1.Molecular Mechanism of Astragali Radix and Hedyotis diffusa in Regulating LINC01134-CTCF-p21 Axis to Inhibit Lung Adenocarcinoma Proliferation
Haipeng SUN ; He ZHUANG ; Xue LIU ; Siyuan LIU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(3):131-138
ObjectiveTo explore the interaction and competitive binding of Homo sapiens long intergenic non-protein-coding RNA 1134 (LINC01134) to CCCTC-binding factor CTCF, affecting the transcription of cyclin-dependent kinase inhibitor (p21) and influencing the proliferation of A549 cells, in order to investigate the possible mechanism of Astragali Radix and Hedyotis diffusa (A-H) in inhibiting A549 proliferation by regulating this axis. MethodsRNA-binding protein immunoprecipitation (RIP) assays were conducted to examine the interaction between LINC01134 and CTCF, and chromatin immunoprecipitation (ChIP) assays were used to study the effect of LINC01134 overexpression on the interaction between CTCF and p21. Stable A549 cell lines (oe-NC and oe-LINC01134) were established using lentiviral transfection, and each group was treated with 10% A-H drug-containing serum. Real-time PCR and Western blot analyses were performed to detect the effects of A-H on the expression of LINC01134, CTCF, and p21 in A549 cells. Cell counting kit-8 (CCK-8) and colony formation assays were used to assess the effects of A-H on A549 cell proliferation via LINC01134. Flow cytometry was employed to evaluate the effects of A-H on the A549 cell cycle through LINC01134, and Western blot was used to detect changes in cell cycle proteins. ResultsCompared with the IgG group, the oe-CTCF group showed a significantly increased abundance of LINC01134 aggregates (P0.01). Compared with the oe-Vector group, p21 abundance in CTCF complexes was significantly reduced in the oe-LINC01134 group (P0.01). Compared with the 10% blank + oe-LINC01134 group, the 10% A-H + oe-LINC01134 group reversed the expression of LINC01134 and p21 (P0.05), but had no significant regulatory effect on CTCF. Compared with the 10% blank + oe-LINC01134 group, the 10% A-H + oe-LINC01134 group reversed cell viability at 72 h (P0.05), inhibited malignant proliferation (P0.05), and reversed the proportions of cells in the G0/G1 and S phases (P0.01). Furthermore, compared with the 10% blank + oe-LINC01134 group, the 10% A-H + oe-LINC01134 group reversed the expression of Cyclin D1, CDK4, Cyclin E, CDK2, phosphorylated retinoblastoma protein (p-Rb), and E2F transcription factor 3 (E2F3) (P0.01). ConclusionA-H regulates the LINC01134-CTCF-p21 axis to block the G1/S phase transition of A549 cell cycle, accelerate cellular senescence, and inhibit malignant proliferation.
2.Molecular Mechanism of Astragali Radix and Hedyotis diffusa in Regulating LINC01134-CTCF-p21 Axis to Inhibit Lung Adenocarcinoma Proliferation
Haipeng SUN ; He ZHUANG ; Xue LIU ; Siyuan LIU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(3):131-138
ObjectiveTo explore the interaction and competitive binding of Homo sapiens long intergenic non-protein-coding RNA 1134 (LINC01134) to CCCTC-binding factor CTCF, affecting the transcription of cyclin-dependent kinase inhibitor (p21) and influencing the proliferation of A549 cells, in order to investigate the possible mechanism of Astragali Radix and Hedyotis diffusa (A-H) in inhibiting A549 proliferation by regulating this axis. MethodsRNA-binding protein immunoprecipitation (RIP) assays were conducted to examine the interaction between LINC01134 and CTCF, and chromatin immunoprecipitation (ChIP) assays were used to study the effect of LINC01134 overexpression on the interaction between CTCF and p21. Stable A549 cell lines (oe-NC and oe-LINC01134) were established using lentiviral transfection, and each group was treated with 10% A-H drug-containing serum. Real-time PCR and Western blot analyses were performed to detect the effects of A-H on the expression of LINC01134, CTCF, and p21 in A549 cells. Cell counting kit-8 (CCK-8) and colony formation assays were used to assess the effects of A-H on A549 cell proliferation via LINC01134. Flow cytometry was employed to evaluate the effects of A-H on the A549 cell cycle through LINC01134, and Western blot was used to detect changes in