In view of the high prevalence of diabetes mellitus in patients with liver cirrhosis and the increasing trend of non?alcoholic fatty liver disease?associated cirrhosis, the diagnosis and treatment of diabetes mellitus in patients with liver cirrhosis are becoming widespread concerns. Therefore, the Chronic Disease Management Branch, China Pharmaceutical Biotechnology Association, organized multidisciplinary experts from gastroenterology, infective disease, endocrinology, etc, to draw up expert consensus on the management of diabetes mellitus in patients with liver cirrhosis, with focusing on the classification and management of hyperglycemia in cirrhotic patients. The consensus summarizes the prevalence, pathogenesis, clinical setting and prognosis of the concomitant diabetes mellitus in patients with liver cirrhosis, and definitely puts forward a proposal regarding "hepatogenous diabetes" as one of the four subtypes of diabetes mellitus in cirrhotic patients, and further recommends the basic principles for diagnosing and monitoring diabetes mellitus and the selection of antidiabetic drugs based on liver functions in patients with liver cirrhosis.

Objective To analyze the therapeutic effect of primary liver cancer treated by stereotactic radiotherapy. Methods 266 patients with primary liver cancer were treated with γ ray stereotatic radiotherapy（SRT）. The dose of 3200~4600cGy（300~500cGy/F,6F/w） were delivered to PTVs over 7 to 10 fracions,6 consecutive fractions per week. Results All patients were examined with image of CT or MRI. The total effective rate（CR+PR）,steady diseae（SD）,progressive disease（PD） was 79%,18% and 3%. The 1,2,3-year survival rates of patcents were 71.2%,40.3%,22.8%,respectively. No RILD and serious side effect occurred,and the gastrointestinal complications were uncomfortable in upper abdomen and poor appetite. Conclusions Stereotactic radiotherapy has good effect and little side effect in the treatment of primary liver cancer.

Objective To investigate the counts of natural killer cells and T lymphocytes in patients with chronic hepatitis B. Methods The CD3⁺T cells,CD3⁺CD4⁺T cells,CD3⁺CD8⁺T cells and CD3^-CD16⁺CD56⁺NK cells in peripheral blood were counted by FCM. Results The T lymphocytes and NK cells decreased in 56 patients with hepatitis B-related hepatic failure;the CD3^-CD16⁺CD56⁺ natural killer cells in 49 patients with chronic hepatitis B increased as compared to in 41 chronic hepatitis B viral carriers. Conclusions The T lymphocytes and NK cells in patients with hepatic failure decreased while T lymphocytes in patients with chronic hepatitis B with HbeAg positive increased.

Objective To observe the clinical efficacy of Dangfei Liganning combined with lecithin for treating patients with non-alcoholic steatohepatitis（NASH）. Methods 116 patients with NASH were randomly divided into three groups. The combination therapy group（n=45）was treated with Dangfei Liganning and lecithin tablets,and the Dangfei Liganning group （n=38）and lecithin group （n=33）were treated with Dangfei Liganning and lecithin tablets orally,respectively. The regimen lasted for three months.Before and after treatment,clinical data including main symptoms,hepatic function parameters,blood cholesterol and fatty liver image under B ultrasound in the three groups were monitored respectively. Results The rates of symptoms alleviation such as fatigue,anorexia,abdominal discomfort in the combination therapy group were higher than in the lecithin group（x²=3.94,x²=10.63,x²=8.54,P<0.05 or P<0.01）. Fatigue improvement was better in the Dangfei Liganning group than in the lecithin group（x²=3.97 or P<0.05）;The levels of AST and ALT were declined obviously in the combination therapy group and Dangfei Liganning group than in the lecithin group after treatment（P<0.05 or P<0.01）. AST,ALT,TG,TC were also lower in the combination therapy group than in the Dangfei Liganning group （P<0.05 or P<0.01）;Fatty liver under B ultrasound in the combination therapy group and lecithin group were obviously improved after treatment（P<0.05 or P<0.01）; Some patients had abdominal distension,nausea,anorexia and other gastrointestinal reactions after taking Dangfei Liganning. Conclusion Dangfei Liganning combined with lecithin has good clinical efficacy and security for the treatment of patients with NASH.

