01-1. 07,P =0. 006). There was no significant difference in the incidence rate of hepatic encephalopathy during follow-up between the TIPS group and the medical treatment group( 25. 7% vs 20. 0%,χ2= 0. 43,P = 0. 51). Conclusion Compared with medical treatment,TIPS is a safe and effective method for acute decompensated cirrhotic events in patients with ACLF and can significantly improve disease progression and survival,and meanwhile,it does not increase the incidence rate of hepatic encephalopathy.
Clinical effect of artificial liver support system in treatment of drug-induced liver failure: A Meta-analysis
Tian Bing, Li Fan, Deng BaoCheng
2020, 36(4): 823-828. DOI: 10.3969/j.issn.1001-5256.2020.04.023
Abstract:
Objective To systematically review the clinical of artificial liver support system( ALSS) in the treatment of drug-induced liver failure. Methods PubMed,Embase,The Cochrane Library,CMB,CNKI,and VIP databases were searched for related randomized controlled trials or randomized controlled trials on ALSS in the treatment of drug-induced liver failure published up to October 2019,and a statistical analysis was performed. Odds ratio( OR) was the effect size for categorical data,and the difference between groups was the effect size for continuous data. The weighted mean difference( WMD) method was used for the pooled analysis of effect size,and 95% confidence interval( CI) was calculated for each effect size. I2 and P values were used to evaluate the heterogeneity of the articles included in the analysis; a fixed effect model was used when I2< 50% and P > 0. 1,otherwise a random effects model was used. Results A total of 16 articles with 945 patients were included,with 520 patients in the ALSS + routine medical treatment( RMT) group and 425 in the RMT group. The meta-analysis showed that compared with the RMT group,the ALSS + RMT group had a significantly lower mortality rate of drug-induced liver failure( OR = 0. 27,95% CI: 0. 20-0. 36,P < 0. 001),significant improvements in albumin( Alb)( MD = 1. 21,95% CI: 0. 18-2. 25,P = 0. 02) and prothrombin activity( PTA)( MD = 11. 84,95% CI: 6. 34-17. 35,P < 0. 001),and a significant reduction in total bilirubin( TBil)( MD =-104. 97,95% CI:-163. 63 to-46. 30,P < 0. 001). Further analysis of Alb,TBil,and PTA after the withdrawal of ALSS showed that ALSS significantly improved Alb( MD = 1. 74,95% CI: 1. 20-2. 27,P < 0. 001) and PTA( MD = 4. 45,95% CI:2. 80-6. 10,P < 0. 001) and significantly reduced TBil( MD =-128. 41,95% CI:-217. 22 to-39. 59,P = 0. 005). Conclusion Compared with RMT alone,RMT combined with ALSS can significantly improve the main biochemical indicators of patients with drug-induced liver failure and reduce their mortality rate.
Effect of fenofibrate on the diversity of intestinal flora in a mouse model of nonalcoholic fatty liver disease
Zhang Dan, Zhou Bo, Deng Yi, Wen Yu, Lu: JunYan, Wang JinXiang, Geng ZuoTao, Luo SuFeng, Ying YunYan, Wen DaiYan, Shi ChunJing, Pu GuangYu, Jiang Xin, Ma LanQing
2020, 36(4): 829-834. DOI: 10.3969/j.issn.1001-5256.2020.04.024
Abstract:
Objective To investigate the effect of fenofibrate on the diversity of intestinal flora in mice with nonalcoholic fatty liver disease( NAFLD). Methods A total of 30 mice were randomly divided into normal group,high-fat group,and fenofibrate treatment group,with10 mice in each group. The mice in the high-fat group and the fenofibrate treatment group were given high-fat diet intervention for 14 weeks,and those in the normal group were given normal diet for 14 weeks. After 10 weeks of dietary intervention,the mice in the fenofibrate treatment group were given fenofibrate by gavage and high-fat diet for another 4 weeks,and the change in body weight was monitored during the whole process. Fecal samples were collected after 14 weeks,and high-throughput sequencing 16 S rRNA was used to investigate the diversity and difference of intestinal flora. Liver tissue samples were collected,and HE staining and oil red O staining were performed to observe the degree of steatosis. A one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups. Results After 10 weeks of intervention,the fenofibrate treatment group had a significantly lower body weight than the high-fat group( P < 0. 05). The results of HE staining and oil red O staining showed that the fenofibrate treatment group had a significantly lower degree of fat deposition than the high-fat group. There was a significant difference in intestinal flora between the fenofibrate treatment group and the high-fat group,while there was no significant difference in intestinal flora between the fenofibrate treatment group and the normal group. The fenofibrate treatment group had significant increases in the abundance of Bacteroidetes,Verrucomicrobia,Faecalibaculum,Muribaculaceae_norank,and Akkermansia and significant reductions in the abundance of Firmicutes,Actinobacteria,Clostridium,Turicibacter,and Bifidobacterium. Conclusion The increases in the abundance of Bacteroidetes and Verrucomicrobia and the reductions in the abundance of Firmicutes and Actinobacteria suggest that fenofibrate may have positive significance in the treatment of NAFLD.
