World Journal of Hepatology最新文献

Non-alcoholic fatty liver disease (NAFLD) without special drugs shows symptoms of liver fat accumulation and steatosis in patients without alcohol intake. Ultrasound evaluation is a critical method in the early diagnosis of NAFLD stages as well as image processing and should be encouraged. Olive oil is an important component of the Mediterranean diet and has a beneficial role in the prevention of NAFLD progression. Physical activity and exercise can have anti-oxidant and anti-inflammatory effects to reduce liver fat and body weight via regulation of mitochondrial capacity in the development of NAFLD. Both the Mediterranean diet and physical exercise should be combined to achieve the ideal fat content reduction and weight loss in patients with NAFLD.

Background: The hepatosplenic schistosomiasis (HSS) with portal hypertension can cause vascular complications such as hepatopulmonary syndrome (HPS). HPS increases the risk of mortality in patients with cirrhosis; however, there is no data on the mortality of patients with HSS and HPS.

Aim: To perform a survival analysis of patients with HPS related to cirrhotic and non-cirrhotic (schistosomiasis) portal hypertension.

Methods: From August 2023 to January 2024, medical records and the official mortality information service of 121 patients who participated in a cross-sectional study on HPS between 2010 and 2012 were analyzed. Survival curves were created using the Kaplan-Meier method, and comparisons were performed using the log-rank test. Cox regression models estimated the hazard ratios (HR).

Results: Overall, data of 113 patients were analyzed; most (55.8%) had HSS and concomitant cirrhosis (HSS/cirrhosis). Meanwhile, HPS was present in 39 (34.5%) patients. Death occurred in 65 patients [57.5%; 95% confidence interval (CI): 48%-67%. The average time to death was lower in those with HPS when compared to those without HPS (3.37 years vs 5.65 years; P = 0.017). According to the cause of liver disease, patients with HSS/cirrhosis died earlier, and their risk of death was twice as high compared with patients with HSS without cirrhosis (HR: 2.17; 95%CI: 1.3-3.60; P = 0.003). Meanwhile, there were no differences when comparing the two groups with and without HPS (HR: 1.01; 95%CI: 0.59-1.73; P = 0.967).

Conclusion: Patients with HSS and concomitant cirrhosis had a lower survival rate, but there was no difference in survival regardless of the presence of HPS.

The growing global burden of metabolic dysfunction-associated steatohepatitis (MASH) demands a deeper understanding of its underlying mechanisms and risk factors. Recent studies, such as the large population-based case-control analysis by Abdel-Razeq et al, suggest a significant association between Helicobacter pylori (H. pylori) infection and an increased risk of developing MASH. This study provides compelling data supporting this association, even after adjusting for confounders such as obesity, diabetes, and hyperlipidemia. However, the complexity of this relationship remains unresolved, requiring further investigation into the biological, genetic, and environmental pathways that connect these two conditions. This article critically reviews the study's findings and identifies its limitations, offering innovative research directions for the future. Key areas of focus include integrating genomic and microbiome analyses, exploring the impact of H. pylori eradication on MASH progression, studying molecular mechanisms at the intersection of infection and liver disease, and developing personalized therapeutic strategies.

This manuscript is based on a recent study by Pillay et al that was published in recently. Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin. The incidence rate in Europe is lower than in developing countries, but it is a major complication with high morbidity, particularly in immunocompromised patients. They are most frequently caused by Enterobacterales infections, but hypervirulent Klebsiella strains are an emerging problem in Western countries. Amoebiasis has been a public health problem in Europe, primarily imported from other endemic foci. At the same time, this infection is becoming an emerging disease, as the number of infected patients who have not traveled to endemic areas is rising. Treatment options for hydatid liver cyst include chemotherapy, open or laparoscopic surgery, percutaneous treatment (percutaneous aspiration, re-aspiration and injection and its modification) and ''wait and watch'' strategy. Most hydatid liver cyst patients in Pillay et al's study received surgical treatment, but several studies have confirmed the safety and efficacy of percutaneous aspiration, re-aspiration and injection.

The etiology, risk factors, and management of sarcopenia and metabolic dysfunction-associated steatotic liver disease (MASLD) are comparable, which prompted the investigators to search for a particular diagnostic or prognostic biomarker that was involved in both disorders. Peptides or proteins known as myokines, or exerkines, are produced and secreted by contracted muscles. Myokines work similarly to hormones in their actions. One common clinical hallmark of sarcopenia and MASLD is physical inactivity, which is associated with alterations in the levels of myokines. Irisin is a positive regulator of muscle size that is elevated in the biological fluids during exercise. Significantly low levels were observed in the pathological conditions associated with physical inactivity. The serum levels of irisin are significantly higher in MASLD patients, while their levels were lower in risk factors of MASLD, e.g., diabetes mellitus, obesity, and insulin resistance. In sarcopenia with obesity (sarcopenic obesity) or with a normal build, serum irisin levels are significantly lower than in healthy subjects. Therefore, serial determination of irisin levels that showed a transition from higher to lower levels in MASLD indicated the development of sarcopenia in those patients.

