Table of Content

31 August 2026, Volume 31 Issue 8

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Liver Fibrosis and Cirrhosis

The clinical characteristics and prognosis of liver cirrhotic patients with acute decompensation

Xu Danqing, Mu Huan, Zhang Yingyuan, Mou Chunyan, Sa Caifen, Liu Li, Li Weikun

2026, 31(8):  1084-1090. 

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Objective To analyze the clinical characteristics of cirrhotic patients with acute decompensation events and to investigate the factors influencing their prognosis. Methods Patients diagnosed with decompensated cirrhosis due to HBV, HCV, alcoholic hepatitis, and autoimmune hepatitis who visited the Third People's Hospital of Kunming from January 1, 2016 to December 31, 2022 were collected. Relevant clinical data of all patients were collected and they were divided into an acute de-compensation group and a non-acute de-compensation group. The clinical characteristics of the two groups were analyzed. At the end of the study, patients who developed hepatocellular carcinoma (HCC) or died were classified as the poor prognosis group, while those who did not were classified as the control group. Univariate and multivariate logistic regression analyses were conducted to identify the factors that might affect the poor prognosis of patients with decompensated cirrhosis. Kaplan-Meier method was used to estimate survival rates and draw survival curves for patients with different compensation status. Log-rank test was used to compare their survival curves. Results A total of 863 patients with decompensated cirrhosis were included, with 624 in the acute decompensation group and 239 in the non-acute decompensation group. The incidence of acute decompensation was 72.3%. Among them, 116 patients died (97 in the acute decompensation group and 19 in the non-acute decompensation group), 109 patients developed HCC (83 in the acute decompensation group and 26 in the non-acute decompensation group), and 558 achieved recompensation (428 in the acute decompensation group and 130 in the non-acute decompensation group). The result of log-rank test showed that there were statistically significant differences between the two groups in recompensation rate (χ²=15.509, P<0.001) and liver disease-related mortality (χ²=7.359, P=0.007), with Kaplan-Meier curves clearly separated. However, there was no statistically significant difference in the incidence of HCC (χ²=0.757, P=0.384). Univariate Logistic regression analysis showed that in the poor prognosis group, there were 159 cases of acute decompensation (79.5%), Child classification [A grade 23 cases (11.5%), B grade 88 cases (44.0%), C grade 89 cases (44.5%)], age 53.0 (46.0, 60.0) years, TBil 40.05 (24.95,80.25) μmol/L, GGT 81.50 (40.55,149.00) U/L, ALP 143.80 (108.00,210.00) U/L, Alb 28.65 (24.40,32.80) g/L, IL-6 20.11 (10.28,41.35) pg/mL, PT 17.50 (15.70,19.75) s, compared with the control group with 468 cases of acute decompensation (70.1%), Child-Pugh classification [A grade 106 cases (16.0%), B grade 338 cases (46.5%), C grade 219 cases (33.0%)], age 50.0 (44.0, 57.0) years, TBil 31.80 (21.10,57.75) μmol/L, GGT 40.55 (28.00,68.00) U/L, ALP 108.00 (80.00,148.00) U/L, Alb 29.00 (25.00, 32.00) g/L, IL-6 10.28 (5.28, 19.35) pg/mL, PT 15.70 (14.00,17.40) s. The differences in 63.00 (35.00,134.50) U/L, ALP 132.00 (98.50,179.00) U/L, Alb 30.00 (26.15,34.80) g/L, IL-6 15.27 (9.00,28.51) pg/mL, and PT 17.00 (15.40,18.83) S were statistically significant (χ²=6.728, χ²=9.249, Z=-2.652, -0.331, -2.057, -2.140, -3.229, -3.465, -2.240, all P<0.05). The results of the multivariate analysis showed that age [OR 95% CI:1.024 (1.008~1.041), P=0.003], TBil [OR 95% CI:1.003 (1.001~1.005), P=0.010], and Alb [OR 95% CI:0.962 (0.929~0.996), P=0.030] were independent influencing factors for poor prognosis in decompensated patients. Conclusion Elevated total bilirubin, decreased albumin, and increasing age are key risk factors for poor prognosis in patients with decompensated liver cirrhosis. Acute decompensated cirrhosis events are significantly associated with increased liver disease-related mortality and decreased re-compensation rate.

An analysis on the predictors of recompensation in hepatitis B virus-related cirrhotic patients following esophagogastric variceal bleeding

Lv Min, Liu Wen, Gu Mengdi, Yao Zhibo, Ding Qin

2026, 31(8):  1091-1095. 

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Objective To identify the factors influencing recompensation in patients with hepatitis B virus (HBV)-related cirrhosis presenting with esophageal-gastric variceal bleeding (EGVB) as their first de-compensation event. Methods A total of 107 HBV-related cirrhotic patients with EGVB as initial de-compensation event who were treated in the Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2023 were enrolled in this study. The patients were categorized into a re-compensation group (n=44) and a persistent de-compensation group (n=63) according to the criteria for re-compensation from Chinese Society of Hepatology at 2022. Demographic, laboratory, imaging, and treatment data were collected from all patients. Intergroup comparisons were performed using Mann-Whitney U test、χ² or Fisher′s exact test. The independent factors influencing recompensation were identified by binary logistic regression analysis, and the performance of predictive value was evaluated using the area under the receiver operating characteristic curve (AUC) method. Results Among 107 patients with esophageal-gastric variceal bleeding, re-compensation was observed in 44 cases (41.1%). In the re-compensation group, age, serum potassium, serum chloride, and the proportion of diabetes mellitus were recorded as (46.1±9.2) years, 3.93 mmol/L, 104.85 mmol/L, and 4.55%, respectively, which were all lower than those of [(52.3±11.9) years, 4.03 mmol/L, 105.90 mmol/L, and 19.05%] in the persistent de-compensation group. A higher rate of splenectomy combined with pericardial de-vascularization (SPD) was found in the re-compensation group compared to the persistent de-compensation group (40.91% vs. 9.52%), with statistically significant differences (t/χ²=2.91, -2.04, -1.97, 4.79, 14.67, all P<0.05). By Logistic regression analysis it was revealed that increased age, elevated total bilirubin levels, and SPD treatment were identified as independent influencing factors for recompensation (95% CI: 0.90~0.99, 0.90~0.99, 1.95~16.52; OR=0.94, 0.94, 5.68, all P<0.05). ROC analysis showed that the AUC values for age, SPD treatment history, and total bilirubin were 0.64, 0.65, and 0.56, respectively, with sensitivities of 0.46, 0.90, and 0.68, and specificities of 0.30, 0.41, and 0.05. The combined predictive model achieved an AUC of 0.79, with a sensitivity of 0.73 and a specificity of 0.70. Conclusion HBV-related cirrhotic patients with EGVB who are older or have elevated total bilirubin are less likely to achieve re-compensation, while those undergoing SPD are more likely to attain re-compensation.

The clinical value of ultrasound elastography combined with serum levels of NOX2 and CX3CL1 in the diagnosis of liver fibrosis in chronic hepatitis B patients

Liu Yanxia, Liang Zhandong, Wu Bo

2026, 31(8):  1096-1100. 

