Background: Cryoablation of hepatocellular carcinoma (HCC) close to major organs or viscus is challenging because it can cause complications. This retrospective study aimed to investigate the safety and efficacy of percutaneous argon-helium cryoablation of small HCC located adjacent to major organs or viscus. Material/Methods: Ninety-two patients who underwent percutaneous argon-helium cryoablation between February 2012 and December 2018 at the Fifth Medical Center of the Chinese People's Liberation Army General Hospital were included. Treatment efficacy was evaluated by magnetic resonance imaging or triphasic computed tomography scan within 1 week after each cryoablation procedure. Local tumor progression, distant recurrence, and overall survival were analyzed using the Kaplan-Meier method and log-rank test. Results: A total of 92 patients with small HCC located adjacent to major organs or viscus who underwent cryoablation were retrospectively reviewed. The number of patients with tumors adjacent to the gallbladder, portal or hepatic vein, diaphragm, stomach, heart, and intestine was 22, 1, 39, 6, 8, and 16, respectively. Cumulative local tumor progression rates at 1 and 2 years were 2.8% and 7.3%, respectively. Cumulative distant recurrence rates at 1, 2, and 3 years were 11.1%, 17.6%, and 20.7%, respectively. The overall survival rates at 1, 2, and 4 years were 100%, 93.6%, and 74.9%, respectively. Major complications were observed in 5 (5.4%) patients. Minor complications were observed in 85 (92.4%) patients. Conclusions: This experience from a single center showed that percutaneous argon-helium cryoablation was safe and effective in the management of small HCC that is located adjacent to major organs or viscus.

This study aimed to investigate the functional roles of kinesin family member 18B (KIF18B) in hepatocellular carcinoma (HCC) development, as well as the related molecular mechanisms. Tissue specimens were collected from 105 patients with HCC, and the messenger RNA (mRNA) and protein levels of KIF18B were detected using quantitative real-time polymerase chain reaction and immunohistochemistry assays, respectively. The chi(2) test was performed to estimate the association of KIF18B with clinical characteristics of patients with HCC. Effects of KIF18B expression on biological behaviors of HCC cells were detected by clone formation, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, and transwell assays. The expression patterns of proteins were investigated using Western blot analysis. HCC tissues and cell lines showed significant upregulation of KIF18B at both mRNA and protein levels (p > .05, for all). Furthermore, the elevated KIF18B expression was positively correlated with the tumor-node-metastasis stage (p = .015) and lymph node metastasis (p = .007). Knockdown of KIF18B might suppress HCC cell clone formation, proliferation, migration, and invasion in vitro. Besides, the activity of Wnt/beta-catenin pathway was also significantly inhibited after the KIF18B knockdown. However, the antitumor actions caused by KIF18B knockdown might be reversed by lithium chloride treatment, which was the inducer of Wnt/beta-catenin-signaling pathway. KIF18B may serve as an oncogene in HCC through enhancing the activity of Wnt/beta-catenin pathway.

Molecular targeted agents, such as sorafenib, remain the only choice of an antitumor drug for the treatment of advanced hepatocellular carcinoma (HCC). The Notch signaling pathway plays central roles in regulating the cellular injury/stress response, anti-apoptosis, or epithelial–mesenchymal transition process in HCC cells, and is a promising target for enhancing the sensitivity of HCC cells to antitumor agents. The ADAM metalloprotease domain-17 (ADAM-17) mediates the cleavage and activation of Notch protein. In the present study, microRNA-3163 (miR-3163), which binds to the 3′-untranslated region of ADAM-17, was screened using online methods. miRDB and pre-miR-3163 sequences were prepared into lentivirus particles to infect HCC cells. miR-3163 targeted ADAM-17 and inhibited the activation of the Notch signaling pathway. Infection of HCC cells with miR-3163 enhanced their sensitivity to molecular targeted agents, such as sorafenib. Therefore, miR-3163 may contribute to the development of more effective strategies for the treatment of advanced HCC.

