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Table of Content

    31 January 2021, Volume 26 Issue 1
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    Recognize, disclose and manage conflicts of interest to protect academic integrity
    CHEN Cheng-wei, REN Hong, NIU Jun-qi, HOU Jin-lin, JIA Ji-dong
    2021, 26(1):  1-2. 
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    Liver Failure
    Study on the expression of IL-6 in patients with hepatitis B virus related acute on-chronic liver failure and its impact on prognosis
    ZHOU Chao, ZHANG Ning, HE Ting-ting, WANG Yan, WANG Yao, ZHANG Jing-jing, WANG Xuan, FU Shuang-nan, LIANG Xiao-xiao, LI Xin, LI Jun, GONG Man
    2021, 26(1):  12-15. 
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    Objective To identify the association between IL-6 and liver impairment, and the impact of IL-6 on the prognosis of patients with hepatitis B virus related acute on-chronic liver failure (HBV -ACLF).Methods A total of 754 HBV - ACLF patients was included and analyzed the association between IL-6 level and indexes for liver impairment, and the impact of IL-6 on prognosis.Results IL-6 level was positively correlated with the international standardized ratio, total bilirubin, and MELD scores, and the correlation coefficients were 0.108, 0.143, and 0.173 (P<0.001), respectively. It was negatively correlated with platelet count, alanine aminotransferase, aspartate aminotransferase, and albumin, and the correlation coefficients were -0.160, -0.151, -0.129 (P<0.001). The patients at the early stage had lower IL-6 level than those at the mediate or late stages (P<0.001). The patients with 2 organ failures at least had higher level of IL-6 than those with no more than 1 organ failure (P=0.014). The 4-week and 48-week mortality rates in patients with high level of IL-6 (> 9.78 pg/ml) were significantly higher than those in patients with low level of IL-6 (≤9.78 pg/mL) (4 weeks: 17.2% vs 8.2%, P=0.002; 48 weeks: 33.7% vs 22.0%, P<0.001); after adjusting for age and MELD score, The HR were 1.93 (P=0.003), 1.47 (P=0.008), respectively.Conclusion IL-6 level is a promising candidate marker to reflect the severity of liver injury and to predict mortality in patients with HBV-ACLF.
    Viral Hepatitis
    The change of HBsAg positive rate among tibetan farmers in gamba county, Tibet within 2015 and 2020
    MIMA Lamu, ZHU Dan, BAI Sang, DA Zhen, CIREN Deji, CIWANG Quzong, ZHAXI Weise, MA Shi-wu
    2021, 26(1):  16-18. 
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    Objective To evaluate the change of HBsAg positive rate in Gamba County in 5 years after the implementation of Health Poverty Alleviation project for hepatitis B.Methods The positive rates of HBsAg were analyzed among the Tibetan farmers that were outpatients received physical examination and were inpatients in Gamba within 2015 and 2020.Results The positive rate of HBsAg among people who underwent physical examination in 2020 was significantly lower than that in 2015 (15.7% vs 20.0%, P=0.007), so was in the population aged less than 20 (1.6% vs 14.3%, P<0.001). The positive rate of HBsAg was 1.1% in children aged 5-14, while children aged 1-4 all showed negative for HBsAg. In addition, the HBsAg positive rates of Tibetan farmers in both outpatient and inpatient in 2020 were significantly lower than those in 2015 (15.0% vs 24.7%, P=0.001; 14.9% vs 26.4%,P=0.001).Conclusion After targeted prevention and treatment of hepatitis B infection under Health Poverty Alleviation project, the HBsAg positive rates of total Tibetan farmers and children population in Gamba County have been significantly decreasing in five years.
    The correlation between serum soluble E-cadherin expression and oxidative stress in patients with chronic hepatitis B
    XU Jun, XIE Guo-yan, HUANG Min
    2021, 26(1):  19-21. 
