Objective To investigate the prevalent viral genotypes and possible gene mutation in adults with acute hepatitis B（AHB）. Methods Serum samples of 39 patients with AHB admitted in our hospital were collected between December 2012 and January 2014. Viral genotypes and sequences of P region,S region,Pre C region and basic core promoter（BCP） were detected by direct sequencing and parallel allele specific sequencing （PASS）. Results 35 out of 39 patients with AHB were sequenced successfully. Genotype distribution in these 35 cases was as follows. Genotype B accounted for 36.4% （12/35）,genotype C for 57.6% （21/35）,and genotype D for 6.0%（2/35）;A181S drug resistance mutation was found in one patient by both sequencing methods,while S132F and W172C mutations in S region as well as G1896A and T1758C mutations in PreC/BCP regions were noticed by direct sequencing in two different cases,respectively. Conclusions Viral genotype distribution of common genotype C and B in patients with AHB is not different in patients with CHB. Patients infected with P region,S region or PreC/BCP region mutants might have similar prognosis as patients infected with wild HBV.

Objective To investigate hepatitis B virus （HBV） subgenotypes distribution and its implication in patients with chronic hepatitis B in Guangzhou. Methods 424 patients were enrolled in this study,including 137 with chronic hepatitis B（CHB）,90 with HBV-related acute-on-chronic liver failure （HB-ACLF）,90 with 1iver cirrhosis（LC） and 107 with hepatocellular carcinoma（HCC）. HBV subgenotypes were determined by direct sequencing of HBV S gene and the phylogenetic tree was constructed. The data was compared by x² test,one way ANOVA and Logistic regression analysis. Results Out of 424 patients with HBV infection, 269（63.44%） were infected with HBV B2,117 （27.59% with HBV C1,36 （8.49%） with HBV C2 and 2 （0.47%） with C5; the HBV B2,C1,C2 and C5 Infection in patients with CHB were 70.1%,24.09%,5.11%,0.73%;the HBV B2,C1 and C2 in patients with HB-ACLF were 87.78%,7.78%,4.44%,with HBV B2 subgenotpe significantly higher than in patients with CHB（x²=9.641,P=0.002）,with LC（x²=19.565,P=0.000） or with HCC（x²=26.789,P=0.000）;the subgenotypes of HBV B2,C1 and C2 in patients with LC were 50.00%,36.67%,13.33%,with HBV C1 and C2 subgenotpes significantly higher than in patients with CHB（x²=6.262,P=0.012,x²=4.790,P=0.029） or in patients with HB-ACLF（x²=25.894 P=0.000,x²=4.390,P=0.036）;the subgenotypes of HBV B2,C1,C2 and C5 in HCC patients were 45.79%,41.12%,12.15%,0.93,with HBV C1 and C2 subgenotypes significantly higher than in patients with CHB（x²=11.264,P=0.001,x²=3.957,P=0.047） or in patients with HB-ACLF（x²=28.327,P=0.000,x²=3.904,P=0.048）;there was no significant difference between HCC patients with HBV C1 and C2 subgenotype infection and LC patients;Logistic regression analysis showed that HBV B2 subgenotype was the independent risk factor for HB-ACLF occurrence, and HBV C genotype was the independent risk factor for HCC occurrence. Conclusion HBV B2,C1,C2 are the most frequent HBV subgenotypes in Guangzhou. The HBV B2 subgenotpe is prevalent in patients with HB-ACLF and HBV C1 and C2 is frequent in patients with LC and HCC.

Objective To observe the efficacy of pegylated interferon α-2a combined with adefovir dipivoxil and their effects on serum T lymphocyte cytokines and hepatic fibrosis indexes in patients with HBeAg-positive chronic hepatitis B（CHB）. Methods 144 patients with CHB were randomly divided into observation group and control group with 72 cases in each group according to the inclusion orders. The patients in control group was given adefovir dipivoxil, and in the observation group was given pegylated interferon α-2a combined with adefovir dipivoxil. After 24-week treatment,the efficacy of treatment,and changes of serum IL-2,IL-10,IL-6 and INF-γ and PⅢP,LN,HA and Ⅳ-C in each group were recorded. Results At the end of 24 weeks of treatment,the negative rates of serum HBV DNA,HBeAg and HBeAg/anti-HBe seroconversion in observation group were 72.22%,58.33% and 41.67%,respectively,much higher than those in the control group（5.56%,22.22% and 20.83%,respectively,P<0.05 for all）;Compared with in control group,serum IL-2 and INF-γ in observation group were much higher [（2.18±1.26） pg/ml vs. （1.71±1.05） pg/ml,and （99.65±11.03） pg/ml vs. （85.70±11.82） pg/ml,P<0.05 for both],while serum IL-6 and IL-10 levels were much lower [（4.53±2.15） pg/ml vs. （5.47±2.25） pg/ml,and （15.42±9.39） pg/ml vs.（20.07±13.08） pg/ml,P<0.05 for both];Serum hepatic fibrosis indexes in observation group were much lower than those in the control group [HA （127.28±59.60） μg/L vs. （261.35±81.46） μg/L,LN （110.52±37.39） μg/L vs. （162.32±38.82） μg/L,Ⅳ-C （116.56±28.61） μg/L vs. （174.13±43.05） μg/L, PⅢ（163.65±64.38） μg/L vs. （212.43±64.25） μg/L,P<0.05 for all]. Conclusion Compared with single use of adefovir dipivoxil,pegylated interferon α-2a combined with adefovir dipivoxil have better antiviral effects and better improvement on T lymphocyte cytokines and hepatic fibrosis indexes in patients with HBeAg-positive chronic hepatitis B.

