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    30 November 2023, Volume 28 Issue 11
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    Drug-induced Liver Injury
    An analysis of clinical and pathological features of 148 cases of drug-induced liver injury
    WANG Shuang-shuang, XIONG Qing-fang, HU Yi-fan, CHEN Miao-yang, YANG Yong-feng
    2023, 28(11):  1280-1284. 
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    Objective To analyze the clinical characteristics of drug-induced liver injury (DILI) patients with different clinical classifications and to compare the relationship between clinical and pathological classifications.Methods This study retrospectively screened DILI patients who underwent liver punctures with RUCAM>6 points in Nanjing Second Hospital from January 2018 to December 2022. Data of age, gender, medication history, disease course, liver function indexes and pathological results were collected.Results A total of 200 patients met the inclusion criteria, and 148 patients were included in the analysis after exclusion criteria. The median age of the 148 patients was 49.5 years. The male to female ratio was 1∶1.96. The drugs suspected of liver damage were divided into three categories, i.e., traditional Chinese medicine, western medicine, and mixed Chinese and western medicine, accounting for 45.3%, 43.9% and 10.8% of the cases, respectively. The main clinical classifications were hepatocellular injury (40.5%); The analysis of pathological classifications in DILI patients with different severities showed that inflammatory necrosis type was the main type among mild and moderate cases, and cholestatic type was mainly distributed in severe and acute liver failure cases. The correlation analysis between the clinical and pathological classifications of the DILI patients showed that the Cramer’s V coefficient value was 0.264 (P<0.05).Conclusion There is a certain correlation between pathological and clinical classifications of DILI patients but the relationship is moderate.
    The serological and histological characteristics of drug-induced liver injury patients with autoimmune-like manifestations
    WU Jin-ling, GAO Min
    2023, 28(11):  1285-1288. 
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    Objective To investigate the serological and histological characteristics of drug-induced liver injury (AL-DILI) patients with autoimmune-like manifestations.Methods Seventy-five DILI patients admitted to hospital between July 2016 and August 2021 were divided into two groups according to whether they had autoimmune manifestations. The basic conditions, serological and histological characteristics of the patients were compared.Results 87.9% of the patients in the observation group were female, which were significantly higher than that of 61.9% in the control group (P<0.05). Comparing the serological characteristics of the observation group and the control group, The levels of AST, GGT, globulin, IgG and IgA in the observation group were 220.0 (79.9, 398.9) U/L, 187.5 (105.8, 299.5) U/L, 30.6 (27.9, 34.1) g/L, 14.9 (12.8, 18.2) g/L and 2.9 (2.3, 3.4) g/L, respectively, which were significantly higher than those of [95.1 (60.3, 276.5) U/L, 104.5 (51.5, 205.5) U/L, 26.3 (24.4, 28.0) g/L, 10.1 (8.7, 12.6) g/L and 2.0 (1.5, 2.8) g/L] in the control group (P<0.05). The level of ChE was 5626 (4812, 7356) U/L in the observation group, which was significantly lower than that of [6981 (5328, 8096) U/L] in the control group (P<0.05). Comparing the histological characteristics of the observation group and the control group, the proportion of eosinophil and/or neutrophil infiltration in the observation group was 54.8%, which was significantly higher than that of 15.2% in the control group (P<0.05).Conclusion The difference of serological and histological characteristics is helpful to distinguish AL-DILI from simple DILI, which provides a theoretical basis for their differential diagnosis.
    Liver Fibrosis & Cirrhosis
    The diagnostic value of hepatic hemodynamic changes in staging liver fibrosis
    CHEN Yong-liang, LI Ruo-xu, YAN Wei-jing, WANG Yong-sha, WANG Xiao-jing, LI Qiu-yu, LI Zhen-yan
    2023, 28(11):  1289-1292. 
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    Objective To explore the application value of “Liver Hemodynamics Software” in diagnosing liver fibrosis stages.Methods The spectrum waveforms of portal vein, left hepatic vein, middle hepatic vein and right hepatic vein were detected by color Doppler ultrasound, and the heart rates were measured by M-mode ultrasound. The spectrum images and heart rates were uploaded to the “Liver Hemodynamics Software” system produced by Hangzhou Jingkang Technology. The liver fibrosis values were then calculated, and further compared with the pathological diagnosis of Percutaneous Liver Biopsies.Results Among 148 patients, 32 cases were diagnosed as stage 0, 39 cases as stage 1, 24 cases as stage 2, 12 cases as stage 3 and 41 cases as stage 4. According to the diagnostic values of Liver Hemodynamics Software, 148 patients were divided into four groups, and the area under the receiver operating characteristic curve (AUC) of each group was AUC=0.91 (95% confidence interval 0.867~0.959), 0.962 (95% confidence interval 0.938~0.987), 0.975 (95% confidence interval 0.956~0.994), and 0.966 (95% confidence interval 0.940~0.993), respectively. According to the principle of maximum Jordan index, the cutoff values of staging liver fibrosis for ≥ S1, S2, S3 and S4 by liver hemodynamics software were 1.27, 3.78, 3.98 and 5.85, respectively. The Liver Hemodynamics Software showed a high accuracy in assessing whether there had severe fibrosis and cirrhosis. The AUC of each phase was greater than 0.9, of which S3>S4>S2>S1.Conclusion As a new non-invasive method for detecting liver fibrosis, the liver fibrosis values obtained by Liver Hemodynamics Software has a good correlation with the pathological stagings of liver fibrosis, thus may accurately evaluate the degrees of liver fibrosis, and can be widely used in clinical practice.
    The diagnostic value of contrast-enhanced ultrasound for liver perfusion post transjugular intrahepatic portosystemic shunt in patients with hepatitis B-related cirrhosis and portal hypertension
    ZHANG Xiao-dan, YUAN Ying-ying
    2023, 28(11):  1293-1295. 
