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Table of Content

    31 January 2025, Volume 30 Issue 1
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    CONTENTS
    2025, 30(1):  0-0. 
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    Drug-Induced Liver Injury
    The clinical features and prognosis of 360 patients with pathologically diagnosed drug-induced liver injury
    XU Shan-shan, QIU Li-xia, LIU Ya-li, ZHANG Jing
    2025, 30(1):  16-20. 
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    Objective To investigate the clinical characteristics and prognostic factors of patients with drug-induced liver injury (DILI), so as to provide early warning for patients with high risk of DILI deterioration and reduce the risk of death. Methods Patients diagnosed with DILI by liver biopsy who were hospitalized to Beijing You An Hospital at Capital Medical University between March 2013 and January 2024 were collected. The social demographic information, clinical data, and patient outcomes were recorded and the patients were split into two groups: an improvement group and a deterioration group. Comparisons were made then between the social demographic information and clinical features of the two groups. The risk factors associated with DILI prognosis were analyzed by univariate and multifactorial analysis, and the rate of deterioration in patients with different risk factors was compared. Methods A total of 360 patients with a median age of 49.00 (37.00, 57.00) years were enrolled in this study, the clinical manifestations of enrolled patients were non-specific. Most of the patients were females (240 cases, 66.70%). Among the suspicious drugs used, the majority of patients were single drug use (314 cases, 87.22%), and the proportion of traditional Chinese medicine/proprietary Chinese medicine was the highest (53.90%). In this study, there were 347 patients in the improvement group and 13 patients in the deterioration group. When compared with the improvement group, the white blood cell count (WBC), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) in the deterioration group were significantly increased, cholinesterase (CHE), albumin (ALB), prothrombin time activity (PTA) and Delta-TBil were significantly decreased, and the number of hospital days was shorter. Univariate analysis and multivariate analysis showed that PTA (OR 0.716 (0.535,0.960), P=0.025) and Delta-TBil (OR 0.970 (0.941,0.999), P=0.044) were independent risk factors for the prognosis of DILI. PTA and Delta-TBil were processed as categorical variables. It was found that the deterioration rate of 100.00% in patients with 2 risk factors (PTA≤51 and Delta-TBil≤-37.8) was significantly higher than that in patients with ≥1 risk factor (PTA≤51 or/and Delta-TBil≤-37.8) and patients without risk factors. Conclusion The risk variables influencing DILI prognosis are PTA and Delta-TBil. To lower the mortality, patients with these two risk factors should have their disease surveillance reinforced and be placed in the liver transplant waiting list as soon as possible.
    The clinical characteristics and regularity of adverse reactions of drug-induced liver injury in children
    YANG Hui-min, PENG Qi, ZHAO Yuan
    2025, 30(1):  21-23. 
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    Objective To investigate the clinical characteristics and regularity of adverse reactions in children with drug-induced liver injury (DILI), and to provide a theoretical reference for the safe and rational use of drugs by clinical pediatricians. Methods The clinical data of 114 children with DILI admitted to our hospital from January 2020~December 2022 were collected, including gender, age, history of underlying diseases, medication time, drug type, mode of administration, clinical manifestations, treatment outcomes, etc., and the clinical characteristics and regularities of DILI occurrence were summarized. Methods Among the 114 patients, 69 (60.5%) were 13~18 years old, with 33 males and 36 females, accounting for the largest proportion. 10 cases (8.8%) that were ≤ 1 year of age accounted for the lowest proportion. Respiratory tract infection affected 31 cases (27.2%) was the most common underlying disease. Ninety-nine cases (86.8%) had clinical symptoms and 15 cases (13.2%) had no obvious symptoms. The clinical symptoms included decreased appetite, fatigue, fever, vomiting, jaundice, rash, nausea and abdominal distention; Among the 114 patients, there were 97 cases (85.1%) of hepatocellular injury type, 6 cases (5.3%) of cholestatic type, and 11 cases (9.6%) of mixed type. The serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) levels of patients with hepatocellular injury was (531.7±149.6) U/L, (765.6±217.5) U/L, and (330.4±187.5) U/L, respectively, which was significantly higher than those of cholestatic type [(296.1±105.5) U/L, (123.4±79.1) and (301.2±101.3) U/L, respectively] and those of mixed type [(167.9±72.8) U/L, (358.2±104.7) U/L, and (198.3±171.6)U/L, respectively]( All P<0.05). Among the 114 patients, 65 (74.1%) patients improved, 32 (28.1%) patients were cured, 4 (3.5%) patients were uncured, and 13 (11.5%) patients had unknown clinical outcomes. The drug categories that caused DILI in children were antibacterial drugs (26.7%), traditional Chinese medicines (21.6%), antipyretic analgesics (18.8%), tumor chemotherapy drugs (11.9%), anti-tuberculosis drugs (10.2%), psychiatric drugs (5.7%), antivirals (2.8%) and hormones (2.27%). The causal drugs were administered orally in ninety-three cases (52.8%), accounting for the largest proportion, and the number of onset days was (30.2±8.9) days; The minimum proportion was 1 case (0.5%) who was administered by subcutaneous injection, and the number of onset days was (20.0±0.0) days. Conclusion Clinicians should be cautious about the use of drugs in children. Children's own factors, drug factors and clinical characteristics should all be considered. Active drug publicity and regular testing are necessary for the prevention, early diagnosis and treatment of DILI in children, and to ensure the safety of children's medication.
    Liver Failure
    The efficacy of double plasma molecular adsorption system in the treatment of patients with HBV-related acute-on-chronic liver failure
    ZHANG Dong-qing, LIAO Zi-yuan, LIN Sheng-long, WU Wen-jun, WANG Xiang-mei, MA Hua-xi, GAO Hai-bing
    2025, 30(1):  24-30. 
