ObjectiveTo investigate the clinical features and outcomes of recompensation in patients with autoimmune hepatitis （AIH）-related decompensated cirrhosis， to identify independent predictive factors， and to construct a nomogram prediction model for the probability of recompensation. MethodsA retrospective cohort study was conducted among the adult patients with AIH-related decompensated cirrhosis who were admitted to The Fifth Medical Center of PLA General Hospital from January 2015 to August 2023 （n=211）. The primary endpoint was achievement of recompensation， and the secondary endpoint was liver-related death or liver transplantation. According to the outcome of the patients at the end of the follow-up， the patients were divided into the recompensation group （n=16） and the persistent decompensation group（n=150）.The independent-samples t test was used for comparison of normally distributed continuous data with homogeneity of variance， and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data with heterogeneity of variance； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups； the Kaplan-Meier method was used for survival analysis； the Cox proportional-hazards regression model was used to identify independent predictive factors， and a nomogram model was constructed and validated. ResultsA total of 211 patients were enrolled， with a median age of 55.0 years and a median follow-up time of 44.0 months， and female patients accounted for 87.2%. Among the 211 patients， 61 （with a cumulative proportion of 35.5%） achieved recompensation. Compared with the persistent decompensation group， the recompensation group had significantly higher white blood cell count， platelet count （PLT）， total bilirubin （TBil）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， total bile acid， prothrombin time， international normalized ratio （INR）， SMA positive rate， Model for End-Stage Liver Disease （MELD） score， Child-Pugh score， and rate of use of glucocorticoids （all P0.05）， as well as significantly lower age at baseline， number of complications， and death/liver transplantation rate （all P0.05）. At 3 and 12 months after treatment， the recompensation group had continuous improvements in AST， TBil， INR， IgG， MELD score， and Child-Pugh score， which were significantly lower than the values in the persistent decompensation group （all P0.05）， alongside with continuous increases in PLT and albumin， which were significantly higher than the values in the persistent decompensation group （P0.05）. The multivariate Cox regression analysis showed that baseline ALT （hazard ratio ［HR］=1.067， 95% confidence interval ［CI］： 1.010 — 1.127， P=0.021）， IgG （HR=0.463，95%CI：0.258 — 0.833， P=0.010）， SMA positivity （HR=3.122，95%CI：1.768 — 5.515， P0.001）， and glucocorticoid therapy （HR=20.651，95%CI：8.744 — 48.770， P0.001） were independent predictive factors for recompensation， and the nomogram model based on these predictive factors showed excellent predictive performance （C-index=0.87，95%CI：0.84 — 0.90）. ConclusionAchieving recompensation significantly improves clinical outcomes in patients with AIH-related decompensated cirrhosis. Baseline SMA positivity， a high level of ALT， a low level of IgG， and corticosteroid therapy are independent predictive factors for recompensation. The predictive model constructed based on these factors can provide a basis for decision-making in individualized clinical management.

Objective To investigate the influencing factors for the prognosis of adult patients with chronic drug-induced liver injury (DILI). Methods A total of 255 patients who were diagnosed with chronic DILI by liver biopsy in The Fifth Medical Center of Chinese PLA General Hospital from January 2014 to December 2018 were enrolled, and according to the liver function after 2 years, they were divided into non-recovery group and recovery group. The two groups were analyzed in terms of the clinical data including age, sex, body mass index, types of drugs used, type of DILI injury, severity of DILI injury, underlying diseases, laboratory markers, liver histology, and 2-year prognosis. 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; the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate logistic regression analyses were used to investigate the independent risk factors for the prognosis of chronic DILI. Results After 2 years of follow-up, 195 patients (76.5%) achieved the recovery of liver function, while 60 patients (23.5%) did not achieve such recovery. There were significant differences between the two groups in the type of DILI injury ( P =0.028), the proportion of patients with diabetes ( P =0.048), and the degree of liver fibrosis ( P < 0.001), and compared with the recovery group, the non-recovery group had significantly higher levels of baseline white blood cell count, platelet count (PLT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase, and total bile acid and a significantly lower level of cholinesterase (ChE) (all P < 0.05). The baseline characteristics were included in the univariate logistic regression analysis, and the results showed that PLT, ALT, AST, ChE, and fibrosis degree were significantly associated with the prognosis of chronic DILI (all P < 0.05). The multivariate logistic regression analysis of the above variables showed that PLT < 100×10 9 /L (odds ratio [ OR ]=3.592, 95% confidence interval [ CI ]: 1.128-11.438, P =0.003) and ALT > 2×upper limit of normal (ULN) ( OR =3.080, 95% CI : 1.331-7.127, P =0.009) were independent risk factors for the prognosis of chronic DILI. Conclusion When patients meet the diagnostic criteria for chronic DILI, the independent risk factors PLT < 100×10 9 /L and ALT > 2×ULN may be used to screen out the patients who are more likely to have poor prognosis.