Objective To investigate the differences in endothelial function between patients with chronic hepatitis B（CHB）,nonalcoholic fatty liver disease（NAFLD） and CHB with NAFLD. Methods The peripheral arterial tension determination （PAT） of patients with CHB（n=32）,NAFLD（n=35） and CHB combined with NAFLD （n=44） was detected by Endo-PAT 2000 endothelial function testing instrument,and the vascular reactivity congestion index （RHI） was calculated. The biochemical index,such as fasting plasma glucose（FPG）,alanine amino transferase （ALT）,aspartate aminotransferase （AST）,total cholesterol （TC）,total glycerine （TG）,high density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C）,lipoprotein a（ApoA）,load of apolipoprotein B （apoB）,lipoprotein a （LP-A） and free fatty acid （FFA） were also analyzed. Results The levels of RHI in patients with NAFLD （1.95±0.44） was higher than that in patients with CHB [（1.68±0.28）,P<0.05];the levels of body mass index（BMI）,TG,TC,LDL-C and apoB in patients with NAFLD [（24.77±3.13）kg/m²,（1.52±0.70）mmol/L,（4.32±0.1.32）mmol/L,（10.72±46.51）mmol/L,（0.90±0.20） g/L]and in patients with CHB and NAFLD[（25.79±2.80）kg/m²,（1.68±0.89）mmol/L,（4.18±1.18）mmol/L,（2.71±0.96）mmol/L,（0.85±0.28）g/L] were higher than those in patients with CHB [（22.63±3.14） kg/m²,（0.89±0.26）mmol/L,（3.51±0.74）mmol/L,（2.23±0.56） mmol/L,（0.68±0.15） g/L,P<0.01]. Conclusion The endothelial function and lipid metabolism may be different between patients with CHB and NAFLD.

Objective To explore the prevalence of thyroid dysfunction in patients with chronic hepatitis C during pegylated interferon（Peg-IFN） combined with ribavirin（RVB） therapy and its impact on antiviral efficacy. Methods 204 patients （HCV 1b infection in 173,2a in 9,3b in 2,and undefined in 20） with chronic hepatitis C who had normal thyroid function at the beginning of the study received the treatment of Peg-IFN combined with RBV. The regimen lasted for 48 weeks for patients with HCV 1 and undefined genotypes,and for 24 weeks for patients with genotype 2 and 3. Serum FT3,FT4,sTSH,Tg-Ab,TPOAb and TRAb were detected. Results Thyroid dysfunction occurred in 43 patients（19.0%） during the PEG-IFN/RBV treatment,among whom 16.3% presented with hypothyroidism,39.5% with subclinical hypothyroidism,25.6% with hyperthyroidism,and 18.6% with subclinical hyperthyroidism. Thyroid dysfunction mainly occurred at 24 to 36 week treatment. At the end of observation,37 patients with thyroid dysfunction recovered spontaneously or after medical intervention,however,six patients with high serum titer of thyroid autoantibodies still needed close monitoring of thyroid function and sustained administration of anti-thyroid agents. There were no significant differences as respect to RVR,EVR,ETVR and SVR between 43 patients with thyroid dysfunction and 161 with normal thyroid function（P>0.05）. Conclusion Thyroid dysfunction occurs in patients with chronic hepatitis C during Peg-IFN/RBV treatment. The thyroid dysfunctions are reversible,and do not influence the antiviral efficacy.

