Consensus on Diagnosis and Therapy of Peptic Ulcer (2022, Shanghai) / 胃肠病学

Due to the difficult eradication of Helicobacter pylori caused by gradual increase of antibiotic resistance, the widespread use of nonsteroidal anti‑inflammatory drugs, and the common use of antithrombotic therapy in the aging population, the diagnosis and treatment of peptic ulcer are more challenging than ever. To further explore a new model of diagnosis and treatment of peptic ulcer in accordance with our national conditions, the Editorial Board of Chinese Journal of Digestion organized an expert committee to develop a new version of the consensus based on "Standardized diagnosis and treatment of peptic ulcer (2016, Xi′an)". The consensus has 30 statements, divided into 9 parts, covering the definition, clinical manifestations, pharmacological treatment, treatment of complications, and prevention of peptic ulcer.

Chinese Consensus on Clinical Diagnosis and Therapy of Liver Cirrhosis / 胃肠病学

Liver cirrhosis, characterized by diffuse hepatocytes necrosis, insufficient regeneration of hepatocytes, angiogenesis, severe fibrosis and the formation of pseudolobules, is a progressive chronic hepatic disease induced by a variety of causes. It is clinically characterized by liver function damage and portal hypertension, and many complications may occur in the late stage. Based on the update relevant guidelines, experts' consensus, and research advances on the diagnosis and treatment of cirrhosis, Chinese Society of Gastroenterology of Chinese Medical Association established a consensus aiming to standardize the clinical diagnosis and treatment of liver cirrhosis and guide clinical practice. This consensus contains 43 statements on the etiology, pathology and pathogenesis, clinical manifestations, major complications, diagnosis, treatment, prognosis and chronic disease management of liver cirrhosis. Since several guidelines and experts' consensus on the complications of liver cirrhosis have been published, this consensus focuses on the research progress of liver cirrhosis itself.

Practice Guidance on Use of Terlipressin for Liver Cirrhosis-related Complications (2021) / 胃肠病学

Liver cirrhosis is a major global health burden worldwide due to its high risk of morbidity and mortality. Role of terlipressin for the management of liver cirrhosis-related complications has been recognized during recent years. This paper aims to develop evidence-based clinical practice guidance on the use of terlipressin for liver cirrhosis-related complications. Hepatobiliary Study Group of Chinese Society of Gastroenterology and Hepatology Committee of Chinese Research Hospital Association invited gastroenterologists, hepatologists, infectious disease specialists, surgeons, and clinical pharmacists to formulate the clinical practice guidance based on comprehensive literature review and experts' clinical experiences. Overall, 10 major statements regarding efficacy and safety of terlipressin in liver cirrhosis - related complications were proposed. Terlipressin can be beneficial for the management of cirrhotic patients with acute gastroesophageal variceal bleeding and hepatorenal syndrome (HRS). However, the evidence regarding the use of terlipressin in cirrhotic patients with ascites, post-paracentesis circulatory dysfunction and bacterial infections, as well as in those undergoing hepatic resection and liver transplantation remains insufficient. Terlipressin - related adverse events, mainly including gastrointestinal symptoms, electrolyte disturbance, and cardiovascular and respiratory adverse events, should be closely monitored. The current clinical practice guidance supports the use of terlipressin for gastroesophageal variceal bleeding and HRS in liver cirrhosis. High-quality studies are needed to further clarify its potential effects in other liver cirrhosis-related complications.

Current Status of Application of Electrical Stimulation Therapy in Gastrointestinal Diseases / 胃肠病学

In recent years, as a new treatment method developed on the basis of traditional acupuncture, electrical stimulation, including electroacupuncture and transcutaneous electrical acustimulation, has shown great potential in the treatment of various gastrointestinal diseases. Because of the characteristics of family therapy, it can greatly reduce the cost of treatment and has a comparative advantage over drug therapy, however, it has not been widely used in clinical practice. This article reviewed the advantages and disadvantages of electrical stimulation, stimulation parameters, mechanism, and research progress of the treatment.

