Objective To investigate the upregulation of stearoyl-CoA desaturase 1（SCD1）-related lipid synthesis by IL-6 stimulus in HepG2 cells in vitro. Methods HepG2 cells were stimulated by rIL-6,and the lipid accumulation and SCD1 levels were evaluated. The SCD1 eukaryotic plasmid and small interfering RNA were conducted and transfected into HepG2 cells,respectively,and the lipid metabolism-related genes and intracellular triglyceride contents were detected. Results The intracellular triglyceride content in rIL-6-stimulated cells was significantly higher than in control group（P<0.05）;the SCD1 gene increased by 1.36 folds compared with in the control （P<0.01） and the SCD1 protein increased at the same time;the upregulation of intracellular lipid synthesis-related SREBP1c and FASN also increased by 1.35 and 1.27 folds,respectively,and the downregulation of lipid oxidation-related PPARα and ASCL3 decreased by 12.3% and 13.5%,respectively;In addition,the SCD1 transfection increased intracellular TG content in HepG2 cells（P<0.01） as compared to that in vector transfected group;conversely,after transfection with small interfering RNA and stimulation by rIL-6,the SCD1 was reduced compared with in the negative control, the intracellular TG content significantly decreased（P<0.05） and the lipid synthesis-related SREBP1c and FASN decreased by 32.3% and 51.9%, while the lipid oxidation-related PPARα also decreased by 80% （P<0.05） with the ASCL3 gene not significantly changed （P=0.832）. Conclusion rIL-6 stimulation might induce lipid synthesis and increase the triglyceride content by upregulating SCD1 expression in HepG2 cells.

Objective To analyze the correlation between serum and fecal HBV DNA and biochemical indexes and intestinal flora in patients with chronic hepatitis B（CHB）. Methods 73 patients with CHB were recruited in our hospital between August 2015 and March 2017,and liver function index,serum HBV markers and HBV DNA were detected. Besides,fecal HBV DNA and Bifidobacterium,Lactobacillus,Escherichia Coli, Enterococcus,Clostridium,Candida albicans,Bacteroides,Poulet,Rumen bacteria aureus in intestinal flora were assayed. The correlation between serum and fecal HBV DNA,and liver function index and intestinal flora DNA were compared. Results Fecal and serum HBV DNA levels in 48 patients with serum HBeAg positive were （5.9±1.6） copies/ml and （7.2±1.6） copies/ml,respectively,much higher than （5.0±1.9） copies/ml and （6.1±1.3） copies/ml （t=4.401,P=0.024;t=5.936,P=0.008） in 25 patients with serum HBeAg negative;there were no significant differences as respect to serum and fecal HBV DNA levels among 21,47 and 5 patients with mild, moderate and severe hepatitis B（P>0.05）;the fecal HBV DNA level was positively correlated to serum HBV DNA（r=0.61,P=0.002）;fecal HBV DNA was negatively correlated serum ALP and TBIL（r=-0.49,r=-0.54,P<0.05）,and serum HBV DNA load was negatively correlated to serum ALT and AST levels（r=-0.46,P=0.023;r=-0.52,P=0.008）;Fecal HBV DNA level was positively correlated to fecal enterococci（r=0.49,P=0.005） and serum HBV DNA was negatively correlated with lactobacillus（r=-0.53,P<0.001）. Conclusion The fecal HBV DNA is positive in patients with CHB,which warrants further investigation.

Objective To investigate the changes of peripheral blood CD8⁺CD28⁺T lymphocyte percentages in patients with hepatitis B. Methods A total of 88 patients with hepatitis B and 20 healthy individuals were recruited in 902nd hospital of PLA between April 2018 and August 2018,and the patients with hepatitis B included patients in immune tolerance phase（n=20）,immune clearance phase（n=28）,low replication phase （n=20）,and re-activation phase（n=20）. The percentages of CD8⁺CD28⁺T lymphocytes in peripheral blood were measured by flow cytometry. Results The percentages of CD8⁺CD28⁺T lymphocytes in patients in immune tolerance phase were（26.3±3.4）%,not significantly different as compared to（26.1±3.5）% in healthy persons（P>0.05）;the percentages of CD8⁺CD28⁺T lymphocytes in patients in immune clearance were（40.1±4.7）%,significantly higher than that in healthy control（P<0.05）;the percentages of CD8⁺CD28⁺T lymphocytes in patients inactive phase and reactive stage were （20.3±2.2）% and （26.1±2.2）%,respectively,significantly lower than that in healthy control （P<0.05）;the CD8⁺CD28⁺T lymphocytes in patients with high,moderate and low serum HBsAg level were（24.0±7.5）%,（28.4±8.9）% and （33.2±8.5）%,respectively,with statistically significant differences among them （P<0.05）. Conclusion s There are significant differences in the percentages of peripheral blood CD8⁺CD28⁺T lymphocytes in patients with hepatitis B at different immune phases,which might be related to the dysfunctions of immune system activated by the viral infection.

Objective To investigate the impact of blood IL28B gene polymorphism on viralogic response in patients with HBeAg positive chronic hepatitis B（CHB） receiving peginterferon alfa （Peg-IFNα） therapy. Methods 143 patients with serum HBeAg positive CHB were recruited in this study between August 2014 and October 2016. All patients received Peg-IFN alpha therapy for 24 to 144 weeks, and were followed-up for 52 weeks. Blood were obtained and DNA was extracted to detect single nucleotide polymorphism（SNP） of IL28B gene. The impact of SNP locus of IL28B gene on virological response was analyzed by the two classification multivariable Logistic regression. Results At the end of followed-up,58 patients（40.6%） responded and 85 patients failed to the regimen;out of the 143 patients with CHB,the type CT was 9.1%,type TT accounted for 0.7% and type CC accounted for 90.21% in rsl2979860 site,the type GT accounted for 9.1%,and type TT was 90.9% in rs8099917 site,and type AG accounted for 10.5%,and type AA accounted for 89.51% in rsl2980275 site;the genotype CC of rsl2979860 was 94.8% in responded patients,much higher than 87.1% （P<0.05）,the genotype TT of rs8099917 was 96.6%,much higher than 87.1%（P<0.05）,and genotype AA of rsl2980275 was 94.8%,much higher than 85.9% in non-responders（P<0.05）;two classification multivariable Logistic regression analysis with correction of baseline data showed that the rsl2979860 locus of the IL28B gene was the independent factor affecting the virology response（P<0.05）. Conclusion s The SNP locus of blood IL28B gene is closely related to the virologic response to Peg-IFNα therapy in patients with serum HBeAg positive CHB. The SNP detection of IL28B gene before antiviral therapy might help the clinicians make a reliable choice and get an optimal efficacy.

