The present letter to the editor is related to the review with the title“Past,present,and future of long-term treatment for hepatitis B virus.”Chronic hepatitis B(CHB)represents an important and pressing public heal...The present letter to the editor is related to the review with the title“Past,present,and future of long-term treatment for hepatitis B virus.”Chronic hepatitis B(CHB)represents an important and pressing public health concern.Timely identification and effective antiviral therapy hold the potential to reduce liver-related mortality attributable to chronic infection with hepatitis B virus(HBV)substantially.However,the current global treatment rates for CHB remain conspicuously low,with the excessively stringent treatment criteria advocated by national CHB guidelines being a contributing factor to these low rates.Nevertheless,recent strides in comprehending this malady and the emergence of novel antiviral agents prompt the imperative re-evaluation of treatment standards to extend the sphere of potential beneficiaries.An impending need arises for a novel paradigm for the classification of patients with CHB,the expansion of antiviral treatment eligibility for HBV-infected individuals,and even the streamlining of the diagnostic process for CHB to amplify cost-effectiveness and augment survival prospects.展开更多
Background and Aims:The recently proposed concept of metabolic dysfunction-associated fatty liver disease(MAFLD)has remained controversial.We aimed to describe the features and associated outcomes to examine the diagn...Background and Aims:The recently proposed concept of metabolic dysfunction-associated fatty liver disease(MAFLD)has remained controversial.We aimed to describe the features and associated outcomes to examine the diagnostic ability of MAFLD for identifying high-risk individuals.Methods:In this retrospective cohort study,we enrolled 72,392 Chinese participants between 2014 and 2015.Participants were classified as MAFLD,nonalcoholic fatty liver disease(NAFLD),non-MAFLD-NAFLD,and a normal control group.The primary outcomes were liver-related and cardiovascular disease(CVD)events.Person-years of follow-up were calculated from enrolment to the diagnosis of the event,or the last date of data(June,2020).Results:Of the 72,392 participants,31.54%(22,835)and 28.33%(20,507)qualified the criteria for NAFLD or MAFLD,respectively.Compared with NAFLD,MAFLD patients were more likely to be male,overweight,and have higher biochemical indices including liver enzyme levels.Lean MAFLD diagnosed with≥2 or≥3 metabolic abnormalities presented similar clinical manifestations.During the median follow-up of 5.22 years,919 incident cases of severe liver disease and 2,073 CVD cases were recorded.Compared with the normal control group,the NAFLD and MAFLD groups had a higher cumulative risk of liver failure and cardiac-cerebral vascular diseases.There were no significant differences in risk between the non-MAFLD-NAFLD and normal group.Diabetes-MAFLD group had the highest incidence of liver-related and cardiac-cerebral vascular diseases,lean MAFLD came second,and obese-MAFLD had the lowest incidence.Conclusions:This real-world study provided evidence for rationally assessing the benefit and practicability of the change in terminology from NAFLD to MAFLD.MAFLD may be better than NAFLD in identifying fatty liver with worse clinical features and risk profile.展开更多
