Objective The aim of this study was to investigate the diagnostic performance of FibroScan and gamma-glutamyl transpeptidase to platelet ratio (GPR), aspartate aminotransferase to platelet ratio index (APRI)and fibrosis-4(FIB-4)for liver fibrosis (LF) evaluation in patients with chronic hepatitis B virus infection without serum alanine aminotransferase (ALT) level elevation. Method A total of 154 individuals with high serum HBV DNA loads and normal serum ALT levels were recruited in our hospital between February 2015 and December 2020, and all persons underwent liver biopsy, blood and serum parameters detection. Based on the Scheuer scoring system, the LF was determined, the liver stiffness measurement (LSM) was detected by FibroScan, and the GPR, APRI and FIB-4 were calculated. A multivariate binary Logistic regression analysis (Enter)was applied to construct predictive formulas, the receiver operating characteristic (ROC)curve was plotted, and the area under the ROC curve (AUC)was calculated, and compared by Delong method. Results Among the 154 individuals with chronic CHB infection, the liver histopathological examination showed significant LF (≥S2)in 73 cases(47.4%) and progressive LF (≥S3)in 25 cases(16.2%); the FIB-4, APRI, GPR and LSM in patients with ≥S2 were 1.0(0.8, 1.2), 0.3(0.2, 0.4), 0.2(0.2, 0.3) and 7.0(6.0, 9.0)kPa, and in patients with ≥S3 were 1.3(1.0, 1.7), 0.4(0.3, 0.5), 0.3(0.2, 0.4) and 9.0(7.4, 11.0)kPa, all significantly greater than [0.7(0.6, 1.0), 0.2(0.2, 0.3), 0.1(0.1, 0.2) and 5.0(4.1, 6.1)kPa, respectively, P<0.05] in persons with S0-S1; the predictive formula of the four parameter combination by Logistics regression analysis were as follows, Logit(≥S2)=1.303×FIB-4+9.8×GPR-0.684×APRI+0.7×LSM-7.565, with the AUC of 0.858 for predicting ≥S2 LF, and Logit(≥S3)=3.307×FIB-4+5.361×GPR-4.394×APRI+0.635×LSM-9.632, with the AUC of 0.914 for predicting ≥S3 LF, both superior to any parameter alone (all P＜0.001). Conclusion Nearly half of the individuals with chronic hepatitis B viral infection with normal serum ALT levels and detectable serum HBV DNA loads have significant LF or even progressive LF, and the FibroScan, GPR, APRI and FIB-4 might help non-invasively predict the existence of LF and warrants further investigation.

Objective The aim of this study was to investigate serum hepatitis B virus pregenomic RNA (HBV pgRNA) level changes in patients with chronic hepatitis B (CHB) receiving nucleos(t)ide analogues (NAs) treatment. Methods 78 patients with CHB were recruited in our hospital between September 2019 and September 2021, and all were treated with NAs for 12 months. Serum HBV DNA and HBV pgRNA levels were detected by fluorescence quantitative PCR. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were observed. Serum HBsAg level was assayed by enzyme-linked immunosorbent assay. The factors influencing complete response (CR) to antiviral therapy were analyzed by Cox regression analysis, and the the predictive performance of serum HBV pgRNA for NAs treatment efficacy was evaluated by receiver operating characteristic (ROC) curves. Results At the end of 48 week observation of antiviral treatment, 66 patients with CHB obtained CR in our series; at presentation, serum HBV DNA loads, HBsAg levels and HBV pgRNA lads in patients with CR were (6.0±0.7)lg IU/mL, (2.4±0.5)lg IU/mL and (3.0±0.9)lg copies/mL, significantly lower than [(7.1±1.3)lg IU/mL, (3.8±0.9)lg IU/mL and (6.8±0.4)lg copies/mL, respectively, P＜0.05) in patients without CR; the Cox analysis showed that serum HBsAg levels (HR=1.432, 95%CI:1.022-2.006) and HBV pgRNA(HR=1.237, 95%CI:1.060-1.445) at admission were the factors influencing antiviral response (P＜0.05), and the ROC analysis demonstrated that the AUC was 0.825(95%CI:0.722-0.902), with the sensitivity of 89.4% and the specificity of 83.3% when serum HBV pgRNA loads equal to 4.8 lg copies/mL was set as the cut-off-value in predicting the antiviral response in patients with CHB. Conclusion The monitoring of serum HBV pgRNA loads has certain clinical predictive efficacy for antiviral therapy with NAs in patients with CHB, which needs further clinical investigation.

Objective The aim of this study was to investigate the 3-year follow-up results of patients with serum HBeAg-positive chronic hepatitis B (CHB) after 48 to 72 week pegylated interferon α-2a (peg-IFN α-2a) treatment. Methods 72 na-ve patients with serum HBeAg-positive CHB were recruited in our hospital between March 2017 and March 2018, and all received peg-IFN α-2a treatment, including 33 patients in group A treated for 48 weeks and 39 patients in group B for 72 weeks. All patients in our series were followed-up for three years. The clinical efficacy, as serum HBsAg disappearance rate, HBeAg disappearance rate, HBeAg seroconversion rate, HBV DNA negative conversion rate and ALT normalization rate were compared between the two groups. The liver stiffness measurement (LSM) was measured by FibroTouch liver transient elastography. The independent impacting factors for serum HBeAg seroconversion were analyzed by Logistics regression analysis. Results At the end of 48 week treatment, there was no significant difference respect to the antiviral efficacy between the two groups (P>0.05); at the end of 72 weeks, serum HBsAg disappearance, HBeAg disappearance, HBeAg seroconversion, HBV DNA loss and ALT normalization rates in group B were 33.3%, 64.1%, 71.8%, 69.2% and 74.4%, much higher than 12.1%, 39.4%, 48.5%, 45.5% and 51.5% (P<0.05) in group A; at the end of two year follow-up, serum HBsAg disappearance, HBeAg disappearance, HBeAg seroconversion, HBV DNA loss and ALT normalization rates in group B were 43.6%, 69.2%, 74.4%, 74.4% and 79.5%, much higher than 21.2%, 42.4%, 51.5%, 48.5% and 54.6% (P<0.05) in group A and at the end of 3 year follow-up, they were 46.2%, 76.9%, 82.1%, 79.5% and 84.6% in group B, also much higher than 27.3%, 57.6%, 60.7%, 60.6% and 72.7% (P<0.05) in group A; at the end of 3 year follow-up, serum HBeAg seroconversion was obtained in 52 cases in our series, and there were significant differences as respect to the ages, antiviral regimen period and serum HBeAg levels at baseline between patients with and without serum HBeAg seroconversion (P<0.05); the multivariate Logistics analysis showed that the age, treatment course of peg-IFN α-2a and baseline HBeAg levels were the independent factors affecting HBeAg seroconversion (P<0.05). Conclusion The prolongation of antiviral course of peg-IFN α-2a might improve the clinical efficacy, and the regimen has a good safety and could enhance the anti-hepatic fibrosis ability.

Objective The aim of this study was to explore the changes of liver stiffness measurement (LSM) and S index in patients with chronic hepatitis B (CHB) and their diagnostic performance in evaluating liver fibrosis (LF). Methods A total of 95 patients with CHB were enrolled in our hospital between June 2020 and June 2022, and all patients underwent liver biopsy. The histological activity index and fibrosis staging were evaluated by Scheuer scoring system. The ultrasonic elastography was used to detect LSM. Serum glutamyl transpeptidease (GGT), albumin (ALB) and blood platelet count (PLT) were detected and S index was calculated. The receiver operating characteristic (ROC) curves were drawn by SPSS 25.0 statistical software, and the area under the curve (AUC) was calculated to determine the diagnostic efficacy of LSM and S index for the severity of LF. Results The liver histological examination showed that out of the 95 patients with CHB, there were 66 cases with non-significant intrahepatic inflammation and 29 cases with significant liver inflammation,and there were 62 cases with liver fibrosis stage S0-S1, 19 cases with stage S2 and 14 cases with stage S3-S4; the LSM and S index in CHB patients with significant intrahepatic inflammation were (9.6±1.2)kPa and (0.9±0.2), significantly higher than [(6.7±0.8) kPa and (0.5±0.1), respectively, P＜0.05)] in patients without significant liver inflammation; the LSM and S index in patient with S3-S4 were (11.2±2.3) kPa and (1.1±0.2), significantly higher than [(8.4±1.5) kPa and (0.9±0.2), P＜0.05] in patients with S2 or [(5.7±1.1)kPa and (0.4±0.1), P＜0.05] in patients with S0-S1; the AUCs were 0.891(95%CI:0.811-0.946, P＜0.001) and 0.889(95%CI:0.808-0.944, P＜0.001) when the LSM and S index were applied to predict significant LF, with the sensitivities (Se) of 0.879 and 0.727, and the specificities (Sp) of 0.807 and 0.887; the AUCs were 0.872(95%CI:0.787-0.932, P＜0.001) and 0.807(95%CI:0.713-0.881, P＜0.001) when the LSM and S index were applied to predict the advanced LF, with the Se of 0.786 and 0.786, and the Sp of 0.938 and 0.765. Conclusion The LSM and S index are closely correlated to the severity of LF in patients with CHB, and monitoring their changes might be beneficial to evaluate the severity of LF.

