Loading...

Table of Content

    31 July 2025, Volume 30 Issue 7
    Previous Issue   
    Frontier, Exploration and Controversy Liver Fibrosis&Cirrhosis
    The risk factors affecting the maintenance of the first re-compensatory state in patients with HBV-related decompensated cirrhosis
    XU Jia-jun, MIAO You-han, YU Chong, WANG Zhong-cheng, GU Er-li, LI Min
    2025, 30(7):  906-911. 
    Asbtract ( 33 )   PDF (532KB) ( 5 )  
    References | Related Articles | Metrics
    Objective To analyze and identify the risk factors associated with recurrent decompensation in patients with HBV-related decompensated cirrhosis after treatment-induced re-compensation. Methods A retrospective study was conducted by telephone follow-up and review of medical records to select HBV-related patients with initial decompensated cirrhosis treated in the department of hepatology from January 2017 to January 2021. Patients whose liver function recovered to a recompensated state after comprehensive treatment, including antiviral therapy, were included as study subjects. Continuous follow-up was conducted for 12 months. Based on the occurrence of decompensation, patients were divided into a sustained compensation group and a re-decompensation group. The groups were compared for general information such as gender and age, biochemical indicators at the time of initial decompensation, the first decompensation event, organ damage, Child-Pugh score, and serum HBV-DNA negativity. Multivariate binary logistic regression analysis was performed, including indicators with statistical significance (P<0.2) from univariate binary logistic regression analysis, to explore risk factors for re-decompensation after re-compensation. Results This study initially included 412 patients, with 203 cases (49.27%) achieving re-compensation after treatment and follow-up. These 203 patients were continuously observed over 12 months and were categorized into two groups based on the presence of decompensation: sustained re-compensation (102 cases) and recurrent decompensation (101 cases). Comparative analysis between the groups revealed statistically significant differences in disease course, number of complications during initial decompensation, biochemical indicators including total bilirubin (TBil), cholinesterase (CHE), prealbumin (PA), creatinine (Cr), FBG (fast blood glucose), procalcitonin (PCT) during the initial decompensation, Child-Pugh scores (at initial decompensation, 6 months, and 12 months), and the HBV-DNA negative conversion rate at 6 months (P<0.05). Univariate binary logistic regression analysis identified variables with P<0.2, including disease course, multiple complications during initial decompensation, biochemical indicators (TBil, CHE, Cr) during initial decompensation, Child-Pugh scores (at initial decompensation, 6 months, and 12 months), and the HBV-DNA negative conversion rate (at 6 and 12 months), which were then included in a multivariate binary logistic regression analysis (stepwise regression). The results indicated that multiple complications during the initial decompensation event, biochemical indicators (CHE, Cr) during initial decompensation, the HBV-DNA negative conversion rate at 6 months, and the Child-Pugh score at 6 months were risk factors for recurrent decompensation after the first re-compensation in HBV-related decompensated cirrhosis (P<0.05). Specifically, high serum CHE levels during initial decompensation and the negative conversion of HBV-DNA at 6 months were protective factors against recurrent decompensation after re-compensation, while multiple complications during initial decompensation, high serum Cr levels, and a high Child-Pugh score at 6 months were risk factors for recurrent decompensation after re-compensation. Conclusion After comprehensive treatments including antiviral therapy, approximately 49.27% of patients can achieve re-compensation. The number of complications during the first decompensation event, biochemical indicators (CHE, Cr) at the initial decompensation, and HBV-DNA and Child-Pugh scores during follow-up monitoring can provide predictive references for the maintenance of re-compensation.
    The risk factors and the prediction model based on ultrasonic shear wave elastography for esophageal and gastric varices rupture in cirrhotic patients
    YANG Qian-dong, FU Wen-xue, XU Lin-lin
    2025, 30(7):  912-916. 
    Asbtract ( 52 )   PDF (665KB) ( 8 )  
    References | Related Articles | Metrics
    Objective To analyze the risk factors of esophageal and gastric varices (EGV) in patients with cirrhosis based on ultrasonic shear wave elastography, and to construct and verify the prediction model. Methods Ninety-eight patients with cirrhosis admitted to Anqing Municipal Hospital from August 2021 to September 2024 were randomly divided into a training set (n=78) and a validation set (n=20) according to 8:2 quantitative analysis. The factors of EGV occurrence in cirrhotic patients were analyzed, and the predictive model was constructed and validated. Results In the training set, 22 patients developed EGV. In the validation set, EGV occurred in 6 cases. The Child-Pugh grades were B and C, combined with splenomegaly, SS and LS (P<0.05). Binary logistic regression analysis showed that splenomegaly [OR=4.173 (95%CI: 1.454~11.972)], SS level [OR=1.291 (95%CI: 1.118~1.492)], LS level [OR=1.662 (95%CI: 1.270~2.176)] and Child-Pugh grade B and C [OR=3.652 (95%CI: 1.184~11.265)] were the influencing factors for EGV occurrence in cirrhotic patients (P<0.05). The sensitivity and specificity of the training set model to predict EGV in patients with cirrhosis were 90.91%, 89.82%, and 0.894, respectively. The sensitivity and specificity of the validation set model for predicting EGV in patients with cirrhosis were 86.40%, 84.50%, and 0.879, respectively. Conclusion The incidence of EGV in cirrhosis patients is correlated with higher Child-Pugh grades, along with the presence of splenomegaly, SS, and LS. Developing a nomogram prediction model proves to be an effective tool for forecasting the likelihood of EGV occurrence in these patients.
    Bibliometric and visual analysis of studies on the correlation between gut microbiota and hepatic encephalopathy
    CAO Yan-mei, MA Su-ping, XIAO Zhun
    2025, 30(7):  917-921. 
    Asbtract ( 24 )   PDF (3894KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To analyze the research status, hot spots and frontier trends of the correlation between hepatic encephalopathy and gut microbiota over the past 20 years. Methods English literatures on the correlation between hepatic encephalopathy and gut microbiota were searched from the Web of Science (WOS) core database from January 1, 2004 to December 31, 2023. The bibliometric analysis software VOS viewer was used to analyze the countries, institutions, authors and hot spots and frontier directions in this research field. Results A total of 681 articles were retrieved, and the number of papers published gradually increased, Virginia Commonwealth University was the largest institution contributing to these publications. The United States, China and Italy were the largest countries, Bajaj JS was the highest author, and the《world journal of gastroenterology》was the most published journal in this field. The research focus can be summarized as hepatic encephalopathy, gut microbiota, liver cirrhosis, flora disorders and so on. Conclusion Through visual analysis of the hot spots and emerging trends in the study of the correlation between hepatic encephalopathy and gut microbiota, a more comprehensive reference was provided for the research in this field.
    An investigation on the relationship between three biochemical indices and liver reserve function and comorbidities of viral hepatitis-related cirrhotic patients
    MIAO Han, ZHAO Dan-dan, JI Hai-yan, SONG Xiao-dong
    2025, 30(7):  922-925. 