Value of serum high density lipoprotein-cholesterol in risk assessment of non-alcoholic fatty liver disease / 中华消化杂志

Objective To investigate the value of high density lipoprotein-cholesterol (HDL-C) in the diagnosis and risk assessment of non-alcoholic fatty liver disease (NAFLD).Methods A cross-sectional study and multistage stratified random sampling method were performed in epidemiological survey.According to inclusion and exclusion criteria,a total of 3 312 individuals were enrolled and divided into NAFLD group (913 cases) and non-NAFLD group (2 399 cases).The serum lipid levels were compared between the two groups.Receiver operating characteristic (ROC) curve was performed to evaluate the value of HDL-C in the diagnosis of NAFLD.The binary logistic regression models were established based on HDL-C level.The differences in liver function indexes were compared among the research objects with different HDL-C levels.T test and MannWhitney U test were performed for statistical analysis.Results The serum levels of total cholesterol,triglyceride and low density lipoprotein-cholesterol (LDL-C) of NAFLD group were all higher than those of non-NAFLD group ((5.24 ±0.92) mmol/L vs.(4.98 ±0.92) mmol/L,(1.95 ± 1.41) mmol/L vs.(1.13 ± 0.68) mmol/L,(3.31 ± 0.84) mmol/L vs.(3.09 ± 0.84) mmol/L),and the differences were statistically significant (t =-7.29,-22.38 and-6.84,all P ＜ 0.01).However the serum HDL-C level of NAFLD group was lower than that of non-NAFLD group((1.30 ±0.33) mmol/L vs.(1.64 ±0.40) mmol/L),and the difference was statistically significant (t =24.93,P ＜0.01).The incidence of hypercholesterolemia,hypertriglyceridemia,hypo-high-density lipoprotein cholesterolemia and hyper-low-density lipoprotein cholesterolemia of NAFLD group was 48.0％ (438/913),44.8％ (409/913),31.0％ (283/913) and 82.8％ (756/913),respectively,which were significantly higher than that of non-NAFLD group (36.8％,882/2 399;13.2％,317/2 399;10.5％,251/2 399;71.8％,1 723/2 399),and the differences were statistically significant (x2 =34.65,385.43,206.18 and 42.37,all P ＜ 0.01).Using the cut-off values of HDL-C ≤ 1.66 mmol/L in female and ≤ 1.33 mmol/L in male,the area under curve (AUC) values for NAFLD diagnosis were 0.720 (95％ confidence interval (CI) 0.693 to 0.747) and 0.708 (95％ CI 0.679 to 0.737),respectively,the sensitivity was 79.1％ and 76.6％,and the specificity was 55.0％ and 54.6％.The results of binary logistic regression models based on HDL-C level indicated that prevalence of NAFLD in female with low HDL-C was 4.584 times (95％ CI 3.530 to 5.940,P ＜0.01) higher than that in female with high HDL-C;the prevalence of NAFLD in male with low HDL-C was 3.898 times (95％ CI 3.020 to 5.030,P ＜0.01) higher than that of male with high HDL-C.The alanine aminotransferase (ALT),aspartate transaminase (AST),gamma glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP) levels of low HDL-C group were all higher than those of high HDL-C group (20.10 U/L,14.40 U/L to 29.40 U/L vs.16.80 U/L,12.70 U/L to 23.00U/L;19.20 U/L,16.00 U/Lto23.70 U/Lvs.19.00 U/L,16.00 U/Lto22.17 U/L;22.00 U/L,14.00 U/L to34.00 U/L vs.15.00 U/L,11.00 U/L to 23.00 U/L and 71.00 U/L,59.00 U/L to 85.00 U/L vs.66.00 U/L,55.00 U/L to 82.00 U/L),and the differences were statistically significant (Z =-10.53,-2.20,-14.19 and-5.87,all P＜0.05).Conclusion The serum HDL-C level is negatively correlated with the risk of NAFLD level,and the NAFLD risk of individuals with low HDL-C level is significantly higher than individuals with high HDL-C level.

