Objective To investigate the prognostic factors for patients with hepatitis B virus-related acute-on-chronic liver failure, and to provide a basis for clinical diagnosis and treatment.Methods A total of 172 patients with hepatitis B virus (HBV) -related acute-on-chronic liver failure who were admitted to The First Hospital of Jilin University from January 1, 2006 to January 1, 2016 and had complete medical records and follow-up data were enrolled, and a retrospective analysis was performed for their clinical data and laboratory markers to determine prognostic factors.The independent-samples t test was used for comparison of continuous data between groups, the chi-square test was used for comparison of categorical data between groups, and a multivariate logistic regression analysis was performed for the indices determined to be statistically significant by the univariate analysis to screen out independent risk factors for the prognosis of patients with HBV-related acute-on-chronic liver failure.Results The multivariate logistic regression analysis was performed for the indices determined to be statistically significant by the univariate analysis, and the results showed that the prognostic factors were total bilirubin (TBil) , prothrombin time activity (PTA) , Na+, total cholesterol (TC) , Child-Turcotte-Pugh (CTP) score, age ≥50 years, the presence of liver cirrhosis, bilirubin-enzyme separation, and complications.The multivariate regression analysis was performed for the complications determined to affect prognosis by the univariate analysis, and the results showed that the complications as risk factors were hepatic encephalopathy, hepatorenal syndrome, and infection.Conclusion TBil, PTA, Na+, TC, CTP score, age ≥50 years, the presence of liver cirrhosis, bilirubin-enzyme separation, and complications are independent risk factors for the prognosis of patients with HBV-related acute-on-chronic liver failure.Liver failure patients with hepatic encephalopathy, hepatorenal syndrome, and infection tend to have poorer prognosis.Therefore, early judgment of the prognosis of patients with liver failure is of great importance in the prevention and treatment of related complications.

Objective To investigate the clinical features of elderly patients with drug-induced liver injury (DILI) .Methods A retrospective analysis was performed for the clinical data of elderly and young and middle-aged patients with DILI who were hospitalized in Dalian Municipal Central Hospital and The First Affiliated Hospital of Dalian Medical University from January 2010 to December 2015, including sex, age, underlying diseases, drugs causing liver injury, main clinical manifestations, liver function parameters [serum levels of alanine aminotransferase (ALT) , aspartate aminotransferase, alkaline phosphatase (ALP) , gamma-glutamyl transpeptidase (GGT) , albumin, total bilirubin (TBil) , and direct bilirubin (DBil) ], clinical type, treatment, and prognosis.The chi-square test was used for comparison of categorical data between groups, and the Kolmogorov-Smirnov Z test was used for comparison of continuous data between groups.Results Among the 350 patients with DILI, there were 98 elderly patients (elderly group) .The three most common underlying diseases in the elderly group were cerebrovascular and cardiovascular diseases (31.6%) , osteoarthropathy (26.5%) , and malignant tumor (18.4%) , and the elderly group had significantly higher proportions of patients with these diseases than the young and middle-aged group (31.6%/26.5%/18.4% vs 5.6%/6.3%/4.8%, χ2=42.825, 27.214, and 16.667, all P<0.001) .Among the drugs causing liver injury, traditional Chinese medicine was applied most frequently in the elderly group and the young and middle-aged group (53.1% and44.4%, respectively) , and the elderly group had significantly higher proportions of patients using cardiovascular drugs or antitumor drugs than the young and middle-aged group (26.5%/9.2% vs 4.0%/3.2%, χ2=38.925 and 5.513, P<0.001 and P=0.026) .The elderly group had significantly higher proportions of patients with jaundice (53.1%) or pruritus (22.4%) than the young and middle-aged group (40.5%, 7.1%) (χ2=4.536 and 16.331, P=0.041 and P<0.001) .The most common clinical type in both groups was hepatocellular injury type;compared with the young and middle-aged group, the elderly group had a significantly lower proportion of hepatocellular injury type cases (60.2% vs 81.7%, χ2=17.807, P<0.001) and a significantly higher proportion of cholestasis type cases (28.6% vs 7.9%, χ2=25.389, P<0.001) .Compared with the young and middle-aged group, the elderly group had significantly lower levels of ALT and ALP and significantly higher levels of GGT, TBil, and DBil (Z=-3.141, -2.599, -7.449, -10.277, and-9.278, all P<0.01) .Three patients in the elderly group and one in the young and middle-aged group died during hospitalization.Conclusion Underlying diseases and drugs causing liver injury in elderly patients with DILI are different from those in young and middle-aged patients, and the elderly patients have a higher proportion of cholestasis type cases compared with the young and middle-aged patients.Therefore, prevention and treatment of DILI in elderly patients should be taken seriously.

