Objective Non-alcoholic fatty liver diseases (NAFLD) is the most prevalent chronic liver disease worldwide at present, and the main mechanisms involved in the pathogenesis include insulin resistance, oxidative stress and so on. Different serum markers are closely related to the pathogenesis of NAFLD, but there is no clear conclusion yet. This article reviewed the important role of different serum markers in patients with NAFLD.

Objective This experiment aimed to investigate the protective effects and mechanisms of berberine (BBR) on hepatic steatosis by activation of KLF4 via targeting HDAC/H3K9ac in palmitic acid (PA)-induced HepG2 cells in vitro. Methods HepG2 cells were induced by PA to construct hepatocyte steatosis model. The fat deposition was determined by oil red O staining. The cellular HDAC1, H3K9ac, KLF4, SREBP-1c and PPARγ expression was assayed by Western blot. The H3K9Ac in the KLF4 promoter region was determined by chromatin immunoprecipitation (ChIP). The supernatant cytokine levels were identified by ELISA kits. The KLF4 gene was silenced by siRNA to verify the protective effects of BBR by targeting HDAC/H3K9Ac/KLF4 in PA-induced HepG2 cells. Results The BBR treatment significantly improved lipid deposition in PA-induced HepG2 cells compared to that in model cells, and the supernatant TNF-α, IL-1β and IL-6 levels were (514.7±46.4) pg/ml, (241.5±37.7) pg/ml and (362.7±19.9) pg/ml, significantly lower than [(1162.0±110.8) pg/ml, (635.8±73.4) pg/ml and (1110.0±85.1) pg/ml, respectively, P < 0.001] in the model; the expression of HDAC1 protein in BBR-intervened group decreased by 19.0%, while the expression of H3K9ac and KLF4 protein increased by 1.53 and 1.52 times, the level of H3K9ac in KLF4 promoter region increased by 3.97 times, and the expression of lipid synthesis related gene SREBP-1c protein decreased by 49.1%, the expression of lipid decomposition related gene PPARγ protein increased 1.84 times compared to in the model cells; compared with empty plasmid transfection, the expression level of HDAC1 protein in cells transfected with eukaryotic plasmids was increased by 2.02 times, and the expression level of H3K9Ac protein was decreased by 57.1%; compared with SiRNA-NC transfection, the KLF4 protein expression level in HepG2 cells after SiRNA-KLF4 transfection was significantly decreased (P < 0.01), lipid deposition was significantly increased, the levels of TNF-α, IL-1β and IL-6 were (887.9±89.9) pg/ml, (471.9±38.4) pg/ml and (793.1±59.3) pg/ml, significantly higher than [(534.2±46.1) pg/ml, (260.3±26.9) pg/ml and (372.0±30.6) pg/ml, P < 0.01] in SiRNA-NC transfected cells, and the expression of lipid synthesis related gene SREBP-1c protein was increased by 1.77 times, while the expression of PPARγ protein associated with lipid decomposition decreased by 41.6%. Conclusion Taking together, the findings in the present study indicate that BBR protects from cell steatosis and inflammatory reactions by activation of KLF4 via regulating HDAC1/H3K9ac in PA-induced HepG2 cells, which provides the insight into new therapeutic approaches for patients with non-alcoholic fatty liver disease management.

