Table of Content

30 July 2023, Volume 28 Issue 7

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Liver Fibrosis & Cirrhosis

The addition of von Willebrand factor to MELD scoring system improves prediction of short-term prognosis in liver cirrhosis

ZHUANG Yan, LIN lan-yi

2023, 28(7):  759-763. 

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Objective To determine the relationship of plasma von Willebrand factor (vWF) level and the severity of liver cirrhosis and its predictive value when combined with the MELD scoring system in short-term prognosis. Methods A total of 234 cirrhotic patients who were hospitalized in Department of Infectious Diseases, Ruijin Hospital from September 2017 to March 2022 were initially enrolled. Plasma vWF:Ag levels were measured and clinical data were recorded. The correlations between plasma vWF:Ag level and MELD/MELD-Na scores were analyzed. Its predictive effect on 1-month and 3-month prognosis were evaluated. Results Plasma vWF:Ag levels were positively correlated with MELD and MELD-Na scores (r=0.576 and r=0.579, both P<0.01). Death／liver transplantation occurred in 16.7％(29/174) and 24.8％ (38/153) of patients at 1 and 3 months, respectively. Plasma vWF:Ag levels in higher mortality risk groups were both significantly higher than those in lower mortality risk groups (1 month, non-death/liver transplantation vs death/liver transplantation, 224.4±42.7％ vs 260.7±34.5%, P<0.01;3 months, non-death/liver transplantation vs death/liver transplantation, 219.0±40.3％ vs 262.5±34.2％, P<0.01). Multivariate analysis revealed that plasma vWF:Ag level was independently associated with 3-month death/liver transplantation (OR=1.026, 95％CI:1.006~1.046, P<0.01). Prediction of 3-month mortality risk was assessed by receiver operating characteristic curve (ROC-AUC). The diagnostic performance of MELD-Na score was slightly higher than those of MELD score and plasma vWF:Ag level in terms of 3-months outcome, which can be improved by of plasma vWF:Ag level incorporated into MELD-Na score as MELD-Na-vWF score (AUC:vWF:Ag, 0.795;MELD, 0.835;MELD-Na, 0.851;MELD-Na-vWF, 0.881). Conclusion Plasma vWF:Ag level increases with the severity of liver cirrhosis. vWF:Ag was an independent predictor of death／liver transplantation at 3 months. The addition of vWF-Ag to MELD-Na score improves prediction value.

Predictive factors of spontaneous bacterial peritonitis of Gram-positive bacteria in hepatitis B patients

JIN De-fu, JI Jin-ling

2023, 28(7):  764-766. 

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Objective To determine the influencing factors of spontaneous bacterial peritonitis (SBP) caused by Gram-positive and Gram-negative bacterial infections. Methods From October 2015 to February 2020, 116 patients with hepatitis B cirrhosis complicated with SBP were admitted to our hospital, including 92 males and 24 females. The average age was (57.6±7.2). According to the results of ascites culture, they were divided into Gram-positive and Gram-negative groups. The diagnosis of hepatitis B and SBP met the requirements. The flora characteristics were compared between the Gram-positive and Gram-negative groups, and the influencing factors of Gram-positive bacterial infection in patients with hepatitis B cirrhosis complicated with SBP were further analyzed. Results Among 16 patients with hepatitis B cirrhosis complicated with SBP, 41 cases (35.3%) were infected by Gram-positive bacteria and 75 cases (64.7%) were by Gram-negative bacteria. The former included 16 cases of Enterococcus (13.8%), 13 cases of Staphylococcus aureus (11.2%), 10 cases of Aeromonas (8.6%) and 2 cases of Streptococcus (1.7%). The latter included 40 cases of Escherichia coli (34.5%), 27 cases of Klebsiella pneumoniae (23.3%), 6 cases of Pseudomonas aeruginosa (5.2%), and 2 cases of Providence reyi (1.7%). In Gram-positive groups, Child-Pugh score, MELD score and SOFA score of gram-positive group were (7.9±1.8), (18.0±5.8) and (4.7±1.8), respectively, which were significantly lower than those in gram-negative group [(9.7±2.1), (22.4±7.0) and (6.7±2.1), with statistically significant difference (P<0.05). Furthermore, 20 cases (48.8%) and 18 cases (24.0%) in Gram-positive and Gram-negative groups received antimicrobial therapy within one month, respectively, with statistically significant difference (P<0.05). There was no significant difference in age, sex, BMI, serology, ascites index and 28-day mortality between the two groups (P>0.05). By multivariate analysis, antimicrobial therapy within one month and SOFA score were the independent influencing factors of SBP Gram-positive bacterial infection (P<0.05). Conclusion Similarly to the previous studies, the SBP caused by Gram-positive bacteria in patients with liver cirrhosis was significantly related to antimicrobial therapy within one month before SBP diagnosis and low SOFA score. Therefore, it is necessary to consider these factors when diagnosing and treating patients with cirrhosis and SBP.

Diagnostic value of echocardiography combined with plasma NT proBNP in patients with alcohol dependent cirrhosis with cardiac insufficiency

XUE Xue, GAO Qin, ZHAO Sheng

2023, 28(7):  767-771. 

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Objective To investigate the diagnostic value of echocardiography combined with plasma N-terminal pro B-type natriuretic peptide (NT proBNP) in patients with alcohol dependent-cirrhosis with cardiac insufficiency (CIS). Methods From May 2020 to May 2022, 79 patients with alcohol dependent-cirrhosis in the Ultrasound Department of Fuyang Third People's Hospital were enrolled. They were divided into CIS group and non-CIS group. All patients received echocardiography and the plasma NT proBNP level test. The clinical data, Tei index and plasma NT proBNP level between the two groups were compared to analyze the influencing factors of CIS. The diagnostic value of Tei index combined with plasma NT proBNP level for CIS were further evaluated. Results In CIS group, the duration of cirrhosis was (3.12 ± 0.40) years, the proportion of cirrhosis grade C was 58.82%, AST was (79.23 ± 8.92) U/L, ALT was (68.52 ± 9.21) U/L. It was higher than those in non-CIS group, with duration of cirrhosis as (2.44 ± 0.35) years, the proportion of 16.13%, ALT of (58.25 ± 6.23) U/L, AST of (51.28 ± 7.10) U/L (P<0.05). Tei index (0.59 ± 0.16) and plasma NT proBNP level (251.36 ± 39.47) pg/mL in CIS group were also higher than those in non-CIS group (0.48 ± 0.11) and (178.25 ± 30.19) pg/ml (P<0.05). Logistic regression analysis showed that the course of liver cirrhosis, liver cirrhosis grade, Tei index, and plasma NT proBNP level were the risk factors for CIS (P<0.05). The Receiver operating characteristic curve (ROC) analysis showed that the cut-off values of patients with alcohol dependent cirrhosis diagnosed by Tei index and plasma NT proBNP level were 0.54 and 227.42U/ml, AUC values were 0.873 and 0.750. And the AUC value predicted by Tei index combined with plasma NT proBNP level is 0.932. Conclusion Echocardiography combined with plasma NT proBNP showed a high diagnostic value for CIS in patients with alcohol dependent cirrhosis.