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    Objective To investigate the efficacy of double plasma molecular adsorption system (DPMAS) and plasma exchange (PE) in patients with HBV-related acute-on-chronic liver failure. Methods Forty patients with HBV-related acute-on-chronic liver failure who were hospitalized in Mengchao Hepatobiliary Hospital of Fujian Medical University from September 2022 to January 2023 were retrospectively collected. The patients were divided into a DPMAS treatment group (group A) and a PE treatment group (group B), with 20 cases in each group. The clinical indicators including blood routine, biochemical indicators, coagulation function, inflammatory indicators and the occurrence of complications were collected before and after treatment, and the MELD value and MELD-Na value before treatment were calculated. All patients were followed up for 3 months. The disease progression, laboratory parameters and liver transplantation-free survival rate during the observation period were compared. Methods 1. There were no significant differences in gender, age, disease stage, complications, clinical indicators, MELD score and MELD-Na score between the two groups before artificial liver treatment (P>0.05). 2.The 3-month liver transplantation-free survival rate was 80% in group A and 70% in group B. There was no statistical difference between the two groups. 3. At 24 hours after treatment, the levels of total bilirubin (TBil) and direct bilirubin (DBil) in the two groups decreased, and the difference was statistically significant (Group A:TBil 362.2(302.8, 443.1) vs. 263.0(219.9, 349.2)μmol/L,Z=-3.003,P=0.003;DBil 180.6(154.7, 222.3) vs. 127.6(112.0, 178.7)μmol/L,Z=-2.867,P=0.004;Group B:TBil 419.2±147.0 vs. 339.7±113.3 μmol/L,t=1.914,P=0.063;DBil 202.9±59.3 vs. 164.5±48.1 μmol/L,t=2.254,P=0.030). Compared with group B, the reduction rate of TBil and DBil in group A was higher ( TBil:25.6±8.3 vs. 17.9±7.4 μmol/L,t=3.090,P=0.004;DBil:25.7±9.2 vs. 18.4±8.1 μmol/L,t=2.682,P=0.011). The prothrombin time (PT) and international normalized ratio (INR) in the group B decreased (PT:28.6(21.1, 32.7) vs. 21.9(17.7, 24.8) s,Z=-2.489,P=0.013;INR:2.7(1.9, 3.2) vs. 1.9(1.4, 2.2),Z=-2.462,P=0.014), whereas the prothrombin time activity (PTA) increased (31.2±11.1% vs. 42.7±13.7%,t=-2.918,P=0.006). There was no significant difference in coagulation indexes before and after treatment in group A. Group B had a significant increase in albumin (Alb) [11.8(7.1, 21.4) vs. 8.0(5.4, 12.0)g/L,Z=-2.002,P=0.045], whereas group A had no significant difference in Alb before and after treatment. Group A had a decrease in C-reactive protein (CRP) after treatment, while group B had no significant difference in CRP before and after treatment. 4. At72 hours after treatment: TBil and DBil in DPMAS treatment group continued to decrease and had statistical significance [TBil:362.2(302.8, 443.1) vs. 297.8(213.4, 394.6)μmol/L,Z=-2.110,P=0.035;DBil:180.6(154.7, 222.3) vs. 143.8(102.8, 184.9)μmol/L,Z=-2.218,P=0.027]. While TBil and DBil in group B had no statistical significance before and after treatment; There was no significant difference in coagulation function between the two groups before and after treatment. The patients in group B had a significant reduction in hemoglobin (Hb) before and after treatment (121.4±14 vs. 111.3±12.3 g/L,t=2.423,P=0.020), whereas group A had no significant difference in HB before and after treatment. There was no statistically significant difference in 3-month liver transplantation-free survival rate between group A and group B patients. Conclusion DPMAS is superior to PE in the clearance of bilirubin and inflammatory mediators such as CRP. DPMAS treatment has no significant effect on coagulation function.
    Glucocorticoids improve the outcomes of patients in the pre- and early stages of acute-on-chronic liver failure
    DENG Ru-xin, LEI Si-xian, Meng Zhong-ji
    2025, 30(1):  31-36. 
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    Objective To study on the clinical efficacy and safety of glucocorticoid (GC) in the treatment of patients with acute-on-chronic pre-liver failure (pre-ACLF) or acute-on-chronic liver failure in the early stage. Methods The data of patients with pre-ACLF or acute-on-chronic liver failure in the early stage hospitalized in Taihe Hospital of Shiyan City from Jan. 2009 to Dec. 2021 were retrospectively analyzed. Patients received standard medical therapy (SMT) were enrolled into a SMT group, and those received glucocorticoid (GC) based on SMT treatment were enrolled into a SMT+GC group. By using propensity score matching (PSM) method. The incidences of ACLF and complications, and short-term survival rates (28 days, 90 days, 1 year) were analyzed. Methods A total of 177 patients with pre-ACLF or ACLF in early stage were included in this study, including 132 patients in the SMT group and 45 cases in the SMT+GC group. There was no statistical difference in baseline data comparison between the SMT+GC group and SMT group after PSM matching. Compared with those who received SMT treatment only, patients received SMT+GC combination treatment showed significantly higher 1-year survival rate (93.2% vs. 75.0%, P=0.020), and in hospital improvement rate (84.4% vs. 66.4%,P=0.03). On the other hand, Prothrombin Activity (PTA), Prothrombin Time (PT), and International Normalized Ratio (INR) in SMT+GC group improved significantly on the 7th day (P<0.05). Attractively, significantly less pre-ACLF patients developed ACLF if they received SMT+GC combination treatment (6.66% vs. 34.48%, P=0.008). There was no significant difference in the incidence of complications between SMT+GC group and SMT group (P>0.05). Conclusion GC can effectively block the deterioration of patients with pre-ACLF or ACLF in early stage, especially circumvent the development of ACLF in pre-ACLF patients. It may improve the survival of patients without increasing the incidence of complications.
    An analysis on the treatment effect of rifaximin on liver failure and its complications
    ZHANG Li, BIAN Zhao-lian, TIAN Li-jun, LIU Yi-cun, CHEN Wei-jie, XUE Hong
    2025, 30(1):  37-41. 
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    Objective To investigate the treatment effect of rifaximin on liver failure (LF) and its complications. Methods The clinical data of 75 patients with liver failure treated at the Third People's Hospital of Nantong City from January 2020 to October 2022 were retrospectively analyzed. On the basis of comprehensive medical treatment and partial artificial liver support, patients were divided into a rifaximin group and a control group according to the presence or absence of rifaximin treatment. The patients in rifaximin group were given rifaximin 400 mg three times daily for 3 months on top of the treatment of control group. The occurrence of complications (i.e., infection, hepatic encephalopathy, ascites) at the time of admission and the improvement of complications during the follow-up period were recorded in both groups; Kaplan-Meier survival curves were plotted to compare the 90-day survival rates of the two groups according to the survival status of patients at 90 days of follow-up. Methods There were no statistically significant differences in age, sex, artificial liver, Child-Turcotte-Pugh (CTP) score and Model for End-Stage Liver Disease (MELD) score between the two groups (P>0.05); after 3 months of regular treatment, the rate of improvement of infection was higher in the rifaximin group than in the control group (77.8% vs. 44.4%, P=0.020), and the rate of improvement of hepatic encephalopathy (HE) was higher than that in the (88.9% vs. 37.5%, P=0.013) and ascites (62.5% vs. 31.2%, P=0.038), all statistically significant (P<0.05); Kaplan-Meier analysis showed that the 90-day survival rate of patients with liver failure in the rifaximin group [36.0% (9/25)] was higher than that in the control group [16.0% (8/50)] (P<0.05). Conclusion In patients with liver failure, rifaximin treatment significantly improved the complications of infection, Hepatic Encephalopathy (HE), and ascites, and helped prolong the survival of patients, demonstrating the feasibility of rifaximin in the treatment of liver failure and its complications.    
    The effect of Neutrophil extracellular traps on mice with acute liver failure
    YANG Shi-xin, SHI Chun-xia, GUO Jin, ZHANG, Dan-mei, WANG Yu-kun, GONG Zuo-jiong
    2025, 30(1):  42-45. 
