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The expressions of CK19, Ki67 and CK7 in hepatocellular carcinoma tissues ZHOU Jin-hong, CHONG Yang Chinese Hepatolgy    2022, 27 (8): 887-890.   Abstract （1172）      PDF （677KB）（224）       Knowledge map    Objective To observe the expression of cytokeratin 19 (CK19), proliferating cell nuclear antigen (Ki67) and cytokeratin 7 (CK7) in primary hepatocellular carcinoma (HCC) tissues.Methods 65 patients with HCC hospitalized from March 2016 to March 2018 were selected as the research objects. The specimens of cancer tissue and adjacent normal tissue were taken during operation. The expressions of CK19, Ki67 and CK7 were measured by immunohistochemical staining. The positive rates of CK19, Ki67 and CK7 between cancer tissues and adjacent tissues were compared. The positive detection rates of CK19, Ki67 and CK7 in cancer tissues of HCC patients with different clinicopathological features were counted and compared. The 3-year survival of HCC patients with different expression levels of CK19, Ki67 and CK7 were analyzed.Results The positive rates of CK19, Ki67 and CK7 in cancer tissues were 40.00%, 73.85% and 70.77% respectively, which were significantly higher than those of 1.54%, 23.08% and 1.54% in adjacent tissues (χ2=29.216, 33.639, 67.483; P<0.05). The positive rates of CK19, Ki67 and CK7 were higher in HCC patients with TNM stage III~IV, poorly differentiated tissue, lymph node metastasis and capsule infiltration (P<0.05). The positive rates of CK7, CK19 and Ki67 in patients with lymph node metastasis and capsule infiltration were higher (P<0.05). The 3-year survival rates of CK19, Ki67 and CK7 positive HCC patients were 34.52%, 58.33% and 58.70% respectively, which were lower than those of 87.18%, 88.24% and 84.21% in negative HCC patients (Log-rank=19.250, 4.767, 3.910; P<0.05).Conclusion The expression levels of CK19, Ki67 and CK7 were highly correlated with TNM stage, tissue differentiation, lymph node metastasis and capsule infiltration, and have impact on the survival of HCC patients. Reference | Related Articles | Metrics

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Early efficacy of tenofovir amibufenamide (TMF) in the treatment of patients with chronic hepatitis B: a real-word multicenter clinical study LI Ya-ping, CUI Dan-dan, GOU Guo-e, LIN Yong-mei, ZU Hong-mei, XU Guang-hua, GAO Xiao-hong, DANG Shuang-suo Chinese Hepatolgy    2023, 28 (1): 100-104.   Abstract （1016）      PDF （762KB）（223）       Knowledge map    Objective To evaluate the efficacy and safety of tenofovir amibufenamide (TMF) in the treatment of patients with chronic hepatitis B (CHB). Methods In this multicenter, prospective, real-world cohort study, we recruited 91 patients with CHB who attended the outpatient clinic of the Department of Infection of the 4 sites from August 2021 to August 2022 and were treated with TMF antiviral therapy. We collected clinical data, and compared the changes of HBV DNA, alanine transaminase (ALT), hepatitis B virus e antigen (HBeAg) and hepatitis B virus surface antigen (HBsAg) conversion, renal function and lipid metabolism at 12W and 24W. Results A total of 91 CHB patients were enrolled at 24W, 28 patients in treatment-naïve and 63 patients in previously treated. Complete virological response was achieved in 17.4% and 47.9% of treatment-naïve patients at 12W and 24W. The proportion of treated patients achieving complete virological response at 12W and 24W was 48.4% and 58.1%, respectively. HBV DNA [(4.88±0.54) lg IU/mL vs (2.69±0.35) lg IU/mL vs (2.40±0.39 lg IU/mL)] was significantly lower compared to baseline and 12W primary patients (F=24.51, P=0.000); HBV DNA in previously treated patients[(2.67±0.31) lg IU/mL vs (1.70±0.24) lg IU/mL vs (1.49±0.09) lg IU/mL decreased from before (F=5.83, P=0.009). The ALT recurrence rates based on laboratory criteria were 64% and 92% for 12W and 24W, respectively. And the ALT recurrence rates were 38.4% and 78.9% for 12W and 24W using AASLD 2018 criteria. After 24W of antiviral therapy 4.53% of patients had HBeAg conversion, 2.17% of patients had HBeAg seroconversion, 1.09% of patients had HBsAg conversion, no patients have yet had HBsAg seroconversion. In terms of safety, there was no significant change in blood Cr, eGFR and CysC at 24 weeks of antiviral therapy in CHB patients compared with baseline. 33 treated patients who had early kidney injury switched to TMF and continued antiviral therapy for 24W had a significant decrease in urinary α1-MG and urinary NAG and urinary β2-MG compared with baseline, with P values <0.05, which were statistically significant. Compared with baseline, there was a trend of decreasing TG and increasing TC, but the difference was not statistically significant.Conclusion TMF is effective and safe in the treatment of patients with CHB. Reference | Related Articles | Metrics

