Role of T lymphocytes in primary sclerosing cholangitis / 临床肝胆病杂志

Primary sclerosing cholangitis （PSC） is an immune-mediated chronic cholestatic liver disease and can progress to end-stage liver diseases such as liver cirrhosis and liver failure， and there are still no effective treatment methods at present. Studies have found that T lymphocytes are closely associated with the development and progression of PSC. This article reviews the role of T lymphocytes in PSC， so as to provide new ideas for research on the pathogenesis of PSC and the clinical diagnosis and treatment of PSC.

Value of Charlson comorbidity index in predicting the prognosis of patients with acute-on-chronic liver failure / 临床肝胆病杂志

Objective To investigate the value of Charlson comorbidity index (CCI) in predicting the short- and long-term risks of death in patients with acute-on-chronic liver failure (ACLF). Methods A total of 317 patients with ACLF who attended The First Hospital of Lanzhou University from December 1, 2016 to December 1, 2021 were enrolled, and according to their prognosis, they were divided into death group with 169 patients and survival group with 148 patients. The two groups were analyzed in terms of clinical data and follow-up data. The group 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. The univariate and multivariate Cox proportional-hazards regression model analyses were used to investigate the influencing factors for the prognosis of ACLF patients. The Kaplan-Meier method was used to plot survival curves, and the Log-rank test was used for comparison of survival time between patients with different CCI scores. The receiver operating characteristic (ROC) curve was used to evaluate the performance of CCI and other indices in assessing the prognosis of ACLF patients. Results Among the 317 patients, there were 225 (71.0%) male patients. There were significant differences between the death group and the survival group in age, hemoglobin, white blood cell count, total bilirubin, albumin, Model for End-Stage Liver Disease (MELD) score, prothrombin time activity, CCI, age-adjusted Charlson co-morbidity index (ACCI), and follow-up time (all P < 0.05). The multivariate Cox regression analysis showed that the CCI (hazard ratio [ HR ]=1.351, 95% confidence interval [ CI ]: 1.112-1.641, P =0.002), ACCI ( HR =1.200, 95% CI : 1.011-1.423, P =0.037), and MELD score ( HR =1.076, 95% CI : 1.054-1.099, P < 0.001) were independent risk factors for the prognosis of ACLF patients. Based on CCI score, the patients were divided into CCI ≤4 group with 167 patients, CCI=5 group with 64 patients, and CCI ≥6 group with 86 patients, with a 3-year mortality rate of 26.5%, 83.2%, and 96.9%, respectively, and there was a significant difference in survival time between any two groups after 3 years of follow-up and at the time of follow-up till September 2022 (all P < 0.001). CCI, ACCI, and MELD scores had an area under the ROC curve of 0.845, 0.811, and 0.790, respectively, in predicting the prognosis of ACLF patients. Conclusion As commonly used comorbidity assessment indices, CCI and ACCI scores have certain value in evaluating the short- and long-term prognosis of ACLF patients.

Research advances in nonalcoholic fatty liver disease-related hepatocellular carcinoma / 临床肝胆病杂志

The incidence rate of nonalcoholic fatty liver disease-related hepatocellular carcinoma (NAFLD-HCC) tends to increase worldwide, while its pathogenesis remains unclear. With reference to the literature in recent years, this article summarizes the role of adipose tissue inflammation, oxidative stress, gut microbiota, and insulin resistance in the pathogenesis of NAFLD-HCC and the advances in the prevention and treatment of the above mechanisms, so as to provide new ideas for the treatment of NAFLD-HCC.

Application value of portal vein flow velocity after different interventions on rebleeding in patients with hepatitis B cirrhosis complicated with esophageal and gastric variceal bleeding / 中华传染病杂志

Objective:To investigate the predictors of rebleeding three months after treatment of esophageal and gastric variceal bleeding (EGVB) in patients with hepatitis B cirrhosis and the effects of different treatments on rebleeding.Methods:From January 2018 to January 2020, the hepatitis B cirrhosis patients with first onset of EGVB in the First Hospital of Lanzhou University were enrolled and followed up for three months. The development of rebleeding, information about portal vein flow velocity and model for end-stage liver disease (MELD) scores after treatment of first bleeding were collected. The statistical analysis was conducted by chi-square test and binary logistic regression analysis. The efficacy for predictors of rebleeding was evaluated by using area under the receiver operating characteristic curve.Results:Among the 33 patients with the first EGVB, the rebleeding rate during three months follow-up was 42% (14 cases), including one patient (1/8) who underwent transjugular intrahepatic portosystemic shunt, 10 patients (10/19) were treated with therapeutic endoscopy, and three patients (3/6) were treated with vasoactive drugs. No statistically significant difference in rebleeding rates was found among the three treatment groups ( χ2=3.853, P=0.175). Portal vein flow velocity after treatment for the first onset of EGVB (odds ratio ( OR)=0.21, 95% confidence interval ( CI) 0.05 to 0.93, P=0.039) and MELD score ( OR=1.53, 95% CI 1.02 to 2.30, P=0.040) were independent predictors for the occurrence of rebleeding events during three months. When the portal vein flow velocity after treatment for the first bleeding was 19 cm/s, the area under the receiver operating characteristic curve for prediction of the occurrence of rebleeding during three months was 0.86, with the sensitivity of 92% and the specificity of 61%. Conclusion:Among the patients with hepatitis B cirrhosis and the first onset of EGVB, different treatments may have little relationship with three-month rebleeding, while portal vein flow velocity ≤19 cm/s is the main predictor for rebleeding within three months.

