【Abstrat】 Objective To explore the protective effect of berberine on intestinal leak in mice with alcoholic hepatitis. Methods Forty male C57BL/6mice were randomly divided into control, alcohol, berberine, alcohol plus berberine group with10animals in each. Mice were fed with alcohol or vehicle for8weeks, all were sacrificed. Serum alanine aminotransferas （ALT）, aspartate aminotransferase（AST）, lipopolysaccharide （LPS） were detected by enzyme-linked immunosorbent assay（ELISA）. The pathologic changes of liver tissues were assessed by HE staining, and the ultrastructures of tight junction（TJ） complex was observed by transmission electron microscope. In vitro, occludin, the main structural protein of intercellular TJ, was detected by immunofluorescence in intestinal epithelial Caco-2cells, which were cultured with ethanol （EtOH）, BBR, EtOH plus BBR respectively. Results Serum ALT, AST, LPS levels in alcohol group were（46.5±5.9） U/L, （57.0±6.1） U/L, （0.40±0.05） ng/ml, respectively, significantly higher than those in control group （P<0.01）;There was no significant difference between alcohol plus BBR group, control group;Serum ALT, AST, LPS levels in alcohol plus BBR group were （27.6±4.2） U/L, （31.8±4.1） U/L and（0.24±0.03） ng/ml, respectively, significantly lower than those in alcohol group（P<0.05）;The histopathologic examination of liver tissues showed alcoholic hepatitis in alcohol group, and it was alleviated as respect to steatosis, inflammatory cell infiltration in alcohol plus BBR group;Electron micrographs showed that the TJ structures between intestinal epithelial cells were fuzzy, the gaps were expanded obviously in alcohol group, and all of these were improved obviously in alcohol plus BBR group;Immunofluorescence indicated that the occludin on Caco-2cell membranes were decreased, interrupted, partly entered into cytoplasm in alcohol group, while in alcohol plus BBR group, the distribution of occludin was decreased, though, but was continuous.Conclusion Berberine improves the decrease in occludin expression on cell membranes, the disruption of TJ structures between intestinal epithelial cells induced by chronic ethanol intake, alleviates intestinal leak

Objective To study the effect of different doses of liraglutide on insulin resistance（IR） in model rats with nonalcoholic fatty liver disease（NAFLD）. Methods High fat diet was given to 50 male Sprague-Dawley rats to establish NAFLD and 32 rats with successful NAFLD were randomly divided into 4 groups,e.g. group A （model group,n=8）,and liraglutide were given in group B [0.9 mg·kg-1·d-1,n=8],group C [1.8 mg·kg-1·d-1,n=8] and group D[3.6 mg·kg-1·d-1,n=8]. Rats were sacrificed after 4 weeks of medicine intervention. Data of body weight and liver weight were recorded. Blood from the abdominal aorta and livers were collected. Liver index,blood glucose,insuli （FINS）,blood lipids（TG,TC）,transaminase（ALT,AST）,malondialdehyde （MDA）,and glutathione peroxidase （GSH-Px）,superoxide dismutase （SOD） and tumor necrosis factor alpha （TNF-alpha） in liver tissues were detected. Results Compared with in the model group,the rat body weight,liver index,ALT,FINS,FPG,HOMA-IR,MDA in blood and TG,TC,MDA in liver tissues decreased significantly in intervention groups （P<0.05）,and in group D with highest dose of liraglutide gained the most decrease in the above index than in the other two intervention groups（P<0.05）;Compared with in model group, the GSH-Px and SOD in intervention groups significantly increased（P<0.05）,and GSH-Px and SOD in group D increased the most（P<0.05）;There was no significant difference of TNF-α among all the groups. Conclusion Liraglutide can significantly reduce the liver index, serum lipid and blood glucose in rats with NAFLD,and improve IR,and the treatment effect is dose-dependent.

