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    29 February 2020, Volume 25 Issue 2
    Viral Hepatitis
    Clinical profiles and treatment patterns of patients with HBV-related liver cirrhosis
    KONG Yuan-yuan, WEI Wei, SHAN Shan, MA Hong, OU Xiao-juan, XU Xiao-yuan, DUAN Zhong-ping, HOU Jin-lin, WEI Lai, YOU Hong, JIA Ji-dong, CR-HepB Group
    2020, 25(2):  123-127. 
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    Objective To analyze the clinical profiles and treatment patterns of patients with hepatitis B virus (HBV)-related cirrhosis in real-world clinical setting in China. Methods The demographic, clinical and treatment data were analyzed from enrolled patients in China Registry of Hepatitis B. Results A total of 5263 patients with HBV-related liver cirrhosis were included in the study, including 2013 (38.2%) patients with compensated status, 2752 patients (52.3%) with decompensated status and 498 patients (9.5%) unspecified. From 2010 to 2019, the proportion of patients ≥ 50 years old in those diagnosed with cirrhosis increased from 45.6% to 57.9%, the hepatitis B envelope antigen (HBeAg) positive rate decreased from 47.4% to 35.8%, and the use of the first-line antiviral drugs (entecavir or tenofovir) increased from 41.9% to 92.8%. Conclusion The real-world study demonstrated that the age of patients with diagnosis of cirrhosis gradually increased, the HBeAg positive rate gradually decreased, and the use of first-line antiviral drugs dramatically increased.
    Clinical characteristics and related factors of spontaneous HBsAg seroclearance in inactive HBsAg carriers
    WEI Xin-huan, ZHANG Jing, ZHANG Wei, LIU Ya-li
    2020, 25(2):  128-130. 
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    Objective To investigate the clinical characteristics and related factors of spontaneous hepatitis B surface antigen (HBsAg) clearance in inactive HBsAg carriers (IHCs). Methods IHCs in our hospital from January 2009 to December 2015 were enrolled and followed up at least once. None of the patients received any nucleoside analogues and/or interferon antiviral therapy. The differences between patients with and without spontaneous HBsAg clearance during follow-up were retrospectively analyzed. Results A total of 289 IHCs were enrolled in this study, including 161 males (55.71%) with an average age of 46.80 years. The alanine aminotransferase level was 21.40 ± 7.64 U/L, and serum HBsAg, hepatitis B envelope antigen (HBeAg) and hepatitis B virus deoxyribonucleic acid (HBV DNA) levels were 4592.00 (2262.00-6741.00) COI, 0.10 (0.09-0.12) COI and 430.05 (213.25-824.25) IU/mL, respectively. Serum HBsAg level was correlated with HBeAg level (r=1.86, P<0.01) and age (r=-1.82, P<0.01), but had no relationship with HBV DNA (r=0.09, P=0.58). During an average follow-up of 3 years, 17 patients (2.60%) had spontaneous HBsAg serological clearance, with an annual incidence of 0.87%. The serum levels of HBsAg, HBeAg and HBV DNA in patients with spontaneous HBsAg serological clearance were significantly lower than those in patients without (all P<0.01), but there were no significant differences in gender, age and liver function between the 2 groups. Conclusion There is no significant correlation between serum HBsAg and HBV DNA levels in IHCs. Patients with lower serum levels of HBsAg, HBeAg and HBV DNA are more likely to achieve spontaneous HBsAg serological clearance.
    Differential expression of T lymphocyte and NK G2D in patients with chronic HBV infection in different immune states
    WANG Xian, LIN Tao-fa, ZHAN Zhi-yu, WANG Shao-yang
    2020, 25(2):  131-134. 
