Table of Content

30 November 2025, Volume 30 Issue 11

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Frontier, Exploration and Controversy

The value of 5-hydroxymethylcytosine in predicting hepatocellular carcinoma risk in HBV-carrying population: an evaluation based on differential analysis

GAO Guo-feng, YU Jiao

2025, 30(11):  1466-1468. 

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Objective To clarify the application value of 5-hydroxymethylcytosine (5hmC) in evaluating the progression risk of chronic hepatitis B (CHB) to hepatocellular carcinoma (HCC) based on differential analysis. Methods Eighty-four CHB patients without HCC progression were included in the control group (CG), and 96 CHB patients with HCC development were included in the research group (RG). Two-thirds of the samples were used in the training set and one-third of the samples were used in the validation set to detect the level of 5hmC in both groups based on a modified nano-hmC-Seal technique. The expression levels of 5hmC-related genes TET2 and TET3 were quantified by qPCR method, and the correlation between TET3 and 5hmC was analyzed by Pearson′s correlation coefficients method. Receiver operating characteristic (ROC) curves were drawn to evaluate the application value of the TET3-based 5hmC prediction model in the early diagnosis of HCC. Results The expression of 5hmC in patients of RG group was lower than that in CG group, no matter in the training set or in the validation set (training set: 0.73±0.31 vs.0.98±0.31, validation set: 1.01±0.34 vs.2.98±1.25). 5hmC was significantly enriched in the region between the transcription initiation site and the transcription ending site but was depleted in the flanking region. 5hmC-related genes TET2 and TET3 were significantly down-regulated in HCC patients, both in the training set and in the validation set (training set: TET2 0.72±0.26 vs.1.04±0.36, TET3 0.73±0.34 vs.0.96±0.34, validation set: TET2 1.89±0.28 vs.3.25±1.25, TET3 0.71±0.22 vs.1.04±0.27). In both the training and validation sets, TET3 showed a positive association with 5hmC. ROC analysis results showed that the 5hmC prediction model could be used to predict the progression of CHB to HCC (training set: AUC=0.81, 0.729~0.893; validation set: AUC=0.84, 0.739~0.936). Conclusion TET3 expression based on 5hmC sequencing is a landmark molecule for evaluating the progression of HCC in CHB patients, which is worthy of further study and promotion.

Liver Tumor

The clinical characteristics and survival analysis of patients with genotype 3 hepatitis C viral infection-related hepatocellular carcinoma

MU Huan, ZHANG Ying-yuan, MOU Chun-yan, HE Yuan-qiang, CHANG Li-xian, LIU Chun-yun, LIU Li, XU Dan-qing

2025, 30(11):  1469-1474. 

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Objective To investigate the clinical characteristics and survival analysis of patients with genotype 3 (GT3) hepatitis C viral infection related hepatocellular carcinoma (HCV-HCC). Methods One hundred patients with GT3 HCV-HCC in the Third People′s Hospital of Kunming from January 2020 to December 2022 were collected in this study. According to the patient′s admission time and their outcomes in 2-year follow-up, the patients were divided into a death group and a survival group. The relevant clinical data, biochemical indicators, personal history, and other related indicators of these patients were collected. Univariate and multivariate Cox proportional hazards regression models were used to analyze the influencing factors of mortality in these patients with GT3 HCV-HCC. Receiver operating characteristic curve (ROC curve) and area under the curve (AUC) analysis was adopted. Survival curves for liver cancer were drawn using Kaplan Meier method with prothrombin time (PT), complications of ascites and bleeding as predictive indicators. Results There were 45 cases (45%) in the death group, and 55 cases (55%) in the survival group. According to the CNLC tumor staging system in China, there were 26 cases in stage I, 28 cases in stage II, 36 cases in stage III, and 10 cases in stage IV. According to the Child-Pugh grading system, there were 32 cases in stage A, 46 cases in stage B, and 22 cases in stage C. The results of Cox univariate and multivariate analysis showed that prothrombin time (PT) (HR=1.138, 95%CI 1.020~1.270, P=0.020), complication of peritoneal effusion (HR=1.414, 95%CI 1.016~1.970, P=0.040), and complication of bleeding (HR=1.901, 95% CI 1.337~2.704, P<0.001) were independent factors leading to mortality in patients with HCV-HCC. According to the ROC curve analysis, the maximum value of PT (AUC=0.763), the maximum value of complication of bleeding (AUC=0.797), the maximum value of complicaion of ascites (AUC=0.653), and the combined prediction of the three indicators for the maximum value (AUC=0.892). Conclusion PT, complication of ascites, and complication of bleeding are all risk factors affecting the survival of patients with GT3 HCV-HCC, and may serve as clinical indicators for predicting their prognosis.

Clinical diagnosis of hepatocellular carcinoma complicated with esophageal and gastric variceal bleeding

GU Lei-lei, CHEN Ping, WU Yun-lin

2025, 30(11):  1475-1477. 

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Objective To investigate the clinical characteristics and diagnosis of gastroesophageal variceal hemorrhage (GEVH) of patients with hepatocellular carcinoma (HCC), and to evaluate the efficacy and safety of patient-oriented endoscopic therapy for GEVH. Methods The clinical characteristics, patient-oriented endoscopic therapy efficacy, and prognosis of 40 HCC patients with GEVH from the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between January 2013 and December 2023 were retrospectively studied. Results Most of the patients (38/40) had a poor liver function, among which 90.0% of the patients were Child-Turcotte-Pugh grade B and C, and most patients were with severe initial bleeding. 77.5% of the patients had hematemesis. The initial patient-oriented endoscopic therapy was mainly endoscopic variceal ligation (EVL) (82.5%), and the patients′ bleeding symptoms were all controlled after endoscopic therapy. Twenty-two patients continued the follow-ups after the first endoscopic therapy, with an average follow-up duration of 37 months. Only 3 patients had rebleeding symptoms at the last follow-up, without serious complications during the follow-ups. Conclusion Endoscopic diagnosis and patient-oriented endoscopic therapy for HCC with GEVH are effective and safe, which may prolong the patients’ survival and improve the patients’ quality of life.

The efficacy and safety of sequential C-TACE microwave ablation therapy combined with lenvatinib in the treatment of unresectable advanced hepatocellular carcinoma

LI Shi-cheng, LU Xiang, SHEN Yong

2025, 30(11):  1478-1482. 