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    Objective To observe the diagnostic value of contrast-enhanced ultrasound (CEUS) for liver perfusion post transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatitis B-related cirrhosis and portal hypertension.Methods A total of 56 patients who underwent CEUS examination after TIPS between January 2016 and April 2021 were selected, including 30 males and 26 females, aged from 20 to 70 years, with an average age of (51.0±7.5) years old. At the same time, color doppler ultrasound (CDUS) was performed on 56 patients, and the diagnostic results of CEUS and CDUS were compared and analyzed.Results Comparison of the diagnostic results of hepatic perfusion by CEUS in patients, both HAP and HPI increased [(28.9±13.4) min·100 mL and (64.2±11.2)%] after operation, which were significantly different from those of before operation [(20.0±9.3) min·100 mL and (54.4±19.5)%] (P<0.05). The differences between PVP and TLP before and after surgery were not statistically significant (P>0.05). Comparison of the diagnostic results by CDUS and CEUS showed that in the majority of cases (89.3%), the findings of CEUS and CDUS were highly consistent; the diagnostic sensitivity of CEUS was 98.2%, and the differences were statistically significant (P<0.05). Also, in some cases, CEUS provided additional examination information compared to CDUS.Conclusion CEUS provides a safe and effective imaging method for following-up after TIPS. In contrast to CDUS, CEUS also enables dynamic visualization of individual microbubbles with high spatial and temporal resolution, enabling specific assessment of stent pathology and stent dysfunction. CEUS can be applied to a very broad patient population due to a lower adverse events associated with the use of contrast agents and a higher specificity and sensitivity of ePTFE stents.
    The significance of thromboelastography in evaluating hepatitis B related cirrhosis complicated with gastrointestinal bleeding
    CHEN Hui-yuan, CHEN Ran, LIU Bo, SHI Xue-mei, YUAN Xia, GUO Qing-jiang, ZHANG Qiong
    2023, 28(11):  1296-1300. 
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    Objective To explore the significance of thromboelastography parameters (TEG) in evaluating hepatitis B-related cirrhosis complicated with gastrointestinal bleeding.Methods Forty patients with hepatitis B-related cirrhosis who were treated in our hospital from May 2018 to May 2019 were enrolled as the research objects. Twenty healthy people who underwent physical examination during the same period of time were included as the control.group. According to whether the cirrhotic patients were complicated with gastrointestinal bleeding, the patients were divided into a bleeding group (n=20) and a non-bleeding group (n=20). The conventional coagulation function indexes and TEG test results were compared between the bleeding group, the non-bleeding group and the control group. Receiver operating characteristic curve (ROC) was drawn to analyze the value of TEG test results and conventional coagulation test in evaluating hepatitis B-related cirrhosis complicated with gastrointestinal bleeding.Results The platelet count (PLT) and fibrinogen (FIB) levels in the bleeding and non-bleeding groups of patients with hepatitis B-related cirrhosis were (67.1±33.2)×109/L and (1.4±0.4)g/L, respectively; The non-bleeding group was (84.2±29.4)×109/L and (1.9±0.5)g/L], respectively, which were significantly lower than those in the control group [(190.6±47.3)×109/L, (2.9±0.5)g/L, respectively, P<0.05]. While the levels of prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (APTT) in the bleeding group were [(15.3±3.4)s, (1.3±0.3), and (38.1±5.0)s, respectively; which were significantly longer than those of (15.4±3.5)s, (1.3±0.2), and (36.4±5.2)s in the non-bleeding group, and those of (10.4±0.8)s, (0.9±0.1), and (26.4±3.1)s in the control group respectively ( P<0.05]; The PLT and FIB levels in the bleeding group were [(67.1±33.2)×109/L and (1.4±0.4)g/L, respectively, which were significantly lower than those of (84.2±29.4)×109/L and (1.9±0.5)g/L in the non-bleeding group [P<0.05]; The blood clot formation time (K) in the bleeding group and the non-bleeding group of patients with hepatitis B cirrhosis were (3.3±0.5)min and (3.4±0.5)min, respectively, which were significantly higher than that of (2.2±1.4) min in the control group [P<0.05]. The coagulation angle (α) and maximum oscillation radiation (MA) levels were [(45.4±5.7) deg and (40.7±5.2) mm in the bleeding group; (51.3±5.1) deg and (48.4±6.0) mm] in the non-bleeding group, which were significantly lower than those of (60.3±6.7) deg and (58.6±7.3)mm in the control group, P<0.05], respectively; The K values of the treatment group of cirrhotic patients with bleeding were (7.4±3.0) min, which was significantly greater than that of (3.0±1.0) min in the non-treatment group (P<0.05), and the α angle and MA values in the treatment group were (46.2±5.8) deg and (32.8±8.0) mm respectively, which were significantly smaller than those of (58.4±7.3) deg and (42.3±6.8) mm in the non-treatment group (P<0.05). In the TEG test results, α angle, R, K and MA were the influencing factors of hemagglutinin in cirrhotic patients with bleeding (P<0.05).Conclusion For patients with hepatitis B related cirrhosis and gastrointestinal bleeding, thromboelastography may provide a more accurate and comprehensive assessment of coagulation status, among which the α angle parameter has the highest diagnostic performance.
    A study on TEG/ROTEM in predicting the bleeding amount and for guiding blood preparation in liver cirrhotic patients with variceal bleeding
    WEI Li-xian, SHAO Chen, LUO Lei-lei, HE Hong-mei, XU Shu-yan, SHI Ling-ling, GU Hao-ran, ZHU Chen, CHEN Jian, BIAN Zhao-lian
    2023, 28(11):  1301-1305. 
