Hepatocellular carcinoma is a common malignant tumor with a very heavy disease burden in China. Screening and surveillance are effective measures to improve the early diagnosis and treatment and survival rate of patients with hepatocellular carcinoma. Chronic hepatitis B virus infection is the main cause of hepatocellular carcinoma, so it is necessary to formulate special screening and surveillance strategies in China. The Chinese Foundation for Hepatitis Prevention and Control organized relevant domestic experts to review domestic and foreign guidelines, combined with current research progress and clinical practice experience, to form a review, with aim to provide standard reference and improve preventive control and outcome effectiveness for HCC screening and surveillance in patients with chronic HBV infection.

Objective The experiment aimed to study the protective effects and its mechanism of caffeic acid phenethyl ester (CAPE) on the lipotoxicity of hepatocytes in vitro. Methods Wild type L02 cells and peroxisome proliferator-activated receptor coactivator 1α (PGC1α) knockdown LO2 cells were respectively divided into control, palmitate- and palmitate plus CAPE-intervened groups. In palmitate-intervened group, the cells were cultured at 300 mM palmitate for 7 days, and in palmitate plus CAPE-intervened cells were cultured at 10μM CAPE and 300mM palmitate for 7 days. Cell triglycerides (TG), and tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels in the supernatants were detected. The mitochondrial reactive oxygen species (ROS) was measured by flow cytometry, the PGC1α and superoxide dismutase 2 (SOD2) mRNA were detected by qPCR, and the PGC1α proteins were detected by Western blotting. Results The cell TG level in palmitate-intervened group was (16.92±1.43)mg/g protein, significantly higher than [(10.53±0.81)mg/g protein, P<0.05] in palmitate plus CAPE-intervened group; the TNF-α and IL-6 levels in supernatants were (117.6±3.72)pg/ml and (67.9±2.7)pg/ml, both significantly higher than [(74.88±3.37)pg/ml and (53.94±2.39)pg/ml, respectively, P<0.05] in palmitate plus CAPE-intervened group; the ROS level was (1.7±0.06), much higher than [(1.36±0.04), P<0.05] in palmitate plus CAPE-intervened group; the SOD2 and PGC1α mRNA levels in palmitate plus CAPE-intervened group were (0.76±0.03) and (0.73±0.04), significantly higher than [(0.55±0.05) and (0.57±0.03), P<0.05] in palmitate-intervened group; the PGC1α protein expression was more strong than in palmitate-intervened group. After PGC1α knockdown, the cell TG level in palmitate plus CAPE-intervened knockdown L02 cells was (23.73±1.95)mg/g protein, not significantly different compared to (25.86±1.02)mg/g protein in palmitate-intervened cells (P>0.05), supernatant TNF-α and IL-6 levels were (128.33±4.41)pg/ml and (80.33±3.76)pg/ml, not significantly different compared to (145.78±5.79)pg/ml and (87.23±4.85)pg/ml in palmitate-intervened cells (P>0.05); the mitochondrial ROS level was (1.83±0.25), also not significantly different compared to (2.05±0.14) in palmitate-intervened group (P>0.05). Conclusion The CAPE could effectively protect the L02 cells from lipotoxicity, which might be through PGC1α pathway activation.

Objective This experiment aimed to investigate the protective effects and mechanisms of berberine (BBR) on hepatic steatosis by activation of KLF4 via targeting HDAC/H3K9ac in palmitic acid (PA)-induced HepG2 cells in vitro. Methods HepG2 cells were induced by PA to construct hepatocyte steatosis model. The fat deposition was determined by oil red O staining. The cellular HDAC1, H3K9ac, KLF4, SREBP-1c and PPARγ expression was assayed by Western blot. The H3K9Ac in the KLF4 promoter region was determined by chromatin immunoprecipitation (ChIP). The supernatant cytokine levels were identified by ELISA kits. The KLF4 gene was silenced by siRNA to verify the protective effects of BBR by targeting HDAC/H3K9Ac/KLF4 in PA-induced HepG2 cells. Results The BBR treatment significantly improved lipid deposition in PA-induced HepG2 cells compared to that in model cells, and the supernatant TNF-α, IL-1β and IL-6 levels were (514.7±46.4) pg/ml, (241.5±37.7) pg/ml and (362.7±19.9) pg/ml, significantly lower than [(1162.0±110.8) pg/ml, (635.8±73.4) pg/ml and (1110.0±85.1) pg/ml, respectively, P < 0.001] in the model; the expression of HDAC1 protein in BBR-intervened group decreased by 19.0%, while the expression of H3K9ac and KLF4 protein increased by 1.53 and 1.52 times, the level of H3K9ac in KLF4 promoter region increased by 3.97 times, and the expression of lipid synthesis related gene SREBP-1c protein decreased by 49.1%, the expression of lipid decomposition related gene PPARγ protein increased 1.84 times compared to in the model cells; compared with empty plasmid transfection, the expression level of HDAC1 protein in cells transfected with eukaryotic plasmids was increased by 2.02 times, and the expression level of H3K9Ac protein was decreased by 57.1%; compared with SiRNA-NC transfection, the KLF4 protein expression level in HepG2 cells after SiRNA-KLF4 transfection was significantly decreased (P < 0.01), lipid deposition was significantly increased, the levels of TNF-α, IL-1β and IL-6 were (887.9±89.9) pg/ml, (471.9±38.4) pg/ml and (793.1±59.3) pg/ml, significantly higher than [(534.2±46.1) pg/ml, (260.3±26.9) pg/ml and (372.0±30.6) pg/ml, P < 0.01] in SiRNA-NC transfected cells, and the expression of lipid synthesis related gene SREBP-1c protein was increased by 1.77 times, while the expression of PPARγ protein associated with lipid decomposition decreased by 41.6%. Conclusion Taking together, the findings in the present study indicate that BBR protects from cell steatosis and inflammatory reactions by activation of KLF4 via regulating HDAC1/H3K9ac in PA-induced HepG2 cells, which provides the insight into new therapeutic approaches for patients with non-alcoholic fatty liver disease management.

Objective The aim of this experiment was to investigate the impact of yes-associated protein (YAP)signal on hepatic ductular reaction in mice with choline-deficient and ethionine-supplemented (CDE) diet-induced chronic liver injury (CLI) and YAP's effect on liver progenitor cell proliferation in vitro. Methods The male wild-type C57BL/6J mice were fed with CDE diet for 3 weeks. The Western blot and qPCR were applied to detect YAP protein and gene levels in liver tissue. The immunohistochemistry were used to detect hepatic ductular reaction, the immunofluorescence to evaluate the YAP expression in ductular reaction cells, and the two-step perfusion method was used to isolate primary liver progenitor cells. The liver progenitor cells were infected by lentivirus and were divided into YAP overexpression (YAP-OE group),overexpression empty vector(OE-control group),YAP knockdown(shYAP group), and knockdown empty vector(sh-control group). The infection efficacy was evaluated by Western blot. CCK8 and EdU experiments were applied evaluate the effects of YAP on the liver progenitor cell proliferation. Results The expression of YAP protein inliver tissues in the CDE-induced model increased greatly compared to in the control group and the YAP mRNA level increased by 2.45 times than that in the control group (P＜0.01); the degree of hepatic ductular response in the CDE model and the YAP mRNA level in liver progenitor cells were higher than in the control group; the EdU test found that under the same culture conditions, the percentage of EdU positive cells in the YAP-OE group was significantly increased compared to in the OE-control group [(0.41±0.05) vs. (0.25±0.06), respectively, P＜0.01]; the CCK8 detection showed that the proliferation activity of cells in the YAP-OE group was 1.78 times higher than that in the OE-control group at 72 hours of culture (P＜0.01); the EdU test found that the proportion of EdU positive cells in the shYAP group was significantly lower than that in the sh-control group [(0.25±0.04) vs. (0.13±0.02), respectively, P＜0.01]; the CCK8 detection indicated that the proliferation activity of cells in the shYAP group was 1.92 times lower than that in the sh-control group after 72 hours of culture (P＜0.01). Conclusion The CDE diet could induce chronic liver injury in mice, which results in the increase of YAP expression in progenitor cells with active ductual response. The YAP might promote the proliferation of liver progenitor cells in vitro.

Objective The aim of this experiment was to investigate the effect of trimetazidine on the expression of NOX2 and NOX4 in liver tissues of mice with D-Galn/LPS-induced acute liver failure (ALF). Methods 65 male C57BL/6 mice were randomly divided into control, model, low-, moderate- and high-dose of trimetazidine, as wells as reduced glutathione-intervened group, 10 in each except for those (n=15) in the model. The ALF model was established by D-Galn/LPS intraperitoneal injection. The liver tissue homogenate malondialdehyde (MDA) and peroxidase (CAT) levels were detected, and hepatic NOX2/4 mRNA levels and protein expression were assayed by RT-PCR and Western blot. Results Serum ALT, AST and hepatic MDA levels in model group were (121.4±3.7)U/L,(208.9±27.4)U/L and (51.0±20.5)nmol/mg, all significantly higher than [(35.3±3.2)U/L, (49.9±4.4)U/L and (14.1±5.2) nmol/mg, P＜0.05] in the control, while hepatic CAT level was (51.7±16.8)U/mg, significantly lower than [(110.2±33.7)U/mg, P＜0.05] in the control; the hepatic NOX2/4 mRNA level and their protein expression in the model were (8.2±2.0)/(1.2±0.1) and (2.6±0.1)/(1.3±0.1), significantly higher than [(1.0±0.2)/(0.5±0.1) and (1.0±0.1)/(0.4±0.1), P＜0.05] in the control, serum ALT, AST and hepatic MDA levels in moderate- and high-dose trimetazidine-intervened groups were (86.4±1.00)U/L, (154.0±6.2)U/L and (22.5±1.9)nmol/mg, as well as (81.1±1.5)U/L, (134.7±5.3)U/L and (20.1±3.7)nmol/mg, significantly lower than [(121.4±3.7)U/L, (208.9±27.4)U/L and (51.0±20.5) nmol/mg, P＜0.05] in the model, hepatic CAT level were (99.4±15.5) and (102.3±15.5), significantly higher than [(51.6±16.8), P＜0.05] in the model; hepatic NOX2/4 mRNA levels and their protein expression were (5.6±0.2)/(0.7±0.0) and (5.2±1.4/0.6±0.1) as well as (1.7±0.2)/(0.7±0.2) and (1.5±0.1)/(0.6±0.2), significantly lower than [(8.2±2.0)/(1.2±0.1) and (2.6±0.1)/(1.3±0.1), P＜0.05] in the model. Conclusion Trimetazidine might inhibit the oxidative stress by down-regulation of hepatic NOX2/4 expression and improve the liver functions in D-Galn/LPS-induced mice.

