Hepatic fibrosis is a repair reaction of diffuse excessive deposition and abnormal distribution of extracellular matrix (collagen, glycoprotein, proteoglycan, etc.) after various liver injuries. It is a key step in the development of various chronic liver diseases to cirrhosis. In recent years, there have been many advances in the basic and clinical aspects of liver fibrosis and its understanding. For this reason, we have organized domestic experts in this field to form consensus on the diagnosis and evaluation of liver fibrosis, the treatment of liver fibrosis and the clinical development and application of drugs for the treatment of liver fibrosis, so as to better guide the diagnosis and treatment of liver fibrosis and drug research and development.

Objective To induce the steatosis of HepG2 cells by palmitic acid （PA） in vitro to establish a nonalcoholic fatty liver disease （NAFLD cell model,and to observe the effect of salvianolic acid B （Sal B） and autophagy inhibitor of 3-methyladenine（3-MA） intervention on intracellular steatosis. Methods HepG2 cells were divided into control,model （PA intervention）,intervention （PA plus Sal B intervention） and inhibitor （3-MA, PA and Sal B intervention） groups. The best intervention concentrations of PA and Sal B were screened by MTT method,red O staining was used to observe lipid droplets in each group of cells and the fluorescence intensity of autophagy marker,LC3B was detected by fluorescence microscopy. Western blot was used to detect the expression of LC3B protein. Results The TC,TG,ALT and AST levels in supernatant of the model group were（0.57±0.07） mmol/L,（0.99±0.07） mmol/L,（98.47±7.00） IU/L and （88.36±8.54） IU/L,significantly higher than [（0.14±0.02） mmol/L,（0.26±0.03） mmol/L,（23.37±2.24） IU/L and（27.27±3.19） IU/L,respectively,P<0.01],which were also higher than [（0.30±0.04） mmol/L,（0.56±0.06） mmol/L,（53.36±5.33） IU/L and （56.37±7.66） IU/L in intervention group or （0.43±0.02） mmol/L,（0.83±0.10） mmol/L,（86.84±3.37） IU/L and （75.82±3.43） IU/L in the inhibitor group,P<0.05];the absorbance value of oil red O in the model group was （0.666±0.009）,significantly higher than （0.247±0.011） in the control group,or （0.477±0.013） in intervention group or （0.507±0.002） in the inhibitor-intervened group （P<0.001）;the expression of LC3B protein in intervention group was（0.97±0.01）,significantly stronger than 【（0.22±0.02）,P<0.01】 in the model group,while it decreased a little,e.g.（0.44±0.05） in inhibitor-intervened group. Conclusion Sal B might reduce the lipid accumulation in HepG2 cells by increasing intracellular autophagy.

Objective To explore the protective effects of astragaloside in rats with CCL₄-induced liver injuries. Methods 50 SD rats were randomly divided into control,model,low-dose（40 mg·kg^-1）,middle-dose （80 mg·kg^-1） and large-dose（160 mg·kg^-1） of astragaloside-intervened groups. After successful modeling,the astragaloside was administered intragastricly except rats in control and model group. Serum parameters,hydroxyprolin （Hyp） and liver tissue homogenate superoxide dismutase（SOD）,glutathione（GSH） and malondialdehyde （MDA） were detected. The hepatocyte apoptosis was detected by TUNEL. Results Compared with in model group,liver tissue SOD,GSH and MDA and blood ALT,AST,bilirubin levels in low-dose,middle-dose and large-dose of astragaloside groups were significantly improved（P<0.05）,serum Hyp levels were significantly decreased （P<0.05）,and albumin levels were significantly increased （P<0.05）;the apoptotic bodies in liver tissues were（55.36±2.15）,（44.58±3.06） and （33.24±3.18）,respectively in low-dose,in middle-dose and in large-dose of astragaloside-intervened groups, significantly lower than （66.54±2.56） in the control （P<0.05）;liver histopathologic Results showed that the cellular cord disorder,cellular hydropic degeneration and inflammatory cell infiltration in the liver tissues were significantly improved in low-dose,middle-dose and large-dose of astragaloside groups. Conclusion Astragaloside has a good protective effect in rats with CCL₄-induced liver injuries.

Objective To investigate the protective effect of human umbilical cord mesenchymal stem cell （UCMSC） transplantation on alcoholic liver injury in rats. Methods 40 healthy SD rats were randomly divided into control （group A）,model （group B）,UCMSC transplantation （group C） and UCMSC as well as glycyrrhizic acid（group D） intervention. Serum levels of aspartate aminotransferase（AST）,alanine aminotransferase （ALT）,malondialdehyde （MDA）,superoxide dismutase （SOD） and glutathione peroxidase （GPx） were measured and liver tissue cytochrome P450（CYP2B1） mRNA was detected by RT-PCR. Results Serum AST,ALT and MDA levels in the model were （210.6±26.0） U/L,（111.2±13.7） U/L and （1.6±0.1） μmo/L,significantly higher than 【（85.5±12.7） U/L,（30.8±4.5） U/L and（0.6±0.1） μmo/L,respectively,P<0.05】 in the control,while serum levels of SOD and GPx were （141.3±6.9） U/L and （336.5±26.1） U/L,significantly lower than 【（225.7±16.4） U/L and （912.3±29.5） U/L,P<0.05】 in the control;the liver injuries reflected by serum parameter changes improved in rats with UCMSCs transplantation or UCMSCs and glycyrrhizic acid intervention;the CYP2B1 mRNA level in liver tissues in model decreased obviously as compared to that in the control,while they intensified heavily in liver tissues in rats with cell transplantation or in rats with cell and glycyrrhizic acid intervention（P<0.05）. Conclusion Umbilical cord mesenchymal stem cell transplantation might protect alcoholic liver injury in rats to a certain extent,and the combination of glycyrrhizic acid with cell transplantation might improve the protective effect.

Objective The aim of this study was to explore the changes of serum IL-12 （IL-12） and IL-18 levels as well as peripheral blood mononuclear cell（PBMCs） forkhead/winged helix transcription factor （FOXp3） in patients with chronic hepatitis B（CHB）. Methods 78 patients with CHB and 25 healthy persons were recruited in our hospital,and all patients received liver biopsies. Serum IL-12 and IL-18 levels were detected by ELISA,and Foxp3 mRNA from PBMCs were assayed by RT-PCR. Results Out of the 78 patients with CHB,21 cases were found with G1,24 cases in G2,19 cases in G3 and 14 cases in G4 by histopathological examination;serum ALT and AST levels in patients with CHB were（278.3±89.4） U/L and（305.3±84.6） U/L,significantly higher than [（25.3±7.6） U/L and （20.3±6.5） U/L,P<0.05] in healthy control;serum level of ALT and AST in G4 group were （563.5±132.4） U/L and （513.3±102.5） U/L,significantly higher than [（113.2±67.4） U/L and （73.5±25.3） U/L in G1 group] or [（153.6 ±45.3） U/L and （113.8 ±35.2） U/L in G2 group] or [（240.5±56.6） U/L and（156.7±51.2） U/L in G3 group,P<0.05];serum IL-12 and IL-18 as well as PBMC Foxp3 in patients with CHB were （198.3±19.6） pg/ml,（408.6±91.2） pg/ml and（4.5±0.7）,significantly higher than[（64.5±10.9） pg/ml,（127.3±15.7） pg/ml and（3.3±0.4）,P<0.05] in healthy individuals;serum IL-12,IL-18 and Foxp3 mRNA in G4 group were （237.5±23.6） pg/ml,（431.5±106.3） pg/ml and（5.1±0.3）,significantly higher than [（146.3±15.2） pg/ml],（390.2±90.3） pg/ml and （3.3±0.4）] in G1,[（185.2±13.6） pg/ml,（403.6±93.2） pg/ml and （3.9±0.5）] in G2 group,or [（203.2±18.3） pg/ml,（414.3±105.4） pg/ml and （4.3±0.7） P<0.05] in G3 group. Conclusion IL-12 and IL-18 might be involved in the pathogenesis of CHB,and early detection of IL-12,IL-18 and Foxp3 gene could be beneficial to predict the progress of the disease.