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    Objective To analyze the changes of Neutrophil extracellular traps (NETs) in liver tissue of mice with acute liver failure (ALF). To investigate the pathogenic role of NETosis in ALF liver inflammation. Methods 20 male mice were randomly divided into a normal group and a model group with 10 mice in each group. Acute hepatic failure model in mice was induced with D-galactosamine in combination with lipopolysaccharide. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) levels were detected in both groups of Mice. Hematoxylin-eosin (HE) staining was used to observe the pathological changes in liver. Terminal deoxynucleotidyl transferase dUTP Nick-End Labeling (TUNEL) staining was used to detect hepatocyte apoptosis. Immunofluorescence staining was used to detect the expression of citline histone H3, a marker of NETs in liver. Enzyme linked immunosorbent assay (ELISA) was used to detect the level of NETs in serum and liver tissue of mice. Methods The liver structure of ALF model group was damaged, and inflammatory cell infiltration increased significantly. Serum AST, ALT and TBil levels were significantly increased (P＜0.05) . NETs in the liver tissue of mice in model group (10.52±0.53 ng/mL) were significantly higher than those in normal mice (4.61±0.84 ng/mL), and the difference was statistically significant (P<0.05). Conclusion NETs play an important role in the inflammatory response of ALF. It can be used as a feasible target for the treatment of acute liver failure.
    Liver Tumor
    Clinico-pathological characteristics of undifferentiated embryonal sarcoma in the liver
    XIANG Juan, QU Yan-Gang
    2025, 30(1):  46-49. 
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    Objective To investigate the clinicopathological characteristics, diagnosis, differential diagnosis and prognosis of undifferentiated embryonal sarcoma of the liver (UESL). Methods A retrospective analysis was collected and analyzed on a case of UESL, which focused on the following aspects: histomorphology, immunohistochemical staining and Clinicopathological manifestations. Meanwhile, the published literatures on UESL were reviewed. Methods The patient was a 5-year-old male child with a massive liver mass measuring 15 cm×11 cm×9 cm. Microscopically, the tumor cells were composed of light-moderate atypia spindle cells or stellate mesenchymal cells. Tissue in the interstitium was obviously loose with mucoid degeneration. Eosinophilic bodies were seen inside or outside the cytoplasm. Multinucleated or gigantiform cells could often be seen. Tumor cells were positive for Vimentin, Bcl-2, CD99, CD10, CK7, and Desmin. Eosinophilic bodies were positive for PAS. Ki67 positive index was 60%. Conclusion UESL is a highly malignant tumor composed of originally undifferentiated mesenchymal cells of the liver, most commonly occurred in children. It is necessary to differentiate UESL from hepatoblastoma, hepatic embryonal rhabdomyosarcoma, hepatic mesenchymal hamartoma, and gastrointestinal stromal tumor.
    The value of cytokeratin-19, CA50, and alpha-fetoprotein in assessing disease progression in hepatocellular carcinoma
    JIANG Cheng-cheng, DONG Xin-yuan
    2025, 30(1):  50-54. 
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    Objective To investigate the expression levels of cytokeratin-19 (CK-19), carbohydrate antigen 50 (CA50), and alpha-fetoprotein (AFP) in patients with hepatocellular carcinoma, and to assess the utility of these biomarkers in evaluating disease progression. Methods A total of 89 patients diagnosed with hepatocellular carcinoma at Wujin Hospital of Traditional Chinese Medicine in Changzhou from February 2021 to February 2024 were included in the hepatocellular carcinoma group. Additionally, 33 patients with benign liver nodules treated during the same period were included in the benign nodule group, and 50 healthy adults served as the control group. The expression levels of CK-19, CA50, and AFP were measured, and their correlation with TNM staging was analyzed. Receiver operating characteristic (ROC) curve analysis was utilized to evaluate the diagnostic efficacy of these biomarkers in tracking disease progression. Methods Serum levels of CK-19, CA50, and AFP were significantly higher in the hepatocellular carcinoma group (18.96±5.20 ng/mL, 31.54±8.60 U/mL, and 310.16±63.14 U/L, respectively) compared to the benign nodule group (5.84±0.79 ng/mL, 15.15±3.47 U/mL, 78.26±23.58 U/L) and the reference group (2.61±0.35 ng/mL, 7.08±1.86 U/mL, 41.02±9.72 U/L; P<0.05). A trend of increasing biomarker levels from stage I to IV was observed (P<0.05). Spearman's correlation analysis showed a positive correlation between disease progression and serum levels of CK-19, CA50, and AFP (r=0.649, 0.452, 0.408; all P<0.05). The combined predictive performance of CK-19, CA50, and AFP for disease progression in hepatocellular carcinoma was high, with an AUC of 0.872, sensitivity of 80.8%, and specificity of 81.1%. Conclusion The expression levels of CK-19, CA50, and AFP are closely related to the progression of hepatocellular carcinoma and can serve as effective biomarkers for assessing disease progression.
    Evaluation value of TGF-β1, Ca2+and BALP combined assay in patients with bone metastasis from hepatocellular carcinoma
    MENG Chun, ZHOU Wen-juan, SHEN Yu-chneg
    2025, 30(1):  55-60. 
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    Objective To evaluate the clinical value of transforming growth factor-β1 (TGF-β1), calcium ion (Ca2+) and bone-specific alkaline phosphatase (BALP) in patients with bone metastasis from hepatocellular carcinoma (HCC). Methods A total of 350 HCC patients were selected and divided into no bone metastasis group (n=304) and the bone metastasis group (n=46) according to clinical symptoms and imaging results. HCC patients with bone metastases were divided into single bone metastasis group (n=21) and multiple bone metastases group (n=25) according to PET-CT results. According to the occurrence of complications such as pathological fracture and spinal cord compression, the patients were divided into the non-complication group (n=40) and the complication group (n=6). The clinical data and serum TGF-β1, Ca2+and BALP levels of all groups were compared. TGF-β1, Ca2+and BALP levels were correlated with visual analog scale (VAS), modified Barthel Index Scale (BI) and bone metastases-specific sub-scale (QLQ-BM22) by Pearson correlation analysis. The receiver operating characteristic (ROC) curve was plotted to assess the efficacy of combining TGF - β 1, Ca2+, and BALP indicators in evaluating HCC with bone metastasis. Methods Bone metastasis occurred in 46 of 350 HCC patients (13.14%). The levels of ALP, AFP-L3, CEA, TGF-β1, Ca2+and BALP in bone metastasis group were 157.35±13.67 U/L, 138.47±12.18 μg/L, 11.69±2.53 μg/L, 58.95±7.26 μg/L, 2.74±0.39 μmol/L, 12 6.49±14.35 U/L, which were higher than that in the group without bone metastasis (97.35±8.73 U/L, 82.39±7.75 μg/L, 2.47±0.56 μg/L, 26.75±4.38 μg/L, 1.96±0.28 μmol/L, 51.74±6.18 U/L). The difference was statistically significant (F=9.581, 9.263, 13.582, 9.265, 6.527, 12.672, all P<0.05). In patients with bone metastasis, TGF-β1, Ca2+and BALP levels in patients with multiple bone metastasis were 73.16±8.41 μg/L, 2.95±0.48 μmol/L, 137.26±15.71 U/L. It was higher than that of patients with single bone metastasis (37.28±4.59 μg/L, 2.14±0.31 μmol/L, 69.45±8.02 U/L), and the difference was statistically significant (F=9.672, 8.427, 12.036, all P<0.05). The levels of TGF-β1, Ca2+and BALP were 79.56±9.25 μg/L, 3.02±0.51 μmol/L and 143.19±16.58 U/L in patients with bone metastasis complications. It was higher than that of patients without complications (35.47±4.38 μg/L, 2.17±0.32 μmol/L, 72.38±8.14 U/L), and the difference was statistically significant (F=10.247, 9.138, 13.257, all P<0.05). Pearson analysis showed that serum levels of TGF-β1, Ca2+and BALP in HCC patients with bone metastasis were positively correlated with VAS and QLQ-BM22 scores, and negatively correlated with BI scores (P<0.01). ROC curve showed that the area under the curve (AUC), sensitivity and specificity of the combined detection of TGF - β 1, Ca2+, and BALP were higher than that of any single item (P<0.01). Conclusion TGF-β1, Ca2+, and BALP have higher value in early warning and disease assessment of HCC patients with bone metastasis, and the combined detection has better efficacy.
