Measurement of hepatic functional mass by means of ^(13)C-methacetin and ^(13)C-phenylalanine breath tests in chronic liver disease: Comparison with Child-Pugh score and serum bile acid levels

AIM: To evaluate and compare the clinical usefulness of 13C-phenylalanine and 13C-methacetin breath tests in quantitating functional hepatic mass in patients with chronic liver disease and to further compare these results with those of conventional tests, Child-Pugh score and serum bile acid levels.METHODS: One hundred and forty patients (50 HCV-related chronic hepatitis, 90 liver cirrhosis patients) and 40 matched healthy controls were studied. Both breath test and routine liver test, serum levels of cholic and chenodeoxycholic acid conjugates were evaluated.RESULTS: Methacetin breath test, expressed as 60 min cumulative percent of oxidation, discriminated the hepatic functional capacity not only between controls and liver disease patients, but also between different categories of chronic liver disease patients. Methacetin breath test was correlated with liver function tests and serum bile acids.Furthermore, methacetin breath test, as well as serum bile acids, were highly predictive of Child-Pugh scores. The diagnostic power of phenylalanine breath test was always less than that of methacetin breath test.CONCLUSION: Methacetin breath test represents a safe and accurate diagnostic tool in the evaluation of hepatic functional mass in chronic liver disease patients.

Could quantitative liver function tests gain wide acceptance among hepatologists?

It has been emphasized that the assessment of residual liver function is of paramount importance to determine the following： severity of acute or chronic liver diseases independent of etiology; long-term prognosis; step-bystep disease progression; surgical risk; and efficacy of antiviral treatment. The most frequently used tools are the galactose elimination capacity to asses hepatocyte cytosol activity, plasma clearance of indocyanine green to assess excretory function, and antipyrine clearance to estimate microsomal activity. However, a widely accepted liver test （not necessarily a laboratory one） to assess quantitative functional hepatic reserve still needs to be established, although there have been various proposals. Furthermore, who are the operators that should order these tests？ Advances in analytic methods are expected to allow quantitative liver function tests to be used in clinical practice.

Indocyanine green kinetics to assess liver function: Ready for a clinical dynamic assessment in major liver surgery?

Indocyanine green(ICG) kinetics(PDR/R15) used to quantitatively assess hepatic function in the perioperative period of major resective surgery and liver transplantation have been the object of an extensive, updated and critical review. New, non invasive bedside monitors(pulse dye densitometry technology) make this opportunity widely available in clinical practice. After having reviewed basic concepts of hepatic clearance, we analysed the most common indications ICG kinetic parameters have nowadays in clinical practice, focusing in particular on the diagnostic and prognostic role of PDR and R15 in the perioperative period of major liver surgery and liver transplantation. As recently pointed out, even if of extreme interest, ICG clearance parameters have still some limitations, to be considered when using these tests.

Measurement of serum paraoxonase-1 activity in the evaluation of liver function

Paraoxonase-1 (PON1) is an esterase and lactonase synthesized by the liver and found in the circulation associated with high-density lipoproteins. The physiological function of PON1 seems to be to degrade specific oxidized cholesteryl esters and oxidized phospholipids in lipoproteins and cell membranes. PON1 is, therefore, an antioxidant enzyme. Alterations in circulating PON1 levels have been reported in a variety of diseases involving oxidative stress including chronic liver diseases. Measurement of serum PON1 activity has been proposed as a potential test for the evaluation of liver function. However, this measurement is still restricted to research and has not been extensively applied in routine clinical chemistry laboratories. The reason for this restriction is due to the problem that the substrate commonly used for PON1 measurement, paraoxon, is toxic and unstable. The recent development of new assays with non-toxic substrates makes this proposal closer to a practical development. The present editorial summarizes PON1 biochemistry and function, its involvement with chronic liver impairment, and some aspects related to the measurement of PON1 activity in circulation.

