Table of Content

30 April 2017, Volume 22 Issue 4

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Original Articles

Long-term effect of nucleoside(tide) analogues and interferon treatment on hepatocellular carcinoma occurrence and death in chronic HBV-infected patients

ZHANG Xiu-cui, PU Rui, WU Ting, YIN Jian-hua, NI Wu, CAO Guang-wen

2017, 22(4):  305-309. 

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Objective To investigate the long-term effect of nucleos(t)ide analogues (NAs) and interferon-alpha (IFN-α) treatment on hepatocellular carcinoma (HCC) occurrence and mortality in patients with chronic hepatitis B (CHB) and compensated liver cirrhosis (LC) patients.Methods CHB and compensated LC patients admitted in our hospital from August 1998 to December 2007 were enrolled for the clinical cohort in January 2008, and followed up untill May 2013. Results A total of 2 035 cases were enrolled in the cohort, including 380 NAs-treated patients, 153 IFN-treated patients and 1 502 non-antiviral treated cases (control group). Median follow-up period of IFN-treated group, NAs-treated group and control group was 10.08 years (IQR: 7.96-11.67 years), 7.58 years (IQR: 6.08-9.67 years) and 9.2 years (IQR: 7.0-11.33 years), respectively. Incidence of HCC among the three groups were 2.70/1 000 person-years, 6.76/1 000 person-years and 13.02/1 000 person-years, respectively. In IFN-treated group, the cumulative incidence of HCC and cumulative liver-specific death were both significantly lower than those in control group and patients treated with NAs for less than 5 years. In CHB patients treated with NAs for more than 5 years, the cumulative liver-specific mortality was significantly lower than that in control group (P=0.019) and short-term (< 5 years) NAs-treated patients (P=0.034). In the compensated LC patients treated with long-term ( ≥ 5 years) NAs, the cumulative incidence of HCC and cumulative liver-specific mortality were lower than those in control group and short-term (< 5 years) NAs-treated group. Conclusion IFN- treatment can significantly reduce the risk of HCC and liver-specific mortality in CHB Patients. Long-term NAs treatment (≥ 5 years) can not only prevent the occurrence of HCC in compensated LC patients, but also improve the survival in both CHB and compensated LC patients.

Expression of miRNA-21/101/125a/195/200b in hepatic cirrhosis and carcinoma

LEI Yang, TAO Yan-yan, WANG Qing-lan, LUO Yun-quan, LIU Cheng-hai

2017, 22(4):  310-313. 

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Objective To investigate the differential expression of microRNA (miRNA, miR) 21/101/125a/195/200b in patients with hepatic cirrhosis and hepatocellular carcinoma (HCC). Methods Liver samples of hemangioma (6 cases), cirrhosis (10 cases) and HCC and adjacent tissues (14 pairs) were collected, in which hepatitis B surface antigen (HBsAg) was positive except samples from hemangioma. Real-time polymerase chain reaction (RT-PCR) was applied to detect the expression of miR-21/101/125a/195/200b, respectively. Pearson correlation analysis was carried out between expression of miR-101 and the related clinical indexes. Results In cirrhosis group, levels of prothrombin time (PT), international normalized ratio (INR), aspartate transaminase (AST) and serum total bilirubin (TBiL) were significantly higher than those in hemangioma group, while blood platelet (PLT) was significantly lower. Hematoxylin and eosin (HE) staining, Masson staining and reticular fiber staining were all consistent with the diagnosis of cirrhosis. In HCC group, white blood cell (WBC) and PLT were increased, while levels of PT, INR, AST and TBil were decreased compared with those in cirrhosis group. Using immunohistochemical staining, alpha fetal protein was significantly higher in HCC group than that in hemangioma or cirrhosis groups, which was confirmed the diagnosis of HCC in turn. Compared with hemangioma group, miR-101 and miR-195 were down-regulated in cirrhosis group. Compared with the para-carcinoma tissues, miR-21 was up-regulated in HCC tissue, while miR-101 and miR-195 were down-regulated. There were no statistical difference in the expression of miR-125a and miR-200b among the three groups. miR-101 was positively correlated with the expression of PLT with coefficient of 0.375. Conclusion miR-101 is remarkably decreased in both HBV-related cirrhosis and HCC, which is positively correlated with PLT. It suggests that miR-101 might be a negative regulator of chronic liver disease.

Investigation on the sero-epidemiology of hepatitis B virus infection in Tibetan peasants and herdsmen of Gamba county

BAI Sang, ZHANG Hui, ZHAXI Weise, SUOLANG Ciren, LONG Hai, YE Tao, DAN Zeng, MA Shi-wu.

2017, 22(4):  314-316. 

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Objective To investigate the prevalence of hepatitis B surface antigen (HBsAg) among Tibetan peasants and herdsmen in high-altitude plateau of more than 4,500 meters.Methods It was retrospectively analyzed that Tibetan peasants and herdsmen received health examinations with measurements of hepatitis B virus serum markers (HBV-M) or single HBsAg, as well as patients from hospital in Gamba from 2014 to 2015. Results There were 904 peasants and herdsmen from 5 towns with the HBsAg positive rate as 20.0% (95% CI: 17.4%~22.6%), ranging from 14.1% to 30.0%. HBsAg positive rates of out-patients (n=299) and in-patients (n=299) from Gamba hospital were 24.7% (95% CI: 22.3%~32.5%) and 26.4% (95% CI: 21.4%~31.4%), respectively. There were 181 patients receiving HBV-M detection with 58.6% (95% CI: 51.4%~65.8%) showing negative results. Conclusion Tibetan peasants and herdsmen showed high HBsAg positive rate and low protection rate of HBV vaccine in Gamba, which suggests that more attention should be payed to HBV infection.