The role of shear wave elastography in evaluating hepatic fibrosis and therapeutic response in patients with autoimmune hepatitis

SHI Xia, NI Xue-jun, MA Xin, WU Dou, HUANG Chen

2023, 28(7):  772-774. 

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Objective To determine the effectiveness of shear wave elastography (SWE) in evaluating liver stiffness measurement (LSM) to assess liver fibrosis and treatment response in patients with autoimmune hepatitis (AIH). Methods A total of 65 patients with AIH between June 2017 and October 2022 were enrolled, including 7 males and 58 females, averagely aged 57 (41, 73) years. The diagnosis of AIH met the requirements. According to METAVIR classification, AIH liver fibrosis was classified into stages. Standardized treatment was prednisone combined with or without azathioprine. The clinical data of AIH before and after treatment was compared, and the predictive value of LSM for AIH liver fibrosis staging was analyzed using the ROC curve. Results Among the 65 patients with AIH, there were 16 cases in F1, 21 cases in F2, 15 cases in F3 and 13 cases in F4 stages, respectively. The PLT and Alb of patients with stage F1 AIH were 238 (193, 420) ×10⁹/L and 41.2 (38.0, 43.3) g/L, compared with F2 [194 (130, 253) ×10⁹/L, 37.4 (36.2, 40.4) g/L], F3 [167 (92, 233) ×10⁹/L, 37.0 (35.1, 39.0) g/L] and F4 [118 (74, 170) ×10⁹/L, 34.4 (32.2, 37.1) g/L], F3 [167 (92, 233) ×10⁹/L, 37.0 (35.1, 39.0) g/L], with statistically significant difference (P<0.05). The APRI, FIB-4 and LSM of patients with F1 AIH were 2.6 (1.7, 4.1), 3.0 (2.0, 4.5) and 7.2 (5.0, 9.7) kPa, compared with F2 [4.4 (2.8, 6.8), 6.4 (3.4, 8.3) and 12.7 (7.7, 15.3) kPa], F3 [5.7 (3.0, 7.2), 9.3 (5.8, 13.2) and 13.0 (9.2, 18.7) kPa] and F4 [2.3 (1.4, 3.8), 8.7 (6.4, 12.9) and 15.4 (13.3, 21.5) kPa], with statistically significant difference was (P<0.05). The AUC value of LSM in diagnosis of hepatic fibrosis of AIH in stage ≥F2 and F4 was significantly higher than that of APRI and FIB-4(P<0.05). The cut-off point and AUC value of LSM in diagnosis of AIH liver fibrosis in stage ≥F2 were 8.7 kPa and 0.90 (0.81-0.96), respectively. The cut-off point and AUC value of diagnosis of liver fibrosis in F4 AIH were 13.6kPa and 0.85(0.75-0.93), respectively. Among 65 patients with AIH, 43 patients received steroid therapy and 22 patients did not. Compared with the baseline, both the steroid group and non-steroid group showed significant decreases in ALT and AST during follow-up (P<0.05). Furthermore, the steroid group showed significant decreases in APRI, FIB-4 and LSM [0.6 (0.4, 0.8), 3.3 (1.4, 4.9) and 7.5 (3.2, 9.4) kPa, P<0.05]. However, there was no significant difference in APRI, FIB-4 and LSM at baseline and follow-up in non-steroid group (P>0.05). Conclusion SWE is an effective method to evaluate liver fibrosis in AIH patients. LSM can be used as a reliable parameter to evaluate the response of AIH upon the treatments.

Liver Cancer

Expression and prognostic value of ANLN, CYP2C9 and HMMR in hepatitis B virus-associated hepatocellular carcinoma

HUANG Qian, LI Ya-nan, ZENG Da-wu

2023, 28(7):  775-780. 

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Objective To investigate the expression of actin binding protein (ANLN), Cytochromes P450 (CYPs) subfamily members CYP2C9 and hyaluronic acid mediated movement factor receptor (HMMR) in hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC) tissues and the effects on the prognosis of HCC patients. Methods Samples of 25 surgically resected HCC patients were collected, and immunohistochemistry was used to analyze the differences in the protein expression levels of ANLN, CYP2C9 and HMMR in tumor tissues and adjacent tissues, as well as the effects on postoperative recurrence and long-term survival of HCC patients were evaluated by log-rank test. Results The Immunoreactivity scoring system (IRS) of ANLN and CYP2C9 in tumor tissues of HCC patients were lower than those in adjacent tissues (ANLN:2.4±2.5 vs.3.7±2.7, t=2.18, P=0.039;CYP2C9:4.2±2.8 vs. 8.6±1.4, t=6.21, P<0.001), but the IRS of HMMR in tumor tissues was higher than that in adjacent tissues (8.0 (4.0, 8.0) vs. 4.0 (2.5, 4.0), Z=3.94, P<0.001). However, different protein expression levels of ANLN, CYP2C9 and HMMR had no significant difference in postoperative recurrence time and 5-year survival rate of HCC patients(Disease-free survival high vs. low:ANLN 38.6m vs.33.3 m, CYP2C9 36.5 m vs.35.5 m, HMMR 33.1 m vs.41.3 m;5-year overall survival high vs. low:ANLN 56.3 m vs.51.1 m, CYP2C9 55.1 m vs.51.5 m, HMMR 53.0 m vs.55.2 m;P>0.05). Multivariate Cox regression analysis showed that the influence of BCLC and family history on postoperative recurrence time was statistically different (HR=2.435, P=0.025;HR=0.165, P=0.009). AFP and family history were independently associated with 5-year survival rate in HCC patients (HR=229.488, P=0.041;HR=0.054, P=0.014). Conclusion The protein expression levels of ANLN, CYP2C9 and HMMR were different in HCC tumor and adjacent tissues. It suggested that they could be used as potential markers for the diagnosis of HCC.

Effect of TACE on serum tumor markers and recurrence risk after radical hepatocellular carcinoma resection at different time

LI Gang, CAO Zhi-qun, NIU Shuai

2023, 28(7):  781-784. 