Role of epidural anesthesia in a fast track liver resection protocol for cirrhotic patients-results after three years of practice

AIM To evaluate the potential benefits and risks of the use of epidural anaesthesia within an enhanced recovery protocol in this specific subpopulation.METHODS A retrospective review was conducted, including all cirrhotic patients who underwent open liver resection between January 2013 and December 2015 at Bologna University Hospital. Patients with an abnormal coagulation profile contraindicating the placement of an epidural catheter were excluded from the analysis. The control group was composed by patients refusing epidural anaesthesia. RESULTS Of the 183 cirrhotic patients undergoing open liver resections, 57 had contraindications to the placement of an epidural catheter; of the remaining 126, 86 patients received general anaesthesia and 40 combined anaesthesia. The two groups presented homogeneous characteristics. Intraoperatively the metabolic data did not differ between the two groups, whilst the epidural group had a lower mean arterial pressure(P = 0.041) and received more colloid infusions(P = 0.007). Postoperative liver and kidney function did not differ significantly.Length of mechanical ventilation(P = 0.003) and hospital stay(P = 0.032) were significantly lower in the epidural group. No complications related to the epidural catheter placement or removal was recorded.CONCLUSION The use of Epidural Anaesthesia within a fast track protocol for cirrhotic patients undergoing liver resections had a positive impact on the patient's outcomes and comfort as demonstrated by a significantly lower length of mechanical ventilation and hospital stay in the epidural group. The technique appears to be safely manageable in this fragile population even though these results need confirmation in larger studies.

Glutamine and recombinant human growth hormone protect intestinal barrier function following portal hypertension surgery

AIM： To evaluate the effects of combined treatment of glutamine （Gln） and recombinant human growth hormone（rhGH） on intestinal barrier function following portal hypertension surgery. METHODS： This study was designed as a prospective, randomized and controlled clinical trial. Forty two patients after portal hypertension surgery were randomly assigned into 2 groups： control group （n = 20） and supplemental group （adding Gin and rhGH, n = 22）. Every patient received isocaloric and isonitrogenous standard total parenteral nutrition （TPN） starting 3 d after surgery for 7 d. Blood samples were obtained before surgery and at the 3rd and 10th day postoperatively. Host immunity was evaluated by measuring levels of CD4, CD8, CD4/CD8, IgG, IgM and IgA, and the inflammatory responses were determined by assessing IL-2, TNF-α and C-reactive protein （CRP） levels. Intestinal permeability and integrity was evaluated by L/M test and histological examination, respectively. RESULTS： On postoperative d 10, CD4, CD4/CD8, IgG and IL-2 levels in supplemental group were significantly higher than those in control group （33.7±5.5 vs 31.0 ± 5.4, P 〈 0.05, （1.17±0.32 vs 1.05 ± 0.15, P 〈 0.05, 13.94±1.09 vs 12.33±1.33, P 〈 0.05, and 368.12 ± 59.25 vs 318.12 ± 45.65, P 〈 0.05, respectively）, whereas the increase in serum TNF-α concentration was significantly reduced （41.02 ± 27.56 vs 160.09 ± 35.17, P 〈 0.05）. The increase in L/M ratio was significantly lower in the supplemental group than in the control group （0.0166 ± 0.0017 vs 0.0339 ± 0.0028, P 〈 0.05）. Moreover, mucosal integrity in the supplemental group was better than in the control group.CONCLUSION： Postoperative administration of TPN supplemented with Gin and rhGH in patients after portal hypertension surgery improves immune function, modulates inflammatory response, prevents the intestinal mucous membrane from atrophy and preserves intestinal integrity.

