The Chinese Society of Hepatology of the Chinese Medical Association invited relevantexperts to revise and update the Guideline of Prevention and Treatment of Nonalcoholic Fatty Liver Disease(2018Version) and renamed it as (Version 2024) Guideline for the Prevention and Treatment of MetabolicDysfunction-associated (non-alcoholic) Fatty Liver Disease. Herein, the guiding recommendations on clinicalissues such as screening and monitoring, diagnosis and evaluation, treatment and follow-up of metabolicdysfunction-associated fatty liver disease are put forward.

Objective The aim of this study was to observe the combination of glutathione and tiopronin in the treatment of patients with drug-induced liver injury (DILI). Methods 72 patients with DILI were enrolled in our hospital between December 2019 and August 2022, and were randomly divided into control (n=36) and observation (n=36) group, receiving tiopronin alone or tiopronin and glutathione combination treatment for two to four weeks. Serum malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were detected by thibabituric acid, xanthine oxidation or dithiobis-nitrobenzoic acid methods, respectively. Serum human heme oxygenase-1 (HO-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), IL-1β and C-reactive protein (CRP) levels were detected by ELISA. Results At the end of treatment, serum ALT and AST levels in the observation group were (40.6±11.5)U/L and (31.0±2.6)U/L, both significantly lower than [(64.6±13.9)U/L and (63.7±15.3)U/L, respectively, P＜0.05] in the control, while there were no significant differences respect to serum bilirubin and GGT levels in the two groups [(16.8±3.9) μmol/L and (59.2±13.3)U/L vs. (20.2±4.2)μmol/L and (60.8±14.7)U/L, respectively, P>0.05]; serum SOD, GSH-Px and HO-1 levels in the observation group were (82.4±12.7)U/L, (99.8±16.6)U/L and (256.7±20.8)U/L, all significantly higher than [(75.6±10.9)U/L, (80.6±15.4)U/L and (197.5±24.9)U/L, respectively, P＜0.05], while serum MDA level was (5.1±0.8)μmol/L, much lower than [(6.2±1.3)μmol/L, P＜0.05] in the control; serum IL-6, TNF-α, IL-1β and CRP levels were (5.1±1.7)pg/mL, (4.4±1.7)pg/mL, (11.2±4.1)ng/mL and (3.9±2.0)mg/L, all significantly lower than [(9.7±1.1)pg/mL, (10.2±1.8)pg/mL, (25.3±4.8)ng/mL and (13.6±2.9)mg/L, respectively, P＜0.05] in the control group. Conclusion The combination of glutathione and tiopronin in the treatment of patients with DILI could effectively improve liver function tests back to normal, which might alleviate body inflammatory and oxidative stress reactions, and warrants further clinical investigation.

The nonalcoholic fatty liver disease (NAFLD) is the most common liver diseases worldwide. Currently, due to the lack of effective drugs for treatment of NAFLD, the scholars recommend reducing body weight and improving metabolism through dietary interventions. In this paper, we summarize the research progress of NAFLD-related dietary interventions and the mechanisms by which they play roles in therapeutic effects in order to better guide clinical practice.

The Epstein-Barr virus (EBV) is one of the members of the human herpesvirus family, which might cause many diseases. The children with EBV infection often have liver injury, which is usually manifested as mild to moderate liver dysfunctions. In severe cases, it can develop into liver failure and even lead to death. Most children with acute EB viral infection recover after supportive treatment. However, in cases of chronic infection or post-transplant infection, the immunomodulatory therapy, chemotherapy, and even bone marrow transplantation may be required in addition to actively management of the underlying diseases. In this review, we describes the comprehensive updates of the epidemiology, pathogenesis, diagnosis, treatment and prognosis of children with liver injury associated with EBV infection.

Objective The aim of this study was to investigate the evaluation of hepatic steatosis by controlled attenuation parameter (CAP) of ultrasonic transient elastography in patients with nonalcoholic fatty liver diseases (NAFLD). Methods 78 patients with NAFLD were enrolled in our hospital between May 2020 and May 2022, and they all received liver ultrasonography and ultrasonic transient elastography for CAP. The receiver operating characteristic curve (ROC) was plotted and the area under the curve (AUC) was calculated to evaluate the efficacy of CAP in predicting the degree of hepatic steatosis in patients with NAFLD. Results The liver ultrasonography showed that out of the 78 patients with NAFLD in our series, there were mild hepatic steatosis in 41 cases, moderate hepatic steatosis in 23 cases and severe hepatic steatosis in 14 cases; serum ALT and AST levels in patients with severe liver steatosis were (77.2±14.9) U/L and (59.1±11.7)U/L, significantly higher than in patients with moderate or in patients with mild liver steatosis; serum triglyceride level and the CAP in patients with severe liver steatosis were (3.5±0.7)mmol/L and (317.7±27.6)dB/m, both significantly higher than in patients with mild or in patients with moderate, while serum high-density lipoprotein cholesterol level was (0.8±0.4)mmol/L, much lower than in patients with mild or in patients with moderate liver steatosis; with the CAP>280.4dB/m as the cut-off value for the diagnosis of moderate hepatic steatosis in patients with NAFLD, the AUC, sensitivity (Se) and specificity (Sp) were 0.783 (95%CI: 0.669-0.896), 78.3% and 75.6%, and with the CAP>309.1 dB/m as the cut-off value for the diagnosis of severe hepatic steatosis, the AUC was 0.696 (95% CI: 0.515-0.876), with the Se of 78.6% and the Sp of 69.6% (P<0.05). Conclusion The application of CAP obtained by ultrasonic transient elastography might help assess more accurately the severity of liver steatosis in patients with NAFLD.

