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Table of Content

    31 May 2021, Volume 26 Issue 5
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    Liver Fibrosis & Cirrhosis
    An analysis of the possible causes of low liver stiffness measurement in patients with esophageal and gastric varices bleeding
    BAI Yan-feng, HE Ling-ling, WEI Hong-shan
    2021, 26(5):  490-493. 
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    Objective To investigate the possible causes of low liver stiffness measurement in patients with esophageal and gastric varices bleeding.Methods The clinical data of 29 patients with liver stiffness measurement less than 12kPa and 37 patients with liver stiffness measurement greater than 17.5kpa who visited Beijing Ditan Hospital due to esophageal and gastric varices rupture bleeding from January 2017 to October 2019 were retrospectively analyzed. The differences of liver function, portal hemodynamic indicators, etiology and complications between these two groups of patients were compared. Results Compared with the patients in the group of liver stiffness measurement ≤ 12kPa, patients in the group of liver stiffness measurement≥ 17.5kPa had significantly lower levels of albumin (Alb)(Z=-3.05, P=0.002), cholinesterase (CHE)(Z=-3.81, P=0.000), Prothrombin activity (PTA)(Z=-2.34, P=0.019), platelet (PLT) count(Z=-2.29, P=0.022), and significantly higher Child-Puch (CHILD) scores (Z=-2.41, P=0.016), levels of aspartate aminotransferase(AST)(Z=-2.33, P=0.020)and aspartate aminotransferase(Cr)(Z=-1.97, P=0.048), prolongation of prothrombin time(PT)(Z=-2.88 ,P=0.004)and International Normalized Ratio(INR)(Z=-2.15, P=0.031). The etiologies of patients in the LSM≤ 12kPa group was mainly idiopathic portal hypertension (34.4%) and hepatitis B viral infection (44.8%), while in the LSM≥ 17.5kPa group were mainly hepatitis B virus infection (40.5%) and alcoholic (32.4%). The difference of etiological composition ratio was statistically significant (χ2=11.3, P=0.023). The difference in developing complications and the rate of ascites between these two groups had no statistical significance (χ2=0.695, P=0.405, χ2 = 2.363, P=0.124).Conclusion Esophageal and gastric varices bleeding is not always caused by cirrhosis. It may also be due to idiopathic portal hypertension. The degree of portal hypertension and the risk of bleeding cannot be predicted by liver stiffness measurement alone.
    Diagnosis performance of simplified animal naming experiment on minimal hepatic encephalopathy
    WANG Na, DAI Fu, ZHENG Ji-shun, PENG Qiong, XU He-xiang, CHEN Li-xue
    2021, 26(5):  494-496. 
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    Objective To explore the application value of the simplified animal naming experiment (S-ANT) in the diagnosis of minimal hepatic encephalopathy (MHE).Methods 149 patients with liver cirrhosis who were hospitalized from August 2018 to June 2020 were selected as the experimental group. The basic information and laboratory indicators of these patients were collected within 48 hours after admission. The patients were divided into A, B, and C groups based on their Child -Pugh gradings. At the same time, 149 healthy medical examiners were selected as the control group. The Psychometric Hepatic Encephalopathy Score Test (PHES) was used as the gold standard for diagnosing MHE. The simplified animal naming experiment (S-ANT) were compared with PHES for screening the prevalence of MHE. Results By S-ANT screening 61 (40.94%) patients with liver cirrhosis were identified to complicate with MHE; The S-ANT score was the lowest among MHE patients (13.82±4.54), followed by grade 1 hepatic encephalopathy (HE) patients (14.33±2.94), patients without chronic hepatic encephalopathy (non-CHE) (18.99±4.61) and healthy control group (24.98±5.64), the comparison between the groups is statistically significant (P<0.05); S-ANT<17 is the best cut-off value for the diagnosis of MHE with a sensitivity of 80.3%, specificity of 67.0%, positive predictive value of 81.82%, and negative predictive value of 72.06%.Conclusion S-ANT is a more convenient and effective method for diagnosing MHE.
    Noninvasive prediction model for upper gastrointestinal bleeding in patients with hepatitis B related cirrhosis
    SHANG Lian-qin, YUE Dong-li, ZHU Bing-xi
    2021, 26(5):  497-501. 
