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Table of Content

    30 September 2016, Volume 21 Issue 9
    Potential clinical significance of HBV RNA virus-like particle
    LU Feng-min, WANG Jie, ZHUANG Hui
    2016, 21(9):  717-718. 
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    Our recent studies confirmed that the HBV RNAs present in the serum of chronic hepatitisB (CHB) patients are pregenomic RNAs (pgRNAs) with a size of 3.5 kb. These pgRNAs are located in viruslikeparticles whose morphological structure is similar to that of Dan particles. Since pgRNAs can only betranscribed from the covalently closed circular DNA (cccDNA) located in the nuclear of infected hepatocytes,and the production of pgRNAs is not affected by nucleos(t)ide analogues (NUCs), the presence of viral RNAin serum can reflect the presence of cccDNA in hepatocytes and its transcriptional activity in patients treatedwith medication. It can be inferred that serum viral RNA can be used as a potential index for safe withdrawal ofNUCs. Our results based on a small-sample cohort show that the presence of HBV RNA in serum at the time ofdrugs withdrawal is indeed associated with virological rebound after drug withdrawal.
    Original Articles
    The clinical value of FibroScan for evaluating the hepatic fibrosis stage in patients with alcoholic liver disease
    XU Wei
    2016, 21(9):  719-721. 
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    Objective To investigate the clinical value of FibroScan for evaluating the hepatic fibrosis stage in patients with alcoholic liver disease. Methods In the study, 60 patients with alcoholic liver disease admitted in our hospital from June 2013 to June 2015 were enrolled. The liver stiffness was measured by FibroScan and quantified with FibroScan value, and liver biopsy was also conducted as the gold standard. The correlation between FibroScan value and the stage of hepatic fibrosis was analyzed by receiver operating characteristic (ROC) curve. Results The value of liver stiffness measured by FibroScan from stage 0 to stage 4 were 5.31±1.06, 7.91±2.81, 9.81±3.39, 14.66±4.31 and (19.81±6.02) kPa, respectively. The FibroScan value has a positive correlation with hepatic fibrosis stage in patients with alcoholic liver disease (r=0.706, P<0.05). The area under ROC for the patients with fibrosis stage ≥S1, ≥S2, ≥S3 and S4 was 0.833, 0.871, 0.906 and 0.919, respectively. Conclusion FibroScan could be used as a noninvasive technology to evaluate the hepatic fibrosis stage in patients with alcoholic liver disease.
    Efficacy of telbivudine in chronic hepatitis B patients with decompensated liver crirrhosis and its influence on renal function
    GAO De-yong, WANG Ying-ying, WANG Yan-yan, XU Guo-rong, WU Jian-qing, XIA Li-ping, LIU Liang-ming
    2016, 21(9):  722-725. 
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    Objective To investigate the efficacy of telbivudine (LDT) in patients with hepatitis B virus (HBV)-related decompensated liver cirrhosis and evaluate its influence on renal function. Methods In the retrospective analysis, 72 patients with HBV-related decompensated liver cirrhosis in our hospital from April 2012 to October 2015 received LDT (600 mg/d) antiviral therapy. The levels of alanine aminotransferase (ALT), total bilirubin (TBil), albumin (Alb), prothrombin time (PT), ascites, Child-Pugh integral, HBV DNA load, HBV DNA undetectable rate and resistance mutation were evaluated at baseline, week 24 and 48. Serum creatinine (CR) and estimated of glomerular filtration rate (eGFR) were also monitored. Comparisons among baseline, week 24 and 48 were carried out by chi-square test and t-test. Results At week 24, mean levels of ALT, TBil, HBV DNA load and HBV DNA undetectable rate were 46.12 U/L, 44.31 mol/L, 1.89 lg copies/mL and 75.00%, respectively. All results were significantly improved, as compared with those at baseline (P<0.05). Meanwhile, resistance mutations occurred in 2 cases, and ascites regression had not been reported. At week 48, levels of Alb and PT were 34.16 g/L and 15.09 sec, and Child-Pugh integral was significantly decreased as compared to that at baseline (P<0.05). In addition, resistance mutations occurred in 5 cases, and ascites regression was found in 3 cases. Compared with those at baseline, CR level reduced to 0.83 mg/dL and eGFR level raised to 108.48 mL/(min·1.73 m2) after 48-week treatment (P<0.05). Furthermore, 9 (23.08%) patients with mild renal impairment improved with eGFR≥90 mL/(min·1.73 m2). Conclusion LDT is a crucial strategy for inhibiting virus replication and improving liver function in chronic hepatitis B patients with decompensated liver cirrhosis. Although prolonging treatment can enhance therapeutic efficacy, it also increases resistance mutations risk. In terms of patients with mild renal impairment, LDT might be an appropriate option for its improvement in renal function.
    Alteration of T-cell subsets in peripheral blood and immunologic function in liver cirrhosis patients with splenectomy
    Guo Ting-ting
    2016, 21(9):  726-728. 
