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Mei L, Ma Y, Zhao L, Chen Q, Zhou L, Yang H, Liu J, Li J. Correlation between serum liver fibrosis markers and early gastroesophageal varices among patients with compensated liver cirrhosis: a cross-sectional analysis. BMC Gastroenterol 2022; 22:515. [PMID: 36510159 PMCID: PMC9746016 DOI: 10.1186/s12876-022-02546-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/19/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND AIM Portal hypertension is a common complication of chronic liver diseases responsible for most liver cirrhosis consequences. In patients with portal hypertension, oesophagogastric variceal bleeding is a leading cause of death. Most research has focused on high-risk gastroesophageal varices and bleeding, with only a few studies on early varices. However, early intervention of gastroesophageal varices was found to better improve the prognosis and reduce mortality, but there is still no relevant research. Ultrasonic endoscopy is a combination of endoscopy and ultrasonic imaging. It can gastroscopically detect varices around the oesophagus and stomach and detect oesophageal collateral veins and perforating veins earlier, which is helpful for the early diagnosis of varices. Therefore, this study aimed to explore the correlation between serum fibrosis markers and early gastroesophageal varices in compensated cirrhosis patients. METHODS This study included 791 patients with compensated cirrhosis. The selected patients were categorized into three groups. The early gastroesophageal varices group included patients with gastroesophageal varices found by endoscopic ultrasonography but not by gastroscopy. The no gastroesophageal varices group underwent endoscopic ultrasonography and gastroscopy without varices. In addition, gastroesophageal varices can be detected with both techniques. Multiple logistic regression analysis explored the association of serum fibrosis markers with early gastroesophageal varices. RESULTS Among the 791 compensated liver cirrhosis patients, 198 patients were without gastroesophageal varices, 279 patients had early gastroesophageal varices, 314 patients had gastroesophageal varices, and both techniques could detect varices. There was a positive correlation between serum fibrosis markers and early gastroesophageal varices. In univariate logistic regression analysis, the patients with early gastroesophageal varices had lower platelet counts (P = 0.034) and higher aspartate aminotransferase (P = 0.046), total bilirubin (P = 0.041), hyaluronic acid (P < 0.001), laminin (P < 0.001), type III procollagen (P = 0.005), type IV collagen (P = 0.002), liver stiffness measurement (P = 0.001), APRI (P = 0.019) and FIB-4 (P = 0.002). Multivariate analysis showed that laminin (OR 1.011; 95% CI 1.004-1.017, P = 0.001) was an independent risk factor for predicting early gastroesophageal varices in compensated cirrhosis patients. CONCLUSION Higher laminin was independently associated with early gastroesophageal varices in compensated cirrhosis patients.
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Affiliation(s)
- Ling Mei
- grid.265021.20000 0000 9792 1228Department of Gastroenterology and Hepatology, Clinical School of the Second People’s Hospital, Tianjin Medical University, Tianjin, China ,Department of Hepatology, Tianjin Second People’s Hospital, No. 7, Sudi South Road, Nankai District, Tianjin, 300192 China
| | - Ying Ma
- grid.265021.20000 0000 9792 1228Department of Gastroenterology and Hepatology, Clinical School of the Second People’s Hospital, Tianjin Medical University, Tianjin, China ,Department of Hepatology, Tianjin Second People’s Hospital, No. 7, Sudi South Road, Nankai District, Tianjin, 300192 China
| | - Lili Zhao
- Department of Hepatology, Tianjin Second People’s Hospital, No. 7, Sudi South Road, Nankai District, Tianjin, 300192 China
| | - Qingling Chen
