Loading...

Table of Content

    30 June 2026, Volume 31 Issue 6
    Previous Issue   
    Frontier, Exploration and Controversy
    The clinical and pathological features of drug-induced liver failure in pediatric and adult liver transplantation recipients
    Wei Runjie, Ma Zikun, Guo Tiantian, Meng Yao, Zhang Mengmeng, Sun Liying, Zhu Zhijun, Zhao Xinyan
    2026, 31(6):  790-797. 
    Asbtract ( 11 )   PDF (1923KB) ( 3 )  
    References | Related Articles | Metrics
    Objective To investigate and compare the clinical and pathological characteristics of drug-induced liver failure (DILF) in pediatric and adult patients undergoing liver transplantation. Methods Nineteen patients diagnosed with DILF who received liver transplantation at our center from February 2013 to December 2024 were retrospectively analyzed. The clinical data including causative drugs, types of liver injuries, laboratory parameters, and pre- and post-transplantation survival of all patients were collected. The pathological features of explanted livers, such as the extent of hepatocyte necrosis and cholestasis, were also assessed. The differences between pediatric and adult groups were systematically compared. Results There were no significant differences between pediatric and adult groups in terms of gender, types of liver injuries, clinical presentations, surgical procedures, or preoperative plasma exchanges. However, the types of causative drugs did differ significantly (P=0.004), with a higher proportion of traditional Chinese medicine had been used in adults (0.00% vs. 72.73%). Pediatric patients had significantly higher alkaline phosphatase (ALP) levels at initial testing[341.00 (312.00, 367.00) vs. 175.00 (147.00, 182.00), P=0.028] and at admission[232.50 (196.75, 327.00) vs. 115.00 (93.00, 143.00), P<0.001], consistent with physiological characteristics. Both the pre-transplant waiting time[16.50 (12.00, 19.25) vs. 27.00 (18.00, 82.00), P=0.047] and post-transplant survival[75.00 (16.25, 361.00) vs. 1 001.00 (448.00, 1430.00), P=0.020] were significantly shorter in patients of the pediatric group. Pathological analysis revealed that children had more severe hepatocyte necrosis and less pronounced bile duct reaction, regeneration, and fibrosis when compared with those adult patients, but these pathological differences did not reach statistical significance. Conclusion Pediatric patients with DILF experience more rapid disease progression, greater severity, and higher mortality risk compared to adults. The underlying pathology is characterized by extensive hepatocyte necrosis with limited regeneration. Early evaluation for liver transplantation should be considered in pediatric DILF patients to prevent adverse outcomes.
    A cost-effectiveness analysis of in-hospital screening and diagnosing procedures for hepatitis E virus infection
    Li Wenjing, Li Ziqiang, Li Qing, Xie Qing, Lu Jie
    2026, 31(6):  798-803. 
    Asbtract ( 8 )   PDF (551KB) ( 3 )  
    References | Related Articles | Metrics
    Objective To compare the cost-effectiveness of various screening and diagnosing procedures for hepatitis E virus (HEV) infection, and optimize the HEV screening scheme in medical institutions. Methods Seven departments in Shanghai Ruijin Hospital were selected, where patients at high risk of HEV infection or bearing extrahepatic manifestations after HEV infection are relatively concentrated. Patients from these departments who tested HEV antibody from January 2024 to October 2024 were prospectively included. The accuracy rate and cost-effectiveness of various HEV screening and diagnostic strategies were compared. Results Among 2,420 enrolled subjects, 949 (39.2%), 161 (6.7%) and 115 (4.8%) patients were positive for anti-HEV IgG, anti-HEV IgM and HEV RNA, respectively. There were statistically significant differences of anti-HEV IgG positive rate (25.6%~50.0%), IgM positive rates (0.0%~19.7%) and HEV RNA positive rates (0.0%~16.5%) among departments (χ2=86.9, 272.9 and 292.1, respectively, all P<0.000 1). The vast majority of patients with positive HEV RNA had abnormal alanine aminotransferase (ALT) levels (≥2×ULN) at the time of admission (111/115, 96.5%), with a median ALT level of 825 U/L (interquartile range 365~1 599 U/L). The HEV RNA positive rate was significantly higher in the patients with abnormal ALT (111/501, 22.2%) than those patients with normal ALT (4/1 919, 0.2%) (χ2=422.8, P<0.000 1). Compared with simultaneously detecting anti-HEV IgG and IgM, the cost of detecting anti-HEV IgM alone was halved (2 664.2 CNY vs. 1 308.1 CNY for diagnostic cost per case with HEV infection), and the accuracy rate was comparable (97.9% vs. 97.8%). Screening for HEV antibodies or nucleic acid markers in the ALT-abnormal population saved 80% of the cost compared with screening in the general population, while the specificity and accuracy were basically unchanged. Conclusion The detection of anti-HEV IgG has limited contribution in improving the screening efficiency of HEV infection. Conducting HEV screening only in patients with abnormal ALT levels can significantly reduce medical expenses.
    The efficacy and safety of sofosbuvir/velpatasvir in the treatment of children and adolescent patients with chronic hepatitis C
    Chen Ming, Sun Jieyu
    2026, 31(6):  804-807. 
    Asbtract ( 11 )   PDF (438KB) ( 3 )  
    References | Related Articles | Metrics
    Objective To analyze the efficacy and safety of sofosbuvir/velpatasvir in the treatment of children and adolescent patients with chronic hepatitis C (CHC). Methods A retrospective analysis was conducted on the medical records of 153 children and adolescents with CHC admitted to the hospital from March 2022 to January 2024. They were divided into an observation group (n=78) and a control group (n=75) according to different treatment methods. The efficacy, changes in liver function and liver fibrosis indexes and occurrence of adverse reactions in the two groups were compared. Results The sustained virological response at 24 weeks (SVR24)(100.00% vs. 82.67%), end of treatment response (EOT)(100.00% vs. 84%) and early virological response rate (EVR)(92.31% vs. 81.33%) at the end of treatment were higher in the observation group than those in the control group (P<0.05). After treatment, the levels of liver function index[AST(26.10±2.29)U/L vs. (35.02±3.36)U/L; total bilirubin (10.09±1.75)μmol/L vs. (13.20±2.23)μmol/L;ALT(25.04±2.40)U/L vs. (34.21±3.32) U/L] in both groups were decreased (P<0.05), and the downward trend of the observation group is more obvious. (P<0.05). After intervention, the serum concentrations of type III procollagen N-terminal peptide (PC-Ⅲ)[(35.01±3.25) ng/mL vs. (42.38±4.46) ng/mL], hyaluronidase acid (HA)[(84.11±9.13) ng/mL vs. (95.26±11.08) ng/mL] and laminin (LN)[(44.02±4.19) ng/mL vs. (53.65±7.83) ng/mL] demonstrated significant declines in both cohorts, with the observation group showing greater suppression in the biomarkers′ levels (P<0.05). There was no difference in the total incidence of adverse reactions between the two groups (14.10% vs. 10.67%) (χ2=0.415,P=0.519). Conclusion Sofosbuvir/velpatasvir is effective in the treatment of CHC in children and adolescents. It can improve the liver function and alleviate the progression of liver fibrosis, and is safe and reliable.
