Table of Content

29 February 2024, Volume 29 Issue 2

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Liver Fibrosis & Cirrhosis

The clinical characteristics of patients with spontaneous portalsystemic shunt and isolated gastric variceal bleeding

WENG Cheng-zhao, WANG Chao, ZHANG Jun, LIN Si-hui, LIN Chong, CHEN Shi-yao, JIANG Wei

2024, 29(2):  157-161. 

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Objective To analyze the clinical characteristics of patients with spontaneous portalsystemic shunt and isolated gastric variceal bleeding. Methods A retrospective study was performed on the patients with spontaneous portalsystemic shunt (SPSS) and bleeding caused by isolated gastric varices type 1 (IGV-1). The portal vein diameter, Hepatic Venous Pressure Gradient (HVPG), portal vein thrombosis (PVT), Child Pugh score, MELD score and treatment method of different types of SPSS patients were recorded. The patients were followed up for 3 years, and recorded the number of bleedings and their survival rate. Results A total of thirty- seven patients were included in this study, including 15 patients with splenorenal shunt, 14 patients with gastrorenal shunt, and 8 patients with both splenorenal shunt and gastrorenal shunt. During the follow-up period of time, within 18 patients who were treated with transjugular intrahepatic portosystomic stent shunt (TIPS), 4 cases (22.2%) each occured rebleeding and hepatic encephalopathy. Six cases were treated with gastric coronary vein embolization combined with partial splenic embolization. Within them, 4 cases of rebleeding and 1 case of death occurred during the follow-up. Nine cases accepted endoscopic treatment. Within them, 3 cases (33.3%) had rebleeding, 1 patient (11.1%) had hepatic encephalopathy, and 1 case (11.1%) died during the follow-up. Univariate Cox regression analysis showed that PVT and the level of HVPG were risk factors for rebleeding. Conclusion The incidences of rebleeding, ascites and PVT in patients with SPSS and IGV-1 are high. PVT and the level of HVPG are risk factors associated with rebleeding. The form of shunt has important value for the selection of IGV-1 treatment options.

The value of portal vein imaging parameters of computer tomography in evaluating liver function grading and esophageal variceal bleeding risk in hepatitis B patients with cirrhosis

HUANG Ya-bo, YANG Ying, WANG Jin-jun

2024, 29(2):  162-165. 

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Objective To analyze the clinical value of computer tomography (CT) portal vein imaging parameters in evaluating liver function classification and esophageal variceal bleeding (EVB) risk in hepatitis B patients with cirrhosis. Methods From January 2020 to June 2023, sixty hepatitis B patients with cirrhosis were selected as the cirrhotic group(31 patients with gastrointestinal bleeding and 29 patients without bleeding). Fifty-four healthy people were selected in the same time period as the control group. CT portal vein imaging was used to measure the main portal vein (MPV), splenic vein (SPV), left gastric vein (LGV), left intrahepatic portal vein (IHLPV), and right intrahepatic portal vein (IHRPV) in the two groups; The diameters of portal and splenic veins with different Child Pugh grades in the cirrhotic patients were compared; The diameters of portal and splenic veins in the cirrhotic patients of gastrointestinal bleeding group and non-bleeding group were compared; The value of the diameters of portal and splenic veins in predicting EVB in cirrhotic patients were analyzed by reciever operating characteristic curve (ROC) method. Results The diameters of MPV, LGV, SPV, IHRPV and IHLPV in the hepatitis B cirrhosis group were (1.8 ± 0.5) cm, (1.5 ± 0.4) cm, (1.4 ± 0.3) cm, (1.4 ± 0.4) cm and (1.2 ± 0.3) cm, respectively, which were significantly higher than those in the control group [(1.1 ± 0.2) cm, (0.6 ± 0.1) cm, (0.8 ± 0.2) cm, (0.7 ± 0.2) cm and (0.6 ± 0.2) cm, respectively, P<0.05]; The diameters of MPV, LGV, SPV, IHRPV and IHLPV in Child-Pugh grade A patients were (1.9 ± 0.4) cm, (1.6 ± 0.4) cm, (1.5 ± 0.4) cm, (1.4 ± 0.4) cm and (1.3 ± 0.4) cm, respectively, which were significantly lower than those of [(2.5 ± 0.5) cm, (1.9 ± 0.3) cm, (1.8 ± 0.5) cm, (1.8 ± 0.6) cm and (1.8 ± 0.4) cm, P<0.05] in Child-Pugh grade B patients. and those of [(2.7 ± 0.7) cm, (2.3 ± 0.6) cm, (2.2 ± 0.6) cm, (2.2 ± 0.7) cm, (2.2 ± 0.7) cm in Child-Pugh C,patients [ P<0.05]; The diameter of IHRPV in the gastrointestinal bleeding group [(1.6 ± 0.4) cm] was significantly higher than that in the non-bleeding group [(1.5 ± 0.3) cm] (P>0.05). The diameters of MPV, LGV, SPV and IHLPV in the gastrointestinal bleeding group were (2.4 ± 0.7) cm, (2.1 ± 0.5) cm, (1.7 ± 0.5) cm and (1.7 ± 0.4) cm, respectively, which were significantly higher than those of (1.6 ± 0.4) cm, (1.2 ± 0.3) cm, (1.3 ± 0.3) cm and (1.1 ± 0.5) cm in the control group (P<0.05); ROC analysis confirmed that the diameters of portal and splenic veins could predict the occurrence of EVB in patients with hepatitis B cirrhosis, and the areas under the curves (AUC) of MPV, LGV, SPV and IHLPV were 0.815, 0.841, 0.829, 0.813, respectively, with all P<0.05. Conclusion CT portal vein imaging can clearly reflect the collateral circulation of portal hypertension in hepatitis B patients with cirrhosis, and the diameters of its trunks and branches has clinical value in predicting the occurrence of EVB.

