Table of Content

30 September 2024, Volume 29 Issue 9

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Liver Cancer

The establishment of a predictive model for the actual long-term survival after liver resection in hepatitis B-related intrahepatic cholangiocarcinoma

HU Zhi-liang, LI Feng-wei, WANG Kui

2024, 29(9):  1029-1034. 

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Objective To investigate the outcomes of actual long-term survival in patients with hepatitis B virus-related intrahepatic cholangiocarcinoma (ICC) after surgical resection, identify the associated predictive factors, and to establish a nomogram for predicting survival. Methods This study was conducted on ICC patients who underwent liver resection from January 2011 to December 2014 at the eastern hepatobiliary surgery hospital. The patients were divided into a ‘long-term survivor group’ and a ‘short-term survivor group’ according to their 5-years survival. Clinical and pathological characteristics between the two groups were compared using univariate and multivariate logistic regression analyses to identify the independent factors associated with actual long-term survival and establish a predictive nomogram. The model performance was assessed in the testing group. Results A total of 508 patients were collected in this study, with an actuarial long-term survival rate of 23.4%. After excluding 59 survival patients that had less than 5 years of follow-up, 85 patients survived more than 5 years postoperatively, and 364 patients died within 5 years after liver resection, resulting in an actual long-term survival rate of 18.9%. Multivariate logistic regression analysis revealed that HBV DNA > 2000 IU/mL, CA19-9, maximum tumor diameter > 5cm, multiple tumors, peritumoral tissue invasion, vascular invasion, and lymph node metastasis were independent associated factors with patients’ actual long-term survival. The nomogram model built based on independent risk factors had a concordance index (C-index) of 0.831 (95%CI: 0.786-0.876) in the modeling group and 0.804 (95%CI: 0.702-0.906) in the testing group, with the model prediction curve closely aligning with the calibrated prediction curve. Conclusion Nearly 1/5 of patients with HBV-related ICC achieve more than 5 years of long-term survival postoperatively. Long-term survivors typically exhibit lower levels of HBV DNA and CA19-9, solitary tumor with diameter no more than 5cm, and absence of peritumoral tissue invasion, vascular invasion, and lymph node metastasis. The nomogram constructed with independent risk factors can predict long-term survival after liver resection for HBV-related ICC effectively.

The value of contrast-enhanced ultrasound combined with ultrasound elastography in predicting microvascular invasion of hepatocellular carcinoma

CHEN Yuan-li, ZENG De-feng, FAN Hui-wen

2024, 29(9):  1035-1039. 

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Objective To investigate the value of contrast-enhanced ultrasound combined with ultrasound elastography in predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC). Methods The data of 75 patients with HCC admitted from May 2019 to March 2022 were retrospectively analyzed. According to the postoperative pathological examination, the patients were divided into a non-MVI group (n=28) and a MVI group (n=47). All patients were given ultrasound elastography and contrast-enhanced ultrasound before surgery. The quantitative parameters of ultrasound elastography and contrast-enhanced ultrasound were compared between the two groups. The factors affecting the occurrence of MVI in HCC, and the value of contrast ultrasound, elastography and their combination in predicting MVI in HCC were analyzed. Results The clearance time of MVI group was shorter than that of non-MVI group [(60.57±19.45) s vs (83.23±25.74) s, P<0.05]. There was no significant difference between the onset time and peak time between these two groups of patients (P>0.05). Although there was no significant difference in the hardness at 2 cm of tumor edge (S2) between two groups (P>0.05), the hardness at 1 cm of tumor margin (S1) in MVI group and S1/S2 index were higher than those in non-MVI group [(11.89±4.22) kPa vs (10.06±2.15) kPa, (13.04±2.76) vs (010.28±2.18), respectively, (P<0.05)]. The average of tumor length diameter, and the level of aspartate aminotransferase, the proportions of patients with multi-focal tumors and alpha-fetoprotein (AFP) > 400 μg/L in MVI group were higher than those in non-MVI group (P<0.05), whereas the level of albumin and platelet counts in MVI group were lower than those in non-MVI group (P<0.05). The increased tumor length (OR: 2.843, 95%CI: 1.250-6.468), with multi-focal tumors (OR: 3.251, 95%CI: 1.429-7.394), AFP>400 μg/L (OR: 3.999, 95%CI: 1.758-9.097), shortened clearance time (OR:3.504, 95%CI: 1.540-7.972) and increased S1/S2index (OR: 4.272, 95%CI: 1.878-9.717) were the influential factors associated with MVI development of HCC (P<0.05). By receiver operating characteristic curve (ROC) analysis, it was shown that the sensitivity of clearance time, S1/S2index value and their combined prediction of MVI in HCC were 82.98%, 85.11% and 85.11%,, and the specificity was 82.14%, 85.71% and 96.43%, respectively. The area under the curve (AUC) values were 0.781, 0.843 and 0.927 (P<0.05), respectively, and the AUC values of the two combined prediction were higher (P<0.05). Conclusion The clearance time of quantitative parameters of CEUS combined with S1/S2 index value of quantitative parameters of ultrasound elastic imaging has higher value in predicting MVI of HCC.

The predictive value of multiparametric magnetic resonance imaging combined with CT dynamic enhancement on the efficacy of immunotherapy for patients with advanced hepatocellular carcinoma

ZHU Ji-lan, ZHAO Xia, WANG Shi-wei, YANG Lei

2024, 29(9):  1040-1046. 

