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    31 December 2023, Volume 28 Issue 12
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    Liver Failure
    An analysis on the factors affecting adsorption capacity during dual plasma molecular adsorption combined with lower volume plasma exchange therapies
    ZHANG Xiu-xiu, HU Yan-ming, TANG Ru-jia, WANG Kai-li, Yao Hong-yu, Xing Han-qian, LIU Hong-ling, ZHOU Xia
    2023, 28(12):  1410-1412. 
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    Objective To analyze the common factors affecting the adsorption capacity of patients with liver failure or severe hyperbilirubinemia during dual plasma molecular adsorption (DPMAS) and lower volume plasma exchange (LPE) treatment.Methods A total of 161 cases of liver failure or hyperbilirubinemia treated with DPMAS and LPE from January 1,2021 to May 31,2022 were collected. The common conditions, alarm and influencing factors of the adsorption reduction (less than 4000ml) caused by various reasons were analyzed.Results Of the 161 patients treated with DPMAS combined with LPE, 24 had the adsorption volume less than standard dose, accounting for 14.9% of the total treatment. The decrement of bilirubin level was lower than that in the standard treatment group, but there was no significant statistical difference (P=0.337). The vascular access varied greatly between the two groups (χ2=6.463, P=0.039), the proportion of peripheral arteriovenous imparements (AVIs) was higher in the low adsorption group than the standard group (62.5% vs 42.5%), and the flow velocity in the low adsorption group was lower than that in the standard group (t=-2.344, P=0.02). Among the 24 patients in the low adsorption group, all had uncorrected instrument alarm occurred, which included 11 transmembrane pressure (TMP) alarms (45.8%) and 8 venous pressure (VP) alarms (33.3%). In the low adsorption group, there were 4 cases of coagulation in vevous and multi-seperator, 7 cases of coagulation in single separator, 3 cases of fat deposition, and 1 case of hypotension.Conclusion When patients with severe liver disease are treated with DPMAS and LPE, peripheral arteripuncture and low blood flow rate are more likely to cause unplanned suspension of adsorption. The alarm mode is mainly transmembrane pressure alarm and venous pressure alarm, with blood clot and fat deposition as the main reasons.
    A meta-analysis on the therapeutic effect of mesenchymal stem cells on liver failure patients
    LI Ping, XIE Fang, ZHENG Wen-kai, SUN Hao-nan, YAO Chuan-xia, WANG Yong
    2023, 28(12):  1413-1417. 
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    Objective To analyze the clinical efficacy of mesenchymal stem cells on the treatment of liver failure through evidence-based medicine.Methods Seventeen case-control studies published at domestic and international journals on mesenchymal stem cells in the treatment of liver failure were analyzed with RevMan 5.3 statistical software. The primary evaluation index was survival rate, and the secondary index was liver biochemical index and end-stage liver disease model score (MELD).Results A total of 1054 subjects were included in 17 articles. The survival rates of the mesenchymal stem cells treatment group were better than those of the control group at different periods of time (4 weeks OR=5.45, 95%CI 2.80~10.59, P<0.001; 8 weeks OR=2.82, 95%CI 1.74~4.58, P<0.001; 12 weeks OR=2.59, 95%CI 1.76~3.80, P<0.001; 24 weeks OR=2.13, 95%CI 1.43~3.17, P<0.001); MELD scores showed significant differences at 12 weeks (MD=-2.89, 95%CI -5.02~-0.75, P=0.008) and 24 weeks (MD=-2.28, 95%CI -4.27~-0.30, P=0.02). There was no significant difference in most liver biochemical indexes between the two groups.Conclusion Mesenchymal stem cells treatment can improve the survival rate and long-term MELD score of patients with liver failure. It is an effective cellular therapeutic method with value of clinical application.
    The application of serum alpha fetoprotein, p62, and microtubule associated protein 1 light chain 3- Ⅱ in the prognostic evaluation of patients with HBV-related acute-on-chronic liver failure
    FANG Rao-hong, SHANG Gao-xia, YIN Peng-yan, ZHANG Shi-de, CHEN Mei, LI Qing-rong
    2023, 28(12):  1418-1422. 
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    Objective To explore the application value of serum alpha fetoprotein (AFP), autophagy associated protein p62, and microtubule associated protein 1 light chain 3- Ⅱ (LC3- Ⅱ) in the prognostic evaluation of patients with HBV-related acute-on-chronic liver failure (HBV-ACLF).Methods This is a retrospective study that was conducted on 102 HBV-ACLF patients admitted from January 2020 to January 2023 in South Central Hospital of Yunnan Province as the observation group. Additionally, 50 hepatitis B patients admitted during the same period of time and 50 healthy individuals were selected as the disease control group and healthy control group, respectively. The levels of serum AFP, p62, and LC3- Ⅱ were measured and compared among three groups. The prognosis of patients in the observation group were followed up, and the serum AFP, p62 and LC3-Ⅱ levels of patients with good and poor prognosis were compared. The predictive efficacy of serum AFP, p62, and LC3- Ⅱ levels on the prognosis of HBV-ACLF patients were analyzed with the receiver operating characteristic curve (ROC) method.Results The serum AFP and LC3-Ⅱ levels were observed in the observation group>disease control group>healthy control group, and the serum p62 levels were observed in the observation group<disease control group<healthy control group. Pairwise comparisons between the groups showed statistically significant differences (P<0.05). During follow-up, 31 cases died (i.e., with poor prognosis) and 71 cases survived (i.e., with good prognosis) in the observation group, with a mortality rate of 30.39%. The serum AFP and p62 levels in the group with good prognosis were higher than those in the group with poor prognosis, whereas the serum LC3-II levels were lower than those in the group with poor prognosis (P<0.05). The ROC curve analysis showed that when the AFP value was >115.65 ng/mL, p62 >1.12 ng/mL, and LC3-Ⅱ <53.07, it had certain predictive value for the good prognosis of HBV-ACLF patients (AUC>0.7). When compared with the single use of three indicators, the combined use of three indicators had a higher diagnostic efficacy for HBV-ACLF patients with good prognosis (AUC=0.878), with diagnostic sensitivity and specificity of 92.17% and 85.68%, respectively.Conclusion Serum AFP, p62, and LC3- Ⅱ all have certain predictive value for the prognosis of HBV-ACLF patients, and the combined predictive efficacy of the three items is higher.
