ObjectiveTo analyze and compare the clinical and pathological characteristics of patients with porto-sinusoidal vascular disease (PSVD) and liver cirrhosis (LC), so as to provide a reference for reducing misdiagnosis and missed diagnosis. MethodsThe patients who underwent liver biopsy in the Department of Infectious Diseases in the First Hospital of Lanzhou University from January 2008 to December 2022 were retrospectively collected. The clinical, biochemical, imaging, and liver biopsy pathological data of the patients with PSVD and LC were compared. ResultsA total of 45 patients with PSVD and 48 patients with LC were included. The males to females ratio in the patients with PSVD and LC was 25∶20 and 21∶27, respectively, and the average age of the patients with PSVD was younger than that of the patients with LC (P<0.001). The patients with PSVD had overall better liver function, although the proportion of the patients with the Child-Pugh class B in the two groups was all higher, the proportion of patients with the Child-Pugh class B and the end stage liver disease model score ≥10 points in the patients with PSVD was lower (nearly three times) than those in the patients with LC (P<0.05). The initial diagnosis rate of the patients with PSVD was lower than that of the patients with the LC (6.7% vs. 95.8%, χ2=74.0786, P<0.001). The imaging findings of the patients with PSVD as compared with LC showed that the proportion of the portal hypertension was higher (33.3% vs. 39.6%) in both, but the flow velocity of the portal vein was faster (P=0.039), and the extrahepatic bile duct diameter was smaller (P=0.001). The main specific manifestations of liver biopsy histopathology in the patients with PSVD were the portal occlusion [19 (42.2%)], nodular regenerative hyperplasia [1 (2.2%)], and incomplete septal cirrhosis or fibrosis [14 (31.1%)], as well as the non-specific manifestation was the fine bile duct reaction [8 (17.8%)]. And the proportion of the patients with the liver tissue inflammatory activity grading (G) and liver fibrosis staging (S) ＞G2S2 in the patients with PSVD was lower as compared with the patients with LC [12 (26.7%) vs. 48 (100%), χ2=54.560, P<0.001]. ConclusionThe diagnosis of PSVD and LC should “seek common ground while reserving differences”, and it is necessary that a routine examination in combination with imaging manifestation and liver pathology, and should focus on a liver vascular abnormality so as to reduce a rate of misdiagnosis.
【Abstract】ObjectiveTo investigate the effects of rhGH on hypoalbuminemia in cirrhotic rats after partial hepatectomy. MethodsThirty rats were randomly divided into normal control group (n=6), liver cirrhosis group (LC group, n=6), liver cirrhosis and hepatectomy group (LCH group,n=6), PN (parenteral nutrition) group (n=6， given PN after hepatectomy) and rhGH+PN group (n=6,given rhGH and PN after hepatectomy). Liver function and blood glucose were measured. The expression of ALB mRNA was detected by RTPCR. Liver Ki67 immunohistochemistry was studied. ResultsCompared with PN group, serum ALP was lower; serum ALB and blood glucose were higher in rhGH+PN group. The expression of hepatic ALB mRNA was higher, and hepatic Ki67 labeling index was higher as well in this group. ConclusionrhGH can improve hypoalbuminemia after partial hepatectomy in cirrhotic rats with partial hepatectomy.
Objective To approach the prognosis after liver transplantation （LT） of liver function for Child grade A in patients with portal hypertension， and to compare with periesophagogastric devascularization with splenectomy （PDS）. Methods The data of 195 portal hypertension cases with Child A caused by hepatitis B cirrhosis who received surgical treatment of PDS （152 cases） or LT （43 cases） in division of liver transplantation center of West China Hospital of Sichuan University from 1999 to 2011 were retrospectively analyzed. The pre-， intra-， and postoperative variables in two groups that including patients’ age， score of Child， score of model for end-stage liver disease （MELD）， total bilirubin （TB），creatinine （Cr）， international normalized ratio （INR）， albumin （Alb）， complications of portal hypertension， amount of intraoperative bleeding and blood transfusion， operative time， and in the ICU and hospital stay time were compared. The postoperative outcomes were statistically analyzed including severe postoperative complications， short-term and long-term survival rates. Results Compared with PDS group， the amount of intraoperative bleeding and blood transfusion of LT group were morer （P＜0.05）， the operative time， in the ICU and hospital stay time of LT group were longer （P＜0.05）. The rate of severe postoperative complications in LT group was higher than that in PDS group 〔18.60% （8/43） vs. 1.97% （3/152），P＜0.05〕. The levels of TB and Cr during the postoperative period in LT group were higher than that in PDS group （P＜0.05）. Although the INR on day 1 after operation in LT group was higher than that in PDS group （P＜0.01）， but the difference disappeared soon on day 7 after operation in two groups （P＞0.05）.The 1-， 3-， and 5-year survival rates of the LT and PDS groups were 90.3%， 86.5%， 86.5%， and 100%， 100%， 100%， respectively， significant difference were observed in both short-term and long-term survival rates between the two groups （P＜0.05）. Conclusion LT offered no significant survival benefit to patients with portal hypertension and Child A due to hepatitis B cirrhosis， whereas PDS could be an effective treatment.
