Annals of hepatology最新文献_第3页

Is the liver resilient to the process of ageing? 肝脏对衰老过程有抵抗力吗？

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2024-09-12 DOI: 10.1016/j.aohep.2024.101580

Nirupama Chatterjee , Rishabh Sharma , Pratibha R Kale , Nirupma Trehanpati , Gayatri Ramakrishna

The liver's unique regenerative capacity, immunotolerant feature, and polyploidy status distinguish it as a metabolic organ unlike any other in the body. Despite aging, the liver generally exhibits fewer pathological abnormalities than other organs (such as the kidney), maintaining its functions near-normal balanced manner. Subtle changes in the liver, including reduced blood flow, detoxification alterations, pseudo-capillarization, and lipofuscin deposition, may occur with chronological age. Research indicates that carefully selected liver grafts from octogenarian donors can perform well post-transplant, emphasizing instances where age doesn't necessarily compromise liver function. Notably, a recent report suggests that the liver is a youthful organ, with hepatocytes averaging an age of only 3 years.

Despite the liver's impressive regenerative capabilities and cellular reserve, a lingering question persists: how does the liver maintain its youthful characteristic amidst the chronological aging of the entire organism? The various adaptive mechanism possibly include:(a) cellular hypertrophy to maintain physiological capacity even before proliferation initiates, (b) the "ploidy conveyor" as a genetic adaptation to endure aging-related stress, (c) sustained telomere length indicative of youthfulness (d) active extracellular matrix remodelling for normal cellular functioning, (e) Mitochondria-Endoplasmic Reticulum based metabolic adaptation and (c) cellular plasticity as fitness mechanisms for healthy aging. However, it is crucial to note that aged livers may have compromised regenerative capacity and chronic liver disease is often associated with declining function due to premature hepatocyte senescence. This review delves into varied cellular adaptations sustaining liver homeostasis with chronological aging and briefly explores the role of accelerated hepatocyte aging as a precursor to chronic liver disease.

肝脏具有独特的再生能力、免疫耐受特性和多倍体状态，是人体中与众不同的代谢器官。尽管肝脏已经衰老，但与其他器官（如肾脏）相比，肝脏一般很少出现病理异常，其功能接近正常的平衡状态。随着年龄的增长，肝脏可能会发生一些微妙的变化，包括血流量减少、解毒功能改变、假性毛细血管扩张和脂褐素沉积。研究表明，经过精心挑选的八旬高龄捐献者的肝脏移植后表现良好，这说明年龄并不一定会影响肝功能。值得注意的是，最近的一份报告表明，肝脏是一个年轻的器官，肝细胞的平均年龄仅为3岁。尽管肝脏的再生能力和细胞储备令人印象深刻，但一个挥之不去的问题依然存在：在整个机体按时间顺序衰老的过程中，肝脏是如何保持其年轻特性的？各种适应机制可能包括：(a) 细胞肥大，以在增殖开始前维持生理能力；(b) "倍性输送器 "作为一种基因适应，以承受与衰老相关的压力；(c) 端粒长度的持续，表明年轻；(d) 细胞外基质的积极重塑，以维持正常的细胞功能；(e) 基于线粒体-内质网的代谢适应；(c) 细胞可塑性作为健康衰老的适应机制。然而，必须注意的是，老年肝脏的再生能力可能会受到影响，慢性肝病往往与肝细胞过早衰老导致的功能下降有关。这篇综述深入探讨了随着年龄增长维持肝脏稳态的各种细胞适应性，并简要探讨了肝细胞加速衰老作为慢性肝病前兆的作用。

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引用次数: 0

Surveillance and management of hepatocellular carcinoma after treatment of hepatitis C with direct-acting antiviral drugs 使用直接作用抗病毒药物治疗丙型肝炎后肝细胞癌的监控和管理。

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2024-09-12 DOI: 10.1016/j.aohep.2024.101582