    The effects of piceatannol on proliferation, apoptosis and autophagy of liver cancer HepG2 cells were investigated based on ULK1/Atg13 signaling pathway
    ZHANG Sha-sha, LIU Gai-ling, ZHOU Hong-xia
    2025, 30(1):  61-64. 
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    Objective To investigate the regulatory effects of piceatannol on proliferation, apoptosis and autophagy of liver cancer HepG2 cells, as well as its effects on the UNC-51-like kinase 1 (ULK1)/autophagy associated protein 13 (Atg13) signaling pathway. Methods HepG2 cells cultured in vitro until the logarithmic growth phase were divided into control group (HepG2 cells were conventionally cultured), cisplatin group (add 10 μmol/L of cisplatin to the culture medium containing HepG2 cells) and low piceatannol (add 10 μmol/L of piceatannol to the culture medium containing HepG2 cells), medium piceatannol (add 20 μmol/L of piceatannol to the culture medium containing HepG2 cells), high piceatannol (add 40 μmol/L of piceatannol to the culture medium containing HepG2 cells) groups. The cells in all groups were cultured for 72 hours. The proliferation rate, apoptosis rate and autophagy of HepG2 cells were detected by methyl thiazolyl tetrazolium assay, flow cytometry and monodansyl pentanediamine staining, respectively. The messenger RNA (mRNA) and protein levels of microtubule-associated protein light chain 3Ⅱ (LC3Ⅱ), ULK1, Atg13, B-lymphoblastoma-2-associated X protein (Bax) in HepG2 cells were detected by fluorescence quantitative PCR and western blot, respectively. Methods The control group HepG2 cells did not form autophagosomes. A large number of autophagosomes were formed in HepG2 cells of the cisplatin group. The number of autophagosome formation in HepG2 cells in the piceatannol low, medium, and high concentration groups were increased sequentially, but was not as high as that in the cisplatin group. Compared with control group, the proliferation rate of HepG2 cells in cisplatin group, piceatannol low, medium and high concentration groups was significantly decreased (P<0.05), and the apoptosis rate, the mRNA and protein levels of LC3Ⅱ, ULK1, Atg13 and Bax were significantly increased (P<0.05). Compared with cisplatin group, the proliferation rate of HepG2 cells in piceatannol low, medium and high concentration groups was significantly increased (P<0.05), and the apoptosis rate, the mRNA and protein levels of LC3Ⅱ, ULK1, Atg13 and Bax were significantly decreased (P<0.05). Compared with piceatannol low concentration group, the proliferation rate of HepG2 cells in piceatannol medium and high concentration groups was decreased in turn (P<0.05), and the apoptosis rate, the mRNA and protein levels of LC3Ⅱ, ULK1, Atg13 and Bax were increased in turn (P<0.05). Conclusion Piceatannol can inhibit proliferation of HepG2 cells, promote apoptosis and autophagy of HepG2 cells, and its mechanism may be related to the activation of ULK1/Atg13 signaling pathway.
    Liver Fibrosis & Cirrhosis
    The diagnostic value of the psoas muscle index combined with arm circumference in patients with cirrhosis and sarcopenia
    YU Hong, JING Jin-hua, GUZAINUR Yiliar, SUN Wei, DOU Jing, NING Zhong-hui, XU Qiang, WANG Xiao-bo, WANG Zhuan-guo, WANG Xiao-zhong, JIANG Yi, GUO Feng
    2025, 30(1):  65-73. 
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    Objective To evaluate the diagnostic value of the psoas muscle index combined with nutritional assessment in patients with cirrhosis and sarcopenia. Methods The clinical data of 215 patients diagnosed with cirrhosis in Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region were collected. Using skeletal muscle index (SMI) of the third lumbar spine (L3) (male < 50 cm2/m2 or female < 39 cm2/m2) as the diagnostic criterion, patients were divided into sarcopenia and non-sarcopenia groups for intergroup comparisons. The receiver operating characteristic curve (ROC) was plotted, and the area under the curve (AUC) was used to determined the diagnostic value of nutritional assessment indicators, and CT imaging indicators. Methods (1) According to comparison results of serological indexes and liver function between patients in sarcopenia and non-sarcopenia groups, the differences in age, RBC count, and HGB were statistically significant (P<0.05). The nutritional scores of patients in sarcopenia group were higher than those in non-sarcopenia group. The TSF, AMC, upper arm circumference, calf circumference, SMI, PMI, and psoas muscle area of patients in sarcopenia group were lower than those of patients in non-sarcopenia group, and the differences were all statistically significant (P<0.05). (2) In patients with cirrhosis and sarcopenia, upper arm circumference had a high diagnostic value, with the AUC=0.769 (95% CI: 0.676～0.861) and a cutoff value of 28.25 cm for men, and the AUC=0.789 (95% CI: 0.688～0.889) and a cutoff value of 29.50 cm for women. (3) In the AUC of CT imaging diagnostic evaluation indicators for liver cirrhosis with muscular dystrophy, the order from high to low is: PMI, psoas muscle area, APMI and axis diameter psoas muscle, which were 0.732 (95% CI 0.629～0.835), 0.694 (95% CI 0.587～0.802), 0.640(95% CI 0.522～0.757), and 0.611 (95% CI 0.494～0.727) for male; and 0.692 (95% CI 0.574～0.810), 0.685 (95% CI 0.571～0.799), 0.530 (95% CI 0.409～0.650), and 0.544 (95% CI 0.425～0.662) for female, respectively. The cutoff values of PMI were 7.41 cm2/m2 for male and 4.64 cm2/m2 for female.(4) The AUC of the psoas muscle index combined with upper arm circumference was higher with a value of 0.824 (95% CI 0.745～0.903) for male, and 0.833 (95% CI 0.745～0.921) for female. Conclusion The psoas muscle index can be used as one of the clinical evaluation tools in patients with cirrhosis and sarcopenia. The psoas muscle index combined with arm circumference has a higher diagnostic value.
