Table of Content

30 November 2024, Volume 29 Issue 11

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The clinical characteristics and prognosis of acute-on-chronic liver failure induced by different precipitating factors

YANG Yan-rong, WU Yu, LI Shan-shan, ZOU Huai-bin, DUAN Zhong-ping, XU Man-man, CHEN Yu

2024, 29(11):  1319-1324. 

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Objective To analyze the clinical characteristics and prognostic differences of acute-on-chronic liver failure (ACLF) patients induced by different precipitating factors, in order to provide reference for disease diagnosis and treatment. Methods The clinical data of ACLF patients admitted to Beijing You’an Hospital affiliated with Capital Medical University from January 2015 to February 2023 were retrospectively analyzed. Patients were divided into hepatic-ACLF and extrahepatic-ACLF based on the precipitating factors. The clinical features of hepatic- and extrahepatic-ACLF patients were analyzed. T-tests or Mann-Whitney U tests were used for the comparison of continuous data. Chi-square tests or Fisher's exact tests were used for the comparison of categorical data. Log-rank tests, Landmark analysis, and COX proportional hazards models were used to analyze the differences and influencing factors of 28-day and 90-day prognoses between hepatic- and extrahepatic-ACLF patients. Results A total of 376 ACLF patients with clear precipitating factors were collected. Among patients with ACLF caused by hepatitis B, HBV reactivation was the main cause (107, 41.6%). Among non-hepatitis B ACLF patients, infection was the main precipitating factor (48, 40.3%). ACLF induced by HBV reactivation and drugs was defined as hepatic-ACLF, while ACLF induced by infections and gastrointestinal bleeding was defined as extrahepatic-ACLF. A higher proportion of cirrhotic patients developed ACLF due to extrahepatic factors, with a statistically significant difference (85.7% vs 67.7%, χ²=15.411, P<0.001). No statistical difference in 28-day and 90-day transplant-free survival rates between hepatic and extrahepatic-ACLF patients. By subgroup analysis based on the underlying liver disease it was revealed that extrahepatic factors were an independent influencing factor for the 90-day prognosis in patients with decompensated cirrhosis. Conclusion Compared to non-cirrhotic patients, patients with cirrhosis (compensated and decompensated) are more likely to develop ACLF induced by extrahepatic factors. Compared with intrahepatic triggers, the 90-day mortality rate of ACLF with decompensated cirrhosis caused by extrahepatic triggers is lower.

The expression levels and significance of miR-92a-3p in exosomes, serum and liver tissue of patients with hepatitis B-related liver fibrosis

WANG Qian-qian, JIANG Xu-hua, LI Xin-yan, SONG Jie, ZHANG Yi, JI Yuan-yuan, REN Xiao-jing, QI Xun, CHEN Liang, ZHANG Jian, HUANG Yu-xian

2024, 29(11):  1325-1329. 

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Objective To investigate the expression levels of microRNA miR-92a-3p in exosomes, serum and liver tissue samples of patients with HBV-related hepatic fibrosis and to analyze the difference and significance. Methods Real-time fluorescent quantitative PCR technology was used to detect the expression levels of miR-92a-3p in exosomes, serum, and liver tissue of patients with hepatitis B-related liver fibrosis at different stages. The Mann-Whitney U test or Kruskal-Wallis test was used to compare the differences in miR-92a-3p expression levels during different stages of liver fibrosis. Spearman’s correlation coefficient method was employed to analyze the correlation between the level of miR-92a-3p in exosomes and that in serum and liver tissue. The receiver operating characteristic curve (ROC) was applied to evaluate the predictive efficacy of exosomal and serum miR-92a-3p levels for significant liver fibrosis in hepatitis B. Results The expression level of miR-92a-3p in exosomes showed significant differences among different stages of liver fibrosis (P<0.05). The expression level of miR-92a-3p in exosomes from patients in S2-4 stages was significantly higher than that in S0-1 stages (P<0.0001). The relative expression levels of serum miR-92a-3p in S0-1, S2, S3 and S4 stages were 0.69±0.20, 1.01±1.35, 0.74±0.88 and 0.87±1.33, respectively. There was no statistically significant difference in the expression level of miR-92a-3p in serum among different stages of liver fibrosis (P=0.3817). The relative expression levels of liver tissue miR-92a-3p in S0-1, S2, S3 and S4 stages were 1.69±1.31, 1.54±1.26, 1.05±0.61 and 0.68±0.54, respectively. Similarly, no statistically significant difference was observed in the expression level of miR-92a-3p in liver tissue among different stages of liver fibrosis (P=0.1040). The expression level of miR-92a-3p in exosomes did not show a significant correlation with its expression level in serum (r=0.1787, P=0.1083). Similarly, there was no significant correlation between the expression levels of miR-92a-3p in exosomes and liver tissue (r=0.051, P=0.7311). When the cut-off value was 0.245, the AUROC for serum miR-92a-3p was 0.61 (95%CI: 0.48~0.75), with a sensitivity and specificity for diagnosing significant liver fibrosis of 63.46% and 60%, respectively. For exosomal miR-92a-3p, at a cut-off value of 0.7459, the AUROC was highest at 0.87 (95%CI: 0.80~0.94), with a sensitivity and specificity for diagnosing significant liver fibrosis of 84.13% and 72.09%, respectively. Conclusion The expression levels of miR-92a-3p in exosomes, serum, and liver tissue showed no significant correlation. The concentration of miR-92a-3p in exosomes is significantly higher than in serum and liver tissue, indicating that circulating miR-92a-3p is enriched in exosomes. Compared to serum miR-92a-3p, exosomal miR-92a-3p demonstrated higher diagnostic efficacy for significant liver fibrosis in hepatitis B patients.

The application of multi-slice spiral CT measurement of portal vein system-related indicators in the diagnosis of portal hypertension in liver cirrhotic patients

CHEN Kai, ZHANG Fang-fang, GE Shang

2024, 29(11):  1330-1333. 

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Objective To investigate the application value of multi-slice spiral CT (MSCT) in the diagnosis of portal hypertension in liver cirrhosis. Methods A total of 100 cirrhotic patients with portal hypertension who were treated in our hospital between July 2020 and July 2023 were selected as the observation group. Ninety-five healthy people who underwent physical examination in our hospital during the same period of time were selected as the control group. MSCT examination was performed in all patients. The related indexes of portal vein system [main portal vein (MPV), splenic vein (SPV), left branch of intrahepatic portal vein (IHLPV), right branch of intrahepatic portal vein (IHRPV)] of the two groups, and the related indexes of portal vein system of patients with different liver function grades were compared. The values of using portovenous system-related indicators in the diagnosis of portal hypertension in cirrhotic patients were analyzed by receiver operating characteristic (ROC) curve consistency method. Results The MPV, SPV, IHLPV and IHRPV in the observation group were [(18.42±4.21) mm, (14.53±3.61) mm, (13.52±3.27) mm, (13.87±3.52) mm], respectively, which were higher than those of [(11.37±2.70) mm, (9.23±1.88) mm, (9.16±1.62) mm, (9.25±1.62) mm] in the control group (P<0.05); The diameters of MPV, SPV, IHLPV and IHRPV in grade C patients were [(21.15±3.83) mm, (16.49±3.05) mm, (16.07±3.12) mm, (16.11±3.25) mm], respectively, which were higher than those of [(18.19±3.02) mm, (15) .01±2.54] mm, (14.58±2.95) mm, (14.57±3.03) mm] in grade B patients. These parameters in patients with liver function grade B were higher than those of [(16.57±2.31) mm, (13.37±2.03) mm, (13.15±2.55) mm, (13.16±2.74) mm] in patients with liver function grade A (P<0.05). With MPV≥13.68 mm, SPV≥11.32 mm, IHLPV≥11.75mm and IHRPV≥10.9 mm as cut-off points, the areas under the curve (AUC) of MPV, SPV, IHLPV and IHRPV for the diagnosis of portal hypertension in cirrhosis was 0.801 (95%CI: 0.707~0.894), 0.702 (95%CI: 0.587~0.817), 0.806 (95%CI: 0.705~0.907), and 0.813 (95%CI: 0.720~0.906), with all P<0.05; By consistency analysis it was confirmed that the accuracy of MSCT measurement of portal vein system related indicators in the diagnosis of portal hypertension in cirrhosis was 96.00%, with a sensitivity of 96.74%, specificity of 87.50%, positive predictive value of 98.89%, negative predictive value of 70.00%, Kappa value =0.756. Conclusion MSCT measurement of portal vein system-related indicators for the diagnosis of cirrhosis portal hypertension has high accuracy, sensitivity and specificity, which is conducive not only to reducing the occurrence of missed diagnosis and misdiagnosis, but also to dynamically monitoring of patients' conditions, The detection operation method is non-invasive and convenient, which can provide reliable basis for clinical diagnosis and treatment, with high promotion value.

