2026 No. 4

Raising awareness of vascular liver diseases： Diagnosis and treatment

Chengwei TANG

2026, 42(4): 745-747. DOI: 10.12449/JCH260401

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Vascular liver diseases （VLD） are defined as a group of diseases with damage of the liver vascular system including the hepatic artery， the portal vein， the hepatic vein， hepatic sinusoids and lymphatic vessels due to various pathogenic factors. VLD has not been fully understood in the field of gastroenterology， leading to difficulties in the clinical diagnosis and treatment of certain liver diseases. Acute VLD is often comorbid with critical illnesses and drug-induced conditions， while chronic VLD is usually diagnosed in its advanced stage or when it causes severe complications. Liver biopsy， ultrasound， multi-phase computed tomography， and magnetic resonance imaging are of great importance for the diagnosis of VLD. Exploration of the etiology， pathophysiology， diagnosis， and treatment of VLD can help to reexamine approaches to the diagnosis and treatment of liver diseases from a new perspective and improve the overall level of diagnosis and treatment of liver diseases.

Diagnosis and treatment of portal vein thrombosis

Yuqin HE, Liangzhi WEN

2026, 42(4): 748-754. DOI: 10.12449/JCH260402

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Portal vein thrombosis （PVT） involves the main portal vein and its tributaries， and acute PVT can cause intestinal ischemia and necrosis， while chronic PVT can cause cavernous transformation of the portal vein and portal hypertension-related complications （such as ascites and gastroesophageal variceal bleeding）. Liver cirrhosis is the main risk factor for PVT. the Classification of PVT provides a basis for clinical diagnosis. Ultrasound is the preferred method for screening， and contrast-enhanced computed tomography is the gold standard for diagnosis， while magnetic resonance imaging/magnetic resonance venography can help to identify acute or chronic thrombosis. Treatment emphasizes individualized strategies： anticoagulant therapy is the first-line therapy for acute PVT， and direct oral anticoagulants have shown great potential in clinical practice； thrombolytic therapy is appropriate for severe acute PVT， and it is needed to strictly control the risk of bleeding； transjugular intrahepatic portosystemic shunt is an important method for the diagnosis and treatment of PVT-related ascites and gastroesophageal variceal bleeding； surgical operation can be used for the treatment of patients with no response to pharmacotherapy or those with serious complications such as intestinal necrosis. Future diagnosis and treatment of PVT should be based on multidisciplinary collaboration， focusing on the optimization of individualized regimens， balancing efficacy and safety， and continuously leveraging technological advances to improve clinical practice.

Differences in the etiology and diagnostic and therapeutic mode of Budd-Chiari syndrome between China and Western countries

Zhen WANG, Jun TIE

2026, 42(4): 755-760. DOI: 10.12449/JCH260403

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Budd-Chiari syndrome （BCS） is a clinical syndrome of portal vein and/or inferior vena cava （IVC） hypertension caused by obstruction of the hepatic veins and/or the IVC proximal to its opening. Previous studies have shown that there are significant differences in the etiology， clinical classification， and therapeutic strategy of BCS across different regions. In Western countries， BCS is often secondary to thrombotic disorders， especially myeloproliferative neoplasms， with hepatic vein obstruction as the main lesion； the treatment of BCS mainly follows a stepwise strategy of anticoagulation， recanalization， shunting， and liver transplantation， with relatively early timing for transjugular intrahepatic portosystemic shunt. In contrast， BCS in China mainly involves membranous obstruction of the retrohepatic IVC and mixed-type obstruction， and percutaneous transluminal angioplasty is the core treatment method for BCS. These differences may be associated with various factors such as genetic background， environmental exposure， and healthcare practice patterns， with a significant impact on clinical decision-making and prognostic assessment. This article systematically summarizes the geographic heterogeneity of BCS through a literature review， so as to provide a cross-regional diagnostic and therapeutic reference for clinicians， as well as clues and directions for international collaborative research on the regional differences of BCS in the future.

Porto-sinusoidal vascular disorder and hepatic sinusoidal obstruction syndrome： Different stages of the same disease？

Chunxiang WANG, Siwei LIANG, Yuzheng ZHUGE, Feng ZHANG

2026, 42(4): 761-764. DOI: 10.12449/JCH260404

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Both porto-sinusoidal vascular disorder and hepatic sinusoidal obstruction syndrome belong to hepatic vascular diseases， and they have differences in etiology， clinical manifestations， treatment， and prognosis. However， recent research evidence has gradually shown that the association between porto-sinusoidal vascular disorder and hepatic sinusoidal obstruction syndrome has not been fully understood， suggesting that they may be two different manifestations of the same disease. This article reviews the association between these two diseases and related research evidence.

Diagnosis and treatment of hepatic vascular malformations

Mengyao WANG, Guangchuan WANG

2026, 42(4): 765-770. DOI: 10.12449/JCH260405

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Hepatic vascular malformations are a group of congenital or acquired disorders characterized by structural abnormalities of the intrahepatic arterial， venous， or portal venous systems， with the clinical manifestations of hyperdynamic circulation， portal hypertension， and complications of portosystemic shunting. Due to the low incidence rate and nonspecific clinical manifestations of such disorders， they are easily confused with cirrhotic portal hypertension， leading to the delay in diagnosis and treatment. This article introduces the common clinical manifestations and differential diagnosis of hepatic vascular malformations and elaborates on three typical types of hepatic vascular malformations， in order to provide ideas and references for clinical diagnosis and treatment.

Advances in the diagnosis and treatment of ischemic cholangiopathy

Tianhui HU, Zhiyin HUANG, Bo WEI

2026, 42(4): 771-776. DOI: 10.12449/JCH260406

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Ischemic cholangiopathy （IC） is a severe clinical condition resulting from blood supply impairment in bile ducts， and its etiology includes vascular causes and non-vascular factors. The pathogenesis of IC mainly involves microcirculatory disturbance of the peribiliary blood plexus and biliary epithelial necrosis and fibrosis induced by ischemia-reperfusion injury. The clinical manifestations of IC are highly heterogeneous. The typical symptoms include jaundice， abdominal pain， and cholangitis， while non-specific symptoms， such as fatigue and fever， often cause delays in diagnosis. The diagnosis of IC mainly relies on radiological examination for identifying characteristic stenosis and microcirculatory disturbance， assisted by cholestasis biomarkers including alkaline phosphatase and gamma-glutamyl transferase. Therapeutic strategies include conventional pharmacotherapy， endoscopic intervention， and innovative techniques. Prognostic evaluation emphasizes the dynamic monitoring of alkaline phosphatase and bilirubin and classification based on radiological examination， and long-term management requires individualized monitoring regimens to prevent complications.

