1.Construction of a renal rehabilitation, diagnosis and quality control information platform
Ying SHI ; Xiaomeng SUN ; Jun CHENG ; Di CHEN ; Yifan TIAN ; Yingchun MA ; Xinxin WANG ; Haiyan YE
Chinese Journal of Rehabilitation Theory and Practice 2026;32(4):488-496
ObjectiveTo develop a full-process data platform of renal rehabilitation, diagnosis and quality control information. MethodsA hierarchical architectural design was proposed, adhering to clinical pathway models and standardized data protocols. The platform comprehensively covered assessment, intervention, follow-up and quality control for maintenance hemodialysis (MHD) patients. By integrating multidisciplinary resources and standardizing rehabilitation workflows, it delivered standardized and intelligent rehabilitation services. ResultsThe platform achieved standardized and intelligent management of rehabilitation services, effectively improved the physiological function, psychological state and quality of life convenience for MHD patients, while significantly reduced the economic and care burden on patients' families and society. ConclusionThe rehabilitation service model based on a full-process data platform may provide scientific and systematic support for MHD patients.
2.Herbal Textual Research on Quisqualis Fructus in Famous Classical Formulas
Xiuping WEN ; Shiying CHEN ; Ying TAN ; Guanwen ZHENG ; Huilong XU ; Wen XU ; Chengzi YANG ; Zehao HUANG ; Yu LIN ; Zhilai ZHAN
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(6):225-237
This article systematically analyzed the historical evolution of the origin, scientific name, producing area, quality evaluation, harvesting and processing, and other aspects of Quisqualis Fructus by consulting the ancient materia medica, medical books, prescription books, local literature and combining with the modern literature and standards, summarized and explored the development rules of its medicinal properties and efficacy along with their underlying causes, in order to provide support for the development and utilization of famous classical formulas containing this herb. According to the textual research, Shijunzi was first recorded as Liuqiuzi in Nanfang Caomuzhuang of the Jin dynasty, and the name of Shijunzi was first used in Kaibao Bencao of the Song dynasty, which has been consistently used throughout subsequent dynasties, and there were also aliases such as Junziren, Sijunzi, and Dujilizi. The mainstream source of Quisqualis Fructus used in the past dynasties has been the dried mature fruits of Quisqualis indica, a plant belonging to the family Combretaceae. In modern times, its variety Q. indica var. villosa has also been recorded as the medicinal material of Quisqualis Fructus. In 2007, the Flora of China(English edition) designated Q. indica var. villosa as a synonym of Q. indica. Today, the accepted name of Shijunzi is updated to Combretum indicum. According to ancient herbal records, the producing areas of Quisqualis Fructus were Guangdong, Hong Kong, Macao, Guangxi, Hainan, Sichuan and Fujian, and then gradually expanded to Yunnan, Taiwan, Jiangxi and Guizhou. Since the Song dynasty, two major production regions have gradually emerged in Sichuan, Chongqing and Fujian. Currently, it is primarily cultivated in Chongqing, Guangxi and other areas, with Chongqing yielding the highest output. Since modern times, superior quality has been defined by large size, a purple-black surface, plump grains, and a yellowish-white kernel. According to ancient herbal records, the harvesting period of Quisqualis Fructus was the July and August of the lunar calendar, mostly used raw after shelling or with the shell intact, it underwent processing methods such as cleaning, slicing, mixing, steaming, roasting, stewing, and frying. Currently, the harvesting period is autumn, followed by sun-drying or low-heat drying, with processing methods including cleaning, stir-frying, and stewing. In ancient and modern literature, the records of the properties, functions and indications of Quisqualis Fructus are basically the same, that is, sweet in taste, warm in nature, predominantly non-toxic, belonging to the spleen and stomach meridians. It possesses effects of insecticide, decontamination and invigorating spleen for ascariasis, enterobiasis, abdominal pain due to worm accumulation and infantile malnutrition.The contraindications for use primarily include avoiding consumption by individuals without parasitic infestations, limiting use for those with spleen-stomach deficiency-cold, refraining from drinking hot tea during medication, and avoiding excessive intake. Based on the textual research, it is suggested that the dried mature fruits of Q. indica should be used as the medicinal material for the development of famous classical formulas containing Quisqualis Fructus. Processing methods may be chosen according to prescription requirements, and the raw products is recommended for medicinal use if not specified.
