Current research status of spleen stiffness measurement in predicting portal hypertension and its complications in patients with liver cirrhosis / 临床肝胆病杂志

Liver stiffness measurement (LSM) has been widely used in predicting portal hypertension in clinical practice, and in recent years, spleen stiffness measurement (SSM) has also become a diagnostic tool. Studies have shown that SSM can predict portal hypertension and its complications such as esophagogastric variceal bleeding in patients with chronic liver diseases and assist in the risk stratification management of portal hypertension and esophagogastric variceal bleeding. It can accurately predict clinically significant portal hypertension, high-risk esophageal and gastric varices, decompensation rate, and mortality rate in patients with chronic liver diseases. At present, SSM data in most studies are obtained by detection using the liver equipment FibroScan Ⓡ (SSM@50 Hz). FibroScan Ⓡ 630 is a new scanner dedicated for SSM with a special mode for SSM (SSM@100 Hz). This article elaborates on the significance of SSM in predicting portal hypertension and briefly introduces the advantages and disadvantages of the new equipment for SSM.

Hepatocellular carcinoma prediction model performance decreases with long-term antiviral therapy in chronic hepatitis B patients

Background/Aims@#Existing hepatocellular carcinoma (HCC) prediction models are derived mainly from pretreatment or early on-treatment parameters. We reassessed the dynamic changes in the performance of 17 HCC models in patients with chronic hepatitis B (CHB) during long-term antiviral therapy (AVT). @*Methods@#Among 987 CHB patients administered long-term entecavir therapy, 660 patients had 8 years of follow-up data. Model scores were calculated using on-treatment values at 2.5, 3, 3.5, 4, 4.5, and 5 years of AVT to predict threeyear HCC occurrence. Model performance was assessed with the area under the receiver operating curve (AUROC). The original model cutoffs to distinguish different levels of HCC risk were evaluated by the log-rank test. @*Results@#The AUROCs of the 17 HCC models varied from 0.51 to 0.78 when using on-treatment scores from years 2.5 to 5. Models with a cirrhosis variable showed numerically higher AUROCs (pooled at 0.65–0.73 for treated, untreated, or mixed treatment models) than models without (treated or mixed models: 0.61–0.68; untreated models: 0.51–0.59). Stratification into low, intermediate, and high-risk levels using the original cutoff values could no longer reflect the true HCC incidence using scores after 3.5 years of AVT for models without cirrhosis and after 4 years of AVT for models with cirrhosis. @*Conclusions@#The performance of existing HCC prediction models, especially models without the cirrhosis variable, decreased in CHB patients on long-term AVT. The optimization of existing models or the development of novel models for better HCC prediction during long-term AVT is warranted.

Efficacy and influencing factors of ursodeoxycholic acid in the treatment of cholesterol gallstone / 中华消化杂志

