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Table of Content

    31 December 2024, Volume 29 Issue 12
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    CONTENTS
    2024, 29(12):  0-0. 
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    Viral Hepatitis
    Risk of hepatitis B virus reactivation in HBsAg negative/anti-HBc positive patients with malignancies: a prospective study
    HAO Kun-yan, ZHANG Yi-qing, WANG Feng, ZHU Hao, WANG Wen-yang, SHEN Min, CHEN Xiao-hui, LI Ping, YU Yue-cheng
    2024, 29(12):  1464-1467. 
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    Objective To prospectively evaluate the rate of hepatitis B virus reactivation (HBVr) in HBsAg negative/anti-HBc positive (HBsAg-/anti-HBc+) patients with malignancies, thus to assess the risk of HBVr more accurately and optimize the management in this special population.Methods HBsAg-/anti-HBc+ patients with malignant tumors admitted to the Department of Oncology in a tertiary hospital from June to July 2021 and received anti-tumor treatment were selected as the subjects. Demographic data, tumor type, anti-tumor regimen, HBV markers such as HBV RNA, HBV DNA, HBsAg and HBeAg were collected prospectively at baseline and 6 months of anti-tumor treatment. HBVr was confirmed if any of the HBV markers turned positive, and the incidence of HBVr was analyzed to evaluate the risk of HBVr in the HBsAg-/anti-HBc+ background.Results A total of 36 HBsAg-/anti-HBc+patients with malignancies were included, all of whom had baseline serum HBV DNA <10 IU/mL, HBV RNA <50 copies/mL, HBsAg and HBeAg negative. Anti-HBs was detectable in 24 cases (66.67%), with 9 patients (25.00%) had anti-HBs≥100 mIU/mL. There were 2 patients (5.56%) in high risk subgroup, 4 patients (11.11%) in moderate risk subgroup, 26 patients (72.22%) in low risk subgroup, and 4 patients (11.11%) in uncertain risk subgroup. After 6 months of anti-cancer treatment, the total incidence of HBVr was 8.33% (3/36). The rates of HBVr in the high, moderate, low and uncertain risk subgroups were 0% (0/2), 25% (1/4), 3.85% (1/26) and 25% (1/4), respectively. No significant difference in HBVr rates were seen between anti-HBs positive and negative subgroups (3/24 vs 0/12, P=0.54), or between anti-HBs≥100 mIU/mL and <100 mIU/mL subgroups (1/9 vs 2/27, P=1.00). The levels of HBV DNA by the end of 6 months in the three HBVr patients (with baseline anti-HBs and risk stratification of anti-tumor treatment) were 12.49 IU/mL (23.19 mIU/mL and moderate risk), 19.24 IU/mL (1.23 mIU/mL and low risk), and 71.55 IU/mL (145.58 mIU/mL and uncertain risk).Conclusion Tumor patients with baseline HBsAg-/anti-HBc+and both HBV RNA and HBV DNA below the lower limit of detection, even those with relatively higher baseline anti-HBs and low or uncertain risk of anti-tumor regimens, may be still at risk of HBV reactivation. The results strongly mean that careful assessment and prevention of HBVr should also be emphasized in these patients.
    An analysis on the clinical efficacy and outcome of chronic hepatitis B patients with double-positive hepatitis B virus surface antigen and antibody treated with different antiviral regimens
    YANG Xi, GE Jun, XU Chen-yang, YAN Xue-fang
    2024, 29(12):  1468-1471. 
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    Objective To analyze the clinical efficacy and outcome of chronic hepatitis B patients with double-positive hepatitis B virus surface antigen and antibody treated with different antiviral regimens.Methods Sixty-five chronic hepatitis B patients with double-positive hepatitis B virus surface antigen and antibody admitted to Jiangsu Shengze Hospital Affiliated to Nanjing Medical University between February 2020 and June 2023 were divided into an interferon group (n=30) and an entecavir group (n=35) according to the patients' treatment modality. The clinical efficacy and outcome of the two groups were compared.Results In the entecavir combined with interferon group, the decrease in hepatitis B e antigen, the rate of hepatitis B e antigen reversion, and the rate of glutamate reversion were (1.29±0.65) PEIU/mL, 85.7%, and 85.7%, respectively, which were better than those of (0.96±0.36) PEIU/mL, 33.3%, and 43.3% in the interferon group; the decrease in hepatitis B e antibody, the decrease in hepatitis B virus deoxyribonucleic acid (DNA), and the rate of hepatitis B virus DNA reversion in the interferon group were (0.15±0.03) PEIU/mL, (4.27±2.10) U/mL and 83.3%, respectively, which were better than those of (0.06±0.02) PEIU/mL, (3.12±1.12) U/mL and 57.1% in the entecavir combined with interferon group (P<0.05); After treatment, the percentage of hepatitis B e antigen conversion and hepatitis B e antibody positivity in the interferon group was 83.3%, which was significantly higher than that of 42.9% in the entecavir combined with interferon group (P<0.05).Conclusion Treating chronic hepatitis B patients who are double positive for hepatitis B virus surface antigen and antibody with antiviral regimens, especially interferon therapy, is the key to improve the effective rate.
    An analysis on the characteristics of Entecavir resistance mutation in patients with chronic hepatitis B
    WANG Zhang-yun, WANG Yan-li, HE Xing-chang
    2024, 29(12):  1472-1475. 
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    Objective To explore the entecavir resistance mutation pattern and its clinical characteristics in patients with chronic hepatitis B.Methods Between October 2020 and May 2023, 121 patients were diagnosed with CHB and treated in Wuxi Branch of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Drug-resistant mutations need to be positive for rtL180M, rtM204V (or only rtM204I) and any one or more of rtV173, rtT184, rtS202, rtV169 and rtV250; After at least 12 months of oral treatment with at least one antiviral drug such as lamivudine (LAM), telbivudine (Ldt), adefovir dipivoxil (ADV), entecavir (ETV) and tenofovir dipivoxil fumarate (TDF), HBV DNA is at least in a low viral load status. In the study, the antiviral regimen received NAs treatment including single drug therapy, combined therapy and sequential therapy.Results Among 121 patients, there were 46 cases of ETV drug-resistant mutation, and the drug-resistant rate was 38.0%. Specific drug-resistant mutation sites and their mutation patterns include 9 cases of rtT184A/M204V/L180M (19.6%), 8 cases of rtT184L/M204V/L180M (17.4%), 1 case of rtT184S/M204V/L180M (2.2%), 18 cases of rtS202g/M204V/L180m (39.1%), 3 cases of rtS202G/M204I/M240I (6.5%), 3 cases of rtM250V/M204V/L180M (6.5%), 2 cases of rtM250L/M204V/M204I (4.3%) and 2 cases of rtT184/S202/M204V/L180M (4.3%). In patients with drug-resistant mutations of ETV, 17 cases were shift to LAM (37.0%), 15 cases were shift to ADV (32.6%), 4 cases were shift to LDT (8.7%), 3 cases were shift to ETV (6.5%), 2 cases were shift to TDF (4.3%), and the remaining 5 cases (10.7%) were shift to combined or sequential therapy. There were 11 cases (64.7%) with rtT184 mutation in LAM-resistant patients, which was significantly higher than that in ADV-resistant patients [3 cases (20.0%)], and the difference was statistically significant (P<0.05).Conclusion The main gene mutation pattern of entecavir-resistant patients is rtS202G/L180M mutation. Patients should receive careful clinical evaluation during treatment with NAs to prevent the emergence of drug-resistant strains.