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Objective To investigate the predictive value of multiparametric magnetic resonance imaging (mpMRI) combined with CT dynamic enhancement on the efficacy of immunotherapy for patients with advanced hepatocellular carcinoma (HCC). Methods 123 patients with advanced HCC diagnosed by histopathological examination of puncture biopsy from August 2020 to August 2022 were selected for the study. All patients received MRI and CT dynamic enhancement examination before immunotherapy. They were randomly divided into a training group and a validation group, Among them, 86 cases were included in the training group and 37 cases were included in the validation group. At 8 weeks after immunotherapy, all patients in the training group were further divided into a control group (32 cases) and a progressive group (54 cases) according to the modified solid tumor efficacy evaluation criteria, and the two groups were compared for MRI parameters [i.e., enhancement rate (ER), fat fraction (FF), maximum downward slope (MSD), maximum upward slope (MSI), mean enhancement time (MET), apparent diffusion coefficient (ADC), volume conversion constant (Ktrans), rate constant (Kep), extravascular extracellular volume fraction (Ve), plasma volume fraction (Vp)] and CT dynamic Enhancement scan quantitative parameters [i.e.,perfusion value, peak enhancement (PH), ratio of mass to peak aortic enhancement (M/A) value, and time to peak mass enhancement (Tp). Spearman’s correlation coefficient was used to analyze the correlation between MRI parameters and quantitative CT dynamic enhancement scan parameters and the efficacy of immunotherapy for advanced HCC. The receiver operating characteristic (ROC) curve were plotted to assess the predictive value of MRI parameters combined with quantitative CT dynamic enhancement scan parameters on the efficacy of immunotherapy for advanced HCC, and the efficacy was validated in the validation group. Results The ER, MSI, and Ktrans in patients of the control group were greater than those in the progressive group, and the ADC and Ve were smaller than those in the progressive group, with statistically significant differences (P<0.05). The perfusion and PH value in the control group were smaller than those in the progressive group, and Tp was larger than that in the progressive group, with statistically significant difference (P<0.05). In the mpMRI parameters, ER and MSI were positively correlated with immunotherapy efficacy (r=0.326, 0.331, both P<0.05), whereas ADC, Ktrans and Ve were negatively correlated with immunotherapy efficacy (r=-0.331, -0.342, -0.350, all P<0.05). In the quantitative parameters of CT dynamic enhancement scan , the perfusion value and PH were negatively correlated with immunotherapy efficacy (r=-0.402, -0.394, both P<0.05), and Tp was positively correlated with immunotherapy efficacy (r=0.387, P<0.05). The area under the curve (AUC) of ER, MSI, ADC, Ktrans, and Ve of the MRI parameters in the training group for predicting immunotherapy efficacy was 0.742, 0.770, 0.761, 0.720, and 0.731, respectively. And the AUCs of perfusion value, PH and Tp of the CT dynamic enhancement scan quantitative parameters for predicting immunotherapy efficacy were 0.730, 0.743, and 0.699, respectively, all of which were lower than that of 0.879 as predicted by the combination of mpMRI and quantitative parameters of CT dynamic enhancement scan (all P<0.05). The joint prediction also had good diagnostic efficacy with a AUC value of 0.868 in the validation group. Conclusion The mpMRI combined with quantitative CT dynamic enhancement scan parameters have good predictive value for the efficacy of immunotherapy for advanced HCC patients.

The predictive value of KRAS gene mutation for survival after DEB-TACE treatment in patients with middle and advanced primary hepatic carcinoma

XU Ying, JI Han-chao, ZHANG Hai-jun, XU Jing

2024, 29(9):  1047-1051. 

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Objective To investigate the predictive value of Kirsten rat sarcoma viral oncogene homolog (KRAS) gene mutation in patients with middle and advanced primary hepatic carcinoma (PHC) treated by drug‐eluting beads transarterial chemoembolization (DEB-TACE). Methods The clinical data of 158 patients with middle and advanced PHC treated with DEB-TACE from January 2020 to January 2022 were retrospectively analyzed. Tumor tissue samples were obtained and paraffin embedded before DEB-TACE, and KRAS gene mutation status was detected. The relationship between the mutation status of KRAS gene and clinicopathological features, the short-term efficacy of DEB-TACE and the prognosis of the patients was analyzed. Results Among 158 patients, KRAS gene mutation was detected in 41 cases (25.95%), all mutations were in exon 2, including 38 patients with codon 12 mutation and 3 patients with codon 13 mutation. KRAS gene mutation was significantly correlated with tumor differentiation, China liver cancer staging (CNLC), AFP level, and intrahepatic metastasis (all P<0.05). The DEB-TACE objective response rate (ORR)(31.71% vs. 71.79%) and disease control rate (DCR)(68.29% vs. 86.32%) of patients with mutant type (KRAS-MT) were significantly lower than those with wild-type (KRAS-WT) (both P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the sensitivity and specificity of KRAS mutation status in predicting DEB-TACE efficacy were 78.80% and 76.40%, and the area under the curve (AUC) was 0.873(P=0.000, 95%CI: 0.764～0.936). The median overall survival (OS) in KRAS-MT patients was shorter than that in KRAS-WT patients (P<0.001). Multivariate Cox risk regression analysis showed that patients with low tumor differentiation (OR=2.014), CNLC stage Ⅲa (OR=4.742), intrahepatic metastasis (OR=3.861), and KRAS-MT (OR=5.137) had a higher risk of death after DEB-TACE treatment (all P<0.05). Conclusion KRAS gene mutation is associated with the short-term efficacy and prognosis of DEB-TACE in patients with middle and advanced PHC, and can be used as a predictor of DEB-TACE efficacy and prognostic survival.

A comparison between TACE combined with sorafenib or ¹²⁵I seed implantation for the treatment of hepatocellular carcinoma patients with portal vein tumor thrombus and arteriovenous fistula

QIN Si-wei, ZHU Xiao-qiang, XU Lei-lei, LUO Xin

2024, 29(9):  1052-1055. 

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Objective To compare the efficacy of TACE combined with sorafenib and TACE combined with ¹²⁵I seed implantation for the treatment of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus and arteriovenous fistula. Methods Sixty-two patients with HCC, portal vein thrombosis, and arteriovenous fistula admitted in Suzhou Hospital of Integrated Traditional Chinese and Western Medicine between April 2019 and April 2022 were enrolled in this study. The patients in the control group were treated with TACE combined with sorafenib, and the patients in the observation group was treated with TACE combined with 125I seed implantation. Results The total effective rate in the observation group (83.8%) was higher than that in the control group [(58.0%), P<0.05]; the serum levels of alpha fetoprotein (AFP), PLT, WBC, and RBC in the observation group were (213.3±8.6) ng/mL, (154.3±8.3)×10⁹/L, (4.2±0.5)×10⁹/L, (2.0±0.3)×10¹²/L, respectively. Both groups were superior to the control group [(117.5±6.8) ng/mL (168.7±10.9), respectively×10⁹/L, (5.7±0.7)×10⁹/L, (3.8±0.8)×10¹²/L, P<0.05]; the levels of AST, ALT, TBil and Alb in the observation group were (23.5±7.8) IU/L, (30.68±4.9) IU/L, (6.7±2.7) μmol/L, and (39.8±2.8) g/L, respectively, all were better than those of (35.6±12.6) IU/L, (34.3±6.3) IU/L, (13.2±2.5)μmol/L, and (36.0±2.3)g/L in the control group(P<0.05). The incidence of complications such as fever, ascites, nausea, vomiting, and infection in the observation group was significantly lower than those in the control group (P<0.05). Conclusion Compared with TACE combined with sorafenib, TACE combined with implantation of ¹²⁵I particles for treating HCC patients with portal vein thrombosis and arteriovenous fistula has less impact on liver function, with a better improvement in the treatment effect, relief of symptoms and reduction of complications, which is worthy of clinical use.

The significance of contrast-enhanced ultrasound in assessing hepatocellular carcinoma in cirrhotic patients and its association with serum levels of AFP-L3, GPC3 and GP73

LIU Cui-cui, HE Yi, QIU Jing-qi, LIANG Shuang, WANG Qian, ZHANG Zhi-bo

2024, 29(9):  1056-1059. 

