Yu He, Hong Nie, Jian Shen, Shuai Zhang, Binyan Zhong, Xiaoli Zhu
{"title":"Endovascular embolization for upper gastrointestinal bleeding due to portal hypertension caused by a superior mesenteric arteriovenous fistula","authors":"Yu He, Hong Nie, Jian Shen, Shuai Zhang, Binyan Zhong, Xiaoli Zhu","doi":"10.1002/poh2.69","DOIUrl":"https://doi.org/10.1002/poh2.69","url":null,"abstract":"","PeriodicalId":506204,"journal":{"name":"Portal Hypertension & Cirrhosis","volume":"12 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140433553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although useful for distinguishing drug‐induced liver injury (DILI) from autoimmune hepatitis (AIH), liver biopsy is an invasive examination, and the presence of antinuclear antibody (ANA) positivity in patients with DILI could lead to excessive use of biopsy. Hence, we aimed to identify screening markers for histological features of AIH in patients with ANA‐positive DILI and verify their clinical outcomes after 1 year.This retrospective study included patients with ANA‐positive DILI, who underwent liver biopsy between January 2017 and April 2022. Two pathologists identified histological features of AIH. We detected the independent indicators associated with histological features of AIH using logistic regression. We evaluated their diagnostic ability for histological features of AIH using the receiver operating characteristic curve. The follow‐up period to determine clinical outcomes was 1 year after DILI onset. The χ2 test or Fisher's exact test was used to compare categorical data and the Wilcoxon rank‐sum test was used to compare continuous variables. Two‐sided p < 0.05 was considered to indicate significance.The final analysis included 125 patients with ANA‐positive DILI, of whom 18 had AIH‐like histology. Factors independently associated with AIH‐like histology included globulin levels (odds ratio [OR] = 1.154, 95% confidence interval [CI] = 1.046–1.288; p = 0.006) and ANA titer ≥ 1:1000 (OR = 3.531, 95% CI = 1.136–11.303; p = 0.029). The optimal globulin cutoff indicating AIH‐like histology was 31.8 g/L. This globulin level in combination with ANA titer ≥ 1:1000 (area under the curve = 0.785, 95% CI = 0.738–0.832) provided a sensitivity of 100% and a specificity of 57% for indicating histological features of AIH in patients with ANA‐positive DILI. During follow‐up, more patients developed AIH in the group with AIH‐like histology than in the group without AIH‐like histology (35.3% vs. 0, p < 0.001).For patients with ANA‐positive DILI and ANA titer ≥ 1:1000 or globulin ≥ 31.8 g/L, liver biopsy is recommended to determine the presence of histological features of AIH and guide further monitoring.
虽然肝活检有助于区分药物性肝损伤（DILI）和自身免疫性肝炎（AIH），但肝活检是一种侵入性检查，而DILI患者出现抗核抗体（ANA）阳性可能会导致过度使用活检。因此，我们旨在确定 ANA 阳性 DILI 患者 AIH 组织学特征的筛查标志物，并验证他们 1 年后的临床结果。这项回顾性研究纳入了 2017 年 1 月至 2022 年 4 月间接受肝活检的 ANA 阳性 DILI 患者。两名病理学家确定了AIH的组织学特征。我们使用逻辑回归法检测了与AIH组织学特征相关的独立指标。我们使用接收者操作特征曲线评估了他们对 AIH 组织学特征的诊断能力。确定临床结果的随访期为 DILI 发病后 1 年。χ2检验或费雪精确检验用于比较分类数据，Wilcoxon秩和检验用于比较连续变量。最终分析包括125名ANA阳性的DILI患者，其中18人具有AIH样组织学。与AIH样组织学独立相关的因素包括球蛋白水平（几率比[OR]=1.154，95%置信区间[CI]=1.046-1.288；P=0.006）和ANA滴度≥1:1000（OR=3.531，95% CI=1.136-11.303；P=0.029）。表明 AIH 样组织学的最佳球蛋白临界值为 31.8 克/升。该球蛋白水平与 ANA 滴度≥ 1:1000（曲线下面积 = 0.785，95% CI = 0.738-0.832）相结合，可使 ANA 阳性 DILI 患者 AIH 组织学特征的敏感性达到 100%，特异性达到 57%。对于ANA阳性DILI且ANA滴度≥1:1000或球蛋白≥31.8 g/L的患者，建议进行肝活检以确定是否存在AIH的组织学特征并指导进一步的监测。
{"title":"Serum markers for detecting histological features of autoimmune hepatitis and predicting prognosis in patients with antinuclear antibody‐positive drug‐induced liver injury","authors":"Feiyu Zhang, Meishan Jin, Hongqin Xu, Peng Xiao, Yanhang Gao","doi":"10.1002/poh2.71","DOIUrl":"https://doi.org/10.1002/poh2.71","url":null,"abstract":"Although useful for distinguishing drug‐induced liver injury (DILI) from autoimmune hepatitis (AIH), liver biopsy is an invasive examination, and the presence of antinuclear antibody (ANA) positivity in patients with DILI could lead to excessive use of biopsy. Hence, we aimed to identify screening markers for histological features of AIH in patients with ANA‐positive DILI and verify their clinical outcomes after 1 year.This retrospective study included patients with ANA‐positive DILI, who underwent liver biopsy between January 2017 and April 2022. Two pathologists identified histological features of AIH. We detected the independent indicators associated with histological features of AIH using logistic regression. We evaluated their diagnostic ability for histological features of AIH using the receiver operating characteristic curve. The follow‐up period to determine clinical outcomes was 1 year after DILI onset. The χ2 test or Fisher's exact test was used to compare categorical data and the Wilcoxon rank‐sum test was used to compare continuous variables. Two‐sided p < 0.05 was considered to indicate significance.The final analysis included 125 patients with ANA‐positive DILI, of whom 18 had AIH‐like histology. Factors independently associated with AIH‐like histology included globulin levels (odds ratio [OR] = 1.154, 95% confidence interval [CI] = 1.046–1.288; p = 0.006) and ANA titer ≥ 