中华肝脏病杂志最新文献

Objective: To investigate the efficacy and safety profile of transjugular intrahepatic portosystemic shunt received by elderly patients with cirrhosis (age >75 years). Methods: A retrospective analysis was conducted on the data of patients who underwent TIPS for cirrhosis at Nanjing Drum Tower Hospital, affiliated with Nanjing University School of Medicine, from January 2019 to December 2021. Patients were divided into an elderly group (> 75 years) and a younger group (≤ 75 years) according to age. Propensity score matching was performed in a 1∶1 ratio. Statistical analysis was performed using the independent samples t-test, the Mann-Whitney U test, and the χ² test. Postoperative survival rate, rebleeding rate, and incidence rate of hepatic encephalopathy were analyzed using the Kaplan-Meier method between the two patient groups. Results: A total of 37 elderly and 478 younger cases were screened. Propensity score matching was performed in line with a 1∶1 ratio. Finally, 32 cases were included in each group. The elderly and younger patient groups had no statistically significant differences in the 1-year postoperative rebleeding rate [9.4% (3/32) vs. 6.3% (2/32), P=0.562], the incidence rate of hepatic encephalopathy [37.5% (12/32) vs. 18.8% (6/32), P=0.060], and the survival rate [25% (8/32) vs. 15.6% (5/32), P=0.371]. The incidence rate of hepatic encephalopathy according to the Child-Pugh class A stratification at 1 year following surgery had no statistically significant difference between the two patient groups' liver function [12.5% (1/8) vs. 11.1% (1/9), P=0.896]. However, the incidence rate of hepatic encephalopathy at 1 year following surgery with Child-Pugh class B and C had a statistically significant difference between the two patient groups' liver function [45.8% (11/24) vs. 21.7% (5/23), P=0.037]. Conclusion: Transjugular intrahepatic portosystemic shunt (TIPS) is equally safe and effective in elderly compared to younger patients. However, the incidence rate of postoperative hepatic encephalopathy is significantly higher in patients with Child-Pugh class B and C.

Objective: To explore the occurrence of risk factors, construct a nomogram, and evaluate its predictive value for progressive liver fibrosis (PLF) in patients with metabolic-associated fatty liver disease (MAFLD). Methods: The clinical data of 259 MAFLD cases who visited the Obesity Department of Hubei Provincial Hospital of Traditional Chinese Medicine from May 2022 to October 2023 was retrospectively analyzed. Patients were divided into the PLF and non-progressive liver fibrosis (NPLF) group based on whether their liver stiffness measurement (LSM) value detected by FibroTouch >12 kPa. Univariate analysis was used to screen influencing factors. The original dataset of influencing factors was reconstructed using the Synthetic Minority Over-sampling Technique (SMOTE) algorithm. LASSO-logistic regression was used to determine independent risk factors for progressive liver fibrosis in MAFLD patients based on the SMOTE algorithm. A nomogram was constructed. Receiver operating characteristic (ROC) curves, Hosmer-Lemeshow calibration curves, and decision curves were plotted to evaluate the nomogram performance. Results: Univariate analysis showed statistically significant differences in terms of gender, smoking history, body mass index, visceral fat area, skeletal muscle content, basal metabolic rate, waist circumference, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1, high-sensitivity C-reactive protein (hs-CRP), glycated hemoglobin, homeostatic model assessment for insulin resistance index (HOMA-IR), ultrasound attenuation parameter (UAP), and stages of liver fatty degeneration (P<0.05) between the PLF group and the NPLF group. LASSO-logistic regression showed that HDL-C, hs-CRP, HOMA-IR, and UAP were independent occurrence risk factors for progressive liver fibrosis in MAFLD (P<0.05). The nomogram model constructed based on logistic regression results showed areas under the ROC curves of 0.893 (95% CI: 0.848-0.938), 0.802 (95% CI: 0.711-0.892), and 0.863 (95% CI: 0.815-0.911) in the SMOTE training, validation, and original datasets, respectively. The Hosmer-Lemeshow tests showed all P>0.05. The calibration curves indicated substantial consistency between the model's predictions and actual results. Decision curve analysis showed that the model had high clinical benefit when the threshold probabilities were 0.02-0.87, 0.03-0.96, and 0.02-0.79, respectively. Conclusion: HDL-C, hs-CRP, HOMA-IR, and UAP levels are independent risk factors for progressive liver fibrosis. The nomogram model established on these grounds has high accuracy and can be used for early-stage identification and risk prediction of progressive liver fibrosis in patients with MAFLD.