    Analysis of etiology, clinical features and prognosis of hepatic myelopathy
    Sudbayan er Subuda, WU Xi-de, Udungova
    2025, 30(1):  74-77. 
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    Objective To explore the etiology, clinical features and prognosis of hepatic myelopathy (HM). Methods Forty-nine patients with liver cirrhosis admitted to Baotou Mongolian Traditional Chinese Medicine Hospital between April 2016 and May 2022 were divided into HM group (n=24) and non-HM group (n=25) according to the presence of HM. HM group was divided into improvement group (n=6) and non-improvement group (n=18) according to prognosis. The etiologies of HM patients and non-HM patients were compared and the clinical data of improvement group and non-improvement group were compared. Methods There was no significant difference when comparing the etiology of HM patients with that of non-HM patients. Hepatitis B was the most common cause of HM (54.2%). Comparing the clinical data of the patients in the improvement group and the non-improvement group, the CHE level and the proportion of Child-Pugh grade B in the improvement group were (3597.7±1194.5) U/L and 83.3% respectively, which were significantly higher than that of non-improvement group [(1953.8±863.4) U/L and 22.2%]. Conclusion Hepatitis B is the most common cause of HM, and decreased muscle strength is the most common clinical manifestation in patients with hepatic myelopathy. CHE level and Child-Pugh grade may reflect the prognosis of patients.
    Viral Hepatitis
    Risk factors associated with hypophosphatemia in chronic Hepatitis B patients treated with Entecavir of initial therapy
    WANG Liang, YU Yan-qing, WU Xiao-ping, MA Shi-peng, LIU Li-ping, CAI Tian-pan, LI Xiaopeng, GE Shan-fei
    2025, 30(1):  78-82. 
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    Objective To investigate the risk factors associated with hypophosphatemia and their dynamic changes in chronic Hepatitis B (CHB) patients treated with Entecavir of initial treatment. Methods 148 CHB patients treated with Entecavir of initial ireatment in the Department of infectious Diseases of the First Affiliated Hospital of Nanchang University from January 2020 to June 2023 were selected. Patients were divided into normal phosphorus group (n=131) and low phosphorus group (n=17) according to serum phosphorus. The Multivariate Cox regression analysis was performed to analyze the independent risk factors of hypophosphatemia in CHB patients. The efficacy of predicting hypophosphatemia in patients with CHB was evaluated with the receiver operating characteristic(ROC) curve. The cumulative incidence of hypophosphatemia was analyzed by Kaplan-Meier analysis and was compared by the Log-rank test. Spearman Correlation was used for correlative analysis. Serum phosphorus and estimated glomerular filtration rate (eGFR) were dynamically observed during treatment. Methods Of all 148 patients, 17 experienced hypophosphatemia, resulting in hypophosphatemia rate of 11.5%, The results of univariate analysis showed that sex and serum phosphorus at baseline were statistically significant (P<0.05) between the normal group and the low phosphorus group. The multivariate cox regression analysis showed that baseline serum phosphorus (HR=0.001, 95%CI: 0~0.021, P＜0.001) was an independent influencing factor for hypophosphatemia in CHB patients. The area under ROC curve of baseline serum phosphorus was 0.7786, indicating a good prediction efficiency. The optimal cut-off point was 1.03, and the sensitivity and specificity were 88.2% and 60.3% respectively. The cumulative incidence of hypophosphatemia in CHB patients with baseline serum phosphorus ≤ 1.03 mmol/L was significantly higher than that in patients with baseline serum phosphorus > 1.03 mmol/L(HR=81.79, 95%CI:4.127~28.550, P<0.001). There was no correlation between hypophosphatemia and eGFR (r=-0.084, P=0.749). For all patients with both hypophosphatemia and abnormal eGFR, hypophosphatemia occurs no earlier than eGFR abnormalities, occurring 0 to 1.17 years(median 0.58 years). The levels of blood phosphorus and eGFR in CHB patients showed a decreasing trend. The levels of serum phosphorus in hypophosphatemia group were always lower than those in normal group during follow-up. Conclusion For the CHB patients treated with entecavir of initial treatment, lower baseline phosphorus level are more likely to develop hypophosphatemia. Dynamic monitoring of serum phosphorus has great significance for the safe use of entecavir.
    Metabolic Dysfunction-Associated Steatotic Liver Disease
    Characteristics and correlation analysis of clinical indexes in patients with different degrees of lean non-alcoholic fatty liver disease
    SUN Pei-qi, YUAN Yi-fu, SHEN Hong-quan, LIU Qin-yi, JIANG Yuan-ye
    2025, 30(1):  83-86. 
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    Objective To analyze the characteristics of clinical indexes of leannon-alcoholic fatty liver disease (NAFLD) patients with different degrees of B-ultrasound, and to explore the differences among their clinical indicators. Methods From December 2019 to December 2022, 336 patients with lean NAFLD were selected from the outpatient department, inpatient department, and physical examination center of the Department of Gastroenterology in Putuo District Central Hospital, Shanghai. The patients were divided into mild group (n=119), moderate group (n=190) and severe group (n=27) according to the results of B-ultrasound and liver ultrasound grading diagnostic criteria.At the same time, we collect the clinical laboratory data of each patient, including B-ultrasound, blood routine, liver and kidney function, blood lipids, tumor indicators and other common clinical data for analysis. SPSS statistical software (version 26.0) was used to analyze the correlation of these indicators. Methods There were significant differences in the distribution of HCT(P=0.017),RDW(P=0.01),BASO(P=0.026),AKP(P=0.002),γ-GT(P<0.001),ALT(P<0.001),AST(P<0.001),FPG(P<0.001),LDL-C(P=0.006),TC(P=0.006),TG(P<0.001),APOB(P<0.001),CEA(P=0.002),AFP(P<0.001),CA211(P=0.017), and NSE(P=0.004) in NALFD patients with different degrees of B-ultrasound, and the differences were only statistically significant in mild and moderate groups. The distribution of other indicators was not statistically significant (P> 0.05). There was a significant correlation between the severity of B-ultrasound and RDW(r=0.159,P=0.004)、BASO(r=0.141,P=0.01)、AKP(r=0.145,P=0.008)、γ-GT(r=0.194,P<0.001)、ALT(r=0.236,P<0.001)、AST(r=0.215,P<0.001)、FPG(r=0.202,P<0.001)、LDL-C(r=0.149,P=0.006)、TC(r=0.158,P=0.004)、TG(r=0.202,P<0.001)、APOB(r=0.169,P=0.002)、CEA(r=0.125,P=0.022)、AFP(r=0.209,P=0.001)、CA211(r=0.152,P=0.005) and NSE(r=0.169,P=0.002) in patients with lean NALFD. The correlation of other indexes was not statistically significant (P>0.05). Conclusion Compared with mild lean NALFD patients, the laboratory indexes of moderate NAFLD patients are higher. These experimental indicators combined with B-ultrasonic grades can be used as an auxiliary tool for the diagnosis of the severity of mild lean NAFLD.
