Table of Content

31 August 2018, Volume 23 Issue 8

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Original Articles

Prospective clinical study of 187 cases with liver damage caused by Chinese herbal medicine and its preparations

HE Ting-ting, ZHONG Xue-wen, ZHANG Ning, BAI Yun-feng, ZHOU Kun, ZHOU Chao, WANG Yao, GONG Man

2018, 23(8):  666-669. 

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Objective To observe clinical characteristics of herb-induced liver injury (HILI).Methods A total of 187 inpatients in our hospital between September 2015 and June 2016 were prospectively enrolled in the study, whose general condition, medical history, clinical manifestations, biochemical indices, prognosis and diagnosis differences using integrated evidence chain-based causality identification algorithm (iEC), structured expert opinion process (SEOP) and the Roussel Uclaf Causality Assessment Method (RUCAM) were analyzed.Results Among the patients, 137 (73.3%) were females aging from 18 to 81 years old, with majority in 40~59 years old. The median time from the application of Chinese herbs to the occurrence of liver injury was 60 days. Moreover, 139 cases (74.3%) were classified as hepatocellular injury. The most important 5 diseases, herbs for which were most likely to cause HILI, were gastritis (8.0%), disc herniation (5.3%), insomnia (4.8%), hair loss (4.8%), and psoriasis (4.3%). Among the Chinese herbs and traditional patent medicines that lead to HILI, the top 5 Chinese herbal with hepatotoxicity were Polygonum multiflorum (n=21), Corydalis Rhizome (n=10), Rhei Radix et Rhizome (n=9), Bupleuri Radix (n=8) and Psoraleae corylifolia (n=7). In the HILI patients, there were 29 (15.5%) with cirrhosis, 30 (16.0%) with chronicity and 3 (1.6%) died. The clinical diagnosis rates using iEC and SEOP were 47.6% and 29.9%, respectively. The ratio of HILI/DILI diagnosed with iEC, RUCAM and SEOP were 23.2%, 48.7% and 14.6%, respectively.Conclusion Attention should be paid to herbal hepatotoxicity. Our study suggests that iEC method could improve the clinical diagnosis rate of HILI and decrease the radio of HILI to DILI.

Clinical features of 39 patients with acute liver injury induced by Polygonum multiflorum

CHANG Yue, LIU Qin-yu, LV Cheng-jiao, DING Yu-ping, ZHANG Wen, LI Hai

2018, 23(8):  670-672. 

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Objective To analyze the clinical characteristics of acute liver injury induced by Polygonum multiflorum retrospectively.Methods Patients diagnosed of Polygonum multiflorum induced liver injury at discharge in our hospital from January 2012 to December 2017 were included, and their medical records and prognosis were collected and analyzed.Results There were 39 patients in the study, including 28 cases (71.79%) receiving Polygonum multiflorum compound preparations. The symptoms of most patients appeared within 1 month and no more than 3 months. Liver aminotransferase, bilirubin and coagulation were significantly abnormal in the patients. All patients receiving Polygonum multiflorum monotherapy and the majority (89.29%) of patients taking Polygonum multiflorum compound preparations were with hepatocellular injury type. Alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin and other biochemical indicators of most patients were normalized within 7 days after treatment. No liver failure or death occurred in all patients.Conclusion Clinicians should pay attention to the acute liver injury induced by Polygonum multiflorum. The liver function of patients receiving Polygonum multiflorum should be examined within 3 months.

Hepatitis C virus core protein induces incomplete mitophagy via activation of endocannabinoids system

SUN Li-jie, SHI Yu-guang, ZHANG Xiao-yu, SHU Meng-ni, CHEN Mo-yang, YU Jian-wu

2018, 23(8):  673-675. 

