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    30 September 2025, Volume 30 Issue 9
    Previous Issue   
    Metabolic Associated Fatty Liver Disease
    The clinical and pathological features and prognostic analysis of progressive liver fibrosis in metabolic dysfunction associated steatotic liver disease
    CHANG Liu-yi, SHAO Mo-li, TENG Guo-xin, MA Zi-kun, LI Min, ZHAO Xin-yan
    2025, 30(9):  1186-1191. 
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    Objective To comparatively study on the similarities and differences in clinical, pathological characteristics, and clinical outcomes between advanced liver fibrosis (F3) and cirrhosis (F4) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Methods A retrospective analysis was conducted on 65 patients with MASLD diagnosed with advanced liver fibrosis via liver biopsy. The patients were divided into two groups: F3 and F4. The clinical, pathological characteristics, and clinical outcomes of the two groups of patients were compared. Cox regression models were used to analyze the factors influencing the progression of patients with advanced liver fibrosis to decompensated cirrhosis. Results Among the 65 patients analyzed, 28 were in the F3 stage and 37 were in the F4 stage. There were no statistically significant differences between the two groups in terms of gender, age, body mass index (BMI), or comorbidities (P>0.05). Laboratory tests showed that, compared to the F3 group, the F4 group had lower prothrombin activity and ferritin levels (81.30% vs 93.45%, P<0.05; 135.60 ng/mL vs 261.45 ng/mL, P<0.05), and higher international normalized ratio and liver stiffness measurement values (1.11 vs 1.06, P<0.05; 20.80 kPa vs 16.30 kPa, P<0.05). In terms of pathological features, there were no significant differences in the extent of steatosis or ballooning degeneration between the two groups (P>0.05). However, compared to the F3 group, the F4 group exhibited more irregular distribution of steatosis, significantly reduced lobular inflammation, significantly increased portal inflammation and interface hepatitis, as well as ductular reaction (P<0.05). Regarding clinical outcomes, there were no significant differences between the two groups in the occurrence of decompensated cirrhosis, hepatocellular carcinoma, or death/transplantation (P>0.05). Univariate Cox regression analysis of factors influencing the progression of patients with advanced liver fibrosis to decompensated cirrhosis identified that age, BMI, fasting blood glucose, gamma-glutamyl transferase, and controlled attenuation parameter (CAP) were the significant factors. Multivariate Cox regression analysis revealed that age and fasting blood glucose were independent risk factors for the progression of patients with advanced liver fibrosis to decompensated cirrhosis (HR=0.859, 95%CI:0.754~0.977, P<0.05; HR=1.343, 95%CI:1.004~1.796, P<0.05). Conclusion There are certain differences in clinical and pathological characteristics between F3 and F4 stages of advanced liver fibrosis in MASLD patients, but there is no significant difference in clinical outcomes.
    A clinical study on quantitative assessment of hepatic steatosis using ultrasound-derived fat fraction
    QIAN Rong, ZHANG Zhen, WANG Cheng-chen, GUO Ming-yang, HE Shen-yan, CHEN Hui-chong, TU Jiao, CHEN Ting-ting, LIU Ting, PEI Feng
    2025, 30(9):  1192-1194. 
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    Objective To explore the clinical significance of ultrasound-derived fat fraction (UDFF) from the right lobe of liver for quantitatively assessing liver fat content of patients with non-alcoholic fatty liver disease (NAFLD). Methods Fifty-eight subjects were selected in this study and divided in Group A (normal control group:18 cases) and Group B (fatty liver group: 40 cases). All subjects first underwent conventional ultrasound examination, followed by measurements of the controlled attenuation parameter (CAP) and UDFF. The differences in CAP and UDFF between the two groups of patients were compared. The consistency and correlation between UDFF and CAP were analyzed. Results Group A had a CAP of (223.16 ± 12.59) dB/m and a UDFF of (4.69 ± 1.27)%, both within the normal range. Group B had a CAP of (258.49 ± 15.14) dB/m and a UDFF of (14.75 ± 2.87)%, both of which were significantly higher than those in Group A (P<0.05). Pearson correlation analysis showed that UDFF and CAP were positively correlated in assessing hepatic steatosis (r=0.938, P<0.001). Bland-Altman analysis of their agreement revealed that all subjects in Group A fell within the 95% confidence interval, while in Group B, 95% (38/40) of the cases were within the confidence interval, indicating a good consistency between UDFF and CAP values in the right liver lobes of patients in both groups. Conclusion UDFF is a non-invasive technique for quantitatively assessing liver fat content and holds significant clinical value in evaluating NAFLD.
    Exploring the impact of PNPLA3 expression on metabolic related fatty liver disease based on bioinformatics analysis
    HE Xiao-xuan, MA Xue-er, YANG Xue-xia, LI Qin, ZHU Kai, CAI Wen
    2025, 30(9):  1195-1199. 
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    Objective To Explore the expression and functional enrichment of PNPLA3 in metabolic related fatty liver disease (MAFLD) through bioinformatics analysis. Methods A slow virus transfection model for PNPLA3 over-expression in MAFLD cells was established. The differentially expressed genes were screened from PNPLA3 over-expressed cells. Enrichment analysis was performed to determine the biological significance of these genes. Differential expression analysis was performed to determine the pathways involved in different expression levels of PNPLA3 and its relationship with MAFLD. Results The alignment rates of genomic sequence alignment ranging from 97.27% to 97.96%; A total of 32 788 expressed genes were detected through analysis; A total of 158 930 transcripts were expressed; Compared with the model control group, the PNPLA3 overexpression group had 2 748 differentially expressed genes, including 1 264 upregulated genes and 1 484 downregulated genes. The differentially expressed genes in The PNPLA3 overexpression group mainly includes genes that were involved in cellular processes, biological regulation, metabolic processes, cellular component organization or biogenesis, and response to stimuli in biological processes. In molecular functions, there were mainly binding, catalytic activity, transcriptional regulatory activity, and molecular function regulators. The enrichment analysis of KEGG pathway showed that the pathways of PNPLA3 overexpression group included stem cell pluripotency regulation signaling pathway, ECM receptor interaction, IL-17 signaling pathway, chemical carcinogenesis, reactive oxygen species, human papillomavirus infection, lipid and atherosclerosis. Conclusion The expression level PNPLA3 is upregulated, and associated with the occurrence and development of MAFLD. This protein participates in reactions including biological regulation and metabolic processes.
    The value of lipase, lipoprotein (a) and lipoprotein-associated phospholipase A2 in the diagnosis of early cardiovascular injury in patients with non-alcoholic fatty liver disease
    YANG Sen, WU Chun-fang, ZHANG Yang-yang, CHENG Si, SHI Lei, WANG Li-li
    2025, 30(9):  1200-1203. 
