Table of Content

30 November 2018, Volume 23 Issue 11

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Original Articles

Research of diagnostic value of urinary L-FABP and KIM-1 levels in HBV-related ACLF patients with AKI

PENG Jing, TANG Yi

2018, 23(11):  959-963. 

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Objective To investigate the diagnostic value of urinary liver fatty acid binding protein (uL-FABP) and urinary kidney injury moleculer-1 (uKIM-1) in hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) patients with acute kidney injury (AKI). Methods A total of 215 patients with HBV-related ACLF admitted to our hospital from October 2014 to May 2017 were enrolled, which were divided into AKI group (n=88) and non-AKI group (n=127). The uL-FABP and uKIM-1 levels were tested by ELISA. The correlations of uL-FABP and uKIM-1 with clinical parameters were analyzed. Diagnostic values of uL-FABP and uKIM-1 for AKI in patients with HBV-related ACLF were evaluated by receiver operating characteristic (ROC) curve. Results The uL-FABP (605.40±276.67 vs. 298.51±108.71 ng/mg, P<0.001) and uKIM-1 (7.90±2.85 vs. 2.89±1.09 ng/mg, P<0.001) levels in AKI group were both significantly higher than those in non-AKI group. In AKI group, the uL-FABP and uKIM-1 levels were both significantly positively associated with white blood cell count, serum creatinine level, model for end-stage liver disease score and AKI stage, while negatively correlated with estimated glomerular filtration rate. In diagnosis of AKI in patients with ACLF, area under the ROC curve (AUC) of uL-FABP was 0.800, AUC of uKIM-1 was 0.793, and AUC of uL-FABP/uKIM-1 combination was 0.836. To distinguish severe AKI (AKI-3) from mild to moderate AKI (AKI-1 and AKI-2), AUCs of uL-FABP, uKIM-1, and uL-FABP/uKIM-1 combination was 0.754, 0.809, and 0.813, respectively. Conclusion The clinical diagnostic values of uL-FABP and uKIM-1 used alone or in combination in patients with HBV-related ACLF were relatively high.

Predictive value of dynamic changes of new biomarkers in the treatment of liver cirrhosis complicated with acute kidney injury

ZHONG Rui, XU Man-man, CHEN Yu

2018, 23(11):  964-968. 

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Objective To investigate the predictive value of dynamic changes of new biomarkers in hypervolemic therapy for liver cirrhosis with acute kidney injury (AKI). Methods Patients with liver cirrhosis complicated with AKI in our hospital from May 2017 to April 2018 were consecutively enrolled. The patients' general clinical data and laboratory examination results were collected. Urine samples were collected the day diagnosing AKI and 2 days after hypervolemic therapy. Urine angiotensinogen (uAGT), urine neutrophil gelatinase-associated lipocalin (uNGAL), urine kidney injury molecule-1 (uKIM-1) and urine creatinine (uCr) were measured. The patients were divided into effective group and ineffective group. Indexes above, the defferences and decrease rate of urine indexes before and after volume expansion were compared between 2 groups. Results There was no significant difference in alanine aminotransferase, aspartate aminotransferase, platelet count, hemoglobin, white blood cell count, total bilirubin, direct bilirubin, blood urea nitrogen, albumin between the effective group and the ineffective group (P>0.05). Prothrombin time activity (PTA) in the effective group was significantly higher than that in the ineffective group (P=0.020), and the blood creatinine was lower in the effective group than that in the ineffective group (P=0.047). The proportion of patients with upper gastrointestinal bleeding in effective group was higher than that in ineffective group (63.6% vs. 25.0%, P=0.011). In the diagnosis of AKI, uAGT/uCr and uKIM-1/uCr were not statistically different between 2 groups; the uNGAL/uCr of the ineffective group was statistically higher than that of the effective group (45.8 vs.188.8 ug/g, P=0.011). The indicators above before and after the expansion were compared between 2 groups. In effective group, the decrease values of uAGT/uCr (0.02 vs.-0.99 ug/g, P=0.056), uNGAL/uCr (20.73 vs.-37.36 ug/g, P=0.052), uKIM-1/uCr (2.06 vs.-0.12 ug/g, P=0.082) were higher than those in the ineffective group, but the difference was not statistically significant. The decrease rates of uNGAL/uCr and uKIM-1/uCr in the effective group were significantly higher than those in the ineffective group (51.0% vs. 19.6%, P=0.001; 65.3% vs. 37.5%, P=0.004). Multivariate regression analysis showed that upper gastrointestinal bleeding was an independent predictor of the effectiveness of volume expansion therapy for AKI patients with cirrhosis. Conclusion The dynamic changes of uNGAL and uKIM-1 levels, upper gastrointestinal bleeding, serum creatinine and PTA could predict the expansion effect of AKI patients with cirrhosis.

