Table of Content

31 August 2025, Volume 30 Issue 8

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Viral Hepatitis

An analysis on the clinical characteristics and risk factors for the progression of liver failure in acute hepatitis E patients

ZHU Bi-lian, TANG Ying-mei, BAO Wei-min, LI Qin-nian

2025, 30(8):  1039-1045. 

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Objective To study on the clinical characteristics and prognosis of hepatitis E, and to explore the risk factors for its progression to liver failure. Methods The clinical data of 109 patients with acute hepatitis E were retrospectively analyzed. The patients were divided into an elderly group (n=37) and a non-elderly group (n=72) according to the patients′ age. Based on their comorbidities the patients were classified into an acute hepatitis E group (n=86) and an acute hepatitis E combined with other liver diseases group (n=23). The patients were further categorized into a liver failure group (n=23) and a non-liver failure group (n=86) based on whether they progressed to liver failure. The clinical characteristics, laboratory indicators, and treatment outcomes among the groups were compared. Results Within the 109 patients, 35 cases were cured, 61 cases improved. The peak values of alkaline phosphatase (ALP), total bilirubin (TBiL) and international normalized ratio (INR), the incidences of jaundice and complications of ascites and hepatic encephalopathy, the rate of liver failure, hospital stay duration, and the hospitalization costs of the elderly group were higher than those of the non-elderly group (P<0.05), whereas the levels of TCHOL (total cholesterol) and HDL-C (high-density lipoprotein cholesterol), valley value of Alb (albumin), and the cure rate of the elderly group were lower than those of the non-elderly group (P<0.05). There were no statistically significant differences between the two groups in terms of gender composition, other symptoms, the rates of other complication, the rates of improvement or inefficacy (P>0.05). In the group of patients with hepatitis E combined with other liver diseases, the peak values of TBiL, the peak values of PT (prothrombin time), the peak values of INR, the incidence of symptoms abdominal distension and fatigue, the incidence of complications ascites and hepatic encephalopathy, and the rate of liver failure were all higher than those of the hepatitis E group (P<0.05), whereas the valley value of Alb and the level of low-density lipprotein cholesterol (LDL-C) of patients in the hepatitis E combined with other liver diseases group were lower than those of the hepatitis E group (P<0.05). There were no statistically significant differences between the two groups in terms of gender composition, age distribution, hospital stay duration, hospitalization costs, cure rate, and improvement rate (P>0.05). In the liver failure group, the peak values of alanine aminotransferase (ALT), aspartate aminotransferase (AST), TBiL, PT, activated partial thromboplastin time (APTT), INR, globulin (GLO), and triglyceride (TG), the incidences of symptoms such as jaundice, abdominal distension, fatigue, poor appetite, skin itching and dark urine, the incidences of complications including hypoproteinemia, ascite, hepatic encephalopathy, hospitalization duration, hospitalization costs and improvement rates were all higher than those in the non-liver failure group (P<0.05), whereas the valley value of Alb, TCHOL and HDL-C levels, as well as the cure rate of patients in the liver failure group were lower when compared to those of the non-liver failure group. There were no statistically significant differences between the two groups in terms of gender composition, inefficacy, peak values of ALP, γ-glutamyl transpeptadase (GGT), creatinine (Cr), urea (Ur), and LDL-C (P>0.05). The indicators with statistically significant differences between the two groups were included in binary Logistic regression analysis, and the peak value of INR and TBiL were found to be independent risk factors for liver failure in patients with hepatitis E (P<0.05). Conclusion Elderly patients and those with hepatitis E combined with other liver diseases tend to have more severe conditions, with a higher incidence of ascites, complications such as hepatic encephalopathy, and liver failure. Therefore, it is important to enhance the screening and monitoring of hepatitis E in these two populations. Binary logistic regression analysis found that the peak values of INR and TBiL are independent risk factors for the progression of hepatitis E to liver failure.

The impact of medication intervention strategies during pregnancy on the prognosis of maternal and infant and the occurrence of postpartum hepatitis in hepatitis B infected patients

WANG Xing-zhen, LIU Kai-yan, WANG Xiao-yan

2025, 30(8):  1046-1050. 

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Objective To explore the effects of medication intervention strategies during pregnancy on the prognosis of maternal and infant and the occurrence of postpartum hepatitis in patients with hepatitis B viral infection during pregnancy. Methods A retrospective analysis was conducted on 102 pregnant women with hepatitis B viral (HBV) infection who were admitted to Nantong Third Affiliated Hospital of Nantong University from January 2018 to January 2023. Based on the duration of treatment intervention, the participants were categorized into an observation group consisting of 56 cases and a control group comprising 46 cases. On the second day after enrollment, the observation group began oral treatment with tenofovir. The control group started taking oral tenofovir treatment from 24 weeks of pregnancy. The serum level of alanine aminotransferase (ALT), peripheral blood HBV DNA load and the negative rate of hepatitis B e antigen (HBeAg) were compared between the two groups at each time point. The outcomes of pregnancy, neonatal HBV DNA positive infection rate, and postpartum hepatitis incidence rate in pregnant women were recorded. Results At 6 weeks, 12 weeks, and 24 weeks of pregnancy, the serum ALT and HBV DNA levels in the observation group were lower than those in the control group (all P<0.05). At 6 weeks postpartum, no statistically significant differences were observed in serum ALT and HBV DNA levels between the two groups (both P>0.05). At 6 weeks, 12 weeks, 24 weeks, 36 weeks of pregnancy, and 6 weeks postpartum, there was no statistically significant difference in the HBeAg seroconversion rates between the observation group and the control group [0.00%, 1.79%, 5.36%, 5.36%, 0.00% vs 0.00%, 0.00%, 0.00%, 2.17%, 0.00%] (all P>0.05). There was no statistically significant difference between the two groups in terms of preterm birth, premature rupture of membranes, postpartum hemorrhage, intrauterine distress, and hyperbilirubinemia (all P>0.05). The incidence of postpartum hepatitis in the observation group was 33.93%, which was lower than that in the control group (58.70%, P<0.05), and the positive infection rate of HBV DNA in newborns was lower than that in the control group (P<0.05). Conclusion Early initiation of antiviral therapy during pregnancy can help reduce maternal prenatal viral load, improve the blocking effect of mother to child transmission, and reduce the occurrence of postpartum hepatitis in mothers.

Liver Fibrosis & Cirrhosis

The risk factors and clinical model for predicting hepatic steatosis-related fibrosis in non-viral chronic liver diseases

JIA Jin-rui, ZHANG Jing, SHI Jia, ZHANG Wen-si, CHEN Shi-shi, YE Chen, CHEN Long, LU Yun-fei, YANG Zong-guo

2025, 30(8):  1051-1054. 

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Objective This study aims to evaluate the risk factors for hepatic steatosis-related fibrosis in non-viral chronic liver diseases, and further construct its clinical prediction model. Methods Clinical records and pathological data from non-viral chronic liver diseases were retrospectively collected. Logistic methods were used to identify the risk factors for hepatic steatosis-related fibrosis and construct a predictive model. The predictive values of this model were further calculated using OptimalCutpoints package in the R software. Results A Total of 153 cases were included in this study within which 19 (12.4%) patients developed hepatic steatosis-related fibrosis. Univariate and multivariate logistic regression analysis showed that liver stiffness measurement (LSM) and triglycerides were risk factors for hepatic steatosis-related fibrosis in non-viral chronic liver diseases (OR=1.09, 95% CI=1.03~1.15, P=0.002 and OR=6.17, 95% CI=1.29~29.48, P=0.023; respectively). A predictive Model =1.09 × LSM + 6.17 × triglycerides (abnormal, 1; normal, 0) was constructed. The optimal cut-off value of the Model is 10.79, with a sensitivity of 0.95, specificity of 0.54, positive predictive value of 0.23, and negative predictive value of 0.986. Compared with the LSM (AUC=0.71), this model has a higher predictive value (AUC=0.77) and shows a statistically significant trend (P=0.071). Conclusion LSM and serum triglycerides can be used to predict the occurrence of hepatic steatosis-related fibrosis in patients with non-viral chronic liver disease.

