Objective The aim of this study was to investigate impacting factors on early virological response (EVR) in patients with serum HBeAg-negative chronic hepatitis B (CHB) undergoing pegylated interferon α-2b (PEG-IFN-α2b) therapy. Methods This clinical trial enrolled 156 serum HBeAg-negative patients with CHB in our hospital between January 2018 and January 2024, and all received PEG-IFNα-2b therapy. Serum HBV markers were detected by ELISA, serum HBV DNA loads were assayed by PCR, and peripheral blood lymphocyte subsets were determined by FCM. Multivariate Logistic regression analysis was applied to explore factors affecting EVR, which was evaluated at end of 12 week antiviral treatment. Results By end of 12 week treatment, the EVR was obtained in 62 cases(39.7) in our series; concomitant fatty liver percentage, peripheral blood CD8⁺ cell percentage, serum HBsAg level and HBV DNA load in patients with EVR were 14.5%, (33.4±4.2)%, (3.6±0.5)lgIU/ mL and (6.0±1.2)lgIU/ mL, all significantly lower than [29.8%, (38.6±4.3)%, (8.3±2.7)lgIU/ mL and (7.5±1.4)lgIU/ mL, respectively, P<0.05], while serum ALT level, peripheral blood CD3⁺ and CD4⁺ cell percentages were (143.3± 5.1)(U/ L, (46.3±5.1)% and (31.1±4.3)%, all significantly higher than [(46.1±5.6)(U/ L, (40.0±4.8)% and (25.2±3.7)%, respectively, P<0.05] in those without EVR; multivariate Logistic regression analysis showed that baseline serum HBsAg levels, HBV DNA loads and T lymphocyte subsets were the independent factors impacting EVR acquirement in patients with serum HBeAg-negative CHB(P＜0.05). Conclusion Some host and viral factors could impact virological response in patients with CHB undergoing Peg-IFNα-2b antiviral treatment, which needs further investigation and might help clinicians making an appropriate antiviral strategy.

Objective The aim of this study was to investigate entecavir (ETV) in combination with Ruangan Sanjie prescription, a herbal medicine formula, in the treatment of patient with chronic hepatitis B (CHB). Methods A total of 124 patients with CHB were enrolled in this study between July 2022 and July 2024, and the recruited patients belonged to CTM liver-depression/spleen deficiency syndrome, and were randomly assigned to receive ETV in 62 cases in group A, or receive ETV and the herbal medicine combination in another 62 cases in group B for 48 weeks. The scores of main TCM syndromes, such as lateral thorax lumps, abdominal distension, fatigue due to anorexia and pale complexion were evaluated. Serum hyaluronic acid (HA), laminin (LN), IV collagen (IV-C) and III procollagen (PCIII) levels were detected by ELISA, and peripheral blood T lymphocyte subsets were determined by FCM. Results By end of 48-week of treatment, TCM lateral thorax lumps, abdominal distension, fatigue due to anorexia and pale complexion scores in group B were(1.4±0.8)points, (2.4±0.9)points, (2.1±0.9)points and (1.8±0.6)points, all much lower than [(2.7±1.2)points,(3.1±1.6)points,(2.9±1.1)points and (2.6±1.3)points, respectively P＜0.05] in group A;serum ALT and AST levels were much lower than in group A(P＜0.05); serum HA, LN, Ⅳ-C and PCⅢ levels were (62.9±15.2)μg/mL, (94.1±18.8)ng/mL, (78.6±12.7)ng/mL and (99.7±18.1)ng/mL, all significantly lower than [(85.7±17.9)μg /mL, (132.9±21.7)ng/mL, (112.9±18.2)ng/mL and (159.8±26.9)ng/mL,respectively, P＜0.05] in group A;percentages of peripheral blood CD3⁺ and CD4⁺ cells, and CD4⁺/CD8⁺ cell ratio were (68.1±5.3)%, (37.6±4.1)% and (1.3±0.4), all much higher than [(61.9±4.9)%, (32.4±3.8)% and (1.0±0.3),respectively P＜0.05] in group A;serum HBV DNA negative rates in the two groups were 96.8% to 95.2%,not significantly different (P>0.05). Conclusion Combination of ETV and herbal medicine, Ruangan Sanjie Prescription , in the treatment of patients with CHB could improve TCM syndromes, and even ameliorate liver fibrosis, which might be related to modulation of body immune system.

Objective The aim of this study was to investigate diagnostic efficacy of transient elastography (TE) with combination of fibrosis-4 index (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) in assessing significant liver fibrosis (SLF) in patients with chronic hepatitis B(CHB). Methods A total of 102 consecutive patients with CHB were enrolled in our hospital between January 2022 and October 2024, and all received liver biopsies, TE for liver stiffness measurement (LSM), routine blood tests to calculate FIB-4 and APRI. Multivariate Logistic regression analysis was applied to reveal influencing factors, and receiver operating characteristic curve (ROC) was used to evaluate diagnostic performance. Results Of the 102 patients with CHB, liver histo-pathological examination found liver fibrosis stage 0 (S0) in 11 cases, S1 in 25 cases and S2 or above (SLF) in 66 cases; LSM, FIB-4 and APRI in patients with SLF were (11.6±2.1)kPa, (1.6±0.4) and (0.6±0.1), all much higher than [(5.6±1.4)kPa, (1.3±0.5) and (0.4±0.1), respectively, P<0.05] in those without LF; multivariate Logistic regression analysis showed that LSM (OR:2.857,95%CI:1.048-7.783), FIB-4(OR:2.886, 95%CI:1.267-6.575) and APRI(OR:2.264, 95%CI:1.371-3.739) were all the independent risk factors for SLF in patients with CHB(P<0.05); ROC analysis demonstrated that the AUC was 0.930(95%CI:0.861-0.971), when LSM in combination with FIB-4 and APRI in predicting SLF, much superior to any parameter did alone (P<0.05). Conclusion TE in combination with FIB-4 and APRI could improve the diagnostic efficacy for SLF in patients with CHB.

Objective The aim of this study was to explore the diagnostic performance of serum tenascin-C (TN-C) level as well as gamma-glutamy transpeptidase-to-platelet ratio (GPR), aspartate transaminase-to-platelet ratio index (APRI),non-alcoholic fatty liver disease fibrosis score (NFS), fibrosis index based on four factors (FIB-4) and S index for liver fibrosis (LF) in patients with chronic hepatitis B (CHB). Methods A total of 163 patients with CHB were enrolled in our hospital between January 2021 and December 2024, and all underwent percutaneous liver biopsy. Serum and blood tests were routinely performed to calculate LF indexes. Serum TN-C level was detected by ELISA, the influencing factors of advanced liver fibrosis (ALF) was analyzed by multivariate Logistic regression analysis, and the diagnostic efficacy was evaluated by receiver operating characteristic (ROC) curves. Results Of the 163 patients with CHB, the liver histo-pathological examination found no LF in 50 cases, significant LF (SLF) in 52 cases and ALF in 48 cases; serum TN-C level, GPR, APRI, NFS, FIB-4 and S index in patients with ALF were (62.4±9.1)ng/mL, (0.6±0.2), (1.0±0.3), (-0.3±0.1), (3.1±0.7) and (1.2±0.2), all significantly higher than [(37.5±5.2)ng/mL, (0.2±0.1), (0.7±0.2), (-1.0±0.4), (0.8±0.2) and (0.4±0.1), respectively, P＜0.05] in patients with SLF; Logistic regression analysis showed that increased serum TN-C level as well as GPR, APRI, NFS, FIB-4 and S index were all the independent risk factors for ALF in patients with CHB (P＜0.05); the AUC was 0.915, with sensitivity of 98.4% and specificity of 61.8% when combination of serum TN-C level and LF indexes mentioned above in predicting ALF in patients with CHB. Conclusion The combination of serum TN-C level and GPR, APRI, NFS, FIB-4 and S index in diagnosing ALF in patients with CHB is satisfactory, which needs further clinical investigation.