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    Objective To investigate the correlation of lipase, lipoprotein (A) and lipoprotein-associated phospholipase A2 with early cardiovascular injury in patients with non-alcoholic fatty liver disease (NAFLD). Methods A total of 100 NAFLD patients (study group) and 100 healthy subjects (control group) were collected. Their general data and laboratory indicators were compared and the correlation between the indexes of the study group and the NAFLD group were studied. At the same time, the diagnostic efficacy of a combined detection with three indicators in the diagnosis of early cardiovascular injury in NAFLD was analyzed. Results The levels of lipase (50.58±11.52 mmol/L), lipoprotein (a) (93.50±32.57 mmol/L), and lipoprotein-associated phospholipase A2 (551.15±67.47 mmol/L) in the study group were significantly higher than those in the control group, with statistically significant differences (P<0.05). Logistic multivariate regression analysis showed that gender, age, hypertension, and diabetes were not associated with NAFLD, while lipase (β=11.25, P=0.02), lipoprotein (a) (β=9.56, P=0.01), and lipoprotein-associated phospholipase A2 (β=13.46, P=0.00) were all significantly associated with NAFLD, and lipoprotein-associated phospholipase A2 having the highest correlation coefficient. The combined detection of lipase, lipoprotein (a), and lipoprotein-associated phospholipase A2 showed a sensitivity of 82.33%, an accuracy of 64.27%, and an AUC of 0.725 for the diagnosis of NAFLD-related cardiovascular injury, which was significantly higher than that of individual detection, with statistically significant differences (P<0.05). Conclusion Lipase, lipoprotein (A) and lipoprotein-associated phospholipase A2 are independent risk factors for NAFLD. A combined detection of these three is more valuable in evaluating NAFLD lesions.
    Liver Fibrosis&Cirrhosis
    A study on the recompensation of decompensated cirrhotic patients with genotype 3 hepatitis C viral infection based on propensity score matching analysis
    XU Dan-qing, ZHA Xing-kun, SA Cai-fen, MU Huan, ZHANG Ying-yuan, MOU Chun-yan, LI Wei-kun, LIU Li
    2025, 30(9):  1204-1209. 
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    Objective Propensity score matching (PSM) analysis was used to investigate the factors affecting the occurrence of recompensation in decompensated cirrhotic patients with genotype (GT)-3 hepatitis C viral (HCV) infection, and to establish a prediction model. Methods A total of 184 patients admitted to Kunming Third People's Hospital from January 1, 2019 to December 31, 2022 who were diagnosed as decompensated cirrhosis related to GT-3a or 3b HCV infection were retrospectively collected. The relevant clinical data were collected. The re-hospitalized patients without portal hypertension-related complications within at least 1 year were grouped as the recompensated group (n=51), while the control group was not compensated (n=133). With a caliper value of 0.1, the recompensation group and control group with well-balanced PSM were obtained by 1∶1 matching. The factors that may affect the occurrence of recompensation were analyzed by univariate and Multivariant COX proportional risk regression model. Results One hundred and two cases were successfully matched, with 51 cases in the re-compensation group and 51 cases in the control group. Single factor Cox regression analysis showed that in the re-compensation group, there were 11 cases (21.6%) with a history of endoscopic treatment, 12 cases (23.5%) with Child-Pugh score A, 29 cases (56.9%) with Child-Pugh score B, 10 cases (19.6%) with Child-Pugh score C, 11 cases (21.6%) without ascites grading, 22 cases (43.1%) with small ascites, 18 cases (35.3%) with moderate to large ascites, Alb level of (31.83±5.73) g/L, PTA of (66.24±16.51)%, CD4+lymphocyte count of 541.36 (331.80, 722.98)/μL], which were significantly different when compared to those of 13 cases (9.8%), 9 cases (6.8%), 79 cases (56.4%), 45 cases (33.8%), 13 cases (9.8%), 33 cases (24.8%), 87 cases (65.4%), (28.55±5.77 g/L), PTA (54.78±16.00)%, and CD4+lymphocyte count [345.93 (235.38, 676.71)/μL] in the control group (HR=2.111, HR=2.485, HR=0.293, HR=1.060, HR=1.028, HR=1.002). The results of multivariate analysis showed that the history of endoscopic treatment (HR=2.718, 95%CI: 1.307~5.653, P=0.007), moderate to large ascites (HR=0.325, 95%CI: 0.117~0.903, P=0.031), PTA (HR=1.027, 95%CI: 1.004~1.051, P=0.023), and CD4+lymphocyte count (HR=1.002, 95%CI: 1.000~1.003, P=0.005) were the influencing factors of decompensation in cirrhotic patients with GT-3 HCV infection. Conclusion Recompensation is more likely to occur in decompensated cirrhotic patients with GT-3 HCV infection, with a history of endoscopic therapy, and less likely to occur in patients with a large amount of abdominal ascites. PTA and CD4+ lymphocyte count are closely related to the occurrence of recompensation. The established nomogram prediction model can effectively evaluate the probability of the occurrence of recompensation in GT-3 HCV infection related cirrhotic patients at decompensated stage.
    The diagnostic efficacy and influencing factors of two-dimensional shear wave elastography in fibrosis of autoimmune liver disease
    CHEN Li-hong, TU Hai-bin, FENG Si-yi
    2025, 30(9):  1210-1214. 
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    Objective To explore the diagnostic efficacy and influencing factors of two-dimensional shear wave elastography (2D-SWE) in autoimmune liver disease (AILD). Methods The clinical data of AILD patients pathologically confirmed by aspiration liver biopsy and grouped as autoimmune hepatitis (AIH) group, primary biliary cholangitis (PBC) group, and overlap syndrome (OS) group were retrospective analyzed, including liver 2D-SWE value, pathological S grade, essential information such as age and gender, ultrasound echo of liver parenchyma and size of spleen, blood routine and biochemistry, immunity inspection index, and so on. Pearson or Sperman rank method was used for correlation analysis between groups. Receiver working curve (ROC) was drawn and the diagnostic cut-off value was found according to Youden index, the sensitivity and specificity were calculated, and Linear regression was used for analyzing the influencing factors. Results There were 107 AILD patients, including 21 in AIH group, 58 in PBC group, and 28 in OS group. Liver 2D-SWE value were 7.4(5.2, 9.8)kPa. Median BMI was (22.6±2.8) kg/m2. 26 patients had splenomegaly, hemoglobin (Hb) (122.3±17.0) g/L, alanine aminotransferase (ALT) 79(41, 150)IU/L, aspartate aminotransferase (AST) 72(43, 132)IU/L, total bilirubin 18.6(11.9, 46.1)μmol/L, IgG 18.40(15.18, 23.15)mg/mL. Pathological S classification: 79 patients were grade 0~2 and 28 patients of them were in overall group; 10 patients were grade 0~2 and 11 patients were grade 3~4 in AIH group; 53 patients were grade 0~2 and 5 patients were grade 3~4 in PBC group; 16 patients were grade 0~2 and 12 patients were grade 3~4 in OS group. The liver 2D-SWE values were positively correlated with the pathological fibrosis grade in the overall, PBC and OS groups (r=0.431, P<0.001; r=0.279, P=0.034; r=0.442, P=0.018, respectively). If S≥3, the area under curve of the three groups were 0.783, 0.787 and 0.758, the diagnostic cut-offs were 7.35 kPa, 7.6 kPa, 9.3 kPa, the sensitivity and specificity were 89.3%, 63.3%; 80.0%, 75.5%; 83.3% and 75.0%, respectively. Univariate analysis showed age (P=0.040), splenomegaly (P=0.007), BMI (P=0.007), Hb (P=0.003), AST (P=0.005), total bilirubin (P<0.001), IgG (P<0.001) were influencing factors for 2D-SWE values, multiplicity analysis showed splenomegaly (P=0.013), total bilirubin (P=0.004) and IgG (<0.001) were independent influencing factors. Conclusion 2D-SWE can be used to distinguish mild to moderate fibrosis from severe fibrosis in AILD patients, especial in PBC and OS patients, which is affected by size of spleen, bilirubin and IgG levels.