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Objective To observe the effect of transcatheter arterial chemoembolization (TACE) on serum tumor markers and recurrence risk after radical resection of primary hepatocellular carcinoma (HCC). Methods A total of 65 patients with HCC who underwent radical resection in Bozhou Hospital of Traditional Chinese Medicine from March 2016 to October 2019 were divided into observation group (33 cases) and control group (32 cases) by random number table method. Both groups received TACE treatment after radical resection, the observation group received TACE treatment 4 weeks after surgery, the control group received TACE treatment 8~12 weeks after surgery. Both groups received the second treatment 4 weeks after the first TACE treatment. Serum carcinoembryonic antigen (CEA), alpha fetoprotein (AFP), carbohydrate antigen 199 (CA199) were detected. Postoperative complications and intrahepatic recurrence rates were compared between the two groups. Results At baseline, CEA was (26.63±5.19) ng/mL and (25.48±4.03) ng/mL, AFP was (84.39±8.61) μg/L and (85.52±9.36) μg/L, CA199 was (81.06±7.93) U/L and (80.54±6.68) U/L, respectively. There was no significant difference in CEA, AFP and CA199 between the two groups (P>0.05). After treatment, CEA was (4.13±0.72) ng/mL, (6.18±0.95) ng/mL, AFP was (16.28±3.65) μg/L, (24.97±5.14) μg/L, respectively. The CA199 levels of the two groups were (23.74±4.16) U/L and (28.09±5.52) U/L, respectively, which were lower in the observation group (P<0.05). The 1-year recurrence rates of the two groups were 15.15% and 37.50%, the 2-year recurrence rates were 27.27% and 53.13%, and the 3-year recurrence rates were 51.52% and 71.88%, respectively. The 1-year and 2-year recurrence rates of the observation group were lower (P<0.05). In the observation group, there were 2 cases (6.06%) with bone marrow suppression, 15 cases (45.45%) with liver function impairment, 9 cases (27.27%) with fever, 12 cases (36.36%) with upper abdominal pain, and 7 cases (21.21%) with digestive tract symptoms. In the control group, there were 3 cases with bone marrow suppression (9.38%), 13 cases with liver function impairment (40.63%), 6 cases with fever (18.75%), 10 cases with upper abdominal pain (31.25%) and 8 cases with digestive tract symptoms (25.00%). There were no significant differences in the incidence of complications (P>0.05). Conclusion TACE 4 weeks after radical resection of HCC is safe, and is beneficial to down-regulate the levels of serum tumor markers such as CEA, AFP and CA199. It reduces the recurrence rate within 2 years after surgery, with no significant effect on the recurrence rate after 2 years.

Application of SVM prediction model in judging the degree of pathological differentiation of primary hliver cancerepatocellular carcinoma

CHEN Yong-ying, PENG Pan, XU Lei-lei

2023, 28(7):  785-788. 

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Objective To study the application value of linear support vector machine (SMV) prediction model in judging the degree of pathological differentiation of primary hepatocellular carcinomaliver cancer (HCC). Methods A total of 78 patients who were diagnosed with HCC from June 2018 to June 2020 in Wuxi Fifth People's Hospital were selected. All patients underwent CT texture analysis, selected the characteristics of arterial phase, and used the SMV prediction model to judge the degree of HCC pathological differentiation. Taking postoperative pathological examination results as the gold standard, Kappa test was used to determine the consistency of the arterial phase SVM in predicting the degree of tumor differentiation in CT texture analysis. Results The degree of tumor differentiation of 78 HCC patients was poorly differentiated, moderately differentiated, and well differentiated, accounting for 25.64 %, 34.62 %, and 39.74 % of the total. The arterial phase SVM judged that the tumors of HCC patients were poorly differentiated, moderately differentiated, and highly differentiated, and the results of pathological examination were relatively consistent. The Kappa values were 0.835, 0.860, and 0.892, respectively. The sensitivity, specificity and accuracy of arterial SVM in predicting HCC differentiation were 85.71 %, 96.49 % and 93.59 %, respectively. The sensitivity, specificity and accuracy of in predicting HCC differentiation were 89.29 %, 96.00 % and 93.59 %, respectively, . The sensitivity, specificity and accuracy oinf predicting high differentiation of HCC were 96.55 %, 93.88 % and 94.87 %, respectively. Conclusion The SMV prediction model has a high value in judging the degree of HCC pathological differentiation.

The inhibitory effects of mTOR inhibitor combined with ursodeoxycholic acid on the growth, immune escape, and Ras/ERK signaling pathway of hepatocellular carcinoma in rats

YANG Ya-meng, LUO Dan-feng

2023, 28(7):  789-793. 

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Objective To investigate the effects of mTOR inhibitor combined with ursodeoxycholic acid (UDCA) on the inhibition of growth, immune escape and Ras/ERK signaling pathway of hepatocellular carcinoma (HCC) in rats. Methods A total of 50 SPF grade of SD male rats were randomly divided into a normal (NO) group, a model (MO) group, a mTOR inhibitor (MI) group, a UDCA (UD) group, and a mTOR inhibitor combined with UDCA (UN) group, with 10 rats in each group. HCC model was established by intraperitoneally injection of Diethylnitrosamine (DMN) in each group of rats except the NO group. After successful modeling, the MI group was administrated with 2 mg/kg of mTOR inhibitor sirolimus, the UD group was given 30 mg/kg of UDCA, and the UN group was given 2 mg/kg of mTOR inhibitor sirolimus and 30 mg/kg of UDCA. The tumor growth in rats of NO group and MO group was observed and recorded by intragastric administration of the same volume of normal saline. The pathological morphology of liver tissue was detected by H&E staining. The immune escape related factors were detected by enzyme linked immunosorbent assay (ELISA), and the expression of Ras/ERK signaling pathway related proteins was detected by Western blotting. Results Compared with the NO group, the body weight of the MO group was significantly decreased (P<0.05), and the liver weight and liver coefficient were significantly increased (P<0.05). Compared with the MO group, the body weight of the MI group was significantly increased (P<0.05), and the liver weight and liver coefficient were significantly decreased (P<0.05). There were no significant differences in body weight, liver weight and liver coefficient in the UD group (P>0.05). Compared with the UD group, the body weight of rats in the UN group was significantly increased (P<0.05), and liver weight and liver coefficient were significantly decreased (P<0.05). While the tumor inhibition curve of the MI group was significantly increased compared with the MO group (P<0.05), there was no significantly difference between those of the UD group and the MI group (P>0.05). Compared with the UD group, the tumor inhibition curve of the UN group was significantly increased (P<0.05). The liver morphology of rats in NO group showed clear and intact liver lobular structure, radiate out in a clear demarcation without cell hyperplasia, death and inflammatory cells infiltration. The liver tissues of MO group showed that the liver cable structure was unclear, with disordered swelling cells, visible cancer nests and a large number of inflammatory cells infiltration. When compared with the MO group, the pathological structure of MI group, UD group, and UN group obviously improved, Inflammatory cells and cancer cells decreased. The serum levels of IL-4, IL-10 and TGF-β1 in rats of MO group were significantly higher than those of rats in the NO, MI, UD and UN groups (P<0.05). There was no difference between the UD group and the MI group (P>0.05), and the UN group was significantly lower than the UD group (P<0.05). The expressions of Ras protein in NO group, MO group, MI group, UD group and UN group were 1.16±0.11, 2.26±0.29, 1.51±0.17, 1.55±0.18, 1.19±0.14, respectively. The expression of P-ERK protein was 1.05±0.10, 2.94±0.28, 1.66±0.14, 1.68±0.16, 1.14±0.11, respectively. The expressions of Ras and P-ERK proteins in liver tissue of rats in MO group was significantly increased when compared with those of the NO group (P<0.05), The protein expressions of Ras and P-ERK in the liver tissues of rats in MI, UD and UN groups were significantly decreased compared with those of the MO group (P<0.05). There was no difference between the UD group and the MI group (P>0.05), but the expressions in the UN group was significantly decreased compared with the UD group (P<0.05). Conclusion mTOR inhibitor combined with ursodeoxycholic acid (UDCA) can significantly inhibit tumor growth, immune escape and the activation of Ras/ERK signaling pathway in HCC rats.

