11 Liver and Biliary System

11 Liver and Biliary System

2015217 Investigation on the causes of increased hepatitis E cases reported in Guizhou province. ZHANG Qian（张倩），et al.Chin Dis Contr&Prev Center，Beijing 102206.Chin J Epidemiol 2015；36 （3）：228-231.

Objective To analyze cause of growing hepatitis E （HE）cases reported in Guizhou province，and probe into existing problems faced by medical institutions in diagnosis of clinical and laboratory-confirmed cases，for the purpose of improving the quality of HE surveil lance sys-tem.Methods Six hospitals reporting greater HE cases from 2007 to 2011 were pinpointed，whose reported cases rose suddenly in 2011.Such cases were investigated by means of impatient medical record review，results of laboratory test and clinician interview.Results 136 of the 354 reported HE cases investigated were found compliant with the diagnostic criteria of HE with an accordance rate of 38.42%.Difference of the HE diagnostic accordance rate among individual years，hospitals and reporting departments was statistically significant.Such rate of hospital reports was found to be the lowest in 2011，ranging from 0 to 18.18%respectively；HE cases reported by non-infectious departments accounted for 61.30%of total cases reported，with its accordance rate considerably below the infectious departments（8.29%）.HE positive cases and HE positive rate in 2011 were significantly higher than that of preceding years.Conclusion Such increase of reported HE cases in 2011 in the province was mostly attributable to more HE laboratory tests made by the hospitals，yet the accordance rates were lower than satisfactory.In this regard，the medical institutions in question were advised to enhance their competency training for HE diagnosis and case report quality.

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2015218 The correlation between interleukin-28B gene polymorphism and its antiviral efficacy in patients with chronic hepatitis C infection.LIU Liming（刘立明），et al.Clin Lab Center，302nd Hosp，PLA，Beijing 100039.Chin J Lab Med 2015；38（3）：155-158.

Objective To evaluate the association between IL-28B（rs12979860）polymorphism and antiviraltherapeutic effect by detecting the genotype of interleukin-28B（IL-28 B）in patients with hepatitis C（HCV）.Methods Of total 1153 HCV patients，303 diagnosed with CHC had been treated with pegylated interferon plus ribavirin for 24-48 weeks.IL-28B（rs12979860）was genotyped by two-color fluorescent TaqMan assay.Results Among 1153 patients，CC，CT and TT genotype frequencies of IL-28B rs12979860 are 83.26%，16.22%and 0.52% respectively.The results of HCV genotyping of 580 in 1153 cases，the frequencies of 1b，2a and their non-1b/ 2a type were 63.45%，35.00%and 1.55%respectively；In 303 CHC patients with clear medical history，the proportion of SVR was 71.98%in patients with CC genotype and 16.90%in those with either the CT or TT genotypes.Logistic regression model was adopted to analyze the association of rs12979860 with SVR while adjusting for age，gender，viral load and HCV GT factors.Populations carrying combined genotype（CT+TT）were making it harder to get SVR compared with those with CC genotype（OR，95%CI：11.10，5.35-23.04；P＜0.000 1）. The percentages of SVR in HVC patients with 1b and 2a genotypeare 48.02%and 81.19%respectively. There is a statistically significant difference between these subgroups（χ2=30.639，P＜0.000 1）.Conclusion IL-28B rs12979860 genotype is closely related to SVR in CHC patients.Patients with CC genotype have a higher virus sustained response rate than those carrying CT or TT genotype.The SNP，rs19979860，might be applied as a predictor of clinical antiviral efficacy in the furture.

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2015219 Inhibition of BMI-1 expression increases the sensitivity to doxorubicin in human hepatocellular carcinoma cells.LI Min（李敏），et al.Lab Center，1stHosp，ShanghaiJiaotongUniv，Shanghai 200160.Tumor 2015；35（3）：237-245.