cell cycle proteins. ResultsCompared with the IgG group, the oe-CTCF group showed a significantly increased abundance of LINC01134 aggregates (P0.01). Compared with the oe-Vector group, p21 abundance in CTCF complexes was significantly reduced in the oe-LINC01134 group (P0.01). Compared with the 10% blank + oe-LINC01134 group, the 10% A-H + oe-LINC01134 group reversed the expression of LINC01134 and p21 (P0.05), but had no significant regulatory effect on CTCF. Compared with the 10% blank + oe-LINC01134 group, the 10% A-H + oe-LINC01134 group reversed cell viability at 72 h (P0.05), inhibited malignant proliferation (P0.05), and reversed the proportions of cells in the G0/G1 and S phases (P0.01). Furthermore, compared with the 10% blank + oe-LINC01134 group, the 10% A-H + oe-LINC01134 group reversed the expression of Cyclin D1, CDK4, Cyclin E, CDK2, phosphorylated retinoblastoma protein (p-Rb), and E2F transcription factor 3 (E2F3) (P0.01). ConclusionA-H regulates the LINC01134-CTCF-p21 axis to block the G1/S phase transition of A549 cell cycle, accelerate cellular senescence, and inhibit malignant proliferation.
3.A survey of clinical application of stereotactic radiotherapy technology in China in 2024
Xiaoxue KOU ; Jiayi YU ; Jingwei ZHANG ; Nan BI ; Xuwei CAI ; Guanghui CHENG ; Yufei LU ; Yanyang WANG ; Ligang XING ; Yonggang XU ; Jianxin XUE ; Li ZHANG ; Hongqing ZHUANG ; Anhui SHI
Chinese Journal of Radiation Oncology 2025;34(9):897-904
Objective:To investigate the current status of application of stereotactic body radiation therapy (SBRT) in China, aiming to provide reference for promoting the development of this technology.Methods:From January to March 2024, a questionnaire was designed and distributed online, targeting member units of the Professional Committee of Stereotactic Radiosurgery Treatment, which covers 175 radiotherapy units in 30 provinces and regions nationwide. The survey focused on the current application of SBRT technology and its utilization in the treatment of early-stage non-small cell lung cancer (NSCLC). A statistical description of the survey results was presented.Results:Of 175 questionnaires distributed, a total of 130 valid responses were collected, with an effective response rate of 74.3%. A total of 81.5% (106/130) of the units had implemented SBRT technology, and 99.1% of the respondents believed it was necessary to further promote SBRT technology, yet the actual training rate was only 67.0%. SBRT equipment configuration: there were a total of 267 SBRT equipment, featuring a diverse range of types, with traditional linear accelerators as the mainstays, accounting for 76.0% ( n=203), followed by 12.0% ( n=32) for TOMO, 6.4% ( n=17) for Cyber knife, 3.7% ( n=10) for Gamma knife, and proton/heavy ion equipment at 1.5% ( n=4), respectively. The percentage of units with multi-leaf collimator leaf widths ≤0.5 cm was 93.4% (99/106). The application of SBRT: the first radiotherapy unit commenced SBRT in 2000, and this technology entered a period of rapid growth after 2015, sustaining a steady increase over the past decade; SBRT technology was mainly applied in the brain, lung, liver, bone, adrenal gland, and kidney, with application rates of 97.2%, 94.3%, 86.8%, 71.7%, 56.6%, and 27.4%, respectively, while the application rates for the pancreas, metastatic lymph nodes, and other parts were less than 5%. Current status of SBRT technology application in early-stage NSCLC: 90.6% (96/106) of units had implemented SBRT; pre-treatment multi-disciplinary diagnosis and treatment accounted for 77% (74/96); the proportion of application units for peripheral and central type lung cancer lesions both exceeded 57.3%, whereas the application rate for ultra-central type and lesions > 5 cm lung cancer was less than 30%; there was significant variability in the selection of reference guidelines, dose fractionation patterns, and the concept of central type among units. Conclusions:The development of SBRT technology in China is in a period of steady growth, but several issues such as low training rate and lack of standardization still exist. The survey results provide important reference for clinical training and promotion of SBRT technology in China.