Objective The aim of this experiment was to investigate the impact of yes-associated protein (YAP)signal on hepatic ductular reaction in mice with choline-deficient and ethionine-supplemented (CDE) diet-induced chronic liver injury (CLI) and YAP's effect on liver progenitor cell proliferation in vitro. Methods The male wild-type C57BL/6J mice were fed with CDE diet for 3 weeks. The Western blot and qPCR were applied to detect YAP protein and gene levels in liver tissue. The immunohistochemistry were used to detect hepatic ductular reaction, the immunofluorescence to evaluate the YAP expression in ductular reaction cells, and the two-step perfusion method was used to isolate primary liver progenitor cells. The liver progenitor cells were infected by lentivirus and were divided into YAP overexpression (YAP-OE group),overexpression empty vector(OE-control group),YAP knockdown(shYAP group), and knockdown empty vector(sh-control group). The infection efficacy was evaluated by Western blot. CCK8 and EdU experiments were applied evaluate the effects of YAP on the liver progenitor cell proliferation. Results The expression of YAP protein inliver tissues in the CDE-induced model increased greatly compared to in the control group and the YAP mRNA level increased by 2.45 times than that in the control group (P＜0.01); the degree of hepatic ductular response in the CDE model and the YAP mRNA level in liver progenitor cells were higher than in the control group; the EdU test found that under the same culture conditions, the percentage of EdU positive cells in the YAP-OE group was significantly increased compared to in the OE-control group [(0.41±0.05) vs. (0.25±0.06), respectively, P＜0.01]; the CCK8 detection showed that the proliferation activity of cells in the YAP-OE group was 1.78 times higher than that in the OE-control group at 72 hours of culture (P＜0.01); the EdU test found that the proportion of EdU positive cells in the shYAP group was significantly lower than that in the sh-control group [(0.25±0.04) vs. (0.13±0.02), respectively, P＜0.01]; the CCK8 detection indicated that the proliferation activity of cells in the shYAP group was 1.92 times lower than that in the sh-control group after 72 hours of culture (P＜0.01). Conclusion The CDE diet could induce chronic liver injury in mice, which results in the increase of YAP expression in progenitor cells with active ductual response. The YAP might promote the proliferation of liver progenitor cells in vitro.

Objective The aim of this study was to investigate the short-term efficacy of dapagliflozin and liraglutide combination in treatment of patients with non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus type 2(T2MD). Methods 60 patients with NAFLD and T2MD were admitted to our hospital between September 2017 and October 2020, and were randomly divided into control and observation group, with 30 cases in each group. All the patients were supervised for routine lifestyle intervention and oral metformin administration for blood glucose control. In addition, the patients in the control group were treated with liraglutide intravenouly, and those in the observation group were treated with dapagliflozin and liraglutide combination. The regimen lasted for 3 months. The fasting plasma glucose (FPG), 2 hour-postprandial plasma glucose (2h PG) and glycated hemoglobin (HbA1c) as well as serum triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL－C) and high density lipoprotein cholesterol (HDL－C) levels were routinely obtained. Serum fasting insulin(Fins) and 2 h Ins levels were assayed, and the HOMA-IR was calculated. The controlled attenuation parameter (CAP) of livers was detected by FibroTouch. Results At the end of 3 month observation, the FPG, 2hPG and HbA1 levels in the observation group were(5.8±0.7)mmol/L, (6.9±0.8)mmol/L and (6.3±0.9)%, all significantly lower than [(6.6±0.6)mmol/L,(7.7±0.7)mmol/L and (7.2±1.0)%, respectively, P＜0.05] in the control group; serum Fins, 2hIns and HOMA-IR levels were (9.8±1.2)mIU/L, (20.2±1.7)mIU/L and (2.6±0.4)%, significantly lower than [(11.9±1.1)mmol/L, (24.8±1.6) mmol/L and (3.2±0.5)%, respectively, P＜0.05] in the control; serum TG level was (2.6±0.4) mmol/L, significantly lower than [(3.0±0.3)mmol/L, P＜0.05], while serum HDL-C level was (1.6±0.2) mmol/L, significantly higher than [(1.2±0.3)mmol/L, P＜0.05] in the control; the CAP was (249.2±7.5)dB/m, also significantly lower than [(264.7±8.6)dB/m, P＜0.05] in the control; serum AST level was (39.9±3.8)U/L, significantly lower than [(44.9±4.2)U/L, P＜0.05] in the control. Conclusion The application of dapagliflozin and liraglutide combination is efficacious in the treatment of patients with NAFLD and T2MD, which could effectively reduce blood glucose and lipid levels, improve liver function tests back to normal, with the ability of alleviation of insulin resistance.

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.

Chronic hepatitis B virus infection is an important factor in the progression of liver disease and hepatocellular carcinoma. The complete life cycle of hepatitis B virus is dependent on the host cell, which makes host-targeting antiviral (HTA) treatment options promising. The HTA includes inhibition of virus entry, destabilization of viral nucleic acids and enhancement of host immune response to HBV infection. This paper reviewed the development of medicines that target hosts and host factors in order to achieve the goal of hepatitis B virus suppression, with a view to providing a reference for subsequent antiviral research and clinical treatment.