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Objective To analyze the effect of iodized oil via hepatic arterial chemoembolization (C-TACE) sequential microwave ablation therapy combined with lenvatinib in the treatment of advanced hepatocellular carcinoma (HCC). Methods The medical records of 105 unresectable patients with advanced HCC admitted to Hanzhong Central Hospital from February 2019 to January 2022 were retrospectively analyzed. The patients were divided into a control group (n=51, C-TACE sequential microwave ablation) and an observation group (n=54, Lenvatinib combined with C-TACE sequential microwave ablation) according to different treatment regimens.Tumor markers, adverse reactions, liver function indexes, survival and clinical efficacy [i.e., disease control rate (DCR) and objective response rate (ORR)] were compared between the two groups. Results The DCR and ORR in the observation group were 81.48% and 48.15%, respectively, which were higher than those of 60.78% and 24.45% in the control group (P<0.05). After treatment, the serum levels of carcinoembryonic antigen (CEA), aspartate aminotransferase (AST), α-L-fucosidase (AFU), total bilirubin (TBil), alpha-fetoprotein (AFP) and alanine aminotransferase (ALT) in both groups were decreased (P<0.05), but the values of the observation group were lower than those of the control group (P<0.05). The survival rate of observation group was 70.37%, which was higher than that of the control group (50.98%) (P<0.05). There was no difference in adverse reactions between the two groups (P>0.05). Conclusion C-TACE sequential microwave ablation combined with lenvatinib in the treatment of unresectable middle and advanced HCC patients is effective, as indicated by reducing the levels of tumor markers, good safety, and improving liver function and prognosis of the patients.

A comparison of the efficacy of DEB-TACE, radiotherapy combined with lenvatinib or apatinib in the treatment of hepatocellular carcinoma with portal vein tumor thrombus

ZHENG Xue-li, LI Hua-yu, ZHAO Si-qi, HUANG Ping

2025, 30(11):  1483-1488. 

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Objective To explore the efficacy of drug-eluting bead transarterial chemoembolization (DEB-TACE), radiotherapy combined with lenvatinib or apatinib in the treatment of hepatocellular carcinoma with portal vein tumor thrombosis. Methods 72 patients with hepatocellular carcinoma complicated with portal vein thrombosis were randomly divided into an observation group and a control group, with 36 cases in each group. The control group received DEB-TACE, radiotherapy combined with apatinib, while the observation group received DEB-TACE, radiotherapy combined with lenvatinib. After 3 months of treatment, the clinical efficacy, adverse reactions, serum biochemical indicators of liver function, coagulation indicators, tumor markers were compared between the two groups. An 18-month follow-up was conducted to record the primary endpoints, including progression-free survival (PFS) and overall survival (OS). Results The disease control rates of the observation group and the control group were 91.67% and 72.22%, respectively. The disease control rate was higher in the observation group compared with the control group (P<0.05). The occurrence rates of diarrhea, increased urine protein, and hypertension in the observation group were 8.33%, 5.56%, and 0.00%, respectively, which were lower than those of 27.78%, 22.22%, and 13.89% in the control group (P<0.05). After treatment, the PTA and AFP levels in the observation group were (88.71 ± 3.95)% and (210.93 ± 32.08) μg/L, respectively, which were better than those of (86.14 ± 6.09)% and (229.41 ± 34.57) μg/L in the control group (P<0.05). The PFS and OS curves in the observation group were higher than those in the control group (both P<0.05). Conclusion DEB-TACE combined with radiotherapy and either lenvatinib or apatinib demonstrates good short-term efficacy in the treatment of hepatocellular carcinoma with portal vein tumor thrombosis. Patients treated with the combination of DEB-TACE, radiotherapy, and lenvatinib experience greater survival benefits and the treatment is more suitable for patients with underlying renal insufficiency and hypertension.

The value of combining serum AFP and LECT2 levels with ultrasound for the early diagnosis of hepatocellular carcinoma

WEI Na, LIANG Hong-liang

2025, 30(11):  1489-1491. 

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Objective To investigate the value of combining serum levels of leukocyte cell-derived chemotaxin 2 (LECT2) and alpha fetoprotein (AFP) with ultrasound for the early diagnosis of hepatocellular carcinoma (HCC). Methods The information of patients who underwent liver biopsy or surgical pathology due to space-occupying liver lesions admitted from June 2021 to September 2023 was collected. Patients with early HCC were included in the observation group (n=57), and the remaining HCC patients were included in the control group (n=95). The levels of serum AFP, LECT2 were detected the liver lesions were examed with ultrosound. The diagnostic value of the detected indicators was explored by univariate and multivariate Logistic regression analysis and receiver operating characteristic (ROC) curve method. Results Compared with the control group, the observation group had significant differences in the positive rate of AFP (15.79% vs 71.93%), LECT2 level (34.84±19.14 ng/mL vs 54.54±20.70 ng/mL), abnormal ultrasound morphology (42.11% vs 59.65%), abnormal blood flow signal (12.63% vs 26.32%) and Young′s modulus of ultrasound shear wave elastography (SWE) (47.23±7.88 kPa vs 37.37±8.12 kPa) (P<0.05). By logistic regression analysis it was shown that AFP positive, LECT2 level, abnormal blood flow signal and SWE were reliable indicators for the early diagnosis of HCC (P<0.05). ROC analysis results showed that the area under the curve (AUC) of AFP positive was 0.781, the AUC of LECT2 was 0.764, the AUC of abnormal ultrasound blood flow signal was 0.568, the AUC of SWE was 0.719, and the AUC of combined indicators was 0.901, which had the highest diagnostic value. Conclusion The combination of serum AFP, LECT2, ultrasonic blood flow situation and SWE testing index is a good strategy for the early detection of HCC, and may ultimately improve the therapeutic effect and prognosis of the patients.

The clinical value of multimodal MRI imaging in differentiating malignant liver tumors from benign rich of blood supply lesions

HUANG Lei, LI Jun, HU Gang-feng, ZHANG Bo

2025, 30(11):  1492-1497. 

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Objective To explore the application value of multimodal nuclear magnetic resonance (MRI) based imaging features in the differential diagnosis of malignant hepatic tumor and benign rich of blood supply hepatic lesions. Methods A total of 50 cases of hepatic malignant tumor (liver cancer group) and 60 cases of benign rich of blood supply hepatic lesions (liver hypertrophic lesion group) were selected from the Surgical Department of Chongming Hospital Affiliated to Shanghai Health Medical College from January 2023 to June 2024. The image omics features of T2-weighted imaging (T₂WI) and diffusion-weighted imaging (DWI) were extracted, and combined with clinical risk factors. Multiple logistic regression and 5-FCV were used to establish a nomogram model. The model performance was evaluated by receiver operating characteristic (ROC) curve, calibration curve and decision-curve-analysis (DCA) method. Results The male ratio, age, cirrhosis, tumor diameter, alpha fetoprotein (AFP) and vascular endothelial growth gactor (VEGF) levels in the liver cancer group were 70.00%, (65.1±5.0) years old, 40.00%, (5.06±1.02) cm, (100.01±50.06) ng/mL, and (5.01±1.56) pg/mL, respectively, which were higher than those of 48.33%, (50.3±14.5) years old, 5.00%, (3.04±1.06) cm, (5.14±1.02) ng/mL, and (2.02±0.01) pg/mL in the benign liver hypertrophic lesion group. The differences were statistically significant (t/χ²=4.510, 6.862, 5.337, 10.123, 14.710, 14.860, all P<0.05). A multi-factor analysis showed that male, age, history of cirrhosis, tumor diameter, increased AFP and VEGF levels were independent predictors of liver malignancy (95%CI: 1.295~1.570, 0.923~1.146, 1.517~1.748, 1.159~1.405, 1.826~2.269, 2.058~2.536, 95%CI: 1.295~1.570, 0.923~1.146, 1.517~1.748, 1.159~1.405, 1.826~2.269, 2.058~2.536). All P<0.05). The calibration curves of the training set and the test set show that the two are basically identical, and the DCA display model has clinical application value in distinguishing liver malignant tumor from benign rich of blood supply hepatic lesions. Conclusion Multimodal MRI imaging features have important application value in the differential diagnosis of liver malignant tumors from benign hypertrophic liver lesions. The prediction model combined with clinical risk factors can effectively distinguish liver malignant tumors and benign hypertrophic liver lesions, and has a good clinical application prospect.

