Influencing factors for acute necrotizing pancreatitis in Eastern and Western countries: A meta-analysis / 临床肝胆病杂志

Objective To investigate the differences in the influencing factors for acute necrotizing pancreatitis (ANP) and infectious pancreatic necrosis (IPN) between Eastern and Western countries, and to provide a theoretical basis for the prediction and prevention of ANP. Methods Databases including PubMed, Embase, the Cochrane Library, and Web of Science were searched for articles on the influencing factors for ANP and IPN published up to January 21, 2021, and a Meta-analysis was performed. Results A total of 59 studies were included, with 22 studies from Eastern countries and 37 studies from Western countries.The Meta-analysis showed that in Eastern countries, male sex (odds ratio[ OR ]=1.51, 95% confidence interval[ CI ]: 1.18-1.91, P < 0.01), C-reactive protein (CRP)(standardized mean difference[ SMD ]=1.39, 95% CI : 1.06-1.71, P < 0.01), D-dimer ( SMD =0.44, 95% CI : 0.07-0.81, P =0.02), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE-Ⅱ) score (mean difference[ MD ]=3.51, 95% CI : 1.38-5.64, P < 0.01), alcoholic etiology ( OR =3.57, 95% CI : 2.68-4.75, P < 0.01), and biliary etiology ( OR =0.60, 95% CI : 0.46-0.77, P < 0.01) were the influencing factors for ANP, and in Western countries, male sex ( OR =1.63, 95% CI : 1.30-2.05, P < 0.01), CRP ( SMD =2.09, 95% CI : 1.12-3.05, P < 0.01), APACHE-Ⅱ score ( MD =4.28, 95% CI : 2.73-5.83, P < 0.01), Ranson score ( MD =2.99, 95% CI : 2.50-3.47, P < 0.01), and organ failure ( OR =10.87, 95% CI : 2.62-45.04, P < 0.01) were the influencing factors for ANP.In Eastern countries, age ( MD =2.16, 95% CI : 0.43-3.89, P =0.01), body mass index (BMI)( MD =1.74, 95% CI : 1.23-2.25, P < 0.01), albumin level ( SMD =-0.43, 95% CI : -0.75 to-0.12, P < 0.01), CRP ( SMD =0.58, 95% CI : 0.04-1.11, P =0.03), procalcitonin ( SMD =0.80, 95% CI : 0.56-1.04, P < 0.01), D-dimer ( MD =0.23, 95% CI : 0.15-0.31, P < 0.01), APACHE-Ⅱ score ( MD =2.47, 95% CI : 0.73-4.22, P < 0.01), Ranson score ( MD =1.60, 95% CI : 1.46-1.73, P < 0.01), and extent of necrosis ≥30%( OR =2.52, 95% CI : 1.26-5.06, P < 0.01) were the influencing factors for IPN, while in Western countries, age ( MD =4.07, 95% CI : 1.82-6.31, P < 0.01), APACHE-Ⅱ score ( MD =3.28, 95% CI : 1.39-5.17, P < 0.01), Ranson score ( MD =2.18, 95% CI : 1.75-2.62, P < 0.01), SIRS score ( OR =3.88, 95% CI : 1.58-9.51, P < 0.01), alcoholic etiology ( OR =0.61, 95% CI : 0.42-0.87, P < 0.01), and organ failure ( OR =3.63, 95% CI : 1.11-11.92, P =0.03) were the influencing factors for IPN. Conclusion Current evidence shows that biliary etiology and alcoholic etiology are unique influencing factors for ANP in the Eastern population, while Ranson score is a unique influencing factor in the Western population.BMI and extent of necrosis ≥30% are unique influencing factors for IPN in the Eastern population, while alcoholic etiology is a unique influencing factor in the Western population.

The association between obesity measurement indices and nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease (NAFLD) is a type of metabolic disorder syndrome of abnormal lipid deposition in hepatocytes, and with the improvement of living standards, the incidence rate of NAFLD has reached a worrying level. Several anthropometric indicators, including waist circumference, waist-hip ratio, and waist-height ratio, have been used in the evaluation of obesity and the correlation study of various metabolic diseases. This article introduces the association between NAFLD and various anthropometric indicators for obesity and points out that anthropometric indicators for obesity can be used for the prevention and control of NAFLD.