A correlation analysis of right heart function measured by ultrasound with Child-Pugh grading in liver cirrhotic patients

LIU Su-hui, MA Ya-feng, DING Li-li

2024, 29(2):  166-169. 

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Objective To investigate the correlation between right heart function measured by ultrasound and Child-Pugh grading in patients with cirrhosis. Methods A retrospective analysis was conducted on 78 patients with liver cirrhosis as the observation group and 78 healthy individuals who underwent physical examination from March 2021 to March 2023 as the control group.According to Child-Pugh classification, 78 patients with cirrhosis were divided into Grade A (N=38 cases), Grade B (N=30 cases) and grade C (N=10 cases) groups. The right ventricular structure and right cardiac function indexes of cirrhosis patients and healthy subjects were compared. The difference of right heart function in patients with different Child-Pugh grades was compared and the correlation between them was analyzed. Results In the observation group, right atrial systolic diameter (RASd), right atrium long diameter (RALd), right atrial diastolic diameter (RADd), right ventricular diastolic diameter (RVDd) and right ventricular wall thickness (RVAW) were (38.79±4.16) mm, (44.94±5.17) mm, (36.07±2.16) mm, (21.45±1.84) mm, and (2.39±0.57) mm, respectively, which were significantly higher than those of (41.01±4.13) mm, (35.31±2.08) mm, (19.38±1.63) mm, (2.01±0.21) mm, and (35.42±2.88) mm in the control group (P<0.05). The early mitral inflow velocity and mitral annular early diastolic velocity (E/E') values of the two groups were (6.50±1.39) and (6.60±1.62), respectively, and there was no significant difference (P>0.05). The right ventricular fractional area change (RVFAC) and early to late diastolic transmitral flow velocity (E/A) of the observation group were (43.20±6.04) % and (1.28±0.27), respectively, which were significantly lower than those of (45.08±4.12) % and (1.39±0.31) in the control group. The tricuspid annular planes systolic excursion (TAPSE) and myocardial performance index (Tei index) of the observation group were (23.80±3.06) mm and (0.43±0.10), respectively, which were significantly higher than those of (22.61±3.11) mm and (0.37±0.12)mm in the control group (P<0.05). The RVFAC of cirrhosis patients with Child-Pugh grade A was (41.71±5.03)%, which was significantly lower than that of patients with Child-Pugh grade B (45.09±6.07)%. The E/A ratio of cirrhotic patients with Child-Pugh grade A was (1.41±0.36), which was significantly higher than that of (1.11±0.21) in patients with Child-Pugh grade C. The Tei index of liver cirrhotic patients with Child-Pugh grade A was (0.38±0.09), which was significantly lower than that of (0.45±0.04) in patients with Child-Pugh grade C (P<0.05). By Correlation analysis it was shown that E/A ratio was negatively correlated, whereas Tei index was positively correlated with Child-Pugh classification (P<0.05). Conclusion Ultrasonic measurement of right heart function in patients with cirrhosis is simple and reproducible. It was shown by Ultrasonography that the right heart function is damaged in patients with cirrhosis, and worsen with the progression of cirrhosis.

The correlation between vitamin B12, Folic acid, growth hormone and liver function in hepatitis B patients with cirrhosis

LI Cui-fen, HU Shan-shan

2024, 29(2):  170-173. 

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Objective To investigate the correlation between vitamin B12 (VitB12), folic acid (FA), growth hormone (GH) and liver function in hepatitis B patients with cirrhosis. Methods One hundred and forty-eight hepatitis B patients with cirrhosis admitted from January 2020 to December 2021 were enrolled as the hepatitis B group. 100 subjects with normal physical examination at the same period of time were selected as the normal control group. Fasting venous bloods were taken from individuals of both groups, and the serum levels of VitB12, FA, GH, and liver function indicators including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBil) were detected and compared between the two groups. The patients were further divided into Child-Pugh A, B and C groups according to their Child-Pugh grading of liver function. Their serum indicators were compared within the groups, Pearson correlation coefficient was used to analyze the correlation between ALT, AST, TBil and VitB12, FA, GH levels. Results Serum VitB12, GH, ALT, AST and TBil of hepatitis B group were (321.81±37.81) ng/L, (7.21±1.23) μg/L, (91.78±10.28) U/L, (99.01±15.78) U/L, (66.21±14.91) μmol/L, respectively, which were significantly higher than those in normal group. The FA level of hepatitis B group was (5.21±1.90) μg/L, which was significantly lower than that of normal group (P<0.05). According to Child-Pugh grading, there were 30, 71 and 47 cases in grade A, B and C groups, respectively. The levels of serum VitB12, GH, ALT, AST, and TBil in Child-Pugh Grade A patients were (271.91±31.90) ng/L, (5.91±1.19) μg/L, (82.90±14.91) U/L, (72.90±16.91) U/L, and (32.91±10.21) μmol/L, respectively, which were significantly lower than those of (331.09±37.91) ng/L, (7.57±1.20) μg/L, (95.25±13.30) U/L, (101.78±20.21) U/L, and (68.91±16.89) μmol/L in Grade B patients, and (442.10±40.81) ng/L, (9.21±1.43) μg/L, (137.91±14.89) U/L, (182.91±30.22) U/L, and (172.14±17.82) μmol/L in grade C patients, The serum level of FA in grade A patients was (7.89±1.21) μg/L, which was significantly higher than that of (5.01±1.23) μg/L in grade B or (2.90±0.51) μg/L in grade C patients (P<0.05). Pearson correlation coefficient analysis showed that serum VitB12 and GH were positively correlated with liver function indexes of ALT, AST and AST, whereas serum FA was negatively correlated with these indexes (P<0.05). Conclusion With the aggravation of liver function damage in hepatitis B patients with liver cirrhosis, serum VitB12, GH levels increase and FA level decreases. Serum levels of VitB12, GH and FA may therefore be used as effective indicators to evaluate the severity of liver injuries.

