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    30 June 2024, Volume 29 Issue 6
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    CONTENTS
    2024, 29(6):  0-0. 
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    Viral Hepatitis
    A side-by-side comparative study on the efficacy of HBsAg clearance by PegIFN therapy for 48 weeks on NA-treated and treatment naive CHB patients with low baseline HBsAg levels
    HAO Kun-yan, CHEN Yu-xing, WANG Wen-yang, ZHU Hao, SHEN Min, YANG Wen-xin, YU Yue-cheng
    2024, 29(6):  635-640. 
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    Objective This is a side by side comparative study (SSS) on the efficiency of functional cure (HBsAg clearance) by pegylated interferon alpha (PegIFNα) treatment between nucleos(t)ide analogue (NA)-treated and NA treatment-naive chronic hepatitis B (CHB) patients with low baseline HBsAg levels, and explored the related factors for HBsAg clearance. Methods Forty-nine CHB patients with serum HBsAg<5000 IU/mL (especially<1500 IU/mL) and HBV DNA<104 IU/mL collected from 2018 to 2022 were divided into three groups, including group NP (NA treated-patients for more than one year in combination with PegIFNα-2b), group P (NA treatment-naïve patients with PegIFNα-2b monotherapy), and group C (patients without receiving any antiviral treatment). Serum HBV DNA, HBsAg, anti-HBs, HBeAg and liver function tests were measured and compared at baseline, week 12 and week 48. Results Twenty, seventeen and twelve patients were distributed into group NP, group P and group C respectively. The baseline HBsAg levels had no significant difference among the three groups (median, interquartile range: 201.06, 47.82~863.06 vs 184.15, 50.79~386.17 vs 77.70, 19.22~839.27, respectively, P=0.58). There were 19, 15 and 11 patients with baseline HBsAg<1500 IU/mL in group NP, P and C, respectively. After 48 weeks PegIFNα-2b therapy, a significant higher HBsAg clearance rate was observed in patients of NP and P groups than that of C group (35.00% vs 29.41% vs 0.00%, P<0.017). A tendency of higher HBsAg clearance rate was found in patients of NP group compared with that of P group (P>0.05). All the 12 patients who achieved HBsAg clearance had significant lower baseline HBsAg level (79.71, 6.10~206.59) than that of patients without HBsAg clearance (202.09, 115.73~9.81, H=224.00, P=0.02). They also had lower HBsAg levels at week 12 (1.76, 1.08~13.20 vs 107.99, H=224.00, P=0.02). Among the 12 patients who achieved HBsAg clearance, the highest baseline HBsAg level was 484.64 IU/mL. The Baseline level of serum HBV DNA (log10) in group NP were all <50 IU/mL, while the levels were 2.66±0.61 IU/mL and 2.78±0.71 IU/mL in group P and C, respectively (t=-0.51, P=0.62). At week 48, serum HBV DNA level in all of the 17 patients in group P was <50 IU/mL; however, only one patient in group C had HBV DNA<50 IU/mL (P<0.01). Four patients in group NP were HBeAg-positive (4.04, 4.05, 2.92 and 1.52 S/CO) at baseline. Only one of them had serum HBeAg-reversion at week 48. All of the patients in group P and C were HBeAg-negative. Conclusion Patients with PegIFNα-2b added on continuous NA treatment had a similar HBsAg clearance rate as that of patients with PegIFNα-2b monotherapy, but the former seemed to have higher HBsAg clearance potential. The lower the baseline HBsAg, the greater the likelihood of “functional cure” achieved by PegIFNα-2b treatment, especially when a baseline level of HBsAg was less than 500 IU/mL in both sides with or without NA treatment.
    An analysis on the correlation between thyroid hormone and HBsAg levels and disease severity of hepatitis B patients
    WANG Chun-ju, GAO Jia-min, LI Li-rong
    2024, 29(6):  641-644. 
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    Objective To analyze the correlation between the levels of thyroid hormone and hepatitis B surface antigen (HBsAg) and the severity of chronic hepatitis B patients (CHB). Methods A total of 115 CHB patients admitted from July 2021 to July 2023 were selected as the study subjects of the observation group, and 100 healthy subjects who underwent physical examination during the same period were selected as the control group.The levels of thyroid hormone [free three iodine thyroid original glycine (FT3) and free iodine thyroid four original glycine (FT4), thyroid stimulating hormone (TSH)] and HBsAg levels were compared between these two groups of patients. The association between theses parameters with the severity of illness, and pathological stages of liver cirrhosis were analyzed by Pearson correlation analysis. Results Compared with the levels of serum FT3, FT4, TSH and HBsAg [(4.95±0.61) pmol/L, (17.56±2.34) pmol/L, (2.94±0.31) μIU/mL, and (0.04±0.01) IU/mL, respectively] in the control group, the levels of FT3, FT4 and TSH in the observation group, [(3.75±0.42) pmol/L, (15.41±2.13) pmol/L, and (2.67±0.45) μIU/mL, respectively] were significantly decreased, whereas the HBsAg level [(3.11±1.12) IU/mL] was significantly increased (t=16.973, 7.051, 5.048, 27.041, P<0.05). The levels of FT3, FT4 and TSH in mild hepatitis B patients were (4.15±0.51) pmol/L, (16.24±2.08) pmol/L, and (2.23±0.65) μIU/mL, respectively, which were higher than those of (3.73±0.49) pmol/L, (15.23±2.31) pmol/L, and (1.94±0.52) μIU/mL in moderate hepatitis B patients. The levels in moderate patients were higher than those of 3.34±0.37) pmol/L, (14.19±2.04) pmol/L, and (1.66±0.67) μIU/mL in severe hepatitis B patients. The HBsAg levels in these three groups were gradually increased [(2.45±0.63) IU/mL, (2.84±0.75) IU/mL, (3.23±1.01) IU/mL, F=25.761, 7.604, 7.513, 8.039, P<0.05]. The serum FT3, FT4 and TSH levels in patients with hepatic fibrosis S1 were (4.06±0.61) pmol/L, (16.54±2.23) pmol/L, and (2.62±0.54) μIU/mL, respectively, which were higher than those of (3.75±0.53) pmol/L, (15.17±2.21) pmol/L, and (2.17±0.62) μIU/mL in S2 patients, The levels of S2 patients were higher than those of (3.37±0.49) pmol/L, (14.02±2.45) pmol/L, and (1.83±0.42) μIU/mL in S3 patients, and the levels of S3 patients was higher than those of [(2.68±0.47) pmol/L, (12.81±2.07) pmol/L, and (1.36±0.57) μIU/mL in S4 patients. The HBsAg levels were gradually increased in these four groups [(1.85±0.21) IU/mL, (2.09±0.57) IU/mL, (2.64±0.62) IU/mL, (3.08±0.97) IU/mL, and F=35.438, 11.509, 23.256, 17.201, respectively, P<0.05). By Correlation analysis it was found that the level of thyroid hormone was negatively correlated with the severity of hepatitis B and liver fibrosis (r=-0.458, -0.651, -0.715, -0.694, -0.597, -0.712, P<0.05). HBsAg level was positively correlated with the severity of hepatitis B and liver fibrosis (r=0.531, 0.673, P<0.05). Conclusion The level of thyroid hormone in patients with hepatitis B is closely related to the level of HBsAg and the severity of the disease. A combined detection of FT3, FT4, TSH and HBsAg may effectively evaluate the severity of the disease and predict the progression of fibrosis.
    Liver Cancer
    A clinical and imaging analysis of hepatic epithelioid angiomyolipoma
    GU Yan-mei, HAO Lei, REN Hong-wei, ZHANG Meng-meng, DONG Jing-hui, LIU Chang-chun, GAO Shen, LIU Yuan
    2024, 29(6):  645-647. 
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    Objective To analyze the clinical and MR imaging features of 19 patients with hepatic epithelioid angiomyolipoma (HEAML). Methods The clinical data including sex, age, clinical signs, laboratory tests and imaging findings of 19 patients with pathological data of biopsy or surgery who were admitted to the fifth medical centre of PLA general hospital from October 2013 to October 2023 were summarized and analyzed. Results The clinical manifestations of these 19 HEAML patients were mainly focal liver lesions found by physical examination, symptoms of abdominal pain or distension, nausea and poor appetite. Among the 19 patients, 3 patients were positive for hepatitis B viral markers and 15 patients were negative for tumor markers. On the MR images, 18 patients had single lesions with an average diameter of about 5.4cm,14 patients were diagnosed with liver cancer, 16 patients had obvious enhancement in liver lesions, and 6 patients had false capsule enhancement in the delayed phase. Conclusion HEAML was predisposed to middle-aged women. It was mostly discovered by physical examination. Most of the patients have normal laboratory test results. Only individual patient has mild abnormal tumor markers. The imaging features were usually single rich-blood liver lesions. The strengthening mode was early obvious strengthening. False capsule enhancement in the delayed period can be found in part of the patients. The imaging features has certain guiding significance for the diagnosis of HEAML. The diagnosis of HEAML may be confirmed by a combination of clinical data with typical pathological results.
    An analysis on the clinical efficacy and prognostic factor of hepatectomy and local ablation treatment for recurrent hepatitis B-related hepatocellular carcinoma after surgery
    CHEN Jie, XU Chao-li, LIU Hong
    2024, 29(6):  648-651. 
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    Objective To evaluate the clinical efficacy of repeat hepatectomy and local ablation in patients with recurrent hepatocellular carcinoma (HCC). Methods A retrospective analysis was conducted on 64 patients who presented with intrahepatic recurrence of HCC post-surgery between January 2020 and November 2023. Based on the post-relapse surgical procedure adopted, they were divided into two groups: 26 patients underwent a repeat hepatectomy through open surgery, and 38 patients underwent local ablation using ultrasound-guided tumor ablation. Surgical parameters, postoperative recurrence, and survival outcomes were recorded. Results The Patients in local ablation group showed significantly lower operation time, less intraoperative blood loss, and shorter hospital stay, with values of (52.7±16.6) min, (3.9±1.5) mL, and (4.3±1.1) days, respectively, compared to those of (146.3±23.5) min, (205.1±12.7) mL, and (12.2±3.6) days in the repeat hepatectomy group, P<0.05. The overall survival rates (OS) for the repeat hepatectomy and local ablation groups, at 1, 3, and 5 years were 88.4%, 69.2%, 61.5% and 86.8%, 73.6%, 57.8%, respectively. There was no significant difference in overall survival (OS) between these two groups (P=0.16). The recurrence-free survival rates (RFS) at 1, 2, and 3 years post-operation were 76.9%, 65.3%, 57.6% for the repeat hepatectomy group, and 73.6%, 50%, 23.6% for the local ablation group, which had a statistically significant difference (P=0.042).Using COX regression analysis, it was found that the significant risk factors affecting OS were older age at recurrence (RR=1.6, 95%CI=1.1-2.3, P<0.05), AFP level higher than 400 ng/mL (RR=2.8, 95%CI=1.2-4.2, P<0.05), and tumors adjacent to major vessels at the time of recurrence (RR=2.9, 95%CI=1.1-5.7, P<0.05). A single recurrent lesion was identified as a protective factor for OS with an RR value of 0.4 (95%CI=0.2-0.7, P<0.05). For RFS, age (RR=1.8, 95%CI=1.1-3.1, P<0.05) and tumors adjacent to major vessels (RR=2.6, 95%CI=1.2-4.4, P<0.05) were risk factors, while a single recurrent lesion served as a protective factor with an RR value of 0.5 (95%CI=0.2-0.8, P<0.05). Conclusion For HCC recurrence that meets the Milan criteria, both repeat hepatectomy and local ablation treatments are feasible and safe.
