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    31 December 2022, Volume 27 Issue 12
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    Liver Fibrosis & Cirrhosis
    Efficacy of ascites ultrafiltration concentration and peritoneal reinfusion in the treatment of refractory cirrhotic ascites in 305 cases
    TANG Ru-jia, ZHOU Xia, YAO Hong-yu, HU Yan-ming, WANG Huan, WANG Kai-li, XING Han-qian, ZHAO Jun, LIU Hong-ling
    2022, 27(12):  1268-1270. 
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    Objective To investigate the clinical efficacy of ascites ultrafiltration concentration and peritoneal reinfusion (referred to as ascites reinfusion) in the treatment for patients with refractory cirrhotic ascites.Methods A total of 305 patients with cirrhosis and refractory ascites admitted to our hospital from January 2019 to December 2020 were selected as the research objects. On the basis of conventional liver protection treatment and diuresis, ascites infusion therapy was performed. The clinical symptoms and signs (abdominal distention, anorexia, body weight, abdominal circumference, etc.) of the patients before and after treatment were observed. Laboratory indicators including serum creatinine (Scr), blood urea nitrogen (BUN), albumin, platelets, hemoglobin, and ascites routine were detected.Results After ascites reinfusion treatment, the clinical symptoms of 274 patients (89.8%) were improved, including weight loss, reduction in abdominal circumference, reduced bloating and dyspnea, and appetite improvement. Thirty-one patients (10.2%) had no obvious effect or progressed. During the treatment, 10 patients developed hypotension (3%), 4 patients muscle spasm (1.3%), and 2 patients mild abdominal pain (0.6%), all of which resolved spontaneously after operation and no serious complications occurred. After treatment, the Scr and BUN levels did not increase significantly, but the serum albumin level increased significantly (28.4 g/L vs. 29.6 g/L, P=0.000), and the platelet count decreased (93.34×109 vs. 90.39×109, P=0.006). There was no significant deference in serum sodium, international normalized ratio (INR), hemoglobin and other indicators before and after treatment.Conclusion Routine treatment combined with ascites reinfusion therapy can safely and effectively improve the clinical symptoms of patients with decompensated liver cirrhosis and refractory ascites.
    Nutritional risk screening and influencing factors in patients with decompensated alcoholic liver cirrhosis
    WANG Yan, JING De-huai, XU Zhen, AI Kuan-kuan
    2022, 27(12):  1271-1276. 
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    Objective To investigate the nutritional risk status of patients with decompensated alcoholic liver cirrhosis and the related influencing factors.Methods One hundred and eighty-six patients with decompensated alcoholic cirrhosis in our hospital were selected. The clinical data of the patients were collected, and a questionnaire was issued to investigate the nutritional risk, family care and dietary behavior of the patients. The nutritional risk status of patients and the relevant influencing factors were analyzed.Results Among the patients with decompensated alcoholic liver cirrhosis, 110 cases with nutritional risk and 76 cases without nutritional risk. The incidence of nutritional risk was 59.14%. The scores of dietary behavior and family care in the nutrition risk group [(30.99 ± 7.17) and (6.48 ± 2.01)] were significantly lower than those in the non nutrition risk group [(45.85 ± 6.87) and (7.90 ± 1.67)], (P<0.05). There was no significant difference in family monthly income, occupation and BMI between the 2 groups (P>0.05). Compared with the non nutritional risk group, the nutritional risk group had higher proportions of people aged 60 ~ 75 and > 75, unmarried/divorced ratio, Child Pugh grade B and C, with portal hypertension, pleural/peritoneal effusion and hypoproteinemia, a lower proportion of junior high school education and below and family care < 7 and dietary behavior < 35 (P<0.05). Based on the analysis, age > 75, Child Pugh grade C, unmarried/divorced ratio, portal hypertension, pleural/peritoneal effusion, hypoproteinemia, family care < 7 points and dietary behavior < 35 points were the risk factors of nutritional risk (OR=1.669, 1.417, 2.305, 1.338, 1.296, 1.605, 1.315, 1.617, P<0.05). College degree or above was the protective factor (OR=0.854, P<0.05).Conclusion Nutritional risk is common in patients with decompensated alcoholic liver cirrhosis, and the incidence of malnutrition is high. Age, portal hypertension, hypoproteinemia, dietary behavior and family care are the influencing factors of nutritional status. Patients with decompensated alcoholic liver cirrhosis should be screened for nutritional risk, and intervention measures should be taken timely.
    Relationship between quantitative parameters of high frequency ultrasound and liver function classification in patients with hepatitis B related cirrhosis
    LIU Jian-xiang, LI Yi-hui, ZHAO Zi-yan
    2022, 27(12):  1277-1279. 