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Establishment and investigation of carbon tetrachloride-induced acute liver injury model in mice FU Shuang-nan, GAO Da, GUO Jia-jia, MIAO Ming-san, ZHU Ping-sheng, GONG Man Chinese Hepatolgy    2022, 27 (9): 1036-1040.   Abstract （798）      PDF （1030KB）（410）       Knowledge map    Objective To investigate the stable animal model of carbon tetrachloride (CCl4)-induced acute liver injury in mice, which is convenient for the research and application of new clinical drugs. Methods The Kunming (KM) mice were randomLy divided into blank group, model group, and bifendate group (5.625 mg/kg), and the acute liver injury of mice was replicated by intraperitoneal injection of 0.1% CCl4 solution. The aminotransferase level, liver index, and pathological changes of liver tissue at 3h, 6h, 12h, and 24h after modeling were detected to study the stability of the model. Results After exposure to the model group, alanine aminotransferase (ALT) increased slightly at 3 h [(45.21 ± 13.17) IU/L, P<0.01], and increased significantly at 12 h [(112.30 ± 30.54) IU/L] and 24 h [(121.98 ± 21.66) IU/L] (both P<0.01); AST increased at 3 h [(162.51 ± 28.57) IU/L], 6 h [(192.07 ± 31.05) IU/L], 12 h [(250.75 ± 90.82) IU/L] and 24 h [(274.27 ± 44.02) IU/L] (all P<0.01), but increased significantly at 12 and 24 h; liver index slightly increased at 3 h [(6.72 ± 1.90) g/100 g] and 6h [(6.72 ± 1.90) g/100 g] (both P<0.01). At 12 h [(12.41 ± 1.18) g/100 g] and 24 h [(14.90 ± 2.56) g/100 g] (both P<0.01), the liver pathological changes showed obvious hepatocyte swelling and inflammatory cell infiltration, and the injury degree was more significant at 24 h. Conclusion When the mouse acute liver injury model was prepared by intraperitoneal injection of 0.1% CCl4 solution, the modeling time between 12 h and 24 h was more appropriate. Reference | Related Articles | Metrics

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Chinese Hepatolgy    2022, 27 (7): 725-729.   Abstract （704）      PDF （699KB）（310）       Knowledge map    Reference | Related Articles | Metrics

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Efficacy and safety of tenofovir alafenamide fumarate in the treatment of CHB patients complicated with fatty liver disease LU Jia-hui, ZHANG Cong-nan, HE Peng-yuan, OU Meng-dang, HUANG Ming-xing Chinese Hepatolgy    2022, 27 (8): 858-862.   Abstract （697）      PDF （735KB）（174）       Knowledge map    Objective To explore the efficacy and safety of tenofovir alafenamide fumarate (TAF) in the treatment of chronic hepatitis B (CHB) patients complicated with fatty liver disease.Methods A total of 86 patients with CHB and fatty liver disease diagnosed and treated in our hospital from June 2019 to September 2020 were enrolled. They were divided into a the treatment-naive group (22 cases) and a treatment-experienced group (64 cases). The clinical markers of 2 groups were compared at baseline and 48 weeks after treatment.Results After 48 weeks of treatment in treatment-naive group, the undetected rate and the ratio of hepatitis B virus (HBV) DNA less than 20 IU/mL (50.0% vs 0.0%, 22.7% vs 0.0%, respectively, P<0.001) were higher than those at baseline. The levels of beta2-microglobulin (β2-MG) (median 1.82 mg/L vs 2.02 mg/L, P<0.001) and fasting blood glucose (median 5.11 mmol/L vs 5.41 mmol/L, P<0.001) at 48 weeks after treatment were lower than those at baseline, and the difference was statistically significant. In the treatment-experienced group, the undetected rate of HBV DNA at 48 weeks after treatment was higher than that at baseline, and the rate of HBV DNA more than 20 IU/mL at 48 weeks after treatment was lower than that at the baseline (64.1% vs 39.1%, 12.5% vs 35.9%, respectively, P=0.003); Total cholesterol (TC) (median 4.71 mmol/L vs 4.00 mmol/L, P<0.001), triglyceride (TG) (median 2.19 mmol/L vs 2.00 mmol/L, P<0.001), high-density lipoproteincholesterol (HDL-C) (median 1.16 mmol/L vs 1.00 mmol/ L, P<0.001) at 48 weeks after treatment were higher than those at baseline, low-density lipoprotein cholesterol (LDL-C) (median 2.61 mmol/L vs 3.00 mmol/L, P<0.001) and fasting blood glucose at 48 weeks after treatment (median 5.60 mmol/L vs 6.00 mmol/L, P<0.001) were lower than those at baseline, the differences were statistically significant.Conclusion CHB patients complicated with fatty liver disease in treatment-naive and treatment-experienced group can achieve higher virological and biochemical responses after treated with TAF, and the renal impairment of TAF is lower. However, TAF may have potential effect on increasing TCH, TG and HDL-C levels, lowering fasting blood sugar. Reference | Related Articles | Metrics