Background: Cardiovascular health (CVH) plays a crucial role in overall health, but its association with metabolic-associated fatty liver disease (MAFLD) remains unclear.

Aim: To investigate the relationship between CVH, measured using Life's Essential 8 (LE8) and Life's Simple 7 (LS7), and the prevalence of MAFLD.

Methods: This cross-sectional study had a sample of 2234 individuals, representing approximately 120 million individuals in the United States. Baseline parameters were compared between the LE8 and LS7 groups. Logistic regression models were used to evaluate the relationship between LE8, LS7, and MAFLD, while taking into account confounding factors. The investigation employed restricted cubic splines to investigate non-linear associations. Subgroup analyses and sensitivity studies were performed to evaluate the strength and reliability of the results.

Results: Higher LE8 and LS7 scores were significantly associated with a decreased risk of MAFLD, even after controlling for demographic, socioeconomic, and clinical variables. This association demonstrated a non-linear pattern, with the most dramatic risk reduction observed at higher CVH levels. Individual CVH components, notably healthy behaviors and factors, exhibited strong relationships with MAFLD. Subgroup analyses indicated consistent relationships across several demographics. Sensitivity tests utilizing other MAFLD definitions validated the robustness of the findings.

Conclusion: Higher adherence to CVH criteria, as indicated by LE8 and LS7 scores, is associated with a significantly lower risk of MAFLD. These results emphasize the need to advance CVH to control and avoid MAFLD.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease characterized by combinations of insulin resistance and insulin deficiency. Non-alcoholic fatty liver disease (NAFLD) is emerging as a public health problem worldwide and affects up to 70% of patients with T2DM. Although patients with T2DM have an increased risk of developing advanced liver disease compared to healthy individuals, varying prevalence rates of NAFLD among patients with T2DM, ranging from 34% to 94%, have been reported.

Aim: To determine prevalence and identify associated factors of NAFLD among Limbe patients with T2DM and evaluate correlation with glycemic control.

Methods: A cross-sectional study was carried out from February to June 2024 among patients with T2DM. Gamma-glutamyl transferase (GGT) activity and serum triglycerides (TGs) were measured by spectrophotometry. NAFLD was diagnosed using the fatty liver index score. Data were analyzed using SPSS version 26.0 for Windows. Student's t-test was used to compare the means of two groups. The χ ² test was applied to determine the association of NAFLD and T2DM. Logistic regression analysis was performed to identify predictors of NAFLD. P < 0.05 was considered statistically significant.

Results: Of the 150 patients with T2DM recruited for this study, 63 (58%) were females and the majority (84.7%) had good glycemic control (glycated hemoglobin < 7%). Prevalence of NAFLD among patients with T2DM was 19%. Patients with NAFLD had significantly elevated levels of TGs, GGT, and increased body mass index and waist circumference compared to those without NAFLD. There was a significant association between NAFLD and glycemic control. Predictive factors of NAFLD among patients with T2DM were vegetable intake of less than three times per week [adjusted odds ratio (aOR): 0.131, 95%CI: 0.020-0.839; P = 0.032], central obesity (aOR: 0.167, 95%CI: 0.037-0.748; P = 0.019), and metformin treatment for T2DM (aOR: 0.167, 95%CI: 0.037-0.718; P < 0.001).

Conclusion: The prevalence of NAFLD in patients with T2DM in Limbe Regional Hospital was 19%. Age, central obesity, metformin use, and infrequent consumption of vegetables were important predictors of NAFLD.

Background: Acute drug-induced liver injury (DILI) events caused by chronic liver disease are relatively common. Some researchers believe that nonalcoholic fatty liver (NAFL) increases the overall risk of DILI. The clinical characteristics and prognosis of DILI in the context of NAFL disease (NAFLD) are still unclear. Therefore, hospitalized patients with NAFLD combined with DILI at the Tianjin Second People's Hospital were included in this study. The clinical manifestations, classifications, severities, laboratory indicators, and clinical outcomes of the enrolled patients were analyzed, and the clinical characteristics and prognoses of the NAFL + DILI patients were evaluated.

