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ObjectiveTo investigate the safety and efficacy of endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips in the treatment of cirrhotic patients with gastric varices and gastric-renal shunt （GRS）. MethodsThe patients who attended Beijing Ditan Hospital， Capital Medical University， due to liver cirrhosis and gastric varices from February to June 2023 were enrolled， and all patients were confirmed to have GRS and received endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips. The primary evaluation index was alleviation or disappearance of varicose veins after surgery， and the secondary evaluation indices were surgical completion and complications. ResultsA total of 11 patients were enrolled in this study， among whom there were 7 male patients and 4 female patients， with a median age of 55 years. Of all patients， 1 had Child class A liver function， 7 had Child class B liver function， and 3 had Child class C liver function. The maximum （median） diameter of the shunt was 8 mm， and the minimum （median） diameter of the shunt was 4 mm. The median blood flow velocity of the target vessel was 11 cm/s before treatment and 5 cm/s after occlusion with metal clips. The median amount of tissue adhesive injected was 2 mL， and the amount of lauromacrogol used was 1 mL. Disappearance of blood flow signals was observed in all patients after surgery （100%）， and the success rate of surgery was 100%. No patient experienced rebleeding after follow-up for 6 weeks. Gastroscopy at 1 month after surgery showed that gastric varices were eradicated or almost disappeared in 9 patients and were alleviated in 2 patients. ConclusionEndoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips is a feasible， safe， and effective treatment method for cirrhotic patients with gastric varices and GRS.
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Objective To investigate the rebleeding rate after endoscopic selective variceal devascularization (ESVD) and the predictive factors for rebleeding in patients with hepatitis B cirrhosis and esophageal variceal bleeding (EVB). Methods The patients with hepatitis B cirrhosis and EVB who attended Beijing Ditan Hospital, Capital Medical University, from October 2010 to December 2019 and underwent ESVD for the first time were enrolled, and a total of 442 patients were screened out based on inclusion and exclusion criteria. Routine clinical indices, laboratory markers, imaging findings, and endoscopic findings were compared between patients, and the patients were followed up to observe rebleeding. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to describe rebleeding and survival status, and a Cox regression analysis was used to determine the independent risk factors for variceal rebleeding. Results The 1-, 2-, 3-, 4-, and 5-year cumulative rebleeding rates after first ESVD treatment were 25.11%, 33.94%, 39.82%, 42.08%, and 45.02%, respectively. The univariate analysis showed that age, systolic pressure, duration of antiviral therapy ≥1 year, ascites, white blood cell count, neutrophil, and direct bilirubin were associated with rebleeding (all P < 0.05), and the multivariate analysis showed that duration of antiviral therapy ≥1 year (hazard ratio [ HR ]=0.504, 95% confidence interval [ CI ]: 0.357-0.711, P < 0.001) and ascites ( HR =1.424, 95% CI : 1.184-1.714, P < 0.001) were independent influencing factors for variceal rebleeding. Conclusion ESVD has a low rebleeding rate in the treatment of hepatitis B cirrhosis with EVB, and presence of ascites and a short duration of antiviral therapy are independent risk factors for rebleeding after treatment.
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ObjectiveTo investigate the antioxidant effect of matrine and its clinical effect in the treatment of rats with nonalcoholic steatohepatitis (NASH). MethodsA total of 30 rats were randomly divided into three groups: control group, NASH group, and matrine group, with 10 in each. A high-fat diet was used to establish the rat model of NASH, and matrine was given by gavage for treatment at a dose of 36 mg·kg-１·d-1. The changes in body weight and liver weight were observed in all rats. HE staining was used to observe the histopathological changes of the liver. The serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and the content of reduced glutathione (GSH), superoxide dismutase (SOD), and malondialdehyde (MDA) in liver tissue were measured. A one-way analysis of variance was used for the comparison between multiple groups, and the SNK-q test was used for further comparison between any two groups. ResultsCompared with the NASH group, the matrine group had significant reductions in the serum levels of ALT and AST (ALT: 52.0±3.0 U/L vs 41.8±3.7 U/L, P＜0.001; AST: 233.6±9.4 U/L vs 170.1±1.8 U/L, P＜0.001). The matrine group showed marked improvement in the histopathological changes of the liver compared with the NASH group. Compared with the NASH group, the matrine group had significantly increased content of SOD and GSH in liver tissue (SOD: 17.7±2.0 μg/mg vs 27.0±3.6 μg/mg, P＜0.001; GSH: 16.5±1.6 U/mg vs 28.5±2.1 U/mg, P＜0.001) and significantly reduced content of MDA (22.9±1.9 nmol/mg vs 17.8±1.8 nmol/mg, P＜0.001). ConclusionMatrine has an antioxidant effect and a marked clinical effect in the treatment of rats with NASH.
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0.05) , while at the 4th week significantly increased (P