A predictive model established on quantitative parameters of enhanced CT for the efficacy of TACE treatment on primary liver cancer

SUN Wei-wei, GE Jing-jun, HUANG Jing-jing, KE Wei-wei, GU Fan, ZHANG Ji-chun

2025, 30(11):  1498-1502. 

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Objective To construct a predictive model based on quantitative parameters of contrast-enhanced CT for the efficacy of transcatheter arterial chemoembolization (TACE) on the treatment of patients with primary liver cancer (PLC). Methods A total of 117 PLC patients who underwent TACE treatment in Zhongda Hospital Affiliated to Southeast University and Dongtai Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were retrospectively selected. All patients underwent enhanced CT examination before operation, and the peak enhancement (PH), time to peak enhancement (Tp), perfusion value, and PH ratio of the mass to the aorta (M/A) were collected. At 3 months after operation, the patients were divided into an effective group (76 cases) and an ineffective group (41 cases) according to the efficacy. The clinical data of patients were collected, and the influencing factors of the treatment efficacy were analyzed. A nomogram prediction model was constructed based on the quantitative parameters of enhanced CT, and the area under the receiver operating characteristic (ROC) curve (AUC) was used to analyze the prediction efficiency of the model. Results The parameters of ineffective group vs. effective group were as the following: PH[(41.28±10.32) HU vs. (35.57±8.89) HU], M/A[(0.19±0.05) vs. (0.17±0.04)], perfusion value [(0.38±0.12) mL·min^-1·mL^-1 vs. (0.21±0.11) mL·min^-1·mL^-1], the values in the ineffective group were higher than those in the effective group (P<0.05). When compared the proportion of Chinese HCC staging plan (CNLC) as stage III [60.98% vs. 15.79%], the proportion of Child-Pugh grade B [60.98% vs. 40.79%], the proportion of multiple tumors [75.61% vs. 48.68%], the preoperative level of alpha-fetoprotein (AFP) [(534.62±81.95) ng/mL vs. (421.58±63.24) ng/mL], and the ratio of C-reactive protein/albumin (CAR) levels [(1.53±0.38 vs. (1.21±0.31)], the values of the ineffective group were higher than those in the effective group (P<0.05). By multivariate stepwise Logistic regression analysis it was showed that the perfusion value (OR=5.233, 95%CI: 2.261~12.107), CNLC stage (OR=6.561, 95%CI: 3.152~13.656), tumor number (OR=3.471, 95%CI: 1.269~9.487) and preoperative AFP level (OR=5.725, 95%CI: 3.105~10.552) were independent risk factors for the efficacy of patients (P<0.05). The C-index of the nomogram model based on the Logistic results was 0.834, and the correction of the predicted efficacy was close to the ideal curve (P>0.05). The ROC curve showed that the sensitivity of the model for predicting the efficacy of TACE treatment on PLC patients was 88.90%, the specificity was 91.70%, and the AUC was 0.899 (P<0.05). Conclusion The nomogram prediction model based on the perfusion values of contrast-enhanced CT quantitative parameters can better predict the efficacy of TACE on the treatment of PLC patients.

Efficacy and significance of DCE-MRI parameters in evaluating tumor pathological grading in patients with primary liver cancer

ZHAO Yan, LI Wen-hua, ZENG Xu, WANG Xu-sheng

2025, 30(11):  1503-1506. 

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Objective To study the efficacy and significance of dynamic enhanced magnetic resonance imaging (DCE-MRI) parameters in evaluating the pathological grading of primary liver cancer (PLC) patients. Methods Eighty PLC patients admitted to our hospital from June 2020 to June 2023 were selected as the observation group and 50 patients with hepatic benign nodules were selected as the control group. Edmondson-Steiner's tumor pathological grading method was used to evaluate the patients in the observation group, and 24 cases of grade Ⅰ were included in the mild group, 30 cases of grade Ⅱ to Ⅲ were included in the moderate group, and 26 cases of grade Ⅳ were included in the severe group. All patients underwent DCE-MRI, and their extracellular volume (V_e), plasma volume fraction (V_p), transfer constant (K^trans), and outflow rate (K_ep) were recorded. Receiver operating characteristic (ROC) curves were used to analyze the value of DCE-MRI parameters in diagnosing severe PLC. Results The values of V_e, V_p, K^trans and K_ep in the observation group were (0.75±0.24), (0.41±0.09), (1.04±0.31) and (2.74±0.49), respectively. The values of V_e, V_p, K^trans and Kep in control group were (0.43±0.12), (0.24±0.07), (0.63±0.17) and (1.58±0.34), respectively. The values of V_e, V_p, K^trans and K_ep in observation group were higher than those in control group (P<0.05). The values of V_e, V_p, K^trans and K_ep in mild group were (0.53±0.17), (0.27±0.07), (0.84±0.19) and (1.93±0.45), respectively. The values of V_e, V_p, K^trans and K_ep in the moderate group were (0.68±0.22), (0.39±0.12), (0.97±0.23) and (2.51±0.72), respectively. The values of V_e, V_p, K^trans and K_ep in the severe group were (0.91±0.29), (0.51±0.16), (1.15±0.29) and (3.18±0.85), respectively. The values of V_e, V_p, K^trans and K_ep in the mild group were lower than those in the moderate and severe groups. The V_e, V_p, K^trans and K_ep values in moderate group were lower than those in severe group (P<0.05). ROC analysis showed that the area under the curve (AUC) value of the V_e, V_p, K^trans, and K_ep for diagnosing the moderate to severe PLC were 0.905 (95% CI: 0.846~0.964), 0.751 (95% CI: 0.639~0.830), 0.772 (95% CI: 0.674~0.870), and 0.916 (95% CI: 0.871~0.961), respectively. Conclusion The quantitative parameters in DCE-MRI of PLC patients with different pathological grades are different to some extent, and the higher the pathological grade is, the higher the V_e, V_p, K^trans, K_ep values are. Clinically, the pathological grading of patients can be evaluated based on indicators such as V_e, V_p, K^trans, K_ep, etc., with good efficacy.

Clinicopathological characteristics of combined hepatocellular-cholangiocarcinoma

NIE Xi, WU Xiao-jie, GUI Ren-jie, DUAN Hua-xin

2025, 30(11):  1507-1510. 