Effect of Huatan Qushi Huoxue prescription on the key proteins of the ADPN/PI3K/Akt signaling pathway in rats with nonalcoholic steatohepatitis
Zhang LiHui, Zhang JianBo, Zhao WenXia
2020, 36(4): 835-839. DOI: 10.3969/j.issn.1001-5256.2020.04.025
Abstract:
Objective To investigate the effect of Huatan Qushi Huoxue prescription on the key proteins of the ADPN/PI3 K/Akt signaling pathway in a rat model of nonalcoholic steatohepatitis( NASH). Methods After one week of adaptive feeding,72 male Sprague-Dawley rats were randomly divided into blank group,model group,polyene phosphatidylcholine group,and high-,middle-,and low-dose Huatan Qushi Huoxue prescription groups,with 12 rats in each group. The rats in the blank group were given normal diet,and those in the other groups were given high-fat diet to establish a model of NASH. All rats except those in the blank group were given corresponding drug by gavage. The rats in the model group were given normal saline( 1 ml·100 g-1·d-1) by gavage,those in the polyene phosphatidylcholine group were given the suspension of polyene phosphatidylcholine capsules( 0. 028 5 g·100 g-1·d-1) by gavage,and those in the high-,middle-,and low-dose Huatan Qushi Huoxue prescription groups were given Huatan Qushi Huoxue prescription at a dose of 5. 04 g·100 g-1·d-1,2. 52 g·100 g-1·d-1,and 1. 26 g·100 g-1·d-1,respectively. Samples were collected 10 weeks later; chemiluminescence was used to measure the serum levels of alanine aminotransferase( ALT),aspartate aminotransferase( AST),gamma-glutamyl transpeptidase( GGT),alkaline phosphatase( ALP),triglyceride( TG),and total cholesterol( TC),and Western blot was used to measure the protein expression of adiponectin( ADPN),adiponectin receptor 2( AdipoR2),phosphoinositide 3-kinase( PI3 K),protein kinase B( Akt),phosphorylated Akt( p-Akt),nuclear factor-kappa B( NF-κB),and phosphorylated NF-κB( p-NF-κB) in liver tissue.A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the least significant difference ttest was used for further comparison between two groups. Results Compared with the blank group,the model group showed fatty change of liver tissue and had significant increases in the serum levels of ALT,AST,ALP,GGT,TG,and TC( all P < 0. 05),as well as significant reductions in the protein expression of ADPN,AdipoR2,PI3 K,Akt,and p-Akt( all P < 0. 05) and significant increases in the protein expression of NF-κB and p-NF-κB( all P < 0. 05). Compared with the model group,each treatment group had significant reductions in the serum levels of ALT,AST,ALP,GGT,TG,and TC( all P < 0. 05),significant increases in the protein expression of ADPN,AdipoR2,and p-Akt( all P < 0. 05),and significant reductions in the protein expression of NF-κB and p-NF-κB( all P < 0. 05). Compared with the polyene phosphatidylcholine group,the high-dose Huatan Qushi Huoxue prescription group had significant reductions in the serum levels of ALT,AST,ALP,GGT,TG,and TC( all P < 0. 05),significant increases in the protein expression of ADPN,AdipoR2,PI3 K,and p-Akt( all P < 0. 05),and significant reductions in the protein expression of NF-κB and p-NF-κB( all P < 0. 05). Conclusion Huatan Qushi Huoxue prescription may exert a therapeutic effect on NASH by regulating the ADPN/PI3 K/Akt signaling pathway,upregulating the protein expression of ADPN,AdipoR2,PI3 K,and p-Akt,and downregulating the protein expression of NF-κB and p-NF-κB.
Screening for differentially expressed genes in mice with autoimmune hepatitis and effect of saikosaponin-d on the expression of several differentially expressed genes
Chen Hao, Hao JianHeng, Li ZhenCheng, Xu HuiChao, Gao Yan, Miao YuChuan, Hao HuiQin, Liu Yang
2020, 36(4): 840-846. DOI: 10.3969/j.issn.1001-5256.2020.04.026
Abstract:
Objective To investigate the differentially expressed genes in autoimmune hepatitis( AIH) mice by microarray screening,the effect of saikosaponin-d( SS-d) on several differentially expressed genes,the pathogenesis of AIH,and the therapeutic mechanism of SS-d.Methods A total of 40 healthy female specific pathogen-free C57 BL/6 mice( with a body weight of 20 ± 2 g) were divided into gene chip group with 8 mice and SS-d treatment group with 32 mice. The mice in the gene chip group were further divided into normal control group and model group,with 4 mice in each group; the mice in the normal control group were given normal feeding,and those in the model group were given injection of concanavalin A( Con A) via the caudal vein at a dose of 15 mg/kg; the mice were sacrificed 12 hours later to collect liver tissue samples,the differentially expressed genes were screened out according to the instructions of Agilent chip,and some differentially expressed genes were verified by quantitative real-time PCR. The mice in the SS-d treatment group were randomly divided into normal control group( routine feeding),model group( injection of Con A via the caudal vein at a dose of 15 mg/kg),and low-and high-dose SS-d groups( pretreated with intraperitoneal injection of SS-d at doses of 2. 5 mg/kg and 5. 0 mg/kg,respectively,followed by the injection of Con A via the caudal vein at a dose of 15 mg/kg 8 hours later),with 8 mice in each group. Venous blood samples were collected 12 hours later,and ELISA was used to measure serum alanine aminotransferase( ALT) and aspartate aminotransferase( AST). Liver tissue samples were collected under sterile conditions; some samples were fixed by paraformaldehyde to prepare sections,and HE staining was performed;some liver tissue samples were used to extract RNA,and quantitative real-time PCR was used to measure the changes in the mRNA expression of several differentially expressed genes( interferon γ [IFN γ],interleukin-4 [IL-4],interleukin-5 [IL-5],interleukin-13[IL-13],and interleukin-17 [IL-17]). A one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups. The t-test was used between two groups. Results A total of 11 512 differentially expressed genes were screened out for the gene chip group,with 5189 upregulated genes and 6323 downregulated genes,which were significantly enriched in 138 signaling pathways. The results of quantitative real-time PCR showed that increases in the mRNA expression of IFN γ and IL-17 and reductions in the mRNA expression of IL-4,IL-5,and IL-13( all P < 0. 01),which was consistent with the results of chip screening. Compared with the normal control group,the SS-d treatment group had significant increases in the serum levels of ALT and AST( all P < 0. 01) and the mRNA expression of IFN γ and IL-17( all P < 0. 05),significant reductions in the mRNA expression of IL-4,IL-5,and IL-13( all P < 0. 05),and infiltration of a large number of lymphocytes in liver tissue. Compared with the model group,the low-and high-dose SS-d groups had significant reductions in the serum levels of ALT and AST( all P < 0. 05) and the degree of lymphocyte infiltration in liver tissue,as well as significant reductions in the mRNA expression of IFN-γ and IL-17( all P <0. 05) and significant increases in the mRNA expression of IL-4,IL-5,and IL-13( all P < 0. 05),and there were significant differences in the changes in these genes between the high-and low-dose SS-d groups( P < 0. 05). Conclusion The development and progression of AIH is the result of abnormal expression of a large number of genes,among which IFN γ,IL-4,IL-5,IL-13,and IL-17 are closely associated with the pathogenesis of AIH and are the main biological targets for SS-d to exert an immunoregulatory effect and a protective effect against liver injury.
