中华肝脏病杂志最新文献

Objective: To explore the effect of psoas muscle index (PMI) and construct a machine learning model to validate the 180-day prognosis in patients with decompensated liver cirrhosis. Methods: Retrospective data were collected from patients with decompensated liver cirrhosis at Henan Provincial People's Hospital from January 2022 to November 2022. The area of the psoas muscle index (PMI) at the level of the third lumbar vertebra was measured and calculated based on the abdominal X-ray computed tomography images stored in the Eastern China Hospital Information System (HIS). Patients were divided into low PMI and normal PMI groups according to the receiver operating characteristic curve. Patients clinical data and complication status were collected.The general conditions of both groups were compared using a t-test, chi-square test, and Mann-Whitney U test. The Kaplan-Meier method was applied for survival analysis. The outcome variable was 180-day mortality, and variables were selected using Cox and LASSO regression. The dataset was divided into training and testing sets in a 7∶3 ratio. Machine learning algorithms were used to build models in the training set, and model performance was validated by the test set. The model for MELD-Na score was compared with the model for End-Stage Liver Disease score. Results: A total of 298 patients with decompensated liver cirrhosis were included.The MELD scores, Child-Pugh classification, and NRS2002 scores, along with the incidence rate of complications such as ascites, hepatic encephalopathy, infections, and gastrointestinal bleeding, were significantly higher in the low PMI than the normal PMI group, with statistically significant differences (P<0.05). The area under a receiver operating characteristic curve for the extreme gradient boosting model was higher than traditional clinical scores (MELD score 0.658, MELD_Na score 0.719) in the machine learning model. Furthermore, the application of SHAP results model indicated that PMI, hemoglobin, NRS2002 score, direct bilirubin, and blood ammonia were important factors in predicting the prognosis of patients with decompensated liver cirrhosis. Conclusion: A low PMI is closely related to poorer survival rates and the development of complication rates in patients with decompensated liver cirrhosis. The machine learning prediction model based on this construction, especially extreme gradient boosting, has favorable predictive performance, which is superior to the traditional clinical scoring system and can provide patients with the most accurate risk assessment and individualized treatment plan.

Chronic hepatitis B (CHB) can gradually progress to life-threatening diseases such as cirrhosis and hepatocellular carcinoma (HCC). In recent years, with the change in people's lifestyles, the incidence rate of metabolic associated fatty liver disease has been steadily increasing and the patients combined with CHB and MAFLD has significantly surged. However, the impact of MAFLD on patients with CHB in aspects of antiviral response, clinical outcomes, and others is still controversial. This article reviews research progress on the impact of MAFLD with regard to natural course and antiviral treatment response in CHB and the survival rate in combination with CHB and MAFLD so as to provide a certain theoretical reference for prevention, diagnosis, and treatment of this disease.

Drug-induced liver injury (DILI) is an important adverse drug reaction with diverse clinical manifestations. Drug-induced autoimmune-like hepatitis (DI-ALH) is a special type of DILI possessing clinical, serological, and histological features similar to autoimmune hepatitis (AIH). However, there are significant differences between DI-ALH and AIH in terms of treatment plan, course of disease, and prognosis; therefore, differential diagnosis between DI-ALH and AIH is crucial. This article summarizes the epidemiology, pathogenesis, clinical characteristics, diagnosis and differential diagnosis, treatment, and prognosis of DI-ALH and analyzes the existing problems in order to provide guidance for the diagnosis, treatment, and future research direction.

Primary biliary cholangitis (PBC) is a type of autoimmune liver disease characterized by chronic intrahepatic cholestasis. Although portal hypertension is a common complication in patients with cirrhotic PBC, portal hypertension and its related complications can occur in the early stage of the disease, that is, before the cirrhosis onset. Therefore, early identification and long-term management are of great significance to reduce the occurrence of portal hypertension and decompensation events and improve long-term prognosis in patients with PBC. This paper focuses on the epidemiology, pathophysiological mechanism, clinical characteristics, non-invasive diagnosis, and treatment strategies for portal hypertension in early-stage PBC patients.