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Objective The clinicopathological features of 82 cases of combined hepatocellular-cholangiocarcinoma (cHCC-CCA) were analyzed. Methods The medical records of 82 cases with cHCC-CCA were analyzed retrospectively, including 50 HCC patients and 30 CCA patients in the same period. The general clinical data and pathological data of the three groups were compared, and the pathological manifestations under cHCC-CCA microscope were analyzed. Results The onset age and AFP level in CCA group were (57.1±8.2) years old and (312.0±37.4) U/mL, and the differences were statistically significant (P<0.05) when compared with cHCC-CCA [(52.6±6.7) years old, (364.3±35.2) U/mL] and HCC [(53.0±7.0) years old, (382.4±44.9) U/mL]. However, there was no significant difference among cHCC-CCA, HCC onset age and AFP level (P>0.05). HBV infection was found in 63 patients (76.8%) with cHCC-CCA and 46 patients (92.0%) with HCC. They were significantly higher than those of CCA patients [11 cases (36.7%), P<0.05], but there was no significant difference between cHCC-CCA and HCC patients (P>0.05). In HCC group, the tumor diameter and poorly differentiated cases were (4.6±1.2)cm and 42 cases (84.0%), the difference was statistically significant (P<0.05) when compared with cHCC-CCA [(5.7±1.4) cm, 51 cases (62.2%)] and CCA [(5.5±1.6) cm, 19 cases (63.3%)]. However, there was no significant difference in tumor diameter and poorly differentiated cases between cHCC-CCA and HCC (P>0.05). In CCA group, there were 7 cases (23.3%) of cirrhosis and 11 cases (36.7%) of lymph node metastasis. Compared with cHCC-CCA [56 cases (68.3%), 7 cases (8.5%)] and HCC [41 cases (82.0%), 3 cases (6.0%)], the difference was statistically significant (P<0.05). However, there was no statistically significant difference (P>0.05) in the cases of cirrhosis and lymph node metastasis between cHCC-CCA group and HCC group. Under the microscope of cHCC-CCA, HCC(80 cases, 97.6%) and CCA(78 cases, 95.1%) were included. The HCC region showed thick trabecular cord-like and pseudoglandular structures under the microscope, with hepatocyte-like differentiation and rich eosinophilic cytoplasm, and the nucleus was round. In the CCA region, the moderately and poorly differentiated atypical glands were arranged in irregular glandular tubular and solid cord structures, accompanied by interstitial fiber tissue. In another 11 cases (13.4%), there was a cholangiolocellular carcinoma (CLC) region in the tissues. Microscopically, the glands showed a narrow cavity-like and "staghorn" growth pattern, accompanied by obvious interstitial fibrous tissue proliferation. The cells were small, the cytoplasm was sparse and basophilic, the nucleus was oval, and transparent stroma was abundant around the glands. Conclusion There are similarities and differences in clinicopathological features among the cHCC-CCA and HCC and CCA patients. Paying attention to the composition ratio of HCC and CCA under cHCC-CCA microscope may provide scientific basis for clinical diagnosis and treatment of cHCC-CCA.

Liver Fibrosis & Cirrhosis

Value of transient elastography combined with portal vein hemodynamics in assessing liver fibrosis in patients with chronic hepatitis B

ZHANG Ying, WANG Xu, CAO Wen-ting, ZHANG Yu-han

2025, 30(11):  1511-1514. 

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Objective To evaluate the value of transient elastography combined with portal vein hemodynamics in assessing liver fibrosis in patients with chronic hepatitis B (CHB). Methods A total of 102 CHB patients were admitted to Shanxi Fenyang Hospital from January 2021 to January 2024. Liver stiffness measurement (LSM) was evalued using transient elastography, while a color Doppler ultrasound diagnostic device was used to measure the portal vein diameter (PVD), maximum flow velocity (Vmax), and mean flow velocity (Vmean). Multivariate logistic regression analysis was conducted to identify the factors influencing the occurrence of liver fibrosis. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of combining transient elastography with portal vein hemodynamics in differentiating liver fibrosis in CHB patients. Results In this study, 102 patients with chronic hepatitis B (CHB) were included. Liver biopsy diagnosed 41 cases (40.20%) with non-significant liver fibrosis and 61 cases (59.80%) with significant liver fibrosis. The LSM of patients with significant liver fibrosis were (13.0±2.6) kPa and (13.6±2.7) mm, respectively, which were higher than those in patients with non-significant fibrosis [(7.1±1.9) kPa and (10.9±2.1) mm]. Additionally, the Vmax and Vmean in significant fibrosis patients were (28.9±3.6) cm/s and (25.3±3.3) cm/s, respectively, which were lower than those in non-significant fibrosis patients [(36.7±4.4) cm/s and (30.9±4.1) cm/s], with statistical significance (P<0.05). Multivariate analysis indicated that patients with higher LSM and PVD, and lower Vmax and Vmean had a higher risk of liver fibrosis (P<0.05). ROC curve analysis showed that the combination of transient elastography and portal vein hemodynamics had a diagnostic accuracy of 0.974 (95% CI: 0.949~0.999), with a sensitivity of 91.8% and specificity of 92.7%. Conclusion The combined application of LSM and portal vein hemodynamics is highly effective in assessing liver fibrosis in patients with CHB, offering superior diagnostic accuracy.

Viral Hepatitis

The predictive value of serum HBV-LP combined with HBV RNA for recurrence after discontinuation of long-acting interferon in the treatment of chronic hepatitis B

CHEN Chong, ZHANG Min-min

2025, 30(11):  1515-1520. 

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Objective To analyze the predictive value of serum hepatitis B virus large protein (HBV-LP) combined with hepatitis B virus ribonucleic acid (HBV RNA) for recurrence after discontinuation of long-acting interferon in the treatment of chronic hepatitis B (CHB). Methods A total of 70 CHB patients who received long-acting interferon treatment in our hospital from January 2022 to December 2023 were selected and divided into the recurrence group (n=19) and the non-recurrence group (n=51) according to the recurrence situation after drug withdrawal. All included patients were tested for serum level of the HBV-LP and HBV RNA on the day after drug withdrawal. General data, related biochemical indicators, and the level of the HBV-LP and HBV RNA of each group were analyzed and compared. The predictive value of serum HBV-LP combined with HBV RNA for recurrence after drug withdrawal in CHB patients were evaluated by the receiver operator characteristics (ROC) curve. The related factors affecting recurrence after drug withdrawal in CHB patients were investigated by multivariate logistic regression analysis. Results The proportion of alcohol consumption history in the recurrence group was higher than that in the non-recurrence group (52.63% vs. 21.57%), and the difference was statistically significant (P<0.05). In the recurrence group, the serum ALT was (89.55±23.42) U/L, AST was (72.35±20.65) U/L, AFP was (30.11±10.23) μg/L, HBsAg was (8.10±1.67) lg IU/mL, and HBcrAg was (7.09±1.55) lg IU/mL, HBV DNA (4.24±0.88) lg IU/mL, HBV-LP (41.41±9.55) μg/L, HBV RNA (4.65±1.01) lg copies /mL, higher than the non-recurrence group [(31.34±10.55) U/L, (27.45±9.10) U/L, (21.52±6.56) μg/L, (5.10±1.09) lg IU/mL, (5.07±1.08) lg IU/mL, (2.11±0.43) lg IU/mL, (18.67±4.39) μg/L, (1.98±0.40) lg copies /mL], and the difference was statistically significant (P<0.05). ROC curve analysis showed that the area under the curve (AUC) of serum HBV-LP, HBV RNA, and their combination for predicting recurrence after drug withdrawal in CHB patients were 0.840, 0.852, and 0.901, respectively. ALT≥55.87 U/L (OR=2.421), HBcrAg≥6.33 lg IU/mL (OR=2.787), HBV DNA≥2.88 lg IU/mL (OR=1.900), HBV-LP ≥ 30.56 μg/L (OR=2.239), and HBV RNA ≥ 3.09 lg copies/mL (OR=3.557) were all risk factors for recurrence after drug withdrawal in CHB patients (P<0.05). Conclusion Abnormal elevation of serum HBV-LP and HBV RNA are closely related to recurrence after drug withdrawal in CHB patients treated with long-acting interferon, and both can effectively predict recurrence after drug withdrawal. Moreover, their combination has a higher predictive value.

