Effect of laparoscopic splenectomy on portal vein thrombosis and serum YKL-40 in patients with cirrhotic portal hypertension

Significance of chitinase-3-like protein 1 in the pathogenesis of inflammatory diseases and cancer

Chitinase-3-like protein 1 (CHI3L1) is a secreted glycoprotein that mediates inflammation, macrophage polarization, apoptosis, and carcinogenesis. The expression of CHI3L1 is strongly upregulated by various inflammatory and immunological diseases, including several cancers, Alzheimer's disease, and atherosclerosis. Several studies have shown that CHI3L1 can be considered as a marker of disease diagnosis, prognosis, disease activity, and severity. In addition, the proinflammatory action of CHI3L1 may be mediated via responses to various proinflammatory cytokines, including tumor necrosis factor-α, interleukin-1β, interleukin-6, and interferon-γ. Therefore, CHI3L1 may contribute to a vast array of inflammatory diseases. However, its pathophysiological and pharmacological roles in the development of inflammatory diseases remain unclear. In this article, we review recent findings regarding the roles of CHI3L1 in the development of inflammatory diseases and suggest therapeutic approaches that target CHI3L1.

Clinical efficacy of total laparoscopic splenectomy for portal hypertension and its influence on hepatic hemodynamics and liver function

BACKGROUND

The liver hemodynamic changes caused by portal hypertension (PH) are closely related to various complications such as gastroesophageal varices and portosys-temic shunts, which may lead to adverse clinical outcomes in these patients, so it is of great clinical significance to find treatment strategies with favorable clinical efficacy and low risk of complications.

AIM

To study the clinical efficacy of total laparoscopic splenectomy (TLS) for PH and its influence on hepatic hemodynamics and liver function.

METHODS

Among the 199 PH patients selected from October 2016 to October 2020, 100 patients [observation group (OG)] were treated with TLS, while the remaining 99 [reference group (RG)] were treated with open splenectomy (OS). We observed and compared the clinical efficacy, operation indexes [operative time (OT) and intraoperative bleeding volume], safety (intraperitoneal hemorrhage, ascitic fluid infection, eating disorders, liver insufficiency, and perioperative death), hepatic hemodynamics (diameter, velocity, and flow volume of the portal vein system), and liver function [serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), and serum total bilirubin (TBil)] of the two groups.

RESULTS

The OT was significantly longer and intraoperative bleeding volume was significantly lesser in the OG than in the RG. Additionally, the overall response rate, postoperative complications rate, and liver function indexes (ALT, AST, and TBil) did not differ significantly between the OG and RG. The hepatic hemodynamics statistics showed that the pre- and postoperative blood vessel diameters in the two cohorts did not differ statistically. Although the postoperative blood velocity and flow volume reduced significantly when compared with the preoperative values, there were no significant inter-group differences.

CONCLUSION

TLS contributes to comparable clinical efficacy, safety, hepatic hemodynamics, and liver function as those of OS in treating PH, with a longer OT but lesser intraoperative blood loss.

Diagnostic validity of serum YKL-40 as a non-invasive diagnostic marker of oesophageal varices in cirrhotic hepatitis C virus patients

Background

Liver cirrhosis is the last phase of chronic hepatitis C virus infection. During the compensated phase, portal pressure is still below the point where varices start to form. On the contrary, decompensated individuals have clinically significant portal hypertension. YKL-40 protein is categorized as an inflammatory protein and is related to various different variables in expressing the severity of hepatic fibrosis, including hepatic venous pressure gradient. The objective of this research was to evaluate the diagnostic validity of serum YKL-40 in cirrhotic hepatitis C virus patients as a predictive non-invasive marker for the diagnosis of oesophageal varices and to compare it to other non-invasive clinical, laboratory, and ultrasonographic parameters, as well as endoscopy with and without treatment modalities.

Results

The present research was done on 80 participants visiting the Tropical Medicine Department at the Main University Hospital in Alexandria; they were divided into four groups, group I (n = 20) cirrhotic patients with no oesophageal varices, group II (n = 20) with small varices, group IIIa (n = 20) with large varices, and group IIIb same patients of group IIIa but after disappearance of varices by band ligation and medical treatment with carvedilol and group IV as apparently healthy control. YKL-40 in serum was evaluated using ELISA. Serum YKL-40 was statistically significantly higher in all cirrhotic patients than healthy controls (p = <0.001). Furthermore, it was statistically significantly greater in patients with small varices compared to those without varices (p = <0.001) and in large varices rather than no varices or small varices (p < 0.001) and (p < 0.001) respectively. However, there was no statistically significant difference between IIIa and IIIb (p = 0.881). In all tested groups, there was no correlation between serum YKL-40 and FIB-4 or APRI. However, only participants in group I exhibited a significant negative correlation between serum YKL-40 and AST/ALT ratio, whereas subjects in groups II and IIIa exhibited no significant correlation.

Conclusion

Serum YKL-40 could be used as a sensitive non-invasive predictor for diagnosis and grading of oesophageal varices but not for follow up after treatment.