Objective The purpose of this study was to investigate the correlation of muscle mass loss to intestinal microecology in patients with liver cirrhosis (LC). Methods Fecal specimens were collected from 60 patients with LC and 30 healthy persons in the same period in Shanxi Bethune Hospital from April 2019 through October 2019. All the samples were sequenced by metagenomics. According to the third lumbar skeletal muscle index (L3 SMI), the patients with LC were divided into muscle mass loss group (n=24) and normal muscle group (n=36), and the differences in intestinal microecology between the two groups were analyzed. Results The L3 SMI in patients with muscle mass loss was (30.9±5.1)cm²/m², much lower than 【(52.0±12.9)cm²/m²,P＜0.05】 in patients with normal muscle; the shannon index in the muscle mass loss group was (2.1±0.8), which was significantly lower than【(2.7±0.8), P<0.05】in the normal muscle group; on phylum level, the relative abundance of Proteobacteria in patients with LC was (6.2±7.9)%, which was significantly higher than【(1.7±1.5)%, P<0.05】in the healthy persons, and the relative abundance of Proteobacteria in patients with muscle mass loss was (7.7±9.3)%, significantly higher than【(3.6±4.1)%, P<0.05】in those with normal muscle; on species level, there was a difference of 16 strains between the two groups of patients with LC (P<0.05), and further analysis found that the relative abundance of Lachnospiraceae bacterium and Bacteroides uniforms were positively correlated with SMI(P<0.05). Conclusion Muscle mass loss in patients with cirrhosis is related to intestinal microecological imbalances. The improvement of intestinal microecology in patients with cirrhosis might help the improvement of malnutrition in this setting.

Objective To investigate the relationship between skeletal muscle index of the third lumbar vertebrae (L3-SMI) and clinical indexes in patients with acute on chronic liver failure (ACLF). Methods 126 patients with ACLF were admitted to our hospital From January 2015 to June 2019,and underwent abdominal CT or MRI scan. L3-SMI was calculated and the clinical characteristics of patients with different SMI levels were compared. Results In this study, 113 male patients and 13 female patients were included; the L3-SMI of male patients was (40.3±7.4) cm²/m², significantly higher than that of female patients [(33.9±4.5) cm²/m², P< 0.05]; the L3-SMI of male patients with liver cirrhosis was (38.1 ±5.9)cm²/m², which was significantly lower than that of non-liver cirrhosis patients [(42.0±7.9)cm²/m², P＜0.05]; the L3-SMI of patients with alcoholic liver disease was (34.8±6.8)cm²/m², which was significantly lower than that of patients with non-alcoholic liver disease [(41.5±7.0)cm²/m², P＜0.05]; the L3-SMI in 90-day survival was (40.7±7.7) cm²/m², not significantly different compared to [(38.8±6.3) cm²/m², P > 0.05]in dead patients; according to the median L3-SMI, the male patients were divided into low L3-SMI group (n = 61) and high L3-SMI group (n = 52); the percentages of hepatic encephalopathy in low L3-SMI group and high L3-SMI group were 19.7% and 13.5%, respectively (P > 0.05), the 90-day survival rate in low L3-SMI group was 68.9%, not significantly different compared to 76.9% in high L3-SMI group (P> 0.05), while the BMI of high L3-SMI group was (24.5±3.9) kg/m², significantly higher than that of low L3-SMI group [(20.5±2.9) cm²/m², P < 0.05]; the blood hemoglobin level in patiets with high L3-SMI group was (126.4±23.2) mmol/L, significantly higher than that in low L3-SMI group [(114.7±21.3) mmol/L, P < 0.05]; serum sodium in patients high L3-SMI group was (136.6±4.1)g/L, significantly higher than that in low L3-SMI group[(133.5±4.5)g/L, P <0.05]; serum total bilirubin level in patients with low L3-SMI group and high L3-SMI group were [(437.1±198.3)μmol/L and (317.4±173.0)μmol/L, respectively, P < 0.05]. Conclusion The level of L3-SMI in female patients, low weight patients, patients with liver cirrhosis and patients with alcoholic liver disease is lower. The level of L3-SMI in patients with ACLF is negatively correlated with the severity of the disease and has a certain correlation with the outcome of the patients, but the samples need to be further expanded to verify the correlation.

Objective The aim of this study was to investigate the effects of shikonin, a herbal medicine, on proliferation,apoptosis and phosphatidylinositol 3-kinase (PI3K)/protein kinase (Akt)/nuclear transcription factor-κB (NF-κB) signaling pathway protein expression in HepG2 cells in vitro. Methods HepG2 cells in logarithmic growth phase were treated with different concentration [0(control), 1, 2.5 and 5 μmol/L of shikonin for 48h. The proliferation inhibition rate of HepG2 cells was detected by MTT assay, the apoptosis by flow cytometry and the expression of apoptosis-related proteins (Bax, Bcl-2, Caspase-3), autophagy-related proteins (LC3-I, LC3-II, p62) and PI3K/Akt/NF-κB proteins were detected by Western bloting. Results After intervention for 48 h, the proliferation inhibition rates of cells from low, middle and high dose of shikonin were (23.7±3.5)%, (36.2±6.1)% and (56.9±8.3)%, all significantly higher than [(0.0±0.0)%, P<0.05]in the control, and theapoptosis rates were (19.2±5.3)%, (37.4±7.6)% and (58.6±8.8)%, also significantly higher than [(2.5±1.2)%, P<0.05]in the control; the apoptosis-related protein expression Bax/Bcl-2 ratio and relative expression of Caspase-3 were (1.3±0.2) and (2.7±0.3), (8.2±0.6) and (0.45±0.10), and (0.78±0.16) and (0.95±0.21), all significantly higher than [(0.6±0.1) and (0.18±0.06), respectively, P<0.05]in the control; the autophagy-related protein expression LC3-II/LC3-I ratio were (1.25±0.08), (1.43±0.10) and (1.76±0.22), significantly higher than [(0.96±0.08), P<0.05]in the control, while the relative expression of p62 were (0.81±0.09), (0.62±0.15), (0.43±0.08), significantly lower than that [(1.06±0.05), P<0.05]in the control, and the PI3K, Akt and p65 protein expression were [0.64±0.16), (0.51±0.12) and (0.32±0.06)], [(0.54±0.17), (0.37±0.05) and (0.05±0.01), and [(0.63±0.15), (0.52±0.10) and (0.36±0.09)], all significantly lower than [(0.84±0.13), 0.76±0.15) and (0.89±0.11), respectively, P<0.05]in the control. Conclusion Shikonin promotes apoptosis and autophagy of HepG2 cells in vitro, which might be related to the inhibition of PI3K/Akt/NF-κB signaling pathway protein expression.

Objective The aim of this study was to investigate the effect of Yinchen Siling granule, a herbal medicine, on the improvement of liver injuries in rats with alpha-naphthylisothiocyanate (ANIT)-induced cholestatic hepatitis. Method Thirty SD rats were randomly divided into control, model and herbal medicine-intervened group. The interleukin (IL)-17, interferon-γ (IFN-γ), superoxide dismutase (SOD), and farneside x receptor (FXR) mRNA in liver tissues were assayed. Results Serum ALP and GGT levels in herb-intervened group were (254.3±16.4)U/L and (14.3±5.8)U/L, significantly lower than 【(625.8±36.5)U/ and (26.7±7.9)U/L, respectively, P＜0.05】 in the model; serum IL-17, IFN-γ and malondialdehyde levels were (162.2±16.4)pg/ml, (28.9±6.2)pg/ml and (19.2±3.8)U/ml, significantly lower than [(223.4±18.8)pg/ml,(39.3±9.8)pg/ml and (28.6±2.4)U/ml, respectively, P＜0.05], while serum SOD level was (324.1±33.5)U/ml, much higher than [(250.8±25.4)U/ml,P＜0.05]in the model; the IL-17 and IFN-γ mRNA levels in liver tissues in herb-intervened group were (2.1±0.3) and (17.3±3.5), significantly lower than [(3.4±0.5) and (34.5±7.2), P＜0.05],whileSOD and FXR mRNA levels were (0.8±0.4) and (2.2±0.5), much higher than [(0.3±0.2) and(1.5±1.1), P＜0.05]in the model. Conclusion Yinchen Siling granule could significantly improve liver injuries in rats with cholestatic hepatitis, and the mechanism might be related to its alleviating inflammatory reaction and improve antioxidant capacities by regulating IL-17, IFN-γ and other factor expression.