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Clinical outcome of liver cirrhosis patients with different complications treated by TIPS YAO Yong, FENG Lei, LIU Tian-yu, LIU Jie, PAN Jin Chinese Hepatolgy    2023, 28 (1): 61-64.   Abstract （642）      PDF （877KB）（176）       Knowledge map    Objective To investigate the clinical outcome of liver cirrhosis patients with different complications treated by transjugular intrahepatic portosystemic shunt (TIPS) and investigate the best indications of TIPS for patients with cirrhosis. Methods A total of 80 patients with liver cirrhosis and portal hypertension treated by TIPS were included, they were divided into refractory ascites (RA) group and variceal bleeding (VB) group according to the complication. Clinical data including age, sex, Child score and the model for end-stage liver disease score (MELD score) were collected and analyzed. The Kaplan Meier method was used to calculate survival rate and log rank test was used to compare the survival condition. Results There was no significant difference of age (VB group: 61.4±10.3 years,RA group: 63.5±10.5 years), sex (male/female in VB group: 32/20, male/female in RA group: 15/13), Child score (level A/ level B/ level C in VB group: 24/26/2, level A/ level B/ level C in RA group: 7/18/3) or MELD score (VB group: 11.35±4.4,RA group: 13.2±5.3) between the 2 groups. The median survival times of RA and VB group were 28 months and 60 months respectively, and the difference was significant (P=0.008). After TIPS implantation, the average survival time of patients without stent occlusion (>60 months) was significantly higher than patients with stent occlusion (50 months), (P=0.025). The average survival time of patients with MELD score≤10 (51.3 months) was significantly higher than patients with MELD score>10 (36.1 months), (P=0.001). Overall survival curve showed there was a gradual decline of postoperative survival rates in patients with liver cirrhosis after the TIPS and survival rate was 45.3% at 60-month follow-up.Conclusion Compared to patients with liver cirrhosis and RA, patients with liver cirrhosis and VB benefit more from TIPS. In addition, stent occlusion and MELD score >10 are influencing factors of the survival time in patients with liver cirrhosis treated by TIPS. Reference | Related Articles | Metrics

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Clinical and liver pathological features and mutation of UGT1A1 Gene in a case with Crigler-Najjar Syndrome type Ⅱ XU jing, DONG yuan, WANG Shou-ming, HAO Kun-yan, YU Yue-cheng Chinese Hepatolgy    2022, 27 (8): 908-911.   Abstract （603）      PDF （1043KB）（174）       Knowledge map    Objective Through analyzing the clinical, liver pathology and family uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) gene mutation characteristics of a patient with hereditary hyperbilirubinemia, in order to understand the genetic characteristics and diagnostic methods of Crigler-Najjar Syndrome type Ⅱ.Methods The medical history, liver biochemistry, imaging examination results, liver pathological data of a patient with Crigler-Najjar Syndrome type Ⅱ were collected, we also analyzed the UGT1A1 gene sequencing results of this patient and his parents.Results The increase of bilirubin in patients with Crigler-Najjar Syndrome type Ⅱ was usually greater than 5 times the upper limit of normal value, which was a significant increase in indirect bilirubin (IBIL). ALT and AST of the patient were normal, inflammation and necrosis of hepatocytes were seldom in hepatic pathology from the patient. The patient was a homozygous mutation in UGT1A1 gene Exon 5 c.1456T>G (p.Tyr486Asp), and heterozygotes of the mutation were found in his parents. The treatment of Phenobarbital was effective.Conclusion Missense mutation of Tyr486Asp in Exon 5 of UGT1A1 gene is the pathogenic factor of this patient with Crigler-Najjar Syndrome type Ⅱ and his family, which is autosomal recessive inheritance, with significantly increased IBIL. There is no inflammatory injury in the liver, and phenobarbital induction is effective. Reference | Related Articles | Metrics

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Chinese Hepatolgy    2023, 28 (2): 148-151.   Abstract （573）      PDF （723KB）（262）       Knowledge map    Reference | Related Articles | Metrics