Objective The aim of this study was to serum interleukin-38 (IL-38) and β2 glycoprotein I(β2GPI) levels in rats with autoimmune hepatitis (AIH) and their relationship with liver tissue lesions. Methods The AIH model was established by liver-specific lipoprotein and complete Freund' s adjuvant intraperitoneal injection. The liver tissues was obtained for phthological examination, and serum IL-38 and β2GPI levels were detected by ELISA. Results SerumIL-38 level in 8 AIH rats with severe hepatic injuries was (63.8±9.5)pg/ml, significantly lower than in 17 rats with mild or 15 rats with moderate hepatic injuries [(100.3±16.9)pg/ml and (85.1±11.3)pg/ml, respectively, P<0.05), while serum β2GPI level was (4005.9±428.6)μg/L, significantly higher than in rats with mild or moderate hepatic injuries [(2752.1±310.9)μg/L and (3190.5±362.7)μg/L, respectively, P<0.05]; serum IL-38 level in 6 rats with hepatic vascular lesion grade 3 was (39.5±6.9)pg/ml, significantly lower than in 18 rats with grade 1 or 16 rats with grade 2 hepatic vascular lesions [(102.1±17.2)pg/ml and (88.4±11.5)pg/ml, respectively, P<0.05], while serum β2GPI level was (3866.3±401.7)μg/L, much higher than in rats with grade 1 or 2 [(2779.3±309.0)μg/L and (3341.5±370.2)μg/L, respectively, P<0.05]. Conclusion Serum IL-38 levels decrease, while serum β2GPI levels increase with the deterioration of liver tissue injuries in rats with AIH, and the balance of the two cytokines might take part in the pathogenesis of AIH, which needs further investigation.

Objective This experiment aimed to explore protective effect of saikosaponin A (SSa) on hepatic steatosis in rats with non-alcoholic fatty liver disease (NAFLD) by affecting peroxide proliferator activated receptor α(PPARα) signaling pathway. Methods 46 rats were randomly divided into control (n=10), NAFLD model (n=12), SSa-intervened (n=12) and SSa plus GW6471-intervened group (n=12), and NAFLD model was established by high fat diet feeding. After the model completed, the normal saline, or SSa or SSa and GW6471 were given by gavage and intraperitoneal injection, respectively. The hepatic adenosine 5′-monophosphate-activated protein kinase (AMPK), p-AMPK and PPARα expression was detected by Western blotting. The fasting blood glucose (FBG), fasting insulin (FINS) and insulin resistance index (HOMA-IR) were detected and culculated. Results The FBG, FINS and HOMA-IR in model group were (10.2±1.2)mmol/L, (24.2±2.3)mU/L and (11.0±2.1), significantly higher than [(4.7±0.5)mmol/L, (15.3±2.1)mU/L and (3.2±0.4), respectively, P<0.05] in the control, while they decreased greatly in SSa-intervened group as compared to those in the model (P<0.05), e.g. (6.3±0.7)mmol/L, (18.6±2.5)mU/L and (5.2±0.6), respectively, and they increased in SSa and GW6471 combination group as compared to in the SSa-intervened group [(8.1±1.0)mmol/L, (21.7±2.8)mU/L and (7.8±0.9), respectively, P<0.05]; the hepatic index, hepatic TC, TG and free fatty acid levels in the model were (3.3±0.3)%, (0.8±0.1)mmol/g, (1.1±0.1)mmol/g and (543.6±62.7)mmol/g, significantly higher than [(2.2±0.2)%,(0.3±0.1)mmol/g,(0.5±0.1)mmol/g and (406.5±58.9)mmol/g, P<0.05] in the control, they decreased greatly in SSa-intervened group compared to in the model, and they increased greatly in SSa and GW6471 combination intervention group compared to in SSa-intervened group (P＜0.05); the hepatic steatosis improved obviously in SSa- and SSa plus GW6471-intervened groups compared to that in the model; the hepatic PPARα expression and the p-AMPK/AMPK expression ratio in the model decreased greatly compared to in the control (P＜0.05), while they both elevated in SSa-intervened group (P＜0.05), and they decreased obviously in SSa and GW6471-intervened group (P＜0.05). Conclusion SSa could improve hepatic steatosis in rats, which might be related to the activation of PPARα signaling pathway and inhibit insulin resistance.

Objective The aim of this study was to investigate the corrlation of peripheral blood mononuclear cell (PBMC) galectin-3 levels in patients with chronic hepatitis B (CHB) receiving interferon-α therapy. Methods 106 patients with CHB were enrolled in our hospital for treatment between December 2016 and December 2019, and all patients with CHB were treated with peginterferon α-2a (peg-IFN-α-2a) for 48 weeks and followed-up for 24 weeks. The peripheral blood mononuclear cells were isolated, and relative galectin-3 levels were detected by PCR and Western bloting. Results At the end of 24 week treatment, 27 patients (22.6%)got complete response, and at the end of 48 week treatment, 44 patients (67.0%) responded to anti-viral therapy; at presentation, serum AST, ALT and HBV DNA levels in patients responded at 24 week were(122.8±98.2)U/L,(108.1±51.1)U/L and (6.3±0.6)lg copies/ml, not significantly different compared to (124.2±94.7)U/L, (113.1±47.3)U/L and (6.5±0.8)lg copies/ml in patients responded at 48 week, and also not significantly different compared to (121.9±97.4)U/L, (96.1±56.4)U/L and (6.8±0.9)lg copies/ml in non-responders (P>0.05); the PBMC galectin-3 mRNA level was (3.0±0.5) and its protein level was (1.4±0.2) in patients responded at 24 week, significantly higher than [(1.8±0.4) and (0.9±0.1), respectively, P<0.05] in patients responded at 48 week or [(1.1±0.2) and (0.8±0.1), respectively, P<0.05] in non-responders. Conclusion The galectin-3 levels in peripheral blood mononuclear cells is closely related to the response to anti-viral treatment in patients with CHB, and it might predict the outcome of patients with CHB after interferon-α therapy.

Objective The aim of this clinical trial was to investigate the response of peginterferon-α-2a (PEG-IFNα-2a)and ribavirin combination in treatment of patients with chronic hepatitis C and its impact on resting energy expenditure (REE) and nutritional status. Methods Forty-eight patients with CHC were enrolled in this clinical trial between April 2017 and April 2019, and were randomly divided into observation and control group, with 24 cases in each group. The patients in the observation group were treated with PEG-IFNα-2a and ribavirin, and those in the control group were treated with interferon α-2a (IFNα-2a) and ribavirin combination for 48 weeks. The REE, predicted REE (pREE) as well as body mass index (BMI) and serum prealbumin (PA) and albumin (ALB) levels were obtained. Results At the end of 48 week treatment and 6 month of followed-up, the complete response in the observation group were 62.5% and 54.2%, both significantly higher than 37.5% and 29.2% in the control (P＜0.05); at presentation, the REE and pREE in the observation were (1504.6±481.5)kcal/d and (1432.3±229.3)kcal/d, both increased to (1822.1±546.7)kcal/d and (1241.8±208.6)kcal/d at the end of the treatment, and they were (1505.2±482.1)kcal/d and (1433.5±231.2)kcal/d in the control before treatment, and they also increased to (1824.4±547.6)kcal/d and (1243.1±208.8)kcal/d at the end of the regimen, not significantly different between the two groups (P>0.05); before treatment, the BMI, serum PA and ALB levels in the observation were (19.2±2.0)kg/m², (161.5±45.2)mg/L and (38.4±4.2)g/L, they decreased to (17.1±1.5)kg/m², (135.8±40.2)mg/L and (34.2±3.2)g/L at the end of the treatment, and those in the control before treatment were (19.3±2.1)kg/m², (161.3±45.0)mg/L and (38.5±4.4)g/L, and all decreased to (17.2±1.5)kg/m², (136.3±40.2)mg/L and (34.2±3.1)g/L at the end of the treatment, without significant differences between the two groups (P>0.05). Conclusion Compared with IFNα-2a and ribavirin combination, the application of PEG-IFNα-2a and ribavirin in treatment of patients with CHC could achieve a better virological response, while no matter IFNα-2a or PEG-IFNα-2a might increase resting energy expenditure and induce malnutrition, which warrants clinical attentions.