Objective The aim of this study was to explore the effects of blueberry anthocyanin on hepatic tissue apoptotic protein expression in rats with diethylnitrosamine (DEN)-induced liver cirrhosis (LC). Methods 30 SD rats were selected and randomly divided into control, model and blueberry anthocyanin-intervened group, with 10 rats in each group. The model of LC was established by intraperitoneally injection of DEN at dose of 75 mg.kg^-1 .d^-1 for eight weeks, and the blueberry anthocyanin solution was intragastrically administered at 50 mg.kg^-1 .d^-1. At the end of 8 weeks, the rats were sacrificed, and sera and liver tissues were obtained. The malonaldehyde (MDA) and superoxide dismutase (SOD) in liver and expression ofBcl-2, Bad and c-caspase-3 were detected by Western bloting. Results The model was successfully built up by pathological examination. Serum ALT, AST, tumor necrosis factor-α (TNF-α) and transforming growth factor-β(TGF-β) levels in model group were (579.87±20.37)U/L, (428.58±18.25)U/L, (2.56±0.18)ng/L and (2.12±0.15)ng/L, significantly higher than [(102.47±3.25)U/L,(104.45±3.87)U/L,(0.81±0.05) ng/L and (0.92±0.07)ng/L, respectively, P<0.05], while all of them greatly decreased in blueberry anthocyanin-intervened 【(371.89±14.72)U/L, (148.71±6.34)U/L, (1.73±0.11)ng/L and (1.45±0.12)ng/L, respectively, P<0.05], serum albumin level in model group was (30.69±2.58)g/L, significantly lower than 【(37.68±3.08)g/L, P<0.05】 in control, while it increased to 【(34.71±3.34)g/L, P<0.05]in blueberry anthocyanin-intervened; hepatic homogenate MDA level in model was (0.49±0.11)μmol/L, significantly higher than 【(0.06±0.01)μmol/L, P<0.05】 in control, and hepatic homogenate SOD was (0.34±0.09)U/mg, significantly lower than 【(0.98±0.21)U/mg, P<0.05】 in the control, while homogenate MDA level in blueberry anthocyanin-intervened group decreased to 【(0.17±0.03)μmol/L, P<0.05】and SOD level increased to 【(0.71±0.19)U/mg, P<0.05】; hepatic tissue Bcl-2 expression in model group was (0.48±0.03), while Bad and c-caspase-3 expression were (1.50±0.18) and (1.41±0.17), all of them significantly decreased or increased as compared to 【(1.76±0.18), (0.41±0.02) and (0.28±0.01), respectively, P<0.05】 in the control group, while hepatic tissue Bcl-2 express intensified, and Bad as well as c-caspase-3 expression much weaken in blueberry anthocyanin-intervened group【1.47±0.14), (0.64±0.05) and (0.50±0.05), P<0.05]. Conclusions Blueberry anthocyanin has some liver function protective effect in rats with DEN-induced liver cirrhosis, which might be related to hepatic oxidative stress reduction and modulation of apoptotic proteins.

Objective To study the effect of depletion of intrahepatic macrophages by clodronate liposomes on CCl₄-induced portal hypertension in rats. Methods Forty-eight male Wistar rats were randomly divided into two groups with 24 in each, and the rats in the model group were injected with olive oil and carbon tetrachloride (CCl₄) twice a week, respectively. At d₇₀, the rats in the two groups were further divided into two subgroups. The rats in one subgroup were injected with phosphate buffered solution liposomes (PL), and in the other were dealt with clodronate liposomes (CL) intravenously through tail veins once a week to remove intrahepatic macrophages. At d₁₀₅, the portal pressure in vivo was measured by BL-420F physiological function experiment system, the serum level of sCD163 was assayed by ELISA, and the positive expression of CD163 and inducible nitric oxide synthase (iNOS) in the liver tissues were detected by immunohistochemistry staining. Results In the control groups, serum level of sCD163 was (798.6±61.9) pg/L in CL injected rats, significantly lower than in the PL injected rats[(848.3±26.2) pg/L, P<0.05]; in the model groups, the liver coefficients and portal vein pressure in CL-treated rats were (4.7±0.8) and (10.6±2.0) mmHg, respectively, significantly lower than [(5.6±1.3) and (12.4±2.7) mmHg, P <0.05]in PL-treated rats; serum levels of ALT, AST and sCD163 in CL-treated rats were (69.9±21.4) U/L, (202.8±14.2) U/L and (980.1±122.3) pg/L, respectively, which were significantly lower than[(97.8±39.6) U/L, (290.6±168.1) U/L and (1083.2±97.2) pg/L, P<0.05]in PL-treated rats; the Results of immunohistochemistry showed that the expression of CD163 and iNOS protein in the liver tissues in CL-treated rats were weaker than those in PL-treated rats. Conclusion Hepatic macrophages is involved in the pathogenesis and development of portal hypertension, and needs further investigation.

Objective To investigate the effects of Phyllanthus emblica extract on hepatic LXRα/FAS pathway protein expression in rats with non-alcoholic fatty liver disease (NAFLD). Methods A total of 48 SD rats were randomly divided into control group, model group, polyene phosphatidylcholine group, low-dose, moderate-dose and high-dose Phyllanthus emblica-intervened groups. After the successful establishment of the model, except for in the control group and in the model group, the rats were given intragastric administration of agents for 6 weeks. The histopathological changes of liver were examined, serum TNF-α, IL-17 and IL-10 levels were detected by ELISA, and the percentages of peripheral blood CD4⁺IL-17⁺ and CD4⁺CD25⁺Treg cells were detected by flow cytometry, and the expression of LXRα and FAS in liver tissues were detected by WB. Results Compared with in the model group, the administration of high dose of Phyllanthus emblica extract could improve the pathological changes of liver tissues, serum ALT, AST, TC and TG levels were significantly decreased, serum TNF-α and IL-17 levels were (34.7±0.9) pg/ml and (3.2±0.2) pg/mL, significantly decreased, while serum IL-10 level was significantly increased, e.g. (4.8±0.2 pg/mL,P<0.05); the percentage of CD4⁺IL-17⁺ cells in the high-dose of Phyllanthus emblica intervention was (1.1±0.6)%, significantly lower than [(1.9±0.4)%, P<0.05]in the model group, the percentage of CD4⁺CD25⁺Treg was (1.5±0.6)%, significantly higher than in the model group [(0.9±0.2)%, P<0.05]; the hepatic expression of LXRα and FAS in the small, moderate and high dose ofPhyllanthus emblica extract-intervened groups were significantly decreased [(1.8±0.1) and (2.0±0.2),P<0.05]compared to those in the model. Conclusion The extract of Phyllanthus emblica could improve the histopathological changes of liver tissues of rats with NAFLD, which might be related to the inhibition of inflammatory cytokines and hepatic LXRα/ FAS expression as well as modulation of Th17/Treg cells.

Objective The aim of this study was to investigate the hepatic extracellular volume fractions (fECV) measured by CT scan as a novel noninvasive marker for significant liver fibrosis and cirrhosis in patients with chronic hepatitis B virus infection. Methods A total of 138 patients with chronic hepatitis B (CHB) were recruited in our hospital between January 2015 and January 2020, and all underwent routine multi-stage enhanced liver CT scan and liver biopsies. The fECV were measured. The ROC curve and the area under the curve (AUC) were calculated and the sensitivity, specificity and accuracy were obtained. Results Out of our series of 138 patients with CHB, the histopathological examination showed the F0 in 14, F1 in 28, F2 in 45, F3 in 36 and F4 in 15, e.g. F0-1 in 42, F2-4 in 96 and F3-4 in 51; the absolute enhancement of liver parenchyma in patients with F0-1 was(24.6±8.8)HU, not significantly different compared to (25.2±5.6)HU in F2-4 (P>0.05), while the absolute enhancement value of aorta, fECV and hematokrit were (44.8±9.4)HU, (27.8±4.5)% and (40.8±5.2)%, significantly different compared to 【(40.6±7.2)HU,(37.5±4.8)% and (37.6±6.2)%, respectively, P<0.05】 in F2～4 group; the cut-off-value, the AUC (95% CI) , sensitivity, specificity and accuracy of fECV in diagnosing F2-4, F3-4 and F4 in patients with CHB were 30.2%, 0.71(0.59 to 0.84), 65.5%, 78.0% and 74.5%; 34.0%, 0.76(0.62 to 0.89), 75.8%, 74.2% and 75.0%; and 36.8%, 0.81(0.67 to 0.96), 90.5%, 72.6% and 86.8%. Conclusion The measurement of fECV by multi-phase dynamic CT scan might be applied as an effective noninvasive index for the diagnosis of HF in patients with CHB, which needs further investigation.