Objective To study the effect of B cell-specific murine leukemia virus integration site-1（BMI-1）gene expression inhibited by RNA interference on doxorubicin （Dox）-resistance of hepatocellular carcinoma cells，and to explore its related molecular mechanism.Methods The Dox-resistant MHCC-97H cell line was established and named as 97H/Dox，while the parental MHCC-97H cell line（named as 97H）was used as the control.The drug-resistance，cell colony-forming capacity and invasive ability were measured by MTT method，cell colony formation assay and in vitro Transwell invasive experiment，respectively.The mRNA and protein levels of tumor-related genes were detected by real-time fluorescent quantitative-PCR（RFQ-PCR）and Western blotting. Then the small interference RNA（siRNA）targetingBMI-1 gene（BMI-1-siRNA）was transfected into 97H/Dox and 97H cells.After BMI-1 gene silencing，the changes of Dox-resistance of 97H/Dox and 97H cells were detected by MTT method，and the change of expressions of tumor-related proteins in 97H cells was detected by Western blotting.Results The 97H/Dox cell line had a stable multiple-drug resistance，and its colony formation capacity was higher than that of the control cell line 97H （P＜0.05）.The levels of BMI-1，ATP-binding cassette superfamily G member 2（ABCG2）and matrix metalloproteinase-2（MMP-2）were significantly increased in 97H/Dox cells compared with those in the control 97H cells（all P＜0.05）.Knock down of BMI-1 gene by siRNA significantly increased the sensitivity to Dox in 97H/ Dox and 97H cells（both P＜0.05），and resulted in a significant reduction of the expression levels of phospho-Akt（p-Akt），phospho-c-Jun N-terminal kinase（p-JNK）and ABCG2 in 97H cells（all P＜0.05）.Conclusion The upregulation of BMI-1 gene expression may be involved in the acquisition of Dox-resistance in hepatocellular carcinoma 97H cells.Inhibition of BMI-1 expression can enhance the sensitivity to Dox in hepatocellular carcinoma cells.Therefore，interfering the expression of BMI-1 gene may be a potential strategy for enhancing the response to chemotherapy in treatment of hepatocellular carcinoma.

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2015220 Impact of overweight on postoperative complications and oncological outcome after radical hepatectomy for metastatic colorectal cancer.WANG Hongwei（王宏伟），et al.Key Lab Carcinogene&Trans Res，1st Dept Hepatopancreatobil Surg，Peking Univ Cancer Hosp，Beijing 100142.Chin J Oncol 2015；37 （3）：200-203.

Objective To evaluate the correlation between overweight and postoperative complications and prognosis after radical hepatectomy for colorectal liver metastasis （CRLM）.Methods A total of 192 patients who underwent hepatectomy for colorectal liver metastases between January 2000 and March 2012 were eligible for the study. We retrospectively summarized their clinicopathological data，BMI index and postoperative complications，and investigated the relation between these data and complications and prognosis.Results Of the 192 patients，109 cases were classified as overweight with a BMI≥24 and 83 patients were classified as non-overweight with a BMI＜24.Seventy-five complications occurred in 68 of the 192 patients（35.4%）who underwent hepatectomy. Surgical complications（P=0.428），operation time（P= 0.837），and blood loss（P=0.272）were not statistically significantly associated with BMI.173 patients were included to analyze the influence of overweight on oncologic outcome.The median survival for the overweight patients was 59 months，while that of non-overweight patients was 31 months（P=0.016）.The overweight patients had a longer OS assessed by both univariate analysis（P=0.016）and multivariate analysis（P=0.031）. However，no statistical differences in disease-free survival（DFS）were detected between the overweight and nonoverweight groups（P=0.058）.Conclusion Overweight is not independently associated with an increasing complication rate.BMI does not significantly affect the CRLM-DFS，and high BMI patients might have a better overall survival.

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2015221 Diagnosis value of combined detection of serum golgi protein 73，desgamma carboxy prothrombin and α-fetoprotein in primary hepatic carcinoma.HUO Qun（霍群），et al.Dept Biochem，Guilin Med Univ，Guilin 541004.Natl Med J China 2015；95 （10）：757-760.

Objective To analyze the clinical value of the detection of serum desgamma carboxy prothrombin（DCP），golgi glycoprotein 73（GP73），heat-shock protein 70 （HSP70）in primary hepatic carcinoma（PHC）diagnosis.Methods Enzyme-linked immunosorbent assay and electrochemiluminescence immunoassay were used to detect the serum DCP，GP73，HSP70 and α-fetoprotein （AFP）levels in 35 PHC patients and 35 healthy controls.Results AFP，DCP and GP73 levels in PHC patients were 13.780（1.140-8 487.00）μg/L，3 213.953 （2.510-53 994.602）pg/ml and 76.838（ 24.500-232.875）ng/ml respectively，significantly higher than those in healthy controls［1.240（0.605-5.310）μg/L，104.610（0.000-4 138.770）pg/ml and 30.770 （16.343-87.453）ng/ml，U value were 134.50，258.00 and 168.00，all P＜0.01］；HSP70 could not be detected in any objects.The area under the ROC curve of DCP or GP73 was 0.789，0.863 respectively. The sensitivity and specificity to PHC diagnosis were 54.3%and 97.1%by DCP（2 939.4 pg/ml as cut-off value），85.7%and 74.3%by GP73（41.3 ng/ml as cut-off value），45.7%and 100%by AFP（20 μg/L as cut-off value）.In combined detection，the sensitivity，specificity and accuracy were 88.6%，74.3%，81.4% by GP73/AFP and 91.4%，71.4%，81.4%by GP73/ DCP/AFP.Conclusion GP73，DCP are new effective markers in the diagnosis of PHC，and the combined detection of GP73，DCP and AFP can improve the diagnosis value of PHC.