SOX9 promotes the progression of liver fibrosis by regulating hepatic stellate cells activation and proliferation

XIONG Min-li, GONG Xiao-yuan, WAN Shu-qi, LUO Sheng-zheng

2024, 29(2):  174-177. 

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Objective To explore the effect of SRY-Box Transcription Factor 9 (SOX9) gene on the activation and proliferation of hepatic stellate cells. Methods An experimental model of liver fibrosis were induced by intraperitoneally injection of 15% carbon tetrachloride (CCl4) or corn oil as a control treatment three times a week in mice. H&E staining and Masson staining were used to observe the morphologies of mouse liver fibrosis. Real-time Quantitative PCR (qPCR) was used to detect the relative mRNA expression of SOX9, α-smooth muscle actin (α-SMA), and collagen type 1 (Col1) in the mouse liver. Transforming growth factor-β1 (TGFβ1) was used to induce hepatic stellate cell line LX2 activation, and qPCR was used to detect the relative mRNA expression of SOX9, α-SMA, Col1, Cyclin D1, and proliferating cell nuclear antigen (PCNA) genes with different treatments. Results By H&E and Masson staining it was shown that the liver fibrosis model was constructed successfully. The qPCR results showed that SOX9 gene was significantly upregulated in the liver of fibrotic mice, along with over-expressions of α-SMA and Col1, the main marker genes of hepatic stellate cells activation. The expression of SOX9 was tested to be significantly up-regulated in TGFβ1 stimulated LX2 cells. After knocking down of SOX9, the expressions of α-SMA, Col1, Cyclin D1 and PCNA were significantly decreased, and the activation and proliferation of LX-2 cells were significantly inhibited. Conclusion The expression of SOX9 is significantly increased in the mice livers with fibrogenesis. Knocking down of SOX9 can significantly reduce the hepatic stellate cells activation. SOX9 may therefore become a target for the treatment of liver fibrosis.

Liver Cancer

The clinicopathological features and diagnostic difficulties of hepatic angiosarcoma

LIU Zhou-ying, DU Jun, ZHANG Jing-song, LIU Dong-ge, YANG Chong-qing

2024, 29(2):  178-181. 

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Objective To investigate the clinicopathological characteristics of hepatic angiosarcoma and analyze its diagnostic difficulties. Methods The pathological and clinical data of 6 patients diagnosed with hepatic angiosarcoma in the department of pathology of Beijing Hospital from 2013 to 2022 were retrospectively analyzed. Results The clinical manifestations and images of the 6 patients with hepatic angiosarcoma were non-specific. The morphologies were diverse. Atrophic liver cell plates and hepatic sinusoids lined with atypia cells were observed in high-grade angiosarcoma, while low-differentiated angiosarcoma was more atypical, and should be distinguished from other sarcomas. The tumor cells expressed vascular endothelial markers CD31, CD34 and ERG. Conclusion Hepatic angiosarcoma is a rare malignant tumor without specificity in clinical manifestations and image examinations. Comprehensive analyses of the clinical manifestations, morphology and immunohistochemical staining are helpful for a right pathological diagnosis.

The impact of different antiviral therapy on the development of hepatocellular carcinoma in patients with chronic hepatitis C

ZHAO Ya-lin, SHEN Chuan, WEI Meng-ping, ZHAO Cai-yan

2024, 29(2):  182-188. 

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Objective To compare the occurrence of hepatocellular carcinoma in patients with chronic hepatitis C who achieved sustained virologic response after direct-acting antiviral agents (DAAs) or pegylated interferon combined with ribavirin (PR regimen), and to analyze the risk factors for developing hepatocellular carcinoma. Methods We retrospectively analyzed the clinical data of patients with chronic hepatitis C who met the inclusion criteria at the Third Hospital of Hebei Medical University from January 2006. Patients were divided into the DAAs group and the PR group based on the treatment regimens. Propensity Scores Matching was utilized to mitigate the confounding bias between the two groups. The Kaplan-Meier method was employed to estimate the incidience rate, and the Log-rank test was used to assess the differences. Cox proportional hazard regression analysis was conducted to identify the risk factors for HCC occurence. Results A total of 369 patients were enrolled, with 229 (62.1%) patients receiving PR regimen and 140 (37.9%) patients receiving DAAs. After propensity matching, 106 patients in each group were further analyzed. The 4-year incidence of hepatocellular carcinoma in the two groups was 7.9% and 10.2% respectively, with no statistical significance (P=0.070). Multivariate analysis revealed that age at the initiation of treatment (HR=1.093, 95%CI: 1.007, 1.186), diabetes mellitus (HR=9.988, 95%CI: 2.093, 47.662), liver cirrhosis (HR=9.422, 95%CI: 1.079, 82.250), baseline AFP ≥10 ng/mL (HR=5.683, 95%CI: 1.100, 29.369), and high HCV RNA level (HR=2.877, 95%CI: 1.203, 6.878) were independent predictors of HCC occurence in patients with chronic hepatitis C who achieved sustained virologic response. Conclusion There was no significant difference in the 4-year incidence of hepatocellular carcinoma in patients with sustained virologic response to different antiviral treatment regimens.

