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    31 October 2023, Volume 28 Issue 10
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    Liver Fibrosis & Cirrhosis
    The value of hepatic vein pressure gradient in assessing the risk of rebleeding after endoscopic treatment of esophageal variceal bleeding in cirrhotic patients
    LIU Jie1, LIU Tang2, WEN Wei1, TANG Shi-xiao3
    2023, 28(10):  1162-1166. 
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    Objective To explore the values of serum type IV collagen (CIV) and vitamin B12 levels, and hepatic vein pressure gradient (HVPG) measurements in assessing the risk of rebleeding after endoscopic treatment in patients with esophageal variceal bleeding (EVB) due to cirrhosis. Methods A case-control study was performed on 61 patients with cirrhosis and EVB who underwent endoscopic venous ligation surgery in Weiyuan County People's Hospital between April 2019 and April 2021. These patients experienced recurrent bleeding within 24 months after surgery and were selected as the bleeding group. Additionally, 80 patients who underwent the same surgery without experiencing recurrent bleeding within 24 months of follow-up post surgery were selected as the control group. The preoperative serum levels of CIV and vitamin B12, and the measured value of HVPG of the two groups of patients were compared, The values of the aboval three indicators in predicting postoperative rebleeding in patients were compared with receiver operating curve (ROC) analysis and logistic regression model. Results The preoperative serum levels of CIV and vitamin B12, and the value of HVPG in patients with recurrent bleeding were (117.4 ± 28.0) μg/L, (498.6 ± 84.0) pg/mL, and (21.9 ± 4.4) mmHg, respectively, which were significantly higher than those of [96.3 ± 17.5] μg/L, (421.8 ± 78.0) pg/mL, (15.6 ± 3.3) mmHg, respectively in the non-rebleeding group (P<0.05); The sensitivities of preoperative CIV, vitamin B12, and HVPG for predicting postoperative bleeding were 68.27%, 73.81%, and 90.66%; the specificities were 65.43%, 76.46%, and 81.52%, respectively; and AUC values were 0.716,0.791, 0.893.The logistic regression model showed that the longer the course of esophageal varices in cirrhotic patients, complicated with portal vein thrombosis, the increments in INR value, CIV value, vitamin B12 level, and the measured value of hepatic vein pressure gradient are risk factors for rebleeding after endoscopic treatment (OR values=1.636, 2.079, 1.493, 1.402, 1.507, 1.790, respectively, all P<0.05), The elevations of PLT count and Alb level were protective factors for patients with recurrent bleeding after endoscopic treatment (POR values were 0.531 and 0.618, respectively, P<0.05). Conclusion The serum levels of CIV and vitamin B12, and HVPG measurement before endoscopic treatment in cirrhotic patients with EVB were closely related to the risk of postoperative bleeding, which is of great significance for predicting the prognosis of EVB and for guiding the clinical treatment.
    An analysis on the etiologies and complications of liver cirrhosis in Dali area of China
    WU Ze-sheng, YAO Qiu-yan, YANG Bo
    2023, 28(10):  1167-1170. 
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    Objective To investigate the changing regularity of the etiologies and complications of patients with cirrhosis and decompensated liver function in Dali area in recent 10 years. Methods A retrospective study was conducted to collect the data of patients with liver cirrhosis and decompensated liver function in the First Affiliated Hospital of Dali University in the past 10 years, and to compare the causes and complications between the first five years ( from January 2012 to December 2016) and the last five years (from January 2017 to December 2021). Results There was no statistical difference between the causes of cirrhosis in the last 5 years and the first 5 years. The top 5 causes were alcohol, chronic hepatitis B, schistosomiasis, overlapping causes and cryptogenic cirrhosis. The main causes were alcohol, chronic hepatitis B and schistosomiasis. The proportion of patients with alcoholic liver cirrhosis in the second 5 years was significantly higher than that in the first 5 years (36.8% vs 31.1%), the difference was statistically significant (χ2=7.030, P=0.008), and the proportion of patients with chronic hepatitis B and cryptogenic cirrhosis in the second 5 years was significantly lower than that in the first 5 years (24.4% vs 29.0%, 5.6% vs 7.7%, respectively). The difference was statistically significant (χ2=5.457, P=0.019; χ2=3.844, P=0.050), there was no significant difference between the proportions of patients with schistosomiasis and overlapping causes in the first 5 years and the last 5 years, which were 15.5% vs 14.0%, and 8.0% vs 9.6% (χ2=0.882, P=0.348; χ2=1.600, P=0.206); The most common complications were abdominal effusion and infection. The proportion of patients with complications of abdominal effusion, infection and cholelithiasis in the last 5 years was significantly higher than those in the first 5 years (85.8% vs 73.0%, 47.0% vs 39.3%, and 24.5% vs 16.6%), the difference was statistically significant (χ2=50.824, P<0.001; χ2=11.848, P=0.001; and χ2=18.256, P<0.001), the proportion of patients with gastrointestinal bleeding in the last 5 years was significantly lower than that in the first 5 years (14.3% vs 28.7%), the difference was statistically significant (χ2=62.58, P<0.001). There was no significant difference in the proportion of patients with primary liver cancer (9.6% vs 10.4%, χ2=0.381, P=0.537). Conclusion The main cause of liver cirrhosis and liver function decompensation in Dali area is alcohol, followed by chronic hepatitis B and schistosomiasis. The cirrhosis caused by alcohol is on the rise, while the cirrhosis caused by chronic hepatitis B is in the decline. The most common complications were abdominal effusion and infection, which were on the rise.
