Canadian Journal of Gastroenterology and Hepatology最新文献

Feasibility and Acceptability of Antenatal Hepatitis C Screening: A Pilot Study. 产前丙型肝炎筛查的可行性和可接受性：一项试点研究。

IF 2.7 4区医学 Q2 Medicine

Canadian Journal of Gastroenterology and Hepatology

Pub Date : 2024-08-27 eCollection Date: 2024-01-01 DOI: 10.1155/2024/7696410

Joseph Valamparampil, Jaswant Sira, Maxine Brown, Saket Singhal, Deirdre Kelly

Introduction: Hepatitis C virus (HCV) is not currently included in the United Kingdom routine antenatal screening program, but the latest guidelines from the Centers for Disease Control and Prevention, American Association for the Study of Liver Diseases, and Infectious Diseases Society of America recommend HCV screening for all pregnant women during each pregnancy. The aim of this study was to collect qualitative data on the feasibility and acceptability of antenatal HCV screening in pregnant women at the time of routine antenatal screening at 12 weeks, to estimate patient knowledge about HCV and identify the prevalence of HCV infection in antenatal women.Methods: This was a pilot study targeting a single hospital-based antenatal clinic in Birmingham, initially conducted for eight weeks with a further extension of the study period to enhance recruitment to meet the feasibility target of 500 patients. Data collected included demographic and epidemiological details. Pregnant women attending the antenatal unit were given information regarding HCV and antenatal screening for HCV prior to their initial antenatal visit. During the antenatal visit, research nurses provided further information about the study and HCV infection. Consent was obtained for taking part in the study and testing for HCV using blood samples taken at the same time as other routine antenatal screening blood tests. All women who agreed to participate in the study were asked to complete an acceptability and knowledge questionnaire. All women had HCV antibody testing as the primary screening assay. The test result was communicated in writing to the women and their general practitioner. Confirmatory positive antibody tests were followed up with quantitative HCV PCR and genotype analysis. The outcomes of testing were no evidence of HCV infection and evidence of past HCV infection or current HCV infection.Results: Five hundred and forty-nine women were approached in the antenatal clinic; 30 women refused consent while 29 women were excluded from the study (blood tests not performed after consenting, age less than 18 years, and consent form lost). Four hundred and ninety women were included in the study. The median age of the study population was 29 years (range, 18-46). Knowledge about blood-borne viruses was limited; 75% of women had some understanding about antenatal hepatitis B (HBV) and human immunodeficiency virus (HIV) testing. Previous awareness about hepatitis C was reported by 55%. Ninety-one percent of women found the information they were given about hepatitis C helpful. Ninety-six percent of the women included in this study found the counselling they received about HCV useful and felt that the delivery of this information was carried out in an acceptable manner. Once given information about HCV, 99% felt that universal screening for HCV should be implemented. HCV antibody was negative in 489 women. One pati

导言：丙型肝炎病毒（HCV）目前尚未纳入英国常规产前筛查计划，但美国疾病控制与预防中心、美国肝病研究协会和美国传染病学会的最新指南建议所有孕妇在每次怀孕期间都进行 HCV 筛查。本研究旨在收集孕妇在 12 周常规产前筛查时进行产前 HCV 筛查的可行性和可接受性的定性数据，估计患者对 HCV 的了解程度，并确定产前妇女 HCV 感染率：这是一项以伯明翰一家医院产前门诊为对象的试点研究，最初进行了八周，为达到招募 500 名患者的可行性目标，进一步延长了研究时间。收集的数据包括人口统计学和流行病学的详细信息。接受产前检查的孕妇在首次产前检查前会获得有关丙型肝炎病毒和产前丙型肝炎病毒筛查的信息。在产前检查期间，研究护士提供了有关该研究和 HCV 感染的进一步信息。在进行其他常规产前筛查血液检测的同时抽取血液样本进行 HCV 检测，并征得同意参与研究和检测。所有同意参与研究的妇女都被要求填写一份可接受性和知识问卷。所有妇女都将 HCV 抗体检测作为主要筛查方法。检测结果以书面形式告知产妇及其全科医生。对确诊为阳性的抗体检测结果进行后续的定量 HCV PCR 和基因型分析。检测结果为无证据显示感染 HCV、有证据显示既往感染过 HCV 或目前感染过 HCV：产前检查诊所共接触了 549 名妇女，其中 30 名妇女拒绝同意，29 名妇女被排除在研究之外（同意后未进行血液检测、年龄小于 18 岁、同意书遗失）。研究共纳入了 490 名妇女。研究对象的年龄中位数为 29 岁（18-46 岁不等）。对血液传播病毒的了解有限；75% 的妇女对产前乙型肝炎（HBV）和人类免疫缺陷病毒（HIV）检测有一定了解。据报告，55%的妇女对丙型肝炎有所了解。91%的妇女认为向她们提供的有关丙型肝炎的信息很有帮助。在参与本研究的妇女中，96% 的人认为她们接受的丙型肝炎病毒咨询很有用，并认为提供信息的方式是可以接受的。在获得有关丙型肝炎病毒的信息后，99% 的人认为应该对丙型肝炎病毒进行普遍筛查。489 名妇女的 HCV 抗体呈阴性。一名 HCV 抗体呈阳性的患者（发病率：0.2%）的 HCV PCR 呈阴性：结论：英国目前并不推荐产前常规筛查 HCV。我们的研究表明，产前 HCV 筛查对于大多数接受产前检查的孕妇来说是可行且可接受的。虽然孕妇对 HCV 的认知度较低，但通过适当的咨询和沟通，99% 的孕妇赞成进行 HCV 产前筛查。产前筛查可以发现 HCV 阳性的母亲，并对其婴儿进行随访，从而为受感染的母亲和婴儿提供有效的治疗，防止肝病恶化。纳入 HCV 产前筛查将完善血液传播病毒的概况，提高世卫组织在英国消除 HCV 的目标。