    Liver Fibrosis & Cirrhosis
    An analysis on the value of FibroTouch and liver hemodynamic changes in staging liver fibrosis of chronic hepatitis B patients
    CHEN Yong-liang, WANG Yong-sha, YAN Wei-jing, CHEN Jing-zi, PAN Li, LI Zhen-yan
    2023, 28(12):  1423-1425. 
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    Objective To explore the diagnostic value of Fibro-Touch and “Liver Hemodynamics Software” (PMD) for the degree of liver fibrosis in chronic hepatitis B patients.Methods Eighty-two chronic hepatitis B patients and 32 normal individuals were selected as the study cohorts. Liver stiffness (LSM) was measured with FibroTouch in all subjects. Simultaneously, color Doppler ultrasound was used to detect the spectrum waveform of blood flow in portal vein, left hepatic vein, middle hepatic vein, and right hepatic vein. M-mode ultrasound was used to measure heart rate. The obtained blood flow spectrum images and heart rate were uploaded to the “Liver Hemodynamics Detection Software” system to calculate the liver blood flow frequency value (LBFF). The liver hardness value measured by FibroTouch and the frequency of liver blood flow measured by PMD were compared with the pathological diagnosis of liver tissue puncture biopsy.Results For the pathological diagnosis of liver tissue of 82 patients with chronic hepatitis B, 33 cases were in stage 1, 22 cases were in stage 2, 10 cases were in stage 3, and 17 cases were in stage 4. The liver hardness values of 114 subjects ranged from 3.7 to 55.1kPa, showing a significant positive correlation with liver fibrosis stages (r=0.811, P<0.01); The frequency of liver blood flow ranged from 0 to 26Hz, which was positively correlated with the stages of liver fibrosis (r=0.831, P<0.01). The cutoff values of LSM≥S1, ≥S2, ≥S3, and=S4 were 6.05, 7.95, 11.2, and 10.35 kPa, respectively, and the AUC were 95.9%, 88.3%, 91.6%, and 90%, respectively; The sensitivities were 89%, 93.9%, 88.9%, and 100%, respectively; The specificities were 100%, 78.5%, 83.9%, and 73.2%, respectively. The cutoff values for LBFF ≥S1, ≥S2, ≥S3, and=S4 were 1.233, 1.99, 3.8, and 5.815 Hz, respectively; The AUC values were 0.899, 0.939, 0.944, and 0.972, respectively. The sensitivities were 78%, 78.8%, 88.9%, and 88.2%, respectively; The specificity were 100%, 83.1%, 83.9%, and 95.9%, respectively.Conclusion FibroTouch and PMD, as non-invasive methods for detecting liver fibrosis, have a good correlation with the pathological stages of liver fibrosis. They can accurately evaluate the degrees of liver fibrosis and can be widely used in clinical practice.
    Preliminary evaluation of esophageal varices in patients with hepatitis B related cirrhosis by LSP score based on liver stiffness measurement, spleen diameter and platelets
    LIU Cheng-shuai, WU Xian-quan, ZHANG Pu, SONG Kun
    2023, 28(12):  1426-1425. 
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    Objective To investigate the influence of paltelet (PLT), hyaluronic acid (HA), laminin (LN), type III procollagen N-terminal peptide (PIIINP), type IV collagen (CIV), spleen diameter (SD), liver hardness (LSM) and LSP score obtained by combining LSM, SD and PLT on esophageal varices (EV) in patients with hepatitis B virus (HBV) related cirrhosis.Methods The data of 162 patients with HBV related cirrhosis admitted to our hospital from January 2019 to March 2022 were reviewed, including 105 males and 57 females, aged 54 (40, 76) years. HBV related cirrhosis meets the diagnostic requirements. According to gastroscopy, patients withe EV were divided into different groups.Results Among the 62 patients with HBV related cirrhosis, 27 cases without EV, 59 cases with mild to moderate EV and 76 cases with severe EV, respectively. The PLT of no-EV group, mild to moderate EV group and severe EV group were 122 (76, 140) × 109/L, 76 (56, 102) × 109/L and 58 (44, 81) × 109/L, the difference was statistically significant (P<0.05). HA, LN, PIIINP and CIV in the EV group were 258.2 (105.6, 580.5) μg/mL, 107.5 (60.7, 142.9) μg/mL, 14.0 (6.8, 17.2) μg/mL and 128.0 (63.2, 264) μg/mL, compared with mild to moderate EV group [352.4 (167.0, 627.8) μg/mL, 140.2 (69.8, 188.5) μg/mL, 16.2 (7.3, 33.5) μg/mL and 153.2 (84.8, 229.9) μg/mL, severe EV group [640.2 (290.2, 918.7) μg/mL, 158.7 (94.6, 236.4) μg/mL, 19.6 (9.5, 47.5) μg/mL and 180.7 (119.0, 282.6) μg/mL], the differences were statistically significant (P<0.05). SD of no EV group, mild to moderate EV group and severe EV group were 13.2 (10.8, 15.0) cm, 14.4 (11.4, 16.0) cm and 15.8 (14.6, 17.2) cm, the difference was statistically significant (P<0.05). The scores of LSM and LSP in EV group were 14.8 (10.6, 24.0) kPa and 1.9 (1.0, 3.5) points, compared with mild to moderate EV group [24.7 (17.8, 29.5) kPa and 4.6 (2.4, 7.2) points] and severe EV group [37.2 (28.8, 42.6) kPa and 10.0 (6.2, 14.2) points], respectively, the differences were statistically significant (P<0.05). The correlation between the above indexes of liver fibrosis and EV degree was analyzed. The results showed that SD, LSM and LSPS were moderately positively correlated with EV degree (r=0.51, 0.63 and 0.67, P<0.05), while HA, LN, PIIINP and CIV were weakly positively correlated with EV degree (r=0.25, 0.28, 0.21 and 0.23, P<0.05), however, PLT was negatively correlated with EV (r=-0.41, P<0.05). Evaluation of diagnostic efficacy of various indexes of liver fibrosis for EV showed that the diagnostic AUC values of PLT, HA, LN, PIIINP, CIV, SD, LSM and LSP scores were 0.77, 0.65, 0.64, 0.61, 0.59, 0.77, 0.84 and 0.87, respectively. Evaluate the diagnostic efficacy of various liver fibrosis indexes for severe EV. As shown in Table 3, the diagnostic AUC values of PLT, HA, LN, PIIINP, CIV, SD, LSM and LSP scores are 0.71, 0.64, 0.59, 0.62, 0.60, 0.77, 0.84 and 0.86, respectively.Conclusion PLT, HA, LN, PIIINP, CIV, SD, LSM and LSP scores were correlated with EV status in patients with HBV related cirrhosis, among which LSP score had better diagnostic efficacy for the presence of EV and severe EV, and had guiding significance for the treatment of patients with HBV related cirrhosis.
