Journal of Clinical and Experimental Hepatology最新文献

英文中文

Peripheral Venous Access for Low-Volume Centrifugal Plasma Exchange to Treat Patients With Liver Disorders 小容量离心血浆置换治疗肝脏疾病患者的外周静脉通路

IF 3.2 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Clinical and Experimental Hepatology

Pub Date : 2026-01-07 DOI: 10.1016/j.jceh.2025.103465

Asisha M. Janeela , Gayathiri K. Chellaiya , Rohan Thomas , Alok Bansal , Snehil Kumar , Gnanadeepam Sunderraj , Sumathy Jayaraman , Santhosh E. Kumar , Vijay Alexander , Vinoi G. David , Santosh Varughese , Dolly Daniel , Sukesh C. Nair , Chundamannil E. Eapen , Ashish Goel , Uday G. Zachariah

Background/Aims

Centrifugal plasma exchange (PLEX), by virtue of low blood flow rates, can be performed via peripheral venous access. This study aims to assess the utilization, safety, and efficiency of low-volume centrifugal plasma exchange via peripheral venous access (P-PLEX) in liver disease patients.

Methods

This retrospective cohort study compared patients with liver disease who underwent low-volume centrifugal P-PLEX (2019–2024) with syndrome-matched patients who underwent plasma exchange via central venous access (C-PLEX). Data on PLEX procedure, venous access, and extraction efficiency for molecules of interest were noted.

Results

Of 448 liver disease patients who underwent centrifugal low-volume PLEX, 81 patients (18.1%) who underwent P-PLEX (M: 60; age: 37 [29.5–46.5] years; median, interquartile range) were compared with 81 syndrome-matched patients who underwent C-PLEX (M: 62; age: 37 [29.5–46.5] years; acute-on-chronic liver failure: 44, acute liver injury/acute liver failure: 21, others: 20). Targeted P-PLEX sessions were completed in 67 of 81 (82%). P-PLEX access was mostly 18-G (n = 64/72 for inlet/return) in antecubital fossa. Thirteen of 81 (16%) P-PLEX patients required access change to C-PLEX. Procedure time was longer in P-PLEX group (105 [82.5–120] min) than in the C-PLEX group (75 [60–91.3] min, P value< 0.001) due to lower flow rates in P-PLEX. When controlled for exchange volumes and baseline values, extraction efficiency of bilirubin (P-PLEX: 34.3% [21.2–42.6], C-PLEX: 27.1% [10.3–41.7]; P value: 0.14) and von Willebrand factor antigen (P-PLEX: 36.1% [21.8–46.8], C-PLEX: 45.6% [32.8–58.3]; P value: 0.19) were similar in both groups. PLEX was performed in the ward (in high monitoring area) in majority of patients in the P-PLEX group (73 [90.1%]) and in the high-dependency unit (43 [53.1%]) in the C-PLEX group. Lower line-related complications with P-PLEX (2/81) vis-à-vis C-PLEX (9/81, P-value: 0.03) were noted.

Conclusion

In this report, low-volume centrifugal PLEX to treat liver disease was performed via peripheral venous access in 18% of patients. P-PLEX was done in the ward, with similar efficiency and better line-related safety; however, the PLEX duration was prolonged by 30 min.

离心血浆交换术（PLEX）由于血流量低，可以通过外周静脉通道进行。本研究旨在评估外周静脉低容量离心血浆置换（P-PLEX）在肝病患者中的应用、安全性和有效性。方法本回顾性队列研究比较了接受低容量离心P-PLEX（2019-2024）治疗的肝病患者与通过中心静脉通道（C-PLEX）进行血浆置换的综合征匹配患者。记录了PLEX程序、静脉通路和感兴趣分子提取效率的数据。结果在448例接受离心低容量PLEX的肝病患者中，81例（18.1%）接受P-PLEX （M: 60；年龄：37[29.5-46.5]岁；中位数，四分位数范围）与81例综合征匹配的C-PLEX患者（M: 62；年龄：37[29.5-46.5]岁；急性慢性肝衰竭：44，急性肝损伤/急性肝衰竭：21，其他：20）进行比较。81例患者中有67例（82%）完成了靶向P-PLEX治疗。枕前窝P-PLEX通道主要为18-G（进/回通道n = 64/72）。81例P-PLEX患者中有13例（16%）需要改用C-PLEX。由于P- plex的流速较低，P- plex组的手术时间（105 [82.5-120]min）比C-PLEX组（75 [60-91.3]min， P值<； 0.001）更长。在控制交换量和基线值的情况下，两组胆红素（P- plex: 34.3% [21.2-42.6], C-PLEX: 27.1% [10.3-41.7]， P值为0.14）和血管性血友病因子抗原（P- plex: 36.1% [21.8-46.8], C-PLEX: 45.6% [32.8-58.3]， P值为0.19）的提取效率相似。P-PLEX组大多数患者（73例[90.1%]）在病房（高监护区）进行PLEX， C-PLEX组大多数患者（43例[53.1%]）在高依赖病房进行PLEX。P-PLEX（2/81）与-à-vis C-PLEX （9/81， p值：0.03）的下线相关并发症被注意到。结论在本报告中，18%的患者通过外周静脉通道行小容量离心PLEX治疗肝病。P-PLEX在病房内进行，效率相似，线相关安全性更好；然而，PLEX持续时间延长了30分钟。