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    Objective To study on the risk factors and to construct a noninvasive prediction model for upper gastrointestinal bleeding (UGB) in patients with hepatitis B related cirrhosis.Methods The clinical data of 255 patients with hepatitis B related cirrhosis admitted to the Affiliated Hospital of Xuzhou Medical University from January 2017 to June 2019 were collected. They were devided into two groups and studied by retrospective case-control method. 119 Patients with UGB were in the experimental group and 136 patients without UGB were in the control group. A non-invasive prediction model for UGB in patients with hepatitis B related cirrhosis was established through Logistic regression analysis. The receiver operating characteristic curve (ROC curve) of the prediction model with various indicators were drawn and the area under the curve (AUC) was calculated. Results It was shown that hepatocellular carcinoma, albumin, fibrinogen, leukocyte count, esophageal and gastric varices, platelet/spleen length were independent influencing factors for UGB in the model (P<0.05). The sensitivity and specificity of the risk factors-based model for screening UGB in hepatitis B related cirrhosis were 80.7% and 86.8%, respectively. The area under the ROC curve (AUC) was 0.904 (0.867 ~ 0.941), which was better than any other single index.Conclusion The established non-invasive prediction model based on six independent influencing factors in this study has good accuracy for UGB, which warrants further verification and model tuning.
    The application single energy imaging of energy spectrum computed tomography and metal artifact reduction algorithm in the angiography of patients with liver cirrhotic portal hypertension after transjugular intrahepatic portosystemic stent shunt treatment
    SHAN Qin-xing, ZHANG Xiao-dong, WANG Xi
    2021, 26(5):  502-504. 
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    Objective To explore the application value of single energy imaging of energy spectrum computed tomography (CT) and metal artifact reduction algorithm (MAR) in the angiography of patients with liver cirrhotic portal hypertension after transjugular intrahepatic portoystemic stent shunt (TIPSS) treatment.Methods A total of 127 patients with liver cirrhotic portal hypertension who were admitted to affiliated hospital of Nantong University from May 2018 to May 2019 were selected. All the patients received TIPSS after admission and underwent single-energy imaging of energy spectrum CT examination at one month after the treatment. The images were processed by MAR method. The artifact index (AI) of 60keV, 120keV, 120kV-like, 60keV+120keV, 120kV-like +keV images were calculated, and the images were then reviewed by two experienced radiologists. The anatomical structure clarity, artifact suppression, and overall image quality of the images were evaluated by 5 grade scoring method, and the differences in image quality scores of different images were compared. Results The AI values of the images of 0keV, 120keV, 120kV-like, 60keV+120keV and 120kV-like +keV were (33.51±6.87), (17.42±2.90), (26.43±4.71), (24.12±3.44) and (21.50±3.13), respectively, and the differences were statistically significant (P<0.05).The anatomical clarity scores of 120keV and 60keV+120keV images were significantly higher than those of 60keV, 120kV-like and 120kV-like +keV images (P<0.05). Artifact inhibition and overall image quality scores of 60keV+120keV images were significantly higher than those of 60keV, 120keV, 120kV-like and 120kV-like +keV images, all with P<0.05.Conclusion In patients with portal hypertension due to cirrhosis, MAR image processing can eliminate postoperative artifacts when performing single-energy imaging of energy spectrum CT examination after TIPSS treatment, in which 60keV+120keV can eliminate image artifacts while clearly show the vascular condition.
    The value of endoscopic ultrasonography in evaluating collateral circulation and predicting esophageal varices in patients with liver cirrhosis
    DU Ju-jie, ZHENG Hong, LI Jin
    2021, 26(5):  505-509. 