    The changes of platelet parameters and coagulation indexes in patients with cirrhosis and their correlation with upper gastrointestinal bleeding
    SU Xiao-hong, LI Jing-bo
    2023, 28(10):  1171-1174. 
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    Objective To study on the changes of platelet parameters and coagulation indexes in patients with cirrhosis and their correlation with the incidence of upper gastrointestinal bleeding. Methods A retrospective analysis was performed on the medical records of 45 patients with cirrhosis complicated with upper gastrointestinal bleeding admitted from January 2020 to January 2021 (group A), 57 patients with cirrhosis without upper gastrointestinal bleeding (group B), and 49 normal people who received physical examination during the same period of time (group C). The levels of serum platelet count (PLT), mean platelet volume (MPV), platelet volume ratio (PCT), platelet distribution width (PDW), activated partial thrombin time (APTT), prothrombin time (PT), thrombin time (TT) and fibrinogen (FIB) in the three groups were compared, the correlation between serum PLT, MPV, PCT, PDW, APTT, PT, TT, FIB and upper gastrointestinal bleeding was analyzed by Pearson correlation analysis. Results The levels of PLT, MPV, PCT, and PDW were (301.16±50.24)×109/L, (8.37±1.34) fL, (0.25±0.06)%, and (19.00±1.27)% in group A, which were significantly higher than those of (330.03±55.28)×109/L, (9.38±1.50) fL, (0.35± 0.10)%, and (22.02±1.49)% in group B, and (200.15±40.30)×109/L, (7.18±1.19)fL, (0.18±0.03)%, and (16.36±1.02)% in group C. The levels of PLT, MPV, PCT, PDW in group A were significantly higher than those in group C, the difference were statistically significant (P<0.05); the TT levels in groups A and B were (17.35±0.72)s and (15.25±0.64)s, respectively, which were significantly lower than that of (19.78±1.03)s in group C, The APTT, PT, and FIB levels were (33.15±5.30)s, (12.38±1.50)s, and (4.52±0.74)s in group A, (40.03±6.28)s, (14.37±2.34)s, and (5.66±0.87)s in group B, all were significantly higher than those of (27.16±4.24)s, (11.18±1.09)s, and (3.36±0.40)s in group C. The APTT, PT, and FIB levels in group A were significantly lower, whereas the TT level was significantly higher than those in group B, the differences were statistically significant (P<0.05); Pearson correlation analysis showed that the incidence of upper gastrointestinal hemorrhage was inversely correlated with TT (r=-0.762, P<0.05), whereas positively correlated with PLT, MPV, PCT, PDW, APTT, PT and FIB levels (r=0.618, 0.391, 0.400, 0.537, 0.451, 0.328, and 0.694, respectively, P<0.05). Conclusion The changes of platelet parameters and coagulation indexes in patients with cirrhosis can be used to evaluate the degree and tendency of upper gastrointestinal bleeding, and the monitoring of aboval indexes is of great clinical significance for predicting upper gastrointestinal bleeding.
    Incidence of iron deficiency anemia in patients with compensatory and decompensated liver cirrhosis and its impact on clinical outcomes
    CHEN Feng-juan, GONG Jian-tao, YANG Xiao-jun, WANG Zheng-qiu
    2023, 28(10):  1175-1178. 
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    Objective To analyze the incidence of iron deficiency anemia and its influence on clinical outcomes in patients with compensatory and decompensated liver cirrhosis. Methods We conducted a retrospective analysis of cirrhosis patients with hepatitis B who were admitted to our hospital from February 2010 to May 2022. The patients were divided into compensatory stage and decompensated stage according to Child-Pugh classification of liver function. Serum transferrin and hemoglobin levels of all patients were collected, and the incidence of iron deficiency anemia was analyzed in both groups. The Chi-square test was used to compare the incidence of iron deficiency anemia between patients in the compensatory stage and those in the decompensated stage. The adverse outcomes of both groups were followed up to analyze the influence of iron deficiency anemia on the clinical outcomes of the two groups. Results A total of 189 cirrhosis patients with hepatitis B were included, comprising of 109 males and 80 females, with an age range of 32-68 years. Among them, 86 cases in the compensatory period, while 103 cases in the decompensated period. There were 14 cases (16.3%) and 88 cases (85.4%) of ascites in compensatory and decompensated patients, respectively, and the difference was statistically significant (P<0.05). In the compensatory period, there were 62 cases (72.1%) with no anemia, 16 cases (18.6%) with iron deficiency anemia, and 8 cases (9.3%) with anemia resulting from other causes. In the decompensated period, there were 37 cases (35.9%) with no anemia, 42 cases (40.8%) with iron deficiency anemia, and 24 cases (23.3%) with anemia resulting from other causes. The difference was statistically significant (P<0.05). The hemoglobin concentration, ferritin concentration, transferrin concentration and transferrin saturation in compensatory patients were (14.±2.4) g/dL, (161.1±23.1) mcg/L, (248.3±69.1) mg/dL and (34.6 3.1) mg/dL, respectively, which were significantly higher than those in decompensated patients [(11.3±2.8) g/dL, (138.4±27.2) mcg/L, (213.2±53.4) mg/dL and (29.7±3.7) mg/dL, P<0.05]. The difference in the incidence of anemia between decompensated and compensated patients with hepatitis B cirrhosis was statistically significant (P<0.05). Furthermore, the incidence of iron deficiency anemia in the decompensated period was significantly higher than that in compensated patients with hepatitis B cirrhosis (P<0.05). The hemoglobin concentration, ferritin concentration, transferrin concentration and transferrin saturation in patients without anemia were (13.7±2.8) g/dL, (165.1±27.1) mcg/L, (251.1±71.2) mg/dL and (36.8±4.2) mg/dL, respectively, which were significantly higher than those in patients with decompensation[(10.4±2.3) g/dL, (135.2±26.5) mcg/L, (221.2±57.8) mg/dL and (29.7±3.1) mg/dL, P<0.05]. During the follow-up, 44 patients in the compensatory period progressed to decompensated period, among which 16 patients developed iron deficiency anemia. There were 56 cases with adverse outcomes in the decompensation period, including 21 cases with massive ascites, 10 cases with hepatorenal syndrome, 5 cases with severe hepatic encephalopathy, 13 cases with varicose veins bleeding and 7 cases with liver failure. Among the patients with adverse outcome in the decompensation period, 45 cases had iron deficiency anemia. In the compensatory and decompensated patients, patients with iron deficiency anemia were more likely to have adverse clinical outcomes (P<0.05). Conclusion The incidence of iron deficiency anemia is higher in patients with hepatitis B decompensated cirrhosis. When iron deficiency anemia is present, patients with compensatory and decompensated hepatitis B cirrhosis are prone to adverse clinical outcomes.
