Chinese Hepatolgy

Local tumor progression after ultrasound-guided radiofrequency ablation for hepatocellular carcinoma: risk factors analysis

LI Meng LI Zhi-yan GAO Yue-juan ZHANG Da-kun DONG Jing-hui TANG Yu TIAN Jiang-ke

2017, 22(2): 104-107.

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Objective To investigate the risk factors for local tumor progression (LTP) after ultrasound-guided radiofrequency ablation (RFA) in treatment of hepatocellular carcinoma (HCC).Methods Ninety-nine patients with 107 lesions involved in this study received RFA for HCC. Contrast-enhanced ultrasound (CEUS) perfusion parameters, liver stiffness measurement (LSM) and other examinations in all those patients were collected at a mean follow-up of 10.6 months. Kaplan-Meier model, log-rank test and Cox proportional hazard model was applied for survival analysis and identifying risk factors for LTP in HCC patients after RFA.Results Tumor size, distance to large vessels, tumor perfusion and LSM were independent risk factors for LTP with the hazard ratios (HR) as 1.12, 1.38, 1.59 and 1.77, respectively. Additionally, transarterial chemoembolization (TACE) before RFA treatment was a protective factor for LTP (HR 0.52).Conclusion Tumor size, distance to large vessels, tumor perfusion and LSM are the most important risk factors for LTP after RFA. Besides, using TACE before RFA treatment can effectively improve LTP.

Clinical characteristics of 25 cases with Gynura segetum-induced hepatic veno-occlusive disease

HAO Jun-gui,YAN Xue-bing,JI Fang

2017, 22(2): 108-110.

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Objective To investigate the clinical characteristics and prognosis of hepatic veno-occlusive disease (HVOD) induced by gynura segetum. Methods Clinical data of 25 gynura segetum-induced HVOD patients was retrospectively analyzed, and the comparison between rehabilitation group and death group were carried out.Results After taking gynura segetum for 3 months, 20 patients (80%) had clinical symptoms and signs such as abdominal distension, ascites, hepatomegaly and jaundice. Laboratory tests also indicated abnormal liver function, prolonged prothrombin time (PT) and decreased platelet count. In death group, levels of white blood cell (WBC), PT and blood urea nitrogen (BUN) were significantly higher than those in rehabilitation group (P<0.05). Image examination showed hepatomegaly, ascites and "leopard" or "patchy" low echo area in color doppler ultrasound, and characteristic "map" or "patchy" enhancement in enhanced computed tomography (CT). The mortality was about 50% during the follow-up. Conclusion Definite medication history, clinical manifestations, laboratory tests and imaging examinations can help diagnose gynura segetum-induced HVOD. Elevated WBC count, prolonged PT, and elevated BUN levels may be indicators for poor prognosis. To date, there is no specific treatment for HVOD and the mortality is high.

Plasmadiafiltration in treatment of hepatitis B virus related acute-on -chronic liver failure: analysis of prognostic factors

QIAN Zhi-ping, CHEN Nan, ZHANG Yu-yi, ZHANG Zheng-guo, ZOU Ying, ZHU Hui, GUO Hong-ying, WANG Jie-fei, MEI Xue

2017, 22(2): 111-115.

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Objective To investigate the efficacy and the prognostic factors of plasmadiafiltration treatment in hepatitis B virus (HBV) related acute-on-chronic liver failure (ACLF) patients.Methods Clinical data of 41 HBV-related ACLF patients in our department was retrospectively analyzed. According to the 3-month prognosis, patients were divided into survival group and death group, and the clinical parameters and laboratory tests were compared between the 2 groups. Chi square test and t test were applied for statistical analyses.Results Among these patients, levels of plasma prothrombin activity (PTA) (18.33±7.75 % vs 29.20±15.07 %; t=-3.826, P<0.05), total bilirubin (TBil) (445.66±209.67 μmol/L vs 396.88±151.78 μmol/L; t=2.042, P<0.05) and model for end-stage liver disease (MELD) score (32.08±6.75 vs 29.67±7.70; t=2.026, P<0.05) were significantly changed on day 3 after three subsequent treatments of plasmadiafiltration.There were 12 cases in survival group and 29 cases in death group. In survival group, the ratio of patients with cirrhosis at admission was lower than that in death group (16.7% vs 68.9%, χ²=7.351, P<0.05), while the ratio of hepatic encephalopathy showed no significant difference (83.3% vs 96.6%, χ²=0.672, P>0.05). The duration from diagnosis to plasmadiafiltration treatment was significantly shorter in survival group than that in death group (2.58±0.67 d vs 6.07±4.38 d; t=-4.167, P<0.05). Compared with survival group, death group showed higher ratio of stage Ⅱ and Ⅲ acute kidney injury (AKI) at baseline (65.5% vs 8.3%, χ²=8.711, P<0.05). After plasmadiafiltration therapy, the improvements of MELD score and PTA in the survival group were significantly higher than that in death group.Conclusion Plasmadiafiltration therapy can improve liver function and blood coagulation function in patients with HBV-related ACLF. Moreover, pre-existing with liver cirrhosis, liver failure for long course and serious AKI stage at admission might be indicators for poor prognosis after plasmadiafiltration therapy, while significant improvements of PTA and MELD score after therapy might suggest favorable prognosis.