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    Objective To investigate the alteration of peripheral blood T lymphocyte subsets and varied immune function in liver cirrhosis patients after splenectomy. Methods The absolute quantity of peripheral blood T lymphocyte subsets was detected using flow cytometry in 75 patients with liver cirrhosis before and after splenectomy. Results Compared with the prior to splenectomy, obviously decrease in absolute value of T cell was received in patients after splenectomy. The percentages of CD3+, CD4+ and CD8+ T cells were decreased from (63.47±6.45)%, (33.08±3.05)%, (22.45±7.85)% to (48.62±5.85)%, (26.28±3.87)%, (15.89±4.84)% respectively. However, CD4+/CD8+ ratio rose dramatically from (1.47±0.43) to (1.69±0.53) (t=P<0.05). The percentage of patients, which the frequencies of CD3+, CD4+ and CD8+ T cells were less than 50%, 27%, and 15% respectively, was increased from 8%, 20% and 14.7% to 37.3%, 50.7% and 32%, respectively. Additionaly, the percentage of patients with CD4/CD8<0.71 increased from 5.3% to 6.7%. Compared to before splenectomy, abnormal percentage of lymphocyte subsets after splenectomy, including CD3+、CD4+ and CD8+, was increased significantly (t=3.59, 6.44 and 4.89 respectively, all P<0.01), meanwhile the levels of cytokines secreted by T cells after splenectomy, including IL-2, IL-4, IFN-γ and TNF-a, were decreased significantly. Conclusion There might be immune disorders in liver cirrhosis patients after splenectomy, such as apparent reduction in quantity of T lymphocyte subsets and hyperfunction of CD4+ T cell compared to CD8+ T cell. As the disease condition aggravates, the immune response ability of CD4+ T cell could be further weaken. Patients after splenectomy showing significant abnormality of lymphocyte subsets should be alert to the occurrence of tumor or infection.
    Clinical significance of emperipolesis in autoimmune hepatitis
    BIAN Zhao-lian, QIN Gang, CHEN Lin, SHAO Jianguo, MIAO Qi, MA Xiong
    2016, 21(9):  729-732. 
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    Objective To investigate the incidence and clinic significance of emperipolesis in autoimmune hepatitis (AIH) patients in China. Methods A histological evaluation by hematoxylin-eosin staining in all AIH patients was performed. Assessment of Ishak score was carried out for intrahepatic inflammation or fibrosis, as well as evaluation of interface hepatitis, plasma cell infiltration and rosette formation in the liver. Then the incidence of emperipolesis was analyzed statistically in patients with AIH. Furthermore, the relation of emperipolesis with intrahepatic inflammation or fibrosis and other pathological characteristics of AIH were analyzed. Results The presence of emperipolesis was observed in 57.3% AIH cases which was with hepatocyte eosinophilic stained. The incidence of emperipolesis showed positive correlations with the aggravation of intrahepatic inflammation or fibrosis. Histologically, patients with emperipolesis had higher incidences of interface hepatitis and rosette formation as compared with patients without emperipolesis. Conclusion Emperipolesis might be an important pathological hallmark for AIH, which might even illustrate a novel mechanism of hepatocyte damage in AIH.
    Differentiation of human umbilical cord mesenchymal stem cells into functional hepatocyte induced by liver homogenate supernatants in vitro
    XUE Gai, HAN Hua, CHEN Ze-sha, WU Hong-hai, LIU Jian-fang, HOU Yan-ning
    2016, 21(9):  733-737. 
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    Objective To investigate functional characteristics of hepatocytes that differentiating from human umbilical cord mesenchymal stem cells (hUCMSCs) induced by liver homogenate supernatants (LHS). Methods The 3rd Passage of hUCMSCs were selected and divided into control group and LHS group. At three time points (3d, 5d, 7d) after being induced, the immunofluorescence-cytochemistry staining of alpha-fetoprotein (AFP), cytokeratin 18 (CK18), tryptophan hydroxylase 2 (TPH2), cytochrome P450 3A4 (CYP3A4), albumin (Alb) and hepatocyte growth factor (HGF) were performed, and the CYP3A enzyme activity and levels of HGF, Alb and BUN were detected. Results The cells had expressed liver specific protein at the third day after LHS inducing, including AFP, CK18, TPH2, CYP3A4, Alb and HGF. In LHS group, the metabolism yield of midazolam, the specific metabolic substrates of enzyme CYP3A was increased significantly than that in control group (30.14±1.19, 50.20±6.24 and 120.85±15.52 ng/mg versus 0.026 to 0.030 ng/mg, P<0.01). Compared with control group, the secretion levels of HGF and Alb in LHS group were increased significantly at 3 time points. Additionally, the urea production of cells in LHS induction group increased 14 times more than that in control group (P<0.01). Conclusion The study has demonstrated that hUCMSCs could differentiate into hepatocytes with mature functions in vitro after LHS induction.