Objective The aim of this study was to investigate the screening of patients with hepatitis C in the real world, and the efficacy of sofosbuvir and velpatasvir in patients with hepatitis C. Methods Serum anti-HCV screening was carried out in 3966 inpatients and outpatients in our hospital between September 2017 and September 2019, and the confirmed patients with chronic hepatitis C (CHC) received sofosbuvir and velpatasvir treatment for 12 weeks. Results Among the 3966 patients screened, serum anti-HCV positive was 2.0% (80/3966), and out of the 80 patients with anti-HCV positive, 42 cases had their serum HCV RNA loads tested and 40 cases (95.2%) were positive; in the 40 patients with CHC, there were 12 cases without any obvious symptoms and signs, 18 cases had abdominal distension, fatigue and anorexia, 10 cases had vascular spider, liver disease face, liver palms, and splenomegaly; there were 35 cases having serum AST level ＞90 U/L, 4 cases having mildly elevated serum AST level and 1 case having normal serum AST level; 3 cases had mixed HBV/HCV infection; the B-mode ultrasound examination showed normal liver in 14 cases, and increased intrahepatic light spots in 26 cases; in 40 patients with CHC treated with sofosbuvir and velpatasvir, the early virologic response, rapid virologic response, the end treatment virologic response, sustained virologic response, none response and recurrence rates were 75.0%, 80.0%, 82.5%, 72.5%, 10.0% and 10.0%, respectively; serum bilirubin level in patient after 12 weeks of treatment was (30.7±4.3) μmol/L, significantly lower than [(80.4±15.6) μmol/L, P＜0.05] before treatment, and serum AST level was (72.5±18.6) U/L, significantly lower than [(247.7±110.4) U/L, P＜0.05] before treatment; serum albumin level was (49.2±11.5) g/L, significantly higher than [(35.9±9.2) g/L, P＜0.05] before treatment; the incidence of adverse reactions was 22.5% in our series. Conclusion The prevalence of hepatitis C in the real world is relatively high, and the screening of infection is of great importance. The application of sofosbuvir and velpatasvir in the treatment of patients with hepatitis C has a promising clinical efficacy, with a good serum virological response and safety.

Objective The aim of this study was to explore the clinical implication of long non-coding RNA high expression in HCC (LncRNA-HEIH) in serum and exosomes in patients with chronic hepatitis C (CHC). Methods 77 patients with CHC and 40 CHC and 40 patients with hepatocellular carcinoma (HCC) were recruited in this study betweenSeptember 2017 and July 2020, and LncRNA HEIH in serum and exosomes were detected by RT-PCR. The patients received peg-interferon-α and ribavirin therapy for six months and liver biopsies. The multivariate Logistics regression analysis was done, and the prognostic value of LncRNA HEIH in serum and exosomes was analyzed by ROC curves. Results Serum and exosome LncRNA HEIH levels in patients with CHC were (2.3±0.2) and (3.6±0.6), both significantly lower than [(13.4±2.5) and (8.6±1.5), respectively, P<0.05] in patients with HCC; serum and exosome LncRNA HEIH levels in 53 patients with hepatic G0-G1 inflammatory activity were (2.5±0.3) and (3.9±0.6), significantly higher than [(1.9±0.4) and (2.9±0.5), respectively, P<0.05] in 24 patients with significant hepatic inflammatory activity (>G2), and serum and exosome LncRNA HEIH levels in 62 patients with S0-S1 hepatic fibrosis were (2.6±0.4) and (4.1±0.7), significantly higher than [(1.6±0.4) and (2.5±0.5), respectively, P<0.05] in 15 patients with significant hepatic fibrosis (>S2); serum and exosome LncRNA HEIH levels in 59 CHC patients responsive to antiviral therapy were (2.8±0.4) and (4.1±0.6), both significantly higher than [(2.1±0.5) and (3.4±0.6), respectively, P<0.05] in 18 patients nonresponsive to antiviral therapy; the AUC of serum and exosome LncRNA HEIH levels in predicting significant liver histologic activity index (HAI) or hepatic fibrosis were 0.764-0.778 or 0.723-0.736, suggesting some valuable in clinical practice. Conclusion Abnormal serum and exosome LncRNA HEIH levels exist in patients with CHC patients, and the surveillance of them might help predict the hepatic HAI and the response to antiviral therapy.

Objective The aim of this study was to investigate the changes of serum chemokine C-C-motif ligand 4 (CCL4) and C-X-C motif chemokine ligand 10 (CXCL10) levels in patients with autoimmune hepatitis (AIH). Methods A total of 72 patients with AIH were enrolled in our hospital between December 2016 and December 2020, and all patients received liver biopsy and standardized treatment recommended by related the guidelines for more than 2 years. Serum chemokines CCL4 and CXCL10 were detected by ELISA. Results At the end of two year treatment, 25 patients got complete response (CR) and 47 patients got incomplete response (IR); serum CCL4 and CXCL10 levels ad admission in patients with CR were (46.4±18.4)pg/ml and (42.2±8.5)pg/ml, significantly lower than [(61.3±22.6)pg/ml and (89.1±47.4)pg/ml, respectively, P<0.05] in patients with IR; the abnormal blood coagulation function tests was found in 26 patients out of our series, and all of them were IR patients; the PT, APTT and TT levels in patients with CR were (11.8±1.3) s, (29.6±2.2) s and (15.6±1.2)s, significantly lower than [(13.9±3.6)s, (41.3±6.2)s and (18.9±1.9)s, respectively, P<0.05], while the FIB was (3.1±0.8)g/l, significantly higher than [(3.7±1.2)g/l, P<0.05] in patients with IR; serum CCL4 and CXCL10 levels in patients with normal blood coagulation function tests were (50.2±16.5)pg/ml and (66.3±18.2)pg/ml, significantly lower than [(68.0±24.2)pg/ml and (85.5±39.7)pg/ml, P<0.05] in patients with abnormal blood coagulation function tests. Conclusion Serum chemokines CCL4 and CXCL10 levels in patients with AIH might predict the response to immunosuppression therapy, which needs further clinical trials to verify it.

Objective The aim of this study was to explore plasma cytotoxic T lymphocyte associated antigen-4 (CTLA-4) gene polymorphisms in patients with primary biliary cholangitis(PBC). Methods A total of 30 patients with PBC and 35 healthy persons were included in our hospital between September 2015 and December 2020, and the gene polymorphisms of CTLA-4 at rs231775, rs4675369 and rs7599230 loci were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The Logistic regression analysis was applied to reveal the risk factors for PCB occurrence. Results The percentages of CTLA-4 genotypes (CC, CT, TT) at rs7599230 locus in patients with PBC were 16.7%, 46.7% and 36.6%, not significantly different compared with those in healthy persons (20.0%,45.7%, 34.3%, respectively, P>0.05), and the percentages of alleles (C, T) in patients with PBC were 40.0% and 60.0%, also not significantly different compared with those in healthy individuals (42.9% and 57.1%, respectively, P>0.05); the percentages of CTLA-4 genotype GG and allele G at rs231775 locus in patients with PBC were 40.0% and 61.7%, significantly higher than 14.2% and 35.7% in healthy persons (P<0.05), while the percentages of of AA genotype and allele A were 16.7% and 38.3%, significantly lower than 42.9% and 64.3% in healthy persons (P<0.05); the percentages of CTLA-4 genotype GG and allele G at rs4675369 locus in patients with PBC were 43.3% and 65.0%, significantly higher than 17.1% and 41.4% in healthy individuals (P<0.05), while the percentages of AA genotype and allele A were 13.4% and 35.0%, significantly lower than 34.3% and 58.6% in healthy control (P<0.05); after the correction of gender and age by unconditional Logistic regression model, we found that the GG genotype at rs4675369 locus (OR: 1.523, 95%CI: 1.113-2.085) and the GG genotype at rs231775 locus (OR:1.636, 95%CI: 1.161-2.305) were the risk genotype for the occurrence of PBC. Conclusion Our findings suggest that the GG genotype at rs231775 and rs4675369 loci of CTLA-4 gene might be the susceptible genotype for PBC occurrence, and needs further investigation.

Objective The aim of this study was to explore the clinical implication of serum cytokeratin 18 fragment M30 (CK18-M30) and fibroblast growth factor-21 (FGF-21) levels in patients with non-alcoholic steatohepatitis (NASH). Methods 85 patients with NASH and 5 healthy individuals were recruited in our hospital between October 2018 and October 2020, and liver biopsies were performed in patients with NASH. Serum CK18-M30 and FGF-21 levels were detected by ELISA. The blood glucose-lipid metabolism indexes, such as fasting blood glucose (FPG), insulin (FIN), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triacylglycerol (TG)], and homeostasis model assessment of insulin resistance (HOMA-IR) were detected by full-automatic biochemical analyzer. Results Serum FIN, FPG, TC, TG, HOMA-IR, LDL-C, CK18-M30 and FGF-21 levels in patients were (17.1±4.9)mIU/L,(5.4±1.4)mmol/L, (5.4±0.9)mmol/L, (2.0±0.6)mmol/L, (1.4±0.2), (3.6±0.6)mmol/L, (96.4±14.6)U/L and (283.6±79.2)pg/mL, all significantly higher than [(13.1±1.1)mIU/L, (4.9±0.9)mmol/L, (4.8±0.7)mmol/L, (1.5±0.2)mmol/L, (1.3±0.1), (2.6±0.5)mmol/L, (70.3±8.7)U/L and (155.3±60.4)pg/mL, respectively, P＜0.05]; serum FIN, FPG, TC, TG, CK18-M30 and FGF-21 levels in 48 patients with moderate to severe NASH were (18.4±43.9)mIU/L, (5.7±1.3)mmol/L, (5.6±0.9)mmol/L, (2.1±0.5)mmol/L, (101.9±13.9)U/L and (299.5±77.4)pg/mL, all significantly higher than [(15.3±4.2)mIU/L, (5.1±1.2)mmol/L, (4.9±0.8)mmol/L, (1.8±0.6)mmol/L, (89.3±12.5)U/L and (263.0±69.8)pg/mL, respectively, P＜0.05] in 37 patients with mild NASH; serum TC, TG, HOMA-IR, CK18-M30 and FGF-21 levels in 35 NASH patients with concomitant diseases such as hyperlipidemia, diabetes and high blood pressure, were (5.8±0.9)mmol/L, (2.2±0.5)mmol/L, (1.5±0.6), (101.7±14.3)U/L and (306.9±63.1)pg/mL, all significantly higher than [(5.1±0.8)mmol/L, (1.9±0.6)mmol/L, (1.3±0.5), (92.6±13.1)U/L and (267.2±77.9)pg/mL, respectively, all P＜0.05] in those without. Conclusion Serum CK18-M30 and FGF-21 levels increase in patients with NASH, which is correlated to the disease severity and concomitant hyperlipidemia, higher blood pressure and diabetes. The detection of serum CK18-M30 and FGF-21 levels might be helpful in assessing the diagnosis and management.