Objective To evaluate the efficacy and safety of boceprevir in combination with peginterferon alfa and ribavirin for treatment of hepatitis C patients with hepatitis C viral genotype 1 infection. Methods MEDLINE,CENTRAL,EMBASE were searched for randomized controlled trial articles published from January 2006 to October 2015 on subject of patients with HCV-G1 infection receiving triple-therapy regimens with boceprevir and peginterferon alfa plus ribavirin. According to the predefined inclusion and exclusion criteria,the included studies were evaluated and analyzed by meta-analysis with RevMan 5.3 software. The primary outcomes was sustained virological response（SVR） and adverse events,and the secondary outcomes included rapid virological response （RVR） and relapse. Results Four RCTs involving 2211 patients were included in this study. The results of meta-analysis showed that the triple-therapy regimens increased SVR [naive:64.08% （737/1150） vs.42.20% （176/417）,OR=0.34,95% CI （0.27,0.42）,P<0.00001;and retreatment:63.02% （288/457） vs.21.09% （31/147）,OR=0.16,95%CI （0.10,0.24）,P<0.00001],and the triple-therapy regimens reduced the risk of relapse in both naive and retreatment patients [11.33% （115/1015） vs.24.00% （66/275）,OR=2.69,95% CI （1.90,3.81）,P<0.00001],as to the RVR,there was no statistical difference between the two groups [72.11% （843/1169） vs.51.861% （265/511）,OR=0.48,95% CI（0.19,1.78）,P=0.28];the incidence of severe anaemia in triple-therapy regimens was obviously higher than in control group [3.98% （64/1607） vs.1.46% （9/614）,OR=0.33,95% CI（0.16,0.68）,P=0.003],and the same phenomena was found as to serious adverse events [10.45% （168/1607） vs.7.33% （45/614）,OR=0.66,95% CI （0.48,0.90）,P=0.01] or the discontinuation because of adverse events [12.49% （109/873） vs.5.18% （13/251）,OR=0.37,95% CI（0.20,0.67）,P=0.001]. Conclusion Boceprevir in combination with peginterferon and ribavirin might increase SVR significantly in patients with hepatitis C and hepatitis C viral genotype one infection,reduce the rate of relapse,but increase the rates of severe anaemia,serious adverse events and the discontinuation because of adverse events. As for the quantity of the included studies is limited,this conclusion still needs to be further proved by more RCT studies.

Objective To investigate the clinical efficacy of western medicine and Chinese traditional medicine in the treatment of patients with type I autoimmune hepatitis（AIH）. Methods 13 patients with type I AIH were treated with thymosin-α,licorice diammonium and herbal medicine （compound） for 3 months. During the treatment,clinical symptoms and signs,liver function indexes such as alanine aminotransferase （ALT）, aspartate aminotransferase（AST）,γ-glutamyltranspeptidase（GGT）,total bilirubin （TBIL）,alkaline phosphatase （ALP）,albumin （Alb） as well as globulin（Glo）,hepatic fibrosis indexes such as hyaluronic acid （HA）,laminin （LN）,type Ⅲ procollagen （PC-Ⅲ） as well as type Ⅳ collagen （Ⅳ-C）,immunoglobulin （Ig） G,IgA and IgM, and peripheral blood T cell subsets,e.g. CD4⁺,CD8⁺ and ratio of CD4⁺/CD8⁺ were observed,and the adverse reactions were recorded. Results At the end of three month treatment,serum ALT,AST,GGT,TBIL,ALP,Alb and Glo levels were （67.5±12.8） U/L,（48.2±13.6） U/L,（57.2±24.5） U/L,（23.6±5.5） μmol/L,（152.9±35.4） U/L,（32.8±4.4） g/L and（30.6±3.7） g/L,respectively,significantly lower than those before treatment [（185.3±51.4） U/L, （198.3±55.2） U/L,（149.3±33.4） U/L,（98.5±26.4） μmol/L,（266.4±40.8） U/L,（37.7±6.1） g/L and （38.4±5.0） g/L, respectively,P<0.05 for all];serum HA,LN,PC-Ⅲ and Ⅳ-C levels declined [（179.7±43.6） μg/L vs. （311.8±72.4） μg/L,（121.7±35.6） μg/L vs. （334.2±42.6） μg/L,（118.5±35.4） μg/L vs. （253.7±56.4） μg/L and （143.1±25.8） μg/L vs.（254.7±42.5） μg/L,respectively,P<0.05 for all];Blood IgG levels was significantly decreased compared to that before treatment[（14.52±3.15） g/L vs.（19.38±3.86） g/L,P<0.05],but blood IgA and IgM levels remained unchanged;Peripheral CD4⁺,CD8⁺ and ratio of CD4⁺/CD8⁺ improved [（0.42±0.04） vs. （0.32±0.03）,（0.30±0.04） vs. （0.27±0.02） and （1.41±0.25） vs. （1.20±0.21）,respectively,P<0.05 for all];No serious adverse reactions was noticed during the treatment. Conclusion Combination of western medicine and Chinese herbal medicine exhibites satisfactory efficacy in the treatment of patients with type I AIH, which warrants further investigation.

