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    31 December 2025, Volume 30 Issue 12
    Previous Issue   
    Viral Hepatitis
    A real world 4-year follow-up study of tenofovir alafenamide treatment for chronic hepatitis B patients
    SONG Yu-xuan, SONG Guang-jun, MA Hui, FENG Bo, XIE Yan-di
    2025, 30(12):  1604-1610. 
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    Objective To evaluate the long-term efficacy and safety of tenofovir alafenamide (TAF) for the real world treatment of chronic hepatitis B (CHB) patients. Methods Patients who received TAF treatment admitted to people's Hospital of Peking University from January to December 2019 were included in a single-center prospective study. The 114 patients were divided into two groups based on whether they had received treatment or not, 50 treatment-native and 94 treatment-experienced. They were followed up every 12 weeks for a total of 192 weeks. To analyze biochemical indicators including alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL); viral markers including hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), hepatitis B virus DNA (HBV DNA); and renal function indicators including estimated glomerular filtration rate (eGFR), urinaryretinol binding protein (URBP), β2 microglobulin (β2-MG), NAG, to evaluate the therapeutic effect of TAF and its impact on kidneys and blood lipids. Results At baseline treatment-naive patients had higher levels of ALT (179.7 U/L vs 41.6 U/L, P=0.006) and AST (124.0 U/L vs 34.6 U/L, P=0.009), while those with treatment before had higher levels of albumin (45.1 g/L vs 43.5g/L, P=0.007), lower levels of HBsAg (3.37 lgIU/mL vs 3.46 lgIU/mL, P=0.029), APRI (0.60 vs 2.53, P=0.033) and eGFR [90.74 mL(min·1.73 m2) vs 98.78 mL(min·1.73 m2), P=0.010]. The virological response rates of newly treated patients at 48 weeks, 96 weeks, 144 weeks, and 192 weeks were 76%(38/50), 90%(45/50), 96%(48/50), and 100%, with the corresponding HBeAg conversion rates were 4.8%(1/21), 14.3%(3/21), 28.6%(6/21), and 33.3%(7/21), and the HBsAg negative conversion rates were 0, 0, 2%, and 2%, respectively. The virological response rates of treated patients at 48 weeks, 96 weeks, 144 weeks, and 192 weeks were 89%(84/94), 100%, 100%, and 100%, with corresponding HBeAg conversion rates of 6.7%(3/45), 17.8%(8/45), 31.1%(14/45), and 40.0%(18/45), respectively. At baseline, the HBsAg levels in treatment-naive patients were higher than those in treatment-experienced patients (4.31 lgIU/mL vs 3.97 lgIU/mL). At 96 weeks, the HBsAg levels in treatment-naive patients began to be lower compared to those in treatment-experienced patients (3.37 lgIU/mL vs 3.67 lgIU/mL). There was a significant statistical difference (P=0.01) in the degree to which the HBsAg levels in treatment-naive patients decreased from baseline between 144 and 192 weeks. Multivariate analysis showed that baseline BMI<25 kg/m2(P=0.02) and HBsAg<3.3 lgIU/mL(P=0.04) were favorable factors for a decrease of ≥0.5 log10IU/mL in HBsAg at 48 weeks. The eGFR of treatment-experienced patients at all time points was lower than that of treatment-naive patients. Urinary URBP, β2MG and NAG showed no abnormal increase in the treatment-naive patients. There was no abnormal increase in URBP in treatment-experienced patients, but their β2MG and NAG increased at baseline and showed a decreasing trend with prolonged treatment time. All patients had an increase in TC from baseline at 144 weeks (4.66 mmol/L vs 4.95 mmol/L, P=0.01), and at 192 weeks (4.66 mmol/L vs 4.91mmol/L, P=0.03), but both did not exceed the upper limit of normal. Conclusion Extending the duration of TAF treatment can improve the virological response rate. TAF treatment showed a more significant decrease in HBsAg levels in treatment-naive patients, with high renal safety and no significant impact on blood lipids.
    An evaluation on the efficacy of serum anti-HBc versus ALT tandem HBV replication markers in identifying HBeAg-positive non-aggressive hepatitis patients with chronic HBV infection
    HUANG Dan, LU Wei, ZHANG Zhan-qing, LI Hai-cong, ZHU Zhao-qin
    2025, 30(12):  1611-1619. 
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    Objective To re-explore the functional cutoff values for serum hepatitis B core antibody (anti-HBc), alanine transaminase (ALT), hepatitis B surface antigen (HBsAg), hepatitis B core-related antigen (HBcrAg) and hepatitis B virus (HBV) DNA in identifying hepatitis B e antigen (HBeAg)-positive non-aggressive hepatitis (NAH) in patients with chronic HBV infection, in the context of disaffiliating the criteria for the natural history phases that have always been subject to disagreements and controversies, and to reappraise the performance of anti-HBc versus ALT tandem HBsAg, HBcrAg, and HBV DNA in identifying HBeAg-positive NAH. Methods 176 HBeAg-positive patients were enrolled from Shanghai Public Health Clinical Center between Feburary 2011 and August 2018, they were without antiviral therapy and followed up for 6.0 to 129.0 months, of which 43 patients had experienced spontaneous HBeAg sero-conversion (ESC). According to the sequential Kaplan-Meier survival analyses based on receiver operating characteristic (ROC) curve analyses, the functional cutoffs for anti-HBc, ALT, HBsAg, HBcrAg and HBV DNA for predicting spontaneous ESC and determining HBeAg-positive NAH termination were designated. Results Anti-HBc ≤3 lgIU/mL, ALT ≤60 U/L, HBsAg >4.602 lgIU/mL, HBcrAg >5.477 lgkU/mL and HBV DNA>7.477 lgIU/mL were designated as the functional cutoffs for identifying HBeAg-positive NAH. With criteria of the functional cutoffs, the sensitivities and specificities of low levels of anti-HBc tandem high levels of HBsAg, HBcrAg, and HBV DNA in identifying liver pathological “grade ≤G1 and stage ≤S1” were 17.6% and 94.9%, 15.7% and 96.6%, and 15.7% and 91.5%, respectively, and the positive and negative likelihood ratios of which were 3.451 and 0.868, 4.618 and 0.873, and 1.847 and 0.921, respectively; the sensitivities and specificities of low levels of ALT tandem high levels of HBsAg, HBcrAg, and HBV DNA in identifying liver pathological “grade ≤G1 and stage ≤S1” were 30.6% and 85.7%, 31.8% and 89.0%, and 34.1% and 79.1%, respectively, and the positive and negative likelihood ratios of which were 2.140 and 0.810, 2.891 and 0.766, and 1.632 and 0.833, respectively. Conclusion Low levels of anti-HBc, and ALT tandem high levels of HBsAg, HBcrAg, and HBV DNA are all effective combinations and have close capablity and similar performance in identifying HBeAg-positive NAH.
    The significance of novel biomarkers in predicting the natural course of chronic hepatitis B
    WANG Yu-jiao, CHEN Yong, TIAN Long
    2025, 30(12):  1620-1627. 
