Objective To investigate the diagnostic efficiency of shear wave elastography ( SWE) in evaluating chronic hepatitis B ( CHB) liver fibrosis and related influencing factors. Methods A total of 147 CHB patients who visited Shengjing Hospital of China Medical University from January 2016 to September 2017 were enrolled. SWE was performed for all patients, and liver biopsy was performed within one week after SWE. General information and serological test results of the patients were collected. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data; the chi-square test was used for comparison of categorical data between groups.The receiver operating characteristic ( ROC) curve was plotted to evaluate diagnostic efficiency, and the logistic regression model was used to determine the factors associated with the accuracy of SWE in assessing liver fibrosis stage. Results With liver fibrosis stage determined by liver histology as the standard, the areas under the ROC curve of SWE in the diagnosis of ≥F1, ≥F2, ≥F3, and ≥F4 liver fibrosis were0. 824, 0. 880, 0. 914, and 0. 986, respectively, with sensitivities of 91. 0%, 91. 7%, 87. 0%, and 88. 9%, respectively and specificities of 66. 0%, 82. 8%, 66. 0%, and 94. 9%, respectively, at the optimal cut-off values of 6. 1 kPa, 7. 0 k Pa, 8. 1 kPa, and 10. 0 k Pa, respectively. The positive predictive values were 85. 0%, 78. 6%, 48. 3%, and 53. 3%, respectively, and the negative predictive values were 77. 5%, 93. 5%, 97. 2%, and 99. 2%, respectively. According to the results of liver biopsy, of all 147 patients, 94 had an accurate diagnosis based on SWE, while 53 had an inaccurate diagnosis; there were significant differences between these two groups in alanine aminotransferase, aspartate aminotransferase, and liver inflammation grade ( Z =-4. 211、-4. 649、-3. 513, all P < 0. 01) . Liver inflammation grade ( odds ratio [OR]= 0. 552, 95% confidence interval [CI]: 0. 317-0. 963, P = 0. 028) was an independent influencing factor for the diagnostic accuracy of SWE, and it had a significant effect on SWE in diagnosing liver fibrosis in the case of stage F0 liver fibrosis ( OR= 1. 809, 95% CI: 2. 305-51. 195) and stage F2 liver fibrosis ( OR = 1. 345, 95% CI: 1. 037-13. 647) . Conclusion Liver stiffness measured by SWE has good diagnostic efficacy in assessing liver fibrosis stage, and the accuracy of liver fibrosis stage assessment is affected by liver inflammation stage.

Objective To investigate the predictive value of G9 teborg University Cirrhosis Index ( GUCI) score in the noninvasive diagnosis of liver fibrosis stage in patients with chronic hepatitis B virus ( HBV) infection by comparing it with the classical noninvasive serological diagnosis models of aspartate aminotransferase-to-platelet ratio index ( APRI) score and fibrosis-4 ( FIB-4) index for liver fibrosis.Methods A total of 846 patients with chronic HBV infection who underwent liver biopsy in The Second Affiliated Hospital of Anhui Medical University from January 2010 to December 2016 were enrolled and divided into marked liver fibrosis ( stage ≥S2) group with 396 patients, severe liver fibrosis ( stage ≥S3) group with 204 patients, and liver cirrhosis ( stage S4) group with 100 patients. Of all 846 patients, 491 had alanine aminotransferase ( ALT) < 2 × upper limit of normal ( ULN) , among whom 275 had marked liver fibrosis ( stage ≥S2) , 143 had severe liver fibrosis ( stage ≥S3) , and 73 had liver cirrhosis ( stage S4) ; there were 383 HBeAg-negative patients, among whom 218 had marked liver fibrosis ( stage ≥S2) , 110 had severe liver fibrosis ( stage ≥S3) , and 55 had liver cirrhosis ( stage S4) . Liver biopsy was performed for all patients, and clinical indices of routine blood test, liver function, and coagulation function were measured on the same day of liver biopsy to calculate GUCI score, APRI score, and FIB-4 index. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H rank sum test was used for comparison of non-normally distributed continuous data between multiple groups; the chi-square test was used for comparison of categorical data between multiple groups; the Spearman correlation analysis was used to investigate rank correlation between three serological models and liver fibrosis stage. The receiver operating characteristic ( ROC) curve was plotted to analyze the diagnostic efficacy of three serological models for liver fibrosis, and the Z test was used for comparison of the area under the ROC curve ( AUC) . Results GUCI score, APRI score, and FIB-4 index were positively correlated with liver fibrosis stage ( r = 0. 472, 0. 435, and 0. 401, all P < 0. 001) ; aspartate aminotransferase ( AST) level and prothrombin time-international normalized ratio ( PT-INR) were positively correlated with liver fibrosis degree in patients with hepatitis B ( r = 0. 316 and 0. 401, both P < 0. 001) ; platelet count ( PLT) was negatively correlated with liver fibrosis degree in patients with hepatitis B ( r =-0. 353, P < 0. 001) . GUCI score had a higher AUC than APRI score and FIB-4 index in the diagnosis of marked liver fibrosis ( Z = 6. 291 and3. 159, both P < 0. 001) and a higher AUC than APRI score in the diagnosis of severe liver fibrosis ( Z = 5. 306, P < 0. 0001) . In 491 patients with ALT < 2 × ULN, GUCI score had a higher AUC than APRI score and FIB-4 index in the diagnosis of marked or severe liver fibrosis ( marked liver fibrosis: Z = 5. 969 and 3. 089, both P < 0. 01; severe liver fibrosis: Z = 4. 455 and 3. 192, both P < 0. 01) . In 383 HBeAg-negative patients, GUCI score had a higher AUC than APRI score and FIB-4 index in the diagnosis of marked liver fibrosis ( Z =5. 725 and 2. 162, both P < 0. 05) and a higher AUC than APRI score in the diagnosis of severe liver fibrosis ( Z = 4. 743, P < 0. 001) . In the patients with ALT < 2 × ULN, at the cut-off value of 0. 446, GUCI score had a sensitivity of 61. 82%, a specificity of 82. 73%, a positive predictive value of 73. 14%, and a negative predictive value of 74. 02% in the diagnosis of marked liver fibrosis ( P < 0. 001) ; at the cut-off value of 0. 492, GUCI score had a sensitivity of 76. 92%, a specificity of 72. 30%, a positive predictive value of 44. 49%, and a negative predictive value of 91. 56% in the diagnosis of severe liver fibrosis ( P < 0. 001) ; at the cut-off value of 0. 499, GUCI score had a sensitivity of 72. 00%, a specificity of 77. 90%, a positive predictive value of 29. 74%, and a negative predictive value of 95. 54% in the diagnosis of liver cirrhosis ( P < 0. 001) . Conclusion GUCI score is a simple and practical serological model for the diagnosis of liver fibrosis, especially for patients with chronic HBV infection with ALT < 2 × ULN. GUCI score has a higher value than APRI score and FIB-4 index in the diagnosis of marked liver fibrosis and severe liver fibrosis; as for the diagnosis of liver cirrhosis, GUCI score has a similar diagnostic value as APRI score and FIB-4 index.

