World Journal of Hepatology最新文献

Acrylamide, a contaminant formed during high-temperature cooking of common foods, is increasingly recognized as a silent and underestimated contributor to liver injury. In this editorial, we comment on the study by Nour El Deen et al, demonstrating that a chemically standardized ginger (Zingiber officinale) extract (≥ 20% 6-gingerol) mitigates acrylamide-induced hepatotoxicity in rats through antioxidant, anti-inflammatory, and cytoprotective mechanisms. By combining biochemical, histopathological, and molecular evidence, the authors establish a coherent experimental basis for future translational research. Their results are consistent with a growing body of data supporting the hepatoprotective properties of ginger and emphasize the importance of using standardized nutraceutical preparations in preventive hepatology. From a precision-nutrition perspective, ginger phytocompounds appear to influence key oxidative, inflammatory, and metabolic pathways, possibly involving the gut-liver axis. Confirmatory studies in chronic exposure models and human cohorts, together with compositional and protein-level validation, will be essential to strengthen both the mechanistic and translational significance of these findings.

Background: Metabolic associated steatotic liver disease (MASLD) has become a growing global health burden, with its potential to progress to liver fibrosis, cirrhosis, and hepatocellular carcinoma. Qushi Huoxue ointment (QSHXO), a traditional Chinese medicine formula, has demonstrated efficacy in the management of MASLD. However, its underlying mechanisms remain incompletely elucidated.

Aim: To investigate the mechanism by which QSHXO alleviated hepatic lipid deposition and inflammatory injury in MASLD, with a focus on its role in activating hepatocyte autophagy and inhibiting ferroptosis.

Methods: This study employed a comprehensive research strategy. First, a methionine-choline-deficient diet-triggered MASLD mouse model was established and treated with different doses of QSHXO. The therapeutic effects of QSHXO were comprehensively evaluated using histological analysis, serum biochemical assays, and inflammatory cytokine measurements. Subsequently, bioactive components of QSHXO in serum were identified utilizing liquid chromatography-tandem mass spectrometry. Network pharmacology was then applied to predict potential targets of QSHXO in treating MASLD related to autophagy and ferroptosis. These predicted targets were validated through western blotting, quantitative reverse-transcription polymerase chain reaction, immunohistochemistry, and transmission electron microscopy.

Results: QSHXO significantly ameliorated liver lipid deposition and inflammation in MASLD mice. Specifically, QSHXO promoted autophagic flux, as indicated by upregulation of Beclin1, an increased light chain 3 II/light chain 3 I ratio, and downregulation of P62. Concurrently, QSHXO activated the nuclear factor erythroid 2-related factor 2 pathway, promoting its nuclear translocation and enhancing the expression of downstream targets (SLC7A11 and glutathione peroxidase 4), while reducing hepatic iron deposition; these collectively suggested suppression of ferroptosis. Ultrastructural analysis further confirmed improved mitochondrial morphology and increased autophagic vesicles in QSHXO-treated groups.

Conclusion: QSHXO ameliorates MASLD by reducing lipid accumulation, mitigating inflammation, and suppressing hepatocyte damage, which is mediated through the activation of autophagy and inhibition of ferroptosis.

The management of complex hepatolithiasis remains a formidable challenge in hepato-pancreato-biliary surgery. The recent retrospective comparative study by Lin et al provides valuable insights into the evolving role of minimally invasive techniques for this complex condition. Their data convincingly demonstrate that laparoscopic surgery, while requiring longer operative time, facilitates significantly accelerated postoperative recovery and reduced wound infection rates, while maintaining comparable stone clearance and overall complication profiles to open surgery. The strategic utilization of Laennec's capsule as an anatomical guide represents a noteworthy technical advancement. However, the non-randomized design and single-center experience highlight the need for prospective validation. This article discusses these findings in the context of advancing minimally invasive hepatobiliary surgery and identifies future directions for research and clinical application.

Epstein-Barr virus (EBV) infection commonly occurs in children, particularly in developing countries. Most children infected with EBV are asymptomatic, though some develop significant complications, including EBV-associated malignancies, hemophagocytic lymphohistiocytosis, and multiple sclerosis. In immunocompromised children, including those with liver transplantation, EBV infection manifests with a diverse spectrum of presentations, varying from asymptomatic to post-transplant lymphoproliferative disorder, which can evolve into lymphoma. Therefore, close monitoring, early detection, and prompt management are crucial. This review aimed to investigate the pathogenesis and manifestations of EBV in healthy children and those who underwent liver transplantation. The proposed algorithm for early EBV detection and management, along with case studies, is provided to help pediatricians increase their index of suspicion.

Background: Patients with decompensated cirrhosis frequently experience severe psychological distress, anxiety, and depression, yet psychological support is often fragmented in conventional care.