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    Objective To investigate the novel biomarkers for predicting the natural course of chronic hepatitis B (CHB) by observing the levels of hepatitis B virus (HBV) RNA, DNA, hepatitis B core-associated antigen (HBcrAg) and other markers in patients with HBV infection. Methods A total of 185 CHB patients who were treatment-naive were enrolled at the First Affiliated Hospital of Hebei North University from Jan 1, 2018 to Jan 1, 2021. The patients were divided into an immune tolerance (IT) group (n=45), an immune clearance (IC) group (n=44), a negative inactive/quiescent carrier (ENQ) group (n=48) and an HBeAg negative hepatitis (ENH) group (n=48) according to the staging criteria of HBV infection. The levels of serum HBV RNA, HBV DNA, HBcrAg and alanine aminotransferase (ALT) were detected by different methods, and the model for predicting CHB staging were established and verified via different statistical software. Results Based on the staging criteria of HBV infection, the levels of HBV DNA, HBV RNA, HBcrAg, HBsAg in IT and IC groups were significantly higher than those in ENQ and ENH groups (all P<0.001); similarily, the concentrations of alanine transaminase (ALT), aspartate transaminase (AST), glutamyl transferase (GGT), controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) in IC and ENH groups were higher than those in IT and ENQ groups (all P<0.05). The HBV RNA concentrations of each stage of infection was significantly different except for IT group when compared with IC group. The proportion of HBV RNA>6 lg copies/mL in the IT group and IC group was 93.34% and 81.82%, respectively (all P<0.05). The concentration distribution of HBcrAg in the four stages was similar to those of HBV RNA. Correlation analysis showed that HBV RNA, HBcrAg, HBV DNA concentrations were positively correlated with each other in HBeAg-positive patients (all P<0.001). In the HBeAg-negative patients, HBV RNA was positively related to HBV DNA (r=0.43) and HBcrAg (r=0.72) (all P<0.001), HBV DNA was positively associated with HBcrAg (r=0.40, P<0.001). On the basis of HBV RNA and HBcrAg, HBeAg-positive and negative patients were compared after ALT stratification, with statistically significant difference (all P<0.01). In this study, baseline data were divided into a training (n=129) and a validation (n=56) group with a ratio of 7:3. The results of C5.0 model for the significance of prediction showed that HBV RNA and ALT were important predictors, with an accuracy of 93.15%. The results of association rules showed that the predictive and association effects of ALT > 38.15, HBcrAg > 7.18, HBV RNA > 4.34 were the best. The results of internal and external validations showed that the actual observed values fit well with the predicted values by this model, and the clinical net benefit of the model was better. The area under curve (AUC) of the training group and validation group were 0.97 (95%CI: 0.94~1.00) and 0.96 (95%CI: 0.91~1.00), respectively, indicating that the training model predicted well. Conclusion Serum HBV RNA and HBcrAg combined with ALT may be helpful in monitoring the progression of CHB.
    The clinical significance of serum miR-625-5p levels in patients with chronic hepatitis B
    CHU Li, REN Chuan-lu, DING Jun, TANG Min, CAI Dong-ping, ZHOU Xin
    2025, 30(12):  1628-1631. 
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    Objective To analyze the serum levels of miR-625-5p in patients with chronic hepatitis B viral (HBV) infection and explore its potential significance in clinical diagnosis and prognosis. Methods The study was conducted from February 2021 to February 2024, including 106 confirmed cases of chronic hepatitis B (CHB), with 93 healthy individuals serving as controls during the same period of time. The serum levels of miR-625-5p, liver function, and HBV viral load were measured using quantitative real-time polymerase chain reaction (qRT-PCR). The relationship between miR-625-5p, liver function, and HBV viral load was investigated. The diagnostic values of miR-625-5p for liver inflammatory grading (G0~G4) and fibrosis staging (F0~F4) were assessed using the receiver operating characteristic (ROC) curve method. Results The values for miR-625-5p, ALT, AST levels in the control group were 1.03±0.15, (28.26±6.47) U/L, and (29.87±5.67) U/L, respectively, The values for miR-625-5p, ALT, AST levels, and HBV viral load were 0.89±0.16, (83.14±15.46) U/L, (58.36±12.41) U/L, and (10.09±3.62) IU/mL in the G0 group; 0.71±0.13, (99.57±19.82) U/L, (70.13±18.79) U/L, and (18.47±5.87) IU/mL in the G1~2 group; and 0.64±0.11, (118.41±29.59) U/L, (79.68±25.94) U/L, and (25.46±8.52) IU/mL in the G3~4 group. The differences of viral load among the groups were statistically significant (F=79.216, 337.692, 130.472, 48.862, P<0.05). There was a significant negative correlation between miR-625-5p, ALT, AST, and HBV viral load (r=-0.283, -0.212, -0.453, P<0.05). The levels of miR-625-5p, ALT, AST, and viral load were (0.92±0.21), (75.23±16.48)U/L, (63.17±16.46)U/L, and (8.76±4.89) IU/mL in patients with F0~1, and 0.68±0.17, (115.75±27.78) U/L, (74.82±23.67) U/L, and (23.79±9.33) IU/mL in patients with F2~4, respectively. The comparisons between these two groups had statistically significant differences (t=6.204, 7.675, 2.529, 8.600, P<0.05). The ROC curve evaluation of miR-625-5p for the diagnosis of liver fibrosis stages showed a sensitivity of 83.8%, a specificity of 68.7%, and an AUC of 0.806, indicating an high diagnostic value. Conclusion Low expression of miR-625-5p in patients with CHB was associated with liver inflammation and liver function impairment. Therefore, miR-625-5p could serve as a potential biomarker for CHB to assess disease’s activity and prognosis.
    Liver Tumor
    Evaluate the recurrence of hepatocellular carcinoma after transarterial chemoembolization therapy using dynamic contrast-enhanced magnetic resonance perfusion imaging combined with serum vascular endothelial growth factor levels
    WANG Bao, JI Sheng-chao, MA Le, TIAN Peng
    2025, 30(12):  1632-1636. 
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    Objective To assess the value of dynamic contrast-enhanced magnetic resonance perfusion imaging (DCE-MRI) combined with serum vascular endothelial growth factor (VEGF) levels in evaluating postoperative recurrence of hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE) therapy. Methods A total of 141 HCC patients treated between January 2019 and January 2023 were selected in this study. All patients underwent TACE. Preoperative DCE-MRI was used to measure the parameters such as the volume transfer constant (Ktrans), the efflux rate constant between extravascular extracellular space and plasma (Kep), and the volume fraction of the extravascular extracellular space (Ve). Peripheral venous blood was drawn to determine serum VEGF levels. All patients were followed up for one year post operation and categorized into recurrence (n=51) and non-recurrence groups (n=90). Logistic regression analysis was used to identify factors influencing postoperative recurrence, and the predictive value of DCE-MRI parameters and serum VEGF levels was evaluated using receiver operating characteristic (ROC) curves method. Results Patients in the recurrence group were characterized by a higher proportion of poorly differentiated tumors (66.67%) and the presence of portal vein tumor thrombus (56.86%), which were higher than those in the non-recurrence group. Additionally, preoperative levels of Ktrans, Kep, Ve, and VEGF in the recurrence group were (0.59±0.25) min, (0.98±0.33) min, (0.57±0.28) %, and (383.71±39.41) pg/mL, respectively. Multifactorial analysis indicated that Ktrans, Kep, Ve, and VEGF are important factors influencing postoperative recurrence (P<0.05). The ROC curve analysis demonstrated that the combined assessment of DCE-MRI parameters and serum VEGF levels had a predictive accuracy of 96.5% for postoperative recurrence of HCC patients after TACE therapy. Conclusion Higher preoperative DCE-MRI parameters and serum VEGF levels are associated with an increased risk of recurrence after TACE therapy in HCC patients.
    The efficacy of ALBI, Caspase-4 combined with tumor apparent diffusion coefficient value for predicting the recurrence of primary liver cancer in patients after transarterial chemoembolization therapy
    YANG Yu-jing, LIU Li-ye, YANG Hui-fang, E Nan, WANG Zhen-xia
    2025, 30(12):  1637-1641. 
