Table of Content

31 May 2024, Volume 29 Issue 5

Previous Issue    Next Issue

CONTENTS

2024, 29(5):  0-0. 

Asbtract ( 27 )   PDF (13635KB) ( 11 )  

Related Articles | Metrics

Liver Fibrosis & Cirrhosis

Efficacy and safety of switching to tenofovir alafenamide in poor responsive/low-level viremia hepatitis B patients with decompensated cirrhosis to nucleos(t)ide analogs therapy

ZENG A-juan, LI Lei, DING Hui-guo

2024, 29(5):  504-507. 

Asbtract ( 42 )   PDF (542KB) ( 26 )  

References | Related Articles | Metrics

Objective Real-world efficacy and safety of switching to TAF in decompensated hepatitis B-related cirrhotic patients poor responsive or with low-level viremia (LLV) to nucleos(t)ide analogue (NA) therapy are unclear. The purpose of this study was to investigate the efficacy and safety of the sequential therapy in order to optimize antiviral treatment. Methods In this prospective cohort study 56 patients with decompensated hepatitis B cirrhosis were enrolled who had been switched to TAF monotherapy due to poor response to NA therapy or LLV for at least 6 mooths. According to the baseline HBV DNA level, they were divided into LLV group (HBVDNA<2000 IU/mL) and poor response group (HBV-DNA≥2000 IU/mL). All patients were followed up every 12 weeks. Their virological/biochemical responses were evaluated after switchover. Results (1) Complete virological response (CVR) at 48 weeks [32.14%(18/56)] after swithing to TAF was significantly increased than that at 12 weeks [80.00%(16/20)](P<0.05). (2)Subgroup analysis of LLV group and poor response group showed that the former achieved favours CVR at 12 weeks [61.54%(16/26) vs 6.67%(2/30)]. However, there was no statistical difference between the two groups at 24 weeks, 36 weeks and 48 weeks. (3) Additionally, the mean changes in HBsAg and HBV DNA levels were significant at 48 weeks (-0.44 and -3.38 logIU/mL, respectively) (P<0.05).(4) The normalization rate of ALT at 48 week was 95.00%(19/20), which were significantly higher than that of 66.07%(37/56) at the baseline (P<0.05). (5) The mean Child-Pugh score and the proportion of Child-pugh A at 48 weeks was 5.45±0.76 and 85%(17/20), respectively, which were significantly improved than those of 8.66±2.30 and 21.43% (12/56) at the baseline (P<0.05). (6) During the 48-weeks’ treatment period, there were no significant changes in serum creatinine, phosphorus, and eGFR (P>0.05), However, the median urinary β2-microglobulin (β2-MG) at 24-weeks was 0.98, compared to 1.14 at the baseline, however, the difference was not statistically significant. Conclusion (1) Switching to TAF monotherapy is effective in patients with decompensated hepatitis B-related cirrhosis due to poor response to NA therapy /LLV, regarding both CVR and the liver function benefits. (2) TAF has a good renal safety in the treatment of decompensated hepatitis B-related cirrhosis.

Clinical features and influencing factors of hepatitis B-related cirrhosis complicated by spontaneous enterococcal peritonitis

TANG Ya-jun, SHAN Ya-lin

2024, 29(5):  508-511. 

Asbtract ( 42 )   PDF (371KB) ( 18 )  

References | Related Articles | Metrics

Objective To explore the clinical characteristics of hepatitis B-related cirrhosis complicated by spontaneous enterococcus peritonitis (SEP), and analyze the influencing factors of the complication. Methods From July 2018 to March 2023, 120 patients were admitted with hepatitis B related cirrhosis. Among them, 55 patients complicated with SEP were classified as concurrent group, and the remaining 65 patients were classified as non-concurrent group. The clinical characteristics of patients in these two groups were compared, and the risk factors of SEP in hepatitis B-related cirrhosis were analyzed. Results The proportion of gastrointestinal bleeding, previous treatment with antibiotics, and history of abdominal surgery in the concurrent group was 32.7%, 85.5%, and 43.6%, respectively, which were higher than those in the non-concurrent group (12.3%, 49.2%, and 7.7%); The levels of albumin and creatinine were (29.5 ± 3.6) g/L and (95.7 ± 9.4) respectively μmol/L, lower than the non-concurrent group [(32.9 ± 4.3) g/L, (121.7 ± 11.8) μmol/L, P<0.05]. By multivariate logistic regression analysis it was found that gastrointestinal bleeding, previous antimicrobial treatment, history of abdominal surgery, low albumin and low creatinine were all risk factors for SEP in hepatitis B-related cirrhosis patients (OR=4.721, 4.623, 5.013, 5.286, 5.124, P<0.05). Conclusion The risk of SEP in hepatitis B-related cirrhosis is high,with gastrointestinal bleeding, history of antimicrobial treatment, abdominal surgery, and low levels of albumin and creatinine as the risk factors, which warrant clinical attention.

The application of FibroScan and liver fibrosis index in evaluating liver fibrosis in NAFLD patients with comorbid HBV infection

GONG Li, HU Feng

2024, 29(5):  512-515. 

Asbtract ( 52 )   PDF (388KB) ( 18 )  

References | Related Articles | Metrics

Objective To investigate the value of instantaneous elastic imaging system (FibroScan) and hepatic fibrosis index in evaluating hepatic fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) complicated with hepatitis B virus (HBV). Methods The clinical data of 93 patients with NAFLD with comorbid HBV infection admitted from June 2021 to June 2023 were retrospectively analyzed. According to pathological examination there were 70 cases with mild to moderate fibrosis and 23 cases with severe fibrosis. The general and clinical data of these patients were collected, including gender, age, body mass index (BMI), diabetes mellitus, hypertension, alcohol consumption, smoking, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), platelets (PLT), albumin (ALB), hepatitis B virus e antigen (HBeAg), NAFLD fibrosis score (NFS), liver stiffness measurement (LSM) and liver fibrosis index-4 (FIB-4). The risk factors of severe liver fibrosis in patients with NAFLD and HBV infection were analyzed by unconditional Logistic stepwise regression; Receiver operating characteristic curve (ROC) was used to analyze the value of LSM and FIB-4 in evaluating liver fibrosis in NAFLD patients with HBV infection; Spearman correlation coefficient was used to analyze the correlation between LSM, FIB-4 and liver fibrosis stage in NAFLD patients with HBV infection. Results The levels of ALT, AST, NFS, LSM and FIB-4 in mild to moderate group were (41.76±8.52)U/L, (31.58±8.07)U/L, (-2.62±0.71)g/dL, (5.75±1.24)kPa, and (1.21±0.39)], which were significantly lower than those of (61.89±7.33)U/L, (45.36±12.94)U/L, (-1.44±0.45)g/dL, (10.71±2.97)kPa, and (1.88±0.62) in severe group. The level of PLT in mild to moderate group was (177.26±48.31) 10⁹/L], which was significantly higher than that of 138.74±41.65)10⁹/L in severe group (P<0.05). There was no significant difference in gender, age, BMI, diabetes, hypertension, drinking, smoking, ALB and HBeAg between the two groups (P>0.05). By multiple logistic regression analysis it was confirmed that ALT, AST, PLT, NFS, LSM and FIB-4 were risk factors for severe liver fibrosis in patients with NAFLD and HBV infection (P<0.05). The results of correlation analysis showed that LSM and FIB-4 were positively correlated with liver fibrosis stage in patients with NAFLD and HBV infection (r=0.614, 0.583), and all P<0.05. By ROC curve analysis it was showed that the area under the curve (AUC) of LSM and FIB-4 in evaluating severe liver fibrosis was 0.853 and 0.842, respectively, and P<0.05. The AUC of the combined evaluation of the two methods for severe liver fibrosis in patients with NAFLD and HBV infection was 0.888, the sensitivity was 0.826, and the specificity was 0.929. Conclusion Both FibroScan and liver fibrosis index have a certain value in evaluating liver fibrosis in NAFLD patients with comorbid HBV infection, and the efficacy of a combined evaluation is higher.

