Objective The purpose of this study was to establish a rapid and efficient liquid chromatography tandem mass spectrometry(LC-MS/MS) for simultaneous determination of 15 bile acids in mouse liver tissues. Methods The activated charcoal was utilized to prepare bile acid-free liver, which served as the biological matrix for the preparation of standard and quality control samples. The mouse liver tissue was homogenized, and a basic acetonitrile solution, including 5% NH₄OH was added to precipitate proteins. The proteins were separated on an Agilent Poroshell 120 EC C18 column (100 mm×4.6 mm,2.7 μm) by using ²H₄-DCA, GUDCA-d₅, and LCA-d₄ as internal standards. The mobile phase is ammonium acetate aqueous solution and methanol acetonitrile mixed solution for gradient elution, the column temperature was 30℃, the flow rate was 0.3mL/min, and the injection volume was 2 μL. The electrospray ion source (ESI) was operated in negative ion mode, and in multiple reaction monitoring (MRM). Results The linearity of the 15 bile acids was good with R² greater than 0.993, the limits of determination were less than 2 ng/mL, and the matrix effects were 90.76%-109.25%; the intra-day and inter-day accuracy and precision were less than 15%, and the stability was good under 4℃ for 24 h, repeated freeze-thaw, and freeze-storage for one month, meeting the analytical requirements of biological samples; the detection of mouse liver tissues showed that both unconjugated BAs and conjugated BAs (G-BAs, T-BAs) were dominated by maternal CA, with the highest content of TCA; the concentration of unconjugated BAs was (723.89±50.65) ng/mL, significantly higher than that of G-BAs [(56.90±11.28) ng/mL, P<0.001]; the concentration of T-BAs was (40322.90±14034.80)ng/mL, significantly higher than unconjugated BAs (P＜0.001), and also significantly higher than G-BAs (P＜0.001). Conclusion The LC-MS/MS method we established is sensitive, accurate, reliable, and suitable for the determination of bile acids concentrations in mouse liver tissues, which might help for further studies.

Objective The aim of this study was to investigate the protective effect of glycogen synthase kinase 3β (GSK3β) inhibitor TDZD-8 on liver injuries in mice with D-Gal/LPS-induced acute liver failure(ALF). Methods Twenty-four male mice were randomly divided into control, model and TDZD-8-intervened group, with eight in each. The model of ALF was established by intraperitoneal injection of D-Gal/LPS. Serum free DNA (cf-DNA) was detected by fluorescent dye, and liver homogenate tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were assayed by ELISA. The hepatic expression of L-18, IL-1β, UNC-51-like kinase 1 (ULK1), Beclin 1 and P62 were detected by Western blotting. Results Serum ALT, AST and total bilirubin levels in model group were (3460.8±105.2)U/L, (2710.4±84.3)U/L and (93.8±1.1)μmol/L, all significantly higher than [(28.1±4.2)U/L,(25.78±2.5)U/L and (3.4±0.4)μmol/L, respectively, P<0.05] in the control, while they all greatly decreased in TDZD-8-intervened group [(370.1±7.1)U/L, (277.3±20.3)U/L and (35.1±0.8)μmol/L, respectively, P<0.05]; the liver homogenate TNF-α, IL-1β and serum cf-DNA levels in the model were (3004.6±239.2)pg/mL, (469.6±56.7)pg/mL and (772.2±192.2) ng/mL, while they all greatly decreased in TDZD-8-intervened group [(2353.3±284.7)pg/mL, (339.2±48.7)pg/mL and (180.0±15.4)ng/mL, respectively, P<0.05]; the hepatic expression of IL-18 and IL-1β in the model intensified greatly as compared to in the control (P<0.05), while they both became weaker in TDZD-8-intervened group (P<0.05); the relative hepatic expression of ULK1 and Beclin1 obviously decreased(P<0.05), and the hepatic expression of P62 protein increased greatly(P<0.05)compared to in the control, while the ULK1 and Beclin1 expression greatly intensified, and the P62 expression became weaker (P<0.05) in TDZD-8-intervened mice. Conclusion The inhibition of GSK3β activity in a mouse model of acute liver failure could protect the liver injuries, which might be related to the up-regulation of autophagy and the inhibition of inflammatory cytokine release.

Objective The aim of this study was to compare whether or not different for Young's modulus in predicting liver fibrosis (LF) in patients with chronic hepatitis B (CHB) obtained by two-dimensional shear wave elastography (2D-SWE). Methods 72 patients with CHB were enrolled in our hospital between October 2019 and June 2022, and all underwent liver biopsies. The LF was determined by Scheuer score, and Scheuer score≥S2 was defined as significant LF. Based on 2D-SWE of color Doppler ultrasonography, the Young's modulus was determined by its median value (Method 1) or by its mean value (Method 2). The diagnostic performance of Young's modulus was evaluated by the area under the receiver operating characteristic curve (AUC). Results The liver histopathological examination showed S0/S1 stage in 31 cases, S2 stage in 19 cases, S3 stage in 12 cases and S4 stage in 10 cases, that’s S2-S4 stage in 41 cases in our series; the Young's modulus by method one in patients with S0/S1, S2, S3 and S4 were (6.1±1.2)kPa, (8.1±1.1)kPa, (11.5±1.8)kPa and (20.9±2.5)kPa, all not significantly different compared to(6.0±1.1)kPa, (8.3±1.2)kPa, (11.6±1.5)kPa and (21.1±2.8)kPa obtained by method two (P>0.05); the Young's modulus by method one or two was positively correlated to LF(r=0.427, P<0.05; r=0.442, P<0.05); the AUCs were 0.938 or 0.956 (P>0.05) in predicting LF in patients with CHB as the Young's modulus equal to 6.04 kPa by method one or 6.14 kPa by method two was set as the cut-off-value, and the AUCs were 0.973 or 0.968(P>0.05) in predicting significant LF as the Young's modulus equal to 8.12 kPa by method one or 8.25 kPa by method two was set as the cut-off-value. Conclusion The median or mean value of five measurements of liver elastic modulus as the final parameter by 2D-SWE might have the equivalent diagnostic performance in the diagnosis of LF in patients with CHB.

Objective The aim of this study was to investigate the diagnostic efficacy of significant liver fibrosis (SLF) by two-dimensional shear wave elastography (SWE) andγ-glutamyltransferase (GGT)/platelet (PLT) ratio (GPR) in patients with chronic hepatitis B (CHB). Methods 130 patients with CHB were encountered in our hospital between February 2021 and December 2022, and all underwent liver biopsy. The Young's modulus of livers was detected by SWE of ultrasonography, serum GGT levels and whole blood PLT counts were detected routinely, and the GPR was calculated. The consistency between the Young's modulus and GPR and the pathological diagnosis was evaluated by Kappa test, and the diagnostic efficacy was assessed by the area under the receiver operating characteristic curve (AUROCs). Results Out of the 130 patients with CHB, the liver histopathological examination showed F0, F1, F2, F3 and F4 in 93 cases, 14 cases, 8 cases, 12 cases and 3 cases, with SLF in 23 cases; the GPR and the Young's modulus in patients with stage F3 liver fibrosis were 0.5(0.4, 0.7) and (10.4±1.5)kPa, and in patients with F2 were 0.4(0.3, 0.6) and (8.9±1.6)kPa, all significantly greater than [0.4(0.3, 0.5) and (7.3±1.2)kPa, respectively, P<0.05] in patients with F1; the AUROCs analysis showed the good consistency between the Young's modulus, GPR or the combination of the two parameters, and the pathological diagnosis (Kappa=0.42, Kappa=0.50 and Kappa=0.63, respectively, P＜0.05); the AUC was 0.83 (95%CI:0.76-0.94), with the sensitivity and the specificity of 83.8% and 83.9% by the combination of GPR and Young's modulus in predicting SLF in patients with CHB, much superior to that by any one of the two alone(P＜0.05). Conclusion The GPR and the SWE by ultrasonography might be applied to predict the SLF in patients with CHB clinically, and warrants further investigation.