Role of des-gamma-carboxy prothrombin in assessment of liver function and prognosis of patients with liver cirrhosis / 中华消化杂志

Objective@#To investigate the role of des-gamma-carboxy prothrombin (DCP) in assessment of liver function and prognosis of patients with liver cirrhosis. @*Methods@#From January 2013 to August 2016, a total of 137 patients with liver cirrhosis in Shanghai Changzheng Hospital were enrolled. The serum DCP level was measured, the clinical data was collected and the complication and survival situation was followed up. The 137 patients were divided into DCP negative group (DCP≤40 mAU/mL, 118 cases) and DCP positive group (DCP>40 mAU/mL, 19 cases). Forty-five patients with compensated liver cirrhosis were divided into high-level DCP group (DCP>16.5 mAU/mL, 32 cases) and low-level DCP group (DCP≤16.5 mAU/mL, 13 cases). Chi square test was used to analyze the difference in the positive rate of DCP in patients with different Child-Pugh classification. Spearman correlation test was performed to analyze the correlation between DCP and model for end-stage liver disease (MELD) scores. Kaplan-Meier survival curve was used to analyze the correlation between DCP and liver disease related mortality. @*Results@#Compared to that of DCP negative group, albumin level of patients in DCP positive group decreased (35 g/L, 20 to 57 g/L vs. 29 g/L, 17 to 42 g/L), however, total bilirubin (TBil), prothrombin time (PT), and international normalized ratio all increased (12.9 mg/L, 1.80 to 83.0 mg/L vs.22.2 mg/L, 6.4 to 169.0 mg/L; 15.5 s, 11.7 to 35.7 s vs.17.5 s, 13.9 to 33.4 s; 1.24, 0.96 to 3.72 vs.1.44, 1.09 to 3.22), and the differences were statistically significant (Z=-2.785, -2.891, -2.945 and -2.879, all P<0.01). The DCP positive (DCP>40 mAU/mL) rates of Child-Pugh A, B and C patients were 1.8% (1/55), 21.2% (11/52) and 23.3% (7/30), respectively, and the difference was statistically significant (χ2=11.246, P=0.003). The DCP levels of patients with Child-Pugh class B and C cirrhosis were significantly correlated with MELD scores (r=0.259, P=0.021). There were 16 and three patients with ascites and spontaneous bacterial peritonitis (SBP) of DCP positive group, and the incidence was higher than that of DCP negative group (55.1%, 65/118 and 1.7%, 2/118), and the differences were statistically significant (χ2=5.744 and 97.636, both P<0.05). Patients in high-level DCP group had a higher proportion of clinical decompensation than low-level DCP group (53.1% (17/32) and two cases), the difference was statistically significant (χ2=5.397, P=0.024). The overall survival rate of DCP positive group (nine survival cases) were lower than that of DCP negative group (87.9%, 87/99), and the difference was statistically significant (χ2=5.442, P=0.020). @*Conclusions@#Serum DCP level is closely related to liver function, ascites and SBP in patients with liver cirrhosis. Furthermore, it is associated with occurrence of decompensation in compensated patients and liver-related mortality in patients with liver cirrhosis. DCP may be a useful serum marker for evaluation of disease severity and prognosis in patients with liver cirrhosis in clinical practice.

Management of Cirrhotic Ascites / 胃肠病学

Ascites formation represents a hallmark of decompensation of liver cirrhosis and predicts a poor prognosis. Patients with cirrhotic ascites are at high risk of some complications,such as hyponatremia,hepatorenal syndrome and spontaneous bacterial peritonitis(SBP). Currently,there are consensuses on treatment with sodium intake restriction, diuresis,paracentesis,albumin supplement,anti-infection and etc. In recent years,some advancements have been achieved,such as aquaretics,vasoactive drugs,prevention of SBP with rifaximin,alfapump?,stem cell transplantation and etc.,and yet there are still many issues deserved to be researched. This article focused on the management of cirrhotic ascites and related controversies with reference to current international and local guidelines and latest evidences.

