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    31 May 2026, Volume 31 Issue 5
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    Liver Fibrosis & Cirrhosis
    The impact of recompensation on the prognosis of decompensated patients with viral hepatitis-related cirrhosis
    XU Dan-qing, MU Huan, ZHANG Ying-yuan, LI Wen-yan, SA Cai-fen, LIU Li, LI Wei-kun
    2026, 31(5):  619-624. 
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    Objective To investigate the impact of recompensation on liver disease-related mortality and the incidence of hepatocellular carcinoma (HCC) in patients with decompensated liver cirrhosis due to viral hepatitis. Methods A total of 734 patients diagnosed with decompensated liver cirrhosis due to chronic hepatitis B viral (HBV) and chronic hepatitis C viral (HCV) infection who were treated at the Third People′s Hospital of Kunming from January 1, 2016 to December 31, 2022 were collected. The patients′ data were reviewed and they were divided into a recompensation group (n=270) and a persistent decompensation group (n=464). The incidence of HCC and liver disease-related death from the time of enrollment to the end of the study was collected. Univariate logistic regression analysis was conducted to identify the factors that might affect the poor prognosis of patients with decompensated liver cirrhosis due to viral hepatitis. Variables with significant differences in the univariate comparison analysis were further screened by lasso regression to select a subset of variables without multicollinearity, which were then included in the multivariate logistic regression analysis. Survival curves were plotted using the Kaplan-Meier method and compared using the log-rank test. Results The mortality rate of patients in the persistent decompensation group was significantly higher than that in the recompensation group (13.60% vs. 8.10%, χ2=4.914, P=0.027)(63/464 vs. 22/270). The incidence of HCC in the recompensation group was significantly lower than that in the persistent decompensation group (8.10% vs. 17.70%, χ2=12.731, P<0.001)(22/270 vs. 82/464). Univariate logistic regression analysis showed that recompensation, etiology, history of drug abuse, history of TIPS surgery, age, PLT, TBil, DBil, TBA, Alb, PA, IL-6, PTA, APTT, CEA, CA125, PIVKA-II, TSH, IL-1β, IgG, blood ammonia, and complement C4 were the influencing factors of HCC risk and death risk in patients with decompensated viral hepatitis-related cirrhosis (P<0.05). Multivariate logistic regression analysis showed that recompensation (OR=0.572, 95% CI: 0.374~0.874, P=0.010), age (OR=1.025, 95% CI: 1.006~1.044, P=0.011), and PIVKA-II (OR=1.002, 95% CI: 1.000~1.004, P=0.017) were independent influencing factors for the occurrence of liver cancer and liver disease-related death in patients with decompensated viral hepatitis-related cirrhosis. Conclusion The occurrence of re-compensation can significantly reduce the incidence risk of HCC and the mortality rate in patients with decompensated liver cirrhosis caused by viral hepatitis.
    The relationship between serum C-C motif chemokine ligand 5 and liver fibrosis in chronic hepatitis B patients
    ZENG Hua-li, SHI Ying-ying, GAO Xiao-wen, LV Hai-ming
    2026, 31(5):  625-630. 
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    Objective To investigate the relationship between serum C-C motif chemokine ligand 5 (CCL-5) and liver fibrosis in patients with chronic hepatitis B (CHB). Methods A total of 180 CHB patients diagnosed and treated in Jinjiang City Hospital from June 2022 to June 2024 and 70 healthy volunteers served as the control group were enrolled in this study. The CHB patients were divided into a non-significant liver fibrosis group (n=112) and a significant liver fibrosis group (n=68) based on the modified Scheuer scoring system. The general data [age, sex, body mass index, comorbidities (e.g., hypertension, diabetes, hyperlipidemia), CHB duration (only CHB patients)], liver ultrasound findings [e.g., intrahepatic nodules, diameter of the left/middle/right hepatic veins, liver stiffness measurement (LSM), portal vein flow velocity], and laboratory parameters [hepatitis B virus DNA (HBV DNA), hepatitis B surface antigen (HBsAg), alanine aminotransferase (ALT), aspartate aminotransferase (AST), platelet count, international normalized ratio (INR), CCL-5] were collected and compared within the groups. Indicators with statistical significance in univariate analysis between the two CHB groups were included in multivariate Logistic regression analysis. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of relevant indicators for significant liver fibrosis in CHB patients. Results No significant differences were observed among the three groups in sex, body mass index, portal vein flow velocity, ALT, AST and INR (P＞0.05). Between the 2 CHB groups, no significant differences were found in comorbidities, CHB duration and intrahepatic nodules (P＞0.05). Compared with the control group, both CHB groups showed significantly reduced diameters of the left/middle/right hepatic veins and platelet counts (P＜0.05), whereas the LSM and CCL-5 levels were significantly elevated (P＜0.05). Compared with the non-significant fibrosis group, the significant liver fibrosis group showed significantly reduced diameters of the left [(6.62±2.02) mm vs. (5.32±1.52) mm]/middle [(6.79±2.11) mm vs. (5.53±1.60) mm]/right hepatic veins[(7.55±1.97) mm vs. (5.46±1.38) mm] and platelet counts [(193.26±46.64) ×109/L vs. (171.65±33.57) ×109/L] (P＜0.05), whereas the LSM, HBV DNA, HBsAg, and CCL-5 levels were significantly elevated (P＜0.05), and the age [(6.8±2.1)y vs. (58.5±9.9) y]), LSM [(8.91±2.41) kPa vs. (1.79±2.65) kPa], HBV DNA [(4.09±1.11) IU/mL vs. (4.62±1.30) IU/mL], HBsAg [(3.20±0.69) lg U/mL vs. (4.16±1.21) lg U/mL] and CCL-5 [(4.62±1.21) ng/mL vs. (5.53±1.60) ng/mL] were significantly higher (P＜0.05). By Logistic regression analysis it was identified that age [OR(95%CI: 1.204 (1.073~1.351)], LSM[OR(95%CI: 1.754 (1.281~2.402)] and CCL-5 [OR(95%CI: 14.737 (5.936~36.589)] as independent risk factors for significant liver fibrosis in CHB patients (P＜0.05). The optimal cutoff values for predicting significant fibrosis were: age ≥52 years, LSM ≥10.10 kPa and CCL-5 ≥3.58 ng/mL. The combination of these three indicators demonstrated a higher predictive efficacy [area under the curve (AUC) and sensitivity] than that of any single parameter. Conclusion Serum CCL-5 levels are significantly elevated in CHB patients with significant liver fibrosis. CCL-5 is an independent risk factor for liver fibrosis, and its combination with age and LSM significantly improves its diagnostic efficacy as a non-invasive marker for significant liver fibrosis in CHB patients.
    Viral Hepatitis
    Using serum HBV RNA measurement to predict HBeAg seroconversion in chronic hepatitis B patients with normal alanine aminotransferase levels
    JIN Ye-sen, YANG Guang-yue, TAO Le, WU Liu, YE Jun , MA Wen-ting
    2026, 31(5):  631-634. 