Objective This study aimed to investigate diagnostic performance of acoustic radiation force impulse (ARFI)-based tissue quantification in assessing significant liver fibrosis (SLF) in patients with chronic hepatitis B (CHB). Methods A total of 97 patients with CHB were admitted to our hospital between June 2023 and June 2025, and all underwent liver biopsy. Shear wave velocity (SWV) was obtained by ARFI, aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) were calculated. Serum hyaluronic acid (HA) level was routinely detected. Receiver operating characteristic (ROC) curve analysis was applied to evaluate the diagnostic performance. Results Age, serum ALT and AST levels in 50 patients with SLF were significantly older or higher, while peripheral blood platelet count was significantly lower than in 47 patients with non-SLF(P<0.05); SWV, APRI and FIB-4 scores, and serum HA level in patients with SLF were (2.1±0.4)m/s, (1.2±0.7), (2.0±1.0) and 132.2(95.4,210.5)ng/ml, all much higher than [(1.3±0.3)m/s, (0.6±0.3), (1.0±0.4) and 55.2(38.4,72.6)ng/ml, respectively, P<0.05] in those with non-SLF; the AUC was 0.94(95%CI:0.90-0.97), with sensitivity of 91.5% and specificity of 86.0%, when SWV was combined with any other fibrosis index mentioned above in predicting SLF in patients with CHB. Conclusion Combination of SWV with other liver fibrosis index commonly used could help clinicians screen liver fibrosis in patients with CHB, which warrants further investigation.

Objective The aim of this study was to investigate the antiviral efficacy efficacy and its impact of on peripheral blood mononuclear cell (PBMC) T cell immunoglobulin and mucin domain-containing protein 3 (Tim-3) and programmed cell death protein 1 (PD-1) expression of sofosbuvir/velpatasvir in the treatment of patients with chronic hepatitis C (CHC) and concomitant diabetes mellitus type 2 (T2DM). Methods 74 patients with CHC and concomitant T2DM were enrolled in our hospital between January 2023 and June 2024, with 37 cases in each group, and were randomly assigned to receive peg-interferon-α and ribavirin treatment for 24 weeks in control, or receive sofosbuvir/velpatasvir orally once daily for 12 weeks in observation group. Serum HCV RNA loads were determined by RT-PCR, fasting plasma glucose (FPG), 2h postprandial blood glucose (2hPG) and glycated hemoglobin (HbAlc) were routinely obtained, and HOMA-IR was calculated. Percentages of PBMC Tim-3 and PD4 positive cells were detected by flow cytometry, and serum liver fibrosis parameters were assayed by chemiluminescent assay. Results Rapid virological response, end of treatment virological response and sustained virological response rates in the observation group were 75.7%, 100.0% and 97.3%, all significantly higher than 13.5%, 73.0% and 67.6%, respectively (P<0.05) in the control; by end of 24 week treatment, serum ALT and AST levels were (32.8±4.5)U/L and (30.6±5.9)U/L, both much lower than [(50.5±19.1)U/L and (46.5±8.2)g/L, respectively, P<0.05] in the control group; there were no significant differences as respect to FPG, 2hPG, HbAlc and HOMA-IR changes between the two group(P>0.05); percentages of peripheral blood TIM-3 CD4, PD-1 CD4 and PD-1 CD8 positive cells in the observation were (1.5±0.3)%, (0.3±0.1)% and (1.4±0.2)%, all much lower than [(1.8±0.2)%, (0.5±0.1)% and (1.6±0.3)%, P<0.05] in the control group; serum hyaluronic acid, procollagen type III N-terminal propeptide and type 4 collagen levels were much lower in the observation as compared to in the control group. Conclusion Application of sofosbuvir and velpatasvir is a satisfactory regimen in the treatment of patients with CHC and concomitant T2DM, which might have an inhibitory effects on TIM-3 and PD-1 expression.

Objective The aim of this study was to set up and validate a precise yet low-cost early prediction model for fatty liver disease based on routine indicators available in health-checkup centers. Methods A retrospective cohort of 1212 individuals for physical examination was analyzed, and the fatty liver was diagnosed based on ultrasonography. Various indexes were calculated based on clinical materials. Nested cross-validation (10-fold outer loop for validation and 5-fold inner loop for tuning) was combined random-forest and XGBoost with LASSO Logistic regression was conducted for feature selection. Variable importance was interpreted with SHAP values. Internal validation was used 1000-bootstrap optimism-corrected AUC and external validation was employed by a 30 % random split. Results Of the 1212 individuals, fatty liver was found in 542 cases(44.7%);the final model retained four variables, e.g.,triglyceride-glucose-body mass index (TyG-BMI), body-fat percentage, diastolic blood pressure and monocyte to high-density lipoprotein cholesterol (MHR); AUC of nested-cross-validation was 0.874 (95 % CI: 0.855-0.893), AUC of final-model was 0.880 (95 % CI: 0.861-0.898), AUC of optimism-corrected was 0.878 (95 % CI: 0.860-0.897) and AUC of external was 0.866 (95 % CI: 0.830-0.902); calibration was excellent (slope ≈ 1; Hosmer-Lemeshow P=0.433) and robust under 30 % Gaussian noise (AUC=0.878); SHAP analysis identified TyG-BMI as the dominant contributor. Conclusion The four-variable model demonstrates high discrimination, excellent calibration, easy acquisition and strong generalizability, which might offer health-checkup centers a“precise, efficient and low-cost” screening tool for fatty liver disease.

Objective The aim of this study was to investigate the changes and clinical implication of serum levels of chemokine C-X-C motif ligand 12 (CXCL12) and its receptors chemokine receptor 4 (CXCR4) and chemokine receptor 7 (CXCR7) in patients with non-alcoholic fatty liver disease (NAFLD). Method A total of 137 patients with NAFLD were admitted to our hospital between June 2021 and June 2024, and all patients underwent liver biopsy. Liver fibrosis S2 was defined as significant liver fibrosis. Serum CXCL12, CXCR4 and CXCR7, and hyaluronic acid (HA), type III procollagen (PCⅢ), type IV collagen (CⅣ) and laminin (LN) levels were assayed by ELISA. Multivariate Logistic regression model was applied to analyze the related influencing factors of liver fibrosis in patients with NAFLD, and the receiver operating characteristic (ROC) curves were drawn to analyze the predictive efficacy of serum CXCL12, CXCR4, and CXCR7 for liver fibrosis. Result Liver histo-pathological examination found liver fibrosis S0/S1 in 50 cases, S2 in 37 cases, S3 in 34 cases and S4 in 16 cases in our series; serum PCⅢ, CⅣ, LN, HA, CXCL12, CXCR4 and CXCR7 levels in patients with S4 were (135.6±10.7)μg/L,(87.1±8.1)μg/L, (120.3±12.1)μg/L, (107.1±9.8)μg/L, (17.6±2.9)pg/L, (60.2±7.2)pg/mL and (7.5±1.4)ng/L, all significantly higher than [(110.1±13.4)μg/L, (69.2±7.6)μg/L, (99.2±10.8)μg/L, (88.7±10.2)μg/L, (11.5±2.6)pg/L, (45.6±7.5)pg/mL and (4.6±1.0)ng/L, respectively, P＜0.05] in those with S0/S1 or [(117.4±12.8)μg/L, (75.8±8.9)μg/L, (105.3±15.7)μg/L, (93.6±9.1)μg/L, (13.7±2.7)pg/L, (50.7±6.3)pg/mL and (5.5±1.1)ng/L, respectively, P＜0.05] in those with S2 or [(124.5±12.1)μg/L, (81.1±9.1)μg/L, (111.6±13.9)μg/L, (98.8±8.3)μg/L, (15.4±3.0)pg/L, (54.2±8.1)pg/mL and (6.7±1.3)ng/L, respectively, P＜0.05] in those with S3; multivariate Logistic regression analysis showed that serum PCⅢ, CⅣ, LN, HA, CXCL12, CXCR4 and CXCR7 levels were all the independent risk factors for liver fibrosis in patients with NAFLD(P＜0.05); ROC analysis demonstrated that the AUC was 0.896, with sensitivity of 82.76% and specificity of 87.93%, when combination of serum CXCL12, CXCR4 and CXCR7 levels was applied to predict significant liver fibrosis. Conclusion Elevated serum CXCL12, CXCR4 and CXCR7 levels indicate the presence of liver fibrosis in patients with NAFLD, and combination of these three indicators has a high predictive performance for screening liver fibrosis.

