Objective To investigate the epidemiological characteristics of nonalcoholic fatty liver disease ( NAFLD) with elevated alanine aminotransferase ( ALT) and related risk factors. Methods A total of 1007 patients with NAFLD who were admitted to The Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces from April 4, 2016 to September 13, 2016 were enrolled, and among these patients, 123 had an elevated ALT level ( higher than the upper limit of normal 50 U/L) ( elevated ALT group) and 884 had normal ALT ( normal ALT group) . A statistical analysis was performed for their general data and laboratory markers [number of peripheral blood mononuclear cells, fasting blood glucose, triglyceride ( TG) , total cholesterol ( TC) , high-density lipoprotein ( HDL) , low-density lipoprotein ( LDL) , LDL/HDL ratio, ALT, aspartate aminotransferase ( AST) , gamma-glutamyl transpeptidase ( GGT) , alkaline phosphatase ( ALP) , uric acid ( UA) , creatinine, blood urea nitrogen, urinary protein, urinary microproteins], blood pressure, body mass index ( BMI) , concomitant biliary disease, and thyroid nodules. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was used to identify the risk factors for elevated ALT in NAFLD patients. Results Among the 1007 patients with NAFLD, there were 752 male and 255 female patients.Of all male patients, 13. 7% ( 103/752) were in the elevated ALT group, and of all female patients, 7. 8% ( 20/255) were in the elevated ALT group; there was a significant difference in the prevalence rate between male and female patients ( χ2= 5. 552, P = 0. 018) . According to the age, the 1007 patients were divided into 20-39 year group with 242 patients, 40-59 year group with 555 patients, and 60-90 year group with 210 patients, and there was a significant difference in the proportion of patients with an elevated ALT level between these three groups ( 26. 03% vs 8. 83% vs 5. 24%, χ2= 52. 327, P < 0. 001) ; further comparison between any two groups showed that the 20-39 year group had a significantly higher proportion of patients with an elevated ALT level than the 40-59 year group and the 60-90 year group ( χ2= 39. 886 and 34. 009, both P < 0. 001) . Most patients in the elevated ALT group were young and middle-aged adults, and compared with the normal ALT group, the elevated ALT group had a significantly younger age and a significant higher BMI ( t = 7. 419 and-4. 595, both P < 0. 001) ; there were also significant differences between the two groups in UA, number of peripheral blood mononuclear cells, LDL/HDL ratio, HDL, AST, and GGT ( U = 42 942, 47 697, 48 106, 49 086, 31 938, and 36 283, all P < 0. 05) . Of all 1007 patients, 392 had NAFLD complicated by thyroid nodules, and the elevated ALT group had a significantly higher proportion of such patients than the normal ALT group ( 40. 2% vs 30. 1%, P < 0. 05) . The univariate analysis showed that male sex, age ( young and middle ages) , a high number of peripheral blood mononuclear cells, increased LDL/HDL ratio, a low level of HDL, a high level of GGT, a high BMI, and absence of thyroid nodules were associated with elevated ALT in NAFLD patients ( all P < 0. 05) . The multivariate logistic regression analysis showed that young and middle ages ( 20-39 years) , a high number of peripheral blood mononuclear cells, and a high level of GGT were independent risk factors for elevated ALT in NAFLD patients ( all P < 0. 001) . Conclusion Young and middle ages ( 20-39 years) , a high number of peripheral blood mononuclear cells, and a high level of GGT are predictive factors for elevated ALT in NAFLD patients and may have a certain value in guiding the early diagnosis of nonalcoholic steatohepatitis.

