World Journal of Hepatology最新文献

Acute decompensation in cirrhotic patients signifies the onset of clinically evident events due to portal hypertension. The transition from compensated to decompensated cirrhosis involves hemodynamic changes leading to multiorgan dysfunction, managed predominantly in outpatient settings with regular monitoring. The mortality risk is elevated in decompensated patients. Therefore, diligent outpatient management should focus on regular medical follow-ups, medication adjustments, patient education, addressing emergent issues and evaluation for liver transplantation. The ultimate goal is to improve quality of life, prevent disease progression, reduce complications, and assess possible recompensation. This guide provides valuable recommendations for medical experts managing decompensated cirrhotic patients post-hospitalization.

Background: Autoimmune phenomena can be used in some patients with nonalcoholic fatty liver disease (NAFLD) in the clinic, but these patients are not autoimmune hepatitis patients.

Aim: To determine whether autoimmunity is present in patients with NAFLD, this study was performed.

Methods: A total of 104 patients with NAFLD diagnosed by liver biopsy at Tianjin Second People's Hospital between 2019 and 2023 were enrolled. The patients were divided into three groups according to their biopsy results: The NAFL (n = 36), nonalcoholic steatohepatitis (n = 51), and liver cirrhosis groups (n = 17).

Results: The differences in IgA, an immune marker, among the three groups of patients were statistically significant (P = 0.025). In all NAFLD patients, antinuclear antibody and anti-smooth muscle antibody were the most common autoantibodies. The antinuclear antibody detection rate was the highest at 48.1%. The cirrhosis group had the highest autoantibody positivity rate (64.7%). Portal enlargement is also common in NAFLD patients. The rates of positivity for portal lymphoplasmacytic infiltration, small bile duct hyperplasia and interfacial hepatitis were highest in the cirrhosis group; the differences between the cirrhosis group and the other two groups were significant (P < 0.05). Hepatocellular rosettes were identified only in the cirrhosis group (11.8%).

Conclusion: Autoimmune phenomena occur in NAFLD patients, especially in patients with NAFLD-related cirrhosis, in whom this phenomenon may be more pronounced.

Background: Liver transplantation (LT) has demonstrated favorable efficacy in managing end-stage alveolar echinococcosis. Nevertheless, the current research focal points and advancement trends remain ambiguous.

Aim: To map the research landscape to underscore critical areas of focus, influential studies, and future directions of LT for echinococcosis treatment.

Methods: Publications on LT for echinococcosis treatment published between 1900 and 2023 were searched in the Web of Science database and analyzed using bibliometrics.

Results: A total of 14 countries/regions, 75 institutions, and 499 authors have published research articles, with China, Turkey, and France being the three most productive countries. The four institutions with the most contributions were Sichuan University, Xinjiang Medical University, the University de Franche Comte, and Inonu University. The three authors who contributed the most were Wen Hao, Wang Wentao, and Bresson Hadni Solange. The four most common keywords were alveolar echinococcosis, LT, ex-vivo liver resection and autotransplantation, and echinococcosis multilocularies.

Conclusion: Our study found that the treatment of complications after LT for echinococcosis treatment and the preoperative surgical plan based on the anatomical relationship between the lesion and the blood vessel are early research hotspots. Recent research focuses on the treatment of complications after ex-vivo liver resection and autotransplantation, especially vascular complications.

The intersection between metabolic-associated steatotic liver disease (MASLD) and chronic hepatitis B virus (HBV) infection is an emerging area of research with significant implications for public health and clinical practice. Wang et al's study highlights the complexities of managing patients with concurrent MASLD and HBV. The findings revealed that patients with concurrent MASLD-HBV exhibited more severe liver inflammation and fibrosis, whereas those with HBV alone presented a better lipid profile. The growing recognition of metabolic dysfunction in liver disease, reflected in the shift from nonalcoholic liver disease to MASLD, demands updates to clinical guidelines, particularly for patients with dual etiologies. Understanding the biological interactions between MASLD and HBV could lead to novel therapeutic approaches, emphasizing the need for personalized treatment strategies. The coexistence of MASLD and HBV presents therapeutic challenges, particularly in managing advanced fibrosis and cirrhosis, which are more likely in these patients. The aim of this editorial is to analyze the interaction between MASLD and HBV, highlight the pathophysiological mechanisms that exacerbate liver disease when both conditions coexist, and discuss the clinical implications of the findings of Wang et al.

Background: Hepatic abscesses represent infections of the liver parenchyma from bacteria, fungi, and parasitic organisms. Trends in both abscess microbiology and management of abscesses (infective collections) have changed over the past decade. There is a paucity of published data regarding the clinicopathological features of liver abscesses in sub-Saharan Africa and other low-income and middle-income countries.

Aim: To evaluate the clinical presentations of liver abscesses and hydatid liver disease at two South African tertiary-level hospitals.