    Liver Tumor
    The metabolic, renal and hematological changes in chronic hepatitis C patients after receiving direct antiviral therapy to achieve rapid virological response
    Yang Juan, Zhu Xiaoyan
    2026, 31(6):  808-811. 
    Asbtract ( 11 )   PDF (370KB) ( 5 )  
    References | Related Articles | Metrics
    Objective To analyze the efficacy and safety of sofosbuvir/velpatasvir in the treatment of children and adolescent patients with chronic hepatitis C (CHC). Methods A retrospective analysis was conducted on the medical records of 153 children and adolescents with CHC admitted to the hospital from March 2022 to January 2024. They were divided into an observation group (n=78) and a control group (n=75) according to different treatment methods. The efficacy, changes in liver function and liver fibrosis indexes and occurrence of adverse reactions in the two groups were compared. Results The sustained virological response at 24 weeks (SVR24)(100.00% vs. 82.67%), end of treatment response (EOT)(100.00% vs. 84%) and early virological response rate (EVR)(92.31% vs. 81.33%) at the end of treatment were higher in the observation group than those in the control group (P<0.05). After treatment, the levels of liver function index[AST(26.10±2.29)U/L vs. (35.02±3.36)U/L; total bilirubin (10.09±1.75)μmol/L vs. (13.20±2.23)μmol/L;ALT(25.04±2.40)U/L vs. (34.21±3.32) U/L] in both groups were decreased (P<0.05), and the downward trend of the observation group is more obvious. (P<0.05). After intervention, the serum concentrations of type III procollagen N-terminal peptide (PC-Ⅲ)[(35.01±3.25) ng/mL vs. (42.38±4.46) ng/mL], hyaluronidase acid (HA)[(84.11±9.13) ng/mL vs. (95.26±11.08) ng/mL] and laminin (LN)[(44.02±4.19) ng/mL vs. (53.65±7.83) ng/mL] demonstrated significant declines in both cohorts, with the observation group showing greater suppression in the biomarkers′ levels (P<0.05). There was no difference in the total incidence of adverse reactions between the two groups (14.10% vs. 10.67%) (χ2=0.415,P=0.519). Conclusion Sofosbuvir/velpatasvir is effective in the treatment of CHC in children and adolescents. It can improve the liver function and alleviate the progression of liver fibrosis, and is safe and reliable.
    The imaging and clinical analyses of hepatic angiosarcoma
    Liu Yang, Liu Jing, Li Zhiyan, Ren Hongwei, Zhang Mengmeng, Liu Shuhong, Gao Shen, Liu Changchun, Liu Yuan
    2026, 31(6):  812-815. 
    Asbtract ( 10 )   PDF (2609KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To explore and analyze the imaging and clinical features of hepatic angiosarcoma (HA), so as to improve the understanding of this disease and accumulate diagnostic experience. Methods A retrospective analysis was performed on the imaging and clinical data of 23 patients with hepatic angiosarcoma who were hospitalized in Fifth Medical Center of Chinese PLA General Hospital from March 2018 to October 2025, with the diagnosis confirmed by surgical pathology and liver biopsy. The chief complaints, gender and age, laboratory test results, imaging findings and other clinical information of the patients were summarized and sorted out. Results Among the 23 patients with HA, 14 were male and 9 were female, aged from 20 to 88 years old. Their chief complaints at admission included a detection of liver lesions during physical examination, abdominal distension or abdominal pain, and abnormal liver function. Most of the laboratory test results showed no obvious abnormalities or only mild abnormalities. The majority of patients had no concurrent viral hepatitis, with only 2 cases being positive for hepatitis B. In addition, 6 cases presented with mild elevation of CA199, and 10 cases had elevated CA125. Of the 23 lesions, 1 was cystic-solid, 1 was cystic, and the rest were solid. Only 2 patients had a single intrahepatic lesion located in the right lobe of the liver, while the remaining 21 patients had multiple intrahepatic lesions. The maximum diameter of the intrahepatic lesions ranged from 1.2 cm to 17.7 cm, with an average of approximately 7.9 cm. On ultrasonography, the lesions were predominantly characterized by heterogeneous echoes, with visible peripheral vascular signals. Liver MRI revealed that only 2 cases had solitary intrahepatic lesions located in the right hepatic lobe, whereas the remaining 21 cases presented with multiple intrahepatic lesions. Contrast-enhanced scans mostly showed progressive enhancement: the lesions exhibited mild to moderate heterogeneous enhancement or rim enhancement in the arterial phase, and in both the portal venous phase and delayed phase, the lesions presented as isointense or slightly hyperintense signals. Conclusion HA predominantly occurs in middle-aged and elderly males. Its clinical manifestations and laboratory test results are mostly non-specific. The main imaging feature is multiple intrahepatic lesions, presenting heterogeneous echoes and progressive enhancement. The diagnosis of this disease needs to be made by combining imaging findings with clinical data. When the diagnosis is difficult, pathological results are required for confirmation.
    The significance of an immunohistochemical panel in histological classification of intrahepatic cholangiocarcinoma in liver biopsy specimens
    Wang Yulin, Ji Yuan, Guo Xinxin, Han Jing, Zhang Xin
    2026, 31(6):  816-821. 
    Asbtract ( 8 )   PDF (4802KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To investigate the optimal immunohistochemical panel for subclassifying intrahepatic cholangiocarcinoma (ICC) into small- and large-duct types from liver biopsy specimens by evaluating the expression of S-100P, CD56, MUC5AC, CRP, TFF-1, and N-cadherin. Methods Two hundred and fourteen surgical cases of ICC diagnosed by the department of pathology of Zhongshan Hospital Affiliated to Fudan University from December 2019 to December 2021 were retrospectively analyzed. The expression of S-100P, CD56, MUC5AC, CRP, TFF-1, and N-cadherin was detected by immunohistochemistry. An immunohistochemical panel with maximum diagnostic efficacy for histological classification in liver biopsy specimens was explored based on receiver operating characteristic curve (ROC) and area under curve (AUC) analyses. Seventy-seven paired puncture biopsy specimens and surgical resection specimens diagnosed as ICC from January 2022 to March 2023 were collected to verify the accuracy and consistency of the classification panel. Results In surgical specimens, S-100P, MUC5AC, and TFF-1 were mainly expressed in large-duct ICC (P<0.001), while CD56, CRP, and N-cadherin were mainly expressed in small-duct ICC (P<0.001). The combined detection of multiple biomarkers could improve the diagnostic accuracy when compared to any of the single biomarker (P<0.05). For large-duct type ICC, the panel of S-100P/MUC5AC/TFF-1 demonstrated optimal efficacy in diagnosis (AUC=0.943,95%CI:0.913~0.974), no significant statistical difference was observed between the combined TFF-1/S-100P and the triple panel (P=0.062); For small-duct type ICC, the panel of CD56/CRP/N-cadherin achieved optimal efficacy in the diagnosis (AUC=0.889,95%CI:0.842~0.937), while no significant statistical difference was observed between the combined CD56/CRP panel and the triple panel(P=0.099). The immunohistochemical panel of S-100P, CD56, TFF-1, and CRP presented the optimal classification model, which reached a strong consistency between biopsy pathology and surgical pathology (κ=0.814,P<0.001). Conclusion The immunohistochemical panel of S-100P, CD56, TFF-1, and CRP has maximum diagnostic efficacy for the histological classification of ICC in liver biopsy specimens, which provides a pathological basis for the clinical diagnosis and treatment.
