Objective To investigate the prevalence,natural history,and causes of death of nonalcoholic fatty liver disease( NAFLD),as well as related influencing factors. Methods A total of 833 retired cadres and staff members who underwent physical examination in Shanghai Changzheng Hospital and Shanghai 85 Hospital of the PLA from January 1 to December 31,2011 and received follow- up visits in either hospital every year since 2011 were enrolled as study subjects,and were divided into NAFLD group( 459 patients who were diagnosed with NAFLD before December 31,2011) and control group( 374 patients without liver or biliary diseases). The patients' clinical data were collected,including body height,body weight,systolic pressure,diastolic pressure,blood biochemical parameters,presence or absence of diabetes,hyperlipidemia,cerebrovascular and cardiovascular diseases,and malignant tumor,and smoking and drinking,and the death time and causes of death were clarified for the patients who died. The prevalence and natural course of NAFLD and related risk factors and prognostic factors were analyzed in this population. The t- test was applied for comparison of continuous data between groups,the chi- square test was applied for comparison of categorical data between groups,the multivariate binary logistic regression was applied to analyze the risk factors for the pathogenesis of NAFLD,and the multinomial logistic regression was applied to analyze the influencing factors for aggravation or alleviation of NAFLD. Results The patients in NAFLD group accounted for 55. 1% of all subjects,and the proportion of male patients was higher than that of female patients( 58. 0% vs 46. 7%,χ2= 4. 962,P = 0. 026). Compared with the control group,the NAFLD group had significantly higher body mass index( BMI),systolic pressure,diastolic pressure,alanine aminotransferase( ALT),fasting blood glucose,serum uric acid,and triglyceride( TG),a significantly higher proportion of male patients,and significantly higher proportions of patients with hypertension,diabetes,metabolic syndrome,newly- onset diabetes,and newly- onset metabolic syndrome( all P < 0. 05),as well as a significantly lower high- density lipoprotein cholesterol level( t =- 9. 818,P < 0. 001). Of all 374 patients in the control group,64( 17. 1%) had newly- onset NAFLD,and the incidence rate of newly- onset NAFLD showed no significant difference between male and female patients( 18% vs 15%,χ2= 0. 349,P > 0. 05); BMI and TG were the independent risk factors for newly- onset NAFLD( OR =1. 304,95% CI: 1. 153- 1. 474,P < 0. 001; OR = 1. 509,95% CI: 1. 080- 2. 166,P = 0. 016). At the end of follow- up in NAFLD group,235 patients( 51. 2%) achieved a stable disease,40( 8. 7%) achieved improvement,144( 31. 4%) achieved remission,and 40( 8. 7%) experienced aggravation. The increase in BMI increased the risk of aggravation of NAFLD( OR = 1. 163,95% CI: 1. 028- 1. 316,P = 0. 016),while reductions in BMI and serum uric acid were the protective factors against NAFLD( OR = 0. 849,95% CI: 0. 781-0. 923,P < 0. 001; OR = 0. 997,95% CI: 0. 995- 1. 000,P = 0. 038). Ten patients in NAFLD group died( including 5 patients with malignant tumor and 2 patients with cerebrovascular and cardiovascular diseases),and 6 patients in the control group died( including 2 patients with malignant tumor,no patients with cerebrovascular and cardiovascular diseases),and the risk of death showed no significant difference between the two groups( P > 0. 05). Conclusion The prognosis of NAFLD is relatively good in people who underwent physical examination,and BMI,TG,and serum uric acid are the factors affecting the prognosis of such patients. The major causes of death in NAFLD patients are malignant tumor and cerebrovascular and cardiovascular diseases,rather than end- stage liver disease.

