Objective To investigate the influence of live combined bifidobacterium, lactobacillus and enterococcus powder assisted with nasal jejunum nutrition on laboratory index, complication rate and economical efficiency in patients with severe acute pancreatitis (SAP). Methods Fifty patients with SAP were divided into treatment group and control group by random draw method with 25 cases each. The patients of 2 groups received conventional therapy of SAP and nasal jejunum nutrition, and the patients in treatment group were treated with the above treatment combined with live combined bifidobacterium, lactobacillus and enterococcus powder. The laboratory indexes, gastrointestinal function score, complications, hospitalization time and hospitalization expenses were compared between 2 groups. Results The white blood cell, amylase, lipase, C reactive protein, interleukin (IL)-8, tumor necrosis factor (TNF)-α, lactate dehydrogenase (LDH) and gastrointestinal function score after treatment in treatment group were significantly lower than those in control group:(5.9 ± 2.1) × 109/L vs. (8.4 ± 3.1) × 109/L, (210.4 ± 47.6) U/L vs. (271.9 ± 82.2) U/L, (205.2 ± 22.3) U/L vs. (249.3 ± 34.7) U/L, (14.7 ± 0.4) mg/L vs. (35.1 ± 0.8) mg/L, (16.0 ± 4.8)μg/L vs. (36.5 ± 12.9)μg/L, (21.7 ± 5.6) ng/L vs. (43.4 ± 9.5) ng/L, (212.5 ± 95.4) U/L vs. (284.0 ± 124.6) U/L and (0.81 ± 0.24) scores vs. (1.37 ± 0.36) scores, and the total incidence of complications, hospitalization time and hospitalization expenses were significantly lower than that in control group: 12.0%(3/25) vs. 64.0%(16/25), (18.72 ± 1.90) d vs. (21.13 ± 2.35) d and (4.48 ± 0.55) × 104 yuan vs. (4.73 ± 0.78) × 104 yuan. There were statistical differences (P<0.05). Conclusions Live combined bifidobacterium, lactobacillus and enterococcus powder assisted with nasal jejunum nutrition in the treatment of SAP patients can efficiently improve the laboratory indexes, promote gastrointestinal function recovery, decrease the risk of complications and reduce the economic burden.

ObjectiveTo explore the association between hepatic steatosis and the liver tissue expression of HBsAg and HBcAg in chronic hepatitis B (CHB) patients.MethodsFrom January 2005 to June 2008,a total of 147 CHB patients with hepatic steatosis diagnosed by liver biopsy and other 149 CHB patients without hepatic steatosis but with similar HBV DNA titer were enrolled.The differences of HBsAg and HBcAg immunostaining and liver injury in these two groups were compared.The data were analysed using t test and chi square test.ResultsCompared with non-steatosis group,the average age and body weight index of hepatic steatosis group were higher (t values were -3.31and -6.57,both P＜0.01).The percentage of moderate to severe hepatic inflammation in liver,obvious hepatic fibrosis and the strong positive HBsAg staining was lower (30.6％ vs 15.4％ ； 26.5％vs 12.8％； 23.1 ％ vs 6.7 ％； x2=9.63,8.92,15.76； all P＜0.01),and the percentage of strong positive HBcAg staining was also in downtrend.Compared with degree F1 and F2 of liver steatosis,the percentage of HBsAg and HBcAg strong positive staining in liver tissues of degree F3 and F4 was in downtrend.ConclusionsHepatic steatosis affected the expression of HBsAg and HBcAg in liver tissue of CHB patients.As hepatic steatosis appeared and became more severe,both expression of HBsAg and HBcAg and the degree of liver injury were in downtrend.

Objective To explore the clinical and pathological characters of chronic hepatitis B (CHB) in combination with hepatic steatosis in the elderly.Methods Totally 223 elderly patients with CHB and hepatic steatosis diagnosed by liver biopsy were retrospectively analyzed and 220 nonelderly patients with CHB and hepatic steatosis were randomly selected as control group.Clinical and pathological features and change in liver histology were compared between the two groups.Results The incidences of hypertension,coronary heart disease,type 2 diabetes mellitus and metabolic syndrome were increased in elderly groups (all P＜0.01 or 0.05),while the proportion of patients with hyperlipemia and obesity were decreased as compared with non-elderly group (both P＜0.01).The levels of body mass index,serum triglyceride and HBV-DNA were lower in elderly group than in non-elderly group (all P＜0.01).The ratio of mild degree of CHB was elevated in elderly group as compared with non-elderly group (P＜0.05).Liver histopathological examination showed that the proportion of patients with the inflammation grade less than G2 and fibrotic stages exceeding S2 were increased,while the positive rate of HBcAg by immunohistochemistry was reduced in elderly group as compared with non-elderly group (both P＜0.05).Conclusions The degree of inflammatory liver injury and inflammation grade are slighter,but the fibrotic stage is more serious in elderly patient with CHB and hepatic steatosis,which indicating a slower progress of liver injury.It is still to be investigated whether metabolic syndrome,hypertension,coronary heart disease and type 2 diabetes mellitus are easily complicated in elderly patient with CHB and hepatic steatosis.The serum hepatitis B virus DNA replication may be negatively correlated with ageing.