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    Objective To explore the predictive value of albumin-bilirubin (ALBI), cysteine aspartic acid protease-4 (Caspase-4), and apparent diffusion coefficient value (ADC) for the recurrence of primary liver cancer (PLC) in patients after transarterial chemoembolization (TACE) therapy. Methods A total of 90 PLC patients who underwent TACE therapy and were admitted to the Department of Hepatobiliary Surgery of the Affiliated Hospital of Inner Mongolia Medical University from January 2022 to December 2024 were selected as the observation group. According to whether recurrence occurred within 6 months after TACE, they were divided into a recurrence group (n=31 cases) and a non-recurrence group (n=59 cases). Ninety healthy individuals who underwent physical examinations in our hospital during the same period of time were selected and included in the control group. The ALBI score, Caspase-4 level and ADC value were detected and compared between the observation group and the control group, and between the recurrence group and the non-recurrence group in the observation group. Pearson analysis was used to analyze the correlations between ALBI, Caspase-4 and ADC in the observation group and the levels of alpha-fetoprotein heterogeneity 3 (AFP-L3), Child-Pugh classification and Model for advanced liver Cancer (MELD) score. The receiver operating characteristic curve (ROC) was drawn to analyze the predictive efficacy of the combined detection of ALBI, Caspase-4 and ADC for the recurrence of PLC in patients after TACE treatment. Results The ALBI of the observation group was (2.34±0.47) points, which was higher than that of the control group (1.05±0.26 points). The Caspase-4 and ADC were (34.59±4.62) ng/mL and (1.93±0.45) mm2/s, respectively, which were lower than those of (57.86±6.37) ng/mL and (3.08±0.67) mm2/s in the control group, and the differences were statistically significant (t=10.265, 12.364, 8.792) All P<0.05. The ALBI of the recurrence subgroup in the observation group was (2.87±0.56) points, which was higher than that of the control group (1.93±0.32 points). The Caspase-4 and ADC were (23.65±3.09) ng/mL and (1.61±0.38) mm2/s, respectively, which were lower than those of the control group [(40.27±5.16) ng/mL and (2.36±0.59) mm2/s], and the differences were statistically significant (t=9.014, 11.276, 8.317) All P<0.05. Pearson analysis showed that in the observation group, ALBI was positively correlated with AFP-L3, Child-Pugh classification and MELD score, while Caspase-4 and ADC were negatively correlated with AFP-L3, Child-Pugh and MELD score (P<0.05). The ROC curve showed that the AUCs of single and combined detection of ALBI, Caspase-4 and ADC levels for evaluating the recurrence of PLC patients after TACE were 0.752, 0.783, 0.826 and 0.915, respectively. The sensitivity and specificity of the combined detection were both higher than those of any single detection (all P<0.05). Conclusion The combined detection of ALBI, Caspase-4 and ADC has a relatively higher predictive value for the recurrence of PLC patients after TACE therapy.
    An analysis on the expression and clinical significance of PRMT5 and ADAM17 in hepatocellular carcinoma tissue
    DAI Yi-xuan, ZHU Jie, YANG Jing-jing, WANG Qiu-lei
    2025, 30(12):  1642-1646. 
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    Objective To analyze the expression and clinical significance of histone arginine methyltransferase 5 (PRMT5) and disintegrin metalloproteinase 17 (ADAM17) in hepatocellular carcinoma (HCC) tissues. Methods Ninety-eight postoperative cancer tissues and 77 corresponding adjacent tissues from HCC patients archived in the department of pathology of Zhangjiagang First People's Hospital from September 2018 to September 2021 were collected. The expression of PRMT5 and ADAM17 in HCC and adjacent tissues was detect with Immunohistochemistry, and their clinical significance was further analyzed. Results The positive expression rate of PRMT5 and ADAM17 was 56.12% (55/98) and 65.31% (64/98) in HCC tissues and 15.58% (12/77) and 9.09% (7/77) in para-cancerous tissues, res[ectively, both of which were significantly higher in HCC tissues compared with para-cancerous tissues (P<0.001). Both PRMT5 and ADAM17 in HCC patients were correlated with tumor diameter, degree of differentiation, lymph node metastasis, Tumor-Lymph nodes-Metastasis (TNM) stage, and alpha-fetoprotein (AFP) level. Moreover, PRMT5 expression was associated with cirrhosis (P<0.05). The 3-year survival rates of patients with positive expression of PRMT5 and ADAM17 were 18.18% (10/55) and 26.56% (17/64), respectively, which were significantly lower than those of 58.14% (25/43) and 52.94% (18/34) in patients with negative expression (P<0.05). Multifactorial Cox regression analysis showed that the degree of differentiation (OR=1.892, 95% CI: 1.063~3.345, P<0.001), lymph node metastasis (OR=1.964, 95%CI: 1.102~3.457, P<0.001), TNM stage (OR=2.011, 95%CI: 1.473~4.152, P<0.001), PRMT5 expression (OR=2.100, 95%CI: 1.657~3.410, P<0.001) and ADAM17 expression (OR=2.457, 95%CI: 1.974~3.469, P<0.001) were independent factors associated with the prognosis of HCC patients. Pearson correlation analysis found that in cancer tissues of HCC patients, The expression level of PRMT5 was positively correlated with that of ADAM17 (r=0.549, P<0.05). Conclusion PRMT5 and ADAM17 are both positively expressed in HCC tissues and are correlated with clinical pathological features such as tumor diameter and differentiation degree. Patients with HCC who positively express PRMT5 and ADAM17 have a lower survival rate and thus they may serve as important indicators for evaluating patient prognosis.
    Effect and safety of TACE combined with lenvatinib mesylate and combined with apatinib in the treatment of intermediate and advanced primary liver cancer
    YAO Min, YANG Jun-jun, GUO Xiao-hong, XU Ai-bing
    2025, 30(12):  1647-1651. 
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    Objective To evaluate the effects of TACE combined with lenvatinib or combined with apatinib in treating advanced primary liver cancer (PLC). Methods Eighty-five patients (2022.01-2023.12) with middle- to late-stage PLC admitted to the Affiliated Cancer Hospital of Nantong University were selected and divided into two groups according to their treatment regimens. Forty-two patients in the control group received TACE combined with apatinib, while forty-three patients in the observation group were treated with TACE combined with lenvatinib. Results TheObjective remission rate (ORR 60.47%) and disease control rate (DCR 74.42%) in the observation group were significantly better than those in the control group (ORR 35.71%; DCR 52.38%) (P<0.05). After treatment, the level of tumor markers [CEA(13.36±2.47)ng/mL vs. (19.63±3.14)ng/mL,CA125(52.63±6.89)U/mL vs.(58.49±8.69)U/mL,VEGF(292.69±23.46)ng/mL vs. (341.63±28.48)ng/mL], liver function [TBil(16.85±3.89)μmol/L vs. (21.78±4.02)μmol/L,ALT(42.63±6.52)U/L vs. (53.69±7.25)U/L,VEGF(38.52±4.69)U/L vs. (48.20±5.06)U/L]and immune function[CD4+(46.32±4.87)% vs. (42.69±4.38)%,CD8+(22.36±3.25)% vs. (26.82±3.84)%,CD4+/CD8+ ratio(1.95±0.28) vs. (1.54±0.25)] in the observation group were better than those in the control group (P<0.05). Comparing the adverse events of the two groups, the differences were not statistically significant (P>0.05). Conclusion TACE combined with lenvatinib showed better clinical outcomes, improved tumor and immune markers, and enhanced liver function compared to TACE combined with Apatinib in patients with advanced PLC, with no significant difference in adverse reactions.
    Effect of transarterial chemoembolization combined with camrelizumab on immune function and tumor markers in patients with primary liver cancer
    LIU Mei-qiang, GAO Yong-jiang
    2025, 30(12):  1652-1655. 
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    Objective To explore the effectiveness of combining transarterial chemoembolization (TACE) with camrelizumab in treating primary liver cancer. Methods Ninety-six individuals with primary liver cancer treated in Shenmu City Hospital from January 2020 to January 2022 were randomly assigned into treatment group and control group. Two groups underwent TACE, and the observation group additionally received Camrelizumab for three months. The clinical efficacy was evaluated and the immune function, tumor marker levels, liver function, and serum levels of PD-1and VEGF were compared after three months of treatment. Progression-free survival (PFS) and survival rates over a 2-year follow-up period were also compared. Results The overall effective treatment rate for the treatment group was 78.17% (38/48), which was greater than the 54.17% (26 out of 48) in the control group. Following three months of therapy, the levels of CD3+, CD4+, and CD4+/CD8+ ratios in the treatment group were (47.21±5.23)%, (34.71±4.04)%, and (2.11±0.42) respectively, and the levels of CD8+, tumor markers, liver function indicators, PD-1, and VEGF were reduced in the treatment group compared to the control group, all showing statistical significance (all P<0.05). PFS in 2-year and survival rates of the treatment group were (15.83±2.69) months and 79.17% (38/48) respectively, compared to (10.44±2.01) months and 54.17% (26/48) in the control group, with significant statistical differences observed (P<0.05). Conclusion TACE combined with Camrelizumab enhances immune function and reduces tumor marker levels in patients with primary liver cancer.
    Application of transarterial chemoembolization, camrelizumab and lenvatinib in the treatment of unresectable hepatocellular carcinoma
    LIN Jian-quan, HUANG Can-po, LI Ming-xing
    2025, 30(12):  1656-1659. 