Objective To inhibit the gene expression of connective tissue growth factor （CGTF） by small interfering RNA（siRNA） and observe its influence on downstream gene expression. Methods 293T cells were cotransfected with lent viral transferred plasmid containing siRNA targeted to CTGF,packaging plasmid,and envelope protein plasmid. The lent viral vector was packed to mediate CTGF gene silence and infect hepatic stellate cell line HSC-T6 cells. The lent viral vector with the highest inhibition efficiency was screened by real-time PCR and Western blot. Efficiency of infection was measured by the expression of green fluorescent protein. mRNA levels of tissue inhibitor of metalloproteinase-1 （TIMP-1）,TIMP-2,and collagen I were detected by real-time PCR. Results Efficiency of infection of the packing lent viral vector was more than 50%. After infecting HSC-T6 cells,the expression of CTGF was suppressed on both mRNA and protein level,with the highest inhibition efficiency by TS1. The expressions of mRNA in TIMP-1,TIMP-2,and collagen I were significantly restrained by inhibition of CTGF（P<0.05）. Conclusion The packing lent viral vector in HSC-T6 has a better efficiency of infection and CTGF gene silencing effect. Gene silencing can further inhibit the TIMP-1,TIMP-2 and collagen type I gene expression in HSC-T6 cells. It has an active significance in anti-fibrosis studying.

Objective To probe the membrane protein changes in rats with hepatic fibrosis after the treatment of Fufang Biejia Ruangan Pian. Method This research set up an rat model with porcine sera-induced hepatic fibrosis and the model rats were treated by intragastric infusion of Fufang Biejia Ruangan Pian solution for 8 weeks. Plasma membrane was purified by density gradient centrifugation,the purity of them was verified by Western blot and differential proteomic analysis of liver plasma membrane was done. Result An animal model of hepatic fibrosis was set up successfully at week 8. After treatment with Fufang Biejia Ruangan Pian for eight weeks,the livers returned to normal levels;Western blot analysis showed that the plasma membrane was enriched while the contamination of other subcellular fractions such as mitochondrion reduced. 22 proteins with more than three-fold differences were found and 9 proteins were successfully identified. Western blotting verified the different expression of keratin 8 and annexin A2. Conclusion Fufang Biejia Ruangan Pian has anti-fibrotic effects by regulating keratin 8 and annexin A2 expression in the plasma membrane during hepatic fibrosis process.

Objective To investigate the serum levels of extracellular matrix protein 1（ECM1），matrix metalloproteinase-9（MMP-9）and vascular endothelial growth factor（VEGF）in patients with HCC. Methods Serum levels of ECM1，MMP-9 and VEGF were detected by enzyme-linked immunosorbent assay in 40 patients with HCC. Results The serum ECM1，MMP-9 and VEGF levels were 150.01±5.85pg/ml，467±30.81μg/l and 751.29±51.08pg/ml；The serum levels of them were significantly associated with tumor capsula，TNM stage，lymph metastasis and Edmondson grade；ECM1 levels was positively correlated with MMP-9 and VEGF levels（r=0.438，P=0.005；r=0.427，P=0.006）.Conclusion ECM1 may stimulate angiogenesis，metastasis and invasion of HCC via interaction with MMP-9 and VEGF.

Objective To explore genotype distribution and clinical significance of HCV in Taiyuan region. Methods To amplify 5’ UTR of HCV RNA in 62 patients using RT-nested-PCR,to cut 5’UTR fragment into different length clips by using incision enzyme HaeⅢ and Bsh1236Ⅰ. Results In 62 patients with hepatitis C,43 cases were infected with genotype 1b,9 cases were infected with genotype 2a,5 cases was 1b/2a mixed-type,1 case was type 1a,1 case was type 3a,and 3 cases were not tested. The patients with 1b genotype were more serious than the patients with non-genotype 1b in the hepatic function and liver fatty degeneration. Conclusion In this locality hepatitis C were dominated by genotype 1b，and the pathogenetic condition of genotype 1b patients more serious than non-genotype 1b patients. HCV genotypes 1b accounted for 69.4% of HCV infections in patients from this geographical region. HCV genotype 1b was associated with more serious clinical performance.

