Table of Content

31 July 2019, Volume 24 Issue 7

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Original Articles

Logistic regression analysis of risk factors for portal vein thrombosis in liver cirrhosis

SHU Dan, HUANG Xiang-rong, JIANG Yu-jin, HUANG Ting, LIU Ying-xia, XU Cheng.

2019, 24(7):  740-743. 

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Objective To investigate the risk factors for portal vein thrombosis (PVT) in patients with liver cirrhosis.Methods From January 2016 to December 2017, the data of 314 hospitalized patients with liver cirrhosis were retrospectively analyzed. Patients were divided into PVT and control groups according to the occurrence of PVT. Data including age, gender, etiology of cirrhosis, Child-Pugh score, blood cell count, serum biochemical index, blood coagulation function, D-dimer, main portal vein internal diameter and portal vein velocity (PVV) were recorded and analyzed. Non-conditional logistic regression model was used to screen for risk factors. Area under the receiver operator characteristic curve (AUC) was calculated to evaluate the predictive value of each index. Results The incidence of PVT was 10.51% (33/314) in patients with liver cirrhosis. Univariate analysis showed that platelet count (70.42±28.96 ×10⁹/L vs 85.61±33.24 ×10⁹/L, P=0.012), antithrombin Ⅲ (AT-Ⅲ) (49.39±17.33 % vs 57.31±18.27 %, P=0.009), PVV (12.67±1.19 cm/s vs 14.40±1.36 cm/s, P<0.001), D-dimer (2.09±1.98 mg/L vs 0.95±0.52 mg/L, P=0.003) and Child-Pugh score (9.67±1.11 vs 8.77±1.03, P<0.001) were correlated with the development of PVT. Non-conditional logistic regression analysis indicated that AT-Ⅲ (OR=0.956, P=0.009), D-dimer (OR=6.351, P<0.001), PVV (OR=0.301, P<0.001), and Child-Pugh score (OR=2.486, P<0.001) were independent risk factors for PVT in patients with liver cirrhosis. The AUC of the 4 factors was 0.629, 0.786, 0.842 and 0.722, respectively. Conclusion Low PVV, high Child-Pugh score, high D-dimmer level, and low AT-Ⅲ are independent risk factors for PVT in patients with liver cirrhosis.

Meta-analysis on risk factors for relapse after discontinuation of nucleos(t)ide analogues in patients with chronic hepatitis B

WANG Yan, YAO Tian-tian, QIAN Jian-dan, CHENG Hao, WANG Gui-qiang.

2019, 24(7):  744-751. 

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Objective To investigate the risk factors for relapse after discontinuation of nucleos(t)ide analogues (NAs) in patients with chronic hepatitis B (CHB).Methods Electronic searches were conducted in PubMed, Cochrane Library, EMBASE and CBM before March 2018. A meta-analysis was performed based on the extracted data using Review Manager software (RevMan version 5.3). Results From 2002 to 2018, a total of 64 studies were included to investigate the correlation between candidate risk factors and virological relapse (VR). For each additional year of age, the risk of VR was relatively increased by 4%. For each additional month to complete virological response, the risk of VR was relatively increased by 13%. For each additional logarithmic level of hepatitis B surface antigen (HBsAg), the risk of VR was relatively increased by 81%. Interestingly, new markers such as Hepatitis B core-related antigen (HBcrAg), hepatitis B virus ribonucleic acid (HBV RNA) and quantitative detection of antibody to hepatitis B core antigen (anti-HBc) preliminarily indicated their predictive potential in VR. Conclusion The age of patients with chronic hepatitis B, the time required for virological response to antiviral treatment, and HBsAg level at the end of NAs treatment are positively correlated with VR. Predictive value for VR of new markers such as HBcrAg, HBV RNA and quantitative detection of anti-HBc remains to be further investigated and confirmed by extensive clinical studies.

Feasibility study of functional residual liver volume in predicting postoperative liver dysfunction in patients with hepatocellular carcinoma

HU Chao-feng¹, TONG Zhong², HUANG Jun³.

2019, 24(7):  752-755. 