    Liver Cancer
    Comparative study of enhanced CT and magnetic resonance imaging in the diagnosis of primary clear cell carcinoma in liver
    YE Ying, YANG Jiao, WU Shi-chen
    2023, 28(10):  1179-1181. 
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    Objective To compare enhanced CT and magnetic resonance imaging (MRI) in the diagnosis of primary clear cell carcinoma in liver (PCCCL). Methods A total of 69 suspected PCCCL patients admitted to Suzhou Hospital of Integrated Traditional Chinese and Western Medicine from May 2020 to May 2022 were selected. All patients underwent enhanced CT and MRI examinations. The imaging features of enhanced CT and MRI were analyzed, and the detection efficacies of PCCCL by enhanced CT and MRI was compared by Kappa consistency analysis based on the pathological diagnosis of PCCCL. Results Among 69 suspected PCCCL patients, 59 were confirmed to have PCCCL after pathological diagnosis. The detection rate of enhanced CT for PCCCL was 62.32%, which hadn’t significant difference when compared with that of 75.36% by MRI (P>0.05). The total coincidence rate of enhanced CT in the diagnosis of PCCCL was 72.88% (43/59). After Kappa consistency analysis, the detection rate of enhanced CT had a good consistency with the pathological gold standard for the diagnosis of PCCCL (Kappa=0.438, P<0.05). The total coincidence rate of MRI diagnosis for PCCCLwas 88.14% (52/59), also shown good consistency with the pathological diagnosis (Kappa=0.714, P<0.05). The coincidence rate between MRI and gold standard in the diagnosis of PCCCL was 88.14%, which was higher than that of CT plain scan (72.88%) (χ2=4.374, P=0.036). The Yoden index of enhanced CT and MRI were 0.145 and 0.414, respectively. The sensitivity of MRI for the diagnosis of PCCCL was higher than that of enhanced CT, and the rate of misdiagnosis was lower than that of enhanced CT (P<0.05). Conclusion Both enhanced CT and MRI have certain reference value for the diagnosis of PCCCL, among which MRI has higher sensitivity and may reduce the occurrence of misdiagnosis.
    Effect of visceral adipose tissue index on hepatocellular carcinoma patients with non-cirrhosis viral hepatitis
    LI Bo-wen, FEI Su-juan
    2023, 28(10):  1182-1185. 
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    Objective To analyze the risk factors of hepatocellular carcinoma (HCC) in non-cirrhosis patients infected with hepatitis B virus (HBV) and hepatitis C virus (HCV). Methods A total of 212 cases of HBV/HCV-infected HCC patients admitted to Xuzhou Medical University Affiliated Hospital were collected from January 2019 to June 2022. The cases included 143 males and 69 females, with an average age of (65.0±11.8) years. The diagnosis of HCC met the requirements. According to the previous literature, when the FIB-4 index was >3.25, patients with chronic liver disease could be diagnosed with cirrhosis. Based on this, the cases were divided into a non-cirrhosis group and a cirrhosis group. The clinical data of HBV-HCC, HCV-HCC, non-cirrhosis and cirrhosis groups were compared, and multivariate logistic regression analysis was used to identify the factors influencing HCC in non-cirrhosis patients infected by HBV or HCV. Results The average age of HBV-HCC patients was 61.2±11.8 years, with 23 cases (15.9%) having diabetes and 41 cases (28.3%) having hypertension. The Child-Pugh score and FIB-4 index for HBV-HCC patients were 9.0±1.2 and 3.4±0.6, respectively. In comparison, HCV-HCC patients had an average age of 70.1±10.7 years, with 19 cases (28.3%) having diabetes and 29 cases (43.3%) having hypertension. The Child-Pugh score and FIB-4 index for HCV-HCC patients were 5.7±0.9 and 6.2±1.1, respectively. These differences were found to be statistically significant (P<0.05). Additionally, there was a statistically significant difference in tumor staging between HBV-HCC and HCV-HCC patients (P<0.05). Among both non-cirrhosis and cirrhosis patients with HBV-HCC, the visceral adipose tissue index (VATI), Child-Pugh score and HbA1c were significantly different (P< 0.05). Similarly, there were significant differences in sex, VATI, Child-Pugh score and HbA1c between non-cirrhosis and cirrhosis patients with HCV-HCC (P<0.05). Multivariate logistic regression analysis showed that age, male, VATI, HbA1c, hypertension and HBV infection were independent risk factors for HCC in non-cirrhosis patients (P<0.05). Conclusion High VATI, male gender, diabetes, hypertension, and HBV infection are risk factors for HCC in non-cirrhosis patients. It is clinically significant to screen for HCC in patients with non-cirrhosis.