The impacts of transjugular intrahepatic portosystemic shunt on the portal vein diameter and long-term outcome of liver cirrhotic patients with portal hypertension

MA Zhi-gang, LIU Li-li, WANG Xu, FENG Peng-li, YANG Fan, YANG Yong-bin

2024, 29(5):  516-520. 

Asbtract ( 43 )   PDF (501KB) ( 12 )  

References | Related Articles | Metrics

Objective To investigate the impacts of transjugular intrahepatic portosystemic shunt (TIPS) on portal vein diameter (PVD) and long-term outcome of patients with liver cirrhosis and portal hypertension (PHT). Methods A total of 100 patients with liver cirrhosis and PHT admitted from January 2017 to January 2020 were randomly grouped into a control group (50 cases, treated with pericardial revascularization) and a study group (50 cases, treated with TIPS) using a random number table method. The clinical data of all patients were collected and the liver hemodynamics, liver function, and long-term efficacy of the treatments in both groups of patients were compared. Results One day before surgery, there were no obvious differences in PVD, portal venous blood flow (PVF), splenic venous inner diameter (SVD), splenic venous blood flow (SVF), portal venous flow velocity (PVV), splenic venous flow velocity (SVV), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL) between the two groups (P>0.05). At 7d after surgery, The PVD [(1.15±0.22) cm vs (1.53±0.32) cm], PVF [(774.45±101.28) mL vs (845.33±120.39) mL], SVD [(1.17±0.21) cm vs (1.32±0.27) cm], SVF [(304.47±63.38) mL vs (400.01±74.12) mL], ALT [(38.45±8.61) U/L vs (50.26±10.05) U/L], AST [(39.18±8.97) U/L vs (48.51±10.13) U/L], and TBil [(28.19±6.08) μmol/L vs (39.53±8.96) μmol/L] were decreased and improved more in the study group when compared with those in the control group (P<0.05), whereas PVV [(45.69±9.98) cm/s vs (30.08±6.57) cm/s] and SVV [(24.76±6.02) cm/s vs (18.96±4.04) cm/s] were increased (P<0.05). The survival rate of PHT patients with liver cirrhosis in both groups decreased with the increase of postoperative time, and the survival rate in the study group was obviously higher than that in the control group in 3 years after surgery (P<0.05), moreover, the total incidence of adverse events in the study group was lower than that in the control group in three years after surgery, however, there was no obvious difference between the two groups (P>0.05). Conclusion TIPS is effective in the treatment of PHT in patients with liver cirrhosis, and may obviously improve liver hemodynamics and liver function in patients with liver cirrhosis and PHT, with a good long-term effect on the patients.

The value of a combination of serum β-arrestin 2, HIF-1α and CA125 to predict hepatic fibrosis in chronic hepatitis B patients

WANG Lei, CHEN Chen, HUA Xi-mei, HU Feng-fen

2024, 29(5):  521-525. 

Asbtract ( 46 )   PDF (680KB) ( 31 )  

References | Related Articles | Metrics

Objective To investigate the value of serum β-inhibitory protein 2 (β-arrestin 2), hypoxia-inducing factor 1α (HIF-1α) and carbohydrate antigen 125 (CA125) in the prediction of hepatic fibrosis in chronic hepatitis B (CHB) patients. Methods One hundred and ten CHB patients admitted from May 2019 to May 2022 were selected as the study subjects, and were set as the observation group. Another 110 healthy people who were examined in the physical examination center at the same period of time were selected as the control group. The serum β-arrestin 2, HIF-1α, CA125 were compared between the two groups of people, and the above indicators in patients with different pathological stages of liver fibrosis were observed. Receiver operating characteristic curve (ROC) analysis was used to determine the value of the above indexes in predicting liver fibrosis stage 4 (S4) in CHB patients., Multiple logistic regression analysis was used to identify the risk factors of S4 CHB, Pearson correlation analysis was used to analyze the correlation between the above indexes and the pathological stage of cirrhosis. Results Compared with the control group, serum β-arrestin2, HIF-1α and CA125 levels in observation group were significantly increased (t=21.376, 21.548, 71.752, P<0.05). The serum β-arrestin2, HIF-1α and CA125 levels were increased gradually in CHB patients with S1, S2, S3 and S4 of hepatic fibrosis (F=140.309, 63.837, 82.963, P<0.05). It was proved by ROC analysis that serum β-arrestin2, HIF-1α and CA125 levels could be used to predict S4 of CHB, with the areas under the curve (AUC) of 0.984, 0.926 and 0.956, respectively. The combined diagnosis could obtain a higher AUC as 0.999 (P<0.05). Multivariate logistic regression analysis showed that β-arrestin2≥96.37 pg/mL (OR=2.011, 95%CI: 1.211~3.339), HIF-1α≥74.345 μg/L (OR=1.696, 95%CI: 1.026~2.804), CA125≥173.27 U/mL (OR=2.117, 95%CI: 1.974~3.987) were risk factors for S4. Serum β-arrestin2, HIF-1a, CA125 levels were positively correlated with hepatic fibrosis stages in CHB patients (r=0.458, 0.651, 0.531, all P<0.05). Conclusion Serum β-arrestin2, HIF-1α and CA125 levels can all be used to predict liver fibrosis stages in CHB patients. The higher the level of the aboval indexes, the more severe in the degree of liver fibrosis. The sensitivity of a combined application was higher than individual index. A combined diagnosis with multiple parameters may further improve the objectivity and accuracy of the diagnosis, and reduce the occurrence of missed diagnosis and misdiagnosis. It provides a reliable basis for clinical practice thus worthy of clinical promotion.

