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    31 August 2024, Volume 29 Issue 8
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    CONTENTS
    CONTENTS
    2024, 29(8):  0-0. 
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    Liver Fibrosis & Cirrhosis
    Establishing a diagnostic model of hepatic cirrhosis complicated with portal vein thrombosis based on quantitative parameters of contrast-enhanced ultrasound and ultrasonic flow parameters
    QIU Yuan-yuan, ZHANG Min, XIANG Wei-yan
    2024, 29(8):  905-909. 
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    Objective To establish and verify a diagnostic model of hepatic cirrhosis complicated with portal vein thrombosis based on quantitative parameters of contrast-enhanced ultrasound (CEUS) and ultrasonic flow parameters. Methods Ninety-seven cirrhotic patients complicated with portal vein thrombosis admitted to the hospital from April 2019 to July 2023 were selected as the research group. Fifty-six cirrhotic patients without portal vein thrombosis admitted during the same time period were selected as the control group. All patients underwent ultrasound examination, and the quantitative parameters of contra-enhanced ultrasound [peak intensity, peak time and area under curve (AUC)] and ultrasonic blood flow parameters [portal vein diameter (PVD) and portal vein flow velocity (PVV) ] were recorded. The influencing factors of cirrhosis complicated with portal vein thrombosis was analyzed. The diagnostic model of cirrhosis complicated with portal vein thrombosis was constructed and validated. Results The values of AUC, peak intensity, and PVD in the research group were (2147.85±372.41) dB/s, (16.33±4.29) dB, and (16.83±4.67) mm, respectively, which were significantly higher than those of (1259.34±196.25) dB/s, (11.06±3.10) dB, and (12.26±3.35) mm in the control group (P<0.05). The time to peak and PVV in the research group were (47.19±6.58) s and (10.69±2.43) cm/s, respectively, which were significantly lower than those of (79.23±10.17) s and (14.98±3.65) cm/s in the control group (P<0.05). The values of aspartate aminotransferase, activated partial thromboplastin time (APTT), and alanine aminotransferase in the research group were 21.07±3.45 U/L, (27.15±4.38) s, and (29.48±4.71) U/L, respectively, which were significantly lower than those of 27.84±4.90 U/L, (30.24±5.66) s and (42.53±5.89) U/L in the control group (P<0.05). The D-dimer level in the research group was (3.19±0.57) mg/mL, which was significantly higher than that of (1.46±0.93) mg/mL in the control group (P<0.05). The Peak intensity (OR=5.135, 95%CI: 2.257~11.680), AUC (OR=4.540, 95%CI: 1.996~10.328), PVD (OR=5.801, 95%CI: 2.550~13.196), time to peak (OR=4.242, 95%CI: 1.865~9.649), PVV (OR=4.513, 95%CI: 1.984~10.267), and APTT (OR=0.237, 95%CI: 0.104~0.540) were identified as influencing factors for portal vein thrombosis in liver cirrhosis (P<0.05).The sensitivity of the nomogram model in the diagnosis of portal vein thrombosis was 89.69% (95%CI: 73.41%~94.15%), the specificity was 91.07% (95%CI: 74.28%~96.43%), and the AUC was 0.905 (95%CI: 0.882~0.963). Conclusion The diagnostic model of liver cirrhosis complicated with portal vein thrombosis which was constructed based on quantitative parameters (AUC, peak intensity, peak time) and ultrasonic blood flow parameters (PVD, PVV) is helpful for early screening of the risk patients.
    The application of stress echocardiography in evaluating left heart function reserve in patients with liver cirrhosis
    ZHANG Xu-hui, MENG Fan-kun
    2024, 29(8):  910-913. 
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    Objective To observe the changes of left ventricular function in patients with hepatitis B-related cirrhosis and alcoholic cirrhosis before and after the standard isometric grip test, and to evaluate the left ventricular function reserve of patients in these two groups under stress. Methods Sixty patients with hepatitis B-related cirrhosis and 62 patients with alcoholic cirrhosis were selected in this study. The two groups of patients were further divided into Child A group and Child B+C group according to Child-Pugh classification. Standard isometric grip test was carried out to measure the left ventricular Tei index of patients before and after the load test, and analyze the difference of cardiac function between the two groups of patients before and after the load test. Results 1. The Tei index of patients with hepatitis B-related cirrhosis (0.43±0.03 vs 0.45±0.07) and alcoholic cirrhosis (0.44±0.05 vs 0.46±0.08) before and after the experiment had statistical significance (P<0.05). 2. There was no statistical difference in Tei index before and after the experiment in Child A group, Child B+C group of patients with hepatitis B-related cirrhosis and Child A group of patients with alcoholic cirrhosis (P>0.05). However, there was statistical difference in Tei value before and after the experiment in Child B+C group of patients with alcoholic cirrhosis (0.44±0.04 vs 0.47±0.07) (P<0.05). Conclusion While the cardiac structure and function of patients with hepatitis B-related cirrhosis and alcoholic cirrhosis are roughly the same at rest, the cardiac function of patients in both groups has decreased after stress test. There has application value of stress echocardiography in reflecting left heart function reserve under stress in patients with liver cirrhosis, and the cardiac reserve function of patients with decompensated alcoholic cirrhosis has decreased more significantly.
    An observation of SAAG, LDH, CA199, and CA125 levels in hepatitis B-related cirrhotic patients with ascites
    LI Xiao-ling, DU Hai-gang
    2024, 29(8):  914-918. 
