Table of Content

30 September 2023, Volume 28 Issue 9

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Liver Failure

The application of low molecular heparin in the treatment of liver failure patients with non-biological artificial liver system

TANG Ru-jia, HU Yan-ming, YAO Hong-yu, XING Han-qian, ZHOU Xia, WANG Kai-li, LIU Hong-ling, ZHAO Jun

2023, 28(9):  1024-1027. 

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Objective To observe the anticoagulation effect and safety of low molecular heparin (LMWH) in liver failure patients treated with artificial liver system.Methods A total of 161 liver failure patients treated with dual plasma molecular adsorption system (DPMAS) combined with plasma exchange (PE) from June 2021 to June 2022 were selected. They were divided into a well-anticoagulated group, an under-anticoagulated group, and an over-anticoagulated group based on the anticoagulant effect of LMWH during treatment. The proportion of patients with good anticoagulation in different LMWH dose groups and the baseline levels of patients in the three groups were compared. Results Of the 81 patients, 65 were male, with a mean age of 54.55 years and 41 were hepatitis B virus (HBV) infected. A total of 161 DPMAS combined with PE treatments were performed and all were successfully completed. Among them, 131 were in the good anticoagulation group, 9 in the insufficient anticoagulation group and 21 in the over-anticoagulation group. There were no significant differences in gender, age, baseline level of total bilirubin (TBil) and albumin (Alb) among the three groups (P values were 0.712, 0.658, 0.079 and 0.057, respectively). When prothrombin avtivity (PTA)>30% and platelet (PLT) > 40×10⁹/L, the proportion of LMWH with good anticoagulative effect was > 83%; hemoblobin (HB) and PLT levels were significantly higher in patients in the under-anticoagulated group than in the well-anticoagulated group (all P values were 0.000); compared with the well-anticoagulated group, patients in the over-anticoagulated group had significantly lower PTA and HB and higher international normalized ratio (INR) values (P values were 0.000, 0.000 and 0.027). Within 24 hours prior the end of treatment, 18 patients experienced blood leakage from the central venous line and 3 experienced gingival bleeding, but no other serious complications such as gastrointestinal bleeding occurred. Conclusion When patients with early liver failure and good PLT levels are treated with DPMAS+PE, different doses of LMWH should be given according to the pre-treatment PTA and PLT levels, and the effect of HB on anticoagulation should also be considered.

Efficacy analysis of three different modes of non-bioartificial liver in the treatment of liver failure

NIU Dan, LI Bo-ling, ZONG Yuan

2023, 28(9):  1028-1036. 

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Objective To observe the efficacy of three different modes of non-bioartificial liver, which are dual plasma molecular adsorption (DPMAS), plasmapheresis (PE), and dual plasma molecular adsorption combined with low volume plasmapheresis (DPMAS+LPE) three different modes of non-bioartificial liver in the treatment of liver failure: dual plasma molecular adsorption (DPMAS) plasmapheresis (PE) and dual plasma molecular adsorption combined with low volume plasmapheresis (DPMAS+LPE).Methods A total of 109 patients with liver failure treated with non-bioartificial liver were selected as the research objects, and their clinical data were retrospectively collected. According to the different modes of artificial liver supporting system that they received for treatments, the patientsy were divided into three groups: dual plasma molecular adsorption (DPMAS) group, plasma exchange (PE) group, and dual plasma molecular adsorption combined with low volume plasma exchange (DPMAS+LPE) group. To compare tThe efficacy of artificial liver therapy in 3 groups of patients were compared. Results Total bilirubin (TBil) (284.65±89.90, 218.10±73.7, t=6.345; 256.73±98.53, 194.41±89.91, t=9.374; 245.63±60.75, 176.26±49.72, t=9.413, all P=0.0001), direct bilirubin (DBil) (195.52±86.36, 152.97±69.22, t=5.297; 182.81±86.03, 113.42±64.74, t=5.630; 170.56±46.22, 125.64±41.38, t=8.107, all P=0.0001) and alanine aminotransferase (ALT) [109.50 (33.25～342.50), 101.50(28.75～208.25), Z=-3.198, P=0.001; 86.00 (35.50～199.00), 64.00 (36.50～133.00), Z=-3.751, P=0.0010; 49.00 (30.00～123.75), 37.50 (27.75～101.25), Z=-3.324, P=0.001] in 3 groups of patients decreased significantly within 24 h after the first non-bioartificial liver treatment. Albumin (Alb) level in PE group increased significantly after treatment (31.25±5.33, 32.87±7.11, t=-2.200, P=0.034). In DPMAS group, Hemoglobin (Hb) (96.47±18.48, 84.88±23.82, t=3.919, P=0.0001) and Fibrinogen (FIB) (2.36±2.02, 1.67±0.89, t=2.764, P=0.009) decreased significantly after treatment. Pairwise comparison between groups: The decline rate of MELD score in the PE group [0.13 (0.09～0.27) ] and DPMAS+LPE group [0.19 (0.12～0.24)] was significantly higher than that in the DPMAS group [0.05 (0.00～0.11)] (P<0.05). The decline rate of prothrombin time (PT) in the PE group [0.21 (0.11～0.35)] and DPMAS+LPE group [0.18 (0.10～0.32)]was significantly higher than that in the DPMAS group[0.00 (-0.13～0.10)] (P<0.05). The decline rate of international normalized ratio (INR) in the PE group [0.19 (0.11～0.39)] and DPMAS+LPE group [0.21 (0.13～0.32)]was significantly higher than that in the DPMAS group[0.02 (-0.11～0.11)] (P<0.05). The reduction rate of white blood cell (WBC) in the PE group [0.14 (-0.05～0.34)] and DPMAS+LPE group [0.15 (-0.05～0.34)] was significantly higher than that in the DPMAS group [0.01 (-0.30～0.11)] (P<0.05). The reduction rate of neutrophil-lymphocyte ratio (NLR) in the PE group [0.26 (-0.07～0.45)] and DPMAS+LPE group [0.21 (0.16～0.46)] was significantly higher than that in the DPMAS group [-0.14 (-0.84～0.09)] (P<0.05).The decline rate of prothrombin activity (PTA) in DPMAS group [0.00 (-0.17～0.12)] was significantly higher than that in PE group [-0.46 (-1.09～-0.23)] and DPMAS+LPE group [-0.35 (-0.81～-0.16)], respectively. There was no significant difference in the above indexes between PE group and DPMAS+LPE group (P＞0.05) . The decrease of procalcitonin (PCT) in DPMAS+LPE group was the most significant [0.08 (-0.09～0.27), 0.29 (0.13～0.42), 0.48(0.34～0.69), KW=30.935, P<0.0001]. There was no significant difference in survival rate among the three groups (47.1%, 54.1%, 60.5%, χ²=1.953, P=0.377). Conclusion DPMAS, PE and DPMAS+LPE can improve liver function into different degreeextents. PE and DPMAS+LPE can effectively improve coagulation function and inflammatory response. DPMAS can reduce Hb and FIB. There was no significant difference in survival rate among patients treated with the three non-biological artificial liver systems.

