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Objective To investigate the difference in blood lipid parameters between acute-on-chronic pre-liver failure (pre-ACLF) and acute-on-chronic liver failure (ACLF) and the risk factors for disease progression. Methods A retrospective analysis was performed for the related data of 118 patients with ACLF (ACLF group) and 44 patients with pre-ACLF (pre-ACLF group) who were treated in The General Hospital of Western Theater Command from January 2012 to December 2020, including baseline age, albumin, creatinine, routine blood test results, and blood lipids. The independent samples t -test was used for comparison between normally distributed continuous data; and the Mann-Whitney U test was used for comparison between non-normally distributed continuous data; the chi-square test was used for comparison of categorical data between groups. A binary logistic regression analysis was used for multivariate analysis to identify independent predictive factors. The receiver operating characteristic (ROC) curve was used to compare the sensitivity and specificity of related indicators, and Youden index was used to calculate cut-off values. Results Compared with the pre-ACLF group, the ACLF group had significantly lower levels of total cholesterol (TC)[2.02(1.56-2.37) mmol/L vs 3.01(2.57-3.66) mmol/L, Z =5.411, P 0.05). The logistic regression analysis showed that TC (odds ratio [ OR ]=0.003, 95% confidence interval [ CI ]: 0.000-0.068, P < 0.05), LDL ( OR =61.901, 95% CI : 3.354-1142.558, P < 0.05), and WBC ( OR =3.175, 95% CI : 1.097-9.185, P < 0.05) had an independent predictive value, and the ROC analysis showed that the area under the ROC curve of TC was 0.852, the sensitivity of LDL was 0.887, and TC had the best specificity of TC was 0.840. Conclusion There are reductions in blood lipid parameters in the progression from pre-ACLF to ACLF, suggesting that clinicians should pay attention to the changes in lipids in the pre-ACLF stage and adjust the nutritional regimen in a timely manner.
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Objective To investigate the association between platelet count (PLT) and the prognosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), to establish a new PLT-related scoring model, and to assess its value in predicting the short-term prognosis of HBV-ACLF. Methods A retrospective cohort study was conducted among the patients with HBV-ACLF who were hospitalized and treated in Department of Gastroenterology, The General Hospital of Western Theater Command, from January 2018 to January 2022. Clinical data within 24 hours after admission were collected from all patients, and according to the survival after 180 days of follow-up, the patients were divided into survival group and death group. The independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Pearson correlation coefficient was used to investigate the correlation between different indicators, and the logistic regression model was used to analyze the influencing factors for prognosis. The receiver operating characteristic (ROC) curve was used to assess the predictive value of the prognostic model, and the Kaplan-Meier curve analysis was used to investigate the survival condition of the high AIP group and the low AIP group. Results A total of 236 patients were enrolled, with a 180-day survival rate of 75.85% (179/236). Compared with the survival group, the death group had significantly higher age (53.98±10.45 vs 47.44±12.46, P =0.001), international normalized ratio (INR) [1.78 (1.46-2.04) vs 1.47 (1.23-1.68), P < 0.001], total bilirubin [275.60 (165.00-451.45) vs 230.60 (154.90-323.70), P =0.035], Model for End-Stage Liver Disease (MELD) score [21.47 (18.14-24.76) vs 18.67 (15.70-21.62), P < 0.001], and albumin-bilirubin (ALBI) score [-1.06 (-1.64~-0.86) vs-1.32 (-1.73~-1.01), P =0.034], as well as significantly lower PLT [80.00 (50.00~124.50) vs 115.00 (82.00~143.00), P =0.001] and platelet-to-white blood cell ratio (PWR) [13.40 (9.54~20.70) vs 18.49 (13.95~24.74), P =0.001]. The Pearson correlation analysis showed that PLT was negatively correlated with liver cirrhosis and INR ( r =-0.332 and -0.194, P < 0.001 and P =0.003). The multivariate logistic regression analysis showed that age (odds ratio [ OR ]=1.045, 95% confidence interval [ CI ]: 1.015-1.076), PLT ( OR =0.990, 95% CI : 0.983-0.998), and INR ( OR =2.591, 95% CI : 1.363-4.925) were independent risk factors for the 180-day prognosis of HBV-ACLF patients. The new predictive model was established as follows: AIP=0.006×age+0.187×INR-0.001×PLT. The AIP scoring model had an area under the ROC curve (AUC) of 0.718 in predicting the 180-day prognosis of HBV-ACLF patients, with a sensitivity of 81.1% and a specificity of 54.1%, while PLT, PWR, LPACLF score, MELD score, and ALBI score had an AUC of 0.673, 0.659, 0.588, 0.647, and 0.578, respectively. The AIP scoring model had an optimal cut-off value of 0.48. The Kaplan-Meier survival analysis showed that the high AIP group had a significantly lower survival rate than the low AIP group ( P < 0.001). Conclusion The PLT-related scoring model has a better value than other models in predicting the prognosis of HBV-ACLF, and HBV-ACLF patients with a relatively high PLT level tend to have a high overall survival rate.