Liver Cancer

The value of contrast-enhanced ultrasound in evaluating microwave ablation therapy for patients with special site primary liver cancer

HAO Yuan-yuan, WANG Jun, XU Da-chao

2024, 29(5):  526-529. 

Asbtract ( 49 )   PDF (2022KB) ( 21 )  

References | Related Articles | Metrics

Objective To explore the application of contrast-enhanced ultrasound to evaluate the efficacy of microwave ablation for the treatment of special site primary liver cancer. Methods Between June 2020 and June 2022, 70 patients with primary liver cancer at special sites confirmed by pathological examination were divided into a microwave ablation group (n=30) and a microwave ablation combined with absolute alcohol group (n=40) according to the treatment method. A retrospective study was carried out in these two groups of patients. At one month after surgery, contrast-enhanced ultrasound and enhanced CT were performed to evaluate the ablation effect and compare the incidences of complications in them. Results By contrast-enhanced ultrasound it was shown that 22 cases were completely ablated in microwave ablation group, and the complete ablation rate was 73.3%, while 38 cases were completely ablated in microwave ablation combined with absolute ethanol group, and the complete ablation rate was 95.0%. The difference between the two treatment methods was statistically significant (χ²=6.572, P=0.010). By enhanced CT it was shown that 21 cases were completely ablated in microwave ablation group, and the complete ablation rate was 70.0%, while 36 cases were completely ablated in microwave ablation combined with absolute ethanol group, and the complete ablation rate was 90.0%. The difference between the two treatment methods was statistically significant (χ²=4.534, P=0.033). However, there was no significant difference in the complete ablation rate between contrast-enhanced ultrasound and enhanced CT in microwave ablation group and microwave ablation combined with absolute alcohol group (χ²=0.082, 0.721, P=0.774, 0.396). In the microwave ablation group, there was 1 case of postoperative bleeding, 1 case of infection, 2 cases of bile leakage, 2 cases of abdominal fluid accumulation, and 1 case of peripheral organ injury. The total incidence rate of these complications was 23.3% (7/30); In the microwave ablation combined with anhydrous ethanol group, there was 1 case of postoperative bleeding, 2 cases of infection, 1 case of bile leakage, 4 cases of abdominal fluid accumulation, and 1 case of peripheral organ damage. The total incidence rate of complications was 22.5% (9/40). There was no statistically significant difference in the total incidence of complications between the two groups (P>0.05). Conclusion The application of microwave ablation combined with anhydrous ethanol in the treatment of primary liver cancer at special sites has significant effects, which improves the tumor ablation rate without increasing recurrence risk. Contrast enhanced ultrasound has a definite value in evaluating the ablation effect, which is equivalent to the efficacy of enhanced CT and should play a guiding role in clinical practice.

Value of contrast-enhanced ultrasonography in differential diagnosis of hepatic space-occupying lesions in high-risk patients with hepatocellular carcinoma

PAN Long, LIU Xiao-gang, ZHANG Hui-min, WANG Chang-you

2024, 29(5):  530-533. 

Asbtract ( 58 )   PDF (1456KB) ( 16 )  

References | Related Articles | Metrics

Objective To assess the efficacy of contrast-enhanced ultrasonography in differentiating hepatic space-occupying lesions in high-risk patients with hepatocellular carcinoma. Methods A retrospective analysis was conducted on the imaging data from 160 high-risk patients diagnosed with hepatocellular carcinoma who had presented with space-occupying lesions (204 lesions) between September 2018 and June 2022. All patients underwent contrast-enhanced ultrasonography, with pathological examination being utilized as the gold standard. The consistency between contrast-enhanced ultrasonography finding and pathological results was assessed. Additionally, the arrival time, the peak time, the washout time were compared between benign and malignant liver lesions. Results A total of 204 liver space-occupying lesions were identified in the study cohort, of which 158 malignant lesions (93 hepatocellular carcinoma lesions, 56 metastatic hepatocellular carcinoma, and 9 cholangiocarcinoma) and 46 benign lesions (34 hepatic hemangioma, 7 cirrhotic nodular lesions and 5 hepatic focal nodular hyperplasia lesions). Malignant lesions demonstrated earlier arrival time, shorter peak time, and earlier washout time compared to benign lesions (P<0.05). Among the 204 hepatic focal lesions, contrast-enhanced ultrasound diagnosed 151 malignant lesions and 37 benign lesions, aligning well with the pathological diagnoses and demonstrating good agreement (Kappa=0.772, P<0.05). ROC analysis indicated that the sensitivity, specificity and Youden index of contrast-enhanced ultrasonography in diagnosing malignant liver space-occupying lesions in high-risk patients with hepatocellular carcinoma were 95.57% (151/158), 80.43% (37/46), and 0.760, respectively. Conclusion CEUS emerges as a valuable modality for distinguishing between hepatic space-occupying lesions in high-risk patients with hepatocellular carcinoma.

Application of enhanced CT texture parameters in evaluation of efficacy after interventional therapy for Hepatitis B associated hepatocellular carcinoma

YANG Jing-jing, LI Sha, CAI Ming-yue

2024, 29(5):  534-537. 

Asbtract ( 39 )   PDF (603KB) ( 12 )  

References | Related Articles | Metrics

Objective To investigate the efficacy of enhanced CT texture parameters in predicting poor prognosis after interventional therapy for hepatitis B associated hepatocellular carcinoma (HCC). Methods A total of 69 patients diagnosed with hepatitis B-related HCC and admitted to our hospital between October 2020 and October 2022 were included in the study. The patients underwent enhanced CT scans before treatment and were then divided into two groups based on the efficacy of hepatic artery chemoembolization (TACE) for hepatocellular carcinoma: a poor prognosis group consisting of 14 patients and a good prognosis group consisting of 55 patients. Comparative analysis was conducted on baseline data and enhanced CT texture parameter levels between the two groups. The predictive value of various indicators in determining poor prognosis was evaluated through ROC curves, and risk factors associated with poor prognosis in HCC patients after TACE treatment were identified. Results No significant disparities were found in terms of gender, age, BMI, tumor diameter, proportion of smokers, and kurtosis between the two groups (P>0.05). However, the poor prognosis group exhibited notably higher values in terms of proportion, skewness, entropy and mean value of portal vein metastasis (78.57 %, 1.38±0.39, 2.29±0.41, 88.65±15.72) compared to those in the good prognosis group (38.18 %, 0.80±0.26, 1.77±0.35, 66.94±11.07). Additionally, the energy level [(1.71±0.48) ×10⁶] was significantly lower in the poor prognosis group in comparison to the good prognosis group [(5.14±1.35) ×10⁶] (P<0.05). The ROC analysis revealed that the areas under the curve of skewness, energy, entropy, and mean value in predicting poor prognosis of HCC patients were 0.884, 0.825, 0.795 and 0.864, respectively, all with statistical significance (P<0.05). Logistic regression analysis highlighted portal vein metastasis, skewness ≥ 1.020, and energy ≤ 2.415 ×10⁶, entropy value ≥ 2.265, and average value ≥ 80.495 as risk factors for poor prognosis in HCC patients (P<0.05). Conclusion The texture parameters of portal vein metastasis and enhanced CT, including skewness, energy, entropy and average value, have been identified as potential prognostic predictors for poor prognosis in HCC patients after TACE treatment. It is essential to consider these indicators before treatment and take appropriate measures to improve patient prognosis.