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    Objective To investigate the predictive value of serum hepatitis B virus (HBV) RNA in predicting the HBeAg seroconversion in chronic hepatitis B patients with normal alanine aminotransferase (ALT) levels. Methods A total of 28 treatment-na?ve CHB patients with normal ALT levels admitted to the Putuo District Central Hospital in Shanghai between January 2017 and June 2021 were enrolled in this study. The clinical data of all patients were collected, and serum hepatitis B virus (HBV) RNA levels were measured using PCR fluorescence probe assays. All patients received nucleos(t)ide analog (NAs) therapy for 96 weeks and were then divided into an HBeAg seroconversion group and a non-seroconversion group. Regression analysis was used to explore the predictive factors associated with HBeAg seroconversion, and the receiver operating characteristic (ROC) curve was employed to evaluate the predictive performance. Results Twenty-eight CHB patients were included and treated with entecavir or tenofovir disoproxil fumarate. After 96 weeks of follow-up, 7 patients (25%) achieved HBeAg seroconversion. The HBeAg seroconversion group had significantly lower baseline HBV DNA levels (5.91±2.30 lg IU/mL) and HBV RNA levels (5.49±2.19 lg copies/mL) compared to those of the non-seroconversion group (7.50±1.37 lg IU/mL and 7.10±1.35 lg copies/mL, respectively), with statistical significance (P<0.05). Logistic regression analysis revealed that baseline HBV RNA levels (OR=0.521, 95%CI: 0.281~0.967, P=0.039) and liver fibrosis stage (OR=3.584, 95%CI: 1.291~9.953, P=0.014) were associated with HBeAg seroconversion. The area under the ROC curve (AUC) for baseline HBV RNA was 0.782, with an optimal cutoff value of 7.14 lg IU/mL, yielding a sensitivity of 66.6% and specificity of 85.7%. Conclusion Serum HBV RNA may serve as a valuable predictor for HBeAg seroconversion in HBeAg-positive CHB patients with normal ALT levels undergoing antiviral therapy.
    A comparison of the efficacy and safety of entecavir and tenofovir disoproxil fumarate treatment for chronic hepatitis B patients with normal ALT levels
    HU Yan-rong, LU Jia-yun, SUN Shu, YOU Hong, QIAN Xian-zhong
    2026, 31(5):  635-638. 
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    Objective To compare the efficacy and safety of entecavir (ETV) and tenofovir disoproxil fumarate (TDF) treatment for chronic hepatitis B (CHB) patients who have persistently normal serum alanine aminotransferase (ALT) levels, and to provide evidence for antiviral treatment strategies in this population. Methods The clinical data of 94 patients with CHB treated in No.904 Hospital of the Joint Logistics Support Force between January 2020 and December 2024 were retrospectively analyzed. According to the initial antiviral regimen, patients were divided into an ETV group (n=50) and a TDF group (n=44). Virological response parameters, noninvasive liver fibrosis indices, immunological responses, and safety outcomes at 12 months of treatment were compared between the two groups. Results The median time to achieve complete virological response (CVR) was shorter in the TDF group than that in the ETV group [6.0 (5.0, 10.0) months vs. 7.5 (5.0, 11.0) months, P<0.05]. At 12 months of treatment, there were no significant differences between the two groups in the rate of HBV DNA negativity (84.1% vs. 76.0%, P>0.05) or the CVR rate (79.5% vs. 72.0%, P>0.05). Similarly, no significant differences were observed in the incidence of low-level viremia (LLV) (13.6% vs. 14.0%, P>0.05) or the duration of LLV between the two groups. Regarding immunological response, the proportions of patients achieving HBsAg declines of ≥0.3, ≥0.5, and ≥1.0 lg IU/mL were significantly higher in the TDF group than those in the ETV group (61.4% vs. 40.0%, 50.0% vs. 28.0%, and 22.7% vs. 8.0%, respectively; all P<0.05), and the mean magnitude of HBsAg reduction was also greater in the TDF group [(0.27±0.12) lg IU/mL vs. (0.18±0.09) lg IU/mL, P<0.05]. No significant difference was observed in the HBeAg seroconversion rate between the two groups. The safety analysis showed that renal function and bone metabolism-related parameters remained generally stable in the ETV group, whereas the incidences of eGFR<90 mL/min/1.73 m2, proteinuria, and hypophosphatemia were higher those in the TDF group (all P<0.05); however, no serious adverse events were observed this group of patients. Conclusion Chronic hepatitis B patients with persistently normal ALT levels can effectively achieve virological suppression and hepatic benefits from antiviral therapy. TDF demonstrates certain advantages in early virological response and HBsAg decline, whereas ETV shows a more stable long-term safety profile. Initiation of antiviral therapy and selection of agents for CHB patients with normal ALT levels should be individualized by balancing virological benefits and safety considerations.
    An analysis on the clinical efficacies of different antiviral treatment approaches for chronic hepatitis C patients with hepatitis C virus genotype 1b infection
    HUANG Hui, PENG Yu-feng
    2026, 31(5):  639-642. 
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    Objective To investigate the efficacy and safety of different antiviral treatment regimens for chronic hepatitis C (CHC) patients with hepatitis C virus (HCV) genotype 1b infection. Methods A retrospective analysis was conducted on the clinical data of 155 CHC patients with HCV genotype 1b infection admitted to Sanya People′s Hospital from January 2021 to December 2024. All patients were divided into three groups based on different treatment regimens they received: a ledipasvir/sofosbuvir (LDV/SOF) group, a sofosbuvir/velpatasvir (SOF/VEL) group, and a peginterferon α-2b injection/ribavirin (PR) group. The levels of serological liver function and blood routine test indicators were compared before and after treatment in each group, and the virological response rates at 4 weeks, 12 weeks, and 12 weeks after the end of treatment were also compared between the two groups. Results After treatment, the levels of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the LDV/SOF and SOF/VEL groups were [(34.9±6.7)U/L, (31.6±5.9)U/L] and [(35.1±6.3)U/L, (32.7±4.2)U/L], respectively, which were significantly lower than those in the PR group [(48.4±5.9)U/L, (44.7±4.8)U/L] (both P<0.05). The white blood cell (WBC) and platelet count (PLT) levels in the LDV/SOF and SOF/VEL groups were [(6.4±1.2)×109/L, (206.5±30.1)×109/L] and [(6.3±1.4)×109/L, (208.7±32.7)×109/L], respectively, which were significantly higher than those in the PR group [(3.6±1.1)×109/L, (135.4±35.2)×109/L] (both P<0.05). The virological response rates at 4 weeks, 12 weeks, and 12 weeks after the end of treatment in the LDV/SOF and SOF/VEL groups were 87.30%, 95.24%, and 93.65%, respectively, which were significantly higher than those in the PR group (63.16%, 73.68%, and 71.05%, respectively) (both P<0.05). During treatment, the adverse reaction rates in the LDV/SOF and SOF/VEL groups were 15.87% and 14.81%, respectively, which were significantly lower than that in the PR group (63.16%) (both P<0.05). Conclusion The application of direct antiviral drug regimens according to the condition of CHC patients with HCV genotype 1b infection results in high virological response rates, good efficacy, significant improvement in liver function, and good safety.
    An analysis on the quantitative tests of HBsAg and anti-HBs levels with magnetic particle chemiluminescence method in 23 069 different cases in Zhengzhou
    TIAN Zhen-ying, CHEN Yan
    2026, 31(5):  643-647. 
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    Objective To investigate the status and characteristics of patients with hepatitis B viral infection in Zhengzhou area by magnetic particle chemiluminescence method. Methods The data of 23 069 cases with detected HBV serum markers from January 2022 to December 2023 in the Second Peoples Hospital of Zhengzhou were selected for statistical analysis. Results There were 1 266 HBsAg positive cases (5.49%) were detected from the 23,069 patients. The positive rate in male (6.22%) was significantly higher than that in female (4.74%), and the difference was statistically significant (χ2=24.42, P<0.05). There was no significant difference in the positive rate of HBsAg in different years (χ2=0.24, P>0.05). The positive rate of male was higher than that of female in different years, and the difference was statistically significant (χ2=5.11、21.31, P<0.05). There were 13,681 anti-HBs positive cases (59.30%) were detected from the 23,069 patients, and the positive rate in women (60.78%) was higher than that in men (57.86%), the difference was statistically significant (χ2=20.29, P<0.05), The anti-HBs positive rates of the cases in different years, genders and ages were statistically significant (χ2=43.16, 103.18, 30.40, 100.21, 250.76, P<0.05). Conclusion The positive rate of HBsAg in male was higher than that in female, and the positive rate of anti-HBs in female was higher than that in male in Zhengzhou. The high protective capacity of hepatitis B antibody in Zhengzhou population is insufficient, suggesting that active immunity for HBV infection should be strengthened.