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    Objective To investigate the levels of Serum-Ascites Albumin Gradient (SAAG), Serum Lactate Dehydrogenase (LDH), Cancer Antigen 199 (CA199), and Cancer Antigen 125 (CA125) in hepatitis B-related cirrhotic patients with ascites, in order to assess the application value of these biochemical markers in the diagnosis and treatment of this condition. Methods A retrospective analysis was conducted on the clinical data of 94 hepatitis B-related cirrhotic patients with ascites collected from June 2018 to June 2022. According to the Child-Pugh classification of liver cirrhosis, patients were classified into Group A (liver function class A, n=23), Group B (liver function class B, n=46), and Group C (liver function class C, n=25). The levels of SAAG, serum LDH, CA199, and CA125, as well as the prognosis of patients across different liver function classifications were compared. Logistic regression analysis was used to analyze the relationship between the levels of SAAG, serum LDH, CA199, CA125, and liver function classification. The survival curves for patients with different levels of SAAG and serum markers were plotted. The risk factors affecting patient survival were analyzed. Results Patients in Group C had significantly higher levels of SAAG (22.34±2.69 g/L), serum LDH (318.50±22.56 IU/L), CA199 (112.87±66.92), and CA125 (319.41±98.43) compared to those of Group A [SAAG(15.97±2.64 g/L), serum LDH (281.97±21.82 IU/L), CA199 (8.09±5.94), CA125 (19.27±13.91)] and Group B [SAAG(18.86±2.61 g/L), serum LDH(303.42±21.73) IU/L, CA199 (60.52±40.63), CA125(210.56±134.76)], with statistical significance (P<0.05). The deceased group exhibited higher levels of SAAG (21.07±2.84 g/L), serum LDH (309.86±22.57 IU/L), CA199 (86.57±28.85), and CA125 (268.14±58.71) compared to the survival group [SAAG (18.82±2.62 g/L), serum LDH (289.47±21.93 IU/L), CA199 (39.42±13.64), CA125 (103.63±21.43), also with statistical significance (P<0.05)]. The ROC curve analysis shows that the AUCs for SAAG, serum marker levels, and combined diagnosis for liver function grading are 0.863, 0.885, and 0.971, respectively. The sensitivity and specificity of the combined diagnosis are 98.6% and 95.7%, respectively. Logistic regression analysis indicates that high levels of SAAG and serum markers at admission are independent risk factors for patients’ liver function being classified as Grade C (P<0.05); Patients with high levels of SAAG (≥21.68 g/L) at admission have a lower 18-month survival rate than those with low levels of SAAG (<21.68 g/L) (P<0.05). Conclusion Elevated levels of serum SAAG, LDH, CA199, and CA125 in hepatitis B-related cirrhotic patients are associated with the development of ascites. These biochemical markers can serve as auxiliary diagnostic tools for ascites in hepatitis B-related cirrhotic patients, which may facilitate early diagnosis and monitoring disease.
    The association between the value of real-time shear wave elastography combined with serum IL-6/IL-22 levels and liver fibrosis in patients with autoimmune liver diseases
    YU Min, ZHONG Ji-feng, JI Yu
    2024, 29(8):  919-923. 
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    Objective To investigate the value of real-time shear wave elastography (SWE) combined with serum interleukin-6 (IL-6)/interleukin-22 (IL-22) levels in evaluating hepatic fibrosis (HF) of patients with autoimmune liver diseases (AILD). Methods A total of 130 patients with AILD admitted to Haian Hospital of Traditional Chinese Medicine from June 2021 to September 2022 were selected as the study subjects. SWE examination was performed and blood routine, liver function, IL-6 and IL-22 levels were determined in all patients. HF staging was evaluated according to liver biopsy and Metavir staging system. Among 108 patients with fibrosis stage F1 to F4, patients with primary biliary cirrhosis (PBC) were treated with ursodeoxycholic acid in combination with prednisolone, and patients with autoimmune hepatitis (AIH) were treated with prednisolone tablets in combination with azathioprine tablets orally for 6 months. Young’s modulus and serum IL-6/IL-22 levels were compared at each stage of HF. The correlation between Young’s modulus and serum IL-6/IL-22 levels and the four items of liver fibrosis and FIB-4 were analyzed by Pearson method. The diagnostic efficiency of Young’s modulus combined with serum IL-6/IL-22 levels for the diagnosis of HF were analyzed by receiver operating characteristic curve (ROC) method. Young’s modulus and serum IL-6/IL-22 levels were observed after 6 months of treatment. Results The Young’s modulus and IL-6/IL-22 levels in the cirrhosis group were 14.50±3.92 kPa and 2.46±0.35, respectively, which were higher than those of 11.17±2.78 kPa and 2.15±0.31 in the advanced HF group, 7.29±1.56 kPa and 1.92±0.28 in the HF group, as well as 4.93±0.71 kPa and 1.67±0.24 in the non-HF group (t=34.681, 13.275, all P<0.05). Pearson analysis showed that Young’s modulus value and serum IL-6/IL-22 level in AILD patients were positively correlated with laminin (LN), hyaluronic acid (HA), type III procollagen (PC-Ⅲ), type IV collagen (Ⅳ-C) and FIB-4 levels (P<0.01). After treatment, the Young’s modulus and serum IL-6/IL-22 levels in AILD patients with HF were 6.90±1.48 kPa and 1.78±0.23 in the effective group, which were lower than 8.35±1.87 kPa and 1.90±0.27 in the effective group, and 9.51±2.24 kPa and 2.04±0.29 in the ineffective group. The difference was statistically significant (t=17.256, 9.037, all P<0.05). The ROC curve analysis showed that the AUC, sensitivity and specificity of Young’s modulus combined with IL-6/IL-22 level in the diagnosis of HF stages of AILD patients were higher than any single efficacy (P<0.05). Conclusion SWE combined serum IL-6/IL-22 level is closely related to the severity of HF in AILD patients, which can objectively reflect and be used to dynamically monitor the treatment effect and the prognosis of disease.
    The relationship between serum miR-122 levels and the degree of liver fibrosis in patients with hepatitis B-related cirrhosis
    SUN Ying, KONG Yan, ZHAO Dan-mei, CHEN Ying-qing
    2024, 29(8):  924-928. 