    A study on the relationships between HCV genotypes and the disease severity, and the expression of immune regulatory cytokines in hepatitis C patients
    CAI Jing-jing, DU Kai
    2024, 29(12):  1476-1479. 
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    Objective To observe the relationships between the genotypes of hepatitis C virus (HCV) and the severity of disease, and the expression of immune regulatory cytokines in chronic hepatitis C (CHC) patients.Methods Between February 2021 and February 2023, 150 CHC patients treated in Nanyang First People's Hospital were collected in this study, including 92 males and 58 females, aged from 40 to 68 years, with an average age of (45.8±7.2) years. The patients were divided into a mild CHC group (58 cases), a moderate CHC group (48 cases) and a severe CHC group (44 cases) according to the severity of their disease. The HCV genotypes of these patients were determined at the same time. The expression of immunocompetent cells in patients with different severity and genotypes were compared.Results One hundred and thirteen CHC patients were HCV RNA positive and 37 patients were HCV RNA negative. The number of HCV RNA positive and HCV RNA negative cases in CHC patients with different severity was statistically significant (P<0.05). Six HCV genotypes were detected, including 15 cases of type 1a (10.0%), 61 cases of type 1b (40.7%), 59 cases of type 2a (39.3%), 7 cases of type 2b (4.7%), 3 cases of type 3a (2.0%) and 5 cases of type 6 (3.3%). There was no significant difference in the number of cases of CHC patients with different severity (P>0.05). In view of the small number of cases with HCV genotypes 2b, 3a and 6 , the serum IFN-γ. and IL-4 levels were only compared in patients with HCV genotypes 1a, 1b and 2a. The levels of IFN-γ and IL-4 in serum of CHC patients with HCV genotypes 1a, 1b and 2a were significantly different (P<0.05). The levels of serum IFN-γ and IL-4 in patients with mild, moderate and severe CHC were significantly different (P<0.05).Conclusion There are multiple HCV genotypes in CHC patients, and there is a close relationship between subtype 1b and the severity of disease and the expression of Th1/Th2/Th17 cytokines. At the same time, there are significant differences in the expression of immune regulatory cytokines in patients with different severity of the disease.
    Liver Cancer
    An analysis on the efficacy and safety of sintilimab combined with lenvatinib in the treatment of advanced hepatocellular carcinoma
    TIAN Yi-cheng, TANG Zu-xiong, RU Gan, WANG Qi, ZHAI Chun-tao
    2024, 29(12):  1480-1483. 
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    Objective To analyze the efficacy and security of sintilimab combined with lenvatinib in the treatment of advanced hepatocellular carcinoma (HCC).Methods A total of 68 patients with advanced HCC were selected from January 2021 to December 2023 as the research subjects. Thirty-four patients in the control group received lenvatinib monotherapy, and 34 patients in the observation group received sintilimab combined with lenvatinib treatment. Patients' vital signs and clinical laboratory results were continuously evaluated until they died, lost contact, or the study was ended. The antitumour response was assessed using the HCC specific modified RECIST (mRECIST), the survival curves were plotted and the occurrence of adverse events during treatment was recorded.Results There were no significant differences in the baseline clinical data and the occurrence of adverse events during treatment between the two groups (P＞0.05). The median PFS were 11.5 months and 6.8 months in two groups, with significant difference (P=0.013, HR=0.568, 95%CI=0.359-0.886). The median OS were 21.5 months and 12.7 months in two groups, with significant difference (P=0.005, HR=0.426, 95%CI=0.237-0.782). After treatment, the ORR and DCR were 44.12% and 85.29%, respectively, in the observation group, and were 23.53% and 58.82% in the control group, with significant differences (P＜0.05).Conclusion Sintilimab combined with lenvatinib is effective and safe in the treatment of advanced HCC and may lead to a better long-term outcome than lenvatinib monotherapy.
    Exploration of the relationship between non-alcoholic fatty liver disease and the occurrence of hepatocellular carcinoma in patients with previous HBV infection
    ZHANG Meng-di, LIU Xia
    2024, 29(12):  1484-1488. 
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    Objective To explore the relationship between non-alcoholic fatty liver disease (NAFLD) and the development of hepatocellular carcinoma (HCC) in patients with previous chronic hepatitis B virus (HBV) infection.Methods A retrospective study was conducted on 104 patients with HBV-related HCC who were admitted from February 2023 to February 2024 as the observation group. Among them, 23 were previously infected with HBV (HBsAg negative, anti HBc positive), and 81 were currently infected (HBsAg positive, anti HBc positive). Another 100 non-HCC chronic hepatitis B patients who received treatment during the same period of time were selected as the control group. The general information about the research subjects were collected by flipping through medical records. The clinical characteristics of the observation group and the control group, as well as the past and current HBV infections were compared. The influencing factors of HCC in HBV infected individuals through univariate and multivariate analysis were analyzed, and the relationship between NAFLD and HCC by adjusting for confounding factors were further analyzed.Results Compared with the control group, the proportion of males in the observation group (78.43% vs 63.00%), family history of liver cirrhosis (14.71% vs 6.00%), family history of liver cancer (12.75% vs 3.00%), NAFLD (20.59% vs 9.00%), liver cirrhosis (32.35% vs 15.00%), and AFP>400 ng/mL (40.20% vs 18.00%) were higher, and the average age was older [(57.96±10.43) years vs (52.14±9.86) years, all P<0.05]. Multivariate analysis showed that gender, age, family history of liver cancer, NAFLD, cirrhosis, and AFP>400 ng/mL were all influencing factors for the occurrence of HBV-related HCC (OR=2.250, 1.047, 2.586, 1.064, 2.016, 1.730, all P<0.05). Among HCC patients, compared with the current infection group, the average age of the former infection group was higher [(59.20± 9.44) years vs (53.70±10.60) years], the family history of liver cancer (38.10% vs 6.17%), diabetes (33.33% vs 12.35%), hypertension (42.86% vs 24.69%), and NAFLD (38.10% vs 16.05%) were higher (P<0.05). The patients in the HBV infection group were taken as the reference objects, and the multifactor analysis after adjusting for age, diabetes and hypertension factors showed that NAFLD was an independent imaging factor for HCC in patients with previous HBV infection (OR=1.643,95%CI: 1.301-2.818, P<0.05).Conclusion The occurrence of HBV -related HCC is associated with multiple factors such as gender, age, family history of liver cancer, NAFLD, etc. Compared to current HBV infections, patients with HBV infection related HCC have a higher incidence of NAFLD, and NAFLD may be an important risk factor for the occurrence of HCC in HBV infected individuals.