Clinical manifestations and histopathological features of liver failure caused by autoimmune hepatitis

WANG Shu-shu, WANG Shu-ren

2023, 28(9):  1037-1040. 

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Objective To analyze the clinical manifestations and histopathological features of autoimmune hepatitis-related liver failure (AIH-LF) patients with different clinical outcomes.Methods Twenty-three patients with AIH-LF admited in the first people’s hospital of Yancheng city from January 2010 to June 2022 were collected retrospectively, including 3 males and 20 females, aged 44 (30, 53) years. According to the condition, they were divided into an AIH-LF remission group and a progression group. The clinical data and histopathological features of the two groups of patients were compared. Results In terms of clinical data, the duration of AIH patients in the remission group was more than 6 months, and the number of cases and the time interval of the diagnosis of liver failure was 4 cases (33.3%) and 11 (2, 17) months, which were significantly lower than those in the progressive group [7 cases (63.6%) and 23 (4, 51) months, P<0.05]. There were 8 cases (66.7%) and 2 cases (18.2%) of subacute, acute on chronic liver failure in AIH-LF remission group, compared with 2 cases (18.2%) and 8 cases (72.7%) in AIH-LF progression group, the difference was statistically significant (P<0.05). There were 1 case (8.3%) and 5 cases (45.4%) of cirrhosis in AIH-LF remission and progression group, and the difference was statistically significant (P<0.05). 9 patients (75.0%) in AIH-LF remission group were treated with steroid hormone, which was significantly higher than that in AIH-LF progression group [3 patients (27.3%), P<0.05]. Anorexia, infection, renal insufficiency and gastrointestinal bleeding in AIH-LF remission group were 3 cases (25.0%), 4 cases (33.3%), 0 (0) and 0 (0), respectively, which were significantly lower than those in AIH-LF progression group [8 cases (72.7%), 9 cases (81.8%), 4 cases (36.4%) and 4 cases (36.4%), P<0.05]. The levels of AFP in the remission and progression group of AIH-LF were 104 (42, 176) ng/mL and 55 (4, 122) ng/mL, and the difference was statistically significant (P<0.05). The number of IgG positive cases in AIH-LF remission group was 1 case (8.3%), which was significantly lower than that in AIH-LF progression group [5 cases (45.4%), P<0.05]. As for the histopathological features, there were 10 cases (83.3%) of interfacial hepatitis in AIH-LF remission group, which were significantly higher than those of 4 cases (36.4%) in AIH-LF progression group [P<0.05]. The cases of bile duct injury and F3-F4 hepatic fibrosis in AIH-LF remission group were 1 case (8.3%) and 2 cases (16.7%), respectively, which were significantly lower than those of 6 cases (54.5%) and 6 cases (54.5%) in the AIH-LF progression group [P<0.05]. Conclusion Although the incidence of AIH-LF is not high, it causes high mortality. Different clinical features indicate different clinical outcomes, which is of great significance for clinical work. Patients with advanced AIH-LF have a long course of AIH and liver cirrhosis, often accompanied by anorexia, infection, renal insufficiency, gastrointestinal bleeding and other symptoms. At the same time, histopathology is characterized by bile duct injury and significant liver fibrosis.

Viral Hepatitis

Clinical analysis of 5 children cases of chronic hepatitis C genotype 1b treated with elbasvir/grazoprevir

LIU Li, LI Mei, CHANG Li-xian, LIU Chun-yun, LI Hui-min, FANG Ming, LI Jun-yi

2023, 28(9):  1041-1043. 

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Objective To explore the efficacy and short-term safety of elbasvir/grazoprevir (EBR/GZR) in the treatment of chronic hepatitis C (CHC) genotype 1b in children.Methods The children infected with genotype 1b hepatitis C virus enrolled from January 2019 to March 2022 were given EBR/GZR treatment for 12 weeks, and followed-up for biochemical and virological indicators for 12 weeks after drug withdrawal. The main efficacy indicators were the sustained virological response (SVR) obtained at the end of the treatment and the occurrence of adverse reactions during the treatment. Results There were 5 CHC children, with 3 males and 2 females, and an average of 7.68 years. There were 2 cases of mother transmission, 1 of grandfather transmission, 1 of father transmission, and 1 was unknown of the transmission route. The SVR of EBR/GZR treatment for 4, 8, 12 weeks, and 12 weeks after drug withdrawal were 60%, 100%, 100% and 100%, respectively. In all patients alanine transferase and aspartate transferase returned to normal after 4 weeks of treatment. For the adverse reactions, there was only 1 case with slightly nausea. Conclusion EBR/GZR was effective and safe for the treatment of CHC genotype 1b children.

Dynamic changes of serum exosomal HBV-miR-3 in patients with chronic hepatitis B treated with antiviral therapy and its relationship with virological indicators

ZHONG Jian-qiu, XU Yan, XU Min

2023, 28(9):  1044-1047. 

