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Tempol Alters Antioxidant Enzyme Function, Modulates Multiple Genes Expression, and Ameliorates Hepatic and Renal Impairment in Carbon Tetrachloride (CCl4)-Intoxicated Rats Tempol改变四氯化碳(CCl4)中毒大鼠的抗氧化酶功能,调节多基因表达,改善肝肾功能损害
Pub Date : 2023-03-08 DOI: 10.3390/livers3010010
Ishrat Jahan, Md. Didarul Islam, Sumaia Sarif, Israt Jahan Amena, Asif Ul Haque Shuvo, N. Akter, F. I. Chowdhury, R. Akter, Iqbal Ahmed, Ferdous Khan, Nusrat Subhan, Md. Ashraful Alam
The purpose of this study was to determine the effect of the superoxide dismutase mimic compound “tempol” on liver and renal damage in Long Evans male rats administered with carbon tetrachloride (CCl4). Methods: The antioxidant enzyme activity and oxidative stress parameters were investigated in the liver, kidney, and plasma tissues. Histological examination of the liver and kidney sections affirmed inflammatory cell infiltration, collagen deposition, and iron deposition. RT-PCR was also employed to evaluate the expression of oxidative stress and inflammatory genes. Results: The CCl4-administered rats exhibited increased plasma activities of ALT, AST, and ALP compared to the control rats. The tempol treatment in the CCl4-administered rats significantly lowered ALT, AST, and ALP enzyme activities compared to the CCl4 group. Oxidative stress parameters, such as the MDA, NO, and APOP levels in various tissues of the CCl4-administered rats, showed increased concentrations, whereas tempol significantly lowered the level of oxidative stress. Moreover, CCl4 administration decreased the antioxidant enzyme activities, which were further significantly restored by the tempol treatment. The control rats that underwent treatment with tempol did not present with any abnormality or toxicity. Furthermore, the tempol treatment in the CCl4-administered rats increased Nrf-2-HO-1-mediated gene expression and enhanced related antioxidant enzyme gene expressions. The tempol treatment in the CCl4-administered rats also decreased anti-inflammatory gene expressions in the liver. In histological sections of the liver, CCl4 increased inflammatory cell infiltration, collagen deposition, and iron deposition, which were reduced significantly due to the tempol treatment. Conclusion: The results of this investigation revealed that tempol could protect against liver and kidney damage in CCl4-administered rats by modulating antioxidant gene expressions and restoring antioxidant defense mechanisms.
本研究的目的是确定超氧化物歧化酶模拟化合物“丹波尔”对服用四氯化碳(CCl4)的Long-Evans雄性大鼠肝脏和肾脏损伤的影响。方法:检测肝、肾和血浆组织中抗氧化酶活性和氧化应激参数。肝和肾切片的组织学检查证实了炎症细胞浸润、胶原沉积和铁沉积。RT-PCR也用于评估氧化应激和炎症基因的表达。结果:与对照大鼠相比,CCl4给药大鼠的ALT、AST和ALP活性增加。与CCl4组相比,CCl4给药大鼠的天妇罗治疗显著降低了ALT、AST和ALP酶活性。氧化应激参数,如CCl4给药大鼠各种组织中的MDA、NO和APOP水平,显示浓度增加,而丹波醇显著降低了氧化应激水平。此外,CCl4给药降低了抗氧化酶活性,而天妇罗处理进一步显著恢复了抗氧化酶的活性。接受天妇罗治疗的对照大鼠没有出现任何异常或毒性。此外,在CCl4给药的大鼠中,坦波尔处理增加了Nrf-2-HO-1介导的基因表达,并增强了相关的抗氧化酶基因表达。在CCl4给药的大鼠中,坦波尔治疗也降低了肝脏中抗炎基因的表达。在肝脏的组织学切片中,CCl4增加了炎症细胞浸润、胶原沉积和铁沉积,这些都因天妇罗治疗而显著减少。结论:天妇罗通过调节抗氧化基因表达和恢复抗氧化防御机制,对CCl4给药大鼠的肝肾损伤具有保护作用。
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引用次数: 0
Single Center Experience of Oral Vancomycin Therapy in Young Patients with Primary Sclerosing Cholangitis: A Case Series 口服万古霉素治疗原发性硬化性胆管炎的单中心经验:一个病例系列
Pub Date : 2023-03-06 DOI: 10.3390/livers3010009
Amala J. Alenchery, Sophia Patel, L. Mahajan, J. Kurowski, S. Worley, V. Hupertz, Kaddakal Radhakrishnan, M. Kabbany
