Loading...

Table of Content

    31 March 2025, Volume 30 Issue 3
    Previous Issue    Next Issue
    Liver Fibrosis & Cirrhosis
    The application and influencing factors of endoscopic ultrasound in measuring portal vein pressure gradient in patients with liver cirrhosis and portal hypertension
    MA Ying-hui, LIN He, WANG Lei, ZHANG Yu, ZHAO Ya-li
    2025, 30(3):  301-304. 
    Asbtract ( 12 )   PDF (395KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To explore the application and influencing factors of endoscopic ultrasound in the measurement of portal pressure gradient of patients with liver cirrhosis and portal hypertension.Methods A total of 122 patients with suspected cirrhosis and portal hypertension admitted to Beijing You'an hospital from January 2022 to October 2023 were selected as the study subjects. The general information of the study subjects, measured values of portal vein pressure gradient (PPG), hepatic vein pressure gradient (HVPG), and surgical related indicators were recorded. The measurement values of PPG and HVPG in patients with and without cirrhosis portal hypertension, and the measurement values of PPG and HVPG in cirrhotic patients with different portal hypertension degrees and liver function levels wer compared, and the diagnostic value of PPG values for cirrhosis portal hypertension and its severity were analyzed through the area under the curve (AUC) of receiver operating curve (ROC).Results The surgical success rate of PPG value guided by endoscopic ultrasound in this study was 98.4%. The PPG value measured by EUS method was (18.74±10.1) mmHg, while the HVPG value measured by jugular vein puncture was (19.06±8.2) mmHg (t=0.269, P=0.788), There was no significant difference between the values of the two groups. The PPG value of (10.7±3.3) mmHg in the group without portal hypertension was significantly lower than that of (20.7±10.5) mmHg in the group with portal hypertension (t=5.646, P=0.000). The PPG value of (16.2±4.1)mmHg in the mild portal hypertension group was significantly lower than that of (25.2±7.6) mmHg in the severe portal hypertension group, (t=7.230, P=0.000). The PPG values of children with liver function grades A, B, and C were (16.2±8.3) mmHg, (18.9±7.3) mmHg, and (17.3±8.8) mmHg (t=1.657, P=0.195), respectively. ROC curve analysis shows that PPG measurement values have good diagnostic values for diagnosing portal hypertension (0.981, P=0.000) and the severity of portal hypertension (0.947, P=0.000).Conclusion For the diagnosis of patients with liver cirrhosis and portal hypertension, ultrasound guided PPG measurement can be used, instead of HVPG measurement, which provide a new mean for the diagnosis and evaluation portal hypertension in patients with liver cirrhosis.
    A preliminary exploration for the diagnosis and treatment of pseudocirrhosis
    HE Yang, YANG Bo-shuai, HOU Yi-bin, ZHOU Su, YUAN Min
    2025, 30(3):  305-309. 
    Asbtract ( 14 )   PDF (1210KB) ( 2 )  
    References | Related Articles | Metrics
    Objective In recent years, the incidence of metastatic liver cancer-related pseudocirrhosis has been gradually increasing However, there is a lack of research about pseudocirrhosis in China at present. Here we have made a preliminary exploration.Methods A retrospective study was performed on 346 patients with metastatic liver cancer admitted from January 2018 to December 2023, and the diagnosis of pseudocirrhosis was retrospectively analyzed, and the clinical features, related complications, diagnosis, treatment, and prognosis were statistically analyzed. A prospective study was conducted on 4 patients with pseudocirrhosis from September 2023 to July 2024 to explore feasible diagnostic procedures, treatment methods, and outcomes.Results Twenty-three cases of pseudocirrhosis were retrospectively diagnosed, with an incidence rate of 6.6%, the median time from the diagnosis of metastatic liver cancer to the discovery of pseudocirrhosis was 23 months, 19/23 (82.6%) had multiple tumor metastases (>10 lesions), 11/23 cases (47.8%) had stable or responding disease at the time of pseudocirrhosis diagnosis. Compared with the control group, patients with pseudocirrhosis had lower platelet count and higher total bilirubin (P<0.001), 20/23 (86.9%) with ascites, 5/23 (21.7%) had newly developed splenomegaly, 8/23 (34.8%) of esophagogastric varices, 1/23 (4.3%) of hepatic encephalopathy, 16/18 (88.9%) of high serum albumin ascites gradient, and 19/23 (82.6%) of patients had been treated with oxaliplatin during the course of the disease. The median survival after diagnosis of pseudocirrhosis was 10 months. In the prospective study, 4 patients with pseudocirrhosis, 1 case with a large amount of ascites effusion who was treated by a combination of non-selective beta-blocker medication significantly improved the symptoms. Another patient with splenomegaly and thrombocytopenia resumed anti-tumor treatment after partial splenic embolization, and the patient’s condition remained stable for a long time.Conclusion Pseudocirrhosis is not rare in long-term survival patients with metastatic liver cancer, An early identification and diagnosis are crucial. Immediate cessation the use of potential inducing drugs or treatment may reverse the condition. A combined treatment with NSBB medication after the onset of pseudocirrhosis can improve symptoms. PSE and TIPS have certain value for the treatment of complications associated with the occurrence of portal hypertension.
    The diagnostic value of non-invasive diagnostic indicators such as liver hardness-spleen diameter/platelet ratio (LSPS) for predicting high-risk oesophageal varicose veins (HERV) in liver cirrhotic patients
    SUN Wei, YU Hong, NIU Li-na, LONG Qiang, DOU Jing, LIU Yun-xiao, GUO Feng, WANG Xiao-zhong
    2025, 30(3):  310-315. 
    Asbtract ( 14 )   PDF (490KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To evaluate the diagnostic value of non-invasive diagnostic indicators such as liver hardness-spleen diameter/platelet ratio (LSPS) in predicting patients with high-risk oesophageal varicose veins (HERV) in liver cirrhosis.Methods A total of 143 patients with liver cirrhosis who were hospitalized in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University from March 2022 to March 2023 were enrolled in this study. Their clinical data and serological indicators were collected. Electronic gastroscopy, abdominal ultrasound and liver instantaneous elastic imaging (LSM) were conducted at the same time in all patients. Taking gastroscopy as the gold standard, the patients are divided into a high-risk varicose and a non-high-risk varicose groups. LSPS, varicose risk score, PH score, FIB-4, APRI and GPR were calculated, and the working characteristics (ROC) curve of the subjects were drawn to evaluate the efficacy of these non-invasive models for the diagnosis of HERV.Results (1) Within the 143 cases included in this study, 63 patients had high-risk varicose veins and 80 patients had non-high-risk varicose veins. (2) When compared with the non-high-risk varicose veins group, the serological indicators, imaging indicators (portal vein diameter, spleen thicknes, spleen length) and liver function scores (CTP, MELD), the non-invasive diagnostic indicators such as LSPS, PH score, risk score of varicose veins, LSM, FIB-4, APRI and GPR of patients in the high-risk varicose group were significantly different (P<0.05). (3) The area under the curve (AUC) for the non-invasive diagnostic index is LSPS: 0.865 (95%CI 0.806～0.923), PH score: 0.856 (95%CI 0.796～0.917), static pulse risk score: 0.855 (95%CI 0.795～0.916), FIB-4:0.817 (95%CI 0.744～0.890), APRI: 0.766 (95%CI 0.686～0.846), CTP score: 0.761 (95%CI 0.680～0.843), LSM: 0.740 (95%CI 0.660～0.821), MELD score: 0.693 (95%CI 0.607～0.780) and GPR: 0.667 (95%CI 0.575～0.758). (4) Compared with the joint index of non-invasive diagnosis and the individual index, the diagnostic efficacy of HERV was not significantly improved.Conclusion LSPS has good diagnostic value for HERV, which is better than other individual non-invasive diagnostic indicators and joint models.