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Objective To evaluate the efficacy of Contrast-Enhanced Ultrasound (CEUS) in assessing hepatocellular carcinoma (HCC) in cirrhotic patients and its association with serum levels of Alpha-fetoprotein-L3 (AFP-L3), Glypican-3 (GPC3), and Golgi Protein-73 (GP73). Methods A total of 124 patients with cirrhosis treated between January 2020 and January 2023 were selected as study subjects. Within them, seventy one patients with small HCC were set as the observation group, and 53 patients with benign lesions were designated as the control group. All patients underwent CEUS to compare the arterial phase, portal phase, and delayed phase enhancement, as well as CEUS parameters (TTP, PI, ET, ES), and MicroVascular Density (MVD). Tumor markers including AFP-L3, GPC3, and GP73 were also measured. Pearson correlation analysis was used to investigate the relationship between CEUS parameters and tumor markers, and the diagnostic efficiency of CEUS was analyzed using ROC curve method. Results The number of cases with arterial portal enhancement, PI, ES, MVD, and levels of AFP-L3, GPC3, GP73 in the observation group were 65 cases, (28.93±2.14) dB, (2.42±0.48), (52.35±4.12) strips, (1409.57±15.02) ng/L, (751.48±62.68) pg/mL, (120.43±12.53) ng/mL, respectively, all higher than those in the control group [17 cases, (22.10±1.67) dB, (0.86±0.21), (31.84±2.47) strips, (1213.35±13.74) ng/L, (583.84±49.11) pg/mL, (106.59±10.71) ng/mL], with P<0.05. The TTP and ET in the observation group were (26.12±2.01) s and (19.07±1.73) s, and in the control group were (35.23±2.78) s and (23.64±2.04) s, respectively, with the observation group being lower than those of the control group, P<0.05. Correlation analysis showed that the levels of tumor biomarkers were positively correlated with PI, ES, and MVD, and negatively correlated with TTP and ET (P<0.05). The area under the ROC curve reached 0.972. Conclusion There is a significant correlation between CEUS parameters and serum levels of tumor markers in cirrhotic patients with HCC. CEUS has a high diagnostic value which is worthy of clinical promotion.

The value of DCE-MRI combined with enhanced CT scan in evaluating the treatment effect of TACE on patients with primary hepatocellular carcinoma

YANG Zi-jun, YANG Jia-xin, GUO Li-li

2024, 29(9):  1060-1063. 

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Objective To explore the effect of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with enhanced electronic computed tomography (CT) in evaluating the residual or recurrent lesions of primary hepatocellular carcinoma after transcatheter hepatic arterial chemoembolization (TACE). Methods Eighty-nine patients with primary hepatocellular carcinoma admitted to Huai’an First People’s Hospital from April 2020 to January 2023 were included in the study. One to two months after TACE treatment, digital subtraction angiography was taken as the gold standard, and DCE-MRI and CT enhanced scanning were performed in all patients at the same time. Results By digital subtraction angiography, a total of 116 liver cancer lesions were detected in 89 patients. After TACE treatment, there were 74 lesions remained or recurred, and 42 lesions were completely inactivated. DCE-MRI and contrast-enhanced CT detected 76 and 77 residual or recurrent lesions, and 40 and 39 completely inactivated lesions, respectively. Receiver operating curve (ROC) analysis showed that the sensitivities of DCE-MRI and contrast-enhanced CT for single and combined diagnosis of residual or recurrent lesions were 90.48%, 85.71%, and 92.86%, with the specificities of 97.30%, 95.95%, and 97.30%, and the areas under the curve (AUC) of 0.939, 0.908, and 0.951, respectively. The Kappa values of residual or recurrent lesions after TACE treatment in primary hepatocellular carcinoma diagnosed by DCE-MRI and enhanced CT alone and in combination with digital subtraction angiography were 0.887, 0.829, and 0.906, respectively. Conclusion DCE-MRI combined with CT enhanced scan can be used to evaluate the residual or recurrent lesions of primary hepatocellular carcinoma after TACE treatment,with a good efficacy.

A clinical comparison of open anatomical hepatectomy with different approaches for the treatment of hepatocellular carcinoma

WANG Guo-feng, JIA Yu-qing, SHU Chang-xin, CAI Xiao-dong, WANG Hong-bo, XU Jian-hong

2024, 29(9):  1064-1067. 

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Objective To compare the clinical efficacy of open anatomical hepatectomy using different approaches for the treatment of hepatocellular carcinoma (HCC). Methods This study was a prospective randomized controlled study. Sixty-four patients with HCC admitted to the hospital from January 2020 to January 2023 were included. According to the random number table method, the patients were divided into a control group (n=32 cases, the patients received conventional approach for open anatomical hepatectomy) and an observation group (n=32 cases, the patients received open anatomical hepatectomy along with the main hepatic vein approach). The peri-operative related indexes, liver function indexes, immune function indexes and inflammatory factors levels before and 7 days after operation were compared between the two groups, and the postoperative complications of the two groups were counted. Results The intra-operative blood loss in the control group was (324.44±76.73)mL, which was statistically significant different with that of (250.27±68.64)mL in the observation group (t=4.075, P<0.05). At 7 days after operation, the levels of aspartate aminotransferase, alkaline phosphatase, alanine aminotransferase and total bilirubin in the control group[(73.33±8.23)U/L, (94.44±9.19)U/L, (84.61±8.53)U/L and (24.39±2.64)μmol/L respectively] were higher than those in the observation group [(64.52±7.46)U/L, (94.44±9.19)U/L, (73.36±9.58)U/L and (22.14±2.96)μmol/L respectively,P<0.05] . Three days after operation, the levels of IgA, IgG and IgM in the control group (1.71±0.23, 8.31±1.53 and 1.21±0.28, respectively) were lower than those in the observation group (1.95±0.24, 9.39±1.75 and 1.35±0.32, respectively, P<0.05). Three days after operation, the levels of serum interleukin-6, tumor necrosis factor-α, and C-reactive protein in the control group [(149.89±30.79)ng/L, (229.15±27.24)ng/L and (28.74±3.26)mg/L respectively] were higher than those in the observation group [(128.85±20.81)ng/L, (208.11±23.26)ng/L and(22.21±3.44)mg/L respectively, P<0.05]. The total incidence of postoperative complications in the control group was 21.88% (7/32), while that in the observation group was 15.63% (5/32), without statistical significant difference (χ²=0.410, P=0.522). Conclusion Compared with conventional approaches, the use of a main hepatic vein approach in patients with HCC can alleviate the liver damage and immune dysfunction caused by open anatomical hepatectomy, thus has a higher safety.

Clinical study of Sintilimab combined targeted therapy for intermediate and advanced primary liver cancer

DONG Yan-bing, NIU Meng, LUO Yue-bin, WEN Ting-liang

2024, 29(9):  1068-1073. 

