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    31 October 2020, Volume 25 Issue 10
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    Liver Fibrosis & Cirrhosis
    A prognostic model for long-term survival in alcoholic liver cirrhosis patients complicated with spontaneous bacterial peritonitis
    WANG Rui-rui, JIANG Yu-yong, WANG Xian-bo, YANG Jin-xiang
    2020, 25(10):  1030-1033. 
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    Objective To investigate the factors affecting the long-term prognosis of patients with alcoholic cirrhosis (ALC) complicated with spontaneous bacterial peritonitis (SBP) and to develop a prognostic model. Methods The clinical information of 159 ALC patients complicated with SBP were collected. They were divided into modeling group (123 cases) and verifying group (36 cases). Patients in the modeling group were subdivided into death group (47 cases) and survival group (76 cases) according to their outcomes after 1-year. Clinical information of all patients was collected and compared. Significant single risk variants were selected for further Logistic regression analysis to obtain the risk factors for building a prognostic model. The resulting model was further validated in the verifying group of patients. Results Logistic regression analysis showed that age(OR=0.935,95% CI:0.883~0.990), history of SBP(OR=0.195,95% CI:0.082~0.462), history of hypertension(OR=0.364,95% CI:0.134~0.990), complicated upper gastrointestinal bleeding(OR=0.364,95% CI:0.140~0.942), complicated with hepatorenal syndrome(OR=0.271,95% CI:0.094~0.777), Maddery discriminant function(OR=0.981,95% CI:0.969~0.994)and albumin level(OR=1.061,95% CI:0.999~1.127) were independent risk factors associated with survival (P<0.05). The area under the ROC curve of the prediction model was 0.805 (95% CI:0.727-0.883).The sensitivity, specificity, and the total accuracy of the model was 87.50%, 95.00%, and 91.67% respectively. Conclusion Age, history of SBP, history of hypertension, complicated with upper gastrointestinal bleeding, complicated with hepatorenal syndrome, Maddery discriminant function and albumin level are the high risk factors for the poor long-term prognosis in ALC patients with SBP. The prediction model established on these factors is accurate for predicting long-term prognosis of ALC patients with SBP.
    Viral Hepatitis
    Correlation between miR-122 rs7227488 gene polymorphism and HBV intrauterine infection in HBsAg-positive pregnant women
    LIN Jing, XIA Lin, FENG Di-lu
    2020, 25(10):  1034-1037. 
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    Objective To investigate the relationship between rs7227488 polymorphism site at the gene promoter region of miR-122 and the susceptibility of intrauterine infection in HBsAg-positive pregnant women. Methods One hundred and fourty-one HBsAg positive pregnant women who underwent prenatal examination and deliveried were selected in this study. General data of the pregnant women (age, gestational week at delivery, mode of delivery, sex of newborn) were collected. The HBsAg-positive pregnant women were divided into HBV intrauterine infection group (47 cases) and non-HBV intrauterine infection group (94 cases) according to the occurance of HBV infection in their neonates. The rs 7227488 polymorphism of miR 122 gene in all subjects was detected using polymerase chain reaction-restriction fragment length polymorphism (PCR-RELP). Risk factors of HBV intrauterine infection in HBsAg positive pregnant women and the correlation between rs7227488 and neonatal HBV infection were analyzed by logistic regression analysis. Results The G/A genotypes of rs7227488 in non-HBV intrauterine infection group and HBV intrauterine infection group were accordant with Hardy-Weinberg equilibrium law (P>0.05). The G/A mutation rate of rs7227488 in non-HBV intrauterine infection group (44.6%) was significantly higher than that of the HBV intrauterine infected group (55.3%) (P<0.05). Bivariate logistic regression analysis showed that HBV DNA load and rs7227488 AA type were risk factors for intrauterine HBV infection in HBsAg-positive pregnant women (Or=1.512,1.898,all P<0.05). Conclusion The miR-122 rs7227488 AA genotype of HBsAg-positive pregnant and lying-in women are risk factors of intrauterine HBV infection.
    The association of mir-122 and mir-146a levels in serum exosomes with HBV DNA load in chronic hepatitis B patients
    LIU Jiao, LIU Qing, WANG Da-ming, JIA Xing-wang
    2020, 25(10):  1038-1042. 