    The predictive value of LSPS combined with GBWT for esophageal and gastric varices bleeding post endoscopic treatment
    LI Xia, ZENG Yuan, ZUO Na, LI Jia-ying, LU Yi
    2025, 30(3):  316-318. 
    Asbtract ( 15 )   PDF (313KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To investigate the predictive value of Liver stiffness-spleen diameter-to-patelet ratio score (LSPS) combined with Gall bladder wall thickeness (GBWT) for esophageal and gastric varices bleeding post endoscopic treatment.Methods A total of 90 patients with hepatitis B-related cirrhosis and esophagogastric varices who received endoscopic variceal ligation, sclerosing agent injection, and tissue adhesive injection during hospitalization in the Second People's Hospital of Pingxiang from January 2020 to April 2024 were selected. According to whether bleeding occurred post treatment, they were divided into a bleeding group (22 cases) and a non-bleeding group (68 cases). The age, GBWT, platelet, alanine aminotransferase (ALT), hemoglobin, creatinine, LSPS, and CTP scores of the two groups were observed and compared. Through univariate analysis of the differences in the above indicators, variables with P<0.05 were included in binary logistic regression analysis to screen out independent risk factors of bleeding after endoscopic treatment. The receiver operating characteristic curve (ROC) was drawn, and the value of LSPS combined with GBWT in predicting esophagogastric varices bleeding after endoscopic treatment was evaluated according to the area under the ROC curve (AUC), and to determine the best cut-off point, sensitivity and specificity for predicting bleeding after endoscopic treatment of esophagogastric varices.Results Univariate analysis showed that there were significant differences in LSPS and GBWT between the two groups (P<0.01). Binary logistic regression analysis showed that LSPS and GBWT of the two groups were independently associated with bleeding after endoscopic treatment of esophageal and gastric varices (P<0.05). ROC analysis showed that the AUC of LSPS and GBWT in the two groups were 0.961 and 0.898, the best cut-off points were 11 and 2.5, the sensitivity were 0.818 and 0.864, and the specificity were 0.971 and 0.779, respectively.Conclusion LSPS and GBWT are independent risk factors for bleeding post endoscopic treatment of esophagogastric varices. LSPS combined with GBWT has a higher predictive value for bleeding after endoscopic treatment.
    An analysis on the efficacy of CT parameters combined with FIB-4 and serum BNP, HIF-1α levels in predicting esophageal varices in patients with hepatitis B-related cirrhosis
    SONG Ying-yu, WANG Yan, ZHANG Hong
    2025, 30(3):  319-321. 
    Asbtract ( 18 )   PDF (324KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To analyze the efficacy of CT parameters combined with fibrosis-4 factor (FIB-4), serum brain natriuretic peptide (BNP), and hypoxia-inducible factor-1α (HIF-1α) levels in predicting esophageal varices (EV) in patients with hepatitis B-related cirrhosis.Methods This study included 106 patients with hepatitis B-related cirrhosis admitted to the Second People's Hospital of Mengcheng from June 2022 to June 2024. According to the presence of EV, patients were divided into an EV group (50 cases) and a non-EV group (56 cases). All patients underwent CT examination. Professional software was used to measure liver and spleen volumes, as well as to record the diameters of the main portal vein (MPV), splenic vein (SPV), and left gastric vein (LGV), FIB-4 was calculated, and serum BNP and HIF-1α levels were measured using the ELISA method. The efficacy of combined prediction for EV was evaluated using ROC curves.Results The spleen volume, MPV, LGV, FIB-4, serum BNP, and HIF-1α levels in the EV group were (592.33±83.30) cm3, (15.31±1.50) mm, (6.04±1.10) mm, (5.97±1.46), (183.23±21.38) pg/mL, and (22.14±5.03) pg/L, respectively, which were higher than those in the non-EV group [(457.70±77.46) cm3, (12.25±1.22) mm, (4.53±0.62) mm, (4.58±0.95), (161.36±16.75) pg/mL, (17.57±4.27) pg/L] (P<0.05). The combined sensitivity and specificity of spleen volume, MPV, LGV, FIB-4, BNP, and HIF-1α were 94.0% and 92.9%, respectively, with an AUC of 0.954.Conclusion The combination of CT parameters, FIB-4, serum BNP, and HIF-1α levels demonstrates good efficacy in predicting the occurrence of EV in patients with hepatitis B-related cirrhosis, making it worthy of clinical application. This combined predictive method not only enhances the accuracy of assessing the risk of esophageal varices but also provides effective intervention guidelines for clinicians, and contributes to improving patient outcomes.
    The epidemiological characteristics of cirrhosis in Mianyang city of China in recent five years
    LI Ling, XIAO Ting-ting, LI Shu-mei
    2025, 30(3):  322-325. 
    Asbtract ( 14 )   PDF (607KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To provide reference for prevention and treatment of cirrhosis in Chinese people in the new era by analyzing the epidemiological characteristics and changes of different types of cirrhosis in recent five years.Methods A total of 2201 patients with cirrhosis were collected from January 2017 to December 2021 in the first People's Hospital of Mianyang city, Sichuan, China. Fisher's Exact Test was used to analyze the differences of age, sex, etiology and complications in patients with cirrhosis, and to analyze the alteration trends in etiologies.Results The average age of 2201 patients with cirrhosis was (58.64 ± 12.78) years, among them, the age of post-hepatitis B cirrhosis was the youngest (55.23 ± 11.58 years), and the age of Alcoholic cirrhosis was the oldest (68.67 ± 11.02 years). Most of the patients with cirrhosis were male (69.70%), and most of them were post-hepatitis B cirrhosis and Alcoholic cirrhosis. The ratio of male to female in Autoimmune cirrhosis was inversely proportional (1∶3.52) . The most common etiology of cirrhosis was hepatitis B-related cirrhosis (1238 cases, 56.25%), followed by Alcoholic cirrhosis (177 cases, 8.04%), cirrhosis caused by Schistosomiasis has been decreasing in recent two years. The common complications of cirrhosis were Spontaneous bacterial peritonitis (23.53%), primary liver cancer (20.45%), Upper gastrointestinal bleeding (13.63%) and Hepatic encephalopathy (7.31%). Among them, Spontaneous bacterial peritonitis was common in hepatitis B-related cirrhosis (30.29%) and alcoholic cirrhosis (22.03%), primary liver cancer was common in hepatitis B-related cirrhosis (28.11%) and hepatitis C-related cirrhosis (18.99%) .The most common Upper gastrointestinal bleeding were hepatitis C-related cirrhosis (18.35%) and autoimmune cirrhosis (11.11%) .Conclusion At present, the epidemiological characteristics of cirrhosis in our country are changing. The type of hepatitis B-related cirrhosis is still the most common, yet the trend is decreasing year by year. On the contrary, the trend of alcoholic cirrhosis is increasing year by year. Spontaneous bacterial peritonitis and primary liver cancer are the most common complications of cirrhosis, The incidences of different complications in patients with different etiologies of cirrhosis are however significantly different.