An analysis on the efficacy of bedside emergent endoscopic therapy for esophagogastric varices bleeding and the factors of rebleeding

XIA Zhuo-lin, CUI Yong-hui

2025, 30(8):  1055-1060. 

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Objective To evaluate the outcome of bedside urgent endoscopic treatment and risk factors for postoperative rebleeding in patients with moderate-to-severe esophagogastric variceal hemorrhage. Methods One hundred and sixty-eight patients with moderate-to-severe esophagogastric variceal bleeding who received bedside emergency endoscopic treatment in the intensive care unit (ICU) of Shangqiu First People′s Medical Hospital from June 2020 to June 2023 were retrospectively analyzed. The patients were divided into two groups according to the operative modality: 79 cases in the endoscopic sleeve treatment group (EVL group) and 89 cases in the endoscopic sleeve sequential tissue adhesive injection group (Combined group). The treatment efficacy and prognosis of different operative modalities were compared. Univariate and multivariate regression analyses were used to further explore the risk factors associated with postoperative rebleeding. Receiver operating characteristic (ROC) curves were drawn to evaluate their predictive value for rebleeding. Results In 168 patients enrolled in these studies, the rate of successful hemostasis by bedside emergency endoscopy was 94.60% (159/168), and the difference between the two commonly used endoscopic treatment procedures in terms of hemostasis success rate, hospitalization time, total effective rate of treatment, rebleeding rate at 1 month, 3 months, and 6 months post operation, and mortality rate was not significant when comparing the two types of endoscopic treatment procedures (P>0.05), The duration of hemostasis in patients in the EVL group (0.82±0.20) h was shorter than that in the combined group (0.89±0.25) h, with a significant difference in comparison between the groups (P<0.05); endoscopic follow-up revealed that 41 patients in the combined group developed postoperative deglutitional ulcers/bleeding, and the ulcers were deep and large; The rebleeding rate within 3 months after successful hemostasis by emergency endoscopy was 30.8% (49/159), and the results of univariate analysis showed that smoking, shock index, platelet (PLT), prothrombin time (PT), prothrombin activity (PTA), albumin (Alb), portal vein thrombus (PVT), ascites, hepatic encephalopathy, MELD-Na score, Child-pugh classification, and varicose vein score showed statistically significant differences between the two groups (P<0.05) , The results of multifactorial analysis showed that Child-pugh grade C [OR=6.030, 95% CI: 1.558~23.347, P=0.009], PVT [OR=4.388, 95% CI: 1.375~14.006, P=0.013] were the independent risk factors for rebleeding within 3 months after endoscopic sequential treatment, Alb [OR=0.820, 95% CI: 0.706~0.954, P=0.010], and PLT [OR=0.970, 95% CI: 0.951~0.989, P=0.003] were protective factors for rebleeding within 3 months; the area under the curve (AUC) of the four combined to predict rebleeding was 0.873 (95% CI:0.815 to 0.931), with a sensitivity of 73.50% and a specificity of 89.10%. Conclusion Bedside emergency endoscopy can effectively control acute bleeding in patients with moderate-to-severe esophagogastric varices in the intensive care unit (ICU); EVL and endoscopic combined treatment of acute esophagogastric variceal hemorrhage have comparable efficacy in the near future, EVL can obviously shorten the endoscopic hemostasis time and has a small postoperative vascular ulcer surface, which is warranted for further usage in patients with moderate-to-severe esophagogastric variceal bleeding who need emergency hemostasis in ICUs; Child-pugh Grade C, Alb, PLT, and PVT were all associated with rebleeding risk within 3 months after emergency endoscopic hemostasis, and the combination of all four was effective in predicting the risk of rebleeding after endoscopic sequential therapy.

The diagnostic value of serum insulin-like growth factor binding protein-7 levels in patients with hepatitis B-related cirrhosis complicated with acute kidney injury

MA Xiao-min, JIANG Ye-zhou, CHEN Guo-fei

2025, 30(8):  1061-1065. 

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Objective To evaluate the diagnostic value of serum insulin-like growth factor binding protein-7 (IGFBP-7) levels in patients with hepatitis B-related cirrhosis complicated by acute kidney injury (AKI). Methods The study included 132 patients with hepatitis B-related cirrhosis treated in Suzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2018 to January 2023. Patients who developed AKI were assigned to the observation group (n=40), while those without AKI constituted the control group (n=92). Basic data including gender, age, etiology and underlying diseases were collected from both groups of patients. Blood and urine samples were collected within 72 hours of enrollment to measure serum levels of total bilirubin (TBil), creatinine (Scr), blood urea nitrogen (BUN), cystatin C (CysC), and β2-microglobulin (β2-MG), as well as IGFBP-7 levels in both serum and urine. Logistic regression analysis was used to identify risk factors for AKI in patients with hepatitis B-related cirrhosis, and the diagnostic value of IGFBP-7 levels in serum and urine for assessing AKI was evaluated using Receiver operating characteristic (ROC) curve method. Results In the observation group, the levels of serum TBil, Scr, BUN, CysC, β2-MG, and IGFBP-7 were respectively 40.03 ± 6.32 μmol/L, 110.42 ± 23.36 μmol/L, 14.53 ± 3.23 mmol/L, 1.57 ± 0.42 mg/L, 2.77 ± 0.46 mg/L, and 12.12 ± 3.76 μg/L. The level of IGFBP-7 in urine was 28.09 ± 4.52 μg/L, all of which were higher than those in the control group (P< 0.05). Multifactorial analysis indicated that higher levels of Scr, BUN, CysC, and IGFBP-7 are associated with an increased risk of acute kidney injury (AKI) in patients (P<0.05). The ROC curve analysis revealed that the accuracy of serum IGFBP-7 in assessing the risk of AKI in patients with hepatitis B virus-induced cirrhosis was 0.857, which increased to 0.978 when combined with the measurement of urinary IGFBP-7 levels. Conclusion Elevated serum IGFBP-7 levels are closely related to the occurrence of AKI in patients with hepatitis B-related cirrhosis, and combined measurement of serum and urine IGFBP-7 levels provides higher diagnostic accuracy.

Risk factors of bacterial infection in patients with decompensated cirrhosis and the value of early diagnosis by inflammatory indicators

YU Bin-bin, WU Jun, LU Yi-jun, XIANG Qian

2025, 30(8):  1066-1070. 

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Objective To investigate the risk factors of bacterial infection in patients with decompensated cirrhosis and the value of early diagnosis by inflammation index. Methods A retrospective analysis was performed on 278 patients with decompensated cirrhosis admitted to our hospital from January 2022 to December 2023. According to whether the patients were accompanied by bacterial infection, they were divided into an infected group (102 cases) and a non-infected group (176 cases). The clinical characteristics of infection were analyzed. Multiple logistic regression was used to analyze the risk factors of decompensated cirrhosis complicated with bacterial infection. The value of white blood cell count (WBC), neutrophil to lymphocyte count ratio (NLR), C-reactive protein (CRP) and procalcitonin (PCT) in early diagnosis of decompensated cirrhosis complicated with bacterial infection was calculated by receiver operating characteristic curve (ROC). Results Decompensated cirrhosis is prone to complications of respiratory tract infection and spontaneous peritonitis, and the pathogenic bacteria are mainly Escherichia coli (36.8%) and Klebsiella pneumoniae (22.8%). Multivariate analysis suggests that diabetes mellitus, upper gastrointestinal hemorrhage, and Child-Pugh grade C are the risk factors of bacterial infection in cirrhosis patients. The clinical reference value for the diagnosis of decompensated cirrhosis complicated with bacterial infection was calculated by ROC curve: the clinical reference value of WBC was 6.25×10⁹/L (AUC=0.787, P<0.05, 95%CI 0.720~0.855), and the clinical reference value of NLR was 3.17 (AUC=0.706, P<0.05, 95%CI 0.631~0.781), the clinical reference value of CRP was 15.19 mg/L (AUC=0.621, P<0.05, 95%CI 0.536~0.707), and the clinical reference value of procalcitonin was 0.335ng/mL (AUC=0.835, P<0.05, 95%CI 0.774~0.895), the sensitivity and specificity of the combined diagnosis were 90.6% and 64.3%, respectively. Conclusion Patients with decompensated cirrhosis are prone to complicated with respiratory tract infection and spontaneous peritonitis, mainly caused by Escherichia coli and Klebsiella pneumoniae. Patients with cirrhosis combined with diabetes, upper gastrointestinal hemorrhage and Child-Pugh grade C are prone to bacterial infection. During clinical diagnosis and treatment, the WBC count, NLR, C-reactive protein, procalcitonin and other inflammatory indicators should be dynamically monitored for patients with decompensated cirrhosis with the abovel risk factors, so as to early detect and promptly treat potential infection and improve prognosis.