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Objective To explore the diagnostic value of ultrasound elastography (UE) combined with serum levels of nicotinamide adenine dinucleotide phosphate oxidase (NOX2) and CX3C chemokine ligand (CX3CL1) for liver fibrosis in chronic hepatitis B (CHB) patients. Methods A total of 159 chronic hepatitis B (CHB) patients admitted to Zhangjiakou Infectious Disease Hospital from May 2023 to April 2025 were designated as the study cohort. They were separated into a non-occurrence group (n=64) and an occurrence group (n=95) based on whether the patients had significant liver fibrosis. Another 137 healthy individuals were designated as a healthy control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum NOX2 and CX3CL1. The correlation between serum NOX2, CX3CL1 and liver fibrosis staging in CHB patients was explored by Spearman method. Multivariate logistic regression was used to explore the influencing factors of significant liver fibrosis in CHB patients. ROC was used to explore and evaluate the diagnostic value of elastic modulus value and serum NOX2 and CX3CL1 for significant liver fibrosis in CHB patients. Results The research group had higher serum NOX2 (7.27±1.48 ng/mL vs. 4.12±0.67 ng/mL, t=22.963, P<0.001), and lower CX3CL1 than the healthy group (6.83±1.42 ng/mL vs. 9.05±1.49 ng/mL, t=13.109, P<0.001). The occurrence group had higher elastic modulus value and serum level NOX2 (9.22±1.97 kPa vs. 6.63±1.12 kPa, 7.89±1.42 ng/mL vs. 6.36±1.04 ng/mL, t=9.526, 7.385, P<0.001), and lower CX3CL1 than the non-occurrence group (6.26±1.14 ng/mL vs. 7.68±1.37 ng/mL, t=7.096, P<0.001). Spearman analysis showed a prominent correlation between serum NOX2 and CX3CL1 levels with the staging of liver fibrosis in CHB patients (r=0.463、-0.440, P<0.05). Multiple logistic regression showed that the occurrence of significant liver fibrosis in CHB patients was related to the course of CHB (OR=1.608), the levels of alanine aminotransferase (ALT) (OR=1.419), aspartate aminotransferase (AST) (OR=1.263), NOX2 (OR=2.032), and CX3CL1 (OR=0.927) (P<0.05). The results of receiver operating characteristic curve (ROC) analysis showed that the area under the curve (AUC) values of elastic modulus, serum NOX2 and CX3CL1 levels in the diagnosis of significant liver fibrosis in CHB patients were 0.863, 0.803, and 0.787, respectively. The AUC (0.948) for the combined diagnosis of these three indicators was higher than that of NOX2 (Z=4.961, P<0.001) and CX3CL1 (Z=4.941, P<0.001) alone in the diagnosis of significant liver fibrosis in CHB patients. Conclusion CHB patients have higher serum NOX2 and lower CX3CL1 levels. The elastic modulus value detected by UE combined with serum levels of NOX2 and CX3CL1 has good diagnostic efficacy for significant liver fibrosis, which is of positive significance for the development of multimodal diagnostic strategies.

The risk factors of QTc interval prolongation in patients with liver cirrhosis

Jiang Huaye, Fan Yongmei

2026, 31(8):  1101-1106. 

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Objective To explore the risk factors for the occurrence of QTc interval prolongation in patients with liver cirrhosis, so as to provide a basis for taking appropriate intervention measures in clinical diagnosis and treatment activities, with the aim of reducing the risk of QTc interval prolongation in cirrhotic patients. Methods The data of 648 patients diagnosed with liver cirrhosis during their hospitalization in People′s Hospital of Hunan Province (the First Affiliated Hospital of Hunan Normal University) from January 2020 to December 2023 were retrospectively collected. According to whether the QTc interval was prolonged or not, the patients were divided into a group with QTc interval < 440 ms (275 cases) and a group with QTc interval ≥ 440 ms (373 cases). The clinical characteristics, laboratory tests and examination indicators of the patients in these two groups were compared, and the relevant risk factors for the occurrence of QTc interval prolongation in patients with liver cirrhosis were analyzed. Results By comparing the data of the patients in the two groups and performing univariate logistic regression analysis, it was shown that there were statistically significant differences in Child-Pugh score, moderate to massive ascites, hypertension, left ventricular end-diastolic diameter (LVEDD), left ventricular posterior wall thickness at end-diastolic (LVPWd), filling peak of rapid filling during late diastole of the mitral valve orifice (A wave), hemoglobin (Hb), platelet (PLT), prothrombin activity (PTA), albumin (Alb), globulin (GLB), total bilirubin (TBil), total bile acid (TBA), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), potassium (K), sodium (Na), calcium (Ca) and creatine kinase-MB (CK-MB) (P<0.05). Univariate analysis showed that all of the above-mentioned indicators were statistically significant (P<0.05).The results of multivariate binary logistic regression analysis showed that hypertension, LVPWd, A peak, Hb, GLB, and K were independent influencing factors for the prolongation of the QTc interval in patients with liver cirrhosis (with odds ratios of 2.145, 1.178, 3.772, 0.990, 1.044, 0.639 respectively, P<0.05). ROC curves were plotted with LVPWd, A peak, Hb, GLB, K and the combined variable (a combination of the five variables) as the test variables. The results showed that the areas under the curve (AUC) were 0.700, 0.565, 0.602, 0.625, 0.614 and 0.573 respectively. Conclusion Hypertension, LVPWd, A peak, Hb, GLB, and K are independent influencing factors for the prolongation of the QTc interval in cirrhotic patients. These indicators should be highly emphasizedand effectively intervented s in clinical work, hould be promptly formulated and implemented to reduce the risk of QTc interval prolongation in patients.

Liver Cancer

The risk factors of microvascular invasion after radical hepatectomy for hepatitis B-related liver cancer

Ye Qing, Mao Yufeng

2026, 31(8):  1107-1111. 

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Objective To explore the risk factors of microvascular invasion (MVI) after radical hepatectomy for hepatitis B virus (HBV)-related hepatocellular carcinoma. Methods One hundred and twenty patients with hepatitis B-related liver cancer in General Hospital of Eastern Theater Command from January 2020 to June 2024 were retrospectively selected. All patients underwent operation of radical hepatectomy. According to the postoperative pathological results, they were divided into a MVI group (n=30) and a non-MVI group (n=90). The general data of both groups of patients were compared and the levels of total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), carbohydrate antigen 19-9 (CA19-9), alpha fetoprotein (AFP), neutrophil to lymphocyte ratio (NLR), and carcinoembryonic antigen 19-9 (CA19-9)/gamma glutamyl transpeptidase (GGT) ratio of all patients were measured; The risk factors of MVI after radical hepatectomy for hepatitis B-related liver cancer were identified through multiple factors and unconditional logistic stepwise regression analysis. Results The proportion of pathological low differentiation (66.67%), tumor maximum diameter>5 cm (73.33%), capsule enhancement (70.00%), AFP>400 μg/L (60.00%), NLR level (3.21 ± 1.02), CA19-9/GGT level (3.03 ± 0.56) in the MVI group were higher than those of the proportion of pathological low differentiation (33.33%), tumor maximum diameter>5 cm (47.78%), capsule enhancement (48.89%), NLR level (1.75 ± 0.56), CA19-9/GGT level (2.41 ± 0.47), AFP>400 μg/L (40.00%)} in the non-MVI group (P<0.05); Pathological poor differentiation (OR=2.685, 95%CI:1.124～6.414), maximum tumor diameter>5 cm (OR= 2.756, 95% CI:1.231～6.170), capsule enhancement (OR=2.674, 95% CI:1.198～5.969), NLR (OR=2.168, 95%CI:1.321～3.558), CA19-9/GGT (OR: 1.639, 95% CI: 1.210～2.220), AFP>400 μg/L (OR: 2.895,95% CI: 1.358～6.172) are the risk factors of patients with MVI after radical hepatectomy for hepatitis B-related liver cancer (all P<0.05). Conclusion The occurrence of MVI in patients with hepatitis B-related liver cancer after radical hepatectomy is closely related to poor pathological differentiation, tumor maximum diameter>5 cm, capsule enhancement, NLR, CA19-9/GGT ratio, AFP>400 μg/L, and thus these should be closely monitored in clinical practice.

The application of artificial intelligence-assisted contrast-enhanced ultrasound technology in the diagnosis of tiny liver cancer

Wu Sisi, Yang Yang

2026, 31(8):  1112-1114. 