3.Modified Guizhi Fulingwan Regulates miR-34a-5p/DLL1/Notch Signaling Pathway to Promote Apoptosis and Inhibit Prostate Cancer
Yuanguang DONG ; Ying YANG ; Penghao SUN ; Yang HONG ; Lu PAN ; Jiapeng LI ; Lijiang ZHOU ; Di ZHANG ; Mingdian YUAN
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(18):122-133
ObjectiveTo explore the molecular mechanism through which modified Guizhi Fulingwan (MGZFLW) promotes apoptosis and inhibits prostate cancer through the miR-34a-5p/δ-like protein 1 (DLL1)/Notch signaling pathway based on the traditional Chinese medicine theory of Yang transforming Qi while Yin constituting form. MethodsThe optimal intervention conditions of MGZFLW-containing serum and docetaxel (DXT) were screened by the cell counting kit-8 (CCK-8) method. Human prostate cancer cells (PC-3) were allocated into blank, MGZFLW (10%), and DXT (30 nmol·L-1) groups. The effects of MGZFLW-containing serum on the migration and proliferation of PC-3 cells were evaluated by cell scratch and colony formation assays, and the apoptosis of PC-3 cells was detected by terminal-deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay. The cells were transfected with miR-34a-5p mimics and miR-34a-5p inhibitor. The mRNA levels of miR-34a-5p, DLL1, Notch1 and its downstream effector factors Notch1 intracellular domain (NICD1), Hes family basic helix-loop-helix transcription factor 1 (Hes1), and hairy/enhancer-of-split related with YRPW motif 1 (Hey1) were determined by Real-time PCR. The protein levels of DLL1, Notch1, NICD1, Hes1, and Hey1 were determined by a WES fully automatic protein system. The effect of miR-34a-5p on the DLL1-mediated Notch pathway was evaluated based on the results. Further, after MGZFLW-containing serum intervention, the expression of DLL1 and Notch1 was detected by the immunofluorescence (IF) assay, and the mRNA and protein levels of miR-34a-5p/DLL1/Notch pathway-related molecules were quantified by Real-time PCR and the WES fully automatic protein system, respectively, to explore the regulatory effect of MGZFLW-containing serum on the miR-34a-5p/DLL1/Notch pathway. ResultsMGZFLW-containing serum inhibited the viability, migration, and proliferation and promote the apoptosis of PC-3 cells (P<0.01). The overexpression of miR-34a-5p down-regulated the mRNA and protein levels of key molecules in the DLL1/Notch signaling pathway and promoted cell apoptosis (P<0.01), while inhibition of miR-34a-5p had the opposite effects. MGZFLW-containing serum reversed the activation of the DLL1/Notch pathway and the inhibition of apoptosis caused by miR-34a-5p inhibition, up-regulated the expression of miR-34a-5p, and down-regulated the expression of related molecules in this pathway (P<0.01). ConclusionMGZFLW can up-regulate the expression of miR-34a-5p to inhibit the DLL1/Notch signaling pathway and promote the apoptosis of prostate cancer cells, thereby inhibiting prostate cancer. This study provides experimental evidence for clarifying the molecular mechanism of the anti-prostate cancer effect of this formula.