Liver Failure

Predictive value of AARC-ACLF score combined with NLR in the short-term prognosis of chronic hepatitis B-related acute liver failure

HAN Zhao-dan, XU Jun, LI Peng-peng, ZHAO Wei-juan

2024, 29(5):  538-541. 

Asbtract ( 37 )   PDF (433KB) ( 12 )  

References | Related Articles | Metrics

Objective To investigate the predictive value of the ACLF Research Group (AARC-ACLF) score combined with the neutrophil-to-lymphocyte ratio (NLR) in assessing the short-term prognosis of hepatitis B (HBV)-related chronic acute liver failure (ACLF). Methods A total of 94 patients diagnosed with HBV-related ACLF were included in this study. Upon admission, the NLR was assessed, and the AARC-ACLF score was calculated within 24 hours. Based on clinical efficacy and survival outcomes, patients were divided into a favorable prognosis group and an unfavorable prognosis group for further analysis of factors influencing disease progression in HBV-related ACLF. The predictive capacity of the AARC-ACLF score and serum NLR level on the prognosis of HBV-related ACLF was assessed. Results Among the 94 participants, 58 showed a favorable prognosis, while 36 exhibited an unfavorable prognosis. In the unfavorable prognosis group, the prothrombin time (PT), total bilirubin (TBIL), white blood cell count (WBC), NLR, and AARC-ACLF score were significantly higher [(26.68±6.91) s, (330.2±126.4) μmol/L, (6.67±2.06) ×10⁹/L, (6.45±2.76), and (10.14±1.29) points, respectively] compared to those in the favorable prognosis group [(20.32±4.20) s, (180.1±83.7) μmol/L, (5.06±1.97) ×10⁹/L, (2.85±1.67), and (8.03±1.09) points; P<0.05]. Elevated NLR and AARC-ACLF scores were identified as significant indicators of poor prognosis among HBV-related ACLF patients (P<0.05). The AUC values for predicting prognosis using serum NLR level, AARC-ACLF score, and the combination of NLR with AARC-ACLF score in HBV-related ACLF patients were 0.878, 0.892, and 0.943, respectively. Conclusion Higher serum NLR levels and AARC-ACLF scores in HBV-related ACLF patients suggest their potential as valuable clinical predictors for short-term prognosis. Combining both factors can enhance the predictive power significantly.

The prognostic value of TBRR and TBCR in patients with acute-on-chronic liver failure associated with hepatitis B treated with artificial liver

ZHOU Xiao-li, WEI Li, WANG Zhao-xun, YANG Xue-fang, SHI Wen-juan, WAN Hong

2024, 29(5):  542-544. 

Asbtract ( 45 )   PDF (423KB) ( 36 )  

References | Related Articles | Metrics

Objective To investigate the value of total bilirubin rebound rate (TBRR) and total bilirubin clearance rate (TBCR) in evaluating the prognosis of artificial liver therapy in patients with hepatitis B associated acute-on-chronic liver failure (HBV-ACLF). Methods An analysis was conducted on the clinical data of HBV-ACLF patients who had undergone artificial liver treatment at our hospital between January 2020 and December 2022. Patients were divided into an improvement group and a death group based on their clinical outcomes. Various parameters, including blood cells counts, liver biochemical indicators, coagulation indicators, MELD scores, as well as differences in TBRR and TBCR after artificial liver treatment, were compared between the two groups. Receiver operating characteristic curve (ROC) analysis was performed to determine the area under the curve (AUC) for these values and identify optimal cutoff points. Results A total of 98 HBV-ACLF patients with complete clinical data were included in the study. In the improvement group (65 cases), the levels of PLT、INR、MELD scores and TBRR were 122.2±50.5、1.7±0.5、18.8±5.2、22.59±39.29, respectively. In the death group (33 cases), the levels of PLT、INR、MELD scores and TBRR were 91.7±38.1、2.0±0.5、21.9±4.8、67.69±65.50, respectively. Statistically significant differences were observed between the two groups (t=2.186, P=0.03; t=0.013,P=0.050; t=2.048, P=0.046; t=2.067, P=0.016). The AUC for TBRR in predicting clinical outcomes in HBV-ACLF patients was 0.709, with a 95% CI of 0.549 to 0.870. The optimal cutoff value for TBRR was 71.13%, with a sensitivity of 50% and specificity of 85.5% at a Jordan index of 0.408. Conclusion Higher TBRR value after artificial liver treatment is associated with increased mortality in patients with HBV-ACLF. A TBRR value exceeding 71.13% may indicate a greater risk of death in this patient population.

Drug-Induced Liver Failure

Clinical characteristics and medication history of 166 patients with drug-induced liver injury

LIU Ru-jia, XIN Xiao-juan

2024, 29(5):  545-551. 

Asbtract ( 43 )   PDF (2530KB) ( 31 )  