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Prospective study of iPV-LPV and CV-LPV in the treatment of extrahepatic portal hypertension in children PENG Qiu, GAO Hai-yan, CHEN Zhi-li, DU Yong, ZOU Bing Chinese Hepatolgy    2022, 27 (7): 803-806.   Abstract （431）      PDF （733KB）（122）       Knowledge map    Objective To prospectively analyze the clinical efficacy of main portal vein-left portal vein shunt with interposition of portal vessels (iPV-LPV) and gastric coronary vein-left portal vein shunt (CV-LPV) in the treatment of extrahepatic portal hypertension in children.Methods 64 children with extrahepatic portal hypertension admitted to our hospital from March 2016 to 2021 were selected. After admission, they were divided into iPV-LPV group (n=31) and CV-LPV group (n=33) according to different treatment methods. We compared perioperative related indicators of two groups after surgery, including operation time, intraoperative blood loss, first postoperative eating time, first postoperative getting out of bed time and hospitalization time. The hepatic venous blood flow, portal vein blood flow, spleen length spleen thickness, and blood platelet (PLT) count and hemoglobin (Hb) were examined and compared between the two groups at admission and 6 weeks after operation. Finally, the complications during hospitalization were counted and compared between the two groups.Results In the iPV-LPV group, the operation time, intraoperative blood loss, first postoperative eating time, first postoperative getting out of bed time and hospitalization time were (176.9±47.5) min, (54.2±12.8) mL, (27.5±4.1) h, (2.4±0.5) d, (8.1±1.7) d, those in CV-LPV group were (210.4±50.4) min, (59.7±15.7) mL, (27.4±4.0) h, (2.8±0.9) d, (9.8±2.4) d. The operation time, first postoperative getting out of bed time and hospitalization time in the iPV-LPV group were significantly shorter than those in the CV-LPV group (P＜0.05). There was no significant difference between the two groups in intraoperative blood loss and first postoperative eating time (P>0.05). The preoperative hepatic artery blood flow, portal vein blood flow, spleen length, and spleen thickness in the iPV-LPV group were (375.4±72.4) mL/min, (1421.4±304.5) mL/min, (13.5±2.7) cm, (4.5±0.9) cm, and those postoperatively were (514.7±94.8) mL/min, (1104.1±124.8) mL/min, (10.6±2.0) cm, (2.9±0.5) cm. The preoperative hepatic artery blood flow, portal vein blood flow, spleen length, and spleen thickness in the CV-LPV group were (375.6±72.7) mL/min, (1422.0±304.9) mL/min, (13.4±2.7) cm, and (4.4±0.9) cm, respectively, which were (439.8±84.1) mL/min, (1280.4±235.7) mL/min, (11.8±2.3) cm, (3.5±0.7) cm postoperatively. The postoperative hepatic artery blood flow in the iPV-LPV group was significantly higher than that in the CV-LPV group, while the portal vein blood flow, spleen length, and spleen thickness were significantly lower than those in the CV-LPV group after surgery (P＜0.05). The postoperative hepatic artery blood flow in the two groups was significantly higher than that before the operation, while the portal vein blood flow, spleen length, and spleen thickness were significantly less than those before the operation (P<0.05). The preoperative PLT and Hb levels in the iPV-LPV group were (159.1±42.4) × 109 and (92.4±23.4) g/L, respectively, and the postoperative PLT and Hb levels were (224.7±70.6) × 109 and (105.4±26.4) g/L, respectively. The levels of PLT and Hb before operation in the CV-LPV group were (159.3±42.5) × 109 and (92.5±23.5) g/L, respectively, and after operation there were (189.4±67.8) × 109 and (105.6±26.4) g/L, respectively. The postoperative PLT level in the iPV-LPV group was significantly higher than that in the CV-LPV group (P＜0.05). The levels of PLT and Hb after operation in the two groups were significantly higher than those before operation (P<0.05). There was no significant difference in the total incidence of postoperative complications in the iPV-LPV group and CV-LPV group (16.1% vs 18.2%, P>0.05).Conclusion Compared with CV-LPV, IPV-LPV in the treatment of children with extrahepatic portal hypertension can better improve the hepatic venous blood flow, portal venous blood flow, spleen length, spleen thickness and serum PLT, which is more conducive to postoperative recovery of children. Reference | Related Articles | Metrics

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Application value of GLDH and GR in clinical diagnosis of drug-induced liver injury YANG Fan, WANG Lan, GU Chang, ZHANG Wei-wei, ZHU Yue-rong, QIU Hong Chinese Hepatolgy    2022, 27 (12): 1327-1330.   Abstract （395）      PDF （682KB）（109）       Knowledge map    Objective To explore the clinical value of glutamate dehydrogenase (GLDH) and glutathione reductase (GR) in the diagnosis of drug-induced liver injury (DILI).Methods The clinical data and serum liver function indexes of 111 DILI patients hospitalized in the military liver disease center of Qinhuai Medical Treatment Area of General Hospital of Eastern Theater CommandPLA from January 2021 to March 2022 and 100 healthy people in the physical examination center of the hospital in the same period were retrospectively analyzed. A total of 56 DILI patients were hospitalized for more than 10 days and had at least three liver function tests. The differences between DILI group and healthy group and the diagnostic efficiency of GLDH and GR were analyzed, Correlation with other liver function indexes, the indexes of other liver functions at different activity levels of GR and the changes of liver function indexes in DILI patients during hospitalization were evaluated by stratified comparison.Results GLDH and GR in DILI group [12.1 (6.8, 24.8) U/L, 87 (74, 108.7) U/L] were significantly higher than those in healthy group [3.80 (2.50, 5.68) U/L, 58.15 (51.35, 62.80) U/L] (P<0.001); The correlation coefficients of GLDH with alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were 0.296, 0.328, 0.308, 0.262 and 0.234 respectively, and the correlation coefficients of GR with ALT, AST, GGT, ALP and LDH were 0.464, 0.612, 0.322, 0.375 and 0.543 respectively. The area under the AUC curve, sensitivity, specificity, and Jordan index of GLDH were 0.861, 72.97%, 89.0% and 0.620 respectively, while those of GR were 0.941, 90.99%, 95.00% and 0.824 respectively. The GR results were stratified according to the interquartile distance and divided into four groups. It was found that there was no statistical significance in liver function indicators from Q1 to Q2 (P>0.05), while the most significant indicators in Q3 and Q4 were AST [165 (97, 256) U/L, 282 (171, 501) U/L], ALT [302 (158, 502) U/L, 545 (234, ,974.75) U/L], LDH [221 (185, 243) U/L, 294 (225.5, 376.25) U/L] and PA [(154 ± 80.23) mg/l, (103.07 ± 86.00) mg/L] (P<0.001) were used to analyze the changes of liver function indexes of 56 hospitalized DILI patients during hospitalization. It was found that GLDH was 20.05 (13.45, 31.3) U/L at admission, and decreased to 8.3 (4.53, 15.38) U/L after (5 ± 2) days of admission, most of them can return to the normal range of 5.5 (2.93, 10.7) U/L after (10 ± 2) days.Conclusion Compared with traditional liver function indexes, GLDH and GR play a great supplementary role in clinical diagnosis and treatment of DILI in terms of diagnostic efficacy, early diagnosis and curative effect observation. They can be used as new serum markers of DILI in clinical popularization. Reference | Related Articles | Metrics

