Integrated traditional Chinese and Western medicine diagnosis and treatment of hepatic encephalopathy: Advances and perspectives / 临床肝胆病杂志

Hepatic encephalopathy is the most common complication of liver cirrhosis and portal hypertension, and a confirmed diagnosis requires the clarification of predisposing factors and disease stage based on neuropsychological tests or clinical symptoms and signs. The treatment of hepatic encephalopathy emphasizes the elimination of predisposing factors, ammonia-lowering treatment, and reasonable and appropriate nutrition support, and integrated traditional Chinese and Western medicine therapy has certain advantages and characteristics in treatment. This article discusses the advances in the integrated traditional Chinese and Western medicine diagnosis and treatment of hepatic encephalopathy, so as to guide clinical practice and select reasonable treatment regimens.

Effect of Liangxue Jiedu decoction on intestinal flora in patients with hepatitis B virus-related acute-on-chronic liver failure: An analysis based on high-throughput sequencing / 临床肝胆病杂志

Objective To investigate the effect of Liangxue Jiedu decoction on intestinal flora in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods The patients who were hospitalized and diagnosed with HBV-ACLF in Beijing Ditan Hospital from October 2018 to October 2019 were enrolled, and healthy individuals were enrolled as HP group. High-throughput sequencing was used to screen for the differences in bacterial diversity and species between HBV-ACLF patients and healthy individuals, and differentially expressed bacteria between the two groups were screened out at the phylum and genus levels. With the help of in vitro simulated fermentation experiment, fecal samples were collected from the patients with HBV-ACLF and were then cultured in the medium containing different concentrations of Liangxue Jiedu decoction (0, 10%, 50%, and 100%) for 24 hours, and the changes in intestinal flora were analyzed and compared between the HBV-ACLF treatment group, the HBV-ACLF non-treatment group, and the HP group at the genus level. 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. Results A total of 10 HBV-ACLF patients were enrolled, with 5 in the HBV-ACLF treatment group and 5 in the HBV-ACLF non-treatment group, and there were 15 individuals in the HP group. Compared with the HP group, the HBV-ACLF non-treatment group had significant reductions in the diversity and abundance of intestinal flora. At the phylum level, Bacteroidetes and Firmicutes were mainly observed in the samples of the HP group, while the HBV-ACLF non-treatment group had a significant reduction in Bacteroidetes and significant increases in Fusobacteria , Proteobacteria , and Fibrobacteres. At the genus level, compared with the HP group, the HBV-ACLF non-treatment group had significant reductions in Ruminococcus, Blautia , and Eubacterium and significant increases in Parabacteroides, Lactobacillus, Fusobacterium , and Streptococcus . The in vitro fermentation experiment showed that compared with the HBV-ACLF non-treatment group, the HBV-ACLF treatment group had significant increases in Ruminococcus, Lachnospira, Bacteroides , and Genusgenus and significant reductions in Fusobacterium and Proteobacteria (all P < 0.05). Conclusion Liangxue Jiedu decoction can regulate intestinal flora disturbance, restore the diversity of intestinal flora, increase dominant bacteria, and reduce pathogenic bacteria, which may be one of its important mechanisms of action in the treatment of HBV-ACLF.

Influencing factors for chronic kidney disease in patients with hepatitis B cirrhosis / 临床肝胆病杂志