Objective The aim of this study was to compare contrast-enhanced ultrasound (CEUS) manifestation differences in patients with hepatocellular carcinoma (HCC) and hepatic hemangioma (HH). Methods A retrospective analysis was performed on the clinical data of 95 patients with liver space-occupying lesions between January 2020 and December 2021, and all patients underwent hepatectomy, having pathologically confirmed diagnosis, e.g. HCC in 51 cases and HH in 44 cases. All patients underwent CEUS examination before operation, and the arrival time (AT), time to peak (TTP), peak enhancement intensity, enhancement rate and 50% gradient of slope were obtained and compared between the two groups. The diagnostic performance of CEUS for liver space-occupying lesions was analyzed by receiver operating characteristic (ROC) curves. Results The conventional ultrasonography showed that the percentages of clear edge, hyperecho, regular shape and even intratumor echo in cancerous foci were 19.6%, 21.6%, 17.7% and 13.7%, all significantly lower than 68.2%, 65.9%, 72.7% and 75.0%(P<0.05) in HH foci, and the grade Ⅱ and Ⅲ blood signals in cancerous lesions were 68.6% and 17.7%, both significantly higher than 11.4% and 4.6%(P<0.05) in HH lesions; the rapid enhancement and hyperechoic tumor tissues in arterial phase was found, while in HH foci, there was a peripheral slow enhancement in early arterial phase, a centripetal filling enhancement in portal phase and an increased enhancement in delayed phase; the AT in cancerous lesions was (14.6±4.5) s, much longer than [(11.4±3.3)s, P<0.05], and the TTP was (36.8±9.7) s, significantly shorter than [(44.2±11.6) s, P<0.05] in HH lesions, the peak enhancement intensity and 50% gradient of slope were (8.8±2.5) and (0.4±0.2), significantly lower than [(12.5±3.6) and (0.9±0.4), P<0.05] in HH lesions, and the enhancement velocity was (0.8±0.3), much higher than [(0.6±0.2), P<0.05] in HH lesions; the ROC analysis showed that the sensitivity and the specificity were 92.5％ and 77.4％, when the combination of the AT, TTP, peak enhancement intensity, enhancement velocity and 50％ gradient of slope was applied to predict the quality of the space-occupying lesions of liver. Conclusion There are some different features of CEUS manifestations, which might help effectively differentiate lesions of HCC and HH.

Objective Hepatocellar carcinoma (HCC) is still a heavy health burden in China. Hepatitis B and C infection is the main cause for it. Most patients with HCC are diagnosed at advanced stage with poor prognosis, owing to the lack of early symptoms. The present available monitoring approaches seem to unable to find liver cancer early. It is urgent to explore more sensitive markers to facilitate the early screening of liver cancer. The current research confirms that protein induced by vitamin K absence (PIVKA-II) is conducive to solving the problem. In this paper, we reviewed the progress on PIVKA-II as a new biological marker in this field.

Objective Liver failure (LF) is a serious syndrome with liver function, such as synthesis, detoxification, metabolism and biotransformation damages, caused by various factors. The causes of LF are diverse, the prognosis is extremely poor, and the mortality rate is extremely high. How to evaluate the severity of liver failure objectively and provide a timely and appropriate treatment plan for patients with LF is very important. The pathogenesis of LF is complicated, the disease progresses rapidly, and there are many factors affecting its prognosis. At present, the research on the prognosis has become a hot spot. In addition to the MELD score, CTP score, SOFA score, etc., many prognostic evaluation systems and new prognostic markers have been discovered. In this article, we provide a review of models and scores for prognostic evaluation of patients with LF.

