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Table of Content

    31 October 2024, Volume 29 Issue 10
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    CONTENTS
    2024, 29(10):  0-0. 
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    Liver Cancer
    Prognostic difference between entecavir and tenofovir treatments in patients with hepatitis B related intrahepatic cholangiocarcinoma
    MIAO Hui, SHI Liang-hui, WAN Qian-qian, YANG Zi-yu, SUN Bao-mu, WAN Xu-ying
    2024, 29(10):  1180-1183. 
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    Objective To determine whether the long-term use of different antiviral agents entecavir (ETV) or tenofovir (TDF) has impact on the prognosis of hepatitis B related intrahepatic cholangiocarcinoma (ICC). Methods A retrospective analysis was performed in 96 patients with hepatitis B related ICC, including 25 cases with TDF treatment, and 71 cases with ETV treatment. The long-term overall survival (OS) and disease progression free survival (PFS) periods were compared between the two groups. Results The median OS of TDF group was 38 months and that of ETV was 30 months. The 1-year, 3-year and 5-year survival rates of TDF group were 92.0%, 46.2% and 30.8%, respectively. The 1-year, 3-year and 5-year survival rates of ETV group were 94.1%, 39.9% and 13.5%, respectively, but there was no significant difference between the two groups (P=0.514). The median PFS in TDF group was 25 months, and the 1-year, 3-year and 5-year progression free survival rates were 75.8%, 38.0% and 12.7%, respectively; The median PFS in ETV group was 20 months, and the 1-year, 3-year and 5-year progression free survival rates were 71.1%, 30.0% and 12.9%, respectively. Similarly, there was no significant difference in PFS between the two groups (P=0.403). Cox multivariate analysis showed that TNM stage, radical surgery, lymph node metastasis and HBV DNA > 104 IU/ml were independent prognostic factors. Conclusion There is no significant difference between the treatments with antiviral drugs ETV and TDF in the prognosis of hepatitis B related ICC. This result is awaiting further confirmation by retrospective analysis with a larger number of patients.
    The effect of PD-1/PD-L1 immunosuppressants on hepatocellular carcinoma based on TumorFisher CTCs
    XU Jing, DING Zhe, XU Ying
    2024, 29(10):  1184-1188. 
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    Objective To investigate the efficacy of immunosuppressants programmed death-1/ programmed death ligand-1 (PD-1/PD-L1) in the treatment of hepatocellular carcinoma (HCC) based on TumorFisher circuiting tumor cells (CTCs) assay. Methods 120 patients with middle and advanced HCC treated in Yancheng People's Hospital of Jiangsu Province from August 2021 to December 2022 were selected and divided into two groups, with 60 cases in each group. The control group was treated with drug-eluting beads trans-arterial chemoembolization (DEB-TACE) combined with tyrosine kinase inhibitor (TKI), and the observation group was treated with PD-1/PD-L1 immunosuppressant. Tumor response, TumorFisher CTCs, serum vascular endothelial growth factor receptor (VEGFR), matrix metalloproteinase-9 (MMP-9) levels and adverse reactions were compared, and progression-free survival (PFS) and overall survival (OS) were followed-up. Results The objective response rate (ORR)(71.67% vs 53.33%) and disease control rate (DCR)(81.67% vs 63.33%) were higher in the observation group (P<0.05). After treatment, the total CTCs, total PD-L1+CTCs and serum VEGF and MMP-9 levels were decreased in both groups, and the levels were lower in the observation group (P<0.05). There was no significant difference in the incidence of hand-foot syndrome, thrombocytopenia, hypothyroidism, kidney injury and neutropenia grade I/II and grade III in the observation group (P>0.05). The median PFS (8.26 months vs 5.81 months) and the median OS (19.51 months vs 14.43 months) were longer in the observation group (P<0.05). Conclusion PD-1/PD-L1 immunosuppressive agents can improve tumor response in patients with middle and advanced HCC, decrease total CTCs number, total PD-L1+CTCs number, serum VEGF and MMP-9 levels, prolong PFS and OS, without increasing adverse reactions.
    An evaluation of immune function, clinical efficacy and safety of ramucirumab combined with sorafenib treatment in patients with hepatocellular carcinoma
    YIN Xing, XU Jian, YANG Tao, DONG Li, GAO Li-li
    2024, 29(10):  1189-1193. 
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    Objective To observe the effects of ramucirumab combined with sorafenib on immune function, quality of life and survival status of patients with hepatocellular carcinoma (HCC), and evaluate the clinical efficacy and safety of the combined treatment regimen. Methods Eighty-six patients with HCC in our hospital from January 2017 to December 2018 were included as the study subjects. They were randomly divided into a monotherapy group (46 cases) and a combined treatment group (46 cases) by random number table method. Patients in the monotherapy group received oral administration of sorafenib, and patients in the combined treatment group received ramucirumab injection treatment. All patients were continually treated until disease progression or intolerance. The clinical efficacy, liver function index, T cell ratio, tumor marker level and quality of life were compared between the two groups before and after treatment. Results After treatment, the serum albumin (Alb) (41.87±8.96 vs 46.00±6.52), alanine aminotransferase (ALT) (105.42±26.08 vs 92.24±18.19), aspartate aminotransferase (AST) (108.63±24.32 vs 96.75±20.29) and total bilirubin (TBil) (61.07±6.11 vs 53.54±6.71) of combined treatment group patients were significantly lower than those of the monotherapy group patients (t=2.663, 3.940, 2.962, 5.929, all P<0.05). CD4+T (42.15±6.61 vs 36.24±6.15) and CD4+/CD8+ ratio (1.79±0.37 vs 1.45±0.39) were significantly higher than those in monotherapy group, while CD8+ T ratio (21.56±4.97 vs 26.58±4.59) was significantly lower (t=4.677, 5.299, 4.607, all P<0.05). The serum alpha fetoprotein (AFP) (52.96±13.80 vs 74.40±20.26) and carbohydrate antigen 242 (CA242) (36.72±9.94 vs 44.82±12.47) were significantly lower than those in the monotherapy group (t=6.245, 3.627, all P<0.05). Short-form 36 questionnaire (SF-36) score (62.78±6.59 vs 59.04±5.81) and objective response rate (ORR) (80.39% vs 60.78%) were significantly higher than those in the monotherapy group (t=3.043, χ2=4.722, all P<0.05). During the treatment, there was no significant difference in the incidence of adverse events between the two groups (9.80% vs 15.69%, P>0.05). Conclusion Ramucirumab combined with sorafenib can effectively improve immune function, reduce liver function injury degree and serum tumor markers in HCC patients, and has better clinical efficacy, which has important clinical application value for improving quality of life and prognosis of HCC patients.
    Efficacy and safety of CalliSpheres○R microspheres-based drug-eluting beads transaterial chemoembolization in the treatment of hepatocellular carcinoma
    ZHENG Ya-lu, XIONG Kai, SHI Qing, YANG Hui, ZHENG Xiong
    2024, 29(10):  1194-1199. 