    Asbtract ( 49 )   PDF (465KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To observe the relationship between serum lactate dehydrogenase (LDH), 5′-nucleotide (5′-NT), and aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratios and the function of hepatic reserve and consolidated ascites in viral hepatitis-related cirrhotic patients. Methods One hundred cirrhotic patients with viral hepatitis admitted from June 2020 to June 2023 were selected, including 40 cases complicated with ascites (ascites group) and 60 cases without ascites (non-ascites group). Serum LDH, 5′-NT, AST, and ALT were measured at the time of admission, and the AST/ALT ratio was calculated. Serum LDH, 5′-NT, AST, ALT levels and AST/ALT ratios were compared between patients with different hepatic function classifications (Child-Pugh classification: 39 cases of class A, 37 cases of class B, 24 cases of class C) and in different groups. The relationship between serum LDH, 5′-NT, and the AST/ALT ratio and the hepatic reserve function of patients with viral hepatitis-related cirrhosis was analyzed by Spearman′s correlation coefficient analysis, and the relationship between serum LDH, 5′-NT, and AST/ALT ratio and the combined ascites was analyzed by logistic regression analysis. Results Serum LDH (317.79±35.56) IU/L, 5′-NT (19.36±2.15) U/L, AST (174.06±18.38) U/L, ALT (140.43±16.62) U/L, and AST/ALT ratio (1.24±0.15) were higher in patients with grade C than those of (298.41± (32.27) IU/L, (15.69±2.01) U/L, (138.41±15.05) U/L, (120.84±14.49) U/L, (1.15±0.12) in grade B patients and (280.25±30.14) IU/L, (11.14±1.53) U/L, (100.15±13.39) U/L, (92.12±11.23) U/L, (1.09±0.10) in grade A patients. The values in grade B patients was higher than those of grade A patients (F=10.211, 149.576, 178.196, 96.344, 11.457, P<0.05). Serum LDH (313.97±32.25) IU/L, 5′-NT (18.89±2.11) U/L, AST (168.32±18.85) U/L, ALT (130.25±15.56) U/L, and AST/ALT ratio (1.29±0.15) in the combined ascites group were higher than those of (283.98± (29.67) IU/L, (12.07±1.56) U/L, (107.86±12.27) U/L, (103.74±12.29) U/L, and (1.04±0.13) in the non-ascites group (t=4.782, 18.571, 19.444, 42.782, and 8.855, P<0.05). Spearman′s correlation analysis showed that serum LDH, 5′-NT and AST/ALT ratio were all positively correlated with the patients′ hepatic reserve function (r=0.415, 0.657, 0.632, P<0.05). Logistic regression analysis showed that serum LDH, 5′-NT and AST/ALT ratio might be the patients with cirrhosis of viral hepatitis with risk factors for concurrent ascites (OR=3.369, 2.748, 1.425, P<0.05). Conclusion Serum LDH, 5′-NT and AST/ALT ratio are strongly associated with liver reserve function and the occurrence of ascites in viral hepatitis-related cirrhotic patients.
    An evaluation on the efficacy and safety of peginterferon α-2b in nucleoside-treated patients with low serum level of HBsAg and compensated hepatitis B-related cirrhosis
    DAI Xue-feng, DING Ti-long, DING Ye-ying, MA Yan-chun
    2025, 30(7):  926-929. 
    Asbtract ( 33 )   PDF (440KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To explore the efficacy of pegylated interferon α-2b therapy in the treatment of low serum level of hepatitis B surface antigen (HBsAg) and compensated hepatitis B-related cirrhosis patients treated with nucleosides, and to analyze the safety. Methods From July 2018 to May 2022, eighty-four patients with compensated hepatitis B-related cirrhosis treated with nucleosides were selected and divided into a single drug group and a combination group. The combination group was treated with pegylated interferon α -2b combined with nucleosides, and the single drug group continued to treat with nucleosides for 48 weeks. The levels of alanine aminotransferase (ALT), total bilirubin (TBil), and HBsAg, HBsAg seroconversion rate, and negative conversion rate of HBsAg were compared between the two groups. The adverse drug reactions in both groups of patients were monitored. Results The ALT values at 24 weeks for the combination group and monotherapy group were (76.6±34.3) and (36.2±13.9) U/L, respectively, showing a significant difference (P<0.05). The quantitative HBsAg levels at 24 weeks and 48 weeks for the combination group were (482.8±317.2) and (258.8±227.9) U/L, respectively, both were lower than those of [(661.7±494.5) and (628.1±466.2) U/L] in the monotherapy group, with statistically significant differences (P<0.01). At 24 weeks, 6 patients (38.1%) in the combination group achieved HBsAg clearance, which was significantly higher than that of the monotherapy group (χ2=6.462, P=0.011). At 48 weeks, the rate increased to 38.1%, which was still significantly higher than that of the monotherapy group (χ2=22.909, P<0.01). The HBsAg seroconversion rate at 48 weeks in the combination group was 23.8%, which was significantly different from that of the monotherapy group (χ2=11.351, P<0.01). Regarding adverse reactions, the combination group experienced a reduction in white blood cells and platelets during the early stage of treatment, but these were tolerable, and they gradually recovered with continued treatment. All patients were able to complete the 48-week treatment regimen. Conclusion Peg-IFN-α-2b treatment in low-level HBsAg compensated HBV cirrhosis patients previously treated with NAs showed significance in HBsAg clearance rate and HBsAg serological conversion, with good tolerability and without severe adverse events in patients.
    Liver Cancer
    An analysis on the prognosis and recurrence of patients with hepatocellular carcinoma after hepatectomy combined with intraperitoneal hyperthermic chemotherapy
    LI Zhuang, LIU Yong, ZHU Feng
    2025, 30(7):  930-933. 
    Asbtract ( 37 )   PDF (436KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To explore the impact of hepatectomy combined with intraperitoneal hyperthermic chemotherapy (HIPEC) on patients with hepatocellular carcinoma. Methods A total of 106 liver cancer patients who were randomly divided into a control group (53 cases) and an observation group (53 cases), using a random number table. The control group received hepatectomy, while the observation group underwent hepatectomy combined with hyperthermic intraperitoneal chemotherapy. The clinical efficacy, tumor markers [carcinoembryonic antigen (CEA), tumor-specific growth factor (TSGF), immune function (CD3+, CD4+, CD8+), liver function [aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBil), direct bilirubin (DBil)], and postoperative recurrence and metastasis were compared between the two groups. Results The observation group showed a significantly higher total effective rate (90.57%) post-treatment, compared to that of 66.04% in the control group (P<0.05). The levels of CEA and TSGF in the observation group were significantly lower [(4.06±0.92) ng/mL vs. (8.31±1.57) ng/mL, (35.28±5.02) U/mL vs. (52.89±6.17) U/mL, P<0.05]. The immune function markers CD3+ and CD4+ levels were significantly higher in the observation group [(73.94±6.83)% vs. (65.89±6.11)%, (39.25±4.73)% vs. (33.12±4.06)%, P<0.05], while CD8+ levels were lower in the observation group [(25.54±3.15)% vs (29.75±3.68)%, P<0.05]. Liver function parameters (AST, ALT, TBil, DBil) were significantly lower in the observation group [(23.78±2.79) U/L vs. (29.06±3.15) U/L, (34.66±3.29) U/L vs. (43.89±4.08) U/L, (33.58±3.42) μmol/L vs. (55.29±5.37) μmol/L, (16.84±2.12) μmol/L vs. (24.05±2.69) μmol/L, P<0.05]. The recurrence rate in the liver and peritoneal implantation metastasis rate in the observation group were 30.19% and 7.55%, respectively, which were notably lower than those of 69.81% and 47.17% in the control group’s (P<0.05). Conclusion Hepatectomy combined with intraperitoneal hyperthermic chemotherapy shows significant clinical advantages in improving the overall treatment efficacy, enhancing tumor markers and immune function, reducing liver function damage, and decreasing the rates of intrahepatic recurrence and abdominal implantation metastasis in patients with hepatocellular carcinoma.
