Comparison of Acoustic Structure Quantification,Transient Elastography (FibroScan) and Histology in Patients with Chronic Hepatitis B and without Moderate to Severe Hepatic Steatosis

The purpose of this study was to compare acoustic structure quantification (ASQ) with transient elastography for staging liver fibrosis. One hundred eighty-two patients with chronic hepatitis B and without moderate to severe hepatic steatosis scheduled for liver biopsy underwent ASQ and transient elastography examinations. All ASQ parameters, including total mode, total average, red mode, red average, red standard deviation, blue mode, blue average, blue standard deviation and focal disturbance (FD) ratio and liver stiffness obtained via transient elastography were found to correlate with fibrosis stage (Spearman's r?=?0.783, 0.791, 0.750, 0.771, 0.544, 0.718, 0.691, 0.439, 0.815 and 0.814, respectively; all p values < 0.001). Among the ASQ parameters, the FD ratio had the highest correlation with the stage of fibrosis. The areas under the receiver operating characteristic curves (AUCs) of FD ratio and liver stiffness were 0.911 and 0.906 for F ≥ F1, 0.918 and 0.882 for F ≥ F2, 0.911 and 0.914 for F ≥ F3 and 0.926 and 0.978 for F?=?F4, respectively. There was no significant difference in AUCs between FD ratio and liver stiffness in predicting different stages of fibrosis (p?=?0.062–0.912). ASQ is a promising technique for assessing liver fibrosis in the absence of moderate to severe hepatic steatosis.     

采用改良的Sugiura术治疗肝硬化并发门脉高压症患者疗效研究*

目的 探讨采用改良的Sugiura术治疗肝硬化并发门脉高压症患者的疗效及其对门脉血流动力学指标的影响。方法 回忆性分析2013年5月~2015年5月期间我院治疗的56例肝硬化并发门脉高压症患者的临床资料,手术前后采取玻璃管水柱法测量自由门静脉压（FPP）,采用吲哚氰绿15分钟潴留率(ICGR15)检测肝脏储备功能,计算肝脏有效血流（ELBF）,使用B超检测门脉内径、门静脉血流量（PVF）、肝动脉血流（HAF）和肝总血流量（THF）的变化。结果 经过改良的Sugiura术治疗,56例患者手术成功,出现肺部感染和胸腔积液4例,切口感染2例,门静脉血栓形成5例,吻合口狭窄4例,胃瘘1例。经充分引流、营养支持、抗感染、补充白蛋白或输注血浆等对症支持治疗,病情逐步缓解或痊愈;术后FPP水平为（21.3±3.4） cmH₂O,显著低于术前水平【（32.5±5.0）cmH2O,P<0.05】;在术后,56例患者EHBF、THF和PVF水平分别为（0.5±0.1） ml/min、（1481.1±354.0） ml/min和（1046.1±258.0） ml/min,在术后3 m,分别为（0.5±0.3）ml/min、（1574.1±326.0） ml/min和（1131.0±304.1） ml/min,均显著低于术前水平 [分别为（0.7±0.3） ml/min、（1891.0±392.1） ml/min和（1523.1±291.1）ml/min,P<0.05];术后HAF水平为 （435.0±142.1） ml/min,术后3 m时为（443.0±183.1） ml/min,均显著高于术前水平【（368.1±139.1）ml/min,P<0.05】;术后患者ICGR15为（22.7±7.9）%, 显著高于术前的（19.3±5.5）%,差异显著（F=7.327,P<0.05）;手术前后门静脉内径变化差异无统计学意义（P>0.05）;术后1 m和术后3 m,患者血清白蛋白水平大幅升高【分别为（35.2±2.3） g/L和（36.8±1.7） g/L对（31.8±1.7） g/L,P<0.05】;在术后1 m时,患者外周血PLT和WBC计数分别为（144.5±7.2）×10⁹/L和（13.8±0.6）×10⁹/L,在术后3 m时则分别为（98.1±10.6）×10⁹/L和（4.2±0.8）×10⁹/L,均显著高于术前水平【分别为（75.3±6.7）×10⁹/L和（3.4±0.3）×10⁹/L,P<0.05】。结论 采用改良的Sugiura术治疗肝硬化并发门脉高压症患者能够改善肝功能、血细胞和门脉系统血流动力学指标,降低门静脉压力,对防治病情恶化和消化道出血有帮助,其远期疗效还有待观察。     

