Table of Content

31 January 2016, Volume 21 Issue 1

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Orginal Articles

Assessment of SF-36 scale in life quality of compensated HBV-related cirrhosis patients improved by antiviral therapy and its related indicators

WEI Wei, YIN Ji-peng, LI Han, KONG Yuan-yuan, WU Xiao-ning, ZHOU Jia-ling, SUN Dong-yang, SUN Ya-meng, YOU Hong, JIA Ji-dong

2016, 21(1):  2-5. 

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Objective To investigate feasibility of SF-36 scale in assessing the life quality of compensated hepatitis Bvirus（HBV）-related cirrhosis patients im proved by different anti-viral strategies and its related indicators.Methods Atotal of 405 compensated HBV-related cirrhosis patients were divided into Monotherapy group（entecavir 0.5 Mg,qd）and combination group（adefovir 10 Mg,lamivudine 100 Mg,qd）according to their healthy condition and financial status. During 104 weeks of treatment,HBVDNAload,Fibroscan,levels of alanine aminotransferase（ALT）,aspartate transaminase（AST）and other related indicators were recorded,and SF-36 scale was performed to assess patients'life quality. Results At the end of follow-up,life quality of these patients was im proved（F=10.78,P<0.01）,which was related to HBVDNAload（r=-0.647,P=0.030）,Fibroscan（r=-0.485,P=0.047）and ALT/ AST（r=-0.356,P=0.022）at baseline. Conclusion Different antiviral treatments could im prove life quality of compensated HBV-related cirrhosis patients,which is related to so me antiviralindicators.

Effect of seru Msodiu Mon complications in patients with decompensated liver cirrhosis

SHU Meng-ni, LI Shu-chen

2016, 21(1):  6-8. 

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Objective To investigate the effect of seru Msodiu Mlevel on complications in patients with decompensated liver cirrhosis. Methods According to seru Msodiu Mlevel,212 decompensated liver cirrhosis cases were divided into normal group and hyponatremia group（including mild,Moderate and severe subgroups）. Sequentially,the influences of different seru Msodiu Mlevels on complications in all enrolled patients were retrospectively analyzed. Results As seru Msodiu Mlevel declined,Mortality and Morbidity were significantly increased because of complications,such as ascites,spontaneous bacterial peritonitis and hepatic encephalopathy（except gastrointestinal bleeding）and so on. The occurrence rates of complications in normal,mild,Moderate and severe groups were 33.0％,73.8％,91.4％,100.0％for ascites,3.5％,14.3％,28.6％,55.0％for spontaneous bacterial peritonitis,7.0％、11.9％、28.6％、60.0％for hepatic encephalopathy,respectively,with Mortality of 6.09％,11.90％,31.43％,60.00％,respectively. Normal group displayed significantly lower complication Morbidity and Mortality than Moderate and severe groups did（P<0.05）. Mean w hile,complication Morbidity and Mortality in mild and Moderate group were significantly lower than those in severe group（P<0.05）. Conclusion Seru Msodiu Mlevel can be a Monitoring indicator to predict the prognosis of patients with decompensated liver cirrhosis.

Elevated expression of activation marker CD38 and HLA-DRon peripheral blood iNKTcell and their correlation with liver injury in patients with HBV-related liver cirrhosis

CHEN Wei-hong, CHEN Yan, ZENG Zhen

2016, 21(1):  9-12. 

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Objective To investigate potential correlation between frequency of peripheral blood invariant nature killer T（iNKT）cell,expression of activation markers CD38 or HLA-DRand severity of hepatic injury in patients with hepatitis Bvirus（HBV）-related liver cirrhosis（LC）. Methods Frequency of peripheral blood iNKTcells and expression of CD38 or HLA-DRMolecules were detected by flow cyto metry to analyze their correlations with Child-Pugh score,Model of end-stage liver disease（MELD）score and seru Mbiochemical parameters for liver function in HBV-related LCpatients. comparison and correlation analysis between the two groups were performed by Mann-Whitney Utest and Spearman rank test,respectively. Results When compared to healthy controls,LCpatients displayed significantly lower frequency of iNKTcells and proportion of CD4^-iNKTcells（0.106％,P=0.026;31.2％,P<0.01）,w hile higher proportion of CD4⁺iNKTcells（66.7％,P<0.01）,higher expression of CD38 and HLA-DRMolecules on iNKT,CD4⁺iNKTand CD4^-iNKTcells（14.2％,24.9％,18.8％,19.1％,18.4％,36.9％respectively,P<0.05）,respectively. However there was no statistically different expression of CD38 and HLA-DRam ong different Child-Pugh score. Mean w hile,expression of CD38 and HLA-DRon CD4⁺iNKTcells was negatively correlated with albu min level（r=-0.496,P=0.019;r=-0.501,P=0.018）. Conclusion compared to those in healthy controls,peripheral blood iNKTcells in LCpatients manifested significantly lower frequency,but higher cellular activation level which was associated with aggravation of hepatic injury.In another word,iNKTcells might play a role in the pathogenesis of liver injury in LCpatients.