    The effect of microwave ablation combined with Sintilimab on disease control, immune function and prognosis of patients with advanced hepatocellular carcinoma
    LI Hui, ZHOU Yi-wen, WANG Wu-jun, CHEN Jiang-bo
    2025, 30(7):  934-937. 
    Asbtract ( 41 )   PDF (420KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To analyze the effect of microwave ablation (MWA) combined with Sintilimab on disease control, immune function and prognosis of patients with advanced hepatocellular carcinoma (HCC). Methods Between June 2020 and October 2022, eighty-three patients with advanced HCC were diagnosed and treated in people′s hospital of Langxi county. The combined group was treated with MWA combined with Sintilimab, while the MWA group was only treated with MWA. The effect of disease’ control, immune function and prognosis of the two groups of patients were compared. Results The combined treatment group achieved an objective response rate (ORR) of 60.0% (CR+PR) , which was significantly higher compared to that of 30.2% in the MWA group (P<0.05), along with superior post-treatment quality of life scores (P<0.05). Post-treatment laboratory results in the combined group showed significantly better outcomes for serum alpha-fetoprotein (AFP) (92.4±22.9 vs 117.5±32.0 ng/mL), Treg cells (1.3±0.2% vs 1.5±0.3%), CD4+ cells (33.1±6.9% vs 29.1±5.4%), CD8+ cells (24.6±5.3% vs 27.1±5.0%), CD4+/CD8+ ratio (1.4±0.5 vs 1.1±0.4), and Karnofsky (KPS) score (87.4±7.0 vs 79.2±7.4 points, all P<0.05). With 2 vs 3 cases lost to follow-up in the combined and MWA groups, respectively. Kaplan-Meier analysis revealed significantly higher survival rates in the combined group at both 1-year [94.7% (36/38) vs 77.5% (31/40)] and 2-year follow-up [76.3% (29/38) vs 52.5% (21/40), P<0.05]. Conclusion MWA combined with Sintilimab has obvious advantages in local control, systemic immune regulation and survival benefit, and its clinical promotion and optimization research should be further promoted in the future.
    The value of contrast-enhanced ultrasound combined with CT quantitative parameters in differentiating focal nodular hyperplasia from hepatocellular carcinoma
    LI Xiao-yan, ZHANG Jing-fang, WANG Chun-ping, ZHOU Ping-an
    2025, 30(7):  938-942. 
    Asbtract ( 25 )   PDF (835KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To explore the value of contrast-enhanced ultrasound (CEUS) combined with computed tomography (CT) quantitative parameters in differentiating focal nodular hyperplasia (FNH) from hepatocellular carcinoma (HCC), and to provide a reference for clinical diagnosis and treatment. Methods The clinical data of 51 HCC patients and 62 FNH patients diagnosed and treated from August 2021 to September 2024 were collected. All patients underwent non-contrast CT scans, perfusion-enhanced CT scans, and CEUS examinations. CT quantitative parameters [hepatic blood volume, hepatic blood flow, hepatic arterial perfusion (HAP), portal venous perfusion (PVP), total liver perfusion (TLP), hepatic arterial perfusion index (HPI), and mean transit time (mTT)] and CEUS characteristics [time to maximum intensity (RT), time to peak enhancement (TTP), mean transit time (MTT), and peak intensity (PI)] were compared between the two groups. Two radiologists independently analyzed the differences of the parameters. Diagnostic efficacy was evaluated using receiver operating characteristic (ROC) curves and Youden′s index. The combined detection efficacy was assessed in terms of sensitivity, specificity, and area under the curve (AUC). Results Hepatic blood volume, hepatic blood flow, and PVP were significantly higher in the HCC group than those in the FNH group (P<0.05), whereas HAP, HPI, and mTT were significantly lower (P<0.05). In CEUS, RT was shorter in the HCC group, whereas TTP, MTT, and PI were longer than those in the FNH group (P<0.05). For differentiating FNH from HCC, the sensitivity of RT, TTP, and MTT was 74.5%, 51.0%, and 47.1%, respectively; their specificity was 62.9%, 91.9%, and 74.2%; and their AUC values were 0.711, 0.743, and 0.622, respectively. The sensitivities of PI and hepatic blood volume was 56.9% and 58.8%, respectively, with specificities of 83.9% and 88.7%, and AUC values of 0.748 and 0.757. The sensitivities of hepatic blood flow,, PVP, and HPI was 76.5%, 84.3%, and 90.2%, respectively, with specificities of 87.1%, 96.8%, and 77.4%, and AUC values of 0.824, 0.949, and 0.925. The sensitivity and specificity of mTT were 86.3% and 72.6%, with an AUC of 0.814. When CEUS and CT quantitative parameters were combined, the sensitivity and specificity reached 96.1% and 96.8%, respectively, with an AUC of 0.979. Conclusion CEUS combined with CT quantitative parameters can effectively improve the diagnostic accuracy in differentiating FNH from HCC. This combined approach demonstrates high sensitivity, specificity, and accuracy, offering significant clinical value.
    Serum UCA1 and WRAP53 expression levels in HBV-related hepatocellular carcinoma patients and their correlation with hepatocellular carcinoma
    YANG Bin, WANG Yong-gang, CAO Hong-gang, GAO Jian-yong
    2025, 30(7):  943-947. 
    Asbtract ( 35 )   PDF (619KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To investigate the relationship between serum urothelial carcinoma-associated 1 (UCA1) and WD repeat-containing antisense to TP53 (WRAP53) levels and hepatocellular carcinoma (HCC) in patients with hepatitis B virus (HBV)-related HCC. Methods A total of 82 patients with HBV-related HCC treated at the Oncology Department of Lezhi County People′s Hospital from June 2022 to March 2024 were selected as the observation group, and 80 chronic HBV-infected patients during the same period were selected as the control group. Serum UCA1 and WRAP53 levels were measured by quantitative real-time polymerase chain reaction (PCR). Binary logistic regression analysis of risk factors for HCC occurrence in chronic HBV-infected patients. The diagnostic value of UCA1 and WRAP53 for HBV-related HCC was evaluated by the area under the receiver operating characteristic curve (AUROC). Results The serum UCA1 and WRAP53 expression levels in the observation group were (2.42±0.72) and (3.16±1.07), respectively, which were higher than those in the control group ((1.25±0.37) and (1.18±0.31)). The differences were statistically significant (t=13.054, 16.079, both P<0.05). Logistic regression analysis showed that elevated UCA1 and WRAP53 levels were independent risk factors for HCC in chronic HBV patients. ROC curve analysis showed that the sensitivity and specificity of UCA1 and WRAP53 in diagnosing HCC were 84.1% and 88.7%, and 90.2% and 96.3%, respectively, with AUROC values of 0.921 and 0.930. This indicated a high diagnostic accuracy. When UCA1 and WRAP53 were combined, the sensitivity and specificity were 93.9% and 98.8%, respectively, and the AUROC was 0.980, indicating a higher diagnostic performance. Conclusion The serum levels of UCA1 and WRAP53 in patients with HBV-related HCC were significantly elevated. These biomarkers can serve as potential diagnostic tools for HBV-related HCC, with high diagnostic value.