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    Objective To investigate the association between serum miR-122 levels and the severity of liver fibrosis in hepatitis B-related cirrhotic (HBV-LC) patients. Methods A total of 98 blood samples were collected from HBV-LC patients from May 2022 to December 2023, forming the HBV-LC group. Meanwhile, blood samples from 40 healthy individuals were collected as the control group. Serum miR-122 expression levels and liver biochemical markers were tested in all participants. The HBV-LC group was divided into stage S0 (19 cases), S1 (22 cases), S2 (23 cases), S3 (18 cases), and S4 (16 cases) based on the degree of liver fibrosis. The differences in miR-122 and liver biochemical markers across different stages were compared. The correlation between serum miR-122 levels and fibrosis markers were analyzed. A logistic regression model was used to analyze the risk factors for liver fibrosis in the HBV-LC group, and a ROC curve was constructed. Results In the HBV-LC group, the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBil), alpha-fetoprotein (AFP), gamma-glutamyltransferase (GGT), and the expression level of miR-122 were (59.80±13.60) U/L, (67.89±14.94) U/L, (19.07±4.20) μmol/L, (13.06±3.88) ng/mL, (76.46±20.31) U/L, and (4.03±1.38), respectively, which were significantly higher than those of (23.23±5.17) U/L, (21.22±4.98) U/L, (11.33±3.05) μmol/L, (3.54±1.12) ng/mL, (29.81±7.28) U/L, (1.25±0.37) in the control group (P<0.05). With the progression of liver fibrosis stages, the levels of ALT, AST, TBil, AFP, GGT increased, whereas the miR-122 expression decreased (P<0.05). Serum miR-122 expression levels in the HBV-LC group were negatively correlated with AFP, AST, ALT, GGT, Fibrosis-4 Index (FIB-4), AST to Platelet Ratio Index (APRI), TBIL, and Forns index (P<0.05). The result of Logistic regression analysis indicated that alcohol consumption and lower serum miR-122 expression levels are risk factors for liver fibrosis in HBV-LC patients (P<0.05). The ROC curve analysis demonstrated that miR-122 expression levels have a high diagnostic efficiency for liver fibrosis (S1~S4) with an area under the curve of 0.939, a sensitivity of 94.7%, and a specificity of 91.1%. Conclusion The study shows that serum miR-122 levels decrease as liver fibrosis worsen in patients with hepatitis B virus-related cirrhosis and are significantly correlated with liver biochemical markers and fibrosis markers. Alcohol consumption and low serum miR-122 expression are important risk factors for the progression of liver fibrosis. Therefore, serum miR-122 expression levels may serve as an effective biomarker for assessing the degree of liver fibrosis in patients with HBV-LC and predicting disease progression, thus offering significant clinical application value.
    An analysis on the efficacy of MRI multi-B-value imaging combined with 64-slice spiral CT in the diagnosis of liver regenerating nodules in hepatitis B-related cirrhotic patients
    ZHOU Pei-yu, WU Yi
    2024, 29(8):  929-933. 
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    Objective To analyze the value of magnetic resonance imaging (MRI) combined with 64-slice spiral computed tomography (CT) in the diagnosis of liver regenerating nodules in hepatitis B-related cirrhotic patients. Methods The clinical data of 69 patients with space occupying liver lesions and hepatitis B-related cirrhosis admitted from March 2020 to July 2022 were retrospectively analyzed. They were divided into a control group (n=24, with cancerous nodules in liver) and a study group (n=45, with regenerative nodules in liver) according to pathological diagnosis. All patients received MRI multi-B value imaging examination and 64-slice spiral CT examination. General data, CT values of portal vein and aorta scanning in different periods, and CT values of hepatic parenchyma scanning in different periods were compared between the two groups. The pathological diagnosis was taken as the gold standard. The consistency of 64-slice spiral CT, MRI multi-B-value imaging, and pathological diagnosis results was analyzed. Receiver operating characteristic curve (ROC) was made while the area under the curve (AUC) was used to evaluate the diagnostic value of MRI multi-B-value imaging, 64-slice spiral CT and their combination in liver regenerating nodules in patients with hepatitis B-related cirrhosis. Results The pathological results showed that there were 37 cancerous nodules detected in the control group and 98 regenerated nodules detected in the study group. There were no differences in the sex, age, Scheuer stage of cirrhosis and nodule diameter between the two groups (P>0.05). The delayed phase and arterial phase of portal vein, the portal phase and arterial phase of aorta, the arterial phase, portal phase and delayed phase of hepatic parenchyma of CT values in the study group were higher than those of the control group (P<0.05). The values in the study group were higher than those of the control group (P<0.05). The Kappa values of MRI multi-B value imaging, 64-slice spiral CT and their combination in the diagnosis of liver regeneration nodules and pathological diagnosis in patients with hepatitis B-related cirrhosis were 0.821, 0.758 and 0.897, respectively, showing good consistency (P<0.05). The result of ROC curve analysis showed that the AUC values of MRI multi-B-value imaging, 64-slice spiral CT and the combined diagnosis of liver regenerating nodules in hepatitis B-related cirrhotic patients were 0.792, 0.739 and 0.942, respectively (P<0.05). Conclusion MRI multi-B-value imaging combined with 64-slice spiral CT is of an higher value in the diagnosis of liver regenerating nodules in hepatitis B-related cirrhotic patients.
    Analysis of predictive value of serological indicators combined with Child-Pugh score on rebleeding after EVL in patients with liver cirrhosis complicated with esophageal varices bleeding
    HU Jing, YI Ting-zhuang, NONG Xin-lei, WANG Tong-hua
    2024, 29(8):  934-938. 
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    Objective To analyze the predictive value of serological indicators combined with Child-Pugh score on rebleeding after esophageal variceal ligation (EVL) in patients with liver cirrhosis complicated with esophageal varices bleeding (EVB). Methods 97 patients with liver cirrhosis and EVB who received EVL treatment in our hospital between September 2020 and September 2022 were enrolled, and divided into rebleeding group (n=31) and non-rebleeding group (n=66) according to whether rebleeding occurred within 6 months after EVL. Clinical data of patients were collected. Multivariate logistic regression analysis was used to analyze the related factors affecting rebleeding after EVL in patients with liver cirrhosis and EVB, and the predictive value of serological indicators combined with Child-Pugh score on rebleeding after EVL in patients with liver cirrhosis and EVB was analyzed by receiver operating characteristic curve (ROC) and area under the curve (AUC). Results Multivariate logistic regression analysis showed that Child-Pugh grading (OR=2.259, 95%CI: 1.040-4.909), portal vein diameter (OR=2.933, 95%CI: 1.509-5.700), APTT (OR=1.451, 95%CI: 1.158-1.817), PT (OR=1.982, 95%CI: 1.120-3.506) and Child-Pugh score (OR=3.834, 95%CI: 1.849-7.950) were the risk factors of rebleeding after EVL in patients with liver cirrhosis and EVB, and PLT (OR=0.585, 95%CI: 0.369-0.927) and Alb (OR=0.824, 95%CI: 0.723-0.940) were the protective factors effecting rebleeding after EVL in patients with liver cirrhosis and EVB (P<0.05). The results of ROC showed that the AUCs of PLT, APTT, PT, Alb, Child-Pugh score and the combination of the above indicators in predicting rebleeding after EVL in patients with liver cirrhosis and EVB were 0.800, 0.671, 0.729, 0.721, 0.789 and 0.916 respectively, and the sensitivities were 83.9%, 64.5%, 71.0%, 77.4%, 80.6% and 87.1%, and the specificities were 63.6%, 68.2%, 75.8%, 66.7%, 65.2% and 74.2% respectively. Conclusion Child-Pugh grading, portal vein diameter, PLT, APTT, PT, Alb and Child-Pugh score are the influencing factors of rebleeding after EVL in patients with liver cirrhosis complicated with EVB. Serological indicators of PLT, APTT, PT and Alb combined with Child-Pugh score can help to enhance the predictive value on rebleeding after EVL in patients with liver cirrhosis complicated with EVB.
