Objective To observe the histological changes of the liver in chronic HBV carriers aged above 40 years. Methods A total of442 chronic HBV carriers aged above 40 years who underwent liver biopsy in Hepatology Hospital of Jilin Province from August 2012 to August 2015 were enrolled. Liver tissue samples were collected from all patients using ultrasound-guided rapid puncture, and the proportion of patients with grade ≥G2S2 liver fibrosis or liver cirrhosis was calculated. The association of medical history of HBV infection, liver function, body mass index ( BMI) and Fibro Scan with histological changes of the liver was analyzed. The t-test was used for comparison of continuous data between groups, relative risk ( RR) was used to analyze risk factors, and a Kappa analysis was used for consistency test. Results Of all 442 chronic HBV carriers aged ≥40 years, 56. 56% had grade ≥G2S2 liver fibrosis and 20. 14% had liver cirrhosis. The length of the medical history of HBV infection and BMI were correlated with the degree of liver fibrosis, and medical history > 10 years ( OR= 64. 06, 95% CI: 33. 72-121. 69, P < 0. 001) and BMI ≥24 ( OR = 6. 93, 95% CI: 4. 64-10. 35, P < 0. 001) were risk factors for liver fibrosis and cirrhosis. There were significant differences between grade < G2S2 liver fibrosis patients and grade ≥G2S2 liver fibrosis patients in the levels of alanine aminotransferase, aspartate aminotransferase, adenosine deaminase, gamma-glutamyl transpeptidase, alkaline phosphatase, and prealbumin ( t = 40. 00, 2. 16, 25. 35, 47. 73, 12. 62, and 13. 38, all P < 0. 05) . The consistency analysis of Fibro Scan and liver biopsy in the diagnosis of liver cirrhosis showed a Kappa value of 0. 76, suggesting that there was a good diagnostic consistency between these two methods. Conclusion Monitoring and management of chronic HBV carriers aged above 40 years should be taken seriously in clinical practice, and liver biopsy should be performed as soon as possible for those with ALT > 30 U/L and marked liver fibrosis suggested by Fibro Scan.

Objective To investigate the clinical features of patients with cholestatic autoimmune hepatitis ( AIH) and their prognosis after corticosteroid therapy. Methods The patients with AIH, autoimmune hepatitis-liver cirrhosis ( AIH-LC) , or autoimmune hepatitis-liver failure ( AIH-LF) who were hospitalized in 302 Hospital of PLA from January 2014 to December 2015 were enrolled, and a retrospective analysis was performed for the clinical data of the patients with cholestatic AIH who met the inclusion criteria. The improvement rate of patients receiving corticosteroid therapy and reasons why corticosteroid therapy was not applied were analyzed. 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 non-normally distributed continuous data between multiple groups; the chi-square test was used for comparison of categorical data between groups. Results A total of 181 patients with cholestatic AIH were enrolled, with 15 patients in AIH group, 142 in AIH-LC group, and 24 in AIH-LF group. The male/female ratio was 1 ∶ 11. 1. Type-1 AIH patients with positive anti-nuclear antibody and/or anti-smooth muscle antibody accounted for 96. 7% ( 175/181) . Most patients with cholestatic AIH had liver cirrhosis ( 78. 5%) . There were significant differences between the three groups in age, albumin, prothrombin time activity, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase and total bilirubin ( F = 3. 836, 13. 271, and 41. 819, χ2= 29. 153, 22. 759, 8. 826, and 26. 942, all P <0. 05) . The 181 patients with cholestatic AIH achieved an overall improvement rate of 36. 5%, and the AIH group had the highest improvement rate ( 66. 7%) . Of all patients, 35 ( 19. 3%) received corticosteroid therapy, and these patients had a significantly higher improvement rate than those who did not receive corticosteroid therapy ( 57. 1% vs 31. 5%, χ2= 8. 009, P = 0. 005) . Infection, ascites, and gastrointestinal bleeding were main reasons for the absence of corticosteroid therapy. Conclusion Cholestatic AIH is commonly seen in female patients, and most of patients with cholestatic AIH have liver cirrhosis or type-1 AIH. Corticosteroid therapy is an effective method, but its application is limited by infection, ascites, and gastrointestinal bleeding.