There is no single proven therapy that prolongs hepatic transplant-free survival in patients with primary sclerosing cholangitis (PSC). Oral vancomycin (OV) has shown some benefit in small pediatric and adult series. We describe the effect of OV on pediatric onset PSC at our tertiary hospital. This is a single-center, retrospective, descriptive case series involving patients (<21 years at diagnosis) with PSC on OV from 2001 till 2021. The therapy effect was assessed based on symptoms, biochemical labs, imaging and liver biopsy at six and twelve months, and then annually until therapy was discontinued. The inclusion criteria identified 17 patients. Baseline GGT (n = 17) was elevated among 88.2% which then normalized among 53.8% (n = 13) at six months and 55.6% (n = 9) at one year post-OV. Baseline ALT normalized in 58.8% (n = 17) at six months and 42.8% (n = 14) at one year. Imaging findings within one year of OV revealed improved/stable biliary findings among 66.7% (n = 8/12). No adverse events were reported. OV was associated with an improvement in bile duct injury marker (GGT) after at least six months of therapy, with no disease progression on imaging within one year of therapy.
没有一种单一的治疗方法可以延长原发性硬化性胆管炎(PSC)患者的无肝移植生存期。口服万古霉素(OV)在小型儿科和成人系列中显示出一些益处。我们描述了在我们的三级医院OV对儿科发病PSC的影响。这是一个单中心、回顾性、描述性的病例系列,涉及2001年至2021年OV PSC患者(诊断时<21岁)。在6个月和12个月时,根据症状、生化实验室、影像学和肝活检来评估治疗效果,然后每年评估一次,直到停止治疗。纳入标准确定了17名患者。基线GGT(n=17)在88.2%中升高,然后在OV后6个月时在53.8%(n=13)和1年时在55.6%(n=9)中正常化。基线ALT在6个月时正常化58.8%(n=17),在1年时正常化42.8%(n=14)。OV一年内的影像学检查结果显示,66.7%(n=8/12)的胆道检查结果改善/稳定。未报告不良事件。OV与治疗至少六个月后胆管损伤标志物(GGT)的改善有关,在治疗一年内影像学上没有疾病进展。
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引用次数: 0
Acetaminophen-Induced Hepatotoxicity in Obesity and Nonalcoholic Fatty Liver Disease: A Critical Review. 对乙酰氨基酚引起的肥胖和非酒精性脂肪性肝病的肝毒性:一项重要综述
Pub Date : 2023-03-01 DOI: 10.3390/livers3010003
Karima Begriche, Clémence Penhoat, Pénélope Bernabeu-Gentey, Julie Massart, Bernard Fromenty

The epidemic of obesity, type 2 diabetes and nonalcoholic liver disease (NAFLD) favors drug consumption, which augments the risk of adverse events including liver injury. For more than 30 years, a series of experimental and clinical investigations reported or suggested that the common pain reliever acetaminophen (APAP) could be more hepatotoxic in obesity and related metabolic diseases, at least after an overdose. Nonetheless, several investigations did not reproduce these data. This discrepancy might come from the extent of obesity and steatosis, accumulation of specific lipid species, mitochondrial dysfunction and diabetes-related parameters such as ketonemia and hyperglycemia. Among these factors, some of them seem pivotal for the induction of cytochrome P450 2E1 (CYP2E1), which favors the conversion of APAP to the toxic metabolite N-acetyl-p-benzoquinone imine (NAPQI). In contrast, other factors might explain why obesity and NAFLD are not always associated with more frequent or more severe APAP-induced acute hepatotoxicity, such as increased volume of distribution in the body, higher hepatic glucuronidation and reduced CYP3A4 activity. Accordingly, the occurrence and outcome of APAP-induced liver injury in an obese individual with NAFLD would depend on a delicate balance between metabolic factors that augment the generation of NAPQI and others that can mitigate hepatotoxicity.