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    Objective To study on the association of microRNA-122 (mir-122) and microRNA-146a (mir-146a) levels in serum exosomes of chronic hepatitis B (CHB) patients with hepatitis B viral DNA (HBV DNA) load. Methods 285 CHB patients were divided into low viral load group (HBV DNA < 1 ×105 copy/ml), medium viral load group (1 ×105 copy/ml ≤ HBV DNA ≤ 1 ×107 copy/ml) and high viral load group (HBV DNA > 1 ×107 copy/ml) with 95 cases in each group. Serum HBV DNA was detected by fluorescence real time quantitative PCR (RT-qPCR). In addition, serum samples from 95 healthy outpatients were collected simultaneously as the control group. The levels of mir-122 and mir-146a in serum exosomes were detected by RT-qPCR; Serum indexes of liver fibrosis were measured by chemiluminescence method. Pearson correlation analysis was applied for analyzing the association between serum exosome levels of mir-122 and mir-146a with HBV DNA load, and liver fibrosis indexes. Results Compared with the control group, the HBV DNA load, mir-122 level in serum exosomes, and the levels of serum hepatic fibrosis indexes including Hyaluronidase (HA), procollagen Ⅲ (PC Ⅲ), collagen Ⅳ(C Ⅳ) and laminin (LN) in low, medium and high HBV DNA load groups increased, whereas the level of mir-146a decreased in turn (P<0.05). The levels of mir-122 and mir-146a in serum exosome were found negatively correlated with HBV DNA load (r=0.765, P<0.05). The level of mir-122 was positively correlated with HBV DNA load and serum HA, PC Ⅲ, C Ⅳ and LN levels (r= 0.773, 0.764, 0.699, 0.665, 0.697, respectively, P<0.05), whereas the level of mir-146a was negatively correlated with these parameters (r=-0.840, -0.779, -0.731, -0.691, -0.738, respectively, P<0.05). Conclusion The expression and secretion of Mir-122 in serum exosome of CHB patients is up-regulated and that of mir-146a is down-regulated. They are closely co-related with HBV DNA load and may impact on HBV DNA replication, the severity of hepatic fibrosis, and the progression of CHB.
    An analysis of genetic mutations of HBV in a tertiary hospital specialized in infectious disease in Shanghai from 2015 to 2019
    ZHANG Li, MENG Xian-Min, DONG Ping
    2020, 25(10):  1043-1047. 
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    Objective To evaluate mutations of HBV genes and explore the factors affecting mutations in Shanghai. Methods Detection data of gene mutations in HBV reverse transcriptase region (including sites at I169, V173, L180, A181, T184, A194, S202, M204, N236 and M250) of patients with chronic hepatitis B(CHB) in Shanghai Public Health clinical Center from 2015 to 2019 were collected, as well the consumptions of nucleoside (acid) medications (NAs) ; explore the factors influencing mutation out of gender, age, HBV DNA, glutamic oxaloacetic transaminase(AST), glutamic pyruvic transaminase(ALT), HBV sreological markers(HBVM) and genotype by univariate and multivariate analysis. Results 651 out of 4182 samples were detected mutations in HBV from 2015 to 2019, with a mutation rate of 15.57%; the mutation rate decreased along with the increasing consumptions of NAs with a higher genetic barrier year by year. Within 32 genetic mutation patterns of HBV in Shanghai, rtM204I, rtM204V+rtL180M and rtM204I+rtL180M were the dominant patterns with propotion of 32.41%, 29.33% and 16.44%, respectively; the rate of HBV resistant to lamivudine was the highest, followed by adefovir 2.13% and entecavir 0.22%, while no HBV resistant to tenofovir was found. Univariate analysis showed that age, genotype, ALT, AST, HBeAg and HBeAb were related to mutations, while multivariate analysis showed that age growth and HBeAb negative were risk factors of mutations. Conclusion 1. The genetic mutation rate of HBV decreased year by year from 2015 to 2019 in Shanghai, which may relate to the increasing consumptions of NAs with higher resistant barrier;2. HBV genetic mutation patterns are diversified with the dominant patterns of rtM204I, rtM204V+rtL180M and rtM204I+rtL180M; 3. The resistance rate of HBV to lamivudine is the highest; we should pay close attention to HBV resistant to entecavir in the future; 4. CHB patients who are older and HBeAb negative are more prone to mutate in HBV gene and resist to NAs.
    The clinical significance of vitamin D levels in chronic hepatitis B patients
    LI Li, SHAN Ben, PAN Xiu-cheng, FU Juan-juan
    2020, 25(10):  1048-1051. 
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    Objective To investigate the clinical significance of serum vitamin D levels in patients with chronic hepatitis B. Methods The peripheral vein serum samples of 201 patients with chronic hepatitis B and 100 cases of healthy controls matched by age and gender were collected. Markers of hepatitis B vius (HBV) were detected quantificationally with chemiluminescent micropartical immunoassay; HBV DNA load was detected with fluorescence quantitative polymerase chain reaction (PCR); Paremeters of the liver function test were detected by automatic biochemical analyzer. Serum 25-hydroxy vitamin D concentration was detected with electrochemiluminescence assay. Results The serum 25-(OH)D levels of chronic hepatitis B patients were higher than healthy controls [(24.48±10.51) ng/ml vs (21.69±7.45) ng/ml, P=0.008]. After a correction with sampling time, the average serum 25-(OH)D levels of chronic hepatitis B patients was (28.66±11.65) ng/ml and much more higher than that of the healthy controls (P<0.001). The incidence of sufficient vitamin D in chronic hepatitis B group was higher than that in the control group (P=0.001). The 25-(OH)D levels in patients with chronic hepatitis B showed significant linear correlations with ALT (r=0.18, P=0.04), GGT (r=0.27, P<0.01) and HBeAg (r=-0.20, P=0.02); when defining Log10 HBV DNA load as (4.2 ~ 8) IU/ml, there was a significant negative linear correlation between vitamin D levels and Log10 HBV DNA (n=119,r=-0.20, P=0.03). Conclusion The serum vitamin D levels increase in chronic hepatitis B patients and are associated with liver inflammation and HBV replication status. A moderate to high levels of HBV DNA loads and the titers of HBeAg in chronic hepatitis B patients are reversely co-related with their serum vitamin D levels.
