Objective To investigate the roles of Norrin/Frizzled-4 in the interstitial remodeling of acute liver injury. Methods 32 healthy male rats were randomly divided into control（n=8） and model group （n=24）. The model of acute liver injury was established by thioacetamide （TAA） injuction. Western blot was used to detect the expression of Norrin/Frizzled-4 protein in liver tissues,and enzyme-linked immunosorbent assay was performed to measure serum CD105 and vascular endothelial growth factor （VEGF） levels. Results There were 11（45.8%） out of 24 rats died in model group during model establishment. Hematoxylin-eosin staining showed that the acute liver injury model was successfully established. Serum CD105 level was（2.18±0.05） ng/mL and VEGF was （61.48±0.39） pg/mL in control group,significantly lower than[（2.36±0.07） ng/mL and [（62.09±0.54） pg/mL,P<0.05] in TAA-treated for one week,or [2.42±0.03） ng/mL and （64.52±0.25） pg/mL,P<0.05] in TAA-treated for two week;Western blot analysis showed that the expressions of Norrin/Frizzled-4 proteins in model group were higher than in normal control group or in primary hepatic stellate cells（P<0.01）. Conclusion The expressions of Norrin/Frizzled-4 proteins increase in liver tissues of rats with acute liver injury,which might be related to the maintaing of vascular network morphology and interstitial remodeling.

Objective To perform a systematic review on the predictive value of serum HBsAg levels in patients with HBeAg positive chronic hepatitis B（CHB） treated with nucleos（t）ide analogues（NAs）. Methods A systematic search was performed on clinical trials regarding quantitative detection of serum HBsAg before and after antiviral treatment with NAs in patients with HBeAg positive CHB in PubMed,EMBASE and Cochrane Central Register between January 1,2006 and August 1,2016. Data was extracted by two reviewers independently. Statistical analysis was performed by using RevMan 5.2. HBsAg response was defined as serum HBsAg levels declined more than 1 lg IU/mL from baseline levels within 1 year after treatment with NAs. The other observation indexes were baseline HBsAg levels,HBeAg seroconversion and HBsAg loss. Results 10 eligible studies（467 patients in total） were enrolled in this Meta-analysis. The rate of HBeAg seroconversion in patients with HBsAg response was 64.3%,significantly higher than 19.8% in patients without HBsAg response（P<0.0001）;the rate of HBsAg loss in patients with HBsAg response was 30.5%,also significantly higher than 0.4% in patients without HBsAg response（P<0.05）;the baseline HBsAg levels were not shown different between patients with,（3.4±0.6 lg IU/mL） and paitents without HBeAg seroconversion（3.7±0.4 lg IU/mL,P﹥0.05）. Conclusions During the treatment with NAs,a rapid decline of serum HBsAg levels might predict serological response in HBeAg positive CHB patients.

Objective To investigate the clinical efficacy and safety of long-term application of entecavir for patients with lamivudine-resistant chronic hepatitis B. Methods 98 patients with lamivudine resistant chronic hepatitis B in our hospital between January 2007 and January 2009 were recruited and were treated with entecavir at dose of 1 mg daily. The application of adefovir dipivoxil combination with lamivudine were given in 27 patients because of virological rebound. The clinical efficacy,virologic rebound rate,HBV DNA negative rate,HBsAg and HBeAg nageive rate,ALT normalization and adverse reactions were observed. Results At the end of 24 weeks of treatment,the total response rate was 88.8%,as the prolongation of treatment,the total response gradually increased,and at the end of 192 weeks of treatment,the total response rate reached to 92.9%;there was no virologic rebound at 24 weeks,there was 6 cases with virologic rebound at 48 weeks of treatment,and the virological rebound rate increased gradually with the prolongation of treatment and at the end of the 8-year observation,the virological rebound rate was up to 27.6%;serum HBV DNA negative rate were up to 46.9% at 96 weeks after treatment,serum HBV DNA negative rate increased slowly and it reached to 60.2% at the end of the observation;there was no serum HBeAg or HBsAg turn to negative before 48 weeks of treatment,and there were 31 cases with serum HBeAg negativity and 12 got serum HBsAg negative at the end of the observation; serum ALT levels decreased with the prolonged treatment,and at the end of 12 weeks of treatment,serum ALT levels gradually returned to normal;there were 25 cases （25.5%） with adverse reactions including 8 cases with fatigue,6 cases with tachycardia,10 cases with nausea and 1 cases with a white blood cell detection in urine. Conclusion Long-term application of entecavir in the treatment of patients with lamivudine-resistant chronic hepatitis B has significant clinical efficacy with no obvious adverse reaction,which warrants further investigation.

