2023 No. 2

Advances in the experimental research on traditional Chinese medicine against liver fibrosis

Xiaofei SHANG, Xiuhui LI

2023, 39(2): 249-259. DOI: 10.3969/j.issn.1001-5256.2023.02.001

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Liver fibrosis is the common pathological process of chronic liver diseases caused by various etiologies such as viral hepatitis and alcoholism, and it can progress to liver cirrhosis and even liver cancer and seriously threatens human health. Traditional Chinese medicine (TCM) has the characteristics of multiple components, targets, and pathways in inhibiting the progression of liver fibrosis and promoting the reversal of liver fibrosis and thus has unique clinical efficacy. In recent years, great progress has been made in the experimental research on the anti-liver fibrosis potential of TCM, and related studies have found a variety of compound TCM prescriptions, single TCM medicine, and their effective constituents and revealed their potential mechanism of action from the cellular and molecular levels. In order to further clarify the advances in the experimental research on the anti-liver fibrosis potential of TCM, this article systematically reviews the research advances in the past five years from the aspects of experimental animal models for the anti-liver fibrosis potential of TCM, the mechanism of action of TCM in the treatment of liver fibrosis, and TCM research from animal experiments to clinical trials, so as to provide a reference for researchers and clinicians to develop and apply anti-liver fibrosis TCM drugs.

Advances and thoughts in traditional Chinese medicine diagnosis and treatment of chronic hepatitis B-related liver fibrosis

Huanming XIAO, Meijie SHI, Yubao XIE, Xiaoling CHI

2023, 39(2): 260-266. DOI: 10.3969/j.issn.1001-5256.2023.02.002

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Liver fibrosis is a necessary intermediate process from the progression of chronic hepatitis B to liver cirrhosis and liver cancer. In recent years, breakthroughs have been made in the research on traditional Chinese medicine (TCM) for the prevention and treatment of chronic hepatitis B liver fibrosis. For the purpose of improving clinical outcome, multidisciplinary industry-university-research studies are conducted to explain the biological basis of TCM syndromes of chronic hepatitis B liver fibrosis, and establishment and development of a non-invasive diagnostic model with TCM characteristics, optimization of TCM/integrated traditional Chinese and Western medicine treatment regimens, and elaboration on the scientific connotation of TCM treatment can help TCM for the prevention and treatment of liver fibrosis to enter the global world.

Advantages and characteristics of traditional Chinese medicine in the treatment of liver fibrosis

Junhong LIU, Xinyu LI, Miaolei WANG, Boya FU, Linman LI, Hui FANG

2023, 39(2): 267-272. DOI: 10.3969/j.issn.1001-5256.2023.02.003

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Hepatic fibrosis (HF) is the common pathological process of various chronic liver diseases and is associated with the progression of liver diseases, and it is also a key factor affecting the outcome of liver diseases and the risk of hepatocellular carcinoma (HCC). The early process of HF is reversible, but without timely intervention and treatment, HF may gradually aggravate and progress to liver cirrhosis and even HCC, which will endanger people's health. Therefore, it is of great significance to actively prevent and treat HF; however, due to the complex pathogenesis of HF, Western medicine treatment is limited and there is still a lack of effective and widely accepted anti-fibrotic drugs, and thus there is a huge demand for medical treatment. With the efforts of scholars in China and globally, traditional Chinese medicine treatment has become a hotspot and a key breakthrough point in reversing HF and preventing its progression, with the advantages of multiple targets and pathways. This article elaborates on the advantages and characteristics of TCM treatment of HF from the aspects of syndrome differentiation, method of treatment, drug compatibility, and modern molecular mechanism.

Blocking and reversing liver fibrosis with traditional Chinese medicine compound prescriptions: Beyond the known frontiers

Zhaofang BAI, Xiaoyan ZHAN, Guiji LYU, Yongping YANG

2023, 39(2): 273-277. DOI: 10.3969/j.issn.1001-5256.2023.02.004

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Liver fibrosis is the inevitable course for the progression of chronic hepatitis B to liver cirrhosis and is also the most important risk factor for hepatocarcinogenesis, and therefore, blocking and reversing liver fibrosis is an important strategy to effectively reduce the development of chronic hepatitis B cirrhosis and liver cancer. There are currently no effective drugs and measures for the treatment of liver fibrosis in Western medicine, and traditional Chinese medicine (TCM) has unique advantages in the treatment of liver fibrosis; however, due to a lack of strict and standardized clinical research, there is still no high-quality evidence for support from the aspect of evidence-based medicine (EBM). With subsidies from National Science and Technology Major Project in the 12th and 13th five-year plans, the authors conducted a multicenter, randomized, double-blind, placebo-controlled clinical trial on compound Biejia Ruangan tablets combined with entecavir in blocking and reversing chronic hepatitis B liver fibrosis. With liver biopsy as the gold standard, 1000 patients were enrolled to confirm the efficacy of compound Biejia Ruangan tablets combined with entecavir in blocking and reversing liver fibrosis and cirrhosis, and this study has become the first clinical trial investigating the anti-liver fibrosis effect of TCM supported by high-quality EBM evidence, bringing great hope to patients with chronic liver diseases and helping TCM move towards the world. This article introduces these research findings and reviews the current status and challenges of TCM in blocking and reversing liver fibrosis.

Association between liver fibrosis and gut microbiota based on "harmonizing liver and spleen"

Yunxiao LIU, Jing DOU, Xiaozhong WANG

2023, 39(2): 278-283. DOI: 10.3969/j.issn.1001-5256.2023.02.005

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Liver fibrosis is the leading cause of the morbidity and mortality of liver diseases worldwide and has become one of the key issues in the research on chronic liver diseases among domestic and foreign scholars. An increasing amount of evidence has shown that gut microbiota dysbiosis plays a crucial role in the development and progression of liver fibrosis, and improvement of gut microbiota dysbiosis has become a new target for anti-fibrotic treatment. At present, traditional Chinese medicine has attracted much attention in improving gut microbiota. Studies have shown that "harmonizing liver and spleen" plays an important role in reducing fibrosis degree and delaying the progression of liver fibrosis. Therefore, based on the theory of "harmonizing liver and spleen", the achievements in liver-gut axis and gut microbiota by modern molecular biological techniques can provide a theoretical basis for the treatment of liver fibrosis from "harmonizing liver and spleen" in clinical practice, as well as new directions and ideas for anti-fibrotic treatment with traditional Chinese medicine.