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    Objective To study on the value of endoscopic ultrasonography (EUS) in evaluating esophageal collateral circulation and predicting esophageal varices (EV) in patients with liver cirrhosis.Methods 76 patients with liver cirrhosis collected from January 2018 to January 2020 were investigated in the study. All patients had received EUS examination and recorded for the diameters and numbers of para-esophageal collateral veins (para-ECV) and peri-esophageal collateral veins (peri-ECV). The patients were divided into observation group (cirrhosis with EV) and control group (cirrhosis without EV) according to whether they were accompanied by EV. Logistic multivariate analysis was used to analyze the independent influence factors of liver cirrhosis with EV. A predictive model was established based on the results of the multi-factor analysis. Receiver operator characteristic (ROC) and the area under the curve (AUC) were used to analysis and verify the value of this model in predicting EV risk. Results Among the 76 patients, 32 cases (42.1%) were accompanied by EV. Within them, 18 cases were mild, 10 cases were moderate, and 4 were severe in EV. The EVs with mild and moderate cirrhosis accounted for 87.5%. The para-ECV and peri-ECV diameters of patients in the observation group (19 and 21 severe cases, respectively) were significantly larger than those in the control group, which were significantly more than the control group (15 and 14 severe cases, respectively) (P<0.05). There were 23 cases in the observation group who had lesions ≥5, which was significantly more than that in the control group (19 cases) (P<0.05). The Logistic multivariate analysis results showed that the antiviral therapy (β=-0.393, 95%CI=0.479-0.951, OR=0.675, P=0.025), para-ECV diameter (β=1.664, 95%CI=3.412-8.174, OR =5.281, P=0.000), peri-ECV diameter (β=0.658, 95%CI=1.454-2.562, OR=1.930, P=0.000) and the number of lesions (β=2.082, 95%CI=1.167-55.034, OR=8.014, P=0.034) were independent factors affecting EV. The ROC analysis results showed that without antiviral therapy (AUC=0.655, 95%CI=0.530-0.780, P=0.022), peri-ECV (AUC=0.693, 95%CI=0.572-0.814, P=0.004), para-ECV (AUC=0.651, 95%CI=0.525-0.776, P=0.026) and the number of lesions (AUC=0.678, 95%CI=0.555-0.801, P=0.009) had certain application value for predicting EV in liver cirrhotic patients. The prediction model based on the logistic multi-factor analysis was then established as: Y=0.465-0.393X1+0.658X2+1.664X3+2.082X4. It was shown by ROC analysis that the AUC value of the EV was 0.802 (SE=0.050, 95%CI=0.704-0.900,P=0.000), the sensitivity was 0.938 and the specificity was 0.545. The Hosmer-Lemeshow goodness-of-fit test results showed that there was no statistically significant difference between the actual observation results and the expected results of EV (χ2=0.154, P=0.695).Conclusion EUS examination is helpful in assessing the status of esophageal collateral circulation in patients with liver cirrhosis. The prediction model established on EUS examination has high accuracy for the risk of EV.
    A study on the therapeutic effect of stem cells from human exfoliated deciduous teeth on a mouse model of liver cirrhosis
    LU Guan-zhu, BAO Yu-jie, BAI yu-pan, YAN Lei, XU Jie
    2021, 26(5):  510-513. 
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    Objective To evaluate the therapeutic effect of stem cells from human exfoliated deciduous teeth (SHED) on a mouse model of liver cirrhosis.Methods A mouse model of experimental liver cirrhosis was induced by introperitoneally injection of CCl4. SHED and normal saline solution were injected through the tail veins in the experimental group and the control group per week, respectively. After 4 weeks injection, liver function and liver pathological manifestations of the mice were evaluated. Results The total bilirubin (4.73±0.06 μmol/L vs 6.27±0.50 μmol/L, P=0.038), alanine aminotransferase (48.33±5.13 U/L vs 64.33±3.06 U/L, P=0.0097), aspartate aminotransferase (107.67±17.56 U/L vs 149.00±7.55 U/L, P=0.020) and alkaline phosphatase (142.00±28.93 mmol/L vs 240.00±30.51 mmol/L, P=0.0156) of the SHED group were significantly recovered than those of the control group. The body weight (25.80±1.02 g vs 22.86±0.97 g,P=0.0016) and liver weight (2.16±0.11 g vs 1.88±0.15 g, P=0.0101) of the SHED group regained as well. Meanwhile, the pathological manifestation of liver tissues after SHED treatment was obviously reversed in mice of the SHED group.Conclusion In CCl4 induced mouse model of liver cirrhosis, both the liver functions and pathology manifestations were significantly improved after SHED treatment, which indicated that SHED had a promising therapeutic effect on liver cirrhosis.
    Liver Cancer
    Detection and clinical significance of mitochondrial DNA content in peripheral blood mononuclear cells of patients with primary liver cancer
    LIAO Xin-ai, FENG Hui-juan, ZHUO Chuan-shang, YE Zhi, LIU Li-juan
    2021, 26(5):  514-517. 