    Analysis of serum levels and correlation of miR-504, miR-200a and IL-24 in patients with HBV-related hepatocellular carcinoma
    CHENG Xiao-mei1, TIAN Hong2, LI Xiang1, YANG Jie3
    2023, 28(10):  1186-1190. 
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    Objective To investigate the serum levels of micro-RNA (miR) 504, miR-200a and IL-24, and thier correlation in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma. Methods We selected patients with HBV-related hepatocellular carcinoma who were treated in our hospital from February 2020 to February 2023 and met the inclusion and exclusion criteria as the observation group (N=60). The control group (N=60) consisted of patients with chronic HBV infection in the same period. The general data of the two groups were compared. The levels of serum miR-504 and miR-200a were measured by real-time fluorescence quantitative PCR, and the level of serum IL-24 was measured by enzyme-linked immunosorbent assay (Elisa). The risk factors associated with hepatocellular carcinoma in patients with chronic HBV infection were screened by correlation analysis and binary Logistic regression analysis. The diagnostic value of these factors was evaluated by the receiver working characteristic curve (ROC) and the area under the curve. Results The average HBV DNA load in the observation group was significantly higher than that in the control group (21.87 ±4.64 vs 13.61 ±3.36, P<0.05), but there was no significant difference in other general data. The serum levels of miR-504 (0.75±0.16 vs 1.09±0.20), miR-200a (0.79±0.24 vs 1.01±0.28) and IL-24 (187.65±19.04 vs 213.25±20.27) in the observation group were significantly lower than those in the control group. Correlation analysis and Logistic regression analysis showed that the decrease of serum miR-504, miR-200a and IL-24 levels were independent risk factors for hepatocellular carcinoma in patients with chronic HBV infection(P<0.05). ROC curve analysis showed that serum miR-504 had the highest diagnostic value for hepatocellular carcinoma in patients with chronic HBV infection (AUC=0.898, P<0.05). Conclusion The levels of miR-504, miR-200a and IL-24 in the serum of patients with HBV-related hepatocellular carcinoma showed a significant decrease. Moreover, each of these indicators exhibited a negative correlation with the occurrence of hepatocellular carcinoma in patients with chronic HBV infection. These findings suggest that the measurement of these indicators had a certain diagnostic value for HBV-related hepatocellular carcinoma.
    Observation on postoperative recurrence of hepatocellular carcinoma patients with different miR-148a mRNA relative expression
    CHEN Yan1, ZHANG Jian-hua1, CHEN Jian1, YANG Yang2
    2023, 28(10):  1191-1194. 
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    Objective To explore the value of the relative expression level of micrornA-148A (miR-148a) mRNA in predicting the early postoperative recurrence of primary liver cancer. Methods The study included 115 patients with primary liver cancer from the Department of Oncology, Huai'an Hospital, Huai′an City, between March 2018 and June 2021. All patients underwent radical resection of liver cancer and were followed up for 12 months. Based on the prognosis, they were divided into a recurrent group (24 cases) and a non-recurrent group (91 cases). Gender, age, complications (hypertension, hyperlipidemia, diabetes), tumor status (location, number, diameter), liver function child classification, operation time, intraoperative bleeding, vascular invasion, tumor capsule completeness, and serological indicators were compared between the two groups. The relative expression of miR-148a mRNA in liver cancer tissue was detected by qRT-PCR after operation. Results In both the recurrence group and the non-recurrence group, there were 10 (41.67%) and 16 (17.58%) cases of multiple tumors, 17 (70.83%) and 36 (39.56%) cases of vascular invasion, 16 (66.67%) and 39 (42.86%) cases of incomplete tumor envelope, respectively. The relative expression level of miR-148a mRNA in the two groups was (0.23±0.05) and (0.52±0.11), respectively. Comparing with the non-recurrence group, the recurrence group had a higher proportion of patients with multiple tumors, vascular invasion and incomplete tumor envelop, as well as a lower relative expression level of miR-148a mRNA (P<0.05). According to ROC analysis, the optimal cutoff value for the relative expression level of miR-148a mRNA in predicting the recurrence of liver cancer after radical resection in patients with liver cancer was 0.329. The area under the curve was 0.821 (95% CI: 0.732-0.910), with a sensitivity of 0.742 and specificity of 0.707 (P<0.05). Multivariate logistic regression analysis showed that tumor number, vascular invasion, tumor envelope and miR-148a mRNA were risk factors for recurrence of hepatocellular carcinoma after radical resection (P<0.05). Conclusion There are several risk factors for recurrence of liver cancer after radical resection, including the number of tumors, vascular invasion, tumor envelope, and reduced relative expression of miR-148a mRNA in liver cancer tissue. The relative expression of miR-148a mRNA can be used as a predictor of recurrence of liver cancer after radical resection.
    Application of MRI and contrast ultrasound in the diagnosis and differentiation of hepatocellular carcinoma and hemangioma
    XIE Yu-wen1, ZHANG Quan-lu1, WANG Ping-ping2
    2023, 28(10):  1195-1198. 