Study on the factors influencing the long-term efficacy of ultrasound-guided microwave ablation for recurrent liver cancer

YANG Li-ping, YU Jie, LI Qin-ying, XIA Yan, QI Gao-ang, SHANG Rui, WU Long-jun, GAO Lei

2024, 29(2):  189-192. 

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Objective To investigate the influence factors of ultrasound-guided microwave ablation on the long-term treatment outcomes of recurrent liver cancer. Methods We collected data from 80 patients with recurrent liver cancer treated at our hospital from September 2019 to September 2021 and conducted a retrospective analysis. The patients were divided into a poor prognosis group (22 deaths) and a good prognosis group (55 survivals) based on their 1-year postoperative survival. Clinical data were compared between the two groups, including serum levels of alpha-fetoprotein (AFP), albumin (Alb), alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Multiple Logistic regression analysis was conducted to identify the factors influencing the long-term efficacy of ultrasound-guided microwave ablation in patients with recurrent liver cancer. Results In the poor prognosis group, 8 cases (36.36%) of patients were classified as Child-Pugh grade B, 11 cases (50.00%) had multiple lesions, 10 cases (45.45%) had lesion diameter ≥3 cm, and 9 cases (40.91%) had AFP ≥100 ng/mL. In comparison, the good prognosis group had 8 cases (13.79%) with Child-Pugh grade B, 12 cases (20.69%) with multiple lesions, 13 cases (22.41%) with lesion diameter ≥3 cm, and 10 cases (17.24%) with AFP ≥100 ng/mL. These differences were found to be statistically significant (P＜0.05). Multivariate Logistic regression analysis further confirmed that Child-Pugh grade B, multiple lesions, lesion diameter ≥3 cm, and AFP≥100 ng/mL were identified as risk factors for a poor prognosis in patients with recurrent liver cancer after ultrasus-guided microwave ablation (P<0.05). Conclusion Ultrasound-guided microwave ablation has better long-term efficacy for patients with Child-Pugh grade A, single lesion, lesion diameter < 3 cm, and AFP < 100 ng/mL.

Analysis of the incidence and influencing factors of radiation induced liver injury in patients with hepatitis B hepatocellular carcinoma after stereotactic radiotherapy

ZHOU Jin-feng, CHEN Jun-jie, ZHAN Bao-bin

2024, 29(2):  193-196. 

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Objective To investigate the occurrence and influencing factors of radiation-induced liver injury in patients with hepatitis B hepatocellular carcinoma following stereotactic radiotherapy. Methods A retrospective analysis was conducted on the clinical data of 200 patients with hepatitis B hepatocellular carcinoma who underwent stereotactic radiotherapy at our hospital between September 2020 and September 2022. Among them, 36 patients experienced radiation-induced liver injury after treatment and were designated as the occurrence group, while the remaining 164 patients were classified as the non-occurrence group. Clinical data of the two groups were compared, and the multivariate logistic regression analysis was conducted. The study also observed the peak time, curve rising slope, and area under the curve of patients in the occurrence group before radiotherapy, 2 weeks after radiotherapy, and 4 weeks after radiotherapy. Results The proportion of patients with age >50 years old, tumor diameter >5 cm, and Child-Pugh grade C in the occurrence group (86.1%, 47.2%, 63.9%) was higher than that in the non-occurrence group (68.3%, 25.0%, 35.4%), and the white blood cell count level was [(3.5 ± 1.5) × 10⁹/L], lower than that in the non occurrence group [(5.4 ± 1.7) × 10⁹/L] (P<0.05). Multivariate logistic regression analysis revealed that age>50 years, tumor diameter>5 cm, Child Pugh grade C, and decreased white blood cell count were independent risk factors for radiation-induced liver injury in patients with hepatitis B hepatocellular carcinoma after stereotactic radiotherapy (OR=4.614, 4.968, 5.233, 5.496, P<0.05). Compared with before radiotherapy groups, the peak time of patients in the 2 week and 4 week radiotherapy groups was significantly prolonged, and the slope of curve rise and area under curve were significantly reduced (P<0.05). Conclusion Following stereotactic radiotherapy, patients with hepatitis B hepatocellular carcinoma may be at risk for radiation-induced liver injury, which is associated with older age, large tumor diameter, poor liver reserve function, and decreased white blood cell count. This warrants increased vigilance in clinical practice.

The value of CEUS combined with serum AFP, CA199 and CA125 in the diagnosis of early hepatocellular carcinoma

ZHU Wei, Nurpol, DING Xiao-jun

2024, 29(2):  197-201. 