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The therapeutic effect and adverse events of lenvatinib combined with PD-1 inhibitor in the treatment of advanced liver cancer WANG Lu, SUN Xiao-hu, BAI Jing-hui Chinese Hepatolgy    2022, 27 (8): 891-894.   Abstract （393）      PDF （707KB）（171）       Knowledge map    Objective To investigate the therapeutic effect and adverse events of Lenvatinib combined with PD-1 inhibitor in the treatment of advanced liver cancer.Methods A retrospective analysis was performed for the clinical data of 48 patients hospitalized with advanced liver cancer from January 1, 2019 to January 1, 2021 who were treated with Lenvatinib combined with Pabolizumab as a PD-1 inhibitor. The treatment outcome of intrahepatic lesions was evaluated with Modified Response Evaluation Criteria in Solid Tumors (mRECIST), during follow-up, and RECISTL1.1 was used to evaluate extrahepatic metastatic lesions. Kaplan-Meier method was used to evaluate the patients' survival time.Results Among the 48 patients with treatment experience, 21 achieved partial response, 15 achieved stabilization, and 12 had disease progression. The resulting Objective response rate was 43.75% and the disease control rate was 75.0%. The median time without disease progression was 7.39 (95% confidence interval 5.88-8.92) months. The incidence rate of adverse events was 52.08%. The most common adverse events were rash (31.25%), fatigue (31.25%) and hypertension (27.08%).Conclusion Lenvatinib combined with PD-1 inhibitor has a marked clinical effect in the treatment of advanced primary liver cancer, with a low incidence rate of serious adverse events It is therefore a safe and effective treatment regimen. This treatment is worthy of clinical promotion. Reference | Related Articles | Metrics

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Risk factors of moderate and severe pain in patients with hepatocellular carcinoma after radiofrequency ablation LIU Min-qiang, ZHA Xiao-liang, HUANG Xiang-rong, WU Qiang, HE Ren-liang Chinese Hepatolgy    2022, 27 (6): 640-643.   Abstract （373）      PDF （669KB）（174）       Knowledge map    Objective To investigate risk factors of moderate and severe pain in patients with hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA).Methods One hundred and two patients with HCC who underwent computed tomography (CT)-guided percutaneous RFA under general anesthesia were enrolled. According to the visual analog scale (VAS) within 24 hours after operation, patients were divided into moderate and severe pain group (VAS ≥ 3 points) and non moderate/severe pain group (VAS < 3 points). Clinical data of the patients including gender, age, American Society of Anesthesiologists (ASA[A1]) classification, history of cirrhosis and liver surgery, preoperative pain, tumor size, tumor location, distance between tumor and liver capsule, tumor number, ablation number, ablation time and operation time were collected. Multivariate logistic regression analysis was performed to screen the risk factors for moderate and severe pain after operation.Results Fifty-six patients (54.9%) had moderate or severe pain within 24 hours after operation. Compared with the non moderate/severe pain group, the proportion of preoperative pain, tumor size > 1.5cm and ablation time > 12min in the moderate and severe pain group were higher (P<0.05). Multivariate logistic regression analysis showed that tumor focus > 1.5 cm and ablation time > 12 min were independent risk factors of moderate and severe pain in HCC patients after RFA (P<0.05).Conclusion Tumor size > 1.5 cm or RFA time > 12 min are positively related to the occurrence of moderate and severe pain in HCC patients after operation. Prompt analgesic treatment after RFA should be paid more attention to. Reference | Related Articles | Metrics