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Objective To analysis the application value of Contrast-Enhanced Ultrasound (CEUS) technology assisted by Artificial Intelligence (AI) in the diagnosis of small hepatocellular carcinoma (SHCC). Methods The clinical data of 80 patients with 90 lesions suspected to be SHCC who underwent examinations in Taizhou Second People′s Hospital from January 2023 to January 2025 were retrospectively analyzed. All patients underwent CEUS and pathological examinations. The dynamic imaging data of all lesions were input into the AI-CEUS system for analysis, and the AI diagnosis conclusions were obtained. Taking the pathological or final clinical diagnosis as the gold standard, the consistency of CEUS alone and in combination with AI for diagnosing SHCC was analyzed. Results More than 90 lesions were detected in 80 patients, within them. 58 cases (64.44%) were pathologically diagnosed as SHCC, 32 cases (35.56%) were of benign lesions,, which included 12 cases (37.50%) of hemangioma and 8 cases (25.00%) of focal nodular hyperplasia. 7 cases (21.88%), were of atypical hyperplasia nodules, and 5 cases (15.62%) were of inflammatory pseudotumor. Consistency analysis confirmed that the accuracy, sensitivity, and specificity of CEUS technique in the diagnosis of SHCC were 86.67%, 82.76% and 93.75%, respectively, with a positive predictive value of 96.00%, a negative predictive value of 75.00%, and a Kappa value of 0.724. The sensitivity, accuracy specificity, positive predictive value, negative predictive value, and Kappa value of AI auxiliary CEUS technique in diagnosing SHCC were 92.22%, 91.38%, 93.75%, 96.36%, 85.71%,and 0.834, respectively. Conclusion AI auxiliary CEUS technique can significantly improve the accuracy, specificity for diagnosing SHCC, with superior and stable performance, thus has high clinical value.

The diagnostic value of contrast-enhanced ultrasound features in dysplastic nodules of cirrhosis and small hepatocellular carcinoma

Zhang Yan, Wei Rufeng, Zhang Chunling, Yang Lin, Xiao Yan

2026, 31(8):  1115-1119. 

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Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) characteristics and quantitative parameters in differentiating dysplastic nodules (DN) of cirrhosis from small hepatocellular carcinoma (SHCC). Methods A retrospective study included 45 SHCC patients and 45 DN patients admitted to Hanzhong Central Hospital between January 2020 and December 2025. All underwent CEUS. Qualitative features (enhancement level and type in arterial, portal, and delayed phases) and quantitative parameters [regional blood volume (RBV), regional blood flow (RBF) in three phases] were compared. Multivariate logistic regression analysis was used to identify independent differentiating factors between DN and SHCC, and receiver operating curve (ROC) analysis was used to validate the diagnostic performance. Results The SHCC group had significantly higher arterial enhancement level, arterial RBV and arterial RBF, and significantly lower portal enhancement level, delayed enhancement level, portal RBV and delayed RBV than the DN group (P<0.05). Multivariate analysis confirmed portal enhancement level, arterial RBV, portal RBV, delayed RBV and arterial RBF as independent factors (P<0.05); arterial RBV and RBF were risk factors, whereas others were protective factors. Combined detection achieved an AUC of 0.970, sensitivity 97.8% and specificity 91.1%, superior to single indicators (P<0.05). Conclusion CEUS qualitative features and quantitative parameters (RBV, RBF) effectively distinguish DN from SHCC. Portal enhancement level, arterial RBV, portal RBV, delayed RBV and arterial RBF are key indicators, and their combined application improves diagnostic accuracy with important clinical value.

Efficacy of sintilimab combined with gemcitabine and cisplatin in the treatment of patients with advanced intrahepatic cholangiocarcinoma

Yao Weifeng, Zhou Rengui

2026, 31(8):  1120-1123. 

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Objective To assess the clinical outcomes and safety profile of sintilimab in combination with gemcitabine and cisplatin for patients diagnosed with advanced intrahepatic cholangiocarcinoma (ICC). Methods A total of 84 advanced ICC patients treated at Wuxi Taihu Hospital between December 2022 and December 2024 were enrolled and categorized into two groups based on therapeutic regimen. The experimental group (n=42) received sintilimab alongside gemcitabine and cisplatin, while the control group (n=42) was administered gemcitabine and cisplatin alone, with both groups completing three treatment cycles. Efficacy evaluation, liver function markers, and adverse event occurrence were compared between the groups. Overall survival (OS) over 12 months was evaluated using Kaplan-Meier methodology. Results The experimental group demonstrated superior therapeutic response compared to the control group. Objective response rate (ORR) was 59.5% (25/42) in the experimental group versus 31.0% (13/42) in the control group, and disease control rate (DCR) reached 90.5% (38/42) compared to 69.0% (29/42), with both differences being statistically significant (P<0.05). Post-treatment measurements indicated lower serum alanine aminotransferase (ALT, 41.3 ± 12.6 U/L vs. 58.6 ± 15.4 U/L), aspartate aminotransferase (AST, 45.7 ± 14.8 U/L vs. 63.2 ± 17.6 U/L), and total bilirubin (21.4 ± 7.6 μmol/L vs. 29.8 ± 9.4 μmol/L) levels in the experimental group (all P<0.05). Conversely, serum albumin was higher in the experimental group (38.9 ± 4.3 g/L vs. 35.1 ± 4.0 g/L, P<0.05). Survival analysis showed a 12-month OS rate of 71.4% (30/42) for the experimental group, significantly exceeding the 47.6% (20/42) observed in the control group (log-rank χ²=8.788, P=0.003). The frequency of adverse events did not differ meaningfully between the two groups (P>0.05). Conclusion The therapeutic regimen combining sintilimab with gemcitabine and cisplatin exhibits significant clinical benefits and favorable safety in advanced ICC management, supporting its promising role in clinical practice.

Expression and clinical significance of SRPK1 and IGF2BP3 in liver cancer tissue

Hu Fangyu, Wang Xirong, Wang Haiqing

2026, 31(8):  1124-1128. 

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Objective To investigate the expression and clinical significance of serine arginine protein kinase 1 (SRPK1) and insulin-like growth factor 2-mRNA binding protein 3 (IGF2BP3) in liver cancer tissue. Methods A total of 118 patients with liver cancer who treated in the Lianyungang First People′s Hospital from March 2019 to March 2021 were selected for the study. Immunohistochemical methods were applied to detect the expression levels of SRPK1 and IGF2BP3 proteins. Multivariate Cox regression was used to analyze the relationship between SRPK1 and IGF2BP3 expression, clinicopathological features and prognosis of patients. Results The positive expression rates of SRPK1 and IGF2BP3 in liver cancer tissues (72.88%, 75.42%) were significantly higher than those in adjacent tissues (32.20%, 28.81%) (χ²=39.16, P<0.001; χ²=51.36, P<0.001). The positive expression of SRPK1 and IGF2BP3 were found in patients with TNM stage Ⅲ to Ⅳ (76.74%, 74.16%), tumor diameter > 5 cm (81.40%, 79.78%), low differentiation (40.70%, 37.08%) and lymph node metastasis (67.44%, 60.67%). The proportion of positive expression was significantly increased (all P<0.05). The 3-year survival rate (78.13%) of patients with SRPK1 negative expression was higher (χ²=31.416, P<0.001). The 3-year survival rate (82.76%) of patients with IGF2BP3 positive expression was higher (χ²=30.763, P<0.001). SRPK1(HR=2.16; 95%CI:1.16~4.00; P=0.015), IGF2BP3(HR=2.14; 95%CI:1.05~4.36; P=0.035), TNM staging (HR=2.25; 95%CI:1.20~4.21; P=0.012), differentiation degree (HR=2.36; 95%CI:1.21~4.61; P=0.012), lymph node metastasis (HR=2.39; 95%CI:1.07~5.31; P=0.033) were the prognostic factors of patients with liver cancer (P<0.05). Conclusion The positive expression rates of SRPK1 and IGF2BP3 are increased in liver cancer tissues, which are closely related to differentiation degree, TNM staging, lymph node metastasis, and prognosis.

