Objective The aim of this study was to investigate the effect of sirolimus on peripheral blood Treg/Th17 cell ratio in high fat diet-inducednon-alcoholic fatty liver disease (NAFLD) in rats. Methods 60 SD rats were randomly divided into sirolimus intervention group, model group and control group with 20 rats in each group. The NAFLD model was established by high fat diet feeding for 12 weeks and when the model was successfully built up, 20 rats were fed with sirolimus for two weeks.Serum aspartate aminotransferase(AST),alanine aminotransferase (ALT)], blood triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)], serum interleukin-10(IL-10), IL-17,tumor necrosis factor-α(TNF-α)] and peripheral blood regulatory T lymphocyte (Treg)/T help cell 17(Th17) were detected. Results At the end of the experiment, serum AST and ALT levels insirolimus-intervened group were (134.9±15.3)U/L and (109.4±18.2)U/L, both significantly lower than 【(151.1±28.9)U/L and (128.9±17.7)U/L, respectively,P<0.05】 in model group; blool TG, TC and LDL-C levels were (0.9±0.3)mmol/L, (2.6±0.8)mmol/L and (3.3±1.2)mmol/L, significantly lower than 【(1.1±0.5)mmol/L, (3.6±1.3)mmol/L and (5.4±1.8)mmol/L, respectively, P＜0.05】 in the model, while blood HDL-C level was (1.3±0.5)mmol/L, much higher than 【(0.7±0.4) mmol/L, P＜0.05】 in the model; serum IL-10 level was (68.9±26.6)pg/ml, much higher than 【(37.8±17.2)pg/ml, P＜0.05], while serum IL-17 and TNF-α levels were (13.2±3.3)pg/ml and (0.7±0.2)ng/ml, significantly lower than 【(22.6±4.0)pg/ml and(1.2±0.4)ng/ml, P＜0.05】 in the model; the percentage of Treg cells was (4.5±0.7)%, the percentage of Th17 cells was (1.7±0.6)% and the ratio of Treg/Th17 cells was (2.6±0.7), significantly different compared to 【(3.8±0.9)%, (2.8±1.1)% and(1.5±0.7), respectively, P＜0.05] in the model.Conclusion The administration of sirolimus could inhibit inflammatory response and correct Treg / Th17 cell imbalance in rats with high fat diet-induced NAFLD, which mightalleviates hepatic steatosis.

Objective If it is not consistent with the genotype in a given patient, the recombinant human interferon alpha would induce the production of more anti-interferon neutralization antibodies and leads to therapeutic failure. By analyzing the gene polymorphisms of IFNA1 and IFNA2 in Chinese population, the genetic background of recombinant human interferon α1 and α2 in Chinese population was clarified, so as to provide a reference for clinical medication. Methods Single nucleotide polymorphism (SNP) loci in the coding region of IFNA1 and IFNA2 were retrieved from the SNP database, and the distribution of IFNA1 and IFNA2 alleles in Chinese population were searched in the 1000 genome database. The polymorphisms of the two genes were counted and all of allele frequencies were calculated. Results A total of 310 Chinese diploid genome sequences were included in the 1000 genomes database, and all the Chinese persons had IFNA1 and IFNA2 gene loci; the IFNα1 gene loci contained IFNα1,IFNA1(Ala137Val) and IFNα1(Arg148Gln) alleles, with the gene frequencies of 99.6%, 0.2% and 0.2%, respectively; the IFNA2 gene locus also contained three alleles: e.g. IFNα2b, IFNα2b (Leu140Val) and IFNα2b (Ala120Thr), with the gene frequencies of 98.4%, 0.2%, and 1.4%, respectively.Conclusion The IFNα1 and IFNα2b are the dominant alleles of IFNA1 and IFNA2 gene loci in Chinese population, while only IFNα2b is consistent with the Chinese human genotype among the three subtypes of IFNα1b, IFNα2a and IFNα2 approved for marketing in China.

Objective The aim of this study was to analyze the serological and virological response to pegylated interferon α-2a (peg-IFN-α-2a) and entecavir combination in patients with chronic hepatitis B (CHB). Methods 77 patients with CHB were recruited in this study between February 2018 and February 2019, and divided randomly into control group (n=36) and observation group (n=41) . The patients in the control group were treated with entecavir, and those in the observation group were treated with peg-IFN-α-2a and entecavir combination for 24 weeks. Serum HBV DNA loads were detected by polymerase chain reaction, serum HBeAg and anti-HBe were detected by chemiluminescence method, and serum procollagen type III (PC III), laminin (LN), hyaluronic acid (HA), collagen type IV (IV-C), people end limb homologous protein 2 (Pygo2) and Golgi glycoprotein 73 (GP73) levels were detected by ELISA. Results At the end of 24 week treatment, serum HBV DNA negativity rates in the two groups were 100.0% vs. 100.0%, while serumHBeAg negativity rate in the observation group was 36.6%, significantly higher than that in the control group (19.4%, P<0.05), and serum HBeAg conversion to anti-HBe rate was 22.0%, significantly higher than that in the control group (8.3%, P<0.05); serum ALT level in the observation group was (32.3±13.5) U/L, significantly lower than that in the control group ; serum LN level in the observation group was (84.7±31.5) μg/L, significantly lower than that in the control group , Ⅳ-C level was (79.8±16.1) μg/L, significantly lower than that in the control group , PC-Ⅲ level was (94.5±21.2) μg/L, significantly lower than that in the control group , and serum HA levels was (107.1±25.2) μg/L, significantly lower than that in the control group ; serum Pygo2 level in the observation group was (50.8±5.9) μg/L, significantly lower than that in the control group , and serum GP73 level was (108.6±10.6) ng/mL, significantly lower than that in the control group .Conclusion The combination of entecavir and pegylated interferon α-2a for the treatment of patients with CHB could effectively improve serological and virological response, which might be related to the reduction of serum levels of Pygo2 and GP73 and relieve liver fibrosis.

Objective The aim of this study was to investigate the diagnostic efficacy of serum IL-34 level and transient elastography in predicting liver fibrosis in patients with chronic hepatitis B (CHB). Methods A total of 100 patients with CHB underwent percutaneous liver biopsies in our hospital from June 2018 through June 2019. Serum IL-34 levels were detected by ELISA and the liver stiffness measure (LSM) were obtained by elastography. The asparate aminotransferase/platelet ratio index (APRI) and the liver fibrosis -4 factor index (FIB-4) were calculated. The univariate and multivariate Logistic regression analysis were performed to determine the independent predictors of significant liver fibrosis in patients with CHB. The receiver operating characteristic (ROC) curve was used to analyze the cutoff value of independent predictors, and the area under the curve (AUC), diagnostic sensitivity (Se) and specificity (Sp) were calculated. Results Out of 100 patients with CHB, the liver histopathological examination showed fibrosis 0 (F0) in 7 cases, F1 in 25 (non-significant liver fibrosis in 32), and F2 in 32, F3 in 28 and F4in 8 cases (>F2 as significant liver firobosis in 68); the age in non-significant liver fibrosis was (35.2±8.0)yr, much younger than , serum IL-34 level was (10.8±3.6)pg/ml, much lower than , the LSM was (6.1±1.4)kPa, much lower than , the APRI score was (0.5±0.2), much lower than and the FIB-4 score was (1.2±1.0), much lower than in patients with significant liver fibrosis; the multivariate Logistic regression analysis showed that serum IL-34 levels, the LSM, the APRI and FIB-4 scores were the independent factors affecting liver fibrosis (P<0.05); the AUC in diagnosing liver fibrosis by serum IL-34 levels, the LSM, the APRI and FIB-4 scores were 0.84, 0.89, 0.74 and 0.72, and the AUC, the Se and Sp by serum IL-34 and LSM combination were 0.92, 89.4% and 94.0%, respectively.Conclusion The application of serum IL-34 levels might be used as an efficacious index for the diagnosis of liver fibrosis in patients with CHB, and its combination with LSM could improve the diagnostic efficacy.