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Objective To investigate the dynamic changes of serum exosomal HBV-miR-3 in patients with chronic hepatitis B (CHB) treated with antiviral therapy and its relationship with virological indicators.Methods A total of 116 patients with CHB who were admitted from June 2020 to June 2021 were selected, all received antiviral therapy for 12 months. The patients were divided into a virological response group (VR⁺ group) and a non-viral response group (VR^- group) according to their levels of HBV DNA after treatment. The general data and dynamic changes of virological parameters and serum exosomal HBV-miR-3 before and after antiviral therapy were compared between VR⁺ and VR^- groups. The relationship between exosomal HBV-miR-3 levels and virological indicators was investigated by Pearson correlation analysis, and the predictive efficacy of exosomal HBV-miR-3 levels on virological response was analyzed by receiver operating characteristic (ROC) curve analysis. Results After 12 months of antiviral treatment, 54 cases had virological response (VR⁺ group) and 62 cases did not obtain viral response (VR^- group). The virological response rate was 46.55%. The level of ALT in the VR⁺ group was higher than that in the VR^- group, while the HBsAg concentration, HBV DNA load and exosomal HBV-miR-3 levels were lower than those in the VR^- group (P<0.05). The HBsAg concentration, HBV DNA load and exosomal HBV-miR-3 level in the VR⁺ group decreased significantly after receiving antiviral treatment, while the VR^- group decreased but did not change significantly, and was always higher than the VR⁺ group (P<0.05). Serum exosomal HBV-miR-3 levels were not significantly correlated with ALT (r=0.049, P=0.241), but were positively correlated with HBV DNA and HBsAg (r=0.314, 0.809, P<0.05). The ROC curve results showed that at 3 months of treatment, the AUC (0.857) (95% CI: 0.716-0.962) with 4.52 lg copies/ml as the optimal cutoff value was the largest, and the sensitivity and specificity were the highest, which were 82.70% and 82.70%, respectively. Conclusion The level of serum exosomal HBV-miR-3 in CHB patients decreased with the prolongation of antiviral treatment time, and was positively correlated with virological indicators of HBV DNA and HBsAg, and HBV-miR-3≤4.52 lg copies/ml at 3 months of antiviral therapy can be used as an indicator to predict the virological response of CHB patients with 12 months of antiviral therapy.

Clinical efficacy analysis of nucleoside (acid) analogues combined with polyethylene glycol interferon in the treatment of chronic hepatitis B

JIANG Zhao-rong, ZOU Mei, JI Teng-fei, LIU Huan, GU Sheng-wang, FENG Wei-guang, Zhao Wen-xi

2023, 28(9):  1048-1049. 

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Objective To study the clinical cure effect of polyethylene glycol interferon α-2b in combination with nucleotide (acid) analog in the treatment of chronic hepatitis B.Methods Three hundred and ten patients with chronic hepatitis B enrolled during January 1, 2017 to June 30, 2022 were given polyethylene glycol interferon α-2b plus nucleoside (acid) analogue and set as the observation group. Another 310 patients previously treated with nucleotide (acid) analogue were taken as the control group. The HBsAg conversion rate, HBV DNA conversion rate and liver function regaining rate in both groups were compared. Results HBV DNA conversion, liver function regaining rate and HBsAg conversion rate in the observation group were 301 (97%), 278 (89.7%), 120 (38.7%), respectively, which were statistically significant different with those of 288 (92.98%), 243 (78.3%), 8 (2.58%) in the control group (χ²=262.091/161.895/167.293, all P<0.01). Conclusion The combination of polyethylene glycol interferon α -2b and nucleoside (acid) analogue is very effective in reducing the level of hepatitis B virus, and promoting liver function normalization in the treatment of chronic hepatitis B.

An investigation of Hepatitis B surface antigen carriers in children aged 0~6 years in Tibet region

WEN Qing-ping, ZHANG Yan, QIAN Hua, SHI Li

2023, 28(9):  1050-1052. 

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Objective To investigate the situation of HBsAg carriers in children aged 0~6 years in Tibet, and to provide reference for hepatitis B vaccination, health education and mother-to-child transmission in children in Tibet.Methods A total of 32,927 children under 6 years of age in Tibet were included in this study by random sampling method from January 2021 to July 2022. Venous blood samples of the children and their mothers were collected for HBsAg screening by Colloidal gold test method. Results 1313 (3.99%) children and 2626 (7.98%) mothers were HBsAg positive carriers in this group. The positive rate of HBsAg in male and female children was 4.07% and 3.86%, respectively, with no significant difference. The positive rate of HBsAg in children of different ages was different. The positive rate of HBsAg in children of 2~3 years old was the lowest. The positive rate of HBsAg in children of less than 3 years old gradually increased with the decreasing of age, and the positive rate of HBsAg in children of over 3 years old gradually increased with the increasing of age. The positive rate of HBsAg in children without hepatitis B vaccination (6.27%) was significantly higher than that in children with hepatitis B vaccination (3.81%). The positive rate of HBsAg in children with HBsAg positive mothers (36.97%) was significantly higher than that in children with HBsAg negative mothers (1.13%). Conclusion The positive rate of HBsAg in children aged 0 to 6 years is generally high in Tibet, and the immunization plan of hepatitis B needs to be strengthened, especially for the children who haven′t received hepatitis B vaccine and the children whose mothers are HBsAg positive.

Predictive effect of serum IL-10 level on HBeAg conversion in chronic HBV-infected patients undergoing nucleos(t)ide analogues treatment

GU Da, TONG Cong, WANG Wei-zhao, XIANG Xiao-xing, ZHAO Xiang-An

2023, 28(9):  1053-1056. 

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Objective To explore the predictive effect of serum IL-10 level on the e-antigen seroconversion in patients with chronic hepatitis B after antiviral therapy.Methods Ninety-seven patients with chronic hepatitis B were included, including 6 inactive carriers (IC), 22 immunotolerant patients (IT), 44 HBeAg positive patients (EPH) and 18 HBeAg negative patients (ENH). Meanwhile, 11 healthy people (HC) were included as controls. The serum levels of IL-10 in healthy people and patients with chronic hepatitis B, and the serum levels of IL-10 in patients with chronic hepatitis B with different immune status were compared. Thirty EPH patients who received antiviral therapy were followed-up for 5 years. The changes of serum liver enzymes, HBV DNA, and IL-10 were detected in the 0th, 4th, 12th, 24th and 48th weeks after antiviral treatment. The baseline serum e-antigen and IL-10 levels were compared between the patients with and without e-antigen seroconversion in the first, second, third, and fifth years after antiviral treatment. Results The serum IL-10 level in patients with chronic hepatitis B was significantly higher than that in healthy blood donors, and the serum IL-10 levels in the IT group, EPH group and ENH group were significantly higher than those in the HC group and IC group. After antiviral treatment, the serum levels of alanine transaminase (ALT), HBV DNA load, and IL-10 gradually decreased. During follow-up, it was found that a total of 9, 10, and 13 patients achieved e-antigen negative conversion in the 2nd, 3rd, and 5th years after antiviral treatment. By a further analysis it was found that when compared with the HBeAg-positive group, the HBeAg-negative group had significantly higher levels of IL-10 at 2, 3, and 5 years (6.49±2.16 vs 3.33±1.22 pg/mL,P=0.062;5.88±1.99 vs 2.27±1.36 pg/mL,P=0.026;6.01±1.91 vs 1.15±0.63 pg/mL,P=0.027). Conclusion Serum IL-10 levels were significantly elevated in patients with chronic hepatitis B. Antiviral therapy could reduce serum IL-10 levels. Higher levels of serum IL-10 before antiviral therapy predicted better treatment outcomes.