Drug-induced liver injury：clinical characteristics analysis of traditional Chinese medicine and western medicine induced liver injury

WANG Xin-fa, LIU Ying-xia

2016, 21(1):  13-16. 

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Objective To explore the different clinical features of liver injury induced by traditional Chinese medicine and western medicine,and to provide evidences for pro Moting clinical rational drug use and avoiding drug-induced liver injury（DILI）. Methods Three hundred and twenty-eight patients with primary diagnosis of DILIwere assessed by Roussel Claf causality assessment method Roussel Uclaf Causality Assessment Method（RUCAM）rating system,274 of which with scores≥6 were enrolled in this study for comparison of occurrence,clinical features and risk factors between traditional Chinese medicines and western medicine induced liver injury. Results Ratio of traditional Chinese medicine and western medicine induced liver injury was 1:2.22,in which male/female ratio was 1:1.74 and 1:0.77,respectively. Besides,main drugs of western and traditional Chinese medicine due to DILIwere anti-tuberculosis drugs and polygonu MMultifloru m,respectively. Levels of alanine aminotransferase（ALT）,total bilirubin（TBiL）,aspartate transaminase （AST）,gam ma-glutam yl transpeptidase（GGT）and alkaline phosphatase（ALP）in traditional Chinese group were Much higher than those in western medicine group. Furtherm ore,levels of ALTand TBiLshowed statistically significant difference（P<0.0001,P<0.018,respectively）between the 2 groups. The prognosis of DILIwas related to hospitalization days and levels of ALT,ASTand ALP.In addition,hepatitis Bvirus（HBV）infection was a risk factor of severe DILI（P=0.022）. Conclusion Traditional Chinese drug induces liver injury More frequently than western medicine does,even causes serious liver damage,which should be paid More attention to. Levels of ALT,ASTand ALPat first diagnosis are significant predictors for prognosis.

The mid-long-term clinical efficacy of transjugular intrahepatic portosystemic shunt com bined with gastric coronary vein em bolization for portal hypertension complicated by upper gastrointestinal bleeding

SHAO Qing-hua, ZHENG Sheng, YANG Juan, ZHANG Fan, YANG Jin-hui, TANG Ying-mei

2016, 21(1):  17-20. 

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Objective To evaluate the mid-long-term clinical efficacy of transjugular intrahepatic portosystemic shunt （TIPS）combined with gastric coronary vein em bolization（GCVE）for portal hypertension complicated with upper gastrointestinal bleeding. Methods Ninety-nine cirrhosis patients,w ho had received TIPSfor upper gastrointestinal hem orrhage due to portal hypertension fro MJanuary 2008 to January 2013 in the second affiliated hospital of Kun ming Medical University,were retrospectively analyzed. AMong these patients,43 received TIPS（TIPSgroup）and 56 received TIPSplus GCVE（TIPS+GCVEgroup）.Portal venous pressure（PVP）and portal pressure gradient（PPG）of both groups before and after treatment were compared by Ttest. Upper gastrointestinal rebleeding rate,survival rate and stent patencybook=18,ebook=22rate in both groups during a follow-up were analyzed by Kaplan-Meier method,which was further compared by log-rank test between the two groups. Results Preoperative PVPin TIPSgroup and TIPS+GCVEgroup were（35.2±3.1）,（35.3± 3.6）MMHg（1 MMHg=0.133 kPa）,w hile postoperative PVPwere（21.9±2.8）,（22.7±3.1）MMHg;preoperative PPGin two groups were（25.8±3.2）,（25.5±2.3）MMHg,w hile postoperative PPGwere（11.6±1.7）,（12.8±1.5）MMHG. Postoperative PVPand PPGwere lower than preoperative ones in both groups,which showed statistically significant differences（TIPSgroup：t=15.772、15.722,P=0.000;TIPS+GCVEgroup：t=31.069、31.096,P=0.000,respectively）. However,there was no significant difference in PVPbefore and after treatment between two groups. Between the two groups,preoperative PPGshowed no significant difference,while postoperative PPGin TIPS+GCVEgroup was statistically significantly higher than thatin TIPSgroup（t=-4.726,P=0.000）. A1l cases were followed up for 1 to 54 Months after operation with an average of（36.3±11.1）Months. The free of variceal rebleeding rates in 6 Months,12 Months,24 Months and 48 Months after operation were 90.7％,86.0％,76.7％and 65.1％in TIPSgroup,respectively,and 98.2％,92.6％,89.3％and 85.7％in TIPS+GCVEgroup,respectively,which revealed statistically significant differences（χ²=5.987,P=0.014）. Stent patency rates in 6 Months,12 Months,24 Months and 48 Months after operation were 95.3％、88.4％、79.1％and 72.1％in TIPSgroup,respectively,and 92.9％、87.5％、82.1％and 78.6％in TIPS+GCVEgroup,respectively,which indicated no significant difference（χ²=0.736,P=0.328）. Survival rates in 6 Months,12 Months,24 Months and 48 Months after operation were 93.0％、88.4％、83.7％and 72.1％in TIPSgroup,respectively,and 94.6％、92.9％、87.5％and 80.4％in TIPS+GCVEgroup,respectively,which pointed out no significant difference（χ²=2.18,P=0.094）. Conclusion The combined treatment of TIPSwith GCVEcould reduce rebleeding rate of esophageal and gastric varices,which is More effective than TIPSalone,with reliable security and satisfactory long-term efficacy.