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    Objective To investigate the relationship between quantitative parameters of high frequency ultrasound and liver function classification in patients with hepatitis B cirrhosis.Methods A total of 105 hepatitis B cirrhosis patients were selected as hepatitis B cirrhosis group, and another 105 healthy cases who underwent physical examination in our hospital during the same period were selected as the control group. Both groups underwent high frequency ultrasound examination after admission, fasting and water-deprivation for 12 hours before examination. High frequency ultrasound examination was performed in supine position. After locating the defects in the image of liver parenchyma, the local maximum value per unit area of defect map was passed χ (D) Mean (d) of defect graph and entropy of defect graph ε (D) Quantitative evaluation of the degree of liver cirrhosis. The difference among χ (D), Mean (D) and ε (D) between the 2 groups were compared. According to the Child-pugh score, Child-pugh A, B and C was set as group A (n=41), group B (n=38), and group C (n=26), respectively. The quantitative parameters of high frequency ultrasound images of groups A, B and C were compared.Results The χ (D), mean (d) and ε (D) [(5.4 ± 2.5), (4.4 ± 2.3) and (4.5 ± 2.0)] of hepatitis B cirrhosis group were significantly higher than those of the control group [(2.8 ± 2.1), (2.0 ± 1.3) and (1.5 ± 0.9), P<0.05].The (d), mean (d) and ε (D) of group A was (4.7 ± 1.9), (3.9 ± 1.7) and (3.3 ± 1.5), group B (5.1 ± 2.5), (4.3 ± 1.9) and (3.7 ± 2.0), group C (4.5 ± 1.8), (3.7 ± 1.8) and (3.2 ± 1.5), respectively. The χ (D), mean (d) and ε (D) of group A were significantly lower than those of group B (P<0.05). But there was no significant difference among the parameters of group A and C, the same was true between group B and C.Conclusion Compared with healthy people, the texture parameters χ (D), mean (d) and ε (D) of patients with hepatitis B cirrhosis were significantly higher. There were significant differences in the above indicators between Child-Pugh grade A and B patients. The Child-Pugh A and B could be assessed by high frequency ultrasound, but Child-Pugh C level should be evaluated with other imaging features.
    Liver Cancer
    Ultrasonographic characteristics of primary liver cancer patients with KRAS gene mutation and the correlation between KRAS gene mutation and lymph node metastasis
    HUANG Shi-wen, ZENG Mei-hui
    2022, 27(12):  1280-1283. 
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    Objective To investigate the ultrasonographic features of primary liver cancer (PLC) patients with KRAS gene mutation, and investigate the correlation between KRAS gene mutation and lymph node metastasis.Methods A total of 168 patients with primary liver cancer admitted to our hospital from March 2018 to March 2021 were prospectively included as the research subjects. According to the occurrence of lymph node metastasis, they were divided into metastasis group (n=63) and non-metastasis group (n=105). Peripheral blood, cancer and para-cancer tissues were collected from the 2 groups, respectively. The KRAS gene mutation was detected by the KRAS/NRAS gene mutation combined detection kit. The KRAS protein expression levels in cancer and para-cancer tissues were detected by immunohistochemistry. Color Dopplar ultrasound was used to detect the imaging manifestations of liver tumors in 2 groups. To analyze the ultrasonic characteristics of primary liver cancer patients with KRAS gene mutation and the correlation between KRAS gene mutation and lymph node metastasis.Results (1) Among 168 patients with liver cancer, 36 patients with KRAS gene mutation. The KRAS gene mutation rate in patients with extrahepatic metastasis group was 57.14%(36/63), which was significantly higher than that in patients without extrahepatic metastasis group 0% (0/105). The difference was statistically significant (χ2=76.364, P<0.05). (2) Thirty-six patients with KRAS gene mutation were divided into KRAS low expression group and KRAS high expression group according to the expression level of KRAS protein. There was no significant difference of tumor size between the 2 groups (P>0.05). The expression level of KRAS protein in the patients with the number of tumor nodules ≥2, tumor capsule (-), blood flow grade III and vascular invasion (+) was significantly higher than that in the patients with the number of single tumor nodule, tumor capsule (+), blood vessel invasion (-), and blood flow grades I and II. The differences were statistically significant (χ2=8.333, 3.955, 10.823, 4.730, P<0.05). (3) The RI of the KRAS protein high expression group was significantly higher than that of the KRAS protein low expression group. The RI of the patient with the number of tumor nodules ≥2 was significantly higher than that with single tumor nodule, (t=18.725,21.897, P<0.05). (4) The results of Log stic binary regression analysis showed that the expression level of KRAS protein in liver cancer tissues was positively correlated with the number of tumor nodules, blood flow grade, vascular invasion, RI and other ultrasonic parameters. The higher the expression level of KRAS protein is, and negatively correlated with the capsule formation of the tumor.Conclusion KRAS gene mutation is more frequent in patients with primary liver cancer, especially in those combined with extrahepatic metastasis. KRAS gene mutation is closely related to the progression of liver cancer. KRAS gene expression level in liver cancer tissues combined with color Dopplar ultrasound imaging analysis can provide a reference value for clinical diagnosis and treatment for liver cancer.
    Contrast-enhanced ultrasound features and pathological analysis of 3 cases with primary hepatic sarcoma
    ZANG Jia-wei, LI Li, CHEN Xiao, TAN Bi-xing
    2022, 27(12):  1284-1287. 
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    Objective To investigate contrast-enhanced ultrasound (CEUS) characteristics of primary liver sarcoma (PLS) and compare the diagnostic value between CEUS and pathology.Methods The clinical data of 3 cases with PLS diagnosed by pathology were retrospectively analyzed. The relevant literature was reviewed to summarize the diagnosis experience of CEUS and pathology.Results The characteristics of two-dimensional ultrasonography were round-like or irregular-shaped mixed echogenic masses, expansion growth with clear boundary, accompanied by cystic degeneration, necrosis or bleeding in the center. CEUS arterial phase of 3 cases showed clear boundary and envelope, among which 2 cases showed uneven slightly high or high enhancement, which internal showed the “flame” sign, and the peripheral of 1 case showed high enhancement. CEUS showed the feature of center was massive cystic necrosis or hemorrhage, with no enhancement. The lesion began to be cleared slowly in the portal phase with low enhancement, and the overall clearance rate was slower than that of liver metastatic tumor (LM), and the “black hole” sign was not observed.Conclusion PLS is mostly single solid masses with clear boundaries and its clinical symptoms are not specific. However, the CEUS features of PLS are certain, which could provide an important basis for clinical diagnosis and preoperative evaluation.However, the definitive diagnosis still depend on pathology.
