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    31 March 2024, Volume 29 Issue 3
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    Liver Fibrosis & Cirrhosis
    The predictive value of transient elastography and serum non-invasive diagnostic models for liver fibrosis in patients with chronic drug-induced liver injury
    REN Yan, XU Man-man, KONG Ming, BAI Li, CHEN Yu
    2024, 29(3):  269-272. 
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    Objective To explore the diagnostic value of transient elastography and serum non-invasive models including APRI, FIB-4, Sheth index, GUCI score, GPR, and King's score in assessing liver fibrosis in patients with chronic drug-induced liver injury. Methods From September 2020 to July 2023, a total of sixty-three patients with chronic drug-induced liver injury who underwent liver biopsy at Beijing You'an Hospital of Capital Medical University were included in the study. LSM values were measured using ultrasonic transient elastography, and APRI, FIB-4, Sheth index, GUCI score, GPR, and King's score were calculated according to the formulas. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic value of each model by calculating the areas under the curves (AUC), sensitivities, specificities, positive predictive values, and negative predictive values. Results Within the 63 patients that were included in this study, 11 patients were pathologically with stage S0-1 of liver fibrosis, 30 with S2, and 22 with S3-4. Except for GPR values [0.98(0.43~1.39) vs. 1.18(0.63~3.06) vs. 1.28(0.85~2.48, P=0.478] that were not significantly different among the three groups of patients (i.e., S0-1 vs. S2 vs. S3-4) , there were differences in LSM values [5.4(5.0~7.4) vs. 14.7(9.55~39.6) vs. 21.3(13.7~33.8), P=0.016], APRI[0.57(0.31~1.64) vs. 1.70(0.67~3.20) vs. 1.35(0.82~2.60), P=0.048], FIB-4[1.19(0.90~3.00) vs. 3.02(1.92~6.46) vs. 4.39(2.61~7.24), P=0.002], Sheth index [0.75(0.52~0.91) vs. 1.04(0.68~2.02) vs. 1.32(0.96~2.15), P=0.009], GUCI score [0.56(0.32~1.76) vs. 1.67(0.70~3.13) vs. 1.39(0.87~3.10), P=0.043], and King's score [10.36(6.46~25.40) vs. 34.12(14.03~67.39) vs. 34.82(13.96~76.65), P=0.022]. The ROC curve of Sheth index had the largest AUC (AUC=0.848, 95%CI=0.723~0.973) and a cutoff value of 1.13 for diagnosing liver fibrosis of S≥2, with a sensitivity of 0.68 and a specificity of 1. Secondly, the AUC of LSM was 0.817 (95%CI=0.631~1.003), the sensitivity was 0.844, and the specificity was 0.857. The AUC of FIB-4, GUCI score, and King's score were all larger than 0.7. The AUC of LSM for diagnosing S≥3 liver fibrosis was 0.728 (95%CI=0.568~0.887), and that of the other indicators was <0.7. Conclusion Compared with transient elastography, APRI, FIB-4, GUCI score, GPR and King's score, the Sheth index has the best diagnostic value for significant liver fibrosis (S≥2).
    An analysis on the latent classification and influencing factors of the characteristic symptoms in liver cirrhotic patients
    ZHANG Shu-hua, JIANG Ping-mei, CAI Xiao-lan, CAO Zhu-jun, QIAN Zhu-ping
    2024, 29(3):  273-277. 
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    Objective To classify the symptomatic characteristics of patients with liver cirrhosis, and to explore the demographic differences and disease characteristics in patients with different symptomatic categories. Methods A total of 220 liver cirrhotic patients in the department of infectious disease of a tertiary hospital in Shanghai from June 2020 to June 2021 were selected as the research subjects by using convenient sampling method. The general information questionnaire and memorial symptom assessment scale were used for investigating the patients. Latent classification analysis were used to classify the liver cirrhotic patients according to their symptoms. Multivariate logistic regression was used to explore the differences in demographics and disease’ characteristics of patients with different categories. Results According to symptom characteristics, patients with liver cirrhosis were divided into 2 potential categories, "symptoms high incident group" (65.45%) and "low fatigue and non-bloated group" (34.55%). Compared with the "low fatigue and non-bloated group", there were higher rates of liver tumor (28.95%/45.83%), hypoproteinemia (56.58%/70.83%), nutritional risk (39.47%/60.42%), and higher levels of ascites volume (14.47%/34.02%) and Child-Pugh grade (B+C 57.89%/69.44%), and lower ability of daily living activities (99.87/96.88) in the "symptoms high incident group" (P<0.05). Complicated with liver tumors (OR=0.526, P<0.05) and increased volume of ascites (OR=1.612, P<0.01) were the main influencing factors associated with the classifications of symptomatic characteristics in liver cirrhotic patients. Conclusion The symptomatic characteristics of liver cirrhosis are heterogeneous and can be divided into 2 latent classes. More attention should be paid to the patients complicated with liver tumor, liver function damage, hypoproteinemia, malnutrition and larger volume of ascites. The symptoms should be managed through early recognition and precise intervention.