    Changes of BMI, PNI and NPAR levels and their effects on quality of life in patients with HCC after nutritional intervention
    LI Long, ZHENG Zhen-dong, DU Cheng, LIU Bo-na
    2025, 30(7):  948-952. 
    Asbtract ( 36 )   PDF (448KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To examine the alterations in body mass index (BMI), prognostic nutrition index (PNI), neutrophil percentage/albumin ratio (NPAR), as well as their impact on the quality of life among individuals diagnosed with hepatocellular carcinoma (HCC) following nutritional intervention. Methods From May 2021 to July 2023, our hospital treated 128 patients diagnosed with primary HCC. These patients were randomly assorted into a nutrition intervention group (n=64), and a routine rehabilitation group (n=64). All patients underwent standard postoperative rehabilitation procedures, with the nutrition intervention group receiving additional nutritional support through a multi-disciplinary approach to diagnosis and treatment. Various parameters, including general clinical characteristics, liver function indices (including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein (TP), albumin (Alb), nutritional status indicators (BMI, PNI, and NPAR), as well as immune function markers (such as the proportion of CD4+T cells, CD8+T cell ratio, and CD4+T/CD8+T ratio) were gathered and compared between the two groups both before and after the intervention. Moreover, the impact of the intervention on the patients′ quality of life was assessed using the SF-36 scale. Spearman correlation analysis was employed to explore the relationship between SF-36 scores and changes in indicators of liver function, nutritional status, and immune function post-treatment. Results Following the intervention, the nutrition intervention group exhibited a noticeably higher average CD4+T/CD8+T cell ratio compared to both pre-intervention levels and the routine rehabilitation group (1.46±0.13 vs 1.38±0.13, P<0.05). Additionally, the average CD4+T cell ratio of post-intervention levels was markedly elevated compared to pre-intervention levels, with no significant difference observed between the two groups (P>0.05). Furthermore, after intervention, the average serum TP (43.45±3.50 vs 38.54±3.57) and ALB (35.48±4.08 vs 31.35±3.50) levels showed a significant increase from pre-intervention and the routine rehabilitation group (P<0.05), while serum ALT and AST levels also show a noticeable decvease from pre-intervention levels with no significant variance between the two groups (P>0.05). The average serum BMI (22.93±1.04 vs 21.54±1.03) and PNI (49.35±3.71 vs 44.89±2.92) levels after intervention were significantly higher than those before interventionand in the conventional rehabilitation group, whereas the NPAR (1.30±0.16 vs 1.47±0.15) level showed a significant decrease from pre-treatment and routine rehabilitation levels (P<0.05). The average physical function score (8.64±1.20 vs 7.91±1.11) and overall SF-36 score after intervention exhibited a significant improvement compared to pre-intervention levels and those of the routine rehabilitation group (6.83±1.73 vs 5.98±1.13, P<0.05). Spearman correlation analysis indicated a significant positive correlation between BMI, PNI and the total SF-36 score (r=0.266, 0.304, P<0.05), as well as a significant negative correlation between the NPAR score and SF-36 after HCC treatment (r=-0.322, P<0.05). Conclusion Providing nutritional support after HCC surgery can enhance immune function, liver function, and nutritional status. Patients undergoing nutritional intervention reported improved quality of life, with the extent of enhancement being directly linked to the degree of nutritional recovery. These findings underscore the significant clinical relevance of nutritional intervention for HCC postoperative patients.
    Viral Hepatitis
    Clinical research on early efficacy and safety of TMF for the treatment of patients with chronic hepatitis B
    TIAN Xiao-li, CHEN Xin, NI Yan, WU Song-lin, DENG Cun-liang
    2025, 30(7):  953-957. 
    Asbtract ( 42 )   PDF (419KB) ( 3 )  
    References | Related Articles | Metrics
    Objective This study aimed to reveal the effectiveness and safety of tenofovir amibufenamide (TMF) in the real world,compared with tenofovir alafenamide (TAF) in patients with chronic hepatitis B (CHB). Methods In this study, TMF or TAF treated-chronic hepatitis B patients were included at the Affiliated Hospital of Southwest Medical University and the First People′s Hospital of Neijiang City from August 2022 to July 2023. 64 patients were included in the TMF group, 57 patients were included in the TAF group. All patients received 24 weeks of treatment.The virological response (HBV DNA < 100 IU/mL) rate, alanine aminotransferase recovery (ALT＜40 U/L) rate,changes of hepatitis B surface antigen (HBsAg), renal function, and blood lipid profile were compared between baseline and after 24 weeks of treatment (intergroup and intragroup). Results At baseline, the age, ALT, HBVDNA, and HBsAg levels of the patients in the TMF group and the TAF group were not statistical significance between two groups (P>0. 05). After 24 weeks of treatment, △HBsAg, virological response (VR) rate in TMF group and TAF group were (TMF -477.98 IU/mL vs. TAF -133.63 IU/mL, P=0.117)、(95.31% vs. 84.21%, P=0.041),respectively. After 24 weeks of treatment, ALT recovery rate, △Cr, △eGFR, △TG, and △TC were not statistical significance between two groups (P>0. 05). For treatment-naive patients, VR rates at week 24 were 97.05% in the TMF group and 76% in the TAF group (P=0.013). Conclusion TMF had profound antiviral effectiveness and no adverse effects on renal function or blood lipids. Additionally, TMF was more efficient than TAF in inhibiting viral replication for treatment-naive patients.
    Immune function changes and their association with hepatitis activity in HBeAg-positive chronic HBV carriers after cessation of maternal-infant blockade therapy
    CAO Yan-min, XING Bao-heng, ZONG Fang, GAO Su-juan
    2025, 30(7):  958-962. 