    The relationship between blood uric acid levels and the incidence and progression of non-alcoholic fatty liver disease in adolescent students
    DING Jian-bo, LI Li, LI Xiu-hui
    2025, 30(1):  87-90. 
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    Objective To study the levels of blood uric acid and alanine aminotransferase (ALT) in adolescent students with non-alcoholic fatty liver disease (NAFLD), and further explore the correlation between blood uric acid levels and the prevalence of NAFLD and ALT in adolescent students. Methods A retrospective analysis was conducted on the physical examination data of 312 adolescent students of a university in Beijing from 2017 to 2019. The prevalence of NAFLD was analyzed and the differences in ALT and uric acid levels between adolescent students with and without NAFLD were compared. And analyze the relationship between uric acid and NAFLD, as well as the correlation between uric acid and ALT. Methods In this study, the prevalence of NAFLD among adolescent students was 23.4%. The prevalence rate for males was 26.8%, for females was 18%, for underage adolescents was 25.6%, and for adult adolescents was 18.6% (P>0.05). The ALT levels in adolescent students with NAFLD have significantly increased (P<0.05). Adolescent students with NAFLD have significantly higher levels of uric acid compared to non NAFLD students (418.45 ± 77.65 μmol/L vs 357.35 ± 83.21 μmol/L). The prevalence of NAFLD in adolescent students with normal uric acid was 16.5%, and with hyperuricemia(>420 μmol/L)was 40.9% (P<0.05). Logistic regression analysis showed that uric acid was a risk factor for the occurrence of NAFLD (Odds ratio = 3.50), indicating that the adolescent students with hyperuricemia were 3.5 times more likely to develop NAFLD than those with normal uric acid, while other factors remain unchanged. Moreover, there was a significant positive correlation between uric acid and ALT. Conclusion Adolescent students with NAFLD have developed liver injury and elevated uric acid levels. Moreover, high uric acid is a risk factor for the occurrence of NAFLD, and as uric acid increases, liver damage will worsen to a certain extent.
    Protective effect of chitosan oligosaccharides on nonalcoholic fatty liver disease
    ZHAO Kang-tao, HUANG Wen-qi, Lin Ying-jun, SUN li, ZHAO Zuo-dou, HUANG Zong-xiu, WU Zhen-hong, ZHENG Li-hong, LIN Yun, HAN Yao-yue, LIN Xiu-fen
    2025, 30(1):  91-94. 
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    Objective To study the protective effect of chitosan oligosaccharides on mouse nonalcoholic fatty liver disease. Methods 75 KM mice were randomly divided into 5 groups. Three sample groups and the model group were given with a high-fat diet daily for 8 weeks, while the negative group was given ordinary diet consecutively. Three sample groups of mice were given different doses of samples by oral gavage for 30 days after nine weeks. The animals of the negative control group and the model control group were simultaneously given equal amounts of pure water. At the end of the experiment, the animals were weighed and fasted for 16 hours. On the 31st day, the animals were anesthetized and killed. Blood samples were collected. We performed anatomical observation and histopathology examination on the liver tissue. Simultaneously take some liver tissue homogenate and examine changes in levels of TG, GSH, MDA, TNF-α、TGF-β and IL-6 in it. Methods After administering different doses of chitosan oligosaccharides to mice by oral gavage for 30 days ,the level of AST, TGF-β and TNF-α (68.0±5.4 U/L, 62±5.0 pg/mL, 52±3.0 pg/mL)in liver tissue of medium dose group,and the level of TG(0.25±0.15 mmol/L), MDA(2.3±0.75 nmol/L), IL-6(2.8±0.3 pg/mL), ALT(35.5±2.7 U/L) in the liver tissue of high-dose groups are decreased(AST 89.5±9.4 U/L,TGF-β 75±4.2 pg/mL, TNF-α 60±5.3 pg/mL, TG 0.3±0.1 mmol/L)(P<0.05)compared with the model group, while the concentration of GSH in the medium and high-dose groups (Medium 2.0±0.4 μmol/gprot , High-dose 2.1±0.8 μmol/gprot) is increased (P<0.05) , the results of liver pathology examination showed that the distribution, range, and area of lipid droplets in the medium and high-dose groups were lower than those in the model control group (P<0.05). Conclusion Chitosan oligosaccharides display an auxiliary protective effect on non-alcoholic fatty liver disease.
    Establishment of an absolute risk prediction model for bone metabolism and osteoporosis in elderly patients with nonalcoholic fatty liver disease
    ZHU Shui-jin, WANG Hong, LAI Hua-Mei, SHEN Dan-dan
    2025, 30(1):  95-100. 
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    Objective To explore the method of establishing the absolute risk prediction model for elderly patients with non-alcoholic fatty liver disease (NAFLD) and osteoporosis (OP). Methods In this study, 240 patients with NAFLD admitted to our hospital from January 2020 to January 2023 were selected as the research objects, and 120 healthy people were selected as the control group. According to whether the patients were combined with OP, they were divided into the NAFLD group and the NAFLD combined OP group. Baseline data were collected. The absolute risk of nonalcoholic fatty liver disease with osteoporosis was calculated using decision tree and Gail absolute risk estimation, and the receiver operating characteristics (ROC) curve was generated using R software to identify the best cutoff value. Methods There were statistically significant differences in TG, PINP, β-CTX, BMD, GHb, OCN, and ALP among the three groups (P<0.05). Compared with the control group, the levels of PINP, β-CTX, BMD, and OCN in NAFLD group and NAFLD combined OP group were significantly reduced. The levels of TG, GHb, and ALP were significantly increased. Four variables, PINP, β-CTX, BMD, and OCN, were selected by the decision tree model as risk factors for NAFLD and OP. The 5-year risk and IQR of the control group were 2.4% and 0.132%, 23.1% and 0.255% in the NAFLD group, and 42.3%and 0.451% in the NAFLD combined OP group, respectively. The optimal cut-off value was 0.100%. The empirical set verifies that the AUC of this model is 0.826, the sensitivity is 81.25%, the specificity is 75.38%, the accuracy is 72.94%, and the accuracy is 78.36%. Conclusion This study established a prediction model of bone metabolism characteristics and absolute risk of osteoporosis in elderly patients with nonalcoholic fatty liver disease, enabling initial predictions of bone metabolism and osteoporosis risk, thereby providing guidance for disease treatment and intervention.
    Other Liver Diseases
    Clinical characteristics of 36 cases of Granulomatous Hepatitis
    HE Meng, HAN Xiao, ZHAO Xin-yan
    2025, 30(1):  101-106. 