Clinical cure strategies for chronic hepatitis B patients with hepatitis B virus surface antigen <100 IU/mL after treatment with nucleos（t）ide analogues

Junfeng LU, Shan REN, Sujun ZHENG, Xinyue CHEN

2026, 42(4): 777-781. DOI: 10.12449/JCH260407

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Among chronic hepatitis B patients undergoing long-term treatment with nucleos（t）ide analogues （NAs）， approximately 10%—20% can achieve a low level of <100 IU/mL for hepatitis B surface antigen （HBsAg）. These patients have the advantage to achieve clinical cure （HBsAg clearance） and are currently a key focus for treatment discontinuation and combination treatment strategies. As for the selection of clinical management strategies， the NAs discontinuation strategy， based on the “immune reactivation” hypothesis， may lead to HBsAg clearance in some patients， especially among Caucasians， but the risk of recurrence after discontinuation cannot be neglected. The treatment strategies based on pegylated interferon-α exhibit a higher potential for active HBsAg clearance， and some novel immunomodulators have also shown preliminary efficacy. Overall， for patients with HBsAg <100 IU/mL previously treated with NAs， treatment discontinuation or active combination treatment should be carefully assessed based on individual risk-benefit profiles. In the future， it is essential to incorporate more refined biomarkers for precise stratification and explore novel combination regimens with finite treatment courses that are safe and highly effective， in order to help more patients achieve clinical cure and reduce long-term risks of liver disease.

Guidelines for microecological therapy in patients with metabolic associated fatty liver disease

Liver Disease （Combined Traditional Chinese and Western Medicine） of Chinese Research Hospital Association, Zhejiang Provincial Key Laboratory for Accurate Diagnosis and Treatment of Chronic Liver Diseases & Hepatology Center， the First Affiliated Hospital of Wenzhou Medical University

2026, 42(4): 782-793. DOI: 10.12449/JCH260408

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These guidelines put forward standardized recommendations for microecological therapy in patients with metabolic associated fatty liver disease （MAFLD）. They systematically elaborate the core role of gut-liver axis dysfunction in the pathogenesis of MAFLD， and clarify the diagnostic approaches for intestinal microecological dysbiosis. The guidelines highlight recommendations on the clinical application of a full spectrum of microecological preparations including probiotics， prebiotics， synbiotics and postbiotics， and specify in detail the donor screening， therapeutic preparation manufacturing， indications， operational procedures， follow-up monitoring， and efficacy evaluation criteria for fecal microbiota transplantation. These guidelines aim to provide clinicians with an evidence-based foundation for clinical decision-making in the application of microecological therapy for MAFLD， so as to optimize patient management and ensure the safety and efficacy of the treatment.

Guideline for diagnosis and treatment of primary liver cancer （2026 edition）

National Health Commission of the People’s Republic of China

2026, 42(4): 794-827. DOI: 10.12449/JCH260409

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To further enhance the standardization of the diagnosis and treatment of primary liver cancer， ensure the safety and quality of medical care， and protect the health rights and interests of patients， the National Health Commission of the People’s Republic of China organized the revision of Guidelines for the diagnosis and treatment of primary liver cancer （2024 edition） and formulated the 2026 edition of Guidelines for the diagnosis and treatment of primary liver cancer. Based on the prevalence， diagnosis， and treatment of liver cancer in China， the 2026 edition integrates the latest evidence-based medical findings， especially the original studies led by Chinese scholars and published in top international journals， and makes systematic revisions and content expansions across multiple dimensions， including framework structure， epidemiological data， prevention and screening， diagnostic techniques， treatment strategies， and pathological assessment. The guidelines comprehensively standardize the entire clinical pathway for liver cancer， covering the aspects of prevention， screening， diagnosis， staging， and treatment， thereby providing authoritative technical guidance for the clinical practice of primary liver cancer in China.

An excerpt of AGA clinical practice update on the management of ascites， volume overload， and hyponatremia in cirrhosis： Expert review （2025 edition）

Junyuan ZHU, Yuwen CHEN, Chunqing ZHANG

2026, 42(4): 828-830. DOI: 10.12449/JCH260410

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In December 2025， American Gastroenterological Association released the expert review of clinical practice update on the management of ascites， volume overload， and hyponatremia in cirrhosis. The expert review proposes 13 best practice recommendations based on available evidence. This article gives an excerpt of the main recommendations from the expert review.

Impact of hyperglycemia on liver fibrosis and end-stage liver disease in patients with comorbidities of chronic hepatitis B and steatotic liver disease

Xueli ZHANG, Lina JIANG, Meng LI, Shuhong LIU, Jingmin ZHAO

2026, 42(4): 831-839. DOI: 10.12449/JCH260411

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Objective To analyze the clinicopathological features of patients with comorbidities of chronic hepatitis B （CHB） and steatotic liver disease （SLD）， to investigate the impact of hyperglycemia on the risk of liver fibrosis and end-stage liver diseases （ESLD）， and to provide a basis for the clinical management of such population. Methods A total of 668 adult patients with CHB-SLD confirmed by liver biopsy in The Fifth Medical Center of Chinese PLA General Hospital from January 2011 to December 2019 were enrolled， and a retrospective cohort was established with the time of liver biopsy as the baseline and the onset of ESLD as the endpoint. All patients were followed up to March 31， 2024. Propensity score matching （PSM） was performed at a ratio of 1∶4 to balance baseline features between groups， resulting in 82 patients in the hyperglycemia group and 281 in the non-hyperglycemia group. The two groups were compared in terms of metabolic profiles， laboratory markers， and histopathological features. The Mann-Whitney U test was used for comparison of non-normally distributed quantitative data between two groups. The chi-square test or Fisher exact test was used for comparison of categorical data between two groups. A multivariate Logistic regression analysis was used to investigate the influencing factors for advanced fibrosis （AF）， and the Kaplan-Meier survival analysis and the Cox proportional-hazards regression model were used to determine the influencing factors for the development of ESLD. Results Compared with the non-hyperglycemia group， the hyperglycemia group had a significantly higher number of factors for metabolic disorders， a significantly higher degree of hepatic steatosis， and a significantly higher detection rate of AF （all P<0.05）. The multivariate Logistic regression analysis showed that hyperglycemia was a risk factor for AF （odds ratio = 1.753， 95% confidence interval ［CI］： 1.017　—　3.023， P=0.043）. The survival analysis showed that hyperglycemia increased the risk of ESLD （χ²=4.340， P=0.037）. The multivariate Cox regression analysis confirmed that hyperglycemia was a significant metabolic risk factor for ESLD in patients with AF （adjusted hazard ratio=3.208， 95%CI： 1.201　—　8.568， P=0.020）. Conclusion Hyperglycemia can increase the risk of AF and ESLD in CHB-SLD patients. Clinical monitoring and active management should be strengthened for patients who have already developed AF and hyperglycemia.