    Liver Cancer
    The establishment of preoperative prediction model for the prognosis of patients with primary liver cancer and portal vein tumor thrombus
    CHEN Han-bo, WANG Heng-wu, CHEN Fu-jun
    2020, 25(10):  1052-1054. 
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    Objective To establish a preoperative prediction model for the prognosis of patients with primary liver cancer and portal vein tumor thrombus. Methods Eight-six cases of primary liver cancer with portal vein tumor thrombus who received the radical resection of liver cancer in combination with section thrombectomy were included as the research objects. Their 2-year survival rates were recorded by followed up. Logistic multivariate analysis was used to obtain the independent factors that were associated with the prognosis of patients with primary liver cancer and portal vein tumor thrombus. These factors were used to establish a preoperative prediction model. Results The 86 patients were followed up for 2 years in which 18 cases died and 68 cases survived, with a 2-years survival rate of 79.07%. By logistic multivariate analysis it was found that Child Pugh liver function grade (OR=1.682, P=0.029), tumor diameter (OR=2.279, P=0.000) and tumor stage (OR=1.231, P=0.006) were the risk factors of poor prognosis in patients with primary liver cancer and portal vein tumor thrombus. Serum albumin (Alb) level was a protective factor for poor prognosis (OR=0.712, P=0.002). The preoperative prediction model was established as the Y=1.682X1+2.279X2+1.231X3-0.712X4 (X1 was Child Pugh liver function grade, X2 was tumor diameter, X3 was tumor stage, X4 was Alb). The receiver operating characteristic curve (ROC) analysis showed that the area under the curve (AUC) of this prediction model was 0.810 (S.E.=0.056, 95%Cl=0.700-0.921,P=0.000) and the best cut off value was 7.500 scores. Conclusion The prognosis of patients with primary liver cancer and portal vein tumor thrombus is co-related with their liver function, Alb level, tumor stage and tumor diameter. The established preoperative prediction model is helpful in evaluating the patients’ prognosis and provide a reference for clinical practice.
    A clinical study on the efficacy of natural killer cell therapy on patients with malignant liver tumors
    LI Li, ZHOU Feng, WANG Xiao-jin, XU Yi-bing, SHI Li-qin, LI Zhen-yu, ZHOU Heng, FU Qing-chun, CHEN Cheng-wei
    2020, 25(10):  1055-1057. 
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    Objective To observe the safety and efficacy of natural killer (NK) cell transfusion in the treatment of malignant liver tumors. Methods Ten patients with malignant liver tumors that had been treated by operation, transcatheter arterial chemoembolization (TACE) or microwave ablation were enrolled in this study. They received transfusion therapy with NK cells derived from their immediate family. The safety and short-term efficacy of this treatment was evaluated by observing the patients’response to transfused allogeneic NK cells, and the changes of life quality (KPS score),liver and kidney function, blood routine, circulating tumor cells (CTC),overall remission rate, overall survival rate and other indicators before and after the treatment. Results (1) After allogenic NK cell transfusion, one patient developed chills with chest tightness at half an hour post cell infusion and received symptomatic treatment. After 15 minutes, the symptoms were relieved and the temperature rose to the highest of 39.9℃, accompanied by nausea and vomiting. After being treated with Metoclopramide and Tylenol, the symptoms gradually disappeared and there was mild muscle soreness at the next day. One case had insomnia. The mental, appetite and physical strength of 5 patients improved significantly;(2) The number of CTC measured at 24 hours after infusion in 10 patients was lower than that before transfusion and the difference was statistically significant (P< 0.05). There was no significant change in liver and renal function;(3) Patients were followed up for 3 ~ 36 months. According to the Response Evaluation Criteria in Solid Tumors (mRECIST:complete response=CR,partial response=PR,stable disease=SD;progressive disease=PD), the 3-month overall survival rate was 100%,effective response rate was 80%(no death,2SD,3PR, 5CR); the 6-month overall survival rate was 90%,effective Response rate was 80%(1 death,1PD,3PR,5CR);overall survival rate at 12 months was 80%,effective response rate was 60% (2deaths,2PD,3PR,3CR);overall survival rate at 36 months was 50%, and effective response rate was 30% (5 deaths,2PD,3CR). Conclusion NK cells transfusion in the treatment of malignant liver tumors has good clinical safety. The treatment may improve the short-term quality of patients’ life, improve clinical symptoms and thus has certain clinical value in the treatment of malignant liver tumors.