The association between obesity measurement indices and nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease (NAFLD) is a type of metabolic disorder syndrome of abnormal lipid deposition in hepatocytes, and with the improvement of living standards, the incidence rate of NAFLD has reached a worrying level. Several anthropometric indicators, including waist circumference, waist-hip ratio, and waist-height ratio, have been used in the evaluation of obesity and the correlation study of various metabolic diseases. This article introduces the association between NAFLD and various anthropometric indicators for obesity and points out that anthropometric indicators for obesity can be used for the prevention and control of NAFLD.

Value of albumin-bilirubin score in predicting the prognosis of cirrhotic patients with esophagogastric variceal bleeding / 临床肝胆病杂志

ObjectiveTo investigate the value of albumin-bilirubin (ALBI) score in predicting the prognosis of cirrhotic patients with esophagogastric variceal bleeding, and to identify risk stratification and increase clinical applicability. MethodsA retrospective analysis was performed for the clinical data of 273 cirrhotic patients with esophagogastric variceal bleeding who were hospitalized in Subei People’s Hospital of Jiangsu from October 2012 to August 2018, and all patients received standard management after admission. Survival status was obtained through electronic medical records and telephone follow-up, and according to the prognosis in August 2020, the patients were divided into death group with 109 patients and survival group with 164 patients. General data were compared between the two groups. The Mann-Whitney U test was used for comparison of continuous variables between two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical variables between two groups; univariate and multivariate Cox regression analyses were used to identify independent risk factors for prognosis. The Kaplan-Meier curve was used to analyze the survival rates of patients with different ALBI grades, and the log-rank test was used for comparison between groups; the receiver operating characteristic (ROC) curve was plotted to compare the ability of ALBI score, Child-Turcotte-Pugh (CTP) score, and Model for End-Stage Liver Disease (MELD) score in predicting short-term (6 weeks) and long-term prognoses. ResultsDuring follow-up, 109 patients (39.9%) died, and the death group had a significantly higher ALBI score than the survival group ［-1.49 (-1.82 to -1.11) vs -1.79 (-2.22 to -1.49), Z=5.630, P＜0.001］. The univariate analysis showed that age ≥55 years, hemoglobin ≤100 g/L, neutrophil count ≥3.4×109/L, platelet count ≤42×109/L, albumin ≤28 g/L, total bilirubin ≥21 μmol/L, alanine aminotransferase ≥42 U/L or aspartate aminotransferase ≥48 U/L, creatinine ≥94 μmol/L, serum sodium ≤137 mmol/L, international normalized ratio of prothrombin ≥1.5, ascites, and hepatic encephalopathy were risk factors for death in cirrhotic patients with esophagogastric variceal bleeding, and the patients with ALBI grade 3 had a significantly higher risk of death than those with ALBI grade 1 or 2; prophylactic ligation was a protective factor for survival improvement in cirrhotic patients with esophagogastric variceal bleeding (all P＜0.05). The multivariate analysis showed that age ≥55 years (hazard ratio ［HR］=2.531, 95% confidence interval ［CI］: 1.624-3.946, P＜0.001), creatinine ≥94 μmol/L (HR=1.935, 95% CI: 1.208-3.100, P=0.006), serum sodium ≤137 mmol/L ［HR=1.519, 95% CI: 1.015-2.274, P=0.042］, ascites (HR=1.641, 95% CI: 1.041-2.585, P=0.033), hepatic encephalopathy (HR=9.972, 95% CI: 3.961-25.106, P＜0.001), and ALBI grade 3 (HR=1591, 95% CI: 1.007-2.515, P=0.047) were independent risk factors for death. The patients with ALBI grade 3 had a significantly lower survival rate than those with ALBI grade 1 (χ2=18.691, P＜0.001) and ALBI grade 2 (χ2=21.364, P＜0.001), and the patients with ALBI grade 1 had a significantly higher survival rate than those with ALBI grade 2 (χ2=6513, P=0.011). The ROC curve analysis showed that ALBI score, CTP score, and MELD score had an area under the ROC curve (AUC) of 0770, 0.730, and 0.706, respectively, in predicting short-term (6 weeks) prognosis, and they had an AUC of 0.701, 0685, and 0659, respectively, in predicting long-term prognosis. ConclusionALBI score has a good value in predicting short-term (6 weeks) and long-term prognoses of cirrhotic patients with esophagogastric variceal bleeding, and the risk of death increases with ALBI grade. ALBI score can be used as an objective and simple model in clinical practice.