HBV genotype characterization and distribution in patients with HBV-related liver diseases in Zhejiang Province, P. R. China: possible association of co-infection with disease prevalence and severity

BACKGROUND: There are 8 well-documented genotypes of hepatitis B virus (HBV) at this time point. Genotyping can be accomplished based on a partial sequence of hepatitis B virus (HBV) genome such as the pre-S or S gene. Several methods have been developed and used for HBV genotyping including direct sequencing, restriction fragment length polymorphism, line probe assay and enzyme-linked immunoassay. Recently, a novel, rapid and cost-effective genotyping method based on PCR amplification assay using type-specific primers that can identify all six major genotypes has been developed. This study was undertaken to characterise HBV genotypes and investigate the association between the prevalence of different genotypes and the severity of HBV-induced liver diseases. METHODS: Serum samples from carriers of HBV and patients with HBV-related liver diseases from Zhejiang Province were screened for viral serological markers using commercially available radioimmunoassay (RIA) and enzyme linked immunosorbent assay (ELISA) kits. Serum HBV DNA load was determined by real-time detection PCR. A type-specific primer based the nested-PCR method was employed in the HBV genotyping. The genotype results obtained were confirmed by direct sequencing of nested PCR amplicons of the pre-S region. Ten samples of each genotype (B and C) were sequenced. RESULTS: The survey on a cohort of 125 HBV carriers in and around Hangzhou City, Zhejiang Province showed the existence of HBV genotypes A (0.8%), B (48%), C (40.8%), D (0.8%), mixed B and C (9.6%) and an absence of E and F genotypes. Distribution of HBV genotypes in patients with liver diseases revealed a statistically insignificant higher prevalence of genotype B in mild chronic hepatitis (CH). Among the three genotypes B, C and mixed B/C infections 11 (73.3%), 3 (20%) and 1 (6.7%), (P< 0.05), respectively in subjects with moderate CH, genotype B was significantly predominant. The infection patterns for genotypes B, C and B/C mixed in (i) liver cirrhosis (LC) 4 (23.5%), 10 (58.8%) and3 (17.7%) and (ii) hepatocellular carcinoma (HCC) 2 (28.6%), 5(71.4%) and 0 (0.0%) respectively revealed a marked association of C genotype with liver disease; however, the association was statistically insignificant (P >0.05). Differences in positive rate of HBeAg for the three genotypes B, 16(30.8%), C, 27(51.9%), and mixed B/C, 9(17.3%) were significant (P < 0. 05 ) , with genotype C showing predominance. CONCLUSIONS : These findings show an interesting distribution of HBV A-D genotypes in Zhejiang Province. Furthermore, our results indicate a novel and markedly high prevalence of mixed B/C genotype infections in subjects with severe CH and LC, and a possible association of mixed B/C infections with the severity of liver diseases in this region of China's Mainland.

Liver-related effects of chronic hepatitis C antiviral treatment

More than five years ago,the treatment of hepatitis C virus infection was revolutionized with the introduction of all-oral direct-acting antiviral(DAA)drugs.They proved highly efficient in curing patients with chronic hepatitis C(CHC),including patients with cirrhosis.The new DAA treatments were alleged to induce significant improvements in clinical outcome and prognosis,but the exact cause of the expected benefit was unclear.Further,little was known about how the underlying liver disease would be affected during and after viral clearance.In this review,we describe and discuss the liver-related effects of the new treatments in regards to both pathophysiological aspects,such as macrophage activation,and the time-dependent effects of therapy,with specific emphasis on inflammation,structural liver changes,and liver function,as these factors are all related to morbidity and mortality in CHC patients.It seems clear that antiviral therapy,especially the achievement of a sustained virologic response has several beneficial effects on liver-related parameters in CHC patients with advanced liver fibrosis or cirrhosis.There seems to be a timedependent effect of DAA therapy with viral clearance and the resolution of liver inflammation followed by more discrete changes in structural liver lesions.These improvements lead to favorable effects on liver function,followed by an improvement in cognitive dysfunction and portal hypertension.Overall,the data provide knowledge on the several beneficial effects of DAA therapy on liverrelated parameters in CHC patients suggesting short-and long-term improvements in the underlying disease with the promise of an improved longterm prognosis.