    Clinical study of cold cycle microwave ablation combined with TACE in the treatment of primary liver cancer
    WU Jie, DONG Gang, LIU Ting-ting, SUN Lu-lu
    2020, 25(10):  1058-1061. 
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    Objective To study the clinical effect of cold cycle microwave ablation combined with transcatheter arterial chemoembolization (TACE) in the treatment of primary hepatocellular carcinoma (HCC). Methods There were 90 HCC patients included in the study, divided into the observation group (n = 45) and the control group (n = 45) by the random number table. The control group received TACE, and the observation group received TACE and cold cycle microwave ablation. Clinical efficacy, time of hospitalization, cost of hospitalization, pretreatment and posttreatment Short Form-36 (SF-36) score, and the occurrence of adverse reactions after treatment was compared between the 2 groups. Results The response rate and disease control rate of the observation group were 77.78% and 86.67, respectively, which were significantly higher than those of the control group (62.50% and 68.89%, P<0.05). The time and cost of hospitalization in the observation group were significantly more than those in the control group (P<0.05). The posttreatment SF-36 score in the observation group was significantly higher than pretreatment score and posttreatment score in the control group (P<0.05). There was no significant difference in the total incidence of adverse reactions between the 2 groups (P>0.05). Conclusion The cold cycle microwave ablation combined with TACE has significant efficacy in the treatment of HCC, which can effectively improve patients’ quality of life.
    Clinical application of liver imaging reporting and data system for CT and MRI to evaluate liver nodules
    MA Zhen-chu, JIANG Zhao-jie
    2020, 25(10):  1062-1064. 
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    Objective To investigate the value of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of liver nodules in patients with suspected hepatocellular carcinoma (HCC) by using liver imaging report and data system (LI-RADS). Methods From June 2016 to December 2019, 80 patients with suspected HCC (58 males and 22 females) with an average age of (55.4 ± 9.0) years were enrolled. The Youden’s index was calculated in receiver operating characteristic (ROC) curve to determine the diagnostic cutoff points of CT and MRI. The measurement data (x ± s) were analyzed by t-test, and the counting data (%) were analyzed by chi-square test. Results There were 71 HCC lesions and 37 benign lesions (9 hepatic hemangiomas, 11 focal nodular hyperplasia, 4 hamartomas and 13 inflammatory lesions) diagnosed by operation (n = 64) and CT-guided percutaneous biopsy (n = 16). The Youden's index of CT for LI-RADS (LR) 2-5, LR 3-5, LR 4-5 and LR-5 lesions were 0, 0.190, 0.354 and 0.096, respectively. The Youden's index of MRI for LR 2-5, LR 3-5, LR 4-5 and LR-5 lesions were 0, 0.042, 0.381 and 0.150, respectively. It was suggested that both CT and MRI have best diagnostic efficacy for LR 4-5 lesions. CT had lower sensitivity, higher specificity and lower accuracy than MRI (40.8% vs.73.2%, 94.6% vs. 64.9%, 59.2% vs. 70.4%, P< 0.05). There was no significant difference in the area under ROC curve between CT and MRI. Conclusion There were differences between CT and MRI in the diagnosis of suspected HCC lesions based on LI-RADS classification. Compared with CT, MRI has obvious advantages in the suspected HCC lesion diagnosis. Generally speaking, the diagnostic value of MRI is higher than that of CT.
    Evaluation of diffusion kurtosis imaging in diagnosing peritumoral infiltration in patients with hepatocellular carcinoma
    ZHAO Hai-yang, TANG De, JIANG Kai
    2020, 25(10):  1065-1067. 
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    Objective To evaluate the value of diffusion kurtosis imaging (DKI) in diagnosing the peritumoral infiltration of hepatocellular carcinoma. Methods Fifty-six cases of liver cancer patients admitted to our hospital from October 2017 to October 2019 were included as the liver cancer group, and 56 cases of healthy physical examination persons admitted during the same period were selected as control group. All of the them received DKI scanning. Liver cancer tissue, peritumoral liver parenchyma and distant liver parenchyma were examined in the liver cancer group, respectively, as group A, B and C. DKI parameters of the 4 groups were recorded. According to the clinical comprehensive diagnosis, patients with liver cancer were divided into peritumoral infiltration group (41 cases) and non-peritumoral infiltration group (15 cases). The value of DKI parameters in diagnosing the peritumoral infiltration of liver cancer was analyzed. Results The mean diffusivity (MD), radial diffusivity (Dr) and axial diffusivity (Da) of group A, B and C were significantly lower than those of control group, and fractional anisotropy (FA), axial kurtosis (Ka) and fractional anisotropy of kurtosis (FAk) were significantly higher than those of control group (P<0.05). The MD, Dr and Da of group A were significantly lower than those of group B and group C, and the FA of group A was significantly lower than that of group B (P<0.05). MD, Dr And Da in peritumoral infiltration group were significantly lower than those in non-peritumoral infiltration group, and Ka was significantly higher than that in non-peritumoral infiltration group (P<0.05). The area under the receiver operating characteristic curve of MD, Dr, Da and Ka were 0.749, 0.733, 0.720 and 0.685, respectively. Conclusion DKI has high value in diagnosing the peritumoral infiltration of liver cancer. MD, Dr, Da and Ka can be used as the focused parameters to diagnose peritumoral infiltration in liver cancer patients.