Advances in integrated traditional Chinese and Western medicine diagnosis and treatment of hepatic fibrosis

Xueping ZHANG, Xiaofei SHANG, Xiuhui LI

2023, 39(2): 284-289. DOI: 10.3969/j.issn.1001-5256.2023.02.006

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Hepatic fibrosis (HF) is a key stage in the progression of chronic hepatitis to liver cirrhosis and even liver cancer, and it is a dynamic and reversible pathological change. Studies have shown that integrated traditional Chinese and Western medicine therapy has a good therapeutic effect on HF and can delay or reverse the progression of this disease. This article summarizes the pathogenesis of HF and discusses the diagnosis of HF, traditional Chinese medicine and Western medicine therapies, and the path of integrated traditional Chinese and Western medicine therapy, so as to provide ideas for the basic research and clinical application of integrated traditional Chinese and western medicine in the prevention and treatment of HF.

Chinese guidelines for the diagnosis and treatment of pancrestic cystic neoplasm(2022)

National Clinical Research Center for Digestive Diseases (Shanghai), Professional Committee of Pancreatic Disease, Chinese Medical Doctor Association

2023, 39(2): 290-298. DOI: 10.3969/j.issn.1001-5256.2023.02.007

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Predictive factors for functional cure after sequential therapy with nucleos(t)ide analogues and pegylated interferon alfa-2b in treatment of chronic hepatitis B

Haiyang ZANG, Weina LI, Shousheng LIU, Yong ZHOU, Yongning XIN

2023, 39(2): 299-306. DOI: 10.3969/j.issn.1001-5256.2023.02.008

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Objective To investigate the independent predictive factors for functional cure after long-term nucleos(t)ide analogue (NUC) antiviral therapy followed by pegylated interferon α-2b therapy in chronic hepatitis B (CHB) patients. Methods A total of 162 CHB patients who were admitted to several hospitals in Qingdao, China, from 2018 to 2021 were enrolled as subjects, and all patients received pegylated interferon α-2b for at least 48 weeks after NUC therapy for one year or longer. According to whether HBsAg clearance was achieved at week 48 of pegylated interferon α-2b treatment, the patients were divided into functional cure group with 79 patients and non-cure group with 83 patients, and related clinical indices were compared between the two groups. The two-independent-samples t test and the Mann-Whitney U rank sum test were used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The Spearman correlation analysis was performed, and the univariate and multivariate logistic regression analyses were used to investigate the independent predictive factors for functional cure. The receiver operating characteristic (ROC) curve was plotted for related variables, and the area under the ROC curve (AUC) was used to evaluate the prediction accuracy of the variables. Results Compared with the non-cure group, the functional cure group had a significantly lower HBsAg level at baseline [21.63 (3.33-157.60) IU/mL vs 794.70 (336.10-1 185.34) IU/mL, Z=-8.869, P < 0.001], at week 12 of pegylated interferon α-2b treatment [1.34 (0.04-16.59) IU/mL vs 567.11 (226.09-1 047.86) IU/mL, Z=-9.847, P < 0.001), and at week 24 of pegylated interferon α-2b treatment [0.01 (0.00-0.34) IU/mL vs 304.79 (89.24-772.23) IU/mL, Z=-10.474, P < 0.001) and a significantly greater reduction in HBsAg at weeks 12 and 24 of pegylated interferon α-2b treatment [week 12: 89.6% (57.5%-99.4%) vs 21.8% (2.0%-40.9%), Z=-7.926, P < 0.001; week 24: 99.9% (99.0%-100.0%) vs 44.1% (20.6%-73.8%), Z=-9.593, P < 0.001]. Compared with the non-cure group, the functional cure group had a significantly lower HBeAg positive rate at baseline (8.9% vs 25.3%, χ²=7.652, P=0.006), a significantly lower proportion of patients with baseline HBV DNA > 1000 IU/mL (0 vs 8.4%, χ²=5.073, P=0.024), a significantly lower level of total bilirubin at baseline [12.60 (10.12-15.93) μmol/L vs 15.50 (11.80-24.10) μmol/L, Z=-3.611, P < 0.001], a significantly higher level of aspartate aminotransferase (AST) at week 12 of treatment [47.00 (34.00-68.00) U/L vs 41.00 (30.00-56.50) U/L, Z=-2.031, P=0.042], and a significantly higher proportion of patients with AST > 2×upper limit of normal (16.5% vs 4.8%, χ²=5.835, P=0.016). The multivariate logistic regression analysis showed that baseline HBsAg (odds ratio [OR]=0.996, 95% confidence interval [CI]: 0.995-0.997, P < 0.001), HBsAg at week 12 of pegylated interferon α-2b treatment (OR=0.990, 95%CI: 0.986-0.994, P < 0.001), HBsAg at week 24 of pegylated interferon α-2b treatment (OR=0.983, 95%CI: 0.975-0.991, P < 0.001), and baseline total bilirubin (OR=0.885, 95%CI: 0.826-0.949, P=0.001) were independent predictive factors for functional cure. The ROC curve of baseline HBsAg showed an AUC of 0.904 and the optimal cut-off value of 118.24 IU/mL; the ROC curve of HBsAg at week 12 of pegylated interferon α-2b treatment showed an AUC of 0.948 and the optimal cut-off value of 73.74 IU/mL; the ROC curve of HBsAg at week 24 of pegylated interferon α-2b treatment showed an AUC of 0.975 and the optimal cut-off value of 11.01 IU/mL; the ROC curve of baseline total bilirubin showed an AUC of 0.664 and the optimal cut-off value of 19.9 μmol/L. Conclusion Baseline HBsAg, HBsAg at week 12 of pegylated interferon α-2b treatment, HBsAg at week 24 of pegylated interferon α-2b, and baseline total bilirubin are independent predictive factors for functional cure at week 48 of pegylated interferon α-2b treatment in CHB patients receiving sequential therapy with NUC and pegylated interferon α-2b.