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    Objective To explore the practical utility of magnetic resonance diffusion-weighted imaging and contrast-enhanced ultrasound in the diagnosis and differentiation of hepatocellular carcinoma and hemangioma. Methods We retrospectively analyzed the clinical data of 86 patients with substantial hepatic space-occupying lesions from January 2018 to May 2020. Pathological examination confirmed 46 cases of hepatocellular carcinoma and 40 cases of hepatic hemangioma. MRI and contrast-enhanced ultrasound examinations were conducted to observe the imaging appearances of hepatocellular carcinoma and hemangioma. Additionally, contrast-enhanced ultrasound parameters (start time, peak time, and regression time) and MRI parameters (ADC, PF) of hepatocellular carcinoma and hemangioma were evaluated. The start of enhancement time, peak time, regression time, ADC, PF AUC, sensitivity, specificity, and Youden index were assessed for the diagnosis of hepatocellular carcinoma and hemangioma. Results The start time, peak time, regression time, ADC and PF of hepatocellular carcinoma patients were (10.34±1.89) s, (22.98±8.32) s, (36.85±12.32) s, (1.37±0.32) ×10-3 s/mm2, and (23.25±3.32) %, respectively. The initial enhancement time, peak time, regression time, ADC, PF were (14.59±4.25) s, (35.06±10.65) s, (52.05±15.75) s, (2.18±0.65) ×10-3 s/mm2, (30.18±5.98) %, respectively. The differences were statistically significant (P<0.05). Analysis of the ROC curve showed that the AUCs of start time, peak time, regression time, ADC, and PF in the diagnosis and differentiation of hepatocellular carcinoma and hemangioma were 0.746, 0.786, 0.747, 0.828, 0.833, P<0.05. The sensitivity was 100.00%, 100.00%, 95.70%, 58.70%, 71.70%, respectively. The specificity was 50.00%, 47.50%, 50.00%, 92.50% and 85.00%, respectively. Conclusion Both magnetic resonance diffusion-weighted imaging and contrast-enhanced ultrasound can provide reference information for the diagnosis and distinguishing between hepatocellular carcinoma and hemangioma. However, MRI is considered to be more applicable in this regard.
    Value of magnetic resonance combined with dual-source CT in the differential diagnosis of hepatic hemangioma and hepatocellular carcinoma
    HAN Xue-feng, JING Gui-yin, GE Shang
    2023, 28(10):  1199-1203. 
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    Objective To investigate the value of magnetic resonance imaging (MRI) combined with dual-source CT three-phase enhanced scanning in the differential diagnosis of hepatic hemangioma (HHE) and hepatocellular carcinoma (HCC). Methods 42 patients with HHE (51 lesions in total) and 60 patients with HCC (65 lesions in total) admitted to the hospital from April 2020 to November 2022 were selected as subjects. All patients underwent MRI and dual-source CT three-phase enhanced scanning. The imaging data of lesions obtained from plain CT scan were compared between patients with HHE and HCC. The gold standard for analysis was pathological diagnosis, which was used to assess the consistency of MRI, dual-source CT three-phase enhanced scanning and their combination with pathological diagnosis. Receiver operating characteristic curve (ROC) was plotted, and the area under the curve (AUC) was used to evaluate the diagnosis value of MRI, dual-source CT and their combination in distinguishing between HEE and HCC. Results MRI detection results: 46 lesions were detected in 42 HHE patients, with a detection rate of 90.20%; 60 lesions were detected in 60 HCC patients, with a detection rate of 92.31%. Results of dual-source CT three-phase enhanced scanning: 41 lesions were detected in 42 patients with HHE, with a detection rate of 80.39%; 54 lesions were detected in 60 patients with HCC, with a detection rate of 83.08%. The number of circular lesions, the degree of border indistinctness, and the number of single lesions in HCC patients were higher than those in HHE patients (P<0.05). There was no significant difference in lesion density between HHE and HCC patients (P>0.05).The total coincidence rate of MRI in distinguishing HEE from HCC compared to pathological diagnosis was 91.38%. The Kappa consistency test indicated that there was a good consistency (Kappa=0.821, P<0.05) between MRI and pathological diagnosis in identifying HHE and HCC. The total coincidence rate of three-phase dual-source CT scanning in distinguishing HEE from HCC was 81.90%. The Kappa consistency test, indicated that there was a general consistency (Kappa=0.714, P<0.05) between dual-source CT three-phase enhanced scanning and pathological diagnosis in identifying HHE and HCC. The total coincidence rate of the combined examination in distinguishing HEE from HCC was 96.55%. The Kappa consistency test indicated that there was a good consistency (Kappa=0.895, P<0.05) between the combined examination and pathological diagnosis in identifying HHE and HCC. ROC curve results showed that the AUC values of MRI, dual-source CT three-phase enhanced scanning and the combined diagnosis of HEE and HCC were 0.913, 0.817 and 0.965, respectively (P<0.05), and the AUC value of MRI was higher than that of dual-source CT three-phase enhanced scanning (P<0.05). The AUC value of combined diagnosis was higher than that of single diagnosis (P<0.05). Conclusion MRI and dual-source CT are valuable tools for distinguishing between HHE and HCC, and their combination has a higher value in the differential diagnosis.
    Liver Failure
    Pathogen characteristics and prognosis of pulmonary infection in hospitalized patients with hepatitis B liver failure
    XU Xiao-guo, SI Jin-mei, CHEN Min, YING Xue-min
    2023, 28(10):  1204-1207. 