    The clinical characteristics and prognosis of hepatocellular carcinoma and combined hepatocellular-cholangiocarcinoma
    HOU Qing-zhu, XIONG Jing-ping, PENG Yuan-yuan
    2020, 25(10):  1068-1071. 
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    Objective To investigate the clinical characteristics and prognosis of hepatocellular carcinoma (HCC) and combined hepatocellular-cholangiocarcinoma (cHCC-CC). Methods From December 2014 to December 2017, 60 patients with HCC and 60 patients with cHCC-CC in our hospital were enrolled as HCC group and cHCC-CC group. The clinical data of the patients were collected. On the day of admission, 2 ml of elbow vein blood was collected to examine the levels of carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA). The receiver operating characteristic (ROC) curve was drawn to evaluate the value of related indexes in differential diagnosis for HCC and cHCC-CC. And the 2-year prognosis was compared between the 2 groups. Results The proportions of local infiltration, intrahepatic biliary ductal dilatation, portal vein involvement and tumor capsule in cHCC-CC group were significantly higher than those in HCC group (P<0.05). Serum CA19-9 level in cHCC-CC group was significantly higher than that in HCC group (P<0.05). There was no difference in serum CEA level between the 2 groups (P>0.05). The area under the ROC curve of serum CA19-9 for the identification of cHCC-CC and HCC was 0.735 (standard error = 0.046, P=0.000, 95% confidence interval = 0.644 ~ 0.825), and the optimal cut-off was 215.400 mIu/L. There was no significant difference in the 2-year tumor-free survival rate between the 2 groups (P>0.05). And the overall survival rate in the cHCC-CC group was significantly lower than that in the HCC group (P<0.05). Conclusion There were significant differences in the rates of local infiltration, intrahepatic biliary ductal dilatation, portal vein involvement and tumor capsule between HCC and cHCC-CC patients. And serum CA19-9 can be used as an important indicator to distinguish them. The prognosis of cHCC-CC patients is relatively poor.
    Safety and efficacy of hepatic artery embolization plus microwave ablation for special hepatocellular carcinoma less than 0.5 cm away from organs
    AN Jun-hai, SHENG Yin-hang, WEI Chun-miao, DUAN Guo-bin
    2020, 25(10):  1072-1075. 
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    Objective To investigate the therapeutic value of hepatic artery embolization plus microwave ablation in special hepatocellular carcinoma with the shortest distance between the lesion and organs less than 0.5 cm. Methods One hundred and ten patients with liver cancer in special sites treated in our hospital from May 2014 to May 2017 were selected. According to the location of the lesion, the patients were divided into adjacent diaphragm group (n = 38), adjacent heart group (n = 32) and adjacent gallbladder group (n = 40). Thirty-five patients with hepatocellular carcinoma in common sites admitted in the same period were selected as control group. All patients were treated with hepatic artery embolization combined with microwave ablation. Short-term efficacy of the 4 groups was compared, tumor specific growth factor (TSGF), albumin (ALB) and alpha-fetoprotein (AFP) levels in the 4 groups were detected before and after treatment, and complications were observed. Long-term prognosis was evaluated in the 4 groups after 2 years of follow-up. Results The overall remission rates of adjacent diaphragm group, adjacent heart group, adjacent gallbladder group and control group were 73.68%, 71.88%, 67.50% and 82.86%, respectively. There was no difference among the 4 groups (P>0.05). After treatment, TSGF and AFP decreased and ALB increased in the 4 groups (P<0.05), but there was no difference among the groups (P>0.05). There was no difference in complications rate, disease-free survival time, overall survival time and mortality among the 4 groups (P>0.05). Conclusion Hepatic artery embolization combined with microwave ablation is applicable to patients with liver cancer in special sites < 0.5 cm away from the viscera, with similar efficacy and safety in patients with liver cancer in special and common sites.
    Application value of helical tomography in SBRT therapy for hepatocellular carcinoma
    XUE Jian, CHEN Lu, WANG Rui, TANG Chen-hu
    2020, 25(10):  1076-1078. 