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    Objective To explore the value of thromboelastogram (TEG)/rotational thromboelastometry (ROTEM) in predicting the bleeding amount of cirrhotic patients with esophageal variceal bleeding (EVB) and for guiding the study of blood preparation.Methods One hundred patients with EVB who were diagnosed and treated in our hospital from July 2021 to October 2022 were randomly divided into an experimental group and a conventional group according to the random grouping software, with 50 patients in each group. The conventional group and the experimental group were given traditional common caugulation tests (CCTs) guidance and TEG guidance respectively. The difference of coagulation index, blood product dosage and prognosis before and after transfusion were observed.Results There was little difference in the amount of concentrated red blood cells (CRC) between the two groups (t=3.244, P>0.05); The input of fresh frozen plasma (FFP), Platelet concentrates (PC) and cryoprecitation (CRYO) in the experimental group were significantly lower than those in the conventional group (t=6.866, 8.335, 10.256, P<0.05); The number of patients in the routine group who need to inject two kinds of blood products during treatment was significantly more than that in the experimental group (χ2=12.245, P<0.05), and the number of patients in the routine group who do not need to inject related blood products during treatment was significantly less than that in the experimental group (χ2=8.051, P<0.05). In addition, the number of patients with blood transfusion reaction in the conventional group was significantly more than that in the experimental group (χ2=9.256, P<0.05). The blood transfusion reaction of all patients was slight, and no severe blood transfusion reaction such as heart failure, hemolysis, shock occurred. Before treatment, the levels of coagulation related indicators of patients in the two groups were similar, without statistical difference (P>0.05). After treatment, the coagulation related indicators of patients were significantly improved,(P<0.05). The related values of coagulation related indicators in the conventional group were lower than those in the experimental group, indicating that the improvement in the experimental group was significantly better (P<0.05). There was no significant difference in the success rate of hemostasis, rebleeding rate, mortality, hepatic encephalopathy and ascites incidence, between the two groups (χ2= 0.762, 0.271, 1.010, 0.211, 0.298, P<0.05).Conclusion Compared with blood transfusion guided by routine coagulation, the TEG/ROTEM guided blood transfusion scheme can significantly reduce the amount of blood products, without reducing the success rate of hemostasis and increasing the rate of rebleeding, mortality, and the incidence of hepatic encephalopathy and ascites, thus is worth of clinical promotion.
    Prognostic value of peripheral blood Th9 cell percentage combined with MELD score in decompensated hepatitis B cirrhosis
    HE Xiao-rong, TIAN Yao, GE Gui-ping
    2023, 28(11):  1306-1309. 
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    Objective To investigate the prognostic value of peripheral blood Th9 cell percentage combined with model of End-stage liver disease (MELD) score for decompensated hepatitis B cirrhosis (HBC).Methods We collected and analyzed clinical data from 107 patients with decompensated HBC admitted to the Gastroenterology Department of Hai 'an People's Hospital between May 2017 and May 2022. Based on their survival condition within 6 months after treatment, the patients were divided into a good prognosis group and a death group. The percentage of Th9 cells in peripheral blood was measured by flow cytometry, and the MELD score was evaluated for all decompensated HBC patients. General data, MELD score and percentage of Th9 cells in peripheral blood were compared between the two groups. Logistic regression analysis was conducted to identify factors influencing the prognosis of decompensated HBC. The ROC curve was used to analyze the predictive value of the combination of peripheral blood Th9 cell percentage and MELD score on the prognosis of decompensated HBC.Results Among the 107 patients with decompensated HBC, 81 survived and 26 died within 6 months after treatment. The MELD score (23.87±4.16) points and the percentage of Th9 cells in peripheral blood (3.16±0.34) % in the death group were higher than those in the survival group [(16.95±3.35) points and (1.32±0.28) % (P<0.05)]. Logistic analysis showed that both the MELD score and the percentage of Th9 cells in peripheral blood were independent risk factors for the poor prognosis of decompensated HBC (OR=3.651, 95% CI: 1.656~6.001, P<0.001; OR=3.846, 95% CI: 1.691~5.646, P<0.001). ROC analysis showed that the AUC values of the MELD score and the percentage of Th9 cells in peripheral blood to evaluate the prognosis of decompensated HBC were 0.744 and 0.779, respectively, with 95% CI from 0.651 to 0.824 and 0.688 to 0.853. When both factors are combined for prediction, the AUC value was 0.913, with a 95% CI of 0.843~0.959.Conclusion The percentage of Th9 cells in peripheral blood combined with MELD score has a high predictive value for the prognosis of decompensated HBC, providing an effective reference for clinical intervention.
    Liver Cancer
    Diagnostic value of 3.0-T diffusion-weighted magnetic resonance imaging combined with contrast-enhanced ultrasound in benign and malignant liver lesions
    LIU Yang-yang, YANG Xing-xing, GE Shu
    2023, 28(11):  1310-1313. 
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    Objective To analyze the diagnostic effect of 3.0T magnetic resonance diffusion-weighted imaging (MRI-DWI) combined with contrast-enhanced ultrasound in benign and malignant liver lesions.Methods We conducted a retrospective analysis of clinical data from 69 patients with hepatic space-occupying lesions who were admitted to the hospital from February 2020 to July 2022. All patients underwent 3.0TMRI-DWI examination, contrast ultrasound examination and pathological examination. The pathological diagnosis results of all patients were recorded. We compared the apparent diffusion coefficient (ADC) values of patients with benign and malignant liver lesions, as well as the contrast-enhanced ultrasound parameters. Pathological diagnosis was taken as the gold standard to analyze the diagnostic efficacy of 3.0TMRI-DWI examination, contrast-enhanced ultrasound examination, and their combined examination for benign and malignant liver lesions.Results Pathological diagnosis results showed that among the 69 patients with liver lesions (85 lesions in total), 38 cases were diagnosed as benign lesions (55.07%, 47 lesions) and 31 cases as malignant lesions (44.93%, 38 lesions). The ADC value in patients with malignant liver lesions was lower than that in patients with benign liver lesions (P<0.05). The peak intensity of liver malignant lesions was higher than that of liver benign lesions (P<0.05), and the disappearance time, onset time and peak time of liver malignant lesions were shorter than those of liver benign lesions (P<0.05). The diagnostic accuracy of 3.0T MRI-DWI, contrast-enhanced ultrasound and their combined examination for benign and malignant liver lesions were 82.61%, 68.12% and 94.20%, respectively. The sensitivity values of 3.0T MRI-DWI, contrastus-enhanced ultrasound, and combined tests for detecting benign and malignant liver lesions were 88.87%, 70.97%, 93.55%, while the specificity values were 81.57%, 65.79%, 94.74%, respectively. The kappa values of 3.0T MRI-DWI examination, contrastus-enhanced ultrasound examination, and combined examination for benign and malignant liver lesions and pathological diagnosis were 0.851, 0.727 and 0.873, respectively, indicating good consistency (P<0.05).Conclusion Contrast-enhanced ultrasound and 3.0T MRI-DWI can be used in the diagnosis of benign and malignant liver lesions, and their combination has a higher diagnostic value.