Objective The aim of this study was conducted to explore the clinical prediction of significant liver fibrosis by transient ultrasound elastography and the aspartate aminotransferase/platelet ratio index (APRI) combination in patients with autoimmune hepatitis (AIH). Methods 67 patients with AIH and 54 healthy individuals at physical examination were enrolled in our hospital between August 2019 and August 2022, and all received FibroScan detection for liver stiffness measurement (LSM) and blood routine for the calculation of APRI. The patients with AIH underwent liver biopsies. The receiver operating characteristic curve (ROC) was applied to analyze the diagnostic performance of APRI and LSM for predicting significant liver fibrosis (SLF, >=S2) in patients with AIH. Results Serum AST level in patients with AIH was (104.3±21.9)U/L, significantly higher than [(30.5±5.1)U/L, P<0.05], the APRI and LSM were (1.4±0.1) and (8.1±1.2)kPa, both significantly greater than [(0.4±0.1) and (4.3±0.7)kPa, P<0.05], while the peripheral blood platelet count was (157.8±23.1)×10⁹/L, significantly less than [(208.5±20.7)×10⁹/L, P<0.05] in the healthy control; the liver histopathological examination showed the liver fibrosis S0 stage in 10 cases, S1 in 17 cases, S2 in 19 cases, S3 in 13 cases and S4 in 8 cases in our series; the APRI and LSM in patients with liver fibrosis S4 were(2.1±0.3) and (13.9±2.8)kPa, in S3 were (1.8±0.2) and (11.2±2.1)kPa, and in S2 were (1.5±0.2) and (7.6±1.5)kPa, all significantly higher than(1.1±0.2) and (6.1±1.2)kPa in S1 (P<0.05) or (0.8±0.1) and (4.0±0.5)kPa in S0 (P<0.05); the ROC analysis showed that the AUC was 0.950, with the sensitivity (Se) of 95.0% and the specificity (Sp) of 85.2%, when the APRI (with the cut-off-value of 1.5) and the LSM (with the cut-off-value of 7.5 kPa) were combined in predicting SLF, much superior to that by APRI(with the Se of 90.0% and the Sp of 81.5%) or by the LSM(with the Se of 75.0% and the Sp of 96.3%)diagnosis. Conclusion The combination of LSM and APRI might a high diagnostic efficacy in predicting SLF in patients with AIH, and warrants further clinical investigation.

Objective The aim of this study was to investigate the efficacy of transcatheter arterial chemoembolization (TACE) with CalliSpheres drug-loaded microspheres followed by radiofrequency ablation (RFA) in the treatment of patients with primary liver cancer (PLC). Methods 79 patients with PLC were enrolled in our hospital between January 2019 and January 2021, and were divided into observation (n=43) and control group (n=36), receiving TACE with CalliSpheres drug-loaded microspheres followed by RFA, or the routine TACE followed by RFA. All patients were followed-up for two years. The disease control rate in the two groups after treatment was evaluated according to the Response Evaluation Criteria in Solid Tumors. Serum alpha-fetoprotein (AFP) and human heat shock protein 90α (HSP90α) levels were detected by electrochemiluminescence analyzer. Results At the end of one month after treatment, the complete remission, partial remission, stable disease and the total disease control rate in the observation group were 23.3%, 46.5%, 16.3% and 86.1%, while they were 11.1%, 36.1%, 19.4% and 66.7% in the control, with the latter significantly different (P<0.05) between the two groups; at the end of three months after treatment, serum AFP and HSP90α levels in the observation group were (87.5±14.5)μg/L and (126.1±13.3)ng/mL, both significantly lower than [(164.6±17.2)μg/L and (150.8±19.7)ng/mL, respectively, P<0.05] in the control; during the period of treatment, the incidence of side effects in the two groups were 48.8% and 50.0%, not significantly different (P>0.05); the one-year survival rates in the observation and control groups were 83.7% and 72.2%, not significantly different (P>0.05), while the two-year survival rates were 69.8% and 47.2%, significantly different (P<0.05). Conclusion The TACE with CalliSpheres drug-loaded microspheres followed by RFA has a definite efficacy in the treatment of patients with PLC, which might prolong the survival rates.

