Loading...

Table of Content

    31 May 2023, Volume 28 Issue 5
    Previous Issue    Next Issue
    Chronic Liver Disease
    Clinical characteristics of nephropathy in patients with chronic liver disease combined with chronic kidney disease
    KANG Wei-wei, LIU Li-wei, ZHANG Yuan, ZHONG Rui, FENG Li-li, CHEN Yu
    2023, 28(5):  518-522. 
    Asbtract ( 120 )   PDF (492KB) ( 102 )  
    References | Related Articles | Metrics
    Objective To investigate the clinical characteristics of chronic kidney disease (CKD) progression in patients with chronic liver disease combined with CKD.Methods Patients with chronic liver disease complicated with CKD admitted to our hospital from June 2020 to December 2021 were enrolled, they were divided into stage 1-2 group, stage 3 group and stage 4-5 group according to CKD staging. The clinical characteristics of patients in each group were compared. Logistic regression was used to analyze the risk factors for the progression of CKD to stage 4-5 in patients with chronic liver disease.Results A total of 65 patients with chronic liver disease complicated with CKD were included. With the progression of CKD staging, the levels of serum β2 microglobulin (CKD1-2 2.6 mg/L,CKD3 6.9 mg/L,CKD4-5 12.8 mg/L, P<0.001), urinary α1 microglobulin (CKD1-2 23.3 mg/L, CKD3 30.1 mg/L, CKD4-5 72.6 mg/L, P=0.001), urinary β2 microglobulin (CKD1-2 0.4 mg/L, CKD3 0.5 mg/L, CKD4-5 8.3 mg/L, P=0.005) increased significantly, while urinary creatinine (CKD1-2 8881 μmol/L, CKD3 5512 μmol/L, CKD4-5 4388 μmol/L, P<0.001) and urinary sodium (CKD1-2 111.4 mmol/L, CKD3 75.8 mmol/L, CKD4-5 73.2 mmol/L, P<0.001) decreased significantly. The resistance index of bilateral renal hilar artery (right CKD1-2 0.69,CKD3 0.77,CKD4-5 0.74, P=0.010, left CKD1-2 0.69, CKD3 0.76, CKD4-5 0.78, P=0.009) and segmental artery resistance index (right CKD1-2 0.66,CKD3 0.71,CKD4-5 0.72, P=0.034, left CKD1-2 0.66, CKD3 0.69, CKD4-5 0.73, P=0.027) also increased with the progression of CKD stage. Multivariate logistic regression analysis showed that higher blood retinol binding protein (OR 1.073, 95% CI 1.006-1.145; P=0.032) and serum β 2-microglobulin (OR 1.932, 95% CI 1.233-3.027; P=0.004) were independent risk factors for the progression of CKD4-5 in patients with chronic liver disease complicated with CKD.Conclusion Active monitoring of blood and urine biomarkers in patients with CKD in combination with chronic liver disease can help detect the progression of CKD in patients with chronic liver disease at an early stage and facilitate early intervention and prognosis improvement.
    Effect of plasma replacement combined with dual plasma adsorption mode artificial liver therapy on fibrinogen
    DAI Mei, SHEN You-shu, ZHAO Fei, XIAO Le-yao, YANG Ping, LUO Ya-wen
    2023, 28(5):  523-526. 
    Asbtract ( 173 )   PDF (430KB) ( 94 )  
    References | Related Articles | Metrics
    Objective To investigate the effect of plasma exchange (PE) and double plasma molecular adsorbent system (DPMAS) on fibrinogen in patients with chronic liver disease.Methods A totl of 58 patients with end-stage liver disease admitted to our hospital from January 2020 to may 2022 were selected as the research objects, among which 29 patients received PE treatment and 29 patients received PE+DPMAS treatment. Compare the changes of coagulation function (especially fibrinogen) and liver function indexes before and after treatment between the 2 groups, and the incidence of adverse reactions during treatment.Results The differences of fibrinogen, total bilirubin, absolute lymphocyte values, prealbumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), fractional albuminuria rate (FAR), and formyl peptide receptor (FPR) before and after treatment were statistically significant (P<0.05) before and after treatment in 2 groups, and the decrease in fibrinogen was more significant (1.76±0.62 vs 1.41±0.40, t=3.788, P<0.001) in the PE+DPMAS. Platelet levels in the PE+DPMAS group were significantly lower than those in the PE+DPMAS group (111.72±42.96 vs 93.69±48.33, t=2.753, P<0.05), but there was no statistically significant difference in platelet level changes after treatment in the PE group (95.97±47.73 vs 88.72±59.70, t=0.753, P>0.05), and there was no statistically significant difference in albumin before and after treatment between the 2 groups (P>0.05). There was no significant difference in the incidence of pruritus (10.3% vs 10.3%), rash (10.3% vs 3.4%), blood pressure, decreased heart rate (3.4% vs 0.0%), chills, bloating, and dyspnea (0.0% vs 6.9%) between the 2 groups during treatment (P>0.05).Conclusion Compared with PE model, PE+DPMAS artificial liver model has greater loss of fibrinogen, more significant reduction of platelet, and higher bleeding risk than PE model.
    Viral Hepatitis
    The risk of hepatitis attack and the clinical value of NAs intervention in pregnant women with HBV infection during pregnancy and postpartum
    LI Fen, WEI Shu-zhen, LI Liang, MO Yu-ling, FU Xiao-fan, LEI Ren-guo, ZHENG Zi-yu
    2023, 28(5):  527-529. 