Objective To explore the impact of combination telbivudine（LDT） and adefovir dipivoxil （ADV） on renal functions in the treatment of patients with chronic hepatitis B. Methods 178 patients with CHB were recruited in our hospital between April 2014 and July 2016,and our patients with CHB included 59 patients with LDT resistant,59 with ADV resistant,and 60 naive. All patients received LDT and ADV combination therapy,and were followed-up for 48 weeks. The changes of serum creatinine（Cr） levels and estimated glomerular filtration rate（eGFR） were compared among the three groups. Results At the end of 48 weeks,the complete response rate in naive patients was 46.7%,significantly higher thant 28.8% in LDT resistant group or 27.1% in ADV resistant group（P<0.05）;before treatment,serum Cr levels and eGFR in the three groups were not significantly different （P>0.05）,while at the end of 48 weeks,serum Cr level in naive patients was （63.2±12.3）μmol/L,much lower than （71.2±14.3） μmol/L in LDT resistant or （73.2±14.8） μmol/L in ADV resistant group （P<0.05）,and the eGFR was （111.4±16.1） ml·min^-1·1.73m²,significantly higher than （99.7±13.4） ml·min^-1·1.73m² in LDT resistant or（99.3±13.1） ml·min-1·1.73m² in ADV resistant group（P<0.05）. Conclusion Application of LDT and ADV combination is effective in the treatment of patients with chronic hepatitis B with resistant hepatitis B viral mutation infection,and the de novo combination of the two nucleosides might be in clinical trial for decreasing HBV mutation.

Objective The aim of this study was to investigate the implications of serum adipocytokines in patients with chronic hepatitis B（CHB）. Methods 154 patients with CHB and 154 healthy persons were recruited in our hospital between November 2014 and April 2018,and serum visfatin,leptin,adiponectin and omentin levels were detected by ELISA. All patients with CHB received liver biopsies. Results There were no significant differences as respect to serum visfatin,leptin,and adiponectin levels in patients with CHB and in healthy persons（P>0.05）,while serum omentin level in patients with CHB was（361.0±132.4） μg/L,significantly higher than （300.9±110.5） μg/L（P﹤0.05）;there were no significant differences as respect to serum visfatin,leptin,adiponectin and omentin levels in 89 patients with severe and in 65 with mild intrahepatic histological activities（P>0.05）;there were also no significant differences as respect to serum visfatin,leptin,and adiponectin in 96 patients with severe and in 58 with mild liver fibrosis（P>0.05）,while serum omentin level in patients with severe liver fibrosis was （397.8±150.4） μg/L,significantly higher than （316.7±118.5） μg/L（P﹤0.05） in patients with mild liver fibrosis. Conclusion Serum omentin levels in patients with CHB increase greatly,and might be related to the severity of liver fibrosis,which might help predict the intrahepatic liver tissue lesions in clinical practice.

Objective The aim of this study was to explore the prediction of response to peginterferon alfa-2a by blood interferon lambda 4（IFNL4） and interleukin-28B（IL-28B） gene polymorphisms in patients with chronic hepatitis B（CHB）. Methods 140 patients with CHB were enrolled in our hospital between March 2015 and March 2017,and all the patients were given peginterferon alfa-2a for antiviral therapy for 12 months. The blood genetic polymorphisms of IFNL4 and IL-28B were assayed by PCR. Results At the end of discontinuation of the regimen,108 patients （77.1%） responded,and 32 （22.9%） didn’ t responded to the anti-viral therapy;the percentage of IL-28Brsrs8099917 type TT was 88.9%,significantly higher than 68.8% （P<0.05） in non-responders;serum ALT,AST and HBV DNA levels in responders were（35.4±3.2） U/L,（38.6±2.1） U/L and （3.8±2.1） lg copies/ml,significantly lower than （61.5±4.8） U/L,（73.5±3.0） U/L and （5.2±3.1） lg copies/ml （P<0.05） in non-responders;serum ALT,AST and HBV DNA levels in 125 patients with IFNL4 type TT/TT were（47.1±2.5）U/L, （49.1±1.6） U/L and （4.5±1.2） lg copies/ml,not significantly different as compared to （48.0±2.1） U/L,（59.4±1.5）U/L and （4.7±1.3） lg copies/ml in 15 patients with type TT/△G （P>0.05）;serum ALT,AST and HBV DNA levels in 118 patients with IL-28B type TT were（36.4±2.1） U/L,（38.9±2.7） U/L and（4.0±1.7） lg copies/ml,significantly lower than [（59.0±1.4） U/L,（72.1±1.1） U/L and （6.0±2.1） lg copies/ml,respectively,P<0.05] in 22 patients with type TG. Conclusion The majority of CHB patients have genotype TT/TT of IFNL4rs368234815 and genotype TT of IL-28Brs8099917,and the detection of IL-28B gene polymorphism might,and that of IFNL4 polymorphism might not predict the response to anti-viral therapy in patients with CHB,which needs further investigation.

Objective To investigate the diagnostic efficacy of four non-invasive diagnostic models in evaluating significant liver fibrosis in chronic asymptomatic hepatitis B virus carriers（ASC）. Methods 203 chronic ASCs were recruited in ourhospital between July 2015 and November 2017,and FIB-4 scoring systems,liver stiffness measure（LSM） by Fibroscan,aspartate aminotransferase/alanine aminotransferase ratio（AAR） and aspartate aminotransferase/platelet ratio index（APRI） were obtained. The liver biopsies were performed,and≥S2 was defined as significant liver fibrosis. The diagnostic efficacy was evaluated by area under ROC. Results Out of the 203 chronic ASCs,the liver histopathological examination showed that no liver fibrosis in 24（11.8%）,S1 in 143（70.4%）,S2 in 32（15.8%）,S3 in 3（1.48%） and S4 in l（0.5%）,with 36（17.7%） having ≥S2 liver fibrosis;the FIB-4 in 36 ASCs with ≥S2 was （2.2±1.6）,significantly higher than （1.3±0.9） in 167 with less than S2,and the LSM,AAR and APRI scores in ASCs with significant liver fibrosis were all significant higher than in those with less than S2 liver fibrosis [（15.3±5.1） vs. （6.3±4.2）,（0.8±0.4） vs. （0.5±0.1）,and （1.0±0.6） vs. （0.5±0.2）,P<0.01];the AUC in predicting significant liver fibrosis by LSM was 0.967（95%CI 0.945 to 0.990）,with sensitivity （Se） of 94.4% and specificity （Sp） of 86.0%,and that by AAR was 0.8（95%CI 0.821 to 0.966）,with Se of 72.2% and Sp of 99.4%,by APRI was 0.884（95%CI 0.810 to 0.958）,with Se of 72.2% and Sp of 99.8%,and by FIB4 was 0.792（95%CI 0.689 to 0.895）,with Se of 69.4% and Sp of 90.1%. Conclusion The application of the four non-invasive diagnostic model in predicting significant liver fibrosis in ASCs might help clinical managements,which warrants further multi-centre investigation.