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    Objective To investigate the correlation between serum soluble E-cadherin expression and oxidative stress in patients with chronic hepatitis B.Methods Fifty-four HBsAg-positive patients that were diagnosed as HBV infection were selected in this study. They were divided into mild (16 cases), moderate (20 cases) and severe (18 cases) subgroups according to the severity of CHB. Twenty healthy subjects were also enrolled as the control group. The serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), sE-cadherin, glutathione (GSH), Malondialdehyde (MDA), NADPH oxidase 2 (NOX2), superoxide dismutase (SOD) and HBV DNA load were detected. The data were applied to Pearson correlation analysis. The influencing factors for the severity of CHB were analyzed by multivariate binary logistic regression.Results Compared with the control group, the serum levels of AST, ALT, sE-cadherin, MDA, NOX2 and HBV DNA were significantly increased [AST: (72.59±10.42), (107.59±8.24), (160.13±24.84) vs (28.51±4.67) U/L, ALT: (64.27±8.91), (118.43±15.37), (194.30±12.61) vs (24.18±5.64) U/L, sE-cadherin: (566.27±73.16), (671.51±80.43), (735.65±43.29) vs (309.51±43.28) pg/mL, MDA: (12.58±2.37), (17.35 ±3.51), (24.35±4.18) vs (7.59±0.83) nmol/mL, NOX2: (1837.25±106.25), (2766.52±428.14), (2766.52±428.14) vs (972.58±34.82) pg/mL, and HBV DNA: (42.27±8.37), (76.26±15.52), (101.64±8.94)log10 copies/mL, On the contrary, the levels of GSH and SOD significantly decreased [GSH: (9.92±1.58), (5.23±0.94), (3.77±0.51) vs (15.16±2.26) ng/mL, SOD: (140.75±15.26), (127.31±10.58), (97.35±10.94) vs (168.29±24.62) U/mL] in each CHB group, and changed accordingly with the aggravation of the disease (P<0.05). The serum levels of sE-cadherin were positively correlated with AST, ALT, HBV DNA, MDA and NOX2 (r=0.591, 0.538, 0.675, 0.527, 458, respectively, P<0.05), whereas negatively correlated with GSH and SOD (r=-0.499, -0.492, P<0.05). The result of multivariate analysis showed that sE-cadherin, HBV DNA and NOX2 were the influencing factors for severe CHB (P<0.05).Conclusion Serum sE-cadherin in patients with chronic hepatitis B viral infection increased with the severity of the disease, which was positively associated with the oxidative stress in the patients.
    A meta-analysis for the efficacy and safety of telbivudine and tenofovir in preventing mother-to-child transmission of hepatitis B virus
    DENG Yong, GUO Xia-li, LI Zhao-liang, ZENG Tao, TAO Xue-ping, HUANG Shui-gen, OU Shu-qiang
    2021, 26(1):  22-26. 
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    Objective To evaluate the treatment efficacy and safety of telbivudine (LDT) and tenofovir (TDF) for preventing mother-to child transmission in HBV DNA-positive pregnant women at their middle and late stages of pregnancy.Methods The literatures published by Chinese scholars from January 2010 to August 2019 on the comparative application of LDT and TDF to prevent HBV mother-to-child transmission in pregnant women at the middle and late stages of pregnancy were retrieved from CNKI, Wan Fang, Weipu, Pubmed, and CBM. meta analysis was performed on these studies using Rev. Man 5.0 software.Results One randomized control trial (RCT) and 9 cohort studies were recruited, with a total of 897 and 716 cases of pregnant women in LDT group and TDF group, respectively. The numbers of HBsAg positive cases at birth in these two groups were 11 and 2, respectively [OR=1.66, 95 % CI(0.76, 3.62), P=0.21]. There were no significant differences in the neonatal birth weight [OR=17.83, 95 % CI(-39.47±75.14), P=0.54], and the numbers of neonatal malformation [6(0.67 %) vs 1(0.14 %)].Conclusion Both LDT and TDF treatments for the middle and late stages of pregnant women with high HBV DNA load reduce the risk of mother-to-child transmission of HBV effectively and safely.
    A predictive analysis for the therapeutic effect of adding peginterferon to entecavir on chronic hepatitis B patients
    LIN Bin-bin, XIAO Zhi-hong, WANG Fei, RUAN Qing-fa, TANG Yu-jing, OUYANG Li-juan
    2021, 26(1):  27-32. 