Clinical registration status of liver fibrosis in China

Zhang Lili, Wang Shaohua, Hu Jianhua

2026, 31(8):  1129-1132. 

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Objective In order to provide reference for the design and implementation of clinical trials in the future, this article collates the registration status of clinical studies on liver cancer combined with portal vein tumor thrombus (PVTT) in the database of the Chinese Clinical Trial Registry (ChiCTR), summarizes the current research results and analyzes the existing problems. Methods Using “portal vein tumor thrombus” as the search term, all clinical studies related to PVTT in the ChiCTR from 2005 to June 30, 2025 were searched. Results A total of 51 clinical studies on liver cancer combined with PVTT were included, covering 15 provincial administrative regions across the country. The total sample size of the clinical studies was 6 094 cases. 49 of them had clear sources of funding. There were two types of studies, among which 42 were interventional studies, accounting for the highest proportion (82.35%), and observational studies accounted for 17.65%. Seven types of research protocols were involved. Randomized parallel controlled trials were the most numerous, with a total of 25 trials (49.02%). Six studies explicitly stated that they were open-label trials, while the remaining 45 did not explicitly mention blinding. Conclusion Currently, there are many treatment options for clinical trials related to liver cancer combined with PVTT, and the research results are relatively concentrated. However, there are problems such as a small number of registrations, uneven geographical distribution, a large proportion of financial support, and a lack of innovative non-invasive diagnostic tests.

Viral Hepatitis

A real-world study of emitasvir phosphate combined with sofosbuvir in the treatment of patients with genotype 1 non-cirrhotic chronic hepatitis C virus infection

Ruan Jun, Kou Guoxian, Pu Yiyun, Yang Qing, Yin Heng

2026, 31(8):  1133-1136. 

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Objective To evaluate the clinical efficacy and safety of emitasvir phosphate combined with sofosbuvir in the treatment of patients with genotype 1 non-cirrhotic chronic hepatitis C virus (HCV) infection. Methods A total of 81 patients with genotype 1 non-cirrhotic chronic HCV infection who were initially treated in Mianyang Central Hospital from January 2024 to December 2024 were selected as the study subjects and were treated with emitasvir phosphate combined with sofosbuvir for 12 weeks. The sustained virological response at 12 weeks (SVR12) after the end of treatment, rapid virological response at 4 weeks after treatment, virological response at 12 weeks after treatment and the occurrence of adverse reactions were observed. Results Most of the 81 patients with genotype 1 non-cirrhotic chronic HCV infection who were initially treated were middle-aged and elderly married men (46 cases, 56.8%), mostly from rural areas with low economic development level (67 cases, 82.7%). HCV infection was mainly transmitted through blood contact (69 cases, 85.2%), and the most common HCV genotype was genotype 1b (78 cases, 96.3%). All patients completed the 12-week combination regimen of emitasvir phosphate plus sofosbuvir, with a 4-week rapid virologic response rate of 96.3% (78/81) and a 100% (81/81) virologic response rate at 12 weeks after treatment. The SVR12 after the end of treatment was 100% (81/81). There were no serious adverse reactions during the treatment period, but 13 patients had mild adverse reactions. Conclusion The 12-week regimen of emitasvir phosphate combined with sofosbuvir has good efficacy and safety, and can be used as an effective treatment for patients with genotype 1 non-cirrhotic chronic HCV infection, which is worthy of further clinical application.

Liver Failure

Establishment and evaluation of a prognostic model for patients with hepatitis B virus-associated acute-on-chronic liver failure after plasma exchange treatment

Chen Lixia, Lin Jianhui

2026, 31(8):  1137-1141. 

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Objective To explore the influencing factors of short-term prognosis in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) treated with plasma exchange (PE), develop a new prognostic model and evaluate its value for prognosis. Methods A total of 294 HBV-ACLF patients who received more than 3 sessions of PE treatment at Meng Chao Hepatobiliary Hospital of Fujian Medical University from January 2020 to December 2024 were selected. They were divided into a survival group and a death group based on their survival status after 24 weeks. The study analyzed the differences in baseline characteristics between the two groups, used multivariate analysis to identify independent predictors of patient prognosis, and established a prognostic model. The predictive performance of the new model, the Model for End-Stage Liver Disease (MELD), and the Prealbumin-Bilirubin (PALBI) score was evaluated using the Receiver Operating Characteristic (ROC) curve. Results Among the 294 HBV-ACLF patients treated for PE, 230 were in the survival group and 64 were in the death group. Compared with the survival group, the death group had a higher proportions of ascites [58.26% vs. 79.69%(χ²=9.853,P=0.002)], hepatic encephalopathy [6.09% vs. 37.50% (χ²=43.899, P<0.001)] and infections [68.26% vs. 89.06% (χ²=10.938, P=0.001)]. There were also higher levels of total bilirubin [347.60 (294.20, 423.33)μmol/L vs. 396.00 (309.65, 511.33)μmol/L (Z=-2.366, P=0.018)], lower levels of prealbumin [52.00 (35.75, 64.25)g/L vs. 35.00 (26.00, 47.00)g/L (Z=-5.461, P<0.001)], prolonged prothrombin time [22.10 (19.58, 24.83)s vs. 28.80 (23.00, 33.25)s (Z=-7.582, P<0.001)], higher levels of blood urea nitrogen [3.50 (2.70, 4.53)μmol/L vs. 4.45 (3.30, 5.55)μmol/L (Z=-3.231, P=0.001)], lower levels of alpha-fetoprotein [101.05 (33.30, 231.60)g/L vs. 29.15 (9.75, 107.25)g/L (Z=-5.236, P<0.001)], and higher levels of lactate [1.30 (1.00, 1.70)mmol/L vs. 1.57 (1.10, 1.98)mmol/L (Z=-2.135, P=0.033)]. Multivariate analysis showed that total bilirubin, prealbumin, prothrombin time, blood urea nitrogen, and alpha-fetoprotein were independent predictors of poor short-term prognosis in HBV-ACLF patients treated with PE. The regression coefficient for total bilirubin was 0.006 (95% CI: 1.003~1.009, P<0.001). The regression coefficient for prealbumin was -0.043 (95% CI: 0.936~0.981,P<0.001). The regression coefficient for prothrombin time was 0.186 (95% CI: 1.123~1.293, P<0.001). The regression coefficient for blood urea nitrogen was 0.211 (95% CI: 1.062~1.435, P=0.006). The regression coefficient for alpha-fetoprotein was -0.010 (95% CI: 0.984~0.996, P=0.002). The equation for TPPBA is: TPPBA = 0.006×[TBil(μmol/L)]-0.043×[PAB(mg/L)]+0.186×[PT(s)]+0.211×[BUN(mmol/L)]-0.010×[AFP(μg/L)]-6.768. The area under the ROC curve for TPPBA was 0.905 (95% CI: 0.871~0.939, P<0.001). Similarly, the AUCs for MELD were 0.804 (95% CI: 0.741~0.866, P<0.001), and those for PALBI scoring were 0.750 (95% CI: 0.681~0.820, P<0.001). When comparing the ROC curves among these three methods, there was no significant difference between MELD and PALBI scoring (Z=1.293, P=0.196). However, there were significant differences between MELD and TPPBA (Z=3.958, P<0.001) and between PALBI and TPPBA (Z=4.826, P<0.001). Thus, TPPBA outperformed both MELD and PALBI scoring in terms of predictive accuracy (P<0.05). Conclusion Total bilirubin, prealbumin, prothrombin time, blood urea nitrogen, and alpha-fetoprotein are independent predictors of short-term prognosis in PE-treated HBV-ACLF patients. The TPPBA model, based on these indicators, demonstrates better predictive value than the MELD and PALBI scores.

