Risk factors for deterioration of long-term liver function after radiofrequency ablation therapy

AIM:To identify factors that influence long-term liver function following radiofrequency ablation(RFA)in patients with viral hepatitis-related hepatocellular carcinoma.METHODS:A total of 123 patients with hepatitis B virus-or hepatitis C virus-related hepatocellular carcinoma(HCC)(n=12 and n=111,respectively)were enrolled.Cumulative rates of worsening Child-Pugh(CP)scores(defined as a 2-point increase)were examined.RESULTS:CP score worsening was confirmed in 22patients over a mean follow-up period of 43.8±26.3mo.Multivariate analysis identified CP class,platelet count,and aspartate aminotransferase levels as significant predictors of a worsening CP score(P=0.000,P=0.011 and P=0.024,respectively).In contrast,repeated RFA was not identified as a risk factor for liver function deterioration.CONCLUSION:Long-term liver function following RFA was dependent on liver functional reserve,the degreeof fibrosis present,and the activity of the hepatitis condition for this cohort.Therefore,in order to maintain liver function for an extended period following RFA,suppression of viral hepatitis activity is important even after the treatment of HCC.     

Age-dependent slowing of enteric axonal transport in insulin-resistant mice

AIM:To investigate retrograde tracer transport by gastric enteric neurons in insulin resistant mice with low or high glycosylated hemoglobin(Hb).METHODS:Under anesthesia,the retrograde tracer fluorogold was superficially injected into the fundus or antrum using a microsyringe in KK Cg-Ay/J mice prior to onset of type 2 diabetes mellitus(T2DM;4 wk of age),at onset of T2DM(8 wk of age),and after 8,16,or 24 wk of untreated T2DM and in age-matched KK/HIJ mice.Six days later,mice were sacrificed by CO 2 narcosis followed by pneumothorax.Stomachs were removed and fixed.Sections from fundus,corpus and antrum were excised and mounted on a glass slide.Tracer-labeled neurons were viewed using a microscope and manually counted.Data were expressed as the number of neurons in short and long descending and ascending pathways and in local fundus and antrum pathways,and the number of neurons in all regions labeled after injection of tracer into either the fundus or the antrum.RESULTS:By 8 wk of age,body weights of KKAy mice(n=12,34±1 g) were heavier than KK mice(n=17,29±1 g;F(4,120)=4.414,P=0.002] and glycosylated Hb was higher [KK:(n=7),4.97%±0.04%;KKAy:(n=6),6.57%±0.47%;F(1,26)=24.748,P<0.001].The number of tracer labeled enteric neurons was similar in KK and KKAy mice of all ages in the short descending pathway [F(1,57)=2.374,P=0.129],long descending pathway [F(1,57)=0.922,P=0.341],local fundus pathway [F(1,53)=2.464,P=0.122],local antrum pathway [F(1,57)=0.728,P=0.397],and short ascending pathway [F(1,53)=2.940,P=0.092].In the long ascending pathway,fewer tracer-labeled neurons were present in KKAy as compared to KK mice [KK:(n=34),302±17;KKAy:(n=29),230±15;F(1,53)=8.136,P=0.006].The number of tracer-labeled neurons was decreased in all mice by 16 wk as compared to 8 wk of age in the short descending pathway [8 wk:(n=15),305±26;16 wk:(n=13),210±30;F(4,57)=9.336,P<0.001],local antrum pathway [8 wk:(n=15),349±20;16 wk:(n=13),220±33;F(4,57)=8.920,P<0.001],short ascending pathway [8 wk:(n=14),392±15;16 wk:(n     

不同血清ALT水平的乙型肝炎病毒感染者肝纤维化指标变化

目的 研究不同血清谷丙转氨酶(ALT)水平的慢性HBV感染者肝纤维化指标的变化.方法 2018年4月～2020年4月我院诊治的68例慢性HBV感染者(HBV携带者21例,CHB患者47例),根据血清ALT水平不同将患者分为A组(ALT<40 U/L,n=21)、B组(40U/L≤ALT<80U/L,n=24)和C组(A...     