Objective To investigate the correlation of liver fat content ( LFC) with serum vitamin A ( VA) level and insulin resistance ( IR) in patients with nonalcoholic fatty liver disease ( NAFLD) . Methods A total of 200 patients with an initial diagnosis of NAFLD in Shanghai Chongming from February 2016 to January 2017 were enrolled. According to the results of oral glucose tolerance test with 75 g glucose and insulin releasing test, NAFLD patients were divided into simple NAFLD group with 91 patients, NAFLD-impaired glucose regulation ( IGR) group with 69 patients, and NAFLD-type 2 diabetes mellitus ( T2 DM) group with 40 patients. A total of 98 healthy volunteers were enrolled as healthy control group. The homeostasis model was used to evaluate IR, high-performance liquid chromatography was used to measure serum VA level, and 3. 0 T1 H-magnetic resonance spectroscopy was used to measure LFC. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the LSD-t-test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Mann-Whitmey U test was used for further comparison between two groups. The Pearson's chi-squared test was used for comparison of categorical data between groups. A Spearman correlation analysis was also performed. Results There were significant differences in fasting plasma glucose ( FPG) , 2-hour postprandial glucose ( 2 h PG) , and Hb Alc between the healthy control group, simple NAFLD group, NAFLD-IGR group, and NAFLD-T2 DM group ( F = 303. 8, 133. 1, and 249. 3, all P < 0. 01) . The simple NAFLD group, NAFLD-IGR group, and NAFLD-T2 DM group had significant increases in FPG, 2 h PG, and Hb Alc ( all P < 0. 01) , and compared with the simple NAFLD group, NAFLD-IGR group, and NAFLD-T2 DM group, the healthy control group had significant reductions in body mass index, alanine aminotransferase, triglyceride, and low-density lipoprotein ( all P < 0. 01) . The simple NAFLD group, NAFLD-IGR group, and NAFLD-T2 DM group had significantly higher serum VA level, LFC, and HOMA2-IR than the healthy control group ( F = 9. 2, H = 216. 1, and H = 151. 0, all P < 0. 01) . HOMA2-IR and LFC gradually increased in the simple NAFLD group, NAFLD-IGR group, and NAFLD-T2 DM group ( H = 26. 7 and 38. 6, both P < 0. 01) . There were significant differences in HOMA2-IR and LFC between the NAFLD-IGR group and the NAFLD-T2 DM group ( U = 995 and 800, both P < 0. 01) ; there were also significant differences in HOMA2-IR, LFC, and VA between the NAFLD-IGR group and the simple NAFLD group, as well as between the NAFLD-T2 DM group and the simple NAFLD group ( all P < 0. 05) . LFC was positively correlated with VA ( R2= 0. 103, P < 0. 001) and HOMA2-IR ( R2= 0. 531, P < 0. 001) . Conclusion The increase in LFC is closely associated with high serum VA level and disorder of glucose metabolism in patients with NAFLD.

Objective To investigate the value of transient elastography ( TE) in the diagnosis of nonalcoholic fatty liver disease ( NAFLD) . Methods A total of 21 patients without fatty liver disease and 92 patients with NAFLD, who visited Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from June to December, 2016, were enrolled. Their general information was collected and body mass index ( BMI) was calculated. Routine blood test, liver function evaluation, and measurement of blood lipid, serum insulin, and alpha-fetoprotein were performed, and liver CT and Fibro Touch were performed. The receiver operating characteristic ( ROC) curve was plotted with liver/spleen CT ratio as diagnostic criteria, and the ROC curve was used to evaluate the ability of controlled attenuation parameter ( CAP) to diagnose NAFLD. The area under the ROC curve ( AUC) was calculated, the Z test was used to evaluate diagnostic effectiveness, and Youden index was used to determine the optimal cut-off value. 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 any two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. The chi-square test was used for comparison of categorical data between groups. Results There were significant differences in age, alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , serum insulin, fat attenuation, and liver stiffness measurement ( LSM) between the patients without fatty liver disease and those with varying degrees of NAFLD ( all P < 0. 05) . The severe NAFLD group had a significantly lower mean age than the non-fatty liver disease group ( P < 0. 001) . There was a significant difference in CAP between the non-fatty liver disease group and the groups with varying degrees of NAFLD ( all P < 0. 001) , while there was no significant difference in CAP between the moderate and severe NAFLD groups ( P = 0. 127) . There was a significant difference in LSM between the non-fatty liver disease group and the moderate NAFLD group ( P = 0. 034) , as well as between the non-fatty liver disease group and the severe NAFLD group ( P < 0. 001) , while there was no significant difference between the moderate and severe NAFLD groups ( P = 0. 327) . There were significant differences in the levels of ALT and AST between the non-fatty liver disease group and the groups with varying degrees of NAFLD ( all P < 0. 001) , and the severe NAFLD group had significantly higher levels of ALT and AST than the mild NAFLD group ( both P =0. 001) . There was a significant difference in the level of insulin between the non-fatty liver disease group and the groups with varying degrees of NAFLD, while there was no significant difference between the groups with varying degrees of NAFLD ( all P > 0. 05) . The optimal cut-off values of CAP for the diagnosis of mild, moderate, and severe NAFLD were 244 d B/m, 272 d B/m, and 272 d B/m, respectively, with AUC of 0. 778 ( 95% confidence interval [CI]: 0. 663-0. 894) , 0. 893 ( 95% CI: 0. 809-0. 976) , and 0. 942 ( 95% CI: 0. 886-0. 998) ( all P < 0. 001) . Conclusion TE is a reliable noninvasiveness method for the diagnosis of NAFLD. CAP can accurately and quantitatively evaluate the degree of NAFLD and effectively differentiate mild NAFLD from moderate or severe NAFLD and thus has a good value in the grading of NAFLD. But it is difficult to differentiate moderate NAFLD from severe NAFLD.

