Research advances in non-cirrhotic portal hypertension / 临床肝胆病杂志

Although liver cirrhosis is the most common cause of portal hypertension (PH), about 20% of PH cases are caused by non-cirrhotic reasons, which are referred to as non-cirrhotic portal hypertension (NCPH), with a high incidence rate in developing countries. NCPH is a group of heterogeneous hepatic vascular diseases, including idiopathic portal hypertension (IPH) and extrahepatic portal vein obstruction (EHPVO), as well as the rare diseases in clinical practice such as Budd-Chiari syndrome, congenital hepatic fibrosis, and nodular regenerative hyperplasia. The patients with NCPH usually have the symptoms of portal hypertension, such as recurrent variceal bleeding and splenomegaly, but liver function is well preserved in these patients. At present, the diagnosis of NCPH lacks a universally accepted standard and remains a challenge. In clinical practice, the method of exclusion is usually applied for the diagnosis of HCPH, and liver biopsy is performed when necessary to make a confirmed diagnosis. This paper introduces the pathogenesis and pathological manifestations of IPH and EHPVO, as well as the selection of diagnostic methods and therapeutic strategies. If upper gastrointestinal bleeding can be effectively controlled, NCPH is considered to have a relatively good prognosis.

Long-term therapeutic effect of transjugular intrahepatic portosystemic shunt in patients with intractable cirrhotic ascites and prognostic factors / 临床肝胆病杂志

ObjectiveTo investigate the long-term therapeutic effect of transjugular intrahepatic portosystemic shunt (TIPS) in patients with intractable cirrhotic ascites and prognostic factors. MethodsA retrospective analysis was performed for the clinical data of 57 patients with intractable cirrhotic ascites who were received TIPS in our hospital from January 2009 to June 2014. Regular telephone follow-up was performed in all patients. Laboratory testing results and abdominal ultrasound and CT findings were examined. The improvement in ascites and survival were evaluated. The χ2 test was applied for comparison of categorical data between groups. The Kaplan-Meier method was used to calculate the cumulative probability of survival and other cumulative probabilities, the log-rank test was used for survival difference analysis, the Cox regression model was used to analyze prognostic factors, and the receiver operating characteristic curve(ROC) and the area under the curve(AUC) were used to determine the optimal cut-off values of prognostic factors. ResultsThe 1-year ascites remission rate after TIPS was 93%, and the 1- and 2-year survival rates were 60% and 43%, respectively. The multivariate Cox regression analysis showed that Child-Pugh score (HR=268, 95%CI: 1.009-1.594, P=0.042) and urea nitrogen (HR=1.143, 95%CI: 1034-1.264, P=0.009,) were predictive factors for 1-year survival rate after TIPS in patients with intractable cirrhotic ascites. The area under the ROC curve of Child-Pugh score was 0.699 (P=0011, 95%CI: 0.558-0.840), and the optimal cut-off value of Child-Pugh score was 8, with a sensitivity of 75% and a specificity of 67%. The Kaplan-Meier survival analysis demonstrated that the 1-year survival rates of patients with Child-Pugh scores of ≤8 and ＞8 were 82% and 38%, respectively (χ2=10.888, P=0.001). ConclusionTIPS is safe and effective in the treatment of intractable ascites, and Child-Pugh score ≤8 is a predictive factor for 1-year survival rate in such patients.

Effect of Puerarin on Expression of C-reactive Protein in Iliac Artery of Atherosclerotic Rabbit / 中国康复理论与实践

@#Objective To investigate the effect of Puerarin on expression of C-reactive protein(CRP)in iliac artery of atherosclerotic rabbits.Methods Twenty male New Zealand white rabbits were divided into the normal control group(n=6,fed on a normal diet),basic control group(n=8,fed on a cholesterol diet)and Puerarin group(n=8,fed on a cholesterol diet).The balloon injury of iliac arteries was performed in animals of the basic control group and Puerarin group,and the animals of the Puerarin group were injected with Puerarin(25 mg/kg/d per rabbit)after injury.Four weeks after balloon injury,untreated and balloon injury iliac arteries were harvested for immunocytochemical staining.The mRNA and protein expression of CRP were tested by RT-PCR and immunucytochemistry.Results The mRNA and expression of CRP in atheroseclerotic plaque of iliac artery in the Puerarin group was significantly lower than that in the basic control group(P<0.01).Conclusion Puerarin can make atheroseclerotic plaque stable by regulating of the expression of CRP in iliac artery of atherosclerotic rabbit.