Objective To investigate the clinical significance of image- guided transient elastography Fibro Touch with fat attenuation parameter( FAP) in the diagnosis of fatty liver disease. Methods A total of 1080 persons who underwent physical examination in The First Affiliated Hospital of China Medical University from January to December,2014 were enrolled,and liver FAP,the results of color Doppler ultrasound for the liver,and liver / spleen CT ratio on computed tomography( CT) scan for the liver were collected and analyzed. The Kruskal- Wallis H test was applied for comparison of continuous data between groups,and the Kappa consistency coefficient and receiver operating characteristic curve were used to investigate the consistency between FAP and the results of color Doppler ultrasound for the liver or liver / spleen CT ratio on CT scan for the liver in the diagnosis of fatty liver disease and their diagnostic values. Results Liver ultrasound found 336 patients( 31. 11%) without fatty liver disease and 744 patients( 68. 89%) with fatty liver disease; with reference to the results of ultrasound,the sensitivity and specificity of Fibro Touch were 80. 5% and 75. 3%,respectively. Liver CT found 821 patients( 76. 02%)without fatty liver disease( grade 0) and 259 patients with fatty liver disease,among whom 216 had mild fatty liver disease( grade 1),34 had moderate fatty liver disease( grade 2),and 9 had severe fatty liver disease( grade 3); with reference to the results of liver CT,the sensitivity and specificity of Fibro Touch were 95. 4% and 47. 0%,respectively,and the sensitivity and specificity of ultrasound were 93. 1%and 36. 8%,respectively. As for the diagnosis of fatty liver disease,the results of Fibro Touch had a higher consistency with ultrasound results( Kappa coefficient = 0. 597,P < 0. 0001),and a lower consistency with CT results( Kappa coefficient = 0. 113,P < 0. 0001). Conclusion Fibro Touch has the advantages of high accuracy,easy operation,noninvasiveness,and low cost,and therefore it is a promising imaging method for the diagnosis of fatty liver disease.

Objective To investigate the current status of nonalcoholic fatty liver disease( NAFLD) in an enterprise in Xi'an,China,and to provide a scientific basis for further studies on NAFLD in Shanxi. Methods A total of 415 employees who underwent health examination in The First Affiliated Hospital of Xi'an Medical University from June to July,2014 were enrolled. All the patients underwent physical examination,abdominal ultrasound,and serological examination,and completed related questionnaires. The t- test was applied for comparison of continuous data,and the Pearson correlation analysis was applied for correlation analysis. Results Of all the 415 patients,86( 20. 7%)had NAFLD,consisting of 70 patients( 16. 9%) with mild NAFLD and 16 patients( 3. 8%) with moderate NAFLD. The population with an age of 50- 58 years had the highest prevalence rate( 30. 8%,16 /52). Of all the 86 patients with NAFLD,57( 66. 3%) had obesity,and76( 88. 4%) had abdominal obesity. The employees with moderate NAFLD had a significantly higher alanine aminotransferase( ALT) level,a significantly higher aspartate aminotransferase( AST) level,a significantly larger abdominal circumference,and a significantly higher body mass index( BMI) than those with mild NAFLD( t =- 4. 140,- 3. 512,- 4. 405,and- 5. 051,respectively,all P < 0. 05). In the employees with NAFLD,BMI and abdominal circumference were correlated with AST level( r = 0. 283 and 0. 271,both P < 0. 05) and ALT level( r = 0. 325 and 0. 316,both P < 0. 05). Most employees in this enterprise had a bad eating habit,a sedentary lifestyle,and a lack of physical exercise. Conclusion This enterprise has a high prevalence rate of NAFLD. BMI and abdominal circumference of patients with NAFLD have certain clinical values in predicting the degree of fat deposition in the liver,and are correlated with AST and ALT levels.