Objective To investigate the effect of miRNA-384 ( miR-384) expression on hepatic steatosis in mice with nonalcoholic fatty liver disease ( NAFLD) induced by high-fat diet ( HFD) . Methods A total of 30 male C57 BL/6 J mice were fed for 7 days to adapt to the environment and then randomly divided into 2 groups, with 15 mice in each group. The mice in the control group were given normal diet, and those in the model group were given HFD for 8 weeks and then the liver tissue was harvested. HE and Nile red staining were used to observe the pathological changes of the liver. Microarray sequencing was performed to determine the whole-genome miRNA expression profile of liver tissue, and PCR was used to measure the relative expression of miR-384. The t-test was used for the comparison of continuous data between groups. Results In the control group, the liver was red with sharp edges, the lobular structure was clear, and there was no hepatic steatosis; in the model group, the liver was yellow with blunt edges, and the hepatocytes were swollen with a large number of fat vacuoles in the cytoplasm and nuclear deviation caused by the fusion of lipid droplets. Compared with the normal mice, the NAFLD mice had 12 upregulated miRNAs and 18 downregulated miRNAs in liver tissue. Some of the differentially expressed miRNAs between the control group and the model group were screened to obtain the same cluster diagram. Among the 8 miRNAs with significant changes, miR-384 showed a significant fold change. Conclusion The upregulation of miR-384 is closely associated with hepatic steatosis, but its mechanism still needs further study.

Objective To investigate the prevalence rate of fatty liver disease among people undergoing physical examination in Tangshan, China, and to provide a reasonable basis for the prevention and treatment of fatty liver disease. Methods The clinical data of 12 808 individuals who underwent physical examination in Tangshan from March 2014 to February 2016 were collected, and among these individuals, 3540 had fatty liver disease. The data including age, sex, body mass index ( BMI) , fasting plasma glucose ( FPG) , total cholesterol ( TC) , triglyceride ( TG) , low-density lipoprotein cholesterol ( LDL-C) , and liver ultrasound findings were analyzed. The t-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 Of all 7151 male individuals who underwent physical examination, 2750 ( 38. 46%) had fatty liver disease, and of all 5657 female individuals, 790 ( 13. 96%) had fatty liver disease; there was a significant difference in the prevalence rate of fatty liver disease between male and female individuals ( χ2= 947. 25, P < 0. 01) . There was a significant difference in the detection rate of fatty liver disease between male and female individuals in each age group of 18-29, 30-39, 40-49, and ≥50 years ( χ2= 337. 58, 474. 06, 449. 38, and 12. 86, all P <0. 01) . There was a significant difference in the detection rate of fatty liver disease between male or female individuals with different BMIs[obese ( BMI ≥28) , overweight ( 24≤BMI < 28) , and normal ( BMI < 24) ] ( χ2= 1104. 01 and 500. 23, both P < 0. 01) . In the three groups of obese ( BMI ≥28) , overweight ( 24≤BMI < 28) , and normal ( BMI < 24) individuals who underwent physical examination, there was a significant difference in the detection rate of fatty liver disease between male and female individuals in each group ( χ2= 71. 24, 87.97, and 323. 84, all P < 0. 01) . Male and female individuals with obesity ( BMI ≥28) and overweight ( 24≤BMI < 28) had a significantly higher detection rate of fatty liver disease than those with normal BMI ( both P < 0. 01) . There were significant differences in FPG, TC, TG, and LDL-C between the fatty liver group and the non-fatty liver group ( t = 17. 482, 13. 698, 22. 133, and 27. 334, all P < 0. 001) . In male individuals who underwent physical examination, there were significant differences in FPG, TC, TG, and LDL-C between the individuals with and without fatty liver disease ( t = 11. 288, 8. 652, 11. 671, and 20. 118, all P < 0. 01) ; in female individuals, there were also significant differences in FPG, TC, TG, and LDL-C between the individuals with and without fatty liver disease ( t = 16. 816, 5. 532, 15. 154, and 18. 507, all P < 0. 01) . Conclusion Among the adults undergoing physical examination in Tangshan, male adults have a significantly higher prevalence rate of fatty liver disease than female adults. Overweight or obesity, hyperlipidemia, and abnormal glucose metabolism are major causes of fatty liver disease.