Objective The aim of this study was to investigate the efficacy of semaglutide in the treatment of patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). Methods 104 patients with T2DM and NAFLD were encountered in our hospital between June 2022 and June 2024, and were randomly assigned to receive oral dapagliflozin and metformin in 52 cases in the control, or subcutaneous injection of semaglutide at base of oral dapagliflozin and metformin in another 52 cases in the observation group for 24 weeks. Blood biochemical parameters and blood glucose index, including glycosylated hemoglobin (HbA1c) were routinely detected, and liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were measured by transient elastography. The visceral adiposity index (VAI) and lipid accumulation product index (LAP) were calculated. Results By end of 24-week treatment, serum alanine aminotransferase, aspartate aminotransferase and CAP in the observation group were (34.9±3.7)U/L, (35.8±3.6)U/L and (270.7±30.6)dB/m, all significantly lower than [(59.1±3.3)U/L, (51.1±3.9)U/L and (289.7±20.5)dB/m, respectively, P＜0.05] in the control; fasting blood glucose, postprandial 2 h blood glucose and HbA1c were(6.1±0.5)mmol/L, (7.5±0.9)mmol/L and (6.2±0.7)%, all much lower than [(6.6±0.6)mmol/L, (9.9±0.6)mmol/L and (7.1±0.6)%, respectively, P＜0.05] in the control group; total cholesterol, triacylglycerol, low density lipoprotein cholesterol, VAI and LAP were(5.3±0.4)mmol/L, (2.1±0.2)mmol/L, (2.7±0.4)mmol/L, (103.7±9.2) and (55.9±6.9), all much lower than [(5.9±0.5)mmol/L, (2.7±0.3)mmol/L, (3.5±0.6)mmol/L, (119.2±10.3) and (61.4±7.2), respectively, P＜0.05], while high density lipoprotein cholesterol level was (1.3±0.3)mmol/L, much higher than [(1.0±0.2)mmol/L, P＜0.05] in the control group. Conclusion The clinical efficacy of semaglutide in the treatment of patients with T2DM and NAFLD at base of dapagliflozin and metformin is short-termly satisfactory, which might be related to modulation of glucose-lipid metabolism.

Objective The aim of this study was to summarize the clinical features of patients with drug-induced liver injury (DILI) with underlying non-alcoholic fatty liver disease (NAFLD). Methods 31 patients with DILI with concomitant NAFLD and 52 patients with DILI alone were encountered in our hospital between January 2023 and August 2025, homestasis model assessment for insulin resistance (HOMA-IR) and fibrosis based on 4 factors(FIB-4) were calculated, and liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were detected by FibroScan 502. Results Body mass index, percentages of underlying diabetes, hyperlipidemia, hypertension and multiple medicine administration, and taking medicine time in patients with NAFLD and DILI were much greater or higher or longer than in patients with patients with DILI(all P<0.05); serum ALT and lipid levels were much higher than in those with DILI(P<0.05); HOMA-IR, FIB-4, CAP and LSM were (3.9±1.5), (2.8±0.9), (291.4±33.7)dB/m and (9.6±3.8)kPa, all much higher than [(2.7±1.1), (2.0±0.8), (257.2±14.9)dB/m and (7.1±2.5)kPa, respectively, P<0.05] in those with DILI; percentages of hepatocyte injury type, cholestasis type and mixed type were 58.1%, 19.3% and 22.6%,significantly different as compared to 80.8%, 7.7% and 11.5% in those with DILI (P<0.05); time for blood biochemical parameter recovery was 40.4(25.5,75.2)d,much longer than [27.1(18.7,45.9)d,P<0.05],hospital stay was 13.3(9.2,22.6)d,much longer than [9.4(6.5,15.7)d,P<0.05],and percentage of chronicity was 19.3%,much higher than 5.5%(P<0.05) in patients with DILI. Conclusion Patients with NAFLD and DILI should be carefully managed clinically, as they have much more underlying diseases, relatively severe manifestations and much slower recovery.

Objective The aim of this study was to compare diagnostic efficacy of transient elastography (TE) to two-dimensional shear wave elastography (2D-SWE) in assessing significant liver fibrosis (SLF) in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). Methods A total of 110 patients with MAFLD were encountered in our hospital between March 2022 and October 2024, and all underwent liver biopsies. TE was performed to obtain liver stiffness measurement (LSM) and controlled attenuation parameter (CAP), and Young's modulus was obtained by 2D-SWE. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance. Results Of the 110 patients with MAFLD, liver histo-pathological examination proven metabolic related simple fatty liver (MRSFL) in 62 cases and metabolic dysfunction-associated steatohepatitis(MASH) in 48 cases, including F2 stage of liver fibrosis in 30 cases, F3 in 15 cases and F4 in 3 cases; serum total cholesterol, triglyceride, low-density lipoprotein and alanine aminotransferase levels in patients with MASH were significantly higher, while serum high-density lipoprotein level was significantly lower than in patients with MRSFL(P<0.05); CAP, LSM and Young's modulus in patients with MASH were (315.2±20.6)dB/m, (12.0±2.3)kPa and (10.1±2.1)kPa, all much higher than [(267.8±8.4)dB/m,(5.9±1.4)kPa and (4.9±1.4)kPa, respectively, P<0.05] in those with MRSFL; ROC analysis showed that the AUC was 0.899(95%CI: 0.831-0.987), with sensitivity (Se) of 0.888 and specificity (Sp) of 0.826, when LSM was applied to predict SLF, and the AUC was 0.885 (95%CI:0.822-0.949), with Se of 0.796 and Sp of 0.806, when Young's modulus was applied. Conclusion Both LSM and 2D-SWE could help predict SLF non-invasively in patients with MAFLD, which should be a widespread tool for clinical application.

Objective The purpose of this study was to investigate the changes and implication of polyreactive IgG (pIgG)levels in patients with autoimmune hepatitis (AIH). Methods 48 patients with AIH were recruited in our hospital between September 2022 and June 2024, all patients underwent liver biopsy and were treated with standardized immunosuppressive therapy for six months. Serum pIgG level was assayed and calculated. Results Serum ALT, AST, bilirubin and pIgG levels at baseline in 29 patients with severe degree of liver activity were (152.8±35.2) U/L, (128.3±32.6)U/L, (73.1±23.5)μmol/L and (83.5±23.2)mg/L, all significantly higher than [(72.5±15.6) U/L, (68.3±16.8)U/L, (27.8±6.3)μmol/L and (45.4±15.8)mg/L, respectively, P<0.05] in 19 patients with mild to moderate degree, while there was no significant difference as respect to serum IgG levels between them (P>0.05); serum pIgG level in 31 patients with liver histoactivity of G3/G4 was (84.6±25.0)mg/L, much higher than [(44.5±16.3)mg/L, P<0.05] in 17 patients with G1/G2; by end of six-month immunosuppressive therapy, complete biochemical response (CR) was obtained in 38 cases (79.2%), and 10 patients (20.8%)didn’t; serum pIgG level in patients with CR was (42.0±11.7) mg/L, much lower than [(81.8±17.2)mg/L, P<0.05] in non-responders, while there was no significant difference as respect to serum IgG levels between the two groups (P>0.05). Conclusion Serum pIgG level might serve as a novel biomarker for assessing disease activity and predicting treatment response in patients with AIH, which warranted further clinical investigation.