    Liver Tumor
    The serum DNMT1 and M2BPGi levels in patients with primary hepatocellular carcinoma and their relationship with prognosis
    XI Chen-yang, SONG Jing-jing, MA Li-li
    2026, 31(5):  648-652. 
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    Objective The aim of the present study was to investigate the serum levels of DNA methyltransferase 1 (DNMT1) and Mac-2 binding protein glycosylation isoform (M2BPGi) in patients with primary hepatocellular carcinoma (PLC) and their relationship with the patients′prognosis. Methods Seventy-nine PLC patients who underwent hepatectomy for hepatocellular carcinoma treatment in Tangshan People′s Hospital from May 2020 to May 2021 were retrospectively selected as the study group. Another 37 cases of healthy people for physical examination at the same period of time were selected as the control group. The serum levels of DNMT1 and M2BPGi in subjects of the two study groups were compared and analyzed for their relationship with the clinicopathological characteristics of the PLC patients. The diagnostic efficacy of serum DNMT1 and M2BPGi levels for the occurrence of PLC was assessed using the subjects′ working curves (ROC) and the areas under the curves (AUC). The diagnostic efficacy of serum DNMT1 and M2BPGi levels for the occurrence of PLC was assessed using the Kaplan-Meier curve method. Log-rank test were used to analyze the relationship between the serum DNMT1 and M2BPGi levels and the prognosis of the PLC patients. The risk factors affecting the prognosis of PLC patients were analyzed by univariate and multivariate Cox regression method. Results The levels of serum DNMT1 and M2BPGi in PLC patients of the study group were (2.98±1.57) ng/mL and (3.68±2.07) mg/mL respectively, which were significantly higher than those of (0.67±0.23) ng/mL and (0.52±0.26) mg/mL in the control group (P<0.05). The serum DNMT1 and M2BPGi levels were associated with clinicopathological features such as tumor diameter, the presence of cirrhosis, the presence of lymph node metastasis, and the presence of vascular invasion (P<0.05). The results of the ROC curves showed that serum DNMT1 and M2BPGi levels for predicting PLC occurrence had AUCs of 0.708 and 0.799, sensitivities of 64.62% and 74.72%, and specificities of 71.26% and 75.98%, respectively. The combined prediction of the above indexes for PLC occurrence had an AUC of 0.923, a sensitivity of 86.14%, and a specificity of 91.29%. The AUC of the combined prediction was significantly higher than that of DNMT1 (Z=4.615, P<0.001) and M2BPGi (Z=3.382, P<0.001) used alone (P<0.05). The results of the Kaplan-Meier survival curve analysis showed that the overall survival rate of patients with PLC who had high levels of serum DNMT1 and M2BPGi (4.35% and 6.12%) was significantly lower than that of patients with low levels of serum DNMT1 and M2BPGi (21.21% and 20.00%, P<0.05); the results of multifactorial Cox regression analysis showed that the tumor diameter (≥5 cm), the presence of cirrhosis, the presence of lymph node metastasis, the presence of vascular invasion, and the high expression levels of DNMT1 and M2BPGi were independent risk factors associated with poor prognosis (P<0.05). Conclusion Serum DNMT1 and M2BPGi levels were high in PLC patients, and their serum levels were closely related to the poor prognosis of PLC patients, which may be used as an effective indicator to evaluate the poor prognosis of PLC patients.
    The value of CT quantitative parameters combined with serum CA199, CEA, and VEGF-C levels for differentiating focal nodular hyperplasia from hepatocellular carcinoma
    ZHANG Meng, QIAN Xiao-jian
    2026, 31(5):  653-657. 
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    Objective To investigate the application value of computed tomography (CT) quantitative parameters combined with serum carbohydrate antigen 199 (CA199), carcinoembryonic antigen (CEA), and vascular endothelial growth factor C (VEGF-C) levels in the differentiating diagnosis of focal nodular hyperplasia (FNH) and hepatocellular carcinoma (HCC). Methods A retrospective study was conducted on the collected data of 88 cases treated at Rugao People′s Hospital between January 2020 and December 2024, including 40 HCC patients and 48 FNH patients. All patients underwent both CT plain and enhanced scans, and their serum samples were collected for detecting CA199, CEA, and VEGF-C levels. The differences in CT quantitative parameters [hepatic blood volume (BV), hepatic blood flow (HBF), hepatic arterial perfusion (HAP), portal venous perfusion (PVP), total liver perfusion (TLP), hepatic arterial perfusion index (HPI), mean transit time (mTT)] and serum markers between the two groups were analyzed. The sensitivity, specificity, and the area under the curve (AUC) of each indicator were evaluated by receiver operating characteristic (ROC) curve analysis. Results In terms of CT quantitative parameters, the HCC group showed higher BV (32.11±10.06 mL/100 mL), HBF (203.09±61.10 mL/100 mL·min), and PVP (22.10±6.02 mL/100 mL·min) compared to those of the FNH group (BV: 22.72±6.13 mL/100 mL, HBF: 126.01±33.13 mL/100 mL·min, PVP: 10.16±3.31 mL/100 mL·min), whereas the HCC group had lower HAP (43.80±11.22 mL/100 mL·min), HPI (66.02±10.16%), and mTT (5.79±1.70 s) compared to those of the FNH group (HAP: 59.54±16.10 mL/100mL·min, HPI: 84.74±8.83%, mTT: 8.12±2.10 s) (P<0.05). In terms of serum biomarkers, the HCC group had higher CA199 (126. 20±28.46 U/mL), CEA (58.41±23.84 ng/mL), and VEGF-C (336.41±101.93 pg/mL) levels than the FNH group (CA199: 30.21±6.08 U/ mL, CEA: 3.42±1.27 ng/mL, VEGF-C: 88.76±29.06 pg/mL) (P<0.05). The ROC curve analysis results showed that in the differential diagnosis of FNH and HCC, the AUCs of CT quantitative parameters combined with serum markers were as follows: BV 0.776, HBF 0.833, PVP 0.728, HAP 0.890, HPI 0.881, and mTT 0.780. The AUCs of serum markers CA199, CEA, and VEGF-C were 0.934, 0.933, and 0.936, respectively. When combined with all these serum markers, the AUC was 0.974. Conclusion The combination of CT quantitative parameters and serum markers CA199, CEA, and VEGF-C significantly improves the sensitivity and specificity for diagnosing of focal nodular hyperplasia and hepatocellular carcinoma, thus offering high clinical value.
    Impact of scheduled hepatoprotective therapy on survival in lenvatinib-treated advanced HCC patients with Child-Pugh B cirrhosis
    HU Xia, ZHANG Yi-sheng, LU Cheng-hong, PAN Hua-jiang, ZHONG Zai-wen, YANG Yang
    2026, 31(5):  658-663. 