Objective To investigate the value of liver stiffness-spleen diameter-to-platelet ratio score ( LSPS) in predicting esophageal varices ( EV) in patients with liver cirrhosis. Methods A total of 76 patients with liver cirrhosis who visited The Second Central Hospital of Baoding from October 2012 to August 2017 were enrolled and divided into EV group with 32 patients and non-EV group with 44 patients.Blood samples were collected from all patients for liver function test, routine blood test, and coagulation test. Gastroscopy was performed to evaluate the presence or absence of EV and the degree of EV. Liver stiffness was measured, and aspartate aminotransferase-to-platelet ratio index, fibrosis-4, and LSPS were calculated. The Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The Spearman correlation analysis was also performed. The receiver operating characteristic ( ROC) curve was plotted to select LSPS corresponding to the maximum sum of sensitivity and specificity as the optimal cut-off value. Results Compared with the non-EV group, the EV group had a significantly lower platelet count ( Z =-6. 932, P < 0. 01) and significantly higher spleen diameter, liver stiffness, and LSPS ( Z =-4. 566, -6. 575, and-7. 323, all P < 0. 01) .Spleen diameter, liver stiffness, and LSPS were positively correlated with EV ( rs= 0. 537, 0. 759, and 0. 775, all P < 0. 001) . The patients with moderate EV had a significantly higher LSPS than those with mild EV [6. 50 ( 5. 71-9. 20) vs 4. 63 ( 2. 12-6. 13) , Z =-2. 010, P = 0. 044]. At the optimal cut-off value of 1. 59, LSPS had a sensitivity of 100%, a specificity of 93. 2%, a positive predictive value of91. 4%, and a negative predictive value of 100% in the diagnosis of EV, with an accuracy of 96. 1%, a Youden index of 93. 2%, and an area under the ROC curve of 0. 994 ( 95% confidence interval: 0. 985-1. 004) , suggesting that LSPS > 1. 59 showed the possibility of EV in cirrhotic patients and gastroscopy was unnecessary for patients with LSPS < 1. 59. Conclusion LSPS has a certain value in predicting the presence or absence of EV in patients with liver cirrhosis.

Objective To investigate the clinical effect of Shenqi Gankang tablets combined with antiviral therapy after transcatheter arterial chemoembolization ( TACE) in the treatment of hepatitis B virus ( HBV) -related hepatocellular carcinoma ( HCC) . Methods A total of106 patients with HBV-related HCC who were admitted to The First Affiliated Hospital of Xinxiang Medical University from October 2015 to February 2017 were enrolled and randomly divided into control group with 57 patients ( treated with TACE + entecavir) and experimental group with 49 patients ( treated with Shenqi Gankang tablets + TACE + entecavir) . Among these patients, 89 completed follow-up ( 44 in the control group and 45 in the experimental group) . The levels of total bilirubin ( TBil) , alanine aminotransferase ( ALT) , alpha-fetoprotein ( AFP) , and albumin ( Alb) were measured before treatment and after 1, 3, 6, and 12 months of treatment; the percentages of CD3+, CD4+, and CD8+T lymphocytes, Child-Pugh class, and Karnofsky Performance Scale ( KPS) score were recorded before treatment and after 12 months of treatment, and survival rate was calculated after 12 months of treatment. The chi-square test or Wilcoxon rank sum test was used for comparison of sex and genotype and allele frequencies between the two groups. The independent samples t-test and Wilcoxon rank sum test were used for comparison of continuous data between the two groups. Results After 3 months of treatment, the experimental group had significant improvements in the levels of ALT, TBil, and Alb than the control group ( all P < 0. 05) ; after 6 and 12 months of treatment, the experimental groups had further improvements in these indices than the control group ( all P < 0. 05) . Compared with the control group, the experimental group had a better change trend of ALT, AFP, TBil, and Alb and continuous improvements in ALT, TBil, and Alb. After 12 months of treatment, compared with the control group, the experimental group had a significantly higher percentage of CD4+T lymphocytes, a significantly higher CD4+/CD8+ratio, and a significantly lower percentage of CD8+T lymphocytes ( t =-2. 202, 3. 851, and-5. 324, P = 0. 030, < 0. 001, and < 0. 001) . At month 12 of follow-up, in the control group, 44 patients survived and 9 died, resulting in a survival rate of 83. 0%; in the experimental group, 45 survived and 2 died, resulting in a survival rate of 95. 7%; there was a significant difference in survival rate between the two groups ( χ2= 4. 121, P = 0. 042) . The experimental group had a significant improvement in Child-Pugh class than the control group, and there was a significant difference in Child-Pugh class between the two groups ( Z =-2. 260, P = 0. 024) . In the experimental group, 11 patients achieved a significant improvement in KPS score and 25 achieved a certain improvement, resulting in an improvement rate of 80. 00%; in the control group, 5 patients achieved a significant improvement in KPS score and 19 achieved a certain improvement, resulting in an improvement rate of 54. 55%; there was a significant difference in improvement rate between the two groups ( Z =-2. 688, P = 0. 007) . Conclusion Compared with antiviral therapy after TACE in the treatment of HBV-related HCC, Shenqi Gankang tablets combined with antiviral therapy after TACE has a better clinical effect in regulating the immune system, improving liver function, reducing bilirubin level, and improving survival rate.

