Search

Copyright of Journal of Clinical Hepatology / Linchuang Gandanbing Zazhi is the property of Journal of Clinical Hepatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Comprehensive scoring models are one of the main methods for liver function evaluation and an important part of the treatment strategy for hepatocellular carcinoma. This article summarizes the value and limitations of traditional scoring models(Child-Turcotte-Pugh score and Model for End-Stage Liver Disease score) and new scoring models(albumin-bilirubin score,platelet-albumin-bilirubin score,and albumin-indocyanine green score) in radiofrequency ablation for hepatocellular carcinoma and points out that the new scoring models,especially platelet-albumin-bilirubin score,are advantageous. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical value of acoustic radiation force impulse (ARFI) elastography in predicting esophageal variceal bleeding in patients with liver cirrhosis. Methods A retrospective analysis was performed for the clinical data of 271 patients with liver cirrhosis who attended the Fifth Medical Center of Chinese PLA General Hospital from October 2014 to May 2017, and ARFI elastography was performed for all patients to measure the elasticity of the liver and the spleen. According to the presence or absence of esophageal variceal bleeding, the patients were divided into bleeding group and non-bleeding group, and related indices were compared between the two groups. The receiver operating characteristic (ROC) curve was used to evaluate the value of ARFI elasticity in the diagnosis of esophageal variceal bleeding in liver cirrhosis. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. Results The bleeding group had a significantly higher ARFI elasticity of the spleen than the non-bleeding group ［3.89(3.49-4.11) m/s vs 3.46(2.93-3.80) m/s, Z=-4.941, P＜0.001］, and there was no significant difference in the ARFI elasticity of the liver between the bleeding group and the non-bleeding group ［2.08 (1.57-2.74) m/s vs 1.98 (1.49-2.70) m/s, Z=-1.025, P=0.305］. The areas under the ROC curve for ARFI elasticity values of the spleen and the liver were 0.714 and 0.544, respectively, in predicting esophageal variceal bleeding in patients with liver cirrhosis (P=0.002 5). At the cut-off value of 3.71 m/s, the ARFI elasticity of the spleen had a sensitivity of 0.68 and a specificity of 0.69 in predicting esophageal variceal bleeding. Conclusion The ARFI elasticity value of the spleen has a better value than that of the liver in predicting the risk of esophageal variceal bleeding and thus holds promise for clinical application. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical effect of transjugular intrahepatic portosystemic shunt(TIPS) alone versus TIPS combined with stomach and esophageal variceal embolization(SEVE) in the treatment of gastroesophageal variceal rebleeding in cirrhotic patients.Methods A total of 142 cirrhotic patients with gastroesophageal variceal bleeding who underwent TIPS or TIPS + SEVE in Department of Gastroenterology,Drum Tower Hospital,from January 2009 to December 2013 were enrolled and divided into TIPS group with 31 patients and TIPS + SEVE group with 111 patients. The two groups were analyzed in terms of intraoperative conditions,follow-up results,and risk factors for postoperative rebleeding. The independent samples t-test was used for comparison of continuous data between groups,the chi-square test was used for comparison of categorical data between groups,and the Mann-Whitney U test was used for comparison of ranked data between groups. The Kaplan-Meier method was used to plot the curves of rebleeding rate,shunt dysfunction rate,and survival rate,and the Log-rank test was used for the comparison of cumulative rebleeding rate,shunt dysfunction rate,and survival rate. The Cox proportional hazards regression model was used for univariate and multivariate analyses. Results All 142 patients completed the surgery successfully. There were no significant differences between the TIPS group and the TIPS + SEVE group in mean follow-up time(34 ± 23 months vs32 ± 21 months,t = 0. 501,P > 0. 05) and incidence rate of hepatic encephalopathy after surgery(12. 9% vs 18. 9%,χ2= 0. 641,P >0. 05). There were no significant differences between the TIPS group and the TIPS + SEVE group in 1-,2-,3-,and 5-year cumulative rebleeding rates during follow-up(χ2= 1. 511,P > 0. 05),while there were significant differences between the two groups in 1-,2-,3-,and 5-year cumulative shunt dysfunction rates(13%/21%/34%/34% vs 7%/12%/13%/13%,χ2= 4. 087,P < 0. 05).There were no significant differences between the two groups in 1-,2-,3-,and 5-year cumulative survival rates during follow-up(χ2= 0. 471,P > 0. 05). Preoperative Child-Pugh class(hazard ratio [HR]= 0. 385,95% confidence interval [CI]: 0. 165-0. 898,P <0. 05),stent type(HR = 0. 429,95% CI: 0. 240-0. 766,P < 0. 05),and postoperative shunt dysfunction(HR = 5. 840,95% CI: 2. 566-13. 294,P < 0. 05) were influencing factors for postoperative rebleeding in cirrhotic patients with gastroesophageal variceal bleeding. The multivariate analysis showed that bare stent(relative risk [RR]= 0. 527,95% CI: 0. 290-0. 954,P < 0. 05) and postoperative shunt dysfunction(RR = 4. 436,95% CI: 1. 899-10. 360,P < 0. 05) were independent risk factors for postoperative rebleeding in cirrhotic patients with gastroesophageal variceal bleeding. Conclusion Compared with TIPS alone,TIPS + SEVE can reduce the incidence rate of postoperative shunt dysfunction in cirrhotic patients with gastroesophageal variceal bleeding,but it cannot reduce postoperative rebleeding rate or increase survival rate. Bare stent and shunt dysfunction are independent risk factors for postoperative rebleeding in cirrhotic patients with gastroesophageal variceal bleeding. [ABSTRACT FROM AUTHOR]