Objective The aim of this study was to compare whether or not different for Young's modulus in predicting liver fibrosis (LF) in patients with chronic hepatitis B (CHB) obtained by two-dimensional shear wave elastography (2D-SWE). Methods 72 patients with CHB were enrolled in our hospital between October 2019 and June 2022, and all underwent liver biopsies. The LF was determined by Scheuer score, and Scheuer score≥S2 was defined as significant LF. Based on 2D-SWE of color Doppler ultrasonography, the Young's modulus was determined by its median value (Method 1) or by its mean value (Method 2). The diagnostic performance of Young's modulus was evaluated by the area under the receiver operating characteristic curve (AUC). Results The liver histopathological examination showed S0/S1 stage in 31 cases, S2 stage in 19 cases, S3 stage in 12 cases and S4 stage in 10 cases, that’s S2-S4 stage in 41 cases in our series; the Young's modulus by method one in patients with S0/S1, S2, S3 and S4 were (6.1±1.2)kPa, (8.1±1.1)kPa, (11.5±1.8)kPa and (20.9±2.5)kPa, all not significantly different compared to(6.0±1.1)kPa, (8.3±1.2)kPa, (11.6±1.5)kPa and (21.1±2.8)kPa obtained by method two (P>0.05); the Young's modulus by method one or two was positively correlated to LF(r=0.427, P<0.05; r=0.442, P<0.05); the AUCs were 0.938 or 0.956 (P>0.05) in predicting LF in patients with CHB as the Young's modulus equal to 6.04 kPa by method one or 6.14 kPa by method two was set as the cut-off-value, and the AUCs were 0.973 or 0.968(P>0.05) in predicting significant LF as the Young's modulus equal to 8.12 kPa by method one or 8.25 kPa by method two was set as the cut-off-value. Conclusion The median or mean value of five measurements of liver elastic modulus as the final parameter by 2D-SWE might have the equivalent diagnostic performance in the diagnosis of LF in patients with CHB.

Objective The pandemic of COVID-19 has ravaged all over the world. The respiratory tract is considered to be the main target of SARS-CoV-2 infection.Some COVID-19 patients have different degrees of liver injuries. We reviewed the progress on mechanism of liver injuries, so as to provide a therapeutic strategies for COVID-19 patients with liver injuries.

Objective The aim of this study was to compare the efficacy of glycyrrhizic acid diamine and compound glycyrrhizin in the treatment of patients with drug-induced liver injuries (DILI). Methods 97 tumor patients with DILI caused by cyclophosphamide were encountered in Nantong Tumor Hospital between July 2018 and January 2021, and were randomly divided into control group (n=47) and observation group (n=50), receiving compound glycyrrhizin or glycyrrhizic acid diamine, respectively for six months. Serum malonaldehyde (MDA), reduced glutathione (GSH), superoxide dismutase, (SOD) and advanced protein oxidation products (APOPs) levels were detected by purine oxidase; Serum interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), nitric oxide (NO) and macrophage migration inhibitory factor (MIF) levels were determined by ELISA. Results At the end of six month observation, serum bilirubin, ALT and GGT levels in the observation group were(12.3±1.5)μmol/L, (34.9±9.5)U/L and (36.9±8.8)U/L, significantly lower than [(21.7±3.1)μmol/L, (75.3±18.2)U/L and (74.2±15.2)U/L, respectively, P＜0.01] in the control; serum TNF-α, IL-6 and MIF levels were (4.1±0.8)ng/ml, (17.6±5.3)pg/ml and (6.0±0.5)ng/mL, significantly lower than [(5.9±1.2)ng/ml,(28.8±6.1)pg/ml and (10.7±0.9)ng/mL, respectively, P＜0.01] in the control group; serum MDA and APOPs levels were (4.3±0.7)μmol/L and (2.4±0.2)μmol/L, significantly lower than [(6.4±1.2)μmol/L and (4.3±0.5)μmol/L, P＜0.01], while serum SOD and GSH levels were (83.6±7.9)U/L and (7.6±1.5)μmol/L, significantly higher than [(75.2±9.2)U/L and (6.4±1.2)μmol/L, P＜0.01] in the control; at the end of one-year follow-up, 25 patients(25.8%) died of malignant tumors in our series. Conclusion The oral administration of glycyrrhizic acid diamine in the treatment of patients with DILI caused by cyclophosphamide is convenient and seems to be more efficacious compared with compound glycyrrhizin, which could improve liver function index normal and inhibit the inflammatory reactions and oxidative stress.

