Oral nucleos (t) ide analogues (NAs) is one of the main and efficient way for the treatment of chronic hepatitis B (CHB) . Considering the antiviral potency and drug resistance of domestic and foreign guidelines, NAs are divided into first-line and non-first-line drugs. “An Expert Consensus for the Adjustment of Treatment Strategies in Patients with Chronic Hepatitis B Treated with Non-first-line Nucleos (t) ide Analogues, ”is mainly aimed at those patients who are currently using non-first-line NAs drugs. In addition, how to standardize the adjustment to first-line NAs drugs of choice, which can strengthen the effectiveness of initial antiviral treatment to obtain better antiviral efficacy, and improve patient compliance, coinciding with the avoidance of occurrence of serious drug adverse reactions in patients with CHB is presented.

Malnutrition is common in patients with end-stage liver disease (ESLD) and is an independent risk factor for survival, therefore it should be treated as the same important complications as ascites and hepatic encephalopathy. However, up to now, there is no clinical nutrition guideline for patients with ESLD in China. In order to standardize the nutrition treatment, Chinese Society of Hepatology (CSH) and Chinese Society of Gastroenterology (CSGE) , Chinese Medical Association (CMA) co-organized and co-developed this guideline. Recommendations on nutritional screening and assessment as well as principles of intervention and management in patients with ESLD were provided to help clinicians make rational decisions on clinical malnutrition.

Objective To establish a new prognostic model, MACLF, for predicting the short-term prognosis of hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) , and to investigate its value in predicting the short-term prognosis of HBV-ACLF.Methods A retrospective cohort study was performed for the clinical data of 270 patients with HBV-ACLF who were admitted to The First Affiliated Hospital of Nanchang University from January 2015 to November 2018. The patients were divided into survival group with 153 patients and death group with 117 patients according to their conditions after 3 months of treatment, and influencing factors for the short-term prognosis of HBV-ACLF were analyzed. The chi-square test was used for comparison of categorical data between two groups, A binary logistic regression analysis was performed for statistically significant indices determined by multivariate analysis and a model was established.and the Mann-Whitney U test was used for comparison of continuous data between two groups. A binary logistic regression analysis was used for multivariate analysis, a binary logistic regression analysis was performed for statistically significant indices determined by multivariate analysis and a model was established, and the receiver operating characteristic (ROC) curve was plotted to evaluate the value of MACLF in predicting the short-term prognosis of HBV-ACLF. Results The univariate analysis showed that there were significant differences between the survival group and the death group in free triiodothyronine (FT3) , thyroid stimulating hormone, international normalized ratio, neutrophil-lymphocyte ratio (NLR) , platelet count (PLT) , alanine aminotransferase, aspartate aminotransferase-alanine aminotransferase ratio, total bilirubin (TBil) , albumin, creatinine, total cholesterol, triglyceride, sodium, alpha-fetoprotein, serum ferritin, Child -Turcotte-Pugh (CTP) class, Model for End-Stage Liver Disease (MELD) score, and complications (hepatic encephalopathy, hepatorenal syndrome, spontaneous peritonitis, gastrointestinal bleeding, and pulmonary infection) (all P < 0. 05) . The multivariate analysis showed that TBil (odds ratio [OR]= 1. 007, P = 0. 001) , INR (OR = 5. 750, P < 0. 001) , FT3 (OR = 0. 084, P = 0. 003) , PLT (OR =0. 987, P = 0. 022) , hepatorenal syndrome (OR = 7. 146, P = 0. 045) , and pulmonary infection (OR = 3. 816, P = 0. 023) were independent influencing factors for the short-term prognosis of HBV-ACLF. Therefore, a new model of MACLF was established for the short-term prognosis of HBV-ACLF: Logit (P) = 0. 007 ×[TBil (umol/L) ]+ 2. 181 × INR-2. 762 × [FT3 (pg/mL) ]-0. 014 ×[PLT (×109/L) ]+ 1. 797 × [hepatorenal syndrome (with: 1; no: 0) ]+ 1. 339 × [pulmonary infection (with: 1; no: 0) ]-2. 291. The ROC curve analysis showed that MACLF had significantly higher area under the ROC curve (0. 934) and Youden index (0. 774) than CTP class, MELD, and MELD combined with serum sodium concentration. Conclusion The new model of MACLF has a good value in predicting the short-term prognosis of patients with HBV-ACLF after 3 months of treatment.