Objective To analyze the therapeutic effects of 48-week entecavir treatment in patients with decompensated cirrhosis caused by hepatitis B virus（HBV）. Methods In this cohort study,98 patients with liver cirrhosis caused by HBV were divided into three groups randomly: entecavir（ETV） group （n=32）,lamivudine （LAM） group（n=42）,and control group（n=24）:conventional liver protection treatment. The course of treatment lasted 48 weeks. The virological and biochemical parameters,PT,hepatic fibrosis index and Child-Pugh scores were observed at different time points during treatment. Results The HBV DNA levels in entecavir group were significantly decreased. The negative rates of HBV DNA（<500 copies/ml） were correspondingly and significantly higher than those in lamivudine group and control group（P<0.05）. At week 24 and 48,the negative rates of hepatitis B e antigen（HBeAg） and the rates of HBeAg/anti-HBe sero-conversion in entecavir group were higher than those in control group（P<0.05）. ALT,AST,total bilirubin, hepatic fibrosis index and Child-Pugh scores were significantly improved in entecavir group and lamivudine group after treatment（P<0.05）. Conclusion Entecavir can rapidly and effectively inhibit HBV DNA replication and improve liver function,hepatic fibrosis index and Child-Pugh scores in patients with liver cirrhosis caused by HBV.

Objective To investigate the therapeutic efficacy of polyene phosphatidylcholine in patients with anti-tuberculosis agents-induced liver injury and its effect on serum heme oxygenase (HO-1), glutathione peroxidase (GSH-Px), and superoxide dismutase (SOD) levels. Methods 78 patients drug-induced liver injury (DILI) during anti-tuberculosis therapy for pulmonary tuberculosis were enrolled in our hospital between March 2018 and March 2019, and were randomly divided into control and observation group with 39 in each, receiving diammonium glycyrrhizinate or polyene phosphatidylcholine orally for 12 weeks. Serum interleukin-6, IL-1β and tumor necrosis factor-α(TNF-ɑ) as well as serum HO-1, GSH-Px and SOD levels were detected.Results At the end of 12 week observation, serum level of alanine aminotransferase (ALT) in the observation group was (28.1 ± 20.5) U/L, which was significantly lower than that in the control group [(59.4 ± 22.7) U/L, P <0.05], and serum level of aspartate aminotransferase (AST) in the observation group was (345.1 ± 17.3) U/L, which was significantly lower than that in the control group [(45.1 ± 17.3) U/L, P <0.05]; serum TNF-ɑ level inthe observation group was (7.4 ± 1.5) pg/mL, which was significantly lower than that in the control group [(10.3 ± 1.8) pg/mL, P <0.05], and serum IL-1β level in the observation group was (13.7 ± 2.1) ng/mL, which was significantly lower than that in the control group [(34.2 ± 4.8) ng / mL, P <0.05]; serum HO-1 level in the observation group was (294.1 ± 16.9) U/L, which was significantly higher than that in the control group [(198.8 ± 17.2) U/L, P <0.05], and serum level of SOD was (544.2 ± 13.3) U/L, which was significantly higher than that in the control group [(421.0 ± 12.8) U/L, P <0.05]. Conclusion The administration of polyene phosphatidylcholine in the treatment of patients with DILI caused by anti-tuberculosis medicine is efficacious, which could significantly increase serum HO-1 and SOD levels, and reduce oxidative stress response, and needs further clinical investigation.

Objective The aim of this study was to summarize the magnetic resonance imaging (MRI) characteristics of patients with wall-thickening gallbladder carcinoma. Methods A total of 60 patients with gallbladder diseases were admitted to our hospital between January 2019 and December 2020, and all patients underwent MR scan and surgical cholecystectomy or radical cholecystectomy. Results The gallbladder width and gallbladder wall thickness in 21 patients with wall-thickening gallbladder carcinoma were (3.5±0.4)cm and (1.5±0.2)cm, significantly larger than in 39 patients with chronic cholecystitis, and the incidences of blurred interface with adjacent tissues, biliary obstruction, gallbladder wall stiffness, irregular gallbladder morphology and incomplete gallbladder mucosal line in patients with thick-thickening gallbladder carcinoma were 61.9%, 76.2%, 71.4%, 85.7% and 95.2%, all significantly higher than 0.0%, 10.3%, 2.6%, 25.6% and 0.0%, respectively, in patients with chronic cholecystitis (P＜0.05). Conclusion MRI is high valuable in diagnosis and differentiation of patients with wall-thickening gallbladder carcinoma, which has some characteristic features for clinicians to make medical plan early for them.