Objective The aim of this study to investigate serum uric acid (UA) levels and its clinical implications in patients with diabetes mellitus type 2 (T2DM) and concomitant metabolism-related fatty liver diseases (MAFLD). Methods A total of 514 patients with T2DM were admitted to the Department of Endocrinology and Metabolism in our hospital between 2012 and 2019, and out of them, 347 (67.5%) had concomitant MAFLD. The Logistic regression analysis was performed to analyze the risk factors for MAFLD, and the ROC curve was established to predict the performance of UA for MAFLD. Results The incidence of hyperuricemia (HUA) in our patients with T2DM was 8.2%, and the incidence of HUA in MAFLD group was 10.7%, significantly higher than 4.2% in non-MAFLD group (P<0.05); the incidence of dyslipidemia was 55.6%, significantly higher than 41.3% in non-MAFLD group (P<0.05) and the incidence of abnormal liver function tests was 45.2%, significantly higher than 31.7% in non-MAFLD group (P<0.05); the body mass index (BMI) in MAFLD group was (25.9±3.8) kg/m², significantly higher than that in non-MAFILD group [(23.9±3.1)kg/m², P<0.05]; serum alanine aminotransferase, aspartate transaminase and glutamyl transpeptidase levels in MAFLD group were 29(19,43)U/L, 18(13,25)U/L and 39(25,64)U/L, significantly higher than [21(15, 32)U/L, 15(12,20)U/L and 31(20,51)U/L, respectively, P<0.05] in non-MAFLD group; serum UA, fasting C-peptide and insulin resistance index in MAFLD group were (294.3±91.3)μmol/L, (1.9±1.0)ng/mL and 3.6 (2.9, 4.4), significantly higher than [(254.9±79.2)μmol/L, (1.6±0.8)ng/mL and 3.2(2.7,4.0), P<0.05] in non-MAFLD group; srum total cholesterol, triglyceride and high-density lipoprotein cholesterol levels in MAFLD group were (5.0±1.2) mmol/L, 2.3(1.7,3.5)mmol/L and (1.0±0.2) mmol/L, significantly different from [(4.7±1.2) mmol/L, 1.8(1.4±2.9)mmol/L and (1.1±0.4)mmol/L, respectively, P<0.05] in non-MAFLD group; the Logistic regression analysis showed that UA (OR=1.004, 95%CI: 1.001-1.006, P=0.005) was an independent risk factor for MAFLD, the ROC curve analysis showed that the area under the curve for UA to predict the occurrence of MAFLD in T2DM patients was 0.634, and when UA equal to 267.35μmol/L as the cut-off value, the diagnostic sensitivity and specificity for MAFLD were 56.8% and 66.5%, respectively. Conclusion In naïve patients with T2DM, the concomitant MAFLD, dyslipidemia, HUA and liver function impairment are common, and UA is an independent risk factor for MAFLD. The findings in our study suggest that we should not only pay attention to obesity and dyslipidemia, it is also necessary to monitor and control UA levels.

Objective The aim of this study was to summarize the clinical feature of patients with anti-tuberculosis drug-induced liver injury (DILI). Methods 142 patients with anti-tuberculosis DILI were enrolled in this study between January 2012 and March 2020, and the clinical catalogue and liver injury severity were clarified. Results There were hepatocyte injury in 109, cholestasis in 17 and mixed injury in 16 in our series; serum ALT levels in patients with hepatocyte injury, cholestasis and mixed injury were (652.5±350.6)U/L, (172.6±92.8)U/L and (380.6±218.5)U/L, significantly different among them (P<0.05), serum AST levels were (451.8±418.1)U/L, (185.5±105.2)U/L and (276.0±144.5)U/L, significantly different among them (P<0.05), serum ALP levels were (94.5±77.5)U/L, (468.8±312.8)U/L and 209.1±144.5)U/L(P<0.05), total serum bilirubin levels were (42.3±32.3)μmol/L, (126.8±103.5)μmol/L and (57.8±42.8)μmol/L(P<0.05) and serum albumin levels were (36.8±7.2)g/L, (32.2±6.8)g/L and (33.0±7.0)g/L, all significantly different among them (P<0.05); there were mild liver injury in 102, moderate liver injury in 14 and severe liver injury in 26 patients out of the 142 patients, and the clinical feature of patients with mild liver injury included more younger than 60 year old, no underlying liver disease and presented with hepatocy injury; 95 patients recovered and 47 not, and the recovered patients had more younger patients, low serum AST, ALP and bilirubin levels with relatively higher serum albumin levels, significantly different compared to those unrecovered (P<0.05). Conclusion The majority of patients with anti-tuberculosis DILI presents with hepatocyte injury, and those with low serum albumin and high total serum bilirubin levels are prone to have a poor prognosis.

Objective This study aimed to investigate the efficacy of N-acetylcysteine (NAC) and dicyclol combination in the treatment of patients with antituberculous drugs-induced liver injury (DILI). Methods Seventy-six patients with DILI caused by anti-tuberculocidal agents for pulmonary tuberculosis were enrolled in our hospital between January 2018 and January 2020, and were randomly divided into group A and group B, with 38 cases in each group. All patients received symptomatic supporting treatment and nutritional supplement without discontinuing antituberculosis medication. The patients in group A were treated with bicyclol, and those in group B received bicyclol and NAC combination therapy for one month or didn't stop until serum liver function tests recovered. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBIL), gamma glutamine transferase (GGT), superoxide dismutase (SOD), malondialdehyde (MDA), interleukin-6 (IL-6) and C-reactive protein (CRP) levels were detected. Results At the end of treatment, serum AST, ALT and GGT levels in group B were (39.3±10.5)U/L, (35.9±32.5)U/L and (58.4±10.5)U/L, significantly lower than [(75.4±14.6)U/L, (86.9±44.8)U/L and (95.8±14.5)U/L, respectively, P<0.05] in group A; serum SOD level was (83.5±8.0)U/L, significantly higher than [(74.5±7.3)U/L, P<0.05], while serum MDA, IL-6 and CRP levels were (5.0±0.8)μmol/L, (4.1±1.2)ng/L and (9.1±2.2)mg/L, all significantly lower than [(6.9±1.2)μmol/L, (6.8±2.4)ng/L and (14.5±3.7)mg/L, respectively, P<0.05] in group A; the complications such as dizziness, diarrhea, rash, fever, and nausea and vomiting in the two groups were not significantly different (18.4% vs. 15.8%, P>0.05). Conclusion The administration of bicyclol and NAC combination in treatment of patients with DILI caused by anti-tuberculosis agents could achieve a good curing efficacy with improved recovery of liver function index, which might be related to the inhibition of oxidative stress and inflammatory reactions. The long-term efficacy still needs further observation.

Objective The aim of this study was to explore the short-term prognosis of patients with acute on chronic liver failure (ACLF) and invasive fungal infection (IFI) by the model for end-stage liver disease (MELD), MELD-serum sodium (MELD-Na⁺), APASL-ACLF research consortium score (AARC-ACLF) and chronic liver failure-sequential organ failure assessment (CLIF-SOFA). Methods 60 patients with ACLF and IFI were admitted to our hospital between January 2018 and October 2020, and were given convensional supporting therapy. Thescores of MELD, MELD-Na⁺, AARC-ACLF and CLIF-SOFA were calculated. The predictive efficacy of the four prognostic scoring systems for death risk in patients with ACLF and IFI was evaluated by receiver operating characteristic (ROC) curves. Results At the end of 12 week treatment, the fatality rate in our series was 68.3%; serum bilirubin, INR, creatinine and lactate in 41 dead patients at the peak were (362.9±79.7)μmol/L,(2.3±0.2), (131.7±21.5)μmol/L and (1.6±0.4)mmol/L, all significantly higher than [(277.4±63.6)μmol/L, (1.7±0.1), (102.9±15.3)μmol/L and (1.3±0.3)mmol/L, respectively, P＜0.05], while serum albumin level was (29.6±2.2)g/L, significantly lower than [(31.8±2.7)g/L, P＜0.05] in the survivals; the incidence of hepatic encephalopathy was 43.9%, much higher than 10.5% (P＜0.05) in the survivals; the MELD, MELD-Na⁺, CLIF-SOFA and AARC-ACLF scores were (29.1±7.3), (30.4±7.5), (8.7±1.4) and (9.2±1.1), all significantly higher than [(20.7±4.6), (21.9±5.2),(6.8±1.0) and (7.3±0.8), respectively, P＜0.05] in the survivals; the ROC curves analysis showed that the AUC were 0.687, 0.716, 0.893 and 0.884 by MELD, MELD-Na⁺, CLIF-SOFA and AARC-ACLF scores, respectively, in predicting the 12-week death of patients with ACLF AND IFI, when the cut-off-value were set 22.0, 23.0, 8.0 and 8.0, suggesting the CLIF-SOFA and AARC-ACLF scoring system were superior to the other two (P＜0.05). Conclusion We recommend the AARC-ACLF and CLIF-SOFA scoring system in predicting the short-term fatality in patients with ACLF and IFI.