Objective To investigate the protective mechanism of histone deacetylase inhibitor ACY1215 on liver mitochondrial damage in rats with acute hepatic failure（AHF）. Methods 24 male SD rats were randomly divided into control group,model group and ACY1215-intervened group. Lipopolysaccharide（LPS） and D-galactosamine （D-Gal） were used to establish acute liver failure model in rats. The ACY1215 （10 mg·kg-1） was given 2 hours before the establishment of acute liver failure. Serum and liver samples of rats were obtained at end of 48 hours after AHF induction. The liver histological changes were observed by light and electron microscopy,and the mitochondria of hepatocytes were separated by gradient centrifugation. The relative fluorescence （RFU） of mitochondrial membrane permeability transition porosity （MPTP） was tested by fluorescence spectrometry. The content of cytochrome C（Cytc） in mitochondria supernatants was determined by ELISA. The contents of serum ALT,AST and total bilirubin were detected by routine biochemical method. Results Compared with in the model group,the degree of liver histological damage was reduced in the ACY1215-intervened group,and the mitochondrial swelling of the hepatocytes was improved;serum ALT [（5114.1±252.6） U/L vs. （56.0±4.4） U/L],AST [（2909.8±31.7） U/L vs. （130.4±12.6） U/L] and total bilirubin levels [（97.6±1.4） μmol/L vs. （7.4±0.7） μmol/L] in the model group were significantly higher than those in the control group （P<0.05）,while they[（799.4±11.2） U/L,（401.0±5.6） U/L and（28.0±1.2） μmol/L,respectively] in the ACY1215-intervened group significantly decreases as compared to those in the model group（P<0.05）;the MPTP in acute liver failure model group was significantly higher than that in the normal control group[（968220.0±16733.1） RFU/mgprot vs.（156300.0±24043.3）RFU/mgprot，P<0.05）]，and also higher than in the ACY1215-intervened group [（127150.0±12337.6） RFU/mgprot，P<0.05]；the mitochondrial Cytc level in the model group was significantly lower than that in the control group [（0.17±0.03） ng/mgprot vs. （0.39±0.10） ng/mgprot，P<0.05]，and also lower than that in the ACY1215-intervened group [（0.32±0.06） ng/mgprot，P<0.05]. Conclusion ACY1215 has a protective effect on liver mitochondria in rats with acute hepatic failure，and the mechanism might be the inhibition of opening of mitochondrial MPTP in the livers and reduction of translocation of Cytc into the cytoplasm.

Objective To observe the efficacy of entecavir combined with silybin meglumine amine in treatment of patients with chronic hepatitis B （CHB） and non-alcoholic fatty liver disease （NAFLD）. Methods 80 patients with CHB and NAFLD in our hospital were enrolled between January 2015 and January 2016 in this study. Patients were randomly divided into control group and observation group with 40 cases in each group. The patients in control group was treated with entecavir alone and in observation group was given entecavir combined with silybin meglumine amine. The regimen continued in both groups,and we assessed the efficacy at the end of six month treatment. Results At the end of six month treatment,serum alanine aminotransferase and aspartate amonotransferase levels in observation group were significantly lower than those in the control group[（64.3±27.9） U/L vs. （83.7±26.0） U/L,and （42.0±24.5） U/L vs. （57.6±26.6） U/L,respectively,P<0.05 for both];serum levels of PCⅢ,Ⅳ-C,LN and HA in observation group were lower than those in the control group [（106.0±54.5） ng/L vs. （147.6±76.6） ng/L,（69.23±21.24） ng/L vs. （86.74±21.30） ng/L,（119.2±61.2） ng/L vs. （212.7±100.3） ng/L,and （119.2±71.2） ng/L vs. （205.7±91.3） ng/L,respectively,P<0.05 for all];there were no differences as respect to serum HBV DNA and HBsAg levels between the two groups [（2.3±0.9） Ig IU /ml vs. （2.7±1.0） Ig IU /ml,and （4458.0±945.5） S/CO vs. （4744.0±1256.5） S/CO,respectively,P<0.05 for both]. Conclusion The combination of entecavir and silybin meglumine amine is effective in improving liver enzymes and serum indexs of hepatic fibrosis in patients with CHB and NAFLD,but we don’t find any benefit on serum HBsAg eradication by this regimen.

Objective To evaluate the efficacy of combination of entecavir and Chinese herbal medicine in treatment of patients with hepatitis B. Methods 69 patients with hepatitis B were enrolled between January 2015 and December 2016 in this study. 34 patients with hepatitis B received combination of entecavir and herbal medicine,and 35 patients with hepatitis B received entecavir alone for 24 weeks. The data of liver function index and serum liver fibrosis markers were compared. SPSS 19.0 statistical software was applied to complete the data processing and analysis. Results There was no significant difference in serum albumin level between the two groups before and after the treatment （P>0.05）,while there were significant differences as respect to serum bilirubin, alanine aminotransferase,and aspartate aminotransferase levels between the two groups （P<0.05）,e.g. serum bilirubin level in the combination group at the end of 24 weeks was（20.1±4.7） μmol/L,much lower than（28.7±4.8）μmol/L in the controls （P<0.05）,serum ALT leves was （40.9±6.8） U/L,much lower than （50.2±6.7） U/L in the control （P<0.05）,and serum AST level was （39.6±8.4） U/L,much lower than （52.5±8.1） U/L in the control （P<0.05）;at the end of observation,serum HA,LN,IV-C and PC-Ⅲ levels decreased both in the two groups,e.g. serum HA level in the combination group decreased from [（256.3±9.3） μg/L to（98.3±9.1）μg/L,while serum HA levels in the control decreased from （255.3±9.8） μg/L to（140.3±9.6） μg/L,serum LN level in the combination decreased from[（241.3±7.8） μg/L to （110.3±7.7） μg/L,seerum LN level in the control decreased from [（240.4±7.8） μg/L to （170.5±7.9） μg/L,serum IV-C levels in the combination decreased from [（98.4±6.8） μg/L to（53.6±6.7）μg/L,serum IV-C level in the control decreased from [（98.00±6.5） μg/L to （70.9±6.6） μg/L,serum PC-Ⅲ level in the combination decreased from [（193.6±13.2） μg/L to（98.3±9.9） μg/L,while serum PC-Ⅲ levels in the control decreased from [（193.5±13.4） μg/L to（120.3±9.7） μg/L（P<0.05）;there was no significant differences as respect to serum HBeAg and/or HBV DNA negativity in the two groups（P>0.05）. Conclusion Combination of entecavir and Chinese herbal medicine can quickly inhibit HBV replication,and enhance the efficacy of anti-liver fibrosis.