ObjectiveTo investigate the influencing factors for chronic kidney disease (CKD) in patients with hepatitis B cirrhosis within 3 years. MethodsA total of 376 patients with hepatitis B cirrhosis who attended Beijing Ditan Hospital, Capital Medical University, from January 2014 to July 2017 were enrolled and followed up for 3 years, and according to the presence or absence of CKD, they were divided into CKD group with 23 patients and non-CKD group with 353 patients. Related general information and laboratory markers were collected. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups; a stepwise forward Cox regression analysis was used to screen out the independent influencing factors for CKD within 3 years in patients with hepatitis B cirrhosis. The area under the receiver operating characteristic curve (AUC) was used to investigate the value of the influencing factors in predicting CKD in patients with hepatitis B cirrhosis; the Kaplan-Meier method was used for survival analysis, and the log-rank test was used for comparison of the cumulative incidence rate of CKD between the patients with different risks. ResultsThe multivariate Cox regression analysis showed that age (hazard ratio ［HR］=1.078, 95% confidence interval ［CI］: 1.007-1.114, P=0.026), albumin (Alb) (HR=0.923, 95% CI: 0.860-0.989, P=0.024), and estimated glomerular filtration rate (eGFR) (HR=0.977, 95% CI: 0.955-0.999, P=0.037) were independent influencing factors for CKD within 3 years in patients with hepatitis B cirrhosis. Age, Alb, and eGFR had a relatively good value in predicting CKD, with AUCs of 0.701, 0.710, and 0.706, respectively. The Kaplan-Meier survival curve showed that the patients with baseline age ≥55 years, Alb ＜32 g/L, and eGFR ≥60 ml·min-1·1.73 m-2 and ＜76 ml·min-1·1.73 m-2 had a higher risk of CKD (χ2=9647, 13621, and 30.940, all P＜0.05). ConclusionRenal function should be closely monitored for patients with old age and low Alb and eGFR levels.

Role of probiotics in primary prevention of esophagogastric variceal bleeding / 临床肝胆病杂志

ObjectiveTo investigate the effect of probiotics on the risk of esophagogastric variceal bleeding (EVB) within 1 year in cirrhotic patients with gastroesophageal varices. MethodsA retrospective analysis was performed for the clinical data of 692 cirrhotic patients with gastroesophageal varices who were hospitalized in Beijing Ditan Hospital, Capital Medical University, from February 2008 to February 2017 and were followed up for more than 1 year. Among these patients, 346 patients who received probiotics during the 1-year follow-up were enrolled as probiotics cohort (probiotics group), and then, by using the 1∶1 propensity score method, 346 patients who did not receive probiotics treatment were enrolled as non-probiotics group after adjustment for Child-Pugh class, degree of varices, and red color sign. All patients were managed according to the primary prevention strategy recommended by related guidelines, and in addition, the patients in the probiotics group were given probiotic therapy. The incidence rate of EVB within 1 year was compared between the two groups. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate backward Cox regression analyses were used to screen out the influencing factors for EVB. The Kaplan-Meier analysis was used to investigate the cumulative incidence rate of EVB in both groups, and the log-rank test was used for comparison. ResultsProbiotic therapy was an independent protective factor against EVB in cirrhotic patients (adjusted hazard ratio=0.510, 95% confidence interval: 0.299-0.870, P=0.013). A total of 61 patients experienced EVB during the 1-year follow-up, with 23 patients in the probiotics group and 38 in the non-probiotics group, and the probiotics group had a significantly lower cumulative incidence rate of EVB within 1 year than the non-probiotics group (6.6% vs 11.0%, χ2=4.045, P=0.042). The probiotics group had a significantly longer median time from baseline to the occurrence of EVB than the non-probiotics group ［137.0 (85.0-258.0) days vs 123.0(72.5-206.5) days, Z=-1.101, P=0.271］. ConclusionProbiotics can effectively reduce the incidence rate of EVB within 1 year in cirrhotic patients with gastroesophageal varices, with a tendency to delay the occurrence of bleeding events.

Nucleos(t)ide Analogues for Reducing Hepatocellular Carcinoma in Chronic Hepatitis B Patients: A Systematic Review and Meta-Analysis

Background/Aims@#Studies have shown that nucleos(t)ide analogue (NA) treatment can reduce the risk of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients, but it is unclear which NA is most effective. We performed a meta-analysis and systematic review comparing the efficacies of NAs in CHB patients. @*Methods@#We searched literature databases for randomized controlled trials (RCTs) and observational studies that analyzed the hepatic biochemical response, virological response, seroconversion rate, drug resistance rate, and HCC incidence rate in CHB patients treated with NAs. Meta-analyses were performed with RevMan and Stata/SE software. @*Results@#Twelve cohort studies and one RCT were selected, in which entecavir (ETV), lamivudine (LAM), telbivudine (LdT), and/or tenofovir disoproxil fumarate (TDF) were evaluated in CHB patients. The meta-analysis showed that ETV was superior to LAM with regard to the HCC incidence (p<0.001), biochemical response (p=0.001), virological response (p=0.02), and drug resistance (p<0.001), and ETV was superior to LdT with regard to the virological response (p<0.001) and drug resistance (p<0.001). We found no significant difference between ETV and TDF with regard to the HCC incidence (p=0.08), biochemical response (p=0.39), virological response (p=0.31), serological conversion (p=0.38), or drug resistance (p=0.95). NA-treated patients with pre-existing cirrhosis had a 5.49 times greater incidence of HCC than those without cirrhosis (p<0.001). @*Conclusions@#ETV or TDF should be used for long-term first-line monotherapy in CHB patients according to the current guidelines. Standardized protocols are needed for future studies of ETV and TDF to facilitate conclusive comparisons. Patients with cirrhosis are at significantly elevated risk for HCC, despite the benefits of NA treatment.