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引用次数: 0

When Epstein-Barr Virus Strikes Twice: Concurrent Lymphoproliferative and Smooth Muscle Tumor After Liver Transplantation! 当eb病毒两次袭击：肝移植后并发淋巴增生性和平滑肌肿瘤！

IF 3.2 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Clinical and Experimental Hepatology

Pub Date : 2026-01-03 DOI: 10.1016/j.jceh.2025.103461

Dhiraj Agrawal, Shwetha Kamath, Sunil Gupta, Guru N. Reddy, Vijay Yeldandi, Dharmesh Kapoor

引用次数: 0

Endoscopic Ultrasound-Directed Trans-Gastric ERCP for Management of Choledocholithiasis in a Roux-en-Y Gastric Bypass Anatomy 内镜下超声引导的经胃ERCP在Roux-en-Y胃旁路解剖中治疗胆总管结石

IF 3.2 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Clinical and Experimental Hepatology

Pub Date : 2026-01-03 DOI: 10.1016/j.jceh.2025.103466

Sanish Ancil , Jahnvi Dhar , Rahul Thakur, Pankaj Gupta, Cherring Tandup, Satish S. Nagaraj, Saroj K. Sinha, Jayanta Samanta

引用次数: 0

Collagen Proportionate Area and Histological Grading of Fibrosis as Predictors of Clinical Outcomes and Mortality in Patients with Steatotic Liver Disease 胶原比例面积和纤维化组织学分级作为脂肪变性肝病患者临床结局和死亡率的预测因子

IF 3.2 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Clinical and Experimental Hepatology

Pub Date : 2026-01-02 DOI: 10.1016/j.jceh.2025.103464

Andreas Bartholdy , Pernille Y. Nielsen , Lise L. Gluud , Laust H. Mortensen , Birgitte M. Viuff , Elisabeth D. Galsgaard , Majken K. Jensen

Background/Aims

Steatotic liver disease (SLD) including metabolic dysfunction-associated and alcoholic liver disease, is the most prevalent chronic liver condition globally. Liver biopsy remains the gold standard for fibrosis assessment, but traditional staging is difficult even for highly skilled experts. Collagen proportionate area (CPA), a quantitative digital pathology measure, may offer an alternative, yet its prognostic value in population-based settings is unclear.

Methods

Liver biopsies from a cohort of 166 adults with biopsy-confirmed SLD, diagnosed between 1995 and 2008, were retrieved. The liver biopsies underwent fibrosis staging (stages F0–F4) by a pathologist and digital CPA quantification. Clinical outcomes and mortality were tracked via national registries over a median follow-up of 14.8 years. Associations between fibrosis stage, CPA, and all-cause mortality and liver-related events were assessed using Cox regression and cause-specific hazard models, adjusting for alcohol use and age. Predictive performance was evaluated with area under the receiver operating characteristic curve (AUC), index of prediction accuracy (IPA), and calibration plots, internally validated by bootstrapping.

Results

CPA correlated significantly with fibrosis stage (Spearman's ρ = 0.63), particularly in advanced fibrosis. Higher fibrosis stages and greater CPA were associated with increased all-cause mortality and liver-related events, but the associations for CPA were nonsignificant after adjustment for age and alcohol use. Scaled estimates of HRs from CPA were lower compared to HRs from fibrosis stages. Predictive models for mortality demonstrated comparable and moderate discrimination for CPA and fibrosis stage, improving with age adjustment. IPA values and calibration plots indicated positive predictive accuracy for mortality but poor performance for liver-specific outcomes.