    Dynamic changes in regional neural activity and its relationship with clinical behavior of patients with mild hepatic encephalopathy using resting state functional magnetic resonance imaging
    XIE Xiao-zhen, YANG Xiao-liang, LIU Wen-feng
    2025, 30(3):  326-329. 
    Asbtract ( 14 )   PDF (410KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To analyze the dynamic changes of regional neural activity in patients with mild hepatic encephalopathy (MHE) using resting state functional magnetic resonance imaging and its relationship with clinical behavior.Methods Thirty MHE patients who were diagnosed and treated in Joint Logistics Support Force 904 Hospital between March 2020 and March 2022 were selected as the disease group, 30 healthy volunteers who underwent physical examinations in 904 hospital in Wuxi during the same period of time were selected as the control group. Both groups underwent resting state functional magnetic resonance imaging, digital connectivity test A (NCT-A), digital sign test (DST), and Montreal Cognitive Assessment Scale (MoCA) evaluations. The time variability of dynamic local consistency (dReHo) was calculated using a sliding time window, and the temporal dynamic characteristics of local consistency (ReHo) in the brain region of MHE patients were evaluated. Pearson correlation test was used to analyze the variability of dReHo and NCT-A The correlation between DST and MoCA scores.Results The time required for NCT-A in the disease group was (72.5±7.6) seconds, which was longer than that in the control group (35.9±5.4) seconds. The DST and MoCA scores were (25.2±3.6) points and (21.0±2.2) points, respectively, which were lower than those of (48.6±6.5) points and (26.1±3.8) points in the control group (all P<0.05). Through one-way ANOVA, it was found that there were significant differences in dReHo between the disease group and the control group in the left middle frontal gyrus, inferior frontal gyrus, globus pallidus, hippocampus, right middle frontal gyrus and inferior temporal gyrus (P<0.05). In order to further explore the correlation between dReHo and MoCA score, correlation analysis showed that MoCA score was negatively correlated with the dReHo value of the right middle frontal gyrus and infratemporal gyrus, respectively (r=-0.5, 0.7, P<0.05).Conclusion The coordination and consistency of brain activity in MHE patients are abnormal, and resting state functional magnetic resonance imaging (dReHo) analysis has potential value in monitoring the condition of MHE, providing neuroimaging evidence for elucidating the underlying neuropathological mechanisms of MHE patients.
    Risk factors of esophageal and gastric varices rupture and bleeding in chronic hepatitis B cirrhosis
    BENG Guo-ping, YIN Rong-hua, YANG Li
    2025, 30(3):  330-335. 
    Asbtract ( 13 )   PDF (624KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To analyze the risk factors of esophageal variceal bleeding (EGVB) complicated with chronic hepatitis B (CHB) cirrhosis, and to provide reference for primary prevention and intervention treatment.Methods A total of 274 CHB cirrhosis patients with esophageal and gastric varices (EGV) admitted to the People’s Hospital of Hai’an City from January 2021 to December 2023 were involved in the study. According to whether EGVB occurred during admission or hospitalization, the subjects were divided into EGVB group (n=55) and non-EGVB group (n=219). Baseline data, serological and imaging indicators were collected. Univariate and multivariate logistic analysis were conducted to analyze the influencing factors and independent risk factors of EGVB in patients with CHB cirrhosis and EGV. The predictive value of each independent influencing factor was analyzed by receiver operating curve (ROC).Results EGVB occurred in 55 of 274 CHB cirrhosis patients with EGV (20.07%). The duration of cirrhosis, history of accidental trauma, history of portal vein thrombosis (PVT), hypersensitivity C-reactive protein (hs-CRP), positive red sign, portal vein diameter (PVD), liver hardness value (LSM), Child-Pugh grade C and model of end-stage liver disease (MELD) scores in EGVB group were 14.35±4.38 years, 16.36%, 23.64%, 11.07 mg/L, 83.64%, 17.52±2.48 mm, 20.47±3.65 kPa, 47.27% and 19.58±2.46 min respectively. They were higher than that in the non-EGVB group (12.46±4.15 years, 5.02%, 8.68%, 9.16 mg/L、31.51%、14.35±2.07 mm, 15.39±2.84 kPa, 19.63% and 16.28±2.4 min). The non-selective β-blocker (NSBB) treatment history and portal blood flow peak (PPV) in EGVB group were 29.10% and 0.13 m/s, which were lower than those in non-EGVB group (19.63% and 0.17 m/s). The above differential analyses all have statistical differences (t/χ2= 5,263, 3.482, 3.618, 5.068, 6.127, 7.629, 7.314, 4.576, 7.136, 3.482, 4.359, all P<0.05). Logistics regression analysis showed that positive red sign, elevated PVD and LSM, and Child-Pugh grade C were independent risk factors for EGVB in patients with CHB cirrhosis (95%CI 3.126-9.483, 3.457-11.296, 2.653-7.527, 1.735-6.428, 95%CI 3.126-9.483, 3.457-11.296, 2.653-7.527, 1.735-6.428). OR=4.715, 5.283, 4.129, 3.176, all P<0.05); Treatment history of NSBBs was a protective factor (95%CI 1.275-5.013, OR=2.461, P<0.05). ROC analysis showed that the area under the curve (AUC) of NSBB treatment history, positive red sign, elevated PVD and LSM, and Child-Pugh grade C were 0.702, 0.784, 0.827, 0.851 and 0.735, respectively. The sensitivity was 72.72%, 81.82%, 87.27%, 74.55%, 83.64%, and the specificity was 70.91%, 89.09%, 83.64%, 80.00%, 78.18% (all P<0.01).Conclusion NSBB treatment history, positive red sign, elevated PVD and LSM, and Child-Pugh grade C are the influencing factors for EGVB in patients with CHB cirrhosis.
    Liver Cancer
    Clinical efficacy analysis of capecitabine peritoneal arterial perfusion chemotherapy combined with cindilimab and bevacizumab injection in patients with unresectable hepatic cancer
    TAO Ting, SUN Juan
    2025, 30(3):  336-339. 