Objective To compare the clinical and histopathological features in patients with chronic hepatitis B（CHB） and chronic hepatitis C （CHC）. Methods The clinical data of 300 patients with CHB and 100 patients with CHC in our hospital between 2013 and 2017 were collected and analyzed retrospectively. The liver biopsies were performed in all the cases. Results The materials in our series indicated that the age was older 【（47.6±12.8）yr vs. （36.3±9.7）yr】,the illness period was longer 【（13.1±0.9）yr vs. （6.2±1.8）yr】,underlying disease was more multiple （39.0% vs. 18.7%）,blood-borne infection was more common（63.0% vs. 36.7%）,mother-to-infant vertical transmission was more less（3.0% vs. 29.7%）,intravenous infection was more common （40.0% vs. 7.0%） and sexual transmitted infection was more less（14.0% vs. 26.7%） than in patients with CHB（P<0.05）;serum ALT level was （76.5±10.8） U/L and serum AST level was（111.2±21.3） U/L in patients with CHB,significantly different as compared to 【（105.2±20.8） U/L and （98.3±20.1） U/L】 in patients with CHC（P<0.05）;the hepatic histopathological examination showed that >G2 hepatic activity （HAI） index in patients with CHC was 83.0%,much higher than 48.7%（P<0.05） in patients with CHB,and >S2 liver fibrosis was 65.0%,also significantly higher than 28.3%（P<0.05） in patients with CHB. Conclusion There are many clinical and histopathological differences between patients with CHC and with CHB,and severe liver injuries and fibrosis might be more common in patients with CHC due to longer infection periods,which needs more medical interventions.

Objective To compare the difference of programmed cell death receptor-1 （PD-1） receptor on peripheral blood follicular helper T lymphocyte （Tfh） surface in chronic hepatitis C （CHC） patients with low and high serum viral loads. Methods 180 patients with CHC were divided into two group,and 76 had serum HCV RNA level of less than 6 lg copies/ml and 104 had serum HCV RNA level of greater than 6 lg copies/ml. The percentage of PD-1 on peripheral blood Tfh cell surface,percentage of Tfh,peripheral blood T and B lymphocyte subsets and serum interleukin 21 （IL-21） level were detected. Results In patients with low and high viral load groups,serum HCV RNA levels were （4.5±1.2） lg copies/ml and （6.4±0.7） lg copies/ml,the percentages of PD-1 on Tfh cell surface were （26.2±2.2）% and （37.2±1.1）%,the percentages of Tfh cells were （7.9±0.7）% and （5.1±0.4）%,and serum IL-21 levels were（46.8±1.3） ng/l and（21.7±1.1） ng/l,all significantly different between the two groups （P<0.05）;the percentages of CD4⁺T lymphocyte were （51.1±4.6）% and （37.6±4.4）%], the percentages of CD8⁺T cell were （24.0±3.1）% and （31.7±3.9）%],the ratios of CD4⁺T/CD8⁺T cells were （3.3±0.2） and （2.3±0.1）],the percentage of CD19⁺B cell were（16.7±3.9）% and（11.8±3.2）%,all significantly different between the two groups（P<0.05）;the percentages of PD-1 on CD4⁺T lymphocyte surface were（10.1±2.3）% and （2.4±0.6）%],and the percentages of PD-1 on CD8⁺T cell surface were （6.3±2.2）% and（1.0±0.3）% （both P<0.01）. Conclusion There were significant differences between patients with low and high serum HCV RNA loads as respect to their peripheral blood Tfh and PD-1 expression,which might be important in evaluating the response to antiviral therapy and prognosis.

Objective To investigate the risk factors of severe hepatic fibrosis in patients with chronic hepatitis C（CHC） with previous paid blood donation. Methods 248 patients with CHC who had paid blood donation history were recruited in this study between January 2015 and December 2017. FIB-4 index was used to diagnose liver fibrosis,and we set the FIB-4 index greater than 3.25 as severe hepatic fibrosis and the FIB-4 index less than 3.25 as non-severe hepatic fibrosis. Univariate analysis of variance（ANOVA） and multivariate Logistic regression analysis were applied to analyze the risk factors of severe hepatic fibrosis in patients with CHC. Results Out of 248 patients with CHC and paid blood donation,86 cases（34.7%） had severe hepatic fibrosis,and 162 cases（65.3%） were non-severe hepatic fibrosis;univariate analysis showed that the ducation,course of disease,month income,concomitant diabetes mellitus,smoking,alcohol consumption and antiviral therapy （interferon-αplus ribavirin≥9 months） between the two groups were significantly different（P<0.05）,while age,gender,concomitant blood hypertension,with hepatitis B viral coinfection were not significantly different（P>0.05）;serum HCV RNA load in patient with severe hepaitc fibrosis was（86250.4±673.7） IU/ml,no significantly different as compared to （86193.1±702.5）IU/ml in patients without severe hepatic fibrosis （P>0.05）,while fasting blood glucose level was （6.8±1.3） mmol/L,serum ALT level was （47.3±10.4）U/L,AST level was（48.1±10.7） U/L,and peripheral white blood cell count was（3.8±1.0）×10⁹/l,significanyly different as compared to[（5.9±1.1） mmol/L,（36.9±9.6） U/L,（35.6±10.1） U/L and（5.0±1.2）×10⁹/l,respectively,P<0.05】 in patients without severe hepatic fibrosis;multivariate Logistic regression analysis showed that concomitant diabetes mellitus（OR=1.982,P=0.002）,alcohol consumption（OR=3.422,P=0.019）,long course of disease（OR=2.648,P=0.006）,month income （OR=2.413,P=0.029）,and without antiviral therapy（OR=4.733,P=0.030） were the independent risk factors for severe hepatic fibrosis in patients with CHC and previous paid blood donation. Conclusion Hepatitis C infection tends to be a chronic process,which might induce liver fibrosis. The individuals with HCV infection could have severe hepatitis fibrosis if they had unhealthy life style, concomitant diseases and couldn’t afford antiviral therapy. The clinicians must pay more attention to them.