Objective:To study the efficacy and influencing factors of ursodeoxycholic acid (UDCA) in the treatment of cholesterol gallstone, so as to provide reference for the treatment of cholesterol gallstone by internal medicine.Methods:From March 1, 2017 to March 31, 2018, at outpatient department of gastroenterology of 9 Beijing medical centers including Peking University People′s Hospital, the Sixth Medical Center of PLA General Hospital, Beijing Huaxin Hospital, PLA Rocket Force Characteristic Medical Center, Peking University Aerospace Center Hospital, Beijing Youan Hospital of Capital Medical University and Beijing Tiantan Hospital of Capital Medical University, Beijing Tongren Hospital of Capital Medical University, and Beijing Shijitan Hospital of Capital Medical University, the data of patients with cholesterol gallstone treated by UDCA were collected. The inclusion criteria were that the largest diameter of stone was ≤10 mm and the stone was not detected under X-ray. The treatment plan was taking UDCA orally for 6 months at a dose of 10 mg·kg -1·d -1. The basic information of patients, the ultrasound examination results before treatment and 6 months after treatment, and scores of biliary abdominal pain and dyspepsia symptom were collected. Univariate and multivariate logistic regression were used to analyze the influencing factors of the efficacy in gallstrone dissolution by UDCA, and Wilcoxon signed rank test was used for statistical analysis. Results:A total of 215 patients were enrolled. The complete dissolution rate of gallstone was 19.5% (42/215) and partial dissolution rate was 50.7% (109/215), and the total effective rate was 70.2% (151/215). The complete dissolution rate of sandy stone was significantly higher than that of lumped stones (37.0%(17/46) vs. 14.8%(25/169); OR=3.377, 95% confidence interval (95% CI) 1.621 to 7.035, P=0.001). In lumped stones, the complete dissolution rate of the stones with diameter ≤5 mm was significantly higher than that of the stones with diameter >5 mm (37.5%(9/24) vs. 11.0%(16/145); OR=4.837, 95% CI 1.823 to 12.839, P=0.002). The complete dissolution rate of patients with higher body mass index ( OR=0.872, 95% CI 0.764 to 0.995, P=0.043) and longer disease course ( OR=0.942, 95% CI 0.912 to 0.973, P<0.001) was low. The results of multivariate logistic analysis indicated that long disease course of gallstone ( OR=0.940, 95% CI 0.908 to 0.974, P=0.001), rough gallbladder wall ( OR=0.438, 95% CI 0.200 to 0.962, P=0.040) and lumped stone ( OR=0.236, 95% CI 0.101 to 0.550, P=0.001) were independent risk factors of influencing the efficacy of stone dissolution by UDCA. As for lumped stones, the independent risk factors included long disease course of gallstone ( OR=0.926, 95% CI 0.877 to 0.978, P=0.006) and stone diameter >5 mm ( OR=0.142, 95% CI 0.043 to 0.470, P=0.001). After 6 months of UDCA treatment, score of biliary abdominal pain decreased from 0 (0 to 6) to 0 (0 to 0) and the score of dyspepsia symptom decreased from 1 (0 to 2) to 0 (0 to 0), and the differences between before treatment and after treatment were statistically significant ( Z=-8.50, and -9.13, both P<0.001). Conclusions:UDCA has a certain efficacy in cholesterol gallstone dissolution and can ease biliary abdominal pain and dyspepsia symptom. Long disease course of gallstone, rough gallbladder wall and stone diameter >5 mm are independent risk factors of poor efficacy in gallstone dissolution by UDCA.

Effect of intrahepatic veno-venous communications on the consistency of hepatic venous pressure gradient and portal vein pressure gradient / 中华普通外科杂志

Objective:By using balloon occlusive hepatic angiography in cirrhotic portal hypertension to evaluate contrast doses on the detection rate of intrahepatic venous-lateral branch shunt (HVVC), and the effect on hepatic venous pressure gradient (HVPG) and portal vein pressure gradient (PPG).Methods:From Jan 2018 to Jun 2021, 131 patients received transjugular intrahepatic portosystemic shunt (TIPS) at Beijing Shijitan Hospital.Results:A positive correlation between PVP and weged hepatic venous pressure (WHVP) ( r=0.241, P=0.001) was found when only by right hepatic vein approach. Ten ml of iodine contrast medium when compared to 5ml doses found more cases of intrahepatic venous-venous lateral branch shunt. The mean PPG of patients with HVVC was significantly higher than the mean of HVPG( P<0.05).The right hepatic vein was the only reliable vein by which WHVP was measured. Conclusions:Right hepatic vein manometry,adequate ballon occlusion and using 10ml of iodine contrast help get reliable WHVP and found HVVC; HVVC can affect the consistency of HVPG and PPG.