Value of indocyanine green clearance test combined with total bilirubin actual resident rate in evaluating the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure after artificial liver support system therapy

Honglian DU, Ye LI, Bo WANG, Linkun MA, Tiantian HU, Yunjian SHENG, Wen CHEN, Gang WU, Cunliang DENG

2023, 39(2): 307-315. DOI: 10.3969/j.issn.1001-5256.2023.02.009

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Objective To establish a new model of indocyanine green (ICG) clearance test combined with total bilirubin actual resident rate (TBARR) for predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) treated with artificial liver support system (ALSS) therapy. Methods A retrospective analysis was performed for the clinical data of 136 patients with HBV-ACLF who underwent ALSS therapy in Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, from June 2017 to July 2021, and according to the prognosis at 3-month follow-up, they were divided into survival group with 92 patients and death group with 44 patients. Related indicators were measured at the time of the confirmed diagnosis of ACLF, including biochemical parameters, coagulation, indocyanine green retention rate at 15 minutes (ICGR₁₅), and effective hepatic blood flow (EHBF), and related indices were calculated, including Model for End-Stage Liver Disease (MELD) score, MELD difference (ΔMELD), Child-Turcotte-Pugh (CTP) score, total bilirubin clearance rate (TBCR), total bilirubin rebound rate (TBRR), and TBARR. The Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups; the chi-square test was used for comparison of categorical data between groups. A binary logistic regression analysis was used to establish a combined predictive model for the prognosis of HBV-ACLF after ALSS therapy. The area under the ROC curve (AUC) was used to compare the accuracy of various models in judging the short-term prognosis of patients with HBV-ACLF after ALSS therapy, and the Z test was used for comparison of AUC. Results There were significant differences between the death group and the survival group in MELD score, ΔMELD, CTP score, ICGR₁₅, EHBF, TBRR, TBARR, neutrophil count, percentage of neutrophils, lymphocyte count, platelet count, alkaline phosphatase, gamma-glutamyl transpeptidase, total bilirubin, albumin, prothrombin time, international normalized ratio, prothrombin time activity, prealbumin, fibrinogen, serum sodium, age, and the incidence rate of hepatic encephalopathy (all P < 0.05). The multivariate logistic regression analysis showed that age (odds ratio [OR]=1.096, 95% confidence interval [CI]: 1.056-1.137, P < 0.001), neutrophil count (OR=1.214, 95%CI: 1.044-1.411, P=0.012), TBRR (OR=0.989, 95%CI: 0.982-0.996, P=0.001), TBARR (OR=1.073, 95%CI: 1.049-1.098, P < 0.001), ΔMELD (OR=1.480, 95%CI: 1.288-1.701, P < 0.001), CTP score (OR=2.081, 95%CI: 1.585-2.732, P < 0.001), and ICGR₁₅(OR=1.116, 95%CI: 1.067-1.168, P < 0.001) were independent influencing factors for short-term mortality in patients with HBV-ACLF after ALSS therapy. The binary logistic regression analysis was used to establish four combined predictive models for predicting the prognosis of HBV-ACLF after ALSS therapy, i.e., TBRR-ICGR₁₅, TBARR-ICGR₁₅, TBARR-ICGR₁₅-ΔMELD, and TBARR-ICGR₁₅-ΔMELD-age, with an AUC of 0.830, 0.867, 0.900, and 0.917, respectively, and the combined predictive models had a larger AUC than each index alone (age, neutrophil count, TBRR, TBARR, ΔMELD, MELD score, CTP score, and ICGR₁₅), among which the TBARR-ICGR₁₅-ΔMELD-age model had the largest AUC. The combined models TBARR-ICGR₁₅-ΔMELD and TBARR-ICGR₁₅-ΔMELD-age had sensitivities and specificities of > 80%. Conclusion The combined predictive model established by ICGR₁₅ and TBARR has a good value for in predicting the short-term prognosis of patients with HBV-ACLF after ALSS therapy, and the combined predictive model has a better accuracy than the single model in judging prognosis.

Effect of cyclin D1 on HBV transcription and replication

Siwen PENG, Guiwen GUAN, Ting ZHANG, Fengmin LU, Jia LIU, Xiangmei CHEN

2023, 39(2): 316-324. DOI: 10.3969/j.issn.1001-5256.2023.02.010

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Objective To investigate the effect of cyclin D1 (with CCND1 as the gene name) on HBV replication and its potential mechanism. Methods With reference to GSE84044 dataset, the Spearman's rank correlation analysis was used to investigate the correlation between the expression levels of genes in liver tissue and serum HBV DNA load in patients with HBV-related liver fibrosis. Cyclin D1 and cyclin D1 T286A mutant were transiently expressed in the HBV cell replication model, and time-resolved immunofluorescence and quantitative real-time PCR were used to measure the levels of HBsAg/HBeAg and HBV DNA in cell culture supernatant; Western blot was used to measure the level of HBV core protein in cells; reverse-transcription quantitative real-time PCR was used to measure the level of HBV RNA in cells; dual-luciferase reporter assay was used to observe the effect of cyclin D1 on the activity of HBV basic core promoter (BCP). GSE83148 dataset was used to investigate the correlation between CCND1 and HBV-related regulatory factors. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. Results The analysis of GSE84044 data showed that 7 cell cycle genes were significantly negatively correlated with HBV DNA load in liver tissue of the patients with HBV-related liver fibrosis (all r < -0.3, all P < 0.05), which included the CCND1 gene (r=-0.474, P < 0.001). Exogenous expression of cyclin D1 and cyclin D1 T286A mutant reduced the levels of HBsAg, HBeAg, and HBV DNA in culture supernatant of the HBV replication cell model, as well as the levels of HBV core protein and HBV RNA in cells. Exogenous expression of cyclin D1 significantly inhibited the transcriptional activity of HBV BCP. The expression level of CCND1 in liver tissue of chronic hepatitis B patients was significantly positively correlated with the expression of APOBEC3G (r=0.575, P < 0.001), SMC5 (r=0.341, P < 0.001), and FOXM1 (r=0.333, P < 0.001) which inhibited HBV replication, while it was significantly negatively correlated with the expression of the HBV entry receptor NTCP (r=-0.511, P < 0.001) and HNF1α as the transcription factor for positive regulation of HBV replication (r=-0.430, P < 0.001). Overexpression of cyclin D1 in HepG2 cells reduced the transcriptional levels of HNF1α and NTCP. Conclusion Cyclin D1 inhibits HBV transcription and replication possibly by downregulating the expression of HNF1α and NTCP.

Prevalence of primary biliary cholangitis in the Chinese general population and its influencing factors: A systematic review