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2015222 Value of quantitative iodine-based material decomposition images with gemstone spectral CT imaging in the follow-up of patients with hepatocellular carcinoma after TACE treatment.XING Gusheng（邢古生），et al.Dept Diag Imaging，Cancer Instit，CAMS &PUMC，Beijing 100021.Chin J Oncol 2015；37（3）：208-212.

Objective To investigate the value of quantitative iodine-based material decomposition images with gemstone spectral CT imaging in the follow-up of patients with hepatocellular carcinoma（HCC）after transcatheter arterial chemoebolization（TACE）.Methods Consecutive 32 HCC patients with previous TACE treatment were included in this study.For the follow-up，arterial phase（AP）and venous phase（VP）dual-phase CT scans were performed with a single-source dual-energy CT scanner（Discovery CT 750HD，GE Healthcare）.Iodine concentrations were derived from iodine-based material-decomposition images in the liver parenchyma，tumors and coagulation necrosis（CN）areas.The iodine concentration difference（ICD）between the arterial-phase（AP）and venal-phase（VP）were quantitatively evaluated in different tissues.The lesion-to-normal parenchyma iodine concentration ratio（LNR）was calculated.ROC analysis was performed for the qualitative evaluation，and the area under ROC（Az）was calculated to represent the diagnostic ability of ICD and LNR.Results In all the 32 HCC patients，the region of interesting（ROI）for iodine concentrations included liver parenchyma（n=42），tumors（n= 28）and coagulation necrosis（n=24）.During the AP the iodine concentration of CNs（median value 0.088 μg/mm3）appeared significantly higher than that of the tumors（0.064 μg/mm3，P=0.022）and liver parenchyma（0.048 μg/mm3，P=0.005）.But it showed no significant difference between liver parenchyma and tumors （P=0.454）.During the VP the iodine concentration in hepatic parenchyma（median value 0.181 μg/mm3）was significantly higher than that in CNs（0.140 μg/mm3，P=0.042）.There was no significant difference between liver parenchyma and tumors，CNs and tumors（both P＞0.05）.The median value of ICD in CNs was 0.006 μg/ mm3，significantly lower than that of the HCC（0.201 μg/mm3，P＜0.001）and hepatic parenchyma（0.117 μg/mm3，P＜0.001）.The ICDs in tumors and hepatic parenchyma showednosignificantdifference（P= 0.829）.During the AP，the LNR had no significant difference between CNs and tumors（a median value 1.805 vs.1.310，P=0.389），and during the VP，the difference was also non-significant（the median value 0.647 vs.0.713，P=0.660）.The mean Az value of ICDs for evaluation of surviving tumor tissues was 0.804，while LNR measured a disappointing result in both AV images and VP images.Conclusion Quantitative iodinebased material decomposition images with gemstone spectral CT imaging can improve the diagnostic efficacy of CT imaging for HCC patients after TACE treatment.

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2015223 The impact of non-alcoholic fatty liver disease on islet function in type 2 diabetes.YAN Lihui（闫丽辉），et al.Dept Gastroenterol，Metab Dis Hosp，Tianjin Med Univ，Tianjin 300070.Chin J Intern Med 2015；54（3）：197-200.

Objective To analyze the influence of hepatosteato-sis on pancreatic β-cell function in type 2 diabetes mellitus（T2DM）.Methods A total of 213 subjects with T2DM from Metabolic Disease Hospital，Tianjin Medical University from January 2013 to December 2013 were included in the study.Non-alcoholic fatty liver disease （NAFLD）was diagnosed with abdominal ultrasonography.Patients were divided into two groups：T2DM with NAFLD and T2DM without NAFLD.ALT，AST，γ-glutamyltransferase，serum lipid，glycosylated hemoglobin A1c（HbA1c），fructosamine，fasting glucose，insulin and 2 hours plasma glucose，insulin after 75g glucose load were detected.The insulin resistance and β-cell function were assessed by HOMA-IR and HOMA-β.Results Among the 213 T2DM subjects，51%（108 cases）were with NAFLD.The HOMA-IR［4.76（2.83，7.21）vs 2.79（1.76，4.37），P＜0.05］and HOMA-β［49.18 （37.78，85.09）vs 29.50（18.09，45.54），P＜0.05］were significantly higher in T2DM with NAFLD than those in T2DM alone.Subjects with T2DM and NAFLD，the HOMA-IR［6.28（2.87，8.17）vs 2.95（2.07，3.66）P＜0.05］and HOMA-β［59.18（37.78，85.09）vs 30.59（28.56，34.49），P＜0.05］levels were higher in subjects with normal liver function than those with abnormal liver function.Conclusion T2DM patients with NAFLD have severer insulin resistance than those without NAFLD.The β-cell function of those patients was compensatory increased，which was decreased in subjects with abnormal liver function.

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