Measurement of liver function for patients with cirrhosis by ^13C-methacetin breath test compared with Child-Pugh score and routine liver function tests

^13C-methacetin breath test was used for the evaluation of liver function, as for quantitative data could be achieved using this method, it had the characteristics of safety, quantification, and repetition and got recognition gradually through the world. We began this ^13C- methacetin test to assess liver function of patients with cirrhosis from January 2002. The aim of this study was to explore the characteristic of this test for liver function evaluation and explore the correlation of this method with some clinical liver biochemical parameters and Child-Pugh score.

Differential hepatic features presenting in Wilson disease-associated cirrhosis and hepatitis B-associated cirrhosis

BACKGROUND Cirrhosis is a chronic late stage liver disease associated with hepatitis viruses,alcoholism, and metabolic disorders, such as Wilson disease(WD). There are no clear markers or clinical features that define cirrhosis originating from these disparate origins. We hypothesized that cirrhosis is not one disease and cirrhosis of different etiology may have differential clinical hepatic features.AIM To delineate the liver features between WD-associated cirrhosis and hepatitis Bassociated cirrhosis in the Chinese population.METHODS In this observational study, we reviewed the medical data of consecutive inpatients who had WD-associated cirrhosis or hepatitis B-associated cirrhosis from January 2010 to August 2018, and excluded patients who had carcinoma,severe heart or pulmonary diseases, or other liver diseases. According to the etiology of cirrhosis, patients were divided into two groups: WD-associated cirrhosis group(60 patients) and hepatitis B-associated cirrhosis group(56 patients). The liver fibrosis degree, liver function indices, and portal hypertension features of these patients were compared between the two groups.RESULTS No inter-group differences were observed in the diagnostic liver fibrosis markers,however, clinical features clearly defined the origin of cirrhosis. WD-associated cirrhosis patients(16-29 years) had lower levels of alanine transaminase,aspartate transaminase, and bilirubin, lower prothrombin time, lower incidence of hepatic encephalopathy, and lower portal vein diameter(P < 0.05), compared to cirrhosis resulting from hepatitis B in older patients(45-62 years). Importantly,they had decreased risks of progression from Child-Pugh grade A to B(odds ratio = 0.046, 95% confidence interval: 0.006-0.387, P = 0.005) and of ascites(odds ratio = 0.08, 95% confidence interval: 0.01-0.48, P = 0.005). Conversely, WDassociated cirrhosis patients had a higher risk of splenomegaly(odds ratio = 4.15,95% confidence interval: 1.38-12.45, P = 0.011).CONCLUSION WD-associated cirrhosis presents a higher risk of splenomegaly associated with leukopenia and thrombocytopenia, although revealing milder liver dysfunction and portal hypertension symptoms, which recommends WD patients to be monitored for associated complications.

Clinical efficacy of antiviral therapy in patients with hepatitis Brelated cirrhosis after transjugular intrahepatic portosystemic shunt