Objective The aim of this study was to investigate the early efficacy of tenofovir amibufenamide (TMF) in the treatment of naïve patients with chronic hepatitis B (CHB). Methods A total of 90 naïve patients with CHB were recruited in the First Affiliated Hospital, China University of Science and Technology between January 2020 and March 2022, and were divided into observation (n=50) and control group (n=40), receiving TMF or tenofovir disoproxil fumarate (TDF) treatment for 48 weeks. Serum alanine transaminase (ALT), HBV DNA loads, HBeAg and HBsAg levels were detected routinely. Results At 12, 24, 36 and 48 weeks of treatment, serum ALT levels in the observation group were 38.0(25.0,55.0)U/L, 31.5(23.8,35.0)U/L, 29.5(22.8,35.0) U/L and 26.0(21.8,34.0)U/L, all not significantly different compared to 38.5(25.0,60.0)U/L, 30.0(22.0,44.0)U/L, 31.0(22.8,44.5)U/L and 28.0(19.8,42.0)U/L (P>0. 05), serum HBV DNA loads were 0(0, 3)lgIU/ml, 0(0, 0.5)lgIU/ml, 0(0, 0)lgIU/ml and 0(0, 0)lgIU/ml, not significantly different compared to 2(0, 3)lgIU/ml, 0(0, 2)lgIU/ml, 0(0, 1.5)lgIU/ml and 0(0,0)lgIU/ml (P >0.05) in the control; serum HBV DNA loss were 58%, 76%, 78% and 88%, not significantly different compared to 45%, 65%, 75% and 85%(P >0.05) in the control; at 12, 24 and 36 week treatment, serum ALT normalization rates in the observation group were 56%, 80% and 92%, all not significantly different compared to 55%, 70% and 65%(P >0.05) , while at the end of treatment 48 week, serum ALT normalization rate in the observation group was 100.0%, much higher than 72.5%(P＜0.01) in the control; during the period of antiviral regimen, there was no obvious untoward effects in the two groups. Conclusion The antiviral performance of TMF in the treatment of naïve patients with CHB is as efficacious as of TDF, while the long-term efficacy and its impact on renal functions needs further clinical investigation.

Objective The purpose of this clinical trial was to investigate the auxiliary treatment of a herbal compound, Ganshuang granule, with entecavir for patients with chronic hepatitis B (CHB). Methods 60 patients with CHB were enrolled in our hospital between January 2019 and January 2021, and were randomly divided into control and observation groups, with 30 cases in each. The patients in the control group received entecavir, and those in the observation were treated with entecavir and a herbal compound, Ganshuang granule, for 48 weeks. The AST to platelet ratio index (APRI), fibrosis 4 score (FIB-4) were obtained, and the liver stiffness measurement (LSM) was determined by FibroTouch scan. Serum interleukin-6(IL-6), transforming growth factor-beta (TGF-β), platelet-derived growth factor (PDGF) and C-reactive protein (CRP) levels were assayed by ELISA. Results At the end of 48 week treatment, serum ALT and AST levels in the observation group were significantly lower than in the control group (P<0.05); serum HBV DNA loss in the two groups were both 100.0%, and serum HBeAg negative rates were both 0.0% (P>0.05); the APRI, FIB-4 and LSM in the observation group were (1.02±0.23), (4.38±0.77) and (7.73±1.53), all significantly lower than [(1.30±0.33), (5.26±0.85) and (9.68±2.02), respectively, P<0.05] in the control; serum IL-6, TGF-β, PDGF and CRP levels in the observation were much lower than in the control (P<0.05). Conclusion The auxiliary treatment of Ganshuang granule at base of entecavir antiviral therapy could significantly improve biochemical response in patients with CHB, which might be related to the anti-fibrotic effect and inhibition of body inflammatory reaction of the herbal compound.

Objective The aim of this study was to observe the antiviral efficacy and blood glucose control of direct acting antivirals (DAAs) in treatment of patients with genotype 1b chronic hepatitis C (CHC) and type 2 diabetes mellitus(T2DM). Methods 62 patients (42 naïve and 20 re-treated) with CHC and T2DM with genotype 1b HCV infection were recruited in our hospital between May 2018 and January 2022, and were randomly divided into observation and control group, with 31 cases in each group. The patients with CHC in the observation group were treated with oral sofosbuvir/velpasvir administration, and those in the control were treated with peginterferon-α and ribavirin combination. The regimen in both groups lasted for 24 weeks, and all patients were followed-up for 24 weeks after discontinuation of the treatment. The antiviral efficacy was determined as for early virological response (EVR), virological response at the end of treatment (ETVR) and sustained virological response (SVR). The liver function tests, fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), fasting insulin and fasting C-peptide levels were measured, and the steady-state model insulin resistance index (HOMA-IR) was calculated. Results The EVR, ETVR and SVR in the observation group were 87.1%, 100.0% and 96.8%, all significantly higher than 58.1%, 71.0% and 64.5% (P<0.05) in the control; at the end of 24 week treatment, serum ALT, AST and GGT levels in the observation group were 35(23, 47)U/L, 31(19, 47)U/L and 62(38, 81)U/L, all significantly lower than [39(36, 57)U/L, 42(34, 64)U/L and 80(47, 104)U/L, P<0.05] in the control; the FPG, serum HbA1c, HOMA-IR and fasting serum C peptide levels in the observation group were 6.1(5.0, 7.9)mmol/L, 7.1(6.0, 9.2)%, 2.2(1.8, 3.1) and 1.6(1.2, 2.2)ng/ml, all significantly lower than [7.1(5.5, 9.4)mmol/L, 7.8(6.4, 9.4)%, 2.8(2.1, 3.4) and 2.2(1.6, 2.4)ng/ml, P<0.05] in the control group. Conclusion The oral administration of sofosbuvir and velpasvir combination treatment is efficacious in patients with CHC with genotype 1b HCV infection and T2DM , which seems not impacting the blood sugar control.

Objective The aim of this study was to explore the implications of serum amyloid A (SAA), plasma heme oxygenase-1 (HO-1) and bone morphogenetic protein 9 (BMP-9) level changes in patients with nonalcoholic fatty liver diseases (NAFLD). Methods 87 patients with NAFLD [simple fatty liver (SFL, n=28), nonalcoholic steatohepatitis (NASH, n=48) and liver cirrhosis (n=11)] and 56 healthy individuals were enrolled in our hospital between July 2018 and March 2022, and all patients with NAFLD underwent liver biopsies. The patients with NASH were divided histopathologically into early (n=10) and liver fibrosis stage (n=38). Serum SAA level was assayed by chemiluminescence immunoassay, and plasma HO-1 and BMP-9 levels were detected by double antibody sandwich ELISA. Results Serum SAA and plasma HO-1 levels in patients with NAFLD were (8.2±1.5)mg/L and (14.9±2.3)ng/ml, both significantly higher than [(3.3±0.6) mg/L and (10.1±2.1)ng/ml, respectively, P<0.05], while plasma BMP-9 level was (95.1±6.1)pg/ml, significantly lower than [(153.7±10.8)pg/ml, P<0.05] in healthy persons; serum SAA and plasma HO-1 levels in patients with NAFLD-related liver cirrhosis were (9.9±1.5)mg/L and (17.2±2.6)ng/ml, both much higher than [(8.3±1.1)mg/L and (15.2±2.4)ng/ml, respectively, P<0.05] in patients with NASH or [(7.5±0.9)mg/L and (13.7±2.1)ng/ml, respectively, P<0.05] in patients with SFL, while plasma BMP-9 level was (81.8±6.9)pg/ml, much lower than [(93.6±7.3)pg/ml, P<0.05] in patients with NASH or [(101.7±5.1)pg/ml, P<0.05] in patients with SFL; serum SAA and plasma HO-1 levels in patients with NASH-related fibrosis were (9.0±1.8)mg/L and (16.4±2.5)ng/ml, significantly higher than [(6.6±1.9)mg/L and (12.0±2.8)ng/ml, respectively, P<0.05], while plasma BMP-9 level was (87.5±4.7)pg/ml, significantly lower than [(98.8±5.1)pg/ml, P<0.05] in patients with early fibrosis. Conclusion The changes of serum SAA, and plasma HO-1 and BMP-9 levels in patients with NAFLD might be related to hepatic steatosis and fibrosis, which needs further investigation.