Objective The aim of this study was to investigate the clinical feature and risk factors impacting response to immunosuppressive therapy in elderly patients with autoimmune hepatitis (AIH). Methods 61 elderly patients with AIH were encountered in our hospital between January 2023 and June 2025, and all received immunosuppressive therapy for six months. Patients underwent liver biopsies and serum IgG and IgM levels were detected. Frailty score was assessed and sarcopenia was diagnosed. Multivariate Logistic regression analysis was performed to identify independent factors impacting response to immunosuppressive therapy. Results By end of six-month treatment, complete response (CR) was obtained in 47 cases, and non-CR (NCR) was found in 14 cases; baseline body mass index in patients with NCR was much lower(P<0.05), while percentages of concomitant diabetes, hypertension and sarcopenia, and frailty score were much higher than in those with CR(P<0.05); baseline serum ALT, AST, IgG and IgM levels were 158.2(92.3, 243.4)U/L, 132.1(85.3, 221.5)U/L, (23.6±4.8)g/L and (2.1(1.6, 2.5)g/L, all much higher than [106.3(71.8, 159.1)U/L, 95.6(64.1, 147.2)U/L, (19.7±3.9)g/L and 1.7(1.2, 2.1)g/L, respectively, P<0.05] in patients with CR; lobular inflammation, bile duct injury, steatosis, interface inflammation and fibrosis were more severe in patients with NCR than in those with CR(all P<0.05); multivariate Logistic regression analysis indicated that frailty score, sarcopenia, diabetes, elevated IgG level, hepatic bile duct injury and fibrosis were all the independent risk factors for poor response to immunosuppressive therapy(P<0.05), while serum albumin level was a protective factor (P<0.05). Conclusion Elderly patients with AIH might not response to immunosuppressive therapy, and the criminal factors should be taken into consideration in dealing with them.

Objective This study aimed to summarize the clinical features and clinical outcomes of patients with anti-tumor drug-induced liver injury (DILI). Methods A total of 197 patients with anti-tumor DILI were encountered in this study between January and December 2024, and the clinical types were recorded. Clinical outcomes were observed after active liver protection treatment. Results Of the 197 patients with DILI, there were 26 cases of mixed type, 54 cases of cholestasis type and 117 cases of hepatocyte injury type; proportion of anorexia in hepatocyte injury type group was 47.9%, significantly higher than 25.9% in cholestasis type group or 25.0% in mixed type group (P<0.05); serum GGT and ALP levels in hepatocyte injury group were (241.6±79.3)U/L and (99.7±22.8)U/L, both much lower than [(835.2±274.8)U/L and (269.4±78.5)U/L, respectively, P＜0.05] in cholestasis type group or [(439.7±145.1)U/L and (203.2±66.9)U/L, respectively, P＜0.05] in mixed type group, while serum AST and ALT levels were (382.4±126.7)U/L and (601.9±183.5)U/L, both much higher than [(124.9±41.3)U/L and (109.8±32.7)U/L, respectively, P＜0.05] in cholestasis type group or [(140.5±46.2)U/L and (126.4±42.8)U/L, respectively, P＜0.05] in mixed type group; percentage of severe liver injury in patients with hepatocyte injury was 29.9%, much lower than 61.1% in patients with cholestasis type or 53.9% in those with mixed injury(P＜0.05); liver function tests returned to normal in 175 cases (88.8%) and didn’t in 22 cases (11.2%), and there were no significant differences among liver function recovery rates in the three groups(P＞0.05). Conclusion Anti-tumor immune, targeting and chemotherapy might induced DILI easily, and the hepatocyte injury type is very common. The prognosis is usually good with discontinuing anti-tumor medicines in time and active liver protecting treatment.

Objective The aim of this study was to explore diagnostic performance of serum procalcitonin (PCT), interleukin-26 (IL-26) and interferon-γ (IFN-γ) levels and model for end-stage liver disease (MELD) score in predicting secondary infection in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). Methods 71 consecutive patients with HBV-ACLF were enrolled in our hospital between January 2021 and December 2024, serum PCT level was detected by fluorescence immunochromatography, serum IL-26 and IFN-γ levels were detected by ELISA, and MELD scores were calculated. Multivariate Logistic regression analysis was applied to find risk factors, and receiver operating characteristic curve and the area under the curve (AUC) was obtained to evaluate diagnostic efficacy. Results Of the 71 patients with HBV-ACLF, secondary bacterial infection was found in 34 cases (47.9%); serum PCT, IL-26 levels and MELD score in patients with infection were (2.7±1.0)ng/mL, (223.8±74.3)pg/mL and (29.5±4.2), all significantly higher than [(0.3±0.1)ng/mL, (135.7±32.4)pg/mL and (22.3±3.6), respectively, ,P＜0.05], while serum IFN-γ level was (20.2±5.5)ng/mL, significantly lower than [(55.7±8.4)ng/mL, P＜0.05] in those without infection; multivariate Logistic regression analysis showed that serum PCT(OR=2.214, 95%CI:1.264-3.879), IL-26(OR=2.040,95%CI:1.162-3.581), IFN-γ(OR=3.854, 95%CI:1.063-13.967) and MELD score (OR=2.492, 95%CI:1.474-4.213) were all independent risk factors for secondary infection in patients with HBV-ACLF(P＜0.05); the AUC was 0.978, with sensitivity of 94.1% and specificity of 96.5%, when serum IFN-γ, PCT and IL-26, and MELD was combined for prediction of infection in patients with HBV-ACLF, much superior to any parameter did alone. Conclusion Combination of serum PCT, IL-26, IFN-γ levels and MELD score has a certain predictive efficacy for secondary infection in patients with HBV-ACLF.

Objective The aim of this study was to investigate the clinical efficacy of plasma exchange (PE) plus sequential dual plasma molecular adsorption system (DPMAS) in the treatment of patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). Methods 63 patients with HBV-ACLF were enrolled in our hospital between June 2022 and December 2024, and were randomly assigned to receive PE plus sequential DPMAS in 31 cases in group A, or receive DPMAS plus sequential PE in another 32 cases in group B. Serum biochemical parameters and serum prothrombin time (PT) were measured routinely, and international normalized ratio (INR) was calculated. The disease severity was evaluated by chronic liver failure consortium acute-on-chronic liver failure score (CLIF-C ACLF). Results By end of three week treatment, total serum bilirubin level in group B was (121.3±25.6)μmol/L, much lower than [(151.3±31.6)μmol/L, P<0.05] in group A, while there were no significant differences as respect to serum albumin, INR and CLIF-C ACLF scores [(31.2±5.1)g/L, (1.6±0.3) and (43.9±4.1) vs. (30.6±5.2)g/L, (1.6±0.4) and (45.3±4.8), respectively] between the two groups (P>0.05); during PE/DPMAS treatment, the incidences of adverse effects, such as pipeline blockage or clogging, unstable heart beats, hypotension and hypocalcemia between the two groups were not significant different(7.4% vs. 10.0%, P>0.05); the 28-day and 90-day survival rates in group A were 87.1% and 58.1%, both not significant different as compared to 93.8% and 68.8% (P>0.05) in group B. Conclusion Multiple liver-supporting system treatment, no matter which one first, in dealing with patients with HBV-ACLF might be helpful for improving short-term survivals, and needs further clinical investigation.

Objective The aim of this study was to investigate the efficacy of dual plasma molecular adsorption system (DPMAS) with sequential half-volume plasma exchange (HPE) in the treatment of patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). Methods 61 patients with HBV-ACLF were encountered in our hospital between January 2023 and December 2024, and were randomly divided into control (n=31) and observation (n=30) group, receiving conventional supporting treatment or DPMAS with sequential HPE at base of supporting treatment respectively. Serum C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were measured by ELISA. Results By end of four week treatment, total serum bilirubin and international normalized ratio of prothrombin time in the observation group were (73.2±16.2)μmol/L and (1.4±0.2), both significantly lower than [(143.4±31.4)μmol/L and (1.6±0.4), respectively, P<0.05], while serum albumin level was(34.1±2.7)g/L, significantly higher than [(31.9±3.8)g/L, P<0.05] in the control; serum CRP, IL-6 and TNF-α levels were (12.8±3.2)mg/L, (10.2±3.2)pg/L and (105.2±24.5) mg/L, all much lower than [(19.2±4.1)mg/L, (18.5±3.2)pg/L and (143.5±23.7)mg/L, respectively, P<0.05] in the control group; 28 d survival was 93.3% in the observation group, much higher than 83.9%(P<0.05) in the control, while there was no significant difference respect to 90 d survivals (80.0% vs. 77.4%) in the two groups (P>0.05). Conclusion DPMAS with sequential HPE at base of conventional supporting treatment might help patients with HBV-ACLF survive liver failure short-termly, which needs further clinical investigation.

