Table of Content

05 July 2016, Volume 31 Issue 7

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Functional cure of chronic hepatitis B: current status and perspectives

Shen Chuan1， Wang Jing2， Zhao Caiyan1， Zhang Wenhong2

2016, 31(7):  697-700.  doi:10.3969/j.issn.1004-583X.2016.07.001

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Treatment of chronic hepatitis B (CHB) with nucleos(t)ide  analogs (NA) and interferonα (IFNα) can lead to a significant suppression of viral replication， as well as reduced risk of disease progression and hepatocellular carcinoma. However， challenge remains regarding curing CHB because hepatic covalently closed circular DNA can not be completely eradicated. Discovering new drugs targeted hepatitis B virus may enable the possibility of functional curing CHB in future. Among available therapeutic strategies， switching to or sequential combination with IFNα in patients with longterm NA treatment can induce increased percentages of responses， even make the likelihood of functional cure in a proportion of patients.

2015 Chinese Practice Guidelines of Chronic Hepatitis B: an update

Li Jun，Han Tao

2016, 31(7):  701-704.  doi:10.3969/j.issn.1004-583X.2016.07.002

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As the researches home and abroad progress， the 2015 edition of Chinese Clinical Practice Guidelines: Prevention and Management of Chronic Hepatitis B  was published in the 17th national conference on viral hepatitis and liver disease of Chinese Medical Association. With clear concept， the content refinement， summarization of the epidemiology， pathogenesis， noninvasive diagnosis of liver fibrosis， new guidelines highlight the importance of antiviral therapy and give detailed recommendations including in special populations， as well as point out the direction prevention and management of the chronic hepatitis B in the future. In a word， the publication of the new guidelines will help further standardize and improve the level of hepatitis B prevention and management in China.


Related issues of  antiviral treatment of chronic hepatitis B patients during fertile period

Sun Hui，Zhao Caiyan

2016, 31(7):  705-709.  doi:10.3969/j.issn.1004-583X.2016.07.003

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The related issues of the antiviral treatment of chronic hepatitis B patients during fertile period get wide attention. This review will focus on the following aspects:the choice of the timing of pregnancy during fertile period， pregnancy testing and antiviral therapy， mothertoinfant transmission blocking in HBV infection， breast feeding and follow up.We hope to  standardize and optimize the process of clinical diagnosis and treatment  by providing clinicians with detailed and reliable treatment guidance.


Progression of diagnosis and treatment in portal hypertension

Shang Jia， Li Wei

2016, 31(7):  710-712.  doi:10.3969/j.issn.1004-583X.2016.07.004

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Portal hypertension is a serious clinical syndrome caused by the increasing portal vein resistance and blood flowing， and the difficulty of its clinical treatment is due to a series of serious complications， such as esophageal varices， splenomegaly， ascites， etc. In recent years， as the new evidencebased medical evidence on diagnosis and treatment of portal hypertension appear constantly， clinical guidelines or consensus have also been updated， making treatment more standardized.

Drug induced liver injury

Ren Meixin，Meng Qinghua

2016, 31(7):  713-716.  doi:10.3969/j.issn.1004-583X.2016.07.005

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Drug induced liver injury (DILI) is one of the important causes of liver disease. With more and more types of drugs are used widely， the incidence of DILI  raiseds  year by year， which has become a serious public health problem. Therefore， it is very important to understand the etiology， pathogenesis， clinical features， diagnosis and treatment of DILI. This paper makes a brief summary of some research progress.

The clinical application of artificial liver support system

Chen Yu，Li Shuang

2016, 31(7):  717-722.  doi:10.3969/j.issn.1004-583X.2016.07.006

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The main treatment strategies for liver failure include drug therapy， artificial liver support system and liver transplantation etc. At present， non biological artificial liver， including plasma exchange， plasma diafiltration， hemoperfusiuon， molecular adsorbent recirculating system(MARS) and Prometheus are commonly used in clinical treatment， and the therapeutic effect is discussed. In addition， the progress of bioartificial liver in recent years， and the construction of a new artificial liver are summarized. The problems and new trends of artificial liver are also summarized.

Pathogenesis in alcoholic liver disease

Li Yuanyuan， Hua Yanfang， Zhou Junying

2016, 31(7):  723-726.  doi:10.3969/j.issn.1004-583X.2016.07.007

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Alcoholic liver disease (ALD) is a chronic disease caused by chronic alcohol abuse，and its histological spectrum ranges from hepatic steatosis， steatohepatitis， fibrosis， and ultimately to cirrhosis. Due to the incomplete understanding of pathogenesis， little progress has been made in ALD treatment. So， we attempt to discuss the effects of oxidative stress， endoplasmic reticulum stress，nitrative stress and  lipid regulators in the pathogenesis of ALD.