Objective The aim of this study was to explore the implications of microRNA(miR)-183-5p and miR-96-5p level changes in patients with nonalcoholic fatty liver diseases (NAFLD). Methods 62 patients with NAFLD and 80 healthy individuals with matched gender and age and without history of excessive drinking were enrolled in our hospital between November 2019 and January 2022. Serum miR-183-5p and miR-96-5p levels were detected by real-time fluorescent quantitative RT-PCR, and the factors impacting the occurrence of severe NAFLD was analyzed by multivariate Logistic regression analysis. The diagnostic performance of miR-183-5p and miR-96-5p in predicting the severity of NAFLD was evaluated by the area under the receiver operating characteristic curves(AUC). Results The body mass index, HOMA-IR, fasting plasma glucose and blood fat levels in patients with NAFLD were significantly higher than in healthy persons (P＜0.05), while serum miR-183-5p and miR-96-5p levels were (0.8±0.2) and (1.2±0.3), much lower than [(1.4±0.4) and (2.3±0.6), respectively, P＜0.05] in healthy control; serum miR-183-5p and miR-96-5p levels in 17 patients with severe NAFLD were (0.4±0.1) and (0.8±0.2), significantly lower than [(0.8±0.2) and (1.2±0.3), respectively, P＜0.05] in 21 patients with moderate NAFLD or [(1.1±0.3) and (1.5±0.4), respectively, P＜0.05] in 24 patients with mild NAFLD; the multivariate Logistic regression analysis revealed that the BMI, HOMA-IR, FPG, triglyceride and low-density lipoprotein cholesterol as well as serum miR-183-5p and miR-96-5p levels were the independent risk factors for the existence of severe NAFLD(P＜0.05); the AUC was 0.821, with the accuracy, sensitivity and specificity of 77.4%, 76.5% and 77.8% when the combination of serum miR-183-5p and miR-96-5p levels was applied to predict the severe NAFLD, much superior to anyone of the two parameters alone (with the AUC of 0.713 or 0.718, respectively, P＜0.05). Conclusion Serum miR-183-5p and miR-96-5p levels are down-regulated in patients with NAFLD, and the lowest the serum levels of them, the more severe of the NAFLD, which hints the more severe intrahepatic steatosis, and warrants further clinical investigation.

Objective The aim of this study was to analyze the risk factors of non-alcoholic fatty liver diseases (NAFLD) in physical examination individuals. Methods 1742 persons received physical examination in our hospital between January 2018 and January 2020, and 485 individuals were eligible for this study based on inclusion and exclusion criteria. The NAFLD was found by ultrasonography in 78 cases and not in 407 cases. The visceral adipose tissue (VAT)was obtained by CT scan, and fasting plasma glucose (FPG) and other common blood parameters were assayed. The risk factors for NAFLD was analyzed by univariate and multivariate Logistic regression. Results The incidences of concomitant blood hypertension, diabetes and hyperlipidemia in patients with NAFLD were 29.5%, 35.9% and 51.3%, much higher than 18.7%, 23.8% and 23.6% (P<0.05), the body mass index, waist and hip circumference were (25.1±1.)kg/m², (90.4±6.3)cm and (101.3±8.4)cm, much higher than [(22.4±1.1)kg/m², (81.6±5.7)cm and (95.7±6.2)cm, respectively, P<0.05] in persons without NAFLD; serum TG, LDL-C and VAT were (2.9±0.3)mmol/L,(3.7±0.4)mmol/L and (146.3±12.1)cm², significantly higher than [(1.6±0.2)mmol/L, (3.1±0.2)mmol/L and (70.5±4.6)cm², respectively, P<0.05] in persons without NAFLD; serum ALT, FPG and UA levels were (56.6±11.7)u/L, (5.8±0.7)mmol/L and (387.8±36.3)μmol/L, all significantly higher than [(32.4±3.1)u/L, (5.1±0.4)mmol/L and (313.6±51.4)μmol/L, respectively, P<0.05] in persons without NAFLD; the multivariate Logistic regression analysis showed that the increased BMI, elevated VAT, concomitant blood hypertension, and elevated serum TG, LDL-C, ALT and UA levels were all the independent risk factors, while the increased serum HDL-C level was the protective factor for the existence of NAFLD. Conclusion The prevalence of NAFLD in physical examination individuals is relative high, and some increased body health, blood and imaging parameters hints its existence, and warrants further check-up.