    Asbtract ( 36 )   PDF (500KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To investigate the differences in immune function between the hepatitis activity group and the non-hepatitis activity group among HBeAg-positive chronic HBV carriers after discontinuation of maternal-infant blockade therapy and to analyze the association between immune function changes and hepatitis activity. Methods A total of 105 HBeAg-positive chronic HBV carriers who attended at Cangzhou People′s Hospital from January 2022 to June 2024 were enrolled. Based on hepatitis activity status after three months of discontinuation, patients were divided into the hepatitis activity group (n=32) and the non-hepatitis activity group (n=73). Clinical data, including liver function indicators (alanine aminotransferase (ALT), aspartate aminotransferase (AST)), immune markers (CD4+ T-cell ratio, CD4+/CD8+ T-cell ratio), HBV DNA load, and inflammatory cytokines (interleukin-6 (IL-6), tumor necrosis factor (TNF) -α), were collected. Pearson correlation coefficient was used to determine the correlation between liver function indicators and immune function markers. Multivariate logistic regression analysis was conducted to identify factors influencing hepatitis activity in HBeAg-positive chronic HBV carriers after cessation of maternal-infant blockade therapy. Results At 1, 3, and 6 months after drug withdrawal, patients in the hepatitis activity group showed significantly elevated levels of ALT and AST, along with decreased CD4+ T cell percentage and CD4+/CD8+. These differences were most significant after 3 months of discontinuation [ALT at 3 months: (72.09±8.10) U/L vs. (36.12±6.45) U/L, P<0.05; AST: (68.59±7.22) U/L vs. (33.55±4.22) U/L, P<0.05; CD4+ T cell percentage: (37.01±3.04)% vs. (39.91±3.15)%, P<0.05; CD4+/CD8+: (1.48±0.18) vs. (1.70±0.19), P<0.05]. At 1, 3, and 6 months after drug cessation, levels of HBV DNA, IL-6, and TNF-α were also significantly higher in the hepatitis activity group than in the non-hepatitis activity group. Differences in IL-6 and TNF-α were most significant at 3 months post-withdrawal [IL-6: (15.67±4.02) pg/mL vs. (11.51±2.94) pg/mL, P<0.05; TNF-α: (18.41±4.55) pg/mL vs. (14.58±3.62) pg/mL, P<0.05], while the difference in HBV DNA was most significant at 6 months [(6.13±0.90) vs. (4.71±0.90) log10 U/mL, P<0.05]. Pearson correlation analysis showed that the CD4+ T cell percentage had significantly negative correlation with ALT and AST (r=-0.390, -0.440; P<0.05), and the CD4+/CD8+ had also negatively correlation with ALT and AST (r=-0.483, -0.460; P<0.05). Multivariate logistic regression analysis indicated that ALT, AST, CD4+, CD4+/CD8+, HBV DNA, IL-6, and TNF-α were all influencing factors for hepatitis activity (P<0.05). Conclusion After cessation of maternal-infant blockade therapy, the decline in CD4+ T-cell ratio and CD4+/CD8+ is significantly associated with the occurrence of hepatitis activity in HBeAg-positive chronic HBV carriers. Changes in these immune indicators, HBV DNA load, and inflammatory cytokines may serve as potential biomarkers for predicting hepatitis activity.
    Therapeutic efficacy of switching to tenofovir alafenamide fumarate in entecavir-treated chronic hepatitis B patients with low-level viremia
    WU Yu, LI Yong-wei, ZHOU De-bing
    2025, 30(7):  963-966. 
    Asbtract ( 38 )   PDF (401KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To analyze the curative effect of switching treatment to tenofovir alafenamide fumarate (TAF) in chronic hepatitis B (CHB) patients with low-level viremia (LLV) after entecavir (ETV) treatment. Methods A retrospective analysis was conducted of 138 patients with CHB who were diagnosed and managed at our institution from January 2022 to December 2023. They were divided into ETV group (n=68) and TAF group (n=70) according to whether the patients continued to use ETV or switched to TAF. The changes of HBV markers, liver and kidney function levels before and after treatment were compared between the two groups, and the complete virological response (CVR) rate, the HBeAg negativity rate and ALT normalization rate were analyzed. Results After treatment, the HBV markers such as HBV DNA and HBsAg in TAF group and ETV group decreased significantly after 48 weeks of treatment (P<0.05). Compared with ETV group, HBV markers decreased more significantly after 48 weeks of treatment (P<0.05). After treatment, the liver function of TAF group and ETV group decreased significantly after 48 weeks of treatment (P<0.05). Compared with the ETV group, the liver function decreased significantly after 48 weeks of treatment (P<0.05). After treatment, the serum creatinine and β2- microglobulin in TAF group and ETV group were significantly decreased after 48 weeks of treatment, while eGFR was significantly increased in TAF group (P<0.05). Compared with ETV group, the improvement of renal function was more significant after 48 weeks of treatment (P<0.05). After treatment, the CVR rate and HBeAg negativity rate in TAF group were significantly higher than those in ETV group (P<0.05), but the normalization rate of ALT between the two groups was not statistically significant (P>0.05). Conclusion TAF has obvious advantages in antiviral efficacy of CHB patients, especially in complete virology inhibition, negative HBeAg conversion and improvement of liver function and renal function.
    Drug Induced Liver Injury
    Analysis of clinical characteristics of liver injury associated with immune checkpoint inhibitors
    ZHAO Meng-yu, WANG Yan, LIU Li-wei, CHEN Wei, ZHAO Xin-yan
    2025, 30(7):  967-971. 
    Asbtract ( 28 )   PDF (498KB) ( 3 )  
    References | Related Articles | Metrics
    Objective To explore the clinical characteristics of patients with immune-mediated liver injury induced by immune checkpoint inhibitors (ICIs). Methods A retrospective analysis was conducted on patients with malignant tumors who were hospitalized at Beijing Friendship Hospital, Capital Medical University, and received ICIs from April 2016 to December 2022. The clinical characteristics of patients with ICIs-related liver injury and non-ICIs-related liver injury were compared. Results A total of 1,355 patients with malignant tumors treated with ICIs were included in the study, among whom 66 cases (4.9%) developed ICIs-related liver injury, while 1,289 cases (95.1%) did not develop ICIs-related liver injury. There were no statistically significant difference between the two groups in age, gender, tumor location, number of ICIs cycles, type of ICIs, type of ICIs drug, and other systemic immune-related adverse events (irAEs). The baseline levels of alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) in the ICIs-related liver injury group were significantly lower than those in the non-ICIs-related liver injury group (87 vs. 98, P=0.025; 37.5 vs. 49, P=0.003), while the peak levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), GGT, and total bilirubin (TBil) were significantly higher in the ICIs-related liver injury group than in the non-ICIs-related liver injury group (122 vs. 24,P<0.01; 133 vs. 29,P<0.01; 189 vs. 97,P=0.04; 23.9 vs. 16.4, P<0.01). The mortality rate within twelve months was not statistically different between the ICIs-related liver injury group and the non-ICIs-related liver injury group (7.6% vs. 3.0%, P=0.065). There was also no statistically significant difference in mortality rate between patients who received corticosteroids and those who did not (8.3% vs. 10.7%, P=0.85). Conclusion The incidence of ICIs-related liver injury in patients with malignant tumors treated with ICIs was 4.9%. ICIs-related liver injury mainly manifested as elevated ALT and AST levels, with increased GGT and TBil levels. Most cases were mild, and deaths due to ICIs-related liver injury were rare, indicating a relatively better prognosis.
    Analysis of clinical characteristics in patients with statin-induced drug-induced liver injury
    XU Yan, PANG Xuan
    2025, 30(7):  972-974. 