Role of gut microbiota and bile acid pathway in nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease is a group of diseases with unclear pathophysiological mechanism and is closely associated with metabolic syndrome. Bacterial components and metabolites produced by gut microbiota can regulate glucose and lipid metabolism, inflammatory response, and oxidative stress, and bile acids regulate immune function, energy metabolism, and material metabolism through various signaling pathways after activating their receptors. Gut microbiota and bile acids interact with each other through enterohepatic circulation, and the changes of their structure and function are involved in the development and progression of nonalcoholic fatty liver disease. This article reviews the effect of the homeostatic dysregulation of gut microbiota and bile acids and their interactions on nonalcoholic fatty liver disease.

Expression and significance of OX40/OX40L in peripheral blood of patients with autoimmune hepatitis, primary biliary cholangitis, and their overlap syndrome / 临床肝胆病杂志

ObjectiveTo investigate the expression and clinical significance of OX40/OX40L (CD134/CD134L) in CD4+ T cells, CD8+ T cells, monocytes, and B lymphocytes in peripheral blood of patients with autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and their overlap syndrome before and after standardized treatment. MethodsA total of 74 patients with AIH, PBC, and their overlap syndrome who were diagnosed in Subei People’s Hospital of Jiangsu from August 2015 to August 2019 were enrolled, and according to related diagnostic criteria, they were divided into AIH group (group A) with 29 patients, PBC group (group P) with 26 patients, and overlap syndrome group (group C) with 19 patients. A healthy control group with 30 individuals was also established. Peripheral blood samples were collected before and after standardized treatment to measure the expression of OX40/OX40L on the surface of peripheral blood cells by immunofluorescence flow cytometry, and the expression of OX40/OX40L was compared before and after treatment and between the three groups and the healthy control group to investigate its clinical significance. A one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the paired t-test was used for comparison of paired samples between two groups. ResultsThere were no significant differences in sex composition and age composition between the three groups (P＞0.05). Before treatment, the positive rate of OX40 in peripheral blood CD4+ T cells gradually increased in groups A, P, and C, and groups A, P, and C had a significantly higher positive rate of OX40 than the control group (14.80%±4.99%/17.11%±2.71%/25.18%±5.55% vs 6.67%±2.26%, F=14.823, P＜0.001); groups A, P, and C had a significantly higher positive rate of OX40 in CD8+ T cells than the control group (4.86%±1.54%/6.40%±1.88%/7.33%±2.12% vs 4.09%±2.69%, F=5.486, P＜0.001); the positive rate of OX40L in CD14+ monocytes was 19.84%±6.11% in group A, 21.17%±4.35% in group P, 29.13%±6.32% in group C, and 4.86%±2.34% in the control group, and there was a significant difference between groups (F=17004, P＜0.001); the positive rate of OX40L in CD19+ B cells was 17.62%±3.86% in group A, 14.75%±4.32% in group P, 1013%±2.56% in group C, and 4.50%±1.38% in the control group, showing a trend of gradual reduction, and groups A, P, and C had a significantly higher positive rate than the control group (F=12.221, P＜0.001). After treatment, the positive rate of OX40 in CD8+ T cells decreased significantly to a similar level as the control group, and there was no significant difference between groups (F=0731, P=0.538). For the other three types of cells, although there were varying degrees of reduction in the positive rate of OX40/OX40L after treatment, groups A, P, and C still had a significantly higher positive rate than the control group; in CD4+ T cells, the positive rate of OX40 was 11.00%±1.98% in group A, 13.72%±1.03% in group P, 19.72%±3.47% in group C, and 6.67%±2.26% in the control group, and groups A, P, and C had a significantly higher positive rate than the control group (F=11.365, P＜0.001); in CD14+ monocytes, the positive rate of OX40L was 11.82%±2.23% in group A, 15.19%±4.42% in group P, 24.51%±4.09% in group C, and 4.86%±2.34% in the control group, and groups A, P, and C had a significantly higher positive rate than the control group (F=13748, P＜0.001); in CD19+ B cells, the positive rate of OX40L was 9.09%±3.25% in group A, 6.81%±2.20% in group P, 748%±2.85% in group C, and 4.50%±1.38% in the control group, and groups A, P, and C had a significantly higher positive rate than the control group (F=8.052, P＜0.001). Groups A, P, and C had significant reductions in the expression of OX40/OX40L in peripheral blood CD4+ T cells, CD8+ T cells, CD14+ monocytes, and CD19+ B lymphocytes after treatment (all P＜0.05). ConclusionThe expression of OX40/OX40L in peripheral blood increases in patients with AIH, PBC, and their overlap syndrome and decreases after treatment, indicating that the OX40/OX40L pathway is involved in the pathogenesis of the above diseases, and the role of OX40 on the surface of CD8+ T cells may better reflect the treatment outcome.