BACKGROUND As a country with a high burden of hepatitis B,China has about 86 million cases of hepatitis B virus infection,ranking the first in the world.Currently,there are about 390000 deaths due to hepatitis B-related complications such as liver cirrhosis and liver cancer every year.Consequently,how to control portal hypertension,improve liver functional reserve,and reduce the incidence of hepatic failure and liver cancer in such patients is the focus of current clinical attention.Previous clinical study in our center suggested that at 24 mo after transjugular intrahepatic portosystemic shunt(TIPS),the liver functional reserve of patients with hepatitis B cirrhosis was better than that of patients with alcoholinduced and immune cirrhosis,which may be related to the effective etiological treatment.AIM To investigate the clinical efficacy of three first-line antiviral drugs recommended by the guidelines of prevention and treatment for chronic hepatitis B in China(2019)in the treatment of patients with hepatitis B-related cirrhosis who had received a TIPS.METHODS The clinical data of 137 patients with hepatitis B-related cirrhosis with portal hypertension after receiving TIPS at our centre between March 2016 and December 2020 were analysed retrospectively.According to different anti-viral drugs,the patients were divided into entecavir(ETV)(n=70),tenofovir alafenamide fumarate(TAF)(n=32),and tenofovir disoproxil fumarate(TDF)(n=35)groups.The cumulative incidence of hepatic encephalopathy and hepatocellular carcinoma,survival,and changes in hepatic reserve function and glomerular filtration rate in patients treated with different antiviral drugs within 24 mo after surgery were investigated.RESULTS At 24 mo after surgery,the Child-Pugh score in the TAF group(6.97±0.86)was lower than that in the TDF(7.49±0.82;t=-2.52,P=0.014)and ETV groups(7.64±1.17;t=-2.92,P=0.004).The model for end-stage liver disease score in the TAF group at 24 mo after surgery was 9.72±1.5,which was lower than that in the TDF(10.74±2.33;t=-2.09,P=0.040)and ETV groups(10.97±2.17;t=-2.93,P=0.004).At 24 mo after surgery,the estimated glomerular filtration rate(eGFR)in the TAF group(104.41±12.54)was higher than that in the TDF(93.54±8.97)and ETV groups(89.96±9.86)(F=21.57,P<0.001).CONCLUSION At 24 mo after surgery,compared with TDF and ETV,TAF has significant advantages in the improvement of liver functional reserve and eGFR.

Clinical indicators for progression of nonalcoholic steatohepatitis to cirrhosis

Non-alcoholic fatty liver disease(NAFLD),is a disease spectrum characterized by fat accumulation in hepatocytes presenting as hepatic steatosis to advance disease with active hepatic inflammation,known as nonalcoholic steatohepatitis.Chronic steatohepatitis will lead to progressive hepatic fibrosis causing cirrhosis and increased risk for developing hepatocellular carcinoma(HCC).Fatty liver disease prevalence has increased at alarming rates alongside obesity,diabetes and metabolic syndrome to become the second most common cause of cirrhosis after alcohol related liver disease worldwide.Given this rise in prevalence,it is becoming increasingly more important to find non-invasive methods to diagnose disease early and stage hepatic fibrosis.Providing clinicians with the tools to diagnose and treat the full spectrum of NAFLD will help prevent known complications such as cirrhosis and HCC and improve quality of life for the patients suffering from this disease.This article discusses the utility of current noninvasive liver function testing in the clinical progression of fatty liver disease along with the imaging modalities that are available.Additionally,we summarize available treatment options including targeted medical therapy through four different pathways,surgical or endoscopic intervention.

Knowledge about non-invasive diagnostic tests for varices in liver cirrhosis:A questionnaire survey to the Gastroenterology Branch of the Liaoning Medical Association,China

Background and aims:Due to the invasiveness of upper gastrointestinal endoscopy,non-invasive diagnostic tests for varices in liver cirrhosis have been widely established by numerous studies.A questionnaire survey,which was aimed at understanding the current knowledge about non-invasive diagnostic tests for varices in liver cirrhosis,was distributed among the members of Gastroenterology Branch of the Liaoning Medical Association.Methods:A questionnaire assessing the knowledge about non-invasive diagnostic tests for varices was sent to 42 members who participated in the entire ninth committee.They were from 33 hospitals in 13 cities of Liaoning Province,China.Results:Overall,97.6%(41/42)of participants responded to the questionnaire.A majority of participants were chief physicians(85.4%),had>20 years of experience in clinical work of digestive diseases(80.5%)and worked at tertiary hospitals(97.6%).In 46.3%of participants’departments,there were>200 patients with liver cirrhosis and gastroesophageal varices admitted every year.In 90.2%of participants’departments,upper gastrointestinal endoscopy was regularly employed for the diagnosis of gastroesophageal varices.Only six(15%)participants often used non-invasive diagnostic tests for varices in clinical practice.Thirty(75%)participants knew at least one non-invasive diagnostic test for varices.The knowledge of at least one non-invasive diagnostic test was significantly associated with the number of cirrhotic patients with varices(P¼0.038)or the regular use of gastrointestinal endoscopy to diagnose varices(P¼0.022).Conclusions:This questionnaire survey suggested that non-invasive diagnostic tests for varices in liver cirrhosis were rarely or never used in clinical practices in Liaoning Province,China.Reliable,non-invasive indexes should be further explored in a well-designed multi-center observational study.