Predicting the risk of gastric variceal rupture in patients with hepatitis B-related cirrhosis by shear wave elastography and portal venous hemodynamics

LI Feng, NIU Na, WU Ying

2025, 30(8):  1071-1075. 

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Objective To investigate the application value of shear wave elastography (SWE) technology and portal vein hemodynamic parameters for predicting the risk of gastric varices (GV) rupture in patients with hepatitis B virus (HBV)-related cirrhosis. Methods A total of 81 patients with HBV-related cirrhosis admitted to Suzhou Hospital of Traditional Chinese and Western Medicine from August 2021 to May 2024 were selected as study subjects. Based on the classification system of the Japan Society for Portal Hypertension, patients were categorized into a high-risk group (n=18) and a low-risk group (n=63) according to their risk of GV rupture. All participants underwent color Doppler ultrasound and SWE to assess Child-Pugh classification, portal venous hemodynamics [portal vein diameter (PVD), portal venous flow volume (PVQ), splenic index (SI), portal venous velocity (PVV)], and spleen stiffness. The correlations between Child-Pugh classification and hemodynamic/spleen stiffness parameters were analyzed. Receiver operating characteristic (ROC) curves were generated to evaluate predictive performance. Results The high-risk group exhibited significantly higher proportions of Child-Pugh-B (44.44%) and Child-Pugh-C (38.89%) patients compared to that of the low-risk group (31.75% and 9.52%, respectively; χ²=13.190, P<0.05). Elevated PVD (1.62±0.09 cm vs. 1.41±0.07 cm), PVQ (1424.83±186.37 mL/min vs. 1320.95±171.19 mL/min), SI (77.29±8.12 cm² vs. 71.58±7.03 cm²), and spleen stiffness (16.36±3.18 kPa vs. 12.22±2.27 kPa) were observed in patients of the high-risk group (all P<0.05), whereas their PVV was reduced (10.49±1.37 cm/s vs. 13.84±1.52 cm/s, P<0.05). Child-Pugh classifications were positively correlated with PVD (r=0.303), PVQ (r=0.302), SI (r=0.361), and spleen stiffness (r=0.464), but negatively correlated with PVV (r=-0.311; all P<0.05). ROC analysis demonstrated superior predictive performance of the combined SWE-hemodynamic model (AUC=0.974, sensitivity=94.4%, specificity=98.4%). Conclusion The integration of SWE and portal venous hemodynamic parameters provides an effective noninvasive approach for stratifying GV rupture risk in patients with HBV-related cirrhosis, supporting its clinical utility in the risk assessment.

The application of quantitative ultrasound and GGT/PLT ratio in the evaluation of liver fibrosis in hepatitis B patients

WAN Pin-feng, ZHOU Shu-min, FANG Qun, LI Na

2025, 30(8):  1076-1079. 

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Objective To analyze the application value of quantitative ultrasound and gamma glutamyltransferase (GGT)/platelet count (PLT) ratio in the evaluation of liver fibrosis in hepatitis B patients. Methods The clinical data of 108 patients with hepatitis B and liver fibrosis treated from January 2021 to January 2024 were retrospectively analyzed. Based on the degree of liver fibrosis, the patients were divided into S1 stage group (n=28), S2 stage group (n=30), S3 stage group (n=28), and S4 stage group (n=22). The quantitative ultrasound parameters and serum test results of each group were compared. Spearman rank correlation analysis was used to examine the correlation between quantitative ultrasound parameters and serum test results in hepatitis B patients with liver fibrosis. Results The quantitative ultrasound parameters of the patients in S4 stage group were higher than those in S1, S2, and S3 stage groups. The quantitative ultrasound parameters of the patients in S3 stage group were higher than those in S1 and S2 stage groups, and the quantitative ultrasound parameters of the patients in S2 stage group were higher than those in S1 stage group (F=95.866, 76.567, 36.158, 25.092, P<0.05). The GGT level and GGT/PLT ratio of the patients in S4 stage group were higher, whereas PLT level was lower than those in S1, S2, and S3 stage groups. The GGT level and GGT/PLT ratio of patients in S3 stage group were higher, whereas the PLT level was lower than those in S1 and S2 stage groups. The GGT level and GGT/PLT ratio of patients in S2 stage group was higher than that of patients in S1 stage group (F=265.225, 352.658, 222.817, P<0.05). The result of corelation analysis showed that ultrasound quantitative parameters in patients with hepatitis B and liver fibrosis were positively correlated with serum GGT level and GGT/PLT ratio, and negatively correlated with PLT level (P<0.05). Conclusion The quantitative evaluation of ultrasound, GGT/PLT ratio, and the degree of liver fibrosis in hepatitis B patients are closely related. In clinical diagnosis and treatment, the above indicators can be combined to evaluate the severity of the patients’ condition.

Value of liver stiffness measured by acoustic radiation force impulse in predicting portal hypertension in patients with decompensated hepatitis B cirrhosis

MIAO Li, ZHU Min-min, LI Wei, WANG Xian

2025, 30(8):  1080-1083. 

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Objective To evaluate the diagnostic efficacy of liver stiffness (LS) measured by acoustic radiation force impulse (ARFI) in noninvasive prediction of portal hypertension (PH) in patients with decompensated hepatitis B cirrhosis. Methods Between April 2013 and June 2023, 74 patients with decompensated hepatitis B cirrhosis who received the measurement of hepatic venous pressure gradient (HVPG) and ARFI at the Second People′s Hospital of Lianyungang City from April 2013 to June 2023 were selected, including 53 males and 21 females, with an age of (56.0±13.2) years. According to the previous literature, the patients were divided into significant PH group (HVPG≥10 mmHg) and non-significant PH group (HVPG<10 mmHg). The clinical data of the two groups were compared, and the predictive efficacy of LSM, portal and splenic vein width and HVPG for significant PH and bleeding was analyzed. Results Among 74 patients, the significant and non-significant PH were 49 and 25 respectively. The ascites, WBC, INR, LSM, portal vein width, splenic vein width, HVPG and Child-Pugh score in the significant PH group were 16 cases (64.0%), (9.4±0.7) ×10⁹/L, (1.4±0.2), (2.3±0.7) m/s, (1.8±0.3) cm, (1.2±0.3), (12.7±2.0) mmHg and (7.3±1.7) points, which were significantly higher than those in the non-significant PH group [13 cases (26.5%), (5.9±0.5) ×10⁹/L, (1.1±0.3), (1.8±0.5) m/s, (1.5±0.3) cm, (0.9±0.2) cm and (8.9±1.1) mmHg, P<0.05]. After a six-month follow-up, 17 cases of 74 patients occured esophageal and gastric varices bleeding. LSM, width of portal and splenic vein and HVPG in the bleeding group were (2.4±0.8) m/s, (1.8±0.5) cm, (1.3±0.4) cm and (14.3±2.3) mmHg, which were significantly higher than those in the non-bleeding group [(1.7±0.7) m/s, (1.5±0.3) cm, (0.9±0.2) cm and (8.9±1.1) mmHg, P<0.05]. We respectively evaluated the diagnostic efficacy of the LSM, portal vein width, splenic vein width, and HVPG for significant PH using receiver operating characteristic (ROC) curve. The ROC curve showed that LSM, portal vein width and HVPG were ideal for diagnosis, and the area under the curve (AUC) of LSM was significantly higher than portal vein width and HVPG (P<0.05). Similarly, ROC curves were used to test the diagnostic efficacy of LSM, portal vein width, splenic vein width, and HVPG for bleeding (occurrence/non occurrence). The AUC value of LSM was significantly higher than the width of portal vein and HVPG (P<0.05). Conclusion In patients with decompensated cirrhosis, LSM detected by ARFI has certain value in the diagnosis of significant PH, which is worth popularizing in clinical practice.