Zhicheng LIU, Zilong WANG, Jiarui ZHENG, Yandi XIE, Guangjun SONG, Bo FENG

2023, 39(2): 325-332. DOI: 10.3969/j.issn.1001-5256.2023.02.011

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Objective To systematically review the epidemiological studies on primary biliary cholangitis (PBC), and to investigate the prevalence rate of PBC in the Chinese general population and its influencing factors. Methods PubMed, Embase, The Cochrane Library, CNKI, and Wanfang Data were searched for articles on the epidemiology of PBC in China published up to 31th March 2022. Two researchers independently performed screening and data extraction, and then related analyses were performed. Results A total of 9 articles were included. The positive rate of AMA was 1 049.05/100 000 (ranging fr om 159.65/100 000 to 2287.40/100 000), and the prevalence rate of PBC was 123.68/100 000 (ranging from 42.70/100 000 to 276.59/100 000). The positive rate of AMA was 636.51/100 000 (ranging from 52.55/100 000 to 1 164.33/100 000) in men and 1 265.47/100 000 (ranging from 225.23/100 000 to 1 704.93/100 000) in women, with a male/female ratio of 1∶1.99 for the prevalence rate of AMA. The prevalence rate of PBC was 40.81/100 000 (ranging from 23.54/100 000 to 75.10/100 000) in men and 148.71/100 000 (ranging from 77.36/100 000 to 214.91/100 000) in women, with a male/female ratio of 1∶3.64 for the prevalence rate of PBC. Conclusion Different studies show great differences in the positive rate of AMA and the prevalence rate of PBC in the Chinese general population, which is mainly affected by sex, age, and region. The positive rate of AMA and the prevalence rate of PBC increase with age, and the patients aged ≥50 years have a significantly higher positive rate of AMA than those aged < 50 years. The positive rate of AMA is significantly higher than the prevalence rate of PBC. There are significantly more women than men in the AMA-positive population and the PBC patients, and the influence of sex on AMA is lower than that on PBC.

Efficacy of transjugular intrahepatic portosystemic shunt in treatment of primary biliary cholangitis with portal hypertension

Yaru TONG, Xiaochun YIN, Wei ZHANG, Chang SUN, Ming ZHANG, Yuzheng ZHUGE

2023, 39(2): 333-338. DOI: 10.3969/j.issn.1001-5256.2023.02.012

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Objective To investigate the long-term efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of primary biliary cholangitis (PBC) with portal hypertension. Methods A retrospective analysis was performed for 102 patients who received TIPS in Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2015 to August 2021, and these patients were divided into PBC group with 41 patients and viral hepatitis cirrhosis group with 81 patients. Related indicators were collected, including routine blood test results, liver and renal function, coagulation function, portal vein thrombosis, hepatic encephalopathy, and etiology of TIPS treatment shortly after admission, preoperative portal venous pressure, and stents used in surgery, and Child-Pugh score was calculated. Follow-up data were collected and analyzed, including postoperative upper gastrointestinal rebleeding, stent dysfunction, hepatic encephalopathy, and the data on survival and prognosis. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups; the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used for survival analysis, and the log-rank test was used for survival difference analysis. Results In the PBC group and the viral hepatitis cirrhosis group, the median percentage of reduction in portal venous pressure after surgery was 33.00% and 35.00%, respectively, and there was no significant difference between the two groups (P > 0.05). At the end of follow-up, there were no significant differences between the PBC group and the viral hepatitis cirrhosis group in stent dysfunction rate (14.63% vs 24.69%, χ²=1.642, P > 0.05), upper gastrointestinal rebleeding rate (17.07% vs 24.69%, χ²=0.917, P > 0.05), the incidence rate of overt hepatic encephalopathy (12.20% vs 7.41%, χ²=0.289, P > 0.05), and disease-specific death rate (14.63% vs 9.88%, χ²=0.229, P > 0.05). Conclusion For PBC patients with portal hypertension, TIPS can achieve the same efficacy as the treatment of portal hypertension caused by viral hepatitis cirrhosis and can also effectively reduce portal hypertension without increasing the incidence rate of complications and disease-specific death rate. Therefore, it is a safe and effective treatment method.

Value of blood ammonia and cholinesterase in the early diagnosis of liver cirrhosis with minimal hepatic encephalopathy

Xuhong YANG, Yong YANG, Minglei WANG, Wenxiao LIU, Wanlong MA, Minxing WANG, Xiangchun DING, Xiaodong WANG

2023, 39(2): 339-344. DOI: 10.3969/j.issn.1001-5256.2023.02.013

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Objective To investigate the value of serum markers in the early diagnosis of liver cirrhosis with minimal hepatic encephalopathy (MHE). Methods A prospective analysis was performed for 81 patients who were hospitalized and treated in General Hospital of Ningxia Medical University from April 2020 to February 2022, and all these patients were diagnosed with hepatitis B cirrhosis based on clinical manifestation, laboratory examination, and radiological examination or liver biopsy. According to digital connection test A (NCT-A) and digital symbol test (DST), these patients were divided into simple cirrhosis group with 45 patients and MHE group with 36 patients. Related indices were measured, including liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), and total bilirubin (TBil)], albumin, blood ammonia, cholinesterase, and prothrombin time. The independent samples t-test was used for comparison of normally distributed continuous data between two groups; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups; the chi-square test was used for comparison of categorical data between groups. The logistic regression analysis and the area under the ROC curve (AUC) were used to investigate the predictive factors for MHE. Results Compared with the simple cirrhosis group, the MHE group had a significant increase in NCT-A score (Z=-7.110, P < 0.001) and a significant reduction in DST score (t=12.223, P < 0.001). The univariate analysis showed that there were significant changes in AST, albumin, prothrombin time, cholinesterase, and blood ammonia in the patients with MHE (Z=-2.319, -2.643, -1.982, -6.594, and -5.331, all P < 0.05), while the multivariate analysis showed that only cholinesterase and blood ammonia were significant predictive factors (all P < 0.05) and were correlated with Child-Pugh score (all P < 0.05). Cholinesterase, blood ammonia, and their combination had an AUC of 0.925, 0.845, and 0.941, respectively, in the diagnosis of MHE, with an optimal cut-off value of 2966, 60, and 0.513, respectively. Conclusion Blood ammonia, cholinesterase, and their combined measurement have a potential clinical value in the early diagnosis of liver cirrhosis with MHE.

Effect of traditional Chinese medicine on portal vein thrombosis in patients with liver cirrhosis and its medication characteristics

Yanan GUO, Hongtu GU, Changqing ZHAO, Yongping MU, Jili YUAN, Feng XING, Yanyan TAO, Jing LYU, Chenghai LIU