Objective To investigate the efficacy and safety of combined therapy of telbivudine and compound embryonic bovine liver extract in patients with chronic hepatitis B（CHB）. Methods Eighty-seven patients with chronic hepatitis B were randomly divided into combination treatment group （n=43） and control group（n=44）. Patients in combination treatment group were treated with compound embryonic bovine liver extract plus telbivudine,and those in control group were treated with telbivudine alone. The data of liver function index,renal function index,serum hyaluronic acid （HA）,laminin （LN）,type IV collagen（IV-C）,type III procollagen,N-terminal peptide（P IIINP）,creatine kinase（CK）,HBV DNA undetectable rates,HBeAg loss rates and adverse reaction rates were compared between the two groups. Results At the end of 24 weeks of treatment,serum alanine transaminase （ALT）,aspartate aminotransferase （AST） levels in combination treatment group were（25.4±8.5） U/L,（23.8±6.5） U/L,respectively,significantly lower than those in control group [（46.3±9.3） U/L,（49.0±7.3）U/L,P<0.05];serum HA,LN,Ⅳ-C,PⅢNP levels in combination treatment group were（128.4±83.2） μg/L,（88.4±64.3） μg/L,（64.4±49.0） μg/L,（112.3±73.8） μg/L,respectively,significantly lower than those in control group[（249.3±82.1） μg/L,（163.1±55.1） μg/L,（98.2±50.3） μg/L,（183.2±63.2） μg/L,P<0.01];serum HBV DNA undetectable,HBeAg loss and adverse reaction rates in the two groups were not significantly different（P>0.05）. Conclusions Telbivudine combined with compound embryonic bovine liver extract can significantly improve the liver function and liver fibrosis in patients with CHB,and have a good safety profile.

Objective To analyze the diagnostic value of quantitative analysis of liver fibrosis by real time tissue elastography in patients with hepatitis B. Methods 175 patients with hepatitis B and 100 healthy persons between July 2015 and December 2016 were recruited in our hospital,and liver biopsies were performed in patients with hepatitis B. Real-time tissue elastography （RTE） was conducted in the two groups. The receiver operating characteristic curve （ROC） was used to analyze the efficacy of diagnostic value of each parameter. When the area under curve（AUC） of ROC was greater than 0.5,the diagnosis was set up. Results The average relative value （ARV） in health group was（128.3±8.1）,much higher than （106.3±5.2） in CHB patients （P<0.05）;the area ratio of low-strain region （AREA）,complexity （COMP）,skewness （SKEW）,contrast （CONT） and inverse different moment（IDM） in health group were （3.7±0.5）,（16.6±1.2）,（-0.1±0.0）,（91.8±9.1）,（0.1±0.0）,much lower than [（19.9±2.6）,（29.4±3.1）,（0.3±0.1）,（173.9±17.9）,（0.2±0.1）,all P<0.05） in patients with CHB;the ARV in 67 patients with S0-S1 staging was （118.5±5.6）,much higher than [（101.6±5.3）,P<0.05] in 82 with S2-S3,and also much higher than [（89.7±4.9）,P<0.05] in 26 with S4 staging;the AREA,COMP,SKEW,CONT and IDM in S0-S1 group were（9.4±1.7）,（22.4±2.4）,（0.11±0.0）,（121.0±11.2）,（0.1±0.0）,much lower than[（23.5±2.4）,（31.8±2.7）,（0.32±0.1）,（188.2±15.2）,（0.2±0.1）,all P<0.05） in S2-S3 group,and the AREA,COMP,SKEW,CONT in S2-S3 group were also much lower than[（36.2±2.6）,（40.1±2.9）,（0.46±0.1）,（265.3±16.1）,all P<0.05） in S4 group;ROC curve analysis showed that the ARV,AREA and SKEW had diagnostic value for diagnosis of S0-S1,S2-S3 and S4 as the AUC were greater than 0.5. Conclusion Non invasive diagnosis of quantitative analysis by real time tissue elastography has diagnostic significance for liver fibrosis in patients with hepatitis B,and it might be used as one of the alternative methods for liver fibrosis.