    An analysis on the combination of apparent diffusion coefficient values and circulating tumor cells in evaluating the efficacy of TACE combined with PD-1 inhibitors for treating advanced liver cancer
    ZHNAG Hong-juan, ZHOU Heng-chen, ZHOU Jian-jun, HUANG Kai-hong
    2024, 29(6):  652-656. 
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    Objective To analyze the value of apparent diffusion coefficient (ADC) combined with circulating tumor cells (CTC) in evaluating the efficacy of transcatheter arterial chemoembolization (TACE) combined with programmed death receptor-1 (PD-1) inhibitors for treating advanced liver cancer. Methods Between July 2018 and July 2023, 102 patients with advanced hepatocellular carcinoma (HCC) admitted to Hai 'an Hospital of Traditional Chinese Medicine who had received TACE combined with PD-1 inhibitors treatment were enrolled in this study. Based on the treatment efficacy after 2 months, the patients were divided into an effective group and an ineffective group. The ADC, CTC, and the difference (△) between the two groups of patients before and after one month of treatment were measured. The influencing factors of treatment responsiveness in patients with advanced HCC were screened, and the evaluation value of △ADC and △CTC for the treatment efficacy were analyzed. Results After treatment, 34 (33.33%) out of 102 advanced HCC patients progressed, and 68 patients (66.67%) showed stable or remission. The proportion of CNLC stage IV and Child Pugh grade C in the effective group was lower than that in the ineffective group [(41.2% (28/68) and 73.5% (25/34) in CNLC stage IV, and 20.6% (14/68) and 52.9% (18/34) in Child Pugh grade C, respectively) (P<0.05)]. After treatment, the effective group had higher ADC than the ineffective group (2.3 ± 0.5) mm2/s and (1.9 ± 0.4) mm2/s, respectively), while the CTC was lower than that of the ineffective group (19.3 ± 2.9 and 34.5 ± 3.8, respectively) (P<0.05); The effective group had significantly higher △ADC [(0.6 ± 0.2) mm2/s] and △CTC [(0.3±0.1) mm2/s, respectively] compared to the ineffective group (20.7 ± 2.5 and 5.2 ± 1.6, respectively) (P<0.05). CNLC staging (OR=3.53, 95% CI: 1.20-10.31), Child Pugh grading (OR=3.22, 95% CI: 1.10-9.43), △ADC (OR=0.28, 95% CI: 0.09-0.81), and △CTC (OR=0.21, 95% CI: 0.07-0.61) are all influencing factors for treatment response in advanced HCC patients (P<0.05). The sensitivity and specificity of single and combined evaluation of efficacy for advanced HCC with △ADC and △CTC were 0.62, 0.76, and 0.81, respectively. The AUC was 0.71, 0.73, and 0.81, respectively. Conclusion The efficacy of TACE combined with PD-1 inhibitors in evaluating the changes of ADC and CTC before and after treatment in patients with advanced HCC is good.
    The clinical efficacy of a comprehensive regimen combining recombinant human vascular endothelial inhibitor with doxorubicin in arterial intervention therapy for the treatment of colorectal cancer liver metastases
    GUO Ren-fen, CHAI Fang, XING Kong-lang, ZHANG Qi-mei, LI Wei
    2024, 29(6):  657-661. 
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    Objective To observe the clinical efficacy of a comprehensive regimen combining recombinant human vascular endothelial inhibitor with doxorubicin in arterial intervention therapy for the treatment of colorectal cancer liver metastases. Methods In this study, 110 patients with colorectal cancer liver metastasis who were diagnosed from February 2020 to May 2022 were selected and divided into two groups by using an odd-even grouping method. The control group was given arterial intervention treatment with doxorubicin comprehensive therapy, and the observation group was combined with recombinant human vascular endothelial inhibitor treatment. The differences in Golgi protein 73 (GP73), carcinoembryonic antigen (CEA), omentin-1, and cytokeratin 19 fragment (CYFRA21-1) were compared between the two groups, and the overall quality of survival was assessed, and the immediate and long-term efficacy of the two groups was recorded. Results There was no statistical difference in GP73, CEA, Omentin-1 and CYFRA21-1 levels in these two groups before treatment (P>0.05). The levels significantly decreased in both groups after treatment (P<0.05), and was significantly lower in the observation group when compared with those of the control group (P<0.05). The overall Karnofsky Performance Status (KPS) score of the observation group was better than that of the control group (P<0.05). All patients had grade 1-2 toxic side effects, and no grade 3-4 toxic side effects occurred. There was no statistical difference in the incidence of anemia, thrombocytopenia, neutropenia, diarrhea, elevated AST or ALT, elevated blood pressure, nausea and vomiting between the two groups (P>0.05). The recentObjective remission rate (ORR) of 61.82% (34/55) in the observation group was higher than that of 41.82% (23/55) in the control group, which was statistically different (P<0.05).The follow-up of patients ended in August 2023, with a follow-up period of 4~18 months and a median follow-up period of 10.47 months, with a median progression-free survival time of 4.5 months in the control group and 7.7 months in the observation group. Conclusion A comprehensive regimen of arterial intervention with doxorubicin in combination of recombinant human vascular endothelial inhibitor for the treatment of colorectal cancer liver metastases inhibits the expression of GP73, CEA, and other factors, improves immediate and long-term efficacy,without increasing the risk of adverse effects.