- grid.265021.20000 0000 9792 1228Department of Gastroenterology and Hepatology, Clinical School of the Second People’s Hospital, Tianjin Medical University, Tianjin, China ,Department of Hepatology, Tianjin Second People’s Hospital, No. 7, Sudi South Road, Nankai District, Tianjin, 300192 China
| | - Li Zhou
- Department of Hepatology, Tianjin Second People’s Hospital, No. 7, Sudi South Road, Nankai District, Tianjin, 300192 China
| | - Hang Yang
- grid.265021.20000 0000 9792 1228Department of Gastroenterology and Hepatology, Clinical School of the Second People’s Hospital, Tianjin Medical University, Tianjin, China ,Department of Hepatology, Tianjin Second People’s Hospital, No. 7, Sudi South Road, Nankai District, Tianjin, 300192 China
| | - Jie Liu
- Department of Hepatology, Tianjin Second People’s Hospital, No. 7, Sudi South Road, Nankai District, Tianjin, 300192 China
| | - Jia Li
- Department of Hepatology, Tianjin Second People’s Hospital, No. 7, Sudi South Road, Nankai District, Tianjin, 300192 China
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Bai DS, Jin SJ, Xiang XX, Qian JJ, Zhang C, Zhou BH, Gao TM, Jiang GQ. Vagus Nerve-Preserving Laparoscopic Splenectomy and Azygoportal Disconnection with Versus Without Intraoperative Endoscopic Variceal Ligation: a Randomized Clinical Trial. J Gastrointest Surg 2022; 26:1838-1845. [PMID: 35676457 DOI: 10.1007/s11605-022-05374-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/27/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Esophagogastric variceal bleeding is the most common lethal factor for patients with cirrhotic portal hypertension. We firstly developed a laparoscopic splenectomy and azygoportal disconnection (LSD) with intraoperative endoscopic variceal ligation (LSDL) technique. In this study, we aimed to evaluate whether LSDL is feasible and safe and whether LSDL can effectively prevent esophagogastric variceal re-bleeding (EVR), as compared with single LSD. METHODS In this randomized controlled single-center study, 88 patients with cirrhosis who had esophagogastric variceal bleeding and hypersplenism were randomly assigned to receive either LSD (n = 44) or LSDL (n = 44) between January 2020 and December 2021. The primary outcome was EVR. RESULTS No patients withdrew from the study. There were no significant differences in estimated blood loss, incidence of blood transfusion, time to first flatus and off-bed activity, or postoperative hospital stay between the two groups. Compared with that in the LSD group, operation time was significantly longer in the LSDL group (138.5 ± 19.4 min vs. 150.3 ± 19.0 min, P < 0.05); however, LSDL was associated with a significantly decreased EVR rate at 1-year follow-up (8/44 vs. 1/44, P < 0.05). Univariate analysis and multivariate logistic regression revealed that LSDL was a significant independent protective factor against EVR in comparison with LSD (relative risk: 0.105, 95% confidence interval 0.012-0.877; P = 0.037). CONCLUSIONS Our newly developed LSDL procedure is not only technically feasible and safe; it also contributed to lowering the EVR risk more so than single LSD. TRIAL REGISTRATION We registered our research at https://www. CLINICALTRIALS gov/ . The name of research registered is "Laparoscopic Splenectomy and Azygoportal Disconnection with Intraoperative Endoscopic Variceal Ligation." The trial registration identifier at clinicaltrials.gov is NCT04244487.
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Affiliation(s)
- Dou-Sheng Bai
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225000, China
| | - Sheng-Jie Jin
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225000, China
| | - Xiao-Xing Xiang
- Department of Digestive Diseases, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jian-Jun Qian
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225000, China
| | - Chi Zhang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225000, China
| | - Bao-Huan Zhou
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225000, China
| | - Tian-Ming Gao
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225000, China
| | - Guo-Qing Jiang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225000, China.