The value of instantaneous elastic imaging to detect the hardness of liver and spleen combined with doppler ultrasound to detect the inner diameter of portal vein in assessing chronic hepatitis C liver fibrosis

YANG Yue-hua, FU Jin

2025, 30(8):  1084-1088. 

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Objective To investigate the clinical value of liver hardness (LSM) and spleen hardness (SSM) measured by transient elastography (TE) combined with portal vein diameter (PVD) measured by color Doppler ultrasound (CDUS) to detect the liver fibrosis in chronic hepatitis C (CHC). Methods Ninety-four patients with CHC admitted to the Ultrasound Department of Haian People′s Hospital from June 2021 to October 2023 were included in the observation group, and 70 healthy physical examination personnel were included in the control group during the same period. LSM and SSM values were detected by TE and PVD values were detected by CDUS in both groups. Fasting blood samples were collected to calculate the ratio of red blood cell distribution width to platelet count (RPR), liver fibrosis-4 factor index (FIB-4) and serum albumin-bilirubin (ALBI) levels. Patients in observation group underwent liver biospy under the guidance of CDUS, and liver fibrosis staging was performed according to Scheuer method. The levels of LSM, SSM and PVD in the observation group and the control group at different stages of liver fibrosis were compared. Pearson analysis was used to analyze the correlation between LSM, SSM and PVD and the levels of RPR, FIB-4 and ALBI in CHC patients. Receiver operating characteristic (ROC) curve were used to analyze the diagnostic efficacy of LSM, SSM, and PVD indicators alone and in combination for liver fibrosis staging in CHC patients. Results LSM, SSM and PVD in observation group were (10.28±2.09) kPa, (16.62±2.78) kPa and (12.85±2.03) mm, which were higher than those in control group (4.35±0.76) kPa, (7.47±1.26) kPa, (10.64±1.59) mm. The differences were statistically significant (t=8.215, 8.672, 6.538, all P<0.05). The LSM, SSM and PVD of CHC patients in S4 group were (17.95±2.26) kPa, (20.63±3.75) kPa and (14.27±2.63) mm, which were higher than those in S3 group (14.07±2.51) kPa, (18.50±3.06) kPa and (13.49±2.37) mm. They were (10.38±2.16) kPa, (14.59±2.67) kPa, (12.57±2.18) mm in S2 group and (6.72±1.34) kPa, (10.47±2.31) kPa, (11.36±1.84) mm in S1 group. In S0 group, there were (4.93±0.82) kPa, (8.26±1.45) kPa, (10.85±1.62) mm, and the differences were statistically significant (F=25.694, 18.357, 11.462, all P<0.05). Pearson analysis showed that LSM, SSM and PVD in CHC patients were positively correlated with APRI and FIB-4, and negatively correlated with ALBI (P<0.01). ROC curve showed that the AUC of LSM, SSM and PVD alone or in combination for diagnosing of liver fibrosis stage in CHC patients were 0.758, 0.769, 0.652 and 0.846, respectively, and the sensitivity and specificity of combined diagnosis were higher than that of any single efficacy (P<0.01). Conclusion The combined detection of LSM, SSM and PVD by TE and CDUS can reliably diagnose and evaluate the degree of liver fibrosis in CHC patients, which has high clinical application value.    

The value of Rh system D, C, c, E, e antigen-compatible transfusion in individualized transfusion therapy for liver cirrhosis patients with upper gastrointestinal bleeding

WANG Jian, LEI Jian-dong, XU Shi-man, WU Lin-jun

2025, 30(8):  1089-1092. 

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Objective To explore the value of compatibility transfusion based on Rh system antigens (D, C, c, E, e) in individualized transfusion therapy for liver cirrhosis patients with upper gastrointestinal bleeding (UGIB). Methods A total of 100 liver cirrhosis patients with UGIB requiring transfusion at Leshan Hospital of Traditional Chinese Medicine from March 2022 to February 2025 were selected and randomly divided into two groups (50 cases each) using a random number table. All patients underwent blood type identification and antibody screening before transfusion. The control group received conventional ABO blood type and RhD antigen testing, while the observation group underwent Rh system D, C, c, E, e antigen testing. Transfusion efficacy, crossmatch success rate, irregular antibody screening results, pre- and post-transfusion blood parameters [red blood cell count (RBC), hemoglobin (Hb), hematocrit (HCT)], and transfusion adverse reactions were compared. Results The crossmatch success rate in the observation group (96.00%) was higher than that in the control group (80.00%) (P<0.05), while no significant difference was observed in transfusion efficacy (94.00% vs. 86.00%, P>0.05). The observation group had lower rates of irregular antibody positivity (4.00% vs. 20.00%) and Rh system antibody positivity (2.00% vs. 16.00%) (P<0.05), with no difference in mixed-field reaction frequency (2.00% vs. 10.00%, P>0.05). Post-transfusion RBC, Hb, and HCT levels increased in both groups, with higher values in the observation group (P<0.05). No significant difference was found in transfusion adverse reactions (4.00% vs. 12.00%, P>0.05). Conclusion The application of Rh system D, C, c, E, and e antigen compatibility transfusion in personalized transfusion therapy for patients with cirrhosis and UGIB demonstrates significant efficacy. It effectively improves blood matching success rates, reduces the positive rate of irregular antibodies, enhances routine blood parameters, and does not significantly increase the incidence of adverse transfusion reactions.

Liver Cancer

Clinicopathological characteristics of early-onset hepatocellular carcinoma and its comparison with non-early-onset hepatocellular carcinoma

ZHU Ran, CHEN Shu-rao, ZOU Meng-qi, YANG Yu-feng

2025, 30(8):  1093-1096. 

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Objective To compare the clinicopathological features of HBV-related early-onset HCC(EO-HCC) and late-onset HCC(LO-HCC), and to clarify the clinical features of EO-HCC, so as to provide guidance for clinical management. Methods 113 HCC patients treated between June 2016 and December 2021 in Dongguan Songshan Lake Central Hospital were collected and divided into EO-HCC and LO-HCC. Traditional open radical resection of liver cancer was performed in the included cases, and TACE was performed in some cases according to the postoperative situation. During the 3-year follow-up, patients underwent regular CT/MRI examination and recorded the all-cause death or follow-up to the deadline as the end point. Breslow method was used to compare the overall survival rate between groups through K-M survival curve. Results There were 46 cases of EO-HCC and 67 cases of LO-HCC. The tumor diameters in EO-HCC group and LO-HCC group were (3.8±1.1) cm and (4.7±1.4) cm, and the difference was statistically significant (P<0.05). On the other hand, there were significant differences in T1/T2 and T3/T4 between EO-HCC and LO-HCC groups (P<0.05). The positive rates of MVI and AFP in EO-HCC patients were 22 cases (47.8%) and 24 cases (52.2%). which were significantly higher than those in LO-HCC [19 cases (28.3%) and 22 cases (32.8%), P<0.05]. We compared the difference of clinical outcomes between EO-HCC and LO-HCC using the K-M survival curve, there was no significant difference in the 1-year, 3-year and 5-year survival rates between EO-HCC and LO-HCC (P>0.05). Tumor stage (T3/T4 stage), tumor differentiation degree (low differentiation), MVI positive and postoperative TACE were independent factors affecting the prognosis of HCC. Among them, MVI positive was an independent risk factor for poor prognosis (P<0.05), while postoperative TACE was a protective factor (P<0.05). Conclusion EO-HCC is more likely to have increased AFP and positive MVI than LO-HCC, but the former has better tumor diameter and tumor differentiation. The overall clinical outcomes of EO-HCC and LO-HCC are similar. The COX regression analysis shows that MVI positive is an independent risk factor for poor prognosis of HCC, while postoperative TACE is a protective factor. EO-HCC needs active postoperative anti-tumor treatment.