    Clinical efficacy of TACE combined with sorafenib and ablation in the sequential treatment of large liver cancer and its influence on the time of postoperative disease progression
    Wang Jianbin, Liang Dong
    2026, 31(6):  822-825. 
    Asbtract ( 8 )   PDF (498KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To investigate the clinical efficacy of sequential treatment of large liver cancer with transarterial chemoembolization (TACE) combined with sorafenib and ablation, and its impact on postoperative disease-free survival time. Methods Clinical data of 86 patients with large liver cancer admitted to the No.988 Hospital of Joint Logistic Support Force from January 2020 to January 2022 were retrospectively collected. They were divided into a control group (n=40, treated with TACE combined with sorafenib) and a study group (n=46, treated with TACE combined with sorafenib and sequential ablation) according to different treatment methods. The efficacy, alpha-fetoprotein (AFP), health status, adverse reactions, and survival time were compared between two groups. Results The objective remission rate of the research group was 76.09%, significantly higher than the control group′s 50.00% (P<0.05); After treatment, the serum AFP level in the study group (124.29 ± 20.62) μg/L was lower than that in the control group (205.13 ± 32.59) μg/L. The KPS score in the study group after treatment (88.68 ± 9.03) was higher than that in the control group (79.38 ± 8.15), and the differences were statistically significant (P<0.05). There was no significant difference in the incidence of adverse reactions such as nausea, vomiting, diarrhea, fever, bone marrow suppression, and hand foot skin reactions between the two groups (P>0.05). The progression-free survival time and overall survival time of the study group were (16.01 ± 2.15) months and (19.37 ± 2.69) months, respectively, which were significantly longer than the control group′s (11.84 ± 1.62) months and (13.90 ± 2.04) months (P<0.05). Conclusion TACE combined with sorafenib and sequential ablation therapy has significant clinical efficacy in the treatment of large liver cancer, without significantly increasing the incidence of adverse reactions, and can effectively prolong the postoperative disease-free survival time of patients.
    A study on the efficacy of toripalimab combined with lenvatinib in TACE treatment for advanced liver cancer
    Luan Xinying, Zhao Jinxia, Sun Shuo, Chen Yuchen
    2026, 31(6):  826-830. 
    Asbtract ( 8 )   PDF (618KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To investigate the efficacy of toripalimab combined with lenvatinib in the treatment of advanced liver cancer with transarterial chemoembolization (TACE). Methods A total of 150 patients with advanced liver cancer admitted to our hospital between September 2020 and September 2024 were enrolled. They were randomly assigned to the control group (lenvatinib plus TACE) and the observation group (lenvatinib + TACE combined with toripalimab), with 75 patients in each group. The therapeutic efficacy of the two groups was compared after treatment, and their survival status was followed up for 1 year. Results After treatment, the objective response rate (ORR) of the observation group reached 58.67%, which was notably higher compared to the 34.67% recorded in the control group (P<0.05). Regarding serum indicators, the observation group showed respective levels of vascular endothelial growth factor, hypoxia-inducible factor-1α, basic fibroblast growth factor, alpha-fetoprotein, carbohydrate antigen 19-9, aspartate aminotransferase, and alanine aminotransferase of (203.27±25.68) pg/mL, (30.86±4.59) ng/L, (20.42±2.97) pg/mL, (212.24±25.89) ng/mL, (49.26±9.37) U/mL, (51.28±9.85) U/L, and (52.33±4.25) U/L, respectively, which were significantly lower than those in the control group[(228.15±22.17) pg/mL, (36.37±5.24) ng/L, (26.15±3.46) pg/mL, (271.61±23.47) ng/mL, (58.73±10.16) U/mL, (62.61±10.37) U/L, (59.74±5.69) U/L], with statistical significance (P<0.05). The two groups had similar adverse reaction incidences (P>0.05). However, the observation group had a significantly higher 1-year survival rate (58.67%) than the control group (34.67%) (P<0.05). Conclusion The combination of toripalimab and lenvatinib with TACE in the treatment of advanced liver cancer can significantly improve the objective response rate, reduce tumor markers and angiogenesis-related factors, improve liver function, and increase prolong short-term survival without increasing the incidence of adverse reactions.
    Unveiling the expression profiles and functional significance of CD10 and CD34 in primary liver cancer
    Guo Feiyu, Li Wei, Jing Fa
    2026, 31(6):  831-833. 
    Asbtract ( 8 )   PDF (474KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To explore the biological roles of CD10 and CD34 in primary liver cancer (PLC), this study conducted analyses on their expressions and explored the clinical significance. Methods A total of 56 patients who underwent surgical resection for primary liver cancer at Wuxi Hospital Affiliated to Nanjing University of Traditional Chinese Medicine between March 2021 and March 2024 were enrolled. Immunohistochemistry Envision staining was used to detect CD10 and CD34 protein expression in post-operative cancer tissues. Spearman correlation analysis quantified the correlation coefficient between CD10 and CD34 expression to evaluate the correlation of them. Associations between marker levels and clinicopathological features (age, gender, tumor stage) were examined. Multiple statistical methods evaluated the prognostic value of CD10 and CD34 in PLC. Receiver operating characteristic (ROC) curves determined diagnostic accuracy. Kaplan-Meier survival curves and Log-rank tests compared survival outcomes across expression levels, and the Cox proportional hazards model identified independent prognostic factors by integrating marker expression with other clinical variables. Results Immunohistochemistry revealed CD10 positivity in 18 of 56 cases (32.14%) and CD34 positivity in 28 cases (50.00%). A significant positive correlation was observed between CD10 and CD34 expression (r=0.431, P=0.006), indicating coordinated regulation in liver cancer tissues. In PLC, CD10 expression differed significantly by gender (χ2=4.038, P<0.05), suggesting gender-dependent regulation. CD34 positivity correlated with patient prognosis (χ2=6.402, P<0.05). CD10 exhibited poor diagnostic accuracy, with an area under the ROC curve (AUC) of 0.579 (standard error 0.095, 95%CI: 0.392~0.766), whereas CD34 showed the higher predictive value (AUC=0.704, standard error 0.085, 95%CI: 0.538~0.870). Kaplan-Meier survival analysis showed that the expressions of CD10 and CD34 both had a significant impact on the survival status of patients.Cox regression analysis identified tumor size, CD10, and CD34 expression as key predictors of liver cancer prognosis (all P<0.05). Conclusion CD10 and CD34 have high positive expression in PLC and were positively correlated. CD10 and CD34 could predict the survival status and the survival time of patients after operation. Both CD10 and CD34 were prognostic indicators.
    The efficacy and influencing factors of ultrasound-guided microwave ablation in the treatment of patients with colorectal cancer liver metastasis
    Li Meng, Wang Xiaodong, Chen Xin, Lu Yuhan, Zhuang Yan, Hou Dongdong
    2026, 31(6):  834-837. 