Liver Failure

The value of serum prealbumin-bilirubin scores for predicting the prognosis of hepatitis B virus associated acute-on-chronic liver failure treated by plasma exchange

CHEN Li-xia, XU Zhen-e, LIU Hai-yu, LIN Jian-hui

2023, 28(7):  794-798. 

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Objective To explore the value of serum prealbumin bilirubin score (PALBI) in evaluating the short-term prognosis of patients with hepatitis B virus-associated chronic acute liver failure (HBV-ACLF) treated with plasma exchanges (PE). Methods A total of 112 HBV-ACLF patients who received mutiple times (>3) of PE treatment were enrolled in this study. According to the clinical outcomes of patients, they were divided into two groups: a survival group and a death group. The difference of baseline characteristics between the two groups was analyzed and compared. The independent prognostic factors of patients post PE treatments were analyzed by multivariate analysis with an establishment of PALBI model. The differentiation of PALBI was evaluated by receiver operator characteristic curve (ROC) method. The model for end-stage liver disease model (MELD) and albumin-bilirubin (ALBI) scores of patients in each group were compared. Results Among the 112 cases of HBV-ACLF treated with PE, 77 cases survived and 35 cases died. Compared with the survival group, the proportion of patients with hepatic encephalopathy in the death group [15.58% vs. 48.57% (χ²=11.980, P=0.001)] and the advanced stages of liver failure disease [in the early stage 27.27% vs. 22.86%, in the middle stage 64.93% vs. 40%, in the advanced stages 7.80% vs. 37.14% (χ²=14.021, P=0.001)] was higher, the total bilirubin level was higher [364.07(287.05, 427.95) vs 456.16(351.20, 542.90) (Z=-3.810, P<0.001)], the prothrombin time was longer [22.61(18.40, 24.75), 26.58(21.40, 30.40) (Z=2.916, P=0.004)], and the prealbumin level was reduced [51.23 (37.50, 62.50), 37.14 (25.00, 52.00) (Z=3.212, P=0.001)]. Multivariate analysis showed that total bilirubin and prealbumin were independent influencing factors for the short-term poor prognosis of HBV-ACLF patients, The regression coefficient of total bilirubin was 0.011 (95%CI: 1.005~1.017; P<0.001), the regression coefficient of prealbumin was -0.064 (95CI%: 0.903~0.975; P=0.001), and the PALBI = 0.011×[TBIL (μmol/L)]-0.064×[PAB (mg/L)]-1.848. The area under the curve (AUC) of ROC for the PALBI model=0.827(95%CI:0.747~0.908, P<0.001), for MELD model=0.710 (95%CI: 0.604~0.815, P<0.001), for ALBI score=0.726 (95%CI:0.631~0.821, P<0.001), Pairwise comparison of ROC curve of PALBI and MELD (Z=2.470, P=0.014), and pairwise comparison of PALBI and ALBI (Z=2.274, P=0.023), shown that PALBI was better than ALBI score and MELD for predicting the prognosis of PE treatment (P<0.05). Conclusion PALBI has a certain clinical value in predicting the short-term prognosis of HBV-ACLF patients treated with plasma exchanges.

Non-alcoholic Fatty Liver Disease

The clinical characterization and serum lipidomic analysis of lean nonalcoholic fatty liver disease

ZHANG Si-min, DU Shen-nan, YUAN Yi-fu, HE Shi-jia, CAO Qin, JIANG Yuan-ye

2023, 28(7):  799-805. 

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Objective To compare the clinical features and serum lipidomic profiles between lean nonalcoholic fatty liver disease (NAFLD) patients and lean healthy subjects. Methods A total of 57 patients with lean NAFLD and 50 lean healthy controls were included in this study. The clinical information and blood biochemical indicators of all subjects were collected. The serum lipidomics was analyzed by ultra-performance liquid chromatography-Orbitrap mass spectrometry (UPLC-Orbitrap MS). Principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA) were used for multivariate statistical analysis of lipidomics data. Results The gender difference between the lean NAFLD group and the lean control group was statistically significant (P<0.05). BMI in the lean NAFLD group was significantly higher than that in the lean control group (P<0.01). Among the blood biochemical indexes, white blood cells (WBC), red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), creatinine, uric acid, γ-glutamyl transpeptidase (γ-GT), alanine aminotransferase (ALT) and triglyceride (TG) are (6.10±1.57)×10⁹/L, (4.51(4.34, 4.81))×10¹²/L, (137(127, 148))g/L, (41.1 (38.15, 43.7)%, (67 (57.5, 81)) μmol/L, (339.5 (298.75, 380)) μmol/L, (27 (19, 37)) U/L, (14.5 (9, 21.25)) U/L, (1.42 (0.95, 1.95)) μmol/L, respectively, which were significantly higher than those in the control group (P<0.05 or P<0.01), while HDL and APOA1 in the thin NAFLD group were (1.27 (1.10, 1.52) μmol/L, and (1.39 (1.29 6, 1.57)) g/L, which were significantly lower than those of the control group (P<0.05 or P<0.01). The results of lipomics showed that there were significant differences in lipid metabolism between the two groups. A total of 570 kinds of differential lipids were identified (VIP value>1, P<0.05) with the fold change of content difference between the two groups >1.5 (FC>1.5), mainly including phosphatidylcholine (PC), triglyceride (TG), sphingomyelin (SM), lysophosphatidylcholine (LPC), phosphatidylethanolamine (PE), diglyceride (DG), lysophosphatidylethanolamine (LPE) and ceramide (Cer). Compared with the control group, most of the serum lipids in the lean NAFLD group were up-regulated; The main serum lipids with downregulated trend included 22 kinds of SM and 22 kinds of PC. Conclusion The clinical characteristics of lean NAFLD patients suggest that they may have metabolic abnormalities, impaired liver function, and insulin resistance compared with lean healthy subjects. Serum lipidomics results showed that the profile of lipid metabolism in patients with lean NAFLD was significantly different from that in lean healthy subjects. These results have reference meaning for further study of the pathogenesis of lean NAFLD and provide potential application for the diagnosis of NAFLD in lean individuals.