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引用次数: 0

Primary Care Support Tools for Digestive Health Care: A Mixed Method Study. 消化系统保健的初级保健支持工具：混合方法研究。

IF 2.7 4区医学 Q2 Medicine

Canadian Journal of Gastroenterology and Hepatology

Pub Date : 2024-07-24 eCollection Date: 2024-01-01 DOI: 10.1155/2024/6805365

Mubashir Arain, Leanne Reeb, Rebecca C Miyagishima, Julia Carter, Kerri L Novak

Background: To address the increasing demands for gastroenterology specialty care and increasing wait times, centralized access and triage (CAT) systems, telephone support, and clinical care pathways were implemented to streamline referrals and support management of low-risk gastrointestinal (GI) conditions in the primary care medical home. This study aimed to understand primary care providers (PCPs) and GI specialists' perceptions of these supports, factors that affect support implementation and identify barriers and facilitators for implementing supports from both PCP and GI specialists' perspectives.

Methods: We conducted a mixed method study including surveys and interviews with PCPs and GI specialists. Online surveys and semistructured qualitative interviews were conducted from July 2022 to September 2022. All interviews were transcribed and coded to perform a thematic analysis. Survey data were analyzed in SPSS version 25. Descriptive statistics were employed to summarize and describe the data collected. Inferential statistics were used to identify associations and relationships within the dataset. T-test and chi-square tests were applied at 95% confidence level, with a p value <0.05 (two-sided) considered statistically significant.

Results: A total of 36 PCPs responded to the survey. Most respondents were working full-time (73.5%, n = 25) and were female (73.5%, n = 25). Overall, 42% used the pathways regularly, 48% (n = 16) used them occasionally, and very few (9.1%, n = 3) said they were aware but had not used pathways. Overall, PCPs were satisfied with CAT processes and the use of primary care pathways, recognizing the importance of fair and equitable access to specialty care. Specific processes in CAT for vulnerable populations and patients using walk-in clinics were recognized as a limitation, given the lack of ease in completing the required testing and follow-up needed when utilizing the care pathway. Of the 112 GI specialists who received the survey, 28 (25%) completed it, with males (50.0%, n = 14) and females (39.2%, n = 11), remainder no response. Most participate in CAT (73.9%, n = 17) and were remunerated by an alternative relationship plan (ARP) (53.6%, n = 15). Overall, GIs were satisfied with central triaging and primary care pathways, reducing unnecessary time and resource expenditure for referrals. There were statistically significant differences in perceptions among fee for service and alternative relationship plan GI specialists regarding the effectiveness of CAT in improving access and use of health system resources.

Conclusion: Overall, PCPs and GI specialists believe utilizing CAT and primary care pathways improves referral quality, reduces resource expenditure, and provides fair and equitable access to GI specialty services. Improvement in CAT processes with i