    Changes and clinical significance of serum SLC7A11 in patients with hepatocellular carcinoma
    ZHAN You-fang, ZHANG Jue, WANG Peng
    2022, 27(12):  1288-1291. 
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    Objective To investigate the clinical significance of serum SLC7A11 in patients with hepatocellular carcinoma (HCC).Methods A total of 120 patients with HCC admitted to our hospital from January 2018 to December 2020 were enrolled as HCC group, and 78 liver cirrhosis persons (LC) who underwent physical examination were enrolled as control group. Among the 120 patients in the HCC group, 60 were the early stage HCC and 60 were advanced HCC. Clinical data of all patients including serume levels of total bilirubin (TBil), alanine aminotransferase (ALT), prothrombin time (PT), albumin (Alb), alpha-fetoprotein (AFP), and SLC7A11 were collected. The TBil, ALT, PT, Alb, AFP and SLC7A11 levels of HCC patients were analyzed. The diagnostic values of AFP, SLC7A11 and AFP combined with SLC7A11 were analyzed. Continuous data was compared by independent samples t-test, categorical data was analyzed by chi-square test. The ROC curve analysis was used for diagnostic evaluation.Results The serum levels of TBil and PT in the early stage HCC group were significantly lower than those in the advanced HCC group (t=-5.015 and -6.068, all P<0.01),and the level of Alb in the early stage HCC group was significantly higher than that of the advanced HCC group (t=-3.503, P<0,01). The serum SLC7A11 of patients with early stage HCC was lower than that of patients with advanced HCC [(55.71 ± 18.98) ng/mL vs (65.31 ± 22.31) ng/mL, t=-2.538, P<0.05]. The serum TBil and PT of patients in the early stage HCC group were significantly lower than those of LC group (t=2.999 and 4.687, all P<0.01). The serum SLC7A11, AFP and Alb of patients in the early stage HCC group were significantly higher than that of patients in LC group [SLC7A11: (55.71 ± 18.98) ng/mL vs (37.38 ± 19.98) ng/mL, t=-5.462, P<0.01; AFP (673.58 ± 587.90) vs (147.87 ± 95.05), t=-7.775, P<0.01; Alb (35.71 ± 3.83) ng/mL vs (32.10 ± 5.52) ng/ mL, t=-4.333, P<0.01]. There was no significant difference between SLC7A11 and AFP in the diagnosis of HCC (AUC 0.792 and 0.801, respectively), but the combined test (AUC 0.869) was significantly higher than the single test. There was no significant difference between SLC7A11 and AFP alone in the diagnosis of early stage HCC (AUC 0.752 and 0.765, respectively), but the combined detection (AUC 0.802) was significantly higher than that of single detection.Conclusion The serum SLC7A11 has certain clinical value in the diagnosis of early HCC, especially combined with AFP.
    The efficacy and safety of DEB-TACE compared with cTACE in the treatment of unresectable intrahepatic cholangiocarcinoma
    HE Hai-tao, LIU Shang-da, WEI Guang-xu, XU Kang-xiang, ZHOU Peng-cheng
    2022, 27(12):  1292-1295. 
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    Objective To compare the efficacy and safety of transarterial chemoembolization using drug-eluting bead transarterial chemoembolization (DEB-TACE) and traditional transarterial chemoembolization (cTACE) in the treatment of unresectable intrahepatic cholangiocarcinoma (ICC).Methods From May 1, 2016 to May 1, 2021, thirty five patients with ICC in our hospital were retrospectively analyzed. Among them, 17 patients received DEB-TACE and 18 patients received cTACE. After 4 to 8 weeks, the patients were evaluated according to the solid tumor efficacy evaluation criteria (RECIST) and followed up for survival, and the efficacy of the treatments in two groups was compared. The postoperative adverse events were recorded and compared between the two treatment groups. The degree of pain was evaluated by visual analogue scale (VAS). The degree of vomiting and fever was evaluated according to CTCAE version 4.0 and the liver function of patients before and 3 days after operation was compared.Results The overall Objective response rate (ORR) of patients in the DEB-TACE group was significantly higher than that in the cTACE group (58.8% vs. 16.7%, P=0.012). The median survival period of patients in the DEB-TACE group was 14 (9, 24) months, which was longer that in the cTACE group 12 (8, 24) months (P=0.697). There were no severe adverse events in the two groups after operation, but the incidence of post-embolization syndrome in the DEB-TACE group was significantly higher than that in the cTACE group (94.1% vs. 55.6%, P=0.026), and abdominal pain was the most common symptom (94.1% vs. 44.4%, P=0.002). However, different degrees of liver function injury occurred in both groups after surgery, and the difference was not statistically significant (P>0.05).Conclusion DEB-TACE is safe and effective in the treatment of unresectable ICC without distant metastasis, and its short-term efficacy for unresectable ICC is better than that of cTACE.
    The changes of histone acetylation modification in low invasive hepatocellular carcinoma cells
    ZHANG Jian-dong, LI Liang-he, CHENG Hai-yu, JIANG Dong-bin, YANG Qin, ZHAN Wei
    2022, 27(12):  1296-1299. 