Effect of serum Maresin-1 level on nonalcoholic fatty liver disease

ZHAO Xin-yi, SUN Jie, XU Wei-xin

2023, 28(7):  806-809. 

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Objective To compare the clinical data of nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis B (CHB), and to explore the relationship between Maresin-1 (MaR1) and liver histological features of NAFLD patients, including liver fibrosis stages, and liver inflammation and fatty liver degrees. Methods From January 2021 to February 2022, 126 NAFLD patients (NAFLD group) were selected, including 75 males and 51 females, with an average age of (44.3±8.4) years. In the same period of time, 120 patients with CHB (CHB group) were selected as the control group, including 63 males and 57 females, aged (41.6±7.3) years. The diagnosis of NAFLD and CHB met the requirements. The clinical data of NAFLD group and CHB group were compared, and the changes of MaR1 level in patients with NAFLD were analyzed. receiver operator characteristic curve (ROC) was constructed, The value of area under the curve (AUC) was calculated, and the cutoff point of serum MaR1 for NAFLD patients with different liver histology was analyzed. Results BMI of NAFLD group and CHB group was (27.3±3.4) mg/m² and (22.5±2.7) mg/m², the difference was statistically significant (P<0.05). Compared with CHB group [(4.8±1.0) mmol/L], FBG in NAFLD group increased significantly [(5.7±1.0) mmol/L, P<0.05]. The levels of ALT, AST, TC, TG, UA, LDL and Scr in NAFLD group were (38.0±5.2) U/L, (34.8±5.0) U/L (5.0±0.7) mmol/L, (2.0±0.5) mmol/L, (5.2±0.6) mmol/L, (3.4±0.5) mmol/L and (70.5±14.6) μmol/L, compared with CHB group [(26.8±4.3) U/L, (23.0±4.1) U/L, (4.6±0.6) mmol/L, (1.2±0.4) mmol/L, (4.7±0.4) μmol/L, (3.0±0.5) and (63.3±12.9) μmol/L, the difference was statistically significant (P<0.05). The HDL levels in NAFLD group and CHB group were (1.1±0.3) mmol/L and (1.4±0.4) mmol/L, and the difference was statistically significant (P<0.05). Compared with CHB group [(79.1±5.5) pg/mL], MaR1 in NAFLD group decreased significantly [(63.6±4.3) pg/mL, P<0.05]. The liver fibrosis stages were F0 stage in 18 cases, F1 stage in 26 cases, F2 stage in 44 cases, F3 stage in 23 cases and F4 stage in 15 cases. The MaR1 of each liver fibrosis was (78.8±5.7) pg/mL, (73.0±5.0) pg/mL, (65.2±4.4) pg/mL, (60.4±4.5) pg/mL and (57.0±4.4) pg/mL, respectively, the difference was statistically significant (P<0.05). The degree of liver inflammation was grade 1 in 29 cases, grade 2 in 62 cases, grade 3 in 23 cases and grade 4 in 12 cases, the inflammatory degree of each liver tissue MaR1 was (75.6±5.4) pg/mL, (66.9±4.8) pg/mL, (60.6±5.3) pg/mL and (50.2±5.0) pg/mL, respectively, the difference was statistically significant (P<0.05). In patients with NAFLD, the degree of hepatic steatosis was S0 in 25 cases, S1 in 46 cases, S2 in 35 cases and S3 in 20 cases. The degree of hepatic steatosis MaR1 was (77.8±5.2) pg/mL (72.4±5.1) pg/mL, (64.0±4.4) pg/mL and (61.3±4.6) pg/mL, respectively, the difference was statistically significant (P<0.05). The cut-off points of serum MaR1 were 68.2 pg/mL, 70.5 pg/mL and 66.6pg/mL, respectively, when evaluating liver fibrosis stage ≥F2, liver tissue inflammatory activity grade ≥2 and liver steatosis degree ≥S2, the corresponding AUC values are 0.78, 0.77 and 0.87, respectively. Conclusion Serum MaR1 level in patients with NAFLD decreased significantly, which can be used to predict and prevent the occurrence of NAFLD.

The clinical significance of the alteration of serum 25(OH)D levels in obese children with nonalcoholic fatty liver disease

LI Hong-lin, DENG Quan-min

2023, 28(7):  810-813. 

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Objective To investigate the changes of serum 25-hydroxyvitamin D[25(OH)D] levels and its clinical significance in obese children with nonalcoholic fatty liver disease (NAFLD). Methods The clinical data of 120 obese children admitted to our hospital from April 2021 to April 2023 were selected for a correlation analysis. According to whether the children had NAFLD or not, they were divided into an obesity group with NAFLD and an obesity group without NAFLD, with 54 cases and 66 cases in each group, respectively. The clinical data of the two groups were compared. Multivariate logistic regression was used to analyze the risk factors of NAFLD in obese children. Results There were 34 (62.96%) boys in the obese NAFLD group and 28 (42.42%) boys in the obese group (χ²=5.017, P=0.025). The average age of the obese MAFLD group was (12.23±3.04) years, and that of the obese group was (10.48±2.62) years (t=3.386, P=0.001). Body mass index (BMI) in the obese NAFLD group was (30.07±5.11) kg/m², and that of the obese group was (25.06±2.55) kg/m² (t=6.978, P=0.000). Triglyceride (TG) in the obese NAFLD group was (1.29±0.32) mmol/L, and that of the obese group was (0.88±0.24) mmol/L (t=8.015, P=0.000). Low-density lipoprotein cholesterol (LDL-C) in the obese NAFLD group was (2.54±0.74) mmol/L, and that of the obese group was (2.29±0.52) mmol/L, (t=2.168, P=0.032). Fasting insulin (FINS) in the obese group was (12.68±3.84) mmol/L and that of the obese group was (9.67±3.11) mmol/L (t=4.745, P=0.000). Homeostasis model assessment-insulin resistance (HOMA-IR) of the obese NAFLD group was (2.05±0.34) and that of the obese group was (1.78±0.38) (t=4.058, P=0.000). Alanine transaminase (ALT) in the obese NAFLD group was (52.74±14.81) U/L and that of the obese group was (24.16±7.22) U/L (t=13.808, P=0.000). Aspartate transaminase (AST) in the obese NAFLD group was (36.02±10.14) U/L and that in he obese group was (22.44±6.43) U/L (t=8.912, P=0.000). Serum 25-hydroxyvitamin D [25(OH)D] in the obese NAFLD group was (21.03±5.14) ng/mL, and that of the obesity group was (25.08±6.86) ng/mL (t=3.590, P=0.001). Logistic analysis showed that BMI and HOMA-IR were independent risk factors, and 25(OH)D was a protective factor for NAFLD in obese children (P<0.05). Conclusion Serum 25(OH)D level in obese children with NAFLD are significantly decreased. The. monitoring of serum 25(OH)D level may provide guidance for formulating clinical protocols.

