2026 No. 5

Construction and consideration on a traditional Chinese medicine efficacy evaluation system for liver diseases

Qianqian NIU, Wei CHEN, Xiuhui LI

2026, 42(5): 993-997. DOI: 10.12449/JCH260501

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Traditional Chinese medicine （TCM） has unique advantages in the management of liver diseases； however， traditional TCM efficacy evaluation is highly subjective with a lack of standardized criteria， and the evaluation criteria for modern medicine are incompatible with the characteristics of TCM interventions， leading to a marked dissociation between diseases， symptoms， and syndromes. To address the above issues， this article proposes the core principle of disease-symptom-syndrome integration and establishes a four-dimensional efficacy evaluation system including TCM syndrome efficacy， patient-reported outcomes， overall disease prognosis， and changes in biological indicators. This article systematically elaborates on the core connotation， indicator selection criteria， and quantification methods of each dimension and clarifies the implementation principles and strategies， in order to provide methodological support for high-quality clinical research and the production of high-level evidence-based data in TCM treatment of liver diseases and promote the modernization and internationalization of TCM diagnosis and treatment.

Construction of a clinical efficacy evaluation system for traditional Chinese medicine treatment of chronic hepatitis B and related reflections

Liyun HE, Xiaoliang ZHAO, Lin LUO

2026, 42(5): 998-1003. DOI: 10.12449/JCH260502

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Traditional Chinese medicine （TCM） is widely used in the clinical management of chronic hepatitis B in China and has exhibited certain advantages in alleviating symptoms， regulating overall physiological status， and assisting in the intervention against disease progression. However， there is still a lack of a comprehensive clinical efficacy evaluation system for TCM treatment of chronic hepatitis B， with inconsistencies in the selection of evaluation indicators and limited objectivity and standardization in the assessment of syndromes and symptoms， which have limited the systematic accumulation of evidence regarding TCM efficacy and the incorporation of TCM into clinical guidelines and expert consensus statements. This article systematically reviews the current status of research on the clinical efficacy evaluation of TCM for chronic hepatitis B and analyzes the achievements made in the field of TCM therapy and integrated traditional Chinese and Western medicine therapy for chronic liver diseases in China’s national major infectious disease research programs during the periods of the Eleventh to Thirteenth Five-Year Plans. It also points out related issues that remain to be addressed and proposes a conceptual framework and specific components for constructing a TCM clinical efficacy evaluation system from the perspectives of evaluation objectives， indicator composition， and application scenarios， in order to provide a reference for the development of related standards， clinical research， and the standardization of integrated traditional Chinese and Western medicine diagnosis and treatment.

Construction of a clinical efficacy evaluation framework for traditional Chinese medicine treatment of metabolic dysfunction-associated fatty liver disease

Yuxin SUN, Guangdong TONG

2026, 42(5): 1004-1008. DOI: 10.12449/JCH260503

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Based on a review of clinical trial assessment indices for metabolic dysfunction-associated fatty liver disease （MAFLD） and the current status of traditional Chinese medicine （TCM） research， this article proposes a multi-dimensional， stratified， and operable clinical efficacy evaluation framework for TCM with reference to the features of MAFLD and the therapeutic effect of TCM. This system encompasses eight dimensions of liver histology， radiology， biochemical indicators， metabolic markers， anthropometry， TCM syndromes， patient-reported outcomes， and safety indicators， which are stratified according to research objectives and disease stages. This study further explores the implementation pathways for the standardization of syndrome evaluation， research design norms， and quality control， in order to provide methodological support for conducting high-quality TCM clinical research and promote the transition of TCM efficacy evaluation from “single indicators” to “multi-dimensional composite indicators”.

Construction of a goal-oriented efficacy evaluation system for traditional Chinese medicine in the prevention and treatment of primary liver cancer

Ning ZHANG, Yinying LU

2026, 42(5): 1009-1014. DOI: 10.12449/JCH260504

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Traditional Chinese medicine （TCM） plays an important role in the full-cycle management of primary liver cancer； however， the current evidence-based evaluation system with the main assessment index of objective tumor remission is mainly centered on randomized controlled trials and systematic reviews/meta-analyses and cannot fully reflect the characteristics and advantages of TCM. Based on the current status of TCM efficacy evaluation in the prevention and treatment of liver cancer， this article proposes the construction of a multi-dimensional evaluation system that is oriented by stage-specific treatment goals and integrates outcome indicators with process indicators. Outcome indicators include modern medical endpoints such as overall survival and recurrence-free survival， and process indicators include short-term outcomes such as the improvement in TCM syndrome， patient-reported outcomes， the remission rate of adverse events， and the discontinuation rate of the core regimen. It is emphasized that the development of standardized TCM regimens should follow the order of theoretical connotation， accumulation of proven cases， observational evaluation， and interventional evaluation. Furthermore， it is recommended to incorporate artificial intelligence approaches into this evaluation system， so as to promote the intelligent and precise assessment of TCM efficacy.

Expert consensus on the integrated traditional Chinese and Western medicine diagnosis and treatment of proteinuria associated with molecular targeted drugs for primary liver cancer

Work Group of Expert Consensus on the Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Proteinuria Associated with Molecular Targeted Drugs for Primary Liver Cancer

2026, 42(5): 1015-1026. DOI: 10.12449/JCH260505

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Proteinuria is a common adverse reaction in patients with primary liver cancer undergoing molecular targeted therapy and falls in the categories of “turbid urine”， “edema”， and “consumptive disease”， among others， in traditional Chinese medicine. Currently， there is a lack of specific clinical treatments and monitoring and management strategies for proteinuria associated with targeted drugs for liver cancer， and integrated traditional Chinese and Western medicine therapy is an effective prevention and treatment method. Following the principles of evidence-based medicine and using the methods of literature review， grading of evidence， and multidisciplinary expert discussions， the work group established an expert consensus on integrated traditional Chinese and Western medicine diagnosis and treatment with unique advantages of traditional Chinese medicine and convenient clinical operation with reference to recent clinical practice experience and the latest guidelines and expert consensus statements in China and globally， in order to provide a reference for the clinical practice of integrated traditional Chinese and Western medicine therapy for proteinuria associated with targeted drugs for liver cancer.

Key recommendations from consolidated guidance on hepatitis B and C prevention， testing， treatment， service delivery and monitoring： An implementation handbook for a public health approach by the World Health Organization （2026 edition）

Yujie CHENG, Fuqiang CUI

2026, 42(5): 1027-1033. DOI: 10.12449/JCH260506

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In February 2026， the World Health Organization released the latest edition of Consolidated guidance on hepatitis B and C prevention， testing， treatment， service delivery and monitoring： An implementation handbook for a public health approach. This guidance integrates more than 80 evidence-based recommendations and good practice statements issued from 2015 to 2025， and it is the first handbook that combines all hepatitis B， C and D guidelines into a single reference document. The guideline centers around five core areas of prevention， testing and diagnosis， treatment and care， simplified services， and strategic information to simplify and expand access to interventions through public health approaches， so as to accelerate the achievement of the global goal of eliminating the public health threat of viral hepatitis by 2030. This article summarizes the core recommendations and implementation considerations in the handbook.

An excerpt of 2025 AASLD/AST practice guideline on adult liver transplantation： Candidate evaluation

Zhao LI, Jiye ZHU

2026, 42(5): 1034-1037. DOI: 10.12449/JCH260507

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In December 2025， the American Association for the Study of Liver Diseases （AASLD） and the American Society of Transplantation （AST） jointly issued an updated guideline on the evaluation of adult liver transplant candidates. The guideline is organized into four domains， i.e.， referral for liver transplantation， candidate evaluation， contraindications to liver transplantation， and special considerations （e.g.， living donor liver transplantation）， in order to provide a standardized framework for clinical assessment. This new guideline updates the 2013 edition based on the latest evidence-based medical evidence and incorporates discussions on emerging indications for liver transplantation， including intrahepatic cholangiocarcinoma and colorectal liver metastases. This guideline emphasizes that candidate assessment must be individualized， and the assessment process must be transparent and consistent. This article gives an excerpt of the key recommendations in this guideline for readers’ reference.