Objective The aim of this study was to investigate the predicting performance of liver stiffness measurement (LSM) and serum glutamyl transpeptidase (GGT)/platelet (PLT) ratio combination in judging liver fibrosis (LF) in patients with chronic hepatitis B (CHB). Methods A total of one hundred and seventy-five patients with CHB were encountered in our hospital between February 2019 and February 2021, and all patients had received nucleos(t)ides for antiviral therapy. The liver biopsies were performed and the LF was determined by METAVIR scoring system, the LSM was obtained by transient ultrasound elastography (FibroScan) and the GGT/PLT ratio was culculated. Serum laminin (LN), hyaluronidase (HA), type Ⅲ procollagen (PCⅢ) and Ⅳ-collagen levels were detected routinely. The multivariate Logistic analysis was applied to reveal the impacting factors for LF, and the area under the receiver operating characteristic curve (AUC) was applied to predict the efficacy of LSM and GGT/PLT ratio for the diagnosis of LF. Results Out the 175 patients with CHB, the liver histopathological examination showed significant LF in 25 cases(F₂ in 10 cases, F₃ in 9 cases and F₄ in 6 cases), and non- or minor-LF in 150 cases(F₀ in 138 cases, F₁ in 12 cases); the LSMs in patients with F₁, F₂, F₃ and F₄ were (5.3±1.1)kPa, (10.6±2.3)kPa, (14.1±3.4)kPa and (19.3±4.1)kPa, and the GPRs were (0.2±0.1), (0.3±0.1), (0.4±0.1) and (0.5±0.1), significantly different among them (P＜0.05); serum AST, ALT, PCⅢ, Ⅳ-C, HA levels and LSM and GPR in patients with significant LF were (69.3±6.4)U/L,(87.4±7.1)U/L,(17.6±3.2)ng/ml,(19.2±3.4)ng/ml,(96.2±9.9)ng/ml, (14.9±3.7)kPa and (0.4±0.1), all much higher than [(31.2±5.4)U/L, (31.1±4.5)U/L, (10.2±2.0)ng/ml, (13.4±2.4)ng/ml, (52.8±8.9)ng/ml,(5.9±1.1)kPa and (0.2±0.1), respectively, P＜0.05] in patients without significant LF; the multivariate Logistic analysis showed that serum Ⅳ-C and HA levels as well as the LSM and the GPR were all the independent risk factors for significant LF (P＜0.05); the ROC analysis demonstrated that the AUC was 0.975, with the sensitivity of 76.0% and the specificity of 98.0%, when the LSM, with the cut-off value of 10.4 kPa, and the GPR, with the cut-off value of 0.3, combination was applied to predict the significant LF. Conclusion As for the patients with CHB receiving nucleos(t)ides therapy, the LSM and GPR combination might predict significant LF, and warrants further clinical validation.

Objective The aim of this clinical trial was to investigate the virological response to direct acting antivirals (DAAs) in patients with chronic hepatitis C (CHC) and liver fibrosis. Methods 65 patients with CHC were encountered in our hospital between June 2019 and January 2022, all patients underwent liver biopsies at presentation, and the combination of sofosbuvir and ribavirin was given to 37 patients and the combination of sofosbuvir and daratavir was given to 28 patients, both lasting for 12 weeks. All the patients were followed-up for 24 weeks. The aspartate aminotransferase to platelet ratio index (APRI) and fibrosis index based on the 4 factors (FIB-4) were obtained, and the liver stiffness measurement (LSM) was measured by FibroScan. The peripheral blood lymphocyte subsets was determined by FCM. Results The liver histopathological examination showed that ≤F2 liver fibrosis in 31 cases and ≥F3 liver fibrosis in 34 cases in our series; at admission, there were significant differences as respect to the ages [54(35, 62) year old vs. 60(51, 67) year old], LSM [8.1(6.5, 9.0)kPa vs. 17.0(13.1, 26.4)kPa], APRI[ 0.4(0.3, 0.7) vs. 0.9(0.6, 1.4)], FIB-4[ 1.6(0.9, 2.5) vs. 3.7(2.4, 5.2)], PLT counts [174(123, 217)×10⁹/L vs. 130(93, 147)×10⁹/L] and AST levels [76(56, 79)U/L vs. 62(47, 67)U/L, all P<0.05] between patients with ≤F2 and ≥F3 liver fibrosis; at the end of 24 week follow-up, the sustained virologic response (SVR) was 100.0% in the 65 patients with CHC; at baseline, the end of treatment and end of follow-up, the percentages of peripheral blood CD4⁺ cells [(34.6±2.8)%, (41.4±3.4)% and (44.8±3.7)%] and the ratio of CD4⁺/CD8⁺ cells [(1.1±0.2), (1.3±0.3) and (1.6±0.4)] in patients with ≤F2 liver fibrosis were not significantly different compared to [(34.3±3.0)%, (39.6±3.8)% and (41.8±3.7)%] and [(1.1±0.3), (1.4±0.3) and (1.6±0.4)] in patients with ≥F3 liver fibrosis, although they both increased as the prolongation of the antiviral treatment. Conclusion The application of DAAs in the treatment of patients with CHC and different stage of liver fibrosis is efficacious, which not only by the direct antiviral action, but by the modulation of immune functions.

Objective The aim of this study was to observe the direct acting antivirals (DAAs) in treatment of patients with chronic end-stage renal disease ((ESRD)) and concomitant hepatitis C virus infection. Methods 26 patients with ESRD and concomitant chronic hepatitis C (CHC) were enrolled in our hospital between January 2015 and January 2021, including 20 naïve cases and 6 peg-interfoeron-α2a and ribavirin combination treated cases. The patients with CHC had 1b infection in 9 cases, 2a infection in 5 cases, 3b infection in 6 cases and 6a infection in 6 cases. All patients received sophorbuvir (200 mg.d^-1) and daclatavir (90 mg.d^-1) combination anti-viral treatment for 24 weeks. The rapid virological response (RVR), end of treatment virological response (ETVR), sustained virological response at six month discontinuation (SVR 6) and SVR at 12 month discontinuation (SVR12) were recorded. Results The RVR, ETVR, SVR6 and SVR12 in all patients with different HCV genotype infection were 100.0%, except for in patients with 3b infection, in which the SVR6 and SVR12 were 83.3%, as one patients had relapse after discontinuation of DAA treatment; at admission, serum HCV RNA loads in naïve patients was 4.4(0.8,7.4)×10⁶IU/ml, much higher than 4.0(0.6, 6.0)×10⁶IU/ml in re-treated patients (P<0.05); after DAAs antiviral treatment, the SVR in naïve patients was 95.0%, not significantly different compared to 100.0% in re-treated patients (P>0.05); at admission, serum ALT and AST levels in 26 CHC patients were 92(57, 109)U/L and 86(54, 97)U/L, both got back to normal [27(19, 31)U/L and 19(17, 28)U/L, P<0.05] after treatment, while serum Cr levels had no significant changes [286.2(176.0, 391.2)μmol/L vs. 282.4(177.8, 387.9)μmol/L, P>0.05] in our series; during the period of antiviral treatment, there were eight kinds(43 case times)of DAAs-related untoward effects, including nausea in 38.5%, fatigue in 38.5%, anorexia in 30.8%, hyperkalemia in 26.9%, arthralgia in 11.5%, hypoglycemia in 7.7%, hypertension in 7.7% and hematuresis in 3.8%. Conclusion The DAAs regimen by fosbuvir and daclatasvir combination is efficacious and safe in treatment of patients with ESRD and CHC, which warrants further clinical investigation.

Objective The aim of this study was to investigate the skeletal muscle mass (SMM) changes in patients with non-alcoholic fatty liver diseases (NAFLD). Methods A total of 7467 individuals were encountered in the Health Management Center, First Affiliated Hospital, Nanjing Medical University between January 2020 and June 2021, and the physical examination were carried out. The abdominal ultrasonography showed the NAFLD in 3385 cases and other 4082 persons served as the control. The NAFLD fibrosis score (NFS) greater than 0.676 was found in 39 cases with advanced liver fibrosis (ALF), in 2591 cases without liver fibrosis and in 755 cases with non-advanced liver fibrosis. The SMM index (SMI) was calculated as follows: the appendicular skeletal muscle mass/ body weight. Results The SMI in patients with NAFLD was (38.8±3.3)%, significantly lower than [(40.7±3.3)%, P<0.01] in the control; the Logistic regression analysis showed that the SMI was the independent impacting factor for NAFLD occurrence as corrected by metabolic factors (OR=0.719, 95%CI 0.694-0.745, P<0.001); the 7467 individuals were divided into three groups by SMI tertiary, the analysis showed corrected by age, blood sugar and fat that individuals with low and middle SMI had 1.482 times and 2.328 times high tendency of risk for NAFLD compared to those with high SMI as the reference, and the incidences of NAFLD in individuals with low, middle and high SMI were 53.5%, 46.8% and 35.8%(P<0.05); the SMI in patients with ALF was (37.6±3.6)%, significantly lower than in with non-advanced or without liver fibrosis [(38.1±3.5)% or (39.0±3.2)%, P<0.01]; the patients with NAFLD were divided into three groups by SMI tertiary as with low SMI in 1129 cases, middle in 1128 cases and high in 1128 cases, and the analysis showed that the incidences of ALF in patients with low, middle and high SMI were 1.9%, 1.0% and 0.6%(P<0.05), of without ALF were 26.6%, 22.2% and 18.0%(P<0.05), and of without liver fibrosis were 71.5%, 76.8% and 81.4%(P<0.05). Conclusion The decreased SMM is common in patients with NAFLD and might be related to ALF, which needs further investigation.