A prognostic analysis of 81 patients with hepatitis E-related liver failure

Huang Yanping, Xu Haiting, Yang Weiqi, Yu Dawei

2026, 31(8):  1142-1145. 

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Objective To summarize the clinical data of patients with hepatitis E -related liver failure, to analyze the causes of liver failure, and to identify the independent risk factors affecting their prognosis, with the aim of improving clinical diagnosis and treatment capabilities. Methods A retrospective analysis was conducted on 81 patients with hepatitis E-related liver failure who were admitted to No.904 Hospital of the Joint Logistics Support Force of the People′s Liberation Army between January 2020 and June 2024. Their clinical manifestations and signs were collected, and their outcomes were followed-up. Based on their clinical outcomes, the patients were categorized into a survival group and a death group. The clinical data were compared between the two groups of patients and the factors influencing the patients′ prognosis were analyzed. Results The common clinical manifestations and signs in patients with hepatitis E-related liver failure predominantly include jaundice, ascites, and fatigue. Additional symptoms encompass loss of appetite, nausea and vomiting, and dull pain in the right upper quadrant. Among 81 patients, 68 survived while 13 died due to progressive deterioration. The causes of death included: multiple organ failure in 7 cases (53.8%), severe infection in 4 cases (30.8%), cerebral edema/intracranial hypertension in 1 case (7.7%), and acute pancreatitis in 1 case (7.7%). The median survival time from disease confirmation to death was 12 days (range: 7~35 days). Compared with the survivors, the deceased patients exhibited significantly higher values in parameters including age, incidence of multiple organ failure, hyperbilirubinemia, alanine aminotransferase (ALT), aspartate transaminase (AST), total bilirubin (TBil), Creatinine (Cr), blood lactate, blood ammonia, International Normalized Ratio (INR), and model for end-stage liver disease (MELD) score (P<0.05), whereas their Platelet (PLT) levels were significantly lower (P<0.05). By multivariate logistic regression analysis it was identified that age, multiple organ failure, and hyperbilirubinemia were independent risk factors for the mortality of patients with hepatitis E-induced liver failure (P<0.05). Conclusion Age, multiple organ failure, and hyperbilirubinemia are independent risk factors for death in patients with hepatitis E-related liver failure. It is essential to strengthen dynamic monitoring of multi-organ function, especially respiratory, renal, and coagulation functions, and to closely follow-up the trend of bilirubin levels in order to provide a basis for the formulation of individualized intervention strategies.

Metabolic Dysfunction-Associated Steatotic Liver Disease

Comparative analysis of intestinal flora characteristics in patients with alcoholic fatty liver and metabolism associated fatty liver based on 16S rDNA sequencing

Sun Yue, Niu Haoshu

2026, 31(8):  1146-1151. 

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Objective To analyze the changes in intestinal flora in patients with alcoholic fatty liver disease (AFLD) and metabolism-associated fatty liver disease (MAFLD) and to explore the differences in intestinal flora between them. Methods Forty-five patients who visited Inner Mongolia Baogang Hospital from June 2023 to June 2024 were selected as the study subjects, including 15 patients in the AFLD group, 15 patients in the MAFLD group and 15 patients in the normal control group (NC group), and the data on the changes in the diversity of the bacterial flora between the groups were obtained to analyze the differences in gut microorganisms among AFLD, MAFLD patients and healthy control patients, and to detect the alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglycerides (TG), total cholesterol (TC), and lipopolysaccharide (LPS) at the same time. The body mass index (BMI) was calculated and compared and analyzed. Results Compared with the NC group, the levels of serum LPS were elevated in patients in the AFLD and MAFLD groups (all P<0.05), and LPS was significantly higher in the AFLD group than in the MAFLD group (P>0.05). For the analysis of intestinal flora: (i)Alpha diversity: there was no significant difference in Shannon index (P=0.15), Simpson index (P=0.06) in AFLD, MAFLD and control group, and there was a difference in gut microbial community among the three groups in Beta diversity analysis. (ii) Species composition analysis: at the phylum level, the abundance of Pseudomonadota in AFLD and MAFLD groups was higher than that in NC group, and the abundance of Verrucomicrobiota was higher in AFLD than that in MAFLD group. At the family level, the abundance of Enterobacteriaceae, Veillonellaceae and Streptococcaceae in AFLD and MAFLD groups were all elevated, and that of Lachnospiraceae Bifidobacteriaceae and Barnesiellaceae were all reduced and the abundance of Lachnospiraceae was significantly lower in the AFLD group than in the MAFLD group. (iii)Analysis of variance among the three groups: when the LAD score was >3.5, Bacteroidota, Verrucomicrobiota, Acidaminococcaceae, Escherichia, and Phascolarctobacterium in the AFLD group were the differential species compared to the NC group. In the MAFLD group, Bacillota, Faecalibacterium, Oscillospiraceae, Veillonellaceae and Blautia were the differential species. And compared with the AFLD and MAFLD groups, Eubacteriales, Clostridia, Lachnospiraceae and Bifidobacteriaceae were the differential species in the NC group. (iiii) KEGG analysis: Compared with the NC group, the intestinal flora of the AFLD and MAFLD groups were significantly down-regulated in lipid metabolism and carbohydrate metabolism pathways, while the intestinal flora of the AFLD group were significantly up-regulated in the immune system pathway. Correlation analysis: in the AFLD group and the healthy control group, Bacteroidota and Pseudomonadota were positively correlated with serum LPS, and Bacillota was negatively correlated with serum LPS; whereas in the MAFLD group and the healthy control group, Pseudomonadota was positively correlated with serum LPS, and Actinomycetota was negatively correlated with serum LPS. Conclusion Patients with AFLD and MAFLD have elevated levels of LPS, which may indicate intestinal inflammation. The inflammatory response involving LPS may be one of the causes of FLD, and LPS levels are higher in the AFLD group than in the MAFLD group, suggesting that alcohol can exacerbate the inflammatory response in AFLD. Patients with AFLD and MAFLD had intestinal dysbiosis, as evidenced by increased abundance of pathogenic bacteria (e.g., Pseudomonadota, Enterobacteriaceae, Veillonellaceae, Streptococcaceae) and decreased abundance of beneficial bacteria (e.g., Lachnospiraceae, Bifidobacteriaceae, and Barnesiellaceae), and Lachnospiraceae was significantly decreased in the AFLD group as compared to the MAFLD group, which may be related to alcohol. AFLD has an imbalance in gut microbiota, and alcohol may alter the gut microbiota, affect immune system pathways, generate inflammatory responses, and promote the occurrence and development of AFLD.

Metabolic characteristics and the severity of hepatic steatosis and fibrosis in patients with lean non-alcoholic fatty liver disease

Yang Ying, Xia Lingli, Li You, Cao Ting

2026, 31(8):  1152-1155. 