Association between triglyceride glucose-body mass index and new-onset metabolic dysfunction-associated fatty liver disease

Xiaohong XIANG, Yang LI, Bo LI, Mei WEI, Zhongfang ZHOU, Suqiong HUANG

2026, 42(4): 840-847. DOI: 10.12449/JCH260412

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Objective To investigate the association between serum fasting triglyceride glucose-body mass index （TyG-BMI） and new-onset metabolic dysfunction-associated fatty liver disease （MAFLD） within 10 years. Methods A retrospective analysis was performed for the data of individuals who underwent physical examination in The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University in 2013， 2018， and 2023 and were not diagnosed with MAFLD in 2013， and a total of 1 340 valid subjects were enrolled according to the inclusion and exclusion criteria. The gbmt package in R 4.3.0 was used to construct the dynamic change trajectory model of TyG-BMI， and four different TyG-BMI trajectory groups were determined， i.e.， the low-level group （n=352）， the medium-level group （n=517）， the high-level group （n=314）， and the extremely high-level group （n=157）. The data on general information and blood biochemical parameters were collected from all subjects and were then compared between groups. The chi-square test was used for comparison of categorical data between groups， and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data with heterogeneity of variance between multiple groups. The Cox regression analysis was used to investigate the association between different TyG-BMI trajectories and the risk of MAFLD， and the receiver operating characteristic （ROC） curve was used to assess the value of TyG-BMI in the diagnosis of MAFLD. Results The cumulative incidence rate of MAFLD increased with the increase in the level of TyG-BMI trajectory， with a cumulative incidence rate of 4.83% in the low-level group， 29.98% in the medium-level group， 61.15% in the high-level group， and 83.44% in the extremely high-level group （P<0.001）， and the cumulative incidence rate of MAFLD in men was significantly higher than that in women （51.34% vs 20.67%， P<0.001）. The multivariate Cox regression analysis showed that increases in the levels of TyG-BMI trajectory， uric acid， diastolic blood pressure， hemoglobin， and alanine aminotransferase were independent risk factors for the onset of MAFLD （all P<0.05）， while the increase in high-density lipoprotein cholesterol was an independent protective factor against MAFLD （P<0.001）. After adjustment for confounding factors， the medium-， high-， and extremely high-level groups had a hazard ratio of 4.430 （95% confidence interval ［CI］： 2.660 — 7.377， P<0.001）， 6.937 （95%CI： 4.110 — 11.708， P<0.001）， and 7.989 （95%CI： 4.616 — 13.827， P<0.001）， respectively. The ROC curve analysis showed that TyG-BMI had the highest diagnostic value， with an area under the ROC curve of 0.859 （95%CI： 0.840 — 0.879）， a sensitivity of 79.8%， and a specificity of 76.3%. Conclusion The risk of MAFLD increases with the increase in the level of TyG-BMI trajectory， and TyG-BMI can be used as a predictive indicator for MAFLD.

Construction and validation of machine learning predictive models for the risk of metabolic associated fatty liver disease

Linjie QIU, Haiyan REN, Yan REN, Meijie LI, Chacha ZOU, Zijing WU, Jin ZHANG

2026, 42(4): 848-855. DOI: 10.12449/JCH260413

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Objective To investigate the value of predictive models established based on machine learning methods in predicting the risk of metabolic associated fatty liver disease （MAFLD）， and to analyze its key risk factors. Methods A retrospective analysis was performed for the 50 variables of 2 168 healthy individuals who underwent physical examination in Department of Health Assessment， Xiyuan Hospital， China Academy of Chinese Medical Sciences， from January 2021 to December 2024， including body composition， past history， and laboratory tests， and according to whether they were diagnosed with MAFLD or not， they were divided into MAFLD group with 265 individuals and non-MAFLD group with 1 903 individuals. The Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. Randomly split the research data into a training set and a validation set in a 70% to 30% ratio. Predictive factors were screened from the training set data using univariate analysis， LASSO regression， and multivariate Logistic regression analysis. Predictive models were then constructed using seven machine learning methods： Logistic regression， decision tree， random forest （RF）， eXtreme gradient boosting， light gradient boosting machine， support vector machine， and artificial neural network. Model performance was evaluated by plotting receiver operating characteristic curve for the validation set and calculating the area under the curve （AUC）， sensitivity， specificity， and Youden index for each model. Furthermore， the SHapley Additive exPlanation （SHAP） method was used to analyze the contribution of variables in the optimal model. Results The prevalence rate of MAFLD among the 2 168 subjects was 12.22% （265/2 168）. Smoking， diastolic blood pressure， phase angle， visceral fat area， muscle fat ratio， waist-to-hip ratio， aspartate aminotransferase， non-HDL-C/HDL-C ratio， triglyceride-glucose index， and gallstones were independent risk factors for MAFLD （all P<0.05）. The seven predictive models of support vector machine， eXtreme gradient boosting， decision tree， light gradient boosting machine， artificial neural network， RF， and Logistic regression had an AUC of 0.738， 0.754， 0.757， 0.786， 0.795， 0.796， and 0.815， respectively， in the validation set， among which the RF model had the best discriminatory ability （AUC=0.796， 95% confidence interval： 0.754 — 0.839）， with a sensitivity of 81.01%， a specificity of 63.16%， and a Youden index of 44.17%. The SHAP analysis showed that visceral fat area， waist-to-hip ratio， and diastolic blood pressure were the top three predictive factors in terms of importance. Conclusion The RF model， constructed based on body composition and clinical indicators， has a good performance in predicting the risk of MAFLD， and its interpretability can help to identify high-risk individuals in the early stage in clinical practice.

Bidirectional association between metabolic associated fatty liver disease and the risk of atherosclerotic cardiovascular disease

Yanan ZHAO, Qi QI, Xinyu WU, Quanle HAN, Jing YANG, Boheng ZHANG, Xuyang LI, Lei LI, Yun ZHANG, Shouling WU, Kangbo LI

