中华肝脏病杂志最新文献

With the rapid development of systemic therapy for primary hepatocellular carcinoma, how to scientifically formulate subsequent treatment strategies following first-line treatment failure has become a key issue that urgently needs to be addressed in clinical practice. In this context, developing a consensus on standardized second-line drugs that corresponds with the characteristics of patients and clinical practice in China is of significant practical importance. This consensus is based on high-level evidence-based medicine, combined with the experience of multidisciplinary experts in China, proposing unified evaluation criteria and stratified treatment recommendations for core issues such as disease progression assessment, drug resistance evaluation, and timing of switching therapy following failure of targeted therapy, immune checkpoint inhibitors, and combination therapy. In addition, it advocates for evidence-based, individualized treatment decisions that balance efficacy and safety profile, with the aim of promoting the standardization and homogenization of second-line drugs for hepatocellular carcinoma in our country, thereby providing authoritative guidance for clinical practice and effectively improving and benefiting patients' long-term survival and quality of life.

Objective: To compare and analyze the impact of key indicator dynamic change on the 90-day prognosis of patients who remain in a state of acute-on-chronic liver failure (ACLF) at 28 days so as to provide new evidence for individualized treatment. Methods: ACLF patients who visited Beijing You'an Hospital, affiliated with Capital Medical University; Tianjin Third Central Hospital; and the Fifth Medical Center of the Chinese PLA General Hospital between January 2015 and December 2023 were prospectively included. Follow-up was conducted until 90 days for patients who remained in an ACLF state at 28 days. The key clinical indicator dynamic changes were compared from baseline to 28 days, including total bilirubin (TBil) and international normalized ratio (INR) for their impact on 90-day prognosis. TBil trends were classified as recovery, improvement, and deterioration. INR trends were classified as improvement and deterioration. Patients of both groups were divided into survival and death (including liver transplantation) according to their 90-day outcomes. Continuous data were compared using independent t-tests or rank-sum tests. Categorical data were compared using χ² tests. Kaplan-Meier survival analysis was used to compare survival curves among different patient groups. Results: A total of 739 cases were included, of which 313 remained in an ACLF state at 28 days, with a 90-day survival rate of 66.1% (207/313), a liver transplantation rate of 5.1% (16/313), and a mortality rate of 28.8% (90/313). The proportion of INR deterioration was 30.9% (64/207) and 90.6% (96/106), and the improvement was 69.1% (143/207) and 9.4% (10/106) in the survival group and the death group (including liver transplantation), respectively. The proportion of TBil deterioration was 31.4% (65/207) and 71.7% (76/106) and the proportion of improvement 68.6% (142/207) and 28.3% (30/106), with statistically significant differences (P < 0.05). Univariate and multivariate Cox analyses indicated that 28-day INR deterioration [8.06 (4.07-15.95)] and TBil deterioration [3.03 (1.04-8.82)] were independent risk factors affecting 90-day mortality. The area under the curve (AUC) was higher in the INR trend than the TBil trend (0.80 vs. 0.71, P < 0.05) for predicting 90-day mortality. Conclusion: INR and TBil deterioration are independent risk factors for 90-day mortality for patients who remain in an ACLF state at 28 days. However, the INR trend has a greater impact on the 90-day prognosis compared to the TBil trend. This finding provides new insights for prognostic assessment of ACLF patients, aiding individualized treatment achievement and guiding clinicians in developing rational diagnostic and therapeutic strategies.