    Asbtract ( 11 )   PDF (408KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To evaluate the clinical efficacy of capecitabine peritoneal arterial perfusion chemotherapy combined with cindilimab and bevacizumab injection in patients with unresectable hepatic cancer.Methods Between April 2017 and October 2023, 81 patients with unresectable liver cancer admitted to our hospital were included in this study. Using a random number table method, patients were divided into an EPI group (n=40, receiving pirarubicin intraperitoneal arterial perfusion chemotherapy) and a trial group (n=41, receiving additional sintilimab and bevacizumab injection on basis of the EPI treatment). The clinical outcomes, changes of tumor markers in liver cancer, liver function, quality of life, and adverse events were compared between the two groups.Results After four weeks of treatment, the Objective response rate (ORR) in the trial group was found to be higher than that in the EPI group (P<0.05). After treatment, the levels of alpha-fetoprotein (AFP), vascular endothelial growth factor (VEGF), and β-catenin in the trial group were (185.21±42.87) ng/mL, (126.12±30.94) pg/mL, and (267.45±41.77) pg/L, respectively, all of which were lower than those in the EPI group [(234.19±60.12) ng/mL, (173.09±44.03) pg/mL, (398.72±52.83) pg/L, P<0.05]. Similarly, the levels of ALT [(62.18±6.94) U/L] and AST [ (34.09±2.71) U/L] in the trial group were lower than those in the EPI group [(94.89±8.78) U/L, (66.34±3.91) U/L, P<0.05]. Conversely, the level of total bilirubin (TBIL) was higher in the trial group [(33.64±4.03) μmol/L], compared to (27.42±2.97) μmol/L in the EPI group (P<0.05). Additionally, the Karnofsky performance status (KPS) scores at two weeks (68.18±2.94) and three months (62.45±2.93) after treatment were higher in the trial group, compared to (63.76±2.71) and (62.45±2.93) in the EPI group (P<0.05).Conclusion Capecitabine peritoneal arterial perfusion chemotherapy combined with cindilimab and bevacizumab injection significantly can enhance the quality of life and immune function of patients with unresectable hepatic cancer, and reduce tumor marker levels, which is safe for clinical use and is supported for a broader clinical application.
    Observation of the therapeutic effect of bevacizumab combined with programmed death receptor-1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors in the treatment of primary liver cancer
    LI Da-wei, XUE Le-gang, LIU Xiao-fen
    2025, 30(3):  340-342. 
    Asbtract ( 10 )   PDF (308KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To investigate the efficacy of bevacizumab combined with programmed death receptor-1 (PD-1) / programmed death ligand 1 (PD-L1) inhibitors in the treatment of primary liver cancer (HCC) patients.Methods From June 2020 to February 2024, 80 cases of HCC were enrolled in our hospital. A control group (40 cases) and an observation group (40 cases) were randomly assigned according to a random number table. The patients in control group were treated by PD-1/PD-L1 inhibitor, and the patients in observation group were treated by PD-1/PD-L1 inhibitor and bevacizumab. The clinical efficacy, levels of alpha fetoprotein (AFP), alanine aminotransferase (ALT), vascular endothelial growth factor (VEGF), aspartate aminotransferase (AST), carbohydrate antigen 199 (CA199), albumin (ALB), and safety were compared between two groups.Results The results showed that the therapeutic effect was better in the observation group (95.00%) than that in the control group (75.00%) (P<0.05). After treatment, the observation group had lower levels in VEGF[(85.38 ± 7.26) pg/mL], AFP [(89.62 ± 7.65) ng/mL], and CA199 [(47.13 ± 9.66) U/mL] when compared with the control group [(102.21 ± 10.34) pg/mL (VEGF), (108.35 ± 10.76) ng/mL (AFP), (58.61 ± 10.12) U/mL (CA199)], (P<0.05). The observation group showed a better improvement in the levels of AST [(50.39 ± 5.11) U/L], ALT [(30.57 ± 3.26) U/L], and ALB [(44.26 ± 4.01) g/L] when compared to the control group [(55.32 ± 5.26) U/L, (35.45 ± 3.24) U/L, and (39.42 ± 3.86) g/L) (P<0.05)]. The safety of the two groups was comparable (P>0.05).Conclusion The combination of bevacizumab and PD-1/PD-L1 inhibitors can reduce the levels of relevant serum tumor markers in patients with primary liver cancer, and improve the liver function with a great safety.
    Predictive value of aMAP risk score combined with liver stiffness measurement for hepatocellular carcinoma associated with hepatitis B cirrhosis
    KANG Ya, MA Jin-xin
    2025, 30(3):  343-346. 
    Asbtract ( 10 )   PDF (465KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To evaluate the predictive performance of aMAP score combined with liver stiffness measurement (LSM) for hepatocellular carcinoma associated with hepatitis B cirrhosis.Methods A total of 416 patients with hepatitis B cirrhosis were selected to calculate the aMAP score and evaluate the predictive performance of the aMAP combined with LSM model.Results The predictive performance of aMAP+LSM is the highest, superior to that of aMAP and LSM alone, with corresponding AUROCs of 0.748 (0.703-0.789), 0.697 (0.650-0.740), and 0.721 (0.676-0.764), respectively. The optimal critical value of LSM is 15.35 kPa, with a sensitivity of 70.0% and a specificity of 68.5%. The 3-year and 5-year cumulative incidence rate of hepatocellular carcinoma in high-risk group was higher than that in intermediate and low-risk group (P<0.05), which were 4.5%, 14.5%, 0.0%, 5.8%, 0.0% and 0.0%, respectively. In the intermediate-risk group, when LSM>15.35 kPa, the 3-year and 5-year cumulative incidence rate of HCC is 10.0% and 20.0%, and when LSM<15.35 kPa, the 3-year and 5-year cumulative incidence rate of HCC is only 0.0% and 0.6% (P<0.05).Conclusion The predictive performance of aMAP combined with LSM model is better than that of aMAP score alone, and the variables involved are simple and easy to obtain, making it easy for clinical screening. The optimal critical value of LSM is 15.35 kPa. In the medium risk group, compared with LSM<15.35 kPa, the cumulative incidence rate of hepatocellular carcinoma increased significantly when LSM>15.35 kPa. It should be managed according to the high-risk population of aMAP to screen hepatocellular carcinoma.
    Diagnostic value of MRI combined with serum KLF5 and PIVKA-Ⅱ in liver focal nodular hyperplasia
    YANG Ming, XING Wei-hong, LI Ruo-xu, DONG Fa-fa, HOU Yi-xuan
    2025, 30(3):  347-351. 