血浆GP73联合肝脏硬度检测诊断乙型和丙型肝炎患者肝纤维化临床价值分析*

目的 探讨血浆高尔基体蛋白73(GP73)水平联合肝脏硬度测定(LSM)诊断慢性乙型和丙型肝炎患者肝纤维化分期的价值。方法 2015年6月～2019年1月我院收治的慢性乙型肝炎患者46例,慢性丙型肝炎患者98例,乙型肝炎肝硬化患者17例,丙型肝炎肝硬化患者35例,另选择健康人56例,使用Fibrotouch检测LSM,采用ELISA法检测血浆GP73水平。对肝病患者行肝活检。应用受试者工作特征曲线(ROC)分析GP73、LSM及两者联合诊断肝纤维化的效能。结果 在本组196例患者中,经病理学检查,诊断为S₁期45例(23.0%),S₂期50例(25.5%),S₃期49例(25.0%)和S₄期52例(26.5%),其中≥S₂期者151例(77.0%),≥S₃期者101例(51.5%); S₁、S₂、S₃和S₄期患者血浆GP73水平分别为(118.1±30.6) ng/ml、(135.8±39.7) ng/ml、(175.8±54.8) ng/ml和(228.7±74.6)ng/ml,LSM分别为(6.1±1.8) kpa、(10.1±2.2) kpa、(15.3±4.5) kpa和(23.0±9.4) kpa,均显著高于健康人[分别为为(94.0±19.4) ng/ml和(5.4±2.0 )kpa,P＜0.05];ROC曲线分析显示,GP73诊断肝纤维化≥S₂、≥S₃和S₄的截断点分别为127.7 ng/ml、142.5 ng/ml和155.6 ng/ml,LSM诊断的截断点分别为8.8 kPa、12.6 kPa和17.9 kPa,两者联合诊断的ROC下面积(AUC)分别为0.917(95% CI:0.875～0.948)、0.954(95% CI:0.920～0.977)和0.950(95% CI:0.914～0.973),其灵敏度分别为71.5%、86.1%和88.5%,其特异度分别为94.6%、95.1%和89.1%,准确性分别为96.8%、92.3%和90.7%。结论 应用血浆GP73联合LSM诊断乙型和丙型肝炎患者肝纤维化的效能较好,值得临床进一步验证。     

Prevalence of minimal hepatic encephalopathy and quality of life evaluations in hospitalized cirrhotic patients in China

AIM:To investigate the prevalence of minimal hepatic encephalopathy(MHE)and to assess corresponding health-related quality of life(HRQoL)in hospitalized cirrhotic patients in China.METHODS:This multi-center cross-sectional study included 16 teaching hospitals,which were members of "Hepatobiliary Cooperation Group,Society of Gastroenterology,Chinese Medical Association",from different areas of China carried out between June and October in 2011.All the eligible hospitalized cirrhotic patients(n = 538)were required to complete triplicate number connection tests combined with one digit symbol test for diagnosing MHE.Patients’ clinical examination data were complemented by a modified questionnaire assessing HRQoL.Written informed consent was obtained from each patient.RESULTS:Male was predominant(68.6%)in 519 patients who met the criteria of the study,with a mean age of 49.17 ± 11.02 years.The most common cause of liver cirrhosis was chronic hepatitis B(55.9%).The prevalence of MHE was 39.9% and varied by ChildPugh-Classification score(CPC-A:24.8%,CPC-B:39.4% and CPC-C:56.1%,P < 0.01).MHE(P < 0.01)and higher CPC scores(P < 0.01)were associated with a high HRQoL scores(reflecting poorer quality of life).The prevalence of MHE was proportionate to CPC(P = 0.01)and high quality of life scores(P = 0.01).CONCLUSION:Hospitalized cirrhotic patients have a high prevalence of MHE that is proportionate to the degree of liver function and HRQoL impairment.     