    A clinical observation on the reversal of liver fibrosis and early cirrhosis in patients with chronic hepatitis B by entecavir antiviral therapy
    LI Ling-jie, YANG Ming, WU Wei-ping, WU Ya-nan, HUANG Yong-peng
    2025, 30(9):  1215-1218. 
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    Objective To observe the clinical application of entecavir antiviral therapy in reversing liver fibrosis and early cirrhosis in patients with chronic hepatitis B. Methods Eighty patients with chronic hepatitis B between February 2020 and February 2022 were selected in this study. They were divided into an observation group and a control group on the premise of meeting the drug use standard of the pharmacy department of the affiliated hospital of North Sichuan Medical College. Patients in the former group were given entecavir and those in the latter group were given pegylated interferon α-2b injection. The indexes of hepatitis B virus, liver function, liver fibrosis and clinical efficacy of the above groups were compared. Results In the observation group, the levels of deoxyribonucleic acid quantification of hepatitis B virus (HBV DNA), hepatitis B surface antigen (HBsAg), and hepatitis B virus e antigen (HBeAg) were (4.2 ± 0.1) IU/mL, (848.6 ± 115.6) U/mL, and (181.3 ± 70.0) U/mL respectively, all of which were significantly lower than those of [(4.6 ± 0.2) IU/mL, (939.1 ± 125.2) U/mL, and (222.2 ± 82.3) U/mL, P<0.05] in the control group. After 3 months of treatment, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (Alb), and total bilirubin (TBil) in the observation group were (48.2 ± 10.1) U/L, (45.6 ± 15.6) U/L, (43.2 ± 4.1) g/L, and (18.3 ± 3.0) μmol/L respectively, which were significantly lower than those of [(55.6 ± 10.2) U/L, (56.1 ± 15.2) U/L, (41.1 ± 3.2) g/L, and (20.2 ± 4.1) μmol/L, P<0.05] in the control group. After treatment, the levels of hyaluronic acid, type Ⅲ procollagen, laminin, and type Ⅳ collagen in the observation group were (84.22 ± 28.1), (38.2 ± 5.6), (36.2 ± 5.1), and (69.6 ± 6.6) respectively, all of which were significantly lower than those of [(115.1 ± 40.2), (41.1 ± 5.2), (40.1 ± 6.2), and (76.1 ± 8.2), P<0.05] in the control group. Conclusion Entecavir antiviral therapy can not only quickly restore liver function, but also further reduce the indicators of hepatitis B viral infection and liver fibrosis, with definite clinical effect.
    The clinical value of the combined detection of CHI3L1, GP73 and four items of liver fibrosis in the early liver fibrosis patients with chronic hepatitis B
    HUANG Su-qin, LIN Cheng, ZHENG Si-yu
    2025, 30(9):  1219-1224. 
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    Objective To explore the clinical value of the chitinase-3-like protein 1(CHI3L1), Golgi protein 73 (GP73) and four items of liver fibrosis- hyaluronicacid(HA),laminin(LN),type Ⅲ procollagen peptide (PⅢP) and collagen type Ⅳ(CⅣ) in diagnosing early liver fibrosis in patients with the chronic hepatitis B (CHB). Methods A total of 295 patients with CHB who underwent liver biopsy at Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2018 to January 2024 were included in this study.Based on liver histopathological staging, the patients were divided into five stages: S0 (n=26), S1 (n=112), S2 (n=63), S3 (n=54), and S4 (n=40).The correlation between (CHI3L1 ,GP73) and (HA,LN,PⅢNP,CⅣ) was anlyzed. Receiver operating characteristic (ROC) curve of CHI3L1,GP73,HA,LN,PⅢNP and CⅣ and their combined detection value in the different fibrosis(S1/S0,S2/S1,S3/S2) were analyzed. Results The serum levels of CHI3L1,GP73,HA,LN,PⅢNP and CⅣ increased with their progress of liver fibrosis (Z=82.926,37.635,22.441,33.136,49.484,53.823,P<0.001),There was no significant difference between the groups of S1 and S0 stage on various indicators. There were significant differences between the groups of S1 and S2 stage on CHI3L1、GP73、HA and LN (Z=-4.278,-3.389,-3.114,-0.331,P<0.05). There were significant differences between the groups of S3 and S2 stage on CHI3L1,GP73,PⅢNP and CⅣ (Z=-2.856, -1.976, -2.365, -3.020,P<0.05). There was significant difference between the groups of S4 and S3 stage only on PⅢNP[39.60 (28.27,71.20) vs. 28.64(19.66,55.20),Z=-2.119,P<0.05].Pearson correlation analysis showed that the levels of CHI3L1 and GP73 were positively correlated with HA,LN,PⅢNP and CⅣ levels(r=0.289,0.372,0.326,0.341,P<0.01)and (r=0.365,0.400,0.510,0.543,P<0.01) respectively;CHI3L1 level was positively correlated with GP73 (r=0.39,P<0.01).The area under curve (AUC) of CH3L1,GP73,HA,LN,PⅢNP and CⅣ and their combined detection in the diagnosis of (S1/S0,S2/S1,S3/S2) stages were (0.478,0.508,0.441,0.570,0.544,0.410,0.689),(0.684,0.682,0.603,0.674,0.580,0.570,0.756)and(0.759,0.711,0.610,0.651,0.723,0.745,0.847) respectively.In S1 stage, AUC of all items were lower than 0.55 (0.478,0.508,0.441,0.570,0.544 ,0.410),which had no diagnostic value for S1. However, the combined detection yielded an AUC of 0.689, providing some reference value for predicting S1. In S2 stage,the size of AUC of these items were CHI3L1＞GP73＞LN＞HA＞PⅢNP＞CⅣ(0.684,0.682,0.674,0.603,0.580,0.570)and only the first 3 items were higher than 0.61,and AUC,sensitivity,specificity and Youden index of their combined items were 0.75,93.0%,46.7% and 0.397,which had good valuable for prediction of S2.In S3 stage,the size of AUC of these items were CHI3L1＞CⅣ＞PⅢNP＞GP73＞LN＞HA (0.759,0.745,0.723,0.711,0.651,0.610), and all items were higher than 0.6,and AUC,sensitivity,specificity and Youden index of their combined items were 0.847,92.5%,70.7% and 0.632,and both single and combined items were all valuable for prediction of S3. Conclusion With the progression of liver fibrosis, the serum levels of CHI3L1,GP73 and four items progressively increased.TAmong individual biomarkers, CHI3L1 exhibits the highest diagnostic efficacy for early liver fibrosis, followed by GP73 and the four liver fibrosis markers. Clinical diagnostic value of combined detection was superior to the single detection in the diagnosis of early liver fibrosis with CHB and can enhance the detection of early liver fibrosis up to the S1 stage.
