BACKGROUND:The impact of spontaneous portosystemic shunt (SPSS) on decompensated events and mortality for patients with hepatitis B-related cirrhosis remains poorly investigated. AIMS:To evaluate the prevalence, clinical characteristics, and outcomes of SPSS among patients with hepatitis B-related cirrhosis. METHODS:Patients who were diagnosed with hepatitis B-related cirrhosis were retrospectively recruited. All eligible patients were classified into SPSS and non-SPSS groups and their clinical characteristics and outcomes were compared and analyzed. RESULTS:Of the 1282 patients included in this study, SPSS was identified in 488 patients (38.1%). SPSS group had more severe liver function impairment, higher prevalence and severity of esophageal and gastric varices (EGV), and a higher prevalence of EGV bleeding (EGVB), portal vein thrombosis (PVT), hepatic encephalopathy (HE), ascites, and hepatocellular carcinoma (HCC, all P<0.05). During the follow-up period, SPSS group experienced a significantly higher incidence of EGVB, PVT, and HE (all P<0.05); however, there was no significant difference in the incidence of ascites, HCC, and mortality between the two groups (all P>0.05). CONCLUSION:With hepatitis B-related cirrhosis, SPSS was common and characterized by severe liver damage and a high prevalence of decompensated events. Moreover, patients with SPSS had higher risks of EGVB, PVT, and HE.

AbstractBackground and aim Patients with cirrhosis have a high prevalence of spontaneous portosystemic shunt (SPSS), but it remains controversial whether the presence of SPSS is associated with liver function and portal hypertension (PHT)-related complications. In this study, we aimed to investigate the prevalence, clinical characteristics and related factors of SPSS in cirrhotic patients. Methods Patients who were diagnosed with hepatitis B-related cirrhosis between Jan 2020 and Oct 2021 were retrospectively recruited from five centers in China. All eligible patients were classified into SPSS and non-SPSS groups and their clinical characteristics were compared. Logistic regression analyses were performed to identify clinical characteristics associated with SPSS, and then to assess the independent impact of SPSS on the risk of PHT-related complications. Results Of the 1282 patients included in this study, SPSS was identified in 488 patients (38.1%). SPSS group had a higher proportion of patients with hepatofugal flow in portal vein, thinner diameter of right branch of portal vein (RPV), thicker diameter of left branch of portal vein (LPV), splenic vein (SV) and superior mesenteric vein (SMV), more severe liver function impairment, higher incidence and severity of esophageal and gastric varices (EGV), and a higher prevalence of PHT-related complications [EGV bleeding (EGVB), portal vein thrombosis (PVT), hepatic encephalopathy (HE), ascites, and hepatocellular carcinoma (HCC)] (allP < 0.05). On multivariable logistic regression analyses, MELD score, diameter of RPV and SV, hepatofugal flow in portal vein, EV or GV or EGV on radiological evaluation, presence of EGVB, PVT, HE, and moderate–severe ascites were independently associated with SPSS (allP < 0.05). In addition, presence of SPSS was identified as an independent risk factor for EGVB, PVT and HE (allP < 0.05). Conclusion SPSS may indicate severe liver damage and a high risk of PHT-related complications.