Construction of a nomogram model for clinical cure of chronic hepatitis B with a low level of hepatitis B surface antigen treated with pegylated interferon α-2b

Yingyuan ZHANG, Huan MU, Lixian CHANG, Danqing XU, Yuanzhen WANG, Chunyun LIU, Weikun LI, Huangchenghao ZHANG, Chunyan MOU, Li LIU

2026, 42(5): 1038-1047. DOI: 10.12449/JCH260508

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Objective To investigate the predictive factors for HBsAg clearance in chronic hepatitis B （CHB） patients with a low level of hepatitis B surface antigen （HBsAg） treated with pegylated interferon α-2b （PEG-IFN-α-2b）， to establish a combined predictive model and a nomogram based on multiple factors， and to provide a reference for formulating individualized treatment regimens and predicting treatment outcome in clinical practice. Methods A retrospective analysis was performed for 167 CHB patients with HBsAg <1 500 IU/mL who attended The Third People’s Hospital of Kunming from January 2022 to January 2024 and were treated with PEG-IFN-α-2b. According to whether clinical cure was achieved， the patients were divided into HBsAg clearance group and HBsAg non-clearance group. Related data were collected， including general information and serological/biochemical/virological indicators at different time points during treatment. The independent samples t-test was used for comparison of normally distributed continuous data， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data； the chi-square test was used for comparison of categorical data. The multivariate logistic regression analysis was used to identify independent influencing factors. The receiver operating characteristic （ROC） curve was used to assess the value of indicators used alone or in combination in predicting clinical cure， and calibration curves were plotted to assess the risk prediction model. Results The univariate analysis showed that there were significant differences between the two groups in age （t=-6.839， P<0.05）， history of nucleos（t）ide analogue treatment for over 1 year （χ²=59.339， P<0.05）， genotype （χ²=4.610， P<0.05）， nonalcoholic fatty liver disease （χ²=5.319， P<0.05）， hepatitis B virus DNA status before treatment （χ²=60.861， P <0.05）， compensated liver cirrhosis （χ²=10.960， P<0.05）， HBeAg status before treatment （χ²=19.060， P<0.05）， a history of interferon treatment （χ²=8.162， P<0.05）， presence of interferon antibodies after treatment （χ²=12.858， P<0.05）， HBsAg level before treatment （Z=-7.412， P<0.05）， alanine aminotransaminase （ALT） level at baseline （Z=-6.117， P<0.05）， ALT level at 12 weeks of treatment （Z=-7.171， P<0.05）， platelet count （PLT） at 24 weeks of treatment （Z=-3.622， P<0.05）， and thyroid stimulating hormone （TSH） level at 24 weeks of treatment （Z=-2.830， P<0.05）. The multivariate logistic regression analysis showed that age （odds ratio ［OR］=1.230， P=0.007）， history of nucleos（t）ide analogue treatment for over 1 year （OR=0.008， P=0.011）， HBeAg status before treatment （OR=0.003， P=0.012）， HBsAg level before treatment （OR=1.005， P=0.014）， ALT level at baseline （OR=0.949， P=0.014）， ALT level at 12 weeks of treatment （OR=0.969， P=0.016）， PLT at 24 weeks of treatment （OR=0.969， P=0.022）， and TSH level at 24 weeks of treatment （OR=3.608， P=0.045） were independent influencing factors for HBsAg clearance at 48 weeks of treatment in CHB patients with HBsAg <1 500 IU/mL. The Hosmer-Lemeshow goodness-of-fit test yielded χ²=1.398， P=0.994， indicating that the model had good fitting. The Bootstrap method was used to perform internal validation of the nomogram model， and there was a good degree of fitting between the calibration curve and the ideal curve， with a mean absolute error of 0.029. The ROC curve analysis showed that the combination of predictive factors had an area under the ROC curve of 0.982 （95% confidence interval： 0.961 — 0.999）， with a sensitivity of 94.10% and a specificity of 93.10%， suggesting that the nomogram model had a good discriminatory ability. For the CHB patients with HBsAg <1 500 IU/mL and different features， further analysis of HBsAg clearance rate at 48 weeks of treatment showed an HBsAg clearance rate of 69.60% for those with HBsAg ≤67.65 IU/mL before treatment， 58.30% for those with a baseline ALT level of ≥62.50 U/L， 68.30% for those with an ALT level of ≥92.50 U/L at 12 weeks of treatment， 42.40% for those with PLT ≥104×10⁹/L at 24 weeks of treatment， and 48.30% for those with a TSH level of ≤1.38 μIU/mL at 24 weeks of treatment， with significant differences between the two groups （all P<0.001）. Conclusion Age， history of nucleos（t）ide analogue treatment for over 1 year， HBeAg status before treatment， HBsAg level before treatment， baseline ALT level， ALT level at 12 weeks of treatment， PLT level at 24 weeks， and TSH level at 24 weeks of treatment are independent predictive factors. The combined prediction nomogram model constructed in this study has a relatively high value in predicting clinical cure at 48 weeks of PEG-IFN-α-2b treatment in CHB patients with HBsAg<1 500 IU/mL， thereby providing a reference for selecting suitable treatment population and predicting clinical cure.

Changing trend of non-alcoholic fatty liver disease among young people aged 20—44 years in East Asian countries in 1990—2023

Fei SU, Chunzhi SU, Xianxin MENG, Jingyao LI, Xiaodi ZHU, Jinli ZHANG

2026, 42(5): 1048-1055. DOI: 10.12449/JCH260509

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Objective To investigate the disease burden of non-alcoholic fatty liver disease （NAFLD） among young people in East Asian countries （including China， North Korea， Japan， Mongolia， and South Korea） in 1990—2023， and to provide a basis for formulating and adjusting the prevention and treatment strategies for NAFLD. Methods Related disease burden data of NAFLD among the young people in these five East Asian countries were collected from the Global Burden of Disease 2023 （GBD 2023） database， including incidence rate， prevalence rate， and disability-adjusted life years （DALY）， and the young people were divided into groups based on country， sex， and age. Estimated annual percentage change （EAPC） was used to comprehensively evaluate the changing trend of the disease burden of NAFLD among young people from 1990 to 2023， and the Autoregressive Integrated Moving Average model was used to predict the disease burden of NAFLD among the young people in China. Results In 2023， the standardized incidence rates of NAFLD among the young people in China， North Korea， Japan， Mongolia， and South Korea were 926.57/100 000， 805.83/100 000， 412.66/100 000， 747.66/100 000， and 534.08/100 000， respectively； the standardized prevalence rates of NAFLD among the young people in China， North Korea， Japan， Mongolia， and South Korea were 16 817.94/100 000， 14 500.98/100 000， 8 534.40/100 000， 13 705.28/100 000， and 11 587.93/100 000， respectively； the standardized DALY rates of NAFLD among the young people in China， North Korea， Japan， Mongolia， and South Korea were 6.34/100 000， 10.18/100 000， 5.23/100 000， 47.93/100 000， and 6.76/100 000， respectively. From 1990 to 2023， there was a tendency of increase in the standardized incidence rate of NAFLD among the young people in China， North Korea， Japan， Mongolia， and South Korea， with an EAPC of 0.87%， 0.52%， 0.26%， 0.48%， and 0.87%， respectively； there was also a tendency of increase in the standardized prevalence rate of NAFLD among the young people in China， North Korea， Japan， Mongolia， and South Korea， with an EAPC of 0.99%， 0.49%， 0.24%， 0.59%， and 0.93%， respectively； conversely， there was a tendency of reduction in the standardized DALY rate of NAFLD among the young people in China， Japan， Mongolia， and South Korea， with an EAPC of -2.21%， -2.01%， -0.37%， and -4.62%， respectively， while the standardized DALY rate of NAFLD among the young people in North Korea remained relatively stable， with an EAPC of -0.01%. The subgroup analysis based on sex showed that there was a significant difference in the disease burden of NAFLD between the young people with different sexes in the five East Asian countries， and the subgroup analysis based on age showed that the incidence rate of NAFLD in young people decreased with the increase in age， while the prevalence rate and DALY rate of NAFLD increased with age. In addition， the standardized incidence rate and standardized prevalence rate of NAFLD among Chinese young people would further increase in the future， while there would be a reduction in standardized DALY rate in the future. Conclusion There is a significant difference in the disease burden of NAFLD in young people across different countries， sexes， and age groups. In the future， targeted prevention and treatment measures should be developed based on the distribution characteristics of the disease burden of NAFLD， in order to effectively reduce the disease burden of NAFLD among young people.

