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    31 May 2025, Volume 30 Issue 5
    Previous Issue   
    Frontier，Exploration and Controversy Liver Fibrosis & Cirrhosis
    The clinical and imaging analysis of confluent hepatic fibrosis
    LIU Yang, LIU Jing, LI Zhi-yan, REN Hong-wei, ZHANG Meng-meng, LIU Shu-hong, LIU Chang-chun, GAO Shen, LIU Yuan
    2025, 30(5):  592-594. 
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    Objective To explore the clinical and imaging features of hepatic confluent fibrosis (CF) in order to increase the diagnostic experience and awareness of the disease. Methods The clinical and imaging data of 19 patients with hepatic confluent fibrosis confirmed by imaging and puncture pathology from October 2023 to October 2024 in the fifth medical center of PLA general hospital were analyzed, and the general data, etiological types and imaging characteristics of the patients were sorted out and summarized. Results The clinical symptoms of 19 CF patients were mainly liver function abnormalities, fatigue, abdominal distension and abdominal pain. 8 patients were drug-induced liver damage and 6 patients were autoimmune liver diseases who were diagnosed by pathology. MR enhanced abdominal scan images showed that 18 patients were single lesions, and lesions were located in the right lobe of the liver in 15 patients. In 6 patients, the liver volume decreased and wrinkling of the liver capsule was seen. The enhancement mode was progressive enhancement, with no obvious enhancement in the arterial stage, and the high signal in the portal stage and delay stage was relatively obvious. Conclusion CF is more common in middle-aged and old women, without specific clinical symptoms, The main pathogenic factors are mainly drug-induced or autoimmune damage, MR images usually show wedge lesions and progressive enhancement pattern, which is not easy to diagnose when showing mass appearance. The combination of clinical history and imaging findings may help to diagnose CF, and pathological results may provide accurate result when the diagnosis is difficult.
    An analysis on the clinical effect of propofol tenofovir fumarate combined with fuzhenghuayu tablet in the treatment of compensated patients with hepatitis B-related cirrhosis
    ZHANG Yan, WEN Qing-ping, QIAN Hua, SHI Li
    2025, 30(5):  595-598. 
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    Objective To investigate the difference between the efficacy of propofol tenofovir fumarate (TAF) combined with Fuzheng Huayu Tablet (FZHY) and TAF alone in compensated patients with hepatitis B-related cirrhotic patients in Xizang. Methods The clinical data of 60 patients with compensatory hepatitis B cirrhosis were analyzed and divided into two groups with 30 patients in each group according to random number table method. The control group was treated with TAF, and the study group was treated with TAF combined with FZHY. The treatment course of both groups was 24 weeks. The liver biochemical indexes, serum liver fibrosis indexes, HBV DNA negative conversion rate, liver hardness and incidence of adverse reactions were compared between the two groups before and after treatment. Results ALT, AST and TBil levels in both of the control group and study group were significantly decreased after 24 weeks of treatment compared with those of before treatment (AST levels of the control group before/after treatment: 51.97±3.77 U/L/25.93±1.19 U/L; AST levels of the study group before/after treatment: 49.23±3.29 U/L/25.80±1.01 U/L; ALT levels of the control group before/after treatment: 55.17±3.48 U/L/30.83±1.52 U/L; ALT levels of the study group before/after treatment: 53.26±1.98U/L/24.87±2.68 U/L; TBil levels of the control group before/after treatment: 17.10±1.23 μmol/L/14.33±1.18 μmol/L; TBil levels of the study group before/after treatment: 19.03±3.16 μmol/L/16.63±3.2 μmol/L), but Alb levels were not significantly increased after treatment (Alb levels of the control group before/after treatment: 35.65±0.57 g/L/37.23±0.51 g/L; Alb levels of the study group before/after treatment: 35.44±0.33 g/L/38.10±0.51 g/L). HA, LN, PCⅢ and Ⅳ-C in both groups decreased significantly after treatment compared with those of before treatment (HA levels in the control group before/after treatment: 293.47±8.66 ng/mL/259.20±8.83 ng/mL; HA levels in the study group before/after treatment: 296.77±9.10 ng/mL/215.57±9.07 ng/mL; LN levels in the control group before/after treatment: 193.23±6.34 ng/mL/125.87±6.98 ng/mL; LN levels in the study group before/after treatment: 192.23±7.57 ng/mL/91.80±4.12 ng/mL; PCⅢ levels in the control group before/after treatment: 251.07±11.60 ng/mL/199.10±8.13 ng/mL; PCⅢ levels in the study group before/after treatment: 252.07±10.60 ng/mL/123.02±6.38 ng/mL; Ⅳ-C levels in the control group before/after treatment: 243.30±8.09 ng/mL/192.23±7.57 ng/mL, Ⅳ-C levels in the study group before/after treatment: 249.93±8.02 ng/mL/139.67±3.45 ng/mL; P<0.05). The decrease values of the study group after treatment were significantly higher than those of the control group (P<0.05).There was no significant difference in the negative HBV DNA conversion rate between the two groups at before and after 24 weeks of treatment (χ2=0.150, P=0.698). After 24 weeks of treatment, the liver hardness level in both groups decreased compared with that of before treatment (13.03±0.35/11.69±0.36 in control group and 13.67±0.35/9.73±0.44 in study group), and the decrease was more significant in control group (P<0.05). The incidence of adverse reactions in the control group and the study group was 6.67% and 10%, respectively, with no significant difference between the two groups (χ2=0.218, P=1.000). Conclusion TAF combined with FZHY can improve liver hardness better than TAF alone in patients with liver cirrhosis in compensatory stage, suggesting that it can inhibit or reverse liver cirrhosis more effectively.
    The correlation between serum vitamin B12 and β-arrestin2 levels and the severity and prognosis of cirrhotic patients with upper gastrointestinal bleeding
    SHEN Wen-wen, ZHAO Dan-dan, MIAO Han, JI Hai-yan
    2025, 30(5):  599-603. 
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    Objective To investigate the correlation between the levels of serum vitamin B12 (VB12) and β-arrestin2 with the severity and prognosis of liver cirrhotic patients with upper gastrointestinal bleeding. Methods From December 2020 to December 2023, 102 patients with upper gastrointestinal bleeding due to liver cirrhosis admitted to our hospital were collected. Serum VB12 and β-arrestin2 levels were detected with enzyme linked immunosorbent assay (ELISA). The factors influencing the severity of condition and prognosis were analyzed with logistic regression methods. The predictive value of serum VB12 and β-arrestin2 levels on prognosis was analyzed with receiver operating characteristic (ROC) curve method. Spearman method was applied to analyze the correlation between the levels of VB12 and β-arrestin2 with the severity of condition, gradings of liver function, and scores of Model End-Stage Liver Disease (MELD) of the patients. Results Compared with the mild group, the VB12 levels in the moderate and severe groups increased [(498.65±51.26 vs. 539.28±54.58 and 597.22±61.38), P<0.001], whereas the β-arrestin2 level decreased [(241.35±26.71 vs. 219.37±25.89 and 187.05±21.94), P<0.001]. The VB12 level in the severe group was higher than that in the moderate group, whereas the β-arrestin2 level was lower than that in the moderate group (P<0.05); VB12 [OR(95%CI):1.388(1.130~1.705), P=0.002] was a risk factor that affected the severity of the patient′s condition, On the contrary, β-arrestin2 [OR(95%CI)=0.588(0.387~0.894), P=0.013], hemoglobin [OR(95%CI)=0.764(0.603~0.968), P=0.026], prothrombin time (PT) [OR(95%CI)=0.788(0.645~0.962), P=0.019], platelets [OR(95%CI)=0.851(0.736~0.984), P=0.029], and fibrinogen [OR(95%CI)=0.851(0.736~0.984), P=0.029] levels were protective factors that affected the severity of the patient′s condition. There were statistically significant differences in liver function grading [(7.05±0.71 vs. 9.65±1.02), P<0.001], MELD score [(13.36±1.48 vs. 16.98±1.79), P<0.001], hemoglobin [(81.65±8.62 vs. 74.68±7.49), P<0.001], PT [(86.35±8.97 vs. 82.49±8.36), P=0.042], fibrinogen [(84.22±8.54 vs. 75.62±7.86), P<0.001, and serum VB12 [(510.32±52.41 vs. 593.66±59.95), P<0.001] and β-arrestin2 [(233.59±27.98 vs. 192.32±19.68), P<0.001] levels between the improvement group and the deterioration group; among them, VB12 [OR(95%CI)=1.974(1.193~3.267), P=0.008] was a risk factor that affected deterioration, whereas β-arrestin2 [OR(95%CI)=0.527(0.294~0.945), P=0.032], hemoglobin [OR(95%CI)=0.584(0.353~0.966), P=0.036], and fibrinogen [OR(95%CI)=0.697(0.512~0.948), P=0.021] levels were protective factors that affected deterioration; the AUC of VB12, β-arrestin2, and their combination in predicting prognosis was 0.854, 0.847, and 0.922, respectively, the combined prediction was better than VB12 (Z=2.154, P=0.031) and β-arrestin2 (Z=2.111, P=0.035) alone. VB12 level was positively correlated with liver function grading, disease severity, and MELD score (r=0.409, 0.425, 0.471, P<0.05). On the contrary, β-arrestin2 was negatively correlated with liver function grading, disease severity, and MELD score (r=-0.422, -0.467, -0.430, P<0.05). Conclusion In patients with upper gastrointestinal bleeding caused by liver cirrhosis, serum VB12 level increases whereas β-arrestin2 level decreases. The expression of both is correlated with the severity and prognosis of the patient′s condition.