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Su J, Zhang H, Ren M, Xing Y, Yin Y, Liu L. Efficacy and Safety of Ligation Combined With Sclerotherapy for Patients With Acute Esophageal Variceal Bleeding in Cirrhosis: A Meta-Analysis. Front Surg 2021; 8:664454. [PMID: 34179067 PMCID: PMC8219859 DOI: 10.3389/fsurg.2021.664454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/22/2021] [Indexed: 01/30/2023] Open
Abstract
Objective: To evaluate the efficacy and safety of endoscopic variceal ligation + endoscopic injection sclerotherapy (EVL+EIS) to control acute variceal bleeding (AVB). Methods: Online databases, including Web of Science, PubMed, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM) disc, VIP, and Wanfang, were searched to identify the studies comparing the differences between EVB+EIS and EVB, EIS from the inception of the databases up to December 30, 2020. STATA 13.0 was used for the meta-analysis. Results: A total of eight studies involving 595 patients (317 patients in the EVL group and 278 patients in the EVL+EIS group) were included. The results of the meta-analysis did not reveal any statistically significant differences in the efficacy of acute bleeding control (P = 0.981), overall rebleeding (P = 0.415), variceal eradication (P = 0.960), and overall mortality (P = 0.314), but a significant difference was noted in the overall complications (P = 0.01). Conclusion: EVL is superior to the combination of EVL and EIS in safety, while no statistically significant differences were detected in efficacy. Further studies should be designed with a large sample size, multiple centers, and randomized controlled trials to assess both clinical interventions.
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Affiliation(s)
- Juan Su
- Department of Gastrology Ward III, Xi'an International Medical Center Hospital, Xi'an, China
| | - Huilin Zhang
- Department of Digestive Endoscopy and Treatment Center, Xi'an International Medical Center Hospital, Xi'an, China
| | - Maifang Ren
- Department of Gastrology Ward I, Xi'an International Medical Center Hospital, Xi'an, China
| | - Yanan Xing
- Department of Gastrology Ward III, Xi'an International Medical Center Hospital, Xi'an, China
| | - Yuefei Yin
- Department of Gastrology Ward I, Xi'an International Medical Center Hospital, Xi'an, China
| | - Lihua Liu
- Department of Gastrology Ward III, Xi'an International Medical Center Hospital, Xi'an, China
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Kui X, Wang Y, Zhang C, Li H, Li Q, Ke Y, Wang L. Prognostic value of SH3PXD2B (Tks4) in human hepatocellular carcinoma: a combined multi-omics and experimental study. BMC Med Genomics 2021; 14:115. [PMID: 33906640 PMCID: PMC8080318 DOI: 10.1186/s12920-021-00963-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the most common and fatal cancers worldwide. HCC invasion and metastasis are crucial for its poor prognosis. SH3PXD2B is a scaffold protein and critical for intravascular and extravascular invasion and metastasis of various types of tumors. However, the role of SH3PXD2B in HCC progression remains unclear. METHODS The levels of SH3PXD2B mRNA transcripts in the TCGA database and SH3PXD2B protein expression in the Human Protein Atlas were analyzed. Furthermore, the levels of SH3PXD2B expression in clinical samples were analyzed by quantitative RT-PCR and immunohistochemistry. The potential association of the levels of SH3PXD2B expression with clinicopathological characteristics, overall survival (OS), and recurrence-free survival (RFS) of HCC patients was analyzed. The impact of SH3PXD2B silencing by shRNA-based lentivirus transduction on the proliferation and invasion of human HCC Hep3B and Huh7 cells was determined. RESULTS SH3PXD2B expression was up-regulated in HCC tissues in the TCGA and Human Protein Atlas as well as clinical samples, relative to that of non-tumor liver samples. The levels of SH3PXD2B expression in HCC tissues were significantly associated with higher HBV infection rate, higher HCC grades and TNM stages, higher Ki-67 expression, higher serum α-fetoprotein (AFP), a shorter OS and RFS of HCC patients. Functionally, SH3PXD2B silencing significantly inhibited the formation and function of invadopodia and the invasion of Hep3B and Huh7 cells, but did not affect their proliferation in vitro. CONCLUSIONS Our data suggest that SH3PXD2B may promote the invasion and metastasis of HCC and be a valuable therapeutic target and biomarker for treatment and prognosis of HCC.
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Affiliation(s)
- Xiang Kui
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Yan Wang
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Cheng Zhang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
- Department of Hepatobiliary Surgery, The Sixth People's Hospital of Chengdu, Chengdu, 610051, China
| | - Hai Li
- School of Medicine, Kunming University, Kunming, 650214, China
| | - Qingfeng Li
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Yang Ke
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.
| | - Lin Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.
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