Objective The aim of this study was to explore peripheral blood serine protease inhibitor A1 (SERPINA1) gene polymorphism in patients with primary biliary cirrhosis (PBC). Methods 60 patients with PBC and 60 healthy persons for physical examination were recruited in our hospital between March 2018 and March 2020. The gene sequencing method was applied to detect the genotype of the rs28929474 locus of the SERPINA1 gene, and the chi-square test and the Hardy-Weinberg balance test were applied to test the genotype and allele distribution differences of the rs28929474 locus of the SERPINA1 gene between the two groups. Results The genotype distribution at the rs28929474 locus of the SERPINA1 gene in the two groups conformed to the Hardy-Weinberg equilibrium (P>0.05), which suggested the representative of the population; the frequencies of AA genotype and A allele in patients with PBC were 37.1% and 46.8%, both significantly higher than 11.7 % and 27.5 %(P>0.05), while the frequencies of GG, GA genotype and G allele were 43.5%, 19.4%, and 53.2%, all significantly lower than 56.7%, 31.7 % and 72.5 % (P>0.05) in the healthy persons, suggesting that A allelemight be a protective factor for, while G allele might be a risk factor for individuals prone to PBC; the Child score and MELD score in PBC patients with GA/AA were (7.9±1.8) and (19.2±2.4 ), significantly higher than (6.8±1.6) and (15.7±2.1) in PBC patients with GG (P>0.05) ; there was no significant difference respect to serum ANA and AMA-M2 positive rates between the two groups (P>0.05). Conclusion The susceptibility of PBC among the residents in this area might be related to the rs28929474 polymorphism of the SERPINA1 gene, the A gene might be a protective, while the G gene might be a risk gene, and monitoring peripheral blood SERPINA1 gene rs28929474 polymorphism could predict the occurrence of PBC.

Objective The aim of this study was to analyze the dyslipidemia in patients with liver cirrhosis (LC). Methods A total of 448 patients with LC were admitted to our hospital between January 2013 and December 2017, and included hepatitis B in 194, hepatitis C in 20, alcohol-induced in 46, hepatitis B or C with alcohol in 41, cryptogenic in 85, autoimmune hepatitis in 33, NAFLD in 10 and schistosomiasis in 19 cases. The blood lipid were analyzed, including total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low density lipoprotein (LDL), apolipoprotein A (APOA) and apolipoprotein B (APOB). Results Out of the 448 patients with LC, 221 cases (49.3%) had dyslipidemia, and the majority of dyslipidemia was low HDL (n=207, 93.7%); the mixed hyperlipidemia was the least (n=1, 0.5%);the blood TC in 186 patients with Child class A was (3.8±0.9) mmol/L, significantly higher than [(3.4±1.3) mmol/L,P<0.01] in 183 patients with class B, or [(3.1±1.3) mmol/L, P <0.01] in 79 patients with class C; the blood TG in class A was (1.1±0.6) mmol/L, significantly higher than [(0.9±0.5) mmol/L, P <0.05] in class B, or [(0.9±0.5) mmol/L, P <0.01] in class C; the HDL level was (1.3±0.4) mmol/L, significantly higher than [(1.1±0.4) mmol/L, P <0.01] in class B, or [(0.8±0.4) mmol/L, P <0.01] in class C; the LDL was (2.1±0.6) mmol/L, significantly higher than [(1.8±0.9) mmol/L, P <0.01] in class B, or [(1.7±0.8) mmol/L, P <0.01] in class C; the APOA was (1.1±0.3) mmol/L, significantly higher than [(0.9±0.3) mmol/L, P <0.01] in class B, or [(0.8±1.3) mmol/L, P <0.01] in class C; the APOB was (0.7±0.2) mmol/L, significantly higher than [(0.6±0.3) mmol/L, P <0.01] in class B; the proportion of dyslipidemia increased significantly with the Child-Pugh classification deteriorated, e.g., the percentages of dyslipidemia was 32.3% in class A, 52.5% in class B, and 82.3% in class C (P <0.01); the dyslipidemia was most common in patients with NAFLD associated (60.0%) and hepatitis C-induced LC (60.0%), and relatively less common in hepatitis B-induced (43.8%). Conclusion Low HDL level is the most common type of dyslipidemia in patients with LC, and as the liver function deteriorates, it becomes common.

Objective The paper aimed to investigate the prevalence of nosocomial infection and resistance of pathogens in patients with decompensated liver cirrhosis (LC). Methods A total of 67 patients with decompensated liver cirrhosis were enrolled in the Department of Infectious Diseases in our hospital between January 2018 and January 2020, and the prevalence of nosocomial infections were retrieved. The pathogens in patients with nosocomial infection was identified by VITEK-2 Compact full-automatic microbial analysis system. The drug sensitivity tests of pathogens were conducted by KB paper agar diffusion method. Results Of the 67 patients with decompensated cirrhosis, 24 cases (35.8%) were identified as with nosocomial infection, and out of which, the main infection sites were abdominal (45.8%), lung (33.3%) and urinary infection (20.8%); the percentages of younger than 60 years old, with gastrointestinal bleeding, long hospitalization and Child class C in infected patients were significantly higher than in those without infection (P<0.05), while serum albumin level and percentage of preventive administration of antibiotics in infected group were significantly lower than those in non-infected group (P<0.05); it was found by Logistic regression analysis that the age (OR=1.16, 95%CI:1.09-1.24), hospitalization time (OR=1.13, 95%CI: 1.05-1.93), gastrointestinal bleeding (OR=1.50, 95%CI: 1.09-2.09), serum albumin (OR=1.11, 95%CI: 1.02-1.20) and preventive antibiotics (OR=1.48, 95%CI: 1.21-1.81) were the impacting factors of nosocomial infection in patients with decompensated cirrhosis (P<0.05); out of the 24 patients with nosocomial infections, there were 37 strains of pathogens, including 21 strains of Gram-negative bacteria (56.8%), 11 strains of Gram-positive bacteria (29.7%) and 5 strains of fungi (13.5%) separated; the resistance rate of Escherichia Coli was high to ampicillin and piperacillin, the resistance rate of Klebsiella Pneumoniae to antimicrobial agents was lower than 16.7%, and that of Staphylococcus Aureus to gentamicin was higher than 60.0%. Conclusion The risk of nosocomial infection is high in patients with hospitalized decompensated liver cirrhosis, and its influencing factors are many and complex. The common pathogens are mainly Gram-negative bacteria, but the drug resistance of pathogens is also common. In clinical practice, it is necessary to pay more attention to high-risk infection population. When necessary, the preventive administration of sensitive antibacterial agents is of particularly importance to reduce the occurrence of secondary nosocomial infection in patients with decompensated cirrhosis.

Objective The purpose of this study was to investigate the effect of probiotics on intestinal barrier function of patients with liver cirrhosis (LC) complicated with spontaneous bacterial peritonitis (SBP). Methods 120 LC patients with SBP were admitted to our hospital between January 2018 and January 2020,and were randomly divided into control (n=60) and observation group (n=60). The patients in the control were given conventional supporting treatment and antimicrobial therapy, and those in thecombination were treated with enteric solution of triple viable bifidobacterium capsule for 14 days. Serum tumor necrosis factor-α (TNF-α), C - reactive protein (CRP), procalcitonin (PCT), soluble myeloid cells trigger receptor 1 (sTREM - 1), monocyte chemotactic protein 1 (MCP 1), D - lactic acid (D-Lac), diamine oxidase (DAO), lipopolysaccharide (LPS), closed tight junction protein (occludin) and small atresia with protein 1 (ZO - 1) were detected. Results At the end of 14 day treatment, the total effective rate in the observation group was 90.0%, significantly higher than 73.3% in the control group (P＜0.05); serum TNF-α, CRP, PCT, STREm-1 and McP-1 levels in the observation group were (28.1±5.0) ng/L, (14.0±2.6) mg/L, (1.1±0.2) g/L, (74.1±10.2) ng/L and (150.5±20.5) ng/L, all significantly lower than [(39.1±6.2) ng/L, (19.6±2.9) mg/L, (1.9±0.2) g/L, (114.2±12.9) ng/L and (204.1±26.5) ng/L, respectively,P<0.05] in the control; serum D-Lac, DAO, LPS, occludin and ZO-1 levels in the observation group were (4.6±0.6) mg/L, (2.7±0.4)κU/L, (0.5±0.1)κEU/ L,(0.5±0.1) and (0.4±0.1), all significantly lower than [(8.6±0.9) mg/L, (3.9±0.5) κU/L, (0.7±0.1))ΚEU/L, (0.8±0.1) and (0.8±0.2), respectively, P＜0.05] in the control. Conclusion The application of probiotic preparations has a definite clinical efficacy in the treatment of LC patients with SBP, which could effectively inhibit the secretion of inflammatory factors and improve the intestinal barrier functions.