Apocynum venetum L., belonging to the family Apocynaceae, is a popular medicinal plant, which is commonly used in the treatment of hypertension, neurasthenia, and hepatitis in China. In the present study, the total flavonoids (TFs) were prepared from the leaves of A. venetum, and its protective effects on carbon tetrachloride (CCl4)-induced hepatotoxicity in a cultured HepG2 cell line and in mice were investigated. Cell exposed to 0.4% CCl4 (v/v) for 6 h led to a significant decrease in cell viability, increased LDH leakage, and intracellular reactive oxygen species (ROS). CCl4 also induced cell marked apoptosis, which was accompanied by the loss of mitochondrial membrane potential (MMP). Pretreatment with TFs at concentrations of 25, 50, and 100 μg/mL effectively relieved CCl4-induced cellular damage in a dose-dependent manner. In vivo, TFs (100, 200, and 400 mg/kg BW) were administered via gavage daily for 14 days before CCl4 treatment. The high serum ALT and AST levels induced by CCl4 were dose-dependently suppressed by pretreatment of TFs (200 and 400 mg/kg BW). Histological analysis also supported the results obtained from serum assays. Furthermore, TFs could prevent CCl4-caused oxidative damage by decreasing the MDA formation and increasing antioxidant enzymes (CAT, SOD, GSH-Px) activities in liver tissues. In summary, both in vitro and in vivo data suggest that TFs, prepared from A. venetum, showed a remarkable hepatoprotective and antioxidant activity against CCl4-induced liver damage.

目的:观察肝癌合并门静脉癌栓分级对索拉非尼治疗效果的影响.方法:收集2014年7月 2016年2月本院收治的晚期肝癌合并门静脉癌栓216例患者的临床资料,均接受肝动脉栓塞治疗,其中联合索拉非尼治疗42例;密切随访患者预后,用生存期分析探索门静脉癌栓分级对索拉非尼治疗效果的影响.结果:索拉非尼联合肝动脉栓塞治疗42例的生存期为(9.83±4.63)个月,中位生存期为9个月;其中门静脉癌栓Ⅰ或Ⅱ级27例的生存期为(11.44±4.47)个月、中位生存期为11个月,门静脉癌栓Ⅲ或Ⅳ级15例的生存期为(6.93±3.41)个月、中位生存期为6个月.单纯肝动脉栓塞治疗174例的生存期为(7.60±3.49)个月,中位生存期为8个月;其中门静脉癌栓Ⅰ或Ⅱ级119例的生存期为(8.72±3.38)个月、中位生存期为8个月,门静脉癌栓Ⅲ或Ⅳ级55例的生存期为(5.16±2.25)个月、中位生存期为5个月.索拉非尼联合肝动脉栓塞治疗肝癌合并门静脉癌栓Ⅰ或Ⅱ级患者的生存期,非常显著高于单纯肝动脉栓塞治疗的同级患者(P＜0.01).结论:门静脉癌栓分级与索拉非尼治疗效果显著相关,门静脉癌栓Ⅰ或Ⅱ级患者采用索拉非尼治疗获益明显.

Objective To investigate the risk factors for vascular invasion of primary liver cancer (PLC).Methods A retrospective analysis was performed for the clinical data of 211 patients with liver cancer who were hospitalized in 302 Hospital of PLA from January 2013 to June 2014.The logistic regression model fitting was used for the data of 133 patients,and the data of the other 78 patients was used for the verification of this model.Univariate and multivariate logistic regression analyses were used to identify the influencing factors for vascular invasion of PLC;the logistic regression model was established and the receiver operating characteristic (ROC) curve was plotted to determine the optimal cut-off value of this model.Results The univariate logistic regression analysis showed that tumor diameter (odds ratio [OR]=1.594,95％ confidence interval [CI]:1.376-1.846,P =0),neutrophil-lymphocyte ratio (NLR) (OR =2.783,95％ CI:1.847-4.195,P=0),platelet-to-lymphocyte ratio (PLR) (OR=1.016,95％ CI:1.008-1.024,P=0),fibrinogen (Fb) (OR=2.295,95 ％ CI:1.608-3.274,P =0),and lymph node metastasis (OR =11.664,95 ％ CI:3.744-36.338,P =0) were risk factors for vascular invasion of PLC;the multivariate logistic regression analysis showed that tumor diameter (OR =1.506,95％ CI:1.250-1.815,P =0),PLR (OR=1.499,95％ CI:0.173-0.998,P=0.022),NLR (OR =2.491,95％ CI:1.411-4.397,P=0.002),and Fb(OR =1.486,95％ CI:1.008-2.193,P =0.046) were used for regression model fitting.The area under the ROC curve was 0.927 (95％ CI:0.881-0.973),and the ROC curve showed that the model had the highest sensitivity of 92.9％,the highest specificity of 86.5％,and a prediction accuracy rate of 82.79％.Conclusion The regression equation containing tumor diameter,PLR,NLR,and Fb established in this study has a high prediction accuracy of vascular invasion of PLC and provides a reference for early warning of vascular invasion of PLC.