The value of ultrasound transient elastography combined with systemic immunoinflammatory index in predicting cirrhosis in autoimmune hepatitis patients

SHAN Ya-lin, WANG Qiu-yang

2024, 29(11):  1334-1337. 

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Objective To analyze the value of ultrasonic transient elastography combined with systemic immunoinflammatory index (SII) in the prediction of cirrhosis in autoimmune hepatitis (AIH) patients. Methods The levels of platelet count (PLT), neutrophil count (NEUT) and lymphocyte count (LYM) in pre-treatment blood routine examination were collected from 85 patients with AIH admitted from January 2022 to August 2023. The values of SII were calculated, and the liver stiffness measurements (LSM) before treatment were detected by ultrasonic instantaneous elastography. Patients were given routine interventions such as immunosuppressants, appropriate exercise, and diet conditioning. The patients were divided into a cirrhosis occurrence group and a non-occurrence group according to whether they had the occurrence of cirrhosis. The basic data of patients with and without AIH were compared to analyze the affecting factors for the occurrence of cirrhosis in AIH patients and the efficacy of ultrasound instantaneous elastic imaging combined with SII in predicting the occurrence of cirrhosis in AIH patients. Results Among the 85 AIH patients, 22 cases (25.88%) had cirrhosis, whereas 63 cases (74.12%) did not. The ratio of Child-Pugh grade C (72.73%, 16/22), the levels of TBIL (84.25±7.26) μmol/L, SII (2011.62±124.58) ×10⁹/L, LSM (12.63±1.74) kPa in the occurrence group were higher than those of 38.10% (24/63), (59.63±6.57) μmol/L, (1338.95±108.74)×10⁹/L, (8.29±1.47) kPa in the non-occurrence group by (P<0.05). Binary Logistic regression analysis showed that Child-Pugh grade C, TBIL, SII and LSM were the influencing factors for cirrhosis in AIH patients (P<0.05). According to ROC curve analysis, The sensitivities of Child-Pugh grade C, TBIL, SII and LSM, and the joint assessment was 68.18%, 72.73%, 77.27%, 72.73% and 90.91%, respectively. The specificity was 68.25%, 73.02%, 74.60%, 71.43% and 88.89%, respectively. The combination of Child-Pugh grade C, TBIL, SII and LSM had a higher value in predicting cirrhosis in AIH patients (P<0.05). Conclusion Child-Pugh grade C, TBil, SII and LSM are associated with cirrhosis in AIH patients, and the combined evaluation is effective for cirrhosis in AIH patients.

The application of sound velocity matching technique and shear wave elastography in the evaluation of nonalcoholic fatty liver disease and prediction of cirrhosis

GU Yan, FAN Cui-cui, WANG Hai-yan

2024, 29(11):  1338-1341. 

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Objective To evaluate the value of sound speed correction (SSC) and shear wave elastography (SWE) in the evaluation of nonalcoholic fatty liver disease (NAFLD) and the prediction of cirrhosis. Methods Forty-eight patients with NAFLD and 50 patients with cirrhosis admitted to Aoyang Hospital in Zhangjiagang from July 2022 to July 2023 were selected and examined with SWE and SSC technologies. The maximum shear velocity (Vmax), average value (Vmean) and elastic modulus values were detected by SWE. Sound velocity matching value (ZSI value) was detected by SSC technique. The difference of the above indexes was compared to analyze the efficacy of single and combined application of each parameter in the diagnosis of cirrhosis, and the success rate and time consuming time of SSC and SWE. Results The echo in the cirrhosis group was higher by 32.00%, the mass with abundant blood flow was 62.5042.00%, the blood flow grade 0 was 0.00%, and the internal echo was not uniform by 54.00%, which was lower than those of 54.17%, 42.0062.50%, 025.00%, 25.00% in the NAFLD group (P<0.05). The values of ZSI (38.46±3.12) m/s, elastic modulus (30.41±3.95)kPa, (3.56±0.34) m/s and Vmean (3.28±0.29) m/s in cirrhosis group were higher than those of (22.63±3.20) m/s, (16.53±2.41) kPa and (2.63±0) .24) m/s, (2.51±0.20) m/s (P<0.05). According to ROC curve analysis, the sensitivity of ZSI, elastic modulus, Vmax, Vmean and combined diagnosis of cirrhosis were 70.00%, 72.92%, 72.92%, 75.00% and 91.67%, and the specificity was 72.00%, 74.00%, 76.00%, 78.00% and 90.00%, respectively. The combination of ZSI, elastic modulus, Vmax and Vmean had high value in the diagnosis of cirrhosis (AUC=0.908). The success rate of SWE technique is lower than that of SSC technique (98.98%) (P>0.05), and the time of SSC technique is shorter (4.05±0.51) min than that of SWE technique (3.63±0.46) min (P<0.05). Conclusion SSC technique combined with SWE technique has good application value in differentiating NAFLD and cirrhosis, and has potential application value in dynamic observation of NAFLD progression.

The clinical application of CT portal vein three-dimensional reconstruction in the surgery of hilarcholangiocarcinoma

LIU Shang-da, HE Hai-tao, ZHOU Peng-cheng

2024, 29(11):  1342-1345. 

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Objective To explore the clinical value of CT portal vein three-dimensional reconstruction in the surgery of hilarcholangiocarcinoma (HCCA). Methods Between August 2017 and August 2022, 68 HCCA patients were collected and underwent routine CT examination (N=38 cases) or 3D reconstruction of the portal vein (N=30 cases). The Bismuth Colette typing results, surgical conditions, and liver volume were compared between the routine CT and CT portal vein three-dimensional reconstruction. Results The diagnostic results of conventional CT preoperative imaging evaluation for type I HCCA are consistent, whereas the diagnostic results for type II, IIIa, IIIb, and IV HCCA are inconsistent with that of the postoperative pathological examination; The diagnostic results of pre-operative CT three-dimensional reconstruction imaging for types I, II, and IIIa were consistent, whereas the diagnostic results for types IIIb and IV were inconsistent with those of postoperative pathological examination. The intraoperative bleeding volume, surgical time, hospital stay, and postoperative extubation time of CT portal vein three-dimensional reconstruction were (524.3 ± 16.8) mL, (4.8 ± 1.2) h, (13.3 ± 2.0) d, and (9.6 ± 1.8) d, respectively, which were less/shorter than those of [(679.1 ± 17.3) mL, (6.3 ± 1.5) h, (16.4 ± 2.2) d, and (11.4 ± 1.9) d by conventional CT (All P<0.05). There was no statistically significant difference in the incidence of complications, liver resection volume, total liver volume, and percentage of remaining liver volume between the two groups (P>0.05). Conclusion The application of CT portal vein 3D reconstruction in the surgery of HCCA is not only conductive to evaluating Bismuth Colette classification, but also to reducing intraoperative bleeding and optimizing surgical indicators, which has certain clinical guidance significance.