    Asbtract ( 141 )   PDF (429KB) ( 84 )  
    References | Related Articles | Metrics
    Objective To investigate the risk of hepatitis during pregnancy and postpartum in pregnant women carrying chronic hepatitis B virus (HBV) and the value of nucleoside analogues (NAs) intervention.Methods A total of 300 pregnant women with HBV admitted to our hospital from January 2020 to January 2022 were enrolled in the study. The patients were divided into observation group (232 cases) and control group (68 cases) according to their willingness to be treated.The chitosanase 3-like protein 1 (CHI3L1) were tested at 6 weeks of gestation, alanine aminotransferase (ALT), HBV DNA and hepatitis B e antigen (HBeAg) were also tested at different time points. The control group received only hepatoprotective therapy, while the observation group was given long-term NAs intervention if hepatitis attack or CHI3L1>79 ng/ml [oral tenofovir at 300 mg/d once/d if hepatitis flares or CHI3L1 > 79 ng/mL; or oral tenofovir at 300 mg/d once/d from the 24th week of gestation if no hepatitis symptoms were present and discontinued after delivery]. The ALT level, HBV DNA negative rate, HBeAg negative rate and hepatitis attack rate were compared between the 2 groups at each time point.Results With the extension of NAs intervention time, the HBV DNA negative rate and HBeAg negative rate in the observation group were significantly increased, and all the indicators at 36 weeks of pregnancy were better than other time points [6 weeks of pregnancy (3.45%, 0.00%), 12 weeks of pregnancy (26.29%, 3.88%), 24 weeks of pregnancy (43.97%, 5.60%), and 36 weeks of pregnancy (70.26%, 7.76%)]. There was no difference in the control group at 6 weeks of gestation (4.41%, 0.00%), 12 weeks of pregnancy (8.82%, 4.41%), 24 weeks of pregnancy (11.76%, 7.35%), and 36 weeks of pregnancy (13.24%, 8.82%) (P>0.05%). The total rate of hepatitis attacks during pregnancy and postpartum in the observation group (21.55%) was significantly lower than that in the control group (73.53%), P<0.05.Conclusion Regardless of NAs intervention, HBV carriers have hepatitis attacks during pregnancy and postpartum, and the attack rate is higher at 6 weeks after delivery, while individualized NAs intervention during pregnancy and postpartum is effective in reducing the total hepatitis attack rate.
    Effect of direct antivirals on liver fibrosis in patients with persistently virologically responsive chronic hepatitis C
    YAN Jing-quan, LIU Juan, LU Xue-lan, LAN Yun-cui, LIN Zhan-zhou
    2023, 28(5):  530-533. 
    Asbtract ( 99 )   PDF (417KB) ( 78 )  
    References | Related Articles | Metrics
    Objective To investigate the effect of direct antiviral agents (DAAs) therapy on the improvement of liver fibrosis status in patients with chronic hepatitis C (CHC).Methods From January 2018 to December 2021, 104 patients (65 males and 39 female) with CHC were selected, including, aged (45.6±11.2) years. CHC diagnosis met the criterion and sustained virological response (SVR) was obtained. The changes of indexes of CHC patients before and after DAAs treatment were compared, and they were divided into chronic hepatitis, compensated cirrhosis and decompensated cirrhosis according to their liver disease status, and the changes of liver fibrosis indexes before and after treatment of three CHC liver diseases were compared. Logistic binary regression analysis was performed for univariate and multivariate analysis.Results The white blood cell (WBC), platelet (PLT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) of CHC patients before DAAs treatment were (5.0±1.2) × 109/L, (142.6±36.6) × 109/L, (62.0±13.7) U/L, (52.8±11.3) U/L and (21.5±5.2) μmol/L, which were significant from those after treatment [(5.3±1.5) × 109/L, (171.4±41.3) ×109/L, (18.2±3.8) U/L, (21.6±4.1) U/L and (16.1±4.7) μmol/L], (P<0.05). The aspartate aminotransferase/platelet ratio index (APRI), fibrosis-4 index (FIB-4) and liver stiffness measurement (LSM) of CHC patients before DAAs treatment were (1.2±0.4), (3.0±1.0) and (11.6±3.7) kPa, which were significantly higher than those after DAAS treatment [(0.4±0.1), (1.7±0.7) and (7.3 ±2.0) kPa, P < 0.05]. According to the medical history, examination indexes and imaging data, CHC patients were divided into chronic hepatitis (n=67), compensated cirrhosis (n=22) and decompensated cirrhosis (n=15). The changes of APRI and FIB-4 in chronic hepatitis, compensated cirrhosis and decompensated cirrhosis before and after treatment were (-0.4±0.1), (-1.4±0.5) and (-1.9±0.9); (-0.4±0.2), (-2.2±0.8) and (-4.0±1.7), and the differences were statistically significant (P<0.05). In addition, before and after treatment, the changes of LSM in the three groups were (-2.3±1.0) kPa, (-4.6±1.5) kPa and (-9.5±3.8) kPa, and the difference was statistically significant (P<0.05). Combined with information from previous literature, a >30% reduction in LSM test values in patients with chronic liver disease after treatment compared to pre-treatment was defined as LSM improvement. Taking whether LSM of CHC patients improved after DAAs treatment as the dependent variable (assignment 0 = no improvement, 1 = improvement), the indexes before treatment were analyzed by univariate analysis, and the results showed that ALT, AST and APRI before treatment were related to LSM improvement. Further multivariate analysis showed that ALT and AST before treatment were independent influencing factors of LSM improvement.Conclusion DAAs can effectively improve the degree of liver fibrosis in patients with CHC. Once HCV infection is diagnosed, anti-HCV treatment should be started as soon as possible to prevent the progression of the disease.
    Evaluation of clinical characteristics and prognosis in patients with chronic hepatitis C complicated with metabolic-related fatty liver disease
    FENG Wei-wei, KONG Yan, KANG Ru
    2023, 28(5):  534-536. 
    Asbtract ( 77 )   PDF (362KB) ( 98 )  
    References | Related Articles | Metrics
    Objective To investigate of the clinical characteristics and prognosis of patients with chronic hepatitis C (CHC) complicated with metabolic associated fatty liver disease (MAFLD).Methods A total of 354 patients (173 males and 181 females) with CHC from January 2014 to February 2022 in our hospital were selected, with an age of 44 (35, 53) years. Patients with CHC were divided into simple CHC group and MAFLD group according to whether they were combined with MAFLD. Univariate and multivariate analyses were performed to identify independent predictors associated with the degree of liver fibrosis in CHC combined with MAFLD.Results There were 225 cases in CHC group and 129 cases in MAFLD group respectively, and the incidence of MAFLD was 36.4%. Comparing the clinical data of the 2 groups, the number of men in the simple CHC group was 122 (54.2%), which was significantly higher than that in the MAFLD group [51 cases (39.5%), P<0.05]; The body mass index (BMI), aspartate aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglyceride (TG), HbA1c and HOMA-IR ofn simple CHC group were significantly lower than those of MAFLD group [25 (22, 29) kg/m2, 78 (44, 151) U/L, 54 (37, 152) U/L, 4.3 (3.7, 5.0) mmol, 0.9 (0.7, 1.3) mmol/L, 5.0 (4.8, 5.7) % and 1.7 (1.1, 3.1)] vs [27.5 (23, 32) kg/m2, 91 (54, 168) U/L, 70 (44, 114) U/L, 4.5 (3.8, 5.4) mmol/L, 1.1 (0.8, 1.7) mmol/L, 5.5 (5.0, 6.3) % and 3.4 (1.8, 5.5), P<0.05]. Compared with simple CHC group [1.3 (1.1, 1.8) mmol/L], high density lipoprotein (HDL) in MAFLD group was significantly lower [1.1 (0.9, 1.5) mmol/L, P<0.05]. The rates of diabetes mellitus and progressive liver fibrosis in simple CHC group were 3 cases (1.3%) and 30 cases (13.3%), which were significantly lower than those in MAFLD group [11 cases (8.5%) and 43 cases (33.3%), P<0.05]. The logistic univariate regression analysis showed that age, gender, BMI, diabetes mellitus and MAFLD may influence the degree of hepatic fibrosis in CHC (all P values<0.05). The Forward LR method was used to include age, gender, BMI, diabetes mellitus and MAFLD in logistic multi-factor regression analysis, and the results showed that age and MAFLD were independent risk factors for the development of progressive liver fibrosis in CHC patients [OR=1.05 (95% CI: 1.03~1.07), 2.45 (95% CI: 1.64~3.77), respectively, P<0.001], men were the protective factors [OR=0.52 (95% CI: 0.26 ~ 0.78), P=0.007].Conclusion CHC patients with combined MAFLD have a more severe state of liver fibrosis, and age and MAFLD are independent risk factors for the development of progressive liver fibrosis in CHC patients, while men is a protective factors.