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Objective To explore the clinical effect of Sintilimab combined targeted therapy on intermediate and advanced primary liver cancer (PLC). Methods 84 patients with PLC treated from September 2019 to June 2023 at funan county people's hospital and the north district were involved and divided into two groups by random number method. The control group (42 cases) was treated with Sintilimab, and the observation group (42 cases) was treated with Sintilimab combined with bevacizumab. After 3 cycles of treatment, the levels of serum markers related to angiogenesis and tumor were measured by enzyme-linked immunosorbent assay, and the levels of immune markers were measured by flow cytometry. Kapkan-Meier curve was used for the survival analysis. Results After treatment, the disease control rate (64.29% vs 92.86%) and objective response rate (42.86% vs 76.19%) in the observation group were higher than those in the control group, and the mortality rate (23.81% vs 47.62%) was lower than that in the control group (P<0.05). The levels of CEA, AFP, CA19-9 and DCP in the observation group [(16.7±3.3) ng/mL, (138.7±27.7) ng/mL, (142.7±20.3) U/mL, (30.5±4.3) mAU/mL, respectively] were significantly lower than those in the control group [(21.4±4.2) ng/mL, (176.2±35.2) ng/mL, (165.6±23.6) U/mL, (35.2±5.1) mAU/mL, respectively] (P<0.05). The levels of CD3⁺ and CD4⁺/CD8⁺ in the observation group [(72.9±4.8) %, (1.7±0.4)] were significantly higher than those in the control group [(68.4±4.5) %, (1.4±0.3)] (P<0.05). The levels of VEGF, MMP-9 and Ang-2 in the observation group were [(22.5±4.3) ng/mL, (40.5±5.2) mg/L, (21.6±3.6) μg/L, respectively] were significantly lower than those in the control group [(26.4±5.1) ng/mL, (44.6±5.5) mg/L, (25.1± 4.2) μg/L] (P<0.05). Conclusion Sintilimab combined with bevacizumab is effective in the treatment of advanced PLC. The levels of tumor markers and angiogenesis-related factors are decreased, the immune function and survival rate are improved, and the drug is safe.

Observation on imaging characteristics of multi-slice spiral CT enhanced scanning in the diagnosis of hepatic hemangioma and its differentiation from hepatic metastasis

LI Wei, HUANG Shi-kun, REN Dao-chang, TANG Yan

2024, 29(9):  1074-1076. 

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Objective To explore the value of multi-slice spiral CT (MSCT) enhanced scanning in the diagnosis of hepatic hemangioma (HH) and hepatic metastasis. Methods Between March 2022 and January 2024, 82 cases of HH and 82 cases of liver metastases were collected. According to the standard reconstruction algorithm, the outline of the tumor including plain scan, arterial phase, portal phase and delayed phase was carefully drawn manually along the boundary of the tumor, and the parameters of enhanced CT scanning were automatically obtained. Results HH hepatic blood flow, hepatic blood volume, contrast agent transit time and capillary surface permeability were (152.4±23.8) mL/(100 g·min), (22.5±4.7) mL/100 g, (14.2±1.3) s, (33.6±9.2)%, compared with liver metastases [(193.5±31.6) mL/100 g/min, (14.1±3.5) mL/100 g, (9.3±1.0) s, (27.0±7.9)%], the difference was statistically significant (P<0.05). There were 116 lesions in 82 cases of HH, of which 80 were <10 cm and 36 were >10cm. It was found that the tumor volume, tumor enhancement volume and arterial phase enhancement ratio of the lesions >10 cm HH [(104.2±23.2) mm³, (41.8±9.3) mm³ and (41.3±4.6) %] had the significant difference (P<0.05) when compared with <10 cm HH [(314.5±72.3) mm³, (53.8±10.9) mm³, (27.1±2.9)%]. The fusion lesions, subcapsular distribution, target ring sign, quasi-circular center low density and bull's eye sign in HH were 43 cases (52.4%), 60 cases (73.2%), 23 cases (28.0%), 3 cases (3.6%) and 1 case (1.2%), compared with liver metastases [2 cases (2.4%), 0(0), 0(0), 51 cases (62.2%) and 37 cases (45.1%)], the difference was statistically significant (P<0.05). The results of MSCT, as the experimental group, were defined as positive and negative results by referring to pathological results. The sensitivity, specificity and accuracy of MSCT in diagnosing HH were 90.2% (74/82), 84.1% (69/82) and 87.2% (143/164), which were in good agreement with pathological results (Kappa coefficient = 0.710). Conclusion Taking pathological results as the gold standard, MSCT has a good consistency in differential diagnosis of HH, which shows that the application of enhanced CT scanning mode can know the blood supply of HH patients in time, and can accurately identify HH, which has a positive effect on guiding the formulation of reasonable treatment plans.

Liver Fibrosis & Cirrhosis

Assessment of anthropometric indicators and nutritional status in hospitalized patients with cirrhosis

SHEN You-shu, DAI Mei, ZHAO Fei, YANG Ping

2024, 29(9):  1077-1080. 

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Objective To analyze the anthropometric indicators and nutritional status of hospitalized cirrhotic patients for the early detection of nutritional risk or malnutrition. providing a basis for the formulation of nutritional treatment strategies. Methods A total of 164 patients with liver cirrhosis, hospitalized at a tertiary general hospital in Zunyi City from May 2022 to April 2023, were selected for this study. Nutritional risk was assessed within 48 hours of admission using the Nutritional Risk Screening 2002 (NRS2002) scale. Based on this assessment, patients were divided into malnourished and non-malnourished groups. Measurements taken included upper arm circumference (UAC), upper arm muscle circumference (UAMC), tricep skinfold(TSF) thickness , handgrip strength (HGS), and body mass index (BMI), which was calculated from the patients' height and weight. Data were statistically analyzed using SPSS 25.0 software. Results Among the 164 cirrhotic patients, 60 were found to have malnutrition, resulting in an incidence rate of 36.59%. Specifically, 12 cases (20%) were classified as Child-Pugh A, 27 cases (45%) as Child-Pugh B, and 21 cases (35%) as Child-Pugh C. In the compensated stage, 15 cases (25%) had malnutrition, whereas in the decompensated stage, 45 cases (75%) had malnutrition. Additionally, 24 patients(40.00%) with ascites were malnourished. Measurements of AC, AMC, TSF, and HGwere significantly lower in patients with nutritional risk compared to those without nutritional risk. Differences in BMI, AC, AMC, and HG between the two groups were statistically significant (P<0.05). Conclusion The incidence of nutritional risk in cirrhotic patients is high. Therefor, it is crucial to screen these patients for anthropometric indicators and nutritional risk as early stage. Early screening allows for the formulation of appropriate nutritional interventions, which can promote better prognosis and improve their overall condition.

Clinical characteristics, diagnosis and treatment of liver cirrhosis combined with coeliacal pleural ascites: A case series study

HUA Jing, PAN Ya-jie, LV Xue-yan, CHEN Ru-yue, ZENG Qing-lei

2024, 29(9):  1081-1084. 

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Objective To investigate the features, diagnosis and treatment of liver cirrhosis complicated with chylothorax and/or chylous ascites. Methods Select 4 patients with liver cirrhosis complicated with chylothorax/ chylous ascites admitted to our hospital from March 2022 to March 2023, collect their characteristics and laboratory data, and give high-dose human albumin combined with somatostatin analog therapy, and observe its curative effect and prognosis. Results (1) The average age of the patients was 61±8.91 years old, and 3/4 were male; 3 cases were caused by hepatitis B virus infection, 1 case was alcohol; 3 cases were complicated with renal insufficiency, 2 cases had hypoproteinemia; 2 cases The Child-Pugh classification was grade C, 1 case was complicated with hepatorenal syndrome, and the MELD score was greater than 20; (2) 3 cases had chylomicron appearance, and 1 case was light yellow; 3 cases were positive for chylomicrons, and 3 cases were present at the same time chylothorax and ascites effusion, 1 case of pleural effusion, 1 case of chylous ascites; (3) After administration of large doses of human serum albumin, the effusions of four patients all subsided compared with before, and the serum creatinine improved. Patients were followed up at 1 month, 3 months, and 6 months after discharge; three patients were in stable condition, and one patient died after four months of follow-up. Conclusion The treatment of patients with chylothorax/ chylous ascites with high-dose albumin combined with somatostatin analogues can help the effusion subside, improve the renal function and even the quality of life of the patients.