    Asbtract ( 31 )   PDF (364KB) ( 6 )  
    References | Related Articles | Metrics
    Objective To analyze the clinical characteristics of patients with statin-induced drug-induced liver injury (SILI). Methods A total of 78 patients with SILI treated in our hospital from January 2022 to December 2024 were enrolled and divided into improved and unimproved groups based on clinical outcomes. The clinical data and prognostic factors were compared between the two groups. Results Among the 78 SILI patients, the statins used included atorvastatin, rosuvastatin, and simvastatin, with atorvastatin being the most frequently prescribed. The median time from drug initiation to liver injury onset was 90 (70, 122) days, and the median hospitalization duration was 10 (5, 18) days. Concurrent HBV infection was present in 13 cases (16.7%), and CYP450 enzyme gene variations were detected in 11 cases (14.4%). Among the 78 SILI patients, 53 showed improvement, while 25 did not. Significant differences (P<0.05) were observed between the improved and unimproved groups in age, statin dosage, time to liver injury onset, hospitalization duration, HBV coinfection, CYP450 gene variations, and levels of ALT, AST, and TBil. Age, statin dosage, HBV coinfection, and CYP450 gene variations were identified as independent risk factors affecting clinical prognosis (P<0.05). Conclusion Before prescribing statins, clinicians should thoroughly assess patients for pre-existing liver disease. During treatment, special attention should be paid to elderly patients and those receiving higher doses to minimize the risk of liver injury. Regular liver function monitoring, particularly after drug initiation, is essential to reduce adverse reactions.
    Other Liver Diseases
    Clinical characteristics and risk factors analysis of liver abscess complicated with sepsis
    ZHU Xiao-hong, LIANG Dong
    2025, 30(7):  975-978. 
    Asbtract ( 29 )   PDF (371KB) ( 3 )  
    References | Related Articles | Metrics
    Objective To explore the clinical characteristics and risk factors of liver abscess complicated with sepsis. Methods A retrospective analysis was conducted on the clinical data of 169 patients with liver abscess admitted to the 988th Hospital of the Joint Logistics Support Force from January 2000 to June 2023. Patients were divided into sepsis group and non sepsis group based on clinical diagnosis. The basic information, laboratory tests, pathogenic bacteria, types of antibiotics, length of hospital stay, and disease outcomes of the two groups were compared and analyzed. Results There were 51 cases (30.2%) in the sepsis group and 118 cases (69.8%) in the non-sepsis group. Both groups were mainly middle-aged and elderly patients, with male patients accounting for 68.66% and 61.0% in each group, respectively. There was no significant difference in age and gender (P>0.05); In terms of basic diseases, the proportion of sepsis group complicated with diabetes was significantly higher than the non-sepsis group(64.7% vs 33.1%) (P<0.05); In terms of clinical manifestations, fever was the main clinical manifestation in both groups, and there was no significant difference between two groups(P>0.05); In terms of laboratory tests, the sepsis group showed higher levels of neutrophils (85.61 ± 10.33 vs 77.91 ± 12.45)%, C-reactive protein (199.75 ± 85.71 vs 129.76 ± 68.32) mg/L, procalcitonin (20.35 ± 10.16 vs 8.87 ± 6.73) ng/mL, creatinine (99.37 ± 72.69 vs 82.48 ± 60.81) umol/L, and lower levels of blood platelets (179.36 ± 84.84 vs 278.56 ± 110.82) ×109/L and albumin (25.75 ± 5.08 vs 29.43 ± 4.26) g/L(P<0.05); In terms of pathogenic bacteria, the proportion of Klebsiella pneumoniae in the sepsis group was higher compared to the non-sepsis group (66.7% vs 42.4%) (P<0.05); In terms of antibiotic selection, the use rate of carbapenem antibiotics was significantly higher in the sepsis group compared to the non-sepsis group (80.4% vs 27.1%) (P<0.05); In terms of hospitalization time, the sepsis group had a significantly longer duration compared to the non-sepsis group (27.31 ± 12.16 vs 18.94 ± 9.27)d (P<0.05); In terms of disease progression, the improvement rates of both groups were relatively high, at 78.4% and 87.3%, respectively, but there was no significant difference between two groups (P>0.05). Multivariate regression analysis showed that diabetes (P<0.001, OR=1.021, 5% CI 1.011~1.032), Klebsiella pneumoniae infection (P=0.033, OR=1.891, 5% CI 1.059~3.379), thrombocytopenia (P=0.024, OR=1.053, 5% CI 1.009~1.102), and procalcitonin elevation (P=0.029, OR=1.257, 5% CI 0.793~1.826) were risk factors of liver abscess complicated with sepsis. Conclusion Patients with liver abscess complicated by sepsis exhibited a higher prevalence of diabetes and Klebsiella pneumoniae infection along with evelated levels of procalcitonin, neutrophil ratio, C-reactive protein and creatinine are higher, as well as reduced levels of platelet and albumin. Among them, combination of diabetes, Klebsiella pneumoniae infection, elevated procalcitonin, and decreased platelet count are risk factors for liver abscess complicated with sepsis, which should be focused on.
    Analysis of therapeutic effects of ultrasound-guided percutaneous liver puncture and catheterization drainage in the treatment of patients with bacterial liver abscess
    YANG Zheng-fang, QI Jia-gao, ZHANG Fu-qun, WANG Yuan
    2025, 30(7):  979-982. 
    Asbtract ( 30 )   PDF (500KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To analyze the effects of ultrasound-guided percutaneous hepatic puncture for pus extraction and tube placement for drainage on the therapeutic efficacy of patients with bacterial liver abscesses. Methods 80 patients with bacterial liver abscesses treated in our hospital from 2020.10 to 2023.4 were enrolled in this study, prospectively. Patients were divided into a control group (34 cases, ultrasound-guided percutaneous hepatic puncture for pus extraction) and an observation group (46 cases, ultrasound-guided percutaneous hepatic puncture for drainage) according to the randomized numerical method. Clinical efficacy, symptom improvement, inflammatory indicators, and complication rates were compared between the 2 groups. Results Clinical efficacy in the control group was 88.2% , lower than 91.3% in the observation group; the recovery time of body temperature, the disappearance time of pain, and the disappearance time of abscess were (3.0±0.7) d, (2.8±0.6) d, and (12.6±2.0) d, respectively, as for the observation group, the recovery time of body temperature, the disappearance time of pain, and the disappearance time of abscess were (3.1±0.8) d, (2.7±0.6) d, and (12.8±2.2) d, respectively; the serum interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) levels in the control group after treatment were (21.9±3.4) ng/mL, (25.3±3.9) ng/mL, (8.6±1.5) ng/mL, respectively, higher than (22.1±3.5) ng/mL, (25.7±3.9) ng/mL, and (8.9±1.6) ng/mL in the observation group; the total complication rate of the control group was 17.7% , and the total complication rate of the observation group was 20.6%, there was no difference between two groups (P>0.05). Conclusion Ultrasound-guided percutaneous hepatic puncture to extract pus and tube drainage exhibited good efficacy in the treatment of patients with bacterial liver abscess, which can improve clinical symptoms, reduce the level of inflammatory factors, and have good safety, worthy to be selected as clinical treament according to the patient′s condition.
    Analysis of risk factors and intervention measures for adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy
    HANG Yu, SUN Dong-mei, XU Xiao-ying, JIN Yan-fei
    2025, 30(7):  983-987. 