Aim: To investigate the clinical characteristics and prognosis of DILI in the context of NAFL.

Methods: Eighty-nine patients diagnosed with DILI and 110 patients diagnosed with both DILI and NAFL at the Tianjin Second People's Hospital were enrolled. Clinical data, including demographic characteristics, clinical features, laboratory test results, pathology findings, autoantibody titers, suspected drugs, and outcomes, were collected from the two groups of patients. All enrolled patients were followed up to determine the liver function recovery time.

Results: Compared with the patients in the DILI group, those in the NAFL + DILI group had higher body mass indices; Controlled Attenuation Parameter scores; and triglyceride, total cholesterol, low-density lipoprotein, and insulin levels. The levels of the cytokines interleukin-4 and complement complement c3 (C3) were also greater in the NAFL + DILI group than in the DILI group. The proportions of patients with cholestatic-type DILI (16.4% vs 4.5%), cholestasis seen on pathoscopy (40.9% vs 25.8%), grade 2 or above DILI (48.18% vs 40.45%), and a recovery time for liver function ranging from 90 to 180 days (30.6% vs 15.5%) were greater in the NAFL + DILI group than in the DILI group. All of the abovementioned differences between the groups were statistically significant (P < 0.05). The autoantibody positivity rates did not significantly differ between the two groups (P > 0.05), and the proportions of patients who progressed to chronic drug hepatitis or autoimmune hepatitis were not significantly different between the two groups (both P > 0.05).

Conclusion: In the context of NAFL, DILI is more likely to be cholestatic, with a greater degree of liver injury, a longer recovery time, and more pronounced expression of immune factors.

Background: Idiopathic portal hypertension (IPH) is a subtype of portal hypertension that arises in the absence of cirrhosis. IPH frequently manifests with clinical features typical of portal hypertension, including splenomegaly and esophagogastric fundal varices, along with other associated symptoms. Imaging studies may indicate portal hypertension; however, they typically do not provide evidence of cirrhosis. There are no standardized diagnostic criteria for IPH, and diagnosis is often established by excluding other hepatic diseases. Liver biopsy remains the most reliable approach to verify the diagnosis of IPH.

Case summary: A patient previously diagnosed with "hepatitis B cirrhosis" at an external hospital presented to our facility with gastrointestinal bleeding. Initial assessment revealed minor liver injury, splenomegaly, esophagogastric varices, and portal hypertension. Imaging studies did not indicate cirrhosis and repeated hepatitis B serology tests yielded negative results. After excluding various causes of cirrhosis and other non-cirrhotic etiologies of portal hypertension, liver biopsy confirmed the diagnosis of IPH. The patient was managed with regular endoscopic therapy and long-term carvedilol administration.

Conclusion: Currently, there are no standardized diagnostic criteria for IPH, and its diagnosis is generally established by excluding other conditions. Liver biopsy remains the most reliable method for IPH diagnosis.

Background: Various prognostic scores have been developed to predict mortality and response to steroids in alcoholic hepatitis (AH). We aimed to further validate and compare these scores, particularly pre-day 7 Lille scores, in addition to identifying reliable predictors of complications and mortality such as renal dysfunction and nutritional status.

Aim: To identify predictors of complications and mortality in AH, particularly focusing on demographics, renal involvement, underlying liver disease, and nutrition.

Methods: This is a retrospective analysis of patients admitted to a large urban tertiary care center with AH from 2020 to 2022. Receiver operating characteristics (ROC) curve analysis was conducted to compare established prognostic scores with Lille scores from day 3 to day 7 (LM3-7). Logistic regression equations were conducted to identify predictor variables.

Results: Severe AH (SAH) as defined by Maddrey's discriminant function ≥ 32 was diagnosed in 150 out of 425 patients with AH. LM3-7 had 28-day mortality rates in the responder group of 7%-11%, while in the non-responder group, mortality rates were approximately 38%-42%. LM3-7 had 90-day mortality rates in the responder group of 12% to 17%, while in the non-responder group, mortality rates were 48%-53%. Furthermore, all LM3-7 scores showed comparable efficacy in predicting mortality using ROC curve analysis; Area under ROC ranged from 0.771 to 0.802 for 28-day mortality and 0.743 to 0.809 for 90-day mortality. Regarding complications and mortality in AH, significant predictors included poor nutritional status, underlying cirrhosis, and acute renal dysfunction.

Conclusion: LM3-6 is as accurate as LM7 in predicting corticosteroid efficacy for 28-day and 90-day mortality in patients with SAH. Holding glucocorticoids early during the disease course can prevent unnecessary complications.