Diagnostic value of MRIand CTapplied alone or in com bination in hepatocellular carcinoma

WANG Bao-ling, ZHOU Lian-xin

2016, 21(1):  21-23. 

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Objective To investigate the diagnostic value of magnetic resonance imaging（MRI）and computed to Mography（CT）applied alone or in combination in hepatocellular carcino ma（HCC）. Methods Forty-nine patients pathologically confirmed as HCCin our hospitalfro MAugust 2013 to Septem ber 2014 were enrolled to receive both CTscan and MRIscan within one week.In terms of CTand MRIused alone and in combination,analysis of sensitivity,specificity,accuracy and diagnostic efficacy on tu Mors am ong these patients were performed,respectively. Results There were 73 focuses in livers of 49 HCCpatients.In tu Mors less than 1cm in diameter,average sensitivity of CT,MRIand CT+MRIwere 46.00％,70.00％and 94.00％,respectively,which indicated that CT+MRIand MRIalone were More sensitive than CTalone（P=0.000 and 0.019,respectively）,and CT+MRIwas More sensitive than MRIalone（P=0.023）.In tu Mors of 1~3 cm in diameter,average sensitivity of CTscan（87.09％）and CT+MRI（98.39％）showed significantly different （P<0.05）,diagnostic accuracy of CT+MRIwas higher than both CTand MRIalone（P=0.015 and 0.027,respectively）,and area under the curve（AUC）of CT+MRIwas statistically different fro MCTand MRI（P=0.019 and 0.021,respectively）. Conclusion In diagnosis of HCC,CTcombined with MRIhas higher sensitivity,specificity and accuracy than CTand MRIalone,which is worth clinical pro Motion.

Dynamic variation of inflam matory cytokines,chemokines and Toll-like receptors in APAP-induced liver injury

JIN Yu-ting, LI Da-wei, MING Ya-nan, ZHANG Jiang, ZHANG Ming, XIA Qiang

2016, 21(1):  24-27. 

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Objective To explore the dynamic changes ofinflam matory cytokines,chem okines and Toll-like receptors （TLR）in acetaminophen（APAP）-induced liver injury within 24 hours. Methods C57BL/6 mice were rando mly divided into six groups：control group,APAP1h group,APAP3h group,APAP6h group,APAP12h group and APAP24h group,including 5 mice in each group. After fasting for 15 hours,control group were given 0.9％saline by intraperitoneal injection,w hile other groups were given 300 Mg/kg APAP. Assessment of the various inflam matory cytokines,chem okines and TLRin mice liver was carried out at MRNAlevel by realtime poly merase chain reaction（RT-PCR）. Degrees of APAP-induced liver injury were evaluated by haematoxylin eosin（HE）staining. Results According to HEstaining result,APAP-induced liver injury in APAPgroups increasingly aggravated within 24 hours w hen compared with that in control group.In APAPgroups,RT-PCRindicated that MRNAlevels of IL-6,IL-10,IL-1βand IP-10 rose to various degrees at different time points,w hile MIP-3α MRNAlevels declined distinctly（P<0.05）,which was in contrast to control group. Additionally,variation ofinterferon（IFN）-γ and tu Mor necrosis factor（TNF）-α had no statistical difference between APAPand control groups.In APAPgroups,levels of CXCR-2 and CCR-2 were obviously lower at 24h（P<0.05）than those in control group,w hile level of CXCL-2 rose to 14.8 and 7.8 times higher at 12h and 24h（P<0.05）,respectively. Furtherm ore,levels of TLR-9 and TLR-4 changed to various extents at different time points（P<0.05）. Conclusion APAPfor 300 Mg/kg induces mice liver injury within 24h,which makes inflam matory cytokines,chem okines and TLRchange obviously at MRNAlevels in mice liver.