1:1000 (OR = 3.531, 95% CI = 1.136–11.303; p = 0.029). The optimal globulin cutoff indicating AIH‐like histology was 31.8 g/L. This globulin level in combination with ANA titer ≥ 1:1000 (area under the curve = 0.785, 95% CI = 0.738–0.832) provided a sensitivity of 100% and a specificity of 57% for indicating histological features of AIH in patients with ANA‐positive DILI. During follow‐up, more patients developed AIH in the group with AIH‐like histology than in the group without AIH‐like histology (35.3% vs. 0, p < 0.001).For patients with ANA‐positive DILI and ANA titer ≥ 1:1000 or globulin ≥ 31.8 g/L, liver biopsy is recommended to determine the presence of histological features of AIH and guide further monitoring.","PeriodicalId":506204,"journal":{"name":"Portal Hypertension & Cirrhosis","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140443380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Surveys and research on the applications of the hepatic venous pressure gradient (HVPG) are important for understanding the current status and future development of this technology in China. This article aimed to investigate the status of hepatic venous pressure gradient measurement in China in 2022.We investigated the overall status of HVPG technology in China—including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications, and current challenges by using online questionnaire. By counting the number and percentages of cases of these results, we hope to clarify the current status of HVPG measurements in China.According to the survey, 85 hospitals in China used HVPG technology in 2022 distributed across 29 provinces. A total of 4989 HVPG measurements were performed in all of the surveyed hospitals in 2022, of which 2813 cases (56.4%) were measured alone. The average cost of HVPG measurement was 5646.8 ± 2327.9 CNY. Of the clinical teams who performed the measurements (sometimes multiple per hospital), 94.3% (82/87) used the balloon method, and the majority of the teams (72.4%, 63/87) used embolectomy catheters.This survey clarified the clinical application status of HVPG in China and confirmed that some medical institutions in China have established a foundation for this technology. It is still necessary to continue promoting and popularizing this technology in the future.
{"title":"One‐year status of hepatic venous pressure gradient measurement from 85 hospitals in China","authors":"Jitao Wang, Ting Cui, Linpeng Zhang, Zhiping Yan, Lei Li, Jinjun Chen, Junhui Sun, Hua Xiang, He Zhu, Hao Wu, Jiancuo Gengzang, Feng Zhang, Wei Wu, Guohong Cao, Wuhua Guo, Haibin Shi, Hui Xue, Guangjun Huang, Qiang Yu, M. Niu, Huiling Xiang, Derun Kong, Wei Gou, Xuefeng Luo, Fuliang He, M. Yuan, Wei Liu, Yong Wang, Hongjie Hu, Xiaoliang Zhu, Tao Yu, Qinxue Sun, Wei Qu, Ting Lu, Deqiang Ma, Li Zhang, Jun Ma, Jun Yang, Ketao Mu, Xiaoliang Zhu, Kai Xiong, Huiguo Ding, Shengjuan Yao, Mingsheng Huang, Fang Wang, Zexin Wang, Yong Huang, Jianan Li, Hongfeng Yi, Birun Huang, Zhongwei Zhao, Duiping Feng, Yanming Lei, Changlong Hou, Wen-Liang Guo, Shirong Liu, Gao-Yun Teng, Kangshun Zhu, Fan Wu, Xiaogang Hu, Wenfeng Zhang, Shao-bing Yang, Zhouchao Hu, P. Pang, S. Zhuang, Weidong Wang, Q. Zhu, Kunpeng Zhang, Chengyu Liu, Dongliang Li, Chao Ma, Hong Jiang, Xingong Zhao, W. Ren, Zhiwei Wang, Lei Yu, Fuhuang Lin, Chaoguang Yan, Feng Wang, Lei Yu, Hui Huan, Wenyong Shen, Shaofei He, Chengda Zhang, Jin Bao, Jiangtao Liu,","doi":"10.1002/poh2.68","DOIUrl":"https://doi.org/10.1002/poh2.68","url":null,"abstract":"Surveys and research on the applications of the hepatic venous pressure gradient (HVPG) are important for understanding the current status and future development of this technology in China. This article aimed to investigate the status of hepatic venous pressure gradient measurement in China in 2022.We investigated the overall status of HVPG technology in China—including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications, and current challenges by using online questionnaire. By counting the number and percentages of cases of these results, we hope to clarify the current status of HVPG measurements in China.According to the survey, 85 hospitals in China used HVPG technology in 2022 distributed across 29 provinces. A total of 4989 HVPG measurements were performed in all of the surveyed hospitals in 2022, of which 2813 cases (56.4%) were measured alone. The average cost of HVPG measurement was 5646.8 ± 2327.9 CNY. Of the clinical teams who performed the measurements (sometimes multiple per hospital), 94.3% (82/87) used the balloon method, and the majority of the teams (72.4%, 63/87) used embolectomy catheters.This survey clarified the clinical application status of HVPG in China and confirmed that some medical institutions in China have established a foundation for this technology. It is still necessary to continue promoting and popularizing this technology in the future.","PeriodicalId":506204,"journal":{"name":"Portal Hypertension & Cirrhosis","volume":"591 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140446611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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