    The value of CEUS enhancement characteristics in the differential diagnosis of intrahepatic cholangiocarcinoma, hepatocellular carcinoma and hepatic hemangioma
    LIU Ping, WU Ren-mei, PENG Yue-ru
    2024, 29(6):  662-666. 
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    Objective To explore the value of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of intrahepatic cholangiocarcinoma (ICC), hepatocellular carcinoma (HCC), and hepatic hemangioma (HH). Methods 157 patients with liver space occupying lesions were selected, including 41 patients with ICC, 50 patients with HCC, and 66 patients with HH. The differences in CEUS image characteristics and quantitative parameters were pairwise compared. Results The proportions of irregular morphology, blurred lesion boundaries, uneven enhancement in arterial phase, and low enhancement in portal vein phase in ICC were 65.85%, 53.66%, 90.24%, and 100.00%, respectively, which were significantly higher than those with HCC and HH (all P<0.05). The proportion of delayed low enhancement in ICC and HCC was 100.00% and 94.00%, respectively, which were significantly higher than that in HH (both P<0.05). The rates of blurred border and low enhancement of portal vein in HCC were 12.00% and 68.00%, respectively, which were significantly higher than those in HH (both P<0.05). The initial time of enhancement, the time of reaching peak in ICC were (8.89±1.95) s and (18.65±7.11) s, respectively, which were significantly faster than those in HCC and HH (all P<0.05). The initial time of enhancement, time of reaching peak in HCC were (10.82±2.21) s and (22.15±8.36) s, respectively, which were significantly faster than those in HH (all P<0.05). The area under the ROC curves for differential diagnosis of ICC and HH by the onset time and peak time were higher than 0.800 (P<0.05). Conclusion The CEUS image characteristics of ICC, HCC, and HH are different, and CEUS can provide quantitative parameters for differential diagnosis.
    Correlation analysis of enhanced MRI multimodal parameters and liver function grading in patients with primary liver cancer
    CHEN Yan-xia, A Ni, XU Xuan, BAI Rong, LIU Xiao-zhi
    2024, 29(6):  667-670. 
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    Objective To analyze the correlation between multimodal parameters of enhanced magnetic resonance imaging (MRI) and liver function grading in patients with primary liver cancer. Methods Seventy patients with primary liver cancer treated at the hospital from September 2020 to September 2023 were enrolled, and were divided into grade A (n=21), grade B (n=36) and grade C (n=13) according to Child-Pugh classification. Spearman rank correlation analysis was used to compare the consistency of enhanced MRI with surgical pathological grade and the correlation of enhanced MRI multimodal parameters with liver function grade in patients with primary liver cancer. Results Consistency analysis showed that the accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappa value were 91.43%, 90.48%, 92.86%, 95.00%, 92.86%, 0.824, respectively. The T1, D* and f values [(503.49±40.32) ms, (61.35±5.89) ×10-3 mm2/s, (28.65±3.27) %] of patients with liver function grade A were lower than those of patients with liver function grade B [(545.67±45.39) ms, (65.87±6.36) ×10-3 mm2/ s, (33.26±3.82) %]. T2, ADC and D values [(73.56±6.82) ms, (1.67±0.32) ×10-3 mm2/s, (1.47±0.19) ×10-3 mm2/s] were higher than those with grade B liver function [(65.43±5.89) ms, (1.41±0.26) ×10-3 mm2/s, (1.2 8±0.16) ×10-3 mm2/s]. T1, D* and f values of patients with liver function grade B were lower than those of patients with grade C liver function [(575.52±56.31) ms, (71.33±6.52) ×10-3 mm2/s, (36.13±4.36) %]. T2, ADC and D values were significantly higher than those with grade C liver function [(61.26±5.37) ms, (1.24±0.19) ×10-3 mm2/s, (1.06±0.13) ×10-3 mm2/s] (P<0.05). Correlation analysis showed that T1, D* and f values were positively correlated with liver function grade in patients with primary liver cancer (r=0.535, 0.432, 0.519, P<0.05), while T2, ADC and D values were negatively correlated with liver function grade (r=-0.426, -0.597, -0.524, P<0.05). Conclusion Enhanced magnetic resonance imaging (MRI) multimodal parameters can effectively modify the degree of liver function in patients with primary liver cancer, and can be combined with the above results in clinical diagnosis and treatment plan.
    The Expression and mechanism of Tim-3 in hepatocellular carcinoma
    ZHAO Tong, GUO Hai-ping, ZHENG Qin
    2024, 29(6):  671-675. 
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    Objective To clarify the expression of TIM-3 in hepatocellular carcinoma (HCC) tissues, and investigate the malignant biological behavior of TIM-3-induced HCC cells in vitro and the possible mechanisms involved. Methods A total of 34 patients with primary HCC were enrolled who underwent surgical treatment for HCC from January 2021 to December 2021 in Nanjing Second Hospital. HCC tissues and adjacent neoplastic tissues were collected. The expression of TIM-3 in HCC tissues were detected by immunohistochemistry to analyze the correlation between TIM-3 expression and the clinicopathological parameters. Western blot was used to investigate the effect of TIM-3 expression and its binding to Galectin-9 on NF-κB/STAT3/IL-6 signaling axis. Results The expression of TIM-3 gene in tumor tissues was 73.5% (25/34), which was significantly higher than 50% (17/34) in normal tissues adjacent to cancer (χ2=3.985, P=0.046). The expression of TIM-3 in HCC tissues was significantly correlated with histological staging and clinical stage (χ2=7.404, 5.625, P<0.05). The increase rate and migration rateof HCC cells silenced with TIM-3 were significantly reduced (t=12.39, 3.129, P<0.05) . TIM-3 expression upregulated IL-6/STAT3/NF-κB-related proteins, and the expression of pathway-related proteins was inhibited after blocking Galectin-9. Conclusion TIM-3 is highly expressed in HCC tissues and promotes proliferation and migration of HCC cells. TIM-3 expression and interaction with Galectin-9 induce malignant biological progression of HCC cells by activating the IL-6/STAT3/NF-κB signaling axis.