Construction and initial application of HNF4 α enhanced 1.0-fold HBVreplication modelinvitro

DING Ning, ZHANG Ming-xiang

2016, 21(1):  28-33. 

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Objective To construct a hepatocyte nuclear factor 4 alpha（HNF4 α）enhanced 1.0-fold hepatitis Bvirus （HBV）replication Model. Methods Afull-length HBVDNAfro Mseru Mof acute hepatitis B（AHB）patients was isolated for am plification and cloning,and total RNAof liver tissue fro Msurgery was extracted for HNF4 α gene cDNAam plifying and cloning. Bsp QI/ScaIwas used to digest HBVDNAplasmid and recover HBVDNAproduction. HNF4 α gene cDNAwas directionally connected to the eukaryotic expression vector pcDNA3.1（+）for construction of pcDNA3.1-4 α expression vector. Hep G2 cells were transfected with full-length HBVDNA（1μg/well）,according to proportion of transfection pcDNA3.1-4 α（0μg,0.5μg,1μg）. After 96 hours,HBs Ag,HBe AGlevels and HBVDNAload in cell supernatant were detected. Hep G2 cells were transfected with 0.5μg/1μGpcDNA3.1-4 α and full-length HBVDNA,which were added with different concentrations of LAM（0μMol/L,100μMol/L）and ETV（0μMol/L,10μMol/L）to evaluate the replication Modelin vitro. Results The 1％TAEagarose gel detection showed that the lengths of the strips of full-length HBVDNAand HNF4 α cDNAPCRproduct were 3.2 kb and 1.5 kb,respectively,of which cloning target frag ments were sequenced and identified. The full-length HBVDNAwas recycled fro Mgel for cloning digested target frag ments. The constructed pcDNA3.1-4 α expression vector was sequenced and identified. Hep G2 cells were transfected with different ratios of pcDNA3.1-4 α and full-length HBVDNA.In 0μg/1μGgroup,HBe AGand HBs AGwere negative with a HBVDNAload of 10³in supernatant;in 0.5μg/1μGgroup,HBe AGwas negative and HBs AGODrose fro M0.1 to 1.99 with an increasing HBVDNAload fro M1×10³to 4×10⁴;in 1μg/1μGgroup,HBe AGwas negative and HBs AGODbook=29,ebook=33rose fro M0.1 to 2.4 with an increasing HBVDNAload fro M1×10³to 1×10⁵. HBVDNAload in supernatant was reduced by 97.6％as lamivudine increasing fro M0μMol/Lto 100μMol/L,and was also reduced by 99.0％as entecavir increasing fro M0μMol/Lto 10μMol/L. Conclusion HNF4 α enhanced 1.0-fold HBVreplication Model is constructed successfully,which could be used to evaluate anti-HBVagents in vitro and provide new insights for HBVstudy.

Establish ment and expression of recom binant pEGFP-prohibitin plasmid in HepG2 cell line

ZHAI Song, SUN Ming-zhu, WANG Wen-jun, LI Ya-ping, ZHANG Xin, LI Mei, DANG Shuang-suo

2016, 21(1):  34-38. 

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Objective To construct eukaryotic expression plasmid of enhanced green fluorescent protein plasmids （pEGFP）prohibitin,and to observe its expression in transfected Hep G2 cells. Methods The full coding sequence of prohibitin was am plified by high fidelity poly merase chain reaction（PCR）. Mean w hile,the eukaryotic expression vector of pEGFP-prohibitin was constructed and identified by gene sequencing and basic local align ment search tool（BLAST）. Plasmids of pEGFP-prohibitin and pEGFP-N1 were extracted and transfected into Hep G2 cells by TurboFect oligofectamine reagent,expression of which in transfected Hep G2 cells was assessed by real time PCRat MRNAlevel and western blot at protein level. Results Recombinant pEGFP-prohibitin plasmid was successfully constructed then transfected into Hep G2 cells,prohibitin expression in which was apparently higher than that in Mock-vehicle and non-transfection groups. Conclusion The eukaryotic expression vector of pEGFP-prohibitin was constructed successfully,and prohibitin was confirmed to be up-regulated in Hep G2/pEGFP-prohibitin cells.