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    Objective To analyze the curative effect of adding peginterferon α-2a to entecavir (ETV) for the treatment of chronic hepatitis B (CHB) patients and to explore the related indexes for the prediction of clinical cure.Methods Patients with CHB who had received ETV for at least one year and achieved HBV DNA negative were selected and treated with ETV in combination with peginterferon α-2a for 48 weeks, or extended the treatment to 72 weeks with a prolonged observation duration of 96 weeks. The HBsAg reduction ratio [(Baseline HBsAg- HBsAg in the Follow-up period of Treatment)/Baseline HBsAg] was calculated as a judgement of treatment efficacy.Results A total of 35 patients were included and divided into two groups, baseline HBeAg positive group (N=18 cases) and baseline HBeAg negative group (N=17 cases). There was no significant difference in baseline parameters between the two groups. Three patients withdrew from the study due to side effects, and 10 patients received interferon for 72 weeks. The HBsAg disappearance rates and HBsAg seroconversion rates of all patients were 1/32 (3.1%) and 0/32 (0) at week 48, 2/32 (6.3%),2/32 (6.3%) at week 72, 3/32 (9.4%),and 2/32 (6.3%) at week 96. At week 48, 72 and 96, the rates of HBsAg<1 IU/mL were 6/32 (18.8%), 8/32 (25.0%) and 6/32 (18.8%), respectively. At week 24, 48, 72 and 96, the medians of the HBsAg reduction ratios were 53.5%, 83.8%, 68.4% and 62.5%, respectively. When compared with the baseline HBeAg positive group, the HBsAg disappearance rate, HBsAg seroconversion rate, HBsAg reduction ratio in the baseline HBeAg negative group were all higher, but without significant difference. The average area under the receiver operating characteristic curve (ROC) for using the HBsAg levels at baseline, Week 24, Week 48 to predict HBsAg clearance, HBsAg<1 IU/mL and HBsAg<10 IU/mL at 48 weeks and 96 weeks was 0.927, which had a high predictive value. According to the analysis of ROC curve coordinates, when the baseline HBsAg was less than 1312 IU/mL, the probability of HBsAg<1 IU/mL at Week 48 and 96 was higher than zero; when the HBsAg level was less than 201 IU/mL at Week 24, the probability of HBsAg<10 IU/mL at Week 48 and HBsAg clearance at Week 96 was higher than zero; when the HBsAg level was less than 7.25 IU/mL at Week 48, the probability of HBsAg clearance at Week 96 was higher than zero. For the preponderant patients with baseline HBsAg<1500 IU/mL, the rate of patients with HBsAg<200 IU/mL at Week 24 was as high as 80%. For patients with baseline HBsAg<1 500 IU/mL and HBsAg<200 IU/mL at Week 24, the HBsAg clearance rates and HBsAg conversion rates were 1/12(8.3%) and 0/12(0) at Week 48, 3/12(25.0%) and 2/12(16.7%) at Week 96 respectively. The rates of patients with HBsAg<1 IU/mL at Week 48 and 96 were all 6/12(50.0%). The HBsAg reduction ratios were as high as 99.6% and 99.2% at Week 48 and 96, respectively.Conclusion No matter HBeAg positive or negative, a combined interferon therapy should be considered in CHB patients treated by entecavir to improve HBsAg serological response rate and even reach the goal of clinical cure. Patients with low HBsAg level (less than 1 500 U/mL) were the advantageous population. HBsAg<200 IU/mL at Week 24 of the combined therapy was a predictive factor for a better HBsAg decline. It is advocated to apply individualized treatment regime to CHB patients formulated by their response in order to achieve a clinical curative effect.
    Treatment effect of sofosbuvir combined with velpatasvir on patients with hepatitis C viral infection
    LIU Yang, XU Li, FENG You-cheng, JIANG Sheng-chang
    2021, 26(1):  33-36. 