Role of Akt signaling pathway in immune regulation and therapeutic potential in chronic hepatitis B and HBV-related acute-on-chronic liver failure

WU Hang, LIN Yi-ping, LI Jia-xuan, CHEN Ai-ping, ZHENG Rui-dan

2025, 30(11):  1521-1524. 

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Objective Chronic hepatitis B (CHB) and hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) are major health issues worldwide, leading to immune dysregulation and T cell dysfunction. This study aimed to reveal the immune mechanisms of the Akt signaling pathway in HBV-related diseases and its potential therapeutic value. Methods A total of 6 subjects each were enrolled from Zhangzhou Zhengxing Hospital between January 2020 and March 2024, comprising healthy controls (NC), patients with chronic hepatitis B (CHB), and patients with HBV-related acute-on-chronic liver failure (HBV-ACLF). Flow cytometry was utilized to measure the expression of the apoptosis marker (Annexin V) and activation molecules (CD25, CD38, and CD69) in CD4⁺ and CD8⁺ T lymphocytes treated with DMSO and an Akt inhibitor, as well as the levels of IFN-γ, IL-2, and TNF-α secreted by CD4⁺ T lymphocytes. Results Compared to the DMSO group (NC: 9.418 ± 1.539%; CHB: 8.455 ± 0.693%; HBV-ACLF: 13.233 ± 2.652%), the proportion of Annexin V-positive CD4⁺ T cells was significantly increased in the Akt inhibitor group for CHB (15.132 ± 1.073%) and HBV-ACLF (18.767 ± 6.998%) patients, while no significant increase was observed in the NC group (8.820 ± 1.388%). Additionally, the Akt inhibitor did not affect CD8⁺ T cell apoptosis. Compared to the DMSO group, treatment with the Akt inhibitor significantly reduced the expression of CD25, CD38, and CD69 on CD4⁺ T and CD8⁺ T cells in CHB and HBV-ACLF patients, but did not reduce the expression of activation markers on CD4⁺ T and CD8⁺ T cells in the NC group. After treatment with the Akt inhibitor, the proportions of CD4⁺ IFN-γ⁺, CD4⁺ IL-2⁺, and CD4⁺TNF-α⁺ T cells in the NC, CHB, and HBV-ACLF groups were similar to those in the DMSO group. Conclusion The Akt signaling pathway plays a significant role in regulating T cell function in HBV infection, which could open up new possibilities for immunotherapy in HBV-related diseases.

Liver Failure

Analysis of the occurrence, clinical characteristics and regression of invasive fungal infections in patients with HBV-ACLF after treatment with an artificial liver support system

ZHU Xiao-hong, WANG Juan, HUANG Zuo-yu

2025, 30(11):  1525-1528. 

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Objective To analyze the incidence, clinical characteristics and prognosis of invasive fungal infection in patients with HBV-ACLF after artificial liver support system treatment. Methods Fifty patients with HBV-ACLF treated with artificial liver support system admitted to our hospital between October 2018 and January 2024 were divided into occurrence group (n=25) and non-occurrence group (n=25) according to whether fungal infection occurred or not. The two groups were compared in terms of clinical characteristics, glucocorticoid treatment regression analysis, and multi-factor logistic regression was used to analyze independent risk factors for invasive fungal infections in patients with HBV-ACLF after treatment with artificial liver support system. Results The mean number of hospital days and duration of treatment was (68.0±4.7) d in the occurrence group, respectively, which was higher than in the non-occurrence group [(34.6±6.8) d, P<0.05], The number of people with a history of cirrhosis and diabetes was 32.0% and 44.0%, respectively, which were higher than those in the no-incidence group (8.0% and 16.0%, respectively, P<0.05). The albumin, total bilirubin, white blood cell count and model score of end-stage liver disease in the occurrence group were (31.2±4.5) g/L, (314.2±101.3) μmol/L, (12.7±1.8) ×10⁹/L, and (26.1±2.6), respectively, which were significantly different from the non-occurrence group [(34.8±4.9) g/L, (212.5±101.6) μmol/L, (10.6±0.2) × 10⁹/L, and (22.9±1.8) points], P<0.05. The number of hospital days, albumin, total bilirubin level, and white blood cell count in the death group were (94.6±5.8) d, (29.1±4.0) g/L, (412.5±121.6) μmol/L and (13.6±2.2) × 10⁹/L, which were different from the survival group [(60.3±4.2) d, (33.2±4.3) g/L, (118.2±2.3) μmol/L, and (5.6±2.5) × 10⁹/L, respectively, P<0.05]. Multifactorial logistic regression analysis showed that days of hospitalization, albumin, total bilirubin level and white blood cell count were independent risk factors for invasive fungal infections in patients with HBV-ACLF after treatment with an artificial liver support system (OR=5.217, 4.928, 5.063, 4.923, P<0.05). Conclusion The prognosis of invasive fungal infection in HBV-ACLF patients is related to the number of days in hospital, albumin, total bilirubin level, and white blood cell count after treatment with artificial liver support system.

Prediction of short-term clinical outcome of HBV-related patients with acute-on-chronic liver failure by maximum amplitude of thromboelastography

ZHOU Hui-min, ZHANG Yi-de, SHEN Yan

2025, 30(11):  1529-1533. 