The association between Helicobacter pylori infection and nonalcoholic liver disease

WANG Yuan-yuan, LI Xiao-meng, DING Xiu-ting

2023, 28(7):  814-817. 

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Objective To study on the relationship between Helicobacter pylori (Hp) infection and non-alcoholic liver disease (NAFLD), and to observe the changes of metabolic parameters before and after Hp eradication. Methods A total of 490 patients who underwent physical examination in Qinhuangdao Military Hospital were divided into a NAFLD group (N=127 cases) and a control group (N=363 cases). The general data and serological indicators of these two groups were compared. The influencing factors of NAFLD were analyzed by Logistic regression, and the metabolisms of glucose and lipid were observed before and after the eradication treatment of Hp. Results The body mass index was (25.36±2.97)kg/m² in the NAFLD group, and (21.53±2.62)kg/m² in the control group (t=13.685, P<0.001). There were 30 cases (23.62%) of hypertension in the NAFLD group and 24 cases (6.61%) of hypertension in the control group (χ²=27.763, P<0.001). The alanine aminotransferase level was (31.03±22.56)U/L in the NAFLD group and (17.15±12.25) U/L in the control group (t=8.641, P<0.001). The glutamic oxaloacetic transaminase level was (23.24±11.67)U/L in the NAFLD group and (17.97±7.52)U/L in the control group (t=5.821, P<0.001). The level of LDL cholesterol was (2.84±0.84) mmol/L in the NAFLD group and (2.52±0.68) mmol/L in the control group (t=4.283, P<0.001). The level of high density lipoprotein cholesterol was (1.20±0.27)mmol/L in the NAFLD group and (1.61±0.39)mmol/L in the control group (t=10.960, P<0.001). The total cholesterol level was (5.11±1.02)mmol/L in the NAFLD group and (4.69±0.93)mmol/L in the control group (t=4.270, P<0.001). Triacylglycerol level was (2.38±1.81)mmol/L in the NAFLD group and (1.30±0.95)mmol/L in the control group (t=8.510, P<0.001). The fasting blood glucose was (4.98±1.28)mmol/L in the NAFLD group, and (4.49±0.96)mmol/L in the control group (t=4.518, P<0.001). There were 54 cases (42.52%) of Hp infection in the NAFLD group and 112 cases (30.85%) in the control group (χ²=5.716, P=0.017). Logistic regression analysis showed that body mass index (OR=4.125, 95%CI: 1.792~9.495), hypertension (OR=3.793, 95%CI: 1.836~7.836), alanine aminotransferase (OR=3.412, 95%CI: 1.625~7.164), aspartate aminotransferase (OR=3.314, 95%CI: 1.568~7.004), low-density lipoprotein cholesterol (OR=2.506, 95%CI: 1.307~4.805), high-density lipoprotein cholesterol (OR=2.741, 95%CI: 1.110~6.769), total cholesterol (OR=3.644, 95%CI: 1.194~11.121), triglyceride (OR=2.815, 95%CI: 1.246~6.360), fasting blood glucose (OR=3.488, 95%CI: 1.712~7.106) and Hp infection (OR=3.073, 95%CI: 1.429~6.608) were the influencing factors of NAFLD (P<0.05). The fasting blood glucose, fasting insulin, insulin resistance index, total cholesterol, triglyceride and low density lipoprotein cholesterol of NAFLD patients with Hp infection after Hp eradication treatment were (6.17±0.69)mmol/L, (7.66±1.34)μIU/mL, (2.11±0.31) and (3.25±0.68), (1.54±0.42)mmol/L, (0.94±0.30)mmol/L, respectively, which were lower than those of (6.91±1.04)mmol/L, (11.18±2.83)μIU/mL, (3.62±0.50), (6.62±1.51) mmol/L, (4.53±1.33) mmol/L, (3.63±0.73) mmol/L before treatment, On the contrary, the level of high density lipoprotein cholesterol was (2.75±0.62)mmol/L, which was higher than that of (1.39±0.54)mmol/L before treatment (P<0.05). Conclusion Hp infection is correlated with NAFLD. It is necessary to actively eradicate Hp for the treatment of NAFLD.

Mechanism study of liver steatosis induced by amiodarone via PPARα signaling pathway

SUN Shuang-shuang,TAO Shuai,TANG Xi-xi,FU Qing-chun

2023, 28(7):  818-822. 

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Objective To investigate the mechanism of hepatic steatosis induced by amiodarone. Methods Male C57BL/6J mice aged 8 weeks were divided into 3 groups of 5.control group with normal diet (WT group, n=5); Amiodarone at 150mg.kg-1.d-1 was administered intragastatically for 10 days as the model group (AM group, n=5). In the intervention group (AM+PPARα agonist WY14643 (2.5mg/kg), n=5) amiodarone was used simultaneously by gavage with WY14643 (2.5mg/kg) for 10 consecutive days;After 10 day, serum alanine aminotransferase, aspartate aminotransferase, triglyceride, total cholesterol and high density lipoprotein in each group were detected.The pathological changes of liver were observed by HE staining and oil red staining. The expression of PPARαand its regulated lipid metabolism genes were detected by RT-PCR. t test was used for intra-group comparison, one-way analysis of variance was used for inter-group comparison, and Mann-Whitney U test for non-parametric test was used for semi-quantitative data. Results Pathological observation showed that compared with the model group, the results of liver oil red and HE staining in the intervention group showed that the liver fat change was significantly reduced ;RT-PCR results showed that mRNA expression of PPARαand downstream related genes CPTI, Cyp4a14, Acot1decreased in amiodarone group. After treatment, the expressions of PPARα and some related genes were increased compared with those of model group ((P=0.0003, 0.0157, 0.0057, 0.0203). Conclusion Amiodarone may induce liver steatosis by regulating PPARα and its downstream related genes.

Other Liver Diseases

Effect of terlipressin on acute kidney injury after liver transplantation

XU lei, CAO Lin, WU Ming-ming, ZHANG Yan-lin, SUN Hao

2023, 28(7):  823-826. 

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Objective To analyze the impact of perioperative terlipressin on bleeding and postoperative renal function following liver transplantation. Methods A retrospective analysis was performed on 236 patients who underwent liver transplantation at our hospital from September 2020 to September 2022. Patients were divided into two groups based on whether they received a continuous intraoperative terlipressin infusion: the terlipressin group and the control group. Clinical data from both intraoperative and postoperative periods were compared using propensity score matching to balance preoperative variables. Results Among the 224 patients included in the subgroup analysis, acute kidney injury occurred in 87 (38.8%) individuals. Using 1:1 propensity score matching, 89 patients who received perioperative terlipressin were matched with 69 control patients In the terlipressin group (n=69), 25 patients (36.2%) developed acute kidney injury, which was lower than the 30 patients(43.5%) in the control group (n=69). However, there was no statistical difference between the two groups (P>0.05). There was also no significant difference in perioperative bleeding and blood transfusion rates between the two groups (P>0.05). The perioperative urine volume in the terlipressin group was significantly higher[median: 1250ml, interquartile range: 875 mL-1750 mL] compared to the control group [median: 950ml, interquartile range: 565 mL-1450 mL](P<0.05). For severe acute kidney injury, the terlipressin group had fewer instances(3 cases, 4.3%) compared to the control group(12 cases, 17.4%) (P<0.05). Conclusion Continuous infusion of terlipressin during the perioperative period can significantly enhance perioperative urine output and may potentially reduce the incidence of severe acute kidney injury.

