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    31 October 2025, Volume 30 Issue 10
    Previous Issue   
    Liver Fibrosis&Cirrhosis
    An analysis on the clinical characteristics and associated factors of decompensated cirrhosis complicated by hepatopulmonary syndrome
    GOU Guo-e, ZHANG Meng, YANG Liu, MENG Ting, LI Ya-ping, DANG Shuang-suo
    2025, 30(10):  1319-1323. 
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    Objective This study aims to investigate the general clinical characteristics and associated factors of hepatopulmonary syndrome (HPS) in patients with decompensated cirrhosis. Methods A total of 83 patients with decompensated cirrhosis who met the inclusion criteria and were admitted to the Second Affiliated Hospital of Xi′an Jiaotong University from October 2023 to August 2024 were enrolled in this study. The participants were grouped based on the presence or absence of HPS. Comprehensive clinical data and laboratory test results were collected and compared between HPS and Non-HPS groups of patients. Results Among the 83 patients, 59% were male; additionally, 61.45% (51/83) exhibited intrapulmonary vascular dilatations (IPVD), while 39.8% (33/83) had HPS. Notably, HPS was observed in 54.1% of those patients positive for IPVD. No significant differences in disease duration, age, etiology, or gender were found between the HPS group and non-HPS group (P>0.05). Symptoms such as shortness of breath, and cyanosis occurred in 51.5% and 24.2% of HPS patients, respectively, which were significantly higher than those of 26% and 6% reported in the non-HPS group (P=0.021 and 0.006, respectively). The incidence rate of prior gastrointestinal bleeding was recorded at 51.5% within the HPS cohort compared to only 26% among non-HPS individuals (P=0.018). Furthermore, median PaO2 levels in the HPS group (76 mmHg) were significantly lower than those observed in their non-HPS counterparts (87 mmHg) (P=0.022). Additionally, serum albumin levels within the HPS cohort were markedly reduced compared to those without HPS (P=0.018), with a higher proportion exhibiting albumin-bilirubin score of grade 3 in comparison to that of the non-HPS subjects (27.3% vs. 14%, respectively, P=0.013). Logistic regression analysis identified IL-8 as an independent risk factor for developing HPS (OR=1.05, 95%CI=1.017-1.087, P=0.03). Receiver operating characteristic curve (ROC) analysis indicated that IL-8 demonstrated superior diagnostic efficacy for identifying cases of HPS, with an area under curve (AUC) of 0.695 (95%CI=0.571-0.818, P=0.004) and a specificity rate reaching 0.913. Conclusion Patients diagnosed with hepatopulmonary syndrome are predisposed to hypoxic symptoms alongside increased risks for gastrointestinal bleeding as well as relatively compromised liver function. The level of IL-8 may serve as a crucial biomarker for diagnosing hepatopulmonary syndrome.
    An analysis on the effect of human serum albumin combined with diuretics for improving symptoms of ascites in elderly patients with liver cirrhosis
    DENG Long-wen, XIE Li-fang
    2025, 30(10):  1324-1325. 
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    Objective To study and analyze the treatment effect of using human serum albumin combined with furosemide and spironolactone on ascites of elderly patients with liver cirrhosis. Methods Fifty elderly patients with liver cirrhosis related ascites admitted from January 2022 to June 2024 were randomly divided into an experimental group (n=25, treated with human serum albumin combined with furosemide and spironolactone) and a control group (n=25, treated with furosemide and spironolactone). The clinical efficacies of the two groups of treatments were compared. Results The relief time of abdominal distension (16.21±3.40 days) and the reduction time of ascites (46.80±10.27 days) in the experimental group were shorter than those of (35.24 ±4.15 days) and (95.61±13.25 days) in the control group, respectively. After treatment, the albumin (Alb) level in the experimental group was significantly higher than that in the control group (40.71±2.64 g/L vs. 33.24±3.48 g/L). In contrast, the levels of alanine aminotransferase (ALT), creatinine (Cr), and 24 hour urinary protein quantitative (NDBDL) were all significantly lower in the experimental group compared to the control group: (61.20±3.15 U/L vs. 67.91±4.25 U/L)、(73.00±10.42 mmol/L vs. 78.00±10.16 mmol/L), and (1.03±0.15 g/24 h vs. 1.58±0.14 g/24 h), respctively (P<0.05 for all comparisons). Conclusion The combination of human serum albumin, furosemide, and spironolactone has a definite effect on the treatment of ascites in elderly patients with cirrhosis.
    Liver Cancer
    The treatment effect of cold cycle radiofrequency ablation combined with 125Ⅰ particle implantation and TACE on intermediate massive liver cancer
    DU Ting-wei, YUAN Gao-ming, LIU He-yang
    2025, 30(10):  1326-1329. 
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    Objective To analyze the effect of cold cycle radiofrequency ablation combined with 125I particle implantation and transcatheter arterial chemoembolization (TACE) on the treatment of intermediate massive liver cancer. Methods In this retrospective study, the clinical data of 79 patients with mid-stage massive liver cancer were collected from the First Affiliated Hospital of Henan University of Science and Technology from June 2020 to May 2022. Based on different treatment approaches, the participants were divided into a control group (n=40, treated with TACE in combination with 125I particle implantation) and an observation group (n=39, treated with TACE in combination with 125I particle implantation and cold circulation radiofrequency ablation). The clinical efficacy, adverse reactions, and serum indexes were compared between the two groups before and after treatment. Both groups of patients were followed-up until April 2024, and their survival rate and status were compared. Results The Objective response rate (ORR) and disease control tate (DCR) of observation group were 74.36% and 92.31%, respectively, which were significantly higher than 52.50% and 75.00% of control group (P<0.05). After treatment, the levels of CD3+ and CD4+/CD8+ in the observation group were (64.38±5.73) % and (1.76±0.35), respectively, which were significantly higher than those of (57.46±5.12) % and (1.17±0.25) in the control group. The alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alpha fetoprotein (AFP) levels in the observation group were (56.38±15.85) U/L, (65.48±21.53) U/L, and (325.28±26.35) μg/L, respectively, which were significantly lower than those of (73.28±18.54) U/L, (84.72±23.57) U/L, and (438.49±34.29) μg/L in the control group (all P<0.05). In terms of prognosis, the 12-month and 24-month survival rates in the observation group were 97.30% and 80.60%, respectively, which were significantly higher than those of 87.20% and 60.00% in the control group. The median progression-free-survival (PFS) and overal survival (OS) in the observation group were 32 months and 33 months, respectively, which were significantly longer than 26 months and 27 months in the control group (P<0.05). The incidences of adverse reactions were 20.00% and 33.33% in control group and observation group, respectively, and there was no statistical significance between groups (P>0.05). Conclusion Cold circulation radiofrequency ablation combined with 125I particle implantation and TACE is effective in the treatment of middle stage massive liver cancer, which can improve liver function and immune function, reduce AFP level, prolong survival time, and do not increase the occurrence of adverse reactions.
    The predictive value of microvascular invasion in primary liver cancer using neutrophil gelatinase associated lipocalin expression in combination with microflow imaging before TACE treatment
    FENG Yan-mei, WU Juan, LUO Yu-jiao
    2025, 30(10):  1330-1334. 