References | Related Articles | Metrics

Objective To investigate the clinical characteristics and medication history of patients with drug-induced liver injury. Methods A total of 166 patients diagnosed with drug-induced liver injury and admitted to the first affiliated hospital of Chongqing Medical University between January 2018 and June 2022 were included in this study. Patients were divided into three groups based on their medication history: Chinese herbal medicine, Chinese patent medicine, or health products-induced liver injury group (HDS group, n=61), Western medicine-induced liver injury group (DILI group, n=65), and mixed medication group (MIX group, n=40). Statistical analysis was conducted using SPSS and EXCEL. Results The majority of patients were female, under the age of 60, with a BMI below 24 kg/m², no history of alcohol consumption, and no prior drug-induced liver injury. They predominantly exhibited hepatocellular liver injury. Patients in the DILI group had the highest incidence of prior drug-induced liver injury (8 cases, χ⁼6.334, P=0.033). The HDS group showed the highest liver injury grade (1/3/4/5) on admission (14/45/2/0, χ²=28.683, P<0.001), and significantly elevated total bilirubin level [115.6 (129.7), H=30.515, P<0.001]. There were no significant differences in the utilization of artificial liver, the use of hormone therapy, length of hospital stay, and clinical outcomes among the three groups. There was one case (1.2%) of drug-induced autoimmune hepatitis or cholangitis. The most common drugs causing liver injury included Chinese herbal medicine (26.5 %) used for 30 days, Western medicine combined with other drugs (10.2 %) for 22 days, anti-tuberculosis drugs (9.6 %) for 30 days, Chinese patent medicine (7.2 %) for 30 days, antipyretic-analgesic and anti-inflammatory drugs (6.0 %) for 10.5 days, anti-malignant tumor drugs (6.0 %) for 1.5 days, multi-type western drugs (6.0 %) for 17.5 days, other anti-infective drugs (5.4 %) 3 for days, and unknown drug use (13.9 %) for 25 days. Conclusion Patients with drug-induced liver injury are typically female, young, have normal or low weight, and tent to have hepatocellular type injury. Liver function tests should be conducted after a one-day course of antitumor drugs, a 10-day regimen of antipyretic analgesics and anti-inflammatory drugs, and a 3-day treatment with non-antituberculosis antibacterial agents to detect potential liver injury early. The concurrent use of multiple drugs emerges as a significant contributor to liver injury. Although patients with liver injury from Chinese herbal medicine, Chinese patent medicine, or health products exhibit higher total bilirubin levels and liver injury grades upon admission compared to those in the western medicine group, outcome were similar between the two groups.

Analysis of influencing factors of acute liver failure in 147 patients with liver injury induced by antituberculosis drugs

ZHANG Zhao-jun, LIU Yue

2024, 29(5):  552-556. 

Asbtract ( 40 )   PDF (434KB) ( 12 )  

References | Related Articles | Metrics

Objective To explore the clinical and laboratory characteristics of patients with liver injury induced by anti-tuberculosis drugs, and to determine the predictive factors of acute liver failure (ALF). Methods A total of 147 patients with anti-tuberculosis drug-induced liver injury were divided into an ALF group and a non-ALF group based on the presence of acute liver failure between January 2016 and December 2022. Demographic characteristics, clinical symptoms, and laboratory results were compared between these two groups. Risk factors for the occurrence of acute liver failure were analyzed by univariate and multivariate logistic regression analysis. Results In the ALF group, there was a significantly higher incidence of previous hepatitis history, longer duration of treatment, and a greater proportion of Hy's 's law at 44.2%, 51 (73, 328) days and 51.9%, respectively, compared to 18.9%, 24 (219) days and 14.7% in the non-ALF group (P<0.05). Additionally, clinical symptoms and laboratory findings revealed that patients in the ALF group exhibited a significantly higher prevalence of jaundice, nausea, ascites, abdominal distension, pruritus, elevated levels of ALT, AST, ALP, total bilirubin, direct bilirubin, PT, WBC and alpha-fetoprotein [90.4%, 53.8%, 42.3%, 36.5%, 23.1%, 243 (25, 2024) U/L, 134 (75, 1542) U/L, 141 (79, 530) U/L, 265 (27, 528) μmol/L, 151 (10, 289) μmol/L, 18.5 (3.1, 56.7) s, 6.1 (2.8, 49.6)×10⁹/L and 25.7 (2.4, 1870) ng/mL] compared to the non-ALF group [20.0%, 20.0%, 13.7%, 14.7%, 10.5%, 116 (12, 724) U/L, 88 (27, 479) U/L, 86 (61, 646) U/L, 14 (6, 138) μmol/L, 7 (3, 102) μmol/L, 12.2 (9.8, 16.3) s, 5.2 (2.1, 25.6) ×10⁹/L and 2.3 (0.7, 3021.1) ng/mL] (P<0.05). Furthermore, the univariate logistic regression analysis identified AST level, TBil level, WBC count, PLA count, history of previous hepatitis, PT, DBil level, AFP level, Alb level, ALT level, ALP level, treatment duration, jaundice, abdominal distension, nausea, vomiting, pruritus, and a positive Hy's law as potential risk factors for the development of ALF during anti-tuberculosis therapy. Additionally, the multivariate logistic regression analysis indicated that AST level, TBil level, WBC count, PLA count, and history of previous hepatitis were strong predictors of ALF. Conclusion Elevated serum bilirubin, WBC count, AST level, low platelet count ,and a history of previous hepatitis are found to be independent predictors of acute liver failure in patients who have experienced liver injury due to anti-tuberculosis medications.

Relationship between serum IL - 6, TNF alpha, IL - 10 levels and the severity of Drug-induced liver injury in patients

LI Lan-ya, TU Tao, SUN Zhi-tang

2024, 29(5):  557-560. 

Asbtract ( 53 )   PDF (530KB) ( 18 )  

References | Related Articles | Metrics

Objective To explore the levels of serum interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10) and their correlation with the severity of drug-induced liver injury(DILI). Methods Between June 2021 and June 2023, a total of 96 patients treated for DILI at our hospital were designated as the observation group. This group was stratified into 48 cases with mild liver injury, 37 with moderate liver injury, and 11 with severe liver injury based on the extent of liver function impairment. Additionally, 84 individuals with normal liver function, who underwent physical examinations at our hospital’s examination center during the same period, selected as the healthy control group. We conducted comparisons of serum IL-6, TNF-α and IL-10 levels between the DILI patients and the healthy group. The analysis also included comparisons of these cytokine levels among DILI patients with varing degrees of liver injury both before and after receiving symptomatic treatments, such as liver protection measures. Furthermore, the types of drugs responsible of liver injury in patients were compared across different severity levels. To determine the correlation between cytokine levels and the severity of liver injury, Spearman rank correlation analysis was utilized. This comprehensive approach allowed for a detailed examination of the relationship between inflammatory markers and liver injury severity in patients experiencing DILI. Results In the Observation group of 96 patients with DILI, levels of IL-6 and TNF-α were significantly higher compared to the healthy control group: IL-6 at [(29.8±6.4) pg/mL and TNF-α at (13.6±3.5) pg/mL) versus (12.4±3.7)pg/ml and (3.8±1.3) pg/mL, respectively, in the control group. Conversely, IL-10 levels were lower in the DILI group[(1.3±0.4) pg/mL] compared to the healthy group [(4.9±0.8) pg/mL ], with statistical significance(P<0.05). The analysis revealed no significant difference in the classes of drugs causing liver injury among patients with varying degrees of drug-induced liver injury (P>0.05). In severe liver injury, levels of IL-6 and TNF-α levels[(37.6±10.5) pg/mL, (23.1±5.6) pg/mL] were higher than those in moderate liver injury [(31.5±8.1) pg/mL, (15.9±3.4) pg/mL], and IL-10 levels were lower (1.1±0.3) pg/mL compared to moderate liver injury[(1.6±0.6) pg/mL]. In moderate liver injury, cytokine levels were also higher than those in the mild liver injury group, where IL-6, TNF-α levels were (26.6±3.7) pg/mL and (11.3±1.1) pg/mL, respectively, and IL-10 levels were (2.7±0.6) pg/mL. After treatment, the serum levels of IL-6 and TNF-α in the severe liver injury were still higher than those in the moderate liver injury grou, recorded at [(23.5±3.7) pg/mL and (8.9±3.6) pg/mL respectively. Compared to (19.4±3.5) pg/mLand (6.2±1.4) pg/mL in the moderate group. Additionally, IL-10 levels were lower in the severe injury group[ (2.9±0.9) pg/mL] compared to the moderate injury group [(3.7±0.8) pg/mL]. In the moderate liver injury group, IL-6 and TNF-α levels were higher than in the mild liver injury group, which showed levels of[(16.5±2.9) pg/mL, and (4.7±1.2) pg/mL, respectively. IL-10 levels were also lower in the moderate group compared to the mild group[ (4.2±1.1) pg/mL] (P<0.05). Correlation analysis indicated a positive correslation between the severity of liver damage and serum levels of IL-6 and TNF-α in patients with DILI. Conversely, IL-10 levels showed a negative correlation with the severity of liver injury(r=0.753, 0.814, -0.792, P<0.05). Conclusion The serum levels of IL-6, TNF-α,and IL-10 in patients with drug-induced liver injury(DILI) are closely associated with the degree of liver injury. These biomarkers can be used as clinical tools for assessing disease severity, evaluating treatment effects and predicting prognosis. Thus, they possess significant clinical and diagnostic value.