Diagnostic value of endoscopic ultrasonography in staging of rectal cancer / 中华消化杂志

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) in staging of rectal cancer (RC).Methods From January 2015 to January 2017,the clinical data of 204 patients with RC and received EUS and surgery were retrospectively analyzed.Patients were divided into surgery alone group (155 cases) and preoperative neoadjuvant chemoradiation therapy (CRT) plus surgery group (49 cases).The preoperative staging by EUS and postoperative pathological staging of two groups were compared.Kappa test was performed for statistical analysis.Results Compared with postoperative pathologic diagnosis,the accuracy rate of EUS in the evaluation of invasion depth of RC in surgery alone group was 81.9％ (127/155),and the accuracy rates in the diagnosis of Tis,T1,T2,T3 and T4 were 3/4,11/13,82.1％(32/39),91.1％(41/45) and 74.1％(40/54),respectively,with a good consistency (kappa=0.751,P＜0.01).However,the accuracy rate of EUS in the invasion depth of RC in CRT plus surgery group was 34.7％ (17/49),and the accuracy rates in the diagnosis of T2,T3 and T4 were 1/13,2/7 and 14/16,respectively,with a poor consistency (kappa =0.107,P=0.850).Compared with postoperative pathologic diagnosis,the diagnostic accuracy rate of EUS in evaluating regional lymph node metastasis in surgery alone group was 70.3％ (109/155),and the accuracies in the diagnosis of cases with or without regional lymph node metastasis were 40.7％ (24/59) and 88.5％ (85/96),respectively,with a poor consistency (kappa=0.317,P＜0.01).The diagnostic accuracy rate of EUS in evaluating regional lymph node metastasis of preoperative CRT plus surgery group was 51.0％ (25/49),and the accuracies in the diagnosis of cases with or without regional lymph node metastasis were 5/11 and 52.6％ (20/38),respectively,with a poor consistency (kappa =0.014,P =0.911).Conclusions EUS can accurately evaluate the depth of tumor invasion and lymph node metastasis in preoperative staging of RC,which may be helpful for determining clinical treatment strategy.However,for patients received CRT treatment,EUS has a limited value in diagnosing and staging the tumor.

Primary Study on Non-invasive Evaluation of Portal Vein Pressure in Model of Liver Cirrhosis in Rats / 胃肠病学

The measurement of portal vein pressure (PVP) is important for the evaluation of therapeutic efficacy and prognosis in patients with liver cirrhosis.Aims: To investigate a non-invasive method for evaluating PVP in model of liver cirrhosis in rats.Methods: Liver cirrhosis model in rats was induced by intraperitoneal injection with thioacetamide.Magnetic resonance imaging with TOF sequence was used to measure portal vein diameter (PVD).PVP was detected directly by transvenous catheterization of portal vein.Body weight, liver weight, spleen weight, liver volume and spleen volume were determined.The hydroxyproline content in liver was determined by alkaline hydrolysis assay, proportion of collagen area in liver was detected by Sirius red staining.Results: Liver cirrhosis model in rats was successfully established after intraperitoneal injection for 20 weeks.Compared with control group, mean PVP, liver weight, liver volume, spleen weight, PVD, liver volume/body weight (LV/BW) ratio, spleen volume/body weight (SV/BW) ratio, hydroxyproline content and proportion of collagen area were significantly increased in model group (P<0.05), and body weight was significantly decreased (P<0.001).PVP was positively correlated with LV/BW ratio and proportion of collagen area (P<0.05).Conclusions: LV/BW and proportion of collagen area can indirectly reflect the PVP, and may provide a non-invasive approach for evaluation of portal hypertension.