Objective The aim of this study was to investigate the short-term efficacy of glycyrrhizin and fenofibrate combination in the treatment of patients with metabolic associated fatty liver disease (MAFLD). Methods 74 patients with MAFLD were recruited in our hospital between December 2019 and December 2021, and were randomly divided into control and observation group, with 37 cases in each, receiving oral glycyrrhizin or glycyrrhizin and fenofibrate combination therapy for 24 weeks. The controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were detected by Fibrotouch, and the fatty liver index (FLI) was calculated. Results At the end of 24 weeks of treatment, serum high-density lipoprotein level in the observation group was (1.7±0.4)mmol/L, significantly higher than [(1.4±0.3)mmol/L, P＜0.05], while serum total cholesterol, triglyceride and low density lipoprotein levels were(4.7±0.7)mmol/L,(2.2±0.4)mmol/L and (2.0±0.3)mmol/L, all significantly lower than [(5.5±0.9)mmol/L, (3.4±0.7)mmol/L and (2.6±0.4)mmol/L, respectively, P＜0.05] in the control; serum alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transferase levels in the observation group were (50.5±4.9)U/L,(56.5±6.8)U/L and (92.0±11.5)U/L, all not significantly different compared to [(53.6±5.8)U/L, (50.4±7.7)U/L and (90.3±18.6)U/L, respectively, P＜0.05] in the control group; the CAP and the FLI in the observation group were (281.2±16.7)dB/m and (19.9±4.5), both significantly lower than [(316.1±29.5)dB/m and (23.2±5.0), respectively, P＜0.05] in the control, while there was no significant difference as respect to the LSM between the two groups [(8.4±1.7)kPa vs.(8.2±1.3)kPa, P>0.05]. Conclusion The application of glycyrrhizin and fenofibrate combination in treatment of patients with MAFLD is efficacious, which might regulate lipid metabolism, improve liver function recovery and reduce liver fat content.

Objective The aim of this study was to explore the changes of serum hypoxia-inducible factor-1α (HIF-1α), chemerin and adiponectin (ADPN) levels in patients with metabolic-associated fatty liver diseases (MAFLD). Methods 86 patients with MAFLD and 43 healthy individuals at physical healthy examination matched by age and gender were consecutively encountered in our hospital between March 2020 and October 2022. Serum levels of HIF-1α, Chemerin and ADPN were detected by ELISA, and the hepatic steatosis was evaluated by ultrasonography. The area under the receiver operating characteristic curve (AUC) was applied to analyze the diagnostic performance of serum indicators on severe steatosis in patients with MAFLD. Results Serum HIF-1α and chemerin levels in patients with MAFLD were (16.6±3.1)μg/L and (92.7±8.9)μg/L, both significantly higher than [(9.2±2.1)μg/L and (60.4±9.5)μg/L, P<0.05] in the control, while serum ADPN level was (15.1±3.8)mg/L, significantly lower than [(25.4±6.2)mg/L, P<0.05] in the control; serum HIF-1α and chemerin levels in 35 patients with severe hepatic steatosis were (19.9±3.7)μg/L and (107.9±10.5)μg/L, both significantly higher than [(16.3±1.9)μg/L and (92.9±8.7)μg/L, P<0.05] in 29 patients with moderate liver steatosis or [(10.5±1.8)μg/L and (84.0±8.3)μg/L, P<0.05] in 22 patients with mild steatosis, while serum ADPN level was (12.3±2.8)mg/L, much lower than [(16.4±4.8)mg/L, P<0.05] in patients with moderate steatosis or [(24.2±4.2)mg/L, P<0.05] in patients with mild steatosis; the multivariate Logistic regression analysis showed that the fasting blood glucose, triglyceride, total cholesterol, low-density lipoprotein cholesterol, HIF-1α and chemerin and low level of ADPN were the independent risk factors for severe steatosis in patients with MAFLD (P<0.05); the AUC was 0.920 by the combination of serum HIF-1α, chemerin and ADPN levels in predicting severe steatosis in patients with MAFLD, much larger than 0.846, 0.742 and 0.795(P<0.05) by the three parameter alone. Conclusion Serum HIF-1α and chemerin levels increase, while serum ADPN level decrease in patients with MAFLD, and the changes of the above three parameters are related to the steatosis degree in patients with MAFLD, and their clinical implications are worthy of further investigation.

Objective The aim of this study was to analyze the changes of peripheral blood mononuclear cell (PBMC) Toll-like receptor 2 (TLR2) and cytotoxic T lymphocyte associated antigen-4 (CTLA-4) in patients with autoimmune hepatitis (AIH). Methods 47 patients with AIH and 50 healthy subjects were encountered in our hospital between June 2018 and June 2022, and all patients with AIH received liver biopsies. The peripheral blood was drawn for separation of PBMCs, the TLR2 and CTLA-4 mRNA in PBMCs were detected by PCR, and the percentages of TLR2 and CTLA-4 positive PBMCs were detected by flow cytometry. Results The PBMC TLR2 mRNA level and the percentage of TLR2 positive PBMCs in patients with AIH were (1.7±0.4) and (34.2±7.9)%, both significantly higher than [(0.9±0.2) and (21.4±3.5)%, respectively, P<0.05], while the PBMCs CTLA-4 mRNA level and the percentage of CTLA-4 positive PBMCs were (0.5±0.2) and (2.3±0.8)%, both significantly lower than [(1.1±0.2) and (13.7±3.9)%, respectively, P<0.05] in healthy persons; the PBMC TLR2 mRNA level and the percentage of TLR2 positive PBMCs in 21 AIH patients with grade G3/G4 were(1.9±0.3) and (37.2±5.7)%, both much higher than [(1.5±0.3) and (30.5±6.2)%, respectively, P<0.05] in 26 AIH patients with grade G1/G2, while the PBMCs CTLA-4 mRNA level and the percentage of CTLA-4 positive PBMCs were (0.3±0.1) and (1.9±0.6)%, both much lower than [(0.7±0.2) and (2.6±0.8)%, respectively, P<0.05] in patients with G1/G2; the PBMC TLR2 mRNA level and the percentage of TLR2 positive PBMCs in 17 AIH patients with stage F3/F4 were(1.9±0.3) and (37.6±5.3)%, both much higher than [(1.6±0.3) and (32.9±4.2)%, respectively, P<0.05] in 25 patients with stage F1/F2 or [(1.3±0.2) and (28.7±1.9)%, respectively, P<0.05] in 5 patients without liver fibrosis, while the PBMCs CTLA-4 mRNA level and the percentage of CTLA-4 positive PBMCs were(0.3±0.1) and (1.8±0.6)%, both much lower than [(0.6±0.2) and (2.3±0.7)%, respectively, P<0.05] in patients with stage F1/F2 or [(0.9±0.2) and (4.2±0.4)%, respectively, P<0.05] in patients with stage F0. Conclusion The PBMC TLR2 mRNA levels and the percentage of TLR2 positive PBMCs increase, and the PBMCs CTLA-4 mRNA level and the percentage of CTLA-4 positive PBMCs decrease in patients with AIH, which might be correlated to the hepatic activity index and liver fibrosis staging, and needs further investigation.

Objective The aim of this study was to explore serum microRNA-21 (miR-21), nuclear factor-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) level changes in pregnant women with drug-induced liver injury (DILI). Methods 83 pregnant women with DILI and 58 healthy pregnant women who underwent obstetric examination at the same time were enrolled in our hospital between August 2017 and September 2021. Serum miR-21 was detected by real-time fluorescence PCR, and serum Nrf2 and HO-1 levels were measured by ELISA. Results The patients with DILI in our series included hepatocyte injury type in 53 cases, cholestasis type in 21 cases and mixed in 9 cases; based on the severity of liver injuries, it was found grade 1 in 31 cases, grade 2 in 32 cases, grade 3 in 16 cases and grade 4 in 4 cases; in our series, 67 women had a very good pregnant outcomes, while in 16 women, the pregnant outcomes were not satisfied as showed with premature baby, dead fetus, and intrauterine fetal growth retardation; serum miR-21, Nrf2 and HO-1 levels in women with DILI were (1.5±0.2), (537.4±53.8)U/L and (16.7±3.1)U/L, significantly higher than [(0.4±0.1), (203.5±47.2)U/L and (11.4±2.2)U/L, respectively, P<0.05] healthy pregnant women; serum miR-21 and Nrf2 levels in women with cholestasis were (2.1±0.4) and (574.6±37.2)U/L, significantly higher than [(1.3±0.2) and (521.8±39.5)U/L, P<0.05] in women with hepatocyte injury or [(1.5±0.2) and (542.1±34.8)U/L, P<0.05] in women with mixed injury, and serum miR-21 level in women with mixed injury was much higher than in women with hepatocyte injury(P<0.05); serum miR-21, Nrf2 and HO-1 levels in women with grade 4 liver injury were (2.3±0.4),(589.0±35.1)U/L and (21.5±2.8)U/L, much higher than [(1.7±0.3), (573.2±38.6)U/L and (19.1±1.8)U/L, P<0.05] in women with grade 3, or [(1.5±0.3), (539.5±45.3)U/L and (16.4±2.5)U/L, P<0.05] in women with grade 2 or [(1.2±0.2), (503.7±41.0)U/L and (14.5±2.1)U/L, P<0.05] in women with grade 1 liver injury; serum miR-21, Nrf2 and HO-1 levels in pregnant women with unsatisfied outcomes were (1.6±0.2), (542.7±49.5)U/L and (17.1±2.3)U/L, all much higher than [(1.2±0.3), (515.3±41.8)U/L and (15.1±2.5)U/L, respectively, P<0.05] in women with normal outcomes. Conclusion Serum miR-21, Nrf2 and HO-1 levels in pregnant women with DILI increase greatly, which might be helpful in assessing the severity of liver injuries.