An investigation on the access to drugs against hepatitis B virus in comprehensive hospitals, Yunnan province (2018)

YANG Zhibin, CHEN Qing, SHEN Enrui, KUANG Chongshu, LI Guowei, HOU Wenfeng, MA Wanhong, MA Shiwu

2018, 23(11):  969-972. 

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Objective Although the nucleoside analogues against hepatitis B virus (HBV) have been used in clinic for about 20 years, the access to drugs in the primary county-level hospitals remains unclear. Methods The hospitals in 16 cities or states in Yunnan Province were enrolled, in which the questionnaire surveyed the setting of department of infectious diseases and the owning rate of antiviral drugs against HBV. The comparative analysis was conducted in the owning rates of antiviral drugs with the peculiarities of high resistance barrier and mother to child transmission (MTCT) prevention. Results In total investigated county-level hospitals (n=102), 71.57% (73/102) of them had less than 3 kinds of anti-HBV drugs, and the top 3 anti-HBV drugs were entecavir (59.80%, 61/102), lamivudine (57.84%, 59/102) and regular interferon (31.37%, 32/102), respectively. According to the guideline in 2015, the owning rate of anti-HBV drugs with the peculiarity of high resistance barrier was lower in the county-level hospitals than that in the city or state-level hospitals (60.78% vs. 93.75%, P=0.0100), and the owning rate of pregnancy-grade B anti-HBV drugs with the peculiarity of MTCT prevention was also lower in the county-level hospitals than that in the city or state-level hospitals (11.76% vs. 81.25%, P<0.0001). If lamivudine was considered to use as MTCT prevention, the owning rate of the MTCT prevention drug in county-level hospitals would increase 5.25 times (61.76% vs. 11.76%, P<0.0001). Conclusion The access to drugs against HBV varies widely between the county and the city or state hospitals. The lower access to anti-HBV drug may adversely affect the standardized diagnosis and treatment of patients in the county-level hospitals

ICG R15 in the Prediction of the radiation-induced liver damage of stereotactic body radiotherapy in patients with hepato cellular carcinoma

SUN Jing, LIU Li-ying, YANG Xiao, ZHANG Ai-min, ZHANG Tao, WANG Jia, ZHANG Dan, DING Jun-qiang, LI Wen-gang, DUAN Xue-zhang

2018, 23(11):  973-976. 