Objective The aim of this study was to investigate the impact of segmented injection of contrast agent, ioversol, on hepatic vein imaging by CT angiography (CTA) in patients with hepatitis B-induced liver cirrhosis (LC). Methods 62 patients with hepatitis B cirrhosis were enrolled in our hospital between March 2018 and September 2020, and were divided into observation (n=32) and control group (n=30) when CTA was underwent, with segmented injection or conventional injection of contrast medium, respectivley. The hepatic artery perfusion (HAP), hepatic portal perfusion (HPP), hepatic perfusion index (HPI) and arterial perfusion fraction (APF) were recorded. Results The imaging quality in observation was much more superior to that in the control (P<0.05); the CT value of hepatic vein [(138.6±13.4)HU vs. (125.5±11.8 )HU], of main portal vein[(218.8±41.3)HU vs. (176.9±35.8)HU],of right branch of portal vein[(204.6±31.5)HU vs. (163.3±28.7)HU] and of left branch of portal vein [(198.5±21.9)HU vs. (154.0±23.2)HU]were statistically significantly different between the two groups (P<0.05); the peak contrast media time of portal vein [(17.5±2.2)HU vs. (19.7±3.0)HU] and the peak time of liver parenchyma [(35.7±3.8)HU vs. (40.1±4.3)HU]were statistically significantly different between observation and control group (P<0.05); the HAP[(16.3±4.8) ml/min/100ml vs. (15.8±5.2) ml/min/100ml], HPP [(18.9±5.7)ml/min/100ml vs. (17.5±6.4)ml/min/100ml], HPI[(40.6±10.1)% vs. (42.2±9.6)%]and APF [(31.2±8.3)% vs. (30.9±7.5)%] in the two groups were not statistically significantly different (P>0.05). Conclusion The segmented injection of contrast medium is superior to conventional injection when CTA is done, which might give us a high-quality imaging and help us make an appropriate diagnosis.

Objective The aim of this study was to investigate the efficacy of continuous renal replacement therapy (CRRT) without heparinization in patients with liver cirrhosis complicated by hepatic encephalopathy (HE), and its influence on blood ammonia and cytokine levels. Methods 62 patients with liver cirrhosis complicated by HE were enrolled in our hospital between January 2018 and January 2021. Among them, 31 patients received conventional liver protection and anti-hepatic coma treatment (control group), and on this basis, another 31 patients were treated with CRRT without heparinization (observation group). Serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-10 levels were detected by enzyme-linked immunosorbent assay. Serum total bilirubin (TBIL), albumin (ALB) and ammonia levels were detected by fully automatic biochemical analyzer. Results The consciousness recovery time and hospital stay were(3.1±1.0)d and (8.1±1.3)d, both significantly shorter than [(4.8±1.1)d and (12.5±1.5)d, respectively, P<0.01] in the control, and the fatal rate was 6.5%, significantly lower than 25.8%(P<0.05) in the control; after treatment, serum ammonia, TNF-α and IL-6 levels were (69.3±10.5)mmol/L, (7.1±1.7)ng/L and (9.5±2.0)ng/L, all significantly lower than [(94.8±8.1)mmol/L, (9.4±1.9)ng/L and (12.4±2.5)ng/L, respectively, P<0.01] in the control, while there was no significant difference respect to serum IL-10 levels [(8.1±1.4)ng/L vs. (7.3±1.6)ng/L, P>0.01] in the two group ; total serum bilirubin level in the observation group was (41.2±8.6)μmol/L, significantly lower than [(50.4±9.7)μmol/L, P<0.05] in the control, while there were no significant differences respect to serum albumin levels [(32.9±3.2)g/L vs.(32.4±2.8)g/L] or INR [(1.2±0.4) vs. (1.3±0.4)] in the two groups (P>0.05). Conclusion The application of CRRT without heparinization is significantly efficacious in dealing with patients with liver cirrhosis and HE, and it could effectively reduce blood ammonia and cytokine levels and improve survival.

Objective The paper aimed to investigate the risk factors of rebleeding in hepatitis B liver cirrhotics with esophageal varices bleeding (EVB) after endoscopic variceal ligation (EVL). Methods 178 patients with hepatitis B liver cirrhosis (LC) with EVB were enrolled in our hospital betweenApril 2016 and October 2019, and all underwent EVL after hemostasis. A Nomogram model was established to predict the risk factors of rebleeding after multivariate Cox Logistic analysis was done. Results 12 (6.7%)patients died out of the 178 patients with EVB, and 166 patients received successful EVL in our series; at the end of 12 to 54 month follow-up, 27 patients(16.3%) had rebleeding of esophageal varices; at presentation, the peripheral blood hemoglobin and serum albumin levels in the 27 patientswith rebleeding were significantly lower than, while the fasting plasma glucose (FPG) and HbA1c levels were significantly higher than those in 139 patients without(P<0.05);the checked-up after hemostasis showed that the diameters of portal and splenic veins in patients with rebleeding were significantly wider than those in without (P<0.05); the Cox risk model analysis showed that the Child-Pugh class(95%CI=1.125-3.439, HR=1.967, P=0.018), ascites (95%CI=1.754-2.329, HR=2.021, P=0.000), HbA1c(95%CI=1.173-1.921, HR=1.501, P=0.001), FPG(95%CI=1.379-3.152, HR=2.085, P=0.000) and hepatic diabetes (95%CI=1.321-2.945, HR=2.076, P=0.006) were the independent risk factors for rebleeding after EVL; the Nomogram model was established based on the Cox analysis, and the ROC analysis showed that the area under the ROC (AUC) by theNomogram was 0.804(SE=0.053, 95%CI=0.700-0.907, P=0.000), with the sensitivity of 0.857 and the specificity of 0.565, in predicting rebleeding after EVL. Conclusion The incidences rate of rebleeding in LC patients with EVB after EVL is higher, and among others, the hepatic diabetes might be the important risk factor for rebleeding in this setting, which should be dealt with appropriately.

Objective The purpose of this study was to analyze the risk factors of acute kidney injury (AKI) in patients with hepatitis B-induced liver cirrhosis (LC). Methods 136 patients with hepatitis B-induced LC were admitted to our hospital between March 2018 and March 2020, and the clinical data were retrieved from HIS system. The AKI in 40 patients was diagnosed met with related guidelines, and the Logistic regression was applied to analyze the risk factors that affect the occurrence of AKI. Results The univariate analysis showed that the percentage of decompensated liver cirrhosis in patients with AKI was 52.5%, significantly higher than 31.3%(P<0.05) in those without, the incidence of ascites was 55.0%, significantly higher than 29.2%(P<0.05) in patients without AKI, and the hepatic encephalopathy was 22.5%, significantly higher than 4.2%(P<0.05) in those without, while there were no significant differences respect to age, gender, disease course and Child-Pugh class between the two groups (P>0.05); the multivariate Logistic regression analysis showed that compensated or decompensated liver functions, ascites, and hepatic encephalopathy were the independent risk factors for AKI occurrence in patients with hepatitis B-induced LC (P<0.05). Conclusion The patients with hepatitis B-induced LC might have AKI, especially in those with risk factors such as decompensated liver cirrhosis, ascites and complicated hepatic encephalopathy.

Objective The aim of this study was to explore the efficacy of transarterial intrahepatic transplantation of autologous bone marrow stem cells (BMSCs) in the treatment of patients with decompensated hepatitis B-induced liver cirrhosis (LC). Methods A total of 76 patients with decompensated hepatitis B-induced LC were enrolled in our hospital between January 2015 and January 2020, and 41 patients received transarterial intrahepatic transplantation of BMSCs and all patients were treated by comprehensive internal medical therapy. Results At the end of 24 week treatment, serum bilirubin level in patients receiving BMSC transplantation was (17.2±2.3)μmol/L, significantly lower than [(21.7±2.9)μmol/L, P<0.05], while serum albumin and prealbumin levels were (31.4±5.8)g/L and (241.4±54.3)mg/l, significantly higher than [(28.9±5.2)g/L and (197.8±42.7)mg/l, respectively, P<0.05] in the control; serum hyaluronic acid, type III procollagen and type IV collagen levels were (116.1±42.7)μg/L, (67.1±18.1)μg/L and (92.2±14.9)g/L, significantly lower than [(163.5±38.8)μg/L, (98.7±21.3)μg/L and (112.8±16.7)g/L, respectively, P<0.05] in the control; the percentages of peripheral blood CD3⁺ cells and CD4⁺ cells as well as the ratio of CD4⁺/CD8⁺ cells were (67.2±4.3)%, (42.8±1.2)% and (1.5±0.1), significantly higher than [(60.8±3.3)%, (37.6±4.6)% and (1.4±0.1), respectively, P<0.05] in the control; the Child-Pugh score was (7.8±1.7), and the model for end-stage liver disease (MELD) score was (14.3±2.8), both significantly lower than [(8.8±2.3) and (17.6±2.4), respectively, P<0.05] in the control. Conclusion Transarterial intrahepatic transplantation of autologous bone marrow stem cells could effectively and safely improve liver functions in patients with decompensated hepatitis B cirrhosis, which is worthy of further clinical verification.