    An analysis on the risk factors of portal vein thrombosis in cirrhotic patients with portal hypertension and hypersplenism after laparoscopic splenectomy
    LIU Jia, LIU Yan, CHEN Jin
    2025, 30(5):  604-608. 
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    Objective To analyze the risk factors of portal vein thrombosis (PVT) after laparoscopic splenectomy (LS) for hepatic portal hypertension (CPH) and hypersplenism (HS), and to provide reference for the prevention and treatment of perioperative PVT. Methods A total of 69 CPH patients with HS treated with LS were selected from People's Hospital of Hai’an from January 2020 to December 2023. According to whether LS-PVT occurred in imaging examination in one week after surgery, they were divided into LS-PVT group (n=18) and non-LS-PVT group (n=51). Baseline data, serological and imaging indicators were collected. Univariate and Logistic multivariate analysis were conducted to analyze the risk factors and independent influencing factors of LS-PVT in CPH patients combined with HS, and the predictive value of each independent influencing factor was analyzed by receiver operating curve (ROC) method. Results Among 69 patients with CPH combined with HS, 18 cases of LS-PVT occurred within 1 week after surgery, with an incidence rate of 26.09%. History of diabetes mellitus, history of upper gastrointestinal bleeding, preoperative fibrinogen (FBI), preoperative portal vein diameter (PVD), preoperative spleen length diameter (SL), intraoperative blood loss, intraoperative blood transfusion volume, platelet elevation rate (PPER3) in 3 days post-operation, and D-dimer (D-D) level in LS-PVT group were 44.44%, 22.22%, 3. 49 g/L, 18.24±1.86 mm, 19.06±1.95 mm, 376.49±45.37 mL, 254.56±28.41 mL, 1.47%, 2.03 mg/L, respectively. All of them were higher than those of 19.61%, 7.84%, 3.14 g/L, 15.47±1.69 mm, 15.83±1.82 mm, 321.76±41.05 mL, 216.90±24.52 mL, 1.18%, 0.84 mg/L in the non-LS-PVT group. The differences were statistically significant (t/χ2=4.836, 4.259, 4.576, 7.465, 7.263, 5.034, 5.628, 8.476, 9.158, all P<0.05). Logistics regression analysis shows that Increased levels of PVD and SL before surgery and PPER3 and D-D after surgery were independent influencing factors for the occurrence of LS-PVT in CPH patients with HS (95%CI: 0.754 ~ 1.705, 0.713 ~ 1.627, 0.860 ~ 1.842, 0.917 ~ 1.863; OR=1.162, 1.048, 1.256, 1.379, all P<0.05). ROC analysis showed that the areas under the curve (AUC) of preoperative PVD, SL and postoperative PPER3 and D-D levels were 0.773, 0.695, 0.845 and 0.758, respectively, with sensitivities of 72.22%, 77.78%, 88.89% and 83.33%. The specificities were 83.33%, 66.67%, 72.22%, and 66.67% (all P<0.01). Conclusion The increased levels of PVD and SL before surgery and PPER3 and D-D after surgery are independent influencing factors for the occurrence of LS-PVT in CPH patients with HS, and can be used as a reference for the prevention, evaluation and intervention of PVT in the perioperative period of LS.
    An analysis on the value of high frequency ultrasound combined with STE in the diagnosis of liver cirrhosis at different stages
    ZHOU Xiu-mei, LIU Hui, WANG Shi-jun
    2025, 30(5):  609-612. 
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    Objective To analyze the value of high frequency ultrasound combined with sound touch elastography (STE) in the diagnosis of liver cirrhosis at different stages. Methods 100 patients with hepatitis B cirrhosis admitted between October 2022 and October 2024 were selected. The echo of liver parenchyma, the clarity of liver capsule and hepatic vein, the border shape and the thickness of spleen were evaluated by high-frequency ultrasound with reference to the ultrasonic semi-quantitative scoring standard. STE detected the liver hardness (LSM) and spleen hardness (SSM), and calculated APRI and FIB-4 according to the clinical test results. Receiver operating characteristic curve (ROC) and area under curve (AUC) were used to evaluate the efficacy of hepatitis B cirrhosis at compemsated and decompendated stages. Results There were 61 patients with compensated and 39 patients with decompensated hepatitis B-related cirrhosis. In the decompensated group, platelet (PLT) count, albumin (Alb) level, values of aminotransferase-to-platelet ratio index (APRI), Fibrosis-4 Index (FIB-4), LSM and SSM were (94.5±22.4) ×109/L, (31.4±3.5) g/L, (0.47±0.08), (0.63±0.13), (15.3±3.2) kPa and (18.9±6.9) kPa, respectively, compared with those of (74.0±14.1) ×109/L, (29.8±2.5) g/L, (0.54±0.12), (0.80±0.21), (18.4±4.1) kPa and (23.5±9.3) kPa in the compensatory group [P<0.05]. Comparing the two groups′ ultrasonic semi-quantitative scores, in the decompensated group, the scores of liver parenchyma echo, liver capsule, hepatic vein clarity, border shape and spleen thickness were (2.6±0.4) points, (2.0±0.4) points, (2.0±0.3) points, (2.5±0.4) points, (2.1±0.3) points, (2.1±0.3) points and (11.3±1.3) points, respectively, which were significantly higher than those of (2.9±0.7) points, (2.4±0.6) points, (2.3±0.5) points, (2.8±0.6) points, (2.5±0.5) points and (13.2±2.8) points in the compensatory group (P<0.05). The AUC values of APRI+FIB-4+LSM+SSM+ semi-quantitative score and LSM+SSM+ semi-quantitative score in the diagnosis of decompensated cirrhosis were 0.89 and 0.87, respectively, which were significantly higher than those of single diagnosis (P<0.05), but there was no significant difference in the AUC values of the first two diagnosis modes (P>0.05). Conclusion High-frequency ultrasound combined with STE in the diagnosis of hepatitis B-related cirrhosis can help to distinguish the compensate or decompensate status of cirrhosis, which is worthy of further clinical verification.
    The value of endoscopic ultrasonography in diagnosing esophageal and gastric varices in patients with hepatitis B-related cirrhosis and an evaluation of the efficacy of esophageal variceal ligation treatment
    ZHANG Zhi-bo, LI Jing, QIU Jing-qi, WANG Qian, LIANG Shuang, LIU Cui-cui
    2025, 30(5):  613-616. 
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    Objective To explore the diagnostic value of Endoscopic Ultrasound (EUS) for esophagogastric varices in patients with hepatitis B-induced cirrhosis and evaluate the therapeutic effect of endoscopic variceal ligation (EVL) using EUS. Methods Between January 2020 and June 2022, 67 patients with hepatitis B-related cirrhosis and esophagogastric varices who received EVL treatment at our hospital and regularly underwent endoscopic follow-up were included. The patients were grouped based on whether they experienced variceal rebleeding before the follow-up. The observation group (n=31) had variceal rebleeding, while the control group (n=36) did not. EUS parameters and biochemical indicators were compared between the two groups. Results The detection rates of esophageal perforating veins, gastric perforating veins, and paracholedochal veins in the observation group were 58.1%, 64.5%, and 61.2%, respectively, which were significantly higher than those of 30.1%, 27.7%, and 22.2% in the control group (P<0.05). The total cross-sectional area, diameter of the left gastric vein, superior mesenteric vein, splenic vein, and portal vein in the observation group were (0.7±0.1) cm2, (6.4±0.3) mm, (13.3±0.8) mm, (14.9±0.7) mm, and (17.16±0.53) mm, respectively, which were significantly higher than those of (0.4±0.1) cm2, (5.1±0.2) mm, (9.9±0.7) mm, (12.6±1.0) mm, and (14.3±0.3) mm in the control group (P<0.05). The thickness of variceal wall in the observation group was (0.5±0.1) mm, which was significantly lower than that of (0.7±0.1) mm in the control group (P<0.05). Platelet count and albumin level in the observation group were (127.0±40.1) ×109/L and (28.8±5.2) g/L, respectively, which was significantly lower than those of (141.2±22.5) ×109/L and (34.1±9.6) g/L in the control group (P<0.05). The prothrombin time in the observation group was (12.9±2.6) s, which was significantly higher than that of (12.9±2.6) s in the control group (P<0.05). There was no significant difference in total bilirubin and direct bilirubin between the two groups. Binary logistic regression analysis revealed that the presence of esophageal perforating veins (OR=1.66, P=0.011, 95%CI:1.24-2.48), gastric perforating veins (OR=1.70, P=0.014, 95%CI:1.36-2.92), increased total cross-sectional area of varices (OR=2.40, P=0.021, 95%CI:1.01-5.16), enlarged splenic vein diameter (OR=2.10, P=0.028, 95%CI:1.10-4.40), widened portal vein diameter (OR=2.40, P=0.026, 95%CI:1.12-4.58), and prolonged prothrombin time (OR=1.80, P=0.011, 95%CI:1.75-2.70) were risk factors for variceal rebleeding in patients with esophagogastric varices. Thinner (thicker Please check) variceal wall thickness (OR=0.66, P=0.031, 95%CI:0.22-0.81) was a (risk)protective factor (for) against rebleeding. Conclusion EUS has significant advantages in assessing esophagogastric varices in cirrhotic patients and can effectively evaluate the therapeutic effect of EVL and predict bleeding risk.