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Hepatic encephalopathy is a serious complication of liver cirrhosis and can cause neuropsychiatric symptoms such as cognitive impairment and motor impairment. More than 30% of patients with liver cirrhosis may develop hepatic encephalopathy， posing a huge economic burden to the health of patients and bringing many challenges to clinical diagnosis and treatment. Therefore， early identification， diagnosis， and treatment are the key to improving patient prognosis. Based on the clinical experience of our center， this article elaborates on hepatic encephalopathy from the aspects of pathogenesis， time dimension， minimal hepatic encephalopathy， and non-organic brain lesions， in order to provide new ideas or strategies for the diagnosis and treatment of hepatic encephalopathy in liver cirrhosis.
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Sarcopenia is one of the most common complications of end-stage liver disease (ESLD) and is an independent risk factor for mortality in ESLD patients. Increasing evidence has indicated that nutritional intervention plays an important role in improving the prognosis of ESLD complicated with sarcopenia. Timely identification and early treatment of sarcopenia in ESLD are indispensable for improving patient outcome and quality of life. Accumulating in-depth researches on the pathogenesis and metabolic characteristics of sarcopenia in ESLD patients have provided increasing evidence for the nutritional treatment of sarcopenia in ESLD. Here we reviewed and summarized the research progress regarding the early identification, nutritional risk screening, assessment, and intervention of sarcopenia in ESLD.
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Bile acids are synthesized and catabolized by the liver, and many factors can lead to disorders in the production, secretion, and reabsorption of bile acids, thereby causing abnormal bile acid metabolism in vivo . Common predisposing factors include hepatitis, viruses, alcohol, drugs, biliary obstruction, and inheritance. It has been reported that abnormal bile acid metabolism is associated with transporter gene mutation, and in-depth studies have been conducted in China and globally. This article reviews the mechanism of abnormal bile acid metabolism caused by gene mutations and related research advances, so as to provide a new basis and new ideas for the diagnosis and treatment of such diseases.
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Acute-on-chronic liver failure (ACLF) is a clinical syndrome with rapid deterioration of liver function caused by a series of predisposing factors on the basis of chronic liver diseases, and it is characterized by multiple organ failure and high short-term mortality. The onset of systemic inflammation is one of the important influencing factors for the progression of ACLF and is the body's natural defense against infection; however, the excessive release of inflammatory mediators breaks the original dynamic balance between "pro-inflammation" and "anti-inflammation", which may aggravate liver function impairment and even lead to decompensation. Therefore, the intensity of inflammatory response is closely associated with the prognosis of patients with ACLF, while at present, not enough attention has been paid to the impact of inflammatory response on patients with ACLF and the measures to deal with cytokine storm. Therefore, this article summarizes the impact of inflammatory response on ACLF and related advances in treatment, so as to provide ideas for the diagnosis and treatment of ACLF in clinical practice.
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Autoimmune hepatitis (AIH) is a chronic progressive inflammatory disease of the liver caused by the attack of liver cells by the autoimmune system, with the features of positive serum autoantibodies, high IgG, and/or γ-globulinemia. Current studies on pregnancy in patients with AIH mainly focus on labor complications, and there is still a lack of systematic recommendations for the evaluation, treatment, and management of diseases in the progestational stage, during pregnancy, and after delivery. Although immunity is suppressed during pregnancy, poor disease control within one year before pregnancy and spontaneous drug withdrawal during pregnancy can significantly increase adverse pregnancy outcomes. Therefore, this article describes how to implement multidisciplinary collaboration and management of the whole cycle of pregnancy, so as to improve maternal and fetal safety.
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China is a big country with liver diseases, and various hepatitis viruses, drug poisons, and alcohol can cause liver injury and even liver failure. The key to the prognosis of patients with liver failure is liver self-repair and regeneration. Alpha-fetoprotein (AFP) has been extensively studied as a tumor marker in liver cancer, but its role in liver regeneration in patients with liver failure awaits further studies. This article summarizes the basic research on AFP in liver regeneration and the clinical research on AFP in acute liver failure and acute-on-chronic liver failure (ACLF), as well as the previous research findings of our group that AFP is an important prognostic index and regeneration factor for liver regeneration after hepatitis B virus-related ACLF. The analysis shows that further studies on the role of AFP in the prognosis of various types of liver failure and the mechanism of liver regeneration will help deepen our understanding of AFP and liver regeneration, thereby providing new ideas and methods for the clinical diagnosis, treatment, and prognostic evaluation of patients with various types of liver failure.