Objective To investigate the association between baseline blood ammonia (BLA) and 90-day prognosis in patients with hepatitis B virus (HBV) -related acute-on-chronic liver failure (HBV-ACLF) . Methods A retrospective analysis was performed for the clinical data of 789 patients with HBV-ACLF who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from January2013 to December 2016, and the association between baseline BLA and 90-day prognosis was analyzed. The Cox regression risk model was used for multivariate analysis. The Kaplan-Meier survival curve was used to analyze the 90-day survival rate of patients with different levels of baseline BLA, and the log-rank test was used for comparison. Results The Cox multivariate regression analysis showed that BLA was independently and positively correlated with the risk of 90-day death in HBV-ACLF patients (Model 2: hazard ratio = 1. 007, 95%confidence interval: 1. 005-1. 010, P < 0. 00001) . The log-rank test indicated that in the patients without hepatic encephalopathy (HE) , the BLAhigh group had the highest 90-day cumulative mortality rate, followed by the BLAmid group and the BLAlow group (P = 0. 0023) ; among the patients with HE, the BLAhigh group had a significantly higher 90-day cumulative mortality rate than the other two groups (P= 0. 012) , while there was no significant difference in 90-day cumulative mortality rate between these two groups (P = 0. 18) . Conclusion Baseline BLA is independently and positively correlated with the risk of 90-day death in HBV-ACLF patients, and it may have a certain clinical value in treatment and prognostic evaluation.

Objective To investigate the expression of single nucleotide polymorphisms (SNP) of vitamin D-related genes in patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF) and its association with short-term prognosis of HBV-ACLF. Methods The patients with chronic hepatitis B who were admitted to Liver Diseases Research Center, The First Affiliated Hospital of Fujian Medical University, from July 2012 to March 2018 were enrolled, and according to the presence or absence of acute-on-chronic liver failure during the course of the disease (n = 400) , they were divided into HBV-ACLF group (n = 122) and non-ACLF group (n = 278) . The clinical data and laboratory examination results were collected; peripheral blood samples were collected, and imLDRTM multiple SNP typing kit was used to determine the genotypes of the SNPs of vitamin D receptor (VDR) rs1544410 and rs2228570 and vitamin D-binding protein (VDBP) rs2282679. The patients in the HBV-ACLF group were followed up for 3 months to observe their survival. The association of vitamin D-related gene SNP with HBV-ACLF susceptibility and prognosis was analyzed. Hardy-Weinberg equilibrium was used to evaluate the representativeness of gene samples. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. A logistic regression analysis was used to investigate the odds ratio of SNP in the development of HBV-ACLF. Results There were no significant differences in the genotype and allele frequencies of VDR rs1544410 and rs2228570 and VDBP rs2282679 between the HBV-ACLF group and the non-ACLF group (all P > 0. 05) . In addition, there were also no significant differences in the genotype and allele frequencies of VDR rs1544410 and rs2228570 and VDBP rs2282679 between the HBV-ACLF patients who survived and those who died (all P > 0. 05) . Conclusion SNPs of VDR rs1544410 and rs2228570 and VDBP rs2282679 are not associated with the development and short-term prognosis of HBV-ACLF.

Objective To investigate the mechanism of HCV infection in the pathogenesis of atherosclerosis with a model of human umbilical vein endothelial cells (HUVECs) stimulated by HCV in vitro. Methods HUVECs were stimulated with 1. 0 MOI HCVcc for 48 hours.CCK8 assay was used to measure cell proliferation; flow cytometry was used to measure cell apoptosis and cell cycle; wound healing assay and monocyte-endothelial adhesion assay were used to evaluate the influence of HCV on the migration and adhesion of HUVECs; quantitative real-time PCR and Western blot were used to measure the expression of inflammatory factors and endothelial injury factors in HUVECs stimulated by HCV. The two-independent-samples t test was used for comparison between two groups; an analysis of variance was used for comparison between multiple groups, and the LSD-t test was used for further comparison between two groups. Results Compared with the control group, the HCV group had no significant changes in the growth, apoptosis, and cell cycle of HUVECs (all P > 0. 05) . HCV stimulation inhibited the migration of HUVECs and enhanced their adhesion ability. Compared with the control group, the HCV group had significant increases in the mRNA and protein expression of the inflammatory factors interleukin-6 and interleukin-1β and the chemokines CXCL10 and monocyte chemotactic protein 1 (mRNA expression: t =-10. 155, -12. 048, -5. 025, and-20. 116, all P < 0. 05; protein expression: F = 2541. 739, 4806. 490, 477. 608, and 501. 38, all P < 0. 001) . HCV stimulation significantly upregulated the expression of the endothelial injury factors endothelin-1 and vascular endothelial growth factor and the adhesion molecules intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 in HUVECs (t =-4. 530, -4. 497, -7. 692, and-7. 449, all P < 0. 05) . Conclusion HCV can cause inflammatory changes and dysfunction in endothelial cells and thus affect the development of atherosclerosis.