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    Objective To determine the efficacy and safety of NS5B inhibitor sofosbuvir (SOF) combined with NS5A inhibitor velpatasvir (VEL) in the treatment of patients with chronic hepatitis C virus infection (CHC).Methods A total of 72 CHC patients received SOF/VEL 400/100 mg daily for 12 weeks, The patients were then tested for serum HCV RNA and liver function, including parameters of Alanine aminotransferase (ALT), Aspartate aminotransaminase (AST), total bilirubin (TBil). The safety of the medication was also evaluated.Results Serum AST, ALT and TBIL levels of the hepatitis C patients were significantly decreased after 4 and 12 weeks of SOF/VEL treatment (P<0.05). APRI index also significantly decreased at these time points (P<0.05). HCV RNA was below the detection limit in 42 patients (57%) after 2 weeks of antiviral treatment, and in 64 (89%), 69 (96%) and 70 patients (97%) after 4, 8 and 12 weeks of continued treatments, respectively. High sustained virologic response (SVR) rates were achieved in 18 patients with genotype 2a (100%), 43 patients with genotype 1b (97%), and 6 patients with genotype 3 (75%) at the end of 12 weeks' treatment (SVR12). respectively. Adverse reactions were reported in 46 (64%) patients during the treatment, which were most commonly headache, fatigue, nausea, cough and other mild symptoms.Conclusion SOF/VEL treatment is effective in patients with genotypes 1b, 2a and 3 HCV infection. The medication also has significant early efficacy, low incidence and mild adverse reactions, and high clinical safety.
    Liver Fibrosis & Cirrhosis
    Clinical study on peritoneal lavage combined with intraperitoneal injection of antibiotics in the treatment of cirrhosis patients with spontaneous peritonitis
    LIANG Dong, BIAN Xu-qiang, ZHANG Din
    2021, 26(1):  37-40. 
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    Objective To investigate the clinical effect of intraperitoneal catheterization and lavage combined with intraperitoneal injection of antibiotics in the treatment of spontaneous peritonitis (SBP) of liver cirrhosis.Methods Seventy-three patients with cirrhosis and SBP from June 2016 to June 2019 in our hospital were randomly divided into a treatment group and a control group. The control group was treated with intravenous drip infusion of antibiotics, while the treatment group was treated with intraperitoneal catheterization and lavage combined with intraperitoneal injection of antibiotics on the basis of the control group. The course of treatment was 14 days. The symptoms and signs (fever, abdominal pain, abdominal distention, abdominal tenderness and rebound pain, etc) were observed before and after treatment. The liver function indexes (alanine aminotransferase, aspartate aminotransferase, total bilirubin) and inflammation indexes (white blood cell count, procalcitonin and C-reactive protein) were recorded before and after treatment.Results In the treatment group, the remission time of clinical symptoms and signs were shorter than the control group (P<0.05). The liver function and inflammatory indexes improved more than the control group (P<0.05). The efficacy rate and total effective rate of the treatment group were higher than those of the control group (P<0.05).Conclusion Intraperitoneal catheterization and lavage combined with intraperitoneal injection of antibiotics can significantly alleviate the clinical symptoms and signs of SBP, and improve the liver function and inflammatory indicators, with high treatment efficacy.
    Analysis of the correlation between APRI and portal vein pressure in patients with liver cirrhosis
    ZUO Chen-yan, SUN Lian-qin, LIU Cheng, YANG Wei, CHENG Wen-fang
    2021, 26(1):  41-43. 
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    Objective To evaluate the correlation between aspartate aminotransferase to platelet ratio index (APRI) and portal vein pressure (PVP) in patients with liver cirrhosis, and to investigate the diagnostic value of APRI for portal hypertension.Methods The patients with cirrhosis and portal hypertension who underwent transjugular intrahepatic portosystemic shunt (TIPS) in the Department of Intervention in our hospital from August 2015 to June 2019 were selected, and their APRI and PVP were measured.Results There were 54 patients enrolled in the study, with an median age of 56 years (range 26-74 years), and 64.8% of them were males. The etiology of cirrhosis was virus in 30 (55.6%), alcohol in 3 (5.6%), and others in 21 (38.9%). The median of PVP was 40 cmH2O (range 16-61 cmH2O). The median of APRI was 1.255 (range 0.08-4.72). There was significant positive correlation between PVP and APRI (Spearman's rho=0.356, P=0.008). Area under the receiver operating characteristic curve of APRI for predicting high portal pressure (PVP>30 cmH2O) was 0.881(P=0.001, 95% confidence interval: 0.756-1.000). APRI ≥ 0.81 was 78.7% sensitive and 85.7% specific in predicting PVP>30 cmH2O, with positive predictive value of 97.4%, negative predictive value of 37.5%, and diagnostic accuracy of 79.6%.Conclusion APRI correlates positively with PVP in patients of liver cirrhosis. APRI ≥ 0.81 has an acceptable accuracy for the prediction of high portal pressure and APRI can be used as a serum marker for noninvasive diagnosis of portal hypertension.