To identify the potential application of anlotinib on human intrahepatic cholangiocarcinoma(ICC)cell line HC-CC-9810.Methods:After treatment of HCCC-9810 cells with serial concentrations of anlotinib, sorafenib and sunitinib as controls,MTT experiments were performed.Inhibition rate and IC50were analyzed by MTT-assays.The invasion or migration of HCCC-9810 cells was i-dentified by tranwell assays.Results:The IC50value of anlotinib,sorafenib and sunitinib on HCCC-9810 cells was(0.97 ±0.14),(8.27 ±1.17),and(8.18 ±0.82)μmol· L-1,respectively.At the same concentration(1μmol· L-1),anlotinib could significantly inhibit the metastasis and invasion of HCCC-9810 cells.The inhibitory effects of sorafenib and sunitinib were not obvious.Conclusion:Anlotinib can kill intrahepatic bile duct epithelial tumor cells,and may be a hopeful strategy for intrahepatic cholangiocarcinoma treatment.

Recent studies suggest that several bacterial species are involved in tumor immunosurveillance and antitumor immunity. The role of bacteria in immune responses in HBV-related hepatocellular carcinoma (HCC) patients is still unknown. In this study, we examined the bacteria-reactive CD8+ T cell response in patients with HBV-related HCC. We found that circulating CD8+ T cells from healthy individuals demonstrated minimal or zero specificity toward a series of commensals and bacteria previously associated with antitumor effects, including Escherichia coli, Enterococcus faecium, Bifidobacterium longum, Bacteroides fragilis, and Enterococcus hirae. In contrast, the circulating CD8+ T cells from HBV-related HCC patients presented significantly elevated bacteria-reactive responses, albeit with high variations among different HCC individuals. Reactivity toward bacteria was also identified in tumor-infiltrating CD8+ T cells. These bacteria-reactive responses were not primarily induced by TLR ligand, but were dependent on the presence of antigen-presenting monocytes, and were MHC class I-restricted. Interestingly, we observed that the CD8+ T cell-to-Foxp3+ regulatory T cell ratio was positively correlated with the proportions of Bifidobacterium longum-reactive and Enterococcus hirae-reactive CD8+ T cells, while the frequency of PD-1+ CD8+ T cells was negatively correlated with the frequency of Enterococcus hirae-reactive CD8+ T cells. Furthermore, the disease-free survival time of HCC patients after tumor resection was positively correlated with the frequencies of Bifidobacterium longum-reactive and Enterococcus hirae-reactive CD8+ T cells. Together, these results suggested that certain bacterial species might present valuable antitumor effects.