Cross-sectional investigation and analysis of factors influencing bed procrastination, depression, and anxiety among living donors

LU Ye-feng, GU Hai-feng

2023, 28(7):  827-832. 

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Objective To investigate the bed procrastination, depression and anxiety of donors involved in pediatric living-related liver transplantation. Methods A total of 97 living donors were assessed via the Bedtime Procrastination Scale, the Generalized Anxiety Disorder 7-item(GAD-7), and the Patient Health Questionnaire 9-item(PHQ-9), among others. Results The average age of the participants was 31.8±6.5 years. Their average height and weight were 165.7±7cm and 59.9±9.0kg, respectively. The mean score of bed procrastination was 29.2±7.3, showing no significant statistical difference compared with college students. The PHQ-9 and GAD-7 scores were 7.9±7.0 and 8.2±7.1, respectively. Single factor analysis showed that “debt” and “satisfaction with housing conditions” were significant impact factors of depression and anxiety. Multiple regression analysis revealed that GAD-7 scores and fatigue were significant impact factors for depression, while PHQ-9 scores, fatigue and happiness were significant impact factors for anxiety. Conclusion The bed procrastination of living donors was slightly higher than the medium level, showing no statistical difference compared to college students. GAD-7 scores and fatigue were found to be significant factors influencing depression, while PHQ-9 scores, fatigue and happiness were significant factors influencing anxiety.

Impact of blood supply type on the three-year therapeutic effect of interventional embolitzation in patients with hepatic hemangioma

HAN Ting-chao, WANG Zhong, SHEN Meng-yuan, TANG Meng-ge, YU Jin-song

2023, 28(7):  833-836. 

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Objective To investigate the effect of different blood supply types on the three-year efficacy of interventional embolism of patients diagnosed with hepatic hemangioma(HL). Methods A total of 75 HL patients admitted from July 2016 to July 2019 were enrolled as the study subjects and were divided into group A (rich blood supply, n=25), group B (moderate blood supply, n=28) and group C (deficient blood supply, n=22) according to the type of blood supply, and all patients underwent interventional embolism and were followed up for 3 years post-procedure. Clinical efficacy, maximum lesion diameter, and liver function metrics, including alanine aminotransferase (ALT) and total bilirubin (TBil)] levels, were compared among the three groups at 6, 12, and 36-month post-procedure. Results Compared with pre-operation measurements, the diameter of the lesion was significantly reduced post-operation in Group A (9.41±1.81, 5.71±0.94, 2.91±0.26, 2.74±0.21, respectively), Group B (9.52±1.87, 5.87±1.03, 3.29±0.38, 2.89±0.27, respectively), and Group C (9.39±1.87, 7.17±1.55, 6.53±0.78, 6.15±0.63, respectively) (P<0.05); The postoperative efficacy rates in Group A (64.00%, 80.00%, 88.00%) and Group B (64.29%, 67.86%, 78.57%) were notably higher than in Group C (22.73%, 31.82%, 31.82%). Moreover, the postoperative diameters of lesions in groups A and B were lower than that in group C (P<0.05). No significant differences were observed in ALT and TBIL among the three groups at different postoperative time points (P>0.05). Postoperative complications, such as nausea, vomiting, fever, and pain were reported in all three groups. The rich blood supply group reported 2 cases of Liver injury and one case of liver abscess. The moderate blood supply group reported 2 cases of liver injury and 1 case of biliary duct injury. The deficient blood supply group reported 2 cases of liver injury, and all complications were successfully managed with symptomatic treatment. Conclusion The therapeutic effect of interventional embolization varies among HL patients with different types of blood supply. Specifically, patients with a rich or moderate blood supply tend to experience therapeutic outcomes, while those with a deficient blood supply have less favorable results. However, the type of blood supply does not appear to influence the complications or liver function in HL patients following interventional embolization.

Factors affecting thrombus formation and efficacy of interventional therapy in patients with type II Budd-Chiari syndrome

GAO Yan-mei, ZHANG Hui-ling, LEI Wen-fang

2023, 28(7):  837-839. 

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Objective To investigate the influencing factors of inferior vena cava (IVC) thrombosis in patients with type Ⅱ Budd-Chiari syndrome(BCS) and observe the curative effect of interventional therapy. Methods From January 2005 to January 2020, 106 patients with type Ⅱ BCS successfully treated by interventional therapy in our hospital were analyzed, including 66 males and 40 females, aged (45.4±10.4) years. They were divided into groups based on the presence or absence of thrombus. The treatment encompassed urokinase thrombolysis via catheter, balloon dilatation or stent implantation. The clinical data of patients with or without type Ⅱ BCS were analyzed by univariate and multivariate analysis. The patients were followed up and the effectiveness of the interventional therapy was assessed by comparing the patients conditions before and after interventional. Results Out of the 106 patients with type Ⅱ BCS, 17 cases were complicated by thrombus formation (Group A), while the remaining 89 cases exhibited no such complication(Group B). The median age in Group A [50 (43, 67) years old] was significantly higher than that of Group B [44 (37, 62) years old, P<0.05]. Abdominal distension and ascites in Group A were 10 cases (58.8%) and 9 cases (52.9%) respectively, which were significantly higher than those in Group B[29 cases (32.6%) and 21 cases (23.6%) respectively, P<0.05]. The median levels of WBC, ALT, AST, TBil, Alb, PTA and fibrinogen in Group A were 5.7 (4.4, 7.1) ×10⁹/L, 77 (52, 146) U/L, 74 (60, 135) U/L, 36.4 (23.4, 78.6) μmol/L, 34 (28, 37) g/L, 66 (63, 70) % and 5.2 (3.4, 7.0) g/L respectively. When compared with those in Group B[4.3 (3.0, 6.5) × 10⁹/L, 24 (15, 80) U/L, 31 (18, 76) U/L, 25.2 (16.8, 44.0) mol/L, 39 (35, 46) g/L, 75(70, 78) % and 2.9 (2.6, 6.0) g/L], The differences were statistically significant(P<0.05). The Child-Pugh scores of Group A and Group B were 7.3 (6.0, 9.2) points and 6.4 (4.8, 7.0) points respectively, the difference being statistically significant (P<0.05). Significant factors(P<0.05) were further subjected to multivariate analysis, revealing age, WBC count, TBil and Alb as statistically distinct from other factors(P<0.05), thus deeming them as independent influencers of type Ⅱ BCS complicated by thrombosis. Among the 17 patients with type Ⅱ BCS complicated by thrombus, 14 cases experienced complete dissolution, 3 showed partial dissolution, and in all patients, unobstructed IVC blood flow was achieved. The pressure difference between the IVC and right atrium significantly decreased from the preoperative measure[19 (14, 27) cmH₂O] to the postoperative measure[5 (3, 8) cmH₂O, P<0.05]. In a follow-up period ranging from 1 to 40 months, there was one death; two cases of IVC restenosis were successfully managed with additional balloon dilatation again. Conclusion Age, WBC and TBil serve as independent risk factors for thrombosis in patients with type Ⅱ BCS, while Alb is a protective factor. The recurrence rate for thrombosis in patients with type Ⅱ BCS who undergo interventional therapy is low, indicating a satisfactory long-term therapeutic outcome.