Liver Fibrosis & Cirrhosis

Effect of IL-22 on ileal tight junction protein and nrf2/HO-1 antioxidant pathway in mice with alcoholic liver fibrosis

YAN Hong-you, XU Xiao-juan, WEI Yan-fang, LIU Xing, HUO Jun-yan, LI Ke, XU Cui-ping

2023, 28(9):  1057-1063. 

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Objective To investigate the effects of interleukin 22 (IL-22) on tight junction proteins Occludin and ZO-1 in the ileum of mice with alcohol liver fibrosis, as well as its impact on nuclear factor-E2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) antioxidant pathway.Methods Sixty clean-grade healthy male C57/6j mice were used to construct a composite model of ALF by feeding with chronic ethanol plus intraperitoneal injection of CCL4. The mice were divided into a normal group (Group N), a control group (Group C), a model group (Group M), an IL-22 group, and an IL-22+ML385 (Nrf2 inhibitor) group, with 12 mice in each group. Immunohistochemistry was used to detect the expression levels of ileal tight junction proteins Occludin, ZO-1 and Nrf2, as well as their downstream genes heme oxygenase-1 (HO-1) and NAD(P)H quinone oxidoreductase 1 [NQO1]. Immunofluorescence was used to detect the expression level of Occludin and ZO-1 in the ileal mucosal epithelium. Researchers observed the pathological changes of liver and ileum, as well as the degree of hepatic fibrosis. Results Compared with group C, the mean optical density values of ileal tissue for Occludin and ZO-1 were lower in group M (0.292±0.015, 0.237±0.036 vs. 0.236±0.025, 0.158±0.025, P<0.05), and the fluorescence intensity was significantly weakened. The mean optical density values of Nrf2, NQO1, and HO-1 were higher (0.141±0.011、0.196±0.019、0.166±0.033 vs. 0.172±0.042、0.223±0.011、0.215±0.044, P<0.05). The collagen fiber deposition in liver tissue significantly increased (1.723±0.415 vs. 19.759±1.319, P<0.05). Compared with the M group, the mean optical density values of Occludin, ZO-1, Nrf2, NQO1 and HO-1 in ileal tissues were higher in the IL-22 group (0.322±0.020, 0.289±0.024, 0.217±0.012, 0.321±0.018, 0.273±0.030, P<0.05). The fluorescence intensity of Occludin and ZO-1 was significantly increased. There was a reduction in collagen fiber deposition in liver tissue (10.851±0.951, P>0.05). Compared with the IL-22 group, the mean optical density values of Occludin, ZO-1, Nrf2, NQO1 and HO-1 were lower in the IL-22+ML385 group (0.248±0.011, 0.175±0.030, 0.179±0.013, 0.229±0.053, 0.218±0.030, P<0.05). The fluorescence intensity of Occludin and ZO-1 was reduced, and there was a decrease in collagen fiber deposition in liver tissue (19.264±0.932, P<0.05). ML385 inhibited the Nrf2/HO-1 pathway, resulting in a notable reduction in the protective effect of IL-22 on ileal tissue injury in ALF mice. There was no significant difference between group N and group C in any of the above results (P>0.05). Conclusion The dysfunction of ileal barrier,caused by a decrease in the expression of ileal tight junction proteins in ALF mice, may be influenced by oxidative stress. On the other hand, IL-22 enhanced the Nrf2/HO-1 antioxidant pathway in the ileun, leading to increased expression of tight junction proteins in the ileal epithelial cells and improvement in the barrier function of the ileum. As a result, the progression of ALF was inhibited.

Evaluation of liver fibrosis in patients with chronic hepatitis B by detecting liver and spleen stiffness measurement based on ultrasonic elastography and serum liver fibrosis index

YIN Lin-lin, LV Hui, WANG Wu-chen, LIU Xue-jin

2023, 28(9):  1064-1067. 

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Objective To assess liver fibrosis in patients with chronic hepatitis B (CHB) by liver and spleen stiffness measurement based on ultrasonic elastography (UE), and serum liver fibrosis indexes (APRI, FIB-4, and King′s score).Methods A total of 98 CHB patients were selected as the research subjects from October 2018 to August 2021. The participants included 51 males and 47 females, with an age of (35.3±7.8) years. UE was used to measure liver hardness (LSM) and spleen hardness (SSM) in each patient. Additionally, all patients underwent ultrasound-guided liver biopsy after the UE examination. Results The success rate of UE measurement was 100%, and the data was reliable. The AST, LSM and SSM of male were (86.0±23.1) U/L, (10.6±3.4) kPa and (18.1±4.7) kPa, which were significantly higher than those of female [(71.4±19.3) U/L, (8.7±2.7) kPa and (15.5±5.4) kPa, P<0.05]. The age and GGT of males were (34.7±6.4) years and (70.6±29.3) U/L, respectively, which were significantly different from those of females ((37.0±6.8) years and (88.2±34.5) U/L) (P<0.05). With the increase of liver fibrosis, LSM, SSM, APRI, FIB-4 and King′s scores increased significantly (P<0.05). The AUC values of LSM and SSM were significantly higher compared to APRI, FIB-4 and King′s scores (P<0.05) when evaluating ≥S2 hepatic fibrosis. The AUC, cut-off point, sensitivity and specificity of LSM in diagnosing ≥S2 hepatic fibrosis were 0.82, 7.8 kPa, 77.4% and 92.5%, respectively. The AUC, cut-off point, sensitivity and specificity of SSM in diagnosis of ≥S2 hepatic fibrosis were 0.85, 8.7 kPa, 80.6% and 94.0%, respectively. Conclusion Compared to APRI, FIB-4, and King′s scores, LSM and SSM detected by UE exhibit superior diagnostic efficiency for CHB liver fibrosis staging.

Liver Cancer

Analysis of the effect of TACE combined with PMCT in patients with advanced liver cancer

CHEN Xiu-feng, JIANG Li-ping, SHEN Ling

2023, 28(9):  1068-1071. 