    Liver Tumor
    Inhibitory effect and its mechanism of guggulsterone on diethylnitrosamine-induced hepatocellular carcinoma in rats
    LIU Xiong-tao, WANG Yi-kai, XUE Peng-jun, KANG Pei, ZHANG Xin, SHI Juan-juan
    2025, 30(9):  1225-1229. 
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    Objective To explore the inhibitory effect and its mechanism.of guggulsterone (GS) on diethylnitrosamine (DEN)-induced hepatocellular carcinoma (HCC) in rats. Methods DEN-induced HCC model was constructed in SD rats. Successful HCC modeling rats were randomly divided into the HCC group (n=6) and the GS group (n=6, 50 mg/kg), and free-feeding rats were randomly selected as the control group (n=6). The GS group was continuously injected with GS for four weeks, while the control group and HCC group were injected with an equal amount of physiological saline. The liver gross morphology was observed and the body mass, liver mass and liver-body mass ratio were measured in rats. Pathological changes of rat liver were detected by hematoxylin and eosin (HE) Staining staining, and the expression levels of p53-associated mitochondrial apoptotic signaling pathway proteins, p53, B-cell lymphoma 2 (Bcl-2), BCL2-associated X protein (Bax), caspase-3, and caspase-9 were detected by immunohistochemistry staining and Western blot methods, respectively. Results Compared with the control group (501.04 ± 18.03) g, the body mass of rats was significantly decreased in both HCC (406.07 ± 22.91) g and GS groups [(357.83 ± 29.01)g, P<0.001]. The liver mass and liver body mass ratio of the HCC group (27.68 ± 6.34, 6.88 ± 1.87) g and the GS group (18.25 ± 2.20, 5.13 ± 0.72) g were significantly higher than those of control group (13.67 ± 1.40, 2.74 ± 0.38) g, and the GS group was lower than the HCC group (P=0.002, P=0.003). The liver of the HCC group was enlarged with multiple cancerous nodules diffusely distributed on the surface, and multiple cancerous nodules diffusely distributed were also seen in the GS group, but the number of cancerous nodules was significantly reduced compared with that in the HCC group. Microscopically, the phenomena of hepatocellular heterogeneous hyperplasia and focal nodular hyperplasia were seen in the HCC group, whereas hepatocellular heterogeneous hyperplasia necrosis and focal nodular hyperplasia were significantly improved in the GS group. Immunohistochemistry showed that the protein expression levels of p53 (56.42 ± 6.84), Bax (43.02 ± 5.27) and caspase-3 (13.37 ± 2.50) in the GS group were significantly higher than those in the control group (19.33 ± 2.98, 16.07 ± 3.22, 3.42 ± 1.04) and the HCC group (39.32 ± 5.99, 27.42 ± 3.74, 9.63 ± 1.53), and there was a statistically significant difference in the comparison of the three groups (P<0.05), while the protein expression level of Bcl-2 (8.52 ± 3.31) was significantly lower than that in the control group (22.03 ± 3.74) and the HCC group (15.38 ± 2.10), and there was a statistically significant difference among the comparison of the three groups (P<0.05). The caspase-9 protein expression level was not statistically different among the three groups (1.27 ± 0.71, 1.07 ± 0.70, 1.43 ± 0.81, P>0.05). Similar results were obtained by Western blot. Conclusion GS inhibited DEN-induced HCC, which may be related to the p53-related mitochondrial apoptotic signaling pathway.
    Value of CT perfusion imaging parameters in analyzing residual lesions of primary liver cancer after TACE
    GE Jing-jun, ZHANG Jia-jin, KE Wei-wei, GU Fan, GE Chen-mei, HUANG Jing-jing
    2025, 30(9):  1230-1233. 
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    Objective To analyze the value of hepatic CT perfusion imaging parameters in evaluating residual lesions after transcatheter arterial chemoembolization (TACE) in patients with primary liver cancer (PLC). Methods The clinical data of 95 PLC patients admitted to the Interventional Departments of Dongtai Traditional Chinese Medicine Hospital and Nanjing Zhongda Hospital between October 2021 and September 2024 were retrospectively analyzed. This study compared the changes in CT perfusion imaging parameters between completely perfused lesions and residual lesions before and after TACE treatment, and further evaluated their capability in assessing residual lesions. Results Among the 95 patients, 30 cases (31.6%) achieved complete remission. Compared with pre-TACE values, completely embolized lesions showed significant post-TACE decreases in blood volume of the region of interest, embolized area blood volume, hepatic arterial perfusion, and hepatic perfusion index (P<0.05), while time to peak and portal venous perfusion increased significantly (P<0.05). In contrast, residual lesions exhibited significant reductions in portal venous perfusion (P<0.05) but increases in hepatic arterial perfusion and hepatic perfusion index (P<0.05) after TACE, with no significant difference in blood volume of the region of interest, embolized area blood volume, or time to peak before and after treatment (P>0.05). A multi-parameter diagnostic model combining CT perfusion imaging parameters was constructed to predict residual lesions (binary outcome) after TACE. ROC curve analysis confirmed that the area under the curve (AUC), sensitivity, and specificity of this multi-parameter diagnostic model were 0.93, 87.7% (57/65), and 90.0% (27/30), respectively. These values were significantly outperforming the individual parameters (AUC range: 0.72~0.84; Delong test, P<0.05), indicating complementary diagnostic information among parameters. Conclusion CT perfusion imaging parameters sensitively reflect hemodynamic changes in PLC lesions after TACE. The multi-parameter diagnostic model exhibits high efficacy for postoperative evaluation, demonstrating promising clinical utility.