Objective The aim of this study was to investigate the short-term clinical efficacy of pitavastatin and polyene phosphatidyl choline combination in the treatment of patients with nonalcoholic steatohepatitis (NASH). Methods 46 patients with NASH were enrolled in our hospital between January 2020 and August 2021, and were divided randomly into control (n=22) and observation group (n=24), receiving polyene phosphatidyl choline or pitavastatin and polyene phosphatidyl choline combination treatment for six months. Serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were routinely detected, and the homeostasis model assessment-insulin resistance index (HOMA-IR) was calculated. Serum tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10) and high-sensitivity C-reactive protein (hs-CRP) levels were detected by ELISA. Serum ALT, AST and γ-glutamyltransferase (GGT) levels were obtained. Serum insulin-like growth factor 1 (IGF-1) level was detected by radioimmunoassay. Results At the end of the six month treatment, serum TC, TG and LDL-C levels in the combination group were (4.7±0.5)mmol/L, (2.1±0.4)mmol/L and (2.9±0.5)mmol/L, all significantly lower than [(5.8±0.4)mmol/L, (4.5±0.6)mmol/L and (4.3±0.4)mmol/L, respectively, P<0.05], while serum HDL-C level was (1.8±0.3)mmol/L, significantly higher than [(1.0±0.3)mmol/L, P<0.05] in the control; serum ALT, AST and GGT levels were (53.5±6.9)U/L, (45.2±5.6)U/L and (66.7±3.9)U/L, all significantly lower than [(59.4±6.7)U/L, (49.1±5.5)U/L and (79.3±3.7)U/L, respectively, P<0.05] in the control; the HOMA-IR was (2.2±0.4), much lower than [(2.7±0.5), P<0.05], while serum adiponectin and IGF-1 levels were (11.9±0.8)mg/L and (0.4±0.1)μg/L, both significantly higher than [(9.2±0.8)mg/L and (0.2±0.1)μg/L, respectively, P<0.05] in the control group; serum TNF-α, IL-10 and hs-CRP levels were (3.5±0.5)ng/L, (27.5±5.2)ng/L and (4.1±0.8)mg/L, all not significantly different as compared to [(3.6±0.4)ng/L, (26.9±4.9)ng/L and (4.2±0.9)mg/L] in the control group (P>0.05). Conclusion The administration of pitavastatin and polyene phosphatidyl choline combination in the treatment of patients with NASH could reduce blood lipid levels and improve liver function normalization, which might be related to the reduction of insulin resistance.

Objective The purpose of this study was to investigate the changes of serum resistin and triacylglycerol glucose (TyG) index in patients with type 2 diabetes mellitus (T2DM) and concomitant non-alcoholic fatty liver diseases (NAFLD) to predict progressive liver fibrosis. Methods A total of 204 patients with T2DM and NAFLD were encountered in our hospital between March 2019 and February 2022, and the progressive liver fibrosis was evaluated by NAFLD fibrosis score (NFS). Serum resistin levels were detected by ELISA, and blood triacylglycerol and gl ucose levels were obtained routinely and the TyG index werecalculated. The multivariate Logistic regression analysis was applied to reveal the risk factors for the occurrence of progressive liver fibrosis in T2DM and NAFLD.The area under the receiver operating characteristic curves (AUC) was applied to evaluate the predictive performance of serum resistin and TyG index on the occurrence of progressive liver fibrosis in patients with T2DM and NAFLD. Results Out of the 204 patients with T2DM and NAFLD, the progressive liver fibrosis was found in 31 cases(15.2%); the age, disease history of diabetes, HOMA-IR , serum resistin level and TyG index in patients with progressive liver fibrosis were significantly higher or longer than in patients without(P＜0.05), while the estimated glomerular filtration rate(eGFR) was significantly lower than in those without (P＜0.05); the multivariate Logistic regression analysis showed that the age (OR=2.901, 95%CI: 1.042-5.238), serum resistin level (OR=3.404, 95%CI:1.874-9.435) and the TyG index (OR=2.965, 95%CI:1.258-6.439) were all the independent risk factors for the occurrence of progressive liver fibrosis in patients with T2DM and NAFLD(P＜0.05); the ROC analysis demonstrated that the sensitivities were 71.0%, 74.2% and 71.0%(P>0.05), and the specificities were 76.3%, 78.2% and 96.5% (P<0.05) when serum resistin level, the TyG index or the combination of the two parameters was applied to predict the existence of progressive liver fibrosis. Conclusion Serum resistin levels and TyG index are related to the occurrence of progressive liver fibrosis in patients with T2DM and NAFLD, and the combination of the two parameters might be used to predict severe liver fibrosis in this setting and help clinicians to make decisions for early management.

Objective The aim of this study was to explore the diagnostic performance of ultrasound elastography (UE) in evaluation of liver fibrosis in patients with autoimmune hepatitis (AIH). Methods 58 patients with AIH were encountered in our hospital between March 2017 and March 2022, and all patients received liver biopsy and UE scan for detection of the shear wave velocity (SWV). The aspartate aminotransferase to platelet ratio index (APRI) was obtained. The diagnostic efficacy was evaluated by the area under the receiver operating characteristic curve (AUC). Results The liver histopathological examination showed that out of the 58 patients with AIH, there were 7 cases in liver fibrosis stage F0 (12.1%), 15 cases in F1 (25.9%), 17 cases in F2 (29.3%), 13 cases in F3 (22.4%) and 6 cases in F4 (10.3%), e.g., 22 cases (37.9%) without or with mild liver fibrosis, and 36 cases (62.1%) with significant liver fibrosis (SLF); the platelet count in patients with SLF was (119.7±26.4)×10⁹/L, significantly lower than [(180.9±31.2)×10⁹/L, P<0.05], the APRI was (3.6±1.1), significantly higher than [(2.7±0.8), P<0.05] and the SWV was (1.7±0.3)m/s, significantly higher than [(1.2±0.2)m/s, P<0.05] in patients without or with mild liver fibrosis; the AUCs were 0.74, 0.75 and 0.95, respectively, with the sensitivities of 66.7%, 75.0% and 91.7%, and the specificities of 77.3%, 68.2% and 86.4%, when the PLT count <120.0×10⁹/L, the APRI≥3.0 and the SWV≥1.6 m/s were set as the cut-off-value, in predicting SLF in patients with AIH, superior by SWV among them (P<0.05).Conclusion The application of UE scan for SWV detection is helpful for liver fibrosis staging in patients with AIH, and is expected to become an important non-invasive quantitative diagnostic parameter for liver fibrosis determination.

Objective The purpose of this study was to investigate the ultrastructural changes of liver tissues in children with Wilson]s disease (WD), non-alcoholic fatty liver diseases (NAFLD) and autoimmune hepatitis (AIH). Methods 37 children with WD, 20 children with NAFLD and 17 children with AIH were encountered in our hospital between December 2018 and February 2022, and all children underwent liver biopsies for routine and ultrastructural examination. Results The proportion of liver fibrosis and copper staining positive in children with WD were 78.4% and 29.7%, significantly higher than 10.0% and 0.0%(P<0.05) in children with NAFLD, while the proportion of macrovesicular steatosis and lipid droplets were 62.2% and 75.7%, significantly lower than 95.0% and 95.0%(P<0.05)in children with NAFLD; the proportion of hepatocyte nucleus vacuolar degeneration in children with WD was 59.5%, much higher than 17.6%(P<0.05) in children with AIH, while the proportion of portal inflammation, interfacial hepatitis, lobular inflammation, plasma cell infiltration and hepatocyte rosette structure were 78.4%, 10.8%, 64.9%, 5.4% and 24.3%, significantly lower than 100.0%, 88.2%, 82.4%, 64.7% and 76.5% in children with AIH (P<0.05); as for the ultrastructural changes, the proportion of mitochondrial pleomorphism, crest tip dilatation, membrane replication and increased matrix density in children with WD were 81.1%, 83.8%, 62.2% and 62.2%, significantly higher than 30.0%, 15.0%, 5.0% and 5.0%(P<0.05) in children with NAFLD or 23.5%, 11.8%, 5.9% and 5.9%(P<0.05) in children with AIH, while the proportion of quasicrystal inclusion was 0.0%, much lower than 15.0%(P<0.05) in children with NAFLD. Conclusion The liver histo-pathological changes, including ultrastructural features, in children with WD, NAFLD and AIH are specific, which could provide evidences for diagnosis of them.