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    Objective To investigate the pathogenic characteristics of pulmonary infection in hospitalized patients with hepatitis B liver failure, as well as the factors associate with poor prognosis. Methods A total of 103 patients with hepatitis B liver failure, who were hospitalized in Shuyang Hospital Affiliated to Xuzhou Medical University from January 2019 to January 2021, were selected as the study subject. All patients received routine medical support treatment and routine antiviral therapy for hepatitis B virus (HBV) after admission. After hospitalization, all patients were followed up for 1 year with regular check-ups every 3 months. The patients were divided into two groups based on their prognosis: the good prognosis group and the poor prognosis group. During hospitalization, the patient were closely monitored for the occurrence of pulmonary infection. Pathogenic culture was conducted for those who developed pulmonary infection to identify the distribution of pathogenic bacteria. Additionally, baseline data information including age, gender, body mass index, liver failure classification, presence of family history of hepatitis B, MELD score, presence of lung infection, electrolyte disorders were compared between the two groups. Laboratory indicators such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), platelet count (PLT), urea nitrogen (BUN), creatinine (SCR), hepatitis B virus DNA (HBV DNA) and HBeAg were also compared. Furthermore, multifactor logistic analysis was conducted to identify the risk factors associated with poor prognosis in patients. Results Among the 103 patients included in the study, 20 (19.4%) patients developed pulmonary infection during hospitalization. All 20 patients with pulmonary infection underwent pathogenic culture, and 57 strains of pathogenic bacteria were isolated. These included 8 strains of Gram positive bacteria (14.0%), 19 strains of Gram negative bacteria (33.3%), and 30 strains of fungi (52.6%). The proportion of patients aged ≥ 60 years in the poor prognosis group was significantly higher than that in good prognosis group (72.9% vs 40.9%, P<0.05). The proportion of patients with MELD score>18 in the poor prognosis group was significantly higher than that in the good prognosis group (57.6% vs 34.1%, P<0.05). The proportion of pulmonary infection in poor prognosis group was significantly higher than that in good prognosis group (30.5% vs 4.6%, P<0.05). The proportion of electrolyte disturbance in poor prognosis group was significantly higher than that in good prognosis group (25.4% vs 6.8%, P<0.05). Multivariate logistic analysis showed that age ≥ 60 years, MELD score>18, pulmonary infection, and electrolyte disorder were identified as the risk factors for poor prognosis (P<0.05). Conclusion Pulmonary infection is one of the risk factors for poor prognosis in patients with hepatitis B liver failure. Patients with pulmonary infection during hospitalization should be analyzed and treated with effective broad-spectrum antibiotics in a timely manner to improve their prognosis.
    Probiotic treatment in acute-on-chronic liver failure: insights into gut microbiota and patient prognosis
    CHENG Yan-ming, TIAN Zhi-ao, LI Hui
    2023, 28(10):  1208-1211. 
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    Objective To evaluate the impact of probiotic adjuvant therapy on the gut microbiota compostion and clinical prognosis of patients with acute-on-chronic liver failure (ACLF). Methods In our hospital, 84 patients diagnosed with ACLF were randomly divided into two groups. The control group received conventional symptomatic treatment, while the observation group was treated with both conventional treatment and gut microbiota. The bacterial distribution, levels of immune factors [CD4+, CD8+], inflammatory factors,and liver function indicators [ALT, AST, GGT, TBil] between the two groups were compared. Both groups were followed up for 1 year to observe their survival rates. Results Before treatment, the number of lactobacillus and bifidobacteria in the observation group was (6.9±0.8) log10nCFU/g, and (5.5±0.9) log10nCFU/g, respectively, while the counts of Escherichia coli and coliforms were (9.2±1.4) log10nCFU/g (8.8±0.4) log10nCFU/g, respectively. After treatment, the counts of lactobacilli and bifidobacteria were (8.4±0.6) log10nCFU/g, and (9.7±0.8) log10nCFU/g, respectively, whereas the counts of Escherichia coli and coliforms were (5.9±0.5) log10nCFU/g, and (6.1±0.4) log10nCFU/g, respectively. For the control group, before treatment, the counts of lactobacillus and bifidobacteria were(6.8±0.7) log10nCFU/g and (5.4 ± 0.8) log10nCFU/g, respectively., The counts of Escherichia coli and coliforms were (9.0±1.3) log10nCFU/g, and (8.7 ± 0.4) log10nCFU/g, respectively. Post-treatment, lactobacilli and bifidobacteria counts were(7.7±0.6) log10nCFU/g, (7.6±0.8) log10nCFU/g, respectively, while Escherichia coli and coliforms counts were (6.8±0.5) log10nCFU/g and (7.2±0.5) log10nCFU/g, respectively. Post-treatment counts of lactobacilli and bifidobacteria in the observation group were significantly higher than their pre-treatment values and those in the control group. Conversely, the counts of Escherichia coli and coliforms were significantly lower post-treatment compared to pre-treatment and those in the control group (P<0.05). Before treatment, the levels of CD4+, IL-6 and IL-10 in the observation group were (32.8±5.4)%, (87.1±11.2) pg/mL and (31.8±4.4) pg/mL respectively. After treatment, the levels of GGT, alt, AST and TBil were(49.2±11.0)U/L, (59.6±9.2)U/L, (45.2±9.1)U/L, (158.6±18.6)μmol/L respectively. In the control group, the levels of GGT, ALT, AST and TBil before treatment were (62.04±11.18) U/L, (84.5±11.5) U/L, (97.5±21.5) U/L, (314.5±20.3) U/L, respectively μmol/L; After treatment, the levels of GGT, AST, AST and TBil were (53.7±12.3) U/L, (62.5 ±10.9) U/L, (48.5±9.2) U/L and (162.8±20.3)μmol/L, respectively. After treatment, liver function indices in both groups were significantly lower than their pre-treatment levels in the same group (P<0.05). The 1-year cumulative survival rate was 83.33% (35/42) in the observation group compared to 78.57% (33/42) in the control group. Conclusion The application of probiotics in ACLF patients can suppress the proliferation of harmful intestinal bacteria, enhance immune and liver functions, and potentially lead to better clinical outcomes.
