Annals of hepatology最新文献_第3页

Pancreatic involvement and its prognostic impact in acute-on-chronic liver failure 急性-慢性肝衰竭患者胰腺受累及其预后影响。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2026-01-01 DOI: 10.1016/j.aohep.2025.102165

Georg Kramer , Vlad Taru , Benedikt Simbrunner , Lorenz Balcar , Nina Dominik , Benedikt Silvester Hofer , Lukas Hartl , Mathias Jachs , Georg Semmler , Christian Sebesta , Paul Thöne , Marlene Hintersteininger , Mathias Schneeweiss-Gleixner , Philipp Schwabl , Michael Trauner , Mattias Mandorfer , Thomas Reiberger

Introduction and Objectives

Acute-on-chronic liver failure (ACLF) in cirrhotic patients is marked by a multiorgan failure and high mortality. The role of the pancreas in ACLF is poorly understood. This study evaluated the prevalence, progression and prognostic impact of elevated lipase (eLIP) and amylase (eAMY) in ACLF.

Patients and Methods

We retrospectively analyzed ACLF patients (EASL-CLIF criteria) at the Vienna General Hospital (11/2003–11/2022). eLIP and eAMY were defined as levels ≥3 times the upper limit of normal. Data were collected before ACLF onset, at diagnosis (D0), and on days 7 (D7), 28 (D28), and 90 (D90) post-diagnosis. Factors associated with eLIP were identified using univariable logistic regression, and survival was examined with uni- and adjusted multivariable Cox regression models.

Results

Among 193 patients, D28 and D90 mortalities were 39.9% and 53.9%, respectively. At D0, lipase and (alpha-)amylase elevations were found in 43.5% and 50.2% of patients, with strong correlation (Spearman’s rho: 0.687; p<0.001). eLIP was observed in 8.8% at D0 and 15.7% at D7. At D0, impaired circulation (MAP <70 mmHg, odds ratio [OR] 4.41; p=0.048) and kidney failure (OR 6.31; p=0.030) were linked to eLIP, and circulatory failure at D0 (OR 3.30; p=0.012) to D7 eLIP. Although D0 enzyme levels did not prognosticate mortality, eLIP at D7 independently predicted D28 (adjusted hazard ratio [aHR]: 2.15; p=0.031) and D90 mortality (aHR 2.14; p=0.011).

Conclusions

Increased lipase and (alpha-)amylase levels are common in ACLF. Notably, lipase levels ≥3x ULN at ACLF-D7 predict mortality independent from liver function, suggesting a role in disease progression.

简介和目的：肝硬化患者的急性慢性肝衰竭（ACLF）以多器官衰竭和高死亡率为特征。胰腺在ACLF中的作用尚不清楚。本研究评估了ACLF中脂肪酶（eLIP）和淀粉酶（eAMY）升高的患病率、进展和预后影响。患者和方法：我们回顾性分析了维也纳总医院（2003年11月- 2022年11月）的ACLF患者（EASL-CLIF标准）。eLIP和eAMY升高被定义为≥正常上限的3倍。数据收集于ACLF发病前、诊断时（D0）、诊断后第7天（D7）、28天（D28）和90天（D90）。使用单变量逻辑回归确定与eLIP相关的因素，并使用单变量和调整后的多变量Cox回归模型检查生存率。结果：193例患者中，D28和D90病死率分别为39.9%和53.9%。在D0时，脂肪酶和（α -）淀粉酶升高分别在43.5%和50.2%的患者中发现，两者具有很强的相关性（Spearman’s ρ: 0.687）。结论：脂肪酶和（α -）淀粉酶水平升高在ACLF中很常见。值得注意的是，脂肪酶水平≥3倍ULN的ACLF-D7预测死亡率独立于肝功能，提示在疾病进展中的作用。

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引用次数: 0

Drug-induced liver injury: a real-world pharmacovigilance study using the FDA Adverse Event Reporting System database (2004–2024) 药物性肝损伤：使用FDA不良事件报告系统数据库2004-2024的真实世界药物警戒研究

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2026-01-01 DOI: 10.1016/j.aohep.2025.102156

Dongxuan Li , Duan Wang , Guili Huang , Qinglong Liu , Yalan Wang , Rui Zhang , Songqing Liu , Qian Du

Introduction and Objectives

Timely identification and discontinuation of culprit-drug is the cornerstone in managing drug-induced liver injury (DILI), and this study aims to thoroughly investigate the potential hepatotoxic drugs by using the FDA Adverse Event Reporting System (FAERS) database.