    The effect of exogenous thyroid hormone T3 on liver cell proliferation and apoptosis in alcoholic liver fibrosis mice
    FENG Jia-yang, LI San-qiang, LUO Ren-li, CUI Qin-yi, ZHANG Kai-jie, ZHANG Ming-hang
    2024, 29(8):  939-942. 
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    Objective Exploring the effects of exogenous thyroid hormone T3 on liver cell proliferation and apoptosis in alcoholic liver fibrosis in mice. Methods Thirty eight healthy SPF grade C57BL/6N male rats aged 6-8W were divided into five groups: six mice in the normal control group, eight in the model group and eight in the three different doses of T3 intervention groups. The control group was fed with TP4060C liquid control diet for 8W, the model group and T3 intervention groups were fed with TP4060A alcohol diet for 8W and gavage with 31.5% alcohol from the 3rd week to establish an alcoholic liver fibrosis model. Starting from the 6th week, mice in the intervention group were injected intraperitoneally with different doses of T3 daily until the 8th week. Blood samples were taken from the eyeballs of all mice to detect serum transaminase (ALT, AST) activity. Liver samples were dissected for HE staining and Sirius red staining; Western blot was used to detect the expression levels of PCNA, Caspase-9, and a-SMA. Results The ALT activity (35.544 ± 4.039) and AST activity (78.250 ± 9.307) in the model group were higher than those in the normal group (ALT activity: 14.336±3.553; AST activity: 40.842±3.834, P<0.05), but the serum ALT activity (25.242 ± 3.469, 22.940 ± 4.566, 27.556 ± 4.609) in the T3 intervention groups was lower than that in the model group (P<0.05); At the same time, the AST activity of T3 intervention groups (52.213 ± 9.664, 40.938 ± 7.565, 48.696 ± 12.443) was also decreased in varying degrees compared with the model group (P<0.05). Immunoblotting showed that PCNA (0.475 ± 0.019, 1.001 ± 0.034, 0.876 ± 0.015, 0.618 ± 0.035, 0.906 ± 0.092), caspase-9 (0.832 ± 0.024, 1.23 ± 0.054, 1.040 ± 0.035, 0.943 ± 0.036, 1.114 ± 0.072), a-SMA (0.592 ± 0.046, 1.037 ± 0.043, 0.892 ± 0.028, 0.715±0.034、0.854±0.047) in the five groups of mice, the relative expression levels of the three factors in the model group were higher than those in the normal group (P<0.05), and the relative expression levels of the three factors in the T3 intervention group were lower than those in the model group (P<0.05). Conclusion Adequate supplementation of thyroid hormone T3 can inhibit the activation of HSC in liver fibrosis mice, thereby inhibiting liver cell apoptosis.
    Viral Hepatitis
    Study on the clinical characteristics and genotype of direct-acting antiviral therapy failure in treatment of hepatitis C
    CUI Rui, MA Zhi, YANG Tian-fen, ZHOU Hao-jun, LI Ping-ping
    2024, 29(8):  943-946. 
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    Objective To explore the clinical and genotypic characteristics of patients with chronic hepatitis C (CHC) who experienced treatment failure with direct-acting antiviral drugs (DAAs). Methods Between September 2021 and December 2022, 28 patients who failed in DAA treatment in our hospital were selected as the observation group, and 100 patients who succeeded in DAA treatment in the same period were selected as the control group. Liver function was detected by enzyme method, hepatitis C virus (HCV) genotype was detected by PCR- reverse hybridization method, and drug resistance-associated substitution mutation (RAS) fragment was detected by Sanger sequencing method. The clinical characteristics and genotype characteristics of patients in DAA observation group were analyzed. Results There were 23 cases (82.1%) and 34 cases (34.0%) with HCV-RNA load > 105 IU/ml in the observation group and the control group respectively, and the difference was statistically significant (χ2=20.526, P=0.001). In DAA treatment observation group, the TBIL and DBIL of male patients were 14.61(10.98-20.78) μmol/L and 4.94(3.08-7.48) μmol/L, respectively, which were significantly higher than those of female patients [6.65(4.90-8.40) μmol/L and 2.50(1.78-3.07) μmol/L, Z=- 2.018, -2.456, P=0.010 and 0.010, respectively]. Three HCV genotypes were detected in the included patients, namely 1b, 2a and 3b, and 26 of them were undetected. HCV 1b, 2a and 3b genotypes in the observation group were 11 (39.3%), 6 (21.4%) and 5 (17.8%), of while in the control group were 56 (56.0%), 15 (15.0%) and 9 (9.0%), respectively. NS5A and NS5B2 gene fragments were detected in DAA treatment observation group, but the incidence of RAS was different. Conclusion Patients who experience DAA treatment failure are influenced by factors such as patient gender, viral load, genotypic variations, and types of RAS.
    Correlation between HBV DNA load and serum miR-122, miR-223 levels in patients with chronic hepatitis B
    YANG Li, SUN Jun
    2024, 29(8):  947-951. 