    Influence of hepatitis E virus infection on the severity of chronic hepatitis C patients
    LIU Huang-cun, LI You-lei, LIU Yong-cheng
    2023, 28(5):  537-540. 
    Asbtract ( 85 )   PDF (338KB) ( 79 )  
    References | Related Articles | Metrics
    Objective To evaluate the prevalence of HEV infection in patients with chronic hepatitis C (CHC) and its influence on the severity and the incidence of liver fibrosis.Methods A total of 184 patients with CHC were collected from January 2016 to October 2021, including 86 males and 98 females, with an average age of 60 (31, 80) years old. Patients with CHC were divided into simple CHC group and HEV group according to whether they were infected with HEV. The general data and pathological results of the two groups of patients were compared.Results 22 cases (11.9%) of CHC patients were positive for anti-HEV-IgM, 3 cases (1.6%) were positive for anti-HEV-IgM, and 1 case (0.5%) was positive for both anti-HEV-IgM and anti-HEV-IgG. The infection rate of HEV was 14.1% (26/184). Compared with clinical data, the average age of simple CHC group was 60 (31, 70) years old, which was significantly lower than that of HEV group [66 (52, 80), P<0.05]. Compared with HEV group [14 cases (53.8%)], the proportion of diabetes in CHC group alone was significantly lower [33 cases (20.9%), P<0.05]; the PLT of simple CHC group was 182 (111, 304) ×109/L, which was significantly higher than that of HEV group [116 (70, 192) ×109/L, P<0.05]. The ALT and TBil in CHC group were 111 (81, 194) U/L and 124.2 (70.8, 255.5) μmol/L, which were lower than those in HEV group [163 (102, 321) U/L and 204.8 (110.6, 375.0) μmol/L, respectively. HA, pIIINP, c-IV and LN in CHC group were 126 (86, 190) ng/mL, 8.7 (6.0, 13.4) ng/mL, 118 (74, 168) ng/mL and 112 (93, 128) ng/mL, which were lower than those of 310 (178, 502) ng/mL, 24.4 (17.2, 27.0) ng/mL, 292 (144, 380) ng/mL and 130 (114, 175) ng/mL in the combined HEV group (P<0.05). The duration and course of jaundice in CHC group were 26 (18, 40) days and 26.5 (22.0, 33.5) months, which were significantly shorter than those in HEV group [38 (33, 52) days and 45.0 (38.5, 55.0) months, P<0.05].Conclusion In HCV infected patients, the positive rate of HEV serum is high, while the degree of liver fibrosis is higher and the clinical outcome is worse. HEV screening should be routinely carried out in HCV infected patients.
       
    Liver Fibrosis & Cirrhosis
    Prediction value of esophageal varices in patients with primary biliary cholangitis by two-dimensional shear wave elastography
    GONG Li, ZHANG Yun-jiang
    2023, 28(5):  541-543. 
    Asbtract ( 76 )   PDF (339KB) ( 81 )  
    References | Related Articles | Metrics
    Objective To investigate the predictive value of two-dimensional shear wave elastography (2D-SWE) for esophageal varices (EV) in patients with primary biliary cholangitis (PBC).Methods A total of 114 PBC patients (22 males and 92 females) admitted to our hospital from January 2014 to December 2021 were selected, aged 54 (48,63) years. PBC diagnosis meets the requirements. According to the guideline grading criteria, those with varicose veins >5 mm had a high risk of rupture and bleeding and were defined as high-risk EV group; those with <5 mm and no varicose veins were defined as low-risk EV group, comparing the data of the two groups and analyzing the diagnostic efficacy of liver stiffness measurement (LSM) on high-risk EV.Results There were 41 cases in the high-risk and 73 cases in the low-risk EV groups respectively. According to the comparative data, the ages of high-risk and low-risk EV groups were 60 (52, 66) years and 53 (47, 60) years, and the difference was statistically significant (P<0.05). The platelet (PLT), albumin (Alb), alanine aminotransferase (ALT) and prothrombin time (PT) in the high-risk EV group were 77 (50, 104) ×109/L, 38.0 (34.4, 41.2) g/L, 39 (24, 65) U/L and 12.4 (11.4, 13.5) s, which were significantly higher than those in the low-risk EV group [142 (91, 180) ×109/L, 44.4 (41.2, 46.8) g/L, 47 (30, 94) U/L and 11.0 (10.6, 12.0) s, P<0.05]. The Aspartate aminotransferase/platelet ratio index (APRI), fibrosis-4 index (FIB-4) and LSM of high-risk EV group were 1.8 (1.3, 2.5), 7.2 (4.5, 10.2) and 17.2 (13.1, 22.5) kPa, which were higher than those of low-risk EV group [1.1 (0.7, 1.7), 3.0 (1.6, 5.5) and 9.3(7.2, 12.1) kPa, P<0.05]. The value of APRI, FIB-4 and LSM of 14 PBC patients were 1.3 (0.7, 2.5), 4.1 (1.6, 9.8) and 13.2 (7.2, 21.6) kPa, respectively. Pearson correlation analysis showed that they were positively correlated with the EV degree of PBC patients (r=0.68, 0.54, and 0.38, respectively). The area under the curve (AUC) value, cutoff point, sensitivity and specificity of APRI, FIB-4 and LSM in diagnosing high-risk EV were [0.69, 1.4, 87.8% (36/41) and 42.5% (31/73)], [0.72, 4.6, 80.5% (33/41) and 63.0% (46/73)] and [0.87,13.2 kPa, 90.2% (37/41) and 75.3% (55/73)]. In the diagnosis of high-risk EV, the AUC values of LSM detected by 2D-SWE were significantly higher than those of APRI and FIB-4 (P<0.05).Conclusion 2D-SWE detection of LSM can effectively predict the occurrence of moderate to severe EV in PBC patients.