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    Objective To explore the efficacy and safety of transarterial chemoembolization (TACE) combined with camrelizumab and lenvatinib in the treatment of unresectable hepatocellular carcinoma (HCC). Methods Eighty-six HCC patients treated at our hospital from March 2019 to March 2021 were selected as the study sample and randomly divided into two groups. The control group (n=43) received TACE alone, while the experimental group (n=43) underwent TACE combined with lenvatinib and camrelizumab. The efficacy, tumor marker levels [serum alpha-fetoprotein (AFP), abnormal prothrombin (PIVKA-Ⅱ), carbohydrate antigen 199 (CA199), and carcinoembryonic antigen (CEA)], maximum tumor diameter after treatment, survival status, and adverse reactions (liver function damage, thyroid dysfunction, hypertension, gastrointestinal bleeding, anemia, leukopenia) were compared between the two groups. Results The experimental group demonstrated superior clinical outcomes, with anObjective response rate (ORR) of 39.5% and a disease control rate (DCR) of 81.4%, compared to 18.6% and 55.8% in the control group, respectively (χ2=4.568, 6.532; P=0.033, 0.011). Serum levels of AFP, PIVKA-Ⅱ, and CA199 in the experimental group were (78.9 ± 17.4) ng/mL, (41.7 ± 10.4) ng/mL, and (18.0 ± 4.8) kU/L, respectively, which were significantly lower than those in the control group [(152.6±31.5) ng/mL, (85.4 ± 18.4) ng/mL,(24.1 ± 4.7) kU/L] (t=17.233, 12.855, 6.188; P<0.05). The average maximum tumor diameter was significantly smaller in the experimental group [(4.61 ± 0.5) cm] than in the control group [(6.23 ± 0.8) cm] (t=10.551; P<0.05). After two years of follow-up, the median progression-free survival (PFS) in the experimental group was 17.5 months, compared to 13.8 months in the control group. Although the difference in PFS rate (39.5% vs. 27.9%) was not statistically significant (P>0.05), the experimental group demonstrated a significantly longer median overall survival (OS) of 21.2 months versus 17.2 months in the control group, with OS rate also higher (65.1% vs. 50.0%) (P<0.05). The incidence of gastrointestinal adverse events was lower in the experimental group (13.9%) than in the control group (37.2%) (χ2=6.108; P=0.013). Conclusion The combined therapy of TACE with camrelizumab and lenvatinib for patients with unresectable hepatocellular carcinoma has shown potential to significantly enhance treatment effects, reduce tumor marker levels, decrease maximum tumor diameter, significantly improve overall survival, and is controllable in terms of adverse reactions, presenting a promising clinical application prospect.
    Diagnostic manifestations of quantitative parameters of energy spectrum CT in hepatocellular carcinoma and its differentiation from hepatic hemangioma
    SUN Yi-feng, WU Hua-ping, HUANG Jing-jing
    2025, 30(12):  1660-1663. 
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    Objective To explore the diagnostic value of quantitative parameters of energy spectrum CT in hepatocellular carcinoma (HCC) and its differentiation from hepatic hemangioma (HH). Methods Between January 2021 and December 2024, 82 patients who were initially diagnosed with intrahepatic space occupying lesions were collected in Dongtai Hospital of Traditional Chinese Medicine, of whom 42 were diagnosed with HCC and 40 with HH by histopathological results obtained by ultrasound-guided puncture or surgical resection. The CT values of the lesions in HCC and HH patients at different keV energy levels were analyzed, and the iodine concentration (IC), water concentration (WC), iodine uptake ratio (IUR) and Effective-Z atomic number of HCC and HH were compared. Results Generally speaking, the CT values of HCC and HH patients decreased with the increase of keV energy level. The CT value of HCC at 40 ~ 90 keV energy level was significantly higher than that of HH (P<0.05). There was no significant difference in CT values between HCC and HH at the energy level of 100～140 keV (P>0.05). There was no significant difference in WC between HCC and HH patients in arterial phase and portal phase (P>0.05). However, IC, IUR, Effective-Z and the slope of energy spectrum curve of HCC patients in arterial phase and portal phase were significantly higher than HH(P<0.05). The cutoff points of quantitative parameters such as IC, IUR, Effective-Z and the slope of the focus energy spectrum CT in differentiating HCC and HH in arterial phase and portal phase were 1.8(100 μg/cm3), 2.0, 7.9 and 1.9; 2.0(100 μg/cm3), 0.9, 8.3 and 2.0. The sensitivity, specificity, accuracy, area under the curve (AUC) and Kappa values of combined diagnosis of arterial phase and portal phase were significantly higher than those of single diagnosis of arterial phase and portal phase (P<0.05). Conclusion Quantitative parameters of energy spectrum CT (IC, IUR, Effective-Z and slope of energy spectrum curve) are of great value in the differential diagnosis of HCC and HH. The combined diagnosis of arterial phase and portal phase significantly improves the sensitivity, specificity and accuracy of diagnosis.
    Multimodal ultrasonographic features and diagnostic performance of hepatic hemangioma
    SHI Jing, ZHOU Feng-sheng, ZHU Qiao-ying, ZHAN Li-li
    2025, 30(12):  1664-1667. 
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    Objective To perform a comprehensive analysis of multiple ultrasonographic modalities and provide a more accurate andObjective basis for the qualitative diagnosis of hepatic hemangioma (HH). Methods A total of 122 patients with pathologically confirmed HH and 80 patients with hepatocellular carcinoma (HCC) admitted between January 2022 and August 2024 were enrolled. The ultrasonographic features of HH and HCC under different imaging modalities were compared, and their diagnostic performance for HH was evaluated. Results Compared with the HCC group, HH lesions more frequently exhibited homogeneous internal echotexture, a distinct marginal fissure sign, and reticular internal echoes (P<0.05). The incidence of posterior acoustic enhancement and non-calcified posterior acoustic shadowing was also significantly higher in the HH group (P<0.05). In addition, HH lesions were more deformable under probe compression, indicating a softer and more compressible texture, whereas HCC lesions were firm and resistant to deformation. On color Doppler flow imaging (CDFI), HH lesions showed sparse blood flow signals predominantly with a “track-like” pattern, while HCC lesions demonstrated abundant blood flow and a central flow pattern. The venous-like low-velocity spectrum was more common in HH, and the peak flow velocity was significantly lower than that of HCC (P<0.05). Shear wave elastography (SWE) revealed that both the Young’s modulus value and tumor-to-liver elasticity ratio of HH were significantly lower than those of HCC (P<0.05). HH lesions predominantly displayed blue/green low-elasticity patterns with a “high-peripheral-low-central” distribution, consistent with the histological characteristics of central cavernous dilation and peripheral fibrosis. In contrast, HCC lesions primarily presented a mosaic pattern, reflecting heterogeneous stiffness due to necrosis and neovascularization. On contrast-enhanced ultrasound (CEUS), HCC lesions mainly exhibited a “fast-in and fast-out” enhancement pattern, whereas HH lesions typically showed peripheral nodular enhancement in the arterial phase, centripetal filling, and the “black hole sign”. During the portal phase, the time required for HH lesions to achieve 50% centripetal filling was significantly longer than that of HCC (P<0.05), and HH maintained iso- or hyper-enhancement in the delayed phase. The combined multimodal diagnostic approach integrating B-mode structural features, CDFI hemodynamics, SWE elasticity parameters, and CEUS perfusion patterns markedly improved the differentiation between HH and HCC. Conclusion HH exhibits characteristic imaging features across B-mode, CDFI, SWE, and CEUS modalities. Multimodal ultrasonographic analysis significantly enhances the sensitivity and specificity for diagnosing HH, providing a more comprehensive and reliable imaging basis for differentiating benign and malignant hepatic lesions.
    The mechanism of metformin inhibiting liver cancer cell proliferation through the REDD1-mTOR signaling pathway
    WANG Yan, LI Qin, LI Jun-jun, ZHANG Xiao-li, Tan Li-ling
    2025, 30(12):  1668-1673. 