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    Objective To investigate the impact of scheduled hepatoprotective therapy on survival outcomes in lenvatinib-based treatment advanced hepatocellular carcinoma (HCC) patients with and Child-Pugh B (CP-B) cirrhosis. Methods A total of 48 patients diagnosed with advanced HCC and CP-B cirrhosis between April 2019 and April 2024 were retrospectively enrolled and divided into two groups: the hepatoprotection group (n=33, receiving polyene phosphatidylcholine combined with monoammonium glycyrrhizinate-cysteine) and the non-hepatoprotection group (n=17). Median survival time (MST), overall survival (OS), and survival rates were compared between the two groups. Subgroup analyses were performed based on imaging characteristics (portal vein tumor thrombus [PVTT] vs. extrahepatic metastasis) and treatment regimens (lenvatinib±TACE/PD-1). Results The hepatoprotection group demonstrated superior survival outcomes, with MST of 18 months (versus 7 months) and OS of 22 months (versus 8 months) compared to controls (both P<0.01). Survival rates at 6, 12, and 24 months were 90.32%, 70.97%, and 29.03% respectively in the hepatoprotection group, significantly higher than those in the non-hepatoprotective group (70.05%, 17.64%, and 0%, P<0.01). Subgroup analysis revealed comparable survival benefits regardless of tumor extension pattern (portal invasion versus distant metastases). Notably, combination therapies incorporating hepatoprotection showed consistently better outcomes across all regimens, with particular benefit observed in the lenvatinib plus TACE and PD-1 inhibitor subgroup (1-year survival 100% versus 50% in unprotected patients). Conclusion Scheduled hepatoprotective therapy significantly prolongs survival, improves survival rates, and enhances quality of life lenvatinib-treated advanced HCC patients with Child-Pugh B cirrhosis.
    Efficacy analysis of ultrasound-guided percutaneous catheter drainage with anhydrous ethanol irrigation combined with lauromacrogol foam in the treatment of simple hepatic cysts
    HU Xuan, WU Qing
    2026, 31(5):  664-667. 
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    Objective To evaluate the efficacy of ultrasound-guided percutaneous catheter drainage with anhydrous ethanol irrigation combined with polidocanol foam in the treatment of simple hepatic cysts (SHC). Methods A retrospective analysis was conducted on 90 patients with SHC treated in Ezhou Central Hospital between January 2022 and December 2024. Patients were divided into three groups: anhydrous ethanol group (n=32), polidocanol group (n=30), and combination group (n=28). Cyst shrinkage and recurrence rates, changes in cyst wall thickness, treatment efficacy, and perioperative data were compared among the groups. Results At the 1-month, 3-month, and 6-month treatment marks, the cyst reduction rates in the combination group were (68.4±12.0)%, (84.0±18.6)%, and (93.5±22.3)%, respectively, which were significantly greater than those in the absolute ethanol group [(55.8±7.8)%, (72.1±15.4)%, and (82.3±18.4)%, P<0.05] and the lauromacrogol group [(58.4±8.1)%, (75.2±14.9)%, and (84.0±19.0)%, P<0.05]. There was no statistically significant difference in the cyst recurrence rates at 6 months among the absolute ethanol group, the lauromacrogol group, and the combination group (P>0.05). The degree of cyst wall thinning in the combination group was (1.2±0.4) mm, which was significantly smaller than those in the absolute ethanol group [(2.2±0.5) mm] and the lauromacrogol group [(1.9±0.5) mm], with the differences being statistically significant (P<0.05). At the 6-month treatment mark, the treatment efficacy rate in the combination group was 96.4%, which was significantly higher than that in the absolute ethanol group and the lauromacrogol group (71.9% and 73.3%, respectively, P<0.05). Major postoperative complications included secondary infection, biliary tract injury, severe allergic reactions, and puncture-related bleeding. There was no statistically significant difference in the incidence of complications among the groups (P>0.05). The VAS score, number of treatment sessions, and hospital stay duration in the combination group were significantly lower than those in the other two groups (P<0.05). Conclusion Ultrasound-guided percutaneous catheter drainage with anhydrous ethanol irrigation combined with polidocanol foam is a safe and effective treatment for SHC, offering advantages including higher efficacy, lower recurrence, more complete cyst wall destruction, better patient comfort, and good procedural feasibility. This combined approach holds promise for broader clinical application.
    Metabolic Associated Fatty Liver Disease
    Correlation study between serum antinuclear antibody and pathological characteristics of metabolic associated fatty liver disease
    WANG Xiao-ming, GUO Tian-tian, CHANG Liu-yi, LUO Juan, WANG Yu, OU Xiao-juan, JIA Ji-dong, ZHAO Xin-yan
    2026, 31(5):  668-672. 
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    Objective To assess the association of serum antinuclear antibody (ANA) titers with clinicopathological features and immune indicators in patients with metabolic associated fatty liver disease (MAFLD). Methods We enrolled 133 biopsy-confirmed MAFLD patients at Beijing Friendship Hospital from January 2015 to December 2021, excluding those with other liver diseases. ANA titers (≥1∶80 considered positive) were measured. The relationships between ANA titer and lobular inflammation, hepatocyte ballooning, steatosis grade, NAFLD Activity Score (NAS), liver fibrosis grade and IgG levels were analyzed. Results ANA positivity (≥1∶80) was found in 75.9% (101/133) of patients, with titers of 1∶80 in 61.4%, 1∶160 in 27.7%, and ≥1∶320 in 10.9%. ANA-positive patients were more often female (72.3% vs. 40.6%, P<0.001) and older (P<0.001). High-titer patients (ANA≥1∶160, n=38) had higher hepatocyte ballooning scores (P=0.017) and IgG levels (1 664±333 vs. 1 353±381 mg/dL, P<0.001) compared to low-titer patients (ANA≤1∶80, n=95). No significant differences were observed in lobular inflammation, steatosis, NAS or fibrosis stage between groups (all P>0.05). Conclusion Higher ANA titers are associated with increased hepatocyte ballooning and elevated IgG levels in MAFLD, but not with inflammation, steatosis, NAS or fibrosis. ANA may contribute to immune-mediated hepatocyte injury, warranting further investigation into its role in disease progression.
    The interaction of hypertension, type 2 diabetes on metabolic dysfunction-associated steatotic liver disease with hepatic fibrosis
    LIU Yun-xiao, ZHANG Rong , WANG Xiao-zhong
    2026, 31(5):  673-677. 
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    Objective To investigate the effect of interaction between hypertension and type 2 diabetes mellitus (T2DM) on the risk of liver fibrosis in MASLD, and to provide reference for scientific and reasonable prevention or delay of liver fibrosis in MASLD. Methods The clinical data of 733 inpatients in the Department of Hepatology, Xinjiang Medical University affiliated Traditional Chinese Medicine from January 2018 to June 2024 were collected. The patients were divided into MASLD group and MASLD with liver fibrosis group according to whether they were complicated with liver fibrosis. The baseline data of the two groups were compared. The effects of hypertension and type 2 diabetes on the risk of liver fibrosis in MASLD were analysed by binary logistic regression model. The interaction between hypertension and type 2 diabetes was analysed using a multiplicative and additive model. The relative excess risk (RERI), interaction attribution ratio (API) and interaction index (SI) were calculated. Results Compared with the MASLD group, the MASLD with liver fibrosis group had a higher proportion of hypertension, hyperuricemia and T2DM, which were 43.4%, 72.5% and 25.5% respectively. The levels of TG and CAP were also higher, at 1.91 (1.36, 2.74) mmol/L and (278.73±31.78) dB/m, respectively.The risk of MASLD-related liver fibrosis in patients with hypertension and T2DM was 24.43 times higher than that of those without hypertension and T2DM (OR=24.35, 95%CI:4.82~122.95, P<0.05). There was an additive interaction between hypertension and T2DM(RERI=13.07,95%CI:2.42~60.29,SI=8.06,95%CI:6.26~16.07,API=0.82,95%CI:0.62~0.92). Conclusion There may be an additive interaction between hypertension and T2DM. Maintaining blood pressure and blood glucose at normal levels may collaboratively prevent or delay liver fibrosis in MASLD.
    Risk prediction model of ASCVD for type 2 diabetes mellitus with nonalcoholic fatty liver disease constructed based on MMC platform and its application
    E Xue-ling, CAI Ruo-nan, HUO Yan, HUANG Xi-hong, CHEN Zhang-zhe
    2026, 31(5):  678-686. 