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    Objective To evaluate the treatment response, survival benefit, change of liver function and adverse events (AEs) of CalliSpheres○R (CSM) based drug-eluting beads transarterial chemoembolization (DEB-TACE) in treating hepatocellular carcinoma (HCC). Methods Sixty-six HCC patients who underwent CSM-based DEB-TACE in the Second Affiliated Hospital of Nanchang University were consecutively enrolled in this retrospective cohort study. The baseline characteristics of HCC patients were recorded. Treatment responses at 1 month after treatment, liver function related laboratory indexes pre and post-treatment, and the post-treatment AEs were recorded. Disease-free survival (DFS) and overall survival (OS) were documented and evaluated. Results Complete response (CR), Overall Response Rate (ORR) and Disease Control Rate (DCR) within 1 month post treatment were 18.2%, 75.8%, and 93.9%, respectively. Subgroup analysis revealed that patient with higher Child-Pugh stage (B stage 50.0% vs A stage 80.4%, P=0.039) and higher BCLC stage (C stage 40.0% vs B stage 82.4% vs A stage 94.1%, P=0.001) had worse ORR. The median PFS and OS were 6.0 months and 20.0 months, respectively. Subgroup analysis disclosed that patients with Child-Pugh B and higher BCLC C had both shorter DFS (P=0.015 and P=0.009), as well as worse OS (P=0.018 and P=0.002); additionally, the patients with multifocal disease had worse DFS (P=0.007). The Alb (median 34.7 g/L vs 37.7 g/L, P<0.001) and Scr (median 66.7 μmol/L vs 70.7 μmol/L, P=0.016) level decreased, while TBil (median 20.4 μmol/L vs. 16.8 μmol/L, P=0.025) increased after treatment. Other liver function-related indexes did not change after treatment. The most common AEs post treatment was pain (incidence rate of 47.0%). Conclusion CSM based DEB-TACE achieves favorable treatment response and survival benefit in Chinese HCC patients, also with good tolerance. Several clinical features might have the potentials to serve as prognostic markers.
    Effect of DEB-TACE combined with Lenvatinib in the treatment of unresectable middle and advanced liver cancer
    JIANG Wei, ZHANG Yan, LU Ying-ying
    2024, 29(10):  1200-1204. 
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    Objective To investigate the efficacy and safety of DEB-TACE combined with lenvatinib in the treatment of unresectable advanced hepatocellular carcinoma (HCC). Methods Seventy patients with unresectable advanced HCC admitted to the Department of Oncology, Haian People's Hospital from January 2021 to March 2022 were randomly divided into an observation group and a control group. On the basis of oral lenvatinib, the observation group was treated with DEB-TACE, and the control group was treated with iodized oil hepatic arterial chemoembolization (cTACE). The changes of tumor internal environment and liver function indexes, as well as the efficacy and safety indexes were observed before and after treatment. Results The 3-month objective response rate (ORR), disease control rate (DCR) and 1-year survival rate of the observation group were 77.14%, 91.43% and 57.14%, respectively, which were higher than those of 54.29%, 71.43% and 37.14% in the control group. The 1-year recurrence rate of the observation group was 20.00%, which was lower than that of the control group (42.86%), and the difference was statistically significant (χ2=4.086, 3.695, 3.369, 4.879, all P<0.05). After 3 months of treatment, the serum levels of hypoxia-inducible factor-1α (HIF-α), tumor-specific growth factor (TSGF) and hepatocyte growth factor (HGF) in the observation group were 308.47±32.65 pg/mL, 54.36±5.81 U/mL, and 4.37±0.83 μg/L, respectively. They were lower than those of 382.45±38.39 pg/mL, 63.49±6.34 U/mL, and 5.08±0.96 μg/L in the control group, and the differences were statistically significant (t=7.516, 8.342, 8.754, all P<0.05). The serum alanine aminotransferase (ALT) and total bilirubin (TBil) levels in the observation group were 58.83±6.73 U/L and 21.69±3.12 μmol/L, respectively, which were lower than those of 72.56±7.45 U/L and 23.25±3.18 μmol/L in the control group, whereas the albumin (Alb) level in the observation group was 34.56±2.37 g/L, which was higher than that of 32.89±2.29 g/L in the control group, and the differences were statistically significant (t=5.163, 4.746, 3.725, all P<0.05). The incidence of adverse reactions in the observation group was slightly lower than that in the control group, without statistical significance (P>0.05). Conclusion DEB-TACE combined with lenvatinib in the treatment of unresectable middle and advanced HCC can improve the internal environment of tumor lesions, reduce liver damage, and improve clinical treatment effect with high safety.
    The application value of serum microRNA-142-3p and miR-493-5p expression levels in the early diagnosis and disease assessment of primary hepatocellular carcinoma
    WANG Hui-zhe, LU Shuang-dong, WANG Qian, LIU Long-yan, WANG Ming-quan
    2024, 29(10):  1205-1208. 
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    Objective To explore the application value of serum microRNA(miR)-142-3p and miR-493-5p expression levels in the early diagnosis and disease assessment of primary hepatocellular carcinoma (PHC). Methods From June 2020 to August 2023, eighty-six PHC patients admitted to Baoding Second Central Hospital were collected as the PHC group, and 50 patients with autoimmune hepatitis were collected during the same period of time as the benign group. Additionally, 86 healthy individuals who underwent physical examination were collected as control group. Real-time quantitative fluorescence polymerase chain reaction (qRT-PCR) was used to measure the serum levels of miR-142-3p and miR-493-5p. Receiver operating characteristic (ROC) curve was applied to analyze the value of serum miR-142-3p and miR-493-5p in the early diagnosis and disease assessment of PHC. Results The expression levels of miR-142-3p (0.79±0.21) and miR-493-5p (0.83±0.22) in the serum of the PHC group were significantly lower than those of the benign group [(0.89±0.11) and (0.92±0.10), respectively] and control group [(1.01±0.12) and (1.02±0.13), respectively] (P<0.05). The levels of serum miR-142-3p and miR-493-5p in PHC patients with tumor diameter ≥3cm, portal vein invasion, distant metastasis were obviously lower than those in patients with tumor diameter <3 cm, non-portal vein invasion, and non-distant metastasis (P<0.05); the expression levels of miR-142-3p [(0.76±0.06), (0.67±0.05)] and miR-493-5p [(0.81±0.09), (0.70±0.06)] in the serum of patients with stage III and IV PHC, respectively, were significantly lower than those in stages I-II [(0.89±0.09), (0.93±0.11)] (P<0.05). The AUC of the combination of serum miR-142-3p and miR-493-5p for early diagnosis of PHC was 0.910, which was obviously higher than that of the two alone (Z=3.184, 2.739, all P<0.05). The AUC of serum miR-142-3p combined with miR-493-5p for disease assessment was 0.940, which was obviously higher than those of the two assessment alone (Z=1.994, 2.470, all P<0.05). Conclusion MiR-142-3p and miR-493-5p are both low expressed in the serum of PHC patients, which can be used as serum biomarkers for the diagnosis and assessment of PHC. A combined detection of these two miRs can significantly improve the diagnostic and assessment efficiency of PHC.
    A comparison between the contrast-enhanced ultrasound manifestations of inflammatory liver lesions and primary hepatocellular carcinoma and analysis of the factors affecting clearance time
    LI Kai, SHI Bo, ZHANG Jing
    2024, 29(10):  1209-1213. 