    Analysis of the correlation between shear wave elastography parameters and tumor marker levels with lesion tissue characteristics in liver cancer patients
    LIU Miao, ZHANG Qun-qing, WU Juan
    2025, 30(9):  1234-1237. 
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    Objective To investigate the correlation between shear wave elastography (SWE) parameters and tumor marker levels with lesion tissue characteristics in liver cancer patients. Methods 93 liver cancer patients in our hospital between June 2020 and June 2023 were recruited into the study as the liver cancer group, and 50 patients with liver nodules were included in the nodule group for comparison. SWE was utilized to measure elasticity parameters such as liver stiffness measurement (LSM), maximum velocity (Vmax), and mean velocity (Vmean). Serum levels of alpha-fetoprotein (AFP), gamma-glutamyl transferase (GGT), and carcinoembryonic antigen (CEA) were determined using enzyme-linked immunosorbent assay (ELISA), and the relationship between these SWE parameters and tumor marker levels with lesion tissue characteristics was analyzed. Results Significant differences were observed between the liver cancer and nodule groups in terms of liver function grading, liver fibrosis grading, and liver inflammation activity (P<0.05). Serum levels of AFP, GGT, and CEA were (245.68 ± 82.43) μg/L, (257.55 ± 95.72) U/L, and (18.22 ± 4.67) U/L, respectively, all of which were significantly higher than in the nodule group [(9.15±2.72) μg/L, (16.24±5.43) U/L, and (0.91±0.24) U/L, respectively; P<0.05]. In the liver cancer group, LSM was (33.47±2.68) kPa, Vmax was (3.92±0.57) m/s, and Vmean was (3.47±0.35) m/s, which were significantly higher than those in the nodule group [(15.87±1.23) kPa, (2.61±0.24) m/s, and (2.36±0.22) m/s, respectively; P<0.05]. Spearman correlation analysis indicated that liver function grading, liver fibrosis grading, and liver inflammation activity were positively correlated with the levels of AFP, GGT, CEA, LSM, Vmax, and Vmean (P<0.05 for all). Conclusion The analysis of the correlation between SWE parameters and tumor marker levels with lesion tissue characteristics in liver cancer patients demonstrates that SWE parameters along with serum AFP, GGT, and CEA levels can serve as effective tools for assessing the condition of liver cancer.
    Value of serum miR-524-5p and miR-411-5p expression in early diagnosis and clinical prognosis with liver cancer
    CHEN Jie, TIAN Le, WU Ke, ZHANG Qian
    2025, 30(9):  1238-1243. 
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    Objective To explore the relationship between serum miR-524-5p and miR-411-5p expression in early diagnosis and clinical prognosis of patients with liver cancer (LC). Methods From October 2018 to October 2020, 96 patients with LC admitted to our hospital were collected as the LC group, and 96 healthy individuals from the same hospital were regarded as the control group. The expression levels of serum miR-524-5p and miR-411-5p were detected. The diagnostic efficacy of serum miR-524-5p and miR-411-5p levels in LC was analyzed. The relationship between the expression of serum miR-524-5p and miR-411-5p and prognosis in LC patients was analyzed. Further, the factors affecting the prognosis of LC patients were investigated. Results Compared with the control group, the expression level of miR-524-5p in LC group was significantly lower (0.76±0.19 vs. 1.01±0.21, t=8.625, P<0.001), and the expression level of miR-411-5p was also significantly lower (0.79±0.23 vs. 1.01±0.18, t=7.380, P<0.001). The area under the curve (AUC) for the combined diagnosis of LC using serum miR-524-5p and miR-411-5p was the highest at 0.850, which was better than the individual diagnosis of serum miR-524-5p and miR-411-5p (Zcombination-miR-524-5p=2.126, P=0.034, Zcombination-miR-411-5p=3.577, P<0.001). The expression level of miR-524-5p and miR-411-5p in LC patients was related to TNM staging, lymph node metastasis, depth of infiltration, and degree of differentiation (P<0.05). The 3-year survival rate of LC patients with high expression level of miR-524-5p and miR-411-5p was higher than that of patients with low expression of miR-524-5p and miR-411-5p (χ2=4.525, 5.596, P=0.033, 0.018). Multivariate Cox analysis showed that miR-524-5p and miR-411-5p were protective factors affecting the prognosis of LC patients (P<0.05), and TNM stage, lymph node metastasis, invasion depth and differentiation degree were risk factors affecting the prognosis of LC patients (P<0.05). Conclusion The expression levels of serum miR-524-5p and miR-411-5p are decreased in LC patients, and their expressions are related to clinicopathological features and prognosis. The combination of them has the best efficacy in diagnosing LC.
    The combination of MRI multi-modal parameters and MRI texture parameters has value in the diagnosis of background liver nodules in fatty liver
    ZHANG Wei, WEN Lei-tao, LIU Wen-qian
    2025, 30(9):  1244-1248. 
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    Objective To analyze the value of magnetic resonance imaging (MRI) multimodal parameters combined with MRI image texture parameters in diagnosing small liver nodules in the background of fatty liver. Methods A retrospective analysis was performed on medical records of 94 patients with fatty liver background liver nodules treated at Xi'an High tech Hospital from March 2021 to March 2023. T1WI, liposuppression T2WI, MRI diffusion-weighted imaging (DWI), dynamic enhanced imaging (DEC)-MRI scan data were collected from all patients before pathological puncture or surgery. Multimodal parameters and image texture feature parameters were analyzed. Using pathological diagnosis as the gold standard, determine the benign or malignant nature of liver nodules in the background of fatty liver. Analyze the influencing factors for malignancy of liver nodules in the context of fatty liver, and analyze the sensitivity and specificity of MRI-DWI parameters, DEC-MRI parameters, and image texture feature parameters for the single or combined diagnosis of benign or malignant liver nodules in fatty liver. Results Among 94 patients with background liver nodules in fatty liver, 40 patients were diagnosed as malignant nodules (+) and 54 patients were diagnosed as benign nodules (-) by pathology. Under diffusion sensitive gradient factor (b value) conditions of 100 s/mm2, 500 s/mm2, and 1 000 s/mm2, the apparent diffusion coefficient (ADC) of the malignant nodule group was (1.99±0.51)×10-3 mm2/s, (1.87±0.54)×10-3 mm2/s, and (1.65±0.49)×10-3 mm2/s, respectively, which were lower than those of the benign nodule group [(2.40±0.68)×10-3 mm2/s, (2.23±0.57)×10-3 mm2/s, and (2.09±0.53)×10-3 mm2/s, (P<0.05)]. The maximum slope increase (MSI), maximum slope decrease (MSD), and peak value (PV) of the malignant nodule group were (301.08±59.06), (92.63±24.08), and (512.36±72.19), respectively, which were lower than those of the benign nodule group [(369.16±58.14), (106.35±27.41), and (581.34±80.27), (P<0.05)]. The S(5,5) Sum Varnc/×102, S(3,3) Sum Varnc/×102, S(2,3) Sum Varnc/×102, and S(0,1) Sum Varnc/×102 of the malignant nodule group were higher than those of the benign nodule group (P<0.05). ADC value (b=1 000 s/mm2, OR=0.282, 95%CI: 0.104~0.763), MSI (OR=0.271, 95%CI: 0.100~0.735), MSD (OR=0.265, 95%CI: 0.098~0.717), PV (OR=0.318, 95%CI: 0.117~0.860), S(5,5) Sum Varnc/×102 (OR=3.823, 95%CI: 1.411~10.356) were identified as influencing factors for malignancy of liver nodules in the background of fatty liver (P<0.05). The sensitivity of MRI-DWI parameters, DEC-MRI parameters, and image texture feature parameters for single and combined diagnosis of benign or malignant liver nodules in fatty liver were 0.624, 0.697, 0.683, and 0.731, respectively, while the specificity was 0.713, 0.772, 0.659, and 0.800, and the area under the curve was 0.720, 0.751, 0.713, and 0.832, respectively. Conclusion The combination of MRI multimodal parameters and MRI image texture parameters has a high accuracy in diagnosing small liver nodules in the background of fatty liver, and could be used to assist in the diagnosis of benign and malignant liver nodules in the background of fatty liver.