Objective To evaluate the diagnostic efficacy of ten noninvasive indexes for liver fibrosis in patients with chronic hepatitis B. Methods The data of 1362 patients with chronic hepatitis B between January 2008 and December 2014 were collected and statistically analyzed. Results For significant fibrosis diagnosis,the best AUROCs of S index,GPRI and APRI were 0.745,0.736 and 0.681,respectively;For cirrhosis diagnosis,the best AUROCs were S index（0.716）,FIB-4 （0.708） and GPRI 0.707,respectively;In diagnosing liver cirrhosis,the cut-off value of S index was 0.03,with a sensitivity of 98.8%,a negative predictive value of 97.0% and a negative likelihood ratio of 0.14;and the cut-off value 1.5 showed a specificity of 99.5%,a positive predictive value of 70.0% and a positive likelihood ratio of 10.1;For significant fibrosis diagnosis,the cut-off value of S index was 0.89,with a specificity of 99.5%,a positive predictive value of 98.5% and a positive likelihood ratio of 11.5;the cut-off value 0.02 showed a sensitivity of 97.7%,a negative predictive value of 40.0% and a negative likelihood ratio of 0.26. Conclusions S index has a relatively good accuracy and is superior to other nine noninvasive diagnostic indexes in diagnosing significant liver fibrosis in patients with chronic hepatitis B.

Objective Due to the interference between two viruses,the clinical features and prognosis in patients with superinfection of hepatitis B virus and hepatitis C virus（HBV/HCV） are usually different from the patients with single hepatotropic virus infection. The aim of this study is to investigate the characteristics of the mutual interference between the viruses and disease outcomes in patients with HBV/HCV superinfection,and provide evidence to help the diagnosis and treatment for the HBV/HCV superinfection patients. Methods 30 patients with HBV/HCV superinfection were enrolled between November 2002 and December 2013 in the Third Hospital, Hebei Medical University,and 59 patients with chronic hepatitis B（CHB） and 54 patients with chronic hepatitis C（CHC） between June 2013 and December 2014 in the Third Hospital,Hebei Medical University were also included in this study. All the patients in each group were retrospectively analyzed for the patient's general conditions and clinical data. Results Serum level of globulin in patients in HBV/HCV superinfection was （32.12±6.76） g/L,significantly higher than that in CHB patients【（28.69±7.16） g/L, P<0.05】,serum level of ALT was（134.02±209.34） U/L,significantly higher than that in CHB group【（71.57±53.23）U/L,P<0.01】, serum level of total bilirubin was（62.18±99.05）μmol/L,which was significantly higher than that in CHB group【（30.98±30.70）μmol/L,P<0.01】, serum level of GGT was（71.60±51.92）U/L,which was significantly higher than that in CHB group【（50.28±47.23）U/L,P<0.05】,and the level of prothrobin time activity （PTA） was （73.39±17.19）%,which was significantly lower than that in CHB group 【（91.28±17.71）%,P<0.01】;the negative rate of serum HBeAg in HBV/HCV superinfection group was 50.0%,not significantly different（P>0.05） as compared to 45.0% in HBV infection group; the positive rate of serum HBV DNA in HBV/HCV superinfection group was 50.0%,which was significantly lower than that in HBV infection group（79.7%,P<0.01）;the serum viral load in HBV/HCV superinfection group was significantly lower than that in CHB group,and the difference was significant （Z=-3.331, P<0.01）;the incidence of severe chronic hepatitis and cirrhosis in HBV/HCV superinfection group was 53.3%,which was significantly higher than that in HBV infection group（34.0%,P<0.05）,and there was an significant difference in terms of disease outcome（Z=-3.121,P<0.01）;serum albumin level in patients with HBV/HCV superinfection was（37.78±6.74） g/L,which was significantly lower than that in CHC group【（43.07±4.48） g/L, P<0.01】,serum globulin level was significantly higher than that in CHC group【（28.83±5.84）g/L,P<0.05】,serum level of AST was significantly higher than that in CHC group【（51.29±38.61）U/L,P<0.05】,serum level of ALT was significantly higher than that in CHC group【（52.91±29.71） U/L,P<0.01】,serum bilirubin level was significantly higher than that in CHC group【（16.71±7.65）μmol/L,P<0.01】,serum level of GGT was significantly higher than that in CHC group【（38.39±29.10）U/L,P<0.01】 and PTA was significantly lower than that in CHC group【（104.62±16.10）%,P<0.01】;serum HCV RNA load in patients with HBV/HCV superinfection was significantly lower than that in CHC group（Z=-5.612,P<0.01）;the incidence of severe liver function damage in HBV/HCV superinfection group was 53.3%,which was higher than that in CHC group（13.0%,Z=-5.249,P<0.01）. Conclusions HBV/HCV superinfection tends to lead to more severe liver damage,and the incidence of liver cirrhosis is also significantly increased,while the serum viral loads might be lower,which needs to take into consideration in clinical practice.