Objective To investigate the liver function injury and the rate of complications in living liver transplantation donors in different graft type transplantation.Methods Postoperative data of 154 living liver donors satisfying our inclusion criteria were prospectively collected and registered from Jan 2002 to May 2009 in our hospital.We divided the donors into two groups (right-lobe graft, R group and left-lobe graft, L group), and made comparison on the liver function and complications.Results Remnant liver weight in R group were smaller than those in L group (t = 11.418, P ＜ 0.05).the ratio of remnant liver weight to standard liver weight in R group were smaller than those in L group (t = - 5.040, P ＜ 0.05 ) .Peaks of ALT, AST and INR in both groups appeared on the first day after operation, while the peak of TB in R group appeared on the third day after operation.All the index values returned to a normal baseline after reaching its peak.Mean values of TB in R group were higher than those in L group on the 1st, 3rd, 7th day after operation (seperately t1 = 5.285, t3 = 3.747, t7 = 2.729, all P ＜ 0.05).Mean values of INR in R group were higher than those in L group on the 1st, 3rd, 7th day after operation (seperately t1 = 5.260, t3 = 5.035, t7 = 2.267, all P ＜ 0.05).The level of TB in both groups returned to normal range on the 7th postoperative day, while the level of ALT and AST remained twice the upper limits of the normal.There were no deaths; Complications occurred in 53 of 154 donors (34.42% ) , 52/141 (36.88% ) in R group and 1/13 (7.69% ) in L group (x2 = 3.292, P ＞ 0.05).Conclusions Ramnant liver function of R group during early postoperative period was poorer than that of the L group.Donors were safe, though suffering from comparatively high complication rate.

ObjectiveTo investigate the incidence of early postoperative complications in living donor liver transplantation.MethodsPostoperative data of 170 living liver donors were retrospectively collected from January 2002 to August 2009 and the collected data were divided into two groups according to the type of donors (right-lobe graft,R group and left lobe graft,L group). Early postoperative complications were analyzed using Clavien classification system.ResultsThe difference between two groups was no statistically significant in donor's age,body mass index,operation time and other characters (P＞0.05).R group had a bigger actual cut weight of donor liver (P＜0.05),smaller residual liver weight (P＜0.05) which also smaller than standard liver weight (P＜0.05),and a longer hospital stay (P＜0.05) than L group.During hospitalization,62 complications occurred in 55 cases with the total complication rate being 32.35％ (55/170). In detail,the incidence of complications was 34.39％ (54/157) in R group,and 7.69％ (1/13) in L group (chi-square value =2.787,P＞0.05).Among these 62 complications,there were 39 times of Ⅰ grade,5 times of Ⅱ grade,16 times of Ⅲ grade,2 times of Ⅳ a grade. All the complications were cured by active treatment and all donors survived well.Conclusion Although the security of living donor liver transplantation is better,the risk of serious complications must be faced.We must strictly select and assess the donor before the operation,very carefully carry out surgical operation,and pay more attention to postoperative management in order to avoid postoperative complications of donors.

Diagnosis, Differential ; Humans ; Liver Diseases, Alcoholic ; diagnosis ; Non-alcoholic Fatty Liver Disease ; diagnosis