2023, 39(2): 345-351. DOI: 10.3969/j.issn.1001-5256.2023.02.014

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Objective To investigate the therapeutic effect of traditional Chinese medicine (TCM) on portal vein thrombosis (PVT) in patients with liver cirrhosis and its medication characteristics. Methods A retrospective analysis was performed for 89 patients with liver cirrhosis and PVT who were hospitalized and treated in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, and according to whether TCM treatment was applied in combination, they were divided into TCM group with 59 patients and control group with 30 patients. Related data were collected for the two groups, including demographic data, laboratory examination, radiological examination, gastroscopy, history of surgery, portal hypertension-related complications, medication, and follow-up data. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. An ordinal polytomous Logistic regression analysis was used for multivariate analysis. TCM Inheritance Computing Platform (V3.0) was used to perform a drug effect cluster analysis of TCM prescriptions. Results The multivariate logistic regression analysis showed that esophageal and gastric varices (odds ratio [OR]=3.144, 95% confidence interval [CI]: 1.221-8.094), PVT involving the portal vein (PV) and the superior mesenteric vein (SMV) (OR=51.667, 95%CI: 3.536-754.859), PVT involving PV+spleen vein (SV)+SMV (OR=13.271, 95% CI: 2.290-76.928), cavernous transformation of the portal vein (OR=11.896, 95%CI: 1.172-120.696), and TCM intervention (OR=0.348, 95%CI: 0.129-0.938) were influencing factors for the outcome of PVT in liver cirrhosis. Follow-up results showed that compared with the control group, the TCM group had a significantly lower progression rate (16.95% vs 56.67%, P < 0.001) and a significantly lower incidence rate of variceal rupture and bleeding (8.47% vs 33.33%, P < 0.001). Effective TCM drugs with a relatively high frequency of use included deficiency-tonifying drugs (359 times, 34.6%), blood-activating and stasis-resolving drugs (202 times, 19.5%), and diuresis-inducing and dampness-draining drugs (180 times, 17.3%); the TCM drugs with a relatively high frequency of use included Astragalus membranaceus (57 times, 8.7%), Angelica sinensis (50 times, 7.6%), and leech (48 times, 7.3%); TCM drug combinations with a relatively high frequency of use included Astragalus membranaceus+Angelica sinensis, Astragalus membranaceus+leech, Angelica sinensis+leech, and Astragalus membranaceus+Angelica sinensis+leech. Conclusion Qi-tonifying, blood-activating, and stasis-breaking drugs, such as Astragalus membranaceus, Angelica sinensis, and leech, can promote the stabilization or recanalization of PVT in liver cirrhosis and reduce the incidence rate of bleeding events due to portal hypertension.

Distribution of traditional Chinese medicine syndrome types and elements in liver cirrhosis patients with dysplastic nodules: An analysis of 138 cases

Xiaoxiao YAO, Yaokun HAO, Zhun XIAO, Lan ZHANG, Suping MA, Wenxia ZHAO

2023, 39(2): 352-358. DOI: 10.3969/j.issn.1001-5256.2023.02.015

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Objective To investigate the distribution of traditional Chinese medicine (TCM) syndrome types and elements in liver cirrhosis patients with dysplastic nodules (DN), and to provide a basis for exploring the connotation and pattern of TCM syndrome types of DN in liver cirrhosis. Methods A total of 138 patients who attended The First Affiliated Hospital of Henan University of Chinese Medicine from March 2013 to January 2021 and were diagnosed with liver cirrhosis and DN were enrolled. General data such as age of onset and sex were collected, as well as the data on etiology, TCM syndrome types, and Child-Pugh class for liver function, and the distribution characteristics of TCM syndrome types and elements were summarized. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. Results The liver and the spleen were the main syndrome elements of disease location in liver cirrhosis patients with DN, accounting for 97.83% and 94.93%, respectively, followed by the kidney (23.91%); Qi deficiency and Qi stagnation were the main syndrome elements reflecting the nature of disease, accounting for 73.91% and 58.70%, respectively, followed by dampness (34.78%). The main TCM syndrome types included stagnation of liver Qi and spleen deficiency, damp-heat internal excess syndrome, blood stasis and toxin accumulation syndrome, and water-dampness retention syndrome, among which stagnation of liver Qi and spleen deficiency was more common and accounted for 58.70% (P < 0.05). There were no significant differences in TCM syndrome types between the patients with different sexes, ages, and etiologies (all P > 0.05). There was a significant difference in Child-Pugh class between the liver cirrhosis DN patients with different TCM syndrome types (χ²=34.320, P < 0.05), and Child-Pugh class A was more common in the patients with stagnation of liver Qi and spleen deficiency (59.8%), while Child-Pugh class C was more common in the patients with damp-heat internal excess syndrome (39.1%). Conclusion This article summarizes the distribution characteristics of common TCM syndrome types and elements of DN in liver cirrhosis, which provides a reference for the syndrome differentiation-based TCM treatment of DN in liver cirrhosis.

Influencing factors for acute kidney injury in acute liver failure and establishment of a predictive model

Mengyue SHANG, Yalin TONG, Yongzhong CHEN, Jie BAO

2023, 39(2): 359-364. DOI: 10.3969/j.issn.1001-5256.2023.02.016

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Objective To investigate the predictive factors for acute kidney injury (AKI) in patients with acute liver failure (ALF), and to establish a new predictive model. Methods Clinical data were collected from 253 patients who were diagnosed with ALF in The First Affiliated Hospital of Zhengzhou University from January 2015 to October 2021, and according to the presence or absence of AKI, these patients were divided into non-AKI group with 170 patients and AKI group with 83 patients. Related clinical data and laboratory markers were collected. Non-normally distributed continuous data were expressed as M(P₂₅-P₇₅), and the Mann-Whitney U test was used for comparison between two groups; categorical data were expressed as cases (%), and the chi-square test was used for comparison between two groups. The binary logistic regression analysis was used to investigate the risk factors for AKI in ALF patients, and the receiver operating characteristic (ROC) curve was used to evaluate the performance of the indices obtained in predicting AKI in ALF patients. Results Compared with the non-AKI group, the AKI group had a significantly higher proportion of patients with hypertension, diabetes, hepatic encephalopathy, ascites, and pulmonary infection, significantly higher levels of white blood cell count (WBC), international normalized ratio (INR), C-reactive protein, procalcitonin (PCT), neutrophil-to-lymphocyte ratio, and Model for End-Stage Liver Disease (MELD) score, and significantly lower levels of platelet count, lymphocyte-to-monocyte ratio, and PNI (all P < 0.05). The multivariate logistic regression analysis showed that WBC (odds ratio [OR]=1.267, 95% confidence interval [CI]: 1.124-1.428, P < 0.001), INR (OR=1.663, 95%CI: 1.205-2.293, P=0.002), PCT (OR=1.416, 95%CI: 1.137-1.764, P=0.002), and MELD score (OR=1.098, 95%CI: 1.029-1.172, P=0.005) were risk factors for the development of AKI in patients with ALF. The ROC curve analysis showed that the combination of WBC+INR+PCT+MELD had the largest area under the ROC curve (AUC) of 0.908 in predicting AKI in ALF patients, while WBC, INR, PCT, and MELD alone had an AUC of 0.776, 0.771, 0.746, and 0.780, respectively, in predicting AKI. Conclusion WBC, INR, PCT, and MELD score are independent influencing factors for AKI in patients with ALF, and the predictive model established based on these four indices has a relatively high predictive value.