    A study on the influencing factors of liver stiffness in hepatitis B patients with liver fibrosis by STE/STQ
    SUN Jing, QIAN Kui
    2025, 30(5):  617-619. 
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    Objective To analyze the influence factors of liver stiffness values (LSM) of hepatitis B patients with liver fibrosis determined by sonopalpation elastography (STE) and sonopalpation elastometry (STQ). Methods The clinical data of 80 patients with hepatitis B-related liver fibrosis treated in our hospital from January 2018 to December 2023 were retrospectively analyzed. The patients were divided into F1 (n=20), F2 (n=23), F3 (n=15), and F4 (n=22) groups according to the degree of liver fibrosis. Baseline data, laboratory indicators including alanine aminotransferase (ALT], aspartate aminotransferase (AST), prothrombin time, partially activated thrombin time, liver stiffness values of STE and STQ in all groups were compared. Correlation analysis was conducted to analyze the correlation between liver hardness values of STE and STQ, and the levels of ALT and AST. Results The levels of ALT, AST, LSMSTE and LSMSTQ in stage F4 group were (260.62±36.13)U/L, (120.97±23.65) U/L, (18.52±4.63) kPa, and (19.24±5.33) kPa, respectively, which were higher than those in stage F1, F2 and F3 patients. The levels of ALT, AST, LSMSTE, LSMSTQ in stage F3 group were 237.46±35.67) U/L, (105.43±21.33) U/L, (14.21±3.94) kPa, and (14.83±4.62) kPa, which were higher than those in stage F1 and F2 patients. Similarly, the levels of ALT, AST, LSMSTE, and LSMSTQ in stage F2 group were (207.32±33.58) U/L, (90.45±20.71) U/L, (11.63±3.58) kPa, and (12.45±3.94) kPa, respectively, which were higher than those of (185.33±30.64) U/L, (185.33±30.64) U/L, (76.54±19.26) U/L, (8.32±1.56) kPa, and (8.99±2.03) kPa in stage F1 patients (P<0.05); Correlation analysis showed that LSMSTE and LSMSTQ values were positively correlated with the levels of ALT and AST (r=0.658, 0.531, 0.613, 0.594, P<0.05). Conclusion The levels of ALT and AST are closely related to LSM, which may affect the results of STE/STQ in the examination of hepatitis B liver fibrosis. In the clinical evaluation of the degree of liver fibrosis, imaging and laboratory examination results should be comprehensively judged to further improve the diagnostic accuracy.
    Liver Cancer
    An analysis on the correlation between ADC value and microvascular invasion in small hepatocellular carcinoma
    HAO Lei, WANG Wei-wei, REN Hong-wei, ZHAO Sheng-xiang
    2025, 30(5):  620-623. 
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    Objective To analyze the feasibility of digital simulation of weighted pathological images in preoperative magnetic resonance (MR) examination for predicting postoperative recurrence of small liver cancer. Methods A total of 26 patients with subcellular liver cancer who underwent surgical resection at the Fifth Medical Center of the General Hospital of the People's Liberation Army from December 2011 to May 2018 and underwent dynamic contrast-enhanced MR scanning within 1 week to 1 month before surgery were collected and organized. They were divided into early recurrence group and late recurrence group. The T1, T2, DWI, arterial phase, portal phase, delayed phase, and double echo signal values of the lesions were measured before surgery, and the signal values of the normal liver parenchyma range of the same size within a 4cm range of the lesions were measured. The corresponding group ratios were calculated, and the interlobular artery, interlobular vein, interlobular bile duct, central venous vein, hepatic cell plate, and hepatic sinuses were delineated in the pathological images. MR was also used as a reference. Perform motion assignment on image measurement data to create dynamic images. Results Among the 26 patients, there were 15 in the early recurrence group and 11 in the late recurrence group. The lesion size was 0.5～1.0 cm, and the recurrence time was 2～63 months. The ratio of the reverse phase signal values of the double echo sequence in the early recurrence group was 1.055, and the ratio of the signal values in the late recurrence group was 1.165, with statistical differences between the groups (P=0.03). The ratio of the signal values in the delayed early recurrence group was 0.902, and the ratio of the signal values in the late recurrence group was 0.975, with statistical differences between the groups (P=0.04). Conclusion In the late stage recurrence group, the delayed phase signal of small liver cancer lesions is higher and contains more fat, and the combination of pathological images and MR signal measurement values with dynamic images presents better.
    EGF rs4444903 gene polymorphism is associated with the risk of HCV infection-related hepatocellular carcinoma: a Meta-analysis
    WANG Hui, BIAN Na-na, FENG Gong, ZHANG Fen-na, ZHANG Xin-yi, WANG Zi-yi, SUN Rong-rong, HE Na
    2025, 30(5):  624-629. 
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    Objective To investigate the association between EGF polymorphisms on rs4444903 locus and the risk of HCV infection-related hepatocellular carcinoma (HCC). Methods A computer-based search was performed on all case-control studies in the databases of PubMed, CNKI, Wan Fang Date, Springer-Verlag, Cochrane and Embase to identify the association of EGF rs4444903 polymorphisms with the risk of HCV infection-related HCC. Meta-analysis was performed by applying Stata 17.0 software, and the OR and 95% CI were calculated. A sensitivity analysis was performed, and the publication bias was evaluated. Results A total of five case-control studies were included in this meta-analysis study. It was shown that EGF rs4444903 gene polymorphisms were significantly associated with the risk of HCV infection-related HCC: 1) allelic model G vs A: (OR=1.48, 95% CI: 1.22~1.80, P=0.001); 2) pure model GG vs AA: (OR=2.54, 95% CI: 1.65~3.91, P=0.001); 3) recessive model GG vs GA+AA: (OR=1.76, 95% CI: 1.16~2.66, P=0.01). Conclusion EGF rs4444903 gene polymorphism was significantly associated with the risk of HCV infection-related HCC.
    Study on the expression of serum ferritin, homocysteine, and vitamin B12 in hepatitis B, cirrhosis, and primary liver cancer
    XIE Wei-min, LIU Jie
    2025, 30(5):  630-632. 
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    Objective To explore the changes and clinical value of serum ferritin (SF), homocysteine (Hcy), and vitamin B12 (VitB12) levels in patients with hepatitis B, cirrhosis, and primary liver cancer. Methods 98 patients diagnosed with hepatitis B virus (HBV) related liver disease in our hospital from September 2022 to November 2023 were selected as the survey subjects. Among them, there were 45 patients with liver cirrhosis after hepatitis B (Group A) and 53 patients with primary liver cancer (Group B). 42 healthy individuals who underwent physical examinations during the same period were selected as the control group.They were detected the serum levels of SF, Hcy, VitB12, and SF in each group separately, and performed correlation analysis using Pearson correlation analysis. The Receiver Operating Characteristic (ROC) curves were used to evaluate the diagnostic value of the three indicators. Results Serum total bilirubin (TBil), SF, Hcy, and VitB12 showed an increasing trend in the control group, group A, and group B (F=11.739, 20.537, 18.413, 26.709, all P<0.01), while serum Alb showed a decreasing trend (F=10.046, P<0.01). The serum levels of ALT, AST, and Alb in Group B were lower than those in Group A [(79.42±22.39)vs.(198.48±18.44),(94.93±22.25)vs.(163.93±22.25),(21.71±5.17)vs.(30.74±4.68)] (P<0.05), while the serum levels of TBil, SF, Hcy, and VitB12 were higher than those in Group A[(74.12±20.15)vs.(35.50±10.27),(469.46±105.89)vs.(266.05±71.57),(23.29±5.64)vs.(18.83±5.10),(876.68±235.16)vs.(588.91±117.39)] (P<0.05). As the Child Pugh grading increased, serum levels of ALT, AST, TBil, SF, Hcy, and VitB12 gradually increased (F=8.749, 10.073, 15.262, 9.418, 12.095, 16.639, all P<0.01), while serum Alb showed a decreasing trend (F=7.418, P<0.01). The levels of SF, Hcy, and VitB12 are correlated with ALT, AST, TBil, and negatively correlated with Alb. The area under curve (AUC = 0.955) of the combination with SF, Hcy, and VitB12 in ROC curve for predicting the risk of primary liver cancer caused by cirrhosis is the highest. Conclusion The levels of serum SF, Hcy, and VitB12 vary with the progression of the disease. Monitoring the three indicators has certain clinical value in the diagnosis and judgment of patients with hepatitis B, cirrhosis, and primary liver cancer.