Objective To investigate the spleen stiffness of patients with chronic hepatitis and liver cirrhosis by spleen acoustic radiation force impulse (ARF1) , aspartate aminotransferase - to - platelet ratio index (APR1) , and aspartate aminotransferase/alanine aminotransferase ratio (AAR) , as well as the clinical value of these three noninvasive techniques in predicting esophageal varices (EV) in patients with liver cirrhosis. Methods A total of 247 patients with chronic hepatitis and liver cirrhosis were enrolled, and ARF1 was used to measure real - time spleen stiffness. APR1 and AAR were calculated. Gastroscopy was performed within one week before and after measurement to clarify the degree of EV. With the results of gastroscopy as the gold standard , the receiver operating characteristic ( ROC) curve was used to compare the clinical value of spleen ARF1 value, APRI, and AAR in the diagnosis of EV in patients with liver cirrhosis. The t - test was used for comparison of continuous data between two groups. Results There were significant differences between the EV group ( n = 169) and the non - EV group (n =78 ) in spleen ARF1 stiffness (3. 64 ±0. 53 m/ s vs 2. 97 ±0.65 m/s, t = -7.93, P <0.001) , APRI (0.87 ± 0. 91 vs 0.52 ±0.80, t = -2.90 . P =0.004 ), and AAR (1.54 ±0.67 vs 1.29 ±0.55 , t = -2. 93 , P =0.004). Spleen ARFI, APRI, and AAR had an area under the ROC curve of 0. 80,0.72 , and 0. 63 , respectively , in predicting EV in patients with liver cirrhosis; there was a significant difference between spleen ARFI stiffness and AAR (P =0.005) , while there was no significant difference between spleen ARFI stiffness and APRI (P =0.10). Conclusion ARFI is a real -time ultrasound elastography technique, and compared with APRI and AAR, spleen stiffness measured by ARFI can predict EV in patients with chronic hepatitis and liver cirrhosis more accurately and noninva-sively and thus holds promise for clinical application. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical value of acoustic radiation force impulse (ARFI) in quantitative prediction of the degree of esophageal varices in patients with cirrhotic portal hypertension. Methods A total of 116 patients with liver cirrhosis who were admitted to 302 Hospital of PLA from October 2014 to February 2016 were enrolled. ARFI was used to measure real-time liver and spleen stiffness for all patients. With the degree of esophageal varices determined by gastroscopy as the gold standard for diagnosis, these patients were divided into non-varices group (EV0, 16 patients), mild varices group (EV1, 39 patients), moderate varices group (EV2, 26 patients), and severe varices group (EV3, 35 patients). The receiver operating characteristic (ROC) curve was used to analyze the clinical value of liver/spleen ARFI in predicting the degree of esophageal varices. An analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the least significant difference Mann-Whitney U test was used for further comparison between any two groups; the chi-square test was used for comparison of categorical data between groups. The Spearman correlation analysis was used to investigate the correlation between the stiffness measured by ARFI and the degree of esophageal varices. Results The ARFI value of the spleen was 2.54±0.34 m/s for EV0 patients, 3.05±0.34 m/s for EV1 patients, 3.48±0.50 m/s for EV2 patients, and 3.69±0.33 m/s for EV3 patients (χ2=60.121,P＜0.001). The ARFI value of the spleen was positively correlated with the grade of esophageal varices (r=0.713, P＜0.001). The areas under the ROC curve for the ARFI value of the spleen in the diagnosis of ≥EV1, ≥EV2, or EV3 esophageal varices were 0.93, 0.88, and 0.83, respectively. There was no significant difference in the ARFI value of the liver between groups (P=0.085), and the ARFI value of the liver was not correlated with the degree of esophageal varices (P=0.245). Conclusion The ARFI value of the spleen helps to achieve accurate quantitative prediction of the degree of esophageal varices in patients with cirrhotic portal hypertension and holds promise for clinical application. [ABSTRACT FROM AUTHOR]

Early identification and effective treatment of hepatocellular carcinoma plays an important role in improving survival rate. The establishment of simple and effective procedures for early diagnosis, census methods, and effective minimally invasive treatment is an important project in China to improve the diagnosis and treatment level of liver cancer. Contrast-enhanced ultrasound plays an important role in the early diagnosis of liver cancer and radiofrequency ablation treatment. This article describes how contrast-enhanced ultrasound helps with the identification of small hepatocellular carcinoma and degree of tumor differentiation in patients with liver cirrhosis, as well as the differential diagnosis of hyperplasia/canceration and precancerous lesion. It also introduces the important role of contrast-enhanced ultrasound in standard radiofrequency ablation and development of therapeutic regimens and strategies and clarifies that it can be used before, during, and after radiofrequency ablation treatment. [ABSTRACT FROM AUTHOR]