Advances in integrated traditional Chinese and Western medicine diagnosis and treatment of hepatic fibrosis / 临床肝胆病杂志

Hepatic fibrosis (HF) is a key stage in the progression of chronic hepatitis to liver cirrhosis and even liver cancer, and it is a dynamic and reversible pathological change. Studies have shown that integrated traditional Chinese and Western medicine therapy has a good therapeutic effect on HF and can delay or reverse the progression of this disease. This article summarizes the pathogenesis of HF and discusses the diagnosis of HF, traditional Chinese medicine and Western medicine therapies, and the path of integrated traditional Chinese and Western medicine therapy, so as to provide ideas for the basic research and clinical application of integrated traditional Chinese and western medicine in the prevention and treatment of HF.

Advances in the experimental research on traditional Chinese medicine against liver fibrosis / 临床肝胆病杂志

Liver fibrosis is the common pathological process of chronic liver diseases caused by various etiologies such as viral hepatitis and alcoholism, and it can progress to liver cirrhosis and even liver cancer and seriously threatens human health. Traditional Chinese medicine (TCM) has the characteristics of multiple components, targets, and pathways in inhibiting the progression of liver fibrosis and promoting the reversal of liver fibrosis and thus has unique clinical efficacy. In recent years, great progress has been made in the experimental research on the anti-liver fibrosis potential of TCM, and related studies have found a variety of compound TCM prescriptions, single TCM medicine, and their effective constituents and revealed their potential mechanism of action from the cellular and molecular levels. In order to further clarify the advances in the experimental research on the anti-liver fibrosis potential of TCM, this article systematically reviews the research advances in the past five years from the aspects of experimental animal models for the anti-liver fibrosis potential of TCM, the mechanism of action of TCM in the treatment of liver fibrosis, and TCM research from animal experiments to clinical trials, so as to provide a reference for researchers and clinicians to develop and apply anti-liver fibrosis TCM drugs.

Improving the efficacy of traditional Chinese medicine in treatment of primary liver cancer based on etiology and pathogenesis / 临床肝胆病杂志

At present, the treatment of primary liver cancer is mainly based on modern medicine. Studies have found that traditional Chinese medicine (TCM) can promote the apoptosis of hepatoma cells and regulate the immunity of human body by affecting multiple critical pathways involved in the development and progression of tumor. TCM plays an irreplaceable role in the treatment of liver cancer, and the focus on the etiology and pathogenesis of liver cancer is the key to achieving good efficacy. Although there are still no ideal anti-HBV drugs in TCM, intervention on the etiologies of dampness, heat, phlegm, toxin, stasis, and deficiency and the change in struggle between vital Qi and pathogen during each stage of disease progression may delay or even prevent disease progression, which is the treatment based on etiology and pathogenesis and is the theory that "treatment should focus on the principal cause of a disease". In clinical practice, modern medical treatment combined with TCM can improve patients' quality of life and reduce tumor recurrence, and TCM combined with sorafenib has stronger efficacy and fewer side effects. Meanwhile, further studies are needed to explore how integrated traditional Chinese and Western medicine therapy exerts a therapeutic effect on liver cancer and the detailed mechanism of action of TCM in the treatment of liver cancer.

Value of a new predictive model in evaluating short-term prognosis of patients with hepatitis B virus related acute-on-chronic liver failure / 中华危重病急救医学

Objective:To establish a predictive model and investigate its value in evaluating short-term prognosis of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF).Methods:Patients with HBV-ACLF admitted to Tianjin Second People's Hospital and Beijing Youan Hospital, Capital Medical University from May 2015 to October 2018 were enrolled. The data of gender, age, laboratory markers at admission, model for end-stage liver disease (MELD) score and clinical complications were collected for analysis. According to the prognosis on 12-week, patients were divided into survival group and death group. Univariate analysis and binary Logistic regression analysis were used to test the risk factors for short-term prognosis of the patients with HBV-ACLF, and a prediction model was established. The accuracy of each index and the established model were verified by the receiver operating characteristic (ROC) curve.Results:A total of 148 patients with HBV-ACLF were enrolled in the study, 91 cases survived while 57 cases died during the 12-week period. The age, total bilirubin (TBIL), neutrophil percentage (NEUT%), hepatitis B surface antigen (HBsAg), MELD score of death group were higher than those of survival group [age (years old): 50.00 (44.50, 55.00) vs. 43.00 (34.00, 53.00), TBIL (μmol/L): 310.30 (240.70, 405.70) vs. 266.40 (184.20, 360.20), NEUT%: (74.52±13.05)% vs. (66.64±12.35)%, lg HBsAg (kU/L): 3.72 (3.29, 3.92) vs. 2.97 (2.49, 3.78), MELD score: 24.27 (19.71, 27.40) vs. 21.88 (18.83, 24.38), all P < 0.05], while albumin (ALB), total cholesterol (CHO), prothrombin activity (PTA) and alpha-fetoprotein (AFP) were lower than those of survival group [ALB (g/L): 29.80 (27.05, 31.05) vs. 30.80 (28.00, 33.90), CHO (mmol/L): 1.98 (1.50, 2.38) vs. 2.49 (2.05, 3.01), PTA: (30.37±7.09)% vs. (32.94±6.03)%, AFP (μg/L): 21.54 (9.28, 51.54) vs. 66.16 (24.50, 152.80), all P < 0.05]. Logistic regression analysis showed that NEUT%, HBsAg and AFP were independent risk factors for short-term prognosis of patients with HBV-ACLF [odds ratio ( OR) was 77.843, 1.439, 0.995, respectively, all P < 0.05]. According to the results of regression analysis, the NHA-ACLF model (NEUT%+HBsAg+AFP) was established. The formula was logit (NHA-ACLF) = -5.441+5.688×NEUT%+0.430×lg HBsAg-0.005×AFP. The area under the ROC curve (AUC) of the NHA-ACLF model for pred HBV-ACLF patients was 0.790, which was better than NEUT% (AUC = 0.696), lg HBsAg (AUC = 0.670), AFP (AUC = 0.703) and MELD score (AUC = 0.640). When the cut-off value of NHA-ACLF model score was 0.459, the sensitivity was 73.7%, and the specificity was 79.1%. Conclusions:NEUT%, HBsAg and AFP are independent predictive indicator for short-term prognosis in patients with HBV-ACLF. Compared with MELD score, the risk assessment model NHA-ACLF has a greater value in predicting the short-term prognosis of patients with HBV-ACLF.