A clinical research on the risk factors and the development of diagnostic model for hepatic encephalopathy

DENG Wen-jia, WANG Lei, WANG Hao-ran, ZHAO Ge

2024, 29(9):  1085-1090. 

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Objective To identify laboratory diagnostic markers of hepatic encephalopathy (HE), we developed a diagnostic model of HE and investigated the diagnostic value of serum homocysteine, lactate, procalcitonin, and bile acid levels in HE. Methods A total of 371 patients with liver cirrhosis admitted to the First Affiliated Hospital of Harbin Medical University from August 2020 to August 2022 were analyzed using Spearman’s correlation coefficient, univariate and multivariate analysis to identify factors affecting the occurrence of HE, and to establish a diagnostic model. Results Procalcitonin (378.2 ± 71.5 pg/mL), bile acid ( 41.6 ± 9.5 μmol/L) in patients with HE was higher than those (Procalcitonin 47.3 ± 8.1 pg/mL, bile acid 9.7 ± 0.8 μmol/L) in non HE (P<0.05), lactic acid (0.29 ± 0.11 mmol/L), serum homocysteine (2.8 ± 1.1 μmol/L) in patients with HE was lower than those (lactic acid 0.94 ± 0.17 pg/mL, serum homocysteine 10.2 ± 2.3 μmol/L) in patients with non HE (P<0.05). Spearman correlation analysis showed that the correlation coefficients between lactate, procalcitonin, bile acids, serum homocysteine and HE were -0.15, 0.41, 0.29 and -0.19, respectively. Univariate logistic regression analysis showed that the risk of developing HE increased with higher bile acid levels (P=0.004) and higher serum homocysteine levels (P=0.058). The multivariate logistic regression diagnostic model of bile acid levels and serum homocysteine showed that the area under the ROC curve (AUC) was 0.720, indicating that the diagnostic model achieved satisfactory evaluation effect. The model formula was the logistic regression equation P=-2.4544 + 0.0117 * (bile acid level) + 0.0198 * (serum homocysteine). Conclusion In this study, logistic regression analysis was used to establish a diagnostic model of HE, which is beneficial for the early differential diagnosis of patients. Especially the combined detection of serum homocysteine and bile acid levels was considered more meaningful.

Significance of thromboelastography parameters in evaluating hepatitis B cirrhosis complicated with esophageal-gastric varices bleeding

SUN Meng-qiu, ZHANG Ai-xia, ZHANG Li, LIN Zi-xi

2024, 29(9):  1091-1095. 

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Objective To investigate the importance of thromboelastography (TEG) in the evaluation of hepatitis B liver cirrhosis associated with esophageal and gastric varicose bleeding. Methods A total of 40 patients with hepatitis B liver cirrhosis admitted to Xuzhou Central Hospital from February 2021 to February 2023 and 20 patients who underwent a healthy physical examination during the same period were included. The healthy physical examination population was included as a control group, and patients with hepatitis B cirrhosis were divided into a bleeding group (n=20) and a non-bleeding group (n=20). The bleeding group was randomly divided into group A (n=10) and group B (n=10), with group A and group B taking a routine coagulation test and a TEG test to guide blood transfusion respectively. The ROC curve was designed to compare the results of the TEG test with the index of agglutination function in the bleeding group, non-bleeding group and control group, and to analyze the equilibrium value of the results of the TEG test and conventional coagulation test, as well as the prognosis and dosage of the transfusion components of groups A and B. Results The platelet count (PLT) and fibrinogen (FIB) levels in the bleeding group and the non-bleeding group were significantly lower than those in the control group, while the levels of prothrombin time (PT), international normalized ratio (INR) and activated partial thromboplastin time (APTT) were significantly higher than those in the control group (P<0.05). The levels of PLT and FIB in the bleeding group were significantly lower than those in the non-bleeding group [PLT: (67.13±33.18) vs. (84.23±29.34) ×10⁹/L; FIB: (1.47±0.49) vs. (1.97±0.52) g/L, P<0.05]; The blood clot formation time (K) of the bleeding group and the non-bleeding group were significantly higher than those in the control group, and the coagulation angle (α) and maximum vibration radiation (MA) levels were significantly lower than those in the control group (P<0.05). The α angle and MA levels in the bleeding group [(45.45±5.79) deg and (40.71±5.25) mm, respectively] were significantly lower than those in the non-bleeding group [(51.34±5.14) deg and (48.46±6.08) mm, P<0.05], respectively; The area under the PLT, FIB, α angle and MA curve exceeded 0.5 (P<0.05), and the area under the α angle curve was the largest. The improvement rate of prognosis in group B was significantly higher than that of group A (100% vs. 60%), and the number of days of hospital stay was (9.12±1.02) d, which was significantly lower than that of group A (11.48±1.25) d (P<0.05); The dosage of red blood cells and plasma in group B [(3.14±0.67) U and (534.07±80.42) mL, respectively] was less than that of group A [(4.11±0.74) U and (617.18±90.51) mL], respectively, and the dosage of platelets and cryoprecipitate [(0.32±0.07) U and (33.48±6.25) U, respectively] was significantly greater than that of group A [(0.25±0.06) U and (28.12±5.02) U] (P<0.05), respectively]. Conclusion The TEG coagulation test can better guide the management of blood transfusion than traditional coagulation tests such as standard PT, PLT and INR, and has the highest diagnostic efficiency of α angular parameters. TEG can improve patient outcomes by providing accurate guidance for transfusion treatment.

CT perfusion imaging study of esophageal variceal collateral circulation in patients with hepatitis B cirrhosis portal hypertension

DANBA Yu-zhen, WANG Wan-ting

2024, 29(9):  1096-1099. 