背景：为了应对日益增长的胃肠病专科护理需求和不断增加的等待时间，实施了集中访问和分流（CAT）系统、电话支持和临床护理路径，以简化转诊并支持初级保健医疗之家对低风险胃肠病（GI）的管理。本研究旨在了解初级保健提供者（PCP）和消化道专科医生对这些支持的看法、影响支持实施的因素，并从初级保健提供者和消化道专科医生的角度找出实施支持的障碍和促进因素：我们开展了一项混合方法研究，包括对初级保健医生和消化道专家进行调查和访谈。在线调查和半结构化定性访谈于 2022 年 7 月至 2022 年 9 月进行。对所有访谈进行了转录和编码，以进行主题分析。调查数据在 SPSS 25 版本中进行分析。描述性统计用于总结和描述收集到的数据。推断统计用于确定数据集中的关联和关系。采用置信度为 95% 的 T 检验和卡方检验，P 值为结果：共有 36 名初级保健医生回复了调查。大多数受访者为全职（73.5%，n = 25）和女性（73.5%，n = 25）。总体而言，42% 的受访者经常使用路径，48%（n = 16）的受访者偶尔使用路径，极少数（9.1%，n = 3）的受访者表示知道但未使用路径。总体而言，初级保健医生对 CAT 流程和初级保健路径的使用表示满意，并认识到公平、公正地获得专科医疗服务的重要性。他们认为，CAT 中针对弱势人群和使用无预约门诊的患者的特定流程是一个局限，因为在使用护理路径时，不容易完成所需的检测和随访。在收到调查问卷的 112 名消化道专科医生中，有 28 人（25%）完成了问卷，其中男性（50.0%，n=14）和女性（39.2%，n=11）没有回复。大多数人参加了计算机辅助医疗（CAT）（73.9%，n = 17），并通过替代关系计划（ARP）获得报酬（53.6%，n = 15）。总体而言，消化内科医生对中央分流和初级医疗路径感到满意，因为这减少了转诊所需的不必要时间和资源支出。对于 CAT 在改善医疗系统资源的获取和使用方面的有效性，收费服务和替代关系计划的消化道专科医生之间的看法存在统计学上的显著差异：总体而言，初级保健医生和消化道专科医生认为，利用 CAT 和初级保健路径可提高转诊质量、减少资源支出，并提供公平、公正的消化道专科服务。通过提高对路径的认识来改进 CAT 流程，可以减少不必要的转诊。

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引用次数: 0

Long-Term Treatment with Bulevirtide in Patients with Chronic Hepatitis D and Advanced Chronic Liver Disease. 慢性 D 型肝炎和晚期慢性肝病患者长期使用布来韦肽治疗。

IF 2.7 4区医学 Q2 Medicine

Canadian Journal of Gastroenterology and Hepatology

Pub Date : 2024-07-23 eCollection Date: 2024-01-01 DOI: 10.1155/2024/2364031

Ayaz Sapuk, Leonie Steinhoff, Kristin Huenninghaus, Katharina Willuweit, Jassin Rashidi Alavijeh, Benedikt Hild, Lucia Asar, Hartmut H Schmidt, Christoph Schramm

Bulevirtide (BLV) is approved for the treatment of chronic hepatitis D (CHD). Because only limited long-term experience has been reported, we aimed to evaluate the efficacy and safety of BLV treatment in patients with advanced chronic liver disease (ACLD). We performed a retrospective analysis of patients with CHD who received BLV 2 mg/day for >12 months at a tertiary center. Virological response (VR) was defined as a reduction in hepatitis delta virus-ribonucleic acid (HDV-RNA) ≥2 log₁₀ from baseline or HDV-RNA negativity and biochemical response (BR) as gender-specific normalization of transaminases. We identified 14 patients (9 men, 5 women; median age of 48 years; interquartile range (IQR) of 37-55), of whom 12 (86%) had suggested or assumed ACLD according to Baveno VI criteria. The median duration of BLV treatment was 26 months (IQR 17-27). During treatment, the mean HDV-RNA level decreased from log₁₀ 5.58 IU/ml to levels between log₁₀ 2.19 IU/ml and log₁₀ 3.19 IU/ml. HDV-RNA negativity was achieved in up to 63% after 24 months. VR and BR were 86% and 43% after 12 months, 90% and 60% after 18 months, 75% and 75% after 24 months, and 100% and 50% after 30 months, respectively. Two nonpersisting viral breakthroughs were observed after 24 months of treatment. The Child Pugh score and model of end-stage liver disease (MELD) scores remained stable or improved in 12 patients (86%). Only one patient developed hepatic decompensation after 24 months of treatment with ascites requiring large-volume paracentesis which was not associated with viral breakthrough, portal vein thrombosis, or hepatocellular carcinoma. Treatment with BLV beyond one year is effective and safe for patients with CHD and ACLD. Liver function remained stable or improved during treatment in the vast majority of patients, and only one case of hepatic decompensation occurred during a median follow-up of 26 months.

布来韦肽（BLV）被批准用于治疗慢性丁型肝炎（CHD）。由于仅有有限的长期经验报道，我们旨在评估 BLV 治疗晚期慢性肝病 (ACLD) 患者的疗效和安全性。我们对在一家三级中心接受 BLV 2 mg/天治疗超过 12 个月的 CHD 患者进行了回顾性分析。病毒学应答（VR）定义为肝炎病毒核糖核酸（HDV-RNA）比基线降低≥2 log10或 HDV-RNA 阴性，生化应答（BR）定义为转氨酶正常化的性别特异性。我们确定了 14 名患者（9 名男性，5 名女性；中位年龄为 48 岁；四分位数间距 (IQR) 为 37-55），其中 12 人（86%）根据 Baveno VI 标准提示或假定患有 ACLD。BLV治疗的中位持续时间为26个月（IQR为17-27）。治疗期间，HDV-RNA 的平均水平从 log10 5.58 IU/ml 降至 log10 2.19 IU/ml 至 log10 3.19 IU/ml 之间。24 个月后，HDV-RNA 阴性率高达 63%。12个月后VR和BR分别为86%和43%，18个月后分别为90%和60%，24个月后分别为75%和75%，30个月后分别为100%和50%。治疗 24 个月后观察到两次非持续性病毒突破。12 名患者（86%）的 Child Pugh 评分和终末期肝病模型（MELD）评分保持稳定或有所改善。只有一名患者在治疗 24 个月后出现肝功能失代偿，并伴有腹水，需要进行大容量腹腔穿刺术，这与病毒突破、门静脉血栓或肝细胞癌无关。对患有心脏病和 ACLD 的患者来说，BLV 一年以上的治疗是有效和安全的。绝大多数患者的肝功能在治疗期间保持稳定或有所改善，在中位随访 26 个月期间仅有一例出现肝功能失代偿。