Objective To investigate the differences and similarities between drug-induced liver injury (DILI) and autoimmune hepatitis (AIH) in serum biochemical parameters and liver pathology,and to provide some thoughts for clinical diagnosis and differentiation of these two diseases.Methods A retrospective analysis was performed for the biochemical,immunological,autoantibody,and liver pathological data of 106 DILI patients and 63 AIH patients who were hospitalized,diagnosed,and treated in our hospital from January 2012 to October 2014.The patients' general data,biochemical parameters,immunological data,Ishak score,and qualitative changes in liver tissue were analyzed and compared.The Kruskal-Wallis test was used for comparison of nonparametric data between multiple groups,the Nemenyi test was used for comparison of nonparametric data between any two groups,the Wilcoxon rank sum test was used for comparison of Ishak scores,and the chi-square test was used for comparison of constituent ratio of categorical data.Results There were significant differences between AIH group and DILI hepatocyte injury group/mixed-type DILI group in the following serum biochemical parameters:alanine aminotransferase (187.2 U/L vs 1 326.5 U/L and 455.6,P ＜ 0.05),aspartate aminotransferase (172.2 U/L vs 759.5 U/L and 349.5 U/L,P ＜0.05),alkaline phosphatase (209.3 U/L vs 157.3 U/L and 169.4 U/L,P ＜ 0.05),gamma-glutamyl transferase (254.8 U/L vs 176.5 U/L and 170.5 U/L,P ＜ 0.05),total bilirubin (37.2 μmol/L vs 95.8 μmol/L and 52.6 μmol/L,P ＜ 0.05),serum iron (18.9 μmol/L vs 36.2 μmol/L and 23.9 μmol/L,P ＜ 0.05),serum ferritin (122.5 μmol/L vs 410.4 μmol/L and 186.5 μmol/L,P ＜ 0.05),immunoglobulin G (18.4 g/L vs 12.6 g/L and 12.3 g/L,P ＜ 0.05),and immunoglobulin M (1.8 g/L vs 1.3 g/L and 1.1 g/L,P ＜ 0.05).There were also significant differences between AIH group and DILI hepatocyte injury group/mixed-type DILI group in the Ishak score for interface inflammation (2.2±0.8 vs 1.3±0.7 and 1.3±0.6,P ＜ 0.05),Ishak score for portal inflammation (2.3±0.9 vs 1.5±0.7 and 1.4±0.8,P ＜ 0.05),and fibrosis score (2.8±1.1 vs 1.5±0.7 and 1.3±0.7,P ＜ 0.05).There were significant differences between AIH group and DILI hepatocyte injury group/mixed-type DILI group in the proportion of wax-like deposition (0 vs 29.2％ and 34.5％,P ＜0.05) and proportion of iron deposition (11.1％vs 52.1％ and 25.9％,P ＜ 0.05).Conclusion There are differences in biochemistry,immunology,and liver histology between DILI and AIH patients.AIH patients have more serious interface inflammation and portal inflammation and a higher fibrosis degree compared with DILI patients,while DILI patients have greater proportions of wax-like deposition and iron deposition compared with AIH patients.

BACKGROUND/AIMS: This study aimed to verify the reliability of the alcoholic liver disease (ALD)/nonalcoholic fatty liver disease (NAFLD) index (ANI) for distinguishing ALD in patients with hepatic steatosis from NAFLD, and to investigate whether ANI combined with γ-glutamyl transferase (GGT) would enhance the accuracy of diagnosis in China. METHODS: A hundred thirty-nine cases of fatty liver disease (FLD) were divided into two groups of ALD and NAFLD. The ANI was calculated with an online calculator. All indicators and ANI values were analyzed using statistical methods. RESULTS: ANI was significantly higher in patients with ALD than in those with NAFLD (7.11 ± 5.77 vs. -3.09 ± 3.89, p < 0.001). With a cut-off value of -0.22, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of diagnosed ALD cases was 87.1%, 92.5%, and 0.934 (95% confidence interval [CI], 0.879 to 0.969), respectively. The corresponding values for aspartate aminotransferase (AST)/alanine transaminase (ALT), mean corpuscular volume (MCV), and GGT were 75.29%, 72.94%, and 0.826 (95% CI, 0.752 to 0.885); 94.34%, 83.02%, and 0.814 (95% CI, 0.739 to 0.875) and 80.23%, 79.25%, and 0.815 (95% CI, 0.740 to 0.876), respectively. ANI AUROC was significantly higher than the AST/ALT, MCV, or GGT AUROCs (all p < 0.001), moreover, ANI showed better diagnostic performance. The combination of ANI and GGT showed a better AUROC than ANI alone (0.976 vs. 0.934, p = 0.016). The difference in AUROCs between AST/ALT, MCV, and GGT was not statistically significant (all p > 0.05). CONCLUSIONS: ANI can help distinguish ALD from NAFLD with high accuracy; when ANI was combined with GGT, its effectiveness improved further.
Alcoholics* ; Aspartate Aminotransferases ; China ; Diagnosis ; Diagnosis, Differential ; Erythrocyte Indices ; Fatty Liver* ; gamma-Glutamyltransferase ; Humans ; Liver Diseases, Alcoholic* ; ROC Curve ; Sensitivity and Specificity ; Transferases*

Objective:To investigate the influencing factors of significant liver fibrosis in patients with chronic hepatitis B (CHB) concurrent with non-alcoholic fatty liver disease (NAFLD).Methods:Those who underwent liver pathological examination and confirmed diagnosis of CHB and NAFLD in Tianjin Second People′s Hospital from August 2014 to September 2017 were enrolled. Data regarding their demographic information, laboratory tests results, and liver pathology results were analyzed. The latter results were used to categorize the patients either in non-significant liver fibrosis group (Metavir stage