Study on the comprehensive effect of splenectomy on liver cirrhosis / 中华肝胆外科杂志

Objective:To study the impact and the mechanism of splenectomy combined with pericardial devascularization on cirrhotic livers.Methods:Serum samples and clinical data were collected preoperatively and postoperatively from 54 patients with cirrhosis who underwent splenectomy combined with pericardial devascularization from May 2013 to Oct 2014 at Beijing You’an Hospital, Capital Medical University. Changes in hepatic arterial and portal venous blood flow, liver function and fibroscan results were analyzed. The levels of nitric oxide (NO), endothelin-1 (ET-1), interleukin-6 (IL-6), hepatocyte growth factor (HGF), transforming growth factor-β1 (TGF-β1) and matrix metalloproteinase 1 (MMP1) were measured.Results:There were 31 males and 23 females, aged(45.48±10.21)years. Free portal vein pressure decreased significantly from (37.0±7.1) cmH 2O (1 cmH 2O=0.098 kPa) to (26.1±5.7) cmH 2O after surgery ( P<0.05). Significant increases in postoperative lumen diameter (4.0±1.0) mm vs (3.1±0.7) mm were observed, accompanied by increase in peak flow velocity and blood flow of the hepatic artery. Significant deductions in lumen diameter (11.9±2.0) mm vs (13.1±1.9) mm, accompanied by reduction of peak flow velocity and blood flow of the portal vein were observed following surgery (all P<0.05). The NO level was significantly elevated immediately after splenectomy and was subsequently remained at high levels. The ET-1 level decreased 2 days after surgery and became fluctuated at low levels. The IL-6 and HGF levels increased significantly 2 days after surgery and decreased gradually after 7 days and 1 month, respectively. The TGF-β1 and the MMP1 levels increased after surgery. The endotoxin level decreased significantly after surgery (all P<0.05). Conclusion:Splenectomy combined with pericardial devascularization induced hepatic blood flow restoration, hepatocyte regeneration and reversal of fibrosis in cirrhotic livers. Splenectomy has a protective effect on cirrhotic liver when combined with pericardial devascularization.

Risk factors for early rebleeding after endoscopic therapy for esophageal varices in cirrhotic patients / 临床肝胆病杂志

Objective To investigate the risk factors for early rebleeding after endoscopic ligation or sclerotherapy for esophageal variceal bleeding in cirrhotic patients. Methods A retrospective analysis was performed for the clinical data of 153 cirrhotic patients with esophageal variceal bleeding who underwent endoscopic ligation or sclerotherapy in Beijing YouAn Hospital, Capital Medical University, from May 2017 to May 2019, and according to the presence or absence of rebleeding from 72 hours to 6 weeks after endoscopic therapy, the patients were divided into rebleeding group and non-rebleeding group. A logistic regression analysis was performed to investigate independent risk factors for early 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 or the Fisher's exact test was used for comparison of categorical data between two groups. Results Early rebleeding rate was 24.8% (38/153). Compared with the non-rebleeding group, the rebleeding group had a significantly lower albumin (Alb) and significantly higher activated partial thromboplastin time and prothrombin time (all P < 0.05), and there were also significant differences between the two groups in proportion of male sex, degree of varicose veins, red color sign, portal vein thrombosis, severity of ascites, and liver function grade (all P < 0.05). The multivariate logistic regression analysis showed that portal vein thrombosis (odds ratio [ OR ]=9.781, 95% confidence interval [ CI ]: 2.248-42.556, P =0.002), massive ascites ( OR =6.195, 95% CI : 1.053-36.447, P =0.044), and Child-Pugh class C liver function ( OR =6.434, 95% CI : 1.067-38.786, P =0.042) were independent risk factors for early rebleeding, while Alb ( OR =0.806, 95% CI : 0.685-0.947, P =0.009) was a protective factor against early rebleeding. Conclusion Portal vein thrombosis, massive ascites, Child-Pugh C liver cirrhosis, and hypoproteinemia are independent risk factors for early rebleeding after endoscopic therapy in cirrhotic patients with esophageal variceal bleeding, which should be taken seriously in clinical practice.

Risk factors for early rebleeding after initial sclerotherapy for esophageal varices / 临床肝胆病杂志

ObjectiveTo investigate the effect of initial esophageal variceal sclerotherapy (EVS) on liver function and blood biochemistry in patients with liver cirrhosis and the risk factors for early rebleeding after initial EVS. MethodsA retrospective analysis was performed for the clinical data of 120 cirrhotic patients with esophageal variceal bleeding who were hospitalized in Beijing YouAn Hospital, Capital Medical University, from January 2016 to December 2017 and received initial EVS. The patients were divided into groups according to the Child-Pugh class, and liver function and blood biochemistry were compared between groups before and after treatment to evaluate the effect of EVS on the above indices. Early rebleeding after surgery was defined as bleeding within 14 days after surgery. The patients were divided into bleeding group and non-bleeding group according to the presence or absence of early rebleeding, and a logistic regression analysis was performed to investigate the main risk factors for early 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 or the Fisher′s exact test was used for comparison of categorical data between groups. ResultsAfter treatment, Child-Pugh class A/B patients had significant changes in total bilirubin (Z=-3.975 and -3.670, both P＜0.001), direct bilirubin (Z=-3.455 and -3.086, P=0.001 and 0.002), and white blood cell count (Z=-2.811 and -3.683, P=0.005 and P＜0001). Early rebleeding rate after EVS was 10% (12/120). The logistic regression analysis showed that the amount of ascites (odds ratio ［OR］=2.92, P=0.047) and presence of portal vein thrombosis (OR=4.94, P=0.018) were independent risk factors for early rebleeding after EVS. ConclusionEVS does not have a significant impact on liver function, and bacterial infection should be taken seriously during treatment. The amount of ascites should be reduced before surgery, in order to reduce the incidence rate of early rebleeding after EVS. For patients with portal vein thrombosis, the risk of treatment should be evaluated and an appropriate treatment regimen should be selected based on patient′s conditions.