Objective The aim of this study was to investigate the changes of serum thrombopoietin (TPO) levels and its relationship with peripheral blood platelet (PLC) counts in patients with hepatitis B liver cirrhosis (LC). Methods 72 patients with chronic hepatitis B (CHB) and 44 with LC were recruited in our hospital between January 2012 and January 2020, and serum TPO levels were detected. Results The peripheral blood PLT counts in patients with LC was 82(24,208)×10⁹/L, serum albumin (ALB)level was(31.6±6.7)g/L, the international normalized ratio of prothrombin time(INR) was (1.3±0.4), serum d-dimer level was 187(75,495)μg/L and serum TPO level was (70.4±25.8)pg/ml, all significantly different as compared to [180(36,352)×10⁹/L, (39.2±5.4)g/L, (1.1±0.2), (102.6±20.6) pg/ml and(102.6±20.6)pg/ml, P<0.05] in patients with CHB; the PLT count in 6 patients with LC of Child-Pugh class C was 56(24, 70)×10⁹/L, significantly lower than [108(66,170)×10⁹/L, P<0.05] in 14 LC patients with Child-Pugh class B or [130(76, 208)×10⁹/L, P<0.05] in 24 patients with Child-Pugh class A, serum ALB level was (22.9±7.5)g/L, significantly lower than[(32.4±6.1)g/L, P<0.05]in patients with Child-Pugh class B or [(36.5±7.9) g/L, P<0.05] in patients with Child-Pugh class A, the INR was(1.4±0.8), significantly higher than [(1.2±0.6), P<0.05] in patients with Child-Pugh class B or [(1.1±0.5), P<0.05] in patients with Child-Pugh class A, serum D-dimer was 235(114, 495)μg/L, significantly higher than [166(84, 298)μg/L, P<0.05] in patients with Child-Pugh class B or [108(75, 169)μg/L, P<0.05] in patients with Child-Pugh class A, serum TPO level was (41.4±26.5)pg/ml, significantly lower than [(60.8±23.6) pg/ml, P<0.05] in patients with Child-Pugh class B or [(88.6±14.7)pg/ml, P<0.05] in patients with Child-Pugh class A; serum TPO level was positively correlated to serum ALB and peripheral blood PLT counts(r=0.43, r=0.52, P<0.05), while it negatively correlated to INR and serum D-dimer (r=-0.38, r=-0.48, P<0.05) in patients with LC. Conclusion With the decline of liver functions, serum TPO levels and peripheral blood PLT counts decrease significantly, and the correlation of decreased PLT counts to serum TPO levels warrants further investigations.

Objective The aim of this study was to investigate gastric mucosal lesions in patients with hepatitis B and hepatitis B-induced liver cirrhosis. Methods 70 patients with chronic hepatitis B (CHB), 56 patients with liver cirrhosis and 50 healthy persons were enrolled in our hospital between January 2017 and January 2019, and all underwent gastroscopy. Serum PGI and PGII levels were detected by ELISA, and peripheral blood CD3⁺, CD4⁺ and CD8⁺ cells were detected by FCM. Results Serum PGI level in patients with hepatitis B-induced liver cirrhosis was(93.8±28.3)μg/L, significantly lower than [(135.7±21.6)μg/L, P<0.05] in healthy persons or [(116.3±32.4)μg/L, P<0.05] in patients with CHB, serum PGII level was (13.3±5.7)μg/L, significantly higher than [(9.2±2.4)μg/L, P<0.05] in healthy persons, and the ratio of serum PGI/PGII was (7.1±2.3), significantly lower than [(14.8±3.4), P<0.05] in healthy persons or [(9.6±2.9), P<0.05] in patients with CHB; the prevalences of chronic superficial gastritis in healthy persons, in patients with CHB and in patients with cirrhosis were 68.0%, 32.9% and 19.6%(P<0.05), and the incidences of mild, moderate and severe chronic atrophic gastritis in patients with cirrhosis were 37.5%, 25.0% and 17.9%, significantly different compared to 8.0%, 6.0% and 2.0% (P<0.05) in healthy persons or 37.1%, 11.4% and 5.7% (P<0.05) in patients with CHB; the percentage of peripheral blood CD3⁺ cells in patients with cirrhosis was (62.4±7.9)%, significantly lower than [(68.3±5.8)%, P<0.05] in healthy persons or [(66.4±7.4)%, P<0.05] in patients with cirrhosis, the percentage of CD4⁺ cells was (35.7±7.4)%, significantly lower than [(50.3±6.6)%, P<0.05] in healthy persons or [(45.4±6.4)%, P<0.05] in patients with CHB, while the percentage of CD8⁺ cells was (34.4±4.7)%, significantly higher than [(27.2±4.3), P<0.05] and the ratio of CD4⁺/CD8⁺ cells was (1.8±0.3), significantly lower than [(2.8±0.9), P<0.05] in healthy persons. Conclusion The chronic atrophic gastritis in patients with hepatitis B cirrhosis is common, serum PGI and PGII levels change obviously, and the mechanism involved needs further investigation.

Objective The aim of this clinical trial was to investigate the impact of HCV genotypes on the treatment response of recombinant human interferon α-2a (IFN-α-2a) in patients with chronic hepatitis C (CHC) and hepatitis C liver cirrhosis. Methods A total of 198 patients with CHC and 200 patients with hepatitis C-induced liver cirrhosis were enrolled in our hospital between January 2015 and April 2020, and all received liver biopsies and IFN-α-2a treatment for 24 weeks and followed-up for 24 weeks. Serum HCV RNA loads were detected by Roche's lightcycle real-time fluorescent quantitative PCR and the HCV genotypes were detected by gene sequencing. The liver injuries were evaluated by Knodell histological activity index scoring systems. The factors impacting response to IFN-α-2a therapy was analyzed by univariate or multivariate regression analysis. Results The percentage of HCV 1b genotype in patients with liver cirrhosis was 31.0%, significantly higher than 15.1% in 86 CHC patients with less than S1 liver fibrosis or 18.8%(P<0.05) in 112 CHC patients with S2-3 liver fibrosis; the percentage of HCV 1b genotype in 212 patients without response to IFN-α-2a therapy was significantly higher than(29.7% vs. 17.7%), and the percentage of genotype 1a was significantly lower than (17.9% vs. 28.0%, P<0.05) in 186 responders; the early virological response rate in responders was 60.8%, significantly higher than 18.9%(P<0.05), and high serum HCV RNA loads was 37.1%, significantly lower than 47.6%(P<0.05) in non-responders; the HCV 1b genotype (OR:0.553, 95%CI:0.316-0.969) was the independent risk factor, while the early response (OR:1.704, 95%CI:1.008-2.881) was the protective factor for response to IFN-α-2a therapy. Conclusion The detection of HCV genotype could predict the response to IFN-α-2a therapy in patients with CHC and CHC-induced liver cirrhosis, which might guide the selection of antiviral therapy strategy and the treatment period.

Objective The aim of this study was to evaluate the value of contrast-enhanced ultrasound (CEUS) and serum carbohydrate antigen (Ca19-9) levels in differential diagnosis of patients with intrahepatic cholangiocellular carcinoma (ICC) and hepatocellular carcinoma (HCC). Methods 48 patients with histopathological confirmed ICC and 78 patients with histopathological confirmed HCC were enrolled in this study, and all underwent CEUS and serum CA19-9 levels were detected. A binary Logistic regression model was established for the differential diagnosis of ICC and HCC. Results 45.8% ICC patients had peripheral rim enhancement of tumors at CEUS, significantly higher than 2.6% in HCC patients (P <0.05); the marked washout was found in 58.3% of ICC patients,However, 94.9% HCC patients were weak or not washout (P <0.05); the washout time in ICC group was(54.6±10.2)s, significantly earlier than (76.1±25.1)s in HCC group (P <0.05); 72.9% ICC patients had increased serum CA19-9 levels, significantly higher than 19.2% in HCC group (P<0.05); a binary Logistic diagnostic model equation was established: e.g. Logit(P)=-4.030+2.640×enhancement mode +2.486×washout time +2.579×washout degree +2.731×CA19-9 (u/ml), and the AUC was 0.943, with the sensitivity and specificity of 79.2% and 93.6% (P<0.05) in diagnosing ICC by this equation. Conclusion Compared with the diagnostic effect of a single indicator, logistic regression analysis based multi-indicator combined differential diagnosis of ICC and HCC has higher diagnostic value.

Objective The aim of this study was to investigate the efficacy of thymosin alpha 1 in maintained treatment of patients with primary liver cancer (PLC) after radiofrequency ablation (RFA). Methods A total of 75 patients with PLC and single-focal less than 5 cm were enrolled in our hospital, and all patients with PLC underwent RFA and were followed-up for 36 months to observe the relapse-free survival (RFS). After the interventional management, 35 patients received and 40 patients didn't received thymosin alpha 1 for maintained treatment for three months. Serum cytokines were detected by ELISA. Results The complete response (CR) after once RFA treatment in combination group was 80.0%, and in RFA-treated group was 82.5% (P<0.05), and all patients in the two groups got CR after second RFA or TACE; at the end of three month, there were no significant differences as respect to the changes of peripheral blood lymphocyte subset percentages (P>0.05), while serum IL-2 and IFN-γ levels in the combination group were 34.5(26.7,39.6)ng/L and 77.2(74.4,82.7)ng/L, significantly higher than [26.8(22.3, 28.4)ng/L and 64.6(59.7,75.9)ng/L, respectively, P<0.05] in the RFA-treated group; the median RFSs in the combination and control group were 26 months and 23 months (P>0.05), and the 1-year, 2-year and 3-year RFSs were 62.9%, 28.6% and 5.7%, some significantly different as compared to 55.0%, 17.5%(P＜0.05) and 0.0% in RFA-treated group; the multivariate analysis showed that the application of thymosin alpha 1, size of foci, special foci and CR after treatment were the independent factors impacting the prognosis of patientswith PLC after RFA treatment. Conclusion The administration of thymosin alpha 1 for maintained treatment after RFA might improve the survival of patients with PLC, which needs further investigation.