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    Objective To summarize the clinical characteristics of Granulomatous Hepatitis (GH) to improve the awareness, diagnosis and management of the disease. Methods We retrospectively collected clinical data of 36 GH patients treated from January 2016 to March 2024 at Beijing Friendship Hospital, Capital Medical University. Subgroup analyses were conducted based on etiologies, spontaneous remission, prognosis, and relapse. Methods The median age of 36 GH patients was 51.0 years old, with a higher prevalence in females (Female∶Male, 1.25∶1). All patients had liver enzyme abnormalities; there are 14 cases of hepatocellular injury type (38.8%), 17 cases of cholestasis type (47.2%), and 5 cases of mixed type (13.8%). The median ALT is 137.50 (range 30.7-235.3) U/L, and the median ALP is 132.6(range 98.6-198.5) U/L. In subgroup analyses, drug-related(47.2%)and idiopathic(19.4%) etiologies were the most common causes of GH. Patients with drug-related GH had significantly higher ALT and AST levels compared to those with idiopathic GH and sarcoidosis (P<0.05). Granulomas were found in the portal areas (41.7%) or within the lobules (38.9%), with a minority (19.4%) of patients having granulomas present in both the portal areas and within the lobules. The predominant type of granuloma was non-necrotizing epithelioid granuloma (83.3%). All patients exhibited inflammation within the lobules, with the majority (83.3%) having varying degrees of inflammation in the portal areas. Most patients (61.1%) showed no signs of fibrosis, and the vast majority of patients (91.7%) had bile duct injury, with only one case showing bile duct loss. Patients treated with corticosteroids showed significantly higher ALP level compared to those with spontaneous remission (P=0.003). The ALP level demonstrated good predictive performance for spontaneous remission (AUC 0.796(95%CI 0.649-0.943). Conclusion GH is a rare chronic inflammatory liver disease, characterized by non-specific clinical manifestations and a variety of causes. Liver biopsy can help the diagnosis. Corticosteroid therapy is commonly used in patients with GH and results in a favorable prognosis for most patients.
    Clinical features and prognostic evaluation of 50 patients with acute severe autoimmune hepatitis
    SI Jin-mei, WANG Qian, CHEN Min, XU Xiao-guo, JI Hui-chun
    2025, 30(1):  107-111. 
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    Objective To analyze the clinical features and prognostic evaluation of 50 patients with acute severe autoimmune hepatitis. Methods A retrospective analysis was conducted on the clinical data of 50 patients with acute severe autoimmune hepatitis admitted to our hospital from January 2015 to January 2023. Their clinical characteristics were analyzed. After one month of hormone treatment, they were divided into a survival group (n=40) and a death group (n=10) based on the prognosis. The clinical characteristics of the two groups were compared, and logistic regression models were used to analyze the risk factors affecting the prognosis of patients with acute severe autoimmune hepatitis. Methods Among the 50 patients with acute severe autoimmune hepatitis, 38 (76.0%) were aged 30-60 years old, 46 (92.0%) were female, and 41 (82.0%) were positive for antinuclear antibodies, accompanied by changes in multiple laboratory indicators (decreased albumin, increased total bilirubin, alanine aminotransferase, aspartate aminotransferase, platelet count, white blood cell count, and immunoglobulin G). The histological manifestations were mainly lymphocyte infiltration, hepatic lobular necrosis, and liver fibrosis. Moreover, the mortality risk was elevated(10 cases, 20.0%). Model for end-stage liver disease (MELD) score, total bilirubin level, and white blood cell count in the death group [(25.8 ± 6.2) points, (393.5 ± 25.1) μmol/L, (5.8±1.3) × 109/L] were higher than those in the survival group [(19.4 ± 4.2) points, (242.6 ± 18.7) μmol/L, (3.9±0.7) × 109/L](P<0.05). Logistic regression analysis showed that MELD score, total bilirubin level, and white blood cell count were risk factors affecting the prognosis of patients with acute severe autoimmune hepatitis (OR=5.249, 5.191, 4.918, P<0.05). Conclusion Acute severe autoimmune hepatitis exhibits specific clinical characteristics, often occurring in middle-aged women, accompanied by changes in multiple laboratory examination indicators, positive anti nuclear antibodies, and histological manifestations mainly characterized by lymphocyte infiltration, liver lobular necrosis, and liver fibrosis. The mortality risk is high, and clinical outcomes can be predicted based on MELD scores, total bilirubin levels, and white blood cell counts.
    Clinical significance of changes in the number and subpopulations of placental macrophages in patients with intrahepatic cholestasis of pregnancy
    DAI Tao-fang, WU Xiao-rong, ZENG Li
    2025, 30(1):  112-116. 
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    Objective To analyze the clinical significance of changes in the number and subpopulations of placental macrophages in patients with intrahepatic cholestasis of pregnancy (ICP). Methods 105 ICP patients who were hospitalized and delivered in our hospital from May 2022 to July 2024 were selected and divided into a mild ICP group (n=51) and a severe ICP group (n=54); during the same period, 30 hospitalized healthy pregnant women were selected as the control group. Compare the total number of placental macrophages and subgroups of M1 and M2 macrophages, as well as the levels of IL-10, IL-4, IL-12, INF - γ, TNF - α, TBA, ALT, AST, and TBil in three groups. Methods The total macrophages, M1 subtype, and M2 subtype in the severe ICP group were (3.04 ± 0.87)%, (19.75 ± 5.73)%, and (81.84 ± 10.98)%, while in the mild ICP group they were (2.07 ± 0.54)%, (28.42 ± 7.65)%, and (72.11 ± 9.86)%. The control group had (0.32 ± 0.10)%, (46.55 ± 12.44)%, and (50.76 ± 8.57)%, respectively. There were statistically significant differences among the three groups (F=171.265, 100.055, 92.183, all P<0.05) There was no significant difference in IL-10 levels among the three groups (P>0.05); The levels of IL-4, IL-12, INF - γ, and TNF - α in the severe ICP group were (37.01 ± 10.35) pg/mL, (51.44 ± 8.51) pg/mL, (181.76 ± 15.64) pg/mL, and (108.35 ± 12.73) pg/mL, while those in the mild ICP group were (76.33 ± 19.32) pg/mL, (38.94 ± 7.63) pg/mL, (153.54 ± 12.65) pg/mL, and (84.53 ± 11.71) pg/mL. The control group had levels of (128.17 ± 22.54) pg/mL, (23.95 ± 6.42) pg/mL, (136.22 ± 11.73) pg/mL, and (62.34 ± 10.08) pg/mL. The differences were statistically significant (F=273.158, 122.976, 117.775, 152.725, all P<0.05). The TBA, AST, ALT, and TBil levels in the heavy ICP group were (83.54 ± 11.35) μmol/L, (198.76 ± 51.85) U/L, (347.95 ± 103.74) U/L, and (23.54 ± 3.11) μmol/L, while those in the light ICP group were (30.07 ± 5.23) μmol/L, (50.21 ± 11.38) U/L, (64.35 ± 18.26) U/L, and (11.72 ± 2.89) μmol/L. The control group had (14.15 ± 4.57) μmol/L, (28.93 ± 8.76) U/L, (30.17 ± 9.78) U/L, and (7.29 ± 1.32) μmol/L. The differences between the three groups were statistically significant (F=892.232, 349.851, 320.673, 420.008, all P<0.05). The levels of total macrophages, M2 subtype, IL-4, IL-12, INF-γ, and TNF-α were positively correlated with liver function in ICP patients (P<0.05); The M1 subtype and IL-4 levels were negatively correlated with liver function in ICP patients (P<0.05); There was no significant correlation between IL-10 levels and liver function in ICP patients (P>0.05). Conclusion There are abnormalities in the number and subpopulation differentiation of placental macrophages in ICP patients. Imbalance of M1/M2 macrophage subpopulations may cause damage to the maternal fetal interface immune microenvironment, resulting in disease onset and progression.