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Objective To investigate CT perfusion imaging of the lateral branch circulation of esophageal varices in patients with portal hypertension in hepatitis B cirrhosis. Methods Between August 2021 and July 2023, 105 patients with hepatitis B cirrhosis portal hypertension with esophageal varices were admitted to our hospital as the occurrence group, and 60 patients with no esophageal varices in the same period were selected as the control group. CT perfusion imaging was performed in both groups, and their parameters were compared between the two groups. ROC curve was used to analyze the value of CT perfusion mean contrast passage time, peak contrast time, vascular permeability, and blood flow changes in predicting oesophageal varices in patients with portal hypertension in hepatitis B cirrhosis. Results The mean contrast passage time, peak contrast time, and vascular permeability of the occurrence group were (13.8±3.5) s, (19.9±5.4) s, and (40.8±11.3) mL/(100 g·min), respectively, which were higher than those of the control group [(10.2±2.4) s, (17.1±3.1) s, and (31.7±10.2) mL/(100 g·min)], the blood flow in the occurrence group was (16.5±3.6) mL/(100 g·min), which was lower than that in the control group [(22.8±5.3) mL/(100 g·min), P<0.05]; The results of ROC curve analysis showed that CT perfusion mean contrast passage time, peak contrast time, vascular permeability, and blood flow changes were of great value in predicting esophageal varices in patients with hepatitis B cirrhotic portal hypertension complicated. Conclusion CT perfusion mean contrast passage time, peak contrast time, vascular permeability, and blood flow changes can be highly evaluated as predictors of concomitant esophageal varices in patients with hepatitis B cirrhotic portal hypertension.

Viral Hepatitis

Expression of transcription factor MafB and its effect on immune regulation in patients with chronic hepatitis C

LI Min, JING Qiao-ling, CHANG Bai

2024, 29(9):  1100-1104. 

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Objective To investigate the expression of transcription factor MafB and its role in immunomodulatory function in patients with chronic hepatitis C, and to provide a scientific basis for finding molecular markers for syndrome differentiation in traditional Chinese medicine (TCM). Methods Between August 2019 and October 2022, 65 patients with chronic hepatitis C were selected. According to TCM syndrome types, 41 cases were liver depression and spleen deficiency syndrome (liver depression and spleen deficiency group) and 24 cases were other TCM types, such as liver and gallbladder damp-heat type, liver and kidney yin deficiency type and blood stasis blocking collateral type (other syndromes group). 59 healthy people in the same period were divided into healthy control group. The clinical features and immunological indexes of different groups were compared. Results The ALT level in chronic hepatitis C group was significantly higher than that in healthy control group, and the difference was statistically significant (P<0.05). Comparing the immunological indexes, we can know that the relative expression level of monocyte MafB mRNA, the relative abundance value of monocyte MafB protein, IL-4 and IL-12 levels in chronic hepatitis C group are significantly higher than those in healthy control group, and the levels of serum INF-α1 and INF-β are significantly lower than those in healthy control group, with statistical significance (P<0.05). In subgroup analysis of hepatitis C virus (HCV) genotypes, the levels of serum INF-α1 in HCV genotypes 2a and 3 were significantly lower than those in genotype 1b, and the difference was statistically significant (P<0.05). The INF-α1 of HCV infection in other syndrome groups was significantly lower than that in the group of liver depression and spleen deficiency, and the difference was statistically significant (P<0.05). Correlation analysis showed that MafB expression level was negatively correlated with serum INF-α1, It is positively correlated with serum IL-4 levels (P<0.05). Conclusion The increased expression of transcription factor MafB in patients with chronic hepatitis C and inhibition of immunomodulatory function in patients with chronic hepatitis C may be one of the important reasons for the chronic infection of HCV.

Risk factors for hypoviremia in chronic hepatitis B patients undergoing antiviral therapy: A comprehensive analysis

HE Pu, LIU Wen-zong

2024, 29(9):  1105-1108. 

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Objective To identify risk factors associated with hypoviremia in chronic hepatitis B patients receiving antiviral therapy. Methods A total of 108 chronic hepatitis B patients receiving antiviral treatment at our hospital were selected for this study. Based on high-sensitivity HBV DNA quantitative testing results, they were catergorized into a hypoviremia group (60 cases) and a complete virological response group (48 cases). Clinical data from both groups were collected and compared, and logistic regression analysis was employed to identify risk factors associated with hypoviremia. Results The rate of second-line initial treatment in the hypoviremia group was significantly higher than that in the complete virological response group(18.75% vs 2.63%,P<0.05), while the medication adherence rate was significantly lower (71.88% vs 91.67%, P<0.05). No statistically significant differences were observed bettwen the two groups in AST[(30.22±8.34)U/L vs (28.30±8.23)U/L],ALT[(25.35±3.49)U/L vs (27.03±4.63)U/L],TBil[(14.35±3.71)μmol/L vs (13.74±2.87)μmol/L], or HBcAb levels[(94.66±23.82)S/CO vs (95.14±26.73)S/CO] (P>0.05). However, the hypoviremia group exhibted significantly higher rates of HBeAg positivity(59.38% vs 10.53%), HBsAg levels[(3.24±0.36)IgIU/ml vs (2.87±0.32)IgIU/ml], and baseline HBV DNA levels[(7.40±1.33) vs (5.78±1.42)] compared to the complete virological response group (P<0.05). The factors of second-line initial treatment, HBeAg positivity, HBsAg levels, and baseline HBV DNA levels were negatively correlated with complete virological response(r=-0.411, -0.352, -0.413, -0.492,P<0.05), while good medication adherence is positively correlated (r=0.425,P<0.05). Logistic regression analysis identified HBeAg positivity, HBsAg levels, and baseline HBV DNA levels as significant risk factors for hypoviremia(OR=2.809,1.861,1.311,P<0.05), whereas good medication adherence emerged as a protective factor(OR=0.810,P<0.05). Conclusion Positive HBeAg, elevated HBV DNA load, and high HBsAg levels prior to antiviral treatment are significant risk factors for the develpment of hypoviremia in chronic hepatitis B patients. Ensuring good medication adherence is crucial for achieving virological responses. Early, targeted interventions should be implemented in clinical practice for CHB patients identified with these high-risk factors.

Impact of interferon-inducible protein-10 levels on sustained virological response in chronic hepatitis C patients treated with direct-acting antivirals

CHEN Xiao-yu, JIA Gui, MENG Qin, YANG Chun-mei

2024, 29(9):  1109-1112. 

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Objective To investigate the impact of interferon-inducible protein-10 (IP-10) levels on sustained virological response (SVR) in patients with chronic hepatitis C (CHC) undergoing treatment with direct-acting antivirals (DAAs). Methods A retrospective analysis was conducted on the clinical data of 60 CHC patients admitted to Xijing Hospital, First Affiliated Hospital of Air Force Military Medical University, between May 2020 and May 2022. The patients were divided into two groups based on their treatment regimens: the peginterferon (Peg IFN) plus ribavirin (RBV) group (PR scheme, n=20) and DAAs group (n=40). An additional 10 healthy individuals were selected as the control group. The study compared the general characteristics and laboratory tests across the three groups, examined changes in IP-10 levels in CHC patients during treatment, and analyzed the impact of IP-10 level on SVR in CHC patients receiving DAAs. Results The serum alanine aminotransferase (ALT) and IP-10 levels, as well as liver IP-10 mRNA and protein levels, were significantly higher in CHC patients [(70.8 ± 4.7) U/L, (427.5 ± 15.4) pg/mL, (2.0 ± 0.4), and (2.7 ± 0.5), respectively], compared to the control group [(21.5 ± 6.0) U/L, (135.1 ± 33.5) pg/mL, 1,1[1], P<0.05]. During treatment with DAAs, the serum IP-10 levels in CHC patients gradually decreased, with more pronounced reductiosn observed in patients who achieved SVR . Multivariate logistic regression analysis identified a serum IP-10 level below 450 pg/mL and a reduction of more than 30% after 12 weeks of treatment as independent predictors of SVR in CHC patients treated with DAAs (OR=5.333, 5.485, P<0.05). Conclusion IP-10 can interfere with virus replication, and the dynamic decrease in serum IP-10 levels in CHC patients during DAAs treatment can serve as a predictor of SVR.