    Using dynamic three-dimensional contrast-enhanced ultrasonography to evaluate the clinical efficacy and post-operative recurrence of microwave ablation for patients with hepatitis B-related hepatocellular carcinoma
    YIN Wen, SHEN Rong
    2025, 30(9):  1249-1253. 
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    Objective To explore the efficacy of dynamic three-dimensional contrast-enhanced ultrasonography (3D-CEU) in evaluating the clinical efficacy and recurrence of patients with hepatitis B-related hepatocellular carcinoma (HCC) after microwave ablation. Methods A total of 45 patients who received microwave ablation for hepatitis B-related HCC were selected between November 2018 and January 2023. Two-dimensional contrast-enhanced ultrasonography (2D-CEU) and 3D-CEU were used to evaluate the curative effect and recurrence at one month after the operation, and the two methods were compared on their imaging results of tumor in contrast mode and their efficacies on evaluating the curative effect. Results The numbers of cases in which 3D-CEUS detected tumor blood vessels was not displayed in 2 cases, normal in 5 cases, or clear in 38 cases, which were statistically significantly different with those of 8 cases, 12 cases and 25 cases, respectively, with 2D-CEUS (χ2=9.165, P=0.010). There were 4 cases, 6 cases and 35 cases in which 3D-CEUS showed no tumor boundary, normal tumor boundary and clear tumor boundary. Compared with those of 5 cases, 20 cases and 20 cases with 2D-CEUS, the difference was statistically significant (χ2=11.740, P=0.003). The results of postoperative biopsy showed that 11 of 45 patients had insufficient treatment or recurrence. Comparing their efficacy on evaluating the curative effect, the diagnostic efficacy indexes of 3D-CEUS are significantly higher than those of 2D-CEUS, and the difference is statistically significant (P<0.05). Conclusion Dynamic 3D-CEUS is helpful in evaluating the clinical efficacy and recurrence of patients with hepatitis B-related HCC after microwave ablation.
    Influence of different blood supply typing on the efficacy of hepatic artery chemoembolization in the treatment of patients with hepatic hemangioma
    YAO Yu, XU Chun-yang, REN Jian-wu
    2025, 30(9):  1254-1257. 
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    Objective To explore the influence of different blood supply typing on the efficacy of hepatic artery chemoembolization in the treatment of hepatic hemangioma patients, and to provide a basis for clinical treatment of hepatic hemangioma. Methods In this retrospective study, 102 patients with hepatic hemangiomas treated with hepatic artery chemoembolization admitted to our hospital during February 2019 to February 2024 were included. According to the different blood supply types, the patient were divided into a hupovascular group (34 cases), a moderately vascular group (34 groups), and a hupervascular group (34 cases). The clinical efficacy, blood biochemical indicators and incidence of complications were compared among three groups. Results At 1 week postoperatively, the clinical efficacy of the blood-rich group was 88.24%, which was higher than that of the intermediate blood-supply group and the lack of blood-supply group (64.71% and 44.12%, P<0.05). The amount of bleomycin-iodized oil in the rich blood supply group was (12.02±1.01) mL, which was higher than that in the intermediate blood supply group and the lack of blood supply group [(7.58±1.05) mL and (4.85±1.02) mL, respectively, P<0.05]. Compared with the preoperative period, serum ghrelin, total bilirubin, and direct bilirubin levels increased in all three groups at 1 week postoperatively, but were lower in the rich blood supply group at (101.25±20.45) U/L, (11.65±1.02) μmoL/L, and (10.58±1.23) μmoL/L than those of the moderate blood supply group at (142.35±21.55) U/L, (13.69 ± 1.62) μmoL/L, (13.25 ± 1.14) μmoL/L in the spent blood supply group [168.56 ± 22.36) U/L, (15.56 ± 1.58) μmoL/L, (15.25 ± 1.02) μmoL/L, respectively, P<0.05]. Conclusion After treatment by hepatic artery chemoembolization, the clinical efficacy of hepatic hemangioma rich blood supply type was higher, which could improve their clinical indexes and optimize liver function, and the safety of different blood supply subtypes is good.
    A comparative study of MRCP and multi row spiral CT in the diagnosis of malignant biliary obstruction
    WU Shi-chen, JIANG Kai, ZHANG Zhai-wen, SHI Chuan-qi, ZHANG Zhao-dong
    2025, 30(9):  1258-1262. 