Caiyun Yang , Fengxiang Lv , Jiaqi Yang , Dawei Ding , Lina Cui , Ying Han

Hepatitis C virus (HCV) belongs to the Flaviviridae family, and is a single-stranded RNA virus with positive polarity. It is the primary cause of hepatocellular carcinoma (HCC) worldwide. The treatment of HCV has entered a new era with the advent of direct-acting antiviral drugs (DAAs) and is associated with cure rates of more than 95 %, making HCV the only curable viral disease. The successful treatment of chronic hepatitis C has greatly reduced, but not eliminated, the risk of HCC. Certain individuals, especially those with cirrhosis already present, remain vulnerable to HCC after achieving a sustained virological response (SVR). This article systematically reviews the recent studies on the risk and mechanisms of HCC development after HCV viral cure, the screening and predictive value of biological markers, and patient surveillance. Factors such as older age, diabetes, hepatic fat accumulation, alcohol use, and lack of fibrosis reversal are linked to increased HCC risk after HCV cure. The mechanism of HCC development after DAAs treatment remains unclear, but the possible mechanisms include immune cell dysfunction during HCV infection, cytokine network imbalance, epigenetic alterations, and host factors. Several biological markers and risk prediction models have been used to monitor the risk of HCC in CHC patients who have achieved SVR, but most still require validation and standardization. The implementation of risk-stratified surveillance programs is becoming urgent from a cost-effective point of view, but the availability of validated biomarkers to predict HCC in cured patients remains an unmet clinical need. Additionally, managing CHC patients who achieve SVR is becoming a growing challenge as an increasing number of HCV patients are cured.

丙型肝炎病毒（HCV）属于黄病毒科，是一种具有正极性的单链 RNA 病毒。它是全球肝细胞癌（HCC）的主要病因。随着直接作用抗病毒药物（DAAs）的出现，HCV 的治疗进入了一个新时代，治愈率超过 95%，使 HCV 成为唯一可治愈的病毒性疾病。慢性丙型肝炎的成功治疗大大降低了患 HCC 的风险，但并没有消除这种风险。某些患者，尤其是已经出现肝硬化的患者，在获得持续病毒学应答（SVR）后仍然很容易发生 HCC。本文系统回顾了近期关于HCV病毒治愈后HCC发生的风险和机制、生物标记物的筛查和预测价值以及患者监测的研究。高龄、糖尿病、肝脏脂肪堆积、饮酒和纤维化未逆转等因素与HCV治愈后HCC风险增加有关。DAAs治疗后发生HCC的机制仍不清楚，但可能的机制包括HCV感染期间免疫细胞功能失调、细胞因子网络失衡、表观遗传学改变和宿主因素。一些生物标记物和风险预测模型已被用于监测获得 SVR 的 CHC 患者的 HCC 风险，但大多数仍需要验证和标准化。从成本效益的角度来看，实施风险分级监测计划已变得迫在眉睫，但提供有效的生物标志物来预测治愈患者的 HCC 仍是一项尚未满足的临床需求。此外，随着越来越多的 HCV 患者被治愈，如何管理获得 SVR 的 CHC 患者正成为一项日益严峻的挑战。

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引用次数: 0

Clinically significant portal hypertension in patients with primary biliary cholangitis: Clinicopathological features and prognostic value 原发性胆汁性胆管炎患者中有临床意义的门静脉高压症：临床病理特征和预后价值。

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2024-09-12 DOI: 10.1016/j.aohep.2024.101577

Ying Zhang , Huaying Lai , Jing Chen , Ruimin Lai , Xiaoyu Lin , Shan Lin , Bingping Liu , Qiuxiang Lin , Bin Wang , Qi Zheng

Introduction and Objectives

Primary biliary cholangitis (PBC) may progress to clinically significant portal hypertension (CSPH) before the development of cirrhosis. This study aimed to investigate CSPH incidence as well as the clinicopathological characteristics and predictive value of these features for the prognosis of patients with PBC, especially at early histologic stage.

Patients and Methods

Patients diagnosed with PBC between January 2013 and April 2022 were retrospectively enrolled. The prognostic value of baseline clinicopathological characteristics for long-term outcomes in PBC patients with CSPH was assessed using Kaplan–Meier survival analysis and COX regression analysis.

Results

Among 280 patients with PBC, 104 underwent liver biopsy and 68 were at early histologic stage. CSPH was present in 47.2 % of participants with 20.6 % at early histologic stage. CSPH was a risk factor for predicting the liver transplant-free survival in PBC patients (hazard ratio [HR], 6.78; 95 % CI, 2.94–15.63), especially those at early stage. Perisinusoidal fibrosis and nodular regenerative hyperplasia (NRH) were common histopathological features in PBC patients with CSPH at the early stages. Fibrous septa formation in the hepatic lobules (HR, 4.85; 95 % CI, 1.51–15.52) and cholestasis (HR, 7.70; 95 % CI, 2.56–23.18) were independent predictors of adverse outcomes.