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Objective To explore the application value of thromboelastography (TEG) parameter, maximum amplitude (MA), in HBV-related acute-on-chronic liver failure (HBV-ACLF), and provide more evidence for optimizing the diagnosis and treatment strategy of ACLF. Methods Between January 2023 and June 2024, 53 patients with HBV-ACLF were admitted, 40 patients with chronic hepatitis B and 30 healthy people (control group) during the same period were included in the study. The coagulation indexes and TEG parameters of the three groups were compared. After a 90-day follow-up, the patients were divided into survival group and death group, and the clinical data of the two groups were compared. Cox regression analysis was used to find the factors affecting the clinical outcome of HBV-ACLF, and the prediction of the above factors on different clinical outcomes was analyzed by drawing the receiver operating characteristic (ROC) curve. Results The differences in INR, APTT, TT, FIB, R time, K time, α angle and MA among HBV-ACLF group, CHB group and control group were statistically significant (P<0.05). After a 90-day follow-up observation, there were 35 surviving and dead cases in HBV-ACLF group. Compared with the survival group, PLT, α-angle, MA and FIB in the dead group decreased significantly (P<0.05), while the scores of R time, K time, INR and MELD increased significantly (P<0.05). Univariate Cox regression analysis showed that PLT, INR, FIB, K-time, MA and MELD scores were related with the death of HBV-ACLF patients (P<0.05). The multivariate Cox regression analysis showed that INR and MA were independent predictors of the death of HBV-ACLF patients (P<0.05), with specific hazard ratios of 0.93 (95% CI: 0.84~0.97, P<0.05) and 3.11 (95% CI: 1.93~5.07, P<0.05). The value of MA and INR in predicting the death of HBV-ACLF patients was evaluated by drawing ROC curve. The diagnostic values (area under the curve, AUC) of MA and INR were 0.85 (95% CI: 0.77~0.93) and 0.77 (95% CI: 0.74~0.80), respectively. When they were combined, the diagnostic AUC value was 0.90 (95% CI: 0.82~0.97, P<0.05). Conclusion MA, as a dynamic index to evaluate the coagulation function of HBV-ACLF patients, has shown a important clinical value in predicting short-term clinical outcomes. By monitoring MA, the risk of bleeding and thrombosis in HBV-ACLF patients can be better identified, thus providing basis for individualized treatment and more comprehensive support for clinical decision-making.

Metabolic Associated Fatty Liver Disease

Exploring the mechanism of fuzheng huayu formula in preventing and treating metabolic dysfunction-associated steatohepatitis based on network pharmacology

ZENG Hao-tian, LI Xu-tao, WANG Si-yuan, RUAN Tian-yin, TAO Yan-yan, RAN Yun

2025, 30(11):  1534-1541. 

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Objective To investigate the mechanism of Fuzheng Huayu Formula (FZHY) in treating metabolic dysfunction-associated steatohepatitis (MASH). Methods The study utilized TCMSP to systematically analyze FZHY′s active ingredients and target proteins, while the potential MASH treatment targets were acquired by integrating data from GeneCards and OMIM resources.Intersecting targets were analyzed via protein-protein interaction (PPI) networks to identify core proteins, followed by KEGG enrichment analysis to determine key signaling pathways. A methionine-choline-deficient (MCD) diet-induced MASH mouse model was established. Mice were randomly divided into a model control group, an obeticholic acid group (10 mg/kg/day), a FZHY group (20.57 g crude drug/kg/day), and a normal control group (n=10/group). The MCD diet was administered to model and treatment groups for 8 weeks, while the normal control group received standard chow diet. Drug interventions began at week 3 and lasted for 6 weeks. Serum and liver tissues were collected 12 hours after the final dose. Serum liver function markers, hepatic total cholesterol (TC), triglycerides (TG), and hydroxyproline levels were measured using biochemical kits. Histopathological changes were assessed via hematoxylin-eosin (HE), Sirius red, and Oil Red O staining. Hepatic IL-6, IL-1β, and TNF-α levels were quantified by ELISA. Key network pharmacology-predicted signaling molecules were validated via qRT-PCR and Western blotting. Results The analysis yielded 136 shared targets between the drug′s action targets and disease pathogenesis targets. Both PPI network and KEGG pathway enrichment analyses demonstrated significant enrichment of the PI3K-Akt signaling transduction pathway (P<0.05), indicating its potential role as a pivotal regulatory pathway for FZHY′s therapeutic effects on MASH.The experimental results demonstrated that, compared with the control group, the model group exhibited elevated serum AST、ALT 、hepatic TC and TG levels, (79.95 ± 28.69) IU/L、(147.60 ± 27.11) IU/L and (0.25 ± 0.04) mmol/L、 (0.51 ± 0.09) mmol/L,FZHY treatment group showed significantly reduced serum AST、ALT、hepatic TC and TG levels, (29.67 ± 11.10) IU/L、(62.41 ± 20.13) IU/L and (0.14 ± 0.01) mmol/L、 (0.20 ± 0.06) mmol/L(P<0.05).Additionally, FZHY treatment alleviated hepatic IL-6, IL-1β, TNF-α levels, liver fibrosis, and liver lipid accumulation. It decreased mRNA expression of AKT1, NF-κB, HSP90, CASP9, BCL2, and TP53, and decreased protein levels of AKT, phosphorylated AKT (p-AKT), NF-κB, phosphorylated NF-κB (p-NF-κB), and TP53. Conclusion FZHY exerts therapeutic effects on MASH in mice, potentially through modulation of the PI3K-Akt signaling pathway.

Other Liver Diseases

Epidemiological characteristics of liver transplantation patients at Beijing You’an Hospital from 2015 to 2023

WU Yu, DUAN Xiao-wan, XU Man-man, WANG Wen-ling, CHEN Yu

2025, 30(11):  1542-1545. 

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Objective To explore the epidemiological characteristics and trends of liver transplantation, and to provide evidence-based medical data for the treatment and management of liver transplantation. Methods A retrospective analysis was conducted on the epidemiological data of patients who underwent liver transplantation at Beijing You′an Hospital from 2015 to 2023. The Man-Kendall trend test was used to analyze the annual changes in age, gender, length of hospital stay, indications for liver transplantation, and causes of liver disease. Results Among 1,118 liver transplant patients, 876 were male (78.4%). The average age was 52.1 years, with the majority of patients aged between 41 and 60 years. 678 patients (60.6%) came from outside Beijing. The average length of hospital stay was 26.5 days, which showed a significant yearly decrease (Z=-3.232, P=0.001). The main indications for liver transplantation were liver malignancies (46.5%) and decompensated cirrhosis (24.3%), followed by acute-on-chronic liver failure (15.2%) and chronic liver failure (6.2%). Acute/subacute liver failure accounted for 6.5%, showing a significant increasing trend over the years (Z=2.398, P=0.017). Hepatitis B remained the leading cause of chronic liver disease (55.5%), followed by alcoholic liver disease (17.7%), cryptogenic liver disease (8.1%), autoimmune liver disease (6.0%), and hepatitis B + alcoholic liver disease (5.8%). Longitudinal analysis revealed a decreasing trend in the proportion of hepatitis B (Z=-2.189, P=0.029), while the proportion of alcoholic liver disease showed a significant increasing trend (Z=2.819, P=0.005). Conclusion Males and individuals aged 41~60 years represent the main population for liver transplantation patients, with liver malignancies and decompensated cirrhosis as the primary indications. Although hepatitis B remains the major cause of chronic liver disease, its proportion has decreased annually, while alcoholic liver disease has shown a significant increase.

Early efficacy evaluation of glucocorticoids combined with mannitol in the treatment of cholestatic hepatitis

DONG Xiao-feng, LIANG Dong

2025, 30(11):  1546-1548. 