Correlation of serum NLR, sVCAM-1 and IGFBP-3 levels with the severity and prognosis of intrahepatic cholestasis during pregnancy

GU Jing-xian, ZHANG Ying-ping, XU Xiao-ying

2023, 28(7):  840-844. 

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Objective To investigate the value of serum neutrophil/lymphocyte ratio (NLR), soluble vascular cell adhesion factor-1 (sVCAM-1) and insulin-like growth factor binding protein 3 (IGFBP-3) in the diagnosis and prognosis of intrahepatic cholestasis during pregnancy (ICP). Methods A total of 83 pregnant women with ICP admitted from January 2019 to December 2021 were included in the observation group. They were divided into mild subgroup (n=34), moderate subgroup (n=30) and severe subgroup (n=19) according to serum TBA level. Based on pregnancy outcomes, they were further classified into good outcome subgroup (n=65) and poor outcome subgroup (n=18). Meanwhile, 35 healthy pregnant women who underwent prenatal checkups and delivery during the same period were included in the control group. The levels of NLR, SVCAM-1 and IGFBP-3 were compared between the observation group and the control group, as well as among the subsets of the observation group categorized by disease severity and different pregnancy outcomes. Pearson analysis was used to examine the correlation of NLR, sVCAM-1 and IGFBP-3 levels with serum ALT, TBil levels, fetal growth restriction (FGR) and postoperative blood loss. ROC curves were constructed to assess the diagnostic and prognostic efficacy of individual and combined measurements of NLR, sVCAM-1 and IGFBP-3 levels for ICP. Results The NLR and sVCAM-1 levels in the observation group were 3.76±0.85 and 769.50±69.53 pg/L respectively, which were significantly higher than those in the control group (1.82±0.49 and 423.29±48.37 pg/L respectively). Additionally, the IGFBP-3 level in the observation group was 4.38±0.72 μg/L. The differences were statistically significant (t=9.528, 15.947, 11.852, all P<0.05). The NLR and sVCAM-1 levels in the severe subgroup were 4.86±1.025 and 952.41±89.76 pg/L respectively, higher than those in both the moderate (3.90±0.85 and 734.65±67.53 pg/L) and mild subgroups(2.71±0.69 and 564.52±55.49 pg/L respectively). The IGFBP-3 level in the severe subgroup was 2.36±0.42 μg/L, lower than those in the moderate and mild subgroups (2.93±0.54 μg/L and 3.58±0.67 μg/L respectively), the differences were statistically significant (F=23.924, 36.571, 17.862, all P<0.05). The NLR and SVCAM-1 levels of the poor outcome subgroup were 4.95±1.05 and 971.46±92.35 pg/L respectively, which were higher than those of the good outcome subgroup (3.67±0.78 and 698.75±63.24 pg/L respectively). Moreover, the IGFBP-3 level in the poor outcome subgroup was 2.24±0.39 μg/L, significantly lower than the 3.12±0.58 μg/L observed in the good outcome subgroup, the differences were statistically significant (t=8.207, 7.853, 7.426, all P<0.05). Pearson analysis showed that in the observation group, NLR and sVCAM-1 were positively correlated with ALT, TBIL, and postoperative blood loss, and negatively correlated with FGR. IGFBP-3 was positively correlated with FGR, but negatively correlated with ALT, TBIL and postoperative blood loss (P<0.01). ROC curve revealed that the AUC values for the evaluation of ICP using NLR, sVCAM-1 and IGFBP-3 levels individually and in combination were 0.691, 0.638, 0.725 and 0.914, respectively. The sensitivity and specificity of combined detection were both higher than any single test, and the difference was statistically significant (P<0.01). Conclusion The combined detection of serum NLR, sVCAM-1 and IGFBP-3 levels has high clinical value in evaluating the severity and prognosis of ICP patients.

Risk factors for postoperative cholangitis in children undergoing laparoscopic choledochal cysts surgery

XIANG Qiang-xing, ZHOU Yu-xiang, TANG Xiang-lian, LIU Deng-hui, HUANG Zhao

2023, 28(7):  845-848. 

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Objective To explore the risk factors associated with the development of cholangitis following laparoscopic surgery for pediatric congenital choledochal cysts, and to provide preventive a framework to help reduce the incidence of postoperative cholangitis. Methods Eighty-five children diagnosed with congenital choledochal cysts who underwent laparoscopic surgery at our hospital from June 2018 to June 2022 were included in the study. Based on the occurrence of postoperative cholangitis, participants were divided into two groups: a concurrent group (n=14) and a non-concurrent group (n=71). Differences in clinical characteristics between the two groups were compared. Univariate and multivariate Logistic regression analyses were used to evaluate the risk factors for cholangitis following laparoscopic surgery for congenital choledochal cysts in children. Results In the concurrent group, the proportions of anemia, biliary calculi, cyst diameter>5cm, preoperative albumin ≤ 30g/L, intraoperative bleeding>60ml, and preoperative total bilirubin>1.7 μmol/L was 64.28%, 78.57%, 71.43%, 71.43%, 78.57%, 85.71% respectively, which were significantly higher than those in the non-concurrent group( 28.17%, 40.85%, 30.99%, 42.25%, 45.07%, 35.21%, respectively)(all P<0.05); Multivariate logistic regression analysis confirmed that anemia, biliary calculi, cyst diameter>5cm, preoperative albumin ≤ 30g/L, intraoperative bleeding>60ml, and preoperative total bilirubin>1.7 μ mol/L were risk factors for cholangitis after laparoscopic surgery for congenital choledochal cyst in children(P<0.05). Conclusion The incidence of cholangitis following laparoscopic surgery for congenital choledochal cyst in children is significantly associated with factors such as anemia, cyst diameter, intraoperative bleeding, presence of biliary calculus, preoperative albumin levels, and preoperative total bilirubin levels.