BACKGROUND Microwave ablation (MWA) is an effective treatment option for patients with primary liver cancer. However, it has been reported that the MWA procedure induces a hepatic inflammatory response and injury, which may negatively affect the efficacy of MWA. As such, the discovery of reliable markers to monitor the patient’s response to MWA is needed. Golgi protein 73 (GP73) has been shown to be associated with chronic liver disease. To date, the potential value of serum GP73 in the dynamic monitoring during MWA of liver cancer remains unclear. AIM To examine the effects of MWA on the serum levels of GP73 in patients with primary liver cancer. METHODS A total of 150 primary liver cancer patients with a single small lesion (≤ 3 cm in diameter) were retrospectively enrolled spanning the period between January 2016 and October 2018. All of the patients received MWA for the treatment of primary liver cancer. Serum GP73, alpha-fetoprotein (AFP), and widely used liver biochemical indicators [serum albumin, total bilirubin (TBIL), alanine aminotransferase (ALT), and aspartate aminotransferase (AST)] were compared before MWA and at different time points, including 1, 2, and 4 wk following the ablation procedure. RESULTS Complete tumor ablation was achieved in 95.33% of the patients at 1 mo after MWA. The 1-, 2-, and 3-year disease-free survival rates were 74.67%, 59.33%, and 54.00%, respectively. The serum AFP levels were significantly decreased at 1, 2, and 4 wk after MWA; they returned to the normal range at 12 wk after MWA; and they remained stable thereafter during follow-up in those cases without recurrence. In contrast, the serum GP73 levels were significantly increased at 1 and 2 wk after MWA. The serum GP73 levels reached the peak at 2 wk after MWA, started to decline after hepatoprotective treatment with glycyrrhizin and reduced glutathione, and returned to the pretreatment levels at 12 and 24 wk after MWA. Notably, the changes of serum GP73 in response to MWA were similar to those of TBIL, ALT, and AST. CONCLUSION Serum GP73 is markedly increased in response to MWA of liver cancer. Thus, serum GP73 holds potential as a marker to monitor MWA-induced inflammatory liver injury in need of amelioration.

BACKGROUND:Acute-on-chronic liver failure (ACLF) is the abrupt exacerbation of declined hepatic function in patients with chronic liver disease.AIM:To explore the independent predictors of short-term prognosis in patients with hepatitis B virus (HBV)-related ACLF and to establish a predictive short-term prognosis model for HBV-related ACLF.METHODS:From January 2016 to December 2019, 207 patients with HBV-related ACLF attending the 910th Hospital of Chinese People's Liberation Army were continuously included in this retrospective study. Patients were stratified based on their survival status 3 mo after diagnosis. Information was collected regarding gender and age; coagulation function in terms of prothrombin time and international normalized ratio (INR); hematological profile in terms of neutrophil-to-lymphocyte ratio (NLR) and platelet count (PLT); blood biochemistry in terms of alanine aminotransferase, aspartate aminotransferase, total bilirubin (Tbil), albumin, cholinesterase, blood urea nitrogen (BUN), creatinine, blood glucose, and sodium (Na); tumor markers including alpha-fetoprotein (AFP) and Golgi protein 73 (GP73); virological indicators including HBV-DNA, HBsAg, HBeAg, Anti-HBe, and Anti-HBc; and complications including hepatic encephalopathy, hepatorenal syndrome, spontaneous peritonitis, gastrointestinal bleeding, and pulmonary infection.RESULTS:There were 157 and 50 patients in the survival and death categories, respectively. Univariate analysis revealed significant differences in age, PLT, Tbil, BUN, NLR, HBsAg, AFP, GP73, INR, stage of liver failure, classification of liver failure, and incidence of complications (pulmonary infection, hepatic encephalopathy, spontaneous bacterial peritonitis, and upper gastrointestinal bleeding) between the two groups (P < 0.05). GP73 [hazard ratio (HR): 1.009, 95% confidence interval (CI): 1.005-1.013, P = 0.000], middle stage of liver failure (HR: 5.056, 95%CI: 1.792-14.269, P = 0.002), late stage of liver failure (HR: 22.335, 95%CI: 8.544-58.388, P = 0.000), pulmonary infection (HR: 2.056, 95%CI: 1.145-3.690, P = 0.016), hepatorenal syndrome (HR: 6.847, 95%CI: 1.930-24.291, P = 0.003), and HBsAg (HR: 0.690, 95%CI: 0.524-0.908, P = 0.008) were independent risk factors for short-term prognosis in patients with HBV-related ACLF. Following binary logistics regression analysis, we arrived at the following formula for predicting short-term prognosis: Logit(P) = Ln(P/1-P) = 0.013 × (GP73 ng/mL) + 1.907 × (middle stage of liver failure) + 4.146 × (late stage of liver failure) + 0.734 × (pulmonary infection) + 22.320 × (hepatorenal syndrome) - 0.529 × (HBsAg) - 5.224. The predictive efficacy of the GP73-ACLF score was significantly better than that of the Model for End-Stage Liver Disease (MELD) and MELD-Na score models (P < 0.05).CONCLUSION:The stage of liver failure, presence of GP73, pulmonary infection, hepatorenal syndrome, and HBsAg are independent predictors of short-term prognosis in patients with HBV-related ACLF, and the GP73-ACLF model has good predictive value among these patients.

