Digestive and Liver Disease最新文献

英文中文

The association analysis between exposure to volatile organic compounds and fatty liver disease in US Adults 美国成年人接触挥发性有机化合物与脂肪肝之间的关联分析。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.09.027

Xiaoxia Duan , Zhenhua Chen , Juan Liao , Mingsheng Wen , Yong Yue , Li Liu , Xiaojing Li , Lu Long

Background

Limited epidemiological research has explored the associations between ambient volatile organic compounds (VOCs) and fatty liver disease (FLD). This study aimed to explore the associations between VOCs and FLD and liver function biomarkers. We obtained urinary concentrations of VOCs metabolites from NHANES.

Methods

Weighted logistic regression models were employed to investigate the relationships between VOCs and FLD risk, including alcoholic FLD (AFLD) and non-alcoholic FLD (NAFLD). The associations of VOCs and liver function biomarkers were also investigated using weighted linear regression.

Results

Among the 2050 participants, 774 were classified as having FLD. After adjustment, each log-transformed SD increase in N-Acetyl-S-(2-carboxyethyl)-_l-cysteine (CEMA), 2-Aminothiazoline-4-carboxylicacid (ATCA), and trans-trans-muconic-acid (MUCA) had a OR (95%CI) of 1.30 (1.06–1.61; P-trend=0.014), 1.34 (1.12–1.61; P-trend=0.002), and 1.22 (1.01–1.47; P-trend=0.035), respectively. ATCA and MUCA were associated with higher risks of NAFLD (OR=1.47, 95%CI: 1.20–1.79, and OR=1.26, 95%CI: 1.02–1.56, respectively). VOCs were positively associated with gamma glutamyl transaminase (GGT) and C-reactive protein (CRP), while inversely associated with albumin, total protein and alanine aminotransferase (ALT) (P < 0.05).

Conclusions

Urinary metabolites of VOCs have been found to be strongly correlated with a higher risk of FLD and NFALD, and impaired liver function. These novel findings merit further prospective studies to comprehend the effect of VOCs on liver diseases.

背景：有关环境中挥发性有机化合物（VOCs）与脂肪肝（FLD）之间关系的流行病学研究十分有限。本研究旨在探讨挥发性有机化合物与脂肪肝和肝功能生物标志物之间的关系。我们从 NHANES 中获得了 VOCs 代谢物的尿液浓度：方法：采用加权逻辑回归模型研究 VOCs 与 FLD（包括酒精性 FLD（AFLD）和非酒精性 FLD（NAFLD））风险之间的关系。此外，还采用加权线性回归法研究了挥发性有机化合物与肝功能生物标志物之间的关系：在 2050 名参与者中，有 774 人被归类为 FLD。经调整后，N-乙酰基-S-（2-羧乙基）-l-半胱氨酸（CEMA）、2-氨基噻唑啉-4-羧酸（ATCA）和反式-粘多糖酸（MUCA）的对数变换标度每增加 1，其 OR（95%CI）为 1.30（1.06-1.61；P-趋势=0.014）、1.34（1.12-1.61；P-趋势=0.002）和1.22（1.01-1.47；P-趋势=0.035）。ATCA和MUCA与较高的非酒精性脂肪肝风险相关（OR=1.47，95%CI：1.20-1.79；OR=1.26，95%CI：1.02-1.56）。VOC与γ谷氨酰转氨酶（GGT）和C反应蛋白（CRP）呈正相关，而与白蛋白、总蛋白和丙氨酸氨基转移酶（ALT）呈反相关（P < 0.05）：结论：研究发现，尿液中的挥发性有机化合物代谢物与罹患 FLD 和 NFALD 的风险较高以及肝功能受损密切相关。这些新发现值得进一步开展前瞻性研究，以了解挥发性有机化合物对肝病的影响。

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引用次数: 0

Predictive value of renal shear wave elastography in liver cirrhosis 肾剪切波弹性成像对肝硬化的预测价值

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.10.018

Christian Hagel , Michael Hirth , Jan Bißbort , Andreas Teufel , Svetlana Hetjens , Matthias P. Ebert , Christoph Antoni

Background

In liver cirrhosis, prognosis is profoundly affected by renal function. This study evaluates the usefulness of renal stiffness measurement by point-shear wave elastography and renal perfusion by duplex.