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Objective To investigate diagnostic value of contrast-enhanced ultrasound (CEUS) characteristics and changes in serum alpha-fetoprotein (AFP), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125) in patients with early primary liver cancer (HCC). Methods Using pathological results as the gold standard for diagnosis, 80 patients with early HCC diagnosed in Nanjing Gaochun People's Hospital from August 2018 to August 2021 were selected as the HCC group, while 80 patients with liver benign nodules were selected as the benign group. The characteristic parameters of CEUS in the two groups were compared and analyzed. Serum levels of AFP, CA199 and CA125 in the HCC and benign group were measured and analyzed by statistical hypothesis testing. 2×2 four-grid tables were conducted based on the gold standard diagnosis results to evaluate the accuracy of different diagnosic methods when use alone and in combination for distinguishing between benign and malignant liver tumors. Results In the HCC group, 87.50% of cases had single lesions, 30.00% had unclear boundary features, 26.25% had irregular lesions, and 26.25% had rich blood supply. Additionally, 80.00% exhibited equal or low enhancement in the CEUS portal phase, and 86.25% displayed equal or low enhancement in the CEUS delay phase, all of which were significantly higher than those in the benign group. These parameters demonstrated significant differences between the HCC group and the benign group (P<0.05). Furthermore, laboratory examination revealed significantly higher levels of AFP (25.91 ± 8.44) μg/L, CA199 (41.46 ± 10.20) U/mL, and CA125 (39.20 ± 11.32) U/mL in the HCC group compared to the benign group (P<0.05), where the levels of AFP, CA199, and CA125 were (16.42 ± 6.73) μg/L, (28.74±8.62) U/mL, and (27.13±7.57) U/mL, respectively. The combination of CEUS, AFP, CA125, and CA199 demonstrated a sensitivity of 95.00%, specificity of 82.50%, missed diagnosis rate of 5.00%, misdiagnosis rate of 17.50%, positive predictive value of 84.44% and negative predictive value of 94.29% in the diagnosis of HCC and benign liver tumors. Conclusion The combined use of CEUS, AFP, CA125, and CA199 in the diagnosis of early HCC and benign liver tumors has been shown to significantly enhance diagnostic sensitivity and ensure superior diagnostic specificity compared to the application of each index individually.

Efficacy of Callispheres-TACE in combination with Sindillimab for unresectable hepatocellular carcinoma

ZHANG Yong-hong, CHU Jian-hua, CHEN Guo-dong

2024, 29(2):  202-207. 

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Objective To evaluate the effectiveness of combining Callispheres-hepatic arterial chemoembolization (TACE) with sindillimab in the management of unresectable hepatocellular carcinoma. Methods A total of 110 patients with unresectable hepatocellular carcinoma were admitted to our hospital from January 2020 to January 2022. They were randomly divided into the control group or the observation group, with 55 patients in each group. The control group received Callispheres-TACE treatment, while the observation group received Callispheres-TACE combined with sindillimab. The levels of tumor markers [alpha-fetoprotein (AFP), CA242, CA724], tumor growth factors [basic fibroblast growth factor (bFGF) vascular endothelial growth factor (VEGF)], anti-tumor immune response factors [CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺], oncogenes [proliferation-related genes (C-myc), fibroblast growth factor 2 (FGF2)] and tumor suppressor genes [cell cycle dependent protein kinase inhibitor (P16), iron apoptotic protein (Hepcidin)] were compared between the two groups. Furthermore, a comparative analysis of the recent treatment efficacy, adverse reactions, and survival status was conducted between the two groups. Results After treatment, the observation group demonstrated significantly lower AFP, CA242 and CA724 (405.12±40.86 μg/L, 6.57±1.02 U/mL, 13.34±3.08 U/mL, respectively), compared to the control group (557.56±67.45μg/L, 9.69±1.63 U/mL and 16.34±3.69 U/mL), with statistically significant differences (t=14.340, 12.108, 8.377, P<0.05). Similarly, the levels of bFGF and VEGF in the observation group (3.64±0.57 pg/mL and 155.71±15.72 pg/mL) were significantly lower than those in the control group (6.33±0.86 pg/mL and 221.46±36.33 pg/mL), with statistically significant differences (t=19.340, 12.320, P<0.05). Furthermore, the observation group exhibited higher levels of CD3⁺, CD4⁺, and CD4⁺/CD8⁺ (68.31±7.42%, 44.12±5.13% and 1.58±0.26) and a lower level of CD8⁺ (21.24±2.01%) when compared to the control group (56.43±6.36%, 36.35±4.20%, 1.25±0.14, and 26.34±2.71%, respectively), and the difference was statistically significant (t=9.015, 8.691, 11.210, 8.288, all P<0.05). The levels of C-myc and FGF2 in the observation group (1.09±0.14 pg/mL and 1.21±0.25 pg/mL, respectively) were also lower than those in the control group (6.75±1.22 pg/mL and 5.78±1.33 pg/mL) while the levels of P16 and Hepcidin in the observation group (11.42±0.83 pg/mL and 12.95±1.27 pg/mL) were higher than those in the control group (7.45±0.98 pg/mL and 8.42±1.35 pg/mL). The difference was statistically significant (t=34.180, 25.040, 22.930, 18.130, all P<0.05). The observation group achieved a higher objective response rate (ORR) of 80.00% compared to the control group’s 61.82% (P<0.05). However, there was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Additionally, the observation group demonstrated longer median progression-free survival time, median overall survival time, and 12-month survival rate (8.12±1.09 months, 10.35±1.04 months and 72.73%, respectively), compared to the control group (6.84±0.87 months, 8.98±1.43 months, 52.73%) (t=6.807, 5.823, 4.705, all P<0.05). Conclusion The combination of Callispheres-TACE and Sindillimab shows promise in inhibiting lesion growth, restoring the expression imbalance of oncogenes and tumor suppressor genes, and improving survival outcomes in patients with unresectable hepatocellular carcinoma, thereby enhancing short-term efficacy.