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Analysis on the long-term survival status and clinical characteristics of patients with acute-on-chronic liver failure KANG Wei-wei, TIAN Hui, FENG Li-li, LIU Li-wei, XU Man-man, KONG Ming, ZOU Zheng-sheng, DUAN Zhong-ping, CHEN Yu Chinese Hepatolgy    2022, 27 (5): 516-520.   Abstract （362）      PDF （806KB）（170）       Knowledge map    Objective To investigate the long-term survival status of patients with acute-on-chronic liver failure (ACLF). Methods This was a retrospective cohort study. A total of 167 patients diagnosed as ACLF were enrolled. The survival status and laboratory examination results at 3 months and 1 year after follow-up were recorded, and the changes of short-term and long-term survival status were observed. The long-term prognosis of ACLF patients (≥24 weeks) was divided into 5 grades: Grade I was an ideal outcome: without cirrhosis; Grade II was a satisfactory outcome: compensatory cirrhosis, manifested as reversible or long-term compensatory cirrhosis; Grade III was an acceptable outcome: decompensated cirrhosis, manifested as decompensated cirrhosis or chronic liver failure; Grade IV was the survival outcome after transplantation; Grade V was the death outcome. Results A total of 167 patients with ACLF were enrolled, with a median age of 45 years (39, 53) and 136 cases (81.4%) were male. The etiology of 123 cases (73.7%) was chronic hepatitis B virus (HBV) infection which was the main cause, and the other 44 cases were caused by other diseases. At baseline, 68 cases (40.7%) without liver cirrhosis, and 99 cases (59.3%) with liver cirrhosis. Three months after liver transplantation, 16 cases (9.6%) survived and 56 cases (33.5%) died. At 1 year after liver transplantation, 15 cases (9.0%) survived and 67 cases (40.1%) died. After a 3 months follow-up among the 68 patients without liver cirrhosis, 11 patients (16.2%) still without liver cirrhosis, 23 cases (33.8%) with compensated cirrhosis, 14 cases (20.6%) with decompensated cirrhosis, 5 cases (7.4%) survived after liver transplantation, and 15 cases (22.1%) died. Continue the follow-up to 1 year, among the 11 patients without cirrhosis at 3 months, 8 of which were still in non-cirrhotic state, 1 of which developed compensated cirrhosis and 2 of which developed decompensated cirrhosis; among the 23 patients with compensatory cirrhosis at 3 months, 15 of which without liver cirrhosis, 5 of which still with compensatory cirrhosis, and 3 of which developed decompensated cirrhosis; among the 14 patients with decompensated cirrhosis at 3 months, 3 of which without liver cirrhosis, 9 of which with compensated cirrhosis and 2 of which still with decompensated cirrhosis. Among the 5 patients who survived after liver transplantation at 3 months, 1 patient died. After a 3 months follow-up among the 99 patients with liver cirrhosis, all of them still with liver cirrhosis 14 patients (14.1%) with compensated cirrhosis, 33 patients (33.3%) with decompensated cirrhosis, 11 patients (11.1%) survived after liver transplantation and 41 patients (41.1%) died. Continue the follow-up to 1 year, among the 14 patients with compensatory cirrhosis at 3 months, 11 of which still with compensatory cirrhosis and 3 of which developed decompensated cirrhosis; among the 33 patients with decompensated cirrhosis at 3 months, 13 of which with compensatory cirrhosis, 10 of which still with decompensated cirrhosis, 1 of which survived after liver transplantation and 9 of which died after liver transplantation. Among the 11 patients who survived after liver transplantation at 3 months, 1 patient died. Conclusion The short-term and long-term survival status of patients with ACLF is uncertain, which requires close follow-up and active treatment. The ACLF patients without cirrhosis at baseline have a longer survival time and a better survival state after active treatment. Reference | Related Articles | Metrics

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An analysis for the diagnostic?significance of clinical manifestation, autoantibodies and liver pathology of 84 patients with primary biliary cholangitis CHENG Ya-jiao, LU Guan-zhu, WANG Yu-huan, BAO Yu-jie, XU Jie, YUAN Xiao-ling Chinese Hepatolgy    2022, 27 (5): 566-569.   Abstract （360）      PDF （632KB）（199）       Knowledge map    Objective To analyze the clinical features, autoantibodies and the diagnostic significance of liver histopathology of primary biliary cholangitis (PBC), in order to improve the understanding of this disease. Methods The clinical characteristics, results of autoantibody tests and liver histopathological examination of 84 patients diagnosed with PBC or PBC-AIH overlap syndrome were analyzed. Results Among the 84 patients, the male to female ratio was 1:4.6, and the average age was (55.54±11.10) years. Among the common clinical symptoms, the incidence of skin pruritus in AMA-M2-positive patients (27.3%) is higher than that in AMA-M2-negative patients (3.4%), with statistical difference (χ2=6.990, P=0.008). The results of autoantibody tests indicated that the positive rates of AMA-M2, p210 and Sp100 were 65.5%, 23.8%, and 16.7%, respectively. Among 52 patients who underwent liver biopsies, 23 each of AMA-M2 positive and AMA-M2 negative patients have histopathologically confirmed PBC. Compared with the AMA-M2 positive patients, the AMA-M2 negative patients had more cases with significant fibrosis (i.e., PBC stage III, 7.3% vs 24.1%, χ2=4.746, P=0.042). Conclusion AMA positive has high sensitivity and specificity for the diagnosis of PBC. However, AMA-M2 negative PBC is also common in Chinese patients. Although the combination of Sp100 and gp210 tests can improve the diagnostic rate of PBC patients, the diagnosis was still easy to be missed or delayed. Histopathological examination to achieve early diagnosis and treatment is also important for improving the patient's prognosis and life qualities. Reference | Related Articles | Metrics