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    Objective To investigate the difference of T lymphocyte and natural killer cell G2D (NKG2D) expression in chronic HBV infected persons under different immune conditions. Methods Eighty patients with chronic HBV infection were divided into immune tolerance group (28 cases), immune clearance group (30 cases) and low (non) replication group (22 cases) according to the different immune status. Another 30 healthy people were selected as control group. Peripheral blood T lymphocyte subsets, NK cells, NKG2D cell frequencies and serum levels of tumor necrosis factor-alpha (TNF-α) and interferon-γ were measured among four groups. Results The percentage of CD3+ T cells in the four groups was not statistically significant (P>0.05). The percentage of CD4+, CD4+/CD8+, NK cells in the immune clearance group were (30.14±5.36) %, (1.10±0.33)%, (9.67±4.31)%, which were significantly lower than the other three groups. The percentage of CD8+, NKG2D+/NK cells were (33.56±5.37)%, (12.96±3.42)%, which were significantly higher than the other three groups (P<0.05). The percentage of NKG2D+/NK cells in immune tolerance group and low (non) replication group were (3.46±1.15)% and (3.55±1.07)% respectively, which were significantly lower than that in control group, and the percentage of NKG2D+/NK cells in immune clearance group was significantly higher than that in control group (P<0.05). The levels of TNF-α and IFN-γ in immune clearance group were (69.62±16.46) ng/L and (69.85±12.30) ng/L respectively, which were significantly higher than those in immune tolerance group, low (non) replication group and control group (P<0.05). There was no significant difference in the levels of TNF-α and IFN-γ between the immune tolerance group, the low (non) replication group and the control group (P>0.05). Conclusion The expression of peripheral blood lymphocyte and NKG2D cells in patients with chronic HBV infection is significantly different under different immune conditions. The immune status of patients can be evaluated by measuring the levels of peripheral blood T lymphocyte and NKG2D cells in patients with HBV infection to guide clinical treatment.
    The effect of HCV NS3 protein on proliferation and telomerase activity of L02 cell line
    ZHANG Jun-jian, ZHANG Kuang-zhao
    2020, 25(2):  135-137. 
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    Objective To establish the cell model of HCV NS3 expression and to observe the proliferation and telomerase activity of stable LO2 cell line transfected with pcDNA3.1(+)/HCV NS3 plasmids. Methods The plasmid of pcDNA3.1(+)/HCV NS3 was constructed by molecular cloning technique, which were transfected into human liver cell lines L02 to get the stable cell line. Stable cell line was verified by Western Blotting. The cell proliferation was detected by MTT assay. The expression of hTERT mRNA was analyzed using TAGGG Telomerase PCR ELISA kit. Results The recombinational plasmid pcDNA3.1(+)/HCV NS3 was constructed successfully. HCV NS3 proteins were observed in pcDNA3.1(+)/HCV NS3 transfected stable cell line by Western blotting assay. The proliferation of L02 cells were promoted by HCV NS3 protein compared with blank L02 cells and pcDNA3.1(+) transfected cells. The increased expression of hTERT mRNA was detected on pcDNA3.1(+)/HCV NS3 transfected stable cell line. Conclusion HCV NS3 protein can accelerate proliferation of human normal liver cells, enhance the gene expression of hTERT mRNA and induce the activity of telomerase.
    Liver Cancer
    CT and MRI features and diagnostic values of microvascular infiltration in hepatocellular carcinoma
    DU Pin-qing, LIU Yun-guo, HU Yi
    2020, 25(2):  138-141. 
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    Objective To analyze the CT and MRI features of microvascular invasion in hepatocellular carcinoma and to evaluate its diagnostic value in hepatocellular carcinoma. Methods Forty-nine patients with hepatocellular carcinoma underwent CT or MRI plain and enhanced scan before operation. According to the pathological results, the patients were divided into positive group and negative group. The CT and MRI signs and diagnostic efficacy of the two groups were analyzed. Results 49 cases (61.25%) had microvascular infiltration lesions. Compared with negative group, the percentage of incomplete capsule, single nodule extranodal growth and continuous multiple nodules in positive group was significantly higher than that in negative group (P<0.05). The ADC value of the positive group was (1.261±0.263)×10-3 mm2/s, and that of the negative group was (1.071±0.325)×10-3 mm2/s. There was a significant difference between the two groups (P<0.05). Tumor morphology and ADC were the influencing factors of microvascular invasion (P<0.05). The diagnostic sensitivity and specificity of ADC value for microvascular invasion respectively were 75.00% and 87.50%. The diagnostic sensitivity and specificity of tumor morphology for microvascular invasion respectively were 91.67% and 75.00%. Conclusion Among the CT and MRI imaging features of hepatocellular carcinoma, tumor morphology and ADC value have high diagnostic efficiency for microvascular infiltration.
    Role of RNA and lnc-EGFR in hepatocellular carcinoma immune evasion
    WEi Yuan-yuan, TIAN Yan-hong, Li Hong-jing, ZHANG Hao, LI Mu-song
    2020, 25(2):  142-145. 