    An analysis on the efficacy and prognostic impact factors of postoperative primary suture of laparoscopic common bile duct exploration for the treatment of liver cirrhosis complicated with bile duct stones
    LIU Shuang, WU Ya-kun, LIU Yuan-jun, TIAN Yin-sheng
    2023, 28(5):  544-548. 
    Asbtract ( 190 )   PDF (473KB) ( 80 )  
    References | Related Articles | Metrics
    Objective To investigate the efficacy of primary suture after laparoscopic common bile duct exploration (LCBDE) in the treatment of liver cirrhosis complicated with bile duct stones and the impact factors on postoperative prognosis.Methods One hundred and twenty-four cases of liver cirrhosis complicated with bile duct stones who were operated in hepatobiliary surgery of Suining Central Hospital from March 2020 to March 2022 were analyzed retrospectively. According to the random number table method, all patients were divided into a control group (N=62 cases) and a study group (N=62 cases). LCBDE was performed in both groups. Patients in the control group were treated with T-tube drainage, and patients in the study group were primary sutured after operation. The perioperative indexes and postoperative complications of these two groups were observed. Pain visual analogue scale (VAS) score were obtained at 24 hours after operation. The influencing factors for postoperative prognosis were analyzed by logistic regression.Results When compared the patients in the control group with those in the study group, the intraoperative bleeding volumes were not statistically significant (P>0.05). The drainage times for patients in the study group (4.95±0.22 d) were longer than those of the control group (4.42±0.26 d) (P<0.05). The opertation times (90.16±8.12 min) and hospital stays (5.19±1.16 d) of patients in the study group were shorter than those of 99.2±9.14 min and 7.62±1.26 d, respectively, in the control group (P<0.05); The incidence of postoperative complications was 11.29% in the study group, which had no significant difference than that of 9.68% in the control group (P>0.05); The VAS score of the study group was lower than that of the control group (P<0.05). By univariate analysis it was showed that complicated with basic diseases, diameter of common bile duct, total number of cases operated by the chief surgeon, and T-tube drainage were the influencing factors for a poorer effect of primary suture after LCBDE (P<0.05), while gender, age, ASA score, neutrophil count, CRP and preoperative bilirubin level, bile duct suture mode and bile duct stone number were not the influencing factors (P>0.05). By logistic regression analysis it was showed that the combination of basic diseases, the diameter of common bile duct <1 cm, the number of cases operated by the chief surgeon< 28, and T-tube drainage were independent high-risk factors for poor primary suture effect after LCBDE (P<0.05).Conclusion Compared with T-tube drainage, one-stage suture after LCBDE has the advantages of a shorter operation time, less postoperative pain and a shorter hospital stay, without causing poor postoperative effect. Complicated with basic diseases, common bile duct diameter <1cm, operated cases < 28 by the chief surgeon, T-tube drainage were independent risk factors for a poorer primary suture outcome after LCBDE.
    Relationship between SHP2 expression and the activation and proliferation of hepatic stellate cells in liver tissues of rats with CCl4-induced liver fibrosis
    ZHANG Peng-lei, ZHANG Ming-ting, HAO Li-sen, JIN Li-min, PAN En-liang, HE Yu, MIAO Xiao-jia, WANG Wei
    2023, 28(5):  549-553. 
    Asbtract ( 86 )   PDF (6813KB) ( 85 )  
    References | Related Articles | Metrics
    Objective To explore the relationship between SH2 domain-containing protein tyrosine phosphatase 2 (SHP2)expression and the activation and proliferation of hepatic stellate cells (HSC)in liver tissues.Methods A liver fibrosis rat model was established by using CCl4 treatment. 50 healthy male SD rats were randomly divided into control group (10)and model group (40). Masson's trichrome staining and Hematoxylin and eosin (HE)staining were used to detect histological changes in liver tissues of rats. The expressions of SHP2 and alpha-smooth muscle action (α-SMA)in hepatic tissues of rats were analyzed through immunohistochemical staining. The expressions of SHP2 in HSC in vivo were analyzed through α-SMA and SHP2 immunofluorescence double-labeling.Results Compared with the integrated optical density (IOD)of α-SMA in the liver tissues of the control group (0.09±0.01), the IOD of α-SMA in the fibrotic liver tissues of rats at weekly time points (2, 4, 6, 8 weeks)during making model (0.13±0.01, 0.18±0.01, 0.24±0.02, 0.28±0.02)notably increased (P<0.05), and the more severe liver fibrosis, the higher α-SMA expression of hepatic tissues in rats (P<0.05). Since the α-SMA is a marker of activated HSC, the activation and proliferation of HSC in vivo gradually accelerated with the progress of liver fibrosis. Compared with the IOD of SHP2 in the liver tissues of the control group (0.19±0.01), the IOD of SHP2 in the fibrotic liver tissues of rats in the model group (0.23±0.01, 0.27±0.01, 0.30±0.01, 0.33±0.01)significantly increased (P<0.05), and the more severe liver fibrosis, the higher SHP2 expression in hepatic tissues of rats (P<0.05). The α-SMA and SHP2 immunofluorescence double-labeling showed that, at weekly time points (2, 4, 6, 8 weeks)during model formation, the percentage of activated HSC expressing SHP2 to the all activated HSC (54%±3%, 62%±2%, 73%±4%, 86%±3%)gradually heightened (P<0.05).Conclusion In rats with CCl4-induced liver fibrosis, the expressions of SHP2 in both liver tissues and HSC in vivo have an evident positive correlation with the activation and proliferation of HSC.
    Liver Cancer
    Effect of microwave ablation on serum levels of Golgi protein 73 and alpha fetoprotein in patients with primary liver cancer
    XU Zheng-ju, LIU Hui-guo, YAN Yan-yan, YE Qiao-xia, ZHANG Xiao-man, HUANG Jin-fa, LI Yong-fei, WU Jin-piao
    2023, 28(5):  554-558. 