Materials and Methods

DILI-related reports in the FAERS database between 2004 and 2024 were used to compile a reported culprit-drug list, and the single drug and drug class with the highest reporting frequency were counted accordingly. The disproportionality analysis was used to assess the DILI risk of each reported culprit-drug.

Results

236,918 DILI-related reports were submitted to the FAERS database between 2004 and 2024, in which 1459 drugs were reported as culprit-drug. Paracetamol is the most frequently reported single drug, while antineoplastic agents are the most frequently reported drug class. 806 of 1459 drugs showed positive signals in disproportionality analysis, among which vorasidenib is the drug with the highest signal strength, followed by floxuridine, pyrazinamide, delandistrogene moxeparvovec, and isoniazid. In the distribution analysis of positive signal drugs, antineoplastic agents have the largest number of positive drugs and occupy a dominant position among high-risk level drugs.

Conclusions

Our study summarized a reported culprit-drug list of DILI by comprehensively reviewing the liver injury-related reports in the FAERS database, and highlighted the prominent position of antineoplastic agents in reporting frequency, risk signal strength ranking, number of positive signal drugs, and high-risk drug distribution, suggesting that we may need to pay more attention to the liver injury risk of antineoplastic agents in clinical practice.

前言和目的：及时识别和停药是治疗药物性肝损伤（DILI）的基础，本研究旨在通过FDA不良事件报告系统（FAERS）数据库全面调查潜在的肝毒性药物。材料与方法：采用FAERS数据库中2004 - 2024年dili相关报告编制报告的元凶-药物清单，并对报告频次最高的单一药物和药物类别进行统计。歧化分析用于评估每种报告的罪魁祸首药物的DILI风险。结果：2004 - 2024年FAERS数据库共收到与dili相关的报告236918份，其中1459种药物被报告为罪魁祸首药物。扑热息痛是最常报道的单一药物，而抗肿瘤药物是最常报道的药物类别。1459种药物中有806种在歧化分析中显示阳性信号，其中沃拉西尼是信号强度最高的药物，其次是氟尿定、吡嗪酰胺、德兰异构体莫舍帕韦克和异烟肼。在阳性信号药物分布分析中，抗肿瘤药物阳性药物数量最多，在高危水平药物中占主导地位。结论：我们的研究通过对FAERS数据库中肝损伤相关报告的综合梳理，总结出了DILI报告的罪魁药物清单，并强调了抗肿瘤药物在报告频次、风险信号强度排序、阳性信号药物数量、高危药物分布等方面的突出地位，提示我们在临床实践中可能需要更加重视抗肿瘤药物的肝损伤风险。

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引用次数: 0

Fenofibrate in managing cholestatic pruritus in paediatric patients 非诺贝特治疗儿童胆汁淤积性瘙痒。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2026-01-01 DOI: 10.1016/j.aohep.2025.102132

Jesús Quintero-Bernabeu , Javier Juamperez-Goñi , Cristina Padrós-Fornieles , Mauricio Larrarte-King , Simone Mameli , Lis Vidal-Valdivia , Susana Clemente-Bautista , Aurora Fernández-Polo , José Andrés Molino-Gahete , Maria Mercadal-Hally

Introduction and Objectives

Cholestatic pruritus is a difficult-to-manage symptom in cholestatic disorders. This study presents our experience with fenofibrate for treating refractory cholestatic pruritus in paediatric patients.

Materials and Methods

We conducted a retrospective review involving patients under 18 with moderate to severe pruritus (5D Itch score >15), unresponsive to conventional treatments. Fenofibrate was administered at 100 mg/20 kg daily, with a maximum dose of 100 mg for those under 20 kg. A good response was defined as a >50% reduction in the 5D Itch score, with partial relief as a 25-50% reduction.

Results

Between May 2017 and May 2023, 25 patients were treated, with a median treatment duration of 24.2 months. Pruritus reduction at 2 weeks, 1, 3, 6, and 12 months was 36.8%, 52.2%, 53.6%, 57.1%, and 60.8%, respectively. After 12 months, 64% (16/25) achieved >50% improvement, and 16% (4/25) showed partial relief. Fenofibrate significantly reduced serum bile acids, AST, ALT, bilirubin, cholesterol, and triglycerides, without affecting elastography. No serious adverse events occurred.

