Objective This study was to assess the implications of serum matrix metalloproteinase-1 (MMP-1), matrix metalloproteinase-2 (MMP-2), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) and hypoxia inducible factor-1α (HIF-1α) levels in patients with chronic hepatitis B (CHB). Methods 73 patients with CHB and 50 healthy persons were included in this study between January 2019 and June 2022, and serum MMP-1, MMP-2, TIMP-1 and HIF-1α levels were detected by ELISA. All patients with CHB underwent liver biopsies, and the significant liver fibrosis (SLF) was defined as equal to or greater than S2. The diagnostic performance was evaluated by the area under the receiver operating characteristic curve (AUROC). Results Serum MMP-1 level in patients with CHB was (9.3±2.7)μg/L, much lower than [(12.7±3.3)μg/L, P<0.05], while serum MMP-2, TIMP-1 and HIF-1α levels were (387.2±54.2)mg/L, (296.3±72.9)μg/L and (68.9±11.3)μg/L, all significantly higher than [(251.6±33.5)mg/L, (142.2±23.6)μg/L and (35.1±7.6)μg/L, respectively, P<0.05] in healthy individuals; the liver histopathological examination showed liver fibrosis S0-S1 in 18 cases, S2 in 22, S3 in 19 cases and S4 in 14 cases (>=S2 in 55 cases); serum MMP-1 level in patients with S4 liver fibrosis was (6.3±1.8)μg/L, while serum MMP-2, TIMP-1 and HIF-1α levels were (516.7±39.2)mg/L, (373.6±55.4)μg/L and (96.8±10.8)μg/L, and serum MMP-1 level in patients with S3 was (7.9±2.2)μg/L, while serum MMP-2, TIMP-1 and HIF-1α levels were (482.5±48.3)mg/L, (324.7±59.6)μg/L and (87.5±13.9)μg/L, both significantly different as compared to in patients with S0-S1 or with S2(P<0.05); the ROC analysis demonstrated that the AUCs were 0.835(0.752-0.918), 0.948(0.917-0.979), 0.955(0.928-0.982) and 0.919(0.877-0.961), when serum MMP-1, MMP-2, TIMP-1 and HIF-1α levels equal to 10.9 μg/L, 309.4 mg/L, 212.3 μg/L and 54.1 μg/L were set as the cut-off-value in predicting SLF in patients with CHB, superior for serum TIMP-1 and HIF-1α to the other two. Conclusion Serum TIMP-1 and HIF-1α, and/or MMP-1 levels might be used to screen liver fibrosis in patients with CHB, and needs further investigation.

Objective The aim of this study was to observe the efficacy of combination of entecavir and polyene phosphatidylcholine (PPC) therapy in the treatment of patients with chronic hepatitit B (CHB) and nonalcoholic steatohepatitis (NASH). Methods 94 patients with CHB and non-alcoholic fatty liver disease (NAFLD) were recruited in our hospital between May 2021 and June 2023, including nonalcoholic fatter liver (NAFL) in 61 cases and NASH in 33 cases. All patients received enticavir (ETV) for antiviral treatment, and the patients with CHB and concomitant NASH received ETV and PPC combination therapy. The regimen lasted for six months. The routine serum detection was carried out for HOMA-IR calculation. Serum hyaluronic acid (HA), procollagen type III (PCIII), collagen type IV (IVC) and laminin (LN) levels were detected by ELISA. The Liver stiffness measurement (LSM) and controlled attenuation parameters (CAP) were detected by Fibroscan. Results At the end of six-month observation, serum ALT and AST levels in patients with CHB and NASH were (37.1±4.6)U/L and (34.5±3.8)U/L, both significantly lower than [(80.8±16.4)U/L and (62.7±12.8)U/L, respectively, P<0.05] at admission, and serum HBV DNA in all patients in the two groups became negative; there were no significant changes about the serum fat parameters and HOMA-IR (P>0.05) in the two groups; serum PCⅢ and HA levels in CHB patients with NASH were (109.5±13.7)ng/mL and (101.3±12.7)ng/mL, both significantly lower than [(136.4±17.1)ng/mL and (138.5±17.3)ng/mL, respectively, P<0.05] in CHB patients with NAFL; the CAP in CHB patients with NASH was (255.8±26.9)dB/m, much lower than [(269.4±30.1)dB/m, P<0.05] in CHB patients with NAFL. Conclusion The oral administration of PPC for auxiliary treatment at base of ETV antiviral therapy in patients with CHB and NASH could help improve biochemical parameters back to normal, and ameliorate hepatic steatosis.

Objective The aim of this study was to investigate the phenomena of low level viremia (LLV) in patients with chronic hepatitis B (CHB) receiving nucleos(t)ide analogue (NAs) treatment. Methods A retrospective study on 98 patients with CHB admitted to our hospital between January 2021 and December 2022 were performed, the tenofovir alafenamide fumarate (TAF) were given in 25 cases, the entecavir (ETV) in 43 cases and tenofovir disoproxil fumarate (TDF) in 30 cases. All enrolled patients got the antiviral treatment for at least 24 weeks. Serum HBV DNA loads were assayed by Taqman real-time quantitative PCR, and serum HBsAg and HBeAg levels were detected by highly sensitive chemiluminescence Immunoassay. The risk factors were evaluated by multivariate Logistic regression analysis. Results At the end of 24 week treatment, the LLV was found in 43 patients (43.9%) and the virological response (VR) was found in 55 patients(56.1%); the percentages of baseline ETV administration, hepatitis B family history, concomitant fatty liver, and serum HBsAg level and HBV DNA load in patients with LLV were 60.4%, 60.5%, 55.8%, (4.6±0.9)lg IU/mL and (7.2±1.2)lg IU/mL, all significantly higher than [30.9%, 40.0%, 43.6%, (3.5±0.7)lg IU/mL and (5.7±1.8)lg IU/mL, P<0.05] in patients with VR; at the end of 12 week and 24 week treatment, serum HBV DNA loads in patients with LLV were (5.3±1.4)lg IU/mL and (0.5±0.3)lg IU/mL, both significantly higher than [(3.4±1.1)lg IU/mL and (0.0±0.0)lg IU/mL, P<0.05] in patients with VR; the multivariate Logistic regression analysis showed that the hepatitis B family history, concomitant fatty liver, baseline serum HBV DNA loads and the virological response speed were all the independent risk factors for the occurrence of LLV in patients with CHB undergoing NAs antiviral treatment(P<0.05). Conclusion Almost half of patients with CHB could not obtain complete VR during NAs antiviral treatment as serum HBV DNA loads were monitored by highly sensitive Taqman real-time quantitative PCR, the clinicians should take the risk factors leading to LLV into consideration, and deal appropriately with it.

Objective The aim of this study was to investigate the hepatic histological changes in adult individuals under 30 years old with chronic hepatitis B viral infection with normal serum alanine aminotransferase (ALT) levels. Methods A total of 108 individuals under 30 years old with chronic hepatitis B viral infection and with normal ALT levels were enrolled in our hospital between 2013 and 2023, and all underwent liver biopsies. The chronic hepatitis B was diagnosed based on the finding of liver histological activity index ≥G2 and/or liver fibrosis stage ≥S2, and those were classified into chronic HBV carriers who didn’t meet the requirement of CHB. The binary Logistic regression analysis was applied to screen the predictors of significant liver injuries, and the area under receiver operating characteristic curve (AUC) was used to predict the relevant indicators for significant liver inflammatory and fibrotic lesions. Results Out of the 108 individuals with chronic HBV infection, the liver histo-pathological examination found G1S1 in 73 cases, e.g., the HBV carriers, and G2/S2 in 30 cases and G3/S3 in 5 cases, e.g., the CHB in 35 cases; 65.7% of patients with CHB had positive hepatitis B viral infection family history, much higher than 13.7%(P＜0.05) in HBV carriers, and serum ALT level and HBV DNA load in patients with CHB were (30.3±6.7)U/L and 4.4(3.7, 5.8)lg IU/ml, both significantly higher than [(20.2±8.8)U/L and 3.5(2.9, 5.4) lg IU/ml, respectively, P＜0.05] in HBV carriers; the multivariate Logistic analysis showed that serum ALT level and HBV DNA load were the independent indicators for predicting significant liver injuries (P＜0.05); the AUC was 0.969, with the sensitivity and specificity of 88.6% and 95.9%, when the combination of serum ALT (the cut-off-value was 26.5 U/L) and HBV DNA load (the cut-off-value was 3.3 lgIU/ml) were applied to predict significant liver injuries, much superior to any of the two parameters alone (P＜0.05). Conclusion In adults under 30 years old with chronic HBV infection with normal serum ALT levels, when serum ALT level is greater than 27 U/L and serum HBV DNA load is greater than 2000 IU/ml, whether or not the antiviral therapy is given is worthy of further study.