    The clinical significance of preoperative systemic immunoinflammatory index in patients with hepatocellular carcinoma after transcatheter arterial chemoembolization
    TAN Shu-dan, WANG Tong-hua, CHENG Ji-yun, GUO Yu-xiu, LAN Chang-ming, YU Xian-en
    2025, 30(5):  633-637. 
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    Objective To investigate the role of preoperative systemic immune inflammation index (SII) in the prognosis of hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE). Methods The clinical data of 127 patients with HCC who underwent TACE in the Baise people’s hospital from January 2017 to October 2021 were analyzed retrospectively. We determine the predictive value of SII by calculating SII value and making receiver operating characteristic (ROC) curve. Results The area under curve (AUC) of SII calculated by ROC curve was 0.707, the corresponding optimal cut-off value was 337.125. With this value as the boundary, the SII was defined as low SII group and high SII group. The 1-year and 2-year survival rates of low SII group were 67.4% and 51.1%, while those in high SII group were 35.4% and 20.2%. The median values of low SII group and high SII group were 36.0 months and 9.0 months, respectively. The survival rate of low SII group revealed a better prognosis. Conclusion A higher level of SII before surgery may be a risk factor for poor prognosis of HCC, and the survival rate of patients with lower SII level is better than those of patients with higher SII level.
    Viral Hepatitis
    Histological improvement in chronic hepatitis B patients treated with nucleos(t)ide analogues combined with (pegylated-) interferon: a systematic review and Meta-analysis
    SHI Li-chen, LI Shun, MENG Tong-tong, HUANG Cheng, WANG Hao, XU Xiao-qian, JIA Ji-dong, KONG Yuan-yuan
    2025, 30(5):  638-644. 
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    Objective To evaluate the efficacy of nucleos(t)ide analogs (NAs) and (pegylated-) interferon (IFN) combination therapy in histological improvement in chronic hepatitis B (CHB) patients. Methods For comparing combination therapy with NAs and IFN versus either NAs or IFN monotherapy for CHB treatment, we searched randomized controlled trials (RCTs) and nonrandomized studies of interventions (NRSIs) in PubMed, Embase, and the Cochrane Library up to May 31, 2024. Results A total of 14 studies (13RCTs and 1 NRSI) involving 1411 patients were included. There were no statistically significant differences in the improvement of liver necroinflammation rate (RR=1.07, 95% CI: 0.82-1.40) or liver fibrosis rate (RR=1.00, 95% CI: 0.71-1.40) between NAs-IFN combination therapy and NAs monotherapy. Similarly, there were no statistically significant difference in the improvement of liver necroinflammation rate (RR=1.88, 95% CI: 0.91-3.90) between NAs-IFN combination therapy and IFN monotherapy. However, in studies recruiting patients with 75th percentile of age ≥45 years old, combination therapy significantly improved liver necroinflammation rate than IFN monotherapy (RR=3.02, 95% CI: 1.49-6.16). In studies with a baseline mean HBV DNA level of ≥7 log10 IU/mL, combination therapy significantly improved the liver necroinflammation rate (RR=1.41, 95% CI: 1.07-1.87) and liver fibrosis rate (RR=1.55, 95% CI: 1.08-2.22) than NAs monotherapy. Conclusion The combination therapy of NAs and IFN shows similar efficacy to monotherapy in improving liver necroinflammation and fibrosis. However, in studies involving older patients or those with higher baseline HBV DNA levels, the combination therapy demonstrates a significant advantage in histological improvement compared to NAs monotherapy.
    Analysis of the efficacy and safety of applying initial treatment with tenofovir amibufenamide versus entecavir in patients with HBeAg-positive chronic hepatitis B
    QIN Yao, WU Cheng-sheng, WANG Guo-ning, SUN Chao, ZHANG Yu-rui, WANG Hai-xia
    2025, 30(5):  645-649. 
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    Objective To investigate the clinical effect and safety of Tenofovir amibufenamide (TMF) versus entecavir (ETV) in the treatment of previously untreated HBeAg-positive chronic hepatitis B (CHB) patients for 120 weeks. Methods A retrospective analysis was performed for the clinical data of 161 HBeAg-positive CHB patients who were first treated with ETV or TMF, and the patients were categorized into the TMF group (n=90) and the ETV group (n=71). The patients’ age, gender, HBV DNA, serum alanine aminotransferase (ALT), creatinine, blood calcium, and blood phosphorus were collected, and Fibrosis-4 (FIB-4) and aminotransferase-to-platelet ratio index (APRI) indices were calculated and followed up at 24th, 48th, 96th, and 120th weeks of the treatment. Follow-up and evaluated visits were performed at weeks 24, 48, 96, and 120 of treatment to compare the HBV DNA conversion rate, ALT normalization rate, HBeAg seroconversion, and changes in FIB-4 and APRI indices between the 2 groups at each time point. Results In the TMF group and the ETV group, 90 and 71 cases completed 96-week follow-up. After excluding patients with incomplete responses, 88 and 67 patients completed 120-week follow-up. The results of univariate analysis of the two groups showed no statistical significance for age, HBV DNA level, HBeAg, FIB-4, and APRI index at baseline (P>0.05). There were no statistically significant difference in complete virologic response rate between the TMF group and the ETV group at 24, 48, and 96 weeks of treatment, which were 56.67%/77.78%/97.78% vs 63.38%/80.28%/94.37% (P>0.05). There were also no statistically significant differences in ALT recovery rate between the TMF group and the ETV group at 24, 48, and 96 weeks of treatment, which were 78.9%/94.4%/97.78% vs 81.69%/94.37%/97.18% (P>0.05). The FIB-4 index and APRI index decreased from the baseline at 24, 48, 96, and 120 weeks in both groups, and there was no statistically significant difference in inter-group comparisons (P>0.05). Among the patients who completed the 120-week follow-up, the complete virologic response rate and ALT recovery rate at 120 weeks in the TMF group were 96.59% and 98.86%, and the differences were not statistically significant when compared with those in the ETV group, which were 92.54% and 97.01%, respectively (P>0.05). Among them, there were 44 cases in the TMF group and 27 cases in the ETV group with baseline HBV DNA >108 IU/mL(which means CHB patient with a high viral load), with baseline HBV DNA values of 7.53±0.89 lg IU/mL vs. 7.43±0.87 lg IU/mL, after 96 weeks of treatment, the HBV DNA values were 2.05±0.26 lg IU/mL vs 2.12±0.48 lg IU/mL, and the conversion rate was 95.45% vs 88.89%, which means there were no statistically significant between the two groups. The HBV DNA value was significantly reduced after 96 weeks of treatment, and the TMF group’ descend range was greater than the ETV group. During the whole treatment period, no severe complications occurred in both two groups. Conclusion The antiviral efficacy of 120-week treatment of HBeAg-positive CHB patients with TMF and ETV is significant and also effective in patients with high viral loads, and there are no significant adverse reaction to either drug, with a favorable safety profile. TMF and ETV had similar significant antiviral effects on HBeAg-positive CHB patients in the 120-week-treatment and were also effective in patients with high viral loads, with few adverse reaction and a favorable safety profile.
    Analysis of factors affecting postpartum flare in pregnant women with hepatitis B infection undergoing mother-to-child transmission blockade
    CHEN Bei-bei, ZHANG Xiao-qin
    2025, 30(5):  650-654. 