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    Objective To investigate the changes of histone acetylation modification in normal hepatocyte line LO2 cells and low invasive hepatocellular carcinoma (HCC) line MHCC-97L cells.Methods The proliferation and apoptosis of LO2 and MHCC-97L cells were detected by real-time cell analysis (RTCA); the modification of acH3K14, acH3K18, acH3K27 in LO2 and MHCC-97L cells were analyzed by Western Blot.Results The results of RTCA showed that the proliferation rate of low invasive MHCC-97L cells was significantly higher than that of LO2 cells, of which the difference was statistically significant (P<0.05). There was little difference in apoptosis between the two cell lines under fluorescence microscope. The levels of acetylation modification of histone H3K14, H3K18, H3K27 in MHCC-97L cells were significantly lower than those in LO2 cells (P<0.05).Conclusion Compared to LO2 cells, the multiplication rate of MHCC-97L cells was significantly higher whereas the natural apoptosis rate was not different. The histone modification of acH3K14, acH3K18 and acH3K27 in MHCC-97L cells were decreased which might be associated with the hepatocarcinogenesis. Monitoring the levels of histone acetylation in hepatocytes may have a reference value for the clinical diagnosis of HCC and the upregulation of it may be a target for drug development against HCC.
    Viral Hepatitis
    A study on the efficacy and safety of switching initial poor-responsive nucleoside analogues to Tenofovir treatment in chronic hepatitis B patients
    CHEN Tong-tong, FAN Rui-fang, YANG Ya-xuan, ZHANG Ye-qiong, XU Wen-xiong, PENG Liang, LI Yang-mei
    2022, 27(12):  1300-1304. 
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    Objective To observe the efficacy and safety of switching poor virological responsive nucleoside analogues (NAs) to Tenofovir (TDF) treatment in chronic hepatitis B (CHB) patients.Methods One hundred and eight CHB patients were enrolled after screening. They were divided into the following three groups based on their drug switch regimes: ETV to ETV group (n=32), ETV to TDF group (n=30) and NON-ETV to TDF group (n=46). The differences of cumulative HBV DNA undetectable rate, HBV DNA quantification load and other viral indicators, alanine aminotransferase, serum creatinine and other biochemical parameters in each group at baseline and at each follow-up point were observed and compared.Results The quantitative logarithms of HBV DNA at week 24 were 2.0 (2.0-2.0) IU/mL in the ETV-to-TDF group compared with that of 2.0 (2.0-2.50) IU/mL in the ETV-to-ETV group (P=0.034). At week 24, the cumulative undetectable rate of HBV DNA in ETV to TDF group was 83.3%, which was significantly higher than that of 56.3% in ETV to ETV group (χ2=5.34, P=0.021). There was no significant difference in the duration of HBV DNA undetectable time between the two groups(24.8±3.57 vs. 36.4±5.35 weeks, P=0.124). The cumulative undetectable rates of HBV DNA at 24 and 48 weeks of the ETV to TDF group compared with those of the non-ETV to TDF group were 83.3% vs. 82.8% (P=0.935) and 90% vs. 93.5% (P=0.675), respectively, and the differences were not statistically significant. There was no statistical correlation between the course of ETV treatment within 48 to 96 weeks and the HBV DNA negative conversion time after switching to TDF (P=0.270). No virological breakthrough occurred in any of the patients. None of the patients had serious adverse reactions such as rhabdomyolysis.Conclusion TDF is an effective and safety treatment for patients with poor virological response to initial treatment with other nucleoside drugs. Switching to TDF therapy rather than continuing ETV therapy may promote HBV DNA negative conversion in patients with poor responsiveness to ETV treatment. The course of ETV treatment within 48 to 96 weeks may not affect the efficacy of switching to TDF treatment thereafter.
    Liver Failure
    The prognostic impact factors and therapeutic effect evaluation of patients with acute-on-chronic liver failure induced by chronic hepatitis B reactivation
    SHAO Song-ze, ZHU Yong, LIN Li
    2022, 27(12):  1305-1308. 
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    Objective To analyze the prognostic impact factors and therapeutic effect evaluation of patients with acute-on-chronic liver failure (ACLF) induced by chronic hepatitis B (CHB) reactivation.Methods From October 2018 to October 2020, sixty-eight patients (including 37 males and 31 females) with ACLF due to CHB reactivation were selected, with an average age of (45.1±6.0) years. All patients were given individualized comprehensive treatment. On this basis, antiviral drugs including entecavir, lamivudine and adefovir dipivoxil were used alone or in combination. The changes of main indexes of the ACLF patients were observed before and after treatment. The patients were divided into treatment improvement group and ineffective death group based on their different outcomes. Logistic regression analysis was used to indentify the influencing factors of the patients’ outcomes.Results Among 68 patients with ACLF, 48 cases improved after treatment (treatment improvement group) and 20 cases died after ineffective treatment (ineffective death group). According to the general data, the age of treatment improvement group [(41.4±10.2) years] was significantly younger than that of ineffective death group [(50.2±9.7) years (P<0.05). In the treatment improvement group, there were 21 cases (43.7%), 17 cases (35.4%) and 10 cases (20.8%) of hepatitis, compensated cirrhosis and decompensated cirrhosis, respectively, which were significantly more than those of 3 cases (15.0%), 1 case (5.0%) and 16 cases (80.0%) in the ineffective death group (P<0.05). Ascites, upper gastrointestinal bleeding, hepatic encephalopathy and hepatorenal syndrome in the treatment improvement group were 19 cases (39.6%), 2 cases (4.2%), 2 cases (4.2%) and 4 cases (8.3%), respectively, which were significantly lower than those of 16 cases (80.0%), 6 cases (30.0%) in the ineffective death group (P<0.05). The prothrombin time activity (PTA), blood ammonia and serum creatinine levels in the treatment improvement group were (38.6±7.8)%, (38.2±9.0) μmol/L and (62.4±13.2) μmol/L, respectively, which were significantly higher than those of [(27.0±6.6)% and (63.4±15.6) μmol in the ineffective death group (P<0.05). In addition, age, PTA, blood ammonia and serum creatinine levels were verified as independent risk factors to predict death in the ACLF patients due to ineffective treatment (P<0.05). Alanine transaminase (ALT) and HBV DNA decreased significantly after treatment, similarly, Total bilirubin (TBil) level decreased significantly after 12 and 24 weeks of treatment (P<0.05), and PTA decreased significantly before and after 24 weeks of treatment (P<0.05).Conclusion Age, PTA, blood ammonia and serum creatinine levels in this study are independent risk factors that affecting the prognosis of ACLF patients caused by CHB reactivation. Antiviral drugs can significantly improve the condition of the ACLF patients induced by CHB reactivation.