Conclusions

CSPH indicates an increased risk of adverse outcomes in PBC patients, especially those in early histologic stage. Perisinusoidal fibrosis and NRH are valuable histological features of CSPH in patients with early-stage PBC. Identification of clinicopathological features and assessment of portal hypertension (especially at early stage), contribute to the development of personalized strategies.

引言和目的：原发性胆汁性胆管炎（PBC）在发展为肝硬化之前可能会发展为具有临床意义的门静脉高压症（CSPH）。本研究旨在调查CSPH的发生率、临床病理特征以及这些特征对PBC患者预后的预测价值，尤其是在早期组织学阶段：回顾性纳入2013年1月至2022年4月期间确诊的PBC患者。采用卡普兰-梅耶生存分析和COX回归分析评估基线临床病理特征对患有CSPH的PBC患者长期预后的影响：在280名PBC患者中，104人接受了肝活检，68人处于早期组织学阶段。47.2%的患者存在CSPH，其中20.6%处于组织学早期阶段。CSPH是预测PBC患者无肝移植存活率的一个风险因素（危险比[HR]，6.78；95 % CI，2.94-15.63），尤其是早期患者。窦周纤维化和结节性再生增生（NRH）是CSPH早期PBC患者常见的组织病理学特征。肝小叶纤维隔形成（HR，4.85；95 % CI，1.51-15.52）和胆汁淤积（HR，7.70；95 % CI，2.56-23.18）是不良预后的独立预测因素：结论：CSPH表明PBC患者，尤其是组织学早期患者出现不良预后的风险增加。在早期PBC患者中，窦周纤维化和NRH是CSPH的重要组织学特征。识别临床病理特征和评估门脉高压（尤其是早期）有助于制定个性化策略。

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引用次数: 0

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2024-09-12 DOI: 10.1016/j.aohep.2024.101567

Camila Marques de Alcântara Barreto , Eliane Almeida do Valle , Jessica Pronestino de Lima Moreira , Katia Farias e Silva , Siane Lopes Bittencourt Rosas , Patrícia Teixeira Santana , Ana Maria Pittella , Gustavo Pereira , Flavia Ferreira Fernandes , Renata de Mello Perez , Heitor Siffert Pereira de Souza

Introduction and Objectives

Microbial translocation contributes to cirrhosis progression and complications. This study aims to investigate whether molecules related to intestinal permeability or microbial translocation can serve as prognostic biomarkers in patients with decompensated cirrhosis.

Materials and Methods

We prospectively evaluated hospitalized patients with decompensated cirrhosis for liver function, complications during hospitalization, in-hospital mortality, composite outcomes of in-hospital mortality and complications, 12-month mortality, and survival rates. Blood samples were collected upon admission, and 1,3 beta-d-glucan, zonulin, calprotectin, and lipopolysaccharide-binding protein were measured using commercial kits.

Results

Ninety-one patients with decompensated cirrhosis were enrolled. The mean age was 58 ± 12 years; 57% were male. The three main cirrhosis etiologies were hepatitis C (35%), alcohol (25%), and non-alcoholic steatohepatitis (17%). In terms of liver function, 52% were Child C, and 68% had model for end-stage liver disease ≥15. The in-hospital and one-year mortality rates were 31% and 57%, respectively. Child-Pugh, 1,3 beta-glucan, and model for end-stage liver disease were positively correlated; zonulin was associated with complications during hospitalization (acute kidney injury) and composite outcomes, and calprotectin was associated with all outcomes except 12-month mortality.

Conclusions

Serum calprotectin and zonulin levels emerge as noninvasive prognostic biomarkers for potentially unfavorable outcomes in patients with decompensated cirrhosis.