4.Analysis of Volatile Component Variations in Coptidis Rhizoma Processed with Euodiae Fructus Juice by HS-SPME-GC-MS Combined with Chemometrics and ROAV
Lin YAN ; Yun WANG ; Puling LI ; Lingbang MENG ; Zhe JIA ; Ying LI ; Ying LIU ; Min JIN ; Cun ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(21):218-225
ObjectiveTo analyze the volatile components in raw Coptidis Rhizoma, Euodiae Fructus juice-processed Coptidis Rhizoma (Yuhuanglian), and the processing adjuvant Euodiae Fructus juice, identify marker volatile components in the processed product, and elucidate the material basis changes during the processing with Euodiae Fructus juice. MethodsHeadspace solid-phase microextraction coupled with gas chromatography-quadrupole-time-of-flight mass spectrometry (HS-SPME-GC-Q-TOF-MS) was employed to analyze the volatile components in raw Coptidis Rhizoma, Yuhuanglian, and Euodiae Fructus juice. Chemometric analysis was performed to compare volatile components among samples and screen the marker components. Finally, the relative odor activity value (ROAV) was calculated to investigate odor characteristics. ResultsA total of 127 components were detected, with 27, 75, 84 volatile components identified in Euodiae Fructus juice, raw Coptidis Rhizoma, and Yuhuanglian, respectively. Processing with Euodiae Fructus juice significantly increased the number and content of volatile components. Chemometric analysis revealed significant changes in volatile components among the three sample types, allowing clear discrimination. After processing, 39 components such as methyl octanoate and allyl propionate were introduced, while 34 components including furfural and hexanoic acid increased in content, and 11 components including butyric acid and octanal decreased. Additionally, eight components, including zingiberene, 6-methyl-6-hepten-2-one, and 5-methyl-2-hexanone, were screened as marker components of Yuhuanglian. Moreover, processing enhanced the ROAV values of 2,5-dimethylpyrazine (roasted, nutty, coffee-like aroma), 3-ethylphenol, and guaiacol (smoky, woody aroma). Additionally, it incorporated 1-hepten-3-one from Euodiae Fructus juice and the newly generated 1-hexen-3-one, contributing mushroom and cucumber-like odors. The sensory profile of Yuhuanglian integrated nutty, roasted, smoky, and woody notes with the citrus and fruity aroma originally contributed by octanal. ConclusionThe processing with Euodiae Fructus juice introduced components from adjuvant, significantly altering the volatile component profile and enhancing the sensory odor characteristics of Yuhuanglian. This study provides a valuable reference for exploring the material basis of volatile components and establishing processing specifications for Yuhuanglian.
5.Analysis of Volatile Component Variations in Coptidis Rhizoma Processed with Euodiae Fructus Juice by HS-SPME-GC-MS Combined with Chemometrics and ROAV
Lin YAN ; Yun WANG ; Puling LI ; Lingbang MENG ; Zhe JIA ; Ying LI ; Ying LIU ; Min JIN ; Cun ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(21):218-225
ObjectiveTo analyze the volatile components in raw Coptidis Rhizoma, Euodiae Fructus juice-processed Coptidis Rhizoma (Yuhuanglian), and the processing adjuvant Euodiae Fructus juice, identify marker volatile components in the processed product, and elucidate the material basis changes during the processing with Euodiae Fructus juice. MethodsHeadspace solid-phase microextraction coupled with gas chromatography-quadrupole-time-of-flight mass spectrometry (HS-SPME-GC-Q-TOF-MS) was employed to analyze the volatile components in raw Coptidis Rhizoma, Yuhuanglian, and Euodiae Fructus juice. Chemometric analysis was performed to compare volatile components among samples and screen the marker components. Finally, the relative odor activity value (ROAV) was calculated to investigate odor characteristics. ResultsA total of 127 components were detected, with 27, 75, 84 volatile components identified in Euodiae Fructus juice, raw Coptidis Rhizoma, and Yuhuanglian, respectively. Processing with Euodiae Fructus juice significantly increased the number and content of volatile components. Chemometric analysis revealed significant changes in volatile components among the three sample types, allowing clear discrimination. After processing, 39 components such as methyl octanoate and allyl propionate were introduced, while 34 components including furfural and hexanoic acid increased in content, and 11 components including butyric acid and octanal decreased. Additionally, eight components, including zingiberene, 6-methyl-6-hepten-2-one, and 5-methyl-2-hexanone, were screened as marker components of Yuhuanglian. Moreover, processing enhanced the ROAV values of 2,5-dimethylpyrazine (roasted, nutty, coffee-like aroma), 3-ethylphenol, and guaiacol (smoky, woody aroma). Additionally, it incorporated 1-hepten-3-one from Euodiae Fructus juice and the newly generated 1-hexen-3-one, contributing mushroom and cucumber-like odors. The sensory profile of Yuhuanglian integrated nutty, roasted, smoky, and woody notes with the citrus and fruity aroma originally contributed by octanal. ConclusionThe processing with Euodiae Fructus juice introduced components from adjuvant, significantly altering the volatile component profile and enhancing the sensory odor characteristics of Yuhuanglian. This study provides a valuable reference for exploring the material basis of volatile components and establishing processing specifications for Yuhuanglian.