    Other Liver Diseases
    SPARC knockout affects the development of metabolic fatty liver related liver cancer by regulating liver lipid metabolism
    CHANG Ye-fei, ZHENG Sheng, HU Tao, HONG Ying, ZHONG Yong, ZHANG Xiao-jun
    2022, 27(12):  1309-1313. 
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    Objective To investigate the impact of secreted protein acidic and rich in cysteine (SPARC) gene knockout on the development of metabolic fatty liver related liver cancer by regulating liver lipid metabolism.Methods The study samples were selected from 17 adult healthy rats as the control group and 17 SPARC knockout rats as the study group. Hepatocytes were extracted from one rat each from both groups for in vitro experiments. The remaining animals were treated with streptozotocin Injection and high-fat diet to induce metabolic fatty liver related liver cancer. The pathological changes, the lipid deposition, lipid synthesis, lipid metabolism, cell viability related indicators and the protein expression of AMPK and α-Tubulin in the livers of two groups of rats were studied.Results At the 16th week, all rats from both groups developed liver cancer. The average diameter of liver cancers in the study group was (1.39±0.14) mm, which was significantly larger than that of (1.01±0.09) mm in the control group; the NAS score showed that the fatty degeneration score of the study group was (2.71±0.25), which was significantly higher than that of (1.55±0.19) of the control group. The score of lobular inflammation in the study group was (0.74±0.09), which was significantly lower than that of (1.27±0.11) in the control group. The results of H&E staining showed that the portal vein inflammation of the rats in the study group was weaker; the results of Sirius red staining showed that the liver fibrosis of the rats in the study group was more severe than that of the control group; in the in vitro study, the results of oil red O staining showed that the lipid deposits in the cells of the study group increased, and the expression of GL-TAG (23.15±5.39 vs. 5.73±1.47) and GPL (0.29±0.03 vs. 0.23±0.02) were significantly higher than those of the control group; the expression of [U-14C]-glycerol in the liver cells of the study group was significantly higher than that of the control group; The relative expressions of PPARγ (1.95±0.20 vs. 1.01±0.11), PPARα(1.27±0.12 vs. 0.98±0.09), CD36 (2.24±0.26 vs. 0.98±0.09), FABP4 (1.92±0.19 vs. 0.99±0.10), FABP5 (2.31±0.27 vs. 0.97±0.10), ACC1 (2.52±0.27 vs. 1.01±0.11), FASN (1.28±0.13 vs. 0.99±0.09), SREBP1 (3.95±0.43 vs. 1.02±0.11), LXRα (1.52±0.16 vs. 0.97±0.09), CPT1 (2.76±0.29 vs. 1.02±0.11), LIPIN (2.49±0.26 vs. 1.01±0.11), ACOX1 (2.69±0.28 vs. 1.01±0.11) mRNAs in rat livers of the study group were significantly lower than that of the control group (all P<0.05). There was no statistically significant difference in ACADSB mRNA expression in rat livers from these two groups (P>0.05); the results of acridine orange-ethidium bromide staining showed that cells from the study group had higher viability than those from the control group, and had a significantly higher cell survival rate than those from the control group {(97.89±1.44)% vs. (48.47±1.21)%}; Immunofluorescence detection results showed that cells in the study group had increased nuclear localization of SREBP in hepatocytes. By Western blot analysis it was shown that the expression of AMPK and α-Tubulin protein in the study group was lower than that of the control group.Conclusion SPARC knockout can affect the development of metabolic fatty liver-related liver cancer by regulating lipid metabolism, cell viability and lipid accumulation in the liver cells in rats.
    Correlational research of Gensini score and coronary atherosclerotic disease complicated with nonalcoholic fatty liver disease
    ZHANG Qi-feng, MIAO lei-ming, ZHONG Fang-ming, HE Xue-bo, HUANG Jun-ping
    2022, 27(12):  1314-1317. 
