Objective To evaluate the efficacy and safety of long-term nucleos (t) ide analogue treatment in patients with chronic hepatitis B (CHB).Methods Two hundred and two initially treated patients with CHB admitted in Zhejiang Provincial People's Hospital during March 2013 and August 2016 were enrolled in the study.Patients were divided into six groups according to the different antiviral therapy:adefovir group (ADV,n =43),entecavir group (ETV,n =44),lamivudine group (LAM,n =25),telbivudine group (LDT,n =23),LDT + ADV group (n =22),and LAM + ADV group (n =45).HBV DNA negative conversion rate,HBeAg serological conversion rate and estimated glomerular filtration rate (eGFR) at baseline and at 48th,96th,144th wk of treatment were measured.Chi-square test and repeated measure of ANOVA were used to analyze the data.Multivariate Logistic regression analysis was applied to detect the relevant risk factors of renal dysfunction in CHB patients.Results After treatment for 144 wks,the HBV DNA negative conversion rates in ETV and LDT group were higher than that in ADV group (both P ＜ 0.01),the levels of eGFR in ADV,ETV,LAM and LAM + ADV group were declined with time,while the eGFR levels in LDT and LDT + ADV group were increased with time (Ftime =3.939,Fgroup =3.983,P ＜0.01 or ＜0.05).After treatment for 96 wks and 144 wks,the levels of eGFR were higher in LDT and LDT + ADV group than those in other groups,respectively (all P ＜ 0.05).Multivariate Logistic regression analysis showed that age ≥40 (x2 =16.145,OR =4.452,95 ％ CI 2.149-9.223,P ＜ 0.05),mild abnormality of eGFR at baseline (x2 =16.449,OR =4.336,95％ CI 2.144-8.891,P ＜ 0.05),and ADV treatment (x2 =5.837,OR =5.280,95％ CI 1.369-20.365,P ＜ 0.05) were independent risk factors of renal dysfunction in CHB patients.Conclusion LDT long-term monotherapy or combination with ADV may improve renal function for patients with CHB,which provides a reference for long-term treatment of CHB patients with nucleos(t) ide analogues.

Objective To analyze the clinical and pathological features of chronic hepatitis B (CHB) patients with hepatic steatosis.Methods Clinical and pathological data of 841 patients with CHB who underwent liver biopsy in Zhejiang Provincial People’s Hospital during September 2015 to September 2018 were retrospectively reviewed.One hundred and thirty five gender and age-matched pairs of steatosis and non-steatosis patients entered the analysis.Multivariable Logistic regression and rank sum test were used to analyze the clinical features and risk factors of hepatic steatosis in CHB patients .Spearman correlation test was used to analyze the correlation between hepatic steatosis and HBV DNA , hepatic inflammation and fibrosis status.Results Logistic regression analysis showed that overweight ／obesity ( χ2 ＝3.947, OR ＝1.436, 95%CI 1.005-2.051, P＜0.05) and hyperlipidemia (χ2 ＝4.277,OR＝1.803,95%CI 1.031-3.151, P＜0.05) were the risk factors for hepatic steatosis in CHB patients.There was no correlation of hepatic steatosis with serum HBeAg and HBV DNA levels (Z＝-1.762,r＝-0.011, both P＞0.05). However, hepatic steatosis was negatively correlated with inflammatory grade and fibrosis grade of the liver (r＝-0.146 and -0.192, both P＜0.05).Conclusions Overweight／obesity and hyperlipidemia are associated with steatosis in CHB patients.Hepatic steatosis may not aggravate the degree of liver inflammation and fibrosis in CHB patients.

Objective To analyze the levels of serum thrombin-activatable fibrinolysis inhibitor ( TAFI) in patients with chronic hepatitis B ( CHB ) with different degrees of hepatic fibrosis , and to evaluate the value of TAFI in the evaluation of liver fibrosis .Methods Forty six patients with CHB who underwent liver biopsy from June 2016 to March 2017 in Zhejiang Provincial People' s Hospital were enrolled.According to liver fibrosis stage (S0-4), they were divided into mild liver fibrosis group (S0-1, n=16), significant liver fibrosis group (S2, n=15) and severe liver fibrosis group (S3-4, n=15).At the same time, 16 healthy subjects were randomly selected as health controls in the physical examination center of the hospital .Serum TAFI levels were analyzed in each group , and the receiver operating curve ( ROC) was used to evaluate the diagnostic value of TAFI in CHB patients with significant liver fibrosis and severe liver fibrosis (S≥2).The SPSS 23.0 software was used to analyze the data .Results Serum TAFI levels in the mild liver fibrosis group , significant liver fibrosis group , severe liver fibrosis group and health controls were (63.4 ±18.2), (43.8 ±20.4), (27.5 ±19.2) and (71.3 ±25.6) ng/mL, the difference between the four groups was statistically significant (F=13.512, P<0.01).The level of TAFI in the significant liver fibrosis group was lower than that in the healthy control group and the mild liver fibrosis group (t=3.283 and 2.822, P<0.01).The level of TAFI in the severe fibrosis group was lower than that in the significant liver fibrosis group (t=2.260, P<0.05).Serum TAFI levels were negatively correlated with liver fibrosis stage (r=-0.562, P<0.01).The area under the ROC curve of TAFI for predicting liver fibrosis (S≥2) was 0.832, and the sensitivity and specificity were 81.3％and 78.3％, respectively. Compared with the APRI score and the FIB4 index, the difference was not statistically significant ( P >0.05).Conclusion The serum TAFI level is negatively correlated with the degree of liver fibrosis in CHB patients, which has a good diagnostic value for liver fibrosis (S≥2) in patients with CHB.

As the environmental foundation for tumor survival，the tumor microenvironment is characterized by immunosuppression， ischemia and hypoxia， metabolic reprogramming， and inflammatory infiltration， providing conditions for tumor cell colonization， malignant transformation and migration. In traditional Chinese medicine （TCM）， yang qi is considered to be closely related to the onset of tumors. Based on the TCM theory of “where there is mass hardness， there must be latent yang”， this paper suggests that the state of “latent yang” formed by abnormal yang energy is highly similar to the tumor microenvironment. The loss of protection of latent yang leads to the weakening of positive immunity， invasion of disease and then accumulation of tumors. The constraint of latent yang leads to microcirculation disorders， blocked vessels and collaterals， and finally qi and blood blockage. The turbidity of latent yang leads to abnormal metabolic products gathering， pathogenic turbidity accumulation， and tumor formulation through contention and binding between them. The transformation of fire by latent yang mediates “inflammation-cancer” transformation， and leads to malignant transformation of cancerous tumors. The transformation of latent yang into toxin leads to premeditated pre-metastatic niches， healthy qi deficiency and toxin accumulation， and cancerous toxins flow. Based on the theory of “latent yang” and modern researches， this paper summarized the method of “warming yang and invigorating qi to consolidate the root， promoting yang and moving qi to eliminate stasis， strengthening yang capacity of transforming qi to remove the disadvantages， diffusing yang and opening up constraint to disperse fire， and reinforcing healthy qi and clearing the source to prevent toxins” in the intervention of the tumor microenvironment， so as to provide ideas for TCM to reshape the tumor microenvironment and regulate the tumor process.