Objective To investigate the changes of serum adenosine deaminase（ADA） levels in patients with autoimmune hepatitis（AIH） and its correlation to hepatic activity index and response to steroid therapy. Methods 70 patients with AIH were enrolled in our hospital between April 2013 and May 2016,all patients received liver biopsies under US guidance and serum ADA levels were detected by ELISA. The area under ROC was applied to evaluate the efficacy of every parameter for the diagnosis of hepatic interfacial inflammation and the influencing factors for non-response to steroid therapy was made by Logistic analysis. Results Serum ADA levels in 53 patients with active AIH,17 at remission and 38 healthy persons were （30.2±7.1）U/L,（16.5±4.3）U/L and （12.9±2.2） U/L,and the differences were significant （P<0.05）;serum ADA levels in 17 patients with mild,21 with moderate and 32 with severe hepatic interfacial inflammation were（16.5±4.3） U/L,（26.0±4.7） U/L and （32.9±7.2） U/L,and the differences were statistically significant（P<0.05）;the AUC for serum ADA to diagnose the interfacial inflammation was 0.867（95%CI：0.764-0.936）,the cut-off-value was 22.1 U/L,the sensitivity and specificity were 100.0% and 63.2%;univariate analysis showed that female,serum ADA,ALT,AST,TBIL,GGT,ALP,IgG,IgM,anti-gp210 positive and cirrhosis were related to non-response to steroid therapy and the Logistic analysis demonstrated that serum ADA,ALP and liver cirrhosis were the independent factors for failed steroid therapy. Conclusion Serum ADA levels in patients with AIH is closely related to hepatic activity index, which might be helpful in predicting the response of patients with AIH to steroid therapy.

Objective To investigate the expression of programmed death receptor 1 （PD-1） in liver tissue of patients with autoimmune hepatitis（AIH） and its clinical implications. Methods 68 patients with AIH （48 active and 20 at remission） were admitted to our hospital between May 2015 and April 2017,and liver biopsies were performed. 13 patients with hepatic hemangioma were included and their liver tissues were obtained by surgery for control. The expression of PD-1 in liver tissues was detected by immunochemical staining. The correlation between the positive expression of PD-1 in liver tissues and serum liver function indexes in patients with AIH was analyzed. Results Serum bilirubin,AST, ALT,ALP and GGT levels in 48 patients with active AIH were （72.1±48.9） μmol/L,（243.1±170.4） U/L,（345.3±217.7） U/L,（154.3±94.6） U/L and （86.5±43.5） U/L,much higher than（14.8±4.2） μmol/L,（28.3±8.7） U/L,（27.6±8.8） U/L,（73.3±51.3） U/L and （71.3±27.3） U/L in 20 patients at remission （all P<0.05）,and serum globulin and IgG levels were （34.3±11.3） g/L and （23.2±7.5） g/L,much higher than （30.7±10.2） g/L and （11.7±4.6）g/L in patients at remission（P<0.05）;the positive rate of PD-1 expression in liver tissues of 68 patients with AIH was（13.61±6.87）%,significantly higher than （2.25±0.68）% in patients with hepatic hemangioma（P<0.05）,and the positive rate in 48 patients with active AIH was（16.56±7.81） %,significantly higher than（6.56±3.21）% in patients at remission（P<0.05）;the incidences of interfacial inflammation,lymphocyte invasion and single tube destructive inflammation in 48 patients with active AIH were 93.75%,89.58% and 6.25%;the PD-1 expressions in liver tissues of patients with active AIH were positively correlated to serum bilirubin（r=0.996,P<0.001）,AST（r=0.989,P<0.001）,ALT（r=0.995,P<0.001）,ALP（r=0.998,P<0.001）,GGT（r=0.995,P<0.001）,GLO（r=0.996,P<0.001） and IgG levels（r=0.997,P<0.001）,and they were positively correlated to serum bilirubin （r=0.999,P<0.001）,AST（r=0.999,P<0.001）,ALT （r=0.999,P<0.001）,ALP（r=0.999,P<0.001）,GGT（r=0.999,P<0.001） and IgG levels（r=0.999,P<0.001） in patients at remission. Conclusion The expression of PD-1 in liver tissues of patients with AIH is strongly intensified and positively correlated to hepatic activity index,and the mechanism by which it take part in the pathogenesis of AIH needs further investigation.

Objective To summarize the clinical and laboratory characteristics of patients with drug-induced liver injury（DILI）. Methods 21 patients with DILI were recruited in our hospital between March 2015 and October 2016,and all the patients received methylprednisolone and 13 were followed-up for 3 to 16 months. Results Out of the 21 patients,6 were men and 15 women with an average age of（49.3±15.2） years;12 cases were diagnosed as acute DILI,and 9 as chronic;serum autoantibodies were positive in 17（81.0%） cases;liver biopsies were performed in 15 patients with DILI,and the average score of autoimmune hepatitis （AIH） was （3.9±1.2） points;serum biochemical parameters improved after glucocorticoid therapy at the dose of （0.65±0.15） mg·kg^-1·d^-1;white blood cell counts significantly increased after steroid therapy,but no complications occurred in this series;Out of 13 patients followed-up,7 relapsed after discontinuation of corticosteroids. Conclusion Glucocorticoids might be administered in patients who poorly respond to conventional therapy,especially in those with serum autoantibodies positive. But the discontinuation of steroid might lead to the relapse of illness,which needs further investigations.

Objective To investigate the changes of plasma microRNA（miRNA） -4284 in patients with anti-tuberculosis drug-induced hepatotoxicity（ATDH）. Methods A total of 200 naive patients pulmonary tuberculosis were recruited in this study,and all the patients received standardized WHO-recommended anti-tuberculosis therapy. High throughput real-time fluorescence quantitative PCR was applied to assay plasma miRNA-4284 levels. The ROC curve was drawn to evaluate the efficacy of plasma miRNA-4284 for diagnosis of ATDH. Results At the end of six month anti-tuberculosis,ATDH occurred in 70 cases（35.0%）,and out of them,the hepatocyte injuries in 24,cholestasis in 20,and mixed injuries in 26;plasma miRNA-4284 level in patients with ATDH was （1.9 ±1.6）,significantly higher than 【（0.9±0.6）,P<0.05】 in patients without;the sensitivity was 70.0%,the specificity was 69.9%,the positive predictive value was 77.8%,the negative predictive value was 67.4% and the accuracy was 68.0% when plasma miRNA-4284 level equal to 1.15 acted as the cut-off-value with the AUC being 0.71 （95%CI：0.43-1.45）;after three-month hepatoprotective therapy,serum liver function index in all the patients with ATDH recovered and their plasma miRNA-4284 levels also decreased to（0.8±0.5）. Conclusion Plasma miRNA-4284 level in patients with ATDH significantly increases,which might be helpful in the diagnosis and evaluation of anti-tuberculosis efficacy in clinical practice.