Primary liver cancer （PLC） is one of the most common malignant tumors in China. Early diagnosis of liver cancer is crucial for the outcome of patients with PLC. Protein induced by vitamin K absence or antagonist II（PIVKA-II） is a new serum tumor marker documented in recent years. It has a diagnostic value for hepatocellular carcinoma,reportedly better than the widely used serum tumor marker alpha-fetoprotein （AFP）. In this paper,we reviewed the progress of PIVKA-II in the fundamental research and clinical application.

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 Liver is an important organ for the metabolism of sex hormones, lipids and other substances. Male patients with chronic liver disease often suffer from a variety of dysfunctions, such as sex hormone metabolism, glucose and lipid metabolism and mental and psychological disorder. Erectile dysfunction is easy to occur, which affects the physical and mental health and the family life of patients.Existing studies have shown that the prevalence of male erectile dysfunction in patients with chronic liver disease was 24.6% to 85%, the prevalence in chronic hepatitis patients was 8.6% to 78%, and in patients with cirrhosis was 41.2% to 92%.In this paper, we reviewed the incidence, impacting factors, possible pathogenesis, and treatment of erectile dysfunctions in male patients with chronic liver disease.

Objective The aim of this study was to investigate summarize the ultrasonographic features of cavernous transformation of the portal vein (CTPV) in patients with chronic liver diseases (CLD). Methods Abdominal ultrasonography was conducted in 101 patients with CLD, who was diagnosed with CTPV by CT or MRI in Beijing Ditan Hospital affiliated to Capital Medical University between June 2017 and June 2020. The ultrasonic image features of CTPV and its related complications were summarized, and the causes of ultrasonic missed diagnosis were analyzed with the solutions proposed. Results Out of the 101 patients with CTPV proven by CT and/or MRI, the ultrasonic diagnosis was correct in 82 cases (82.2%), with 19 cases (17.8%) missed; among the cases correctly diagnosed by ultrasonography, 82 patients (100.0%) showed extensive or local cellular vascular structures around the portal vein trunk and its branches, the wall of portal vein was thickened in 70 cases (85.4%), the tortuously dilated cellular vascular structure showed red and blue interlaced rich blood flow signals in 76 patients (92.7%), the low-speed blood flow spectrum of portal vein was measured by pulse Doppler, the tortuously dilated honeycomb vessels around the portal vein compressed the bile duct, resulting in bile duct dilatation in ten cases (12.2%), the gallbladder enlargement occurred in 8 patients (9.6%), the cholecystolithiasis was present in 6 patients (7.4%), the bile duct stones were found in 5 cases (6.1%) and the portal shunt occurred in 5 cases (6.1%). Conclusion Ultrasonography is an important imaging method for the diagnosis of cavernous transformation of portal vein. The main reasons for ultrasonic missed diagnosis are small vascular lumen, small lesion scope, abdominal distension, pseudotumor of bile duct, narrow intercostal space and substernal angle. The enhanced CT or MRI examinations need to perform for correct diagnosis. The liver is scanned at acoustic windows of abdominal effusion or gallbladder and the contrast-enhanced ultrasonography might help reduce the missed diagnosis.