Objective The aim of this study was to summarize the contrast-enhanced ultrasound (CEUS) features of hepatic hemangioma (HCH), hepatocellular carcinoma (HCC)and hepatic angiomyolipoma(HAML). Methods A total of 112 patients with intrahepatic occupying lesions were encountered in our hospital between November 2017 and November 2020, and all underwent histopathological examination. The patients received conventional sonography and CEUS check-up after admission before treatment. Two experienced ultrasound physicians read the images in a blind way to observe the number, size, boundary, echo, morphology, blood supply and other information of hepatic lesions in conventional ultrasound examination, and observe the enhancement pattern at arterial phase, portal vein phase and delayed phase in contrast-enhanced ultrasound examination. Results The histopathological examination showed HCH in 39 cases, HCC in 64 cases and HMAL in 9 cases out of our series; the female accounted for 66.7% in patients with HCH, significantly higher than 18.8% in patients with HCC or 33.3% in patients with HAML (P＜0.05), the average age of patients with HCC was (57.5±5.8)yr, and that in patients with HMAL was (55.3±5.1)yr, both significantly higher than [(46.2±5.2)岁, P<0.05] in patients with HCH, the incidence of hepatitis B viral infection in patients with HCC was 76.6%, significantly higher than 28.6% in patients with HMAL or 12.8%(P<0.05)in patients with HCH; the conventional ultrasound scan showed that the proportions of unclear boundary, low echo and mixed echo of lesions in patients with HCC were 65.6%, 43.8% and 42.2%, significantly higher than 2.6%, 10.3% and 7.7% in patients with HCH or 0.0%, 11.1% and 11.1% in patients with HAML(P＜0.05), and there were no significant differences as respect to hepatic tumor number, size, shape and blood supply among lesions in patients with HCH, HCC and HAML(P＞0.05); the CEUS demonstrated the percentage of intensified enhancement of HCH lesions at arterial phase was 92.3%, significantly higher than 87.5% in HCC lesions or 88.9% in HMALlesions (P＜0.05), the proportion of low enhancement of lesions at portal phase and delayed phase in patients with HCC were 65.6% and 90.6%, both significantly higher than 5.1% and 43.6% in patients with HCH or 11.1% and 22.2% in patients with HMAL(P＜0.05). Conclusion The conventional ultrasound and contrast-enhanced ultrasonography are helpful in diagnosing and discriminating intrahepatic occupying lesions, which warrants further clinical multi-central study.

Objective This study aimed to investigate the advantage of damage control surgery (DCS) in dealing with patients with traumatic liver rupture (TLR). Methods 63 patients with TLR were admitted to our hospital between January 2016 and January 2020, and were randomly divided into group A (n=31) and group B (n=32). The vital signs of patients in the two groups were closely monitored after admission and two or more venous pathways were established. The patients in group A were treated with one-stage conventional surgery, and those in group B were treated with DCS. Serum cortisol (COR), C-reactive protein (CRP), epinephrine (EP) and interleukin-6 (IL-6) levels were detected by ELISA. Results The rescue success rate in group A was 64.5%, significantly lower than 81.3%(P=0.032) in group B; the operation time, intraoperative blood loss, body temperature-returning time and lactic acid clearance time in group B were (135.4±25.7)min, (806.1±44.9)mL,(7.5±1.3)h and (12.3±5.1)h, significantly shorter or less than 【(182.1±28.6)min, (958.7±64.2)mL, (15.8±2.4)h and (24.8±8.6)h, respectively, P＜0.05】 in group A; at the end of seven days after operation, serum COR, CRP, EP and IL-6 levels were (206.1±26.4)nmol/L, (21.2±2.7)mg/L, (225.7±21.0)ng/L and (51.5±6.0)μg/L, significantly lower than【 (228.4±28.9)nmol/L, (26.0±3.2)mg/L, (281.4±27.1)ng/L and (70.2±8.9)μg/L, respectively, P＜0.05】 in group A; serum prothrombin time, thrombin time and activated partial thromboplastin time were (16.1±1.5)s, (15.1±0.7)s and (34.0±1.9)s, significantly shorter than 【(20.4±1.7)s, (18.7±0.8)s and (39.5±2.4)s, respectively, P＜0.05】 in group A; the incidence of postoperative complications was 6.3%, significantly lower than 22.6%(P＜0.05) in group A. Conclusion The application of DCS in patients with TLR could successfully improve survival with low incidence of complications, which might be related to the inhibition of reactive stress and the improvement of coagulation functions.

Objective The aim of this study was to analyze the impact of periampullary diverticula (PAD) on surgical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in dealing with patients with choledocholithiasis. Methods A total of 275 patients with choledocholithiasis were admitted to our hospital between December 2016 and December 2019, and the presence of PAD were found in 101 patients, a papillary diverticulum in 37 cases and non-papillary diverticulum in 64 cases. All patients underwent ERCP for removal of stones. Results The success rates of intubation in patients with PAD and without PAD were 95.1% and 98.4%, respectively, and the success rates of stone removal in the two groups were 91.1% and 92.0%, respectively (P>0.05); the total incidence rate of postoperative complications was 19.8% in patients with and was 19.0% in patients without PAD (P>0.05); the success rate of intubation and success rate of stone removal in patients with papillary diverticulum were significantly lower than those with non-papillary diverticulum (86.5% vs. 100.0% and 81.1% vs. 96.9%, respectively, P<0.05); the total incidence rate of postoperative complications in patients with papillary diverticulum was 24.3%, not significantly different compared to 17.2% in patients with non-papillary diverticulum (P>0.05). Conclusion PAD has a certain influence on surgical intubation of ERCP for treatment of patients with choledocholithiasis, especially in those with papillary diverticulum, which could increase the difficulty of intubation and reduce the success rate of stone removal. The clinicians should practice for it as proficiently as possible.

Objective The aim of this study was to probe gallbladder mucosal tissue helicobacter pylori (Hp) infection and its toxic gene cytotoxin-associated gene A (CagA) and cholecystokinin-A receptor (CCK-AR) mRNA in patients with gallbladder calculous cholecystitis. Methods 98 patients with calculous cholecystitis were enrolled in our hospital between January 2019 and December 2020, and all patients underwent surgical removal of gallbladder. The Hp DNA in gallbladder mucosa was detected by polymerase chain reaction amplification, and the CagA and CCK-AR mRNA levels were measured by real-time fluorescent quantitative polymerase chain reaction. The activity of gallbladder mucosal phospholipase A2 (PLA2) was detected by hydrochloric titration. Results The transmission electron microscopy showed simple hyperplasia of gallbladder mucosal epithelium in 33 cases, intestinal metaplasia in 45 cases, and dysplasia in 20 cases; the gallbladder mucosa Hp DNA positive rates in simple hyperplasia, intestinal metaplasia and dysplasia group were 30.3%, 40.0% and 50.0%, respectively, without significant differences among them (P>0.05); the relative CagA mRNA level and the activity of PLA2 in patients with gallbladder mucosa dysplasia were(5.1±0.9) and (188.9±22.3)U/L, both significantly higher than [(1.9±0.4)和(160.5±21.5)U/L, respectively, P<0.05] in patients with simple hyperplasia of gallbladder mucosa or [(3.3±0.6) and (170.9±20.4)U/L, respectively, P<0.05] in patients with intestinal metaplasia of gallbladder mucosa, while the relative CCK-AR mRNA level was (2.9±0.6), significantly lower than [(7.0±1.4), P<0.05] in patients with simple hyperplasia of gallbladder mucosa or [(5.4±1.1), P<0.05] in patients with intestinal metaplasia of gallbladder mucosa. Conclusion Hp infection might accelerate the gallbladder mucosal lesion progression by up-regulating CagA mRNA levels and the activity of PLA2, while by down-regulating CCK-AR mRNA levels, which needs further investigation.

Wilson's disease (WD) is an autosomal recessive genetic disease characterized by abnormal copper metabolism, which can cause secondary damage to pathological organs, mainly liver and brain. The current basic treatment for patients with WD is based on medicines that increase excretion of copper from the body,such as chelators or zinc salts, etc. The choices of these agents should be based on patients' clinical manifestations and tolerance to them owing to side effects, physicians' experience and the cost and availability of them. The treatment of WD remains challenging for its side effects, compliance problems and life-long treatment. The shortage of donor liver, high cost, and the need for sustained immunosuppressive therapy after operation restrict the application of liver transplantation. Therefore, new treatment or methods, especially ones with better safety and permanent cure, are also attracting more and more attention. Therefore, this article systematically reviews the current research progress in treatment of patients with WD.

Objective Liver is an important organ for the metabolism of sex hormones, lipids and other substances. Male patients with chronic liver disease often suffer from a variety of dysfunctions, such as sex hormone metabolism, glucose and lipid metabolism and mental and psychological disorder. Erectile dysfunction is easy to occur, which affects the physical and mental health and the family life of patients.Existing studies have shown that the prevalence of male erectile dysfunction in patients with chronic liver disease was 24.6% to 85%, the prevalence in chronic hepatitis patients was 8.6% to 78%, and in patients with cirrhosis was 41.2% to 92%.In this paper, we reviewed the incidence, impacting factors, possible pathogenesis, and treatment of erectile dysfunctions in male patients with chronic liver disease.