Value of metabolic markers combined with anthropometric indicators in predicting and risk stratification of metabolic dysfunction-associated fatty liver disease and establishment of a nomogram model

Sirui ZHAO, Zheyu LI, Wenqiang HE, Junfeng LI, Liting ZHANG

2026, 42(5): 1056-1066. DOI: 10.12449/JCH260510

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Objective To develop a novel clinical predictive model for metabolic dysfunction-associated fatty liver disease （MAFLD） based on metabolic markers and anthropometric indicators， and to provide a more effective tool for the early screening and intervention of MAFLD. Methods A retrospective analysis was performed for 2 824 individuals who underwent abdominal color Doppler ultrasound at Health Examination Center of The First Hospital of Lanzhou University from January 1， 2024 to January 1， 2025， and at a ratio of 7∶3， they were randomly divided into training set with 1 976 patients and validation set with 848 patients. Clinical data， serological markers， and abdominal ultrasound results were collected from all patients， and triglyceride-glucose （TyG） index， triglyceride-to-high-density lipoprotein cholesterol （TG/HDL-C） ratio， and anthropometric indicators were calculated. The independent samples t-test was used for comparison of normally distributed or approximately 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 or the Fisher’s exact test was used for comparison of categorical data between groups. The multivariate logistic regression analysis was used to identify independent predictive factors for MAFLD and intermediate- to high-risk MAFLD. Five risk prediction models were established for MAFLD based on the independent influencing factors， and a nomogram was plotted. The receiver operating characteristic （ROC） curve was plotted to assess model performance， and the area under the ROC curve （AUC） was calculated. The calibration curve was used to evaluate the predictive accuracy of the models， and decision curve analysis was used to assess the clinical practicability of the models. These models were then compared with traditional models. Results Among the 1 976 individuals in the training set， 937 （47.42%） were diagnosed with MAFLD， and 423 （21.41%） were diagnosed with intermediate- to high-risk MAFLD； among the 848 individuals in the validation set， 406 （47.88%） were diagnosed with MAFLD. The multivariate logistic regression analysis showed that male sex （odds ratio ［OR］=0.23， 95% confidence interval ［CI］： 0.13 — 0.39， P<0.05）， waist circumference （OR=1.11， 95%CI： 1.06 — 1.17， P<0.05）， alanine aminotransferase （ALT） >40 U/L （OR=2.24， 95%CI： 1.44 — 3.51， P<0.05）， high-density lipoprotein cholesterol （HDL-C）（OR=0.07， 95%CI： 0.04 — 0.15， P<0.05）， TyG index （OR=8.27， 95%CI： 5.09 — 13.44， P<0.05）， TG/HDL-C ratio （OR=0.84， 95%CI： 0.71 — 0.99， P<0.05）， A Body Shape Index （ABSI）（OR=0.45， 95%CI： 0.39 — 0.52， P<0.05）， and body roundness index （BRI）（OR=2.31， 95%CI： 1.50 — 3.55， P<0.05） were independent influencing factors for MAFLD， and male sex （OR=0.17， 95%CI： 0.10 — 0.31， P<0.05）， age （OR=1.09， 95%CI： 1.07 — 1.11， P<0.05）， hemoglobin （OR=0.98， 95%CI： 0.97 — 0.98， P<0.05）， platelet count （OR=0.81， 95%CI： 0.70 — 0.93， P<0.05）， fasting blood glucose （OR=0.80， 95%CI： 0.71 — 0.89， P<0.05）， triglycerides （OR=0.14， 95%CI： 0.07 — 0.29， P<0.05）， TG/HDL-C ratio （OR=0.78， 95%CI： 0.67 — 0.91， P<0.05）， TyG index （OR=5.26， 95%CI： 3.32 — 8.33）， waist circumference （OR=2.50， 95%CI： 1.72 — 3.61， P<0.05）， ABSI （OR=0.58， 95%CI： 0.51 — 0.66， P<0.05）， and BRI （OR=0.01， 95%CI： 0.00 — 0.21， P<0.05） were independent influencing factors for intermediate- to high-risk MAFLD. Among the five models established， model 5 （incorporating sex， ALT elevation， HDL-C， TyG index， TG/HDL-C ratio， waist circumference， and ABSI） had the best performance， with an AUC of 0.917 （95%CI： 0.905 — 0.929） in the training set and 0.911 （95%CI： 0.892 — 0.930） in the validation set. The calibration curve showed that model 5 had good predictive accuracy， and the decision curve analysis confirmed its clinical practicability. Conclusion The predictive model for MAFLD constructed based on metabolic markers and anthropometric indicators has good discriminatory ability and can be used to assess the risk of MAFLD. In addition， this study shows that waist circumference， TyG index， TG/HDL-C ratio， ABSI， and BRI are independently associated with intermediate- to high-risk MAFLD， but further studies are needed to confirm their value in predicting liver fibrosis progression.

Value of serum intestinal fatty acid-binding protein in predicting short-term mortality after endoscopic hemostasis for esophagogastric variceal bleeding in patients with liver cirrhosis

Caijun HAN, Yuxuan HE, Meihua PIAO, Xing JIN, Yuan HUANG, Zhengxie WU

2026, 42(5): 1067-1074. DOI: 10.12449/JCH260511

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Objective To investigate the value of intestinal fatty acid-binding protein （I-FABP） in predicting 6-week mortality in patients with liver cirrhosis after successful endoscopic hemostasis for esophagogastric variceal bleeding （EVB）. Methods A retrospective analysis was performed for the clinical data of 207 patients with liver cirrhosis who underwent successful endoscopic treatment for EVB （including ligation and sclerotherapy） in The Affiliated Hospital of Yanbian University from September 2020 to June 2025， with the endpoint of 6-week bleeding-related mortality. ELISA was used to measure the serum level of I-FABP on admission， and a stratified analysis was performed based on the quartiles of I-FABP measurements. 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 two groups. The Kaplan-Meier survival analysis， Cox regression analysis， and restricted cubic spline （RCS） curve were used to investigate the association between I-FABP and mortality. Machine learning models were used to further quantify the impact of I-FABP on mortality. The integrated Brier score and an integrated cumulative/dynamic area under the curve were used to assess the importance of time-dependent variables， and the receiver operating characteristic （ROC） curve was used to assess the performance of the predictive model. Results During the study， 29 patients （14.0%） died within 6 weeks after successful endoscopic hemostasis， with a median time to death of 16 （8—26） days. The mortality group had a significantly higher serum level of I-FABP than the survival group （Z=-3.731， P<0.001）. The Kaplan-Meier survival analysis showed that there was a significant difference in 6-week mortality between the groups of patients based on I-FABP quartiles （χ² =12.78， P=0.005）. The multivariable Cox regression analysis showed that an increase in I-FABP （hazard ratio=1.87， P=0.003） was an independent influencing factor for 6-week mortality. The RCS analysis showed a linear relationship between I-FABP and 6-week mortality （P_non-linear=0.280， P_overall=0.029）. Machine learning models showed that there was a dynamic change in the importance of I-FABP over time， and Brier score loss and the loss of cumulative/dynamic area under the curve after permutation showed that I-FABP was an important variable affecting 6-week mortality rate. Conclusion I-FABP level is independently associated with the risk of 6-week mortality endoscopic hemostasis for EVB in patients with liver cirrhosis， and therefore， it can be used as a potential biomarker for poor short-term prognosis.

Value of liver and spleen stiffness measured by two-dimensional shear wave elastography in diagnosing the severity of portal hypertension

Min WANG, Guanhua ZHANG, Lijuan FENG, Yuhong SUO, Fuliang HE, Xiangdong HU, Min LI, Yu WANG

2026, 42(5): 1075-1082. DOI: 10.12449/JCH260512

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Objective To investigate the value of liver stiffness measurement （LSM） and spleen stiffness measurement （SSM） measured by two-dimensional shear wave elastography （2D-SWE） in the diagnosis of severe portal hypertension （SPH） and high-risk varices （HRV）， and to provide a basis for noninvasive assessment of portal hypertension. Methods A prospective study was conducted among 78 patients with cirrhotic portal hypertension who were treated in Liver Research Center of Beijing Friendship Hospital， Capital Medical University， from December 2019 to April 2023. According to hepatic venous pressure gradient （HVPG）， the patients were divided into 6 mmHg≤HVPG<12 mmHg group， 12 mmHg≤HVPG<20 mmHg group， and HVPG ≥20 mmHg group. All patients underwent gastroscopy and 2D-SWE within 1 week after HVPG measurement， and SWE-LSM and SWE-SSM measured by 2D-SWE were recorded. A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. With HVPG and gastroscopy findings as the gold standard， the receiver operating characteristic （ROC） curve was plotted and the area under the ROC curve （AUC） was calculated to evaluate diagnostic performance， while the DeLong test was used for comparison of AUC. The Pearson or Spearman correlation analysis was used to investigate the correlation between variables， and the linear regression analysis and the Logistic regression analysis were used to investigate the influencing factors for HVPG and HRV. Results The mean HVPG was 18.1±6.4 mmHg for the patients enrolled in this study， and HRV was observed in 62 patients （79.5%）. Both SWE-LSM and SWE-SSM were significantly positively correlated with HVPG （r=0.413 and 0.633， both P<0.001）， with an AUC of 0.812 and 0.902， respectively， in the diagnosis of HVPG≥12 mmHg and an AUC of 0.804 and 0.789， respectively， in the diagnosis of HVPG≥20 mmHg （all P>0.05）. The multivariate linear regression analysis showed that SWE-SSM was an independent influencing factor for HVPG （β=0.17， P<0.001）. In the diagnosis of HRV， only SWE-SSM showed a significant positive correlation with HRV （r=0.432， P<0.001）， with a better diagnostic performance than SWE-LSM in terms of AUC （0.808 vs 0.642， Z=2.775， P=0.006）. The multivariate Logistic regression analysis showed that platelet count was an independent influencing factor for HRV （odds ratio=0.97， P=0.014）. Conclusion SWE-SSM is closely correlated with both HVPG and HRV， showing a good performance in the diagnosis of SPH and HRV， and therefore， it is expected to become an effective noninvasive tool for assessing portal hypertension.