Background and aims:Drug-induced liver injury(DILI)is a leading cause of death from acute liver failure(ALF).Hy's law warns that a hepatocellular pattern of injury accompanied by jaundice and normal alkaline phosp...Background and aims:Drug-induced liver injury(DILI)is a leading cause of death from acute liver failure(ALF).Hy's law warns that a hepatocellular pattern of injury accompanied by jaundice and normal alkaline phosphatase(ALP)levels is associated with a 10%or greater chance of progression to transplant or liver-related death.This meta-analysis of DILI studies evaluates acute and chronic outcomes of DILI according to clinical pattern of injury.Methods:We conducted a systematic search using electronic databases PubMed and EMBASE through to 8 March 2022.Our primary outcome was to compare acute outcomes including ALF,liver-related death,and liver transplant between patients experiencing hepatocellular,cholestatic,and mixed patterns of DILI.Our secondary outcome was to compare the rate of DILI chronicity between patients of these three differing patterns of injury.Pooled odds ratios(ORs)and 95%confidence intervals(CIs)were calculated using a random-effects model.Results:Overall,12 studies comprising 4290 patients were included.Patients with cholestatic DILI demonstrated similar rates of ALF(OR:0.80,95%CI:0.46–1.40,p=0.429)and liver-related death(OR:0.92,95%CI:0.50–1.69,p=0.792)compared to patients with hepatocellular DILI.Patients with cholestatic DILI were significantly more likely to experience chronicity compared to patients with hepatocellular DILI(OR:2.53,95%CI:1.34–4.79,p=0.004).展开更多
In patients with chronic liver diseases,identification of significant liver fibrosis and cirrhosis is essential for determining treatment strategies,assessing therapeutic response,and stratifying long-term prognosis.A...In patients with chronic liver diseases,identification of significant liver fibrosis and cirrhosis is essential for determining treatment strategies,assessing therapeutic response,and stratifying long-term prognosis.Although liver biopsy remains the reference standard for evaluating the extent of liver fibrosis in patients with chronic liver diseases,several non-invasive methods have been developed as alternatives to liver biopsies.Some of these non-invasive methods have demonstrated clinical accuracy for diagnosing significant fibrosis or cirrhosis in many cross-sectional studies with the histological fibrosis stage as a reference standard.However,non-invasive methods cannot be fully validated through cross-sectional studies since liver biopsy is not a perfect surrogate endpoint marker.Accordingly,recent studies have focused on assessing the performance of non-invasive methods through longterm,longitudinal,follow-up studies with solid clinical endpoints related to advanced stages of liver fibrosis and cirrhosis.As a result,current view is that these alternative methods can independently predict future cirrhosis-related complications,such as hepatic decompensation,liver failure,hepatocellular carcinoma,or liver-related death.The clinical role of non-invasive models seems to be shifting from a simple tool for predicting the extent of fibrosis to a surveillance tool for predicting future liver-related events.In this article,we will summarize recent longitudinal studies of non-invasive methods for predicting forthcoming complications related to liver cirrhosis and discuss the clinical value of currently available non-invasive methods based on evidence from the literature.展开更多
BACKGROUND Liver fibrosis leads to liver-related events in patients with chronic hepatitis C(CHC)infection.Although non-invasive tests(NITs)are critical to early detection of the development of liver fibrosis,the prog...BACKGROUND Liver fibrosis leads to liver-related events in patients with chronic hepatitis C(CHC)infection.Although non-invasive tests(NITs)are critical to early detection of the development of liver fibrosis,the prognostic role of NITs remains unclear due to the limited types of NITs and liver outcomes explored in previous studies.AIM To determine the prognostic value of NITs for risk stratification in CHC patients.METHODS The protocol was registered in PROSPERO(International Prospective Register of Systematic Reviews;no.CRD42019128176).The systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Search was performed using