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    Objective To investigate the mechanism by which metformin (MET) inhibits the proliferation of liver cancer cells by regulating the regulated in development and DNA damage response 1 (REDD1) - mammalian target of rapamycin (mTOR) signaling pathway. Methods MTT assay was used to detect the effects of different concentrations of MET (0.0, 2.5, 5.0, 10.0 mmol/L) on the proliferation of HepG2 cells. 10.0 mmol/L MET was selected for subsequent experiments and the cells were separated into Control group, MET group, sh-NC group, and sh-REDD1 group. QRT-PCR method was applied to detect the expression of REDD1 mTOR p70s6k and Cyclin D1 mRNA in HepG2 cells in each group. The plate cloning experiment was applied to detect the proliferation of HepG2 cells in each group. Flow cytometry was applied to detect the cell cycle of HepG2 in each group. WB was applied to detect the expression of REDD1, mTOR, p70s6k, and Cyclin D1 proteins in HepG2 cells of each group. Results The proportion of G1 phase cells (81.25%±10.35%), apoptosis rate(42.55%±4.52%), REDD1 mRNA (7.52±0.80) and protein expression (0.86±0.13) in the MET group were higher than those in the Control group 36.58%±8.49%,1.87%±0.64%,1.00±0.33,0.27±0.08, the proportions of S phase(11.19%±2.58%) and G2 phase cells(7.56%±2.12%), number of clones(53.41±9.28 number), mTOR mRNA (0.36±0.08) and protein (0.52±0.15), p70s6k mRNA (0.47±0.14) and protein (0.43±0.09) , and Cyclin D1 mRNA (0.53±0.13) and protein expression (0.48±0.11) were lower than those in the control group (30.87%±4.28%, 32.55%±4.36%, 118.43±12.92 number, 0.99±0.12, 1.17±0.17, 1.00±0.21, 0.94±0.14, 1.01±0.17, 1.05±0.17) (P<0.05). Compared with the MET group and sh-NC group, proportion of G1 phase cells, apoptosis rate, REDD1 mRNA and protein expression in the sh-REDD1 group were lower, the proportions of S phase and G2 phase cells, number of clones, mTOR mRNA and protein, p70s6k mRNA and protein, and Cyclin D1 mRNA and protein expression were higher (P<0.05). Conclusion MET can inhibit the proliferation activity of HepG2 cells, and its possible molecular mechanism is to exert an inhibitory effect on liver cancer cell proliferation through the REDD1-mTOR signaling pathway.
    Liver Fibrosis&Cirrhosis
    Effects of changes in SHP2 expression on the activation of human hepatic stellate cell LX-2 based on ERK1/2 signaling pathway
    HAO Li-sen, GAO Ying-ying, ZHAN Zong-yuan, LIAN Jun, LIU Tian, WANG Jin-mei, YANG Dong-jie, MAO Jia-qi
    2025, 30(12):  1674-1677. 
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    Objective To explore the effects of changes in protein tyrosine phosphatase 2 (SHP2) expression on activation and extracellular signal regulated kinase 1/2 (ERK1/2) in human hepatic stellate cell LX-2. Methods Adenovirus Ad-SHP2 with wild-type SHP2 gene and Ad-shRNA/SHP2 with shRNA targeting SHP2 were introduced into LX-2 cells cultured in vitro, respectively. Application of real-time fluorescence quantitative PCR and Western blot to analyze expression of SHP2 and ERK1/2 in LX-2 cells. Expression of phosphorylated ERK1/2 (p-ERK1/2) in LX-2 cells was analyzed by Western blot analysis. The expression of α-smooth muscle actin (α-SMA), an activated marker of hepatic stellate cells was detected immunocytochemical staining and Western blot. DMEM was used instead of adenovirus to transfect LX-2 cells in control group, the LX-2 cells was transfected with empty virus Ad-GFP in Ad-GFP group. Ad-SHP2 was transfected into LX-2 cells in Ad-shRNA/SHP2 group. Results Wild-type SHP2 and shRNA targeting SHP2 significantly increased and decreased the expression of SHP2 in LX-2 cells (P<0.05). Immunocytochemical staining showed that compared with the positive expression integral optical density (IOD) of α-SMA protein in LX-2 cells in control group and Ad-GFP group (0.073±0.003, 0.074±0.004), that in Ad-shRNA/SHP2 group (0.048±0.003) showed a significant (P<0.05) decrease and in Ad-SHP2 group (0.127±0.004) remarkably (P<0.05) increased. Expression levels of α-SMA and p-ERK1 protein in LX-2 cells of Ad-shRNA/SHP2 group (0.154±0.033, 0.134±0.023) significantly (P<0.05) lowered and in Ad-SHP2 group (0.517±0.036, 0.522±0.053) exhibited a significant (P<0.05) increase compared with those in control group (0.342±0.043, 0.302±0.035) and Ad-GFP group (0.308±0.038, 0.315±0.037). There was no significant difference in ERK1 mRNA and protein expression of LX-2 cells among 4 groups (P<0.05). Conclusion Overexpressed SHP2 can promote activation of LX-2 cells, while low expression of SHP2 can suppress activation of LX-2 cells, and the ERK1/2 signaling pathway mediates the effects of SHP2 on activation of LX-2 cells.
    Evaluation of hepatic blood flow ultrasound parameters in assessing esophageal varices in patients with hepatitis B cirrhosis
    NUlimangu·Maimaiti, BUajiguli·Yasenjiang, SONG Tao, LIU Huan, WU Shi-ji, DIlinuer·Yuetikuer
    2025, 30(12):  1678-1681. 
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    Objective To explore the evaluation value of hepatic blood flow ultrasound parameters in assessing esophageal varices (EV) in patients with hepatitis B cirrhosis and to assess their potential role in predicting the occurrence and severity of EV. Methods A total of 118 patients with hepatitis B-related cirrhosis who underwent Doppler ultrasound and contrast-enhanced ultrasound from October 2022 to November 2023 at our hospital were selected. Liver blood flow ultrasound parameters and the Fibrosis-4 (FIB-4) index were measured, and all patients underwent gastroscopy to assess the occurrence and severity of EV. Results Gastroscopy revealed that 80 patients had esophageal varices (EV), with 21 severe EVs, 30 moderate EVs, and 29 mild EVs. In the cirrhosis with EV group, the portal vein velocity (PVV) and hepatic vein arrival time (HVAT) were (15.42 ± 2.63) cm/s and (15.55 ± 2.74) s, respectively, lower than those in the cirrhosis-only group, which were (18.71 ± 2.43) cm/s and (21.82 ± 3.84) s (P<0.001). The portal vein diameter (PVD), portal vein pressure index (PV-CI), hepatic vein diameter index (HV-DI), and FIB-4 index were (1.71 ± 0.34) cm, (0.41 ± 0.13) cm/s, (0.82 ± 0.21), and (4.81 ± 1.70), respectively, higher than those in the cirrhosis-only group, which were (1.32 ± 0.31) cm, (0.22 ± 0.11) cm/s, (0.61 ± 0.13), and (2.82 ± 1.02) (P<0.001).In the different severity groups of EV, patients with severe EV had a PVV of (12.42 ± 2.92) cm/s and HVAT of (9.26 ± 2.94) s, lower than the PVV of (14.92 ± 2.20) cm/s and HVAT of (13.03 ± 2.46) s in the moderate EV group, or the PVV of (18.11 ± 2.24) cm/s and HVAT of (22.71 ± 2.52) s in the mild EV group (P<0.001), the PVD, PV-CI, HV-DI, and FIB-4 index in the severe EV group were (2.39 ± 0.52) cm, (0.81 ± 0.24) cm/s, (1.22 ± 0.23), and (6.71 ± 1.91), higher than those in the moderate EV group, which were (1.62 ± 0.20) cm, (0.32 ± 0.10) cm/s, (0.83 ± 0.21), and (4.93 ± 1.74), and the mild EV group, which were (1.31 ± 0.21) cm, (0.21 ± 0.10) cm/s, (0.52 ± 0.10), and (3.31 ± 1.16) (P<0.001).In a 12-month follow-up, 54 patients had bleeding from esophageal varices (EVB). The PVV and HVAT in the bleeding group were (14.72 ± 2.51) cm/s and (12.91 ± 2.13) s, lower than those in the non-bleeding group, which were (16.87 ± 2.77) cm/s and (21.03 ± 3.24) s (P<0.001). The PVD, PV-CI, HV-DI, and FIB-4 index in the bleeding group were (1.85 ± 0.42) cm, (0.49 ± 0.23) cm/s, (0.90 ± 0.22), and (5.40 ± 1.93), higher than those in the non-bleeding group, which were (1.42 ± 0.32) cm, (0.24 ± 0.11) cm/s, (0.65 ± 0.11), and (3.58 ± 1.40) (P<0.001). Conclusion Hepatic blood flow ultrasound parameters, such as PVV, HVAT, PVD, PV-CI, and FIB-4, are of significant clinical value in evaluating the severity of esophageal varices and the risk of bleeding in patients with hepatitis B cirrhosis, providing an effective tool for clinical assessment.