    Viral Hepatitis
    Based on serum anti-HBC quantification to establish a noninvasive diagnostic model of significant liver histopathological changes in chronic HBV infection
    LIN Wei-jia, LU Wei, WANG Yan-bing, ZHANG Zhan-qing
    2024, 29(3):  278-284. 
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    Objective To establish a mathematical model for predicting significant liver histopathological changes in chronic HBV infection, and evaluate the diagnostic value of the model. Methods A retrospective analysis was performed on 457 patients with chronic HBV infection who were hospitalized and underwent liver biopsy without antiviral therapy in the Department of Hepatobiliary Medicine of Shanghai Public Health Clinical Center from December 2011 to December 2017. The pathological results of liver biopsy and routine laboratory indexes were collected, and anti-HBc quantitative detection was performed. According to Scheuer method, the inflammatory grade (G) and fibrosis stage (S) were divided into significant and non-significant hepatic necrotizing inflammation, hepatic fibrosis and hepatic injury groups. A mathematical model for predicting significant liver necrotizing inflammation, significant liver fibrosis and significant liver injury was constructed based on univariate analysis and multivariate Logistic regression analysis.Compared with FIB-4, GPR, APRI and RPR, the predictive performance of the model was evaluated by ROC curve analysis, and the diagnostic value was compared according to the area under ROC curve (AUC). Results Of the 457 patients, 178 had significant hepatic necrotizing inflammation (G≥2) and 279 had non-significant hepatic necrotizing inflammation (G<2), 248 had significant liver fibrosis (S≥2) and 209 had non-significant liver fibrosis (S<2), 264 had significant liver injury (G≥2 or/and S≥2) and 193 had non-significant liver necrotizing inflammation (G< 2 and S<2). According to the results of univariate analysis and multivariate Logistic regression analysis, the mathematical model M-SHN composed of anti-HBc, AST, PLT and TTR was established to predict significant liver necrotizing inflammation, and the mathematical model M-SHF composed of anti-HBc, PLT, ChE, TTR and gender to predict significant liver fibrosis, and M-SHI, a mathematical model composed of anti-HBc, PLT, TTR and sex, predicted significant liver injury, respectively. The predictive value of each model was analyzed by ROC curve. The AUC of M-SHN was 0.826 (95%CI: 0.788~0.860), and M-SHF was 0.776 (95%CI: 0.735~0.814), and M-SHI was 0.789 (95%CI: 0.748~0.825). Conclusion Based on routine laboratory indicators and serum anti-HBC quantification, M-SHN, M-SHF and M-SHI models were established, which have reliable predictive value for significant liver necrotizing inflammation, significant liver fibrosis and significant liver injury, and can help clinical evaluation of whether patients need antiviral therapy.
    An investigation on natural drug resistance mutations in 268 patients with chronic hepatitis B viral infection in Nanjing
    GONG Jin, CHEN Li, YU Jing, ZHANG Kai, LV Chen-yang
    2024, 29(3):  285-288. 
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    Objective To investigate and analyze the natural drug resistance mutations of 268 patients with chronic hepatitis B viral (HBV) infection in Nanjing, and analyze the relevant factors affecting the occurrence of natural resistance mutations to nucleos(t)ide analogues of anti-HBV drugs. Methods The data of 268 patients with chronic HBV infection in Nanjing from October 2019 to October 2022 were analyzed retrospectively. The occurrences of natural drug resistance and the types of drug resistance mutations were counted. The clinical characteristics of patients with and without mutations were compared. Logistic analysis was used to analyze the relevant factors affecting the occurrence of natural drug resistance mutations in these patients. Results In 268 patients with chronic HBV infection, a total of 9 natural drug-resistant mutations were detected by gene sequencing, the detection rate was 3.36% (9/268). The drug resistance sites of the 9 patients with natural drug resistance mutations were rt180M, rt204V, rt204I, rt250V, rt180M, rt204V+rt180M, rt213T, rt236T and rt204I+rt180M, respectively. The age, HBV DNA load, and the course of disease in patients with mutation were higher than those without mutation (P<0.05). By logistic multivariate regression analysis it was shown that age, HBV DNA level and the course of disease were independent risk factors for the occurrence of natural drug-resistant mutations in patients with chronic HBV infection (OR=4.162, 4.411, 5.766, P<0.05). Conclusion There are natural drug-resistant mutations in chronic HBV infected people in Nanjing area. Age, HBV DNA level, the course of disease are independent risk factors that affect the occurrence of natural drug-resistant mutations in chronic HBV infected patients, Prevention should therefore be strengthened.