Objective The aim of this study was to compare the antiviral response to pegylated interferon-α (PEG-IFNα-2a) or PEG-IFNα-2b in patients with chronic hepatitis B (CHB). Methods 74 patients with CHB were enrolled in our hospital between July 2016 and May 2018, and were randomly divided into group A (n=37) and group B (n=37). The patients in group A were treated with PEG-IFNα-2a, and those in group B were treated with PEG-IFNα-2b. The antiviral therapy lasted for 48 w, and all patients were followed-up for 24 weeks. Results At the end of 12 w, 24 w and 48 w treatment and 24 w followed-up, serum alanine aminotransaminase (ALT) normalization rates in goup A were 29.7%, 35.1%, 83.8% and 75.7%, all not significantly different as compared to 27.0%, 29.7%, 86.5% and 78.4%, respectively, (P>0.05) in group B; serum HBV DNA loss were 59.5%, 73.0%, 78.4% and 75.7%, all not significantly different as compared to 45.9%, 51.4%, 81.1% and 75.7%, respectively, (P>0.05) in group B; serum HBeAg negative rates were 33.3%, 36.7%, 36.7% and 40.5%, all not significantly different as compared to 29.2%, 29.2%, 33.3% and 35.1%, respectively, (P>0.05) in group B; during the treatment, the incidences of flu-like symptoms and abnormal thyroid functions in the two groups were the same, and the incidences of thrombocytopenia and granulocytopenia in group A were 40.0% and 76.6%, both notsignificantly different as compared to 37.8% and 75.7% in group B (P>0.05).Conclusion At present, both PEG-IFNα-2a and PEG-IFNα-2b could be selected for the treatment of patients with CHB, and the surveillance of untoward effects is pivotally important for the regimen going and the achievement of antiviral therapy.

Objective To investigate the clinical efficacy of sofosbuvir/vipatavir and ribavirin combination in the treatment of patients with chronic hepatitis C (CHC). Methods 105 patients with CHC were recruited in the Department of Hepatology in our hospital between May 2018 and May 2019, and were randomly divided into control (n=51) and observation group (n=5), receiving ribavirin and interferon-α-2b, or sofosbuvir/vipatavir and ribavirin combination treatment for three months. Serum cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), tumor necrosis factor alpha-induced protein 8-like molecule 2 (TIPE2), and interleukin-12 (IL-12) levels were detected by ELISA. Results The rapid virologic response (RVR) rate in the observation group was 88.9%, significantly higher than 43.1% (P<0.05) in the control, the early virologic response rate (EVR)was 90.7%, significantly higher than 52.9% (P<0.05) in the control, the end treatment virological response (ETVR) rate was 96.3%, significantly higher than 76.5% (P<0.05) and sustained virologic response (SVR) rate was 92.6%, much higher than 60.8% (P<0.05) in the control; the white blood cell count was (5.2±2.0)×10⁹/L, significantly higher than 【(3.4±1.8)×10⁹/L, P<0.05】, the red blood cell count was (4.9±0.5)×10⁹/L, significantly higher than 【(4.6±0.7)×10⁹/L, P<0.05】, and the platelet count was (113.2±38.6)×10⁹/L, significantly higher than 【(94.7±41.2)×10⁹/L, P<0.05】 in the control; serum CTLA-4 level was (1.1±0.4)ng/mL, much lower than 【(1.6±0.7)ng/mL, P<0.05】, serum IL-12 level was (29.6±7.3)pg/mL, much lower than 【(41.5±11.7)pg/mL, P<0.05】, while serum TIPE2 level was (0.8±0.1)μg/L, significantly higher than 【(0.6±0.3)μg/L, P<0.05】 in the control group; during the treatment period, the incidence of side effects was 25.9%, significantly lower than 94.1% (P<0.05) in the control.Conclusion The application of sofosbuvir/vipatavivir and ribavirin combination in treatment of patients with CHC is efficacious, which might be related to the strong direct anti-viral effect and the reduction of serum CTLA-4 and IL-12 levels, and increase of serum TIPE2 levels.

Objective The aim of this study was to investigate the short-term efficacy of danorevir and peginterferon-α in the treatment of patients with genotype 3 infected chronic hepatitis C (CHC). Methods 132 patients with genotype 3 infected CHC were admitted to our hospital between October 2017 and May 2019, and 66 patients were treated with peginterferon-2a and ribavirin for 24 weeks, and another 66 patients were treated with ritonavir and danorevir at base of standardized therapy for 12 weeks. All patients were followed-up for 24 weeks. Results At the end of 2 week, 4 week and 12 week treatment, the virological response rates in the combination group were 90.9%, 97.0% and 100.0%, respectively, significantly higher than 66.7%, 75.8% and 81.8% in standardized therapy-treated group (P<0.05); at the end of 24 week of follow-up after treatment, the sustained virological response (SVR) in the combination group was 92.4%, significantly higher than 74.2% in the control group (P<0.05); there were no statistically significant differences in white blood cell counts, platelet counts and hemoglobin levels in the two groups (P>0.05) and there wereno significant differences in the incidences of adverse reactions between the two groups (P>0.05).Conclusion The application of ritonavir and danorevir at base of standardized therapy in the treatment of patients with CHC and genotype 3 infection is efficacious and safe, which warrants further investigation.

Objective To explore the relationship between high blood hemoglobin levels and the risk of non-alcoholic fatty liver disease (NAFLD). Methods 6540 NAFLD-free participants at physical examination in Baoshan Steel were recruited and their data including blood glucose, blood lipids and hemoglobin in 1995 to 1996 were collected. We explored the baseline blood hemoglobin level longitudinal associations with NAFLD risk throughout 6 years. Results During follow-up, 2 (11.7%) cases of NAFLD developed among 106 patients with anemia, 645(11.0%) NAFLD in 5884 participants with normal hemoglobin, and 116 (21.1%) NAFLD in 550 patients with high blood hemoglobin; Cox univariate analysis showed that hemoglobin level was related to the risk of NAFLD (high hemoglobin group vs. anemia group, HR=11.18, 95% CI: 2.76-45.23, P=0.001; normal hemoglobin vs. anemia group, HR=5.81, 95% CI: 1.45-23.28, P=0.013); Cox multivariate analysis showed that male (HR=1.465,95% CI:1.114-1.928,P=0.006), BMI (HR=1.298,95% CI:1.259-1.320,P<0.001), hypertriglyceridemia (HR=1.781, 95% CI: 1.533-2.068, P<0.001) and hemoglobin (HR=1.008, 95% CI: 1.002-1.015, P=0.014) were the independent risk factors for occurrence of NAFLD.Conclusion High blood hemoglobin levels is correlated with NAFLD risk. The potential value of early screening blood hemoglobin and intervention for NAFLD deserve further study.

Objective To investigate the diagnostic value of serum syndecan-4 (SDC4) in patients with nonalcoholic fatty liver disease (NAFLD). Methods The individuals having no history of excessive alcohol consumption were selected between June to December 2019, and all underwent ultrasonography. Serum SDC4 level was detected by enzyme-linked immunosorbent assay. The univariate and multivariate analysis and the receiver operating characteristic curve (ROC) were applied to analyze the diagnostic value of serum SDC4 level for NAFLD. Results A total of 209 adults were included in this study, including 102 patients with NAFLD and 107 healthy persons after US check-up; serum SDC4 level in patients with NAFLD was significantly higher than that in the control group (11.7±4.2 ng / mL vs. 5.3±2.5 ng / mL, P < 0.05), and serum SDC4 levels increased significantly as the severity of fatty liver became severe in patients with NAFLD; the Logistic regression analysis found that the increased serum SDC4 level was independently related to NAFLD occurrence; when serum SDC4 level equal to or greater than 8.45 ng/mL as the cut-off-value, the area under ROC was 0.917, with the sensitivity of 84.3% and the specificity of 87.9%. Conclusion The increased serum SDC4 levels could be closely related to obesity, metabolic disorders and the incidence of NAFLD, and the detection of serum SDC4 levels might be helpful for non-invasive diagnosis of NAFLD.