Methods

In this case-control study, organ stiffness was quantified using point-shear wave elastography and duplex sonography to calculate the arterial resistive (RI) and pulsatility indices (PI) in 123 patients, including patients with liver cirrhosis with (LC+A) and without ascites (LC-A) and patients without liver cirrhosis (NLC).

Results

PI and RI were significantly increased in LC-A and LC+A compared to NLC (p<0.001) and correlated with MELD and Child Pugh scores. Point-shear wave elastography showed significantly lower renal stiffness in LC+A compared to LC-A (p<0.01) and NLC (p<0.001). Renal stiffness correlated inversely with MELD and Child Pugh scores.

Reduced renal stiffness, but not PI or RI, was associated with the presence of hepatorenal syndrome (p<0.001). Reduced renal stiffness was associated with an increased risk of death due to complications of liver cirrhosis within 3 years (p<0.01).

Conclusion

Point-shear wave elastography and duplex sonography correlate with progression of liver cirrhosis, but only shear wave elastography represents a valuable prognostic tool for hepatorenal syndrome and mortality in patients with liver cirrhosis.

背景：肝硬化患者的预后受到肾功能的严重影响。本研究评估了通过点剪切波弹性成像测量肾脏僵硬度和通过双工超声测量肾脏灌注的实用性：在这项病例对照研究中，使用点剪切波弹性成像技术和双工超声技术对 123 名患者的器官僵硬度进行量化，以计算动脉阻力指数（RI）和搏动指数（PI），这些患者包括伴有腹水（LC+A）和无腹水（LC-A）的肝硬化患者以及无肝硬化（NLC）患者：结果：与 NLC 相比，LC-A 和 LC+A 患者的 PI 和 RI 均明显增加（p）：点剪切波弹性成像和双工超声波成像与肝硬化的进展相关，但只有剪切波弹性成像是肝硬化患者肝肾综合征和死亡率的重要预后工具。

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引用次数: 0

Types, behaviour and therapeutic requirements of inflammatory pouch disorders: Results from the RESERVO study of GETECCU 炎性肠袋疾病的类型、行为和治疗要求：GETECCU的RESERVO研究结果。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.09.023

F. Mesonero , Y. Zabana , A. Fernández-Clotet , A. Solá , B. Caballol , E. Leo-Carnerero , M.J. García , F. Bertoletti , G. Bastida , G. Suris , B. Casis , R. Ferreiro-Iglesias , M. Calafat , I. Jiménez , J. Miranda-Bautista , L.J. Lamuela , I. Fajardo , L. Torrealba , R. Nájera , R.M. Sáiz-Chumillas , M. Barreiro-de Acosta

Background and Aims

Inflammatory pouch disorders exhibit a heterogeneous clinical spectrum and therapeutic requirements have not been properly studied.

Methods

This retrospective, multicentre study included ulcerative colitis patients with ileal pouch construction and were later diagnosed with an inflammatory pouch disorder between 1995 and 2020. Classifications, behaviour and therapies applied were recorded and compared in the long-term.

Results

Overall, 338 patients were recruited. The most common disorders were pouchitis (n = 258, 76%), Crohn's disease of the pouch (n = 55, 16%) and cuffitis (n = 25, 7%). Pouchitis presented mainly as chronic (65.2%) and recurrent (87%) forms. Crohn's disease manifested as stricturing/penetrating in 53% of cases and perianal disease in 42%. Patients received multiple therapies: 86% antibiotics, 42% steroids, 27% immunosuppressants, 43% biologics and 27% surgery. Compared with pouchitis, Crohn's disease of the pouch was characterised by a later diagnosis (99 vs. 55 months, p < 0.001) and greater needs for immunosuppressants (OR 3.53, 1.79–6.94, p < 0.0001), biologics (OR 5.45, 2.78–10.6, p < 0.0001) and surgeries (OR 2.65, 1.43–4.89, p < 0.001).