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    Objective To investigate the role of ribonucleic acid (RNA) and long non-coding RNA of epidermal growth factor receptor (lnc-EGFR) in hepatocellular carcinoma (HCC) immune evasion. Methods A total of 30 HCC specimens and 30 normal adjacent tissues collected in our hospital from January 2017 to January 2019 were randomly selected. The expression levels of RNA and lnc-EGFR in tissues were detected by reverse transcription polymerase chain reaction, and the expression of chemical factors and cellular immune factors in HCC tissues were detected by Western blot. HCC cell lines were randomly divided into 2 groups: RNA/lnc-EGFR inhibition group (n=15) and blank control group (n=15). The 3-(4, 5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide assay was used to detect cell proliferation, and flow cytometry was used to detect cell apoptosis and cell cycle distribution. Results The expression levels of RNA and lnc-EGFR in adjacent normal tissues (0.46 ± 0.12, 0.62 ± 0.15) were lower than those in HCC tissues (0.22 ± 0.06, 0.14 ± 0.05) (P<0.05). The expression level of C-X-C motif chemokine ligand 12 (CXCL12)-C-X-C motif chemokine receptor 4 (CXCR4) in HCC tissues was lower than that in adjacent normal tissues (P<0.05). The expression levels of C-C motif chemokine ligand 20 (CCL20)-C-C motif chemokine receptor 6 (CCR6) and C?X3?C motif chemokine ligand 1 (CX3CL1)-C?X3?C motif chemokine receptor 1 (CX3CR1) in HCC tissues were higher than those in adjacent normal tissues (P<0.05). The expression levels of cellular immune factors including interleukin-6 (IL-6), interleukin-10 (IL-10), transforming growth factor-β (TGF-β) and tumor necrosis factor-α (TNF-α) in HCC tissues were higher than those in adjacent normal tissues (P<0.05). The expression levels of RNA and lnc-EGFR were significantly negatively correlated with CXCL12-CXCR4 (P<0.05), and significantly positively correlated with CCL20-CCR6, CX3CL1-CX3CR1, IL-6, IL-10, TGF-β and TNF-α (P<0.05); The relative absorbance, apoptosis rate and cell cycle ratio of HCC and adjacent normal tissues were statistically different (P<0.05). Conclusion RNA and lnc-EGFR are highly expressed in HCC tissues, and can upregulate immune evasion of cancer cells by up-regulating the levels of chemical factors and cellular immune factors in tissues, which has a significant correlation with HCC immune evasion regulation.
    Clinical efficacy comparison of percutaneous radiofrequency ablation and laparoscopic liver resection for the treatment of stage Ia primary liver cancer
    WANG Jia-huan, LI Zhen
    2020, 25(2):  146-148. 
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    Objective To compare the clinical effects of percutaneous radiofrequency ablation and laparoscopic liver resection for primary stage Ia hepatocellular carcinoma. Methods A total of 114 patients with stage Ia primary liver cancer admitted to Luotian County People's Hospital from January 2015 to January 2017 were enrolled. The patients were randomly divided into PRFA group and laparoscopic group, with 57 cases in each group. The PRFA group underwent percutaneous radiofrequency ablation, and the laparoscopic group underwent laparoscopic liver resection. The survival time and tumor-free survival time of the two groups were compared. The liver function of the two groups was compared before and after treatment. The complication rate of the two groups was compared. Results After treatment, the total incidence of complications in the PRFA group was 7.02% (4/57), and the total incidence of complications in the laparoscopic group was 24.56% (14/57). The total incidence of complications in the PRFA group. The difference was statistically significant (P<0.05). There was no significant difference in serum ALT and AST levels between the two groups before treatment (P>0.05). After 1 month of treatment, the two groups were treated. The liver function level of patients was significantly better than that before treatment, and the liver function level of patients in PRFA group was significantly better than that of laparoscopic group, the difference was statistically significant (P<0.05). After treatment, the survival time and tumor-free survival time of the patients in the laparoscopic group were (28.30±4.11) months and (22.67±3.99) months, respectively, and the survival time and absence of the patients in the PRFA group were (34.29±2.88) months and (27.14±4.16) months, respectively. The tumor survival time was significantly better than that of the endoscopy group, and the difference was statistically significant (P<0.05). Conclusion For the treatment of stage Ia primary liver cancer, percutaneous radiofrequency ablation is more conducive to liver function recovery than laparoscopic liver resection, which can effectively prolong the survival time and tumor-free survival time, and reduce the incidence of complications is worthy of clinical promotion.
    Others
    The role and mechanism of paraoxonase 1 in the regulation of lipid metabolism and insulin resistance in nonalcoholic fatty liver disease
    ZHANG Rong, CHEN Jing, HUANG Jiang-tao, LU Hai-long, YANG Yi-cun, WANG Hao-bin, ZHANG Shu
    2020, 25(2):  149-154. 