Research advances in the risk prediction models for chronic hepatitis B-related hepatocellular carcinoma / 临床肝胆病杂志

Hepatocellular carcinoma is the third common cause of cancer-related death, and early diagnosis of hepatocellular carcinoma has great influence on the prognosis of patients. This article summarizes the risk prediction models for chronic hepatitis B-related hepatocellular carcinoma in the recent 5 years, and the analysis shows that the prediction models for hepatocellular carcinoma have important clinical significance in risk stratification and individualized monitoring strategy for patients.

Culture-Positive Spontaneous Ascitic Infection in Patients with Acute Decompensated Cirrhosis: Multidrug-Resistant Pathogens and Antibiotic Strategies

Biochemical response and integrated traditional Chinese and Western medicine therapy for primary biliary cholangitis / 临床肝胆病杂志

Primary biliary cholangitis (PBC) is an immune-mediated chronic and progressive intrahepatic cholestasis disease. Treatment with ursodeoxycholic acid (UDCA) can significantly improve the prognosis of patients with PBC, but some patients still have poor response to UDCA, which is the main risk factor for disease progression. Several evaluation models and scoring systems based on biochemical response have been applied to screen out patients with poor response in clinical practice. Integrated traditional Chinese and Western medicine therapy for PBC has certain advantages in improving the symptoms, liver biochemistry, fibrosis indices, and biochemical response rate of PBC patients and thus holds promise for clinical application; however, further improvement is needed for experimental design and efficacy evaluation.

Prediction of acute-on-chronic liver failure and integrated traditional Chinese and Western medicine therapy / 临床肝胆病杂志

Acute-on-chronic liver failure (ACLF) is a reversible and complex clinical syndrome caused by various factors in patients with pre-existing chronic liver diseases, with the clinical features of acute liver function decompensation and high short-term mortality rate. ACLF has a complex pathogenesis, rapid progression, and a dangerous prognosis, and early and accurate prediction of prognosis is of vital importance. At present, there is still no ideal therapy for ACLF, and in recent years, integrated traditional Chinese and Western medicine therapy has achieved a certain effect in the treatment of this disease. This article reviews the advances in prognostic evaluation and integrated traditional Chinese and Western medicine therapy for ACLF, in order to provide guidance to prognostic evaluation of ACLF and selection of the regimens of integrated traditional Chinese and Western medicine therapy.

The role of gut microbiota in the pathogenesis of portal hypertension / 临床肝胆病杂志

Gut microbiota is the largest collection of commensal micro-organisms in the human body. Since the liver has unique anatomical location and vascular system, it is easily exposed to gut microbiota and their metabolites. Under normal conditions, the barrier function of the intestinal epithelium and the cleaning and detoxification function of the liver can prevent microorganisms or their products from entering the liver and systemic circulation. However, when the intestinal barrier function is damaged, a large number of bacterial products may enter the liver and systemic circulation and stimulate the body’s immune and inflammatory responses, and such perturbations become prominent in liver cirrhosis and may increase the risk of clinically significant portal hypertension. This article summarizes the role of gut microbiota in the pathogenesis of portal hypertension and provides ideas for clinical treatment.

Research advances in the pathogenesis of autoimmune hepatitis / 临床肝胆病杂志

Autoimmune hepatitis (AIH) is a progressive chronic inflammatory liver disease with unknown etiology. At present, genetic susceptibility and environmental factors are universally recognized as the etiological factors for AIH. With the deepening of research in recent years, other etiological factors, such as immune cells, immune factors, liver transplantation, and drugs, have attracted more and more attention. This article briefly describes related research findings in the past five years.