Objective The aim of this study was to analyze the efficacy and risks of lamivudine and telbivudine in blocking mother-to-infant intrauterine infection of hepatitis B virus (HBV). Methods 120 pregnant women with chronic hepatitis B viral carrier were enrolled in our hospital between June 2014 and June 2018, and at gestation 28 week, 40 pregnant women received lamivudine, 40 received telbivudine for antiviral therapy, and another 20 did not receive any antiviral agents. The antiviral regimen discontinued immediately after giving birth. All women and their children were followed-up for 12 months. Serum HBV DNA, HBsAg and HBsAb were assayed. Results At presentation, serum HBV DNA loads in the three groups were not significantly different (P>0.05); at delivery, serum HBV DNA loss were 100.0% in both groups receiving anti-viral therapy, hence their serum viral loads were significantly lower than that in the women without antiviral therapy 【(7.6±1.5)lg copies/ml, P<0.05】, and three months after delivery, serum HBV DNA in the two antiviral groups returned back to high levels before enrollment, without significantly differences to that in the control (P<0.05); at delivery, serum HBsAg prevalence in 40 newborns in lamivudine-treated, 40 in telbivudine-treated, and 21 in non-antiviral therapy group were 5.0%, 5.0% and 9.5%(P>0.05), and atone year old, their serumHBsAg prevalence were 7.5%, 5.0% and 14.3%, with serum anti-HBs positive rates of 92.5%, 95.0% and 85.7%, respectively(P>0.05); during antiviral therapy, the incidence of rash, transient serum ALT elevation and creatinene kinase elevation in women with lamivudine treatment were 5.0%, 2.5% and 2.5%, not much different as compared to 2.5%, 7.5% and 5.0%, in telbivudine-treated women (P>0.05). Conclusion Both lamivudine and telbivudine could effectively reduce serum HBV DNA loads in pregnant women with hepatitis B infection, which might help block HBV intrauterine infection from mother to infants, and the medication is relatively safe as no severe untoward effects is found during the antiviral therapy.

Objective The aim of this study was to explore the impact of inosine triphosphatase genotype (ITPA) gene rs1127354 polymorphism on ribavirin (RBV)-related hemolysis in patients with chronic hepatitis C (CHC) receiving pegylated interferon alpha-2a and RBV (PR) therapy. Methods 235 patients with CHC were recruited in our hospital between March 2016 and March 2018, and all patients received PR therapy for 24 to 48 weeks. The blood ITPA gene locus rs1127354 were detected by gene sequencing. Results The gene sequencing showed that ITPA genotype rs1127354 locus were CC in 93 and AA/AC in 42; 188 patients with CHC (152 with CC and 36 with AA/AC) completed the 24-week antiviral regimen, and the rapid virological response (RVR) and early virological response (EVR) in patients with genotype AA/AC were 44.4% and 47.2%, not significantly different as compared to 42.1% and 42.7% in those with genotype CC(P>0.05), while the sustained virological response (SVR) was 72.2%, significantly higher than 53.3%(P<0.05) in patients with genotype CC; at the end of week 4, 8, 12 and 24, blood hemoglobin levels in patients with genotype AA/AC were (138.2±14.7) g/L, (130.5±12.6) g/L, (123.7±12.5)g/L and (118.0±10.2)g/L, significantly higher than 【(132.3±13.9)g/L, (113.1±10.5)g/L, (108.4±9.4)g/L and (106.7±11.3)g/L, respectively, P＜0.05】 in patients with genotype CC. Conclusion The CHC patients with ITPA genotype CC are more prone to RBV-related hemolysis during PR antiviral therapy, which should be taken into consideration in clinical decision-making process.

Objective The aim of this study was to investigate the preliminary efficacy of asunaprevir (ASV) and daclatasvirin (DCV) combination therapy in patients with chronic hepatitis C and hepatitis C liver cirrhosis and the resistance mutations and quasispecies changes. Methods 27 patients with CHC and 13 with hepatitis C-induced liver cirrhosis were recruited in this study, and all patients received ASV and DCV combination therapy for 24 weeks. All the patients were followed-up for 12 weeks. Serum HCV gene regions, including core, E1, E2, NS2, NS3, NS4, NS5A and NS5B were sequenced by using second-generation sequencing and the difference of resistance mutations, HCV quasispecies and Tajima test were analyzed. Results At the end of 12-week follow-up, the sustained virological response was achieved in 38 patients (95.0%), and one patient had Y93H and another one had L31V+Y93H NS5A resistance-associated mutations (RAVs) in the two failed patients; during the period of treatment,7 patients (17.5%) had abnormal laboratory examinations, including serum alanine aminotransferase or uric acide elevation or platelet counts or hemoglobin decrease; in a recurrent patient, L31V+Y93H RAVs was found at baseline and recurrent blood samples, however, the percentage of L31V+Y93H RAVs in recurrent sample was significantly higher than that at baseline; the HCV quasispecies complexity (Sn: 0.91±0.02 vs. 0.40±0.07, t=19.127, P<0.001) and diversity (d:17.70±6.63 vs. 1.65±0.36, t=6.75, P<0.001; dN: 3.55±2.18 vs. 1.37±0.41, t=2.801, P=0.026; dS:48.11±10.06 vs. 2.06±0.90, t=13.598, P<0.001, respectively) in recurrent sample were significantly decreased as compared to those at baseline; in addition, the Result of Tajima test showed that the D<0 in amplified HCV regions from recurrent sample, and the D value was significantly lower in recurrent sample (1.84±1.20 vs.-2.30±0.18,t=10.352, P<0.001). Conclusion Excellent clinical efficacy and safety were observed in our series of patients with CHC or hepatitis C liver cirrhosis with HCV 1b genotype infection, which warrants further and long-term investigation.

Objective The aim of this study was to analyze the auxiliary diagnostic value of serum adenosine deaminase (ADA) and serum amyloid A (SAA) protein in patients with autoimmune hepatitis (AIH). Methods 60 patients with AIH, 98 patients with hepatitis B or C or alcoholic hepatitis (non-AIH group), and 100 healthy persons with normal physical examination Results were recruited between January 2017 and December 2018, and serum SAA and ADA, as well as serum antinuclear antibody (ANA), anti-liver-kidney microsomal antibody (LKM-1), anti-hepatocyte cytoplasmic antibody type I ( LC-1) and anti-soluble liver antigen/hepatic pancreatic antigen (SLA/LP) were detected. Results In AIH patients, serum SAA level was (58.7±6.2)mg/L, significantly higher than 【(12.3±2.5)mg/L, P<0.05】 in non-AIH patients or 【(6.3±1.2)mg/L, P<0.05】 in healthy persons, and serum ADA level was (88.4±10.1)U/L, significantly higher than 【(17.7±3.0)U/L, P<0.05】 in non-AIH patients or 【(10.3±2.1)mg/L, P<0.05】 in healthy persons; the prevalence of serum ANA, anti-LKM-1 and anti-SLA/LP in patients with AIH were 68.3%, 16.7% and 11.7%, while only 42.9%(P<0.05) of patients with non-AIH had serum ANA positive; in our series, the diagnostic sensitivity (Se), specificity (Sp) and accuracy (Ac) ANA were 68.3%, 57.1% and 60.0%, while when serum SAA level greater than 52.1 mg/L of serum or serum ADA level greater than 77.9 U/L was set as the cut-off-value, their auxiliary diagnostic Se, Sp and Ac were 76.7%, 89.8% and 70.4% on condition of exclusion of common etiologic reasons, such as viral hepatitis, fatty liver and drug-induced liver injuries in individuals with serum ALT elevation and serum autoimmune antibody negative. Conclusion As for individuals with serum ALT elevation and serum autoimmune antibody negative, the autoimmune hepatitis should be suspected as serum ADA or/and SAA level increases as common liver injury causes are excluded.

Objective The aim of this study was to explore the diagnostic value of serum anti-fumarate hydratase (anti-FH) in patients with autoimmune hepatitis (AIH). Methods 166 patients with liver disease, including AIH in 52, chronic hepatitis B (CHB) in 81 and drug-induced liver injury (DILI)]in 33, were recruited in our hospital between February 2018 and May 2019. Serum anti-FH and antinuclear antibody were detected by ELISA. Results Serum GGT, ALP and IgG levels in patients with AIH were (304.6±28.1)U/L, (258.1±24.0)U/L and (24.7±1.9)g/L, significantly higher than 【(104.5±12.3)U/L, (85.7±9.2)U/L and (15.2±1.5)g/L, respectively, P<0.05】 in patients with CHB and serum IgG level was also much higher than 【(14.8±1.2)g/L, P<0.05】 in patients with DILI, and serum bilirubin and ALT levels in the three groups were not significantly different (P>0.05); serum anti-FH positive rate in patients with AIH was 36.5%, significantly higher than 6.1% in patients with DILI or 3.7%(P<0.05) in those with CHB; serum ANA positive rate in patients with AIH was 73.1%, significantly higher than 54.5% in DILI patients or 50.6%(P<0.05) in CHB patients; the sensitivity (Se), specificity (Sp), Yorden index, positive predictive value and negative predictive value by serum anti-FH in diagnosing AIH were 36.5%, 95.6%, 0.3, 35.2% and 76.8%, while those by serum anti-FH and ANA combination were 76.9%, 44.7%, 0.2, 38.8% and 80.9%, respectively, meaning the Se increased, while the Sp decreased greatly. Conclusion Serum anti-FH has a high diagnostic specificity for patients with AIH, which under some circumstances might have a good differential effect in clinical practice.