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Objective To investigate the metabolic characteristics of patients with lean non-alcoholic fatty liver disease (NAFLD) and to analyze the severity of hepatic steatosis and liver fibrosis, thereby providing evidence for the clinical identification and risk assessment of lean NAFLD. Methods Between January 2021 and June 2025, study participants were classified into three groups according to body habitus and the presence of NAFLD: a lean NAFLD group (n=35), an obese NAFLD group (n=42), and a lean healthy control group (n=28). Differences among the three groups in metabolic parameters, the degree of hepatic steatosis and related indicators, as well as liver fibrosis-related indices were compared. Results Compared with the lean healthy control group, the lean NAFLD group showed significantly higher fasting insulin levels [FINS: 11.8 (8.9, 15.2) IU/mL vs 7.4 (5.6, 9.2) IU/mL] and homeostatic model assessment of insulin resistance (HOMA-IR) values [2.9 (2.1, 3.7) vs. 1.6 (1.2, 2.1)]. Triglyceride levels [TG: (1.7±0.6) mmol/L vs. (1.1±0.4) mmol/L] were increased, whereas high-density lipoprotein cholesterol levels [HDL-C: (1.1±0.3) mmol/L vs. (1.4±0.3) mmol/L] were decreased (all P<0.05). Indicators related to hepatic steatosis showed that liver fat content [(11.4±4.6)%] and controlled attenuation parameter (CAP) values [(262±38) dB/m] in the lean NAFLD group were significantly higher than those in the lean healthy control group [(3.2±1.5)%, (208±31) dB/m], but lower than those in the obese NAFLD group [(18.9±6.7)%, (302±46) dB/m] (P<0.05). In the lean NAFLD group, 18 patients (51.4%) had mild steatosis and 17 patients (48.6%) had moderate-to-severe steatosis. Assessment of liver fibrosis showed that liver stiffness measurement (LSM) [(7.9±2.6) kPa], the FIB-4 index [1.4 (1.0, 1.9)], and the NAFLD fibrosis score (NFS) [(-0.3±0.1)] were all significantly higher in the lean NAFLD group than those in the lean healthy control group [(4.8±1.3) kPa, 0.9 (0.6, 1.1), (-1.3±0.6)], while the platelet count was lower than that in the control group [(212±46)×10⁹/L vs. (236±41)×10⁹/L] (all P<0.05). In the lean NAFLD group, the proportion of patients with significant fibrosis (≥F2) was 25.7% (9/35), and the proportion with advanced fibrosis (≥F3) was 11.4% (4/35). Conclusion Although patients with lean NAFLD do not exhibit overt obesity, they already demonstrate a certain degree of metabolic abnormality and may be accompanied by a substantial risk of hepatic steatosis and liver fibrosis. In clinical practice, greater attention should be paid to screening and evaluation of NAFLD in lean individuals, so as to avoid underestimating disease severity based solely on body habitus.

Clinicopathological features and prognosis analysis of non-alcoholic fatty liver disease complicated with drug-induced liver injury

Mao Fei, Tao Yue, Dong Lei, Ou Jiang

2026, 31(8):  1156-1159. 

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Objective To analyze the clinicopathological features and prognosis of non-alcoholic fatty liver disease (NAFLD) complicated with drug-induced liver injury (DILI). Methods A total of 102 patients with DILI confirmed by liver biopsy, who were hospitalized in Pengshui Miao and Tujia Autonomous County People′s Hospital, Pengshui Miao and Tujia Autonomous County Hospital of Chinese Medicine and Chongqing Municipal of Traditional Chinese Medicine. from January 2020 to December 2024, were enrolled. According to the presence or absence of NAFLD, they were divided into an observation group (n=38) and a control group (n=64). The clinical characteristics, liver pathological features, and clinical outcomes were compared between the two groups. Results The BMI in the observation group was significantly higher than that in the control group (27.8±2.5 vs. 22.9±1.8 kg/m², P<0.05), and the incidence rates of type 2 diabetes (31.6% vs. 7.8%) and hyperlipidemia (47.4% vs. 14.1%) were also markedly increased (both P<0.05). The peak ALP level in the observation group was significantly lower than that in the control group [185 (145, 250) vs. 245 (180, 355) U/L, P<0.05]. Regarding liver histology, no significant differences were observed in portal inflammation (78.9% vs. 85.9%), eosinophil infiltration (26.3% vs. 39.1%), or bile duct injury (10.5% vs. 14.1%) between the two groups (P>0.05). However, the proportion of patients with hepatocellular ballooning was significantly higher in the observation group (65.8% vs. 12.5%, P<0.05), and the rate of advanced liver fibrosis (≥S3) was also markedly increased (21.1% vs. 3.1%, P<0.05). Follow-up outcomes revealed that the 3-month biochemical resolution rate was significantly lower in the observation group (65.8% vs. 85.9%, P<0.05), and the time to biochemical resolution was significantly prolonged [75 (45, 120) vs. 48 (30, 75) days, P<0.05]. The incidence of disease progression within 6 months was significantly higher in the observation group (18.4% vs. 3.1%, P<0.05), including 5 cases progressing to cirrhosis and 2 cases developing hepatic decompensation, whereas only one case each occurred in the control group. Conclusion NAFLD is a potential susceptibility factor for DILI and can significantly influence the disease severity, histological pattern, and clinical outcomes of DILI.

Autoimmune Liver Disease

Thyroid function alterations in patients with autoimmune hepatitis and their association with treatment response

Wang Zihong, Hu Ping, Song Tao, Li Xiang, Gao Yulin

2026, 31(8):  1160-1163. 

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Objective The present study sought to delineate alterations in thyroid function among patients with autoimmune hepatitis (AIH), with the ultimate aim of clarifying their potential role not only in the assessment of disease activity but also in the prediction of therapeutic response. Methods Seventy-eight patients diagnosed with AIH and admitted to Leshan Maternal and Child Health Hospital and Shaanxi Rehabilitation Hospital between August 2023 and June 2025, together with 50 healthy individuals who underwent routine examinations and served as controls, were included. Comparative analyses of thyroid functional indices were performed between patients and controls; subsequently, post-treatment evaluations were conducted, in which patients were stratified by disease severity and therapeutic response status. Results Before treatment, serum FT3 and FT4 levels in AIH patients were (4.1±0.4) pmol/L and (13.8±2.2) pmol/L, respectively, both significantly lower than those in the control group [(4.8±0.6) pmol/L and (15.9±2.7) pmol/L, P<0.05], while TSH was markedly higher [(3.7±0.8) mIU/L vs. (2.8±0.6) mIU/L, P<0.05]. In patients with severe disease, FT3 and FT4 levels [(3.9±0.4) pmol/L and (13.2±2.1) pmol/L] were significantly lower than those in patients with mild to moderate disease [(4.3±0.5) pmol/L and (14.2±2.4) pmol/L, P<0.05], whereas TSH was significantly higher [(4.0±0.9) mIU/L vs. (3.5±0.6) mIU/L, P<0.05]. Compared with patients with mild to moderate disease, histological inflammation grade <2, or liver fibrosis stage <2,patients with severe conditions, histological inflammation grade ≥2 or fibrosis stage ≥2 exhibited lower FT3 and FT4 levels and markedly elevated TSH levels (P<0.05). After treatment, 51 AIH patients (65.4%) achieved a therapeutic response. In the response group, FT3 and FT4 levels were (4.8±0.7) pmol/L and (15.8±2.7) pmol/L, respectively, significantly higher than those in the non-response group [(4.2±0.4) pmol/L and (14.0±2.2) pmol/L, P<0.05], while TSH was significantly lower [(2.8±0.5) mIU/L vs. (3.4±0.8) mIU/L, P<0.05]. Conclusion Characteristic alterations in thyroid function in AIH patients-alterations that appear to correlate with both the severity of hepatic involvement and the likelihood of treatment response-were identified. Such abnormalities may represent, rather than isolated endocrine derangements, a composite reflection of inflammatory activation, metabolic imbalance, and immune dysregulation. Taken together, indicators such as FT3, FT4, and TSH may thus not only carry prognostic implications but also serve as valuable predictors of therapeutic responsiveness.

Other Liver Diseases

Analysis of influencing factors of complications of damage control surgery in patients with traumatic hepatic rupture

Chen Baokun, Zhou Song, Chen Yufan

2026, 31(8):  1164-1168. 