目的 比较经颈静脉肝内门体静脉分流术(TIPS)与TIPS联合胃冠状静脉栓塞术(GCVE)对肝硬化患者Child-Pugh评分的影响.方法 收集2014年3月至2017年3月我院34例TIPS肝硬化患者和24例TIPS联合GCVE肝硬化患者,收集术前和术后的Alb、TBil、PT、腹水及肝性脑病等数据,获得Child-Pugh,采用t检验或卡方检验进行统计分析.结果 TIPS组的Child-Pugh评分在术后第1、3个月与术前相比,差异有统计学意义(P<0.05),在术后6、12个月与术前相比差异无统计学意义(P>0.05),而TIPS联合GCVE组术后的1、3、6、12月的Child-Pugh评分与术前相比均差异无统计学意义(P>0.05).TIPS组的术后Child-Pugh评分为8.56±1.82、8.01±1.68、7.58±1.32、7.29±1.45,显著差于TIPS联合GCVE组的(7.53±1.91)、(7.16±1.34)、(6.69±1.57)、(6.08±1.21),(P<0.05).TIPS组术后总胆红素逐渐升高,在第1、3、6月分别为(38.1±10.5)μmol/L、(49.4±10.8)μmol/L和(52.3±11.7)μmol/L,显著高于术前的(26.7±8.6)μmol/L(分别为t=4.898,P<0.01;t=9.587,P<0.01;t=10.28,P<0.01),术后第12月TBil为(30.8±10.9)μmol/L与术前相比差异无统计学意义(t=1.722,P=0.089),而TIPS联合GCVE的TBil在术后第3、6、12月显著低于TIPS组(分别为t=6.187,P<0.01;t=7.006,P<0.01;t=3.958,P<0.01).TIPS组术后凝血酶原时间(PT)逐渐升高,与术前相比均差异有统计学意义(均P<0.01),TIPS联合GCVE在术后第3、6、12月的PT显著优于TIPS组(分别为t=2.082,P=0.042;t=3.137,P<0.01;t=2.04,P=0.046).结论 TIPS联合GCVE对肝硬化患者术后Child-Pugh评分较单纯T IPS组恢复快.

As a noninvasive marker, serum alanine aminotransferase (ALT) has limitations, because a large proportion of patients chronically infected with hepatitis B virus (HBV) suffer from severe hepatic necroinflammation, but have normal or mildly elevated ALT. In the present study, we aimed to investigate the potential value of serum Golgi protein 73 (GP73) in predicting significant hepatic necroinflamation among chronic HBV infected patients. A cohort of 497 chronic HBV infected patients was retrospectively recruited. Liver biopsy was performed in all patients and serum GP73 levels were measured by enzyme-linked immunosorbent assay. Serum GP73 increased in parallel with the increase in hepatic necroinflammatory activity grade (r = 0.682) and the stage of liver fibrosis (r = 0.539). The positive correlation of serum GP73 with the degree of hepatic necroinflammatory activity was statistically significant, while serum GP73 with the stage of liver fibrosis was weaker than that with hepatic necroinflammation. Furthermore, serum GP73 levels were significantly greater in patients with normal or mildly elevated ALT and significant hepatic necroinflammation (≥G2) than in patients with minimal to mild hepatic necroinflammation. The sensitivity and specificity of GP73 for the diagnosis of G2 hepatic necroinflammation was 42.35% and 95.0%, respectively, at a cut-off value of 88.38 ng/mL. When the cut-off value was set at 124.76 ng/mL, the sensitivity and specificity of GP73 for the diagnosis of G3 hepatic necroinflammation was 55.56% and 97.29%, respectively. These findings indicate that GP73 holds promise as an important candidate for diagnosing significant hepatic necroinflammation.