Liver Failure

Comparative analysis of clinical and histological features in liver failure due to autoimmune hepatitis with varied prognoses

WANG You-jie, XIE Pei-yu

2024, 29(9):  1113-1116. 

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Objective To compare the clinical and histological characteristics of autoimmune hepatitis-related liver failure (AIH-LF) across different prognostic outcomes. Methods A total of 150 patients with AIH-LF admitted for treatment between June 2022 and June 2023 were selected for this study. Following standardized treatment, the patients were categorized into a remission group and an ineffective group based on their prognoses. Clinical data and examination results were retrospectively collected, and the clinical and liver histological characteristics were compared between the two groups. Results Based on the prognosis, 74 patients were classified into the remission group, and 76 cases into the ineffective group. In the ineffective group, 42 cases (55.3%) had a disease course exceeding 6 months, 43 cases (56.6%) presented with chronic and acute features, 21 cases (27.6%) experienced bleeding, the AFP level was 112.2 ± 26.3 ng/mL, and the MELD score was 27.54 (23.4, 30.1). The differences between the ineffective group and the remission group were statistically significant (P<0.05). No significant differences were found in the detection rates of serum antibodies ANA, AMA, and P-ANCA between the two groups(P>0.05). However, the detection rates of LKM-1 and SLA/LP were 2 cases (2.7%) and 3 cases (4.1%) in the remission group, respectively, compared to 11 cases(14.5%) and 16 cases (21.1%) in the ineffective group, with statistical significance (P<0.05). When comparing liver histology, the remission group exhibited a higher rate of interfacel hepatitis and F2 phase liver fibrosis compared to the ineffective group (P<0.05). In contrast, the ineffective group had higher rates of portal vein inflammation, bile duct injury, plasma cell infiltration, lobular hepatitis, and rosette formation(P<0.05). Conclusion The clinical and liver histological characteristics of AIH-LF patients vary significantly based on their prognoses. Compared to patients with a favorable prognosis, those with a poor prognosis tend to have a longer course of AIH, more frequent bleeding symptoms, and more severe portal vein inflammation, bile duct injury, and liver fibrosis. These findings provide valuable insights for clinical diagnosis and treatment strategies.

Risk factors for hypoglycemia in hepatitis B-related acute-on-chronic liver failure and its impact on clinical outcomes

DONG Xu, LIAO Wei, XU Ming-xiao, GE Ling-ling, CHEN Yi, LI Cheng-zhong

2024, 29(9):  1117-1122. 

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Objective To investigate the clinical characteristics of fasting glucose levels and the incidence of hypoglycemia in patients with hepatitis B virus(HBV)-related acute-on-chronic liver failure (ACLF), and to analyze the risk factors of hypoglycemia and its association with clinical outcomes, providing valuable insights for early clinical recognition and intervention. Methods Clinical data from 308 patients with HBV-related ACLF, admitted to the Department of Infectious Diseases at the First Affiliated Hospital of Naval Medical university between January 2016 to December 2021, were retrospectively analyzed. Patients were categorized into hypoglycemic and non-hypoglycemic groups based on fasting glucose levels. Risk factors for hypoglycemia were assessed using univariate and logistic regression analyses. Results The incidence of hypoglycemia in patients with HBV-related ACLF was 33.1%. Significant differences were observed between the hypoglycemic and non-hypoglycemic groups in gender, total bilirubin, γ- gl utamyltranspeptidase, white blood cell count, neutrophil count, prothrombin time, international normalized ratio, MELD score, MELD grade, presence of type 2 diabetes and ascites (P<0.05). Logistic regression analysis identified female gender, high baseline total bilirubin, elevated white blood cell and neutrophil counts, and the presence of ascites as risk factors for hypoglycemia, while type 2 diabetes was a protective factor. The ROC curve analysis yielded an AUC of 0.7910 (P＜0.01, 95%CI: 0.7394～0.8425). Clinical outcomes included 192 cases (62.3%) in the improvement group and 116 cases (37.7%) in the transplantation and death group. Hypoglycemia was associated with poor clinical outcome (χ²=8.379, P=0.004), For every 1mmol/L decrease in blood glucose, the risk of poor prognosis increased by 19.9% (OR=1.199, 95%CI: 1.055-1.362, P=0.005). Conclusion The incidence of hypoglycemia is elevated in patients with HBV-related ACLF and is linked to increased mortality. Women and those with ascites, high baseline total bilirubin, elevated white blood cells and neutrophil counts are at greater risk. Early identifcation and management of these high-risk patients are crucial for improving outcomes.

Drug-Induced Liver Injury

Clinicopathological features of granulomatous hepatitis induced by Bacillus Calmette-Guerin (BCG) bladder instillation: a case series and literature review

WANG Yan, WANG Qian-yi, FENG Li-juan, WANG Min, CHEN Sha, WANG Yu, ZHAO Xin-yan

2024, 29(9):  1123-1127. 

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Objective To elucidate the clinicopathological characteristics of hepatitis associated with Bacillus Calmette-Guerin (BCG) bladder instillation. Methods We summarized and documented cases of hepatitis associated with BCG bladder instillation treated at Beijing Friendship Hospital. A systematic review of previously reported cases were conducted. Data were collected and analyzed on variables including gender, age, frequency of BCG bladder instillations, liver biochemical results, liver histopathology, Mycobacterium tuberculosis testing, treatment regimens, and patient outcomes. Results A total of 23 patients, including 2 cases from our center and 21 cases from the literature, were re-evaluated. All patients were male, with a median age of 66 years at onset(range 34-88) and had received a median of 6 BCG bladder instillations (range 1-17). All patients exhibited a significant increase in alkaline phosphatase (ALP) and/or gamma-glutamyl transferase (GGT), with most also demonstrating varying degrees of elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Additionally, 52.2% (12/23) of the patients had elevated serum total bilirubin (TB). Among the cases, 6 tested positive for Mycobacterium tuberculosis, 14 tested negative and 3 had unclear results. Liver biopsies were performed in 20 cases, revealing granulomatous hepatitis in 19 cases, while 1 case showed expansion and infiltration of inflammatory cells in the portal area without granuloma formation. Seven patients received anti-tuberculosis treatment, 14 were treated with a combination of anti-tuberculosis and glucocorticoid therapy, and 2 received glucocorticoids alone. Outcomes were favorable in 87%(20/23) of cases, with recovery noted in 20 patients; 2 cases improved but were lost to follow-up, and 1patient died. Conclusion Hepatitis resulting from intravesical BCG is rare and typically manifests with elevated ALP and/or GGT levels, often accompanied by jaundice. Most cases present as granulomatous hepatitis, with only a few miniority testing positive for Mycobacterium tuberculosis. While some patients recovered with anti-tuberculosis treatment alone, the majority required a combination of anti-tuberculosis therapy and glucocorticoid, or achieved recovery with glucocorticoids alone, suggesting a significant role of the immune response in the pathogenesis of the disease.