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Objective To investigate the mechanism of hepatitis C virus (HCV) core protein inducing incomplete mitophagy via activation of endocannabinoids system.Methods Hepatic stellate X-2 cells were co-cultured with HepG2 cells or HepG2 cells expressing HCV core protein. After co-culture, 2-arachidonoylglycerol (2-AG) level, reactive oxygen species (ROS) and activity of mitochondrial respiratory chain enzyme complexes were measured with liquid chromatography/mass spectrometry, flow cytometer and spectrophotometric method, respectively. Mitochondria membrane potential and calcium (Ca²⁺) concentration were detected with laser scanning confocal microscope. The levels of cannabinoid receptor 1(CB1R), phosphorylated serine-threonine kinase (p-Akt), mammalian target of rapamycin (mTOR), microtubule-associated protein 1 light chain 3 (LC3)-Ⅱ and p62 protein were measured using western blot. The levels of malondialdehyde (MDA) and superoxide dismutase (SOD) were assayed with kit. All quantitative data was analyzed with t-test.Results In LX-2 cells co-cultured with HepG2 cells expressing HCV core protein, levels of 2-AG, ROS, Ca²⁺ concentration, MDA, CB1R protein and expression of LC3-Ⅱ protein were increased, while the activity of mitochondrial respiratory chain enzyme complexes, mitochondria membrane potential, SOD level, expression of p-Akt and p-mTOR protein were decreased compared with those in LX-2 cells co-cultured with HepG2 cells. However, the expression level of p62 protein did not change.Conclusion HCV core protein may not only increase 2-AG content, ROS level and Ca²⁺ concentration, but also up-regulate the expression of CB1R. Meanwhile, it may decrease mitochondria membrane potential, and down-regulate p-Akt and p-mTOR protein to induce incomplete mitophagy.

A randomized controlled trial of Ringer’s malate solution in perioperative hepatic ischemia protection

JI Jie, CAI Lin-lin, FU Hai-long, YUAN Hong-bin, WANG Jun-xue, XU Hai-tao

2018, 23(8):  676-680. 

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Objective To compare the effects of Ringer's malate solution and Ringer's lactate solution on the hemodynamics, intraoperative environment, liver reserve function, liver and kidney biochemical function and health economics in the operation, and to evaluate the effects of Ringer's malate solution on the recovery of liver and kidney function in patients during perioperative period.Methods In the randomized controlled double blind study, 50 patients with liver tumor resection were randomly assigned to 2 groups of Ringer's lactate (RL) solution or Ringer's malate (RM) solution. General data of the patients, operative procession and treatment records were collected and the differences in the related indexes of the 2 groups were statistically analyzed.Results There was no statistical difference between the 2 groups in sex, age, body mass index, American Society of Anesthesiologists (ASA) classification, operation time, blocking time, bleeding volume, transfusion volume, infusion volume, and the number of liver segments (P>0.05). The average arterial pressure and the central venous pressure showed no statistical differences between the 2 groups at the moment after anesthetic induction (T1), the time of hepatic portal occlusion (T2), the time of hepatic portal patency (T3) and 40 minutes after hepatic portal patency (T4) (P>0.05). The value of pH, arterial blood glucose and arterial lactate levels at T3 and T4 time points in the 2 groups were statistically different (P<0.05). At the time of T1, T3 and T4, there was no statistical difference in the ion concentrations of potassium, sodium, calcium and chlorine between the 2 groups (P>0.05). Compared to that at T1 time point, indocyanine green plasma disappearance rate (ICG PDR) at T4 time point was significantly decreased [RL group (18.73±1.97 vs. 13.48±2.79, P=0.000), RM group (19.64±2.47 vs. 14.62±2.74, P=0.000)], while R15 was significantly increased [RL group (7.06±1.51 vs. 12.02±2.24, P=0.000), RM group (6.26±1.91 vs. 10.53±3.40, P=0.000)]. On the first day after operation, the differences of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) between the 2 groups were statistically significant (AST: 414.32±213.60 vs 304.52±152.15, P=0.042; ALT: 443.88±239.53 vs 305.32±190.46, P=0.029), and other indexes of liver and kidney function showed no significant difference. Moreover, there was no statistical difference between the liver and kidney function indexes at the second day after the operation (P>0.05). There was no statistical difference in hospitalization days and total hospitalization cost between the 2 groups (P>0.05).Conclusion Ringer's malate solution can provide better internal environment stability and reduce liver damage after liver surgery.