Objective To investigate the effect of food intake on the accrracy of fatty liver by the assessment of controlled attenuation parameter（CAP） in patients with liver steatosis. Methods Hepatic CAP values were measured by Fibroscan in 10 volunteers including 7 healthy subjects and 3 with fatty liver with average age of 29 （21~39） yr and body mass index of （22.7±3.13） kg/m²,and the CAPs were obtained at fasting （CAP0）,30 minutes （CAP30）,120 minutes （CAP120） after a standard meal,and the next day of fasting （CAP02）. Results The CAP0,CAP30,CAP120 and CAP02 were（227.8±59.5） dB/m,（244.9±42.1） dB/m,（241.1±51.4） dB/m and （245.7±49.4） dB/m,respectively,with no statistical differences between them（H=0.62,P=0.89）;there was no statistical differences between CAP at fasting state（baseline and the next day fasting）,and at the post-prandial state（30,120 minutes,Z=-1.37,P=0.17）,while the misdiagnosis rates were 5% and 15%,respectively（x²=0.28,P=0.59）. Conclusion The effect of eating on Fibroscan detection of CAP value is not significant,but might increase the rate of misdiagnosis of fatty liver to some extent.

Objective To observe the therapeutic effect of compound fetal bovine liver extract in patients with nonalcoholic steatohepatitis （NAFLD）. Methods 120 patients with nonalcoholic steatohepatitis were recruited in our hospital between January 2014 and January 2016,and the patients with NAFLD were randomly divided into study and control group with 60 cases in each. All patients were given the same dietary guidelines to reduce calorie and fat intake,and daily exercise was also instructed. Patients in the control group received nothing that might have impact on lipid metabolism or liver function,while patients in the study group were given compound fetal bovine liver extract tablets for three months. Liver function,blood lipids,liver fibrosis index and Fibroscan score（CAP value） before and after treatments were obtained. Results After the end of three month treatment,serum AST,ALT and GGT levels in study group were significantly lower than those in patients in control group [（38.53±10.56） U/L vs. （48.83±9.46） U//L,（42.35±12.04） U//L vs. （57.92±13.84） U//L and （44.99±8.74） U//L vs. （50.35±9.84） U//L, respectively,P<0.05 for all];Patients in study group also had lower blood TG and HDL-C levels than those in patients in control group after the treatment [（4.41±1.12） mmol/L vs. （5.20± 0.79） mmol/L, （0.87±0.17） mmol/L vs. （0.74±0.11） mmol/L,respectively,P<0.05 for both];The level of serum HA,LN,PC Ⅲ,and C-Ⅳ levels in patients in study group were remarkably lower than those in the controls after the treatment [（70.18± 20.57） μg/L vs. （82.18±21.53） μg/L,（126.84±27.15） μg/L vs. （133.19±26.68） μg/L,（113.84+25.68） μg/L vs. （128.85±26.35） μg/L,and（61.96±9.46） μg/L vs. （67.94±10.75） μg/L,respectively,P<0.05 for all]; Compared with patients in control group,hepatic CAP values in patients in study group declined more obvious after the treatment （P<0.05）. Conclusion Compound fetal bovine liver extract can improve liver function, blood lipids and liver fibrosis index in patients with nonalcoholic fatty hepatitis.

To explore the relationship between cyp2e-3 gene expression and alcoholic liver disease. Methods In the present study,we recruited 126 patients with alcohol liver disease（ALD） in our hospital from February 2013 to February 2015,and the patients were divided into group A（n=40,with the disease history less than one year）,group B（n=43,with the disease history one to three years）,and group C（n=43,with the disease history greater than three years）. We selected 121 healthy subjects at the same period for control. The hepatic cyp2e-3 mRNA was detected by quantitative PCR,serum cyp2e-3 levels were assayed by ELISA,and hepatic cyp2e-3 expression were detected by Western-blotting or stained immunohistochemistry. Results The hepatic cyp2e-3 mRNA levels in patients with ALD were（34.8±1.7）,much higher than【（6.6±0.7,P<0.05】 in healthy persons;serum cyp2e-3 levels in patients with ALD were higher than in control too;Western-blotting and SP detection found that cyp2e-3 expression in liver tissues in group A,group B,and group C were much stronger than in healthy persons as no cyp2e-3 expression were found in the latter hepatic tissues. Conclusion The activated expression of cyp2e-3 gene in liver tissues in patients with ALD might play a role in the occurrence of liver disease,and it warrants further study.