肥胖、2型糖尿病和非酒精性肝病(NAFLD)的流行有利于药物消费,这增加了包括肝损伤在内的不良事件的风险。30多年来,一系列实验和临床研究报道或提示,常见的止痛药对乙酰氨基酚(APAP)在肥胖和相关代谢疾病中可能具有更大的肝毒性,至少在过量服用后是如此。尽管如此,几项调查并没有重现这些数据。这种差异可能来自肥胖和脂肪变性的程度、特定脂质种类的积累、线粒体功能障碍和糖尿病相关参数(如酮血症和高血糖)。在这些因素中,其中一些似乎是诱导细胞色素P450 2E1 (CYP2E1)的关键,CYP2E1有利于APAP转化为有毒代谢物n -乙酰基-对苯醌亚胺(NAPQI)。相比之下,其他因素可能解释了为什么肥胖和NAFLD并不总是与更频繁或更严重的apap诱导的急性肝毒性相关,例如体内分布体积增加、肝糖醛酸化升高和CYP3A4活性降低。因此,肥胖NAFLD患者apap诱导的肝损伤的发生和结果取决于增加NAPQI生成的代谢因子和其他可以减轻肝毒性的代谢因子之间的微妙平衡。
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引用次数: 3
Role of Genetic and Epigenetic Modifications in the Progression of Hepatocellular Carcinoma in Chronic HCV Patients 遗传和表观遗传修饰在慢性HCV患者肝细胞癌进展中的作用
Pub Date : 2023-02-20 DOI: 10.3390/livers3010008
Anum Syyam, Hira Raheem Akbar, Z. Jílková, S. Afzal
Globally, hepatocellular carcinoma (HCC) is a significant cause of mortality and morbidity among chronically infected HCV patients. It is established that HCV is a primary risk factor for HCC progression. The treatment of HCV infection has been transformed by the introduction of DAAs with high rates of virological clearance. The reduction in cirrhosis-related consequences, particularly HCC, is the long-term objective of DAAs therapy for HCV. Although the risk of developing HCC is decreased in HCV patients who achieve a disease-sustaining virological response, these patients are nevertheless at risk, especially those with severe fibrosis and cirrhosis. Previous studies have shown that HCV induce several mechanisms of hepatocarcinogenesis in the host’s hepatic micro- and macro-environment, which leads to HCC progression. In an HCV-altered environment, compensatory liver regeneration favors chromosomal instability and irreversible alterations, which encourage hepatocyte neoplastic transformation and the development of malignant clones. These mechanisms involve a series of genetic and epigenetic modifications including host genetic factors, dysregulation of several signaling pathways, histone, and DNA modifications including methylation and acetylation. This review highlights the genetic and epigenetic factors that lead to the development of HCC in chronic HCV-infected individuals and can be targeted for earlier HCC diagnosis and prevention.
在全球范围内,肝细胞癌(HCC)是慢性感染HCV患者死亡率和发病率的重要原因。已经确定HCV是HCC进展的主要危险因素。通过引入具有高病毒学清除率的DAAs,HCV感染的治疗已经发生了转变。减少肝硬化相关后果,特别是HCC,是DAAs治疗HCV的长期目标。尽管获得持续疾病病毒学应答的HCV患者发生HCC的风险降低,但这些患者仍有风险,尤其是那些患有严重纤维化和肝硬化的患者。先前的研究表明,HCV在宿主的肝脏微观和宏观环境中诱导多种肝癌发生机制,从而导致HCC的进展。在HCV改变的环境中,代偿性肝脏再生有利于染色体不稳定和不可逆的改变,这有助于肝细胞肿瘤转化和恶性克隆的发展。这些机制涉及一系列遗传和表观遗传学修饰,包括宿主遗传因子、几种信号通路的失调、组蛋白和DNA修饰,包括甲基化和乙酰化。这篇综述强调了导致慢性HCV感染者发生HCC的遗传和表观遗传学因素,可用于早期HCC诊断和预防。
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引用次数: 0
Liver Transplantation and dd-cfDNA: A Small Solution for a Big Problem 肝移植和dd-cfDNA:大问题的小解决方案
Pub Date : 2023-02-20 DOI: 10.3390/livers3010007
E. Avramidou, S. Vasileiadou, N. Antoniadis, G. Katsanos, Athanasios Kofinas, K. Karakasi, G. Tsoulfas
Dd-cfDNA is a novel biomarker with many diagnostic applications in various areas of medicine. In this review of the literature, we investigate its role in the diagnosis of many complications that occur in liver transplantations. In our review, we retrieved data from the medical databases PubMed and Scopus. In our bibliography, many areas concerning the contributions of dd-cfDNA to the field of liver transplantation, such as in the diagnosis of complications that include signsof rejection or graft injury, are mentioned. Dd-cfDNA, which are correlated with other biomarkers such as liver enzymes, can have a high diagnostic value. Measurements of Dd-cfDNA also depend on the graft’s size and origin; therefore, these data should be taken into account for the estimation and explanation of dd-cfDNA values. Despite the utility of this novel diagnostic technique, it comes with some limitations and applicational exclusions, such as cases where there is a blood relation between the donor and recipient.