    Asbtract ( 16 )   PDF (590KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To explore the diagnostic value of magnetic resonance imaging (MRI) combined with serum Kruppel like factor 5 (KLF5) and abnormal prothrombin (PIVKA-II) in liver focal nodular hyperplasia.Methods From March 2020 to March 2023, 146 confirmed patients with liver nodular hyperplasia treated in our hospital were regarded as subjects. Based on pathological examination as the gold standard, they were grouped into two groups according to the examination results: the liver focal nodular hyperplasia group (90 cases) and the non-liver focal nodular hyperplasia group (56 cases). Enzyme linked immunosorbent assay (ELISA) was applied to measure serum KLF5 level. Chemiluminescence method was applied to detect serum PIVKA-II level. Receiver operating characteristic (ROC) curve was applied to analyze the diagnostic value of serum KLF5 and PIVKA-II levels for liver focal nodular hyperplasia. Four grid table method was applied to analyze the diagnostic value of MRI combined with serum KLF5 and PIVKA-II levels for liver focal nodular hyperplasia.Results The proportion of alcohol consumption [51 (56.67%) vs. 22 (39.29%)], serum KLF5 [(4.15±1.25) ng/mL vs. (1.87±0.31) ng/mL], and PIVKA-Ⅱ [(26.43±5.33) mAu/mL vs. (19.24±4.64) mAu/mL] levels in the liver focal nodular hyperplasia group were obviously higher than those in the non-liver focal nodular hyperplasia group (P<0.05). The area under the curve (AUC) of serum KLF5 and PIVKA-Ⅱ for diagnosing liver focal nodular hyperplasia was 0.912 and 0.871, respectively, with sensitivity of 88.76% and 84.27%, the specificity of 82.14% and 83.93%, and the optimal cut-off value of 2.84 ng/mL and 21.22 mAu/mL, respectively. The MRI examination results were consistent with the gold standard (Kappa value=0.426, P value < 0.001). The results of serum KLF5 and PIVKA-II tests were consistent with the gold standard (Kappa values = 0.430, 0.438, P values < 0.001). The joint examination results of the combination of MRI, serum KLF5 and PIVKA-II had high consistency with the gold standard (Kappa value=0.709, P value < 0.001). The sensitivity and accuracy of MRI combined with serum KLF5 and PIVKA-II in diagnosing liver focal nodular hyperplasia were obviously higher than those of the individual diagnosis of MRI, serum KLF5, PIVKA-II (P<0.05).Conclusion Serum KLF5 and PIVKA-II levels are up-regulated in patients with liver focal nodular hyperplasia, and MRI combined with serum KLF5 and PIVKA-II has higher diagnostic value for disease.
    3D liver analysis software in complex hepatocellular liver cancer resection
    CHENG Xiao-jie, PENG Xing-hua, GE Hai-jiang, CHENG Hai-chao, ZHANGMing, LI Zhi-feng
    2025, 30(3):  352-355. 
    Asbtract ( 15 )   PDF (477KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To analyze the value of 3D liver analysis software in complex hepatocellular cancer resection.Methods 64 patients with hepatocellular cancer admitted to our hospital between May 2020 and March 2023 were divided into a control group (n=32) and an observation group (n=32) according to the random number table method. The control group was examined preoperatively by ultrasound and the observation group was examined preoperatively using 3D liver analysis software.Results Operating time, intraoperative bleeding, virtual liver resection volume, actual resected liver volume, residual liver volume, and standard residual liver volume in the observation group [(311.2±72.5) min, (310.2±128.6) mL, (993.6±211.3) mL, (981.2±206.5) mL, (689.5±81.6) mL, (46.5± (7.6) %] were better than those in the control group [(352.9±85.6) min, (406.8±225.6) mL, (1171.5±245.6) mL, (1141.6±216.5) mL, (625.6±58.9) mL, (41.2±6.5) %, P<0.05]. The levels of methemoglobin, glutathione, ghrelin and bilirubin in the observation group [(116.5±7.8) ng/mL, (22.8±8.6) IU/L, (30.65±4.6) IU/L, (6.8±2.9) μmol/L] were better than those in the control group [(215.3±6.1) ng/mL, (35.2±11.5) IU/L, (34.62±5.3) IU/L, (13.1±2.4) μmol/L, P<0.05]. The ability of daily living (ADL) score of the observation group at 1-6 months after surgery was 86.8 ± 2.9, significantly higher than that of the control group [(61.1±2.4), P<0.05]. The overall incidence of complications such as bleeding, infection, biliary fistula and liver failure in the observation group (9.4%) was significantly lower than that in the control group [(56.3%), P<0.05].Conclusion Applying 3D liver analysis software to complex hepatocyte resection not only optimizes surgical and clinical indices, but also reduces complications and improves daily survival of patients, which is worthy of clinical application.
    The expression of miR-490-3p and miR-503-5p in hepatocellular carcinoma tissues and their relationship with clinicopathological features and prognosis
    WANG Jun-wei, ZHANG Xiao-long, LI Yan, LIU Zheng, ZHANG Ji-guang, YUE Ya-ling
    2025, 30(3):  356-360. 
    Asbtract ( 13 )   PDF (518KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To investigate the expression of microRNA (miRNA)-490-3p and miR-503-5p in hepatocellular carcinoma (HCC) and their relationship with clinicopathological features and prognosis.Methods 102 HCC patients who underwent radical resection in Handan Central Hospital from March 2018 to March 2020 were selected. The expression of miR-490-3p and miR-503-5p in HCC tissues and adjacent tissues (more than 5 cm from the edge of cancer tissues) were detected by real-time fluorescence quantitative polymerase chain reaction. The expression of miR-490-3p and miR-503-5p in cancer tissues of HCC patients with different clinicopathological features was compared. The overall survival of HCC patients with different miR-490-3p and miR-503-5p expression were analyzed by Kaplan-Meier method. Log-Rank test was used to compare the differences in survival curves between different groups. Univariate and multivariate COX risk regression models were used to analyze the prognostic factors of HCC patients.Results The relative expression levels of miR-490-3p and miR-503-5p in HCC cancer tissues were (0.86±0.23) and (0.91±0.22) respectively, which were lower than those in cancer adjacent tissues (1.90±0.31) and (2.12±0.41), with a statistically significant difference (t=27.409, 26.379, P=0.000, 0.000). The expression of miR-490-3p and miR-503-5p in HCC tissues was related to the degree of tumor differentiation, the maximum diameter of tumor, and the Chinese liver cancer staging (CNLC), and the differences were statistically significant (all P<0.05). The expression of miR-490-3p and miR-503-5p was not related to gender, age, number of tumors, HBsAg and preoperative alpha-fetoprotein, and the difference was not statistically significant (all P>0.05). The 3-year overall survival rates of miR-490-3p high expression group and low expression group were 84.62% (44/52) and 48.00% (24/50) respectively. The 3-year overall survival rates of miR-503-5p high expression group and low expression group were 87.76% (43/49) and 50.94% (27/53) respectively. The 3-year cumulative survival rate of miR-490-3p low expression group and miR-503-5p low expression group was significantly lower than that of miR-490-3p high expression group and miR-503-5p high expression group respectively, and the difference was statistically significant (Log-rank χ2=16.231, 10.604, P=0.000, 0.001). CNLC stage IIIa, tumor maximum diameter ≥5 cm, and poor differentiation were independent risk factors affecting the prognosis of HCC patients, and increased expression of miR-490-3p and miR-503-5p was a protective factor.Conclusion The decrease expression of miR-490-3p and miR-503-5p in HCC patients is relate to poor clinicopathological features and is an independent risk factor affecting the prognosis of HCC patients.
    Quantitative parameters of dynamic enhanced magnetic resonance imaging (DCE-MRI) combined with computed tomography (CT) dynamic enhanced scanning in the diagnosis of benign and malignant liver space occupying lesions in children
    WU Lin, CHEN Meng-meng, WANG Ai-ping
    2025, 30(3):  361-365. 