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    Objective To analyze the differences of contrast-enhanced ultrasound (CEU) manifestations between liver inflammatory lesions and primary hepatocellular carcinoma (PHC), as well as the influencing factors of clearance time. Methods Between June 2017 and June 2022, 30 patients with hepatic inflammatory lesions and 50 patients with PHC were diagnosed with pathology in Chengdu Medical College Second Affiliated Hospital. The CEU manifestations and quantitative CEU parameters of the two diseases were compared, and the value of quantitative CEU parameters in the differential diagnosis of hepatic inflammatory lesions and PHC was analyzed using the receiver operating characteristic curve (ROC). Results The proportion of irregular arterial phase enhancement, unclear boundaries, and low portal phase enhancement in liver inflammatory lesions was 60.0%, 80.0%, and 80.0%, respectively. The difference was statistically significant compared to PHC (16.0%, 6.0%, and 40.0%) (P<0.05). The descending time, average passage time, and initial clearance time of liver inflammatory lesions were (31.7 ± 3.4) s, (18.2 ± 2.1) s, and (63.4 ± 7.1) s, respectively, the differences were statistically significant when compared to those of (46.1 ± 5.2) s, (34.3 ± 3.7) s, and (35.1 ± 3.8) s in PHC patients (P<0.05). The ROC curve analysis results show that the descent time, average passage time, and start clearance time have high value in the differential diagnosis of liver inflammatory lesions and PHC. Conclusion CEU examination has certain value in differential diagnosis of liver inflammatory lesions and PHC. Quantitative analysis of CEU can objectively display the blood flow perfusion characteristics of liver inflammatory lesions and PHC, thereby elucidating the associated factors for their difference in clearance times.
    Application of Gd EOB DTPA enhanced examination in the diagnosis of small hepatocellular carcinoma in the context of liver cirrhosis
    CHEN Yan-xia, XU Xuan, A Ni, BAI Rong, LIU Xiao-zhi, HE Xiao-fang
    2024, 29(10):  1214-1216. 
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    Objective To explore the value of gadolinium oxalate disodium (Gd EOB DTPA) enhanced examination for small hepatocellular carcinoma (SHCC) in the context of liver cirrhosis. Methods 72 cases of focal liver lesions in the context of liver cirrhosis were included in our hospital from January 2020 to January 2024. Gd EOB DTPA liver enhanced magnetic resonance imaging (MRI) scans were performed on all cases. Using the pathological biopsy results as the gold standard, we observed and analyzed the imaging features of Gd EOB DTPA MRI enhanced scans, and compared the results and efficacy of Gd EOB DTPA MRI enhanced scans in distinguishing between benign and malignant liver focal nodules. Results 72 patients with focal liver lesions underwent pathological biopsy, and a total of 87 focal liver nodules were detected, including 50 benign nodules (57.47%, 50/87) (benign group); 37 malignant nodules (SHCC) (42.53%, 37/87) (malignant group). Compared with the benign group, the malignant group had a higher proportions of T1W1 low signal, DWI high signal, T2W1 high signal, hepatobiliary phase low signal, and arterial phase enhancement (P<0.05); Gd-EOB-DTPA MRI enhanced scans diagnosed 51 benign nodules (58.62%, 51/87) and 36 malignant nodules (41.38%, 36/87); The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and Kappa value of Gd-EOB-DTPA enhanced MRI in the differential diagnosis of SHCC were 89.66%, 86.49%, 92.00%, 88.89%, 88.89%, and 0.788%, respectively. Conclusion Gd-EOB-DTPA enhanced examination has a good accuracy in diagnosing SHCC in the background of liver cirrhosis, and is consistent with the gold standard, which has a clinical application value.
    Value of magnetic resonance imaging multimodal parameters combined with contrast-enhanced ultrasound parameters in the diagnosis of focal nodular hyperplasia of liver without scar
    WU Ai-qiang, YOU Ren-fang, YANG Qian, YU Jin, YU Hai-xia
    2024, 29(10):  1217-1220. 
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    Objective To evaluate the value of magnetic resonance imaging (MRI) multimodal parameters combined with contrast-enhanced ultrasound (CEUS) parameters in the diagnosis of focal nodular hyperplasia of the liver without scar. Methods The clinical data of 56 patients with non-scar focal nodular hyperplasia of liver admitted to the hospital from January 2016 to July 2023 were retrospectively analyzed as the study group, and the clinical data of 67 patients with hepatocellular carcinoma without cirrhosis were retrospectively analyzed as the control group. All subjects underwent the examinations including intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI), MRI, contrast-enhanced ultrasound (CEUS), and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). By comparing the general data, MRI multimodal parameters and CEUS parameters of the two groups , we analyzed the factors related to the occurrence of cicatricial focal nodular hyperplasia of the liver, as well as the diagnostic value of the combination of parameters for the occurrence of focal nodular hyperplasia in the liver without scar was analyzed. Results There was no difference in signal enhancement rate (SER) and proportion of fast diffusion components (f) between the two groups (P>0.05). The values of maximum slope of decrease (MSD), maximum slope of increase (MSI), rapid apparent diffusion coefficient (D*), apparent diffusion coefficient (ADC), proportion of rapid diffusion components (f) and slow apparent diffusion coefficient (D) in the study group were higher than control group (P<0.05). The study group with peak intensity (PI) was lower than control group (P<0.05), and the study group with peak time (TTP) and start enhancement time (AT) were higher than control group (P<0.05). Logistic regression analysis showed that MSD (OR=3.943, 95%CI: 1.733~8.970), TTP (OR=4.162, 95%CI: 1.830~9.468), AT (OR=4.536, 95%CI: 1.994~10.318) and ADC (OR=3.333, 95%CI: 1.465~7.583) were associated with the occurrence of focal nodular hyperplasia of liver without scar (P<0.05). The area under the curve (AUC) values of MSD, TTP, AT, ADC and the combined diagnosis of scar-free focal nodular hyperplasia of liver were 0.815, 0.804, 0.822, 0.793 and 0.901, respectively (P<0.05). And the combined AUC was higher (P<0.05). Conclusion MSD, TTP, AT and ADC are of great value in the diagnosis of cicatar-free focal nodular hyperplasia of the liver, and the combined value of the four is higher.
    The relationship between perfusion parameters and treatment efficacy of 320 row volume CT scanning after TACE for liver cancer
    HE Yu, ZHANG Xue-jian, ZHANG Lei
    2024, 29(10):  1221-1224. 
