Chinese Hepatolgy

Analysis of clinical characteristics in 140 patients with herb-induced liver injury

ZHU Chun-wu, WANG Hai-nan, ZHANG Ya-lei, YUAN Ji-li, XUE Dong-ying, ZHANG Qin, LIU Cheng-hai

2019, 24(4): 362-364.

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Objective To analyze the clinical characteristics of herb-induced liver injury(HILI). Methods Clinical data of the patients such as medical history, symptoms, signs, examination results, treatment and prognosis were collected and retrospectively analyzed. Results The majority of the 140 HILI patients were female(67.14%), aged from 40 to 69 years old. The herbal medicine was mainly decoction in formulation(58.57%) which mainly contained Polygonum multiflorum, Corydalis ambigua and Tripterygium wilfordii. Xianlinggubao capsules, Xiaoying mixture, Huolisu oral liquid, Jingwu capsules were the commonest to induce liver injure in the involved 40 kinds of Chinese patent medicines. The common clinical symptoms were fatigue, anorexia, jaundice, etc. Hepatocellular injury was the main clinical classification, accounting for 78.57%. There were significantly differences between alanine transaminase, aspartate aminotransferase and alkaline phosphatase among different classifications of HILI. According to Roussel Uclaf Causality Assessment Method, only 2.86% of cases were classified as highly probable and 70.71% as probable. Most patients had a good prognosis. Conclusion Traditional Chinese medicine can lead to liver injury, which is common in middle-aged and elderly women, mainly hepatocyte injury type, the cause of liver injury of traditional Chinese medicine is complex, and the prognosis is good.

Clinical analysis of biochemical persistent nonresponse in chronic hepatitis patients with nucleos(t)tide analogue therapeutics achieving virological response

JIN Hong-hui, HU Chen-bo, CHEN Xiao-rong, LU Yun-fei, FENG Yan-ling

2019, 24(4): 365-367.

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Objective To investigate the causes of biochemical persistent nonresponse in chronic hepatitis B(CHB) patients with nucleos(t)ide analogues treatment achieving virologic response, and lead to liver disease progression. Methods From December 2016 to June 2018, 40 CHB patients treated with nucleos(t)ide analogues who had no biochemical response after achieving virological response over 1 month were selected to undergo liver biopsy to explore the cause of liver disease progress. Results Histopathologic examination of 40 liver biopsy samples showed 14 cases of nonalcoholic steatohepatitis(NASH, 35%), 9 cases of autoimmune hepatitis(AIH, 22.5%), 7 cases of drug-induced liver injury(DILI, 17.5%), 5 cases of nonspecific inflammation(12.5%), 3 cases of primary biliary cholangitis(PBC, 7.5%), 1 case of hemochromatosis(2.5%) and 1 case of amyloidosis(2.5%). After comprehensive treatments including lifestyle improvement, immunoregulation, hepatoprotective management and avoidance of hepatotoxic drugs, biochemical indexes were decreased significantly(alanine transaminase: 36.33±18.28 vs. 95.15±19.21, alkaline phosphatase: 101.10±37.96 vs. 123.85±39.29, gamma-glutamyltransferase: 76.50±45.55 vs. 183.15±93.12, P<0.05) and as was liver stiffness values(8.17±4.61 vs. 10.85±5.63, P<0.05). Conclusion The common causes of biochemical persistent nonresponse in CHB patients with nucleos(t)ide analogues treatment achieving virologic response are NASH, AIH, DILI, nonspecific inflammation and PBC, thus liver disease in these patients progress. Therefore, it is necessary to explore the causes of liver disease progression in order to give clinical intervention and improve the prognosis as soon as possible.

Expression of CCL23 in hepatocellular carcinoma and its effect on prognosis

WANG Jian-ye, ZHAO Zhi-cong, HOU jia-jie, XIA Qiang

2019, 24(4): 368-372.

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Objective To investigate the most significant chemokine of expression in hepatocellular carcinoma(HCC) and its clinical value in prognosis of HCC patients. Methods CC chemokine ligand 23(CCL23) was screened as the the most significant chemokine of expression in hepatocellular carcinoma and adjacent tissues using a public databases. Its expression was verified in HCC tissues in our hospital by quantitative polymerase chain reaction and immunohistochemistry staining. Then the correlation between the level of CCL23 and the clinicopathological characteristics, the prognosis of HCC patients was investigated. Results CCL23 was significantly downregulated in liver cancer tissues in public databases and HCC patients in our hospital(TCGA, GSE14520, GSE25097: P<0.0001, GE64041: P=0.0003, GSE57957: P=0.0001, our hospital: P<0.0001). The patients with higher level of CCL23 in tumor tissues had longer overall survival period(TCGA: P=0.0026, GSE14520: P=0.0014, our hospital: P<0.0001) and recurrence-free survival period(TCGA: P=0.0306, GSE14520: P=0.0189, our hospital: P<0.0001). Conclusion The expression of CCL23 in liver cancer tissues is significantly decreased, which may predict the prognosis of HCC patients and act as a potential target for clinical treatment.