Advances in Studies on Noninvasive Assessment of Portal Venous Pressure / 胃肠病学

Portal hypertension is a common complication of chronic liver diseases and is responsible for most of the clinical consequences of cirrhosis.Accurate assessment of portal venous pressure is essential for the designing of treatment strategy and judging of prognosis.Measurement of hepatic venous pressure gradient (HVPG) is the gold standard for evaluating portal venous pressure, however, it is an invasive procedure and is hard to be performed routinely in clinical practice.Therefore, it is urgent to explore a noninvasive method for assessing portal venous pressure.Recent evidence highlights that biochemical parameters, transient elastography, CT, MRI and the conjoint analysis model of multiple parameters have the potential diagnostic value.This article reviewed the advances in study on noninvasive assessment of portal venous pressure.

Clinical Characteristics and Outcome of Gastrointestinal Involvement of Henoch-Sch(o)nlein Purpura: Analysis of 35 Cases / 胃肠病学

Background: Gastrointestinal involvement of Henoch-Sch(o)nlein purpura (HSP) lacks specific clinical manifestations, which makes it difficult to be diagnosed and easy to misdiagnose.Aims: To analyze the clinical characteristics and outcome of gastrointestinal involved HSP across all ages and provide evidence for early diagnosis and treatment of the disease.Methods: A retrospective analysis was conducted on 35 gastrointestinal involved HSP patients admitted to Shanghai Changzheng Hospital from Jan.2006 to Jan.2016.The clinical outcome was followed up by phone interview.Results: Of the 35 gastrointestinal involved HSP patients, 22 were male and 13 were female, with a mean age of disease onset at 33.6 years.The frequent disease onset seasons were winter and spring, and the most frequent precipitating events were eating foreign proteins and upper respiratory tract infection shortly before disease onset.Abdominal pain was the presenting manifestation in 35 patients (57.1%) and was most frequently at periumbilical area (42.9%), and 48.6% of the pain was of paroxysmal colicky pain.The abdominal signs were mild.Laboratory tests showed 57.1% of the patients had elevated leukocyte count and 25.0% had elevated serum IgA.Stomach, duodenum, rectum and colon were frequently involved endoscopically, and the endoscopic lesions included mucosal petechia, diffuse mucosal erythema, edema and erosion.Nonspecific inflammatory cells infiltration was demonstrated by biopsy pathology.The overall prognosis was good with a recurrence rate of 21.9%.Elevated serum fibrinogen degradation product (FDP) and D-dimer were found in all the recurrent patients at admission.Conclusions: Purpura rash usually appeared later than gastrointestinal symptoms in gastrointestinal involved HSP.Typical clinical manifestations and endoscopic appearances are helpful for early diagnosis and treatment.Elevated FDP and D-dimer might be the predictor of recurrence.

Research Progress on Role of Hepatic Stellate Cells in Liver Development and Regeneration / 胃肠病学

Hepatic stellate cells(HSCs),the pluripotent cells,exist between liver sinusoidal endothelial cells and hepatic epithelial cells. Activated HSCs transform to myofibroblast-like cells,start to proliferate,and de novo express some proinflammatory and profibrogenic genes,which promote hepatic fibrogenesis. Previous studies mainly focused on the relationship between HSCs and liver fibrosis,however,recent studies indicate that HSCs are essential for proliferation, differentiation and maturation of various liver cells in the process of liver development and regeneration. This review systematically summarized the source,developmental regulation and function of HSCs,and focused on progress of recent studies on the role of HSCs in liver development and regeneration. The novel knowledge of HSCs may provide clues for treatment of liver diseases.