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引用次数: 0

Wulingsan Alleviates MAFLD by Activating Autophagy via Regulating the AMPK/mTOR/ULK1 Signaling Pathway. 五灵脂通过调节AMPK/mTOR/ULK1信号通路激活自噬作用缓解MAFLD

IF 2.7 4区医学 Q2 Medicine

Canadian Journal of Gastroenterology and Hepatology

Pub Date : 2024-07-13 eCollection Date: 2024-01-01 DOI: 10.1155/2024/9777866

Yaning Biao, Dantong Li, Yixin Zhang, Jingmiao Gao, Yi Xiao, Zehe Yu, Li Li

Here, we presented the study of the molecular mechanisms underlying the action of Wulingsan (WLS) in rats with metabolic-associated fatty liver disease (MAFLD) induced by a high-fat diet (HFD). High-performance liquid chromatography was employed to identify the chemical components of WLS. After 2 weeks of HFD induction, MAFLD rats were treated with WLS in three different doses for 6 weeks, a positive control treatment or with a vehicle. Lipid metabolism, liver function, oxidative stress, and inflammatory factors as well as pathomorphological changes in liver parenchyma were assessed in all groups. Finally, the expressions of autophagy-related markers, adenosine monophosphate-activated protein kinase (AMPK)/mechanistic target of rapamycin (mTOR)/unc-51-like kinase-1 (ULK1) signaling pathway-related genes, and proteins in liver were detected. The results revealed that WLS significantly ameliorated liver injury, the dysfunction of the lipid metabolism, the oxidative stress, and overall inflammatory status. Furthermore, WLS increased the expressions of LC3B-II, Beclin1, p-AMPK, and ULK1, along with decreased p62, p-mTOR, and sterol regulatory element-binding protein-1c levels. In conclusion, we showed that WLS is capable of alleviating HFD-induced MAFLD by improving lipid accumulation, suppressing oxidative stress and inflammation, and promoting autophagy.

在此，我们介绍了五灵散（WLS）对高脂饮食（HFD）诱导的代谢相关性脂肪肝（MAFLD）大鼠作用的分子机制研究。采用高效液相色谱法鉴定五灵散的化学成分。高脂饮食诱导 MAFLD 大鼠 2 周后，分别用三种不同剂量的 WLS、阳性对照组或药物治疗 MAFLD 大鼠 6 周。对所有组的脂质代谢、肝功能、氧化应激和炎症因子以及肝实质的病理形态学变化进行了评估。最后，检测了自噬相关标志物、单磷酸腺苷激活蛋白激酶（AMPK）/雷帕霉素机械靶标（mTOR）/unc-51样激酶-1（ULK1）信号通路相关基因和蛋白质在肝脏中的表达。结果显示，WLS能明显改善肝损伤、脂质代谢障碍、氧化应激和整体炎症状态。此外，WLS还增加了LC3B-II、Beclin1、p-AMPK和ULK1的表达，降低了p62、p-mTOR和固醇调节元件结合蛋白-1c的水平。总之，我们的研究表明，WLS 能够通过改善脂质积累、抑制氧化应激和炎症反应以及促进自噬来缓解 HFD 诱导的 MAFLD。

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引用次数: 0

Lobe-Based Hepatic Uptake Index of Gd-EOB-DTPA on Contrast-Enhanced MRI to Quantitatively Discriminate between Compensated and Decompensated Hepatitis B-Related Cirrhosis. 对比增强磁共振成像中基于肝叶的 Gd-EOB-DTPA 肝摄取指数定量区分乙肝相关肝硬化的代偿期和失代偿期

IF 2.7 4区医学 Q2 Medicine

Canadian Journal of Gastroenterology and Hepatology

Pub Date : 2024-06-21 eCollection Date: 2024-01-01 DOI: 10.1155/2024/6623848

Fulin Lu, Bangguo Tan, Yucheng Huang, Lin Xu, Changqiang Wu, Haiying Zhou, Rui Li, Xiaoming Zhang, Tianwu Chen, Hongjun Li

Purpose: To use hepatic uptake index (HUI) of liver lobes on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) to discriminate between patients with hepatitis B-related cirrhosis in compensated and decompensated statuses.