Objective Primary biliary cholangitis (PBC) is a common autoimmune disease all over the world. The aim of this study was to investigate prevalence of serum autoantibodies and clinic features in patients with PBC. Methods A retrospective analysis was performed on 230 patients with PBC. All clinic characteristic and serum autoantibodies including Anti-Sm, RNP, SSA60, SSA52, SSB, CENP-B, dsDNA, antihistone antibodies, AMA-M2, Sp100, gp210 and ANua, were assayed. Other autoimmune diseases, such as Sjogren syndrome (SS), systemic lupus erythematosus (SLE) were recorded. Results Out of the 230 patients with PBC, the prevalence of serum AMA-M2, anti-gp210 and anti-Sp100 were positive in 167(72.6%), 101(43.9%), and 39(17%) patients; serum ANA was positive in 178(77.4%) patients; serum anti-SSA and anti-CENP-B were positive in 37.4% and 20.0% in spite of positive serum autoantibodies above; SS and SLE were found in 54 and 21 patients (23.5% and 9.1%); anti-gp210 and anti-SSA52 had a higher positive rates in 74 patients with decompensated liver functions (63.5% vs. 34.6%,P <0.05 and 44.6% vs. 29.5%, respectively, P <0.05) as compared to those in 156 patients with compensated liver functions. Conclusion Serum AMA-M2, anti-GP210 and anti-Sp100 are still key diagnostic index, and serum anti-SSA52 and anti-CENP-B have relatively high positive rate in patients with PBC. We also found that the patients with positive anti-gp210 and anti-SSA52 might have a severe liver disease.

Objective The aim of this study was to investigate the efficacy and serum cytokine level changes of ursodeoxycholic acid (UDCA) and fenofibrate combination in the treatment of patients with primary biliary cholangitis (PBC). Methods Fourty-eight patients with PBC were recruited in this study between December 2016 and December 2018, and were randomly divided into observation (n=24) and control group (n=24). The patients in control group were treated with UDCA at dose of 15 mg.kg^-1·d^-1, and those in the observation were treated with UDCA at the same dose and fenofibrate combination. The regimen lasted for six months. Serum transforming growth factor-β (TGF-β), interferon-γ(IFN-γ) and interleukin-10 (IL-10) levels were detected by ELISA. Liver stiffness measurement (LSM) was detected by FibroTouch. Results At the end of six-month observation, serum ALT level in combination was (51.4±23.7)U/L, significantly lower than 【(74.9±21.2)U/L, P<0.05】, serum AST level was (59.5±32.3)U/L, much lower than 【(81.3±35.8)U/L, P<0.05】, serum GGT level was (95.7±31.8)U/L, significantly lower than 【(127.3±50.7)U/L, P<0.05】 in the control; serum IFN-γ level was (57.4±21.3) pg/mL, significantly higher than 【(39.7±23.7)pg/mL, P<0.05】, while serum TGF-β level was (14.3±4.8)pg/mL, much lower than 【(23.6±3.5)pg/mL, P<0.05】 in the control; serum immunoglobulin M(IgM) was (2.3±0.4)g/L, significantly lower than 【(3.1±0.9)g/L, P<0.05】, serum IgG level was (11.3±1.8)g/L, significantly lower than 【(15.5±1.3)g/L, P<0.05】 and serum IgA level was (2.7±0.6)g/L, significantly lower than 【(3.5±0.2)g/L, P<0.05】 in the control; the LSM was (10.8±6.5)kPa, not significantly different compared to (9.7±7.7)kPa (P>0.05) in the control. Conclusion The combination of ursodeoxycholic acid and fenofibrate in treatment of patients with PBC significantly improves blood biochemical parameters, which might be related to the increased IFN-γ secretion. The long-term prognosis should be observed in the future.

Objective The aim of this study was to observe the effects of ursodeoxycholic acid (UDCA) and microecological agents on intestinal flora in patients with primary biliary cholangitis (PBC). Methods 128 patients with PBC were admitted to our hospital from June 2017 through June 2019, and were randomly divided into two groups, with 64 cases in each group. The patients in the control group were treated with UDCA, and those in the observation group were treated with UDCA and microecological agent combination for 24 weeks. The fecal flora were detected by PCR, and serum tumor necrosis factor-α(TNF-α), interleukin-2 (IL-2), IL-6, IL-17 and IL-22 as well as serum hyaluronic acid (HA), laminin (LN), collagen type Ⅳ (Ⅳ-C) and procollagen-Ⅲ-peptide (PⅢP) were assayed respectively. Results At the end of the treatment, the fecal colonies of bifidobacteria and bacteroides in the observation group were (8.7±0.9) lg CFU/g and (8.9±0.9 lg CFU/g, respectively, significantly higher than [(8.0±0.6) lg CFU/g and (8.1±0.6) lg CFU/g, respectively, P<0.05], while the colonies of yeast-like fungi and escherichia coli were (4.3±0.7) lg CFU/g and (8.7±0.6) lg CFU/g, significantly lower than [(5.1±0.7) lg CFU/g and (9.2±0.7) lg CFU/g, respectively, P<0.05]in the control; serum TNF-α, IL-2, IL-6, IL-17 and IL-22 in the observation group were (5.9±1.6) pg/ml, (65.5±12.6) pg/ml, (5.6±1.1) pg/ml, (7.6±2.3) pg/ml and (17.5±2.7) pg/ml, significantly lower than [(7.0±2.1) pg/ml, (85.7±20.1) pg/ml, (6.7±1.5) pg/ml, (9.2±3.2) pg/ml and (23.3±4.4) pg/ml, P<0.05]in the control group; serum HA, Ⅳ - C and P Ⅲ P were (113.2±24.1) μg/L, (145.5±19.8) μg/L and (134.6±21.5), significantly lower than [(168.4±47.2) μg/L, (178.4 ±51.7) μg/L and (170.5±48.2) μg/L, respectively, P<0.05]in the control. Conclusion Ursodeoxycholic acid and microecological agents combination regimen might effectively correct intestinal flora imbalance, regulate serum cytokines and alleviate the degree of liver fibrosis in patients with PBC.

Objective The aim of this study was to investigate the s short-term efficacy of polyene phosphatidylcholine combined with metformin and fenofibrate in patients with nonalcoholic fatty liver disease (NAFLD). Methods 64 patients with NAFLD were recruited in our hospital between March 2015 and June 2019, and were randomly divided into control (n=32) and observation group (n=32). The patients in the control group were treated orally with metformin and fenofibrate capsules, while those in the observation group were additionally treated with polyene phosphatidylcholine capsules at the base of medicine mentioned above. The observation lasted for 12 weeks. Serum hyaluronic acid (HA), laminin (LN), high mobility group protein (HMGB1) and interleukin -17 (IL-17) were detected.Results At the end of 12 week observation, blood triglyceride (TG) level was (1.8±0.1)mmol/L, significantly lower than 【(2.7±0.4)mmol/L, P＜0.05】, total cholesterol (TC) level was (4.6±0.4)mmol/L, significantly lower than 【(5.8±0.6)mmol/L, P＜0.05】, while blood high density lipoprotein cholesterol (HDL-C) level was(1.9±0.5)mmol/L, significantly higher than 【(1.5±0.4)mmol/L, P＜0.05】 in the control; serum ALT level was (28.4±3.2)U/L, much lower than 【(35.9±4.1)U/L, P＜0.05】, AST level was (22.1±2.0)U/L, much lower than 【(32.6±3.4)U/L, P＜0.05】, serum HMGB1 level was (13.7±1.5)μg/L, significantly lower than 【(20.2±2.4)μg/L, P＜0.05】, and serum IL-17 level was (75.6±7.8)pg/mL, significantly lower than 【(90.7±10.2)pg/mL, P＜0.05】 in the control group; serum HA level was (84.5±9.2)mg/L, significantly lower than 【(117.6±10.3)mg/L, P＜0.05】, LN level was (91.2±10.2)μg/L, significantly lower than 【(108.7±11.3)μg/L, P＜0.05】, and serum Pygo2 level was (37.5±4.1)μg/L, much lower than 【(42.4±5.0)μg/L, P＜0.05】 in the control. Conclusion The administration of polyene phosphatidylcholine combined with metformin and fenofibrate tablets might obviously improve blood lipid metabolism and inhibit inflammatory reactions in patients with NAFLD, which needs long-term investigation.