Objective To investigate the clinical features and prognosis of patients with primary biliary cholangitis ( PBC) complicated by hepatitis virus infection. Methods A total of 16 patients who were admitted to Beijing You An Hospital from October 2004 to October 2012 and diagnosed with PBC complicated by hepatitis virus infection were enrolled, among whom 7 had chronic hepatitis B virus infection, 3 had hepatitis C, 4 had hepatitis E, 1 had hepatitis B and hepatitis C, and 1 had hepatitis A. A total of 76 hospitalized patients with PBC alone were enrolled as controls. The two groups were compared in terms of clinical features, laboratory markers, and autoantibodies, and follow-up visits were performed to investigate prognostic features. The independent samples t-test was used for comparison of normally distributed continuous data, and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data; the chi-square test or Fisher's exact test was used for comparison of categorical data. The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used to compare survival rates between groups. Results Compared with the control group, the PBC-hepatitis virus infection group had significantly lower proportion of female patients ( χ2= 12. 22, P = 0. 002) , alkaline phosphatase ( U = 225. 00, P < 0. 001) , CHO ( U = 363. 50, P = 0. 036) , and Ig G level ( t = 2. 79, P = 0. 007) , and no patients in the PBC-hepatitis virus infection group experienced abdominal wall varices, upper gastrointestinal bleeding, or hepatic encephalopathy. The PBC-hepatitis virus infection group had various autoantibodies including anti-nuclear antibody, smooth muscle antibody, anti-parietal cell antibody ( APCA) , anti-liver specific protein antibody, and anti-myocardial antibody, as well as a significantly higher APCA positive rate than the control group ( 25% vs 3. 9%, χ2= 5. 608, P = 0. 016) . The median follow-up time was 49. 5 months ( 2-312 months) . The PBC-hepatitis virus infection group had a significantly lower incidence rate of adverse events than the control group ( 25. 0% vs 64. 5%, χ2= 8. 43, P = 0. 005) , and there were no significant differences between the two groups in cumulative survival rate and proportion of patients who did not experience any adverse event ( both P > 0. 05) . Conclusion Most patients with PBC complicated by hepatitis virus infection are in the early stage of PBC and have various nonspecific autoantibodies. Current study does not indicate that hepatitis virus infection has influence on the survival of PBC patients.

Objective To investigate the clinical features and prognosis of AIDS patients complicated by drug-induced liver injury ( DILI) . Methods A total of 119 patients who were diagnosed with AIDS in First Department of Infectious Diseases in Shanghai Public Health Clinical Center from January 2014 to December 2015 and met the diagnostic criteria for DILI were enrolled. The clinical data including medications, CD4~+T lymphocyte count, clinical manifestations, liver biochemical parameters, therapies, duration of liver injury, and prognosis were analyzed, and DILI type and classification were determined for all patients. The influence of DILI caused by different drugs on liver biochemical parameters was analyzed. The Wilcoxon rank sum test was used for comparison of 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 The 58 patients who received highly active antiretroviral treatment ( HAART) had significantly higher grade of liver injury ( χ2= 15. 756, P < 0. 001) and levels of total bilirubin ( TBil) ( Z =-3. 466, P = 0. 010) and albumin ( Alb) ( Z =-1. 968, P = 0. 049) than the 61 patients who did not. Among the patients who had a clear cause of DILI, 8 had DILI caused by antifungal drugs, 41 had DILI caused by antibacterial drugs, 18 had DILI caused by antitubercular agents, and 24 had DILI caused by antiviral drugs; the patients with DILI caused by antitubercular agents had a significantly higher level of TBil than those with DILI caused by other three types of drugs ( H = 12. 804, P = 0. 005) , the patients with DILI caused by antibacterial drugs and antitubercular agents had a significantly lower level of Alb than those with DILI caused by the other two types of drugs ( H = 14. 236, P = 0. 003) , and the patients with DILI caused by antitubercular agents and antiviral drugs had a significantly higher grade of liver injury than those with DILI caused by the other two types of drugs ( χ2= 16. 373, P = 0. 008) . The hepatocellular injury-type patients had a shorter length of hospital stay ( χ2= 8. 046, P = 0. 045) .A high level of alkaline phosphatase and a low level of alanine aminotransferase indicated a longer length of hospital stay ( Z =-2. 943 and-2. 592, both P < 0. 05) . Conclusion AIDS patients are given various drugs and have a high incidence rate of DILI. HARRT can aggravate liver injury, but it does not significantly affect patients' prognosis. Liver function examination should be performed regularly during clinical medication to know the state of liver inflammation and reduce the incidence rate of DILI in AIDS patients.