Objective To explore the effect of therapeutic communication of external extension nursing in patients with chronic hepatitis C on negative emotion and sense of self-efficacy. Methods Eighty-two patients with chronic hepatitis C were recruited in our hospital between January 2013 and February 2016. The patients were divided into observation group and control group with 41 in each. The traditional care model was given in the control,while the patients in the observation were given the extended care at the base of nursing in the control. The patients in the two groups accepted SF-36 quality of life scale,self efficacy questionnaire,self rating anxiety scale（SAS） and self rating depression scale（SDS） evaluation before and 4 weeks after intervention. Results The SF-36 score of each dimension of quality of life in the two groups before the intervention were not significantly different（P>0.05）;the physiological functions,physical disease,general situation,energy,social functions, emotional functions and mental health scores in the observation group at the end of 4 weeks were much higher than in the control group（P<0.05）;the basic knowledge of disease,poor diet harmfulness cognition,treatment knowledge,self management knowledge and complication prevention knowledge scores were much higher than in the control group（P<0.05）;the SAS scores and SDS scores in the two groups were statistically significantly different（P<0.05）. Conclusion The application of extended nursing mode of therapeutic communication might relieve the anxiety and depression,and improve the self-efficacy in patients chronic hepatitis C.

Objective To analyze the clinical features of patients with sporadic hepatitis E （HE）. Methods The clinical data of 156 patients with HE were collected in our department between January 2012 and December 2015, and the epidemiologic,clinical features and prognosis were retrospectively analyzed. Serum anti-HEV-IgM and-IgG were detected by ELISA. Results The average age of the 156 patients was 52.9±12.7 years old,129 cases were male and 27 were female,and the male and female ratio was 4.8:1;the disease occurred in every quarter,mainly occurred from January to May,especially in February （accounting for 20.5%）;serum bilirubin levels and the hospitalization stay in patients with HE with underlying chronic hepatitis B were（180.8±111.1） μmol/L and（23.1 ±12.2） days,significantly higher or longer than（148.6±89.9） μmol/L and（16.7±8.8） days in patients with HE （P<0.05）,and the incidence of hepatic failure in the two groups were（3.8% and 10.0%,P<0.05）;serum bilirubin levels and the hospitalization stay in patients older than 60 years were（194.6±121.4） μmol/L and （22.1±7.0） days,significantly higher or longer than （144.1±104.9） μ mol/L and （16.9±8.8） days in patients 18 to 59 years old（P<0.05）,and the incidence of hepatic failure in the two groups were（10.5% and 4.0%,P<0.05）. Conclusion HE is more common in middle-aged men,and the incidence of sporadic HE varies from January to March. More attention should be taken to elderly patients with HE,especially in patients with underlying chronic liver disease,as they often have a relatively long hospital stays,high serum bilirubin levels and a high incidence of hepatic failure, and the overall prognosis of patients with HE is good.

Objective To investigate the efficacy and safety of Ganzaoning granules in the treatment of patients with nonalcoholic fatty liver. Methods 300 patients with nonalcoholic fatty liver were recruited in our hospital between October 2015 and October 2016，and they were randomly divided into two groups，with 150 case in each group. All patients were given a regular diet and exercise therapy，and 150 patients were treated with Ganzaoning granules at the base of diet and exercise therapy. TCM syndrome scores，blood biochemical parameter，clinical efficacy and adverse reactions were observed. Results At the end of 3 month treatment，the total effective rate in the Ganzaoning granule-treated group was 93.3%，significantly higher than 61.3% in the control group （P<0.01）；TCM syndrome score was （9.3±2.1），significantly lower than [（12.8±3.6），P<0.01] in the control group； serum ALT，AST，TC and TG levels were（38.1±12.4） U/L，（36.4±9.6） U/L，（2.1±0.4） mmol/L and（5.2±1.4） mmol/L，significantly lower than [（54.2±9.3） U/L，（50±11.2） U/L，（2.7±0.4） mmol/L and（6.5±1.2） mmol/L in the control，respectively，P<0.01]. Conclusion Ganzaoning granule treatment at the base of diet and exercise therapy in patients with nonalcoholic fatty liver has a good clinical efficacy and safety.