Objective The aim of this study was to investigate the safety and clinical efficacy of double filtration plasmapheresis (DFPP) in ABO-incompatible kidney transplantation (ABOi-KT). Methods 80 patients with renal failure were encountered in our hospital between January 2020 and December 2021, all received ABOi-KT, and underwent DFPP in 62 cases, and underwent plasma exchange (PE) in 18 cases for removal of blood type antibodies before KT. Serum A/B IgM and IgG antibodies were determined by column agglutination technology (CAT). Result In DFPP group, serum antibody titers of all blood types decreased significantly after removal, except for serum IgM anti-B antibody; in the PE group, only serum IgG anti-A showed remarkably decreased; there was no significant difference as respect to overall removal of serum antibodies between the two methods; there were no removal-related adverse reactions in the perioperative period in either group; three patients (4.8%) in the DFPP group experienced dysfunctions of the transplanted kidney, and four patients (6.4%) died. Conclusion DFPP exhibits efficacious and safe for removal blood type antibodies before ABOi-KT, which warrants further clinical investigation.

Objective The purpose of this study was to investigate the diagnosticefficacy of serum cystatin C (Cys-C), model for end-stage liver disease (MELD) and albumin-bilirubin (ALBI) score combination for hepatorenal syndrome-acute kidney injury (HRS-AKI) in patients with decompendated liver cirrhosis (DLC). Methods 99 patients with HRS-AKI and 117 hospitalized patients with DLC were encountered in our hospital between October 2020 and April 2025, baseline clinical materials,serum biochemical index and serum Cys-C levels were collectedby retrieving our hospital information management (HIS) system, and MELD and ALBI scores were calculated. Binary Logistic regression analysis was appliedto identify factors influencing the occurrence of HRS-AKI, and receiver operating characteristic (ROC) curves were employed to evaluate the diagnostic efficacy for HRS-AKI. Results Serum Cys-C levels, MELD and ALBI scores in patients with HRS-AKI were 2.4 (1.6, 3.3) mg/L, 19.9 (11.8, 24.3) and -1.1 (-1.5, -0.6), all significantly higher than [1.1 (0.9, 1.4) mg/L, 10.9 (7.4, 14.5) and -1.4 (-1.5, -0.9), respectively, P<0.05] in the cirrhosis group; Logistic regression analysis revealed that prothrombin time was a protective factor against HRS-AKI in patients with DLC (OR = 0.852, 95% CI = 0.752-0.964, P<0.05), while serum Cys-C level (OR = 42.318, 95% CI = 13.179-135.888, P<0.05), MELD score (OR = 25.539, 95% CI = 4.266-152.892, P<0.05) and concurrent hepatic encephalopathy (OR = 4.527, 95% CI = 1.283-15.969, P<0.05) were the independent risk factors; ROC analysis showed that the AUC was 0.918 (95% CI: 0.877-0.959), when combination of serum Cys-C level, MELD and ALBI score was set for diagnosing HRS-AKI. Conclusion Serum Cys-C levels in combination with MELD and ALBI scores could assist clinicians for the early diagnosis of HRS-AKI in hospitalized patientswith DLC, which warrants further study.

Objective The aim of this study was to investigate efficacy of ultrasound shear wave elastography (SWE) in predicting esophageal variceal bleeding (EVB) in patients with liver cirrhosis (LC). Methods 79 patients with LC were encountered in our hospital between May 2022 and February 2024, and all underwent gastroscopy to determine esophageal varices (EV). SWE was conducted to record Yang’s modulus in region of interest (ROI) as maximum value (Emax), minimum value (Emin) and mean value (Emean). The risk factors of EVB in patients with LC were explored by multivariate Logistic regression analysis, and predicting efficacy was analyzed by receiver operating characteristic (ROC) curve. Results Gastroscopy found mild EV in 12 cases, moderate in 32 cases and severe in 35 cases; by end of one-year follow-up, EVB occurred in 30 cases (38.0%) in our series; percentages of ascites and Child-Pugh class C in patients with EVB were 53.3% and 90.0%,both significantly higher than 10.2% and 18.4%(P<0.05), and serum ALB level and peripheral blood PLT count were (30.7±2.6)g/L and (65.9±13.2)×10⁹/L, both much lower than [(35.9±4.2)g/L and (94.2±11.8)×10⁹/L,respectively, P<0.05] in those without EVB; Emax, Emin and Emean in patients with EVB were (17.4±3.1)kPa, (11.3±2.1)kPa and (14.0±2.6)kPa,all much greater than [(12.7±2.6)kPa, (8.7±1.8)kPa and (11.2±2.2)kPa,respectively, P<0.05] in those without EVB; multivariate Logistic regression analysis showed that PLT counts((OR=1.458,95% CI:1.140-2.162), Emax(OR=1.415,95% CI:1.103-1.815),Emin(OR=1.318,95% CI:1.056-1.645) and Emean(OR=1.631,95%CI:1.232-2.158) were all the independent risk factors for EVB occurrence; ROC analysis demonstrated that the AUC was 0.900(95% CI:0.812-0.956), with sensitivity of 70.0% and specificity of 95.9%, when PLT count combined with SWE parameters was set in predicting EVB risk. Conclusion SWE parameters in combination with PLT counts is valuable in predicting EVB risk in patients with decompensated LC, which might help clinicians making appropriate measures early in clinical practice.

Objective The aim of this study was to investigate prevalence, pathogens distribution and risk factors of multi-drug resistant (MDR) bacteria infection in patients with hepatitis B-induced liver cirrhosis (LC). Methods A total of 1085 consecutive patients with hepatitis B-induced LC were admitted to our hospital between January 2021 and December 2024, clinical materials were collected, and incidence of bacterial infection, distribution of pathogens and impacting risk factors were statistically analyzed. Results Of 1085 patients with LC, incidence of bacterial infection was 28.9% and 381 strains of pathogens, including 233 (61.2%) strains of Gram-negative bacteria and 148 (38.8%) strains of Gram-positive bacteria, were separated from the 314 cases; resistance rate of Escherichia Coli to ciprofloxacin was 74.2%, resistance rate of Pseudomonas Aeruginosa to ciprofloxacin was 74.2%, resistance rate of Staphylococcus to ampicillin was 87.8%, and resistance rate of Enterococcus Faecalis to erythromycin was 71.1%; MDR infection was found in 182 cases(58.0%) out of the 314 patients with bacterial infection, long periods of hospital stay, percentages of Child-Pugh class C, repeatedly antibiotic administration within 90 days, invasive manipulation, concomitant diabetes and complicated gastrointestinal bleeding in patients with MDR infection were significantly higher than in those without, and all these parameters were independent risk factors(P＜0.05) for MDR infection. Conclusion Patients with hepatitis B-induced LC have a tendency of bacteria infection, and those with deteriorated liver functions are even more susceptible to MDR infections, which should be carefully managed for prevention and treatment.

Objective This study aimed to investigate the predictive performance of real-time tissue elastography with combination of aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis factor-4 (FIB-4) for esophageal varices (EV) in patients with hepatitis B-induced liver cirrhosis (LC). Methods A total of 111 patients with hepatitis B-induced LC were encountered in Chenzhou Third People's Hospital between January 2021 and December 2024, and all underwent gastroscopy for evaluation of EV. Liver fibrosis index (LF_index) was obtained by using real-time tissue elastography check-up, and APRI and FIB-4 scores were routinely calculated. The predictive efficacy of these parameters for EV occurrence was analyzed by using receiver operating characteristic (ROC) curves. Results Of the 111 patients with hepatitis B-induced LC, gastroscopy found EV in 32 cases(28.8%); PLT count in patients with EV was (96.6±13.4)×10⁹/L, much lower than [(128.4±18.3)×10⁹/L, P<0.05] in those without, while there was no significant differences respect to common liver function tests between the two groups (P>0.05); the LF_index, APRI and FIB-4 scores in patients with EV were (3.4±0.7), (1.4±0.5) and (4.3±0.6), all significantly higher or greater than [(2.2±0.4), (0.5±0.2) and (1.9±0.3), respectively, P<0.05] in those without EV; ROC analysis showed that the AUC was 0.985, with sensitivity of 92.6% and specificity of 97.1%, when the LF_index was combined with APRI and FIB-4 scores in predicting EV existence in patients with LC, much superior to any parameter did alone (P<0.05). Conclusion Real-time tissue elastography in combination with APRI and FIB-4 scores demonstrates an excellent predictive efficacy for EV in patients with hepatitis B-induced LC, which needs further clinical investigation.