Objective The purpose of this study was to investigate the efficacy of atorvastatin and tiopronin combination in patients with nonalcoholic fatty liver diseases (NAFLD). Methods 104 patients with NAFLD were admitted to our hospital between December 2016 and September 2019, and were randomly divided into observation (n=52 and control group (n=52). The patients with NAFLD in control group received routine exercise and diet intervention plus tiopronin enteric-coated tablets and those in the observation group received atorvastatin and tiopronin orally for 8 weeks. Serum nuclear factor kappa B (NF-κ B), transforming growth factor -β(TGF-β),insulin-like growth factor -1(IGF-1, insulin resistance (IR) and serum alanineaminotransferase (ALT), aspartic acid transaminase (AST), glutamyl transpeptidase ( GGT), triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were detected. Results At the end of treatment, serum ALT level in the observation group was (27.8±2.5)U/L, significantly lower than 【(43.6±3.0)U/L, P<0.05】, serum AST level was (22.1±6.3)U/L, significantly lower than 【(46.4±6.9)U/L, P<0.05】, serum GGT level was (55.6±9.8)U/L, significantly lower than 【(71.3±10.3)U/L, P<0.05】, and blodd TG level was (2.4±0.5)mmol/L, much lower than 【(3.0±0.4)mmol/L, P<0.05】, blood TC level was (3.6±0.7)mmol/L, significantly lower than 【(4.9±0.5)mmol/L, P<0.05】, blood LDL-C level was (2.6±0.7)mmol/L, significantly lower than 【(3.1±0.6)mmol/L, P<0.05】, while blood HDL-C level was (1.3±0.2)mmol/L, much higher than 【(1.1±0.3)mmol/L, P<0.05】 in the control group; serum NF-κB level was (1.2±0.1)pg/mL, significantly lower than 【(2.6±0.2)pg/mL, P<0.05】, serum TGF-β level was (3.3±1.2)pg/mL, significantly lower than 【(5.7±1.0)pg/mL, P<0.05】, the HOMA-IR was (2.2±0.4), significantly lower than 【(2.7±0.5), P<0.05】, while serum IGF-1 level was (0.4±0.2)μg/L, significantly higher than 【(0.3±0.1)μg/L, P<0.05】, and serum adiponectin level was (11.9±2.1)mg/L, much higher than 【(10.7±1.8)mg/L, P<0.05】 in the control; the incidences of side effects in the two group during the treatment was not significantly different (13.5% vs. 9.6%, P>0.05). Conclusion The regimen with atorvastatin and tiopronin combination in dealing with patients with NAFLD could protect liver functions, which might be related to the reduction of serum levels of NF-κB and TGF-β, and inhibition of inflammatory reactions.

Objective The aim of this study was to investigate the efficacy of fenofibrate at base of calorie restriction diet in treatment of patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) and serum human cartilage glycoprotein-39 (HCGP39), adiponectin (APN) and asymmetric dimethylarginine (ADMA) level changes. Methods 128 patients with NAFLD complicated by T2DM were randomly divided into control (n=64) and observation group (n=64), receiving calorie-restricted diet or oral fenofibrate at the basis of calorie-restricted diet, respectively for 12 weeks. Serum glycated hemoglobin (HbA1c) levels were detected by immunochromatography, serum fasting blood glucose (FPG) and postprandial 2 hour blood glucose (2 h PPG) level were detected by glucose oxidase method, serum fasting insulin (FINS) level was detected by microparticle chemiluminescence method, by which the insulin resistance (IR) index was calculated, and serum HCGP39, APN and ADMA levels were detected by ELISA. Results At the end of 12 week observation, serum alanine aminotransferase level in the observation group was (39.4±5.3) U/L, significantly lower than , serum aspartate aminotransferase level was (46.3±4.4) U/L, significantly lower than , and serum glutamyl transferase level was (40.7±14.6) U/L, significantly lower than in the control; serum FBG level was (5.9±1.9) mmol/L, significantly lower than , serum 2 h PPG level was (7.4±2.2) mmol/L, significantly lower than , and IR level was (4.1±0.4), significantly lower than that【(4.7±0.5), P<0.05】 in the control; serum total cholesterol level was (1.5±0.2) mmol/L, significantly lower than , serum triacylglycerol level was (4.0±0.7 ) mmol/L, significantly lower than , serum low-density lipoprotein level was (2.1±0.5) mmol/L, significantly lower than , while serum high density lipoprotein level was (1.6±0.5) mmol/L, significantly higher than in the control; serum HCGP39 level was (61.4±7.5) ng/mL, significantly lower than , serum ADMA level was (1.8±0.3) μmol/mL, significantly lower than [(2.2±0.5) μmol/mL, P<0.05】, while serum APN level was (14.6±6.2) ng/mL, significantly higher than in the control.Conclusion The administration of fenofibrate at base of calorie restriction diet in treating patients with NAFLD and T2DM could reduce serum HCGP39 and ADMA levels and elevate serum APN levels, which might reduce liver injury, improve insulin resistance, and thus improve liver function, and glucose and lipid metabolism.

Objective The aim of this study was to investigate the changes of serum uric acid (SUA) levels and its clinical implication in patients with nonalcoholic fatty liver disease ((NAFLD)) and type 2 diabetes mellitus (T2DM). Methods The study enrolled 316 patients with NAFLD in our hospital from June 2015 through December 2019, including 218 patients with NAFLD and T2DM, and 98 NAFLD patients without T2DM. The univariate and multivariate Logistic regression analysis was performed in patients with NAFLD to determine the independent risk factors related to T2DM occurrence. Results The proportion of male cases in patients with NAFLD and T2DM was 59.6%, significantly higher than 42.9% (P<0.05) in those without T2DM, the body mass index (BMI) was (27.2±2.9) kg/m², significantly higher than , blood HbA1c was (9.2±2.1)%, significantly higher than , blood high density lipoprotein (HDL) level was (0.9 ±0.2) mmol/l, significantly lower than , blood triglyceride (TG) level was (1.9±0.5) mmol/l, significantly higher than , the SUA was (335.8±72.6) mol/L, significantly higher than , the estimated glomerular filtration rate (eGFR) was (158.4±40.6) ml/min/1.73 m², significantly higher than , the fasting insulin (FINS) level was (5.1±2.6) MIU/L, significantly higher than , and the insulin resistance index (HOMA-IR) was (1.9±1.1), significantly higher than in NAFLD patients without T2DM; we taken gender, BMI, HbA1c, HDL, TG, SUA, eGFR, FINS and HOMA-IR as independent variables, and the multivariate Logistic regression analysis showed that the gender, HbA1c, SUA, FINS and HOMA-IR were (P<0.05)the independent risk factors, while the BMI, HDL, TG and eGFR were not (P>0.05)the independent risk factors for T2DM occurrence in patients with NAFLD; we divided SUA into three groups based on its levels from low to high as SUA-1, SUA-2 and SUA-3, and in 218 NAFLD patients with T2DM, the percentages of T2DM were 21.5%, 32.1% and 46.3%, with significant differences among them(P<0.05), and in 88 female NAFLD patients with T2DM, those were 10.2%, 28.4% and 61.4%, also significant different (P<0.05), while in 130 male patients ,those were 29.2%, 34.6% and 36.2%, not significant different (P>0.05).Conclusion Gender and SUA are independent predictors of T2DM occurrence in patients with NAFLD. The risk factors for T2DM should be found out and some measure should be taken to prevent the progress of NAFLD to severe consequences in clinical practice.