Objective The aim of this study was to investigate the prevalence of serum autoantibody spectrums in patients with different liver diseases. Methods 92 patients with autoimmune liver diseases (ALD), including autoimmune hepatitis (AIH) in51 cases, primary biliary cholangitis (PBC) in 27 cases and primary sclerosing cholangitis (PSC) in 14 cases, chronic hepatitis B(CHB) in 61 cases and chronic hepatitis C (CHC) in 15 cases, nonalcoholic steatohepatitis (NASH) in 34 cases, drug-induced liver injury (DILI) in 27 cases and healthy persons in 68 cases were recruited in our hospital between March 2019 and March 2022, and serum autoimmune antibody spectrum was detected by immunoblotting. Results The positive rates of anti-mitochondrial antibody M2 subtype (AMA-M2), anti-soluble liver antigen/anti-liver pancreas antibody (SLA/LP), anti-liver kidney microsomal antibody type I (LKM-1), anti-transmembrane glycoprotein 210 (gp210), anti-liver cytosol antigen type I (LC-1), anti-3E, anti-promyelocytic leukemia (PML) and anti-RO-52 in patients with ALD 23.9%,13.0%,33.7%,19.6%,26.1%, 33.7%, 23.9% and 55.4%, significantly higher than in patients with other liver diseases (P<0.05); the positive rates of anti-SLA/LP, anti-LKM-1 and anti-LC-1 in patients with AIH were much higher than in patients with PBC or in patients with PSC(P<0.05), while the positive rates of AMA-M2, anti-gp210 and anti-3E in patients with PBC were much higher than in patients with AIH or in those with PSC(P<0.05); the positive rates of serum anti-LKM-1 and anti-LC-1 in 24 patients with AIH type Ⅱ were 100.0% and 66.7%, much higher than 19.0% and 19.0% (P<0.05) in 21 patients with AIH type Ⅰ or 16.7% and 33.3% (P<0.05) in 6 patients with AIH type Ⅲ, while the positive rate of serum anti-SLA/LP in patients with AIH type Ⅲ was 83.3%, much higher than 9.5% in patients with AIH type Ⅰ or 16.7% in patients with AIH type Ⅱ(P<0.05). Conclusion The detection of serum autoantibody spectrums is a key approach for the diagnosis and clinical classification of patients with ALD, and why they appear, though at low prevalence, in patients with other liver diseases needs further investigation.

Objective The purpose of this study was to summarize the clinical and liver pathological features of patients with autoimmune hepatitis-primary biliary cholangitis overlap syndrome (AIH-PBC OS). Methods 42 patients with AIH-PBC OS were encountered in our hospital between March 2018 and March 2022, and all underwent liver biopsies and received ursodeoxycholic acid (UDCA) with or without prednisolone combination therapy for six months. Serum antinuclear antibody (ANA), anti-mitochondrial antibody (AMA), anti-mitochondrial antibody type II (AMA-M2), anti-nuclear membrane glycoprotein 210 antibody (gp210) and anti-soluble acidic phosphorylated nuclear protein (sp100) were detected. Results Among the 42 patients with AIH-PBC OS, 85.7% cases were female, and the average age of onset was (53.9±10.6) years; the abnormal rates of serum bilirubin, albumin and ALP levels were 57.1%, 60.0% and 75.7%, and the elevated serum ALT, AST and GGT levels were all more than 83.0%, and all but serum albumin, decreased greatly after six month treatment (P<0.05); the increased plasma immunoglobulin IgG, IgM and IgA levels were 69.0%, 52.3% and 33.3%; the positive rates of serum ANA, AMA, AMA2, gp210 and SP100 were 90.5%,73.5%,72.7%,47.1% and 36.7%, respectively; the common fluorescence models of ANA were cytoplasmic granules in 23 cases, centromere in 13 cases, and nuclear membrane in 8 cases; the liver histopathological examination showed the interface hepatitis, mainly mild-moderate inflammation, and mild hepatic fibrosis. Conclusion The female patients with AIH-PBC OS is more common, and the disease has the dual features of PBC and AIH. We recommend early administration of UDCA with or without steroid therapy, which might be helpful to improve the prognosis of patients with AIH-PBC OS.

Objective The aim of this study was to explore the rescued therapy of budesonide in patients with primary biliary cholangitis (PBC) for poor response to ursodeoxycholic acid (UDCA) treatment. Methods 76 patients with PBC who had not response to UDCA treatment were recruited in our hospital between February 2019 and February 2022, and were divided randomly into control group (n=38) and observation group (n=38). The patients in the control group maintained treatment with UDCA, and those in the observation group were treated with budesonide at base of UDCA treatment. The observation lasted for 24 weeks. Serum interleukin-2 (IL-2), IL-6, IL-10, malondialdehyde (MDA), superoxide dismutase (SOD), hemeoxygenase-1(HO-1) and nuclear factor-related factor 2(Nrf2) levels were detected by ELISA. Plasma immunoglobulin levels were detected by turbidimetric inhibition immnoassay. Results At the end of 24 week treatment, serum ALP, GGT and bilirubin levels in the observation group were (97.6±18.5) U/L, (82.4±10.2) U/L and (25.4±4.2)μmol/L, all significantly lower than [(234.8±40.6) U/L, (160.6±17.6) U/L and (34.5±6.1)μmol/L, respectively, P＜0.05] in the control; serum IL-2 and IL-10 levels were (62.9±15.7) pg/ml and 154.9±12.8)pg/ml, both significantly higher than [(37.4±18.3) pg/ml and (89.6±17.6) pg/ml, respectively, P＜0.05], while serum IL-6 levels was (5.3±1.3) pg/ml, much lower than [(7.9±1.7) pg/ml, P＜0.05] in the control; plasma IgM, IgG and IgA levels were (2.4±0.3) g/L, (11.2±1.9) g/L and (2.8±0.4) g/L, all significantly lower than [(4.1±0.5) g/L, (15.7±2.4)g/L and (4.4±0.6) g/L, respectively, P＜0.05]; serum MDA level was (5.2±0.7)μmol/L, much lower than [(7.9±1.1)μmol/L, P＜0.05], while serum SOD, HO-1 and Nrf2 levels were (86.2±9.6)U/L, (22.1±2.9) U/L and (669.8±87.6) U/L, all significantly higher than [(72.5±8.2) U/L, (16.8±2.5) U/L and (547.5±80.4) U/L, respectively, P＜0.05] in the control group. Conclusion The rescue treatment of budesonide in PBC patients without response to UDCA therapy could improve the recovery of liver function tests, which might be related to the regulation of immune system and inhibition of oxidative stress.