Objective To investigate the efficacy and safety of tenofovir in the treatment of pregnant women with high serum HBV DNA loads. Methods The study had selected 83 pregnant women with high serum HBV DNA loads between March 2015 and September 2017，and 56 cases of them received tenofovir for antiviral therapy at the late gestation，and 27 didn’t. All the newborns received immediately hepatitis B immunoglobulin（HBIG） and hepatitis B vaccine after birth，and all the infants were followed-up for 12 months. The HBV infection was defined by serum HBsAg and/or HBV DNA positive. Results Serum HBV DNA load in women receiving tenofovir after delivery was（3.9±0.7） lg IU/ml，significantly lower than [（7.6±0.5） lg IU/ml，P<0.05]，serum HBsAg level was （674.3±301.9） IU/ml，significantly lower than [（1104.1±401.2） IU/ml，P<0.05]，and serum HBeAg level was（2059.8±996.4） s/co，significantly lower than [（3479.4±1287.6） s/co，P<0.05] in those without antiviral therapy；the successful block of mother-to-infant HBV infection in women with antiviral therapy was 100.0%，much higher than 81.5% （P<0.05） in those without；there was no adverse reaction caused by antiviral agent in tenofovir-treated women，and there was no significant difference in the growth and development indexes of newborns at birth between the two groups（P>0.05）. Conclusion The antiviral therapy with tenofovir administration for pregnant women with high serum HBV DNA loadS in late pregnancy has good effect on blocking intrauterine HBV infection with very good clinical safety.

Objective The purpose of this study is to investigate the changes of serum interleukin-17A （IL-17A）,fibroblast growth factor （FGF） and IL-7 levels in patients with hepatitis C virus （HCV） infection and to explore the possible mechanism of clearance of viral infection. Methods 70 patients including 52 with chronic hepatitis C and 18 with spontaneous viral clearance of HCV infection were recruited in our hospital between January 2017 and January 2018. 30 healthy persons were selected at the same time in our hospital for control. Serum aspartate aminotransaminase （AST） and alanine aminotransaminase （ALT） levels were detected by automatic biochemical analyzer. Serum anti-HCV antibodies were detected by automatic electrochemiluminescence immunoanalyzer. Serum IL-17A,FGF and IL-7 levels were detected by ELISA,and serum hepatitis C virus RNA loads were detected quantitative detection kits purchased from the United States. Results In our series of patients with chronic hepatitis C,the infected HCV genotypes were mainly type 1b and type 2a,accounting for 67.3% （35/52） and 25.0% （13/52）,respectively;serum ALT and AST levels in patients with chronic hepatitis C were（61.1±50.5） U/L and（57.0±42.8） U/L,respectively,which were significantly higher than those in individuals with spontaneous HCV clearance [（25.0±14.2） U/L and（25.5±9.4） U/L,respectively,P<0.01];serum levels of IL-17A,FGF and IL-7 in patients with chronic hepatitis C were （0.25±0.13） ng/L,（0.51±0.13） ng/L and （0.49±0.12） ng/L, statistically significantly lower than 【（0.75±0.14） ng/L,（0.93±0.11） ng/L and （0.71±0.10） ng/L,respectively,P<0.01】 in individuals with spontaneous HCV clearance,or 【（1.35±0.12） ng/L,（1.49±0.12） ng/L and（0.99±0.12） ng/L,P<0.01】 in healthy persons and there were a significant differences as respect to the three cytokines between patients with spontaneous HCV clearance and healthy persons （P<0.01）. Conclusion In the individuals with spontaneous HCV clearance,serum IL-17A,FGF,and IL-7 levels significantly increased as compared to those in patients with chronic hepatitis C,hinting those cytokines might be involved in the immune response of human body to terminate the hepatitis C viral infection and the mechanisms needs further investigation.

Objective To investigate the changes of serum interleukin-21 （IL-21） and chemokine levels in patients with autoimmune hepatitis（AIH） and their implications. Methods 21 patients with AIH were recruited in our hospital between march 2015 and march 2017,and out of them, 5 were diagnosed as severe,and 16 were diagnosed as mild to moderate disease. Serum IL-21 as well as chemokine C-C- ligand 20 （CCL20）,chemokine ligand 9 （CXCL9）,chemokine C-C- receptor 6 （CCR6）,chemokine C-X-C- receptor 3 （CXCR3） were detected by enzyme-linked immunosorbent assay. The efficacy of serum IL-21 level in predicting illness exacerbation and intrahepatic activity index in patients with AIH were analyzed by the area under the recipient’s operating characteristic curve（AUC）. Results Serum albumin,alanine aminotransferase,aspartate aminotransferase,international normalized ratio,bilirubin,CCL20,CCR6 and IL-21 levels in five patients with severe AIH were（2.6±0.2） g/dL,（716.8±363.2） U/L,（632.6±334.9） U/L,（1.4±0.7）,（96.1±4.2） μmol/L,（263.2±123.8） pg/mL, （162.4±70.3） pg/mL and（400.2±102.3）pg/mL,significantly different compared to（3.7±0.4）g/dL,（384.5±143.7） U/L,（327.1±98.6） U/L,（1.2±0.3）, （25.8±4.3） μmol/L,（147.5±63.7） pg/mL,（63.8±25.3）pg/mL and （256.3±122.6） pg/mL,respectively in sixteen patients with mild/moderate AIH （all P<0.05）, while peripheral blood platelet count was （110.4±2.8）×10⁹/L,much lower than （170.4±5.3）×10⁹/L in the latter （P<0.05）; univariate analysis showed that the above parameters in seven patients with hepatic G3 to G4 were significantly different compared to those in fourteen patients with hepatic G1 to G2（P<0.05）,while no significant differences were found as respect to peripheral white blood cell counts,serum CXCL9,CXCR3 and IgG levels between the two groups （P>0.05）;the sensitivity （Se） was 80.0%,and the specificity （Sp） was 100.0% when serum IL-21 level greater than 380 pg/mL was set as the cut-off-value for prediction of clinical illness exacerbation, with the AUC of 0.900（95%CI：0.690 to 0.987）;the Se was 100.0%,and the Sp was 70.0% when serum IL-21 level greater than 405.7 pg/mL was set as the cut-off-value for prediction of intrahepatic histological activity index of grade 3,with the AUC of 0.857（95%CI：0.605 to 0.976）;multivariate analysis showed that serum IL-21≥405.7 ng/mL was the independent factor for predicting severe intrahepatic inflammation（OR:5.673,95%CI:2.952 to 9.118,P=0.000）. Conclusion The detection of serum IL-21 level might helpful in determining disease severity in patients with AIH, which needs further investigation.

Objective The purpose of this study was to investigate the correlation of polymorphism of acetaldehyde dehydrogenase 2 （ALDH2） rs671 to morbidity in individuals prone to nonalcoholic fatty liver disease （NAFLD）. Methods Transient elastography and sequencing of ALDH2 rs671 were performed in 120 subjects. The odd ratio and confidence interval were calculated by Logistic analysis. Results Out of the 120 individuals,73 had NAFLD and 47 had not by the controlled attenuation parameter;the proportions of ALDH2 genotype GA/AA were 52.1% in the fatty liver group,and 34.0% in the non-fatty liver group（P<0.05）;out of female and overweight,the proportions of GA/AA type（48.8% vs. 53.3%）in the fatty liver group were both significantly higher than in non-fatty liver group （22.2% vs.23.1%,P<0.05）;Logistic analysis revealed that carriers of GA/AA type was at 3.756 -fold higher risk of NAFLD compared with non-carriers;the carriers of GA/AA type had significantly higher body weight,hip circumference and waist height ratio（P<0.05）,and serum GGT level in carriers of GA/AA type was（55.57±99.97） U/L,significantly higher than that in carriers of GG type【（38.17±48.02） U/L,P<0.05】. Conclusion The mutation of ALDH2 rs671 might increase the risk of having NAFLD,which needs further investigation.