Copper, as a kind of trace element, is crucial for the physiological functions of various key enzymes in the body, and the liver plays a central role in maintaining copper metabolism. Theoretically, dysfunction in the body's metabolic processes, such as copper absorption, transportation, and excretion, can lead to copper deposition or deficiency in various organs. Wilson's disease's characteristic pathological manifestation is deposition of copper in liver. However, during liver pathological examinations, it has been found in clinical practice that certain patients with non-Wilson's disease and inherited metabolic liver disease may also have copper deposition. This review summarizes the inherited metabolic liver diseases that can cause liver copper deposition, their related pathogenesis, and the differential diagnosis approach from the perspectives of clinical and pathological characteristics.

Metabolic-associated fatty liver disease has become a common chronic liver disease with changes in lifestyle and the increasing prevalence rate of overweight and obesity in adults and even children. The liver synthesizes bile acids via cholesterol metabolism, which are important signaling molecules that modulate and regulate host glucose, lipid metabolism, and immunity. Abnormal bile acid metabolism closely correlates with the occurrence and progression of metabolic-associated fatty liver disease. This article systematically organizes the research of bile acid metabolism in children and adults with metabolic-associated fatty liver disease from the perspective of analyzing bile acid profiles by mass spectrometry detection, and compares the characteristics of bile acid metabolic disorders across different age groups and different developmental stages of disease so as to provide a reference for subsequent research.

The liver cancer ablation specialized disease database is an important tool for interventional practitioners to collect data and conduct scientific research for patients. This article will exemplify the application of a database for liver cancer ablation based on the establishment of a standardized structured disease database so as to elaborate its application in clinical and scientific research. The goal is to improve the management level of ablation data through the construction of specialized disease databases, providing a reference for clinical doctors and researchers in building ablation databases, and promoting the application of specialized disease databases in clinical research.

Objective: To detect the expression level and clinical significance of centromere protein I (CENPI) in hepatocellular carcinoma (HCC) and to preliminarily explore the effects of CENPI on the biological behavior of liver cancer cells and its possible molecular mechanisms. Methods: The TCGA database, real-time fluorescent quantitative polymerase chain reaction, Western blot, and immunohistochemical staining experiments were used to analyze and detect the expression differences of CENPI in liver cancer and adjacent tissues. The correlation between CENPI expression levels and clinical pathological features were analyzed in combination with clinical data from HCC patients. The value of CENPI in the diagnosis and prognosis assessment of HCC was explored by plotting receiver operating characteristic curves and Kaplan-Meier survival curves. Furthermore, we investigated the impact of CENPI overexpression on the migration and healing capabilities of liver cancer cells using Transwell and wound healing experiments. Finally, the effects of CENPI on the epithelial-mesenchymal transition process in liver cancer cells and the potential molecular mechanisms were explored using Western blot. Comparisons between two groups were analyzed using t-tests, and comparisons among multiple groups were analyzed using one-way ANOVA. The expression of CENPI and its correlation with clinical pathological features were analyzed using the 􀱽² test. Results: The TCGA database analysis showed that the expression level of CENPI was significantly higher in liver cancer tissues than adjacent tissues, which was further validated by real-time fluorescent quantitative polymerase chain reaction, Western blotting, and immunohistochemical staining experiments. Combined clinical data analysis from HCC patients demonstrated that high expression of CENPI was positively correlated with the degree of tumor malignancy, T stage, and disease prognosis. The Kaplan-Meier survival curve indicated that the 5-year survival rate was significantly lower in patients with high CENPI expression compared to those with low expression. The results of the receiver operating characteristic curve further indicated that the expression level of CENPI had accurately predicted the prognosis of liver cancer patients (area under the curve=0.962). Transwell and wound healing experiment results indicated that overexpressing CENPI in Hep3B and Huh7 cells significantly increased cell migration numbers and healing rates. Further research results showed that overexpressing CENPI significantly upregulated the expression of mesenchymal cell-related marker genes: N-cadherin, Vimentin, and Snail protein, while the expression of the epithelial cell-related marker gene E-cadherin was significantly reduced. The mechanistic study revealed that when CENPI was overexpressed, the MEK and ERK phosphorylation levels and the expres