Original articles_Biliary diseases
Application of ultrasound-guided real-time percutaneous transhepatic-cholangial or transhepatic-cholecyst drainage in treatment of acute obstructive cholangitis in primary hospitals
Yang DongXiao, Zhang Yong, Wang XueFeng, Li Jiang
2020, 36(4): 847-849. DOI: 10.3969/j.issn.1001-5256.2020.04.027
Abstract:
Objective To investigate the clinical value of ultrasound-guided real-time percutaneous transhepatic-cholangial or transhepatic-cholecyst drainage( PTCD) in the treatment of patients with acute obstructive cholangitis in primary hospitals. Methods A retrospective analysis was performed for the clinical data of 38 patients with acute obstructive cholangitis who underwent ultrasound-guided real-time PTCD in Tengchong People's Hospital from February 2012 to June 2018,and among these patients,4 had malignant biliary obstruction and cholangitis and 34 had acute obstructive suppurative cholangitis caused by hepatolithiasis. Results Of all patients,30 underwent puncture of the bile duct in the right lobe of liver,6 underwent puncture of the bile duct in the left lobe of liver,and 2 underwent puncture of the gallbladder. The success rate of first-time needle insertion was 91. 2%( 35/38),and the overall success rate of puncture was 100%. There were no complications such as massive hemorrhage,biliary peritonitis,and biliary-vascular fistula. At 2 weeks after surgery,89. 5%( 34/38) of the patients had a bilirubin level reduced by ≥1/2,and 32 patients( 84. 2%) had a level of alanine aminotransferase reduced to normal. As for the 34 patients with hepatolithiasis,second-stage surgeries including bile duct exploration/cholecystolithotomy and hepatic lobectomy were performed after the infection was under control,or they were referred to superior hospitals with tube indwelling for further treatment. The 4 patients with neoplastic bile duct obstruction were referred to superior hospitals with tube indwelling,among whom 3 underwent radical surgery and 1 underwent biliary stent placement via the former deep blind fistula. Conclusion Ultrasound-guided real-time PTCD can be used as an effective,simple,and safe biliary drainage technique for the early treatment of acute biliary obstruction in primary hospitals. This technique has a high success rate and low requirements for medical equipment,and therefore,it holds promise for clinical application in primary hospitals after related technical procedures are standardized.
Clinical effect of endoscopic sphincterotomy with balloon dilation versus sphincterotomy alone in treatment of large common bile duct stones: A Meta-analysis
Ren XiaoYing, Wu YongBiao, Ding XiangYuan, Li Xue, Yan HuiMing
2020, 36(4): 850-854. DOI: 10.3969/j.issn.1001-5256.2020.04.028
Abstract:
Objective To investigate the clinical effect of endoscopic sphincterotomy with balloon dilation( ESBD) versus sphincterotomy( EST) alone in the treatment of large common bile duct stones. Methods Foreign databases( including PubMed,Cochrane Central,and Embase) and Chinese databases( including CNKI and Wanfang Data) were searched for randomized controlled trials( RCTs) on the clinical effect of ESBD versus EST in the treatment of large common bile duct stones published up to July 8,2019. Related data were extracted and RevMan5. 3 was used for analysis. Results A total of 13 RCTs with 1926 patients were included,with 973 patients in the ESBD group and953 patients in the EST group. The meta-analysis showed that there were significant differences between the ESBD group and the EST group in stone clearance rate( odds ratio [OR]= 1. 53,95% confidence interval [CI]: 1. 03-2. 29,P = 0. 04),one-time clearance rate( OR= 1. 77,95% CI: 1. 06-2. 93,P = 0. 03),rate of use of mechanical lithotripsy( OR = 0. 40,95% CI: 0. 25-0. 63,P < 0. 000 1),bleeding rate( OR = 0. 23,95% CI: 0. 11-0. 50,P < 0. 001),incidence rate of cholangitis( OR = 0. 31,95% CI: 0. 12-0. 78,P = 0. 01),incidence rate of early complications( OR = 0. 59,95% CI: 0. 42-0. 84,P = 0. 003),and time of operation( mean difference =-8. 89,95% CI:-17. 56 to-0. 22,P = 0. 04),while there were no significant differences between the two groups in perforation( OR = 0. 27,95% CI: 0. 05-1. 30,P = 0. 10) and pancreatitis after endoscopy( OR = 1. 03,95% CI: 0. 66-1. 61,P = 0. 91). Conclusion In endoscopic treatment of large common bile duct stones,ESBD has several advantages over EST in stone clearance rate,rate of use of mechanical lithotripsy,bleeding rate,incidence rate of cholangitis,and time of operation.