Objective To investigate the optimal cut-off value of alpha-fetoprotein ( AFP) in the diagnosis and early screening of hepatocellular carcinoma ( HCC) . Methods The clinical data of 2212 HCC patients who were diagnosed and hospitalized in our hospital and 1998 non-HCC patients were collected, and the AFP level was summarized. The AFP level was divided into 10 ranges of 10-20 μg/L, 21-65μg/L, 66-110 μg/L, 111-155 μg/L, 156-200 μg/L, 201-250 μg/L, 251-300 μg/L, 301-350 μg/L, 351-400 μg/L, and >400 μg/L, and a comparative analysis was performed for the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of each cut-off value of AFP, ultrasound, and their combination in the diagnosis of HCC. The receiver operating characteristic ( ROC) curve was plotted to determine the optimal cut-off value. Results The cut-off valve of AFP of 200-250 μg/L had the largest sum of sensitivity and specificity ( 1. 370 1) and the largest area under the ROC curve ( 0. 896 4) . AFP > 20 μg/L combined with ultrasound had the highest sensitivity ( 95. 35%) in the diagnosis of HCC, with a diagnostic odds ratio of 26. 13. Conclusion The optimal cut-off value of AFP in the diagnosis of HCC is 200 μg/L. When AFP combined with ultrasound is used for the screening of people at a high risk of HCC, AFP > 20 μg/L is recommended as a positive index, and its combination with differential diagnosis and close follow-up and examinations can reduce the false negative rate of screening.

Objective To investigate the clinicopathological features of hepatic epithelioid hemangioendothelioma ( HEHE) . Methods The clinical data, histopathological data, and immunohistochemical results of 5 patients with HEHE were observed. Results There were 3 male and 2 female patients. Major clinical manifestations included persistent abdominal discomfort, abdominal pain, nausea, loss of weight, and pyrexia. One patient was found to have this disease during physical examination. Of all patients, 2 had a single nodule and 3 had multiple nodules. The tumor cells were relatively normal in morphology and were arranged in a cord-like shape or a small nested shape; the cells had a round, spindle-like, or irregular shape; the cells were rich in epithelioid eosinophilic cytoplasm, with branched cytoplasmic processes and cavity formation in cytoplasm. The tumor background was characteristic mucoid hyaline degeneration of cartilage-like matrix or glassy degeneration of fibrous matrix. Nuclear division and necrosis were observed occasionally. Vascular markers, such as CD31, CD34, Fli-1, coagulation factor VIII, and vascular endothelial growth factor, were expressed in tumor cells, and tumor cells tended to have a low proliferative activity. Conclusion HEHE has various clinical manifestations and treatment methods. Liver biopsy helps to make a confirmed diagnosis and select a proper treatment regimen before treatment.