Dd-cfDNA是一种新型的生物标志物,在医学的各个领域都有许多诊断应用。在这篇文献综述中,我们探讨了它在肝移植并发症诊断中的作用。在我们的综述中,我们从医学数据库PubMed和Scopus中检索数据。在我们的参考书目中,提到了许多关于dd-cfDNA对肝移植领域的贡献的领域,例如在诊断包括排斥症状或移植物损伤在内的并发症方面。Dd-cfDNA与肝酶等其他生物标志物相关,具有较高的诊断价值。Dd-cfDNA的测量也取决于移植物的大小和来源;因此,在估计和解释dd-cfDNA值时应考虑这些数据。尽管这种新的诊断技术很实用,但它也有一些限制和应用排除,比如供体和受体之间有血缘关系的情况。
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引用次数: 0
Bio-Artificial Liver Support System: A Prospective Future Therapy 生物人工肝支持系统:一种前瞻性的未来治疗方法
Pub Date : 2023-02-09 DOI: 10.3390/livers3010006
C. Jasirwan, A. Muradi, R. Antarianto
Whether acute or chronic, liver failure is a state of liver dysfunction that can progress to multiorgan failure. Mortality in liver failure patients is approximately 80–90% and is caused by detoxification failure, which triggers other immediate complications, such as encephalopathy, coagulopathy, jaundice, cholestasis, and acute kidney failure. The ideal treatment for liver failure is liver transplantation, but the long waiting period for the right donor match causes unavoidable deaths in most patients. Therefore, new therapies, such as tissue engineering, hepatocyte transplantation, and stem cells, are now being studied to anticipate the patient’s condition while waiting for liver transplantation. This literature review investigated the effectiveness of some bio-artificial liver support systems using review methods systematically from international publication sites, including PubMed, using keywords, such as bio-artificial liver, acute and chronic liver failure, extracorporeal liver support system (ECLS), MARS, single-pass albumin dialysis (SPAD). Artificial and bioartificial liver systems can show specific detoxification abilities and pathophysiological improvements in liver failure patients but cannot reach the ideal criteria for actual liver function. The liver support system must provide the metabolic and synthetic function as in the actual liver while reducing the pathophysiological changes in liver failure. Aspects of safety, cost efficiency, and practicality are also considered. Identifying the technology to produce high-quality hepatocytes on a big scale is essential as a medium to replace failing liver cells. An increase in detoxification capacity and therapeutic effectiveness must also focus on patient survival and the ability to perform liver transplantation.
无论是急性还是慢性,肝衰竭都是一种肝功能障碍状态,可发展为多器官衰竭。肝衰竭患者的死亡率约为80-90%,是由解毒失败引起的,这会引发其他直接并发症,如脑病、凝血障碍、黄疸、胆汁淤积和急性肾衰竭。肝衰竭的理想治疗方法是肝移植,但长期等待合适的供体匹配会导致大多数患者不可避免的死亡。因此,目前正在研究新的治疗方法,如组织工程、肝细胞移植和干细胞,以预测患者在等待肝移植时的病情。这篇文献综述使用国际出版物网站(包括PubMed)的综述方法,系统地研究了一些生物人工肝支持系统的有效性,使用了关键词,如生物人工肝、急性和慢性肝衰竭、体外肝支持系统(ECLS)、MARS、单程白蛋白透析(SPAD)。人工和生物人工肝系统可以在肝衰竭患者中显示出特定的解毒能力和病理生理学改善,但不能达到实际肝功能的理想标准。肝脏支持系统必须提供与实际肝脏一样的代谢和合成功能,同时减少肝衰竭的病理生理变化。还考虑了安全性、成本效益和实用性方面的问题。确定大规模生产高质量肝细胞的技术,作为替代衰竭肝细胞的培养基至关重要。提高解毒能力和治疗效果还必须关注患者的生存率和进行肝移植的能力。
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引用次数: 1
Acknowledgment to the Reviewers of Livers in 2022 对2022年《肝脏》评审者的感谢
Pub Date : 2023-01-19 DOI: 10.3390/livers3010005
High-quality academic publishing is built on rigorous peer review [...]