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    Objective This research seeks to identify the determinants of postpartum hepatitis outbreaks in pregnant women with hepatitis B infection who are receiving treatment to prevent mother-to-child transmission based on the nomogram model. Methods A total of 136 pregnant women with chronic hepatitis B infection treated from January 2021 to January 2023, were selected as research subjects. All patients received mother-to-child transmission blockade therapy. General data of the patients were collected, and serum levels of Alanine Aminotransferase (ALT), HBV DNA, Hepatitis B Surface Antigen (HBsAg), Hepatitis B e Antigen (HBeAg), and Hepatitis B Core-related Antigen (HBcrAg) were measured before antiviral therapy. Following delivery, all mothers were followed up for 48 weeks. Based on the follow-up outcomes, they were divided into a flare group (n=31) and a non-flare group (n=105). Logistic regression analysis was used to screen for factors affecting postpartum hepatitis flares, a nomogram model was developed, and its fit was evaluated using calibration curves. Results In the flare group, pre-treatment serum levels of ALT, HBcrAg, HBsAg, HBeAg, and HBV DNA were (29.30 ± 2.71) U/L, (7.42 ± 1.03) log10μg/mL, (4.25 ± 0.56) log10IU/mL, (2.57 ± 0.42) log10SCO, and (7.49 ± 1.12) log10IU/mL (P<0.05). Multivariate analysis indicated that levels of ALT, HBcrAg, HBsAg, HBeAg, and HBV DNA were significant factors affecting postpartum hepatitis flare, with higher levels associated with an increased risk of flare (P<0.05). The calibration curve showed a mean absolute error of 0.026, indicating that the predictive model’s calibration curve approached the ideal curve. Conclusion ALT levels and hepatitis B virus markers can influence postpartum flares in pregnant women. Effective interventions based on these markers can reduce the risk of flare.
    The relationship between peripheral blood T lymphocytes and liver function, as well as HBV DNA, in patients with chronic hepatitis B
    WANG Qian, GAO Cui-hua
    2025, 30(5):  655-658. 
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    Objective To explore the correlation between peripheral blood T lymphocyte subsets and liver function, as well as HBV DNA in patients with chronic hepatitis B (CHB). Methods Between March 2022 and March 2024, 70 patients with a diagnosis of CHB were included in this study from the People's Hospital of Linquan County, Anhui Province. Based on HBV DNA levels, patients were categorized into a high viral load group (36 cases) and a low viral load group (34 cases), alongside a healthy control group (n=40). Peripheral blood T lymphocyte subsets were measured for all participants, and liver function indicators along with HBV DNA were recorded. Pearson correlation analysis was employed to examine the relationship between peripheral blood T lymphocytes and liver function indicators, as well as HBV DNA. Results Patients in the high-load group exhibited the lower levels of CD4+ (42.17±5.40%) and Albumin (Alb, 31.21±4.13 g/L) compared to those in the low-load group (CD4+: 45.08±6.13%, Alb: 36.32±5.26 g/L) and the control group (CD4+: 48.50±5.29%, Alb:45.83±6.15 g/L). Furthermore, the levels of CD8+ (29.50±3.30%), CD4+CD25+ (35.09±6.12%), Alanine Aminotransferase (ALT, 62.86±9.25 U/L), Aspartate Aminotransferase (AST, 59.35±6.08 U/L), and Total Bilirubin (TBil, 37.19±3.27 μmol/L) were higher in the high-load group than in the low-load group (CD8+: 23.82±3.76%, CD4+CD25+: 30.57±5.41%, ALT: 37.52±5.30 U/L, AST: 35.72±5.17 U/L, TBil: 19.61±4.43 μmol/L) and the control group (CD8+: 21.26±3.16%, CD4+CD25+: 26.75±3.34%, ALT: 18.35±3.11 U/L, AST: 16.22±3.23 U/L, TBil: 9.21±2.65 μmol/L). The HBV DNA level (7.48±2.09 lgIU/mL) in the high-load group was higher than that in the low-load group (5.53±1.11 lgIU/mL) (P<0.05). Pearson correlation analysis revealed that CD4+ levels were significantly negatively correlated with ALT, AST, TBil, and HBV DNA, and positively correlated with Alb. The CD8+ and CD4+CD25+ levels were significantly positively correlated with ALT, AST, TBil, and HBV DNA, and negatively correlated with Alb (P<0.05). Conclusion The subsets of peripheral blood T lymphocytes in patients with CHB are closely related to liver function indicators and HBV DNA levels, serving as important immunological markers for assessing disease progression and prognosis.
    Metabolic Associated Fatty Liver Disease
    A study on the correlation between serum levels of 7 mineral nutrients and the risk of non-alcoholic fatty liver disease in patients with metabolic syndrome
    CHEN Xiao-yan, SUN Pei-qi, YUAN Yi-fu, CAO Qin, JIANG Yuan-ye
    2025, 30(5):  659-665. 
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    Objective To investigate the correlation between seven serum minerals (calcium, iron, phosphorus, potassium, sodium, selenium, manganese) and the risk of non-alcoholic fatty liver disease (NAFLD) in patients with metabolic syndrome (MS). Methods By analyzing the laboratory data of the NHANES database from 2017 to 2018, the variables such as age, gender, race/nationality, marital status, body mass index, smoking status, drinking status, education level, intensity of physical activity, diabetes history and cardiovascular history were included in the model. The Spearman correlation analysis was used to evaluate the cross correlation between biomarkers, and Bayesian kernel machine regression (BKMR) model was used to fit the association between serum minerals and the risk of NAFLD. Results Among the 1661 MS patients included, NAFLD patients were found to have the higher serum selenium and manganese concentrations and the lower serum phosphorus concentrations. The results of the BKMR model showed a positive linear relationship between mineral mixed serum concentration and the risk of NAFLD prevalence. The increase in selenium concentration of a single mineral in the mixture is significantly positively correlated with the risk of NAFLD. When the concentration of other mineral concentrations is fixed, the IQR of serum selenium concentration increases from 2.25 μmol/L to 2.64 μmol/L, and the correlation with the proportion of increased risk of NAFLD is 19.3% (95% CI: 10%~27.5%), 19.1% (95% CI: 11.2%~25.8%), and 17.8% (95% CI: 8.9%~26.3%), respectively. In addition, the research suggests that there may be interactions among selenium, potassium, and phosphorus. Conclusion There is a positive linear relationship between the mixed serum concentration of minerals and the risk of NAFLD, with an increase in serum selenium concentration being significantly positively correlated with the risk of NAFLD.
    Mechanism of FABP4 deficiency in improving non-alcoholic steatohepatitis in mice
    CHEN Yan-jun, LI Jia-xun, ZHONG Fu-di, JIANG Ke-qing
    2025, 30(5):  666-674. 
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    Objective To investigate the role of fatty acid binding protein 4 (FABP4) in the progression of non-alcoholic steatohepatitis (NASH) in mice. Methods Male C57BL/6J mice, aged 8-10 weeks and weighing about 20 g, were randomly divided into three groups with six mice in each group: normal control diet plus intraperitoneal injection of corn oil (ND+Oil), western diet plus intraperitoneal injection of corn oil (WD+Oil), and western diet plus intraperitoneal injection of carbon tetrachloride (WD+CCl4). The mice were raised for 12 weeks to construct the NASH model. Hematoxylin-eosin (H&E) staining, Sirius red staining, liver tissue biochemistry and real-time fluorescence quantitative PCR (qRT-PCR) were used to detect the degree of fat deposition, inflammatory reaction and fibrosis in the mouse liver; the expression of FABP4 was detected by qRT-PCR and Western blotting (WB). Then, FABP4 knockout (FABP4 KO) mice and littermate C57BL/6J wild-type mice (8-week-old male mice, weighing about 20 g) were used to construct the NASH model with a western diet plus intraperitoneal injection of CCl4. After 12 weeks, the degree of fat deposition, inflammatory reaction and fibrosis in the mouse liver were detected. The expression profiling sequencing of the mice liver tissues were performed and related signaling pathways were verified. Results Compared with the ND+Oil group, elevated serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the WD+Oil group were observed. Lipid droplet accumulation, triglycerides (TG) level,and positive areas of Sirius red were elevated in the mice liver tissue. The mRNA expression of lipid synthesis genes (Acc, Fasn), the inflammatory factors (Tnf-a, Il-6, and Il-1β), and the fibrosis-associated factors (Col1a1, α-Sma) in the liver tissues were upregulated in the WD+Oil group (all P<0.05); while there was no statistical significance for Acc and Col1a1. Compared with the WD+Oil group, the levels of serum AST and ALT in the WD+CCl4 group were increased (all P<0.05). Significant increase of lipid droplet and fibrotic areas, and elevated TG level in liver tissue were observed. The mRNA expression of Acc, Fasn, Tnf-α, Il-6, Il-1β, Col1a1 and α-Sma was upregulated (all P<0.05). However, there was no statistical significance for Acc and Il-6. Furthermore, we found the mRNA and protein expression of FABP4 in the mice liver were elevated in the WD+Oil group and WD+CCl4 group when comparing with the respective control group. In the NASH model, compared with WT mice, FABP4 KO mice showed a significant reduction in hepatic lipid droplets. The positive areas of F4/80, Col1a1, and α-Sma in liver tissue were significantly decreased by immunohistochemical (IHC) detection, and the mRNA expression levels of hepatic Acc, Fasn, Tnf-α, Il-6, α-Sma, and Col1a1 were significantly reduced (all P<0.05). The protein levels of TNF-α, IL-1β, α-SMA, COL1A1, and TGF-β1 were also downregulated. Mechanistically, deficiency of FABP4 reduces hepatic steatosis, inflammatory changes, and fibrosis in NASH mice by regulating the PPAR γ and TGF-β1/Smad2/3 signaling pathways. Conclusion FABP4 is highly expressed in liver tissues of NASH mice. Deficiency of FABP4 improves the progression of NASH in mice by partially reducing lipogenesis, enhancing lipolysis and inhibiting the phosphorylation level of Smad2/3, which suggests that FABP4 may be a therapeutic target for improving NASH.