Objective To investigate the effect of metadoxine（MT） on acute alcoholic liver injury in rats with alcohol-induced liver diseases（ALD）. Methods Twenty-four Wistar rats were randomly divided into normal control,alcoholic liver disease and metadoxine-intervened group,with 8 rats in each group. All rats were fed with normal chow. In the first two weeks,the rats in control and in ALD groups were administered normal saline,while in MT group were treated with metadoxine at dose of 300 mg·kg^-1·d^-1. The protocol lasted for 2 weeks. Then,the rats in ALD group and MT group were made acute liver injuries by alcohol gavage with 50%（v/v） ethanol at dose of 5 g·kg^-1 once every 12 hours,and a total of 3 times,while in rats in NC group were still administered normal saline. Eight hours after the last ethanol administration,the rats were sacrificed,and the blood and liver tissues were collected. The hepatic inflammatory cytokine mRNA was assayed by RT-PCR,and serum NF-κB,TNF-ɑ,IL-1β,IL-6,IL-8 and IL-10 levels were detected by ELISA. The t-test was used for statistical analysis. Results Serum ALT levels in ALD group elevated obviously than in control [（100.13±10.64） U/L vs. （33.37±4.81） U/L,P<0.05],and serum AST and GGT levels increased also（all P<0.05）;serum IL-10, IL-1β,TNF-α,IL-6,IL8 and NF-ΚB levels in control group were（14.73±2.03） pg/ml,（92.38±12.85） pg/ml,（2.66±0.81）pg/ml,（43.57±10.62） ng/ml,（0.29±0.07） ng/ml and （679.45±36.38） pg/ml,in ALD group were （16.19±1.94）pg/ml,（1927±233.69） pg/ml,（16.92±2.38） pg/ml,（127.49±9.33） ng/ml,（2.63±0.22） ng/ml and（1247.35±146.05）pg/ml,while in MT group were （36.81±4.53） pg/ml,（304.13±34.79） pg/ml,（8.83±1.01） pg/ml,（81.98±8.02） ng/ml,（1.45±0.22） ng/ml and（814.84±82.40） pg/ml,respectively,suggesting serum TNF-α,IL-1β,IL-6 and IL-8 levels were higher than those in control（all P<0.05）,serum TNF-α,IL-1β, IL6 and IL-8 levels in MT group were lower,and serum IL-10 level in MT group was higher than in ALD group（all P<0.05）;hepatic TNF-α,IL-1β,IL-6 and IL-8 mRNA levels in ALD group were much higher than in NC group（all P<0.05）,hepatic TNF-α,IL-1β,IL-6 and IL-8 mRNA levels in MT group were much lower,while IL-10 mRNA level much higher than in ALD group（P<0.05）. Conclusion Metadoxine can protect the alcohol-induced acute liver injuries by down-regulating pro-inflammatory cytokines and alleviating hepatic inflammation.

Objective To investigate the protective effect of Hainan fresh coconut water on alcoholic liver injury in rats. Methods Hepatic injury in rats was induced by daily administration of white spirit with alcohol concentraion of 56% by gavage for 29 days. Thirty Sprague-Dawley rats were randomly divided into model group （n=9）,control group （n=8） and coconut water group （n=9）. The animals in control was given 0.9% saline and in experimental group was given alcohol plus Hainan fresh coconut water. At the end of the experiment,the rats were sacrificed and blood and livers were collected. The histopathological change in liver was revealed by HE staining and the levels of alanine aminotransferase （ALT）,aspartate aminotransferase （AST）,triglyceride （TG） in blood and the content of superoxidedismutase（SOD） and malondialdehyde（MDA） in hepatic homogenates were detected. Results Serum AST levels in model group was （123.0±36.2） U/L,significantly higher than that in control group [（86.5±21.0） U/L,P<0.05] or in coconut water group [（96.9±26.0） U/L,P<0.05];there was no significant differences in serum ALT and TG levels among the three groups （P>0.05）;the MDA level in model group was higher than that in control group or in coconut water group [（0.479±0.069） nmol/mg vs. （0.258±0.078） nmol/mg and（0.311±0.139） nmol/mg,P<0.01 for both];the SOD levels in coconut water group and model group were higher than in control group[（0.068±0.008） U/mg and （0.071±0.010） U/mg vs. （0.044±0.022） U/mg,P<0.05 for both],but there was no difference in SOD level between coconut water group and model group;Mild fatty degeneration of hepatocytes was observed in model group and fat droplet were found from hepatocytes in centrilobular regions with some hepatic congestion,however,the histology in coconut water group revealed regular hepatic lobules with intact and distinct hepatocyte structure. Conclusion Hainan fresh coconut water has certain protective effect against alcoholic liver injury in rats,and its antioxygenation might be involved in this process.