高质量的学术出版建立在严格的同行评审基础上〔…〕
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引用次数: 0
Lights and Shadows of Paracentesis: Is an Ultrasound Guided Approach Enough to Prevent Bleeding Complications? 穿刺的光影:超声引导的方法足以预防出血并发症吗?
Pub Date : 2023-01-16 DOI: 10.3390/livers3010004
M. Patturelli, L. Pignata, P. Venetucci, M. Guarino
Paracentesis is a validated procedure for diagnosing and managing ascites. Although paracentesis is a safe procedure with a 1–2% risk of complications such as bleeding, it is necessary to inform the patient about the possible adverse events. We would like to share our experience with two cases of bleeding after paracentesis. In our unit, two major hemorrhagic complications occurred in 162 procedures performed over the year 2020 (frequency of bleeding complications: 1.2%). We report two clinical cases of post-paracentesis abdominal wall hematomas. Despite a similar clinical presentation, the management approach was different: in the first case, embolization of the epigastric artery supplying the hematoma was performed. In the second case, conservative treatment was adopted. Our report aims to provide food for thought about a potentially challenging hemorrhagic complication, even with the risk of adverse outcomes.
穿刺术是诊断和处理腹水的有效方法。虽然穿刺术是一种安全的手术,有1-2%的并发症风险,如出血,但有必要告知患者可能发生的不良事件。我们想分享两例穿刺后出血的经验。在我们单位,在2020年进行的162例手术中发生了两种主要的出血性并发症(出血并发症的频率:1.2%)。我们报告两例穿刺后腹壁血肿的临床病例。尽管临床表现相似,但治疗方法不同:在第一例中,对供应血肿的腹壁动脉进行栓塞。第二例采用保守治疗。我们的报告旨在为考虑潜在的具有挑战性的出血性并发症提供食物,即使有不良后果的风险。
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引用次数: 0
Metabolic Associated Fatty Liver Disease as a Risk Factor for the Development of Central Nervous System Disorders 代谢相关脂肪肝是中枢神经系统疾病发展的危险因素
Pub Date : 2023-01-05 DOI: 10.3390/livers3010002
Sayuri Yoshikawa, Kurumi Taniguchi, Haruka Sawamura, Yuka Ikeda, Tomoko Asai, Ai Tsuji, Satoru Matsuda
MAFLD/NAFLD is the most ordinary liver disease categorized by hepatic steatosis with the increase of surplus fat in the liver and metabolic liver dysfunction, which is associated with bigger mortality and a high medical burden. An association between MAFLD/NAFLD and central nervous system disorders including psychological disorders has been demonstrated. Additionally, MAFLD/NAFLD has been correlated with various types of neurodegenerative disorders such as amyotrophic lateral sclerosis or Parkinson’s disease. Contrasted to healthy controls, patients with MAFLD/NAFLD have a greater prevalence risk of extrahepatic complications within multiple organs. Dietary interventions have emerged as effective strategies for MAFLD/NAFLD. The PI3K/AKT/mTOR signaling pathway involved in the regulation of Th17/Treg balance might promote the pathogenesis of several diseases including MAFLD/NAFLD. As extrahepatic complications may happen across various organs including CNS, cooperative care with individual experts is also necessary for managing patients with MAFLD/NAFLD.