MEDLINE and EMBASE databases under a timeframe from the inception of the databases through February 25,2020.We restricted our search to CHC cohort studies reporting an association between liver fibrosis assessed by NITs and the development of hepatocellular carcinoma,decompensation,or mortality.Pooled hazard ratios(HR)and area under the receiver operating characteristic(AUROC)for each NIT were estimated using a random effects model.Subgroup analyses were performed for NITs assessed at pre-treatment or post-treatment with sustained virologic response(SVR),treatment with either pegylated interferon and ribavirin or direct acting antiviral,Eastern or Western countries,and different cutoff points.RESULTS The present meta-analysis included 29 cohort studies,enrolling 69339 CHC patients.Fibrosis-4(FIB-4)index,aspartate aminotransferase to platelet ratio(APRI)score,and liver stiffness measurement(LSM)were found to have hepatocellular carcinoma predictive potential with pooled adjusted HRs of 2.48[95%confidence interval(CI):1.91-3.23,I2=96%],4.24(95%CI:2.15-8.38,I2=20%)and 7.90(95%CI:3.98-15.68,I2=52%)and AUROCs of 0.81(95%CI:0.73-0.89,I2=77%),0.81(95%CI:0.75-0.87,I2=68%),and 0.79(95%CI:0.63-0.96,I2=90%),respectively.Pooled adjusted HR with a pre-treatment FIB-4 cutoff of 3.25 was 3.22(95%CI:2.32-4.47,I2=80%).Pooled adjusted HRs f展开更多
目的:系统评价中国肝衰竭医院感染预后相关研究,分析医院感染预后指标,为改善预后提供循证依据.方法:检索中国知网、万方、维普、中国生物医学文献数据库、Pubmed、ISI web ofknowledge、Embase、Cochrane数据库文献,采用纽卡斯尔-渥太...目的:系统评价中国肝衰竭医院感染预后相关研究,分析医院感染预后指标,为改善预后提供循证依据.方法:检索中国知网、万方、维普、中国生物医学文献数据库、Pubmed、ISI web ofknowledge、Embase、Cochrane数据库文献,采用纽卡斯尔-渥太华量表对纳入文献进行质量评价及Meta分析.结果:纳入19篇文献,肝衰竭医院感染1989例,死亡1842例.Meta分析结果显示:肝衰竭医院感染患者在死亡组与存活组间(OR=4.13)、肝衰竭医院感染患者死亡在亚急性与慢性(OR=0.50)、单部位与多部位(OR=0.52)、血清总胆红素≤342.2μmol/L与>342.2μmol/L(OR=0.47)、血清白蛋白≤30 g/L与>30 g/L(OR=2.85)、凝血酶原活动度<20%与≥20%(OR=14.49)组间均有统计学意义.结论:影响肝衰竭医院感染患者预后指标复杂多样.慢性肝衰竭合并医院感染及多部位感染患者为重点监测对象,血清总胆红素>342.2μmol/L、血清白蛋白≤30 g/L、凝血酶原活动度<20%为重点监测指标.展开更多
目的:本研究旨在结合二维剪切波弹性成像(2D-SWE)技术、超声特征及血清学指标构建自身免疫性肝病(AILD)相关肝硬化的预测模型并评估该模型的预测效能。方法:收集2019年月至2022年5月于福建医科大学孟超肝胆医院行肝脏活检确诊为AILD,并...目的:本研究旨在结合二维剪切波弹性成像(2D-SWE)技术、超声特征及血清学指标构建自身免疫性肝病(AILD)相关肝硬化的预测模型并评估该模型的预测效能。方法:收集2019年月至2022年5月于福建医科大学孟超肝胆医院行肝脏活检确诊为AILD,并行肝胆脾超声、2D-SWE及相关血清学检查的患者。根据病理结果,分为肝硬化组与非肝硬化组。通过多因素logistic回归分析筛选出AILD相关肝硬化的独立风险因素,构建AILD相关肝硬化的列线图模型(AILDC)。采用Bootstrap法对模型进行内部验证,绘制ROC曲线,校准曲线及临床决策曲线评估模型的区分度、校准度及临床净获益。结果:共纳入AILD255例,肝硬化组共45例。logistic回归分析结果显示:肝硬度(OR:1.322,95%CI:1.186-1.474),脾脏厚度>4 cm(OR:5.154,95%CI:1.943-13.674),补体C4(OR:0.001,95%CI:0.000-0.674),高尔基体-73(OR:1.014,95%CI:1.002-1.027)均是AILD肝硬化独立预测指标。AILDC的最佳截断值为80,敏感度84.4%,特异度78.6%;曲线下面积(Area under curve,AUC)0.866。AILD肝硬度的最佳截断值为10 Kpa,敏感度为71.1%,特异度为85.2%,AUC为0.803。相较于其它无创指标,AILDC具有更高的净重新分类指数、综合判别改善指数及临床决策曲线。结论:AILDC具有较好的预测效能,优于其他无创指标,适于在临床中运用并进一步推广。展开更多
文摘The present letter to the editor is related to the review with the title“Past,present,and future of long-term treatment for hepatitis B virus.”Chronic hepatitis B(CHB)represents an important and pressing public health concern.Timely identification and effective antiviral therapy hold the potential to reduce liver-related mortality attributable to chronic infection with hepatitis B virus(HBV)substantially.However,the current global treatment rates for CHB remain conspicuously low,with the excessively stringent treatment criteria advocated by national CHB guidelines being a contributing factor to these low rates.Nevertheless,recent strides in comprehending this malady and the emergence of novel antiviral agents prompt the imperative re-evaluation of treatment standards to extend the sphere of potential beneficiaries.An impending need arises for a novel paradigm for the classification of patients with CHB,the expansion of antiviral treatment eligibility for HBV-infected individuals,and even the streamlining of the diagnostic process for CHB to amplify cost-effectiveness and augment survival prospects.