Objective The aim of this study was to investigate the diagnostic performance of sound touch elastography (STE) and sound touch quantify (STQ) combined with ultrasound (US) score for assessment of liver fibrosis in patients with chronic hepatitis B (CHB). Methods 106 patients with CHB were enrolled in our hospital between January 2020 and December 2022, and they all underwent liver biopsies for the assessment of liver fibrosis Metavir staging (≥F2 as significant liver fibrosis). The liver stiffness measurement (LSM) was obtained by STE and STQ. The ultrasound score for liver fibrosis was calculated according to the two-dimensional ultrasonography. The receiver operating characteristic (ROC) curve was applied to assess the diagnostic efficacy of US parameters. Results Among the 106 patients with CHB, the ≥F2 liver fibrosis were found in 62 cases and <F2 (no significant liver fibrosis) in 44 cases; the LSM_STE, LSM_STQ and LSM_US in patients with significant liver fibrosis were (12.7±2.2)kPa, (13.3±2.3)kPa and (10.5±2.2), all significantly greater than [(9.2±2.1)kPa, (8.9±1.7)kPa and (7.2±1.3), respectively, all P<0.05] in patients without significant liver fibrosis; the ROC analysis showed that the AUCs were 0.869(95%CI:0.803-0.935), 0.809(95%CI:0.728-0.891) and 0.767(95%CI:0.679-0.855), when the LSM_STE, LSM_STQ and LSM_US were applied for predicting the significant liver fibrosis, and the diagnostic performance of the three parameter combination was much superior to any one of them(the AUC was 0.949, with the 95%CI of 0.912-0.986, P<0.05). Conclusion The combination of LSM_STE, LSM_STQ and LSM_US is greatly efficacious in predicting significant liver fibrosis in patients with CHB, and as a non-invasive diagnosis, it is worthy of further clinical verification.

Objective The aim of this study was to observe the clinical efficacy of silymarin and compound methionine choline combination in treating patients with alcoholic hepatitis (AH). Methods 101 patients with AH were admitted to our hospital between January 2021 and January 2023, and were randomly divided into control (n=50) and observation (n=51) groups, receiving oral compound methionine choline or oral compound methionine choline and silymarin combination treatment for six months. The liver function tests were detected by fully automatic biochemical analyser, serum laminin (LN), hyaluronic acid (HA), type Ⅲ procollagen N-terminal peptide (PCⅢ) and type Ⅳ collage (Ⅳ-C) levels were assayed by radioimmunoassay and serum peroxisome proliferators-activated receptor γ (PPARγ), leptin (LEP), adiponectin (APN) and interleukin 18 (IL-18) were determined by ELISA. Results At the end of six-month treatment, serum alanine transferase and aspartate transaminase levels in the observation group were(41.8±4.9)IU/L and (42.5±4.9)IU/L, both significantly lower than [(75.3±6.8)IU/L and (62.7±5.8)IU/L, respectively, P<0.05] in the control group; serum HA, PCⅢ and Ⅳ-C levels in the observation group were (103.6±13.5)μg/L, (94.2±9.8)μg/L and (75.2±8.6)μg/L, all significantly lower than [(146.2±15.3)μg/L, (125.8±13.3)μg/L and (112.3±14.5)μg/L, P<0.05] in the control; serum PPARγ, LEP and IL-18 levels in the observation group were (231.7±26.8)pg/mL, (5.4±0.7)μg/L and (92.5±11.7)ng/mL, all significantly lower than [(285.3±29.4)pg/mL, (8.3±0.9)μg/L and (118.5±12.4)ng/mL, respectively, P<0.05], while serum APN level was (15.4±1.7)ng/L, significantly higher than [(11.3±1.9)ng/L, P<0.05] in the control group. Conclusion The oral administration of compound methionine choline and silymarin combination in treatment of patients with AH is short-termly efficacious, which could improve liver function tests back to normal, and relieve liver fibrosis and body inflammatory reactions.

Objective The aim of this study was to investigate the prevalence and risk factors of non-alcoholic fatty liver diseases (NAFLD) in persons at normal physical examination. Methods A total of 14415 individuals participated annually physical examination in our hospital in 2022, and all had normal routine physical examination (PE), including anthropology, hematology, biochemical parameters and ultrasonography. The univariate and multivariate Logistic regression analysis was applied to reveal the risk factors for the occurrence of NAFLD. Results Out of the 14415 individuals participating PE, the NAFLD was found in 5016 cases(34.8%), with the prevalence of 47.0% in male, much higher than 21.8%(P＜0.05) in female; the body mass index (BMI), white blood cell count and platelet count in patients with NAFLD were (25.8±3.0)kg/m², (7.0±1.7)×10⁹/L and (263.4±62.4)×10⁹/L, all significantly greater than [(21.9±2.6)kg/m², (6.3±1.6)×10⁹/L and (253.3±55.4)×10⁹/L, respectively, P＜0.05] in individuals without NAFLD; serum ALP, GGT, total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDLC), glucose (Glu) and uric acid (UA) levels in patients with NAFLD were significantly higher than in those without NAFLD (P＜0.05), while serum high density lipoprotein cholesterol (HDLC) level was much lower than in those without NAFLD (P＜0.05); the univariate Logistic regression analysis showed that the age, BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), ALT, ALP, GGT, TC, TG, LDLC, Glu, UA, white blood cell count and platelet count were all the factors affecting NAFLD occurrence (P ＜ 0.05), while the HDLC level was the protective factor (P＜0.05); the multivariate Logistic regression analysis demonstrated that the age (OR=1.028), BMI(OR=1.607), DBP(OR=1.039), ALP(OR=1.029), TG(OR=2.847), Glu(OR=2.716) and UA(OR=1.005) were the independent risk factors impacting the NAFLD occurrence (P＜0.05), while serum HDL-C level(OR=0.054) was still the protective factor(P＜0.05). Conclusion The prevalence of NAFLD is high in population at PE, and the obesity, hyperlipidemia and hyperuricemia are all the risk factors, which should be properly managed.

Objective The aim of this study was to explore the changes and clinical implications of serum fibroblast growth factor-21 (FGF21) and secreted frizzled related protein 5 (SFRP5) in patients with non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus type 2(T2DM). Methods 101 patients with NAFLD, including nonalcoholic fatter liver(NAFL) in 64 cases, nonalcoholic steatohepatitis (NASH) in 25 cases and liver cirrhosis (LC) in 12 cases, and 81 patients with NAFLD and T2DM, including NAFL in 58 cases, NASH in 16 cases and LC in 7 cases, were enrolled in this study between May 2020 and March 2023, and the fasting blood glucose (FBG) and fasting insulin (FINS) levels were detected, and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Serum FGF21 and SFRP5 levels were detected by ELISA. Results The FBG, serum FINS, the HOMA-IR and serum FGF21 levels in patients with NAFLD and concomitant T2DM were (8.7±1.4)mmol/L, (28.9±5.8)μIU/mL, (11.1±2.7) and (304.8±36.0)pg/mL, all significantly higher than [(5.5±1.2)mmol/L,(20.8±4.1)μIU/mL, (5.1±1.5) and (267.6±34.5)pg/mL, respectively, P＜0.05], while serum SFRP5 level was (6.8±1.2)pg/mL, much lower than [(10.3±2.2)pg/mL, P＜0.05] in patients with NAFLD; serum total cholesterol, triglyceride,high-density lipoprotein cholesterol and low-density lipoprotein cholesterol levels in patients with NAFLD and T2DM were(6.7±1.0)mmol/L,(3.7±0.6)mmol/L,(1.3±0.2)mmol/L and (3.4±0.8)mmol/L, all not significantly different as compared to [(6.2±0.9)mmol/L, (4.1±0.5)mmol/L, (1.3±0.3)mmol/L and (3.2±0.7)mmol/L, respectively] in patients with NAFLD (P>0.05); serum SFRP5 levels in patients with T2DM and underlying NAFL, NASH and LC were (7.8±1.1)pg/mL, (6.4±0.8)pg/mL and (5.1±0.7)pg/mL, all significantly lower than [(11.9±2.1)pg/mL, (9.8±1.6)pg/mL and (8.4±1.1)pg/mL, respectively, P＜0.05], while serum FGF21 levels were (295.6±31.2)pg/mL, (316.8±32.9)pg/mL and (353.6±36.7)pg/mL, all significantly higher than [(255.1±32.5)pg/mL, (279.5±33.4)pg/mL and (309.7±35.8)pg/mL, respectively, P＜0.05] in patients with NAFL, with NASH or with LC. Conclusion Serum FGF21 level significantly increases, while serum SFRP5 level significantly decreases in patients with NAFLD and concomitant T2DM, which might be applied to predict the severity of the entity in clinical practice.

Objective This study was conducted to investigate diagnostic performance of atherogenic index of plasma (AIP)in predicting patients with metabolic-associated fatty liver disease (MAFLD) from physical examination population. Methods 4988 individuals underwent physical examination in the Physical Examination Center, West China Hospital, affiliated to Sichuan University between July 2020 and December 2022. Routine blood fat was detected for calculation of AIP. Multivariate Logistic regression analysis was applied to reveal risk factors, and receiver operating characteristic curve (ROC) was used to assess diagnostic efficacy. Results Of 4988 individuals at physical examination, 1589 patients(32.4%)was found having MAFLD; hyperlipidemia was common in patients with MAFLD, and AIP was 0.2(0.0-0.4), much greater than [0.1(0.1-0.3), P<0.001] in those without MAFLD; multivariate Logistic regression analysis showed that AIP, TG, HDL, LDL and TC were all the independent risk factors for MAFLD existence (P<0.05); ROC analysis demonstrated the AUC was 0.785 by AIP predicting MAFLD, much higher than TG(0.764), HDL (0.750), LDL (0.568) OR TC (0.552) doing; the AUC was 0.817 by AIP in diagnosing female MAFLD, much higher than 0.714 in diagnosing male MAFLD, and it was 0.825 in predicting MAFLD in persons younger than 45 year old, much higher than 0.742 in predicting MAFLD in those older than 45 year old (P<0.001). Conclusion AIP has a satisfactory diagnostic performance in predicting MAFLD, which might be used for screening at physical examination centers.