Diagnosis and treatment of pre-hepatic (sinusoidal) non-cirrhotic portal hypertension and related difficulties / 临床肝胆病杂志

Pre-hepatic (sinusoidal) non-cirrhotic portal hypertension is a group of vascular heterogeneous diseases with portal hypertension as the prominent manifestation and has a complex etiology. Compared with the patients with cirrhotic portal hypertension, the patients with pre-hepatic (sinusoidal) non-cirrhotic portal hypertension have normal liver functions, normal or a mild increase in hepatic venous pressure gradient, and better prognosis. Pre-hepatic (sinusoidal) non-cirrhotic portal hypertension may easily be misdiagnosed as unexplained cirrhotic portal hypertension, and liver pathology is the gold standard for diagnosis. Non-selective β-receptor blockers and endoscopy are major therapies for this disease, but there is a lack of high-quality clinical evidence from large-scale prospective multicenter studies.

Recent advances in drug-induced liver injury: Potential mechanisms, pathological features, and biomarkers / 临床肝胆病杂志

Drug-induced liver injury (DILI) is one of the main causes of acute liver failure, black box warnings, and drug withdrawal from the market, and it is also a major concern in public health, drug research and development, and the pharmaceutical industry. However, a lack of specific diagnostic markers for DILI makes the diagnosis of this disease a major challenge for clinicians. This article summarizes the recent advances in DILI research, including potential mechanisms, pathological features, biomarkers, and in vitro methods, in order to provide a reference for clinical and pathological diagnosis and prognostic evaluation of DILI.

The application of virtual digestive endoscopy simulation system in gastroscopy skills teaching in infectious diseases specialized hospital / 中华医学教育探索杂志

Endoscopic teaching has always been a difficult point in clinical medical skill teaching.A standardized teaching plan was set up for the beginners to learn gastroscopy skills,which took 16 weeks.This training program included teaching the basic structure of a gastroscopy,the theory of operation skills,cleaning and disinfection of gastroscopy,and the operation of the virtual digestion endoscopy simulation training system.Only by passing the examinations of what mentioned above,could a beginner do gastroscopy of clinical subjects and write reports.According to a questionnaire survey of 15 trainees,100％ of trainees believed that virtual digestive endoscopy was necessary for the teaching of endoscopic skills.It was believed that the teaching plan were very strict and strict with 63.3％ and 33.3％ respectively.Therefore,this teaching plan with higher recognition and acceptance is suitable for the clinicians specializing in liver diseases and infectious diseases in infectious diseases specialist hospitals,who want to learn gastroscopy skills.

Strategy for diagnosis and precise treatment of portal hypertension with hepatic venous pressure gradient: a dream or a reality? / 中华肝脏病杂志

Liver fibrosis and cirrhosis, is a chronic, occult progression that is potentially reversible and complicated. The hepatic venous pressure gradient is a "gold standard" for risk stratification of liver cirrhosis and is superior to pathological examination of liver. This article briefly assesses the invasive and non-invasive measuring methods of the hepatic venous pressure gradient. With the hepatic venous pressure gradient-guided precise treatment for hepatic cirrhosis of portal hypertension, the incidence of clinical endpoints of hepatic portal hypertension can be significantly reduced. Establishing a long-term monitoring and management model similar to "high blood pressure" is a dream for the diagnosis and treatment of future cirrhosis and portal hypertension.