    The relationship between serum tumor abnormal protein and mean platelet volume/lymphocyte ratio and the prognosis of patients with primary liver cancer undergoing laparoscopic hepatectomy
    ZHANG Bei-ke, FAN Yong-gang, ZHANG Ying-nan, YAO Guo-liang
    2024, 29(12):  1489-1492. 
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    Objective To explore the relationship between serum tumor abnormal protein (TAP), mean platelet volume/lymphocyte ratio (MPVLR) and prognosis of patients with primary liver cancer (PLC) after laparoscopic hepatectomy.Methods Eight-five patients with PLC were enrolled in our hospital between January 2020 and September 2022. All patients underwent laparoscopic hepatectomy. The levels of TAP and MPVLR were detected before operation. The patients were followed up for 1 year after surgery to observe tumor recurrence, metastasis and death, and were divided into a poor prognosis group and a good prognosis group. Univariate and multivariate binary Logistic regression methods were used to analyze the influencing factors of prognosis in patients with PLC undergoing laparoscopic hepatectomy. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the predictive efficacy of serum TAP and MPVLR for the prognosis of patients.Results The incidence of poor prognosis in patients with PLC undergoing laparoscopic hepatectomy was 27.06% (23/85). The proportion of tumor diameter ≥3 cm, the proportion of CNLC stage Ⅲa, the proportion of multiple tumor numbers, TAP and MPVLR levels were 73.9%, 60.9%, 65.2%, (187.8±37.5) μm2, and (7.7±1.93) in the poor prognosis group, respectively, which were higher than those of 37.1%, 27.4%, 32.3%, (139.2±27.8) μm2, and (4.1±1.1) in the good prognosis group (P<0.05). Multivariate analysis showed that CNLC stage (OR=6.62), TAP (OR=5.39) and MPVLR (OR=3.85) were independent risk factors for the patients' prognosis (P<0.05). ROC curve analysis showed that the sensitivity, specificity and AUC of TAP, MPVLR and their combination in evaluating the prognosis of patients with PLC undergoing laparoscopic hepatectomy were 0.78, 0.74 and 0.87, 0.76, 0.74 and 0.92, 0.82, 0.80 and 0.91, respectively.Conclusion Serum TAP and MPVLR are independent risk factors for poor prognosis in patients with PLC undergoing laparoscopic hepatectomy. TAP combined with MPVLR has a better efficacy in evaluating the patients' prognosis.
    An observation study on the therapeutic efficacy of ultrasound-guided microwave ablation combined with camrelizumab for advanced primary liver cancer
    SHU Jia-ju, YE Xi-rong
    2024, 29(12):  1493-1497. 
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    Objective To observe the therapeutic efficacy of ultrasound-guided microwave ablation combined with camrelizumab for advanced primary liver cancer (PLC).Methods A total of 97 patients with middle and late stages of PLC were selected from March 2020 to February 2022.They were divided into a control group (48 cases) and an observation group (49 cases) according to different treatment methods. The control group received ultrasound-guided microwave ablation, and the observation group received additional carrilizumab treatment. The immune function, tumor marker levels [abnormal prothrombin (DCP), alpha-fetoprotein heteroplasmic (AFP-L3), carbohydrate antigen 199 (CA199), carcinoembryonic antigen (CEA)], clinical efficacy [disease control rate (DCR) and Objective response rate (ORR)] and adverse reactions were compared between the two groups. The overall survival of the two groups was recorded during 1-year follow-up.Results After treatment, serum immunoglobulin A (IgA), IgM and IgG levels in the observation group were (2.75±0.52) g/L, (18.74±3.24) g/L and (48.79±6.51) g/L, respectively, which were significantly higher than those of [(1.31±0.24) g/L, (8.45±1.62) g/L and (26.79±4.20) g/L in the control group (P<0.05). The levels of AFP-L3, DCP, CA199 and CEA in the observation group after treatment were (177.81±36.47) ng/mL, (26.15±3.24) mAU/mL, (50.28±4.03) ng/L, and (8.79±1.65) ng/mL, respectively, which was lower than those of [(287.39±56.21) ng/mL, (35.27±4.82) mAU/mL, (72.34±5.16) ng/L, and (26.37±3.20) ng/mL in the control group (P<0.05). The observation group demonstrated significantly higher DCR and ORR when compared to the control group (P<0.05). At 1-year follow-up, the observation group exhibited a survival rate of 79.17% (38/48), while the control group had a survival rate of 55.32% (26/47).Conclusion Ultrasound-guided microwave ablation combined with carrellizumab may improve immune function and reduce the levels of serum tumor markers in advanced PLC patients, and significantly improve their survival rate.
    The diagnostic value of combined detection of serum APE1 and miR183 in primary hepatocellular carcinoma
    JIAN Hui-ling, GAO Li-xia, LI Gui-yuan, ZHU Hai-peng, LI Di, JIA Xiao-ling, HU Jun
    2024, 29(12):  1498-1502. 