【Abstract】 Objective To investigate the changes of personality, emotional states in patients with nonalcoholic fatty liver diseases（NAFLD）. Methods319adults taking physical examination, 64patients with liver diseases except NAFLD（57of them were with chronic hepatitis B, CHB） were recruited to complete the controlled attenuation parameter （CAP）, liver stiffness measurement （LSM）, serum aminotransferase tests. Type A behavior pattern scale（TABP）, 9-item patient health questionnaire （PHQ-9）, 7-item generalized anxiety disorder scale（GAD-7） were used to evaluate their personality traits, emotional states. Results Out of319adults, 29cases were ruled out, and the rests were found to be healthy people （n=93）, NAFLD （n=197）. Out of197with NAFLD, 88were with mild, 109with moderate to severe NAFLD;62were non-obese, 135obese;240cases were fibrosis-free, 57with fibrosis, 22with cirrhosis;Out of319, 188took liver function test, 118of them were found with normal alanine aminotransferase（ALT）, and70cases being with elevated ALT. Time hurry（TH）, competitive, hostility（CH） scores by TABP in NAFLD group was25.97±6.81, significantly higher than in healthy people（23.41±6.09, P0.05）; No significant difference was found as respect to TH/CH scores between NAFLD group, other liver diseases group （25.73±7.41, P0.05）;39.1% of cases in NAFLD group were with type A personality, significantly higher than in healthy people（24.7%, P0.05）;No significant difference was found as for type A personality between NAFLD group, other liver diseases group（46.9%, P0.05）;In NAFLD group, 62.4% cases were with mild or severe depressive mood, 51.3% cases with mild or severe anxious mood, both significantly higher than in healthy people（33.3%, 10.8%, respectively, P0.05）;No significant difference was found between NAFLD group, other liver diseases group as respect to the above emotional states （56.3%, 42.2% in the latter, P0.05）;In cirrhosis group, 86.4% were with mild or severe depressive mood, and68.2% with mild or severe anxious mood, both significantly higher than in liver fibrosis group（49.1%, 40.4%, respectively） or in fibrosis-free group （48.8%, 33.3%, respectively, P0.05）;51.6% cases in non-obese NAFLD group were with type A personality, significantly higher than that in obese NAFLD group（33.3%, P0.05）;47.1% cases were with type A personality, 64.3% with mild or severe depressive mood, and54.3% with mild or severe anxious mood in elevated ALT group, all significantly higher than those in normal ALT group（29.7%, 44.9%, 34.7%, respectively, P0.05）. Conclusion Our findings show than NAFLD patients have emotional problems such as personality changes, depression, anxiety, which validates further investigations

Objective To summarize the features of chronic cholestatic liver disease（CLD）,as a kind of drug-induced liver injury（DILI）. Methods 87 patients with DILI were recruited between Jan. 2011 and Dec. 2013 in this study. The diagnosis was made by RUCAM score of equal to or greater than six at the base of exclusion. Results The clinical classification presented as CLD in 23,and as DILI without intrahepatic cholestasis in 64 cases,and the cholestatic disease was found more common in CLD patients（P<0.01）;the triggering medicines,including Chinese herbal medicines in the two groups,was not significantly different （P>0.05）;serum gamma-glutamyl transpeptidase （GGT） and alkaline phosphates （ALP） levels in 23 patients with CLD were 【430.7（156.00,1142.00）】 U/L and（285.07±131.52） U/L,much higher than【111.5（18.00,185.60）】 U/L and （140.28±101.36） U/L（P<0.05） in 64 patients with DILI;the recovering time for serum alanine aminotransferase,GGT,ALP and bilirubin back to normal in the two groups was not significantly different（P>0.05）. Conclusions The patients with chronic drug induced cholestatic liver disease have clinical manifestations of liver inflammation and cholestasis. They might get good prognosis in the short-term observation.

【Abstract】 Objective To study the efficacy of acoustic radiation imaging （ARFI） technique, erythrocyte parameters in assessing the degree of liver fibrosis in patients with hepatolenticular degeneration （HLD）. Methods168patients with HLD, 154healthy subjects in our hospital were selected in this study. The peripheral blood erythrocyte parameters were measured, compared between the two groups. On the basis of conventional two-dimensional ultrasonography, the shear wave velocity （SWV） in HLD patients was measured by ARFI technique, the efficacy of them was obtained as for the liver fibrosis evaluation. Results The red blood cell counts [（4.26±0.29）×1012/L vs. （4.67±0.28）×1012/L], hemoglobin concentration （HGB）[（124.48±5.87） g/L vs. （138.43±7.95） g/L], red blood cell volume distribution width [（RDW-CV, （13.20±3.76）% vs. （11.87±3.20） %] in patients with HLD were significantly lower than those in the normal controls（P<0.01）;the mean red blood cell volume（MCV） in patients with HLD was much smaller than[（85.71±2.49） fl vs.（88.78±2.94）fl, P<0.01] in the healthy persons;the shear wave velocity in HLD patients were（2.05±0.58） m/s, which was negatively correlated with RBC （r=-0.190, P=0.013）, HGB（r=-0.197, P=0.011）, MCV（r=-0.164, P=0.034） in HLD patients, and positively correlated with RDW-CV（r=0.177, P=0.021）. Conclusion Ultrasound ARFI technique combined with erythrocyte parameters can properly evaluate the degree of liver damage in patients with HLD, which is important for clinical disease monitoring, prognosis evaluation

Objective To explore the prevalence of small intestinal bacterial overgrowth（SIBO） and the changes of Toll-like receptor 4（TLR-4） expression on the surface of peripheral blood mononuclear cells （PBMCs） in patients with liver cirrhosis. Methods SIBO was detected by lactulose hydrogen breath test and TLR-4 expression was assayed by flow cytometry in 40 cirrhotics and 16 healthy persons. Results The prevalence of SIBO in patients with liver cirrhosis was 42.5%,significantly higher than 6.3% in healthy people（P<0.01）;the expression of TLR4 on the surface of PBMCs in patients with cirrhosis was（23.4±11.4）,significantly higher than [（14.4±5.2）,P<0.05] in the control;the expression of TLR4 in 17 cirrhotic patients with SIBO-positive was （30.2±12.3）,significantly higher than[（19±8.6）,P<0.05] in 23 with SIBO-negative. Conclusions The patients with liver cirrhosis have a high incidence of small intestinal bacterial overgrowth,and the expression of TLR4 on PBMCs increases,which might play an important role in the development of cirrhosis.