Conclusions

Chronic pouchitis is the most common pouch disorder presentation. These entities have diverse therapeutics requirements, particularly for Crohn's disease of the pouch.

背景和目的：炎症性肠袋疾病的临床表现多种多样，治疗要求尚未得到适当研究：这项回顾性多中心研究纳入了 1995 年至 2020 年期间修建回肠袋并随后被诊断为炎症性肠袋疾病的溃疡性结肠炎患者。研究记录了患者的分类、行为和采用的疗法，并进行了长期比较：结果：共招募了 338 名患者。最常见的疾病是胃袋炎（258 人，占 76%）、胃袋克罗恩病（55 人，占 16%）和袖套炎（25 人，占 7%）。胃袋炎主要表现为慢性（65.2%）和复发性（87%）。53%的克罗恩病表现为狭窄/穿透性，42%表现为肛周疾病。患者接受多种治疗：86%的患者使用抗生素，42%使用类固醇，27%使用免疫抑制剂，43%使用生物制剂，27%使用手术。与储袋炎相比，储袋克罗恩病的特点是诊断较晚（99 个月对 55 个月，p < 0.001），需要更多的免疫抑制剂（OR 3.53，1.79-6.94，p < 0.0001）、生物制剂（OR 5.45，2.78-10.6，p < 0.0001）和手术（OR 2.65，1.43-4.89，p < 0.001）：结论：慢性胃袋炎是最常见的胃袋疾病。结论：慢性肛门袋炎是最常见的肛门袋疾病，这些疾病对治疗有不同的要求，尤其是肛门袋克罗恩病。

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引用次数: 0

Are early-life exposures associated with inflammatory bowel disease? A critique of a recent nested case-control study 早期暴露与炎症性肠病有关吗？对最近一项嵌套病例对照研究的评论。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.11.013

Samuel Rochette

引用次数: 0

Clinical features and long-term outcomes of patients with ZFYVE19 variants.

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2025.01.183

Jia-Qi Li, Yue-Yong Zhu, Mei-Yan Xue, Hao Chi, Xin-Bao Xie, Yi Lu, Jian-She Wang

Background: ZFYVE19-associated progressive familial intrahepatic cholestasis is a rare ciliopathy, with limited information on its natural history.

Aims: Investigate long-term outcomes, especially after liver transplantation (LT), in ZFYVE19-deficient patients.

Methods: Medical data of 13 Chinese individuals genetically diagnosed with ZFYVE19 deficiency, including 4 unreported patients, were reviewed.

Results: All patients harbored biallelic null variants in ZFYVE19 and were alive at a median age of 13.2 years (range 1.1-39) with a median follow-up of 6.4 years (range 1-19.7). The first manifestation was neonatal cholestasis in 4 patients, isolated abnormal hepatobiliary-injury biomarkers in 3, and portal hypertension in 6. Eleven patients were administered ursodeoxycholic acid, with temporary normalization of hepatobiliary-injury biomarkers in 7. Six patients underwent LT (4 with living-related donors) at a median age of 3.5 years (range 0.6-7). After a median follow-up of 5.3 years (range 0.5-19) after LT, all 6 patients survived and were asymptomatic. Chronic renal disease or malignancy has not supervened.

Conclusion: ZFYVE19 deficiency caused by biallelic null variants primarily affects the liver without clinically significant involvement of other organs. ZFYVE19-related neonatal cholestasis can progress to liver failure necessitating LT in infancy. Ursodeoxycholic acid may improve hepatobiliary indices but may not avoid cirrhosis / LT. LT outcomes are generally good, even with parental grafts.