    Asbtract ( 9 )   PDF (477KB) ( 3 )  
    References | Related Articles | Metrics
    Objective To evaluate the efficacy of ultrasound-guided microwave ablation (MWA) in treating patients with colorectal cancer liver metastases (CRLM) and to investigate the key factors influencing prognosis. Methods A retrospective analysis was conducted on the clinical data of 120 CRLM patients who underwent ultrasound-guided MWA at Peking University Shougang Hospital between June 2022 and June 2024. Outcome measures included the complete ablation rate, complication rate, local tumor progression (LTP) rate, progression-free survival (PFS), and overall survival (OS). Survival rates were calculated using the Kaplan-Meier method. Univariate analysis was performed using the Log-rank test, and multivariate analysis was conducted using a Cox proportional hazards regression model to identify independent prognostic factors. Results A total of 225 lesions were ablated in all patients. The initial complete ablation rate was 96.0%, and the major complication rate was 2.5%. After a median follow-up of 18.5 months, the LTP rate was 8.3%, and the median PFS was 14.0 months. The median OS was not reached by the end of the follow-up period, with a 1-year cumulative OS rate of 92.3%. Multivariate analysis identified failure to receive systemic chemotherapy, the presence of ≥3 liver metastases, and a maximum tumor diameter >3 cm as independent risk factors for shortened PFS. Conclusion Ultrasound-guided MWA is a safe and effective local treatment modality for CRLM. Active combination with systemic chemotherapy and effective control of intrahepatic tumor burden are key to improving patient prognosis.
    The value of pathological grading of microvascular invasion in hepatocellular carcinoma in evaluating the risk of poor prognosis in patients
    Wang Xiaohui, Zang Dan, Chen Yiyang, Xue Yun, Li Jian
    2026, 31(6):  838-841. 
    Asbtract ( 7 )   PDF (427KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To establish a pathology-based microvascular invasion (MVI) risk stratification system for hepatocellular carcinoma (HCC), analyze the pathological invasion characteristics and immune microenvironment differences among different risk levels, and assess their association with postoperative prognosis. Furthermore, this study aimed to evaluate the independent prognostic value of MVI risk stratification and provide a reference for postoperative risk assessment and individualized treatment. Methods Clinical and pathological data of 81 patients with HCC who underwent curative resection in the First Affiliated Hospital of Henan Medical University were retrospectively analyzed. According to the number, distribution, and morphological characteristics of MVI, patients were categorized into three groups: M0 (n=53), M1 (n=18), and M2 (n=10). Pathological invasive behaviors, postoperative recurrence patterns, and immune infiltration characteristics were compared among different MVI risk levels. Recurrence-free survival was analyzed using the Kaplan-Meier method. Results With increasing MVI risk stratification, invasive pathological features of HCC progressively intensified. The M2 group showed significantly lower capsule integrity and markedly higher proportions of moderate-to-poor differentiation, unclear/infiltrative margins, and satellite nodules (P<0.05). Postoperative recurrence analysis revealed recurrence rates of 50.0%, 70.0%, and 90.0% at 6 months, 1 year, and 2 years, respectively, in the M2 group, which were significantly higher than those in the M0 and M1 groups. In the M2 group, the median recurrence time was markedly shorter, re-resection rates decreased, and 1-year mortality after recurrence increased (P<0.05). Regarding the immune microenvironment, high-risk MVI patients exhibited significantly reduced CD4+, CD8+, and NK cell infiltration, whereas Treg, TAM, and MDSC levels increased progressively (P<0.05), indicating an immunosuppressive phenotype. Kaplan-Meier analysis showed significant differences in recurrence-free survival among the risk groups (log-rank test, P<0.001). Conclusion The pathology-based MVI risk stratification system effectively reflects the invasive characteristics of HCC and differences in the immune microenvironment and serves as an independent predictor of postoperative recurrence and survival. Compared with traditional binary MVI assessment (presence/absence), this stratification system provides a more refined approach and may offer important guidance for postoperative risk management, follow-up strategies, and adjuvant treatment decision-making in HCC patients.
    Liver Fibrosis and Cirrhosis
    Clinical registration status of hepatic fibrosis in China
    Zhang Lili, Wang Shaohua, Hu Jianhua
    2026, 31(6):  842-846. 
    Asbtract ( 7 )   PDF (802KB) ( 2 )  
    References | Related Articles | Metrics
    Objective This paper reviews the registration status of hepatic fibrosis (HF) clinical research in the Chinese clinical trial Registry(ChiCTR), summarizes the current research results and analyzes the existing problems, so as to provide reference for the design and implementation of clinical trials in the future. Methods All HF-related clinical studies in the ChiCTR from 2005 to 2024-12-31 were searched with "hepatic fibrosis" as the search term. The relevant information of HF registration in ChiCTR was analyzed, including but not limited to registration time, registration status, study type, program design, sample size and whether there was financial support. Results A total of 83 clinical studies on hepatic fibrosis were included, covering 19 provincial-level administrative regions across the country, with a total sample size of 29 572 cases. At present, there are some problems in HF-related clinical trials, such as small number of registrations, concentrated research results, uneven geographical distribution, large proportion of financial support, and diverse innovative non-invasive diagnostic tests, but the accuracy and staging criteria need to be unified. Conclusion Relevant researchers should enhance their professionalism in clinical trials, optimize trial design, complete registration information, and standardize the application of blinding methods. It is necessary to establish a cross-regional and multi-institutional collaborative mechanism to conduct high-quality clinical trials and innovate research protocols tailored to the characteristics of traditional Chinese medicine. Meanwhile, it is essential to improve the diagnostic efficacy of non-invasive hepatic fibrosis, carry out evidence-based studies, and explore new randomized controlled trial models for traditional Chinese medicine to boost its modernization.
    Value of shear wave elastography combined with APRI in assessing liver fibrosis in patients with alcohol-related liver disease
    Zhao Yingchao, Luo Duoduo, Wu Xianghua, Ren Yuhui, Wang Yan, Qiang Xiaohui, Du Haifeng
    2026, 31(6):  847-850. 