Methods: Forty-four consecutive patients with hepatitis B-related cirrhosis who underwent Gd-EOB-DTPA-enhanced MRI were divided into compensated and decompensated statuses based on clinical evaluation. Volume and signal intensity of individual lobes were retrospectively measured to calculate HUI of the right liver lobe (RHUI), medial (MHUI) and lateral (LHUI) left liver lobes, and caudate lobe (CHUI). Spearman's rank correlation analyses were performed to evaluate relationships of lobe-based HUI with Child-Pugh and model for end-stage liver disease (MELD) scoring system scores in compensated and decompensated statuses. The Mann-Whitney U-test was used to compare the lobe-based HUI between compensated and decompensated statuses. The performance of lobe-based HUI in distinguishing cirrhosis was evaluated using receiver operating characteristic (ROC) analysis, and the area under the ROC curve (AUC) was calculated as a measure of accuracy. Delong's method was used for statistical analysis to elucidate which HUI is optimal.

Results: Compensated and decompensated liver cirrhosis were confirmed in 25 (56.82%) and 19 (43.18%) patients, respectively. According to Spearman's rank correlation analysis, RHUI, MHUI, LHUI, and CHUI were all significantly associated with Child-Pugh and MELD scores (all P values <0.05). Receiver operating characteristic analysis demonstrated that among all lobe-based HUI parameters, RHUI could best perform the previous discrimination with a cut-off of 485.73 and obtain an AUC of 0.867. The AUC of RHUI improved and was significantly different from that of MHUI, LHUI, and CHUI (P = 0.03, P = 0.007, and P < 0.001, respectively, Delong's test).

Conclusions: The RHUI could help quantitatively discriminate hepatitis B-related cirrhosis between compensated and decompensated statuses.

目的：利用钆乙氧苄基二乙三胺五乙酸（Gd-EOB-DTPA）增强磁共振成像（MRI）上的肝叶摄取指数（HUI）来区分乙肝相关肝硬化患者的代偿期和失代偿期：根据临床评估结果，将连续接受 Gd-EOB-DTPA 增强 MRI 检查的 44 例乙肝相关肝硬化患者分为代偿期和失代偿期。通过回顾性测量单个肝叶的体积和信号强度，计算右肝叶（RHUI）、左肝叶内侧（MHUI）和外侧（LHUI）以及尾状叶（CHUI）的 HUI。进行斯皮尔曼等级相关分析，以评估在代偿和失代偿状态下，基于肝叶的 HUI 与 Child-Pugh 和终末期肝病模型（MELD）评分系统评分的关系。曼-惠特尼 U 检验用于比较代偿期和失代偿期的肝叶 HUI。使用接收器操作特征（ROC）分析评估了基于肝叶的 HUI 在区分肝硬化方面的性能，并计算了 ROC 曲线下面积（AUC）作为准确性的衡量标准。德隆法用于统计分析，以阐明哪种 HUI 最佳：分别有 25 例（56.82%）和 19 例（43.18%）患者确诊为肝硬化代偿期和失代偿期。根据斯皮尔曼秩相关分析，RHUI、MHUI、LHUI 和 CHUI 均与 Child-Pugh 和 MELD 评分显著相关（所有 P 值分别为 P = 0.03、P = 0.007 和 P < 0.001，德隆检验）：RHUI有助于定量区分乙肝相关肝硬化的代偿期和失代偿期。

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引用次数: 0

Clinical Outcomes of Ileostomy Closure during versus after Adjuvant Chemotherapy in Patients with Rectal Cancer 直肠癌患者在辅助化疗期间与化疗后关闭回肠造口的临床疗效对比

IF 2.7 4区医学 Q2 Medicine

Canadian Journal of Gastroenterology and Hepatology

Pub Date : 2024-03-20 DOI: 10.1155/2024/2410643

Fan He, Fuyu Yang, Chenglin Tang, Defei Chen, Dongqin Zhao, Junjie Xiong, Yu Zou, Guoquan Huang, Kun Qian

Background. Protective ileostomy can effectively prevent severe anastomotic leakage after rectal cancer surgery; however, the optimal timing for ileostomy closure during adjuvant chemotherapy remains unclear. This study aimed to explore the safety and long-term outcomes of early ileostomy closure during adjuvant chemotherapy. Method. Patients who underwent laparoscopic rectal cancer surgery combined with protective ileostomy and adjuvant chemotherapy between April 2017 and April 2021 were retrospectively evaluated. Patients were divided into an early closure group during chemotherapy (group A) and a late closure group after chemotherapy (group B). Results. A total of 215 patients were included in this study, with 115 in group A and 100 in group B. There were no significant differences in demographic and clinical characteristics between the two groups. In group A, durations of stoma status () and low anterior resection syndrome (LARS) () were shorte