Mechanism of action of regulatory B cells in the development and progression of autoimmune hepatitis / 临床肝胆病杂志

Autoimmune hepatitis is a type of autoimmune disease and has known pathogenesis at present, which is believed to be associated with immune imbalance in the body. In inflammatory diseases, regulatory B cells (Bregs) inhibits the differentiation of CD4+ T lymphocytes into T helper 1 cells and T helper 17 cells by secreting interleukin-10 (IL-10) to inhibit inflammatory response. Patients with autoimmune hepatitis have reductions in the level of IL-10 in peripheral blood and the number and function of Bregs, which leads to the fact that Bregs cannot effectively inhibit inflammatory response, suggesting that Bregs play a certain role in the pathogenesis of autoimmune hepatitis. This article reviews the mechanism of action of Breg subsets in autoimmune hepatitis.

Clinical effect of ultrasound-guided percutaneous drainage in treatment of liver abscess / 临床肝胆病杂志

ObjectiveTo investigate the clinical value of ultrasound-guided percutaneous drainage in the treatment of liver abscess from the aspects of laboratory markers and size of abscess. MethodsA total of 79 patients with liver abscess who underwent ultrasound-guided percutaneous drainage in Department of Gastroenterology in Northern Jiangsu People’s Hospital from January 2013 to August 2018 were enrolled, among whom 36 patients who were lost or transferred, abandoned treatment, had an age pf ＜18 years, or were not followed up in the outpatient service were excluded. A total of 43 patients were finally included in the retrospective study. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsAll 43 patients achieved a one-time success of puncture and placement of drainage tube. Of all 43 patients, 36 had fear of cold and pyrexia, among whom 31 (86.1%) had a normal body temperature on day 3 after surgery, and there were significant changes in leukocyte count, percentage of neutrophils, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase after surgery (t=6.668, 6.255, 2337, 3.001, and 5.198, all P＜0.05). There was a significant reduction in the diameter of abscess after surgery (74±31 mm vs 31±28 mm, t=18.517, P＜0.05). The average length of hospital stay was 19.84±9.37 days. Of all 43 patients, 19(44.2%) were cured and 24(55.8%) had response to treatment. Of all 43 patients, 38 had positive results of liver abscess culture, among whom 25(65.8%) had Klebsiella pneumoniae infection, suggesting that Klebsiella pneumoniae was the most common pathogenic bacteria. ConclusionUltrasound-guided percutaneous drainage has a high success rate, few complications, and reliable clinical efficacy in the treatment of liver abscess. Therefore, it is recommended as the first choice for the clinical treatment of liver abscess.