Conclusions

CPA closely correlates with fibrosis stage and has comparable long-term prognostic value in SLD. Interpretation of study results is limited by the small sample size and low number of liver-specific events. Larger studies are needed to validate CPA's clinical utility and explore its integration into routine practice.

背景/目的脂肪变性肝病（SLD）包括代谢功能障碍相关和酒精性肝病，是全球最常见的慢性肝病。肝活检仍然是评估纤维化的金标准，但即使对技术高超的专家来说，传统的分期也很困难。胶原蛋白比例面积（CPA），一种定量数字病理测量，可能提供另一种选择，但其在基于人群的情况下的预后价值尚不清楚。方法收集1995年至2008年间诊断的166例经活检证实的成人SLD的银切片。肝活检由病理学家进行纤维化分期（F0-F4期）和数字CPA量化。临床结果和死亡率通过国家登记处进行追踪，平均随访时间为14.8年。使用Cox回归和病因特异性危险模型，调整酒精使用和年龄，评估纤维化分期、CPA、全因死亡率和肝脏相关事件之间的关联。预测性能通过受试者工作特征曲线下面积（AUC）、预测精度指数（IPA）和校准图进行评估，并通过自举进行内部验证。结果scpa与纤维化分期显著相关（Spearman ρ = 0.63），尤其是晚期纤维化。较高的纤维化分期和较高的CPA与全因死亡率和肝脏相关事件的增加相关，但在调整年龄和酒精使用后，CPA的相关性不显著。与纤维化阶段的hr相比，CPA的hr比例估计较低。死亡率预测模型显示，CPA和纤维化分期具有可比性和中度的区别，随着年龄调整而改善。IPA值和校准图表明，对死亡率的预测准确性较高，但对肝脏特异性结局的预测准确性较差。结论scpa与纤维化分期密切相关，在SLD中具有相当的远期预后价值。研究结果的解释受到样本量小和肝脏特异性事件数量少的限制。需要更大规模的研究来验证注册会计师的临床效用，并探索其与日常实践的结合。

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引用次数: 0

Characterization of Both CD24+ and CD24- T Cells can Better Elucidate the Influence of CD24 on Cytokine Production CD24+和CD24- T细胞的表征可以更好地阐明CD24对细胞因子产生的影响

IF 3.2 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Clinical and Experimental Hepatology

Pub Date : 2026-01-01 DOI: 10.1016/j.jceh.2025.103467

Zhencheng Zhang, Zaixing Yang

引用次数: 0

Post-Liver Transplantation Acute Kidney Injury: New Concepts 肝移植后急性肾损伤：新概念

IF 3.2 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Clinical and Experimental Hepatology

Pub Date : 2026-01-01 DOI: 10.1016/j.jceh.2025.103443

Carmine Gambino, Paolo Angeli

引用次数: 0

From Shunt to Strength: Toward an Indian Model of TIPS Prehabilitation 从分流到加强：印度的TIPS康复模式

IF 3.2 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Clinical and Experimental Hepatology

Pub Date : 2026-01-01 DOI: 10.1016/j.jceh.2025.103444

Vinay Jahagirdar, Ali Khan, Jasmohan S. Bajaj

引用次数: 0

Beyond Genetic Protection: Revisiting Hepatic Resilience in Prader-Willi Syndrome 超越基因保护：重新审视普瑞德-威利综合征的肝脏恢复能力

IF 3.2 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Clinical and Experimental Hepatology

Pub Date : 2026-01-01 DOI: 10.1016/j.jceh.2025.103419

Nathkapach K. Rattanapitoon, Chutharat Thanchonnang, Patpicha Arunsan, Schawanya K. Rattanapitoon

引用次数: 0

Issue Highlights 问题突出

IF 3.2 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Clinical and Experimental Hepatology

Pub Date : 2026-01-01 DOI: 10.1016/j.jceh.2026.103483

引用次数: 0

Endoscopic Transpapillary Gallbladder Stenting for Complicated Cholecystitis in Patients With Cirrhosis and High Surgical Risk: An Observational Study 内镜下经乳头胆囊支架置入术治疗肝硬化和高手术风险患者的复杂胆囊炎：一项观察性研究