肝硬化患者肝内LR-3类结节恶变风险评估及预测模型的建立*

目的 探讨存在LR-3类肝内结节的肝硬化患者恶性转变的危险因素,并在此基础上建立恶性转变预测模型。方法 2014年3月～2016年3月我院诊治的124例存在肝内LR-3类结节的肝硬化患者,规律随访进行磁共振成像(MRI)检查,对可疑病灶进行穿刺活检。应用多因素Logistic回归分析影响癌变的危险因素,并建立预测模型。结果 经随访60～78个月(平均74个月),120例患者完成随访,发现癌变24例(20.0%),另96例无癌变;癌变组有饮酒、吸烟、合并糖尿病、乙型肝炎病毒感染和酒精性肝炎者分别为91.7%、87.5%、75.0%、100.0%和41.7%,显著高于未癌变组(分别为45.8%、52.1%、41.7%、58.3%和20.8%,P<0.05);Cox风险回归分析显示,饮酒(HR=2.264,95%CI=1.597～3.210,P<0.001)、糖尿病(HR=1.294,95%CI=1.107～1.513,P=0.001)、乙型肝炎(HR=1.795,95%CI=1.329～2.561,P<0.001)和酒精性肝炎(HR=0.658,95%CI=0.552～0.784,P<0.001)是存在LR-3类病变结节的肝硬化患者癌变的独立危险因素;根据Cox多因素分析结果建立癌变预测模型,即Y=0.817X₁+0.258X₂+0.585X₃-0.419X₄(X₁=饮酒,X₂=糖尿病,X₃=乙型肝炎,X₄=酒精性肝炎)。经ROC分析显示,该模型判断LR-3类病变结节患者癌变风险的AUC为0.812(SE=0.064,95%CI=0.687～0.936,P<0.001),其敏感度为0.833,特异度为0.673。结论 了解危险因素可能对判断肝硬化患者肝内结节的性质有帮助,加强随访,必要时穿刺才是明确诊断的正确方法。     

Expression of interleukin-22/STAT3 signaling pathway in ulcerative colitis and related carcinogenesis

AIM:To investigate the expression of interleukin (IL)-22 and its related proteins in biopsy specimens from patients with ulcerative colitis (UC) and UC-related carcinogenesis. METHODS:Biopsy specimens were obtained from patients with inactive (n = 10), mild-to-moderately active (n = 30), severely active (n = 34), initial (n = 30), and chronic UC (n = 44), as well as UC patients with dysplasia (n = 10). Specimens from patients without colonic abnormalities (n = 20) served as controls. Chronic colitis in experimental mice was induced by 2.5% dextran sodium sulfate. The expression levels of IL-22, IL-23, IL-22R1 and phosphorylated STAT3 (p- STAT3) were determined by immunohistochemistry. Bcl-2, cyclin D1 and survivin expression was detected by Western blotting. RESULTS:Patients with active UC had significantly more IL-22, IL-23, IL-22R1 and p-STAT3-positive cells than the patients with inactive UC and normal controls. Furthermore, IL-22 and related proteins were closely related to the severity of the colitis. The expression of IL-22 and IL-22R1 in the tissue of initial UC was stronger than in that of chronic UC, whereas the expression of p-STAT3 was significantly increased in chronic UC tissues. In dysplasia tissues, the expression level of IL-22 and related proteins was higher compared with controls. Mouse colitis model showed that expression of IL-22, IL-22R1 and IL-23 was increased with time, p-STAT3 and the downstream gene were also remarkably upregulated.CONCLUSION:IL-22/STAT3 signaling pathway may be related to UC and UC-induced carcinogenesis and IL-22 can be used as a biomarker in judging the severity of UC.     

Elevated serum levels of human relaxin-2 in patients with esophageal squamous cell carcinoma

AIM: To assess the prognostic value of serum human relaxin 2 (H2 RLN) level in patients with esophageal squamous cell carcinoma (ESCC). METHODS: From October 1998 to September 2009, 146 patients with histopathologically confirmed ESCC were enrolled in this study. One hundred patients underwent en bloc esophagectomy, and 46 patients with unresectable tumors underwent palliative surgery. Five of the 146 patients died of surgical complications. Serum levels of H2 RLN were measured by enzyme linked immunosorbent assay. The relationship between serum H2 RLN level and each of the clinicopathological parameters was analyzed using the χ2 test. Patients were classified into two groups according to their H2 RLN level (< 0.462 ng/mL vs ≥ 0.462 ng/mL). When any analysis cell had fewer than five cases, the Fisher’s exact test was used. The statistical difference between groups A and B in each clinicopathological category was determined by the Student’s t test (two-tailed) or analysis of variance. Survival curves were plotted using the Kaplan-Meier method. The statistical difference in survival between the different groups was compared using the log-rank test. Survival correlation with the prognostic factors was further investigated by multivariate analysis using the Cox proportional hazards model with backward stepwise likelihood ratio. RESULTS: ESCC patients tended to have significantly higher serum H2 RLN concentrations (0.48 ± 0.17 ng/ mL, n=141) compared with the healthy control group (0.342 ± 0.12 ng/mL, n=112). There was a significant difference between patients with lymph node involvement (0.74 ± 0.15 ng/mL, n=90), distant metastasis (0.90 ± 0.19 ng/mL, n=32) and those without lymph node involvement (0.45 ± 0.12 ng/mL, n=51), and distant metastasis (0.43 ± 0.14 ng/mL, n=109), respectively (P < 0.01). Patients with high H2 RLN levels (≥ 0.462 ng/mL) had a poorer prognosis than patients with low serum H2 RLN levels (< 0.462 ng/mL; P=0.0056). The H2 RLN level was also correlated with survival and     