Effect of hepatocyte nuclear factor 1α on expression profile of hepatocellular carcinoma cells HuH7 / 中华消化杂志

Objective To investigate the regulation effect of hepatocyte nuclear factor (HNF) 1α on the gene expression profile and the signal pathways in HuH7 cells.Methods The expression of HNF1α was increased or decreased in HuH7 cells by Lenti-virus carrying HNF1α or shHNF1α.The expression profile of the cells after treated was examined by microarray technology.The difference expressed gene regulated by HNF1α were screened and the pathway was analyzed with DAVID software and related analysis system.The regulation effect of HNF1α on transforming growth factor (TGF)β signal pathway was detected by reporter gene test and the regulation role of HNF1α on related genes of TGFβ signal pathway was determined by real-time polymerase chain reaction (PCR) and Western blotting assay.Results The expression of HNF1α in HuH7 cells was significantly up-regulated by Lenti-virus carrying HNF1α gene (Lenti-HNF1α) and which was down regulated by Lenti-virus with shHNF1α gene (LentishHNF1 α).Expression profile analysis revealed that 339 genes were positively up regulated two times by HNF1α and 325 genes were negatively down regulated two times.Signal pathway analysis revealed that HNF1α regulated drug metabolism,biosynthesis of unsaturated fatty acids and glycolysis/gluconeogenesis metabolism signal pathways.Moreover,it also involved in the regulation of TGFβ、nuclear factor (NF)-κB and p53 tumor-related signal pathways.Furthermore,Luciferase reportor gene experiment indicated that up-regulated HNF1α could inhibit the activation of TGFβ signal pathway.And the results of real-time PCR and Western blotting verified that up-regulated HNF1α could inhibit TGFβ signal pathway related gene c-myc and TGFβ1 and then inhibited the activation of TGFβ signal pathway.Conclusion HNF1α broadly affects the gene expression profile and the tumor genesis and development related signal pathways in HuH7 cells,furthermore,HNF1α can inhibit the activation of TGFβ signal pathway.

Advances in Study on Liver Regeneration / 胃肠病学

One of the most important characteristics of adult liver is its regenerative ability to maintain its original mass and function after injury. With remarkable self-replication ability, hepatocytes play a critical role in liver regeneration. When there is a restriction in the proliferation capacity and/ or a massive loss of mature hepatocytes,other cells in liver can contribute to liver regeneration in different ways. Deep study on the effects and mechanisms of various hepatic cells’contribution to liver regeneration is helpful for increasing the understanding about liver regeneration and providing new insights for diagnosis and management of various advanced liver diseases.

Controversial problems in management of cirrhotic ascites / 临床肝胆病杂志

Ascites is an important indicator of poor prognosis of liver cirrhosis.Although several guidelines and consensus statements on the management of ascites have been published in the past years,there are still a lot of controversial problems in this regard.The current contro-versial problems and difficulties in the management of ascites,such as the timing of sodium supplementation or sodium restriction,the selec-tion of diuretics,the application value of aquaretics,the strategy of albumin administration after large-volume paracentesis,and the indica-tions and efficacy of transjugular intrahepatic portosystemic shunt,are reviewed.It is pointed out that further studies on these problems with evidence-based medicine means will enhance the diagnosis and treatment of cirrhotic ascites and improve patients'prognosis.

Effects of deoxyribonucleic acid methylation on the expression of hepatocyte nuclear factor-4α / 中华消化杂志