    Asbtract ( 182 )   PDF (505KB) ( 87 )  
    References | Related Articles | Metrics
    Objective To observe the efficacy of microwave ablation (MWA) in the treatment of primary liver cancer (PLC) and its effect on serum levels of Golgi protein 73 (GP73) and alpha fetoprotein (AFP).Methods A total of 102 PLC patients with a single small lesion (≤ 3 cm in diameter) and elevated AFP were retrospectively enrolled between January 2016 and October 2018. All of the PLC patients received MWA. Serum GP73, alpha-fetoprotein (AFP), and liver biochemical tests [serum albumin (Alb), total bilirubin (TBil), alanine aminotransferase (ALT), and aspartate aminotransferase (AST)] were compared before MWA and at different time points post the ablation procedure. The efficacy of MWA was evaluated by enhanced MRI or CT follow-up for more than 3 years.Results Complete tumor ablation was achieved in 97 patients (95.10%) with PLC at one month after MWA. The overall survival rates of 1, 2 and 3 years after MWA were 100.00%, 97.06% and 89.22%, respectively. In terms of PLC recurrence, cumulative recurrence occurred in 47 cases (46.08%) at 3 years after MWA, including 9 cases (8.82%) with local tumor progression and 38 cases (37.25%) with new tumors. The disease-free survival rates at 1, 2 and 3 years after MWA were 74.51%, 58.82% and 53.92%, respectively. The serum AFP levels significantly decreased at 1, 2, and 4 weeks after MWA, and returned to the normal range at 12 weeks after MWA. On the contrary, the serum GP73 level increased significantly at 1 and 2 weeks after MWA, and reached the peak at 2 weeks after MWA. After hepato-protective treatment, the serum GP73 declined at 4 weeks after MWA, and returned to the pre-treatment level at 12 weeks after MWA. Liver biochemical indicators of TBil, ALT, and AST were increased significantly at 1 week after MWA. Notably, the changes of serum GP73 in response to MWA were similar to those of liver biochemical indicators (TBil, ALT and AST).Conclusion Serum GP73 increased significantly after MWA treatment for PLC. Therefore, serum GP73 holds potential as a biomarker for monitoring and assessment of MWA-mediated inflammatory injury in patients with PLC. AFP can be used as a monitoring index to evaluate the treatment efficacy of MWA and HCC recurrence after MWA. The normalization of AFP is closely associated with a complete tumor ablation.
    The application of three-dimensional reconstruction in the evaluation of vascular system of primary liver cancer before TACE intervention
    ZHU Ye-chen, GENG Cheng-jun, YIN Hui-kang, LI Ya-nan, FENG Quan-ye
    2023, 28(5):  559-563. 
    Asbtract ( 166 )   PDF (1575KB) ( 99 )  
    References | Related Articles | Metrics
    Objective To investigate the application value of maximum density projection (MIP) and volume reconstruction (VR) of three-dimentional (3D) reconstruction in vascular system evaluation of primary liver cancer (PLC) before transcatheter arterial chemoembolization (TACE).Methods A total of 72 PLC patients who underwent TACE treatment from January 2020 to January 2022 were selected and included in the study. All patients received multi-slice spiral computed tomography (MSCT) and angiography (DSA) examinations before treatment. The images obtained by MSCT were reconstructed by MIP and VR. Finally, the results of DSA were used as the gold standard to compare the grading of hepatic artery, extrahepatic artery, tumor feeding artery, tumor blood vessel, and portal vein in MIP, VR of 3D reconstruction and DSA.Results The display rates of MIP, VR and DSA in the results of grade 1 and grade 2 hepatic artery display were all 100%, and there was no significant difference in the number of displayed cases (χ2=0.000、0.000, P>0.05); Among the results of grade 3 hepatic artery display, 69 cases were shown by MIP (95.8%), 72 cases were shown by DSA (100.0%), which were significantly higher than that of 41 cases shown by VR (56.9%)(χ2=61.226, P<0.05). In the results of hepatic artery of grade 4 and above, 34 cases (47.2%) displayed by MIP, which were significantly higher than that of 13 cases (18.1%) displayed by VR, and 62 cases (81.6%) displayed by DSA, which were significantly higher than that of 34 cases (47.2%) displayed by MIP. (χ2=67.154, P<0.05). MIP showed celiac trunk in 72 cases (100.0%), superior mesentery in 67 cases (93.1%), splenic artery in 72 cases (100.0%), common hepatic artery in 72 cases (100.0%), gastroduodenal artery in 72 cases (100.0%) ), proper hepatic artery in 72 cases (100.0%), celiac trunk in 72 cases (100.0%), superior mesenteric in 67 cases (93.1%), splenic artery in 72 cases (100.0%), and common hepatic artery in 72 cases (100.0%), gastroduodenal artery in 72 cases (100.0%), proper hepatic artery in 72 cases (100.0%), DSA showed celiac trunk in 72 cases (100.0%), superior mesentery in 69 cases (95.8%), splenic artery in 72 cases (100.0%), common hepatic artery in 72 cases (100.0%), gastroduodenal artery in 72 cases (100.0%), and proper hepatic artery in 72 cases (100.0%), there was no significant difference in the number of cases among the three (χ2=24.376, P>0.05). MIP showed tumor feeding arteries in 70 cases (97.2%), VR showed tumor feeding arteries in 68 cases (94.4%), DSA showed tumor feeding arteries in 72 cases (100.0%), and there was no significant difference between the three cases (χ2=4.114, P>0.05); As the results of tumor blood vessel display, 63 cases (87.5%) displayed by MIP and 72 cases (100.0%) displayed by DSA, both were significantly higher than those of 26 cases (36.1%) displayed by VR(χ2=87.716, P<0.05). As for portal vein branches, MIP displayed 70 cases (97.2%) of grade 4 portal vein branches, 67 cases (93.1%) of grade 5 portal vein branches, 46 cases (63.9%) of grade 6 and above portal vein branches; VR displayed 66 cases (91.7%) of grade 4 portal vein branches, 63 cases (87.5%) of grade 5 portal vein branches, and 44 cases (61.1%) of grade 6 and above portal vein branches. There were no significant difference was found between the portal vein branches displayed by MIP and VR (χ2=0.004, P>0.05).Conclusion 3D reconstruction by MIP and VR in PLC patients before TACE treatment can intuitively and three-dimensionally display liver vascular system, which can provide basis for establishing optimised treatment regimes, as well as the follow-up plans post surgical treatment.