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    Objective To constructed risk prediction model of arteriosclerotic cardiovascular disease (ASCVD) for type 2 diabetes mellitus (T2DM) with nonalcoholic fatty liver disease (NAFLD) based on national metabolic management center (MMC). Methods The clinical data of 391 T2DM patients with NAFLD recorded in the MMC platform of Xuzhou First People′s Hospital from September 2021 to January 2024 were retrospectively analyzed, they were randomly divided into training group (274 cases) and verification group (117 cases) according to a 7∶3 ratio. They were continuously followed up on the MMC platform continued to following up from the day of discharge to August 2024. The training group was divided into ASCVD group and ASCVD group according to the presence or absence of ASCVD during the following up period, the clinical data of the 2 groups were compared, and Cox regression method was used to analyze the influencing factors of ASCVD. Regression coefficient, standard error, hazard ratio (HR) and 95% confidence interval (95%CI) were calculated. Based on the influencing factors, the risk prediction nomogram model of ASCVD in T2DM patients with NAFLD was constructed. Based on the data from the training and validation groups, the receiver operating characteristic (ROC) curve and Hosmer-Lemeshow goodness of fit analysis were used to verify the prediction efficiency and calibration degree of the model, and decision curve analysis (DCA) was used to evaluate the clinical benefit of the model. Results The following-up period was ranged from 6 to 42 months, with a median of 22 (10,35) months. The incidence of ASCVD was 31.02% (85/274) in the training group, 30.77% (36/117) in the verification group, and 30.95% (121/391) in the overall incidence. Urinary albumin to creatinine ratio (UACR) (HR=2.328, 95%CI: 1.498~3.618), atherogenic index of plasma (AIP) (HR=2.237, 95%CI: 1.505~3.323), triglyceride glucose-body mass index (TyG-BMI) (HR=2.787, 95%CI: 1.626~4.778), framingham risk score (FRS) (HR=2.497, 95%CI: 1.376~4.531), visceral-to-subcutaneous fat ratio (VSR) (HR=2.809, 95%CI: 1.564~5.048) and pulse wave velocity (PWV) (HR=3.050, 95%CI: 1.619~5.744) were the risk factors of ASCVD (P<0.05), and estimated glomerular filtration rate (eGFR) (HR=0.396, 95%CI: 0.262~0.599) was the protective factors for ASCVD (P<0.05). Based on the above 7 influencing factors, the risk prediction model of ASCVD in T2DM patients with NAFLD was constructed. The area under ROC curve for predicting ASCVD in the verification group and the training group were 0.959 (95%CI: 0.929~0.980) and 0.890 (95%CI: 0.819~0.941), the sensitivity were 87.06% and 83.33%, and the specificity were 93.65% and 92.59%. There was no significant difference between the predicted probability of ASCVD and the actual probability in the verification group and the training group (P>0.05). The model predicted that the threshold probability of ASCVD in the validation group and the training group was 0.05~0.87 and 0.04~0.85. Conclusion Based on the discovery from the MMC platform discovery, UACR, AIP, TyG-BMI, FRS, VSR and PWV are risk factors for ASCVD in T2DM patients with NAFLD, while eGFR is a protective factor, the risk prediction nomogram model based on these influencing factors has high predictive value for ASCVD.
    Observation of risk factors for the progression of significant liver fibrosis F3~F4 in elderly patients with non-alcoholic fatty liver disease
    MIAO Rui-tian, LIU Min, ZHOU Yun, LIU Chun-fang
    2026, 31(5):  687-692. 
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    Objective To explore the risk factors for the progression of liver fibrosis to stages F3-F4 in elderly patients with non-alcoholic fatty liver disease (NAFLD). Methods 110 elderly patients diagnosed with NAFLD at the 904th Hospital of the Joint Logistics Support Force from January 2022 to October 2025 were selected. Based on the LSM values detected by FibroScan, the patients were divided into F0~F2 stage group (no moderate fibrosis) and F3~F4 stage group (significant fibrosis). Compare two sets of clinical data and screen independent risk factors for progression to liver fibrosis stages F3~F4 through multiple logistic regression analysis. Results The proportion of patients combined with diabetes mellitus was significantly higher in the F3~F4 group than in the F0~F2 group (59.52% vs. 32.35%). Additionally, waist circumference (97.63±8.51 cm vs. 92.10±7.92 cm), BMI (28.02±3.25 kg/m2 vs. 26.11±2.84 kg/m2), fasting blood glucose (7.55±1.83 mmol/L vs. 6.23±1.34 mmol/L), glycosylated hemoglobin (6.93%±1.22% vs. 6.10%±0.82%), triglycerides (2.40±0.72 mmol/L vs. 1.81±0.56 mmol/L), alanine aminotransferase (ALT) (55.26±17.95 U/L vs. 38.45±12.28 U/L), aspartate aminotransferase (AST) (48.56±15.24 U/L vs. 30.22±10.07 U/L), gamma-glutamyl transferase (85.42±24.53 U/L vs. 50.76±18.18 U/L), fibrosis-4 index (FIB-4) (3.62±1.04 vs. 1.90±0.53), blood urea nitrogen (6.30±1.79 mmol/L vs. 5.44±1.36 mmol/L), controlled attenuation parameter (310.42±44.57 dB/m vs. 285.35±38.71 dB/m), and the uric acid to high-density lipoprotein cholesterol ratio (UHR) (6.84±2.01 vs. 5.03±1.46) were all significantly higher in the F3~F4 group. Conversely, high-density lipoprotein cholesterol (1.03±0.21 mmol/L vs. 1.22±0.31 mmol/L) and maresin 1 (MaR1) (59.13±4.74 pg/mL vs. 77.56±5.42 pg/mL) were significantly lower in the F3~F4 group. All differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that the combination of diabetes, elevated AST, high FIB-4, low MaR1 level and high UHR were independent risk factors for elderly NAFLD patients to progress to phase F3 to F4 of liver fibrosis (P<0.05). ROC curve analysis showed that the AUC values of AST, FIB-4, MaR1, and UHR for predicting the progression of liver fibrosis in elderly NAFLD patients to stages F3~F4 were 0.773, 0.787, 0.818, and 0.743, respectively. By combining the four factors to construct a predictive factor, the AUC was increased to 0.880. Conclusion The combination of diabetes, elevated AST, elevated FIB-4, decreased MaR1, and elevated UHR are independent risk factors for the progression of elderly NAFLD patients to phase F3 to F4 of liver fibrosis. The combination of AST, FIB-4, MaR1, and UHR can significantly improve the prediction efficiency.
    The correlation between CagA genotype Hp infection and the severity of NAFLD
    YE Ye, SUN Ya-qiong, GU Yan-hong, LIU Ke
    2026, 31(5):  693-696. 