Value of modified surgical Apgar score in predicting postoperative complications of hilar cholangiocarcinoma
Liu JunPeng, Su Yang
2020, 36(4): 855-859. DOI: 10.3969/j.issn.1001-5256.2020.04.029
Abstract:
Objective To investigate the value of modified surgical Apgar score( m SAS) in predicting the postoperative complications of hilar cholangiocarcinoma. Methods A retrospective analysis was performed for the clinical data of 188 patients who underwent surgery due to hilar cholangiocarcinoma in Shengjing Hospital of China Medical University from April 2013 to September 2019,and the patients were divided into complication group with 125 patients and non-complication group with 63 patients. The two groups were compared in terms of related clinical data,including sex,age,carcinoembryonic antigen,carbohydrate antigen 19-9,Bismuth-Corlett type,preoperative jaundice,albumin,surgical Apgar score,and surgical approach. The nonparametric Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups,and the chi-square test was used for comparison of categorical data between two groups. A logistic regression model was used for multivariate analysis,and the receiver operating characteristic( ROC) curve was plotted. Results Of all 188 patients,125( 66. 5%) experienced complications after surgery. There was a significant difference in m SAS between the complication group and the non-complication group( χ2= 65. 685,P < 0. 001),and the patients with high m SAS had an incidence rate of postoperative complications of 40. 6%,while those with low m SAS had an incidence rate of 96. 6%. The analysis of each complication showed that there was a significant difference between the high m SAS and low m SAS patients with bacteremia,pulmonary infection,abdominal infection,incision complications,intraperitoneal hemorrhage,and liver failure( χ2= 15. 196,52. 245,48. 409,5. 556,11. 087,and 17. 772,all P <0. 05). The multivariate regression analysis showed that m SAS( odds ratio [OR]= 0. 026,95% confidence interval [CI]: 0. 007-0. 099,P < 0. 001),surgical procedure( OR = 2. 195,95% CI: 1. 070-4. 500,P = 0. 032),and severity of preoperative jaundice( OR = 2. 479,95% CI: 1. 376-4. 434,P = 0. 002) were independent influencing factors for complications after surgery for hilar cholangiocarcinoma. The m SAS had an area under the ROC curve( AUC) of 0. 830( 95% CI: 0. 768-0. 880) in predicting complications after surgery for hilar cholangiocarcinoma,while SAS had an AUC of 0. 776( 95% CI: 0. 710-0. 834). At the optimal cut-off value of 6. 5,m SAS had a sensitivity of 96. 6%,a specificity of 59. 4%,and an accuracy of 76. 6%. Conclusion The m SAS can help to predict the postoperative complications of hilar cholangiocarcinoma.
Original articles_Pancreatic diseases
Clinical features of hyperlipidemic acute pancreatitis and their association with lipid metabolism
An WenHui, Yang Jing, He XuChang, Ren BeiBei, Yang QiuJin, Zheng Jie
2020, 36(4): 860-864. DOI: 10.3969/j.issn.1001-5256.2020.04.030
Abstract:
Objective To investigate the clinical features of patients with hyperlipidemic acute pancreatitis( HLAP) and the association between lipid metabolism profile and HLAP. Methods A total of 61 patients with HLAP who were treated in Department of Gastroenterology,The Second Affiliated Hospital of Kunming Medical University,from September 2017 to September 2019 were enrolled as HLAP group,and77 patients with non-hyperlipidemic acute pancreatitis were as non-HLAP group. The clinical features of the two groups were analyzed,including baseline data,laboratory markers,disease grade,comorbidities,and severity score. The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The chi-square test was used to for comparison of categorical data between groups. A multivariate binary logistic regression analysis was used to investigate the independent risk factors for HLAP,and the Z test was used for comparison of the area under the ROC curve( AUC). Results There were significant differences between the two groups in age( t =-6. 125,P < 0. 05),body mass index( t = 4. 125,P < 0. 05),infection( χ2= 4. 364,P < 0. 05),fatty liver disease( χ2= 50. 567,P < 0. 05),diabetes( χ2=28. 408,P < 0. 05),high-sensitivity C-reactive protein( Z =-2. 456,P < 0. 05),white blood cell count( t = 2. 652,P < 0. 05),neutrophils( t = 2. 232,P < 0. 05),lymphocytes( Z =-2. 339,P < 0. 05),D-dimer( Z =-8. 601,P < 0. 05),fasting blood glucose( Z =-4. 416,P < 0. 05),uric acid( t = 4. 644,P < 0. 05),total cholesterol( Z =-8. 937,P < 0. 05),triglyceride( Z =-8. 87,P <0. 05),low-density lipoprotein cholesterol( Z =-7. 972,P < 0. 05),non-high-density lipoprotein( Z =-9. 085,P < 0. 05),apolipoprotein B( Z =-3. 244,P < 0. 05),systemic inflammatory response syndrome score( Z =-2. 817,P < 0. 05),and Modified Early Warning Score( Z =-2. 226,P < 0. 05). Triglyceride( odds ratio [OR]= 0. 675,95% confidence interval [CI]: 0. 484-0. 943,P =0. 021) and non-high-density lipoprotein( OR = 0. 320,95% CI: 0. 164-0. 624,P = 0. 001) were independent risk factors for HLAP.Non-high-density lipoprotein( AUC = 0. 951,sensitivity = 100%,specificity = 88. 31%,95% CI: 0. 901-0. 981,SE = 0. 020,Youden index = 0. 883) and triglyceride( AUC = 0. 940,sensitivity = 95. 08%,specificity = 81. 82%,95% CI: 0. 887-0. 974,SE = 0. 018,Youden index = 0. 769) had high diagnostic efficiency. Non-high-density lipoprotein with a cut-off value of > 4. 55 mmol/L had the highest diagnostic value. Conclusion HLAP often occurs in the population with metabolic syndrome,with a younger age of onset and more severe inflammatory response. Non-high-density lipoprotein has a high value in the diagnosis of HLAP,which provides a new idea for guiding clinical treatment.
