Clinical and Experimental Hepatology最新文献

Aim of the study: Metabolic associated steatotic liver disease (MASLD) was proposed to replace non-alcoholic fatty liver disease (NAFLD) in 2023. It has different diagnostic criteria from metabolic associated fatty liver disease (MAFLD). The comparison between the two disease names and diagnostic criteria deserves investigation.

Material and methods: We recruited participants from the Taiwan Bio-bank database. NAFLD was diagnosed based on the presence of hepatic steatosis after excluding chronic hepatitis B or C virus infection, chronic drinkers, or other known liver diseases. According to the presence of cardiometabolic criteria, NAFLD is divided into two groups: MASLD and cryptogenic steatotic liver disease (SLD). The "missing" group was defined as those patients who met the diagnostic criteria for MASLD but not for MAFLD. Cryptogenic SLD was used as the control group. We used the NAFLD fibrosis score (NFS) as an indicator for liver fibrosis.

Results: This study included 17,595 participants, among whom 7,274 (41.3%) had MASLD, and 6,905 had pure MAFLD, defined as MAFLD having no other causes of liver diseases. The cryptogenic SLD group consisted of 264 (1.5%) patients, while the "missing" group had 369 patients. There were no differences in metabolic parameters, liver markers and the percentage of carotid plaques between these two groups. When comparing the "missing" group to the control group, the "missing" group had higher NFS and a higher proportion of carotid plaques.

Conclusions: In this large, population-based study, is not advisable to exclude the "missing" group having higher risk of liver fibrosis and atherosclerosis than controls. MASLD misses fewer high-risk patients than pure MAFLD for replacing NAFLD.

In the hepatitis B virus (HBV) elimination strategy announced by the World Health Organization (WHO) in 2016, one of the main aspects is the prevention of vertical infections. In the prevention of vertical HBV infections, chemoprophylaxis with tenofovir is recommended from the 28^th week of pregnancy in women with a high viral load (HBV DNA > 2 × 10⁵ IU/ml) or the presence of HBeAg in the serum and active-passive immunoprophylaxis (HepB-BD+ HBIG) in all newborns born to mothers infected with HBV. Attention was paid to the incidence of latent HBV infections among children and adolescents and the role of the vaccine dose and additional hepatitis B booster vaccination in the prevention of HBV, especially in highly endemic areas and risk groups. The role of the age of initiation of therapy in the context of functional cure was indicated.

Cannabinoids are biologically active substances acting via feedback-coupled CB1 and CB2 receptors. Their expression in myofibroblasts and liver endothelial cells is reported to be elevated in chronic liver diseases. The effect of CB1 receptor stimulation is to increase fibrosis and inflammatory activity in the liver by stimulating stellate cells, while activation of the CB2 receptor results in inhibition of fibrosis. Stimulation of the CB1 receptor may also lead to progression of liver steatosis and carcinogenesis. In end-stage liver disease, the endocannabinoid system plays an important role in the pathogenesis of encephalopathy and vascular effects, such as portal hypertension, splanchnic vasodilatation and cirrhotic cardiomyopathy. It seems that interference in endocannabinoid transmission may serve as an attractive target for the development of hepatological drugs.

Aim of the study: Popping during radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) can cause complications such as bleeding and tumor seeding. Perfluorobutane microbubbles (Sonazoid, GE Healthcare) are employed to enhance visualization through the use of vascular and Kupffer imaging. This study aimed to assess the impact of Sonazoid on popping during RFA for HCC and evaluate popping and local recurrence rates.

Material and methods: We examined 135 patients and 308 nodules undergoing RFA for HCC using a unipolar needle electrode between December 2019 and December 2023. Popping and local recurrence rates were compared between RFA groups with and without Sonazoid.

Results: The cohort comprised 99 males and 36 females, with a mean age of 72 (range: 35-93) years. Background liver conditions included 21 hepatitis B virus (HBV), 44 hepatitis C virus (HCV), and 70 non-HBV/HCV cases. The group without Sonazoid had 267 nodes, while the Sonazoid group had 41 nodes. In energy-related comparisons, the Sonazoid group exhibited lower power (p = 0.039) and energy delivery (p = 0.013) and shorter cauterization time (p = 0.021). The popping rate during cauterization was significantly lower in the Sonazoid group (28.8% vs. 12.2%, p = 0.023). There was no significant difference in local recurrence rate between the two groups.