Clinical features of myeloproliferative neoplasms with portal hypertension as the main manifestation

Lijuan FENG, Yan WANG, Min WANG, Guanhua ZHANG, Fuliang HE, Xinyan ZHAO, Yu WANG

2023, 39(2): 365-369. DOI: 10.3969/j.issn.1001-5256.2023.02.017

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Objective To investigate the clinical features, liver histological features, and diagnostic and treatment methods for patients with myeloproliferative neoplasms (MPN) with portal hypertension as the main manifestation. Methods A retrospective analysis was performed for related data of the patients who attended the hospital due to portal hypertension and were finally diagnosed with MPN in Liver Research Center, Beijing Friendship Hospital, from January 2019 to February 2022, including clinical manifestation, liver pathological features, treatment, and follow-up results. Results Nine patients were included in this study, and all the patients had splenomegaly and esophageal and gastric varices, while portal vein thrombosis was observed in eight patients. All patients had normal or slightly abnormal liver function and routine blood test results. Six patients underwent liver biopsy, without the formation of fibrous septum and pseudolobule, and hepatic extramedullary hematopoiesis was observed in two patients. All nine patients underwent bone marrow biopsy and genetic testing, among whom six had essential thrombocythemia and three had primary myelofibrosis, and genetic testing revealed JAK-2V617F gene mutation in seven patients and CALR gene mutation in two patients. Conclusion MPN is one of the rare causes of portal hypertension and has the clinical manifestations of esophageal and gastric varices, splenomegaly, and even megalosplenia, without the manifestations of hypersplenism such as leukopenia and thrombocytopenia. Detection of the JAK-2V617F and CALR genes can improve the diagnostic rate of MPN.

Value of endoscopic ultrasonography in the diagnosis of muddy stones of the common bile duct

Xuecai WANG, Qifang ZHANG, Xiaoyan LI, Wei PAN, Liangqing YANG, Hailian ZHANG

2023, 39(2): 370-375. DOI: 10.3969/j.issn.1001-5256.2023.02.018

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Objective To investigate whether endoscopic ultrasonography (EUS) can be an alternative method for diagnostic endoscopic retrograde cholangiopancreatography (ERCP) by comparing the ability of EUS versus CT and transabdominal ultrasonography (TUS) in the diagnosis of muddy stones of the common bile duct. Methods A prospective study was conducted for 53 patients suspected of muddy stones of the common bile duct who attended Nanxishan Hospital of Guangxi Zhuang Autonomous Region from July 2019 to December 2021, and all patients underwent EUS, TUS, and CT before ERCP. With ERCP and endoscopic sphincterotomy (EST) for removing muddy stones of the common bile duct as the gold standard for the diagnosis of muddy stones of the common bile duct, EUS, TUS, and CT were compared in terms of their ability to display the muddy stones of the common bile duct. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. Results In the 53 patients, EUS, TUS, and CT had a positive rate of 88.68%, 50.94%, and 62.26%, respectively, in detecting muddy stones of the common bile duct. As for the positive results confirmed by EST under ERCP, EUS had a sensitivity of 93.75%, a specificity of 60.00%, and an accuracy of 90.57% in detecting muddy stones of the common bile duct, while TUS had a sensitivity of 56.25%, a specificity of 100.00%, and an accuracy of 60.38% and CT had a sensitivity of 66.67%, a specificity of 80.00%, and an accuracy of 67.92%. There was a significant difference between EUS and CT in the accuracy in detecting muddy stones of the common bile duct (χ²=8.26, P=0.004), and there was also a significant difference in diagnostic accuracy between EUS and TUS (χ²=13.05, P < 0.001). Conclusion EUS is more accurate than TUS and CT in the diagnosis of muddy stones of the common bile duct, and instead of ERCP, EUS is thus recommended for suspected muddy stones of the common bile duct when TUS and CT fail to identify the lesions in clinical practice, so as to make a confirmed diagnosis and reduce related costs and complications.

Effect of Dahuang Lingxian prescription on the scf/c-kit signaling pathway in gallbladder interstitial cells of Cajal in a guinea pig model of cholesterol gallstone

Lijun XIAO, Yirong GAN, Chunli LIU, Chengji LI, Wen YANG, Jiaoan PANG, Jinhao TENG, Yuan YU

2023, 39(2): 376-382. DOI: 10.3969/j.issn.1001-5256.2023.02.019

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Objective To investigate the expression levels of scf and c-kit under the regulation of Dahuang Lingxian prescription and the possible mechanism of its effect on gallbladder dynamics, and to provide a theoretical basis for Dahuang Lingxian prescription in preventing the development and recurrence of cholesterol gallstone. Methods A total of 45 specific pathogen-free healthy male guinea pigs were randomly divided into normal group, model group, and traditional Chinese medicine (TCM) group. The guinea pigs in the normal group were fed with normal diet, and those in the model group and the TCM group were fed with high-fat lithogenic diet. After 8 weeks of feeding, 5 guinea pigs were randomly selected from each group, and successful modeling was determined if gallstone was observed with the naked eye in more than 4 guinea pigs. After successful modeling, the guinea pigs in the TCM group were given Dahuang Lingxian prescription by gavage, and those in the model group were given an equal volume of normal saline by gavage. After 8 consecutive weeks of administration by gavage, gallbladder tissue samples were collected, and HE staining was used to observe the pathological changes of gallbladder tissue; Western blot was used to measure the expression level of tumor necrosis factor-α (TNF-α) in gallbladder tissue; immunohistochemistry was used to measure the protein expression levels of scf and c-kit in gallbladder smooth muscle tissue. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference multiple comparison method was used for further comparison between two groups. Results HE staining showed marked inflammation of gallbladder tissue in the model group, and compared with the model group, the TCM group had a significantly lower degree of inflammation. Western blot showed that the model group had the highest expression level of TNF-α in gallbladder tissue, followed by the TCM group and the normal group (P < 0.05); immunohistochemistry showed that compared with the model group, the normal group and the TCM group had significantly higher protein expression levels of scf and c-kit in gallbladder smooth muscle tissue (P < 0.05). Conclusion Dahuang Lingxian prescription can enhance the dynamic function of the gallbladder, possibly by upregulating the scf/c-kit signaling pathway in interstitial cells of Cajal in gallbladder.