    The construction of a risk model for esophageal and gastric variceal bleeding in cirrhotic patients involves analyzing the influencing factors
    XU Jing-jing, ZONG Fu-qiang
    2025, 30(12):  1682-1686. 
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    Objective To investigate the influencing factors of esophageal and gastric variceal bleeding (EGVB) in cirrhotic patients and develop a risk model. Methods 128 cirrhotic patients with esophageal and gastric varices (EGV) admitted to Zhangjiagang Aoyang Hospital were randomly divided into a training set of 102 cases and a validation set of 26 cases at an 8∶2 ratio. Based on the occurrence of esophageal and gastric variceal bleeding (EGVB), they were divided into an EGVB group of 48 cases and a non-EGVB group of 54 cases. The risk factors for EGVB in EGV patients with cirrhosis were screened, and a risk model was constructed and validated for predicting EGVB in cirrhosis. Results The PLT level in the EGVB group was (77.31 ± 8.02) × 109/L, which was lower than that in the non-EGVB group [(89.61 ± 9.75) × 109/L, P<0.05]. The PT, splenic vein diameter, spleen elasticity value, and the proportion of moderate-to-severe EGV in the EGVB group were (19.82 ± 4.05) s, (11.03 ± 2.75) mm, (16.85 ± 2.14) kPa, and 91.67%, respectively, all of which were higher than those in the non-EGVB group [(15.61 ± 3.27) s, (8.41 ± 2.91) mm, (12.68 ± 2.81) kPa, and 75.93%, P<0.05]. PLT, PT, splenic vein diameter, spleen elasticity value, and EGV severity are influencing factors for the occurrence of EGVB in cirrhotic patients with EGV (P<0.05). The sensitivity, specificity, and area under the curve of the risk model prediction training set for liver cirrhosis EGVB are 0.775, 0.865, and 0.875, respectively. The sensitivity of the risk model prediction validation set for liver cirrhosis EGVB is 0.763, the specificity is 0.841, and the area under the curve was 0.861. Conclusion PLT, PT, inner diameter of splenic vein, splenic elasticity value, and severity of EGV are related to the occurrence of EGVB in liver cirrhosis. Constructing a risk model is helpful for early assessment of EGVB in liver cirrhosis.
    Evaluation of liver fibrosis in chronic hepatitis B by liver stiffness measurement combined with portal vein hemodynamics
    LIU Jing, GONG Li, JIANG Yuan-man
    2025, 30(12):  1687-1690. 
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    Objective The role of liver stiffness measurement combined with portal venous hemodynamic parameters in evaluting hepatic fibrosis states in patients with CHB. Methods 145 patients with CHB who were diagnosed and treated in Santai County People's Hospital between February 2020 and June 2024 were collected. According to the degree of liver fibrosis, patients with CHB were divided into a mild fibrosis group and a severe fibrosis group, and the differences in LSM and portal vein hemodynamics indexes between the two groups were compared, and the evaluation efficiency of LSM and portal vein hemodynamic indexes for severe liver fibrosis and cirrhosis was analyzed. Results Among 145 patients with CHB, 49 cases were mild and 96 cases were severe liver fibrosis. The values of LSM, PVD, PVVmean, PVQ, and CI in mild hepatic fibrosis were (6.3±1.1) kPa, (1.0±0.2) cm, (16.9±0.6) cm/s, 1 030.0 (895.6~1 233.5) mL/min, and (0.05±0.01), respectively. These parameters showed statistically significant differences compared to those in severe hepatic fibrosis [(13.0±1.8) kPa, (1.4±0.4) cm, (14.8±0.5) cm/s, 1 570.2 (1 382.4~1 687.5) mL/min, and (0.09±0.02), P<0.05]. Taking the above indexes as test variables and the severity of liver fibrosis as state variables, the evaluation efficiency of LSM and portal hemodynamics indexes in patients with severe liver fibrosis in CHB was analyzed. The results showed that the AUC, sensitivity and specificity of combined diagnosis of LSM, PVD, PVVmean, PVQ and CI were higher than those of single diagnosis (P<0.05). Thirty-seven patients with severe liver fibrosis can be diagnosed as cirrhosis. In non-cirrhotic patients, the values of LSM, PVD, PVVmean, PVQ, and CI were (11.0±1.4) kPa, (1.2±0.3) cm, (16.7±1.0) cm/s, 1 530.2 (1 382.4~1 577.2) mL/min, and (0.08±0.02), respectively. These parameters demonstrated statistically significant differences when compared to cirrhotic patients [(16.1±2.1) kPa, (1.7±0.4) cm, (11.8±0.4) cm/s, 1 611.4 (1 424.3~1 687.5) mL/min, and (0.11±0.02), P<0.05]. Taking the above indexes as test variables and cirrhosis status as the state variable, the evaluation efficiency of LSM and portal hemodynamics in patients with CHB was analyzed. The results showed that the AUC, sensitivity and specificity of combined diagnosis of LSM, PVD, PVVmean, PVQ and CI were higher than those of single diagnosis (P<0.05). Conclusion LSM combined with portal hemodynamics can effectively differentiate hepatic fibrosis state in CHB patients, which can be popularized in clinical practice.
    The value of remazolam mesylate in endoscopic varicose vein ligation under general anesthesia in elderly patients with liver cirrhosis
    LI Zhao-gang, GONG Zheng-jun
    2025, 30(12):  1691-1694. 
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    Objective Observation of the value of remazolam mesylate in endoscopic varicose vein ligation under general anesthesia in elderly patients with cirrhosis. Methods 160 cases of elderly cirrhotic patients who underwent endoscopic varicose vein ligation under general anesthesia in our hospital from January 2022 to December 2024 were selected and divided into two groups using a random number table. The control group was given propofol anesthesia induction and maintenance, and the observation group was given remazolam mesylate anesthesia induction and maintenance. Differences in hemodynamic parameters, operative time, anesthetic recovery time, vasoactive drug use rate, cumulative postoperative cognitive dysfunction (POCD) incidence, and incidence of adverse reactions were compared between the two groups. Results There was no difference in hemodynamic comparison between the two groups at preoperative (T0) (P>0.05). Mean arterial pressure (MAP) and heart rate (HR) were lower at intraoperative nadir (T1) than at T0 in both groups, but were higher at T1 in the observation group than in the control group (P<0.05). Blood oxygen saturation (SpO2) at T1 and immediate postoperative (T2) was higher than at T0 in both groups, but there was no difference between the two groups (P>0.05). There was no difference between the two groups in MAP and HR at T2 compared to T0 within each group, and no significant difference between the two groups at T2 (P>0.05). The recovery time of consciousness (4.21±1.29) min and PACU stay (12.33±3.16) min in the observation group were shorter than those in the control group, and the cumulative POCD incidence rate in the 5d postoperative period (5.00%) was lower than that in the control group (P<0.05), and the operative time, the rate of use of vasoactive drugs, and the cumulative POCD incidence rate in the observation group in the 1d postoperative period and 3d postoperative period compared with those in the control group(P>0.05). There was no difference in the incidence of adverse reactions between the observation group and the control group (P>0.05). Conclusion The use of remazolam mesylate in general anesthesia for endoscopic varicose vein ligation stabilizes intraoperative hemodynamics, promotes awakening, and reduces postoperative POCD in elderly cirrhotic patients.
    Metabolic Associated Fatty Liver Disease
    The causal relationship between daytime nap and non-alcoholic fatty liver disease: a two-sample mendelian randomization analysis
    WANG Ji-cai, ZHANG Guang-quan, WU Fen-fang, SHI Xian-jie
    2025, 30(12):  1695-1699. 