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    Objective Exploring the correlation between hepatitis B virus deoxyribonic acid (HBV DNA) load and serum microRNA-122 (miR-122) and microRNA-223 (miR-223) levels in patients with chronic hepatitis B (CHB). Methods The clinical data of 540 patients with CHB who received treatment in our hospital from June 2022 to March 2023 were retrospectively analyzed. According to the serum HBV DNA load, the patients were divided into low load (＜105 copies/mL) group (n=230), medium load (105~107 copies/mL) group (n=180) and high load (> 107 copies/mL) group (n=130). Another selection of 300 healthy subjects was made during the same period in our hospital physical examination center to serve as control group. Serum miR-122 and miR-223 levels were compared in different HBV DNA load groups, ROC curve was drawn to evaluate the diagnostic efficacy of serum miR-122 and miR-223 in CHB, and the risk factors of CHB were analyzed by multivariate logistic regression. Pearson correlation analysis was used to investigate the correlation between HBV DNA load and serum levels of miR-122 and miR-223. Results Serum miR-122 (1.45±0.37, 2.84±0.72, 4.11±0.90) and miR-223 (1.34±0.33, 1.69±0.37, 1.91±0.45) were significantly different among the three groups (F=716.128, 104.744, P<0.05). The proportion of serum miR-122 (2.56±0.49), miR-223 (1.79±0.42) and HBV DNA load > 105 copies/mL in CHB group (310/540) was significantly higher than that in control group (1.07±0.21, 1.05±0.30, 75/300) (t=51.844, 26.935, χ2=81.585, P<0.05); ROC analysis confirmed that serum miR-122 and miR-223 levels could be used to predict CHB, and the areas under the curve were miR-122 (AUC=0.794, 95%CI: 0.690~0.898) and miR-223 (AUC=0.813, 95%CI: 0.720~0.906), all P<0.05; Multivariate logistic regression analysis showed that miR-122 ≥ 1.528, miR-223 ≥ 1.210 and HBV DNA load > 105 copies/mL were risk factors for CHB. OR values were 2.011 (95%CI: 1.211~3.339), 1.696 (95%CI: 1.026~2.804), 2.117 (95%CI: 1.974~3.987), and P<0.05, respectively. Correlation analysis showed that serum miR-122 and miR-223 levels were positively correlated with HBV DNA load (r=0.753, 0.712, P<0.05). Conclusion Serum miR-122 and miR-223 levels were positively correlated with HBV DNA load, and miR-122≥1.528, miR-223≥1.210 and HBV DNA load > 105 copies/mL were risk factors for CHB. These indexes could be used as biological markers for the diagnosis of CHB so as to provide references for clinical condition evaluation and treatment.
    Liver Cancer
    MRI combined with DWI and DCE scanning sequences to evaluate hepatitis B hepatocellular carcinoma and differentiate it from benign lesions with rich blood supply in the liver
    BAI Ling, YIN Hui-kang, GE Qi, GENG Cheng-jun
    2024, 29(8):  952-955. 
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    Objective To analyze the value of MRI combined with DWI and DCE scanning sequences in the evaluation of hepatitis B hepatocellular carcinoma and the identification of benign lesions with rich blood supply in the liver. Methods A total of 109 patients with hepatitis B-related hepatocellular carcinoma and benign liver lesions who were admitted for diagnosis and treatment between August 2020 and June 2023 were selected. According to whether the patients had liver cancer or not, they were divided into a liver cancer group (n=60) and a benign lesion group (n=49). According to the histologic grade of hepatocellular carcinoma, patients were further divided into a low-grade liver cancer group (n=39) and a high-grade liver cancer group (n=21). The perfusion imaging parameters of the low-grade and high-grade liver cancer groups, and the liver cancer and benign lesion groups were compared. The correlation coefficients between different perfusion parameters and microvascular density and pathological grading were analyzed. Additionally, ROC curves were constructed to evaluate the diagnostic performance of different perfusion parameters for identifying hepatocellular carcinoma. Results The values of perfusion imaging parameters in the high-grade liver cancer group can be seen to be significantly lower than those in the low-grade liver cancer group, with D values and Ve values in the high-grade group being (0.82 ± 0.56) × 10-3 mm2/s and 0.10 ± 0.04, respectively, compared to (1.43 ± 0.75) × 10-3 mm2/s and 0.29 ± 0.07 (P<0.05) in the low-grade group. Comparing the perfusion imaging parameter values between the liver cell carcinoma group and the benign lesion group, the D value, D* value, Ktrans value, and Ve value in the liver cell carcinoma group were (0.92 ± 0.59) × 10-3 mm2/s, (48.14 ± 22.93) × 10-3 mm2/s, (0.38 ± 0.22) min-1, and (0.14 ± 0.06), respectively, all significantly lower than those in the benign lesion group ((1.83 ± 0.81) × 10-3 mm2/s, (62.64 ± 32.43) × 10-3 mm2/s, (0.61 ± 0.25) min-1, and (0.38 ± 0.11), P<0.05). Analyzing the correlation coefficients between different perfusion parameters and microvessel density and pathological grading, it can be seen that the Ktrans value, Kep value, D* value, and f value were significantly positively correlated with microvessel density, while Ve value and D value were significantly negatively correlated with pathological grading. Analyzing the ROC curve of different perfusion parameters for diagnosing liver cell carcinoma, the efficiency order of parameters for diagnosing liver cell carcinoma is Ktrans > Kep > f > D* > D > Ve. Conclusion The IVIM-DWI technique is slightly superior to the dual-compartment model pathological grading of DCE-MRI in evaluating the degree of hepatocellular carcinoma (HCC). The combined application of both methods can improve the diagnostic performance of HCC microcirculation functional status and microstructure. However, using either method alone can still demonstrate good diagnostic value.
    Analysis of the correlation between the expression of PPP2R3A gene and prognosis in patients with HBV-related hepatocellular carcinoma
    TIAN Yi-cheng, TANG Zu-xiong, RU Gan, WANG Qi, ZHAI Chun-tao
    2024, 29(8):  956-959. 
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    Objective To investigate the expression level of protein phosphatase 2A regulatory subunit B alpha (PPP2R3A) gene in patients with Hepatitis B virus (HBV) related hepatocellular carcinoma and its relationship with prognosis. Methods Utilizing the immunohistochemical method, we analyzed the expression levels of PPP2R3A protein in 82 samples of HBV-related hepatocellular carcinoma and 21 cases of benign liver disease. Additionally, the RT-PCR technique was applied to quantify the mRNA levels. Results Our findings revealed that the PPP2R3A protein expression in liver cancer tissue(95.12%) was substantially elevated compared to its levels in pericancerous tissue(43.9%), with statistical significance (P<0.05). There was a notable correlation between the expression intensity of PPP2R3A protein and the AFP value of liver cancer patients, exhibiting statistical difference (P<0.05). RT-PCR analysis indicated that the median mRNA expression level of PPP2R3A in HCC tissues was 0.183 (0.008~0.667), which was significantly higher than that in adjacent tissues (0.098 (0.004~0.583) (Z=6.839, P<0.05). By analyzing the survival data of follow-up HCC patients, it was found that the median overall survival (OS) of patients in the PPP2R3A high expression group was 46.6 months, which was significantly different from that in the low expression group (82.9 months) (P<0.05). The median survival of RFS in patients PPP2R3A the high-expression group was 18.3 months, which was lower than that in the low-expression group (42.6 months) (P<0.05). The median survival of PFS in patients PPP2R3A the high-expression group was 15.9 months, which was lower than that in the low-expression group (34.4 months) (P<0.05). The median survival of DSS in patients PPP2R3A the high-expression group was 70.5 months, which was lower than that in the low-expression group (84.7 months) (P<0.05). Conclusion The high expression of PPP2R3A protein in HBV-related hepatocellular carcinomar tissue and serum is related to the clinicopathological characteristics of liver cancer, which may be related to the poor prognosis of liver cancer.