Objective To explore the related drugs,clinical characteristics and prognosis of patients with drug-induced liver failure （DILF）. Method A total of 314 patients with DILF were collected between March 2002 and March 2015 in our hospital. According to Roussel Uclaf causality assessment method score,the underlying diseases,induced drugs,clinical characteristics,treatment and prognosis were retrospectively analyzed. Result Out of the 314 patients with DILF,there were 97 men and 217 women with the proportion of male to female being 1:2.5,and the average age was（43.8±17.0） yr;there was a statistically significant difference between male and female patients at age of 30 to 39 yr;the proportion of DILF accounting for liver failure was on the rise in our hospital in recent decade;the main induced drugs were traditional Chinese herbal medicine（45.5%）,antipyretic analgesics（18.0%）,antituberculosis medicine（12.6%）,etc;the underlying diseases were mainly fever（20.1%）,dermatosis（15.6%） and tuberculosis （12.7%）,etc;the clinical catalogue was mainly subacute liver failure （60.9%）,and the main clinical type was hepatocyte damage（56.7%）;at the end of three month observation,the survival rate was 58.9%. Conclusion In recent decade,the incidence of DILF in our hospital has been increasing rapidly with variety of causative medicine and high mortality,which warrants further study.

Objective To analyze the risk factors for poor prognosis of patients with hepatitis E-induced liver failure. Methods 140 patients with hepatitis E-induced liver failure were admitted to our hospital between March 2009 and March 2016. 63 patients survived and 77 died. The independent risk factors for poor prognosis were analyzed by univariate and multivariate Logistic analysis. Results The peak serum alpha-fetoprotein level in dead patients was（47.6±8.9） ng/ml,significantly lower than（175.8±254.1） ng/ml（P<0.05） in the survival,total serum bilirubin level was（377.3±164.6） μmol/L,much higher than （251.7±151.4） μmol/L （P<0.05） in the survival,the INR was（2.4±0.6）,much higher than[（1.6±0.2）,P<0.001] in the survival,while serum albumin level was （32.2±9.9） g/L,significantly lower than（35.8±8.2）g/L （P<0.05） in the survival;univariate analysis showed that older than 60 year （P<0.001）,with underlying liver disease （P=0.032）,complicated by hepatic encephalopathy （HE,P=0.024）,infection （P=0.03）,gastrointestinal bleeding （GIB,P=0.014） and with ascites （P=0.02） were the related factors impacting prognosis,and multivariate Logistic analysis demonstrated that HE （P=0.005）,infection （P<0.001）,GIB（P=0.001） and underlying liver disease（P=0.004） were the independent risk factors for poor prognosis of patients with hepatitis E-induced chronic-on-acute liver failure. Conclusion Some patients with hepatitis E would deteriorate to liver failure,and the chronic-on-acute are common. About fifty percent of the patients survive with conventional supporting treatment,and patients with hyperbilirubinemia and extremely elevated INR would have poor prognosis,especially in patients with underlying liver diseases and complicated by HE, infection and GIB. Clinicians should take this into consideration to deal with the patients with hepatitis E at risk carefully for improvement of prognosis.

Objective To investigate the changes of serum B7-H3 and IL-18 levels in patients with hepatitis B liver cirrhosis and their clinical implication. Methods 113 patients with liver cirrhosis,including compensated liver cirrhosis in 33 and decompensated in 80,and 20 healthy volunteers at the same period were recruited in this study between April 2015 and March 2017. Serum B7-H3 and IL-18 levels were detected by ELISA,and their correlation was analyzed by linear correlation. Results Serum B7-H3 level in 80 patients with decompensated liver cirrhosis was（62.29±22.17） ng/ml,significantly higher than（32.27±10.29） ng/ml（P<0.05） in 33 patients with compensated liver cirrhosis or than（11.35±4.48） ng/ml（P<0.05） in 20 healthy persons,and serum B7-H3 level in patients with compensated liver cirrhosis was also significantly higher than in healthy control（P<0.05）;serum IL-18 level in decompensated cirrhotics was （585.63±121.28） pg/ml,much higher than （396.29±86.91） pg/ml（P<0.05） in compensated liver cirrhosis or （155.31±76.93） pg/ml （P<0.05） in healthy persons,and serum IL-18 level in patients with compensated cirrhosis was also significantly higher than in healthy control （P<0.05）;serum B7-H3 level in patients with liver cirrhosis was positively correlated to serum IL-18 level （r=0.4111,P<0.01）;serum B7-H3 level in 26 patients with Child-Pugh class C was（76.53±22.76） ng/ml,significantly higher than（23.27±9.84） ng/ml in 33 patients with Child-Pugh class A or （52.21±13.94） ng/ml （P<0. 05） in 54 patients with Child-Pugh class B,and serum IL-18 level in patients with Child-Pugh class C was（594.13±112.21） pg/ml,significantly higher than （408.06±92.41） pg/ml in patients with Child-Pugh class B or （243.82±57.03） pg/ml（P<0.05） in patients with Child-Pugh class A,and serum IL-18 level in patients with Child-Pugh class B was also significantly higher than in patients with Child-Pugh class A（P<0.05）. Conclusion Serum B7-H3 level in patients with hepatitis B-induced liver cirrhosis increase accompanying with serum IL-18 level elevation,which might take part in the pathogenesis of liver cirrhosis.

Objective To investigate the role of transjugular intrahepatic portosystemic shunt（TIPS） in the treatment of cirrhotics with portal hypertension. Methods A retrospective analysis was made on 147 patients with liver cirrhosis and portal hypertension,and all the patients received TIPS between March 2012 and January 2017. The patients received hepatic CT check-up and three-dimensional reconstruction of hepatic vein and portal vein was made. Results All the 147 patients were treated with TIPS by the right jugular vein approach,and 146 cases（99.3%） were successfully operated. Intraoperative punctures in bile duct,gallbladder,hepatic artery and liver capsule were 5 cases （3.4%）,2 cases （1.4%）,4 cases （2.7%） and 8 cases （5.5%）,whereas no abdominal or bile duct bleeding occurred;ectopic embolism occurred in 2 cases （1.4%）;the preoperative dry weight was （13.0±2.1） kg, fasting blood glucose was （6.4±1.0） mmol/L,fasting insulin levels was （20.2±9.3） mU/L,albumin was （37.4±5.0） g/L,creatinine was （59.2±15.9） μmol/L,urea was （5.1±1.6） mmol/L,total bilirubin was （18.6±5.0） μmol/L,blood ammonia was（66.8±24.3） μmol/L,while at the end of 3 months after TIPS,these indexes were （15.4±3.2） kg,（5.8±1.4） mmol/L,（15.3±3.3） mU/L,（34.8±3.6） g/L,（58.5±10.9） μmol/L,（4.1±1.6） mmol/L,（27.3±7.2） μmol/L and（70.1±34.4） μmol/L,respectively,suggesting postoperative portal venous pressure significantly decreased,dry weight and total bilirubin levels significantly increased; within 12 months of follow-up,there were stent stenosis in 31 cases （21.2%） and hepatic encephalopathy in 25 cases （17.12%）. Conclusion TIPS is a reliable method for treatment of liver cirrhosis with portal hypertension,which might effectively improve the patients' conditions. The key of the operation is the precise puncture,preoperative CT three-dimensional reconstruction of liver and hepatic vein and portal vein,and intraoperative portal vein angiography.