    The therapeutic effect of transcatheter arterial chemoembolization combined with toripalimab in 88 patients with advanced primary liver cancer
    JIANG Shi-wu, PENG Xiao-yan, CHEN Jun-yuan, FENG Fei-yao, LIU Mei-ling
    2024, 29(6):  676-680. 
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    Objective To explore the therapeutic effect of transcatheter arterial chemoembolization (TACE) combined with toripalimab in patients with advanced primary liver cancer. Methods 88 patients with advanced primary liver cancer admitted to the Department of Oncology of Wuzhou People's Hospital from January 2020 to December 2022 were randomly divided into an observation group and a control group according to a random number table. The control group was treated with TACE, and the observation group was treated with TACE and toripalimab. The recent efficacy, serum liver biochemical indicators, tumor marker levels, and adverse events were compared between the two groups. The survival curve was conducted and compared by Kaplan-Meier method. Results The baseline data of the two groups of patients before treatment were not heterogeneous (P>0.05). After treatment, theObjective remission rate, disease control rate, and complete pathological remission rate of the observation group were 61.36%, 95.45%, and 59.09%, respectively, which were significantly higher than those in the control group (36.36%, 77.27%, and 36.36%, respectively, P<0.05). The serum alanine aminotransferase, aspartate aminotransferase, total bilirubin, and tumor markers such as carcinoembryonic antigen, alpha-fetoprotein, and α-L-fucosidase in the observation group were significantly lower than those in the control group (P<0.05). The incidence of adverse events in the control group and observation group was 22.73% and 38.64%, respectively, without statistically significant difference (P>0.05). At the end of follow-up, the survival rates of the observation group was 65.91% (29/44), which was significantly higher than the rate of 43.18% (19/44), in the control group (χ2=4.900, P=0.027). Conclusion TACE combined with toripalimab has significant therapeutic effect in patients with advanced primary liver cancer and is suitable for further promotion and application.
    Development and validation of a risk nomogram model for acute liver function deterioration after hepatocellular carcinoma intervention
    WANG Hui-zhe, LU Shuang-dong, WANG Qian, LIU Long-yan, SHEN Dan-ping, ZHANG Yong-hua, WANG Ming-quan
    2024, 29(6):  681-686. 
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    Objective To develop and validate a risk nomogram model for predicting acute liver function deterioration (ALFD) after interventional surgery for hepatocellular carcinoma (HCC). Methods Ninety patients with HCC who underwent interventional surgery at the hospital from May 2020 to May 2022 were selected Patients were divided into a deterioration group (n=29 cases) and a non-deterioration group (n=61 cases) based on the occurrence of ALFD post-surgery. Clinical data from both groups were collected. Univariate and multivariate logistic regression analyses were used to identify risk factors for ALFD after intervention, and the risk prediction model was established and verified. Results Univariate and multivariate logistic regression analyses showed that Child-Pugh grade B and high levels of fibrosis-4 index (FIB-4) and aspartate aminotransferase to platelet ratio (APRI) were risk factors for ALFD in patients with HCC after intervention (P<0.05). The nomogram model showed that Child-Pugh grade B was the strongest predictor, followed by high levels of FIB and APRI. Model validation showed that the area under the ROC curve of the column graph was 0.751 (95%CI: 0.665~0.840), and the C-index was 0.811. The Hosmer-Lemeshow goodness of fit test showed no significant difference between predicted and observed value (χ2=4.001, P=0.463), indicating that the model had accurate predictive capability and good discriminatory power. Conclusion Child-Pugh grade B, high levels of FIB and APRI are risk factors for ALFD in patients with HCC post-intervention. The nomogram model effectively predicts the risk of ALFD after interventional surgery for HCC.
    Liver Fibrosis & Cirrhosis
    Clinical characteristics of hepatitis B patients with decompensated cirrhosis combined with hepatic myelopathy
    LI Ju-hong, HAO Yan-qin, SHI Min
    2024, 29(6):  687-690. 
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    Objective To analyze clinical features of hepatitis B patients with decompensated cirrhosis combined with hepatic myelopathy. Methods Between April 2018 and April 2023, 40 hepatitis B patients with decompensated cirrhosis and hepatic myelopathy were enrolled in this study as the observation group. A control group consisting of 55 hepatitis B patients with decompensated cirrhosis but without hepatic myelopathy was also selected from the same period. Clinical characteristics of both groups were compared, and independent risk factors for hepatic myelopathy in patients with decompensated cirrhosis were analyzed using multifactorial logistic regression. Results The levels of total bilirubin, glutathione, glutathione and serum ammonia in the observation group were (40.5±24.8) μmol/L, (220.6±57.8) U/L, (253.5±66.4) U/L, (116.3±23.5) μmol/L, respectively, which were higher than those in the control group [(32.6±15.4) μmol/L, (120.5±58.2) U/L, (153.1±64.6) U/L, (72.6±13.8) μmol/L]. Conversely, albumin, cholinesterase, and prothrombin time activity in the observation group were (10.3±2.1) g/L, (2.1±0.8) U/L, and (27.8±4.2) %, respectively, which were significantly lower than those in the control group [(12.1± (2.2) g/L, (2.6±0.2) U/L, (31.6±6.8) %, respectively, P<0.05]. Multifactorial logistic regression analysis identified alanine aminotransferase, prothrombin time activity, high serum ammonia, and low albumin as independent risk factors for hepatic myelopathy in hepatitis B patients with decompensated cirrhosis (OR=0.382, 4.568, 4.166, 0.401, P<0.05). Conclusion Albumin transaminase, prothrombin time activity, high blood ammonia, and low albumin are independent risk factors for hepatic myelopathy in patients with decompensated cirrhosis due to hepatitis B.