    Cox regression analysis of the factors affecting the prognosis of liver cancer patients after total caudate lobectomy
    MAO Zhen-zhou, LI Fan, ZHANG Zhe-zhe, FENG Yu, DU Bing-jie
    2023, 28(5):  564-567. 
    Asbtract ( 128 )   PDF (439KB) ( 91 )  
    References | Related Articles | Metrics
    Objective To explore the prognosis of liver cancer patients undergoing pure caudate lobectomy, and analyze the risk factors that affect the prognosis via multivariate COX regression models.Methods 200 patients with liver cancer who underwent total caudate lobectomy in our hospital from July 2019 to July 2020 were selected for clinical and follow-up studies. The follow-up period was from July 2020 to July 2021. The clinical characteristics of all patients were collected, including age, tumor diameter, tumor TNM stage, tumor envelope, tumor location, intrahepatic metastasis, blood metastasis, portal vein cancer thrombus, liver function Child-Pugh classification, smoking, drinking, antiviral Treatment, levels of serum alpha-fetoprotein, bilirubin, aspartate aminotransferase, and the expression of epidermal growth factor receptor. Univariate analysis and multivariate COX regression were used to analyze the factors affecting the prognosis of liver cancer patients after isolated caudate lobectomy.Results Tumor diameter ≥5 cm, without tumor envelope, tumor located at the left lobe, with intrahepatic metastasis and blood metastasis, with cancer-associated potal thrombus, without antiviral therapy, alpha-fetoprotein ≥400 ng/L, bilirubin ≥34.2 μmol, aspartate aminotransferase ≥80 U/L, and aspartate aminotransferase ≥80 U/L were associated with a lower survival rate. The 1 year,follow-up results showed that the average survival time of patients was (9.50±2.31) months, and the overall survival rate of 200 patients was 54.50%; multivariate COX regression analysis showed that the presence of cancer-associated thrombus in portal vein and alpha-fetoprotein ≥400 ng/L were prognostic risk factors(P<0.05).Conclusion The 1-year survival rate of patients with liver cancer undergoing isolated caudate lobectomy is low. Among them, the presence of portal vein tumor thrombus and abnormally increased expression of alpha-fetoprotein are risk factors that affect the patients’ prognosis. It is therefore necessary to address the aboval conditions, effectively monitor and treat the patients for achieving a better prognosis.
    Liver Failure
    The clinical features and prognostic determinates of patients with hepatitis B related acute-on-chronic liver failure complicated with hepatic encephalopathy
    CHEN Keng, LI Ping-hong, LI Yan-ling, YANG Ke-li, LIAO Bao-lin, LIU Hui-yuan
    2023, 28(5):  568-571. 
    Asbtract ( 110 )   PDF (559KB) ( 88 )  
    References | Related Articles | Metrics
    Objective To analysis the clinical characteristics and prognostic influencing factors of patients suffering from the hepatitis B-related acute-on-chronic liver failure complicated with hepatic encephalopathy.Methods Two hundred and thirty-four patients suffering from the hepatitis B virus related acute-on-chronic liver failure complicated with hepatic encephalopathy who were hospitalized in Guangzhou Eighth People’s Hospital, Guangzhou Medical University from January 2015 to December 2020 were enrolled in this study. They were divided into an improved group and a deteriorated/death group. The patients were retrospective analyzed with multiple logistic regression analysis for their clinical characteristics and prognostic influencing factors.Results There were statistically significant differences in the status of liver cirrhosis (with/without), the levels of total bilirubin, prothrombin time activity and serum sodium, the complication of peritonitis (with/without) between the patients of the improved group (71/33, 374.08±100.05 umol/L, 29.63±5.70 %, 135.75±6.46 mmol/L, and 49/55, respectively) and the deteriorated/death group (104/26, 410.55±136.41 umol/L, 23.82±10.87 %, 132.86±5.81 mmol/L, and 78/52, respectively) ( χ2/P=4.217 / 0.040, t/P=-2.357 / 0.019, t/P=5.258/0.000, t/P=3.592 / 0.000, χ2/P=3.865/0.049, respectively). whereas there was no significant difference in the prognosis of patients with or without artificial liver treatment (44/60 in the improved group, and 43/87 in the deteriorated/death group)(χ2/P=2.108/0.147 ). When compared the fatality rates of patients during hospitalization according to their phases of hepatic encephalopathy, there were significant differences among the patients with phases Ⅰ, Ⅱ, Ⅲ and Ⅳ encephalopathy (0, 3.41%, 12.31%, 65.91%, respectively)(χ2/P=94.291/0.000). With background of liver cirrhosis, significant abnormalities in the levels of total bilirubin, serum sodium and prothrombin time activity were independent risk factors for the prognosis of patients suffering from the hepatitis B related acute-on-chronic liver failure complicated with hepatic encephalopathy [OR(95%CI)=2.095(1.046-4.194), P=0.037; OR(95%CI)=1.003(1.000-1.005), P=0.039; OR(95%CI)= 0.911(0.867-0.958), P=0.000; OR(95%CI)= 0.921(0.888-0.955), P=0.000; respectively], and high serum sodium and high prothrombin time activity are the prognostic protective factors.Conclusion With liver cirrhosis background, significant abnormalities in total bilirubin, serum sodium and prothrombin time activity are the independent risk factors for the prognosis of patients suffering from the hepatitis B-related acute-on-chronic liver failure complicated with hepatic encephalopathy. Therefore, active interventions shoud be provided timely to patients with risk factors of poor prognosis for improving the successful rate of treatments.
    Other Liver Diseases
    Clinical and genetic features of an adult Wilson's disease characterized by elevated AFP
    LI Xuan, HUANG Yan, ZHAO Wei-feng, YANG Yong-feng, GAN Jian-he
    2023, 28(5):  572-575. 
    Asbtract ( 107 )   PDF (3242KB) ( 97 )  
    References | Related Articles | Metrics
    Objective To diagnose and report the clinical and genetic features of an adult hepatolenticular degeneration mainly manifested by elevated AFP.Methods The clinical data of the patients were collected, the pathogenic mutations of the patients were detected by exome capture and sequencing, and the spatial structure of the protein before and after the mutation was compared and analyzed.Results The patient was a 49-year-old middle-aged female with clinical manifestations of elevated AFP and pathological manifestations of adult hepatolenticular degeneration with hepatic steatosis. Gene analysis results showed that ATP7B gene mutations c.3316G>A and c.2333G>T were compound heterozygotes, and protein structure prediction analysis showed that the mutation c.2333G>T affected the localization and transportation of ATP7B protein in cells, which was a pathogenic mutation.Conclusion Clinical and genetic analysis confirmed the diagnosis of a rare case of adult hepatolenticular degeneration with elevated AFP as the main manifestation. Penicillamine treatment is effective, expanding the clinical manifestations and differential diagnosis of the disease.
