Chinese Hepatolgy

Clinical features of 100 patients with drug-induced liver failure

HAN Lin, YANG Zhao, LIANG Qing-sheng, HUANG Ang, SUN Ying, ZOU Zheng-sheng

2019, 24(3): 229-233.

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Objective To investigate the medication, clinical characteristics and prognosis of 100 patients with drug-induced liver failure (DILF).Methods A retrospective review of 100 patients with DILF from April 2016 to March 2018 in our hospital were performed by analyzing the drugs leading to DILF, underlying diseases, symptoms, laboratory examination results, complications and prognosis. Results In the DILF patients, the age ranged from 8 months to 84 years, the average age was 47.51±16.71 years. And there were more female patients than male. The onset time of DILI varied greatly, with an average incubation period of 82.21 days. The top 3 kinds of drugs leading to DILF were decoction of traditional Chinese medicine, antipyretic analgesics, and Chinese patent medicine. Drugs for infectious diseases (except tuberculosis), dermatosis and tuberculosis were the top 3 in patients with underlying diseases. DILF was mainly subacute (57, 57.0%) according to the duration, and was mainly hepatocyte injury (63, 63.0%) according to clinical classification. The prognosis of acute DILF was worse than that of subacute DILF (P=0.023). In the 100 patients, 11 (11.0%) were cured, 37 (37.0%) were improved, 44 (44.0%) experienced treatment failure and 8 (8.0%) were dead. The levels of aspartate aminotransferase, total bilirubin, gamma-glutamyltransferase, international normalized ratio, blood ammonia in cured or improved patients were apparently lower than those in patients experienced treatment failure or dead from DILF (P<0.05), while the levels of albumin, plasma prothrombin activity, total bile acid, total cholesterol, platelet were higher (P<0.05). The top 3 complications were hydrothorax/ascites, hyponatremia and infection. Among the complications, hyponatremia, infection, hepatic encephalopathy, hepatorenal syndrome, shock and hemorrhage were associated with poor prognosis (P<0.05).Conclusion DILF is characterized by acute onset, more and serious complications, therefore, clinicians need to strengthen drug control and monitor the adverse reactions during the course of treatment.

The analysis on association between IL28B single gene polymorphisms and the risk of intrauterine infection of HBV in HBsAg positive pregnant women

LI Rong, ZHANG Hang, HUANG Xi-yao, DU Dan

2019, 24(3): 234-238.

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Objective To investigate the association between interleukin 28B (IL28B) single gene polymorphisms (SNPs) and the risk of intrauterine infection of hepatitis B virus (HBV) in hepatitis B surface antigen (HBsAg) positive pregnant women.Methods Single fetus full-term HBsAg positive pregnant women were selected as the research objects, and were divided into infection group (658 cases) and non-infection group (1342 cases) according to whether HBV intrauterine infection occurred or not, and 542 healthy pregnant women were enrolled as the control group. Tetra-primer amplification refractory mutation system-polymerase chain reaction was used to detect the genotype of IL28B rs8099917 locus, the levels of serum interleukin-17 (IL-17), interleukin-21 (IL-21), interleukin-4 (IL-4), transforming growth factor-β1 (TGF-β1) and interferon-γ (IFN-γ) of patients with various genotypes of IL28B rs8099917 locus were measured and compared by enzyme-linked immunosorbent assay, and logistic regression was used to analyze the relationship between IL28B rs8099917 genotype with risk of HBV intrauterine infection. Results There were wild-type homozygous TT genotype, mutant heterozygous TG genotype and mutant homozygous GG genotype of IL28B rs8099917 locus, and the distribution of IL28B genotypes in each group followed Hardy-Weinberg equilibrium law. In infection group, the frequency of G allele was significantly higher than that of T allele (P<0.05), but there was no significant difference in non-infected group and control group (P>0.05). The levels of serum IL-17, IL-21, TGF-β1 and IL-4 in infection group were significantly higher than those in non-infected group and control group (P<0.05). In infection group, the levels in individuals with TG genotype were significantly higher than those with TT genotype (P<0.05), but significantly lower than those with GG genotype (P<0.05), while IFN-γ showed the opposite trend (P<0.05). However, in non-infection and control group, the differences were not significant (P>0.05).Conclusion IL28B SNPs of HBsAg positive pregnant women is related to HBV intrauterine infection, and GG genotype is a risk factor of HBV intrauterine infection.

Evaluation of the cardiac function in patients with liver cirrhosis by tissue Doppleimag Tei index

HU Xing, MENG Fan-kun, HAN Jing, ZUO Qiao

2019, 24(3): 239-242.