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    Objective To investigate the clinical significance of mitochondrial DNA (mtDNA) content in peripheral blood mononuclear cells (PBMC) in the diagnosis of primary liver cancer (PLC).Methods The whole blood samples, clinical data and laboratory indexes of 250 PLC patients (test group) and 48 healthy individuals (control group) were collected. The PBMC were isolated by FicollHypaque centrifugation. The gene content of NADH dehydrogenase subunit 1 (ND1) in mitochondria was detected by quantitative real-time polymerase chain reaction, and the β-globin of nuclear genome was amplified simultaneously as the internal reference. The mtDNA content in PBMC were compared between 2 groups, and the diagnostic efficacy of mtDNA, alpha-fetoprotein (AFP) and mtDNA combined with AFP were analyzed by receiver operating characteristic curves.Results The mtDNA content in PBMC of liver cancer patients (90.51) was significantly lower than that of control group (456.67). The area under the curve (AUC) (0.884) and sensitivity (75.20%) of mtDNA were slightly higher than those of AFP (0.866, 71.70%). The AUC of mtDNA combined with AFP in the diagnosis of PLC was 0.957, significantly higher than that of mtDNA and AFP alone. And the sensitivity increased to 84.91% when the 2 markers were combined.Conclusion The content of mtDNA in PBMC can be used as an auxiliary indicator in the diagnosis of liver cancer.
    The diagnostic value of G-test in the early screening for primary hepatocellular carcinoma
    YANG Xue, LU Guan-zhu, DU Cheng-kan, WANG Bo-cheng, XU Jie, BAO Yu-jie
    2021, 26(5):  518-521. 
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    Objective Early diagnosis is of vital clinical significance in promoting survival in patients with primary hepatocellular carcinoma (HCC). Alpha-fetoprotein (AFP) has been widely applied in the diagnosis of primary HCC, but its sensitivity and specificity are unsatisfactory. Therefore, it is necessary to identify novel diagnostic biomarkers to improve the diagnosis efficacy.Methods Patients with clinically diagnosed HCC or at high risk of HCC in our hospital from January 2019 to August 2019 were enrolled. The diagnostic value of AFP, oligosaccharide chain detection (G-test), and their combination for HCC was analyzed.Results A total of 73 patients were included. Among them, 30 HCC patients were confirmed by pathology or imaging combined with AFP. The area under the receiver operating characteristic curve (ROC-AUC) of G-test was 0.701, and the ROC-AUC of AFP was 0.680. There was no significant difference in the sensitivity between them (P=0.7648). Furthermore, the ROC-AUC of the combination of G-test and AFP was 0.671. The sensitivity and the specificity of the combination were 90.0% and 93.0%, which were significantly higher those of AFP alone.Conclusion G-test combined with AFP could improve diagnostic yield for HCC.
    Prognostic biomarkers of hepatocellular carcinoma identified by bioinformatics
    HE Chun-mei, MO Zhi-jing
    2021, 26(5):  522-526. 
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    Objective To investigate new prognostic biomarkers of hepatocellular carcinoma (HCC) through bioinformatics.Methods The differentially expressed genes (DEGs) in the GSE14520 data set were screened by GEO2R, a protein-protein interaction (PPI) network was constructed by STRING, and key genes were screened out by Cytoscape software. GO and KEGG analyses were performed in DAVID database. Then GEPIA was used to analyze the expression levels of key genes in HCC and their relationship with prognosis.Results A total of 348 DEGs were screened out, including 91 up-regulated genes and 257 down-regulated genes. The top 2 network modules were screen out from the PPI: module 1 and module 2. There were 46 key genes in the center area of the network in the 2 modules. Key genes were significantly enriched in signaling pathways such as cell cycle, DNA replication and drug metabolism. It was verified by GEPIA that PROZ and F9 were significantly under-expressed in HCC patients, and were associated with a decrease in the overall survival rate and disease-free survival rate of HCC patients.Conclusion PROZ and F9 can be regarded as potential prognostic biomarkers for HCC.