Directacting antiviral agents in hepatitis C virus infection

Cui Po， Kong Li， Zhao Suxian

2016, 31(7):  727-731.  doi:10.3969/j.issn.1004-583X.2016.07.008

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Hepatitis C virus (HCV) infection is one of the global public health problem， and the eradication of infection is the most important goal in HCV therapy. In recent years， directacting antiviral agents(DAA) develop quickly. Due to the better safety and tolerability in therapy for HCV infection， these new agents are used generally in many countries. This review aims at  the recent advances of DAA in characteristics， resistance and current optimal management for HCV various genotypes in patients with HCV infections.

Characteristics of plasma amino acids in patients with HBVrelated chronic hepatitis， cirrhosis and acute on chronic liver failure

Kong Ming， Shi Hongbo， Bai Li， Yao Jia， Chen Yu， Duan Zhongping

2016, 31(7):  732-735,740.  doi:10.3969/j.issn.1004-583X.2016.07.009

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Objective To observe the characteristics of plasma amino acids in patients with HBVrelated chronic liver disease， and to investigate the relationship between plasma amino acids with the severity of liver disease and to guide the targeting management for the patients. Methods The level of plasma amino acids， liver function， serum NH3 were measured in 35 cases of HBVrelated chronic liver disease and 10 healthy controls were tested as well. The characteristics of amino acid spectrum， especially the changes of citrulline， ornithine and ammonia were analyzed. Results There was no obvious imbalance of plasma amino acids for most of the patients with chronic hepatitis B. But the blood level of aromatic amino acid increased gradually as the disease moved to cirrhosis and liver failure. At the same time， branched chain amino acids / aromatic amino acids ratio decreased significantly. Comparing with the normal control， the blood levels of ornithine， citrulline and NH3 in patients with HBVrelated liver disease increased gradually. Conclusion Plasma amino acids levels may reflect the state of amino acid metabolism in patients with chronic HBVrelated liver disease. Branched chain amino acids / aromatic amino acids ratio， ornithine and citrulline levels may have some value in assessing the disease severity， predicting the  hepatic encephalopathy and guiding the clinical treatment for the liver patients.

Role of peripheral blood lymphocyte to monocyte ratio during preliminary diagnosis in prognosis assessment  of patients with nonHodgkin lymphoma

Cai Chunying1， Sun Lixia2， Lu Hongyan2

2016, 31(7):  736-740.  doi:10.3969/j.issn.1004-583X.2016.07.010

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Objective To  investigate the effects of lymphocyte to monocyte ratio (LMR) on prognosis assessment of patients with nonHodgkin lymphoma (NHL). Methods Fiftysix patients were enrolled and classified into two groups according to the median value (2.17) of LMR. Multivariate analysis was used to evaluate the association of age， gender， international prognostic index (IPI)， and absolute value of cell subsets in peripheral blood with progress free survival (PFS) and overall survival (OS). Results The two year probabilities of PFS and OS were （55.7±7.7）%  and  （76.1±6.4）%， respectively. Multivariate analysis showed that LMR was associated with PFS (HR=0.167，95%CI=0.0560.503，P=0.001). Factors associated with OS included LMR (HR=0.120，95%CI=0.0140.998，P=0.050) and IPI (HR=4.763， 95%CI=0.98223.114，P=0.053). Conclusion Our results suggested that LMR is a simple  and feasible biomarker during preliminary diagnosis that could be used to predict clinical outcomes of patients with nonHodgkin lymphoma.


Association study between genetic polymorphism in CNOT6 and risk of gastric cancer