Objective This study was conducted to investigate the clinical and liver histopathological features in patients with acute (AP-AIH) and non-acute presentation of autoimmune hepatitis (NAP-AIH). Methods 30 patients with AP-AIH and 22 patients with NAP-AIH were encountered in our hospital between October 2017 and October 2022, and all patients underwent routinely liver biopsies. The clinical materials were retrieved from standardized electronic medical record data bank in our hospital. Results There were no significant differences as respect to the ages (54.0±14.5 yr vs. 53.4±15.0 yr) and the gender (male for 23.3% vs. 22.7%) between the two groups (P>0.05); serum ALT, AST, bilirubin, ALP, GGT and IgG levels in patients with AP-AIH were 714.4(153.0, 2061.0)U/L, 590.5(147.0,2168.0)U/L, 81.6(43.3, 106.2)μmol/L,146.2(70.7,164.0)U/L, 81.4(38.5, 150.3) U/L and 220.0(128.0, 245.1)mg/L, all significantly higher than [116.5(85.0,172.0)U/L,105.8(78.0, 176.0)U/L,23.4(17.4, 30.8)μmol/L, 113.2(66.7, 176.4)U/L, 83.6(41.6, 153.8) U/L and 142.5(90.6, 243.7)mg/L, respectively, P<0.05] in those with NAP-AIH; the response rate to standardized immunosuppression therapy in patients with AP-AIH was 80.0%, much higher than 54.5%(P<0.05)in those with NAP-AIH; the liver histological examination showed that the incidences of hepatocellular necrosis, moderate to severe cobblestone appearance of hepatocytes, hepatic rosette formation in cobblestone appearance areas, prominent plasma cell invasion in the liver parenchyma and moderate to severe interface hepatitis in patients with AP-AIH 76.7%, 50.0%, 20.0%, 33.3% and 56.7%, all significantly higher than 40.9%, 22.7%, 0.0%, 13.6% and 18.2% (P<0.05) in those with NAP-AIH. Conclusion The clinical and histological features in patients with AP-AIH are consistent with acute liver injuries, and respond to immunosuppression therapy relatively satisfactory.

Objective The aim of this study was to investigate the implication of peripheral blood mononuclear CD6 positive cell percentage and its ligand activated leukocyte adhesion molecule (ALCAM) levels in patients with autoimmune hepatitis (AIH). Methods 60 patients with AIH were enrolled in this study between March 2020 and March 2022, and all received liver biopsies. The peripheral blood mononuclear cells (PBMCs) were separated and the percentages of CD 6 positive cells were detected by FCM. Serum ALCAM levels were assayed by ELISA. Results Our series of patients with AIH included clinically mild/moderate disease in 42 cases and severe in 18 cases, and the histopathologically showed <= grade 1 of liver inflammatory activity in 48 cases and ≥grade 2 in 12 cases, and <= stage 1 of liver fibrosis in 44 cases and ≥stage 2 in 16 cases; total serum bilirubin, ALT, AST and ALP levels in patients with severe disease were(94.5±8.3)μmol/L, (215.4±17.2)U/L, (161.5±14.2)U/L and (83.6±16.3)U/L, all significantly higher than [(31.1±4.3)μmol/L, (58.2±9.4)U/L, (49.5±8.3)U/L and (61.6±3.5)U/L, P<0.05] in patients with mild/moderate diseases; the percentage of PBMC CD6 positive cells and serum ALCAM, IgG and IgM levels in patients with severe disease were(65.4±7.8)%, (22.5±2.1)ng/mL, (18.6±2.6)mg/dL and (1.7±0.3)mg/dL, all much higher than [(36.7±4.2)%, (15.4±1.2)ng/mL, (13.7±2.3)mg/dL and (0.7±0.1)mg/dL, respectively, P<0.05] in patients with mild/moderate disease; the percentage of CD6 positive cells and serum ALCAM levels in patients with ≥grade 2 were (71.4±8.3)% and (25.4±3.2)ng/mL, both significantly higher than [(36.2±4.3)% and (14.8±1.4)ng/mL, P<0.05] in patients with <=grade 1, and they were(69.3±7.8)% and (24.7±3.4)ng/mL in patients with ≥stage 2, both much higher than [(36.4±4.4)% and (14.9±1.8)ng/mL, P<0.05] in those with <=stage 1; the AUCs were 0.98 and 0.95, with the sensitivities (Se) of 100.0% and 91.6% and the specificities (Sp) of 87.5% and 97.9%, when the PBMC CD6 positive cells and serum ALCAM levels were applied to predict the significant histoactivities, and the AUCs were 0.98 and 0.90, with the Se of 93.7% and 75.0%, and Sp of 95.5% and 100.00%, when the two were applied to predict significant liver fibrosis. Conclusion The percentages of PBMC CD6 positive cells and serum ALCAM levels in patients with AIH increase, which might be correlated to intrahepatic liver inflammation and fibrosis.

Objective This clinical trial was conducted to observe the changes of peripheral blood myeloid inhibitory cells (MDSCs), serum leukocyte differentiation antigen 38 (CD38) level and hepatic interleukin-35 (IL-35) expression in patients with autoimmune hepatitis (AIH) undergoing prednisone and azathioprine combination therapy. Methods 56 patients with AIH were recruited in our hospital between March 2017 and March 2020, and were randomly divided into control (n=28) and observation (n=28) group, receiving prednisone acetate or prednisone acetate plus azathioprine combination therapy. The regimen lasted for 6 to 36 months. Serum immunoglobulin, CD38, complement 3 (C3) and C4 levels were routinely detected. The percentage of peripheral blood MDSCs was measured by TCM, and hepatic IL-35 expression was determined by Western bloting from liver biopsy tissues. Results At the end of six month treatment, serum ALT and AST levels in the observation group were (54.6±7.1)U/L and (50.7±6.4)U/L, both significantly lower than [(90.7±11.9)U/L and (79.7±12.9)U/L, respectively, P<0.05] in the control; serum IgG, IgM, C3 and C4 levels in the observation were (11.8±1.8)g/L, (2.4±0.8)g/L, (0.5±0.2)g/L and (0.2±0.1)g/L, all significantly lower than [(19.8±3.0)g/L, (3.2±0.9)g/L, (0.7±0.3)g/L and (0.3±0.1)g/L, respectively, P<0.05] in the control; the percentage of peripheral blood MDSCs and serum CD38 level were (0.6±0.2)% and (8.6±2.5)pg/mL, both much lower than [(0.9±0.3)% and (11.5±3.8)pg/mL, P<0.05] in the control group, and the hepatic IL-35 expression became weaker as compared to that in the control, e.g., [(0.4±0.2) vs. (0.6±0.1), P<0.05]. Conclusion The combination of prednisone and azathioprine therapy in the treatment of patients with AIH could improve liver function test normal, reduce serum cytokine and complement levels, and decrease the hepatic IL-35 expression, which needs further investigation.

Objective The purpose of this study was to investigate the clinical feature of primary biliary cholangitis (PBC) patients with serum anti glycoprotein (gp) 210 antibody positive. Methods 63 patients with PBC were encountered in our hospital between January 2017 and January 2021, and the diagnosis was made by serum anti mitochondrial antibody (AMA)/AMA-M2 (control) or serum anti-gp 210 (observation) positive. The ursodeoxycholic acid (UDCA) regimen was given to all the patients in the two groups. Serum cytokines and immunoglobulin levels were routinely assayed. Results There were no significant differences as respect to age and gender between the two groups (P>0.05), while the incidence of fatigue in the observation group was 47.6%, much higher than 35.7% (P<0.05) in the control; at admission, serum bilirubin, ALT and AST levels in the observation group were 30.1(18.5, 66.1)μmol/L, 73(42, 110)U/L and 87(64, 126)U/L, all significantly higher than [20.1(10.4, 31.5)μmol/L, 53(27,90)U/L and 68(53, 101)U/L, P<0.05], while serum albumin (Alb) level was 32.2(29.8, 35.2)g/L, significantly lower than [34.6(30.4, 36.8)g/L, P<0.05] in the control; after six month treatment, serum Alb level in the observation was 37.8(35.4, 38.5)g/L, still much lower than [42.3(37.4, 45.1)g/L, P<0.05] in the control; before treatment, serum IL-6 and IL-10 levels in the observation were 12.7(5.8, 11.3)pg/ml and 125.1(87.4, 120.6)pg/ml, both significantly higher than [9.1(7.0, 11.7)pg/ml and 103.6(90.1, 117.0)pg/ml, P<0.05] in the control; at the end of six month treatment, serum IL-2 and IL-6 levels in the observation were 29.1(18.4, 36.5)pg/ml and 7.2(5.2, 8.5)pg/ml, both significantly higher than [21.0(9.7, 26.3)pg/ml and 5.4(4.0, 6.9)pg/ml, P<0.05] in the control, while serum IL-10 level was 139.5(107.6, 152.9)pg/ml, much lower than [154.8(122.7, 168.2)pg/ml, P<0.05] in the control; six months after treatment, serumIgM, IgG and IgA levels in the observation were 3.1(2.5, 3.7)g/L, 13.7(12.0, 14.6)g/L and 3.8(2.9, 3.8)g/L, all significantly higher than [2.2(1.9, 2.6)g/L, 11.2(10.1, 13.4)g/L and 2.8(2.5, 3.3)g/L, respectively, P<0.05] in the control group. Conclusion The PBC patients with serum anti-gp210 antibody positive seems clinically severe and less or relatively slowly respond to UDCA treatment, which needs further multicenter investigation.