Objective To investigate the efficacy of combination of pegylated interferon-α-2a（peg-IFN-α2a） and ribavirin in treatment of patients with compensated hepatitis C cirrhosis. Methods 122 patients with compensated hepatitis C cirrhosis were recruited in our hospital between January 2003 and December 2016,and were divided randomly into control （n=61） and observation group （n=61）,receiving conventional therapy or peg-IFN-α2a and ribavirin combination for 24 to 48 weeks,respectively. All patients were followed-up for 24 weeks. Serum LN,PC Ⅲ and HA levels were assayed routinely,and liver stiffness measurement（LSM） was obtained by Fibroscan. Results At the end of the observation,serum HCV RNA load in patients receiving antiviral therapy was （2.0±0.4） lg IU/ml,much lower than 【（3.8±1.3）lg IU/ml,P<0.05】 in the control;serum AST and ALT levels were （46.03±24.05） U/L and （36.32±20.1） U/L,much lower than 【（78.7±21.1） U/L and（51.2±20.9） U/L,P<0.05）,respectively in the control;serum LN,PCⅢ and HA levels were（126.3±29.0） μg/L,（212.3±43.8）μg/L and （211.4±42.0） μg/L,significantly lower than【（140.3±32.1） μg/L,（267.5±39.8） μg/L and（329.6±68.4） μg/L,P<0.05】,respectively in the control;the LSM was （13.6±2.4）kPa,much lower than 【（17.6±5.2）kPa,P<0.05】 in the control;at the end of 24 week follow-up,the serum ALT normalization and sustained virologic response（SVR） in the observation group were much higher than those in the control（93.4% vs. 45.9% and 72.1% vs. 9.8%,respectively,P<0.05）,and disease progression was 3.3%,much lower than 13.1% （P<0.05） in the control. Conclusion The application of pe-IFN-α2a and ribavirin combination in treatment of patients with compensated hepatitis C liver cirrhosis is efficient, which might significantly increase serum ALT normalization,improve SVR and postpone the disease progression.

Objective To analyze the clinical efficacy and safety of endoscopic variceal ligation （EVL） combined with somatostatin in treatment of patients with liver cirrhosis complicated by esophageal variceal bleeding （EVB）. Methods 64 patients with liver cirrhosis complicated by EVB were recruited in our hospital between April 2015 and May 2017,and were divided into two groups receiving somatostatin or somatostatin and EVL. Results At the end of one week treatment,the hemostasis in combination group was 100.0%,significantly higher than 90.6% （P<0.05） in the somatostatin-treated patients,and three patients died in the latter;after treatment,the hepatic nenous pressure gradient （HVPG） in combination group was （6.5±1.0） mmHg,much lower than （11.9±1.1）mmHg in the control,while RBC was （4.7±0.5）×10¹²/L,Hb was（118.5±23.1） g/L,significantly higher than （4.1±0.4）×10¹²/L and（104.4±22.5） g/L in the control（P<0.05）;the hemostasis time was（1.3±0.4） d,blood transfusion was （1.7±1.0）U,and hospital stay was（20.4±3.5） d,significantly shorter or less than （2.8±0.5） d,（2.8±1.5） U and （29.8±4.0） d in the control （P<0.05）;at the end of one-year follow-up,the incidences of rebleeding in the two groups were 53.1% and 86.2% （P<0.05）. Conclusion The emergent application of somatostatin and EVL in dealing with patients with liver cirrhosis complicated by EVB is efficient and safe, which can effectively achieve rapid hemostasis and shorten the hospitalization time.

Objective To investigate the application of warfarin in dealing with portal vein thrombosis （PVT） in patients with liver cirrhosis after splenectomy and devascularization. Methods A retrospective analysis of the clinical data was made in 48 patients with cirrhosis and PVT after plenectomy and devascularization between April 2010 and September 2015 in Beijing You’an Hospital. 25 patients took warfarin for 1 months and 3 patients took warfarin for 6 months after the operation. The changes of PVT after splenectomy and devascularization was compared between the two groups according to the US examination. Results Out of the 48 patients with PVT,the PVT progressed in 20 cases （41.7%）,and 6 cases（26.1%） of them was from patients who took warfarin for 6 months,and 14 （56%） was from patients who took warfarin for one month （P<0.05）;the PVT significantly progressed in 11 cases（22.9%）,including 9 cases（36%） in patients taking warfarin for one month and 2 cases（8.7%） in patients taking warfarin for 6 months（P=0.039）;the incidences of repatency of PVT, rebleeding,liver cancer and death in patients taking warfarin shortly were 0.0%,4.0%,8.0% and 4.0%,no significantly different as compared to 4.3%,4.3%,4.3% and 0.0%（P>0.05） in patients taking warfarin for six months. Conclusion The application of warfarin in dealing with portal vein thrombosis（PVT） in patients with liver cirrhosis after splenectomy and devascularization is safe and effective,which might stop the progress of PVT and decrease the risk of rebleeding.

Objective To evaluate right atrial and ventricular functions in patients with nonalcoholic fatty liver disease （NAFLD） -induced liver cirrhosis （LC） by real-time three-dimensional echocardiography （RT-3DE） and speckle tracking imaging （2 D-STI）. Methods 70 patients （compensated in 35 and decompensated in 35） with NAFLD-induced LC and 35 healthy persons were recruited in our hospital between February 2015 and November 2016. The RAVI,LAD,RVIDd,RVIDs,IVS and LVPW were obtained by RT-3DE,and the RVFAC was calculated. The ETV and e'TV were measured and the ratio of ETV/e'TV was calculated. The TAPSE was obtained by M mode echocardiography. The MSs,MSe,MSa,MSRs,MSRe and MSRa were also measured by 2D-STI. Results The LAD,LVPW and ETV/e'TV in patients with compensated cirrhosis decreased as compared to those in healthy persons（P<0.05）;the RVIDs,IVS,LVPW and ETV/e'TV in patients with compensated cirrhosis decreased as compared to those in patients with decompensated cirrhosis（P<0.05）;the RAV max,RAV min,RAV pre,RAVIa and RAVIt in patients with liver cirrhosis significantly increased,while the RAVIp decreased as compared to those in control （P<0.05）;the RAV max,RAV min,RAV pre,RAVIa and RAVIt in patients with compensated cirrhosis significantly decreased,while the RAVIp increased as compared to those in patients with decompensated cirrhosis（P<0.05）;the MSe,MSRs and MSRa in patients with liver cirrhosis significantly increased,while the MSRe and MSa decreased as compared to those in control（P<0.05）;the MSs,MSe,MSRs,MSRe and MSRa in patients with compensated cirrhosis significantly increased,while the MSa decreased in patients with decompensated cirrhosis（P<0.05）. Conclusion The application of RT-3DE and 2D-STI in evaluating right atrial and ventricular functions in patients with NAFLD-induced LC might be helpful for clinicians to early predict the cardiac deficiency,which needs further investigations.