    The clinical characteristics of chronic hepatitis B patients with low viremia post anti-viral therapy and the efficacies of different retreatment strategies
    CHENG Wan-qian, LI Qian, YANG Da-wei
    2024, 29(3):  289-292. 
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    Objective To explore the influencing factors of previously treated chronic hepatitis B patients with low viremia, and to evaluate the efficacies of different re-treatment strategies. Methods A total of 98 patients with chronic hepatitis B were selected between February 2021 and April 2022. According to the serum HBV DNA load after 48 weeks of treatment, the patients were divided into a low viremia group (n=37) and a sustained virological response group (n=61). The clinical characteristics and the serum viral load of the two groups of patients during treatment were compared, and a correlation analysis on the potential factors that caused the patients' low virological symptoms were performed. Results By comparing the clinical characteristics, it was found that the baseline HBV DNA level, baseline HBsAg level, baseline HBeAg level, Aspartate aminotransferase (AST) level and the proportion of patients receiving entecavir (ETV) or tenofovir disoproxil fumarate (TDF) in the low viremia group were 8.9 (6.9, 10.8) (log10 IU/mL), 4.4 (3.6, 4.9) (log10 IU/mL), 87.5 (0.5, 1214.9) (log10 IU/mL), 48.5 (34.6, 70.3) (U/L) and 64.9%, which were significantly higher than those of the sustained virological response group [5.0 (4.1, 7.2) (log10 IU/mL), 2.9 (2.4, 3.7) (log10 IU/mL), 0.4 (0.1, 3.8) (log10 IU/mL), 25.0 (20.8, 43.6) (U/L) and 41.0% (P<0.05)]. The Age, BMI, ALT, proportion of receiving tenofovir alafenamide fumarate (TAF) treatment and the proportion of receiving ETV or TDF combined with peg-IFNα-2b treatment were (44.3±11.8), (22.1±3.2) kg/m2, 43.1 (27.2, 67.7) (U/L), 18.9% and 2.7% respectively, which were significantly lower than those of patients in sustained virological response group [ (48.4±10.2), (24.5±2.7) kg/m2, 65.5 (39.3, 103.7) (U/L), 42.6% and 16.4% (P<0.05)]. Comparing the serum viral load after 24 weeks of treatment, it was shown that the baseline level of HBVDNA and the level at 24 weeks of treatment in the low viremia group were 8.9 (6.9, 10.8) (log10 IU/mL) and 4.9 (3.8, 5.9) (%) respectively, which were significantly higher than those of the sustained virological response group [5.0 (4.1, 7.2) (log10 IU/mL) and 1.0 (0.5, 1.4) (%) (P<0.05)]. The decline value at 24 weeks of treatment and the decline ratio at 24 weeks of treatment were 2.2 (1.5, 3.0) (log10 IU/mL) and 23.0 (19.0, 29.0) (%) respectively, which were significantly lower than those patients of the sustained virological response group [3.8 (2.8, 4.0) (log10 IU/mL) and 74.0 (60.0, 82.0) (%)]. By correlation analysis, it was shown that HBV DNA level, baseline HBsAg level, baseline HBeAg level, baseline AST level of the patients receiving ETV or TDF treatment were significantly positively correlated with low virological symptoms. Age, HBV DNA decline rate during treatment, baseline ALT level, receiving TAF treatment, and receiving ETV or TDF combined with peg-IFNα-2b treatment were significantly negatively correlated with low viremia. Conclusion Serum virological level is an important risk factor for poor prognosis. Switching drugs to TAF sequentially or in combination with interferon therapy can prevent the occurrence of low viremia to a certain extent.
    Liver Cancer
    The function and prognostic value of chemokines and their receptors in hepatocellular carcinoma
    FENG Jie, CAI Xun-quan, PAN Qin-cong
    2024, 29(3):  293-299. 
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    Objective To explored the importance of chemokine and chemokine receptors (CCRs) in liver cancer by analyzing liver cancer samples in TCGA database and normal samples in GTEx database. Methods We first collected 66 CCRs, then screened the differentially expressed CCRs between the liver cancer and normal liver databases. GO functional annotation and KEGG pathway analysis was performed to explore their potential biological functions. By using univariate Cox regression and multivariate Cox regression analyses combined with Lasso regression analysis, we constructed a prediction model based on four-CCRs (CCR9、CCR7、CCR3 and ACKR2) signature. Next, a nomogram was constructed to assess the prognosis of HCC patients. Results We found that the risk score of this model was an independent prognostic factor of HCC. The correlation between the risk score and immune-cell infiltration as indicated by the four-CCRs signature might play a pivotal role in liver cancer immune microenvironment. Conclusion We constructed a prediction model which might guide personalized treatment and prognosis for liver cancer patients.