Conclusions: RFA with Sonazoid using a unipolar needle-type electrode reduced power output, enabling lower-energy ablation and shorter ablation times. This suggests a potential for suppressing the popping phenomenon. Low-power ablation did not affect local recurrence rates, highlighting RFA as a less invasive treatment strategy. Further studies with larger cohorts are needed to evaluate treatment efficacy.

Aim of the study: The new term "metabolic dysfunction associated steatotic liver disease" (MASLD) focuses on the bidirectional interplay between fatty liver and metabolic dysregulation. The aim of this study was to evaluate serum concentrations of uric acid (UA) in overweight/obese children and adolescents and to determine the association of this parameter with MASLD and metabolic dysregulation.

Material and methods: One hundred and ninety-four overweight/obese children with suspected liver disease were included in the study. MASLD was diagnosed according to the latest consensus. Diagnosis of metabolic syndrome (MetS) was based on the International Diabetes Federation criteria in children aged ≥ 10 years (n = 182).

Results: MASLD was diagnosed in 68.56% and MetS in 26.92% of patients. Children with MASLD had significantly higher values of alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (GGT), total cholesterol, triglycerides (TG), UA and carotid intima-media thickness (IMT). Significantly higher levels of insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and UA were observed in patients with MetS. Correlations were observed between UA and ALT, AST, GGT, TG, insulin, HOMA-IR, mean IMT, body mass index (BMI) and high-density lipoprotein cholesterol (HDL-C) in overweight and obese children. UA was helpful in differentiating between children with MetS and without MetS (p = 0.0003), while only borderline statistical significance was observed for MASLD (p = 0.05).

Conclusions: Our results suggest that UA may be a potential additional and readily available marker of metabolic dysfunction in children with MASLD. Further studies on a larger group of patients are needed to confirm this association.

Aim of the study: Non-alcoholic fatty liver disease (NAFLD) is a pathological condition associated with inflammation owing to fat deposition in the liver. Managing hypertriglyceridemia is essential for patients with NAFLD, including treatment with pemafibrate. However, whether pemafibrate affects fat deposition in the liver and whether hypertriglyceridemia is the primary treatment target remain unclear. Thus, in this single-arm, retrospective study, we explored how pemafibrate treatment affects fat deposition in the liver in patients with NAFLD using FibroScan, the only insurance-covered device in Japan for quantitatively measuring fat in the liver.

Material and methods: Patients with NAFLD and hypertriglyceridemia were administered 0.2 mg/day of pemafibrate for either three (n = 51) or six (n = 42) months. The primary endpoint was the FibroScan (FibroScan 430 Mini, Echosens, France) controlled attenuation parameter (CAP) measurement. The secondary endpoints were liver transaminase levels, the FibroScan-aspartate aminotransferase (FAST) score, the hepatic steatosis index (HSI), the fibrosis-4 (FIB-4) index, the aspartate aminotransferase-to-platelet ratio index (APRI), and the albumin-bilirubin (ALBI) score.

Results: Three months of pemafibrate administration significantly improved the CAP values. The FAST score and HSI also significantly improved after three months, suggesting fatty liver improvements. Furthermore, the alanine aminotransferase and γ-glutamyl transpeptidase levels (indicators of hepatitis) decreased, and fibrosis improved in the liver fibrosis prediction assessments, such as the FIB-4 index, APRI, and ALBI score, after three months of pemafibrate administration. Most of these improvements remained after six months.

Conclusions: Oral pemafibrate treatment improved NAFLD in patients with hypertriglyceridemia, indicating that pemafibrate may be a new treatment option for NAFLD.

Aim of the study: The aim of the study was to characterize the population with hepatitis C virus (HCV) infection and steatotic liver disease (SLD) in comparison to the non-SLD HCV-infected patients and to evaluate the effectiveness of treatment with direct-acting antivirals (DAA).

Material and methods: The analysis included 62 patients diagnosed with SLD and 14,284 non-SLD patients from the EpiTer-2 database for the period 2015-2022.