    Analysis of the efficacy of MRI and MSCT in the clinical diagnosis of intrahepatic cholangiocarcinoma
    CHENG Li, LI Jiang-shan, SUN Xiao-ling
    2023, 28(11):  1314-1318. 
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    Objective Analyze the diagnostic value of magnetic resonance imaging (MRI) and multi-slice spiral computed tomography (MSCT) in detecting intrahepatic cholangiocarcinoma (ICC).Methods A total of 70 patients with primary liver cancer were admitted to our hospital between March 2017 and March 2022. All patients underwent MRI and MSCT examinations. The gold standard for diagnosis was postoperative histopathology examination and biopsy. If either MRI or MSCT diagnosed the patient with ICC, it was considered as ICC. We evaluated the efficacy of MRI, MSCT, and the combination of both in diagnosing ICC.Results Pathological diagnosis showed that out of the 70 patients with primary liver cancer, 23 were diagnosed with ICC and 47 with hepatocellular carcinoma (HCC).The MRI results identified 20 cases of ICC and 50 cases of HCC among the 70 cases of primary liver cancer. The sensitivity, specificity, accuracy, and Kappa value of MRI in diagnosing ICC were 69.6%, 91.5%, 84.3%, and 0.632, respectively. The MSCT identified 22 cases of ICC and 48 cases of HCC among the 70 cases of primary liver cancer. The sensitivity, specificity, accuracy, and Kappa value of MSCT in diagnosing ICC were 65.2%, 85.1%, 78.6%, and 0.509, respectively. The combined diagnostic results of MRI and MSCT showed that 21 cases were ICC and 49 cases were HCC among the 70 cases of primary liver cancer. The sensitivity, specificity, accuracy, and Kappa value of MRI combined with MSCT in diagnosing ICC were 82.6%, 95.7%, 91.4%, and 0.801, respectively. The accuracy of MRI and MSCT in diagnosing ICC was 59 cases (84.3%) and 54 cases (78.6%), respectively, with no statistically significant difference (P>0.05). However, the accuracy of MRI combined with MSCT in diagnosing ICC was significantly higher, with 67 cases (95.7%) (P<0.05).Conclusion MRI and MSCT are highly accurate in diagnosing ICC and show good consistency with pathological diagnosis. Furthermore, the combination of these two methods enhances the diagnostic value even further.
    Relationship between serum GP73 and FOXP3 levels and efficacy and prognosis of hepatocellular carcinoma patients with TACE
    LEE EUNJI, LIU Bo, YUAN Xiang-lin
    2023, 28(11):  1319-1322. 
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    Objective To investigate the changes in serum Golgi body protein 73 (GP73) and forkhead spiral transcription factor (FOXP3) expression in patients diagnosed with hepatocellular carcinoma (HCC) after hepatic arterial chemoembolization (TACE) treatment. Additionally, we aim to determine the correlation between these changes and treatment effectiveness as well as prognosis.Methods A total of 198 HCC patients who underwent TACE treatment in our hospital from May 2019 to August 2021 were retrospectively selected as subjects. All patients received TACE treatment and were divided into two groups based on clinical efficacy criteria: an effective group (n=122) and an ineffective group (n=76). After treatment, we compared the levels of GP73 and FOXP3 between the two groups and analyzed the relationship between GP73 and FOXP3 expression and clinical efficacy. Furthermore, all patients were divided into a good prognosis group (n=104) and a poor prognosis group (n=94) based on the outcome. Multivariate Logistic analysis was performed to identify the risk factors that affect prognosis. Finally, we evaluated the predictive effect of GP73 and FOXP3 combined detection on the prognosis of HCC patients using ROC analysis.Results After TACE treatment, the expression of GP73 and FOXP3 in the effective group was significantly lower than that in ineffective group (158.67±69.53 vs. 179.73±61.35, 0.65±0.18 vs. 0.77±0.20 respectively, P<0.05). According to the Spearman correlation coefficient, a significantly negative correlation was observed between GP73 and FOXP3 expression and clinical efficacy (r=-0.662, -0.688, P<0.05) . Logistic regression analysis showed that Child-Pugh grade, GP73 and FOXP3 were risk factors influencing the prognosis of HCC patients. The ROC curve showed that the area under the curve of combined GP73 and FOXP3 detection was significantly higher than that of single detection (ZGP73-combined =4.415, ZFOXP3-combined =5.660, both P<0.001), with a sensitivity of 87.23% and specificity of 85.58%.Conclusion The expression of GP73 and FOXP3 in serum is significantly associated with the efficacy and prognosis of HCC patients after TACE. The combined detection of GP73 and FOXP3 can be used to improve the prognosis assessment of HCC patients.
    The value of COMPASS-CAT, Khorana score, D-dimer (D-D) and fibrin degradation products (FDP) in predicting venous thrombosis in patients with liver cancer
    CHU Qing-yun, GAO Yan, LIU Yan, LI Cheng-hui
    2023, 28(11):  1323-1327. 