Radiomics-based prediction of microvascular invasion in hepatocellular carcinoma using contrast-enhanced CT imaging

GAO Min, XU Ya-yun, ZHANG Yu-chen, ZHU Hai-xue, FANG Hai-yan

2024, 29(11):  1346-1348. 

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Objective To explore the application of radiomics-based analysis in predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients. Methods This retrospective study included 210 patients with surgically confirmed diagnosis of HCC, all of whom underwent contrast-enhanced CT scans and obtained pathological specimens. Multiple radiomics features were extracted from the contrast-enhanced CT images. The clinical data of the patients were also collected. Univariate analysis was performed to identify clinical and radiomics features that were significantly associated with MVI. Subsequently, a multivariate regression model was used to select the predictive factors for MVI. Results Of the 210 patients, 67 were confirmed with MVI through postoperative pathology, resulting in an incidence rate of 31.9%. By univariate and logistic multivariate regression analyses, serum AFP (P=0.039), maximum tumor length (P=0.021), and intra-tumoral arteries (P=0.023) were identified as the influencing factors for MVI. The area under the ROC curve (AUC) for assessing the model's performance was 0.895. Conclusion This study demonstrates a crucial role of radiomics features in predicting MVI in HCC, with promising predictive performance. The radiomics-based model may provide clinicians with comprehensive and accurate information for individualized treatment decisions, thus potentially improve the survival rate and quality of life for HCC patients.

Changes of CEUS parameters after radiofrequency ablation for recurrent hepatocellular carcinoma

ZHAO Bin-bin, WANG Jie, LI Lin-xue, CAO Yu, HAO Jian-hua

2024, 29(11):  1349-1351. 

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Objective To observe the changes of Contrast-enhanced ultrasound (CEUS) parameters after radiofrequency ablation of recurrent hepatocellular carcinoma (RHCC). Methods A total of 126 RHCC patients admitted to our hospital from January 2017 to January 2021 were selected as the study subjects. All patients received radiofrequency ablation, and CEUS examination was performed 1day and 6 months after treatment, respectively. Patients were divided into a recurrence group (n=11) and a non-recurrence group (n=115) according to whether they relapsed within 6 months. The mean transit time (MTT), time to peak (TTP) and peak intensity (PI) of the two groups were compared. We used the ROC analysis to test the CEUS indicators’ predictive ability in the prognosis of patients who treated by a radiofrequency ablation (RFA) therapy for RHCC. Results MTT of the two groups were (59.18±15.37) s, (43.36±14.48) s, TTP of the two groups were (38.55±12.09) s, (29.51±11.26) s, PI of the two groups were (22.74±7.42) dB, (21.05±6.19) dB, respectively. Compared with non-recurrence group, the recurrence group had longer MTT and TTP (P<0.05) and there was no significant difference in PI between the two groups (P>0.05). According to ROC analysis, the area under curve of MTT and TTP for predicting recurrence within 6 months after RFA treatment of RHCC were 0.968 (95%CI: 0.927-1.000) and 0.871 (95%CI: 0.768-0.974), the sensitivity was 0.818 and 0.727, and the specificity was 0.804 and 0.713, respectively. MTT ≥ 56.706s and TTP ≥ 33.185s were the best truncation values for recurrence within 6 months after RHCC patients received RFA therapy (both P<0.05). Conclusion After RFA, the ultrasound parameters of RHCC patients with different prognosis were different in CEUS examination. CEUS can be used to predict the prognosis of RHCC patients after radiofrequency ablation with high sensitivity and specificity.

The effect of triplelizumab combined with TACE on the treatment of massive liver cancer and the levels of Wnt1, β-catenin and DKK1

ZHANG Yue-xin, ZHENG Wen-hong, WU De-jian, TAN Yi-xuan, ZHOU Cong

2024, 29(11):  1352-1357. 

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Objective To investigate the effect of triplimab combined with hepatic arterial chemoembolization (TACE) on the treatment of massive liver cancer and the levels of Wnt1 protein (Wnt1), β-catenin and secreted protein Dickkopf1 (DKK1). Methods Seventy-six cases of massive liver cancer treated from May 2020 to October 2022 were selected and divided into an observation group and a control group according to random number table method with 38 cases in each group.The control group was treated with TACE, and the observation group was treated with 240mg of terriplizumab at 1 week after TACE, followed by once every 3 weeks. The efficacy was evaluated in 6 weeks after operation. Alpha-fetoprotein (AFP), vascular endothelial growth factor (VEGF), Wnt1, β-catenin and DKK1 were detected before treatment and 6 weeks after treatment. The change of quality of life was evaluated by KPS. The incidence of adverse reactions and progression-free survival time (PFS) during treatment were analyzed. Results The objective remission rate (ORR) of the observation group was higher than that of the control group (P<0.05). After 6 weeks of treatment, the levels of AFP, VEGF, β-catenin and DKK1 in both groups decreased, whereas the levels of Wnt1 increased, and the change range of the observation group was greater than that of the control group (P<0.05). The improvement of life quality in the observation group was higher than that in control group (P<0.05). There was no significant difference in the incidence of adverse reactions between these two groups (P>0.05).The PFS of the observation group was 6 (2,8) months, which was longer than that of 3 (1,5) months in the control group(P<0.05). Conclusion Triprilizumab combined with TACE has definite efficacy in the treatment of massive liver cancer, and it can regulate AFP and VEGF levels, inhibit Wnt signaling pathway, promote the patients’ quality of life, prolong the survival of patients, with controllable safety.

Clinical analysis of hepatic arterial infusion chemotherapy combined with cindilizumab and bevacizumab injection in patients with unresectable primary liver cancer

CHENG Ming-liang, CHEN Jun-lin, LIU Xiao-jun, SUN Qiu, CHEN Jiang

2024, 29(11):  1358-1361. 