Objective To systematically evaluate the efficacy and safety of tauroursodeoxycholic acid and ursodeoxycholic acid combination in the treatment of patients with nonalcoholic fatty liver disease （NAFLD）. Methods We searched CNKI,VIP,WanFang Data,CBM,PubMed,The Cochrane Library,EMbase database and retrieved randomized controlled trials （RCT） on the observation of tauro ursodesoxycholic acid and ursodeoxycholic acid combination in the treatment of patients with NAFLD since inception of database. Meta analysis was performed by using RevMan 5.3 software. Results A total of 682 NAFLD patients were included in 6 RCT studies,and 342 in the observation group were treated by tauro ursodesoxy cholic acid and polyene phosphatidyl choline,and 340 in the control group were treated by ursodeoxycholic acid and polyene phosphatidyl choline combination. The Results showed that the overall effective rate [RR=1.10,95%CI（1.03,1.18）,P=0.004],serum ALT reduction [MD=13.34,95%CI（12.20,14.48）,P<0.00001],AST reduction [MD=11.29,95%CI（5.85,16.72）,P<0.0001], GGT reduction [MD=22.54,95%CI（20.75,24.33）,P<0.00001],TG reduction[MD=0.48,95%CI（0.25,0.70）,P<0.0001],LDL-C reduction [MD=0.67,95%CI（0.51,0.83）,P<0.00001] and BMI reduction [MD=1.57,95%CI（1.29, 1.84）,P<0.00001] as well s HDL-C elevation [MD=0.23,95%CI（0.18,0.27）,P<0.00001] in the observation group in the treatment of patients with NAFLD were significantly superior to those in the control group; however,there was no significant difference between the two groups as respect to serum TC reduction [MD=0.30,95%CI（-0.03,0.64）,P=0.08] and the incidence of adverse reactions [RR=1.00,95%CI（0.41, 2.47）,P=1.00];the improvement of hepatic steatosis was also not significantly different between the two groups [RR=2.2,95%CI（0.97,4.98）,P=0.06]. Conclusion The efficacy of tauro ursodesoxy cholic acid combined with polyene phosphatidyl choline in the treatment of patients with NAFLD is good based on the domestic studies,which might be at a low level observations.

Objective To investigate the etiology of 202 patients with abnormal liver function tests. Methods 202 patients with abnormal liver function tests were admitted to our Department of Gastroenterology,Zhongshan Hospital between June 2011 and June 2008. The etiologic examination was routinely conducted. Results Out of the 202 patients with abnormal liver function tests,fatty liver disease was found in 62 cases （30.7%）,drug-induced liver injuries （DILI） in 56 cases （27.7%）,autoimmune liver disease （AILD） in 18 cases （8.9%）,hepatotropic virus infection in 18 cases （8.9%）,tumor in 9 cases（4.5%）,liver cirrhosis in 11（5.5%）,bile duct infection in 11（5.5%）,non-hepatotropic virus infection in 1（0.5%）,toxic injuries in 1（0.5%）,malnutrition in 2（1.0%） and liver injury with unknown cause in 13（6.4%）;the percentages of NAFLD,DILI and hepatotropic virus infection in youth accounted for 49.4%,16.9% and 10.8%,the percentages of DILI,NAFLD and AILD in middle aged group accounted for 34.3%,25.4% and 10.5%,and the percentages of DILI,AILD and tumor in elderly group accounted for 36.5%,15.4% and 13.5%;the percentages of NAFLD,DILI and hepatotropic viral infection in men accounted for 43.6%,20.0% nd 15.8%,and those of DILI,NAFLD and AILD in women accounted for 35.6%,17.8% and 14.9%. Conclusion The causes of abnormal liver function tests are complex and diverse,and the common causes of it in different ages and different genders differ,which might help the clinicians to deal with them.

Objective The aim of this stud was to investigate the changes and its clinical significance of serum lipids,liver function index and estrogen levels in patients with intrahepatic cholestasis of pregnancy （ICP）. Methods The clinical data of 120 patients with ICP who were admitted in our hospital between March 2014 and September 2018 were analyzed. According to the severity of ICP,there were 81 patients with mild and 39 patients with severe ICP. Another 50 healthy pregnant women in the same period were selected as the control group. Serum estradiol,estratriol and total bile acid（TBA） levels were detected by RIA. Results Blood triglyceride （TG）,total cholesterol （CHOL） and low density lipoprotein （LDL） levels in patients with severe ICP were （4.9±0.8） mmol/L,（7.9±1.0） mmol/L and （4.1±1.3） mmol/L,significantly higher than （3.3±0.7） mmol/L,（5.7±0.8） mmol/L and （3.2±0.7） mmol/L in patients with mild ICP or [（2.3±0.5） mmol/L,（4.5±0.6） mmol/L and （2.1±0.5） mmol/L,P<0.05] in healthy women （P<0.05）;serum aspartate aminotransferase （AST）,alanine aminotransferase and TBA levels in patients with severe ICP were（93.2±43.5） U/L,（87.7±52.3） U/L and（65.3±37.5） μmol/L,significantly higher than （38.3±7.4） U/L,（41.4±6.5） U/L and（8.9±5.2） μmol/L in healthy individuals or [（43.4±11.6） U/L,（39.3±11.5） U/L and（15.2±6.5） μmol/L,respectively,P<0.05] in patients with mild ICP;serum estradiol and estratriol levels in patients with severe ICP were （83.6±13.5） ng/L and （47.82±20.19） ng/L,significantly higher than （67.2±11.4） ng/L and （39.2±15.4） ng/L in patients with mild ICP or [（43.2±7.5） ng/L and （23.3±12.6） ng/L,P<0.05] in the control;the incidences of preterm delivery,neonatal asphyxia and intrauterine distress in patients with severe ICP were 18.0%,12.8% and 12.8%,much higher than 11.1%,8.6% and 9.9% in patients with mild ICP or 2.0%,0.0% and 2.0% in the control（P<0.05）. Conclusion The blood lipids,liver function tests and estrogen levels in patients with ICP changes greatly,which might help evaluate the severity of ICP and guide clinical managements.

Objective The aim of this study was to investigate the clinical efficacy of ursodeoxycholic acid （UDCA） in treatment of patients with intrahepatic cholestasis of pregnancy （ICP）. Methods 70 patients with ICP were recruited in our hospital between March 2015 and April 2018,and were randomly divided into observation and control group with 35 cases in each. The patients in control group were given conventional treatment,and those in the observation were given UDCA treatment for four weeks. Serum lithocholic acid （LCA）,UDCA,chenodeoxycholic acid （CDCA）,cholic acid （CA）,glycocholic acid （GCA）,taurocholic acid （TLCA） and total cholic acid （TCA） were assayed by high performance liquid chromatography series mass spectrometry. Results At the end of four-week treatment,the pruritis scores in the observation and control group were（1.1±0.3） vs. （2.3±0.8）,respectively （P<0.05）;serum alanine aminotransferase levels were （25.7±10.0） U/L vs. （85.1 ±24.3） U/L （P<0.05）,serum aspartate aminotransferase levels were （22.6±10.3） U/L vs. （84.3±11.3） U/L （P<0.05） and serum bilirubin levels were （21.6±3.8） μmol/L vs. （30.5±5.4） μmol/L （P<0.05）;serum UDCA levels were （3.2±0.1） μmol/L vs. （2.5±0.2） μmol/L,CA were （1.2±0.1） μmol/L vs. （2.4±0.2） μmol/L,GCA were （1.6±0.2） μmol/L vs. （2.8±0.5） μmol/L and TCA were（1.2±0.3） μmol/L vs.（4.2±0.9） μmol/L,all significantly different（P<0.05）;the incidences of premature delivery,postpartum hemorrhage and neonatal asphyxia in the two groups were significantly different（17.1% vs. 51.4%,P<0.05）. Conclusion The application of UDCA in treatment of patients with ICP has efficacious and safe,which might alleviate the clinical symptoms,and improve liver function tests.