Objective To investigate the relationship between cancerous miRNA-30c levels and the survival of patients with hepatocellular caicinoma （HCC） after hepatectomy. Methods Thirty-five patients with HCC in our hospital between February 2010 and November 2012 were included in this study. All patients were confirmed by pathological examination after hepatectomy,and cancerous miRNA-30c levels were assayed by real-time quantitative polymerase chain reaction. Cancerous miRNA-30c levels were compared between patients with different clinical and pathological features. The survival rate of patients was evaluated by the Kaplan-Meier minimum product method,and the difference of survival rate was evaluated by Log-Rank test. Results The relative level of cancerous miRNA-30c in the 35 patients with HCC was 0.6, with 95% CI of 0.3 to 0.6,and there were 13 patientss with low cancerous miRNA-30c level less than 0.6 and 22 patients with high cancerous miRNA-30c levels greater than 0.6;there were no significant differences of cancerous miRNA-30c levels between patients with diffenrent gender,age,tumor size,degree of differentiation,TNM staging,history of viral hepatitis,and serum AFP levels（P>0.05）,however,the cancerous miRNA-30c levels in 17 patients with lymph node metastasis was（0.2±0.0）,significantly lower than 【（0.8±0.1）,P<0.05】 in 18 patients without lymph node matastasis;the adjusted risk ratio （OR）=5.4,and 95% CI:1.2 to 20.1;the total survival in patients with high cancerous miRNA-30c levels was （14.5±6.7） m,with 95%CI of 11.0-28.4 m,significantly longer than【（7.9±1.5） m,with 95%CI of 3.2-10.7 m,P<0.05】 in patients with lower cancerous miRNA-30c levels. Conclusion Our findings indicate that the cancerous miRNA-30c level is related to the prognosis of patients with hepatocellular carcinoma,and it might be a new potential biomarker for predicting the survival of patients with hepatocellular carcinoma after hepatectomy.

Objective To explore the clinical value of ¹⁸F-FDG PET/CT scan in patients with hepatocellular carcinoma （HCC） and hepatic microvascular invasion （MVI）. Methods We retrospectively analyzed the clinical materials of 99 patients with HCC who admitted to our hospital between February 2014 and December 2015. All these 99 patients received ¹⁸F-FDG PET/CT scan and hepatectomy thereafter,and the postoperative histopathological examination was done to confirm the existence of MVI. Results Out of the 99 patients with HCC,the postoperative pathological examination showed the existence of MVI in 42,and without MVI in 57 cases;the ¹⁸F-FDG PET/CT scan showed that the intrahepatic tumor irregular and mostly rounded,some accompanied by subfoci,presenting with low density or slightly low density shadows. The PET/CT examination was positive in 73（73.7%） cases,85.7% in patients with MVI,and 64.9% in patients without MVI（P<0.05）;the tumor diameter in patients with MVI positive was （7.6±2.8） cm,significantly larger than（5.4±2.4） cm in patients without MVI,and the tumor maximum standardized uptake value （SUVmax） was （7.4±5.2）,significantly higher than 【（5.3±5.2）,P<0.05】 in patients with MVI negative;the histological types of hepatocellular carcinoma in patients with and without MVI were not significantly different （P>0.05）,while the percentage of tumor differentiation type III/IV was much higher in patients with MVI as compared to that in patients without （88.1% vs. 75.4%,P<0.05）;all the patients were followed-up for 12 to 24 months with the median of 18 months,the one-year total survival was 81.8% and the disease-free survival rate was 60.6%;further analysis showed that the one-year survival and one-year disease-free survival rate in patients with MVI positive were 66.7% and 47.6%,significantly lower than 91.2% and 70.2%,respectively （P<0.05） in patients with MVI negative. Conclusion s The patients with hepatocellular carcinoma and hepatic microvascular invasion have some characteristics when the ¹⁸F-FDG PET/CT scan is done,which should be summarized and its implications needs further investigation.

Objective To explore the impact of blood glucose levels on imaging quality of positron emission tomography/computed tomography （PET/CT） examination in patients with primary liver cancer （PLC）. Methods 187 patients with PLC were recruited in this study between January 2015 and January 2018,and 71 had normal blood glucose and 116 were hyperglycemic. All patients received PET/CT examination. SUVmean was measured in the right lobe of the liver. The liver image quality and fluorodeoxyglucose F¹⁸（¹⁸F-FDG） uptake were compared between the two groups,and the correlation of each variable to liver SUVmean was analyzed. Results The grade 0,1,2 and 3 of liver image quality by PET/CT scan in patients with normal blood glucose levels 7.0%,19.7%,29.5% and 43.8%,significantly superior to 17.2%,26.7%,25.8% and 30.3% in patients with elevated blood glucose levels （P<0.05）;the ¹⁸F-FDG uptake in patients with hyperglycemia was significantly higher than in patients with normal blood glucose [（5.1±1.4） vs.（3.9±1.3）,P<0.05];Correlation and partial correlation coefficients between blood glucose,age,free thyroxine 3（FT3） and liver BMR,and SUVmean were statistically significant（P<0.05） and further multivariate stepwise linear regression analysis showed that blood glucose,age and FT3 were the independent factors affecting liver SUVmean. Conclusion s Blood glucose levels and liver glucose metabolism might affect liver ¹⁸F-FDG uptake and the image quality of PET/CT scan in patientswith PLC,and the patients’ age and serum FT3 are independent factors affecting liver SUVmean. Clinicians should actively regulate the blood glucose levels to a reasonable range before PET/CT examination.

