Adipocytokines are mainly bioactive substances produced by adipocytes, which play an important role in the development of steatosis, inflammatory necrosis, fibrosis and cirrhosis of liver.[54] For Apoptosis, studies have shown that changes in the expression levels of cyclin A and D1, cell cycle arrest, and apoptosis may cause hyperammonemia induced liver injury in rats.[55] Regulation of these 2 pathways can alleviate the deterioration of liver disease and prevent the occurrence of HE. This evidence concerns the gene CCNA2 and medical procedure.