Objective To explore the efficacy of fenofibrate and bicyclol combination in the treatment of patients with non-alcoholic fatty liver diseases (NAFLD) and its influence on hepatic peroxisome proliferator-activated receptor gammaγ₂ (PPARγ₂) mRNA level. Methods 66 patients with NAFLD were admitted to our hospital between February 2018 and December 2019, and were randomly divided into control group (n=33) and observation group (n=33), receiving bicyclol or bicyclol and fenofibrate combination for three months. The curative effect in the two groups after treatment were compared. The liver biopsies were performed, and hepatic PPARγ₂ messenger ribonucleotide (mRNA) were assayed by PCR. Serum cytokines and peripheral blood T lymphocyte subsets were compared. Results At the end of the treatment, the total effective rate in the observation group was 97.0%, which was much higher than that in the control group (66.7%, P<0.05); the relative level of PPARγ₂ mRNA in liver tissues in the observation group was (1.5±0.1), significantly higher than in the control; serum tumor necrosis factor-α (TNF-α) level was (26.4±3.1) pg/mL, significantly lower than , serum IL-6 level was (35.94.9) ng/L, significantly lower than (46.45.8) ng/L, P<0.05], and serum high-sensitivity C-reactive protein (hs-CRP) level was (5.1±1.4) mg/L, much lower than in the control; the percentage of peripheral blood CD3⁺ cells was (80.2±11.5)%, significantly higher than , the percentage of peripheral blood CD4⁺ cells was (44.7±5.8) %, significantly higher than , and the ratio of CD4⁺/CD8⁺ cells was (1.5±0.4), significantly higher than in the control.Conclusion The oral administration of fenofibrate and bicyclol combination in the treatment of patients with NAFLD has a short-term efficacy, which might be related to the increased hepatic PPARγ2 mRNA levels and the reduction of serum cytokine levels.

Objective The aim of this study was to investigate the therapeutic efficacy of bifidobacterium triple viable capsule and metformin in the treatment of patients with nonalcoholic fatty liver disease (NAFLD) and the changes of blood dark incubation of insulin receptor substrate 1(IRS1), IRS2 and glucose transporter -4(GLUT4) mRNA. Methods 70 patients with NAFLD were enrolled in our hospital between June 2018 and December 2019,and were randomly divided into control (n=35) and observation (n=35), receiving metformin hydrochloride or bifidobacterium triple viable capsules at base of metformin for three months. Peripheral blood IRS1, IRS2 and GLUT4mRNA were assayed by RT-PCR, and serum highly sensitive c-reactive protein (hs-CRP), interleukin -6 (IL-6) and IL-10 levels were also detected. Results At the end of three month treatment, the total fatty liver improvement rate in the observation group was 91.4%, which was significantly higher than that in the control group (68.6%, P<0.05); serum aspartate aminotransferase (AST) level in the observation group was (23.9±9.7) U/L, significantly lower than that in the control group , serum alanine aminotransferase (ALT) level was (45.5±12.3) U/L, much lower than that in the control group , and serum glutamyltranspeptidase (GGT) level was (66.9±11.9) U/L, significantly lower than that in the control group ; blood IRS1 mRNA was (2.1±0.2), which was much higher than that in the control group , peripheral blood IRS2 mRNA level was (2.3±0.4), which was significantly higher than that in the control group , and peripheral blood GLUT4 mRNA level was (2.5±0.4), which was also significantly higher than that in the control group ; serum hs-CRP level was (3.4±0.7) mg/L, significantly lower than that in the control group , serum interleukin-6(IL-6) level was (26.9±7.4)ng/L, significantly lower than that in the control group , and serum IL-10 level was (46.5±12.8)ng/L, significantly lower than that in the control group .Conclusion The combination of bifidobacterium triple viable capsule and metformin in treatment of patients with NAFLD could effectively improve the hepatic steatosis, which might be related to the elevation of peripheral blood IRS1, IRS2 and GLUT4 and inhibition of serum inflammatory factors.

Objective To investigate the short-term efficacy of tiopronin and polyene phosphatidylcholine combination in treatment of patients with alcoholic liver disease (ALD) and its effect on serum toll-like receptor 4(TLR4), myeloid differentiation protein -2(MD-2) and transforming growth factor -β1(TGF-β1) levels. Methods 104 patients with ALD were enrolled in our hospital between January 2018 control group (n=52). The patients in the control group were treated with polyene phosphatidylcholine capsule orally, and those in the observation group were and December 2019, and were randomly divided into observation (n=52) and treated with tiopronin and polyene phosphatidylcholine combination. The treatment in both groups last continuously for 3 months. Serum TLR4, MD-2 and TGF-β1 levels before and after 3 months of treatment were detected by ELISA. Results At the end of three month treatment, serum alanine aminotransferase (ALT) level in the observation group was (34.8±13.9) U/L, much lower than , serum aspartic acid transaminase (AST) level was (43.1±14.2) U/L, significantly lower than , serum total bilirubin (TBIL) level was (15.5±9.7) μmol/L, significantly lower than , and serum gamma-glutamyl transpeptidase (GGT) level was (53.9±14.2) U/L, significantly lower than in the control group; serum total cholesterol (TC) level was (4.1±0.5) mmol/L, much lower than , serum triglyceride (TG) level was (1.3±0.6) mmol/L, significantly lower than , serum high density lipoprotein cholesterol (HDL-C) was (1.2±0.3) mmol/L, significantly higher than , and serum low density lipoprotein cholesterol (LDL-C) level was (3.4±0.9) mmol/L, much lower than in the control; serum TLR4 level was (3.0±0.6) pg/mL, significantly lower than , serum MD-2 level was (415.4±128.5) pg/mL, much lower than , and serum TGF-β1 level was (3.4±1.1) pg/mL, much lower than in the control.Conclusion The combination of tiopronin and polyene phosphatidylcholine in treatment of patients with ALD is efficacious, which might be related to the reduction of serum TLR4, MD-2 and TGF-β1 levels and alleviation of liver function.

Objective The aim of this study was to investigate the clinical efficacy of compound glycyrrhizin and adenosylmethionine succinate combination in treatment of patients with alcoholic hepatitis (AH) with cholestasis and its influences on serum soluble vascular adhesion molecule 1 (sVCAM 1), phospholipid transporter (PLTP) and oxidative stress parameters. Methods 114 patients with AH and hyperbilirubinemia were recruited in Department of Gastroenterology in our hospital, and were divided randomly into observation (n=57) and control group (n=57). The patients in control group was treated with intravenous adenosylmethionine succinate injection, and those in the observation group were treated with compound glycyrrhizin and adenosylmethionine combination for four weeks. Serum sVCAM 1, PLTP, malondialdehyde ( MDA), glutathione peroxidase (GST-Px) and superoxide dismutase (SOD) levels were detected. Results At the end of treatment, serum bilirubin level in the observation group was (24.6±6.4) μmol/L, which was significantly lower than in the control group, serum alanine aminotransferase level was (36.1±11.4) U/L, much lower than in the control group, serum aspartate aminotransferase level was (45.3±14.8) U/L, significantly lower than in the control, serum alkaline phosphatase level was (81.9±21.3) U/L, significantly lower than [(122.3±35.8) U/L in the control; serum sVCAM 1 level was (453.3±31.8) ng/mL, which was significantly lower than [(573.4±41.2) ng/mL, P<0.05] in the control, and serum PLTP level was (3.6±0.4) pg/mL, significantly lower than in the control; serum MDA level was (23.8±2.8) mmol/L, much lower than in the control, while serum GST-Px level was (115.5±8.2) mmol/L, which was significantly higher than and serum SOD level was (186.3±10.6) U/L, significantly higher than in the control.Conclusion The intravenous administration of compound glycyrrhizin and adenosylmethionine succinate in the treatment of patients with alcoholic hepatitis with intrahepatic cholestasis could improve liver function index normalization and subsiding jaundice, which might be related to the decreased serum sVCAM 1 and PLTP levels, and the inhibition of oxidative stress response, and warrants further investigation.