基金This work was supported by the National Natural Science Foundation of China(grant numbers:81903382)Natural Science Foundation of Jiangsu Province(grant numbers:BK20190652)+1 种基金Science and Technology Young Scientific and Technological Talents Project of Jiangsu Province(grants 2021-50)China Postdoctoral Science Foundation(grant numbers:General Program,2019M651900)。
文摘Background and Aims:The recently proposed concept of metabolic dysfunction-associated fatty liver disease(MAFLD)has remained controversial.We aimed to describe the features and associated outcomes to examine the diagnostic ability of MAFLD for identifying high-risk individuals.Methods:In this retrospective cohort study,we enrolled 72,392 Chinese participants between 2014 and 2015.Participants were classified as MAFLD,nonalcoholic fatty liver disease(NAFLD),non-MAFLD-NAFLD,and a normal control group.The primary outcomes were liver-related and cardiovascular disease(CVD)events.Person-years of follow-up were calculated from enrolment to the diagnosis of the event,or the last date of data(June,2020).Results:Of the 72,392 participants,31.54%(22,835)and 28.33%(20,507)qualified the criteria for NAFLD or MAFLD,respectively.Compared with NAFLD,MAFLD patients were more likely to be male,overweight,and have higher biochemical indices including liver enzyme levels.Lean MAFLD diagnosed with≥2 or≥3 metabolic abnormalities presented similar clinical manifestations.During the median follow-up of 5.22 years,919 incident cases of severe liver disease and 2,073 CVD cases were recorded.Compared with the normal control group,the NAFLD and MAFLD groups had a higher cumulative risk of liver failure and cardiac-cerebral vascular diseases.There were no significant differences in risk between the non-MAFLD-NAFLD and normal group.Diabetes-MAFLD group had the highest incidence of liver-related and cardiac-cerebral vascular diseases,lean MAFLD came second,and obese-MAFLD had the lowest incidence.Conclusions:This real-world study provided evidence for rationally assessing the benefit and practicability of the change in terminology from NAFLD to MAFLD.MAFLD may be better than NAFLD in identifying fatty liver with worse clinical features and risk profile.
文摘Background and aims:Drug-induced liver injury(DILI)is a leading cause of death from acute liver failure(ALF).Hy's law warns that a hepatocellular pattern of injury accompanied by jaundice and normal alkaline phosphatase(ALP)levels is associated with a 10%or greater chance of progression to transplant or liver-related death.This meta-analysis of DILI studies evaluates acute and chronic outcomes of DILI according to clinical pattern of injury.Methods:We conducted a systematic search using electronic databases PubMed and EMBASE through to 8 March 2022.Our primary outcome was to compare acute outcomes including ALF,liver-related death,and liver transplant between patients experiencing hepatocellular,cholestatic,and mixed patterns of DILI.Our secondary outcome was to compare the rate of DILI chronicity between patients of these three differing patterns of injury.Pooled odds ratios(ORs)and 95%confidence intervals(CIs)were calculated using a random-effects model.Results:Overall,12 studies comprising 4290 patients were included.Patients with cholestatic DILI demonstrated similar rates of ALF(OR:0.80,95%CI:0.46–1.40,p=0.429)and liver-related death(OR:0.92,95%CI:0.50–1.69,p=0.792)compared to patients with hepatocellular DILI.Patients with cholestatic DILI were significantly more likely to experience chronicity compared to patients with hepatocellular DILI(OR:2.53,95%CI:1.34–4.79,p=0.004).
基金Supported by The Liver Cirrhosis Clinical Research Center,a grant from the Korea Healthcare Technology RandD Project,Ministry of Health and Welfare,South Korea,No.HI10C2020the Bilateral International Collaborative RandD Program from the Ministry of Knowledge Economy,South Korea
文摘In patients with chronic liver diseases,identification of significant liver fibrosis and cirrhosis is essential for determining treatment strategies,assessing therapeutic response,and stratifying long-term prognosis.Although liver biopsy remains the reference standard for evaluating the extent of liver fibrosis in patients with chronic liver diseases,several non-invasive methods have been developed as alternatives to liver biopsies.Some of these non-invasive methods have demonstrated clinical accuracy for diagnosing significant fibrosis or cirrhosis in many cross-sectional studies with the histological fibrosis stage as a reference standard.However,non-invasive methods cannot be fully validated through cross-sectional studies since liver biopsy is not a perfect surrogate endpoint marker.Accordingly,recent studies have focused on assessing the performance of non-invasive methods through longterm,longitudinal,follow-up studies with solid clinical endpoints related to advanced stages of liver fibrosis and cirrhosis.As a result,current view is that these alternative methods can independently predict future cirrhosis-related complications,such as hepatic decompensation,liver failure,hepatocellular carcinoma,or liver-related death.The clinical role of non-invasive models seems to be shifting from a simple tool for predicting the extent of fibrosis to a surveillance tool for predicting future liver-related events.In this article,we will summarize recent longitudinal studies of non-invasive methods for predicting forthcoming complications related to liver cirrhosis and discuss the clinical value of currently available non-invasive methods based on evidence from the literature.