导言和目的：微生物易位导致肝硬化进展和并发症。本研究旨在探讨与肠道通透性或微生物转运相关的分子能否作为失代偿期肝硬化患者的预后生物标志物：我们对肝硬化失代偿期住院患者的肝功能、住院期间并发症、院内死亡率、院内死亡率和并发症的综合结果、12个月死亡率和存活率进行了前瞻性评估。入院时采集血液样本，使用商业试剂盒测定1,3β-d-葡聚糖、zonulin、钙蛋白和脂多糖结合蛋白：结果：共招募了 91 名失代偿期肝硬化患者。平均年龄为 58 ± 12 岁，57% 为男性。肝硬化的三种主要病因是丙型肝炎（35%）、酒精（25%）和非酒精性脂肪性肝炎（17%）。就肝功能而言，52%的患者为Child C，68%的患者的终末期肝病模型≥15。院内死亡率和一年死亡率分别为31%和57%。Child-Pugh、1,3 β-葡聚糖和终末期肝病模型呈正相关；zonulin与住院期间的并发症（急性肾损伤）和综合结果相关，而钙蛋白与除12个月死亡率以外的所有结果相关：结论：血清钙蛋白和 zonulin 水平是肝硬化失代偿期患者潜在不利预后的无创预后生物标志物。

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引用次数: 0

Characterizing outcomes in a large cohort of latinx patients with autoimmune hepatitis 大型拉丁裔自体免疫性肝炎患者群体的治疗效果特征。

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2024-09-12 DOI: 10.1016/j.aohep.2024.101570

Eleanor Belilos , Jessica Strzepka , Ethan Ritz , Nancy Reau , Costica Aloman

Introduction and Objectives

This study aimed to characterize a large cohort of Latinx patients with autoimmune hepatitis (AIH) and analyze clinical outcomes, including biochemical remission, duration of steroid treatment, fibrosis regression, and incidence of clinical endpoints (hepatic decompensation, need for liver transplant, and death).

Materials and Methods

This was a retrospective descriptive study of patients with biopsy proven AIH (2009–2019) at a single urban center. Demographics, medical comorbidities, histology, treatment course, biochemical markers, fibrosis using dynamic non-invasive testing (NIT), and clinical outcomes at three months and at one, two, and three years were analyzed.

Results

121 adult patients with biopsy-proven AIH were included: 43 Latinx (35.5%) and 78 non-Latinx (65.5%). Latinx patients were more likely to have metabolic dysfunction-associated steatotic liver disease (MASLD) (p = 0.004), and had higher Fibrosis-4 (FIB-4) (p = 0.0279) and AST-to-Platelet-Ratio-Index (APRI) (p = 0.005) at one year. Latinx patients took longer to reach biochemical remission than non-Hispanic Whites (p = 0.031) and longer to stop steroids than non-Hispanic Blacks (p = 0.016). There were no significant differences based on ethnicity in histological fibrosis stage at presentation or incidence of clinical endpoints.

Conclusions

MASLD overlap is highly prevalent in Latinx AIH patients. Longer time to biochemical remission and worse NITs support that this population may have slower fibrosis regression with standard of care AIH treatment. This may indicate differing response rates due to genetic polymorphisms affecting drug metabolism and immune response among Latinx individuals and is less likely related to AIH/MASLD overlap based on the findings of this study.

简介和目标：本研究旨在描述一大批拉丁裔自身免疫性肝炎（AIH）患者的特征，并分析临床结果，包括生化缓解、类固醇治疗持续时间、纤维化消退以及临床终点（肝功能失代偿、肝移植需求和死亡）的发生率：这是一项回顾性描述性研究，研究对象是一家城市中心的活检证实的 AIH 患者（2009-2019 年）。研究分析了患者的人口统计学特征、合并症、组织学、治疗过程、生化指标、使用动态无创检测（NIT）的肝纤维化以及三个月、一年、两年和三年的临床结果：共纳入 121 名经活检证实的 AIH 成年患者：结果：共纳入 121 名经活检证实的 AIH 成人患者：43 名拉丁裔（35.5%）和 78 名非拉丁裔（65.5%）。拉丁裔患者更有可能患有代谢功能障碍相关性脂肪性肝病（MASLD）（p = 0.004），一年后纤维化-4（FIB-4）（p = 0.0279）和谷草转氨酶与血小板比率指数（APRI）（p = 0.005）更高。拉丁裔患者达到生化缓解的时间比非西班牙裔白人长（p = 0.031），停用类固醇的时间比非西班牙裔黑人长（p = 0.016）。在发病时的组织学纤维化阶段或临床终点的发生率方面，不同种族之间没有明显差异：结论：MASLD重叠在拉丁裔AIH患者中非常普遍。较长的生化缓解时间和较差的NITs表明，该人群在接受AIH标准治疗后，纤维化消退的速度可能较慢。这可能表明拉美裔个体中影响药物代谢和免疫反应的基因多态性导致了不同的反应率，而根据本研究的结果，这与AIH/MASLD重叠的可能性较小。