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Objective To explore the effect of combining TACE with PMCT in patients with advanced liver cancer.Methods From March 2018 to April 2020, 60 patients with advanced liver cancer admitted to Yixing People′s Hospital were randomly divided into two groups, with 30 patients in each groups. The patients in the short interval group received simultaneous treatment with TACE and PMCT. The patients in the long interval group received PMCT one month after TACE. After 3 months of treatment, the clinical efficacy, AFP, abnormal prothrombin levels and 2-year survival rate were compared. Results The objective remission rates of short interval group and long interval group after treatment were 43.33% and 36.67% respectively, and there was no significant difference between the two groups (P>0.05). After treatment, the levels of serum AFP and abnormal prothrombin in the short interval group were (107.43±15.32) ng/mL and (2831.26±118.50) mAU/mL, respectively. In the long interval group, the levels of serum AFP and abnormal prothrombin were (135.02±12.51) ng/mL and (3135.65±107.28) mAU/mL, respectively. Both groups showed lower levels of serum AFP and abnormal prothrombin after treatment compared to before treatment, with the short interval group showing a greater reduction (P<0.05).). The 2-year overall survival rates of the long interval group and the short interval group were 23.08% and 46.43%, respectively. The survival curves of the two groups were statistically different (P<0.05). Conclusion PMCT at the same time of TACE treatment is more helpful in inhibiting the expression of tumor factors in patients with advanced liver cancer, prolonging the survival period, and ensuring good safety.

Diagnosis and evaluation of serum midkine levels in response to TACE treatment in patients with hepatocellular carcinoma

WANG Kai-li, HU Xiao-wei, YIN Jian, LIU Qing-yang, WANG Qiu-bo

2023, 28(9):  1072-1074. 

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Objective To analyze the level of serum medium-term factor (MK) in diagnosing and evaluating the response to TACE treatment in HCC patients.Methods 40 HCC patients scheduled to receive TACE treatment and 30 normal healthy subjects were prospectively collected from Wuxi No.9 Institute Affiliated to Suzhou University between January 2020 and May 2022, The serum MK concentration was determined by ELISA. The HCC patients treated with TACE were divided into effective group and ineffective group based on RECIST criteria. Serum MK levels were compared between groups and HCC patients before and after treatment. Results 18 cases were effective and 22 cases were ineffective. The serum MK level in the HCC group before treatment was 740.9 (456.2, 933.3) ng/L, which was significantly higher than that of the normal group [164.5 (114.9, 200.3) ng/L, Z=6.415, P<0.001]. The curative effect of liver cancer group was analyzed. In the effective group, the serum MK level before treatment was 570.0 (280.0, 782.3) ng/L, and the serum MK after treatment was 147.5 (103.4, 213.5) ng/L. In the ineffective group, the serum MK level before treatment was 899.9 (676.1, 1213.0) ng/L, and 469.0 (300.0, 837.5) ng/L after treatment. There were significant differences in serum MK levels between the effective group and the ineffective group before and after treatment (before treatment: Z=2.990, P=0.003; After treatment: Z=4.758, P<0.001). The median decrease of serum MK before and after treatment in the effective group was 361.0 (136.3, 648.6) ng/L, while it was 354.9 (238.9, 516.3) ng/L in the ineffective group. There was no significant difference between the two groups (Z=0.068, P>0.05). Conclusion The level of serum MK has diagnostic and evaluative value in assessing the response to TACE in HCC patients.

Contrast-enhanced ultrasonography and enhanced CT in differentiating intrahepatic cholangiocarcinoma from hepatocellular carcinoma

GE Shu, LIU Yang-yang

2023, 28(9):  1075-1078. 

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Objective To compare and analyze the value of contrast-enhanced ultrasound and enhanced CT in differentiating cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC).Methods The medical records of 69 patients diagnosed with primary liver cancer and admitted to Nantong cancer hospital from January 2020 to January 2022 were retrospectively analyzed. Patients were divided into two groups based on pathological examination: 45 patients with HCC and 24 patients with ICC. All patients underwent contrast-enhanced ultrasound and enhanced CT. The study examined the manifestations of ICC and HCC using contrast-enhanced ultrasound and enhanced CT. Specifically, the researchers compared the blood perfusion parameters [peak intensity (PI), time to peak (TTP), time to arrival (at)] of ICC and HCC in arterial phase of contrast-enhanced ultrasound, as well as the CT values of arterial phase (LAP), portal phase (PVP) and equilibrium phase (EP) of contrast-enhanced CT. The aim was to evaluate the diagnostic value of contrast-enhanced ultrasound and enhanced CT parameters in distinguishing HCC. Results In patients with ICC, the ultrasound contrast imaging showed that the percentages of intrahepatic bile duct dilatation, arterial phase ring enhancement, and hypovascular were 70.83%, 62.50%, and 70.83%, respectively, all of which were higher than those in HCC patients (40.00%, 20.00%, 40.00%, P<0.05). Similarly, the enhanced CT findings in ICC patients showed that the percentages of segmental signs, intrahepatic bile duct dilatation, and arterial phase ring enhancement were 75.00%, 70.83%, and 58.33%, respectively, all of which were higher than those in HCC patients (44.44%, 42.22%, 20.00%, P<0.05). The TTP in the ICC group was (22.28±3.71) s, which was higher than that in the HCC group [(16.75±2.83) s, P<0.05]. The EP phase CT value in the ICC group was (98.65±8.74) Hu, which was higher than that in the HCC group [(87.05±7.24) Hu, P<0.05]. TTP had a higher diagnostic efficacy for ICC than EP (P<0.05). The kappa values for the consistency of ultrasound contrast imaging and enhanced CT with pathological results in diagnosing ICC and HCC were 0.596 and 0.470, respectively. Conclusion Both contrast-enhanced ultrasound and enhanced CT can be utilized for the clinical diagnosis of ICC and HCC. However, contrast-enhanced ultrasound proves to be more effective in the diagnosis of ICC and HCC.

Evaluation of the therapeutic effect of transcatheter hepatic artery chemoembolization combined with large segment three-dimensional conformal radiotherapy on unresectable primary liver cancer

LI Ming, JIANG Zhu-chun, SHI Yong-gang, DONG Shi-liang, HE Zi-huai, PAN Mei-fang

2023, 28(9):  1079-1083. 