Co-treatment with pegylated interferon alfa-2a and entecavir for hepatitis D: a randomized trial

AIM: To investigate the efficacy of pegylated interferon alfa(PEG-IFNα) therapy with and without entecavir in patients with chronic hepatitis D. METHODS: Forty hepatitis D virus(HDV) RNA positive patients were randomized to receive either PEG-IFNα-2a 180 μg weekly in combination with entecavir 0.5 mg daily(n = 21) or PEG-IFNα alone(n =19). Patients who failed to show 2 log reduction in HDV RNA level at 24 wk of treatment, or had detectable HDV RNA at 48 wk of therapy were considered as treatment failure. Treatment was continued for 72 wk in the rest of the patients. All the patients were followed for 24 wk post treatment. Intention to treat analysis was performed.RESULTS: The mean age of the patients was 26.7 ± 6.8 years, 31 were male. Two log reduction in HDV RNA levels at 24 wk of therapy was achieved in 9(43%) patients receiving combination therapy and 12(63%) patients receiving PEG-IFNα alone(P = 0.199). Decline in hepatitis B surface antigen(HBs Ag) levels was insignificant. At the end of treatment, HDV RNA was negative in 8 patients(38%) receiving combination therapy and 10 patients(53%) receiving PEG-IFNα-2a alone. Virological response persisted in 7(33%) and 8(42%) patients, respectively at the end of the 24 wk follow-up period. One responder patient in the combination arm lost HBs Ag and became hepatitis B surface antibody positive. Six out of 14 baseline hepatitis B e antigen reactive patients seroconverted and four of these seroconverted patients had persistent HDV RNA clearance.CONCLUSION: Administration of PEG-IFNα-2a with or without entecavir, resulted in persistent HDV RNA clearance in 37% of patients. The addition of entecavir did not improve the overall response.     

Adult-to-adult living donor liver transplantation for acute liver failure in China

AIM:To investigate the long-term outcome of recipients and donors of adult-to-adult living-donor liver transplantation(AALDLT) for acute liver failure(ALF).METHODS:Between January 2005 and March 2010,170 living donor liver transplantations were performed at West China Hospital of Sichuan University.All living liver donor was voluntary and provided informed consent.Twenty ALF patients underwent AALDLT for rapid deterioration of liver function.ALF was defined based on the criteria of the American Association for the Study of Liver Diseases,including evidence of coagulation abnormality [international normalized ratio(INR) ≥ 1.5] and degree of mental alteration without pre-ex-isting cirrhosis and with an illness of 26 wk duration.We reviewed the clinical indications,operative procedure and prognosis of AALDTL performed on patients with ALF and corresponding living donors.The potential factors of recipient with ALF and corresponding donor outcome were respectively investigated using multivariate analysis.Survival rates after operation were analyzed using the Kaplan-Meier method.Receiver operator characteristic(ROC) curve analysis was undertaken to identify the threshold of potential risk factors.RESULTS:The causes of ALF were hepatitis B(n = 18),drug-induced(n = 1) and indeterminate(n = 1).The score of the model for end-stage liver disease was 37.1 ± 8.6,and the waiting duration of recipients was 5 ± 4 d.The graft types included right lobe(n = 17) and dual graft(n = 3).The mean graft weight was 623.3 ± 111.3 g,which corresponded to graft-torecipient weight ratio of 0.95% ± 0.14%.The segment Ⅴor Ⅷ hepatic vein was reconstructed in 11 right-lobe grafts.The 1-year and 3-year recipient's survival and graft survival rates were 65%(13 of 20).Postoperative results of total bilirubin,INR and creatinine showed obvious improvements in the survived patients.However,the creatinine level of the deaths was increased postoperatively and became more aggravated compared with the level of the survived recipients.Multivariate analysis showed that waiting duration was independently correlated with increased mortality(P = 0.014).Furthermore,ROC curve revealed the cut-off value of waiting time was 5 d(P = 0.011,area under the curve = 0.791) for determining the mortality.The short-term creatinine level with different recipient's waiting duration was described.The recipients with waiting duration ≥ 5 d showed the worse renal function and higher mortality than those with waiting duration 5 d(66.7% vs 9.1%,P = 0.017).In addition,all donors had no residual morbidity.Furthermore,univariate analysis did not show that short assessment time induced the high morbidity(P = 0.573).CONCLUSION:Timely AALDLT for patients with ALF greatly improves the recipient survival.However,further systemic review is needed to investigate the optimal treatment strategy for ALF.     