Association of hypertriglyceridemic waist phenotype with the severity and prognosis of acute pancreatitis
Jiang Xin, Yan YongFeng, Zhong Rui, Peng Yan, Wang Min, Fu WenGuang, Tang XiaoWei
2020, 36(4): 865-869. DOI: 10.3969/j.issn.1001-5256.2020.04.031
Abstract:
Objective To investigate the association of hypertriglyceridemic waist( HTGW) phenotype with the severity and prognosis of acute pancreatitis( AP). Methods A total of 356 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from September 2018 to August 2019 were enrolled as subjects and were divided into normal-waist-normal-triglyceride( NWNT)group,normal-waist-elevated-triglyceride( NWET) group,enlarged-waist-normal-triglyceride( EWNT) group,and HTGW group.The four groups were compared in terms of the clinical features including age sex,laboratory markers,disease grade,and complications. A one-way ANOVA was used for comparison of normally distributed continuous data between 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 between any two groups. The chi-square test was used for comparison of dichotomous variables between multiple groups and between any two groups; the Kruskal-Wallis H test was used for comparison of ordered polytomous variables between multiple groups,and the Mann-Whitney U rank sum test was used for comparison between two groups. Univariate and multivariate logistic regression analyses were performed to investigate the influencing factors for organ failure and pancreatic infection and necrosis.Results The HTGW group had a significantly higher neutrophil count than the NWNT group,a significantly higher C-reactive protein level than the NWNT group and the NWET group,a significantly higher creatinine level than the NWNT group,significantly higher levels of total cholesterol,triglyceride,and low-density lipoprotein than the NWNT group and the EWNT group,a significantly lower level of high-density lipoprotein than the NWNT group and the EWNT group,and a significantly higher level of blood glucose than the NWNT group( all P <0. 05). The HTGW group had a significantly higher incidence rate of severe AP( SAP) than the other three groups( χ2= 189. 519,P <0. 001),as well as significantly higher incidence rates of infectious pancreatic necrosis and organ failure than the other three groups( χ2=11. 770 and 19. 457,P = 0. 008 and P < 0. 001). The univariate logistic regression analysis showed that sex,recurrence history were the risk factors for infectious pancreatic necrosis,and after the adjustment for these risk factors,the risk of infectious pancreatic necrosis in the HTGW group was 3. 347 times that in the NWNT group( 95% confidence interval [CI]: 1. 538-7. 283,P = 0. 002; body mass index,WTI,smoking,diabetes mellitus,and HTGW were the risk factors for organ failure( P < 0. 05),and after the adjustment for these risk factors,the risk of organ failure in the HTGW group was 4. 143 times that in the NWNT group( 95% CI: 1. 299-13. 219,P = 0. 016).Conclusion HTGW is an independent risk factor for the development of SAP and may affect patients' disease severity and complications.Such patients should be identified and diagnosed as early as possible,and improvement of dyslipidemia should be performed to improve patients' conditions and prognosis.
Level of platelet microparticles in acute pancreatitis and their role in the formation of neutrophil extracellular traps
Qi QinQin, Yang Bin, Li HuiHui, Bao JunJun, Li HongYe, Wang BingBing, Mei Qiao
2020, 36(4): 870-873. DOI: 10.3969/j.issn.1001-5256.2020.04.032
Abstract:
Objective To investigate the change in the level of platelet microparticles( PMPs) in acute pancreatitis( AP) and the ability of PMPs to promote the formation of neutrophil extracellular traps( NETs). Methods Blood samples were collected from 55 patients with AP who were admitted to The First Affiliated Hospital of Anhui Medical University from September 2018 to August 2019,and these patients were divided into mild AP( MAP) group with 26 patients,moderate-severe AP( MSAP) group with 17 patients,and severe AP( SAP) group with 12 patients. A total of 15 healthy individuals who underwent physical examination were enrolled as control group. Platelet-poor plasma( PPP)was separated by differential centrifugation and flow cytometry was used to measure the level of PMPs. Neutrophils were collected from the control group and were co-cultured with the PMPs from AP patients. ELISA was used to measure the levels of myeloperoxidase( MPO),neutrophil elastase( NE),and histone H3 in culture solution,and a laser scanning confocal microscope was used to observe the distribution of NETs. The t-test was used for comparison of continuous data between two groups,and a one-way analysis of variance or the Kruskal-Wallis H test was used for comparison between multiple groups; the chi-square test was used for comparison of categorical data between groups; a Pearson correlation analysis was also performed. Results Compared with the control group,the MAP,MSAP,and SAP groups had a significant increase in the level of PMPs [179. 50( 145. 00-308. 750)/μl,1117. 50( 483. 00-2488. 25)/μl,and 1848. 00( 1216. 50-2562. 00)/μl vs 172. 00( 148. 25-204. 25)/μl,H = 4. 348、23. 186、19. 293,all P < 0. 05],and compared with the MAP and MSAP groups,the SAP group had a significant increase in the level of PMPs( H = 29. 068、4. 709,both P < 0. 05). The level of PMPs in AP patients was correlated with APACHEII,BISAP,and Ranson score( r = 0. 636,0. 508,and 0. 430,all P < 0. 001). Compared with the control group,the AP group had significantly increases in the levels of MPO[( 374. 68 ± 92. 01) ng/ml vs( 105. 27 ± 33. 82) ng/ml,t = 9. 105,P < 0. 001],NE[( 267. 45 ± 68. 46) ng/ml vs( 82. 71 ± 19. 22) ng/ml,t = 9. 921,P < 0. 001],and histone H3[( 16. 34 ±4. 02) ng/ml vs( 4. 53 ± 1. 48) ng/ml,t = 7. 524,P < 0. 001],and the formation of NETs was increased under the laser scanning confocal microscope. Conclusion The level of PMPs is significantly increased in AP,which is associated with disease activity. PMPs may promote the formation of NETs and aggravate the progression of AP.