核苷类药物在乙型肝炎后肝硬化治疗中的疗效

目的分析在乙型肝炎后肝硬化治疗中采用核苷类药物的治疗价值。方法将本院在2018年1月—2019年2月期间收治的乙型肝炎后肝硬化患者68例纳入研究,以奇偶法均分为两组,对照组(34例)行常规治疗方案,观察组(34例)行核苷类药物治疗,对比两组乙型肝炎后肝硬化患者的治疗效果。结果对照组HBeAg转阴率14.71%低于观察组44.12%,P<0.05差异有统计学意义。观察组临床指标(ALT、AST、TBIL、ALB、PTA、Child-Pugh)优于对照组患者,P<0.05差异有统计学意义。观察组并发症发生率8.82%低于对照组并发症发生率为41.18%,P<0.05差异有统计学意义。结论在乙型肝炎后肝硬化治疗中采用核苷类药物可以取得显著的治疗效果,可以有效改善患者的临床症状,提升患者的转阴率,安全性较高。     

布氏杆菌引起布加综合征1例报告

布氏杆菌是一种革兰阴性、细胞内寄生菌,可引起人和动物急性或慢性感染,临床表现主要为病情轻重不一的发热,多汗、关节疼痛,可引起多系统损害。由于布氏杆菌试管凝集试验在部分患者存在假阴性,血培养周期长,易造成漏诊、误诊。本文通过对1例布氏杆菌感染致布加综合征误诊为肝硬化失代偿期病例分析并文献复习,以加强对该细菌的认识。     

Bariatric surgery before,during, and after liver transplantation: a systematic review and meta-analysis

Morbid obesity is considered a relative contraindication for liver transplantation (LTX) because of increased risk of complications. The aim of this study was to investigate the role of bariatric surgery before, during, and after LTX. A systematic review of MEDLINE, EMBASE, CENTRAL, and PubMed databases was performed for studies investigating bariatric surgery in patients before, during, or after LTX. Random-effects meta-analysis of proportions was used to calculate pooled effect estimates. One hundred eighty-seven patients underwent bariatric surgery before LTX (8 studies). After surgery, 82% (95% confidence interval, 62%–97%) of patients were successfully listed for LTX and 70% (95% confidence interval, 40%–93%) successfully received LTX. The 30-day mortality rate was 0%. The graft survival rate after 1 year was 70% (95% confidence interval, 30%–99%). Thirty-day minor and major complications rate was 4% and 1%, respectively. Thirty-two patients underwent bariatric surgery during LTX (2 studies). The 30-day mortality rate after surgery was 0% and 1-year graft survival was 100%. Sixty-four patients underwent bariatric surgery after LTX (9 studies). The 30-day mortality was 0%, but 5 deaths occurred beyond 30 days (7.8%). Bariatric surgery may be safe and feasible as a bridge to LTX for patients who would otherwise be ineligible and post-LTX patients for weight loss.     

实时剪切波弹性成像在拉米夫定治疗乙肝纤维化过程中的疗效评估作用

目的探讨实时剪切波弹性成像在评估拉米夫定治疗乙肝纤维化临床疗效中的作用。方法选取2017年1月～2018年1月我院收治的80例乙肝纤维化患者,根据随机数字法分为对照组和观察组,每组40例。对照组采用常规治疗,观察组在对照组的基础上给予拉米夫定进行治疗,治疗6个月。比较两组治疗前后肝功能、肝纤维化指标,利用实时剪切波弹性成像评估两组治疗前后肝脏弹性模量值及肝穿刺活检情况,并进行比较。结果两组治疗后AST、ALT、TBIL水平均明显低于治疗前,差异有统计学意义(P0.05);观察组治疗后AST、ALT、TBIL水平均明显低于对照组,差异有统计学意义(P0.05);两组治疗后HA、LN、PⅢPN-P、CL-Ⅳ水平及杨氏弹性模量值均显著低于治疗前,差异有统计学意义(P0.05);观察组治疗后HA、LN、PⅢPN-P、CL-Ⅳ水平及杨氏弹性模量值均显著低于对照组,差异有统计学意义(P0.05);与治疗前相比,两组治疗后肝穿刺活检结果均有好转,尤其是汇管区、肝小叶内炎症及肝纤维化改善明显。结论实时剪切波弹性成像作为肝脏硬度定量检测的无创性技术,可用于拉米夫定治疗乙肝纤维化临床疗效评估的重要方法。     