胃癌患者血清肿瘤标志CA50和CEA的意义

目的比较胃恶性和良性病变血清人类结肠癌抗原 CA50和 CEA 的变化。方法用放射免疫法测定33例健康对照和86例胃部疾病(胃癌34例,胃溃疡27例和慢性萎缩性胃炎25例)患者血清 CA50和 CEA 含量,胃癌包括窦部27例,体部3例和底部9例,组织学类型包括腺癌21例,上皮癌4例和未分类9例;胃溃疡包括窦部18例,体部3例和底部9例;萎缩性胃炎均伴有肠上皮化生。结果与正常人比较,胃癌血清 CA50(112.67±38.36 kU/L vs 16.26±6.14 kU/L,P<0.01)和 CEA(10.28±3.76μg/L vs 3.12±1.03 μg/L,P<0.01)明显升高;CA50(>22 kU/L)阳性率在胃癌是53.0%(18/34),CEA(>5 μg/L)阳性率是55.8%(19/34);CA50和 CEA 升高呈正相关(r=0.648,P<0.01)。胃癌手术后(n=21),血清 CA50(46.4±25.9 kU/L,P<0.01)和 CEA(6.85±2.43μg/L,P<0.01)有明显下降。胃溃疡和萎缩性胃炎血清 CAS0(P<0.05)轻度升高,而 CEA 无明显变化(P>0.05)。结论血清 CAS0和 CEA 升高可作为诊断晚期胃癌的指标,胃癌手术后血清 CA50和 CEA 明显降低,提示联合测定血清CA50和 CEA 对晚期胃癌的诊治有一定临床意义。     

Comparison of the liver stiffness measurement by transient elastography with the liver biopsy

AIM： To compare the liver stiffness （LS） measurement by transient elastography （TE） to the liver biopsy （LB）considered the ＂gold standard＂ in the evaluation of patients with chronic hepatitis C. METHODS： During a period of 12 mo, we evaluated 199 consecutive patients with chronic hepatitis due to hepatitis C virus （HCV）, in which LB and LS assessments （by means of TE） were performed during the same session. RESULTS： Out of 199 patients, a valid measurement of the LS could not be obtained in 8. The mean value of LS in the cohort of 191 valid measurements was 8.45 ± 4.96 kPa, ranging from 2.3 to 38 kPa. The mean value of LS in patients with significant fibrosis at biopsy （161 patients with F ≥ 2 according to Metavir） was 9.02 ± 5.15 kPa, significantly higher than in patients with no or mild fibrosis （30 patients with F 〈 2 Metavir）： 5.39 ± 1.81 kPa （P 〈 0.0001）. For a cutoff value of 6.8 kPa, the LS had a PPV of 98%, a NPV of 30.1%, a sensitivity of 59.6% and a specificity of 93.3% for the presence of significant fibrosis （at least F2 Metavir）, with a diagnostic performance of 77.3% （AUROC 0.773）. Using this cut-off value, we reached the best discrimination between absence of fibrosis/ mild fibrosis （F 〈 2 Metavir） and the presence ofmoderate to severe fibrosis （F ≥ 2 Metavir）. CONCLUSION： In patients with chronic hepatitis due to HCV, a cut-off value of 6.8 kPa measured by TE can differentiate between significant fibrosis and absent or mild fibrosis, with a PPV of 98%, a NPV of 30.1%, a sensitivity of 59.6%, a specificity of 93.3%, and a diagnostic performance of 77.3%.     