Objective To investigate the effect of pegylated interferon α-2b on peripheral blood T lymphocyte subsets and serum cytokine levels in patients with chronic hepatitis B. Methods 184 patients with chronic hepatitis B were recruited in our hospital between January 2014 and January 2016,and 92 patients were treated with combination of pegylated interferon α-2b and entecavir for 48 weeks,and 92 cases were with entecavir alone. The liver function indexes,serum cytokines IL-6,INF-α,IL-17,IL-4 and TGF-β1,peripheral blood T lymphocyte subsets and nuclear transcription factor （Foxp3,RORγt,IL-17） mRNA were evaluated in all patients before and after treatment. Results At the end of 24 w follow-up after discontinuation of the regimen,serum HBV DNA negative rate in the combined group and entecavir group were 86.96% and 84.78%,respectively（P>0.05）,and serum HBeAg negative rate in combined group was 28.89%（13/45）,without significant difference as compared with that in entecavir group [15.22%（7/46）,P>0.05];there were no significant differences before treatment between the two groups （P>0.05） as respect to serum TBIL,ALT,ALB levels and PTA,while serum ALT level in the combination group at the time of follow-up was （34.6±11.6） U/L,significantly lower than （64.6±20.5） U/L（P<0.05） in the entecavir group; before treatment,the percentage of CD3+,CD8+,CD4+ cells and the ratio of CD4+/CD8+ had no significant difference between the two groups （P>0.05）,while after treatment,the percentage of CD3+,CD4+ cells and the ratio of CD4+/CD8+ in peripheral blood in combination group were （75.6±14.5）%,（42.7±10.3）% and （1.4±0.6）,significantly higher than those in the entecavir group[（66.8±14.4）%,（436.7±8.5）% and（1.0±0.5）,P<0.05];the percentage of CD8+ cells was （29.3±7.3） %,significantly lower than that in the entecavir Group [（34.8±8.5）%,P<0.05];there was no significant difference between the two groups（P>0.05） as respect to the percentage of NK cells;before treatment,serum levels of IL-6,IL-17,IL-4,INF-ɑ and TGF-β1 showed no significant differences between the two groups（P>0.05）,while after the treatment,serum level of IL-6 in the combination group was（6.8±1.2） pg/ml,significantly higher than that in the entecavir group[（3.5±0.8） pg/ml,P<0.05];serum IL-17 level was （0.7±0.3） pg/ml,significantly lower than that in the entecavir group [（2.8±0.9） pg/ml,P<0.05];serum IL-4 level was（1.4±0.5） pg/ml,significantly lower than that in the entecavir group[（3.8±1.5） pg/ml,P<0.05];serum level of INF-ɑ in the combination group was（4.0±1.3） pg/ml,significantly higher than that in the entecavir group [（2.6±0.9） pg/ml,P<0.05];there was no significant difference between the two groups （P>0.05） as respect to serum level of TGF-β1;serum levels of RORγt,Foxp3 and IL-17mRNA before treatment were not significantly different between the two groups （P>0.05）,while serum level of RORγt in the combination group after treatment was （0.86±0.31）,significantly lower than that in the entecavir group [（1.56±0.43）,P<0.05],and there were no significant differences between the two groups（P>0.05） as respect to serum Foxp3 and IL-17 mRNA levels. Conclusion Pegylated interferon α-2b can effectively improve the immune functions of patients with chronic hepatitis B by regulating transcription and expression of cytokines from various aspects,which has good clinical implication for patients with chronic hepatitis B.

Objective To observe the clinical efficacy of entecavir combined with Bailing capsule in the treatment of patients with chronic hepatitis B. Methods 254 patients with CHB were randomly divided into group A and group B （n=127）. Patients in group A was treated with entecavir,and patients in group B was treated with entecavir combined with Bailing capsule. Results At the end of 24 w and 48 w treatment,serum HBsAg levels in group B were （3.2±0.3） lg IU/mL and （3.3±0.4） lg IU/mL,significantly lower than in group A （3.7±0.4）lg IU/mL and （3.6±0.5）lg IU/mL （P<0.05）;serum HBeAg levels were （1.6±0.2） lg PEIU /mL and （1.4±0.1）lg PEIU /mL,significantly lower than in group A（1.8±0.2） lg PEIU/mL and（1.6±0.3） lg PEIU/L（P<0.05）;serum alanine aminotransferase,lactate dehydrogenase（LDH）,aspartate aminotransferase and adenosine deaminase（ADA） levels were significantly lower than in group A（P<0.05）;serum creatinine,cystatin C and urea nitrogen levels were significantly lower than in group A（P<0.05）;cytochrome P450 isoforms,e.g. CYP2E1,CYP2C9 and CYPIA2 were significantly lower than in group A（P<0.05）;serum creatine kinase and MDA levels were significantly lower than in group A （P<0.05）;serum glutathione （GSH） and superoxide dismutase （SOD） were significantly higher than in group A P<0.05）;serum HBV DNA loads in the two groups had no significant difference（P>0.05）. Conclusion Bailing capsule can reduce the risk of renal damage of entecavir in the treatment of patients with CHB.