Objective The aim of this study was to investigate the application of ropivacaine and triamcinolone for transversus abdominis plane block (TAPB) analgesia in patients with primary liver cancer (PLC) after laparoscopic hepatectomy (LH). Methods 74 patients with PLC were encountered in our hospital between February 2018 and February 2022, and all underwent LH. As for the post-operational analgesia, the patients were randomly divided into control (n=37) and observation (n=37) groups. The patients in the control group were given ropivacaine, while those in the observation group were additionally given triamcinolone for TAPB at base of ropivacaine. The postoperative pain was evaluated by scores of visual analogue scale (VAS). Serum substance P (SP), neuropeptide Y (NPY), dopamine (DA) and norepinephrine (NE) levels were detected by ELISA, and serum malondialdehyde (MDA), superoxide dismutase (SOD) and total antioxidant capacity (T-AOC) were detected by thibabituric acid, xanthine oxidation and microdetermination, respectively. Results At 12 h, 24 h and 48 h after surgery, the cumulative consumption of oxycodone in the observation group was significantly lower than in the control group[5.9±1.1)mg, (10.1±1.9)mg and (12.8±2.8)mg vs. (7.1±1.5)mg,(12.3±2.4)mg and (15.1±3.0)mg, P＜0.05]; the static VAS scores were (2.1±0.4), (2.4±0.7) and (2.2±0.5), significantly lower than [(2.7±0.6), (3.1±0.8) and (2.7±0.6), P＜0.05] in the control, and the dynamic state of VAS were (3.4±0.8), (3.1±0.7) and (2.8±0.6), also significantly lower than [(4.0±0.9),(4.2±1.0) and (3.6±0.9), P＜0.05] in the control; at 24 hours post-operationally, serum SP, NPY, DA and NE levels were (2.9±0.7)g/mL, (200.2±37.6)pg/mL, (95.3±17.6)mmol/L and (3.1±0.8)pg/mL, all significantly lower than [(3.5±0.6)g/mL, (233.5±31.4)pg/mL, (128.9±16.3)mmol/L and (3.9±1.1)pg/mL, respectively, P＜0.05] in the control, and the same differences were found at 48 hour post-operationally (P＜0.05); there were no significant differences respect to serum SOD, T-AOC and MDA levels in the two groups at 24 and 48 hours post-operationally (P＞0.05). Conclusion The administration of ropivacaine and triamcinolone combination for TAPB analgesia is efficacious in patients with PLC after LH, and the application of triamcinolone could effectively prolong analgesia and reduce body stress reactions.

Objective The aim of this study was to investigate the diagnostic performance of FibroScan and gamma-glutamyl transpeptidase to platelet ratio (GPR), aspartate aminotransferase to platelet ratio index (APRI)and fibrosis-4(FIB-4)for liver fibrosis (LF) evaluation in patients with chronic hepatitis B virus infection without serum alanine aminotransferase (ALT) level elevation. Method A total of 154 individuals with high serum HBV DNA loads and normal serum ALT levels were recruited in our hospital between February 2015 and December 2020, and all persons underwent liver biopsy, blood and serum parameters detection. Based on the Scheuer scoring system, the LF was determined, the liver stiffness measurement (LSM) was detected by FibroScan, and the GPR, APRI and FIB-4 were calculated. A multivariate binary Logistic regression analysis (Enter)was applied to construct predictive formulas, the receiver operating characteristic (ROC)curve was plotted, and the area under the ROC curve (AUC)was calculated, and compared by Delong method. Results Among the 154 individuals with chronic CHB infection, the liver histopathological examination showed significant LF (≥S2)in 73 cases(47.4%) and progressive LF (≥S3)in 25 cases(16.2%); the FIB-4, APRI, GPR and LSM in patients with ≥S2 were 1.0(0.8, 1.2), 0.3(0.2, 0.4), 0.2(0.2, 0.3) and 7.0(6.0, 9.0)kPa, and in patients with ≥S3 were 1.3(1.0, 1.7), 0.4(0.3, 0.5), 0.3(0.2, 0.4) and 9.0(7.4, 11.0)kPa, all significantly greater than [0.7(0.6, 1.0), 0.2(0.2, 0.3), 0.1(0.1, 0.2) and 5.0(4.1, 6.1)kPa, respectively, P<0.05] in persons with S0-S1; the predictive formula of the four parameter combination by Logistics regression analysis were as follows, Logit(≥S2)=1.303×FIB-4+9.8×GPR-0.684×APRI+0.7×LSM-7.565, with the AUC of 0.858 for predicting ≥S2 LF, and Logit(≥S3)=3.307×FIB-4+5.361×GPR-4.394×APRI+0.635×LSM-9.632, with the AUC of 0.914 for predicting ≥S3 LF, both superior to any parameter alone (all P＜0.001). Conclusion Nearly half of the individuals with chronic hepatitis B viral infection with normal serum ALT levels and detectable serum HBV DNA loads have significant LF or even progressive LF, and the FibroScan, GPR, APRI and FIB-4 might help non-invasively predict the existence of LF and warrants further investigation.