Objective The aim of this study was to investigate the cost-effectiveness of reduced glutathione, diammonium glycyrrhizate and compound glycyrrhizin in the treatment of patients with anti-tuberculosis drug-induced liver injury (DILI). Methods A total of 93 patients with DILI caused by anti-tuberculosis agents were admitted to our hospital between February 2018 and June 2021,and were randomly divided into group A, group B and group C, with 31 cases in each, receiving reduced glutathione injection, diammonium glycyrrhizate sodium chloride injection and compound glycyrrhizin injection treatment for four weeks. Serum superoxide dismutase (SOD), malondialdehyde (MDA) and glutathione peroxidase (GSH-Px) levels were detected. Serum interleukin-6 (IL-6), IL-1β and tumor necrosis factor-α (TNF-α) levels were assayed by ELISA. Results There was no significant difference as respect to the biochemical response rates in the three groups(P＞0.05); serum SOD, MDA and GSH-Px levels in group A were (79.1±10.2)U/L, (5.4±0.9)μmol/L and (112.3±14.6) U/L, not significantly different as compared to [(78.3±7.9)U/L, (6.2±1.5)μmol/L and (106.8±17.1)U/L] in group B or [(77.7±11.4)U/L, (5.9±1.1)μmol/L and (109.6±12.9)U/L] in group C(P＞0.05); serum IL-6, TNF-α and IL-1β levels in group A were (7.9±1.9)pg/mL, (8.2±1.9) pg/mL and (20.9±3.6) ng/mL, not significantly different compared to [(8.6±2.0)pg/mL, (9.3±2.1) pg/mL and (22.0±5.5)ng/mL] in group B or [(8.2±2.2)pg/mL, (8.8±1.6)pg/mL and (21.6±4.7)ng/mL] in group C (P＞0.05); the medical cost of reduced glutathione injection, diammonium glycyrrhizinate sodium chloride injection and compound glycyrrhizin injection were 617.4 yuan, 735.0 yuan and 718.2 yuan, and their C/E ratio were 6.6, 7.6 and 8.0, respectively; as compared with the lowest medical cost of reduced glutathione injection, the one point of increased total effective rate by diammonium glycyrrhizinate sodium chloride injection or compound glycyrrhizin injection had the increment of costs of 35.6 yuan and 31.5 yuan, respectively, and the similar results were found by sensitivity analysis. Conclusion The application of reduced glutathione injection, diammonium glycyrrhizinate sodium chloride injection and compound glycyrrhizin injection in the treatment of patients with DILI caused by anti-tuberculosis medicines is all efficacious, which might inhibit oxidative stress and inflammatory injury, with the cost-effectiveness of reduced glutathione injection best.

Objective The aim of this study was to investigate the preventive efficacy of liver-protecting medicines on the incidence of drug-induced liver injury (DILI). Methods A total of 324 patients with tubercular pleurisy and/or pulmonary tuberculosis were encountered in our hospital between March 2015 and March 2022, and all received standardized six-month anti-tubercular therapy. Simultaneously, the patients were randomly divided into group A (n=80), group B (n=81), group C (n=80) and group D (n=83), receiving oral silibinin, compound glycyrrhizin, polyene phosphatidyl choline and no liver-protecting medicine administration, respectively, until the discontinuation of anti-tubercular therapy. Serum interleukin-2 (IL-2), IL-10 and tumor necrosis factor-ɑ (TNF-ɑ) levels were detected by ELISA. Results The incidences of DILI in group A, group B, group C were 22.5%, 27.2% and 21.3%, all significantly lower than 45.8%(P<0.05) in group D; serum peak levels of biochemical parameters in the four groups with DILI were not significantly different (P>0.05), while at the end of six-month anti-tubercular therapy, serum ALT, AST and bilirubin levels in group A were (43.3±5.1)U/L, (36.9±5.0)U/L and (22.1±4.6)μmol/L, in group B were (54.3±5.3)U/L, (37.5±4.5)U/L and (13.5±4.4)μmol/L, and in group C were (39.1±5.5)U/L,(34.6±4.1)U/L and (18.6±4.4)μmol/L, all significantly lower than [(99.0±5.4)U/L, (146.5±14.8)U/L and (54.3±4.4)μmol/L, respectively, P<0.05] in group D; there were no significant differences respect to serum peak cytokine levels in the four groups(P>0.05); at the end of anti-tubercular therapy, serum IL-2 and IL-10 in group A were (149.3±3.0)ng/L and (50.1±5.7)ng/mL, in group B were (146.3±3.1)ng/L and (27.3±4.4)ng/mL, and in group C were (143.2±3.5)ng/L and (82.9±5.9)ng/mL, all significantly higher than [(72.6±3.7)ng/L and (25.3±5.1)ng/mL, while serum TNF-α levels in group A, B and C were (2.2±0.5)ng/mL, (2.3±0.4)ng/mL and (2.3±0.4)ng/mL, all significantly lower than [(13.0±0.5)ng/mL, P<0.05] in group D. Conclusion The application of liver-protecting medicines could remarkably reduce the incidence of DILI, relieve liver injuries, which might guarantee the anti-tubercular therapy going.

Objective The aim of this study was to compare the efficacy of glycyrrhizic acid diamine and compound glycyrrhizin in the treatment of patients with drug-induced liver injuries (DILI). Methods 97 tumor patients with DILI caused by cyclophosphamide were encountered in Nantong Tumor Hospital between July 2018 and January 2021, and were randomly divided into control group (n=47) and observation group (n=50), receiving compound glycyrrhizin or glycyrrhizic acid diamine, respectively for six months. Serum malonaldehyde (MDA), reduced glutathione (GSH), superoxide dismutase, (SOD) and advanced protein oxidation products (APOPs) levels were detected by purine oxidase; Serum interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), nitric oxide (NO) and macrophage migration inhibitory factor (MIF) levels were determined by ELISA. Results At the end of six month observation, serum bilirubin, ALT and GGT levels in the observation group were(12.3±1.5)μmol/L, (34.9±9.5)U/L and (36.9±8.8)U/L, significantly lower than [(21.7±3.1)μmol/L, (75.3±18.2)U/L and (74.2±15.2)U/L, respectively, P＜0.01] in the control; serum TNF-α, IL-6 and MIF levels were (4.1±0.8)ng/ml, (17.6±5.3)pg/ml and (6.0±0.5)ng/mL, significantly lower than [(5.9±1.2)ng/ml,(28.8±6.1)pg/ml and (10.7±0.9)ng/mL, respectively, P＜0.01] in the control group; serum MDA and APOPs levels were (4.3±0.7)μmol/L and (2.4±0.2)μmol/L, significantly lower than [(6.4±1.2)μmol/L and (4.3±0.5)μmol/L, P＜0.01], while serum SOD and GSH levels were (83.6±7.9)U/L and (7.6±1.5)μmol/L, significantly higher than [(75.2±9.2)U/L and (6.4±1.2)μmol/L, P＜0.01] in the control; at the end of one-year follow-up, 25 patients(25.8%) died of malignant tumors in our series. Conclusion The oral administration of glycyrrhizic acid diamine in the treatment of patients with DILI caused by cyclophosphamide is convenient and seems to be more efficacious compared with compound glycyrrhizin, which could improve liver function index normal and inhibit the inflammatory reactions and oxidative stress.

Objective This study aimed to investigate whether plasma fibrinogen levels affects gastroesophageal variceal rebleeding in patients with hepatitis B-induced liver cirrhosis after endoscopic treatment. Methods The patients with hepatitis B-induced liver cirrhosis and a history of gastroesophageal variceal bleeding (EVB) were encountered in Zhongshan Hospital between 2013 and 2017, and all the patients received endoscopic sandwich tissue glue injection and varicose vein ligation treatment. Based on plasma fibrinogen levels of 150 mg/dL as the cut-off-value, the patients were divided into high and low level groups. The baseline data were analyzed by ROC curve, and the Kaplan-Meier analysis was applied to compare the rebleeding rate between the two groups. The univariate and multivariate cox regression analyzes were conducted to identify the independent prognostic factors of rebleeding after endoscopic treatment. Result A total of 255 patients with liver cirrhosis and EVB history were included; the patients with low plasma fibrinogen level had significantly higher Child-Pugh score and lower platelet count (P<0.05); the Kaplan-Meier analysis showed that the patients with low fibrinogen level had a significantly higher rebleeding rate compared to those with high fibrinogen level within 1 year after endoscopic treatment (25.3% vs, 10.9%, P=0.0016), which was more pronounced in the subgroup with portal vein thrombosis compared to those without (45.2% vs, 11.3%, P=0.0002); the multivariate analysis demonstrated that the elderly patients, those with portal vein thrombosis, with diabetes mellitus or low plasma fibrinogen level (<150 mg/dL) were the independent prognostic factors for gastroesophageal variceal rebleeding. Conclusion The low plasma fibrinogen level could predict higher rebleeding risk within 1 year after endoscopic treatment in patients with EVB. The surveillance of plasma fibrinogen levels after endoscopic treatment might be guide clinical management.