Objective To investigate the clinical value of ultrasound-guided percutaneous drainage in the treatment of liver abscess from the aspects of laboratory markers and size of abscess. Methods A total of 79 patients with liver abscess who underwent ultrasound-guided percutaneous drainage in Department of Gastroenterology in Northern Jiangsu People's Hospital from January 2013 to August 2018 were enrolled, among whom 36 patients who were lost or transferred, abandoned treatment, had an age pf < 18 years, or were not followed up in the outpatient service were excluded. A total of 43 patients were finally included in the retrospective study. 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 All 43 patients achieved a one-time success of puncture and placement of drainage tube. Of all 43 patients, 36 had fear of cold and pyrexia, among whom 31 (86. 1%) had a normal body temperature on day 3 after surgery, and there were significant changes in leukocyte count, percentage of neutrophils, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase after surgery (t = 6. 668, 6. 255, 2. 337, 3. 001, and 5. 198, all P < 0. 05) . There was a significant reduction in the diameter of abscess after surgery (74 ± 31 mm vs 31 ±28 mm, t = 18. 517, P < 0. 05) . The average length of hospital stay was 19. 84 ± 9. 37 days. Of all 43 patients, 19 (44. 2%) were cured and 24 (55. 8%) had response to treatment. Of all 43 patients, 38 had positive results of liver abscess culture, among whom 25 (65. 8%) had Klebsiella pneumoniae infection, suggesting that Klebsiella pneumoniae was the most common pathogenic bacteria. Conclusion Ultrasound-guided percutaneous drainage has a high success rate, few complications, and reliable clinical efficacy in the treatment of liver abscess. Therefore, it is recommended as the first choice for the clinical treatment of liver abscess.

Objective To investigate the clinical effect of ursodeoxycholic acid (UDCA) alone or in combination with diammonium glycyrrhizinate on biochemical response and liver stiffness measurement (LSM) in the treatment of primary biliary cholangitis (PBC) . Methods A total of 66 patients with PBC who visited Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, from January 2014 to March 2016 were enrolled. The FibroTouch test was performed, and LSM was used to indicate the degree of liver fibrosis. The patients treated with UDCA and diammonium glycyrrhizinate (treatment group) and those treated with UDCA alone (control group) were compared in terms of liver biochemical response at 4, 12, 24, and 48 weeks of treatment and LSM at 24 and 48 weeks of treatment. The independent samples t-test was used for comparison of continuous data between two groups, and the paired t-test was used for comparison of biochemical parameters and LSM before and after treatment. Results Compared with the control group, the treatment group had a significantly lower level of aspartate aminotransferase at 4, 12, 24, and 48 weeks of treatment (4 weeks: 38. 4 ± 15. 4 U/L vs61. 6 ± 28. 8 U/L, t = 2. 684, P = 0. 012; 12 weeks: 36. 4 ± 12. 6 U/L vs 58. 1 ± 24. 8 U/L, t = 2. 953, P = 0. 006; 24 weeks: 37. 0 ± 8. 5 U/L vs 52. 9 ± 17. 2 U/L, t = 3. 134, P = 0. 004; 48 weeks: 34. 9 ± 7. 9 U/L vs 48. 6 ± 12. 7 U/L, t = 3. 463, P = 0. 002) , as well as a significantly lower level of alkaline phosphatase at 24 and 48 weeks of treatment (24 weeks: 91. 6 ± 15. 1 U/L vs 137. 3 ± 55. 6 U/L, t =2. 970, P = 0. 006; 48 weeks: 71. 3 ± 14. 7 U/L vs 128. 7 ± 45. 5 U/L, t = 4. 503, P < 0. 001) . There was a significant reduction in LSM at 24 and 48 weeks of treatment in the control group (24 weeks: 12. 9 ± 6. 8 kPa vs 13. 9 ± 7. 6 k Pa, t = 4. 814, P < 0. 001; 48 weeks:12. 6 ± 6. 4 kPa vs 13. 9 ± 7. 6 kPa, t = 3. 928, P = 0. 010) and the treatment group (24 weeks: 13. 4 ± 7. 0 kPa vs 15. 8 ± 9. 7 k Pa, t =3. 031, P = 0. 010; 48 weeks: 12. 0 ± 5. 7 kPa vs 15. 8 ± 9. 7 kPa, t = 3. 044, P = 0. 010) ; however, there was no significant difference in LSM between the control group and the treatment group at 24 and 48 weeks of treatment (all P > 0. 05) . Conclusion In patients with PBC, UDCA combined with diammonium glycyrrhizinate can improve serum biochemical response and has a better clinical effect than UDCA alone.Both groups have a significant reduction in LSM at 24 and 48 weeks of treatment, suggesting that UDCA combined with diammonium glycyrrhizinate can help to maintain disease stability.