    Analysis of risk factors for adverse pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy
    CHEN Wen-dan, HAN Feng-qiong, ZHANG Jin-feng, LIN yue, GUO Jun-hao, SONG Ai-feng, PAN Hai-yan
    2023, 28(5):  576-580. 
    Asbtract ( 92 )   PDF (480KB) ( 81 )  
    References | Related Articles | Metrics
    Objective To investigate the risk factors associated with the occurrence of adverse pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy (ICP).Methods Three hundred and sixty-five pregnant women with ICP who delivered at Shunde Women and Children's Hospital of Guangdong Medical Universityt, Foshan, Guangdong Province, from June 2019 to December 2021 were selected. Pregnant women with ICP were grouped according to whether they had adverse pregnancy outcomes, and the differences in clinical characteristics between the two groups were observed.Results Univariate analysis showed that time of ICP onset, age, total bile acid, direct bilirubin, glutamic oxalacetic transaminase, glutamic alanine transaminase, twin pregnancy, and embryo transfer were associated with adverse pregnancy outcome ( t/χ2=29.369、2.342、4.006、2.111、2.622、2.089、27.801、11.795,P＜0.05); maternal type, BMI, and gestational diabetes were not associated with adverse pregnancy outcome (t/χ2=0.193、0.517、1.321,P>0.05). logistic regression analysis showed that age(31.04±5.13year),total Bile acid (37.17±30.70μmol/L), femur length(64.88±6.52 mm),twin pregnancy, glutathione (34.51±46.37 U/L)and uric acid(369.69±117.78 μmol/L) were independent risk factors for adverse pregnancy outcome in pregnant women with ICP (P<0.05).Conclusion Age, total bile acids, femur length, twin pregnancy, glutathione and uric acid are high risk factors for adverse pregnancy outcomes in pregnant women with ICP.
    Clinical study of 125 iodine particle strip biliary cavity radiation combined with biliary stent implantation in the treatment of malignant obstructive jaundice
    LV Guan-hai, CHEN Rui-wen, WEI Qiang
    2023, 28(5):  581-584. 
    Asbtract ( 88 )   PDF (443KB) ( 89 )  
    References | Related Articles | Metrics
    Objective To study the clinical effect of 125 iodine particle strips combined with biliary stents in the treatment of malignant obstructive jaundice.Methods 56 patients with malignant obstructive jaundice from May 2017 to October 2021 were selected and divided into control group (15 cases) and study group (41 cases).In the two groups,the overall survival time, liver function, complications, clinical efficacy and stent patency time were compared.Results Direct bilirubin (DBIL),alanine aminotransferase (ALT),aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels of 4 weeks after surgery were lower than before surgery (P<0.05), but there were no differences in ALT, TBIL, DBIL and AST 4 weeks after surgery between the two groups (P>0.05). The clinical success rates of the study group and the control group were 95.12% and 93.33%, respectively, with no difference (P>0.05). The total complication rates of the control group and the study group were 13.33% and 14.63%, respectively, with no difference (P>0.05). The median stent patency time of the study group and the control group were 241 d and 147 d, respectively, and the study group with function of stent patency time was better than control group (P<0.05). The median survival time of the control group and the research group was 165 d and 253 d, respectively, and the study group with total survival function was better than control group (P<0.05).Conclusion Biliary stent implantation combined with biliary cavity radiotherapy with 125 iodine particle strips can prolong the overall survival time and stent patency time of patients with malignant obstructive jaundice, which is effective, improves liver function, and is safe and reliable.
    The diagnostic value of ultrasound E imaging and MR mDixon sequence in non-alcoholic fatty liver disease
    ZHONG Xian-feng, CHEN Gui'e, CHEN Yan-chan, HUANG Jian-yuan
    2023, 28(5):  585-589. 
    Asbtract ( 177 )   PDF (1673KB) ( 81 )  
    References | Related Articles | Metrics
    Objective To investigate the diagnostic value of ultrasound E imaging and MR mDixon sequence examination in nonalcoholic fatty liver disease (NAFLD).Methods 147 NAFLD patients (58 mild cases, 59 moderate cases, 30 severe cases) and 125 healthy subjects were diagnosed and treated in our hospital between January 2020 and June 2022, all patients underwent ultrasound E imaging and MR mDixon sequence examination to obtain liver young's modulus and fat content. Spearman correlation analysis was used to evaluate the correlation between the severity of NAFLD and liver young's modulus and fat content. Area under receiver operating characteristic curve (AUC) was used to evaluate the efficacy of young's modulus and fat content in the diagnosis of severe NAFLD.Results AST, ALT, ALP and TBIL in NAFLD patients were (19.62±5.54) IU/L, (27.82±7.10) IU/L, (70.57±7.90) IU/L and (40.72±11.34) μmol/L, respectively, higher than that in healthy subjects [(17.20±5.30) IU/L, (17.54±5.33) IU/L, (67.95±7.82) IU/L and (11.50±5.45) μmol/L, respectively, P<0.05]. AST, ALT, ALP and TBIL in patients with severe NAFLD were (24.64±5.21) IU/L, (30.24±4.00) IU/L, (75.33±10.60) IU/L and (47.43±11.20) μmol/L, respectively, higher than that of patients with moderate NAFLD [(20.50±5.71) IU/L, (29.00±4.87) IU/L, (70.50±10.61) IU/L and (42.56±9.40) μmol/L, respectively, P<0.05] and patients with mild NAFLD [(16.20±3.42) IU/L, (25.31±4.71) IU/L, (67.10±7.55) IU/L and (35.40±8.24) μmol/L, respectively, P<0.05]. Liver young's modulus and fat content in NAFLD patients were (5.30±1.52) kPa and (5.34±1.20) %, respectively, which were higher than those in healthy subjects [(3.04±1.22) kPa and (3.40±1.11) %, respectively, P<0.05)]. Liver Young's modulus and fat content in patients with severe NAFLD were (7.30±1.30) kPa and (6.80±1.23) %, respectively, which were higher than those in patients with moderate NAFLD [5.21±1.41) kPa and (5.50±1.14) %, respectively, P<0.05] and mild NAFLD patients [(4.30±1.32) kPa and (4.21±0.90) %, respectively, P<0.05]. Spearman correlation analysis showed that the severity of NAFLD was positively correlated with liver Young's modulus and fat content (r=0.680, 0.526, P=0.000, 0.000). ROC curve analysis showed that the AUC of young's modulus and fat content in liver in the diagnosis of severe NAFLD was 0.867 and 0.849 respectively, which was lower than that of 0.946 in the combined diagnosis of young's modulus and fat content (P<0.05).Conclusion Ultrasound E imaging and MR mDixon sequence examination can accurately measure young's modulus and fat content of liver, which has high efficacy in diagnosing the severity of NAFLD patients.