    Effectiveness of ultrasound-guided percutaneous transhepatic cholangiographic drainage for treating malignant obstructive jaundice and its influence on serum inflammatory markers
    YANG Zheng-fang, QI Jia-gao, BAI Yu, HE Xiao-fei
    2025, 30(1):  117-121. 
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    Objective To evaluate the effectiveness of ultrasound-guided percutaneous transhepatic cholangiographic drainage (PTCD) in patients with malignant obstructive jaundice. Methods Our research involved 96 patients diagnosed with malignant obstructive jaundice who were treated at our hospital from January 2020 to January 2024. They were divided into two groups of 48 participants each. One group received ERCP accompanied by stent insertion, and the other underwent ultrasound-guided PTCD. Perioperative indicators, treatment efficacy for low and high blockages, and pre- and post-operative levels of inflammatory markers and liver function markers were recorded and compared. Complications such as biliary infection, acute pancreatitis, bile leakage, and bleeding comparisons were also made between the groups. Methods The PTCD group exhibited prolonged surgery duration, increased intraoperative blood loss, longer time to ambulation, and lengthier hospital stay, with values of (79.8±7.6) min, (80.7±8.3) mL, (4.4±0.9) d, and (14.8±2.5) d, respectively, compared to the ERCP group [(70.2±7.3) min, (72.4±7.5) mL, (3.5±0.6) d, (10.2±2.1) d] (P<0.05). In the PTCD group, the effectiveness rate for treating high-level obstructions reached 95.2%, which was higher than that in the ERCP group (56.5%) (P<0.05). The overall treatment effectiveness rates were 79.2% for the PTCD group and 75.0% for the ERCP group (P>0.05). Postoperatively, the PTCD group showed higher levels of inflammatory markers and lower liver function indicators than the ERCP group. The incidence of complications was also lower in the PTCD group (8.3%) compared to the ERCP group (27.1%) (P<0.05). Conclusion Ultrasound-guided PTCD requires longer surgery and recovery times; however, it's beneficial in improving liver function and reducing complications in patients with malignant obstructive jaundice.
    Mechanism of HO-1 expression in hepatic sinusoidal endothelial cells promoting liver regeneration and reconstruction after ischemia-reperfusion injury in mice
    LI Peng-cheng, WANG Lu-bing, ZHU Rong-hua, GONG Qing-hao
    2025, 30(1):  122-127. 
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    Objective To investigate the mechanism of heme oxygenase-1 (HO-1) expression in hepatic sinusoidal endothelial cells promoting liver regeneration and reconstruction after ischemia-reperfusion injury in mice. Methods Sixty male mice were randomly divided into a sham surgery group, a model group, an empty vector group, and a HO-1 transfection group of 15 mice each. Except for the sham surgery group, which only underwent anesthesia and open surgery, the other three groups used the classic liver 70% warm ischemia method to establish a mouse model of liver ischemia-reperfusion injury. After reperfusion, the empty vector group was injected with 200 μL of empty vector virus transfected LSECs via the portal vein, while the HO-1 transfection group was injected with 200 μL of CD31 labeled 2×106/mL HO-1 transfected LSECs via the portal vein. Evaluate liver function indicators [alanine aminotransferase (ALT), aspartate aminotransferase (AST)], serum and liver tissue inflammatory factors [tumor necrosis factor] among different groups of mice- α (TNF- α), Interleukin-1 β (IL-1β), changes in levels of interleukin-6 (IL-6), oxidative stress factors (superoxide dismutase (SOD), malondialdehyde (MDA), hepatocyte growth factor (HGF), apoptotic proteins Bax, Bcl-2, Caspase-3, and nuclear factor E2 related factor 2 (Nrf2) and HO-1 protein expression in the Nrf2/HO-1 signaling pathway were observed in liver tissue. Pathological changes in liver tissue and liver cell apoptosis rate were also observed. Methods RT-PCR assay showed that the mRNA expression of HO-1 in lentivirus carrying HO-1 target gene was significantly higher than that in no-load group (P<0.05). ALT and AST levels in model group, no-load group and HO-1 transfection group were higher than those in sham operation group, while ALT and AST levels in HO-1 transfection group were lower than those in model group and no-load group (P<0.05). There was no difference between model group and no-load group (P>0.05). The levels of TNF-α, IL-1β, IL-6 and MDA in serum and liver tissue of model group, no-load group, and HO-1 transfection group were higher than those of sham operation group, and the level of SOD was decreased (P<0.05). The levels of TNF-α, IL-1β, IL-6 and MDA in serum and liver tissue of HO-1 transfection group were lower than those of model group and no-load group, and SOD was increased (P<0.05). There was no difference between model group and no-load group (P>0.05). The pathological changes and apoptosis rate of hepatocytes in model group, no-load group and HO-1 transfection group were higher than those in sham operation group, while those in HO-1 transfection group were lower than those in model group and no-load group (P<0.05). There was no difference between model group and no-load group (P>0.05). The levels of Bax and Caspase-3 in liver tissues of model group, no-load group, and HO-1 transfection group were higher than those of sham operation group, while HGF and Bcl-2 were decreased (P<0.05). The levels of Bax and Caspase-3 in liver tissue of HO-1 transfection group were lower than those of model group and no-load group, while HGF and Bcl-2 were increased (P<0.05). There was no difference between model group and no-load group (P>0.05). The levels of Nrf2 and HO-1 in liver tissue of model group, no-load group and HO-1 transfection group were lower than those of sham operation group (P<0.05), and the levels of Nrf2 and HO-1 in liver tissue of HO-1 transfection group were higher than those of model group and no-load group (P<0.05). There was no difference between model group and no-load group (P>0.05). Conclusion The transplanted HO-1-transfected LSECs with liver ischemia and reperfusion injury can reduce liver oxidative stress and inflammation, reduce hepatocyte apoptosis, promote liver regeneration and reconstruction, and restore liver function, and the mechanism may be related to the activation of Nrf 2/HO-1 signaling pathway.