    Quzhi formula improves liver fibrosis related to metabolic dysfunction associated steatohepatitis by regulating the ITGB6/IL23A/STAT3 pathway
    CHEN Hui-jie, PENG Zhou, ZHANG Qin
    2025, 30(5):  675-682. 
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    Objective The purpose of this study was to explore whether Quzhi formula has the effect of improving metabolic dysfunction associated steatohepatitis (MASH) related fibrosis and the internal mechanism of its efficacy. Methods LX2 cells were starved for 24 hours with fetal bovine serum-free DMEM medium overnight and then treated with TGF-β1 at 10 ng/mL (Abcam, ab50036). Finally, the cells were treated with serum-free DMEM medium containing 200μg/mL Quzhi formula. The cytotoxicity of Quzhi formula was detected by cell counting kit-8 assay, then western blotting, quantitative reverse transcription-polymerase chain reaction and immunofluorescence were performed to measure whether Quzhi formula reversed the activation of LX-2 induced by TGF-β1. For in vivo experiment, C57BL/6 SPF mice aged 6 weeks were randomly divided into 3 groups: control group, MASH group and Quzhi formula group. The MASH group and Quzhi formula group were fed diets containing 62% kcal fat and 0.1% methionine and choline deficiency for 3 weeks. Mice in the control group and MASH group were administrated with normal saline, and mice in the Quzhi formula group were administrated with Quzhi formula (10g/kg/d). After 9 weeks, the mice were euthanized, plasma and liver tissues were collected, and the effect of Quzhi formula was analyzed. Results The animal experiment proved that the lipid accumulation and liver fibrosis in MASH mice could be alleviated by Quzhi formula. Cell experiments demonstrated that Quzhi formula reversed TGF-β1 induced LX-2 activation by regulating ITGB6/IL23A/STAT3 signaling pathway. In addition, STAT3 inhibitors also reversed LX-2 activation induced by TGF-β1, which further demonstrated that Quzhi formula improves MASH related fibrosis through the above pathway. Conclusion Quzhi formula can not only improve MASH steatosis, but also alleviate MASH related fibrosis. It is suggested that Quzhi formula can be used as a new drug to treat MASH.
    Other Liver Diseases
    To explore the characteristics of intestinal flora in patients with chronic liver disease based on 16S rDNA gene sequencing technology
    MA Chi, YANG Juan, ZHANG Sheng, FU Xin-nian, LUO Jiang-yan, WANG Xin-xin, MA Xiao-ying, MAO Xiao-zhou
    2025, 30(5):  683-689. 
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    Objective By comparing the intestinal flora characteristics of different chronic liver disease patients and healthy volunteers, the differences and associations of intestinal flora between chronic liver disease patients and healthy volunteers were explored. Methods A total of 60 patients with chronic liver disease (including 16 patients with chronic hepatitis B, 37 patients with cirrhosis, and 7 patients with hepatocellular carcinoma) and 37 healthy volunteers were selected from the Third People's Hospital of Yunnan Province from February 2023 to August 2023.Fresh fecal samples were collected, DNA was extracted and 16S rDNA high-throughput sequencing technology was used to detect intestinal flora, and microbial diversity and composition were analyzed. Results In terms of alpha diversity, compared with the healthy control group, the intestinal flora richness and diversity of patients in each chronic liver disease group were significantly reduced, and the flora richness and diversity continued to decline during the progression of chronic hepatitis B→cirrhosis→hepatocellular carcinoma. In terms of species abundance, with the progression of chronic hepatitis B→cirrhosis→hepatocellular carcinoma, the abundance of Escherlchia-Shigella increased continuously.Among the distinct species screened at the generic level, compared to healthy controls, Faecalibacterium, Agathobacter, Prevotella-9, Dialister, Roseburia and Ruminococcus in each chronic liver disease groupThe relative abundance of eight bacteria genera, including Coprococcus and Subdoligranulum, decreased.LEfSe analysis showed that intestinal dominant bacterium was different in different stages of chronic liver disease. Conclusion Patients with chronic liver disease have significantly different intestinal flora characteristics compared with healthy controls, and changes in the abundance of Escherlchia-Shigella may mediate the progression of chronic hepatitis B→cirrhosis→hepatocellular carcinoma. And with the progression of chronic hepatitis B→cirrhosis→hepatocellular carcinoma disease, the intestinal dominant bacterium is also changing.
    Effects of adenosylmethionine butadisulfonate combined with ursodeoxycholic acid on vascular endothelium and liver function and pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy
    CHENG Lan, WU Jian-yun
    2025, 30(5):  690-693. 
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    Objective To investigate the efficacy and safety of adenosine butyldisulfonate combined with ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy (ICP). Methods 68 pregnant women with ICP who were diagnosed and treated from January 2021 to February 2024 were randomly divided into observation group and control group. On the basis of routine intervention and polyene phosphatidylcholine treatment, the control group was treated with ursodeoxycholic acid capsule, and the observation group was treated with adenosylmethionine butadisulfate for injection. The changes of endothelial cell function, bile metabolism and liver function indicators, as well as pregnancy outcomes and safety were observed. Results After 2 weeks of treatment, serum ET-1 and sFlt-1 levels in the observation group were (11.54±2.06)ng/L and (13.86±2.15)μg/L, which were lower than (15.85±2.43)ng/L and (16.75±2.49)μg/L in the control group, and VEGF levels in the observation group were (72.49±8.16)pg/L, higher than (65.81±7.54)pg/L in the control group, the difference was statistically significant (t=7.814, 7.529, 7.354, all P<0.05). The levels of CG, CBA and TBA in the observation group were (2.38±0.51)mg/L, (9.53±1.84)μmol/L and (11.51±2.06)μmol/L, which were lower than those in the control group (2.89±0.62) mg/L, (12.89±2.26) μmol/L and (14.08±2.53) μmol/L. The difference was statistically significant (t=6.824, 7.826, 8.046, all P<0.05). ALT, γ-GT and TBil levels in the observation group were (70.26±5.46)U/L, (205.54±14.23)U/L and (94.52±8.53)μmol/L. It was lower than that in the control group (79.58±6.73) U/L, (246.70±19.29) U/L, (105.63±11.67) μmol/L, and the difference was statistically significant (t=6.563, 6.429, 6.470, all P<0.05). In the observation group, the incidence rates of FGR, premature delivery, fecal amniotic fluid contamination, neonatal asphyxia, cesarean section, postpartum hemorrhage and puerperal infection were 5.88%, 2.94%, 2.94%, 2.94%, 17.65% and 2.94%. They were lower than those in the control group (11.76%, 8.82%, 5.88%, 8.82%, 38.24%, 5.88%), and the difference was statistically significant (P<0.05). There was no statistical significance in the incidence of adverse drug reactions between the two groups (P>0.05). Conclusion Treating ICP with ADT combined with ursodeoxycholic acid capsule can protect endothelial cell function, improve bile metabolism and liver function, and improve pregnancy outcome, with high drug safety.
    Risk factors for adverse pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy and prediction model analysis
    ZHANG Jun-qin, XIN Ling-li, LIU Dan, WANG Li-rong, HOU Qing-xiang, ZHANG Ting-ting
    2025, 30(5):  694-699. 