    Evaluation of imaging differences in different molecular subtypes of hepatocellular adenoma
    LIAO Zhong-yang, LI Hang, CHEN Yong-song
    2024, 29(8):  960-964. 
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    Objective To analyze the differences in imaging manifestations of different molecular subtypes of hepatocellular adenoma (HCA). Methods From January 2015 to December 2022, 100 HCA patients diagnosed and treated in our hospital were divided into inflammatory HCA (I-HCA, 62 cases) and liver cell nuclear factor 1 based on their molecular subtypes α Deactivated HCA (H-HCA, 22 cases) β- Chain protein activated HCA (B-HCA, 9 cases), unclassified HCA (U-HCA, 7 cases). Provide patients with ultrasound and magnetic resonance imaging examinations to analyze the differences in imaging manifestations among patients with different molecular subtypes. Results The ultrasound characteristics showed that there was a statistically significant difference in comparing the internal echoes, blood flow signals, delayed phase enhancement intensity, and subcapsular enhanced vascular shadows of different molecular subtypes of HCA (P<0.05). After magnetic resonance imaging examination, there was a statistically significant difference in T2WI signals, enhancement methods, and fatty liver among different molecular subtypes of HCA (P<0.05). Conclusion The ultrasound and magnetic resonance imaging manifestations of different molecular subtypes of HCA vary. Among them, I-HCA mainly presents as low echo, semi circular or circular blood flow signal, low enhancement in the delay phase, enhancement of blood vessels under the capsule, high signal on T2WI, continuous enhancement, and accompanied by fatty liver. H-HCA is characterized by high echo and overall high enhancement in the arterial phase, while B-HCA and U-HCA have fewer cases and no significant specificity in imaging manifestations, It needs to be improved in future research.
    Drug-Induced Liver Injury
    Analysis of the influence of bile duct injury of the Clinical and pathological characteristics of immune-mediated liver injury
    WANG Yan, LIU Li-wei, ZHAO Meng-yu, CHEN Wei, ZHAO Xin-yan
    2024, 29(8):  965-970. 
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    Objective To explore the clinical features of immune-mediated liver injury induced by PD-1 inhibitors. Methods A retrospective study including patients with malignancies treated with PD-1 inhibitors and diagnosed with immune mediated liver injury hospitalized in Beijing Friendship Hospital between April 2016 and December 2022 was conducted. Patients were categorized into Common Terminology Criteria for Adverse Events (CTCAE) levels 0, 1, 2 and 3 based on serum alkaline phosphatase (ALP) levels classified according to CTCAE 5.0. A comparative analysis was conducted on the clinical presentations, imaging results, and pathological findings of the aforementioned groups. ANOVA test or non-parametric test was used for continuous variables, the chi-square test for categorical variables, and the Bonferroni correction for multiple comparisons. A significance level of P<0.05 is typically used to determine statistical significance. Results A total of 42 cases of immune-mediated liver injury were included in this study. Based on the ALP grading criteria outlined in CTCAE 5.0, 13 patients were classified as grade 0, 14 as grade 1, 8 as grade 2, and 7 as grade 3. Serum bilirubin levels were significantly elevated in patients classified as CTCAE grade 3 compared to those in grades 0~2 [(24.5 (17.2, 47.1), 25.5 (17.2, 65.5), 21.3 (19.6, 263.8) and 153.0 (43.0, 525.3) μmol/L, respectively P=0.036]. Three patients who underwent abdominal CT or MRI showed alterations in the biliary system, such as thickening and edema of the gallbladder wall, irregular narrowing and dilation of the extrahepatic bile duct. Additionally, two cases received liver biopsy, which revealed bile duct hyperplasia, disorganized arrangement of bile duct epithelium, and interstitial edema within the portal tract. Conclusion Over half of the patients with PD-1 related liver injury may exhibit elevated levels of bile duct enzymes, suggestive of bile duct injury. Part of the patients have imaging changes of bile duct systems. Liver pathology is significant for identifying inflammation and damage to the small bile ducts.
    Clinical manifestations, imaging features, and recovery in pharmacological cholestatic liver injury: an analytical approach
    GAO Shuo-yu, ZHANG Qin, ZHANG Shuai, YAO Bo-yang
    2024, 29(8):  971-974. 
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    Objective To analyze the clinical manifestations, imaging features and prognosis of patients with drug-induced cholestatic liver injury. Methods Between March 2020 and March 2022, our hospital diagnosed 47 patients with drug-induced cholestatic liver injury, comprising 29 males and 18 females, with an average age of 55.5±7.1 years. We analyzed the patients age, medication history, clinical manifestations, causative drugs, and imaging findings. Additionally, we compared clinical data based on different prognostic outcomes and identified factors influencing prognosis. Results Among 47 patients diagnosed with pharmacological cholestatic liver injury, age distribution was aas follows: 3 patients(6.4%) were under 40 years old, 23 patients(48.9%) were between 40-60 years old, and 21 patients(44.7%) were over 60 years old. The duration of medication ranged from 3 to 150 days, with a median of 13 days(IQR 3, 25days).Tthe latency period varied from 2 to 180 days, with a median of 21 days(IQR 10, 32days). 42 patients (89.4%) exhibted one or more clinical symptoms, while 5 patients (10.6%) displayed only liver function abnormalities without conscious symptoms. Among the causative agents, a total of 74 drugs were identified, with 31 patients (65.9%) being exposed to more than one causative drug. The top five categories of drugs included Chinese herbs(21 cases, 44.7%), antimicrobials(16 cases, 34.0%), anti-tuberculosis drugs(14 cases, 29.8%), digestive system drugs(13 cases, 27.6%), and antitumor drugs(7 cases, 14.9%). Disease severity was categorized into four levels: level 1 (19 cases, 50.0%), level 2(17 case, 44.7%), level 3 (6 cases, 15.8%), and level 4(5 cases, 13.1%). 30 patients (63.8%) underwent magnetic resonance cholangiopancreatography(MRCP), while the remaining patients underwent B-ultrasound or abdominal CT examination. Imaging revealed sclerosing cholangitis-like changes in 10 patients (21.3%), including extrahepatic strictures (5 cases, 10.6%), strictures of both intrahepatic and extrahepatic bile ducts(3 cases, 6.4%), and hilar bile duct strictures(2 cases, 4.2%). By October 2023, of the 47 patients, 27 were cured (62.5%), 11 showed improvedment (20.0%), 7 had poor outcomes(12.5%) and 2 died (5.0%), resulting in a total effective rate of 82.5%. Patients were divided into an effective group (cured and improved, n=38) and an ineffective group( poor and deceased, n=9). The clinical and laboratory parameters showed significant differences between the effective and ineffective groups. In the effective group, the age, RUCAM score, WBC, PLT, initial ALP, initial TBil, peak ALP, peak TBil and presnece of sclerosing cholangitis-like changes were 53.5±7.0 years, 8 (IQR 7, 9) points, 5.0 (IQR 3.9, 7.5) × 109/L, 227 (IQR 170, 278) ×109/L, 401.6±37.2 U/L, 126.5±21.3 μmol/L, 436.0±37.2 U/L, 146.3±35.6 μmol/L, and 4 cases (10.5%), respectively. In the ineffective group, these parameters were 62.4±11.3 years old, 6 (IQR 6, 7) points, 7.4 (IQR 5.0, 9.3) × 109/L, 130 (IQR 98, 155) × 109/L, 503.4±54.0 U/L, 150.2±47.0 μmol/L, 634.5±82.6 U/L, 181.2±64.5 μmol/L, and 6 cases (66.7%), respectively, with all the differences being statistically significant (P<0.05). In terms of disease severity, the distribution in the effective group was as follows: level 1, 17 cases (44.7%); level 2, 16 cases (42.1%); level 3, 3 cases (7.9%); and level 4, 2 cases (5.3%). In the ineffective group, the distribution was: level 1, 2 cases (22.2%); level 2, 1 case (11.1%); level 3, 3 cases (33.3%); and level 4, 3 cases (33.3%), with statistically significant differences(P<0.05). Conclusion Most patients with drug-induced cholestatic liver injury have a good prognosis; however, close attention should be paid to those with a low RUCAM score, high peak ALP, high peak TBil, and severe disease.