Objective To investigate the association between serum triglyceride ( TG) level and the severity of acute hypertriglyceridemic pancreatitis ( AHTGP) . Methods A retrospective analysis was performed for the clinical data of 63 patients with AHTGP who were hospitalized and treated in Beijing Anzhen Hospital, Capital Medical University, from September 2015 to June 2018, and according to the new Atlanta classification criteria, these patients were divided into mild acute pancreatitis ( MAP) group with 32 patients, moderate-severe acute pancreatitis ( MSAP) group with 20 patients, and severe acute pancreatitis ( SAP) group with 11 patients. Serum TG level was recorded on admission and at 48 hours after admission. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups; the chi-square test was used for comparison of categorical data between multiple groups; the Spearman correlation analysis was used to evaluate the correlation between data; the receiver operating characteristic ( ROC) curve was used to evaluate the diagnostic efficacy of assessment indices. Results There were significant differences between the three groups in serum TG level at 48 hours after admission, Acute Physiology and Chronic Health Evaluation II ( APACHE II) score, modified CT severity index, bedside index for severity of acute pancreatitis, and Ranson score ( F = 14. 423, χ2= 44. 094, 39. 654, 30. 445, and 29. 426, all P < 0. 05) . Serum TG level on admission was only positively correlated with Ranson score ( r = 0. 491, P < 0. 001) ; serum TG level at 48 hours after admission were positively correlated with the new Atlanta classification criteria, APACHE II score, modified CT severity index, bedside index for severity of acute pancreatitis, and Ranson score ( r = 0. 396, 0. 392, 0. 400, 0. 476, and 0. 400, all P < 0. 05) . The areas under the ROC curve of serum TG level on admission and at 48 hours after admission in predicting disease severity were 0. 652 ( P = 0. 115) and 0. 895 ( P < 0. 001) , respectively, with optimal cut-off values of 34. 10 mmol/L and 6. 95 mmol/L, respectively. Conclusion Serum TG level at 48 hours after admission has a certain clinical value in predicting the severity of AHTGP.

Objective To investigate the clinical features of cholestatic liver disease ( CLD) , and to provide a reference for strengthening the diagnosis and treatment of this disease. Methods A retrospective analysis was performed for the clinical data of 107 patients who were admitted to Chenggong Hospital Affiliated to Xiamen University from January 2015 to December 2017 and were diagnosed with CLD. The t-test was used for comparison of continuous data between groups. Results Most patients had the clinical symptoms of weakness, loss of appetite, nausea, abdominal distension, pruritus, and jaundice. According to the site of cholestasis, there were 64 patients ( 59. 8%) with intrahepatic cholestasis and 43 ( 40. 2%) with extrahepatic cholestasis. The cause of the disease was common bile duct stones in 21 patients ( 19. 6%) , bile duct parasites in 1 patient ( 0. 9%) , primary sclerosing cholangitis in 2 patients ( 1. 9%) , primary biliary cirrhosis in 3 patients ( 2. 8%) , liver cancer in 8 patients ( 7. 5%) , bile duct carcinoma in 5 patients ( 4. 7%) , pancreatic cancer in 4 patients ( 3. 7%) , pancreatitis in 12 patients ( 11. 2%) , viral hepatitis in 28 patients ( 26. 2%) , drug-induced liver injury in 11 patients ( 10. 3%) , alcoholic hepatitis in 6 patients ( 5. 6%) , nonalcoholic fatty liver disease in 4 patients ( 3. 7%) , and autoimmune hepatitis in 2 patients ( 1. 9%) . The CLD patients with underlying diseases had a significantly poorer liver function ( alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, alkaline phosphatase, bile acid, and total bilirubin) than those with CLD alone ( t =-3. 44, -2. 99, -2. 42, -4. 39, -3. 34, and-2. 49, all P < 0. 05) . Most of the patients achieved good recovery after liver-protecting, transaminase-lowering, and jaundice clearance treatment. The patients with tumors had poor prognosis. Conclusion CLD has various causes, and its clinical features lack specificity. Clinicians should pay enough attention to this disease.