Regulatory effect of astragaloside Ⅰ and calycosin on a mouse model of cholestatic liver fibrosis

Xiaoyu JIANG, Wei LIU, Jiamei CHEN, Ping LIU, Chunhui LI

2026, 42(5): 1083-1092. DOI: 10.12449/JCH260513

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Objective To identify and validate the optimal compatibility dosage of astragaloside Ⅰ （ASⅠ） and calycosin （CY） in the treatment of cholestatic liver fibrosis. Methods A 3，5-diethoxycarbonyl-1，4-dihydrocollidine （DDC） diet was used to establish a mouse model of liver fibrosis， and the uniform design method was used to identify the optimal combination ratio of the saponin component ASⅠ and the flavonoid component CY in Astragalus membranaceus. In the uniform design experiment， 80 male C57/BL6J mice were divided into normal group， model group， total astragalosides （TAS） group， groups A — F with a uniform design， and obeticholic acid （OCA） group using a random number table， with 8 mice in each group. The multiple regression analysis was used to establish the optimal regression equation and obtain the potential optimal combination ratio. The in vivo efficacy of the empirically optimal combination identified in the uniform design and the optimal dose combination predicted by the regression equation were compared for validation. A one-way analysis of variance was used for comparison of continuous data between multiple groups； the Levene test was used to determine the homogeneity of variance， and the least significant difference t-test was used for comparison of data with homogeneity of variance between two groups， while the Dunnett T3 test was used for comparison of data with heterogeneity of variance. Results In the uniform design regimen， the JYB combination （3.125 mg/kg ASI+50 mg/kg CY） significantly reduced the serum levels of alanine aminotransferase （ALT）， aspartate transaminase （AST）， alkaline phosphatase （ALP）， total bile acid （TBA）， total bilirubin （TBil）， and indirect bilirubin （IBil） in mice with DDC-induced cholestatic liver fibrosis （all P<0.05）， and it also reduced hepatic Hyp content （P<0.01）， semi-quantified collagen deposition area （P<0.001）， and the mRNA expression levels of Acta2， Col1a1， Ck7， Ck19， Adgre1， TLR4， TNF-α， and CCL5 in liver tissue （all P<0.05）. The regression equation showed that 50 mg/kg ASⅠ+50 mg/kg CY was the potential optimal combination， which was named as P1 combination. However， subsequent validation experiments showed that P1 combination only significantly improved the serum levels of AST and IBil and hepatic Hyp content in DDC mice （all P<0.05）， with no significant impact on hepatic collagen deposition and the mRNA expression levels of Acta2， Ck7， Ck19， Adgre1， and CCL5 （all P>0.05）. In contrast， the JYB combination significantly improved the serum levels of ALP， ALT， AST， TBA， TBil， and IBil， hepatic collagen deposition， hepatic Hyp content， and the mRNA expression levels of Acta2， Col1a1， Ck7， Ck19， Adgre1， TLR4， TNF-α， and CCL5 （all P<0.05）. Conclusion This study shows that the JYB combination （3.125 mg/kg ASⅠ+50 mg/kg CY） can significantly alleviate DDC-induced liver fibrosis， with comparable efficacy to total saponins from Astragalus membranaceus， and compared with ASⅠ or CY administered alone， the JYB combination has a significantly better regulatory effect on the serum levels of ALP and TBA.

Clinical features and multimodal quantitative radiological features of primary liver cancer patients with different traditional Chinese medicine syndrome types

Feng WU, Muqing LUO, Wantingting WEN, Ziwei CAI, Yinqi LIU, Jian XIANG, Xiaona ZHOU, Qian GUO, Kun ZHANG

2026, 42(5): 1093-1100. DOI: 10.12449/JCH260514

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Objective To investigate the association of the traditional Chinese medicine （TCM） syndrome types of primary liver cancer （PLC） with clinical features and multimodal quantitative radiological features on computed tomography （CT） and magnetic resonance imaging （MRI）， and to provide a reference for the objectification of TCM syndrome differentiation and precise diagnosis and treatment. Methods A retrospective analysis was performed for the clinical data of 312 patients who were diagnosed with PLC in The First Affiliated Hospital of Hunan University of Chinese Medicine from March 2020 to June 2025， and according to the TCM syndrome type， they were divided into stagnation of liver Qi group with 40 patients， stagnation of liver Qi and spleen deficiency group with 109 patients， Qi stagnation and blood stasis group with 62 patients， dampness-heat toxin amassment group with 81 patients， and liver-kidney Yin deficiency group with 20 patients. Clinical features and multimodal quantitative radiological features were compared between the patients with different TCM syndrome types. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the least significant difference t-test was used for further comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups， and the Dunn’s multiple test was used for further comparison between two groups； the chi-square test was used for comparison of categorical data between groups， and the Bonferroni method was used for further comparison between two groups. Results There were significant differences between the patients with different TCM syndrome types in China liver cancer staging （CNLC）， Child-Pugh class， alanine aminotransferase， aspartate aminotransferase， albumin， direct bilirubin， total bilirubin， prothrombin time， neutrophil， and albumin-bilirubin score （all P<0.05）. In the stagnation of liver Qi group， the patients with Child-Pugh class A accounted for 75.00%； among the patients with CNLC stage I PLC， the patients with stagnation of liver Qi accounted for 60.00%， and those with Qi stagnation and blood stasis syndrome accounted for 59.68%， while among the patients with CNLC stage IV PLC， the distribution proportion of dampness-heat toxin amassment （27.16%） and liver-kidney Yin deficiency （30.00%） was significantly higher than that of stagnation of liver Qi （2.50%）（all P<0.05）. Radiological examination showed that there were significant differences between the patients with different TCM syndrome types in the number of tumors， ascites， venous tumor thrombus， maximum tumor diameter， intrahepatic metastasis， and lymph node metastasis in the hepatic hilar and retroperitoneal regions （all P<0.05）. Compared with the patients with stagnation of liver Qi， the patients with liver depression and spleen deficiency or liver-kidney Yin deficiency were more likely to develop intrahepatic metastasis； the patients with liver depression and spleen deficiency， dampness-heat toxin amassment， or liver-kidney Yin deficiency were more likely to develop lymph node metastasis in the hepatic hilar and retroperitoneal regions； the patients with liver-kidney Yin deficiency were more likely to experience multiple tumors； the patients with liver depression and spleen deficiency or dampness-heat toxin amassment were more likely to develop ascites （all P<0.05）. Compared with the patients with Qi stagnation and blood stasis syndrome， the patients with liver depression and spleen deficiency had a significantly longer maximum tumor diameter and a significantly higher proportion of patients with venous tumor thrombus （both P<0.05）. Furthermore， among the 184 patients with MRI diffusion-weighted imaging sequences， the patients with dampness-heat toxin amassment or Qi stagnation and blood stasis syndrome had significantly higher ADC values and relative ADC values than those with stagnation of liver Qi （all P<0.05）. Conclusion There are significant differences in CT/MRI radiological features and clinical features between PLC patients with different TCM syndrome types， among whom the patients with liver depression and spleen deficiency， dampness-heat toxin amassment， and liver-kidney Yin deficiency tend to exhibit progressive radiological features， and those with dampness-heat toxin amassment or Qi stagnation and blood stasis syndrome tend to have higher ADC values. These findings provide an objective basis for TCM syndrome differentiation in PLC.