    Viral Hepatitis
    Disruption of HBV immune tolerance in mice using CD20 monoclonal antibody: investigating the role of regulatory B cells in hepatitis B
    LIU Zhong-tian, ZHANG Jia-jing, LIN Tao-fa, SHU Dan, WANG Shao-yang
    2023, 28(10):  1212-1214. 
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    Objective To study the role of Regulatory B cells(Bregs) in the Pathogenesis of chronic hepatitis B by Rituximab destroying the immunological tolerance state of HBV infection in mice. Methods In a mouse model of chronic HBV infection, the dynamics of Bregs populations were monitored using Flow cytometry. Additionally, serum IL-10 levels, liver function, and coagulation parameters were assessed. The correlation between Bregs, IL-10, and liver function was further analyzed. Results In mice treated with Rituximab, the percentage of Bregs was significantly reduced in the liver, spleen and peripheral blood compared to untreated mice [0.54(0.49,0.71)% vs 1.34(1.15,1.54)%;3.19(2.90,3.57)% vs 4.75(3.92,5.32)%;2.50(2.29,2.64)% vs 3.35(3.07,3.58)%; all P<0.05]. Serum IL-10 levels in Rituximab-treated mice were also significantly decreased[21.51(14.70,28.28)pg/ml vs 32.87(27.76,35.82)pg/mL,P<0.05]. Furthermore, there was a positive correlation between changes in precentages of Bregs and IL-10 levels in the experimental group(r=0.73,P<0.05;r=0.74,P<0.05;r=0.71,P<0.05). In the experimental group, elevated ALT and AST levels wereobserved compared to the control group, and these increases were inversely correlated with IL-10 levels. Conclusion Bregs play an important role in the pathogenesis of chronic hepatitis B and suppress inflammatory activity by secreting IL-10.
    Clinical and virological investigation of occult hepatitis B virus infection in patients with autoimmune hepatitis
    WANG Mei-juan, XIE Qun, WANG Hua-yu
    2023, 28(10):  1215-1218. 
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    Objective To investigate the prevalence of occult hepatitis B virus(HBV) infection (OBI) in autoimmune hepatitis (AIH) patients and to elucidate its virological characteristics. Methods From January 2015 to August 2022, A total of 69 patients with AIH admitted to hospital were selected, including 7 males and 62 females, aged 50 (30, 73) years. The diagnostic criteria for AIH were rigorously adhered to, meeting all established requirements. Comprehensive assays were performed to evaluate blood biochemical indices, serological markers, and autoantibodies, HBV DNA was isolated, and the S region (nucleotide sites: 84-205) was amplified using semi-nested PCR techniques to generate the target sequence. Following electrophoretic verification, the PCR products were recovered, purified, and sequenced. The resultant sequences were uploaded to the HBVseq database for nucleotide substitution analysis and genotyping. Results In our cohort of 69 AIH patients, the prevalence of OBI was 20.3%, with 14 positive and 55 negative cases. A statistically significant higher prevalence of HBcAb, HBsAb and HBeAb was noted among the OBI-positive cases (35.7%) compared to OBI-negative cases (12.7%) (P<0.05). However, no significant differences were observed in liver function, autoantibodies, or cirrhosis between the two groups (P>0.05). To explore the relationship between OBI status and HBV genotypic variations, we analyzed nucleotide substitution sites within the S region. Among the OBI-postive AIH cases, genotype B was present in 42.8% (6 cases), ad genotype C 57.2%(8cases Notably, the nucleotide substitution frequencies within the S region differed significantly between genotypes B(0.8%) and C(9.8%)(P<0.05). Calculated overall nucleotide substitution frequencies for the two groups were 0.1% and 1.2%, respectively, which was also statistically significant (P<0.05). Conclusion In our studu involving 68 AIH patients, a 20.3% prevalence of OBI is identified. Notably, the incidence of OBI in AIH patients- correlated significantly with nucleotide substitution or mutation within the S region of the HBV genome. These findings suggest that such genomic alterations may serve as clinically relevant predictive markers.
    Non-alcoholic Fatty Liver Disease
    Clinical effects of ezetimibe on the treatment of patients with nonalcoholic fatty liver disease
    SHEN Guo-jun, HUANG Li-fang, HE Cui-xia, HUANG Jie, ZENG Gang, LI Ming
    2023, 28(10):  1219-1221. 
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    Objective To evaluate the clinic efficacy of ezetimibe in treating patients with nonalcoholic fatty liver disease(NAFLD). Methods From April 2020 to october 2021,56 patients with NAFLD were selected and randomly divided into experimental group and control group. The experimental group was given ezetimibe in addition to the treatment received by the control group, in order to regualte cholesterol metabolism. The treatment course lasted 48 weeks. Clinical effficacy, serum biochemical indicators, and liver stiffness values were observed and compared before and after the treatment. Results After 48 weeks of treatment, the total curative effects in the experimental group and control groups were 92.85% and 67.85%, respectively. The difference was statistically significant (P< 0.05). The levels of ALT, AST, γ-GT, TC, TG, LDL-C in the experimental group were lower than those in the control group, with the differences being statistically significant (P<0.05). The liver stiffness value of the experimental group was lower than that of the control group after treatment, showing a significant difference between the two groups (6.21±0.99 kPa vs. 6.79±1.05 kPa, P<0.05). Conclusion Ezetimibe, by regulating cholesterol metabolism, can enhance liver function indices and reduce liver stiffness, thereby improving the clinical outcomes for patients with NAFLD.