6.Liuwei Dihuangwan Reduces Valproic Acid-induced ASD-like Behaviors in Rats by Modulating mTOR-mediated Synaptic Plasticity in Prefrontal Cortex-hippocampus Circuit
Ji WU ; Niya YIN ; Lei OUYANG ; Siyu HE ; Fangyu PEI ; Ying XIE ; Fan LI ; Qian LEI ; Sha ZHAO ; Di ZHANG ; Qinquan ZHU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(22):1-11
ObjectiveTo investigate the effects of Liuwei Dihuangwan on mammalian target of rapamycin (mTOR)-mediated synaptic plasticity in the prefrontal cortex-hippocampus circuit in the rat model of valproic acid (VPA)-induced autism spectrum disorder (ASD) and to explore its potential mechanism for reducing behavioral abnormalities in ASD rats. MethodsThirteen SD pregnant rats were randomized into the VPA group (10 rats) and the control group (3 rats). On gestational day 13, the VPA group was intraperitoneally injected with VPA solution (600 mg·kg-1), while the control group was injected with an equal volume of normal saline. Male pups of 21 days old from both groups underwent behavioral tests to screen the ASD model rats (32 rats). These rats were then randomly assigned to the model (distilled water), vitamin D (1 480 U·kg-1), low-dose (0.75 g·kg-1) Liuwei Dihuangwan, and high-dose (1.5 g·kg-1) Liuwei Dihuangwan groups, and normal male pups were selected as the blank group (distilled water), with 8 rats in each group. Each group was treated with the corresponding drug or an equal volume of distilled water via gavage daily. After drug administration, behavioral tests were conducted again, followed by anesthesia and tissue collection. Nissl staining was carried out to observe the morphological changes of neurons in the prefrontal cortex and hippocampus. Transmission electron microscopy was used to observe changes in hippocampal synaptic structure. Immunohistochemistry and Western blot were employed to determine the expression of mTOR, phosphatidylinositol 3-kinase (PI3K), and protein kinase B (Akt) in the prefrontal cortex, as well as synaptophysin-1 (SYP-1), postsynaptic density 95 (PSD95), and N-methyl-D-aspartate receptors (NMDARs) in the hippocampus. ResultsCompared with the control group, the model group exhibited severe growth retardation and developmental deformities, with abnormal behavioral performance and pathological damage to neurons and synapses in the prefrontal cortex and hippocampus. Compared with the model group, all treatment groups showed reduced behavioral abnormalities and pathological damage to neurons and synapses in the prefrontal cortex and hippocampus, with the most significant effects in the high-dose Liuwei Dihuangwan group. Immunohistochemistry and Western blotting results showed that compared with the control group, the model group exhibited significantly increased protein levels and phosphorylation ratios of p-mTOR, p-Akt, and p-PI3K in the prefrontal cortex (P<0.05, P<0.01), and decreased protein levels of SYP-1 and PSD95 and increased protein level of NMDARs in the hippocampus (P<0.01). Compared with those in the model group, the protein levels of p-mTOR, p-Akt, and p-PI3K in the prefrontal cortex decreased in the vitamin D and high-dose Liuwei Dihuangwan groups (P<0.05), and the p-mTOR/mTOR, p-Akt/Akt, and p-PI3K/PI3K ratios in the prefrontal cortex declined in the vitamin D group (P<0.05). The high-dose Liuwei Dihuangwan group showed a reduction in p-PI3K/PI3K ratio (P<0.05). The protein level of SYP-1 and PSD95 in the hippocampus increased in the vitamin D, low-dose Liuwei Dihuangwan, and high-dose Liuwei Dihuangwan groups (P<0.05, P<0.01), while the protein level of NMDARs decreased in the vitamin D and high-dose Liuwei Dihuangwan groups (P<0.01). ConclusionLiuwei Dihuangwan significantly reduces VPA-induced ASD-like behaviors and enhances the regeneration and repair of neurons in the prefrontal cortex and synaptic structures in the hippocampus by downregulating of PI3K/Akt/mTOR expression in the prefrontal cortex, upregulating SYP-1 and PSD95 expression in the hippocampus, and inhibiting NMDARs expression.
