Table of Content

30 September 2017, Volume 22 Issue 9

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Original Articles

Expression of HBV cccDNA transcription-related factors in liver tissue

HANG Xiao-feng, WEI Bo, ZHANG Rui-qi, XU Wen-sheng, XIE Ying

2017, 22(9):  783-785. 

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ObjectiveTo investigate the expression and significance of SWI/SNF-related matrix-associated actin-dependent regulator of chromatin subfamily B member 1(SMARCB1), interferon stimulated exonuclease gene 20 (ISG20) and P300/CBP-associated factor (PCAF) in the liver tissues from different stages of chronic hepatitis B (CHB). Methods The expression of SMARCB1, ISG20 and PCAF in liver tissues were detected using immunohistochemistry. All the 32 patients were divided into 3 groups, including 11 cases of immune tolerance (IT), 13 cases of immune clearance (IC) and 8 cases of low replication stage (LR). The correlations among the expression of SMARCB1, ISG20 and PCAF at different stages of CHB and the quantification of hepatitis B surface antigen (HBsAg) were analyzed, respectively. Results Expressions of SMARCB1, ISG20 and PCAF varied at different stages of CHB, respectively. SMARCB1 expression in the CHB patients from high to low was IT patients, IC patients and LR patients. The expression of ISG20 was higher in IC patients than that in IT and LR patients. PCAF had the highest expression in IT patients. The expressions of SMARCB1 and PCAF were positively correlated with HBsAg, while the expression of ISG20 was negatively correlated with HBsAg. Conclusion The expressions of SMARCB1, ISG20 and PCAF were closely related to cccDNA transcriptional activity, which might help to evaluate cccDNA transcription activity comprehensively from viral factors and host immune factors.

Morbidity of osteoporosis in patients after liver transplantation and its risk factors analysis

ZHANG Da-li, ZHOU Shuang-nan, ZHANG Min

2017, 22(9):  786-788. 

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ObjectiveTo investigate the morbidity and risk factors of osteoporosis in patients after liver transplantation (LT), and to evaluate the diagnose efficiency of osteoporosis self-assessment tool for Asians (OSTA) for osteoporosis in patients after LT. Methods The bone mineral density (BMD) of 126 patients who underwent LT in our center was detected. The risk factors of osteoporosis in patients after LT were analyzed using univariate and multivariate logistic regression. The receiver operator characteristic (ROC) curve was used to evaluate the sensitivity and specificity of OSTA in screening osteoporosis. Results The morbidity of osteoporosis was 13.5% (17/126) in patients after LT and 3.2% (4/126) in healthy controls (χ²=8.779, P=0.003). Multivariate logistic regression showed that age, body weight and period of postoperative were the independent risk factors of osteoporosis after LT (OR=1.272, 0.868, 0.170, PCI: 0.796-0.963, P<0.001). Conclusion The prevalence of osteoporosis in LT patients was higher than that of the general population. The elderly patients with low body weight and short period post LT would have higher risk of osteoporosis after LT. OSTA could be used for osteoporosis screening in patients after LT.

Diagnostic value of different criteria for inactive HBsAg carriers and liver histological features in HBeAg-negative chronic hepatitis B patients with low HBV DNA level

LI Yang, XIAO li, YE Mao-cong, YANG Xiu-zhen, ZHANG Hui, GENG Ai-wen, LI Xiao-qin, SUN Hong-zhan, XU Hong-tao, XIAN Jian-chun

2017, 22(9):  789-793. 

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ObjectiveTo investigate the histological characteristics of hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) patients with low viral load and to evaluate the diagnostic value of different criteria for inactive hepatitis B surface antigen (HBsAg) carriers (IC). Methods HBeAg-negative CHB patients with HBV DNA < 4.3 log₁₀ IU/mL and alanine aminotransferase (ALT) < 2 the upper limit of normal (ULN) were enrolled in the study. All patients underwent liver biopsy. Patients with histological activity index (HAI) ≤ 3 or mild liver pathological damage were defined as pathologically IC. Four clinical criteria were applied in the study. For diagnosis of IC, group A was based on the 2015 Chinese guidelines (normal ALT, HBV DNA < 2.3 log₁₀ IU/mL), group B was on the 2015 APASL or AASLD guidelines (normal ALT, HBV DNA < 3.3 log₁₀ IU/mL), group C was on ALT < 2 ULN and HBV DNA < 2.3 log₁₀ IU/mL, and Group D was on normal ALT and HBV DNA < 3.3 log₁₀ IU/mL. Diagnostic value of the 4 clinical criteria of IC was evaluated using liver biopsy, which was the golden standard. Results A total of 171 patients were enrolled, including 125 males and 46 females, with mean age of 45.5±4.24 (22-69) year old. HAI ranged from 1 to 11 with the average value of 4.3±2.1, which was ≤ 3 in 94 cases (55.0%). Fibrosis score ranged from 0 to 4 with the average value of 2.0±1.6. A total of 101 (59.1%) cases had fibrosis score from 0 to 1. There was no significant difference in IC diagnosis rate among the 4 groups with different clinical IC diagnostic criteria. The Yourdon′s index for the 4 criteria was 0.08 ~ 0.11 and the area under the curve (AUC) was 0.544 ~ 0.558, respectively, which suggested their limitation of IC diagnosis. There were only 50% ~ 60% patients pathologically diagnosed of IC in patients according to Chinese and APASL/AASLD guidelines. However, in the non-IC patients diagnosed with clinical criteria, there were 33.3% ~ 51.4% patients meeting the pathological IC diagnosis. Conclusion There were 50% ~ 60% patients meeting the pathological IC among HBeAg-negative CHB patients with low viral load. Among the non-IC patients diagnosed by clinical criteria, 33.3% ~ 51.4% patients were pathologically diagnosed of IC. Based on the diagnostic golden standard of histology, clinical diagnosis of IC with current Chinese, APASL and AASLD guidelines showed low sensitivity and limited value.