Objective The aim of this study was to compare the antiviral efficacy of tenofovir amibufenamide to tenofovir disoproxil fumarate (TDF) in the treatment of patients with chronic hepatitis B (CHB). Methods 62 patients with CHB were enrolled in our hospital between August 2021 and February 2022, and were randomly divided into group A and group B, with 31 cases in each group, receiving tenofovir amibufenamide or TDF for 48 weeks. Serum HBV DNA loads were detected by real-time fluorescence quantitative PCR, serum HBsAg and HBeAg levels were detected by ELISA, and blood routine and serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were obtained to calculate fibrosis index based on 4 factor (FIB-4) and estimated glomerular filtration rate (eGFR). The liver stiffness measurement (LSM) was determined by liver transient elastography. Results At 24 weeks of treatment, serum ALT, AST levels and serum HBV DNA load in group A were (64.3±13.6)IU/L, (61.5±4.0)IU/L and (1.2±0.2)Ig IU/mL, and at the end of 48 week treatment, they were (40.1±3.8)IU/L, (39.4±3.3)IU/L and (0.9±0.2)In IU/mL, all not significantly different compared to [(67.2±3.8)IU/L, (65.3±4.2)IU/L and (1.2±0.3)Ig IU/mL, and (38.4±4.1)IU/L, (42.8±3.9)IU/L and (0.9±0.2)Ig IU/mL, respectively, P<0.05] in group B; the LSM, FIB-4 and eGFR in group A were (7.1±1.7)kPa, (2.0±0.4) and (101.3±7.9)mL/min/1.73 m², and (7.2±1.5)kPa, (1.6±0.3) and (100.9±8.2)mL/min/1.73 m², and they were (7.3±1.6)kPa, (2.2±0.5) and (95.6±8.0)mL/min/1.73 m²(P<0.05), and (7.1±1.6)kPa, (1.6±0.4) and (94.0±7.6)mL/min/1.73 m²(P<0.05), not but eGFR, significantly different compared to in group B. Conclusion The oral administration of tenofovir amibufenamide in the treatment of patients with CHB could obtain the same good antiviral efficacy, but might has less untoward impact on renal functions, and warrants further clinical investigation.

Objective Nonalcoholic fatty liver diseases (NAFLD) is a kind of liver injury caused by metabolic stress. With the prevalence of obesity and metabolic syndrome (MetS), the NAFLD has become the most popular chronic liver disease in China. Betatrophin is a newly discovered glycoprotein closely related to glucose and lipid metabolism and insulin resistance (IR), which may be closely related to the onset and progression of NAFLD. This article reviewed the role of betatrophin in the process and development of NAFLD.

Objective This study aimed to explore the mechanism of miR-556-3p in the development of hepatocellular carcinogenesis. Methods The miR-556-3p level in cancerous and its adjacent non-cancerous tissues from patients with hepatocellular carcinoma was detected by real-time fluorescence quantitative PCR, and the phosphatase and tensin homolog (PTEN) expression was revealed by immunohistochemistry. The expression patterns of PTEN/ protein kinase B(Akt) signaling pathway-related proteins were detected by Western blotting after transfection of HepG2 cells with miR-556-3p mimic, miR-556-3p NC, PTEN cDNA and PTEN siRNA. The proliferation ability of HepG2 cells was studied by CCK-8 method, the invasion ability of cells was determined by Transwell method, and the apoptosis was detected by flow cytometry. The regulatory roles of miR-556-3p on PTEN/AKT pathway in HepG2 cells were evaluated by bioinformatics. Results The miR-556-3p loads in cancerous tissues was significantly lower than that in para-neoplastic tissues (P<0.05), and the miR-556-3p loads in HepG2 cells was also significantly lower than that in LO2 cells (P<0.05); the luciferase analysis showed that PTEN was a direct target of miR-556-3p; the proliferation rate, invasion rate and apoptosis rate in miR-556-3p-transfected HepG2 cells decreased significantly than in miR NC-transfected cells (P<0.05); the PTEN overexpression reversed the growth inhibition and apoptosis induction of miR-556-3p in HepG2 cells; the miR-556-3p inhibited PTEN/AKT activation by targeting PTEN. Conclusions The miR-556-3p loads decrease in hepatocellular carcinoma tissues, and the miR-556-3p inhibits the proliferation and invasion, and induce apoptosis in HepG2 cells. The PTEN is regulated by miR-556-3p in HepG2 cells. These findings above suggest that miR-556-3p is closely related to the transformation of liver cells, which needs further verification.