Objective To explore the efficacy of entecavir and silibinin combination in the treatment of patients with chronic hepatitis B. Methods 140 patients with chronic hepatitis B were recruited in our hospital between June 2015 and July 2016,and the patients were divided into observation group （n=70） and control group （n=70） by a randomized grouping method. The patients in the control group was treated with entecavir,and the patients in the observation group was treated with entecavir combined with silibinin capsules. The clinical symptoms and signs,negative conversion rates of serum HBeAg and HBV DNA,liver function index,cytokine levels and peripheral blood T lymphocyte subsets were detected and compared between the two groups. Results At the end of 24 w treatment,the improvement of fatigue,anorexia and abdominal distension in the observation group were 87.1%,90%,82.9%,respectively,significantly higher than those in the control group （41.4%,71.4%,58.6%,P<0.05）;the negative rates of serum HBeAg and HBV DNA in the observation group were 0.0% and 88.6%,no statistical difference（P>0.05） as compared to 0.0% and 68.6% in the control group; serum TBIL,ALT and AST levels in the observation group were （16.49±3.17） μmol/L,（47.36±8.24） U/L and （40.58±5.26） U/L,significantly lower than （23.56±3.48） μmol/L,（68.25±7.93） U/L and （66.24±8.24） U/L in the control （P<0.05）;serum IL-6, TNF-α and TGF-β levels in the observation group were （204.8±27.4） μg/L,（68.2±12.5） μg/L and（158.2±15.2） μg/L, significantly lower than （264.2±29.2） μg/L,（107.4±13.7） μg/L and （193.5±17.3） μg/L in the control （P<0.05）;the peripheral blood CD4+ cells and ratio of CD4+/CD8+ in the observation group were （40.36±3.61） % and（1.50±0.32）,significantly higher than （33.46±3.17） % and （1.33±0.27） in the control（P<0.05）. Conclusion Entecavir combined with silibinin capsules in the treatment of patients with chronic hepatitis B have curative effect by the inhibition of HBV replication,relieving the inflammatory reactions,and improving the immune functions.

Objective To explore the clinical efficacy of tiopronin combined with entecavir in the treatment of patients with chronic hepatitis B with focus on serum liver function and liver fibrosis index. Methods 116 patients with chronic hepatitis B admitted to our hospital between June 2015 and June 2016 were recruited,and were randomly divided into control group and observation group,with 58 cases in each group. Serum liver function,liver fibrosis index,and serologic and virologic markers were detected routinely. Results At the end of three month treatment,serum ALT level in the observation group was（41.2±11.7） U/L,which was significantly lower than that in the control group（49.7±12.4） U/L,P<0.01）,AST level was（37.2±25.2） U/L,which was significantly lower than that in the control group[（51.3±30.2） U/L,P<0.01）,the levels of ALB was（35.2±2.5） g/L,not significantly different as compared with that in the control;serum level of HA was（93.9±4.2） μg/L,which was significantly lower than that in the control group [（103.6±35.1） μg/L,P<0.01],serum level of LN was （103.6±38.2） μg/L,which was significantly lower than that in the control group[（127.9±40.5） μg/L,P<0.01],serum level of C-IV was（105.2±40.3） μg/L,which was significantly lower than that in the control group [（133.8±35.1） μg/L,P<0.01）,and serum level of PCIII was（75.3±16.7） μg/L,which was significantly lower than that in the control group [（91.2±18.5） μg/L,P<0.05）];serum negative rates of HBV DNA in the two groups were 60.3% vs. 60.3%（P>0.05） and no serum HBsAg or HBeAg negativity occurred in the two groups;there was no severe side effects in both groups. Conclusion The clinical efficacy of tiopronin combined with entecavir in the treatment of patients with chronic hepatitis B is significant,especially on the improvement of liver function and liver fibrosis index,and the therapy is safe.

Objective To investigate the diagnostic value of liver fibrosis staging in patients with chronic hepatitis B by acoustic palpation tissue quantification （VTQ） and aspartate aminotransferase/platelet ratio （APRI）. Methods 103 patients with chronic hepatitis B between November 2014 and December 2016 in our hospital were included and all of them received liver biopsies. 36 healthy subjects were selected as controls. VTQ was performed in both groups, and APRI was calculated. The diagnostic efficacy was evaluated by ROC curve. Results The ages of 35 patients with F4 liver fibrotic staging was significantly older than those of healthy persons,20 with F1 and 19 with F3 liver fibrotic staging [（44.10±8.89） yr vs. （33.15±8.08） yr,（34.02±7.36） yr,（38.55±9.39） yr,P<0.05];the oblique diameter of right liver in patients with F4 staging was（121.51±8.61） mm,significantly shorter than（126.61±8.54） mm in healthy persons,（126.59±8.71） mm in with F1,（128.96±9.01） mm in with F2 and （128.88±8.66） mm in with F3 staging （P<0.05）;the VTQ in F4 group was（1.89±0.39） m/s,much faster than（1.11±0.14） m/s in healthy persons,（1.29±0.26） m/s in F1,[（1.35±0.25） m/s in F2,（1.55±0.24） m/s in F3 staging（P<0.05）;VTQ increased as the liver fibrosis got severe;the APRI in healthy persons was （0.16±0.06）,significantly less than （0.23±0.15） in F1,（0.30±0.18） in F2,（0.30±0.18） in F3 and（0.45±0.46） in F4,and APRI increased as the liver fibrosis got severe（P<0.05）;the stage of liver fibrosis was positively correlated with VTQ （95%Cl: 0.715~0.893,r=0.804,P<0.001）,and was negatively correlated with APRI（95% Cl:0.583~0.781,r=0.681,P<0.001）;the ROC analysis showed that the AUCs of VTQ and APRI in diagnosis of F1 were 0.873 and 0.811,of F2 were 0.882 and 0.861,and of F3 were 0.941 and 0.861,and of F4 were 0.940 and 0.817,suggesting that VTQ was superior to APRI,and the specificity and positive predictive value of VTQ were superior to the VTQ/APRI ratio or APRI in diagnosis of greater than F2 liver fibrosis. Conclusion The VTQ and APRI are associated with the staging of hepatic fibrosis in patients with chronic hepatitis B,and the VTQ and APRI have a good diagnostic efficacy for detecting liver fibrosis greater than F2 staging.