IF 3.2 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Clinical and Experimental Hepatology

Pub Date : 2025-12-31 DOI: 10.1016/j.jceh.2025.103462

Arka De, Arpit Shastri, Sweta Rose, Sahaj Rathi, Arwinder Singh, Ganesh Cp, Naveen Bhagat, Babulal Meena, Nipun Verma, Madhumita Premkumar, Sunil Taneja, Ajay Duseja

Background

Patients with cholecystitis and underlying cirrhosis represent a high-risk group for surgical intervention. In patients otherwise meriting an endoscopic retrograde cholangiopancreatography (ERCP), endoscopic transpapillary gallbladder stenting (ETGS) can serve as a bridge to cholecystectomy while awaiting liver transplant or provide long-term gallbladder (GB) drainage in those who are not surgical candidates. We evaluated the technical feasibility, clinical outcomes and safety of ETGS for complicated cholecystitis in patients with cirrhosis and high surgical risk.

Methods

Data of all adult cirrhotic patients with complicated cholecystitis who underwent ETGS between January 2021 and March 2025 were reviewed. Primary indication for ERCP was choledocholithiasis with or without cholangitis. Primary outcome was technical success of ETGS (successful deployment of at least one GB stent). Secondary outcomes included procedure time, safety, clinical success (symptom resolution with improvement in laboratory parameters within 72-h of stent insertion), symptom recurrence, 6-month and 12-month biliary event-free survival, and differences in outcomes among patients with one or two GB stents.

Results

Among 40 patients (age: 56.9 ± 14.3 years, 62.5% females, model for end-stage liver disease score: 16.4) with cirrhosis taken up for ETGS, technical success was achieved in 34 (85%) patients. Among those with technical success, clinical success was achieved in 33 (97%) patients. One and two 7-Fr double-pigtail plastic stents were deployed in 13 (38.2%) and 21 (61.8%) patients, respectively. Elective stent exchanges were not done. The median follow-up duration was 13.5 (11–18) months. One (2.9%) patient had recurrent cholecystitis at 5 months. The 6- and 12-month biliary event-free survival rates were 94% and 86.7%, respectively. No significant difference in clinical success, symptom recurrence, or 6- and 12-month survival was observed among patients with one or two stents. Mild (grade I as per the Adverse events GastRointEstinal Endoscopy classification) procedure-related adverse events occurred in two (5%) patients.

Conclusion

ETGS is a technically feasible and safe, therapeutic option for complicated cholecystitis in cirrhotic patients with high clinical success and favourable intermediate-term outcomes.

胆囊炎合并肝硬化患者是手术干预的高危人群。对于需要内窥镜逆行胆管造影（ERCP）的患者，内窥镜经胰管支架植入术（ETGS）可以作为等待肝移植的胆囊切除术的桥梁，或者为那些不需要手术的患者提供长期的胆囊引流。我们评估了ETGS治疗合并肝硬化和高手术风险的复杂胆囊炎患者的技术可行性、临床结果和安全性。方法回顾了2021年1月至2025年3月期间接受ETGS治疗的所有成年肝硬化合并合并胆囊炎患者的数据。ERCP的主要适应症是胆总管结石伴或不伴胆管炎。主要结果是ETGS的技术成功（至少一个GB支架的成功部署）。次要结局包括手术时间、安全性、临床成功（植入支架后72小时内症状缓解，实验室参数改善）、症状复发、6个月和12个月无胆道事件生存，以及植入一个或两个GB支架患者的结局差异。结果40例肝硬化患者（年龄：56.9±14.3岁，62.5%为女性，终末期肝病模型评分：16.4）中，34例（85%）患者获得技术成功。在技术成功的患者中，33例（97%）患者获得临床成功。13例（38.2%）和21例（61.8%）患者分别使用1个和2个7-Fr双尾塑料支架。未进行选择性支架置换。中位随访时间为13.5（11-18）个月。1例（2.9%）患者在5个月时复发胆囊炎。6个月和12个月无胆道事件生存率分别为94%和86.7%。两组患者的临床成功率、症状复发率、6个月和12个月生存率均无显著差异。2例（5%）患者发生了与手术相关的轻度（根据不良事件胃肠道内窥镜分类为I级）不良事件。结论etgs是一种技术上可行且安全的治疗肝硬化并发胆囊炎的选择，具有较高的临床成功率和良好的中期预后。

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