Objective To investigate the efficacy of transcatheter arterial chemoembolization （TACE） and ultrasound-guided microwave ablation in the treatment of patients with hepatocellular carcinoma（HCC） at special sites. Methods Seventy-two patients with HCC,out of them,thirty-six with HCC at special sites （observation group）,were enrolled in our hospital between January 2012 and January 2015,and all of them received TACE and ultrasound-guided microwave ablation seven days after. The patients with HCC in the two groups were followed- up for two years after the treatment was completed. The survival was analyzed by Kaplan-Meier methods. Results The rates of complete response,partial response,disease stable and disease progress in the observation group were 44.4%,25.0%,19.5% and 11.1%,not significantly different as compared to 47.2%,27.8%,16.7% and 8.3% in the control（P>0.05）;serum AFP negativity rate in the observation group was 84.4%,not significantly different as compared to 83.9% in the control（P>0.05）;the survival rates at 6 m,1 a,18 m and 2 a were 94.4%,88.9%,69.4% and 44.4%,not significantly different as compared to 100.0%,91.7%,75.0% and 47.2%,respectively（P>0.05）;the incidences of right hypochondriac region pain,fever,anorexia and abnormal liver function tests after operations in the two groups were not significantly different（P>0.05）. Conclusion The application of hepatic artery chemoembolization combined with ultrasound-guided microwave ablation in the treatment of patients with HCC at special sites might have the same clinical efficacy as usual,but we still remind clinicians taking much more attention to those patients during the process.

Objective To investigate the effects of dexmedetomidine combined with propofol anesthesia on perioperative stress response,lymphocyte subsets and postoperative recovery quality in patients undergoing hepatectomy. Methods 68 patients with primary liver cancer were admitted to our hospital between January 2015 and March 2017,and the patients were divided into observation and control group with 34 patients in each group. Fifteen minutes before anesthesia,the dexmedetomidine at dose of 0.5 μg·kg^-1 or saline were intravenously given in the observation or the control patients,and the anesthesia were the same in both groups. The percentages of T lymphocyte subsets and NK cells,and the serum interferon （IFN）-γ,interleukin （IL）-2,IL-10,cortisol,adrenocorticotropic hormone,and aldosterone levels were detected at 30 min before induction of anesthesia （T0）,immediate postoperative （T1）,postoperative 24 h （T2）,and postoperative 48 h （T3） and systolic blood pressure （SBP）,diastolic blood pressure（DBP） and central venous pressure（CVP） were measured immediately after intubation （Ta） and extubation （Tb）. The cough and dysphoria after surgery were scored. Results The SBP,DBP and CVP in the observation group at Ta,T1 and Tb were significantly lower than those in the control group （P<0.05）;the percentages of CD3⁺,CD4⁺ and NK cells as well as ratio of CD4⁺/CD8⁺ cells in the observation group were mugh higher than in the control group at T1,T2 and T3 （P<0.05）;serum IFN-γ and IL-2 levles in the observation group were much lower,while serum IL-10 levels were higher than in the control group at T1,T2 and T3 （P<0.05）;serum levels of cortisol,adrenocorticotropic hormone and aldosterone in the observation group were significantly lower than in the control group at T2 and T3 （P<0.05）;the cough and dysphoria scores after hepatectomy in the observation group were much lower than in the control group （P<0.05）. Conclusion The anesthesia by dexmedetomidine combined with propofol can inhibit the stress response and improve the quality of postoperative recovery in patients with liver cancer undergoing hepatectomy.

Objective To investigate the changes of serum miR-335 levels in patients with hepatocellular carcinoma （HCC） undergoing transcatheter arterial chemoembolization （TACE）. Methods 60 patients with HCC,50 with chronic hepatitis B （CHB）,50 with hepatitis B liver cirrhosis （LC） and 50 healthy persons were recruited in our hospital between May 2014 and May 2016. All patients with HCC received TACE for average three times and followed-up for 24 months. Serum miR-335 levels were detected by real-time quantitative reverse transcription PCR,and the prognosis of patients with HCC by serum miR-335 levels was predicted by the area under the curve of receiver-operating characteristic. Results Serum miR-335 level in patients with HCC was（1.18±1.35）,much lower than （1.91±2.11） in patients with CHB,or （2.01±0.75） in patients with LC,and also significantly lower than【（2.07±1.25）,P=0.001】 in healthy persons;serum miR-335 level in 22 HCC patients with portal vain tumor thrombus was significantly lower than in 38 patients without（t=4.586,P<0.001）,serum miR-335 level in 13 dead patients was much lower than in 47 survivals（t=3.324,P<0.001）,while those in patients with different gender,age,tumor sise,TNM stage,serum AFP levels and with or without lymph node metastasis were not significantly different （all P>0.05）;the sensitivity was 83.0% and the specificity was 100.0% when serum miR-335 level being 0.820 was set for the cut-off-value for predicting the two-year patients’ death. Conclusion Serum miR-335 levels in patients with HCC decrease,and the lower the serum miR-335 levels,the poorer the prognosis,which warrants further investigation.

Objective The study was conducted to assess the efficacy of early administration of enteral nutrition （EN） in patients with hepatocellular carcinoma （HCC） undergoing hepatectomy. Methods A retrospective study was conducted in 130 HCC patients who undergoing surgical resection of hepatic tumor in our hospital between January 2015 and December 2017，and the diagnosis of HCC was approved by post-operational pathological examination. After hepatectomy，65 patients in observation received parenteral nutrition（PN） and EN，and another 65 in control received PN. Results At the end of two weeks after operation，serum albumin level in the observation was （41.4±2.9） g/L，prealbumin level was （260.8±12.5） mg/L，and Child-Pugh score was （5.7±1.7），significantly different as compared to [（34.6±2.5） g/L，（233.3±2.4） mg/L and（6.6±1.5），P<0.05] in the control；there were no significant differences in the blood liver tests between the two groups（P>0.05）；after operation，the excrement was（3.3±1.5）d，much earlier than 【（4.3±1.2）d，P<0.05】，while the hospitalization fee was（53696.3±16754.4） yuan，significantly higher than （50780.6±13632.7）yuan （P<0.05） in the control；the biliary leakage，infection，and liver insufficiency in observation group was 26.2%，no significantly different as compared to 32.2% in the control（P>0.05）. Conclusion Early administration of EN and PN combination in patients with HCC undergoing hepatectomy might elevate blood albumin levels，reduce post-operational complications and improve rehabilitation.