Objective The aim of this study was to investigate the clinical significance of peripheral blood Treg and Th17 cells in patients with chronic hepatitis C（CHC） and hepatitis C-induced liver cirrhosis （LC）. Methods 35 patients with CHC-induce LC,31 patients with CHC and 66 healthy subjects were enrolled in our hospital between March 2017 and January 2019. Serum interleukin-6（IL-6）,IL-17 and transforming growth factor-β （TGF-β） were assayed by ELISA,and peripheral blood Treg and Th17 cells were detected by FCM. The area under ROC curve（AUC） was drawn to observe the predictive value of liver cirrhosis by each parameters. Results Serum IL-6,IL-17 and TGF-β levels in patients with LC were （8.08±2.71）ng/L,（17.01±4.55）ng/L and （5.20±1.35） ng/L,significantly higher than [（6.64±2.33） ng/L,（12.76±3.46） ng/L and （4.19±1.07） ng/L,respectively,P<0.05] in healthy individuals or [（7.20±2.49） ng/L,（14.12±3.87） ng/L and （4.41±1.20） ng/L,respectively,P<0.05] in patients with CHC,and high serum TGF-βlevel could predict LC （AUC=0.963,P=0.000）;peripheral blood Treg cell percentage in patients with LC was（6.27±1.02） %,significantly higher than （5.75±0.84） % and （5.37±0.99） %,respectively （P<0.05） in patients with CHC or in healthy persons,while the ratio of Th17/Treg cells was （0.19±0.05）,much lower than （0.23±0.06） and （0.22±0.05）,respectively,in patients with CHC or in healthy persons （P<0.05）;ROC analysis showed that peripheral blood Treg cell percentage （AUC=0.820,P=0.000） or the ratio of Th17/Treg cells （AUC=0.607,P=0.041） could,while the TH17 cell percentage couldn’t predict the existence of LC. Conclusion Serum TGF-β level and peripheral blood Treg cells in patients with hepatitis C-induced LC changes obviously, which might make difference from in patients with chronic hepaitits C and help predict liver disease stage and diagnose LC early.

Objective The purpose of this study to investigate the efficacy of adenosine methionine and glycyrrhizin combination in the treatment of patients with alcoholic cirrhosis and its effect on serum osteocalcin （BGP） levels. Methods A total of 276 patients with alcoholic cirrhosis were recruited in our hospital between March 2016 and February 2018,and were randomly divided into observation group （n=138） and control group （n=138）. The patients in the control group were given adenosine methionine enteric-coated tablets,and the patients in the observation were given an intravenous infusion of compound glycyrrhizin at the base of adenosine methionine administration for three weeks. Serum BGP levels were assayed by radioimmunoassay and serum IGF-1 levels were detected by enzyme-linked immunosorbent assay. Serum f hyaluronic acid （HA）,laminin （LN）,type IV collagen（IV-C） and type III procollagen（PCIII） were detected by chemiluminescence immunoassay. Results Serum albumin level in the observation group was（36.8±10.3） g/L,significantly higher than[（29.4±9.2） g/L,P<0.05] in the control group,serum bilirumin level was（26.4±5.1） μmol/L,significantly lower than [（47.3±9.4） μmol/L,P<0.05] in the control group,and serum GGT level was （158.6±72.8） U/L,significantly lower than[（254.6±100.4） U/L,P<0.05] in the control group;serum HA level in the observation group was （72.6±18.4） μg/L, significantly lower than [（158.4±30.5） μg/L,P<0.05] in the control,serum LN level was（87.4±8.3） μg/L, significantly lower than [（165.3±19.8）μg/L,P<0.05] in the control,serum PCIII level was（94.5±31.3） μg/L,significantly lower than[（147.4±42.5） μg/L,P<0.05] in the control,and serum IV-C level was（64.3±9.5） μg/L,significantly lower than[（98.4±26.4） μg/L,P<0.05] in the control;serum IGF-1 level in the observation group was（198.2±34.6） ng/ml,significantly higher than [（162.5±30.5） ng/ml,P<0.05] in the control,and serum BGP level was （8.8±3.9） ng/ml,significantly higher than [（6.7±3.0） ng/ml,P<0.05] in the control group. Conclusion Application of adenosine methionine and glycyrrhizin is efficacious in the treatment of patients with alcoholic cirrhosis,which can effectively improve liver function tests,and significantly increase serum IGF-1 and BGP levels.

Objective To investigate the changes of insulin resistance（IR）,carotid atherosclerosis and left ventricular function in patients with non-alcoholic fatty liver disease（NAFLD）-induced liver cirrhosis （LC）. Methods The clinical data of 64 patients with NAFLD-induced LC were retrospectively analyzed between June 2016 and June 2018. Out of them,26 were with Child-Pugh class A,21 with class B and 17 were with class C. 30 healthy volunteers were recruited serving as control. The IR-related indicators,such as fasting blood glucose （FPG）,fasting insulin （FINS） and insulin sensitivity index（ISI）],as well as carotid intima-media thickness （IMT） and left ventricular Tei index were obtained. Results In the patients with Child class A,B ad C,the FPG levels were （5.5±1.1） mmol/L,（5.6±1.2） mmol/L and （5.8±1.4） mmol/L,respectively,all significantly higher than [（4.8±0.8） mmol/L,P<0.05] in the control;FINS levels were（8.7±1.7） mIU/L,（10.9±2.2） mIU/L and（15.1±3.1） mIU/L, respectively,all significantly higher than [（6.5±1.3） mIU/L,P<0.05] in the control;ISI were （-4.5±0.4）,（-4.8±0.5） and（-5.1±0.7）,respectively,all significantly lower than[（-4.0±0.3）,P<0.05] in the control;the carotid IMT in patients with Child A,B and C were （0.8±0.1） mm,（1.1±0.2） mm and （1.3±0.3） mm,respectively,all significantly greater than [（0.5±0.1） mm,P<0.05] in the control;carotid PWVES were （8.1±1.3） m/s,（8.5±1.6） m/s and （8.7±1.8）m/s,all significantly higher than [（7.4±1.1） m/s,P<0.05] in the control;left ventricular Tei index were （0.38±0.08）,（0.44±0.09） and（0.52±0.12）,respectively,all significantly higher than [（0.32±0.05）,P<0.05] in the control. Conclusion Patients with NAFLD-induced LC have IR,as well as carotid atherosclerosis and left ventricular dysfunction,which might have a common pathogenesis and needs early intervention.

