Table of Content

30 June 2017, Volume 22 Issue 6

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Original Articles

Clinical features and risk factors of 236 cases with acute hepatitis E

SHI Dong-mei, WANG Xiao-lin, XIANG Xiao-gang, XIE Qing

2017, 22(6):  498-501. 

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Objective To investigate the clinical features of acute hepatitis E (AHE) and the risk factors for severe jaundice and liver failure.Methods In the retrospective study, a total of 236 patient with AHE in our hospital from 2011 to 2014 were enrolled. To analyze risk factors for severe jaundice with AHE, patients were divided into 4 groups according to total bilirubin (TBil) levels (Group 1:TBil<34 μmol/L, Group 2:34 ≤ TBil<85 μmol/L, Group 3:85 ≤ TBil<170 μmol/L, Group 4:TBil ≥ 170 μmol/L). Additionally, patients with severe jaundice (TBil ≥ 170 μmol/L) were divided into liver failure group and non-liver failure group according to the prothrombin time activity (PTA ≤ 40%) for analyzing the risk factors for hepatitis E virus (HEV)-induced liver failure.Results Severe jaundice tended to occur in elderly male patients (P<0.01). Patients with history of alcohol and biliary stone showed higher level of bilirubin (P<0.05). Meanwhile, high level of bilirubin was associated with white blood cell (WBC), blood platelet (PLT) and pre-albumin. Furthermore, patients with cirrhosis, biliary stone or infection were significantly increased in liver failure group (P<0.05). Cirrhosis was a risk factor for HEV-induced liver failure.Conclusion Several factors were involved in the progression of AHE. Cirrhosis, biliary stone and bacterial infection were risk factors for AHE-induced liver failure.

Comparative analysis of clinical features between acute hepatitis A and acute hepatitis E

YIN Dong-lin,BAI Yu-pan,HONG Sheng-zhen,LU Jun-yao,XU Jie

2017, 22(6):  502-504. 

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Objective To investigate the epidemiological and clinical features of acute hepatitis A and acute hepatitis E.Methods The epidemiological and clinical data of patients with acute hepatitis A or hepatitis E in our hospital from Jan 2011 to Dec 2015 were collected and analyzed retrospectively.Results Gender composition showed no difference between acute hepatitis A group and acute hepatitis E group, with male patients as the majority in both groups. However, the age of onset had significant difference between the two groups (P<0.05). Young adults were the major part in acute hepatitis A group, while the aged patients (> 50 years old) accounted for a large percentage in acute hepatitis E group. Different from acute hepatitis A occurred all years, acute hepatitis E was peaked in winter and spring. Acute hepatitis A had more specific exposure history to contaminated food than acute hepatitis E (P<0.05). All patients could appear nausea, vomiting and jaundice. Compared to that in acute hepatitis A, the level of bilirubin was higher (P<0.05) and lasted longer (P<0.05) in acute hepatitis E patients. There were no significant differences in liver function and treatment course between the two groups. Compared to acute hepatitis E, acute hepatitis A showed better prognosis. All cases were with favorable prognosis except that 2 aged acute hepatitis E patients finally progressed into liver failure with poor outcome.Conclusion Young adults were the major part in acute hepatitis A and the aged patients accounted for a large percentage of acute hepatitis E. Compared to acute hepatitis A patients, Acute hepatitis E patients had higher jaundice level, longer lasting time and higher mortality. Therefore, the prevention of acute hepatitis E should be paid more attention.

The MR diagnosis of micro hepatocellular carcinomas in patients with chronic liver disease

HU Hai-dong, ZHANG Jian-zeng, YOU Jin-tao,DONG Jing-hui, AN Wei-min

2017, 22(6):  505-508. 

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Objective To analyze the magnetic resonance (MR) manifestations of micro hepatocellular carcinoma (MHCC) retrospectively, and to improve the awareness and the early diagnostic rate of MHCC. Methods Fifty-five foci from 50 cases clinically and pathologically diagnosed of MHCC were collected, and the manifestations of scan and dynamic contrast-enhancement (DCE) in MR were also analyzed.Results Main MR manifestations were described as follows: foci with high signal in diffusion weighted imaging (DWI) and T2 weighted imaging (T2WI) accounted for 96.4% (53/55) and 76.4% (42/55), respectively, with significant difference (P=0.007). Rate of foci with low signal in T1 weighted imaging (T1WI) was 67.3% (37/55). Foci with lipids compositions in double echo was 14.5% (8/55). In DCE, 67.3% (37/55) foci appeared arterial hypervascularity and venous or delayed phase washout, while 32.7% (18/55) were with arterial hypervascularity and venous or delayed phase late washout. All neoplastic foci were enlarged in reexamination within 2 months to 2.5 years.Conclusion At present, 1.5/3.0T MR might be served as the best method for detecting MHCC, which should be preferred as the first choice in regular examination for patients with chronic liver disease.

Efficacy and safety of glucocorticoid with non-bioartificial liver support system in the treatment of severe drug-induced liver injury

HE Na,ZHENG Yang-yang,QI Yun-fei, ZHU Shao-hua,ZHANG Jing,LI Na,YIN Fang,ZHOU Xin-min

2017, 22(6):  509-512. 