Objective To investigate the changes of electrocardiogram and Doppler echocardiography in cirrhotic patients. Methods A total of 167 cirrhotic patients（45 in Child A,64 in Child B and 58 in Child C）,75 patients with hepatitis B and 90 healthy subjects were enrolled in this study. They were examined by Doppler echocardiography and ECG. The left ventricular end-diastolic dimension（LVDd）,left atrial anteroposterior dimension（LA）,left ventricular posterior wall thickness in diastole（LVPW）,interventricular septal thickness （IVS）,left ventricular ejection fraction（LVEF）,peak E and A and the ratio of E/A were evaluated. Results 112 of 167 cirrhotic patients（67%） had abnormal ECG manifestation,much higher than in hepatitis B（40%） or in healthy control （22.2%,P<0.05）;The abnormal changes of ECG in Child-Pugh class C were significant higher than in other two groups （77.5% vs. 53.3% in class A or 67.1% in class B（P<0.05）;The LVDd was （45.62±4.32）mm,LA was （32.21±4.12）mm,IVS was （10.01±1.25）mm,LVPW was（9.8±1.25）mm,peak A was （0.80±0.20） in patients with cirrhosis,significantly different compared to those [LVDd（43.01±4.7）mm,LA（30.45±1.52）mm,IVS（9.4±0.55）mm,LVPW（9.10±0.22）mm,peak A （0.75±0.45）mm] in patients with CHB or [LVDd（42.35±3.1）mm,LA（28.85±2.24）mm,IVS（9.2±1.5）mm,LVPW（9.2±0.80）mm,peak A （0.72±0.13）] in healthy subjects（P<0.05）;E/A ratio in cirrhotic patients was reduced compared with hepatitis B or controls（P<0.05）. Conclusion The change of ECG is variable in cirrhotic patients. As the deficiency of cardiac diastolic functions in cirrhotic patients exists,the ECG and echocardiography should be performed regularly in order to manage in time.

Objective To explore the noninvasive diagnostic model based on Logistic regression and ROC curve in liver fibrosis and cirrhosis. Methods 58 patients with chronic hepatitis B（CHB）,84 with compensated cirrhosis and 35 with decompensated cirrhosis were included in this study. Fibroscan was conducted to obtain liver stiffness measurement（LSM） in all the patients,and serological examination were carried out. Logistic regression,plotted ROC curve and area under ROC curve（AUC） were applied to assess the diagnostic value of all the diagnostic model. Results The LSM were 5.2（4.2~7.3） kPa,7.3（5.8~15.5） kPa and 12.2（8.9~20.0） kPa in patients with CHB,compensated and decompensated cirrhosis,respectively（P<0.05）;Frons index was strongly positively correlated to fibrosis index based on the 4 factors（Fib-4）,red blood cell volume distribution width （RDW） to platelet ratio（RPR）,and PLT counts（r=0.93,r=0.89,r=-0.91,P<0.01）;aspartate aminotransferase-to-platelet ratio index（APRI） was positively correlated to FIB-4 or PLT（r=0.83,r=-0.80,P<0.01）;FIB-4 was positively correlated to RPR or PLT （r=0.86,r=-0.87,P<0.01）;RPR was negatively correlated to PLT （r=-0.98,P<0.01）;ROC curve analysis showed that the diagnostic accuracy of Logistic prediction model（PRE） was 80%,and the area under the curve（AUC） was 0.86 with the sensitivity and specificity of 86% and 78%,respectively. Conclusion Fibroscan detection has a promising value in the diagnosis of hepatic fibrosis in patients with chronic hepatitis B and the prediction models are noninvasive procedure in clinical practice.

Objective To observe the clinical efficacy of combined treatment of cerebrolysin and probiotics for patients with hepatic encephalopathy（HE）. Methods 76 patients with HE were randomly divided into combined treatment group and control group,with 38 cases in each. The patients in control group were treated with probiotics for 4 weeks,and the patients in combined treatment group were treated with cerebrolysin and probiotics for 4 weeks. The scores of number connection test （NCT） and digit symbol test （DST） were applied to evaluate brain functions.The blood ammonia,ALT,tumor necrosis factor-α （TNF-α） and serum bilirubin levels were assessed before and after the treatment. Results At the end of 4 week treatment,the scores of NCT and DST in control group were （70.47±8.15） and （31.52±8.32）,while they were （41.06±6.61） and （56.89±9.23） respectively in combined treatment group,significantly different in the two groups（P<0.05）;The levels of blood ammonia,ALT,TNF-α and TBIL in control group were（69.71±19.56） μmol/L,（66.34±15.82） U/L,（346.75±45.63） pg/ml,and（51.32±8.77） μmol/L,while they were（49.65±18.33） μmol/L,（58.48±12.66） U/L,（142.57±39.51） pg/ml and（40.19±8.24） μmol/L in combined treatment group,with statistically significant difference（P<0.05）. Conclusion The clinical efficacy of cerebrolysin combined with probiotics for treatment of patients with HE is good,and it is worth to prove in clinical practice.