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    Objective To investigate the risk factors for adverse pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy (ICP) and to develop a prediction model, providing a theoretical basis for early clinical intervention. Methods A retrospective analysis was conducted on the 168 ICP patients who visited our hospital from September 2021 to August 2024. Based on whether adverse pregnancy outcomes occurred, the patients were divided into an adverse outcome group (54 cases) and a favorable outcome group (114 cases). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for adverse pregnancy outcomes in ICP patients. Furthermore, the predictive value of each risk factor for adverse pregnancy outcomes was assessed using receiver operating characteristic (ROC) curves, and a prediction model was established by combining clinical parameters. Results In the adverse outcome group, the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bile acids (TBA), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), and activated partial thromboplastin time (APTT) were (38.02±6.75) U/L, (36.58±7.46) U/L, (44.85±5.33) μmol/L, (5.78±1.10), (14.13±3.27) fL, and (48.59±6.57) s, respectively, which were higher than those in the good outcome group, with values of (30.38±5.95) U/L, (27.90±5.53) U/L, (42.48±5.90) μmol/L, (4.99±0.92), (12.29±2.74) fL, and (43.65±5.75) s (P<0.05). Multivariate logistic regression analysis revealed that high levels of AST, ALT, TBA, NLR, MPV, and APTT were independent risk factors for adverse pregnancy outcomes in ICP patients (P<0.05). The sensitivities of AST, ALT, and TBA for predicting adverse pregnancy outcomes were 74.1%, 75.9%, and 50.0%, with specificity values of 75.4%, 79.8%, and 71.1%, and AUC values of 0.811, 0.826, and 0.612, respectively. The sensitivities of NLR, MPV, and PT were 83.3%, 44.4%, and 55.6%, with specificity values of 45.6%, 84.2%, and 82.5%, and AUC values of 0.695, 0.666, and 0.711, respectively. When these indicators were combined, the sensitivity and specificity were 92.6% and 92.1%, respectively, with an AUC of 0.958. Conclusion AST, ALT, TBA, NLR, MPV, and PT are independent risk factors for adverse pregnancy outcomes in ICP patients. Elevated levels of these indicators significantly increase the risk of adverse pregnancy outcomes and can provide a theoretical basis for early prediction and intervention in clinical practice.
    Analysis of the association between EBV-specific antibody reactivation and liver function damage in children infected with EBV
    WANG Hui, GUO Xin, XIA Ming-qian, LI Chen-xi, CUI Hong-chao
    2025, 30(5):  700-704. 
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    Objective To investigate the clinical data, liver function indicators, and immune markers of children with reactivated EBV-specific antibodies compared to those with primary EBV infections, and to analyze their correlation. Methods From May 2019 to May 2023, 209 children with positive EBV-DNA were admitted to Beijing Children′s Hospital Baoding Hospital, affiliated with Capital Medical University. Based on the results of specific antibody tests, they were divided into two groups: a primary EBV infection group (n=144) and a reactivated EBV infection group (n=65). The clinical data, liver function indicators, and immune markers of the two groups were analyzed. Pearson correlation analysis was employed to assess the association between liver function indicators and immune markers. Results Children in the primary group exhibited a higher incidence of hepatomegaly, splenomegaly, lymphadenitis, and eyelid edema (P<0.05). The reactivation group had a higher incidence of complications in the hematological system, nervous system, and serous effusions (P<0.05). In the reactivated group, ALT levels were 139.22 (range 44.18 to 654.59) compared to 123.64 (range 49.25 to 339.11), AST levels were 148.93 (range 61.57 to 663.85) compared to 98.73 (range 59.50 to 262.66), and DBil levels were 2.87 (range 1.19 to 33.12) compared to 1.85 (range 1.11 to 5.53) in the primary group, all showing statistical significance (P<0.05). For immune markers, CD8+ was lower at 27.85 (range 12.45 to 63.20) compared to 61.72 (range 37.59 to 75.88), CD4/CD8 was 1.07 (range 0.18 to 2.32) compared to 0.25 (range 0.13 to 0.54), and CD20+ was 10.02 (range 1.92 to 31.12) compared to 4.63 (range 1.88 to 10.30) in the primary group, with significant differences (P<0.05). Pearson correlation analysis showed that ALT, AST, and DBil had a negative correlation with CD8+ and a positive correlation with CD4/CD8 and CD20+ (P<0.05). Conclusion Children with reactivated EBV exhibit significant differences in clinical data, liver function, and immune markers, indicating a close association between EBV-specific antibody reactivation, liver function damage, and immune response.
    Function analysis of CD4+ and CD8+T lymphocytes in peripheral blood of children with EB virus infection-related liver damage
    CAI Xin, CHEN Zheng-xu, YUAN Run-lin, CHAI Ye
    2025, 30(5):  705-708. 
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    Objective To evaluate the function of CD4+ and CD8+ T lymphocytes in peripheral blood of children with EB virus infection-related liver damage. Methods 104 cases of children infected with EB virus between January 2022 and June 2024 in our hospital were divided into liver damage group and non-liver damage group according to whether they were complicated with liver damage or not. The general data, CD4+, CD8+ T lymphocyte subsets and their surface markers expression levels in peripheral blood of the two groups were compared before and after treatment. Results There were 43 cases with liver damage and 61 cases without liver damage in 104 children. The levels of ALT, AST and TBil in the liver damage group were (56.3±17.3) U/L, (50.2±15.5) U/L and (23.2±4.3) μmol/L, which were significantly higher than those in the non-liver damage group [(35.6±11.0) U/L, (35.1±9.7) U/L, (15.2±2.4) μmol/L, P<0.05]. After treatment, the ratio of CD4+ T lymphocytes and CD4+/CD8+ in the liver damage group were (36.7±3.6)% and (1.2±0.2), which were significantly higher than those in the non-liver damage group [(34.7±3.2)% and (1.1±0.4), respectively, P<0.05]. The expression percentages of CD45RA, CD45RO, CCR3 and CD28 on the surface of CD4+ T lymphocytes in liver damage group were 21.2 (16.3, 24.4)%, 19.0 (14.5, 23.2)%, 15.1 (8.9, 23.8)% and 42.3 (36.2, 52.7)%, they were significantly higher than those in the non-liver damage group [18.2 (14.3, 23.5)%, 13.7 (9.3, 17.2)%, 8.1 (4.0, 10.3)% and 33.6 (30.3, 38.4)%, P<0.05]. The expression percentages of CD45RA, CCR3 and CD25 on the surface of CD8+ T lymphocytes in liver damage group were 17.3 (13.4, 19.7)%, 1.1 (0.5, 2.6)% and 0.6 (0.3, 1.0)%, they were significantly higher than those in the non-liver damage group [13.9 (9.6, 17.1)%, 0.7 (0.4, 0.9)% and 0.3 (0.2, 0.4)%] (P<0.05). Conclusion The imbalance of CD4+ and CD8+ cells in peripheral blood and the abnormal expression of cell surface markers in children with EB virus infection complicated with liver damage may affect the clinical outcome of patients, whichdeserves further study.
    Clinical characteristics and therapeutic effect evaluation of patients with type 2 diabetes complicated with bacterial liver abscess
    XU Yan-lan, WANG Xiao-wei
    2025, 30(5):  709-712. 
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    Objective To analyze the clinical features and therapeutic effects of type 2 diabetes mellitus (T2DM) complicated with bacterial liver abscess (BLA). Methods The clinical data of 77 patients with BLA between January 2022 and December 2024 were collected. Patients were divided into T2DM group and BLA group according to whether they were complicated with T2DM or not. The baseline data, clinical manifestations and signs, blood biochemical indexes and clinical outcomes of the two groups were compared. Results Among 77 cases of BLA, 31 cases were complicated with T2DM (T2DM group), and the other were simple BLA group (n=46). In T2DM group, the age, abscess course and respiratory infection were (54.3±9.7) years, (25.6±5.4) days and 11 cases (35.4%), which were significantly higher than those in BLA group [(47.8±9.0) years, (17.8±4.4) days and 4 cases (8.7%), P<0.05]. The clinical manifestations and signs of anemia, abdominal pain, weight loss and sepsis in T2DM group were significantly heavier than those in BLA group (P<0.05). The clinical manifestations or signs of anemia, abdominal pain, weight loss and sepsis in T2DM group were 6 cases (19.3%), 20 cases (64.5%), 28 cases (90.3%) and 21 cases (67.7%), which were significantly heavier than those in BLA group [1 case (2.2%), 7 cases (15.2%), 25 cases (54.3%) and 10 cases (21.7%), P<0.05]. After systemic anti-infection combined with necessary abscess puncture and drainage, supplemented by blood sugar control and reasonable diet, 6 cases were cured, 19 cases were improved, 5 cases were not cured and 1 case died in the group with T2DM, and the effective rate was 83.9%, while 9 cases were cured, 33 cases were improved, 4 cases were not cured and 0 cases died in the group with BLA alone, and the effective rate was 91.3%, with no statistical significance (χ2=1.862,P=0.172). Conclusion The clinical manifestations of BLA patients with T2DM are more complicated, and the condition is more serious. The inflammatory reaction is more intense, and the patients exhibits significant metabolic disorders. However, through systematic anti-infection treatment, abscess drainage and comprehensive intervention measures, most patients can still achieve a favorable therapeutic effect.