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Objective To compare the clinical efficacy of transcatheter arterial chemoembolization (TACE) in our hospital, hepatic arterial infusion chemotherapy (HAIC) combined with cindilizumab and bevacizumab injection in the treatment of unresectable primary liver cancer (PLC). Methods Between January 2019 and June 2023 in our hospital, 80 patients with unresectable PLC were analyzed. According to the differences in treatment strategies, the included cases were divided into TACE group and HAIC group, with 40 cases in each group. The two groups were combined with cindilizumab and bevacizumab injection on the basis of TACE or HAIC, and the differences in short-term efficacy, liver function, tumor markers, T lymphocyte subsets, adverse reactions and overall survival rate were compared between the two groups. Results The objective remission rate (Complete Response (CR) + Partial Response (PR)/all cases) and disease control rate (CR + PR + Stable Disease (SD)/all cases) in HAIC group were 55.0% and 82.5%, which were significantly higher than those in TACE group [35.0% and 67.5%, P<0.05]. The alpha-fetoprotein (AFP), alpha-fetoprotein Lens culinaris agglutinin 3 (AFP-L3), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) in TACE group were 184.6 (96.0, 271.9) ng/mL, 176.4 (99.5, 248.7) ng/mL, 98 (70, 137) U/L, 93 (75, 123) U/L and 74.8(37.8, 113.5) μmol/L, which had a significantly difference when comparing with HAIC group [86.4 (60.3, 123.6) ng/mL, 226.2 (110.8, 301.2) ng/mL, 56 (32, 80) U/L, 50 (35, 71) U/L and 41.8 (25.6, 301.2) μmol/L, P<0.05). After treatment, CD4⁺ and CD4⁺/CD8⁺ in HAIC group were 38.5(35.0, 39.8) % and 1.3(1.2, 1.4), which were statistically different from those in TACE group [35.2(34.0, 36.8) % and 1.2(1.0, 1.2)]. After TACE and HAIC treatment, some cases had treatment-related nausea and vomiting, abdominal pain and low fever, which were improved and relieved after symptomatic treatment. Seven cases of fever, four cases of capillary hyperplasia, three cases of anemia and two cases of hypothyroidism occurred in the two groups after receiving immunotherapy. None of the above cases with adverse reactions received follow-up immunotherapy. After 1 year of treatment, follow-up was conducted, with 3 cases lost to follow-up in the TACE group and 1 case lost to follow-up in the HAIC group. The overall survival rates were 64.9% (24/37) and 41.0% (16/39), with statistical significance (P<0.05). Conclusion After HAIC treatment, the combination of cindilizumab and bevacizumab injection in the treatment of advanced PLC patients has an ideal short-term effect. Under the premise of ensuring the safety of medication, the overall survival situation has improved significantly, which is worthy of a further observation by expanding clinical samples.

Predictive value of serum miR-182-5p and miR-204 expression on postoperative efficacy and recurrence in patients with primary hepatic carcinoma after RFA

HUANG Qiu-shuo, WANG Yi

2024, 29(11):  1362-1367. 

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Objective To investigate the predictive value of serum miR-182-5p and miR-204 expression on postoperative efficacy and recurrence in patients with primary hepatic carcinoma (PHC) after radiofrequency ablation (RFA). Methods 298 PHC patients admitted to our hospital from June 2021 to June 2022 were selected as the case group, all of whom were treated with RFA, and 336 healthy individuals who underwent physical examination during the same period were selected as the control group. The expression levels of serum miR-182-5p and miR-204 were compared between the case group and the healthy control group, the RFA complete ablation group and the residual group, and the RFA non-recurrence group and the recurrence group. The area under curve (AUC) of the receiver operating characteristic (ROC) was used to evaluate the predictive value of serum miR-182-5p and miR-204 expression levels on postoperative efficacy and recurrence of RFA, and the relationship between serum miR-182-5p and miR-204 expression and prognosis survival of patients was analyzed. Results The expression level of miR-182-5p in serum of the case group was higher than that of the healthy control group, while the expression level of miR-204 was lower than that of the healthy control group (P<0.05). The rate of complete ablation after RFA was 85.91% (256/298) and the rate of residual tumor was 14.09% (42/298). The expression level of miR-182-5p in the complete ablation group after RFA was lower than that in the residual group, while the expression level of miR-204 was higher than that in the residual group (P<0.05). ROC curve analysis results showed that the combination of miR-182-5p and miR-204 predicted the AUC of postoperative tumor residue in patients after RFA was 0.919 (95% CI: 0.868~0.970), the sensitivity was 85.71%, and the specificity was 93.36%. The recurrence rate was 18.95% (47/248) and the non-recurrence rate was 81.05% (201/248) during follow-up after RFA. The expression level of miR-182-5p in the group without recurrence after RFA was lower than that in the group with recurrence, while the expression level of miR-204 was higher than that in the group with recurrence (P<0.05). ROC curve analysis results showed that the combined detection of miR-182-5p and miR-204 predicted the AUC of postoperative recurrence of patients after RFA was 0.875 (95% CI: 0.817-0.933), sensitivity was 80.85%, and specificity was 90.05%. The median overall survival (OS) of miR-182-5p group was 25.48 months, which was shorter than that of the low expression group (28.67 months). The median OS of the high expression group of miR-204 was 29.34 months, which was longer than that of the low expression group (26.81 months) (all P<0.05). Conclusion The high expression of miR-182-5p and the low expression of miR-204 may be involved in the process of tumor residual and recurrence after RFA in PHC patients, and they are related with shortened prognosis and survival of patients. The combination of miR-182-5p and miR-204 has certain predictive value for tumor residual and recurrence in PHC patients after RFA.

Evaluation value of HIF-1, AFP-L3 and sPD-L1 in patients with primary liver cancer and the efficacy of TACE combined with sorafenib

ZHANG Yong-hong, SHEN Yu-chneg, LU Ying-ying, CHEN Guo-dong

2024, 29(11):  1368-1373. 

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Objective To investigate the evaluation value of hypoxia-inducible factor-1 (HIF-1), alpha-fetoprotein Lens culinaris agglutinin 3 (AFP-L3) and soluble programmed death ligand 1 (sPD-L1) in the treatment of transcatheter arterial chemoembolization (TACE) combined with sorafenib in patients with primary liver cancer (PLC). Methods A total of 112 PLC patients who received TACE combined with sorafenib were included in the observation group. According to the presence or absence of portal vein tumor thrombus (PVTT) before treatment, they were divided into the PVTT combined group (n=84 cases) and the PVTT free group (n=28 cases). And according to the results of the efficacy evaluation after 2 courses, they were divided into the stable group (n=79 cases) and the progressive group (n=33 cases). The control group was selected from 40 healthy subjects who came to our hospital during the same period. The serum levels of HIF-1, AFP-L3 and sPD-L1 were compared between the observation group and the healthy group, the stable group and the progressive group before and after treatment. Pearson analysis was applied to examine the correlation among the Child-pugh grade, proportion of iodol deposition after surgery, and median time to tumor progression (MTTP). The ROC curve was used to evaluate the efficacy of single and combined detection of HIF-1, AFP-L3, and sPD-L1 in assessing disease severity and treatment effect. Results The levels of HIF-1, AFP-L3 and sPD-L1 in the PVTT subgroup were (112.59±8.36) pg/mL, (19.53±3.46) % and (11.37±2.49) ng/mL. which were higher than (82.45±6.37) pg/mL, (14.67±2.29) %, (6.09±1.73) ng/mL in the PVTT subgroup and (17.36±3.51) pg/mL, (2.18±0.54) %, (1.62±0.41) ng/mL in the healthy group. The difference was statistically significant (t=24.725, 27.647, 41.529, all P<0.05). The levels of HIF-1, AFP-L3 and sPD-L1 in the stable group before treatment were (76.42±5.83) pg/mL, (15.38±2.94) % and (6.23±1.79) ng/mL. It was lower than (120.65±8.74) pg/mL, (21.36±3.82) % and (9.86±2.31) ng/mL in the progressive group, and the difference was statistically significant (t=9.367, 8.463, 8.458, all P<0.05). HIF-1, AFP-L3 and sPD-L1 in the stable group after treatment were (37.59±4.68) pg/mL, (10.16±2.56) % and (4.37±0.86) μg/mL. It was lower than (132.61±9.75) pg/mL, (23.29±4.31) % and (12.69±2.04) μg/mL in the progressive group, and the difference was statistically significant (t=14.725, 12.165, 13.027, all P<0.05). Pearson analysis showed that HIF-1, AFP-L3 and sPD-L1 levels in the observation group were positively correlated with preoperative Child-pugh grade, and negatively correlated with postoperative iodol deposition and MTTP (P<0.05). ROC curve showed that the AUC of HIF-1, AFP-L3 and sPD-L1 single and combined tests to evaluate the disease severity and efficacy of PLC were 0.782, 0.829, 0.736 and 0.931, respectively, and the sensitivity and specificity of the combination were higher than that of any single test (all P<0.05). Conclusion The combined detection of HIF-1, AFP-L3 and sPD-L1 has a high clinical value in the evaluation of PLC preoperative disease degree and the effect of TACE combined with sorafenib.