Objective: To analyze the incidence rate, compare the differences, and assess the risk factors for portal vein thrombosis (PVT) formation after different endoscopic treatment methods in patients with esophagogastric varices in cirrhosis. Methods: The laboratory, imaging, and endoscopic treatment methods data for 289 patients with esophagogastric varices in liver cirrhosis who initially received endoscopic treatment at the Endoscopy Center of You'an Hospital, affiliated with Capital Medical University, from January 2020 to December 2022, were retrospectively included. The incidence rate of PVT within 1 year after systematic standardized endoscopic treatment was statistically analyzed. Univariate and multivariate logistic regression analyses were used to screen the risk factors for PVT formation after endoscopic treatment. The t-test or rank-sum test was used to compare continuous data between the two groups. The χ² test was used for categorical data. Results: The incidence rate of portal vein thrombosis (PVT) within 1 year was 20.76% (60/289) among 289 patients with esophagogastric varices in cirrhosis who underwent standard endoscopic treatment. The PVT incidence rate was 22.81% (13/57) in patients who used sclerotherapy alone and 15.22% (7/46) in patients who used ligation rings alone, with no statistically significant difference in the PVT incidence among different endoscopic treatment methods (χ²=2.354, P>0.05). Univariate analysis showed statistically significant differences in preoperative platelet count, spleen thickness, spleen long diameter, model for end-stage liver disease score, ascites, and smoking between the PVT group and the non-PVT group (P<0.05). Multivariate logistic regression analysis showed that preoperative platelet count [odds ratio (OR) = 0.988, 95% (confidence interval, CI): 0.979-0.998, P = 0.018], splenic ultrasound thickness (OR = 1.051, 95%CI: 1.003-1.101, P = 0.038), massive ascites (OR = 14.153, 95%CI: 2.517-79.577, P = 0.003), and smoking (OR = 2.537, 95%CI: 1.267-5.076, P = 0.009) were independent risk factors for PVT formation. Conclusion: The incidence rate of PVT is similar to the current known annual incidence rate of PVT following endoscopic treatment in patients with esophagogastric varices in liver cirrhosis, and different endoscopic treatment methods have no significant effect on PVT formation. Preoperative platelet count, spleen thickness, massive ascites, and smoking are risk factors for PVT formation.

Acute-on-chronic liver failure is a severe syndrome characterized by a rapid decline in liver function and multiple organ failure, with rapid progression often already in the mid-to-late stage by the time it is clinically diagnosed in patients with chronic liver disease. Currently, there are no therapeutic drugs that are efficacious, and the short-to medium-term mortality rate is high. Some academics have proposed establishing a term, "pre-acute-on-chronic liver failure," to denote a transitional stage for patients prior to their progress to acute-on-chronic liver failure. Early-stage intervention has been shown to effectively improve patient prognosis. This review explores the diagnostic and therapeutic aspects of pre-acute-on-chronic liver failure from recent years, with the aim to improve clinicians'' understanding and promote early-stage prevention and treatment.

Objective: To characterize the distribution of liver macrophage subsets in metabolic associated steatohepatitis (MASH) mouse models induced by methionine choline-deficient diet (MCD) and a high-fat, high-fructose, and high-cholesterol diet (HFFC), in order to provide a research basis for subsequent macrophage subset studies. Methods: MASH mouse models were induced by feeding an MCD and HFFC diet for four and sixteen weeks, respectively. Real-time fluorescence quantitative reverse transcription PCR (RT qPCR) was used to detect changes in liver inflammation and fat metabolism-related genes in MASH mice. Liver macrophages were isolated by perfusing and digesting mouse livers. Flow cytometry was used to analyze the subpopulations of liver macrophage subsets. Data between different groups was compared using t-test or one-way analysis of variance. Results: The MCD-fed diet led to the inhibition of liver fat synthesis in mice, while the HFFC-fed diet had increased liver fat synthesis in mice. However, both diets led to a decrease in embryonic Kupffer cells (EmKC) that were derived from the livers of mice. The proportion of EmKC in liver macrophages was significantly lower in the HFFC group (73.74%±7.96%) and the MCD group (39.93%±9.03%) than in the normal diet (ND) group (95.14%±1.09%). The proportion of mononuclear macrophages (MDM) in liver macrophages was significantly increased in the HFFC group (19.26%±6.94%) and the MCD group (52.38%±8.38%) compared with the ND group (2.46%±0.53%). The MCD diet led to a greater loss of EmKC and increased recruitment of monocytes. Monocyte-derived Kupffer cells (MoKC) were the main MDM subset in the livers of HFFC diet-fed mice, while lipid-associated macrophages (LAM) and their precursor CCR2+lipid-associated macrophages (C-LAM) were the main MDM subset in MCD diet-fed mice. Conclusion: The recruitment of MDM and the loss of liver EmKC can be induced by both MCD and HFFC diets; however, the composition of MDM subsets varies. The major MDM subset in the HFFC group was MoKC, while the primary MDM subsets in the MCD group were LAM and C-LAM.

Bones not only play an important role in providing structural support in the human body but also play a critical role in regulating the pathophysiological processes of various organs by secreting specific cytokines (osteokines). Growing evidence confirms the existence of extensive and close interaction between the liver and bone, known as the liver-bone axis. The regulatory role of the liver-bone axis in chronic liver diseases offers a novel research concept, particularly for understanding the complex metabolic regulatory network of metabolic dysfunction-associated fatty liver disease (MAFLD). This paper summarizes the latest advances, elucidates the bidirectional regulatory effects, and explores the roles of key factors in the liver-bone axis in MAFLD progression.