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    Objective To investigate the relationship between perfusion parameters and therapeutic effect of 320-row volume CT scan after transcatheter artery chemoembolization (TACE) for liver cancer. Methods A total of 120 patients with liver cancer admitted to our hospital from January 2019 to June 2022 were selected and studied, all of whom received TACE surgery. They were divided into the effective group (n=88) and the ineffective group (n=32) according to the postoperative efficacy criteria for solid tumors. Statistical data was compared between the two groups using χ2 test. And we used t test to compare the measurement data between the two groups. The gender, age, liver envelope penetration, degree of tumor differentiation, plasma alpha-fetoprotein (AFP) concentration, portal vein cancer embolus, intraoperative blood loss, hepatic artery perfusion (HAP), hepatic blood flow (HBF), hepatic perfusion index (HPI) were compared between the two groups. Multivariate Logistic regression analysis was used to analyze the risk factors of ineffective TACE treatment for liver cancer. Receiver operating characteristic (ROC) curve was drawn to evaluate the efficacy of HAP, HBF and HPI in predicting the failure of TACE treatment for liver cancer. Pearson correlation was used to analyze the relationship between CT perfusion parameters and TACE treatment for liver cancer. Results In the effective group and ineffective group, the comparison of Liver envelope penetration was 45.45% vs. 68.75% (χ2=5.100, P=0.024) and portal vein cancer thrombus was 43.18% vs. 65.63% (χ2=4.729, P=0.030). The proportion of patients in the ineffective group was significantly higher than that in the effective group (P<0.05). HAP (8.89±1.78 vs. 13.04±2.86, t=9.493, P=0.000), HBF (101.24±16.83 vs. 118.08±19.66, t=4.630, P=0.000) and HPI (28.15±4.69 vs. 37.48±6.47), t=8.664, P=0.000) was significantly lower than that in effective group, and the difference was statistically significant (P<0.05). Multivariate logistic regression analysis confirmed that liver envelope penetration, portal vein cancer thrombus, HAP, HBF and HPI were all risk factors affecting the efficacy of TACE treatment for liver cancer, and the OR values were 2.396 (95%CI: 1.017~5.644), 2.308 (95%CI: 1.030~5.632), 1.542 (95%CI: 1.127~2.057), 1.696 (95%CI: 1.026~1.804) and 2.011 (95%CI: 1.211~2.339) respectively. The P value were all lower than 0.05. ROC analysis proved that CT perfusion parameters HAP, HBF and HPI could be used to predict the therapeutic effect of TACE for liver cancer. The area under the curve was 0.907, 0.740 and 0.908, respectively, and the optimal cut-off value was 10.825, 112.437 and 31.542, respectively, with P<0.05. Correlation analysis showed that CT perfusion parameters HAP, HBF and HPI were negatively correlated with TACE treatment effect (r=-0.553, -0.312, -0.448, P<0.05). Conclusion Perfusion parameters of CT scan were negatively correlated with the therapeutic effect of TACE for liver cancer, and liver envelope penetration, portal vein cancer thrombus, HAP > 10.825, HBF > 112.437, HPI > 31.542 were all risk factors affecting the therapeutic effect of TACE for liver cancer. These indicators can be used as the markers to evaluate the therapeutic effect of TACE, providing reference for clinical assessment and treatment.
    Liver Fibrosis & Cirrhosis
    Predictive value of portal vein velocity, platelet count/spleen diameter ratio for esophageal fundus varices in patients with hepatitis B-related cirrhosis
    NIU Li-na, SONG He-wei, ZHAO Jin-ku, LI Xin-he, ZHONG Hao-yi, XU Qiang, WANG Xiao-zhong
    2024, 29(10):  1225-1229. 
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    Objective To investigate the prognostic value of portal vein velocity (PVV), platelet count (PC) to splenic diameter (SD) ratio (PC/SD) for esophagogastric varices (EGV) in patients with hepatitis B-related cirrhosis. Methods A total of 127 patients with hepatitis B-related cirrhosis who received medical treatment in Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine from June 2021 to April 2023 with complete clinical data included electronic gastroscopy, hepatobiliary spleen ultrasound, and portal vein color ultrasound were selected. They were divided into an EGV group of 75 patients and a non-EGV group of 52 patients according to the results of electronic gastroscopy. Univariate analysis was performed on the influencing factors of EGV group, and then binary logistic regression was used to analyze the non-invasive predictive indicators of EGV, and the receiver operating characteristic (ROC) curve was drawn to evaluate the value of each indicator in predicting EGV. The area under the curve (AUC) and its truncation value were calculated, as well as the corresponding sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results Univariate analysis showed statistical differences in the following variables between the two groups, including PVV (t=-4.421), PLT (Z=-5.654), SD (t=-5.163), PC/SD (Z=5.585), AST (Z=-4.005), CHE (t=6.864), Alb (t=7.248), TBil (t=-6.654),INR (t=-8.889), APRI index (Z=-6.372), liver cirrhosis stage (χ2=52.307), ascites (χ2=26.057), hepatic encephalopathy (χ2=7.435), Child-Pugh classification (χ2=83.923), and all P values were less than 0.001. Binary logistic regression analysis showed that PVV (OR:1.426, 95%CI: 1.172~1.735) was an independent risk factor for EGV in patients with hepatitis B-related liver cirrhosis. PC/SD (OR:0.148,95%CI: 0.065-0.337) was a protective factor for EGV. The AUC of PVV in predicting EGV in patients with hepatitis B cirrhosis was 0.718, with the cut-off value of 21.5. And the model's predictive sensitivity and specificity was 77.3% and 44.2%, respectively. The positive predictive value was 66.7%, and the negative predictive value was 57.5%. When the AUC of PC/SD for predicting EGV was 0.812 and the cut-off value was 0.721, its predictive sensitivity was 84.0%, the specificity was 57.7%, the positive predictive value was 74.1%, and the negative predictive value was 71.4%. Conclusion Both PVV and PC/SD have good predictive value for EGV in patients with hepatitis B cirrhosis.
    Clinical value of liver stiffness value detected by FibroTouch combined with portal vein hemodynamics in evaluating liver fibrosis in patients with chronic hepatitis B
    DANG Miao-miao, DU Miao-miao, GAO Yan-mei
    2024, 29(10):  1230-1234. 
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    Objective To explore the evaluation value of liver stiffness value (LSM) combined with the portal vein hemodynamic indicators detected by Doppler ultrasound for liver fibrosis in patients with chronic hepatitis B (CHB). Methods Between August 2020 and July 2023, 99 CHB patients admitted to our hospital underwent liver biopsy, instantaneous elastography, and Doppler ultrasound examination. Their liver fibrosis status, LSM, portal vein main diameter (PVD), resting portal vein maximum flow velocity (Vmax), and mean flow velocity (Vmean) were recorded. According to the Metavir fibrosis scoring system of patients, they were divided into three groups: without liver fibrosis (F0 stage), mild liver fibrosis group (F1-F2 stage) and significant liver fibrosis group (≥ F3 stage). The LSM, PVD, Vmax, and Vmean of the three groups were compared. Spearman correlation analysis was used to analyze the correlation among the LSM, PVD, Vmax, Vmean and Metavir score. Receiver operating curve (ROC) analysis was used to evaluate the value of LSM, PVD, Vmax, and Vmean in evaluating liver fibrosis in CHB patients. Results Pathological biopsy showed that among the 99 patients, there were 16 cases in F0 stage, 30 cases in F1 stage, 24 cases in F2 stage, 20 cases in F3 stage, and 9 cases in F4 stage. LSM and PVD: significant hepatic fibrosis group [(13.67±1.95) kPa, (13.35±1.32) mm] > mild hepatic fibrosis group [(6.81±0.97) kPa, (11.77±1.15) mm] > no hepatic fibrosis group [(5.12±0.84) kPa、(10.84±1.04) mm]. Vmax, Vmean: significant hepatic fibrosis group [(29.04±2.11) cm/s, (24.58±1.93) cm/s] < mild hepatic fibrosis group [(33.26±2.04) cm/s, (27.10±1.86) cm/s]. LSM, PVD and Metavir score in CHB patients were significantly positively correlated (r=0.649, r=0.477, P<0.05), while Vmax and Vmean were significantly negatively correlated with Metavir score (r=-0.561, r=-0.538, P<0.05). The area under the curve (AUC) of LSM, PVD, Vmax, Vmean, and their combined detection for evaluating significant liver fibrosis in CHB patients were 0.938, 0.886, 0.800, 0.867, and 0.983, respectively, with sensitivities of 82.76%, 89.66%, 82.76%, 79.31%, and 96.55%, and specificity of 91.43%, 80.00%, 64.29%, 77.14%, and 90.00%. The combined detection had a better evaluation efficacy for significant liver fibrosis in CHB patients than the individual detection of each indicator (P<0.05). Conclusion LSM and portal vein hemodynamic indicators are related to the liver fibrosis in CHB patients. The combination of LSM and Doppler ultrasound detection of portal vein hemodynamic indicators has a good evaluation efficacy for liver fibrosis in CHB patients.