Effect of CD55 single nucleotide polymorphism on the efficacy of pegylated interferon α-2b in chronic hepatitis B patients with HBeAg-positive

CHEN Ji-liang, ZHOU Wan-yue, XU Ming-chen

2024, 29(11):  1374-1377. 

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Objective To investigate the effect of CD55 single nucleotide polymorphism (CD55-SNP) on the efficacy of pegylated interferon α-2b (Peg-IFNα-2b) in chronic hepatitis B (CHB) patients with HBeAg-positive. Methods From August 2017 to August 2021, 159 CHB patients with HBeAg-positive were selected. According to the results, CHB patients were divided into response group and non-response group. The clinical data of the two groups were retrospectively analyzed to explore the effect of CD55-SNP on the treatment of patients. Results The GG gene (91.4%) of CD55- rs28371597 was significantly higher than that of CT gene (6.4%) and TT gene (3.2%), and the CFB-rs12614 CC gene (92.4%) was significantly higher than that of CT gene (7.6%) and TT gene (0%) in the response group. Compared with the non-response group (75.0%, 79.1%), the CD55-rs28371597 GG gene (91.4%) and CFB-rs12614 CC gene (92.4%) in the response group increased. According to the analysis of the influencing factors of the treatment effect, the comparison of drinking and CD55-rs28371597 genotype between the two groups was statistically significant. After multivariate calibration, HBV DNA, CFB-rs12614 and STAT4-rs7574865 did not affect the treatment outcome (P>0.05), while CD55-rs28371597 significantly affected the treatment outcome (P<0.05). Conclusion CD55-SNP polymorphism affects the efficacy of Peg-IFNα-2b in CHB patients with HBeAg-positive, and is closely related to virological response. Clinicians can predict the therapeutic effect of Peg-IFNα-2b according to the distribution of CD55-SNP polymorphism and give a reasonable treatment plan.

The therapeutic effect of polyethylene glycol interferon and propofol fumarate tenofovir in the treatment of chronic hepatitis B

ZHENG Chang-rong, HUANG Xiao-li

2024, 29(11):  1378-1381. 

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Objective To explore the clinical efficacy of polyethylene glycol interferon combined with propofol tenofovir fumarate in the treatment of patients with chronic hepatitis B. Methods This study adopted a prospective research method and selected 131 patients with chronic hepatitis B admitted to our hospital from January 2021 to December 2022 for a single blind randomized trial. They were divided into a study group of 66 patients and a control group of 65 patients. The control group was treated with basic treatment and propofol tenofovir fumarate, while the study group added pegylated interferon to the treatment plan of the control group. The therapeutic effects were observed after 48 weeks of continuous treatment in both groups. Results Before treatment, there was no difference in serum levels of HBeAg, HBsAg, and HBV-DNA between the study group and the control group patients (P>0.05). After 24 and 48 weeks of treatment, the serum levels of HBeAg, HBsAg, and HBV-DNA in both groups decreased (P<0.05), with the study group showing a more significant decrease (P<0.05). There was no significant difference in the HBV-DNA conversion rate between the two groups of patients after 24 and 48 weeks of treatment (P>0.05). After 48 weeks of treatment, the HBeAg conversion rate in the study group was higher than that in the control group (P<0.05). Before treatment, two groups of serum levels of ALT, AST, IL-17, IL-4, and INF- α had no significant difference (P>0.05) and after 48 weeks of treatment, the serum levels of ALT, AST, IL-17, and IL-4 in both groups significantly decreased (P<0.05), and the serum level of INF- α was significantly increased (P<0.05). The serum levels of ALT, AST, IL-17, and IL-4 in the study group patients were significantly lower than those in the control group (P<0.05), and INF- α’s serum level increased more significantly when comparing to the control group (P<0.05). After 48 weeks of treatment, two groups’ clinical efficacy were evaluated. The overall efficacy of the study group was better than that of the control group, and the difference was statistically significant (P<0.05). Conclusion Polyethylene glycol interferon combined with propofol tenofovir fumarate in the treatment of chronic hepatitis B is conducive to reducing the levels of hepatitis B infection markers and inflammatory factors, which is generally conducive to improving the clinical treatment effect.

The effect of tenofovir fumarate on portal vein hemodynamics in patients with chronic hepatitis B

LIU Wen-zong, HE Pu

2024, 29(11):  1382-1385. 

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Objective To analyze the clinical efficacy of tenofovir fumarate in the treatment of chronic hepatitis B and understand its impact on portal vein hemodynamics. Methods 103 patients with chronic hepatitis B were selected and divided into two groups based on different treatment methods. The tenofovir fumarate group had 52 cases and the tenofovir tablets group had 51 cases. We compared the general information, laboratory indicators, virological indicators, and portal vein hemodynamic indicators of the patients in two groups before and after treatment. Results The laboratory indicators of both groups were significantly improved, and the HBV DNA load of Tenofovir fumarate group was (0.72±0.05), which was lower than (0.88±0.04) that of the Tenofovir tablet group, with statistical significance (P<0.05). In tenofovir fumarate group, the AST was (28.64±5.49) U/L, ALT was (39.23±4.72) U/L, TB was (10.59±1.03) mol/L, which were lower than (32.08±5.04) U/L, (43.54±5.03) U/L and (12.52±1.12) mol/L in Tenofovir tablet group, respectively, with statistical significance (P<0.05). The velocity of blood portal vein (VPV) of Tenofovir fumarate group was (15.09±1.75) cm/s, which was higher than (14.37±1.88) cm/s that of Tenofovir tablet group, while the quantity of portal venous (Qpv) and diameter of portal vein (DPV) of Tenofovir fumarate group were (948.53±92.34) ml/min and (0.98±0.03) cm respectively. Quantity of splenic venous (Qsv) was (456.24±19.82) ml/min, liver hardness was (8.57±1.22) kPa, which were lower than (1006.45±90.76) ml/min, (1.12±0.05) cm, (599.58±22.48) ml/min and (9.83±1.47) kPa in Tenofovir tablet group, respectively, with statistical significance (P<0.05). Conclusion The clinical efficacy of tenofovir fumarate in the treatment of chronic hepatitis B is good, and it has better advantages in portal vein hemodynamics, which can be recommended for clinical use.

A retrospective study on liver pathological diagnosis and efficacy and safety of different therapies in children with chronic hepatitis B

LIN Bin-bin, TANG Yu-jing, OUYANG Li-juan, RUAN Qing-fa

2024, 29(11):  1386-1391. 