Objective s To evaluate the efficacy of combination sofosbuvir and pegylated interferon-α in the treatment of patients chronic hepatitis C（CHC）. Methods We searched PUBMED,Cochrane Library,CNKI,CBM,VIP database for studies on combination sofosbuvir and pegylated interferonα versus sofosbuvir or pegylated interferon-α therapy in patients with CHC up to Mar. 2017. We performed the Meta-analysis by using the Revman 5.2. Results Nine studies were finally obtained including 827 patients with CHC,5 studies reported the observation between SOF/PEG-IFN/RBV （n=339） and SOF/RBV （n=269） and 4 studies reported the viral response between SOF/PEG-IFN/RBV（n=105） and PEG-IFN/RBV（n=114）. The results of Meta-analysis showed that the RVR in SOF/PEG-IFN/RBV group was higher than in SOF/RBV or in PEG-IFN/RBV group（86.7% vs. 71.7%,P=0.002 and 91.7% vs. 32.3%,P=0.006）;the SVR in SOF/PEG-IFN/RBV group was higher than in PEG-IFN/RBV group（85.7% vs. 44.2%,P<0.00001）,while there was no statistical difference between SOF/PEG-IFN/RBV group and SOF/RBV group（89.0% vs. 74.1%,P=0.16）;the adverse events,such as headache,fatigue,nausea,rash,muscle pain,decreased appetite,arthralgia,fever and anemia in SOF/PEG-IFN/RBV group was higher than in SOF/RBV group. Conclusion The efficacy of combination treatment of SOF/PEG-IFN/RBV is better than SOF/RBV or PEG-IFN/RBV with higher RVR or SVR for patients with CHC.

Objective To investigate the etiology of patients with unexplained abnormal liver function tests. Methods Ninety-four out of 2195 patients with abnormal liver function tests were recruited in this study. The blood biochemical parameters,serology,virology,abdominal imaging and liver biopsy were performed routinely. Results The diagnosis included non-alcoholic fatty liver disease （NAFLD） in 40 case（42.6%）,autoimmune liver disease （AIH and PBC） in 22 （23.4%）,drug-induced liver injury （DILI） in 20（21.3%）,and other diseases were occult chronic hepatitis B in 3（3.2%）,and benign recurrent cholestasis,Wilson’s disease,hemochromatosis, lymphoma,cytomegalovirus infection,dysfunction of sphincter of Oddi（SOD）,Kwashiorkor syndrome and muscular dystrophy in 1 of them,and 1 still with unknown etiology. Conclusion NAFLD,ALD and DILI are the most common causes of patients with unexplained abnormal liver function tests. Genetic metabolic and other rare diseases also account for a certain proportion,which the clinicians should take attention in clinical practice.

Objective To analyze the characteristics of human body compositions in patients with non-alcoholic fatty liver disease（NAFLD）,in order to provide scientific basis for the early prevention and therapeutic schedule. Methods The TANITA MC 180 body composition analyzer was applied to measure body compositions,including weight,height,body fat ratio,fat mass,muscle mass,bone mass,visceral fat rating,BMI and some other indexes in 148 patients with NAFLD. Results The high body fat rate in 148 patients with NAFLD was 51.4%,and among them,the high body fat rate in young（18 to 39 year old） patients was 86.3%,significantly higher than 39.3% and 24.4% in middle and old age patients;the muscle mass,bone mass and visceral fat rating in male patients were higher than those in female,and the fat mass and body fat ratio in female were higher than in male （P<0.01）;The body fat ratio and trunk body ratio decreased as the patients with NAFLD got elderly（P<0.01）,and the upper limbs fat ratio and four limbs fat ratio in female patients decreased as the patients got elderly（P<0.01）;the incidence of bone mass below the standard was 49.3%,and the incidence of NASH was 20.3% in this series. Conclusion The main changes of the body compositions among patients with NAFLD are the increase of the body fat ratio and the decrease of the bone mass,and we should take it into consideration that the incidence of excess body fat is higher among the young patients with NALFD.