Objective The aim of this study was to investigate the short-term hemostatic effect of endoscopic variceal ligation (EVL) and omeprazole and octreotide combination in the treatment of cirrhotics with first esophageal varices bleeding (EVB). Methods 60 patients with cirrhosis and EVB were enrolled in this study between January 2018 and January 2021, and 30 patients in the control were treated with omeprazole and octreotide, while another 30 patients in the observation group were treated with EVL on the basis of medicines in the control group. The diameters, mean flow velocities and blood flows of portal vein and splenic vein were detected by color Doppler ultrasound. Serum gastrin (GAS) and glucagon (GLC) levels were detected by ELISA, and serum procollagen type III N-terminal peptide (PIIINP) level was detected by radioimmunoassay. Results 1 week after treatment, the total efficient rate in the observation group was significantly higher than that in the control group (96.7% vs. 76.8%, P<0.05), and the emergent hemostasis rate in the observation group was also higher than that in the control group (93.3% vs. 73.3%, P<0.05); the early re-bleeding rate and the delayed re-bleeding rate in the observation group were 10.0% and 3.3%, both significantly lower than 33.3% and 20.0% (P<0.05) in the control; the mean flow velocity and blood flow of portal vein in the observation group were (14.2±2.3) cm/s and (1224.6±173.2) mL/min, significantly higher than [(12.1±1.6) cm/s and (1030.7±164.5) mL/min, P<0.05], the mean flow velocity and blood flow of splenic vein in the observation group were (14.4±1.9)cm/s and (934.6±185.3)mL/min, both significantly higher than [(12.3±1.7)cm/s and (731.3±172.4)mL/min, respectively, P<0.05] in the control; serum PIIINP, GAS and GLC levels in the observation group were (173.6±19.5) μg/L, (69.7±9.6) ng/L and (52.3±7.1) ng/L, significantly lower than [(202.8±23.1) μg/L, (91.4±12.3) ng/L and (62.4±8.3) ng/L, respectively, P<0.05] in the control group; the total incidence of post-EVL complications, such as sore throat, retrosternal pain, dysphagia, abdominal distension, nausea and vomiting was 53.3%. Conclusion The short-term clinical hemostatic effect of EVL at base of omeprazole and octreotide combination is good in patients with liver cirrhosis and first EVB, which could improve hemodynamic states of portal system, with a relative safety.

Objective The aim of this study was to investigate the efficacy of standardized pegylated interferon α-2a (Peg-IFNα-2a) and ribavirin (RBV) combination in treatment of patients with chronic hepatitis C (CHC). Methods 102 patients with CHC were enrolled in our hospital between February 2017 and April 2020, and were divided randomly into control (n=50) and observation (n=52). The patients in the control received RBV and interferonα-2a therapy, and those in the observation were treated by RBV and Peg-IFNα-2a therapy. The regimen in both groups lasted for 6 months. The peripheral blood T lymphocyte subsets was detected by Flow cytometry. Results The end treatment virological response (ETVR) and the sustained virological response in the observation group were 88.5% and 82.7%, both significantly higher than 62.0% and 62.0%(P＜0.05) in the control group; at the end of treatment, serum ALT and AST levels in the observation were (36.8±4.1)U/L and (38.4±3.4)U/L, both significantly lower than [(61.5±4.3)U/L and(51.6±3.6)U/L, respectively, P＜0.05] in the control group; at week 4, 12 and 24, serum HCV RNA loads in the observation group were (4.6±1.2)Ig IU/mL, (4.1±1.1)Ig IU/mL and (3.6±0.9)Ig IU/mL, all significantly lower than [(5.1±1.1)Ig IU/mL, (4.7±1.2)Ig IU/mL and (4.2±1.0)Ig IU/mL, respectively, P＜0.05] in the control; at the end of the regimen, the percentage of peripheral blood CD3⁺ cells in the observation group was (73.8±7.5)%, significantly higher than [(65.6±6.9)%, P＜0.05], that of CD4⁺ cells was (49.5±6.3)%, significantly higher than [(34.8±5.8)%, P＜0.05], while that of CD8⁺ cells was (17.6±3.8)%, significantly lower than [(25.9±4.6)%, P＜0.05] and the ratio of CD4⁺/CD8⁺ cells was (1.0±0.2), significantly lower than [(1.4±0.3), P＜0.05] in the control group. Conclusion The standardized Peg-IFNα-2a and RBV antiviral therapy is still efficacious in treating patients with CHC, which might be carried out alternatively in case no direct antiviral agents is available.