Objective To investigate the tumor features and the correlation between lymphocyte count and biochemical parameters in patients with hepatitis B virus- associated primary liver cancer( PLC) with yin deficiency. Methods A total of 148 PLC patients who were treated in Beijing Ditan Hospital,Capital Medical University,from July 2013 to February 2015 were enrolled and divided into yin- deficiency PLC group( 52 patients) and non- yin- deficiency PLC group( 96 patients). The patients' general information and laboratory markers were collected,including oncological parameters( alpha- fetoprotein,carcinoembryonic antigen( CEA),and carbohydrate antigen 199( CA19- 9)),virological parameter( HBs Ag),gross type( nodular type,massive type,bulky type,and diffuse type),radiological features( main portal vein diameter,portal vein tumor thrombus,and extrahepatic metastasis),biochemical parameters( Model for End- Stage Liver Disease( MELD) score,white blood cell,red blood cell,platelet( PLT),alanine aminotransferase,aspartate aminotransferase,total bilirubin( TBil),gamma- glutamyl transpeptidase,alkaline phosphatase,albumin,cholinesterase,prothrombin time( PT),and prothrombin time activity( PTA)),and lymphocyte count. The t- test was applied for comparison of normally distributed continuous data between groups,and the Pearson correlation analysis was applied for correlation analysis. The Mann- Whitney U test was applied for comparison of non- normally distributed continuous data between groups,and the Spearman correlation analysis was applied for correlation analysis. The chi- square test was applied for comparison of categorical data between groups. Results HBs Ag showed a significant difference between the two groups( χ2= 5. 658,P = 0. 017). Compared with the non- yin- deficiency PLC group,the yin- deficiency PLC group had significantly increased CEA and CA19- 9( U =- 2. 200 and- 2. 194,both P < 0. 05),significantly increased MELD score,TBil,and PT( t = 2. 2,U=- 2. 0,U =- 2. 0,all P < 0. 05),and significantly reduced PLT and PTA( U =- 3. 1,t =- 2. 5,both P < 0. 05),as well as significantly reduced lymphocyte,T lymphocyte,CD8+T lymphocyte,and CD4+T lymphocyte( t =- 2. 7,U =- 2. 6,t =- 2. 2,U =- 2. 9,all P < 0. 05). In the PLC patients with yin deficiency,CD4+T lymphocyte count was positively correlated with PLT and PTA( r = 0. 360 and 0. 295,both P < 0. 05); CD8+T lymphocyte count was positively correlated with PLT and PTA( r = 0. 352 and 0. 464,both P < 0. 05)and was negatively correlated with MELD score,TBil,and PT( r =- 0. 358,- 0. 378,and- 0. 520,all P < 0. 05). Conclusion Compared with the liver cancer patients with other syndrome types,PLC patients with yin deficiency have a worse liver synthetic function,more significant cholestatic symptoms,and a lower immune function,and coagulation function tends to become worse when CD4+T lymphocyte count decreases. With the decreasing CD8+T lymphocyte count,coagulation function and liver reserve function become worse.

Objective To observe the effect of ursodeoxycholic acid( UDCA) on bile secretion in patients with cholestatic liver disease of various causes. Methods A total of 48 patients who underwent endoscopic nasobiliary drainage( ENBD) in Beijing You'an Hospital Affiliated to Capital Medical University from July 2013 to May 2014 were enrolled and divided into UDCA treatment group( n = 36) and control group( n = 12). The patients in the UDCA group were further divided into common bile duct stone group( n = 9),cholangiocarcinoma group( n = 7),sclerosing cholangitis group( n = 7),and post- liver transplantation group( n = 13). The patients in the UDCA treatment group received oral UDCA capsules( 250 mg,3 times / day) since the second day after surgery,and the daily volume of bile drainage was recorded for 7 days after surgery. Serum levels of total bilirubin( TBil),total bile acid( TBA),gamma- glutamyl transpeptidase( GGT),and alkaline phosphatase( ALP) were measured on the day before surgery and the 7th day after surgery,and the effects of UDCA on volume of bile drainage,TBil,TBA,GGT,and ALP were compared between groups. The t- test was applied for comparison between groups,comparison of continuous data between these groups was made by analysis of variance; the chi- square test was applied for comparison of categorical data between groups. Results Compared with the control group,the UDCA treatment group had a significantly increased volume of bile drainage on the 3rd,4th,and 5th days after surgery( t = 2. 461,3. 896,and 2.760; P = 0. 048,0. 021,and 0. 034),and the increase in volume of bile drainage was more significant in the common bile duct stone group,the cholangiocarcinoma group,and the post- liver transplantation group,with peak values appearing on the 4th day after surgery. The patients in the common bile duct stone group and the post- liver transplantation group had significantly lower serum levels of TBil,GGT,and ALP on the 7th day after surgery( t = 3. 340,2. 503,and 2. 158,P = 0. 016,0. 038,and 0. 045; t = 2. 951,2. 805,and 2. 461,P = 0. 014,0. 029,and 0. 034). Conclusion UDCA can increase bile secretion and improve liver function in patients with cholestatic liver disease of various causes.