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    Objective To evaluate the predictive value of neutrophil gelatinase associated lipocalin (NGAL) expression combined with multimodal ultrasound of microflow imaging (MFI) for microvascular invasion (MVI) in primary liver cancer (PLC)before hepatic arterial chemoembolization (TACE) therapy. Methods A total of 86 PLC patients treated with TACE from October 2019 to August 2023 werecollected from the Second People's Hospital of Shaanxi Province. NGAL levels were detected by enzyme-linked immunosorbent assay and MFI multimodal ultrasonographys were performed before treatment. Patients were divided into an occurrence group (n=22) and a non-occurrence group (n=64) according to whether they had MVI or not, and the influencing factors and predictive value of multi-modal ultrasound technique combined with NGAL and MFI for MVI in PLC patients were analyzed. Results 22 of the 86 PLC patients (25.58%) had MVI and grouped as the occurrence group. 54.55% of them was Child-Pugh grade C, 50.00% of them was blood flow grade Ⅲ, 59.09% had unsmooth tumor edge, 72.73% had portal phase hyper-enhancement, and their average NGAL level was (129.63±15.62) kU/L, which were higher than those of 21.88%, 14.06%, 29 69%, 43.75%, and (120.14±6.47) kU/L, respectively, in patients of the non-occurrence group (P<0.05). Logistic regression equation analysis showed that NGAL level [OR=1.108 (95%CI: 1.040~1.179)], Child-Pugh grade C [OR=4.286 (95%CI: 1.534~11.973)], blood flow grade Ⅲ [OR=6.111 (95% CI: 2.048~18.285)], highly enhanced portal phase [OR=3.429 (95% CI: 1.187~9.899)], unsmooth tumor margin [OR=3.421 (95% CI: 1.252~9.345)] were influencing factors for predicting MVI in PLC patients (all P<0.05). Through ROC curve analysis, the sensitivities of NGAL level, blood flow grade Ⅲ, highly enhanced portal phase, unsmooth tumor edge, Child-Pugh grade C and their combination for predicting MVI in PLC patients were 72.70%, 50.00%, 72.70%, 59.10%, 54.50%, and 90.90%, respectively. The specificities were 79.70%, 85.90%, 56.20%, 70.30%, 78.10% and 89.10%, respectively. In addition, the combination of the aboval five items to predict MVI in PLC patients had a higher value (AUC 0.911). Conclusion The expression level of NGAL in combination with multimodal ultrasound technique of MFI has a higher value in predicting MVI in PLC patients before TACE treatment.
    The efficacy of drug eluting bead transarterial chemoembolization combined with lenvastinib and PD-1 monoclonal antibody in the treatment of large liver cancer
    LIU Yong, LI Zhuang, ZHU Feng
    2025, 30(10):  1335-1339. 
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    Objective To observe the efficacy of drug eluting bead transarterial chemoembolization (DEB-TACE) combined with lenvastinib and programmed death factor-1 (PD-1) monoclonal antibody in the treatment of large liver cancer. Methods The medical records of 85 patients with large liver cancer treated in Sir Run Run Hospital, Nanjing Medical University Hospital from July 2021 to January 2023 were retrospectively analyzed. According to the treatment methods, they were divided into a control group (n=42) and an observation group (n=43). The control group received lenvatinib combined with DCB-TACE treatment. On this basis, the observation group was also given PD-1 monoclonal antibody treatment. The serological indicators, therapeutic effects, liver functions, tumor markers, prognosis and adverse reactions in these two groups of patients were compared. Results Compared with the control group, the objective response rate and disease control rate of the observation group were both higher (P<0.05). In the observation group after treatment, the levels of alanine aminotransferase (ALT) (38.10±3.12) U/L, alpha-fetoprotein (AFP) (97.25±11.08) ng/mL, aspartate aminotransferase (AST) (39.02±3.18) U/L, carbohydrate protein 199 (CA199) (172.03±18.29) U/mL, total bilirubin (TBil) (20.13±1.78) μmol/L, and α-L-fucoidase (AFU) (34.27±4.26) U/L were lower than those of (149.20±18.31) ng/mL, (43.19±3.76) U/L, (217.14±22.68) U/mL, (23.07±2.43) μmol/L, (50.06±6.18) U/L in the control group, respectively (P<0.05). Compared with the control group after treatment, the matrix metalloproteinase-9 (MMP-9) and vascular endothelial growth factor (VEGF) in the observation group were lower (P<0.05). There was no significant difference in the total incidence of adverse reactions between the two groups (P>0.05). The 2-year survival rate of the observation group was higher when compared with the control group (P<0.05). Conclusion The combination therapies of DEB-TACE with lenvastinib and PD-1 monoclonal antibody has demonstrated definite efficacy in the treatment of advanced hepatocellular carcinoma. It can reduce the levels of serum tumor markers, down-regulate VEGF and MMP-9 expression, improve liver function, and has shown a good safety profile.
    A clinical investigation of sintilimab in combination with transarterial microsphere chemoembolization for the treatment of advanced primary liver cancer
    WANG Shu-shan, LIU Chao, YE Jing, CHEN Fen, LI Hong-teng
    2025, 30(10):  1340-1343. 
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    Objective To assess the effectiveness of sintilimab in combination with drug-loaded microspheres transarterial chemoembolization (DEB-TACE) for the treatment of advanced primary liver cancer (PLC). Methods A total of 97 patients with advanced PLC treated at Tai′an Tumor Hospital in Shandong Province from March 2021 to April 2024 were included in the study. They were divided into two groups based on their treatment methods. The control group consisted of 47 patients who underwent DEB-TACE treatment, the observation group had fifty patients and they were treated with sintilimab. The treatment effects, alterations in liver function index, levels of tumor markers and immune function,as well as the incidence of adverse reactions were compared between the two groups. Results The treatment effects of the observation group were better than those of the control group [objective response rate: 58.00% (29/50) vs. 36.17% (17/47);disease control rate:66.00% (33/50) vs. 44.68% (21/47)], with improved liver function index [total bilirubin(TBil): (12.30±1.24) μmol/L vs. (14.02±1.29) μmol/L;aspartate aminotransferase (AST): (31.02±2.45) U/L vs. (37.18±2.69) U/L; alanine aminotransferase (ALT):(24.63±3.52) U/L vs. (29.85±3.74) U/L], immue indexes of tumor markers [carcinoembryonic antigen (CEA): (65.63±3.41)% vs. (61.63±3.02)%; alpha-fetoproteinvariant-L3 (AFP-L3): (43.36±4.43)% vs. (40.39±4.87)%; alpha-fetoprotein (AFP): (25.63±2.74)% vs. (27.63±2.98)%] and indexes of immune function [CD3+: (65.63±3.41)% vs. (61.63±3.02)%;CD4+: (43.36±4.43)% vs. (40.39±4.87)%; CD8+: (25.63±2.74)% vs.(27.63±2.98)%] (All P<0.05). The incidence of adverse reactions of the observation group was lower than that of the control group [6.38% (6/47) vs. 6.00% (6/50)] (P>0.05). After a 6-month follow-up, the mortality rates between the two groups were compared (Log-rank χ2=0.353, P=0.553). Conclusion The combination of sintilimab and DEB-TACE demonstrates significant therapeutic effects in improving the levels of tumor markers, indexes of liver function and immune function, without increasing adverse reactions, and is associated with a lower mortality rate.