Comparative analysis of MRI And CT imaging features in bile duct carcinoma

LIU Cui-e, WANG Wei-wei, FENG Rui, ZHENG Zeng

2024, 29(2):  208-210. 

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Objective To summarize both direct and indirect imaging characteristics of cholangiocarcinoma as revealed by MRI And CT scans. Methods Data were retrospectively collected and analyzed from 62 cholangiocarcinoma resection cases at the Fifth Medical Center of PLA General Hospital, spanning from March 2019 to October 2022. These patients had undergone either MR Or CT dynamic enhancement scans within 1 week prior to their surgery. The imaging sequences and dynamic enhancement scan features were meticulously analyzed, with the prevalence of each distinct radiologic sign observed in these patients being quantified. Results In this study of 62 cholangiocarcinoma patients, lesion sizes ranged from 0.8 to 8.9cm in the longest dimension.,MRI analysis revealed varid signal intensities: on T1WI, lesions exhibited high signal in 4 cases, isointense signal in 2, low signal in 36, and heterogeneous signal in 1. On T2WI, 35cases showed high signals, 3 isointense, 3 low signal, and 2 heterogeneous. Diffusion-weighted imaging(DWI) identified high signal in 40 cases and isointense signal in 3. Enhancement patterins included pronounced enhancement in 19 cases, mild in 17, absent in 6, rapid in-and out in.19, continuous 24 and delayed in 11. CT imaging revealed isodensity in 2 cases, slightly hyperdense in 3 and slightly hypodense in 14. Enhancement patterns on CT were mild in,12 cases, marked in 4, and absent in 3. In the portal venous phases, 7 patients presented with slightly hyperdense lesions, 7 with slightly hypodense, 4 with hyperdense, and 1 with isodense lesions. Additonal findings included 10 cases with slightly hyperdense lesions, 5 with slightly hypodense, 2 with isodense, and 2 with hyperdense. Indirect signs of cholangiocarcinoma, such as biliary dilation, were noted in 47 of the 62 patients. This included 38 cases of mild dilation, 3 moderate, 4 severe with soft vine appearance, and 2 showing earthworm-like dilation. Conclusion Delayed and continuous enhancement patterns, along with biliary duct dilatation, are identified as hallmark direct and indirect signs in MRI And CT imaging for the diagnosis of bile duct carcinoma. These imaging features play a crucial role in differentiating bile duct carcinoma from other hepatic pathologies, underscoring their diagnostic significance in clinical radiology.

Incidence and clinical implications of venous thromboembolism in 65 patients with advanced cholangiocarcinoma

SUN Gen-lin, WANG Na-na, BAO yang-yi

2024, 29(2):  211-214. 

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Objective To investigate the incidence and clinical implications of venous thromboembolism in patients diagnosed with advanced cholangiocarcinoma. Methods From March 2019 to March 2020, Sixty-five patients with clinicopathologically confirmed advanced cholangiocarcinoma were admitted to our hospital. These patients were categorized into two groups based on the occurrence of venous thromboembolism: and occurrence group (n=35) and a non-occurrence group (n=30). Post-admission, all patients underwent laboratory testing, routine blood examinations, lower limb deep vein ultrasound, and Caprini scale assessments, A univariate analysis of indicators from both groups was conducted, followed by a multicariate logistic regression analysis of variables that exhibited statistically significant differences in the univariate analysis. This approach aimed to identify risk factors associated with the development of venous thromboembolism in patients with cholangiocarcinoma. Results The univariate analysis revealed that the occurence group demonstrated significantly higher levels of platelet, D-dimer and fibrinogen, with values of (419.4 ± 102.5) × 10⁹/L, (2.9 ± 1.3) mg/L, and (9.8 ± 2.6) mg/L, respectively, compared to the non-occurrence group, which showed levels of (302.1 ± 25.6) × 10⁹/L, (1.8 ± 1.2) mg/L, (7.5 ± 1.8 ) mg/L. Furthermore, the antithrombin III level in the occurrence group was significantly lower at (72.9±8.5)%, compared to (98.2±25.8)% in the non-occurrence group (P<0.05). The multifactorial logistic regression analysis identified platelets, D-dimer, fibrinogen, antithrombin III, caprini assessment results, and findings from lower extremity deep vein ultrasound as independent risk factors for venous thromboembolism in patients with cholangiocarcinoma, with odds ratios(OR) of 4.577, 4.702, 5.018, 4.797, 5.114, 4.674, and 5.038, respectively(P<0.05). Conclusion Patients with advanced cholangiocarcinoma are identified as having a high incidence of venous thromboembolism. In such patients, factors including platelet count, antithrombin III levels, D-dimer, fibrinogen, Caprini scale ratings, and ultrasound examinations have been found to predict the occurrence of venous thromboembolism to a significant extent. These parameters not only aid in anticipating venous thromboembolism but also serve as crucial clinical tools for confirming its presence in patients with advanced cholangiocarcinoma. Consequently, the results from these tests are instrumental in the clinical diagnosis of venous thromboembolism in this patient population.