Impact of portal vein tumor thrombus classification on rebleeding in hepatocellular carcinoma patients with esophagogastric variceal bleeding

Jiali MA, Xiaohui YE, Hongshan WEI, Ping LI, Xiuxia LIANG

2026, 42(5): 1101-1108. DOI: 10.12449/JCH260515

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Objective To investigate the impact of portal vein tumor thrombus （PVTT） classification on rebleeding in hepatocellular carcinoma （HCC） patients with different PVTT subtypes and esophagogastric variceal bleeding （EGVB）， and to provide a reference for formulating rational treatment regimens for such patients. Methods A retrospective study was performed for 130 patients with HCC and PVTT who were treated due to EGVB in Beijing Ditan Hospital， Capital Medical University， from July 2020 to January 2025， and according to whether endoscopic treatment was performed， the patients were divided into endoscopic treatment group with 97 patients and conservative treatment group with 33 patients. Demographic and clinical data were collected from all patients， and the two groups were compared in terms of hemostasis success rate and rebleeding rate. The independent-samples t test was used for comparison of normally distributed continuous data between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to estimate the cumulative incidence rate of rebleeding in patients with different subtypes of PVTT. Propensity score matching （PSM） was performed for the endoscopic treatment group and the conservative treatment group to balance the baseline data of the two groups. The Cox proportional hazards model was used to perform univariate and multivariate analyses and identify independent risk factors for rebleeding. Results The endoscopic treatment group had a significantly lower cumulative rebleeding rate within 6 months than the conservative treatment group （35.1% vs 57.6%， hazard ratio ［HR］=0.480， 95% confidence interval ［CI］： 0.272—0.851， P=0.019）. The PVTT Ⅲ—Ⅳ group had a significantly higher cumulative rebleeding rate within 6 months than the PVTT Ⅱ group （52.2% vs 37.5%， HR=1.744， 95%CI： 1.008 — 3.018， P=0.022）. After PSM， there was no significant difference in rebleeding rate between the endoscopic treatment group and the conservative treatment group （38.1% vs 14.3%，HR=1.500，95%CI：0.125 — 2.002， P=0.588）， while the PVTT Ⅲ—Ⅳ group had a significantly higher cumulative rebleeding rate than the PVTT Ⅱ group （58.8% vs 12.5%，HR=1.561，95%CI：1.195 — 12.499，P=0.033）. The multivariate Cox regression analysis showed that PVTT subtype （HR=1.412， 95%CI： 0.998 — 1.997， P=0.049）， platelet count （HR=1.006， 95%CI： 1.001 — 1.010， P=0.021）， C-reactive protein （HR=1.011， 95%CI： 1.001 — 1.021， P=0.026）， and ascites （HR=1.803， 95%CI： 1.059 — 3.068， P=0.030） were independent risk factors for rebleeding. Conclusion For HCC patients with PVTT and EGVB， endoscopic treatment can successfully achieve hemostasis， while it fails to significantly reduce rebleeding rates. PVTT classification can affect the risk of rebleeding， and patients with PVTT types Ⅲ—Ⅳ have a relatively high rebleeding rate.

Establishment of a predictive model for the risk of hypoalbuminemia after partial hepatectomy based on machine learning methods

Dongqing CAI, Shanhua TANG, Yuancan XIAO, Xiru LEI, Suicheng LI, Jie ZHOU

2026, 42(5): 1109-1118. DOI: 10.12449/JCH260516

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Objective To investigate the application value of a machine learning model based on preoperative clinical indicators in predicting the risk of hypoalbuminemia after partial hepatectomy. Methods A retrospective analysis was performed for the clinical data of 700 patients who underwent partial hepatectomy in Nanfang Hospital， Southern Medical University， from January 2018 to January 2023， including demographic data， history of underlying diseases， tumor characteristics， preoperative laboratory markers， and perioperative indicators. The research data were divided into a training set and a test set at a ratio of 7∶3. The two-independent-samples t test was used for comparison of normally distributed continuous data between two groups； the two-independent-samples Wilcoxon rank-sum test was used for comparison of continuous data with skewed distribution between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The least absolute shrinkage and selection operator （LASSO） regression analysis was used to identify characteristic variables， and 7 machine learning algorithms were used to construct predictive models， i.e.， logistic regression， decision tree， artificial neural network， K-nearest neighbors （KNN）， support vector machine， eXtreme gradient boosting， and light gradient boosting machine. The receiver operating characteristic （ROC） curve and the area under the ROC curve （AUC） were used to assess the discriminatory ability of models， and the DeLong test was used for comparison of AUC. The calibration curve and decision curve analysis were used to assess the calibration and clinical practicability of models， and the models were compared with albumin-bilirubin （ALBI） score and Model for End-Stage Liver Disease （MELD） score. SHapley Additive exPlanations （SHAP） were used to interpret the key influencing factors for the optimal model. Results A total of 700 patients were finally enrolled， 283 （40.42%） developed hypoalbuminemia after surgery. The LASSO regression analysis identified 8 predictive factors of age， hepatitis B， fatty liver， blockade time， preoperative albumin （Alb）， time of operation， intraoperative blood loss， and preoperative aspartate aminotransferase （AST）. Among the 7 machine learning models， the KNN model showed the best overall predictive performance， with an AUC of 0.835 （95% confidence interval： 0.781 — 0.889）， a sensitivity of 84.0%， and a specificity of 65.5% in the test set. ALBI and MELD scores had an AUC of 0.652 and 0.524， respectively， and the KNN model had a better predictive performance than these two scores （Z=5.309 and 8.945， both P <0.001）. The calibration curve showed good consistency between predicted probabilities and actual incidence rates， and the decision curve analysis showed that the KNN model had net clinical benefit across a wide threshold range. The SHAP analysis showed that preoperative Alb， hepatitis B， time of operation， and age were the most significant influencing factors， and a synergistic effect was observed between hepatitis B and age/time of operation. Conclusion The KNN machine learning model constructed based on preoperative clinical indicators can effectively predict the risk of hypoalbuminemia after partial hepatectomy and has a better performance than traditional scoring models， which provides a reference for the early identification of high-risk patients in clinical practice.

Clinicopathological features and prognostic analysis of vanishing bile duct syndrome

Yangai HE, Tiandan XIANG, Chengjie MAO, Zhonghua LU, Weifeng ZHAO

2026, 42(5): 1118-1124. DOI: 10.12449/JCH260517

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Objective To investigate the differences in clinicopathological features and prognosis between patients with drug-induced vanishing bile duct syndrome （VBDS） and those with VBDS induced by autoimmune liver disease， and to summarize the key points for clinical differentiation. Methods A total of 67 patients who were diagnosed with VBDS by liver biopsy in The First Affiliated Hospital of Soochow University and Wuxi Fifth People’s Hospital from January 2018 to June 2024 were enrolled as subjects， among whom 18 had drug-induced VBDS （D-VBDS group） and 49 had VBDS induced by autoimmune liver disease （A-VBDS group）. Related data were collected， including general information， clinical symptoms and signs， laboratory markers， liver pathomorphological features， 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 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. Results Among the 67 VBDS patients， female patients accounted for a higher proportion （80.60%）， and the patients aged 40 — 59 years accounted for 55.22%； there were 18 patients （26.87%） with D-VBDS and 49 patients （73.13%） with A-VBDS. Yellow urine （83.58%） was the most common clinical symptom in VBDS patients， followed by fatigue （64.18%）， poor appetite （64.18%）， jaundice of the sclera （62.69%）， abdominal distension （23.88%）， pruritus （23.88%）， nausea and vomiting （20.90%）， and fever （13.43%）. Compared with the D-VBDS group， the A-VBDS group had a significantly higher degree of plasma cell infiltration and a significantly lower degree of canalicular bile plugs （χ² =14.186， 6.568， both P<0.05）. Compared with the A-VBDS group， the D-VBDS group had significantly higher peak levels of alanine aminotransferase， total bilirubin， direct bilirubin， and indirect bilirubin （Z=-2.546， -2.957， -2.628， -2.772， all P<0.05）. Compared with the D-VBDS group， the patients in the A-VBDS group were more likely to develop liver cirrhosis （χ² =4.682， P=0.030）. Conclusion The levels of alanine aminotransferase and bilirubin and liver pathomorphological features are objective indicators for differentiating D-VBDS from A-VBDS， and they are of great importance for clarifying diagnosis and determining the degree of liver injury. Patients with A-VBDS are more likely to develop liver cirrhosis.

