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Objective To analyze the levels of serum thrombin-activatable fibrinolysis inhibitor ( TAFI) in patients with chronic hepatitis B ( CHB ) with different degrees of hepatic fibrosis , and to evaluate the value of TAFI in the evaluation of liver fibrosis .Methods Forty six patients with CHB who underwent liver biopsy from June 2016 to March 2017 in Zhejiang Provincial People' s Hospital were enrolled.According to liver fibrosis stage (S0-4), they were divided into mild liver fibrosis group (S0-1, n=16), significant liver fibrosis group (S2, n=15) and severe liver fibrosis group (S3-4, n=15).At the same time, 16 healthy subjects were randomly selected as health controls in the physical examination center of the hospital .Serum TAFI levels were analyzed in each group , and the receiver operating curve ( ROC) was used to evaluate the diagnostic value of TAFI in CHB patients with significant liver fibrosis and severe liver fibrosis (S≥2).The SPSS 23.0 software was used to analyze the data .Results Serum TAFI levels in the mild liver fibrosis group , significant liver fibrosis group , severe liver fibrosis group and health controls were (63.4 ±18.2), (43.8 ±20.4), (27.5 ±19.2) and (71.3 ±25.6) ng/mL, the difference between the four groups was statistically significant (F=13.512, P<0.01).The level of TAFI in the significant liver fibrosis group was lower than that in the healthy control group and the mild liver fibrosis group (t=3.283 and 2.822, P<0.01).The level of TAFI in the severe fibrosis group was lower than that in the significant liver fibrosis group (t=2.260, P<0.05).Serum TAFI levels were negatively correlated with liver fibrosis stage (r=-0.562, P<0.01).The area under the ROC curve of TAFI for predicting liver fibrosis (S≥2) was 0.832, and the sensitivity and specificity were 81.3％and 78.3％, respectively. Compared with the APRI score and the FIB4 index, the difference was not statistically significant ( P >0.05).Conclusion The serum TAFI level is negatively correlated with the degree of liver fibrosis in CHB patients, which has a good diagnostic value for liver fibrosis (S≥2) in patients with CHB.
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Objective To explore the feasibility and safety of primary suture in laparoscopic common bile duct exploration(LCBDE) for treating choledocholithiasis.Methods The clinical data in 185 cases of choledocholithiasis underwent LCBDE in Sun Yat-sen Memorial Hospital from March 2010 to October 2015 were retrospectively analyzed.The patients were divided into 1aparoscopic common bile duct exploration and primary suture(LBEPS) group(117 cases) and T tube drainage group(68 cases) according to different processing modes of common bile duct incision.The operative time,intra-operative blood loss amount and postoperative complications were observed in the two groups.Results All operations were successfully performed in both two groups without converting to laparotomy.The operative time,intra-operative blood loss amounts and postoperative complications had no statistically significant differences between the LBEPS group and T tube drainage group(P>0.05).The postoperative hospital stay of the LBEPS group was significantly shorter than that of the T tube drainage group(P<0.01).There was no bile duct stricture or stone recurrence during the follow up period in the two groups.Conclusion Under strictly grasping the operation indication,selecting correct suture material and possessing practiced operating skills,primary suture of laparoscopic choledocholithiasis is safe and feasible,can avoid the risk of T tube placing related complications,has short postoperative hospitalization duration and increases postoperative living quality.
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Objective To evaluate the efficacy and safety of long-term nucleos (t) ide analogue treatment in patients with chronic hepatitis B (CHB).Methods Two hundred and two initially treated patients with CHB admitted in Zhejiang Provincial People's Hospital during March 2013 and August 2016 were enrolled in the study.Patients were divided into six groups according to the different antiviral therapy:adefovir group (ADV,n =43),entecavir group (ETV,n =44),lamivudine group (LAM,n =25),telbivudine group (LDT,n =23),LDT + ADV group (n =22),and LAM + ADV group (n =45).HBV DNA negative conversion rate,HBeAg serological conversion rate and estimated glomerular filtration rate (eGFR) at baseline and at 48th,96th,144th wk of treatment were measured.Chi-square test and repeated measure of ANOVA were used to analyze the data.Multivariate Logistic regression analysis was applied to detect the relevant risk factors of renal dysfunction in CHB patients.Results After treatment for 144 wks,the HBV DNA negative conversion rates in ETV and LDT group were higher than that in ADV group (both P ＜ 0.01),the levels of eGFR in ADV,ETV,LAM and LAM + ADV group were declined with time,while the eGFR levels in LDT and LDT + ADV group were increased with time (Ftime =3.939,Fgroup =3.983,P ＜0.01 or ＜0.05).After treatment for 96 wks and 144 wks,the levels of eGFR were higher in LDT and LDT + ADV group than those in other groups,respectively (all P ＜ 0.05).Multivariate Logistic regression analysis showed that age ≥40 (x2 =16.145,OR =4.452,95 ％ CI 2.149-9.223,P ＜ 0.05),mild abnormality of eGFR at baseline (x2 =16.449,OR =4.336,95％ CI 2.144-8.891,P ＜ 0.05),and ADV treatment (x2 =5.837,OR =5.280,95％ CI 1.369-20.365,P ＜ 0.05) were independent risk factors of renal dysfunction in CHB patients.Conclusion LDT long-term monotherapy or combination with ADV may improve renal function for patients with CHB,which provides a reference for long-term treatment of CHB patients with nucleos(t) ide analogues.
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Objective To evaluate the relationship between apoE gene polymorphisms and gallstone. Methods We included all the published studies on the association between apoE gene polymorphisms and gall-stone. A meta-analysis was employed to summarize all these studies, calculate the pooled OR and its 95% confidence interval (95% CI) , and test the overall effects. The Egger's publication bias analysis and sensitivity analysis were carried out to evaluate the reliability and stability of the meta-analysis. Results Eleven association studies between the apoE gene polymorphisms and gallstone fulfilled our inclusion criteria. There were 1248 patients with gallstones and 1660 controls. Remarkable heterogeneities were discovered in the allele ε4 and genotype E3/E4 of apoE between gallstone and control subjects in these studies (P<0. 05). Their ORs and 95%CIs were 1.32 (1.01, 1. 71), 1. 60 (1. 04, 2. 46), respectively (P<0. 05). The results of sensitivity analysis and publication bias analysis showed the reliability and stability of this meta-analysis. Conclusion apoE gene polymorphisms are associated with gallstone. Those with the alleleε4 or genotype E3 /E4 had a higher risk of suffering from gallstone.