Analysis of the relationship between miR-4262, miR-934 and clinical pathological characteristics and prognosis of primary liver cancer patients

LIU Jie, DONG Hao

2025, 30(8):  1097-1100. 

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Objective To investigate the relationship among miR-4262, miR-934 and the clinical pathological characteristics and prognosis of patients with primary liver cancer. Methods 50 patients with primary liver cancer who received treatment in our hospital from June 2019 to March 2021 were selected as the observation group, and 50 healthy individuals who underwent physical examinations during the same period were selected as the control group. Real time fluorescence quantitative PCR and differential analysis were used to detect the levels of miR-4262 and miR-934 in serum, liver cancer tissue, and adjacent tissues, respectively, and compare the differences between the two groups. The relationship between the expression of miR-4262 and miR-934 and clinicopathological features was analyzed. After a 3-year follow-up of primary liver cancer patients, the Kaplan Meier survival curves was plotted to analyze the relationship between miR-4262, miR-934 and survival time of primary liver cancer patients. Results The relative expression levels of miR-4262 and miR-934 in the serum of the observation group were 1.75 ± 0.13 and 2.47 ± 0.33, respectively, which were significantly higher than those of the control group (1.02 ± 0.02 and 1.13 ± 0.05, respectively), and the difference was statistically significant (P<0.05). The relative expression levels of miR-4262 and miR-934 in cancer tissues were 1.84 ± 0.21 and 2.52 ± 0.41, respectively, which were significantly higher than those in adjacent tissues of 0.97 ± 0.16 and 0.86 ± 0.32 (P<0.05). There were significant differences in the expression levels of miR-4262 and miR-934 among liver cancer patients in terms of lymphatic vessel metastasis, tumor staging, and vascular invasion (P<0.05). The three-year cumulative survival rate of patients with high expression of miR-4262 in liver cancer tissue was 33.33% (8/24), and 53.85% (14/26) of patients with significantly low expression (P<0.05). The three-year cumulative survival rate of miR-934 high expression patients was 37.04% (10/27), significantly lower than the 52.17% (12/23) of low expression patients (P<0.05. The results of multiple logistic regression analysis indicated that lymph node metastasis and vascular invasion were independent risk factors affecting the prognosis of patients. Conclusion MiR-4262 and miR-934 are closely related to lymph node metastasis and vascular invasion in patients with primary liver cancer, and have a certain prognostic value.

Observation of the efficacy of laparoscopic-assisted hemangioma debulking in the treatment of giant hepatic hemangioma and comparison with anatomical hepatectomy

CHEN Kang, MA Chang-huan, ZHOU Xiao, YANG Yan

2025, 30(8):  1101-1103. 

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Objective To analyze the efficacy of laparoscopic-assisted hemangioma debulking and anatomical hepatectomy in the treatment of giant hepatic hemangioma. Methods Sixty patients with giant hepatic hemangioma from January 2020 to December 2024 in Changzhou Maternal and Child Health Hospital were retrospectively collected and divided into control group (30 cases) and observation group (30 cases) according to treatment methods. The curative effect index, liver function, quality of life and complications were compared between the two groups. Results The observation group had a surgical time, blood loss, and abdominal drainage volume of (162.35±12.15) min, (504.23±15.14) mL, and (338.12±11.56) mL, respectively, which were significantly different from the control group [(146.02±11.47) min, (375.12±12.36) mL, and (227.45±10.15) mL, P<0.05]. At 2 months and 3 months post-surgery, the gastrointestinal quality of life index (GIQLI) scores of the observation group were (116.54±3.32) and (125.65±1.57), respectively, significantly higher than those of the control group [(102.35±2.24) and (112.23±1.26), P<0.05]. Conclusion Hemangioma stripping has a high curative effect on giant hepatic hemangioma, which can reduce the damage to liver function, improve the quality of life and have good safety.

The application of Gd-EOB-DTPA enhanced MRI and MDCT in the diagnosis of hepatitis B cirrhosis combined with small liver cancer

GE Qi, YIN Hui-kang, BAI Ling, YE Dai-xi

2025, 30(8):  1104-1107. 

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Objective To exploring the diagnostic value of specific contrast agent gadolinium oxalate disodium (Gd EOB DTPA) enhanced magnetic resonance imaging (MRI) and multi phase enhanced multi row spiral CT (MDCT) in the diagnosis of hepatitis B cirrhosis with small hepatocellular carcinoma (sHCC). Methods 80 patients with hepatitis B cirrhosis and sHCC who received treatment in The 904th Hospital of the Joint Logistics Support Force of PLA from December 2020 to December 2023 were selected as the study subjects. All patients underwent Gd-EOB-DTPA-MRI and MDCT scans after admission, with a scanning interval of less than 4 weeks, and the diagnostic value of the two techniques for sHCC was analyzed. Results A total of 99 lesions were detected in 80 sHCC patients. The number of lesions detected by Gd-EOB-DTPA-MRI was 99 (100%). The nodule volume was (3.52±0.79) cm³. The typical lesion detection rate was 97.98 (97/99). The number of lesions detected by MDCT was 87 (87.88%), the nodule volume was 2.86±0.71) cm³, and the typical lesion detection rate was 78.16 (68/87). The difference between the two groups was statistically significant (χ²=12.774, t=2.863, χ²=18.061; P<0.05). During the hepatobiliary phase of Gd-EOB-DTPA-MRI, there was 1 lesion with high enhancement (1.01%), 5 lesions with equal enhancement (5.05%), and 92 lesions with low enhancement (92.93%). During the arterial phase of MDCT, there were 80 lesions with high enhancement (91.95%), 7 lesions with equal enhancement (8.05%), and 0 lesions with low enhancement (0.00%). Gd EOB DTPA MRI examination revealed 17 lesions (17.17%) with no significant enhancement at the edge of the capsule, which was lower than MDCT (31 lesions, 35.63%) (χ²=8.242, P<0.05). Conclusion Compared with MDCT, Gd EOB DTPA-MRI improves the detection rate of sHCC in patients with hepatitis B and cirrhosis, which has good diagnostic value.

Other Liver Diseases

Etiological changes and clinical characteristics analysis of severe hepatitis in a tertiary hospital in the past 30 years

ZHANG Yan, ZHU Xiao-hong, LIANG Dong

2025, 30(8):  1108-1110. 

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Objective To retrospectively analyze the changes in the etiology of severe hepatitis patients in our hospital over the past 30 years, as well as the clinical characteristics and prognosis differences in different years and etiologies. Methods Clinical data of 821 patients with severe hepatitis admitted to our hospital from February 1995 to January 2024 were collected. They were divided into three groups (Group A, B, and C) based on their year of hospitalization, and their pathogenic factors, clinical types, and survival rates were compared and analyzed. Results Before 2015, the main etiology of severe hepatitis was hepatitis B virus infection, accounting for 71.6%. In the past 10 years, alcoholic, drug-induced, and immunological severe hepatitis were the most common, accounting for 30.9%, 24.2%, and 10.9%, respectively, with statistically significant differences (P<0.05). The pathogenic factors are different, and there are significant differences in clinical types. The main cause of HBV virus was chronic and acute severe hepatitis, accounting for 73.0%. Acute and subacute severe hepatitis were mainly caused by other viruses and drugs, accounting for 50.7% and 50.6%, respectively. Alcohol, immune, and metabolic factors were mostly manifested as chronic and acute severe hepatitis, accounting for 67.5%, 61.8%, and 44.8%, respectively, with statistical significance (P<0.05). Conclusion Over the past 30 years, the incidence of severe hepatitis has gradually decreased, and common pathogenic factors have shifted from viruses to alcohol, drugs, and immunity. With the diversification and updating of treatment methods, patient survival rates have been increasing year by year.

Study on the application value of AMA, anti-LC-1 antibody and IL-17 in the diagnosis of autoimmune hepatitis

ZHAN You-fang, JIANG Xiu-di, XU Zheng, WANG Peng

2025, 30(8):  1111-1114. 