    Effect of chemoembolization with drug-loaded microspheres on therapeutic effect and serum GGT, calcium and phosphorus metabolism in patients with advanced liver cancer
    MIAO Xiao-fei, WANG Hong-jian
    2024, 29(3):  300-302. 
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    Objective To investigate the efficacy of chemoembolization with drug-loaded microspheres in patients diagnosed with advanced liver cancer. Methods A total of 65 patients with advanced liver cancer treated between May 2018 and January 2023, were divided into 2 groups based on the surgical method used: control group (31 cases: conventional surgery) and observation group (34 cases: drug-loaded microsphere chemoembolization). The efficacy of these two treatment approaches was compared. Results The level of glutamyltransferase (GGT) in the observation group (28.26±2.62 U/L) was significantly lower compared to the control group (53.99±3.71 U/L). Similarly,the levels of CA19-9 (6.84±0.26 U/mL) and AFP (310.87±5.52 ng/ml) were also lower in the observation group than in the control group (459.26±6.18 ng/ml) (t=32.522, P<0.05; t value =60.674, P<0.05; t value=102.256, P<0.05). 1 month pose-surgery, the blood concentrations of Ca ( 2.12±0.14 mmol/L), iPTH (179.56±19.52 pg/mL) and Ca×P product (45.86±3.62 mg2/dL) in the observation group showed a significantly decrease compared to the control group (2.20±0.15 mmol/L, 206.84±22.17 pg/mL, 51.4 7±4.26 mg2/dL). Additionally, the level of blood phosphorus (1.56±0.13 mmol/L) was higher in the observation group than in the control group (1.83±0.14 mmol/L), while the product of calcium and phosphorus (45.86±3.62 mg2/dL) was lower in the observation group compared to the control group (51.47±4.26 mg2/dL) (t value=2.224, P<0.05; t value=5.275, P<0.05; t value=5.737, P<0.05; t value=8.062, P<0.05). Moreover, one month after the operation, the levels of ALT (44.26±3.52 U/L), AST (36.85±5.14 U/L), and Tbil (16.56±2.62) μmol/L were lower than those in the control group (53.97±4.17 U/L, 48.10±6.71 U/L, 21.45±3.05 μmol/L, respectively). (t=10.174, P<0.05; t value=7.627, P<0.05; t value=6.951, P<0.05). The incidence of adverse reactions between the two groups was compared (χ2=0.300, P=0.584). Survival rates at 3 month (χ2=0.375, P=0.540) and 6 months (χ2=6.181, P=0.013) after surgery were also compared. Conclusion Chemoembolization with drug-loaded microspheres has demonstrated effectiveness in the treatment advanced liver cancer patients, with a high survival rate observed at 6 months post-surgery. This treatment approach warrants further investigation and potential application in clinical practice.
    Metabolic Associated Fatty Liver Disease
    The effect of obesity and hyperuricemia on liver steatosis and fibrosis in metabolic dysfunction-associated fatty liver disease
    LIU Yun-xiao, WANG Zhuan-guo, XU Qiang, DOU Jing, WANG Xiao-bo, GUO Yan, GUO Feng, WANG Xiao-zhong
    2024, 29(3):  303-307. 
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    Objective To investigate the influence of obesity and hyperuricemia on steatosis and fibrosis in metabolic dysfunction-associated fatty liver disease (MAFLD). Methods A total of MAFLD 510 patients treated at the Department of Hepatology of the Traditional Chinese Medical Hospital Affiliated to Xinjiang Medical University between January 2020 and December 2022 were included in this study. After application of strict the inclusion and exclusion criteria, 402 patients were ultimately selected for analysis. Patients were divided into four groups based on their body mass index (BMI) and hyperuricemia status: non-obese without hyperuricemia group, non-obese hyperuricemia group, obese without hyperuricemia group and obese hyperuricemia group. Clinical parameters were compared across these groups, and liver steatosis and fibrosis were assessed using transient elastography Fibrotouch. Binary Logistic regression was utilized to evaluate the potential interaction between obesity and hyperuricemia in relation to hepatic steatosis and fibrosis. Results Of the 402 patients included in the study, distribution was as follows; 186 patients in the non-obese without hyperuricemia group, 34 patients in the non-obese with hyperuricemia group, 151 patients in the obese without hyperuricemia group, and 31 patients in the obese with hyperuricemia group. Statistically differences were observed in various demographic and clinical parameters among the groups, including age, sex, BMI, ALT, GGT, TG, Cr, UA, Alb, ALT/AST, D-D, FIB-4, BARD, LSM, CAP, drinking and smoking history (P<0.05). Evalution of liver steatosis and liver fibrosis stage based on the fat attenuation parameters and liver stiffness values revealed statistically significant differences among the groups (P<0.05). The proportion of moderate and severe steatosis (81.5%,83.9%, respectively) and progressive hepatic fibrosis (76.8%,87.1%, respectively) was significantly higher in the obese group compared to the non-obese groups. Binary Logistic regression analysis indicated that obesity was a risk factor for moderate-severe steatosis and progressive fibrosis in MAFLD patients. Moreover, the interaction between obesity and hyperuricemia demonstrated a multiplicative effect on the the likelihood of moderate-severe steatosis and progressive fibrosis (Obesity * hyperuricemia interaction term OR>1). Conclusion The findings of this study suggest a synergistic relationship between obesity and hyperuricemia in driving liver steatosis and fibrosis progression in MAFLD patients.