    Effect of water isolation technology in MWA treatment for primary liver cancer on the 3-year prognosis of patients
    WANG Chuang-sheng, SUN Jie, SHI Jia
    2021, 26(5):  527-529. 
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    Objective To investigate the impact of water isolation technology in percutaneous microwave ablation (MWA) in the treatment for primary liver cancer (PLC) on the 3-year prognosis of patients.Methods One hundred and eight PLC patients admitted to our hospital from July 2019 to 2020 were included and divided into 2 groups according to different treatment methods. The MWA group (n=55) was treated with MWA, and the water isolation + MWA group (n=53) was treated with MWA combined with water isolation technology. The clinical efficacy and postoperative complications were compared between 2 groups. The levels of serum alanine aminotransferase, aspartate aminotransferase, carbohydrate antigen 242 and carbohydrate antigen 19-9 were compared before and after treatment in 2 groups. Moreover, the patients were followed up for 3 years after discharging from hospital, and the 3-year survival rate of the 2 groups was calculated.Results The effective rate and disease control rate of the water isolation + MWA group were significantly higher than those of the MWA group (85.45%, 94.55% vs 69.81%, 81.13%, P<0.05). The serum indexes of the water isolation + MWA group after treatment were significantly lower than those before treatment (P<0.05), and significantly lower than those after treatment in the MWA group (P<0.05). There was no significant difference in the incidence of complications between the 2 groups (7.27% vs 11.32%, P>0.05). During the 3-year follow-up period, 6 patients in the water isolation + MWA group and 5 patients in the MWA group were lost. The 3-year survival rate of the water isolation + MWA group and the MWA group were 67.35% (33/49) and 41.67% (20/48), respectively, and there were statistical differences between 2 groups (P=0.004).Conclusion Water isolation technology in MWA treatment can improve clinical treatment efficacy and long-term prognosis of PLC patients.
    The influence of different degrees of cirrhosis on the prognosis of patients with hepatitis B virus-associated hepatocellular carcinoma
    SHEN Yu, WAN Wei, LI Quan-xi, WU Xing-xing
    2021, 26(5):  530-533. 
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    Objective To investigate the influence of different degrees of cirrhosis on the prognosis of the patients with hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC).Methods One hundred and eight patients with HBV-HCC from January 2016 to October 2020 were enrolled as the research subjects. The survival rate was calculated. The levels of clinicopathological characteristics of patients with different degrees of cirrhosis were compared. The relationship between the degree of cirrhosis and prognosis was analyzed.Results During 2- to 56-month follow-up, 26 of the 108 patients died. The survival rate was 75.93%. The prognosis of patients with different degrees of liver cirrhosis was significantly different (P<0.05). There were significant differences in tumor differentiation, vascular invasion and tumor staging among patients with different degrees of cirrhosis (P<0.05). The Cox multivariate regression model showed that the differentiation degree [95% confidence interval (CI) = 1.859~4.887, hazard ratio (HR) = 3.014, P<0.001], vascular invasion (95%CI=1.075~7.403, HR=2.821, P=0.035), tumor stage (95%CI=1.602~3.867, HR=2.489, P<0.001), treatment plan (95%CI=1.462~2.971, HR=2.084, P<0.001) and the degree of cirrhosis (95%CI=1.118~1.580, HR=1.329, P=0.001) were independent factors for the prognosis of HBV-HCC. According to Cox analysis, the prediction model was as follows: Y2=1.103×X1+1.037×X2+0.912×X3+0.734×X4+0.284×X5 (X1=degree of differentiation, X2 = vascular invasion, X3 = tumor stage, X4 = treatment, X5 = degree of cirrhosis). Area under the curve (AUC) of the model to predict the prognosis was 0.840 (sensitivity = 0.042, 95%CI = 0.758-0.922, P<0.001).Conclusion The degree of liver cirrhosis in patients with HBV-HCC is closely related to the prognosis, and the prediction model based on the degree of liver cirrhosis has a high accuracy in predicting the prognosis.
    Effect of sequential treatment of human albumin on liver function and prognosis in patients with primary liver cancer complicated with cirrhosis after radiofrequency ablation
    JI Xiao-mei, SHAO Chun-yan, JI Hao-ming, GHAO Chun-yan
    2021, 26(5):  534-537. 