Objective The aim of this study was to investigate the liver pathological features of patients with drug-induced liver injury(DILI). Methods Thirty-eight patients with DILI was encountered in our hospital between January 2017 and December 2020, and all were evaluated by structured expert opinion process(SEPO)and underwent liber biopsies. The diagnostic performance of DILI-pathological scroring system (DILI-PSS) was verified by the area under the receiver operating characteristic curve (AUROC). Results Out of the 38 patients with DILI, 14 patients (36.8%) had taken chemical medicines and biological products, 12 patients (31.6%) had taken Chinese herbal medicines, 9 patients (23.7%) had taken Chinese herbal, chemical medicines and biological products, and 3 patients (7.9%) had taken dietary supplements; the pathological examination showed that hepatic steatosis in 20 cases(52.6%), hepatic cholestasis in 22 cases(57.9%), bile duct damage in 15 cases(39.4%), eosinophil immersion in 11 cases(28.9%), hepatocellular wreaths in 9 cases (23.7%), and granuloma in 6 cases (15.8%); the AUROC was 0.775 with 95% confidence interval of 0.669-0.880 (P<0.05), and the sensitivity of 81.6% and the specificity of 65.8% when the DILI-pathological scroring system (DILI-PSS) was applied to predict the diagnosis. Conclusion The application of DILI-PSS might help diagnose patients with DILI, which needs further clinical investigation.

Objective To study the effect of STAT3 signaling pathways on p44/42MAPK and cell growth in hepatocellular carcinoma. Methods The siRNA directed against STAT3 was transfected into HepG2 cells. Cell growth was measured by MTT assay and STAT3 and p44/42MAPK protein expression were measured by Western blot. Results A significant decrease in the number of viable cells（q=9.36，P<0.05）was found in the siRNA transfection group as compared to that in the control or the LipofectamineTM2000 transfected groups；SiRNA inhibited cell growth with the inhibition rates of 33.2% at 24h，39.6% at 48h，43.1% at 72h，and 33.9% at 96h；At 72h and 96h after the transfection，STAT3 protein expression was inhibited and P44/42MAPK protein expression was not influenced and p-p44/42MAPK protein expression was increased.Conclusion siRNA against STAT3 may affect cell growth in vitro.

Objective Dietary copper restriction has long been considered an important treatment for patients with hepatolenticular degeneration (HLD). However, evidence supporting this approach is limited. There are no published randomised controlled trials for the recommendation due to rarity of the disease and variable presentation. This review summarized current knowledge on the absorption and regulation of copper in humans and its relevance to patients with HLD. Studies have demonstrated that as the level of dietary copper increases, the proportion absorbed decreases. This observation implies that ‘high copper' foods that HLD patients are generally advised to avoid would need to be consumed in large amounts to impact markedly on the quantity absorbed. Dietary copper restriction is unlikely to reduce the amount absorbed significantly and is not only difficult to manage but restricts food supply unnecessarily, detracting from the provision of substrates essential for improving nutritional status in a nutritionally compromised group. Medical management for HLD is effective in compliant patients, allowing stabilization of the liver disease. Based on current evidence, dietary copper restrictions in stable HLD patients who are adherent to medical therapy are unnecessary with two food exceptions (shellfish and liver organ).

Objective To analyse causes,clinical features,diagnosis and prognosis of drug-induced liver damage in recent years in order to improve clinical doctors’ understanding of this problem. Methods we scored inpatients with drug-induced liver damage from April 2003 to April 2009 in our hospital according to Maria“clinical diagnosis scales”,and causes of 132 patients among whole patients who scored greater than or equal to 10 were retrospectively analyzed and clinically classified. Result There were more than fifty kinds of drugs from fifteen groups that could induce liver damage. Among these drugs 72.7 percent were Chinese traditional medicine,antitubercular drug,antineoplastic drug and Antibiotics,which were the major medicine that caused liver damage. Incubation period of 5 day to 356 day,the percentage of liver damage happened in fourth week,eighth week,and twelfth week was 61.4 percent,84.9 percent and 91.7 percent respectively.78.8 percent（of the total cases） were hepatocellular injury type,13.6 percent cholestatic type,and 7.6 percent mixed type. There were 27 patients（20.5%） with no clinical symptom and objective sign but abnormal Lab findings. There were 105 patients（79.5%） with clinical symptom such as fatigue（64.4%）,anorexia（53.0%）,and colored urine（41.7%）. Among 104 patients with liver damage,all had their ALT cut down more than 50 percent in 30 days and recovered their liver function in 2 months after discontinuation. Conclusion The main causes of drug-induced liver damage were Chinese traditional medicine,antitubercular drug,antineoplastic drug and Antibiotics. Mostly drug-induced liver damage occurred within 12 weeks,and he longer the drugs are used,the higher the probability of the liver damage occurs.The main damage type were hepatic cellullar damage,and its clinical feature were similar to each acute or chronic liver disease,without specificity,its prognosis were good.