Objective The purpose of this study was to investigate the impact of hyperuricemia on virological response to sofosbuvir/daratavir therapy in patients with chronic hepatitis C (CHC). Methods 200 patients with CHC, including 38 patients with hyperuricemia, were recruited in our hospital between June 2018 and June 2023, and all received sofosbuvir/daratavir therapy for 24 weeks. The patients with CHC were followed-up for 24 weeks after discontinuation of the antiviral treatment. Results The body mass index, serum triglyceride level and the controlled attenuation parameter of liver in patients with hyperuricemia were (26.9±3.5)kg/m², (2.8±0.5)mmol/L and (273.5±15.3)dB/m, all significantly higher than (24.2±2.5)kg/m²,(1.9±0.6)mmol/L and (236.8±16.1)dB/m, respectively, P<0.05] in 162 patients with normal serum uric acid levels; the rapid virological response (RVR) and early virological response (EVR) in patients with hyperuricemia were 78.9% and 84.2%, both significantly lower than 96.9% and 100.0% (P<0.05) in patients with normal serum uric acid levels, while there were no significant differences as respect to the end of treatment virological response (94.7% vs. 100.0%) and the sustained virological response (97.4% vsl 100.0% (P>0.05) between the two groups; generally, serum uric acid levels in 16 male and 22 female patients with hyperuricemia at presentation decreased at the end of antiviral treatment, and the percentages of patients with decreased serum uric acid levels was 93.7% in male and 72.7% in female patients. Conclusion The hyperuricemia in patients with CHC might interfere with the early virological response to direct acting agent therapy, but do not impact the sustained virological response, and serum uric acid levels in most patients with hyperuricemia will return to normal.

Objective The study was conducted to assess the prediction of non-alcoholic fatty liver diseases (NAFLD) in patients with type 2 diabetes mellitus (T2DM) by neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte ratio(PLR) . Methods 110 patients with T2DM and 121 patients with T2DM and NAFLD were included in the Department of Endocrinology, Second Provincial People's Hospital between January 2021 and October 2022, and the NAFLD was proven by ultrasonography. The blood routine was checked-up. The risk factors of T2DM with NAFLD were assessed by multivariate Logistic analysis, and predictive efficacy was evaluated by ROC curve. Results The body mass index in patients with T2DM and concomitant NAFLD was (25.4±3.5)kg/m², much greater than [(23.2±3.1)kg/m², P<0.05], while the course of disease was 5.0(2.0, 8.0)yr, significantly shorter than [8.0(3.0, 13.0)yr, P<0.05] in patients with T2DM; serum alanine aminotransferase, aspartate aminotransferase, glutamyl transpeptidase, uric acid, triglyceride and total cholesterol levels in patients with T2DM and NAFLD were all significantly greater than in patients with T2DM, while serum high density lipoprotein cholesterol level was much lower than in patients with T2DM (P＜0.05); the blood lymphocyte count in patients with T2DM and NAFLD was (1.7±0.4)×10⁹/L, much lower than [(2.2±0.6)×10⁹/L, P<0.05], while the NLR and PLR were (2.4(1.8, 3.2)) and (126.1(93.3, 157.8)), both significantly greater than [1.5(1.2, 2.3) and 89.6(66.9, 116.5), respectively, P<0.05] in patients with T2DM; the Logistic analysis showed that the BMI, NLR and PLR were the risk factors for coincidence of NAFLD in patients with T2DM (P＜0.05); the ROC analysis demonstrated that the sensitivities and the specificities by NLR and PLR in prediction of NAFLD in patients with T2DM were 64.5% and 75.0%, and 71.9% and 65.4%, respectively. Conclusion The surveillance of NLR and PLR, easily accessible, in patients with T2DM might help screen preliminarily NAFLD, and warrants further clinical investigation.

With the in-depth development of liver disease research with integrated traditional Chinese and Western medicine, new approaches and new medicines for liver disease treatment continue to emerge. The traditional Chinese medicine single-target superposition, multi-target synergistic effects and toxic dispersion effects provide more ideas for liver disease treatment and become a rich source of an important way to improve the treatment of liver disease. In this paper, we introduce the mechanism of Shuganning, a herbal medicine compound, in relieving bile and reducing jaundice from the perspectives as follows: liver transporters, metabolic enzymes and nuclear receptors, and its anti-inflammatory and hepatoprotective mechanism.