A case of idiopathic portal hypertension with psoriasis

Hui ZHOU, Bin NIU, Xiaoying ZHANG, Wei CHEN, Yuqiang MI, Ping LI

2023, 39(2): 383-386. DOI: 10.3969/j.issn.1001-5256.2023.02.020

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Report and genetic analysis of autoimmune liver diseases between mother and daughter

Yujie QIN, Wenxiu ZHOU, Xingnian ZHOU, Mingliang CHENG, Hong LI

2023, 39(2): 387-391. DOI: 10.3969/j.issn.1001-5256.2023.02.021

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Klebsiella pneumoniae liver abscess in a patient with selective IgA deficiency

Rui DING, Ligai LIU, Ying FAN, Yanbin WANG, Wen XIE

2023, 39(2): 392-396. DOI: 10.3969/j.issn.1001-5256.2023.02.022

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A case report of successful diagnosis and treatment of hepatic sinusoidal obstruction syndrome

Wenqian GENG, Hao ZHU, Xin YANG, Wanyu LI, Fang XU, Yanjun CAI, Pujun GAO

2023, 39(2): 397-400. DOI: 10.3969/j.issn.1001-5256.2023.02.023

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Association of dietary behavior with nonalcoholic fatty liver disease

Yifu YUAN, Qin CAO, Yuanye JIANG

2023, 39(2): 401-407. DOI: 10.3969/j.issn.1001-5256.2023.02.024

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The prevalence rate of nonalcoholic fatty liver disease (NAFLD) is increasing year by year, which poses a heavy burden on global public health. The pathogenesis of NAFLD is closely associated with the factors including obesity, insulin resistance, and diet, among which diet is the core and cornerstone of the prevention and treatment of NAFLD. In view of the fact that previous studies focused on the association of different dietary components, structures, and plans with NAFLD and seldom explored the impact of overall dietary behavior on NAFLD, this article reviews the effect of dietary behavior on NAFLD, in order to provide a reference for the prevention and treatment of NAFLD and the guidance on rational dietary behaviors and habits for patients.

Advances in the application of elastography in noninvasive diagnosis of liver fibrosis in nonalcoholic fatty liver disease

Meng LU, Mingjie WANG, Li CHEN

2023, 39(2): 408-412. DOI: 10.3969/j.issn.1001-5256.2023.02.025

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Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease, and liver fibrosis is closely associated with the prognosis in NAFLD; therefore, accurate assessment of liver fibrosis is of great importance. Liver biopsy is the gold standard for the diagnosis of NAFLD, but its clinical application is limited by invasiveness. Elastography technique based on ultrasound and magnetic resonance imaging has gradually been applied in the diagnosis of liver fibrosis associated with NAFLD. This article elaborates on the principles of the two techniques, compares their respective advantages and disadvantages, and introduces the advances in application in combination with artificial intelligence.

Research advances in nanomedicine in treatment of liver fibrosis

Jialing GUO, Hui LI, Zijian ZENG, Yujing TAO, Haijian DONG

2023, 39(2): 413-418. DOI: 10.3969/j.issn.1001-5256.2023.02.026

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Liver fibrosis (LF) is a pathological process of hepatic stellate cell (HSC) activation and excessive deposition of extracellular matrix caused by chronic liver injury and inflammation. HSC activation is the core mechanism of LF, and inhibiting HSC activation is the key to promoting the reversal of LF. In recent years, rapid development has been achieved for the application of nanomedicine targeting HSC in the treatment of LF. This article mainly introduces nanomedicine, the mechanism of action of nanomedicine in the treatment of LF, and potential targets, and it is pointed out that nanomedicine may become a new method for the treatment of LF.

Association between liver sinusoidal endothelial cells and liver fibrosis

Weiming DAI, Lungen LU, Xiaobo CAI

2023, 39(2): 419-423. DOI: 10.3969/j.issn.1001-5256.2023.02.027

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Liver sinusoidal endothelial cells (LSECs) are crucial to the maintenance of hepatic homeostasis under physiologic conditions, while under the conditions of pathological liver damage, LSEC can respond to the damage by changing their structure through the process called capillarization, thereby aggravating liver damage. In addition, the interaction between LSEC and other cells in the liver plays a certain role in the development and progression of liver fibrosis, especially the interaction between LSEC and hepatic stellate cells, which are the primary effector cells of liver fibrosis. This article mainly elaborates on the role of LSEC in the development and progression of liver fibrosis during chronic liver injury.

Advances in minimally invasive treatment of upper gastrointestinal bleeding in liver cirrhosis

Min XU, Yu NI, Rui ZHANG, Xiaobing WANG, Yuan HUANG

2023, 39(2): 424-431. DOI: 10.3969/j.issn.1001-5256.2023.02.028

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Liver cirrhosis is a common chronic liver disease in clinical practice, and the main causes of this disease include virus, alcohol, and immunity. Patients may experience a variety of complications in the late stage of liver cirrhosis, including upper gastrointestinal bleeding, hepatic encephalopathy, hepatorenal syndrome, and liver cancer, among which upper gastrointestinal bleeding is the main cause of death, and therefore, the control and prevention of upper gastrointestinal bleeding caused by liver cirrhosis is the key to reducing mortality rate and prolonging survival time. This article summarizes the commonly used minimally invasive methods for the treatment of upper gastrointestinal bleeding in liver cirrhosis and analyzes the indications for different treatment methods and related advances, so as to provide a reference for clinicians to choose the most suitable treatment regimen for the patient, thereby improving the survival rate of patients.

Biological connotation of "phlegm-turbidity" theory in hepatocellular carcinoma microenvironment based on abnormal lipid metabolism

Fangming YANG, Zhun XIAO, Xiaoqi CHEN, Chuanlei ZHANG, Xinju CHEN, Suping MA, Wenxia ZHAO

2023, 39(2): 432-438. DOI: 10.3969/j.issn.1001-5256.2023.02.029

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There is still a lack of effective strategies for the prevention and treatment of liver cancer, and a deep understanding of its pathogenesis may help to develop new treatment methods. Due to the abnormal changes of lipid metabolism in the development and progression of liver cancer, such process is closely associated with the "phlegm-turbidity" theory in traditional Chinese medicine (TCM). Starting from the changes of lipid metabolism in hepatocellular carcinoma microenvironment, this article discusses the association of the abnormal changes of lipid metabolism in tumor cells and immune cells with the "phlegm-turbidity" theory and the clinical efficacy of phlegm-eliminating therapies in clinical practice. Since the "phlegm-turbidity" theory in TCM plays an important role in the pathogenesis and pathological changes of liver cancer, the analysis of its theoretical connotation helps to clarify pathological mechanism, thereby providing a theoretical basis for the role of TCM in the prevention and treatment of liver cancer.