Objective The aim of this study was to investigate peripheral blood lymphocyte spectrum and immune checkpoint receptors and their ligand expression in patients with drug-induced liver injury (DILI). Methods 62 patients with DILI, 35 patients with autoimmune hepatitis (AIH) and 40 patients with nonalcoholic fatty liver disease (NAFLD) were recruited in our hospital between March 2020 and March 2023, and peripheral blood lymphocyte spectrum and immune checkpoints receptors and their ligand expression were detected by FCM. Results The percentage of peripheral blood activated Th cells in patients with DILI was (14.2±3.8)%, significantly higher than [(9.7±2.3)%, P<0.05] in patients with AIH or [(8.2±2.7)%, P<0.05] in patients with NAFLD, the percentage of peripheral blood activated TC cells in patients with DILI and AIH were (31.3±9.2)% and (32.2±7.7)%, significantly higher than [(22.6±5.9)%, P<0.05] in patients with NAFLD, while the percentages of Th9 cells were (19.7±3.3)% and (19.2±2.8)%, much lower than [(25.3±5.4)%, P<0.05] in patients with NAFLD, and the percentages of Th1 cells in patients with DILI and NAFLD were (52.6±12.3)% and (53.2±11.8), much higher than [(43.4±10.7)%, P<0.05] in patients with AIH; the percentage of Th cells with ICOS expression positive in patients with DILI was (5.2±1.5)%, much higher than [(3.9±1.1)%, P<0.05] in patients with AIH or [(1.9±0.8), P<0.05] in patients with NAFLD, while the percentages of Th cells with CTLA-4 and PD-1 expression positive in patients with AIH were (37.4±5.1)% and (15.7±2.3)%, much higher than [(28.3±3.4)% and (12.8±1.9)%, respectively, P<0.05] in patients with DILI or [(18.2±3.2)% and (10.2±1.6)%, respectively, P<0.05] in those with NAFLD. Conclusion During the progress of DILI, the number of peripheral blood activated T lymphocytes increases, which might participate in the pathogenesis of this entity, and needs further investigation.

Objective The purpose of this study was to summarize the clinical features of patients with hemochromatosis (HC). Methods Eight patients with HC were included in this retrospective study, and the patients were encountered in our hospital from 2012 to 2022. We presented the clinical symptoms, sign, iron biochemical tests, abdominal imaging, histopathology by liver biopsies and gene sequencing. Results All th eight patients were male, and three of them were diagnosed as hereditary hemochromatosis (HHC) and other five cases were with secondary hemochromatosis (SHC); fatigue, hepatosplenomegaly and skin pigmentation were common; out of the eight patients, the cirrhosis was found in five cases, diabetes in two and polyarthritis in one case; five patients had an elevated serum iron levels, all eight patients had an elevated transferrin saturation and serum ferritin levels; the liver biopsy and abdominal imaging showed excessive hepatic iron deposition in all the patients; three patients had gene mutation analysis supporting the diagnosis of HHC; the pricking blood therapy or deferrization therapy was the main management, and one patient had improved convalescence, one lost, one died and five had relatively stable diseases in our series. Conclusion The HC is a relatively uncommon entity in our country, and liver biopsies and gene sequencing might help make the diagnosis clear in patients with cryptogenic liver injuries.

Objective The aim of this study was to investigate the predictive performance of prognostic nutritional index (PNI) and systemic immunoinflammatory index (SII) in patients with hepatitis B associated acute-on-chronic liver failure (HBV-ACLF). Methods The clinical data of 308 patients with HBV-ACLF admitted to the First Affiliated Hospital, Naval Medical University the past eight years, were retrospectively analyzed, and the PNI and SII were calculated. The multivariate Logistic regression analysis was applied to reveal the factors impacting the prognosis, and the ROC curve was applied to evaluate the predictive efficacy. Results At the end of 1 to 3 month treatment, 192 patients (62.3%) survived and 116 patients (37.7%) died in our series; there was no significant difference in gender between the two groups(P>0.05), while the medium age of the dead patients was significantly older than in survivals (P<0.05); the PT or INR, total serum bilirubin (TSB) level in dead patients were significantly longer or greater than in those who survived (P<0.05); the incidences of ascites, infection, hepatic encephalopathy, gastrointestinal bleeding or hepatorenal syndrome in dead patients were significantly higher than in survivals (P＜0.05); the MELD scores and SII scores in the dead patients were significantly higher than, while the PNI scores was significantly lower than in survivals (P<0.05); the multivariate Logistic regression analysis showed that the PLT counts, TSB, PNI and SII scores were the independent risk factors impacting the prognosis of patients with HBV-ACLF; the sensitivities and specificities were 53.4% and 81.2%, and 30.2% and 88.0% when the PNI=37.77 and the SII=508.55 were set as the cut-off-value, respectively, in predicting the prognosis. Conclusion The early prediction of prognosis in patients with HBV-ACLF is beneficial for appropriate management, and the PNI is an independent protective factor for good and the SII is an independent risk factor for poor outcomes, and they both have to a certain extent a prognostic efficacy.

Objective This study was conducted to investigate the changes of serum neutrophil extracellular trap (NETs) markers in patients with hepatitis B liver cirrhosis (LC) complicated by portal vein thrombosis (PVT). Methods 55 patients with LC caused by hepatitis B viral infection were admitted to our hospital between September 2018 and October 2022, the clinical materials was retrieved from the HIS system and the PVT was diagnosed by ultrasonography (US). Serum myeloperoxidase (MPO), neutrophil elastase (NE) and citrullinated histone H3 (CitH3) levels were assayed by ELISA. Results The US check-up revealed PVT in 21 cases (38.2%) in our series; the model for end-stage liver disease score, the percentages of Child class C and splenectomy history in patients with PVT were 18.2(17.6,19.5), 52.4% and 42.9%, all significantly greater than [13.2(9.3,16.8), 14.7% and 2.9%, P<0.05] in patients without PVT; serum bilirubin, D-dimer, neutrophil/lymphocyte ratio, MPO, NE and CitH3 levels in patients with PVT were 25.6(21.6, 36.0)μmol/L, 1095.0(532.5, 2202.5)ng/ml, 2.3(1.9, 4.2), 42.4(20.7, 78.9)ng/ml, 2468.2(1344.8, 5620.6) ng/ml and 79.2(44.8, 126.2) ng/ml, all significantly greater than [18.9(16.5, 28.3)μmol/L, 390.0(280.0, 680.0)ng/ml, 1.9(1.2, 2.6), 10.8(5.6, 16.0)ng/ml, 623.5(241.4, 1006.3)ng/ml and 28.8(10.4, 39.6)ng/ml, respectively, P<0.05], while serum albumin level was (31.5 ± 5.8)g/L, much lower than [(35.4 ± 5.8)g/L, P<0.05] in patients without PVT. Conclusion The splenectomy might increase the incidence of PVT in patients with hepatitis B infection-induced LC, and conceal the blood routine manifestations of hypersplenism, while the increased serum NETs markers could remind the necessary of in time clinical management.

Objective The aim of this study was to investigate the distribution and drug resistance of pathogens in patients with decompensated hepatitis B liver cirrhosis (LC) and spontaneous bacterial peritonitis (SBP). Methods A series of 559 patients with decompensated hepatitis B-induced LC were admitted to our hospital between January 2019 and January 2023, and the ascites were obtained for routine bacterial culture. The bacterial characterization and drug susceptibility were conducted by VITEK-2 compact automatic microbial identification system. Results Among the 559 patients with decompensated LC, the ascites bacterial culture was positive in 119 cases (21.3%), including 74 strains (62.2%) of Gram-negative bacteria, 35 strains (29.4%) of Gram-positive bacteria and 10 strains (8.4%) of fungi infection; the Escherichia Coli was resistant to ampicillin up to 97.1%, the resistance to ciprofloxacin and first-generation, second-generation and third-generation cephalosporins greater than 40.0%, and was sensitive to amicacin and ertapenem; the Klebsiella Pneumoniae was resistant to ampicillin up to 100.0%, while sensitive to other commonly administered antibiotics; the Enterobacter Cloacae was resistant to cephalosporins greater than 30.0%, but sensitive to amikacin, gentamicin and ertapenem; the coagulase-negative Staphylococcus, Staphylococcus Aureus and Enterococcus Faecium was resistant to penicillin greater than 80.0%, but sensitive to vancomycin, tigacycline and linezolid; the Fungi we found were all sensitive to common antifungal agents. Conclusion The main pathogens in patients with SBP are Gram-negative bacteria in our hospital, and the drug resistance is common. In clinical practice, the early ascites culture and bacterial characterization are necessary for sensitive antibiotics selection.