4.Audiological characterization of the GJB2 gene c. 109G>A (p.V37I) hotspot variant during childhood and comparison between family members
Zhoushu ZHENG ; Jiangyang XUE ; Lu DING ; Jiewen PAN ; Meihong WANG ; Yinghui ZHANG ; Danyan ZHUANG ; Yihui YANG ; Ming TANG ; Haibo LI
Chinese Journal of Medical Genetics 2025;42(9):1061-1068
Objective:To determine the prevalence of GJB2 gene c. 109G>A (p.V37I) variant among infants with congenital hearing loss and analyze the initial audiological characteristics of children harboring the variant, compare the audiometric difference among individuals with various genotypes, and explore genetic and audiological manifestations of the affected families. Methods:One hundred twenty six infants diagnosed with congenital hearing loss at the Neonate Screening Center of Ningbo City from June 2021 to December 2024 were selected as the study subjects. The neonates, in addition with members from 16 of their families, had undergone genetic screening for variants of 208 hotspot sites within 24 deafness-associated genes. For cases identified with monoallelic variants and concurrent hearing loss, the full GJB2 gene was sequenced. Meanwhile, a retrospective analysis was carried out on 23 children whom were confirmed to have hearing loss and the c. 109G>A variant by whole exome sequencing from March 2022 to December 2024. And 102 children who were excluded to have hearing loss and pathogenic variants by whole exome sequencing were selected as normal controls. Audiological features of individuals harboring the c. 109G>A variant were compared. This study has been approved by the Medical Ethics Committee of The Affiliated Women and Children′s Hospital of Ningbo University (Ethics No.: EC2023-009). Results:For the 126 infants with congenital hearing loss, prospective screening has identified 58 (46.03%) to harbor the c. 109G>A variant. These included 38 homozygotes and 16 compound heterozygotes. Retrospective review of the 23 c. 109G>A positive children has identified 15 as homozygotes and 8 as compound heterozygotes. Genetic testing of the 16 pedigrees has identified 7 homozygotes and 1 compound heterozygote. For the homozygotes combined ( n=53), 96.2% exhibited bilateral symmetric hearing loss, with 78.3% showing high-frequency sloping patterns, and 98.1% having a hearing threshold ranging from 20 to 65 dB. For the compound heterozygotes combined ( n=24), 95.8% showed symmetric loss, with 59.4% having high-frequency sloping, and 97.9% had a hearing threshold ranging from 20 to 65 dB. Both groups showed significantly elevated ABR/PTA thresholds compared with the normal controls ( P=0.000). The compound heterozygous group had higher ABR thresholds (43.3 ± 15.0 dB nHL) compared with the homozygous group (39.1±12.0 dB nHL, P=0.005). Conclusion:Infants harboring the GJB2 c. 109G>A variant primarily manifest as mild-to-moderate, symmetric, high-frequency sloping hearing loss. Nearly one-third of affected children have thresholds between 20 to 35 dB nHL, suggesting that ABR > 35 dB nHL alone may underestimate the hearing impairment in this population. Compared with homozygotes, compound heterozygotes with the the GJB2 c. 109G>A variant can confer a more severe hearing loss.