Other Liver Diseases

Impact of IRS-2 on the regulation of hepatocyte pyroptosis via the PI3K/AKT pathway

GUO Qing-xin, YAO Ting, SHEN Le-er, CHEN Jin-mei, HU Wei-wei, ZHANG Yi, CHEN Xiao-hua

2024, 29(5):  561-566. 

Asbtract ( 59 )   PDF (7466KB) ( 15 )  

References | Related Articles | Metrics

Objective To explore the role and molecular mechanism of insulin receptor substrate (IRS) -2 in hydrogen peroxide (H₂O₂)-induced hepatocyte pyrotosis. Methods HepG2 and L02 cells were stimulated with H₂O₂, and the expressions of IRS-2 and pyroptosis-related proteins were assessed by Western blot analysis. IRS-2 siRNA was synthesized and employed to suppress the expression of IRS-2 gene in both HepG2 and L02 cell lines. The expression levels of IRS-2 and pyroptosis-related proteins were subsequently evaluated using Western blot analysis. Cell viability was determined using the CCK-8 assay, while changes in mitochondrial membrane potential were analyzed via flow cytometry. Cell morphology, mitochondria structure, and pyroptosomes were visualized under an electron microscope, with mitochondria morphology and quantity observed using Mito-Track Green staining. HepG2 and L02 cells were treated with IRS-2 siRNA alone or in combination with a PI3K/AKT pathway agonist to assess the expression levels of PI3K/AKT pathway proteins and pyroptosis-related proteins, Data analysis was conducted using independent sample t tests or one-way analysis of variance(ANOVA) where appropriate. Results In comparison to the control group, exposure to H₂O₂ led to decreased viability of hepatocytes, downregulated expression of IRS-2 protein, and increased expression of pyroptosis-related proteins. Reduced expression of IRS-2 resulted in mitochondrial dysfunction, disrupted hepatocyte morphology, increased pyroptosome numbers, and up-regulate expression of pyroptosis-related proteins. Additionally, the ratio of P-PI3K/PI3K and P-AKT/AKT was decreased. Activation of the PI3K/AKT pathway reversed the expression of pyroptosis-related proteins induced by IRS-2 downregulation. Conclusion Stimulation with H₂O₂ can decrease the expression of IRS-2 protein and induce pyroptosis in hepatocytes. Inhibiting IRS-2 expression may induce mitochondrial dysfunction by reducing PI3K/AKT pathway activation, ultimately leading to hepatocyte pyroptosis.

Prevalence,clinical features, and virological characteristics of occult HBV infection in patients with autoimmune hepatitis

LI Yue-mei, YAO Xuan, LV Jin, XU Jing-ru

2024, 29(5):  567-570. 

Asbtract ( 32 )   PDF (382KB) ( 18 )  

References | Related Articles | Metrics

Objective To investigate the prevalence, clinical features, and virological attributes of occult hepatitis B virus (HBV) infection (OBI) in patients with autoimmune hepatitis (AIH). Methods Between April 2010 and April 2023, 318 patients with AIH admitted to our hospital were tested for HBV DNA. These patients were categorized into groups with combined OBI and without OBI based on thequantification of HBV DNA. We analyed the prevalence, clinical features, and laboratory indices for each group. Viral vectors were assessed using fluorescent polymerase chain reaction, HBV genotyping, and the virological characteristics and mutations associated with AIH combined with OBI were also examined. Results 318 patients diagnosed with AIH were assessed, and 41 of them (12.9%) were found to have a concurrent OBI. The proportion of patients with combined OBI exhibiting seropositivity for anti-hepatitis B core antibody (anti-HBc), hepatitis B surface antibody (anti-HBs), and hepatitis B e antibody (anti-HBe) was 41.5%, significantly exceeding the 17.3% in patients without OBI(P<0.05). The predominant HBV genotypes in the OBI combined cases were type B and C, with 23 cases of type B and 17 of type C identified. The viral load was highest in patients with anti-HBc and anti-HBe positivity at (685.3±154.7) IU/mL. This load decreased sequentially in those with anti-HBc and anti-HBs positivity, anti-HBc positivity alone, and combined anti-HBc, anti-HBs and anti-HBe positivity, with respective values of (465.8±134.5) IU/mL, ( 323.6±103.6) IU/mL, (131.4±83.4) IU/mL(P<0.05). Additionally, 11 patients in the group with combined OBI were found to have “a”determinant mutations on detection of HbsAg were detected. Representing 26.8% of these cases. Conclusion Patients with AIH are at a higher risk of OBI infection, typically indicated by positivity for anti-HBc, anti-HBs, and anti-HBe. The viral genes in AIH cases combined with OBI predominantly belong to types B and C. Moreover, AIH combined with OBI infection is commonly associated with T126A and Q129 mutations.

Exploring the Serum metabonomic profile of aerobic exercise intervention in non-alcoholic fatty liver Disease

YUAN Yi-fu, DU Sheng-nan, ZHANG Si-min, CAO Qin, JIANG Yuan-ye

2024, 29(5):  571-575. 