Objective This clinical trial was conducted to compare the anticoagulant efficacy and safety of nafmostat mesylate (NM) and heparin (HP) during double plasma molecular absorption system (DPMAS) treatment in patients with liver failure (LF). Methods 49 consecutive patients with LF or hyperbilirubinemia were encountered in You'an Hospital affiliated to Capital Medical University between April 2022 and March 2023, and all underwent at least twice DPMAS treatment. During the procedure, the anticoagulation was crossed by NM or HP once. The prothrombin time activity (PTA) and activated partial thromboplastin time (APTT) were monitored. Results Out of the 98 DPMAS treatment, the procedure successfully completed in 97 (99.0%), only discontinued once because of plugged pipes induced by insufficient anticoagulation of HP; the satisfactory anticoagulation rate in NM-managed group was 75.5%, significantly higher than 28.6%, and the over anticoagulation rate was 2.0%, much lower than 67.3%(P<0.05)in HP-intervened group; after the procedure, the PTA and APTT in NM anticoagulant group were 20.5(13.8, 38.0)% and 83.3(55.9, 138.8)s, significantly different compared to [19.5(14.6, 31.5)% and 400.0(303.3, 400.0)s, P<0.05] in HP anticoagulant group; there were no significant differences as respect to serum bilirubin, albumin levels and platelet counts between the two groups [(279.7±99.5)μmol/L, (24.4±4.2)g/L and 59.5(42.5, 119.0) ×10⁹/L vs. (271.7±98.1)μmol/L, 23.3(21.4, 26.6)g/L and 83.8±65.9×10⁹/L, respectively, P＞0.05]; 24 hours after DPMAS, the puncture skin haemorrhage was found in one case in HP anticoagulant group, and transient increased transmembrane pressure, or venous pressure or coagulation alert by the machine occurred in two cases in NM anticoagulant group. Conclusion The extracorporeal local anticoagulation of NM during DPMAS in patients with LF is efficacious and safer, and warrants further clinical investigation.

Objective The aim of this study was to explore the changes of serum hypoxia-inducible factor-1α (HIF-1α), chemerin and adiponectin (ADPN) levels in patients with metabolic-associated fatty liver diseases (MAFLD). Methods 86 patients with MAFLD and 43 healthy individuals at physical healthy examination matched by age and gender were consecutively encountered in our hospital between March 2020 and October 2022. Serum levels of HIF-1α, Chemerin and ADPN were detected by ELISA, and the hepatic steatosis was evaluated by ultrasonography. The area under the receiver operating characteristic curve (AUC) was applied to analyze the diagnostic performance of serum indicators on severe steatosis in patients with MAFLD. Results Serum HIF-1α and chemerin levels in patients with MAFLD were (16.6±3.1)μg/L and (92.7±8.9)μg/L, both significantly higher than [(9.2±2.1)μg/L and (60.4±9.5)μg/L, P<0.05] in the control, while serum ADPN level was (15.1±3.8)mg/L, significantly lower than [(25.4±6.2)mg/L, P<0.05] in the control; serum HIF-1α and chemerin levels in 35 patients with severe hepatic steatosis were (19.9±3.7)μg/L and (107.9±10.5)μg/L, both significantly higher than [(16.3±1.9)μg/L and (92.9±8.7)μg/L, P<0.05] in 29 patients with moderate liver steatosis or [(10.5±1.8)μg/L and (84.0±8.3)μg/L, P<0.05] in 22 patients with mild steatosis, while serum ADPN level was (12.3±2.8)mg/L, much lower than [(16.4±4.8)mg/L, P<0.05] in patients with moderate steatosis or [(24.2±4.2)mg/L, P<0.05] in patients with mild steatosis; the multivariate Logistic regression analysis showed that the fasting blood glucose, triglyceride, total cholesterol, low-density lipoprotein cholesterol, HIF-1α and chemerin and low level of ADPN were the independent risk factors for severe steatosis in patients with MAFLD (P<0.05); the AUC was 0.920 by the combination of serum HIF-1α, chemerin and ADPN levels in predicting severe steatosis in patients with MAFLD, much larger than 0.846, 0.742 and 0.795(P<0.05) by the three parameter alone. Conclusion Serum HIF-1α and chemerin levels increase, while serum ADPN level decrease in patients with MAFLD, and the changes of the above three parameters are related to the steatosis degree in patients with MAFLD, and their clinical implications are worthy of further investigation.

Objective The aim of this study was to investigate the reasons of failed alcohol abstinence in patients with alcoholic liver diseases (ALD). Methods A total of 149 male patients with ALD or ALD with concomitant other liver diseases were admitted to our hospital between February 2021 and June 2022, and all were persuaded and encouraged for alcohol abstinence at first visit. The alcoholic behavior was evaluated by alcohol use disorders identification test (AUDIT), and the univariate and multivariate Logistic analysis was conducted for the factors of alcohol abstinence failure. Results The patients in our series included ALD in 88 cases, with concomitant chronic hepatitis B in 49 cases and with other liver diseases in 12 cases, characterized by mild liver disease in 27 cases, fatty liver in 36 cases, alcoholic hepatitis in 14 cases and liver cirrhosis (LC) or primary liver cancer (PLC) in 72 cases; at the end of three-month of follow-up, the alcohol abstinence failed in 53 cases (35.6%) and succeeded in 96 cases (64.4%); the ages, and the percentages of alcohol abuse longer than 30 yr, with concomitant other liver diseases and alcohol dependence in succeeded patients were (54.8±11.3)yr, 56.3%, 50.0% and 16.7%, significantly different compared to [(49.6±11.5)yr, 28.3%, 24.5% and 60.4%] in failed patients (P＜0.05); the percentages of mild liver diseases, fatty liver, alcoholic hepatitis and LC/PLC in succeeded patients were 17.7%, 15.6%, 6.3% and 60.4%, significantly different compared to 18.9%, 39.6%, 15.1% and 26.4% in failed patients (P＜0.05); the multivariate Logistic analysis showed that the alcohol dependence, simple ALD, mild liver diseases, fatty liver and alcoholic hepatitis were the main risk factors for short-term failed alcohol abstinence (P＜0.05). Conclusion More than one-third (35.6%) of patients with ALD or ALD with other liver diseases fail to abstain from drinking, and the alcohol dependence ALD alone and mild illness are the independent risk factors for abstinence failure.