Case reports
A case of Budd-Chiari syndrome due to Brucella
Wu GuangXin, Fan TianLi, Chen Peng
2020, 36(4): 874-875. DOI: 10.3969/j.issn.1001-5256.2020.04.033
Abstract:
Successful treatment of autoimmune hepatitis-like drug-induced subacute-on-chronic liver failure: A case report
Zhang Jie, Li Lu, Liu Hui, Zou HuaiBin, Chen Yu, Zheng SuJun
2020, 36(4): 876-878. DOI: 10.3969/j.issn.1001-5256.2020.04.034
Abstract:
Autoimmune hepatitis-associated liver cirrhosis with primary immune thrombocytopenia: A case report
Feng Ying, Zhou GuiQin, Yang Li, Li Bin, Wang XianBo
2020, 36(4): 879-880. DOI: 10.3969/j.issn.1001-5256.2020.04.035
Abstract:
Focal hepatic lesion in Gaucher disease mimicking hepatocellular carcinoma: A case report
Wang ShanShan, Li YanYan, Zhang Juan, Gao RunPing
2020, 36(4): 881-882. DOI: 10.3969/j.issn.1001-5256.2020.04.036
Abstract:
Dual-phenotype hepatocellular carcinoma presenting as cholangiocarcinoma on imaging: A case report
Ge JianKang, Wang Yao, Wang Lei, Zhu MingYan, Lin XiDa, Lu LingLing
2020, 36(4): 883-884. DOI: 10.3969/j.issn.1001-5256.2020.04.037
Abstract:
Anemia caused by primary biliary cholangitis and special reasons: A case report
Zhang XiaoXue, Feng LiNa, Chen QingLing, Kui YiWen, Yang QianQian, Wen XiaoYu, Jin QingLong
2020, 36(4): 885-887. DOI: 10.3969/j.issn.1001-5256.2020.04.038
Abstract:
Sarcomatoid cholangiocarcinoma with osteoclast-like giant cells: A case report
Yang Bo, Liu XiaoFang
2020, 36(4): 888-890. DOI: 10.3969/j.issn.1001-5256.2020.04.039
Abstract:
Reviews
Hepatitis B virus-mediated interaction between hepatic stellate cells and innate immune cells
Yang MiaoMiao, Wu ZhiHui, Tu ZhengKun
2020, 36(4): 891-894. DOI: 10.3969/j.issn.1001-5256.2020.04.040
Abstract:
Liver nonparenchymal cells play an important role in hepatitis B virus( HBV)-related liver diseases,and the activation of hepatic stellate cells( HSCs) and their interactions with intrahepatic cells are the main cause of liver fibrosis. This article mainly introduces HBV-induced liver inflammation and the interaction between innate immune cells and HSCs and briefly describes the role of monocytes/macrophages and natural killer cells in the activation and killing of HSCs and the immunomodulatory effect of HSCs in the presence of HBV.
Pathogenesis of sarcopenia in liver cirrhosis and current status of its diagnosis and treatment
Liu Jia, Huang Hua
2020, 36(4): 895-899. DOI: 10.3969/j.issn.1001-5256.2020.04.041
Abstract:
Sarcopenia is an important manifestation of malnutrition in liver cirrhosis and has become a non-negligible complication of patients with liver cirrhosis. It is closely associated with patients' quality of life,length of hospital stay,incidence rate of complications,and mortality rate and has great impact on the prognosis of liver transplantation. Therefore,early diagnosis and intervention are of great importance in improving the prognosis of patients with liver cirrhosis. However,no consensus has been reached on the diagnostic criteria for sarcopenia in China and foreign countries. In recent years,in-depth studies of muscle molecular regulation mechanism,muscle growth-related hormones,hyperammonemia-mediated signaling pathways,and intestinal flora have gradually revealed the pathogenesis of sarcopenia.Proper nutrition intervention,reasonable exercise,ammonia reduction therapy,hormone supplementation,and molecular targeted therapy may improve muscle mass in patients with liver cirrhosis,which are important hotspots for future research. This article summarizes the recent research on sarcopenia in liver cirrhosis and elaborates on its epidemiological features,pathogenesis,diagnosis,and treatment.