    Application of multi-slice spiral CT volume measurement in evaluating liver reserve function in patients with liver cirrhosis
    XIU Zhi, ZOU Zhi-chao, ZHANG Ying-lin, AN xin, XIANG Yi-si
    2024, 29(10):  1235-1238. 
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    Objective To explore the application value of multi-slice spiral CT volu-me measurement of liver reserve function in patients with liver cirrhosis. Methods 42 healthy individuals who underwent liver reserve function examinations in Xuancheng City People's Hospital from June 2020 to June 2023 were selected as the normal group, while 42 patients with cirrhosis admitted during the same period were selected as the cirrhosis group. All patients underwent the multi-slice spiral CT volume measurement to analyze the corr-elation between liver reserve function and multi-slice spiral CT volume measurement value in patients with liver cirrhosis. Results Among 42 patients, there were 17 patients with Child Pugh grade A (40.48%), 18 patients with grade B (42.86%), and 7 patients with grade C (16.67%). The total liver volume [(1040.31±224.51)cm3], right lobe volume [(521.37±105.52)cm3], and left inner lobe volume [(150.85±45.18)cm3] in the cirrhosis group were lower than those in the normal group (total liver volume, 1408.62±158.57); (right lobe volume, 932.27±165.64); (left inner lobe volume, 224.19±43.67). The caudate lobe volume [(39.60±9.69)cm3] was higher than that in the normal group [(20.96±12.18)cm3,P<0.05]. The total liver volume [(1233.85±192.65)cm3], right lobe volume [(624.67±76.11)cm3] and left medial lobe volume [(179.51±47.96)cm3] in patients with grade A were higher than those in patients with grade B and C ( (total liver volume, 1028.52±164.61 and 899.33±141.55); (right lobe volume, 517.53±66.17 and 472.21±57.21); (left medial lobe volume, 154.96±33.77 and 129.91±31.12) ). The volume of caudate lobe [(30.30±6.15)cm3] was lower than that of patients with grade B and C [(39.47±6.02 and 46.11±6.12)cm3,P<0.05]. According to Kendall's tau-b correlation analysis, the total liver volume, right lobe volume, and left inner lobe volume of multi-slice spiral CT were positively correlated with the Child Pugh grade of patients with cirrhosis (r=0.325, 0.329, 0.256, P<0.05), while the measured volume of the caudate lobe by multi-slice spiral CT was negatively correlated with the Child Pugh grade in patients with cirrhosis (r=-0.396, P<0.05). The results of drawing receiver operating curve (ROC) curves showed that the area under the curve (AUC) of the total liver volume, right lobe volume, left inner lobe volume, caudate lobe volume, and combined measurement values for evaluating the Child-Pugh grading of liver function in patients with liver cirrhosis were all greater than 0.7, which had a certain evaluation value. Conclusion Multi-slice spiral CT measurement of total liver volume, right lobe volume, left inner lobe volume, and caudate lobe volume can be used to evaluate liver reserve function in patients with liver cirrhosis, and has certain evaluation value.
    Effectiveness of thromboelastogram clot formation time (K value) and maximum amplitude in predicting bleeding after central vein catheterization in patients with hepatitis B cirrhosis
    ZHANG Li, WANG Meng-jie, SUN Meng-qiu
    2024, 29(10):  1239-1242. 
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    Objective To explore the effectiveness of predicting bleeding events after central venous catheterization in patients with hepatitis B cirrhosis by using thromboelastogram (TEG) clot formation time (K value) and maximum amplitude (MA). Methods The clinical data of 166 patients with hepatitis B cirrhosis who underwent central venous catheterization between May 2021 and May 2022 at Xuzhou Central Hospital were retrospectively analyzed. They were divided into bleeding group (n=45) and non-bleeding group (n=121) according to whether there was bleeding after surgery. All patients were tested by TEG, and univariate analysis was conducted for each index. The statistically significant variables in the univariate analysis were included in the multiple logistic regression analysis, so as to screen out the risk factors predicting the bleeding after central vein catheterization for hepatitis B cirrhosis. The value of each risk factor to predict the bleeding after central vein catheterization for patients with hepatitis B cirrhosis was analyzed using the receiver operating characteristic curve (ROC). Results The results of univariate analysis showed that there were statistically significant differences in coagulation time (K), international normalized ratio (INR) and MA between the two groups (P<0.05). Multivariate Logistic regression analysis showed that K time ≥3.05 min and INR≥2.6 were the risk factors for bleeding after central venous catheterization in patients with hepatitis B cirrhosis (OR=5.613 and 5.703, P<0.05), and MA≥48.8 mm was the protective factor for bleeding after central venous catheterization in patients with hepatitis B cirrhosis (OR=0.874, P<0.05). ROC curve analysis showed that the area under the curve of K, MA, INR to predict the bleeding after central vein catheterization is 0.878, 0.858, 0.854 respectively, with a good prediction efficiency. Conclusion TEG blood clot formation time (K value) and MA have a high value in predicting the bleeding after central vein catheterization in patoents with hepatitis B cirrhosis. K time ≥ 3.05 min and INR ≥ 2.6 are risk factors, and MA ≥48.8 mm was the protective factor for bleeding after central vein catheterization in hepatitis B cirrhosis patients.
    Viral Hepatitis
    Detection of HBV RNA and its influencing factor analysis in hepatitis B patients whose HBV DNA is lower than the limit of detection
    SUN Mei, TAN Guo-lei, XU Lu-lu, SHI Rui, NI Jun-ming, WU Xu-ping
    2024, 29(10):  1243-1246. 