Aim: To investigate the effect of interdisciplinary team scheduling on psychological outcomes in decompensated cirrhosis.

Methods: A randomized, single-blind, single-center trial was conducted from January 2022 to December 2024 in Guangxi Zhuang Autonomous Region. A total of 110 patients with decompensated cirrhosis (Distress Thermometer ≥ 4) were randomized to interdisciplinary team scheduling (n = 55) or conventional scheduling (n = 55). Psychological distress, anxiety, depression, and quality of life were assessed using the Distress Thermometer, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and World Health Organization Quality of Life 100 questionnaire, respectively.

Results: Following the intervention, the interdisciplinary group achieved significantly lower psychological distress [3 (2-3) vs 3 (3-4)], anxiety (41.65 ± 4.29 vs 46.38 ± 4.18), and depression scores (45.79 ± 3.25 vs 50.14 ± 3.69) compared with the control group (all P < 0.05). Quality of life scores also improved significantly in the physical, psychological, and social domains (P < 0.05).

Conclusion: The interdisciplinary team scheduling model effectively alleviates psychological symptoms and enhances quality of life among patients with decompensated cirrhosis. This model addresses unmet psychosocial needs through early, continuous, and collaborative care, providing a practical framework for integrating psychological support into chronic liver disease management.

Background: Lifestyle modifications aimed at weight loss are key to improving metabolic dysfunction-associated steatotic liver disease (MASLD); however, achieving substantial and sustained weight loss through non-surgical approaches may be difficult for some patients. Bariatric surgery should be considered as a therapeutic option in select patients with MASLD, but the national referral rate for eligible patients is low (< 1%).

Aim: To examine referral rates and one-year outcomes among adults with MASLD in a multidisciplinary clinic integrating hepatology and obesity medicine.

Methods: We performed a retrospective cohort study of 965 patients seen in a MASLD-specific clinic over a three-year period (2018-2022). Patients were categorized as bariatric surgery eligible or non-eligible based on standard referral criteria. We assessed bariatric surgery referral rates, weight, and liver-related outcomes, including change in nonalcoholic fatty liver disease fibrosis score. Categorical variables were compared with χ ² tests, and continuous variables were analyzed with two-tailed t-tests. P value < 0.05 was considered significant.

Results: Among 491 patients eligible for bariatric surgery, 127 patients (26%) were referred for surgical evaluation, with 31 patients (24%) ultimately undergoing bariatric surgery (21 sleeve gastrectomy and 10 Roux-en-Y gastric bypass). The remaining 96 patients continued with medication and/or lifestyle management. Individuals who underwent bariatric surgery achieved greater one-year total body weight loss than those who utilized medication and/or lifestyle management alone (20.6% vs 2.5%, P < 0.001). Average nonalcoholic fatty liver disease fibrosis score at one year was -0.91 in surgery patients vs -0.008 in non-surgery patients (P = 0.005).

Conclusion: Integration of weight management with hepatology care in patients with MASLD resulted in bariatric surgery referral rates that substantially exceed the national average, leading to improved weight and liver-related outcomes.

Background: This report describes the development of schizophrenia in a 63-year-old female patient approximately six months after undergoing liver transplantation. The patient exhibited no previous indications of psychiatric conditions and did not have any familial background of schizophrenia.

Case summary: This particular case serves as an illustration of the intricate interaction of various elements, such as the liver transplantation process, surgical trauma, intraoperative narcosis, and immunosuppression, which may potentially contribute to the onset of schizophrenia. This report examines the clinical trajectory, diagnostic assessment, and therapeutic strategies employed in this case.

Conclusion: This report emphasizes the significance of identifying and managing psychiatric issues during the post-transplant phase, highlighting potential underlying mechanisms that may link transplantation-related factors to the onset of schizophrenia.

Background: Liver biopsy, once the gold standard for evaluating liver fibrosis and steatosis, has been largely replaced in routine clinical practice by non-invasive tools like Fibroscan^®, which evaluate liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). While Fibroscan^® is well-validated, cost and accessibility challenges limit its use for regular follow-up, especially in primary care.

Aim: To investigate the diagnostic accuracy and correlation of blood-based parameters fibrosis 4 (FIB-4) score, aspartate transaminase to platelet ratio index (APRI), neutrophil-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and neutrophil percentage-to-albumin ratio (NPAR) with LSM and CAP values in metabolic dysfunction-associated steatotic liver disease (MASLD) patients.

Methods: In a cross-sectional study of 300 MASLD patients we compared FIB-4, APRI, NLR, PLR, and NPAR with LSM and CAP values. Patients were categorized based on LSM into less fibro-progressed (F0-F2) and advanced fibro-progressed (F3-F4) groups, and by CAP into S1, S2 and S3 categories. Sensitivity, specificity, positive predictive value, and negative predictive value of the markers were analyzed, and receiver operating characteristic curves were plotted.