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Liver cirrhosis is the end stage of various chronic liver diseases, and portal hypertension is a main complication of liver cirrhosis. In this pathological state, spontaneous portosystemic shunt (SPSS), as the collateral circulation of the portal venous system, has not attracted enough attention in terms of occurrence mechanism and clinical value. The analysis shows that although SPSS is a natural shunt channel, further studies are still needed to clarify whether it can be used as a decompression method for portal hypertension, and a deeper understanding of SPSS will provide important guiding significance for the diagnosis and treatment of portal hypertension.
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Liver cirrhosis is the end stage of various chronic liver diseases, and portal hypertension is a main complication of liver cirrhosis. In this pathological state, spontaneous portosystemic shunt (SPSS), as the collateral circulation of the portal venous system, has not attracted enough attention in terms of occurrence mechanism and clinical value. The analysis shows that although SPSS is a natural shunt channel, further studies are still needed to clarify whether it can be used as a decompression method for portal hypertension, and a deeper understanding of SPSS will provide important guiding significance for the diagnosis and treatment of portal hypertension.
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Primary biliary cholangitis (PBC) is an autoimmune disease. Although PBC has the features of autoimmune disease, it has poor response to immunosuppressants and good response to the drugs participating in bile acid metabolism, such as ursodeoxycholic acid. Studies have shown that the bicarbonate secretion of biliary epithelial cells is impaired in PBC patients, and bile acid not blocked by HCO3- umbrella enters biliary epithelial cells and mediates their damage and apoptosis, leading to the expression of autoantibodies in apoptotic cells and immunologic injury. In order to explore the role of HCO3- umbrella secreted by biliary epithelial cells in the pathogenesis of PBC, this article briefly introduces the physiological function and production mechanism of HCO3- umbrella and the influencing factors for HCO3- secretion, and it is pointed out that reduced HCO3- secretion may be a key link in the pathogenesis of PBC and a potential therapeutic target.
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Objective@#To investigate the value of alpha-fetoprotein (AFP) level on survived hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) patients treated with artificial liver.@*Methods@#Clinical indicators of HBV-ACLF patients who were previously treated with plasma exchange-based artificial liver at our department were retrospectively collected. The difference of serum AFP level between the survival and the death group was compared at 30, 90 and 180 days after artificial liver treatment. The ROC curves of the subjects were plotted, and the sensitivity and specificity of AFP for the survival prediction of the patients at 30, 90 and 180 days after artificial liver surgery were calculated. AFP was divided into a high AFP group and a low AFP group using median value. AFP and postoperative survival predictive value at 30, 90, and 180 days were analyzed.@*Results@#A total of 93 cases were included in this study. The AFP of the survival group at 30, 90, and 180 days was (231.0 ± 286.2) ng / ml, (237.69 ± 297) ng / ml, (229.44 ± 286.46) ng/ml, and the death group was (76.4 ± 104.7) ng/ml, (103.13 ± 116.99) ng / ml, (136.34 ± 2.9.29) ng/ml, respectively. AFP of the death group was significantly lower than the corresponding survival group (P < 0.05). Receiver operating characteristic (ROC) curve analyses indicated that the area under the curve (AUC) and its 95% confidence interval at 30, 90, and 180 days after artificial liver surgery were 0.739 (0.611 ~ 0.867), 0.675 (0.550 ~ 0.80), 0.653 (0.524 ~ 0.781), respectively. The median serum AFP value was 110 ng/ml, and the survival analysis showed that the survival time of the high AFP group was significantly higher than the low AFP group at 30 d (P = 0.01), 90 d (P = 0.04) and 180 d (P = 0.03) after artificial liver surgery.@*Conclusion@#Serum AFP can be used as a predictor of survival for HBV-ACLF patients after artificial liver therapy and its clinical value needs to be further verified by the larger sample size.
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Liver regeneration is an important response after liver injury and necrosis to maintain liver volume and function, with the involvement of various factors and signaling pathways. This process has three main stages, i.e., the initial stage of mitosis triggered by certain factors, the proliferation stage of promoting hepatocytes to enter the cell cycle, and the termination stage of promoting liver cells to reach a certain number and the recovery of liver mass. This article introduces various factors and multiple cellular signaling pathways that promote the differentiation of liver stem cells into liver cells to restore liver volume and function and summarizes the previous research findings of our group that alpha-fetoprotein is an important serum marker for liver regeneration after liver failure. The analysis shows that in-depth studies of the occurrence and clinical application of liver regeneration will help to improve the understanding of liver regeneration, better predict the prognosis of acute and chronic liver diseases, and provide new ideas and methods for the clinical diagnosis and treatment of various advanced liver diseases.