7.A prediction model for high-risk cardiovascular disease among residents aged 35 to 75 years
ZHOU Guoying ; XING Lili ; SU Ying ; LIU Hongjie ; LIU He ; WANG Di ; XUE Jinfeng ; DAI Wei ; WANG Jing ; YANG Xinghua
Journal of Preventive Medicine 2025;37(1):12-16
Objective:
To establish a prediction model for high-risk cardiovascular disease (CVD) among residents aged 35 to 75 years, so as to provide the basis for improving CVD prevention and control measures.
Methods:
Permanent residents aged 35 to 75 years were selected from Dongcheng District, Beijing Municipality using the stratified random sampling method from 2018 to 2023. Demographic information, lifestyle, waist circumference and blood biochemical indicators were collected through questionnaire surveys, physical examinations and laboratory tests. Influencing factors for high-risk CVD among residents aged 35 to 75 years were identified using a multivariable logistic regression model, and a prediction model for high-risk CVD was established. The predictive effect was evaluated using the receiver operating characteristic (ROC) curve.
Results:
A total of 6 968 individuals were surveyed, including 2 821 males (40.49%) and 4 147 females (59.51%), and had a mean age of (59.92±9.33) years. There were 1 155 high-risk CVD population, with a detection rate of 16.58%. Multivariable logistic regression analysis showed that gender, age, smoking, central obesity, systolic blood pressure, fasting blood glucose, triglyceride and low-density lipoprotein cholesterol were influencing factors for high-risk CVD among residents aged 35 to 75 years (all P<0.05). The area under the ROC curve of the established prediction model was 0.849 (95%CI: 0.834-0.863), with a sensitivity of 0.693 and a specificity of 0.863, indicating good discrimination.
Conclusion
The model constructed by eight factors including demographic characteristics, lifestyle and blood biochemical indicators has good predictive value for high-risk CVD among residents aged 35 to 75 years.
8.Construction of a circRNA-miRNA-mRNA competitive endogenous RNA network based on microarray data and its correlation with liver injury in a mouse model of autoimmune hepatitis
Journal of Clinical Hepatology 2025;42(5):878-887
Objective To construct a circRNA-miRNA-mRNA competitive endogenous RNA(ceRNA)network,to investigate its potential regulatory mechanism in a mouse model of autoimmune hepatitis(AIH)induced by concanavalin A(ConA),and to verify the association between the expression of key genes and liver injury.Methods High-throughput data were used to identify differentially expressed circRNAs,miRNAs,and mRNAs,and the Pearson correlation analysis and the Miranda program were used to predict the pairing relationships between miRNAs and mRNAs/circRNAs and construct a ceRNA network.The gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed for the differentially expressed genes in the network.A total of 12 specific pathogen-free male C57BL/6 mice were divided into control group and model group using a random number table,with 6 mice in each group.The mice in the model group were given injection of ConA via the caudal vein to establish a mouse model of AIH,and those in the control group were given injection of normal saline.The methods of qRT-PCR and Western blot were used to validate the expression levels of circ_0001577,miR-7055-3p,and Akt3.The serum levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were measured,as well as the content of malondialdehyde(MDA)and nitric oxide(NO)in liver tissue,and their correlation with gene expression was analyzed.The independent-samples t test was used for comparison of continuous data between two groups,and the Spearman correlation analysis was used to investigate the correlation between gene expression levels and liver injury indicators.Results A ceRNA network containing 5 795 circRNA-miRNA-mRNA pairings was constructed,and circ_0001577 was identified as the central gene.Compared with the control group,the model group had significant increases in the expression levels of circ_0001577 and Akt3 and a significant reduction in the expression of miR-7055-3p(all P<0.05),and circ_0001577 was positively correlated with Akt3(r=0.861,P<0.001),while miR-7055-3p was negatively correlated with circ_0001577 and Akt3(r=-0.644 and-0.855,both P<0.05).Compared with the control group,the model group had a significantly higher protein expression level of Akt3 in the liver(1.04±0.10 vs 