2026, 42(4): 856-865. DOI: 10.12449/JCH260414

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Objective To investigate the association between metabolic associated fatty liver disease （MAFLD） and the risk of atherosclerotic cardiovascular disease （ASCVD）， and to provide data support for the prevention and treatment of such metabolic-associated diseases in clinical practice. Methods An observation cohort was established for the workers of Kailuan who underwent physical examination for the first time from June 2006 to October 2007 and had complete liver assessment data， without the history of malignant tumor， MAFLD or ASCVD. According to the presence or absence of MAFLD， the patients were divided into non-MAFLD group with 67 565 patients and MAFLD group with 29 004 patients， and according to the presence or absence of ASCVD， the patients were divided into non-ASCVD group with 69 141 patients and ASCVD group with 481 patients. The group t-test or the Wilcoxon rank-sum test was used for comparison of continuous data between the two groups. The χ² test was used for comparison of categorical data between the two groups. The life-table method was used to calculate the cumulative incidence rates of new-onset ASCVD and MAFLD； the Kaplan-Meier method was used to plot the survival curves of the cumulative incidence rates of ASCVD in the MAFLD group and the non-MAFLD group and the cumulative incidence rates of MAFLD in the ASCVD group and the non-ASCVD group， and the log-rank test was used for comparison of cumulative incidence rates between two groups. A multivariate Cox proportional-hazards regression model analysis was used to investigate the impact of MAFLD on the risk of ASCVD and the impact of ASCVD on the risk of MAFLD. Results Compared with the non-MAFLD group， the MAFLD group had significantly higher levels of body mass index （BMI）， waist circumference， systolic blood pressure （SBP）， diastolic blood pressure （DBP）， resting heart rate， alanine aminotransferase， uric acid （UA）， fasting blood glucose （FBG）， triglyceride （TG）， total cholesterol， low-density lipoprotein cholesterol， and high sensitivity C-reactive protein （hs-CRP）， as well as significanty lower levels of estimated glomerular filtration rate （eGFR） and high-density lipoprotein cholesterol （all P <0.05）. Compared with the non-ASCVD group， the ASCVD group had significantly higher levels of BMI， waist circumference， SBP， DBP， UA， FBG， TG， and hs-CRP and a significantly lower level of eGFR （all P<0.05）. The incidence rate of new-onset ASCVD continued to increase over time in the MAFLD group and the non-MAFLD group， while the incidence rate of new-onset MAFLD firstly increased and then remained stable over time in the ASCVD group and the non-ASCVD group. There were 4 263 cases （14.70%） of new-osnet ASCVD in the MAFLD group， with an incidence density of 12.90 per 1 000 person-years， while there were 6 529 cases （9.66%） of new-osnet ASCVD in the non-MAFLD group， with an incidence density of 8.24 per 1 000 person-years， and there were significant differences in the incidence density and cumulative incidence rate of ASCVD between the two groups （χ²=519.09 and 531.80， both P<0.05）. There were 148 cases （30.77%） of new-onset MAFLD in the ASCVD group， with an incidence density of 40.10 per 1 000 person-years， while there were 32 194 cases （46.56%） of new-onset MAFLD in the non-ASCVD group， with an incidence density of 57.59 per 1 000 person-years， and there were significant differences in the incidence density and cumulative incidence rate of MAFLD between the two groups （χ²=19.29 and 30.78， both P<0.05）. The corrected multivariate Cox proportional-hazards regression model analysis showed that MAFLD was a risk factor for new-onset ASCVD （hazard ratio ［HR］=1.11， 95% confidence interval ［CI］： 1.06 — 1.16， P<0.001）， while ASCVD was a protective factor against new-onset MAFLD （HR=0.72， 95%CI： 0.61 — 0.85， P<0.001）. Conclusion There is a significant association between MAFLD and ASCVD， with an increase in the risk of ASCVD in the MAFLD population and a reduction in the risk of MAFLD in the ASCVD population.

Efficacy of yttrium-90 selective internal radiotherapy in treatment of patients with unresectable hepatocellular carcinoma

Yijun ZHANG, Xuehua SUN, Xiaoyan WANG, Xue LIU, Baolong WANG, Yang LIU, Naijian GE, Yefa YANG

2026, 42(4): 866-873. DOI: 10.12449/JCH260415

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Objective To investigate the efficacy of selective internal radiation therapy （SIRT） in patients with unresectable hepatocellular carcinoma， and to provide a reference for the selection of clinical treatment regimens. Methods A retrospective analysis was performed for the clinical data of 73 patients with unresectable hepatocellular carcinoma who received yttrium-90 microsphere SIRT in Eastern Hepatobiliary Surgery Hospital from May 1， 2023 to September 1， 2024. According to tumor characteristics， physical status， liver reserve function， laboratory tests， and SIRT treatment strategy， the patients were divided into radiation segmentectomy group with 9 patients， conversion therapy group with 47 patients， and palliative treatment group with 17 patients. Based on the results of postoperative follow-up， modified Response Evaluation Criteria in Solid Tumors were used to assess radiographic images. A one-way analysis of variance was used for comparison of normally distributed continuous data between three groups， and the chi-square test was used for comparison of categorical data between three groups； the Logistic regression model was used to perform the multivariate analysis. Results There was a significant difference in postoperative outcome between the radiation segmentectomy group， the conversion therapy group， and the palliative treatment group （χ² =30.060， P<0.001）. The disease control rate was 100.0% （9/9） in the radiation segmentectomy group， 83.0% （39/47） in the conversion therapy group， and 29.4% （5/17） in the palliative treatment group， with a significant difference between the three groups （χ² =19.575， P<0.001）， and there was also a significant difference in objective response rate between the three groups （χ² =17.749， P<0.001）. The multivariate Logistic regression analysis showed that the number of tumors （odds ratio ［OR］=0.085， 95% confidence interval ［CI］： 0.008 — 0.906， P=0.041） and combined targeted immunotherapy （OR=18.808， 95%CI： 1.704 — 207.616， P=0.017） were independent influencing factors for achieving complete response. Conclusion The number of tumors is an independent influencing factor for the efficacy of SIRT and is an important basis for selecting different treatment goals. SIRT combined with targeted immunotherapy may achieve better efficacy.

Efficacy of Zishen Huoxue Formula in treatment of molecular-targeted therapy-associated proteinuria in patients with primary liver cancer

Jing JING, Aozhe ZHANG, Simiao YU, Xin WANG, Yongqiang SUN, Yiling WANG, Ruixin GAO, Yinying LU, Xiaohe XIAO, Ruilin WANG