    Asbtract ( 11 )   PDF (561KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To analyze the quantitative parameters of dynamic enhanced magnetic resonance imaging (DCE-MRI) combined with dynamic enhanced computed tomography (CT) scanning in the diagnosis of benign and malignant liver space occupying lesions in children.Methods Clinical data of children with hepatic space occupying lesions who admitted to the Children's Hospital of Soochow University from July 2018 to May 2024 were retrospectively analyzed. They were divided into malignant group (46 cases) and benign group (153 cases) based on pathological examination results. The characteristics of CT scanning and quantitative parameters of DCE-MRI were compared between the two groups. Using the pathological examination as the gold standard, the consistency between CT dynamic enhanced scan and the gold standard in diagnosing benign and malignant liver space occupying lesions, ang the related factors of malignant liver space occupying lesions were analyzed. The diagnostic value of DCE-MRI quantitative parameters combined with CT dynamic enhancement in malignant liver space occupying lesions was analyzed.Results The maximum rise slope (MSI) (92.53±10.87), mean strengthening time (MET) (508.34±51.45) and positive enhancement score (PEI) (34.57±4.82) in the malignant group were lower than those in the benign group [265.14±29.76), 557.42±58.30) and 241], respectively. The initial area under enhancement curve (IAUC) in the malignant group (36.78±5.63) was higher than that in the benign group (23.41±4.29) (P<0.05). In the malignant group, the proportion of low enhancement in delayed stage (95.65%) and high enhancement in arterial stage (100.00%) were higher than those in benign group (0.00% and 11.11%, respectively) (P<0.05), and the proportion of equal enhancement in portal vein stage in the malignant group (67.39%) was lower than that in benign group (96.08%) (P<0.05). There was moderate consistency between CT dynamic enhanced scan and gold standard in the diagnosis of benign and malignant hepatic space occupying lesions (Kappa =0.735, P<0.05). MSI (OR=0.234, 95%CI: 0.103~0.532), PEI (OR=0.277, 95%CI: 0.122~0.629), IAUC (OR=3.823, 95%CI: 1.681-8.696) were associated with malignant liver space occupying lesions (P<0.05). The area under the curve (AUC) values of MSI, PEI, IAUC, CT dynamic enhanced scan and the combination of the four patients were 0.797, 0.803, 0.845, 0.819 and 0.913, respectively (P<0.05), and the AUC values of the combination with the above four indicators were higher (P<0.05).Conclusion MSI, PEI, IAUC and CT dynamic enhanced scanning have important value in the diagnosis of benign and malignant liver space occupying lesions in children, and the diagnostic value of their combination is higher.
    Therapeutic effect of transcatheter arterial chemoembolization combined with three-dimensional conformal radiation therapy on patients with advanced hepatitis B primary liver cancer
    GU Ji, LI Rong-hua, ZHU Hai-yan, DONG Li
    2025, 30(3):  366-370. 
    Asbtract ( 15 )   PDF (551KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To analyze the efficacy of transcatheter arterial chemoembolization (TACE) combined with three-dimensional conformal radiation therapy (3D-CRT) in the treatment of patients with advanced hepatitis B primary liver cancer (PLC).Methods Between January 2019 and June 2024, 72 PLC patients with advanced hepatitis B were enrolled. According to the previous guidelines, the enrolled patients were treated with antiviral therapy, TACE and 3D-CRT. According to the evaluation standard of response to solid tumor treatment, the therapeutic effect was evaluated and divided into two groups: the effective group and the ineffective group. The clinical data of the two groups were compared and factors influencing the short-term clinical effect of TACE combined with 3D-CRT in the treatment of advanced PLC patients was analyzed, and the adverse reactions during the treatment were also analyzed.Results Three months after TACE combined with 3D-CRT treatment, the curative effect was evaluated, of which 51 cases were effective [complete remission (CR)+ partial remission (PR)] and 21 cases were ineffective [disease stability (SD)+disease progression (PD)]. Compared with the ineffective group, the cases of AFP<400μg/L, 50-60 Gy radiotherapy dose, BCLC stage B and Child-Pugh grade A in the effective group increased significantly (P<0.05), while the tumor diameter and gross tumor volume decreased significantly (P<0.05). Multivariate analysis showed that AFP level, gross tumor volume, radiation dose and Child-Pugh grade were independent factors influencing the short-term clinical efficacy of TACE combined with 3D-CRT in the treatment of advanced PLC patients (P<0.05). Adverse reactions during treatment included those during TACE and 3D-CRT. During TACE, the adverse reactions included fever in 9 cases (12.5%), epigastric pain in 7 cases (9.7%) and nausea and vomiting in 5 cases (6.9%). Adverse reactions during 3D-CRT included epigastric fullness in 11 cases (15.3%), agranulocytosis in 6 cases (8.3%), gastric burning discomfort in 4 cases (5.5%) and radiation-induced liver damage in 3 cases (4.2%).Conclusion TACE combined with 3D-CRT has a good curative effect on PLC in the treatment of advanced hepatitis B, but the curative effect is affected by many factors, including AFP level, gross gross tumor volume, radiation dose and Child-Pugh classification. In clinical practice, the treatment plan should be adjusted according to the individual differences of patients, so as to improve the curative effect and reduce the occurrence of adverse reactions.
    Viral Hepatitis
    Comparison of efficacy and safety of Entecavir and Tenofovir profol fumarate in the treatment of chronic hepatitis B with high viral load
    XIANG Wei-yan, ZHU Kou-yun, ZHU Qi, QIU Yuan-yuan
    2025, 30(3):  371-375. 
    Asbtract ( 15 )   PDF (496KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To compare the efficacy of tenofovir fumarate and entecavir in patients with high viral load chronic hepatitis B (CHB).Methods A total of 104 CHB patients with high viral load were enrolled from Baoshan Branch of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from May 2021 to October 2023. They were divided into observation group and control group by random number table method, with 52 cases each, and were treated with tenofovir pofol fumarate and entecavir respectively. Liver function, intestinal barrier function, efficacy, safety and inflammatory response were compared between the two groups.Results The HBV DNA negative conversion rate, alanine aminotransferase (ALT) normalization rate and HBeAg negative conversion rate were 94.23%, 94.23% and 11.54% in the observation group and 84.62%, 90.38% and 7.69% in the control group, respectively, and there were no difference between the two groups (P>0.05). After treatment, serum procalcitonin (PCT), aspartate aminotransferase (AST), tumor necrosis factor α (TNF-α), HBV DNA in the observation group, ALT, interleukin-4 (IL-4) were (0.03±0.01) μg/L, (36.16±4.42) U/L, (11.24±2.71) ng/L, (1.62±0.36) lgIU/mL, (37.43±4.94) U/L, (47.16±4.61), respectively. The corresponding values in control group was (0.03±0.01) μg/L, (37.51±4.78) U/L, (11.54±2.95) ng/L, (1.74±0.35) lgIU/mL, (38.81±5.39) U/L, (47.94±4.82) ng/L, respectively. There were no differences between the two groups (P>0.05). After treatment, there were no differences in serum endotoxin, diamine oxidase and D-lactic acid levels between the two groups (P>0.05). After treatment, the low-density lipoprotein cholesterol (LDL-C) (2.31±0.43) mmol/L and high-density lipoprotein cholesterol (HDL-C) (1.32±0.34) mmol/L in the observation group were lower than those in the control group [(2.70±0.52) mmol/L and (1.65±0.52) mmol/L, respectively] (P<0.05), there were no significant differences in serum creatinine and estimated glomerular filtration rate (eGFR) between the two groups (P>0.05).Conclusion Both entecavir and tenofovir fumarate can achieve satisfactory results in CHB patients with high viral load, both of which can reduce inflammation, improve liver function and intestinal barrier function, and have no significant effect on renal function. However, entecavir can affect blood lipid levels in patients.