Objective To investigate the clinical effect of fenofibrate combined with ursodeoxycholic acid ( UDCA) in the treatment of primary biliary cholangitis ( PBC) patients with poor response to UDCA alone. Methods A total of 67 PBC patients with poor response to UDCA who were treated in Xijing Hospital of Digestive Diseases, Air Force Medical University, from May 2009 to December 2017 were enrolled, and according to whether fenofibrate was used in addition, they were divided into combination treatment group with 33 patients and UDCA group with 34 patients. Related clinical data at baseline ( after one year of UDCA treatment) and at 6 and 12 months after treatment were collected, and the two groups were compared in terms of serum biochemical parameters, biochemical response, and GLOBE score after treatment. The t-test was used for comparison of normally distributed continuous data between two groups; the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. Results Compared with the UDCA group at 12 months after treatment, the combination treatment group had significant reductions in the serum levels of alkaline phosphatase ( ALP) , aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transpeptidase ( t = 3. 465, 2. 406, 2. 057 and 3. 208, P < 0. 001 and P = 0. 019, 0. 002, and 0. 044) .According to the Barcelona criteria and the Paris I/II criteria, the combination treatment group had a biochemical response rate of 54. 5% ( 18/15) , 36. 4% ( 12/21) , and 34. 3% ( 11/22) , respectively, and there was a significant difference in the evaluation results of the Barcelona criteria between the two groups ( t = 4. 349, P = 0. 037) . Compared with the UDCA group at 12 months after treatment, the combination treatment group had a significantly lower GLOBE score[0. 921 ( 0. 519 ~ 1. 657) vs 0. 498 (-0. 026 ~ 1. 027) , Z =-2. 007, P = 0. 045]and significantly higher 5-, 10-, and 15-year transplant-free survival rates ( Z =-2. 000, -2. 004 and-2. 009, P = 0. 045, 0. 045, and 0. 043) . Conclusion In patients with poor response to UDCA alone, fenofibrate combined with UDCA can significantly improve their blood biochemical parameters, especially the serum level of ALP. The combination treatment can also reduce the GLOBE score in patients with poor response and thus may help to improve long-term prognosis.

Objective To investigate the effect of different doses of Daifan powder on peripheral blood T helper 17 ( Th17) cells, CD4+CD25+Foxp3+regulatory T ( Treg) cells, and Th17/Treg ratio in a mouse model of primary biliary cholangitis ( PBC) induced by polyinosinic-polycytidylic acid ( Poly I∶ C) and the mechanism of action of Daifan powder in the treatment of PBC. Methods A total of 90 C57 BL/6 female mice were randomly divided into normal group, model group, low-, middle-, and high-dose Daifan powder groups, and ursodeoxycholic acid ( UDCA) group. Poly I: C was used to establish a model of PBC, and the effect of Daifan powder on the serology of PBC mice was observed. Liver function parameters were measured; flow cytometry was used to measure the percentages of peripheral blood Treg cells and Th17 cells; HE staining was used to observe liver pathology. The t-test was used for comparison of normally distributed continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. The Mann-Whitney U test ( for two independent samples) was used for comparison of non-normally distributed continuous data between two groups; the Kruskal-Wallis H test ( for two or more independent samples) was used for comparison between multiple groups. Spearman correlation was used for the correlation analysis. Results Compared with the normal group, the model group and the UDCA group had significant increases in the serum levels of alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , alkaline phosphatase ( ALP) , total bilirubin ( TBil) , and direct bilirubin ( DBil) ( all P <0. 05) . Compared with the model group, the low-, middle-, and high-dose Daifan powder groups had significant reductions in the serum levels of ALT, AST, ALP, TBil, and DBil ( all P < 0. 05) . In the model group, peripheral blood Th17/Treg ratio was not correlated with ALT, AST, ALP, TBil, and DBil ( all P < 0. 05) . Compared with the normal group, the model group had a significant increase in the percentage of peripheral blood Th17 cells ( P < 0. 01) ; compared with the model group, the low-, middle-, and high-dose Daifan powder groups had a significant reduction in the percentage of peripheral blood Th17 cells ( all P < 0. 01) . Compared with the normal group, the model group had a significant reduction in the percentage of peripheral blood Treg cells ( P < 0. 01) ; compared with the model group, the low-, middle-, and high-dose Daifan powder groups had a significant increase in the percentage of peripheral blood Treg cells ( all P <0. 01) . Compared with the normal group, the model group had a significant increase in peripheral blood Th17/Treg ratio ( P < 0. 01) ; compared with the model group, the low-, middle-, and high-dose Daifan powder groups had a significant reduction in peripheral blood Th17/Treg ratio ( all P < 0. 01) . Conclusion Daifan powder exerts a therapeutic effect on PBC by breaking Th17/Treg balance and reducing immune inflammatory reaction.