DYNAMIC OBSERVATION ON THE CHANGES OF PLASMA SOMATOSTATIN AND GLUCAGON DURING THE DEVELOPMENT OF CIRRHOSIS AND AFTER PORTACAVAL SHUNTING IN THE CIRRHOTIC RATS

In the present study we observed dynamically and systemically the changes of plasma somatostatin and glucagon in the peripheral and portal vein, and the changes of pancreatic immunopathology in the course of development of cirrhosis induced by CCl4 and after portacaval shunt （PCS） in the cirrhotic rats as well as investigated their causes and correlationship. The results showed that hyperglucagonemia was caused by spontaneous portosystemic shunting and surgically induced portacaval anastomosis. Moreover, there was much higher level of glucagon in the portal vein with corresponding increase of A cells in PCS rats than those in the controls, indicating that another cause for elevation of glucagon was hypersecretion of pancreatic A cells. Our data demonstrated that both deterioration of liver function and portosystemic shunting might not be responsible for the elevated level of somatostatin in the cirrhotic rats with PCS. However, there was a closed positive correlation between plasma glucagon and somatostatin. Thus it was concluded that hyperglucagonemia stimulated the release of somatostatin. In view of the fact the elevated level of glucagon was much higher than that of somatostatin, there was probably a relative lack of somatostatin in cirrhosis with portal hypertension.

凝血功能和血小板各项参数对重症肝硬化患者的检测价值

目的探究凝血功能和血小板各项参数对重症肝硬化患者的检测价值。方法选择柳州市柳铁中心医院自2019年1月—2020年12月广西柳州市柳铁中心医院收治的80例重症肝硬化患者作为研究对象(设为研究组),另同期80例非肝硬化患者作为参照对象(设为对照组),两组研究对象均行凝血功能和血小板检测,对比两组研究对象凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)等凝血功能水平、血小板计数(PLT)、血小板压积(PCT)、平均血小板体积(MPV)、血小板分布宽度(PDW)等血小板参数水平、单用凝血功能、血小板各项参数及凝血功能联合血小板各项参数对重症肝硬化检测诊断的准确率。结果研究组患者TT、PT、APTT、MPV、PDW水平均显著高于对照组,研究组患者FIB、PLT、PCT水平均显著低于对照组,两组对比差异具有统计学意义(P<0.05),且凝血功能联合血小板各项参数对重症肝硬化检测诊断的准确率显著高于单用凝血功能、血小板各项参数检测,组间对比差异具有统计学意义(P<0.05)。结论凝血功能和血小板各项参数对重症肝硬化患者的检测价值显著,有利于患者病情的评估。