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    Objective To investigate the role and mechanism of paraoxonase 1 (PON1) and lipid metabolism,insulin resistance in nonalcoholic fatty liver disease(NAFLD). Methods One hundred and twenty-nine NAFLD patients and 130 non-NAFLD individuals were enrolled in the study. The age, height, weight, waist circumference, blood pressure and other information were collected. Plasma blood lipids, fast glucose, and glucagon were detected by routine blood tests, homeostatic index of insulin resistance (HOMA-IR) was calculated, liver and kidney function were evaluated in biochemical assay, LO2 cells were inoculated in 12-well plates for 24 h and then added 0~ 1.2 mM OA solution was treated for 24 h or 10 ng/mL TNF-α for 6 h, and the 1 μg control and PON1 plasmid were transfected with PEI for 24 h. The intracellular lipid content was determined using a Nile Red dye. PON1 activity was detected by ELISA, and PON1, p-IRS1, T-IRS1, p-AKT T-AKT, FAS, HMGCR, SREBP2 and SREBP1C protein were detected by Western Blot. Results Waist circumference, BMI, peripheral blood ALT, AST, FFAs, TG, TC, LDL-C, VLDL-C, fasting blood glucose, insulin, HOMA-IR, resistin, leptin, IL-6 and TNF-α were significantly higher in patients with NAFLD. In non-NAFLD, PON1 activity, content, HDL-C, glucagon and adiponectin were significantly reduced; PON1 activity and content were significantly negatively correlated with FFAs, TG, TC, LDL-C, VLDL-C, fasting blood glucose, insulin, HOMA -IR, resistin, leptin, IL-6 and TNF-α, and positively correlated with HDL-C, glucagon and adiponectin; PON1 activity in LO2 cells of OA group gradually decreased, and the activity of PON1 in LO2 cells of 0.2~1.2 mM OA group was significantly lower than that of control group. Overexpression of PON1 did not affect PON1 activity, the lipid content of LO2 cells in 0.2~1.2 mM OA group was significantly higher. In the control group, it was significantly lower than the OA group; the expression levels of PON1, p-IRS1, p-AKT, FAS, HMGCR, SREBP2 and SREBP1C in the TNF-α group were significantly lower than those in the control group, and the transfected PON1 plasmid was significantly increased. PON1, while the expression levels of p-IRS1, p-AKT, FAS, HMGCR, SREBP2 and SREBP1C protein were significantly increased. Conclusion PON1 activity and content are significantly correlated with NAFLD lipid metabolism and insulin resistance, and may affect insulin resistance and regulate lipid metabolism by regulating p-IRS1/AKT pathway.
    Percentage of Th17/Treg cells in peripheral blood of patients with Sjogren's syndrome and primary biliary cirrhosis and their clinical characteristics
    HUAN Wen,SHI Li-pu
    2020, 25(2):  155-157. 
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    Objective To detect the levels of T helper 17 (Th17) and regulatory T (Treg) cells in peripheral blood of Sjogren's syndrome (SS) patients combined with primary biliary cirrhosis (PBC), to analyze their clinical characteristics, and to investigate the effects of Th17/Treg cells on these patients. Methods A total of 22 patients with SS complicated with PBC aged (54.1 ± 9.6) years, including 7 males and 15 females, and 48 SS patients aged (56.7 ± 10.2) years, including 10 males and 38 females, in our hospital from March 2012 to February 2018 were enrolled. And 68 healthy volunteers were enrolled, including 16 males and 52 females, with an average age of (55.2 ± 4.5) years. The measurement data of normal distribution are expressed by mean ± standard deviation, the measurement data of non-normal distribution are expressed by median (percentage 25, percentage 75)], and the comparison between the groups is conducted by t test or Kruskal-Wallis H test. Counting data are expressed as percentages, and comparisons between the groups are made by chi-square test. Results There were 20 cases (90.9%) in the observation group (SS combined with PBC) with the main clinical manifestations of jaundice, skin pruritus, ascites, gastrointestinal hemorrhage, dry mouth, esophageal varices, fever and dry eyes, higher than 37 cases (77.1%) in the control group (SS). However, the number of patients with weight loss in the control group (46, 95.8%) was significantly higher than that in the observation group (17, 77.3%). The alanine aminotransferase, aspartate transaminase, alkaline phosphatase, γ -glutaminase and total bilirubin in the observation group were higher than those in the control group and the healthy group (P<0.05). The percentage of Th17 cells in the observation group was 16.6% (10.1%, 22.5%), significantly higher than that in the control group [9.4% (7.0%, 13.0%), P<0.05] and the healthy group [4.9% (4.3%, 9.8%%, P<0.05]. The ratio of Th17/Treg cells in observation group [0.52 (0.42, 0.62)] was significantly higher than that in control group [0.25 (0.14, 0.37), P<0.05] and healthy group [0.22 (0.13, 0.26), P<0.05]. Conclusion The levels of Th17/Treg cells and their ratios in peripheral blood of SS patients with PBC are obviously out of balance, suggesting that Th17 cells are very likely to be involved in the pathogenesis process. In addition, Th17/Treg ratio has certain correlation with some liver function indexes, and further hierarchical analysis can be carried out stratified by the severity of the disease in future studies.