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    Objective To evaluate the value of COMPASS-CAT, Khorana score, D-dimer (D-D), and fibrin degradation products (FDP) in predicting venous thrombosis in patients diagnosed with liver cancer.Methods A retrospective analysis was conducted on the clinical data of 125 patients with liver cancer from August 2021 to August 2023. These patients were divided into two groups: the VTE group (27 cases) and the non-VTE group (98 cases) based on the occurrence of venous thromboembolism (VTE) within 3 days after treatment. The clinical data of all patients were collected, including their COMPASS-CAT and Khorana scores, as well as the levels of serum D-D and FDP 3 day after radical resection of liver cancer. The predictive value of serum D-D, FDP alone and in combination with COMPASS-CAT score in predicting the occurrence of VTE in patients with liver cancer was analyzed using ROC curve. Multivariate analysis was conducted using unconditional logistic stepwise regression analysis.Results The VTE group had 5 cases (18.52%) with a history of VTE, 11 cases (40.74%) with hypertension, 9 cases (33.33%) with a central venous catheter, 19 cases (70.37%) with a COMPASS CAT score ≥7, serum D-D level of (21.04±7.81) mg/L, and serum FDP level of (62. 55±20.48) μg/mL. These numbers were all higher compared to the non-VTE group, which had 0 cases with a VTE history (0.00%), 7 cases with hypertension (14.00%), 4 cases with a central venous catheter (8.00%), 15 cases with a COMPASS-CAT score ≥7 (30.00%), serum D-D level of (6.65±2.19) mg/L, and serum FDP level of (17.96±5.82) μg/mL (P＜0.05). The area under the ROC curve of serum D-D and FDP, and their combination in predicting the occurrence of VTE in liver cancer patients was 0.911, 0.883, and 0.949, respectively. Multivariate logistic regression analysis showed that a history of VTE, hypertension, central venous catheter, COMPASS-CAT score, serum D-D and FDP were risk factors for VTE in patients with liver cancer (P<0.05).Conclusion COMPASS-CAT score, serum D-D and FDP show significant differences between VTE group and non-VTE group, and can be used to predict the occurrence of VTE in patients with liver cancer. However, the Khorana score does not show a significant difference between the two groups and has limited predictive value. In addition, combining the prediction of serum D-D, FDP and COMPASS-CAT score can further enhance the predictive value.
    Therapeutic effect of TACE combined with MWA on primary liver cancer
    ZHANG Xiao-yu, XU Chun-yang, YAO Yu, DAI Feng, ZANG Zhi-dong
    2023, 28(11):  1328-1330. 
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    Objective To observe the therapeutic effect of combining transcatheter arterial chemoembolization (TACE) with ultrasound-guided microwave ablation (MWA) in the treatment of primary liver cancer.Methods We collected data from 96 cases of single primary hepatocellular carcinoma in our hospital over the past two years. In the control group, 46 cases were treated with transcatheter arterial chemoembolization. In the treatment group, 50 cases were treated with transcatheter arterial chemoembolization and ultrasound-guided microwave ablation. We not only compared changes in serum total bilirubin (TBil), alanine aminotransferase (ALT), glutamic grass, transaminase (AST), serum alpha fetoprotein (AFP) before and after surgery, but also analyzed and recurrence of hepatocellular carcinoma within one year.Results The treatment group showed a significant decrease in serum AFP levels and a lower recurrence rate of hepatocellular carcinoma within one year (18.00%) compared to the control group (89.13%) (χ2=48.56, P< 0.05). The levels of serum TBil (t=0.065, P>0.05), ALT (t=0.079, P>0.05) and AST (t=0.076, P>0.05) were similar in both groups when undergoing hepatoprotective treatment.Conclusion The combined treatment of hepatic artery chemoembolization and ultrasound-guided microwave ablation yields significantly better curative results compared to simple hepatic artery chemoembolization, with little influence on liver function. However, patients selection plays a crucial role. It is recommended to perform thorough ablation at one time to minimize risk of intrahepatic and extrahepatic metastasis.
    Effect of IL-33 on the proliferation and migration of hepatocellular carcinoma cells by regulating NF-κB signaling pathway
    ZHAO Ying, TIAN Ming
    2023, 28(11):  1331-1334. 
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    Objective To investigate the effect of IL-33 on the regulation of NF-κB signaling pathway and inflammatory factors on the proliferation and migration of HepG2 cells.Methods RT-PCR was used to detect the expression of IL-33 in different hepatocellular carcinoma cell lines (LO2, MHCC97H, LM3, HepG2, SMCC7721, Hep3B). Western Blot was used to assess the regulation of IL-33 on the activation of NF-κB signaling pathway-related proteins (NF-κB, p-NF-κB, IKB, p-IKB) in HepG2 cells. ELISA was used to measure the regulation of IL-33 on the release of inflammatory factors (IL-1α, IL-1β, IL-6, IL-18) in HepG2 cells. The EdU proliferation test was conducted to detect the effect of IL-33 on the proliferation of HepG2 cells. The CCK8 test was performed to assess the viability of HepG2 cells after 24 h and 48 h of treatment with IL-33. Transwell cell test and scratch test were conducted to examine the effect of IL-33 on HepG2 cell migration.Results The RT-PCR results showed a statistically significant difference in the relative expression of IL-33mRNA between LO2 (1.01 ± 0.01), MHCC97H (1.08 ± 0.05), LM3 (1.76 ± 0.21), HepG2 (3.88 ± 0.35), SMCC7721 (2.24 ± 0.43), and Hep3B (2.13 ± 0.30) (F=19.621, P=0.001). LO2 cells and MHCC97H cells had similar expression levels, while LM3, HepG2, SMCC7721, and Hep3B showed higher expression, with HepG2 cells having the highest expression. In the 24-hour group treated with IL-33, the levels of IL-1α (3185.25 ± 194.67), IL-1β(2103.69 ± 124.75), IL-6 (446.58 ± 36.82), and IL-18 (1492.60 ± 180.31) were higher than those in the control group (1001.58 ± 18.65, 1642.81 ± 45.66, 151.34 ± 20.13, 915.48 ± 36.15), with statistical significance (P<0.05).The relative expression levels of phosphorylated NF-κB protein (4.53 ± 0.36) and phosphorylated IKB protein (2.76 ± 0.28) were higher in the 24-hour group treated with IL-33 compared to the control group (1.25 ± 0.23, 0.49 ± 0.09), with statistical significance (P<0.05). The levels of IL-1α, IL-1β, IL-6 and IL-18 factors were higher in the 24-hour group treated with IL-33 than the control group, with a statistically significant difference (P<0.05). The IL-33 treated group showed higher cell proliferation (1.41 ± 0.08), 24-hour cell viability (135.69 ± 6.88)%, and 48-hour cell viability (176.34 ± 25.69)% compared to the control group's cell proliferation (0.86 ± 0.04), and cell viability at 24 hours (98.65 ± 1.05)%, and 48 hours (119.89 ± 10.86)%, with statistically significant differences (t=13.750, P=0.000; t=9.218, P=0.000; t=3.506, P=0.017). The results of the Transwell chamber and scratch experiments indicated that the number of cell invasions (256.38 ± 10.11) and migration relative distance (0.74 ± 0.05) in the IL-33 treated group for 24 hours were higher than those in the control group (185.63 ± 23.54 and 0.45 ± 0.12, respectively), with statistically significant differences (t=4.783, P=0.005; t=3.864, P=0.012).Conclusion IL-33 can affect the inflammatory microenvironment of hepatoma cells by regulating the NF-κB signaling pathway and promote the proliferation and migration of HepG2 cells.