Xiong Fang

2016, 31(7):  741-744.  doi:10.3969/j.issn.1004-583X.2016.07.011

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Objective To explore the association between the 3'UTR +3908 C>T polymorphism of CNOT6 and susceptibility to gastric cancer in Han population. Methods The casecontrol study consisted of 960 patients with histopathologically verified primary gastric adenocarcinoma and age  and sexmatched healthy 972 controls in Chinese Han. The genotypes were determined by polymerase chain reactionbased restriction fragment length polymorphism (PCRRFLP). The associations between genotype and risk of developing gastric cancer were estimated by calculating the odds ratio (OR) and the 95% confidence interval (95% CI) with logistic regression models. Results For rs10069， subjects with TT/CT genotype had a decreased risk for developing gastric cancer  compared with CC genotype(OR=0.74; 95%CI=0.600.93). The association was more pronounced among individuals with <56 years of age. Moreover， a multiplicative joint effect between the CNOT6 SNP and Helicobacter pylori infection that intensified the risk was observed (OR for the presence of both CC genotype and H. pylori infection=2.32; 95%CI=1.413.82). No significant association was observed between the polymorphism and stage and grade of the cancer. Conclusion The +3908 C>T polymorphism of CNOT6 is associated with susceptibility to gastric cancer.

Effect of stressinduced hyperglycemia on myocardial perfusion and prognosis in elderly patients  with acute myocardial infarction undergoing primary percutaneous coronary intervention

Wang Hong， Ma Xiaofeng， Deng Yong

2016, 31(7):  745-747,752.  doi:10.3969/j.issn.1004-583X.2016.07.012

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Objective To investigate the effect of stressinduced hyperglycemia（SHG）on myocardial perfusion and clinical prognosis in elderly patients with acute myocardial infarction（AMI）  who underwent primary percutaneous coronary intervention（PCI）. Methods A total of 459 elderly patients with firsttime occurrence of acute STelevation myocardial infarction（STEMI）  who underwent primary PCI within 12 hours were enrolled and followed up.All patients were divided into three groups according to serum glucose（SG）  on admission：normal group（SG＜7.0  mmol/L，n=148）；SG elevation group（7.0 mmol/L≤SG≤11.1 mmol/L，n=169） and （steady high blood glucose）SHG group（SG＞11.1 mmol/L，n=142）.Myocardial perfusion indexes，including ST segment resolution（STR），TIMI myocardial perfusion grade（TMPG），peak value of creatine kinase CKMB，left ventricular ejection（LVEF），and major adverse cardiac events（MACE） of patients in three groups  were measured and compared after emergency PCI.Results  The sa levels were increased，STelevation 2 h after PCI were well declined，the percentages of patients with TMPG 23 were decreased and peak values of CKMB were increased in three groups（all P＜0.05）.After 12 months’  followup，KaplanMeier survival analysis showed that patients of three groups had significantly different cumulative nonevents survival rates，89.2％（132/148）vs 85.8％（145/169），76.1％（108/142）(P＜0.05).Muhivariate Cox regression analysis showed that steady high sa were the independent predictor for the occurrence of MACE in patients undergoing PCI after adjusting for age and gender. Conclusion SHG in elderly patients with STEMI can decrease myocardial perfusion level after primary PCI，which will lead to high incidence of MACE.

Curative effect of applying tirofiban before primary percutaneons coronary interventin in patients  with ST segment elevation myocardial infarction suffering no/slow reflow phenomenon

Tian Cuiyan1，Han Qiong2，Chen Shutao3，Feng Jinping3

2016, 31(7):  748-752.  doi:10.3969/j.issn.1004-583X.2016.07.013

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Objective To investigate the curative effect and the security of applying tirofiban before primary percutaneous coronary intervention (PCI) in patients with ST segment elevation myocardial infarction (STEMI) suffering no/slow reflow phenomenon. Methods A total of 296 patients with STEMI were selected into this study. All patients underwent primary PCI and applied tirofiban by intravenous route. According to the different mediction time of the tirofiban， all patients were divided into preoperative treatment group and intraoperative treatment group.  Blood flow condition of the infarction related artery (IRA) of preoperation and postoperation， postoperative left ventricular ejection fraction (LVEF)， the incidence of major adverse cardiovascular events (MACE) bleeding and serious thrombopenia (PLT<10×109/L)  during hospitalization were analysed in both groups. Results The ratio of TIMI 3 of IRA in preoperative treatment group was significantly higher than those of intraoperative treatment group in preoperation (74.7% vs 47.2%，P<0.05) and postoperation (98.9% vs 93.2%，P<0.05). The postoperative left ventricular ejection fraction was significantly higher in preoperative treatment group than in intraoperative treatment group (58.31±5.35)%  vs  (52.93±6.01)%(P<0.05). There were no significant difference in the incidence of MACE， bleeding and serious thrombopenia during hospitalization in both groups. Conclusion Preoperative tirofiban treatment can reduce the incidence of no and slow reflow phenomenon and protect the heart function， additionally， preoperative tirofiban does not increase the incidence of postoperative bleeding in patients with STEMI.