Asbtract ( 46 )   PDF (5279KB) ( 13 )  

References | Related Articles | Metrics

Objective To investigate the alteraions in clinical characteristics and serum metabolites in patients with non-alcoholic fatty liver disease (NAFLD) following a four-week aerobic exercise intervention. Methods 20 patients with NAFLD, diagnosed at the Department of Gastroenterology at Putuo District Central Hospital, Shanghai, from June 2021 to June 2022, underwent an aerobic exercise regimen. We collected baseline patients data, liver function tests, and blood lipid profiles. Concurrently, serum sample metabolites were measured, and the metabolic differences pre-and post-intervention were analyzed. Results In patients with NAFLD, significant reductions were observed post-intervention: body weight decreased from 72.21 ± 7.44 kg to 70.63 ± 7.25 kg; BMI dropped from 25.39 ± 1.32 kg/m² to 24.83 ± 1.39 kg/m²; and waist circumference from 96.52 ± 6.61 cm to 93.76 ± 6.23 cm (P<0.05); Post-intervention, liver enzymes showed marked improvements with ALT, AST, AKP, GGT, and CHE levels at [21.00 (17.00, 25.00) U/L, 13.00 (9.00, 19.50) U/L, 68.32 ± 24.14 U/L, 18.00 (14.50, 35.50) U/L, 6466.92 ± 1402.02 U/L] respectively, all significantly lower than pre-intervention values (P<0.05). Additionally, significant decreases were noted in TG and LDL levels[1.14 (1.05, 1.48) mmol/L, 2.48 ± 0.57 mmol/L] respectively(P<0.05). Serum metabolomics analysis identified 31 potential differential metabolites, predominantly lipids and amino acids. Conclusion Aerobic exercise intervention has been shown to effectively reduce body weight, improve blood biochemical indices, and enhance lipid and amino acid metabolism in patients with NAFLD. These improvements can significantly decelerate the progress of NAFLD. This underscores the clinical importance of devising tailored exercise therapy plans for NAFLD patients.

Adenovirus-associated liver injury in children: Clinical characteristics and influencing factors in a cohort of 236 cases

QIN You-yu, DENG Qiao-ni

2024, 29(5):  576-580. 

Asbtract ( 49 )   PDF (466KB) ( 16 )  

References | Related Articles | Metrics

Objective To elucidate the clinical characteristics and identify determinants impacting the course of adenovirus-associated liver injury among a cohort of 236 pediatric patients. Methods Between April 2019 and April 2023, 572 pediatric patients with adenovirus infection were admitted to our hospital and stratified into two cohorts based on liver function: 236 in the liver injury group and 336 in the non-liver injury group. Comprehensive analysis of clinical data was conducted, employing multi-factorial logistic regression to identify risk factors associated with adenovirus-induced liver injury in children. Results In our cohort, pediatric patients with adenovirus-associated liver injury(n=236) demonstrated significantly higher rates of male gender(64.0%), severe pneumonia(19.1%), gastroenteritis(8.1%), wheezing(37.3%), respiratory distress(27.5% for shortness of breath and 20.3% for dyspnea), heart failure(10.6%), and mixed infections(53.0%) compared to those without, liver injury(P<0.05). Additionally, clinical and laboratory parameters including age, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBiL), gamma-glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), and length of hospital stay were significantly elevated in the liver injury group compared to their counterparts, indicating a more severe clinical profile(P<0.05). Conversely, bronchiolitis prevalence, hemoglobin levels, and interleukin-10 (IL-10) were lower in patients with liver injury, underscoring the complexity of adenovirus impact on pediatric health. Multivariable logistic regression identified severe pneumonia, elevated GGT, and LDH levels as independent predictors of liver injury, highlighting their potential as diagnostic markers(P<0.05). Conclusion Adenovirus-associated liver injury predominantly affects male pediatric patients of younger age, with a notably high incidence observed among those presenting with severe pneumonia. The clinical presentation is primarily characterized by fever and severe pneumonia. Furthermore, GGT and LDH levels emerge as significant biochemical markers, influencing the risk and severity of adenovirus-associated liver injury. This underscores the importance of recognizing specific clinical and laboratory parameters for the early identification and management of this condition in the affected pediatric population.

Assessing the prognostic and diagnostic value of MLR, CD4⁺/CD8⁺ ratios, and APRI in children with infectious mononucleosis complicated by liver damage

HE Guo-qing, CHU Kai-dong

2024, 29(5):  581-587. 

Asbtract ( 38 )   PDF (935KB) ( 16 )  

References | Related Articles | Metrics

Objective To evaluate the clinical relevance of the monocyte/lymphocyte ratio (MLR), the CD4⁺T cell/CD8⁺ T cell ratio (CD4⁺/CD8⁺) and the aspartic aminotransferase/platelet ratio index (APRI) in pediatric patients with infectious mononucleosis (IM) complicated by hepatic injury. Methods From January 2021 to October 2022, a cohort of 200 pediatric patients with IM was enrolled from the Department of Pediatrics at Hai 'an People's Hospital. These patients were assigned into liver damage (n=157) and non-liver damage groups (n=43) based on the presence of abnormal liver function. Further subdivision of the liver damage group was based on liver function test results into mild(n=77), moderate (n=59), and severe(n=21) liver damage subgroups . Additionally, children tested for EB virus DNA (EBV DNA) were classified according to viral load into low(n=32), medium(n=97), and high(n=28) load groups. Post-treatment, patients were divided based on EBV DNA load into negative(n=116) and non-negative (n=41) groups after one week.. We collected and compared general demograoghics, hematological parameters, liver function, and serological markers across these groups. Pearson correlation analyzsis was employed to evaluate the relationships between MLR, CD4⁺/CD8⁺ ratios, APRI, and hypersensitive C-reactive protein (hs-CRP), adenosine deaminase (ADA) and the duration of liver damage. Receiver operating characteristic (ROC) curves were utilized to assess the diagnostic effectiveness of combined and individual biomarker. Results Neutrophil (NEU) and platelet (PLT) count levels were significantly lower in the liver damage group compared to the non-liver damage group. Conversely, age, monocyte (MO), lymphocyte ratio (LYM), alanine aminotransferase (ALT), aspartate aminotransferase (AST), adenosine deaminase (ADA), hs-CRP and EBV DNA load were significantly higher in the liver damage group(P<0.05). No significant differences were found in sex, body mass index (BMI), disease duration, albumin (Alb), total bilirubin (TBil) and direct bilirubin (DBil) between the groups (P>0.05). Within the liver damage category, MLR and CD4⁺/CD8⁺ ratios in the severe subgroup( 0.15±0.04 and 0.88±0.32, respectively) were, lower than those in the moderate(0.18±0.05 and 1.09±0.37) and mild subgroups(0.25±0.07, 1.22±0.41). The APRI was also higher in the severe subgroup( 1.24±0.25) compared to mderate(1.13±0.20) and mild subgroups(1.05±0.17), with all differences being statistically significant (F=13.584, 14.267, 11.459, all P<0.05). In high-load EBV DNA groups, MLR and CD4⁺/CD8⁺ ratios were lower than in medium and low-load groups, with statistically significant difference in APRI values as well(P<0.05). Similarly, in the non-negative post-treatment subgroup, MLR and CD4⁺/CD8⁺ ratios were lower than in the negative subgroup, and APRI was significantly higer in the non-negative subgroup (P<0.05). Pearson correlation analysis demonstrated that MLR, CD4⁺/CD8⁺ ratios negatively correlated with hs-CRP, ADA and the duration of liver damage in children with IM, whereas APRI showed a positively correlation (P<0.01). ROC analysis revealed that the combined diagnostic test for MLR, CD4⁺/CD8⁺ and APRI had higher sensitivity and specificity than any single test(P<0.05), with AUC values of 0.539, 0.905, 0.854, and 0.978 respectively. Conclusion MLR, CD4⁺/CD8⁺ and APRI represent straightforward and dependable serological markers. Their collective assessment offers significant value for evaluating disease severity and prognosis in children with IM complicated by liver damage.