生化检验中肝功能指标检测在肝硬化患者中的诊断价值

目的研究生化检验中肝功能指标检测对肝硬化患者的诊断价值。方法将2020年7月—2022年7月在平邑县人民医院就诊的300例肝硬化患者纳入肝硬化组,将200例慢性乙型病毒性肝炎(乙肝)患者纳入乙肝组,将同期在该院进行体检的300例健康体检者纳入健康对照组。再根据Child-Pugh分级将肝硬化组患者分为A级组(149例)、B级组(97例)、C级组(54例)。应用全自动生化分析仪检测天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、碱性磷酸酶(ALP)、胆碱酯酶(CHE),采用比色法检测白蛋白(ALB)、总蛋白(TP)、总胆红素(TBil),比较各组上述指标水平。结果肝硬化组的AST、ALT、ALP、TBil水平均明显高于乙肝组和健康对照组,CHE、ALB、TP水平均明显低于乙肝组和健康对照组[AST(U/L):58.64±8.13比45.36±6.08、20.35±2.17;ALT(U/L):65.20±5.24比54.29±4.83、15.46±2.05;ALP(U/L):189.50±10.51比171.35±7.44、72.65±5.56;TBil(μmol/L):94.55±9.11比84.56±7.36、10.95±1.42;CHE(U/L):2119.43±76.80比3245.52±197.26、7125.65±228.95;ALB(g/L):19.26±1.82比27.91±2.65、42.54±4.28;TP(g/L):38.29±2.10比51.42±2.84、73.72±4.31;均P<0.05]。肝硬化组中,Child-Pugh C级患者的AST、ALT、ALP、TBil水平均明显高于B级和A级患者,CHE、ALB、TP水平均明显低于B级和A级患者[AST(U/L):72.04±9.15比55.16±7.92、48.72±7.35;ALT(U/L):75.77±5.77比62.54±5.13、57.29±4.82;ALP(U/L):201.56±11.72比188.69±10.06、178.25±9.75;TBil(μmol/L):149.20±10.56比74.59±8.95、59.86±7.82;CHE(U/L):1342.72±65.28比1879.54±79.14、3136.03±85.98;ALB(g/L):17.29±1.22比18.47±1.59、22.02±2.65;TP(g/L):33.54±1.31比37.77±2.20、43.56±2.79;均P<0.05]。肝功能指标联合检测诊断肝硬化的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为96.33%、99.00%、97.40%、99.31%、94.74%。结论生化检验中多项肝功能相关指标联合检测对肝硬化进行诊断的价值较高,且能够与慢性乙肝进行鉴别区分。

Breath Biopsy^(®) to Identify Exhaled Volatile Organic Compounds Biomarkers for Liver Cirrhosis Detection

Background and Aims:The prevalence of chronic liver dis-ease in adults exceeds 30%in some countries and there is significant interest in developing tests and treatments to help control disease progression and reduce healthcare burden.Breath is a rich sampling matrix that offers non-invasive so-lutions suitable for early-stage detection and disease moni-toring.Having previously investigated targeted analysis of a single biomarker,here we investigated a multiparametric approach to breath testing that would provide more robust and reliable results for clinical use.Methods:To identify can-didate biomarkers we compared 46 breath samples from cir-rhosis patients and 42 from controls.Collection and analysis used Breath Biopsy OMNI™,maximizing signal and contrast to background to provide high confidence biomarker detec-tion based upon gas chromatography mass spectrometry(GC-MS).Blank samples were also analyzed to provide de-tailed information on background volatile organic compounds(VOCs)levels.Results:A set of 29 breath VOCs differed significantly between cirrhosis and controls.A classification model based on these VOCs had an area under the curve(AUC)of 0.95±0.04 in cross-validated test sets.The seven best performing VOCs were sufficient to maximize classifica-tion performance.A subset of 11 VOCs was correlated with blood metrics of liver function(bilirubin,albumin,prothrom-bin time)and separated patients by cirrhosis severity using principal component analysis.Conclusions:A set of seven VOCs consisting of previously reported and novel candidates show promise as a panel for liver disease detection and mon-itoring,showing correlation to disease severity and serum biomarkers at late stage.