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    Objective To explore the relationship between nonalcoholic fatty liver disease (NAFLD) and Gensini score in patients with coronary atherosclerotic disease (CAD).Methods 340 CAD patients hospitalized from January 2018 to December 2021 were collected, including 252 males and 88 females in Meizhou People’s Hospital, with an average age of (58.3 ± 9.2) years. 340 CAD patients were divided into 164 cases of CAD combined with NAFLD (NAFLD group) and 176 cases of simple CAD (non-NAFLD group). The diagnosis of CAD and NAFLD met the requirements. The clinical data of NAFLD group and non-NAFLD group were compared, and the results of Gensini score of liver histological features in NAFLD group were analyzed.Results The age, body mass index (BMI) of NAFLD group were (57.4 ± 9.6) years old, (24.8 ± 3.4) kg/m2, which were significantly different with non-NAFLD group [(59.0 ± 9.1) years old, (27.2 ± 3.1) kg/m2, P<0.05]. The waist circumference of NAFLD group was (96.5 ± 9.1)cm, which was significantly higher than that of non-NAFLD group [(84.6 ± 9.5) cm, P<0.05]. High-density lipoprotein (HDL) and triglyceride (TG) in NALFD group were (0.9 ± 0.2) mmol/l and (1.8±0.5) mmol/l, which were significantly different from those in non-NAFLD group [(1.1 ± 0.2) mmol/l and (1.6 ± 0.4) mmol/l] (P<0.05). In addition, Gensini score of NAFLD group was (56.9 ± 9.1) points, significantly higher than that of non-NAFLD group [(48.2 ± 8.2) points, P<0.05]. The mild, moderate and severe degree of coronary artery lesions in NAFLD group were 32 cases (19.5%), 21 cases (12.8%) and 111 cases (67.7%), while those in non-NAFLD group were 55 cases (31.2%), 38 cases (21.6%) and 83 cases (47.1%), the difference was statistically significant. In 64 CAD patients with NAFLD, the degree of hepatic steatosis was 20 cases in S0 grade, 57 cases in S1 grade, 64 cases in S2 grade and 23 cases in S3 grade. Gensini scores of each degree of hepatic steatosis were (10.5 ± 1.3) points, (34.4 ± 4.2) points, (65.9 ± 8.0) points and (130.8 ± 15.7) points, respectively.Conclusion Gensini scores of patients with CAD and NAFLD of different degrees of liver steatosis are significantly different, and Gensini scores are helpful to quantitatively evaluate the degree of liver steatosis of patients.
    Clinical features, auxiliary examination results and therapeutic effect evaluation of 44 patientschildren with hepatolenticular degeneration
    ZHANG Ren-hua, JIANG Kai, CHEN Yong-ying
    2022, 27(12):  1318-1321. 
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    Objective To summarize the clinical features, auxiliary examination results and therapeutic effects of 44 patientschildren with hepatolenticular degeneration (HLD), in order to strengthen the understanding of HLD.Methods From February 2007 to October 2021, 44 patients (28 males and 16 females) with HLD were collected, with an average age of (9.3±3.4) years and an age of 2-17 years. HLD meets the diagnostic requirements. According to age, it can be divided into preschool (< 7 years old), school (7 ~ 12 years old) and adolescent (> 12 years old) age. According to the diagnostic guidelines, they are divided into different clinical types.Results Among the 44 patientschildren with HLD, 6 (13.6%), 34 (77.3%) and 4 (9.1%) were in preschool, school and adolescent, respectively. There were 26 cases (59.1%), 6 cases (13.6%), 6 cases (13.6%) and 6 cases (13.6%) of liver type, brain type, mixed type and other types, respectively. The first diagnosis symptoms of HLD patients were mostly in the liver, and abnormal (elevated) liver enzymes were the most common. 34 cases (77.3%), 43 cases (97.7%), 43 cases (97.7%) and 39 cases (88.6%) with positive Kayser-Fleischer ring, positive blood ceruloplasmin, positive 24-hour urine copper and abnormal abdominal ultrasound, respectively. The positive rate of Kayser-Fleischer ring in preschool age (16.7%) was significantly lower than that in school age (85.3%) and adolescence (100%) (χ2=18.610, 10.000, P<0.05). The abnormal rate of abdominal ultrasound in preschool age (50.0%) was significantly lower than that in school age (94.1%) and adolescence (100%) (χ2=14.779, 4.444, P<0.05). The positive rate of Kayser-Fleischer ring in liver type (57.7%) was significantly lower than that in other clinical types (all 100%) (all χ2=3.868, P<0.05). According to different treatment methods, 18 cases of patientschildren with HLD were treated with zinc, 26 cases with penicillamine combined with zinc. Comparing the data, there were significant differences in urine copper before treatment, urine copper after normal liver enzymes and recurrence rate between the two groups (t=8.042, 14.150, χ2=4.011, P<0.05).Conclusion Clinical symptoms of patientschildren with HLD are often atypical, and individual differences are large, especially liver symptoms. The positive rate of Kayser-Fleischer ring and abnormal rate of abdominal color Doppler ultrasound in patients with HLD of type I and preschool age were significantly lower than those in other groups. Zinc alone oror combined with penicillamine areis effective in the treatment of HLD, and the optimization of treatment plan needs further exploration.
    Clinical value of serum NPY, IGF-1 and PCT in neonates with hyperbilirubinemia
    HAN Juan, CHU Kai-dong, DING Xiao-fang, ZHU Min
    2022, 27(12):  1322-1326. 