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引用次数: 0

Aetiology-specific inflammation patterns in patients and rat models of compensated cirrhosis 代偿期肝硬化患者和大鼠模型的病因特异性炎症模式。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.09.006

Benedikt Silvester Hofer , Benedikt Simbrunner , Philipp Königshofer , Ksenia Brusilovskaya , Oleksandr Petrenko , Vlad Taru , Thomas Sorz , Kerstin Zinober , Georg Semmler , Stefan G. Kauschke , Larissa Pfisterer , Michael Trauner , Mattias Mandorfer , Philipp Schwabl , Thomas Reiberger

Background

Cirrhosis is associated with a proinflammatory environment.

Aims

To analyse aetiology-specific inflammation patterns in compensated cirrhosis in animal models and patients.

Methods

Portal pressure (PP), fibrosis (collagen proportionate area [CPA]) and hepatic inflammation were measured in cirrhotic rat models (thioacetamide [TAA;n = 12]; choline-deficient high-fat diet [CDHFD;n = 12]; bile duct ligation [BDL;n = 16]). Compensated cirrhotic patients (alcohol-related liver disease [ALD;n = 67]; metabolic dysfunction-associated steatohepatitis [MASH;n = 50]; cholestatic liver disease [primary biliary cholangitis [PBC]/primary sclerosing cholangitis [PSC];n = 22]) undergoing hepatic venous pressure gradient (HVPG) measurement were included.

Results

In rats, hepatic proinflammatory gene expression was highest in CDHFD and lowest in TAA, despite comparable PP levels. Across all animal models, Tnfa/Il6 correlated positively with CPA, and Mcp1 with elevated PP. Mcp1 was also associated with increased CPA in TAA/CDHFD. Mcp1/Cxcl1 showed a model-independent positive correlation to transaminases. Il1b correlated positively with CPA/PP in BDL and with transaminases in CDHFD. In patients, CRP/IL-6 were lower in MASH compared to ALD or PBC/PSC, regardless of hepatic function. IgA/IgG were highest and complement factors lowest in ALD. More pronounced systemic inflammation was linked to higher HVPG primarily in ALD/MASH.

Conclusion

Proinflammatory pathways are upregulated across all liver disease aetiologies, yet their association with fibrosis and portal hypertension can vary.

背景：肝硬化与促炎症环境有关：目的：分析代偿期肝硬化动物模型和患者的病因特异性炎症模式：在肝硬化大鼠模型（硫代乙酰胺[TAA;n = 12]；胆碱缺乏性高脂饮食[CDHFD;n = 12]；胆管结扎[BDL;n = 16]）中测量门静脉压力（PP）、纤维化（胶原比例面积[CPA]）和肝脏炎症。还包括接受肝静脉压力梯度（HVPG）测量的肝硬化患者（酒精相关肝病[ALD;n = 67]；代谢功能障碍相关性脂肪性肝炎[MASH;n = 50]；胆汁淤积性肝病[原发性胆汁性胆管炎[PBC]/原发性硬化性胆管炎[PSC];n = 22]）：结果：在大鼠中，CDHFD 的肝脏促炎基因表达量最高，而 TAA 的表达量最低，尽管 PP 水平相当。在所有动物模型中，Tnfa/Il6 与 CPA 呈正相关，Mcp1 与 PP 升高呈正相关。在 TAA/CDHFD 中，Mcp1 也与 CPA 的增加有关。Mcp1/Cxcl1 与转氨酶呈模型无关的正相关。Il1b与BDL的CPA/PP呈正相关，与CDHFD的转氨酶呈正相关。在患者中，与 ALD 或 PBC/PSC 相比，MASH 患者的 CRP/IL-6 更低，与肝功能无关。ALD患者的IgA/IgG最高，补体因子最低。更明显的全身炎症主要与 ALD/MASH 中更高的 HVPG 有关：结论：在所有肝病病因中，促炎症通路都会上调，但它们与肝纤维化和门静脉高压的关系却各不相同。