背景。保护性回肠造口能有效防止直肠癌术后严重吻合口漏；然而，辅助化疗期间回肠造口关闭的最佳时机仍不明确。本研究旨在探讨辅助化疗期间尽早关闭回肠造口的安全性和长期疗效。方法。对2017年4月至2021年4月期间接受腹腔镜直肠癌手术联合保护性回肠造口术和辅助化疗的患者进行回顾性评估。患者被分为化疗期间早期闭合组（A组）和化疗后晚期闭合组（B组）。结果两组患者的人口统计学和临床特征无显著差异。在 A 组中，造口状态（）和低位前切除综合征（）的持续时间较短，直肠狭窄（）和造口相关并发症（），尤其是造口狭窄（）较少见。然而，化疗的依从性较差（）。各组之间在手术时间、术后住院时间、术后并发症、LARS 的发生率和严重程度、无病生存率和总生存率方面没有明显差异。结论早期关闭回肠造口可有效缩短造口状态持续时间、LARS持续时间、直肠狭窄和造口相关并发症，同时不会影响手术并发症和肿瘤预后。不应因辅助化疗而推迟回肠造口关闭时间。但应加强随访，以提高化疗的依从性和完整性。

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引用次数: 0

The Role of Inflammatory Biomarkers in Mediating the Effect of Inflammatory Bowel Disease on nonmalignant Digestive System Diseases: A Multivariable Mendelian Randomized Study 炎症生物标志物在调解炎症性肠病对非恶性消化系统疾病影响中的作用：多变量孟德尔随机研究

IF 2.7 4区医学 Q2 Medicine

Canadian Journal of Gastroenterology and Hepatology

Pub Date : 2024-03-18 DOI: 10.1155/2024/1266139

Shu Zhou, Qi Sun, Ning Gao, Zekai Hu, Junjun Jia, Jiangwei Song, Guocong Xu, Aiqiang Dong, Weiliang Xia, Jiafeng Wu

Background. While observation studies have shown a positive correlation between inflammatory bowel disease (IBD) and the risk of nonmalignant digestive system diseases, a definitive causal relationship has not yet been clearly established. Methods. Mendelian randomization (MR) was employed to investigate the potential causal association between genetic susceptibility to IBD and nonmalignant gastrointestinal diseases. Genetic variants were extracted as instrumental variables (IVs) from a genome-wide association study (GWAS) meta-analysis, which included 12,194 cases of Crohn’s disease (CD) and 28,072 control cases of European ancestry. The GWAS for ulcerative colitis (UC) included 12,366 UC and 33,609 control cases of European ancestry. All IVs reached genome-wide significance (GWAS value <5 × 10⁻⁸). Summary-level data for acute pancreatitis (AP), irritable bowel syndrome (IBS), gastroesophageal reflux disease, cholelithiasis, and CeD (celiac disease) were obtained from the GWAS meta-analysis and the FinnGen dataset. Summary-level data on relevant inflammatory factors were provided by the International Genetic Consortium. Univariate MR analysis was conducted using inverse variance weighting as the primary method for estimating causal effects. Multivariate MR analyses were also performed to detect possible mediators. Results. Genetic susceptibility to UC was associated with an increased risk of AP (OR = 1.08; 95% CI = 1.03–1.13; ) and IBS odds ratio (OR] = 1.07; 95% confidence interval (CI] = 1.03–1.11; (

背景。尽管观察研究显示炎症性肠病（IBD）与非恶性消化系统疾病的风险呈正相关，但尚未明确确定两者之间的因果关系。研究方法采用孟德尔随机法（MR）研究 IBD 遗传易感性与非恶性消化系统疾病之间的潜在因果关系。遗传变异是从一项全基因组关联研究（GWAS）荟萃分析中提取的工具变量（IV），该荟萃分析包括 12,194 例克罗恩病（CD）病例和 28,072 例欧洲血统对照病例。溃疡性结肠炎（UC）的 GWAS 包括 12366 例 UC 病例和 33609 例欧洲血统的对照病例。所有 IV 均达到全基因组显著性（GWAS 值为 5 × 10-8）。急性胰腺炎（AP）、肠易激综合征（IBS）、胃食管反流病、胆石症和乳糜泻（CeD）的汇总数据来自 GWAS meta 分析和 FinnGen 数据集。相关炎症因素的摘要级数据由国际遗传学联合会提供。采用反方差加权法进行单变量 MR 分析，作为估计因果效应的主要方法。还进行了多变量磁共振分析，以检测可能的中介因素。结果显示UC 遗传易感性与 AP 风险增加有关（OR = 1.08；95% CI = 1.03-1.13；），与 IBS 机率比 (OR] = 1.07；95% 置信区间 (CI] = 1.03-1.11；（）有关。就潜在的介导因素而言，白细胞介素 6（IL-6）对 UC 和 AP 之间的关联具有推动作用。没有明显证据表明 CD 会增加风险。同时，对 CD 的遗传易感性会增加 CeD 的风险（OR = 1.14；95% CI = 1.03-1.25；）。结论。证据表明，UC 与 AP 和 IBS 风险升高有关，IL-6 可能是 AP 的罪魁祸首。CD 与罹患 CeD 的风险增加有关。为评估 UC 患者（尤其是 IL-6 水平升高的患者）罹患胃肠道疾病的风险而实施的前瞻性监测计划可能值得关注。此外，AP 和 IBS 的存在可能预示着 UC 的存在。在对 CD 患者进行治疗管理时，预防 CeD 是一个重要的考虑因素。