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Objective To investigate the liver pathological diagnosis of chronic hepatitis B (CHB) in children under 18 years old and the efficacy and safety of different therapies. Methods A retrospective analysis was performed for the baseline characteristics, liver pathological results, efficacy and side effects of nucleoside (acid) analogues (NAs) and interferon in patients with CHB under 18 years old who were hospitalized due to abnormal liver function from January 2011 to December 2020 in Xiamen Hospital of Traditional Chinese Medicine. Chi-square test was used to compare the rates. Results (1) 51 patients who completed liver tissue biopsy had liver inflammation grading G ≥ 2 accounting for 96.1%, S ≥ 2 accounting for 33.3%. Patients aged 14-18 had inflammation grading G3 accounting for 37.0%, G4 accounting for 7.4%, and fibrosis grading S3 accounting for 18.5%,grading S4 accounting for 7.4%, respectively. (2) Patients who refused antiviral treatment were accounted for 27.8% (35/126), and 65.7% of them were under 7 years old. The HBV DNA negative rate, HBeAg seroconversion rate and HBsAg seroconversion rate of HBeAg positive CHB patients in the antiviral treatment group at Week 72 were 62.0% (49/79), 46.8% (37/79) and 20.3% (16/79), which were much higher than those in the non-antiviral treatment group (2.9% (1/35), 2.9% (1/35) and 0 (0/35)), and the difference was statistically significant. (3) The HBeAg seroconversion rate and HBsAg seroconversion rate in interferon treatment group at Week 72 were 48.5% (33/68) and 20.6% (14/68), which were higher than those in NAs treatment group (27.3% (3/11) and 9.1% (1/11)), and the difference was not statistically significant. (4) The HBV DNA negative rate, HBeAg seroconversion rate, and HBsAg seroconversion rate in the<7 years old group at 48 and 72 weeks were 83.3% (15/18), 64.7% (11/18), 27.8% (5/18), and 72.2% (13/18), 66.7% (12/18), 61.1% (11/18), respectively. Both were higher than those in the 7-14 years old group (57.9% (11/19), 36.8% (7/19), 5.3% (1/19) and 63.2% (12/19), 36.8% (7/19), 5.3% (1/19),respectively) and the 14-18 years old group (48.4% (15/31), 38.7% (12/31), 3.2% (1/31) and 51.6% (16/31), 45.2% (14/31), 6.5% (2/31), respectively), some of which had the statistically significant differences. (5) The HBV DNA negative rate, HBeAg seroconversion rate, and HBsAg seroconversion rate after 72 weeks of antiviral treatment with Interferon α (IFN α) or Pegylated interferon α (Peg-IFN α) were 50.0% (18/36), 47.2% (17/36), 19.4% (7/36) or 71.9% (23/32), 50.0% (16/32), 21.9% (7/32), respectively, with no statistically significant difference. (6) The HBsAg seroconversion rate of HBeAg negative CHB patients at Week 72 was 0 (0/6), which was lower than that of HBeAg positive CHB (20.3% (16/79)), and the difference was not statistically significant. (7) NAs showed no obvious adverse reaction after antiviral treatment; The adverse reactions of interferon treatment in children were similar to those in adults. The adverse reactions of IFN α and Peg-IFN α were not statistically different. The most common adverse reactions were influenza-likely symptoms in 75.3% (55/73) and myelosuppression in 74.0% (54/73). Conclusion Children with CHB are frequently accompanied by liver inflammatory activity and varying degrees of fibrosis. The antiviral treatment effect of interferon in children with CHB is better than that of nucleoside (acid) analogues. The younger guys, the better antiviral response. The adverse reactions of interferon therapy in children were similar to those in adults, with fewer severe adverse reactions.

Clinicopathological characteristics and regression analysis of patients with chronic hepatitis B and concurrent primary biliary cholangitis

XU Shun-bing, LI Jun-lan, WEN Biao

2024, 29(11):  1392-1395. 

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Objective To analyze the clinicopathological features and perform regression in analysis in patients with chronic hepatitis B (CHB) and concurrent primary biliary cholangitis(PBC). Methods Between February 2017 and December 2022, we collected data from 105 patients diagnosed with PBC who underwent liver biopsy at our hospital, including those with concurrent CHB. The diagnoses of PBC and CHB were confirmed according to established criteria. We compared demographic data, laboratory tests, serum antibody levels, immunoglobulin, and complement levels between the CHB-combined and non-CHB-combined groups. Additionally, we analyzed the pathological characteristics of liver biopsies from both groups. Patients were followed for one year to assess treatment responses, which were then compared between the two groups. Results Among patients with PBC, 7 cases (43.7%) presented with ascites and 13 cases (81.2%) had cirrhosis, significantly higher than those without concurrent CHB, where 17 cases (19.1%) had ascites and 46 cases (51.7%) had cirrhosis( P<0.05). In the CHB group, PLT, ALP, GGT, TG and INR were recorded as follows: 93 (81, 157) × 10⁹/L, 180 (124, 309) U/L, 146 (64, 311) U/L, 1.2 (1.0, 1.6) mmol/L, 1.3(1.2, 1.5), respectively. These values were significantly different from the non- CHB group, which showed PLT at 137 (78, 215) × 10⁹/L, ALP at 132 (75, 178) U/L, GGT at101 (51, 170) U/L, TG at 0.9 (0.7, 1.1) mmol/L, and INR at 1.0 (0.8, 1.1)(P<0.05). The positive rates of ANA and anti-gp210 antibodies in patients with CHB were 15 cases (93.7%) and 7 cases (43.7%), respectively, which were higher than in patients without CHB, where the rates were 62 cases (69.7%) and 15 cases (16.8%)(P<0.05). Serum immunoglobulin levels in the CHB group were significantly elevated, with IgG at 17.9(13.9, 21.2) g/L, IgA at 3.6(2.6, 5.2) g/L, and IgM at 2.5(1.2, 3.5) g/L, comparednto the non-CHB group, which had IgG at 16.4 (12.7, 20.0) g/L, IgA at 3.2 (2.3, 4.5) g/L, and IgM at 2.2 (1.7, 2.9) g/L(P<0.05). Pathological features observed in the 105 PBC patients included interfacial hepatitis in 66 cases(62.8%), bridging necrosis in 27 cases (25.7%), inflammatory cell infiltration in the portal area in 92 cases(87.6%), intrahepatic cholestasis in 19 cases(18.1%), bile duct injury in 12 cases(11.4%), rosette formation in 9 cases (8.6%). After one year of treatment, the response rates were 11 cases (68.7%) in the CHB group and 67 cases (75.3%) in the non-CHB group. Conclusion Patients with PBC complicated by CHB are at increased risk of immune dysfunction, characterized by elevated immunoglobulin levels and decreased complement levels. Monitoring changes in these immune function-related indicators can aid in assessing the condition and prognosis of PBC in clinical practice.

Clinical characteristics of 13 patients with primary sclerosing cholangitis

XIA Shu-min, TANG Ying-mei, XU Jia-min, ZHU bi-lian, LI Qin-nian

2024, 29(11):  1396-1400. 