内镜下食管静脉曲张套扎术治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者再出血风险观察*

目的 研究采用内镜下食管静脉曲张套扎术(EVL)治疗乙型肝炎肝硬化(LC)并发食管静脉曲张(EV)破裂出血患者治疗后再出血的风险。方法 2016年4月～2019年10月我科诊治的178例乙型肝炎肝硬化并发食管静脉曲张破裂出血(EVB)患者,在止血后采用EVL治疗,随访再出血发生情况,应用Cox风险回归模型进行多因素分析,建立Nomogram模型,预测再出血。结果 178例患者急性出血后,死亡12例(6.7%),166例接受EVL术,均获得成功;术后随访12～54个月,27例(16.3%)发生再出血;入院时,27例再出血组外周血Hb和血清白蛋白水平显著低于139例未再出血组(P<0.05),而空腹血糖(FPG)和糖化血红蛋白(HbA1c)水平显著高于未再出血组,差异均有统计学意义(P<0.05);入院止血后检查,发现再出血患者门静脉和脾静脉宽度显著大于未再出血组(P<0.05);Cox风险模型分析显示Child-Pugh分级(95%CI=1.125～3.439,HR=1.967,P=0.018)、腹水(95%CI=1.754～2.329,HR=2.021,P=0.000)、HbA1c(95%CI=1.173～1.921,HR=1.501,P=0.001)、FPG(95%CI=1.379～3.152,HR=2.085,P=0.000)和肝性糖尿病(95%CI=1.321～2.945,HR=2.076,P=0.006)是EVL术后再出血的独立影响因素;根据Cox建立Nomogram模型,ROC分析结果显示Nomogram判断术后再出血的AUC为0.804(SE=0.053,95%CI=0.700～0.907,P=0.000),其敏感度为0.857,特异度为0.565。结论 采取EVL治疗LC并发EVB患者术后再出血发生率较高,除常见的风险因素外,伴有肝性糖尿病也可能是重要的原因,临床应加强对血糖的控制,减少再出血的发生。     

CT相关参数判断乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血风险的价值研究

目的 研究CT相关参数诊断乙型肝炎肝硬化患者临床显著性门静脉高压(SCPH)和判断食管胃底静脉曲张破裂出血风险的价值。方法 2016年5月～2019年11月本院收治的62例乙型肝炎肝硬化患者均接受CT检查,记录CT检查相关参数,同时检测肝静脉压力梯度(HVPG)。以HVPG为金标准,采用受试者工作曲线(ROC)分析CT相关参数诊断SCPH和预测食管胃底静脉曲张破裂出血的价值。结果 在62例患者中27例存在SCPH;27例SCPH组全肝体积为(1015.7±162.8)cm³,显著低于35例非SCPH组[(1174.2±204.5)cm³,P<0.05],脾脏体积为(852.1±264.3)cm³,显著大于非SCPH组[(593.9±303.4)cm³,P<0.05],门静脉宽度为(1.7±0.2)cm,显著大于非SCPH组[(1.5±0.1)cm³,P<0.05],脾静脉宽度为(1.1±0.2)cm,显著大于非SCPH组[(0.9±0.2)cm,P<0.05],HVPG为(12.9±2.4)mmHg,显著高于非SCPH组[(8.0±1.7)mmHg,P<0.05];ROC分析显示脾脏体积(AUC=0.742,敏感度=0.778)、全肝体积(AUC=0.802,敏感度=0.809)、门静脉宽度(AUC=0.777,敏感度=0.815)和脾静脉宽度(AUC=0.708,敏感度=0.815)诊断SCPH具有较高的价值(P均<0.05);随访半年,62例患者发生食管胃底静脉曲张破裂出血13例;ROC分析结果显示脾脏体积(AUC=0.727,敏感度=0.882)、全肝体积(AUC=0.686,敏感度=0.765)、门静脉宽度(AUC=0.684,敏感度=0.824)和脾静脉宽度(AUC=0.787,敏感度=0.771)判断食管胃底静脉曲张破裂出血具有较高的敏感度(P均<0.05)。结论 CT检查的乙型肝炎肝硬化患者门静脉系统相关参数与HVPG密切相关,监测CT相关参数有助于SCPH的诊断和食管胃底静脉曲张破裂出血的预测。     