Low-molecular-weight heparin followed by rivaroxaban for acute occlusive portomesenteric vein thrombosis in a cirrhotic patient treated with multiple endoscopic variceal procedures

Acute portomesenteric vein thrombosis is potentially lethal. In the present paper, a cirrhotic patient with a previous history of esophageal variceal bleeding presented with acute occlusive portomesenteric vein thrombosis, but achieved complete recanalization by low-molecular-weight heparin followed by rivaroxaban. Notably, no bleeding episode occurred during anticoagulation therapy. This case supported early initiation of anticoagulation in such patients.     

Effects of hepatitis B virus infection,alanine aminotransferase,aspartate aminotransferase and gamma-glutamyl transferase on prediabetes and diabetes mellitus: A cohort study

Introduction and objectivesThe purpose of this study was to confirm whether hepatitis B virus (HBV) infection and the levels of liver enzymes would increase the risk of prediabetes and diabetes mellitus (DM) in China.Materials and methodsA total of 10,741 individuals was enrolled in this prospective cohort study. Cox regression analysis was used to calculate the Hazard ratios (HRs) to evaluate the relationships between HBV infection and the risk of DM and prediabetes. Decision trees and dose response analysis were used to explore the effects of liver enzymes levels on DM and prediabetes.ResultsIn baseline population, HBV infection ratio was 5.31%. In non-adjustment model, the HR of DM in HBV infection group was 1.312 (95% CI, 0.529–3.254). In model adjusted for gender, age and liver cirrhosis, the HR of DM in HBV infection group were 1.188 (95% CI, 0.478–2.951). In model adjusted for gender, age, liver cirrhosis, smoking, drinking, the HR of DM was 1.178 (95% CI, 0.473–2.934). In model further adjusted for education, family income and occupation, the HR of DM was 1.230 (95% CI, 0.493–3.067). With the increases of levels of Alanine aminotransferase (ALT), Aspartate aminotransferase (AST) and Gamma-glutamyl transferase (GGT), the risk of prediabetes was gradually increasing (P_{non-linearity} < 0.05). There were dose-response relationships between ALT, GGT and the risk of DM (P_{non-linearity} < 0.05).ConclusionsHBV infection was not associated with the risk of prediabetes and DM. The levels of liver enzymes increased the risk of prediabetes and DM.     

Role of zinc supplementation in the management of chronic liver diseases: A systematic review and meta-analysis

Introduction and objectivesZinc deficiency has been associated with poor prognosis in chronic liver disease. This systematic review and meta-analysis aimed to evaluate the role of zinc supplementation in the management of chronic liver diseases.Materials and methodsWe searched MEDLINE, LILACS, EMBASE, and Cochrane CENTRAL databases from inception to August 2018. We included randomized controlled trials evaluating adult patients with chronic liver disease of any etiology receiving zinc supplementation. Studies with other designs or evaluating chronic conditions other than liver disease were excluded. Two reviewers independently screened and extracted data from eligible studies. Study quality was assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomized studies.ResultsOf 1315 studies screened, 13 were included. Six assessed chronic hepatitis C treatment, with a relative risk of 0.83 indicating no protective effect of zinc supplementation on the improvement of sustained virological response. Three evaluated response to hepatic encephalopathy treatment, with a relative risk of 0.66 indicating a favorable effect of zinc supplementation on clinical improvement of this condition. Of four studies evaluating the management of cirrhosis, two analyzed the effect of zinc supplementation on serum albumin levels, with no statistical difference between zinc and placebo groups.ConclusionsClinical trials assessing zinc supplementation in liver diseases do not show benefits in terms of clinical improvement or disease halting. There are possible benefits of zinc supplementation on hepatic encephalopathy, however, this is based on limited evidence. This research question is still open for evaluation in larger, well-designed, clinical trials.