Effect of ursodeoxycholic acid with traditional Chinese medicine on biochemical response in patients with primary biliary cholangitis: a real-world cohort study / 中华肝脏病杂志

Objective@#To examine the effects of ursodeoxycholic acid combined with Traditional Chinese Medicine on biochemical response in patients with primary biliary cholangitis.@*Methods@#According to the method of receiving treatment, 197 patients with primary biliary cholangitis were divided into Traditional Chinese Medicine plus Western medicine group (93 cases, 47.2%) and Western medicine group (104 cases, 52.8%). From the baseline date, the combined group was treated with ursodeoxycholic acid plus traditional Chinese medicine decoction or Chinese patent medicine for at least one month and the Western medicine group simply took ursodeoxycholic acid . Additionally, Traditional Chinese medicine decoction prescriptions were mainly Xiaoyaosan and Yinchenhao. Chinese patent medicine were restricted to Biejia Ruangan tablets, Fuzheng Huayu capsules, Jiuweigantai capsules and Yinzhihuang capsules, which were used to treat liver fibrosis and cholestasis. The primary efficacy endpoint was defined as ALP level < 1.67 × ULN and ≥ 15% decrease in ALP with baseline level and TBIL≤ULN after 12 months of treatment.@*Results@#The overall biochemical response rate of patients was 35.0% (69/197). The response rate of TCM+ Western medicine group was 43.0% (40/93), and that of Western medicine group was 27.9% (29/104). The difference between the two groups was statistically significant (χ2 = 4.936, P < 0.05). Further analysis showed that the Chinese and Western medicine group was superior to the Western medicine group alone in reducing γ-glutamyltransferase (GGT) and TBiL [the median decline were GGT: 160.1 U/L and 111.3 U/L (Z = -2.474, P < 0.05), TBiL: 5.2 umol/l and 3.1 umol/l (Z = -2.125, P < 0.05)].@*Conclusion@#UDCA combined with TCM therapy can remarkably improve the biochemical response rate in patients with PBC and distinctly decrease the TBIL and GGT levels than UDCA monotherapy.

Research advances in secreted protein acidic and rich in cysteine in hepatocellular carcinoma / 临床肝胆病杂志

Primary liver cancer is a common malignant tumor in clinical practice,and secreted protein acidic and rich in cysteine (SPARC) plays a very important role in the progression and metastasis of liver cancer.This article introduces the structure and biological function of SPARC and analyzes its mechanism of action in malignant tumors and its association with the progression and metastasis of liver cancer,as well as the perspectives of its application in the diagnosis and treatment of liver cancer.

Action of mechanism of traditional Chinese medicine in prevention and treatment of nonalcoholic fatty liver disease / 临床肝胆病杂志

In recent years, extensive studies have been conducted on the pathogenesis of nonalcoholic fatty liver disease (NAFLD), and the action of mechanism of traditional Chinese medicine (TCM) in NAFLD has become a new research topic. TCM has achieved good clinical efficacy in the treatment of NAFLD, with the advantages of specific, flexible, multilevel, and multi-target treatment. This article introduces the role of TCM in improving insulin, regulating lipid metabolism, preventing lipid peroxidation, regulating cytokines, regulating and maintaining the dynamic balance of factors involved in lipid metabolism, and maintaining the balance of intestinal microflora, and analyzes the major problems in TCM research.

Neutrophil-lymphocyte ratio: a novel predictor of clinical outcome of patients with hepatocellular carcinoma / 临床肝胆病杂志

Accumulating evidence has shown that neutrophil-lymphocyte ratio (NLR), as an assessment index for inflammatory response, is closely related to the prognosis of various malignant tumors. This article summarizes the research advances in the relationship of NLR with overall survival, disease-free survival, and pathological features of hepatocellular carcinoma and related mechanisms of action, and points out that NLR is a convenient, economic, and effective predictor for the prognosis of patients with hepatocellular carcinoma.