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    Objective To explore the causal relationship between daytime nap and the risk of non-alcoholic fatty liver disease by using two sample Mendelian randomization analysis. Methods Dataset of daytime nap and non-alcoholic fatty liver disease were obtained from the IEU Open GWAS database. Using the inverse variance weighting, MR Egger, and weighted median methods to explore the causal relationship between daytime nap and non-alcoholic fatty liver disease, and using Cochran's Q test, MR Egger regression, MR-PRESSO, Leave one out, funnel plot, and forest plot methods to evaluate the stability and reliability of the research results. Results The causal effects obtained by the three methods were consistent, and the inverse variance weighting method had statistical significance (OR=2.166, 95% CI=1.274~3.684, P=0.004). The results of WME analysis (OR=1.643, 95%CI=0.758~3.564, P=0.209). MR-Egger regression showed (OR=4.201, 95%CI=0.591~29.863, P=0.155). IVW test (Q=105.474, P=0.217) and MR-Egger test (Q=104.946, P=0.207) results did not show significant heterogeneity. MR-PRESSO analysis (P=0.246) and MR-Egger regression analysis (P=0.493) did not support the presence of horizontal pleiotropy, and the findings were robust. Conclusion From a genetic perspective, this study preliminarily revealed a positive causal relationship between nap time and the risk of non-alcoholic fatty liver disease.
    Risk factors analysis of type 2 diabetes mellitus with metabolically associated fatty liver disease and correlation with thyrotropin and osteocalcin
    YE Jing-jing, LI Jian-ping, GU Yan-hong, XI Wei
    2025, 30(12):  1700-1705. 
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    Objective To analyze the risk factors of type 2 diabetes mellitus (T2DM) combined with metabolically associated fatty liver disease (MAFLD), and explore the correlation with thyrotropin (TSH) and osteocalcin (OC). Methods A total of 372 T2DM patients admitted to the Department of Endocrinology of Haian People's Hospital from January 2022 to March 2024 were collected and divided into MAFLD group (n=228) and non-MAFLD group (n=144) according to the results of abdominal color ultrasonography. Baseline data and clinical indicators of the two groups were collected and compared. Multivariate logistic regression was used to analyze the risk factors for MAFLD in T2DM patients, and the evaluation value of individual risk factors and prediction model was plotted by ROC analysis. Results The levels of BMI, FBG, HbA1c, ALT, AST, ALP, TG, TyG and TSH in T2DM group with MAFLD were (26.38±1.45) kg/m2, (8.35±1.76) mmol/L, 8.79%±1.83%, (35.68±5.92) U/L and (41.56±6.41) U /L, (79.68±9.53) U/L, (2.14±0.53) mmol/L, 8.85±1.79, (1.96±0.48) μU/mL, higher than that in the non-MAFLD group [(24.52±1.34) kg/m2, (7.26±1.54) mmol/L, 7.32%±1.51%, (32.57±5.63) U/L, (37.18±6.15) U/L, (61.37±8.64) U/L, (1.85±0.49) mmol/L, 7.24±1.46, (1.63±0.42) μU/mL)]; The OC level in the MAFLD group was (4.02±0.85) ng/L, and the difference was statistically significant between two groups (6.38±1.02 ng/L) (t/χ2=6.028, 5.794,6.372,5.872, 5.659, 6.836, 5.328, 6.578, 7.204, 8.529, all P<0.05). Logistic regression analysis showed that increased levels of HbA1c, ALP, TyG and TSH and decreased levels of OC were independent influencing factors for the occurrence of MAFLD in T2DM patients (95%CI 0.964~1.478, 0.624~1.056, 1.027~1.619, 0.839~1.372, 0.706~1.235. OR=1.217, 0.839, 1.348, 1.105, 0.972, all P<0.05); TyG had the highest sensitivity and HbA1c had the highest specificity. Conclusion The elevated levels of HbA1c, ALP, TyG and TSH and the decreased levels of OC are independent risk factors for NAFLD in T2DM patients, which can provide a reference for early diagnosis and timely intervention.
    Changes of peripheral blood lymphocyte and CD4+T cell subsets in patients with nonalcoholic fatty liver disease and psoriatic arthritis and their relationship with dyslipidemia
    SHEN Yan, ZHANG Li, ZHOU Hui-min
    2025, 30(12):  1706-1709. 
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    Objective To analyze the changes of peripheral blood lymphocyte subsets and blood lipid levels in patients with nonalcoholic fatty liver disease (NAFLD) complicated with psoriasis, and to analyze their influence on the occurrence of psoriatic arthritis (PA). Methods Between February 2020 and February 2024, 105 patients with NAFLD complicated with psoriasis in our hospital were divided into non-PA group and PA group according to whether they were complicated with PA. The general data, lymphocyte subsets and blood biochemical indexes, of the two groups were compared, and the factors affecting PA in NAFLD complicated with psoriasis were analyzed by multivariate logistic regression. Results Among 105 patients with NAFLD complicated with psoriasis, 14 patients were complicated with PA (PA group). The scores of BMI, diabetes, FBG, HbA1C, hyperlipidemia, metabolic syndrome, fatty liver, lesion area and lesion severity in patients with non-PA group were 24.0 kg/m2, 28 cases (30.8%), 6.5 mmol/L, 6.1%, 43 cases (47.2%), 37 cases (40.6%), 33 cases (36.3%), 4.7 points and 3.5 points, compared with PA group [25.4 kg/m2, 9 cases (64.3%), 7.7 mmol/L, 6.9%, 12 cases (85.7%), 11 cases (40.7%) , 10 cases (71.4%), 6.7points and 4.5points], the difference was statistically significant (P<0.05). The percentage of CD4+ cells and CD4+/CD8+ cells in peripheral blood of patients with non-PA were 35.4 % and 1.3,), which were significantly higher than those of patients with PA (32.7% and 1.1, P<0.05). Substituting these differences into multivariate analysis, hyperlipidemia, metabolic syndrome, fatty liver and CD4+/CD8+ are independent risk factors for PA in patients with NAFLD complicated with psoriasis (P<0.05), while HDL is a protective factor (P<0.05). Conclusion The occurrence of PA is influenced by multiple factors, and the existence of NAFLD may increase the risk of PA in psoriasis by promoting inflammatory response and immune disorder. The changes of blood lymphocyte subsets and blood lipid indexes further reveal the complex interaction between metabolism and immune system. Hyperlipidemia, metabolic syndrome, fatty liver and LDL are independent risk factors for PA in patients with NAFLD complicated with psoriasis, while HDL is a protective factor.
    Other Liver Diseases
    Comparison of the efficacy between ultrasound-guided percutaneous liver abscess aspiration and catheter drainage in treating type 2 diabetes mellitus complicated with liver abscess
    XU Teng-yun, ZHU Mei-di, KAN Xiao-chun, CHEN Chao-bo
    2025, 30(12):  1710-1713. 
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    Objective To compare the efficacy of ultrasound-guided percutaneous liver abscess aspiration versus catheter drainage in treating type 2 diabetes mellitus (T2DM) complicated with liver abscess. Methods A total of 83 patients with T2DM complicated by liver abscess admitted to our hospital between June 2021 and March 2025 were divided into an observation group (n=41, aspiration) and a control group (n=42, drainage) based on the intervention. Perioperative indicators, liver function, WBC counts, inflammatory cytokines, and complications in our study were compared between two groups. Results The observation group showed significantly shorter recovery times of body temperature (3.4±1.2) days, WBC normalization (4.3±1.3) days, liver pain resolution (1.2±0.5) days, and abscess cavity disappearance (7.2±1.5) days compared to the control group [(3.7±1.4) days, (6.2±1.0) days, (1.5±0.6) days, and (10.5±2.8) days, respectively; P<0.05]. After 1 week of treatment, liver function were improved significantly in both groups (P<0.05), but no intergroup differences were observed in ALT, AST, or Alb levels before or after treatment (P>0.05). Similarly, WBC, IL-6, PCT, and TNF-α levels decreased significantly post-treatment (P<0.05), with no intergroup differences (P>0.05). Complications (e.g., hemorrhage, hematoma, incision infection, bile leakage, biliary peritonitis, pneumothorax) occurred in 3 cases (7.3%) in the observation group were significantly lower than the control group [10 cases (23.8%), P<0.05]. Conclusion Ultrasound-guided percutaneous liver puncture and pus aspiration can relieve clinical symptoms more quickly and promote the disappearance of pus cavity, and has a lower incidence of complications than catheter drainage.