Methods: Information accessed from electronic discharge summaries of patients from two South African referral hospitals in Johannesburg, South Africa from January 2016 to December 2020 were reviewed and analyzed. All patients older than 13 years presenting with infective liver collections (pyogenic, amoebic) and hydatid disease were included. Clinical findings and laboratory, microbiology, and radiology results and outcomes were collated and analyzed.

Results: In total, 222 patients were included. There were 123 males (55.41%) and 99 females (44.59%), with a median age of 48 years. Comorbidities included HIV (24.23%), hypertension (20.57%), and diabetes mellitus (16.83%). The majority (74.77%) of abscesses were pyogenic, while amoebic and hydatid abscesses represented 16.22% and 9.01%, respectively. The predominant etiology of the pyogenic liver abscesses (PLA) was biliary-related disease. WBC and C-reactive protein were significantly higher in the pyogenic group (P < 0.0002 and P < 0.007, respectively) when compared to the amoebic and hydatid groups. In patients with PLAs, organisms were cultured on blood in 17.58% and abscess fluid in 56.60%. Klebsiella, Escherichia coli and Streptococci were the most cultured organisms. Sixteen percent of the cultures were polymicrobial. In the overall group, 76.00% (n = 169) of patients requiring drainage had a percutaneous transhepatic catheter drain placed, while 8.76% (n = 19) had open surgery. The median length of hospital stay was 13 days. The mortality rate was 3.02%.

Conclusion: In this study, the most common type of liver abscess was PLAs of biliary origin in middle-aged males. The microbiology was similar to those described in Asian populations, and non-surgical management via percutaneous drainage was sufficient in the majority of cases with acceptable morbidity and mortality.

Background: Neurocognitive impairment, including minimal hepatic encephalopathy (MHE) and overt hepatic encephalopathy, is one of the most common complications of all types of primary liver diseases, such as hepatitis B, biliary cholangitis, and autoimmune hepatitis. The EncephalApp Stroop test is a smartphone application-based test that is time-saving for MHE screening. However, neurocognitive impairment is different between alcoholic cirrhosis patients and nonalcoholic cirrhosis patients, so the cutoff value for MHE diagnosis might be inflated.

Aim: To validate the Stroop test in nonalcoholic cirrhosis patients.

Methods: This external validation was performed at the National Center for Infectious Diseases (Beijing). Liver cirrhosis patients aged between 18 and 65 years who voluntarily enrolled in the study and provided signed informed consent were included. The Psychometric Hepatic Encephalopathy Score (PHES) test was used as the standard diagnostic criterion for MHE. The EncephalApp Stroop test was then performed on the iPad, including two sessions of tests ("off" and "on") to measure patients' ability to differentiate between numbers and letters. We assessed the performance of the EncephalApp Stroop test in terms of the area under the curve (AUC), sensitivity, specificity, positive predictive value, and negative predictive value, with the PHES as the standard criterion.

Results: A total of 160 nonalcoholic cirrhosis patients were included in this validation study, including 87 (54.4%) patients without MHE and 73 (45.6%) patients with MHE. Taking the PHES as the gold standard, the EncephalApp Stroop test performed well for nonalcoholic liver cirrhosis patients in terms of "off" time [AUC: 0.85, 95% confidence interval (CI): 0.79-0.91] and "on + off" time (AUC: 0.85, 95%CI: 0.80-0.91); however, total runs of "off" session (AUC: 0.61, 95%CI: 0.52-0.69), total runs of "on" session (AUC: 0.57, 95%CI: 0.48-0.65), and "on - off" time (AUC: 0.54, 95%CI: 0.44-0.63) were comparatively low. The optimal cutoff points were "off" time > 101.93 seconds and "on + off" time > 205.86 seconds, with sensitivities of 0.84 and 0.90, specificities of 0.77 and 0.71, positive predictive values of 0.75 and 0.72, and false-positive values of 0.85 and 0.89, respectively.

Conclusion: Our results suggest that different cutoffs should be used for the EncephalApp Stroop tool for MHE screening between alcoholic and nonalcoholic living patients, which is a critical check before generalization to screen for neurocognitive impairment among the whole population of chronic liver diseases.

Background: Angiopoietin-2 (Ang-2) level is related to hepatocellular carcinoma (HCC) progression. However, the dynamic expression and regulatory mechanism of Ang-2 remain unclear.

Aim: To investigate Ang-2 levels in chronic liver diseases and validate early monitoring value with a dynamic model in hepatocarcinogenesis.

Methods: Sprague-Dawley rats in hepatocarcinogenesis were induced with diet 2-fluorenylacet-amide, and grouped based on liver histopathology by hematoxylin and eosin staining. Differently expressed genes or Ang-2 mRNA in livers were analyzed by whole-genome microarray. Ang-2 levels in chronic liver diseases were detected by an enzyme-linked immunosorbent assay.