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    Objective To investigate the value of combined detection of serum apurinic/apyrimidinic endonuclease 1 (APE1) and microRNA183 (miR183) in the diagnosis of primary hepatocellular carcinoma.Methods Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum APE1 protein level in 60 healthy individuals (normal group), 180 high-risk patients with hepatocellular carcinoma (high-risk group) and 60 hepatocellular carcinoma patients (hepatocellular carcinoma group). The levels of the serum miR183 in the three groups were detected by real-time fluorescent quantitative polymerase chain reaction (RT-qPCR). Receiver operating characteristic (ROC) curve analysis was used to explore the value of combined detection of APE1 and miR183 in the diagnosis of hepatocellular carcinoma.Results The detection results of APE1 in the hepatocellular carcinomar group were 92.39 (70.76, 418.99) IU/mL, while those in the high-risk group were 88.96 (77.27, 406.28) IU/mL, both of which were higher than the normal group 75.79 (65.09, 81.97) IU/mL (P<0.001), but there was no significant difference between the hepatocellular carcinoma group and the high-risk group (P=0.714). The relative expression of miR183 in the hepatocellular carcinoma group was 2.35 (1.02, 4.15), the high-risk group was 1.38 (0.76, 3.13), and the normal group was 0.98 (0.70, 2.01). The results in hepatocellular carcinoma group were significantly higher than the other two groups (P<0.05), but there was no significant difference between the high-risk group and the normal group (P=0.166). The area under the curve (AUC) of APE1 alone in the diagnosis of hepatocellular carcinoma was 0.703 (95%CI: 0.607-0.799), the diagnostic cut-off value was 94.7 IU/mL, the sensitivity was 50%, and the specificity was 99.5%. The AUC of miR183 alone in the diagnosis of hepatocellular carcinoma was 0.723 (95%CI: 0.634-0.813), the diagnostic critical value of relative expression was 1.78, the sensitivity was 66.7%, and the specificity was 73.3%. The maximum AUC of combined detection of APE1 and miR183 was 0.829 (95%CI: 0.756-0.903), the sensitivity was 83.3%, and the specificity was 70.0%.Conclusion The two indicators of serum APE1 protein and miR183 have certain value in the diagnosis of hepatocellular carcinoma, and the combined detection of the two indicators can improve the ability to detect the primary hepatocellular carcinoma.
    Relationship between serum miR-15b-5p and miR-145 and poor prognosis after TACE treatment in patients with primary liver cancer
    ZHANG Zi-qiang, CHEN Kai-rong, WU Jun, LIU Jin-long, MA Feng
    2024, 29(12):  1503-1507. 
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    Objective To investigate the correlation between serum microRNA (miR) -145 and miR-15b-5p and the prognosis of patients with primary liver cancer after transcatheter arterial chemoembolization (TACE).Methods A total of 129 patients with primary liver cancer admitted to Qidong People's Hospital from March 2020 to April 2022 were selected. According to their 3-month postoperative prognosis, the patients were divided into good prognosis group and bad prognosis group. The study aimed to analyze the influencing factors of poor prognosis in patients with primary liver cancer and the predictive value of miR-145, miR-15b-5p and their combination in predicting the poor prognosis of primary liver cancer.The patients were followed up for 2 years and their survival was recorded.Results The proportion of portal vein cancer thrombus, incomplete capsule and continuous tumor margin in poor prognosis group was higher than good prognosis group (P<0.05). The miR-15b-5p and neutrophil to lymphocyte ratio (NLR) in the poor prognosis group were higher than good prognosis group, but lower in the poor prognosis group (P<0.05). Envelope integrity, serum miR-145, tumor margin, and serum miR-15b-5p were the influencing factors for poor prognosis of patients with primary liver cancer (P<0.05).The area under the curve (AUC) of serum miR-145, serum miR-15b-5p, and a combination of serum miR-145 and serum miR-15b-5p in predicting poor prognosis of patients with primary liver cancer were 0.815, 0.805 and 0.902, respectively (P<0.05). The survival rate of patients with low serum miR-15b-5p level was lower than patients with high serum miR-15b-5p level (P<0.05), and the survival rate of patients with high serum miR-145 level was higher than patients with low serum miR-145 level (37.21%) (P<0.05). Serum miR-145 was negatively correlated with miR-15b-5p (P<0.05).Conclusion The combination of serum miR-15b-5p and miR-145 levels has a higher value in predicting the prognosis of liver cancer after TACE.
    Clinical manifestations and histopathological features of 30 patients with perivascular epithelioid cell tumors of the liver
    WEN Lu-sheng, GENG Yue-hua, LIU Jin-fa, ZHOU Xiao-qin
    2024, 29(12):  1508-1511. 
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    Objective To analyze the clinical manifestations and histopathological features of 30 patients with perivascular epithelioid cell tumors of the liver.Methods Thirty patients with surgically resected and pathologically confirmed hepatic perivascular epithelioid cell tumors admitted to the 909th Hospital of the Joint Support Force between February 2019 and February 2020 were collected for clinical data and analyzed with clinical manifestations and histopathological features.Results Among the 30 cases, there were 10 males and 20 females. The age of onset was mostly 25~54 years old, and most of them had epigastric pain symptoms. The tumors were mostly solitary, the lesions were mostly located in the left outer lobe of the liver, and the tumors were between 60~100 mm. The liver function tests showed elevated levels of serum glutamate transaminase, alkaline phosphatase and bilirubin, and immunohistochemistry was mainly positive for anti-melanoma-specific monoclonal antibody, melanocyte antigen and anti-smooth muscle antibody. Among the 30 cases, 27 cases were available for follow-up within 2 years after surgery, and 3 cases received only 1 year of follow-up, with a follow-up rate of 90.0%. 27 cases were not found to have tumor metastasis or recurrence during the follow-up period, and no other treatment was performed after surgery, and the patients were in good condition until February 2022, and most of the liver CT, blood routine, and liver function tests were not abnormal.Conclusion Perivascular epithelial cell tumor of the liver is a very rare interstitial tumor that is easily confused with other liver tumors. Combining clinical and pathological features, the application of CT imaging, abdominal ultrasound, and MRI imaging can provide reliable basis for the diagnosis and differential diagnosis of perivascular epithelial cell tumors of the liver.
    Liver Fibrosis & Cirrhosis
    The implications and risk factor analysis of portal vein thrombosis in esophageal and gastric variceal bleeding in cirrhotic patients
    LUO Zuan
    2024, 29(12):  1512-1516. 