Objective The aim of this study was to investigate the short-term efficacy of live clostridium butyricum in assisting tiopronin and metadoxine in the treatment of patients with alcoholic liver disease(ALD) and their effects on serum levels of glucose-deficient transferrin (CDT) and hepatocyte growth factor (HGF) as well as intestinal flora distribution. Methods 102 patients with ALD were admitted to the Department of Gastroenterology in our hospital between June 2018 and December 2019, and were randomly divided into control (n=51) and observation group (n=51), receiving tiopronin and metodoxine orally or liver clostridium butyricum orally at base of the two agents for 12 weeks. Serum CDT and HGF, interkeukin-6 (IL-6), tumor necrosis factor-α(TNF-α) and nuclear factor-кB (NF-кB) were detected by ELISA, and fecal bacteria flora were also detected. Results At the end of 12 week treatment, serum CDT level in the observation group was (580.2±74.2) pg/mL, significantly lower than , serum HGF level was (150.7±18.4) pg/mL, significantly lower than [(390.5±40.2) pg/mL, P<0.05] in the control; the distribution of Bifidobacterium in the observation group was (8.7±2.6) lg CFU/g, which was much higher than , that of Lactobacillus was (9.1±1.1) lg CFU/g, which was significantly higher than in the control, while the distribution of Escherichia Coli was (6.5±1.6) lg CFU/g, significantly lower than , and that of Enterococcus Faecalis was (6.8±2.0) lg CFU/g, also significantly lower than in the control; serum IL-6 level was (0.7±0.1) pg/mL, significantly lower than , serum TNF-α level was (5.2±1.6) ng/L, much lower than , and serum NF-кB level was (1.2±0.3) ng/L, significantly lower than in the control.Conclusion The application of live clostridium butyricum in assisting tiopronin and metadoxine in the treatment of patients with ALD could effectively improve intestinal flora distribution, inhibit inflammatory reaction, which might be related to the reduction of serum CDT and HGF levels.

Objective To investigate the changes of peripheral blood lymphocyte programmed death-1 (PD-1) and PD-ligand 1 (PD-L1) expression in patients with autoimmune hepatitis (AIH) receiving tripterygium wilfordii polyglycosides and magnesium iso-glycyrrhizate. Methods 76 patients with AIH were randomly divided into control (n=38) and observation group (n=38). The patients in the control group were treated with magnesium isoglycyrrhizate, and those in the observation group were treated with tripterygium wilfordii polyglycosides and magnesium combination. The regimen lasted for 24 weeks in both groups. The expression of PD-1 and PD-L1 percentages on peripheral blood T lymphocytes were detected by CyFlow Counter flow cytometry, including PD-L1⁺/CD4⁺, PD-L1⁺/CD8⁺, PD-1⁺/CD4⁺ and PD-1⁺/CD8⁺, and serum γ-interferon (IFN-γ) was assayed by ELISA. Results At the end of 24 week treatment, serum alanine aminotransferase (ALT) level in the observation group was (48.9±9.7) U/L, significantly lower than that in the control group (77.5±11.2) U/L, P<0.05), serum aspertate aminotransferase (AST) level was (45.5±7.3) U/L, significantly lower than that in the control group ((81.3±9.5) U/L, P<0.05), and serum alkaline phosphatase (ALP) levels was (65.5±2.3) U/L, significantly lower than that inthe control group (91.3±5.8) U/L, P<0.05); the percentage of peripheral blood lymphocyte PD-L1⁺/CD4⁺ was (15.4±4.5) %, significantly lower than that in the control group , the PD-L1⁺/CD8⁺ percentage was (6.5±2.7) %, significantly lower than that in the control group , the PD-1⁺/CD4⁺ was (7.4±2.6) %, significantly lower than that in the control group , and the peripheral blood lymphocyte PD-1⁺/CD8⁺ percentage was (7.5 ± 1.7)%, significantly lower than that in the control group ; serum globulin level was (13.4±1.5) g/L, significantly lower than that in the control group [(18.3±1.8) g/L, P<0.05), serum IgG level was (10.9±2.4) mg/mL, significantly lower than that in the control group [(13.6±2.9) mg/mL, P<0.05), and serum IFN-γ level was (13.0±2.4) ng/mL, significantly lower than [(18.1±2.8) ng/mL, P<0.05) in the control group.Conclusion The combination of tripterygium wilfordii polyglycosides and magnesium iso-glycyrrhizate in treatment of patients with AIH have a short-term efficacy, which might be related to the reduction of PD-1 and PD-L1 expression on peripheral blood T lymphocytes, and restoration of immune dysfunction.

Objective Due to the similarity of clinical and imaging manifestations and lack of awareness of this disease, IgG4-related sclerosing cholangitis (IgG4-SC) is often misdiagnosed as primary sclerosing cholangitis (PSC), cholangiocarcinoma (CC) or other cholestatic diseases, and unnecessary surgical treatment is performed. The accurate understanding of IgG4-SC is very important. However, available clinical studies about IgG4-SC are comparatively insufficient, and most literatures are reports of sporadic cases, there is a need of systematic review of the entity. We need to know the clinical characteristics and misdiagnosis causes of IgG4-SC, and to improve the clinical diagnosis. Methods With "IgG4-related sclerosing cholangitis" as the key word, the literature published before September 2019 was searched on CNKI database, WANFANG database and VIP database, including general information, clinical manifestations, laboratory examinations, imaging findings, pathological features, misdiagnosis, treatment and prognosis of relevant cases. Results A total of 25 articles, including 100 patients, were obtained. The sex ratio of them was 4:1, with the mean age of illness onset of (58.8±12.3) years; the most common symptoms were jaundice (85%, 85/100) and abdominal pain (53%, 53/100); the serological tests showed that serum IgG4 level increased in 94.2% (81/86) of patients, and serum CA19-9 level increased in 33% of patients; the imaging findings included bile duct stenosis in the lower common bile duct in 57 cases and bile duct stricture in the hilar region with intrahepatic bile duct dilatation in 15 cases; the pathological findings in 34 cases examined showed the hyperplasia of fibrous tissue in the wall of gallbladder/bile duct with numerous lymphocyte, plasma cell infiltration, and obliterative phlebitis or storiform fibrosis; the immunohistochemistry in 15 cases showed the IgG4⁺ plasma cell were >10/HPF; out of the 100 patients, 12 cases were misdiagnosed as CC and surgical operation were inappropriately underwent, and 61 cases were treated with glucocorticoids, with remission in 58 cases (95%).Conclusion The main manifestations of patients with IgG4-SC are obstructive jaundice and abdominal pain, which are very similar to primary sclerosing cholangitis, cholangiocarcinoma, pancreatic cancer and other diseases, so it is necessary to pay attention to the differential diagnosis in this setting.

Objective To investigate the distribution of hepatitis B viral genotype in patients with chronic hepatistis B (CHB) and liver cirrhosis (LC). Methods 261 patients with CHB, 30 with LC and 4 with hepatocellular carcinoma (HCC) were recruited in this study, and HBV genotypes were determined by DNA sequencing. Results Among the 295 HBV infected patients, 132 (44.7%) were with genotype B infection, 161 (54.6%) were with genotype C infection, and 2 (0.7%) were with genotype D infection; 7 positive patterns of HBV serological markers were found in our series, and there were no significant differences with respect to serum bilirubin, ALT and AST between patients with CHB and patients with LC (P>0.05); the indexes of liver fibrosis(P<0.05), serum HBV DNA loads (P<0.05)and serum HBeAg positive rate(x²=5.798,P<0.05) in patients with cirrhosis were significantly higher than those with chronic hepatitis B; te proportions of genotype C in patients with LC and HCC were higher than that in patients with CHB(P<0.05).Conclusions The prevalence of HBV genotypes in patients with CHB and LC are predominantly genotype B and C, and the genotype C infections might lead to severe clinical outcomes.