Objective The aim of this study was to investigate the efficacy of Chinese herbal medicine compound,Fuzheng Huayu table, in the treatment of patients with hepatitis B-induced liver cirrhosis (LC) undergoing entecavir treatment. Methods 122 patients with hepatitis B-induced LC were enrolled in our hospital between August 2018 and December 2022, and were randomly divided into control (n=61) and observation (n=61) group, receiving entecavir or entecavir and Fuzheng Huayu table combination therapy for 52 weeks. Serum HBV DNA loads were detected by PCR, serum HBeAg and HBsAg levels were quantitatively assayed electrochemiluminescence, and liver stiffness measurement was determined by Fibroscan 502. Results At the end of 52 week treatment, serum HBV DNA negative rate in the observation group was 96.7%, not significantly different as compared to 93.4% in the control (P＞0.05), while serum ALT normalization rate was 98.4%, much higher than 85.2%(P＜0.05) in the control; serum HBsAg and HBeAg levels in the combination-treated group were (826.1±152.6)IU/mL and (194.5±33.8)IU/mL, both significantly lower than [(1005.3±207.5)IU/mL and (245.6±51.5)IU/mL, respectively, P＜0.05] in the control; serum ALT, AST and the LSM in the observation group were (49.6±7.3)U/L, (39.2±6.1)U/L and (9.2±2.1)kPa, all significantly lower than [(66.9±10.7)U/L, (52.8±8.7)U/L and (11.8±3.0)kPa, respectively, P＜0.05] in the control group. Conclusion The auxiliary oral administration of Fuzheng Huayu capsule at base of entecavir antiviral therapy might ameliorate liver fibrosis in patients with hepatitis B-induced LC, and is worthy of further clinical investigation.

Objective The aim of this study was to investigate clinical efficacy of antiviral therapy based on sorfosbuvir (SOF) combination in the treatment of patients with hepatitis C-induced liver cirrhosis (LC). Methods 39 patients with chronic hepatitis C-related compensated liver cirrhosis (CHC-CLC) and 23 patients with CHC-related decompensated liver cirrhosis (CHC-DLC) were encountered in our hospital between July 2019 and December 2022, and SOF and verapamil (VEL) combination was given in patients with CHC-CLC, and SOF and verapamil (VEL) combination plus ribavirin was given in patients with CHC-DLC for 12 weeks. Serum HCV RNA loads, biochemical index and routine blood cell counts were detected, and aspartate transaminase(AST)/platelet (PLT)ratio index (APRI) and fibrosis 4 score (FIB-4) were calculated. Liver stiffness measurement (LSM) was detected by Fibroscan. Results By end of treatment, two patients (8.7%) with CHC-DLC died; of survivals, early virologic response, end of treatment virologic response, sustained virologic response at 24 weeks (SVR 24) and SVR 48 in patients with CHC-CLC were 92.3%, 100.0%, 100.0% and 100.0%, all much superior to 80.9%, 100.0%, 76.2% and 66.7% (P<0.05) in patients with CHC-DLC; by end of antiviral treatment, peripheral blood platelet count and serum albumin level in patients with CHC-CLC were (140.6±26.3)×10⁹/L and (36.4±1.8)g/L, both significantly higher than [(70.5±27.0)×10⁹/L and (33.4±2.7)g/L, respectively, P<0.05] in patients with CHC-DLC; APRI, FIB-4 and LSM in patients with CHC-CLC were (1.1±0.4), (3.0±1.0) and (13.8±2.0)kPa, all significantly lower than [(1.7±0.7), (5.1±1.7) and (26.2±2.5)kPa, respectively, P<0.05] in patients with CHC-DLC. Conclusion DAAs therapy based on SOF has an satisfactory virological response in patients with CHC-CLC or CHC-DLC, with improved biochemical parameters, while the long-term efficacy needs further clinical observation.

Objective The aim of this study was to summarize the clinical feature and risk factors of hepatic myelopathy (HM) after transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhotic portal hypertension. Methods The clinical data of 526 patients with cirrhotic portal hypertension were admitted to our hospital between April 2017 and October 2022, and all patients underwent TIPS. The risk factors affecting postoperative HM occurrence were analyzed by using a binary Logistic regression model. Results All patients were followed-up for 7-72 months, with a median of 28 months after TIPS, and the HM was diagnosed in 41 cases (7.8%), male in 33 cases and female in 8 cases, median age of 50(40, 71)yr; the patients with HM had complicated hepatic encephalopathy(HE)in 34 cases (82.9%), portal vein thrombosis (PVT) in 13(31.7%) and esophageal-gastric varices bleeding (EGVB) in 6 cases (14.6%); the main manifestation of HM included decreased muscle strength in 31 cases(75.6%), hyperreflexia in 21 cases (51.2%), increased muscle tone in 23 cases (56.1%), positive pathological signs in 22 cases(53.7%), subjective numbness in 2 cases (4.9%) and anal sphincter dysfunction in 1 case(2.4%); 23 patients with HM died; the one-year and three-year cumulative survival rates were 82.9% and 58.5%; 82 patients from the non-HM group were selected for control, and the ages and the MELD score in patients with HM at admission were(50.9±12.9)year old and (11.3±2.6), both much higher than [(47.0±11.3)year old and (10.1±2.1), P＜0.05] in the control, and the percentages of male, splenectomy, postoperative HE, prolonged PT and elevated blood ammonia levels in patients with HM were 80.5%, 26.8%, 82.9%, 51.2% and 92.2%, significantly higher than 61.0%, 12.2%, 47.6%, 31.7% and 67.1%(P＜0.05) in the control; the binary multivariate Logistic regression model analysis showed the male (OR=2.250, 95%CI:1.654-3.735), splenectomy (OR=1.840, 95%CI;1.120-2.298), elevated blood ammonia level (OR=1.122, 95%CI:1.054-1.605) and HE(OR=3.442, 95%CI:2.248-6.779) were all the risk factors for HM occurrence after TIPS(P＜0.05). Conclusion The male patients with cirrhotic portal vein hypertension could have risk of HM occurrence after TIPS, which should be carefully surveyed and appropriately managed.

Objective The aim of this study was to summarize the clinical feature, electrocardiogram manifestations and related risk factors in patients with cirrhotic cardiomyopathy (CCM). Methods 89 patients with liver cirrhosis were enrolled in our hospital between May 2020 and May 2023, and all underwent digital electrocardiograph (EKG). The echocardiogram was conducted to record the left atrial diameter (LAD), left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs), diastolic interventricular septal thickness (IVSD), left ventricular ejection fraction (LVEF), and mitral valve early diastolic peak velocity/late peak velocity (E/A) ratio. The multivariate Logistic regression analysis was applied to predict the risk factors of CCM occurrence. Results Out the 89 patients with liver cirrhosis, 21 cases (23.6%) were found complicated with CCM; the LAD and IVSD in patients with CCM were (38.7±4.4) mm and (11.8±1.7)mm, significantly greater than [(35.3±3.9)mm and (10.0±1.5)mm, respectively, P<0.05], while the E/A ratio was (0.8±0.1), much less than [(1.3±0.2, P<0.05] in liver cirrhosis patients without CCM; the percentages of prolonged Q-T intervals, ST-T changes and limb lead low voltage in patients with CCM were 76.2%, 66.7% and 28.6%, much higher than 35.3%, 30.9% and 5.9%(P<0.05) in liver cirrhosis patients without CCM; there were significant differences as respect to the ages, Child-Pugh class C, diameters of portal vain, serum creatinine (sCr) levels, prothrombin times and hemoglobin (Hb) levels between the two groups (P<0.05); the multivariate Logistic regression analysis showed that the age (OR=1.54, 95%CI=1.09-2.17), the liver function Child-Pugh class C (OR=2.78, 95%CI=1.18-6.56) and hypohemoglobinemia (OR=2.58, 95%CI=1.29-5.14) were the independent risk factors of CCM occurrence in patients with liver cirrhosis. Conclusion Because of the hyperkinetic circulatory state, the patients with decompensated liver cirrhosis might have the complications of CCM, especially in elderly patients with deteriorated liver functions and hypohemoglobinemia, and the clinicians should pay more attention to them.