{"title":"Aetiology-specific inflammation patterns in patients and rat models of compensated cirrhosis","authors":"Benedikt Silvester Hofer , Benedikt Simbrunner , Philipp Königshofer , Ksenia Brusilovskaya , Oleksandr Petrenko , Vlad Taru , Thomas Sorz , Kerstin Zinober , Georg Semmler , Stefan G. Kauschke , Larissa Pfisterer , Michael Trauner , Mattias Mandorfer , Philipp Schwabl , Thomas Reiberger","doi":"10.1016/j.dld.2024.09.006","DOIUrl":"10.1016/j.dld.2024.09.006","url":null,"abstract":"<div><h3>Background</h3><div>Cirrhosis is associated with a proinflammatory environment.</div></div><div><h3>Aims</h3><div>To analyse aetiology-specific inflammation patterns in compensated cirrhosis in animal models and patients.</div></div><div><h3>Methods</h3><div>Portal pressure (PP), fibrosis (collagen proportionate area [CPA]) and hepatic inflammation were measured in cirrhotic rat models (thioacetamide [TAA;<em>n</em> = 12]; choline-deficient high-fat diet [CDHFD;<em>n</em> = 12]; bile duct ligation [BDL;<em>n</em> = 16]). Compensated cirrhotic patients (alcohol-related liver disease [ALD;<em>n</em> = 67]; metabolic dysfunction-associated steatohepatitis [MASH;<em>n</em> = 50]; cholestatic liver disease [primary biliary cholangitis [PBC]/primary sclerosing cholangitis [PSC];<em>n</em> = 22]) undergoing hepatic venous pressure gradient (HVPG) measurement were included.</div></div><div><h3>Results</h3><div>In rats, hepatic proinflammatory gene expression was highest in CDHFD and lowest in TAA, despite comparable PP levels. Across all animal models, Tnfa/Il6 correlated positively with CPA, and Mcp1 with elevated PP. Mcp1 was also associated with increased CPA in TAA/CDHFD. Mcp1/Cxcl1 showed a model-independent positive correlation to transaminases. Il1b correlated positively with CPA/PP in BDL and with transaminases in CDHFD. In patients, CRP/IL-6 were lower in MASH compared to ALD or PBC/PSC, regardless of hepatic function. IgA/IgG were highest and complement factors lowest in ALD. More pronounced systemic inflammation was linked to higher HVPG primarily in ALD/MASH.</div></div><div><h3>Conclusion</h3><div>Proinflammatory pathways are upregulated across all liver disease aetiologies, yet their association with fibrosis and portal hypertension can vary.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 450-458"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Measured glomerular filtration rate predicts liver related deaths better than estimated glomerular filtration rate in advanced chronic liver disease 在晚期慢性肝病患者中，测量肾小球滤过率比估计肾小球滤过率更能预测与肝脏相关的死亡。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.09.016

Carlos González-Alayón , M. Hernández-Guerra , Sergio Luis-Lima , Coriolano Cruz Perera Lima , Andrea Santana-Delgado , Carlos Díaz-Mesa , Andrea Morant-Domínguez , Laura Díaz Martín , Federico González-Rinne , Alberto Hernández-Bustabad , Miguel Moreno , Flavio Gaspari , Esteban Porrini

Background & aims

Renal dysfunction is prevalent in advanced chronic liver disease (aCLD) and is associated to liver-related death (LRD). This makes a reliable evaluation of renal function (RF) a crucial aspect. RF can be estimated by formulas or measured by gold standard method. Estimated RF is not reliable in aCLD. However, there is a lack of information on the reliability of formulas in the prediction of LRD.