Objective To evaluate the efficacy of ornithine aspartate in the treatment of patients with fatty liver. Methods According to the inclusion and exclusion criteria,China National Knowledge Infrastructure（CNKI）,Wanfang database,PubMed,EMBASE and Cochrane library up to July 20,2017 were screened for randomized controlled trial of ornithine aspartate in the treatment of patients with fatty liver. The Cochrane handbook was used to assess the risk bias,and the Jadad 7 subscales was used to document the quality score. Meta analysis by using RevMan 5.3 was made. Results A total of 727 Chinese patients with fatty liver were enrolled in the 9 Chinese clinical trials. The results of Meta analysis showed that total clinical efficiency rate in L-ornithine-L-aspartate treatment was much higher as compared to that in the control[OR=3.71,95%CI（1.85,7.46）,P=0.0002];the decreased serum total cholesterol level was[MD=-3.04,95%CI（-3.76,-2.31）,P<0.00001],and the decreased serum triglyceride level was[MD=-1.60,95%CI（-2.55,-0.65）,P=0.0009]; the total effective rate in L-ornithine-L-aspartate treatment was[OR=11.99,95%CI（2.36,60.91）,P=0.003];the decreased serum ALT was [MD=-34.04,95%CI（-61.73,-6.35）,P=0.02], and the decreased serum AST level was[MD=-9.48, 95%CI（-24.66,5.70）,P=0.22];the decrease total serum bilirubin was[MD=-14.92,95%CI（-20.70,-9.15）,P<0.00001]. Conclusion The application of L-ornithine-L-aspartate in the treatment of patients with fatty liver has a better therapeutic effect,which might improve the indexes of liver function and blood lipids. The efficacy of L-ornithine L-aspartate in the treatment of patients with fatty liver needs to be confirmed by multi-center,well-designed randomized clinical trials in the future.

Objective To investigate the expression of transforming growth factor β-1（TGFβ-1） in liver tissues of patients with primary biliary cirrhosis（PBC） and its relationship with liver fibrosis. Methods 52 patients with PBC and 20 healthy persons were recruited in our hospital. The patients with PBC received liver biopsies and 20 normal liver tissues from the Department of Pathology in our hospital served as control. The expression of TGFβ-1 in liver tissues was detected immunohistochemistry and serum tumor necrosis factor α（TNF-α） and interleukin 6（IL-6） levels were detected by ELISA. Results TGFβ-1 was not expressed or little expressed in normal liver tissues,while it was highly expressed in cytoplasm of hepatic parenchyma cells in patients with PBC;serum TNF-α and IL-6 levels in patients with PBC were （28.71±13.54） pg/ml and （21.3±9.4） pg/ml,significantly higher than those in control group[（21.3±15.4） pg/ml and （2.1±1.6） pg/ml,respectively,P<0.01];The expression level of TGFβ-1 in liver tissues and serum levels of TNF-α and IL-6 in 7 patients with PBC with liver fibrosis stage S0 were（0.5±0.2） 10-2,（7.1±4.1） pg/ml and（5.1±1.0） pg/ml,significantly lower than those in 12 with stage S1 [（4.2±1.3） 10-2,（18.6±6.2） pg/ml and （11.5±3.6） pg/ml,P<0.01],or in 18 with stage S2 [（6.9±1.2） 10-2,（27.3±9.9） pg/ml and （19.4±4.1） pg/ml,P<0.01],or in 9 with stage S3[（13.3±15.1） 10-2,（39.7±15.18） pg/ml and（27.3±8.1） pg/ml,P<0.01] or in 6 with stage S4 [（21.2±17.1） 10-2,（53.4±17.3） pg/ml,（47.8±11） pg/ ml, respectively,P<0.01];the expression level of TGFβ-1 in liver tissues and serum levels of TNF-α and IL-6 in 15 patients with Child-Pugh class A were（1.9±1.6） 10-2,（12.2±3.1） pg/ml and（7.3±2.5） pg/ml,significantly lower than [（15.9±13.6） 10-2,（32.9±8.6） pg/ml an（21.8±6.3） pg/ml,P<0.01）] in 25 patients with Child-Pugh class B or [（22.6±18.5） 10-2,（49.1±19.3） pg/ml and（45.5±12.7） pg/ml,P<0.01] in 12 patients with Child-Pugh class C. Conclusion The expression of TGFβ-1 in liver tissues and serum TNF-α and IL-6 levels increase in patients with PBC,which might be related to the formation of liver fibrosis and the deteriorated liver function.