Psychiatric and affective symptoms in patients with corpus callosum infarction: seven case reports and review of literature

Han Yangtong， Guo Xiaolei， Yan Xin， Hu Hongtao

2016, 31(7):  753-757.  doi:10.3969/j.issn.1004-583X.2016.07.014

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Objective  To investigate the clinical and neuroimaging features in patients with corpus callosum infarction who presented psychiatric and affective symptoms. Methods Patients with corpus callosum infarction were examined with neuropsychiatric inventory， hamilton anxiety scale and hamilton depression rating scale for depression. All patients were performed with cranial magnetic resonance imaging.Results The study included seven patients who presented psychiatric and affective symptoms. The infarction location of two patients lied in the genu part of corpus callosum， two patients in the genu and body parts of corpus callosum， two patients in the body part of corpus callosum and one patient in the body and splenium of corpus callosum. Three patients showed abnormal behaviors， four patients showed irritability， two patients showed agitation， two patients showed delusion and one patient showed hallucination. Conclusion Corpus callosum infarction should be taken into consideration in patients with risk factors of cerebral vascular diseases who presented acute psychiatric and affective symptoms， cranial magnetic resonance imaging should be early performed to avoid delay in treatment.

Detection significance of AchR antibody， Titin antibody and MuSK antibody in myasthenia gravis combined with thymic lesion

Liu Lanjian， Yang Wenjuan

2016, 31(7):  758-761.  doi:10.3969/j.issn.1004-583X.2016.07.015

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Objective  To explore the significance of AchR antibody， Titin antibody and MuSK antibody in myasthenia gravis patients combined with thymic lesion. Methods  A total 80 cases of myasthenia gravis patients treated in our hospital were selected. They were divided into thymic lesion group(n=48) and nothymic lesion group(n=32). Another 80 cases of healthy individuals were selected as control group. The positive rates of AchR antibody， Titin antibody and MuSK antibody were compared among three groups and different Osserman types. Results  The positive rates of AchR antibody and Titin antibody of myasthenia gravis group(76.3%，52.5%) were higher than those of control group(11.3%，5.0%)(P<0.05). The positive rates of MuSK antibody of two groups were 0， but the level of myasthenia gravis group was higher than that of control (P<0.05). The detection sensitivity of myasthenia gravis could be improved using AchR antibody and Titin antibody. The positive rates of AchR antibody and Titin antibody of thymic lesion group were higher than those of nothymic lesion group(P<0.05). The positive rates of AchR antibody and Titin antibody in generalized myasthenia gravis patients were higher than those in ocular myopathy myasthenia gravis patients(P<0.05). Conclusion  The positive rates of AchR antibody and Titin antibody were related to the illness of myasthenia gravis. It can improve the detection sensitivity of myasthenia gravis using AchR antibody and Titin antibody.

Association of COFNLR with clinicopathological characteristics and prognosis of patients with nonsmallcell lung cancer after curative resection

Li Yanhong， Guo Honghui， Li Xiaojiang， Pan Haiqin， Yao Shuyan， Ma Lan， Li Yun， Hao Yujie

2016, 31(7):  762-766.  doi:10.3969/j.issn.1004-583X.2016.07.016

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Objective  To analyze the combination of preoperative plasma levels of fibrinogen(Fbg) and neutrophiltolymphocyte ratio (COFNLR) with clinicopathologic characteristics as well as the prognosis of nonsmallcell lung cancer (NSCLC) patients after curative resection. Methods  The clinical data of 122 patients with NSCLC who underwent curative resection in our hospital were retrospectively analyzed. A total of  122 patients with NSCLC were divided into three groups based on the criteria of COFNLR: COFNLR 0 group， n=49; COFNLR1 group， n=41; COFNLR2 group， n=32.  The preoperative COFNLR was calculated by combing the fibrinogen and neutrophiltolymphocyte ratio (NLR). The relationship between the COFNLR and clinicopathological features was studied by chisquare test. The postoperative prognostic factors were analyzed using univariate KaplanMeier analysis and multivariate Cox proportional hazards model. Results  The COFNLR was significantly associated with sex， differentiation degrees， T staging， clinical staging（P<0.05）. Univariate analysis showed smoking history， differentiation degrees， T staging， lymph node metastasis， plasma levels of fibrinogen，NLR  and  COFNLR were associated with survival (P<0.05). Multivariate analysis identified that differentiation degrees， lymph node metastasis and COFNLR as independent prognostic factors of all the patients(all P<0.05).Conclusion  Preoperative elevated plasma level of COFNLR indicates tumor progression and poor prognosis in patients with NSCLC. The COFNLR may be a potentially new and useful blood marker for predicting tumor progression and the prognosis of patients with NSCLC.