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    Objective To study the application value of helical tomotherapy (HT) in stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC). Methods A total of 92 patients with HCC admitted to our hospital were divided into 2 groups randomly, 46 cases in each group. The observation group was treated with SBRT by HT, while the control group was treated with SBRT by CyberKnife. The serum levels of aspartate aminotransferase, alanine aminotransferase, bilirubin and albumin were compared pretherapy and 4 weeks after treatment between the 2 groups. The occurrence of adverse reactions and follow-up results were analyzed. Results The total effective rate was 91.30% in the observation group and 93.48% in the control group, with no significant difference (P>0.05). Serum aspartate aminotransferase, alanine aminotransferase, bilirubin and albumin in the observation group were (53.52 ± 14.85) U/L, (44.96 ± 12.95) U/L, (10.98 ± 3.45) μmol/L and (37.02 ± 3.70) g/L 4 weeks after treatment, (51.78 ± 13.30) U/L, (42.36 ± 11.37) U/L, (10.63 ± 3.37) μmol/L and (37.67 ± 3.85) g/L before treatment, respectively. There was no significant difference in the observation before and after treatment (P>0.05). Serum aspartate aminotransferase, alanine aminotransferase, bilirubin and albumin in the control group were (54.05±15.47) U/L, (45.67±14.75) U/L, (11.67±3.20) μmol/L and (36.42±4.51) g/L after treatment. There was no significant difference between the 2 groups after treatment (P>0.05). The incidence of adverse reactions and 2-year cumulative survival rate were 21.74% and 78.26% in the observation group, 32.61% and 89.13% in the control group, respectively, with no significant difference (P>0.05). Conclusion SBRT applied by HT has similar short-term and long-term efficacy with SBRT applied by CyberKnife, and it is safe.
    Tumor markers, IGF-1 and risk factors in patients with primary liver cancer
    SHI Guang-ying, ZHOU Fang, WANG Hong-xia, XIE Jing-dong
    2020, 25(10):  1079-1082. 
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    Objective To investigate the levels of tumor markers and insulin-like growth factor 1 (IGF-1) in patients with primary liver cancer, and to determine risk factors for primary liver cancer. Methods There were 120 primary liver cancer patients treated in Xinjiang Production and Construction Corps Hospital, the First Affiliated Hospital of Xinjiang Medical University and Changji People's Hospital from June 2015 to December 2017 enrolled in the retrospective analysis, including 60 cases with diabetes and 60 cases without. Liver function, tumor markers, IGF-1 and insulin-like growth factor binding protein 3 (IGFBP-3) levels were detected in both groups. Multivariate logistic regression analysis was performed to analyze the risk factors for primary liver cancer. Results There was no significant difference in the levels of aspartate aminotransferase, alanine aminotransferase, total bilirubin, alpha-fetoprotein and carbohydrate antigen 19-9 between primary liver cancer patients with and without diabetes (P>0.05). The levels of IGF-1 and IGFBP-3 in patients with diabetes were significantly lower than those in patients without (P<0.05). Hepatitis B virus infection, alcohol consumption, diabetes, family history of malignant tumors and smoking were independent risk factors for primary liver cancer (P<0.05). Conclusion Diabetic patients have a higher risk of developing primary liver cancer.
    Relationship between contrast-enhanced ultrasound findings and differentiation degree of liver metastases from neuroendocrine tumors
    WANG Xue-wei, GUO Wei-hong, HUANG Xiao-yun, LI Bin
    2020, 25(10):  1083-1085. 
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    Objective To investigate the relationship between contrast-enhanced ultrasonography (CEUS) findings and differentiation of hepatic metastases from neuroendocrine tumors. Methods The clinical data of 140 patients with liver metastases from neuroendocrine tumors admitted to our hospital from May 2016 to May 2019 were retrospectively analyzed. According to the degree of differentiation, the patients were divided into highly differentiated group and moderately/poorly differentiated group.Quantitative analysis indexes of contrast-enhanced ultrasound (CEUS) were compared between the two groups, including peak intensity, rise time, peak time and average transit time, and the relationship between each index and differentiation degree was analyzed.The ROC curve was drawn to analyze the predictive value of each index to the degree of differentiation. Results Among 140 patients, 53 (37.86%) were highly differentiated and 87 (62.14%) were moderately or poorly differentiated.The peak intensity of middle/low differentiation group was higher than that of high differentiation group, and the rising time, peak time and average transit time of high differentiation group were significantly shortened (P<0.05).The area under the curve of peak intensity, rise time, peak time and mean passage time for predicting hepatic metastasis of neuroendocrine tumors was 0.657, 0.691, 0.798 and 0.643 respectively. Conclusion Comparing with the patients with liver metastasis from highly differentiated neuroendocrine tumors, the peak intensity of the patients with moderately or poorly differentiated tumors increased, and the rising time, peak time and average transit time were significantly shortened, and each index had a certain predictive value for the degree of differentiation.
    Other Liver Diseases
    Association between urinary tract infection and primary biliary cholangitis: a meta-analysis
    HUANG Li-juan, PENG Zi-heng, PENG Yu, ZHANG Xiao-mei, LIU Xiao-wei
    2020, 25(10):  1086-1089. 