    Evaluation of liver fibrosis in patients with chronic hepatitis B complicated with nonalcoholic fatty liver disease by transient elastography
    FENG Shao-yang, LI Guang-ming, SU Hang
    2021, 26(1):  44-46. 
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    Objective To evaluate transient elastography in the evaluation of liver fibrosis in patients with chronic hepatitis B (CHB) complicated with non-alcoholic fatty liver disease (NAFLD).Methods A total of 144 patients with CHB complicated with NAFLD between January 2015 and January 2020 were selected. There were 98 males and 46 females with an average age of (41.5±8.5) years.The measurement data were compared by independent t-test, and the counting data were compared by chi-square test. The subjects' working characteristic curve (ROC curve) was drawn by MedCalc 15.1 statistical software, and the area under the curve (AUC), was calculated by Z test. Spearman correlation analysis was used to compare the correlation between LSM and clinical data. The independent predictive factors are screened by multiple linear regression analysis, and the independent predictive factors are analyzed by multiple linear regression analysis, and the regression model is established.Results 144 patients with CHB complicated with NAFLD, there was significant difference among the stages of hepatic fibrosis in F0 stage, kPa, F1 stage, kPa, F2 stage, kPa, F3 stage, kPa, F4 stage and kPa, stage. The value of AUC in F4 stage was significantly higher than that in ≥ F2 stage and ≥ F3 stage, and the difference was statistically significant (P<0.05). The cutoff point, sensitivity, specificity and AUC of LSM for diagnosis of F4 liver fibrosis were 12.4 kPa, 97%, 90% and 0.92, respectively. Spearman correlation analysis showed that age, AST, Alb, TBil, ALP, PLT, PT, HA, LN, C Ⅳ were significantly correlated with the stage of liver fibrosis. Multiple linear regression analysis was carried out with the LSM value as the dependent variable and the above indexes as the independent variable. TBil, Alb, PT and C IV were independent predictors of LSM. The regression equation was Y (LSM) =-30.6+0.21×TBil-0.14×Alb+ 0.27×PT+0.17×CⅣ, and the regression model was statistically significant.Conclusion The detection of LSM by FibroScan is of high value in the diagnosis of liver fibrosis in patients with CHB complicated with NAFLD.
    Vinculin promotes hepatic stellate cells activation in mice
    ZOU Yun-han, CUI Hui-qing, QIU Ying-chen, LI You-di, LONG Zi-xin, CAO Zhi-ming, MA Ning-fang, LIU Shan-shan
    2021, 26(1):  47-50. 
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    Objective To investigate the expression and effect of Vinculin in the mouse model of liver fibrosis.Methods Twenty-five adult male mice were randomly divided into a control group (n=10) and an experimental group (n=15). The experimental group was subcutaneously injected with carbon tetrachloride (CCl4)-corn oil mixture (6ml/kg mass) 2 times/week, and the control group was subcutaneously injected with corn oil at the same dose. After 8 weeks of modeling, the changes of liver structure were observed through the tissue of middle liver lobe using HE staining and Masson staining. The expression and cell localization of desmine and Vinculin in the liver were detected by immunohistochemistry. Vinculin were knocked down in human hepatic stellate cell line LX-2 by transient transfection of small interfering RNA. Quantitative real-time polymerase chain reaction (qPCR) and Western Blot was performed to investigate the impact of knocking down Vinculin on desmin and alpha SMA expression. The content of type Ⅰ collagen fiber after knocking down Vinculin was detected by enzyme-linked immunosorbent assay.Results After 8-week CCl4 treatment, collagen fibers increased in the portal and perilobular areas, and pseudolobule formation was observed. The immunohistochemistry showed that the number of desmin and Vinculin positive cells increased in the experimental group compared with the control group with significant differences (P<0.05), and that Vinculin was specifically expressed on the membrane of activated stellate cells. The qPCR showed that the expression of desmine and alpha SMA decreased after knocking out Vinculin with significant differences (P<0.05), and that the content of type I collagen fiber didn't decrease significantly.Conclusion Vinculin mediates the activation of hepatic stellate cells.