Methods

We analysed a cohort of patients with aCLD in whom RF was measured by the plasma clearance of iohexol (mGFR) and estimated (eGFR) by formulas: MDRD, CKD-EPI, Royal Free Hospital (RFHC), GRAIL and Mindikoglu-eGFR. LRD was defined as death from hepatic causes. Multivariable analysis was used to evaluate association of mGFR or eGFR with LRD.

Results

161 patients were evaluated, with median follow-up of 28 months, 58 died from LRD. In overall group mGFR (OR 0.99; p = 0.022) and formulas: CKD-EPI (OR 0.98; p = 0.044), GRAIL (OR 0.98; p = 0.038) was associated with LRD. In patients with normal creatinine levels (≤ 1.1 mg/dL), mGFR (OR 0.99; p = 0.031) was whereas any formula was not associated with LRD.

Conclusions

eGFR appears as an unreliable method for predicting LRDs in aCLD, especially in those with lower creatinine levels. By contrast, mGFR seems to be a superior predictor.

背景与目的：肾功能障碍在晚期慢性肝病（aCLD）中十分普遍，并与肝相关性死亡（LRD）有关。因此，对肾功能（RF）进行可靠评估至关重要。肾功能可以用公式估算，也可以用金标准方法测量。在 aCLD 中，估计的 RF 值并不可靠。然而，目前还缺乏有关预测 LRD 的公式可靠性的信息：我们对一组 aCLD 患者进行了分析，这些患者的 RF 是通过血浆碘己醇清除率（mGFR）测量的，也是通过公式估算的（eGFR）：MDRD、CKD-EPI、皇家自由医院（RFHC）、GRAIL 和 Mindikoglu-eGFR。LRD定义为肝源性死亡。采用多变量分析评估 mGFR 或 eGFR 与 LRD 的关系：结果：共评估了 161 名患者，中位随访时间为 28 个月，其中 58 人死于 LRD。在所有组别中，mGFR（OR 0.99；p = 0.022）和公式：CKD-EPI（OR 0.99；p = 0.022）与 LRD 的关系最为密切：CKD-EPI（OR 0.98；p = 0.044）、GRAIL（OR 0.98；p = 0.038）与 LRD 相关。在肌酐水平正常（≤ 1.1 mg/dL）的患者中，mGFR（OR 0.99；p = 0.031）与 LRD 无关，而任何公式都与 LRD 无关。结论：eGFR 似乎是预测 aCLD 患者 LRD 的不可靠方法，尤其是在肌酐水平较低的患者中。相比之下，mGFR 似乎是一种更好的预测方法。

{"title":"Measured glomerular filtration rate predicts liver related deaths better than estimated glomerular filtration rate in advanced chronic liver disease","authors":"Carlos González-Alayón , M. Hernández-Guerra , Sergio Luis-Lima , Coriolano Cruz Perera Lima , Andrea Santana-Delgado , Carlos Díaz-Mesa , Andrea Morant-Domínguez , Laura Díaz Martín , Federico González-Rinne , Alberto Hernández-Bustabad , Miguel Moreno , Flavio Gaspari , Esteban Porrini","doi":"10.1016/j.dld.2024.09.016","DOIUrl":"10.1016/j.dld.2024.09.016","url":null,"abstract":"<div><h3>Background & aims</h3><div>Renal dysfunction is prevalent in advanced chronic liver disease (aCLD) and is associated to liver-related death (LRD). This makes a reliable evaluation of renal function (RF) a crucial aspect. RF can be estimated by formulas or measured by gold standard method. Estimated RF is not reliable in aCLD. However, there is a lack of information on the reliability of formulas in the prediction of LRD.</div></div><div><h3>Methods</h3><div>We analysed a cohort of patients with aCLD in whom RF was measured by the plasma clearance of iohexol (mGFR) and estimated (eGFR) by formulas: MDRD, CKD-EPI, Royal Free Hospital (RFHC), GRAIL and Mindikoglu-eGFR. LRD was defined as death from hepatic causes. Multivariable analysis was used to evaluate association of mGFR or eGFR with LRD.</div></div><div><h3>Results</h3><div>161 patients were evaluated, with median follow-up of 28 months, 58 died from LRD. In overall group mGFR (OR 0.99; p = 0.022) and formulas: CKD-EPI (OR 0.98; p = 0.044), GRAIL (OR 0.98; p = 0.038) was associated with LRD. In patients with normal creatinine levels (≤ 1.1 mg/dL), mGFR (OR 0.99; p = 0.031) was whereas any formula was not associated with LRD.</div></div><div><h3>Conclusions</h3><div>eGFR appears as an unreliable method for predicting LRDs in aCLD, especially in those with lower creatinine levels. By contrast, mGFR seems to be a superior predictor.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 477-484"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Why and when could nucleos(t)ide analogues treatment be withdrawn? 为什么以及何时可以停止核苷类似物治疗？