Objective The aim of this study was to investigate the potential role ofatorvastatin in treating patients with nonalcoholic fatty liver disease (NAFLD).Methods 148 patients with NAFLD were admitted to our hospital between June 2016 and June 2019, and were randomly divided into control (n=74) and observation group (n=74), receiving conventional therapy and atorvastatin treatment at base of conventional therapy,respectively, for 24 weeks. Serum interleukin-10(IL-10), IL-17 and IL-18 were detected by ELISA, and flow cytometry was used to detect the percentages of peripheral blood Treg and Th17 cells.Results At the end of 24 week treatment, blood levels of TC, TG, ALT and AST in the observation group were (2.0±0.6) mmol/L, (1.2±0.4) mol/L, (43.8±8.2) U/L and (25.2±7.4) U/L, significantly lower than [(2.6±0.6) mmol/L, (1.5±0.3) mmol/L, (49.9±8.4) U/L and (29.2±8.1) U/L, respectively, P<0.05]in the control; serum level of IL-10 was (31.7±4.4) ng/L, significantly higher than [(26.3±4.2) ng/L, P<0.05], while serum levels of IL-17 and IL-18 were (89.5±31.0) pg/ml and (41.8±9.1) pg/ml, both significantly lower than [104.2±29.5) pg/ml and (52.3±9.2) pg/ml, respectively, P<0.05]in the control; the percentages of peripheral blood Treg cells and the ratio of Treg / Th17 cells were (1.2±0.2)% and (1.1±0.4), significantly lower than [(1.3±0.2)% and (1.3±0.5), respectively, P<0.05], while that of Th17 cells was (1.1±0.2)%, significantly higher than [(1.0±0.2)% , P<0.05]in the control; the total improved rate ofhepatic steatosis was 94.6%, significantly higher than 73.0% in the control group (P<0.05). Conclusion The administration of atorvastatin might have a potential role inameliorating liver steatosis in patients with NAFLD,tentatively related to the alleviation of systemic inflammatory reactions and the regulation of Treg / Th17 cellimbalance.

Objective The aim of this study was to analyze the changes of serum lipase (LP), lipid peroxide (LPO), nitric oxide synthase (NOS) and intestinal flora distribution in patients with alcoholic liver disease (ALD). Methods 88 patients with ALD 【including alcoholic fatty liver (AFL) in 36, alcoholic hepatitis (AH) in 27 and alcoholic liver cirrhosis (ALC) in 25 】 and 40 healthy persons were recruited in our hospital between January 2017 and June 2019, were serum LP, LPO and NOS levels were detected. The intestinal bacteria species and the numbers of major intestinal bacteria were separated and characterized. Results Serum LP level in patients with ALC was (6.2±1.9) μ g/L, significantly higher than [(3.6±1.1) μ g/L, P<0.05]in patients with AH, or [(1.6±0.4) μ g/L, P<0.05]in patients with AFL, or [(1.1±0.2) μ g/L, P<0.05]in healthy control group; serum LPO level in ALC group was (7.2±2.1) μ mol/l, much higher than [(4.7±1.6) μ mol/l, P<0.05]in AH group, or [(3.3±1.0) μ mol/l, P<0.05]in AFL group, or [(2.1±0.5) μ mol/l,P<0.05]in healthy control; serum NOS level in ALC group was (7.8 ±2.6) U/ml, significantly higher than [(4.9±1.7) U/ml, P<0.05]in AH group, or [(3.5±1.2) U/ml, P<0.05]in AFL group, or [(1.3±0.4) U/ml, P<0.05]in healthy control; the fecal bacteria strains in ALC group was (20.7±1.1), much lower than [(30.9 ±1.8), P<0.05]in AFL group, or [(31.7±2.5), P<0.05]in healthy control, while the bacteria strains in AH group was (21.4±1.2), significantly lower than in AFL or in healthy control group (P<0.05); the number of Escherichia coli in ALC group was (9.2±1.8) IgCFU/g, significantly higher than [(8.3±1.4) IgCFU/g, P<0.05]in AH group, or [(6.8±1.5) IgCFU/g, P<0.05]in AFL group, or [(7.1±1 1.3) IgCFU/g, P<0.05]in healthy control group; the number of Enterococcus faecalis in ALC group was (9.5 2.3) IgCFU/g, significantly higher than [(7.1±1.3) IgCFU/g, P<0.05]in patients with AFL, or [(6.5±1.5) IgCFU/g, P<0.05]in healthy control group, or[ (8.6±1.5) IgCFU/g, P<0.05]in AH group; the number of Bifidobalcterium in ALC group was (6.3 0.7) IgCFU/g, much lower than [(7.2±1.1) IgCFU/g, P<0.05]in AH group, or [(7.9±1.4) IgCFU/g, P<0.05]in patients with AFL, or [(8.5±1.4) IgCFU/g, P<0.05]in healthy control. Conclusion Patients with ALD have increased serum LP, LPO and NOS levels and intestinal microecology disorders. As the disease progresses or turns to be AH or ALC, the changes become obvious.

Objective The purpose of this study was to investigate the clinical feature of 290 patients with drug-induced liver injury (DILI). Methods 300 hospitalized patients were admitted in our Department of Infectious Diseases from January 2013 through February 2016, and 290 were diagnosed as DILI by the Roussel Uclaf causality assessment (RUCAM) scale. Results The common agents were traditional Chinese medicine, accounting for 42.8%, antibiotics for 9.3% and anti-tuberculosis medicines for 7.6%; the elevated serum alanine aminotransferase levels was the most obvious manifestation; the underlying diseases were chronic gastritis in 18.6%, the hepatocellular injury type accounted for 54.5% and the moderate DILI accounted for 37.6%; 16 patients 5.5% progressed to liver failure and four died; the total treatment effective rate was 93.8%. Conclusion The RUCAM scale is helpful for the standardization of DILI diagnosis. The traditional Chinese medicines account for the highest proportion of liver injuries in our series, and the hepatocellular damage is the most common type. Most DILI patients have a good clinical prognosis. Attentions should be paid to patients with acute liver failure, which is associated with poor prognosis.

Objective The aim of this study was to investigate the efficacy of human umbilical cord-derived mesenchymal stem cell (UC-MSCs)transplantation at base of double plasma molecular absorption system (DPMAS) in the treamtment of patients with acute-on-chronic liver failure(ACLF). Methods 45 patients with ACLF were recruited in this study from January 2016 through May 2019, and 20 patients were treated with DPMAS for the control and 25 received UC-MSC transplantation at base of DPMAS. All patients were followed-up for eight weeks. Serum interleukin 6 (IL-6), IL-10 and tumor necrosis factor -α(TNF-α) were detected by ELISA, and peripheral blood lymphocyte subsets were tested by FCM. Results At the end of 8 week of treatment, serum bilirubin level in the cell transplanted group was (43.3±14.5)μmol/L and the model for end-stage liver disease score was (16.8±4.1), both significantly lower than 【(56.6±10.5)μmol/L and (20.6±4.8), respectively, P＜0.05】, while serum albumin level was (32.1±6.8)g/L, the PTA was (57.9±5.3)%, both significantly higher than 【(27.2±7.3)g/L and (53.8±5.5)%, P＜0.05】 in the control; the percentage of peripheral blood CD3⁺CD8⁺T cells was (13.1±2.5)%, much lower than 【(17.1±3.3)%, P＜0.05】, while that of CD3⁺T cells was (63.1±3.1)%, significantly higher than 【(59.7±4.2)%, P＜0.05】, and of CD3⁺CD4⁺T cells was (39.1±4.3)%, significantly higher than 【(34.9±4.1)%, P＜0.05】 in the control; serum TNF-α level was (7.1±4.3)ng/L, significantly lower than 【(11.2±5.2)ng/L, P＜0.05】 and serum IL-6 was (8.4±2.7)ng/L, much lower than 【13.2±3.2)ng/L, P＜0.05】 in the control; the survival rate in the control was 60.0%, much lower than 88.0% (P＜0.05) in cell transplanted group. Conclusion UC-MSC transplantation at base of DPMAS in the treatment of patients with ACLF has a good short-term efficacy, and its long-term impact on outcomes should be followed-up.