    A combination of APRI, ALBI and AIMS65 scores for evaluating the severity and prognosis of cirrhotic patients with esophageal-gastric variceal bleeding
    WANG Yan-qiu, ZHOU Ling-hua, GU Yong-mei, PU Zun-guo
    2023, 28(12):  1430-1434. 
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    Objective To investigate the value of a combination of aspartate aminotransferase/platelet ratio index (APRI), albumin-bilirubin score (ALBI) and AIMS65 (albumin, international normalized ratio, mental status, systolic blood pressure, age >65 years) score for evaluating the severity and prognosis of esophageal-gastric variceal hemorrhage (EGVB) in cirrhosis.Methods A total of 120 liver cirrhotic patients with EGVB admitted from July 2020 to September 2022 were included in the observation group. Sixty patients with liver cirrhosis with esophageal and gastric fundus varices without bleeding were included in the control group. Patients in the observation group were divided into mild (n=20), moderate (n=42) and severe (n=58) subgroups according to the degrees of esophageal and gastric varices (EGV) under endoscopy; or with (n=74) and without (n=46) clinical adverse event subgroups according to the prognostic manifestation of EGV before hospitalization. The scores of APRI, ALBI and AIMS65 were compared among all groups. The correlations between APRI, ALBI and AIMS65 scores and liver stiffness (LSM), and Child-Pugh classification of liver function and Acute Physiological and Chronic Health Status Scoring System Ⅱ (APACHEⅡ) scores were analyzed by Pearson. Receiver operating characteristic curve (ROC) was drawn to analyze the efficacy of combined APRI, ALBI and AIMS65 scores in evaluating the prognosis of EGVB in cirrhosis.Results The APRI, ALBI and AIMS65 scores of the observation group were 3.25±0.68, -1.80±0.46 and 3.16±0.57 points, which were higher than those of the control group (2.14±0.51, -2.79±0.54 and 2.39±0.48 points), with statistically significant differences (t=9.037, 10.459, 8.253, all P<0.05). The scores of APRI, ALBI and AIMS65 in the moderate and severe variceal subgroup were 3.52±0.78, -1.32±0.40 and 3.27±0.64 points, which were higher than those in the moderate subgroup (2.47±0.59, -1.98±0.53 and 2.64±0.52 points), and 1.83±0.46, -3.16±0.65 and 2.23±0.46 points in mild subgroup showed a decreasing trend, and the difference was statistically significant (F=18.792, 16.265, 14.537, all P<0.05). The scores of APRI, ALBI and AIMS65 in the with clinical adverse event subgroup were 3.78±0.83, -1.27±0.31 and 3.57±0.65, which were higher than those in the without clinical adverse event subgroup (2.69±0.64, -1.81±0.37 and 2.38±0.50). The difference was statistically significant (t=8.436, 9.035, 8.725, all P<0.05). Pearson analysis showed that the APRI, ALBI and AIMS65 scores of EGVB patients with cirrhosis were positively correlated with LSM, Child-Pugh grade and APACHEⅡ score (P<0.01). The ROC curve showed that the area under curve (AUC), sensitivity and specificity of a combination of APRI, ALBI and AIMS65 scores for evaluating the prognosis of EGVB patients with cirrhosis were higher than that of any individual score (P<0.01).Conclusion APRI, ALBI and AIMS65 scores have value in evaluating the severity and prognosis of EGVB in patients with cirrhosis, and a combined detection has better efficacy.
    Liver Cancer
    The clinical efficacy of Tirelizol on the treatment of advanced liver cancer and its influence on peripheral PRMT5 and PIVKA-II levels
    YE Hai-hui, JIANG Hua
    2023, 28(12):  1435-1439. 
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    Objective To investigate the effects of Tirelizol on protein arginine methyltransferase-5(PRMT5) and PIVKA-II levels and the prognosis of patients with advanced liver cancer.Methods Sixty-eight patients with advanced liver cancer were selected as research objects. They were randomly divided into an observation group and a control group. The control group was treated with Trans-arterial chemo-embolization (TACE), and the observation group was treated with tirellizumab. The levels of liver function paremeters such as alanine aminotransferase (ALT), albumin (ALB), total bilirubin (TBIL), T lymphocytes (CD3+, CD4+, CD8+, CD4+/CD8+), angiogenic factors including acidic and basic fibroblast growth factors (bFGF, aFGF) and vascular endothelial growth factor (VEGF), and the level of PRMT5 mRNA were compared between the two groups before and after treatment. The vitamin K absence or antagonist-II (PIVKA-II) level, the Functional Assessment of Cancer Therapy-General (FACT-G) scores, short-term efficacy and long-term prognosis were also recorded in the two groups.Results After treatment, compared with the control group, ALT, TBil, aFGF, bFGF, VEGF, PRMT5 mRNA, PIVKA-II and FACT-G scores in the observation group were lower, whereas the Alb, CD3+, CD4+, CD8+ and CD4+/CD8+ levels were higher (P<0.05). In the observation group, the Objective response rate, clinical control rate, cumulative survival time and cumulative survival rate were 47.06%, 76.47%, 20.46 (19.07, 21.84) months and 52.94%, and those of the control group were 20.59%, 52.94%, 18.04 (16.42, 19.65) months and 35.29%, the differences were statistically significant (P<0.05). The incidence of adverse reactions in the observation group and the control group was 23.53% vs 32.35%, respectively, without statistical significance (P>0.05).Conclusion Tirelizol has a good clinical effect on treating advanced liver cancer, and may improve the immune function, angiogenesis, PRMT5 and PIVKA-II levels.
    Influence of camrelizumab combined with lenvatinib or apatinib on liver function and tumor markers in patients with advanced hepatocarcinoma
    CAO Jing, XIA Xiao-yang, YOU Dong-shan, HUANG Jing-hui, ZHOU Yun-na
    2023, 28(12):  1440-1445. 