5.Analysis of prediction of carotid in-stent restenosis based on ultrasonographic carotid plaque radiomics
Danhui LAI ; Yanhui JIANG ; Siting YE ; Shulian ZHUANG ; Shuang YANG ; Wen XUE ; Jianxing ZHANG
The Journal of Practical Medicine 2025;41(5):742-750
Objective This study aimed to explore the ability of ultrasonographic radiomics in predicting the occurrence of in-stent restenosis(ISR)after carotid artery stenting(CAS)by analyzing the correlation between radiomic features of responsible plaques in carotid artery stenosis and the incidence of ISR.Methods A retrospective collection was conducted on 206 cases that underwent CAS treatment at our hospital.The enrolled patients were randomly split into a training set(144 cases)and a test set(62 cases)at a 7∶3 ratio.We utilized the Darwin Intelligent Research Platform to extract radiomic features from each region of interest,and then screened 1125 ultrasonographic radiomic features.Different machine learning algorithms were employed to construct diagnostic models,and the best-performing classifier was selected.Various prediction models were established,including a clinical-ultrasonographic feature model,a radiomic model,and a combined clinical-ultrasonographic-radiomic model.Results Multivariate logistic regression analysis in the training set revealed that hypertension,hyperuricemia,triglycerides,and plaque location were independent risk factors for ISR after CAS.For the clinical-ultrasonographic model,the area under the curve(AUC)values for the training and validation sets were 0.896 and 0.644,respectively.The corresponding AUC values for the radiomic model were 0.961 and 0.715,while those for the combined model were 0.947 and 0.727.Conclusion The radiomic model demonstrates superior performance in predicting ISR compared to the traditional clinical-ultrasonographic model.The combined model exhibited an enhanced ability to predict ISR occurrence,thereby improving the diagnostic performance of traditional assessments.
6.Exploration of the comprehensive management practice pathway for long-term prescription medications in psychiatry
Mengxi NIU ; Pengfei LI ; Xue WANG ; Shanshan LIU ; Yanxiang CAO ; Hongyan ZHUANG ; Hu WANG ; Li BAI ; Huawei LI ; Fei PAN ; Sha SHA ; Qing’e ZHANG
China Pharmacy 2025;36(19):2366-2371
OBJECTIVE To explore comprehensive management and potential issues associated with long-term prescriptions medications of psychiatry, in order to provide a reference for the comprehensive management of long-term prescriptions of psychiatry in psychiatric hospitals and other medical institutions’ pharmacies. METHODS Starting from the applicable principles for long-term prescriptions of psychiatry, this study introduced the standardized assessment and precautions before issuing long-term prescriptions, the formulation and adjustment of the drug list, as well as the rational management of the long-term prescriptions. It also analyzed potential issues that may arise in the comprehensive management of long-term prescription medications and proposed corresponding countermeasures and suggestions. RESULTS & CONCLUSIONS Prior to initiating long-term prescriptions, a standardized assessment should be conducted on patients from the aspects of their psychiatric condition and long-term potential risk factors, pharmacological treatment plans and other non-pharmacological therapies, physical illnesses. Additionally, healthcare providers should fulfill their obligation to inform patients or their family members. The comprehensive management of long-term prescription medications should be jointly established and improved by multiple departments, and the formulation of drug catalogs should avoid including drugs with potential social harm or medication risks while complying with policy requirements. Furthermore, measures such as adding special identifiers to long-term prescriptions, providing patients with reminders about (No.YGLX202537) prescription expiration, or offering online consultations can also effectively enhance the rationality of medication use under long-term prescriptions. Currently, the implementation of long-term prescriptions in psychiatry remains challenged by inconsistencies in prescription duration, incomplete coverage of diagnostic categories, poor patient adherence, and the risk of deviation in clinical assessments. In this regard, measures such as collaborating with multiple departments to strengthen long-term prescription information management, providing matching pharmaceutical services, ensuring the quality and rationality of long-term prescription implementation, and using modern methods to screen high-risk patients can be taken to improve patient medication compliance and safety.
7.Berberine promotes expression of AQP4 in astrocytes by regulating production of miR-383-5p in HepG2 cell-derived exosomes under insulin resistance.