    Viral Hepatitis
    Significance of cytokine profiling and virological markers in guiding peginterferon therapy for HBeAg-positive chronic hepatitis B
    SUN Rui-hua, HAO Wen-jie, ZHANG Yue-jun, ZHANG Chang-ju
    2023, 28(11):  1335-1338. 
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    Objective To investigate the significance of cytokine profiles and virological markers in guiding peginterferon therapy for HBeAg-positive chronic hepatitis B(CHB).Methods Between January 2020 and May 2022, HBeAg-positive CHB patients were selected from our hospital based on meeting the diagnostic criteria for inclustion in the study. These patients underwent 48-week treatment with PEG-IFN. Clinical biochemical parameters, HBV serological indices, and cytokine levels were assessed at baseline, 24 weeks, and 48 weeks respectively.Results In our study, 117 HBeAg-positive patients with chronic hepatitis B were enrolled. Of these, 46 demonstrated serum HBeAg responses,while 71 showed non-responses. Within the serumHBsAg responses group, 23 showed HBeAg responses, compared to 17 in the non-response group. Viral marker and cytokine levels were comparable between the HBeAg response and non-response groups. However, at the 24-week mark, the non-response group exhibited lower AST, ALT, TNF-α, TGF-β levels[(43.1±12.9)U/L, (56.58±8.2)U/L, (20.4±2.9) pg/mL, and(3279±960.8)pg/mL] than the response group [(33.4±7.4)U/L, (41.6±8.3)U/L, (15.4±2.8)pg/mL、and(2610.8±705.6)pg/mL],with P＜0.05. By the 48-week treatment mark, AST, ALT, TNF-α, TGF-β, and IL-10 leves[(35.2±7.7)U/L, (33.2±9.5)U/L, (16.6±3.7)pg/mL, (3180.6±1040.9)pg/mL, and(4.4±2.7)pg/mL] in the non-response group dereased less than in the response group[(27.2±6.9)U/L, (29.1±8.1)U/L, (13.8±2.5) pg/mL, (1975.0±474.0)pg/mL, and(3.0±0.9)pg/mL], with P<0.05. Notably, the IFN-γ level in the non-response group[(530.9±146.5)pg/mL] increased more than in the response group [(467.8±147.8)pg/mL], with P<0.05.Conclusion The cytokines TNF-α and TGF-β demonstrated a correlation with serum HBeAg both pre-and post-treatment, suggesting their potential as clinical markers for predicting PEG-IFN efficacy.
    Analysis of gut microbiota structure and diversity in patients with hepatitis B virus infection
    ZHAO Cheng-yan, ZHOU Xin-yi, GAO Ran-ran, HAN Dan, ZHENG Rong-jiong, LU Xiao-bo
    2023, 28(11):  1339-1345. 
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    Objective To examine the variations in gut microbiota among patients infected with hepatitis B virus (HBV).Methods Stool samples were collected from 133 patients with liver disease admitted to the department of liver disease. This cohort comprised 23 HBV carriers (HBV group), 25 with hepatitis B cirrhosis (LC group), 38 with hepatocellular carcinoma (HCC group), 16 with hepatitis B-induced liver failure (ACLF group), 13 with autoimmune hepatitis (AIH group) and 18 with primary biliary cirrhosis (PBC group). Genomic DNA was isolated from these fecal samples, folloed by amplification of the V3~V4 variable region of the 16S rRNA gene using specific primers. Amplified sequences were then analyzed using UPARSE to delineate the OTUs with a set similarity threshold of ≥97%. These OTUs were annotated with taxonomic data from the Silva database. Subsequently, the QIIME software was employed to assess both the intra-and inter-group diversity of the gut microbiota.Results The predominant bacteria across the 6 groups were Firmicutes, Proteobacteria, Bacteroidota and Actinobacteria. Their combind proportions in the HBV, LC HCC, ACLF, AIH, and PBC group was 88.76%, 97.22%, 96.15%, 92.88%, 95.91% and 93.36%, respectively. Notably, the abundance of Actinobacteria was significantly greater in the HBV and HCC groups compared to the LC group. Furthermore, the abundance of Actinobacteriota, as well as other bacteria, in the HBV group surpassed that in the LC, HCC, and ACLF group. The abundance of Actinobacteriota, as well as other bacteria, was notably lower in the LCand ACLF groups compared to the PBC group. In the LC group, the presence of Bacteroidota was significantly greater than in the HCC group. While the HCC group had a higher abundance of Firmicutes compared to the HBV group. When ranking the groups by their intestinal flora anundance, the order is HBV, PBC, LC, HCC group, ACLF, and AIH.The microbial composition in the HBV, LC, HCC, and PBC groups showed significantly variances, with distinct differences in the community structures of their intestinal microflora. On the other hand, the ACLF and AIH groups displayed a more cohesive intestinal microflora community, sharing similar structural characteristics. The number of species in the HBV group was significantly higher than in the LC, HCC, and ACLF group. The LC group had fewer species than both the AIH and PBC group. Both the HCC and ACLF groups had significantly fewer species compared to the PBC group (P<0.05). As for the Shannon index, the HBV group′s score was significantly higher than the LC and ACLF groups, Additionally, the scores for the LC, HCC, and ACLF groups were all significantly lower than that of the PBC group (P<0.05).Conclusion As liver injury in HBV patients worsened, there was a noticeable decrease in the abundance and diversity of their gut microbiota. Furthermore, the abundance and diversity of gut microbiota in HBV patients were markedly different from those in AIH and PBC patients.