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    Objective To investigate the efficacy of carlizumab combined with lenvatinib or apatinib in the treatment of advanced hepatocarcinoma and its influence on liver function and tumor markers.Methods A total of 96 patients with advanced hepatocarcinoma admitted to the First People's Hospital of Chuzhou between December 2019 and October 2021 were divided into two groups based on their treatment plan. The observation group consisted of 48 patients treated with camrelizumab combined with lenvatinib, while the control group consisted of 48 patients treated with camrelizumab combined with apatinib. The short-term efficacy of the two groups was compared by examining the serum leves of total bilirubin (TBil), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199) and α- L-fucosidase (AFU). Furthermore, patient survival was followed up for assessment.Results After treatment, the serum levels of TBil, AST, ALT in the observation group were (20.12±2.03) μmol/L, (43.58±4.12) U/L and (43.46±4.82) U/L, respectively. These levels were significantly lower than those in the control group [(22.06±3.19) μmol/L, (47.62±5.28) U/L, (46.55±6.13) U/L, (P<0.05)]. After treatment, the serum levels of AFP, CEA, CA199 and AFU in the observation group were (101.45±16.22) μg/L, (16.83±3.62) ng/mL, (143.21±21.65) U/mL, (35.02±5.69) U/L, respectively. These levels were significantly lower than those in the control group [(124.87±21.69) μg/L, (18.75±4.43) ng/mL, (166.21±35.16) U/mL, (38.36±7.84) U/L,(P<0.05)]. Additionally, the Objective response rate (ORR) and disease control rate (DCR) of group A were 50.00% and 83.33%, respectively, both of which were higher than those in the control group (33.33% and 68.75%, P<0.05). Furthermore, the median progression-free survival (PFS) in the observation group was 9.6 months, which was significantly longer than 6.2 months in the control group (P<0.05). There were no significant differences in the type and incidence of toxic and side effects between the two groups, and there were no drug withdrawal or drop-outs due to serious treatment-emergent adverse events.Conclusion The combination of camrelizumab with lenvatinib or apatinib in the treatment of advanced hepatocarcinoma has demonstrated promising results in protecting liver function and reducing the level of tumor markers. The toxicity and side effects of this treatment approach are relatively manageable. However, patients may benefit more in terms of survival from the combination of camrelizumab and lenvatinib than from the combination of camrelizumab and apatinib.
    Relationship between the expression levels of FOXC1 and E-Cadherin and the clinical prognosis of hepatocellular carcinoma and their effect on the biological behavior of hepatocellular carcinoma cells
    NIE Yuan-yuan, ZHAO Heng-fang, WANG Ying-juan, ZHAO Yan
    2023, 28(12):  1446-1449. 
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    Objective To investigate the expression levels of forkhead box transcription gene C1 (FOXC1) and epithelial cadherin (E-Cadherin) in hepatocellular carcinoma (HCC) tissues, analyze the correlation of FOXC1 and E-Cadherin with prognosis, and explore the impact of FOXC1 and E-cadherin on the biological behavior of HCC cells.Methods A total of 85 patients with primary hepatocellular carcinoma who underwent radical resection in our hospital from April 2017 to April 2022 were selected for the study. Tumor focal tissues and adjacent tissues were collected during the operation. The expression levels of FOXC1 and E-Cadherin were determined by immunohistochemistry, and their correlation with prognosis of patients was analyzed. The HepG2 cell line was divided into sh FOXC1 group, sh NC group and blank control group. The proliferation and invasion ability of the cells were determined by plate cloning assay and Transwell assay.Results The positive expression rates of FOXC1 protein and E-Cadherin in HCC tissues were 74.12% and 28.24%, respectively. Meanwhile, in adjacent tissues, the rates were 43.53% and 100.00%, respectively.These differences were statistically significant (P<0.05). The positive expression rate of FOXC1 and E-cadherin was significantly higher in patients with TNM stage Ⅲ~Ⅳ, low to moderate differentiation, and tumor diameter ≥3 cm. Conversely, the positive expression rates of E-cadherin was notably decreased in these patients. These differences were statistically significant (P<0.05). Spearman analysis revealed that FOXC1 expression was negatively correlated with prognosis (P<0.05), while E-Cadherin expression was positively correlated with prognosis (P<0.05). In the cell experiment, the expression of FOXC1 protein in the blank control group and sh NC group was higher than that in normal hepatocytes, and the expression of E-cadherin protein was lower than that in normal hepatocytes, with statistically significant differences (P<0.05). Downregulation of FOXC1 significantly impaired the proliferation and invasion of hepatocellular carcinoma cells (P<0.05).Conclusion The expression of FOXC1 and E-cadherin is correlated with the prognosis of hepatocellular carcinoma. FOXC1 promotes the proliferation of cancer cells and inhibits the expression of E-cadherin to promote the process of epithelial-mesenchymal transition, enhance the invasiveness of hepatocellular carcinoma cells, and affect clinical prognosis.
    Changes of intestinal flora after radical resection of primary liver cancer combined with TACE
    REN Hong-tao, WANG Yu-ting, YIN Jia-feng, SU Wang-hui
    2023, 28(12):  1450-1454. 
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    Objective To analyze the changes in intestinal flora in patients with primary liver cancer following radical resection combined with transcatheter arterial chemoembolization (TACE).Methods A total of 114 patients with primary liver cancer treated in our hospital from January 2020 to January 2023 were included in the study. The control group (57 cases) underwent radical liver cancer surgery, while the observation group (57 cases) received combined TACE treatment after radical liver cancer surgery. The clinical efficacy of the two groups was compared, and serum indices as well as the number of lactobacillus, enterobacter, yeast, bifidobacterium and other bacteria were measured. The correlation between these factors was analyzed by the Pearson correlation coefficient.Results The disease control rates in the observation group and the control group were 94.74% and 80.70%, respectively. The observation group had a significantly higher disease control rate compared to the control group (P<0.05). After treatment, the serum levels of alpha-fetoprotein (AFP), tumor necrosis factor-α (TNFα) and interleukin-6 (IL-6) in the observation group were (581.64±47.32) ng/mL, (85.13±15.37) pg/mL, and (124.39±15.73) pg/mL, respectively, which were significantly lower than those of control group [(662.37±52.49) ng/mL, (92.53±19.84) pg/mL, (145.81±19.77) pg/mL, respectively]. The levels of interleukin-2 (IL-2) were (86.22±5.84) pg/mL, which was significantly higher than that in control group [(80.26±7.33) pg/mL, P<0.05]. After treatment, the number of lactobacilli and bifidobacteria in the observation group were (10.52±1.77) lgCFU/g and (10.84±2.25) lgCFU/g, respectively, which were significantly higher than those in the control group [(8.34±1.63) lgCFU/g and (9.52±1.37) lgCFU/g, respectively]. The number of Enterobacteriaceae and yeast in the observation group were (9.93±2.71) lgCFU/g and (5.91±1.37) lgCFU/g, respectively, which were significantly lower than those in the control group [(13.95±3.82) lgCFU/g and (7.83±1.58) lgCFU/g, P＜0.05]. Correlations were observed between serum AFP expression and the number of Lactobacillus, Enterobacter, yeast and bifidobacterium (r=-0.522, 0.498, 0.503, -0.518, P=0.034, 0.041, 0.039, 0.034). Furthermore, the expression of TNFα in serum was correlated with the numbe of intestinal flora (r=-0.637, 0.622, 0.574, -0.592, P=0.005, 0.005, 0.021, 0.018). The expression of serum IL-2 was also correlated with the number of intestinal flora (r=0.536, -0.508, -0.529, 0.564, P=0.032, 0.039, 0.034, 0.023). Similarly, the expression of serum IL-6 was correlated with the number of intestinal flora (r=-0.613, 0.572, 0.603, -0.517, P=0.006, 0.021, 0.007, 0.034).Conclusion TACE treatment following radical surgery for primary liver cancer can improve the disease control rate, promote intestinal microbiota balance, and reduce inflammatory factor levels.