Xue-Ling LIN ; Ying LI ; Meng-Qing GUO ; Yan-Jun ZHANG ; Qing-Sheng YIN ; Peng-Wei ZHUANG
China Journal of Chinese Materia Medica 2025;50(3):768-775
This study aims to explore the role and mechanism of berberine in promoting the expression of aquaporin 4(AQP4) in astrocytes by regulating the expression of miR-383-5p in HepG2 cell-derived exosomes under insulin resistance(IR). The IR-HepG2 cell model was established with 1×10~(-6) mol·L~(-1) insulin. With metformin as the positive control, the safe concentrations of berberine and metformin were screened by cell counting kit-8(CCK-8) and lactate dehydrogenase(LDH) leakage assays, and the effect of berberine on the IR of HepG2 cells was evaluated by glucose consumption. NanoSight was used to measure the particle size and concentration of exosomes secreted by HepG2 cells in each group. HepG2 cell-derived exosomes in each group were incubated with astrocytes for 24 h, and the protein and mRNA levels of AQP4 in HA1800 cells were determined by Western blot and qRT-PCR, respectively. qRT-PCR was performed to determine the expression of miR-383-5p in HepG2 cell-derived exosomes and HA1800 cells after co-incubation. Western blotting was employed to determine the expression levels of miRNAs and proteins associated with exosome production and release in HepG2 cells. The results showed that 10 μmol·L~(-1) berberine and 1 mmol·L~(-1) metformin significantly alleviated the IR of HepG2 cells and reduced the concentration of exosomes in HepG2 cells. The exosomes of HepG2 cells treated with berberine and metformin significantly up-regulated the protein and mRNA levels of AQP4 in HA1800 cells. The mRNA level of miR-383-5p in HepG2 cell exosomes and HA1800 cells co-incubated with berberine and metformin decreased significantly. The intervention with berberine and metformin significantly down-regulated the expression of proteins associated with the production of miRNAs(Dicer, Drosha) as well as the production(Alix, Vps4A) and release(Rab35, VAMP3) of exosomes in IR-HepG2 cells. In conclusion, berberine can promote the expression of AQP4 in astrocytes by inhibiting the production and release of miR-383-5p in HepG2-derived exosomes under IR.
Humans
;
MicroRNAs/metabolism*
;
Berberine/pharmacology*
;
Hep G2 Cells
;
Exosomes/genetics*
;
Aquaporin 4/metabolism*
;
Insulin Resistance
;
Astrocytes/drug effects*
8.Audiological characterization of the GJB2 gene c.109G>A (p.V37I) hotspot variant during childhood and comparison between family members.
Zhoushu ZHENG ; Jiangyang XUE ; Lu DING ; Jiewen PAN ; Meihong WANG ; Yinghui ZHANG ; Danyan ZHUANG ; Yihui YANG ; Ming TANG ; Haibo LI
Chinese Journal of Medical Genetics 2025;42(9):1061-1068
OBJECTIVE:
To determine the prevalence of GJB2 gene c.109G>A (p.V37I) variant among infants with congenital hearing loss and analyze the initial audiological characteristics of children harboring the variant, compare the audiometric difference among individuals with various genotypes, and explore genetic and audiological manifestations of the affected families.
METHODS:
One hundred twenty six infants diagnosed with congenital hearing loss at the Neonate Screening Center of Ningbo City from June 2021 to December 2024 were selected as the study subjects. The neonates, in addition with members from 16 of their families, had undergone genetic screening for variants of 208 hotspot sites within 24 deafness-associated genes. For cases identified with monoallelic variants and concurrent hearing loss, the full GJB2 gene was sequenced. Meanwhile, a retrospective analysis was carried out on 23 children whom were confirmed to have hearing loss and the c.109G>A variant by whole exome sequencing from March 2022 to December 2024. And 102 children who were excluded to have hearing loss and pathogenic variants by whole exome sequencing were selected as normal controls. Audiological features of individuals harboring the c.109G>A variant were compared. This study has been approved by the Medical Ethics Committee of The Affiliated Women and Children's Hospital of Ningbo University (Ethics No.: EC2023-009).