    Non-alcoholic Fatty Liver Disease
    Analysis of liver function and associated metabolic factors in heterogeneous fatty liver disease
    SHI A-meng, WANG Ying, MA Wen-qi, LIU Na, ZHOU Zhi-hua, ZHOU Qi, SHI Hai-tao, DONG Lei
    2023, 28(11):  1346-1350. 
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    Objective To investigate liver function and associated metabolic related factors in heterogeneous fatty liver disease.Methods In a cohort of 180 individuals each from groups with heterogeneous fatty liver, homogeneous fatty liver, and healthy cohorts matched for gender and age, the body mass index (BMI), liver function, blood pressure, blood glucose, lipid profiles and uric acid levels were compared.Results (1) Of the 180 cases diagnosed with heterogeneous fatty liver, 167 were identified as type Ⅲ (diffuse heterogeneous infiltrative). In these, a pronounced, finely enhanced punctate echogenicity was observed in the majority of the liver tissue, contrasted by hypoechogenicity in certain areas. This hypoechogenicity was ambiguously demarcated from the normal liver parenchyma, with no evident space-occupying effect. (2)In the 180 cases of heterogeneous fatty liver, the majority comprised men (75.6%), those under 45 years of age (52.8%), and individuals with a BMI ≥ 28 kg/m2 (43.3%). Furthermore, 74.4% of these cases presented with normal ALT, 25.6% exhibited elevated ALT, and 6.1% display an ALT increase exceeding twice the normal range. (3) When compared to the healthy population, the levels of ALT, AST, ALP and GGT were fournd to be elevated in both heterogeneous fatty liver and homogeneous fatty liver, However, the levels of ALT, AST and GGT were notably lower in the heterogeneous fatty liver group than in the homogeneous fatty liver group. (4) Compared to the healthy population, indices such as BMI, blood pressure, blood glucose, blood cholesterol, triglycerides and uric acid levels were elevated in both heterogeneous and homogeneous fatty liver groups. Yet, the BMI, blood glucose and triglyceride measurements were found to be lower in the heterogeneous fatty liver compared to the homogeneous fatty liver group. (5) The BMI, blood glucose, blood triglycerides and uric acid were identified as independent influencing factors for heterogeneous fatty liver. Their respective OR (95% CI) values were 1.634 (1.362, 1.959), 1.878 (1.244, 2.835), 2.844 (1.049, 7.710), and 1.029 (1.019, 1.039).Conclusion Heterogeneous fatty liver primarily presented as diffuse heterogeneous infiltration, with BMI, blood glucose, blood triglycerides, and uric acid identified as independent risk factors.
    Combined effects of vitamin D and probiotics on nonalcoholic fatty liver disease in obese pediatric patients
    LIU Xi, SHU Chang
    2023, 28(11):  1351-1355. 
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    Objective To explore the combined therapeutic effects of vitamin D and probiotics on nonalcoholic fatty liver disease (NAFLD) in pediatric obesity.Methods 105 obese children diagnosed with NAFLD were enrolled from our hospital and were randomized into three groups (35 cases each) using a stratified random number table. The control group underwent nutritional and lifestyle interventions. In addition to the control goup`s interventions, Group A was administered probiotics, while Group B was given both vitamin D and probiotics. The changes of body mass index (BMI), liver function metrics, glucose and lipid metabolismmarkers, insulin resistance index (HOMA-IR), and inflammatory cytokines levels amont the three groups before and after the intervention were compared.Results After the intervention, there was a notable reduction in the levels of BMI, AST, and ALT across all three groups compared to their pre-intervention levels (P<0.05). On comparing between groups, BMI measurements in Group A and B were statistically comparable (P>0.05), yet both displayed significantly reductions when contrasted with the control group (P<0.05); The levels of AST and ALT in Group B were reduced compared to both Group A and the control group (P<0.05). Post-intevention levels of HOMA-IR, TC, and TG in the three groups also significantly decreased compared to their initial values(P<0.05). An intergroup analysis revealved that the levels of HOMA-IR, TC, and TG in Group B were substantially lower than in Group A, with the difference being statistically significant (P<0.05). In group B, post-intervetion 25 (OH) D3 levels significantly surged, while TNF- α and IL-6 levels saw a considerable decline(P<0.05). Conversly, in both Group A and the control group, no significant fluctuations were obderved in the levels of 25 (OH) D3, TNF- α and IL-6 before and after the intervention(P>0.05). After the intervention, the rates of intestinal microbiota dysbiosis in Group A and B reduced to 45.71% and 37.14% respectively, showing a significant decline from their pre-intervention values of 85.71% and 80.00% (P<0.05). In conreast, the control group′s dysbiosis rate showed no significant alteration, remaining relatively stable at 74.29% pre-intervention and 71.43% post-intervention(P>0.05). The post-intervention imbalance rates of intestinal microbiota were conparable between Group A and Group B(45.71% vs 37.14%, P>0.05). When evaluating the overall treatment efficacy, Group B exhibited the highest rate at 94.29%, followed by Group A at 80.00%, and the Control Group lagging behing at 60.00%. The differences in effective rates between the groups were statistically significant(P<0.05).Conclusion Incorporating probiotics and vitamin D into lifestyle interventions for obese children with NAFLD has been shown to effectively improve their glucose and lipid metabolism, diminish insulin resistance, lower inflammatory cytokine levels, and ameliorate liver function.
    Evaluation of ultrasonic shear wave vs. magnetic resonance elastography in diagnosing nonalcoholic fatty liver disease
    CHEN Tan-shou, MIU Ling-mei, SHI Zeng-jin
    2023, 28(11):  1356-1358. 