Objective To investigate the clinical efficacy of endoscopic variceal ligation combined with sclerotherapy in the treatment of patients with hepatitis B liver cirrhosis complicated by esophageal and gastric varices bleeding （EGVB）. Methods 120 patients with hepatitis B liver cirrhosis and EGVB between February 2012 and February 2016 were recruited in our hospital. The clinical data of patients were retrospectively analyzed. Esophageal variceal bleeding were treated by endoscopic variceal ligation （EVL） combined with endoscopic variceal sclerotherapy （EIS） and gastric variceal bleeding were treated with endoscopic injection of tissue adhesive combined with EIS treatment. Propranolol was given post-operational. The clinical efficacy and risk factors of rebleeding were analyzed. Results The success rate of hemostasis was 100.0% in our series;the varices disappeared in 90.9% of patients with EGVB types one,significantly higher than 66.7% in with type two or 69.4% in with type one/two;the variceal recurrence rate in EGVB type one was significantly lower than those in patients with type one/two or type two（P<0.05）;after treatment,the rates of rebleeding in patients with different types of varices showed no significant difference（P>0.05）;the proportion of male and aged >65 yr in 35 patients with rebleeding were 85.7% and 31.4%,respectively,significantly higher than 49.4% and 14.1%（P<0.05） in 85 patients without rebleeding,the portal vein diameter and Child-Pugh scores were（1.5±0.5）cm and （10.3±2.1）,respectively,significantly wider or higher than （1.1±0.2） cm and [（7.3±1.3）,respectively,P<0.05] in patients without rebleeding; serum albumin level and serum sodium concentration in rebleeding group were （23.4±5.5） g/L and （124.67±31.47） mmol/L,significantly lower than [（33.6±6.7） g/L and（137.5±36.2） mmol/L,respectively,P<0.05] in patients without rebleeding;Logistic regression analysis showed that the portal vein diameter[OR=3.713 （1.253~10.999）] and Child-Pugh score[OR=4.267（1.311~13.886）] were the independent risk factors for rebleeding after operation,and the blood albumin level [OR=0.236（0.062~0.902）] and sodium concentration [OR=0.143（0.026~0.785）] were the protective factors for rebleeding. Conclusion Endoscopic variceal ligation combined injection of sclerosing agent in the treatment of patients with hepatitis B liver cirrhosis with EGVB can get a good significantly clinical curative efficacy and the best efficacy in patients with EGVB type one. The diameter of portal vein and Child-Pugh score are the independent risk factors in forecasting rebleeding in patients with hepatitis B cirrhosis complicated by EGVB after endoscopic treatment.

Objective To investigate the evaluation of left ventricular systolic function by three-dimensional speckle tracking imaging（3D-STI） in patients with liver cirrhosis. Methods 68 patients with viral hepatitis liver cirrhosis and 30 healthy persons were recruited in this study,and ultrasound was performed. Left ventricular end diastolic diameter （LVEDD）,left ventricular end-diastolic diameter （LVESD）,left ventricular end-diastolic volume （LVEDV）,left ventricular end-systolic volume （LVESV）,ejection fraction（LVEF） were routinely measured, and the systolic peak strain of different parts of myocardium was assayed by 3D-STI.The LVEDD,LVESD,LVEDV,LVESV,LVEF,the systolic peak strain at the basal segment,middle segment,apical segment,and apex cap between patients with liver cirrhosis and healthy control were compared. The predictive value of systolic peak strain of the parameters on the prognosis of the patients was evaluated by ROC prediction model. Results The levels of LVEDV and LVESV in patients with liver cirrhosis [（122.7±16.3）ml and （46.2±6.2）ml] were significantly higher than[（102.6±12.2）ml and（35.3±5.2）ml,P<0.001] in healthy persons,while there were no significant differences between the levels of LVEDD,LVESD and LVEF in patients with liver cirrhosis and healthy control（P>0.05）; the peak systolic peak of basal segment,middle segment,apical segment and apex cap in cirrhotics [（18.8±4.3）,（19.2±4.2）,（18.6±3.5）,（19.2±4.1）] were much lower than[（21.3±5.2）,（23.8±3.9）,（22.4±4.1）,（23.9±4.3）,P<0.001] in the healthy person; during the follow-up period, 21 died and 3 lost. The ROC curves showed that the area under ROC by the systolic peak of the basal segment,middle segment,apical segment and apex cap were 0.857,0.893,0.869 and 0.866,the strain was 18.85,20.05,16.25,18.05,and the sensitivity were 78.6%,69.0%,85.7% and 74.7%,and the specificity were 82.0%,91.0%,66.7% and 84.5%,respectively. Conclusion The patients with liver cirrhosis tends to have left ventricular systolic dysfunction. The 3D-STI is an alternative approach to evaluate the left ventricular systolic dysfunction at early stage non-invasively.

Objective To explore the expression of vitamin D receptor（VDR） in cancerous tissues of patients with hepatitis B virus （HBV）-related hepatocellular carcinoma （HCC）. Methods The relative levels of VDR mRNA in liver tissues was detected by real-time PCR. VDR expression were determined by immunohistochemical method, and the relative expression of VDR protein was detected by Western blot. Results Immunohistochemistry showed that cancerous tissues, para-cancerous tissues, normal liver tissues expressed VDR equally. VDR was mainly expressed in the cytoplasm, and there was almost no expression in the nucleus. The RT-PCR detection showed that VDR mRNA in cancerous tissues was（2.77±0.30）, significantly higher than that in the para- cancerous tissues（1.62±0.21） or normal liver tissues[（1.57±0.19）, P<0.01];Western blot showed that the expression of VDR protein in cancerous tissues was（1.15±0.57）, significantly higher than that in the para- cancerous tissues（1.02±0.25） or in normal liver tissues[（0.37±0.11）, P<0.01]. Conclusion VDR is closely related to the development of hepatocellular carcinoma

Objective To investigate the computed tomography （CT） scan in evaluating the therapeutic effect of transcatheter arterial chemoembolization（TACE） in patients with primary liver cancer（PLC）. Methods The clinical data of 92 patients with PLC treated by TACE in our hospital between October 2015 and December 2016 were retrospectively collected. The CT scan and enhanced scan were performed before and after TACE. The density,enhancement patterns,border and size of the intrahepatic lesions before and after TACE were compared. Results There were 22 cases （30.1%） of type I,40 cases （54.7%） of type II,8 cases （10.9%） of type III and 3 cases（4.1%） of type IV lipiodol deposition in 73 patients with intrahepatic huge mass,and there were 14 cases（73.6%） of type I,4 cases（21%） of type II and 1 cases （5.2%） of type III lipiodol deposition in 19 patients with intrahepatic nodular lesions. The total effective rates in the two groups after TACE treatment were 95.5% （69/73） and 94.7% （18/19,P>0.05）. Conclusion CT examination is effective in evaluating the clinical efficacy of TACE treatment in patients with PLC, which provides accurate imaging information for further clinical strategy.