    Analysis of risk factors for developing metabolism-related fatty liver disease in children with simple obesity
    ZHANG Yi, CUI Lei, YUAN Bo-wen
    2024, 29(3):  308-312. 
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    Objective To analyze the relevant indicators in children with simple obesity and explore the high-risk factors associated with the development of metabolism-related fatty liver disease (MAFLD), with the ultimate goal of providing valuable insights for children's healthcare. Methods A total of 140 children with simple obesity were included in the study and categorized into either MAFLD group (n=52) or non-MAFLD group (n=88) based on the presence or absence of MAFLD. Baseline data and clinical indicators of the subjects were meticulously examined and recorded. The predictive value of MAFLD risk factors was evaluated through receiver operating characteristic curve (ROC) analysis in children with simple obese, both through univariate and Logistic multiple factors. Results Among the 140 children with simple obesity, a total of 52 cases were diagnosed with MAFLD, resulting in a prevalence rate of 37.12%. In the MAFLD group, the proportion of males, body mass index (BMI), lipid storage index (LAP), alanine aminotransferase (ALT), alkaline phosphatase (ALP), triglyceride (TG), uric acid (UA) and ferritin (SF) were noted as 71.54%, 27.46 kg/m2, 37.98±6.35, 68 U/L, 5 6 U/L, 1.08 mmol/L, 423.58±27.36 μmol/L, 124.95±13.46 ng/mL, respectively. On the other hand, in the non-MAFLD group, these values were 52.27%, 25.19 kg/m2, 46.82±7.04, 29 U/L, 47 U/L, 0.81 mmol/L, 346.75±21.08 μmol/L, 95.38±7.45 ng/mL. The differences between the two groups were statistically significant (t/χ2/Z=3.517, 6.254, 8.472, 9.596, 6.528, 5.329, 9.427, 9.781, all P<0.05). Logistic regression analysis indicated that LAP, ALT, UA and SF were independent influencing factors for MAFLD in children with simple obesity (95% CI: 1.047-1.092, 1.012-1.157, 1.020-1.059, 1.017-1.063, 95% CI was 1.047-1.092, 1.012-1.157, 1.020-1.059, 1.017-1.063, OR=1.063, 1.084, 1.035, 1.049, all P<0.05). Additionally, ROC analysis showed that the area under the curve (AUC) of LAP, ALT, UA and SF were 0.741, 0.849, 0.783 and 0.682, respectively, with corresponding sensitivities of 86.27%, 81.35%, 72.86% and 87.94%, and specificities of 73.85%, 91.27%, 78.13%, 70.36%. Conclusion Elevations in LAP, ALT, UA and SF are identified as independent influencing factors for MAFLD in children with simple obesity. These findings suggest that these parameters can serve as non-invasive predicators for the early identification, diagnosis and evaluation of MAFLD in this population.
    Other Liver Diseases
    Exploring sleep quality and its determinants in hospitalized liver diseases patients
    MENG Chun-yan, YAN Bao-shu
    2024, 29(3):  313-318. 
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    Objective To investigate and analyze the sleep patterns and their influencing factors among patients suffering from varous liver diseases, thereby offering a scientific foundation for enhancing quality. Methods Clinical data from patients diagnosed with liver disease at Beijing Friendship Hospital, affiliated with Capital Medical University, were systematically gathered through electronic medical records system from August to October 2022 . The Pittsburgh Sleep Quality index (PSQI) scale was employed to evaluate the severity and nature of sleep disorders among these patients. Based on the severity of their sleep disorders, patients were categorized into 4 distinct groups to facilitate a comparative analysis of clinical characteristics across varying degrees of sleep disorder severity in liver disease patients. Furthermore, logistic regression analysis was utilized to identify risk factors associated with severe sleep disorders in this hospitalized cohort. Results This study encompassed a cohort of 204 patients afflicted with liver diseases, among which 97 (47.55%) were male and 107 (52.45%) were female. The median age of participants was 58 (48, 66) years. The median PSQI score among the subjects was 4 (7, 10). A total of 76 patients (37.25%) were identified without a sleep disorder, whereas 128 patients (62.75%) were diagnosed with a sleep disorder. This subgroup was further divided into 78 cases (38.24%) with mild sleep disorder, 39 cases (19.12%) with moderate sleep disorder, and 11 cases (5.39%) with severe sleep disorder. The predominant sleep disorder,symptoms reported included difficulty initiating sleep (118, 57.84%), and nocturnal or early morning awakenings (111, 54.41%). The analysis revealed no statistically significant correlation between the severity of sleep disorders and the type or severity of liver (all P>0.05), However, age (HR 1.061, 95% CI: 1.006, 1.125) and serum alanine aminotransferase (ALT) levels (HR 1.003, 95% CI: 1.001,1.006) emerged as independent risk factors for severe sleep disorders in the studied population. Conclusion Ssleep disorders exhibit a high prevalence among hospitalized patients suffering from liver disease, with a notably higher incidence obersed in middle-aged individuals or those experiencing severe liver injury. Clinically, it is imperative to focus on elderly patients presenting with eleated serum ALT levels, promptly provide sleep management guidance, and deploy effective intervention strategies. These measures aim to enhace sleep quality and ultimately elevate the quality of life.