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Objective To analyze the factors influencing complications after damage control surgery in patients with traumatic hepatic rupture. Methods The clinical data of 92 patients with traumatic hepatic rupture who underwent damage control surgery in Dongnan Hospital Affiliated to Xiamen University from January 2019 to December 2023 were retrospectively analyzed.They were divided into complication group (n=22) and non-complication group (n=70) according to whether postoperative complications occurred.Univariate and multivariate logistic regression analyses were performed to identify factors associated with complications after damage control surgery. According to the results of multifactor analysis, a receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of the multivariate logistic regression model for postoperative complications. Results All 92 patients with traumatic liver rupture underwent damage control surgery. Postoperative complications occurred in 22 cases (23.91%), including bile leakage in 12 cases, infection in 5 cases, hemorrhage in 3 cases and multiple organ failure in 2 cases. According to the AAST liver injury grading system, 17 patients had grade Ⅰ injuries, 10 had grade Ⅱ injuries, 34 had grade Ⅲ injuries, 25 had grade Ⅳ injuries, 6 had grade Ⅴ injuries, and none had grade Ⅵ injuries.The proportion of patients with an interval from injury to damage control surgery of ≥4 h, shock, an AAST liver injury grade of Ⅲ or higher, bile leakage after damage control surgery, postoperative infection control, bile duct injury and other organ injury in complication group was higher than that in non-complication group (P<0.05). Multivariate analysis showed that an interval from injury to damage control surgery of ≥4 h (OR:7.851, 95%CI:1.360～45.337), bile leakage after damage control surgery (OR:13.780, 95%CI: 2.322～81.781), control of postoperative infection (OR:5.634, 95%CI:1.013～31.341), combined with bile duct injury (OR: 6.277, 95%CI: 1.349～29.195) were risk factors for complications after damage control surgery for traumatic hepatic rupture.The ROC curve was drawn according to the multivariate logistic regression model. Area under the curve (AUC) was 0.924, sensitivity was 0.914, specificity was 0.727, 95%CI was 0.871～0.978, P<0.001. Conclusion Patients with traumatic liver rupture still have a high incidence of complications after receiving damage control surgery. A time from injury to damage control surgery of ≥4 h, bile leakage after damage control surgery, infection after damage control surgery, and concomitant bile duct injury are risk factors for complications.

MRI imaging analysis of 60 pediatric patients with hepatic-type and neurological-type Wilson′s disease

Li Weiwei, Xing Yitong, Li Weifeng, Zhan Liqian

2026, 31(8):  1169-1173. 

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Objective Magnetic resonance imaging (MRI) images of 60 pediatric patients with hepatic and cerebral hepatomegaly were analyzed. Methods Sixty children with Wilson′s disease confirmed by genetic testing admitted to the Second Affiliated Hospital of Zhengzhou University between between January 2023 and January 2026 were divided into the brain type group (n=28) and the liver type group (n=32) according to the type of disease occurrence. The clinical features and imaging characteristics of the two groups were compared, and the value of imaging indicators in identifying pediatric patients with hepatic and cerebral hepatomegaly was analyzed using receiver operating characteristic curve (ROC). Results The serum copper levels and ceruloplasmin levels of patients in the brain group were (10.6±3.5) μmol/L and (81.3±35.2) mg/L, respectively, which were lower than those in the liver group [(15.3±5.2) μmol/L and (135.6±56.9) mg/L, respectively], the age of onset was (7.2 ± 1.1) years in the brain-type group, which was lower than that in the liver group [(8.6±2.5) years], and the duration of onset was (2.6±1.2) years in the brain group, which was higher than that in the liver group [(1.2±0.8) years, P<0.05]; The rate of abnormal MRI signals in the nucleus accumbens, caudate nucleus, midbrain, pons, and medulla oblongata, and the T2WI-weighted imaging lesion involvement scores were 89.29%, 78.57%, 71.43%, 100.00%, 92.86%, (2.5±1.1), (1.20±0.30), (0.90±0.40), (1.1±0.3), and (0.80±0.30) points, respectively, in the brain-type group. ) points, (0.8±0.3) points, all higher than the liver type group [37.50%, 40.63%, 40.63%, 62.50%, 43.75%, (0.7±0.2) points, (0.20±0.06) points, (0.20±0.05) points, (0.4±0.1) points, (0.10±0.02) points, respectively]. Patients in the cerebral group had higher involvement scores in the pallidum, nucleus accumbens, caudate nucleus, thalamus, midbrain, pons, and medulla oblongata with (1.8 ± 0.7), (1.4 ± 0.8), (0.7 0± 0.30), (1.8 ± 0.6), (0.7 ± 0.3), (0.6 ± 0.2), and (0.4 ± 0.2) points, respectively, than those in the hepatic group [(1.3 ± 0.5), (0.6 ± 0.2), (0.10 ± 0.04), (0.9 ± 0.2), (0.2 ± 0.1), (0.3 ± 0.1), and (0.1 ± 0.02) points, P<0.05]; The results of ROC curve analysis showed that serum copper levels, ceruloplasmin levels, age at onset, disease duration, T2WI-weighted imaging lesion involvement score and extent of involvement score were of great value in differentiating between hepatic-type and neurological-type Wilson disease in children. Conclusion The serum copper level, ceruloplasmin level, age of onset, disease duration, T2WI-weighted imaging lesion involvement score and involvement score can be used to differentiate between hepatic-type and neurological-type Wilson disease in children and provide assistance for the clinical management of Wilson′s disease.

Clinical and pathological features of immune checkpoint inhibitor-induced drug-induced liver injury

Li Zhaoqiang, Liu Dongmei, Du Junying

2026, 31(8):  1174-1177. 

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Objective To investigate the clinical and pathological features of drug-induced liver injury (DILI) induced by immune checkpoint inhibitors (ICIs). Methods A total of 85 cancer patients treated with ICIs were selected, including 38 cases of non-small cell lung cancer, 21 cases of renal cell carcinoma, 14 cases of urothelial carcinoma, and 12 cases of malignant melanoma. DILI occurring after ICIs treatment was classified into hepatocellular injury type, cholestatic type, and mixed type. Clinical data were compared between DILI and non-DILI patients, as well as among different clinical subtypes of DILI. Liver biopsies were analyzed to compare pathological manifestations across subtypes. Results In the DILI group, the prevalence of hyperlipidemia, duration of ICI treatment, and levels of ALT, AST, ALP, and TBil were 9 cases (16.7%), 120 (80, 140) d, 162 (78, 204) U/L, 155 (70, 195) U/L, 208 (122, 310) U/L, and 78.6 (55.0, 93.8) μmol/L, respectively, which were significantly higher than those in the non-DILI group [1 case (3.2%), 85 (62, 114) d, 54 (38, 68) U/L, 55 (35, 63) U/L, 120 (86, 160) U/L, and 24.5 (17.0, 42.6) μmol/L, respectively; P<0.05].. Conversely, the disease control rate was significantly lower in DILI patients compared to non-DILI patients: 40.7% vs. 64.5% (P<0.05). After hepatoprotective treatment, blood biochemical indicators improved in all DILI subtypes: hepatocellular injury type showed more significant ALT and AST improvements, while cholestatic and mixed types demonstrated greater ALP and TBil improvements. Liver biopsies in some DILI patients revealed statistically significant differences in pathological features such as centrilobular necrosis, spotty necrosis, interface hepatitis, portal inflammation, and ductular reaction among subtypes (P<0.05). Hepatocellular injury type predominantly presented with central necrosis and spotty necrosis, whereas cholestatic and mixed types were characterized by interface hepatitis, portal inflammation, and bile duct reactions. Conclusion Hepatocellular injury type dominates among cases of ICI-induced DILI, but cholestatic and mixed types exhibit distinct biochemical and histological patterns.

Clinical characteristics, pathogen distribution, and early warning indicators of septic shock in liver abscess

Xia Xi, Zhu Xin

2026, 31(8):  1178-1182. 