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    Objective To explore the clinical application value of new serum standard HBVRNA in hepatitis B patients with HBVDNA lower limit after nucleoside treatment. Methods We detected the HBVRNA of 226 chronic hepatitis B patients and 130 liver cirrhosis cases with quantitative cobasHBVDNA value less than 20 IU/mL. By using the regression analysis, we compared the difference in detection rate and detection value between the two cases,and then we used the correlation analysis to figure out the correlation of HBVRNA with sAg and eAg in the two groups. Results 1 HBVRNA detection rate and concentration levels varied significantly in cases of CHB and cirrhosis:The HBVRNA detection rate of HBV sAg-positive cirrhosis group (97.5%) was significantly higher than that in the sAg-positive hepatitis B group (87%) (P<0.01). Similarly, the mean LOG value of HBVRNA concentration (2.37±1.98) of which was significantly lower than that in sAg-positive hepatitis B group (3.86±1.46) (P<0.01). The HBVRNA detection rate in eAg negative cirrhosis patients (25.5%) was significantly higher than that in eAg negative chronic hepatitis B patients (10.7%)(P<0.05), and there was no difference in HBVRNA concentration and the HBVRNA detection rate between two groups. There was no significant difference in the detection rate and concentration of HBVRNA between the eAg positive cirrhosis group and the eAg positive chronic hepatitis B group. 2 Different clinical status, sAg and eAg affected HBVRNA levels. 3 HBVRNA was correlated with sAg in both chronic hepatitis B group (r=0.382, P<0.01) and cirrhosis group (r=0.304, P<0.05). CHB HBVRNA was associated with eAg in the cirrhosis group (r=0.607, P<0.01), but not in cirrhosis group. Conclusion HBVRNA can replace HBVDNA as a biological indicator of continuously monitoring the replication status of the virus in chronic hepatitis B and cirrhosis patients after receiving antiviral drugs.
    Efficacy and safety of tenofovir dipivoxil in preventing mother-to-child transmission of hepatitis B virus during late pregnancy
    FAN Hui-jie, JIANG Guo-wei
    2024, 29(10):  1247-1250. 
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    Objective To investigate the efficacy and safety of tenofovir dipivoxil in preventing mother-to-child transmission of hepatitis B virus (HBV) in carriers during late pregnancy. Methods Our study included 112 pregnant women with HBV who were diagnosed and treated at Jiading District Central Hospital between January 2018 and December 2020. The participants were divided into two groups: a control group and an observation group. The observation group received tenofovir disoproxil fumarate from 26-28 weeks of gestation until delivery, while the control group did not receive antiviral treatment. All infants from both group were administered 100 IU of hepatitis B immunoglobulin within 24 hours after birth and received the hepatitis B vaccine at 0, 1 and 6 months. We compared ALT levels, HBV DNA, HBsAg and HBeAg, neonatal growth and development, and adverse reactions in pregnant women between the two groups. Results The HBV DNA levels in the control group before treatment and 12 weeks postpartum were (7.3±0.6) log10 IU/mL and (7.1±0.8) log10 IU/mL, respectively (P<0.05). In the observation group, the HBV DNA levels were (7.4±0.3) log10 IU/mL before treatment and (6.9±0.9) log10 IU/mL 12 weeks postpartum (P<0.05). The HBV DNA level in the observation group before delivery was (3.2±0.7) log10 IU/mL, significantly lower than that of the control group (7.2±0.4) log10 IU/mL, with a statistically significant difference(P<0.05). The HBsAg positive rate, HBeAg positive rate, and HBV DNA positive rate in newborns from the observation group were lower than those in the control group at birth, and at 6 and 12 months. Furthermore, the HBV infection rate in newborns from the observation group was significantly lower compared to the control group (P<0.05). No cass of abortion, liver or kidney dysfunction, or postpartum hemorrhage occurred in either group of pregnant women. Fetal growth and development were satisfactory in both groups. Conclusion The use of tenofovir disoproxil fumarate during the third trimester of pregnancy in women with hepatitis B virus shows strong antiviral efficacy, is safe, and significantly reduces the rate of mother-to-child transmission.
    Liver Failure
    Clinical analysis of six pediatric cases with influenza-associated encephalopathy and acute liver failure
    CHEN Min-xia, GONG Zong-rong, GU Yi-ling, FANG Chun-xiao, YANG Hua-mei, HE Deng-min, WANG Yan-ling, XU Yi
    2024, 29(10):  1251-1255. 
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    Objective To analyze the clinical characteristics and laboratory findings of children with influenza-associated encephalopathy and acute liver failure, with the aim of improving understanding and management of this condition. Methods Data from six inpatients with influenza-assoicated encephalopathy and acute liver failure, treated at Guangzhou Women and Children's Medical Center between June 2022 to May 2023. were collected and statistically analyzed for their clinical characteristics and laboratory findings. Results The onset of the disease primarily occured in the spring and early summer, affecting children aged 1 year 2 months to 7 years, with 4 males and 2 females. All patients presented with fever, with some also experiencing cough, runny nose, and vomiting. Lung involvement was mild, but the condition progressed rapidly. Neurological symptoms, notably generalized Tonic-Clonic Seizures, emerged within 24 hours, followed swiftly by altered consciousness. Cerebrospinal fluid analysis showed normal white blood cells and glucose levels, with elevated trace proteins. CT/MRI findings revealed symmetrical damage to areas such as the periventricular region, pons, bilateral thalamus, cerebellum, and white matter. Severe liver function impairment developed within 48 hours and peaked by day 3, With mean ALT and AST levels reaching 2629.33 U/L and 7054 U/L, respectively. A marked elevation in LDH was noted, with an average of 5810.33 U/L, while γ- GT, TBil and TBA remained relatively normal, Blood glucose and ammonia levels were mostly normal, but coagulation function was significantly impared. All patients required tracheal intubation and mechanical ventilation, and were treated with immunoglobulin and glucocorticoids. Two patients underwent plasma exchange and continuous renal replacement therapy. Three patients (50%) ultimately died. Conclusion Children with influenza-associated encephalopathy and acute liver failure primarily present with recurrent fever, seizures, altered consciousness, significantly elevated liver enzymes, relatively normal bile enzyme levels, and marked abnormalities in blood coagulation. The condition has an acute onset, progresses rapidly, and is associated with high mortality and poor prognosis, warranting close attention.
    Serum anti-fumarate hydratase autoantibodies in hepatitis-B-associated acute-on-chronic liver failure: changes and their prognostic value
    FU Lu-yu, XIONG Zhi-qiang, LIU Lan-xia, LIU Du-xian, XIONG Qing-fang, ZHANG Jie-dong
    2024, 29(10):  1256-1259. 