Objective To investigate the effect of pharmacotherapy on decompensated liver function in children with hepatolenticular degeneration. Methods Three children with“liver cirrhosis and decompensated liver function”as the onset of hepatolenticular degeneration who were admitted to Jinshan Hospital Affiliated to Fudan University from August 1, 2015 to August 1, 2016 were enrolled, and ATP7 B gene sequencing was performed to make a confirmed diagnosis. Clinical outcome was recorded. Results Compound heterozygous mutation of the ATP78 gene was detected in the three children. After comprehensive medical treatment, all children had improvements in hypoproteinemia and coagulation function, and two children had a reduced Child-Pugh score. Conclusion Hepatolenticular degeneration should be considered for children with unexplained abnormal liver function and even liver cirrhosis, and early diagnosis and timely pharmacotherapy can reduce the need for liver transplantation.

Objective To investigate the CT and MRI manifestations and clinical features of liver fluke granuloma. Methods A retrospective analysis was performed for the clinical and imaging data of 5 patients with pathologically confirmed liver fluke granuloma who were hospitalized in The First Affiliated Hospital of Guangxi Medical University from January 2010 to September 2015. Results Liver fluke granuloma had slightly low density on CT plain scan, as well as a slightly low signal on T1 weighted images and a slightly higher signal on T2 weighted images of MRI plain scan. Three-phase contrast-enhanced CT scan showed delayed enhancement with mild dilatation of the intrahepatic bile duct, and normal vessels ran through the lesion. Conclusion Liver fluke granuloma is a rare disease in clinical practice. A history of eating raw fish, delayed enhancement on three-phase contrast-enhanced CT scan, and normal vessels running through the lesion all contribute to the diagnosis of liver fluke granulomas.

Objective To investigate the change in intestinal mucous barrier in rats with nonalcoholic steatohepatitis ( NASH) , the effect of trefoil factor 3 ( TFF3) on intestinal mucous barrier in NASH rats, and the therapeutic effect of TFF3 on NASH. Methods A total of 60 clean male Sprague-Dawley rats were randomly divided into normal group, model group, and treatment group, with 20 rats in each group.The rats in the normal group were given normal diet, and those in the model group and the treatment group were given high-fat diet to induce NASH. The rats in the treatment group were given intraperitoneal injection of rh TFF3 at a dose of 1 ml·kg-1·d-1 ( a concentration of 0. 1 mg/ml) , and those in the normal group and the model group were given normal saline at a dose of 1 ml·kg-1·d-1; the course of treatment was 3 weeks for all groups. At the end of week 15, fluorescein isothiocyanate-labeled dextran was given by gavage to evaluate intestinal permeability, and after the rats were sacrificed, serum levels of aspartate aminotransferase ( AST) , alanine aminotransferase ( ALT) , total cholesterol ( TC) , triglyceride ( TG) , and endotoxin ( ET) and diamine oxidase ( DAO) activity were measured. HE staining was performed to observe the histopathological changes of the liver and the terminal ileum, PAS staining was performed to observe and count the goblet cells of the terminal ileum, immunohistochemistry was used to measure the expression of the tight junction protein Occludin and TFF3 in the terminal ileum, and quantitative real-time PCR was used to measure the mRNA transcription level of TFF3. 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. Results The model group had significant increases in serum levels of AST, ALT, TC, TG, and ET and DAO activity, and the treatment group had significant reductions compared with the model group ( all P < 0. 01) . The model group had a significant increase in NAFLD activity score compared with the normal group ( P < 0. 01) , and the treatment group had significant improvement in liver inflammation and a significant reduction in NAFLD activity score compared with the model group ( P < 0. 01) . The model group had cell necrosis, damage of the intestinal villi, and a significant reduction in goblet cells in the terminal ileum under a light microscope; in the treatment group, damage of the intestinal villi was repaired and there was an increase in goblet cells. The model group had a significant increase in intestinal permeability compared with the normal group, and the treatment group had a significant reduction compared with the model group ( both P < 0. 01) . The model group had a significant reduction in the expression of Occludin and TFF3, and the treatment group had a significant increase compared with the model group ( all P < 0. 01) . The model group had a downregulated TFF3 mRNA transcription level in the terminal ileum compared with the normal group, and the treatment group had an upregulated level compared with the model group ( both P < 0. 01) . Conclusion NASH rats have damaged goblet cells and mucous barrier dysfunction. TFF3 can repair the damaged terminal ileum, promote the regeneration of goblet cells and mucus secretion, restore intestinal barrier function, reduce intestinal permeability, and thus exert its therapeutic effect on NASH.