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Objective To explore the clinical efficacy of transcatheter hepatic arterial chemoembolization (TACE) combined with large segment three-dimensional conformal radiotherapy in the treatment of unresectable primary liver cancer.Methods 62 patients with unresectable primary liver cancer were retrospectively selected and divided into two groups according to different treatment methods: 30 patients received TACE treatment (intervention group), and 32 patients received TACE combined with large segment three-dimensional conformal radiotherapy for treatment (combined group). The short-term efficacy, mid-term and long-term efficacy, adverse reactions, and changes in serum chemokine 9 (CXCL9) and heat shock protein 90 (HSP90) levels before and after treatment were compared between the two groups. Results The total effective rate of the combination group was similar to that of the intervention group (84.38% vs 76.67%, P>0.05). Compared with before treatment, the serum levels of CXCL9, HSP90, and β-catenin were significantly reduced in both groups after treatment. The serum levels of CXCL9, HSP90, and β-catenin in the combination group after treatment were (658.82±27.96) pg/mL, (0.04±0.01) ng/mL, and (264.52±51.46) pg/L, respectively, which were significantly lower than (760.82±30.64) pg/mL, (0.05±0.02) ng/mL and (390.54±47.28) pg/L in the intervention group, all P<0.05. There was no statistically significant difference in the total incidence of adverse reactions between the combination group and the intervention group (31.25% vs 23.33%^[2], P>0.05). The local control rate and progression free survival rate of the combined group at 6 months after treatment respectively were 81.25% and 78.13%, which were significantly higher than the 60.00% and 60.00% of the intervention group (P<0.05). The overall survival rate of the combined group at 12, 24, and 36 months of treatment was higher than that of the intervention group (84.38% vs 76.67%, 65.63% vs 46.67%, 50.00% vs 33.33%), the local control rate was higher than that of the intervention group (59.38% vs 40.00%, 50.00% vs 33.33%, 37.50% vs 23.33%), and the progression free survival rate was also higher than that of the intervention group (56.25% vs 33.33%, 46.88% vs 30.00%, 34.38% vs 16.67%), all P<0.05. Conclusion TACE combined with large segment three-dimensional conformal radiotherapy for unresectable primary liver cancer can effectively improve the local control rate of liver cancer, improve the mid-term and long-term efficacy of patients, and have good tolerance and high safety. Its mechanism of action may be related to downregulating serum CXCL9 and HSP90 levels, and inhibiting the Wnt signaling pathway.

Evaluation value of CD8⁺ T lymphocyte level in immunotherapy efficacy in patients with advanced hepatocellular carcinoma

ZHANG Xiang, LI Ying-ying, TANG Qing, LI Wei, SUN Li-zhu

2023, 28(9):  1084-1087. 

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Objective To evaluate the efficacy of CD8⁺ T lymphocytes in immunotherapy in patients with advanced hepatocellular carcinoma.Methods A total of 89 patients with advanced hepatocellular carcinoma admitted to the hospital from March 2019 to July 2022 were selected. All patients received immunotherapy. According to clinical efficacy, patients were divided into effective group (partial response (PR) and complete response (CR)) and ineffective group (disease progression (PD) and stable disease (SD)). The level of CD8⁺ T lymphocytes in the 2 groups and the clinical data in the 2 groups were compared. The influencing factors of immunotherapy ineffectiveness in patients with advanced hepatocellular carcinoma was analyzed. The predictive value of CD8⁺ T lymphocytes in patients with advanced hepatocellular carcinoma was analyzed. Results After treatment, SD, PD, PR and CR of the 89 patients were 8, 24, 57 and 0, respectively. The objective response rate (ORR) was 64.04% (57/89), with 32 cases in the ineffective group and 57 cases in the effective group The level of CD8⁺ T lymphocytes in effective group was higher than that in ineffective group (P<0.05). The ECOG score > 0, Child-Pugh classification was B grade, Barcelona stage (BCLC) was end-stage, poorly differentiated, extrahepatic metastasis, and alpha-fetoprotein (AFP) ≥20 ng/mL of proportion of cases in effective group was higher than that in the effective group (P<0.05). Child-Pugh grade B, end-stage BCLC, and AFP and CD8⁺ T lymphocyte levels were influential factors for immunotherapy efficacy in patients with advanced hepatocellular carcinoma (P<0.05). Receiver operating characteristic curve (ROC) curve showed that the area under curve (AUC) value of CD8⁺ T lymphocyte level in predicting immune response in advanced hepatocellular carcinoma patients was 0.781 (P<0.05). Conclusion CD8⁺ T lymphocyte level can be used to predict the efficacy of immunotherapy in patients with advanced hepatocellular carcinoma, and low CD8⁺ T lymphocyte level of patients have a greater risk of treatment failure.

Drug-Induced Liver Injury

Clinical characteristics of non-alcoholic fatty liver disease patients with concurrent acute drug-induced liver injury across varied age cohorts

ZHANG Si-min, YUAN Yi-fu, WU Xiao-xi, DU Sheng-nan, CAO Qin, JIANG Yuan-ye

2023, 28(9):  1088-1092. 

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Objective The clinical characteristics of patients with nonalcoholic fatty liver disease (NAFLD) complicated by acute drug-induced liver injury (DILI) were analyzed retrospectively to furnish both clinical and experimental frameworks for guiding therapeutic drug choices in NAFLD patients.Methods In this retrospective analysis, the general demographics, medication utilization patterns, and laboratory data for a cohort of 68 patients diagnosed with NAFLD concomitant with DILI in our hospital between the years 2020 to 2022 were statistically analyzed. Results The sample comprised 32 males and 36 females, with an age range spanning 24 to 82 years. The cohort included 44 elderly patients and 24 middle-aged individuls. The primary medications imlicated in acute DILI were cardiovascular drugs, followed by non-steroidal anti-inflammatory drugs, anti-gout medications, antidiabetic agents, and anti-tumor drugs. With respect to the clinical severity of DILI, the majority of cases were catogorized as Grade 1(mild), accounting for 65 patients (95.59%). In terms of liver function, the ALT levels were notably elevated in the young and middle-aged group as compared to the elderly cohort[88 (60.5) U/L vs. 58.5 (24.25) U/L, P<0.01]; Lipid profile analyses revealed that levels of HDL and Apo A were significantly lower in the middle-aged group compared to the elderly[1.09 (0.3525) μmol/L vs. 1.21 (0.3425) μmol/L and 1.15 ± 0.27 g/L vs. 1.34 ± 0.22 g/L, P<0.05, P<0.01]. Converstly, Apo B levels were elevated in the middle-age cohort[0.88 (0.28) g/L vs. 0.74 (0.27) g/L, P<0.05]. From a hematological standpoint, the percentage of neutrophils(N)was lower in the middle-aged group compared to the elderly group [52.17 ± 9.3% vs. 57.94 ± 9.05%, P<0.05], whereas levels of lymphocyes(L) and platelets(PLT) were significantly higher[36.11 ± 8.93% vs. 30.86 ± 8.56%, and 248.5 (63.75)] × 10⁹/L vs. 205.5 (69.25) × 10⁹/L,P＜0.05,P＜0.01]. Conclusion Mild liver injury emerged as the predominat clinical manifestation among NAFLD patients experiencing acute DILI. Interestingle, while elderly NAFLD patients appeared to be more susceptible to developing acute DILI compared to their younger and middle-aged counterparts, the severity of liver injury did not demonstrate a direst correlation with age. The etiology of acute DILI in this cohort may be linked to the medications prescribed for comorbidities commonly found in the elderly population.