    Viral Hepatitis
    Expression of TIM-3 and PD-1 at immune checkpoint in patients with chronic hepatitis C treated with sophobuvir/Vipartamivir and its clinical significance
    TONG Yi, HU Su-xia, WANG Ran, DAI Jing-jing
    2023, 28(12):  1455-1458. 
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    Objective To investigate the expression and clinical significance of immunoglobulin mucin 3 (TIM-3) and programmed cell death receptor-1 (PD-1) in immune checkpoint T cells of chronic hepatitis C (CHC) patients treated with sofosbuvir/velpatasvir.Methods Between August 2020 and August 2022, 120 patients with CHC in Huai'an First Hospital Affiliated to Nanjing Medical University were selected as the CHC group, while 118 healthy individuals who underwent physical examination in the same period were selected as the healthy control group. The CHC group was treated with sofosbuvir/velpatasvir for 3 months. Blood biochemical indexes, monocyte subsets, and the levels of TIM-3 and PD-1 in each subgroup were compared between the two groups.Results In the absence of treatment, serum ALT and AST levels in CHC patients [(74.0±35.8) U/L, (55.1±26.0) U/L] were higher than those in healthy control group [(14.9±6.3) U/L, (19.2±7.0) U/L]. After three months of treatment, the PD-1 CD4, PD-1 CD8, TIM-3 CD8, TIM-3 CD4 in CHC patients [(0.6 ± 0.1) %, (1.7 ± 0.6) %, (2.5 ± 1.0) %, (6.5 ± 1.0) %, respectively] were higher than those in the healthy control group [(0.4 ± 0.1) %, (1.5 ± 0.7) %, (1.7 ± 0.8) %, (6.0 ± 2.4) %] (P<0.05).Conclusion Therapy with sophobuvir/velpatasvir can significantly improve liver function in CHC patients. The peripheral blood lymphocyte ratio is disturbed in CHC patients, and the high expression of negative immune checkpoint molecules has been observed to regulate cellular immunity. For patients who do not experience symptom improvement with single drug therapy, the addition of sofosbuvir to velpatasvir therapy may be a potential consideration.
    Analysis of the efficacy and safety of direct antiviral drugs combined with ribavirin in elderly patients with compensated liver cirrhosis caused by genotype 1b chronic hepatitis C
    SU Jing-bo, CAO Guang-hua
    2023, 28(12):  1459-1461. 
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    Objective To evaluate the efficacy and safety of direct-acting antiviral drugs in combination with ribavirin in elderly patients with compensated liver cirrhosis caused by genotype 1b chronic hepatitis C.Methods From April 2021 to April 2022, a total of 120 elderly patients with compensated cirrhosis caused by genotype 1b chronic hepatitis C were treated with a combination of direct-acting antiviral drug and ribavirin in our hospital. We evaluated the seroconversion rate of hepatitis C virus (HCV) RNA, virology response, liver function indicators, and adverse reactions to assess the efficacy and safety of this treatment regimen.Results The seroconversion rate of HCV RNA (66.7%, 82.5%, 93.3%) showed a progressive increase with the duration of treatment time (P<0.05). As the treatment period extended, the sustained virological response rate (93.3%, 89.2%, 86.7%) gradually decreased, but the difference was not statistically significant (P>0.05). Compared to the pre-treatment levels of total bilirubin (TBil), alanine transaminase (ALT), and aspartate transaminase (AST) [(21.6 ± 3.2) μmol/L, (128.7 ± 14.6) U/L, (83.6 ± 9.3) U/L], the levels were significantly decreased after treatment [(17.1 ± 2.4) μmol/L, (34.2 ± 5.8) U/L, (26.4 ± 4.7) U/L] (P<0.05). During the course of treatment, some patients experienced adverse reactions, including 10 cases of dizziness and fatigue ,(8.3%), 5 cases of abnormal blood pressure (4.2%), 5 cases of elevated blood sugar (4.2%), and 4 cases of gastrointestinal reactions (3.3%). All of these adverse reactions resolved after symptomatic treatment, and the patients were able to tolerate them.Conclusion The use of direct antiviral drugs combined with ribavirin in the treatment of elderly patients with compensated liver cirrhosis caused by genotype 1b chronic hepatitis C has demonstrated good efficacy. It has been shown to promote the seroconversion of HCV RNA, achieve sustained virological response, and improve the level of liver function indicators. Furthermore, this treatment regimen has a high level of clinical safety.
    HBsAg and HBV DNA quantification and diagnosis of HBV-related liver diseases
    XUE Rong-rong, CAI Bing-gang, XIAN Jian-chun
    2023, 28(12):  1462-1465. 