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Objective To assess cardiac function impairment in patients with cirrhosis, and to investigate the clinical value of Tei index measured by tissue Doppler imaging (TDI) in evaluating cardiac function in patients with cirrhosis.Methods A total of 172 visits in our hospital from August 2017 to August 2018 were enrolled, including 92 cirrhosis patients as the liver cirrhosis group and 80 healthy individuals as the control group. According to the Child-Pugh grading standard, patients in the cirrhosis group were further divided into Child-Pugh A, B and C subgroups. The parameters of the cardiac structure and function were measured using echocardiography, including left atrial end-systolic diameter (LADs), left ventricular end-diastolic diameter (LVDd), right atrial end-systolic diameter (RADs), right ventricular end-diastolic diameter (RVDd), left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), early-diastolic peak velocity (E) and late-diastolic peak velocity (A) of mitral and tricuspid valves. Then E/A ratio, left and right ventricle Tei indexes were calculated. All the parameters were analyzed among groups. Results 1. Compared with the control group, the cirrhotic group showed significantly increased LADs (37.15±4.13 vs. 35.26±3.28, P< 0.05) and LVDd (49.29±2.94 vs. 47.93±3.10, P<0.05). While there was no significant difference in RADs and RVDd between the 2 groups (P>0.05). 2. The Tei index of left ventricular in the liver cirrhosis group was significantly higher than that in the control group (0.48±0.06 vs. 0.41±0.04, P<0.05), and as was the Tei index of right ventricular (0.42±0.05 vs. 0.38±0.05, P<0.05). While there was no significant difference in LVEF, RVEF, and E/A ratio between the 2 groups (P>0.05). 3. The Tei index of left ventricular in Child-Pugh A, B and C subgroups were 0.45±0.05, 0.48±0.06 and 0.51±0.06, respectively. The Tei index of right ventricular in the 3 subgroups were 0.39±0.05, 0.42±0.06 and 0.44±0.04, respectively. The Tei index of left and right ventricular increased gradually with the increase of Child-Pugh score, and the differences were statistically significant in the 3 subgroups (P<0.05).Conclusion The left cardiac structure has changed in patients with cirrhosis, and both left and right cardiac functions are reduced in different degrees. Tei index measured by TDI has simple and accurate application value in overall evaluation of cardiac function in patients with cirrhosis.

Effects of miR-509-3p and XIAP expression on proliferation and invasion of hepatocarcinoma cells

OUYANG Kao-bin, YUAN Xia, HE Yin

2019, 24(3): 243-247.

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Objective To investigate the influence of the expression of microRNA-509-3p (miR-509-3p) and X-linked inhibitor of apoptosis protein (XIAP) on the proliferation and invasion of hepatocarcinoma cells, and to explore the mechanism.Methods Real-time polymerase chain reaction was used to detect the expression of miR-509-3p and XIAP in 107 liver cancer patients’ cancer tissues and paracancerous tissues. Cell proliferation assay and Transwell chamber invasion assay were used to observe the proliferation and invasion of HepG2 cells which were transfected with miR-509-3p mimics, miR-509-3p inhibitors, small interfering RNA silencing XIAP, respectively. Results The relative expression levels of miR-509-3p and XIAP in liver cancer tissues were 0.415±0.098 and 1.657±0.147, respectively, in paracancerous tissues were 1.127±0.126 and 0.425±0.113, respectively. The relative expression of miR-509-3p in liver cancer tissues was significantly lower than that in paracancerous tissues (t=3.257, P=0.002), while the relative expression of XIAP was significantly higher (t=4.201, P=0.000). There was a negative correlation between miR-509-3p and XIAP mRNA expression in liver cancer tissues (r=0.218, P=0.046). Compared with the control group, the proliferation rate of HepG2 cells was significantly lower at 48, 72, 96 and 120 hours of transfection with miR-509-3p analogs, and the difference was statistically significant (P<0.05). The proliferation rate of HepG2 cells was significantly higher after 48 hours of transfection with miR-509-3p inhibitors (P<0.05). Compared with the control group, the number of invasive HepG2 cells at 24 hours of transfection with miR-509-3p analogs was lower (96.32±0.52, 51.47±0.45, t=2.263, P= 0.021), the difference was statistically significant. Compared with the control group, the number of invasive HepG2 cell at 24 hours of transfection with miR-509-3p inhibitor was higher (94.65±0.42, 120.14±0.45, t=2.463, P=0.013), the difference was statistically significant.Conclusion The expression of miR-509-3p and XIAP are related to the proliferation and invasion of hepatocarcinoma cells. MiR-509-3p may regulate the proliferation and invasion of hepatocarcinoma cells by affecting the expression of XIAP.

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