Effect of plasma vWF level on liver failure patients with plasma exchange

XU Shan-shan, CHEN Ya-li, LIN Wei, CHEN Yu, HU Zhong-jie, DUAN Zhong-ping, ZHANG Jing.

2017, 22(4):  317-319. 

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Objective To investigate the effect of plasma exchange (PE) therapy on plasma von Willebrand factor (vWF) level, and assess the value of artificial liver support system in the treatment of liver failure.Methods Seventy-three patients with liver failure was enrolled in the study. The clinical data was collected, and plasma vWF levels before and after PE treatment were measured using enzyme-linked immunosorbent assay (ELISA), respectively. Results With PE treatment, 50 patients recovered, while 23 patients deteriorated. The liver failure group had significantly higher level of vWF as 22 500.00 (5 760.00, 44 700.00) ng/mL than the normal group (P<0.05). Plasma vWF levels were statistically changed before and after PE treatment [60 215.0 (19 412.4, 127 995.0) ng/mL vs. 42 855.1 (12 714.5, 115 684.7) ng/mL, P<0.05]. Furthermore, decease of plasma vWF level in recovered group was 18 650.65 (1 727.93, 81 110.42) ng/mL, which was significantly higher than 7 517.82 (-25 045.33,22 718.17) ng/mL in deteriorated group (P=0.005). Conclusion PE therapy could effectively reduce plasma vWF levels and improve liver microcirculation, which promotes the recovery of liver function and prolongs the survival in patients with severe liver disease.

Assessment on regional myocardial mechanics of left ventricle in patients with liver cirrhosis using three-dimensional strain parameters

QIAN Rong,XIONG Ai-min,YANG Wei-zhong,WANG Xiu-mei,LIU Ping,LIU Wen-jie, CHEN Ting-ting,ZHOU Zhu,XIE Yan-chun,KE Jing-jing,LI Jing,XU Xiao-ting,YANG Jun.

2017, 22(4):  320-322. 

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Objective To evaluate myocardial mechanics of left ventricle in patients with early-stage liver cirrhosis using three-dimensional echocardiographic strain parameters, and to explore effective ultrasonic parameters for diagnosis of cirrhotic cardiomyopathy.Methods Twenty-eight healthy volunteer were enrolled as controls (group A), and 25 early-stage cirrhotic patients were enrolled in group B. Three-dimensional speckle tracking imaging (3D-STI) were applied to analyze global 3-D strain (G3DS), global longitudinal strain (GLS) and area strain dyssynchrony index (ASDI) of left ventricle. Meanwhile, left ventricular ejection fraction (LVEF),left ventricular end-diastolic volume (LVEDV) and early diastolic wave/atrial contractive wave (E/A) ratio of mitral flow were measured using conventional ultrasound. Results Compared with those in group A, G3DS, GLS and E/A ratio in group B were significantly decreased (P<0.05), while ASDI was significantly increased (P<0.05). Additionally, levels of LVEDV and LVEF in group B showed no significant difference with that in group A (P<0.05). Conclusion Three-dimensional echocardiographic strain parameters could effectively evaluate left ventricular myocardial systolic dysfunction induced by early-stage liver cirrhosis.

Effect of nonalcoholic fatty liver disease on diversity of intestinal flora

ZHANG Jing-yi,TANG Ying-yue,LI Chun-min,MING Ya-nan,TANG Jie-ting,ZENG Min-de,MAO Yi-min

2017, 22(4):  323-326. 

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Objective To investigate the effect of nonalcoholic fatty liver disease (NAFLD) on the diversity of intestinal flora.Methods The NAFLD rat model was established by feeding high fat diet for 18 weeks and validated by liver histological examination. Fecal microbial flora was detected by 16sRNA sequencing technique. Results Liver histology showed bullae and microvesicular fatty degeneration and ballooning, which suggested NAFLD rat model was successfully constructed. Shannon index of control group was significantly higher than that of NAFLD group (P<0.05), suggesting that the microbial diversity in control group was significantly higher than that in NAFLD group. Changes at phylum level of intestinal flora revealed that the relative abundance of Firmicutes and Proteobacteria in NAFLD group were significantly higher (P<0.05) than that in control group, while the relative abundance of Bacteroidetes is significantly lower (P<0.05). Changes at family level of intestinal flora showed that the dominant bacteria were Lachnospiraceae, Ruminococcaceae and Bacteroidales_S24-7_group in control group, while Lachnospiraceae and Ruminococcaceae in NAFLD group. Compared with those in control group, the relative abundance of Lachnospiraceae, Bacteroidaceae, Desulfovibrionaceae, Acidaminococcaceae and Christensenellaceae were significantly higher (P<0.05) in NAFLD group, while the relative abundance of Bacteroidales_S24-7_group, Prevotellaceae and Lactobacillaceae were significantly lower (P<0.05). Conclusion NAFLD can impair the diversity of intestinal flora and significantly change the composition and content of intestinal flora.