Objective To investigate the clinical features of HBsAg-negative HBV-related hepatocellular carcinoma (HCC).Methods The patients who were newly diagnosed with HCC from January 2005 to January 2012 were enrolled.According to the HBV-related serological markers,the patients were divided into HBsAg-negative HBV-related HCC group and hepatitis B-related HCC group.A retrospective analysis was performed for the clinical and laboratory examination data at initial diagnosis,including sex,age,hepatitis B virus markers,total bilirubin (TBil),albumin (Alb),alpha-fetoprotein (AFP),HBV DNA,body mass index (BMI),drinking history,history of diabetes,therapies,and follow-up results.The t-test was used for comparison of normally distributed continuous data between groups;the non-normally distributed data were expressed as median and interquartile range (Q1 and Q3),and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data between groups;the chi-square test or Fisher's exact test were used for comparison of categorical data.The log-rank test was used to compare survival curves between the two groups,and the Kaplan-Meier method was used to calculate survival rates.Results Compared with the hepatitis B group and all patients,the HBsAg-negative group had a significantly higher mean age (59.42 ± 11.13 years) and significantly higher proportions of patients with age ＞ 60 years (46.85％),low body weight (12.24％),and overweight (20.98％) (all P ＜0.01).Compared with all patients and the hepatitis B group,the HBsAg-negative group had a significantly lower male-to-female ratio (2.86∶1),a significantly lower proportion of patients regularly undergoing physical examination every year (10.41％),a significantly lower HBV DNA positive rate (1.77％),and significantly lower proportions of patients with smoking and drinking histories (all P ＜0.01).Of all patients in the HBsAg-negative group,64.08％ had positive anti-HBs,anti-HBe,and anti-HBc,21.13％ had positive anti-HBe and anti-HBc,and 14.79％ only had positive anti-HBc.The HBsAg-negative group had a significantly lower AFP level than all patients and the hepatitis B group (P =0.039).Compared with the hepatitis B group and all patients,the HBsAg-negative group had a significantly higher proportion of multiple lesions,a significantly greater mean maximum tumor diameter,and a significantly higher number of patients with extrahepatic metastasis (all P ＜ 0.001).Compared with the hepatitis B group,the HBsAg-negative group had a higher proportion of patients with an Eastem Cooperative Oncology Group Performance Status score of 0 at initial diagnosis (17.69％) and a lower proportion of patients with early-to-medium Barcelona Clinic Liver Cancer stage (stages A and B) (30.26％ vs 51.60％,P ＜0.001);the number of patients with stages C and D in the HBsAg-negative group was 1.83 times that in the hepatitis B group (P ＜0.001).The HBsAg-negative group had a significantly lower median survival time (15.22 months) than all patients and the hepatitis B group (P =0.024、0.031).Compared with all patients and the hepatitis B group,the HBsAg negative group had significantly lower 1-and 3-year survival rates (1-year survival rate:56.0％ vs 61.7％ and 66.2％,x2 =4.93,P =0.026;3-year survival rate:24.0％ vs 45.2％ and 44.1％,x2 =6.867,P =0.009).Conclusion HBsAg-negative HBV-related HCC is commonly seen in patients aged ＞60 years with positive anti-HBs,anti-HBe,and anti-HBc.The population aged ＞60 years with HBV infection sbould be the high-risk population for HCC,and it is recommended to perform HCC screening every 6 months to increase the early diagnostic rate of HBsAg-negative HBV-related HCC.

The National Health and Family Planning Commission of the People's Republic of China published evidence-based clinical practice guidelines on diagnosis, treatment and management of hepatocellular carcinoma (V2017) in June 2017. In this guidelines, the diagnosis, staging, and treatment of hepatocellular carcinoma are updated. This article briefly describes and interprets only new or changed recommendations.

Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths worldwide and the second most common cause in China. The rate of resection of HCC is limited to 20-30%. Therefore, various local ablative therapies such as radiofrequency ablation (RFA), percutaneous cryoablation (PC), microwave, and percutaneous ethanol injection therapy, which play an important role in the treatment of HCC, have been developed [1]. Recently, PC, a local ablative therapy, has been developed with several advantages (such as ability to produce larger and more precise zones of ablation) over RFA and other thermal ablation treatments. This review mainly focuses on the indications, techniques, patient management, safety, and efficacy associated with PC for patients with HCC. [N A J Med Sci. 2016;9(2):66-70. DOI: 10.7156/najms.2016.0902066]

MicroRNA-153 (miR-153) is considered to be a tumor regulator. Silencing of miR-153 expression induced apoptosis in breast cancer cells. Data on mechanism suggest that up-regulation of miR- 153 level promotes cell proliferation via the down regulation of the expression of PTEN or FOXO1, which attenuates the proliferation of cancerous cells. This study aims to identify the effect of miR-153 on the activity of chemotherapeutic and targeted agents in HCC cells and to investigate the mechanisms involved. MTT, soft agar, trans-well and flow cytometry assays were performed to examine whether miR-153 down-regulated the activity of the chemotherapeutic and targeted drugs, Sorafenib, Etoposide and Paclitaxel in HCC cells. The rate of proliferation inhibition, relative survival rates and IC50 values of each drug were calculated. Western blot and luciferase assays were performed to assess whether miR-153 modulates the expression of important genes related to cell proliferation, apoptosis or survival. Results showed that miR-153 attenuated the effect of Etoposide, Paclitaxel and Sorafenib on HepG2 cells; the IC50 value increased from 0.25±0.01μmol/L to 1.02±0.14μmol/L, 0.05±0.01μmol/L to 0.14±0.02μmol/L and from 1.09±0.15μmol/L to 5.18±0.99μmol/L, respectively. In addition, miR-153 also reduced the effect of these drugs on MHCC- 97H, MHCC-97 L and L-02 cells; and it also reduced the effects of Sorafenib, Etoposide and Paclitaxel on anchor-independent growth of HepG2 cells. Over-expression of miR-153 down-regulated the activity of Etoposide and Paclitaxel on cell cycle arrest of HepG2 cells and the effect of Sorafenib on the invasion and migration of HepG2 cells. Furthermore, overexpression of miR-153 also enhanced the growth of HepG2, MHCC-97H, MHCC-97 L and L-02 cells. Mechanisms data showed that overexpression of miR-153 down regulated the activity of luciferase reporters, p15-Luc and p21-Luc; and enhanced the protein level of pro-survival or anti-apoptosis proteins Survivin and BCL-2. These results show that overexpression of miR-153 protects HepG2 cells against the effects of these drugs via multiple mechanisms, and miR-153 may be a novel target for HCC in future diagnostic and therapeutic interventions.