Clinical characteristics and prognosis related risk factors in nonalcoholic steatosis liver cirrhosis / 中华消化杂志

Objective To investigate the clinical features and prognosis related risk factors in nonalcoholic steatosis liver cirrhosis(NASLC).Methods From January 1st,2006 to December 31st, 2013,in a prospective cohort of 12 489 patients with liver cirrhosis set,174 patients were with NASLC and 306 patients with hepatitis B were the control.The patients were followed up every three months. The clinical data of patients were collected,including gender,age,height,body weight,blood pressure, history of hypertension,history of diabetes,family history of tumor,blood glucose level,high density lipoprotein cholesterol(HDL-C)level,low density lipoprotein cholesterol(LDL-C)level,triglyceride level,white blood cell,platelet,prothrombin time activity,total bilirubin,albumin,cholinesterase,blood urea nitrogen,creatinine,alpha-fetoprotein,abdominal ultrasound,abdominal computer tomography and endoscopy.Body mass index(BMI)and Child-Pugh scores were calculated.The differences between the two groups were analyzed in the incidence of ascites,hepatic encephalopathy,hepatorenal syndrome, esophageal varices bleeding,liver failure,hepatocellular carcinoma and mortality.Chi square test and t test were performed for statistical analysis.logistic regression analysis was used to analyze the risk factors associated with hepatocellular carcinoma in patients with NASLC.Results The proportion of female in NASLC group was higher than that in posthepatic cirrhosis group(56.0%,47/84 vs 28.7%,49/171), and the difference was statistically significant(χ2 =17.653,P<0.01).BMI,systolic pressure,diastolic pressure,level of fasting blood glucose,LDL-C,triglyceride,prothrombin time activity,albumin, cholinesterase,cases number of hypertension,diabetes and metabolic syndrome of NASLC group were all significantly higher than those of posthepatic cirrhosis group(t=6.267,4.091,5.773,2.914,1.877, 2.044,2.326,1.935 and 2.023;χ2=7.241,9.399 and 81.367;all P<0.05),however,serum levels of HDL-C,total bilirubin and creatinine were significantly lower than those of posthepatic cirrhosis group (t=6.127,8.487 and 3.261;all P < 0.05).T he three-year accumulative incidences of hepatic encephalopathy,hepatorenal syndrome and liver failure of NASLC group(8.3%,7/84;1.2%,1/84;0) were all lower than those of posthepatic cirrhosis control group(22.2%,38/171;9.9%,17/171 and 5.8%, 10/171;χ2 = 5.751,3.862 and 3.927,all P< 0.05).The three-year accumulative incidence of hepatocellular carcinoma of NASLC was 8.3%(7/84).The three-year accumulative incidence of mortality was lower than that of posthepatic cirrhosis group(2.4%,2/84 vs 13.5%,23/171;χ2 = 3.884,P=0.049).The results of logistic regression analysis showed that BMI(odds ratio(OR)= 1.469,95%confidence interval(CI)1.093 to 2.176,P=0.016)and diabetes(OR=1.734,95% CI 1.269 to 2.388, P=0.012)were independent risk factors associated with hepatocellular carcinoma in NASLC patients. Conclusions NASLC occurrs mainly in female with good liver function.BMI and diabetes are the risk factors associated with hepatocellular carcinoma in patients with NASLC.

The clinical characteristics and risk factors for acute kidney injury in patients with cirrhosis / 中华内科杂志

Objective To investigate the clinical features and risk factors for acute kidney injury (AKI) in patients with cirrhosis. Methods A total of 1 165 hospitalized patients with chronic liver diseases were enrolled. Among them, 94 patients had chronic hepatitis, while 1 071 patients were diagnosed as cirrhosis. The clinical data, renal and liver function were retrospectively analyzed. AKI was determined according to the criteria proposed by International Club of Ascites. Compared with chronic hepatitis group, the clinical features and risk factors for AKI in patients with cirrhosis were evaluated using logistic regression. Results The prevalence of AKI in chronic hepatitis and cirrhosis were 4.26%(4/94) and 11.11% (119/1 071), respectively. The AKI rates in patients with liver function Child A, B and C were 3.77% (18/377), 10.88% (41/377) and 27.65%(60/217), respectively. The independent risk factors for AKI in cirrhotic patients included infections ( OR=5.37, 95%CI 3.24-8.90, P=0.000), acute on chronic liver failure (ACLF, OR=4.55, 95%CI 2.60-7.98, P=0.000) and diabetes (OR=1.70, 95%CI 1.07-2.70, P=0.024). The mortality rate of cirrhotic patients with AKI was 36.97% within 2 months. Moreover, the mortality rates in stageⅠ,ⅡandⅢAKI were 20.31%, 36.00% and 73.33%, respectively. Conclusions The mortality rate of cirrhotic patients with stageⅢAKI is extremely high. Infections, ACLF and diabetes are the independent risk factors for AKI in patients with cirrhosis.