From viral hepatitis to hepatocellular carcinoma: The role of exosomal microRNAs

Yuanpeng MAO, Zhe YU, Aqian SONG, Hongshan WEI

2023, 39(2): 439-443. DOI: 10.3969/j.issn.1001-5256.2023.02.030

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Exosomes are nano-sized phospholipid bilayer vesicles containing abundant and complex biomolecules, such as DNA, mRNAs, microRNAs (miRNAs), lipids, and proteins. Exosomes can be secreted and ingested by most types of cells to transfer information through intercellular transport. After uptake by recipient cells, exosomes release bioactive substances to regulate the biological processes of recipient cells, such as promoting tumor growth and metastasis. Changes of exosomes and their contents are associated with a variety of diseases. In recent years, the role of exosomal miRNAs in the development and progression of hepatocellular carcinoma (HCC) caused by viral hepatitis has attracted wide attention, and exosomal miRNAs from different sources play different roles in this process. This article briefly reviews the research on the role of exosomal miRNAs in the development and progression of viral hepatitis-related HCC and proposes that exosomal miRNAs may be the targets for immunotherapy for HCC microenvironment.

Research advances in myosteatosis in chronic liver diseases

Jintao SUN, Fengxia LI

2023, 39(2): 444-449. DOI: 10.3969/j.issn.1001-5256.2023.02.031

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Myosteatosis is the main manifestation of malnutrition and is a common complication of chronic liver diseases, with a negative impact on the progression and prognosis of liver diseases. There is no gold standard for the diagnosis of myosteatosis, and CT is a commonly used diagnostic method. Myosteatosis in chronic liver diseases has diverse mechanisms, and hyperammonemia, increased cathepsin D level in circulation, insulin resistance, mitochondrial dysfunction, and chronic systemic microinflammation play an important role in myosteatosis. Early intervention of these factors can improve prognosis. With reference to related studies in China and globally, this article reviews the features, diagnostic methods, pathogenesis, treatment, and intervention of myosteatosis.

Research advances in congenital extrahepatic portosystemic shunt

Ying WANG, Shengrun XU, Di YU, Jinhui YANG, Jiang CHANG

2023, 39(2): 450-456. DOI: 10.3969/j.issn.1001-5256.2023.02.032

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Congenital extrahepatic portosystemic shunt (CEPS) is also called Abernethy malformation, with the manifestation of congenital abnormal anastomosis between the portal vein and the inferior vena cava. CEPS is extremely rare in clinical practice and has diverse clinical symptoms, which often leads to missed diagnosis and misdiagnosis. This article reviews the pathogenesis, classification, clinical manifestation, diagnosis, and treatment of CEPS, so as to improve the awareness of this disease and provide a reference for further standardization of its diagnosis and treatment process in the future.

Advances in the application of three-dimensional visualization technique in hepatic alveolar echinococcosis

Dong ZHANG, Zhixin WANG, Qian ZHAO, Xiaoxia SU, Kai XU, Mingming DONG, Wei LI, Lizhao HOU, Haining FAN, Haijiu WANG

2023, 39(2): 457-462. DOI: 10.3969/j.issn.1001-5256.2023.02.033

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Hepatic alveolar echinococcosis (HAE) is a parasitic disease caused by Echinococcus multilocularis infection and has wide distribution and great harm in China. At present, ultrasound, CT, and MRI are the main radiological examination methods for HAE, with certain limitations in preoperative diagnosis and evaluation. This article introduces the guiding effect of three-dimensional visualization technique and its derivative technologies in the accurate diagnosis and preoperative evaluation of HAE, so as to provide help for the clinical diagnosis and treatment of HAE in the future.

Research advances in immune checkpoint inhibitor-related cholangitis

Yucheng HOU, Hongqiang ZHAO, Caoer DONG, Guangdong WU, Xuan TONG, Ang LI, Qian LU, Hong CHEN, Rui TANG

2023, 39(2): 463-468. DOI: 10.3969/j.issn.1001-5256.2023.02.034

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Immune checkpoint inhibitors (ICIs) have ushered in a new era of tumor treatment; however, immunotherapy-related adverse events are critical issues that restrict the clinical application of ICIs and have attracted wide attention. The liver is one of the target organs that is easily affected. With the progress in research, scholars have found that besides hepatocytes, intrahepatic and extrahepatic bile ducts can also be attacked by the immune system, leading to the disease known as immune-related cholangitis. This article reviews the research advances in ICI-related cholangitis by summarizing related articles, in order to preliminarily reveal its clinical, pathological, and imaging features and provide clues for early identification, standard treatment, and subsequent research.

Role of tumor-associated macrophages in cholangiocarcinoma

Pinsheng HAN, Long YANG, Tao CUI, Yamin ZHANG

2023, 39(2): 469-473. DOI: 10.3969/j.issn.1001-5256.2023.02.035

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Cholangiocarcinoma (CCA) is a highly malignant biliary tumor with strong invasion and poor prognosis and is insensitive to radiotherapy and chemotherapy. Tumor-associated macrophage (TAM) is an important component of the tumor microenvironment. CCA cells recruit TAM into tumor tissue by releasing cytokines and polarize them into M2 TAM, which promotes the progression of CCA through various mechanisms such as assisting immune escape, promoting tumor cell proliferation, regulating angiogenesis, promoting tumor metastasis, and mediating immune resistance. As an emerging target of tumor immunotherapy, TAM provides new ideas for targeted therapy for CCA. This article reviews the mechanisms of TAM in promoting the progression of CCA and immunotherapy targeting TAM in recent years.

Pathogenesis of delayed gastric emptying after pancreaticoduodenectomy and related risk factors

Zhe WANG, Xing LYU, Jiaao YU, Xiaodong SUN, Ting LI, Guoyue LYU

2023, 39(2): 474-480. DOI: 10.3969/j.issn.1001-5256.2023.02.036

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Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD). The etiology and pathogenesis of DGE have not been fully elucidated in China and globally, and the majority of patients can be cured after general symptomatic treatment. This article reviews the risk factors and pathophysiological mechanisms of DGE after PD, in order to provide a reference for the effective management of DGE after PD in clinical practice.

Genes｜Identification of liver fibrosis-related microRNAs in human primary hepatic stellate cells using high-throughput sequencing

2023, 39(2): 283-283. DOI: 10.3969/j.issn.1001-5256.2023.02.gwjpwzjj1

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Journal of Hepatology｜Risk of liver fibrosis associated with long-term methotrexate therapy may be overestimated

2023, 39(2): 407-407. DOI: 10.3969/j.issn.1001-5256.2023.02.gwjpwzjj2

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Hepatology｜Environmental eustress promotes liver regeneration via the sympathetic regulation of type 1 innate lymphoid cells to increase IL-22 in mice

2023, 39(2): 480-480. DOI: 10.3969/j.issn.1001-5256.2023.02.gwjpwzjj3

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Current reviewers

2023, 39(2): 449-449. DOI: 10.3969/j.issn.1001-5256.2023.02.zhixie1

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