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    Objective To investigate the significance of portal vein thrombosis (PVT) in patients with cirrhosis experiencing esophageal and gastric variceal bleeding (EGVB) as well as the safety of anticoagulation therapy. Additionally, it analyzes the risk factors associated with the occurrence of EGVB in this patient group.Methods Patients with cirrhosis treated at our hospital from January 2012 to December 2022 were enrolled and followed clinically for one year to ascertain the incidence of EGVB. The color Doppler ultrasonography and enhanced CT of the upper abdomen were applied to diagnose PVT. Cox proportional hazards regression and Kaplan-Meier analysis were utilized to identify independent risk factors related to EGVB.Results Out of 518 patients followed for one year, 167 were diagnosed with PVT. Compared with patients without PVT, those with PVT exhibited a significantly higher proportion of severe variceal patients (91.0% vs 82.1%) (P<0.05). Cox regression analysis of all cirrhotic patients confirmed that portal vein thrombosis (HR: 1.482, 95% CI: 1.051-2.090), Child-Pugh score (HR: 1.446, 95% CI: 1.270-1.645), AST levels (HR: 1.010, 95% CI: 1.006-1.014), and international normalized ratio (INR) (HR: 0.341, 95% CI: 0.155-0.751) were independently associated with the risk of EGVB within one year (all P<0.05). Cox regression analysis of patients with cirrhosis and PVT found that chronic PVT (HR: 4.089, 95% CI: 2.247-7.441), elevated Child-Pugh score (HR: 1.787, 95% CI: 1.335-2.392), and increased AST levels (HR: 1.008, 95% CI: 1.003-1.013) significantly correlated with the occurrence of EGVB within one year (all P<0.05). However, there was no significant association with the location of PVT and anticoagulation therapy (all P>0.05).Conclusion PVT increases the risk of EGVB in patients with cirrhosis. Among those with cirrhosis and PVT, EGVB occurrence is unrelated to anticoagulation therapy but significantly associated with chronic PVT, Child-Pugh score, and AST levels.
    Efficacy evaluation of liver stiffness measurement, spleen thickness and splenic vein diameter in predicting esophageal varices in patients with hepatitis B cirrhosis
    QIAN Yu-xin, DU Ming-shu, ZHANG Pei
    2024, 29(12):  1517-1520. 
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    Objective To explore the efficacy of noninvasive indexes such as liver stiffness measurement (LSM), spleen thickness (ST) and splenic vein diameter (SVD) in predicting esophageal varices (EV) in patients with hepatitis B cirrhosis.Methods 154 patients with hepatitis B cirrhosis admitted to the Third Medical Center of the General Hospital of the People's Liberation Army between April 2019 and December 2022 were reviewed. The diagnosis of hepatitis B cirrhosis and EV meets the standard. According to gastroscopy, the degree of EV is divided into mild, moderate and severe. We compared the clinical data of patients with or without EV and different EV degrees, analyzed the difference of diagnostic efficiency of LSM, ST and SVD in predicting EV, followed up and observed the occurrence of EVB in EV patients, and compared it with cases without EVB.Results Among 154 patients with hepatitis B cirrhosis, there were 97 cases without EV and 57 cases with EV. 22 cases (38.6%), 24 cases (42.1%) and 11 cases (19.3%) were Child-Pugh A, B and C in patients with EV, and 58 cases (59.8%), 39 cases (40.2%) and 0(0) were Child-Pugh A, B and C in patients without EV. The difference was statistically significant (P<0.05). In EV group, ascites, PLT, Alb, INR, LSM, ST and SVD were 31 cases (54.4%), (76.1±11.7) ×109/L, (27.9±4.6) g/L, (1.3±0.4) and (29.1±10.4) kPa, (45.6±12.4) mm and (10.4±3.2) mm, and, there was a statistically significant difference when compared with the group without EV [2 cases (2.1%), (129.5±16.4) × 109/L, (34.0±3.9) g/L, (1.0±0.2), (14.6±5.5) kPa, (35.3±8.0) mm and (7.6±2.1) mm] (P<0.05). According to the results of gastroscopy, there were 23 cases of mild, 19 cases of moderate and 15 cases of hepatitis B cirrhosis complicated with EV. The LSM, ST and SVD of patients with severe EV were (40.2±17.6) kPa, (53.3±15.0) mm and (13.8±3.2) mm, compared with mild EV [(21.6±9.2) kPa, (40.2±11.1) mm and (7.9±2.3) mm] and moderate EV [(29.3±13.2) kPa, (46.0±12.7) mm and (10.7±3.2) mm], the difference was statistically significant (P<0.05). According to the analysis of ROC curve, the AUC value of LSM, ST and SVD in the joint diagnosis of EV in patients with hepatitis B cirrhosis was significantly higher than that of LSM, ST and SVD alone (P<0.05), and the AUC value, sensitivity and specificity of LSM, ST and SVD in the joint diagnosis were 0.91 (0.83 ~ 0.98), 89.5% and 83.5% respectively. During a one-year follow-up observation, 21 cases (36.8%) of EV patients developed EVB, and the treatments included esophageal variceal ligation (EVL), sclerosing agent injection, EVL combined with tissue glue injection, EVL combined with sclerosing agent and tissue glue injection were applied in 15 cases (71.4%), 4 cases (19.0%), 1 case (4.8%), and 1 case (4.8%) respectively. LSM, ST and SVD in EVB patients were significantly higher than those in non-EVB groups (P<0.05).Conclusion Using LSM, spleen ST or SVD, and other parameters to predict hepatitis B cirrhosis complicated with EV has certain diagnostic value, which can be used for primary screening in clinic and is worthy of further research and application.
    Liver Failure
    Construction and validation of a short-term prognosis prediction model for HBV-related acute-on-chronic liver failure
    QIN Hui-min, WANG Xiao-lin
    2024, 29(12):  1521-1526. 
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    Objective To explore a predictive model for 90-day mortality in patients with Hepatitis B Virus-associated Acute-on-Chronic Liver Failure (HBV-ACLF), thereby assisting in early clinical decision-making for timely intervention and treatment.Methods 88 HBV-ACLF patients admitting who met the inclusion and exclusion criteria and were admitted to Xiangyang Central Hospital from January 2019 to November 2023 were involved in the retrospective analysis. Patients were divided into the survival group with 61 cases (69.32%) and the mortality group with 27 cases (30.68%) based on their 90-day outcomes. Clinical data of both groups were collected, and independent risk factors for 90-day outcomes were identified using multivariate logistic regression. A prognostic prediction model was established and internally validated using 1000 bootstrap resamplings to assess its reliability.Results Among the 88 HBV-ACLF patients, multivariate regression identified C-reactive protein (CRP), procalcitonin (PCT), the ratio of measured liver volume to estimated liver volume (LV/ELV%), and the COSSH-ACLF IIs as independent risk factors for 90-day mortality. A scoring model was developed as Logit(P) = 0.285 × ln(CRP) + 5.291 × ln(PCT) + 1.017 × ln(COSSH-ACLF IIs)-9.757 × ln(LV/ELV%)-7.175. The area under the receiver operating characteristic curve (AUROC) of this model was significantly higher than that of COSSH-ACLF IIs alone, as well as the scores combined with CRP and PCT, or the scores combined with LV/ELV% (P<0.001). Internal validation confirmed the reliability of the combined predictive model.Conclusion The combined model offers higher predictive efficacy for the 90-day prognosis of HBV-ACLF patients, providing evidence-based medical support for early clinical diagnosis and treatment.