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引用次数: 0

Efficacy of prophylactic antibiotics in the adjuvant treatment of alcohol-related liver disease (ALD): A systematic review and meta-analysisProphylactic antibiotics in ALD 预防性抗生素在酒精相关性肝病（ALD）辅助治疗中的疗效：系统综述和荟萃分析预防性抗生素在酒精相关性肝病（ALD）中的应用。

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2024-09-12 DOI: 10.1016/j.aohep.2024.101571

Xiuyan Wang , Endian Zheng , Haoyue Sun , Beibei Xu , Liang Zheng , Yi Huang

Introduction and Objectives

This research aims to evaluate the efficacy and safety of prophylactic antibiotics in patients with alcohol-related liver disease (ALD).

Materials and Methods

We systematically searched databases including PubMed, Embase, Cochrane, and Web of Science up to October 2023. Our scope encompassed the influence of prophylactic antibiotics on all-cause mortality, infection, variceal bleeding, hepatic encephalopathy (HE), hepatorenal syndrome (HRS), adverse events (AE), fungal infection, clostridioides difficile infection (CDI), and multidrug-resistant (MDR) bacterial infection. Additionally, total bilirubin, creatinine, platelet counts, and plasma endotoxin levels were also analyzed.

Results

After comprehensive selection, 10 studies with 974 participants were included for further analysis. The study demonstrated that prophylactic antibiotic therapy was associated with reductions in infection rates, HE incidence, variceal bleeding, and all-cause mortality. The treatment did not increase the incidence of AE, fungal infection, and CDI, but it did raise the MDR bacteria infection rate. The analysis revealed no significant protective effect of antibiotic prophylaxis on total bilirubin and creatinine levels. Furthermore, the administration of antibiotics led to marginal increases in platelet counts, a minor reduction in endotoxin concentrations, and a subtle enhancement in HRS; however, these changes did not reach statistical significance.

Conclusions

Prophylactic antibiotic therapy was an effective and safe treatment for advanced ALD. To mitigate the risk of MDR bacterial infections, a strategy of selective intestinal decontamination could be advisable. Future investigations should prioritize varied ALD patient populations with extended follow-up periods and assorted antibiotic regimens to solidify the efficacy and safety of ALD treatments.

引言和目的：本研究旨在评估预防性抗生素对酒精相关肝病（ALD）患者的疗效和安全性：我们系统地检索了截至 2023 年 10 月的数据库，包括 PubMed、Embase、Cochrane 和 Web of Science。我们的研究范围包括预防性抗生素对全因死亡率、感染、静脉曲张出血、肝性脑病（HE）、肝肾综合征（HRS）、不良事件（AE）、真菌感染、艰难梭菌感染（CDI）和耐多药（MDR）细菌感染的影响。此外，还分析了总胆红素、肌酐、血小板计数和血浆内毒素水平：结果：经过综合筛选，共有 10 项研究、974 名参与者被纳入进一步分析。研究表明，预防性抗生素治疗可降低感染率、高血压发病率、静脉曲张出血和全因死亡率。治疗并没有增加AE、真菌感染和CDI的发病率，但确实提高了MDR细菌的感染率。分析显示，抗生素预防对总胆红素和肌酐水平没有明显的保护作用。此外，服用抗生素可使血小板计数略有增加，内毒素浓度略有降低，HRS也有细微提高；但这些变化未达到统计学意义：结论：预防性抗生素治疗是一种有效、安全的晚期 ALD 治疗方法。为了降低MDR细菌感染的风险，选择性肠道净化策略是可取的。未来的研究应优先考虑不同的ALD患者群体，并延长随访时间和采用不同的抗生素治疗方案，以巩固ALD治疗的有效性和安全性。