Objective The aim of this study was to observe the efficacy of silibinin and polyene phosphatidylcholine combination therapy in patients with anti-tuberculosis drugs-induced liver injury (DILI). Methods 118 patients with pulmonary tuberculosis were encountered in our hospital between June 2018 and June 2021, and all received standardized anti-tuberculosis treatment by 2HRS( E) Z /4HR for six months. During the process, 63 patients were found having DILI, and were randomly divided into control (n=30) and observation (n=33) groups, receiving polyene phosphatidylcholine or silibinin capsule and polyene phosphatidylcholine combination therapy until the anti-tuberculosis regimen ended. Serum interleukin-2 (IL-2), IL-6, IL-1β and tumor necrosis factor-α (TNF-α) levels were detected by ELISA, serum superoxide dismutase (SOD) was detected by radioimmunoassay and serum reduced glutathione (GSH) and malondialdehyde (MDA) levels were assayed by biochemical colorimetry. Results After treatment, serum ALT, AST and GGT levels in the observation group were (32.8±6.1)U/L, (41.2±8.3)U/L and (36.1±6.5)U/L, all significantly lower than [(48.6±8.4)U/L, (53.8±9.2)U/L and (53.8±9.6)U/L, respectively, P<0.05] in the control; serum IL-6, IL-1β and TNF-α levels in the observation were (6.3±1.0)ng/L, (11.0±2.3)μg/L and (6.8±1.5)ng/L, all much lower than [(9.5±1.2)ng/L, (19.2±3.6)μg/L and (9.9±1.3)ng/L, respectively, P<0.05] in the control, while there was no significant difference respect to serum IL-2 levels in the two groups (P>0.05); serum SOD and GSH levels in the observation group were (597.3±71.6)U/L and(7.6±1.5)μmol/L, both significantly higher than [(542.8±68.2)U/L and (6.2±1.3)μmol/L, P<0.05], while serum MDA level was (4.0±0.7)nmol/L, much lower than [(5.8±0.9)nmol/L, P<0.05] in the control. Conclusion The administration of silibinin capsule and polyene phosphatidylcholine combination in treatment of patients with pulmonary tuberculosis during anti-tuberculosis therapy could protect the liver function test normal, and maintain the accomplishment of anti-tuberculosis treatment, which might be related to the relieving inflammation and oxidative stress response.

Objective The purpose of this study was to investigate the common medicines and influencing factors on severity of liver injury in hospital stay patients with drug-induced liver injury (DILI). Methods 104 patients with DILI and 148 patients without DILI were encountered in our hospital between September 2018 and March 2022, and the severity of liver injury was evaluated based on guideline related. Some patients received liver biopsies. The influencing factors on the severity of liver injury was predicted by univariate and multivariate Logistic analysis. Results The alleged causative medicines in our series included Chinese herbal medicines in 39 cases (37.5%), antibiotics in 17 cases (16.3%), non-steroidal anti-inflammatory drugs in 13 cases (12.5%), cardiovascular drugs in 8 cases (7.7%), antirheumatic drugs in 7 cases (6.7%), digestive agents in 7 cases (6.7%), psychotropic drugs in 5 cases (4.8%) and endocrine drugs in 2 cases (1.9%); in 17 patients with DILI having liver biopsies, the liver histopathological examination showed hepatocyte balloon degeneration in 11 cases (64.7%), punctate necrosis in 10 cases (58.8%), bridging necrosis in 4 cases (23.5%), inflammatory cell infiltration in portal area in 15 cases (88.2%), intrahepatocyte cholestasis or bile embolus formation in 5 cases (29.4%), and hepatocyte rose knot in 1 case (5.9%); the incidences of blood hypertension and hyperlipoidemia in patients with DILI were 17.3% and 34.6%, muchhigher than 8.1% and 18.2% (P<0.05) in patients without DILI; serum ALT, AST, GGT, ALP, bilirubin, TG and TC levels in patients with DILI increased greatly in our series; the univariate Logistic analysis showed that the hyperlipoidemia [OR=2.17, 95%CI(1.39-3.40), P=0.001] was the independent factor for the happening of DILI; out of the 104 patients with DILI, it was found that the severity of liver injury ≤grade 2 in 80 cases, and ≥grade 3 in 24 cases; the multivariate Logistic analysis demonstrated that the hyperlipoidemia [OR=3.10, 95%CI(1.34-7.11)] and the period of medicine administered [OR=0.26, 95%CI(0.08-0.80)] were the independent risk factors for the severity of liver injury (P<0.05). Conclusion The common causative medicines for DILI in a general hospital in China are Chinese herbal medicines, antibiotics and non-steroidal anti-inflammatory drugs, and the patients with multi-systemic underlying diseases and hyperlipoidemia are prone to having DILI, which should be carefully dealt with in clinical practice.

Objective The impact of sarcopenia in patients with liver cirrhosis on the clinical prognosis and other comorbidities is not fully understood. The Objective of this study was to investigate the occurrence and influencing factors of sarcopenia in patients with cirrhosis, and its impact on the occurrence of spontaneous bacterial peritonitis (SBP). Methods All inpatients with cirrhosis were included in our hospital between March 2019 and February 2021, and all patients underwent CT scan for muscle evaluation at L3 lumbar vertebra level by SliceOmatic V5.0 software. The multivariate Logistic regression analysis was applied to analyze the impacting factors for sarcopenia. Results A total of 311 patients with cirrhosis were included in this study, with the sarcopenia incidence of 11.6% (36/311); the age, male proportion and the incidence of SBP in patients with sarcopenia were(57.8±13.6)yr, 88.9% and 22.2%, significantly different compared to [(50.0±11.1)yr, 58.2% and 9.3%, respectively, P<0.05] in those without sarcopenia; the body mass index (BMI), white blood cell (WBC) counts, hemoglobulin (Hb), albumin and high-density lipoprotein levels in patients with sarcopenia 19.6(2.4)kg/m², 4.5(3.4)×10⁹/L, 100.5(36.5)g/L, 31.8±6.6 g/L and 0.9(0.4)mmol/L, significantly different compared to [ 22.5(4.2)kg/m², 3.5(2.6)×10⁹/L, 129.0(40.3)g/L, 36.3±6.6g/L and 1.0(0.4)mmol/L, respectively, P<0.05] in patients without sarcopenia; the multivariate Logistic regression analysis showed that the age, gender, WBC, Hb, albumin and BMI were all the independent risk factors for the existence of carcopenia (all P＜0.05). Conclusion The patients with liver cirrhosis could have sarcopenia, which might be a precipitating factor for the occurrence of SBP.

Objective The aim of this study was to investigate serum cytokine level and peripheral blood lymphocyte subset changes in patients with decompensated liver cirrhosis and hepatorenal syndrome (HRS). Methods 84 patients with decompensated liver cirrhosis and 50 healthy persons were enrolled in our hospital between June 2019 and June 2022, and all patients were carefully managed and were followed-up for 90 days. Serum C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were detected by ELISA, and peripheral blood lymphocyte subsets were determined by FCM. Results The HRS was found in 35 cases in our series; serum bilirubin level and INR in patients with HRS were (32.4±5.3)μmol/L and (1.5±0.5), both significantly higher than [(20.4±4.7)μmol/L and (1.4±0.4), P<0.05] in patients without HRS or [(8.3±1.2)μmol/L and (1.0±0.3), P<0.05] in healthy individuals, while serum albumin level was (27.2±1.8) g/L, much lower than [(31.6±2.1)g/L, P<0.05] in patients without HRS or [(46.3±5.2)g/L, P<0.05] in healthy persons; serum Cys-C, sCr and BUN levels in patients with HRS were (1.4±0.5)mg/L, (148.3±22.8)μmol/L and (11.5±2.6)μmol/L, much higher than [(1.0±0.3)mg/L, (86.1±13.2)μmol/L and (5.7±2.1)μmol/L, P<0.05] in patients without HRS or [(0.7±0.2)mg/L, (78.3±10.3)μmol/L and (4.9±1.8)μmol/L, P<0.05] in healthy persons, while 24-hour creatinine clearance (24-cCr) was (35.8±9.3) mL/min, much lower than [(83.2±11.5)mL/min, P<0.05] in patients without HRS or [(90.7±14.3)mL/min, P<0.05] in healthy persons; serum CRP, IL-6 and TNF-α levels in patients with HRS were (6.4±1.0)g/L, (15.6±2.3)pg/mL and (60.2±14.3)pg/mL, much higher than [为(5.6±1.2)g/L, (7.8±1.3)pg/mL and (35.8±7.9)pg/mL, P<0.05] in patients without HRS or [(1.6±0.5)g/L, (5.2±1.0)pg/mL and (20.4±6.1)pg/mL, P<0.05] in healthy persons; the percentages of peripheral blood CD3⁺, CD4⁺ and CD8⁺ cells in patients with HRS were much lower than in patients without HRS or healthy persons (P<0.05), and the ratio of CD4⁺/CD8⁺ cells was much lower in healthy persons (P<0.05); the 90 day fatality in patients with HRS was 82.9% in our series, much higher than 22.2% in patients without HRS(P<0.05). Conclusion The short-term fatality of patients with decompensated liver cirrhosis and HRS is high, which might be related to the activation of cytokines, decreased immune functions and deteriorated renal functions.