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引用次数: 0

A Meta-Analysis of MiRNA-497 and Prognosis of Hepatocellular Carcinoma MiRNA-497与肝细胞癌预后的元分析

IF 2.7 4区医学 Q2 Medicine

Canadian Journal of Gastroenterology and Hepatology

Pub Date : 2024-03-18 DOI: 10.1155/2024/2211179

Zhiqiang Xie, Qingzhi Hao, Rongrong Zhu, Ruiping Ma

Background. Recently, microRNA-497 (miR-497) has been reported as a prognostic marker for hepatocellular carcinoma (HCC). However, there is no systematic study summarizing these data. Herein, we elucidated the prognostic role of miR497 in HCC by using meta-analysis. Methods. We systematically searched Embase, PubMed, Web of Science, and, China National Knowledge Infrastructure for relevant studies. The two researchers conducted data extraction and quality evaluation independently. We used hazard ratios (HRs), odds ratios (ORs), and their 95% confidence interval (95% CI) to evaluate the relationship between miR-497 expression level and HCC prognosis. Results. A total of 6 studies involving 457 participants were included in this meta-analysis. There was a significant association between the lower level of miR-497 expression and the shorter overall survival (HR = 2.17, 95% CI: 1.67–2.84, ). Meanwhile, patients with low miR-497 expression were more prone to vascular infiltration (OR = 2.73, 95%: 1.79–4.17,

背景。最近有报道称，microRNA-497（miR-497）是肝细胞癌（HCC）的预后标志物。然而，目前还没有系统的研究对这些数据进行总结。在此，我们通过荟萃分析阐明了 miR497 在 HCC 中的预后作用。研究方法我们系统地检索了 Embase、PubMed、Web of Science 和中国国家知识基础设施中的相关研究。两名研究人员独立进行数据提取和质量评估。我们使用危险比（HRs）、几率比（ORs）及其 95% 置信区间（95% CI）来评估 miR-497 表达水平与 HCC 预后之间的关系。研究结果本次荟萃分析共纳入了 6 项研究，涉及 457 名参与者。miR-497表达水平越低，总生存期越短（HR = 2.17，95% CI：1.67-2.84）。同时，miR-497表达水平低的患者更容易出现血管浸润（OR = 2.73，95%：1.79-4.17，）。然而，miR-497的低表达水平与TNM（肿瘤-结节-转移）分期无明显相关性（OR = 1.47，95% CI：0.17-12.49，）。结论MiR-497可作为HCC的预后生物标志物，但还需要更多的临床研究来证实这一观点。

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引用次数: 0

Hepatitis C Virus Infection and Hospital-Related Outcomes: A Systematic Review 丙型肝炎病毒感染与医院相关结果：系统回顾

IF 2.7 4区医学 Q2 Medicine

Canadian Journal of Gastroenterology and Hepatology

Pub Date : 2024-03-07 DOI: 10.1155/2024/3325609

Michelle Ng, Patrizia Maria Carrieri, Lindila Awendila, Maria Eugenia Socías, Rod Knight, Lianping Ti

Background. People living with hepatitis C infection (HCV) have a significant impact on the global healthcare system, with high rates of inpatient service use. Direct-acting antivirals (DAAs) have the potential to alleviate this burden; however, the evidence on the impact of HCV infection and hospital outcomes is undetermined. This systematic review aims to assess this research gap, including how DAAs may modify the relationship between HCV infection and hospital-related outcomes. Methods. We searched five databases up to August 2022 to identify relevant studies evaluating the impact of HCV infection on hospital-related outcomes. We created an electronic database of potentially eligible articles, removed duplicates, and then independently screened titles, abstracts, and full-text articles. Results. A total of 57 studies were included. Analysis of the included studies found an association between HCV infection and increased number of hospitalizations, length of stay, and readmissions. There was less consistent evidence of a relationship between HCV and in-hospital mortality. Only four studies examined the impact of DAAs, which showed that DAAs were associated with a reduction in hospitalizations and mortality. In the 14 studies available among people living with HIV, HCV coinfection similarly increased hospitalization, but there was less evidence for the other hospital-related outcomes. Conclusions. There is good to high-quality evidence that HCV negatively impacts hospital-related outcomes, primarily through increased hospitalizations, length of stay, and readmissions. Given the paucity of studies on the effect of DAAs on hospital outcomes, future research is needed to understand their impact on hospital-related outcomes.