Objective To observe the clinical efficacy of biliary stent placement under endosocopic retrograde cholangiopancreatography （ERCP） in the treatment of elderly patients with extrahepatic biliary malignant obstruction. Methods Sixty elderly patients with extrahepatic malignant biliary obstruction were admitted to our hospital between October 2014 and October 2017,30 in control received percutaneous transhepatic cholangiography （PTCD） treatment,while other 30 in observation group received ERCP biliary metal stent implantation. All patients were followed-up for 12 months. Results The stent patency period in the observation group was（225.4±52.6） days,significantly longer than[（156.7±44.2） days,P<0.05] in control group,and hospitalization stay was （12.3±2.4） days,significantly shorter than [（19.9±4.1） days,P<0.05] in control group;total serum bilirubin level 2 weeks after operation in the observation group was（110.2±60.1） μmol/L,significantly lower than[（149.8±64.5） μmol/L,P<0.05],serum alkaline phosphatase level was （216.8±127.6） IU/L,significantly lower than [（312.9±149.5） IU/L,P<0.05],and serum glutamyltransferase level was（196.5 ±100.5） IU/L,significantly lower than[（269.8 ±121.3） IU/L,P<0.05] in the control group;the incidence of post-operational complications was 10.0%,much lower than 33.3% （P<0.05） in the control,and 1-yr survival was 30.0%,much higher than 10.0% （x²=3.922,P=0.045） in the control. Conclusion The elderly patients with malignant extrahepatic biliary obstruction received ERCP biliary stent implantation might be efficacious in a short-term observation,which could shorten hospitalization stay,and prolong survival.

Objective To study the changes and significance of serum cell migration induced hyaluronan-binding protein （CEMIP），carbohydrate antigen 19-9 （CA19-9 and CA242 in patients with pancreatic cancer （PC）. Methods A total of 92 patients with PC，105 patients with benign pancreatic diseases，and 83 healthy volunteers were recruited in our hospital beteen April 2013 and August 2016，and serum CEMIP levels were measured by ELISA，serum CA19-9 and CA242 levels were measured by radioimmunoassay. The area under the receiver-operating characteristic curve（AUC） was applied to evacuate the diagnostic efficacy，Kaplan-Meier and Cox proportional hazard model was applied for the survival analysis and Logistic regression was applied to analyze the risk factors impacting the survival. Results Serum levels of CEMIP，CA19-9 and CA242 in patients with PC were 0.7（0.4，1.0） ng/mL，180.1（89.1，230.3） U/mL and 61.7（20.7，93.5） U/mL，respectively，much higher than those in patients with benign pancreatic disease or healthy controls（P<0.05）；the AUC of combined serum CEMIP，CA19-9，and CA242 in diagnosis of patients with PC was 0.966，and its diagnostic efficacy was higher than either of the three parameters alone；serum CEMIP，CA19-9，and CA242 levels could predict effectively the survival of patients with PC at the end of 1 year after radical removal of the tumor；Kaplan-Meier and Cox multivariate analysis showed that tumor differentiation，vascular invasion， postoperative chemotherapy，serum CEMIP≥0.7 ng/mL，CA19-9≥90.3 U/mL，and CA242≥32.8 U/mL were the independent risk factors influencing the survival of patients with PC after operation. Conclusion The detection of serum CEMIP，CA19-9 and CA242 levels in patients with PC might help to diagnose the disease and evaluate the prognosis.

Objects To investigate serum microRNA-122（miR-122）,high mobility group protein 1 （HMGB1） and caspase-aspartate proteolytic keratin-18 （CCK-18） level changes in patients with cholelithiasis and their clinical significance. Methods 201 patients with cholelithiasis and 103 healthy persons admitted to our hospital between January 2015 and February 2018 were enrolled,and serum miR-122,HMGB1 and CCK-18 levels were compared between the two groups. Logistic regression analysis was applied to analyze the risk factors affecting the progression of simple cholelithiasis into complex cholelithiasis. The efficacy of serum markers in the diagnosis of complex cholelithiasis was analyzed by area under the receiver operating characteristic curve （AUC）. Results Serum levels of miR-122,HMGB1 and CCK-18 in patients with cholelithiasis were 4.7（0.9,14.3）,（2.5±0.7） ng/mL and（126.8±20.5） U/L,respectively,significantly higher than[0.9 （0.4,3.1）,（2.1±0.4） ng/mL and （101.4±18.7） U/L,all P<0.05] in control;serum miR-122,HMGB1 and CCK-18 in 97 patients with simple cholelithiasis were 3.5（0.7,8.5）,（2.2±0.5） ng/mL and （112.4±19.4） U/L,respectively,significantly lower than in 104 patients with complex cholelithiasis [5.8 （0.9,16.2）,（2.8±0.8） ng/mL and （140.2±23.5） U/L,respectively,P<0.05];univariate and multivariate Logistic regression analysis showed that liver cirrhosis,peritoneal effusion,serum miR-122,HMGB1 and CCK-18 were the risk factors related to simple cholelithiasis turned to complex one;our findings also showed that the combination of the three serum parameters increased the diagnostic efficacy of complex cholelithiasis[AUC 0.819（0.758~0.962） vs. AUC miR-122 0.724（0.657~0.815）,AUC HMGB 1 0.701（0.633~0.804） or AUC CCK-18 0.767（0.702~0.873）]. Conclusion The patients with cholelithiasis and high serum mir-122,HMGB1 and CCK-18 levels might be sophisticated in disease severity,and should be taken into consideration and carefully managed.

Nonalcoholic fatty liver disease （NAFLD） is the pathological manifestation of metabolic syndrome in the liver. The morbidity rate of NAFLD in China is increasing,and NAFLD is closely related to the progression and mortality of liver disease and the morbidity of diabetes and cardiovascular disease. Therefore,it is urgent to seek a comprehensive management of patients with NAFLD. In this paper,we reviewed the NAFLD classification,staging,treatment and follow-up evaluation,in order to guide clinical practice.

Hepatocellular carcinoma (HCC) is a malignant tumor with high morbidity and mortality. Screening and monitoring high risk population is very important. Routinely, the liver ultrasonography and serum AFP assay are the main screening methods at present, while the sensitivity and accuracy are not satisfactory. MicroRNAs(miRNAs) are closely related to the pathogenesis, metastasis and recurrence of HCC. Circulating miRNAs are important members of the serological biomarkers of HCC and have a broad prospect in the diagnosis and screening of HCC. The selection of appropriate miRNA and efficient diagnostic methods are the hot focus of related researches.

Nonalcoholic fatty liver disease （NAFLD） includes a spectrum of diseases ranging from nonalcoholic fatty liver （NAFL） to nonalcoholic steatohepatitis （NASH）,cirrhosis and eventually to hepatocellular carcinoma （HCC）. NASH has an increased risk for advanced cirrhosis and HCC,so there has been an urgent need to accurately distinguish between NAFL and NASH and intervene its further development in early time. In recent years,many noninvasive diagnostic methods including serological markers and imaging examination were applied in clinical practice trying to replace liver biopsy. This article reviews the noninvasive diagnosis and evaluation of NASH.