    Asbtract ( 7 )   PDF (531KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To evaluate the diagnostic value of shear wave elastography (SWE) combined with the aspartate aminotransferase-to-platelet ratio index (APRI) for identifying significant liver fibrosis (≥F2) in patients with alcohol-related liver disease (ALD), and to compare its diagnostic performance among different etiologies of chronic liver disease. Methods A total of 104 patients with ALD, 70 patients with chronic hepatitis B (CHB), 60 patients with metabolic dysfunction-associated fatty liver disease (MAFLD), and 50 healthy controls were enrolled. General characteristics, liver function parameters, PLT, APRI, and SWE levels were compared among the groups. APRI and SWE changes across different fibrosis stages in ALD were analyzed. ROC curves were used to assess the ability of APRI, SWE, and their combined model to predict significant fibrosis. Diagnostic performance was further compared across different etiologies. Pearson correlation analysis and binary logistic regression were applied to evaluate the correlation between APRI and SWE and their respective contributions to diagnosing significant fibrosis in ALD, CHB, and MAFLD. Results The ALT levels in the ALD, CHB, and MAFLD groups were (65.4±20.5) U/L, (90.4±35.0) U/L, and (78.4±25.0) U/L, respectively. AST levels were (72.6±25.6) U/L, (78.4±30.2) U/L, and (65.3±18.2) U/L, respectively. GGT levels were (128.5±40.8) U/L, (45.1±18.1) U/L, and (60.2±22.2) U/L, respectively. APRI scores were (0.78±0.30), (1.02±0.40), and (0.55±0.20), respectively, and SWE values were (9.6±3.2) kPa, (8.4±2.5) kPa, and (7.1±2.0) kPa, respectively. All these values were significantly higher than those of the normal control group (all P<0.05). In predicting significant liver fibrosis, SWE demonstrated higher AUC values than APRI, while the combination of both achieved the highest AUC (0.96 for ALD, 0.92 for CHB, and 0.88 for MAFLD), with sensitivities of 90.2%, 86.0%, and 82.6%, and specificities of 92.2%, 85.2%, and 80.8%, respectively. Correlation analysis revealed that SWE and APRI showed the strongest correlation in ALD (r=0.78), with SWE contributing the most to diagnosis (60.6%). In CHB, their contributions were similar (SWE 51.5%, APRI 48.5%), while in MAFLD, SWE contributed significantly more (65.7%) compared to APRI (34.3%). Conclusion SWE combined with APRI provides superior accuracy for diagnosing significant fibrosis in ALD compared with either serum-based markers or elastography alone, showing particularly strong performance in alcohol-related liver injury. The correlation and diagnostic contribution of SWE and APRI differ markedly across disease etiologies, indicating that etiology-based optimization of non-invasive fibrosis assessment strategies is necessary.
    Analysis of sonographic and elastographic features in hepatitis B-related liver fibrosis and the value in diagnosis and severity assessment
    Liu Xiaolan, Wang Tiwei
    2026, 31(6):  851-856. 
    Asbtract ( 9 )   PDF (892KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To explore the value of sonographic and elastographic feature analysis in the diagnosis and severity assessment of hepatitis B-related liver fibrosis. Methods A retrospective study was conducted, including 80 chronic hepatitis B (CHB) patients (case group) admitted to Santai County People′s Hospital from February 2022 to February 2024, and 106 healthy individuals (control group) undergoing physical examinations during the same period. All participants underwent color Doppler ultrasound to evaluate sonographic features, which were semi-quantitatively scored using a comprehensive scoring system. Liver stiffness measurement (LSM) was performed via two-dimensional shear wave elastography (2D-SWE). Serum levels of four liver fibrosis markers—hyaluronic acid (HA), type Ⅲ procollagen peptide (PⅢNP), type Ⅳ collagen (Ⅳ-C), and laminin (LN)—were detected using enzyme-linked immunosorbent assay (ELISA). Liver biopsy was performed in the case group, and patients were stratified by fibrosis stage: no fibrosis (S0, n=13), mild fibrosis (S1-S2, n=44), and significant fibrosis (≥S3, n=23). Comparisons of sonographic features, LSM, and serum fibrosis markers were made between the case and control groups, as well as among fibrosis stages. Pearson correlation analysis was used to assess relationships between sonographic features, LSM, and serum markers. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curves. Results The case group exhibited significantly higher scores compared to the control group in the following parameters: liver capsule score (2.34 ± 0.56 vs. 1.12 ± 0.23 points), hepatic vein (2.12 ± 0.45 vs. 1.05 ± 0.12 points), parenchyma (2.56 ± 0.47 vs. 1.23 ± 0.31 points), margin (2.01 ± 0.34 vs. 1.00 ± 0.21 points), total score (9.03 ± 1.23 vs. 4.40 ± 0.89 points), LSM (10.23 ± 2.34 vs. 5.67 ± 1.03 kPa), and serum levels of HA (123.45 ± 23.45 vs. 78.90 ± 15.23 ng/mL), PⅢNP (56.78 ± 9.01 vs. 34.56 ± 4.56 ng/mL), Ⅳ-C (78.90 ± 12.34 vs. 56.78 ± 9.01 ng/mL), and LN (45.67 ± 8.90 vs. 34.56 ± 4.56 ng/mL) (all P<0.05). The significant fibrosis group showed higher values than the mild fibrosis group, which in turn showed higher values than the no fibrosis group (P<0.05). Positive correlations were observed between sonographic scores, LSM, and serum fibrosis markers (r=0.456, 0.478, 0.491, 0.467; r=0.432, 0.465, 0.476, 0.451; r=0.489, 0.512, 0.528, 0.503; r=0.421, 0.443, 0.459, 0.438; r=0.501, 0.534, 0.547, 0.521; r=0.523, 0.556, 0.578, 0.543; all P<0.001). ROC analysis demonstrated that the combined use of capsule, vein, parenchyma, margin, total scores, and LSM achieved an AUC of 0.820(95%CI:0.781~ 0.891) for diagnosing significant fibrosis, with sensitivity and specificity of 86.41% and 82.35%, respectively, outperforming individual parameters. Conclusion Sonographic scores and LSM increase with the progression of liver fibrosis in CHB patients and correlate positively with serum fibrosis markers. Combined diagnosis enhances the efficacy of fibrosis assessment in CHB.
    Value of ultrasound acoustic structure quantification for assessing the severity of liver fibrosis in patients with chronic hepatitis B
    Zhang Xuemian, Liu Wenchuan, Wu Yunhui
    2026, 31(6):  857-862. 
    Asbtract ( 8 )   PDF (1983KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To assess the value of ultrasound acoustic structure quantification (ASQ) in staging liver fibrosis and identifying moderate-to-severe fibrosis in chronic hepatitis B. Methods A total of 139 patients with chronic hepatitis B and biopsy-confirmed liver fibrosis treated in our hospital from January 2021 to June 2024 were enrolled. According to the METAVIR stage, 61 patients with F0-F2 fibrosis were assigned to the mild group, and 78 patients with F3-F4 fibrosis were assigned to the moderate-to-severe group. ASQ parameters, including the mean of the red curve (RA), mode of the red curve (RM), mode of the blue curve (BM), standard deviation of the blue curve (BSD), and the red-to-blue area under the curve ratio (FD ratio), were compared between groups. Spearman rank correlation was used to analyze their associations with fibrosis stage. Logistic regression and receiver operating characteristic (ROC) analysis were performed with moderate-to-severe fibrosis as the dependent variable. Results Compared with the mild group, the moderate-to-severe group showed higher RA, RM, BM, and FD ratio values: 124.55±6.98 vs. 117.15±7.65, 123.68±4.98 vs. 111.26±5.54, 136.99±6.15 vs. 128.44±8.44, and 0.65±0.15 vs. 0.26±0.14, respectively. Spearman analysis showed that BM, RA, RM, and FD ratio were positively correlated with fibrosis stage. Logistic regression identified the FD ratio as an independent risk factor for moderate-to-severe fibrosis. ROC analysis showed that the FD ratio had an AUC of 0.967[95% CI: 0.939~0.995]; at a cutoff of 0.520, the sensitivity was 0.872 and the specificity was 0.984. Conclusion ASQ can quantitatively reflect fibrosis-related alterations in liver parenchymal echotexture in patients with chronic hepatitis B. The FD ratio showed the strongest association with pathological stage,was an independent predictor of moderate-to-severe fibrosis, and had high diagnostic efficacy.