Objective To observe the influences of dexamethasone on liver function after hepatectomy in patients with primary liver cancer（PLC）. Methods 160 patients with PLC were randomly divided into observation group and control group with 80 cases each. Thepatients in control group received conventional therapy,and those in observation were treated with intravenous administration of dexamethasone for three days. Serum alanine aminotransferas （ALT）,aspartate aminotransferase （AST）,albumin（ALB）,total bilirubin（TBIL）,inflammatory cytokine hypersensitive C-reactive protein（hs-CRP）,interleukin-8（IL-8） levels and incidence of postoperative complications were recorded. Results At third and seventh day,serum ALT levels in observation group were（114.6±14.9） U/L and （50.2±6.7） U/L,respectively,much lower than in the control group [（279.2±21.2） U/L and （79.8±11.0） U/L,P<0.05];serum AST levels were（141.2±16.0） U/L and（59.8±7.1） U/L,much lower than in the control group [（299.3±20.4） U/L and（85.5±12.4） U/L,P<0.05];serum ALB levels were（34.8±1.6） g/L and （38.3±1.9） g/L,much higher than in control [（31.6±1.4） g/L and（35.0±1.8） g/L,P<0.05];serum TBIL levels were （32.2±2.7） μmol/L and （27.1±2.4） μmol/L,much lower than in the control group [（36.2±3.1） μmol/L and （31.2±2.6） μmol/L,P<0.05];at the end of first day and seventh day,serum hs-CRP levels in observation were （25.0±3.1） mg/L and （17.8±2.1） mg/L,much lower than in the control group （30.6±3.8） mg/L and （21.0±2.6） mg/L,P<0.05];seerum IL-8 levels were（24.0±3.0） pg/ml and（14.0±1.9） pg/ml,much lower than in the control group[（28.6±3.7） pg/ml and（18.5±2.1） pg/ml,P<0.05];the postoperative complication rate in observation was 35.0%,without significant difference in control（23.8%,P>0.05）. Conclusion Dexamethasone can protect liver function in patients with PLC after hepatectomy,which might be related to the inhibition of inflammatory reactions.

Objective To evaluate the diagnosis of intrahepatic peripheral cholangiocarcinoma（IHPCC） by spiral computed tomography（CT） and magnetic resonance imaging（MRI）. Methods A total of 80 patients with IHPCC were included in this study. All patients underwent non-enhanced,enhanced,and delayed scanning of spiral CT and MRI examination,and the diagnostic efficacy were estimated by pathologic examination post-operationally or by fine needle biopsy before operation. Results The lesion size ranged from 1.3 cm×2.0 cm to 7.3 cm×9.0 cm （mean 4.6 cm×6.4 cm）;the tumors localized in left lobe in 58 cases,in right lobe in 22 cases;the tumors presented as mass in 46 cases （57.50%）,infiltrating stenosis in 17 cases （21.25%）,growth chamber in 10 cases （12.50%）,and not clear in 7 cases （8.75%）;Unenhanced CT scan showed low-density lesions in all,and enhanced CT scan showed mild to moderate edge enhancement in 50 cases,mild central strip sheet enhancement in 12 cases,and no enhancement in 18 cases;delayed CT scan showed separation of unevenness or sheet-like enhancement in 47 cases,homogeneous enhancement in 5 cases,and no enhancement in 28 cases;Unenhanced MRI scan showed the lesions more clearly than CT,and delayed enhanced MRI scan showed enhancement in 73 cases;the diagnostic accuracy rate of MRI was 91.3%,no statistically significant difference as compared to 80.0% by CT scan（P>0.05）. Conclusions Delayed enhanced CT and MRI scan may improve the diagnostic accuracy of IHPCC, and we recommend MRI in clinical practice.

Objective To compare the clinical effect of hepatic lobe resection with“T” tube drainage and bile duct-jejunum Roux en-Y anastomosis in the treatment of patients with intrahepatic bile duct calculi. Methods From January 2011 to January 2015,80 cases of intrahepatic biliary calculi patients were randomly divided into hepatic lobe resection with “T” tube drainage group（n=39）,and common bile duct-jejunum Roux en-Y anastomosis group （n=41）. Results The early postoperative residual stones was 7 （18.0%）,infection of incision 4 （10.3%）,abdominal cavity infection 6（15.4%）,bile leakage 4（10.3%） in hepatic lobe resection,while they were 8（19.5%,P>0.05）,5（12.2%,P>0.05）,6（14.6%,P>0.05）,and 4（9.8%,P>0.05）;the postoperative residual cholangitis （8.3%）,stone with bile duct calculi recurrence（4.2%）,anastomotic stenosis（4.2%） in patients receiving hepatic lobe resection were significantly lower than in bile duct-jejunum Roux en-Y anastomosis group（24.4%,19.5%,7.3% and 22.0%,respectively,P<0.05）;the serum bilirubin levels in hepatic lobe resection group were（10.87±2.36） μmol/l, ALT were（38.96±10.28） U/L,AST were（34.76±5.47） U/L and ALP were（108.04±23.40） U/L, significantly lower than in bile duct-jejunum Roux en-Y anastomosis group （[（18.96±2.01） μmol/l,（76.83±15.67） U/L,（45.54±4.58） U/L and（176.42±34.58） U/L,respectively,P<0.05]. Conclusion Hepatic lobe resection with “T” tube drainage in the treatment of patients with intrahepatic bile duct stones is effective with lower incidence of complications and improved liver function.