    An analysis on the clinical efficacy and prognosis of sintilimab combined with TACE in the treatment of postoperative unresectable intrahepatic metastases of hepatocellular carcinoma
    HU Jin-ting, SUN Xin-xin, ZUO Chuan-wei
    2025, 30(10):  1344-1348. 
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    Objective This study aimed to evaluate the clinical efficacy and prognosis of sintilimab combined with transarterial chemoembolization (TACE) treatments on patients with unresectable intrahepatic metastases of hepatocellular carcinoma (HCC) after surgery. Methods A prospective study was conducted on 80 patients collected from January 2017 to December 2022 with unresectable intrahepatic metastatic HCC following surgical resection. All patients were randomly assigned to either the combination group (sintilimab plus TACE, n=40) or the monotherapy group (TACE alone, n=40). The clinical efficacy, serum tumor markers, immune indices, and adverse event incidence were compared between the two groups. A survival analysis was also performed. Results After treatment, the objective response rate (ORR) (52.50% vs. 25.00%) and disease control rate (DCR) (92.50% vs. 72.50%) were significantly higher in the combination group than those in the monotherapy group (P<0.05). The combination group exhibited significantly lower levels of cancer antigen 125 (CA125) [(28.47±3.23) U/mL vs. (39.16±4.79) U/mL] and alpha-fetoprotein (AFP) [(403.85±32.79) ng/mL vs. (513.85±47.93) ng/mL], as well as higher levels of CD3+ [(70.14±7.03)% vs. (64.85±5.14)%] and CD4+/CD8+ ratio [(1.78±0.51) vs. (1.47±0.54)] compared to the monotherapy group (P<0.05). The incidence rates of adverse events, including liver dysfunction (22.5% vs. 25.00%), fatigue (50.00% vs. 52.50%), fever (7.50% vs. 8.00%), and leukopenia (32.50% vs. 35.00%), showed no significant differences between the two groups (P>0.05). Kaplan-Meier survival analysis revealed that the combination group had a longer median overall survival (OS) (21.6 months vs. 19.1 months) and median progression-free survival (PFS) (17.4 months vs. 11.8 months) compared to the monotherapy group (P<0.05). Conclusion The combination of sintilimab and TACE significantly improves therapeutic efficacy, enhances immune function, and prolongs OS and PFS in patients with HCC without increasing severe adverse events, demonstrating favorable clinical application potential.
    Characteristics of gut microbiota in patients with primary liver cancer and predictive efficacy of serum TBA, GRP78, and MPO for gut microbiota dysbiosis
    PANG Wu, LIU Yuan-jun, GE Ming-gang, ZHU Yu, GONG Cheng
    2025, 30(10):  1349-1353. 
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    Objective To investigate the characteristics of gut microbiota in patients with primary liver cancer (PLC) and the predictive efficacy of serum total bile acid (TBA), glucose regulatory protein 78 (GRP78), and myeloperoxidase (MPO) on their gut microbiota dysbiosis. Methods Ninety PLC patients who received treatment in our hospital from January 2020 to February 2023 were selected as the PLC group, and were separated into dysbiosis group (n=38) and non-dysbiosis group (n=52) based on whether the patient had gut microbiota dysbiosis. Additionally, 90 healthy individuals who underwent physical examination during the same period were included as the control group. The quantity and characteristics of gut microbiota in the PLC group and control group were measured and analyzed. Enzyme colorimetric method was applied to detect serum TBA level. Enzyme linked immunosorbent assay (ELISA) was applied to detect serum levels of GRP78 and MPO. Multivariate logistic analysis was applied to analyze the factors affecting gut microbiota imbalance in PLC patients. Receiver operating characteristic (ROC) curve was applied to analyze the predictive efficacy of serum TBA, GRP78, and MPO for gut microbiota dysbiosis in PLC patients. Results The numbers of bifidobacteria and lactobacilli in the PLC group were lower than those in the control group [(8.12±2.23) vs (12.59±2.71) 1gCFU/g, (6.53±1.47) vs (17.04±4.02) 1gCFU/g, all P<0.001], while the numbers of Enterococcus and Enterobacterium were higher than those in the control group [(12.32±2.43) vs (6.75±0.79) 1gCFU/g, (16.56±3.49) vs (7.02±1.68) 1gCFU/g, all P<0.001]. Compared with the control group, the expression levels of serum TBA, GRP78, and MPO in the PLC group showed an upward trend [(42.57±9.32) vs (3.12±1.05) μmol/L, (154.33±21.54) vs (60.13±14.42) ng/mL, (24.79±2.59) vs (9.12±1.67) mg/L, all P<0.001]. The expression levels of serum TBA, GRP78, and MPO in the dysbiosis group were obviously higher than those in the non dysbiosis group [(50.14±9.53) vs (37.03±8.86) μmol/L, (174.64±23.64) vs (139.48±17.35) ng/mL, (26.98±2.85) vs (23.19±2.46) mg/L, all P<0.001]. Serum TBA, GRP78, and MPO were all factors that affected the occurrence of intestinal microbiota imbalance in PLC patients (P<0.05). The area under the curve (AUC) of serum TBA, GRP78, MPO, and their combined prediction for gut microbiota dysbiosis in PLC patients was 0.893, 0.933, 0.859, and 0.984, respectively. The combined predictive efficacy of the three indicators was higher than that of the three indicators alone (Ztriple combination-TBA=3.133, Ztriple combination-GRP78=2.147, Ztriple combination-MPO=3.266, all P<0.05). Conclusion The numbers of Bifidobacterium and Lactobacillus in PLC patients decrease, while the numbers of Enterococcus and Enterobacterium increase. The serum levels of TBA, GRP78, and MPO also increase, and these three factors are closely related to intestinal dysbiosis and may serve as biological indicators for predicting the occurrence of intestinal dysbiosis in PLC patients.
    Relationship between DCE-MRI quantitative perfusion parameters and MRI image texture parameters and TACE efficacy in primary liver cancer
    ZHANG Hai-jun, LUO Ke-chun, BAO Jun-jun
    2025, 30(10):  1354-1359. 