Objective To investigate the effect of dexmedetomidine on liver function, plasma cytokine levels, and oxidative stress due to ischemia/reperfusion injury in patients undergoing hepatolobectomy.Methods A total of 106 patients who underwent hepatolobectomy in General Hospital of Jizhong Energy Fengfeng Group Co., Ltd.from January 2014 to January 2016 were enrolled and randomly divided into control group and observation group, with 53 patients in each group.The patients in the observation group were given 1 μg/kg/h dexmedetomidine within 10 minutes, followed by continuous intravenous infusion of 0.5 μg/kg/h dexmedetomidine, and those in the control group were given an equal volume of 0.9% sodium chloride.The two groups were compared in terms of liver function parameters, plasma cytokine levels, and oxidative stress due to ischemia/reperfusion injury after anesthesia (T1) , before abdominal closure (T2) , and at 1, 4, and 8hours after surgery (T3, T4, and T5, respectively) .The chi-square test was used for comparison of categorical data between groups;the t-test was used for comparison of indices between groups, the sphericity test was used for comparison of indices at different time points, and an analysis of variance was performed for repeated measurement data with P<0.05.Results The two groups had significantly higher alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels at T2, T3, T4, and T5 than at T1 (ALT:F=43.72 and 44.16, both P<0.001;AST:F=53.87 and 65.44, both P<0.001) , and the observation group had significantly lower levels than the control group at T2, T3, T4, and T5 (ALT:t=20.54, 22.01, 36.68, and 38.15, all P<0.001;AST:t=32.27, 41.08, 52.82, and 71.89, all P<0.001) .The two groups had significantly higher levels of tumor necrosis factor α (TNFα) and interleukin-8 (IL-8) at T3, T4, and T5 than at T1 (TNFα:F=54.37 and 24.75, both P<0.001;IL-8:F=47.24 and 27.39, both P<0.001) , and the observation group had significantly lower levels than the control group at T3, T4, and T5 (TNFα:t=59.39, 86.32, and 83.16, all P<0.001;IL-8:t=74.47, 72.29, and 76.67, all P<0.001) .The two groups had a significantly higher level of malondialdehyde at T3, T4, and T5 than at T1 (F=37.65 and 17.44, both P<0.001) , and the observation group had a significantly lower level than the control group at T3, T4, and T5 (t=17.35, 19.11, and 24.12, all P<0.001) .The two groups had a significantly lower level of superoxide dismutase at T3, T4, and T5 than at T1 (F=36.54 and 33.65, both P<0.001) , and the observation group had a significantly higher level than the control group at T3, T4, and T5 (t=68.64, 66.35, and 59.48, all P<0.001) .Conclusion Dexmedetomidine can effectively inhibit liver injury, reduce the levels of cytokines, and alleviate ischemia/reperfusion injury in patients undergoing hepatectomy.

Objective To investigate the immunohistochemical expression of glucose transporter 2 (GLUT2) in patients with hepatogenous diabetes and its significance.Methods A total of 40 liver tissue samples were collected from patients who were treated in Department of Severe Liver Disease and Department of Hepatobiliary Surgery in Beijing You An Hospital, Capital Medical University, from June 2012 to July 2014.Immunohistochemistry was used to measure the expression of GLUT2 in liver tissue in all four groups (normal group, chronic hepatitis B group, liver cirrhosis group, and hepatogenous diabetes group) .A one-way analysis of variance was used for the comparison of continuous data between groups, and the least significant difference t-test was used for further comparison between any two groups;the Fisher's exact test was used for the comparison of categorical data between groups.Results There were significant differences in fasting blood glucose, glycosylated hemoglobin, glycosylated serum albumin, body mass index, and proportion of liver tissue with steatosis between the hepatogenous diabetes group and the other three groups (all P<0.05) .Immunohistochemistry showed that GLUT2 was mainly expressed in the liver cell membrane, especially the cell membrane near the sinus cavity.In the patients with normal liver tissue, chronic hepatitis B, or liver cirrhosis, the expression of GLUT2 in liver tissue tended to gradually decrease from the central vein to the portal area, and one patient with liver cirrhosis had enhanced expression of GLUT2 in the regenerative nodules of hepatocytes.In the 10 patients with hepatogenous diabetes, 6 had significant steatosis of the liver tissue and strongly positive and relatively even expression of GLUT2 at the site of steatosis, as well as the cytoplasm around steatotic hepatocytes, with no significant difference from the expression of GLUT2 in the sinus cavity.Conclusion Patients with hepatogenous diabetes tend to have steatosis in the liver tissue and a significant increase in the expression of GLUT2, which may be the pathogenesis of abnormal glucose metabolism.