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    Objective To explore the correlation between cell virulence gene A (CagA), Helicobacter pylori (Hp) infection and the severity of non-alcoholic fatty liver disease (NAFLD). Methods 104 NAFLD patients treated in our hospital from January 2022 to April 2025 were selected as the observation group. According to ultrasound grading, there were 65 mild patients and 39 moderate to severe patients; at the same time, 104 healthy examinees were selected as the control group. The differences in Hp infection, CagA genotype Hp infection, and leukocyte derived chemokine 2 (LECT2), homocysteine (Hcy) levels between the observation group and the control group were compared, as well as the differences in Hp infection and severity among patients in the observation group, and the value of CagA genotype Hp infection in predicting moderate to severe lesions were analyzed. Results The Hp infection rate, CagA genotype Hp infection rate, LECT2 and Hcy in the observation group were 63.46%, 43.27%, 38.50 (29.80, 45.50) ng/mL and (18.29 ± 5.23) mmol/L, respectively, which were higher than those in the control group (P<0.05). Among Hp-infected patients, the LECT2 and Hcy levels in patients with CagA genotype Hp-infected patients were 42.30 (36.50, 50.10) ng/mL and (19.81 ± 4.10) mmol/L, respectively, which were higher than those in patients with non CagA genotype Hp-infected (P<0.05). In the observation group, the infection rates of CagA genotype Hp, LECT2, and Hcy in patients with moderate-to-severe NAFLD were 56.41%, 40.20 (38.50, 46.60) ng/mL, and (20.24 ± 3.65) mmol/L, respectively, in severe patients, which were higher than those in mild patients (P<0.05). CagA genotype Hp infection was positively correlated with severity (rs=0.562, respectively), P<0.05). CagA genotype Hp infection is positively correlated with LECT2 and Hcy (rs=0.384 and 0.391, respectively), P<0.05). The area under the ROC curve of Hp infection with CagA genotype for predicting moderate to serve NAFLD was 0.605 (95% CI: 0.492~0.718), with P>0.05. Conclusion The infection rate of CagA genotype Hp and the levels of LECT2 and Hcy were significantly increased in NAFLD patients, and the three were positively correlated with the severity of hepatic steatosis. At the same time, there was a positive correlation between CagA genotype Hp infection and LECT2 and Hcy levels.
    The value of the ZJU index, TyG index, and their derivative index in screening and predicting the severity of metabolic dysfunction-associated fatty liver disease
    LIU Xiao-tong, ZHANG Bao-jing, WANG Man, WU Feng-xia, SONG Chen-yuan, WANG Shu-jun
    2026, 31(5):  697-703. 
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    Objective To explore the predictive value of the Zhejiang University index (ZJU index), triglyceride-glucose index (TyG index), and their derived indices for metabolic associated fatty liver disease (MAFLD) and its severity. Methods A total of 522 patients in the health examination center and gastroenterology department of Zhengzhou First People′s Hospital from November 2023 to April 2025 were enrolled. According to the diagnosis of MAFLD by liver transient elastography, the participants were divided into MAFLD group (295 cases) and non-MAFLD group (227 cases). According to the controlled attenuation parameters detected by transient elastography, the MAFLD group was divided into mild group, moderate group, and severe group. Logistic regression and ROC curve analysis were conducted to explore the correlation and predictive value of the ZJU index, TyG index, and TyG-BMI index with the occurrence and severity of MAFLD. Results The MAFLD group exhibited significantly higher metabolic indices than the non-MAFLD group (ZJU: 39.2 ± 5.5 vs. 31.8 ± 3.7; TyG: 9.1 ± 0.6 vs. 8.3 ± 0.5; TyG-BMI: 243.2 ± 37.3 vs. 186.6 ± 28.9; all P<0.05). Furthermore, ZJU, TyG, and TyG-BMI progressively increased across mild, moderate, and severe MAFLD subgroups, and the differences were statistically significant (P< 0.05). Multivariate logistic regression identified elevated ZJU (OR=1.058), TyG (OR=20.815), and TyG-BMI (OR=1.485) as independent risk factors for MAFLD occurrence (all P<0.05), and for moderate-to-severe MAFLD development (OR=1.517, 11.702, and 1.061; all P<0.05). For predicting MAFLD, AUC values were: TyG, 0.839 (95% CI 0.805~0.873; cut-off 8.72); ZJU, 0.876 (95% CI 0.847~0.905; cut-off 34.41); TyG-BMI, 0.891 (95% CI 0.864~0.919; cut-off 212.84). Corresponding AUCs for moderate-to-severe MAFLD prediction were: TyG, 0.832 (95% CI 0.796~0.867; cut-off 8.79); ZJU, 0.916 (95% CI 0.893~0.939; cut-off 36.19); TyG-BMI, 0.916 (95% CI 0.892~0.940; cut-off 224.47). Conclusion The TyG, ZJU and TyG-BMI are all independent risk factors for MAFLD and moderate to severe MAFLD, and have predictive value for MAFLD and moderate to severe MAFLD, among which TyG-BMI has a higher predictive value for MAFLD. The ZJU and TyG-BMI have higher predictive value for moderate to severe MAFLD.
    Interventional effect and mechanism of berberine on hepatic lipid deposition in high-fat diet-fed mice
    HU Jing-xian, LI Jing, XIE Xiao-lan, HUA Qian, JIANG Miao
    2026, 31(5):  704-710. 
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    Objective To explore the interventional effect and mechanism of berberine (BBR) on hepatic lipid accumulation in mice with non-alcoholic fatty liver disease (NAFLD) induced by a high-fat diet (HFD). Methods Twenty-one male wild-type C57BL/6J mice were randomly divided into an HFD group, an HFD+BBR group, and a normal control group. The HFD+BBR group received oral BBR intervention at a dose of 200 mg/(kg·d) for 12 weeks. Body weight, liver weight, and serum triglyceride levels were compared among the groups, and histopathological analysis, lipidomics, gut microbiome analysis, and fecal metabolomics analysis were performed. Results BBR significantly ameliorated hepatic steatosis in mice: the HFD+BBR group showed an 8.42% reduction in body weight (P<0.01), a 10.33% decrease in liver weight (P=0.027), a 39.5% decline in serum triglyceride levels (P<0.001), as well as marked reductions in hepatic lipid droplets and NAFLD Activity Score (P=0.03). Lipidomic analysis confirmed that BBR inhibited the accumulation of diacylglycerol (P=0.004) and triglyceride (P=0.01), restored phospholipid homeostasis, and reduced total hepatic lipids by 13.9% (P<0.05). Gut microbiome analysis revealed that BBR reshaped the gut microbial community structure (P=0.002), with a significant increase in the abundance of Bacteroides (P<0.001). Fecal metabolomic analysis demonstrated that BBR increased agmatine levels (P=0.05), and agmatine was strongly positively correlated with Bacteroides (r=0.681, P=0.001) while negatively correlated with hepatic neutral lipids. Conclusion BBR ameliorates HFD-induced hepatic steatosis by regulating the gut microbiome to promote agmatine production and bidirectionally modulating hepatic lipid metabolism, revealing that the microbiome-metabolite-host axis may serve as a key mechanism underlying the therapeutic effects of BBR in NAFLD.
    Gut microbiota-derived trimethylamine induces oxidative stress, inflammation, and apoptosis in HepG2 cells
    ZHANG Qiu-ling, YAO Li-chao, SHE Sha, DAI Kai, LI Xun
    2026, 31(5):  711-717. 
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    Objective This study aims to evaluate the effects of TMA on hepatocytes. Methods HepG2 cells were treated with different concentrations (0, 50 μM, and 10 mM) of TMA for 24 and 48 hours. Cell viability, the conversion of TMA to TMAO, and the expression of flavin-containing monooxygenase (FMO) genes were assessed. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) were used to detect TMAO levels, while oil red O staining was used to evaluate lipid deposition. Oxidative stress and inflammatory responses were analyzed by DHE staining and ELISA. Cell apoptosis was detected by flow cytometry and western blotting (WB). Results High concentrations of TMA significantly reduced the viability of HepG2 cells in a dose- and time-dependent manner. The conversion of TMA to TMAO increased in a concentration-and time-dependent manner, accompanied by upregulation of FMO1, FMO2, and FMO3 gene expression. Although TMA itself did not significantly affect lipid metabolism, it significantly promoted lipid droplet formation when combined with fatty acids. Additionally, TMA induced oxidative stress, inflammation, and apoptosis in HepG2 cells. Conclusion TMA may indirectly accelerate the progression of non-alcoholic fatty liver disease (NAFLD) by inducing oxidative stress, inflammation, and apoptosis.