Objective To assess the efficacy of biphasic insulin aspart 50 in the management of patients with hepatogenic diabetes（HD）. Methods One hundred and seventeen patients with HD were recruited in this study. They were randomoly divided into glargine and acarbose group （n=58） and insulin aspart 50-treated group （n=59）. The dose of insulin was adjusted according to fasting blood glucose （FBG）,2 h postprandial blood glucose（2 h PBG）. FBG,2 hPBG and glycosylated hemoglobin （HbAlc） were monitored for 12 weeks. Blood HbAlc,blood glucose levels,glycemic control time and incidence of hypoglycemia were compared between the two groups. Results At the end of 12 weeks,FBG level in insulin aspart 50-treated group was（5.97±1.26）mmol/L,not significantly different as compared to （5.54±1.48） mmol/L in glargine-treated group （P>0.05）,while the PBG level was（7.45±2.56）mmol/L,significantly lower than（8.95±2.44）mmol/L in glargine group （P<0.05）;meanwhile, the HbA1c level was（6.81±0.23）%,significant lower than （7.56±0.31）% in glargine group （P<0.05）;the dose of insulin was（37.2±7.0）U·d-1 in insulin aspart 50 group,not significantly different as compared to（35.1±6.8）U·d-1 in glargine group（P>0.05）;the glycemic control time was（14.2±2.8）d in insulin aspart 50 injection group,not significantly different as compared to（14.5±3.2）d in glargine group（P>0.05）;the incidence of hypoglycemia was 3.5% in insulin aspart injection group,not significantly different as compared to 5.1% in glargine group（P>0.05）. Conclusion Biphasin insulin aspart 50 therapy is effective and safe for patients with HD.

Objective To investigate the JAG1 protein expression on the prognosis of patients with intrahepatic cholangiocellular carcinoma （CCC）. Methods 60 patients with intrahepatic cholangiocarcinoma in our hospital between Jan 2010 and Dec 2014 were included and 60 patients with benign biliary diseases who were treated in our hospital during the same period were selected as control. JAG1 mRNA and its protein in liver tissues were detected. Serum JAG1 level was also measured by ELISA. Laboratory and clinical pathological parameters were recorded and the correlations of them to JAG1 were calculated. Univariate and multivariate unconditional Logistic regression analysis of risk factors for postoperative prognosis in patients with CCC was conducted. Results In paracancerous tissues,liver tissues and cholangiocarcinoma tissues,the positive expression rates of JAG1 protein were 45.0%（27/60）,56.7%（34/60）and 81.7%（49/60）,respectively,and the relative levels of JAG1 mRNA were （0.91±0.34） and （0.57±0.15）,（1.15±0.48） and （0.84±0.47）,（1.96±0.58） and （1.64±0.58）,respectively,（P<0.05）;serum JAG1 level in patients with CCC was（205.35±22.51）pg/ml,significantly higher than that in the controls[（102.56±16.52）pg/ml,P<0.05];serum JAG1 level in patients with intrahepatic CCC was positively correlated with CA125（r=0.41,P<0.05）,CEA（r=0.0.27,P<0.05）,CRP（r=0.17,P<0.05）,tumor invasion depth（r=0.13,P<0.05）,lymph node metastasis（r=0.08,P<0.05）,TNM stage（r=0.14,P<0.05） and tumor differentiation（r=0.15,P<0.05）;multivariate Cox proportional hazard regression model analysis showed that the depth of tumor invasion,lymph node metastasis,TNM staging,differentiation,high serum JAG1 level were the risk factors of relapse free survival （RFS） in patients with bile duct carcinoma（P<0.05）;the depth of tumor