Objective The aim of this study was to investigate the pathogenic distribution and serum hight mobility group protein-B1 and soluble myeloid cell trigger receptor -1(sTREM-1) changes in patients with hepatitis B liver failure. Methods 179 patients with chronic hepatitis B liver failure were admitted to the Department of Infectious Diseases of our hospital between January 2017 and June 2019, and the pathogenic bacteria were separated and characterized routinely, and serum levels of HMGB1 and sICAM-1 were assayed by enzyme-linked immunosorbent assay. Results During the treatment, the infection occurred in 115 patients (64.2%) and it didn’t occurred in 64 patients, and the single site infection was 67.8%, double site infection was 27.0%,and three site infection was 5.2% with abdominal infection more common (44.9%), followed by respiratory infection (23.4%), biliary tract infection (18.4%), and sepsis (2.5%); a total of 205 pathogenic bacteria were isolated from the 115 infected patients, including 119 Gram-negative bacteria (58.0%), mainly Escherichia coli (41.5%), 55 Gram-positive bacteria (26.8%), mainly Staphylococcus aureus (12.7%), and 31 fungi (15.1%), mainly Candida albicans (8.8%); 59.1% of patients with infection had three or more complications was, significantly higher than 39.1% in the uninfected group (P<0.05), the percentage of hepatic encephalopathy was 37.4% in patients with infection, significantly higher than that in the uninfected group (18.8%, P<0.05), the percentage of hyponatremia was 59.1%, significantly higher than that in the uninfected group (26.6%, P<0.05), and the percentage of gastrointestinal hemorrhage was 13.9%, much higher than that in uninfected group (3.1%, P<0.05); serum level of creatinine was (93.7±31.7) μmol/L, significantly higher than that in the uninfected group [(81.0±26.6) μ mol/L, P<0.05], serum HMGB1 level was (13.1±2.6) ng/ml, much higher than that in the uninfected group [(10.2±2 2.0) ng/ml, P<0.05], and the MELD score was (28.2±5.0), significantly higher than that in patients without infection [(20.3±3.8), P<0.05], while serum sICAM-1 level was (804.3±134.7)ng/ml, much lower than [(1152.7±263.5)ng/ml, P<0.05]in the uninfected group. Conclusion The infection rate in patients with hepatitis B liver failure is high, the abdominal infection is more common, and the pathogenic bacterias are mainly Gram-negative bacteria. Serum HMGB1 level in patients with liver failure increase and serum sICAM-1 decrease, and these features might help clinicians to deal with appropriately in time.

Objective The efficacy of platelet transfusions in increasing platelet counts is variable and may be associated with side effects. The aim of this study was to investigate whether the administration of recombinant human thrombopoietin (rhTPO) could reduce preoperative blood transfusion in patients with liver cirrhosis and hepatocellular carcinoma (HCC) and thrombocytopenia. Methods 40 patients with liver cirrhosis and thrombocytopenia and 36 patients with HCC and thrombocytopenia were recruited in XiJing Hospital From January 2017 through April 2019, and they underwent operations such as esophageal variceal ligation or endoscopic gastric varices tissue adhesive injection for gastroesophageal varices or transcatheter arterial chemoembolization or microwave ablation for cancers. Before operation, the rhTPO was administered once daily for 12 days. Results Of the 76 patients, 23 patients had peripheral platelet count at 40-50×10⁹/L, and 53 patients had it at < 40×10⁹/L; the blood platelet counts in the two groups increased significantly on the 8th day of treatment [>50×10⁹/L, (76.0±26.6)×10⁹ / L and (54.4±24.3)×10⁹ / L, respectively], peaked on the 12th day [(95±34.8)×10⁹ / L and (67.9±25.1)×10⁹ / L, respectively],and dropped to the baseline levels at 30^th days [42.3±5.3)×10⁹ / L and (23.5±4.6)×10⁹ / L, respectively]; the administration of rhTPO had no side effects on blood coagulation parameters and no portal vein thrombosis was found in the two groups. Conclusion The application of rhTPO could be as an alternative therapy for preoperative platelet transfusion in patients with thrombocytopenia and liver diseases, with the ability to reduce risk of intraoperative bleeding, which needs further study.

Objective To analyze the clinical effect of terlipressin combined with ascites concentration and reinfusion on refractory ascites patients with cirrhosis. Methods 54 cirrhotic patients with obstinate ascites were divided into observation group (n = 27) and control group (n = 27) from May 2017 to October 2019. The control group was treated with ascites concentration and reinfusion, and the observation group was treated with terlipressin on the basis of the control group. Results At the end of 14 day observation, the abdominal circumferences of patients in observation and control groups were (86.3±4.3) cm and (89.8±6.4) cm, the depth of ascites were (31.5±8.4) mm and (53.3±9.4) mm, serum bilirubin levels were (60.8±9.8) μmol/L and (71.5±8.7) μmol / L, serum albumin levels were (33.3±3.0) g / L and (30.0±3.1) g / L, serum BUN were (6.8±1.8) μmol / L and (9.8±2.8) μmol / L, sCr were (104.5±14.4) μmol / L and (133.8±15.3) μmol / L, significantly different between the two groups (P<0.05), and the 24 h urine volume were (1088.3±285.9)mL and (1385.9±337.9) mL, the hospital stays were (28.8±3.7) d and (38.5±8.3) d, and the ascites concentration and reinfusion were (4.3±1.4) times and (10.7±3.2) times, respectively, significantly different between the two groups (P<0.05). Conclusion The application of terlipressin combined with ascites concentration and reinfusion could reduce the amount of ascites, improve the functions of liver and kidney, shorten the length of hospital stay, and needs further investigation.

Objective The aim of this study was to explore the value of liver stiffness measurement (LSM) , aspartate aminotransferase- to- platelet ratio index (APRI), fibrosis index based on the 4 factors (FIB- 4) and gamma-glutamyl transpeptidase to platelet ratio (GPR) in predicting the degree of esophageal varices (EV) in patients with liver cirrhosis (LC). Methods 142 patients with LC underwent electronic gastroscopy, LSM was detected by FibroScan, and ARPI, FIB-4 and GPR scores were calculated. The receiver operating characteristic curve (ROC) and the area under ROC (AUROC) were obtained to determine the diagnostic efficacy. Results Out of the 142 patients with LC, the gastroscopy showed EV in 93 patients (G1 in 28,G2 in 30,G3 in 35) and non-EV in 49; the LSM, APRI, FIB-4 and GPR in patients with EV were (25.8±1.6)kPa, (1.5±0.1), (5.3±0.3) and (0.9±0.1), all significantly greater than 【(15.2±1.5)kPa, (0.7±0.1), (2.9±0.3) and (0.4±0.1), respectively, P<0.05】 in patients without EV; the LSM, APRI, FIB-4 and GPR in patients with severe EV were greater than those in patients without or with mild EV; the cut-off-value of LSM, APRI, FIB-4 and GPR in predicting EV≥G2 were 19.20 kPa, 1.9, 4.9 and 0.5, respectively, and their diagnostic sensitivities and specificities were 68.7% and 96.7%, 60.0% and 89.80%, 61.50% and 91.80%, and 60.0% and 85.70%, respectively. Conclusion The application of non-invasive approaches , such as FibroScan and serum index of APRI, FIB-4 and GPR might help clinicians to predict the existence of EV in patients with LC, which warrants further investigation.

Objective The aim of this study was to investigate the impact of injected contrast velocities on portal vein imaging ofmultislice spiral computed tomography portography (MSCTP) in patients with liver cirrhosis (LC). Methods 168 patients with LC were admitted to our hospital between January 2017 and December 2019, and all of them were examined by MSCTP. When the contrast were injected, the patients were divided into three groups, with 56 in each, and in group A, the contrast was injected intravenously at velocityof 2 ml / s, in group B at 3 ml / s and in group C at 4 ml / s. Results The MSCTP was successfully performed in all patients, and the post-processing imaging showed that the smaller than grade 3 portal vain (PV) branches were clearly demonstrated, themain trunk, left and right branches of PV were significantly widened, the collateral circulation around the fundus of stomach was open, and the liver and spleen showed cirrhotic changes; the CT value of PV and thedifference of CT value of PV minus CT value of hepatic parenchyma in group A were (160.8±20.2) HU and (58.3±16.5) HU, significantly smaller than [(184.9±26.9) HU and (75.3±15.9) HU, respectively, P<0.05]in group C; the displayed PV branch in group A was 4.6±1.3, significantly lower than (5.7±0.9, P<0.05) in group C; the CT value of liver parenchyma in group A was not statistically significantly different compared with that in group C (P>0.05), while the PV delayed imaging time in group A was (44.5±1.2) s, significantly longer than that in group B [(42.2±0.8) s, P<0.05]and in group C [(34.5±0.7) s, P<0.05]; the PV delayed imaging time in group B was significantly longer than that in group C (P<0.05). Conclusion The injection velocity of contrast agent has a significant effect on MSCTP imaging quality and PV imaging delayed time in patients with liver cirrhosis. When the flow rate is 4 ml / s, theMSCTP image quality is the best and PV delayed imaging time is the shortest.