Immunological mechanism of Treg/Th17 and Th1/Th2 balance in autoimmune hepatitis and new targets for diagnosis and treatment / 临床肝胆病杂志

Autoimmune hepatitis (AIH) is a chronic autoimmune disease in the liver, with major clinical manifestations of positive autoantibody, abnormal elevation of aminotransferases, and hypergammaglobulinemia. Current studies have shown that regulatory T (Treg)/T helper 17 (Th17) and T helper 1 (Th1)/T helper 2 (Th2) imbalance is one of the mechanisms of the development and progression of AIH. OX40 (also known as CD134, TNFRSF4, or ACT35) and its ligand OX40L are members of the tumor necrosis factor family, and they participate in immune response as co-stimulators of T cell activation and can regulate Treg/Th17 and Th1/Th2 balance, thus affecting the progression of various autoimmune diseases. However, there are few reports on the role of OX40 and OX40L in AIH. With reference to related articles, this article reviews the role of Treg/Th17 and Th1/Th2 balance in AIH and the potential association between OX40/OX40L (new targets for immunological diagnosis and treatment) and AIH.

Association of Th17 cells, regulatory T cells, and their imbalance with nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease (NAFLD) is closely associated with insulin resistance and genetic susceptibility and is one of the chronic liver diseases that threaten human health .Under certain conditions, Th17 cells and regulatory T (Treg) cells can be transformed to each other to maintain immune homeostasis.In recent years, more and more studies have been performed on the involvement of Th 17 and Treg cells in the development and progression of liver diseases .Th17 cells, Treg cells, and their balance may become the new targets for the treatment of NAFLD.This article reviews the latest research advances in the association of Th 17 and Treg cells with NAFLD and the role of Th17/Treg balance in the development and progression of NAFLD .

Research advances in immunoglobulin G4-related sclerosing cholangitis / 临床肝胆病杂志

Immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) is a new type of secondary sclerosing cholangitis which was discovered recently and has unknown pathogenesis.IgG4-SC is characterized by an increased serum level of immunoglobulin G4 (IgG4),chronic progressive obstructive jaundice,diffuse or local infiltration of a large number of IgG4-positive plasma cells and lymphocytes,fibrosis,and obstructive phlebitis.This article reviews the diagnosis and treatment of IgG4-SC and its association with primary sclerosing cholangitis and cholangiocarcinoma.

Value of serum cholinesterase in diagnosis/treatment and prognostic evaluation of liver diseases / 临床肝胆病杂志

Serum cholinesterase (ChE) is synthesized by hepatic parenchymal cells and is released into blood immediately after synthesis,and therefore,serum ChE can be used as an objective and sensitive indicator of liver function.Serum ChE has been used as an independent factor for the evaluation of liver function for a long time and can reflect the synthetic function of the liver and help to determine the severity of liver diseases.Combined measurement of serum ChE and serum prealbumin,total cholesterol,total bile acid,and prothrombin time has an important value in the diagnosis and treatment of liver diseases.At the same time,serum ChE combined with Child-Turcotte-Pugh score or MELD score can accurately evaluate liver reserve function,which may help with the prognostic evaluation of patients with liver diseases.

Value of serum cholinesterase in diagnosis/treatment and prognostic evaluation of liver diseases / 临床肝胆病杂志

Serum cholinesterase (ChE) is synthesized by hepatic parenchymal cells and is released into blood immediately after synthesis,and therefore,serum ChE can be used as an objective and sensitive indicator of liver function.Serum ChE has been used as an independent factor for the evaluation of liver function for a long time and can reflect the synthetic function of the liver and help to determine the severity of liver diseases.Combined measurement of serum ChE and serum prealbumin,total cholesterol,total bile acid,and prothrombin time has an important value in the diagnosis and treatment of liver diseases.At the same time,serum ChE combined with Child-Turcotte-Pugh score or MELD score can accurately evaluate liver reserve function,which may help with the prognostic evaluation of patients with liver diseases.