Objective To explore the application of serum cancer antigen19-9（CA19-9）,CA125 and carcinoembryonic antige （CEA） in the diagnosis of serum alpha-fetoprotein （AFP） negative patients with intrahepatic cholangiocarcinoma （ICC）. Methods 60 patients with ICC were recruited in our hospital between June 2014 and June 2016,and they were divided into two groups,e.g. AFP-negative group and AFP-positive group with 30 in each group according to the results of serum AFP detection. Serum CA19-9,CA125 and CEA levels were detected by array-ELISA. Receiver operating characteristic（ROC） curves were used to evaluate the diagnostic efficacy of each and joint detection of CA19-9,CA125 and CEA for diagnosis of ICC. Results Serum levels of CA19-9,CA125 and CEA in AFP negative group were 138.8（85.7~185.1）U/ml,109.6（48.4~201.8）U/ml, 11.2（17.5~21.9） ng/ml,much higher than 【（38.0（16.9~75.5）U/ml,18.1（9.3~48.1）U/ml,5.5（3.1~8.5）ng/ml）,P<0.01】 in AFP-positive group;The ROC curve area of serum CA19-9,CA125 and CEA in AFP negative group were 0.85,0.83 and 0.81,respectively,significantly higher than[（0.55,0.45 and 0.42）,P<0.05] in AFP positive group; the cut-off-value of serum CA19-9,CA125 and CEA in diagnosis of ICC were 124.89 U/ml,96.04 U/ml and 11.97 ng/ml respectively;The sensitivity,specificity and accuracy rates of CA19-9,CA125 and CEA were （73.33%,76.67% and 71.67%）,（66.67%,70.00% and 68.33%） and（60.00,70.00% and 65.00）,respectively;ROC curve area under joint detection showed that （CA19-9/CA125/CEA）>（CA19-9/CA125）>（CA19-9/CEA）> （CA125/CEA）,the ROC curve area of joint diagnosis in the AFP negative group were 0.94,0.88,0.86 and 0.85,respectively,significantly higher than those in the AFP positive group [（0.74,0.62,0.58 and 0.52）,P<0.05];the sensitivity,specificity and accuracy of joint detection[（CA19-9/CA125/CEA）,（CA19-9/CA125）,（CA19-9/CEA） and 9CA125/CEA）] increased,and they were（90%,90% and 90%）,（83.33%,83.33% and 81.67%）,（76.67%,83.33% and 80%） and（70%,76.67% and 73.33%）,respectively,with the efficacy of （CA19-9/CA125/CEA） was the best. Conclusion We believe that the combination of serum CA19-9,CA125 and CEA detection can improve the correct diagnosis of serum AFP negative patients with ICC,which needs further clinical investigation.

【Abstract】 Objective To explore the clinical efficacy of transcatheter hepatic arterial embolization （TACE） in treatment of patients with liver metastasis from colon-rectal cancer. Methods90patients with liver metastasis from colon-rectal cancer in our hospital between November2013, November2014were recruited, and they were randomly divided into observation group, control group. The patients in both groups were treated with TACE, and the only difference was arterial infusion of raltitrexed in the observation group. Clinical efficacy, serum CA19-9, CEA levels, adverse events, long-term survival rates were observed, recorded in the two groups. Results The total effective rate in the observation group was51.1%, significantly higher than22.2% in the control group（P<0.05）;before treatment, there were no significant differences as respect to serum CA19-9, CEA levels between the two groups （P>0.05）, while three months after treatment, serum CA19-9, CEA levels in the observation group were （18.46±7.59） U/ml, （3.52±2.58） ng/ml, significantly lower than [（27.65±11.85） U/ml and（9.86±3.47） ng/ml, respectively, in the control group, P<0.05];the incidence of adverse reactions was22.2% in the observation group, significantly lower than46.7% in the control group （P<0.05）;the1a, 2a, 3a survival rates in the observation group was88.9%, 73.3%, 57.8%, respectively, obviously higher than66.7%, 42.2%, 33.3% in the control group （P<0.05）. Conclusion The application of raltitrexed in TACE treatment of patients with liver metastasis from colon-rectal cancer can effectively improve patients' clinical efficacy, prolong the long-term survivals

【Abstract】 Objective To investigate the efficacy of ultrasound-guided injection of lauromacrogol in the treatment of patients with simple hepatic cyst. Methods A total of83patients with simple hepatic cyst who were confirmed by B ultrasound, computed tomography （CT） or magnetic resonance imaging （MRI） scan were randomly divided into lauromacrogol-intervened group（n=41）, ethanol-injected group（n=42）, and the patients with hepatic cyst received ultrasound-guided injection of lauromacrogol or ethanol, respectively. The efficacy, blood biochemical index, adverse events were assessed between the two group. Result The clinical data at presentation, such as the age of the patients, gender, diameters of hepatic cyst, the duration of the hepatic cyst history, were not significantly different between the two group（P0.05）. The efficacy at the end of six month follow-up showed that there was no significant differences as respect to the disappearance of the cysts, shrunk cysts between the two groups（P0.05）;there were no significant differences in the blood liver function index before, after the inference between the two groups（P0.05）;the incidence of abdominal distension, abdominal pain （x2=23.11, P0.01） as well as drunkenness（x2=23.11, P0.01） was higher in ethanol-injected group, while the incidence of fever, nausea, vomiting showed no significant differences between the two group（P0.05）. Conclusion The ultrasound-guided intracystic injection of lauromacrogol in the treatment of patients with simple hepatic cyst has the same efficacy as the ultrasound-guided injection of ethanol, with less adverse effects

Gastroesophageal varices is an important collateral circulation in patients with cirrhosis and portal hypertension. The diagnosis of it has been increasingly improved,and as a gold standard,the preferred diagnostic approach is endoscopy. The imaging examination is also used for patients with endoscopy intolerance.