Advances in the clinical application of high-throughput sequencing in detecting microbiota in cirrhotic ascites,serum,and feces
Li Zhen, Zhang Wei, Jia Lin, Hu ZhongJie
2020, 36(4): 900-903. DOI: 10.3969/j.issn.1001-5256.2020.04.042
Abstract:
Liver cirrhosis is a chronic progressive liver disease,and patients with liver cirrhosis are highly susceptible to infection. The changes in microbiota in ascites,serum,and feces are associated with the progression and complications of liver cirrhosis. However,effective bacterial culture cannot be performed for most patients due to low bacterial abundance in ascites and blood,and thus it is difficult to conduct a comprehensive analysis. The high-throughput and high-speed advantages of next-generation sequencing technique can be used for pathogen biology and clinical diagnosis,including pathogen detection and identification,strain typing,and microbiome studies,to help clinicians optimize the application of antimicrobials. At present,the next-generation sequencing technique gradually becomes mature,making it possible to analyze the whole genome of microbiota.
Effect of transjugular intrahepatic portosystemic shunt on the liver and the heart
Huang Shan, Zhou Hao, Chen XueLing, Yao Xin, Tang ShanHong, Yang GuoDong, Qin JianPing
2020, 36(4): 904-907. DOI: 10.3969/j.issn.1001-5256.2020.04.043
Abstract:
Transjugular intrahepatic portosystemic shunt( TIPS) is a minimally invasive technique for the treatment of portal hypertension in liver cirrhosis. With the gradual maturity of TIPS technique and the continuous improvement of stent materials,the indications for TIPS are gradually expanded,the incidence rate of complications gradually decreases,and the treatment outcome is getting better and better. The impact of TIPS on the main organs of patients has attracted more and more attention in recent years,and this article reviews the effect of TIPS on the liver and the heart.
Establishment of Budd-Chiari syndrome models and related research advances
Wang LiBo, Sun YuLing
2020, 36(4): 908-911. DOI: 10.3969/j.issn.1001-5256.2020.04.044
Abstract:
Budd-Chiari syndrome( BCS) is a clinical syndrome of portal hypertension caused by the occlusion of the hepatic vein or the inferior vena cava,with or without inferior vena cava hypertension,and the formation of inferior vena cava diaphragm and/or hepatic venous obstruction are the main features in the Chinese population. At present,little is known about the etiology and pathogenesis of BCS,and most of the studies are clinical studies of diagnosis and treatment strategies. There is a lack of experimental exploration and research on the pathogenesis of BCS,and stable models are a necessary condition for the research on pathogenesis. This article reviews and analyzes the methods for establishing BCS models,the features of each model,and related research advances,in order to provide a reliable experimental basis for the research on the etiology and pathogenesis of BCS.
Association of intestinal microecology with hepatic encephalopathy
Huang YunYi, Liu Yao, Zhang Qun, Shi Ke, Wang XianBo
2020, 36(4): 912-914. DOI: 10.3969/j.issn.1001-5256.2020.04.045
Abstract:
Hepatic encephalopathy( HE) is a common and complex neuropsychiatric complication in patients with liver cirrhosis and has the features of high incidence,recurrence,and mortality rates,and it is also an important factor for the increased risk of hospitalization and rehospitalization. At present,there are still no effective drugs for HE. Recent studies have found that intestinal microecological changes are associated with the development,progression,and prognosis of HE,and the regulation of intestinal flora has a certain preventive effect on HE.This article summarizes the research on the association between intestinal microecology and HE in recent years and hopes to provide new ideas for clinical prevention and treatment of HE.
The role of butyrate in the development and progression of nonalcoholic fatty liver disease
Dang WenCheng, Deng FengCheng, Li ZhaoLong, Wan ShenYi, Zhang YouCheng
2020, 36(4): 915-918. DOI: 10.3969/j.issn.1001-5256.2020.04.046
Abstract:
Nonalcoholic fatty liver disease( NAFLD) is characterized by hepatic steatosis caused by nonalcoholic factors,and its pathogenesis,progression,treatment,and prevention have attracted more and more attention. At present,an increasing number of studies have been conducted on the association of intestinal microecology with various metabolic diseases such as obesity,diabetes,and cardiovascular diseases. Recent studies have found that butyrate,a metabolite of intestinal flora,is closely associated with NAFLD and can affect the development and progression of NAFLD through various mechanisms,such as alleviating inflammatory response,inhibiting insulin resistance,and reducing oxidative stress of liver mitochondria. Exploration of the association between butyrate and NAFLD is expected to provide a new approach for the prevention and treatment of NAFLD.
Research advances in integrated traditional Chinese and Western medicine therapy for nonalcoholic fatty liver disease
Li WenYi, Yuan ChengMin
2020, 36(4): 919-923. DOI: 10.3969/j.issn.1001-5256.2020.04.047
Abstract:
With the improvement of quality of life,the incidence rate of nonalcoholic fatty liver disease( NAFLD) is increasing year by year,and the treatment and prevention of this disease has been taken more and more seriously. Meanwhile,traditional Chinese medicine( TCM) has its own advantages,and its combination with modern medical sciences can make great contributions to the treatment of NAFLD.With reference to the research data on traditional Chinese and Western medicine therapy for NAFLD in recent years,this article mainly reviews TCM disease name,TCM etiology and pathogenesis,pathogenesis based on modern medical sciences,diagnosis,TCM treatment,Western medicine treatment,and integrated traditional Chinese and Western medicine therapy. It is pointed out that integrated traditional Chinese and Western medicine therapy can improve the symptoms,related indices,and imaging findings of patients with NAFLD,which provides a theoretical reference for integrated traditional Chinese and Western medicine therapy for NAFLD.