Objective To investigate the effect of laparoscopic cholecystectomy( LC) on postoperative levels of alanine aminotransferase( ALT) and aspartate aminotransferase( AST) in patients with different types of hyperlipidemia( HLP). Methods A total of 213 HLP patients who underwent LC in Department of Hepatobiliary Surgery in Air Force General Hospital,PLA from January 2012 to December 2014 were analyzed retrospectively,and according to the serum levels of total cholesterol( TC),triglyceride( TG),and high- density lipoprotein cholesterol( HDL),they were divided into high TC group( n = 63),high TG group( n = 53),and mixed group( n = 48),low HDL group( n = 49). The patients with normal blood lipid who underwent LC during the same period of time were enrolled as non- HLP group( n =204). Enzyme- linked immunosorbent assay was performed before surgery and on days 1,3,and 7 after surgery to measure the levels of ALT and AST. Analysis of variance was used for comparison of continuous data between several groups,and q- test was used for comparison of such data between each two groups; the chi- square test was applied for comparison of categorical data between groups. Results All the HLP groups had significantly higher levels of aminotransferases before surgery than the normal control group( all P < 0. 05),and the high TC group had significantly greater increases in ALT and AST levels compared with the other HLP groups( all P < 0. 05). Compared with the control group,all the HLP groups had varying degrees of increase in ALT and AST levels on days 1 and 3 after LC,and the high TC group had significantly greater increases in ALT and AST levels compared with the other HLP groups( all P < 0. 05). In all the groups,the levels of aminotransferases on day 7 after surgery returned to normal,with no occurrence of severe abnormal liver function. Conclusion LC has a little influence on the liver in HLP patients. Clinical observation should be performed,and the treatment to protect the liver and reduce the levels of aminotransferases should be given when necessary.

Objective To investigate the clinical characteristics and prognostic value of liver injury in children with severe sepsis. Methods Children with severe sepsis who were admitted to our hospital and had complete clinical data from November 2013 to May 2015 were enrolled as subjects. Clinical characteristics and parameters of liver function were evaluated within 24 hours after admission to the hospital. The relationship of the parameters of liver function with the level and prognosis of severe sepsis was analyzed. Continuous data of the two groups were compared using the Mann- Whiteny U test and categorical data were copared using the χ2test. Results A total of 110 patients were enrolled as subjects. In these patients,52. 7%( 58 /110) had liver injury. According to the level of alanine aminotransferase( ALT),patients were divided into four groups that had ATL levels of < 80 IU / L,80- 200 IU / L,200- 400 IU / L,and > 400 IU / L,respectively. There were significant differences in mortality rate between the four groups( 40. 7%,47. 6%,64. 3%,and 81. 3%; χ2= 9. 458,P < 0. 05). Patients were divided into jaundice group and non- jaundice group based on the total bilirubin level. The jaundice group had a significantly higher mortality rate than the non- jaundice group( 75. 0% vs 44. 2%,χ2= 7. 129,P < 0. 01). According to the level of serum albumin,patients were divided into four groups that had levels of serum albumin of > 35 g / L,30- 35 g / L,25- 30 g / L,and < 25 g / L,respectively. There were significant differences in mortality rate between the four groups( 35. 9%,44. 1%,59. 1%,and 93. 3%; χ2= 15. 536,P <0. 01). According to the International Normalized Ratio,patients were divided into coagulopathy group and non- coagulopathy group. The mortality rate was significantly higher in the coagulopathy group than in the non- coagulopathy group( 80. 8% vs 41. 7%,χ2= 12. 147,P <0. 01). The survival group had significantly higher incidence rates of increased ALT level,jaundice,hypoproteinemia,and coagulopathy than the dead group( all P < 0. 05). Conclusion The incidence of liver injury is high in children with severe sepsis. The mortality rate in patients is significantly correlated with the increase in the ALT level,jaundice,hypoproteinemia,and coagulopathy,which play an important role in the prognosis of severe sepsis.