2026, 42(4): 874-881. DOI: 10.12449/JCH260416

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Objective To investigate the effect of Zishen Huoxue Formula （ZSXHF） on molecular-targeted therapy-associated proteinuria in patients with primary liver cancer （PLC）， to assess the efficacy of ZSXHF in the treatment of molecular-targeted therapy-associated proteinuria， and to provide a basis for clinical medication. Methods A retrospective cohort study was conducted among the PLC patients with molecular-targeted therapy-associated proteinuria who were diagnosed and treated in The Department of Hepatology of Chinese PLA General Hospital， from January 1， 2022 to July 1， 2025. With ZSXHF treatment as the exposure factor， the patients with a cumulative treatment duration of ≥9 weeks were enrolled as traditional Chinese medicine （TCM） group， while those without TCM treatment were enrolled as control group. Propensity score matching was performed for the two groups at a ratio of 1∶1 based on sex， age， 24-hour urinary protein， blood urea nitrogen， and serum creatinine. 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； the chi-square test was used for comparison of categorical data between groups. Univariate and multivariate Logistic regression analyses were used to investigate the influencing factors for promoting the improvement of targeted-therapy-associated proteinuria. Results A total of 137 PLC patients with targeted-therapy-associated proteinuria were enrolled， with 34 patients in the TCM group and 103 in the control group. After follow-up for 6 months， the TCM group had a significant improvement in urinary protein grade compared with the control group （χ²=9.261， P=0.016）. There were 25 patients in each group after propensity score matching， and after follow-up for 6 months， there were significant differences between the two groups in urinary protein grade （χ²=15.689， P<0.001） and 24-hour urinary protein （Z=-3.075， P=0.002）. After cumulative treatment with ZSXHF for ≥9 weeks， the TCM group had a significantly greater change in 24-hour urinary protein from baseline compared with the control group （t=-2.514， P=0.016）， while there were no significant differences in the changes in liver and renal function after ZSXHF intervention between the two groups （all P>0.05）. The multivariate Logistic regression analysis showed that ZSXHF treatment （odds ratio=2.901， 95% confidence interval： 1.135 — 7.417， P=0.026） was an independent influencing factor for improvement in molecular-targeted therapy-associated proteinuria. Conclusion ZSHXF can effectively alleviate molecular-targeted therapy-associated proteinuria in PLC patients with a favorable safety profile， which provides a new reference for TCM prevention and treatment of molecular-targeted therapy-associated adverse reactions in PLC patients.

Association of insulin-like growth factor binding protein-3 gene polymorphism at the rs10225396 locus with susceptibility to hepatocellular carcinoma

Shijie LIU, Guang JIN, Hesong CUI, Shuyao SUN, Yuke LIN, Qingsong CUI

2026, 42(4): 882-889. DOI: 10.12449/JCH260417

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Objective To investigate the association of the single nucleotide polymorphism （SNP） of the insulin-like growth factor binding protein-3 （IGFBP3） gene at rs10225396 （A>G） locus with the susceptibility to hepatocellular carcinoma， as well as its potential molecular regulatory mechanisms， and to provide novel genetic biomarkers and a theoretical basis for early screening and precise targeted therapy for hepatocellular carcinoma. Methods A total of 192 patients with hepatocellular carcinoma who were admitted to The Affiliated Hospital of Yanbian University and Yanbian Cancer Hospital from January 2009 to August 2016 were enrolled as experimental group， and 190 healthy individuals who underwent physical examination in Physical Examination Center of Yanbian Hospital during the same period of time were enrolled as control group. Peripheral blood samples were collected from all subjects， and after DNA was extracted from whole blood， the DNA samples meeting quality standards were sent to Beijing Genomics Institute Research Center Co.， Ltd.， for Mass ARRAY mass spectrometry， while genotyping was completed. The independent-samples t test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. A binary Logistic regression model was used to analyze the association of the SNP of theIGFBP3 gene at rs10225396 locus with the susceptibility to hepatocellular carcinoma， and odds ratio （OR） and 95% confidence interval （CI） were calculated to assess the risk of developing hepatocellular carcinoma in individuals carrying different genotypes. Results There were two alleles （G and A） at the rs10225396 locus of the IGFBP3 gene， yielding the three genotypes of AA， AG， and GG， and its genotype distribution was consistent with the Hardy-Weinberg equilibrium （χ²=0.072， P=0.789）. The stratified genetic analysis showed that carriers of the IGFBP3 rs10225396 AA genotype had a significant increased risk of hepatocellular carcinoma among individuals of age <63 years， male sex， smoking history， drinking history， and the Chinese Korean population （all P<0.001）. The binary Logistic regression analysis showed that after adjustment for related risk factors in the codominant model， the population with genotype AG and GG had a significant reduction in the risk of hepatocellular carcinoma compared with the population with genotype AA （P<0.001）， and in the dominant model， the population with genotype AG+GG had a significant reduction in the risk of hepatocellular carcinoma compared with the population with genotype AA （P<0.001）. Conclusion Through a genotyping analysis of hepatocellular carcinoma patients and healthy individuals in Yanbian Korean Autonomous Prefecture of Jilin Province， China， this study shows that genotype AA at rs10225396 locus of the IGFBP3 gene is significantly associated with the susceptibility to hepatocellular carcinoma， and this genotype can significantly increase the risk of developing hepatocellular carcinoma with the presence of specific risk factors， which provides a potential genetic marker for early screening and precise treatment of hepatocellular carcinoma.

Analysis of the association between chronic liver disease and depressive disorder and the mediating effect of nocturnal sleep duration

Panshili HAN, Yue FENG, Yanhang GAO

2026, 42(4): 890-899. DOI: 10.12449/JCH260418

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Objective To investigate the association between chronic liver disease （CLD） and depression and the mediating role of nocturnal sleep duration， as well as the consistency of this association between Chinese and American populations. Methods The data from two databases were integrated， i.e.， China Health and Retirement Longitudinal Study （CHARLS）（n=14 225） in China and National Health and Nutrition Examination Survey （NHANES）（n=11 353） in the United States， and the subjects were divided into CLD group and non-CLD group. A stepwise Logistic regression model was used to assess the independent association between CLD and depression. Bootstrap resampling （1 000 times） was used to quantify the proportion of the mediating effect of nocturnal sleep duration， and interaction effects were evaluated through stratified analyses based on the factors including registered residence/race and income. The independent-samples t test was used for comparison of continuous data between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data； a multivariate Logistic regression model analysis was used to investigate the association of different types of CLD with depression. Results After multivariate adjustment， CLD was significantly associated with the increased risk of depression （CHARLS： odds ratio ［OR］=1.76， 95% confidence interval ［CI］： 1.46 — 2.12， P<0.001； NHANES： OR=1.87， 95%CI： 1.50 — 2.35， P<0.001）. Nocturnal sleep duration played a partial mediating role in the association between CLD and depression， with a mediating effect accounted for 12.41% in CHARLS and 2.16% in NHANES （P<0.05）. The interaction analysis showed that in CHARLS， the association between CLD and depression was more significant in the residents with agricultural registered permanent residence （OR=2.07， 95%CI： 1.67 — 2.57， P<0.001）， and in NHANES， this association was more significant in the population with moderate poverty income ratio （OR=2.66， 95% CI： 1.92 — 3.69， P<0.001）. The subtype analysis showed that autoimmune hepatitis （OR=3.63， 95%CI： 1.49 — 8.88， P=0.005）， liver cirrhosis （OR=2.46， 95%CI： 1.32 — 4.60， P=0.005）， and fatty liver disease （OR=1.75， 95%CI： 1.27 — 2.39， P=0.001） significantly increased the risk of depression， while no statistical significance was observed for viral hepatitis or other liver diseases （P>0.05）. Conclusion This study reveals the significant association between CLD and depression at the population level and suggests that nocturnal sleep duration may play a partial mediating role， which is consistent between the Chinese and American populations. These research findings provide quantitative evidence-based support for understanding the underlying mechanism of CLD-related depression and points out the potential significance of sleep issues in CLD management.