Results: Clinical observation reveled that the circulating levels of Ang-2 and hypoxia-inducible factor-1α (HIF-1α) in patients with chronic liver diseases were progressively increased from benign to HCC (P < 0.001). Dynamic model validated that the up-regulated Ang-2 in liver and blood was positively correlated with HIF-1α in hepatocarcinogenesis (P < 0.001). Mechanistically, Ang-2 was regulated by HIF-1α. When specific HIF-1α- microRNAs transfected into HCC cells, the cell proliferation significantly inhibited, HIF-1α and Ang-2 down-regulated, and also affected epithelial-mesenchymal transition via increasing E-cadherin to block cell invasion or migration with reducing of snail, twist and vimentin.

Conclusion: Hypoxia-induced Ang-2 up-regulating expression might serve as a sensitive early monitoring biomarker for hepatocarcinogenesis or HCC metastasis.

Background: Genetic and epigenetic alterations are related to metabolic dysfunction-associated steatotic liver disease (MASLD) pathogenesis.

Aim: To evaluate micro (mi)RNAs and lipophagy markers in an experimental model of metabolic dysfunction-associated steatohepatitis (MASH).

Methods: Adult male Sprague Dawley rats were randomized into two groups: Control group (n = 10) fed a standard diet; and intervention group (n = 10) fed a high-fat-choline-deficient diet for 16 weeks. Molecular evaluation of lipophagy markers in liver tissue [sirtuin-1, p62/sequestosome-1, transcription factor-EB, perilipin-2 (Plin2), Plin3, Plin5, lysosome-associated membrane proteins-2, rubicon, and Cd36], and serum miRNAs were performed.

Results: Animals in the intervention group developed MASH and showed a significant decrease in sirtuin-1 (P = 0.020) and p62/sequestosome-1 (P < 0.001); the opposite was reported for transcription factor-EB (P = 0.020), Plin2 (P = 0.003), Plin3 (P = 0.031), and Plin5 (P = 0.005) compared to the control group. There was no significant difference between groups for lysosome-associated membrane proteins-2 (P = 0.715), rubicon (P = 0.166), and Cd36 (P = 0.312). The intervention group showed a significant increase in miR-34a (P = 0.005) and miR-21 (P = 0.043) compared to the control. There was no significant difference between groups for miR-375 (P = 0.905), miR-26b (P = 0.698), and miR-155 (P = 0.688).

Conclusion: Animals with MASH presented expression changes in markers related to lysosomal stress and autophagy as well as in miRNAs related to inflammation and fibrogenesis, processes that promote MASLD progression.

In this manuscript we comment on the article by Yang et al published recently, focusing on how hepatic angiopoietin-2 (Ang-2) transcription promote the progression of hepatocellular carcinoma (HCC). HCC is one of the most common and lethal malignancies worldwide, especially in regions with high hepatitis B virus infection rates. Ang-2 is a key mediator of angiogenesis and plays a significant role in the progression of chronic liver diseases towards HCC, particularly in the hypoxic microenvironment. This paper reviews the dynamic expression of Ang-2 in hepatocarcinogenesis and its regulation by hypoxia-inducible factor-1α. Furthermore, we discuss Ang-2's potential as an early monitoring biomarker for metastasis, and the therapeutic prospects of silencing hypoxia-inducible factor-1α to downregulate Ang-2 and suppress epithelial-mesenchymal transition in HCC treatment.

Background: The effect of nonalcoholic fatty liver disease (NAFLD) on the efficacy of nucleoside analogues (NAs) in antiviral therapy for patients with chronic hepatitis B (CHB) remains controversial.

Aim: To investigate the influence of NAFLD on virological response in CHB patients undergoing NAs treatment.

Methods: Logistic regression analysis was conducted on a cohort of 465 CHB patients from two hospitals to determine whether NAFLD was a risk factor for adverse reactions to NAs. CHB patients were followed up for more than 28 months after initial antiviral treatment, and further validation was performed using different viral load populations.

Results: NAFLD was identified as an independent risk factor for partial virological response following antiviral therapy with NAs (odds ratio = 1.777, P = 0.017). In our subsequent analysis focusing on CHB patients with high viral load, the NAFLD group exhibited significantly longer virus shedding time and lower proportion of the complete virological response compared with the non-NAFLD group (16.8 ± 6.1 vs 13.0 ± 6.8, P < 0.05). During the 24-month period of antiviral treatment with NAs, hepatitis B virus (HBV) DNA levels decreased slowly in the NAFLD group, and the negative conversion rate of HBV was notably lower than that observed in non-NAFLD group (P = 0.001). Similar results were obtained when analyzing patients with low baseline HBV viral load within the NAFLD group.

Conclusion: Coexistence of NAFLD may diminish virological response among CHB patients receiving antiviral treatment with NAs.