Objective The aim of this study was to explore the predictive efficacy of peripheral blood mononuclear cells (PBMCs) nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) and cysteine protease-1 (caspase-1) mRNA levels in patients with hepatitis B cirrhosis and complicated spontaneous bacterial peritonitis (SBP). Methods 65 patients with hepatitis B cirrhosis complicated by SBP were enrolled in our hospital between January 2018 and May 2020. The PBMC NLRP3 and caspase-1 mRNA levels were detected by real-time fluorescence quantitative PCR and serum interleukin-1β (IL-1β) and IL-18 levels were detected by ELISA. The predictive performance was evaluated by the area under receiver operating characteristic curve (AUC). Results The PBMCs NLRP3, caspase-1 mRNA and serum IL-1β and IL-18 levels in 21 patients with severe SBP were (1.5±0.3), (2.0±0.4), (11.7±2.1)pg/mL and (17.4±1.6)pg/mL, all significantly higher than [(1.1±0.2), (1.6±0.3), (8.6±1.3)pg/mL and (12.1±1.3)pg/mL, respectively, P<0.05] in 44 patients with mild SBP; the AUC was 0.899, with SE(95%CI) of 0.036(0.828-0.971), when predicting severe disease by the combination of PBMCs NLRP3 and caspase-1 levels; the PBMCs NLRP3, caspase-1 mRNA and serum IL-1β and IL-18 levels in 15 dead patients at presentation were (1.7±0.3), (2.3±0.5),(12.5±2.2)pg/mL and (18.2±3.1)pg/mL, all significantly higher than [(1.1±0.2), (1.6±0.3), (8.9±1.8) pg/mL and (12.7±2.5)pg/mL, respectively, P<0.05] in 50 survivals; the AUC was 0.916, with SE(95%CI) of 0.043(0.831-0.999), when predicting the prognosis of patients with SBP by the combination of PBMCs NLRP3 and caspase-1 mRNA levels. Conclusion The PBMCs NLRP3 and caspase-1 levels increase in patients with hepatitis B cirrhosis complicated by SBP, which might be related to the severity of the entity and needs further investigation.

Objective The aim of this study was to analyze the influencing factors of rebleeding in patients with hepatitis B liver cirrhosis complicated by esophageal gastric variceal bleeding (EGVB), and to establish a prediction model for early intervention. Methods 119 patients with hepatitis B cirrhosis and EGVB were encountered in our hospital between July 2020 and July 2022, and all patients received comprehensive internal medical treatment and even endoscopic intervention for hemostasis. The occurrence of re-bleeding within 3 months after hemostasis was recorded and statistically analyzed. The risk factors of re-bleeding were analyzed by multivariate Logistic regression analysis, and the ROC curve was applied to reveal the predictive performance of the model we established for re-bleeding. Results Out of our series, 48 patients(40.3%) had re-bleeding within three months after hemostasis, and four patients died 72 hours after re-bleeding; there were significant differences as respect to the percentage of Child-Pugh class C(97.7% vs. 84.5%), splenic thicknesses [(67.5±5.3)mm vs.(59.1±5.7)mm], diameters of portal vain [(16.8±2.1)mm vs.(14.5±2.3)mm], diameters of splenic vain [(10.9±2.3)mm vs.(8.4±1.8)mm], esophageal and gastric varices grade G3(81.8% vs. 46.5%), endoscopic red-color sign(88.6% vs. 38.0%), ascites (38.6% vs. 18.3%), serum albumin levels [(29.1±4.2)g/L vs. (33.5±4.8)g/L] and prothrombin time (PT)[(16.3±2.6)s vs. (12.7±2.1)s] between 44 patients with re-bleeding and 71 patients without (P<0.05); the Logistic regression analysis showed that the Child-Pugh class C [OR(95%CI):2.3(1.3-3.8)], splenic thickness [OR(95%CI):1.8(1.2-2.9)], diameter of portal vain [OR(95%CI):2.6(1.0-6.4)], diameter of splenic vain [OR(95%CI):1.4(1.0-1.9)], varices grade G3[OR(95%CI):2.4(1.0-5.5)], red-color sign[OR(95%CI):2.1(1.0-4.4)] and prolonged PT [OR(95%CI):1.8(1.1-2.9)] were the risk factors for re-bleeding; we built up a formula as follows: P=1/[1+e^{(0.814X1+0.597X2+0.939X3+0.328X4+0.863X5+0.739X6+0.592X7-1.164)}] based on the Logistic analysis, and a good fitting degree between the prediction model and the standard curve was found by the Hosmer-Lemeshow test (x²=3.711, P=0.882), and its AUC was 0.966 (95%CI:0.938-0.995) with the specificity of 87.3% and the sensitivity of 97.8% in predicting re-bleeding. Conclusion The patients with liver cirrhosis and EGVB might have a high tendency of re-bleeding after emergent hemostasis, and the early prediction as well as appropriate management might decrease the mortality, and needs further investigation.

Objective The aim of this study was to explore the clinical implications of serum and urine neutrophil gelatinase-associated lipocalin (NGAL), insulin-like growth factor binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP-2) levels in patients with hepatitis B liver cirrhosis (LC) complicated with acute kidney injury (AKI) . Methods 119 patients with hepatitis B-induced LC (complicated with AKI in 38 cases, including stage 1 in 15 cases, stage 2 in 14 cases and stage 3 in 9 cases), and 54 healthy individuals at physical examination were enrolled in our hospital between March 2020 and December 2022. Serum NGAL as well as urine NGAL, IGFBP7 and TIMP-2 levels were detected by ELISA. The univariate and multivariate Logistic regression analysis were applied to assess the risk factors for the occurrence of AKI in patients with decompensated LC. Results Serum NGAL, urine NGAL, TIMP-2 and IGFBP7 levels in patients with AKI were (371.7±60.2)μg/L, (59.7±7.3)μg/L, (3.3±0.6)ng/mL and (98.3±19.5)ng/mL, all significantly higher than [(82.3±15.7)μg/L, (10.7±2.5)μg/L, (2.4±0.5)ng/mL and (85.0±18.2)ng/mL, respectively, P<0.05] in patients with LC or [(46.5±10.9)μg/L, (7.9±1.2)μg/L,(0.7±0.1)ng/mL and (16.1±3.7)ng/mL, respectively, P<0.05] in healthy control; serum NGAL, urine NGAL, TIMP-2 and IGFBP7 levels in patients with AKI stage 3 were (552.7±63.5)μg/L, (81.9±13.7)μg/L, (4.0±0.7)ng/mL and (110.4±15.1)ng/mL, all significantly higher than [(249.5±50.7)μg/L, (45.7±11.9)μg/L, (2.8±0.6)ng/mL and (90.3±10.9)ng/mL, P<0.05] in patients with AKI stage 1 or [(386.3±59.8)μg/L, (60.4±9.5)μg/L, (3.4±0.7)ng/mL and(99.1±12.7)ng/mL, P<0.05] in patients with AKI stage 2; the 90 d survival rate in our patients with AKI was 57.9%; the percentages of Child-Pugh class C, AKI stage 3, with hepatic encephalopathy (HE), infection and upper gastrointestinal bleeding (UGIB) in dead group were much higher than in survivals, and serum NGAL level and urine NGAL, TIMP-2 and IGFBP7 levels were also significantly higher than in survivals (P<0.05); the multivariate Logistic regression analysis showed that the Child-Pugh class C, AKI stage 3, HE, UGIB and increased urine NGAL and IGFBP7 levels were all the independent risk factors for poor prognosis in patients with AKI and underlying LC (P<0.05). Conclusion The changes of serum NGAL and urine NGAL, TIMP-2 and IGFBP7 levels in patients with AKI secondary to hepatitis B LC are related to the disease severity, and the increased urine NGAL and GFBP7 levels are risk factors for poor prognosis.

Objective The purpose of this study was to investigate the Rho GTPase-activating protein 18 (ARHGAP18) gene levels and its roles in gene regulation network in patients with hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC). Methods In this study,4 datasets downloaded from the Gene Expression Omnibus (GEO) database was applied to evaluate the changes of ARHGAP18 gene levels. The ARHGAP18 levels in different clinic-pathological characteristics and its correlation to the prognosis of patients with HCC was analyzed in UALCAN website. The transcriptomic data and methylation array data from GEO dataset “HBV-HCC multi-omics cohort” were used to analyze the epigenetic patterns associated with ARHGAP18. Results The ARHGAP18 level in liver tissues from patients with chronic hepatitis B was (5.62±0.66), significantly higher than [(5.04±0.21),P<0.05] in normal control; the ARHGAP18 level in cancerous tissues from patients with HBV-HCC was (3988.63±1701.17), significantly higher than [(1976.34±531.32), P<0.05] in paranon-cancerous samples; the ARHGAP18 levels in liver margin, 2 to 3 cm liver tissue from the tumor, peritumor liver tissue, peri-tumor cancerous tissue and the center of tumors were(7.06±0.61), (6.83±0.47), (6.82±0.42), (7.75± 0.56) and (8.38 ± 0.79), suggesting a tendency of gradually increased ARHGAP18 levels from the so-called normal liver to the center of tumor(P<0.05); the high ARHGAP18 level was associated with shorter survival in patients with HCC (P<0.05); the transcriptomic data analysis found the aberrant activation of multiple immune and inflammation-related pathways, such as the inflammatory response, innate immune response, regulation of immune effector processes, and adaptive immune response in cancerous tissues with increased ARHGAP18 levels. Conclusion The ARHGAP18 might be involved in the hapatocarcinogenesis, and its mechanism deserves further study.