Efficacy and safety of intensity-modulated radiotherapy versus stereotactic body radiotherapy in treatment of locally advanced pancreatic cancer： A meta-analysis

Junjie LEI, Yanjiao WEI, Qilin REN, Hongjian REN, Yarong GUO

2026, 42(5): 1125-1132. DOI: 10.12449/JCH260518

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Objective To systematically analyze the differences in therapeutic efficacy between intensity-modulated radiotherapy （IMRT） and stereotactic body radiotherapy （SBRT） for locally advanced pancreatic cancer （LAPC）， and to provide a basis for treatment decision-making. Methods PubMed， Embase， the Cochrane Library， CNKI， Wanfang Data， and VIP databases were searched for prospective or retrospective cohort studies on IMRT versus SBRT for the treatment of LAPC published up to July 31， 2025. The Newcastle-Ottawa Scale was used to assess the quality of studies， and Review Manager 5.4 was used to perform the Meta-analysis. Results A total of 23 studies involving 2 505 patients were included. In terms of local control rate， an analysis of 13 studies with 847 patients showed that the SBRT group had a significantly higher 1-year local control rate than the IMRT group （84.5% vs 66.7%， relative risk ［RR］=1.27， 95% confidence interval ［CI］： 1.03 — 1.56， I²=28%， P=0.026）. In terms of acute toxicity， an analysis of 15 studies showed that the SBRT group had a significantly lower incidence rate of grade≥3 acute toxicity than the IMRT group （3.5% vs 11.0%， RR=0.32， 95%CI： 0.19 — 0.53， I²=18%， P<0.001）. There was no significant difference in overall survival between the SBRT group and the IMRT group （16.8 months vs 16.3 months）. The subgroup analysis of local control rate showed that in the 9 high-quality studies， the SBRT group had a significantly higher local control rate than the IMRT group （RR=1.25， P<0.001）， and a similar result was observed in the 4 moderate-quality studies （RR=1.31， P=0.021）； the stratified analysis based on technique platforms showed that the MR-guided technique group showed the largest effect size （RR=1.40， I²=10%）. The sensitivity analysis showed that the RR value ranged from 1.21 to 1.28， with stable results. The Egger regression analysis showed no significant publication bias （P>0.05）. Conclusion SBRT is superior to IMRT in terms of local control rate and acute toxicity and is a preferred treatment option for LAPC， with the MR-guided techniques showing the best performance.

Expression levels of Yes-associated protein 1 and human collagen type Ⅵ alpha 1 in pancreatic cancer under hyperglycemic conditions and their impact on prognosis

Jiahua LIAO, Xuehuan HUANG, Ruohan LI, Xiping TANG, Wen QIN

2026, 42(5): 1133-1143. DOI: 10.12449/JCH260519

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Objective To investigate the changes in the expression levels of Yes-associated protein 1 （YAP1） and human collagen type Ⅵ alpha 1 （COL6A1） in pancreatic cancer under hyperglycemic conditions and their association with prognosis. Methods GEPIA database and R software were used to analyze the expression levels of YAP1 and COL6A1 and their correlation in pancreatic cancer， as well as their impact on the prognosis of patients with pancreatic cancer. The cBioPortal database was used to identify the co-expressed genes of YAP1 and COL6A1 in pancreatic cancer， and the gene ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） enrichment analyses were performed. Quantitative real-time PCR and Western blot were used to measure the mRNA and protein expression levels of YAP1 and COL6A1 in human pancreatic cancer PANC-1 cells cultured under hyperglycemic or normoglycemic conditions. A nude mouse model of pancreatic cancer with type 2 diabetes was established， and immunohistochemistry was used to measure the expression of YAP1 and COL6A1 in subcutaneous tumor tissue. Clinical specimens and data of 96 patients with pancreatic cancer were collected from January 2016 to January 2020 in the First Affiliated Hospital of Guangxi Medical University， Guangxi Medical University Cancer Hospital and Wuming Hospital Affiliated to Guangxi Medical University. Among them， 48 patients with pancreatic cancer and diabetes were enrolled as study group， and 48 patients with pancreatic cancer alone were enrolled as control group； immunohistochemistry was used to measure the expression levels of YAP1 and COL6A1 in tissue samples from both groups， and their association with clinical indicators and survival outcomes was analyzed. The t-test was used for comparison of continuous data between groups， and the chi-square test or the Mann-Whitney U test was used for comparison of categorical data between groups； the Pearson correlation analysis was used for normally distributed continuous variables， while the Spearman correlation analysis was used for discontinuous variables or non-normally distributed variables. The Kaplan-Meier method was used to plot survival curves， and the Log-rank test was used for comparison of survival rates. The Cox proportional hazards model was used to perform univariate and multivariate analyses. Results Both YAP1 and COL6A1 were highly expressed in pancreatic cancer， with a strong correlation between them （r=0.85， P<0.001）， and they were associated with the poor prognosis of patients （hazard ratio ［HR］=1.8 and 1.5， both P<0.05）. YAP1 and COL6A1 were significantly correlated with 219 and 122 genes， respectively （r=0.83 and 0.86， both P<0.05）， and the GO and KEGG enrichment analyses showed that these genes affected the development and progression of pancreatic cancer through extracellular matrix-receptor interaction， the Hippo signaling pathway， and the phosphatidylinositol 3-kinase/protein kinase B signaling pathway. Quantitative real-time PCR and Western blot showed that there were significant increases in the mRNA and protein expression levels of YAP1 and COL6A1 in human pancreatic cancer PANC-1 cells under hyperglycemic conditions （mRNA expression： t=4.726 and 6.197， both P<0.05； protein expression： t=6.826 and 5.254， both P<0.05）. Immunohistochemistry showed that there were significant increases in the expression levels of YAP1 and COL6A1 in subcutaneous tumor tissue of nude mice， with a positive correlation between them （r=0.985， P<0.001）. For the clinical specimens of pancreatic cancer tissue， immunohistochemistry showed that there were significant increases in the positive expression levels of YAP1 and COL6A1 proteins in the study group， with a positive correlation between them （r=0.882， P<0.001）. The multivariate analysis of clinical data showed that lymph node metastasis （HR=0.083， 95% confidence interval ［CI］： 0.030 — 0.231， P<0.05）， distant organ metastasis （HR=0.166， 95%CI： 0.065 — 0.420， P<0.05）， YAP1 expression level （HR=2.027， 95%CI： 1.065 — 3.857， P<0.05）， and COL6A1 expression level （HR=2.044， 95%CI： 1.019 — 4.099， P<0.05） were independent influencing factors for the prognosis of patients with pancreatic cancer. The survival analysis showed that the high YAP1 expression group had a significantly lower 2-year survival rate than the low YAP1 expression group （6.82% vs 25.00%， χ²=16.382， P<0.001）， and the high COL6A1 expression group had a significantly lower 2-year survival rate than the low COL6A1 expression group （14.58% vs 18.75%， χ²=4.579， P=0.032）. Conclusion The hyperglycemic environment promotes the high expression of YAP1 and COL6A1 in pancreatic cancer， which is associated with poor prognosis in patients.

Autoimmune-like hepatitis induced by Jiegu Qili tablets： A case report

Yunsong ZHOU, Qi ZHAO, Pingzhen TONG, Zhongqin TU, Guangming FAN

2026, 42(5): 1144-1148. DOI: 10.12449/JCH260520

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Drug-induced autoimmune-like hepatitis （DI-ALH） is one of the special phenotypes of drug-induced liver injury， and since it has similar autoimmune characteristics and liver histological manifestations as intrinsic autoimmune hepatitis， differential diagnosis of these two diseases may be difficult in some cases. This article reports a case diagnosed with DI-ALH after long-term follow-up and conducts a literature review to provide a reference for clinicians.

Transjugular extrahepatic portosystemic shunt assisted by endoscopic ultrasound-guided portal vein localization in treatment of cavernous transformation of the portal vein： A case report

Suzhen YANG, Yuzheng ZHUGE, Ying LYU, Lei WANG, Feng ZHANG

2026, 42(5): 1149-1152. DOI: 10.12449/JCH260521

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Cavernous transformation of the portal vein （CTPV） is a significant challenge in clinical practice. In recent years， transjugular intrahepatic portosystemic shunt has gradually been applied in the treatment of CTPV patients， but it had a technical success rate and a relatively high surgical risk. The scholars have adopted various modified techniques of portosystemic shunt to improve success rate and safety. However， for CTPV patients with extensive occlusion of the main portal vein， this surgery remains difficult， and individualized strategies for portosystemic shunt should be formulated. This article reports a case of CTPV treated by transjugular extrahepatic portosystemic shunt assisted by endoscopic ultrasound-guided portal vein localization， in order to explore a new pathway for the clinical management of patients with CTPV.