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Objective To investigate the clinical characteristics of patients with primary sclerosing cholangitis (PSC) to enhance understanding of the disease and reduce misdiagnosis and missed diagnoses. Methods A retrospective analysis was conducted on the clinical characteristics, diagnostic methods, treatment approaches, and prognosis of patients diagnosed with PSC at the Second Affiliated Hospital of Kunming Medical University from January 2013 to November 2022. Results Of the 13 patients, 8 (66.7%) were male, with a mean age of 46.1 years and a disease duration of 3 (1~26.5) months, Large-duct PSC was diagnosed in 9 patients (69.2%) . Twekve patients presented with symptoms, while one was asymptomatic due to hepatic insufficiency. Key symptoms included abdominal pain in 9 patients (75.0%), pruritus in 3 (25.0%), jaundice in 7 (58.3%), and fatigue in 5 (41.7%). One patients had concurrent primary biliary cholangitis, two had chronic pancreatitis, and three (23.1%) had ulcerative colitis. Liver biochemical abnormalities, including elevated liver enzymes, hyperbilirubinemia, and hypoproteinemia, were present in all patients. Immunological testing revealed ANA positivity in 60%(6/10) of patients and pANCA positivity in 25%. MRCP findings indicated bile duct wall irregularities, including uneven thickness, rigid courses, partial strictures and dilatations, and a “withered tree-like” appearance in 2 cases. Of the 10 patients who underwent liver biopsy, only one displayed the characteristic “Onion skin-like” fibrosis. All 13 patients were treated with ursodeoxycholic acid; 2 also received hormone therapy, and 2 showed limited response to treatment. The median follow-up duration was 41 months (1-86 months), with one patient lost to follow-up and one death due to acute liver failure. Conclusion PSC primarily affects middle-aged men and predominatly involves large-duct disease. Its clinical manifestations are nonspecific, frequently accompanied by ulcerative colitis, and may co-occur with other autoimmune liver diseases. Cholangiography remains the primary diagnostic tool, while treatment with ursodeoxycholic acid can improve clinical outcomes.

Association of blood metabolites with primary sclerosing cholangitis risk: a two-sample Mendelian randomized study

WANG Zeng-xiu, WU Wei-feng

2024, 29(11):  1401-1404. 

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Objective To investigate the association between blood metabolite levels and the risk of primary sclerosing cholangitis(PSC) using Mendelian randomization. Methods Genome-wide association study (GWAS) data for PSC and blood metabolites were obtained. Single nucleotide polymorphisms (SNPs) were selected as instrumental variables, and two-sample Mendelian randomization (MR) analyses were conducted using inverse variance weighting, the weighted median method, and MR-Egger regression. Results Higher levels of mannitol (P=0.049), urea (P=0.035), linoleate (18:2n6) (P=0.049), caffeine (P=0.039), and leucine (P=0.019) were positively associated with an increased risk of PSC. In contrast, elevated levels of L-carnitine (P=0.049), vitamin C (P=0.017), pantothenate (P=0.005), palmitate (16:0) (P=0.030), and creatinine (P=0.043) were negatively associated PSC risk. Conclusion Eleven metabolites may have causal associations with chronic kidney disease, offering potential insights for understanding its pathogenesis and aiding in early screening and therapeutic strategies.

Distribution of blood lipids and liver elasticity in patients with primary biliary cholangitis

SONG Le, ZHANG Bo, KONG De-na, WANG Xin, MO Qiong, ZHENG Ning, WAN Mei-ping

2024, 29(11):  1405-1408. 

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Objective To evaluate liver elasticity and blood lipid distributionin in patients with primary biliary cholangitis (PBC) and to assess changes in blood lipid levels across different stages of liver fibrosis in PBC. Methods A retrospective analysis was conducted on the clinical data of 70 patients with PBC and 71 age- and sex-matched patients with non-alcoholic fatty liver disease (NAFLD) who visited the Central Theater General Hospital between 2019 and 2023. Dyslipidemia distribution and liver elasticity characteristics were compared between the two groups. Additionally, blood lipid distribution was evaluated across different stages of liver stiffness in the PBC group. Results In the PBC group, dyslipidemia was primarily driven by elevated total cholesterol (TC), whereas in the NAFLD group, increased triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) were predominant. Clinical analysis revealed that TC (6.01 [5.42, 6.59] mmol/L )and high-density lipoprotein cholesterol (HDL-C)( 1.54 [1.26, 1.77] mmol/L ) levels in the PBC group were significantly higher than in the NAFLD group. Conversely, TG( 2.00 [1.00, 2.00] mmol/L) and LDL-C (2.99 [2.60, 3.32] mmol/L) levels were higher in the NAFLD group, with statistically significant differences. Despite similar transaminase levels, liver elasticity tests indicated that Controlled Attenuation Parameter(CAP) values in the PBC group(207 [179.5, 241.0] dB/m) were lower than in the NAFLD group, whereas liver stiffness measurement(LSM) values were higher(6.6 [5.15, 11.1] kPa), both showing statistically significant differences. Additionally, variations in blood lipid distribution within the PBC group were observed at different LSM stages. At LSM values between 7.3-9.8 kPa, TC( 6.54[(6.03, 8.03] mmol/L) and LDL-C (3.08±0.79 mmol/L) reached peak levels, followed by a decrease before 17.3 kPa. When LSM exceeded 17.3 kPa, TC (4.26 [3.95, 5.13] mmol/L and LDL-C (1.81±0.47 mmol/L) were at their lowest levels. All observed differences were statistically significant. Conclusion The lipid and liver elasticity profiles in PBC and NAFLD exhibit distinct characteristics. In PBC. dyslipidemia primarily results from TC, with TC and LDL-C levels showing the most significant increases in the early stages of fibrosis and changeing progressively with fibrosis advancement.

Clinical significance and determinants of T lymphocyte mitochondrial damage index in autoimmune hepatitis patients

CHEN Ke-yan, WU Ting, YANG Can

2024, 29(11):  1409-1412. 

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Objective To investigate the clinical relevance of the T-lymphocyte mitochondrial damage index in autoimmune hepatitis patients and to identify factors influencing T-lymphocyte mitochondrial damage. Methods A total of 60 patients with autoimmune hepatitis admitted to our hospital between October 2021 and October 2023 were enrolled in this study. Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), and albumin (ALb) were measured using a Roche cobas 8000 Fully automated biochemical immunoassay analyzer(c701/c702). Antinuclear antibody (ANA) titers and immunoglobulin G(IgG) levels, were assessed via immunofluorescence. Mitochondrial status in peripheral blood T-lymphocytes was evaluated using an Agilent NovoCyte D3000 flow cytometer. Mitochondrial damage in helper T-lymphocytes (Th cells) and suppressor T-lymphocytes (Ts cells) was quatified through a built-in algorithm that compared mitochondrial staining values. Independent risk factors for T-lymphocyte mitochondrial damage in autoimmune hepatitis were analyzed using multifactorial logistic regression. Additionally, receiver operating characteristic (ROC) curve analysis was applied to assess the clinical diagnostic value of T-lymphocyte mitochondrial damage in these patients. Results In the injured group, the positive rates for ALT, ANA titers, IgG, CD4⁺ lymphocyte count, CD8⁺ lymphocyte count, mitochondrial damage rate of Th cells, and mitochondrial damage rate of Ts cells were (142.6±42.5) U/L, 93.3%, (19.6±4.8) g/L, (468.8±22.3) ×10⁶/L, (292.6± 32.3) × 10⁶/L, 86.7%, and 83.3%, respectively. These values were significantly higher than those in the uninjured group, which presented values of (123.5 ± 31.2) U/L, 37.5%, (16.2 ± 2.3) g/L, (417.6 ± 32.1) × 10⁶/L, (265.1 ± 29.3) × 10⁶/L, 25.0%, and 50.0%, respectively (P<0.05). Multifactorial logistic regression analysis indicated that elevated ALT, IgG, ANA titer positivity, CD4⁺ lymphocyte count, and CD8⁺ lymphocyte count were independent risk factors for T-lymphocyte mitochondrial damage in autoimmune hepatitis patients (OR=3.438, 3.804, 3.504, 3.114, 3.699, P<0.05). ROC curve analysis demonstrated that mitochondrial damage in both Th cells and Ts cells has high diagnostic value in identifying autoimmune hepatitis. Conclusion ALT, IgG, ANA titer positivity, CD4⁺ lymphocyte count, and CD8⁺ lymphocyte count are independent risk factors for T-lymphocyte mitochondrial damag in autoimmune hepatitis patients. Early detection of these indices is crucial for diagnosing T-lymphocyte mitochondrial damage. Additionally, mitochondrial damage in Th and Ts cells shows high diagnostic value for autoimmune hepatitis and can be used clinically to predic its occurrence.