Effect of Klotho-derived peptide 7 on pancreatic fibrosis in a mouse model of chronic pancreatitis and its mechanism

Yuxin LI, Jiacai FU, Sai CHEN, Ling QI, Fengjin LI

2026, 42(4): 900-907. DOI: 10.12449/JCH260419

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Objective To investigate the anti‑pancreatic fibrosis mechanism of Klotho‑derived peptide 7 （KL7） by observing its effect on a mouse model of chronic pancreatitis （CP） induced by cerulean， and to provide a basis for clinical medication. Methods A total of 40 male BALB/c mice were randomly divided into control group， model group， low-dose KL7 group （2 mg/kg）， and high-dose KL7 group （4 mg/kg）， with 10 mice in each group. All mice except those in the control group were given intraperitoneal injection of cerulean （50 μg/kg） 6 times a day at an interval of 1 hour， twice a week for 4 consecutive weeks to establish a model of CP. The mice in the low-dose KL7 group and the high-dose KL7 group were treated with different doses of KL7 once a day for 4 consecutive weeks. In vivo imaging was used to observe the accumulation of KL7 in the pancreas； molecular docking was used to detect the binding of KL7 to transforming growth factor-β type Ⅱ receptor （TβRⅡ）； the mice were measured in terms of body weight and pancreatic weight； HE staining was used to observe the pathological changes of pancreatic tissue； Masson staining was used to observe the degree of pancreatic fibrosis； immunohistochemical staining was used to measure the expression of α-smooth muscle actin （α-SMA） and type Ⅰ collagen （COL1A1）； Western blotting was used to measure the protein expression levels of α-SMA， TβRII， and phosphorylated small mothers against decapentaplegic homolog 2/3 （p-Smad2/3） in pancreatic tissue. A one-way analysis of variance was used for comparison of continuous data between multiple groups， and the least significant difference t-test and the Dunnett’s-T3 test were used for further comparison between two groups. Results KL7 was significantly enriched in the pancreatic tissue of CP mice， and there was a strong binding activity between KL7 and TβRⅡ. Compared with the control group， the model group had significant reductions in pancreatic mass and relative pancreatic mass （P<0.000 1）， with disordered structure of pancreatic tissue， an increase in inflammatory cell infiltration， and significant increases in fibrosis degree， the positive areas of α-SMA and COL1A1 （P<0.000 1）， and the protein expression levels of α-SMA， TβRⅡ， and p-Smad2/3 （P<0.05）. Compared with the model group， the high-dose KL7 group had significant increases in pancreatic mass and relative pancreatic mass （P<0.01）， with alleviation of structural damage of pancreatic tissue and inflammatory cell infiltration， a significant reduction in fibrosis degree， and significant reductions in the positive areas of α-SMA and COL1A1 （P<0.001） and the protein expression levels of α-SMA， TβRⅡ， and p-Smad2/3 （P<0.01）. Conclusion KL7 has a significant targeted therapeutic effect on pancreatic fibrosis in CP mice through specific binding of KL7 to TβRⅡ， thereby inhibiting the activation of the TGF-β/Smad signaling pathway.

Construction and evaluation of a novel KPC mouse model of type 2 diabetes mellitus comorbid with spontaneous pancreatic cancer

Xuehuan HUANG, Caihui ZHAO, Yongning XU, Haochang YANG, Wen QIN

2026, 42(4): 908-917. DOI: 10.12449/JCH260420

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Objective To construct a novel KPC mouse model of type 2 diabetes mellitus （T2DM） comorbid with spontaneous pancreatic cancer based on the gene editing-metabolic intervention dual-driven strategy， and to compare it with traditional models. Methods A total of 14 male KPC mice were randomly divided into novel model group （T2DM-KPC group with 7 mice） and control group （KPC group with 7 mice）， and 14 male BALB/c-nu nude mice were randomly divided into traditional model group （T2DM-pancreatic cancer group with 7 mice） and control group （pancreatic cancer group with 7 mice）. The mice in the KPC group and the pancreatic cancer group were fed with normal diet， and those in the T2DM-KPC group and the T2DM-pancreatic cancer group were fed with a high-fat diet. After 4 weeks， the mice in the T2DM-KPC group and the T2DM-pancreatic cancer group were given intraperitoneal injection of streptozotocin. Subsequently， the mice in the KPC group and the T2DM-KPC group developed primary pancreatic tumor spontaneously over time， while those in the T2DM-pancreatic cancer group and the pancreatic cancer group were inoculated with tumor cells to form subcutaneous tumor xenograft at 2 weeks after stabilization of blood glucose. The 4 groups were observed in terms of tumor formation rate， tumor formation time， body weight， and the change in blood glucose； RNA sequencing was performed for tumors from the KPC group and the T2DM-KPC group， and then molecular subtyping was performed； HE staining， Masson staining， and immunohistochemical staining were used to assess the histopathological features and tumor microenvironment of pancreatic tumor from the T2DM-KPC group， which were compared with those of the T2DM-pancreatic cancer group. A one-way analysis of variance was used for comparison of continuous data between multiple groups， and the least significant difference t-test was used for further comparison between two groups； the Fisher’s exact test was used for comparison of categorical data between multiple groups. Results The T2DM-KPC group had a tumor formation rate of 85.71% and a tumor formation time of 104.40±2.87 days， while the T2DM-pancreatic cancer group had a tumor formation rate of 71.43% and a tumor formation time of 95.20±9.47 days， and there were no significant differences between the two groups in tumor formation rate， tumor formation time， body weight， and blood glucose （all P>0.05）. Molecular subtyping showed that the model in the KPC group highly resembled the pancreatic progenitor subtype of human pancreatic ductal adenocarcinoma （PDAC）， and the model in the T2DM-KPC group highly resembled the immunogenic subtype of PDAC. HE staining showed that tumor cells in the T2DM-KPC group were arranged into glandular tubular structures of varying shapes， exhibiting significant cellular atypia， and this model faithfully recapitulated the pathological features of primary pancreatic cancer and showed greater invasiveness than the KPC group. Immunohistochemical staining and Masson staining showed that compared with the T2DM-pancreatic cancer group， the T2DM-KPC group had significantly higher degrees of tumor proliferation （assessed by Ki-67 expression） and fibrosis （assessed by α-SMA and Masson）（all P<0.05）， suggesting that the mouse model in the T2DM-KPC group could better recapitulate the features of hyperproliferation and pronounced desmoplasia in human pancreatic cancer. Conclusion A novel KPC mouse model of T2DM comorbid with spontaneous pancreatic cancer is successfully constructed in this study. This model can accurately mimic the histopathological architecture and stromal microenvironment of T2DM comorbid with pancreatic cancer， realize the longitudinal simulation of the progression of pancreatic tissue from intraepithelial neoplasia to invasive carcinoma and metastasis in the presence of T2DM， and support the translational research on immunotherapy， thereby providing a novel experimental carrier for in vivo studies on spontaneous pancreatic cancer in T2DM.