Objective The aim of this study was to investigate the short-term efficacy of glycyrrhizin and fenofibrate combination in the treatment of patients with metabolic associated fatty liver disease (MAFLD). Methods 74 patients with MAFLD were recruited in our hospital between December 2019 and December 2021, and were randomly divided into control and observation group, with 37 cases in each, receiving oral glycyrrhizin or glycyrrhizin and fenofibrate combination therapy for 24 weeks. The controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were detected by Fibrotouch, and the fatty liver index (FLI) was calculated. Results At the end of 24 weeks of treatment, serum high-density lipoprotein level in the observation group was (1.7±0.4)mmol/L, significantly higher than [(1.4±0.3)mmol/L, P＜0.05], while serum total cholesterol, triglyceride and low density lipoprotein levels were(4.7±0.7)mmol/L,(2.2±0.4)mmol/L and (2.0±0.3)mmol/L, all significantly lower than [(5.5±0.9)mmol/L, (3.4±0.7)mmol/L and (2.6±0.4)mmol/L, respectively, P＜0.05] in the control; serum alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transferase levels in the observation group were (50.5±4.9)U/L,(56.5±6.8)U/L and (92.0±11.5)U/L, all not significantly different compared to [(53.6±5.8)U/L, (50.4±7.7)U/L and (90.3±18.6)U/L, respectively, P＜0.05] in the control group; the CAP and the FLI in the observation group were (281.2±16.7)dB/m and (19.9±4.5), both significantly lower than [(316.1±29.5)dB/m and (23.2±5.0), respectively, P＜0.05] in the control, while there was no significant difference as respect to the LSM between the two groups [(8.4±1.7)kPa vs.(8.2±1.3)kPa, P>0.05]. Conclusion The application of glycyrrhizin and fenofibrate combination in treatment of patients with MAFLD is efficacious, which might regulate lipid metabolism, improve liver function recovery and reduce liver fat content.

Objective The aim of this study was to investigate the 3-year follow-up results of patients with serum HBeAg-positive chronic hepatitis B (CHB) after 48 to 72 week pegylated interferon α-2a (peg-IFN α-2a) treatment. Methods 72 na-ve patients with serum HBeAg-positive CHB were recruited in our hospital between March 2017 and March 2018, and all received peg-IFN α-2a treatment, including 33 patients in group A treated for 48 weeks and 39 patients in group B for 72 weeks. All patients in our series were followed-up for three years. The clinical efficacy, as serum HBsAg disappearance rate, HBeAg disappearance rate, HBeAg seroconversion rate, HBV DNA negative conversion rate and ALT normalization rate were compared between the two groups. The liver stiffness measurement (LSM) was measured by FibroTouch liver transient elastography. The independent impacting factors for serum HBeAg seroconversion were analyzed by Logistics regression analysis. Results At the end of 48 week treatment, there was no significant difference respect to the antiviral efficacy between the two groups (P>0.05); at the end of 72 weeks, serum HBsAg disappearance, HBeAg disappearance, HBeAg seroconversion, HBV DNA loss and ALT normalization rates in group B were 33.3%, 64.1%, 71.8%, 69.2% and 74.4%, much higher than 12.1%, 39.4%, 48.5%, 45.5% and 51.5% (P<0.05) in group A; at the end of two year follow-up, serum HBsAg disappearance, HBeAg disappearance, HBeAg seroconversion, HBV DNA loss and ALT normalization rates in group B were 43.6%, 69.2%, 74.4%, 74.4% and 79.5%, much higher than 21.2%, 42.4%, 51.5%, 48.5% and 54.6% (P<0.05) in group A and at the end of 3 year follow-up, they were 46.2%, 76.9%, 82.1%, 79.5% and 84.6% in group B, also much higher than 27.3%, 57.6%, 60.7%, 60.6% and 72.7% (P<0.05) in group A; at the end of 3 year follow-up, serum HBeAg seroconversion was obtained in 52 cases in our series, and there were significant differences as respect to the ages, antiviral regimen period and serum HBeAg levels at baseline between patients with and without serum HBeAg seroconversion (P<0.05); the multivariate Logistics analysis showed that the age, treatment course of peg-IFN α-2a and baseline HBeAg levels were the independent factors affecting HBeAg seroconversion (P<0.05). Conclusion The prolongation of antiviral course of peg-IFN α-2a might improve the clinical efficacy, and the regimen has a good safety and could enhance the anti-hepatic fibrosis ability.

