Objective To investigate the influencing factors for the length of hospital stay in patients with drug- induced liver injury( DILI),and to guide clinical practice,reduce the pressure of hospitalization,and reduce the patients' economic burden. Methods The clinical data of the patients with DILI who were hospitalized in Qingdao Municipal Hospital from January 2012 to December 2014 were collected,including age,sex,primary disease,medication history,routine blood test,liver function parameters,DILI type,medication,and prognosis.The Spearman rank correlation,Wilcoxon rank sum test,and Kruskal- Wallis H rank sum test were used to analyze the influencing factors for the length of hospital stay. A multivariate linear regression analysis was performed for the factors with statistical significance determined by the univariate analysis. Results The clinical data of 191 patients with DILI were collected. Among these patients,there were 114 male and 77 female patients aged 11- 84 years( mean 50. 83 ± 2. 72 years),and the mean hospital stay was 14 days( range 4- 41 days). Patient's age,the highest levels of alanine aminotransferase( ALT) / alkaline phosphatase( ALP) / total bilirubin( TBil),and the lowest level of prothrombin activity( PTA) were positively correlated with the length of hospital stay( rs= 0. 388,0. 247,0. 172,0. 487,and 0. 120,all P < 0. 05). The presence or absence of the histories of underlying liver disease,hypertension,malignant tumors,tuberculosis,and hyperthyroidism,use of different suspected drugs,therapies for DILI,and DILI types were the influencing factors for the length of hospital stay in patients with DILI( all P < 0. 05). The multivariate linear regression analysis showed that age,the histories of underlying liver disease and malignant tumors,traditional Chinese medicine,antipyretic and analgesic drugs,the highest levels of ALT / ALP / TBil,the lowest level of PTA,therapies for DILI,and DILI types were independent risk factors for the length of hospital stay in patients with DILI( all P < 0. 05).Conclusion Age,the histories of underlying liver disease and malignant tumors,traditional Chinese medicine,antipyretic and analgesic drugs,the highest levels of ALT / ALP / TBil,the lowest level of PTA,therapies for DILI,and DILI types are influencing factors for the length of hospital stay in patients with DILI. Regulation of the influencing factors for the length of hospital stay during clinical diagnosis and treatment can reduce hospital costs and plays an important role in reducing healthcare burden.

Objective To investigate the risk factors for hypersensitivity- associated liver injury induced by the combined antiretroviral therapy( c- ART) including nevirapine( NVP) in patients with acquired immunodeficiency syndrome. Methods The clinical data and blood samples of 132 patients who received the combined therapy including NVP in Zhongnan Hospital of Wuhan University from June 2008 to October 2015 were collected,and PCR- SSP was used to determine the genotypes of human leukocyte antigen( HLA) DRB1 and HLA-Cw. The patients who experienced hypersensitivity- associated liver injury induced by NVP within 6 weeks of c- ART were enrolled in the liver injury group( 41 patients),and those who did not experience liver injury were enrolled in the control group( 91 patients). The risk factors for liver injury induced by NVP hypersensitivity were analyzed. The t- test was used for comparison of continuous data between groups; the chi- square test was used for comparison of categorical data between groups. The univariate logistic regression method was used to analyze the risk factors for liver injury associated with NVP hypersensitivity,and the variables with P < 0. 10 were included in the multivariate logistic regression model to perform stepwise regression analysis. The Spearman correlation coefficient was used to analyze the correlation between the number of CD4 cells and alanine aminotransferase( ALT) level in patients experiencing hypersensitivity- associated liver injury. Results The results of the multivariate logistic regression analysis showed that male sex( OR = 12. 297,95% CI: 2. 467- 61. 300,P = 0. 002),a high CD4 cell count at baseline( OR = 1. 010,95% CI: 1. 001- 1. 018,P = 0. 022),HCV co- infection( OR = 10. 598,95%CI: 1. 411- 79. 613,P = 0. 022),and a HLA- Cw*03 carrier( OR = 34. 119,95% CI: 5. 543- 210. 023,P < 0. 001) were risk factors for liver injury associated with NVP hypersensitivity. In the patients with HCV co- infection or a high CD4 cell count( ≥200 / μl) or carrying HLA- Cw*03 allele,male patients had a significantly higher incidence rate of liver injury than female patients( 63. 9% vs 11. 6%,χ2= 23. 390,P < 0. 001). Baseline CD4 cell count was positively correlated with ALT level( r = 0. 583,P < 0. 001). Conclusion Male patients infected with human immunodeficiency virus who are co- infected with HCV and have a high CD4 cell count at baseline should avoid using NVP.The value of HLA- Cw*03 gene screening in predicting hepatotoxicity associated with NVP hypersensitivity awaits further investigation.