    Correlation between esophageal wall thickness on CT plain scan and red color sign on endoscopy in patients with liver cirrhosis: a cross-sectional study
    WANG Xiao-juan, WANG Ji-tao, LI Jin-long, WANG Wen-chuan, MENG Ling-lei, MIAO Jie, GAO Feng-xiao
    2024, 29(6):  691-694. 
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    Objective To analyze the correlation between esophageal wall thickness(EWT) measured by CT plain scan and the red colour sign(RCS) observed during endoscopy, aiming to predict esophageal variceal bleeding in patients with cirrhosis. Methods A total of 125 patients with hepatitis B cirrhosis who underwent endoscopy and CT plain scans at Xingtai People's Hospital from January 2019 to May 2022 were enrolled in this study. The subjects were divided into two groups based on the presence or absence of the RCS: the RCS-positive group and the RCS-negative group. The clinical characteristics of patients in both groups were compared.Logistic regression analysis was performed to identify variables related to RCS.The diagnostic efficacy of EWT was assessed using the receiver operating characteristic (ROC) curve, and the Youden index was utilized to determine the cut-off value. Results The stufy included 125 patients, consisting of 86 males and 39 females, with a mean age of 53.6±11.7 years. Among them, 84 patients did not present with the RCS, while 41 did. The platelet and serum albumin values in patients with RCS were 75(45.75-93.5)×109/L, and 34.45±4.49 g/L, respectively, which were significantly lower than those in patients without RCS, 97(73-148)×109/L and 37.44±6.25 g/L, (P<0.05). Prothrombin time, international normalized ratio and Child-Pugh score in the RCS-positive group were 14.0(12.5-16.6)s, 1.28(1.15-1.46), and 8(7-9), respectively, which were significantly higher than those in the RCS-negative group,12.5 (11.4,15.1) s, 1.15 (1.04,1.31), and 7 (6,8)(P<0.05). The incidence of ascites was also higher in the RCS-postive group (25 (29.7%) vs20 (48.8%)). EWT was significantly higher in patients with RCS(Z=-6.663,P=0.000). Multivariate regression analysis identified EWT as an independent risk factor for RCS(HR=1.405; 95%CI:1.203-1.64,P=0.000).The area under the curve (AUC) for diagnosing RCs based on EWT was 0.868 (95%CI:0.804-0.931,P=0.000), with a cut off value of 7.14 mm. Conclusion EWT can be used as a screening index for RCS and provide a stratified index for clinical screening of esophageal varices bleeding.
    Significance of combined detection of peripheral blood SAA, WBC/PLT, CD64 and ascites CD64 in patients with liver cirrhosis and spontaneous bactrial peritonitis
    JIANG Jing-rong, ZHANG Tian-hong, CHEN Jing
    2024, 29(6):  695-698. 
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    Objective The aim of this study was to assess the clinical relevance significance of simultaneous detection of peripheral blood amyloid A (SAA), WBC/PLT ratio, cluster of differentiation 64 (CD64) and ascitic fluid CD64 in patients diagnosed with liver cirrhosis and spontaneous bacterial peritonitis (SBP). Methods Between January 2021 and December 2022, 106 patients diagnosed with liver cirrhosis and ascites were admitted to our hospital . They were divided into two groups: the SBP group (49 cases) and non-SBP group (57 cases), based on the presence or absence of SBP. Additionally, 50 healthy subjects comprised the control group. Peripheral blood SAA levels were quantified using immunoturbidimetry. WBC and PLT were assessed using a fully automatic blood analyzer. Peripheral blood CD64 and ascites CD64 levels were measured via fully automated flow cytometry. Comparative analyses of peripheral blood SAA, WBC/PLT ratios, and CD64 leves, both in blood and ascitic fluid were conducted across the three groups. The diagnostic efficacy of of peripheral blood SAA, WBC/PLT ratios, CD64 leves(both blood and ascitic fluid), individually and in combination, for identifying liver cirrhosis complicated by SBP was evaluated using receiver operating characteristic(ROC) curves. Results In the SBP group, peripheral blood SAA, WBC/PLT ratio, CD64, and ascites CD64 levels were (82.3±17.2) mg/mL, (0.4±0.2), (13126.3±90.1) mol/cell and (14912.8±101.7) mol/cell, respectively, which were significantly higher than those in the non-SBP group [(11.2±3.4) mg/mL, (0.1±0.1), (1083.9±61.4) mol/cell and (936.2±51.1) mol/cell, P<0.05] .SAA, WBC/PLT ration, and CD64 levels in the peripheral blood of the SBP group were also significantly elevated compared to the control group [(10.6±2.8) mg/mL, (0.1±0.1) and (1063.7±57.5) mol/cell, P<0.05]. However, no significant differences were observed in SAA, WBC/PLT ratio, and CD64 levels in peripheral blood between the SBP group and the control group (P>0.05). Following treatment, peripheral blood SAA, WBC/PLT ratio, CD64 and ascites CD64 levels in the SBP group decreased to (35.6±6.9) mg/mL, (0.3±0.1), (3302.4±70.5) mol/cell and (4758.4±78.6) mol/cell, respectively, which were significantly lower than those before treatment (P<0.05). ROC curve analysis demonstrated that the combined sensitivity of SAA, WBC/PLT ratio, CD64 and ascites CD64 in diagnosing cirrhosis and SBP was 96.00%, with an AUC of 0.930, which was significantly higher than that of individual detections (P<0.05). Conclusion Elevated levels of peripheral blood SAA, WBC/PLT ratio, CD64, and ascites CD64 are observed in patients with liver cirrhosis and SBP. The combined detection of these markers holds significant diagnostic value for identifying and managing liver cirrhosis complicated by SBP.
