中华肝脏病杂志最新文献

With the widespread implementation of immunoprophylaxis strategies, the primary challenge in HBV infection prevention and control in China has shifted to reducing the burden of existing infections. A crucial approach to decreasing the burden of existing infections is to develop the effective treatment methods to achieve clinical or functional cures within a limited treatment duration for infected patients. The existing infections can be divided into two parts: those that are easy to cure and those that are difficult to treat. Patients who meet the current drug withdrawal criteria and at the same time have HBsAg<100 IU/mL following treatment with nucelos(t)ide analogue therapy are the easier one to treat, accounting for about 12% of the total infections, and the remaining 88% are difficult to cure. A necessary step toward clinical cure is pushing the HBsAg levels of patients to<100 IU/mL, but this driving effect must stem from effective immune reconstitution against HBV. Recent prevention and control, certain characteristics and implementation of clinical cure, and the safe drug withdrawal are discussed here to offer new perspectives on issues related to hepatitis B.

Objective: To evaluate the association between different levels of alcohol intake and all-cause mortality in metabolic dysfunction-associated steatotic liver disease（MASLD）and alcohol-related/associated liver disease（MetALD）. Method: This study included participants aged 20 to 74 who were diagnosed with hepatic steatosis by ultrasound. The data were derived from the Third National Health and Nutrition Examination Survey（NHANES Ⅲ）conducted in the United States from 1988 to 1994. Multivariable-adjusted hazard ratios（aHR）and their 95% confidence intervals（CI）were calculated by Cox proportional risk regression modelling to assess the effect of alcohol consumption levels on all-cause mortality. Participants were categorized into three groups based on daily alcohol intake：low，moderate，and high consumption groups. Results: A total of 2 322 participants were included，with 50.2% males（1 166/2 322），and median age 42.0（31.3-57.0）years. During a median follow up of 316.0（270.0-337.0）months，the overall mortality rate was 1.48% per person-year. The all-cause mortality were 1.38%，1.67% and 2.10% per person-year for those participants in three alcohol intake groups. After adjusting for covariates，daily moderate alcohol intake group（adjusted hazard ratio［aHR］=1.37，95% CI 1.12-1.67，P=0.002），and daily high alcohol intake group（aHR=1.45，95% CI 1.17-1.80，P=0.001），were independently associated with increased all-cause mortality. In subgroup analysis by diabetes status and age，there were significant differences in all-cause mortality across various levels of alcohol intake among non-type 2 diabetes mellitus（T2DM）participants under 60 years old，but not among non-T2DM participants over 60 years old，and T2DM participants of all ages. Conclusion: Alcohol intake has a dose-dependent negative impact on MASLD and MetALD patients. The risk of all-cause mortality significantly increases with higher alcohol intake. To evaluate the association between different levels of alcohol intake and all-cause mortality in metabolic dysfunction-associated steatotic liver disease（MASLD）and alcohol-related/associated liver disease（MetALD）.

Objective: To analyze the distribution of pathogenic microorganisms, drug resistance and influencing factors in patients with hepatitis B virus associated acute -on-chronic liver failure (HBV-ACLF) complicated with abdominal infection (IAI). Methods A retrospective analysis was conducted on 282 HBV-ACLF patients admitted to the Hepatobiliary Internal Medicine Department of Mengchao Hepatobiliary Hospital of Fujian Medical University, from May 2019 to December 2022, with 141 patients who had IAI and positive bacterial culture as the infected group; 141 non-infected patients admitted during the same period were used as the non-infected group. The clinical data, laboratory test results, pathogen species and drug sensitivity test results of the patients were collected, and the influencing factors of IAI in HBV-ACLF patients were analyzed by Logistic regression analysis. Results: A total of 204 pathogenic bacteria were detected in the infection group, including 115 Gram-negative bacteria (56.37%), 74 Gram-positive bacteria (36.28%) and 15 fungi (7.35%). The most frequently detected bacterial genera were Escherichia coli (21.57%, 44/204), Klebsiella pneumoniae (12.25%, 25/204), Enterococcus faecium (6.37%, 13/204), Staphylococcus aureus (5.39%, 11/204) and Staphylococcus epidermidis (4.90%, 10/204). The results of drug sensitivity tests showed that the resistance rates of Escherichia coli and Klebsiella pneumoniae to levofloxacin and ciprofloxacin were over 50% and 30% respectively; the resistance rate of Pseudomonas aeruginosa to carbapenems (meropenem and imipenem) was 60.00%; the resistance rates of Acinetobacter baumannii to meropenem and imipenem were 100% and 50.00% respectively; the resistance rates of Enterococcus faecium and Enterococcus faecalis to penicillin were 100% and 33.33% respectively; and the resistance rates of Staphylococcus aureus to penicillin (77.78%) and oxacillin (33.33%) were relatively high..The results of the multivariate unconditional logistic regression analysis showed that puncture and drainage (OR=17.90, 95% CI: 7.94~43.42, P< 0.001), procalcitonin (OR=3.23, 95% CI: 1.56~8.98, P=0.012), C-reactive protein (OR=1.05, 95% CI: 1.02~1.00, P=0.003), and age (OR=1.06, 95% CI: 1.02~1.10, P=0.001) were independent risk factors for IAI in patients with HBV-ACLF. Conclusions The pathogenic microorganisms of HBV-ACLF patients with IAI were mainly enterobacteriaceae bacteria and enterococcus. Puncture drainage, procalcitonin, C-reactive protein and age were independent risk factors for IAI in HBV-ACLF patients. Early intervention to avoid the increase of inflammatory in dicators is an effective measure to prevent abdominal infection in HBV-ACLF patients.

Although nucleotide analogs (NAs) and interferons are currently the primary treatments for chronic hepatitis B, they do not entirely remove cccDNA from hepatocytes. Antiviral therapy's desired outcome is the absence of hepatitis B surface antigen(HBsAg), often known as a clinical cure. Although interferon therapy has significantly higher HBsAg clearance and serologic conversion rates than NAs, combination or sequential therapy can improve HBsAg clearance and serologic conversion rates to some extent. Still, only a small proportion of patients will achieve clinical cure. As a result, it is critical to explore indications that might predict clinical cure before and during antiviral medication, allowing for early and prompt identification of patients more likely to achieve HBsAg clearance, improving clinical cure rates, and reducing treatment expenses. In this paper, we review the progress of recent studies on predictors of clinical cure in chronic hepatitis B, and discuss their value in predicting clinical cure to provide a reference for optimizing CHB treatment strategy.

Macrophages are the key cells in the process of hepatic fibrosis. Therefore, they promote the progression and regression of liver fibrosis by participating in all stages. The treatment of liver fibrosis is significantly identified by the main subtypes of intrahepatic macrophages. This article summarizes the types and functions of macrophages according to the inflammatory phenotype, origin, and surface markers and their effect on fibrosis; introduces the new subtypes and mode of action in the occurrence and development of hepatic fibrosis, as revealed by the single-cell sequencing technique; and analyzes the limitations of traditional antifibrotic therapy and the advantages of macrophage-targeting therapeutics, which could indicate the new direction for the study of new macrophage subtypes in hepatic fibrosis.