Change in the activity of glucosylceramide synthase in human hepatoma cell line with hepatitis B virus infection in vitro / 临床肝胆病杂志

ObjectiveTo investigate the change in the activity of glucosylceramide synthase, the key enzyme in glycosphingolipid metabolism and synthesis, in Huh7 cells infected by hepatitis B virus (HBV) in vitro. MethodsBlood samples were collected from nine previously untreated patients with acute hepatitis B who attended Department of Infectious Diseases, The First Hospital of Lanzhou University, from June to August, 2019, and the blood samples collected from seven healthy individuals who underwent physical examination were established as control. Huh7 cells were inoculated with the high-copy HBV particles (＞9.9×107 IU/ml) in the serum of patients with HBV infection (infection group), and Huh7 cells co-cultured with the serum of healthy individuals were established as control group. The expression levels of HBsAg and HBV DNA in the cytoplasm of HBV-infected Huh7 cells were measured, and the correlation between GCS activity and virus was analyzed. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups, and a Pearson correlation analysis was performed. ResultsCompared with the control group, the infection group had a significant reduction in the number of cells, an increase in cell volume, and cell membrane fragmentation. The infection group had a significant increase in the expression of HBsAg in cytoplasm at 4 hours, 8 hours, 2 days, and 5 days after infection (P＜0.05); the expression level of HBV DNA tended to increase significantly from 4 hours after infection to 8 hours, 2 days, and 5 days after infection (16.67±11.55 IU/ml vs 112.01±25.94 IU/ml/328.01±10350 IU/ml/101.60±49.84 IU/ml, P＜0.001), with the highest level at 2 days after infection. During HBV infection, the activity of GCS gradually increased with the increase in viral replication from 4 hours after infection (126.21±9.59 IU/ml) and reached a peak at 2 days after infection (226.53±36.27 IU/ml), with a significant difference between the infection group and the control group at 2 days after infection (226.53±36.27 IU/ml vs 136.50±1544 IU/ml, t=3.956, P=0.016 7). The activity of GCS was positively correlated with HBV DNA level (r=0.576 8, P=0047 1). ConclusionHuh7 cells are successfully infected with the high-copy HBV particles in the serum of patients with HBV infection, which mimics the characteristics of HBV infection in vitro to a certain degree. The activity of GCS may be associated with HBV infection, suggesting that glycosphingolipid synthesis and metabolism may be closely associated with HBV.

Efficacy and safety of yimitasvir phospha combined with sofosbuvir in patients with chronic hepatitis C virus infection / 中华传染病杂志