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    Objective To systematically investigate relationship between the urinary tract infections and PBC from the perspective of evidence-based medicine. Methods PubMed, Embase, Web of Science, Cochrane library, China National Knowledge Infrastructure, Wangfang Database and VIP database were searched to for observational studies on association between association between the urinary tract infections and PBC. And then a meta-analysis was performed by using Review manager 5.3 software. Results A total of 7 studies involving 4197 cases of PBC group and 21237 cases of control group. There were 1538 patients with urinary tract infection in PBC group and 4197 patients in control group. A random effect model was used for overall analysis based on heterogeneity. The results showed that the incidence of urinary tract infections in the PBC group is higher compared with the control group (OR=1.50, 95% CI: 1.26 to 1.77, P<0.00001). By subgroup analysis by region, PBC group had significant increasing risk of UTIs compared to the control group in both North America (OR:1.34, 95% CI: 1.23 to 1.46, P<0.00001) and European (OR:1.79, 95% CI: 1.37 to 2.33, P<0.0001). Conclusion The risk of UTIs is higher in the PBC group than the control group. However, more rigorous clinical studies need to be designed to prove the causal relationship.
    Fibrinogen is an independent risk factor affecting the short-term prognosis of HBV-related acute-on-chronic liver failure
    JIANG Ling-ping, CHEN Ruan-qin, CHEN Ming-sheng
    2020, 25(10):  1090-1093. 
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    Objective To compare and evaluate the value of thromboelastogram(TEG)and coagulation indexes in predicting the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), and to analyze the independent risk factors affecting the short-term prognosis of HBV-ACLF. Methods A retrospective study was conducted on 117 patients with HBV-related ACLF treated in Mengchao Hepatobiliary Hospital of Fujian Medical University from May 2017 to January 2019. The indexes of TEG, blood coagulation, biochemistry and blood routine were collected; the differences of the above indexes between the survival group and the death group were compared; the independent risk factors of HBV-ACLF were analyzed by multivariate logistic regression; and the value of independent risk factors in evaluating the prognosis of HBV-ACLF patients was evaluated by ROC curve. Results The R value, K value, PT, INR, D-D, TBil, AST, Scr and HBV DNA load in the death group were significantly higher than those in the survival group〔death group VS survival group: R value is 6.60 ±3.86 vs 4.84 ±1.4, PT is 37.13 ±14.35 vs 24.60 ±6.67, INR is 3.40 (2.57-5.51) vs 1.84 (1.46-2.21), TBil is 5.32 (3.51-9.34) vs 1.78 (0.77-4.29), TBil is 366.20 (326.95-464.85) vs 218.45 (107.20-330.65)〕(all P<0.05), while the CI value, MA value, Angle angle, PTA, Fg and PLT levels in the death group were lower than those in the survival group(death group vs survival group: PTA is 24.69±12.72 vs 38.84±12.92、Fg is 1.04±0.51 vs 1.83±0.62、PLT is 108.88±45.60 vs 126.29±46.86)(all P<0.05). TBil (OR:0.993,95%CI:0.987~0.999) and Fg (OR:14.922,95%CI:2.302~96.741) were statistically significant variables affecting the short-term prognosis of HBV-ACLF patients. The AUC of 90-day survival rate of HBV-ACLF patients evaluated by TBil and Fg were 0.810 (95%CI:0.733~0.886) and 0.851 (95%CI:0.777~0.925). Conclusion Fg and TBil are independent risk factors for short-term prognosis in patients with HBV-ACLF, and Fg is effective in predicting the short-term prognosis of patients with ACLF.
    Effects of colonization of Clostridium difficile on hepatic biochemical indexes in elderly hospitalized patients
    YUAN Bao-yu, WU Qiang, ZHOU Cong, SHEN Fang
    2020, 25(10):  1094-1097. 
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    Objective To explore the impact of Clostridium difficile colonization on elderly hospitalized patients by analyzing the differences in laboratory indicators between Clostridium difficile colonized patients and non-colonized patients and detecting Clostridium difficile in fecal specimens of elderly hospitalized patients. Methods The fecal specimens of elderly inpatients over 60 years old from April to October 2019 in the hospital were collected for Clostridium difficile anaerobic culture, and the immunologic tests were carried out in 35 strains of positive cultures for glutamate dehydrogenase and toxins. The clinical data of patients were collected, and the influence of colonization of intestinal Clostridium difficile on hepatic biochemical indexes of the elderly was analyzed. Results 35 strains of Clostridium difficile were detected in 187 elderly hospitalized patients, the positive rate was 18.72%, and toxin-producing strains accounted for 82.86% (29/35).The colonization rate of Clostridium difficile in elderly hospitalized patients increases with age, and the proportion of abnormal hepatic biochemical indexes such as serum albumin, prealbumin, alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, total bile acid in colonized patients was higher than that in non-colonized patients(P<0.05). Conclusion Elderly hospitalized patients are susceptible to Clostridium difficile colonization. Clostridium difficile colonization may affect the liver and kidney function of elderly patients and increase the risk of Clostridium difficile infection, which increase the burden of treatment. It is recommended to strengthen the surveillance and screening of Clostridium difficile colonization in elderly hospitalized patients with low immune function and underlying disease.