RESULTS:
For the 126 infants with congenital hearing loss, prospective screening has identified 58 (46.03%) to harbor the c.109G>A variant. These included 38 homozygotes and 16 compound heterozygotes. Retrospective review of the 23 c.109G>A positive children has identified 15 as homozygotes and 8 as compound heterozygotes. Genetic testing of the 16 pedigrees has identified 7 homozygotes and 1 compound heterozygote. For the homozygotes combined (n = 53), 96.2% exhibited bilateral symmetric hearing loss, with 78.3% showing high-frequency sloping patterns, and 98.1% having a hearing threshold ranging from 20 to 65 dB. For the compound heterozygotes combined (n = 24), 95.8% showed symmetric loss, with 59.4% having high-frequency sloping, and 97.9% had a hearing threshold ranging from 20 to 65 dB. Both groups showed significantly elevated ABR/PTA thresholds compared with the normal controls (P = 0.000). The compound heterozygous group had higher ABR thresholds (43.3 ± 15.0 dB nHL) compared with the homozygous group (39.1 ± 12.0 dB nHL, P = 0.005).
CONCLUSION
Infants harboring the GJB2 c.109G>A variant primarily manifest as mild-to-moderate, symmetric, high-frequency sloping hearing loss. Nearly one-third of affected children have thresholds between 20 to 35 dB nHL, suggesting that ABR > 35 dB nHL alone may underestimate the hearing impairment in this population. Compared with homozygotes, compound heterozygotes with the the GJB2 c.109G>A variant can confer a more severe hearing loss.
Humans
;
Connexin 26/genetics*
;
Female
;
Male
;
Infant, Newborn
;
Infant
;
Hearing Loss/genetics*
;
Retrospective Studies
;
Child, Preschool
;
Child
;
Genotype
;
Connexins/genetics*
;
Mutation
9.Artesunate attenuating intestinal mucosal barrier injury in acute graft-versus-host disease mice
Jing KANG ; Xu CHENG ; Jin-Miao ZHENG ; Yu-Xue LI ; Li-Zhuang HAN ; Shu YANG
Acta Anatomica Sinica 2025;56(5):566-575
Objective To investigate the mechanism by which artesunate(ART)attenuates intestinal mucosal barrier damage in acute graft-versus-host disease(aGVHD)and the synergistic effect of ART in combination with dexamethasone(DXM)in the treatment of aGVHD mice.Methods The aGVHD mouse model was established by bone marrow haematopoietic stem cell transplantation.The mice were divided into 9 groups,including normal mice control(Ctrl),aGVHD mice(aGVHD),normal mice receiving ART[30 mg/(kg·d)],aGVHD mice receiving low-dose ART[10 mg/(kg·d)],aGVHD mice receiving medium-dose ART[30 mg/(kg·d)],aGVHD mice receiving high-dose ART[50 mg/(kg·d)],aGVHD mice receiving DXM[20 mg/(kg·d)],aGVHD mice receiving ART[30 mg/(kg·d)]and DXM[20 mg/(kg·d)],and aGVHD mice receiving ART[30 mg/(kg·d)]and halved DXM[10 mg/(kg·d)].Survival rate and clinical parameters were assessed.HE staining and Alcian blue-periodic acid-Schiff(AB-PAS)staining were used to observe the histopathological changes in the intestinal mucosa of the mice;Real-time PCR,Western blotting and immunohistochemistry were used to detect the structure of the intestinal mucosal barrier,the T cell differentiation related transcription factors and cytokines,and the key enzymes of energy metabolism.Flow cytometry was used to detect the T helper cell 17(Th17)and regulatory T cells(Treg).Results After 30 days of ART treatment,aGVHD mice showed significant relief of systemic symptoms and increase in survival rate.In aGVHD mice treated with ART,the intestinal mucosal barrier structure was restored,and the intestinal mucosal permeability was reduced.The activity of AMP-activated protein kinase(AMPK)/mTOR pathway was inhibited,and the energy metabolism pattern of T cells was dominated by fatty acid synthesis.The balance of Th17/Treg was restored due to the decrease of Th 17 and the increase of Treg.The effect of ART+DXM treatment on aGVHD mice was comparable to that of DXM treatment alone,and the survival rate of mice was higher.In particular,the recovery of the intestinal mucosal barrier function was most obvious in the mice treated with ART+half-dose DXM.Conclusion ART reduces the immune injury of allo-T cells to the intestinal mucosal barrier by recovering the Th17/Treg balance,thus maintaining the integrity of the intestinal mucosal barrier function.The synergistic effect of ART and DXM combination treatment in aGVHD mice can reduce the incidence of DXM side effects by decreasing the dosage of DXM.