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Objective To evaluate the clinical diagnostic value of combined detection of anti-mitochondrial antibody(AMA),Anti-lc-1 antibody and interleukin-17(IL-17) in autoimmune hepatitis. Methods The study included 50 healthy individuals who underwent physical examination at our hospital from January 2023 to January 2024 as the healthy group, and 50 patients with autoimmune hepatitis diagnosed at our hospital during the same period as the AIH group, 50 patients with viral hepatitis diagnosed at our hospital during the same period as the viral group.IL-17 index, the positive detection rate of AMA and anti-LC-1 antibody, the distribution and positive rate of AMA titer, and the detection rate of AMA karyotypes were compared among the three groups, and the levels of AMA, anti-LC-1 antibody and IL-17 were observed between the viral group and the immune group. The ROC curves of AMA, anti-LC-antibody-1 and IL-17 were evaluated separately and in combination. Results The levels of IL-17, direct bilirubin (DBIL), and total bilirubin (TBIL), aspartate aminotransferase (AST),alanine aminotransferase (ALT), alkaline phosphatase (ALP), γ-glutamyltransferase (GGT) in the AIH group were higher than those in the healthy group, while the white-to-red blood cell ratio was lower than that in the healthy group, with statistically significant differences (P<0.05). There was no significant difference in the levels of DBIL,TBIL,AST,ALT, ALP, GGT, and the ratio of white blood cells to red blood cells between the AIH group and the virus group (P>0.05). The IL-17 level in the immunized group was 29.1±3.5 pg/mL, the IL-17 level in the virus group was 18.3±3.1 pg/mL, and the IL-17 level in the healthy group was 13.5±2.1 pg/mL. The immunized group was significantly higher than the healthy group and the virus group, with statistically significant differences t=12.25, 11.64, P<0.05.The positive rate of AMA, anti-LC-1 antibody and related antibody combined detection in immune group was higher than that in healthy group and viral group, and the difference was statistically significant (P<0.05). The AUC of AMA for diagnosing autoimmune hepatitis was 0.774, with a 95% CI of 0.690~0.857; The AUC of anti-LC-1 antibody diagnosis was 0.57, with a 95% CI of 0.505~0.635; The AUC of IL-17 diagnosis was 0.83, with a 95% CI of 0.737~0.924; When the three indicators were jointly detected, the AUC was 0.958, and the 95% CI was 0.917~0.998. Conclusion This study demonstrates that combined detection of AMA, anti-LC-1 antibody, and IL-17 has high accuracy in the clinical diagnosis of autoimmune hepatitis, providing reliable data support for clinical practice and facilitating early detection and effective treatment of the disease.

Investigation and analysis of the occurrence of autoimmune hepatitis in the elderly population with Hashimoto′s thyroiditis, and related influencing factors

ZHANg Yu, YANG Fan, LIN Ben-rui

2025, 30(8):  1115-1119. 

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Objective To explore the occurrence and related influencing factors of autoimmune hepatitis (AIH) in the elderly population with Hashimoto′s thyroiditis (HT). Methods A total of 152 elderly patients with HT were enrolled from April 2020 to April 2023 in First Affiliated Hospital of Jinzhou Medical University, to investigate the incidence of HT combined with autoimmune hepatitis (AIH). Baseline demographic data of the patients was collected, and their serum levels of antinuclear antibodies (ANA), anti-mitochondrial antibodies, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, thyroid globulin antibody (TGAb), thyroid peroxidase antibody (TPOAb), immunoglobulin G (IgG), immunoglobulin M (IgM), and gamma globulin were tested. Based on whether elderly HT patients were combined with AIH, they were divided into combined group and non-combined group. The influencing factors for the occurrence of AIH in elderly HT population were screened, and a model for predicting the occurrence of AIH in elderly HT population was constructed and validated. Results Among the 152 patients, 28 cases were complicated with AIH, with an incidence rate of 18.42%. There was no statistically significant difference (P>0.05) in the levels of anti-mitochondrial antibodies, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, and IgM between the two groups of patients. The proportion of serum ANA positivity, TGAb, TPOAb, IgG, and gamma globulin in the combined group were 85.71%, (72.51 ± 16.92) IU/mL, (65.29 ± 13.08) IU/mL, (20.35 ± 4.09) g/L, (3.52 ± 0.91) g/L, and (26.83 ± 4.05)%, respectively, which were higher than those in the non-combined group [66.13%, (50.04 ± 15.31) IU/mL, (47.21 ± 12.64) IU/mL, (17.52 ± 3.91) g/L, (3.17 ± 0.84) g/L, and (21.31 ± 3.27)%, P<0.05]. ANA positivity, TGAb, TPOAb, IgG, and gamma globulin were identified as risk factors for the occurrence of AIH in elderly HT population (P<0.05). The sensitivity, specificity, and an area under the curve of the model for predicting the occurrence of AIH in elderly HT population were 0.844 (95% CI: 0.731~0.952), 0.813 (95% CI: 0.706~0.921), and 0.828 (95% CI: 0.721~0.936). Conclusion Elderly patients with HT have a higher incidence of AIH, and the occurrence of AIH is associated with the expression of ANA, TGAb, TPOAb, IgG, and gamma globulin.

The correlation study of MRCP on the morphology of the cystic duct in patients with bile duct stones

XIE Yi, WANG Guang-yong, TIAN Rui, JIA YANG Duo-ji, YU Fei-fei

2025, 30(8):  1120-1123. 

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Objective To classify the different shapes of the cystic duct using magnetic resonance cholangiopancreatography (MRCP) imaging and analyze the correlation with the incidence of different biliary stones. Methods Patients who underwent MRCP in our hospital from January 2023 to December 2023 due to gallstones were selected. The morphology of the cystic duct was observed through imaging, and it was classified into four types based on the degree of curvature and number of angles formed. The length of the cystic duct and the height of its confluence were recorded. Results By analyzing and summarizing the morphology of the cystic duct and the incidence of biliary stones in 362 patients with MRCP, a total of 79 cases were classified as type 1; 132 cases of type 2; 71 cases of type 3; 80 cases of type 4. The correlation coefficient between the morphology of the cystic duct and the complexity of the stone site is 0.580 (P<0.0001); The duration of the disease is positively correlated with the morphology of the cystic duct, with a correlation coefficient of 0.207 (P<0.0001); The length of the cystic duct is positively correlated with its morphology, with a correlation coefficient of 0.507 (P<0.0001). Previous acute attacks [OR=9.625, 95% CI (4.966, 18.655), P<0.0001], abdominal tenderness upon admission, concomitant cystic duct stone entrapment , duration of attacks, cystic duct length are all independent risk factors for complex cystic duct morphology. Conclusion The gallbladder and cystic duct exhibit diverse morphological variation in patients with bile duct stones. MRCP can accurately display the current anatomical variations of the cystic duct and has good diagnostic value for biliary diseases.

Analysis of survival prognosis and risk factors in patients with acute liver failure secondary to sepsis

LI Xing, YANG Jin, LU Sen, DENG Guo-lin, CHEN Ya

2025, 30(8):  1124-1128. 

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Objective To analyze the prognosis and risk factors of patients with acute liver failure secondary to sepsis. Methods A total of 152 patients with acute liver failure secondary to sepsis admitted to our hospital from February 2022 to March 2024 were selected as the research objects. The patients were followed up for 3 months, and were divided into survival group and death group according to whether the patients died. The clinical data of all patients [procalcitonin (PCT), serum total bilirubin (TBiL), alpha-fetoprotein (AFP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), etc.] were collected. Univariate analysis was used to analyze the related factors affecting survival prognosis, and multivariate Cox regression model was used to analyze the independent risk factors affecting survival prognosis. Results Thirty patients died within 3 months, and the mortality rate was 19.74% (30/152). Univariate analysis showed that, Hepatic encephalopathy, fungal infection, age, procalcitonin (PCT), total bilirubin (TBIL), albumin (ALB), model for end-stage liver disease (MELD), neutrophil/lymphocyte ratio (NLR), international normalized ratio (INR), platelet (PLT), sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APAC) HEⅡ) score were related factors affecting the survival prognosis (χ²/t=18.527, 27.136, 10.322, 25.489, 7.212, 3.078, 11.748, 5.350, 15.763, 6.574, 9.594, 7.411, all P<0.05). Cox multivariate analysis showed that fungal infection, PCT, TBiL, age, PLT, SOFA, APACHEⅡ score were independent risk factors affecting the survival prognosis (HR=5.109, 1.881, 4.039, 3.212, 6.862, 1.992, 7.683, all P<0.05). Conclusion The prognosis of patients with acute liver failure secondary to sepsis within 3 months is poor, and PCT, TBiL, fungi, PLT, age, SOFA, APACHEⅡ score are independent risk factors affecting the survival prognosis.

