中华肝脏病杂志最新文献

The article reviews the role and functional diversity of B cells in chronic hepatitis B (CHB). B cells play a crucial role in humoral immunity, participating in the clearance of hepatitis B virus (HBV) through antibody production, antigen presentation, and immune regulation. In HBV infection, B cells exhibit antigenic heterogeneity, with immune responses to different HBV antigens varying. Recent findings reveal that in CHB patients, hepatitis B surface antibody-specific B cells are abnormally differentiated, while hepatitis B core antibody-specific B cells maintain relatively intact functions. Moreover, the deficiency in non-antibody-producing functions of B cells may lead to persistent HBV infection. The article provides important insights into the role of B cells in HBV infection and offers a scientific basis for the development of new therapeutic strategies.

Acute-on-chronic liver failure (ACLF) is a kind of complex syndrome characterized by acute deterioration of liver function on the basis of chronic liver disease, accompanied by organ failure and a high mortality rate. The International Society for Hepatology has proposed different definitions, diagnostic criteria, and treatment guidelines, which have led to differences in the clinical management of ACLF and underestimated the burden of the disease. Currently, there is no specific treatment for ACLF, and the overall prognosis is still not ideal. This article profoundly explores the problems existing in the interventional studies of ACLF and provides a new perspective for in-depth research on the pathogenesis and progression, the development of new intervention measures, the promotion of personalized treatment, and the formulation of more accurate diagnostic criteria and risk prediction models.

End-stage liver disease includes liver failure and decompensated cirrhosis resulting from various etiologies and often leads to patient mortality due to complications and clinical symptoms such as severe jaundice, ascites, hepatic encephalopathy, coagulopathy, and hepatorenal syndrome. Liver transplantation is currently regarded as the most effective treatment, but its clinical application is limited by the shortage of donors, elevated expenses, and post-transplant rejection. Stem cells are a group of cells with multidirectional differentiation potential and self-renewal ability, which can improve the clinical indicator outcomes through mechanisms such as immunoregulation and promotion of tissue repair in patients with end-stage liver disease. Clinical trials of stem cell therapy have achieved a series of results for end-stage liver disease, proving the safety and effectiveness of stem cell therapy. This article reviews the clinical studies that have been registered and published at home and abroad and provides a reference for the clinical plan on stem cell therapy for end-stage liver disease.

Transarterial chemoembolization (TACE) is currently one of the commonly used treatment methods for liver malignancies. The key to ensuring its efficacy is high-quality TACE performance and management.Therefore, to further promote the quality control indicators line for TACE clinical application in the treatment of liver cancer, the National Center for Healthcare Quality Management in Comprehensive Interventional Radiology combined evidence-based medicine, expert consensus, and conditions in China to draft and formulate the "Management standards and quality control index for the clinical application of transarterial chemoembolization in the treatment of liver cancer (2024 edition)" so as to affirm the standardized, precise, and individualized application in clinical practice and improve the overall efficacy in patients with liver malignancies.

The standard clinical application and operational specifications of the double plasma molecular adsorption system are summarized into eleven parts, including the treatment principles, indications and timing selection, treatment plan formulation principles, establishment and maintenance of vascular access, anti-coagulation strategy selection, instrument alarms and handling, and the efficacy evaluation indicators in the treatment of severe liver disease.

Recently, organ support therapy for liver failure has made rapid progress in the direction of clearing bile acids, blood ammonia, and inflammatory factors. However, there is still a lack of high-level evidence-based medicine, necessitating extensive research on the pathogenesis of major subtypes of liver failure so as to explore collaborative key points of clinical research design decisions for appropriate organ support therapy.

Objective: To retrospectively analyze the dual plasma molecular adsorption system (DPMAS) treatment technology and the laboratory data before and after treatment in patients with liver failure and refractory hyperbilirubinemia, so as to provide a clinical basis for the prediction and prevention of common related complications. Method: A retrospective study was conducted on 161 cases with liver failure and 68 cases with refractory hyperbilirubinemia who underwent DPMAS treatment in our department from October 2022 to July 2024. The general clinical data characteristics, DPMAS treatment status, DPMAS-related complications, and changes in important laboratory indicators before and after the initial DPMAS treatment in both patient groups were analyzed. Results: Among the 229 enrolled cases, 82.53% were male, and the median age was 50 years. The cause of liver failure was hepatitis B virus infection in 84.47%, while hepatitis B accounted for only 51.47% in the other group. There were significant differences in platelets, creatinine, coagulation function, and inflammatory factor-related indicators between the two groups at baseline. The total number of DPMAS treatments given was 471 times. The proportion of albumin used in the initial stage of treatment was significantly higher in patients with refractory hyperbilirubinemia than that in the liver failure group, while the proportion of plasma used in the liver failure group was significantly higher (P<0.001). The most commonly used anticoagulation regimen was unfractionated heparin. A combined anticoagulation therapy regimen was used in 9.3% of the refractory hyperbilirubinemia group. The internal jugular vein was selected in nearly half of the treated cases. A peripheral vascular access pathway was the treatment option in 31.2%. The proportion of centrifugal separation was significantly higher than that of membrane separation (76.22% vs. 23.78%). The incidence rate of DPMAS-related complications was 16%. The most common complication was bleeding, including bleeding at the puncture site (accounting for 32% of the total complications) and bleeding at non-puncture sites (12%), followed by hypotension (22%), allergic reactions (13%) and infections (11%), respectively. The indexes of hemoglobin, platelets, total bilirubin, and C-reactive protein were significantly decreased within 24-48 hours after DPMAS treatment in both groups of patients. The prothrombin time and international normalized ratio were significantly increased in the liver failure group, while fibrinogen was significantly reduced. Conclusion: DPMAS clinical application is generally safe in patients with liver disease. The most common complications are bleeding, hypotension, allergic reactions, and infections, which need to be paid special attention and timely intervention to ensure the safety profile of treatment.