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Objective To investigate the clinical efficacy of glucocorticoid combined with mannitol injection in the treatment of patients with cholestatic hepatitis. Methods 80 patients with cholestatic hepatitis admitted to our hospital from March 2018 to December 2023 were divided into a treatment group (36 cases) and a control group (44 cases). The control group received liver protection, jaundice reduction, treatment of the primary disease, and symptomatic treatment. The treatment group received glucocorticoid combined with mannitol injection on the basis of treatment in the control group. The improvement of liver function indicators, overall effective rate, and adverse reactions before and after treatment were observed in both groups. Results There was no significant difference in the levels of liver function related indicators between the two groups before treatment (P>0.05). After treatment, the levels of TIBL, DBil, ALT, AST, ALP, GGT, and TBA in the treatment group and the control group were (98.2±5.9) μmol/L、(52.6±5.2) μmol/L、(40.1±3.9) U/L、(39.7±2.8) U/L、(98.8±12.5) U/L、(101.2±5.1) U/L、(28.7±8.9) μmol/L, and (116.6± 7.9 )μmol/L、(71.1±6.4) μmol/L、(45.4±4.3) U/L、(44.8±3.7) U/L、(123.7±14.9) U/L、(128.5±9.3) U/L、(49.8±11.7) μmol/L, all of which showed a significant decrease compared to before treatment (P<0.05). Among them, the treatment group showed significantly higher levels of TBil, DBil, ALP, GGT, and TBA than the control group (P<0.05), while there was no significant difference in the decrease of ALT and AST (P>0.05); The overall effective rates of the treatment group and the control group were 83.3% and 68.2%, respectively, with a statistically significant difference (P<0.05); Ten patients in the treatment group experienced excitement and insomnia after using hormones, while five patients experienced discomfort due to venous vessel stimulation after using mannitol for pressurized intravenous infusion, two patients developed redness and swelling, all of them persisted until the end of treatment. Conclusion The combination of low-dose and short course glucocorticoids and mannitol injection can significantly improve liver function indicators, shorten the course of disease, improve prognosis, and have controllable adverse reactions in patients with early cholestatic hepatitis. It can be actively applied in clinical practice.

Mendelian randomization study of primary biliary cholangitis and autoimmune thyroid dysfunction

DING Hang, LI Xiao-fen, XIONG Yan, LI Yan-yan, CHEN Xiu-ji, WANG Xiao-lin

2025, 30(11):  1549-1553. 

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Objective To explore the causal relationship between autoimmune thyroid dysfunction and primary biliary cholangitis (PBC) using two-sample Mendelian randomization (MR) analysis. Methods GWAS summary data were extracted from publicly available genome-wide association studies. In the forward MR, PBC was considered as the exposure, and autoimmune hypothyroidism and hyperthyroidism were considered as outcomes. Single nucleotide polymorphisms (SNPs) closely related to and independent of PBC were selected as instrumental variables (IVs). MR analysis was performed using inverse variance weighted (IVW), MR-Egger regression, weighted mode (WM), and weighted median (WME) methods, with odds ratios (OR) and 95% confidence intervals (CI) to evaluate potential causal associations. Heterogeneity tests, pleiotropy tests, and stepwise exclusion tests were used to assess the stability and reliability of the results. Reverse MR study was also conducted. Results PBC was associated with increased risk of autoimmune hypothyroidism (IVW: OR=1.066, 95%CI:1.043~1.09); and with increased risk of autoimmune hyperthyroidism (IVW: OR=1.166, 95%CI:1.103~1.232). The reverse MR indicated that autoimmune hypothyroidism was associated with increased risk of PBC (IVW: OR=1.184, 95%CI:1.08~1.297), and no promoting effect of autoimmune hyperthyroidism on PBC was found. Conclusion PBC can increase the risk of autoimmune thyroid dysfunction, and autoimmune hypothyroidism is also a risk factor for the development of PBC, but there is no causal association between autoimmune hyperthyroidism and PBC.

The percentage of peripheral blood mononuclear cells increased in patients with acute drug-induced liver injury

YANG Bo, YAO Qiu-yan, WU Ze-sheng

2025, 30(11):  1554-1556. 

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Objective To explore the changes in the percentage of peripheral blood mononuclear cells in patients with acute drug-induced liver injury. Methods The clinical data of patients diagnosed with acute drug-induced liver injury in the First Affiliated Hospital of Dali University from January 2015 to December 2022 were retrospectively collected. 185 cases were enrolled and the percentage of peripheral blood mononuclear cells was analyzed. In total 185 cases,there were 124 cases of hepatocyte injury type,27 cases of cholestasis type, 34 cases of mixed type; there were 103 cases of mild type, 71 cases of moderate type, and 11 cases of severe type. The percentage of peripheral blood mononuclear cells in each group was statistically analyzed. Results The average percentage of peripheral blood monocytes among 185 patients was 10.81%, which was significantly higher than healthy person. Among the 185 cases, 76.76% (142 cases) had elevated monocyte percentage, while 23.24% (43 cases) were not. The percentages of peripheral blood mononuclear cells in the hepatocellular injury type, cholestatic type, and mixed type were 11.37%±3.70%, 9.95%±2.06%, and 9.40%±3.30% respectively. The percentage of monocytes in the hepatocellular injury group was higher than cholestasis group and mixed group(P=0.008; P=0.006), and there was no statistically significant difference between cholestasis group and mixed group (P=0.454); the percentages of peripheral blood mononuclear cells in the mild group, moderate group, and severe group were 10.12%±3.49% 11.69%±3.50%, 11.85%±2.66% respectively; the percentage of peripheral blood mononuclear cells in the mild group was lower than that in the moderate group (P=0.004). There was no statistical difference between the mild group and the severe group, and there was no statistical difference between the moderate group and the severe group (P=0.131; P=0.887). Conclusion The percentage of peripheral blood mononuclear cells in most patients with acute drug-induced liver injury is significantly higher than healthy person. The percentage of mononuclear cells in the hepatocyte injury type is higher than that in the cholestatic and mixed types. The percentage of peripheral blood mononuclear cells in the mild group is lower than that in the moderate group. There is no statistically significant difference between mild group and severe group, moderate group and severe group, which may be due to the small number of severe cases. Patients with acute unexplained liver injury may be accompanied with increased percentage of peripheral blood mononuclear cells.

Analysis of risk factors for hepatic dysfunction in elderly patients after intravenous infusion of cefoperazone and sulbactam sodium

LIU Juan-juan, HONG Yuan-yuan, WANG Feng-ling, YU Xue-jiang, MENG Xiang-yun

2025, 30(11):  1557-1560. 