Objective To assess the efficacy and safety of 100 mg or 200 mg yimitasvir phosphate combined with sofosbuvir in patients with non-cirrhotic chronic hepatitis C virus ( HCV) genotype 1 infection who were treatment-na?ve or had a virologic failure to prior interferon-based treatment.Methods A multicenter, randomized, open-label, phase 2 clinical trial was conducted.The patients were randomly assigned to yimitasvir phosphate 100 mg+sofosbuvir 400 mg group (Group 100 mg) and yimitasvir phosphate 200 mg+sofosbuvir 400 mg group ( Group 200 mg) in a 1∶1 ratio with the stratified factors of " treatment-naive" or"treatment-experienced" for 12 weeks and followed up for 24 weeks after the end of treatment.During the clinical trial, HCV RNA was tested in all patients.Resistance of virus in patients who didn′t achieved sustained virological response (SVR) was monitored.Safety and tolerability were assessed by monitoring adverse events , physical examination , laboratory examination, electrocardiogram, and vital signs during the study.The primary end point was SVR12 after the end of therapy.Descriptive statistics were used for categorical variables and eight descriptive statistics were used for continuous variables.Descriptive statistics were used and summarized according to HCV genotypes and treatment groups.Safety data were presented using descriptive statistics and summarized according to treatment groups.Results A total of 174 subjects were screened from July 31, 2017 to September 26, 2018.One hundred and twenty-nine patients were successfully enrolled and received treatment , and 127 completed the study.There were 64 patients and 65 patients assigned to Group 100 mg and Group 200 mg, respectively.Among the 129 patients who underwent randomization and were treated , 18.6% were treatment-experienced and: 100%were HCV genotype 1b infection.The total SVR rate was 98.4%(127／129), with 98.4%(63／64, 95%confidence interval [CI]: 91.60%-99.96%) in the Group 100 mg, and 98.50%(64／65, 95%CI: 91.72%-99.96%) in the Group 200 mg.There was no significant difference between the two groups (χ2 ＝0.000 2, P＝0.989 2).The SVR rates in treatment-naive group and treatment-experienced group were 98.10%(95%CI: 93.29%-99.77%) and 100.00%(24／24, 95%CI: 85.75%-100.00%), respectively.Virological failure during treatment ( including breakthrough , rebound and poor efficacy) and relapse after treatment did not occur during the trial.By Sanger sequencing , 11.6%(15／129) patients had baseline NS5A Y93H／Y or Y93H resistance-associated substitutions ( RAS), 1.6%( 2／129) patients had baseline NS5A L31M RAS.No mutation was observed in NS5B S282 at baseline.There was no S282 mutation in HCV NS5B.A total of 100 (77.5%) subjects had adverse events.No adverse events ≥Grade 3 or severe adverse events related to the study treatment.No patient prematurely discontinued study treatment owing to an adverse event.No life-threatening adverse event was reported.Conclusion Twelve weeks of yimitasvir phosphate 100 mg or 200 mg combined with sofosbuvir 400 mg daily is a highly effective and safe regimen for patients without cirrhosis with HCV genotype 1b infection who had not been treated previously or had a virologic failure to prior interferon-based treatment.

A phase II, single-arm, open-label, multicenter clinical study to evaluate the efficacy and safety of sofosbuvir combined with ribavirin in patients with genotype 2 chronic hepatitis C virus infection / 中华肝脏病杂志

Objective@#To evaluate the efficacy and safety of sofosbuvir (Nanjing Zhengda Tianqing Pharmaceutical Co., Ltd.) combined with ribavirin in patients with genotype 2 chronic hepatitis C virus infection.@*Methods@#Treatment-naïve or treatment experienced genotype 2 chronic hepatitis C patients from sixteen research centers of China were screened. All subjects received once-daily dose of sofosbuvir (400 mg) combined with ribavirin (body weight < 75 kg, 1 000 mg/day, 400 mg in the morning and 600 mg in the evening; body weight > 75 kg, 1 200 mg/d, 600 mg in the morning and 600 mg in the evening) for 12 weeks. Patients were followed-up for a period of 12 weeks after discontinuation of treatment. Continuous variables were expressed as mean ± standard deviation. The proportion of subjects with virologic response at different follow-up time points and 95% confidence intervals were estimated by maximum likelihood ratio and Clopper-Pearson interval.@*Results@#132 cases with genotype 2 chronic hepatitis C virus infection from sixteen research centers of China were included, 12 cases of whom were associated with cirrhosis, and the remaining 120 cases were not associated with cirrhosis. One hundred and thirty-one cases completed the study, and one patient lost to follow-up at week 4 after the end of treatment. The sustained virological response rate was 96.2% (95% confidence interval: 92.37% - 99.16%) after 12 weeks of drug withdrawal. Virological relapse occurred in four cases. Of the 132 subjects enrolled in the study, 119 (90.2%) reported 617 adverse events during treatment, of which 359 (76.5%) were TEAE related to sofosbuvir and/or ribavirin. There were nine TEAEs of grade 3 and above, and six cases (4.5%) of them had six severe adverse events. Only one serious adverse event was associated with sofosbuvir and ribavirin (unstable angina pectoris). There were no adverse events leading to drug discontinuation or death.@*Conclusion@#Sofosbuvir combined with ribavirin has a high SVR rate in the treatment of genotype 2 chronic hepatitis C virus infection, and most of the adverse events occurred were mild with acceptable safety profile.

Research advances in portal hypertension in patients with nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease (NAFLD) is often complicated by clinically significant portal hypertension (PHT) during its progression to liver cirrhosis, which is primarily caused by increased intrahepatic vascular resistance. The pathogenesis of PHT in NAFLD remains unclear. This article summarizes the current research status of PHT in NAFLD and related cellular and molecular mechanisms in the development of PHT, in order to provide a theoretical basis for novel preventive and therapeutic strategies for NAFLD.