Low-dose defibrotide in the treatment of pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome： A case report

Haiqing GUO, Haiqing SUN, Jing ZHANG, Lixia QIU

2026, 42(4): 918-922. DOI: 10.12449/JCH260421

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This article reports a case of a male patient， aged 60 years， who developed pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome （PA-HSOS） due to ingestion of Gynura segetum （Lour.） Merr. The patient presented with ascites and abnormal liver function， and a confirmed diagnosis was made based on radiological examination and liver biopsy. Since the patient was allergic to low-molecular-weight heparin and had no response to supportive therapy， low-dose defibrotide was administered as rescue treatment. After treatment， the patient achieved rapid regression of ascites and recovery of liver function， and liver biopsy reexamination showed alleviation of sinusoidal congestion and hepatocyte regeneration. Self-resolving conjunctival hemorrhage occurred during treatment. This case suggests that for patients with contraindications to standard anticoagulation therapy or those showing no response to such treatment， low-dose defibrotide may be used as an effective and relatively safe alternative treatment regimen.

Intelligent diagnosis and treatment and comprehensive digital health management of metabolic dysfunction-associated fatty liver disease

Yewei JIANG, Yunyi XU, Yuru HE, Wangyu QIAO, Mingyang GOU, Jingqi ZHOU

2026, 42(4): 923-929. DOI: 10.12449/JCH260422

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Metabolic dysfunction-associated fatty liver disease （MAFLD） has become one of the most prevalent chronic liver diseases worldwide， posing a serious challenge to public health. In this context， the integration of artificial intelligence （AI）， especially intelligent diagnosis and treatment and digital health interventions based on machine learning， can break through the limitations of traditional methods， realize efficient screening of multi-dimensional data such as key genes， biomarkers， and biochemical metabolites， and achieve revolutionary breakthroughs in risk prediction， subtype identification， and therapeutic effect assessment for MAFLD. This article systematically reviews the ground-breaking application of machine learning models in driving the innovation of clinical diagnosis and precise risk prediction of MAFLD， conducts a comprehensive comparative analysis of digital health practice cases of MAFLD in China and globally， and deeply analyzes their advantages and limitations in terms of research subjects， interventions， and management team. Studies have shown that the deep integration of digital health and long-term management of MAFLD is becoming the key engine driving the transformation of disease management modes towards an intelligent， individualized， and precise era， but there are various ethical and technical issues that need to be addressed urgently.

Metabolic dysfunction-associated fatty liver disease with different clinical phenotypes： Pathogenesis and strategies for integrated traditional Chinese and Western medicine treatment

Wenxia ZHAO, Lei GAO, Xinju CHEN, Yuanyuan ZHENG, Sutong LIU, Lihui ZHANG, Qing ZHAO, Chenlu ZHAO

2026, 42(4): 930-937. DOI: 10.12449/JCH260423

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Metabolic dysfunction-associated fatty liver disease （MAFLD） is a chronic metabolic liver disorder with complex etiologies. Different clinical phenotypes of MAFLD （such as obesity， hyperlipidemia， type 2 diabetes mellitus， the postmenopausal state， and chronic hepatitis B） have different mechanisms of action in the development and progression of MAFLD， leading to high heterogeneity in its clinical progression and prognosis. This article systematically reviews the pathogeneses and clinical features of the above five clinical phenotypes of MAFLD and elaborates on the corresponding individualized diagnosis and treatment regimens integrating traditional Chinese medicine and Western medicine， in order to provide a reference for clinical practice and improve clinical diagnosis and treatment.

Application prospects of mitochondrial pyruvate carrier inhibitors in treatment of metabolic dysfunction-associated steatohepatitis

Xinyue CHEN, Zhenhua ZHOU

2026, 42(4): 938-942. DOI: 10.12449/JCH260424

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Metabolic dysfunction-associated steatohepatitis （MASH） is a complex liver disease characterized by abnormal fat accumulation in the liver， accompanied by inflammation and hepatocyte injury， and it can gradually progress to liver fibrosis， liver cirrhosis， and even hepatocellular carcinoma. MASH has a complex pathogenesis involving multiple links such as insulin resistance， de novo lipogenesis （DNL）， oxidative stress， and mitochondrial dysfunction. In recent years， mitochondrial pyruvate carrier （MPC） has attracted wide attention as a key molecular target for regulating lipid metabolism. This article systematically reviews the mechanism of action of MPC in MASH， with a focus on how inhibiting MPC expression regulates lipid synthesis and metabolism by reducing DNL production and modulating signaling pathways such as AMPK-ACC， thereby improving liver inflammation. In addition， this article discusses the potential application prospects of MPC inhibitors in MASH treatment， in order to provide new ideas for future clinical research on MASH management.

The regulatory role of microRNA in the progression from metabolic dysfunction-associated fatty liver disease to hepatocellular carcinoma

Jiali XIE, Yaonan LIU, Rui ZHAO

2026, 42(4): 943-949. DOI: 10.12449/JCH260425

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Metabolic dysfunction-associated fatty liver disease （MAFLD） is the main cause of chronic liver disease around the world and can eventually lead to hepatocellular carcinoma. This article describes the evolution of the definition of MAFLD， the epidemiological burden of MAFLD， and the biosynthesis and biological functions of microRNA （miRNA）， as well as the important role of various types of miRNA in the progression of MAFLD by regulating the processes such as lipid metabolism， inflammation and liver fibrosis， oxidative stress， endoplasmic reticulum stress， and glycolysis. This article also evaluates the application prospect of miRNA as diagnostic biomarkers and therapeutic targets. It is pointed out that although existing studies have shown that miRNA plays an important role in the progression of MAFLD， there are still challenges in clinical translation， and large-scale studies should be conducted in the future to clarify the practical value of miRNA in MAFLD diagnosis and treatment， thereby providing new ways for precision medicine.

Metabolic-dysfunction and alcohol-associated liver disease： A new concept and recent advances

Rutao LIN, Fei XU, Xin XIN, Yiyang HU, Qin FENG

2026, 42(4): 950-956. DOI: 10.12449/JCH260426

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In 2023， multiple international societies proposed the concept of metabolic-dysfunction and alcohol-associated liver disease （MetALD） to characterize patients with steatotic liver disease who exhibit metabolic dysfunction and consume alcohol at a moderate level. In recent years， the evidence system in this field has been constantly developed and improved. This article reviews the latest research advances in MetALD from the aspects of background， definition， epidemiological characteristics， natural history， clinical phenotype， diagnostic and assessment methods， and treatment regimens， as well as the directions for future investigation.