Objective To investigate the features of insulin resistance in patients with liver disease and diabetes and possible pathways leading to insulin resistance. Methods A total of 67 patients with liver disease and type 2 diabetes who were admitted to Beijing You'an Hospital from September 2017 to March 2018 were enrolled. The insulin secretory function of pancreas islet B cells and insulin resistance in the stages of chronic hepatitis and liver cirrhosis were analyzed. The presence or absence rs2943650 mutation was detected, and the association between rs2943650 mutation and insulin resistance in different degrees of liver injury was analyzed. The t-test or the rank sum test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results There was no significant difference in the secretory function of pancreas islet B cells between the patients with chronic hepatitis and type 2 diabetes and those with liver cirrhosis and type 2 diabetes ( 52. 72 ± 34. 56 vs 52. 35 ± 36. 59, t = 0. 24, P = 0. 99) , while there was a significant difference in insulin resistance index ( 1. 33 ± 0. 62 vs 2. 08 ± 1. 79, t = 2. 27, P = 0. 02) . There was a significant difference in insulin resistance between the patients with rs2943650 mutation and those without such mutation ( t = 2. 11, P = 0. 04) . There was a significant difference in the presence or absence of rs2943650 mutation between different stages of liver disease ( χ2= 6. 73, P = 0. 01) , and rs2943650 mutation was more common in patients with liver cirrhosis. Conclusion In patients with chronic liver disease and diabetes, there is no significant reduction in the function of pancreas islet B cells with the increase in the degree of liver injury, while there is a significant increase in insulin resistance. The rs2943650 mutation is significantly associated with insulin resistance and increases significantly with the aggravation of liver injury, and therefore, it may be an important pathway for insulin resistance induced by liver disease and diabetes.

Objective To investigate the effect of improvement in internal environment after plasma exchange on the bioactivity of peripheral blood CD34+cells in patients with acute-on-chronic ( subacute) liver failure. Methods The peripheral blood CD34+cells from patients with acute-on-chronic ( subacute) liver failure were cultured in vitro using the medium containing with the serum collected before or after plasma exchange. The growth curves of the two groups of cells were recorded and compared. RT-PCR was used to detect the expression of the cell surface markers PK-M2, Integrin-β1, and L-PK, and immunofluorescence was used to detect the expression of Integrin-β1. A repeated measures analysis of variance was used for comparison of continuous data between groups. Results The CD34+cells in the medium containing the serum collected after plasma exchange grew better than those in the medium containing the serum collected before plasma exchange ( P < 0. 05) . PK-M2 and Integrin-β1 were detected in the CD34+cells of both groups, but L-PK was not detected in either group. Conclusion For patients with liver failure, the improvement in internal environment after plasma exchange helps to maintain the bioactivity of peripheral blood CD34+cells, thus improving the efficacy of stem cell transplantation for liver failure.

