中华肝脏病杂志最新文献

Liver fibrosis is a common pathological process associated with multiple chronic liver diseases. Recent advancements have significantly improved the non-invasive assessment of liver fibrosis. This article focuses on the exploration of hot topics, namely how noninvasive indicators can evaluate liver fibrosis reversal and predict clinical outcomes. Concurrently, it indicates that attention should be paid to the dynamic changes of noninvasive indicators, and population screening efforts should be strengthened to achieve early diagnosis and treatment of liver fibrosis so as to improve long-term clinical outcomes.

Liver fibrosis is a key histologic marker of long-term outcome in chronic liver disease. Non-invasive tests (NITs) have been shown to have predictive value, but the superiority of "dynamic" versus "static" assessment remains controversial. This article systematically reviews the latest evidence to elucidate the association between longitudinal changes in NITs and hepatic adverse events and assess the incremental contribution of dynamic monitoring to the model. Additionally, it reveals that the dynamic monitoring of NITs is truly superior to single evaluation, but the evidence is limited and the heterogeneity is significant. Dynamic modeling approaches for NITs require a shift from traditional parameter estimation to time-series machine learning. Future studies should make breakthroughs in disease stratification, modeling method innovation, data quality improvement, and prediction ability assessment so as to promote the transition of NITs from "static risk label" to "dynamic individualized engine," which can truly serve clinical decision-making.

Liver fibrosis is a key pathological process in the progression of chronic liver disease, and its early stage and accurate diagnosis are crucial for improving patient prognosis. In recent years, the non-invasive diagnosis of liver fibrosis has gradually shifted from the traditional model based on conventional serological indicators to an evaluation system that integrates new biomarkers and multi-omics technologies. This article systematically reviews the evolution of the serological evaluation system for non-invasive diagnosis of liver fibrosis, introduces the application progress of serological models, novel biomarkers, and the introduction of multimodal integration and artificial intelligence technology, and analyzes their advantages and limitations, with aim of providing novel ideas for achieving accurate diagnosis and assisting in clinical management of patients.

The formation of portal vein thrombosis (PVT) is one of the complications of liver cirrhosis, which is easily overlooked but is not uncommon. With the deepening research on PVT in liver cirrhosis, evidence regarding the assessment of PVT formation, treatment effectiveness, and prognostic outcomes is continually being updated. This article summarizes recent studies on predicting the formation, anticoagulation efficacy, and survival models; analyzes and evaluates the rationality, standardization, and practicality of prediction models; and compares their strengths and weaknesses to provide a reference for clinicians in the individualized management and treatment of PVT in patients with liver cirrhosis.

The Chinese Society of Hepatology of the Chinese Medical Association has invited experts in relevant fields to revise and rename the 2019 "Chinese guidelines on the management of liver cirrhosis" to "Chinese guidelines for clinical diagnosis, treatment, and management of cirrhosis (2025)". The guidelines put forward the recommendations for the clinical diagnosis and management of cirrhosis in the compensation, decompensation, and re-compensation stages, as well as for cirrhosis reversal and related complications.

Objective: To dynamically assess liver fibrosis using magnetic resonance elastography (MRE) and explore factors associated with fibrosis reversal in patients with metabolic dysfunction-associated steatohepatitis (MASH). Methods: This study included data from patients diagnosed with MASH by liver biopsy who underwent at least two MRE examinations. Patients were divided into a fibrosis reversal group and a non-reversal group according to whether MRE values decreased by 20% during follow-up. Differences in clinical data between the groups were compared using analysis of variance, the Kruskal-Wallis test, and the chi-square test. Univariate and multivariate logistic regression analyses were used to explore independent risk factors for fibrosis reversal in MASH. Results: A total of 46 cases were included in this study (mean age 50.1±12.3 years, BMI 26.1±3.1 kg/m²). Among them, the reversal group accounted for 26.1%. The rate of decrease in MRI proton density fat fraction (PDFF) was significantly higher in the reversal group (-50.0% vs. -8.1%, P=0.001) than in the non-reversal group between the two MRE examinations. The reversal group showed a more significant change rate of decreases in fasting insulin (-37.3% vs. -3.6%, P=0.011), insulin resistance index (-38.6% vs. -6.5%, P=0.044), and ALP (-24.9% vs. 0, P=0.004). Multivariate logistic regression analysis indicated that the rate of change in MRI PDFF was an independent predictor of fibrosis reversal (OR=0.96, 95% CI: 0.92-1.00, P=0.046). Conclusion: A decrease in MRI proton density fat fraction levels is independently associated with liver fibrosis reversal in MASH, suggesting that intervention targeting liver fat content may be an effective treatment strategy.

Chronic hepatitis B functional (clinical) cure is currently an important therapeutic endpoint, which significantly reduces the incidence risk of cirrhosis and liver cancer. This expert consensus focuses on key clinical issues on the basis of previous studies, systematically elaborates population stratification and stepwise treatment strategies based on patient characteristics, consolidation therapy, relapse management, long-term monitoring after serum HBsAg clearance, and optimal management for patients who have not achieved the cure goal, and formulates suitable clinical guidance recommendations tailored to the characteristics of Chinese patients, providing scientific evidence and decision-making pathways so as to further standardize and guide the practice of functional (clinical) cure of chronic hepatitis B in China.

The research and development of new drugs for metabolic dysfunction-associated steatohepatitis still leads to a high screening failure rate and low efficiency with the repeated liver biopsy as the primary endpoint. Currently, non-invasive testing has been widely used in early-stage efficacy evaluation and patient screening, and evidence of association with clinical outcomes has gradually been established, and a number of new non-invasive scoring systems are also emerging. With the accumulation of data and the improvement of standards, the research and development of new drugs for metabolic dysfunction-associated steatohepatitis is gradually moving from the "histological era" to the "non-invasive era," which is expected to profoundly change clinical trials and disease management strategies.

A partial cure, defined as HBsAg <100 IU/mL and HBV DNA below the lower limit of quantification (i.e., <10 IU/mL) at 24 weeks off-treatment, is an intermediate endpoint on the pathway to a functional cure, not a realistic goal. Patient with chronic hepatitis B achieved a partial cure have good outcomes. qHBsAg in combination with HBV RNA, hepatitis B core related antigen, LHBs, MHBs and qAnti-HBc may predict virological and clinical relapses of patients with a partial cure. The patients achieved partial cure should be monitored closely. Retreatment is necessary for patients who experience a virus-dominated hepatic flare after discontinuation of therapy, whereas it is not for those with a host-dominated flare.

Liver cirrhosis is the terminal stage of chronic liver disease. Minimizing complications of liver cirrhosis and the occurrence of liver cancer has become an important goal for liver cirrhosis treatment. The primary etiology leading to liver cirrhosis is chronic hepatitis B infection. "Dual-anti therapy" refers to the combination of anti-viral and anti-fibrosis treatment, which is the characteristic and advantage of the integration of Chinese and Western medicine. The article elaborates on the concept and strategies of "dual antibody therapy" based on evidence-based medicine and introduces the research progress in terms of representative anti-fibrotic Chinese patent medicines for reversing liver cirrhosis, reducing the occurrence of hepatocellular carcinoma, and loweri ng portal hypertension and its complications and others, revealing that dual antibody therapy can clinically facilitate dual reduction" (reducing both liver cancer and complications of cirrhosis). Additionally, it analyzes and summarizes the mechanism of action of anti-fibrotic Chinese patent medicines and prospects of a new model of liver cirrhosis treatment combining Chinese and Western medicine, thereby providing novel ideas for the prevention and treatment of clinical liver diseases.