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    Objective To investigate the effect of sequential treatment of human albumin (ALB) in patients with primary liver cancer (PLC) complicated with cirrhosis after ultrasound-guided radiofrequency ablation (RFA).Methods One hundred and ten PLC patients with cirrhosis treated with RFA were selected and divided into 2 groups. After RFA, the observation group was given 5% human ALB and 25% human ALB, while the control group was given 5% human ALB. Data such as liver function and treatment efficacy of the 2 groups were recorded.Results ALB, gamma-glutamyl transferase or total bilirubin had no significant difference between the 2 groups on the day 1 or day 3 after the operation (P>0.05), and they were lower in the observation group than control group on the day 7 (P<0.05). Prealbumin and ration of albumin and globulin were lower in the observation group than the control group (P<0.05) on the day 1 after the treatment, and had no significant difference on day 3 or day 7 (P>0.05). The glomerular filtration rate in the observation group was higher than the control group on day 1 and day 3 (P<0.05), and had no difference between the 2 groups on day 7 (P>0.05). High-sensitivity C-reactive protein was higher in the observation group than the control group on day 1 (P<0.05), and had no significant difference between the 2 groups on day 3 or day 7 (P>0.05). There was no significant difference in prothrombin time or fibrinogen between the 2 groups after treatment (P>0.05). The dosage of ALB and plasma and the time of hospitalization in the observation group were lower than those in the control group (P<0.05). There was no significant difference in complication rate or 1-year survival rate between the 2 groups (P>0.05).Conclusion The sequential treatment of isosmotic and hyperosmotic human ALB in PLC patients with cirrhosis after RFA can effectively improve hypoproteinemia and low blood volume, maintain internal environment stability, promote postoperative recovery and improve the utilization efficiency of ALB.
    Liver Failure
    The HGF expression regulated by endoplasmic reticulum stress of hepatic stellate cells in the rats with acute liver failure
    LAN Yuan-qiang, WU Fa-sheng, HUANG Li-zhen, LIANG Min
    2021, 26(5):  538-541. 
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    Objective To study the mechanism of endoplasmic reticulum stress (ERS) regulating the expression of hepatocyte growth factor (HGF) in hepatic stellate cells of rats with acute liver failure (ALF).Methods 60 clean SD rats were used as experimental animals. The 60 rats were divided into A, B and C groups by random number table, with 20 rats in each group. The three groups of rats were treated with D-galactosamine (D-GaIN) and lipopolysaccharide (LPS) to build ALF model. The rats in group A and C were treated with 0.6 mL·kg-1 of tunicamycin one hour after modeling operation. The rats of group C were immediately intraperitoneally injected with 4-phenyl butyric acid (4-PBA) 500 mg·kg-1 after completing the above operation. The rats in group B were negative control group without special intervention. There were 5 rats in each group, which were killed at 0 hour (T1), 2 hours (T2), 8 hours (T3) and 12 hours after ALF modeling (T4), the serum and liver tissue samples were collected, the serum HGF level in rats were measured. The expression of HGF in liver tissue of three groups of rats were detected by real-time-polymerase chain reaction (RT-PCR). Results The serum HGF of T2, T3 and T4 were (63.9±7.0) ng/mL, (54.8±9.5) ng/mL and (42.0±6.7) ng/mL, respectively, which were significantly lower than group B [(82.3±10.6) ng/mL, (78.6±8.3) ng/mL and (76.2±9.0), P<0.05] and group C [(74.7±8.3) ng/mL, (70.4±10.2) ng/mL and (67.8±7.7) ng/mL, P<0.05]. There were significant difference in serum HGF level between group B and group C at T2, T3 and T4 (P<0.05). The relative expression of HGF mRNA in T2, T3 and T4 of group A were (2.9±0.5), (2.5±0.8) and (1.7±0.4), which were significantly lower than those of group B [(4.6±0.7), (4.7±0.9) and (4.4±0.7), P<0.05] and group C [(3.8±0.6),(3.5±0.7) and (3.1±0.8), P<0.05]. There were significant difference of HGF mRNA expression between group B and group C at T2, T3 and T4 (P<0.05).Conclusion The endoplasmic reticulum stress (ERS) can regulate the expression of HGF in hepatic stellate cells of ALF rat and participate in the pathological process of ALF.