    Other Liver Diseases
    Inflammatory markers and risk factors for hepatic dysfunction in scrub typhus
    YANG Dong1, LIU Rui-xia1, WU Hai-yan1, HOU Rui-jun1, YAN Jing-jing2
    2023, 28(10):  1222-1226. 
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    Objective To investigate the inflammation markers and associated risk factors for moderate-to-severe hepatic dysfunction in patients with tsutsugamushi disease presenting with liver impairment. Methods A retrospective study was conducted on 143 hospitalized patients diagnosed with scrub typhus at Nanjing Drum Tower Hospital Group Suqian Hospital from January 2016 to December 2020. Based on alanine aminotransferase levels, patients were categorized into normal liver function, mild liver function impairment, and moderate-to-severe liver function impairment groups. Statistically significant items underwent Multivariate logistic regression analysis to determine independent risk factors for liver impairment. Results In patients with Tsutsugamushi disease, there were no statistically significant differences in gender, age, and duration of diabetes among those with normal liver function, mild liver fuction impairment, and moderate to severe liver function impairment (P>0.05). The biochemical markers, specifically total bilirubin levels (11.12±5.66, 12.77±12.55, 10.78±3.93 μmol/L, χ2=0.226), showed no statistical difference (P>0.05). Patients with moderate to severe liver function impairment had a significantly longer hospital stay (12.67±5.25 d), and elevated levels of lymphocyte count (3.19±1.51×109/L), alanine aminotransferase (190.45±97.66 U/L), aspartate aminotransferase (142.24±95.94 U/L), glutamyl transpeptidase (152.38±133.05 U/L), alkaline phosphatase (144.96±82.29 U/L), β2- microglobulin (7.17±9.13 mg/L ), fibrinogen (3.60±0.54 g/L ) and C-reactive protein (44.61±17.10 mg/L ). These values were significantly higher compard to the normal liver function group and mild liver duction impairment group. The differences were statistically significant (β2 values provided, P<0.05). Multivariate logstic regression analysis indicated that white blood cell count(OR=0.536, 95% CI: 0.348～0.826), lymphocyte count (OR=3.457, 95% CI: 1.736~6.884 ), platelet count (OR=0.979, 95% CI: 0.960~0.998), fibrinogen (OR=5.275, 95% CI: 1.686~16.507), and β2-microglobulin (OR=2.011, 95% CI: 1.169~3.460) were independent risk factors for the occurrence of moderate to severe liver fuction impairment in Tsutsugamushi disease patients(P<0.05). The area under the ROC curve was highest for lymphocyte count (0.678), followed by fibrinogen (0.674), and β2-macroglobulin (0.672), It was lowest for white blood cell count (0.337), and platelet count (0.281). Conclusion The combined assessment of white blood cell count, lymphocyte count, platelet count, fibrinogen, and β2-microglobulin levels in patients with Tsutsugamushi disease provides insights into the extent of liver function damage. This combined approach holds significant clinical value for evaluating the progression of the disease.
    Associations between DCR3, CRP/Alb, Trx and infectous shock in pyogenic liver abscess
    GU Li-hua, HE Jing-jing, YUan Jia-jian, SITU Xia-hao, ZHANG Wen-jing, ZHAO Xia
    2023, 28(10):  1227-1230. 
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    Objective To investigate the correlation between inducible Decoy Receptor 3 (DCR3), the C-reactive protein to albumin ratio (CRP/Alb), and thioredoxin (Trx) in patients with pyogenic liver abscess, especially in those with concurrent infectious shock. Methods From January 2019 to December 2021,,100 patients with pyogenic liver abscess admitted to the hospital were prospectively selected for our study, and the expression levels of DCR3, CRP/Alb, and Trx in all patients were assessed. Based on the presenece or absence of infectous shock within 1 week of admission, patients were categorized into either the ‘occurrence group’ or the ‘non-occurrence group’. The clinical data and laboratory indices between these two groups were compared. Finally, the correlation between DCR3, CRP/Alb, Trx and the incidence of infectious shock in these patients was analyzed. Results Out of 100 patients with pyogenic liver abscess, 21(21%) experienced infectious shock.. The levels of DCR3, CRP, CRP/Alb, and Trx were notably higher in the occurred group compared to the non-occurred group (t=3.626、6.115、4.182、3.572,P<0.05); Logistic regression analysis indicated that DCR3, CRP/Alb and Trx could be potential risk factors for infectious shock complications in patients with pyogenic liver abscess (OR=3.425、2.794、1.137, P<0.05). Through point biserial correlation analysis, DCR3, CRP/Alb, and Trx demonstrated a positive correlation with infectious shock arsing from pyogenic liver abscess(r=0.342、0.391、0.340, P<0.05). Furthermore, the ROC curve showed that DCR3, CRP / Alb, and Trx had predicted AUC values of 0.713,0.740, and 0.719 for septic shock, indicating their potential as predictive value. Conclusion DCR3, CRP/Alb, and Trx are strongly associated with the onset of infectious shock in patients with pyogenic liver abscess. They can be utiilized to predict and assess the likelihood of infectious shock in such patients.