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ObjectiveTo investigate the effect of intraoperative Viatorr stent implantation for shunting of blood flow in the left or right branch of the portal vein on the clinical outcome of patients with cirrhotic portal hypertension undergoing transjugular intrahepatic portosystemic shunt (TIPS). MethodsA retrospective analysis was performed for the clinical data of 120 patients with cirrhotic portal hypertension who underwent TIPS in The General Hospital of Western Theater Command from March 2016 to December 2019, and according to the target position of portal vein puncture determined by intraoperative angiography, the patients were divided into left branch group and right branch group. The two groups were compared in terms of the incidence rates of postoperative recurrence and bleeding, stent dysfunction, and hepatic encephalopathy (HE) and survival. The t-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. The Kaplan-Meier curve was used to calculate rebleeding rate, stent patency rate, incidence rate of HE, and survival rate. ResultsThe surgical success rate was 100% for all 120 patients, with a short-term hemostasis rate of 100%. Among the 120 patients, 52 underwent shunting of the left branch of the portal vein and 68 underwent shunting of the right branch. There was a significant reduction in portal venous pressure after surgery (9.98±2.84 mm Hg vs 24.72±5.11 mm Hg, t=37.76, P＜0.01). The cumulative rebleeding rates at 12 and 24 months after surgery were 3.2% and 11.0%, respectively, and the cumulative incidence rates of HE at 3, 6, 12, and 24 months after surgery were 10.8%, 13.6%, 21.2%, and 24.5%, respectively. Among the 29 patients who experienced HE, 23 had grade Ⅰ-Ⅱ HE and 6 had grade Ⅲ HE. The cumulative incidence rates of stent dysfunction at 12 and 24 months after surgery were 7.1% and 21.4%, respectively. The cumulative survival rates at 12 and 24 months after surgery were 92.0% and 86.5%, respectively. As for comparison of the left branch group and the right branch group, there were no significant differences in postoperative stent patency rate, rebleeding rate, incidence rate of HE, and survival rate(all P＜0.05). ConclusionTIPS is a safe and effective method for the treatment of cirrhotic portal hypertension, and intraoperative Viatorr stent implantation, no matter for establishing the shunt of the left or right branch of the portal vein, will not affect the clinical outcome of patients.
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ObjectiveTo investigate the causes of dysfunction of COOK bare stent, Wallgraft covered stent, and Fluency covered stent after transjugular intrahepatic portosystemic shunt (TIPS) and related countermeasures. MethodsThe clinical data of 54 patients who were found to have stent dysfunction and underwent TIPS correction in our hospital from January 2011 to July 2017 were collected. Balloon dilatation, coaxial stent implantation, or parallel TIPS was selected based on angiography results and portal venous pressure to repair stent dysfunction. The Kruskal-Wallis H test was used to compare in-stent restenosis or occlusion time between the three types of stents, and the paired t-test was used to compare portal vein perfusion (PVP) before and after correction. Radiological examination was performed to evaluate stent dysfunction, and the cause of in-stent restenosis or occlusion was analyzed. ResultsTIPS correction was successfully performed for all 54 patients. Stenosis was observed in the hepatic vein, the liver parenchyma, or the portal vein, and there was a high incidence rate within 6-24 months after surgery. The median time to stenosis or occlusion was 17.0 months for COOK bare stent, 10.0 months for Wallgraft covered stent, and 17.0 months for Fluency covered stent. COOK bare stent and Fluency covered stent had a longer time to stenosis or occlusion than Wallgraft covered stent (P=0.013 and 0.023), and there was no significant difference in the time to stenosis or occlusion between COOK bare stent and Fluency covered stent (P=0.893). As for the surgical procedure of TIPS correction, 4 patients underwent balloon dilatation, 39 underwent coaxial stent implantation, and 11 underwent parallel TIPS. There was a significant reduction in portal venous pressure after surgery (25.6±4.8 cm H2O vs 34.7±6.4 cm H2O, P＜0.001). ConclusionWallgraft stent has a significantly shorter time to stent dysfunction after TIPS than COOK bare stent and Fluency covered stent, suggesting that Wallgraft stent is not suitable for the initial establishment of TIPS shunt. Correction procedures should be selected based on actual conditions to repair stent dysfunction and restore shunt patency.