    Liver Cancer
    Efficacy and safety of TACE and nanoparticles in the treatment of portal hypertension in early-stage liver cancer
    FANG Qi-lou, NI Jian-xun, FAN Hong-xing, JIN Ge
    2021, 26(1):  51-54. 
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    Objective To investigate the clinical efficacy and safety of transarterial chemoembolization (TACE) combined with nanoparticles in the treatment of early-stage liver cancer complicated by portal hypertension.Methods Ninety-eight patients with early-stage liver cancer complicated by portal hypertension treated in our hospital from February 2013 to January 2018 were selected and divided into TACE group (45 cases) and combination therapy group (TACE combined with nanoparticle therapy, 53 cases). The efficacy of treatment, cancer recurrence rate and postoperative complication rate were compared between the 2 groups. The liver function and tumor factor indexes were compared before and 1 month after surgery in the 2 groups.Results (1) The Objective response rate (ORR) and disease control rate (DCR) were 58.49% and 86.79% in combination therapy group, 55.56% and 84.44% in TACE group, respectively. There was no statistical difference between the 2 groups (P>0.05). (2) There was no statistical difference in the levels of alanine aminotransferase or aspartate aminotransferase between the 2 groups before or 1 month after surgery (P>0.05). (3) There was no significant difference in carcinoembryonic antigen levels before or 1 month after surgery between the 2 groups (P>0.05). The level of vascular endothelial growth factor (VEGF) 1 month after surgery in combination therapy group was lower than that in TACE group (P<0.05). (4) The recurrence rates at 1 and 2 years after surgery in combination therapy group were lower than those in TACE group (P<0.05). (5) There was no significant difference in the rate of postoperative complications between the 2 groups (P>0.05).Conclusion TACE has good therapeutic effect on the early-stage liver cancer complicated by portal hypertension. Besides, nanoparticle therapy can significantly reduce the long-term recurrence rate after surgery. The reason may be that nanoparticle therapy can reduce the VEGF level in patients.
    Meta-analysis of clinical efficacy and safety of TACE combined with apatinib in the treatment of advanced liver cancer
    DUAN Rui-fang, YANG Dao-kun, WEI shuai
    2021, 26(1):  55-59. 
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    Objective To evaluate the efficacy and safety of TACE combined with apatinib in the treatment of advanced liver cancer.Methods A randomized controlled trial (RCT) was conducted on a computer from the establishment of the library to May 2019 for the study of TACE combined with apatinib and single TACE in the treatment of advanced liver cancer. The main search databases include Sciencedirect, Pubmed, Embase, and Cork. Lan Library, Wanfang Database, China Biomedical Literature Database, Chinese Science and Technology Periodical Database. Data extraction and literature quality assessment were performed according to the Cochrane systematic review method. Finally, the data was analyzed using Revman 5.3 software.Results After the search and analysis, there were 6 RCTs enrolled in a total of 308 patients. The Objective response rate (ORR) of these patients was 43.31% and 23.38%, respectively. The difference was statistically significant (P<0.000 01), the disease control rate (DCR) of TACE+apatinib group and TACE group were 78.95%, 52.60%, the former was significantly higher than the latter, P=0.02; and the TACE+apatinib group had higher Half-year, one-year, and two-year survival rates; Adverse reactions in the apatinib combination group were significantly higher than those in the TACE group alone. The adverse reactions were mainly hypertension, fever, proteinuria, etc., improved after symptomatic treatment, with no other serious adverse reactions.Conclusion According to the analysis, the clinical efficacy and safety of apatinib combined with TACE in the treatment of advanced liver cancer are obvious.
    Other Liver Diseases
    Comparing the prevalence of metabolic abnormalities between male individuals with alcoholic and non-alcoholic fatty liver disease
    JI Lei, FAN Jian-gao, LI Feng
    2021, 26(1):  60-63. 