Objective The aim of this study was to investigate the clinical efficacy of tolvaptan and concentrated ascites reinfusion (CAR) in the treatment of patients with liver cirrhosis-induced refractory ascites (RA). Methods 93 patients with liver cirrhosis-induced RA were encountered in our hospital between September 2019 and September 2022, and were randomly divided into control (n=46) and observation group (n=47), receiving CAR or oral tolvaptan after CAR. The observation lasted for 7 days. Blood urea nitrogen (BUN), serum creatinine (sCr) and serum sodium levels were detected by fully automatic biochemical analyzer. The diameter of portal vein (DPV), diameter of splenic vein (DSV), portal vein flow (PVF) and splenic vein flow (SVF) were measured by ultrasonography. Results At treatment day 7, the 24-hour urine volume in the observation group was (1957.5±50.3) mL, significantly greater than [(1316.2±49.1) mL, P<0.05] in the control group, and the body weight, abdominal circumference and ascites depth were (58.1±7.2)kg, (80.6±4.7)cm and (16.5±4.2)mm, all significantly less than [(65.4±7.8)kg, (88.1±4.5)cm and (42.7±5.3)mm, respectively, P<0.05] in the control; serum BUN and sCr levels in the observation group were (6.2±1.4)mmol/L and (114.2±9.7)μmol/L, much lower than [(6.9±1.6)mmol/L and (129.4±10.3)μmol/L, P<0.05] in the control, while there were no significant differences respect to liver function tests between the two groups (P>0.05); serum sodium level was (144.3±1.1)mmol/L, much higher than [(138.1±1.0)mmol/L, P<0.05] in the control; the PVF was (994.3±195.7)mL/min, much lower than [(1175.2±210.6) mL/min, P<0.05] in the control, while there were no significant differences respect to DPV, DSV and SVF between the two groups (P>0.05). Conclusion The oral administered tolvaptan at base of CAR in dealing with patients with liver cirrhosis-induced RA could help subside ascites, improve the renal function tests and serum sodium levels, and warrants further clinical observation.

Objective The aim of this study was to explore the application of three-dimensional speckle tracking imaging (3D-STI) in the early diagnosis of cirrhotic cardiomyopathy (CCM) in patients with decompensated cirrhosis. Methods 82 patients with decompensated cirrhosis and 30 healthy individuals at the same time were enrolled in our hospital between February 2020 and February 2022. The scores of model for end-stage liver disease (MELD) were calculated for evaluation of liver functions. The left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs) and ratio of early and late peak diastolic velocity of mitral valve (E/A) were measured by routine two-dimensional ultrasound. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction ( LVEF) and left ventricular mass index (LVMI) were measured by real-time three-dimensional ultrasound. The left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and global area strain (GAS) were measured by 3D-STI. Results The E/A ratio in patients with liver cirrhosis was (1.0±0.2), significantly lower than [(1.2±0.3), P<0.05] in healthy individuals, while the LVDd and LVDs were (46.5±5.0) mm and (31.1±4.3) mm, both not significantly different compared to [(45.3±4.2) mm and (30.9±4.1) mm, respectively, P>0.05] in healthy persons; out of the 82 patients with liver cirrhosis, the CCM was found in 58 cases; there were no significant differences as respect to the LVEF, LVEDV, LVESV and LVMI among patients with, or without CCM and healthy persons(P＞0.05); the absolute GLS, GCS, GRS and GAS in cirrhotics with CCM were (14.5±3.8)%, (17.1±3.5)%, (40.7±6.0)% and (24.3±4.0)%, significantly lower than [(17.9±2.6)%,(19.5±2.9)%,(44.8±8.5)% and (27.7±4.2)%, respectively, P<0.05] in those without CCM or [(18.7±2.2)%, (19.7±3.0)%, (45.4±6.1)% and (28.7±3.4)%, respectively, P<0.05] in healthy persons. Conclusion The incidence of CCM is not uncommon in patients with decompensated cirrhosis, and the 3D-STI could help sensitively reflect the changes of left ventricular systolic functions and diagnose CCM, which warrants further clinical investigation.

Objective The aim of this study was to investigate the clinical implication of serum alpha-fetoprotein (AFP), alpha-fetoprotein-L-3 ratio (AFP-L3%) and protein induced by vitamin K antagonist-II (PIVKA-II) in early diagnosing and predicting prognosis of patients with primary liver cancer(PLC) . Methods A total of 87 patients with PLC, 79 patients with hepatitis B cirrhosis, 73 patients with chronic hepatitis B and 65 healthy persons were enrolled in our hospital between January 2016 and December 2018. All PLC patients underwent transcatheter arterial chemoembolization (TACE) and were followed-up for 3 years. Serum AFP and PIVKA-II levels were detected by chemiluminescence immunoassay, and serum AFP-L3 level was assayed by immumofluorescence. The independent risk factors of impacting 3-year survival in patients with PLC were analyzed by Logistic regression analysis, and the prognostic value of serum AFP, AFP-L3% and PIVKA-II levels was evaluated by the area under the receiver operating characteristic (ROC) curves (AUC). Results Serum AFP, AFP-L3% and PIVKA-II levels in patients with PLC were 402.5±95.3)μg/L, (12.9±3.1) and (824.5±82.1) mAU/mL, significantly higher than [(17.9±2.6)μg/L, (8.6±1.2) and (30.4±3.2)mAU/mL, P＜0.05] in patients with liver cirrhosis or [(20.3±6.4)μg/L,(5.4±0.9) and(29.8±3.0)mAU/mL, P＜0.05]in patients with CHB or [(2.2±0.1)μg/L, (2.7±0.4) and (26.3±3.4)mAU/mL, P＜0.05] in healthy individuals; serum AFP, AFP-L3% and PIVKA-II levels in 52 dead patients with PLC one month after TACE were (447.1±71.2)μg/L, (14.1±2.2) and (883.9±50.8) mAU/mL, much higher than [(336.2±58.4)μg/L, (11.0±1.8) and (736.2±37.0)mAU/mL, respectively, P＜0.05] in 35 survivals; the univariate analysis showed that TNM staging, Child class, extrahepatic metastasis, serum AFP, AFP-L3% and PIVKA-II levels were all influencing prognosis of patients with PLC (P<0.05), and the multivariate Logistic regression analysis showed that TNM staging III-IV, Child class C, extrahepatic metastasis, serum AFP ≥410.5μg/L, AFP-L3% ≥12.1 and PIVKA-II≥807.2 mAU/mL were all independent risk factors for poor prognosis of patients with PLC(P<0.05); the ROC analysis showed that the AUC was 0.908 when combination of serum AFP, AFP-L3% and PIVKA-II level detection in predicting the 3-year survival of patients with PLC, greatly superior to any parameter alone (the AUC were 0.763, 0.830 or 0.792, respectively, P<0.05). Conclusion The combination detection of serum AFP, AFP-L3% and PIVKA-II levels could help diagnose and early predict prognosis of patients with PLC after TACE treatment.

Objective The aim of this study was to investigate the diagnostic efficacy of liver contrast-enhanced ultrasound (CEUS), shear wave elastography (SWE) and contrast-enhanced CT scan in patients with occupying lesions in liver (OLL). Methods 128 patients with OLL were encountered in our hospital between June 2020 and June 2022, and all underwent CEUS, SWE and CT scan at presentation. The histopathological and/or cytology examination were performed after operation. Results Out of the 128 patients with OLL, the pathological examination showed hepatocellular carcinoma (HCC) in 72 cases and benign lesions in 56 cases; there were obvious differences as respect to the enhancement patterns in arterial, portal and delayed phases between malignant and benign lesions (P＜0.05). 79.2% HCC presented with “fast in and fast out”, with 81.9% of increased enhancement at arterial phase, 62.5% of low enhancement at portal phase and 79.2% of low enhancement at delayed phase, while 80.4% benign lesions showed "slow in and slow out", with 44.6%, 76.8% and 80.4% of equal enhancement at arterial, portal and delayed phases. The diagnostic sensitivity (Se), specificity (Sp) and accuracy (Ac) by CEUS detection were 83.3%, 87.5% and 85.2%; the Young's modulus (Emax) in malignant lesions was (42.5±7.1)kPa, much higher than [(36.3±6.5)kPa, t=5.064, P＜0.01] in benign lesions. When the Emax≥39.6 kPa was set as the cut-off-value, the Se, Sp and Ac by SWE were 79.2%, 76.8% and 78.9%; 77.8%HCC presented as “fast in and fast out” at contrast-enhanced CT scan, with 83.3% of intensified enhancement at arterial phase, 59.7% of low enhancement at portal phase and 77.8% of low enhancement at delayed phase, while 82.1% of benign lesions presented with "slow in and slow out", with 42.9%, 78.6% and 82.1% of equal enhancement at arterial, portal and delayed phases. The Se, Sp and Ac by CT scan were 77.8%, 87.5% and 82.0%. Conclusion The CEUS and CT scan are both important measures for the diagnosis of patients with HCC, and the SWE might be an alternative approach for auxiliary diagnosis.