    Constructing a Nomogram prediction model of liver cirrhosis complicated with spontaneous bacterial peritonitis based on biological indicators
    Liu Zhihui, Niu Xingjie, Zhang Jianhua
    2026, 31(6):  863-868. 
    Asbtract ( 7 )   PDF (927KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To construct a Nomogram prediction model for spontaneous bacterial peritonitis (SBP) in liver cirrhosis (LC) based on biological indicators. Methods A total of 185 LC patients admitted to the Affiliated Hospital of Chengde Medical College from March 2023 to March 2024 were selected, and the incidence of SBP during hospitalization was evaluated. According to whether SBP occurs, the patients were divided into a SBP group and a non-SBP group. The general information and biological indicators of the patients at admission were compared between these two groups. Logistic regression analysis was used to identify the influencing factors of SBP in LC patients. Based on these factors, a nomogram prediction model for SBP in LC patients was constructed. The predictive value of the nomogram prediction model was evaluated using receiver operating characteristic (ROC) curves and decision curves (DCA) methods. Results The incidence of SBP during hospitalization in LC patients was 22.70%. At admission, age, proportion of diabetes, abdominal pain, fever, hepatic encephalopathy, hepatorenal syndrome, the proportion of Child-Pugh grade C, peripheral blood white blood cell count, total bilirubin (TBil), C-reactive protein (CRP), procalcitonin (PCT), and CD64 levels in SBP group were (62.1±7.4) years old, 35.71%, 21.43%, 33.33%, 14.29%, 9.52%, 47.62%, (5.08±1.26) 109/L, (81.35±16.27) μmol/L, (9.06±1.82) mg/L, (0.49±0.12) ng/mL, and (11.63±3.85) ng/mL, respectively, which were higher than those of (56.9±6.8) years old, 13.99%, 8.39%, 16.08%, 2.80%, 1.40%, 23.08%, (4.31±1.15) 109/L, (70.76±14.31) μmol/L, (7.43±1.69) mg/L, (0.31±0.10) ng/mL, (7.28±2.31) ng/mL in the non-SBP group. The albumin (Alb) and FIB levels were (30.06±5.41) g/L and (159.37±46.18) mg/L, respectively, which were lower than those of (35.17±6.84) g/L and (210.45±60.72) mg/L in the non-SBP group (P<0.05). At admission, age, diabetes, hepatic encephalopathy, Child-Pugh grade, Alb, TBil, CRP, PCT, CD64, FIB levels in peripheral blood were all the influencing factors of SBP in LC patients (P<0.05); A nomogram prediction model for the occurrence of SBP in LC patients was constructed based on the influencing factors. The AUC of the prediction model was 0.864 (95%CI=0.796~0.932), with a sensitivity of 83.33%, a specificity of 85.31%, and an accuracy of 86.26% for the occurrence of SBP in LC patients. The nomogram prediction model had a significant positive net benefit and good clinical utility in predicting SBP; the external evaluation results showed that the nomogram prediction model had a sensitivity of 84.00%, a specificity of 83.53%, and an accuracy of 83.64% in predicting SBP in LC patients. Conclusion The Nomogram prediction model for SBP in LC patients based on biological indicators has high predictive value and clinical efficacy, and can provide reliable clinical evidence for early identification of high-risk SBP patients in clinical practice.
    Other Liver Diseases
    Efficacy analysis of DPMAS combined with PE in the treatment of hyperbilirubinemia and assessment of short-term prognosis
    Huang Wenqi, Xu Jinchao, Wu Xiaolu, Jin Wen, Wu Weibing, Yuan Yunxiang, Zhao Yajun, Zhou Qing, Kang Yanneng, Wu Fuzhong, Yang Jiao
    2026, 31(6):  869-872. 
    Asbtract ( 8 )   PDF (489KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To analyze the efficacy of double plasma molecular adsorption system (DPMAS) combined with plasma exchange (PE) in the treatment of hyperbilirubinemia, and clarify the short-term prognostic evaluation efficacy of indocyanine green 15-minute clearance rate(ICGR15). Methods A total of 40 patients with hyperbilirubinemia admitted to Xiamen Humanity Hospital from 2022 to 2025 were selected. Based on their clinical outcomes 12 weeks after admission, they were divided into an improved group (28 cases) and a non-healed group (12 cases). All patients received comprehensive internal medicine treatment plus DPMAS combined with PE. Liver function, coagulation function, and ICGR15 were detected before and after treatment, and a 12-week follow-up was conducted. Results The TBil before treatment and after treatment was (326.5 ± 89.7)μmol/L and (158.3 ± 45.2)μmol/L, respectively (t=16.732, P<0.001); the DBil before treatment and after treatment was (215.6±67.3)μmol/L and (98.7±32.1)μmol/L, respectively (t=16.934,P<0.001); the GGT before treatment and after treatment was (389.4±102.6)IU/L and (198.5±56.3)IU/L, respectively (t=17.737,P<0.001); the PⅢP before treatment and after treatment was (218.7±45.3)ng/mL and (135.4±32.1)ng/mL, respectively (t=18.132,P<0.001); the PTA before treatment and after treatment was (42.3±8.7)% and (65.4±10.3)%, respectively (t=19.325,P<0.001). After treatment, the patients' liver function, coagulation function, and liver fibrosis-related indicators all showed improvement. Before treatment, the ICGR15 of the improved group and the non-healed group was (38.7±6.3)% and (39.1±5.8)%, respectively (t=0.212, P=0.834); after treatment, the ICGR15 of the improved group and the non-healed group was (15.42±4.1)% and (23.56±5.2)%, respectively (t=5.872,P<0.001). The reduction in ICGR15 was greater in the improved group compared to the non-healed group. The AUC of ICGR15 for predicting short-term prognosis reached 0.786(95% CI:0.621～0.912), with an optimal cut-off value of 18.5%, sensitivity and specificity of 77.3% and 75.0%, respectively. The incidence of adverse reactions was 16.7%, which resolved after symptomatic treatment without interrupting the treatment process. Conclusion The combination of DPMAS and PE has a definite therapeutic effect and good safety for hyperbilirubinemia. ICGR15 can reliably evaluate the treatment effect and short-term prognosis, and the combination of the two provides a new basis for precise diagnosis and treatment of the disease.
    Association between metabolic factors and the risk of chronic liver disease in middle-aged and older adults: a cohort study based on CHARLS data
    Bao Huiwei, Jiang Siyu, Guo Kefen, Yuan Liuyuan
    2026, 31(6):  873-878. 