Objective The aim of this study was to analyze the risk factors impacting the long-term survival of patients with primary liver cancer (PLC) after radical hepatectomy (RHT). Method 81 patients with PLC were encountered in our hospital between January 2018 and January 2020, and all received RHT. During the operation, the tumors were ablated by a relatively wide margin (≥1 cm) in 41 cases and by a narrow margin (< 1 cm) in 40 cases. The univariate and multivariate Logistic regression analysis were applied to reveal the risk factors impacting the long-term survival, and the receiver operating characteristic curves (ROC) was applied to evaluate the efficacy of serum α-fetoprotein (AFP) levels for predicting the recurrence of tumors after RHT. Result One year after RHT, the recurrence of hepatic tumors were found in 52 cases (64.2%), and no relapse in 29 cases (35.8%) in our series; the percentages of narrow margin operation, tumor at Admenson Ⅲa stage, multiple tumors, the existence of microvascular invasion (MVI) and incomplete capsule of tumors in patients with recurrence of intrahepatic tumors were 61.5%, 32.7%, 73.1%, 69.2% and 65.4%, all much higher than 27.6%, 20.7%, 34.5%, 37.9% and 31.0% (P<0.05), and serum AFP level was (327.6±30.3)μg/L, significantly higher than (189.6±26.9)μg/L in patients without tumor recurrence (P<0.05); the multivariate Logistic regression analysis showed that all the six factors mentioned above were the independent risk factors impacting the recurrence of tumor after RHT (P<0.05); the AUC was 0.806(P＜0.05, with the 95% of CI was 0.709-0.902), with the sensitivity of 0.769 and the specificity of 0.750 when serum AFP level equal to or greater than 259.7μg/L after operation was set as the cut-off-value in predicting the recurrence of tumors after operation; at the end of three-year follow-up, the survival rate in patients with wide margin operation was 68.3%, much high than 40.0% in those with a narrow margin operation (Log-Rank=6.159, P=0.013). Conclusion The recurrence of intrahepatic tumors in patients with PLC after RHT is common, and our findings warrant a relatively wide margin operation during surgery. The patients with PLC after RHT should well be followed-up for early diagnosis of tumor recurrence and an appropriate management might improve the long-term outcomes.

Objective The aim of this study was to investigate the short-term outcomes of patients with hepatocellular carcinoma (HCC) after undergoing transcatheter hepatic arterial chemoembolization (TACE) and radiofrequency ablation (RFA) combination therapy. Methods 60 patients with HCC were encountered in our hospital between February 2020 and April 2021, and out of them, 20 patients received TACE and thereafter RFA, and 40 underlying materials-matched patients received TACE alone during the same period. All patients with HCC were followed-up for 12 months. Results After treatment, the complete remission rate, partial remission rate and effectiveness rate in patients having TACE and RFA combination therapy were 35.0%, 40.0% and 75.0%, all significantly higher than 20.0%, 25.0% and 45.0% (P＜0.05) in TACE-treated patients; serum alpha-fetoprotein level in TACE and RFA-treated patients was (101.4±23.6)μg/L, significantly lower than [(364.2±45.6)μg/L, P＜0.05] in TACE-treated patients; the common complications after TACE or TACE and RFA combination in our series were pleural effusion, skin burning, local pains and transient serum ALT and/or bilirubin level elevation, all disappeared after appropriate management; the one-year survival rate in TACE and RFA-treated patients was 70.0% (14/20), much higher than 40.0% (16/40) in TACE-treated patients (P＜0.05). Conclusion The TACE and RFA combination therapy in the treatment of patients with HCC is efficacious, which might improve the short-term survival, and warrants further clinical investigation.

Objective The aim of this study was to observe the efficacy of sequential drug-eluting beads-transcatheter arterial chemoembolization (DEB-TACE) and radiofrequency ablation (RFA) in the treatment of patients with primary liver cancer (PLC). Methods 72 patients with PLC were admitted to our hospital between November 2017 and November 2020, and among them, the DEB-TACE were done in 38 cases as the control, and the sequential DEB-TACE and RFA were carried out in other 34 cases as the observation group. Serum alpha-fetoprotein (AFP), heat shock protein 90α (HSP90α), carbohydrate antigen 125 (CA125) and CA199 levels were detected by electrochemiluminescence. The post-operational efficacy was evaluated by imaging. Results At the end of three month after operation, the Objective remission rate in the observation and control group were 79.4% and 55.3%, significantly different (P<0.05); serum AFP, HSP90α and CA125 levels in the observation group were (123.6±32.5)μg/L, (97.6±21.6)ng/mL and (30.2±13.2)U/mL, all significantly lower than [(264.5±34.6)μg/L, (129.1±22.3)ng/mL and (71.6±14.3)U/mL, respectively, P<0.05] in the control group; the mean overall survival (OS) in the observation group was 28 months, with one-year and two-year survival of 88.2% and 67.6%, while the OS in the control was 20 months, with the one-year and two-year survival of71.1% and 42.1%, significantly different between the two groups (Log Rank x²=4.258, P=0.039). Conclusion The sequential DEB-TACE and RFA in the treatment of patients with PLC has a definite clinical efficacy, which might prolong the survival of patients.

Objective The aim of this study was to investigate the application of ropivacaine and triamcinolone for transversus abdominis plane block (TAPB) analgesia in patients with primary liver cancer (PLC) after laparoscopic hepatectomy (LH). Methods 74 patients with PLC were encountered in our hospital between February 2018 and February 2022, and all underwent LH. As for the post-operational analgesia, the patients were randomly divided into control (n=37) and observation (n=37) groups. The patients in the control group were given ropivacaine, while those in the observation group were additionally given triamcinolone for TAPB at base of ropivacaine. The postoperative pain was evaluated by scores of visual analogue scale (VAS). Serum substance P (SP), neuropeptide Y (NPY), dopamine (DA) and norepinephrine (NE) levels were detected by ELISA, and serum malondialdehyde (MDA), superoxide dismutase (SOD) and total antioxidant capacity (T-AOC) were detected by thibabituric acid, xanthine oxidation and microdetermination, respectively. Results At 12 h, 24 h and 48 h after surgery, the cumulative consumption of oxycodone in the observation group was significantly lower than in the control group[5.9±1.1)mg, (10.1±1.9)mg and (12.8±2.8)mg vs. (7.1±1.5)mg,(12.3±2.4)mg and (15.1±3.0)mg, P＜0.05]; the static VAS scores were (2.1±0.4), (2.4±0.7) and (2.2±0.5), significantly lower than [(2.7±0.6), (3.1±0.8) and (2.7±0.6), P＜0.05] in the control, and the dynamic state of VAS were (3.4±0.8), (3.1±0.7) and (2.8±0.6), also significantly lower than [(4.0±0.9),(4.2±1.0) and (3.6±0.9), P＜0.05] in the control; at 24 hours post-operationally, serum SP, NPY, DA and NE levels were (2.9±0.7)g/mL, (200.2±37.6)pg/mL, (95.3±17.6)mmol/L and (3.1±0.8)pg/mL, all significantly lower than [(3.5±0.6)g/mL, (233.5±31.4)pg/mL, (128.9±16.3)mmol/L and (3.9±1.1)pg/mL, respectively, P＜0.05] in the control, and the same differences were found at 48 hour post-operationally (P＜0.05); there were no significant differences respect to serum SOD, T-AOC and MDA levels in the two groups at 24 and 48 hours post-operationally (P＞0.05). Conclusion The administration of ropivacaine and triamcinolone combination for TAPB analgesia is efficacious in patients with PLC after LH, and the application of triamcinolone could effectively prolong analgesia and reduce body stress reactions.