    Serum fatty acid binding protein 4 in patients with drug-induced liver injury
    ZHOU Tian-hui, MO Rui-dong, HUANG Yan, LAI Rong-tao, CAI Wei, XIE Qing, TANG Wei-liang
    2020, 25(2):  158-161. 
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    Objective To investigate the potential value of serum FABP4 level and some laboratory indicators in classification and prognosis of DILI. Methods DILI patients, admitted to the Department of Infectious Diseases, Ruijin Hospital, from January 2016 to December 2017, were enrolled. History data, laboratory indicators, and serum within 14 days of onset were collected. The expression of FABP4 was compared among different clinical classifications and outcomes, respectively. Kendall correlation analysis was performed on various clinical data, laboratory indicators and clinical outcomes. Results One hundred and fifty-eight patients, including 111 females, had different types of liver injury: hepatocellular injury (50.0%, 79/158), mixed injury (17.1%, 27/158) and cholestatic injury (32.9%, 52/158). According to clinical outcomes, patients were divided into three groups, including 100 of recovery within 6 months (63.3%), 42 of chronicity (26.6%) and 16 of liver transplantation or death due to DILI (10.1%). Furthermore, serum FABP4 levels in patients with different types of liver injury were 9.83±1.40 ng/mL (hepatocellular injury), 12.70±1.42 ng/mL (mixed injury) and 23.05±3.48 ng/mL (cholestasic injury), respectively. Serum FABP4 level was significantly increased in chronic patients (14.47±1.67 ng/mL) compared with patients who recovered within 6 months (11.58±1.31 ng/mL). It was also notably higher in death/liver transplantation group (36.18±10.07 ng/mL) than the other two groups. Conclusion Serum FABP4 was significantly increased in the cholestasis DILI and death/liver transplantation groups, which was significantly associated with ALT, total bilirubin, outcome and clinical injury type. Serum FABP4 level might be a valuable factor in the prognosis of DILI to some extent.
    Clinical and imaging analysis of 26 cases of hepatic sinusoidal obstruction syndrome
    QI Ru-ping, DONG Jing-hui, LI Yong-wu, AN Wei-min, REN Hong-wei, LIU Yuan
    2020, 25(2):  162-165. 
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    Objective To analyze the clinical and imaging features of 26 patients with hepatic sinusoidal obstruction syndrome (SOS), and to provide experience for clinical diagnosis and treatment of SOS. Methods The clinical data of 26 patients with SOS hospitalized in the Fifth Medical Center of Chinese People's Liberation Army General Hospital from November 2010 to February 2019 were analyzed retrospectively, symptoms and signs, laboratory examinations, imaging features and etiology were summarized. Results In 26 patients with SOS, abdominal distension, fatigue, anorexia and ascites were the main symptoms and signs. Of these patients, 1 after liver transplantation and 1 after renal transplantation had chemotherapy history, 1 patient was with unknown etiology, and the other 23 patients had a history of taking Chinese herbal medicine, among which the most had taken the gynura segetum (80.8%). Laboratory examinations showed that alanine aminotransferase (ALT) elevated in 17 cases, aspartate transaminase (AST) elevated in 20 cases, cancer antigen 125 (CA125) elevated in 23 cases. The imaging features of computed tomography and magnetic resonance were similar, including 11 cases of splenomegaly, 24 cases of ascitic fluid, 21 cases of uneven density and signal intensity of liver, 23 cases of inhomogeneous enhancement in enhanced scan, and 11 cases of thinner or unclear hepatic veins. Conclusion The main cause of SOS is taking gynura segetum, the clinical manifestations are abdominal distention, fatigue, anorexia, abnormal liver function and elevated CA125. The imaging features are hepatosplenomegaly, ascites, uneven liver density and signal, inhomogeneous enhancement of enhanced scanning and thinner or unclear hepatic veins.