    Assessment of liver reserve function in patients with cirrhosis using CT imaging
    CHEN Feng, LI Yan, TANG Wen-yong, WENG Xu-dan, LV Min-li, ZHONG Jian-quan
    2024, 29(6):  699-705. 
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    Objective To investigate the feasibility of developing an image omics model based on portal phase CT images to extract features from the whole liver and specific liver segments. TheObjective is to assess liver reserve function in cirrhotic patients with varying Child-Turcotte-Pugh (CTP) scores. Additionally, the study compares the diagnostic efficacy of the two models. Methods A retrospective analysis was conducted on 148 patients diagnosed with cirrhosis, categorized into CTP A and CTP B+C groups based on CTP scores. All patients were randomly divided into a training set (n=118) and a validation set (n=30). Regions of interest(ROI_t and ROI_s)were defined according to the segmentation of the whole liver and individual liver segements, respectively. Features were extracted and screened using the Spearman correlation coefficient and the least absolute shrinkage and selection operator (LASSO) for dimensionality reduction. The efficiency of the ROI_t and ROI_s models was evaluated using reveiver operating characteristic(ROC) curves and decision curve analysis(DCA). The Delong test was employed to compare the ROC curve efficiencies of the two models. Results The ROI_t model was established by selecting the 10 most significant features. For the training set, the area under the curve(AUC ) was 0.886(95%CI: 0.821 ~ 0.950), with an accuracy of 0.828, sensitivity of 0.849, and specificity of 0.826. For the test, the AUC was 0.895(95%CI: 0.797 ~ 0.992), with an accuracy of, 0.816, sensitivity of 0.884, and specificity of 0.870. The ROI_s model was established by selecting the 13 most significant features. For the training set, the AUC was 0.854(95%CI: 0.765 ~ 0.943), with an accuracy of 0.743, sensitivity of 0.800, and specificity of 0.853. For the test set,the AUC was 0.700(95%CI: 0.575-0.823), with an accuracy of 0.608, sensitivity of 0.744, and specificity of 0.706, respectively. The DeLong test indicated a statistically significant difference bewteen the ROC curves of the ROI_t and ROI_s models(P=0.0369). The DCA demonstrated that both the ROI_t and ROI_s models had good predictive ability for CTP classification, with the ROI_t model outperforming .the ROI_s model. Conclusion Based on the most significant features extracted from the whole liver and local regions of interest in the portal phase CT images of cirrhotic patients, both imaging omics models established using the LightGBM classifier can effectively evaluate liver reserve function in patients with different CTP grades. Notably, the imaging omics model based on regions of interest in the whole liver demonstrates superior performance.
    Other Liver Diseases
    Effect of an isocaloric high-protein low-carbohydrate diet on serum lipid profile in nonalcoholic fatty liver disease
    QIAN Xiao-jing, CHEN Ying, LIU Wang zhen-zu, ZHANG Jia-qi, JIANG Yuan-ye, HU Cheng
    2024, 29(6):  706-713. 
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    Objective To study the effects of an isocaloric low-carbohydrate high-protein diet (CRD)[2] on patients with nonalcoholic fatty liver disease (NAFLD) and its impact on lipid metabolism. Methods Twenty-five patients diagnosed with NAFLD and 25 healthy volunteers from the physical examination center were recruited for the study. The NAFLD patients underwent a CRD intervention. Basic information about the subjects was collected, and biochemical indices,including liver function and blood lipids, were tested. Serum lipid analysis was performed using UPLC-Q-Orbitrap/MS technology. Principal component analysis and orthogonal partial least squares-discriminant analysis were utilized to construct differential serum lipid metabolic profiles and identify lipid biomarkers. Results After 4 weeks of dietary intervention, the patients' weight decreased from 77.88±10.76 kg to 76.62±10.78 kg, (P<0.001), and BMI decreased from 25.63 (24.40-26.80) kg/m2 to 24.88 (24.5-26.34) kg/m2, (P<0.01), while waist circumference showed no significant change (P>0.05). The AKP level significantly decreased from 93.36±30.41U/L to 3.12±23.90 U/L after CRD intervention (P<0.01). GGT and ALT levels were reduced from 43.84±27.78 U/L and 35.0 (25.0-76.5) U/L to 35.16±17.51 U/L and 28.0 (14.5-45.5) U/L respectively( P<0.05 for both). Serum TC levels decreased significantly from 4.56 (3.82-6.31) mmol/L to 3.15 (1.79-4.32) mmol/L (P<0.001). There were no significant changes in the levels of CHE, AST, TG, HDL, and LDL (P>0.05). Lipidomic studies revealed significant changes in serum levels of OAFHA, LPC, MG, LPG, PI, PS, PG, PA, and SM after CRD intervention (P<0.05). Conclusion The CRD intervention effectively reduce body mass, lower BMI and waist circumference, and improve liver function and dyslipidemia in patients with NAFLD. Lipidomic analysis indicated that a CRD diet could mitigate the development of NAFLD by alleviating fatty liver lipotoxicity and regulating sphingolipid metabolism. The 53 lipid biomarkers identified through this screening can serve as potential targets for NAFLD intervention.