Influencing factors and predictive model development for early allograft dysfunction in liver transplantation

LIU Pan, LIU Wei, ZHANG Xue, ZHANG Tao, MIAO Su-qin

2024, 29(11):  1413-1417. 

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Objective To identify key factors influencing early allograft dysfunction (EAD) in liver transplantation and to develop a nomogram model for its early detection. Methods This retrospective study included patients who underwent classic in situ allograft liver transplantation at Eastern Theater General Hospital from November 1, 2018, to October 31, 2023. Univariate analysis was performed, followed by multivariable logistic regression to identify significant variables. Independent risk factors were then incorporated into a nomogram models. The model’s predictive accuracy was evaluated using receiver operating characteristic(ROC) curves, calibration curves, and goodness-of-fit tests. Results A total of 266 liver transplant recipients were included, of whom 74 (27.8%) developed EAD. Univariate analysis indicated that, compared to the non-EAD group (n=192), the EAD group (n=74) had significantly higher values in the following variables: donor liver cold ischemia time (451.4±129.9min vs. 408.8±127.2min), lactate concentration at procedure end (4.8±2.6mmol/L vs. 3.9±2.2mmol/L), MELD score (22.1±5.4 vs. 20.1±6.5), preoperative diabetes [31.1% (23 cases) vs. 18.8% (36cases)], preoperative blood uric acid [299μmol/L, 95% CI (133~423) vs. 260μmol/L, 95% CI (204~384)], and intraoperative blood loss [2000ml, 95% CI (1500~2800) vs. 1500ml, 95%CI (1050~2550)] (P<0.05). Multivariablel logistic regression analysis identified five independent risk factors for EAD: donor liver cold ischemia time [OR=1.003, 95% CI (1.001~1.005), P=0.009], arterial lactate concentration at procedure end [OR=1.167, 95% CI (1.030~1.322), P=0.015], MELD score [OR=1.060. 95% CI (1.011~1.112), P=0.016], diabetes mellitus [OR=2.186, 95% CI (1.109~4.240), P=0.024], and intraoperative blood loss [OR=1.026, 95% CI (1.002~1.049), P=0.030]. These factors were incorporated into a nomogram model, achieving an area under the ROC curve of 0.712 (95% CI: 0.642~0.781), demonstrating good predictive performance. The clinical decision curve further confirmed the model’s clinical utility. Conclusion The nomogram model, incorporating donor liver cold ischemia time, arterial lactate concentration at surgery end, MELD score, diabetes mellitus, and intraoperative bleeding volume, demonstrates clinical utility and may serve as a useful tool for the early diagnosis of EAD.

Analysis of peripheral blood CD19⁺ cells and serum C-reactive protein in pediatric infectious mononucleosis with liver complications

CHEN Lei-lei, LIU Zhi-feng

2024, 29(11):  1418-1421. 

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Objective To examine the changes in peripheral blood CD19⁺ cell percentage, along with serum procalcitonin (PCT) and C-reactive protein (CRP) levels, in children with infectious mononucleosis (IM) complicated by liver damage. Methods A total of 105 children diagnosed with IM were treated at Yancheng First Hospital, affiliated with Nanjing University Medical School, from March 2021 to March 2024. All patients received intravenous ganciclovir for one to two weeks. Those with liver injury were additionally managed with liver-protecting medicines until normalization of liver function tests. Peripheral blood CD19⁺ cell percentage were measured by flow cytometry (FCM), while serum procalcitonin (PCT) and C-reactive protein (CRP) levels were assayed throgh routine assays. Multivariate logistic regression analysis was used to identify risk factors associated with liver damage in children with IM. Results Among the 105 children with IM, liver injury was observed in 64 cases (61.0%). Children with liver injury had a significantly lower body mass index (BMI) [(21.7±1.2) kg/m²] compared to those without liver injury [(23.8±1.5) kg/m², P<0.05]. The incidence of hepatomegaly, artificial feeding, and severe clinical type was markedly higher in children with liver injury (43.8%, 43.8% and 12.5%, respectively) than in those without (22.0%, 12.2% and 0.0% all P<0.05). Serum EBV DNA load was significantly elevated [(3.5±1.2) lg copies/mL] and antiviral therapy duration was longer [(7.4±1.1) days] in children with liver injury compared to those without [(2.0±0.6) lg copies/mL and (3.6±0.5) days, respectively, P<0.05]. Peripheral blood CD19⁺ cells percentage [(8.4±1.9) %] and serum CRP levels [(57.2±14.6) mg/L] were also significantly higher in children with liver injury than in those without [(4.6±1.5) % and (12.4±2.9) mg/L, respectively, P<0.05]. Multivariate logistic regression identified hepatomegaly [OR=1.020, 95% CI: 1.003-1.038, P=0.022], artificial feeding [OR=1.113, 95% CI: 1.011-1.226,P=0.028], duration of antiviral therapy [OR=10.502, 95% CI: 1.561-70.663,P=0.016], severe clinical type [OR=1.121, 95% CI: 1.009-1.245, P=0.033], BMI [OR=0.988, 95% CI:0.978-0.998, P=0.022], serum EBV DNA load [OR=1.777, 95% CI: 1.043-3.028, P=0.035], peripheral blood CD19⁺ cell percentage [OR=1.471, 95% CI: 1.093-1.980, P=0.011], and serum CRP level [OR=2.807, 95% CI: 1.121-7.028, P=0.027] as independent risk factors for liver injury in children with IM (P<0.05). Conclusion Liver injury is a potential complication in children with IM, and clinicians should carefully consider associated risk factors. Extended antiviral therapy may not be advisable, and elevated peripheral blood CD19⁺ cell percentages and serum CRP levels could serve as indicators of liver injury, warranting appropriate management.

NTCP deficiency combined with Alagille Syndrome: a case report and literature review

SHE Lan-hui, LI Xu-fang, FANG Chun-xiao, LIU Shi-ying, XU Yi

2024, 29(11):  1422-1426. 

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Objective To investigate the clinical features and genetic variation characteristics in children with a sodium taurocholate co-transporting polypeptide (NTCP) deficiency combined with Alagille syndrome (ALGS). Methods The clinical data and genetic test results of a child with NTCP deficiency combined with ALGS were retrospectively analyzed, along with a review of relevant literature. Results The patient, a 4-month-old boy, presented with jaundice of the skin and sclera one week after birth. He displayed characteristic facial features, including a prominent forehead, deep-set eyes, and a pointed chin. Laboratory findings revealed significant elevations in serum ALT, AST, TBA, and TBil, with no marked increase in γ-GT. Genomic sequencing identified a heterozygous mutation at the JAG1 gene locus( c.1148_1149del), resulting in a frameshift mutation altering the amino acid at p.C383fs (cysteine in the 383rd position and downstream amino acid), and a homozygous mutation at the SLC10A1 locus( c800C>T), changing the amino acid at p.s267F (serine in the 267th position was replaced by phenylalanine). Based on these findings, the patient was diagnosed with NTCP deficiency combined with ALGS. Conclusion NTCP deficiency combined with ALGS may manifest as low-γ-GT cholestatic hepatitis, and genetic testing is valuable for diagnostic confirmation.