Prevalence, clinical characteristics and risk factors of drug-induced liver injury in hospitalized patients with brucellosis

CHEN Wen, FAN Jun-wei, ZHAO Peng

2025, 30(8):  1129-1132. 

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Objective To investigate the prevalence, demographic and clinical characteristics and risk factors related to drug-induced liver injury (DILI) in hospitalized patients with brucellosis during treatment. Methods The clinical data of 432 hospitalized patients with brucellosis between June 2019 and June 2024 were selected. Statistics of epidemic information and clinical manifestations of brucellosis; According the occurrence of DILI, the patients were divided into two groups: DILI group and non-DILI group. The clinical data of the two groups were compared and multivariate logistic regression analysis was exerted to explore the independent risk factors of DILI in brucellosis patients. Results Among the 432 cases of brucellosis, the age ranged from 18 to 76 years old, with 50 to 64 years old accounting for 42.1% (182/432). Cases occurred all year round, with summer cases accounting for 44.7% (193/432). 54.4% (235/432) patients were engaged in aquaculture; 72.7% (314/432) had definite animal contact experience. Fever is the most common symptom, accounting for 82.2% (355/432), and the temperature ranges from 37.5℃ to 41.9℃, which is more common in the afternoon and night. Other common clinical manifestations include chills 41.0% (177/432), low back pain 35.2% (152/432), night sweats 21.7% (94/432) and joint pain 17.1% (74/432). The prevalence rate of DILI in brucellosis patients was 14.6% (63/432). There were statistically significant differences in CRP and PCT between patients with and without DILI before and after treatment (P<0.05). Compared with the DILI group before treatment, WBC, CRP, ESR and PCT decreased significantly after treatment (P<0.05). Compared with non-DILI group, ALT, AST and LDL in the DILI group increased significantly before treatment (P<0.05). Compared with the non-DILI group before treatment, ALT, AST and LDL decreased significantly after treatment (P<0.05), but there was no significant difference compared with non-DILI group before treatment (P>0.05). Using DILI occurrence (unincorporated=0, combined=1) in brucellosis patients as the dependent variable, and the indicators of differences between unincorporated and combined DILI as the independent variable, CRP, PCT, ALT, AST and LDL were assigned (measured values) and multivariate logistic regression analysis was conducted. The results showed that CRP, PCT and LDL were independent risk factors for the occurrence of DILI in patients with brucellosis (P<0.05). Conclusion The proportion of patients with brucellosis complicated with DILI is common. CRP, PCT and LDL are important factors to predict the occurrence of DILI in patients with brucellosis.

Establishment and validation of a column chart model for individualized prediction of parenteral nutrition associated liver disease in elderly patients after gastrointestinal surgery

ZHANG Zao-chun,LEI Ping, SUN Zu-jian

2025, 30(8):  1133-1137. 

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Objective To construct and validate a column chart prediction model for postoperative parenteral nutrition (PN) associated liver disease(PNALD) in elderly gastrointestinal surgery patients. Methods The complete data were collected from 368 elderly postoperative PN patients in our hospital from March 2018 to March 2022. Patients were divided into two groups based on whether PN related liver injury occurred: the injury group and the control group. A column chart model was established based on data of 368 patients. Data from 158 patients from March 2022 to March 2024 were collected for external validation of the established model. The multi factor logistic regression model was used to analyze the influencing factors. The R3.6.3 software and RMS package were used to construct a column chart prediction model for PN related liver injury in elderly patients after gastrointestinal surgery. The discrimination and consistency of the column chart model ere evaluated using receiver operating characteristic (ROC) curves and calibration curves. Results The albumin (ALB)[(31.75±7.92)g/L] and prealbumin (PAB)[(128.73±32.56)mg/L] in the injury group were lower than those in the control group[(37.82±8.71)g/L、(175.96±38.71)mg/L], while urea nitrogen (BUN), serum creatinine (Scr), C-reactive protein (CRP), fasting time[(15.68±4.28)d], and PN time[(12.85±2.57)d] were higher than those in the control group[(11.04±2.63)d、(9.11±1.84)d] (P<0.05). Multivariate logistic regression showed that ALB(OR=0.910,95CI%=0.842~0.983), PAB(OR=0.951,95CI%=0.931~0.972), PN time(OR=2.225,95CI%=1.535~3.226), and fasting time(OR=1.725,95CI%=1.379~2.157) were all influencing factors of PN related liver injury (P<0.05). The column chart model showed that for every 1g/L decrease in ALB, the weight increased by 3.42 points; for every 10 mg/L decrease in PAB, the weight increased by 7.14 points; the weight increased by 7.81 points for every additional day of fasting time; the weight increased by 5.73 points for every 1-day increase in PN time. The H-L fit test showed a χ² of 8.129 and a P-value of 0.421, indicating good consistency. The area under the ROC curve was 0.881 (95% CI: 0.832~0.929), indicating good discrimination of the model. The external validation results showed good model consistency (χ²=5.586, P=0.694) and discriminability, with an AUC of 0.931 (95% CI: 0.893~0.969). Conclusion Alb, PAB, fasting time, and PN time are all influencing factors of PN-associated liver disease in elderly PN patients undergoing gastrointestinal surgery. The column chart risk prediction model established in this study has high practicality.

Effect of probiotics combined with intermittent blue light therapy on percutaneous bilirubin and immunoglobulin in neonates with hyperbilirubinemia

REN Xiao-tao, LI Yi, ZHENG Jie, ZHAI Meng

2025, 30(8):  1138-1141. 

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Objective To explore the effects of probiotics combined with intermittent blue light therapy on percutaneous bilirubin and immunoglobulin levels in neonates with hyperbilirubinemia. Methods A retrospective analysis was conducted on the clinical data of 123 newborns with hyperbilirubinemia admitted to Mianyang Maternal and Child Health Hospital from October 2022 to October 2023. According to different treatment methods, patients were divided into a control group(n=54) and a combination group(n=69). The control group received intermittent blue light therapy, while the combination group received probiotic bifidobacteria triple active powder combined with intermittent blue light therapy. The clinical efficacy, percutaneous bilirubin levels, T lymphocyte subsets, immunoglobulin (IgM, IgG) levels and total complication rate of hyperbilirubinemia neonates in two groups were compared. Results The effective rate in combination group (98.55%) was higher compared with control group (90.74%) (P<0.05). The transcutaneous bilirubin level in the combination group after treatment was (93.57±24.09)μmol/L, significantly lower than that in the control group (135.21±21.63) μmol/L, P<0.05]. The CD4⁺ levels and CD4⁺/CD8⁺ ratio in the combination group after treatment were (49.61±6.78)% and (2.05±0.54), respectively, which were significantly higher than those in the control group [(28.97±8.21)% and (0.98±0.32), respectively, P<0.05]. The IgM level in the combination group after treatment was (0.71±0.16) g/L, significantly higher than that in the control group (0.47±0.12) g/L, P<0.05]. The total complication rate in combined group was 1.45% (1/69), which was lower compared with control group (12.96%) (7/54) (χ²=4.846, P=0.028). Conclusion Probiotics combined with intermittent blue light therapy can improve the transcutaneous bilirubin levels and immune function of newborns with hyperbilirubinemia, with favorable safety.

Impact of ultrasound-guided percutaneous transhepatic cholangiography drainage on severity scoring and liver function in malignant obstructive jaundice

CHENG Xu, TIAN Zhi-jun, LI Kai

2025, 30(8):  1142-1146. 