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.10.012

Jimmy Che-To Lai , Piero Colombatto , Grace Lai-Hung Wong , Maurizia Rossana Brunetto

Oral antiviral therapy to hepatitis B virus (HBV) with nucleos(t)ide analogues (NUCs) is effective in suppressing the viral load leading to improved clinical outcomes. However, functional cure of HBV, indicated by hepatitis B surface antigen (HBsAg) clearance from the serum, is rare. Although safety and adherence may represent minor issues in long-term treatment with the available NUCs, more efficacious treatments with finite treatment duration for patients with chronic hepatitis B (CHB) are currently undergoing active clinical investigation. Available data suggest that HBsAg loss can be achieved in 10% to 20% of patients after NUC discontinuation, at the cost of about 50% to 80% virological relapse and 40% to 55% retreatment with NUC. With this, NUC treatment in patients with cirrhosis should not be stopped to avoid detrimental risk of hepatic decompensation and death. Viral and immune biomarkers, which may be potentially useful in stratifying the patients at risk of relapse after stopping NUC therapy, are under investigation. In the era of personalized medicine aided by artificial intelligence tools, tight monitoring of viral kinetics and algorithmic modeling appear a promising strategy to assist in individualized decision and conclude the optimal timing of the NUC treatment discontinuation.

使用核苷酸类似物（NUCs）口服抗病毒治疗乙型肝炎病毒（HBV）可有效抑制病毒载量，从而改善临床疗效。然而，以血清中乙型肝炎表面抗原（HBsAg）清除为标志的 HBV 功能性治愈却非常罕见。尽管安全性和依从性可能是现有 NUCs 长期治疗中的次要问题，但针对慢性乙型肝炎（CHB）患者的更有效、疗程更短的治疗方法目前正在积极的临床研究中。现有数据表明，停用 NUC 后，10%-20% 的患者可以实现 HBsAg 消失，但代价是约 50%-80% 的病毒学复发和 40%-55% 的 NUC 再治疗。因此，肝硬化患者不应停止 NUC 治疗，以避免肝功能失代偿和死亡的不利风险。病毒和免疫生物标志物可能有助于对停止 NUC 治疗后有复发风险的患者进行分层，目前正在对这些生物标志物进行研究。在人工智能工具辅助下的个性化医疗时代，对病毒动力学的严密监测和算法建模似乎是一种很有前途的策略，可帮助做出个性化决定，并总结出停止 NUC 治疗的最佳时机。

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引用次数: 0

Cutaneous metastases of colon adenocarcinoma 结肠腺癌的皮肤转移。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.10.017

Nishali Shah , Mahmoud A. Ali , Anish Vinit Patel

引用次数: 0

Key challenges and care approaches in inflammatory pouch disorders: What can we do better? 炎性眼袋疾病的主要挑战和护理方法：我们能做得更好吗？

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.11.014

Olga Maria Nardone , Gianluca Matteo Sampietro

引用次数: 0

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