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Objective To predict the occurrence of postoperative liver dysfunction in patients with hepatocellular carcinoma (HCC) by using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) to measure and evaluate the related indexes of residual liver.Methods A total of 72 patients with HCC who underwent partial hepatectomy in our hospital from May 2013 to December 2018 were included. The relative enhancement of liver (RE), total liver volume (TLV), standard liver volume (SLV) and functional residual liver volume (FRLV) were measured and calculated by EOB-MRI. The general clinical data and perioperative data of the patients were recorded. Normally distributed data was expressed as mean±standard error, and analyzed by Student’s t-tests. Non-parametric data was expressed as median (interquartile range), and analyzed by Mann-Whitney U test. Categorical data was presented as percentage, and analyzed using Chi-square test for comparison between groups. Logistic stepwise regression model was used for multivariate analysis. Results Among the 72 HCC patients, 9 had liver dysfunction and 63 did not. Univariate analysis showed that preoperative aspartate aminotransferase (AST) (P<0.05), RE (P<0.05) and FRLV (P<0.05) were closely related to the occurrence of postoperative liver dysfunction. They were entered into logistic stepwise regression model, and FRLV was found to be the only independent risk factor for postoperative liver dysfunction (OR=0.572, P<0.05). Conclusion FRLV measured by EOB-MRI has predictive value for postoperative liver dysfunction in patients with HCC.

The relationship between programmed death 1 and inflammatory response in autoimmune hepatitis

HE Qi-jun¹, FU Huo², CHEN Yang³, XU Hai-xia⁴.

2019, 24(7):  756-760. 

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Objective To study the relationship between programmed death 1 (PD-1) and inflammatory response of autoimmune hepatitis (AIH) in liver tissues.Methods A total of 60 AIH patients in our hospital were selected as hepatitis group, and were divided into remission stage group (18 cases) and activity stage group (42 cases) according to the degree of disease activity. Sixty healthy subjects in the same period were selected as healthy control group. The expression of PD-1 was detected by avidin-biotin-peroxidase complex immunohistochemical staining method, and the relationship of its expression with inflammatory response of AIH was analyzed. The correlations between PD-1 and total bilirubin (TB), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were studied. Results The expression of PD-1 in hepatitis group was significantly higher than that in healthy control group (P<0.05), besides, the expression of PD-1 in active stage group was significantly higher than that in remission stage and healthy control group (P<0.05). The expression of PD-1 in grade of liver necroinflammation (G) 0 AIH patients was significantly lower than that in G1-G2 and G3-G4 patients (P<0.05). The expression of PD-1 in G1-G2 AIH patients was significantly lower than that in G3-G4 patients (P<0.05). The expression of PD-1 was positively correlated with TB, AST and ALT (r = 0.853, 0.863, 0.884, P=0.000, 0.000, 0.000). Conclusion There is a certain correlation between PD-1 and the degree of AIH inflammation, suggesting that PD-1 may be involved in the development and progression of AIH, which clinical attention should be paid to.

Study on the enhancement of hepatocyte function of HepG2 induced by novel differentiation culture medium

WANG Zhen-yu, LI Wei-jian, ZHANG Hong-dan, JING Hong-shu, YUAN Tian-jie, PENG Yuan, YAN He-xin, ZHAI Bo.

2019, 24(7):  761-764. 

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Objective To investigate whether the novel hepatic maturation medium (HMM) can improve the hepatocyte function of the liver tumor cell line of HepG2, and to develop a more suitable culture system for HepG2 in combination with 3-dimensional (3D) culture technique.Methods Human hepatoma cell line HepG2 was obtained from the cell bank. Subsequently, the cells were cultured both in 2-dimensional (2D) and 3D, using Dulbecco's modified Eagle medium (DMEM) or HMM. Functional evaluation was performed by quantitative polymerase chain reaction (qPCR), periodic acid-schiff staining, urea synthesis assay. Finally, the sensitivity of cultured HepG2 to chlorpromazine was detected in the 3D condition combined with DMEM and HMM, respectively. Results HMM could increase the glycogen synthesis ability of HepG2, and upregulate the expression levels of Cytochrome P450 3A4(CYP3A4), Na⁺-taurocholate cotransporting polypeptide (NTCP), albumin (ALB), Carbamoyl-phosphase synthetase 1(CPS1) and Glucose-6-phosphatase (G6PC), by 4.7±0.18, 1.3±0.10, 1.4±0.10, 4.9±0.20 and 5.6±0.10 times, respectively. More importantly, in HepG2 cultured using HMM in 3D compared with those in 2D , the expression levels of CYP3A4, NTCP, CPS1, G6PC, and the ability of urea synthesis were further increased by 6.5±0.6, 2.0±0.03, 2.3±0.2, 77±1.2 and 479±196 times, respectively. In addition, HMM significantly improved the sensitivity of HepG2 to chlorpromazine toxicity in 3D culture. Conclusion HMM can improve the hepatocyte function of HepG2 in both 2D and 3D conditions. HMM combined with 3D culture will be helpful in HepG2-based researches.