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Objective To explore the impact of ultrasound-guided percutaneous transhepatic cholangiography drainage (PTCD) on severity scoring and liver function in patients with malignant obstructive jaundice (MOJ). Methods From February 2021 to November 2023, 76 MOJ patients were admitted to the Nuclear Industry 416 Hospital and randomly divided into two groups using the envelope drawing method: the ERCP group (n=38) and the PTCD group (n=38). The ERCP group received endoscopic retrograde cholangiopancreatography (ERCP) treatment, while the PTCD group underwent ultrasound-guided PTCD. Perioperative indicators, liver function, immune markers, severity scores, and complications were compared between the two groups before and after treatment. Results The surgery time (52.37±4.28 minutes), number of punctures (2.07±0.17 times), bile drainage volume (3.69±0.23 liters), effective catheterization time (12.52±1.09 days), and first ambulation time (3.15±0.26 days) of the PTCD group were all lower than those of the ERCP group (61.87±5.34 minutes, 4.26±0.33 times, 4.74±0.25 liters, 17.43±1.56 days, and 4.69±0.32 days, respectively) (P<0.05). After treatment, the levels of TBil (154.38±13.71 μmol/L), DBil (116.35±9.21 μmol/L), AST (87.44±6.82 IU/L), and GCT (89.44±7.67 IU/L) in the PTCD group were lower than those in the ERCP group (174.85±16.18 μmol/L, 134.82±11.03 μmol/L, 105.03±8.71 IU/L, and 112.03±10.32 IU/L, respectively) (P<0.05). The levels of IgA (2.63±0.26 g/L), IgM (10.56±1.05 g/L), IgG (12.33±1.20 g/L), CD4⁺ (39.22±4.07%), and CD4⁺/CD8⁺ (1.77±0.16) in the PTCD group were higher than those in the ERCP group (1.80±0.17 g/L, 7.97±0.80 g/L, 9.60±1.10 g/L, 35.41±3.70%, and 1.25±0.12, respectively), while CD8⁺ (22.33±2.46%) was lower than that in the ERCP group (26.41±2.77%) (P<0.05).The systemic inflammatory response syndrome (sSIRS) score (1.20±0.16), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score (6.83±0.42), and Sequential Organ Failure Assessment (SOFA) score (2.64±0.15) in the PTCD group were all lower than those in the ERCP group (1.78±0.27, 8.15±0.61, and 3.35±0.25, respectively) (P<0.05). There was no statistically significant difference in the complication rates between the ERCP and PTCD groups (13.2% vs. 10.5%) (P>0.05). Conclusion Ultrasound-guided PTCD has a positive effect on severity scoring and liver function in patients with MOJ.

Study on the optimal compression sensing acceleration factor for MRI image quality

WANG Yue-rong, LI Ke-ke, JING Hong

2025, 30(8):  1147-1150. 

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Objective To explore the optimal compression sensing (CS) acceleration factor for the image quality of magnetic resonance cholangiopancreatography (MRCP). Methods 60 patients underwent MRCP between October 2021 and October 2023 were retrospectively analyzed. Conventional 3D-MRCP and CS-3D-MRCP (CS18, CS24, CS32) were performed respectively, and objective image analysis was performed by Philips image post-processing workstation. Subjective image analysis was performed by two senior radiologists according to the five-point method. Kappa test was used to analyze the consistency of subjective evaluation results of image quality, and the display score and image sharpness of pancreaticobiliary duct were compared among the four groups, and the display situation and scanning time of pancreaticobiliary duct were compared among the four groups. Results The SD and SNR scores of CS32 group were (38.4±3.0) and (40.4±2.8), they were significantly lower than SENSE4 [(44.3±3.5), (43.9±3.2)], CS18 [(43.2±4.2), (44.5±4.0)] and CS24 [(43.0±3.1), (46.2±5.2)]. The CNR score of CS32 was (8.2±1.3), which was significantly higher than SENSE4 (7.4±1.4), CS18 (7.7±1.3), CS24 (7.8±1.0), respectively, the difference was statistically significant (P<0.05). There was no statistical difference in SD、SNR、CNR scores among SENSE4、CS18 and CS24 (P>0.05). The subjective scores of SENSE4, CS18, CS24 and CS32 of the two observers are consistent (Kappa=0.792, 0.719, 0.800, 0.734, P<0.05). The image sharpness, common bile duct, common hepatic duct, cystic duct, left hepatic duct and right hepatic duct in CS32 group were (3.01±0.70), (3.40±0.45), (3.30±0.53), (3.15±0.53), (2.76±0.65), (2.85±0.60), they were significantly lower than SENSE4 [(3.75±0.42), (3.80±0.35), (3.90±0.21), (3.75±0.43), (3.55±0.47) and (3.50±0 0.47)], CS18 [(3.70±0.48), (3.95±0.15), (3.85±0.33), (3.80±0.43), (3.45±0.49), (3.55±0.45)], CS24 [(3.65±0.44), (3.76±0.35), (3.85±0.35), (3.60±0.45), (3.45±0.48), (3.35±0.41)], the difference was statistically significant (P<0.05). There was no statistical difference between the last three groups (P>0.05). The scanning time of SENSE4, CS18, CS24 and CS32 groups is 186s, 23s, 14s and 12s, respectively. Conclusion Collecting MRCP image information with CS technology can shorten the scanning time on the premise of ensuring the imaging quality, with CS24 was identified as the best acceleration factor.

SEC62 exacerbates hepatocyte inflammation through its involvement in autophagy regulation in a murine model of paracetamol-induced liver injury

LIN Jun-chao, LIU Yu-tong, ZHOU wei, JIANG Wei, HE Jie

2025, 30(8):  1151-1155. 

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Objective To investigate the mechanism of SEC62 in mice model of liver injury induced by Acetaminophen (APAP). Methods 24 mice of SPF grade C57BL/6 strain were randomly divided into blank control group (n=8), SEC62-Hepko APAP group (n=8) and SEC62-Hepflpox APAP group (n=8). Eight SEC62-Hepko and SEC62-Hepflpox mice of SPF C57BL/6 strain were injected with APAP to establish APAP Induced Liver Injury (AILI). Mice in the blank control group were injected with normal saline intraperitoneally, and the liver tissue was collected 24 hours later, and pathological, immunohistochemical staining and flow cytometry of liver tissue were performed. Results Compared with blank control group, liver pathology of mice in SEC62-Hepflpox APAP group exhibited multiple inflammatory and necrotic area of different sizes. In the SEC62-Hepko APAP group, the number and area of inflammatory necrotic lesion in liver tissue decreased. Immunohistochemical oil red staining showed that the degree of oil red staining in liver of mice in SEC62-Hepflpox APAP group was higher than that in blank control group. The degree of oil red staining in liver tissue of SEC62-Hepko APAP group decreased. Western blot analysis showed that compared with control group, the expression level of autophagy related protein P62 in liver of SEC62-Hepflpox APAP group was significantly increased (P=0.0037). The expression levels of the proteins DRP-1 and FIS-1 associated with mitochondrial cleavage and the expression level of IL-1β, a protein associated with inflammation, was significantly increased (all P<0.05). Compared with those in SEC62-Hepflpox APAP group, the expression level of autophagy related protein P62 in liver of mice in SEC62-Hepko APAP group was significantly decreased , the expression levels of the proteins DRP-1 and FIS-1 associated with mitochondrial cleavage were significantly decreased ,and the expression level of IL-1β, a protein associated with inflammation, was significantly decreased (all P<0.05). Flow cytometry showed that ROS level in liver of mice in SEC62-Hepflpox APAP group was significantly increased compared with blank control group (P<0.001). In the liver tissues of mice in SEC62-Hepko APAP group, the level of ROS in the liver of mice was significantly decreased compared with that in SEC62-Hepflpox APAP group (P<0.001). Conclusion SEC62 can affect mitochondrial homeostasis and inflammation in liver by mediating autophagy level. SEC62 knockout in hepatocytes can improve and protect the liver injury induced by APAP.