    Non-Alcoholic Fatty Liver Disease
    Serum lipidomics analysis in non-obese and obese patients with non-alcoholic fatty liver disease
    DING Rong-rong, ZHOU Xin-lan, LI Xiu-fen, HUANG Dan, LIN Wei-jia, CHEN Liang
    2024, 29(8):  975-979. 
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    Objective To compare the serum lipid profiles between non obese and obese patients with non-alcoholic fatty liver disease (NAFLD) patients. Methods A total of 60 NAFLD patients were recruited and categorized into two groups based on body mass index(BMI): non-obese (BMI<25 kg/m2) and obese (BMI ≥ 25 kg/m2) . Serum samples from all patients were analyzed using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS) for lipidomics profiling. Differential lipids were identified through multiple statistical methods, including fold change anaysis, partial least squares discriminant analysis (PLS-DA), and orthogonal partial least squares discriminant analysis (OPLS-DA). Permutation tests were conducted to validate the results. Results A total of 90 differential lipids were identified, Including sphingomyelin (SM), Ether linked phosphatidylcholine (EtherPC), hexosylceramides (HexCer), and phosphatidylethanolamine(PC). KEGG pathway enrichment analysis revealed significant alterations in several metabolic pathways in non-obese NAFLD patients, such as the sphingolipid signaling pathway, necroptosis, glycerophospholipid metabolism pathway, glycosylphosphatidylinositol biosynthetic pathway, and tumor choline metabolism pathway. Conclusion Significant differences in serum lipid mass spectrometry profiles were observed between non-obese and obese NAFLD patients, particularly in PC, PE, SM levels.
    Impact of lifestyle factors on lean non-alcoholic fatty liver disease patients
    YUAN Yi-fu, DU Sheng-nan, HE Shi-jia, Cao Qin, HUA Hong-mei, JIANG Yuan-ye
    2024, 29(8):  980-984. 
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    Objective To investigate the lifestyle characteristics of lean non-alcoholic fatty liver disease (NAFLD) patients and their association with the severity of ultrasound grading. Methods A total of 336 patients with lean NAFLD who attended the outpatient and inpatient departments of the gastroenterology department at Shanghai Putuo District Central Hospital and Shanghai Baiyu Community Health Service Center from December 2019 to December 2021 were selected for a questionnaire survey. Data on general conditions, exercise habits, dietary habits, and other lifestyle factors were collected. Patients were categorized into three groups- mild, moderate, and severe-based on ultrasound results. Descriptive statistics, chi-square test, and ordered logistic regression were utilized to analyze the data. Results Lean NAFLD patients were predominantly female, with ages primarily ranging from 44 to 59 years. Statistically significant differences were observed among patients with varying degrees of lean NAFLD concerning exercise habits, exercise duration, and physical activity levels(χ2=38.381; χ2=142.618; χ2=228.488; P<0.001). Differences in dietary habits were also significant, with preferences for raw and cold foods,fruits and vegetables, and sugary drinks among patients with different degress of leanness(χ2=9.007; χ2=7.631; χ2=6.207; P<0.05). Ordered logistic regression analysis revealed that exercising 1-2 days per week (OR=0.382, P<0.01) and maintaining an ideal physical activity level (OR=0.268, P<0.01) were protective factors against the progression of ultrasound grading severity in lean NAFLD patients. Conversely, a preference for meat (OR=2.677, P<0.001) and sugary beverages (OR=1.330, P<0.05) were identified as independent risk factors for the progression of ultrasound grading severity in these patients. Conclusion Regular and moderate exercise is a protective factor against the progression of lean NAFLD while consumption of meat and sugary drinks are independent risk factors for disease progression in lean NAFLD patients.
    Association between serum uric acid-to-creatinine ratio and metabolic associated fatty liver disease in non-obese patients
    GE Yu, WANG Chao-qun, CHEN Yi, SHEN Ruo-yu, DONG Xu
    2024, 29(8):  985-989. 