       
    The correlationship between Helicobacter pylori infection and autoimmune liver disease
    LI Qing-xin, YIN Qing, GUAN Ying-qi, SHAO Chun-hong
    2023, 28(5):  590-592. 
    Asbtract ( 154 )   PDF (422KB) ( 105 )  
    References | Related Articles | Metrics
    Objective To review the clinical data of AILD patients who were first diagnosed in our hospital and met the inclusion criteria, and to explore the influence of Hp infection on the occurrence and development of AILD.Methods From 2015.9 to 2022.2, 74 patients with AILD first diagnosed were reviewed, including 43 males and 31 females, aged (58.2±12.5) years. The diagnosis of AIH, PBC and PSC met the standard. 14C-UBT and gastric antrum rapid urokinase test were used to understand the Hp infection. The first diagnosed AILD cases in Liaocheng Traditional Chinese Medicine Hospital were divided into groups according to the status of Hp infection or not, and the liver function, autoantibodies, lymphocyte subsets and pathological changes of liver tissues in different groups were compared.Results Among 74 patients with AILD, AIH, PBC and PSC were 34 cases (45.9%), 33 cases (44.6%) and 7 cases (9.5%), respectively. According to the results of 14C-UBT, they were divided into Hp positive group (44 cases, 59.5%) and Hp negative group (30 cases, 40.5%) in this study. In Hp positive group, ANA, AMA, SMA, ANCA, AMA-M2 and LKM-1 were 20 cases (45.4%), 18 cases (40.9%), 17 cases (38.6%), 23 cases (52.2%), 25 cases (56.8%) and 21 cases (47.9%), which were significantly higher than those in Hp negative group [6 cases (20.0%), 4 cases (13.3%), 4 cases (13.3%), 5 cases (16.7%), 2 cases (6.7%) and 2 cases (6.7%), P<0.05]. The percentages of CD3+CD4+T cells, CD4+/CD8+ and CD3-CD19+B cells in Hp positive group were (42.1±6.2)%, (1.9±0.8) and (15.2±3.5)%, which were significantly higher than those in Hp negative group [(37.7±5.5)%, (1.4±0.5) and (11.9±2.5)%, respectively, P<0.05]. In Hp positive group, CD3+CD8+T cells and CD3-CD16+CD56+NK cells were (25.4±5.0)% and (11.7±2.8)% in this study, which were significantly lower than [(29.0±5.1)% and (19.7±3.7)% respectively, P<0.05]. The proportion of Hp positive group [30 cases (68.2%)] ≥F3 was significantly higher than that of Hp negative group [13 cases (43.3%), P<0.05], at the same time, the former [24 cases (54.6%)] ≥ G3 grade was higher than the latter [8 cases (26.7%), P<0.05].Conclusion More than half of AILD patients are infected with Hp, which is closely related to the increase of various autoantibodies and the disorder of lymphocyte subsets, which can lead to the increase of liver fibrosis stage and inflammatory activity grade.
    Correlation of CAR and CD4+/CD8+ levels with disease severity and prognosis in children with infectious mononucleosis complicated with liver damage
    DING Zhong-li, CUI Lei, CHU Kai-dong
    2023, 28(5):  593-598. 
    Asbtract ( 110 )   PDF (628KB) ( 77 )  
    References | Related Articles | Metrics
    Objective To investigate the clinical value of C-reactive protein (CRP)/albumin (CAR) and CD4+T cell /CD8+ T cell ratio (CD4+/CD8+) in evaluating the severity and prognosis of infectious mononucleosis (IM) complicated with liver damage.Methods 130 children with IM liver injury from July 2020 to March 2022 were selected, and their liver function examination was abnormal. They were divided into liver injury group (n=86) and non-liver injury group (n=34). According to the degree of liver damage, the children in the liver damage group were divided into mild liver damage group (n=34), moderate liver damage group (n=30) and severe liver damage group (n=22), and according to the peak load of EBV-DNA, they were divided into low load group (n=14), moderate load group (n=57) and high load group (n=15). Fifty children who received physical examination in our hospital during the same period were included in the health group. The expression levels of CAR and CD4+/CD8+ in each group were observed. Pearson analysis was conducted for correlation with TBA, IgM and APACHE II scores. Receiver operating characteristic curve (ROC) was plotted to analyze the evaluation efficacy of combined and separate tests.Results CAR of liver injury group was 0.83±0.21, higher than 0.62±0.14 and 0.35±0.09, CD4+/CD8+ of liver injury group was 0.85±0.31, lower than 1.04±0.36 and 1.32±0.45, respectively. The difference was statistically significant (F=24.387, 19.482, both P<0.05). In the observation group, CAR was 0.92±0.27 and 0.87±0.25 in the severe liver injury group and the high EBV DNA load group, which were higher than 0.84±0.22 and 0.71±0.16 in the moderate and mild groups, and 0.79±0.18 and 0.65±0.13 in the moderate and low load groups, respectively. CD4+/CD8+ was 0.89±0.31 and 0.78±0.29 in the severe and high load groups, lower than 1.07±0.38 and 1.23±0.43 in the moderate and mild load groups, and 1.13±0.42 and 1.25±0.51 in the medium and low load groups. The differences were statistically significant (F=15.296, 24.387, 28.453, 26.591, all P<0.05). CAR in the observation group was 0.83±0.21 in acute phase, higher than 0.54±0.13 in rehabilitation phase, CD4+/CD8+ was 1.06±0.37 in acute phase, lower than 1.28±0.42 in rehabilitation phase, the difference was statistically significant (t=8.265, 7.483, all P<0.05). Pearson showed that CAR was positively correlated with TBA, IgM and APACHE II scores, while CD4+/CD8+ was negatively correlated (P<0.01). ROC showed that the AUC of CAR and CD4+/CD8+ tests alone and in combination were 0.794, 0.758 and 0.916, respectively, and the combined detection efficiency was higher than that of any single test (P<0.01).Conclusion Serum CAR and CD4+/CD8+ levels were significantly correlated with the severity and prognosis of patients with IM liver injury, and combined detection was of high clinical value.