Objective This study aimed to investigate prevalence and risk factors of myocardial injury (MCI) in patients with liver cirrhosis complicated with esophageal variceal bleeding (EVB) after endoscopic sclerotherapy. Methods Ninety-eight patients with decompensated liver cirrhosis and EVB were urgently admitted to our hospital between January 2023 and June 2024, 66 patients received urgent gastroscopic varicose vein sclerotherapy and another 32 patients were treated conventionally with internal medicine. Serum troponin (CTnI), myoglobin(MYO) and creatine kinase isoenzyme (CK-MB), and B-type natriuretic peptide (BNP) levels were detected routinely. Multivariate Logistic regression analysis was applied to find risk factors for MCI. Results Within 12 hours after admission, the incidence of MCI in the sclerotherapy group was 42.4%, much higher than 28.1%(P<0.05) in internal medicine-treated group; serum CTnI, MYO and CK-MB levels in sclerotherapy group were (0.028±0.018)μg/L, (55.1±4.4)μg/L and (35.2±18.6)U/L, all significantly higher than [(0.008±0.003)μg/L, (48.3±4.5)μg/L and (17.9±11.5)U/L, respectively, P＜0.05] in the control; percentages of cardiac disease history, diabetes, Child class B/C in patients with MCI were 65.0%, 69.2% and 89.2%, all significantly higher than 35.0%, 20.8% and 76.3%(P＜0.05), the age, shock index, serum BNP level, operation time and serum creatinine (sCr) level were(66.4±12.3)yr, (1.2±0.6), (178.6±22.8)pg/ml, (18.9±3.5)min and (97.9±8.6)μmol/L, all much greater or higher than [(57.4±9.2)yr, (0.7±0.4), (119.4±15.7)pg/ml, (15.4±3.8)min and (77.2±8.9)μmol/L, respectively, P＜0.05], while serum albumin level was (25.8±3.2)g/L, much lower than [(33.4±4.3)g/L, P＜0.05] in those without MCI; multivariate Logistic analysis showed that age, Child class, shock index, operation time, cardiac disease, diabetes, serum BNP, albumin and sCr levels were all the independent risk factors for occurrence of MCI (P＜0.05). Conclusion The incidence of acute myocardial injury in patients with cirrhosis complicated with EVB undergoing sclerotherapy is high, and the risk factors are diverse. Clinicians should pay more attention to preoperative assessment and intraoperative monitoring, and take measures to prevent and manage it.

Objective The aim of this study was to investigate the changes of serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and procalcitonin (PCT) levels in patients with decompensated liver cirrhosis (DLC) complicated with spontaneous bacterial peritonitis (SBP) . Methods 132 patients with cirrhotic ascites were enrolled in our hospital between January 2022 and January 2025, and all received antibiotics and general supporting therapy. Serum sTREM-1 level were detected by ELISA, and serum and PCT level were routinely obtained. Results Of 132 patients with DLC in our series, SBP was found in 63 cases (47.7%); percentage of Child-Pugh class C, INR, peripheral white blood cell count and ascites polymorphonuclear leukocyte cell count in patients with SBP were much higher(P<0.05), while serum albumin level was much lower than in those without(P<0.05); serum sTREM-1 and PCT levels as well as percentage of blood leukocytes in patients with SBP were (168.3±19.8)pg/mL, (3.6±1.0)ng/mL and (88.9±6.7)%, all much higher than [(126.2±22.4)pg/mL, (0.1±0.1)ng/mL and (72.7±5.3)%, respectively, P<0.05] in those without; by end of two-week treatment, 58 patients(92.1%) recovered with peritoneal infection controlled, and serum sTREM-1 and PCT levels decreased to normal(P<0.05), while 4 patients died and 1 patient had his SBP protracted. Conclusion Serum sTREM-1 and PCT levels in patients with DLC and SBP are abnormally elevated, and surveillance of them might monitor infection states and help assess the prognosis.

Objective This study aimed to investigate sequential organ failure assessment (SOFA) and model for end-stage liver disease-sodium (MELD-Na⁺) in predicting prognosis of patients with liver cirrhosis (LC) complicated by sepsis. Methods A total of 236 patients with sepsis with underlying LC were admitted to our hospital between January 2022 and June 2024, and routine clinical materials were collected for calculating SOFA and MELD-Na⁺ scores. Multivariate Logistic regression analysis was applied to reveal impacting factors, and receiver operating characteristic (ROC) curve was drawn for assessing predicting efficacy. Results By end of 28 day observation, 94 patients (39.8%) died in our series; incidences of esophageal variceal bleeding and hepatic encephalopathy, serum bilirubin, Cr, INR, SOFA score and MELD-Na⁺ score at baseline in dead group were 43.6%, 33.0%, (82.7±40.9)μmol/L, (122.4±40.4)μmol/L, (2.1±0.5), (9.7±3.2) and (32.1±7.8), all much higher than [26.1%, 16.2%, (71.5±30.2)μmol/L, (95.6±38.8)μmol/L, (1.8±0.4), (6.5±2.6) and (24.0±5.8), respectively, P<0.05], while PaO₂/FiO₂, mean arterial pressure, Glasgow coma scale and serum Na⁺ level were (259.8±45.6) mmHg, (70.2±15.5) mmHg, (12.3±2.4) and (128.5±26.2 )mmol/L, all much lower than [(274.5±50.2) mmHg, (83.5±11.8) mmHg, (13.3±2.1) and (136.8±24.5)mmol/L, respectively, P<0.05] in survival group; Logistic analysis showed that SOFA and MELD-Na⁺ scores were both the independent risk factors for poor prognosis in this setting(P<0.05); combination of SOFA score and MELD-Na⁺ score had a satisfactory predicting performance in patients with LC and sepsis. Conclusion SOFA score in combination with MELD-Na⁺ score could be used as potential indicators for predicting the prognosis of patients with cirrhosis complicated with sepsis, which might provide a tool for early intervention.

Objective The aim of this study was to investigate the clinical effectiveness of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of patients with liver cirrhosis (LC) and hypersplenism. Methods 62 patients with various etiologies-derived LC were encountered in Shanghai Public Health Clinical Center between March 2021 and August 2023, and all underwent TIPS. Portal pressure gradient (PPG) was measured during the operation, and spleen volume was calculated by uAI Research Portal software based on CT scan. Results The operation was successful in all patients with our series; red blood cell count at presentation was(3.5±0.7)×10¹²/L, it increased to (3.8±0.8)×10¹²/L(P＜0.05) by end of one year follow-up, and hemoglobin was (97.9±23.2)g/L, it increased to(108.9±19.0)g/L by three months, and to (117.4±22.4)g/L(P＜0.05) by end of one-year, while there was no significant changes as respect to white blood cell and platelet counts in our series(P>0.05); liver function test deteriorated in our series during one-year follow-up; the PPG at presentation was (23.3±6.8)mmHg, while it decreased to (8.3±3.5)mmHg after TIPS; before TIPS, the spleen volume was (1039.8±561.9)cm³, it turned to (900.9±489.8)cm³ by end of three-month and to (930.4±589.4)cm³ by end of one-year after TIPS. Conclusion TIPS couldn’t ameliorate hypersplenism, and its role on prevention of varies bleeding is still under observation.