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引用次数: 0

Knowledge about metabolic dysfunction-associated steatotic liver disease among the medical professionals from countries in the MENA region 中东和北非地区国家医疗专业人员对代谢功能障碍相关脂肪肝的了解。

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2024-09-12 DOI: 10.1016/j.aohep.2024.101569

Saleh A. Alqahtani , Yusuf Yilmaz , Mohamed El-Kassas , Khalid Alswat , Mohamed Mawardi , Faisal M. Sanai , Faisal Abaakhail , Saad Alghamdi , Waleed K. Al-Hamoudi , Fatema Nader , Maria Stepanova , Zobair M. Younossi , Global NASH Council

Introduction and Objectives

Given the substantial burden of metabolic dysfunction-associated steatotic liver disease (MASLD), there is an urgent need to assess knowledge and awareness levels among physicians. We assessed MASLD knowledge among healthcare providers from Saudi Arabia, Egypt, and Türkiye.

Materials and Methods

Two global surveys containing 54–59 items assessed awareness and knowledge of MASLD/NAFLD- one was for hepatologists and gastroenterologists, and the second was for non-specialists (e.g. endocrinologists, primary care providers [PCPs], and other healthcare professionals). Data were collected using an electronic data collection form. Knowledge scores and variables associated with higher knowledge scores were compared across all specialties.

Results

A total of 584 physicians completed the survey (126 hepatologists, 178 gastroenterologists (GEs), 38 endocrinologists, 242 PCPs/others). Practice guidelines were the primary source for knowledge across all specialties (43–51%), then conferences (24–31%) except PCPs/others who selected the internet as the second common source (25%). Adherence to societal guidelines varied by specialty (81–84% of specialists vs 38–51% of non-specialists). Hepatologists and GEs showed similar mean knowledge scores (51–72% correct answers across three knowledge domains, p > 0.05); endocrinologists outperformed PCPs/others in knowledge scores in all knowledge domains, including Epidemiology/Pathogenesis (72% vs. 60%), Diagnostics (73% vs. 67%), and Treatment (78% vs. 67%) (all p < 0.01). Hospital-based practice and seeing a greater number of patients with MASLD/NAFLD were identified as independent predictors of higher knowledge scores among specialists (both p < 0.05).

Conclusions

A knowledge gap in the identification, diagnosis, and management of MASLD/NAFLD was found despite the growing burden of MASLD/NAFLD in Saudi Arabia, Egypt, and Türkiye. Education to increase awareness is needed.

引言和目的：鉴于代谢功能障碍相关性脂肪性肝病（MASLD）造成的巨大负担，迫切需要评估医生对该病的了解和认识水平。我们评估了沙特阿拉伯、埃及和土耳其医疗服务提供者对 MASLD 的了解程度：两项全球调查包含 54-59 个项目，评估了对 MASLD/NAFLD 的认识和了解程度--一项调查针对肝病专家和消化科专家，另一项针对非专业人士（如内分泌专家、初级保健提供者 (PCP)、其他医疗保健专业人士）。数据使用电子数据收集表收集。对所有专科医生的知识得分以及与较高知识得分相关的变量进行了比较：共有 584 名医生完成了调查（126 名肝病医生、178 名胃肠病医生 (GE)、38 名内分泌医生、242 名初级保健医生/其他）。在所有专科中，实践指南是知识的主要来源（43-51%），然后是会议（24-31%），但初级保健医生/其他医生选择互联网作为第二常见来源（25%）。各专科对社会指南的遵守情况各不相同（81-84% 的专科医生与 38-51% 的非专科医生）。肝病专家和普通医师的平均知识得分相似（三个知识领域的正确答案比例为 51-72% ，P > 0.05）；内分泌专家在所有知识领域的得分均高于初级保健医生/其他人员，包括流行病学/发病机制（72% 对 60%）、诊断（73% 对 67%）和治疗（78% 对 67%）（所有 P 均为结论）：尽管沙特阿拉伯、埃及和土耳其的 MASLD/NAFLD 负担日益加重，但在 MASLD/NAFLD 的识别、诊断和管理方面仍存在知识差距。需要通过教育来提高人们的认识。

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引用次数: 0

Predictors of poor postoperative outcomes in liver transplant patients 肝移植患者术后不良预后的预测因素