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ObjectiveTo investigate the influencing factors for hepatic venous pressure gradient (HVPG) in patients with cirrhotic portal hypertension undergoing transjugular intrahepatic portosystemic shunt (TIPS). MethodsA total of 158 patients with cirrhotic portal hypertension who underwent TIPS in The General Hospital of Western Theater Command of the Chinese PLA from January 2015 to December 2018 were enrolled. Wedged hepatic venous pressure (WHVP), free hepatic venous pressure (FHVP), and portal venous pressure (PVP) were measured during TIPS, and HVPG and portal venous pressure gradient (PVPG) were calculated. The t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. The Pearson correlation coefficient was used to analyze the correlation between HVPG and PVPG, and a multivariate linear stepwise regression analysis was used to investigate the independent risk factors for HVPG. ResultsHVPG was positively correlated with PVPG (r=0.796, P＜0.001). The one-way analysis of variance showed that age and etiology were influencing factors for HVPG (F=19.900 and 10.287, both P＜0.001). The multivariate linear stepwise regression analysis showed that age and etiology were independent influencing factors for HVPG (t=7.870 and -2.178, both P＜0.001). ConclusionAge and etiology are independent influencing factors for HVPG in patients with cirrhotic portal hypertension, and the patients aged ≥60 years or the patients with hepatitis C virus-related cirrhosis tend to have higher HVPG.
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Patients with decompensated cirrhosis often have varying degrees of portal hypertension, and when portal pressure reaches a certain threshold, various clinical complications may occur and even threaten patients′ lives. Therefore, portal pressure assessment is important for the clinical management and prognosis of such patients. Due to the anatomical characteristics of the portal vein, it is difficult to measure portal pressure directly. At present, hepatic venous pressure gradient is used to replace portal pressure in China and foreign countries. However, the measurement of hepatic venous pressure gradient is an interventional procedure and is difficult to perform in clinical practice. Therefore, noninvasive assessment of portal hypertension has become a research hotspot. This article reviews the research advances in the roles of serum markers, ultrasound elastography, computed tomography, and magnetic resonance imaging/magnetic resonance elastography in noninvasive assessment of portal hypertension.
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Objective To explore the risk of tuberculosis infection in patients with malignant tumors.Methods The sputum samples and blood samples from 396 patients with malignant tumor and 80 healthy subjects were detected by modified Roche cul-ture,real-time fluorescence quantitative PCR,colloidal gold,T cell spots(TSPOT.TB)and single immunodiffusion(SRID).Results The positive rate of the experimental group of 396 cases of malignant tumor patients with five kinds of methods for detection of Mycobacterium tuberculosis were improved Lowenstein Jensen 12.1%(48/396),real-time PCR(169/396)42.7%,colloidal gold 38.9%(154/396),TSPOT.TB 44.9%(178/396),SRID 10.4%(41/396).In the control group,the positive result was detected only by real-time fluorescent PCR 8.7%(7/80),colloidal gold 6.3%(5/80),and TSPOT.TB 27.5%(22/80).The differences of the results of the same detection method were statistically significant(P<0.01).The experimental group was grouped according to the location of the lesion,and there was no statistical difference between the indexes of each group(P>0.05).In comparison with other types of tumor,there were no statistical differences in every index of every group(P>0.05).But the positive rates of liver cancer patients were lower than those of other types of tumor,and all the positive rates of lung cancer patients were higher than those of other types of tumor.Conclusion Patients with malignant tumor is a high-risk group of TB infection.It is suggested that early screening and regular monitoring of TB infection should be done for patients with malignant tumor,so as to achieve early de-tection and early treatment.
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There are not many studies on chronic hepatitis C complicated by autoimmune hepatitis, and up to now, the clinical diagnosis and treatment of such diseases still face many difficulties. Although related articles put forward some recommendations, there are no standard guidelines for diagnosis and treatment, and clinical physicians need to provide treatment for these patients based on their personal experience. This article summarizes related articles on chronic hepatitis C complicated by autoimmune hepatitis in order to provide help to clinical physicians when they face similar clinical problems in the future.
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Transjugular intrahepatic portosystemic shunt (TIPS) can effectively reduce portal hypertension, prevent recurrent esophagogastric variceal bleeding, and relieve intractable ascites. TIPS involves vessel puncture, expansion of puncture tract within the liver parenchyma, and stent implantation, and may cause various complications. The effective prevention and treatment of TIPS-related complications have become a new direction for research in TIPS. This article reviews the intraoperative and postoperative complications of TIPS and related preventive and treatment strategies.