Hepatocellular carcinoma (HCC) has complex biological characteristics, highly heterogeneous property and immunosuppressive tumor microenvironment. HCC carries a dismal prognosis. Metabolic reprogramming (MR) is one of the most important features of tumor cells and the lipid metabolism has been an important mechanism underlying HCC growth and metastasis. In this article, we review the roles of common lipid and its metabolism-related molecules in carcinogenesis of HCC and provides new targets for therapy of HCC.

Objective The aim of this study was to observe the efficacy and peripheral blood regulatory B cell subset changes in patients with autoimmune hepatitis (AIH) undergoing magnesium isoglycyrrhizinate and standard immunosuppressive therapy. Methods 108 patients with AIH were encountered in our hospital between April 2017 and April 2022, and were randomly divided into control (n=54) and observation (n=54) group, receiving standard immunosuppression treatment or oral magnesium isoglycyrrhizinate at base of it for six month. Serum immunoglobulin levels were detected by immunoturbidimetry, and peripheral blood B cell and regulatory B cell subsets were detected by FCM. Results At the end of six-month treatment, the biochemical response rate in the observation group was 85.2%, much higher than 66.7%(P＜0.05) in the control; serum ALT, AST and ALP level were (51.2±7.6)U/L, (46.2±8.6)U/L and (67.4±2.4)U/L, all significantly lower than[(80.3±8.5)U/L, (75.7±6.4)U/L and (89.7±2.6)U/L, respectively, P<0.05] in the control; there were no significant differences as respect to serum IgG, IgM and globulin levels between the two groups (P>0.05); the percentages of peripheral blood CD19⁺B cell, CD19⁺IL-10⁺B cell, CD19⁺CD24^hiCD38^hi regulatory B cell and CD19⁺CD24^hiCD27⁺ regulatory B cell were (7.1±2.6)%, (0.6±0.2)%, (2.9±1.0)% and (5.7±1.3)%, all significantly higher than [(5.2±1.8)%, (0.4±0.1)%, (2.2±0.9)% and (4.3±1.2)%, respectively, P<0.05], while the percentages of blood CD19⁺CD27⁺CD38⁺⁺ plasma cell and CD19⁺CD27^-CD38^-/+ naïve B cell were (4.2±1.2)% and (56.2±7.9)%, both much lower than [(6.5±1.7)% and (70.5±7.4)%, P<0.05] in the control. Conclusion The administration of standardized immunosuppressant and magnesium isoglycyrrhizinate combination therapy in the treatment of patients with AIH is efficacious, with a promising biochemical response, which might be related to the roles on modulation of peripheral blood regulatory B cells.

Objective The aim of this study was to investigate the pathogenic bacteria distribution and serum interferon-gamma (IFN-γ) and interleukin-6 (IL-6) level changes in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) complicated by bacterial infections. Methods 86 patients with HBV-ACLF were admitted to our hospital between December 2019 and January 2023, and the bacteria were isolated and identified routinely. Serum procalcitonin (PCT) level was detected by electrochemiluminescence immunoassay, and serum IFN-γ and IL-6 levels were assayed by ELISA. The diagnostic performance was evaluated by the area under the receiver operating characteristic (ROC) curve. Results 37 patients in our series were found having bacterial infection, and out of them, 68 pathogenic bacteria strains were characterized with Gram-negative bacteria infection in 41 strains and Gram-positive bacterial infection in 27 strains(39.7%); serum PCT, IFN-γ and IL-6 levels in patients with bacterial infection were (10.9±3.1)μg/L, (46.5±1.9)pg/mL and (16.9±1.6)pg/mL, all significantly higher [(0.9±0.1)μg/L, (20.1±2.4)pg/mL and (4.8±0.9)pg/mL, respectively, P＜0.05], and 28-day and 90-day fatality rates were 67.6% and 75.7%, both significantly higher than 8.2% and 12.2% (P＜0.05) in patients without bacterial infection; the ROC analysis showed that the AUC was 0.874, with the sensitivity of 93.6% and the specificity of 84.1%, when the combination of serum parameters was applied to predict bacterial infection as serum PCT＞3.3μg/L, serum IFN-γ＞45.5 pg/mL and IL-6＞15.4 pg/mL was set as the cut-off-value. Conclusion The distribution of pathogenic bacteria in patients with HBV-ACLF complicated by bacterial infections is characteristic, and the Gram-negative bacteria is the main common pathogenic bacteria. Besides serum PCT level, the surveillance of serum IFN-γ and IL-6 levels is helpful for early diagnosis of bacterial infection in this setting.