Analysis of MRI features related to clinical classification, severity and prognosis of drug-induced liver injury

XU Shi-feng, WANG Xu-sheng, CAO Lei

2023, 28(9):  1093-1096. 

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Objective To determine MRI features correlated with the clinical classification, severity, and prognosis of drug-induced liver injury (DILI) to better identify high-risk patients with DILI.Methods From January 2018 to October 2022, a total of 122 patients diagnosed with DILI were enrolled in this study, including 35 males and 87 females, aged 55 (44, 63) years. All recruited patients met the established diagnostic criteria for DILI The clinical classifications of DILI were categorized into hepatocellular, mixed, and cholestatic types; while severity as indexed as mild, moderate and severe. Patient outcomes were monitored through follow-up assessments, categorizing the clinical prognosis of DILI into remission, maintenance or progression. The MRI findings for each patient were systematically evaluated, with a particular focus on measuring the apparent diffusion coefficient (ADC). Results Of the 122 patients diagnosed with DLLI, the primary causative agents were Chinese herbal medicine (61.5%, 75 cases), western medicine (25.4%, 31 cases), a combination of both(9.0%, 11 cases), and dietary supplements (4.1%, 5 cases). The median incubation period stood at 26 (9, 48) days. The cases of helatocellular, mixed, and cholestatic types of DILI were 90(73.8%),15(12.3%), and 12(13.9%). respectively. Mild DILI was observed in 19.7%(24 cases), moderate in 68.0%(83 cases), and sever in 12.3%(15 cases). In terms of prognosis, 85.2%(104 cases) reached remission, 6.5%(8 cases) showed maintenance, and 8.2%(10 cases) progressed. The MRI findings revealed various hepatic abnormalities: unsmooth liver surface in 6 cases(4.9%), transient hepatic attenuation difference in 20.5%(25 cases), periportal edema in 55.7%(68 cases), bile duct dilatation in 7.4%(9 cases), and gallbladder wall edema in 30.3%(37 cases), and portal lymph nodes in 16.4%(20 cases). Statistical analyses showed significant differences in periportal edema, portal lymph node enlargement, and ADC values across the clinical types of DILI(P<0.05). Moreover, significant differences in liver surface roughness, transient hepatic attenuation difference, gallbladder wall edema and splenomegaly were observed between mild and severe DILI cases(P<0.05). Multivariate analysis indicated that liver surface roughness, transient hepatic attenuation difference and splenomegaly were risk factors influencing DILI severity(P<0.05). Similarly, transient hepatic attenuation difference, ascites and splenomegaly were identified as significant prognostic risk factors(P<0.05). Conclusion Peripheral edema of portal vein is found to be associated with distinct clinical subtypes of DILI. Notably, an Irregular liver surface, transient hepatic attenuation difference. and splenomegaly are identified as key factos influencing the severity of DILI in patients. Furthermore, transient hepatic attenuation difference and ascites are revealed to possess significant clinical value for the prognostic evaluation of DILI patients.

Clinicopathophysiological characteristics of drug-induced liver injury caused by herbal and dietary supplements

LIU Hua-qing, XIE Ya-ge, XU Yin-yin

2023, 28(9):  1097-1100. 

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Objective To investigate the clinicopathological features of patients suffering from drug-induced liver injury (DILI) triggered by herbal and dietary supplements(HDS), with a view to enhance diagnostic accuracy and treatment efficacy.Methods Between July 2017 and August 2022, a total of 214 patients were admitted to the Department of Gastroenterology and Hepatology at our institution with a confirmed diagnosis of DILI. The patient demographic consisted of 115 males and 99 females, aged (58.4±9.2) years. Diagnoses adhered to the exclusionary criteria for DILI set forth by drug-induced liver disease study group of Hepatology Branch of Chinese Medical Association. Patients were stratified into two cohorts based on the causative agents: those who had taken TCM preparations and those who had consumed dietary supplements. The clinicopathological features of both groups were then comparatively analyzed. Results Of the 214 DILI cases studied,, the primary causaitve agents were anti-tuberculosis drugs(28.5%, n=61), traditional Chinese medicine preparation(22.9%, n=49), dietary supplements(16.8%, n=36), non-steroidal anti-inflammatory drugs(9.3%, n=20), antibacterial drugs(5.6%, n=12), and antipsychotics(5.6%, n=12). Upon comparative analysis of patients affected by DILI from traditional Chinese medicine, dietary supplements, and other categories(non-TCM and non-dietary supplements) we found statistically significant differences in drug latency, duration of medication, initial ALT, ALP levels, peak ALP, TBil, MELD score, occurrences of jaundice, and acute liver failure (P<0.05). Ultraspund-guided liver biopsy were performed on 11 patients from the TCM group and 27 from the dietary supplement groups Histopathological features included portal vein inflammation(n=17), lobular inflammation(n=13), interfacial hepatitis(n=16), focal necrosis(n=9), bridging necrosis(n=7), hepatic fibrosis(n=9), liver cirrhosis(n=2), cholestasis(n=7), fatty degeneration(n=5), balloon-like degeneration(n=7), eosinophil infiltration(n=5), and autoimmune hepatitis-like features(n=7). No statistically significant difference was observed in histopathological characteristics between the TCM and dietary supplement-induced DILI groups(P>0.05). Conclusion Compared with non-HDS-induced DILI, HDS-associated DILI exhibits more detrimental effects on liver function indexes and is asscociated with a higher incidence of complications. Notably, the severity of DILI is especially pronounced when triggered by TCM preparations. Enhancing public awareness about the potential risks associated with TCM preparations and dietary supplements, as well as minimizing their consumption, can serve as effective strategies ofr both the prevention and mitigation of DILI.

Other Liver Diseases

Diagnostic value of multimodal imaging technology with ultrasound shear-wave elastography in metabolisc-associated fatty liver disease

YANG Ru-niu, FU Jin, WANG De-qiin

2023, 28(9):  1101-1104. 