Objective To investigate the efficacy of percutaneous microwave ablation（PMCT） in the treatment of patients with hepatocellular carcinoma with underlying liver cirrhosis. Methods 108 patients with small hepatocellular carcinoma between January 2005 and July 2014 in our hospital were recruited in this study,and 40 patients were treated with PMCT and 68 were with hepatectomy. The Cox regression analysis was applied to analyze the factors associated with postoperative survival. Results There was no significant difference as respect to total survival（60% vs. 58.8%） and recurrence-free survival rates（40.0% vs. 38.2%） between the patients subjected to PMCT or surgical resection at the end of three-year follow-up;univariate analysis showed the Child-Pugh class,serum alpha-fetoprotein and albumin levels at baseline in fatal patients were significantly poorer or lower than those in survival patients（P<0.05）;multivariate cox regression analysis showed that Child-Pugh class （HR=1.81,95%CI: 0.97~3.38）,serum alpha-fetoprotein（HR=1.83,95% CI:0.99~3.37）and albumin levels（HR=1.81,95%CI:0.98~3.36） were the independent factors for prognosis of patients with hepatocellular carcinoma with underlying liver cirrhosis（P<0.05）. Conclusion The survival rate of patients with small hepatocellular carcinoma and cirrhosis treated with PMCT is similar to that of those received surgical resection. The prognosis is correlated with liver function,serum alpha-fetoprotein and albumin levels.

Objective To investigate the efficacy of transcatheter arterial chemoembolization（TACE） combined with radiofrequency ablation（RFA） and Addie injection in the treatment of patients with primary liver cancer（PLC）. Methods A total of 76 PLC patients were recruited in our hospital between January 2013 and January 2015,and they were divided into the observation group （n=36） and the control group （n=40）,receiving combination of TACE, RFA and Addie and TACE and RFA,respectively. Serum C-reactive protein （CRP）,tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6）,and peripheral blood lymphocyte subsets were assayed. The quality of life was evaluated by Karnofsky’s score. Results There were significant difference in the disease control rate between the observation and the control group（91.7% vs. 72.5%） at the end of 3 month after treatment （P<0.05）;serum CRP,TNF-α and IL-6 levels were （109.8±13.2） mg/L,（0.5±0.2） pg/mL and （13.4±2.2） pg/mL in the observation group,significantly lower than [（156.2±20.4） mg/L,（1.1±0.2） pg/mL and （24.1±4.4） pg/mL in the control,P<0.05];the percentages of peripheral blood CD3+ and CD4+ cells and ratio of CD4+/CD8+ cells were（60.1±9.7）%,（44.3±8.3）% and （1.9±0.5）,respectively,significantly higher than [（52.2±9.9）%,（36.30±8.6） % and （1.4±0.3） in the control,P<0.05];the improvement rate of quality of life was significantly higher than that in the control group （80.5% vs. 57.5%,P<0.05）;at the end of 24 month followed-up,28（77.8%） survived in the observation group,while 29（72.5%） survived in the control（P>0.05）. Conclusions Addie injection,a herbal compound,might improve the quality of life in PLC patients receiving TACE and RFA therapy,which might be related to the reduction of inflammatory reaction,and enhance immune functions.

Objective To evaluate the efficacy of cytokine-induced killer （CIK）,three-dimensional conformal radiotherapy（3D-CRT） and transcatheter arterial chemoembolization（TACE） in the treatment of patients with primary liver cancer （PLC）. Methods 51 patients with PLC were randomly divided into combination group （n=26）,receiving TACE/3D-CRT/CIK therapy,and control（n=25）,receiving TACE/3D-CRT therapy. Results At the end of one month therapy,the percentage of CD3+,CD4+,CD16+CD56+ and CD4+/CD8+ ratio in the combination group were （66.47±1.25） %,（56.98±2.65）%,（22.45±6.41） % and （1.52 ±2.10）,significantly higher than 【（53.17±0.98）%,（48.09±0.27）%,（19.74±1.88）% and（1.13±0.06）,P<0.05】,while that of CD8+ cells was（37.56±1.26）%,much lower than 【（42.67±4.35）%,P<0.05】 in the control;the improvement rate of life quality in combination group was 84.6%,significantly higher than that in the control group （52.0%,P<0.05）;the objective effective rate in the combination group was 92.3%,significantly higher than that in the control group（68.0%,P<0.05）;the 1-year survival rate in the combination group was 73.1%,significantly higher than that in the control group（52.1%,P<0.05）. Conclusion CIK cells combined radiotherapy and TACE for patients with PLC could improve the immune function,and patients' quality of life,which might lead to a good short-term efficacy and prolong the survival.