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    Objective To explore the effectiveness and value of magnetic resonance cholangiopancreatography (MRCP) combined with multi row spiral CT in the diagnosis of malignant biliary obstruction. Methods 82 patients with malignant biliary obstruction who received treatment at Suzhou Integrated Traditional Chinese and Western Medicine Hospital from March 2019 to September 2023 were selected. All of the patients had underwent MRCP and multi row spiral CT examinations. The differences in bile duct display ability between MRCP and multi row spiral CT, compare the imaging features of patients with MRCP and multi row spiral CT, including biliary stricture, tumor obstruction, and surrounding liver tissue involvement, and analyze the differences in localization diagnosis results between the two methods were compared; Receiver operating characteristic curve (ROC) was performed to analyze the value and accuracy of MRCP, multi slice spiral CT, and their combination in the diagnosis of malignant biliary obstruction. Results The average bile duct display ability of MRCP was 4.23°, which was 4.01° of multi row spiral CT; In the imaging images of malignant biliary obstruction, both groups showed irregular thickening of the bile duct wall accompanied by retrograde intrahepatic bile duct dilation; The main manifestation of vascular invasion was stenosis or occlusion; Lymph node metastasis often manifested as an increase in short diameter or enhancement in a circular or circular shape; The manifestation of organ invasion was unclear boundary and low-density necrotic lesion. Two methods showed differences in biliary stenosis and tumor obstruction, but both had high consistency with clinical diagnostic results; ROC analysis showed that, MRCP、 The AUC for the diagnosis of malignant biliary obstruction using multi row spiral CT and their combination were 0.889, 0.870, and 0.948, respectively; The corresponding sensitivities were 87.80%, 93.80%, and 97.78%. Conclusion Magnetic resonance cholangiopancreatography (MRCP) combined with multi row spiral CT had significant diagnostic value in the diagnosis of malignant biliary obstruction, which could significantly improve its diagnostic accuracy. It is worthy to be widely used in clinical practice.
    Other Liver Diseases
    Clinical guidance significance of liver biopsy and pathological examination for different types of liver diseases
    HU Da-shan, DONG Yuan, SHENG Yun-feng, Fan Ye, Xu Jing, WANG Shou-ming, JIANG Xun
    2025, 30(9):  1263-1266. 
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    Objective To evaluate the importance of liver biopsy through case analysis of liver tissue pathology examination. Methods A total of 123 patients hospitalized in the Qinhuai Campus of the Eastern Theater Command General Hospital from January 2023 to January 2024 were collected. To identify the characteristics of each case, the proportion of each case, puncture complications, biochemical and pathological indicators of most cases were statistically analyzed. Results Alanine aminotransferase (ALT) levels in drug-induced hepatitis cases (361±461 U/L) were significantly higher than those in autoimmune hepatitis (105±94 U/L), liver dysfunction cases (69±48 U/L), compensated cirrhosis cases (56±72 U/L), and fatty liver disease cases (70±51 U/L) (all P<0.05).Aspartate aminotransferase (AST) levels in drug-induced hepatitis cases (161±138 U/L) were significantly elevated compared to liver dysfunction cases (45±34 U/L), compensated cirrhosis cases (56±73 U/L), and fatty liver disease cases (45±25 U/L) (all P<0.05).Alkaline phosphatase (ALP) showed significant differences between: fatty liver disease cases (90±40 U/L) and autoimmune hepatitis cases (182±154 U/L); and between drug-induced hepatitis cases (254±315 U/L) and liver dysfunction cases (120±61 U/L) (both P<0.05). Albumin levels in fatty liver disease cases (45±3 g/L) were significantly higher than in autoimmune hepatitis cases (42±5 g/L), compensated cirrhosis cases (40±4 g/L), and drug-induced hepatitis cases (39±3 g/L) (all P<0.05). Additionally, compensated cirrhosis cases differed significantly from liver dysfunction cases (44±7 g/L) (P<0.05).Triglyceride levels in fatty liver disease cases (2.32±1.25 mmol/L) were significantly elevated compared to autoimmune hepatitis cases (1.43±0.55 mmol/L), liver dysfunction cases (1.39±0.81 mmol/L), and compensated cirrhosis cases (1.25±0.71 mmol/L) (all P<0.05).Cholinesterase activity in fatty liver disease cases (9 913±1 684 U/L) differed significantly from liver dysfunction cases (7 243±3 206 U/L), compensated cirrhosis cases (6 365±275 U/L), and drug-induced hepatitis cases (P<0.05).Total cholesterol levels differed significantly between fatty liver disease cases (4.83±0.98 mmol/L) and compensated cirrhosis cases (3.82±0.71 mmol/L) (P<0.05).Total bilirubin levels in fatty liver disease cases (14±5 μmol/L) were significantly different from compensated cirrhosis cases (22±14 μmol/L) and drug-induced hepatitis cases (26±12 μmol/L) (both P<0.05).For histological inflammation grade (G-score):Liver dysfunction cases (1.42±0.96) differed from autoimmune hepatitis cases (2.55±0.63) and compensated cirrhosis cases (2.38±1.02).Fatty liver disease cases (1.53±0.83) differed from autoimmune hepatitis and compensated cirrhosis cases.Drug-induced hepatitis cases (2.70±0.67) differed from both liver dysfunction and fatty liver disease cases (all P<0.05).For histological fibrosis stage (S-score):Liver dysfunction cases (1.37±1.16) differed from autoimmune hepatitis cases (2.38±1.15).Compensated cirrhosis cases (3.31±1.01) differed from autoimmune hepatitis, liver dysfunction, fatty liver disease (1.73±1.22), and drug-induced hepatitis cases (all P<0.05). Conclusion Liver puncture showed an overall favorable safety profile with manageable risks. Pathological analysis of liver puncture patients is extremely important for understanding the disease status, prognosis judgment, scientific research, and other aspects, and is worthy for widespread clinical research.
    Development of a differentiation model for autoimmune hepatitis and drug-induced liver injury based on hepatic ultrasound hemodynamics and liver biochemical indicators
    LIU Xiao-fang, KE Jian-mei
    2025, 30(9):  1267-1271. 
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    Objective To distinguish between DIAIH and DILI, a differential diagnosis model for drug-induced autoimmune hepatitis (DIAIH) and drug-induced liver injury (DILI) was established based on hepatic ultrasound hemodynamics and liver biochemical indicators. Methods A retrospective analysis was conducted on medical records of 82 cases of drug-induced liver injury (DILI) and 74 cases of drug-induced autoimmune hepatitis (DIAIH) admitted to the hospital from January 2020 to January 2023. The study aimed to analyze the differences in hepatic ultrasound hemodynamics and liver biochemical indicators between the DILI and DIAIH groups, identify factors influencing the onset of DIAIH, and establish a differentiation model for DILI and DIAIH. Results The portal vein blood flow velocity in DILI group was higher than that in DIAIH group, and the hepatic artery blood flow velocity and resistance index were lower than that in DIAIH group [DILI group: (22.31±3.19) cm/s, (40.23±6.47) cm/s, (0.71±0.13) cm/s, DIAIH group: (19.49±3.02) cm/s (46.91±7.15) cm/s, (0.79±0.12) cm/s] (P<0.05). The levels of total bilirubin, total bile acid, alkaline phosphatase (ALP), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT) and globulin in DILI group were lower than those in DIAIH group [DILI group (18.62) μmol/L, (7.56) μmol/L, (96.05) U/L, (206). 53) U/L, (112.35) U/L, (29.13) g/L, DIAIH group (26.01) μmol/L, (22.61) μmol/L, (129.52) U/L, (328.65) U/L, (199.34) U/L, (35.02) g/L, ] (P<0.05). Portal vein blood flow velocity, hepatic artery blood flow velocity, resistance index, total bilirubin, total bile acids, and ALT were identified as influencing factors for the occurrence of DIAIH (P<0.05). The receiver operating characteristic (ROC) curve analysis showed that the sensitivity of the column chart model in distinguishing DIAIH was 0.825 (95%CI: 0.741~0.952), the specificity was 0.798 (95%CI: 0.703~0.883), and the area under the curve was 0.827 (95%CI: 0.749~0.964). Conclusion There are differences in hepatic ultrasound hemodynamics and liver biochemical indicators between DILI and DIAIH patients. Constructing a differentiation model based on hepatic ultrasound hemodynamics and liver biochemical indicators could be used to assist in the diagnostic differentiation of DILI and DIAIH.