Objective To investigate the protective effect of magnesium isoglycyrrhizinate( Mg IG) in rats with acute liver failure induced by D- galactosamine( D- Gal N) and related mechanisms. Methods A total of 90 Sprague- Dawley rats were randomly divided into normal group( group A,n = 10),model group( group B,n = 20),low- dose Mg IG group( group C,n = 20),medium- dose Mg IG group( group D,n = 20),and high- dose Mg IG group( group E,n = 20). The rats in group A received intraperitoneal injection of the same volume of normal saline,and those in the other groups received single intraperitoneal injection of 10% D- Gal N. At 30 minutes after establishment of the model,the rats in groups C,D,and E received tail vein injection of Mg IG injection( 25,50,and 100 mg / kg). At 24 and 48 hours after establishment of the model,HE staining was performed to observe the pathological changes in the liver,and serum was collected to measure the levels of liver function parameters [alanine aminotransferase( ALT),aspartate aminotransferase( AST),total bilirubin( TBil),and albumin( Alb) ],proinflammatory factors [tumor necrosis factor- α( TNFα),interleukin- 1β( IL- 1β),and interferon-γ( IFNγ) ],and anti- inflammatory factors [interleukin 4( IL- 4),interleukin- 10( IL- 10),and transforming growth factor β( TGFβ) ]in rats. The one- way analysis of variance was applied for comparison between multiple groups,and the Student- Newman-Keuls test was applied for comparison between any two groups. Results The serum levels of ALT,AST,TBil,and Alb showed significant differences across the five groups( F = 74. 6,108. 9,25. 1,and 58. 4,all P < 0. 05); compared with group A,group B had significant increases in the serum levels of ALT,AST,and TBil and a significant reduction in the serum level of Alb( all P < 0. 05); compared with group B,groups C,D,and E had significant reductions in the serum levels of ALT,AST,and TBil and a significant increase in the serum level of Alb,and these parameters showed the most significant changes in group E( all P < 0. 05). The serum levels of TNFα,IL- lβ,IFNγ,IL-4,IL- 10,and TGFβ showed significant differences across the five groups( F = 75. 1,58. 9,25. 4,43. 6,66. 4,and 86. 8,all P <0. 05); compared with group A,group B had significant increases in the serum levels of TNFα,IL- lβ,IFNγ,IL- 4,IL- 10,and TGFβ( all P < 0. 05); compared with group B,groups C,D,and E had significant reductions in the serum levels of TNFα,IL- lβ,and IFNγand significant increases in the serum levels of IL- 4,IL- 10,and TGFβ,and these parameters showed the most significant changes in group E( all P < 0. 05). Conclusion Mg IG can reduce inflammatory response through reducing proinflammatory factors and increasing anti- inflammatory factors,and thus exert protective effect on rats with ALF.

At present,nonalcoholic fatty liver disease( NAFLD) is the most common liver disease,and is often regarded as the manifestation of metabolic syndrome in the liver. There are no specific drugs for this disease at the moment,and the only therapeutic method proved effective is guiding life style to reduce body weight. Insulin resistance,oxidative stress response,inflammatory response,and apoptosis are involved in the pathogenesis of NAFLD. Animal experiments and human studies have proved that various natural drugs have antioxidant,anti- inflammatory,or insulin- sensitizing effects and thus have significant efficacy in the treatment of NAFLD. This article summarizes the research advances in 10 natural drugs commonly used for the prevention and treatment of NAFLD in recent years and treatment of NAFLD in recent years and concludes that more studies are needed to confirm the efficacy of natural drugs in NAFLD patients.