Objective The aim of this study was to explore the clinical implication of Bcl-2-associated transcription factor 1 (BCLAF1) and T cell factor 3 (TCF3) levels in cancerous tissues in patients with hepatocellular carcinoma (HCC). Methods 62 patients with HCC were enrolled in our hospital between January 2017 and January 2022, and all underwent hepatectomy. The cancerous and its adjacent liver tissues were collected. The pathological examinations were routinely observed, and the BCLAF1 RNA and TCF3 RNA loads in cancerous and adjacent liver tissues were assayed by qRT-PCR. All patients with HCC were followed-up for two years. Results The BCLAF1 RNA and TCF3 RNA loads in cancerous tissues in patients with HCC were (1.5±0.2) and (1.9± 0.3), significantly higher than [(0.9±0.1) and (1.2±0.1), respectively, P<0.05] in adjacent liver tissues; the cancerous BCLAF1 RNA level in patients with tumor diameter>3 mm was (1.7±0.3), significantly higher than [(1.3±0.2), P<0.05] in patients with tumor diameter≤3 mm; the cancerous BCLAF1 RNA level in patients with capsular invasion was significantly higher than that in patients without capsular invasion [(1.6±0.3) vs. (1.4±0.2), P<0.05]; the cancerous BCLAF1 RNA and TCF3 RNA levels in patients with moderate/low differentiation were much higher than in patients with high tumor cell differentiation(P<0.05), and the cancerous BCLAF1 RNA and TCF3 RNA levels in patients with TNM stage Ⅰ and Ⅱ were significantly lower than in patients with stage Ⅲ(P<0.05); the cancerous BCLAF1 RNA and TCF3 RNA in patients with microvascular invasion were (1.6±0.3) and (2.0±0.3), significantly higher than [(1.3±0.2) and (1.7±0.3), P<0.05] in patients without microvascular invasion; the BCLAF1 RNA and TCF3 RNA loads in patients with lymph node metastasis were (1.6±0.2) and (2.1±0.4), significantly higher than [(1.4±0.2) and (1.7±0.3), P<0.05] in patients without lymph node metastasis; 38 patients (61.3%) survived at the end of two-year follow-up, and the cancerous BCLAF1 RNA and TCF3 RNA loads in dead group were (1.7±0.3) and (2.2±0.4), much higher than [(1.4±0.2) and (1.7±0.3), P<0.05] in survivals. Conclusion The BCLAF1 and TCF3 RNA loads in cancerous tissues in patients with HCC are up-regulated, and are closely correlated to poor prognosis, which warrants further study.

Objective The purpose of this study was to analyze the diagnostic performance of multi-slice spiral CT and enhanced liver acquisition with volume acceleration (LAVA) in the diagnosis of patients with intrahepatic space-occupying lesions (SOL). Methods 160 patients with intrahepatic SOL were encountered in our hospital between May 2020 and April 2023, and all underwent enhanced multi-slice spiral CT and LAVA scanning. The diagnostic efficacy of CT and LAVA scanning was analyzed based on the histo-pathological examination as the golden standard. Results Out of the 160 patients with intrahepatic SOL, the histo-pathological diagnosis included 87 malignant lesions (hepatocellular carcinoma in 79 cases and intrahepatic cholangiocarcinoma in 8 cases), and 73 benign lesions (cirrhotic nodules in 46 cases, nodular regenerative hyperplasia of liver in 20 cases and focal nodular hyperplasia in 7 cases; the CT diagnose malignant lesions in 77 cases and benign lesions in 83 cases, misdiagnosing 5 benign lesions into malignant and 15 malignant into benign ones, and the LAVA scan diagnose malignant in 86 cases and benign in 74 cases, misdiagnosing 3 benign lesions into malignant and 4 malignant into benign ones; the accuracy, sensitivity, specificity, positive predictive value and negative predictive value by CT scan were 87.5%, 82.8%, 93.2%, 93.5% and 81.9%, while they were 95.6%, 95.4%, 95.9%, 96.5% and 94.6%, respectively by LAVA scan, superior to those by CT diagnosis (P＜0.05). Conclusion The qualitative diagnostic performance by MR LAVA is superior, which might help the clinicians make an appropriate decisions to intervene early.

Objective The study was conducted to investigate the optimal flip angle (FA) for image quality of the biliary system under disodium zocerate (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI) in patients with space-occupying lesions (SOL). Methods Sixty patients with SOL were admitted to our hospital between July 2019 and July 2023, and all underwent Gd-EOB-DTPA-enhanced MRI by using a Philips Elition 3.0 scanner with five different sets of FA at 9°, 20°, 30°, 45° and 60°. The bile duct, artifacts, signal-to-noise ratio and contrast-to-noise ratio of the biliary system with different FA were compared. Results At FA=45° and 60°, the estimated scores of cholangiography were (3.4±0.9) and (3.6±1.0), both significantly higher than at 9°, 20° and 30° [(2.7±0.5), (2.9±0.8) and (3.2±0.8), respectively, P<0.05], suggesting with the increase of FA, the score of biliary duct imaging were getting greater and greater, that is, the image quality was getting better and better; as respect to the Objective evaluation of biliary system, the differences of signal-to-noise ratio of gallbladder, common hepatic duct and common bile duct at each FA were statistically significant (P<0.05); at FA=30°, 45° and 60°, the signal-to-noise ratios of gallbladder, left hepatic duct, right hepatic duct, common hepatic duct and common bile duct were significantly higher than those at FA = 9° (P<0.05); the average signal-to-noise ratio of gallbladder, right hepatic duct and common hepatic duct were the best at FA = 45°, while the average signal-to-noise ratio of left hepatic duct and common bile duct was the best at FA = 30°; there were statistically significant differences in the signal-to-noise ratio of gallbladder, common hepatic duct and common bile duct at different FA (P<0.05); at FA=30°, 45° and 60°, the signal-to-noise ratio of gallbladder, left hepatic duct, right hepatic duct, common hepatic duct and common bile duct were significantly higher than that at FA=9° (P < 0.05); in addition, the average contrast signal-to-noise ratio of gallbladder, right hepatic duct, common hepatic duct and common bile duct were the best at FA=45°, while the average contrast signal-to-noise ratio of left hepatic duct was the best at FA=30°. Conclusions In 3T delayed imaging, the optimal FA of GdEOB-DTPA enhanced T1 weighted imaging of the liver and bile duct is 45 °, which could be used as a parameter setting basis for MR biliary imaging to improve the imaging quality.

Objective The aim of this study was to explore the differentiation of hepatocellular carcinoma (HCC) from metastatic liver cancer (MLC) by time-intensity curve (TIC) related parameters of contrast-enhanced ultrasonography(CEUS). Methods 106 patients with liver cancer were enrolled in our hospital between March 2021 and March 2023, and they all underwent CEUS examination, recording the TIC-related parameters, such as contrast agent arrival time (AT), time to peak (TTP), peak intensity (PI) and rising slope (RS) . The liver biopsies was performed. The receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was applied to evaluate the differential diagnostic efficacy of TIC parameters. Results Among the 106 patients with liver cancer, the pathological examination found HCC in 44 cases (41.5%) and MLC in 62 cases (58.5%); the AT and PI in HCC lesions were (9.1±2.2)s and (41.7±5.1)dB, both significantly lower than [(13.4±2.6)s and (45.8±5.5)dB, P<0.05], while the TTP was (24.8±4.7)s, significantly slower than [(18.9±3.4)s, P<0.05] in MLC foci; serum AFP levels in patients with HCC was (226.7±37.5)ng/mL, much higher than [(73.1±14.6)ng/mL, P<0.05] in patients with MLC; the ROC analysis showed that the AUC was 0.89(95%CI:0.83-0.96), with the sensitivity (Se) and specificity (Sp) of 70.5% and 95.2%, when the combination of AT, TTP and PI was applied to diagnose the HCC, much superior to serum AFP level, the latter had the AUC of 0.78(95%CI:0.68-0.79), with the Se and Sp of 56.8% and 78.8% (P<0.05), respectively. Conclusion The TIC-related parameters of CEUS have certain clinical application in the differential diagnosis of HCC from MLC, which needs multi-center verification.

Objective The aim of this study was to explore the implication of thyroid transcription factor (TTF)-1, p53 and p63 protein expression in cancerous tissues in patients with hepatocellular carcinoma (HCC). Methods 56 patients with HCC were encountered in our hospital between January 2019 and December 2021, and all underwent hepatectomy. All the patients were followed-up for two years. The expression of TTF-1, p53 and p63 in cancerous and adjacent non-cancerous tissues were detected by immunohistochemistry. Results The positive rate of cancerous TIF-1 expression was 33.9%, much lower than 73.2%(P＜0.05), while the positive rates of p53 and p63 expression were 76.8% and 64.3%, much higher than 7.1% and 32.1%(P＜0.05) in non-cancerous tissues; the positive rates of cancerous TIF-1 expression in 34 HCC patients with stage Ⅰ/Ⅱ, and 19 HCC patients high-differentiated tumor were 47.1% and 63.1%, both significantly higher than 13.6% and 18.9%(P＜0.05) in 22 patients with stage Ⅲ/Ⅳ, and in 37 patients with moderate-/low-differentiated tumors; the positive rates of p53 expression in patients with stage Ⅲ/Ⅳ, in 38 patients with lymph node metastasis, in 21 patients with low-differentiated tumor and in 22 patients with portal cancerous thrombosis were 95.4%, 89.5%, 100.0% and 95.4%, all significantly higher than 64.7%, 50.0%, 59.5% and 64.7% (P＜0.05); the positive rates of cancerous p63 expression in patients with stage Ⅲ/Ⅳ, with lymph node metastasis and low-differentiated tumor were 86.4%, 73.7% and 85.7%, significantly higher than 50.0%, 44.4% and 48.7%(P＜0.05) in patients with stage Ⅰ/Ⅱ, without lymph node metastasis and with moderate/high differentiated tumors; the one-year and two-year survival rates in 19 patients with cancerous TTF-1 expression positive were 84.2% and 73.3%, both significantly higher than 51.4% and 35.1%(P＜0.05) in 37 patients with cancerous TIF-1 negative; the one-year and two-year survival rates in 43 patients with cancerous p53 positive were 53.5% and 39.3%, much lower than 92.3% and 76.9%(P＜0.05) in 13 patients with p53 negative; the one-year and two-year survival rates in 36 patients with p63 positive were 47.2% and 33.3%, much lower than 90.0% and 75.0%(P＜0.05) in 20 patients with p63 negative. Conclusion The decreased expression of TTF-1, and the elevated modulation of p53 and p63 might take part in the hepatocarcinogenesis in patients with HCC, and needs further investigation.