    Other Liver Diseases
    Comparison and differential analysis of clinical characteristics between KPLA and ECLA
    LIANG Dong, CAO Meng, HE Xiang, SHEN De-xin
    2025, 30(3):  376-379. 
    Asbtract ( 13 )   PDF (391KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To compare the clinical characteristics of Klebsiella pneumoniae liver abscess (KPLA) and Escherichia coli liver abscess (ECLA), and provide a basis for the diagnosis and treatment of different types of bacterial liver abscess (BLA).Methods A retrospective analysis was conducted on 169 hospitalized patients diagnosed with BLA at the 988th Hospital of the Joint Logistics Support Force from January 2000 to June 2023. Based on etiology, they were divided into KP group (91 cases) and EC group (55 cases). The general conditions, underlying diseases, clinical manifestations, laboratory tests, imaging findings, treatment methods, antibiotic selection, length of hospital stay, and disease outcomes of the two groups were compared.Results There was no significant difference in age and gender between the KP group and EC group (P>0.05); In terms of basic diseases, the proportion of patients in KP group with diabetes (64.8%) was significantly higher than that in EC group (21.8%), and the proportion of patients in EC group with biliary diseases (41.8%) was significantly higher than that in KP group (8.8%) (P<0.05); In terms of clinical manifestations, fever and chills were the main clinical manifestations in both groups, with no significant difference (P>0.05). The proportion of right upper abdominal pain in the KP group was lower than that in the EC group (P<0.05); In terms of laboratory tests, platelet count and albumin levels in the KP group were significantly lower than those in the EC group, while the inflammatory indicators of procalcitonin and C-reactive protein were significantly higher than those in the EC group (P<0.05); In terms of imaging manifestations, both KP group and EC group were mainly characterized by a single lesion in the right lobe of the liver, and there was no significant difference between the two groups (P>0.05); In terms of treatment, the KP group and EC group were mainly treated with antibiotics and puncture drainage, which were 86.8% and 80.0%, respectively, with no significant difference (P>0.05); In the selection of antibiotic types, carbapenems were mainly used in the KP group, accounting for 57.1%, while cephalosporins and other antibiotics were mainly used in the EC group, accounting for 61.8%. The usage rate of carbapenems in the KP group was significantly higher than that in the EC group (P<0.05); In terms of hospitalization time, the KP group was significantly longer than the EC group (P<0.05); In terms of disease progression, the improvement rates of both groups were relatively high, at 89.0% and 92.7%, respectively, with no significant difference (P>0.05).Conclusion KP is the main pathogen of BLA. KPLA is often associated with diabetes, while ECLA is often associated with biliary diseases; KPLA has a more severe condition, with higher levels of procalcitonin, C-reactive protein, platelet infection related indicators, and more significant albumin consumption; KPLA treatment mainly uses carbapenems, while the ECLA group mainly uses cephalosporins and other antibiotics. The overall treatment cycle of KPLA is relatively long.
    The prevalence and influencing factors of osteoporosis in non-alcoholic and non obese patients with fatty liver disease
    WANG Wen, WANG Qian, SHI Hai-tao, DUAN Jin-hua
    2025, 30(3):  380-384. 
    Asbtract ( 17 )   PDF (481KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To explore the prevalence of osteoporosis in non-alcoholic and non-obese patients with fatty liver disease, and analyze the relevant influencing factors.Methods 1172 patients with non-alcoholic fatty liver disease (NAFLD) who underwent physical examinations in our hospital from January 2021 to April 2024 were selected. Patients were divided into three groups based on the lumbar L1-4 bone density T value: osteoporosis (382 cases), bone loss (379 cases), and normal bone mass (412 cases). The incidence of bone loss and osteoporosis in non-obese fatty liver patients was analyzed, and the clinical data of three groups were compared to analyze the relevant factors affecting lumbar spine bone density.Results The incidence of bone loss in this group was 32.34%, and the incidence of osteoporosis was 32.59%. There was no statistically significant difference in BMI, waist circumference, SBP, DBP, drinking history, and previous medical history (hypertension, heart disease, diabetes) among the three groups (P>0.05). Compared with the group with normal bone mass, the proportion of women (65.17%,68.06% vs 51.94%) and those with a history of smoking (31.13%, 37.70% vs 25.49%)in the group with decreased bone mass and the group with osteoporosis were higher, and the average age [(61.52±7.94) years,(65.32±8.51) years vs (58.17±8.73) years]was older. The pairwise differences were statistically significant (P<0.05). The levels of TBIL, GGT, ALB, BUN, CR, TC, TG, HDL-C, LDL-C, TSH, FT3, FT4 and HbAlc in the three groups were similar (P>0.05). Compared with the group with normal bone mass, the ALT[(36.65±12.06)U/L,(38.31±13.26)U/L vs (33.86±10.36)U/L], AST[(34.71±10.32)U/L, (35.84±9.67)U/L vs (30.94±9.65)U/L], UA[(420.65±68.73)μmol/L, (378.54±73.52)μmol/L vs (459.25±72.70)μmol/L], FPG[(6.04±0.94)mmol/L, (6.27±1.04)mmol/L vs (5.31±1.08)mmol/L] levels were higher in the osteoporosis group and bone loss groups, while the 25-OH-D3 [(8.41±0.77)μg/L, (3.95±0.92)μg/L vs (3.95±0.92)μg/L] level was lower (P<0.05). Multivariate analysis showed that age, gender, smoking history, ALT, UA, FPG, and 25-OH-D3 were all influencing factors for the occurrence of bone loss/osteoporosis in non-alcoholic and non-obese fatty liver patients (OR=2.248,2.599,1.627,1.567,0.818,1.505,0.819,P<0.05).Conclusion Non-alcoholic non-obese fatty liver disease patients have a higher incidence of osteoporosis, and gender, age, vitamin D, ALT, and UA levels are all influencing factors for the occurrence of bone loss/osteoporosis in patients.
    Evaluation value of serum miR-33a-5p and Sirt6 in liver fibrosis in infants with cholestasis
    CHANG Dong-zhe, GENG Xian-jie, ZHOU Liang, YANG Zi-jiu
    2025, 30(3):  385-390. 