Objective The aim of this study was to establish an imaging diagnosis model for atypical hepatocellular carcinoma (aHCC) and mass intrahepatic cholangiocarcinoma (mICC) differentiation. Methods 62 patients with aHCC and 31 patients with mICC were encountered in 904th Hospital, Joint Logistics Support Force between May 2019 and May 2024, and all patients underwent contrast-enhanced CT scan to record imaging parameters, and Gd-EOB-DTPA enhanced magnetic resonance (MR) scan to record main and concomitant features of tumors. Hinting parameters for diagnosis were analyzed by multivariate Logistic regression, and diagnostic efficacy was analyzed by receiver operating characteristic (ROC) curve. Results Imaging skewness, energy, entropy, mean value, TP enhancement characteristics, T2WI central hyperintensity, multifocal hyperintensity, tumor (false) capsule, fibrous septum, DWI target sign and "EOB cloud" sign in mICC lesions were significantly different as compared to in aHCC lesions (P<0.05); multivariate Logistic regression analysis showed that serum CA19-9 level (OR=3.473, 95%CI: 1.298～9.290), energy (OR=0.166, 95%CI: 0.075～0.366), entropy (OR=5.319, 95%CI: 2.447～11.558), mean value (OR=2.587, 95%CI: 1.491～4.487) and "EOB cloud" sign (OR=4.527, 95%CI: 1.960～10.453) were independent factors for predicting mICC (P<0.05); C-index of the diagnostic model based on the Logistic results was 0.836, and the diagnostic correction was very close to the ideal curve (P>0.05); ROC analysis showed that the area under the curve (AUC) of the model based on imaging feature was 0.865 (P<0.05), with the specificity of 80.3% and the sensitivity of 85.6%. Conclusion Imaging energy, entropy, mean value and "EOB cloud" sign are independent parameters for the differential diagnosis of aHCC and mICC, which warrants further clinical investigation.

Objective The aim of this study was to investigate the safety and efficacy of immunotherapy and stereotactic body radiation therapy (SBRT) in the treatment of patients with advanced primary liver cancer (aPLC). Methods A total of 102 patients with aPLC were encountered in our hospital between January 2020 and January 2024, and were randomly assigned to receive SBRT in 61 patients in control or receive intravenous camrelizumab after SBRT in another 60 patients in observation. Objective response rate (ORR) and disease control rate (DCR) were observed. Serum alpha-fetoprotein (AFP), thymidine kinase 1 (TK1) and abnormal prothrombin (DCP) levels were measured by ELISA. Peripheral blood T lymphocyte and natural killer (NK) cells were measured by flow cytometry. Survival curves were drawn by Kapkan-Meier method and compared by Log-Rank test. Results The ORR and DCR in the observation group were 60.0% and 95.0%, both much higher than 36.1% and 82.0%(P＜0.05) in the control; after treatment, serum AFP, TK1 and DCP levels in the observation were (82.4±18.3)ng/mL, (1.6±0.3)μg/L and (27.5±3.2)mAU/mL, all much lower than [(143.6±31.9)ng/mL, (2.2±0.4)μg/L and (38.6±3.9)mAU/mL, respectively, P＜0.05] in the control; percentage of peripheral blood CD3⁺ cells, CD4⁺/CD8⁺ cell ratio and percentage of NK cells were (70.5±4.7)%,(1.7±0.2) and (16.3±2.7)%, all significantly higher than [(60.8±4.3)%, (1.4±0.2) and (11.1±2.2), respectively, P＜0.05] in the control; the incidence adverse effects in the observation was 53.3%, much higher than 36.1%(P<0.05) in the control; by end of one-year follow-up, the survival rate in the observation was 80.0%, much higher than 56.9%(P＜0.05) in the control group. Conclusion Immunotherapy after SBRT in the treatment of patients with aPLC is efficacious, which could prolong short-term survival and merits further clinical investigation.

Objective The aim of this study was to investigate the clinical efficacy of lenvatinib therapy after transarterial chemoembolization (TACE) in the treatment of patients with advanced hepatocellular carcinoma (aHCC). Methods A total of 92 patients with aHCC were enrolled in this study between February 2021 and January 2025, and all patients were randomly assigned to underwent TACE in 46 cases for control or lenvatinib maintenance treatment after TACE in another 46 cases for three months. The objective remission rate (ORR) and disease control rate (DCR) were evaluated. Serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), alpha fetoprotein (AFP), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) levels were detected by ELISA. Results The ORR and DCR in combination group were 41.3% and 78.3%, both much higher than 21.7% and 54.3%(P<0.05) in the control; after treatment, serum CA19-9 and AFP levels in the combination group were (28.2±3.3)KU/L and (342.9±42.7)ng/mL, both much lower than [(40.2±4.6)KU/L and (427.9±46.9)ng/mL, respectively, P<0.05] in the control; serum bFGF, VEGF and HGF levels were (118.2±13.5)ng/L, (326.5±36.9)ng/L and (70.6±8.7)ng/mL, all much lower than [(138.9±15.2)ng/L, (427.5±46.2)ng/L and (92.7±10.6)ng/mL, respectively P<0.05] in the control group; during treatment, rash, capillary angiogenesis and proteinuria were found in some cases receiving lenvatinib treatment. Conclusion The lenvatinib maintenance treatment after TACE in the treatment of patients with aHCC is satisfactorily efficacious, which might accelerate tumor remission and inhibit tumor angiogenesis-related factor secretion.

Objective The aim of this study was to investigate emergent management of patients with primary liver cancer (PLC) complicated with spontaneous rupture bleeding under principle of damage controlsurgery(DCS). Methods 43 patients with spontaneous tumor rupture and massive hemorrhage were encountered in our hospital between June 2022 and June 2025,and emergent packing hemostasis and second-stage tumor resection was conducted in 22 cases and one-stage conventional surgery was performed in another 21 cases; Serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)and C-reactive protein (CRP) levels were detected by ELISA.The activated partial thromboplastin time (APTT), thrombin time (TT) and prothrombin time (PT) were detected routinely. Results Rescue success rate in the DCS group was 90.9%, significantly higher than 71.4% in the conventional group (P＜0.05); intra-operational blood loss, operation time, shock reversal time and body temperature recovery time in the DCS group were(782.6±96.3)mL, (149.5±33.6)min, (6.5±1.7)h and (8.2±1.9)h, all significantly less or shorter than [(1085.4±116.9)mL, (188.5±37.2)min, (9.3±2.6)h and (15.4±2.2)h, respectively, P＜0.05], while hospital stay was (15.9±4.5)d, significantly longer than [(10.6±5.2)d, P＜0.05] in conventional group; post-operationally, serum IL-6, TNF-α and CRP levels were (39.4±8.1)pg/mL, (23.8±4.6)ng/mL and (14.2±3.5)mg/L, all much lower than [(72.9±13.6)pg/mL, (38.5±6.2)ng/mL and (23.5±4.2)mg/L, respectively, P＜0.05] in the conventional group; there were no significant differences respect to coagulation parameters between the two groups (P>0.05); incidences of complications in DCS group was 5.0%, much lower than 26.7%(P＜0.05) in the conventional surgery group. Conclusion We recommend emergent packing hemostasis and second-stage tumor resection under DCS principle in dealing with patients with PLC and spontaneous tumor rupture, which might increase rescue success rates.

Objective This study aimed to investigate and summarize magnetic resonance imaging (MRI) feature in patients with primary liver cancer (PLC) and radiation-induced liver injury RILI) after three-dimensional conformal radiotherapy (3D-CRT). Methods A total of 92 patients with PLC were encountered in our hospital between January 2023 and September 2025, and all received 3D-CRT therapy and underwent gadopentetate dimeglumine (Gd-DTPA)-enhanced MRI scan. MRI signal, dynamic contrast-enhancement patterns, distribution morphology, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values were recorded. Results By end of radiotherapy, RILI occurred in 22 cases (23.9%); tumor volume, doses of radiation, target volume and mean hepatic doses of radiation in patients with RILI were all greater than in those without RILI(P<0.05); percentages of hypointensity on T1-weighted imaging, hyperintensity on T2-weighted imaging, abnormal enhancement at arterial phase, decreased enhancement at portal venous phase and persistent hypointensity at delayed phase in lesions in patients with RILI were 77.3%, 86.4%, 81.8%, 72.7% and 68.2%, all significantly greater than 27.1%, 30.0%, 20.0%, 25.7% and 17.1%(P<0.05) in those without RILI; percentages of wedge-shaped distribution, insistency of enhanced area with radiotherapy dose distribution, distributed along hepatic segments or vascular courses and hyperintensity on DWI in patients with RILI were 86.4%, 90.9%, 68.2% and 81.8%, all much greater than 15.7%, 12.9%, 14.3% and 28.6%(P<0.05) in those without RILI; ADC value in patients with RILI was (1.5±0.2)×10^-3mm²/s, much greater than [(1.2±0.2)×10^-3mm²/s, P<0.05] in those without RILI. Conclusion Patients with PLC and RILI could have special MRI features, which might help clinicians make diagnosis and managements.