Syndrome differentiation-based treatment of primary liver cancer developed by Professor Qian Ying: an analysis of experience / 临床肝胆病杂志

ObjectiveTo investigate the traditional Chinese herbs and core prescriptions commonly used by Professor Qian Ying in the syndrome differentiation-based treatment of primary liver cancer, and to guide clinical medication. MethodsA retrospective analysis was performed for the clinical data of the patients diagnosed and treated by Professor Qian Ying. A descriptive analysis was performed to analyze Professor Qian Ying′s clinical medication and prescriptions in the treatment of primary liver cancer, and the complex network and clustering with point mutual information were used to analyze the complex association between multiple traditional Chinese herbs. ResultsA total of 111 patients with primary liver cancer were enrolled. There were 287 visits, 287 prescriptions, and 132 traditional Chinese herbs in total. The core herbs used by Professor Qian Ying were Visci herba, raw Astragalus membranaceus, Salvia miltiorrhiza, Oldenlandia diffusa, and Polygoni Orientalis Fructus, and this result was consistent with the composition of Huqi powder developed by Professor Qian Ying. The prescriptions commonly used included Huqi powder, Shengmai decoction, and Xiaoyao powder. ConclusionSalvia miltiorrhiza is the special herb used by Professor Qian Ying in the treatment of primary liver cancer and Huqi powder developed by Professor Qian Ying is the commonly used prescription.

The relationship between plasma soluble CD14 level and disease progression in patients with acute phase of acquired immunodeficiency syndrome / 中华传染病杂志

Objective To investigate the correlation between plasma soluble CD14 (sCD14)level and disease progression in patients with acute phase of acquired immunodeficiency syndrome (AIDS). Methods Forty-one human immunodeficiency virus (HIV)-infected patients were followed up from June 2007 to June 2010 in Beijing You′an Hospital,including 20 patients with CD4 + T lymphocyte counts more than 350/μL,and 21 less than 350/μL after 3 years of HIV infection.Twenty healthy blood donors were recruited as controls.Enzyme-linked immunosorbent assay (ELISA)was employed to test the plasma sCD14 level of healthy controls and patients infected with HIV at 1 -30 d,31 -90 d,91 - 180 d and 181 -360 d.Student t test was used to compare the means between two groups.ANOVA analysis was used to compare the means among more than two groups.Results The mean plasma sCD14 level in control group was (1 654±904)μg/L.Three years after HIV infection,the sCD14 level of patients with CD4 + T lymphocyte counts less than 350/μL group was (4 214±2 635)μg/L,which was higher than that of patients with CD4 + T lymphocyte counts more than 350/μL ([2 275 ±1 457 ]μg/L).The difference was statistically significant(t=-5 .41 ,P <0.01).The plasma sCD14 level in patients infected with HIV 181 -360 d was significantly higher than that in patients infected with HIV 1 - 30 days ([4 485 ± 2 779]μg/L vs [2 577 ±1 635 ]μg/L;t = -3.39,P <0.05 ).The plasma sCD14 level was positively correlated with HIV viral load (r =0.35,P =0.000 1 ),and negatively correlated with CD4 + T lymphocyte counts (r=-0.28,P =0.001 ).Conclusions The plasma sCD14 level in patients with acute phase of HIV infection is higher than that of healthy people,which increases with prolonged HIV infection.Plasma sCD14 level in of HIV infection acute phase may be closely related to HIV/AIDS progression.