Mechanism of action of Huanglian Wendan decoction in treatment of lipid accumulation in metabolic dysfunction-associated fatty liver disease

Kangmeng YAO, Xinri ZHANG, Yixuan LANG, Yan LENG

2026, 42(5): 1153-1159. DOI: 10.12449/JCH260522

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Metabolic dysfunction-associated fatty liver disease （MAFLD） has the core pathological feature of liver lipid accumulation， which is closely associated with the factors such as lipid metabolism disorders， insulin resistance， and inflammation， and abnormal lipid accumulation can exacerbate these factors and further intensify lipid accumulation， thereby forming a vicious circle. Huanglian Wendan decoction has shown unique advantages in alleviating lipid accumulation associated with MAFLD， but its mechanism of action is relatively complex. With reference to the latest literature evidence， this article systematically summarizes the mechanism of action of Huanglian Wendan decoction in improving lipid accumulation by regulating lipid metabolism， ameliorating insulin resistance， and exerting an anti-inflammatory effect， as well as the pharmacological actions of related active components， in order to provide a theoretical basis for the clinical application of Huanglian Wendan decoction in the management of MAFLD.

Protective effect of short-chain fatty acids against liver fibrosis and analogical application of its mechanism to pancreatic fibrosis

Yunjun YAN, Liang SHENG, Qi WANG, Shun PENG, Jia LI, Lei ZHANG

2026, 42(5): 1160-1165. DOI: 10.12449/JCH260523

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Short-chain fatty acids （SCFA） are the main metabolic products generated by the fermentation of dietary fiber by gut microbiota. Studies have shown that SCFA not only play a role in energy metabolism， but also act as important signaling molecules， exhibiting a significant potential in alleviating liver and pancreatic fibrosis. The core mechanism of SCFA mainly involves the regulation of various key signaling pathways by activating G protein-coupled receptors and inhibiting the activity of histone deacetylase， thereby suppressing the activation and proliferation of hepatic stellate cell （HSC） and pancreatic stellate cell （PSC）， which is a key link in fibrosis formation. In addition， SCFA can effectively alleviate tissue inflammation response， improve intestinal barrier function， and regulate gut microbiota balance， thus indirectly preventing the process of fibrosis mediated by the “gut-liver/pancreas axis”. Compared with the research on SCFA in liver fibrosis， studies on their role in pancreatic fibrosis are limited. Given that HSC and PSC are highly homologous， the transcription factors and proteins that have been confirmed in liver fibrosis-related studies are also similarly expressed in PSC， suggesting that they may also influence the activation of PSC. This article systematically summarizes the recent advances in the research on SCFA in alleviating liver and pancreatic fibrosis， in order to provide new perspectives for exploring the mechanism of pancreatic fibrosis and developing related interventional strategies.

Inhibitory effect and mechanism of traditional Chinese medicine on liver fibrosis and hepatic sinusoidal capillarization

Long WANG, Li MA, Andong SONG, Guohua LI, Tingting JIA

2026, 42(5): 1166-1171. DOI: 10.12449/JCH260524

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Hepatic sinusoidal capillarization is the first event in the process of fibrogenesis， and inhibiting hepatic sinusoidal capillarization can effectively improve the pathological process of liver fibrosis. Various studies have shown that traditional Chinese medicine can significantly inhibit hepatic sinusoidal capillarization. This article systematically reviews the effective constituents， monomers， and compound prescriptions of traditional Chinese medicine， summarizes their mechanism of action in inhibiting hepatic sinusoidal capillarization， and analyzes the theoretical core of traditional Chinese medicine in inhibiting hepatic sinusoidal capillarization from the perspective of traditional Chinese medicine， in order to provide ideas and literature support for the treatment of liver fibrosis.

Ferroptosis in alcoholic liver fibrosis： Mechanism of action and therapeutic strategies

Zhiyuan WEI, Feng LIN, Tao WU

2026, 42(5): 1172-1177. DOI: 10.12449/JCH260525

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Alcoholic liver fibrosis is a critical step in the progression of alcoholic liver disease toward liver cirrhosis， yet there is currently still a lack of effective and specific anti-fibrotic therapeutic strategies. Recent studies have shown that as an iron-dependent， lipid peroxidation-driven form of regulated cell death， ferroptosis plays an important role in alcohol-related hepatocellular injury and fibrogenesis. Reactive oxygen species generated during alcohol metabolism can damage hepatocytes， impair their antioxidant defense ability， and lead to disruption of iron homeostasis and accumulation of lipid peroxides， ultimately triggering ferroptosis. Hepatocyte ferroptosis can promote fibrosis by amplifying inflammatory responses and activating hepatic stellate cells， whereas selective induction of ferroptosis in activated hepatic stellate cells may attenuate fibrosis， highlighting the “double-edged sword” effect of ferroptosis. Current interventions against ferroptosis mainly focus on applying antioxidant approaches， reducing iron burden， or blocking the amplification of lipid peroxidation， which have shown preliminary efficacy and a potential clinical value， but there are still limitations such as single-target actions and insufficient cell selectivity. In the future， nanotechnology-based delivery and other targeting strategies may help to realize multi-pathway coordination and cell-specific modulation， thereby improving the anti-fibrotic efficacy of ferroptosis-oriented therapies.

Timing of endoscopic treatment for acute esophagogastric variceal bleeding in liver cirrhosis： Controversies and challenges

Xinhui LI, Xingshun QI, Xiaofeng LIU, Daiming FAN, Jing WANG

2026, 42(5): 1178-1184. DOI: 10.12449/JCH260526

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Acute esophagogastric variceal bleeding （AEGVB） is one of the life-threatening complications of decompensated cirrhosis. Endoscopy is the main method for the diagnosis and treatment of AEGVB， and endoscopic treatment can effectively control acute bleeding and alleviate or eliminate varices. However， there is still a lack of consistent recommendations for the timing of endoscopic examination and intervention for AEGVB in related guidelines in China and globally. Existing studies in China and globally have low quality of evidence， with significant variations in the definition of “early endoscopy” and inconsistent conclusions. This article reviews the research advances in the timing of endoscopic treatment for AEGVB in liver cirrhosis， points out the controversies over the optimal timing of treatment， and discusses future research directions in this field.

Selection strategies and future perspectives for animal models of gastroesophageal varices

Tianfu LYU, Qiong NAN, Ying ZHAO, Xiaohua WANG, Ninghui MU, Bingtuan LU

2026, 42(5): 1185-1191. DOI: 10.12449/JCH260527

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Gastroesophageal varices （GOV） bleeding is a severe complication of portal hypertension with a high mortality rate. Animal models are indispensable tools for investigating its pathogenesis and developing novel therapeutic strategies. This article systematically reviews the methods for establishing various GOV models， with a particular focus on their efficacy in simulating the key pathological processes such as an increase in hepatic venous pressure gradient and the risk of bleeding， and it also proposes targeted strategies for model selection. Finally， this article discusses the application prospects of emerging techniques in the era of precision medicine， such as organoids and gene editing， in order to provide model selection and a theoretical reference for exploring the mechanism and clinical translation of GOV.

Application of sonodynamic therapy in hepatocellular carcinoma

Xuening ZHANG, Zifeng ZUO, Huimin YAN, Yang ZHANG, Yonghao GAI

2026, 42(5): 1192-1197. DOI: 10.12449/JCH260528

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Sonodynamic therapy （SDT） applies low-frequency ultrasound to activate sonosensitizers that have accumulated in tumor location， which induces cavitation effects and leads to the in-situ generation of reactive oxygen species （ROS）， thereby achieving precise and efficient tumor treatment. Owing to its advantages such as deep tissue penetration and controllable treatment range， SDT has attracted significant attention and has been widely used in the research on the treatment of various tumors. While conventional treatment modalities have achieved significant efficacy in the treatment of hepatocellular carcinoma （HCC）， there are still certain limitations. In this context， nanomedicine-based SDT leverages the targeting capabilities of nano-agents to realize specific killing of HCC cells， and furthermore， it can synergize with photodynamic therapy， chemotherapy， and immunotherapy to provide new opportunities for developing novel treatment modalities for HCC. This article reviews the mechanism of action of SDT and the advances in the research and application of SDT in the treatment of HCC， analyzes the shortcomings of existing studies， and proposes the directions for future development， in order to provide a theoretical foundation and scientific guidance for related research on HCC.