Conclusions

Fenofibrate shows potential in managing pruritus in paediatric patients with cholestatic diseases, warranting further investigation through randomized clinical trials to assess its efficacy and safety.

简介与目的：胆汁淤积性瘙痒是胆汁淤积性疾病中一种较难控制的症状。本研究介绍了我们使用非诺贝特治疗顽固性胆汁淤积性瘙痒症的经验。材料和方法：我们对18岁以下的中度至重度瘙痒患者（5D瘙痒评分bbbb15）进行了回顾性研究，这些患者对常规治疗无反应。非诺贝特每日100mg / 20kg， 20kg以下患者最大剂量为100mg。良好的反应被定义为5D瘙痒评分减少50%，部分缓解为减少25-50%。结果：2017年5月至2023年5月，25例患者接受治疗，中位治疗时间为24.2个月。2周、1、3、6、12个月瘙痒减轻率分别为36.8%、52.2%、53.6%、57.1%、60.8%。12个月后，64%（16/25）的患者达到了50%的改善，16%（4/25）的患者部分缓解。非诺贝特显著降低血清胆汁酸、谷丙转氨酶、胆红素、胆固醇和甘油三酯，不影响弹性图。未发生严重不良事件。结论：非诺贝特在治疗患有胆汁淤积症的儿科患者瘙痒方面具有潜力，值得通过随机临床试验进一步研究，以评估其有效性和安全性。

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引用次数: 0

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2026-01-01 DOI: 10.1016/j.aohep.2025.102175

Byungyoon Yun , Juyeon Oh , Heejoo Park , Jian Lee , Beom Kyung Kim , Jin-Ha Yoon

Introduction and Objectives

The prevalence of diabetes is rising among patients with chronic hepatitis B (CHB). However, the comparative efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) versus dipeptidyl peptidase-4 inhibitors (DPP4i) in this high-risk population remains unclear. We aimed to determine if SGLT2i significantly reduces the risk of liver-related events (LREs) compared with DPP4i, using a target trial emulation approach.

Materials and Methods

We used a nationwide database to identify CHB patients with diabetes (age ≥40 years) receiving SGLT2i or DPP4i alongside metformin for ≥60 consecutive days between January 2015 and December 2020. The primary outcome was LRE, defined as hepatocellular carcinoma (HCC), liver cirrhosis (LC), transplantation, or liver-related mortality. Multivariable Cox-regression models with per-protocol analysis and propensity score matching (PSM) were performed to estimate LRE risk.

Results

Among 16,070 patients (median age, 57 years; 66.9% male), 695 developed LREs (4.7% in SGLT2i group vs. 4.3% in DPP4i group; p=0.413). In the entire cohort, the LRE risk in the SGLT2i group was comparable to that in the DPP4i group: adjusted hazard ratio (aHR) of 0.89 (95% confidence interval [CI] 0.71–1.11). The risk of secondary outcomes in the SGLT2i group was similar to that of the DPP4i group: aHRs of 0.89 (95% CI 0.58–1.37) for HCC, 0.92 (95% CI 0.72–1.17) for LC, and 0.82 (95% CI 0.29–2.35) for all-cause mortality. These trends were consistent in the PSM cohort.

Conclusions

The overall hepatic prognosis was comparable between the SGLT2i and the DPP4i groups. Further prospective studies are required to reach robust conclusions.