    Evaluating MRI omics-based machine learning for preoperative prediction of microvascular invasion in hepatic alveolar echinococcosis margins
    LI Meng-jie, ZHANG Qing-xin
    2024, 29(3):  319-322. 
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    Objective To investigate the utility of an MRI imaging omics-based machine learning model for the preoperative prediction of microvascular invasion in the peripheral zone of hepatic alveolar echinococcosis (HAE). Methods A retrospective analysis was conducted on 200 patients diagnosed with HAE, confirmed via postoperative pathology. MR imaging and histopathological data were collected, with histological characteristics of the lesion being extracted from the MR images. The cohort was divided into a training set of 88 patients and test set of 22 patients , following a 8∶2 ratio. Machine learning models, including XGBoost, Random forest(RF), Logistic Regression, Support Vector Machine, and Classical Decision Tree, were developed to predict microvascular invasion in the peripheral zone of HAE. Model validation was performed, and Receiver operating characteristic(ROC) curves were generated to evaluate the predictive performance of the various models on microvascular invasion in the marginal zone of HAE. Results Pathological analysis revealed that out of 200 patients, 75 exhibited microvascular invasion in the marginal zone, whereas 125 did not. Statistical analysis indicated no significant differences in gender, age, lesion location, and lesion size between patients with and without marginal microvascular invasion (P>0.05). The training set included 60 cases of marginal zone microvascular invasion, with the remaining 15 cases in the test set. From the collected data, 1380 imageomics features were intitially extracted, out of which 406 features were retained using the variance threshold method. Subsequently, six optimal imageomics features were identified through univariate selection, comprising 1 first-order statistical feature and 5 higher-order statistical features. The process of feature selection was refined to ultimately select 6 optimal imaging omics features employing bothe the square difference threshold and univariate selection methods. In the evaluation of diagnostic performance, the XGBoost and RF models demonstrated the highest AUC values in the training set for the diagnosing marginal microvascular invasion, registering AUC values of 0.95 and 0.96, respectively. In the test set, the AUC values for XGBoost and RF were also superior to those of the other model groups, at 0.88 and 0.84 respectively, indicating a higher diagnostic accuracy. Statistical comparison between the AUC values of the XGBoost and RF models in both training and testing sets revealed no significant difference(P>0.05). Conclusion In the preoperative forecasting of microvascular invasion within the marginal zone of HAE, models based on MRI imaging omics, specifically XGBoost and RF, demonstrated superior predictive capabilities.
    Correlation of serum red blood distribution width, albumin, prothrombin time with disease severity in primary biliary cholangitis patients
    DU Yan, WU Ting-ting, ZHANG Yuan-yuan, CHEN Xing
    2024, 29(3):  323-326. 