Effects of hepatitis B virus on liver function, liver fibrosis and liver pathological staging at different ALT stages / 西安交通大学学报(医学版)

Objective To evaluate the effects of hepatitis B virus on liver function,liver fibrosis,and liver pathological staging at different immune stages.Methods We made a retrospective analysis of 657 patients with chronic hepatitis B diagnosed in the First Hospital of Lanzhou University.Their liver function parameters,liver fibrosis parameters,and hepatitis B virus load were measured by automatic biochemical analyzer,automatic gammaradiation immunity analyzer,and quantitative PCR analyzer,respectively.Effects of hepatitis B virus on liver function,liver fibrosis in different immune stages were analyzed by variance analysis.Effects of hepatitis B virus on liver pathological staging at different immune stages were analyzed by linear trend chi square test analysis.Results In ALT normal chronic hepatitis B patients group,viral load had mild effects on liver function and liver fibrosis parameters.However,in ALT abnormal chronic hepatitis B patients group,viral load had a significant effect on liver function and liver fibrosis parameters,and the effect was most obvious in ALT＞double upper limit of normal group.The specific manifestation was that with viral load increasing,liver function parameters including ALT,AST,TBiL,DBiL,and IBiL increased,while TP and ALB decreased.Liver fibrosis parameters HA,LN,PcⅢ,and CIV all increased (P＜0.05).In ALT normal chronic hepatitis B patients group,viral load had no relationship with liver pathological staging.However,in ALT abnormal chronic hepatitis B patients group,especially ALT≥double upper limit of normal group,viral load was significantly related to liver pathological staging.Conclusion The effects of hepatitis B virus on patients' liver function at different immune stages were different,thus providing evidence-based medicine support for clinical antiviral treatment.

Recent research on association between gene polymorphisms of IL-28B and other cytokines and HCV infection / 临床肝胆病杂志

It has been confirmed that the body′s response to hepatitis C virus (HCV) is not only associated with virus, but also associated with some cytokines and their gene polymorphisms. In this paper, the current research on some cytokines associated with HCV and their gene polymorphisms is reviewed. And it is shown that interleukin-28B is closely associated with the course and prognosis of chronic hepatitis C (CHC). Therefore, it is of great significance for the clinical diagnosis and treatment of CHC to investigate host cytokines and their gene polymorphisms.

Analysis of factors influencing hepatitis C with thyroid dysfunction in Chinese patients / 临床肝胆病杂志

ObjectiveTo explore the influencing factors for chronic hepatitis C (CHC) with thyroid dysfunction (TD) in untreated Chinese patients and provide evidence for clinical individualized treatment. MethodsOne thousand and twelve untreated CHC patients were collected nationwide in China. Thyroid function and associated influencing factors (region, age, gender, and hepatitis C virus (HCV) RNA replication level) in the patients were investigated. The relationships between the influencing factors and CHC with TD were analyzed. Between-group comparison of categorical data was performed by χ2 test and Fisher′s exact test. ResultsThere were geographical differences between different types of CHC with TD. Across different regions, the incidence of TD was highest in north and northwest China, i.e., 28.3% and 26.5%, respectively. Subclinical hypothyroidism was the most common type of TD, accounting for 58.8% of the total TD cases. Middle-aged patients were most common among the cases of CHC with TD (44.0%), who had a significantly higher incidence of hypothyroidism than other age groups (χ2=1010、617, P=0.001、0013). Females with CHC had a significantly higher incidence of TD than male patients (58.9% vs. 41.1%, χ2=13.1, P=0.00). Although a high HCV RNA replication level was most common in Chinese patients with CHC, this factor had little influence on TD. ConclusionIn China, CHC with TD is influenced by geographic distribution, gender, and age, but less associated with HCV RNA replication level.

Investigation of impairment of liver function in local residents of Miaofeng Village, Wushan County, China / 临床肝胆病杂志

ObjectiveTo assess the impairment of liver function and investigate possible causes in local residents in Miaofeng Village, Mali Town, Wushan County, Gansu Province, China, and to provide a basis for the etiological study of idiopathic liver damage. MethodsThe residents in Miaofeng Village were screened for liver function and an epidemiological study was conducted. Serological testing was performed for those with abnormal screening results. Trace elements in drinking water and soil such as arsenic, chromium, and selenium were also tested. ResultsOf all residents, 23.8% and 10.7% showed abnormal levels of alanine aminotransferase and aspartate aminotransferase, respectively. Positivity of HBsAg was detected in 11 cases, fatty liver was identified in 3 cases, and absence of selenium in soil was also confirmed. ConclusionA proportion of local residents in Miaofeng Village have impaired liver function and the absence of selenium in soil may be a contributing factor to this phenomenon.