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    Objective To investigate the correlation between the serum uric acid/creatinine (sUA/Cr) ratio and metabolic-associated fatty liver disease (MAFLD) in non-obese patients. Methods A retrospective analysis was conducted on individuals who underwent annual physical examinations at the Health Management Center of the First Affiliated Hospital of the Naval Medical University from July to December 2023. The study subjects were divided into three groups: non-obese MAFLD patients (n=669), obese MAFLD patients (n=1594), and non-obese healthy controls (n=116). Ggeneral conditions, baseline liver and kidney functions, blood glucose levels, and lipid profiles, and sUA/Cr levels were compared between the groups. Binary logistic regression was employed to analyze the risk factors for non-obese MAFLD, while ROC curves were used to evaluate the predictive efficacy of sUA/Cr, BMI, ALT, and TG for non-obese MAFLD. Spearman’s test was utilized for correlation analysis. Results Among 8764 individuals undergoing physical examinations, 26.8% were diagnosed with MAFLD, with the non-obese type accounting for 29.6% of all MAFLD cases. Compared to non-obese healthy controls, non-obese MAFLD patients were older, had a higher proportion of males, and sxhibited elevated levels of ALT, AST, γ-GT, AKP, FBG, TG, TC, LDL-C, sUA[345.0(289.0,399.0) vs. 262.0(230.3,306.5)μmol/L], Cr[73.0(61.0,83.3) vs. 60.0(53.0,68.0)μmol/L], and sUA/Cr ratio[4.8(4.1,5.5) vs. 4.3(3.9,4.9)], while HDL-C was lower. These differences were statistically significant (P< 0.05). Binary logistic regression analysis indicated that older age, male gender, BMI, ALT, and TG were independent risk factors for MAFLD in the non-obese population (P< 0.05), while sUA/Cr was not an independent risk factor (P>0.05). ROC curves analysis demonstrated that sUA/Cr (AUC=0.6399, 95%CI 0.5821-0.6857), BMI (AUC=0.8198, 95%CI 0.7715-0.8681), ALT (AUC=0.7868, 95%CI 0.7408-0.8328), and TG (AUC=0.8208, 95%CI 0.7802-0.8613) could predict MAFLD occurrence in non-obese individuals sUA/Cr was not correlated with BMI (r=0.05, P<0.01), ALT (r=0.04, P<0.01) or TG (r=0.02, P<0.01). Using an optimal cut-off value of 4.365 for sUA/Cr, the non-obese population was divided into low and high sUA/Cr groups, with MAFLD incidences of 78.0% and 89.5%, respectively, showing a statistically significant difference (χ2=19.120, P<0.01). Conclusion The sUA/Cr ratio is associated with the occurrence of non-obese MAFLD and can be used to predict the development of non-obese MAFLD by monitoring sUA/Cr levels.
    Other Liver Diseases
    Effect of probiotic-assisted ganciclovir therapy on disease outcomes in neonatal human cytomegalovirus hepatitis
    JIANG Yu-tong, ZENG Rui, FENG Jie, HUO Jin-yuan
    2024, 29(8):  990-993. 
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    Objective To evaluate the efficacy of combined probiotics and ganciclovir treatment on the outcomes of neonatal human cytomegalovirus (HCMV) hepatitis. Methods Between March 2020 and March 2023, 47 neonates with HCMV hepatitis admitted to the Pediatrics Department of Longquanyi District Maternal and Child Health Hospital in Chengdu were randomly divided into an observation group (n=24) and a control group (n=23). The control group received ganciclovir treatment, while the observation group was administered a combination of probiotics and ganciclovir. Treatment efficacy, HCMV DNA load, liver function indicators (alanine aminotransferase [ALT], total bilirubin [TBil], aspartate aminotransferase [AST], total bile acids [TBA]), and levels of inflammatory factors (tumor necrosis factor-alpha [TNF-α], interleukin-6[IL-6]) were compared between the groups. Additionally, growth and development status, recovery time, and the rate of adverse reactions were analyzed. Results The total effective rate of the observation group (93.18%) was significantly higher than that of the control group (76.74%) (P<0.05). After 2 weeks of treatment, the HCMV DNA load in the control group was 8.44 ± 1.42 copies/mL, with a recovery time of 3.87 ± 0.81 weeks. In the observtion group, The HCMV DNA load was 7.41 ± 1.25 copies/mL, with a recovery time of 2.18 ± 0.51 weeks. Both the HCMV DNA load and recovery time were significantly lower in the observtion group compared to the control group (P<0.05). After two weeks of treatment, the liver function indicators in the control group were as follows: ALT 46.33 ± 8.13 U/L, TBil 31.38 ± 7.11 μmol/L, AST 58.42 ± 12.18 U/L, and TBA 14.42 ± 4.17 μmol/L. In the observation group, the corresponding values were ALT 40.92 ± 6.09 U/L, Tbil 28.03 ± 6.03 μmol/L, AST 52.96 ± 10.11 U/L, and TBA 12.08 ± 3.15 μmol/L. The observation group showed significantly better improvement in liver function (P<0.05). After two week, the growth metrics in the control group were: body weight 3914.28 ± 118.11 g, length 53.25 ± 2.23 cm, and head circumference 36.28 ± 0.24 cm. In the observation group, these values were: body weight 3989.79 ± 115.36 g, length 54.61 ± 1.29 cm, and head circumference 36.74 ± 0.18 cm, indicating superior growth (P<0.05); The incidence of adverse reactions was similar between the two groups and not statistically significant (P>0.05). Conclusion The combination of probiotics and ganciclovir in the treatment of neonatal HCMV hepatitis is notably effective. Thhis approach reduces viral load, improves liver function, supports neonatal growth and development, shortens recovery time, and is well-tolerated, ensuring safety.
    Diagnosis and treatment of Klebsiella pneumoniae liver abscesses in 17 diabetic patients
    JIANG Ying, YANG Huan, ZHENG Yi-jia, TU Yan-fang, HUANG Yan-yu, GAO Hai-bing, ZHENG Rui-dan
    2024, 29(8):  994-997. 
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    Objective To investigate the clinical features and summarize the key aspects of diagnosis and treatment in diabetic patients with invasive Klebsiella pneumoniae liver abscess syndrome. Methods From 2017 to 2023, 17 diabetic patients with liver abscess syndrome were selected. All patients exhibited elevated inflammatory markers, abnormal lung imaging, poor blood glucose control, and Klebsiella pneumoniae was identified in pus or blood culture. Prognosis improved through monitoring vital signs, liver abscess puncture and drainage, antibiotic therapy, blood glucose control, and nutritional support. Results In diabetic patients with invasive Klebsiella pneumoniae liver abscess syndrome, comprehensive treatment-including liver abscess puncture and drainage, blood glucose control, and appropriate antibiotic therapy-resulted in normalization of inflammatory markers, effective blood glucose management, absence of postoperative complications , and no detection of pathogenic bacteria in blood culture. Conclusion In the treatment of diabetic patients with invasive Klebsiella pneumoniae liver abscess syndrome, rigorous clinical standards should be established for blood glucose monitoring, liver abscess puncture and drainage, rational antibiotic use, nutritional support, and daily care.