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    Objective To analyze the relationship between dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) quantitative perfusion parameters and MRI image texture parameters and the therapeutic effect of transcatheter arterial chemoembolization (TACE) for primary liver cancer. Methods The medical records of 101 patients with primary liver cancer treated with TACE from March 2022 to May 2023 were retrospectively analyzed. All patients received TACE treatment and were divided into ineffective group [disease progression (PD) + stable disease (SD)] and effective group [partial response (PR) + total response (CR)] according to the treatment effect. The DCE-MRI quantitative perfusion parameters, MRI image texture parameters and clinical data of the two groups were compared to analyze the influencing factors of the ineffective TACE treatment for primary liver cancer, and analyze the predictive value of DCE-MRI quantitative perfusion parameters combined with MRI image texture parameters for the ineffective TACE treatment for primary liver cancer. Results After a three-month treatment, among 101 patients with primary liver cancer, there were 2 cases of CRs, 54 cases of PRs, 32 cases of SDs, 13 cases of PDs, 56 cases of effective group, and 45 cases of ineffective group. The interstitial plasma rate constant (Kep) and volume transfer constant (Ktrans) of the ineffective group were lower than those of the effective group (P<0.05), and there was no difference in extracellular space volume fraction (Ve) and plasma volume fraction (Vp) between the two groups (P>0.05). The standard deviation of invalid value was higher than that of effective group (P<0.05), and the inertness of invalid group was lower than that of effective group (P<0.05). There were no significant differences in entropy, skewness, evenness and mean value in 2 groups (P>0.05). The carbohydrate antigen 199 and tumor diameterin the ineffective group were higher than effective group (P<0.05). Ktrans, Kep, inertia, standard deviation and tumor diameter were the influential factors of TACE treatment for primary liver cancer (P<0.05). The area under the curve (AUC) values of Ktrans, Kep, standard deviation, inertia and the four combined predicted the failure of TACE treatment for primary liver cancer were 0.803, 0.795, 0.824, 0.816, 0.903 (P<0.05), respectively. The combined AUC value of the four indexes was higher than predicted by the single index (P<0.05). Conclusion Ktrans, Kep, inertia and standard deviation have important value in predicting TACE efficacy of primary liver cancer, and the joint model of the four indicators has higher predictive value.
    Diagnostic value of combined MRI multimodal parameters and contrast-enhanced ultrasound for differentiating hepatocellular carcinoma and focal nodular hyperplasia
    LI Rong-jiang, ZHANG Hai-rong, WEI Ya-juan, HE Xin, LI Jin-song
    2025, 30(10):  1360-1364. 
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    Objective To investigate the diagnostic value of combined MRI multimodal parameters and contrast-enhanced ultrasound (CEUS) in differentiating hepatocellular carcinoma (HCC) from focal nodular hyperplasia (FNH). Methods Clinical data of 33 HCC patients and 30 FNH patients treated in our hospital from January 2019 to March 2024 was collected. All patients underwent enhanced MRI and CEUS, with postoperative pathological and immunohistochemical examinations. Two radiologists analyzed the imaging features and CEUS parameters of HCC and FNH. Quantitative data was compared using t-tests, and categorical data was compared using χ2 tests. Results In multimodal MRI, 30 cases (90.91%) of the HCC group showed persistent enhancement, while 3 cases (9.09%) exhibited rapid wash-in and wash-out; all 30 cases (100.00%) in the FNH group showed persistent enhancement, with no rapid wash-in and wash-out (0.00%), and the difference was not statistically significant (P>0.05). The enhancement rate of signal intensity was (1.37±0.58) in the HCC group and (1.31±0.51) in the FNH group, with no statistically significant difference (P>0.05). The apparent diffusion coefficient of SI (SIADC) was (0.91±0.17) in the HCC group, significantly lower than (1.19±0.18) in the FNH group (P<0.05). In the hepatobiliary phase characteristics, 17 cases (51.52%) in the HCC group showed a peritumoral low-signal ring, while none (0.00%) was observed in the FNH group, with a significant difference (P<0.001); 17 cases (51.52%) in the HCC group showed contrast filling defects, while none (0.00%) was observed in the FNH group, with a significant difference (P<0.001). There were 22 cases (66.67%) in the HCC group with linear low-signal septa, compared to 1 case (3.33%) in the FNH group, showing a significant difference (P<0.001); no central stellate scar (0.00%) was observed in the HCC group, while it was present in 9 cases (30.00%) in the FNH group, with a significant difference (P<0.001). The ADC value in the HCC group was (1233.21±249.27)×10-3 mm2/s, significantly lower than (1451.49±231.50)×10-3 mm2/s in the FNH group (P<0.001). In ultrasound examinations, the rise time (RT) in the HCC group was (2.49±1.22) s, significantly lower than (3.58±1.71) s in the FNH group (P=0.005); the time to peak (TTP) in the HCC group was (33.59±9.45) s, significantly higher than (25.39±8.10) s in the FNH group (P<0.001); the mean transit time (MTT) in the HCC group was (35.20±5.07) s, significantly higher than (32.05±5.45) s in the FNH group (P=0.021); and the perfusion intensity (PI) in the HCC group was (28.58±6.70) dB, significantly higher than (22.82±5.98) dB in the FNH group (P<0.001). Comparison of diagnostic performance showed that the sensitivity, specificity, Youden index, and AUC for MRI multimodal parameters were 87.9%, 93.3%, 0.812, and 0.917, respectively, for CEUS, these values were 69.7%, 93.3%, 0.630, and 0.843, respectively. Combined application improved sensitivity to 90.9%, specificity to 96.7%, Youden index to 0.876, and AUC to 0.961, indicating a higher diagnostic efficiency. Conclusion The combined application of MRI multimodal parameters and CEUS has significant clinical value in differentiating HCC from FNH, with high sensitivity and specificity, and is worthy of clinical promotion.
    Enhanced perfusion scanning parameters combined with serum HMGA2 and PIVKA-Ⅱ for the differential diagnosis of cirrhotic nodules and primary small hepatocellular carcinoma
    LI Zheng, KANG Xin-wei
    2025, 30(10):  1365-1369. 
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    Objective This study aimed to evaluate the application value of enhanced perfusion scanning parameters and serum levels of High Mobility Group A2 (HMGA2) and Protein Induced by Vitamin K Absence or Antagonist-Ⅱ (PIVKA-Ⅱ) in the differential diagnosis between cirrhotic nodules and primary small hepatocellular carcinoma (HCC). Methods A total of 103 patients with liver cirrhosis treated at Zhoukou Central Hospital from March 2021 to March 2024 were selected for this study. Based on histopathological examination, patients were divided into a cirrhotic nodule group (n=75) and a primary small HCC group (n=28). Enhanced perfusion scanning was used to assess the hemodynamic characteristics of hepatic lesions. Serum levels of HMGA2 and PIVKA-Ⅱ were measured, and their correlation was analyzed. The efficacy of HMGA2 and PIVKA-Ⅱ in differential diagnosis was assessed using receiver operating characteristic (ROC) curve analysis. Results The age of patients in the nodule group was significantly lower than that in the HCC group (35.7±10.4 years vs. 62.5±12.7 years; P<0.05). Serum levels of HMGA2 and PIVKA-Ⅱ were significantly higher in the HCC group than those in the nodules group (HMGA2: 57.53±11.50 mg/L vs. 37.74±8.24 mg/L; PIVKA-Ⅱ: 86.03±21.82 mAU/mL vs. 25.27±10.64 mAU/mL; P<0.05). Blood flow, hepatic arterial perfusion, hepatic arterial fraction, and blood volume were significantly lower in the HCC group compared to the nodule group (blood flow: 186.85±14.27 mL/min·100 g vs. 202.17±15.42 mL/min·100 g; hepatic arterial perfusion: 37.92±4.87 mL/min·100 g vs. 52.58±5.61 mL/min·100 g; hepatic arterial fraction: 0.20±0.03 vs. 0.28±0.04; blood volume: 165.27±18.53 mL/100 g vs. 175.63±20.47 mL/100 g; P<0.05). Pearson correlation analysis showed a negative correlation between HMGA2 and blood flow, hepatic arterial perfusion, hepatic arterial fraction, blood volume (r=-0.439, -0.624, -0.532, -0.220; P<0.05 respectively), and similar negative correlation was found for PIVKA-Ⅱ (r=-0.378, -0.704, -0.665, -0.307; P<0.05 respectively). ROC curve analysis indicated that the combined use of HMGA2 and PIVKA-Ⅱ had high diagnostic value, with an AUC of 0.969, sensitivity of 96.4%, and specificity of 96.0%. Conclusion Enhanced perfusion scanning parameters combined with serum HMGA2 and PIVKA-Ⅱ effectively differentiate between cirrhotic nodules and HCC, providing important information for early diagnosis and treatment selection.
