Objective To investigate the risk factors for the presence of hepatic encephalopathy in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) in the midphase.Methods A total of 287 patients with HBV-related ACLF in the mid-phase were recruited.Clinical data (age,gender,diabetes,liver cirrhosis,upper gastrointestinal hemorrhage,spontaneous bacterial peritonitis,and pulmonary infection) and laboratory findings [albumin,globulin,total bilirubin (TBil),alanine transaminase (ALT),aspartate aminotransferase (AST),glutamyl transpeptidase (γ-GT),alkaline phosphatase,total cholesterol,cholinesterase,creatinine,prothrombin activity (PTA),international normalized ratio,alpha-fetoprotein (AFP),loads of HBV DNA,serum potassium,serum sodium,white blood cell,and platelet count] were included as potential risk factors and analyzed with univariate and multivariate Logistic regressions.Results Multiple Logistic regression analysis indicated that serum potassium(B =-2.006,P =0.000,OR =0.135,95％CI:0.051-0.353),serum sodium(B=-0.096,P=0.014,OR=0.908,95％CI..0.841-0.981),pulmonary infection (B =1.648,P =0.018,OR =5.199,95 ％ CI:1.326-20.386),AFP (B=-0.010,P =0.024,OR =0.990,95％ CI:0.982-0.999) were correlated with hepatic encephalopathy.Conclusion Hypokalemia,hyponatremia,pulmonary infection and low levels of AFP are independent risk factors of the presence of hepatic encephalopathy in patients with HBV-related ACLF in the mid-phase.

Objective To explore the correlation between human cytomegalovirus(HCMV) infection with infantile hepatitis syn‐drome(IHS) and hepatic function damage .Methods The real‐time fluorescent quantitative polymerase chain reaction(PCR) was a‐dopted to test the urine HCMV DNA in 236 infants with IHS and 236 healthy infants ,respectively .The hepatic functions in 254 in‐fants with HCMV infection were analyzed retrospectively .Results Among these 236 cases of IHS ,the positive rates of HCMV DNA in urine sample was 62 .7% (148/236) .The positive rates of HCMV DNA and HCMV IgM in the IHS group were significant‐ly higher than those in the control group with statistical difference(P< 0 .01) .The liver function indexes in 254 infants with HCMV infection showed that the serum concentrations of total bilirubin (TBIL ) ,gamma glutamyl transpeptidase (GGT ) ,total bile acid (TBA) ,aspartate aminotransferase(AST ) and alanine aminotransferase(ALT ) were higher than the normal reference ranges ,and the differences were statistically significant(P < 0 .01) .Conclusion The detection rate of HCMV infection is high among the in‐fants with IHS in Guangxi area and HCMV is an important pathogen of IHS .HCMV may lead to hepatic function damage .

OBJECTIVETo investigate the effect of different nucleoside analogues on the long-term survival rate of patients with acute-on-chronic liver failure (ACLF) associated with hepatitis B virus (HBV) infection.

METHODSOne hundred and eighty patients with HBV-related ACLF were enrolled in this prospective cohort study and divided into a basic treatment group (n=30) and an antiviral treatment group, the latter of which was further subdivided into the lamivudine treatment group (n=66), telbivudine treatment group (n=38) and entecavir treatment group (n=46) according to voluntary choice by the patient.All study participants were followed-up for 24 months. The Kaplan-Meier method was applied for survival analysis.

RESULTSThe patients in the four antiviral treatment groups had statistically similar baseline clinical characteristics and 1-month survival rates (Breslow =4.475, P=0.215).However, the basic treatment group had a significantly lower survival rate than the antiviral treatment groups that received lamivudine, telbivudine, or entecavir (all P less than 0.05) at the treatment periods of 2, 3, 6, 12 and 18-months; however, these three treatment groups showed no significant differences in survival rates. At the time point of 24 months of treatment, the basic treatment group retained its lower rate of survival than the three antiviral treated groups (lamivudine:Breslow =5.604, P=0.018; telbivudine:Breslow =5.621, P=0.018; entecavir:Breslow =14.701, P less than 0.001); while the survival rates were similar for the lamivudine treatment group and the telbivudine treatment group at this time point, their survival rates were significantly lower than that of the entecavir treatment group (Breslow =4.010, P=0.045; Breslow =4.307, P=0.038).Stratification analysis showed that when the baseline was 30 less than PTA less than or equal to 40 or MELD less than or equal to 29 or HBV DNA more than or equal to 5 log10 IU/mL, the cumulative survival rates of the basic treatment group and antiviral treatment group were statistically similar even though the patients had completed 1 month of treatment After being treated for 2, 3, 6, 12, 18 and 24 months, the cumulative survival rates of the basic treatment group were consistently below those of the overall antiviral treatment group (P less than 0.05). The cumulative survival rate of the basic treatment group followed-up for 1 to 24 months, with PTA values between 20 and 30, was lower than that of the overall antiviral treatment group (P less than 0.05); two groups of patients with PTA less than or equal to 20 or MELD more than or equal to 30 were followed-up for 1 months to 24 months, and their cumulative survival rates showed no significant difference (P more than 0.05). Among the patients whose baseline was HBV DNA less than 5 log10 IU/mL, the comparison of survival rates between the basic treatment group and the overall antiviral treatment group showed no significant differences after treatment for 1, 2, 3, 6, 12 or 18 months, and the survival rate was lower than that of the overall antiviral treatment group (Breslow =4.055, P=0.044) after 24 months.