The cell fate determinant Numb is aberrantly expressed in cancer. Numb is alternatively spliced, with one isoform containing a long proline‐rich region (PRRL) compared to the other with a short PRR (PRRS). Recently, PRRL was reported to enhance proliferation of breast and lung cancer cells. However, the importance of Numb alternative splicing in hepatocellular carcinoma (HCC) remains unexplored. We report here that Numb PRRL expression is increased in HCC and associated with early recurrence and reduced overall survival after surgery. In a panel of HCC cell lines, PRRL generally promotes and PRRS suppresses proliferation, migration, invasion, and colony formation. Knockdown of PRRS leads to increased Akt phosphorylation and c‐Myc expression, and Akt inhibition or c‐Myc silencing dampens the proliferative impact of Numb PRRS knockdown. In the cell models explored in this study, alternative splicing of Numb PRR isoforms is coordinately regulated by the splicing factor RNA‐binding Fox domain containing 2 (RbFox2) and the kinase serine/arginine protein–specific kinase 2 (SRPK2). Knockdown of the former causes accumulation of PRRL, while SRPK2 knockdown causes accumulation of PRRS. The subcellular location of SRPK2 is regulated by the molecular chaperone heat shock protein 90, and heat shock protein 90 inhibition or knockdown phenocopies SRPK2 knockdown in promoting accumulation of Numb PRRS. Finally, HCC cell lines that predominantly express PRRL are differentially sensitive to heat shock protein 90 inhibition. Conclusion: Alternative splicing of Numb may provide a useful prognostic biomarker in HCC and is pharmacologically tractable. (Hepatology 2015;62:1122‐1131)

BackgroundAccumulating evidences have suggested that percutaneous cryoablation could be a valuable alternative ablation therapy for HCC but there has been no large cohort-based analysis on its long-term outcomes.MethodsA series of 866 patients with Child-Pugh class A-B cirrhosis and HCC within Milan criteria who underwent percutaneous cryoablation was long-term followed. The safety, efficacy, 5year survival, and prognostic factors of percutaneous cryoablation in the treatment of HCC were analyzed.ResultsA total of 1197 HCC lesions were ablated with 1401 cryoablation sessions. Complete response (CR) was achieved in 1163 (97.2%) lesions and 832 (96.1%) patients with 34 (2.8%) major complications, but no treatment-related mortality. After a median of 30.9 months follow-up, 502 (60.3%) patients who achieved CR developed different types of recurrence. The cumulative local tumor recurrence rate was 24.2% at 5-years. Multiple tumor lesions, tumor size > 3 cm, and repeated ablation of same lesion were independent risk factors associated with local recurrence. The 5-year overall survival (OS) rates were 59.5%. Age < 36 years, HCC family history, baseline hepatitis B virus DNA > 10(6) copies/ml, and three HCC lesions were independently and significantly negative predictors to the postcryoablation OS.ConclusionsPercutaneous cryoablation is an effective therapy for patients with HCC within Milan criteria, with comparable efficacy, safety and long-term survival to the reported outcomes of radiofrequency ablation.