Objective To investigate the effect of deoxyribonucleic acid (DNA) methylation on the expression of hepatocyte nuclear factor-4α (HNF4c) and its role in the expression of HNF4α regulated by transforming growth factor-β1 (TGF-β1).Methods The expression of HNF4αP1 mRNA in six human hepatoma cell lines (HepG2,Huh-7,Hep3B,SMMC-7721,BEL-7405 and FOCUS),20 hepatic carcinoma specimens and corresponding adjacent tissues was detected by real-time reverse transcription polymerse chain reaction (real-time RT-PCR).The methylation status of the promoter region of HNF4αP1 in six human hepatoma cell lines was examined by bisulfite sequencing PCR (BSP).FOCUS cells were treated with 5-aza-2'-deoxycytidine (5-AZA-CdR) and then the methylation status of the promoter region of HNF4αP1 was examined by BSP.The expression of HNF4αP1 mRNA was detected by real-time RT-PCR.The six human hepatoma cell lines were treated with TGFβ1 and the expression of HNF4αP1 mRNA was detected by real-time RT-PCR.FOCUS cells were cotreated with 5-AZA-CdR,TGF-β1 and 5-AZA-CdR.The expression of HNF4αP1 mRNA was detected by real-time RT-PCR,and t test was performed for statistical analysis.Results Among 20 human hepatic carcinoma specimens and corresponding adjacent tissues,the expression of HNF4αP1 mRNA of 13 human hepatic carcinoma specimens was lower than that of corresponding adjacent tissues (t=2.350,P＜0.05).The relative quantity of the expression of HNF4αP1 mRNA was higher in Hep3B,HepG2 and Huh-7 cells,whereas that in SMMC-7721,BEL-7405 and FOCUS cells was lower.The methylation of the promoter region of HNF4αP1 in HepG2,Huh-7 and Hep3B was lower,but that in SMMC-7721,BEL-7405 and FOCUS was higher.Along with the increasing of the concentration of 5-AZA-CdR (0,0.1,1.0 and 2.5 μmol/L),the degree of the methylation of the promoter region of HNF4αP1 in FOCUS cells gradually decreased (61％,46％,32％ and 27％),and however the relative quantity of the expression of HNF4αP1 mRNA gradually increased ((9.661 ± 0.336)×10-7,(2.001±0.432)×10-6,(3.689±0.714)×10-6and (4.732±2.451)×10-6).After stimulated with TGF-β1,the relative quantity of the expression of HNF4αP1 mRNA was downregulated in HepG2,Huh-7 and Hep3B cells in which the methylation of the promoter region was low (t=12.994,8.441,and 9.032,all P＜0.01).There was no significant difference in the relative quantity of the expression of HNF4αP1 mRNA in SMMC-7721,BEL-7405 and FOCUS cells in which the methylation of the promoter region was high (all P ＞ 0.05).The relative quantity of the expression of HNF4αP1 mRNA in 5-AZA-CdR treated FOCUS cells ((4.972±0.035) × 10-6) was higher than that of control group ((1.411 ± 0.104) × 10-6) and the difference was statistically significant (t=13.212,P＜0.01).The relative quantity of the expression of HNF4αP1 mRNA in FOCUS cells co-treated with 5-AZA-CdR and TGF-β1 was lower than that in cells treated with 5-AZA-CdR alone and the difference was statistically significant ((1.181 ± 0.132) × 10-6 vs (4.972 ± 0.035) × 10-6,t=13.873,P＜0.01).Conclusions The expression of HNF4αP1 is down-regulated in hepatic carcinoma tissues.DNA methylation may regulate the expression of HNF4αP1 in hepatoma cells.The methylation of HNF4αP1 promoter region inhibits the regulating function of TGF-β1 in the expression of HNF4αP1.

The value of serum-ascites albumin gradient for predicting esophageal-gastric fundus variceal bleeding / 中华消化杂志

Objective To screen the risk factors of esophageal-gastric fundus variceal bleeding,in order to provide a more economical and less invasive method for predicting esophageal-gastric fundus variceat bleeding. Methods A total of 168 diagnosed liver cirrhosis patients accompanied with ascites and 60 cases of liver cirrhosis patients with primary hepatic carcinoma were enrolled. Followed up for one year, the esophageal-gastric fundus variceal bleeding was observed and analyzed with statistic methods. Results Unconditional single factor logistic regression model analysis indicated that albumin level of ascites, serum-ascites albumin gradients (SAAG), platelets, activated partial thromboplastin time (APTT), portal vein width, length and thickness of the spleen were independent risk factors,age and serum albumin were protective factors. Multifactor analysis indicated SAAG, APTT, and portal vein width were the independent risk factors, OR was 3.559 , 2.468 and 2. 608 respectively.After building receiver operating characteristic curve, the best SAAG cut-off value was 18.50 g/L, of which the sensitivity was 96.3％ and specificity was 56.3％. Conclusion SAAG has good value in predicting esophageal-gastric fundus variceal bleeding.