CONCLUSIONNucleoside analogues can improve the long-term survival rate of HBV-related ACLF patients.Entecavir is preferred for the long-term treatment of these patients.Patients in the early and middle stages of this disease and HBV DNA-positive patients should adopt antiviral treatment as early as possible.

Acute-On-Chronic Liver Failure ; Antiviral Agents ; Cohort Studies ; Guanine ; analogs & derivatives ; Hepatitis B virus ; Hepatitis B, Chronic ; Humans ; Lamivudine ; Prospective Studies ; Survival Analysis ; Survival Rate ; Thymidine ; analogs & derivatives ; Time Factors

Objective To investigate the application value of γ-glutamyltransferase(GGT),alkaline phosphatase(ALP)and peripheral blood neutrophil to lymphocyte ratio(NLR)in liver cancer.Methods 100 patients with liver cancer admitted to Wuming Hospital Affiliated to Guangxi Medical University from January 2012 to December 2020 were retrospectively selected to be included in liver cancer group,100 patients with cirrhosis to be included in cirrhosis group,100 patients with hepatitis to be included in hepatitis group,and 100 healthy physical examination subjects from our hospital during the same period were included in physical examination group.The GGT,ALP and NLR levels of the four groups were compared.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of each index for liver cancer.Results The levels of NLR,GGT and ALP in liver cancer group were significantly higher than those in cirrhosis group,hepatitis group and physical examination group(P<0.05).The NLR in cirrhosis group was significantly higher than that in physical examination group and hepatitis group(P<0.05).GGT and ALP in cirrhosis group and hepatitis group were significantly higher than those in physical examination group(P<0.05).Spearman correlation analysis showed that NLR was positively correlated with GGT and ALP,and GGT was positively correlated with ALP(P<0.05).When NLR,GGT and ALP were detected separately,area under the curve(AUC)of NLR was the largest(0.943,95％CI:0.901-0.971,P<0.001),and AUC of ALP was the smallest.The AUC of three combined detections was 0.987(95％CI:0.959-0.998),and the sensitivity was 99.0％.Conclusion The combined detection of NLR,GGT and ALP can significantly improve the detection rate of liver cancer,and the combined detection has better application value.

Objective To establish the murine models of local allergic rhinitis (LAR) and allergic rhinitis (AR) by using ovalbumin (OVA),and to investigate the relationship between them.Methods Thirty BALB/c mice were divided into 5 groups,(1) the nasally sensitized group (group A1) that was challenged with OVA by a 10 d procedure,(2) the control group of A1 that was challenged with phosphatebuffered saline (PBS),(3) the nasally sensitized group (group A2) that was challenged with OVA by a 25 d procedure,(4) the control group of A2 that was challenged with PBS,(5) the intraperitoneally sensitized group (group B).The numbers of sneezing after final challenge were counted,and the serum OVA-specific immunoglobulin E (OVA-slgE),interleukin (IL)-4,IL-13,IL-5 levels in nasal lavage fluid were measured by ELISA.Hematoxylin-eosin staining was performed to evaluate the histological change of nose and lung tissues.Graph Pad Prism 6 software was used to analyze the data.Results Nasally sensitized group A1 displayed LAR symptoms of sneezing and eosinophilic infiltrating,but without increased OVA-sIgE in serum on day 10 compared with the control group of A1(t =0.697,P ＞ 0.05),OVA-sIgE in serum of group A2(2.710 ± 1.406)ng/ml reached to statistical significance and with airway remodeling on day 25 compared with the control group of A2 ((0.221 ± 0.080) ng/ml,t =4.329,P ＜ 0.05).IL-5 and IL-13 in nasal fluid showed a significant increase in the nasally sensitized group A1,compared with the group A2 (t values were 2.442,2.804,P values were less then 0.05).Conclusions A short time intranasal instillation with OVA could establish LAR murine model,continuing OVA challenge could increase serum sIgE level and with airway remodeling.LAR mice show a unique characteristic by expressing higher IL-5 and IL-13 in nose than AR mice,but sIgE in serum remains at a normal level.