Cryoablation is a less prevalent percutaneous ablative therapy for hepatocellular carcinoma (HCC), and current evidence about its usefulness is limited. We report our experience in treating 1595 HCC cases with percutaneous cryoablation to give a comprehensive profile about the effectiveness, safety and long-term outcome of this therapy. From January 2003 to December 2013, 1595 patients with 2313 HCC nodules were ablated with 2958 cryoablation sessions in our center. Complete ablation was achieved in 1294 patients for 1893 nodules with a mean diameter of 3.4 ± 2.2 cm. The complete ablation rate was 81.2%, 99.4%, 94.4%, and 45.6% in all tumors, tumors < 3 cm, tumors < 5 cm, and tumors > 5 cm, respectively. Major complications were observed after 80 (3.4%) of the 2958 cryoablations and minor complications were observed after 330 cryoablations with no treatment-related deaths. After a median follow-up of 33.4 months, 937 patients developed different types of recurrence. The 5- and 10-year overall survival was 25.7% and 9.2%, respectively. Cryoablation showed reliable safety and efficacy and should be considered as a promising technique, particularly when a large zone of ablation is required.

Radiofrequency ablation (RFA) is considered a curative treatment option for hepatocellular carcinoma (HCC). Growing data have demonstrated that cryoablation represents a safe and effective alternative therapy for HCC, but no randomized controlled trial (RCT) has been reported to compare cryoablation with RFA in HCC treatment. The present study was a multicenter RCT aimed to compare the outcomes of percutaneous cryoablation with RFA for the treatment of HCC. In all, 360 patients with Child-Pugh class A or B cirrhosis and one or two HCC lesions4 cm, treatment-naive, without metastasis were randomly assigned to cryoablation (n=180) or RFA (n=180). The primary endpoints were local tumor progression at 3 years after treatment and safety. Local tumor progression rates at 1, 2, and 3 years were 3%, 7%, and 7% for cryoablation and 9%, 11%, and 11% for RFA, respectively (P=0.043). For lesions >3 cm in diameter, the local tumor progression rate was significantly lower in the cryoablation group versus the RFA group (7.7% versus 18.2%, P=0.041). The 1-, 3-, and 5-year overall survival rates were 97%, 67%, and 40% for cryoablation and 97%, 66%, and 38% for RFA, respectively (P=0.747). The 1-, 3-, and 5-year tumor-free survival rates were 89%, 54%, and 35% in the cryoablation group and 84%, 50%, and 34% in the RFA group, respectively (P=0.628). Multivariate analyses demonstrated that Child-Pugh class B and distant intrahepatic recurrence were significant negative predictors for overall survival. Major complications occurred in seven patients (3.9%) following cryoablation and in six patients (3.3%) following RFA (P=0.776). Conclusion: Cryoablation resulted in a significantly lower local tumor progression than RFA, although both cryoablation and RFA were equally safe and effective, with similar 5-year survival rates. (Hepatology 2015;61:1579-1590)

OBJECTIVE To analyze the concentrations of serum procalcitonin (PCT) of the patients with sepsis in‐duced by gram‐negative bacteria and gram‐positive bacteria and define the clinical significance of PCT in diagnosis of the sepsis so as to provide theoretical basis for early treatment .METHODS A total of 145 fever patients were en‐rolled in the study ,including 74 cases with positive blood culture and 71 cases of with negative blood culture .A‐mong the patients with positive blood culture ,there were 37 cases with gram‐negative bacteria cultured positive and 37 cases with gram‐negative bacteria cultured positive .RESULTS The Staphylococcus epidermidis was the predominant species of gram‐positive bacteria causing the sepsis ,accounting for 21 .62% ,and the K lebsiella pneumoniae was dominant among the gram‐negative bacteria causing the sepsis ,accounting for 18 .92% .As com‐pared with the expression of PCT among the three group ,the concentration of serum PCT of the gram‐negative bacteria group was significantly higher than that of the gram‐positive bacteria group and the negative blood culture group ,however ,there was no significant difference in the expression of PCT between the different species of gram‐negative bacteria or gram‐positive bacteria .The ROC curve analysis showed that the sensitivity of the PCT in diagnosis of sepsis caused by the gram‐negative bacteria was 81 .0% ,the specificity 93 .0% ,the area under curve 92 .0% .CONCLUSION The PCT has significant value in the diagnosis of sepsis caused by the gram‐negative bacte‐ria but has little significance in the diagnosis of non‐sepsis or the sepsis caused by the gram‐positive bacteria .