简介和目的：慢性乙型肝炎（CHB）患者中糖尿病的患病率正在上升。然而，钠-葡萄糖共转运蛋白-2抑制剂（SGLT2i）与二肽基肽酶-4抑制剂（DPP4i）在这一高危人群中的比较疗效尚不清楚。我们的目的是确定SGLT2i与DPP4i相比是否能显著降低肝脏相关事件（LREs）的风险，采用目标试验模拟方法。材料和方法：我们使用了一个全国性的数据库，以确定在2015年1月至2020年12月期间连续≥60天接受SGLT2i或DPP4i和二甲双胍治疗的CHB糖尿病患者（年龄≥40岁）。主要终点为LRE，定义为肝细胞癌（HCC）、肝硬化（LC）、移植或肝脏相关死亡率。采用多变量cox -回归模型，按协议分析和倾向评分匹配（PSM）来估计LRE风险。结果：16070例患者（中位年龄57岁，66.9%为男性）中，695例发生LREs （SGLT2i组4.7% vs DPP4i组4.3%,p=0.413）。在整个队列中，SGLT2i组的LRE风险与DPP4i组相当：调整后的风险比（aHR）为0.89（95%可信区间[CI] 0.71-1.11）。SGLT2i组的次要结局风险与DPP4i组相似：HCC的ahr为0.89 (95% CI 0.58-1.37)， LC的ahr为0.92 (95% CI 0.72-1.17)，全因死亡的ahr为0.82 （95% CI 0.29-2.35）。这些趋势在PSM队列中是一致的。结论：SGLT2i组和DPP4i组的总体肝脏预后相当。需要进一步的前瞻性研究来得出可靠的结论。

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引用次数: 0

Genetic risk factors for MASLD/MASH and cardiovascular disease in elderly individuals 老年人MASLD/MASH与心血管疾病的遗传危险因素

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2026-01-01 DOI: 10.1016/j.aohep.2025.102170

Willy B. Theel , Vivian D. de Jong , Diederick E. Grobbee , J. Wouter Jukema , Stella Trompet , Manuel Castro Cabezas

Introduction and Objectives

Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, MASH, are closely related to obesity and lifestyle. From previous studies, MASLD is also known for its strong genetic background. This study aimed to investigate the association between previously reported genetic polymorphisms of MASLD/MASH and clinical outcomes in an elderly Western European population.

Patients and Methods

We performed an analysis of 5,244 participants (mean age 75.3 years) from the PROSPER cohort study who were followed for 3.2 years. FIB-4 scores were calculated using age, AST, ALT, and platelet count, applying age-specific cutoffs. Thirty MASLD/MASH-associated SNPs, previously identified in GWAS analyses, were evaluated for their association with FIB4 scores. For SNPs showing significant differences in FIB-4 score across genotypes, associations with clinical outcomes and all-cause mortality were assessed using Cox proportional hazards regression models, adjusted for relevant clinical covariates.

Results

Five SNPs were significantly associated with FIB-4 scores. PNPLA3_rs738409 and SAMM50_rs3761472 showed higher FIB-4 scores in mutant homozygotes, while SLC39A8_rs13107325, TRIB1_rs2954021, and ANPEP_rs7168849 showed the opposite trend. Despite statistical significance, absolute FIB-4 scores remained within ranges typically associated with low fibrosis risk. TRIB1_rs2954021 was linked to stroke, SLC39A8_rs13107325 to myocardial infarction and ANPEP_rs7168849 to all-cause and cancer-related mortality. No significant associations were observed for PNPLA3_rs738409 or SAMM50_rs3761472 with cardiovascular and mortality outcomes.

Conclusions

Our findings reveal that specific MASLD/MASH-associated genetic variants influence FIB-4 scores and are linked to cardiovascular and mortality outcomes in an elderly population. These results suggest that liver fibrosis may reflect not only hepatic injury, but also broader systemic vulnerability driven by genetic predisposition. Incorporating genetic risk profiles may improve stratification for both liver and cardiometabolic disease.

简介和目的：代谢功能障碍相关脂肪变性肝病（MASLD）及其进行性形式MASH与肥胖和生活方式密切相关。从之前的研究来看，MASLD也因其强大的遗传背景而闻名。本研究旨在调查先前报道的西欧老年人群MASLD/MASH遗传多态性与临床结果之间的关系。患者和方法：我们对来自PROSPER队列研究的5244名参与者（平均年龄75.3岁）进行了为期3.2年的随访分析。FIB-4评分采用年龄、AST、ALT和血小板计数计算，采用年龄特异性截止值。先前在GWAS分析中发现的30个MASLD/ mash相关snp与FIB4评分的相关性进行了评估。对于FIB-4评分在不同基因型中存在显著差异的snp，使用Cox比例风险回归模型评估其与临床结局和全因死亡率的关系，并根据相关临床协变量进行调整。结果：5个snp与FIB-4评分显著相关。突变纯合子中，PNPLA3_rs738409和SAMM50_rs3761472的FIB-4得分较高，而SLC39A8_rs13107325、TRIB1_rs2954021和ANPEP_rs7168849的FIB-4得分则相反。尽管具有统计学意义，但FIB-4绝对评分仍处于典型的低纤维化风险范围内。TRIB1_rs2954021与中风有关，SLC39A8_rs13107325与心肌梗死有关，ANPEP_rs7168849与全因和癌症相关死亡率有关。未观察到PNPLA3_rs738409或SAMM50_rs3761472与心血管和死亡率结局有显著关联。结论：我们的研究结果表明，特定的MASLD/ mash相关遗传变异影响FIB-4评分，并与老年人群的心血管和死亡率结果有关。这些结果表明，肝纤维化可能不仅反映了肝损伤，还反映了遗传易感性驱动的更广泛的系统性易感性。结合遗传风险谱可以改善肝脏和心脏代谢疾病的分层。

