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Value of serum cholinesterase in diagnosis/treatment and prognostic evaluation of liver diseases

Journal of Clinical Hepatology.2017;33(9):1806-1809. doi:10.3969/j.issn.1001-5256.2017.09.040

Serum cholinesterase (ChE) is synthesized by hepatic parenchymal cells and is released into blood immediately after synthesis,and therefore,serum ChE can be used as an objective and sensitive indicator of liver function.Serum ChE has been used as an independent factor for the evaluation of liver function for a long time and can reflect the synthetic function of the liver and help to determine the severity of liver diseases.Combined measurement of serum ChE and serum prealbumin,total cholesterol,total bile acid,and prothrombin time has an important value in the diagnosis and treatment of liver diseases.At the same time,serum ChE combined with Child-Turcotte-Pugh score or MELD score can accurately evaluate liver reserve function,which may help with the prognostic evaluation of patients with liver diseases.

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Role of DNA recognition receptors in pathogenic mechanism of hepatitis B

Jin HUANG ; Xiuqing PANG ; Dongying XIE

Journal of Clinical Hepatology.2017;33(9):1794-1797. doi:10.3969/j.issn.1001-5256.2017.09.037

As a global disease,hepatitis B still threatens human health.However,the pathogenesis of hepatitis caused by HBV remains unclear.The innate immune system in the liver can detect HBV infection and use every strategy to eliminate the virus.DNA recognition receptors play an important role in this process;they recognize tlBV DNA or pgRNA in cytoplasm or nucleus,activate innate immunity through various signaling pathways to produce inflammatory cytokines and interferon,and finally exert their antiviral effect.This article summarizes the DNA recognition receptors involved in inflammation induced by HBV and HBV clearance,elaborates on their detailed pathways,and discusses the issues regarding the role of DNA recognition receptors in liver innate immunity induced by HBV and related perspectives.

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Current status of medical reimbursement for chronic hepatitis B and related countermeasures: an investigation in 333 prefecture-level cities

Jinxin WU ; Chuang LEI ; Jinlin HOU

Journal of Clinical Hepatology.2017;33(9):1789-1793. doi:10.3969/j.issn.1001-5256.2017.09.036

An investigation of the special policies for chronic diseases in medical insurance for urban employees and residents has been conducted in 333 prefecture-level cities in China,and the results showed that 78％ of all cities included chronic hepatitis B (CHB) in medical reimbursement for urban employees and 57％ included CHB in medical reimbursement for urban residents.However,there are still some issues to be resolved,such as inconsistent descriptions of the diagnosis of CHB-related diseases,inconsistent diagnostic criteria,lack of standardization of reimbursement process,infringement of patient privacy,and inadequate dose prescribed for CHB patients in the outpatient service.Therefore,we suggested that the Ministry of Human Resources and Social Security should introduce unified policies to include CHB in medical reimbursement,unify disease name and diagnostic criteria,standardize the reimbursement process for CHB,and increase the prescribed dose.

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Value of real-time shear wave elastography in evaluating classification of liver fibrosis: a Meta-analysis

Yue WU ; Liping HUANG

Journal of Clinical Hepatology.2017;33(9):1717-1721. doi:10.3969/j.issn.1001-5256.2017.09.017

Objective To investigate the diagnostic value of real-time shear wave elastography (SWE) technique in evaluating classification of liver fibrosis.Methods PubMed,CNKI,CBM,VIP,and Wanfang Data were searched for Chinese and English articles on SWE for evaluating classification of liver fibrosis published from January 2010 to December 2016,and these articles were screened and evaluated.Meta-disc 1.4 software was used for the meta-analysis of the data in the articles included.Results A total of 11 English articles were included,with 1560 cases in total.In the ≥F2 group,SWE had a pooled sensitivity of 0.85 (95％ confidence interval [CI]:0.82-0.87),a specificity of 0.79 (95 ％ C1:0.76-0.82),and a diagnostic odds ratio (DOR) of 30.81 (95 ％ CI:16.55-57.34).In the ≥ F3 group,SWE had a pooled sensitivity of 0.87 (95 ％ CI:0.84-0.91),a specificity of 0.84 (95 ％ CI:0.82-0.87),and a DOR of 41.45 (95 ％ CI:18.25-94.45).In the F4 group,SWE had a pooled sensitivity of 0.88 (95％ CI:0.83-0.91),a specificity of 0.91 (95％ CI:0.89-0.92),and a DOR of 67.18 (95％ CI:30.03-150.31).The areas under the receiver operating characteristic curve for these three groups were 0.914 7,0.922 3,and 0.952 0,respectively.Conclusion SWE has a high diagnostic value in evaluating the classification of liver fibrosis and can be used to determine liver fibrosis stage in clinical practice.