Evaluating ultrasonic cord blood flow and serum activin A, malondialdehyde and superoxide dismutase for diagnosing fetal distress in intrahepatic cholestasis of pregnancy

FANG Rui, WANG Xiao-wei, XIA Tian

2024, 29(5):  588-591. 

Asbtract ( 48 )   PDF (642KB) ( 19 )  

References | Related Articles | Metrics

Objective To investigate the diagnostic efficacy of ultrasonic cord blood flow parameters alongside serum activin A (ActA), malondialdehyde (MDA) and superoxide dismutase (SOD) levels for detecting fetal distress (FD) in patients with intrahepatic cholestasis of pregnancy (ICP). Methods Between October 2020 and October 2022, our hospitall enrolled 106 pregnant women diagnosed with ICP. These participants were categorized based on childbirth outcomes into a FD group (45 cases) and a non-FD group (61 cases). Prior to delivery, all subjects underwent ultrasonography and serological assessments. This study compared the levels of end-systolic maximum blood velocity (S)/end-diastolic maximum blood velocity (D), resistance index (RI), pulsation index (PI), ActA, MDA and SOD between the two groups. The diagnostic utility of S/D, RI, ActA, MDA and SOD for FD in ICP patients were evaluated using ROC curve analysis. Additionally, the combined diagnostic accuracy of S/D, RI , ActA, MDA and SOD was assessed for consistency. Results No significant difference was observed in the PI levels between the FD group [(0.56±0.14)] and the non-FD group [(0.60±0.13)] (P>0.05). However, the FD group showed significantly higher levels of S/D, RI, ActA and MDA[(3.08±0.53), (0.66±0.14), (0.46±0.14) pg/L, (4.27±0.62) μmol/L respectively] compared to the non-FD group [(2.57±0.61), (0.45±0.11), (0.32±0.10) pg/L, (3.38±0.57) μmol/L respectively]. Conversely, SOD levels were significantly lower in the FD group [(33.96±3.87) kU/L] than in the non-FD group [(44.75±4.61) kU/L, P<0.05]. ROC curve analysis confirmed the diagnostic capability of S/D, RI, ActA, MDA and SOD in detecting FD, with areas under the curve of 0.730, 0.800, 0.784, 0.837 and 0.884 respectively, all significant(P<0.05). The optimal cut-off values for these markers were 2.635, 0.505, 0.395 pg/L, 3.850 μmol/L, and 39.480 kU/L respectively, with sensitivities of 0.884, 0.800, 0.711, 0.733, and 0.778. Consistency analysis showed that combining S/D, RI, ActA, MDA and SOD improved diagnostic sensitivity, specificity, accuracy, and Kappa to 0.911, 0.967, 0.943 and 0.883, respectively. Conclusion The diagnostic parameters of umbilical cord blood flow, specifically the S/D, RI, along with serum markers ActA, MDA, and SOD, are effective in identifying FD in patients with ICP. The combined use of these markers significantly enhances diagnostic accuracy.

Efficacy and safety evaluation of percutaneous transhepatic cholangioscopic technique in the treatment of elderly patients with complex intra- and extrahepatic bile duct calculi

LUO Qing, SONG Tao

2024, 29(5):  592-595. 

Asbtract ( 39 )   PDF (696KB) ( 14 )  

References | Related Articles | Metrics

Objective To explore the effectiveness and safety of one-stage percutaneous transhepatic choledocholithotomy in elderly patients with complex intrahepatic and extrahepatic stones. Methods Between January 2021 and June 2021, there were 65 elderly patients with complicated liver diseases, including 34 males and 31 females. The average age was (67.2±10.3) years. According to the different surgical methods, they were randomly divided into observation group (n=36), and the bile duct stones were removed by one-stage percutaneous transhepatic cholangioscopy. In the control group (n=29), routine operations were performed, that is, choledocholithotomy, T-tube drainage or cholangioenterostomy. The liver function and stone recurrence of patients in the two groups were detected 6 months after operation, and the related indexes during perioperative period were recorded. Results 6 months after operation, the ALT, AST, TBil and DBil in the observation group were (24.7±11.4) U/L, (22.8±9.7) U/L, (21.8±2.6) mmol/L and (19.5±11.9) mmol/L/L, respectively, significantly lower than the control group [(36.2±9.3) U/L, (31.5±10.3) U/L, (31.3±7.5) mmol/L, (28.6±11.9) mmol/l, respectively, P<0.05]. The operation time, intraoperative blood loss, postoperative fasting time, postoperative exhaust time and hospitalization time in the observation group were (95.5±10.4) min, (45.1±9.3) mL, (15.2±6.6) h, (12.4±1.2) h and (4.5±0.6) d, respectively, they were significantly lower than those in the control group [(157.3±16.4) min, (92.3±10.8) mL, (27.3±5.9) h, (26.3±7.9) h, (6.8±1.0) d, respectively, P<0.05]. The recurrence rate of stones in the observation group was significantly lower than that in the control group (5% vs 28%, P<0.05). According to the analysis of binary logistic regression model, the one-stage percutaneous choledocholithotomy (OR=0.21, P=0.036, 95%CI: 0.052-0.89) can reduce the recurrence of stones, while the preoperative bilirubin is increased (OR=1.12, P=0.002, 95% CI: 1.01-1.48). Conclusion In elderly patients with complex intra- and extrahepatic stones, the single-stage percutaneous transhepatic cholangioscopic lithotripsy is safe, can improve stone clearance rate, reduce complications, and decrease the long-term recurrence of stones.