    Association between platelet levels before selective plasmapheresis and in-hospital prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure
    LIN Jian-hui, CHEN Li-xia, WEN Xin-xin, CHEN Ming, XIE Wen-guo, LIU Hai-yu
    2024, 29(12):  1527-1533. 
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    Objective To explore the association between preoperative platelet levels of selective plasma exchange (SPE) and in-hospital prognosis in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).Methods A total of 129 patients with HBV-ACLF who received SPE intervention in Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2017 to December 2020 were selected as the study subjects, and were divided into three groups according to the preoperative platelet levels of SPE: severe thrombocytopenia group (group A): <50×109/L, moderate thrombocytopenia group (group B): 50~100×109/L and normal group (group C): ≥100×109/L, and the clinical characteristics of the three groups were compared. Multivariate logistic regression analysis found an independent association between preoperative platelet levels and in-hospital prognosis of HBV-ACLF after adjusting for potential confounders.Results Among the 129 patients with HBV-ACLF with SPE intervention, [gender: male/female=112/17, age: 45 (38,53) years], the end-stage liver disease model (MELD) score was 20.86 (18.41, 23.25), and the proportion of in-hospital adverse prognosis was 22.48% (29/129). Multivariate logistic regression analysis and adjustment for potential confounding factors showed that platelet level before SPE was an independent influencing factor for the in-hospital prognosis of HBV-ACLF. In the adjusted model II, the OR of group B and group C was 0.10 (95% CI: 0.01-0.78, P=0.029) and 0.01 (95% CI: 0.00-0.13, P<0.001), respectively, and the direction of effect after adjusting for confounding factors was consistent with that of the unadjusted confounding factors, and the P values of the trend test of platelet levels in the three groups were <0.001.Conclusion The preoperative platelet level of SPE was negatively correlated with the in-hospital prognostic risk of HBV-ACLF patients, and the higher the platelet level, the lower the risk of poor in-hospital prognosis. Patients with low platelet levels prior to SPE should receive more proactive monitoring, assessment and management to improve prognosis.
    Clinical study on the early application of artificial liver support therapy in HBV-ACLF patients with bacterial co-infection
    ZHONG Liang-hui, ZHOU Ding-ying, ZHONG Yuan-bin
    2024, 29(12):  1534-1537. 
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    Objective To evaluate whether the early application of artificial liver support therapy, combined with antibiotic treatment, enhances the anti-infective efficacy of antibiotics and promotes liver function recovery in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) complicated by bacterial co-infection.Methods This study included patients with HBV-ACLF and bacterial co-infection admitted to the First Affiliated Hospital of Nanchang University between January 2019 and December 2022. Patientes were divided into two groups based on whether they received artificial liver support therapy(DPMAS+PE) within three days of confirmed infection alongside antibiotic treatment. The treatment group (n=44) received artificial liver support within three days, while the control group (n=39) did not. Key indicators, including procalcitonin (PCT), total bilirubin (TBil), prothrombin time (PT), international normalized ratio (INR), and infection control time(defined as PCT reduction to ≤80% of baseline or < 0.5 ng/mL), were compared between the two groups before and after artificial liver treatment.Results No statistically significant difference was observed in the reduction of PCT before and after artificial liver treatment between the two groups (treatment group: 0.42±0.32 ng/mL, control group: 0.50±0.30 ng/mL, P>0.05). However, the reduction in TBil was significantly greater in the treatment group compared to the control group (treatment group: 233.63±107.04 μmol/L, control group: 164.21±104.47 μmol/L, P<0.01). The treatment group also required fewer days for infection control than the control group (treatment group: 5.13±2.40 days, control group: 9.00±7.17 days, P<0.01). There was no significant difference in PT or INR between the two groups after treatment compared to baseline.Conclusion In patients with HBV-ACLF and bacterial co-infection, the combination of antibiotics and early artificial liver support therapy (within 3 days of confirmed infection) leads to a significant reduction in PCT levels compared to baselinet. Early application of artificial liver therapy does not interfere with the the anti-infective efficacy of antibiotics or exacerbate the infection, and it helps recude the duration of antibiotic use, thereby facilitating more effective infection control. Additionally, early artificial liver support effectively limits the progression of liver failure, significantly reduces bilirubin levels, and promotes liver function recovery.
    Drug-Induced Liver Injury
    Clinical analysis of 12 cases of drug-induced liver injury associated with polygonum multiflorum and its preparations
    WANG Xiong, SUN Ke-wei, TIAN Tao, ZENG Wei-tao, YUAN Wei
    2024, 29(12):  1538-1540. 
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    Objective To analyze the characteristics of drug-induced liver injury (DILI) associated with Polygonum multiflorum (PM) and its preparations, in order to raise clinical awareness and provide a basis for rational diagnosis and treatment.Methods A retrospective analysis was performed on the clinical data of 12 hospitalized patients diagnosed with DILI, who had a history of using taking PM and its preparations, from January 2017 to March 2024 at the First Affiliated Hospital of Hunan University of Chinese Medicine, Department of Hepatology.Results Among the 12 patients, 9 were female and 3 were male, with a mean age of 47.7±16.1 years. The time from drug intake to onset ranged from 1 day to 6 months, with a mean of 70.6±80.1 days. All 12 patients were clinically classified as having hepatocellular injury, with fatigue, poor appetite, and jaundice as the main clinical manifestations. The severity of the injury was classified as follows: 8 cases (66.7%) were grade 1, 3 cases (25%) were grade 3, and 1 case (8.3%) was grade 4. All patients with grade 3 or above had used traditional Chinese medicine formulations. Patients using proprietary Chinese medicines primarily experienced mild liver injury. All patients improved and were discharged after discontinuing PM and its formulations, along with receiving active liver protection and enzyme- reduction symptomatic supportive treatment.Conclusion DILI caused by PM and its preparations is primarily of the hepatocellular injury type. Clinicians should prescribe these drugs scientifically, according to standardly, and with rational judgement. When using PM and its preparations, close monitoring of liver function is essential, DILI should be detected promptly and managed actively, and the prognosis for most patients with DILI is favorable.