    The relationship between LI-RADS categories of contrast-enhanced ultrasound and the degree of differentiation and GPC3 index of hepatocellular carcinoma
    DU Jing-ni, LIU Ting-ting
    2025, 30(10):  1370-1374. 
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    Objective To analyze the relationship between liver imaging reporting and data system (LI-RADS) categories on contrast-enhanced ultrasound (CEUS) and the differentiation degree and glypican-3 (GPC3) index of hepatocellular carcinoma (HCC). Methods Retrospective selection of 132 patients with surgical treatment of HCC in shenmu city hospital from January 2020 to December 2024 was involved. The clinical data of the patients were recorded, including LI-RADS category, differentiation degree, GPC3 index, etc. The clinical data of patients with different LI-RADS categories were analyzed. Kendall's tau-b correlation analysis was used to analyze the relationship between the LI-RADS categories and the degree of differentiation and the expression of GPC3 index. Results There was no significant difference in gender, age, body mass indecx (BMI), lesion location, tumor diameter, lesion number, microvascular invasion, and the Child-Pugh grade among patients with different LI-RADS differentiation on CEUS (P>0.05). The proportions of low, moderate and high differentiation in class M patients were 28.57% (6/21), 42.86% (9/21) and 28.57% (6/21), respectively. The proportions of low, moderate and high differentiation of the three types of patients were 0.00% (0/7), 28.57% (2/7) and 71.43% (5/7), respectively. The proportions of patients with low, moderate and high differentiation were 22.73% (5/22), 31.82% (7/22) and 45.45% (10/22), respectively. The proportions of low, moderate and high differentiation of the five types of patients were 42.68% (35/82), 37.80% (31/82) and 19.51% (16/82), respectively. There were statistically significant differences in LI-RADS classification and differentiation degree of contrast-enhanced ultrasound (P<0.05). The Kendall tau's - b correlation analysis revealed a negative correlation between LI-RADS classification on CEUS, (tau-b=-0.174, P=0.002). The positive and negative proportions of GPC3 index in patients with type M were 57.14% (12/21) and 42.86% (9/21), respectively. The proportions of GPC3 positive and negative in the three groups were 28.57% (2/7) and 71.43% (5/7), respectively. The positive and negative proportions of GPC3 index in the four groups were 72.73% (16/22) and 27.27% (6/22), respectively. The positive and negative proportions of GPC3 index in the 5 groups were 84.31% (66/82) and 15.69% (16/82), respectively. There were significant differences in the expression of GPC3 index and LI-RADS classification of CEUS (P<0.05). Kendall's tau-b correlation analysis showed that LI-RADS classification was positively correlated with GPC3 index (tau-b=0.227, P<0.001). Conclusion Different LI-RADS classification of CEUS was negatively correlated with the differentiation of HCC patients, and positively correlated with GPC3 index. The higher the LI-RADS category of CEUS, the lower the degree of differentiation and the stronger the expression of GPC3 index.
    Analysis of the diagnostic value of enhanced MRI scanning combined with serum alpha-fetoprotein levels in patients with hepatocellular carcinoma
    REN Jie, XUE Ying, ZHOU Heng-chen
    2025, 30(10):  1375-1378. 
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    Objective To explore the effectiveness of enhanced magnetic resonance imaging (MRI) combined with serum alpha-fetoprotein (AFP) level in diagnosing hepatocellular carcinoma (HCC). Methods The study included 82 HCC patients (observation group) and 80 patients with benign liver diseases (control group) treated at the People's Hospital of Hai′an City in Jiangsu Province from October 2020 to October 2023. Both groups underwent enhanced MRI and had their serum levels of AFP, apolipoprotein B (ApoB), gamma-glutamyl transferase (GGT), tumor supplied group of factor (TSGF), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) measured. Pearson's analysis was used to evaluate the relationship between MRI parameters and serum markers, and the diagnostic value of combining MRI parameters with serum AFP level was assessed using receiver operating characteristic (ROC) curves. Results In the observation group, the values of Ktrans, Kep, and Ve were higher than those in the control group [(0.56±0.21) vs. (0.31±0.17), (1.53±0.41) vs. (1.06±0.32), (0.44±0.15) vs. (0.22±0.08)]; serum levels of AFP, GGT, TSGF, CA19-9, and CEA were also higher [(351.24±82.67) vs. (88.79±11.37), (51.19±6.21) vs. (29.64±3.42), (80.33±9.76) vs. (19.54±2.86), (56.97±6.58) vs. (23.85±3.04), (18.23±2.62) vs. (0.89±0.24)], while ApoB levels were lower [(0.87±0.26) vs. (1.14±0.30)]. Correlation analysis indicated the positive relationships between Ktrans, Kep, Ve and serum AFP, GGT, TSGF, CA19-9, CEA levels, and a negative correlation with ApoB levels. ROC analysis demonstrated that the sensitivity and specificity of the combined MRI parameters and serum AFP levels in diagnosing hepatocellular carcinoma were 95.1% and 95.0% respectively, with an AUC of 0.973, which was superior to individual testing. Conclusion The combination of enhanced MRI parameters and serum AFP levels exhibits high sensitivity and specificity in diagnosing HCC. This combination method is more effective than single testing method, which can significantly improve the diagnostic accuracy of HCC.
    Viral Hepatitis
    Predictive value of interferon γ inducible protein 10 combined with HBV pgRNA for pregnancy outcomes in pregnant women with HBV infection
    YU Hong-yun, HUANG Yan, DING Jian-fen, CAI Liang-liang, SHU Chang-zhen
    2025, 30(10):  1379-1383. 