Other Liver Diseases

The prognostic and diagnostic value of serum pyroprotein levels in assessing the severity of acute liver injury in sepsis patients

SHANG De-min, HE Tong

2024, 29(2):  215-219. 

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Objective To investigate the diagnostic and prognostic significance of serum pyroprotein in assessing the severity and outcome of acute liver injury in sepsis patients. Methods Patients with sepsis admitted to our hospital from May 2019 to April 2022 were enrolled as research subjects and divided into acute liver injury group and non-liver injury groups, according to the diagnostic criteria for acute liver injury. Upon admission, serum samples were collected from the patients to measure leves of pyroprotein, Caspase-1 and Gastermin-D (GSDMD). The research further classified the types of sepsis accompanied by acute liver injury into three categories: high bilirubin type, high transaminase type, and combined high bilirubin and high transaminase type. Additionally, the prognosis of sepsis patients with acute liver injury was evaluated in terms of survival and mortality outcomes. Results In patients with acute liver injury, serum Caspase-1 and GSDMD levels were significantly elevated, measuring(1446.40±351.11) pg/mL and (8.21±2.04) ng/mL respectively, compared to (1021.35±288.32) pg/mL and (6.59±1.57) ng/mL in patients without liver injury (P<0.05). These levels showed a positive correlation with C-reactive protein, procalcitonin, APACHE II and SOFA scores in acute liver injury cases. Notably, in the subset of patients exhibiting both high bilirubin and high transaminase levels, Caspase-1 and GSDMD were found at (1906.02±332.32) pg/mL and (9.94±1.97) ng/mL, respectively. These levels were higher than those in patients with only high transaminase (1333.77±267.70 pg/mL, 7.74±1.28 ng/mL) and those with only high bilirubin (1318.12±270.93 pg/mL, 7.54±2.04 ng/mL) within the acute liver injury group, Furthermore, the serum levels of Caspase-1 and GSDMD in patients who succumbed to their condition were (1685.37±328.10) pg/mL, (9.76±1.61) ng/mL, respectively, significantly higher than those who survived, who presented with levels of (1275.70±256.33) pg/mL, (7.10±1.53) ng/mL(P<0.05). This indicates that serum Caspase-1 and GSDMD levels had diagnostic relevance for identifying high bilirubin and high transaminase types, as well as prognostic value in predicting mortality among sepsis patients with acute liver injury. Conclusion The serum levels of Caspase-1 and GSDMD are elevated in sepsis patients with acute liver injury, indicating their significant value in assessing the severity and predicting the prognosis of the condition.

Associations of NK cell and GGT levels with HCMV DNA in pediatric cytomegalovirus active infections

ZHANG Yu, GUO Ke, LIU Dao-Lu

2024, 29(2):  220-222. 

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Objective To explore the associations between natural killer (NK) cell counts, γ-glutamyl aminotransferase (GGT) levels, and human cytomegalovirus(HCMV) DNA in pediatric patients with active HCMV infection. Methods In this study, 150 pediatric patients with active HCMV infection were examined, who were admitted to our hospital from June 2021 to June 2022. Based on their HCMV DNA levels, these patients were stratified into three groups: a low load group (n=52), a medium load group (n=64), and a high load group (n=34). Additionally, a control group of 50 healthy infants was included. Liver function indices-specifically aspartate aminotransferase(AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), total bile acids (TBA), GGT——along with NK cell levels were compared across the four groups. The correlation between liver function, NK cell levels, and HCMV DNA load was also analyzed in the study. Results In the study, no significant differences were observed in AST, ALT, ALP, and TBA across the four groups(P>0.05). However, the GGT levels in the control group, low load group, medium load group, and high load group were (10.28±2.69) U/L, (15.64±3.13) U/L, (18.56±3.22) U/L, and (23.77±4.17) U/L, respectively. While the percentages of NK cells were (4.87±1.04) %, (6.14±1.15) %, (13.55±2.33) %, (19.84±3.27) %, respectively. A postive correlation was noted between increasing HCMV DNA load and elevated levels of GGT and NK cells(P<0.05). Correlation analysis revealed that while, AST, ALT, ALP, and TBAdid not show significant correlation with HCMV DNA (P>0.05), NK cells and GGT levels were positively correlated with HCMV DNA levels (P<0.05). Conclusion In pediatric patients with active HCMV infection, the levels of NK cells and GGT demonstrate a correlation with HCMV DNA load, while the detection of HCMV DNA aids in diagnosing active HCMV infection, it is not a reliable indicator for assessing the disease′s severity.

Combined impact of bicyclol and probiotics on non-alcoholic fatty liver disease (NAFLD): assessing changes in lipid metabolism and liver function

XU Ying-hong, LING Da-jun, WU Yuan-xiang, LIU Jian

2024, 29(2):  223-226. 