    Clinical evaluation of the dual plasma molecular adsorption system in the treatment of drug-induced liver injury with hyperbilirubinemia
    SHI Hong, HE Jian-cheng, WANG Jun-jie, YANG li
    2024, 29(12):  1541-1544. 
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    Objective To evaluate the therapeutic effect of the Dual Plasma Molecular Adsorption System(DPMAS) on drug-induced liver injury(DILI) with hyperbilirubinemia, aiming to enrich the clinical data on the diagnosis and treatment of this rare condition.Methods A total of 95 cases of DILI with hyperbilirubinemia were collected and divided into two groups: the observation group (PE+DPMAS) and the control group (PE), based on the treatment protocol. The clinical indices and their change rates were compared between the groups and across different treatment stages (pre-treatment and post-treatment).Results In terms of clinical indicators, after treatment at our center, the observation group showed significant improvements in ALT, AST, TBA, TBil and DBil, with values of 56 (35, 70) U/L, 49 (30, 73) U/L, 59.4 (43.2, 70.2) μmol/L and 102.7 (69.4, 148.7) μmol/L,and 84.5(56.8,128.7)μmol/L, respectively. In comparison, the control group had higher values:, 77 (50, 102) U/L, 71 (52, 97) U/L, 78.5 (56.2, 84.7) μmol/L, 145.9 (92.3, 206.5) μmol/L and 122.4 (78.9, 154.0) μmol/L, P<0.05. Regarding the change rate of clinical indicators, the decrease in TBA, TBil and DBil was significantly greater in the observation group than in the control group (P<0.05). For inflammatory markers, after treatment, the observation group had significantly lower levels of TNF-α, IL-6 and hs-CRP, with values of 21.6(17.5, 28.0) pg/mL, 20.6(17.3, 24.8) pg/mL and 14.5(12.6, 17.2) mg/L, respectively. These values were significantly lower than those in the control group: 32.3(25.8, 41.4) pg/mL, 26.7(20.9, 28.9) pg/mL, and 19.3(14.3, 19.5) mg/L, P<0.05]. Regarding treatment-related complications, at the end of the study, there were 1 case of gastrointestinal bleeding, 5 cases of abdominal infection, and 6 cases of electrolyte disturbance in both groups. There was no significant difference in the incidence of complications between the two groups (P>0.05). Notably, one case of gastrointestinal bleeding and two cases of abdominal infection, which were not well-controlled and progressed to severe infection, required ICU care and were later discharged after stabilization.Conclusion DPMAS is effective in treating DILI with severe hyperbilirubinemia.
    Metabolic Dysfunction-Associated Steatotic Liver Disease
    Correlation between intestinal permeability markers and nonalcoholic fatty liver disease
    GUO Tao, DAI Guang-rong
    2024, 29(12):  1545-1552. 
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    Objective To investigate the relationship between nonalcoholic fatty liver disease(NAFLD) and intestinal permeability markers.Methods A rat NASH model was successfully established to observe intestinal pathological changes, and serum markers, along with the expression levels of ZO-1 and Occludin, were analyzed. Additioinally, 94 NAFLD patients were enrolled, divided into two groups based on liver enzyme status: 58 patients with normal liver enzymes and 36 with abnormal liver enzymes. A control group consisting of 39 healthy individuals with normal physical examinations was also included. General baseline data, liver enzyme levels, blood lipids, blood glucose, and changes in ZO-1 and Occludin expression were compared between groups. Correlation analyses were performed to explore potential associations.Results Compared with the control group, the mucosal fold structure of the experimental group was largely intact, with mild epithelial cell detachment observed in the mucosal layer. The intestinal glands in the Lamina propria were atrophied, and their numbers were reduced. Infiltration of inflammatory cells of varying degrees and fat vacuoles of different sizes were observed in both the Lamina propria and muscularis mucosa. Serological markers, including ALT, GGT, LDL, TG, TC, GLU, INS, HOMA-IR, were significantly higher in the experimental group compared to the control group(P<0.05). Moreover, levels of ZO-1 and Occludin were significantly lower in the experimental group(P<0.05). There were significantly differences between the three groups regarding gender, age, weight, BMI, SBP, and DBP (P<0.05). BMI and DBP were higher in both the normal and abnormal liver enzyme groups compared to the control group, with the abnormal liver enzyme group showing higher values than the normal liver enzyme group (P<0.05). Serum AST, ALP, and GGT levels were significantly higher in the abnormal liver enzyme group compared to the normal liver enzyme and control groups (P<0.05); ALT levels were higher in both the normal and abnormal liver enzyme groups than in the control group (P<0.05); TBil was elevated in both the normal and abnormal liver enzyme groups relative to the control group (P<0.05). TG and TC levels were also higher in the normal and abnormal liver enzyme groups compared to the control group (P<0.05). HDL-C levels were lower in the abnormal liver enzyme group compared to both the normal liver enzyme and control groups (P<0.05), while LDL-C was higher in the normal liver enzyme group compared to the control group (P<0.05). GLU levels were higher in the abnormal liver enzyme group than in the control group (P<0.05). Both ZO-1 and Occludin expression levels were lower in the normal and abnormal liver enzyme groups compared to the control group, with the abnormal liver enzyme group showing the lowest leves (P<0.05). ZO-1 was negatively correlated with BMI, AST, ALT, GGT, and TBil (P<0.05), with the strongest correlation observed with ALT. HDL-C was positively correlated with ZO-1. Occludin was negatively correlated with BMI, AST, ALT, GGT, and GLU (P<0.05), with the strongest correlation observed with GGT, HDL-C was positively correlated with Occludin. Multivariate logistic regression analysis identified BMI and TC as risk factors for NAFLD, while ZO-1and Occludin were found to reduce the risk of NAFLD. In the analysis of NAFLD disease progression, BMI remained a risk factor, while ZO-1 and Occludincan continued to reduce the risk of disease progression.Conclusion Increased intestinal permeability is associated with the onset and progression of NAFLD.
    Other Liver Diseases
    Serum PTX3, SULT2A1 and AFABP as predictive biomarkers for intrahepatic cholestasis of pregnancy: analysis of associated risk factors
    SHEN Jia-lei, CAO Ke-dan, WANG Fang
    2024, 29(12):  1553-1557. 