Objective The aim of this study was to estimate the changes and clinical significance of indocyanine green (ICG) clearance test in patients with chronic viral hepatitis, liver cirrhosis and liver failure. Methods A total of 87 patients with chronic liver diseases including chronic viral hepatitis in 9, liver cirrhosis in 69 and chronic liver failure in 9 were hospitalized in the Department of Infectious Diseases, First Hospital affiliated to Shanxi Medical University between November 2017 and August 2019. The ICG retention rate at 15 min(ICG-R15), ICG plasma clearance rate (K value) and effective hepatic blood flow (EHBF) were measured by DDG-3300K analyzer. Meanwhile, all the patients received blood hepatic functions, routine blood tests, abdominal color Doppler ultrasound, abdominal CT scan or MRI scan. The Child-Turcotte-Pugh(CTP) scores were calculated for classification. Results In patients with chronic liver failure, the ICG-R15 was (54.2±11.6)%, the K value was (0.04±0.01)/min, and the EHBF was (0.2±0.1)L/min, significantly different compared to 【(7.4±1.7)%, (0.22±0.05)/min and (0.9±0.3)L/min, respectivel, P<0.05】 in patients with chronic hepatitis; in 11 patients with liver cirrhosis CTP class C, the ICG-R15 was (39.3±8.9)%, the K was (0.06±0.02)/min, and the EHBF was (0.3±0.1)L/min, significantly different compared to【(28.8±12.6)%,(0.10±0.03)/min and (0.4±0.2)L/min, respectively,P<0.05】 in 39 cirrhotic patients with CTP class B or 【(12.2±2.8)%,(0.16±0.05)/min and (0.7±0.2)L/min, P<0.05】 in 19 patients with CTP class A.Conclusion The ICG clearance test could reflect liver reserve functions, and it might be a dynamic parameter for liver function evaluation if we test it often.

Objective The aim of this study was to evaluate esophageal and gastric varices (EGV) by liver and splenic stiffness measurement (LSM and SSM) by elastography in patients with hepatitis B liver cirrhosis (LC). Methods A total of 166 patients with hepatitis B LC were included in our hospital from January 2016 to January 2020, and all of them underwent gastroscopy for EGV finding and FibroTouch for LSM and SSM. The EGV was defined as non-advanced and advanced one. The univariate and multivariate Logistic regression analysis were performed to determine the independent predictors for advanced EGV. The receiver operating characteristic curve (ROC) was drawn, and the area under ROC (AUC), sensitivity, specificity and accuracy were calculated. Results The gastroscopy showed the non-advanced EGV in 92 and advanced EGV in 74 patients with LC in our series; the percentages of Child-Pugh class A, class B and class C in patients with non-advanced EGV were 63.0%, 37.0% and 0.0%, significantly different compared to advanced EGV(40.5%, 40.5% and 18.0%,respectively, P<0.05); the incidence of ascites was 3.3%, significantly lower than 59.5%(P<0.05) in advanced EGV and serum albumin level was (34.1±5.6)g/L, significantly higher than , the INR was (1.1±0.4), much lower than [(1.4±0.6), P<0.05], the platelet count was (132.8±38.0)×10⁹/L, significantly higher than , the diameter of portal vain was (12.6±1.8)mm, much smaller than , the thickness of spleen was (100.4±14.6)mm, significantly smaller than , the LSM was (17.2±10.2) kPa, significantly lower than and the SSM was (26.6±9.1)kPa, much lower than in patients with advanced EGV; the multivariate Logistic regression analysis showed that the serum albumin level, INR, PLT count, diameter of portal vain and thickness of spleen, LSM and SSM were the independent factors for advanced EGV occurrence in patients with LC(P<0.05); when the LSM equal to 26.6 kPa and SSM to 43.2 kPa as the cut-off-value for combination diagnosis of advanced EGV, the AUC, sensitivity, specificity and accuracy were 0.87, 83.5%, 91.8% and 89.6%.Conclusion FibroTouch detection of LSM and SSM in patients with hepatitis B-induced liver cirrhosis could effectively predict the occurrence of EGV, which needs further investigation.

Objective The aim of this study was to meta-analyzed the randomized controlled trials(RCTs) of polyethylene glycol (PEG) and lactulose in the treatment of patients with hepatic encephalopathy (HE). Methods The meta-analysis was conducted in PubMed, EMbase,Cochrane,WanFang Data and CNKI by computer search and retrieve untill November 20,2019. RCTs were selected and their quality was evaluated by RevMan 5.3 software. Results A total of 8 randomized controlled studies were obtained, including 249 patients in the PEG group and 244 patients in the lactulose group; the results of Meta analysis showed that the incidence of adverse reactions in PEG group was 12.9%, significantly lower than that in lactulose group(27.4%, P＜0.0001); the improvement rate of 24-hour HESA score in PEG group was 91.5%, significantil higher than 65.5% in lactulose group (P＜0.0001); the hospital stay in PEG group and lactulose group was ,and serum ammonia decreased after treatment were in the two groups. Conclution Compared with lactulose intervention, the administration of PEG has fewer adverse reactions in patients with HE, which might decrease 24-hour HESA score, shorten hospital stay, and needs further investigation.

Objective The aim of this study was to investigate combination of rifaximin and lactulose in dealing with hepatitis B cirrhotic patients with hepatic encephalopathy (HE) and observe its clinical efficacy and mortality. Methods 74 patients with HE were admitted to our hospital between June 2015 and June 2019, and were randomly divided into two groups, with 37 cases in each. 37 patients were treated with lactulose and another 37 with lactulose and rifaximin combination for seven days. Serum S100B protein, neuron-specific enolase (NSE), C-reactive protein (CRP), tumor necrosis factor-α (TNF-), interleukin-8 (IL-8) and β-endorphin,β-EP) were assayed, and number connection test (NCT) and digital symbol test (DS) were applied for evaluation of cognition. Results The survival rate in combination group was 83.8%, significantlyhigher than 62.1% in lactulose-treated group (P<0.05); after treatment, serum CRP level in the combination group was (14.9±3.5) mg/L, much lower than , serum TNF-α level was (12.3±3.8) ng/L, significantly lower than , serum IL-8 level was (35.8±7.5) pg/mL significantly lower than , serum S100B protein level was (27.4±13.1) ng/L, significantly lower than , serum NSE level was (14.6±6.4) μg/L, significantly lower than , and plasma β-EP level was (46.7±5.3) pg/mL, significantly lower than in lactulose-treated group; serum alanine aminotransferase (ALT) level was (67.3±16.1) U/L, significantly lower than , while serum albumin (ALB) level was (35.3±7.1)g/l, significantly higher than in lactulose-treated group; the blood ammonia level was (61.7 1±1.4) μmol/L, significantly lower than in lactulose-treated group; the time of NCT was (54.3± 8.5) s, which was much shorter than , and the DS score was (58.5 ±7.2), which was significantly higher than in lactulose-treated group.Conclusion The combination of rifaximin and lactulose in the treatment of cirrhotic patients with HE could effectively inhibit the inflammatory reaction, improve liver functions, reduce stress injury, and improve cognitive functions, which might correlated to the reduction of serum S100B protein and NSE levles, and is worthy of further clinical research.