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    Objective To examine serum levels of red blood cell distribution width (RDW), albumin (Alb) and prothrombin time (PT) in primary biliary cholangitis(PBC) patients , and to analyze their association with disease severity. Methods Between March 2017 and September 2021, our hospital recorded 91 PBC patients and 60 healthy subjects. The PBC patients were categorized into non-cirrhotic(47 cases), compensated cirrhotic(29 cases), and decompensated cirrhotic(15 cases) groups, reflecting disease severity. Serum Alb levels were measured using an AU5800 automatic biochemical analyzer, PT was assessed with a STAGO automatic coagulation analyzer; and RDW was determined using a BC-5390 blood cell analyzer. The diagnostic efficacy of serum RDW, Alb, and PT levels for primary biliary cholangitis and cirrhosis was evaluated using the receiver operating characteristic curve (ROC). Results In the observational cohort, serum RDW and PT levels were significantly elevated at 49.6±7.5% and 14.4±3.4 seconds, respectively, compared to 39.8±2.9%and 12.4±0.7 seconds in the control group. Conversely, Alb levels were markedly recuced in the observation group (37.1±7.0 g/L) relative to the control group (46.5 ± 2.5 g/L) (P<0.05). In the non-cirrhosis cohort, serum RDW, Alb, and PT levels were recorded at 46.5±4.1%、40.3±4.9 g/L、and 12.7±0.9 seconds, respectively. The compensated cirrhosis group presented serum RDW, Alb, and PT levels of 48.8±7.5%、38.6±4.8 g/L、and 13.4±1.3 seconds, respectively. In the decompensated cirrhosis group, these levels were significantly higher for RDW(57.4±7.9%) and PT(19.8±3.8 seconds) , and lower for Alb(28.0±6.5 g/L), when compared to both the compensated cirrhosis nd non-cirrhosis groups(P<0.05).The Area Under the Curve(AUC) for the combined diagnostic utility of serum RDW, Alb, and PT levels in distinguishing primary biliary cholangitis and cirrhosis was 0.973, significantly surpassing the AUCs for RDW(0.927), Alb(0.894), and PT(0.707) when used individually. This combined diagnostic approcah achieved a sensitivity, specificity, and accuracy of 92.7%, 93.3%, and 93.0%, respectively, denonstrating superior efficacy. Conclusion In patients with PBC and cirrhosis, serum levels of RDW and PT exhibits significant increase, whereas Alb levels significantly decline. As the disease advances, the combined assessment of RDW, Alb, and PT demonstrates substantial diagnostic efficacy for identifying PBC and cirrhosis, offering valuable insights for the clinical appraisal of disease severity.
    Early detection of bile acid profiles for diagnosing intrahepatic cholestasis in HBV-infected pregnant women
    XU Hong-hui, FU Xu-feng, YIN Yong-xiang, ZHAO Jun, JIA Xiao-tian, SUN Min-ya, ZHANG Yan
    2024, 29(3):  327-331. 
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    Objective To evaluate the diagnostic value of early preggnancy bile acid profiling in detecting intrahepatic cholestasis of pregnancy (ICP) among pregnant women infected with the hepatitis B virus(HBV). Methods Between January 2020 and December 2022, a retrospective analysis was conducted on 186 pregnant women with HBV infection admitted to our hospital. Based on the diagnostic criteria for ICP, participants were categorized into two groups: those with HBV infection alone(124 cases) and those with HBV infection complicated by ICP group (62 cases). We collected and compared the general demographic information, peri-protective liver function indices, and early pregnancy bile acid profiles between the two groups. Through univariate and multivariate logistic regression analyses, we identified the primary factors influencing the occurrence of ICP in HBV-infected pregnant women. Additionally, the fiagnostic efficacy for ICP was evaluated using ROC curve analysis. Results In the comparative analysis between the HBV-alone group and the HBV plus ICP group, significant differences were observed in several biochemical parameters. AST levels were notably higher in the HBV plus ICP group[(46.60±38.98) U/L] compared to the HBV-alone group[(30.97±31.49) U/L, P=0.004]. Similarly, ALT [(50.80±36.81) U/L vs (40.32±29.45) U/L, P=0.0037], DBil [(6.07±2.34) μmol/L vs (4.73±1.83) μmol/L, P<0.001], and TBA [(16.98±2.48) μmol/L vs (6.01±2.34) μmol/L, P=0.010] were significantly elevated in the HBV plus ICP group. Concentrations of cholic acid(CA) , (glycocholic acid)GCA, glycodeoxrycholic acid(GDCA), glycochenodeoxycholic acid(GCDCA) also showed significant increases, with P-values of 0.007, <0.001, <0.001, and <0.001, respectively. Multivariate analysis identified AST, DBil, GCA, GDCA, and GCDCA as major risk factors for the development of ICP in HBV-infected pregnant women(P<0.05). Among these, AST, DBil and GCA demonstrated higher diagnostic values for HBV-complicated ICP with AUCs of 0.747, 0.725 and 0.761, respectively. The diagnostic efficiency of GCDCA and GDCA was moderate, with AUC values of 0.667 and 0.688. Conclusion The study identifies the elevation of GCA, GCDCA, GDCA subtypes in the bile acid profile, along with increases in AST and DBil, as principal risk factors for ICP in HBV-infected pregnant women. Notably, GCA emerges as the biomarker with the highest predictive diagnostic value for ICP. These findings underscore the importance of integrating liver function tests with bile acid spectrum analysis in the clinical diagnosis of ICP among this patient population.
    Post-pediatric liver transplant: blood glucose monitoring and influencing factors analysis
    LU Ye-feng, CHEN Guo-li, FU Jing-jing
    2024, 29(3):  332-337. 