基金Supported by Research Grant for New Scholar Ratchadaphiseksomphot Endowment Fund Chulalongkorn University,No.RGN_2559_055_10_30.
文摘BACKGROUND Liver fibrosis leads to liver-related events in patients with chronic hepatitis C(CHC)infection.Although non-invasive tests(NITs)are critical to early detection of the development of liver fibrosis,the prognostic role of NITs remains unclear due to the limited types of NITs and liver outcomes explored in previous studies.AIM To determine the prognostic value of NITs for risk stratification in CHC patients.METHODS The protocol was registered in PROSPERO(International Prospective Register of Systematic Reviews;no.CRD42019128176).The systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Search was performed using MEDLINE and EMBASE databases under a timeframe from the inception of the databases through February 25,2020.We restricted our search to CHC cohort studies reporting an association between liver fibrosis assessed by NITs and the development of hepatocellular carcinoma,decompensation,or mortality.Pooled hazard ratios(HR)and area under the receiver operating characteristic(AUROC)for each NIT were estimated using a random effects model.Subgroup analyses were performed for NITs assessed at pre-treatment or post-treatment with sustained virologic response(SVR),treatment with either pegylated interferon and ribavirin or direct acting antiviral,Eastern or Western countries,and different cutoff points.RESULTS The present meta-analysis included 29 cohort studies,enrolling 69339 CHC patients.Fibrosis-4(FIB-4)index,aspartate aminotransferase to platelet ratio(APRI)score,and liver stiffness measurement(LSM)were found to have hepatocellular carcinoma predictive potential with pooled adjusted HRs of 2.48[95%confidence interval(CI):1.91-3.23,I2=96%],4.24(95%CI:2.15-8.38,I2=20%)and 7.90(95%CI:3.98-15.68,I2=52%)and AUROCs of 0.81(95%CI:0.73-0.89,I2=77%),0.81(95%CI:0.75-0.87,I2=68%),and 0.79(95%CI:0.63-0.96,I2=90%),respectively.Pooled adjusted HR with a pre-treatment FIB-4 cutoff of 3.25 was 3.22(95%CI:2.32-4.47,I2=80%).Pooled adjusted HRs f
文摘目的:本研究旨在结合二维剪切波弹性成像(2D-SWE)技术、超声特征及血清学指标构建自身免疫性肝病(AILD)相关肝硬化的预测模型并评估该模型的预测效能。方法:收集2019年月至2022年5月于福建医科大学孟超肝胆医院行肝脏活检确诊为AILD,并行肝胆脾超声、2D-SWE及相关血清学检查的患者。根据病理结果,分为肝硬化组与非肝硬化组。通过多因素logistic回归分析筛选出AILD相关肝硬化的独立风险因素,构建AILD相关肝硬化的列线图模型(AILDC)。采用Bootstrap法对模型进行内部验证,绘制ROC曲线,校准曲线及临床决策曲线评估模型的区分度、校准度及临床净获益。结果:共纳入AILD255例,肝硬化组共45例。logistic回归分析结果显示:肝硬度(OR:1.322,95%CI:1.186-1.474),脾脏厚度>4 cm(OR:5.154,95%CI:1.943-13.674),补体C4(OR:0.001,95%CI:0.000-0.674),高尔基体-73(OR:1.014,95%CI:1.002-1.027)均是AILD肝硬化独立预测指标。AILDC的最佳截断值为80,敏感度84.4%,特异度78.6%;曲线下面积(Area under curve,AUC)0.866。AILD肝硬度的最佳截断值为10 Kpa,敏感度为71.1%,特异度为85.2%,AUC为0.803。相较于其它无创指标,AILDC具有更高的净重新分类指数、综合判别改善指数及临床决策曲线。结论:AILDC具有较好的预测效能,优于其他无创指标,适于在临床中运用并进一步推广。