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    Objective To investigate the clinical value of serum neuropeptide Y (NPY), insulin-like growth factor-1 (IGF-1) and procalcitonin (PCT) in neonates with hyperbilirubinemia (NHB).Methods 94 neonates with NHB admitted to the Department of Pediatrics of Haian People’s Hospital from January 2019 to June 2021 were enrolled into the observation group. According to the serum total bilirubin (TBil) level within 24 hours after admission, they were divided into mild group (n=37), moderate group (n=32) and severe group (n=25). According to the results of head MRI, they were divided into two groups: the group with abnormal globus pallidus signal (n=10 cases) and the group without abnormal globus pallidus signal (n=15 cases). Thirty-five healthy neonates who delivered at the same time were included in the control group. Serum levels of NPY, IGF-1, PCT, hemoglobin (Hb), alanine aminotransferase (ALT), albumin (Alb), TBil, unbound bilirubin (UCB) and urea nitrogen (BUN) were detected. The serum levels of NPY, IGF-1 and PCT, ALT, Alb, UCB, Hb, BUN and cTnT were compared between the observation group and the control group. The serum levels of NPY, IGF-1 and PCT in the severe and non-abnormal globus pallidus signal group were compared, and the correlation between serum levels of NPY, IGF-1 and PCT and liver function indexes such as ALT, Alb, TBil and UCB was analyzed by Pearson.Results Serum NPY and PCT levels in severe subgroup were (6.53 ± 1.08) ng/L and (3.48 ± 0.74) ng/mL, which were higher than those in moderate subgroup [(5.82 ± 0.91) ng/L and (2.75 ± 0.58) ng/mL], in mild group [(4.48 ± 0.79) ng/L and (1.82 ± 0.43) ng/mL] and in control group [(3.06 ± 0.47) ng/L and (0.58 ± 0.17) ng/mL]. Serum IGF-1 level in severe subgroup was lower than that in moderate group [(30.92 ± 4.48) ng/mL], mild group [(36.74 ± 6.53) ng/mL] and control group [(49.56 ± 8.71) ng/mL], the difference was statistically significant (F=12.459, 26.385, 18.527, All P<0.05). The levels of ALT, UCB and cTnT in severe subgroup were significantly higher than those in moderate subgroup, mild subgroup and control group, showing a decreasing trend (P<0.01). Serum Alb and Hb levels in severe subgroup were significantly lower than those in moderate subgroup, mild subgroup and control group, with an increasing trend (P<0.05). Serum NPY and PCT levels in the subgroup with abnormal pallidus pallidus signal were (7.12 ± 1.24) ng/L and (4.05 ± 0.89) ng/mL, which were higher than those in the subgroup without abnormal pallidus signal [(6.08 ± 0.97) ng/L and (3.18 ± 0.67) ng/mL]. Serum IGF-1 level in the subgroup with abnormal pallidus signal was (20.37 ± 3.46) ng/mL, lower than that in the subgroup without abnormal pallidus signal [(27.18 ± 3.94) ng/mL], the difference was statistically significant (t=7.682, 6.925, 8.647, all P<0.05). Pearson correlation analysis showed that serum NPY and PCT levels were positively correlated with ALT, Alb, TBil and UCB liver function indexes, while serum IGF-1 levels were negatively correlated with liver function indexes (P<0.05).Conclusion Serum levels of NPY, IGF-1 and PCT are of high clinical value for disease monitoring and prognosis evaluation of NHB.
    Application value of GLDH and GR in clinical diagnosis of drug-induced liver injury
    YANG Fan, WANG Lan, GU Chang, ZHANG Wei-wei, ZHU Yue-rong, QIU Hong
    2022, 27(12):  1327-1330. 
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    Objective To explore the clinical value of glutamate dehydrogenase (GLDH) and glutathione reductase (GR) in the diagnosis of drug-induced liver injury (DILI).Methods The clinical data and serum liver function indexes of 111 DILI patients hospitalized in the military liver disease center of Qinhuai Medical Treatment Area of General Hospital of Eastern Theater CommandPLA from January 2021 to March 2022 and 100 healthy people in the physical examination center of the hospital in the same period were retrospectively analyzed. A total of 56 DILI patients were hospitalized for more than 10 days and had at least three liver function tests. The differences between DILI group and healthy group and the diagnostic efficiency of GLDH and GR were analyzed, Correlation with other liver function indexes, the indexes of other liver functions at different activity levels of GR and the changes of liver function indexes in DILI patients during hospitalization were evaluated by stratified comparison.Results GLDH and GR in DILI group [12.1 (6.8, 24.8) U/L, 87 (74, 108.7) U/L] were significantly higher than those in healthy group [3.80 (2.50, 5.68) U/L, 58.15 (51.35, 62.80) U/L] (P<0.001); The correlation coefficients of GLDH with alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were 0.296, 0.328, 0.308, 0.262 and 0.234 respectively, and the correlation coefficients of GR with ALT, AST, GGT, ALP and LDH were 0.464, 0.612, 0.322, 0.375 and 0.543 respectively. The area under the AUC curve, sensitivity, specificity, and Jordan index of GLDH were 0.861, 72.97%, 89.0% and 0.620 respectively, while those of GR were 0.941, 90.99%, 95.00% and 0.824 respectively. The GR results were stratified according to the interquartile distance and divided into four groups. It was found that there was no statistical significance in liver function indicators from Q1 to Q2 (P>0.05), while the most significant indicators in Q3 and Q4 were AST [165 (97, 256) U/L, 282 (171, 501) U/L], ALT [302 (158, 502) U/L, 545 (234, ,974.75) U/L], LDH [221 (185, 243) U/L, 294 (225.5, 376.25) U/L] and PA [(154 ± 80.23) mg/l, (103.07 ± 86.00) mg/L] (P<0.001) were used to analyze the changes of liver function indexes of 56 hospitalized DILI patients during hospitalization. It was found that GLDH was 20.05 (13.45, 31.3) U/L at admission, and decreased to 8.3 (4.53, 15.38) U/L after (5 ± 2) days of admission, most of them can return to the normal range of 5.5 (2.93, 10.7) U/L after (10 ± 2) days.Conclusion Compared with traditional liver function indexes, GLDH and GR play a great supplementary role in clinical diagnosis and treatment of DILI in terms of diagnostic efficacy, early diagnosis and curative effect observation. They can be used as new serum markers of DILI in clinical popularization.