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Objective To investigate the effects of bicyclol in combination with probiotics on non-alcoholic fatty liver disease (NAFLD) and to evaluate its influence on lipid metabolism and liver function. Methods Between June 2019 and June 2022, a total of 102 patients diagnosed with NAFLD were enrolled at our hospital. These patients were randomly divided into two groups, with each group comprising 51 individuals: an observation group and a control group. Bicyclol were administered to the control group, while the observation group received a combination treatment consisting of bicyclol and bifidobacterium-triplex viable capsules. Liver function and lipid metabolism indicators were evaluated before and after treatment.The clinical efficacy and safety profiles of the two therapeutic strategies were compared. Results The study revealed that the total effective rates for the obersvation and control groups were 90.2% and 74.5%, respectively, with the observation group showing a significantly higher rate (P<0.05). Post-treatment, serum aspartate aminotransferase (AST) levels were measured at (49.2±11.5) U/L for the observation group and (65.3±11.8) U/L for the control group. Similarly, alanine aminotransferase (ALT) levels were(50.8±13.2) U/L and (68.2±12.7) U/L, repectively. Glutamyl transpeptidase (GGT) levels also followed this trend, being(48.5±9.8) U/L in the observation group and (61.2±10.3) U/L in the control group(P<0.05). Furthermore, triglyceride (TG) levels were (1.8±0.4) mmol/L, and total cholesterol (TC) levels were (4.3±0.6) mmol/Lin the observation group, compared to (5.1±0.8) mmol/L in the control group. Low-density lipoprotein cholesterol (LDL-C) levels were also lower in the observation group at (2.6±0.5) mmol/L, compared to (3.5±0.7) mmol/L in the control group, with a significant difference(P<0.05). High-density lipoprotein cholesterol (HDL-C) levels were (1.6±0.4) mmol/L in the observation group and (1.3±0.4) mmol/L in the contrl group, with the observation group showing higher levels(P<0.05). Following treatment, the observation group exhibited a higher serum HDL-C level(P<0.05). Additionally, post-treatment assessments revealed that the counts of enterococcus and Escherichia coli in the observation group, recorded at (4.9±1.2) lgCFU/g and (6.2±0.9) lgCFU/g respectively, were significantly lower compared to the control group, which showed counts of [(6.6±1.0) lgCFU/g and (6.9±1.2) lgCFU/g, respectively(P<0.05). Conversely, the abundance of Bifidobacterium and Lactobacillus in the observation group, measured at (7.5±1.1) lgCFU/g and (6.8±1.3) lgCFU/g respectively, was significantly higher than in the control group. Which had counts of (6.7±1.1) lgCFU/g and (5.9±0.9) lgCFU/g(P<0.05). Post-treatment adverse reactions were observed in 9 cases (17.6%) within the observation group, including fatigure(3 cases, 5.9%), loss of appetite(4 cases, 7.8%), and insomnia(2 cases, 3.9%). In the control group 5 cases (9.80%) experienced adverse reactions, including fatigue(1 case, 2.0%), loss of appetite(2 cases, 3.9%), and insomnia(2 cases, 3.9%). The difference in adverse reactions between the two groups was not statistically significant(P>0.05). Conclusion The application of bicyclol in combination with probiotics for treating patients with NAFLD appears beneficial in mitigating intestinal flora imbalances, regulating lipid levels, and improving liver function. This treatment approach also demonstrates good safety profiles, suggesting its potential value for wider clinical adoption.

Study on clinical manifestation and microbial characteristics of Klebsiella pneumoniae in patients with liver abscess

LIU Ying-jian, WANG Rui-jing, CHANG Jian-hua

2024, 29(2):  227-230. 

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Objective To delineate the clinical presentations, microbiological profiles, and molecular epidemiology of liver abscess induced by Klebsiella pneumoniae. Methods Between June 2020 and October 2022, 67 patients diagnosed with Klebsiella pneumoniae liver abscess(KPLA) were enrolled in our hospital, with clinical data and laboratory findings being systematically collected. The virulence attributes, antimicrobial resistacet profiles, and genetic diversity of the K. pneumoniae strains were comprehensively analyzed. Characterized by their high mucoviscosity phenotypes, these isolates had their virulence factors identified via polymerase chain reaction (PCR), their resistance patterns determined through antimicrobial susceptibility testing, and their clonal distribution ascertained by multilocus sequence typing(MLST). Results In 27 of 67(40.3%) isolates of K. pneumoniae, hypermucoviscosity was observed, indicating the presence of hypermucoviscous K. pneumoniae(hvKP). Infections associated with hypermucoviscous strains were found to be more likely to develop bacteremia compared to infections caused by classic K. pneumoniae strains. Similarly, infections associated with hypermucoiscous strains were more frequently associated with hepatobiliary diseases than those without hepatobiliary diseases. The rmpA and aerobactin genes were present in 44.5% and 37.1% of the isolates, respectivelly, while serotypes K1 and K2 were identified in 44.5% and 33.4% of the hypermucoviscous strains, respectively. A significant association was identified between strains carrying the rmpA and aerobactin genes and the hypermucoviscous phenotype. Through multilocus sequence typing analysis, 10 different sequence types were identified among the 67 strians of K. pneumoniae. Conclusion In the present study, a high prevalence of hvKp strains in KPLA was reported. Liver abscess caused by hvKP were found to be associated with diabetes, hepatobiliary disease, and an increased likelihood of leading to bacteremia. The rpmA gene was identified as the main virulence factor in hvKP liver abscess. It is emphasized that for patients suffering from hvKP liver abscess, the identification of occult lesions warrants careful attention. Considering the diverse clinical presentations and the destructive pathogenicity of such isolates, the determination of their comprehensive characteristics is deemed highly essential. Such knowledge is crucial to effectively undertake optimal management and treatment strategies for KPLA.