Objective Sarcopenia is defined as loss of systemic skeletal muscle mass and functions. It may affect the physiological functions and leads to the declined quality of life, and even death. Sarcopenia occurs in up to 70% of patients with advanced liver diseases, which is associated with untoward clinical outcomes and poor prognosis. At present, most treatments are based on nutrition and exercise, however, there is still a lack of effective targeted molecular therapy. This review summarizes the pathogenesis of sarcopenia in liver diseases, in order to identify potential biomarkers for treatment and improve the clinical prognosis.

The nonalcoholic fatty liver disease (NAFLD) is considered to be the metabolic disorders in liver and is closely related to obesity, insulin resistance (IR), type 2 diabetes mellitus (T2DM) and hyperlipemia, etc. The prevalence of NAFLD among adults worldwide is about 25% and it is to believe increasing year by year. The NAFLD is an important causes of liver cirrhosis, liver cancer and liver transplantation. A large number of studies have shown that thyroid hormone (THs) plays an important role in hepatic lipid metabolism and IR, and the thyroid hormone receptor agonists are expected to become new medicines for the treatment of patients with NAFLD. In this review, we mainly discuss the progress of THs in patients with NAFLD.

Objective The aim of this study was to observe the early impact of first-line nucleos(t)ide analogs (NAs), e.g. entecavir(ETV), tenofovir disoproxil fumarate(TDF) and tenofovir alafenamide(TAF), on renal function tests in patients with chronic hepatitis B (CHB). Methods 68 patients with CHB were encountered in our Hospital between September 2019 and May 2021, and out of them, 22 patients received ETV, 26 patients received TDF and 20 patients took TAF therapy. All the patients were followed-up for six months. Serum creatinine (sCr), estimated glomerular filtration rate (eGFR), urine retinol-binding protein (RBP), urine cystatin C (Cys-C), urine N.acetyl.β.D.glucosidase (NAG), urine α1-microglobulin(α1-MG) and urine β2-microglobulin (β2-MG) levels were observed. Results At the end of 24±2 weeks of treatment, serum alanine aminotransferase levels in ETV-treated, TDF-treated and TAF-treated patients were (33.2±5.4)U/L, (31.4±8.2)U/L and (32.7±6.1)U/L (P>0.05), and serum aspartate aminotransferase levels in the three groups were (23.8±7.6)U/L, (24.3±9.2) U/L and (22.9±7.8)U/L, not significantly different among them (P>0.05); serum HBsAg levels in the three groups were (3.0±0.7) lgIU/ml, (2.9±0.5)lgIU/ml and (2.8±0.6)lgIU/ml, and serum HBV DNA loads in the three groups were (1.9±0.6) lgIU/mL, (1.8±0.5) lgIU/mL and (1.6±0.7) lgIU/mL, not significantly different among them (P>0.05); there were no statistically significantly differences as respect to sCr, eGFR, urinary RBP, urinary Cys-C, urinary NAG and urinary β2-MG levels in the three groups (P>0.05), while urine α1-MG level in TDF-treated patients was (1.4±0.9)ln mg/L, significantly higher than (0.7±1.1) ln mg/L in ETV-treated or (0.7±0.9)ln mg/L in TAF-treated patients (P<0.05). Conclusion Our findings suggests that ETV, TDF and TAF have the same antiviral efficacy in patients with CHB, but the renal function tests should be specially surveyed in patients with TDF treatment.

Objective There is a dense collagen deposition in hepatic sinusoide in patients with severe acute alcoholic hepatitis (SAAH), which increase the sinusoidal resistance with increased pressure and block blood flow through hepatic sinusoids. The portal vein blood flow is compromised in a retrograde manner with obviously reduced portal venous perfusion. Consequently, the hepatic artery buffering response (HABR) is triggered to counteract the decreased blood flow from hepatic artery or portal vein to maintain a physiological requirement and restore the hepatic perfusion, e.g., the sum of hepatic artery and portal vein blood flow. The hepatic hemodynamics and quantitative HABR can be assessed by Duplex Doppler ultrasonography, and the latter could be a noninvasive approach for the diagnosis of SAAH.