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Malnutrition assessment and nutrition support therapy for end-stage liver disease

Bin ZHU ; Congcong ZOU ; Xin ZHENG

Journal of Clinical Hepatology.2017;33(9):1699-1706. doi:10.3969/j.issn.1001-5256.2017.09.014

Malnutrition is a common complication in patients with end-stage liver disease and is associated with patients' clinical prognosis and quality of life,but it has not been taken seriously by clinical physicians.This article elaborates on the pathogenesis of malnutrition in patients with end-stage liver disease and introduces the latest research advances in malnutrition assessment and nutrition support therapy for end-stage liver disease in China and foreign countries.Early nutrition support therapy for patients with end-stage liver disease may help to improve their comprehensive clinical outcome.

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Bioartificial liver and liver transplantation: new modalities for the treatment of liver failure

Yitao DING

Journal of Clinical Hepatology.2017;33(9):1693-1698. doi:10.3969/j.issn.1001-5256.2017.09.013

The main features of liver failure are extensive necrosis of hepatocytes,rapid disease progression,and poor prognosis,and at present,there are no effective drugs and methods for the treatment of liver failure.This article summarizes four treatment methods for liver failure,i.e.,medical treatment,cell transplantation,liver transplantation,and artificial liver support therapy,and elaborates on the existing treatment methods.The current medical treatment regimen should be optimized;cell transplantation has not been used in clinical practice;liver transplantation is the most effective method,but it is limited by donor liver shortage and high costs;artificial liver can effectively remove toxic substances in human body.Therefore,this article puts forward artificial liver as a transition for liver transplantation;artificial liver can buy time for liver regeneration or liver transplantation and prolong patients' survival time and thus has a promising future.The new treatment modality of bioartificial liver combined with liver transplantation may bring good news to patients with liver failure.

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Coping with shortage of plasma-The new therapeutic pattern of non-bioartificial liver

Shuang LI ; Yu CHEN

Journal of Clinical Hepatology.2017;33(9):1687-1692. doi:10.3969/j.issn.1001-5256.2017.09.012

With the increase in patients with liver failure,the artificial liver support system is facing great opportunities and challenges.Although artificial liver has achieved remarkable results in the treatment of patients with liver failure,non-bioartificial liver techniques commonly used in China,mainly plasma exchange,are facing the issue of limited plasma supply.This article focuses on plasma exchange and discusses how to deal with the shortage of plasma in non-bioartificial liver treatment from various aspects,in order to provide a reference for clinical physicians.

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Timing of glucocorticoid therapy for liver failure

Qinghua MENG

Journal of Clinical Hepatology.2017;33(9):1683-1686. doi:10.3969/j.issn.1001-5256.2017.09.011

There are still controversies over the use of glucocorticoids in the treatment of liver failure,and current guidelines for liver failure recommend that glucocorticoids should be used with great caution.However,some latest studies have shown that the use of glucocorticoid therapy in the early stage of liver failure can bring more benefits to patients.Age,disease progression rate and severity,and complications of liver failure may affect the treatment outcome.Further studies are still needed for the selection of right patients,drugs and dose,and treatment timing.

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Hotspots in clinical management of severe liver diseases

Jiayu LYU ; Tao HAN

Journal of Clinical Hepatology.2017;33(9):1617-1620. doi:10.3969/j.issn.1001-5256.2017.09.001

Severe liver diseases such as liver failure and acute decompensated cirrhosis have critical conditions and high mortality rates,and the prognosis of such patients is closely associated with early warning,timely dynamic assessment,and comprehensive and effective therapy.The patients require a series of effective clinical management measures for elimination of causative factors,organ support,and prevention and treatment of complications.Medical treatment-artificial liver-liver transplantation is an important modality for severe liver diseases.Granulocyte colony-stimulating factor,stem cell therapy,and bioartificial liver have a promising future,while there are still controversies over non-selective β-blocker.This article reviews the hotspots in the clinical management of severe liver diseases.

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Research advances in predisposing factors for acute-on-chronic hepatitis B liver failure

Ying ZHENG ; Yongguo LI

Journal of Clinical Hepatology.2017;33(9):1802-1805. doi:10.3969/j.issn.1001-5256.2017.09.039

HBV is the cause of acute-on-chronic liver failure in most patients,and therefore,acute-on-chronic hepatitis B liver failure is one ofthe most challenging public health issues at present.Long-term administration of nucleos (t) ide analogues,abuse of various drugs,and change in drinking habits caused by economic and cultural diversity contribute to the complex predisposing factors for acute-on -chronic hepatitis B liver failure.An analysis of these reasons can help to prevent the development of acute-on-chronic hepatitis B liver failure in the early stage and reduce mortality rate.

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