Traditionally cell death is divided into two categories,e.g. apoptosis and necrosis. But a growing body of research results show that the necrotic apoptosis is a kind of cell death different from necrosis and apoptosis,and plays an important role in a variety of diseases. Activation of necroptosis by ligands of death receptors requires the kinase activity of RIP1,which mediates the activation of RIP3 and MLKL,two critical downstream mediators of necroptosis. Blocking the kinase activity of RIP1,a key druggable target in the necroptosis pathway,by necrostatins inhibits the activation of necroptosis and allows cell survival and proliferation in the presence of death receptor ligands. In this review,we will discuss the difference between apoptosis,necrosis and necrotizing apoptosis,and we will summarizes the mechanism by which the necrotizing apoptosis occur in liver diseases.

The liver fibrosis is closely related to the diagnosis and treatment of chronic liver diseases. Early diagnosis of liver fibrosis might help patients with compensated liver functions slow down to the decompensated period,and also reduce the incidence of hepatocellular carcinoma. Liver biopsy is considered as the gold standard to assess the extent of liver damage in patients with chronic liver disease,but it is invasive. Transient elastography is a relatively novel,safe,noninvasive technique to evaluate liver stiffness. It can not only monitor the progression of liver fibrosis dynamically,but also objectively evaluate the liver damage. It is now widely used in clinic. In this review,the value of transient elastography in diagnosis of liver fibrosis was discussed.

Portal vein thrombosis（PVT） should be treated properly because it has an objective effect on the prognosis of patients with cirrhosis. Anticoagulant therapy is commonly used in clinic，but how to make the correct choice of it for patients with risk of variceal bleeding is very hard. The current worldwide guidelines for the management of cirrhosis patients with PVT do not provide a definite recommendation. We retrieved the relevant clinical trials in literatures and found that the application of anticoagulation in cirrhosis patients with PVT was associated with a high rates of recanalization and didn’t increase the risk of gastrointestinal bleeding. The evidences of current research，however，are generally at a very low levels，and more prospective studies with relatively large samples are needed to give a confirmed conclusion. We think the use of anticoagulant therapy should be individualized based on the specific circumstances at present.

MicroRNAs（miRNAs）have emerged as master regulators in several biological processes. More and more studies have shown that serum miRNAs levels differ in liver cirrhosis. Serum miRNAs may serve as a potential biomarker for dignosis and prognosis of patients with liver cirrhosis

Kupffer cells serve as a protective barrier in the liver tissues. In endotoxinemia-induced liver injury,Kupffer cells produce pro-inflammatory cytokines and other chemical factors as they coupled with pattern recognition receptors such as Toll-like receptor,which can accelerate the processing of liver injury. Conversely,in drug-induced liver injury,such as acetaminophen-induced liver injury,Kupffer cells play several protective roles via secreting anti-inflammatory cytokines and promoting the formation of blood vessels in liver tissues. In this paper,we reviewed the vital role of Kupffer cells in the two types of liver injuries.

Dipeptidyl peptidase-4（DPP-4） is a membrane-associated peptidase, also known as CD26. DPP-4 has widespread organ distribution throughout the body and has pleiotropic effects. A representative target peptide is glucagon-like peptide-1 （GLP-1）,and inactivation of GLP-1 results in the development of glucose intolerance/diabetes mellitus. In addition to its peptidase activity,DPP-4 is associated with immune stimulation, binding to and degradation of extracellular matrix,resistance to anti-cancer agents,and lipid accumulation. The liver expresses DPP-4 to a higher degree,and recent studies suggest that DPP-4 is involved in the development of various chronic liver diseases such as hepatitis C virus infection,non-alcoholic fatty liver disease,and hepatocellular carcinoma. Furthermore,hepatic stem cells express DPP-4,which might plays a crucial role in hepatic regeneration. In this paper,we reviewed the tissue distribution and various biological effects of DPP-4. The impact of DPP-4 in chronic liver disease and the possible therapeutic effects of a DPP-4 inhibitor were also discussed.