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    Objective To investigate the expression of anti-fumarate hydratase autoantibodies (anti-FH antibodies) in the serum of patients with chronic hepatitis B-related acute-on-chronic liver failure (HBV-ACLF), and assess their potential as a biomarker for predicting the prognosis of HBV-ACLF. Methods Between January 2019 and December 2021, 43 patients with chronic hepatitis B (CHB), 40 patients with hepatitis B-related liver cirrhosis (HBV-LC), and 46 patients with HBV-ACLF were enrolled. Anti-FH antibody levels in CHB, HBV-LC and HBV-ACLF patients were compared, and general clinical data were collected for followed-up. Patients with HBV-ACLF were further categorized into an improvement group and a death group, and comparisons were made between the two groups. Results In the HBV-ACLF group, the levels of ALT, AST, TBil and DBil were 72 (36.5, 103.7) U/L, 88 (43.1, 145.6) U/L, 145.8 (100.2, 223.8) μmol/L and 101.9 (88.2, 163.9) μmol/L, respectively. These values were significantly higher than those in the HBV-LC group [32 (27.2, 58.4) U/L, 33 (25.3, 44.3) U/L, 35.4 (20.3, 51.6) μmol/L and 17.1 (14.9, 30.7) μmol/L] and the CHB group [17 (19.3, 31.6) U/L, 15 (18.8, 32.4) U/L, 20.1 (9.4, 32.1) μmol/L and 12.9 (10.5, 26.3) μmol/L], with the differences being statistically significant (P<0.05). The Alb and PLT levels in the HBV-ACLF group were 26.1 (14.2, 38.7) g/L and (90.3±4.6) ×109/L, which were significantly lower than those in the HBV-LC group [38.2 (19.8, 60.2) g/L and (104.4±1.4) ×109/L and the CHB group [40.1 (21.4, 56.8) g/L, (146.6±0.3) ×109/L]. The Anti-FH antibody levels in the CHB group, HBV-LC group and HBV-ACLF groups were (3.5±1.2) mg/L, (25.3±12.5) mg/L and (53.7±11.4) mg/L, respectively. With statistically significant differences(P<0.05). Patients in HBV-ACLF group were categorized into an improvement group (n=31) and a death group (n=15) based on follow-up outcomes. The anti-FH antibody levels, ALT, AST, Alb, TBil, DBil, PT, AFP and MELD scores in the improved group were (13.6±6.8) mg/L, 69.4 (30.6, 80.3) U/L, 79.1 (38.5, 97.8) U/L, 29.3 (23.7, 33.4) g/L, 146.6 (124.7, 200.9) μmol/L, 63.5 (52.2, 93.2) μmol/L, 14.3 (12.0, 26.8), 29 (21.2, 30.4) ng/mL and 1.0 (0.0, 2.4) points, respetively. These values were significantly different from those in the death group, where the values were [ (50.8±25.5) mg/L, 109.9 (68.9, 163.1) U/L, 143.8 (70.3, 193.9) U/L, 16.7 (9.8, 30.4) g/L, 297.4 (208.7, 374.2) μmol/L, 86.7 (53.7, 99.4) μmol/L, 26.8 (20.6, 45.5) seconds, 3.5 (2.1, 7.3) ng/mL and 14.2 (6.0, 20.4) points, with all differences being statistically significant (P<0.05). The area under the ROC curve (AUC) for anti-FH antibodies in predicting mortality in HBV-ACLF patients was 0.751, with an optimal cutoff value of 29.8 mg/L (P<0.05). The sensitivity and specificity at this cutoff were 73.3% and 67.7% respectively. Conclusion The serum expression level of anti-FH antibodies is elevated in patients with HBV-ACLF making it a valuable marker for assessing disease severity and serving as an important prognostic indicator.
    Metabolic Dysfunction Associated Steatotic Liver Disease
    Diagnostic value of ultrasound attenuation imaging parameters combined with residual cholesterol/HDL-C in assessing hepatic steatosis of MAFLD and its correlation with lipid metabolism
    HU Li-jun, LIAN Qian-qian
    2024, 29(10):  1260-1264. 
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    Objective To evaluate the diagnostic accuracy of quantitative ultrasound attenuation imaging parameters combined with the Residual Cholesterol/High-Density Lipoprotein Cholesterol (RC/HDL-C) ratio, in detecting hepatic steotosis in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). Additionally, to investigate the correlation between these parameters and lipid metabolism in the context of liver fat infiltration. Methods A retrospective analysis was performed on the medical records of 146 patients with MAFLD who were examined at the People's Hospital of Handan City from January 2021 to December 2023 in . Based on the degree of hepatic steatosis, patients were categorized into mild, moderate, and severe groups. Differences in attenuation coefficient (AC), and RC/HDL-C levels among these groups were compared. The correlation between AC and RC/HDL-C was analyzed, and factors influencing liver fat infiltration in MAFLD were evaluated. Additionally, the diagnostic efficacy of AC and RC/HDL-C in assessing the severity of hepatic steatosis in MAFLD was examined. Results Among the 146 patients with MAFLD, 36 cases (24.66%) had mild hepatic steatosis, 58 cases (39.73%) had moderate steatosis, and 52 cases (35.62%) had severe steatosis. The AC for the mild, moderate, and severe groups were (0.71±0.22) dB cm-1 MHz-1, (0.80±0.25) dB cm-1 MHz-1, and (0.93±0.28) dB cm-1 MHz-1, respectively. The RC/HDL-C ratios were (0.18±0.04), (0.22±0.05), and (0.23±0.07), respectively. The differences were statistically significant (P<0.05). Both AC (OR=3.677, 95% CI: 1.085-12.453) and RC/HDL-C (OR=4.133, 95% CI: 1.221-13.998) were identidied as risk factors for the severity of hepatic steatosis in MAFLD patients (P<0.05). The sensitivity and specificity for diagnosing moderate to severe liver steatosis using AC, RC/HDL-C, and their combination were 0.61, 0.68, and 0.77, respectively, with corresponding area under the curve(AUC) values of 0.736, 0.738, and 0.829. Conclusion AC, RC/HDL-C can serve as auxiliary diagnostic tools for assessing the degree of hepatic steatosis in MAFLD, demonstrating good diagnostic efficacy.
    Characteristics of serum adiponectin, ROS, and glucose-lipid metabolism in patients with chronic hepatitis B and concurrent non-alcoholic fatty liver disease
    DONG Dan-dan, QIU Li, HU Yi
    2024, 29(10):  1265-1268. 
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    Objective To analyze the characteristics of serum adiponectin (APN), reactive oxygen species (ROS), and glucose-lipid metabolism in patients with chronic hepatitis B virus (HBV) infection combined with non-alcoholic fatty liver disease (NAFLD). Methods Between April 2022 and April 2024, a total of 172 patients were enrolled, including those with chronic HBV infection (HBV group, 61 cases), NAFLD (NAFLD group, 26 cases), and chronic HBV infection combined with NAFLD (HBV+NAFLD group, 85 cases) . Clinical data were analyzed, and serum levels of APN, ROS, and glucose-lipid metabolism indicators_fasting blood glucose (FPG), fasting insulin (FINS), Homeostasis model assessment of insulin resistance(HOMA-IR), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides (TG)-were measured. Liver function andfibrosis markers, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), hyaluronic acid (HA), laminin (LN), type III procollagen peptide (PIIIP), and type IV collagen (CIV), were also assessed. Results The FINS, HOMA-IR, TC, and TG levels in the NAFLD group were (16.31±2.64) μIU/L,(4.08±0.69), (5.22±1.23) mmol/L, and (2.05±0.73) mmol/L respectively, In the HBV+NAFLD group, these values were (16.14±2.58) μIU/L, (4.09±0.71), (4.72±1.21) mmol/L, and (1.76±0.38) mmol/L respectively. Both the NAFLD and HBV+NAFLD groups showed significantly higher values compared to the HBV group, which had FINS, HOMA-IR, TC and TG levels of (9.03±1.25) μIU/L, (2.18±0.33), (4.31±0.82) mmol/L, and (1.16±0.32) mmol/L, respectively (P<0.05). However, no significant differences were observed between the NAFLD and HBV+NAFLD groups (P>0.05). There were no statistically significant differences in ALT, AST, HA, LN, P Ⅲ P, or CⅣ levels among the three groups (P>0.05). The ROS levels in the NAFLD group and HBV+NAFLD group were (2.05±0.43) U/mL and (1.89±0.38) U/mL respectively, both significantly higher than the HBV group at (0.91±0.24) U/mL (P<0.05). The APN levels in the NAFLD and HBV+NAFLD groups were (8.02±1.15) ng/mL and (8.47±1.26) ng/mL, respectively, significantly lower than the HBV group at (10.14±2.33) ng/mL (P<0.05). However, no statistically significant differences in ROS and APN levels were observed between the HBV+NAFLD and NAFLD group (P>0.05). Conclusion Low APN expression elevated ROS levels, and abnormal glucose-lipid metabolism may contribute to the progression of chronic HBV infection combined with NAFLD.