Road map of the diagnosis and treatment of intractable ascites based on guidelines for the diagnosis and treatment of cirrhotic ascites and related complications / 临床肝胆病杂志

Guidelines for the diagnosis and treatment of cirrhotic ascites and related complications put forward the new criteria for the diagnosis and treatment of intractable cirrhotic ascites, and spontaneous bacterial peritonitis is a common cause of intractable cirrhotic ascites. About 50％ -89％ of patients with intractable cirrhotic ascites have a significant response to terlipressin (2-8 mg/d), midodrine hydrochloride (22. 5 mg/d), and tolvaptan (7. 5-15 mg/d) . Intravenous albumin supplementation (8 g/1000 ml ascites) has a similar therapeutic effect as terlipressin (3 mg) in preventing posterior circulation dysfunction after large-volume paracentesis. Patients with a poor response to medication or those who need frequent large-volume paracentesis (more than three times per week) or frequent hospitalization (more than three times per month) should be evaluated for liver transplantation or transjugular intrahepatic portosystemic shunt. α-Crystal rifaximin may become a new strategy for preventing complications of liver cirrhosis by regulating the intestine-microbe-liver axis. Therefore, it is of great significance to explore the"road map"of the diagnosis and treatment of intractable cirrhotic ascites that is suitable for the clinical practice in China.

Relationship between TGF-β1 509T/C Gene Polymorphism and Liver Cirrhosis: a Meta-Analysis / 医学研究杂志

Objective To evaluate the relationship between genetic polymorphism of transforming growth factor(TGF) β1 and susceptibility of liver cirrhosis.Methods CBM,VIP,CNKI,Wanfang technological periodical full-text databases and Pubmed from set up to March,2017 were electronically searched to identify case-control studies on the relationship between genetic polymorphism of TGF-β1 promoter 509 site,and liver cirrhosis.The data were quantitatively analyzed by Stata 12.0 software after assessing the quality of included studies.Results Ten case-control studies were selected for Meta-analysis based on our inclusion and exclusion standards.The results of Meta-analysis showed that the pooled OR value for liver cirrhosis with T allele of TGF-β1 gene at promoter 509 was 1.07 (95％ CI:0.81-1.41),the pooled OR values of dominant gene model analysis (TT + CT vs CC) were 1.08 (95％ CI:0.73-1.61).No significant publication bias was found.Conlcusion The genetic polymorphism of TGF-β1 at promoter 509 showed no association with susceptibility of liver cirrhosis.

Clinical Predicting Factors of Adefovir Dipivoxil Therapy in Patients with Chronic Hepatitis B / 医学研究杂志

Objective To analyze the efficacy and the predictive factors of adefovir dipivoxil (ADV) therapy in patients with chronic hepatitis B(CHB).Methods Fifty two CHB patients were recruited in this study.All patients were treated for 52 weeks.Liver function,blood cell amounts and HBV DNA levels were detected at time course.Results At time point of 4 weeks,the serum HBV DNA level in good response group were significantly less than poor response group (2.48 ± 0.45 log10 vs 4.72 ± 0.28 log10,P ＜ 0.05).The decreased log value of HBV DNA in good response group was significantly higher than poor response group (3.31 ± 0.36 vs 1.54 ± 0.44,P ＜0.05).At time point of 12 weeks,the decreased log value of HBV DNA and neutrophil percent in good response group were significantly higher than poor response group [3.31 ± 0.36 vs 1.54 ± 0.44,(58.38 ± 2.08) × 109/L vs (46.90 ± 3.01) × 109/L,P ＜ 0.05],the serum HBV DNA level and red blood cell level in good response group were significantly less than poor response group[0.80 ± 0.27 log10vs4.63 ±0.43 log10,(4.50±0.08) ×1012/L vs (6.01 ±0.13) × 1012/L,P ＜0.05].Conclusion The decreased log value of HBV DNA and red blood cell level of 12weeks are the independently predictive factors for adefovir dipivoxil (ADV) therapy in patients with chronic hepatitis B.