    Asbtract ( 17 )   PDF (694KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To explore the evaluation value of serum microribonucleic acid 33a-5p (miR-33a-5p) and silent information regulatory factor 6 (Sirt6) in liver fibrosis in infants with cholestasis.Methods A total of 105 infants with cholestasis treated in our hospital from January 2021 to April 2023 were included as the study subjects (observation group). The degree of liver tissue fibrosis in infants was evaluated and grouped into a mild group of 41 cases and a moderate to severe group of 64 cases; 108 healthy infants who underwent routine examinations in our hospital were collected as the control group. Real-time fluorescence quantitative PCR (qRT-PCR) method was applied to detect serum miR-33a-5p level, enzyme-linked immunosorbent assay was applied to detect serum Sirt6 and four indicators: hyaluronic acid (HA), laminin (LN), type IV collagen (Ⅳ-C), and type III procollagen (PC-Ⅲ) levels in liver fibrosis; Pearson correlation analysis was applied to analyze the correlation between serum miR-33a-5p, Sirt6 levels and liver fibrosis indicators in infants with cholestasis; multivariate logistic regression analysis? was applied to analyze and screen the influencing factors of worsening liver fibrosis in infants with cholestasis; receiver operating characteristic curve (ROC curve) was applied to analyze the evaluation value of serum miR-33a-5p and Sirt6 levels for liver fibrosis in infants with cholestasis.Results The serum levels of miR-33a-5p (2.04±0.38), HA (218.95±49.47) ng/mL, LN (130.46±31.05) ng/mL, Ⅳ-C (147.36±40.51) ng/mL, PC-Ⅲ (547.18±92.75) ng/mL in the observation group were higher than those in the control group (1.01±0.24), (80.14±16.31) ng/mL, (17.64±4.98) ng/mL, (75.16±12.94) ng/mL, (140.43±38.22) ng/mL (P<0.05), while the serum Sirt6 (6.59±1.42) pg/mL level was lower than that in the control group (13.84±3.12) pg/mL (P<0.05). The serum miR-33a-5p level in infants with cholestasis was positively correlated with HA, LN, Ⅳ-C, and PC-Ⅲ (r=0.524, 0.508, 0.496, 0.501, P<0.05), while Sirt6 level was negatively correlated with HA, LN, Ⅳ-C, and PC-Ⅲ (r=-0.497, -0.516, -0.529, -0.514, P<0.05). The serum levels of miR-33a-5p, HA, LN, Ⅳ-C, PC-Ⅲ in infants in the moderate to severe group were higher than those in the mild group, while the serum Sirt6 level was lower than that in the mild group (P<0.05). MiR-33a-5p was identified as an independent risk factor for the worsening of liver fibrosis in infants with cholestasis (OR=2.948, P<0.05), Sirt6 was a protective factor for the worsening of liver fibrosis in infants with cholestasis (OR=0.795, P<0.05). The AUC of serum miR-33a-5p, Sirt6 levels and their combination for evaluating liver fibrosis in infants with cholestasis was 0.787, 0.825, and 0.907, respectively.Conclusion The combination of serum miR-33a-5p and Sirt6 levels showed high evaluation value for liver fibrosis in infants with cholestasis.
    Diagnostic value of MDCT combined with MRCP in biliary obstructive diseases in infants and toddlers
    FENG Wei, WANG Zhao-qing
    2025, 30(3):  391-394. 
    Asbtract ( 15 )   PDF (599KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To explore the diagnostic value of Multidetector CT (MDCT) combined with Magnetic Resonance Cholangiopancreatography (MRCP) in biliary obstructive diseases in infants and toddlers.Methods A retrospective study was conducted on children with biliary obstructive diseases admitted to Children's Hospital Affiliated to Soochow University from January 2021 to January 2024. All cases were confirmed by cholangiography and postoperative pathology. Forty-seven patients with cystic biliary atresia (CBA) were assigned to the CBA group, and 42 patients with choledochal cysts (CC) were assigned to the CC group. The preoperative MDCT and MRCP findings were compared between the two groups, and the diagnostic performance was evaluated using ROC curves.Results In the CBA group, the proportion of children with clay-like stools was 21.28% (10/47), significantly higher than the 0.0% in the CC group. The total bilirubin level in the CBA group was (135.78±22.36) μmol/L, higher than the (95.02±13.15) μmol/L in the CC group, with a statistically significant difference (P<0.05). Imaging examination showed that 72.34% (34/47) of the CBA group had abnormal gallbladder shape, higher than the 26.19% (11/42) in the CC group. In contrast, in the CC group, the proportions of children with intrahepatic bile duct dilation and cystic bile sludge deposition were 38.09% (16/42) and 47.62% (20/42), both of which were higher than those in the CBA group. Additionally, the cyst length and width ratios in the CC group were greater than those in the CBA group (P<0.05). The diagnostic accuracy, sensitivity, and specificity of MDCT were 71.91%, 74.47%, and 69.05%, respectively; for MRCP, these were 83.15%, 85.11%, and 80.95%; and for the combined approach, the figures were 94.38%, 95.74%, and 92.86%, indicating that the combined test was superior to individual tests.Conclusion The combined application of MDCT and MRCP can improve the diagnostic accuracy of biliary obstruction in infants and young children.
    Etiological analysis and clinical outcome evaluation of abnormal liver function in pregnant women in early pregnancy
    ZHANG Jun, ZHANG Yang, ZHANG Jin-wei
    2025, 30(3):  395-397. 
    Asbtract ( 13 )   PDF (363KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To analyze the causes of abnormal liver function in pregnant women in early pregnancy and evaluate its clinical outcome.Methods 104 cases of abnormal liver function in early pregnancy admitted to our hospital between January 2022 and December 2024 were included. The causes were analyzed and the changes in liver function indexes before and after treatment were compared. The cases of immunological detection and liver biopsy were analyzed, and the clinical outcome was finally evaluated.Results Through the collection of medical history, the relevant examinations were completed, and liver biopsy was performed if necessary. The causes of 104 patients with abnormal liver function in early pregnancy included 27 cases of CHB (26.0%), 23 cases of NAFLD (22.1%), 20 cases of DILI (19.2%), 14 cases of ICP (13.5%) and 11 cases of AIH (10.6%). Compared with CHB, NAFLD and AIH, after treatment in DILI and ICP, ALT, AST were significantly higher (P<0.05). Compared with other groups, TBil increased significantly before ICP treatment (P<0.05). After treatment, there was no significant difference in ALT, AST and TBil among patients with various causes (P>0.05). NAFLD and DILI serum IgM and IgG were in the normal range; DILI ANA was positive in 8 cases (40.0%); The majority of AIH was IgG, and 9 cases (81.8%) were positive for AMA and/or AMA- M2. 104 patients were treated with liver protection and primary disease. After 2 weeks, liver function was rechecked, and 73 cases (70.2%) had normal liver function. 27 cases (26.0%) had improved liver function, and continued to be treated with liver protection. After 4-6 weeks of follow-up, they gradually returned to normal.Conclusion The causes of abnormal liver function in early pregnancy are complex and diverse, including infectious, metabolic, drug-induced, autoimmune and pregnancy-related special liver diseases. There are some differences in clinical manifestations, laboratory tests and pathological features among various etiologies.