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2024-09-11 DOI: 10.1016/j.aohep.2024.101574

Osman Cagin Buldukoglu

引用次数: 0

Predictive role of microvesicles in cirrhotic patients: A promised land or a land of confusion? A narrative review 肝硬化患者微囊泡的预测作用：应许之地还是混乱之地？叙述性综述。

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2024-09-11 DOI: 10.1016/j.aohep.2024.101563

Andrea Boccatonda , Fabio Piscaglia

Mammalian cells release several membrane-enclosed vesicles called extracellular vesicles. Those vesicles can contain several molecules such as proteins, DNA and various RNA. Therefore, extracellular vesicles can act as a target delivery system and exert multiple biological effects. Several works demonstrated that extracellular vesicles are increased or dysregulated in patients with cirrhosis, and they can be predictive of disease progression, complications and mortality. This review aims to summarize and highlight the role of extracellular vesicles in the cirrhotic patient and how they correlate with the degree of disease and with complications, particularly with the development of portal thrombosis and hepatocellular carcinoma.

哺乳动物细胞释放出几种被称为细胞外囊泡的膜封闭囊泡。这些囊泡可包含多种分子，如蛋白质、DNA 和各种 RNA。因此，细胞外囊泡可作为靶向递送系统，发挥多种生物效应。多项研究表明，肝硬化患者细胞外囊泡增多或失调，可预测疾病进展、并发症和死亡率。本综述旨在总结和强调细胞外囊泡在肝硬化患者中的作用，以及它们如何与疾病程度和并发症，尤其是与门脉血栓和肝细胞癌的发生相关。

引用次数: 0

Alcohol-related liver disease: A global perspective 酒精相关肝病：全球视角

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2024-09-01 DOI: 10.1016/j.aohep.2024.101499

Alcohol-associated liver disease (ALD) represents one of the deadliest yet preventable consequences of excessive alcohol use. It represents 5.1 % of the global burden of disease, mainly involving the productive-age population (15-44 years) and leading to an increased mortality risk from traffic road injuries, suicide, violence, cardiovascular disease, neoplasms, and liver disease, among others, accounting for 5.3 % of global deaths. Daily alcohol consumption, binge drinking (BD), and heavy episodic drinking (HED) are the patterns associated with a higher risk of developing ALD. The escalating global burden of ALD, even exceeding what was predicted, is the result of a complex interaction between the lack of public policies that regulate alcohol consumption, low awareness of the scope of the disease, late referral to specialists, underuse of available medications, insufficient funds allocated to ALD research, and non-predictable events such as the COVID-19 pandemic, where increases of up to 477 % in online alcohol sales were registered in the United States. Early diagnosis, referral, and treatment are pivotal to achieving the therapeutic goal in patients with alcohol use disorder (AUD) and ALD, where complete alcohol abstinence and prevention of alcohol relapse are expected to enhance overall survival. This can be achieved through a combination of cognitive behavioral, motivational enhancement and pharmacological therapy. Furthermore, the appropriate use of available pharmacological therapy and implementation of public policies that comprehensively address this disease will make a real difference.

酒精相关性肝病（ALD）是过度饮酒造成的最致命但却可以预防的后果之一。它占全球疾病负担的 5.1%，主要涉及生产年龄人口（15-44 岁），并导致交通道路伤害、自杀、暴力、心血管疾病、肿瘤和肝病等死亡风险增加，占全球死亡人数的 5.3%。日常饮酒、暴饮暴食（BD）和大量偶发性饮酒（HED）是与罹患 ALD 风险较高相关的饮酒方式。ALD 在全球造成的负担不断加重，甚至超过了人们的预测，这是由于缺乏规范饮酒的公共政策、对该疾病范围的认识不足、转诊到专科医生的时间过晚、现有药物使用不足、分配给 ALD 研究的资金不足，以及诸如 COVID-19 大流行等不可预测事件之间复杂互动的结果。早期诊断、转诊和治疗对于实现酒精使用障碍（AUD）和 ALD 患者的治疗目标至关重要，完全戒酒和预防复酒有望提高患者的总体生存率。这可以通过认知行为疗法、动机强化疗法和药物疗法相结合来实现。此外，适当使用现有的药物疗法和实施全面应对这一疾病的公共政策将带来真正的改变。

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引用次数: 0