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    Objective To investigate the predictive value of interferon Y-inducible protein 10 (IP-10) combined with hepatitis B virus (HBV) genomic RNA (pgRNA) in pregnancy outcomes. Methods A total of 102 pregnant women with HBV infection admitted to Suzhou Hospital of Integrated Traditional Chinese and Western Medicine from March 2020 to December 2023 were selected. IP-10 levels and HBV pgRNA were detected after admission. All pregnant women were followed up from after discharge until all of them gave birth, and they were divided into poor pregnancy outcome group and good pregnancy outcome group according to pregnancy outcomes. The basic data of patients were compared, and the factors affecting the adverse pregnancy outcome were analyzed. Results Among the 102 pregnant women, 23 had adverse pregnancy outcomes (22.55%), including 6 premature births, 5 cases of abnormal amniotic fluid volume, 5 cases of postpartum hemorrhage ≥500 mL, 2 cases of placental abruption, 2 cases of low body weight infant, 2 cases of macrosomia, and 1 case of growth restriction. In the adverse pregnancy outcome group, aspartate aminotransferase (AST) (22.83±3.86) U/L, alanine aminotransferase (ALT) (17.23±2.54) U/L, HBV pgRNA (5.26±1.14) log 10 copies/mL and IP-10 (68.26±6.85) pg/mL were higher than those in the good pregnancy outcome group (19.74±3.18) U/L, (14.93±2.21) U/L and (4.31±1.04) log 10 copies/mL, (62.14±5.74) pg/mL (all P<0.05). Logistic analysis showed that the levels of AST [OR=1.349 (95%CI: 1.132~1.606)], ALT [OR=1.583 (95%CI: 1.232~2.035)], HBV pgRNA [OR=2.518 (95%CI: 1.449~4.375)] and IP-10 [OR=1.185 (95%CI: 1.078~1.304)] were the main factors affecting adverse pregnancy outcomes in pregnant women with HBV infection (P<0.05). The sensitivity and specificity of HBV pgRNA and IP-10 in predicting adverse pregnancy outcomes were 78.30%, 65.20% and 91.30%, respectively, and 63.30%, 73.40% and 86.10%, respectively. Moreover, the combinatiob of HBV pgRNA and IP-10 had a high value in predicting adverse pregnancy outcomes in pregnant women with HBV infection (AUC of 0.895). Conclusion HBV pgRNA and IP-10 are associated with adverse pregnancy outcomes in pregnant women with HBV infection, and the combined prediction of adverse pregnancy outcomes has the high value.
    Metabolic Associated Fatty Liver Disease
    Application of ultrasound TE, SWE, and RTE technologies in evaluating liver stiffness in metabolic associated fatty liver disease
    QU Zhen, ZHOU Ya-ning, XIAO Sa
    2025, 30(10):  1384-1388. 
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    Objective This study explores the effectiveness of Transient Elastography (TE), Shear Wave Elastography (SWE), and Real-Time Elastography (RTE) in assessing liver stiffness values in patients with metabolic associated fatty liver disease(MAFLD). Methods A retrospective analysis was conducted on the clinical data of 104 MAFLD patients who visited our hospital from February 2021 to February 2024. According to the Metavir scoring system, patients were divided into three groups: 41 in the F0~1 steatosis group, 35 in the F2~3 fibrosis group, and 28 in the F4 cirrhosis group. All patients underwent RTE, TE, and SWE ultrasound elastography examinations to measure liver stiffness, with the diagnostic value for MAFLD fibrosis assessed using receiver operating characteristic (ROC) curves. Results Significant differences were observed in liver stiffness measurements between the groups for all three techniques (P<0.05). As the degree of fibrosis increased, the liver stiffness values measured by RTE, TE, and SWE also increased, correlating positively with the degree of fibrosis (TE: r=0.706, SWE: r=0.742, RTE: r=0.739, all P<0.05). The area under the curve (AUC) for RTE, TE, and SWE in diagnosing significant fibrosis (F≥2) and cirrhosis (F4) were 0.912/0.824, 0.924/0.853, and 0.955/0.804, respectively, with sensitivities of 88.9%/96.4%, 81.0%/78.6%, and 88.9%/96.4%, and specificities of 95.1%/61.8%, 97.6%/81.6%, and 90.2%/53.9%, respectively. Among these, TE and SWE showed superior diagnostic values over RTE. Conclusion In the diagnosis of MAFLD, ultrasound elastography techniques (TE, SWE, and RTE) effectively assess liver stiffness. All three techniques accurately reflect the extent of liver fibrosis, with TE and SWE performing better in diagnosing fibrosis and cirrhosis. Clinically, the appropriate technology can be selected based on specific circumstances to improve diagnostic accuracy.
    Clinical efficacy of Ganzhi Formula in treating patients with chronic hepatitis B and metabolic-associated fatty liver disease
    YU Xiao-xiao, ZHOU Long, SHEN Ying-qiu, WANG Kai-xia, WANG Tao, LIU Cheng-hai, QU Li-hong, ZHANG Feng-di
    2025, 30(10):  1389-1392. 
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    Objective To explore the efficacy of Ganzhi Formula in treatment of patients with CHB and MAFLD. Methods A total of 84 patients from the department of Liver Disease of Dongfang Hospital, Tongji University, who met the inclusion criteria CHB combined with MAFLD, were divided into the observation group and the control group with 42 cases in each group. The control group received NAs and polyene phosphatidyl choline, while the observation group received Ganzhi Formula based on the control group. Both groups received treatment for a total of 12 weeks. Liver imaging (FibroTouch liver stiffness LSM value, CAP value), liver serum enzymes, cholesterol levels, APRI, FIB-4, FAST, Agile, Chinese medicine syndrome, and other changes were collected. Results Following 12 weeks of treatment, the observation group's CAP efficiency was 52.4% (22/42) while the control group's was 31.0% (13/42). This difference was statistically significant (P=0.046). Compared to the control group, the observation group's effective rates of TCM evidence score and quality of life score were considerably higher at 83.3% (35/42) and 54.8% (23/42) compared to 40.4% (17/42) and 9.5% (4/42) in the control group (P<0.001). The FIB-4 score was improved in the observation group (1.23±0.49 vs 0.93±0.44,P=0.004). The levels of LDL in observation group was significantly lower than that of the control group [2.95(2.54, 3.17) vs 3.15 (2.67, 3.73), P=0.046]. There was no significant difference in liver function transaminases between the two groups before and after treatment (P>0.05). Conclusion Ganzhi Formula combined with NAs could significantly improve the CAP value, TCM evidence score, and blood lipid level of patients with CHB and MAFLD, suggesting its clinical application value.
    Deep learning-based ultrasound models in the evaluation of magnetic resonance imaging-proton density fat fraction
    GE Hai-long, CHAO Chen, SHI Xing-song, BAI Cui-wei, WANG Yu, YIN Qi
    2025, 30(10):  1393-1397. 
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    Objective The use of Proton Density Fat Fraction (PDFF) in the diagnosis of fatty liver has been limited by its high cost and limited availability. This study aimed to develop a liver ultrasound model using deep learning for the evaluation of fatty liver severity and steatosis assessment based on PDFF. Methods Patients whose liver ultrasound and MRI-PDFF examinations were completed within one week in our hospital were included in the study. Two models were developed: 1) a regression model: quantifying the degree of liver steatosis, with continuous variable PDFF values as predictive data labels; 2) a classification model: classifiers were developed based on three threshold values of PDFF (5%, 10%, and 25%) to qualitatively diagnose and assess the severity of fatty liver. Results Predictions from the regression model based on three views (subcostal longitudinal, second liver portal, and hepatorenal interface) were correlated with actual PDFF values using Spearman correlation analysis. The results showed a close correlation between the predicted values and actual values (r values of 0.860, 0.922, and 0.903, respectively). Moreover, the average value of the three views correlated with the actual PDFF value with an r value of 0.961. The classification model based on the three views for binary classification using a PDFF 5% as the threshold showed significant performance (AUCs of 0.938, 0.946, and 0.959, respectively). The average value of the three views achieved an AUC of 0.970. As PDFF 10% as the threshold, the performance was also significant (AUCs of 0.974, 0.991, and 0.997), with the average achieving 0.998. As PDFF 25% as the threshold, the three AUCs remained significant (0.904, 0.958, and 0.936), with the average AUC being 0.992. Finally, to visualize the deep learning model in liver ultrasound prediction, we used Gradient-weighted Class Activation Mapping for visual interpretation of the convolutional neural network. Conclusion This study proposes deep learning-based ultrasound image classification and quantification models for fatty liver. These models have the potential to improve efficiency and reduce costs in the diagnosis and treatment of fatty liver, and shows significant clinical application prospects.