The dual regulatory effect of locoregional therapy on the tumor immune microenvironment of hepatocellular carcinoma： Mechanisms and combined treatment strategies

Enyu WANG, Hongbo WANG, Liou ZHANG

2026, 42(5): 1198-1203. DOI: 10.12449/JCH260529

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Locoregional therapy （LRT）， including transarterial chemoembolization， transarterial radioembolization， and various ablation techniques， is an important treatment method for hepatocellular carcinoma. Many studies in recent years have confirmed that LRT has a dual regulatory effect on tumor immune microenvironment. While LRT induces immunogenic cell death， activates dendritic cell-mediated and T cell-driven immunity， and triggers systemic antitumor responses， it concomitantly upregulates the adenosine signaling pathway， promotes the accumulation of TREM2⁺ macrophages， and enhances the expression of immunosuppressive factors， thereby forming an immunosuppressive microenvironment. At present， the combination of LRT and immune checkpoint inhibitors has shown a promising future and has promoted the exploration of novel targets within treatment-associated immunosuppressive pathways， such as adenosine， TREM2⁺ macrophages， and IL-6. This article summarizes the dual regulatory effect of LRT on immune microenvironment and highlights that multi-omics techniques and clinical trials should be used in the future to decipher its dynamic alterations， in order to optimize combination strategies， realize individualized precise treatment， and improve the prognosis of patients.

Acute adverse reactions and long-term safety of mesenchymal stem cells in treatment of liver diseases

Bin NIU, Ao LYU, Liaoyun ZHANG

2026, 42(5): 1204-1209. DOI: 10.12449/JCH260530

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In recent years， mesenchymal stem cells （MSC） have been widely explored in the treatment of liver diseases due to their characteristics of multipotential differentiation and immunomodulatory capabilities. Current evidence has shown that MSC therapy can improve liver function， alleviate fibrosis， and promote hepatocyte regeneration in end-stage liver diseases such as liver cirrhosis and liver failure. However， safety concerns have emerged with the increasing clinical use of MSC. This article systematically reviews the acute adverse reactions and long-term safety of MSC-based therapies for liver diseases. It is shown that MSC therapy has a good overall safety profile， with common acute adverse reactions of fever， rash， and mild allergy， most of which are self-limiting or can be alleviated by symptomatic treatment. No clear evidence of tumorigenesis has been reported in long-term follow-up， but some studies have suggested a potential association between MSC and the development of hepatocellular carcinoma. In addition， the risks of embolism， immune rejection， and infection susceptibility should be monitored continuously. Overall， MSC therapy shows good prospects in short-term efficacy and safety in the treatment of liver diseases， but clinical studies with a large sample size and a long follow-up period are needed to further validate its long-term safety and efficacy.

Bidirectional role of triggering receptor expressed on myeloid cells 2-mediated macrophages in liver diseases

Simiao LI, Jiamin XU, Yang FENG, Yingmei TANG

2026, 42(5): 1210-1216. DOI: 10.12449/JCH260531

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As a key receptor for immune regulation， triggering receptor expressed on myeloid cells 2 （TREM2） plays an important role in the development and progression of liver diseases， but its specific mechanisms and regulatory strategies in different types and stages of liver diseases remain to be systematically elucidated. This article systematically reviews the molecular characteristics and signaling pathways of TREM2， elaborates on the multiple functions of TREM2⁺ macrophages in lipid metabolism， phagocytic function， inflammatory response， and fibrosis， and analyzes the dynamic and bidirectional roles of TREM2 in different liver diseases. Targeting the TREM2 signaling axis is expected to become a new strategy for regulating the hepatic immune microenvironment and intervening in disease progression.

Epidemiological features of chronic liver disease with different etiologies comorbid with type 2 diabetes mellitus

Mingming CAI, Qiang LI

2026, 42(5): 1217-1222. DOI: 10.12449/JCH260532

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Both chronic liver disease （CLD） and type 2 diabetes mellitus （T2DM） are major public health issues worldwide， and there is a significant difference in the prevalence rate of T2DM across patients with CLD of different etiologies. Chronic hepatitis C virus infection， dysregulation of fat metabolism， and excessive drinking not only lead to CLD， but also increase the prevalence rate of T2DM. It remains unclear whether chronic hepatitis B virus infection can cause an increase in the risk of T2DM， although the prevalence rate of T2DM significantly increases with disease progression in patients with chronic hepatitis B， and there is still a lack of large-sample evidence for the association between autoimmune liver disease and T2DM. In addition， T2DM may increase the risk of end-stage liver diseases such as cirrhosis and hepatocellular carcinoma. Therefore， early diagnosis and individualized management of T2DM are of great importance for improving the prognosis of patients with CLD.

Multiorgan crosstalk in the pathogenesis of hepatic encephalopathy

Zixin ZHAO, Yeqing ZHU, Cunxin YE, Zhuoyuan SONG, Dong SONG

2026, 42(5): 1223-1228. DOI: 10.12449/JCH260533

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Hepatic encephalopathy is a common and serious complication of end-stage liver diseases such as liver cirrhosis， and it is basically a neuropsychiatric syndrome resulting from metabolic disorders caused by severe acute or chronic liver dysfunction or portosystemic shunt. In clinical practice， the onset of hepatic encephalopathy does not completely correlate linearly with the level of blood ammonia and is often triggered by extrahepatic factors， suggesting the presence of complex multiorgan crosstalk in the pathogenesis of hepatic encephalopathy. Based on the four main pathogeneses of ammonia toxicity， inflammation， neurotransmitter imbalance， and oxidative/nitrosative stress， this article systematically elaborates on the mechanism of multiorgan crosstalk in hepatic encephalopathy and discusses the emerging risk factors such as sarcopenia and diabetes mellitus， in order to provide a novel theoretical framework for deepening the understanding of the pathophysiological mechanisms of hepatic encephalopathy and formulating clinical diagnosis and treatment strategies in the future.

Mechanism and clinical application of traditional Chinese medicine in treatment of cholestatic liver injury by regulating oxidative stress

Yinpei TANG, Linjing SHE, Zhengwang ZHU, Bing WANG, Pingsheng ZHU

2026, 42(5): 1229-1235. DOI: 10.12449/JCH260534

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Cholestatic liver injury （CLI） is a hepatic disorder characterized by the abnormal accumulation of bile acids in the body due to various etiologies， and without timely intervention， it can progress to liver fibrosis， liver cirrhosis， and liver failure and even lead to death. Studies have shown that modulating oxidative stress can alleviate lipid peroxidation and cellular damage， thereby suppressing inflammation and cell apoptosis. In recent years， remarkable progress has been made regarding the active components and compound prescriptions of traditional Chinese medicine in the treatment of CLI by regulating oxidative stress. This article systematically reviews the current status of research on the mechanism of action and clinical application of traditional Chinese medicine in the treatment of CLI by regulating oxidative stress.

Value of ultrasound in assessing microvascular invasion of intrahepatic cholangiocarcinoma and related technical advances

Xingtong WEI, Haochang LI, Xin ZHAO

2026, 42(5): 1236-1240. DOI: 10.12449/JCH260535

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Noninvasive preoperative assessment of microvascular invasion （MVI） of intrahepatic cholangiocarcinoma （ICC） is crucial for developing individualized treatment regimens and judging the prognosis of patients. This article comprehensively explores the application value of ultrasound in this field and elaborates on the performance of techniques such as gray-scale ultrasound， contrast-enhanced ultrasound， and ultrasound elastography in predicting MVI by analyzing lesion morphology， blood perfusion， and stiffness characteristics， and meanwhile， it also discusses the application prospects of emerging techniques such as radiomics， deep learning， and dynamic three-dimensional contrast-enhanced ultrasound. The comprehensive analysis shows that ultrasound has an important clinical value in assessing ICC MVI， and the integration of emerging techniques into the ultrasound evaluation system can help to achieve more objective and accurate preoperative prediction and thus has broad application prospects.

Journal of Hepatology｜Chromatin remodeling in pericentral hepatocytes modulates MASH through CYP450 activity

2026, 42(5): 1047-1047. DOI: 10.12449/JCH2605.gwqkjpwzjj1

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Cell｜Scavenger receptor class F member 2 is an intracellular receptor for hepatitis B virus

2026, 42(5): 1191-1191. DOI: 10.12449/JCH2605.gwqkjpwzjj2

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Hepatology International｜Feasibility and cost-effectiveness of a hospital-based hepatitis B management model in China: The ‘Hot Wave Project’ experience

2026, 42(5): 1235-1235. DOI: 10.12449/JCH2605.gwqkjpwzjj3

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Current reviewers

2026, 42(5): 1082-1082. DOI: 10.12449/JCH2605.zhixie

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