Objective To investigate the prognostic factors for pregnancy-specific liver disease ( PSLD) , to establish a simple effective model ( NEW mode) using the statistic method, and to investigate the value of Model for End-Stage Liver Disease ( MELD) and NEW model in the prognostic evaluation of PSLD patients. Methods A total of 84 pregnant patients who were admitted to The Third Affiliated Hospital of Guangzhou Medical University due to jaundice and hepatic insufficiency from January 1, 2015 to December 31, 2017 and were diagnosed with acute fatty liver of pregnancy, preeclampsia, or hemolysis, elevated liver enzymes, and low platelets ( HELLP) syndrome were enrolled. According to their prognosis, they were divided into death group with 14 patients and survival group with 70 patients. The MELD model and the NEW model were used for scoring, the sensitivity, specificity, positive predictive value, and negative predictive value of the two models were calculated, and the receiver operating characteristic ( ROC) curve was used to assess the value of these two models in predicting the prognosis of PSLD. The t-test was used for comparison of continuous data between two groups, the chi-square test was used for comparison of categorical data between two groups, and the logistic regression model was used to analyze the prognostic models of PSLD.Results The univariate analysis showed that there were significant differences between the two groups in total bilirubin, direct bilirubin, serum creatinine, international normalized ratio ( INR) , alkaline phosphatase, serum total protein, and albumin ( t =-6. 33, -5. 38, -3. 38, -11. 56, -4. 63, 3. 00, and 2. 19, all P < 0. 05) , among which INR showed the most significant difference and was thus used to establish the NEW model ( R = 5. 812 × INR-11. 3) . Both MELD model and NEW model demonstrated a good predictive value, with an area under the ROC curve of 0. 952 ( 95% confidence interval [CI]: 0. 906-0. 997, P < 0. 05) and 0. 982 ( 95% CI: 0. 958-1. 000, P < 0. 05) , respectively, a sensitivity of 92. 9% and 100%, respectively, and a specificity of 87. 3% and 94. 4%, respectively. Higher scores of MELD model and NEW model were associated with higher fatality rates; the fatality rate was 0 when MELD score was lower than 25, but it increased to 81. 8% when MELD score was above 40; the fatality rate was 0 when R score was lower than-3, but it increased to 84. 6%when R score was above 0. Conclusion Both MELD model and NEW model can predict the prognosis of PSLD patients. The NEW model with reference to INR alone achieves a good value in evaluating prognosis and thus has a good clinical value.

Objective To investigate the diagnosis and treatment of acute graft-versus-host disease ( aGVHD) after liver transplantation.Methods This report included 8 patients treated with liver transplantation who were admitted to the Liver Transplantation Center of Beijing YouAn Hospital from April 2011 to August 2016. The key points in the diagnosis of aGVHD and the experience in the treatment of this disease were summarized. Results The key points in the diagnosis of aGVHD after liver transplantation were as follows: ( 1) aGVHD usually occur at two weeks to two months after liver transplantation; ( 2) fever, rash, diarrhea, and reduced whole blood cell count are typical clinical symptoms; ( 3) the percentage of donor T lymphocytes in peripheral blood is more than 10%; ( 4) there are typical histopathological manifestations. The experience in the treatment of aGVHD after liver transplantation were as follows: the overall steroid response rate is 20%-50%, and methylprednisolone ( 1. 5 mg·kg-1·d-1, one week) is recommended; high-dose glucocorticoids are not recommended, thus avoiding increased infection risk; high-dose immunosuppressant is one of the causes of aGVHD, and excessive application of immunosuppressant should be avoided in clinical practice; the prevention of respiratory infection and digestive tract infection was very important; enteral nutrition should be considered; second-line therapies such as siplizumab, antithymocyte globulin, and tumor necrosis factor-alpha inhibitor may play a certain therapeutic role; blood purification can be used to effectively eliminate cytokines and inflammatory mediators, which is helpful to the treatment of aGVHD. Conclusion The diagnostic criteria for aGVHD after liver transplantation are mainly based on time of onset, clinical symptoms, peripheral blood T lymphocyte chimerism rate, and histopathology. Hormone shock and reducing the dose of immunosuppressant may be effective treatments.