彩色多普勒超声评估肝硬化门静脉高压症患者TIPS术后支架功能研究

目的探讨彩色多普勒超声评估肝硬化并发门静脉高压症(PH)患者在接受经颈静脉肝内门体分流术(TIPS)术后支架功能的价值。方法2020年1月~2022年12月我院诊治的136例肝硬化患者,经检测肝静脉压力梯度(HVPG)诊断PH,使用彩色多普勒超声测量门静脉血流速度(Vpv)、门静脉内径(Dpv)和门静脉血流量(Qpv),应用受试者工作特征(ROC)曲线评估门静脉血流动力学指标联合诊断肝硬化并发PH的效能。常规行TIPS术,使用数字减影血管造影(DSA)和超声评估支架功能。结果在本组136例肝硬化患者中,经HVPG检测,发现PH者62例(45.6%),对其中52例行TIPS术;肝硬化并发PH患者Vpv为(13.1±2.3)cm/s,显著低于肝硬化非PH者【(15.9±3.2)cm/s,P<0.05】,而Dpv和Qpv分别为(1.3±0.3)cm和(626.8±106.8)mL/min,均显著高于肝硬化非PH者【分别为(1.1±0.2)cm和(499.9±97.2)mL/min,P<0.05】,在TIPS术后,PH组门脉指标恢复,与肝硬化非PH者比,无显著性差异【分别为(16.2±2.5)cm/s、(1.1±0.2)cm和(502.1±99.4)mL/min,P<0.05】;ROC曲线分析显示,Vpv、Dpv和Qpv联合诊断肝硬化并发PH的AUC为0.902(95%CI:0.849~0.955,P<0.05),其敏感度为79.0%,特异度为83.8%;52例接受TIPS治疗患者术后1年随访,经DSA检查发现8例(15.4%)存在支架功能障碍,彩色多普勒超声诊断支架功能障碍与DSA诊断的一致性较强(Kappa=0.680,P<0.05),其敏感度为87.5%,特异度为90.9%,准确率为90.4%。结论彩色多普勒超声检查评估TIPS术后支架功能具有良好的临床应用价值。

增强CT评估肝硬化患者自发性门体分流研究

目的探讨增强CT评价肝硬化门静脉高压患者自发性门体分流(spontaneousportosystemicshunts,SPSS)的影像价值及相关临床特征。方法回顾性收集2020年6月至2022年7月于盘锦市中心医院就诊的肝硬化患者,进行腹部增强CT检查评价自发性门体分流存在、大小及类型,进行统计学分析,并记录相关临床及实验室指标。结果本研究共纳入119例肝硬化患者。无SPSS组、SPSS<8mm组与SPSS≥8mm组三组患者的总胆红素、白蛋白、凝血酶原时间、国际标准化比值、Child-Pugh分级、肝性脑病、门静脉血栓、肾静脉直径比较,差异有统计学意义(P<0.05)。多因素Logistic分析可以发现Child-PughC级、门静脉血栓为发生SPSS≥8mm的独立危险因素。无SSRS组、SSRS组中,尿酸值、胃左静脉直径、左肾静脉直径比较,差异有统计学意义(P<0.05)。结论通过增强CT可尽早发现SPSS的存在,存在SPSS特别是直径≥8mm的患者肝功能更差,更易发生门静脉血栓。SPSS在一定程度上能反映患者的肝硬化状态。

凝血酶原时间与血小板参数检验对肝硬化患者肝损伤情况的评估作用

目的分析凝血酶原时间(PT)与血小板参数检验对肝硬化患者肝损伤情况的评估作用。方法回顾性分析我院2021年7月至2022年12月收治的60例肝硬化患者的临床资料,以肝损伤程度为标准将其分为有出血组(有出血症状,19例)和无出血组(无出血症状,41例)。比较两组的凝血指标、血小板参数及肝功能指标。结果有出血组的凝血酶时间(TT)、PT、活化部分凝血活酶时间(APTT)均显著长于无出血组,纤维蛋白原(FIB)水平显著低于无出血组,差异具有统计学意义(P<0.05)。有出血组的血小板计数(PLT)、血小板压积(PCT)显著低于无出血组,平均血小板体积(MPV)、血小板分布宽度(PDW)显著高于无出血组,差异具有统计学意义(P<0.05)。有出血组的丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)水平均显著高于无出血组,白蛋白(ALB)水平显著低于无出血组,差异具有统计学意义(P<0.05)。结论PT与血小板参数检验可有效评估肝硬化患者肝损伤情况,为患者的疾病诊断和治疗方案制定提供依据。