Results: Unlike the non-SLD population, the SLD group was dominated by men (49.5% vs. 53.2%, respectively). The mean age of patients did not differ significantly between groups and was 50.8 ±13.8 and 50.8 ±14.9 years for SLD and non-SLD, respectively. As expected, patients with SLD had significantly different BMI values. Genotype (GT) 1b infection predominated in both populations, but the prevalence of GT3 was significantly higher in the SLD group (19.4% vs. 10.6%). The percentage of patients with advanced liver disease (F3/4) was similar in both groups (38.7% vs. 35.6%). Patients with SLD were more likely to be treatment naïve (82.3% vs. 80.5%), HBV co-infected (24.2% vs. 13.6%), and obese (54.8% vs. 17.1%). Out of 62 patients, 59 (95%) achieved a sustained virologic response (SVR), but after excluding 3 lost to follow-up a response rate of 100% was obtained. The corresponding SVR values in the non-SLD HCV-infected population were 95% and 98%, respectively.

Conclusions: Despite some differences in the characteristics of patients with SLD infected with HCV, the effec-tiveness of DAA therapy does not differ significantly from that observed in the general population infected with HCV.

Aim of the study: Sarcoidosis is characterized by noncaseating granulomas that can affect multiple organs. Due to the lack of prospective studies regarding treatment of hepatic sarcoidosis with ursodeoxycholic acid (UDCA), we set out to evaluate its effects in a single-center, open-label, prospective, pre-post study.

Material and methods: A total of 10 patients were screened from August 2018 to July 2020; seven met the criteria and were enrolled. The study was terminated prior to achieving target enrollment of 10 patients due to the difficulty in recruitment around the COVID-19 pandemic. Most patients were women (4/7; 57.1%) and African American (5/7; 71.4%). One patient dropped out during the first month of observation due to a new diagnosis of esophageal cancer. Six completed the 6-month observation and UDCA treatment periods. One patient stopped UDCA within the first month of active treatment due to the side effect of nausea.

Results: There was a decrease in ALP and GGT after six months of UDCA treatment compared to six months of observation (ALP - 257.6 to 202.2, p = 0.23; GGT - 302.5 to 111.8, p = 0.059), but this did not reach statistical significance. There were also decreases in all key secondary endpoints (ALT - 50.8 to 29.8, p = NS; AST - 40.3 to 31.2, p = NS, VCTE kPa - 8.3 to 6.3, p = NS). As with the primary endpoints, none of the key secondary endpoints reached statistical significance.

Conclusions: There is significant potential for UDCA as first-line treatment of hepatic sarcoid. Multi-center, ideally prospective, studies of longer duration are needed.

Echinococcosis is considered one of the world's most dangerous zoonoses, and the tapeworm that causes it is one of the two most dangerous parasites to humans globally. Untreated cases may be associated with as high as 90% mortality. The incidence of this pathology is increasing. The authors present an up-to-date review of the literature on liver echinococcosis; they also present their own material of 73 patients with liver echinococcosis treated in the Department of General and Transplant Surgery since 2019.

Aim of the study: Gallbladder cancer (GBC) lesions are usually solitary. The presence of multifocal disease can alter resectability and management. There are no systematic imaging-based studies evaluating multifocality in GBC. Thus, we aimed to evaluate multifocality in GBC based on cross-sectional imaging studies.

Material and methods: This retrospective study screened cross-sectional imaging (contrast-enhanced computed tomography [CT] or magnetic resonance imaging [MRI]) of consecutive patients with histopathological or cytological diagnoses of GBC. The CT/MRI images of patients with multifocal disease (defined as the presence of two or more foci of abnormal wall thickening, intraluminal polypoidal lesions or masses in the gallbladder, cystic duct, or the extrahepatic bile ducts with the intervening area of normal gallbladder/extrahepatic bile ducts) were evaluated by two radiologists independently for various imaging findings.

Results: Of the 324 patients, 17 (5.2%; 13 females; mean age, 54 ±11 years) had multifocal disease with two sites of involvement in all cases. The most common sites of involvement were the gallbladder fundus and neck region (58.8% of cases), followed by the gallbladder fundus and common bile duct (29.4%). Wall thickening type of GBC was the most common morphological subtype (85.3%), followed by mass forming type (14.7%). The majority (70.6%) of cases showed the same morphology at both sites, while 29.4% showed different morphology. Most (70.6%) of the patients with multifocal GBC were unresectable at the time of diagnosis.

Conclusions: Although rare, imaging-based diagnosis of multifocal GBC may allow appropriate management.