    Drug-Induced Liver Injury
    Clinical characteristics and prognosis of acute liver injury induced by Chinese herbal medicines and Chinese patent medicines
    LI Qin-rong, HAI Shan, XU Zhi-yuan
    2026, 31(5):  718-723. 
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    Objective To analyze the clinical characteristics and prognosis of patients with herb-induced liver injury (HILI) during acute liver injury. Methods A retrospective analysis was conducted on the clinical manifestations, laboratory results, progression to liver failure, and recovery status at discharge of 72 acute HILI patients with varying degrees of liver dysfunction during hospitalization in the Second Affiliated Hospital of Kunming Medical University. Results Among 72 patients with acute HILI, 30 with mild liver injury and 42 with moderate to severe injury, the sex distribution differed significantly between the two groups (male∶female 5∶25 vs. 19∶23, χ2=6.429, P=0.011). Patients in the moderate and above injury group had statistically significant differences compared with the mild injury group in AST(U/L)[631(360,1 049) vs. 263(158,460), U=14.629], ALT(U/L)[923(521,1 337) vs. 533(287,773),U=8.629],TBil(μmol/L)[118.5(83.1,238.9)vs.18.5(13.0,32.8), U=51.429], albumin(g/L)[37.35(33.2,41.4) vs. 40.9(36.6,43.1), U=8.229], PTA(%)[88.9(75.3,109.0) vs. 109.2(86.4,118.9), U=4.462]、INR[1.07(0.98,1.17) vs. 0.95(0.90,1.03), U=13.155]and plasma ammonia levels(μmol/L)[52(33,76) vs. 17(11,27), U=25.621] (P<0.05). Secondly, there was no significant difference in underlying diseases, medication route, and duration among patients with different degrees of liver injury. ALBI showed differences in evaluating patients with varying degrees of liver injury(χ2=19.061, P<0.001), with an AUC value of 0.820 for predicting progression to SALF (95%CI:0.718~0.922,P<0.001). There was no death among 72 patients with acute HILI, and 9 patients progressed to SALF. At discharge, all patients with acute HILI showed improvement in clinical symptoms and significant recovery in liver function. Conclusion Among patients with acute HILI, middle-aged women are more common, and the distribution of female patients is more similar between different degrees of injury, while moderate to severe injuries are more common in male patients. Moreover, there was no significant correlation between underlying diseases and the severity of liver function impairment in patients. The ALBI score has some clinical utility in assessing liver function status in patients with acute HILI and in predicting the risk of progression to SALF. For HILI patients, the short-term prognosis is usually optimistic.
    The predictive value of the γ-glutamyl transferase/platelet ratio for the prognosis of patients with sepsis-related liver injury
    RONG Jin, CHENG Xi-yun, YIN Hong-min
    2026, 31(5):  724-728. 
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    Objective To explore the predictive value of the γ-glutamyl transferase (GGT)/platelet (PLT) ratio (GPR) for the prognosis of cases with sepsis-related liver injury (SRLI). Methods A total of 102 patients with SRLI from June 2022 to July 2024 in Chongming Hospital Affiliated to Shanghai Health Medical College were selected. They were divided into a good prognosis group (n=68) and a poor prognosis group (n=34) according to their 28-day prognosis after admission. GGT levels were detected by enzyme-linked immunosorbent assay, and PLT was detected by an automatic blood cell analyzer. GPR was calculated. The predictive value of GPR for the prognosis of SRLI patients was analyzed by receiver operating characteristic(ROC)curve. The influencing factors of the prognosis of SRLI cases were explored by multivariate logistic stepwise regression analysis. Results The GGT and GPR of the poor prognosis group were (76.84±10.23) U/L and (0.82±0.13), respectively, which were higher than those of the good prognosis group [(51.60±12.19) U/L and (0.43±0.10)]. The PLT of the poor prognosis group was (94.17±15.98) × 109/L, which was lower than that of the good prognosis group [(121.29±17.24) × 109/L] (P<0.05). ROC curve analysis showed that the area under the curve (AUC) of GPR for predicting the prognosis of SRLI patients was 0.925, which was greater than that of GGT and PLT alone (0.832 and 0.778, respectively) (Z=9.475, 11.824, P<0.001). The proportion of patients with acute kidney injury, the proportion of patients with severe liver injury, APACHE Ⅱ score, SOFA score, and CRP in the poor prognosis group were 52.94%, 41.18%, (27.14±7.08) points, (15.03±3.01) points, and (25.83±4.37) mg/L, respectively, which were higher than those in the good prognosis group [32.25%, 14.70%, (18.29±5.76) points, (11.52±2.18) points, and (20.17±4.05) mg/L] (P<0.05). The severity of liver injury (OR=2.396, 95%CI: 1.308~4.391), APACHE Ⅱ score (OR=2.130, 95%CI: 1.328~3.416), SOFA score (OR=2.522, 95%CI: 1.303~4.882), and GPR (OR=2.998, 95%CI: 1.695~5.303) were independent factors associated with poor prognosis for the prognosis of SRLI patients (P<0.05). Conclusion GPR is an independent influencing factor for the prognosis of SRLI patients, and GPR showed good predictive value for the prognosis of SRLI patients.
    Clinical and imaging manifestations of drug-induced liver injury caused by meropenem
    LI Yi-ming, LIU Li-ping, LUO Qiang, SU Bei
    2026, 31(5):  729-731. 
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    Objective To analyze the clinical data and imaging manifestations of patients with meropenem-induced drug-induced liver injury (DILI), and to provide a basis for clinical recognition, diagnosis, and treatment. Methods Sixty-two patients with DILI diagnosed during meropenem treatment in Anhui Zhongke Gengjiu Hospital between January 2022 and June 2025 were retrospectively included, which were divided into three types: hepatocellular injury type (n=32), cholestatic type (n=19) and mixed type (n=11). The liver function indexes and imaging manifestations of each type were analyzed and compared. Results The ALT and AST levels in the cholestatic type were (55.2±17.2) U/L and (61.4±20.1) U/L, respectively, which were significantly lower than those in the other two types [(145.3±27.8) U/L and (162.7±36.1) U/L; (137.6±38.0) U/L and (144.1±41.3) U/L; P<0.05]. Meanwhile, the ALP and TBil levels in the hepatocellular injury type were (96.5±25.1) U/L and (25.1±7.3) μmol/L, respectively, which were significantly lower than those in the other two types [(246.2±52.6) U/L and (56.2±14.7) μmol/L; (228.1±47.1) U/L and (49.5±16.1) μmol/L; P<0.05]. All patients underwent liver ultrasound or MRI examination. Imaging results showed that 17 patients (27.4%) had mildly irregular liver margins or heterogeneous parenchymal echotexture, suggesting possible hepatic parenchymal inflammation; 19 patients (30.6%) had mild intrahepatic bile duct dilation, indicating impaired bile excretion; 22 patients (35.5%) presented with mild to moderate splenomegaly, which might be associated with elevated portal pressure or systemic inflammatory responses; and 10 patients (16.1%) exhibited mild thickening of the gallbladder wall. There were no statistically significant differences in imaging features among different DILI types (P>0.05), although bile duct dilation and gallbladder wall thickening were more frequently observed in patients with cholestatic or mixed injury types. Conclusion Meropenem-induced DILI presents with diverse clinical manifestations, ranging from acute hepatitis characterized by hepatocellular injury to marked cholestatic or mixed-type liver injury. While no significant differences in imaging features were observed among different DILI types, bile duct dilation and gallbladder wall thickening were more commonly seen in the cholestatic and mixed types.