    Liver Failure
    Efficacy and safety analysis of double plasma molecular adsorption system sequential plasma exchange and hemodiafiltration in the treatment of patients with liver failure complicated with renal insufficiency
    WANG Yue-ning,ZHOU Li,ZOU Huai-bin, CHEN Yu
    2025, 30(10):  1398-1401. 
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    Objective To investigate the efficacy and safety of double plasma molecular adsorption system (DPMAS) sequential plasma exchange (PE) and hemodiafiltration (HDF) in patients with liver failure complicated with renal insufficiency. Methods A retrospective analysis was conducted on 27 patients with liver failure and renal insufficiency admitted to Beijing YouAn Hospital affiliated to Capital Medical University from September 2022 to June 2023. A total of 34 patients were treated with DPMAS sequential PE and HDF. The changes in liver function, renal function, coagulation function and model for end-stage liver disease (MELD) score before and after treatment were statistically analyzed to study the short-term efficacy and safety of the combination of DPMAS sequential PE and HDF. Results The hemodynamics remained stable during the 34 treatments, all of which were successfully completed. After 12 weeks, 23 patients survived (including 5 who underwent liver transplantation), while 4 died, resulting in a non-liver transplant survival rate of 66.7% (18/27). Immediately after treatment, the indexes such as TBil(286.60±127.39)μmol/L、DBil(194.32±80.75)μmol/L,BUN(10.51±8.26)mmol/L、CREA(143.29±111.74)μmol/L、eGFR(75.98±45.21)mL/min and MELD scores(26.66±8.83) significantly decreased (P<0.05) compared to pre-treatment levels:TBil(472.60±191.34)μmol/L、DBil(317.80±125.49)μmol/L,BUN(13.56±10.39)mmol/L、CREA(172.65±131.07)μmol/L、eGFR(66.43±43.80)mL/min and MELD scores(31.6±8.9). TBil and DBil levels 24 and 72 hours post-treatment and BUN 24 hours post-treatment also significantly decreased (P<0.05). There was no significant difference in BUN, CREA, eGFR, and MELD scores at 24 and 72 hours post-treatment compared to pre-treatment (P>0.05). There was no significant change in total protein, albumin, globulin, immediately after treatment and prothrombin activity, international normalized ratio immediately after, 24 hours, and 72 hours post-treatment compared to pre-treatment (P>0.05). Conclusion The combination of DPMAS sequential PE and HDF therapy is safe for patients with liver failure complicated with renal insufficiency. This combination of artificial liver can also effectively reduce serum bilirubin levels, improve organ function and prognosis indicators in the short term. It can be used as a transitional measure before liver transplantation for patients with liver failure and renal insufficiency.
    Research on the integrated management model of artificial liver therapy for patients with acute-on-chronic liver failure
    WANG Wen-yang, HU Ling, TONG Shu-rui, LU Ya, FAN Ye, XU Jing, HAO Kun-yan, YU Yue-cheng, WANG Fang
    2025, 30(10):  1402-1405. 
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    Objective To evaluate the clinical effect of the new model of management model based on integration of medical and nursing (MM-IMN), and provide a basis for optimizing the management model of artificial liver treatment for patients with acute-on-chronic liver failure (ACLF). Methods Ninety-two patients with ACLF who received artificial liver treatment at Jinling Hospital Affiliated to Medical School of Nanjing University (General Hospital of the Eastern Theater Command), during the period from January 2022 to December 2024 were enrolled. The patients were randomly divided into the control group receiving traditional management model based mainly on nursing (MM-N group) and the intervention group receiving new management model based on integration of medical and nursing (MM-IMN group), with each group consisted of forty-six cases. The emotional experiences (anxiety, acceptance, compliance and satisfaction) and adverse reaction occurrence of the two groups were comparatively analyzed. Results The proportion of patients with higher levels of anxiety in the MM-IMN group (3rd and 4th levels accounting for 6.5% and 0.0% respectively) was significantly lower than that in the MM-N group (3rd and 4th levels accounting for 19.6% and 4.3% respectively), while the proportions of higher acceptance (82.6% and 56.5% respectively), higher compliance (80.4% and 63.0% respectively), and higher satisfaction (56.5% and 32.6% respectively) were all better than those of the MM-N group, all had a significant difference (P<0.05). The MM-IMN group achieved higher satisfaction scores in terms of the effectiveness of joint communication between medical/nursing staff and patients, clear explanation of treatment plans, timely detection and appropriate handling of adverse reactions. There was no significant difference in the incidence of adverse reactions between the two groups; however, a tendency was seen for the MM-IMN group to have a lower rate of adverse reactions than the MM-B group (4.3% vs. 13.0%, P=0.267). Conclusion The new management model based on integration of medical and nursing for artificial liver treatment is significantly superior to the traditional management model. It can more effectively alleviate the anxiety of patients with ACLF, enhance their acceptance, compliance and satisfaction, and help better prevent and treat adverse reactions related to artificial liver treatment. It is worthy of promotion and application.
    Other Liver Diseases
    Influencing factors of tissue length in ultrasound-guided percutaneous transhepatic liver biopsy
    LI Jun-ying, CHENG Xiao, ZHU You-fu, WU Ai-hua, CHEN Jin-jun
    2025, 30(10):  1406-1409. 
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    Objective To investigate the influencing factors of tissue length in ultrasound-guided percutaneous transhepatic biopsy. Methods 625 patients underwent ultrasound guided percutaneous by liver biopsy in Nanfang hospital zengcheng Branch between January 2019 and March 2024 were analyzed retrospectively. Patients′ demographic, biochemical indexes, the types of needle, indicators such as complications after paracentesis were collected. The differences of the above indexes between the two groups of single tissue length < 15 mm or ≥15 mm, and the three groups of single tissue length < 15 mm, 15-19 mm and ≥20 mm were compared. Logistic multivariate regression analysis was used to analyze the risk factors of the length of single puncture tissue. The differences of abdominal pain and minor bleeding between the two groups were evaluated. Results The mean specimen length was 11.4 mm in the <15 mm group and 17.8 mm in the ≥15 mm group. The ≥15 mm group had a significantly higher proportion of procedures performed with a full-core needle (45.8%) and by operators with more than one year of experience (65.3%), but a lower incidence of abdominal pain (4.5%). Among the three subgroups (<15 mm, 15~19 mm, ≥20 mm), the use of full-core needles and operators with ≥1 year of experience significantly increased with greater specimen length (P<0.05 for trend). Length of a single tissue < 15 mm and 15-19 mm group, the higher length group accounted for less proportion of abdominal pain (3.6%, P=0.005). Length of a single tissue < 15 mm group and ≥20 mm group, shorter length of group in spleen hardness is higher. The full-core needle is an independent protective factor for the length of single tissue in ultrasound-guided percutaneous transhepatic biopsy. Compared two groups of abdominal pain, female, younger, length is shorter, lower preoperative and postoperative Hb statistic in patients were account for more painful. Conclusion The full-core needle is an independent protective factor for the length of single tissue in ultrasound-guided percutaneous transhepatic biopsy.