10.Distribution of traditional Chinese medicine syndromes in intrahepatic cholestasis of pregnancy and its association with perinatal outcomes
Jin CHEN ; Dan YANG ; Qianrong LI ; Yan SANG ; Zhi YU ; Jiao XU ; Xuemei WANG ; Heying HUANG ; Xue TANG ; Lin ZHUANG ; Xiaoyin WANG
Journal of Clinical Hepatology 2025;41(11):2343-2350
ObjectiveTo investigate the distribution of traditional Chinese medicine (TCM) syndromes in intrahepatic cholestasis of pregnancy (ICP) and its association with perinatal outcomes, and to provide a basis for precise treatment based on TCM syndrome differentiation. MethodsA cross-sectional study was conducted among 275 patients with ICP who were admitted to The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from April 2023 to April 2025. A hierarchical cluster analysis was used to summarize TCM syndromes. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. A multivariate Logistic regression analysis was used to identify the clinical features significantly associated with TCM syndrome. ResultsThe cluster analysis identified three core TCM syndromes among the 275 patients with ICP, i.e., liver-gallbladder damp-heat syndrome (45.8%), syndrome of blood deficiency generating wind (30.9%), and liver depression and spleen deficiency syndrome (23.3%). There was a significant difference in the distribution of TCM syndromes between different groups stratified by maternal age at delivery, parity, history of ICP recurrence, gestational weeks at disease onset, total bile acid (TBA), alanine aminotransferase (ALT), and comorbidity with gestational diabetes mellitus (GDM) (all P<0.05). The multivariate Logistic regression analysis showed that<34 gestational weeks at disease onset was significantly associated with all three syndromes (damp-heat: odds ratio [OR]=3.769, P<0.001; blood deficiency: OR=4.031, P<0.001; liver stagnation: OR=3.552, P<0.001). Liver-gallbladder damp-heat syndrome was associated with maternal age ≥35 years at disease onset (OR=2.048, P=0.014), parity ≥2 times (OR=1.921, P=0.034), history of ICP recurrence (OR=2.404, P=0.030), ALT ≥200 U/L (OR=2.051, P=0.018), comorbidity with GDM (OR=1.944, P=0.029), and TBA ≥40 μmol/L (OR=2.542, P=0.024). The syndrome of blood deficiency generating wind syndrome was associated with maternal age ≥35 years (OR=2.939, P=0.003), parity ≥2 time (OR=3.222, P=0.003), history of ICP recurrence (OR=3.809, P=0.010), ALT ≥200 U/L (OR=2.889, P=0.006), comorbidity with GDM (OR=3.711, P=0.001), and comorbidity with hypertensive disorders of pregnancy (OR=4.472, P=0.011). Liver depression and spleen deficiency syndrome was associated with TBA ≥40 μmol/L (OR=2.995, P=0.044). The analysis of perinatal outcomes showed that there were significant differences in mode of delivery, gestational weeks at the time of delivery, postpartum blood loss, and neonatal birth weight between the three groups with different TCM syndromes (all P<0.05). ConclusionLiver-gallbladder damp-heat syndrome, syndrome of blood deficiency generating wind, and liver depression and spleen deficiency syndrome are the main TCM syndrome types in ICP, and the distribution of TCM syndromes is closely associated with clinical factors and perinatal outcomes, which provides a basis for precise TCM syndrome differentiation and individualized treatment.

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