Objective To analyze the improvement of clinical symptoms and hepatic fibrosis in patients with primary biliary cirrhosis（PBC） by compound Biejiaruangan tablets. Methods A total of 78 patients with PBC were admitted to our hospital between January 2016 and December 2017,and they were divided into the control group （n=37） and observation group（n=41）. Patients in the control group were treated with ursodeoxycholic acid（UDCA） capsules,and patients in the observation group were treated with combination of compound Biejiaruangan tablets and UDCA for 24 weeks. trol group. The scores of PBC-40 scale,liver function tests and serum type III procollagen n-terminal peptide （PC-III）,laminin （LN） and type IV collagen （IV-C） were compared between the two groups. Results At the end of 24-week observation,the fatigue score in the observation group was （18.5±5.5）,the itching score was （4.7±1.3）,and social intercourse score was （14.4±3.9）,all significantly lower than（25.5±7.0）,（5.1±1.5）,and（19.2±4.6）（P<0.05） before treatment,and the scores of fatigue and social intercourse in observation group were significantlylower than （23.2±5.5） and （18.1±4.9） in control group（P<0.05）;serum levels of ALT,AST,GGT and AKP in observation group were（90.2±17.6） U/L,（81.5±14.8） U/L,（187.1±16.3） U/L,（117.5±28.1） IU/L,significantly lower than（133.6±24.6） U/L,（124.9±14.9） U/L,（350.4±18.9） U/L and （484.1±52.3） IU/L before treatment （P<0.05）,or than（101.3±15.3） U/L,（95.3±18.0） U/L,（199.8±15.7） U/L,（152.6±21.3） IU/L,respectively,in control group（P<0.05）;serum PC-III,LN and IV-C levels in observation group were （120.9±20.0） μg/L,（123.4±16.9） μg/L,（92.5±18.5）μg/L,significantly lower than （193.5±30.0） μg/L,（160.4±20.1） μg/L,（180.2±21.3） μg/L before treatment （P<0.05）,or than （131.6±21.5） μg/L,（136.8±15.4） μg/L,（109.4±10.0） μg/L,respectively,in the control group（P<0.05）. Conclusion Compound Biejiaruangan tablets has a good curative effect on patients with PBC,it could alleviate clinical symptoms and improve liver fibrosis.

Objective To investigate the changes of hemodynamics after splenectomy combined with pericardial devascularization in patients with cirrhotic portal hypertention complicated by splenic artery steal syndrome. Methods 84 patients with cirrhotic portal hypertension and splenic arterial blood theft syndrome were admitted to our hospital between February 2015 and February 2017,and 42 received splenectomy combined with pericardial vascular devascularization,while another 42 received conventional supporting therapy. The portal vein flow （PVF）,portal vein diameter（PVD）,portal vein velocity （PVV）,spleen venous flow （SVF）,splenic vein diameter （SVD） and splenic venous velocity （SVV） were obtained by ultrasonography. Results At admission,there were no significantly differences as respect to the portal hemodynamic indexes between the two group （P>0.05）,while two weeks after the treatment,the PVD,PVF,PVV,SVD,SVF and SVV in patients receiving surgery were（1.3±0.3cm） cm,（786.2±85.1） ml,（49.6±6.7） cm/s,（1.3±0.2） cm,（310.1±49.3） ml and（26.5±8.2） cm,improved significantly as compared to（1.6±0.4） cm,（848.1±94.6） ml,（40.1±6.5） cm/s,（1.4±0.3） cm,（377.2±55.2） ml and （19.8±7.2） cm in the control,respectively（P<0.05）;the white blood cell and platelet counts in patients receiving surgery were （7.7±3.2）×10⁹/L and （252.1±69.3）×10⁹/L,much higher than （3.1±1.9）×10⁹/L and （47.2±7.4）×10⁹/L（P<0.05）,respectively,in the patients receiving conventional supporting treatment;The liver function tests in patients receiving surgery improved more efficiently. Conclusion Application of splenectomy combined with pericardial devascularization in dealing with cirrhotic portal hypertention complicated by splenic artery steal syndrome is efficacious,but the long-term effect should be investigated in the future.

Objective To investigate the value of acoustic radiation force imaging（ARFI） in evaluating varices hemorrhage and portal vein thrombosis in patients with esophagogastric varices（EGV） complicating cirrhosis. Methods 87 patients with cirrhosis and EGV were recruited in our hospital between April 2015 and June 2017,and liver parenchyma shear wave velocity（LSWV） and splenic shear wave velocity（SSWV） were measured by AEFI in all the patients. Logistic regression analysis was applied to analyze the risk factors of portal thrombosis in patients with cirrhosis,and the efficacy of LSWV and SSWV in the diagnosis of hemorrhage and portal vein thrombosis was analyzed by AUC. Results At the end of 3 month followed-up,the varices bleeding occurred in 34 patients;the LSWV and SSWV in patients with hemorrhage were （2.6±0.5） m/s and （3.3±0.5） m/s,respectively,significantly higher than [（1.9±0.4） m/s and （2.5±0.3） m/s,P<0.05] in 53 patients without;out of the 87 patients,25（28.7%） had portal vein thrombosis,and univariate and multivariate analysis showed that Child class,portal vein diameter,platelet counts,infection,ascites,hepatic encephalopathy,LSWV,SSWV,EGV classification and varices hemorrhage were the risk factors of portal vein thrombosis occurrence;the diagnostic efficacy of combined detection of LSWV and SSWV for portal venous thrombosis was high with the AUC of 0.893（0.829-0.946）. Conclusion The measurement of LSWV and SSWV by ARFI might be helpful in evaluating the existence of portal thrombosis in patients with liver cirrhosis and EGV.

Objection The purpose of this study was to investigate the efficacy of early administration of enteral nutrition and microecological agents in patients with hepatic encephalopathy（HE）. Methods 64 patients with HE were randomly divided into observation and control group,with 32 cases in each group. The patients in control group were treated with routine therapy combined with early administration of enteral nutrition as patients awoke,while those in the observation group were treated with live bifidobacterium lactobacillus triple tablet at the base of the treatment in control group. All patients were followed-up for two weeks. Results At the end of the two-week observation,three and four patients in the control and in the observation died,respectively;the yeast-like fungi in the observation group was （3.2±0.4） CFU/g,significantly lower than （3.9±0.5） CFU/g in the control group （P<0.05）,while the aerobic enterococcus and lactobacillus anaerobicus in the observation group were （12.3±1.2） CFU/g and（9.7±0.7） CFU/g,significantly higher than （9.3±1.2） CFU/g and （8.2±0.8） CFU/g in the control group （P<0.05）;serum levels of endothelin,blood ammonia,interleukin-18 and tumor necrosis factor-α in the observation were （9.4±1.8） EU/mL,（75.4±10.2） μmol/L,（365.3±102.5） pg/mL and （26.3±10.7） ng/mL,significantly lower than （14.5±2.2） EU/mL,（109.3±15.5） μmol/L,（597.5±155.8） pg/mL and（42.8±11.2） ng/mL,respectively,in the control （P<0.05）;serum levels of albumin,plasma proalbumin,transferrin and retinol-binding protein in the observation group were （35.3±3.5） g/L,（341.1±35.2） mg/L,（2.5±0.4） g/L and （41.3±5.6） μg/L,significantly higher than （31.7±2.9） g/L,（310.1±33.4） mg/L,（2.2±0.4） g/L and（36.8±5.2） μg/L in the control（P<0.05）. Conclusion Early administration of enteral nutrition combined with microecological preparation might effectively improve intestinal flora disorders,inhibit inflammatory stress reaction,facilitate nutrient absorption,and improve liver function in patients with HE.

