1.Value of different noninvasive diagnostic models in the diagnosis of esophageal and gastric varices with significant portal hypertension in compensated hepatitis B cirrhosis
Cheng LIU ; Jiayi ZENG ; Mengbing FANG ; Zhiheng CHEN ; Bei GUI ; Fengming ZHAO ; Jingkai YUAN ; Chaozhen ZHANG ; Meijie SHI ; Yubao XIE ; Xiaoling CHI ; Huanming XIAO
Journal of Clinical Hepatology 2025;41(2):263-268
ObjectiveTo investigate the value of different noninvasive diagnostic models in the diagnosis of esophageal and gastric varices since there is a high risk of esophageal and gastric varices in patients with compensated hepatitis B cirrhosis and significant portal hypertension, and to provide a basis for the early diagnosis of esophageal and gastric varices. MethodsA total of 108 patients with significant portal hypertension due to compensated hepatitis B cirrhosis who attended Guangdong Provincial Hospital of Traditional Chinese Medicine from November 2017 to November 2023 were enrolled, and according to the presence or absence of esophageal and gastric varices under gastroscopy, they were divided into esophageal and gastric varices group (GOV group) and non-esophageal and gastric varices group (NGOV group). Related data were collected, including age, sex, imaging findings, and laboratory markers. The chi-square test was used for comparison of categorical data between groups; the least significant difference 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 receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of five scoring models, i.e., fibrosis-4 (FIB-4), LOK index, LPRI, aspartate aminotransferase-to-platelet ratio index (APRI), and aspartate aminotransferase/alanine aminotransferase ratio (AAR). The binary logistic regression method was used to establish a combined model, and the area under the ROC curve (AUC) was compared between the combined model and each scoring model used alone. The Delong test was used to compare the AUC value between any two noninvasive diagnostic models. ResultsThere were 55 patients in the GOV group and 53 patients in the NGOV group. Compared with the NGOV group, the GOV group had a significantly higher age (52.64±1.44 years vs 47.96±1.68 years, t=0.453, P<0.05) and significantly lower levels of alanine aminotransferase [42.00 (24.00 — 17.00) U/L vs 82.00 (46.00 — 271.00) U/L, Z=-3.065, P<0.05], aspartate aminotransferase [44.00 (32.00 — 96.00) U/L vs 62.00 (42.50 — 154.50) U/L,Z=-2.351, P<0.05], and platelet count [100.00 (69.00 — 120.00)×109/L vs 119.00 (108.50 — 140.50)×109/L, Z=-3.667, P<0.05]. The ROC curve analysis showed that FIB-4, LOK index, LPRI, and AAR used alone had an accuracy of 0.667, 0.681, 0.730, and 0.639, respectively, in the diagnosis of esophageal and gastric varices (all P<0.05), and the positive diagnostic rates of GOV were 69.97%, 65.28%, 67.33%, and 58.86%, respectively, with no significant differences in AUC values (all P>0.05), while APRI used alone had no diagnostic value (P>0.05). A combined model (LAF) was established based on the binary logistic regression analysis and had an AUC of 0.805 and a positive diagnostic rate of GOV of 75.80%, with a significantly higher AUC than FIB-4, LOK index, LPRI, and AAR used alone (Z=-2.773,-2.479,-2.206, and-2.672, all P<0.05). ConclusionFIB-4, LOK index, LPRI, and AAR have a similar diagnostic value for esophageal and gastric varices in patients with compensated hepatitis B cirrhosis and significant portal hypertension, and APRI alone has no diagnostic value. The combined model LAF had the best diagnostic efficacy, which provides a certain reference for clinical promotion and application.
2.Prediction and verification of the mechanism of action of herb pair of Angelica sinensis-Poria cocos in intervening in allergic rhinitis
Jingkai CHENG ; Shan ZHU ; Xinlei TIAN ; Wenjie HU ; Xingchan SHI ; Shunan QIAO
China Pharmacy 2025;36(22):2778-2782
OBJECTIVE To study the mechanism of action of herb pair of Angelica sinensis-Poria cocos in intervening in allergic rhinitis. METHODS The core targets of herb pair of A. sinensis-P. cocos in intervening in allergic rhinitis were predicted through network pharmacology. Allergic rhinitis model of rats was established by intraperitoneal injection of aluminum hydroxide and ovalbumin mixture, and the rats were randomly divided into model group, loratadine group (positive control group, 0.9 mg/kg), and low-, medium-, high-dose groups of herb pair of A. sinensis-P. cocos (3, 6 and 12 g/kg), with 10 rats in each group. Another 10 healthy rats were used as the normal group. Each group of rats was intragastrically administered the corresponding liquid or normal saline once a day for 30 consecutive days. After the last administration, the behavioral scores of each group of rats were calculated, the levels of immunoglobulin E (IgE), histamine, interleukin-4 (IL-4) in serum, and the protein expression levels of IL-6, tumor necrosis factor-α (TNF-α), and prostaglandin-endoperoxide synthase 2 (PTGS2) in nasal mucosa tissue were detected. The pathological morphology changes of nasal mucosa tissue were observed. RESULTS Network pharmacology analysis revealed that IL-6, TNF and PTGS2 might play a key role in the intervention of allergic rhinitis by herb pair of A. sinensis-P. cocos, and the IL-17 and TNF signaling pathways might be the typical inflammatory signaling pathways intervened by herb pair of A. sinensis-P. cocos in allergic rhinitis. The results of animal experiments showed that compared with the model group, the behavioral score, the levels of IgE, histamine and IL-4, and the protein expressions of IL-6, TNF-α and PTGS2 in each administration group were decreased significantly (P<0.05), and there was a dose-dependent relationship with the herb pair of A. sinensis-P. cocos (P< 0.05). CONCLUSIONS The herb pair of A. sinensis-P. cocos can effectively alleviate the symptoms of rats with allergic rhinitis, the mechanism of which may be related to the inhibition of the expressions of IL-6, TNF-α and PTGS2.

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