Combination of taurine with silybin meglumine in treatment of patients with non-alcohlic steatohepatitis / 中华消化杂志

Objective To evaluate the therapeutic effects of taurine combined with silybin meglumine in patients with non-alcoholic steatohepatitis (NASH). Methods One hundred patients with NASH were divided into two groups with 50 for each. The patients in the control group received polyene phosphatidyl choline (456 mg) combined with silybin meglumine (100 mg) 3 times daily for 24 weeks. While those in the treatment group received taurine (2 g) combined with silybin meglumine (100 mg) 3 times daily for 24 weeks. All patients were asked to take up basic therapy including drinking without alcohol, restricting sugary and fatty intake, improving food structure, carrying moderate aerobics and lightening body weight. Results At the end of 24 weeks, the clinical symptoms and the liver function ameliorated in two groups. Ultrasonic or CT examination showed that the steatohepatitits was improved significantly in two groups. Additionally, the levels of blood glucose, serum triglyceride and cholesterol as well as BMI decreased simultaneously (all P value <0. 05). Whereas the treatment group was superior to control group in aspect of amelioration of inappetite, nausea and vomiting as well as lever of serum triglyceride (all P value <0. 05). There was no side effect in the treatment group. Conclusion Based on the basic therapy, taurine combined with silybin meglumine can mitigate the degree of NASH, improve the metabolism of blood glucose and lipid with few side-effects.

Clinical value of tumour markers and serum-ascites albumin gradient in diagnosis of malignant ascites / 中华消化杂志

Objective To investigate the clinical value of tumour markers and serum-ascites albumin gradient (SAAG) in diagnosis of malignant ascites. Methods One hundred and fourteen patients with ascites, who were admitted to the hospital between Jan. 2005 and Jan. 2008, were retrospectively reviewed. The patients were divided into malignant (n = 39) or benign (12 with tuberculosis and 93 with aseptic liver cirrhosis) ascites groups according to the etiology. The distribution of tumor markers (CEA, CA19-9 and CA125) and SAAG in both groups were analyzed and receiver operating characteristic (ROC) was constructed. Results The tumor markers and SAAG were found both in malignant ascites group and benign ascites group. The concentrations of CEA and CA19-9 in serum and ascites were higher in malignant ascites group than in benign ascites group. The SAAG in malignant ascites group was significantly lower than that in patients with liver cirrhosis (P<0.05), but had no difference in comparison with tuberculosis patients (P>0. 05). There was no difference in level of CA125 in serum or ascites between malignant ascites group and benign ascites group (P>0.05). The area under the curve of ascitic fluid CEA, CA19-9 and SAAG were 0.79, 0.82 and 0.85, respectively. The cutoff values of ascitic fluid CEA, CA19-9 and SAAG were optimally chosen at 1.45 μ/L, 19.50 μ/L and 13. 50 g/L, respectively. The sensitivity and specificity were 66.7% and 78.1% in CEA, 74.4% and 84.8% in CA19-9, as well as 82.9% and 84.6% in SAAG.The combination of ascitic fluid CA19-9 with SAAG could increase the specificity to 97.14%, but decrease the sensitivity to 61.54%. Conclusion It is feasible to achieve optimum combination of biochemical indicators using ROC in differential diagnosis of malignant ascites from benign ascites.

Change of zero-stress state of portal vein in the rat during the pathogenesis of intrahepatic portal hypertension / 生物医学工程学杂志

A model of intrahepatic portal hypertension was established in SD rats by injection of carbon tetrachloride (CCl4). By observing the opening angle of the portal vein, the zero-stress state of the portal veins was studied at different time during the pathogenesis of intrahepatic portal hypertension. After CCl4 injection, the opening angles of the portal veins were increased, in the tenth week, they were much greater than those in the corresponding controls (P<0.05). The results suggest that during the pathogenesis of portal hypertension, unequal remodeling exists in the portal veins to change its biomechanical properties, and the residual stress and strain of the portal veins in portal hypertensive rats are greater than those in normal controls.