Results: FIB-4 [r = 0.537, P < 0.001; area under curve (AUC) = 0.806; diagnostic accuracy = 75.63%] and APRI (r = 0.513, P < 0.001; AUC = 0.772) showed strong correlations with LSM, confirming their reliability for LSM. APRI and FIB-4 are validated against fibrosis in liver biopsy, our results demonstrate comparable performance between these scores and LSM by Fibroscan^®. PLR exhibited high specificity (98.0%) but showed negative correlation with LSM (r = -0.317, P < 0.01). For CAP, NPAR demonstrated the highest specificity (97.67%) and positive predictive value (91.31%), followed by NLR (specificity 92.77%, positive predictive value 91.58%), though AUC values were modest (0.562 and 0.540, respectively).

Conclusion: FIB-4 and APRI which are robust non-invasive markers for fibrosis, correlates well with LSM as well. NPAR shows potential for steatosis assessment using CAP, warranting further validation. Negative correlation of PLR might suggest its role in liver stiffness evaluation. These markers both conventional and novel, can be used for repeated measurements during follow-up in primary care settings.

Background: The health challenges of partial hepatectomy in patients with clinically significant portal hypertension (CSPH) have been a subject of study for decades. No meta-analysis has systematically evaluated the relationship between CSPH and posthepatectomy liver failure (PHLF), despite its potential role as a critical factor in surgical decision-making. This systematic review and meta-analysis investigated the incidence of PHLF in patients with and without CSPH.

Aim: To include more recent studies and focus on short-term postoperative outcomes, particularly the association between CSPH and PHLF. Additionally, stratified analyses were also performed according to CSPH and PHLF assessment methods, study design, study period, surgical technique, and underlying liver diseases.

Methods: A comprehensive literature search was conducted in EMBASE, PubMed, MEDLINE, ScienceDirect, Elsevier, and Cochrane databases using combinations of the following terms: ("portal hypertension" OR "hypertension, portal" OR "portal hypertensions") AND ("hepatectomy" OR "hepatectomies" OR "liver resection") AND ("liver failure" OR "hepatic failure" OR "liver decompensation"). Studies published from January 1996 to April 2025, 21 published studies were finally included in the systematic review and meta-analysis. The quality assessment was performed independently by using the Newcastle-Ottawa Scale. Odds ratios (OR) and 95% confidence intervals (CI) were calculated and compared using a random-effects model. Heterogeneity was assessed with the χ ² test, and the degree of inconsistency was measured using I ². A P value < 0.05 or I ² > 50% indicated substantial heterogeneity. Sensitivity analysis was conducted to test the robustness of the findings and to identify potential sources of bias.

Results: A total of 6981 patients (1453 patients with CSPH and 5529 patients without CSPH) were finally included in this study. Compared with patients without CSPH, the incidences of PHLF increased in patients with CSPH (OR = 3.14; 95%CI: 2.45-4.02; P < 0.001). Subsequent subgroup analysis suggested that the diagnostic methods for CSPH is a potential interfering factor in PHLF, the OR was maximal in hepatic venous pressure gradient measurement groups (OR = 15.61; 95%CI: 2.11-115.35; P = 0.007).

Conclusion: The presence of CSPH should be considered as a significant risk factor, it still should be taken into account seriously prior to surgery and needs strict perioperative management. Meanwhile, different methods of diagnosing CSPH could influence PHLF.

The global rise in childhood obesity has made metabolic dysfunction-associated steatotic liver disease (MASLD) the leading cause of pediatric liver disease. Studies have consistently reported alarmingly high rates of advanced fibrosis in up to 20% of adolescents with MASLD. There is evidence that pediatric MASLD may run a more severe clinical course compared to adults, as well as pose an independent risk factor for mortality than pediatric obesity or type 2 diabetes mellitus alone. This underscores the necessity for timely recognition, accurate diagnosis and early institution of therapeutic interventions for pediatric MASLD. In this minireview, we discuss the various non-invasive diagnostic modalities used for the evaluation of MASLD, and propose an updated diagnostic and monitoring algorithm incorporating recent multi-societal statements. The advent of non-invasive diagnostics such as vibration-controlled transient elastography in children allows for earlier recognition of liver fibrosis, and may prioritize the need for early pharmacological therapy. We also discuss the importance of early pharmacological intervention in pediatric MASLD, in particular the use of glucagon-like peptide 1 receptor agonists which may have potential to halt MASLD progression if instituted early, and the potential role for novel anti-fibrotic therapy in this population.