Objective The aim of this study was to explore the clinical application of imaging three-dimensional visualization technique (3DVT) in guidance of hepatectomy in patients with hepatocellular carcinoma (HCC). Methods 63 patients with HCC were encountered in our hospital between January 2021 and December 2022, and were randomly divided into control (n=31) and observation group (n=32). All patients in the two groups underwent laparoscopic hepatectomy (LH) and the difference was in the control, the operation was carried out based on routine CT or MR imaging, while in the observation group, the LH was finished based on the 3DVT reconstruction. Serum interleukin-6 (IL-6), cortisol (Cor) and C-reactive protein (CRP) levels were detected by ELISA. Results The operation time, hepatic inflow occlusion time, intraoperative blood loss and hospital stay in the observation group were(190.6±44.1)min, (13.8±3.3)min, (310.5±87.2)mL and (10.8±2.9)d, all significantly shorter or less than [(228.3±56.9)min, (16.6±4.1)min,(399.2±96.92)mL and (13.3±3.5)d, respectively, P＜0.05] in the control; at the end of 7 days after operation, serum bilirubin, albumin levels and INR in the observation were (20.3±2.6)μmol/L, (38.2±3.9)g/L and (0.9±0.1), all not significantly different as compared to [(18.8±3.2)μmol/L, (37.6±4.4)g/L and (0.9±0.2)] in the control (P＞0.05); serum IL-6, Cor and CRP levels were (106.8±19.2)pg/ml, (260.1±35.4)mmol/L and (28.6±4.8)mg/L, all much lower than [(118.6±24.5)pg/ml, (291.6±40.7)mmol/L and (40.5±5.7)mg/L, respectively, P＜0.05] in the control; 3 months after surgery, the incidence of complications, such as infection, bile leakage and liver failure in the observation was 6.2%, much lower than 29.1%(P＜0.05) in the control group. Conclusion The advantage of LH under the guidance of 3DVT is terrific in patients with HCC, which could shorten operation time and hepatic inflow occlusion time, and is worthy of further clinical investigation.

Objective The purpose of this study was to investigate the diagnostic performance of serum serine protease inhibitor Kazal type 1 (SPINK1) levels for hepatocellular carcinoma (HCC) in patients with hepatitis B-induced liver cirrhosis (LC). Methods A total of 204 consecutive patients with hepatitis B-induced LC were encountered in our hospital between April 2020 and April 2023, andall underwent dynamic contrast-enhanced magnetic resonance imaging (MRI). The patients who had intrahepatic space-occupying lesions received fine needle aspiration biopsies (FNAB) for histo-pathological examination. Serum SPTINK1 and alpha-fetoprotein (AFP) levels were detected by ELISA. The multivariate Logistic regression analysis and receiver-operating characteristic curve (ROC) were applied to predict the diagnostic efficacy. Results Out the 204 patients with hepatitis B-induced LC, the intrahepatic space-occupying lesions were found in 30 cases(14.7%)by MRI, and the histo-pathological examination showed all with HCC; serum SPTINK1 and AFP levels in patients with HCC were (23.9±5.2)ng/mL and (426.5±67.0)ng/mL, both significantly higher than [(7.4±2.1)ng/mL and (14.4±4.3)ng/mL, respectively, P＜0.05] in those with LC; both serum SPTINK1(OR:3.69, 95%CI:1.08-12.49) and AFP (OR:3.54, 95%CI:1.04-11.98) were positively correlated to HCC existence; the AUC was 0.80(95%CI:0.72-0.89), with the sensitivity (Se) of 71% and the specificity (Sp) of 73%, when serum AFP level equal to or greater than 360.1 ng/mL was set as the cut-off-value, and the AUC was 0.82(95%CI:0.74-0.91), with the Se of 82% and the Sp of 79%, when serum SPTINK1 level equal to or greater than 15.6 ng/mL was set as the cut-off-value in diagnosing HCC. Conclusion The elevated serum SPINK1 and AFP levels might hint the malignant tumor in LC patients with MRI-proven space-occupying lesions, and the FNAB could determine the diagnosis.

Objective The aim of this study was to analyze the CT enhancement scan imaging feature of cholangiocellular carcinoma (CCC) in a series of patients with intrahepatic space-occupying lesions (ihSOL). Methods A total of consecutive 376 patients with ihSOL revealed by ultrasonography were encountered in our hospital between March 2020 and March 2023, and all underwent CT plain scan and multi-phase enhancement scan. The diagnosis was made based on pathology from tissues obtained by laparoscopic radical operation or fine needle aspiration biopsy. The diagnostic performance of multi-phase CT enhancement scan was analyzed by Kappa coefficient test. Results Out of the 376 patients with ihSOL, the pathological examination showed that there were 149 cases with benign lesions and 227 cases with malignant lesions, including CCC in 18 cases and hepatocellular carcinoma (HCC) in 209 cases; the multi-phase CT enhancement scan diagnosed benign lesions in 151 cases and malignant lesions in 225 cases, including ICC in 21 cases, all single lesion, 61.9% of them located in left lobe, 57.1% of them shaped in mass, with the diameters of(6.7±1.8)cm; the edges of mass tumors mildly intensified at arterial phase and portal phase, while vigorously intensified at delayed phase; the intra-lumen tumors adjacent to porta hepatis mildly intensified at arterial phase, gradually further intensified at portal and delayed phases; intrahepatic infiltrating tumors at bile duct walls mildly intensified, gradually persistently intensified at portal and delayed phases; out of the 225 patients with malignant lesions [intrahepatic cholangiocellular carcinoma (ICC) in 21 and HCC in 204 cases] demonstrated by CT scan, the pathological examination diagnosed ICC in 17 cases and HCC in 208 cases (Kappa=0.766), with the diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of 94.1%, 97.6%, 97.3%, 76.2% and 99.5%. Conclusion The feature of ICC by multi-phase CT enhancement scan is characteristic, which might help the clinicians make a plan for management.

Objective The aim of this study was to explore the efficacy of lauromacrogol and anhydrous ethanol sclerotherapy under ultrasound guidance in the treatment of patients with hepatic cysts (HC). Methods 107 patients with HC were enrolled in our hospital between October 2019 and October 2022, and were divided randomly into observation (n=54) and control group (n=53), receiving lauromacrogol or absolute ethanol sclerotherapy under ultrasound (US) guidance. After 6 months of treatment, the ultrasonography was performed, and the clinical efficacy was evaluated. Serum Golgi protein 73 (GP73), protein disulfide isomerase A3 (PDIA3) and chitosanase 3-like protein 1 (CHI3L1) levels were detected by fluoroimmunoassay. Serum myeloperoxidase (MPO) and cortisol (Cor) levels were measured by ELISA, and serum amyloid A (SAA) level was detected by chemiluminescence. The visual analogue scale (VAS) score was evaluated. Results The total effectiveness rate in the observation group was 98.1%, significantly higher than 88.7% in the control group (P<0.05), and at the end of six-month of follow-up, the recurrence of HC was 3.7%, much lower than 16.9%(P<0.05) in the control; one week after operation, serum GP73, PDIA3 and CHI3L1 levels in the observation group were (23.1±3.8)pg/L, (69.2±5.6)ng/mL and (44.9±4.9)ng/L, all significantly lower than [(37.3±4.3)pg/L, (94.8±5.4)ng/mL and (67.7±4.6)ng/L, respectively, P<0.05] in the control; serum MPO, Cor and SAA levels were (121.5±18.3)U/L, (259.7±24.1)ng/L and (14.5±2.5)mg/L, all significantly lower [(158.1±20.1)U/L, (298.6±26.3)ng/L and (20.2±3.1)mg/L, respectively, P<0.05] in the control; at day one and three after sclerotherapy, the VAS score in the observation group were (3.1±0.6) and (2.2±0.3), both much less than [(4.5±0.5) and (3.2±0.4), P<0.05] in the control; the incidence of untoward effect, such as abdominal pain and drunkenness-like symptoms in the observation group was 3.7%, much lower than 20.8%(P<0.05) in the control group. Conclusion The sclerotherapy with lauromacrogol injection in the treatment of patients with HC has a relatively better clinical efficacy as compared to the ethanol injection, which might be related to a low body stress reaction and low incidence of side effects.