Objective The aim of this study was to investigate the diagnostic performance of dual-source CT hepatic artery three-phase scanning and enhanced perfusion scanning in finding small primary liver cancer (sPLC) under the background of liver cirrhosis. Methods 130 patients with liver cirrhosis and intrahepaticnodules were encountered in our hospital between February 2019 and September 2021, and all underwent dual-source CT hepatic artery three-phase scanning and enhanced perfusion scanning.The blood volume (BV), hepatic artery fraction (HAF), blood flow (BF) and hepatic arterial perfusion (HAP) were recorded. The histopathological diagnosis was made by post-operational or needle aspiration biopsy specimen. The receiver operating characteristic curve (ROC) was drawn, and the area under the curve (AUC) was applied to analyze the diagnostic performance of dual-source CT hepatic artery three-phase scan and enhanced perfusion scan for sPLC under liver cirrhosis background. Results 85 patients with sPLC was proven by pathological examination out of the 130 patients with liver cirrhosis in our series, with the average diameter of(1.85±0.37)cm at range of 0.8-3.0 cm; the absolute CT value of malignant lesion at late arterial and mid-arterial stage were(69.8±15.9)Hu and (65.8±15.2)Hu, both significantly higher than [(48.4±10.3)Hu, P＜0.05], the enhancement CT value were (24.9±5.1)Hu and (23.6±4.9)Hu, both significantly higher than [(15.2±3.9)Hu,P＜0.05], and the detection rates were 91.3% and 88.0%, both significantly higher than 40.2% (P<0.05) at early arterial stage;the BV, HAF, BF and HAP in sPLC lesions were (17.4±5.1)mL/100 g, (0.21±0.02), (183.8±15.4)mL/(min·100 g) and (38.4±4.9)mL/(min·100 g), all significantly lower than [(19.4±6.9)mL/100 g, (0.26±0.03), (201.9±18.3)mL/(min·100 g) and (52.3±5.6)mL/(min·100 g), respectively, P＜0.05] in benign lesions in 45 patients; the AUCs were (95%CI):0.842(0.768-0.899) and 0.888(0.821-0.936) by dual-source CT hepatic artery three-phase scanning and enhanced perfusion scanning in diagnosingsPLC under the background of liver cirrhosis, with the sensitivities of 83.5% and 90.6% and the specificities of 84.8% and 87.0%(Z=1.012, P=0.312). Conclusions Both the application of dual-source CT hepatic artery three-phase scanning and the enhanced perfusion scan is helpful for the detection of small primary liver cancer under the background of liver.

Objective The purpose of this study was to investigate the short-term clinical efficacy of transcatheter arterial chemoembolization (TACE) and three-dimensional conformal radiotherapy(3D-CRT) in the treatment of patients with advanced primary liver cancer (PLC). Methods 89 patients with advanced PLC were admitted to our hospital between January 2015 and September 2020, and all the patients were treated with TACE and 3D-CRT combination therapy. The short-term clinical efficacy were evaluated, and the multivariate Logistic regression analysis was conducted to explore the influencing factors on the short-term clinical efficacy. Results At the end of three-month treatment, the effective rate was 71.9% in our series, including complete remission (CR) 17 cases, partial remission (PR) in 43 cases, stable disease (SD) in 21 cases and progression of disease (PD) in 8 cases; the univariate Logistic regression analysis showed that the percentage of BCLC stage B, Child-Pugh class A, tumor diameter less than 5 cm, serum AFP less than 400.0 μg/L, the neutrophils to lymphocytes ratio (NLR) and the prognostic nutritional index (PNI) in patients with CR/PR were 71.7%, 76.7%,46.7%,81.7%,53.3% and 75.0%, all significantly different compared to 34.5%, 48.3%, 20.7%, 34.5%, 31.0% and 31.0%(P＜0.05); the multivariate Logistic regression analysis showed that the Child-Pugh class B (OR=1.749), serum AFP level >400.0 μg/L(OR=1.988), and PNI<45(OR=1.627) were the independent risk factors affecting the short-term clinical efficacy (P＜0.05). Conclusion The short-term clinical efficacy of TACE and 3D-CRT combination in dealing with patients with advanced PLC is good, and the clinicians should choose the appropriate and eligible patients to receive the protocol for improved efficacy.

Objective The aim of this study was to compare contrast-enhanced ultrasound (CEUS) manifestation differences in patients with hepatocellular carcinoma (HCC) and hepatic hemangioma (HH). Methods A retrospective analysis was performed on the clinical data of 95 patients with liver space-occupying lesions between January 2020 and December 2021, and all patients underwent hepatectomy, having pathologically confirmed diagnosis, e.g. HCC in 51 cases and HH in 44 cases. All patients underwent CEUS examination before operation, and the arrival time (AT), time to peak (TTP), peak enhancement intensity, enhancement rate and 50% gradient of slope were obtained and compared between the two groups. The diagnostic performance of CEUS for liver space-occupying lesions was analyzed by receiver operating characteristic (ROC) curves. Results The conventional ultrasonography showed that the percentages of clear edge, hyperecho, regular shape and even intratumor echo in cancerous foci were 19.6%, 21.6%, 17.7% and 13.7%, all significantly lower than 68.2%, 65.9%, 72.7% and 75.0%(P<0.05) in HH foci, and the grade Ⅱ and Ⅲ blood signals in cancerous lesions were 68.6% and 17.7%, both significantly higher than 11.4% and 4.6%(P<0.05) in HH lesions; the rapid enhancement and hyperechoic tumor tissues in arterial phase was found, while in HH foci, there was a peripheral slow enhancement in early arterial phase, a centripetal filling enhancement in portal phase and an increased enhancement in delayed phase; the AT in cancerous lesions was (14.6±4.5) s, much longer than [(11.4±3.3)s, P<0.05], and the TTP was (36.8±9.7) s, significantly shorter than [(44.2±11.6) s, P<0.05] in HH lesions, the peak enhancement intensity and 50% gradient of slope were (8.8±2.5) and (0.4±0.2), significantly lower than [(12.5±3.6) and (0.9±0.4), P<0.05] in HH lesions, and the enhancement velocity was (0.8±0.3), much higher than [(0.6±0.2), P<0.05] in HH lesions; the ROC analysis showed that the sensitivity and the specificity were 92.5％ and 77.4％, when the combination of the AT, TTP, peak enhancement intensity, enhancement velocity and 50％ gradient of slope was applied to predict the quality of the space-occupying lesions of liver. Conclusion There are some different features of CEUS manifestations, which might help effectively differentiate lesions of HCC and HH.

Objective The purpose of this study was to analyze the clinical features of patients with pyogenic liver abscess (PLA) with different underlying diseases. Methods The adult PLA patients were encountered in our hospital between January 2007 and December 2020, and the clinical materials were collected and analyzed. Results Out of the 1930 patients with PLA in our series, 926 patients (group A) had no underlying diseases, 592 patients (group B) had type two diabetes mellitus (T2DM), 261 patients (group C) had biliary diseases, and 151 patients (group D) had T2DM and biliary diseases; the percentage of neutrophils in group D was (83.6±9.3)％, much higher than in other three groups (P<0.05), serum albumin levels in group B and group D were 30.3(26.1, 35.1)g/L and 30.8(26.9, 34.1)g/L, much lower than [32.3(28.3, 36.8) g/L, P<0.05] in group A; the incidence of jaundice in group C was 11.9％, significantly higher than 5.5％in group A and 2.7％ in group B(P<0.05), the incidence of pulmonary lesions in group D was 39.1％, significantly higher than 28.3％(P<0.05) in group A, the proportions of aerogenic abscess in group B and group D were 15.4％ and 12.6％, significantly higher than 6.6％(P<0.05) in group A, and the diameter of hepatic abscess in group D was 68.0(50.0, 87.0)mm, significantly higher than in other three groups (P<0.05); the medical costs in group B, group C and group D were 20000.2(10000.5,30000.3) yuan, 20000.3(10000.5, 30000.4) yuan and 20000.4(10000.5, 40000.2) yuan, significantly higher than [10000.9(10000.2, 20000.9) yuan (P<0.05) in group A. Conclusion The PLA patients with underlying diseases might have a severe disease, and have a relatively high hospitalization costs.