Objective To investigate the clinical features and risk factors for patients with liver failure complicated by invasive pulmonary aspergillosis( IPA),and to provide a reference for clinical diagnosis and treatment. Methods The clinical data of 477 patients with liver failure who were diagnosed and treated in Henan Provincial People's Hospital from January 2010 to December 2014 were collected,and the clinical features,laboratory markers,and results of imaging examinations of patients with IPA were retrospectively analyzed. Another 49 patients with liver failure who were hospitalized within the same period,had similar ages,and were not complicated by pulmonary infection were randomly selected as controls. The independent samples t- test was used for comparison of continuous data between groups,the chi-square test or Fisher's exact test were used for comparison of categorical data between groups,and multivariate logistic regression analysis was performed to analyze the risk factors for liver failure complicated by IPA. Results Among the 447 patients with liver failure,43( 9. 6%) were complicated by IPA. Age( P = 0. 023),hepatic encephalopathy( P = 0. 021),long- term use of broad- spectrum antibiotics( P = 0.007),use of hormone( P = 0. 016),and deep venous catheterization( P < 0. 001) were independent risk factors for the development of IPA. Clinical manifestations of liver failure patients with IPA lacked specificity. Lung CT scan showed multiple nodules,masses,and wedge- shaped consolidation near the pleura in both lungs,but typical halo sign and air crescent sign were rarely seen. Among the 35 patients who received antifungal therapy,30 were improved or cured,3 died of digestive tract bleeding,2 clied of plumonary infection,and all the other patients who did not receive therapy also died. Conclusion Patients with liver failure have various risk factors for the development of IPA,and the clinical manifestations are not typical,with high incidence and fatality rates. Early detection and treatment is the key to improving survival rates.

Objective To analyze the clinical data of patients admitted with an initial diagnosis of digestive diseases who have human immunodeficiency virus( HIV) / acquired immune deficiency syndrome( AIDS),and to guide clinical diagnosis. Methods The clinical data of HIV / AIDS patients who were hospitalized due to digestive system symptoms from January 1,2013 to December 31,2014 were collected,including epidemiological data,clinical symptoms and signs,auxiliary examinations,and complications. The features of each parameter were observed. 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 A total of 95 HIV / AIDS patients with digestive diseases were enrolled,and the male / female ratio was1. 4∶ 1. Among these patients,57( 60%) were aged 30- 50 years,85( 89. 47%) were Yi people,and 86( 90. 53%) were farmers. Of all patients,46( 48. 42%) were infected via sexual transmission and 44( 46. 32%) were infected via intravenous drug use. In these patients,common clinical symptoms included abdominal pain( 71. 58%),pyrexia( 43. 16%),and diarrhea( 17. 89%),and common signs included ascites( 28. 42%),superficial lymphadenectasis( 21. 05%),and hepatosplenomegaly( 16. 84%). The auxiliary examination showed a significant increase in globulin. The proportion of patients with opportunistic infection reached 83. 16%,mainly lung and digestive tract infections. Among the patients who underwent gastroscopy,31. 58% had mycotic esophagitis. Chronic non- atrophic gastritis,electrolyte disturbance,and intestinal obstruction were commonly seen in patients with noninfectious complications. Of all HIV / AIDS patients,54. 74%( 52 /95) were complicated by HBV and / or HCV infection,and the liver function parameters globulin,total bilirubin,aspartate aminotransferase,alanine aminotransferase,and A / G showed significant differences between these patients and the patients with HIV infection alone( all P < 0. 01). Conclusion HIV infection should be highly suspected in patients who visit the department of gastroenterology due to abdominal pain and diarrhea,have clinical manifestations of ascites,superficial lymphadenectasis,and hepatosplenomegaly,and are complicated by opportunistic infection in the lungs and digestive tract,especially those with histories of drug use and unprotected sex. Meanwhile,HBV and / or HCV infection may aggravate patients' condition and should be taken seriously.

Objective To investigate the effect of extracellular signal- regulated kinase 1/2( ERK1/2) pathway inhibitor PD98059 on the proliferation and killing function of γδT cells cultured in vitro. Methods Mononuclear cells were separated from peripheral blood in healthy subjects and placed in RPMI 1640 complete medium containing zoledronic acid and interleukin- 2 to obtain γδT cells through induction and culture. The ERK1/2 specific inhibitor PD98059 was used to block the ERK1/2 signaling pathway in γδT cells,and the proliferation of γδT cells was measured by cell counting,and the killing function of γδT cells was measured by CCK- 8 method. Flow cytometry was used to measure the expression of granzyme B and perforin in γδT cells. The t- test was used for comparison of continuous data between groups. Results After 10 days of culture,the purity of γδT cells reached 87. 94% ± 2. 36%. The number of γδT cells treated with PD98059 was significantly lower than that of control cells [( 6. 74 ± 0. 36) × 105/ ml vs( 9. 42 ± 0. 31) × 105/ ml,t =- 12. 708,P < 0. 001]. Compared with the control cells,those treated with PD98059 had significantly higher positive expression rates of granzyme B and perforin( granzyme B:48. 89% ± 1. 31% vs 41. 58% ± 1. 58%,t = 7. 582,P < 0. 001; perforin: 65. 92% ± 3. 29% vs 33. 49% ± 2. 83%,t = 15. 478,P < 0. 001) and a significantly higher killing rate of Hep G2 cells( 69. 28% ± 4. 96% vs 48. 34% ± 3. 01%,t = 11. 201,P < 0. 001). Conclusion The ERK1/2specific inhibitor PD98059 can inhibit the proliferation of γδT cells,but it can enhance the in vitro killing function of γδT cells.