0.72±0.06,t=-6.49,P=0.001),which was positively correlated with circ_0001577(r=0.579,P=0.048)and was negatively correlated with miR-7055-3p(r=-0.891,P<0.001).Compared with the control group,the model group had significant increases in the serum levels of ALT and AST and the content of MDA and NO in liver tissue(all P<0.05),and these liver injury indicators were positively correlated with circ_0001577 and Akt3(r=0.849,0.865,0.811,0.801;0.889,0.954,0.938,and 0.961,all P<0.05)and were negatively correlated with miR-7055-3p(r=-0.687,-0.818,-0.833,and-0.870,all P<0.05);in addition,they were positively correlated with the protein expression level of Akt3(r=0.648,0.796,0.848,and 0.860,all P<0.05).Conclusion This study shows that circ_0001577 promotes the expression of Akt3 by competitively adsorbing miR-7055-3p and relieving the inhibition of Akt3,thereby participating in the development and progression of AIH.
9.Latent profile analysis of learned helplessness in patients with chronic disease co-morbidities
Ya WANG ; Limin XING ; Ying FAN ; Yumei ZHOU ; Xiali CHEN ; Di NIU
Chinese Journal of Practical Nursing 2025;41(25):1953-1961
Objective:To explore the characteristics of potential categories of chronic disease co-morbid patients' learned helplessness, and to analyze the differential characteristics of different categories of chronic disease co-morbid patients.Methods:Convenience sampling method was used to select patients with chronic disease co-morbidities who attended The NO.1 People's Hospital of Xiangyang, Hubei University of Medicine, from June to December 2023 as survey respondents. General information questionnaire, Learned Helplessness Scale, Health Questionnaire Somatic Symptom Cluster Scale, Kessler Psychological Distress Scale, and Comprehension Social Support Scale were used for the cross-sectional survey. The potential profile of learned helplessness, and the influencing factors of potential categories of learned helplessness was analyzed.Results:A total of 810 patients with chronic co-morbidities were investigated. There were 453 males and 357 females, aged (65.03±10.89) years old. The learned helplessness of these patients was categorized into three different potential categories, which were named as low-level learned helplessness group, medium-level learned helplessness group, high-level learned helplessness, accounting for 17.5% (142/810), 23.5% (190/810), and 59.0% (478/810), respectively. Compared with the low-level learned helplessness group, the probability of belonging to the medium-level learned helplessness group and high-level learned helplessness group was higher for patients with chronic co-morbidities with more severe physical symptoms ( OR=1.456, 1.391, both P<0.01). Compared with the low-level learned helplessness group, the probability of belonging to the medium-level learned helplessness group and high-level learned helplessness group was higher for patients with chronic co-morbidities with more severe the psychological distress ( OR=1.359, 1.917, both P<0.01). Compared with the low-level learned helplessness group, the probability of belonging to the medium-level learned helplessness group and high-level learned helplessness group was higher for patients with chronic co-morbidities with lower levels of social support ( OR=0.928, 0.874, both P<0.01). Compared with the low-level learned helplessness group, patients with a duration of illness >5 years were used as controls, patients with a duration of illness 2-5 years were more likely to belong to the medium-level learned helplessness group and high-level learned helplessness group ( OR=74.586, 62.620, both P<0.01). Compared with the low-level learned helplessness group, patients with neutral personalities were compared, patients with extroverted personalities had a lower probability of belonging to the medium-level learned helplessness group ( OR=0.105, P<0.05), while patients with introverted personalities had a lower probability of belonging to the medium-level learned helplessness group and high-level learned helplessness group ( OR=0.052, 0.046, both P<0.01). Conclusions:Patients with chronic disease co-morbidities have higher levels of learned helplessness during disease treatment and have more distinctive categorical characteristics. Healthcare professionals should adopt targeted nursing interventions according to different categories of chronic disease co-morbid patients to reduce the level of learned helplessness.