Comparative study of 3 kinds of hepatic blood flow occlusion in hepatectomy for primary liver cancer complicated with liver cirrhosis

MAO An-rong, PAN Qi, ZHAO Yi-min, ZHANG Ning, ZHOU Jia-min, WANG Long-rong, WANG Yi-lin,LIN Zheng-hai,WANG Lu

2017, 22(2): 116-118.

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Objective To investigate the significance of 3 different hepatic blood flow occlusion techniques in the treatment of primary liver cancer complicated with liver cirrhosis.Methods Clinical data of 218 primary liver cancer patients accompanied with liver cirrhosis who received hepatectomy from March 2015 to March 2016 in our hospital was retrospectively analyzed. Among these patients, Pringle maneuver was performed in 77 cases (group A), hemihepatic blood flow occlusion was performed in 76 cases (group B) and hemihepatic blood flow occlusion and selective hepatic vein control was performed in 65 cases (group C). Operation time, bleeding, postoperative liver function and postoperative complications were compared among the 3 groups.Results Among the 3 groups, operation time of hepatectomy showed no significant differences (152±18 min vs.163±21 min vs. 172±23 min) (P>0.05), while mean intraoperative blood losses (495±76 mL vs.397±64 mL vs.317±65 mL) were significantly different (P<0.01). At day 2 and 5 after operation, serum alanine aminotransferase, total bilirubin and prealbumin levels in group A were significantly higher than those in group B and C (both P<0.01).Conclusion Hemihepatic blood occlusion can prevent systemic hepatic ischemia-reperfusion injury. Selective extrahepatic control of the hepatic vein can significantly reduce bleeding during hepatectomy.

Protection effect of herba artemisiae and licorice mixture on mice model of ANIT-induced intrahepatic cholestatic and its mechanism

ZHANG Zhi-rong, ZHANG Lin-lin, FAN Yu-juan, SU Hui-zong, LI Yue, TAN Bo, JIANG Jian, QIU Fu-rong

2017, 22(2): 119-124.

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Objective To investigate the protective effect and mechanism of herba artemisiae and licorice mixture on mice model of intrahepatic cholestasis (IC) induced by alpha-naphthylisothiocyanate (ANIT).Methods C57BL/6 female mice were randomly divided into normal group, model group, herba artemisiae group, licorice group and herba artemisiae/licorice mixture group, which were administrated with normal saline (0.2 mL/20 g), herba artemisiae (1.13 g·kg^-1·d^-1), licorice(1.13 g·kg^-1·d^-1), herba artemisiae and licorice mixture (herba artemisiae 1.13 g·kg^-1·d^-1 and licorice 1.13 g·kg^-1·d^-1) for 10 days, respectively. On day 7, all groups except normal group were additionally administrated with ANIT (100 mg/kg). Serum levels of total bilirubin (TBil), alanine aminotransferase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) and total bile acid (TBA) were detected on day 10. Hepatic pathological examinations were observed by hematoxylin and eosin staining (HE). Pregnane X receptor (Pxr), constitutive androstane receptor (Car) and their target genes were quantitated by reverse transcription-polymerase chain reaction (RT-PCR).Results Compared with those in model group, levels of TBil, ALT, AST, ALP and TBA in herba artemisiae/licorice mixture group were reduced by 22%, 23%, 25%, 20% and 30%, respectively. Meanwhile, transcription levels of Pxr, Car, Ntcp, Oatp1, Bsep, Mdr2, Mrp2, Mrp3, Mrp4, Cyp3a11, Ugt1a1 and Sult2a1 were elevated (P<0.01). Conclusion Herba artemisiae/icorice mixture might have a certain protective effect on mice model of ANIT-induced IC. Mechanistically, it could activate nuclear receptors Pxr and Car, induce drug metabolism enzymes (Cyp3a11, Ugt1a1 and Sult2a1) and upregulate transporters expression (Bsep, Mrp2, Mrp3, Mrp4), which promotes intrahepatic bile acid metabolism and reduces intrahepatic bile acids load.

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