Autoimmune hepatitis (AIH) is an immune-mediated inflammatory injury of hepatocytes, which can develop into liver cirrhosis and end-stage liver disease. Timely immunosuppressive therapy can help patients achieve biochemical remission and even histological remission and thus improve prognosis. However, adverse drug reactions during treatment and recurrence after withdrawal are commonly seen, and therefore, standard therapy, dose reduction at the right time, and timely drug withdrawal are important for improving patients’ prognosis. This article summarizes the advances in guidelines for the diagnosis and treatment of AIH and related studies in China and globally, so as to provide a reference for clinicians in the treatment of AIH.

Primary biliary cholangitis (PBC) is an autoimmune liver disease, mainly characterized by chronic progressive cholestasis. The root cause of PBC is the loss of immune tolerance to autoantigen E2 subunit of pyruvate dehydrogenase (PDC-E2). The unique immunobiological characteristics of intrahepatic bile duct epithelial cells make it an active participant in the pathogenesis of PBC. In recent years, the detection rate of PBC has been increasing year by year, but the clinical situation of ursodeoxycholic acid monotherapy has not changed. Therefore, an in-depth understanding of the immune pathogenesis of PBC will help clinicians better prevent and treat diseases.

Although drug-induced liver injury (DILI) is often an acute process, about 20% of the patients may progress to chronic DILI. Chronic DILI has a long course of disease and there is still no effective treatment. With the development and clinical application of new drugs and the wide application of herbal and dietary supplements, the incidence rate of DILI chronicity gradually increases. This article overviews the latest research advances in DILI chronicity from the aspects of the epidemiology, risk factors, clinical manifestations, diagnosis, and treatment of DILI, so as to gain a comprehensive understanding of chronic DILI.

As the prevalence rate of drug-induced liver injury increases year by year, the pathogenesis of drug-induced liver injury has become the focus of attention. As a large family, CYP450 enzymes participate in almost all oxidative metabolic reactions of drugs in the human liver. Recent studies have shown that CYP450 enzyme gene polymorphisms lead to the differences in pharmacodynamics between individuals, and therefore, exploring the role of CYP450 enzyme gene polymorphisms in drug-induced liver injury may promote the understanding of the pathogenesis of drug-induced liver injury. This article reviews the CYP450 enzyme polymorphisms that have been found to be associated with drug-induced liver injury.

Based on the significant differences in definition, clinical features, and prognosis between alcoholic hepatitis (AH) and severe AH, it is recommended to classify AH into mild and severe AH. As for the disease spectrum of hospitalized patients with alcoholic liver disease, most patients have liver cirrhosis, and about 15% have mild or severe AH. Alcoholic liver failure belongs to the category of severe AH. Severe AH is a clinical diagnosis, while alcoholic steatohepatitis is a pathological diagnosis. The clinical diagnostic criteria for severe AH tend to be consistent in European and the United States of America, but the Chinese guideline released in 2018 is not consistent with the guidelines from western countries.

Purpose To explore the biological significance of BCL-6 and ZEB2 in invasion,metastasis and prognosis of breast cancer.Methods The expressions of BCL-6,ZEB2 protein and mRNA were detected respectively in 228 cases of breast cancer and 80 cases of breast benign lesions by immunohistochemical SP two-step staining and situ hybridization.Result The expression levels of BCL-6,ZEB2 protein and mRNA in breast cancer tissues were significantly higher than in breast benign lesions (P ＜ 0.05).The expressions of BCL-6 was positively correlated with tumor size,lymphatic metastasis,histological grade,TNM staging and HER-2 expression (P ＜ 0.05).The expressions of ZEB2 was positively correlated with tumor size,lymphatic metastasis,TNM staging and HER-2 expression (P ＜ 0.05).The overall survival and relapse-free survival of BCL-6 and ZEB2 positive expression were significantly less than the negative expression (P ＜ 0.01).Conclusion The BCL-6 and ZEB2 are closely correlated with the evolution process of breast cancer,which may become important means for monitoring and warning the metastasis,invasion,and prognosis of breast cancer.