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Objective To analyze the clinical characteristics, pathogen distribution, and antimicrobial susceptibility of liver abscess (LA) patients, to explore early warning indicators of septic shock, the association between cryptogenic liver abscess and tumor, the differentiation between LA and primary hepatocellular carcinoma (HCC), and the pathogen spectrum of invasive LA syndrome. Methods A retrospective analysis was conducted on clinical data of 146 LA patients admitted to the Affiliated Hospital of North Sichuan Medical College from June 1, 2020 to May 31, 2024. General situation, laboratory indices, microbiological results, and imaging features were collected to compare the difference between septic shock and non-shock groups. Results Among the 146 patients, 54.11% were male, with a mean age of 60.1 ± 13.1 years. Diabetes mellitus was present in 56.84% of cases, and hepatobiliary-pancreatic diseases in 52.05%. The main clinical manifestations included fever (69.18%) and abdominal pain (41.78%). Gram-negative bacteria were the predominant pathogens (82.53%), with Klebsiella pneumoniae being the most frequently isolated (65.06%), followed by Escherichia coli (10.24%). In the septic shock group, procalcitonin (PCT) and interleukin-6 (IL-6) were significantly higher than in the non-shock group (P<0.05), while platelet (PLT) levels were significantly lower (P<0.05). Cryptogenic liver abscess accounted for 52.74% of cases, including one patient subsequently diagnosed with ascending colon adenocarcinoma. Alpha-fetoprotein (AFP) levels were within normal limits in all 81 patients tested, while mildly elevated levels of protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) were observed in 48 out of 67 patients. Pathogens such as Klebsiella pneumoniae, Escherichia coli, Enterobacter aerogenes, Streptococcus spp., Candida spp., and Clostridium perfringens were associated with invasive infections involving multiple sites, including the bloodstream, lungs, eyes, urinary tract, peritoneal cavity, spleen, and cervical soft tissues. Conclusion Liver abscess is primarily caused by Klebsiella pneumoniae infection. The proportion of Enterococcus was higher in portal vein infections. PLT, PCT, and IL-6 may serve as early warning indicators for septic shock. Patients with cryptogenic liver abscess should be monitored for potential underlying malignancies, and regular colonoscopy screening is recommended. Antimicrobial therapy should be optimized based on drug susceptibility results, with vigilance for drug-resistant bacteria and fungal co-infections. Combined detection of AFP and PIVKA-Ⅱ contributes to the differential diagnosis between liver abscess and hepatocellular carcinoma. Klebsiella pneumoniae, Escherichia coli, Enterobacter aerogenes, Streptococcus spp., Candida spp., and Clostridium perfringens are potential pathogens causing invasive liver abscess.

Correlations of NLR, AT-Ⅲ, and SUA/Cr levels with disease severity and pregnancy outcomes in patients with acute fatty liver of pregnancy

Qiu Yuyuan, Wang Lijuan, Gao Yanjie, Yang Yuanchen, Yang Jinyan

2026, 31(8):  1183-1187. 

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Objective To investigate the clinical value of neutrophil/lymphocyte ratio (NLR), antithrombin Ⅲ (AT-Ⅲ) and serum uric acid/creatinine ratio (SUA/Cr) in patients with acute fatty liver of pregnancy (AFLP). Methods Twenty-nine pregnant women with AFLP diagnosed and treated from January 2021 to December 2024 were included in the observation group, and were grouped according to whether they developed acute liver failure (ALF) and adverse pregnancy outcome (APO). Fifty healthy parturients during the same period were selected and included in the control group. NLR, AT-Ⅲ, and SUA/Cr levels were detected and analyzed retrospectively. The levels of NLR, AT-Ⅲ, and SUA/Cr were compared between the observation group and the control group, as well as among subgroups in the observation group. The correlation between each index and APRI, Child-Pugh and Nesbitt scores of liver function was analyzed by Pearson, and the evaluation efficiency of each index was analyzed by ROC. Results The levels of NLR and SUA/Cr in the observation group were 3.85±0.79 and 5.37±0.86, which were higher than those in the control group (2.27±0.43 and 3.62±0.47). The AT-Ⅲ in the observation group was 57.49±4.81%, which was lower than that in the control group (74.68±3.56%). The difference was statistically significant (t=9.165, 10.536, 12.724, all P<0.05). The levels of NLR and SUA/Cr of 7 cases in the ALF subgroup were 4.73±0.91 and 5.74±0.97, higher than those in the non-ALF subgroup of 22 cases, (3.47 ± 0.62 and 4.39 ± 0.58), and the AT-Ⅲ level in the ALF subgroup was 52.36±5.28%, which was lower than that in the non-ALF subgroup (62.84±4.35%). The difference was statistically significant (t=7.462, 8.763, 8.017, all P<0.05). The levels of NLR and SUA/Cr in the APO subgroup of 23 cases were 4.58±0.86 and 5.36±0.85, which were higher than those in the non-APO subgroup of 6 cases (3.36±0.58 and 4.18±0.54). The AT-Ⅲ level in the APO subgroup was 53.27%±5.14%, which was lower than that in the non-APO subgroup (61.49%±4.26%). The difference was statistically significant (t=7.429, 7.254, 8.395, all P<0.05). Pearson analysis showed that NLR and SUA/Cr in AFLP pregnant women were positively correlated with APRI and Child-Pugh score, but negatively correlated with Nesbitt. AT-Ⅲ was positively correlated with Nesbitt and negatively correlated with APRI and Child-Pugh score (P<0.001). ROC curve showed that the AUC of NLR, AT-Ⅲ and SUA/Cr in the evaluation of ALF and APO in AFLP pregnant women were 0.679, 0.786, 0.713 and 0.936, and the sensitivity and specificity of the combined model were higher than those of any individual indicator (P<0.001). Conclusion The combined assessment of NLR, AT-Ⅲ, and SUA/Cr levels has high clinical value in the assessment of acute liver failure and adverse pregnancy outcomes in AFLP pregnant women.

Efficacy of silybin meglumine in combination with danning tablets in the treatment of alcoholic hepatitis

Li Mingming, Wang Chuanfu, Sun Tingting

2026, 31(8):  1188-1191. 

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Objective To investigate the clinical efficacy of silybin meglumine combined with Danning tablets in the treatment of alcoholic hepatitis (AH), and to evaluate its effects on liver function, inflammatory response, oxidative stress, and related clinical symptoms. Methods A total of 116 patients with AH who were treated at our hospital between November 2023 and July 2025 were enrolled and divided into an observation group (n=56) and a control group (n=60) according to different treatment regimens. The control group received oral silybin meglumine tablets, while the observation group received Danning tablets in addition to silybin meglumine. Liver function parameters, inflammatory and oxidative stress markers, and improvements in AH clinical symptoms were compared between the two groups before and after treatment. Results After treatment, ALT, AST, GGT, ALP, and TBil in the observation group decreased to (54.7±18.9) U/L, (49.8±16.7) U/L, (72.6±29.1) U/L, (86.9±24.3) U/L, and (21.8±8.4) μmol/L, respectively, which were significantly lower than those in the control group [(69.3±22.4) U/L, (62.1±19.5) U/L, (95.8±34.6) U/L, (104.7±28.6) U/L, and (27.6±9.9) μmol/L; all P<0.05]. Regarding inflammatory and oxidative stress markers, CRP, TNF-α, and MDA in the observation group decreased to (7.9±3.2) mg/L, (24.5±8.3) pg/mL, and (3.8±1.2) nmol/mL, respectively, which were significantly lower than those in the control group [(10.6±4.1) mg/L, (30.8±9.6) pg/mL, and (4.9±1.4) nmol/mL], while SOD increased to (118.6±22.7) U/mL, higher than that in the control group [(103.2±21.4) U/mL] (all P<0.05). The remission times for jaundice and distending pain in the hepatic region in the observation group were (7.1±2.5) d and (6.7±2.2) d, respectively, which were shorter than those in the control group [(9.8±3.1) d and (9.2±2.7) d] (all P<0.05). Conclusion On the basis of alcohol abstinence and supportive therapy, silybin meglumine combined with Danning tablets is more effective than silybin meglumine alone in improving liver function, reducing inflammatory response and oxidative stress injury, and alleviating clinical symptoms in patients with alcoholic hepatitis, indicating favorable clinical application value.