    Asbtract ( 8 )   PDF (1259KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To explore the association of metabolic syndrome and dynamic trajectories of metabolic syndrome scores with the risk of chronic liver disease among middle-aged and older adults in China. Methods Based on data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, 8 479 middle-aged and elderly individuals (≥45 years) without a prior history of chronic liver disease were included. The Cox proportional hazards regression model was used to analyze the independent risk factors for the occurrence of chronic liver disease. The k-means clustering algorithm was applied to identify trajectories of changes in metabolic syndrome scores from 2011 to 2015, and Kaplan-Meier curves were used to evaluate the relationship between different metabolic syndrome score trajectories and the occurrence of chronic liver disease. Results During the 9-year follow-up period, a total of 839 participants (9.90%) newly developed chronic liver disease. Multivariate Cox regression analysis showed that a baseline diagnosis of metabolic syndrome (HR=1.24, 95% CI: 1.07~1.43, P=0.004), a higher baseline metabolic syndrome score (HR=1.19, 95% CI: 1.11-1.27, P<0.001), and a higher metabolic syndrome score in 2015 (HR=1.16, 95% CI: 1.05~1.28, P=0.004) were independent risk factors for the occurrence of chronic liver disease. The trajectories of metabolic syndrome score changes from 2011 to 2015 were further plotted, and based on the trajectory curves, the population was divided into three groups: the high-baseline improvement group, the stable group, and the low-baseline deterioration group. Kaplan-Meier curves showed that the high-baseline improvement group had the highest cumulative incidence of chronic liver disease within 9 years (12.74% vs. 7.88% vs. 7.46%, P=0.002). Conclusion An elevated metabolic syndrome score significantly increases the risk of chronic liver disease in the middle-aged and older adults. Monitoring the dynamic changes of the score and stratifying the population by risk can guide clinical diagnosis and treatment and reduce the risk of liver disease.
    The impact of NAFLD-related indices on brain structure: insights from Mendelian randomization and Bayesian colocalization analysis
    Chen Chong, Wang Jingying, Zheng Yiyuan, Li Yong
    2026, 31(6):  879-885. 
    Asbtract ( 8 )   PDF (5547KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To explore the causal relationship between non-alcoholic fatty liver disease (NAFLD)-related indices and brain structural changes. Methods We selected seven NAFLD-related indices from a genome-wide association study (GWAS) as exposures, and used the data of cerebral cortical thickness and surface area of 51 665 participants from the ENIGMA Consortium as the outcomes. Two-sample Mendelian randomization and Bayesian colocalization were used for analysis. Results The genetically predicted percentage of liver fat was significantly associated with a reduction in the surface area of the parahippocampal region (IVW method: β=-7.871 9 mm2, 95% CI: -11.873 2 mm2～-3.870 5 mm2, P=1.02 × 10-4; MR-Egger method: β=-5.180 3 mm2, 95% CI: -12.014 4 mm2～1.653 8 mm2, P=0.147 1; WM method: β=- 5.501 1 mm2, 95% CI: -11.493 9 mm2～0.491 6 mm2, P=0.072 0). No evidence of horizontal pleiotropy was detected by the MR-Egger intercept test (Egger intercept = -0.236 7, SE=0.248 6, P=0.348 1), and no heterogeneity was observed by Cochran’s Q test (P=0.845 5), and there was no shared genetic variation between the two phenotypes (PPH4 = 0.016 5). Conclusion There is a significant causal relationship between the percentage of liver fat and brain structure, and this effect seems to be driven by factors other than common genetic variants, which supports the concept of the liver-brain axis.
    Clinical value of serum type Ⅳ collagen relative to the upper limit of normal and its combination model in the assessment of hepatic inflammation and fibrosis in metabolic dysfunction-associated steatotic liver disease
    Xu Chengying, Sun Lu, Mao Chengjie, Wang Minying, Lu Zhonghua
    2026, 31(6):  886-890. 
    Asbtract ( 9 )   PDF (935KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To investigate the application value of the Metabolic reaction pathological index (MRPI), a novel non-invasive diagnostic model constructed based on serum type Ⅳ collagen (Ⅳ-C) and pathophysiological dynamics, in evaluating significant liver fibrosis (≥F2) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Methods A retrospective analysis was conducted on the clinical data of 202 MASLD patients who underwent liver biopsy at the Fifth People′s Hospital of Wuxi from January 2017 to December 2025. The MRPI model was established based on the non-linear relationship among hepatic microstructural remodeling, mitochondrial injury, and metabolic load. Using the FIB-4 index as a control, the diagnostic efficacy of MRPI for significant liver fibrosis was analyzed using receiver operating characteristic (ROC) curves. Results The median serum type Ⅳ collagen in the significant fibrosis group was significantly higher than that in the non-significant group[80.00 ng/mL vs. 37.00 ng/mL, P<0.001]. The area under the curve (AUC) of the MRPI model for diagnosing significant liver fibrosis was 0.857 (95% CI: 0.808~0.904), which was significantly superior to that of the FIB-4 index[0.749 (95% CI: 0.688~0.817), P<0.001]. At the optimal cut-off value of 2.442, the specificity and sensitivity of MRPI were 93.1% and 61.4%, respectively, with its specificity being significantly higher than that of FIB-4 (65.3%). Conclusion The MRPI model, constructed by combining serum type Ⅳ collagen with metabolic and inflammatory indicators, effectively reflects the pathophysiological process of fibrosis progression in MASLD and demonstrates high specificity and diagnostic efficacy.
    Etiological distribution and factors influencing disease severity in elderly patients with drug-induced liver injury
    Liu Min, Zuo Dan, Miao Ruitian, Gao Yanfen
    2026, 31(6):  891-895. 
    Asbtract ( 7 )   PDF (521KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To investigate the distribution of causative drugs in elderly patients with drug-induced liver injury (DILI) and to analyze the factors associated with disease severity, as well as the histopathological characteristics of liver tissue. Methods The clinical data of 86 elderly patients with DILI treated at the No. 904 Hospital of the Joint Logistics Support Force and Qingdao Municipal Hospital were retrospectively collected and analyzed. According to the severity of the disease, patients were divided into a mild group (n=51) and a severe group (n=35). Differences in general characteristics, underlying diseases, medication status, and laboratory indicators between the two groups were compared. Liver histopathological examination was performed in 40 patients (24 in the mild group and 16 in the severe group), and the histological changes between the two groups were analyzed. Multivariate logistic regression analysis was used to identify independent risk factors associated with severe DILI in elderly patients. Results A total of 161 suspected causative drugs were identified among the 86 patients, including single-drug use in 47 cases (54.6%) and multiple-drug use in 39 cases (45.4%). Compared with the mild group, the severe group had a higher proportion of patients with malignant tumors[42.9% vs. 21.6%] and a higher proportion of multiple drug use[62.9% vs. 37.3%] (P<0.05). Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) were significantly higher in the severe group than in the mild group[ALT: 465 (266, 814) U/L vs. 214 (123, 394) U/L; AST: 398 (211, 697) U/L vs. 178 (95, 312) U/L; ALP: 212 (142, 390) U/L vs. 165 (94, 280) U/L] (P<0.05). Meanwhile, total bilirubin (TBil), international normalized ratio (INR), and serum creatinine (Scr) levels were significantly increased in the severe group[TBil: (92.5±25.7) μmol/L vs. (28.4±6.3) μmol/L; INR: (1.3±0.3) vs. (1.1±0.2); Scr: (97.8±17.6) μmol/L vs. (82.5±11.4) μmol/L], whereas albumin (Alb) levels were significantly lower[(35.6±5.3) g/L vs. (39.2±4.1) g/L] (P<0.05). Liver histopathological results showed that the scores of hepatocyte necrosis (1.7±0.5 vs. 0.9±0.3), inflammatory activity (1.9±0.7 vs. 1.1±0.4), ballooning degeneration (1.2±0.3 vs. 0.6±0.2), the degree of steatosis (19.7±5.1 vs. 14.5±3.2), and liver fibrosis (2.0±0.6 vs. 1.2±0.4) were all higher in the severe group than in the mild group (P<0.05), and the incidence of cholestasis was also significantly higher (62.5% vs. 25.0%, P<0.05). Multivariate logistic regression analysis indicated that age, malignant tumors, multiple drug use, elevated TBil, elevated INR, and increased liver fibrosis score were independent risk factors for severe DILI in elderly patients, whereas higher Alb levels were a protective factor (P<0.05). Conclusion The severity of DILI in elderly patients is closely associated with age, malignant tumors, multiple drug use, and indicators of liver function injury. Severe DILI is often characterized by more pronounced hepatocyte necrosis, inflammatory responses, and fibrosis, accompanied by cholestasis.