Clinical characteristics of patients with recurrent chronic drug-induced liver injury:an analytical study

LI Ming-jing, LI Bei-bei, MENG Qing-yu, ZHONG Xin-mei

2024, 29(9):  1128-1131. 

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Objective To analyze the clinical characteristics of patients with recurrent chronic drug-induced liver injury. Methods A retrospective analysis was conducted on the clinical data of 265 patients with chronic drug-induced liver injury who were admitted to our hospital between March 2020 and March 2023. After a one-year follow-up, patients were categorized into two groups : a recurrent group(n=33) and a non-recurrent group (n=232), based on the presentce of recurrence. The study compared general informaion, laboratory examination indicators, and liver histological characteristics between the two groups to identify the clinical features associated with the recurrence of chronic drug-induced liver injury. Multivariate logistic regression was employed to analyze high-risk factors for recurrence. Results The mean ages of the recurrent and non-recurrent groups were 44.2±7.9 years and 40.8±7.5 years, respectively, with the difference being statistically significant (P<0.05). The levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBil), γ -glutamyltranspeptidase(GGT), and prothrombin time(PT) in the recurrence group were 89.4±13.2 U/L, 87.2±12.5 U/L, 47.3±6.3 μmol/L, 105.4±15.4 U/L and 14.2±2.7 s. respectively. These are significantly higher compared to the non-recurrent group, which had ALT, AST, TBil, GGT. And PT values of 37.5±7.1 U/L, 32.3±7.0 U/L, 15.2±2.0 μmol/L, 45.3±8.5 U/L and 12.6±2.3 s, respectively(P<0.05). Additionally, the recurrent group exhibited more severe liver inflammation and fibrosis, with rates of 75.8% and 36.3%, compared to 9.9% and 23.7% in the non-recurrent groups, respectively (P<0.05). Multivariate logistic regression analysis identified age, AST, TBil, GGT, PT, cholinesterase, degree of inflammation, and degree of fibrosis as significant risk factors for the recurrence of chronic drug-induced liver injury (OR=5.068, 4.909, 4.993, 4.604, 4.688, 4.531, 4.627, 5.023, P<0.05). Conclusion When chronic drug-induced liver injury recurs, patients typically present with advanced age, abnormal laboratory findings, and more severe liver inflammation, and fibrosis. This high-risk group warrants careful clinical attention.

Other Liver Diseases

Clinical study of dulaglutide combined with a ketogenic diet in the treatment of elderly patients with type 2 diabetes mellitus complicated by non-alcoholic fatty liver disease

PENG Yu-han, LIU Zi-lan, ZHANG Xiao

2024, 29(9):  1132-1136. 

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Objective To evaluate the therapeutic effects of dulaglutide in combination with a ketogenic diet in the management of elderly patients with type 2 diabetes mellitus (T2DM) complicated with non-alcoholic fatty liver disease (NAFLD). Methods From February 2021 to February 2023, 94 patients with T2DM and NAFLD were enrolled in this study. Participants were randomly assigned to two groups: by random draw, the control group (n=47), receiving insulin and a ketogenic diet, and the observation group (n=47), treated with dulaglutide and a ketogenic diet. Clinical efficacy was assessed by comparing pre- and post-treatment levels of blood glucose, lipids, liver function, and oxidative stress markers between the two groups. Additionally, the incidence of adverse reactions was monitored. Results Post-treatment, the efficacy rate in the observation group was 97.87%, significantly higher than in the control group (82.98%). The observation group demonstrated significantly lower levels of fasting blood glucose(FBG) (6.10±1.22), 2-hour postprandial blood glucose(2hPBG) (8.21±1.75), and HbA1c (6.21±1.25) compared to the control group (7.35±1.58, 10.23±2.06, 7.69±1.58, respectively). Lipid levels, including total cholesterol(TC) (3.22±0.87) and TG (1.22±0.21) were also lower in the observation group compared to the control group (4.69±1.01 and 2.15±0.57, respectively). Liver function markers such as AST (23.54±3.59), ALT (41.32±4.76), and GGT (31.62±4.01) were significantly reduced in the observation group compared to the control group (32.78±4.27, 52.36±6.02, and 49.86±5.75, respectively). Additionally, oxidative stress markers,including MDA (642.51±90.27) and 8-iso-PGF2α (125.35±11.05), were lower, while GSH-Px (151.21±15.67) was higher in the observation group compared to the control group (724.25±95.21, 142.58±11.47, and 120.52±12.58, respectively), with all differences being statistically significant (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion The combination of dulaglutide and a ketogenic diet significantly improves clinical outcomes in elderly patients with T2DM and NAFLD, effectively reducing blood sugar and lipid levels, enhancing liver function, and mitigating oxidative stress responses compared to insulin combined with a ketogenic diet, while maintaining a comparable safety profile.

Establishment of a liver-specific Trappc11 gene knockout mouse model using the Cre-loxP system

ZHENG Fan-fan, GAO Feng, LI Meng-yao, Li Xia, YANG Yan-ling, LI You-lei

2024, 29(9):  1137-1140. 

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Objective A liver-specific Trappc11 gene knockout mouse model(Trappc11^flox/flox-Alb-Cre^+/-) was established using the Cre-loxP system to investigate the pathogenesis of fatty liver disease. Methods Trappc11 homozygous mice with a loxP site(Trappc11^flox/flox) were crossed with Alb-Cre transgenic mice (Alb-Cre^+/-), and the genotypes of the offspring were identified. Progeny with the Trappc11^/flox-Alb-Cre^+/- genotype were selected, and liver-specific knockout mice were obtained through further breeding with Trappc11^flox/flox mice. Three groups of mice, including Trappc11^flox/flox-Alb-Cre^+/-、Trappc11^flox/+-Alb-Cre^+/- and Trappc11^flox/flox-Alb-Cre^-/-, aged 3-4 weeks, were selected, DNA was extracted from tissue samples to assesst the knockout efficiency and specificity of Trappc11. with further validation at the mRNA and protein levels. By the forth week, parameters such as food intake and body weight were measured. Results We successfully generated liver-specific Trappc11 gene knockout mice. Although the expression of Trappc11 gene was not affected in various tissues, including the heart, spleen, lung, kidney, pancreas, muscle, fat and brain, our model achieved a knockout efficiency of over 85 % at the mRNA level, significantly decreasing the TRAPPC11 protein level. The knockout mice are currently in good health, exhibiting normal growth, diet and water intake, making them suitable for subsequent breeding and mechanistic studies. Conclusion The successfully constructed Trappc11^flox/flox-Alb-Cre^+/- mice provide a valuable in vivo model for investigating the physiological and pathological roles of Trappc11 in the liver.