Objective To explore the clinical diagnostic efficacy of enhanced magnetic resonance imaging combined with serum AFP and protein induced by vitamin K absence or antagonist-II（PIVKA-Ⅱ） in the diagnosis of patients with hepatocellular carcinoma （HCC）. Methods A retrospective study was conducted on 82 patients with chronic liver diseases admitted to the First Hospital affiliated to Suzhou University between December 2015 and September 2017. 56 patients with HCC and 26 patients with chronic liver diseases （including 13 cases of liver cirrhosis and 13 cases of liver cyst） were diagnosed pathologically. All patients received serum AFP and PIVKA Ⅱ detection,as well as Gd-EOB-DTPA enhanced magnetic resonance imaging scans. Gd-EOB-DTPA enhanced magnetic resonance imaging scans were read by 3 radiologists,and the image rendering “fast in and fast out” and “low signal” in liver specific stage was defined as the characteristics of HCC. Serum AFP level was detected by roche cobas^® e type 601 automatic electrochemical luminescence immunoassay system testing,and serum PIVKA Ⅱ level was detected by using LUMIPULSE G1200 automatic immune analyzer and enzyme chemiluminescence method. Chi-square test was applied to detect the diagnosis efficacy among different parameters,and multiple independent samples nonparametric rank test was applied to compare serum AFP and PIVKA-Ⅱ levels. The sensitivity（Se）,specificity （Sp） and accuracy （Ac） were evaluated by the area under the ROC （AUC）. Results Serum AFP and PIVKA-Ⅱ levels in patients with HCC were 34.5（4.5,594.9） ng/ml and 63.5（25.0,2082.0） Mau/ml,significantly higher than 【3.4（2.2,11.6） ng/ml and 23.0 （18.8,28.0） Mau/ml,P<0.01】 in patients with chronic liver diseases;the area under ROC curve of serum AFP,PIVKA-Ⅱ levels and MRI in diagnosing HCC were 0.763,0.815,and 0.907,respectively;the cut-off-value of serum AFP level was 14.4 ng/ml,with Se,Sp and Ac of HCC diagnosis were 64.3%,84.6% and 67.4%,respectively,that of serum PIVKA-Ⅱ level was 40.5 Mau/ml,with Se,Sp and Ac of HCC diagnosis were 62.5%,100.0% and 74.4%,and the Se,Sp and Ac of HCC diagnosis by enhanced magnetic resonance imaging were 92.9%,88.5% and 91.5%;taking any one parameter among the three positive as the diagnostic criteria,the Se,Sp and Ac of HCC diagnosis were 98.2%,61.5% and 86.6%,while taking all three parameters positive as the diagnostic criteria,the Se,Sp and Ac of HCC diagnosis were 50.0%,100.0% and 50.0%. Conclusion The combination of serum AFP and PIVKA-Ⅱ detection and MRI in diagnosis of patients with HCC is efficacious,and the early diagnosis might be hard at present,which should be investigated in the future.

Objective To evaluate the value of long-time delayed contrast-enhanced scan of magnetic resonance imaging （MRI） in the diagnosis of patients with solitary necrotic nodules of the liver （SNNL）. Methods 17 patients with SNNL and 15 patients with malignant liver tumors（including 10 with hepatocellular carcinomas and 5 with hepatic metastases） were admitted to our hospital between May 2013 and May 2018,and all patients underwent conventional CT/MRI enhanced scan and multi-phase long-delayed to 120 minute MRI scanning. The imaging characteristics,such as density and enhancement type of the lesions were compared between the two groups. Result Out of 17 patients with SNNL,17 single foci were found by CT and MRI scan,all localized in right lobe with the diameters of（2.1±0.4） cm;out of 10 patients with HCC,MRI scan demonstrated 11 foci,8 localized in right and 3 in left lobe with the diameters of（5.4±1.6） cm;out of 5 patients with metastases,12 foci were found,9 localized in right,and 3 in left lobe,with the diameters of （3.1±0.9） cm;four SNNL lesions showed “target sign” on T2WI and the imaging manifestation of liver metastases were similar to those of SNNL;at delayed phase （DP）3/5 min,the edge of HCC and liver metastasis foci showed moderate to severe circular enhancement,and the enhancement in SNNL was intensified as the scan time prolonged;at DP 1 hour,17 SNNL foci showed moderate to severe circular enhancement and no enhancement in the centre of each lesion,while all enhancement in tumors disappeared. Conclusion Long-time delayed contrast-enhanced MRI might effectively distinguish SNNL from malignant hepatic tumors,which needs further investigation.

Objective To summarize the ultrasonographic features of hepatic epitheloid hemangioendothelioma （EHE）. Methods The ultrasonographic features of 5 patients with hepatic EHE confirmed by histopathology were analyzed retrospectively. Results Out of the 5 case,3 cases had multifocal,and the other 2 only a single tumor in liver;tumor located under hepatic subcapsule in 3,located adjacent to the edge of liver in 1,and had diffuse distribution of tumor inside the liver in 1;“capsular retraction” sign was found in all the 5 cases;contrast-enhanced uhrasonography in two patients with EHE showed that high and rapid peak of enhancement in the arterial phase,followed by a relative quick wash-out in the portal phase. Conclusion The characteristics of EHE might be often locating in liver subcapsular or marginal areas,single or multiple occupation,and “capsular retraction”. Contrast-enhanced ultrasonography can’t make difference with other malignant hepatic tumors.

Objective To investigate the efficacy of paravertebral block combined with general anesthesia on pain and postoperative recovery in patients after hepatic hemangioma resection. Methods Eighty patients with hepatic hemangioma were enrolled in our hospital between March 2016 and March 2018,and were randomly divided into observation and control group,with 40 cases in each. All patients received hepatic hemangioma resection,and the patients in control received general anesthesia,and those in the observation received vertebral parasitic nerve block and general anesthesia combination. The visual analogue scale （VAS） was obtained,and serum interleukin-1 （IL-1）,IL-6 and tumor necrosis factor （TNF-α） levels were detected by ELISA. Results At 12 h,24 h and 48 h post-operation,the VAS scores in resting and cough in the observation group were （3.7±1.1,3.0±0.7,2.5±0.5） and （4.5±1.7,4.1±1.0,3.1±0.6）,significantly lower than [（4.5±1.5,3.9±1.1,3.4±0.8） and （5.4±1.8,4.5±1.2,4.3±0.9）,respectively,P<0.05] in the control;serum IL-1,IL-6 and TNF-α levels were （10.5±1.7） pg/ml,（29.6±2.3） pg/ml and（32.3±1.4） pg/ml,all significantly lower than [（14.3±1.9） pg/ml,（38.6±4.4） pg/ml and（44.3±1.8） pg/ml,P<0.05] in the control;the times for eating,walking and hospitalization were（2.0±0.4） d,（2.0±1.4） d and （7.4±2.1） d,much shorter than [（3.6±0.8） d,（4.2±0.4） d and （9.0±1.7） d,P<0.05] in the control. Conclusion The combination of paravertebral nerve block combined with general anesthesia in patients underwent hepatic hemangioma resection effectively reduce postoperative pain and improve postoperative recovery,which might be related to the inhibited cytokine reaction.