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    Objective To investigate the relationship of HBsAg and HBV DNA quantification and diagnosis of HBV-related liver diseases.Methods A total of 314 patients with HBsAg infection primary treated in the department of infection of the First People's Hospital of Yancheng from January 2021 to December 2022 were retrospectively analyzed. According to the clinical diagnosis, they were divided into four groups: chronic hepatitis B (CHB) group (group A, 141 cases), compensated hepatitis B cirrhosis group (group B, 48 cases), decompensated hepatitis B cirrhosis group (group C, 81 cases) and HBV-related liver cancer group (group D, 44 cases).The clinical and quantitative data of HBsAg, HBeAg and HBV DNA were analyzed retrospectively.Results In HBeAg-positive patients, there was a positive correlation between serum HBsAg quantification [(998.7± 944.2) IU/mL] and HBV DNA quantification [(5.4±2.1) lg IU/m] (r=0.294, P<0.001). In HBeAg-negative patients, there was a positive correlation between serum HBsAg quantification [(556.7±718.1)IU/mL] and HBV DNA quantification [(3.9±1.9) lg IU/mL] (r=0.173, P=0.035).The levels of HBsAg and HBV DNA in HBeAg positive patients were higher than those in HBeAg negative patients, and the difference was significant (P<0.05). In HBeAg positive patients, the quantitative levels of HBsAg [(1568.3±990.4、513.4±402.3、380.6±332.4、345.1±254.8)IU/mL]and HBV DNA[(6.0±2.3、5.3±1.6、4.6±1.7、4.5 ±1.7)lg IU/mL] showed a decreasing trend in groups A, B, C and D ( Kruskal-Wallis test showed progressive significance, P<0.05). In HBeAg-negative patients, the quantitative level of HBsAg[(855.9±119.3、497.9±625.0、329.1±452.0、305.1±407.4)IU/mL] in group A, B, C and D showed a decreasing trend (Kruskal-Wallis test showed gradual significance, P<0.05), and there was no significant difference in HBV DNA quantification [(4.3±2.0、3.5±1.8、3.6±1.6、3.8 ±1.7)lgIU/mL]among the four groups, and the correlation was not obvious (Kruskal-Wallis test showed no difference, P=0.242).Conclusion There is a significant positive correlation between HBsAg quantification and HBV DNA quantification, and gradually decreases with the severity of liver disease; while HBeAg is negative, there is no obvious correlation between HBV DNA quantification and the severity of liver disease.
    Non-alcoholic Fatty Liver Disease
    Transcriptomic profiling and analysis of key regulatory molecules in non-alcoholic fatty liver disease
    CHENG Niang-mei, LIU Ke-xin, WANG Ying-chao, CHEN Ming-sheng
    2023, 28(12):  1466-1471. 
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    Objective To explore the differentially expressed genes in Non-alcoholic fatty liver disease (NAFLD) compared to normal liver cells, aiming to elucidate genetic varations contributing to the pathophysiology of NAFLD.Methods Establishing the NAFLD cell model: Human normal liver cells(LO2) were treated with palmitic acid to induce NAFLD characteristics. Subsequently, Oil red O staining was employed to assess cellular fat accumulation, and flow cytometry was utilized to evaluate the apoptotic effects of palmitic acid on LO2 cells. Transcriptome sequencing was performed on both normal LO2 cells and cells in the induced model to identify differentially expressed genes. These genes underwent KEGG and GO functional enrichment analysis. Additionally, the expression levels of these differential genes were quantified using RT-PCR.Results Increasing concentrations of palmitic acid led to more pronounced cellular fat accumulation. Considering this alongside the apoptosis rate, an optimal concentration of palmitic acid was selected for further study. Transcriptomic analysis revealed that, in the model group, there were 780 differentially expressed genes compared to the control group, with 447 genes upregulated and 333 downregulated. GO enrichment analysis demonstrated significant pathway involvement, and KEGG pathway analysis indicated major involvement in 20 signaling pathways, including TNF, protein export, and NOD signaling pathways. RT-PCR results showed that FGF21, AMBP, GOLGA7B, and DDIT3 were highly expressed in the NAFLD model, whereas SPTLC3, PALM2, and SPTSBB showed low expression.Conclusion NAFLD is observed to induce the expression of specific differential genes, potentially regulating the progression of NAFLD through key target genes involved in lipid metabolism.
    Correlation between non-alcoholic fatty liver disease, Helicobacter pylori infection, and the incidence of colorectal polyps
    HU Zhao-suo, YAO Chun-yan, JIN Juan, YAN Bo, CHEN Zheng-xu
    2023, 28(12):  1472-1475. 
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    Objective To explore the association between non-alcoholic fatty liver disease (NAFLD), Helicobacter pylori(Hp) infection, and the incidence of colorectal polyps.Methods From June 2021 to May 2022, a total of 133 patients diagnosed with colorectal polyps through colonoscopy and pathological examination were included in the experimental group. This group comprised 54 cases of hyperplastic polyps and 79 cases of adenomatous polyps. Additionally, 70 patients without colorectal polyps were selected as the control group. In all patients, various parameters, including total cholesterol (CHOL), low-density lipoprotein (LDL), HP antibody, serum gastrin 17 (G-17) and pepsinogen Ⅰ(PG-Ⅰ)/ pepsinogen Ⅱ (PG-II) ratio(PGR) were measured. Binary logistic regression analysis was utilized to assess the impact of each index on the occurrence of colonic polyps. The patients were subsequently categorized into two groups: the proliferative polyp group and the adenomatous polyp group. The differences in NAFLD, gastric histopathology, HP infection, adenomatous polyps with intestinal epithelial neoplasia and seurm G-17 levels between the two groups were observed in the study.Results The occurrence of colon polyps was found to be significantly associated with being older than 60 years (χ2=7.436,P=0.006, OR=2.657), Hp infection (χ2=17.702,P<0.001, OR=4.650), PGR (χ2=10.794,P=0.001,OR=1.129) and elevated levels of serum G-17 (χ2=4.471,P=0.034, OR=3.706). In the adenomatous polyp group, the HP-positive ratio was 75.9%, significantly higher than the 59.3% in the hyperplastic group(χ2=4.190, P=0.041). Similarly, the prevalence of NAFLD in the adenoma group was 32.9%, exceeding the 14.8% in the hyperplastic group (χ2=5.520, P=0.019). The percentage of patients older than 60 years in the adenoma group was 81.0%, which was higher compared to 64.8% in the hyperplasia group (χ2=4.423, P=0.035). No significant differences were observed in the proportion of precancerous lesions (30.4%vs44.4%), the increase rate of G-17 (17.7%vs11.1%), and the level of PGR (14.18±7.74 vs 13.93±8.75) between the two groups(P>0.05). Between the advanced and non-advanced groups, there were no significant differences in the proportion of NAFLD (20.8%vs38.2%) and the increase rate of G-17 (41.7% vs 34.5%) (P>0.05). However, the smoking rate in the advanced group was 37.5%, markedly higher than 16.4% in the non-advanced group(χ2=4.243, P=0.039), and the rate of severe chronic stomach disease with precancer was 45.8% in the advanced group compared to 23.6% in the non-progressive group (χ2=3.892,P=0.049). The HP infection rate was significantly higher in the advanced group(91.7%) compared to the non-advanced group(69.1%) (χ2=4.662, P=0.031).Conclusion The development and progression of colorectal polyps, particularly adenomatous polyps, are linked to gastric precancerous lesions, Hp infection and NAFLD. Effectively treating and preventing severe chronic gastric conditions and NAFLD, as well as the comprehensive eradication of HP, hold significantly potential in both the prevention and management of colorectal polyps.