10.Study on the correlation between sarcopenia, energy metabolism, and the severity of liver disease in patients with type 2 diabetes mellitus combined with metabolic associated fatty liver disease
Jie ZHANG ; Ying LI ; Qing YE ; Na'na YAN ; Hongyan YU ; Fengmei WANG ; Fusheng DI
Chinese Journal of Hepatology 2025;33(8):790-798
Objective:To explore the demographic composition of type 2 diabetes mellitus (T2DM) with metabolic associated fatty liver disease (MAFLD) and the role of energy metabolism in the progression of MAFLD in order to provide theoretical support for improving the prognosis of MAFLD.Methods:A cross-sectional study was conducted. Ninety-four cases with T2DM combined with MAFLD admitted to the Endocrinology Department of Tianjin Third Central Hospital from July 2014 to July 2019 were selected. Patients were divided into three groups: non-metabolic associated steatohepatitis (MASH) group (25 cases), borderline MASH group (49 cases), and MASH group (20 cases) according to the non-alcoholic fatty liver disease activity score (NAS). Patients were further divided into two groups: non/mild fibrosis (F0-1) group (74 cases) and the significant fibrosis (F2-4) group (20 cases) in accordance with liver fibrosis scores. The differences in general clinical and biochemical indicators, body composition, and energy metabolism indicators among the groups were compared. Binary logistic regression analysis was conducted to explore factors affecting liver inflammation and fibrosis severity degree in patients with MAFLD.Results:The visceral fat area (VFA) and body fat percentage (PBF) were significantly higher in the MASH group than in the non-MASH group ( P<0.05), while the skeletal muscle mass index and body mass index (SMI-BMI) were significantly lower in the MASH group than in the marginal MASH group ( P<0.05) during the comparison of body composition and substrate metabolism at different stages of MASH. Alanine aminotransferase (ALT) and homeostasis model assessment of insulin resistance (HOMA-IR) were significantly higher in the fibrotic group than in those in the no/mild fibrosis group ( P<0.05) when comparing clinical and biochemical indicators, body composition, and substrate metabolism at different stages of fibrosis. The skeletal muscle mass (SMM), SMI-BMI, SMM-Weight, resting energy expenditure (REE), and fat oxidation rate (FAT OXR) were significantly lower in the fibrotic group than those in the no/mild fibrosis group ( P<0.05). The respiratory quotient and carbohydrate functional ratio (%CHO) were significantly higher in the fibrotic group than in the no/mild fibrosis group ( P<0.05). Correlation analysis indicated a positive correlation between the NAS score, reflecting the severity of liver inflammatory lesions, with VFA and PBF ( r=0.258 and 0.323, P<0.05); while the F score was positively correlated with the respiratory quotient, %CHO, and VFA ( r=0.292, 0.303, and 0.239, P<0.05), and negatively correlated with REE, the energy ratio from fat, FAT OXR, SMM, SMI-Weight, and SMI-BMI ( r=-0.209, -0.214, -0.333, -0.240, -0.250, and -0.305, P<0.05). Logistic regression analysis indicated that SMI-Weight and FAT OXR were independent factors affecting the progression of liver fibrosis. Conclusion:The reduction of skeletal muscle, particularly because of energy metabolism, is a factor affecting the progression of fibrosis in MAFLD.


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