FibroTouch诊断乙型肝炎病毒携带者肝纤维化价值研究

目的 探讨使用FibroTouch无创检测诊断乙型肝炎病毒(HBV)携带者肝纤维化程度的效能。方法 2017年7月～2019年12月在深圳市龙岗中心医院感染病科住院的HBV携带者66例,所有患者均接受肝脏穿刺活检术。使用FibroTouch行肝脏硬度检测(LSM),常规计算基于4因子(FIB-4)指数,应用MedCalc软件绘制ROC曲线。结果 肝组织病理学检查提示,无显著肝纤维化(S₀～S₁)24例、进展期肝纤维化(S₂～S₃)27例和肝硬化(S₄)15例;无显著肝纤维化组LSM为(7.8±1.8) kPa,显著低于进展期肝纤维化组【(11.4±3.1)kPa,P<0.01】或肝硬化组【(18.2±6.2)kPa,P<0.01】患者,无显著肝纤维化组FBI-4指数为(1.0±0.5),与进展期肝纤维化组的(1.2±0.5)比,无显著性差异(P>0.05),但这两组FIB-4均显著低于肝硬化组[(2.0±1.0,P<0.01];LSM独立诊断S_...     

影响慢性乙型肝炎患者进展为肝硬化的多因素分析

目的 探讨影响慢性乙型肝炎(CHB)患者发生肝硬化的因素。方法 2010～2016年我科住院的CHB患者135例,均接受肝活检,并随访5(7,11)年。随访结束时,临床诊断肝硬化。应用Logistic回归分析并建立预测模型,应用受试者工作特征(ROC)曲线下面积(AUC)评估诊断效能。结果 入组时肝组织学检查显示,非肝纤维化组81例,显著纤维化组54例;随访结束时,临床诊断非肝硬化组111例,肝硬化组24例(来自无纤维化组7例,来自显著肝纤维化组17例);非肝硬化组与肝硬化组年龄、是否抗病毒治疗、血清HBV DNA、血小板计数(PLT)、血浆凝血酶原时间国际标准化比值(INR)、部分活化的凝血活酶时间(APTT)和红细胞分布宽度(RDW)差异具有统计学意义(均P<0.05);多因素回归分析显示INR(P=0.010,OR=369.352)、APTT(P=0.001,OR=1.169)、RDW(P=0.035,OR=1.402)、PLT(P=0.018,OR=0.989)、年龄(P=0.024,OR=1.052)、血小板与淋巴细胞比值(P/L比值,P=0.044,OR=0.983)...     

瞬时弹性成像联合门静脉血流动力学指标诊断慢性乙型肝炎患者肝纤维化意义探讨*

目的 探讨瞬时弹性成像联合门静脉血流动力学指标诊断慢性乙型肝炎(CHB)患者肝纤维化的临床价值。方法 2016年2月～2019年9月我院收治的经肝组织活检诊断的CHB患者98例,使用FibroScan 502型诊断仪行肝脏硬度测定(LSM),使用超声检测门静脉主干内径(PVD)、平静呼吸时门静脉最大流速(Vmax)和平静呼吸时门静脉平均流速(Vmean)。采用多因素分析影响肝纤维化的因素,应用受试者工作特征(ROC)曲线评价诊断效能。结果 98例CHB患者经肝穿组织病理学检查,诊断为肝纤维化F0期6例,F1期22例,F2期34例,F3期28,F4期8例;F4期患者LSM、PVD、Vmax和Vmean分别为(28.6±7.8)kPa、(1.4±0.4)cm、(27.4±2.5)cm/s和(22.8±3.1)cm/s,与F1期比,差异显著[分别为(6.1±0.4)kPa、(1.0±0.2)cm、(33.8±1.4)cm/s和(28.5±1.4)cm/s,P<0.05];以F0和F1期划归为非显著性肝纤维化,将>F2期划归为显著肝纤维化。70例显著肝纤维化患者LSM、PVD、Vmax和Vmean分别为(14.2±3.8)kPa、(1.4±0.4)cm、(29.1±2.1)cm/s和(24.1±2.1)cm/s,与28例非显著肝纤维化患者比,差异显著[分别为(5.9±0.4)kPa、(1.0±0.2)cm、(36.8±1.5)cm/s和(30.5±1.4)cm/s,P<0.05];二分类Logistic回归分析结果提示LSM和PVD是肝纤维化发生的独立预测指标(P<0.05),以LSM等于8.4 kPa为截断点,其诊断显著肝纤维化的AUC为0.84(95%CI :0.80～0.89),敏感性为82%(95%CI:76%～85%),特异性为89%(95%CI:81%～93%),而PVD诊断的截断点为1.4 cm,其AUC为0.83(95%CI :0.78～0.89),敏感性为81%(95%CI:75%～86%),特异性为90%(95%CI:85%～94%)。结论 采用LSM和超声检测的PVD诊断CHB患者显著肝纤维化具有很高的诊断效能,值得临床扩大验证。     