    Other Liver Diseases
    Involvement of cardiac structure and function between primary and secondary hemochromatosis: a comparative study
    WANG Wan-wei, WU Ting, WANG Yu, LI Ke-xin, LIU Li-wei, OU Xiao-juan, JIA Ji-dong, ZHAO Xin-yan
    2021, 26(5):  542-546. 
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    Objective To compare the characteristics of cardiac involvement between primary and secondary hemochromatosis.Methods Patients with hemochromatosis from January 2008 to December 2018 in Beijing Friendship Hospital were retrospectively analyzed. The clinical manifestation, laboratory parameters, electrocardiogram and echocardiographic structural parameters of the patients were collected and compared. Results There were 20 cases of primary hemochromatosis (mean age 45.0 years, male 70.0%) and 20 cases of secondary hemochromatosis (mean age 47 years, male 75%). Patients with primary hemochromatosis had a significant higher level of ferritin (P<0.05) and more frequent extrahepatic manifestations than patients with secondary hemochromatosis. Cardiac arrhythmias were more common in patients with primary haemochromatosis than in patients with secondary hemochromatosis, but the difference was not statistically significant (20% vs.5%, χ2 = 2.057, P=0.342). There were no significant differences in ECG and cardiac structure between two groups (P>0.05). Primary hemochromatosis included 2 patients with arrhythmias, one patient with atrial fibrillation, another one with frequent ventricular premature beats and 2 patients died of cardiac failure.Conclusion The degree of iron overload in primary hemochromatosis was significantly higher than that of secondary hemochromatosis. Cardiac involvement is more common in patients with primary hemochromatosis, including arrhythmias and heart failure. Heart involvement of hemochromatosis often indicates a poor prognosis and warrants attention of hepatologists.
    Comparison of the clinical effect of prednisone slow reduction in the treatment of autoimmune hepatitis
    TIAN Xiao-ling, CHEN Li, LU Ying-jia, HE Yao
    2021, 26(5):  547-549. 
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    Objective To investigate the clinical effect of slow reduction of prednisone in the treatment of autoimmune hepatitis.Methods 86 patients with autoimmune hepatitis were randomly divided into fast group and slow group, with 43 cases in each group. The therapeutic effect, liver function indexes and adverse reactions were compared between the two groups. Results The effective rate of slow group was significantly higher than that of fast group (P<0.05). The index of liver function in slow group was significantly better than that in fast group (P < 0.05). There was no significant difference between two groups (P>0.05).Conclusion The clinical effect of prednisone slow reduction in the treatment of autoimmune hepatitis was better and the adverse reactions were not increased.
    Analysis of the changes of spleen volume and liver fibrosis index in patients with oxaliplatin-induced sinusoidal injury
    FU Xue-lin, DENG Jun, HUANG Xiao-ning, LI Wu-gen, PENG Bi-bo, LI Chun-lai, GONG Liang-geng
    2021, 26(5):  550-553. 
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    Objective To analyze the characteristic changes of spleen volume and liver fibrosis indexes (APRI, FIB-4) in patients with cancer treated with oxaliplatin as basic chemotherapy regimen during the administration period.Methods A total of 63 patients with gastric cancer and colorectal cancer who received oxaliplatin-based chemotherapy from July 2017 to June 2019 were selected. The data of CT image of upper abdomen, platelet count, AST and ALT in patients before and during chemotherapy were collected. The spleen volume of the patients was measured by post-processing software, and the APRI and FIB-4 values were calculated according to the formulas. Results The spleen volume and liver fibrosis indexes of tumor patients showed a trend of gradual increase during oxaliplatin chemotherapy. The volume of spleen was (196.91±90.63)cm3 before oxaliplatin chemotherapy, and increased to (276.27±135.05)cm3 by the last CT examination during chemotherapy. The speen wolume of 32 (50.8%) patients increased by more than 30%. The APRI and FIB-4 of patients were (0.28±0.15) and (1.28±0.60) before oxaliplatin chemotherapy respectively, which increased to (1.11±0.99) and (3.53±2.15) by the end of the seventh chemotherapy cycle. The values of APRI and FIB-4 increased rapidly during the first three chemotherapy cycles of patients, and then increased slowly; in each chemotherapy cycle, the growth rates of APRI and FIB-4 had a good correlation (P<0.05). There also was a positive correlation between the increased percentage in spleen volume measured at the last CT examination during chemotherapy and the increased percentage in APRI and FIB-4 obtained at the same time (P<0.01), with correlation coefficients of 0.362 and 0.582, respectively.Conclusion Along with the increase of oxaliplatin-based chemotherapy cycle, spleen volume and liver fibrosis indexes (APRI, FIB-4) increased gradually, and could be used as noninvasive biological indexes to monitor the oxaliplatin-induced sinusoidal injury.