    Nomogram prediction of short-term prognosis of acute liver failure
    ZHANG Ye-fan, LI Qian
    2025, 30(9):  1272-1275. 
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    Objective To establish a new model for predicting short-term prognosis of patients with acute liver failure. Methods Relevant laboratory indicators of the patients with acute liver failure were collected to screen out meaningful clinical indicators. Independent risk factors related to prognosis were screened by univariate and multivariate Cox regression analysis, and a model for predicting short-term prognosis was established. The risk score was calculated according to the new model, and the median risk score was taken as the critical point to divide the patients into high-risk group and low-risk group, and the difference in survival rate between the two groups was compared. ROC analysis was used to compare the predictive efficacy of the model and MELD scoring system in different time periods. Results A total of 103 patients were included in the study. Four independent risk factors including prealbumin (PA) (HR=0.99,95%CI:0.98~1.00) , lactic acid (Lac) (HR=1.22,95%CI:1.13~1.31) , platelet count (PLT) (HR=0.99,95%CI:0.99~1.00) and International normalized ratio (INR) (HR=1.14,95%CI:1.02~1.27) were screened out by univariate and multifactorial Cox regression analysis. A prognosis prediction model equation for acute liver failure was constructed. The expression formula of the model is as follows: Risk score = 0.195*Lac + 0.178*INR-0.012*PA-0.008*PLT. The median survival rate of the low-risk group was significantly higher than that of the high-risk group (P<0.01). The new model was superior to MELD score in predicting the 30 d outcome[AUROC 0.88 (95%CI 82.25~94.45) vs 0.75 (95%CI 65.56~84.74), P<0.05].The new model was better than MELD score in predicting 90 d outcome [AUROC 0.84 (95%CI 76.67~91.59) vs 0.75 (95%CI 64.87~84.25), P<0.05]. Conclusion The new model including PA, Lac, PLT and INR could predict the short-term prognosis of acute liver failure successfully.
    Efficacy of ursodeoxycholic acid and S-adenosylmethionine combined with polyene phosphorylcholine in treating intrahepatic cholestasis of pregnancy and its impact on maternal and neonatal outcomes
    HAN Ya-qin, JIN Yan-qi, HUANG Li-li, CHENG Xiang-yan
    2025, 30(9):  1276-1279. 
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    Objective To observe the clinical efficacy of ursodeoxycholic acid and S-adenosylmethionine combined with polyene phosphorylcholine in the treatment of ICP patients, and to evaluate their effects on liver function, serum bile acid and maternal and infant outcomes. Methods A total of 80 ICP patients who received standardized prenatal care in the obstetrics outpatient clinics and delivered in the hospitals were selected from Nantong Sixth People's Hospital, Nantong Third People's Hospital, and Nantong Maternal and Child Health Hospital between May 2019 and May 2024. These patients were divided into a control group and a experimental group based on the administration of polyene phosphorylcholine. The differences in liver function, serum bile acids, and maternal-neonatal outcomes between the two groups were compared. Results Both groups exhibited marked reductions in pruritus severity scores, ALT levels, total bile acids (TBA), and total bilirubin (TBil) post-treatment compared to baseline values (all P<0.05), with the experimental group achieving significantly greater decreases in these parameters (P<0.05). Notably, the experimental group demonstrated a shorter duration of jaundice resolution compared to control group [(6.0±1.7) days vs. (8.1±2.3 days; P<0.05]. After treatment, compared with the control group, levels of cholic acid, glycocholic acid, and taurocholic acid in the experimental group were significantly lower (all P<0.05), while deoxycholic acid was significantly higher (P<0.05). Furthermore, the experimental group displayed significantly prolonged gestational age at delivery and higher neonatal birth weights (P<0.05), accompanied by reduced incidences of postpartum hemorrhage, cesarean section, meconium-stained amniotic fluid, and preterm birth when compared to the control group (all P<0.05). Conclusion Ursodeoxycholic acid and S-adenosylmethionine combined with polyene phosphorylcholine demonstrates significant efficacy in improving liver function, alleviating clinical symptoms, optimizing bile acid profiles, and enhancing maternal and neonatal outcomes in ICP patients, warranting further clinical promotion and application.
    Clinical and CT angiography features of hepatic portal vein gas
    CAI Lian-juan, DENG Lin, LIANG Ping
    2025, 30(9):  1280-1283. 
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    Objective To investigate the clinical and imaging features of hepatic portal vein pneumatosis (HPVG). Methods The clinical and imaging data of 23 patients with HPVG found by CT examination were retrospectively analyzed, and they were divided into mild, moderate and severe according to the distribution range of HPVG gas. Results The main causes of 23 patients with HPVG were intestinal ischemia / necrosis in 3 cases (13.0%), intestinal obstruction in 3 cases (13.0%), sepsis in 3 cases (13.0%), acute gastrointestinal bleeding in 2 cases (8.7%), acute severe pancreatitis in 2 cases (8.7%), diving decompression disease in 9 cases (39.1%), hydrogen peroxide poisoning in 1 case (4.3%). CT examination showed that the white blood cell count increased within 24 hours before / after HPVG (>10×109/L). Among the 23 patients with HPVG, there were 3 cases (13.0%) of mild pneumatosis, 3 cases (13.0%) of moderate pneumatosis and 17 cases (73.9%) of severe pneumatosis. Severe HPVG was found in 1 patient with an interval of about 4 hours before and after CT examination. Another patient with severe HPVG was reexamined by CT about 4 hours later and showed that HPVG was basically absorbed. Eighteen patients (78.3%) survived and 5 patients (21.7%) died. All the 5 dead patients had disturbance of consciousness on admission, all of which were severe HPVG. Conclusion CT examination can show the range of gas distribution in patients with HPVG and assist in the diagnosis of etiology. Severe HPVG may be a sensitive sign of fatal results, but not a specific sign. Early diagnosis and intervention can significantly improve the prognosis of patients and reduce mortality.