    Predictive analysis of Th2 cytokines, eosinophils, and T-lymphocyte subsets for anti-tuberculosis drug-induced idiosyncratic liver injury
    JIANG Hong-mei, FEI Zhong-ting, YANG Jing-yue, MA Xue-jiao
    2026, 31(5):  732-736. 
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    Objective To investigate the abnormal expression of Th2 cytokines, peripheral blood eosinophils (EOS), and T-lymphocyte subsets in patients with anti-tuberculosis drug–induced idiosyncratic liver injury (ATD-ILI) and to evaluate their predictive value for adverse hepatic outcomes. Methods Ninety-three patients who received anti-tuberculosis therapy in Huai′an Fourth People′s Hospital between May 2021 and May 2025 were enrolled. According to whether ATD-ILI occurred during treatment, patients were divided into a liver injury group (n=18) and a non-injury group (n=75). Serum levels of interleukin-4 (IL-4), IL-5, and IL-13 were measured, EOS counts were recorded, and CD4+, CD8+, and CD4+/CD8+ ratios were analyzed by flow cytometry. Differences in general clinical data, liver function indices, and immunological parameters between the two groups were compared. Variables with statistical significance in univariate analysis were entered into a multivariate logistic regression model to identify independent risk factors. Receiver operating characteristic (ROC) curves were constructed to assess the predictive performance of individual indicators and their combined application for ATD-ILI. Results In the liver injury group, patients had ALT (156.94 ± 54.78 U/L), AST (121.84 ± 36.52 U/L), TBil (39.61 ± 7.98 μmol/L), and RUCAM score (9.17 ± 3.03), all of which were higher than those in the non-injury group (ALT: 49.73 ± 8.28 U/L, AST: 31.47 ± 7.62 U/L, TBil: 15.84 ± 4.26 μmol/L, RUCAM score: 4.36 ± 1.57), with statistically significant differences (all P<0.05). The liver injury group also exhibited elevated IL-4 levels (23.88 ± 4.82 pg/mL), EOS (0.74 ± 0.24 × 109/L), and CD4+/CD8+ ratio (2.27 ± 0.57) compared with the non-injury group (IL-4: 16.14 ± 4.17 pg/mL, EOS: 0.45 ± 0.16 × 109/L, CD4+/CD8+: 1.51 ± 0.42), all differences being statistically significant (all P<0.05). Multivariate logistic regression analysis demonstrated that increased RUCAM score (OR=2.077, 95% CI: 1.070~4.034, P=0.031), elevated IL-4 level (OR=1.478, 95% CI: 1.108~1.972, P=0.008), increased EOS (OR=10.097, 95% CI: 2.158~47.254, P=0.003), and elevated CD4+/CD8+ ratio (OR=7.504, 95% CI: 1.809~31.132, P=0.005) were independent risk factors for anti-tuberculosis drug-induced idiosyncratic liver injury (all P<0.05). The combination of RUCAM score with IL-4, EOS, and CD4+/CD8+ ratio exhibited the best predictive performance, with an AUC of 0.976 (95% CI: 0.940~1.000), sensitivity of 88.9%, specificity of 100.0%, and Youden index of 0.889, markedly outperforming individual indicators. Conclusion Immune dysregulation involving Th2 cytokines, eosinophils, and T-lymphocyte subsets is closely associated with the occurrence and severity of anti-tuberculosis drug-induced idiosyncratic liver injury. Their combined assessment provides a valuable biological tool for predicting the risk of idiosyncratic liver injury and for evaluating adverse hepatic outcomes.
    Other Liver Diseases
    Impact of bile acid levels on maternal and perinatal outcomes in intrahepatic cholestasis of pregnancy
    ZHAO Qiu-xia, WU Wan-fen, WANG Hong
    2026, 31(5):  737-740. 
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    Objective To investigate the effects of serum bile acid levels on pregnancy and perinatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP) with different times of disease onset. Methods Clinical data of pregnant women with ICP from January 2022 to December 2025 in Yangzhou Maternal and Child Health Care Hospital Affiliated to Yangzhou University were collected, including a total of 115 cases. According to the gestational age at onset, patients were classified as early-onset or late-onset ICP, and further stratified into mild or severe ICP based on serum total bile acid (TBA) levels. The patients were ultimately divided into four groups: early-onset mild (n=15), early-onset severe (n=10), late-onset mild (n=62), and late-onset severe (n=28). General clinical characteristics, laboratory parameters, pregnancy outcomes, and perinatal outcomes were compared among the groups. Results The results showed that there were no significant differences among the four groups in maternal age or pre-pregnancy body mass index (P>0.05). The gestational age at diagnosis was significantly earlier in women with early-onset ICP than in those with late-onset ICP [(24.6±2.1) weeks vs. (33.8±2.6) weeks, P<0.05)]. Serum TBA levels were significantly higher in women with severe ICP than in those with mild ICP [early-onset: (82.4±21.6) μmol/L vs. (24.6±7.8) μmol/L; late-onset: (76.3±18.9) μmol/L vs. (22.9±6.5) μmol/L; all P<0.05]. Regarding pregnancy outcomes, the early-onset severe ICP group had the highest rates of cesarean delivery and preterm birth, at 80.0% and 70.0%, respectively, which were significantly higher than those in the early-onset mild group (40.0% and 26.7%), late-onset mild group (35.5% and 14.5%), and late-onset severe group (60.7% and 39.3%) (P<0.05). Analysis of perinatal outcomes showed that neonates in the early-onset severe ICP group had the lowest gestational age at birth (33.4±2.6) weeks and birth weight (1980±510) g. This group also exhibited the highest incidences of low birth weight (60.0%), fetal distress (50.0%), neonatal intensive care unit admission (70.0%), and neonatal asphyxia (30.0%), all of which were significantly higher than those in the other three groups (P<0.05). Conclusion Serum bile acid levels are closely associated with the severity of liver dysfunction, pregnancy outcomes, and perinatal prognosis in women with ICP. Early-onset severe ICP represents the highest-risk subtype for adverse maternal and fetal outcomes and warrants intensified prenatal surveillance and individualized management.
    Investigation into the correlation between gallbladder contraction function and defecation frequency in post-cholecystectomy patients
    SONG Xin, FAN Qing-quan, TANG Rui, ZHANG Hai-yang, CAO Xue-dong, ZHANG Xiu-cui
    2026, 31(5):  741-743. 
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    Objective To investigate the correlation between preoperative gallbladder contraction function and postoperative defecation frequency in patients who have had a cholecystectomy, as well its effect on postoperative bile acid metabolism. Methods We selected eighty patients with benign gallbladder disease who underwent surgery at our hospital . The median of gallbladder contraction function was used as the basis for grouping , and the patients were divided into groups A and B. The changes in serum bile acid before and after surgery were monitored, and the frequency of defecation and the incidence of diarrhea post-surgery were followed up to analyze the correlation between gallbladder contraction function and postoperative defecation frequency. Results In the two groups, the postoperative defecation frequency (15±5) in Group A, which had better gallbladder contraction function, was significantly higher than that in Group B, which had poorer gallbladder function (10±5, P=0.009). The incidence of diarrhea in Group A was higher than that in Group B (25% vs. 10%). The gallbladder contraction function is correlated with the frequency of defecation in postoperative patients(R=0.3333). Bile acid mass spectrometry analysis revealed that serum chenodeoxycholic acid levels increased in patients after cholecystectomy[A:post-op(727.85±198.17)nmol/L vs. pre-op(553.65±212.19)nmol/L;B:post-op(697.34±188.75)nmol/L vs. pre-op(605.13±218.66)nmol/L], P<0.005, with no significant difference between the two groups. Conclusion Patients with good gallbladder contraction function are more likely to have digestive dysfunction after surgery, including increased defecation frequency and diarrhea. Active enterohepatic circulation of bile acids may be an important reason for these phenomena.