Objective To determine the frequencies and patterns of gastrointestinal wall thickening at muti-slice computed tomography (MSCT) in patients with hepatic cirrhosis. Methods One hundred and nine patients with cirrhosis and 130 patients without cirrhosis for gastrointestinal wall thickening were retrospectively analyzed by the abdominal MSCT scans. The frequencies of wall thickening were determined in the cirrhosis patients and in those without cirrhosis. The segmental distribution, symmetry and enhancement pattern were evaluated in all patients with cirrhosis for gastrointestinal wall thickening. Results Gastrointestinal wall thickening was seen in 72 cases (66%) with cirrhosis patients and in 12 cases (9%) without cirrhosis patients (Plt;0.005). The jejunum and ascending colon were the most common sites of gastrointestinal wall thickening, which was involved in 32 and 31 patients respectively. The scans of 46 (64%) patients with gastrointestinal wall thickening showed multisegmental distribution. Gastrointestinal wall thickening was concentric and homogeneous in all patients with cirrhosis. Conclusion Gastrointestinal wall thickening is common in patients with hepatic cirrhosis. It frequently involves multiple segments. The jejunum and ascending colon are the most common sites of involvement. MSCT plays an invaluable role in diagnostic evaluation of bowel wall thickening in patients with hepatic cirrhosis.
42 Wistar rats were divided into three groups at random, liver cirrhosis (LC), portal vein stricture (PVS) and sham operation (SO) group. The changes of barrier capability of gastric mucosa in portal hypertensive rats were observed. The results demonstrated: the splanchnic blood flow of the portal hypertensive rats increased, as compared with the normal control group (Ｐ＜0.001), but actually gastric mucosa was under the condition of ischemia. Mucosa of gastric wall glycoprotein and PGE2 of gastric mucosa decreased, as compared with the normal control (Ｐ＜0.01); and more seriously decreased in cirrhotic portal hypertensive rats, there was no significant difference about amount of the basal acid secretion (BAS) among the three groups, but the amount of H＋ backdiffusion (H＋BD) was obviously increased, as compared with the normal control group (Ｐ＜0.001). The amount of H＋BD of cirrhotic portal hypertensive rats was the highest among this three groups. The results suggest that the barrier capability of gastric mucosa with portal hypertension is lower than that of the normal control group and much lower with cirrhotic portal hypertensive rats. The portal hypertensive gastropathy is associated with the lower capability of defense of gastric mucosa. The condition of liver function contributes to the change of barrier capability of gastric mucosa.
ObjectiveTo introduce the new nomenclature scheme of the International Working Group (1995) on hepatic nodules, and summarize the imaging features of various hepatic nodules in light of their pathological characteristics, and evaluate the diagnostic values of various imaging facilities.MethodsUltrasound, computed tomography(CT), magnetic resonance imaging(MRI), and angiographic CT were reviewed and introduced.ResultsMany of these types of hepatic nodules play a role in the de novo and stepwise carcinogenesis of hepatocellular carcinoma(HCC) in the following steps: regenerative nodule, lowgrade dysplastic nodule, highgrade dysplastic nodule, small HCC, and large HCC. Accompanying such transformations, there are significant alterations in the blood supply and perfusion of these hepatic nodules.ConclusionModern stateoftheart medical imaging facilities can not only delineate and depict these hepatic nodules, but also provide important clues for the characterization of focal hepatic lesions in most cases, thus facilitating the early detection, diagnosis and management of HCC in its early stage.
Objective To study the diagnosis and treatment of portal hypertension in secondary biliary cirrhosis(PHSBC). MethodsTwenty-five cases of PHSBC within recent 16 years in our hospital were analyzed. Their clinical, pathological and follow-up data were reviewed retrospectively. They were divided into 4 groups according to their primary diseases:13 patients with hepatolithiasis, 6 with postoperative stricture of biliary duct, 4 with malignancy of biliary duct and 2 with others.Results All patients were diagnosed clinically, and 4 were further pathologically confirmed. Eight cases were treated conservatively, while the remaining 17 underwent operations according to their primary diseases, and one combined with splenectomy and esophagogastric devascularization. The rate of discharge with improvement by surgical and non-surgical treatment was 64.7% and 37.5%, and hospital mortality was 17.6% and 12.5% respectively. Conclusion The diagnosis of PHSBC mainly depends on its characteristic clinical manifestations. The early surgical resolution of bile duct obstruction is the key to good prognosis. If complicated with rupture and hemorrhage of oesophagofundal varices, the surgical procedure should be considered carefully.