    Other Liver Diseases
    Clinical characteristics of 60 cases of yellow granulomatous cholecystitis and imaging manifestation differentiation from gallbladder cancer
    WANG Bin, HUA Xing, ZHOU Chen
    2024, 29(10):  1269-1273. 
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    Objective To analyze the clinical features of 25 cases of yellow granulomatous cholecystitis and differentiate their imaging manifestations from those of gallbladder cancer. Methods Sixty patients with surgically and pathological diagnoses of yellow granulomatous cholecystitis and gallbladder cancer, admitted to our hospital between May 2019 and May 2023, were divided into the cholecystitis and gallbladder cancer groups. We compared the clinical features and imaging manifestations of the two groups and analyzed the diagnostic value of imaging manifestations in distinguishing yellow granulomatous cholecystitis from gallbladder cancer using the receiver operating characteristic (ROC) curve. Results The decrease in body mass index(BMI) in the cholecystitis group was (14.1 ± 0.4) kg/m2, and the proportion of patients with decreased appetite was 36.0%, both lower than those in the gallbladder cancer group, which had values of 16.2 ± 0.1 kg/m2 and 80.0%, respectivey (P<0.05). The incidence of gallbladder stones, diffuse thickening of the gallbladder wall, continuous integrity of the mucosal line, and transient enhancement in the arterial phase of adjacent hepatic parenchyma was 72.0%, 60.0%, 80.0%, and 76.0%, respectively, in the Cholecystitis group, all higher than in the gallbladder cancer group [28.6%, 28.6%, 34.3%, and 42.9%, respectively; P<0.05]. ROC curve analysis indicated that gallbladder stones, diffuse thickening of the gallbladder wall, continuous integrity of the mucosal line, and transient enhancement in the arterial phase of adjacent liver parenchyma are valuable for differentiating yellow granulomatous cholecystitis from gallbladder cancer. Conclusion Yellow granulomatous cholecystitis often clinically manifests as decreased body weight, appetite, gallstones, diffuse thickening of the gallbladder wall, continuous integrity of the mucosal lining, and transient enhancement in the arterial stage adjacent to liver parenchyma which is highly valuable for differentiating yellow granulomatous cholecystitis from gallbladder cancer.
    The role of ICG imaging guidance in difficult laparoscopic cholecystectomy
    ZHAO Jie, ZHOU Jian-gang, YANG Yong, SHAO Rong
    2024, 29(10):  1274-1276. 
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    Objective To evaluate the clinical utility of indocyanine green (ICG) fluorescence imaging guidance in facilitating difficult laparoscopic cholecystectomy. Methods A total of 60 patients undergoing difficult laparoscopic cholecystectomy were enrolled between May 2022 and May 2023, comprising 35 males and 25 females, with a mean age of 53.6±2.1 years. The patients were divided into two groups based on the use of ICG imaging guidance during surgery: the observation group (n=35) utilized ICG fluorescence imaging for extrahepatic bile duct visualization, while the control group (n=25) used standard white light imaging. Clinical outcomes and complication rates between the two groups were compared. Results In the observation group, the operating time, intraoperative blood loss, hospital stay, hospital cost, and percentage of four-port laparoscopic cholecystectomy were 75.1±12.8 minutes, 17.6±6.6 mL, 2.8±1.2 days, ￥10,125.2±902.3, and 28.6%, respectively. These values were significantly lower than those in the control group, which were105.6±18.9 minutes, 23.7±8.6 mL, 3.6±1.8 days, ￥10859.6±1405.3, and 80.0%(t/χ2=7.590、7.015、6.837、2.557 and 15.429, respectively; P<0.05). The incidence of bleeding, pulmonary infection, biliary fistula and bile duct injury in the observation group was 0(0%), 1 case (2.9%), 0(0%) and 0(0%) respectively, compared to 1 case (4.0%), 2 cases (8.0%) and 1 case (4.0%) in the control group. The total complication rate between the two groups was statistically significant (χ2=6.326, P=0.012). Conclusion Difficult laparoscopic cholecystectomy poses a higher risk of bile duct injury due to unclear anatomical structures and anatomical variationss. ICG fluorescence imaging significantly enhances the visualization of bile duct structures, reduces operation time and intraoperative blood loss, helps prevent bile duct injury and decreases postoperative complications. Therefore, it is a valuable technique that merits wider adoption in clinical practice.
    Clinical significance of serum PTX-3 and PAF in predicting postoperative pancreatitis following ERCP in patients with cirrhosis and choledocholithiasis
    QING Xiao-song, CHEN Jie, HE Xiao-fei, ZHENG Ying-jun
    2024, 29(10):  1277-1280. 
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    Objective To evaluate the clinical significance of serum penetrating-3 (PTX-3) and platelet-activating factor (PAF) in predicting post-ERCP pancreatitis (PEP) in patients with cirrhosis and choledocholithiasis. Methods A total of 120 patients with cirrhosis and choledocholithiasis who underwent ERCP at the Liver, Biliary, Pancreatic, and Spleen Diagnosis and Treatment Center of Zigong Fourth People's Hospital between April 2017 and October 2022 were enrolled in this stuydy. Patients were divided into two groups based on the occurrence of PEP within 48 hours after the procedure: the control group (n=95, no PEP) and the observation group (n=25, PEP occurred). The factors influencing the occurrence of PEP after ERCP were analyzed through both univariate and multicariate analyses. Additionally, the diagnostic efficacy of combined serum amylase, PAF, PTX-3, and TPS-2 levels in detecting PEP was evaluated. Results ① The levels of PTX-3 (13.52±0.85 ng/ml), amylase (166.80±13.52 U/L), PAF (65.32±3.52 μg/L), CRP (44.63±3.74 mg/L), and TPS-2 (189.26±4.56 μg/L) in the observation group were significantly higher than those in the control group[PTX-3 (1 .89±0.41 ng/mL),amylase (63.52±4.78 U/L), PAF(4.26±0.85 μg/L), CRP(7.20±2.06 mg/L), and TPS-2 (37.52±4.05 μg/L) ](P<0.05). ② Multivariate Logistic regression analysis identified serum PTX-3, amylase, PAF, and TPS-2 as independent predictors of PEP after ERCP (P<0.05). ③ The combined diagnostic efficacy of PTX-3, PAF, serum amylase, and TPS-2 was superior to that of any individual marker, indicating that the combined detection of these four markers has greater value in predicting the occurrence of PEP after ERCP. Conclusion The combined detection of PTX-3, PAF, TPS-2 and serum amylase has significant value in predicting the occurrence of PEP after ERCP,. This approach can facilitate the early diagnosis of PEP, making it a strategy worth promoting in clinical practive.