Objective To explore the efficacy and safety of combination of oxaliplatin and capecitabine (XELOX) plus bevacizumab in conversion treatment of patients with colon cancer and liver metastasis. Methods A total of 41 patients with de novo unresectable colon cancer and liver metastases were enrolled in our hospital between June 2015 and July 2017, and all patients underwent XELOX and bevacizumab for conversion therapy. The response rate, conversion surgical rate and overall survival time (OS) were observed. Results All patients finished at least four courses of conversion therapy, and 31 patients (75.6%) had partial response, 14 patients (34.1%) underwent radical surgery after conversion treatment; 40 patients were followed up for 13 to 26 months with the medium of 18 months and one patient after radical surgery lost, and one-year survival at radical surgery and non-surgery group were 92.3% and 66.7%, which showed significantly difference by Log-rank testing (P=0.019).Conclusion The administration of bevacizumab plus XELOX regimen is safe and efficacious in the conversion treatment of patients with colon cancer and simultaneous liver metastases, and parts of patients might obtain opportunity for radical surgery, which is expected to prolong the survival time.

Objective The aim of this study was to compare CTP score, end-stage liver disease model (MELD), MELD combined with indocyanine green (ICG) clearance test (MELD-ICG) score, chronic liver dysfunction (CLD) score and modified albumin bilirubin (mALBI) scores for predicting early liver dysfunction in patients with primary liver cancer (PLC) undergoing transhepatic arterial chemoembolization (TACE). Methods A retrospective analysis was performed in 87 PLC patients underwent TACE treatment in our hospital from December 2018 through December 2019, and the preoperative CTP, MELD, MELD-ICG, CLD and ALBI scores were calculated. The area under receiver operating curve (AUC) was applied to predict the incidence of liver dysfunction. Results 27 (31.0%) out of 87 patients with PLC after TACE developed postoperative hepatic insufficiency in our series; the preoperative CTP, MELD, MELD-ICG, CLD and ALBI scores in the 27 patients with hepatic insufficiency were (6.9±1.1), 12.0 (10.0 -14.0), 27.4 (20.2-35.0), (1.5±0.9) and (2.6±1.5), significantly higher than in 60 patients with compensated liver functions; the AUC of CTP, MELD, MELD-ICG, CLD and mALBI were 0.708, 0.787, 0.827, 0.735 and 0.723, with the AUC of MELD-ICG in predicting postoperative hepatic insufficiency highest [0.827 (95% CI: 0.730-0.899), significantly higher than CTP or CLD or mALBI .Conclusion The five scoring systems of CTP, MELD, MELD-ICG, CLD and mALBI are all efficacious tools for predicting hepatic dysfunction after TACE in patients with PLC, and the MELD-ICG score has the best predictive value and needs further investigation.

Objective The aim of this study was to investigate the expression of coatomer protein complex subunit beta 2 (copb2) gene in cancerous tissues in patients with hepatocellular carcinoma (HCC) and its relationship with prognosis. Methods 113 patients with HCC underwent hepatectomy, and the COPB2 mRNA and its protein expression in cancerous and adjacent noncancerous tissues were detected by RT-PCR and Western bloting as well as immunohistochemistry. The multivariate Cox proportional risk regression model was established to analyze the independent risk factors affecting the prognosis of patients with HCC. Results The COPB2 mRNA in cancerous and noncancerous tissues were (1.32±0.40) and (0.47±0.14), significantly different between them(P=0.013), and the COPB2 protein expression were (1.35±0.56) and (0.44±0.12), also significantly different between them(P=0.035); the strong cancerous COPB2 expression was found in 45 patients(39.8%), while the weak or negative expression was found in 68 patients(60.2%); the expression of COPB2 was found much different in patients with or without HBV infection, with different serum AFP levels, different tumor foci, different tumor cell differentiation, and with or without tumor invasion (P＜0.05); 68 patients (59.8%) died in our series at the end of follow-up, with the survival time of (1047.0±167.7) days; the survial time in patients with strong cancerous COPB2 expression was (747.3±116.3) days, much shorter than(1673.7±213.5) days in patients with weak or negative COPB2 expression(P=0.001); the multivariate Cox proportional risk regression model showed that the cancerous COPB2 expression, serum AFP levels, tumor invasion and tumor foci were the independent risk factor for overall survival of patients with HCC.Conclusion The up-regulation of COPB2 expression in cancerous tissues in patients with HCC might hint the bad prognosis after hepatectomy, which warrants further investigation.

Objective The aim of this study was to investigate the efficacy of transcatheter hepatic chemoembolization (TACE) and radiofrequency ablation (RFA) in treatment of patients with primary liver cancer (PLC). Methods A total of 108 patients with PLC were recruited in our hospital between March 2016 and March 2018, and were randomly divided into two groups, with 54 in each, receiving TACE or TACE and RFA combination. All patients were followed-up for 12 months. Results After treatment, the effective rate and disease control rate in patients receiving TACE and RFA were 77.8% and 87.0%, significantly higher than 50.0% and 70.4%(P＜0.05) in TACE-treated group; one month after treatment, total serum bilirubin and alpha-fetoprotein levels in combination-treated group were (24.0±6.7)μmol/L and (135.7±15.6)μg/L, significantly lower than 【(28.3±8.2)μmol/L and (226.5±18.2)μg/L, respectively, P＜0.05) in TACE-treated group; during the treatment, the incidence in TACE- and RFA-treated patients was 48.2%, not significantly different compared to 51.9% in TACE-treated group (P＞0.05); the one-year survival rate in TACE- and RFA-treated patients was 75.0%(39/52), significantly higher than, 47.2%(25/53) in TACE-treated group (x²=8.542,P=0.003).Conclusion The application of TACE and RFA combination is safe and efficacious in the treatment of patients with PLC, which might prolong the survival of patients with PLC and warrants further investigation.

Objective The aim of this study was to investigate the short-term efficacy of radiofrequency ablation (RFA) with cold circulation in the treatment of patients with primary liver cancer (PLC) and the change of peripheral blood fegulatory T cells (Treg). Methods A total of 94 patients with PLC were admitted to our hospital between April 2018 and April 2019, and were randomly divided into observation group (n=47) and control group (n=47). The patients in the control group received hepatic artery chemoembolization (TACE), while those in the observation group received RFA with cold circulation under the guidance of color ultrasound. The percentages of peripheral blood Treg cells were detected by TCM. Results At the end of three month after operation, the complete response, partial response and disease stable rates in the RFA-treated patients were 42.6%,40.4% and 6.4%, and the disease control rate was 89.4%, all significantly higher than (31.9%, 27.7%, 12.8%, and 72.3%, P＜0.05】 in TACE-treated patients except for disease stable rate; at presentation, serum ALT, ALP, total bilirubin and the percentage of peripheral blood cells in RFA-treated patients were (96.4±22.4)U/L, (184.5±30.5)U/L,(18.5±5.8)μmol/L and 9.5±1.5)%, not significantly different compared to in TACE-treated patients, while serum ALT, ALP and percentage of peripheral blood Treg cells in RFA-treated patients were (35.1±5.8)U/L,(84.5±15.8)U/L and (6.2±0.5)% after operation, all significantly lower than in TACE-treated patients; the incidence of post operation complications such as abdominal distension, diarrhea, peritonitis, fever and gastrointestinal bleeding was 8.5%, significantly lower than 25.5% (P＜0.05)in TACE-treated group.Conclusion The application of RFA with cold circulation under color ultrasound guidance in treatment of patients with PLC could get excellent short-term efficacy, which might reduce peripheral blood Treg cells, and has a higher safety.