To investigate the change of the portal venous pressure (PVP), conjugated glycocholic acid (CGA) and pancreatic glucagon (PG) concentration in rats peripheral and portal venous blood in the course of experimental liver cirrhosis induced with carbon tetrachloride and to investigate the mentioned changes after portalazygous devascularization. The authors found that in the early stage of cirrhosis the PVP and the concentration of CGA and PG in peripheral venous blood were increased markedly, CGA in portal vein was decreased and PG in portal vein was increased in early stage of liver cirrhosis.With the extent of liver cirrhosis the indexes above changed more markedly. After portalazygous devascularization the concentration of CGA in peripheral vein in the cirrhotic rats was increased but PVP, the concentration of CGA in portal vein and PG in peripheral and portal vein did not change.There was no change in nornal rats. The results suggest that the variation in CGA in peripheral vein can accurately reflect the degree of damage to liver cells, thus making the diagnosis of liver cirrhosis earlier and judging the degree and prognosis of liver cirrhosis.The concentration of PG in portal venous and peripheral vein relate to PVP in liver cirrhosis.Portalazygous devascularization can maintain PVP and PG in portal vein and do not affect liver function of the control rats but it can damage liver cell in cirrhotic rats.
Objective To explore the effect of cyclopamine （Cyc） which is the inhibitor of the Hedgehog signaling pathway on portal venous pressure of normal and liver cirrhosis rats, and it’s possible mechanisms. Moreover, to provide the experimental basis of drug efficacy and clinical treatment. Methods Thirty two healthy male SD rats were randomly average divided into four groups：normal control group, normal treatment group, liver cirrhosis control group, and liver cirrhosis treatment group. The liver cirrhosis models of rat were established by using the thioacetamide （TAA） method, which made 0.03% of TAA as the initial water concentration, and then the concentration of TAA in drinking water was adjusted according to the changes of the weekly body weight of rats lasting for twelve weeks. In thirteenth week, intraperitoneal injection of corn oil （0.1 ml/100 g body weight, 1 time/d） were performed lasting for a week in rats of the normal control group and liver cirrhosis control group; intraperitoneal injection of Cyc 〔1 mg （0.1 ml）/100 g body weight, 1 time/d〕were performed lasting for a week in rats of the normal treatment group and liver cirrhosis treatment group. In fourteenth week, the liver function, portal venous pressure （PVP）, and the ration of liver or spleen weight to body weight were detected, the expressions of α-smooth muscle actin （α-SMA） and typeⅠcollagen α1 （Col1α1） of hepatic stellate cell were detected by using immunohistochemistry. Results PVP were （10.7±0.9） and （12.3±1.3） cm H2O （1 cm H2O=0.098 kPa） in normal control group and normal treatment group, respectivly, the latter was higher than the former （t=-2.918，P=0.011）. PVP were （21.8±0.7） and （14.3±1.4） cm H2O in liver cirrhosis control group and liver cirrhosis treatment group, respectivly, the latter was lower than the former（t=13.602，P=0.000）. The expressions of α-SMA and Col1α1 in liver cirrhosis treatment group was lower than the liver cirrhosis control group. There were no significant difference of the liver function and ration of liver or spleen weight to body weight between the treatment group and the control group （P＞0.05）. Conclusion Cyclopamine could signally reduce the PVP of liver cirrhosis rats through reducing the expressions of α-SMA and Col1α1.
【Abstract】ObjectiveTo prospectively study the effects of recombinant human growth hormone (rhGH) on the changes of liver function and nutritional metabolism in postoperative patients with cirrhosis and portal hypertension. MethodsFortyeight cases with liver cirrhosis and portal hypertension who were collected from February 2003 to January 2004 were randomly divided into 2 groups (24 patients in each group). All patients were given the low calorie parenteral nutrition support and exogenous albumen after operations. Patients in the study group received rhGH from the second day after operations and physiological saline was used in the control group instead. The effects were evaluated in terms of protein metabolism, liver function, blood glucose level at different phases before and after the intervene. Death rates of in patients were also recorded in both groups. ResultsThe rising amplitude of albumen in the study group had been significantly larger than that of the control group from the seventh day after intervene (P＜0.05). The blood transaminase levels (ALT，AST) in the study group were significantly lower than that of the control group (P＜0.05). The blood glucose level of both groups decreased over time and returned to normal on day 14 after intervene, but there was no significant difference for both glucose and plasma bilirubin level between the two groups before and after the intervene (Pgt;0.05). The rates of death were similar, although the length of stay in the study group was much shorter than that of the control group. ConclusionrhGH may inhibit the catabolism, correct hypoproteinemia, improve liver function for postoperative patients with cirrhosis and portal hypertension, and reduce their length of stay.