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    Objective To compare the prevalence of metabolic abnormalities between individuals with alcoholic fatty liver disease (AFLD) and with non-alcoholic fatty liver disease (NAFLD).Methods The medical records from check-ups of male employees with ultrasound-diagnosed fatty liver disease in the Bao-Steel Group (Shanghai, China) were retrospectively analyzed. The prevalence of metabolic abnormalities, including obesity, hypertension, hypertriglyceridemia, hypercholesterolemia and diabetes mellitus, were compared between the individuals with AFLD and with NAFLD by multivariate logistic regression analysis. The clustering of multiple metabolic abnormalities (CMMA) was defined as having any three or more of metabolic abnormalities mentioned above, and its prevalence was also compared between two groups.Results The male individuals with AFLD (n=474) and with NAFLD (n=764) were identified. Obesity, hypertension, hypertriglyceridemia and diabetes mellitus in the individuals with AFLD were as prevalent as with NAFLD, but hypercholesterolemia was more prevalent in AFLD (OR = 1.469, 95%CI = 1.113-1.939, P=0.007). There was no significant difference in the prevalence of CMMA between two groups (OR = 1.270, 95%CI = 0.869-1.855, P=0.217). Both in the younger than 40 years old group and in the older than 60 years old group, there was no significant difference in the prevalence of CMMA between the individuals with AFLD and with NAFLD (54.3% vs. 46.2% and 79.6% vs. 75.7%, respectively, P>0.05 for both comparisons). But in the 40~60 years old group, CMMA was more prevalent in AFLD than in NAFLD (67.4% vs. 52.6%, P=0.001).Conclusion In these male employees, individuals with AFLD are similarly metabolically unhealthy as those with NAFLD. Hence, abundant efforts should also be made to identify and manage accompanying metabolic abnormalities in the treatment of AFLD.
    The value of transient elastography in evaluating the severity of liver fibrosis in non-alcoholic steatohepatitis
    GUO Yuan, ZHONG Yu-dong
    2021, 26(1):  64-66. 
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    Objective To explore the value of transient elastography in evaluating the severity of liver fibrosis in non-alcoholic steatohepatitis.Methods The research subjects selected 236 patients with non-alcoholic steatohepatitis admitted to our hospital from September 2018 to September 2019. According to the degree of liver puncture fibrosis, all patients were divided into 5 groups, which were group A (50 Cases), group B (47 cases), group C (52 cases), group D (44 cases), group E (43 cases). Liver stiffness (LSM) was detected using instantaneous elastic ultrasound imaging within 1 week of liver puncture. The LSM of 5 groups of patients was compared, and the relationship between LSM and the severity of liver fibrosis was analyzed. Draw the ROC of all patients. When calculating and evaluating the severity of non-alcoholic steatohepatitis liver fibrosis, the area under the curve (AUC), specificity and sensitivity were detected.Results Group A LSM was (5.14±1.51) kPa, Group B LSM was (7.42±1.48) kPa, Group C LSM was (9.34±1.63) kPa, Group D LSM was (11.82±1.66) kPa, Group E LSM was (13.61±1.65) kPa. The five groups of LSMs were ranked from low to high, followed by Group A, Group B, Group C, Group D, and Group E, and compared among the five groups, the difference between the groups was significant (P<0.05). Logistic linear regression was used to analyze the correlation between LSM and liver fibrosis stage, and it was found that LSM was positively correlated with liver fibrosis stage (r=0.712), and the difference was statistically significant (P=0.001). The AUC of group B, group C, group D and group E were 0.761, 0.871, 0.910, 0.932, the diagnostic cut-off values were 6.33 kPa, 7.78 kPa, 9.14 kPa, 10.93 kPa, and the specificity was 82.4%, 79.3%, 95.1%, 98.5%, and sensitivities of 73.1%, 76.3%, 88.2%, and 89.5%, respectively.Conclusion Transient elastography is of high application value when it is used to evaluate the degree of non-alcoholic steatohepatitis liver fibrosis, especially when it is applied to S3 and S4 liver fibrosis, its specificity and sensitivity are high.