Objective: To assess the blood ammonia levels value for predicting survival following transjugular intrahepatic portosystemic shunt (TIPS) therapy in patients with cirrhosis. Methods: Data from 236 cirrhotic patients who underwent TIPS treatment at Nanjing Drum Tower Hospital from March 2018 to January 2020 were retrospectively collected. Data included patients' blood routine, liver and kidney function, coagulation function tests, hepatic encephalopathy status, and etiology leading to TIPS treatment at the initial admission. The Child-Turcotte-Pugh (CTP) score and the Model for End-Stage Liver Disease (MELD) score were concurrently calculated for patients' liver function. Patients were grouped into a high AMM-ULN group and a low AMM-ULN group based on the criterion of 1.4 times the upper limit of normal for calibrated ammonia levels (AMM-ULN). Postoperative follow-up information such as rebleeding of the upper gastrointestinal tract, ascites, hepatic encephalopathy, and survival-related outcomes was collected for analysis. Measurement data that did not conform to a non-normal distribution were compared using the Mann-Whitney U test. Categorical data were compared using the χ² test between the groups. Kaplan-Meier survival curves were used to plot survival rate. Cox regression models were used for univariate and multivariate analysis. Results: AMM-ULN, CTP score, and ascites were independent risk factors affecting the liver function in surviving patients with cirrhosis following TIPS (P<0.05). The 3-year survival rates for the high and low AMM-ULN groups were 66.3% and 92.4%, respectively, showing a significant statistical difference (P<0.001) in terms of survival rate. AMM-ULN was superior in terms of predicting 3-year survival rates (0.850 vs. 0.598, P<0.05) compared to the CTP score and had no significant difference compared to the MELD score models in accordance with the receiver operating characteristic curves. Conclusion: AMM-ULN is an independent predictor for cirrhotic patients who have survived following TIPS and has certain advantages in terms of predicting survival rates.

In order to effectively utilize hepatitis B information obtained during routine health checkups, a panel of experts from clinical medicine, public health, laboratory testing, and methodology reviewed the latest research findings in guidelines for hepatitis B prevention and treatment and combined with the actual situation of medical and health institutions within China to formulate the "Expert Consensus on the Management Process within Medical Institutions for Patients with Hepatitis B Virus Infection", outlining the management processes, quality control indicators, referring, diagnosis, and treatment. The implementation of this consensus is expected to increase the diagnosis and treatment rate of viral hepatitis B in Chinese medical institutions, thereby contributing to achieving the World Health Organization's 2030 goal of eliminating viral hepatitis as public health threat.

Objective: To explore the antiviral efficacy and safety profile of nucleos(t)ide analogue (NA) mono-or combination therapy with interferon-α (IFN-α) in children 1-6 years old with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB). Methods: Seventy-eight children 1-6 years old with HBeAg-positive CHB from multiple centers from November 2020 to August 2023 were enrolled as research subjects and were divided into the NA group (n=24) and the NA+IFN group (n=54) according to the antiviral treatment regimen. Oral lamivudine or entecavir and interferon-α (IFN-α) or pegylated interferon-α (PEG-IFN-α) were administered to the NA and NA+IFN groups. The HBV DNA negativity rate, HBeAg negative seroconversion rate, and HBsAg clearance rate were compared at 48 weeks between the two groups, with further stratification by 1-3 and 4-6 years old for the aforementioned comparison. An independent samples t-test or Mann-Whitney U test was used for inter-group comparison of quantitative data. The χ² test or Fisher's exact test was used for inter-group comparison of categorical data. The Benjamini-Hochberg false discovery rate (FDR) method was used for multiple comparison correction. Results: The HBV DNA negativity rate [81.82% (27/33) vs. 41.18% (7/17), P=0.004, q=0.018] and HBsAg clearance rate [36.36% (12/33) vs. 0 (0/17), P=0.004,q=0.018] were higher in the NA+IFN group than in those in the NA group at 48 weeks among children 4-6 years old (n=50), with statistically significant differences. However, there were no statistically significant differences in the HBV DNA negativity rate [57.14% (12/21) vs. 71.43% (5/7)], HBeAg negative seroconversion rate [47.62% (10/21) vs. 28.57% (2/7)], and HBsAg clearance rate [19.05%(4/21) vs. 28.57%(2/7)] for children 1-3 years old (n=28) between the NA+IFN group and the NA group. Conclusion: The antiviral efficacy of the NA+IFN combination therapy group was superior to that of the NA monotherapy group at 48 weeks in children with CHB 4-6 years old. However, there was no statistically significant difference in the efficacy of the two antiviral regimens among young children 1-3 years old, hinting that NA therapy may be a priority for young children.