Objective The aim of this study was to investigate the effects of different concentration of sevoflurane inhalation and propofol target-controlled infusion anesthesia on hemodynamics and postoperative cognitive functions in patients with primary liver cancer (PLC) underwent hepatectomy. Methods 103 patients with PLC were enrolled in our hospital between January 2020 and June 2022, and were randomly divided into observation (n=52) and control group (n=51). All patients in the two groups underwent hepatectomy, and during the surgery, the 1.0 minimum alveolar concentration (MAC) of sevoflurane inhalation and propofol target-controlled infusion anesthesia was given in the observation group, while the 0.5 MAC of that was given in the control group. The scores of observers assessment of alertness/sedation scale (OAA/S) and the recovery room standard (Aldrete) were obtained, and the cognitive functions was assessed by mini-mental state examination (MMSE). Results At T2, the mean arterial pressure in the observation group was (82.2±5.6) mmHg, much lower than [(84.8±5.7)mmHg, P＜0.05] and the heart rate was (71.1±6.9)beats/min, much slower than [(76.9±6.7)beats/min, P＜0.05] in the control; the immediately and 15 minutes after extubation, the OAA/S scores in the observation group were (4.1±0.5) and (4.4±0.6), significantly higher than [(3.5±0.6) and (4.0±0.4), P＜0.05], and the Aldrete’s scores were (9.3±0.8) and (9.4±0.6), significantly higher than [(9.0±0.5) and (9.0±0.6), P＜0.05] in the control; the recovery time of spontaneous respiration, extubation time and eyes opening time in the observation group were(10.6±2.8) min,(12.9±3.7)min and (11.4±3.2) min, all significantly shorter than [(14.3±3.5)min, (15.6±4.1)min and (15.0±3.9)min, respectively, P＜0.05] in the control; the incidence of postoperative cognitive dysfunction in the observation group was 13.5%, much lower than 29.4% in the control (P＜0.05); at 12 hour and 24 hour post-operationally, the MMSE score in the observation were (25.9±1.8) and (27.9±1.1), both significantly higher than [(23.0±2.6) and (25.8±2.0), respectively, P＜0.05] in the control; the incidence of side effects in the observation was 19.1%, much higher than 6.0% (P＜0.05) in the control. Conclusion The high-concentration of sevoflurane inhalation at base of propofol target-controlled infusion anesthesia in PLC patients underwent hepatectomy has a relative fewer effects on intraoperative hemodynamics, and postoperative recovery quality of cognition is higher. There are some adverse reactions, and the clinicians should make appropriate decisions.

Objective The aim of this study was to investigate the diagnostic performance of multi-slice computed tomography (CT) and magnetic resonance imaging (MRI) dynamic enhancement in patients with hypervascular intrahepatic cholangiocarcinoma (ICC). Methods 66 patients with ICC were admitted to our hospital between August 2019 and June 2021, and all patients underwent multi-slice spiral CT and MRI dynamic enhanced examinations, and radical resection of tumor. The CT and MRI imaging characteristics of ICC were analyzed and the histopathological examination was performed. The area under the receiver operating characteristic curve (AUC) was applied to evaluate the diagnostic efficacy. Results 26 cases with hypervascularity and 40 cases with hypovascularity of tumors were diagnosed by post-operational pathology out of our 66 patients with ICC; the multi-slice spiral CT scans showed tumor lesions in the arterial phase, with continuous enhancement in the venous phase and delayed phase in 21 patients with hypervascular ICC, while showed no obvious enhancement in the arterial phase, portal venous phase and delayed phase in 5 patients; the dynamic contrast-enhanced MRI revealed tumor lesions with heterogeneous enhancement in the arterial phase, and heterogeneous enhancement in the venous phase and delayed phase in 24 patients with hypervascular ICC, and did not appear tumorous imaging appearance in the arterial phase and in portal venous phase, and significant homogeneous enhancement in the delayed phase in 2 patients; the ROC analysis showed that the AUC was 0.869 (95%CI:0.77-0.94), with the sensitivity (Se) and specificity (Sp) of 76.9%(95%CI:59.56-90.56) and 95.0%(95%CI:83.96-99.24)by CT scan, while the AUC was 0.872(95%CI:0.78-0.94), with the Se and Sp of 88.5%(95%CI:70.07～95.92) and 85.0%(95%CI:73.05-94.58) by MR scan. Conclusions The hypervascular ICC has certain features on multi-slice spiral CT and MRI dynamic contrast-enhanced scans, which might be helpful for the evaluation of tumor with hypervascularity, and making appropriate measurement.

Objective This paper summarized the clinical features of 5 patients with hepatic perivascular epithelioid cell tumor (PEComa) in order to improve the clinician’s ability for diagnosis and differentiation of intrahepatic occupying lesions. Methods The clinical materials of 5 patients with PEComa were retrospectively analyzed with the emphasis on imaging features. All patients underwent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) MRI scan and hepatectomy. Results Serum bilirubin levels increased in 2 cases, ALT increased in 2 cases and AST increased in 1 case with normal serum AFP, albumin and prothrombin time in all 5 patients; serum HBsAg positive in 3 cases; all the patients had a single intrahepatic lesion, with in the right lobe in 4 cases and in the left in 1 cases; the tumor sizes were 1.2 ×1.3 cm-6.9×9.0 cm shaped lobulated or elliptical, with clear edges in 4 lesions and obscure edge in 1 lesion; the MRI T1WI showed low signal in 5 cases, T2WI showed high signal in 4 cases, intensified in artery phase in 5 cases, presenting as low signals in portal phase in 4 case, equal signal in 1 case, and DWI showed high signal in 5 cases; all 5 patients got along well as followed-up for 10-263 months. Conclusion The PEComa could have similar clinical and imaging manifestations to primary liver cancer, but might have a good prognosis. The clinicians should paid attention to differentiation when the patients have no background of viral hepatitis or cirrhosis, especially when there is a uniform enhancement in arterial phase accompanied by intratumoral vessels or early venous drainage, high signal at tumor edge in portal vein phase, and some signs of fat infiltration.

Objective The aim of this study was to investigate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantitative parameters in the differential diagnosis of small benign and malignant liver space-occupying lesions (LSOL). Methods 83 patients with LSOL were admitted to our hospital between March 2020 and March 2022, the patients included had their liver lesions less than 3 cm, and all underwent DCR-MRI scan to obtain the volume transfer constant (Ktrans), rate constant (Kep), extravascular extracellular volume fraction (Ve) and initial area under the curve (IAUC) by Tissue4D software automatically at region of interest. The diagnosis was pathologically confirmed from post-operational or fine needle aspiration tissues. The diagnostic efficacy was assessed by the receiver operating characteristic (ROC) curves. Results Out of the 83 patients with LSOL, the pathological examination found benign lesions in 38 cases and malignant ones in 45 cases; the Krans, Kep, Ve and IAUC in malignant lesions were (0.4±0.2)min^-1, (0.9±0.3)min^-1,(0.5±0.2) and (37.2±7.1), all significantly greater than [(0.1±0.1)min^-1, (0.4±0.2)min^-1, (0.3±0.1) and (11.1±2.9), respectively, P<0.05] in their adjacent liver tissues, and also much greater than [(0.2±0.1)min^-1, (0.4±0.3)min^-1, (0.3±0.2) and (22.1±5.7), respectively, P<0.05] in benign lesions; the ROC analysis showed that the combination of Krans, Kep, Ve and IAUC in differentiating small intrahepatic LSOL was much superior to any parameter alone, with the AUC of 0.920, the sensitivity of 95.0%, and the specificity of 78.5%(P<0.05). Conclusion The DCE-MRI quantitative parameters are efficacious in the differential diagnosis of small benign and malignant intrahepatic LSOL.

Objective The aim of this study was to analyze the clinical features of pyogenic liver abscess (PLA)in patients with underlying type 2 diabetes mellitus(T2DM). Methods 54 patients with PLA with underlying T2DM and 72 patients with PLA without T2DM were encountered in our hospital between January 2016 and December 2021, and dealt with antibiotics, puncture aspiration and catheter drainage alone or combination for one month. Results The age of patients with T2DM was (58.6±8.4)yr, significantly greater than [(54.2±9.7)yr, P<0.05], the disease period was (27.5±8.1)d, significantly longer than [(17.1±4.9), P<0.05], and the coincidence of cardiovascular diseases was 24.1%, significantly higher than 9.7%(P<0.05) in patients without T2DM; the incidences of abdominal pain, distension, jaundice and weight loss in patients with T2DM were 63.0%, 64.8%, 25.9% and 92.6%, all significantly higher than 19.4%, 11.1%, 12.5% and 62.5% (P<0.05) in patients without T2DM; at presentation, the white blood cell counts, the percentage of neutrophil cells and serum albumin level in patients with T2DM were (17.8±5.2)×10⁹/L,(74.6±7.5)% and (28.4±4.8)g/L, all significantly lower than[(22.2±4.6)×10⁹/L, (85.2±9.3)% and (35.6±6.3)g/L, respectively, P<0.05], while serum bilirubin level was (30.8±4.8)μmol/L, much higher than [(16.5±3.4)μmol/L, P<0.05] in patients without T2DM; the percentage of antibiotic therapy alone in patients with T2DM was 22.2%, much lower than 38.9%, while that of catheter drainage and antibiotic combination therapy was 48.1%, much higher than 33.3% (P<0.05) in patients without T2DM; at the end of one-month treatment, the recovery rate and becoming chronic abscess in patients with T2DM were 74.1% and 24.1%, significantly different compared to 87.5% and 12.5% in patients without T2DM (P<0.05). Conclusion The patients with PLA with underlying T2DM have a relatively severe clinical symptoms and poor prognosis, which might be carefully paid attention to and deal with appropriately.