Objective The aim of this study was to investigate the clinical value of quantitative MRI and serological indexes in the diagnosis of portal hypertension (PH) in patients with primary biliary cirrhosis (PBC). Methods Forty-five patients with PBC were admitted to our hospital from January 2010 through December 2018. The aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4) were obtained. All patients with PBC underwent MRI examination. The receiver-operating characteristic curve (ROC curve) was drawn to analyze the diagnostic value of quantitative MRI index, APRI and FIB-4 for portal hypertension diagnosis. Results 14 (31.1%) patients with PBC in our series had PH; in the 14 patients with PH, the APRI score was 2.21(1.82,2.74), FIB-4 score was 1.65(1.02,1.94), liver stiffness was 4.87(4.15, 5.46)kPa, spleen stiffness was 9.75(7.54, 11.77)kPa, T1 of liver was 1024.8(975.4, 1078.5)ms, T2 of liver was 62.7(57.4, 68.4)ms, and ADC was 1.29(1.11, 1.62)×10^-3mm²/s, significantly higher than 0.68(0.21, 0.94), 0.24(0.18, 0.42), 2.51(2.11, 2.98)kPa, 5.23(4.62, 6.08)kPa, 930.8(870.9, 980.4)ms, 56.8(55.3, 58.7)ms and 1.08(1.02, 1.25)×10^-3mm²/s in 31 patients without PH (P<0.05); the sensitivity by APRI, FIB-4, liver and spleen stiffness by MR determination in diagnosing PH were 90.4%, 82.3%, 92.4% and 90.3%, and the specificity were 79.6%, 91.2%, 92.0% and 93.2%, respectively. Conclusion The serological indexes and liver and spleen stiffness determined by MRI might help judge the existence of portal hypertension in patients with PBC, which needs further investigation.

Objective The aim of this study was to investigate the application of ultrasound single mode fusion imaging (USMFI) in the immediate evaluation of microwave ablation (MWA) in treatment of patients with primary liver cancer (PLC). Methods The clinical data of 88 patients with PLC were recruited in our hospital from March 2018 through December 2019, and all underwent MWA treatment. During MWA procedures, the USMFI guidance was performed in 44 patients, and CT/MRI multimodal fusion imaging was performed in other 44 patients.Results The registration time in US-guided group was (3.8±1.3) minutes, statistically significantly shorter than (5.2±1.7) minutes in CT/MIR-guided group (P<0.05), and the success rates of fusion imaging were 63.6% vs. 56.8%, not significantly different(P>0.05); 52 foci out of 44 patients in US-guided group were found and the successful fusion imaging was obtained in 36 foci(69.2%), and 54 out 44 patients in CT/MRI-guided group were found and the successful fusion was got in 32 foci (59.3%,P>0.05); the complete ablation rates were 97.7% and 93.2% in the two groups(P>0.05) and the incidences of compliattions such as fever, local pain, bile duct bleeding and bile leakage were 9.1%, 20.5%, 4.5% and 0.0% vs. 13.6%, 27.3%, 9.1% and 2.3%, respectively(P>0.05) in the two groups; at the end of 3 to 20 month followed-up, 32 (72.7%) patients in US-guided group survived with total survival (OS) of 15.1(5.0, 20.0) months and with progress free survival (PFS) of 12.8(4.9, 20.0)months, and 32 (72.7%) patients in CT/MRI-guided group survived with OS of 14.2(4.8, 20.0) months, and PFS of 13.3(4.7, 20.2) months (Log rank x²=0.592, P=0.442; x²=1.103, P=0.294). Conclusion Both the single-mode ultrasound fusion imaging and CT/MRI multi-mode fusion imaging could be applied to guide the MWA in the treatment of patients with PLC, but the former is relatively simple and cheap, and should be chosen first.

Objective The aim of this study was to analyze the expression of hydrogen peroxide inducible clone-5 (Hic-5) and collagen type I alpha gene (COL1A1) in cancerous tissues and their predictive value for postoperative survival time of patients with hepatocellular carcinoma (HCC). Methods 97 patients with HCC underwent hepatectomy in our hospital during the period between September 2013 and July 2016, and all patients were followed-up for 36 months. The RT-PCR and immunohistochemistry were performed to detect Hic-5 and COL1A1 mRNA and their proteins in cancerous and non-cancerous tissues. Results The positive rate of Hic-5 protein in cancerous tissues was significantly higher than that in adjacent liver tissues (53.6% vs. 16.5, P<0.05), and the positive rate of Hic-5 mRNA was significantly higher than that in adjacent tissues (66.0% vs. 25.8%, P<0.05); the positive rate of COL1A1 protein in cancerous tissues was significantly higher than that in adjacent tissues (71.1% vs. 25.8%, P<0.05), and the positive rate of COL1A1 mRNA was significantly higher than that in adjacent tissues (78.4% vs. 30.9%, P<0.05); the positive rate of Hic-5 mRNA in patients with TNM stage I/II was significantly lower than that in with stage III/IV (56.4% vs. 78.6%, P<0.05), and the positive rate of COL1A1 mRNA was significantly lower than that in with stage III/IV (70.9% vs. 88.1%, P<0.05); the positive rate of Hic-5 in patients with portal vein thrombosis was significantly higher than that in without (82.5% vs. 54.4%, P<0.05), and the positive rate of COL1A1 mRNA was significantly higher than that in without (90.9% vs. 70.2%, P<0.05); the medium survival in 87 followed-up patients was 8.2 to 36.0 months[36.0(14.6,36.0) m; the 3-year cumulative survival in patients with positive Hic-5 expression was significantly shorter than that in with negative [26.3(16.1,36.0) m vs. 36.0(30.6,36.0) m, P<0.05], and the 3-year cumulative event-free survival was also significantly shorter than that in with negative [21.4(11.7,36.0) m vs. 36.0(24.2,36.0]m, P<0.05). Conclusion The positive Hic-5 expression in cancerous tissues in patients with HCC hint poor prognosis, which might be related to the advanced tumor stage and portal vein thrombosis.

Objective The aim of this study was to observe the efficacy of microwave ablation (MWA) under the guidance of real-time contrast-enhanced ultrasound(CEU) and fusion image navigation (FIN) in treatment of patients with small primary liver cancer (PLC).Methods 142 patients with small PLC were admitted to our hospital between December 2013 and December 2016, and were randomly divided into two groups, with 71 cases in each group. The patients in observation group received MWA under the real-time CEU and FIN guidance, and those in the control group received surgical resection. Serum alpha-fetoprotein (AFP),α-L-fucosidase (AFU) and carbohydrate antigen 19-9 (CA19-9)levels were assayed. Results At the end of three months after treatment, the complete ablation rate in the observation group was 93.8%, and the complete removal in the control was 100.0%(P>0.05); there were no significant differences as compared to serum AFP, AFU and CA19-9 levels in the two groups(P＞0.05); the complication occurrence, such as pulmonary infection, bile leak, incision infection,peritoneal or pleural effusion in the observation group was4.2%, significantly lower than 25.3%(P＜0.05) in the control; the patients were followed-up for 3 to 36 months withmedium of 18 months, and the survival rate in the observation was 73.2%(52/71), not significantly different compared to 71.8%(51/71) in the control (Log-rank=0.086,P=0.763).Conclusion The application of MWA under the guidance of real-time CEU and FIN in the treatment of patients with small PLC is efficacious, similar to surgical resection, which is worthy of clinicalverification.