    Asbtract ( 50 )   PDF (513KB) ( 3 )  
    References | Related Articles | Metrics
    Objective To analyze the risk factors of adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy (ICP) and to provide reference for perinatal prevention and intervention measures. Methods A total of 72 pregnant female patients with ICP were enrolled and divided into adverse pregnancy outcome group (n=23) and non-adverse pregnancy outcome group (n=49) according to whether adverse pregnancy outcome occurred. The baseline data and clinical indicators of the subjects were collected, and the risk factors for adverse pregnancy outcomes in pregnant women with univariate and Logistic multi-factor ICP were identified, and the predictive value of each risk factor was analyzed. Results Among 72 ICP pregnant women, 23 cases had adverse pregnancy outcome (31.94%). The family history of ICP, increase index of body mass index (BMI) during pregnancy, incidence of gestational diabetes mellitus (GDM), fibrinogen (FIB), total bilirubin (TBil), direct bilirubin (DBil), total bile acid (TBA) levels in the adverse pregnancy outcome group were 21.74%, 1.23, 4.56±0.67 g/L, 16 .64±1.95 μmol/L, 7.26±1.15 μmol/L, 36.72±6.18 μmol/L, It was higher than that in the group without adverse outcome (8.16%, 1.11, 4.37±0.53 g/L, 14.73±1.67 μmol/L, 6.34±1.02 μmol/L, 21.68±4.35 μmol/L). The gestational age and levels of 25 hydroxyvitamin D [25- (OH) D3] in the adverse pregnancy outcome group were 30.46±2.38 w and 22.16±4.03 μg/mL, which were lower than those in the control group (32.85±2.56w and 29.75±4.58 μg/mL), and the difference was statistically significant (t/χ2=4.263, 9.596, 3.537, 5.652, 5.239, 5.725, 9.236, 5.461, 7.382 were all P<0.05). logistics regression analysis showed that increased BMI and TBA during pregnancy were independent risk factors for adverse pregnancy outcomes in ICP pregnant women, and 25- (OH) D3 were protective factors (95%CI 2.342-7.016, 3.267-9.584, 2.958-8.263). OR=3.852, 5.025, 4.286, all P<0.05). ROC analysis showed that the area under the curve (AUC) of BMI increase index, TBA and 25- (OH) D3 during pregnancy were 0.746, 0.853 and 0.812, respectively, and the sensitivity was 73.91%, 86.96% and 78.26%. The specificity was 69.57%, 78.26%, 82.61% (all P<0.01). Conclusion The increase of BMI, the increase of TBA and the decrease of 25- (OH) D3 during pregnancy are risk factors for adverse pregnancy outcomes in ICP patients, offered a reliable basis for the formulation of programs and intervention measures to improve pregnancy outcomes.
    Clinical study of 3.0T MRE to evaluate biliary obstruction
    WANG Fang-xu, ZHAO Zhi-jun, XU Ming-lu, YAO Zhong-xin, WANG Qian
    2025, 30(7):  988-991. 
    Asbtract ( 25 )   PDF (362KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To investigate the change of liver stiffness and its correlation with serum markers and pathogenic factors in biliary patients after biliary drainage by 3.0T magnetic resonance elastography(3.0T magnetic resonance elastography). Methods 70 patients with biliary tract diseases diagnosed and treated in our hospital between June 2020 and December 2022 were enrolled. Among them, 35 patients were diagnosised with biliary obstruction and underwent biliary obstruction relief surgery. Liver stiffness was detected by 3.0T magnetic resonance elastography, and blood biochemical indexes were detected by automatic biochemical analyzer. The clinical data of patients with biliary obstruction and non-biliary obstruction were compared. Results The liver stiffness values, total bilirubin, TBA, ALT, AST and GGT levels in patients with non-biliary obstruction were (2.3±0.4) kPa, (9.9±3.8) μmol/L, (4.8±1.5) μmol/L, (65.1±14.2) IU/L, (35.1±8.5) IU/L, and (71.7±12.3) IU/L, respectively, which were significantly lower than those in patients with biliary obstruction [4.5±1.1) kPa, (248.6± 45.2)μmol/L,(53.6±8.4)μmol/L,(136.8±16.5)IU/L,(99.8±28.7)IU/L and(464.2±53.9)IU/L,P<0.05]; Among patients with non-biliary obstruction, the number of patients with pathogenic benign factors was 20, which was significantly higher than that of patients with biliary obstruction in 11. The number of patients with pathogenic malignant factors was 15 cases significantly less than that of patients with biliary obstruction (P<0.05). The liver stiffness of patients with non-biliary obstruction were (2.3±0.4) kPa and (2.3±0.3) kPa lower than those of patients with biliary obstruction [(3.7±0.9) kPa, (4.7±0.9) kPa, P＜0.05], respectively; In patients with biliary obstruction, the liver stiffness (4.7±0.9) kPa in patients with malignant causative factors was significantly higher than that in patients with benign causative factors [(3.7±0.9) kPa, P ＜0.05]; The liver stiffness was highly linearly correlated with the serum total bilirubin and GGT levels (r1=0.657, r2=0.545, P＜0.01), and was linearly correlated with the serum ALT and AST levels (r1=0.334, r2=0.312, P＜0.01), and 35 patients with biliary obstruction underwent biliary drainage compared with (5.3±0.4) kPa and (226.5±51.4) μmol/L. After surgery, the liver stiffness and bilirubin level significantly decreased [(2.5±0.3) kPa, (16.5±4.2) μmol/L, P＜0.05, respectively]. Conclusion 3.0T MRE showed that liver stiffness was increased in patients with obstruction, which is not related to benign or malignant causative factors, but could decrease after early relief of biliary obstruction. Therefore, the measurement of liver stiffness by 3.0T MRE can be used as a non-invasive detection standard to predict the effect of biliary decompression after biliary drainage, which is worthy of clinical application.
    Clinical characteristics and prognostic factors of 39 cases with acute fatty liver in pregnancy at different termination time
    LIU Si, HE Hui
    2025, 30(7):  992-995. 
    Asbtract ( 31 )   PDF (447KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To analyze the clinical features and ultrasonic manifestations of patients with acute fatty liver in pregnancy (AFLP) at different termination time. Methods The clinical data of 39 patients with AFLP in our hospital information system between January 2019 and June 2024 were collected. According to the time of termination of pregnancy, AFLP patients were divided into delayed group and immediate group. The clinical data of the two groups were compared, and the similarities and differences of ultrasonic performance between the two groups were analyzed. Results The clinical symptoms of AFLP patients include digestive tract symptoms in 28 cases (71.8%), yellow staining of skin and sclera in 18 cases (46.1%), edema in 15 cases (38.5%), fatigue in 8 cases (20.5%) and skin itching in 3 cases (7.7%), among which the main symptoms are digestive tract symptoms, including nausea and vomiting in 24 cases (61.5%) and upper respiratory tract symptoms. In addition, complications of HELLP patients include pregnancy-induced hypertension in 5 cases (12.8%), preeclampsia in 4 cases (10.2%), gestational diabetes in 6 cases (15.4%), renal insufficiency in 30 cases (76.9%), hepatic encephalopathy in 3 cases (7.7%), multiple organ dysfunction syndrome in 5 cases (12.8%). After admission, liver protection treatment was selected according to the condition, and the delayed group was prolonged as far as possible (n=30), and the rest were immediately terminated (n=9). Comparing the clinical data, the differences of hepatic encephalopathy, PLT, TBil, Scr, INR, MELD and PI-AFLP between the two groups were statistically significant (P<0.05). All AFLP patients showed varying degrees of increase in liver volume and uneven liver echo, which was related to fat deposition in the liver. In addition to the ultrasonic manifestations of liver, the ultrasonic manifestations of AFLP patients with different clinical outcomes are mainly in extrahepatic organs. The ultrasonic changes of gallbladder, pancreas, spleen, kidney and chest cavity in patients with AFLP were summarized. By comparing the ultrasonic manifestations of delayed group and immediate group, it was found that the number of cases with poor or no bile filling, splenomegaly and pleural effusion in immediate group was significantly higher than that in delayed group (P<0.05). Conclusion There are significant differences in PLT, TBil, INR, MELD score and PI-AFLP index in different termination time of AFLP patients. At the same time, the ultrasonic manifestations of AFLP patients with immediate termination of pregnancy are poor or no bile, splenomegaly and pleural effusion, which provide basis for early identification of high-risk patients and improvement of treatment plan.