    Effect of cytomegalovirus infection on primary immune response to hepatitis B vaccine in infants
    YE Ming, XU Lu, ZHAO Zi-hua, DUAN Shuang-xia
    2021, 26(5):  554-556. 
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    Objective To study the effect of cytomegalovirus infection on the primary immune response to hepatitis B vaccine of infants.Methods A total of 148 full-term newborns (not vaccinated with the second dose of hepatitis B vaccine) were selected from January 2019 to January 2020 in our hospital. Among them, 74 children were diagnosed as human cytomegalovirus (HCMV) infection in our hospital were included in the observation group, and 74 newborns without HCMV infection were selected as the control group.The serum levels of anti-HBs, IL-2 and IL-6 in the two groups were detected after the whole course of immunization. The levels of cellular immune indexes (CD3+, CD4+, CD8+, CD4+/CD8+) were detected. Results The serum levels of anti-HBs and IL-2 in the observation group were lower than those in the control group (P<0.05), while the serum IL-6 level was higher than that in the control group (P<0.05);The primary immune response rate of observation group (67.57%) was lower than that of control group (85.14%) (P<0.05).The levels of CD3+, CD4+, CD4+/CD8+ in the observation group were lower than those in the control group (P<0.05), and the level of CD8+ in the observation group was higher than that in the control group (P<0.05).Conclusion Combined with cytomegalovirus infection will make the immune function of newborns in imbalance and inhibition state, which will lead to the decrease of immune response rate and the intensity of immune response to hepatitis B vaccine.
    Y-box binding protein-1 modulates hepatic progenitor cells proliferation via Gli2
    LI Fei, LI Bing-hang, GUO Yue-cheng, SHEN Bo, GU Tian-yi, QU Ying, ZHANG Qi-di, CAI Xiao-bo, LU Lun-gen
    2021, 26(5):  557-562. 
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    Objective To explore the effect of Y-box binding protein-1 (YB-1) on the proliferation of hepatic progenitor cells (HPCs) and the molecular mechanism.Methods The lentiviral vector system was adopted to down-regulate YB-1 expression. Cell counting kit 8 (CCK-8) and flow cytometry were performed to assess the proliferation rate. RNA-sequencing was employed to evaluate the effect of YB-1 on gene expression of HPCs. Chromatin immunoprecipitation coupled with high-throughput deep sequencing (ChIP-Sequence) was performed to detect the potential target genes of YB-1 in HPCs. ChIP-PCR was conducted to identify the binding of YB-1 and Gli2. Luciferase reporter assay was conducted to analyze the regulatory effect of YB-1 on Gli2 transcription. Gli1/Gli2 inhibitor GANT61 was co-culture with HPCS to assess the effect of Gli2 on HPCs proliferation. Results When YB-1 mRNA expression down-regulated by 67% and 75%, respectively, HPCs proliferation decreased by 58% and 70%. RNA-sequence demonstrated that YB-1 involved in regulation of TGF-beta signaling pathway, Hedgehog signaling pathway, Wnt signaling pathway and MAPK signaling pathway. ChIP-sequence indicated the target gene of YB-1 participated in MAPK signaling pathway, Wnt signaling pathway, Hedgehog signaling pathway. Real-time PCR and Western blotting identified down-regulation of YB-1 depressed the expression of several molecules involving in the Hedgehog signaling pathway. ChIP-PCR and luciferase reporter assay showed that YB-1 could bind to the promoter of Gli2 and modulated the transcription. CCK-8 and EdU assay indicated that Gli-1/Gli2 inhibitor GANT61 could depress HPCs proliferation up to 60%.Conclusion YB-1 can bind to the promoter of Gli2 and modulates the transcription of Gli2 further to regulate the proliferation of hepatic progenitor cells.