    Analysis of clinical manifestations and influencing factors of invasive fungal infection in patients with chronic and acute liver failure
    DAI Jing, ZHU Cun-kui, SUN Xiu-yuan
    2020, 25(10):  1098-1100. 
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    Objective To analyze the clinical manifestations and influencing factors of invasive fungal infection (IFI) in patients with chronic and acute liver failure (ACLF). Methods From January 2017 to January 2019, 136 patients with ACLF (male 107 and female 29, 51.9 ±7.7 years old) were reviewed. ACLF meets the diagnostic requirements of the guidelines for diagnosis and treatment of liver failure (2012 edition). IFI meets the diagnostic requirements of "guidelines for diagnosis and treatment of invasive fungal infections in critically ill patients (2007)". The measurement data are expressed as (x?±s) or [M (P25 ~ P75)], t-test or Kruskal-Wallis H test comparison; count data are expressed as (%), chi-square test comparison. Results The causes of ACLF included hepatitis B virus infection in 78 cases (57.3%), alcoholic factors in 11 cases (8.1%), drug factors in 28 cases (20.6%), autoimmune factors in 12 cases (8.8%) and other factors in 7 cases (5.1%). There were 40 cases of diabetes (29.4%), 46 cases of hemodialysis (33.8%), 61 cases of history of antimicrobial use (44.9%) and 54 cases of invasive treatment or operation (39.7%). There were 62 patients with IFI in ACLF group and 74 patients in non-IFI group. There were significant differences in diabetes, hemodialysis, history of antimicrobial use, invasive treatment or operation and death between the two groups. 70 patients with ACLF survived as the survival group, and 66 patients died as the survival group. There were significant differences in hemodialysis, invasive treatment or operation, MELD score and the number of IFI cases between the two groups. Conclusion The prognosis of ACLF patients with IFI is poor. Patients should pay attention to blood glucose control, rational use of antibiotics, reduce or avoid the number of invasive treatment or operation.
    The value of routine ultrasound combined with LAMP 2 and ARFI in monitoring the degree of liver fibrosis in PBC patients
    CHANG Jun, ZHANG Wen-ting
    2020, 25(10):  1101-1104. 
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    Objective To analyze the value of conventional ultrasound combined with LAMP2,ARFI in monitoring the degree of hepatic fibrosis in patients with PBC. Methods The complete data of 96 patients with PBC diagnosed by liver puncture and pathology from February 2016 to April 2019 were analyzed retrospectively. in addition, 60 patients who underwent physical examination in our hospital were randomly selected as the control group. All the subjects were examined by routine ultrasound, the expression of LAMP2 was detected by immunohistochemistry, and the ARFI. of each group was detected also. Results The scores of ARFI,LAMP2 and ultrasound images in PBC patients were significantly higher than those in control group (P < 0.05). The results of F test showed that there were significant differences in ARFI,LAMP2 and ultrasound scores among PBC patients with different Child-Pugh grades. T test showed that ARFI,LAMP2 and ultrasound scores in patients with grade B Child-Pugh were significantly higher than those in patients with grade A. ARFI,LAMP2 and ultrasound scores in patients with Child-Pugh grade C were significantly higher than those in patients with grade A and B (P < 0.05). LAMP2, ARFI and ultrasound scores were positively correlated with Child-Pugh grade in patients with PBC (P<0.05). Conclusion Conventional ultrasound combined with LAMP2,ARFI can accurately evaluate the degree of hepatic fibrosis in patients with PBC, and has high diagnostic value.
    Study on the operative time of choledocholithiasis treated with LC after EST
    WANG Ming-feng, LI Guang-yao, JIA Li-meng, OU Yun-song
    2020, 25(10):  1105-1107. 
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    Objective To study the clinical effect of laparoscopic cholecystectomy (LC) at different stages after endoscopic sphincterotomy (EST) in patients with choledocholithiasis and cholecystolithiasis. Methods From July 2016 to July 2019, 165 patients with choledocholithiasis and cholecystolithiasis were enrolled in this study. All patients underwent EST before LC.According to the interval time between the two methods, the patients were divided into observation group (LC within 48-72 hours after EST, 82 cases) and control group (LC after 72 hours after EST, 83 cases).The operation time, bleeding volume during LC, total hospital stay and anal exhaust time after LC were observed. The conversion rate to laparotomy and the occurrence of complications were analyzed. The differences of neutrophil counts between the two groups were compared. Results The time of LC operation, the amount of bleeding during LC operation, the total time of hospitalization and the time of anal exhaust after LC operation in the observation group were significantly shorter than those in the control group (P<0.05).The rate of conversion to laparotomy in the observation group was 3.66%, significantly lower than 14.46% in the control group (P<0.05).There was no significant difference in the incidence of complications between the two groups (P>0.05).The number of neutrophils in gallbladder ampulla of observation group was significantly lower than that of control group (P<0.05). Conclusion LC is safe and feasible for patients with choledocholithiasis and cholecystolithiasis within 48-72 hours after EST. It can shorten the operation time, reduce intraoperative bleeding and reduce the conversion rate to laparotomy.