    Factors influencing abnormal liver function in newborns with umbilical vein catheterization
    CHENG Xiang-ning, CHANG Xiao, WANG Xiao-fang
    2025, 30(7):  996-999. 
    Asbtract ( 19 )   PDF (472KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To analyze the influential factors of abnormal liver function in newborns with umbilical vein catheterization (UVC), and to provide theoretical basis for clinical prevention and treatment. Methods A total of 82 neonates receiving umbilical vein catheterization admitted to Jincheng People′s Hospital from February 2023 to November 2024 were selected. Gestational age, catheterization retention time, Apgar score < 7, PICC treatment history, catheterization depth and other data were collected. They were divided into two groups according to whether abnormal liver function occurred, and the basic data of neonates in the two groups were compared. To analyze the multiple factors of liver dysfunction caused by neonatal UVC. Results Apgar score < 7 68.75% (11/16), PICC treatment history 68.75% (11/16), catheterization depth (5.20±0.63) cm in the group with abnormal liver function were higher than those in the group without abnormal liver function 28.13% (18/66), 30.30% (20/66), (3.24±0.45) cm. The gestational age of (33.52±1.52) weeks was lower than that of the group without hepatic dysfunction (35.74±2.03) weeks, and the retention time of catheterization (17.13±2.85) d was longer than that of the group without hepatic dysfunction (14.24±2.34) d (P<0.05). Binary Logistic regression analysis showed that Apgar score < 7 [OR=5.867 (95%CI: 1.789~19.243)], catheterization depth [OR=7.546 (95%CI: 2.579~22.0767)], catheterization retention time [OR=1.574 (95%CI: 1.121~2.044)], PICC treatment history [OR=5.060 (95%CI: 1.554~16.472)] were risk factors for liver dysfunction of neonatal UVC, and gestational age [OR=0.512 (95%CI: 0.344~0.761)] was a protective factor for neonatal UVC liver dysfunction (P<0.05). Conclusion Catheterization retention time, PICC treatment history, Apgar score <7, gestational age and catheterization depth are the influential factors for the abnormal liver function of neonatal UVC.
    The value of ultrasound-guided liver puncture biopsy in the etiologic analysis of unexplained liver disease
    FAN Wen-tao, HE Fei, YAN Pan
    2025, 30(7):  1000-1004. 
    Asbtract ( 34 )   PDF (1485KB) ( 1 )  
    References | Related Articles | Metrics
    Objective To analyze the value of ultrasound-guided liver puncture biopsy in the etiological analysis of unexplained liver disease, and to provide a basis for improving the diagnostic rate of unexplained liver disease. Methods 100 cases of patients with unexplained liver disease admitted retrospectively from December 2019 to December 2023 were examined by ultrasound-guided hepatic aspiration biopsy, and clinical features combined with hepatic aspiration pathology were used as the “gold standard”. The results of ultrasound-guided hepatic aspiration biopsy examination and the diagnostic value of ultrasound-guided hepatic aspiration biopsy examination were compared. Results In 100 patients, clinical features combined with pathological examination by liver puncture led to a clear diagnosis of autoimmune liver disease, cholestatic liver disease, hyperbilirubinemia, steatohepatopathy, and alcoholic liver disease, which amounted to 94 cases, with a positive diagnostic rate of 94.00% (94/100). A total of 90 cases of autoimmune liver disease, cholestatic liver disease, hyperbilirubinemia, steatohepatopathy, and alcoholic liver disease were examined by ultrasound-guided hepatic perforation biopsy, with a positive diagnostic rate of 90.00% (90/100), a false-positive rate of 0.00%, and a Kappa value of 0.858, which showed a good concordance with the clinical features in combination with the hepatic perforation pathologic examination. The sensitivity, specificity, accuracy, and positive predictive value of ultrasound-guided liver puncture biopsy examination were 95.74%, 100.00%, 96.00%, and 100.00%, respectively, which were in high concordance with the clinical features combined with the pathologic examination of liver puncture, and had high diagnostic value, and the differences were not statistically significant (all P>0.05). Conclusion Ultrasound-guided hepatic puncture biopsy has demonstrated high diagnostic efficacy in the diagnosis and treatment of unknown causes of liver function abnormalities, and it can provide an accurate basis for clinical decision-making in a timely manner, thus effectively guiding the formulation and implementation of treatment programs.
    Clinical characteristics of Kawasaki disease with cholestatic jaundice as the initial symptom
    ZHANG Yi, YUAN Juan, YANG Ya-rong, ZHU Xin-xin
    2025, 30(7):  1005-1009. 
    Asbtract ( 30 )   PDF (495KB) ( 2 )  
    References | Related Articles | Metrics
    Objective To explore the clinical characteristics of Kawasaki disease (KD) with cholestatic jaundice as the initial symptom, to enhance awareness and understanding of KD. Methods A retrospective analysis was conducted on 4,381 KD patients admitted between January 1, 2018 and December 31, 2024. Demographic, clinical, and laboratory data were collected from patients with febrile cholestatic jaundice as their first symptom. Patients were categorized into IVIG-resistant and IVIG-non-resistant groups based on their response to IVIG to identify the potential risk factors for IVIG resistance. Results Among 4,381 KD cases, 29 (0.66%) presented with cholestatic jaundice as the initial symptom. The median age of onset was 4.33 (3.17, 6.17) years, and jaundice appeared on the 3rd (3,3.5) day of the illness. At admission, the median total bilirubin (TBil) and direct bilirubin (DBil) levels were 82.75 (72.70, 102.10) μmol/L and 63.5 (45.65, 71.55) μmol/L, respectively. All patients underwent cardiac and hepatobiliary ultrasound before IVIG administration, revealing coronary artery abnormalities (CAA) in 10 cases and hepatobiliary abnormalities in 12 cases. The median time from onset to KD diagnosis was 6 (5,6) days, and IVIG treatment was initiated immediately after diagnosis, with 12 cases showing IVIG resistance. KD with cholestatic jaundice as the initial symptom exhibited a significantly higher IVIG resistance rate (χ2=62.01, P=0.00). Comparing the IVIG-resistant and non-resistant groups, those in the IVIG-resistant group received IVIG treatment earlier (Z=-1.568, P=0.049). Conclusion Clinicians should be vigilant for KD cases presenting with cholestatic jaundice, and this subset is more likely to develop IVIG resistance.