    Changes and clinical significance of serum uric acid level in type 2 diabetes patients with nonalcoholic fatty liver disease
    XIONG Qi-jun, ZHU Wen
    2023, 28(12):  1476-1479. 
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    Objective To observe the variations in serum uric acid levels among patients with type 2 diabetes mellitus(T2DM) and nonalcoholic fatty liver disease(NAFLD) and assess its clinical implications.Methods Between December 2020 and December 2022, 118 patients with T2DM admitted to our hospital were selected, including 64 males and 54 females, aged (57.78±4.07) years. Based on the presence or absence of NAFLD complications, patients were divided into combined group (n=88) and non-combined group (n=30). A retrospective study was carried out. Variables showing statistical differences were subjected to multivariate Logistic regression analysi.Results The BMI for the combined group was (26.72±2.53) kg/m2, while it was (23.31±2.17) kg/m2 for the non-combined group. The difference was statistically significant (P<0.05). The fasting blood glucose and HOMA-IR levels in the combined group were (8.82±1.45) mmol/L and (3.58±0.95), respectively, which were significantly higher than those in the non-combined group [(7.67±1.23) mmol/L and (3.05±0.79), P<0.05]. The levels of ALT, AST, total cholesterol, triglyceride and LDL in the combined group were (37.94±2.68) U/L, (29.20±2.61) U/L, (5.38±1.13) mmol/L, (2.46±0.64) mmol/L and (3.31±0.80) mmol/L, respectively. In comparison, the non-combined group had values of (23.27±2.16) U/L, (21.71±2.03) U/L, (4.34±1.02) mmol/L, (1.32±0.55) mmol/L and (2.56±0.62) mmol/L. The difference between the groups was statistically significant (P<0.05). The serum uric acid in the combined group was (349.14±28.45) μmol/L, compared to (273.34±17.29) μmol/L in the non-combined group, and the difference was statistically significant (P<0.05) . Additionaly, the LDL level in the combined group was (1.35±0.38) mmol/L, which was significantly lower than the (2.29±0.43) mmol/L observed in the non-combined group(P<0.05). According to the multivariate Logistic regression analysis, when incorporating the above differences into the study, it was suggested that BMI, HOMA-IR and serum uric acid were risk factors for T2DM complicated with NAFLD (OR values were 4.604, 5.150 and 4.978, respectively, P<0.05).Conclusion Patients with T2DM may also present with complications related to NAFLD. BMI, HOMA-IR and serum uric acid are the main risk factors that warreant greater attention in clinical settings.
    Other Liver Diseases
    Development of a risk prediction model for non-recovery of liver function following 3 years of chronic drug-induced liver injury
    YANG Hong, XIE Peng-fei, JIANG Man
    2023, 28(12):  1480-1483. 
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    Objective To investigate the factors associated with the failure of liver function recovery following 3 years of chronic drug-induced liver injury (DILI) and to develop a predictive risk nomogram model.Methods Clinical data from 127 patients diagnosed with chronic DILI at the First People's Hospital of Mengcheng County between January 2017 and December 2019 were retrospectively analyzed. Patients were categorized into recovery and non-recovery groups based on their liver function status after 3 years. A comparative analysis was conducted between these groups. The study focused on multivariate analysis of factors influencing non-recovery in liver function among chronic DILI patients after 3 years. The primary Objective was to develop and validate an effective risk prediction model for chronic DILI patients whose liver function did not recover after 3 years.Results In the analysis of chronic DILI patients, no significant differences were observed between the non-recovery and recovery groups in terms of sex distribution, age, BMI, smoking and drinking history, comorbidities, medication history, clinical classification, DILI severity, inflammation grade, hemoglobin(Hb), prealbumin(PAB), white blood cell count(WBC), total bilirubin(TBIL), IgA, IgG and IgM levels(P>0.05). However, higher levels of fibrosis grade S3/S4, ALT, AST, ALP, and GGT were noted in the non-recovery group compared to the recovery group (P<0.05), along with lower platelet counts(PLT)(P<0.05). Multivariate analysis identified fibrosis grade S3/S4 (OR=2.757, 95% CI: 1.054~6.963), PLT (OR=0.347, 95% CI: 0.143~0.844), ALT (OR=3.228, 95% CI: 1.328~7.846) and AST (OR=3.031, 95% CI: 1.247~7.367) as independent factors influencing non-recovery of liver function in chronic DILI patients after 3 years (P<0.05). A nomoram prediction model was established using these risk factors.. The model`s validation indicated a C-index of 0.916 (95% CI: 0.872~0.935), with the correction curve closely aligning with the ideal curve (P>0.05). ROC analysis of the nomograph model revealed its efficacy in predicting the non-recovery of liver function in chronic DILI patients over a three-year period, with a sensitivity of 80.65% (95% CI: 61.94%~91.88%), specificity of 92.71% (95% CI: 85.06%~96.77%), and an AUC of 0.882 (95% CI: 0.812~0.932).Conclusion PLT, ALT and AST are all significantly asoociated with the failure of liver function recovery in patients with chronic DILI after 3 years. The nomogram model, developed based on these risk factors, demonstrates a strong predictive capability for assessing liver function recovery failure in chronic DILI patients over the same period .
    Assessing the diagnostic and therapeutic efficacy of growth differentiation factor 15 (GDF15) in autoimmune hepatitis
    PANG Xue-hua, LIN Mao-xing, LIU Hong
    2023, 28(12):  1484-1486. 