Objective The aim of this study was to investigate prognosis of patients with hilar cholangiocarcinoma (HC) after reconstruction of hepatic artery or of portal vein and conventional radical hepatectomy. Methods 70 patients with HC admitted to our hospital between March 2014 and January 2017 were divided randomly into group A (n=24), receiving radical hepatectomy and hepatic artery resection and reconstruction, group B (n=23), receiving radical hepatectomy and portal vein resection and reconstruction, and group C (n=23), receiving conventional radical hepatectomy. All patients were followed-up for 32 to 46 months, with a median of 36 months. Results In group A, the operation time was (11.4±2.6) h, significantly longer than in group B and in group C , the intraoperative blood loss was (914.5±175.0) ml, significantly higher than in group B and in group C , the exhaust time was (23.2±11.8) h, significantly longer than in group B and in group C , the hospitalization stay was (21.6±7.2) d, significantly longer than in group B and in group C ; the 1-year,2-year and 3-year survival rates in group A were 66.7%,41.7% and 33.3%, respectively, which were significantly lower than 91.3%,73.9% and 52.2% in group B (P<0.05) or 87.0%, 69.6% and 47.8% in group C (P<0.05).Conclusion The combination of hepatectomy and reconstruction of radical hepatectomy is not superior to conventional radical surgery in the treatment of patients with HC, so we don’t recommend this procedure in clinical practice.

Objective To investigate the therapeutic efficacy of laparoscopic regular hepatectomy or lobectomy in treatment of patients with complicated intrahepatic stones (IHS) and serum changes of Junus kinase protein2 (JAK2), signal transduction and transcription activator 3 (STAT3) and monocyte chemoattractant protein 1(MCP-1). Methods 111 patients with complicated IHS were admitted to the Department of Hepatobiliary Surgery in our hospital between January 2017 and January 2020, and were divided into observation (n=58) and control group (n=53) . The patients in the control group received open regular hepatectomy or lobectomy, and those in the observation group received laparoscopic regular hepatectomy or lobectomy. Serum JAK2, STAT3 and MCP-1 were assayed by ELISA. Results The stone clearance rate immediately after operation in the observation group was 91.4%, much higher than 77.4% (P<0.05) and the final stone clearance rate was 98.3%, significantly higher than 88.7% (P<0.05) in the control; the operation time in the observation group was (2.1±0.7) h, much shorter than , the ambulation time was (1.7±0.5) d, significantly shorter than , the eating time was (2.6±0.9) d, significantly shorter than , and the postoperative hospitalization time was (3.8±2.6)d, significantly shorter than 【(9.2±4.4)d, P<0.05】 in the control; three days after operation, serum interleukin -6 level in the observation group was (81.5±9.6) pg/mL, much lower than , serum C- reactive protein level was (59.3±7.5) mg/L, sigfinicantly lower than and serum procalcitonin level was (0.41±0.03)μg/L, significantly lower than 【(0.67±0.05)μg/L, P<0.05】 in the control; serum JAK2 level was (24.8±6.1) pg/mL, much lower than , serum STAT3 level was (152.2±16.1) ng/L, significantly lower than , and serum MCP-1 level was (24.8±6.1) pg/mL, much lower than in the control; the incidence of postoperative complications in the observation group was 6.9%, much lower than 20.8% (P<0.05) in the control.Conclusion The application of laparoscopic regular hepatectomy or lobectomy in treatment of patients with IHS was efficacious, which might be related the reduction of serum inflammatory factors, JAK2, STAT3, MCP-1 levels, and warrants further clinical investigation.

Objective The purpose of this study was to investigate the combination of endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) in treatment of patients with non-expansive extrahepatic bile duct stones. Methods The clinical data of 120 patients with non-expansive extrahepatic bile duct stones were admitted to the Department of Hepatobiliary Surgery in our hospital between July 2017 and May 2019, and were randomly divided into control (n=60) and observation group (n=60), underwent EST or EST and EPBD combination surgery. Results 7 days after the operation, the white blood cell (WBC) counts in the observation group was (7.8±1.4) ×10⁹/L, not statistically significantly different as compared to (7.6±1.2) ×10⁹/L in the control (P>0.05), serum cyclooxygenase-2 level in the observation group was (45.3±11.7) ng/mL, not much different to (49.6±15.2) ng/mL, blood procalcitonin (PCT) level was (0.4±0.3) g/L, not significantly different to (0.4±0.2) g/L, serum C-reactive protein (CRP) level was (8.7±2.9) mg/L, not significantly different to (8.4±3.2) mg/L, serum tumor necrosis factor-α (TNF-α) level was (0.5±0.2) ng/mL, not significantly different to (0.5±0.2) ng/mL, blood amylase level was (60.1±16.7) U/L, not significantly different to (58.7±15.3) U/L in the control (P>0.05); the total incidence of complications in the observation group was 25.0%, not statistically significantly different compared with 31.7% (P>0.05) in the control; the successful rate of primary stone removal in the observation group was 98.3%, significantly higher than 86.7% in the control, and the mechanical gravel rate was 5.0% and the stone recurrence rate was 3.3%, both significantly lower than 16.7% and 15.0%, respectively, (P<0.05) in the EST-treated patients.Conclusion The combination of EST and EPBD in the treatment of patients with non-dilated extrahepatic bile duct stones has a higher successful rate of one-step stone extraction, with less postoperative stone recurrence, which warrants further clinical investigation.

Objective The purpose of this study was to explore the application of pre-operational three-dimensional visualization technology (3DVT) by CT scan in guiding operation in patients with complex hepatolithiasis. Methods 174 patients with complicated hepatolithiasis were admitted to our hospital between January 2016 and January 2018, and all patients underwent upper abdominal spiral CT plain scan with dynamic enhanced scan before surgery. After obtaining high-quality thin-slice CT data, the 3d visualization reconstruction was completed under the medical image three-dimensional visualization system. The surgical planning was formulated. Results The three-dimensional reconstruction was eventually completed in all the patients, and the simulated surgical scheme was completely consistent with the actual surgical operation; 81 out of 174 patients underwent exploration of common bile duct incision, and 93 patients underwent partial hepatectomy due to the presence of multiple stones and/or atrophicliver lobes or segments; the volume of pre-resected liver was (241.8± 26.5) mm³, and the actual volume of resected liver was (239.4 ± 24.8) mm³(P>0.05);during a follow-up of 24 to 32 months, 174 patients survived, and the CT scan found relapse of stones in 11patients(6.3%).Conclusion The application of 3DVT technology in the preoperative evaluation of complex hepatolithiasis is helpful to make up surgical plans, and guide the operation, which might precisely resect the hepatic lobe and improvethe clearance of stones in patients with complicated hepatolithiasis.

Objective Liver fibrosis is caused by excessive deposition of extracellular matrix in liver tissues due to repeated liver injuries and hypoxia injury is a part of liver injury. Hypoxia inducible factor-1 α (HIF-1α) is a key transcription factor in response to hypoxia stress, and its expression in liver fibrotic tissues and activated HSCs is significantly increased. At present, a number of HIF-1α dependent genes and related signaling pathways have been studied to confirm that the changes of these genes and pathways are related to the development of liver fibrosis, suggesting that HIF-1α may play a key role in liver fibrosis. In this review, the mechanism of HIF-1α-related signaling pathway in the development of liver fibrosis and the synthesis and degradation of HIF-1α from the upstream are described.

Objective Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children and adults all over the world. Sarcopenia is a syndrome caused by continuous loss of skeletal muscle mass, strength, and functions. As sarcopenia progresses, lean body mass may decrease while fat mass increases, resulting in sarcopenic obesity. Sarcopenic obesity is associated with NAFLD and its development. Although most of the previous studies have demonstrated the positive correlation between sarcopenia and NAFLD, the difference in diagnostic methods of sarcopenia and NAFLD leads to difficulties in interpretation and application. This review mainly discusses the impact of sarcopenic obesity on NAFLD and the diagnosis and treatment strategies when the two coexist.