Qualitative pathological assessment of liver fibrosis regression after antiviral therapy in patients with chronic hepatitis B / 中华肝脏病杂志

Objective@#To investigate the methods for qualitative pathological assessment of dynamic changes in liver fibrosis/cirrhosis after antiviral therapy in patients with chronic hepatitis B (CHB), since antiviral therapy can partially reverse liver fibrosis and cirrhosis caused by hepatitis B and semi-quantitative, rather than qualitative, pathological assessment is often used for the research on liver fibrosis regression.@*Methods@#Previously untreated CHB patients with liver fibrosis and cirrhosis were enrolled, and liver biopsy was performed before treatment and at 78 weeks after the antiviral therapy based on entecavir. The follow-up assessment was performed once every half a year. Based on the proportion of different types of fibrous septum, we put forward the new qualitative criteria called P-I-R classification (predominantly progressive, predominantly regressive, and indeterminate) for evaluating dynamic changes in liver fibrosis. This classification or Ishak fibrosis stage was used to evaluate the change in liver fibrosis after treatment and Ishak liver inflammation score was used to evaluate the change in liver inflammation after treatment.@*Results@#A total of 112 CHB patients who underwent liver biopsy before and after treatment were enrolled, and among these patients, 71 with an Ishak stage of ≥3 and qualified results of live biopsy were included in the final analysis. Based on the P-I-R classification, 58% (41/71) were classified as predominantly progressive, 29% (21/71) were classified as indeterminate, and 13% (9/71) were classified as predominantly regressive; there were no significant differences between the three groups in alanine aminotransferase, aspartate aminotransferase, albumin, HBeAg positive rate, HBV DNA, and liver stiffness (P < 0.05). After treatment, the proportion of predominantly progressive, indeterminate, or predominantly regressive patients changed to 11% (8/71), 11% (8/71), and 78% (55/71), respectively. Among the 35 patients who had no change in Ishak stage after treatment, 72% (25/35) were classified as predominantly regressive and had certain reductions in the Laennec score, percentage of collagen area, and liver stiffness.@*Conclusion@#This new P-I-R classification can be used to assess the dynamic changes in liver fibrosis after antiviral therapy in CHB patients.

New therapeutic paradigm and concepts for patients with cirrhotic refractory ascites / 中华肝脏病杂志

The activation of renin-angiotensin-aldosterone-vasopressin system is a key factor in the formation of ascites due to splanchnic vasodilation in cirrhosis. In theory, aldosterone antagonists, contraction of blood vessels, vasopressin V2 receptor, and angiotensin receptor antagonists are important targets for the prevention and treatment of cirrhotic ascites. The 15%-20% of patients with cirrhotic ascites that show no response to at least one week’s treatment with potent diuretics (spironolactone 160 mg/d combined with furosemide 80 mg/d) are considered to have refractory ascites. At present, effective treatments for refractory ascites include tolvaptan, large-volume paracentesis (4000-6000 ml/time/day) combined with albumin (4 g/L ascites), ascites ultrafiltration and reinfusion, transjugular intrahepatic portosystemic shunt, and liver transplantation. In the future, with the development of vasoactive drugs, rifaximin, ascites drainage pump, and other new therapies, the treatment of refractory ascites may be more effective to reduce the need for liver transplantation.

Effect of ursodeoxycholic acid on bile secretion after endoscopic nasobiliary drainage in patients with cholestatic liver disease of various causes / 临床肝胆病杂志