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The characteristics and risk factors of hepatic encephalopathy after emergent TIPS operation in patients with bleeding from esophageal and gastric varices LIU Yi, ZHOU Zi-zhong, LIU Gang, XU Hai-rong Chinese Hepatolgy    2022, 27 (6): 658-661.   Abstract （355）      PDF （609KB）（153）       Knowledge map    Objective To investigate the characteristics and risk factors of hepatic encephalopathy after emergent transjugular intrahepatic portosystemic shunt (TIPS) operation in patients with bleeding from esophageal and gastric varices (EGV).Methods The clinical data of 102 patients with liver cirrhosis accompanied by rupture of EGV who were admitted to the Third People’s Hospital of Zigong City from July 2015 to July 2020 and treated with TIPS within 72h were retrospectively analyzed. The patients were followed-up for 6 months. They were divided into 42 cases of hepatic encephalopathy (HE) group and 60 cases of non-hepatic encephalopathy (non-HE) group according to whether they occurred HE after operation. The baseline data and biochemical indicators of patients before TIPS surgery were collected and compared, followed by univariate and multivariate Logistic regression analysis for the risk factors of HE after TIPS.Results There were a total of 102 subjects enrolled in this study. Within them, 42 occurred HE, with 20 cases (47.62%) of grade 0~1, 11 cases of grade 2 (26.19%), 7 cases of grade 3 (16.675), and 5 cases of grade 4 (11.90%). The Results of univariate analysis showed that coagulation time, MELD score and HVPG in patients with EGV hemorrhage were associated with HE after TIPS (P<0.05). Multivariate logistic regression analysis showed that MELD score (OR=3.50, 95%CI: 1.70～7.10), HVPG (OR=3.90, 95%CI: 1.58～9.67) were independent risk factors for HE after TIPS operation in patients with ruptured EGV (P<0.05).Conclusion The incidence of HE after emergency TIPS is higher in patients with EGV bleeding. Among them, MELD score and HVPG are independent risk factors for HE after TIPS. Therefore, preoperative MELD score and HVPG can predict the risk of postoperative HE. Reference | Related Articles | Metrics

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The therapeutic effect of carrelizumab or sintilimab combined with lenvatinib in the treatment of liver cancer and the influence on tumor markers YANG Jian-qi, CAO Wen-miao, WU Yin-xia, YIN Ting, XING En-ming Chinese Hepatolgy    2022, 27 (10): 1080-1083.   Abstract （343）      PDF （647KB）（219）       Knowledge map    Objective To investigate the therapeutic effect of carrelizumab or sintilimab combined with lenvatinib in the treatment of liver cancer and its influence on tumor markers. Methods Ninety-five patients with primary liver cancer admitted to our hospital from June 2018 to June 2021 were selected as the research objects. According to the treatment method, the patients were divided into lenvatinib group (lenvatinib, 33 cases), carrelizumab group (carrelizumab combined with lenvatinib, 30 cases), and sintilimab group (sintilimab combined with lenvatinib, 32 cases). The clinical therapeutic efficacy, side effects, liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil)] and tumor markers [alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), α-L-fucosidase (AFU), carbohydrate antigen 199 (CA199)] among the 3 groups after treatment were compared. Results The clinical efficacy of carrelizumab group and sintilimab group were significantly higher than lenvatinib group (P<0.05). The levels of ALT, AST and TBil in the 3 groups were all significantly decreased after treatment, the liver function of carrelizumab group and sintilimab group were significantly lower than lenvatinib group (P<0.05). The levels of AFP, CEA, AFU, and CA199 in the 3 groups were significantly decreased after treatment, the tumor markers levels of carrelizumab group and sintilimab group were significantly lower than lenvatinib group (P<0.05). There was no significant difference in side effects among the 3 groups (P>0.05). Conclusion Carrelizumab or sintilimab combined with lenvatinib in the treatment of liver cancer can effectively improve the therapeutic efficacy and liver function, reduce the levels of tumor markers, with good safety. Reference | Related Articles | Metrics

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CT and MRI findings in four cases of hepatic angiosarcoma RONG Xue-fei, LIU Shu-hong, DONG Jing-hui, REN Hong-wei Chinese Hepatolgy    2022, 27 (8): 884-886.   Abstract （341）      PDF （1003KB）（207）       Knowledge map    Objective To investigate the specific manifestation of hepatic angiosarcoma under computer tomography (CT) and magnetic resonance imaging (MRI).Methods The CT and MRI features of four cases of hepatic angiosarcoma (HA) confirmed by pathology in the Fifth Medical Center of PLA General Hospital in Beijing were retrospectively analyzed.Results All 4 HA patients had multiple lesions. One patient had lesions with scar and hepatic artery crossing. All 4 patients had bleeding within the lesions, which was shown by CT as uneven low-density shadow in the lesions, and by MRI as low intensity signal on T1WI, high intensity signal on T2WI, mixed or slightly high intensity signal on DWI, and high signal on apparent diffusion coefficient (ADC). Dynamic enhanced scanning showed patchy enhancement at the edge or within the lesion at arterial stage in all patients. With time extension, the enhancement range of the lesion increased, namely centripetal or eccentric enhancement.Conclusion The CT and MRI findings of HA have certain imaging characteristics. Features of multiple lesions, internal bleeding, high signal on ADC, centripetal and eccentric enhancement on dynamic enhanced scan indicate hepatic angiosarcoma. Reference | Related Articles | Metrics