Roles and mechanism of bile acids and gut microbiota in primary biliary cholangitis

Mengyao WU, Jiayin PAN, Rong DING, Jinyu LI, Wenlin TAI

2026, 42(4): 957-964. DOI: 10.12449/JCH260427

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Primary biliary cholangitis （PBC） is a cholestatic autoimmune liver disease characterized by the injury of small intrahepatic bile ducts， and at present， the pathogenesis of PBC remains unclear. Recent studies have shown that bile acid metabolism disorder and gut microbiota imbalance play a key role in the development and progression of PBC， and they form a complex and dynamic interaction network via the “gut-liver axis” and regulate core physiopathological processes such as immune response， metabolic homeostasis， and inflammatory response in a synergistic manner. This article systematically elaborates on the abnormal features of bile acid metabolism and gut microbiota in PBC， discusses their synergistic mechanisms in PBC， and then proposes a combined strategy of targeting bile acid receptors and modulating gut microbiota， in order to overcome the limitations of current treatment modalities and provide new insights and directions for the clinical management of PBC.

Ferroptosis as a double-edged sword in liver fibrosis

Yiyun AO, Anqi WU, Zhenggen WANG

2026, 42(4): 965-971. DOI: 10.12449/JCH260428

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Ferroptosis exhibits a clear “double-edged sword” effect in liver fibrosis， with its impact strictly dependent on the type of target cells. In hepatocytes， ferroptosis induced by specific signaling pathways （such as glutathione peroxidase 4 inhibition） is a key factor for driving hepatic injury and initiating fibrogenesis， and dying hepatocytes activate hepatic stellate cells by releasing damage-associated molecules； on the contrary， in activated hepatic stellate cells， ferroptosis becomes a therapeutic target for promoting liver fibrosis regression， and selective elimination can be achieved by disrupting their distinctive antioxidant defense mechanisms. Moreover， ferroptosis modulates the dynamic balance of the fibrotic liver microenvironment by regulating macrophage polarization and intercellular communication. Based on the above mechanisms， targeting ferroptosis has emerged as a promising strategy for precise treatment. This article summarizes related research advances and discusses the major challenges and future directions for clinical translation.

The application prospects of adeno-associated virus vectors in liver fibrosis

Suyu XIAO, Sisi YAO, Qing LI, Tingzheng ZHAN

2026, 42(4): 972-979. DOI: 10.12449/JCH260429

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Liver fibrosis is a critical pathological stage in the progression of various chronic liver diseases to liver cirrhosis and liver cancer， and it is characterized by the activation of hepatic stellate cells and excessive deposition of extracellular matrix. There are currently limited clinical treatment methods for liver fibrosis， and gene therapy has attracted increasing attention as a promising intervention strategy. Owing to its advantages of low immunogenicity， strong tissue tropism， and long-term gene expression， adeno-associated virus （AAV） has become an ideal vector for gene therapy. This article systematically reviews the structural and functional features of AAV， the tissue-targeting properties of different serotypes， and the methods for preparation and purification of recombinant AAV and focuses on the advances in the application of AAV-mediated gene overexpression， gene silencing， gene editing， and cellular reprogramming in mechanism research and intervention of liver fibrosis， as well as the challenges in clinical translation and corresponding strategies. AAV-mediated gene therapy is expected to provide novel tools and strategies for the precise treatment and mechanism study of liver fibrosis.

Mechanism of the interaction between immunosuppressive therapy and intestinal microflora after liver transplantation

Yan WANG, Yufeng LIU, Haiyang ZHANG, Zhiwei ZHANG, Jun XU, Zhiyong LAI

2026, 42(4): 980-986. DOI: 10.12449/JCH260430

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The application of immunosuppressants has significantly reduced the incidence rate of rejection reaction after liver transplantation， but the clinical efficacy of immunosuppressants is greatly affected by individual differences between patients. This article systematically reviews the recent research advances in the interaction between immunosuppressants and gut microbiota， with a focus on the regulatory role and mechanism of intestinal microflora communities on the efficacy of immunosuppressants. Studies have shown that intestinal microbiome is one of the key factors influencing the efficacy of immunosuppressive therapy after liver transplantation. This review aims to provide a theoretical basis for in-depth research in this field and provide new insights for developing individualized immunosuppressive treatment regimens based on the regulation of intestinal microflora.

Characteristics of the changes in biliary system dynamics under pathological conditions and related clinical translation value

Chenhao WANG, He BAI, Yingzheng REN, Xu SUN, Huichao ZHU, Guixin ZHANG

2026, 42(4): 987-992. DOI: 10.12449/JCH260431

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Changes in biliary system dynamics are closely associated with the development and progression of related diseases， and with the in-depth interdisciplinary research on medical sciences and engineering， the value of biliary biomechanics in clinical diagnosis and treatment has become increasingly important. This article systematically reviews the characteristics of changes in biliary system dynamics under pathological conditions and explores the application value of technologies such as biliary manometry， hydrodynamic evaluation， and experimental simulation in clinical diagnosis， treatment， and postoperative management， so as to deepen the understanding of existing diagnostic and therapeutic modes and provide new ideas for promoting precision medicine for biliary tract diseases.

Hepatology｜A randomized， double-blind， phase 3， non-inferiority trial of pradefovir mesylate versus tenofovir disoproxil fumarate in Chinese patients with chronic hepatitis B

2026, 42(4): 922-922. DOI: 10.12449/JCH2604.gwqkjpwzjj1

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Gut Microbes｜Tamoxifen induced hepatotoxicity via gut microbiota-mediated hyodeoxycholic acid depletion and Farnesoid X receptor signaling disruption

2026, 42(4): 929-929. DOI: 10.12449/JCH2604.gwqkjpwzjj2

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Lancet Gastroenterology & Hepatology｜Cilofexor in non-cirrhotic primary sclerosing cholangitis（ PRIMIS）： A randomised， double-blind， multicentre， placebo-controlled， phase 3 trial

2026, 42(4): 964-964. DOI: 10.12449/JCH2604.gwqkjpwzjj3

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Gut｜Impairment of Rab7-dependent STING degradation hampers HBV replication but accelerates disease progression in chronic hepatitis B comorbid with MASLD

2026, 42(4): 979-979. DOI: 10.12449/JCH2604.gwqkjpwzjj4

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Current reviewers

2026, 42(4): 754-754. DOI: 10.12449/JCH2604.zhixie

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