Objective The purpose of this study was to investigate the prevalence of bacterial infection in patients with hepatitis B viral infection-related acute-on-chronic liver failure (HBV-ACLF). Methods The clinical materials of 214 patients with HBV-ACLF between January 2015 and February 2022 were retrieved from His system in our hospital, and various infections were defined according to related criteria. The multivariate Logistic regression analysis was applied to reveal the impacting factors for infection. Results Out of the 214 patients with HBV-ACLF, the bacteria infection was found in 145 cases(67.7%), involving one organ in 113 cases, two in 28 cases and three in 4 cases, including spontaneous bacterial peritonitis (SBP) in 127 cases (85.2%), pulmonary infection in 41 cases (27.5%), acute cholecystitis in 25 cases(16.8%), urinary tract infection in 4 cases (2.7%) and perianal infection in 2 cases (1.3%); there were significant differences as respect to ages, systemic inflammatory response syndrome (SIRS) score, peripheral white blood cell counts, platelet counts, C-reactive protein, procalcitonin, prothrombin time activity (PTA), serum bilirubin, albumin, the incidence of hepatic encephalopathy (HE) and ascites between patients with and without bacterial infections(P<0.05); the multivariate Logistic analysis showed that the age, SIRS scores, WBC counts, PCT and ascites were the independent risk factors, while the PTA and serum albumin levels were the protective ones for bacterial infection in patients with HBV-ACLF(P<0.05); we set the SIRS score as the basic parameter, and its combination with age in predicting bacterial infection had the sensitivity (Se) and specificity (Sp) of 75.9% and 55.1%, with WBC counts of 77.2% and 62.3%, with PTA of 79.3% and 59.4%, with PCT of 89.7% and 46.4%, with ALB of 80.7% and 63.8%, and with ascites of 67.6% and 72.5%, suggesting a good Se with relatively low Sp. Conclusion The patients with HBV-ACLF are prone to bacterial infection, and some factors, such as elderly persons, hyperbilirubinemia and severe coagulation dysfunction, might trigger the infection, which should be appropriately dealt with as early as possible in clinical practice.

Liver cirrhosis is a very serious chronic progressive liver disease caused by one or more pathological factors repeatedly. The hepatic macrophages is regarded as the important cells for liver damage and repair. The different phenotypic liver macrophages on inflammation of liver are discussed, and the liver macrophage polarization is emphasized in this paper.

Objective This study was aimed to investigate the clinical utility of transient elastic (TE) imaging for the detection and quantification of liver fibrosis (LF) in patients with alcoholic liver cirrhosis diagnosed by histopathology. Methods 68 patients with alcoholic liver diseases (ALD) were encountered in our hospital between January 2019 and January 2022, and all underwent ultrasound-guided liver biopsy and TE imaging detection for liver stiffness measurement (LSM) and spleen stiffness measurement (SSM). The consistency of diagnosis by two methods was evaluated by Kappa. Results Based on the LSM, the patients without or mild LF were found in 28 cases (41.2%), with significant LF in 19 cases (27.9%), with advanced LF in 13 cases (19.1%) and liver cirrhosis (LC) in 8 cases (11.8%); the liver histopathological examination showed LF S0, S1, S2, S3 and S4 in 15 cases(22.1%), 11 cases (16.2%), 20 cases (29.4%), 12 cases (17.6%) and 10 cases (14.7%); the LSM and SSM in 8 patients with LC proven by TE were (18.4±5.6)kPa and (22.6±4.6)kPa, significantly greater than [(10.7±3.3)kPa and (14.9±3.8)kPa, respectively, P<0.05] in 60 patients without LC; based on the gold criteria by histopathology, the sensitivity, specificity and accuracy by TE in predicting LC were 70.0%, 98.3% and 94.1%, with good consistency (Kappa=0.744). Conclusion The TE imaging technique, as a good non-invasive approach, could be utilized in clinical practice for early diagnosis of LF and/or LC, which might be helpful for clinicians making interventional strategy.