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    Objective To evaluate postoperative blood glucose dynamics and determinants in pediatric liver transplant patients. Methods In an observational study, dynamic data were collected from pediatric liver transplant recipents, encompassing routine blood tests, liver transplant biochemistry profiles, cyclosporine drug levels, fasting blood glucose, and glycated hemoglobin measurements. Subsequenty, these data underwent comprehensive statistical analysis to elucidate patterns and outcomes. Results A total of 51 pediatric liver transplant recipients were included in this study, including 31 males (60.8%) and 20 females (39.2%). The age range was 3-66 months, with an average of 11.7 ± 14.9 months. The height range was 54-116 cm, with an average of 69.4 ± 14.1 cm. The weight range was 3.8-22.0 kg, with an average of 8.0 ± 3.8 kg. Fasting blood glucose and glycated hemoglobin both reached their peaks on the first day after surgery, with values of 6.70 ± 1.85 mmol/L and 4.4 ± 0.4%, respectively, and gradually returned to preoperative levels. Lactate levels peaked at 15 minutes in the early post-transplant period, and the data was 2.89±0.95mmol/L. On the first day after surgery, there was a statistically significant difference in height (62.5[58.5,66.0]cm VS 67.0[63.0,75.0]cm) and weight (5.8[5.1,7.4]kg VS 7.8[6.4,9.5]kg) between the normal and abnormal groups in terms of fasting blood glucose. On the first and seventh day after surgery, there was a statistically significant difference in intraoperative blood transfusion between the normal and abnormal groups in terms of glycosylated hemoglobin. On the 14th day after surgery, there was a statistically significant difference in albumin levels (41.9±5.97 VS 38.59±4.14 g/L) between the normal and abnormal groups in terms of glycosylated hemoglobin. All p values were less than 0.05. Conclusion Fasting blood glucose levels and glycosylated hemoglobin exceeded normal values on the first day after liver transplantation. And height, weight, transfusion during surgery and hypoalbuminemia may be influencing factors for fasting blood glucose and glycated hemoglobin levels.
    Effect of low-tube voltage scanning mode with ADMIRE on radiation dose and image quality in dual-source CT liver scans
    JIANG Hao-zhi, QIN Long-quan, ZHANG Ting-ting
    2024, 29(3):  338-341. 
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    Objective To investigate the efficacy of utilizing the low-tube voltage scanning mode with the Advanced Model Iterative Reconstruction Algorithm (ADMIRE) in dual-source CT liver scanning. Methods From March 2020 to March 2023, a cohort of 102 patients with suspected liver diseases, undergoing upper abdominal CT scans at our hospital, were randomly assigned into three groups(A, B, and C), each comprising 34 patients. All groups underwent dual-source CT plain and enhanced scans of the upper abdomen. Group A utilized the ADMIRE low tube voltage (70 kV), Group B utilized the ADMIRE standard tube voltage (120 kV), and Group C adopted conventional FBP (100 kV). Objective image quality metrics, subjective scores, radiation doses, and diagnostic outcomes of liver lesions were compared among the three groups. Results The hepatic parenchyma CT values for the three groups were (105.63±9.81), (107.91±8.52), and (103.74±8.94) respectively, while the CT values of subcutaneous fat were (-97.82±5.37), (-96.33±5.59) and (-96.14±4.25) respectively. Background air CT values were consistent among the three group: (-999.37±14.23), (-995.42±11.36) and (-997.06±15.75), with no statistically significant differences observed(P>0.05). Contrast noise ratio (CNR) values were (15.82±0.94), (16.29±0.61) and (18.74±0.89), and signal-to-noise ratio (SNR) values were (9.74±0.86), (10.29±0.77) and (8.41±0.49), respectively. Standard deviation (SD) values were (10.09±1.98), (10.58±2.35) and (12.36±2.19), while image quality scores were (4.86±0.11), (4.91±0.08) and (4.38±0.17), respectively. CNR and SD were lower in groups A and B compared to group C, while SNR and image quality scores were higher in groups A and B group (P<0.05). No significant differences were observed between groups A and B in terms of CNR, SNR, SD, and image quality scores (P>0.05). The dose-length product (DLP) values were (67.82±19.35) mGy·cm, (126.93±23.88) mGy·cm, (141.25±29.76) mGy·cm, respectively, With corresponding Volume CT Dose Index (CTDI vol) values of (3.82±0.95) mGy, (6.39±1.12) mGy, (8.14±1.36) mGy, and effective radiation dose (ED) values of (1.26±0.28) mSv, (1.94±0.39) mSv, (2.27±0.41) mSv, respectively. DLP, CTDI vol and ED were lowerin groups A and B compared to group C, with group A showing lower values than group B (P<0.05). Diagnosis of liver lesions based on the three reconstructed images aligned with clinical diagnosis. Conclusion The implementation of the low-tube voltage scanning mode of ADMIRE in dual-source CT liver scanning demonstrates notable benefits in reducing image noise and radiation dose while maintaining high image quality. These findings underscore its potential for widespread adoption and clinical utility.