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    Objective To evaluate the utility of growth differentiation factor 15 (GDF15) as a biomarker in the diagnosis and therapeutic management of autoimmune hepatitis (AIH).Methods Data were retrospectively analyzed from 65 patients with AIH, 45 healthy individuals, 40 patients with hepatitis B (HB) and hepatitis C (HC), and 35 patients with primary biliary cholangitis (PBC). These individuals, admitted to our hospital from July 2020 to July 2022, were categorized as the AIH group, healthy control group, HB group, HC group and PBC group, respectively. Clinical baseline data among these diverse liver disease patient groups and the control group were compared. In particular, the serum levels of GDF15 were analyzed for both cirrhosis and non-cirrhosis patients. Additionally, in the AIH group, serum GDF15 levels in patients with cirrhosis were compared to those without cirrhosis, and multivariate regression analysis was performed to assess the correlation of GDF15 levels with the occurrence of cirrhosis and the area under the (ROC) curve for GDF15 was calculated.Results In patients with AIH, levels of ALT, AST, Fib4 index, IgG and TBil were found to be significantly elevated. These levels were meaused at(368.9±59.8)U/L, (294.6±52.7)U/L, (5.8±2.5), (2668.3±901.5)mg/dL and(49.6±11.5) μmol/L, respectively, which were higher compared to the healthy control group[(24.5±4.8 )U/L,(8.4±2.1)U/L,(1.1±0.3),(476.2±172.8)mg/dL and (3.4±1.3)μmol/L], HB group [(61.7±25.8)U/L,(50.9±18.5)U/L,(3.2±1.5),(953.6±253.4)mg/dL and (18.8±5.2)μmol/L], HC group [(48.4±12.5)U/L,(48.6±21.4)U/L,(4.1±1.6),(1868.6±539.8)mg/dL and(19.2±5.3)μmol/L] and PBC group [(59.6±11.2)U/L,(42.3±20.1)U/L,(1.5±0.8),(641.5±125.8)mg/dL and (12.3±3.7)μmol/L] (P<0.05). Additionally, GDF15 levels were(2000.9±699.2)pg/dL, which were higher compared to the control group, HB group and PBC group [(476.2±172.8)pg/dL, (953.6±253.4)pg/dL, and (641.5±125.8)pg/dL, respectively)(P<0.05). In AIH patients with liver cirrhosis, serum levels of ALT, AST, Fib4 index and GDF 15 were significantly higher at (461.7±55.8) U/L, (298.4±41.1) U/L, (6.1±2.3) and (2045.1±350.8)pg/dL, respectively, compared to non-liver cirrhosis AIH patients[(224.5±24.8) U/L, (80.9±18.5) U/L, (3.8±1.5) and (1305.2±200.2)pg/dL, P<0.05]. GDF15 was an independent risk factor for cirrhosis in AIH patients (P<0.05). Using a GDF15 threshold of 1639.0 pg/dL, the area under the curve(AUC), sensitivity and specificity of GDF15 for diagnosing AIH-related cirrhosis were 0.924, 93.3%(14/15) and 82.5%(33/40), respectively.Conclusion The levels of GDF15 in AIH patients are elevated, indicating that GDF15 measurement can aid in the diagnosis of AIH. This finding demonstrates significant potential for evaluating therapeutic efficacy, suggesting that GDF15 testing could have considerable application value and merits further clinical implementation.
    Assessing the prognostic significance of clinical variables and hepatic histopathological alterations in the progression to liver fibrosis and cirrhosis in autoimmune hepatitis
    YANG Yue-hua, LAN Jing, Yao Chao-guang, Huang Jia
    2023, 28(12):  1487-1491. 
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    Objective To evaluate the prognostic significance of clinical variables and hepatic histopathological changes in predicting the progression to liver fibrosis and cirrhosis in patients with autoimmune hepatitis(AIH).Methods Between August 2019 and August 2020, sixty-five patients with autoimmune hepatitis(AIH) were admitted to our hospital, and their clinical data were systematically collected. These patients were categorized into two groups based on the progression of their disease: a liver fibrosis group (n=35) and a cirrhosis group (n=30) . Comparative analyses of clinical variables and hepatic histological changes were conducted between these groups. Additionally, prognostic analysis of hormonal therapy and independent risk factors contributing to the development of hepatic fibrosis and cirrhosis in AIH patients were analyzed by multifactorial Logistic regression.Results In the liver fibrosis group of AIH patients, the mean duration of disease onset was (70.3±4.2) d , significantly longer than the (54.6±5.8) d, observed in the cirrhosis group(P<0.05). Notably, serum levels of total bilirubin, glutathione, glutathione, albumin, globulin, and IgG in the liver fibrosis group were (313.2±102.3) μmol/L, (353.5±65.4) U/L, (322.6±157.8) U/L, (27.2±4.5) g/L, (35.6±8.5) g/L, (28.6±8.3), respectively, which were markedly lower compared to the cirrhotic group [(412.5±101.6) μmol/L, (463.5±48.6) U/L, (420.5±156.3) U/L, (35.8±5.6) g/L, (43.6±8.6) g/L, (38.8±10.5), respectively, P<0.05]. The international normalized ratio was (1.7±0.2) points in the fibrosis group , which was more favorable than the (1.9±0.3) points in the cirrhosis group(P<0.05). The model for end-stage liver disease(MELD) socre was lower in the liver fibrosis group(22.1±2.6) compared to the cirrhosis group [(26.9±1.8), P<0.05]. Additionally, lymphocytic infiltration in confluent areas was less in the liver fibrosis group(5.7%) compared to 33.3% in the cirrhosis group(P<0.05). In terms of prognosis, the survival group showed significantly lower morbidity duration, total bilirubin levels, MELD score, and white blood cell count[(60.3±4.2) d, (243.2±92.3) μmol/L, (12.1±2.6) points, and (2.1±1.8) ×109/L, respectively] compared to the death group[94.6±5.8) d, (412.5±121.6) μmol/L, (25.9±1.8) points, and (4.6±1.5) ×109/L, respectively, P<0.05]; Multifactorial Logistic regression analysis identified duration of morbidity, elevated bilirubin, MELD score, and white blood cell count as independent risk factors for the development of liver fibrosis and cirrhosis in AIH(OR=4.646, 4.968, 5.078, 4.933, P<0.05).Conclusion The prognosis of patients with liver fibrosis and cirrhosis in AIH is closely associated with several key factors: the duration of the disease, total bilirubin levels, MELD score, and white blood cell count.