    Clinical characteristics and prognosis of drug-induced liver injury caused by tripterygium wilfordii in patients with rheumatoid arthritis
    You Hong, Qian Xianzhong, Sun Shu, Hu Yanrong, Lu Jiayun
    2026, 31(6):  896-899. 
    Asbtract ( 8 )   PDF (360KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To investigate the clinical phenotype characteristics and prognostic differences of drug-induced liver injury (DILI) caused by Tripterygium wilfordii in patients with rheumatoid arthritis (RA), and to provide evidence for early identification and risk stratification management of Tripterygium wilfordii-related liver injury. Methods Patients with RA who developed DILI after treatment with Tripterygium wilfordii were enrolled. Based on liver biochemical parameters at onset, the R ratio was calculated and patients were classified into hepatocellular, cholestatic, and mixed DILI phenotypes. Onset characteristics, baseline clinical data, laboratory findings, treatment course, and prognostic outcomes were compared among the different phenotypes. Results A total of 96 patients with Tripterygium wilfordii–associated drug-induced liver injury (DILI) were included, comprising 45 cases of hepatocellular type, 35 cases of cholestatic type, and 16 cases of mixed type. Patients with hepatocellular DILI had the shortest time to onset[28 (18, 41) days] and the highest proportion of acute onset (62.2%), whereas those with cholestatic and mixed DILI showed significantly delayed onset[56 (38, 82) days and 43 (29, 65) days, respectively] and markedly higher rates of concomitant jaundice (60.0% and 56.3%, respectively; all P<0.05). Laboratory findings revealed markedly elevated ALT levels in the hepatocellular group[612 (388, 945) U/L], while ALp[386 (291, 524) U/L and 312 (236, 418) U/L] and total bilirubin (TBil)[68.4 (45.2, 103.7) μmol/L and 52.1 (34.6, 78.9) μmol/L] levels were significantly higher in the cholestatic and mixed groups than in the hepatocellular group (all P<0.05). During treatment, the rates of ursodeoxycholic acid use (62.9% and 50.0%), glucocorticoid use(42.9% and 43.8%), hospitalization (60.0% and 50.0%), and length of hospital stay[14 (10, 19) days and 12 (9, 16) days] were all significantly higher in the cholestatic and mixed groups compared with the hepatocellular group (P<0.05). In terms of prognosis, the hepatocellular group showed the highest rate of complete liver function recovery (91.1%) and the shortest ALT normalization time[46 (32, 68) days], whereas delayed recovery occurred in 51.4% and 43.8% of patients in the cholestatic and mixed groups, respectively, and chronic DILI developed in 20.0% and 18.8% of patients, respectively (P<0.05 or a trend toward difference). Conclusion DILI caused by Tripterygium wilfordii in patients with RA exhibits marked heterogeneity across clinical phenotypes. Significant differences exist among DILI phenotypes in onset patterns, clinical course, and prognostic outcomes, with cholestatic and mixed phenotypes associated with slower recovery and poorer prognosis. Clinical phenotyping of DILI is helpful for early risk assessment and individualized management of Tripterygium wilfordii-related liver injury.
    Clinical efficacy of ERCP in the treatment of common bile duct stones and analysis of risk factors for postoperative recurrence
    Tang Yan, Xu Qian
    2026, 31(6):  900-904. 
    Asbtract ( 8 )   PDF (433KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To investigate the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of common bile duct (CBD) stones and to analyze the risk factors associated with postoperative stone recurrence, so as to provide evidence for recurrence prevention and optimization of treatment strategies. Methods Clinical data of patients with CBD stones treated by ERCP at the PLA Joint Logistics Support Force No.904 Hospital from January 2022 to December 2024 were retrospectively analyzed. According to whether recurrence of CBD stones occurred during follow-up, patients were divided into a recurrence group (n=16) and a non-recurrence group (n=55). Baseline characteristics, ERCP-related factors, postoperative complications, and short-term outcomes were compared between the two groups, and independent risk factors for postoperative recurrence were explored. Results A total of 71 patients were included, comprising 16 patients in the recurrence group (22.5%) and 55 patients in the non-recurrence group (77.5%). The mean age of the recurrence group was (68.4 ± 9.2) years, which was significantly higher than that of the non-recurrence group[(61.7 ± 10.5) years, P<0.05]. The proportion of patients with diabetes mellitus was 43.8% (7/16) in the recurrence group, higher than 18.2% (10/55) in the non-recurrence group (P<0.05). Regarding ERCP-related factors, the maximum stone diameter in the recurrence group was (1.5 ± 0.4) cm, significantly larger than that in the non-recurrence group[(1.1 ± 0.4) cm, P<0.05]. The proportion of multiple stones was 68.8% (11/16) in the recurrence group, higher than 36.4% (20/55) in the non-recurrence group (P<0.05). The rate of biliary stent placement was 56.3% (9/16) in the recurrence group, compared with 27.3% (15/55) in the non-recurrence group (P<0.05). The postoperative hospital stay was longer in the recurrence group[(9.4±2.1) days] than in the non-recurrence group[(7.6±1.8) days, P<0.05]. On postoperative day 3, ALT[(78.5±21.3) U/L] and TBil[(32.6±8.4) μmol/L] levels in the recurrence group were significantly higher than those in the non-recurrence group[(61.2±18.7) U/L and (24.1±6.9) μmol/L, respectively; P<0.05]. The postoperative residual stone rate was 25.0% (4/16) in the recurrence group, significantly higher than 5.4%(3/55) in the non-recurrence group (P<0.05). The clinical cure rate was 75.0% (12/16) in the recurrence group, lower than 92.7% (51/55) in the non-recurrence group (P<0.05). Multivariate logistic regression analysis demonstrated that age ≥65 years (OR=2.84, 95%CI: 1.12~7.21), diabetes mellitus (OR=3.16, 95%CI: 1.18~8.46), maximum stone diameter ≥1.5 cm (OR=4.02, 95%CI: 1.45~11.18), multiple stones (OR=2.67, 95%CI: 1.01~7.06), and biliary stent placement (OR=2.91, 95%CI: 1.09~7.79) were independent risk factors for postoperative recurrence (P<0.05). Conclusion ERCP is a safe and effective treatment for CBD stones; however, there remains a certain risk of postoperative recurrence. Advanced age, diabetes mellitus, a higher stone burden, and biliary stent placement significantly increase the risk of stone recurrence. Enhanced perioperative management and postoperative follow-up are warranted for high-risk patients to reduce recurrence and improve long-term outcomes.