ObjectiveTo observe the effect of ursodeoxycholic acid (UDCA) on bile secretion in patients with cholestatic liver disease of various causes. MethodsA total of 48 patients who underwent endoscopic nasobiliary drainage (ENBD) in Beijing You′an Hospital Affiliated to Capital Medical University from July 2013 to May 2014 were enrolled and divided into UDCA treatment group (n=36) and control group (n=12). The patients in the UDCA group were further divided into common bile duct stone group (n=9), cholangiocarcinoma group (n=7), sclerosing cholangitis group (n=7), and post-liver transplantation group (n=13). The patients in the UDCA treatment group received oral UDCA capsules (250 mg, 3 times/day) since the second day after surgery, and the daily volume of bile drainage was recorded for 7 days after surgery. Serum levels of total bilirubin (TBil), total bile acid (TBA), gamma-glutamyl transpeptidase (GGT), and alkaline phosphatase (ALP) were measured on the day before surgery and the 7th day after surgery, and the effects of UDCA on volume of bile drainage, TBil, TBA, GGT, and ALP were compared between groups. The t-test was applied for comparison between groups, comparison of continuous data between these groups was made by analysis of variance; the chi-square test was applied for comparison of categorical data between groups. ResultsCompared with the control group, the UDCA treatment group had a significantly increased volume of bile drainage on the 3rd, 4th, and 5th days after surgery (t=2.461, 3.896, and 2.760; P=0.048, 0.021, and 0.034), and the increase in volume of bile drainage was more significant in the common bile duct stone group, the cholangiocarcinoma group, and the post-liver transplantation group, with peak values appearing on the 4th day after surgery. The patients in the common bile duct stone group and the post-liver transplantation group had significantly lower serum levels of TBil, GGT, and ALP on the 7th day after surgery (t=3.340, 2.503, and 2.158, P=0.016, 0.038, and 0045; t=2.951, 2.805, and 2.461, P=0.014, 0029, and 0.034). ConclusionUDCA can increase bile secretion and improve liver function in patients with cholestatic liver disease of various causes.

Effects of nucleos(t)ide analogues initial treatment on virology and complications in hepatitis B virus related decompensated liver cirrhosis: a multicenter, prospective and observational study / 中华消化杂志

Objective To evaluate the effects of nucleos (t)ide analogues initial treatment on virology and complications in hepatitis B virus (HBV) related decompensated liver cirrhosis.Methods From May 2012 to October 2013,a total of 209 patients with HBV related decompensated liver cirrhosis of 18 hospitals in China were enrolled.According to antiviral medicine taken by them,they were divided into entecavir (ETV) group (n =161),lamivudine (LAM) monotherapy or combined with adefovir (ADV)group (n=48,LAM 22 cases,LAM+ADV 26 cases).During the 12-month follow up period,ChildPugh scores,the level of HBV DNA and complications of liver cirrhosis were documented every three months,the safety evaluation was also carried out.The t-test or chi-square test was performed for statistical analysis.Results In ETV group,before treatment and 12 months after treatment,Child-Pugh scores were 7.91±2.05 and 5.75±1.72,respectively,and the latter was lower than the former (t=10.130,P＜0.01); in LAM alone or combined with ADV group,Child-Pugh scores were 8.08±2.23 and 5.85±1.44,respectively,and the latter was lower than the former (t=5.480,P＜0.01).However there was no significant difference in Child-Pugh scores between the two groups in different time points (both P＞0.05).The undetectable rates of HBV DNA gradually increased along with the treatment period.After 12 months treatment,the undetectable rate of HBV DNA of ETV group was 91.0％ (61/67),and that of LAM alone or combined with ADV group was 87.5％ (35/40),there was no significant difference between the two groups (P＞0.05).Before treatment and 12 months after treatment,the incidences of ascites were 59.4％ (82/138) and 15.0％ (12/80) in ETV group,the latter was lower than the former (x2 =40.740,P＜0.01) ; the incidences of ascites in LAM alone or combined with ADV group were 62.2％ (28/45) and 8.1％ (3/37),and the latter was lower than the former (x2=25.290,P＜ 0.01).After 12 months treatment,the rates of esophageal varices disappearance of ETV group and LAM alone or combined with ADV group were 26.6％ (33/124) and 25.0％ (7/28),accordingly the rates of gastric varices disappearance were 2.5％ (1/40) and 1/19,and the difference was not statistically significant between the two groups (both P＞0.05).There was no significant difference in serum urea nitrogen,serum creatinine and estimated glomerular filtration rates between the two groups before treatment and at different time points after treatment (all P＞0.05).Conclusion The efficacy and safety of ETV and LAM alone or combined with ADV are similar in patients with HBV related decompensated liver cirrhosis,however,the long-term efficacy should be identified by further clinical observation.