Objective: To predict pre-treatment clinical parameters that are associated with poor response and prognosis to ursodeoxycholic acid (UDCA) in patients with primary biliary cholangitis (PBC) and to use second-line treatment drugs in the early stages to delay the progression of the disease so that patients can benefit from early-stage treatment. Methods: Patients diagnosed with PBC at the Second Affiliated Hospital of Kunming Medical University from 2013 to 2022 were collected. Two hundred fifty-seven cases were screened in accordance with the inclusion and exclusion criteria. The response and prognosis conditions one year after treatment were followed up in outpatient and inpatient departments, as well as through telephone calls. Statistical analyses were performed using t-tests, Mann-Whitney U test, 􀱽² test, Fisher's exact test, and logistic regression analysis according to different data. Results: A total of 257 PBC cases were included, with 223 females (86.80%) and 34 males (13.20%). Univariate and multivariate binary logistic regression analyses showed that baseline high albumin levels [odds ratio (OR): 0.882, 95% confidence interval (CI): 0.805～0.967, P=0.008] were a protective factor for PBC patients' response to UDCA treatment after adjusting for different confounding factors, while baseline high alkaline phosphatase (OR: 1.012, 95%CI: 1.008～1.016, P<0.001) and baseline high neutrophil/lymphocyte ratio (NLR) level (OR: 1.462, 95%CI:1.079～1.981, P=0.014) were risk factors for a poor response to UDCA. Trend analysis showed that the baseline NLR quantile was positively correlated with the risk of poor response to UDCA (OR: 5.512, 95%CI: 1.040～29.216, P=0.045) in patients with PBC. Cox proportional hazards regression analysis identified that age [hazard ratio (HR): 1.050, 95%CI: 1.019～1.082] and NLR value (HR:1.089, 95%CI:1.021～1.161) were independent influencing risk factors for all-cause mortality in PBC patients (P<0.05). Conclusion: Baseline high albumin levels are protective factors against a poor biochemical response to UDCA, while baseline high alkaline phosphatase levels and high NLR are risk factors for a poor biochemical response to UDCA in patients with PBC. Additionally, baseline high NLR values are positively correlated with poor biochemical response to UDCA treatment.

Objective: To explore the clinical characteristics and identification of the independent risk factors for disease progression in patients with anti-gp210 antibody-positive primary biliary cholangitis (PBC). Methods: A retrospective cohort study was performed. A total of 323 cases with PBC diagnosed in Tianjin Medical University General Hospital from January 2013 to June 2023 (125 patients with anti-gp210 antibody-positive and 198 patients with anti-gp210 antibody-negative) were included. Baseline and follow-up data were collected. The independent sample t-test and Mann-Whitney U rank sum test were used for comparison between groups of continuous data. The 􀱽² test was used to compare the data between groups for the count data. The Pearson test was used for correlation analysis between continuous variables. The Kaplan-Meier method was used to analyze the disease progression-free survival rate. The Cox regression model was used to analyze the risk factors for disease progression. Results: The male proportion (11.2% vs. 5.1%, P=0.040) and IgM level [3.29(1.88, 4.80) g/L vs. 2.56(1.44, 3.87) g/L, P=0.019] were significantly higher in patients with PBC with positive anti-gp210 antibodies than those of the negative group. Histopathological analysis showed that the Scheuer score [1(0,3) vs. 0(0,2)], bile duct inflammation [(2(1,3) vs. 1(1,2)] and bile duct reaction score [(2(1,3) vs. 1(1,2)] were higher in the positive group than those of the negative group (P<0.05), and the maturity of the tertiary lymphoid structure was higher (P=0.011). Kaplan-Meier analysis showed that the 5-year disease-free survival rate was significantly lower in patients with positive anti-gp210 antibodies than that of the negative group (55.8% vs. 79.7%, P=0.006) at a median follow-up of 3(2,6) years. Multivariate Cox regression analysis showed that γ-glutamyl transferase [HR=1.002 (95%CI: 1.000～1.003)] and platelet count [HR=0.993 (95%CI: 0.988～0.999)] were the independent influencing factors for disease progression in patients with anti-gp210 antibody-positive PBC (P=0.002, 0.017). Conclusion: Patients with anti-gp210 antibody-positive PBC have more severe clinical pathological manifestations and a higher risk of disease progression. Higher levels of γ-glutamyl transferase and lower platelet counts during the first visit are independent risk factors for disease progression in patients with anti-gp210 antibody-positive PBC, which can be used as dynamic monitoring indicators for this population, suggesting the need for early intensive intervention.