Comparative study on the effects of hepatic arterial embolization with Bletilla striata or Gelfoam in treatment of primary hepatic carcinoma

AIM: To study the safety and efficacy of hepatic arterial embolization (HAE) with Bletilla striata powders containing traditional Chinese herbs in the treatment of primary hepatic carcinoma (PHC). METHODS: From May 1990 to September 1993, 106 patients with PHC were treated by HAE with different types of Bletilla striata powders (n = 56) or Gelfoam powders (n = 50) under clearly specified conditions. We analyzed the effects and complications associated with these two types of treatment. RESULTS: The Bletilla striata powders produced extensive and permanent proximal embolization of the hepatic artery, and stimulated the formation of collateral circulation. Treatment could be stopped for as long as 6-12 mo, and there was obvious evidence of tumor necrosis and shrinkage. The patient survival rates at 1, 2, and 3 years were 81.9%, 44.9%, and 33.6%, respectively, and the mean survival time without a serious complication was 19.8 mo. Patients in the Bletilla striata group displayed better clinical effects from their treatment when compared with patients in the Gelfoam group. CONCLUSION: Bletilla striata powders are superior to Gelfoam powders when used for angioembolus in patients with hepatic carcinoma.     

Differential expression of hepatic apurinic/apyrimidinic endonuclease 1, a DNA repair enzyme,in chronic hepatitis

AIM: To determine hepatic expression of apurinic/apyrimidinic endonuclease 1 (APE-1) and 8-hydroxydeoxyguanosine (8-OHdG) in patients with chronic hepatitis B and C. METHODS: Liver biopsies were obtained from 27 patients with chronic hepatitis B virus (HBV), 30 with chronic hepatitis C virus (HCV), 6 with autoimmune hepatitis (AIH), and 6 with primary biliary cirrhosis (PBC). Normal liver tissue was obtained from surgical resection specimens of four patients. Hepatic APE-1 protein and mRNA expression were assayed by Western blot and by real-time polymerase chain reaction, respectively. Hepatocellular APE-1 and 8-OHdG expression were determined by immunohistochemistry. RESULTS: The staining intensity of hepatocellular nuclear APE-1 was lower in the HBV group than in the other groups (P < 0.05). Hepatic APE-1 protein levels were reduced in the HBV group relative to the other groups. Hepatic APE-1 mRNA levels were also lower in the HBV group. The proportion of hepatocytes with 8-OHdG-positive nuclei was increased in the HCV, AIH and PBC groups (P < 0.05), but not in the HBV group. Hepatocellular nuclear APE-1 levels were positively correlated with hepatocellular 8-OHdG levels in both the HBV and HCV groups (HBV, r = 0.34, P < 0.05; HCV, r = 0.54, P < 0.01). CONCLUSION: An imbalance between oxidative DNA damage and APE-1 expression may contribute to hepatocarcinogenesis in chronic viral hepatitis.     

Serum cytokine profile in patients with hepatitis B e antigen-negative chronic active hepatitis B and inactive hepatitis B virus carriers

An insufficient cellular immune response seems to be critical for the immunopathogenesis of chronic hepatitis B virus infection.We have previously demonstrated no differences of T-lymphocyte subsets in blood between inactive hepatitis B s antigen(HBsAg) carriers and patients with HBeAg-negative chronic active hepatitis B.This study investigated the peripheral blood cytokine profile in patients with HBeAg-negative chronic active hepatitis B infection(Group A,n = 21) and inactive HBsAg carriers(Group B,n = 13).Serum cytokines [interferon(IFN)-γ,tumor necrosis factor-α,interleukin(IL)-1b,IL-4,IL-12,IL-10,IL-2,IL-5,IL-8] were analyzed by using flow cytometry.Patients with chronic active disease presented with significantly decreased levels of IFN-γ and IL-10 compared to inac-tive carriers(P = 0.048 and P = 0.008,respectively).In HBeAg-negative chronic active hepatitis B patients,a significant negative correlation of IFN-γ levels with serum hepatitis B viral load was noted(P = 0.021).In conclusion,patients with HBeAg-negative chronic active hepatitis B and HBsAg inactive carriers display a different cytokine profile.Decreased Th1 response observed in patients with chronic active hepatitis B could be implicated in the persistence of virus replication and ongoing progression of liver disease.