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Objective To evaluate efficacy and safety of glucocorticoid (GC) with non-bioartificial liver support system (NBLS) in the treatment of severe drug-induced liver injury (DILI). Methods In the retrospective study, 96 cases with severe DILI who had underwent the treatment of GC combined NBLS in our hospital from January 2008 to December 2015 were enrolled. Treatment, blood routine, liver functions, and so on, were recorded. The efficacy and complications of GC combined with NBLS in treating severe DILI were observed.Results Treatment of GC combined with NBLS was effective in 84 cases (87.5%). Levels of red blood cell (RBC) (4.22±0.70)×10⁹/L and hemoglobin (Hb) (127.88±22.99) g/L were significantly higher at baseline than those after treatment (P<0.05). Levels of alanine aminotransferase (ALT) (145.48±158.94) U/L, aspartate amino transferase (AST)(98.06±69.26) U/L, total bilirubin (TBil) (165.10±124.21) μmol/L bilirubin tra, direct bilirubin (DBil) (130.66±89.46) μmol/L, indirect bilirubin (IBil) (35.43±37.48) μmol/L, albumin (Alb) (41.12±30.93) g/L and alkaline phosphatase (ALP) (178.64±119.65) U/L were significantly improved compared to those before treatment (P<0.05). However, levels of blood urea nitrogen (BUN) (5.61±2.59) mmol/L and cre-recombinase (Cre) (61.00±14.36) μmol/L in renal function were significantly higher after treatment (P<0.05). No significant difference was observed in the level of prothrombin time (PT) and plasma thromboplastin antecedent (PTA) (P>0.05). Conclusion The treatment of GC with NBLS showed satisfactory effectiveness and safety for severe DILI, which could ameliorate the disease progression, reduce total incidence of liver failure and improve the prognosis.

Balance among Th1, Th2, Th17 and Treg in mild to moderate chronic hepatitis B patients with immune imbalance of CD4⁺ T cells

MEI Zhao-he, NIE Hong-ming, WANG Rong, ZHAO Bin-bin, LIANG Xiao-yu, GAO Yue-qiu, CHEN Jian-jie, ZHAO Gang, ZHANG Bin, WANG Ling-tai

2017, 22(6):  513-516. 

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Objective To investigate the immune imbalance of CD4⁺ T cells in patients with mild to moderate chronic hepatitis B (CHB) through exploring the relationship of the T helper cell 17 (Th17) and the related cytokines with T helper cell 1 (Th1), T helper cell 2 (Th2) and regulatory T Cell (Treg).Methods Seventy mild to moderate CHB patients and 30 healthy volunteers were enrolled, respectively. Immune cells (Th17, Th1, Th2, Treg, Th1/Th2, Treg/Th17) and main effector molecules (perforin and granzyme B) in peripheral blood were measured using flow cytometry. The related cytokines including interleukin (IL)-17, IL-6, transforming growth factor (TGF) β, interferon (IFN) γ and IL-4 were detected using enzyme linked immunosorbent assay (ELISA). Nuclear transcription factor including lonely nuclear receptor (RORγt), Foxp3 were measured using polymerase chain reaction (PCR).Results Compared with those in healthy volunteers, percentage of CD8⁺ T cells was higher but CD4⁺/CD8⁺ was markedly decreased in CHB patients (P<0.01). Levels of Th1, Th1/Th2 and Th17 were significantly increased in CHB patients, while levels of Th2, Treg and Treg/Th17 were decreased compared with control group (P<0.01). Perforin and granzyme B expression were higher in CHB patients (P<0.01). No significant difference was observed in the expression of Foxp3, IL17mRNA and RORγt between healthy volunteers and CHB patients (P>0.05). Compared with healthy volunteers, expressions of TGF-B1, IL-6 and IL-17 were increased significantly in CHB patients (P<0.01), while there was no significant difference in the expression of IFN-γ and IL-4 (P>0.05).Conclusion In mild to moderate CHB patients, the chain of immunity, including immune cells, related cytokines and effector molecules, was in a serious imbalance immune state, especially the ratio of Treg/Th17.

Isolation, purification and identification of human intrahepatic cholangiocarcinoma-associated fibroblasts and its effect on proliferation and migration of cholangiocarcinoma cells

SHA Meng, JEONG Seog-song, GU Jin-yang, ZHANG Jian-jun, XIA Qiang

2017, 22(6):  517-522. 

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Objective To investigate the methods of isolation, purification and identification of human intrahepatic cholangiocarcinoma-associated fibroblasts (iCAFs), and to explore its impact on cholangiocarcinoma cells.Methods The primary iCAFs were isolated using digestive methods and purified through density gradient centrifugation. Immunocytochemistry, immunofluorescence staining and flow cytometry were performed to confirm iCAFs. Cell counting kit-8 (CCK8) and transwell experiments were performed to assess the effect of iCAFs on cholangiocarcinoma cells.Results The typical morphology of obtained iCAFs were shaped spindle-like, which formed the pattern of net or whirlpool. Typical iCAFs showed positive staining for α-smooth muscle actin and fibroblast-specific protein 1 (FSP-1), with 98.2% positive rate of FSP-1. iCAFs conditioned media significantly promoted the proliferation and migration of the cholangiocarcinoma cells.Conclusion Human iCAFs were successfully isolated and identified, which could promote proliferation and migration of the cholangiocarcinoma cells. It provides the basis for further research of iCAFs in the development and progression of intrahepatic cholangiocarcinoma.