Effects of PARP-1 inhibitors AG-014699 and AZD2281 on proliferation and apoptosis of human hepatoma cell line HepG2 / 临床肝胆病杂志

ObjectiveTo observe the inhibitory and pro-apoptotic effects of two poly(ADP-ribose) polymerase (PARP-1) inhibitors, AG-014699 and AZD2281, on human hepatoma HepG2 cells and preliminarily explore the mechanism by which AG-014699 induces HepG2 cell apoptosis, and to provide a new therapeutic target for hepatoma. MethodsThe effects of different concentrations of AG-014699 and AZD2281 on HepG2 cell proliferation were determined by MTT assay. The cell apoptosis rate was measured by flow cytometry. The expression levels of caspase-3 and caspase-8 were measured by Western Blot. Inter-group comparison was made by t test. ResultsBoth AG-014699 and AZD2281 suppressed HepG2 cell proliferation in a time- and dose-dependent manner. However, the sensitivity of HepG2 cells to the two PARP-1 inhibitors was different. The half-maximal inhibitory concentrations of AG-014699 and AZD2281 at 48 h determined by MTT assay were about 20 μmol/L and 400 μmol/L, respectively. Flow cytometry and Western blot were not used to evaluate the apoptosis of HepG2 cells exposed to AZD2281 to which these cells were not sensitive. HepG2 cell apoptosis could be induced by 10, 30, and 50 μmol/L AG-014699, and the highest apoptosis rate at 48 h was significantly higher than that of the control group (3100%±2.13% vs 09%±0013%, P＜0.01). Compared with those in the control group, the protein levels of caspase-3 and caspase-8 in HepG2 cells after 48-h exposure to 30, and 50 μmol/L AG-014699 increased. ConclusionThe two PARP-1 inhibitors AG-014699 and AZD2281 can inhibit the proliferation of HepG2 cells, which showed different sensitivities to the two inhibitors. AG-014699 can induce HepG2 cell apoptosis by up-regulating the protein expression of caspase-3 and caspase-8.

Association of hepatitis C virus genotype with glycolipid iron metabolism in Gansu Han population / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the association of hepatitis C virus (HCV) genotype with glycolipids iron metabolism in Gansu Han population.</p><p><b>METHODS</b>The genotypes of HCV 1b type and 2a type were detected in Gansu Han HCV carriers. The Glu, Insulin, CHOL, TG, UIBC, TRF, TIBC, SF, Serum Iron, AST, ALT, TBil, IBil, DBil, ALP, GGT were measured and compared between patients with different HCV genotypes.</p><p><b>RESULTS</b>There were 84 cases with HCV1b type and 136 cases with 2a type. There were significant differences in TG, ALT, TRF, TIBC between 1b type and 2a type genotype HCV carriers.</p><p><b>CONCLUSION</b>The 2a type HCV carriers may be more inclined to develop hyperlipidemia and liver damage, and 1b type HCV carriers are likely to have iron metabolism defect.</p>

Hepatocyte growth factor and epidermal growth factor induce mesenchymal stem cells isolated from patients with hepatocirrhosis into hepatocyte-like cells in vitro / 第三军医大学学报

Objective To explore the possibility of differentiation of mesenchymal stem cells isolated from patients with hepatocirrhosis into hepatocyte-like cells induced by EGF and HGF and to lay basis for transplanted autologous bone marrow MSCs in treatment of liver disease at terminal stage.Methods Bone marrow cells were obtained from volunteers with liver cirrhosis.MSCs were separated by density gradient centrifugation and were cultured through adhere culture.MSCs were cultured in DMEM medium with HGF,EGF,HGF+EGF or no growth factor.The phenotypes of MSCs were identified by flow cytometry,immunohistochemistry,and Albumin levels in culture supernatants were determined by ELISA.Results Growth and division of adherent cells obtained from the patients with hepatocirrhosis were good and the phenotypes of MSCs were CD29 positive and CD34 negative.The shape of MSCs changed from long fusiform to polygonal or round on 21th-28th days in grow factor induced groups.Immunocytochemical analysis for CK18 and AFP showed positive staining reaction for AFP on 7th day,for CK18 on 21st and 28th day in grow factor induced groups with MSCs-induced Alb production increasing in a time-dependent manner.No markers of hepatocyte linear cells were detected in no growth factor induction group.Conclusion Both HGF and EGF can induce mesenchymal stem cells to differentiate hepatocyte-like cells alone or coordinately.