Objective The aim of this study was to summarize the ultrasonographic and biochemical features of patients with non-alcoholic heterogeneous fatty liver (NAHFL). Methods 90 patients with NAHFL and 30 healthy persons were enrolled in our hospital between January 2016 and December 2018, and ultrasonography and blood biochemical indicators were carried out. Results Out of the 90 patients with NAHFL, 23 cases (25.6%) belonged to type I (local invasive type), 29 cases (32.2%) belonged to type II (segmental infiltration type) and 38 cases (42.2%) belonged to type III (diffuse heterogeneous infiltration) type); serum transferrin (SF) level in patients with type II fatty liver was (254.2±98.7) μg/L, significantly higher than [(175.1±98.4) μg/L, P<0.05] in healthy control; the fasting blood glucose level in patients with type III fatty liver was (6.37±0.79) mmol/L, significantly higher P<0.05] in the control, and HbA1c was than in the control, blood uric acid level was (418.3±40.5)μmol/L, significantly higher than in the control, and SF was (287.3±105.1) mg/l, significantly higher than in the control; serum AST level in patients with type II fatty liver was (51.5±13.4) IU/L, significantly higher than in the control, serum GGT level was (59.3±31.2) IU/L, significantly higher than in the control, blood TC in patients with type III fatty liver was (4.7±0.8) mmol/L, significantly higher than in the control, blood TG was (3.2±1.5) mmol/L, significantly higher than in the control, serum AST was (60.2±18.7) IU/L, significantly higher than , serum ALT was (54.2±29.8) IU/L, significantly higher than , and serum GGT level was (59.3±31.2) IU / L, significantly higher than in the control. Conclusion Ultrasonography might show a characteristic features in patients with NAHFL, and the diagnosis might be made at the base of blood analysis in clinical practice.

Objective The aim of this study was to investigate the CT imaging feature in patients with non-alcoholic fatty liver diseases (NAFLD) with different traditional Chinese medicine (TCM) syndrome.Methods 240 patients with NAFLD were enrolled in our hospital between January 2017 and January 2020, and the TCM syndrome were determined. All patients underwent CT scan.Results The percentage of mild fatty liver by CT diagnosis in patients with liver depression and spleen deficiency was 88.9%, significantly higher than 17.6%, 25.8%, 6.5% and 0.0%(P＜0.05) in patients with damp phlegm and internal resistance syndrome, damp heat and internal gathering syndrome, phlegm and blood stasis syndrome and liver and kidney deficiency syndrome; the percentage of severe fatty liver in patients with liver and kidney deficiency syndrome was 85.7%, and that in patients with phlegm and blood stasis syndrome was 51.6%, significantly higher than 0.0% in patients with liver depression and spleen deficiency, 8.8% in with damp phlegm and internal resistance and 15.7% in damp heat and internal gathering syndrome(P＜0.05); the CT score in patients with liver depression and spleen deficiency was (42.4±4.7)HU and the CT score in patients with damp phlegm and internal resistance was(37.0±5.6)HU, both significantly higher than [(32.0±5.8)HU, (27.0±6.2)HU and (22.8±7.9)respectively, P＜0.05】 in patieHU,nts with damp heat and internal gathering, in with ph legm and blood stasis syndrome and in with liver and kidney deficiency syndrome, while the liver/spleen ratio were (0.8±0.1) and (0.7±0.2),significantly higher than【(0.6±0.1), (0.5±0.1) and (0.4±0.1), respectively, P＜0.05】 in patients with damp phlegm and internal resistance, in patients with damp heat and internal gathering and in with liver and kidney deficiency syndrome.Conclusion The CT imaging of patients with NAFLD with different TCM syndromes is characteristic, which might help the TCM doctors to deal with the entity appropriately in clinical practice.