Different types of left portal shunts for extrahepatic portal hypertension in children

LV Zhong-jun, LI fu-kui, SHI ming-tao, LI hong-xiao

2019, 24(4): 373-376.

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Objective To investigate the therapeutic value of different left portal shunts in children with extrahepatic portal hypertension(EPH). Methods A total of 60 children with EPH admitted to our hospital from February 2013 to February 2018 were selected and divided into group A(n=32) and group B(n=28) according to the operation method. Group A underwent main portal vein-left portal vein shunt with interposition of portal vessels(iPV-LPV), and group B underwent gastric coronary vein-left portal vein shunt(CV-LPV). The perioperative indexes of the 2 groups were collected and analyzed. The blood flows of hepatic artery and portal vein were measured before operation, 2 and 6 weeks after operation. The levels of serum protein S, protein C and antithrombin III were measured before and 6 weeks after operation. And the incidence of complications was recorded. Results The operation time, time to first activity out of bed after operation and time of postoperative hospitalization in group A were significantly shorter than those in group B(174.32±43.65 vs. 207.15±53.76 min, 46.24±5.19 vs. 49.25±6.42 h, 8.64±1.15 vs. 9.42±1.38 d, P<0.05).The hepatic artery blood flows at week 2 and 6 after operation in group A were higher than those in group B(524.31±68.27 vs. 458.82±71.38 ml/min, 536.57±73.15 vs. 462.43±79.61 ml/min, P<0.05), while the portal vein blood flows were lower(1108.32±116.25 vs. 1221.63±107.04 ml/min, 1115.31±109.75 vs. 1208.18±105.42 ml/min, P<0.05). Serum protein S and C levels in group A were(2.48±0.13) μg/mL and(5.12±0.63) μg/mL at week 6 after operation, respectively, higher than those in group B, which were(2.36±0.17) μg/mL and(4.68±0.59) ug/ml(P<0.05). The incidences of complications were 6.25% in group A, which was not statistically significant compared with 14.28% in group B(P>0.05). Conclusion Compared with CV-LPV, iPV-LPV has higher surgical safety, which is able to promote the recovery of physical function in children after operation, to further improve the blood flows of hepatic artery and portal vein, and to up-regulate the levels of serum protein S and protein C.

Preliminary analysis of changes of hepatic macrophages and lymphocyte subsets in CCl₄-induced hepatic fibrosis in mice

TANG Ying-yue, LI Jing, LEI Xiao-hong, LI Chun-min, ZENG Min-de, MAO Yi-min

2019, 24(4): 377-381.

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Objective To study the changes in the distribution of intrahepatic macrophages and lymphocytes in the mouse model of hepatic fibrosis induced by carbon tetrachloride(CCl4). Methods The hepatic fibrosis model was established in C57BL/6 mice by intraperitoneal injection of CCl4. The degree of hepatic fibrosis was evaluated by hematine-eosin and Masson staining. The peripheral serum of mice was collected to detect liver function index and blood lipid level. The distribution of hepatic immune cell subsets in liver mononuclear cells were analyzed using multi-color flow cytometry. Results Levels of serum alanine transaminase, aspartate aminotransferase, triglyceride and high density lipoprotein cholesterol were significantly higher in CCl4 group than those in control group. CCl4 group had advanced fibrosis(stage 3-4) according to Metavir score. The percentage of Kupffer cells in CCl4 group(13.33±1.91%) was significantly higher than that in control group(8.17±2.00%), in which the percentage of M1 phenotype Kupffer cells with CD11c+ marker increased significantly while the percentage of M2 phenotype Kupffer cells with CD206+ marker had no significant difference. The proportions of T cells and natural killer T(NKT) cells in CCl4 group were significantly lower than those in control group(20.17±4.07% vs. 36.00±4.61%, 8.71±1.37% vs. 23.41±3.38%). While there was no significant difference in the proportions of NK cells and B cells between the 2 groups. Conclusion In CCl4-induced hepatic fibrosis model, the increase of Kupffer cells in liver was mainly caused by M1 macrophages with pro-inflammatory effect, while the proportions of NKT cells and T cells were significantly decreased. The role of M1 macrophages in the development of liver fibrosis needs to be further explored.

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