    Effects of ultrasound-guided lauromacrogol sclerotherapy on liver function and levels of Cor, AD,and NE in patients with hepatic cysts
    HAO Dong, WANG Chen-xi, ZHANG Kun-jie
    2024, 29(6):  714-718. 
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    Objective To evaluate the effects of ultrasound-guided lauromacrogol sclerotherapy on liver function and stress hormone levels in patients with hepatic cysts. Methods Sixty-two patients with hepatic cysts admitted to our hospital from January 2020 to March 2023 were randomly assigned to either the observation group or the control group, with 31 patients in each group. The control group received anhydrous ethanol injections under ultrasound guidance, while the observation group received lauromacrogol injections under ultrasound guidance. Clinical efficacy was evaluated in both groups. Liver function was assessed and compared between the groups before and one week after the procedure. Stress indices and routine blood parameters [platelet count (PLT), white blood cell count (WBC), hemoglobin (Hb)] were measured and compared before and one day after the procedure. Complications were also recorded in both groups. Results There was no significant difference in the total effective rate between the two groups (93.55% vs 90.32%, P>0.05). One week post-operation, alanine aminotransferase(ALT) and aspartate aminotransferase(AST) levels in the control group were significantly elevated (P<0.05), and were notably higher than those in the observation group [(47.36±11.27) U/L vs. (62.41±10.35) U/L and (38.06±5.62) U/L vs. (72.85±21.96) U/L, respectively] (P<0.05). One day post-operation, stress indices in both groups increased significantly (P<0.05), but were lower in the observation group [(0.25±0.06) ng/mL vs. (0.32±0.05) ng/mL, (277.16±24.79) ng/mL vs. (317.42±30.15) ng/mL, (60.14±5.49) pg/mL vs. (66.87±7.05) pg/mL] (P<0.05). PLT and Hb levels showed no significant changes compared to pre-treatment values in both groups (P>0.05), while WBC cout in the control group significantly increased (P<0.05) and was higher than in the observation group [(37.32±6.55) ×109/L vs. (41.38±8.07) ×109/L](P<0.05). The incidence of adverse reactions was lower in the observation group (P<0.05). Conclusion Lauromacrogol is effective in the treatment of hepatic cysts, demonstrating minimal impact on liver function, stress response, and inflammatory response, while also reducing the incidence of complications. These findings highlight its clinical significance.
    DEHP plasticizer-induced hepatotoxicity in rats: elevated reactive oxygen species levels as a mechanism
    ZHU Xue-he, WU Jie
    2024, 29(6):  719-724. 
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    Objective To investigate the hepatotoxic effects of the plasticizer DEHP and explore its potential mechanism involving the elevation of reactive oxygen species. Methods A total of 50 Sprague-Dawley rats were randomly divided into five groups: blank control, vehicle contro, DEHP low dose( 1 mg/k), DEHP medium dose(5 mg/kg), and DEHP high dose(25 mg/kg). Body weight was monitored during the treatment period. At the end of the treatment, serum biochemical indices, liver coefficients, and oxidative/reductive indices in hepatic tissues were measured. Human normal hepatocytes HL-7702 were divided into blank control, vehicle control (DEHP 0 μmol/L) and experimental groups (DEHP 0.1 μmol/L, 10 μmol/L and 100 μmol/L). Cell viability was assessed at 24 h, 48 h and 72 h, along with measurements of TG, TC and ROS levels, and the expression of genes and proteins related to the Nrf2/HO-1 signaling. Results (1) The body weights of rats in the DEHP low dose, middle dose and high dose groups decreased in a dose-dependent manner during the 1st 2nd and 4th weeks post- treatment(P<0.05). (2) At the end of treatment, the liver weight and liver coefficient of rats in the DEHP low dose, medium dose and high dose groups increased in a dose-dependent manner compared to the vehicle control group (P<0.05). (3) Serum AST, ALT and ALP levels in the DEHP low dose, medium dose, and high dose groups were elevated in a dose-dependent manner compared to the vehicle control group at the end of the treatment period (P<0.05). (4) The levels of ROS and MDA in hepatic tissues of rats in the DEHP low dos, medium dose, and high dose groups increased in a dose-dependent manner, while the levels of SOD and GSH decreased in a dose-dependent manner at the end of treatment(P<0.05). (5) The viability of HL-7702 cells in the DEHP medium dose and high dose groups decreased in a dose-dependent manner compared to the vehicle control group at 24 h, 48 h, and 72 h post-cultivation(P<0.05), (6) The levels of TG, TC and ROS in HL-7702 cells in the DEHP medium dose and high dose groups increased in a dose-dependent manner (P<0.05). (7) The mRNA expression levels of Nrf2, HO-1 and NQO1 in HL-7702 cells decreased in a dose-dependent manner in the DEHP medium dose and high dose groups (P<0.05). (8) The protein expression levels of Nrf2, HO-1 and NQO1 in HL-7702 cells decreased in a dose-dependent manner in the DEHP medium dose and high dose groups (P<0.05). Conclusion Plasticizer DEHP exhibits hepatotoxicity, potentially through oxidative stress injury in the liver by modulating the Nrf2/HO-1 signal pathway to increase reactive oxygen species levels.