Objective To investigate the efficacy of pulse pressure variation （PPV）-guided fluid therapy in patients with hepatolithiasis underwent partial hepatectomy（PH）. Methods A total of 260 patients with hepatolithiasis were enrolled in our hospital between March 2008 and March 2017,and all patients underwent laparoscopic partial hepatectomy. During operation,PPV-guided fluid therapy was done in 134 patients. Logistic regression analysis was applied to evaluate the risk factors affecting post-operational complications. Results The intraoperative tidal volume in control was （7.5±1.3） mL/kg,much lower than（8.2±1.4） mL/kg in PPV-guided group （P<0.05）;at the beginning of operation,mean arterial pressure （MAP） and hematocrit in the control were（97.3±15.4） mmHg and （28.6±5.8）%,significantly different compared to（87.4±17.2） mmHg and（34.2±7.4）% in PPV-guided group （P<0.05）;the duration of operation and central venous pressure （CVP） were （414.7±164.8） min and [9.4（5.4,10.2） mmHg,significantly different compared to （321.5±124.7） min and 10.3（6.3,12.8） mmHg in PPV-guided group （P<0.05）;24 hours after operation,the MAP and CVP in PPV-guided group were （81.8±13.5）mmHg and 8.3（6.2,10.1） mmHg,significantly lower than （85.6±14.8） mmHg and 11.4（8.1,14.7） mmHg, respectively, in the control（P<0.05）;the colloid and RBC transfusion in PPV-guided group were （503.5±120.4） mL and0.9（0.6,1.7） units,significantly less than （743.4±243.7） mL and 1.7（0.7,1.9） units in the control （P<0.05）;the post-operational complications occurred in 73 cases,and multivariate analysis showed that the hematocrit and PPV guidance were the independent risk factors affecting the post-operational complication occurrence. Conclusion PPV-guided fluid therapy might improve respiratory function of patients undergoing laparoscopic partial hepatectomy for intrahepatic bile duct stones.

Objective In order to compare the clinical value of segmental pedicle hepatectomy and B-ultrasound-guided hepatectomy in the treatment of patients with hepatolithiasis. Methods 80 patients with hepatolithiasis were recruited in our hospital between December 2014 and December 2017,and were randomly divided into observation and control groups,with 40 cases in each,receiving segmental pedicle hepatectomy and ultrasound-guided hepatectomy,respectively. All patients were followed-up for seven months. Results The amount of hemorrhage in observation group was（350.4±105.7） mL,significantly lower than [（489.6±154.6） mL,P<0.05] and the postoperative volume f drainage was （280.4±78.2） mL,significantly lower than [（365.7±116.4） mL, P<0.05] in the control,while there were no significant differences as compared to the operation time,intraoperative blood transfusion volume,postoperative exhaust time and postoperative hospital stay in the two groups （P>0.05）; two weeks after operation,serum glutamyltransferase level in the observation was（197.6±65.3） IU/L,significantly lower than [（269.9±87.6） IU/L,P<0.05] and serum alkaline phosphatase level was （216.9±77.4） IU/L,much lower than [（312.3±95.6） IU/L,P<0.05] in the control;the incidence of postoperative complications in the observation group was 25.0%,significantly lower than that in the control group （P<0.05）. The incidence of postoperative complications in the observation group was 25.0%,significantly lower than 55.0% in the control group （P<0.05）. Conclusion The application of segmental pedicle hepatectomy for the treatment of hepatolithiasis has the advantages of less bleeding, fewer complications,and rapid recovery.

Objective The aim of this preliminary study was to explore the efficacy of laparoscopic hepatic portoenteral anastomosis （HPEA） in the treatment of neonatal with biliary atresia （BA） and the changes of serum interleukin（IL）-12p40 and IL-13Rα2 levels. Methods 72 infants with BA were recruited in our hospital between March 2014 and June 2018,and laparoscopic HPEA was performed in 42,and open HPEA was undergone in 30 infants. Serum IL-12p40 and IL-13Rα2 levels were detected by ELISA. Results At presentation,the ages,heights and body weights in the two groups were not significantly different（P>0.05）;the operation time in the laparoscopic HPEA was longer than that in the open operation [（187.8±32.6） min vs. （152.4±39.3） min,P<0.05],while the intraoperative blood loss and feeding time were much less or shorter than in the open surgery [（15.3±5.2） mL vs.（33.6±12.6） mL,P<0.05 and （1.3±0.4）d vs.（2.3±0.7） d,respectively,P<0.05], and there was no significant difference as respect to the postoperative anesthesia recovery time between the two groups [（77.5±18.0） min vs.（82.1±20.2）min,P>0.05];before operation,serum IL-12p40 and IL-13Rα2 levels in the open operation were [0.7（0.1,2.0）] ng/mL and [6.3（2.2,17.6）] ng/mL,not significantly different as compared to [0.8（0.2,2.4）] ng/mL and [6.7（2.0,19.3）] ng/mL in laparoscopic operation,and after operation,they were [0.4（0.1,0.9）] ng/mL and [1.1（0.4,3.6）] ng/mL,also not significantly different compared to [0.4（0.2,1.0）] ng/mL and [1.1（0.6,4.0）] ng/mL,respectively,in the laparoscopic HPEA （P>0.05）;at three-month follow-up, 37（51.4%） infants with BA survived,and 5（11.9%） laparoscopic HPEA-treated and 4 open HPEA-treated infants died （P>0.05）. Conclusion Laparoscopic HPEA is an alternative modality for the management of neonatal with biliary atresia.

Objective To summarize the characteristics of cholecystopathy in patients with primary biliary cholangitis（PBC）. Methods A total of 110 patients with PBC were enrolled in this study and their cholecystopathy was retrospectively analyzed. Results Out of 110 patients with PBC,83.6% had gallbladder wall roughness,42.7% had cholecystitis,40.0% had gallbladder wall thickening,22.7% had gallstone,19.1% had gallbladder polyp,and 18.2% had gallbladder wall edema;in 44 PBC patients with and 66 without gallbladder wall thickening,leukocyte counts were [（4.3±1.8）×10⁹/L vs. （5.2±2.3）×10⁹/L,P<0.05],hemoglobin was [（96.4±25.8） g/L vs. （122.1±18.2） g/L,P<0.05],platelet counts were [（122.3±101.7）×10⁹/L vs.（178.2±81.8）×10⁹/L,P<0.05],total serum bilirubin levels was [（71.1±81.1） μmol/L vs. （26.4±34.3） μmol/L,P<0.05],serum albumin level was [（31.2±6.1） g/L vs. （41.2±6.1） g/L,P<0.05],cholinesterase was [（3247.8±2058.9） U/L vs. （6829.3±2698.9） U/L,P<0.05],total cholesterol was [（3.6±1.4） mmol/L vs. （4.8±1.5） mmol/L,P<0.05],and inner diameters of portal vein were [（11.9±1.8） mm vs. （11.3±1.6）mm,P<0.05];the percentage of ascites in PBC patients without gall bladder wall thickening was 16.7%,significantly lower than 68.2% in PBC with gallbladder wall thickening（P<0.05）;the percentage of cholecystitis in the former group was 4.5%,significantly lower than 100.0% in the latter （P<0.05）;there was no patient with gallbladder wall edema in the former,while there was 45.5% with gallbladder wall edema in the latter（P<0.05）;the percentage of gallbladder wall roughness in the former was 100.0%,significantly higher than 59.1% （P<0.05） in the latter;in the former group,19.7% patients were with liver function Child class B or C,much lower than 68.2% in the latter （P<0.05）. Conclusion Cholecystopathy is a common manifestation in patients with PBC and gallbladder wall roughness,cholecystitis and gallbladder wall thickening are the most common types of cholecystopathy.

The portal thrombosis in cirrhotic patients with portal hypertension is a difficult problem in clinical practice. In this review,we made a summary about studies related on its pathological mechanism and treatment of portal vein thrombosis in patients with portal hypertension. At present,the mechanisms are mainly involving the activities of hepatic stellate cells,endothelial cell functions and the imbalance between pro-coagulation and anticoagulation. For the treatment,it consists of anticoagulant therapy,such as low molecular weight heparin,reducing portal vein pressure,like the combination of β-blockers with other medicines,simvastatin,rifaximin and probiotics,for instance,the increase of eNOS phosphorylation,and antioxidant therapy for mitochondria.

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