Objective The aim of this study was to investigate imaging feature of multi-slice spiral computed tomography (MSCT) and enhanced magnetic resonance imaging (MRI) in the differential diagnosis of focal nodular hyperplasia (FNH) of liver and hepatocellular carcinoma (HCC). Methods A total of 108 patients with intrahepatic space-occupying lesions (SOL) were encountered in our hospital between January 2016 and August 2024, and all underwent dual-source force 256-slice spiral CT and enhanced MAGNETOM Spectra 3.0 T MRI scans. Results Of 108 patients with SOL in our series, the histo-pathological examination proved FNH in 41 cases, with lesion diameter of (3.3±0.9)cm, and HCC in 67 cases, with diameter of (2.9±0.9)cm; MR arterial enhancement fractional (AEF) and lesion/liver AEF ratio in HCC were (67.7±7.6) and (1.4±0.2), both significantly higher than [(53.7±4.5) and (1.2±0.1), respectively, P＜0.05] in FNH; percentage of low signals on T1WI in HCC was 83.6%, much higher than 58.5%(P＜0.05), percentage of low signals on apparent diffusion coefficient (ADC) was 94.0%, much higher than 14.6%(P＜0.05), and percentage of fast in and fast out style of enhancement was 91.0%, much higher than 2.4%(P＜0.05) in FNH; relative ADC in HCC was (0.8±0.2), much lower than [(1.1±0.2), P＜0.05] in FNH. Conclusion Features of MSCT and enhanced MRI could help clinicians make differential diagnosis of FNH from HCC, which might be very important in clinical practice.

Objective This study aimed to explore qualitative judgement of focal liver lesions (FLL) by quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Methods 107 patients with FLL were encountered in our hospital between January 2022 and January 2025, and all patients underwent DCE-MRI examination to record initial area under enhancement curve (IAUC), maximum slope of increase (MSI), maximum slope of decrease (MSD), mean enhancement time (MET) and positive enhancement integral (PEI). Golden diagnosis was proven by histo-pathological examination. Receiver operating characteristic (ROC) curves was applied to validate the diagnostic efficacy. Results Of the 107 patients with FLL in our series, pathological exam found benign lesions in 37 cases, hepatocellular carcinoma (HCC) in 56 cases and intrahepatic cholangiocarcinoma (ICC) in 9 cases; IAUC and MSD in benign lesions were (21.5±3.5) and (83.2±9.5), both much smaller than(P＜0.05), while MSI, MET and PEI were (283.2±26.6), (552.4±68.6) and (249.9±24.5), all much greater than in malignant lesions (P＜0.05); MSI, MET and PEI in HCC foci were (93.3±11.3), (486.5±61.4) and (32.5±6.6), all significantly smaller than [(103.3±10.3), (515.4±51.3) and (41.5±7.8), respectively, P＜0.05] in ICC foci; the AUC was 0.906, when IAUC, MSI, MSD, MET and PEI were combined to predict malignant lesions, and the AUC was 0.856, when MSI, MET and PEI were combined to differentiate HCC from ICC, both had to some extent implications of clinical practice. Conclusion DCE-MRI quantitative parameters could help clinicians differentiate base on imaging benign from malignant intrahepatic lesions, which warrants further clinical investigation.

Objective The purpose of this study was to investigate the diagnostic performance of dynamic three-dimensional contrast-enhanced ultrasound (CEUS) in combination with shear wave elastography (SWE) in distinguishing benign from malignant focal liver lesions (FLL). Methods A total of 106 patients with FLL were encountered in our hospital between January 2020 and January 2024, and all patients underwent CEUS to record time to peak (TTP), peak intensity (PI), enhancement time (ET) and enhancement slope (ES), and underwent SWE examinations to record Young's modulus. Diagnosis was made by histopathological examination. Multivariate Logistic regression analysis was used to screen factors hinting malignant lesions, and the receiver operating characteristic (ROC) curve was applied to evaluate diagnostic efficacy of CEUS and SWE in assessing benignity or malignancy of the lesions. Results Of the 106 patients with FLL, histopathological examination found malignant lesions in 39 cases and benign ones in 67 cases; TTP and ET in malignant lesions were (25.7±2.4)s and (19.8±1.9)s,both much lower than [(30.9±3.3)s and (23.9±2.7)s,respectively, P＜0.05],while PI, ES and Yang’s modulus were (26.9±2.8)dB, (2.2±0.6) and (24.2±3.4)kPa,all much higher than [(22.6±2.2)dB, (1.0±0.4) and (18.4±2.2)kPa,respectively, P＜0.05] in benign lesions; multivariate Logistic regression analysis showed that increased PI, ES and Yang’s modulus highly pointing out malignant, while increased TTP and ET eliminating malignant lesions (P＜0.05); ROC analysis demonstrated that CEUS in combination with SWE had a high differentiating performance of malignant and benign intrahepatic lesions, with sensitivity of 94.9% and specificity of 97.0%. Conclusion Dynamic three-dimensional CEUS and SWE combination has a high diagnostic efficacy in distinguishing benign from malignant lesions of livers.

Objective This study aimed to compare clinical efficacy and safety of Laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE), and selective LC after endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of patients with cholelithiasis and concomitant choledocholithiasis. Methods A total of 89 consecutive patients with cholelithiasis and concomitant choledocholithiasis were encountered in our hospital between May 2022 and June 2025, of them, 44 patients in observation group underwent LC and LCBDE, and 45 patients in control received selective LC after ERCP. Post-operational pain was evaluated by visual analogue scale (VAS), and serum C-reactive protein (CRP) level was routinely detected. Results Baseline clinical materials, including age, gender, body mass index, diameters of common bile ducts, numbers of stones and total serum bilirubin levels, between the two groups were comparable(P>0.05); one-time stone clearance rate in the observation group was 97.7%, much higher than 80.0%(P<0.05) in the control, and restoration of bowel function time and hospital stay were (2.1±0.6)d and (7.2±1.8)d, both much shorter than [(3.0±0.7)d and (10.4±2.3)d, respectively P<0.05] in the control; by 48 h after operation, VAS score in the observation was (2.3±0.8), much less than [(3.1±0.9), P<0.05] in the control, and by 4 days after surgery, serum CRP level was (6.9±3.1)mg/L, much lower than [(12.8±5.6)mg/L, P<0.05] in the control; incidence of post-operational complications was 15.9%, much lower than 40.0%(P<0.05) in the control group. Conclusion We believe that both LC and LCBDE, or LC after ERCP could be selected for dealing with patients with cholelithiasis and choledocholithiasis, which should be carried out depending on both patient’ condition and technical skills.

Objective The aim of this study was to investigate the clinical efficacy of percutaneous transhepatic cholangial drainage (PTCD) in the treatment of patients with acute biliary tract infections (ABTI). Methods A retrospective analysis was conducted on the clinical data of 83 patients with ABTI who underwent PTCD management in our hospital between January 2021 and December 2024, and patients received phase two surgery for eradication. Serum procalcitonin (PCT) level was routinely detected and interleukin-6 (IL-6) level was assayed by ELISA. Results 77 cases (92.8%) obtained successful PTCD out of the 83 patients with ABTI in our series, and 42 cases of them (54.5%)recovered after phase two operation, with hospital stay of(7.5±1.8)d; no further operation performed in another 35 cases because of elderly ages, concomitant diseases, and they recovered by supporting measures after 3 to 18 months; PTCD failed in 6 cases, and they recovered after 2 to 5 months of supporting management and antibiotic therapy; at admission, white blood cell count, percentage of neutrophil, total serum bilirubin, IL-6 and PCT levels in 77 patients with successful PTCD were(24.7±5.4)×10⁹/L, (83.4±12.6)%,(110.2±23.1)μmol/L, (97.6±15.8)ng/L and (12.1±0.8)μg/L, and they turned to (7.4±2.6)×10⁹/L, (65.3±10.7)%, (16.3±13.4)μmol/L, (27.5±7.7)ng/L and (0.1±0.0)μg/L after recovery (P<0.05). Conclusion PTCD might be a bridge measure as emergent management to phase two surgery for patients with ABTI, which warrants further clinical investigation.