Study on development of Willis ring in patients with ischemic cerebrovascular disease

Liu Shuxiang

2016, 31(7):  767-769.  doi:10.3969/j.issn.1004-583X.2016.07.017

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Objective  To investigate the development and variation of cerebral artery ring (Willis ring) in patients with cerebral vascular disease. Methods  MRA 3DTOP images of 100 patients with cerebral vascular disease were analyzed， and the variation and incidence of each artery were  analyzed and compared with the MRA 3DTOP images of 100 healthy people. Results  There was a large variation in Willis ring between two groups. Willis ring development complete rates of hospitalized patients and healthy checkup people were 13% and 25%， respectively. There was statistically significant difference between two groups (P<0.05). Conclusion  The incompleteness of Willis ring is closely related to the occurrence of cerebrovascular disease.

Predictive value of serum cystatin C in early evaluation of contrast induced nephropathy

Zhang Yao1， Tian Xiang2， Geng Wei2， Zhang Qi2， Zhen Libo2， Liu Qianmei2， Yang Ying2， Song Da2

2016, 31(7):  770-773,778.  doi:10.3969/j.issn.1004-583X.2016.07.018

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Objective  To evaluate of cystatin C (CysC) on the predictive value of contrast induced nephropathy(CIN) by comparing the changes  of creatinine(SCr) and CysC after coronary arteriography (CAG).Methods  Patients who underwent coronary angiography and/or percutaneous coronary intervention were enrolled. Serum  creatinine and CysC were monitored before angiography， 1 day， 2 days， 3 days after angiography. Glomerular filtration rate was estimated by MDRD. The primary end point was the incidence of CIN. Results  A total of 384 patients were enrolled  in this study， and 16 (4.17%) patients developed CIN according to the SCr criteria. Serum CysC was significantly higher at 1 day， 2 days，3 days after angiography (P＜0.05). The level of serum CysC was positively correlated with SCr level (r=0.313，P<0.01)， but negatively correlated with eGFR (r=-0.325，P<0.01). The area under ROC curve at 2 days after angiography was 0.833（95%CI=0.7440.992，P＜0.01）， better than 1 day and 3 days after angiography. The best cutoff point was 1.115 mg/L. The area under ROC curve of varying degrees at 2 days after angiography was 0.812（95%CI=0.8020.822，P＜0.01）  and the best cutoff point was 12.5%. Conclusion   As serum CysC could evaluate the renal function at early period，it could be   a sensitive biomarker to evaluate induced CIN. The accuracy of diagnosis CIN in CysC level 2 days after CAG was higher than that 1 day and 3 days after CAG. Moreover， ≥12.5%  increase can be used as a cutoff point in CIN diagnosis.


A metaanalysis of levetiracetam on prevention of recurrent febrile seizures in children

Xu Xiaonan1a， Dai Shanshan2， Song Pan3， Chen Yongqian1a，Liu Shurao4，Zhang Ni1b

2016, 31(7):  774-778.  doi:10.3969/j.issn.1004-583X.2016.07.019

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Objective  To systematically review the clinical efficacy and security of levetiracetam reducing the recurrence rate of febrile seizures. Methods  Databases such as PubMed， Cochrane Library， Embase， CBM， Wan fang Data， VIP and CNKI were searched  in levetiracetam as interventions in the treatment of febrile seizures from inception to March 20th， 2016. Literature screening， extracting data and evaluating methodological quality were independently performed by two reviewers. Metaanalysis was conducted using RevMan 5.2 software. Results  A total of 5 studies involving 475 patients were included. Metaanalysis showed that compared with conventional method of antifebrile， levetiracetam can significantly reduce the recurrence rate of febrile seizures than the conventional antifebrile method (RR=0.30， 95%CI［0.21，0.43］，P<0.01); but can not reduce the incidence rate of epilepsy (RR=1.11， 95%CI［0.26，4.79］，P=0.89); and can increase the incidence rate of adverse reactions (RR=4.36， 95%CI［1.01，18.76］，P=0.05). Conclusion  Levetiracetam can significantly reduce the recurrence rate of febrile seizures， and can not reduce the rate of epilepsy， but  increase the incidence of adverse reactions.