    Correlation analysis between serum IL-8 level and native liver survival time in patients with biliary atresia after Kasai procedure
    LIU Li-wei, WANG Yan, LI Shan-shan, ZHU Zhi-jun, CHEN Yu, ZHAO Xin-yan
    2025, 30(12):  1714-1719. 
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    Objective This study aims to investigate whether cytokines examination can early identify patients with short-term native liver survival time after Kasai procedure (KP), thereby providing a basis for early liver transplantation in this group of patients and improving postoperative outcomes. Methods This study included children who underwent liver transplantation due to biliary atresia (BA) from July 2017 to June 2019, all of whom had previously undergone the KP. Based on whether the native liver survival time after KP exceeded one year, patients were divided into two groups: the early failure group (KP-EF) and the late failure group (KP-LF). We collected demographic data, laboratory results, and pathological information, and assessed the levels of 38 serum cytokines and their correlation with prognosis. Results Compared to the KP-LF group, the KP-EF group had significantly higher levels of IL-8 (121.4±142.7 vs. 43.3±68.3, P<0.05). IL-8 levels were negatively correlated with autologous liver survival time after KP (R=-0.584, P<0.001) and positively correlated with both Child-Pugh and PELD scores (R values of 0.438 and 0.481, respectively, P<0.05). Conclusion In patients with BA, short-term native liver survival time after KP is associated with higher levels of IL-8 and poorer prognosis. IL-8 may provide important insights for clinicians to early identify patients with early liver failure.
    Characteristics of common bile duct stones with periampullary diverticulum and their impact on ERCP procedure and related complications
    LIU Xin, WANG Xiao-juan, HAN Su-yan, DU Juan
    2025, 30(12):  1720-1723. 
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    Objective To analyze the clinical data of patients with common bile duct stones accompanied by periampullary diverticulum, investigate the characteristics of the stones, ERCP-related procedural parameters, and complication rates, and provide evidence-based guidance for clinical practice. Methods A total of 120 patients with CBD stones who underwent ERCP between December 2022 and December 2024 were retrospectively analyzed in our hospital. Among them, 21 patients (17.5%) had concomitant PAD. General clinical characteristics, ERCP-related procedural data, and complications were compared between patients with and without PAD. Results Compared with patients without PAD, those with PAD had significantly higher rates of prior cholecystectomy, longer stone length, greater number of stones, and larger CBD diameter (P<0.05). PAD patients also had significantly larger balloon dilation diameters, increased intraoperative bleeding, higher rates of plastic stent placement and nasobiliary drainage, increased need for mechanical lithotripsy, lower stone clearance rates, greater difficulty in cannulation, longer cannulation time, and prolonged procedure time compared to those without PAD (P<0.05). Complications during treatment included post-ERCP pancreatitis, biliary tract infection, periampullary perforation, and hyperamylasemia. PAD patients showed a significantly higher incidence of hyperamylasemia and total complication rate compared to those without PAD (P<0.05). Conclusion PAD, as a common but complex anatomical variation, is closely associated with the formation of CBD stones and significantly increases the technical difficulty of ERCP and the risk of postoperative complications.
    Clinical observation of diffusion tensor imaging combined with free water imaging on microstructural damage of brain tissue in hepatolenticular degeneration
    ZHAO Wen-chao, TANG Chen-hu, SHI Meng, CHEN Xin, HU Yu-heng
    2025, 30(12):  1724-1727. 
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    Objective To analyze the evaluation of microstructural damage in brain tissue of hepatolenticular degeneration using diffusion tensor imaging combined with free water imaging. Methods 30 patients with Wilson's disease who underwent diagnosis and treatment in our hospital between December 2022 and December 2024 were selected as the disease group, and 30 healthy volunteers who underwent physical examinations in our hospital during the same period were selected as the control group. Magnetic resonance imaging was used to collect diffusion tensor imaging and free water imaging. Free water values and fractional anisotropy were calculated. Pearson correlation test was used to examine the relationship between nerve function scores, free water values, and FAT values in the unified Hepatolenticular Degeneration Scale for the disease group. Results The free water values of the disease group's pontine tegmentum, bilateral head of the caudate nucleus, dentate nucleus, globus pallidus, putamen, red nucleus, substantia nigra, and thalamus The FAT values [(0.2 ± 0.1), (0.3 ± 0.1), (0.2 ± 0.1), (0.2 ± 0.1), (0.2 ± 0.1), (0.2 ± 0.1), (0.2 ± 0.1), (0.2 ± 0.1), (0.6 ± 0.2), (0.3 ± 0.1), (0.4 ± 0.1), (0.5 ± 0.1), (0.3 ± 0.1), (0.5 ± 0.1), (0.6 ± 0.2), (0.3 ± 0.1)] were all higher than those of the control group [(0.1 ± 0.0), (0.2 ± 0.1), (0.1 ± 0.0), (0.1 ± 0.0), (0.1 ± 0.0), (0.1 ± 0.0), (0.1 ± 0.0) (0.1 ± 0.0), (0.1 ± 0.0), (0.5 ± 0.1), (0.2 ± 0.1), (0.3 ± 0.1), (0.4 ± 0.1), (0.1 ± 0.0), (0.4 ± 0.1), (0.5 ± 0.1), (0.2 ± 0.1), P<0.05]. The neurological function score in the unified hepatolenticular degeneration rating scale for the disease group is (17.5 ± 3.8) points. Pearson correlation test showed that the neurological function score in the Unified Hepatolenticular Degeneration Scale was positively correlated with free water and FAT values (r=0.856, 0.831, P<0.05). To explore the diagnostic value of free water value and FAT value in hepatolenticular degeneration with the free water value and FAT value of each brain region of interest as detection indexes. The results showed that the AUC of FAT in putamen was the highest (0.88), and the AUC of other regions such as substantia nigra and red nucleus was also higher, both of which were higher than 0.8, suggesting that the free water value and FAT value had good discrimination ability. Conclusion The combination of diffusion tensor imaging and free water imaging can detect microstructural changes in the brain tissue of patients with hepatolenticular degeneration, and free water imaging indicators are related to the severity of nerve damage.
    A comparative analysis of quality of life among patients with different types of chronic liver diseases
    MENG Chun-yan, YAN Bao-shu
    2025, 30(12):  1728-1734. 
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    Objective To investigate the quality of life (QoL) and its associated factors among patients with different types of chronic liver disease, and to provide evidence for comprehensive management and health promotion in this population. Methods A cross-sectional study was conducted including 220 patients with chronic liver disease who underwent liver biopsy at Beijing Friendship Hospital, Capital Medical University, between April 2024 and March 2025. Demographic and clinical data were collected, including complete blood count and liver function tests. The Short Form-36 (SF-36) questionnaire was used to evaluate QoL. Patients were categorized into cirrhosis and non-cirrhosis groups, as well as autoimmune and non-autoimmune liver disease groups. Clinical characteristics and QoL scores were compared between groups, and factors associated with QoL were analyzed. Statistical analyses were performed using SPSS version 21.0. Results Patients in the cirrhosis group were older than those in the non-cirrhosis group, with median ages of 54.5 (48.0, 62.5) years and 51.0 (39.0, 59.8) years, respectively (P=0.043). Compared with the non-cirrhosis group, patients with cirrhosis showed significantly lower hemoglobin (Hb) and platelet (PLT) levels, higher total bilirubin (TBil), lower albumin (Alb), and prolonged prothrombin time (PT), all with statistically significant differences (P<0.05). Compared with patients exhibiting mild inflammation (G0–2), those with moderate to severe inflammation (G3–4) showed significantly lower scores in physical functioning[75.0 (25.0, 100.0) vs. 75.0 (0.0, 100.0)] and mental health [78.0 (52.0, 87.0) vs. 65.0 (49.0, 80.0)] domains (P<0.05). In terms of quality of life, patients with cirrhosis had lower physical functioning scores than those without cirrhosis[50.0 (0.0, 93.8) vs. 75.0 (25.0, 100.0); P<0.05]. However, there were no statistically significant differences in any quality of life dimensions between patients with autoimmune liver diseases and those with non-autoimmune liver diseases (P>0.05). Conclusion QoL of patients with chronic liver diseases is negatively correlated with disease severity. Comprehensive assessment and management of QoL should be emphasized in clinical practice. Early multidimensional interventions and individualized treatment and nursing strategies are recommended to optimize outcomes and improve QoL in patients with chronic liver disease.