Objective To investigate the clinicopathological features of hepatic amyloidosis. Methods A retrospective analysis was performed for 8 patients with hepatic amyloidosis confirmed by liver biopsy in 302 Hospital of PLA from January 2005 to December 2012. Clinical data, laboratory examination results, imaging findings, and pathological data were analyzed to summarize the clinicopathological features of hepatic amyloidosis. Results The clinical manifestations and signs of this disease included hepatomegaly ( 7/8) , weakness ( 6/8) , poor appetite ( 6/8) , splenomegaly ( 4/8) , ascites ( 2/8) , portal hypertension ( 2/8) , edema of lower extremities ( 2/8) , pruritus ( 2/8) , a history of heart disease ( 2/8) , and varices ( 1/8) . Laboratory examination showed increases in alkaline phosphatase ( ALP) ( 8/8) and gamma-glutamyl transpeptidase ( 5/8) , hypoproteinemia ( 2/8) , abnormal alanine aminotransferase ( 2/8) , a slight increase in aspartate aminotransferase ( 1/8) , and abnormal total bilirubin ( 1/8) . As for imaging examinations, ultrasound showed uneven echo of liver parenchyma ( 8/8) ; transient elastography showed a significant increase in liver stiffness ( 2/2) ; CT showed diffuse weakness ( 4/8) or focal weakness ( 2/8) . As for histopathological and immunopathological features, HE staining showed the deposition of pink substances around the hepatic sinusoids ( 8/8) and the central vein ( 6/8) , Congo red staining of the pink substances obtained a positive result ( 8/8) , and the pink substances showed a color of apple green under a polarization microscope; therefore, the patients were diagnosed with amyloidosis. As for immunohistochemistry, of all patients, 6 had positive Kappa staining and 4 had positive Lamda staining. Conclusion Hepatomegaly and elevated ALP are relatively common in patients with primary hepatic amyloidosis. When a patient has hepatomegaly and elevated ALP and cannot be diagnosed with common liver diseases, clinical physicians should consider the possibility of hepatic amyloidosis, which is rare but fatal, and make a confirmed diagnosis based on related examinations, in order to provide guidance for clinical treatment.

Objective To investigate the effect of retrograde perfusion via the inferior vena cava on renal function in the early stage after liver transplantation. Methods A retrospective analysis was performed for the clinical data of 103 patients with normal serum creatinine and blood urea nitrogen before surgery who underwent liver transplantation in Fuzhou General Hospital from January 2000 to December 2012. According to the surgical approach, these patients were divided into groups A ( orthotopic liver transplantation, 26 patients) and B ( retrograde perfusion via the inferior vena cava, 77 patients) . The two groups were compared in terms of preoperative data [age, sex, primary diseases ( liver cancer/liver cirrhosis) , Model for End-Stage Liver Disease ( MELD) score], time of inferior vena cava occlusion during surgery, intraoperative infusion volume and total volume of blood products, and urine volume, serum creatinine, and blood urea nitrogen at 1-7, 14, and 28 days after surgery. The independent samples t-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 Compared with group A, group B had a significantly shorter time of inferior vena cava occlusion and significantly lower intraoperative infusion volume and total volume of blood products ( t = 9. 945, 3. 127, and 5. 852, all P < 0. 05) . There was no significant difference in the incidence rate of acute renal failure after surgery between the two groups ( χ2= 1. 920, P > 0. 05) . At 1-2 days after surgery, group A had a significantly higher urine volume than group B ( t = 3. 613 and 2. 929, both P < 0. 05) ; at 2-7, 14, and 28 days after surgery, group B had significantly lower serum creatinine than group A ( t =2. 779, 2. 009, 2. 126, 2. 602, 1. 998, 2. 026, 2. 609, and 3. 870, all P < 0. 05) ; at 1-7, 14, and 28 days after surgery, group B had significantly lower blood urea nitrogen than group A ( t = 5. 895, 3. 212, 1. 830, 2. 348, 3. 030, 3. 549, 2. 287, 2. 996, and 2. 775, all P <0. 05) . Conclusion Retrograde perfusion via the inferior vena cava has little impact on renal function after surgery and brings benefits to the improvement and recovery of renal function after surgery.