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Objective To analyze the prediction value of indocyanine green 15-minute clearance rate (ICG R15) for radiation-induced liver damage (RILD) in patients with primary hepatocellular carcinoma (HCC) undergoing stereotactic body radiotherapy (SBRT). Methods From October 1st, 2016 to August 31st, 2017, 150 patients with HCC employing SBRT were enrolled in this prospective study. The ICG R15 values were measured 1 week before treatment, and biochemical parameters were measured at least 1 year after SBRT. RILD was diagnosed according to the published criteria. The relationship between the ICG R15 and RILD were analyzed in these 150 patients. Results Typical RILD occurred in 14 patients (93.3%), and atypical RILD occurred in 1 patient (6.7%). ICG R15 in Child-Pugh B patients (34.275±16.544%) was significantly higher than that in Child-Pugh A patients (8.936±11.134 %). ICG R15 cut-off value was defined as 11.3% by the receiver operating characteristic curve, whose corresponding sensitivity and specificity were 0.667 and 0.778, respectively. RILD occurred in 5 patients when ICG R15 was less than 11.3% and 10 patients when ICG R15 was more than 11.3% (P=0.001). Multivariate analysis showed that only ICG R15 before radiotherapy showed statistical significance in predicting RILD (RR 9.578, 95%CI: 2.278~40.264). Conclusion ICG R15 value is an effective predictor of RILD in patients with HCC after SBRT.

Effect of indocyanine green on the selection of surgical treatment options for primary small hepatocellular carcinoma patients

TAO Dan, YAN Chen-li

2018, 23(11):  977-980. 

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Objective To investigate the effect of indocyanine green (ICG) on the choice of surgical treatment for patients with primary small hepatocellular carcinoma. Methods A retrospective analysis of 108 patients with small hepatocellular carcinoma who were treated in our hospital from February 2015 to February 2018 was conducted. Among these patients, 52 patients underwent hepatectomy (hepatectomy group) and 56 patients underwent radiofrequency ablation (RFA) therapy (RFA group). The preoperative and postoperative liver function data were collected and patients were classified into hepatic failure group and non-hepatic failure group according to whether liver failure occurred. Results There was no significant difference in gender, age, body mass index, aspartate aminotransferase, alanine aminotransferase, total bilirubin, albumin, Child-Pugh (CP) score and ICG between hepatectomy group and RFA group (P>0.05). The maximum diameter of the tumor in hepatectomy group was significantly higher than that in RFA group (5.2±2.1 cm vs 2.3±2.0 cm, P<0.05). Liver failure occurred in 9 patients and 6 patients in the hepatectomy group and the RFA group, respectively. The CP scores of patients with liver failure were significantly higher than those of patients without liver failure in both hepatectomy and RFA group (8.5±1.0, 8.6±1.1 vs 5.5±0.8, 5.7±0.6, P<0.05). And ICGs were the same (31.2±17.5 %, 38.5±13.5 % vs 13.4±8.6%, 14.2±7.5%, P<0.05). In addition, there were significant differences in the ICG-retention rate at 15 minutes and liver function grading between patients with hepatic failure and non-hepatic failure in hepatectomy and RFA group (P<0.05). Conclusion Hepatectomy and RFA are safe treatment of small hepatocellular carcinoma. The ICG test has limited value in the selection of hepatectomy or RFA, but it has a high evaluation value in predicting postoperative liver failure.

Inhibition of SNAI2 expression enhances tumor stem cell-like characteristics and multi-drug resistance of hepatoma cells

XI Wei, ZHANG Yi-hao, WEI Qing

2018, 23(11):  981-984. 

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Objective The role of Snail family transcriptional repressor 2 (SNAI2) in different types of malignant tumors remains controversial. The study aimed to investigate the role of SNAI2 in hepatocellular carcinoma (HCC). Methods The shRNA lentivirus was used to transfect HCC cells and analyzed the effect of SNAI2 deletion on anchorage-independent growth of HCC cells by cell pelleting assay, and cholecystokinin-8 assay was used to detect the sensitivity of HCC cells with SNAI2 deletion to various chemotherapeutic drugs. Results When the expression of SNAI2 was inhibited by shRNA, the anchorage-independent growth ability and colony formation ability of HCC cells were significantly increased. Inhibition of SNAI2 molecule expression enhanced the resistance of HCC cells to various chemotherapeutic drugs. Conclusion The study indicated that SNAI2 plays a significant tumor suppressive role in HCC by inhibiting epithelial-mesenchymal transition and multidrug resistance.