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Objective To investigate the severity of metabolic-associated fatty liver disease (MAFLD) using multimodal imaging technology (MIT) in conjunction with ultrasonic shear-wave elastography (SWE).Methods From January 2020 to December 2021, 198 patients suspected of having MAFLD were studied. They were categorized based on liver pathology biopsy results into an MAFLD group (observation group, n=174) and a NON-MAFLD group (control group, n=24). The observation group was further classified by disease severity into mild(n=61), moderate(n=87), and severe (n=26) subgroups. Both MIT and SWE were performed on these subgroups. Liver Young′s modulus and proton density fat fraction (PDFF) were observed across all groups. Pearson analysis was conducted to determine the correlation between zthe liver Young′s modulus, PDFF and the triacylglycerol glucose index (TyG) . Additionally, the receiver operating characteristic curve (ROC) was utilized to assess the efficacy of both MIT and SWE, individually and combined, in evaluating MAFLD. Results In the observation group, the liver Young′s modulus was 5.78± 0.56 kpa and the PDFF was 20.33±2.10%. Both values were siginidicantly higher than in the control group, where they were 3.27± 0.33 kpa and 6.53±0.61%, respectively (t=8.510 and 13.429, both P<0.05). Within the severe subgroup, the liver Young′s modulus and PDFF were 6.34±0.64 kPa and 25.97±2.13%, respectively, surpassing the figures of the moderate and mild subgroups (5.59±0.51 kPa, 19.56±1.76% and 4.98±0.42 kPa, 12.37±1.08%, respectively). These differences also held statistically significant (F=13.395, 19.786, all P<0.05). A postive correlation was found between the Liver Young′s modulus, PDFF and TyG in patients with MAFLD (P<0.01). ROC analyses revealed AUC values of 0.801, 0.859 and 0.925 for MIT. SWE, and their combined tests, respectively. The combined tests` sensitivity and specificity exceeded those of the SWE alone (P<0.01). Conclusion Multimodal imaging in conjunction with ultrasound shear-wave elastography demonstrateds significant diagnostic value in the assessment of MAFLD.

Impact of fatty liver on acute pancreatitis severity and persistence of systemic inflammatory response syndrome: a CT imaging study

SUN Gang, XU Lei-lei, XIE Hui

2023, 28(9):  1105-1109. 

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Objective To investigate the CT characteristics of acute pancreatitis (AP) in the context of preexisting fatty liver (FL) and to assess the influence of FL on AP severity and the persistence of systemic inflammatory response syndrome (SIRS).Methods Between January 2019 and March 2022, 102 patients diagnosed with AP were hospitalized and categorized into two distinct cohorts based on the presence or absence of fatty liver. Concurrently, these patients were stratified into groups experiencing either persistent SIRS or non-persistent SIRS. Comparative analyses were conducted to evaluate variations in clinical characteristics, AP severity, and the incidence of persistent SIRS between the cohorts. Employing multivariate analysis techniques, we identified salient risk factors associated with the onset persistent SIRS. Furthermore the predictive validity of fatty liver presence, APACHE II scores and MCTSI scores in forecasting persistent SIRS was rigorously examined. Results Our comparative analyses revealed significant differences in the clinical characteristics beween the fatty liver group and non-fatty liver cohorts. The fatty liver group exhibited higher incidences of alcoholism(9.4% vs. 0.04%), hyperlipidemia(39.6% vs. 18.4%), pancreatic necrosis(24.5% vs. 8.2%), and local complications(49.1% vs. 28.6%), all of which were statistically significant(P<0.05). Conversely, the incidence of idiopathic pancreatitis was considerably lower in the fatty liver group(20.8% vs. 46.9%, P<0.05). In terms of AP severity, the fatty liver group demonstrated significantly elevated rates of moderate and severe AP at 34.0% and 22.6%, respectively, compared to 26.5% and 8.2% in the non-fatty liver group(P<0.05). Similarly, the incidence of persistent SIRS was notably higher in the fatty liver group at 58.5%, as opposed to 26.5% in the non-fatty liver group(P<0.05). Additionally, mean APACHE II scores(6.26±3.84 vs. 5.0±3.0) and MCTSI scores(4.93±1.98 vs. 4.0±2.2) were significantly higher in the fatty liver cohort(P<0.05). Conversely, the proportion of mild AP cases was significantly 43.4% as opposed to 65.3% in the non-fatty liver group(P<0.05). Patients in the persistent SIRS cohort exhibited markedly elevated incidences of hyperlipidemia(42.2% vs. 15.8%), C-reactive protein level(91.2 [1.8, 357.0] mg/dL vs. 26.9 [0.2, 308.2]mg/dL), TG levels(5.2±0.8mg/dL vs. 2.2±0.7 mg/dL), pancreatic necrosis(33.3% vs. 3.5%), and local complications(64.4%, vs. 17.5%), all of which were statistically significant(P<0.05). The incidence of cholelithiasis was significantly lower in th persistent SIRS group, measured at 24.4% in contrast to 49.% in the non-persistent SIRS cohort(P<0.05). In comparing the severity of AP between the persistent SIRS group and non-persistent SIRS group, the persistent SIRS group exhibited a higher proportion of moderate(40.0% ) and severe AP(33.3%), along with elevated APACHE II scores(7.1±3.7) and MCTSI scores(5.7±1.9). These metrics were significantly higher than those in the non-persistent SIRS group, where the proportions of moderate and sever AP were 22.8% and 1.8%, and APACHE II and MCTSL scores were 4.5±2.7 and 3.5±1.8, respectively. Conversely, the proportion of mild AP cases in the persistent SIRS group was 26.7%, significantly lower than the 75.4% observed in the non-persistent SIRS group(P<0.05). Multivariate analysis identified fatty liver, an APACHE II score≥6 and an MCTSI score≥4 as independent risk factors for persistent SIRS in patients with AP. Upon evaluating the predictive value of theses factors for persistent SIRS, the flollowing results were obtained: For fatty liver, the AUC was 0.663, with a sensitivity of 0.673 and a specificity of 0.644. For an APACHE II score ≥6, the AUC was 0.701, with a sensitivity of 0.503 and a tspecificity of 0.781. For an MCTSI score ≥4,the AUC was 0.782, with a sensitivity of 0.676 and a specificity of 0.792. Conclusion Patients with preexisting FL are found to be more susceptible to developing necrosis and local complications, as evidence by CT scans. Additionally, these patients were more likely to exhibit severe AP and persistent SIRS. Importantly, preexisting FL is identified as an independent risk factor in predicting the presence of persistent SIRS in individuals with AP.