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    Objective To evaluate the predictive value of serum Pentraxin 3 (PTX3), Sulfotransferase 2A1 (SULT2A1), and Adipocyte Fatty Acid Binding Protein (AFABP) for Intrahepatic Cholestasis of Pregnancy (ICP) and analyze its associated risk factors.Methods From August 2020 to August 2023, 100 patients with ICP treated at Changzhou Maternal and Child Health Hospital were included in the observation group, and 90 healthy pregnant women were included in the control group. Data were collected for both groups, and serum levels of PTX3, SULT2A1, and AFABP were measured. Multifactorial Logistic regression was performed to identify risk factors for ICP, and the predictive value of combined serum PTX3, SULT2A1, and AFABP levels was evaluated using Receiver Operating Characteristic (ROC) curves.Results The observation group showed significantly higher levels of ALT (79.24±5.78 U/L), AST (58.62±5.21 U/L), ALP (206.79±32.58 U/L), TBA (44.76±4.89 μmol/L), GGT (36.76±4.13 U/L), TBil (12.56±2.38 μmol/L), and DBil (5.92±1.45 μmol/L) compared to the control group (18.45±3.24 U/L, 20.38±3.36 U/L, 174.54±27.61 U/L, 5.01±1.02 μmol/L, 18.22±3.18 U/L, 10.49±2.15 μmol/L, 3.29±0.87 μmol/L; t=88.082, 59.389, 7.318, 75.631, 34.387, 6.265, 14.952, P<0.05). Risk factors for ICP included family history of ICP, hepatitis B virus infection, multiple pregnancies, gestational hypertension, and autoimmune diseases (P<0.05). In the observation group, serum levels of PTX3 (4.93±1.28 μg/L) and AFABP (35.24±9.24 μmol/L) were higher, while SULT2A1 (28.74±7.87 μg/L) was lower compared to the control group (3.27±1.02 μg/L, 21.22±7.45 μmol/L, 43.26±9.12 μg/L respectively; P<0.05). ROC analysis revealed that the sensitivity and specificity of serum PTX3, SULT2A1, AFABP levels, and their combined detection for predicting ICP were 68.0%, 80.0%, 83.0%, 95.0%, and 87.8%, 85.6%, 83.3%, 92.2% respectively, with AUCs of 0.845, 0.889, 0.891, 0.972.Conclusion Combined measurement of serum PTX3, SULT2A1, and AFABP levels demonstrates high sensitivity and specificity in predicting ICP, providing valuable support for early diagnosis and intervention.
    Prevalence of asymptomatic hepatitis B virus infection in intrahepatic cholestasis of Pregnancy and its impact on pregnancy outcome
    QIAN Er-yan, GONG Mi, WANG Li-juan, LIU Yu
    2024, 29(12):  1558-1560. 
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    Objective To investigate the prevalence of asymptomatic hepatitis B virus infection in intrahepatic cholestasis of pregnancy and its impact on pregnancy outcome.Methods A total of 112 pregnant women with chronic HBV infection, who were admitted for treatment and underwent pregnancy termination between January 2018 and December 2022, were included in the study. Based on fasting bile acid levels during pregnancy, participants were classified into a high bile acid group (TBA ≥ 10 μmol/L) (n=56) and a low bile acid group (TBA<10 μmol/L) (n=56). Baseline characteristics, serological markers, and pregnancy outcomes were compared between the two groups.Results Comparison of baseline data revealed that the proportion of elderly individuals in the high bile acid group was 37.5%, significantly higher than that in the low bile acid group (19.6%) (P<0.05). Serological analysis showed that the ratios of ALTmax>40 (U/L) ratio, ASTmax >35 (U/L), GGTmax >32 (U/L), and DNAmax >2×105 (IU/mL) in the high bile acid group were 64.2%, 64.2%, 33.9% and 64.2% respectively, significantly higher than those in the low bile acid group (12.5%, 17.8%, 5.3% and 23.2%) (P<0.05). Regarding pregnancy outcomes, the high bile acid group had a significantly higher incidence of preterm birth (14.2%) and cesarean section (71.43%) compared to the low bile acid group (3.5% and 35.7%, respectively) (P<0.05). The mean gestational age at delivery in the high bile acid group was 37.8 ±1.5 weeks, significantly lower than the low bile acid group (38.8±1.5 weeks) (P<0.05)].Conclusion Pregnant women with intrahepatic cholestasis of pregnancy exhibit a higher incidence of adverse pregnancy outcomes and a greater prevalence of asymptomatic hepatitis B virus infection. Closer monitoring is recommende for pregnant women with elevated bile acid levels.
    Feasibility of shear wave elastography for assessing liver damage in the acute phase of Kawasaki disease
    LI Li, LIU Fang, TUO Fei
    2024, 29(12):  1561-1564. 
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    Objective To assess liver elasticity in children with Kawasaki disease during the acute phase using shear wave elastography (SWE).Methods A total of 104 children with acute Kawasaki disease were enrolled in the Kawasaki disease group, which was further divided into two subgroup: coronary artery dilation(CAD) with 49 cases and non-coronary artery dilation (NCAD) with 55 cases. A control group of 50 healthy children, mached for age and sex, was also included. General and laboratory data were collected for all three groups. Liver elasticity was assessed using SWE to measure the maximum elastic value (Emax) and the average elastic value (Emean), with comparions made between the groups. The correlation between liver function indices and Emean was also analyzed. Additionally, laboratory markers such as white blood cell count (WBC), C-reactive protein (CRP), platelet count (PLT), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were collected from the pediatric patients.Results Serum levels of WBC (17.62±3.48×109/L), CRP (15.3±1.13 mg/L), PLT (478.67±93.45×109/L), ESR (0.56±0.04 mm/h), IL-6 (82.21±6.87 pg/mL), AST (26.12±2.68 U/L), and ALT (28.91±1.87 U/L) in the CAD group were significantly higher than those in the NCAD and control group (P<0.05). Additionally, liver Emax (8.22±1.25 kPa) and Emean (6.67±1.57 kPa) values in the CAD group were higher than those in the NCAD group and control group. Correlation analysis showed that AST and ALT were positively correlated with Emean in the Kawasaki disease group (r=0.539, 0.638, both P<0.05).Conclusion SWE is a feasible method for evaluating liver damage in the acute phase of Kawasaki disease in children.