    Autoimmune liver diseases and pregnancy outcomes: a Mendelian randomization study
    YUAN Yi, XIONG Zi-chen, DENG Xue-ting, MIAO Lin
    2025, 30(5):  713-721. 
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    Objective To investigate the causal links between autoimmune liver diseases (AILDs) and pregnancy outcomes. Methods Mendelian randomization analysis was utilized in this study. From large-scale genome-wide association study (GWAS) databases, single nucleotide polymorphisms highly related to primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and autoimmune hepatitis (AIH) were extracted and selected to act as instrumental variables. Inverse variance weighted (IVW) served as the primary analytical method, supplemented by MR-Egger, weighted median, simple model, and weighted model to evaluate causal effects. Moreover, multiple sensitivity analyses were performed to ensure the robustness of the results. Results This MR study found causal effects of PBC on both preterm birth (IVW OR:1.0298; 95% CI: 1.0088 to 1.0511; P=0.0051) and offspring birth weight (IVW beta: -0.0166; 95% CI: -0.0225 to -0.0107; P=3.14×10-8). PSC was positively associated with ectopic pregnancy (IVW OR: 1.0558, 95% CI: 1.0179 to 1.0951; P=0.0036) and spontaneous abortion (IVW OR: 1.0004; 95% CI: 1.0001 to 1.0006; P=0.0181), while AIH was linked to an increased risk of postpartum depression (OR=1.0436; 95% CI 1.0045 to 1.0843; P=0.0285). Conclusion This study offers novel evidence supporting causal relationships between AILDs and pregnancy outcomes.
    The value of contrast-enhanced ultrasound combined with serum sTIM-3 and YKL-40 levels in differentiating malignant and benign gallbladder lesions
    HU Li-jun, LIAN Qian-qian
    2025, 30(5):  722-726. 
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    Objective To evaluate the diagnostic value of contrast-enhanced ultrasound combined with serum soluble T cell immunoglobulin mucin-3 (sTIM-3) and YKL-40 levels in differentiating malignant and benign gallbladder lesions. Methods A total of 320 patients with gallbladder occupying lesions admitted to Handan People's Hospital from May 2021 to November 2023 were selected. According to postoperative pathological results, patients were divided into a benign group (262 cases) and a malignant group (58 cases). All patients underwent routine and contrast-enhanced ultrasound examinations, and serum sTIM-3 and YKL-40 level testing. Clinical characteristics and detection indicators were compared between the two groups. Results Two-dimensional ultrasound showed that the proportions of irregular lesion shapes, multiple lesion numbers, and liver infiltration in the malignant group were 74.14%, 81.03%, and 43.10%, respectively, which were higher than those in the benign group (23.28% , 46.56%, and 0.00%, respectively) (P<0.05). There was no significant difference in the comparison of combined gallbladder stones between the two groups (P>0.05). Contrast-enhanced ultrasound showed that there was no significant difference in the enhancement levels during the arterial phase between the two groups (P>0.05). In terms of distribution characteristics, the proportion of uniform distribution in the benign group was 73.66% , which was higher than that in the malignant group (56.90%) (P<0.05). In terms of the enhancement level during the venous phase, the proportion of low-level enhancement in the malignant group was 82.76%, which was higher than that in the benign group (7.25%) (P<0.05). In terms of the integrity of the gallbladder wall, the proportion of the integrity of the gallbladder wall in the benign group was 95.80% , which was higher than that in the malignant group (53.45% ) (P<0.05). In terms of the lesion base, the proportion of wide-type lesions in the benign group was 46.95% , which was lower than that in the malignant group (96.55%)(P<0.05). The serum sTIM-3 and YKL-40 levels in the malignant group were (3.20 ± 1.18) ng/mL and (247.48 ± 54.85) ng/mL, respectively, which were higher than those in the benign group [(1.71 ± 0.52) ng/mL and (168.80 ± 34.19) ng/mL, respectively] (P<0.01). ROC curve analysis showed that the sensitivity of contrast-enhanced ultrasound for diagnosing malignant and benign gallbladder lesions was 82.8%, with a specificity of 92.7% and an AUC of 0.898. The sensitivity for serum sTIM-3 was 81.0%, specificity 88.2%, and AUC 0.883. For YKL-40, the sensitivity was 82.8%, specificity 84.0%, and AUC 0.891. When combining contrast-enhanced ultrasound with sTIM-3 and YKL-40, sensitivity increased to 91.4%, specificity reached 98.1%, and the AUC value was 0.966. Conclusion The detection of contrast-enhanced ultrasound combined with serum sTIM-3 and YKL-40 levels can significantly improve the accuracy of differentiating between benign and malignant gallbladder lesions, providing a reliable reference for clinical practice.
    Clinical efficacy of single hole laparoscopic cholecystectomy for the treatment of gallstones
    YU Hai-yang, CHEN Zhi-qun, SHAN Kai, WEI Wei, ZHOU Wei, CHEN Shu-rong
    2025, 30(5):  727-730. 
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    Objective To evaluate the therapeutic effect of single-incision laparoscopic cholecystectomy (SILC) on benign gallbladder diseases. Methods The study sample consisted of 100 patients who underwent cholecystectomy at the People's Hospital of Tinghu District, Yancheng City, from June 1, 2023, to December 30, 2023. All patients were divided into an observation group and a control group using a random number table method, with 50 cases in each group.The observation group received SILC, while the control group underwent multi-port (three or four ports) laparoscopic cholecystectomy. The comparison between the two groups focused on operative duration, blood loss during surgery, hospital stay length, costs of hospitalization, post-surgery pain levels, appearance of surgical scars, occurrence of complications like wound infection, bleeding inside the abdomen, bile leaks, damage to the biliary system, and internal organ injuries, alongside overall patient satisfaction. Results The operative times for the observation and control groups were (40.73±12.34) and (25.81±10.37) minutes, respectively. For the observation group, intraoperative blood loss was (9.74±2.87) mL, hospital stay was (5.89±1.34) days, and costs were (13217±235.21) CNY. In contrast, the control group had (14.37±2.93) mL blood loss, (7.83±1.98) days in the hospital, and (11874±237.83) CNY in costs. The differences between the groups were statistically significant (t=9.674, P<0.05). Postoperative pain scores at various time points were lower in the observation group, and the CVAS scores were higher compared to the control group. The overall satisfaction rates for the observation and control groups were 94% and 54%, respectively, with significant differences between the groups (P<0.05). Conclusion SILC significantly reduced the incidence of postoperative complications and incisional pain, and offers better cosmetic results for surgical scars.
    Analysis of cardiac involvement in 60 patients with hepatolenticular degeneration
    CHANG Li-li, LIU Cheng, ZHENG Bo
    2025, 30(5):  731-733. 
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    Objective To analyze the manifestations of cardiac involvement in 60 patients with hepatolenticular degeneration. Methods Between January 2018 and December 2022, 60 patients with hepatolenticular degeneration were diagnosed and treated in Yellow River Sanmenxia Hospital. Clinical data of the patients were collected, and a 12 lead electrocardiogram was used for examination. Abnormal cases were examined using a color Doppler ultrasound diagnostic instrument for echocardiography, and serum cardiac markers were detected using chemiluminescence and double antibody sandwich immunofluorescence methods. Results 60 patients with hepatolenticular degeneration had liver manifestations as the first symptom, with alanine aminotransferase [(43.7 ± 6.8) U/L], aspartate aminotransferase [(46.5 ± 7.6) U/L], γ- Glutamic transferase [(65.7 ± 8.3) U/L], total bilirubin [(36.9 ± 4.1) μ mol/L] and 24-hour urine copper [(655.3 ± 140.9) μg/d] were significantly increased, while the levels of ceruloplasmin [(73.5 ± 9.2) mg/L] and serum copper [(5.8 ± 0.6) μ mol/L] significantly decreased. Among the 60 patients with hepatolenticular degeneration, 18 had cardiac involvement, with 4 cases of atrial premature beats and 4 cases of increased QRS complex wave width (22.2%), 2 cases of T-wave inversion, ST segment changes, and atrioventricular block (11.1%), and 1 case of ventricular tachycardia, P-wave inversion, sinus bradycardia, and coexistence of sinus bradycardia and T-wave inversion (5.6%). The left ventricular end diastolic diameter [(47.5 ± 7.6) mm], left ventricular ejection fraction [(69.2 ± 8.8)%], and E/A (1.9 ± 0.2) levels are relatively high. When the heart is affected in patients with hepatolenticular degeneration, serum levels of troponin I (cTnI) [(1.4 ± 0.1) ng/mL] and N-terminal B-type natriuretic peptide (NT proBNP) [(693.5 ± 162.7) pg/mL] significantly increase. Conclusion Heart involvement is more common in patients with Wilson's disease, with changes in cardiac structure and function that can be evaluated using imaging and laboratory examinations.