背景。丙型肝炎感染者（HCV）对全球医疗保健系统产生了重大影响，其住院服务使用率很高。直接作用抗病毒药物（DAAs）有可能减轻这一负担；然而，有关 HCV 感染和住院结果影响的证据尚未确定。本系统综述旨在评估这一研究空白，包括 DAAs 如何改变 HCV 感染与医院相关结果之间的关系。方法。我们检索了截至 2022 年 8 月的五个数据库，以确定评估 HCV 感染对医院相关预后影响的相关研究。我们创建了一个潜在合格文章的电子数据库，删除了重复的文章，然后独立筛选了标题、摘要和全文。结果。共纳入 57 项研究。对纳入研究的分析发现，HCV 感染与住院次数、住院时间和再入院率的增加存在关联。关于 HCV 与院内死亡率之间关系的证据不太一致。只有四项研究考察了 DAAs 的影响，结果表明 DAAs 与住院次数和死亡率的减少有关。在针对艾滋病病毒感染者的 14 项研究中，HCV 合并感染同样会增加住院率，但其他医院相关结果的证据较少。结论。有高质量的证据表明，HCV 对医院相关结果有负面影响，主要是通过增加住院次数、住院时间和再入院率。鉴于有关 DAAs 对医院预后影响的研究较少，未来需要开展研究以了解其对医院相关预后的影响。

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引用次数: 0

Hepatitis C Attributable Healthcare Costs and Mortality among Immigrants: A Population-Based Matched Cohort Study 移民中丙型肝炎的医疗成本和死亡率：基于人口的匹配队列研究

IF 2.7 4区医学 Q2 Medicine

Canadian Journal of Gastroenterology and Hepatology

Pub Date : 2024-02-24 DOI: 10.1155/2024/5573068

Aysegul Erman, Yeva Sahakyan, Karl Everett, Christina Greenaway, Naveed Janjua, Jeffrey C. Kwong, William W. L. Wong, Hong Lu, Beate Sander

Background. Data on the economic burden of chronic hepatitis C (CHC) among immigrants are limited. Our objective was to estimate the CHC-attributable mortality and healthcare costs among immigrants in Ontario, Canada. Methods. We conducted a population-based matched cohort study among immigrants diagnosed with CHC between May 31, 2003, and December 31, 2018, using linked health administrative data. Immigrants with CHC (exposed) were matched 1 : 1 to immigrants without CHC (unexposed) using a combination of hard (index date, sex, and age) and propensity-score matching. Net costs (2020 Canadian dollars) collected from the healthcare payer perspective were calculated using a phase-of-care approach and used to estimate long-term costs adjusted for survival. Results. We matched 5,575 exposed individuals with unexposed controls, achieving a balanced match. The mean age was 47 years, and 52% was male. On average, 10.5% of exposed and 3.5% of unexposed individuals died 15 years postindex (relative risk = 2.9; 95% confidence interval (CI): 2.6–3.5). The net 30-day costs per person were $88 (95% CI: 55 to 122) for the prediagnosis, $324 (95% CI: 291 to 356) for the initial phase, $1,016 (95% CI: 900 to 1,132) for the late phase, and $975 (95% CI: −25 to 1,974) for the terminal phase. The mean net healthcare cost adjusted for survival at 15 years was $90,448. Conclusions. Compared to unexposed immigrants, immigrants infected with CHC have higher mortality rates and greater healthcare costs. These findings will support the planning of HCV elimination efforts among key risk groups in the province.

背景。有关移民中慢性丙型肝炎 (CHC) 经济负担的数据非常有限。我们的目标是估算加拿大安大略省移民中可归因于 CHC 的死亡率和医疗成本。方法。我们利用关联的健康管理数据，对 2003 年 5 月 31 日至 2018 年 12 月 31 日期间确诊为 CHC 的移民进行了基于人群的匹配队列研究。患有 CHC 的移民（暴露）与未患有 CHC 的移民 1 ：采用硬性（指数日期、性别和年龄）和倾向分数匹配相结合的方法，将患有 CHC 的移民与未患有 CHC 的移民（未暴露）进行 1 : 1 匹配。从医疗支付方角度收集的净成本（2020 年加元）采用阶段性护理方法计算，并用于估算根据存活率调整后的长期成本。结果。我们将 5,575 名暴露者与未暴露者进行了匹配，实现了均衡匹配。平均年龄为 47 岁，52% 为男性。平均而言，10.5% 的暴露者和 3.5% 的未暴露者在指数发布后 15 年死亡（相对风险 = 2.9；95% 置信区间 (CI)：2.6-3.5）。每人 30 天的净成本为：诊断前 88 美元（95% CI：55 至 122），初期 324 美元（95% CI：291 至 356），后期 1 016 美元（95% CI：900 至 1 132），末期 975 美元（95% CI：-25 至 1 974）。根据 15 年存活率调整后的平均净医疗成本为 90,448 美元。结论。与未接触过 CHC 的移民相比，感染 CHC 的移民死亡率更高，医疗成本也更高。这些发现将有助于规划在该省主要风险群体中消除丙型肝炎病毒的工作。

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