    The expression and significance of serum omentin-1 and vaspin in nonalcoholic fatty liver disease
    SU Xiu-li, WANG Tong-sheng, ZHANG Ying-jian
    2021, 26(1):  67-70. 
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    Objective To investigate the circulating levels of omentin1, visceral adipose tissue-derived serine protease inhibitor(vaspin) in NAFLD patients and to clarify their relationship with biochemical parameters, interleukin-6(IL-6), and C reactive protein(CRP).Methods One hundred and eight patients with NAFLD (NAFLD group), confirmed fatty liver by B-ultrasound, 129 healthy controls as control group. Height, weight, waist circumference, body mass index (BMI), blood biochemistry, serum CRP, IL-6, omentin-1, vaspin and apelin levels were recorded.Results Compared with the control group, the levels of serum vaspin in the NAFLD group were increased, the levels of omentin-1 were decreased, and the levels of IL-6 and CRP were increased. The difference was statistically significant (P<0.05). The vaspin levels were directly proportional to WC, LDL-C, CRP, and IL-6 (r values were 0.231 to 0.341, both P<0.05); negatively correlated with HDL-C and omentin-1 (r values were -0.221, -0.246, respectively, both P< 0.05). Serum omentin-1 levels were negatively correlated with WC, CRP and IL-6 (r value was -0.238 to -0.319, both P<0.05), and positively correlated with HDL-C (r=0.326, P<0.05). Logistic regression analysis showed that omentin-1, vaspin, waist circumference, CRP, IL-6 were independent factors related to NAFLD in patients [β values were 1.471-2.012, OR (1.021-3.012), 95% CI (1.431-4.779), both P< 0.05].Conclusion In patients with NAFLD, levels of omentin-1, vaspin, IL-6, and CRP were different from those in the healthy group. Vaspin may be predictors of NAFLD, and omentin-1 may be a protective factor against the development of NAFLD. Its mechanism may be related to inflammatory factors. The specific mechanism needs further study.
    Clinical analysis of neonatal intrahepatic cholestasis caused by Citrin deficiency:report of 40 cases
    FANG Chun-xiao, CHEN Min-xia, YANG Feng-xia, TAN Li-mei, YE Jia-wei, XU Yi
    2021, 26(1):  71-74. 
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    Objective To analyze the main clinical manifestations, laboratory features and prognosis of neonatal intrahepatic cholestasis caused by Citrin deficiency (NICCD).Methods The clinical characteristics, genetic results and therapeutic outcomes of 40 children with NICCD were retrospectively analyzed, and the differences in the recovery of liver function indicators under different feeding modes were further analyzed.Results Children with NICCD had low birth weight (2.92±1.01) kg, with jaundice as the primary cause, accompanied by chubby face (31/40 cases, 77.50%), large liver (25/40 cases, 62.50%), large spleen (10/40 cases, 25.00%), and growth retardation (13/40 cases, 32.50%). Glutamate transaminase, direct bilirubin and γ-glutamyl transferase were all 100% increased, accompanied by changes of high lactic acid (37/40 cases, 92.50%), hypoproteinemia (36/40 cases, 90.00%), hypoglycemia (26/40 cases, 65.00%), anemia (18/40 cases, 45.00%), and abnormal organic acid analysis by blood tandem mass spectrometry and urinalysis gas chromatography-mass spectrometry. SLC25A13 gene analysis found that 8 types of mutations, The most common types were type I (37 / 40 cases, 92.50%), type III (10 / 40 cases, 25.00%), type X (9 / 40 cases, 22.50%), and homozygous mutations were mainly type I homozygous mutations (19 / 20 cases, 95.00%). After the change of feeding mode and other treatment, the disease of the children gradually alleviated, and the main liver function indicators of the children returned to normal in 1 month of treatment 54.80% (17/31 cases), and in 1 year of treatment 97.50% (39/40 cases). Further analysis showed that the recovery of liver function indexes in the lactose free and MCT fortified formula feeding group was better than that in the lactose free formula feeding group after 2 weeks of treatment.Conclusion For children with cholestasis who conform to the main clinical manifestations of NICCD, genetic testing and early diagnosis should be improved as soon as possible, and treatment such as lactose free and intensive MCT formula feeding should be given. The change of feeding pattern is crucial to the recovery of the disease.