Objective The aim of this study was to investigate the diagnostic efficacy of apparent diffusion coefficient (ADC) by diffusion-weighted imaging (DWI) of magnetic resonance (MR) in patients with hepatic cystic echinococcosis (HCE) and simple hepatic cyst (SHC). Methods Forty-two patients with HCE and 34 patients with SHC were encountered in our hospital between July 2019 and July 2022, and all underwent MR DWI scan. The ADCs of lesions and livers were obtained when the b were at 500 s/mm² and 1000 s/mm². The diagnostic performance of ADC was analyzed by receiver operating characteristic curve (ROC). Finally, the ADC of MR DWI in the diagnosis of HCE was determined by Kappa consistency analysis. Results When the b equal to 500 s/mm², the focal ADC of patients with HCE was(3.1±0.7), and when the b equal to 1000 s/mm², the focal ADC was (2.4±0.6), both much lower than [(3.6±0.9) and (3.2±0.9), respectively, P＜0.05] in patients with SHC; the ROC analysis showed that when the b=500 s/mm², the optimal cut-off-value of ADC was set as it less than 3.235, with the AUC of 0.743 (95% CI:0.631-0.855) in diagnosis of HCE, the sensitivity (Se) of 0.706 and the specificity (Sp) of 0.690(P＜0.05); when the b=1000 s/mm², the focal ADC≤2.650 was set as the diagnosis of patients with HCE, with the AUC of 0.857 (95% CI:0.771-0.944), the Se of 0.824, and the Sp of 0.762(P＜0.05); the diagnosis of HCE was made when any of the cut-off-value of ADC met the criteria at any b, the consistency analysis confirmed that the diagnostic Se was 0.929, the Sp was 0.971, the accuracy was 0.947, the positive predictive value was 0.975, and the negative predictive value was 0.917 (Kappa=0.894). Conclusion The ADC at b =500 s/mm² or b =1000 s/mm² in lesions of HCE significantly decreases as compared with SHC, and the focal ADC could be applied for the differential diagnosis of the two lesions. We recommend each hospital build up its own cut-off-value of ADC for clinical diagnosis.

Objective The aim of this study was to investigate the incidences of early post-operational complications in patients with orthotopic liver transplantation (OLT) receiving different deceased donors. Methods 60 patients with end-stage liver diseases were encountered in our center between April 2017 to December 2020, and all underwent allogeneic classical OLT, receiving donation after brain death (BDB) in 27 cases, donation after cardiac death (DCD) in 26 cases and donation after brain death followed by cardiac death (DBCD) in 7 cases. The early (less than 1 month) postoperative complications was defined according to Clavien-Dindo classification, and the incidences of grade III and the above complications were compared among the three groups. Results Out of the 60 patients after OLT, the early postoperative complications of grade III or above occurred in 16 cases (26.6%), and in the grade III complications, there were 2 cases (7.4%) in DBD group, 2 cases (7.7%) in DCD group and 2 cases (28.6%) in DBCD group; as for the grade IV complications, there were 1 case (3.7%) in DBD group, 2 cases (7.7%) in DCD group, and no cases (0.0%) in DBCD group; in the grade V (death) complications, there were 3 cases (11.1%) in DBD group, 3 cases (11.5%) in DCD group, and 1 case (14.3%) in DBCD group, no significant differences as respect to the incidences of complications among the three groups (P>0.05). Conclusion Compared with the standard DBD donor liver, the patients receiving liver from DCD donor or from DBCD donor do not increase the incidence of early postoperative complications.

Objective The aim of this study was to compare the efficacy of laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of patients with common bile duct stones. Methods 108 patients with common bile duct stones were enrolled in our hospital between March 2018 and May 2022, and 54 patients in the observation group underwent LCBDE surgery, while another 54 patients in the control group underwent ERCP surgery. All patients were followed-up for 12 months after operation. Serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) levels were assayed by ELISA. Results The total stone clearance rate in the observation was 100.0%, not significantly different compared to 98.2% in the control (P＞0.05); the surgical time and hospital stay in the observation group were(105.3±12.7)min and (6.3±1.2)d, much longer than [(63.9±7.8)min and (3.8±0.9)d, respectively, P＜0.05] in the control, and the intraoperational blood loss was (32.2±5.9)mL, much greater than [(10.6±2.5)mL, P＜0.05] in the control; one week after operation, there were no significant differences respect to liver function tests in the two groups (P＞0.05), and serum TNF-α, IL-6 and CRP levels in the two groups were also not significantly different [(59.5±12.8)pg/mL, (7.1±2.2)pg/mL and (14.6±3.3)mg/L vs. (56.8±11.7)pg/mL, (5.9±3.5)pg/mL and (14.7±4.6)mg/L, respectively, P>0.05]; there was no significant difference in the incidence of postoperative complications, such as infection, bile leakage and bleeding, between the two groups (16.7% vs. 13.0%, P>0.05); at the end of 12-month follow-up, the stone recurrence rates in the observation group was 3.7%, significantly lower than 14.8% in the control group (P<0.05). Conclusion The efficacy of LCBDE and ERCP in treating patients with common bile duct stones is similar, but the LCBDE has a relatively lower stone recurrence.

Objective The purpose of this study was to investigate the application of indocyanine green(ICG) fluorescence imaging in laparoscopic cholecystectomy(LC) in the treatment of patients with benign gallbladder diseases. Methods 62 patients with benign gallbladder diseases, such as cholecystolithiasis and chronic cholecystitis, etc, were encountered in our hospital between October 2021 and July 2022, and were divided into two groups, with 31 cases in each, underwent LC under ICG fluorescent navigation or routine operation. Results The operation was successfully completed, and no iatrogenic biliary duct injury occurred in the two groups; one patient (3.2%)in the control group was transferred to open laparotomy; the time of identification and complete anatomic isolation of three tubes, operation time and intraoperative blood loss in the fluorescent navigation group were 0.5(0.5, 1)min, (16.9±0.4)min, 30(28, 33)min and 15(5, 20)ml, all significantly shorter or less than [2(1, 3)min, (24.9±0.1)min, 46(39, 53)min and 30(20, 40)ml, respectively, P< 0.05] in routine operation group; there was no significant difference respect to post-operational complications in the two groups (0.0% vs. 3.2%, P>0.05). Conclusion The ICG fluorescence navigation during LC is a very good measure, especially in difficult surgeries, which might be helpful to identify the anatomical structure of biliary duct, shorten operation times and reduce iatrogenic bile duct injury.

Objective This study was to conducted to evaluate one-stop magnetic resonance imaging (MRI) in typing and evaluating pancreaticobiliary duct anatomy in children with choledochal cysts (CC). Methods 136 children with CC were encountered in our hospital between June 2019 and June 2022, all underwent one-stop MRI, CT and intraoperative cholangiography, and the CC was evaluated based on Todani, Kurumi and Komi typing. Results Out of our children with CC, the Todani typing showed type Ⅰa in 93 cases(68.4%), type Ⅰb in 5 cases (3.7%), type Ⅰc in 5 cases (3.7%), type Ⅱ in 16 cases (11.8%), type Ⅲ in 3 cases (2.2%) and type Ⅳ in 14 cases (10.3%); the Kurumi typing demonstrated type C in 106 cases (77.4%), type L in 5 cases(3.7%), type R in 7 cases (5.1%), type A in 9 cases (6.6%) and type P in 9 cases (6.6%); the Komi typing showed type A in 47 cases (34.5%), type B in 60 cases (44.1%), type C in 16 cases (11.8%) and normal pancreaticobiliary duct confluence in 13 cases (9.5%); the one-stop MRI scan showed that the percentages of normal biliary ducts, biliary duct variation and pancreaticobiliary maljunction were 80.1%, 19.8% and 83.8%, which very similar to 80.1%, 19.8% and 86.8% by cholangiography, significantly different as compared to 94.1%, 5.8% and 69.1%(P<0.05) revealed by CT scan. Conclusion One-stop MRI scan is more sensitive and accurate in typing CC and evaluating pancreaticobiliary duct anatomy, and we recommend it as a priority choice of check-up for children with CC.

This article reported two rare cases of different types of neonatal congenital hepatic arteriovenous fistula (HAVF). One case was vascular HAVF, and abdominal vascular abnormalities of the fetus could not be found before birth, and cardiogenic shock and pulmonary hypertension crisis occurred 28 hours after birth. After continuous follow-up, he developed symptoms of heart failure and pulmonary hypertension 2 days after birth. Another fetus had tumorous HAVF. Both children were diagnosed by abdominal vascular color Doppler ultrasonography and abdominal enhanced CT scan, and were given inotropic diuresis and oral propranolol for symptomatic treatment. After 1 week, the pulmonary arterial pressure gradually decreased, and they were discharged after 2 to 3 week medical cares. During the follow-up of more than 10 months, the imaging examination showed that the HAVF of the two children gradually disappeared, the hemangioma shrank, the growth and development were normal, and no adverse events occurred. At the discussion of this article, the pathophysiology, clinical features, diagnostic methods and treatment options in fetus with congenital HAVF were given at base of literature review, and we hope it might improve neonatologists' awareness of the disease.

Drug-induced liver injury (DILI) is an important challenge to deal with. DILI lacks specific diagnostic parameters and treatment measures, and mainly depends on early diagnosis and supporting treatment. In this article, we reviewed the important achievements on microRNAs study as biomarkers for DILI diagnosis in recent years.

With the in-depth development of liver disease research with integrated traditional Chinese and Western medicine, new approaches and new medicines for liver disease treatment continue to emerge. The traditional Chinese medicine single-target superposition, multi-target synergistic effects and toxic dispersion effects provide more ideas for liver disease treatment and become a rich source of an important way to improve the treatment of liver disease. In this paper, we introduce the mechanism of Shuganning, a herbal medicine compound, in relieving bile and reducing jaundice from the perspectives as follows: liver transporters, metabolic enzymes and nuclear receptors, and its anti-inflammatory and hepatoprotective mechanism.