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Clinical characteristics of primary biliary cirrhosis with negative serum specific antibodies LI Wei- kun , LI Hui-ming, CHANG Li-xian, PENG Dan, LIU Chun-yun, QI Yan-shan, MOU Chun-yan, ZHANG Yin-yuan, XU Dan-qing, LIU Li Chinese Hepatolgy    2022, 27 (7): 795-799.   Abstract （325）      PDF （698KB）（174）       Knowledge map    Objective Comparing a series of clinical features and pathological manifestations of patients with primary biliary cirrhosis (PBC) with negative and positive anti-mitochondrial antibodies (AMA), in order to provide a theoretical basis for the diagnosis and treatment of AMA-negative PBC patients.Methods From January 2017 to December 2020, patients with abnormal liver function for half a year or more, accompanied by elevated γ-glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP) were selected, and the final subjects were obtained according to the inclusion and exclusion criteria. Liver puncture pathological examination was performed on all selected subjects, and they were divided into AMA negative and positive groups. Routine blood, serum biochemical, thyroid function and pathological tests were performed on the two groups. After collecting the clinical data, SPSS25.0 was used for data analysis. The counting data were expressed as (mean±standard deviation), and t test was used for comparison between the two groups. The measurement data was expressed by rate or percentage (%), and chi-square test was used for the comparison of rates between two groups.Results The results showed that the majority of PBC patients with AMA negative (19 cases) and positive (49 cases) were female, and the patients were mainly 50-55 years old. There was no difference in age and sex between the two groups (P<0.05). Laboratory test results showed that there was statistically significant difference between AMA negative (183.27±1.67) and AMA positive (265.67±1.37) in PLT levels of blood routine (P<0.05), and no difference in other indicators. In addition, liver function test results showed that the GGT value of patients in the AMA negative group (444.5±2.72) was higher than that in the AMA positive group (276.33±3.86). For biochemical factors, the results showed that the levels of triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) in AMA negative group were lower than those in AMA positive group [TG: (1.74±0.58) vs (1.97±0.94), P=0.023; LDL-C: (3.57±0.42) vs (4.87±0.7), P=0.016], while the expression of immunoglobulin IgE was opposite. The IgE expression in the AMA negative group was lower that in the AMA positive group [(70.15±0.91) vs (33.67±0.65), P=0.011]. Thyroid function analysis showed that the T4 expression level of AMA negative group was lower than that of AMA positive group [(110.72±10.34) nmol/L vs (122.56±10.88) nmol/L, P<0.05]. Positive results of autoimmunity antibody showed that anti-liver and kidney microsomal antibody 1 (LKM1) was not expressed in PBC, while antinuclear antibody (ANA) and RO52 in AMA negative group were higher than those in AMA positive group (86.36% vs 9.26%, 81.82% vs 14.81%, both P<0.05). Immunohistochemical results of cytokeratin 7 (CK7) and CK19 showed that there was no statistical difference in positive rate between the two groups.Conclusion The clinical features and pathological manifestations of AMA-negative and positive PBC patients are very similar, and equal attention should be paid to AMA-negative patients to improve the diagnosis rate of PBC and the treatment effect. Reference | Related Articles | Metrics

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Retrospective analysis of clinical features of liver dysfunction associated with varicella-zoster virus infection WANG Jian-bin, LIANG Dong Chinese Hepatolgy    2023, 28 (2): 242-243.   Abstract （321）      PDF （700KB）（117）       Knowledge map    Objective To analyze the clinical characteristics and prognosis of abnormal liver function secondary to varicella(chickenpox), so as to provide clinical decision support. Methods The clinical data of the 330 patients with varicella who were treated in our hospital from January 2010 to January 2022 were collected, and the clinical characteristics of the patients with abnormal liver function secondary to varicella were analyzed. Results Liver injury occurred in 68 patients, with an incidence rate of 20.6%. The majority of cases were in the acute stage of varicella infection without obvious clinical symptoms. The main manifestations were mild elevation of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in which the changes of ALT levels were more obvious. Patients with ALT <100 U/L generally did not use drug intervention, while patients with ALT>100 U/L received oral liver-protective drugs, all patients with abnormal liver function were cured and no recurrence was observed. Conclusion Although the prevalence of liver function abnormalities is common in patients with varicella, its clinical symptoms, mainly characterized by mild liver damage, are not obvious and could be cured by appropriate liver protection treatment. Reference | Related Articles | Metrics

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Chinese Hepatolgy    2022, 27 (12): 1340-1343.   Abstract （319）      PDF （795KB）（275）       Knowledge map    Reference | Related Articles | Metrics