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    Objective To compare the diagnostic efficacy of ultrasonic shear wave elastography (SWE) vs. magnetic resonance elastography (MRE) for hepatic steatosis in nonalcoholic fatty liver disease (NAFLD).Methods Clinical data from 88 patients diagnosed and treated for NAFLD between October 2019 to April 2022 in our hospital were retrospectively analyzed. Liver steatosis was categorized based on pathological findings. Both SWE and MRE were used to evaluate each patients, and their diagnostic performance in grading NAFLD liver steatosis was compared.Results For various liver steatosis grades, Emean values were (6.34 ± 0.65) kPa, (8.08 ± 1.22) kPa, (10.95 ± 1.34) kPa, and (14.25 ± 2.02) kPa, while ADC values were (1.25 ± 0.18) 10-3 mm2/s, (1.14 ± 0.13) 10-3 mm2/s, (1.04 ± 0.09) 10-3 mm2/s, (0.92 ± 0.05) 10-3 mm2/s, respectively. As liver steatosis grade escalated, there was a marked increase inn the Emean value and a corresponding decline in the ADC value, with these differences being statistically significant (P<0.05). In terms of diagnostic accuracy, the area under the curve(AUC) for SWE diagnosis across different liver steatosis grades was 0.855, 0.823, 0.841, 0.827. Conversely,for MRE diagnosis, the AUC values were 0.901, 0.897, 0.911, 0.927. Notably, the AUC for MRE diagnosis surpassed that of SWE for all hepatic steatosis grades.Conclusion MRE is more effective than SWE in diagnosing hepatic steatosis in NAFLD.
    Other Liver Diseases
    Clinical and imaging analysis of hepatic amyloidosis
    HAO Lei, REN Hong-wei, DONG Jing-hui, CAI Jian-ming, ZHANG Meng-meng, LIU Chang-chun, GAO Shen, LIU Yuan
    2023, 28(11):  1359-1362. 
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    Objective To analyze the clinical and imaging features of 12 patients with hepatic amyloidosis.Methods Data from 12 patients who had undergone pathological biopsies between February 2017 and February 2023 were collected and analyzed. General demograpgics, clinical findings, laboratory results and imaging findings were included in this study.Results In 12 patients diagnosed with hepatic amyloidosis, the predominant clinical manifestations included abdominal distension, poor appetite, and abnormal liver function. Among these patients, 10 showed elevated alkaline phosphatase(ALP), 11 had elevated glutamyltransferase(GGT), 7 exhibited decreased albumin(ALB), 5 tested negative for tumor markers, 4 had elevated CA125, and 6 indicated elevated CA199 levels. Hepatomegaly was evident in all 12 patients, Additionally, an enlarged spleen was identified in 7 patients, abdominal effusion in 7, and 9 displayed a “frozen snowflakes on window”-like patchy low-density or low signal enhancement in the liver parenchyma during both the portal and delayed phases.Conclusion Hepatic amyloidosis predominantly affects middle-aged and elderly women. The primary clinical symptoms include abdominal distension and abnormal liver function. Most patients exhibit elevated levels of ALP and GGT, with some showing abnormal some tumor markers. The most frequent imaging findings are enlargement of the liver and spleen, ascites, heterogeneous liver parenchymal enhancement, and enhancement patteins reminiscent of “frozen snowflakes on a window”. The definitive diagnosis of hepatic amyloidosis relies on a combination of imaging results and pathological findings from liver puncture biopsy.
    Impact of two different biliary metal stent drainage channels on palliative care outcomes in malignant obstructive jaundice
    GU Xia, ZHONG Ji-feng, SU Dong-sheng
    2023, 28(11):  1363-1368. 
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    Objective To evaluate the therapeutic efficacy and safety profile of two distinct biliary metal stent drainage(EMBE) methods in the management of malignant obstructive jaundice (MOJ).Methods A total of 112 patients diagnosed with MOJ between January 2019 and September 2021 were enrolled in this study. Patients were evenly allocated into either observation group or control group, each containing 56 participants. The observation group underwent EMBE facilitated by endoscopic retrograde cholangiopancreatography (ERCP), whereas the control group received percutaneous transhepatic biliary drainage (PTCD). Various metrics, including perioperative markers, inflammatory and immunological profiles, liver function tests, indices of therapeutic effecacy and safety, were meticulously evaluated.Results There were no statistically significant differences between the two groups in terms of operative time and intraoperative blood loss (P>0.05). Patients in the ERCP group had shorter initial out-of-bed times(29.46±6.30 h), shorter first hospotal stays(4.52±0.76 d), and lower total hospitalization costs(3.93±0.47 million yuan) compared to those in the PTCD group (32.75±6.25 h, 5.19±0.85 d and 4.46±0.58 million yuan, respectively; t=6.527, 6.293, 6.043, all P<0.05). After one week of treatment, both groups exhibited significant reductions in NLR, TNF-α and sIL-2R levels compared to pre-treatment baselines (P<0.05). However, post-treatment levels were not significantly different between the groups(P>0.05). Liver function indicators, including TBIL, ALP and ALB, were significantly improved in the ERCP group(146.59±24.83 μmol/L, 168.34±31.65 U/L, 32.18±2.49 g/L) compared to the PTCD group(180.27±31.54 μmol/L, 201.87±39.25 U/L and 30.83±2.27 g/L; t=8.023, 7.495, 5.876, all P<0.05). No significant differences were observed in surgical success rates or total remission rates between the two groups (P>0.05). The ERCP group had lower remission rate of high obstruction (53.33%) compared to the PTCD group (85.71%), but a higher remission and one-year survival rate for low obstruction(90.24% and 30.36%, respectively) compaared to the PTCD group (64.29% and 16.07%; χ2=5.276, 5.481, 4.297, P<0.05). In terms of complications, the The ERCP group had a higher incidence of PEP(7.14%), compared to the PTCD group (0%). The incidence of biliary tract infection was 3.57% in the ERCP group versus 7.14% in PTCD group, with the difference being statistically significant (χ2=5.239, 4.351, both P<0.05). No significant differences were noted in the overalll incidence rates of biliary bleeding, biliary leakage, stent displacement, slippage, or other complications between the two groups (P>0.05).Conclusion Both ERCP and PTCD demonstrate robust efficacy and a high safety profile in treating patients with MOJ, complicated by EMBE. Specifically, ERCP is particularly advantageous for treatling lower MOJ cases, whereas PTCD exhibits greater suitability for addresing upper MOJ conditions.