    Predictive value of NLR in severity and risk of liver injury in patients with acute pancreatitis
    WANG Lei, WANG Zhao-wei, XU Zhi-hua
    2022, 27(12):  1331-1334. 
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    Objective To investigate the predictive value of neutrophil/lymphocyte ratio (NLR) in the severity of acute pancreatitis (AP) and liver injury.Methods The clinical data of 92 patients with AP were collected and analyzed retrospectively. They were divided into severe, moderate and mild group according to the severity of the disease, and the general situation, NLR value and leukocyte count of the three groups at different time points were compared. According to whether there was liver injury (liver injury group and no liver injury group), we compared the changes of NLR value between the two groups, drew ROC curve, and analyzed the prediction efficiency of NLR on the severity of the disease and liver injury.Results There were significant differences in white blood cell (WBC), neutrophil count, NLR immediately after admission, NLR 48h after admission and lymphocyte count among the three groups (P<0.05). NLR immediately after admission in severe group was significantly higher than that in moderate group [15.24 (8.01) vs 11.20 (4.96), P<0.05]. There were no significant difference in WBC [(14.26 ± 4.39)×109/L vs (15.32±5.79)×109/L], neutrophil count [11.96(5.24)×109/L vs 13.05(5.70)×109/L], lymphocyte count [1.08(0.98)×109/L vs 0.85(0.32)×109/L] and NLR 48h after admission [7.82(4.66) vs 8.21(6.54)] between moderate group and severe group (P>0.05). Compared with the non liver injury group, the WBC [(16.32±4.63)×109/L vs (11.83±3.56)×109/L ], neutrophil count [13.30(8.20)×109/L vs 9.36(4.56)×109/L ], NLR immediately after admission [16.12(7.02) vs 6.54(3.96)] and NLR 48 h after admission [8.26(5.01) vs 8.26(5.01)] in the liver injury group were higher, and the lymphocyte count was lower [0.84(0.25)×109/L vs 1.40(1.01)×109/L, P<0.05]. ROC curve analysis showed that NLR had the highest predictive efficacy for non mild AP and liver injury immediately after admission (AUC = 0.845, 0.877, the best cut-off values were 7.85 and 10.67), followed by NLR for 48 hours after admission (AUC = 0.831, 0.821, the best cut-off values were 4.78 and 5.92).Conclusion The levels of neutrophils and lymphocytes are closely related to the severity of AP and the occurrence of liver injury. Monitoring the NLR value at admission has high prediction accuracy for the severity of AP and liver injury.
    Analysis of application of Recombinant Human Thrombopoietin in patients with liver disease complicated with thrombocytopenia
    CUI Da-guang, XIAO Ling-yan, SHI Dong-yang, LIU Yong-fu, ZHANG Shu-ai, YANG Kai, ZHENG Yi-shan
    2022, 27(12):  1335-1339. 
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    Objective To analyze the application effect of Recombinant Human Thrombopoietin (Tpiao) in patients with liver disease complicated with thrombocytopenia.Methods A total of 120 patients with liver disease and thrombocytopenia admitted to our hospital from March 2020 to March 2021 were selected and divided into control group and study group, which were treated with dexamethasone and the study group was treated with Tpiao. The liver function index, coagulation function, blood routine, inflammation related index, immune related index and platelet count (PLT) levels were compared, and the effectiveness and safety were analyzed.Results The levels of alanine transaminase (ALT), aspartate transaminase (AST) and total bilirubin (TBIL) in the study group were respectively [(28.89 ± 6.55) U/L], [(33.14 ± 5.56) U/L], [(16.98±3.63)μmol/L] lower than those in the control group (P<0.05). The levels of WBC, red blood cell (RBC), prothrombin time (PT) and activated partial thromboplastin time (APTT) in the study group were higher than those in the control group, and the levels of hemoglobin (HGB), albumin (ALB), thromboplastin (TP) and plasma thromboplastin antecedent (PTA) were higher than those in the control group (P<0.05). The levels of IL-1, IL-6, IL-10, C-reactive protein (CRP), and CD8+ in the study group were lower than those in the control group, and the levels of CD4+, CD4+/CD8+ were higher than those in the control group (P<0.05). The level of PLT in the study group was [(114.32±11.86)×109/L] higher than that in the control group (P<0.05). The total effective rate of the study group was 93.33%, which was lower than that of the control group, which was 80.00% (χ2 = 4.615, P=0.032). The adverse reactions in the study group were lower than those in the control group (P<0.05). The mortality rate of the study group was 1.67%, lower than that of the control group (11.67%) (χ2=4.821, P=0.028).Conclusion Tpiao can significantly improve the functional abnormalities of liver disease patients with thrombocytopenia, increase PLT content, reduce mortality, with high effectiveness and high safety, the incidence of adverse events is low, can be used for the treatment of this disease.