    Comparison analysis of Abernethy malformation in children and adults
    WANG Qian, WANG Wei-wei, REN Hong-wei, ZHAO Sheng-xiang, LI wei
    2025, 30(10):  1410-1413. 
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    Objective To compare and analyze the characteristics of Abernethy malformation in adults and children. Methods Abernethy malformation patients from December 2020 to December 2024 were collected and analyzed. They were divided into child and adult groups, and the types of vascular malformations, clinical symptoms, diagnosis and treatment process, and disease outcomes of patients were compared and analyzed. Results A total of one case of Abernethy malformation was collected in both children and adults, both of which were type Ⅱ Abernethy malformations. Children with portal cavernous transformation were accompanied by splenorenal shunting, and the clinical manifestations of children were prone to febrile seizures. Adult patients with hepatic encephalopathy were treated with medication, and the condition was stable. Conclusion Conservative drug treatment can achieve good clinical results in patients with mild Abernethy malformation symptoms.
    Analysis of the efficacy of saccharomyces boulardii combined with ursodeoxycholic acid and blue light phototherapy in treating cholestasis in neonates aged 35 weeks and above
    CHANG Ya-na, JIA Yang
    2025, 30(10):  1414-1418. 
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    Objective To investigate the clinical efficacy of Saccharomyces boulardii in combination with ursodeoxycholic acid and blue light phototherapy on neonatal intrahepatic cholestasis in infants aged ≥35 weeks. Methods From January 2021 to January 2024, 92 infants with intrahepatic cholestasis aged ≥35 weeks were recruited at Xingyuan Hospital in Yulin City. Using a random number table method, they were divided into a reference group (n=46, treated with ursodeoxycholic acid and blue light phototherapy) and a Saccharomyces boulardii group (n=46, treated with the reference group's regimen plus Saccharomyces boulardii). Clinical efficacy, liver function markers, intestinal flora distribution, inflammation levels, liver and spleen size, and jaundice index were compared between the two groups before and after treatment. Results After treatment, the total effectiveness rate in the Saccharomyces boulardii group reached 89.13% (41/46), which was significantly higher than 71.74% (33/46) in the reference group (P<0.05). Post-treatment, the Saccharomyces boulardii group showed lower levels of TBil (81.20±17.13) μmol/L, DBil (65.42±12.44) μmol/L, and TBA (75.19±16.88) U/L compared to the reference group's TBil (91.88±18.69) μmol/L, DBil (73.88±13.59) μmol/L, and TBA (88.09±24.10) U/L (P<0.05). The levels of bifidobacteria (8.64±0.63) lg CFU/g and lactobacilli (8.75±0.66) lg CFU/g were higher, while levels of E. coli (6.37±0.58) lg CFU/g were lower compared to the reference group (P<0.05). Additionally, the Saccharomyces boulardii group exhibited lower hs-CRP (0.57±0.22) mg/L, IL-6 (32.17±4.92) ng/L, and TNF-α (214.27±31.82) ng/L levels than the reference group (P<0.05). Liver span (2.39±0.37) cm, spleen span (0.67±0.10) cm, and jaundice indices (11.12±4.96) mg/dL were also significantly lower than those in the reference group (P<0.05). Conclusion The combination of saccharomyces boulardii, ursodeoxycholic acid, and blue light phototherapy significantly enhances liver function, optimizes intestinal flora, and reduces inflammation in neonates aged 35 weeks and above, suggesting its potential for expanded clinical use.
    The impact of laparoscopic cholecystectomy combined with posterior gallbladder triangle approach on clinical efficacy and safety in patients with cholecystitis
    LIU Lei, CUI Fa-qiang, YIN Tian-ying
    2025, 30(10):  1419-1423. 
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    Objective To evaluate the effectiveness of the posterior gallbladder triangle approach in laparoscopic cholecystectomy. Methods The study sample included 106 patients treated for acute cholecystitis from January 2020 to January 2023. Fifty-three patients were randomly assigned to each of two groups. All patients underwent laparoscopic cholecystectomy; the control group underwent the conventional gallbladder triangle approach, while the observation group used the posterior gallbladder triangle approach. Perioperative indicators were recorded. Levels of inflammatory markers, pain mediators, and stress response markers pre-surgery and 24 hours post-surgery were compared between the groups. Complications were also recorded. Results The surgical time for the observation group and the control group was (33.14±4.06) minutes and (48.83±5.73) minutes, respectively, with the observation group showing significantly less time than the control group (P<0.05). The intraoperative blood loss for the observation group and control group were (35.24±4.12) mL and (49.67±5.69) mL, respectively, with the observation group having significantly less blood loss (P<0.05). The recovery time of bowel sounds, first time to pass gas, first time to defecate, and first time to eat in the observation group were (12.06±2.03) hours, (19.26±2.70) hours, (35.32±4.01) hours, and (1.55±0.36) days, respectively, all of which were significantly shorter than those in the control group (P<0.05). The levels of postoperative pain mediators, inflammatory factors, and stress indicators were all lower in the observation group compared to the control group (P<0.05). The complication rates for the observation group and control group were 5.66% (3/53) and 22.64% (12/53), respectively, with the observation group having a significantly lower rate (P<0.05). Conclusion The use of the posterior gallbladder triangle approach in laparoscopic cholecystectomy can reduce surgical time and intraoperative blood loss, and accelerate postoperative recovery.
    Influencing factors of emotions for caregivers of children with living-related liver transplantation and its correlation with social support
    PANG Xuan, LU Ye-feng
    2025, 30(10):  1424-1429. 
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    Objective To investigate the current situation of emotion and social support among caregivers of children with living-related liver transplantation. Analyze the influencing factors of caregiver emotions and explore their correlation with social support. Methods A cross-sectional study design was conducted using convenience sampling to sellect 224 caregivers of children undergoing living-related liver transplantation who were treated in a tertiary hospital in Shanghai from January 1, 2022 to December 30, 2022. The General Information Questionnaire, Social Support Rating Scale (SSRS) and Brief Profile Mood States (BPOMS) were used as research tools to conduct the questionnaires. Results The positive emotion score of caregivers was (10.42±4.75) points, the negative emotion score was 23.00 (9.00, 42.00) points and the social support score is (40.81±8.88) points. Social support was positively correlated with positive emotions (r=0.283, P<0.01) and negatively correlated with negative emotions (r=-0.284, P<0.01). Social support had a significant impact on positive emotions of caregivers (P<0.01). Social support, work status and debt status had significant effects on negative emotions of caregivers (P<0.05). Conclusion Caregivers exhibited both positive and negative emotions, with a medium level of positive emotions and a low level of negative emotions. Social support for caregivers was moderate, and increasing social support can help improve their emotional state.