The role of oxidative stress and nuclear factor erythroid 2-related factor 2 in nonalcoholic fatty liver disease
Lu XiaoLiang, Jiang YuanYe, Cao Qin
2020, 36(4): 924-927. DOI: 10.3969/j.issn.1001-5256.2020.04.048
Abstract:
Nonalcoholic fatty liver disease( NAFLD) is the most prevalent chronic liver disease around the world,and its incidence rate is increasing year by year. Oxidative stress is the second hit in the classic“two-hit”pathogenesis of NAFLD,which is currently recognized as one of the pathogeneses of NAFLD. Nuclear factor erythroid 2-related factor 2( Nrf2) is a group of positive regulators that protect hepatocytes against oxidative stress. It is a key factor for cellular anti-oxidative stress and a key transcription factor that antagonizes liver oxidative stress. It plays an important role in the development and progression of NAFLD and may be a potential treatment target for improving NAFLD. This article reviews the role of oxidative stress and the Nrf2 pathway in the pathogenesis of NAFLD.
Strategies in the evaluation of coagulation status in patients with liver failure
Lyu BinYue, Li Qian
2020, 36(4): 928-931. DOI: 10.3969/j.issn.1001-5256.2020.04.049
Abstract:
Complex coagulation disorders are observed in patients with liver failure,and currently there is no comprehensive evaluation system to assess the risk of bleeding and thrombosis in such patients. This article summarizes the application of routine coagulation test and the hot techniques for coagulation assessment such as viscoelasticity test and thrombin generation analysis in patients with liver failure. The analysis shows that a single method has poor accuracy in evaluating the risk of bleeding and thrombosis and further exploration of a more accurate and effective assessment method should comprehensively consider the factors such as coagulation and anticoagulation factors,fibrinolytic system,platelet function,and systemic status of patients with liver failure,with reference to emerging coagulation process measurement techniques.
Current status of immunogenetic studies on primary biliary cholangitis
Ma WeiYu, Deng ZhiHua
2020, 36(4): 932-935. DOI: 10.3969/j.issn.1001-5256.2020.04.050
Abstract:
Primary biliary cholangitis( PBC) has the pathological feature of progressive intrahepatic cholestasis caused by immune-mediated apoptotic necrosis of small biliary epithelial cells,with a risk of progression to bile duct fibrosis,liver cirrhosis,and hepatocellular carcinoma. PBC has immunogenetic characteristics,and the abnormal genetic regulation of immune response in patients with PBC includes abnormal immune response of T and B lymphocytes involving human leukocyte antigen( HLA) and non-HLA genes and taking pyruvate dehydrogenase complex-E2 in mitochondria of intrahepatic small biliary epithelial cells as the antigen. More than 30% of PBC patients have poor response to ursodeoxycholic acid treatment,and therefore,clarifying the mechanism of abnormal immune regulation in PBC has great clinical significance in guiding the immunotherapy for PBC.
Role of hepatic macrophages in the development and progression of primary biliary cholangitis
Yang WenXia, Tang YingMei
2020, 36(4): 936-939. DOI: 10.3969/j.issn.1001-5256.2020.04.051
Abstract:
Primary biliary cholangitis( PBC) is a chronic autoimmune liver disease characterized by cholestasis and has unknown etiology.Its specific pathogenesis remains unclear,but hepatic macrophages are one of the key aspects of the immune and inflammatory response of PBC and the injury of biliary epithelial cells. Hepatic macrophages are classified into resident Kupffer cells and monocyte-derived macrophages according to their source,and these cells play an important role in the development and progression of PBC. This article reviews the role of hepatic macrophages in the development and progression of PBC.
Research advances in the role of exosomes in non-neoplastic liver diseases
Xu Shuai, Zhang LiPing
2020, 36(4): 940-943. DOI: 10.3969/j.issn.1001-5256.2020.04.052
Abstract:
The liver is an important metabolic and immune organ in human body. Exosomes are extracellular vesicles released by cells and carry a variety of molecules such as proteins,lipids,DNA,and RNA. Studies have found that exosomes play an important role in various liver diseases. This article elaborates on the role of exosomes in the pathogenesis of non-neoplastic liver diseases and related research advances in their role as biomarkers for disease diagnosis and therapeutic methods. It is pointed out that in-depth studies are needed to explore the biogenesis and release of exosomes and the exact mechanism of exosomes in liver diseases,in order to provide a basis for the prevention and treatment of non-neoplastic liver diseases.
Concurrent hepatitis D virus infection increases risk of hepatocellular carcinoma in patients with chronic hepatitis B
Yu Zhe, Yang YongPing
2020, 36(4): 944-947. DOI: 10.3969/j.issn.1001-5256.2020.04.053
Abstract:
Concurrent hepatitis D virus( HDV) infection accelerates the progression of liver disease in patients with chronic hepatitis B and particularly increases the risk of hepatocellular carcinoma( HCC). Further studies are still needed to explore the carcinogenic mechanism of HDV,related treatment methods,and their clinical effects. This article reviews the new epidemiological characteristics of HDV-related HCC,the new understanding of the pathogenic mechanism of HDV,and the advances in diagnosis and treatment,which is of great significance to promote the development of accurate HDV detection methods and effective drugs and reduce HDV-related HCC.
STAT3: A key molecule in the progression of liver cancer mediated by chronic inflammation
Yin JinPing, Yue ZiChen, Zhuo ShaoYuan
2020, 36(4): 948-952. DOI: 10.3969/j.issn.1001-5256.2020.04.054
Abstract:
STAT3,a member of the signal transducer and activator of transcription family,is abnormally activated in chronic inflammation-related tumors including liver cancer. As a key signal molecule in the microenvironment of liver cancer and inflammation,STAT3 not only participates in the inflammation-cancer transformation during the development of liver cancer,but also promotes the proliferation,invasion,and metastasis of hepatoma cells through many ways,and therefore,it may be a potential target for the treatment of liver cancer. This article reviews the recent advances in the association between STAT3 and liver cancer.