Objective The aim of this study was to compare the efficacy of anhydrous ethanol and lauromacrogol sclerotherapy under ultrasound (US) guidance in the treatment of patients with simple hepatic cysts (SHC). Methods A total of 97 patients with SHC were encountered in our hospital between January 2019 and October 2021, and were randomly divided into two groups, receiving lauromacrogol (n=49) or anhydrous ethanol (n=48) for sclerotherapy under US guidance. All the patients were followed-up for six months. Serum C-reaction protein (CRP), cortisol (Cor) and norepinephrine (NE) levels were detected by ELISA. Results At the end of six month follow-up, the effective rates in the two groups were not significantly different (98.0% vs. 98.0%, P＞0.05); two days after operation, the peripheral white blood cell counts, red blood cell counts and platelet counts in patients with lauromacrogol sclerotherapy were(4.9±0.9)×10⁹/L, (4.4±0.9)×10¹²/L and (118.8±16.5)×10⁹/L, not significantly different as compared to [(5.1±1.1)×10⁹/L, (4.6±0.7)×10¹²/L and (120.5±22.4)×10⁹/L, respectively, P＞0.05] in patients with ethanol sclerotherapy; serum Cor, CRP and NE levels in lauromacrogol-treated patients were (231.6±34.5)ng/mL, (11.5±1.7) mg/L and (257.6±31.6)ng/mL, also not significantly different compared to [(233.7±30.6)ng/mL,(12.0±2.0)mg/L and (260.2±33.5)ng/mL, respectively, P＞0.05] in ethanol-treated patients; after operation, the incidence rates of abdominal distention and pain, nausea and vomiting, drunkenness response, and needle tract bleeding in lauromacrogol-treated patients were 18.4%, 24.5%, 0.0% and 2.0%, significantly lower than 43.8%, 52.1%, 22.9% and 16.7%(P＜0.05) in ethanol-treated patients. Conclusion The clerotherapy with anhydrous ethanol or lauromacrogol under US-guidance in dealing with patients with SHC is safe and efficacious, and the application of lauromacrogol might have relatively fewer side effects as compared with anhydrous ethanol.

Objective The aim of this study was to investigate whether the earlylaparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) is beneficialin the treatment of patients with simultaneous gallbladder and extrahepatic bile duct stones. Methods A retrospective analysis was performed on the clinical data of 65 patients with gallbladder and extrahepatic bile duct stones who were admitted to our hospital between April 2019 and April 2022, and all patients underwent ERCP and EST for removal of bile duct stones firstly. After that,35 patients in the observation group received LC within 48 h, and another 30 patients received in 48 h to 72 h later. Serum C-reactive protein (CRP) and peripheral blood white blood cell (WBC) counts were obtained. Serum interleukin-6 (IL-6) and tumor necrosis factor-α(TNF-α) levels were assayed by ELISA. Results The intraoperative blood loss, hospital stay after operation and medical cost in the observation were (15.6±2.3)ml,(8.3±0.9)days and (19000±200)yuan, much less or shorter than [(34.7±4.1)ml, (12.3±1.5) days and (24000±300)yuan,P＜0.05] in the control, while there were no significant differences as respect to operation times for LC,the conversion rates to laparotomy and the stone clearance rates between the two groups (P>0.05); before and after the operation, there were no significant differences respect to serum bilirubin, AST, ALT and albumin levels between the two groups(P>0.05); after the operation, the WBC count and serum CRP level in the observation were (14.3±1.7)×10⁹/L and (25.5±2.3)mg/L, significantly higher than [(12.8±2.5)×10⁹/L and (18.7±3.4)mg/L, respectively, P＜0.05] in the control, while there were no significant differences as respect to serum IL-6 andTNF-α levels between the two groups [(33.1±6.5)μg/L and (21.8±2.7)μg/mL vs. (36.8±38.2)μg/L and (20.2±3.1)μg/mL, P＜0.05]; there was no significant difference in the incidence of postoperative complications between the two groups (8.6% vs. 23.3%, P>0.05). Conclusion For patients with simultaneous gallbladder and extrahepatic bile duct stones, the LCcould be performed early after ERCP and EST, which might shorten the hospitalization time, with relative less medical costs.

Objective The aim of this study was to compare the clinical efficacy of laparoscopic hepatectomy (LH) and percutaneous transhepatic choledochoscopic lithotomy (PTCL) in the treatment of patients with intrahepatic bile duct stones. Methods 86 patients with intrahepatic bile duct stones were enrolled in our hospital between June 2019 and June 2022, and among them, 41 patients in observation group underwent LH and 45 patients in control group underwent PTCL. Serum cortisol (COR) and epinephrine (EP) levels were detected by chemiluminescence. All patients after operation were followed-up by ultrasonography. Results The surgical time, intraoperative blood loss, anal exhaust time and postoperative hospital stay in the observation group were(152.1±21.9)min,(93.2±18.3)ml,(1.2±0.6)d and (4.6±0.8)d, all significantly shorter or less than [(181.6±26.3)min, (149.6±20.1) ml, (1.7±0.8)d and (6.9±1.2)d, respectively, P<0.05] in the control; 3 days after operation, serum ALT, AST, total bilirubin, COR and EP levels in the observation group were (42.8±6.4)U/L, (35.6±5.1)U/L, (16.6±2.1)μmol/l, (359.2±34.4)nmol/ml and (253.2±24.6)pg/ml, all significantly lower than [(56.5±6.7)U/L, (45.8±5.9)U/L, (24.8±2.6)μmol/l, (472.6±41.3)nmol/ml and (316.8±30.3)pg/ml, respectively, P<0.05] in the control; after operation, the incidences of complications, such as infection, ascites, bile leak and bleeding, in the observation was 9.8%, much lower than 26.7%(P<0.05) in the control; 3 months after operation, the residual or relapse of stones revealed by ultrasonography in the observation was 2.4%, much lower than 15.6%(P<0.05) in the control. Conclusion The application of LH in the treatment of patients with intrahepatic bile duct stones is efficacious, which has less post-operational complications and less relapse of stones.

With the increasing prevalence of obesity and diabetes, the incidence of nonalcoholic fatty liver diseases(NAFLD)has gradually increased. More and more patients with chronic hepatitis B (CHB) are complicated with NAFLD. The chronic HBV infection and NAFLD are both causes of hepatocellular carcinoma(HCC), and the patients with CHB and NAFLD might have the increased risk of HCC. In this article, we review the hepatocarcinogenesis, prevention and control management of patients with CHB and NAFLD, and patients with HCC.

Chronic hepatitis B virus infection is an important factor in the progression of liver disease and hepatocellular carcinoma. The complete life cycle of hepatitis B virus is dependent on the host cell, which makes host-targeting antiviral (HTA) treatment options promising. The HTA includes inhibition of virus entry, destabilization of viral nucleic acids and enhancement of host immune response to HBV infection. This paper reviewed the development of medicines that target hosts and host factors in order to achieve the goal of hepatitis B virus suppression, with a view to providing a reference for subsequent antiviral research and clinical treatment.

Immune checkpoint inhibitor is a kind of cancer immunotherapy agents, which has anti-tumor activities by improving immune microenvironment around the tumors. The hepatocellular carcinoma (HCC) is the most common primary liver cancer, and the treatment efficacy of advanced disease is poor. The immune checkpoint inhibitors have a certain effects on advanced HCC. In this article, we will review the mechanism, treatment and adverse events of immune checkpoint inhibitors in treating patients with advanced HCC.