Objective To explore the optimal laparoscopic minimally invasive surgery for the treatment of patients with choledocholithiasis and cholecystolithiasis. Methods 500 patients with choledocholithiasis and cholecystolithiasis were recruited in our hospital between June 2013 and June 2016,and 234 of them received laparoscopic common bile duct exploration（LCBDE） and 266 received laparoscopic transcystic stone extraction （LTSE）. The patients in LCBDE group was treated with laparoscopic cholecystectomy（LC） plus LCBDE and T tube drainage,and the patients in LTSE group was given LC and LTSE. The number of calculus,the diameters of stones,the removal rates of stones,the periods of operations,the times of first exhaust,the hospital stays,and the postoperative complications and recurrence rates of gallstones were compared between the two groups. Results The number of stones in the LCBDE group was greater than that in the LTSE group [（4.6±1.7） vs. （3.1±2.4）,P<0.05],and the stone diameter in the LCBDE group was larger than that in the LTSE group [（11.8±5.40） mm vs.（5.2±2.2） mm,P<0.05];the operative time,first exhaust time and hospital stays were（114±27） min,（3.4±1.3） d and （7.1±3.2） d,respectively in the LCBDE group,much longer than those in the LTSE group[（73±21） min,（2.2±0.9） d and（3.5±1.8） d,respectively,P<0.05];there was no significant difference in the removal rates of stones between the LCBDE group and the LTSE group（94.9% vs.94.7%,P>0.05）;the total incidence rate of complications was 24.4% in the LCBDE group,significantly higher than that in the LTSE group（10.9%,P<0.05）;during the 1 year of follow-up,the stone recurrence rate in the LCBDE group was 4.7%,much higher than that in the LTSE group（1.5%,P<0.05）. Conclusions The application of LC plus LTSE in treatment of patients with choledocholithiasis and cholecystolithiasis have a good efficacy with fast recovery,short hospital stays,and low morbidity of complications and long-term stone recurrence.

Objective To investigate the inflammatory and oxidative stress in patients with acute pancreatitis （AP） and underlying cholelithiasis after laparoscopic cholecystectomy （LC）. Methods A total of 150 patients with cholelithiasis complicated by AP were recruited in our hospital,and 84 cases were treated with LC and 66 cases received laparotomy after the AP was controlled. Serum interleukin-6（IL-6）,IL-10,C-reactive protein （CRP）,malondialdehyde （MDA）,oxidized low density lipoprotein （ox-LDL） and paranoxonase （PON-1） were detected by ELISA,and serum 8-dihydro-8-oxoguanine（8-OHG） was detected by high-performance liquid chromatography. Results Five days after operation,serum IL-6 level in LC group was（42.3±4.8） μg/L,much lower than【（57.7±5.1）μg/L,P<0.05】 in patients receiving laparotomy,serum IL-10 level was（64.3±5.3） pg/ml,much higher than【（51.2±4.2）pg/ml,P<0.05】 in laparotomy group,serum CRP level was（15.8±5.7） μg/L,much lower than【（38.4±6.8）μg/L,P<0.05】 in laparotomy group;serum MDA level was（3.3±0.9） nmol/mL,much lower than【（5.4±1.8）nmol/mL,P<0.05】 in laparotomy group,serum ox-LDL level was（63.2±11.7） ng/ml,much lower than 【（72.3±11.0）ng/ml,P<0.05】 in laparotomy group,serum PON-1 level was（116.3±10.2） U/ml,much higher than 【（104.5±11.4）U/ml,P<0.05】 in laparotomy group,and serum 8-OHG level was（0.5±0.2） ng/ml,without significant difference as compared to（0.6±0.2）ng/ml（P>0.05） in laparotomy group. Conclusion The LC is practical in clinical practice in dealing with patients with AP and underlying cholelithiasis after AP is controlled,which might inhibit stress response in this settings.

Glucose regulated protein 78 （GRP78） is regarded as a major chaperone of endoplasmic reticulum （ER）,which plays an important role in the process of protein folding and transport as well as endoplasmic reticulum stress. In addition,it also exists in the surface of tumor cells,endothelial cells and monocytes,and serves as a receptor for viral entry into host cells. ER stress is an important pathogenesis of nonalcoholic fatty liver disease（NAFLD）. The excavation of GRP78’s function will provide a new approach for the defense mechanism of NAFLD.

Glucagon-like peptide-1 receptor agonists could meliorate hepatic lipid deposition and histological damage by regulating lipid metabolism,inflammation and autophagy in pathogenesis of non-alcoholic fatty liver disease （NAFLD）,which may serve as a new option for treatment of patients with NAFLD.

Patients with chronic liver diseases are inclined to have malnutrition that would increase the risks of poor prognosis,but the mechanism of malnutrition in liver disease is still not well known. The individualized nutritional intervention and nutrients supplement are also hard to be quantitative assessed. In this review,the common assessment methods of malnutrition,nutrient and metabolic features in patients with chronic liver diseases,and advances of nutritional therapy in liver diseases are reviewed,so as to give some enlightenment to the clinical nutrition intervention in chronic liver diseases.