Nonalcoholic fatty liver disease( NAFLD) is a clinicopathological syndrome characterized by diffuse macrovesicular steatosis and excessive lipid accumulation in the liver due to nonalcoholic reasons and other specific factors for liver injury,including simple fatty liver,nonalcoholic steatohepatitis,and liver cirrhosis. With the increasing incidence of NAFLD,the risk of hepatocellular carcinoma( HCC) is also increasing,but the exact mechanism remains unknown. This paper summarizes the roles of lipid accumulation,related cells,proteins,hormones,and metabolites in malignant transformation of hepatocytes,as well as the relationship between NAFLD,HCC,and lipid metabolism,and provides a new perspective for the prevention of HCC in clinical practice.

Non- alcoholic fatty liver disease( NAFLD) is a common liver disease in clinical practice and has a complex pathogenesis. At present,the " two- or three- hit" theory is still widely acknowledged as the major pathogenesis of NAFLD. However,in recent years,the role of liver immunological inflammation in the development and progression of NAFLD has been taken more and more seriously. This article elaborates on the mechanism of liver immunological inflammation in the development and progression of NAFLD from the perspective of liver immunological inflammation.

Toll- like receptor 4( TLR4) is an important pattern recognition receptor and plays an important role in the inhibition of hepatitis B virus( HBV) infection. It identifies the HBV- related proteins and produces inflammatory factors,such as tumor necrosis factor- α,interleukin- 6,and interleukin- 12,and type I interferon through the myeloid differentiation factor 88( My D88) and the non- My D88 pathway,and thus TLR4 exerts its antiviral effect. Meanwhile,it has been found that TLR4 regulates the balance between T helper 1 and T helper 2 cells,promotes the adhesion of CD8+T lymphocytes in the liver,induces the secretion of inducible nitric oxide synthase,and thus inhibits HBV. If overexpressed,TLR4 will aggravate liver inflammation by excessively activating the body's immune system,aggravating liver ischemia / reperfusion,and activating hepatic stellate cells. This article reviews related articles published at home and abroad in recent years,discusses the mechanisms of action of TLR4 in the pathogenesis of hepatitis B,and summarizes the association between TLR4 and hepatitis B,in order to find new therapies for hepatitis B and new protocols which delay the progression of hepatitis B to liver cirrhosis and liver cancer through the studies on the association between TLR4 and hepatitis B.

Hepatocellular carcinoma( HCC) greatly threatens human health. In clinical treatment,the therapeutic strategies for HCC are attracting more attention. With the research advances in the pathogenesis of HCC and the rapid development of molecular biology techniques,the therapies with molecular- targeted antitumor drugs for advanced HCC have become a hot research topic,and significant efficacy has been achieved in clinical practice. This article summarizes the research advances in clinical application of molecular- targeted drugs for the treatment of HCC and related issues,discusses the future perspectives of therapeutic strategies,and provides a new direction and reference for the clinical treatment of HCC.

Hepatorenal syndrome( HRS) is a serious complication of the end- stage liver disease. The overall treatment outcome of HRS is not satisfactory,with a short survival time and a poor prognosis. Currently,renal replacement therapy is one of the main non- transplantation therapeutic methods,but its clinical effect remains controversial. This review summarizes the research on HRS and advances in the clinical effect of renal replacement therapy for HRS,and points out that renal replacement therapy is not suitable as the conventional therapy for HRS,but it can be applied as the pre- transplantation transitional treatment for patients with a plan for liver transplantation,as well as the short- term treatment for non- transplantation patients who do not respond to vasoconstrictors.