Objective To investigate the serum Golgi protein 73 (GP73) expression and the compensated stage of HBV-related decompensated cirrhosis ( HLC) in correlation of liver function of patients. Methods 150 patients of HBV-re-lated decompensated cirrhosis patients during January 2012 and March 2014 were selected. All patients were treated with ser-um ELISA, and enzyme-linked immunosorbent assay was used to detect GP73 levels in patients. According to the GP73 level, 150 patients were divided into high GP73 group (82. 50 μg/L), medium GP73 group (57. 98 ~ 82. 50 μg/L) and low GP73 group ( < 57. 98 μg/L). Serum alanine aminotransferase ( ALT), aspartic aminotransferase ( AST), and total bilirubin ( TBIL) level in the three groups were detected and compared. Correlation analysis of liver function and GP73 level in HLC patients was carred out. Results AST, TBIL level content of high GP73 patients were significantly higher than low-GP73 and medium-GP73 groups, AST, TBIL level content of medium GP73 groups were significantly higher than low-GP73 group, and the differences were statistically significant (P<0. 05). Serum GP73 levels of gradually increased with in crease of ALT, AST, TBIL content and ALT, AST, TBIL content showed a positive correlation ( r =0. 632, r =0. 646, r =0. 726; P<0. 001). There was no statistically significant difference of the HBV-DNA content in the three group (P>0. 05). Conclusion Serum GP73 level is closely related to liver damage of HLC patients. It is one of the important indicators in the diagnosis of HLC, but has nothing to do with the level of HBV replication.

Objective To investigate the expression characteristics of Treg,Tr1,and Th17 cells in the peripheral blood of patients with chronic hepatitis B (CHB)and their correlations with the state of CHB.Methods A total of 40 patients with mild-to-moderate CHB and 40 patients with severe CHB who were admitted to The 180th Hospital of PLA from January 2013 to June 2014 were included into this study, and 40 healthy people with normal liver function were recruited as control group.Peripheral blood was collected from CHB patients and healthy controls,and then the percentages of Treg,Tr1,and Th17 cells in peripheral blood were determined by flow cytometry.The levels of Foxp3 mRNA and RORγt mRNA in serum were measured by real-time PCR,and the expression levels of TGF-β1,IL-10,and IL-17 were measured by ELISA.Comparison of continuous data between the groups was made by one-way ANOVA analysis and LSD-t test. Results (1)Compared with the control group,the two groups of CHB patients had significantly higher percentages of Tr1,Treg,and Th17 cells (P<0.05),and had significantly higher levels of Foxp3 mRNA and RORγt mRNA (P<0.05)and levels of TGF-β1,IL-10,and IL-17 (P<0.05),while the two groups of CHB patients had significantly lower Treg/Th17 ratio (P<0.05)and Foxp3/RORγt ratio (P<0.05)than the healthy controls.(2)The patients with severe CHB had significantly higher percentages of Treg,Tr1,and Th17 cells (P<0.05),and had significantly higher levels of Foxp3 mRNA and RORγt mRNA (P<0.05)and levels of TGF-β1,IL-10,and IL-17 (P<0.05),as compared with the patients with mild-to-moderate CHB,while the patients with severe CHB had significantly lower Treg/Th17 ratio (P<0.05)and Foxp3/RORγt ratio (P<0.05)than those with mild-to-moderate CHB.Conclusion The expression imbalance of Treg cells (especially Tr1 cells)and Th17 cells in CHB patients is positively correlated with the progression of the disease;therefore,it may be important to correct the expression imbalance of Treg cells and Th17 cells in the treatment of CHB.Meanwhile,monitoring the percentages of Treg cells (especially Tr1 cells)and Th17 cells is helpful for assessing the clinical outcomes of CHB patients and guiding the clinical treatment.