Research advances in non-hormonal therapies for autoimmune hepatitis / 临床肝胆病杂志

Autoimmune hepatitis is a chronic progressive inflammatory disease of the liver, which is mediated by the abnormal autoimmune response. Immunosuppressive therapy is the major therapeutic method for this disease, and liver transplantation can be performed for patients in the advanced stage. At present, the internationally acknowledged standard therapeutic method is prednisone or prednisone combined with azathioprine. Most patients can achieve clinical remission, but the recurrence rate is high and some patients fail to respond to the treatment. This article briefly reviews the therapies except corticosteroid therapy and substitutive therapy after treatment failure, introduces the application of integrated traditional Chinese and Western medicine therapy for autoimmune hepatitis, and points out that non-hormonal therapies are the new directions for the treatment of autoimmune hepatitis, which still needs to be further investigated.

Research progress in immunological mechanisms for primary biliary cirrhosis / 临床肝胆病杂志

Primary biliary cirrhosis (PBC) is an autoimmune liver disease characterized by chronic and progressive cholestasis, which has a tendency to develop cirrhosis. The pathogenesis of PBC is complicated and still unclear. This paper reviews the latest research progress in immunological mechanisms and therapies for PBC in recent years, which focuses on the relationship between the development of PBC and autoantibodies, immune cells, and important cytokines. The review indicates that immunological factors play a key role in pathogenesis of PBC, and further research on immunological mechanisms might be quite important for the identification of pathogenesis and clinical treatment of PBC.

Progress and prospect of diagnosis and treatment of hepatic fibrosis by integrated traditional Chinese and Western medicine therapy / 临床肝胆病杂志

In recent years, non-invasive methods for assessment of hepatic fibrosis have attracted more and more attention, and the application of non-invasive diagnostic techniques such as serum markers and transient elastography (FibroScan) for hepatic fibrosis is reviewed. Anti-fibrosis treatments should integrate etiological treatment, anti-inflammatory and liver-protecting therapy, and inhibiting the synthesis of extracellular matrix and degrading excessively deposited extracellular matrix. Antiviral treatment is the basis for resisting hepatic fibrosis due to chronic viral hepatitis. In this aspect, traditional Chinese medicine (TCM) has advantages in inhibiting the synthesis of extracellular matrix and degrading excessively deposited extracellular matrix, because it effects on multiple links, at multiple levels, and against multiple targets. So integrated traditional Chinese and Western medicine therapy is a promising treatment strategy. However, the benefit of integrative therapy against hepatic fibrosis still needs to be supported by rigorously designed, multicenter, large-sample clinical studies, and the mechanism of anti-fibrosis TCM treatment deserves further studies.

Progress and prospect of diagnosis and treatment of hepatic fibrosis by integrated traditional Chinese and Western medicine therapy / 临床肝胆病杂志

In recent years,non-invasive methods for assessment of hepatic fibrosis have attracted more and more attention,and the appli-cation of non-invasive diagnostic techniques such as serum markers and transient elastography (FibroScan)for hepatic fibrosis is reviewed. Anti-fibrosis treatments should integrate etiological treatment,anti-inflammatory and liver-protecting therapy,and inhibiting the synthe-sis of extracellular matrix and degrading excessively deposited extracellular matrix.Antiviral treatment is the basis for resisting hepatic fibro-sis due to chronic viral hepatitis.In this aspect,traditional Chinese medicine (TCM)has advantages in inhibiting the synthesis of extracellu-lar matrix and degrading excessively deposited extracellular matrix,because it effects on multiple links,at multiple levels,and against multi-ple targets.So integrated traditional Chinese and Western medicine therapy is a promising treatment strategy.However,the benefit of inte-grative therapy against hepatic fibrosis still needs to be supported by rigorously designed,multicenter,large-sample clinical studies,and the mechanism of anti-fibrosis TCM treatment deserves further studies.

Research progress in noninvasive regression models for liver fibrosis in patients with chronic hepatitis B / 临床肝胆病杂志

Objective and accurate assessment of liver fibrosis in patients with chronic hepatitis B (CHB)helps to choose the correct therapeu-tic scheme and guide the clinical treatment.In recent years,the noninvasive diagnostic models for liver fibrosis have been constantly emerging, but no consensus has been reached in this regard.The research advances in noninvasive regression models for liver fibrosis in patients with CHB are reviewed according to different staging methods for liver fibrosis,and the existing models are analyzed in terms of problems and shortages. It is thought that further studies should be done to establish simpler,more effective models that have higher diagnostic values.