Objective The aim of this study was to investigate the efficacy of percutaneous transhepatic gallbladder drainage (PTGD) and lauromacrogol sclerotherapy under ultrasound(US) guidance in patients with simple hepatic cysts (SHC). Methods 67 patients with SHC were enrolled in our hospital between June 2021 and August 2022, and were divided randomly into observation (n=34) and control group (n=33). All patients received US-guided PTGD, while the patients in the control group were given anhydrous ethanol for sclerotherapy, and those in the observation group were given lauromacrogol for sclerotherapy. The patients in both groups were followed-for 6 months after treatment. Serum cortisol (Cor) level was detected by ELISA, and serum amyloid A (SAA) and C-reactive protein (CRP) levels were detected by chemiluminescence assay. Results At the end of 6 months after treatment, the total effectiveness rates between the two groups were not statistically significantly different (97.1% vs. 93.9%, P>0.05); at month 1, 3 and 6 after treatment, the reduction rates of cyst volumes in the observation group was (69.1±7.3) %, (84.6±6.9) % and (92.8±3.7) %, significantly greater than those in control group [(56.8±6.4) %, (75.3±5.7) % and (86.3±4.9) %, P<0.05]; there were no significant differences as respect to serum liver biochemical parameters before and one week after the treatment between the two groups(P＞0.05; at the end of one week after treatment, serum Cor and SAA levels in the observation group were (260.4±15.6)nmol/L and (13.9±2.1)mg/L, both significantly lower than [(305.8±18.9)nmol/L and (18.6±2.7)mg/L, respectively, P＜0.05] in the control; the incidence of untoward effects in the observation group was 5.8%, much lower than 24.2%(P＜0.05) in the control group. Conclusion The efficacy of US-guided PTGD and lauromacrogol sclerotherapy is definitely satisfactory in dealing with patients with SHC, which could effectively reduce the cyst volumes, relieve body stress response and reduce adverse reactions.

Objective The aim of this study was to investigate the prevalence and risk factors of gallstones in non-obese individuals at physical examination. Methods Obese and non-obese persons [body mass index (BMI)≤24 kg/m²] attended physical examinations at Health Management Center, Second Affiliated Hospital, Xi'an Jiaotong University between January 2021 and December 2021, and all underwent abdominal ultrasonography and blood biochemical parameter tests. The univariate and multivariate Logistic regression analysis was applied to reveal the risk factors for gallstone formation. Results There were 66221 persons participating the physical examination in 2021 in our hospital, and 31427 of them were overweight or obese, finding 1591 cases (5.1%) with gallstones and 862 cases (2.7%) having cholecystectomy history, while out 34794 non-obese persons found 1309 cases (3.8%) of gallstones and 657 cases (1.9%) having cholecystectomy, significantly different between the two groups (P< 0.001); the gallstones in the non-obese population were more common in females, relatively elderly and those with relative high BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), high density cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), uric acid (UA),alanine aminotransferase(ALT), aspartate transaminase(AST),alkaline phosphatase(ALP),glutamyl transpeptidase(GGT)and total bilirubin(TBIL)levels; the multivariate Logistic regression analyses showed that the age, female, BMI, FBG, fatty liver diseases and GGT levels were all the independent risk factors for gallstone occurrence in the non-obese population, while blood HDL-C level was the protective factors; out the non-obese population, the gallstones were found in 65.0% of women, 62.4% of those older than 45 years, 32.7% of those with high SBP, 29.4% with low serum HDL-C level, 27.3% with high serum LDL-C level, 24.6% with high serum TG level, 21.3% with high DBP, 21.3% with high TC level, 19.6% with high FBG, 16.8% with fatty liver diseases and 16.0% with high UA level. Conclusion The prevalence of gallstones in non-obese population is relatively lower than that in the overweight and obese population, while the entity is not uncommon in the population, especially in female, in those with a variety of relatively metabolic disorders, such as increased blood glucose level, lipid metabolism disorders and fatty liver.

Objective The aim of this study was to investigate the analgesia with ciprofol and dexmedetomidine combination in patients with cholecystolithiasis undergoing laparoscopic cholecystectomy (LC). Methods 69 patients with cholecystolithiasis were enrolled in our hospital between February 2023 and June 2023, and were randomly divided into control (n=34) and observation group (n=35), and all patients in the two groups received LC. For analgesia, the ciprofol was given in patients in the control, and the ciprofol and low-dose of dexmedetomidine combination were given in patients in the observation during perioperative period. Thereafter, the aspiration anaesthesia was carried out. The visual analogue scale (VAS) and Ramsay sedation scale were applied to evaluate the anesthetic effect before intubation (T0) and 10 min after extubation (T2). The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured by multifunctional monitor at T0, 10 min after intubation (T1) and T2. Serum interleukin-1β (IL-1β), IL-6 and tumor necrosis factor-α (TNF-α) levels were measured by ELISA. Results At T2, the VAS and Ramsay scores in the observation group were (3.5±0.3) and (2.7±0.5), both significantly lower than [(3.9±0.4) and (3.3±0.5), respectively, P＜0.05] in the control; the wakening time and extubation time in the observation group were(12.4±2.7)min and (16.2±2.9)min, both significantly shorter than [(16.8±3.3)min and (19.7±3.8)min, P＜0.05] in the control; at T1, the SBP, DBP and HR were (118.7±8.6)mmHg, (71.0±6.3)mmHg and (78.8±7.4)beats/min, all significantly lower or slower than [(124.1±9.3)mmHg, (74.6±6.5)mmHg and (82.6±6.7)beats/min, P＜0.05] in the control; at T2, the SBP, DBP and HR were (121.4±10.5)mmHg, (76.6±5.9)mmHg and (76.2±6.7)beats/min, significantly lower or slower than [(127.6±10.2)mmHg, (81.6±6.1)mmHg and (80.8±8.6)beats/min, P＜0.05] in the control; 3 days after operation, serum IL-1β, IL-6 and TNF-α levels were (41.3±7.1)pg/mL, (108.9±20.5)pg/mL and (14.7±2.7)pg/mL, all significantly lower than [(46.9±8.4)pg/mL, (122.8±24.7)pg/mL and (19.2±3.9)pg/mL, respectively, P＜0.05] in the control group. Conclusion The anesthesia with cyclopofol and low-dose of dexmedetomidine combination could relieve pain and provide stable hemodynamic conditions in patients with cholecystolithiasis underwent LC, which might be related to the mild stress of body reactions.

Objective This study was conducted to explore application of preoperative multi-slice spiral CT (MSCT) scan for selection of surgical Methods in patients with gallstones and cholecystitis (GCS). Methods A total of 104 patients with GCS were enrolled in our hospital between April 2021 and April 2023, and all patients underwent MSCT examination to observe display of gallbladder artery and gallbladder ducts. Base on the imaging manifestations, open or laparoscopic cholecystectomy (LC) were performed. Results Of the 104 patients with GCS, display rate and display score of gallbladder ducts were 90.4% and (1.5±0.2) points, with duct course variation in 11 cases, including low-level gallbladder ducts in 2 cases, right vagus duct formation in 3 cases and high-level gallbladder ducts in 6 cases, and the display rate and display score of gallbladder artery were 94.2% and (1.8±0.2) points, with vessel course variation in 13 cases, including type Ib in 4 cases, type IIa in 2 cases and type IIb in 7 cases; open cholecystectomy was conducted in 16 patients because of gallbladder trigonum undefined pre-operationally, and LC was performed in left 88 patients; intraoperative blood loss, operation time and hospital stay in LC-treated patients were (36.4±7.8)mL, (46.7±8.3)min and (6.3±1.1)d, all much less or shorter than [(50.6±8.4)mL, (73.5±9.6)min and (8.9±1.5)d, respectively, P＜0.05] in open operation-treated patients; incidence of post-operational complications, such as infection, bleeding and bile leakage in LC group was 8.0%, significantly lower than 25.0% (P＜0.05) in open surgery group. Conclusion The preoperative MSCT scan could clearly display gallbladder ducts and gallbladder artery in patients with GCS, which might help precisely select operation mode and get a best outcomes.

The liver is the most common organ of hematogenous metastasis of colorectal cancer, and about 50% of colorectal cancers will eventually develop liver metastasis, which have become an important untoward factor affecting the survival and prognosis of patients with colorectal cancer. The hepatic artery is the main blood supply vessel for colorectal liver metastases (CRLM), and direct infusion of chemotherapeutic agents through the hepatic artery can improve the local drug concentration and anti-tumor effects. The implantable infusion pumps provide convenient tunnels for infusion chemotherapy easily. The hepatic arterial infusion pump (HAIP) chemotherapy has shown a promising effect in preoperative transformation or downstage of tumors and postoperative adjuvant therapy, which can effectively improve the feasibility of surgical resection of CRLM and reduce the postoperative recurrence rate. The fluorouridine chemotherapy by HAIP can be applied as second or third lines of treatment for patients with CRLM. The HAIP and systemic chemotherapy combination plus targeted therapy can bring better survival benefits for patients in this setting. This article will review and discuss the clinical applications and advances of HAIP chemotherapy in the surgical treatment of CRLM.

The hepatolenticular degeneration (HLD), also known as Wilson's disease, is an entity of disordered copper metabolism caused by ATP7B gene mutation, which leads to intracellular copper transport dysfunction and excessive accumulation of copper in various organs. The early diagnosis and treatment can improve the prognosis of patients with HLD and reduce disability and early death. The current treatments include a diet with low copper, medical intervention and liver transplantation. However, the low copper diet could not significantly reduce the amount of copper absorption in intestinal epithelial cells, and excessive restriction of it will cause nutrient absorption disorders in normal tissue cells. The present treatment regimens often face problems such as poor adherence and worsening neurological symptoms. The application of liver transplantation is often limited by the shortage of donor organs and the need for lifelong immunosuppression. The new therapies, such as new medicine preparations, cell and gene therapy have brought new hopes for patients with HLD.