MAFLD/NAFLD是最常见的肝脏疾病,以肝脏脂肪变性为分类,伴有肝脏多余脂肪增加和代谢性肝功能障碍,死亡率较高,医疗负担较高。NAFLD与中枢神经系统疾病(包括心理障碍)之间的关联已得到证实。此外,MAFLD/NAFLD与各种类型的神经退行性疾病,如肌萎缩侧索硬化症或帕金森病相关。与健康对照相比,MAFLD/NAFLD患者在多器官内出现肝外并发症的风险更高。饮食干预已成为治疗mald /NAFLD的有效策略。参与调节Th17/Treg平衡的PI3K/AKT/mTOR信号通路可能促进包括MAFLD/NAFLD在内的多种疾病的发病机制。由于肝外并发症可能发生在包括中枢神经系统在内的各个器官,因此在治疗MAFLD/NAFLD患者时,与个别专家的合作护理也是必要的。
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引用次数: 2
Support Needs and Coping Strategies in Non-Alcoholic Fatty Liver Disease (NAFLD): A Multidisciplinary Approach to Potential Unmet Challenges beyond Pharmacological Treatment 非酒精性脂肪性肝病(NAFLD)的支持需求和应对策略:药物治疗之外潜在未满足挑战的多学科方法
Pub Date : 2022-12-23 DOI: 10.3390/livers3010001
S. Shea, C. Lionis, L. Atkinson, C. Kite, Lukasz Lagojda, Surinderjeet S. Chaggar, I. Kyrou, H. Randeva
Non-alcoholic fatty liver disease (NAFLD) is the most frequently occurring chronic liver disease, affecting approximately 25–30% of the adult general population worldwide. NAFLD reflects excess hepatic accumulation of fat in the absence of increased alcohol intake, and, due to its close association with obesity, is frequently referred to as the ‘hepatic manifestation’ of metabolic syndrome. Indeed, a high percentage of individuals with NAFLD present with a combination of the cardio-metabolic comorbidities that are associated with the metabolic syndrome. In addition to its well-established link with the metabolic syndrome and increased risk for cardiovascular disease, NAFLD has also been associated with certain mental health issues (e.g., depression and stress). Although this link is now being increasingly recognized, there are still unmet needs regarding the holistic management of patients with NAFLD, which could further contribute to feelings of social isolation and loneliness. The latter conditions are also increasingly reported to pose a substantial risk to overall health and quality of life. To date, there is limited research that has explored these issues among patients with NAFLD, despite existing data which indicate that perceived loneliness and isolation may pose an additional health risk. Notably, many features associated with NAFLD have been related to these concepts, such as perceived stigma, fatigue, stress, and confusion regarding this diagnosis. As such, this review aimed to assess such potential problems faced by patients with NAFLD, and to explore the possibility of unmet support needs which could lead to perceived social isolation. Moreover, the importance of a compassionate approach towards such patients is discussed, together with potential coping strategies. Future research directions and the need for a multidisciplinary approach are also highlighted.
非酒精性脂肪性肝病(NAFLD)是最常见的慢性肝病,影响全球约25-30%的成年普通人群。NAFLD反映了在没有增加酒精摄入的情况下肝脏脂肪的过度积累,并且由于其与肥胖密切相关,通常被称为代谢综合征的“肝脏表现”。事实上,有很高比例的NAFLD患者存在与代谢综合征相关的心代谢合并症。NAFLD除了与代谢综合征和心血管疾病风险增加有明确的联系外,还与某些心理健康问题(如抑郁和压力)有关。虽然这种联系现在越来越被认识到,但在NAFLD患者的整体管理方面仍然存在未满足的需求,这可能进一步导致社会孤立和孤独感。据报道,后一种情况也越来越多地对整体健康和生活质量构成重大风险。迄今为止,在NAFLD患者中探索这些问题的研究有限,尽管现有数据表明,感知到的孤独和孤立可能会造成额外的健康风险。值得注意的是,与NAFLD相关的许多特征都与这些概念有关,例如感知到的耻辱感、疲劳、压力和对这种诊断的困惑。因此,本综述旨在评估NAFLD患者面临的这些潜在问题,并探讨未满足的支持需求可能导致感知到的社会孤立的可能性。此外,讨论了对此类患者采取富有同情心的方法的重要性,以及潜在的应对策略。指出了未来的研究方向和多学科方法的必要性。
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引用次数: 2
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Livers
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