Objective To investigate the value of fumarate hydratase antibody (anti-FH) in the differential diagnosis of autoimmune hepatitis (AIH) and drug-induced liver injury (DILI) . Methods From March 2014 to December 2016, 105 patients with AIH who were hospitalized in Beijing You'an Hospital were enrolled as AIH group, and 92 patients with DILI were enrolled as DILI group. A total of 128 healthy individuals were enrolled as control group. ELISA was used to measure the serum level of anti-FH. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. A consistency analysis of diagnostic compliance of anti-FH based on the Kappa test. The sensitivity, specificity, positive predictive value, and negative predictive value of anti-FH in the diagnosis of AIH were analyzed. Results Compared with the DILI group, the AIH group had significantly higher positive rate of anti-nuclear antibody (72. 4% vs 55. 4%, χ2=6. 147, P = 0. 013) and level of IgG ( (18. 3 ± 6. 1) g/L vs (15. 2 ± 5. 4) g/L, t =-2. 566, P = 0. 011) ) . The AIH group had a significantly higher positive rate of anti-FH than the DILI group and the control group (36. 2% (38/67) vs 6. 5% (6/92) and 2. 3% (3/128) , χ2= 59. 959, P < 0. 001) . In the diagnosis of AIH, anti-FH had a sensitivity of 36. 2%, a specificity of 93. 5%, a positive predictive value of 86. 4%, and a negative predictive value of 93. 5%. Conclusion Serum anti-FH has a certain reference value in the differential diagnosis of AIH and DILI.

Objective To investigate the association of TRIB1 rs2954029 single nucleotide polymorphism with nonalcoholic fatty liver disease (NAFLD) and coronary heart disease (CHD) and its influence on blood lipids in the Chinese Han population in Qingdao, China.Methods A total of 146 patients with NAFLD, 155 patients with CHD, and 156 patients with NAFLD and CHD, who were admitted to Qingdao Municipal Hospital from January to November, 2017, were enrolled as NAFLD group, CHD group, and NAFLD + CHD group, respectively, and 175 healthy individuals were enrolled as control group. Fasting venous blood samples were collected for biochemical analysis and TRIB1 rs2954029 genotyping. The chi-square test was used to analyze whether the distribution of genotypes was in accordance with the Hardy-Weinberg equilibrium. The chi-square test was used for comparison of categorical data between groups; the t-test and the Wilcoxon rank-sum test were used for comparison of continuous data between groups. The unconditioned logistic regression model was used to calculate odds ratio (OR) and its 95% confidence interval (CI) . Results There were no significant differences in rs2954029 genotype/allele frequency and distribution between the CHD group and the control group, as well as between the NAFLD + CHD group and the NAFLD group (all P > 0. 05) . In the CHD group and the control group, rs2954029 AT + AA carriers did not have an increased risk of CHD compared with rs2954029 TT carriers (OR = 1. 496, 95% CI: 0. 947-2. 363, P = 0. 084) ; in the NAFLD + CHD group and the NAFLD group, rs2954029 AT + AA carriers did not have an increased risk of CHD compared with rs2954029 TT carriers (OR = 1. 361, 95% CI: 0. 832-2. 227, P =0. 219) ; there were still no significant differences after adjustment for sex, age, and body mass index. In the whole population and the NAFLD group, there were no significant differences in biochemical parameters between the individuals carrying A allele and those not carrying this allele (P > 0. 05) ; in the CHD group and the NAFLD + CHD group, the individuals carrying A allele had a significantly higher level of triglyceride than those not carrying this allele (Z =-1. 986, -2. 521, all P < 0. 05) ; in the control group, the individuals carrying A allele had a significantly higher level of total cholesterol than those not carrying this allele (Z =-2. 653, P < 0. 05) . Conclusion In the Chinese Han population in Qingdao, TRIB1 rs2954029 single nucleotide polymorphism does not increase the risk of CHD in NAFLD patients.