Progress in emergency management of esophageal variceal bleeding / 临床肝胆病杂志

Esophageal variceal bleeding is a severe complication of cirrhotic portal hypertension and the main cause of mortality in patients. Studies revealed no significant differences in emergency hemostasis rate,fatality rate,and rebleeding rate between patients receiving endo-scopic treatment and vasoactive agents.The advances in emergency management of esophageal variceal bleeding,including endoscopic band ligation,sclerotherapy,and use of vasoactive agents,are reviewed,with emphasis on emergency endoscopic treatment and drug therapy for esophageal variceal bleeding.

Roles of CD4+ T lymphocytes in hepatocellular carcinoma / 国际肿瘤学杂志

As a series of multifunctional cells,recent studies indicate that most of the CD4 + T lymphocyte subsets involve in the tumor angiogenesis and invasion,the apoptosis of tumor cells,and the expressions of acute phase proteins and cancer-promoting genes by activating or inhibiting the innate immune cells,the adaptive immune cells and non-immune cells,thus function as tumor promoters or inhibitors in hepatocellular carcinoma (HCC).

Effect of CpG-ODN on phenotypes,function of monayte-derived dendritic cells and expression of STAT and SOCS in patients with chronic hepatitis B / 基础医学与临床

Objective To study the effect of CpG containing oligodeoxynucleotide(CpG-ODN) on the phenotypes,function and expression of signal transductors and activators of transcription(STAT) and suppressors of cell signaling(SOCS) of peripheral blood dendritic cells(DC) in patients with chronic hepatitis B(CHB).Methods Monocytes isolated from peripheral blood of CHB and healthy volunteers were cultured and induced by granulocyte-monocyte colony stimulating factor(GM-CSF) and interleukin-4(IL-4).Then,CpG-ODN or TNF-? were added to stimulate the immatured DC,their effects on the phenotypes and function of DC were evaluated.(The expression of) signaling molecules of STAT1,3,4,5,6 and SOCS1,3 in DC were detected by Western blotting.Results The(expression) rates of HLA-DR of DC in CHB with the treatment of CpG-ODN or TNF-? were obviously increased;Both the IL-12p70 expression and stimulating capacity of DC to allogenic T lymphocytes were improved significantly in CpG-ODN group and TNF-? group(P

Effect of oxymatrine on murine fulminant hepatitis and hepatocyte apoptosis / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the protective effects and mechanism of action of oxymatrine (OM) on the experimental fulminant hepatitis (FH) and early hepatocyte apoptosis in murine liver tissue.</p><p><b>METHODS</b>Fulminant hepatitis mice were induced by injecting lipopolysaccharide (LPS) intraperitoneally (ip) in galactosamine (GalN) sensitized mice. Two separate experiments were designed, including saline control group, fulminant hepatitis group and oxymatrine pretreated group (50 mg/kg, intraperitoneally, bid x 3 days). The levels of serum tumor necrosis factor alpha (TNFa) in mice from two experiments were determined at 5-hour and 7.5-hour after injecting galactosamine/lipopolysaccharide. Mouse liver samples at 5-hour time point were obtained for in situ end labeling (ISEL) staining and ultrastructural observation of apoptotic cells under transmission electron microscope (TEM). Liver samples at 7.5-hour time point were taken for hematoxylin-eosin (HE) staining and immunohistochemical staining of Fas and its ligand (FasL).</p><p><b>RESULTS</b>As compared with the fulminant hepatitis group, the levels of serum tumor necrosis factor alpha in mice from the OM pretreated group at 5-hour and 7.5-hour time point were all significantly decreased (P < 0.05 and P < 0.01 respectively). Hepatocyte apoptosis in mice at 5-hour time point was significantly inhibited (P < 0.01). Both the degree of liver injury and the degree of Fas and Fas ligand expression in the OM pretreated group were reduced remarkably (P < 0.01 and 0.05 respectively) when compared with the saline control group.</p><p><b>CONCLUSIONS</b>Oxymatrine protects mice from fulminant hepatitis induced by GalN/LPS and may block hepatocyte apoptosis and subsequent necrosis through downregulating the production of serum tumor necrosis factor alpha and the expression of Fas and Fas ligand in liver tissue.</p>