Objective The purpose of this study was to evaluate the value of albumin-bilirubin (ALBI) score and future liver remnant (FLR) combination in predicting the occurrence of post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC). Methods A total of 76 patients with HCC were recuited in our hospital between October 2015 and May 2019, and ALBI were obtained. All the patients underwent abdominal three-dimensional CT reconstruction and hepatectomy. Univariate and multivariate Logistic regression analysis were applied to explore the clinical influencing factors related to the occurrence of PHLF. The diagnostic values of the related index for the occurrence of PHLF were determined by receiver operating characteristic curve. Results Out of the 76 patients with HCC, 28 had PHLF and 48 hadn’t; the average age of patients with non-PHLF was (48.2±6.3) years, significantly younger than [(55.9±7.1) years, P<0.05], the INR was (0.9±0.1), significantly lower than [(1.1±0.1), P <0.05], serum albumin level was (40.6±3.2) g/L, significantly higher than [(36.4±3.1) g/L, P <0.05], blood platelet count was (241.2±80.3)×10⁹/l, significantly higher than [(181.9±60.8)×10⁹/l, P<0.05], the ALBI score was (-2.9±0.8), significantly lower than [(-1.8±1.0), P <0.05], the MELD score was (7.0±1.5), significantly lower than that [(8.4±1.9), P <0.05], the Child-Pugh score was (4.2±1.2), significantly lower than [(5.8±1.4), P <0.05], and the FLR was (890.6±210.6)cm³, significantly larger than [(720.1±180.7)cm³, P <0.05]in patients without PHLF; multivariate Logistic regression analysis showed that ALBI score and and FLR were the independent predictors of PHLF occurrence in patients with HCC (P <0.05); the sensitivity and specificity of ALBI and FLR combination in diagnosing PHLF in patients with HCC were 81.2% and 90.5%. Conclusion The application of ALBI and FLR for evaluating liver reserve function in patients with HCC before hepatectomy is feasible, and might guide the clinicians to make decisions and prevent the occurrence of PHLF.

Objective The aim of this study was investigate the short-term efficacy of radiofrequency ablation (RFA) in patients with hepatic malignant tumors under ultrasound (US)- or US and CT combination-guidance. Methods A retrospective study was conducted on 96 patients with hepatic malignant tumors who underwent RFA under US and CT-guidance (group A) or US-guidance (group B) in our hospital from March 2017 through January 2019. All patients received RFA therapy, and were followed-up for three months. Results At the end of three months after RFA treatment, the total response rate in group A was significantly higher than that in group B (94.0% vs. 80.4%, P<0.05); after RFA treatment, there was no significant difference in incidence of complications between the two groups (4.0% vs. 13.0%, P>0.05); there were no significant differences as respect to serum creatinine and AFP levels between the two groups [(71.5±7.2) μmol/L vs. (70.6±7.3) μmol/L and (30.4±5.7) μg/L vs. (31.8±5.6) μg/L, respectively, P>0.05]. Conclusion The short-term efficacy of RFA guided by ultrasound and CT combination in the treatment of patients with hepatic malignant tumors is better as compared with routine ultrasound guidance, with low postoperative incidence of complications, which might be due to precise guidance and total ablation.

Objective The aim of this study was to investigate the efficacy and safety of ultrasound-guided percutaneous microwave ablation for the treatment of patients with hepatic alveolar echinococcosis. Methods 50 patients with early hepatic vesicular echinococcosis were treated in our hospital between June 2018 and October 2019, and they were divided randomly into control (n=25) and observation group (n=25). The patients in the control group were treated with conventional open surgery, and those in the observation group were treated with microwave ablation under ultrasound guidance. The followed-up period was 1 year. Results The total effective rate in the observation group was 92.0%, which was significantly higher than that in the control group [80.0%, P<0.05]; 1 week after operation, serum total bilirubin level in the observation group was (16.7±1.6) μmol/L, which was not significantly different as compared to that in the control group [(14.2±1.4) μmol/L, P<0.05], serum alanine aminotransferase level in the observation group was (140.8±52.4 ) U/L, which was significantly lower than [(194.7 ± 63.2) U/L, P<0.05]in the control group, and serum GGT level was (95.1±10.2) U/L, which was significantly lower than in the control group [(102.4±11.3) U/L, P<0.05], while serum albumin level in the observation group was (35.7±3.4) g/L, which was significantly higher than that in the control group [ (32.9±3.5) g/L, P<0.05]; the complication rate in the observation group during the follow-up period was 4.0%, significantly lower than36.0%(P＜0.05)in the control. Conclusion The ultrasound-guided microwave ablation in the treatment of patients with hepatic alveolar echinococcosis is efficacious, which might reduce the incidence of post-operational complications.

Objective The aim of this study was to summarize the ultrasound manifestation of hepatic distomiasis and its clinical outcomes. Methods 30 patients with hepatic distomiasis and common bile duct obstruction were included in this study, and all came from the Department of Gastroenterology and General Surgery in our hospital between January 2012 and November 2018. All patients underwent ultrasonography, and the patients received praziquantel for treatment, and some of them received endoscopic retrograde cholangiao-pancreatography (ERCP) for bile duct obstruction after praziquantel therapy. Results The ultrasound manifestation of patients with hepatic distomiasis were the thickness of bile duct walls and intrahepatic bile duct dilation, often with common bile duct diseases; the successful rate by praziquantel therapy was 63.3%, and eleven patients received ERCP, all successful; at presentation, serum bilirubin, aspartate aminotransferase and alanine aminotransferase levels were (56.1±13.9)μmol/L, (151.2±67.8)U/L and (74.3±30.7)U/L, and all improved after treatment or operation 【(13.3±1.3)μmol/L, (91.5±39.2)U/L and (32.7±14.3)U/L, respectively, P<0.05】; post-operationally, acute pancreatitis developed in four patients and blood hyperamylase developed in five patients, and all recovered after two to ten day internal interventions. Conclusion The ultrasound features of hepatic distomiasis and biliary obstruction is characterized by thickening of the bile duct walls, and dilatation of intrahepatic bile ducts. The praziquantel treatment is efficacious in most patients and the intervention of ERCP also has a good outcomes in patients with bile duct obstruction and dilatation.

Objective The aim of this study was to analyze the influencing factors of post-operational complications in patients with intrahepatic stone (IHS) after percutaneous transhepatic cholangioscopic lithotomy (PTCSL).Methods 115 patients with IHS were admitted to the Department of Digestive Diseases in our hospital between May 2015 and May 2019, and 60 received PTCSL and 55 received open operation. The factors impacting the post-operational complications were retrospectively evaluated by Logistic analysis. Results The total successful operation were carried out in our series, and the stones were pull out in the two groups; the incidence of postoperative complications in the PTCSL group was 21.7%, significantly lower than that in the laparotomy group (49.1%, P<0.05), of which, one case of lower limb deep vein thrombosis occurred in the PTCSL group, and four cases in open laparotomy group, all beening found early by color Doppler ultrasonography and improved after active anticoagulant therapy; low serum albumin level before operation, bleeding during operation, biliary tract operation history and bile multi-drug resistant bacteria infection after operation were the factors affecting complications in PTCSL group (P<0.05), and the Logistic analysis showed that low pre-operative serum albumin level [OR(95%CI) :0.5 (0.3-0.9)], hemorrhage during operation [OR(95%CI): 2 (1.4-3)], biliary tract surgery history [OR(95%CI):9 (1.3-2.7)], and bile multidrug-resistant bacteria infection [OR(95%CI):2.2 (1.2- 4.5)]were the independent risk factors for complications in the PTCSL group (P<0.05). Conclusion Compared with conventional laparotomy, PTCSL could greatly reduce the incidence of post-operational complications, which worth further investigation.

Objective The purpose of this study was to observe the role of indomethacin in dealing with patients with cholecystolithiasis and choledocholithiasis after gastroduodenoscopy and endoscopic retrograde biliary drainage (ERBD) operation. Methods 120 patients with cholecystolithiasis and common bile duct stones were recruited in our hospital between February 2017 and April 2018, and they were randomly divided into control and observation group received gastroduodenoscopy and ERBD, and post-operational indomethacin anastomosis for 7 days. Serum retinol-binding protein (RBP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-8 levels were detected, and quality of life (QOL) score was evaluated. Result The surgical operation in the two groups was successful; at the end of 7 days after operation, serum RBP level in the observation group was (45.8±3.2)mg/L, significantly higher than 【(32.5±3.2) mg/L, P<0.05】 in the control, while serum TNF-α, IL-6 and IL-8 level were (2.1±0.4)μg/L, (15.8±7.8)μg/L and (11.6±9.5)μg/L, significantly lower than 【(4.1±0.4)μg/L, (30.8±7.7)μg/L and (37.6±9.5)μg/L, respectively, P＜0.05】 in the control; three months post-operation, the incidences of biliary stricture, incision infection, residual stones and bile leakage in the two groups was not significantly different(P＞0.05); at the end of one month and three months after operation, the QOL scores in the observation group were (45.8±3.2) and (47.2±3.0), much higher than 【(32.5±3.3) and (36.1±3.1), respectively, P＜0.05】 in the control. Conclusion The role of indomethacin is obvious in patients with Choledocholithiasis after surgical operation, which might help elevate serum RBP level, decrease serum cytokine levels and improve QOL.