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Objective To investigate the risk factors of liver dysfunction in elderly patients with intravenous infusion of cefoperazone sulbactam sodium. Methods A total of 274 elderly patients who received intravenous infusion of cefoperazone sulbactam sodium for anti-infective treatment in the Hefei Second People′s Hospital from January 2021 to July 2023 were retrospectively included in this study. The occurrence of abnormal liver function during medication was observed, and the influencing factors of abnormal liver function were analyzed. Results The incidence of abnormal liver function after intravenous infusion of cefoperazone sulbactam sodium in elderly patients was 8.76% (24/274). The results of univariate analysis showed that there were no statistically significant differences in gender, body mass index (BMI), smoking, hypertension, coronary heart disease, cerebral infarction, underlying diseases, albumin (Alb) level, daily medication dose, combined medication, and blood urea nitrogen (BUN) level between the two groups (P>0.05). The age [(76.7±4.0) years vs. (72.2±3.8) years], drinking history [62.50% (15/24) vs. 38.00% (95/250)], proportion of combined diabetes [75.00% (18/24) vs. 50.40% (126/250)], total bilirubin (TBil) [(13.46±2.69) μmol/L vs. (10.47±2.08) μmol/L], prothrombin time (PT) [(15.52±1.03) s vs. (14.23±0.47) s], and the proportion of medication time ≥5 days [58.33%(14/24)vs. 28.40%(71/250)] in the abnormal liver function group were higher than those in the normal liver function group (P<0.05). Multivariate Logistic regression analysis showed that age (OR=3.601, 95%CI: 1.491~8.699), PT (OR=3.107, 95%CI: 1.543~6.254), medication time (OR=4.045, 95%CI: 2.085~7.845) and TBil (OR=6.039, 95%CI: 1.702~21.421) were risk factors for abnormal liver function (P<0.05). Conclusion Age, TBil, PT levels and medication time are risk factors for abnormal liver function after intravenous infusion of cefoperazone sulbactam sodium in the elderly. Therefore, we should strengthen the monitoring of liver function in elderly patients with the above risk factors during medication, and take immediate intervention measures once abnormal results occur.

Analysis of influencing factors in patients with chronic liver disease complicated with osteoporosis

JING Jin-hua, MA Chao, LI Yu-yu, NING Zhong-hui, DOU Jing, WANG Xiao-bo, DING Guo-ning, WANG Xiao-zhong, GUO Feng

2025, 30(11):  1561-1567. 

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Objective To analyze the influencing factors of osteoporosis in patients with chronic liver disease. Methods This study retrospectively collected 215 outpatients and inpatients with liver diseases from the Xinjiang Urumqi Autonomous Region Hospital of Traditional Chinese Medicine and the Xinjiang Changji Hui Autonomous Prefecture Hospital of Traditional Chinese Medicine between September 2023 and June 2024. The clinical data, such as demographic information, serological indexes and nutritional risk, were collected to calculate CTP score and MELD. Patients were divided into osteoporosis group and non-osteoporosis group. Furthermore, multivariate logistic regression analysis was used to screen the risk factors of osteoporosis in patients with chronic liver disease. Results The prevalence of osteoporosis in patients with chronic liver disease was 22.3% . Among the causes of chronic liver disease, chronic hepatitis, primary cholangitis, autoimmune hepatitis and other causes were significantly different between two groups(P<0.05) . There were significant differences between the two groups in age, BMI (P<0.05) , ALP, Alb, DBil , TBA, ChE, BUN, Cys-c,β2-MG, serum calcium and MELD (P<0.05) . In nutrition risk assessment, there were significant differences in nutrition score and nutrition risk (P<0.05) . Multivariate Logistic regression analysis showed that nutritional risk (OR=1.934,95%CI:1.264~2.959 , P=0.002)and age(OR=1.074,95%CI:1.031~1.120, P=0.001 )were risk factors of osteoporosis in patients with chronic liver disease. Conclusion Nutritional risk and age are risk factors of osteoporosis in patients with chronic liver disease.

Comparison of the effect of laparoscopic anatomic hepatectomy by Laennec approach and traditional laparoscopic anatomic hepatectomy by Glisson pedicle

WANG Cai-qing, FANG Jian, XIE Dong-dong, XU Liang-ming, YU De-cai

2025, 30(11):  1568-1571. 

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Objective To compare the efficacy of Laennec approach laparoscopic anatomic hepatectomy with traditional Glisson pedicle anatomic laparoscopic hepatectomy. Methods 97 patients with hepatic tumor, hepatolithiasis and hepatic hemangioma were selected for prospective study. Patinets were divided into 2 groups according to random number table method, and underwent laparoscopic ananatomical hepatectomy via Glisson hepatic pedicle and Laennec approach respectively. The surgical indexes and adverse events were compared between the two groups. Serum indexes(ALT,AST,Alb)were analyzed. Results In the observation group, the operation time was(164.3±31.9)min, the hilar occlusion time was(51.0±6.1)min, the perihepatic free time was(15.5±3.7)min, the liver pedicle separation time was(19.5±4.8)min, the posthepatic separation time was(5.5±1.3)min, and the hepatic parenchyma separation time was(41.0±7.2)min and hospitalization time was(10.3±3.1)d,which were shorter than control group[(196.5±34.8)min,(67.0±5.6)min,(19.0±4.3)min,(24.5±5.4)min,(7.5±2.1)min,(47.0±7.5)min,(13.0±3.4)d]. The intraoperative blood loss(232.4±47.5)mL was lower than that of the control group(284.6±52.3)mL. The overall incidence of adverse events(0%) lower than control group (10%), and the postoperative serum Alb level(38.6±5.1)g/L was higher than the control group (34.2±3.5)g/L. The levels of serum ALT(276.8±13.1)U/L and AST(253.6±15.4)U/L were lower than those of control group after operation[(315.5±14.2)U/L,(297.6±16.5)U/L](P<0.05). Conclusion Compared with traditional laparoscopic hepatectomy via Glisson pedicle dissection, Laennec approach is not only shorter in operation time, but also more beneficial to liver function and postoperative rehabilitation.

Assessment of the effectiveness of high-intensity focused ultrasound in conjunction with CAO chemotherapy for treating advanced hepatoblastoma in children

CHEN Zhen, LI Jing-xian

2025, 30(11):  1572-1576. 

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Objective To evaluate the therapeutic effects of High-Intensity Focused Ultrasound (HIFU) ablation combined with CAO chemotherapy in pediatric patients with advanced hepatoblastoma. Methods From January 2018 to January 2021, 68 pediatric patients with advanced hepatoblastoma were enrolled and divided into two groups: a control group and an observation group, with 34 patients in each group. The control group was treated with CAO chemotherapy, whereas the observation group underwent a combination of CAO chemotherapy and HIFU ablation. The clinical effectiveness, immune function alterations, tumor marker levels, and adverse reactions pre- and post-treatment between two groups were compared. Additionally, a three-year follow-up was performed to evaluate the prognosis. Results The total effective rates of the treatment in the observation group and control group were 70.59% (15/34) and 44.12% (24/34), respectively, with a significant improvement in the observation group (P<0.05). After treatment, the CD3⁺ and CD4⁺ levels in the observation group were (51.71±5.86)% and (30.84±4.03)%, respectively, which were significantly higher than those in the control group (P<0.05). The CD8⁺ level in the observation group was (28.16±3.01)%, and both CD8⁺ and tumor marker levels were significantly lower than those in the control group (P<0.05). The total incidence of adverse reactions in the observation and control groups was 20.59% and 23.53%, respectively, with no statistically significant difference (P>0.05). The progression-free survival (PFS) over 3 years in the observation and control groups was (24.59±4.68) and (18.26±5.76) months, respectively, and the survival rates were 79.41% (27/34) and 47.06% (16/34), significantly higher than the control group (P<0.05). Conclusion The integration of HIFU ablation with CAO chemotherapy in the treatment of pediatric patients with advanced hepatoblastoma helps to enhance clinical efficacy, improve immune function, and increase survival rates.