Pharmacoeconomics evaluation of drug regimen for nonalcoholic fatty liver disease

CHEN Ting, YE Xiao-guang

2017, 22(9):  794-799. 

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ObjectiveTo investigate the pharmacoeconomics of anti-inflammatory and hepatoprotective drugs in treatment of nonalcoholic fatty liver disease (NAFLD). Methods Decision tree analysis model was carried out in the study, based on rate parameters from meta-analysis, efficacy parameters from expert opinions, as well as cost parameters (drug specifications, dosage and unit price) from the literature, expert opinion and real-time drug prices in Guangzhou, etc. The pharmacoeconomics analysis were performed among 7 treatment regimens for 24 weeks as followed: reduced glutathione tablets (Alto Moran), diammonium glycyrrhizinate capsules (Tianqing Ganping), metformin hydrochloride tablets (Gehua only), silybin capsules (Water forest good), bicyclol tablets (Pisanuo), tiopronin enteric-coated tablets (Kesi Lai) and polyene phosphatidylcholine capsules (Yi Shan Fu). Results Patients with bicyclol tablets treatment showed higher (8.80) therapeutic effect than those with reduced glutathione tablets (5.70), diammonium glycyrrhizinate capsules (7.40), metformin hydrochloride tablets (7.10), silybin capsules (8.00), tiopronin enteric-coated tablets (6.80) and polyenoic phosphatidylcholine capsules (7.00), respectively. The average cost-effectiveness ratio was the lowest (166.97) in metformin hydrochloride tablets, but the highest in diammonium glycyrrhizinate capsules (504.97). Incremental cost-effectiveness ratio of bicyclol tablets was 1219.97, which was lowest among the 7 groups. In terms of efficiency, bicyclol tablets had significantly highest (58.00%) efficacy among the 7 groups, and the incremental cost-effectiveness ratio of bicyclol tablets compared with metformin hydrochloride tablets was 32.21. This result was confirmed by sensitivity analysis. Conclusion Bicyclol tablets is effective in the treatment of NAFLD with a significantly cost-effective advantage.

Meta-analysis on risk factors of diabetes complicated with hepatic damage in China

CHEN Xi-yangguang, WU Jun

2017, 22(9):  800-805. 

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ObjectiveTo synthetically evaluate the risk factors of liver injury in diabetes patients in China. Methods English database (PubMed, EBSCO, Highwire, Web of Science)and Chinese database (CNKI, Wanfang, VIP )were applied for risky factor analysis in liver injury occurred in diabetes mellitus (DM) patients from 1990 to 2016. Meanwhile, relevant studies were manually retrieved. According to the inclusion and exclusion criteria, the data were screened and extracted with quality evaluation among those studies. A Meta-analysis was performed by using Revman 5.3 and Stata 12.0 software. Results Eight studies were synthetically and quantitatively analyzed, of which containing 7 Chinese studies and 1 English study. All 3568 cases in this study were divided into patients group (789 cases) and control group (2779 cases). The results of Meta-analysis showed that blood sugar level, total cholesterol (TC), triglyceride (TG), age, as well as complications of diabetes (diabetic nephropathy, diabetic neuropathy, diabetic retinopathy, diabetic ketosis) were associated with the incidence of liver injury in DM patients. The pooled OR/SMD values were 1.52 (95%CI: 1.40~1.64), 1.31 (95%CI: 1.18~1.44), 0.78 (95%CI: 0.17~1.39), 1.42 (95%CI: 0.43~2.41), -0.1 (95%CI: -0.37~-0.1), 3.02 (95%CI: 2.32~3.93), 2.24 (95%CI: 1.66~3.02), 1.95 (95%CI: 1.39~2.31) and 2.44 (95%CI: 1.50~3.96), respectively. Conclusion Blood sugar level, TC, TG, age, diabetic nephropathy, diabetic neuropathy, diabetic retinopathy and diabetic ketosis were considered to be the risk factors for liver injury complicated with DM.

5-HT reuptake specific inhibitor fluoxetine induce HepG2 apoptosis

MA Li-xia, Liu Xiao-hui, ZHANG jing

2017, 22(9):  806-809. 

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ObjectiveTo investigate the effect of 5-hydroxytryptamine (5-HT) reuptake specific inhibitor fluoxetine on apoptosis of human hepatocellular carcinoma cell line (HepG2). Methods HepG2 cells were treated with different concentrations of fluoxetine (5 μM, 7.5 μM, 10 μM, 12.5 μM, 15 μM) for 24 h and 48 h, respectively. Apoptosis was detected using Annexin V-FITC/PI flow cytometry and proteolytic enzyme 3 immunofluorescence assay. Results The 24 h apoptosis rates of HepG2 treated with 10 μM and 12.5 μM fluoxetine were 14.41%±5.40% and 19.43%±5.91%, which were significantly higher than that with control treatment (4.05%±1.90%, both P<0.05 )，respectively. The apoptosis rate was 20. 32%±6. 23% after 48 h treatment with 5 μM fluoxetine, which was significantly higher than that with control treatment (12. 40%±4.18%，P<0. 05). Treatment with 10 μM or 12. 5 μM fluoxetine for 24 h significantly increased activated caspase 3 positive cells. ConclusionFluoxetine could promote the apoptosis of HepG2 cells in a dose-dependent manner, which provides a clue for the clinical application of fluoxetine in the treatment of patients with hepatocellular carcinoma.