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引用次数: 0

Outcomes and risk of relapse after living donor and deceased donor liver transplantation for alcohol-associated liver disease. 酒精相关性肝病活体供体和死亡供体肝移植术后复发的结果和风险

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-12-24 DOI: 10.1016/j.aohep.2025.102177

Chloe Huen Wai Choy, Hills King Hei Suen, Tiffany Cho Lam Wong, Miu Yee Chan, Kin Pan Au, Jeff Wing Chiu Dai, James Yan Yue Fung, Tan To Cheung, Albert Chi Yan Chan

Introduction and objectives: The six-month abstinence rule for alcohol-associated liver disease (ALD) patients may exclude candidates from life-saving transplantation without reliably predicting relapse. We compared outcomes of deceased donor liver transplantation (DDLT) and living donor liver transplantation (LDLT) in ALD patients, with modified abstinence criteria.

Patients and methods: ALD patients evaluated for transplantation from 2008-2020 were analyzed. 6-month abstinence was required for DDLT but not for LDLT patients with favorable psychological assessments. Survival analyses were conducted from evaluation i.e., intention-to-treat (ITT) and transplantation. Patients with living donors were categorized as intended for LDLT (ITT-LDLT) and those without as intended for DDLT (ITT-DDLT). Patients who were ineligible for transplantation served as the control group.

Results: Of the 216 ALD patients evaluated, 79 (36.6%) were accepted for transplantation. Five-year ITT survival was superior in the ITT-LDLT group (83.3%) compared to ITT-DDLT (62.6%, P = 0.04) and controls (30.7%, P < 0.001). Among transplant recipients (DDLT n = 34, LDLT n = 20), five-year graft survival was comparable between DDLT and LDLT (79.8% vs 76.5%, P = 0.84) despite only 40% of LDLT patients achieving six-month abstinence. Alcohol relapse rates were comparable between DDLT and LDLT (32.4% vs. 30.0%, P > 0.99). Alcohol dependence (HR=7.32, P < 0.001) and medical non-compliance (HR=4.19, P = 0.007) predicted relapse.

Conclusions: Liver transplantation provided significant survival benefit for carefully selected ALD patients. With comprehensive psychological assessment, patients without psychiatric disorders or compliance issues can achieve excellent outcomes after transplantation.

前言和目的：酒精相关性肝病（ALD）患者的6个月戒酒规则可能会在没有可靠预测复发的情况下将候选患者排除在挽救生命的移植之外。我们比较了ALD患者的死亡供肝移植（DDLT）和活体供肝移植（LDLT）的结果，并修改了禁欲标准。患者和方法：对2008-2020年接受移植评估的ALD患者进行分析。DDLT患者需要禁欲6个月，而心理评价良好的LDLT患者则不需要。生存分析从评估，即意向治疗（ITT）和移植进行。活体供体患者分为LDLT （ITT-LDLT）和DDLT （ITT-DDLT）两组。不适合移植的患者作为对照组。结果：216例ALD患者中，79例（36.6%）接受移植。ITT- ldlt组的5年ITT生存率（83.3%）优于ITT- ddlt组（62.6%，P=0.04）和对照组（30.7%,P0.99）。结论：肝移植为精心挑选的ALD患者提供了显著的生存益处。通过全面的心理评估，没有精神障碍或依从性问题的患者可以在移植后获得良好的预后。

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引用次数: 0

Telemedicine and hybrid engagement models facilitate hepatitis C cascade of care during periods of healthcare disruption. 远程医疗和混合参与模式在医疗保健中断期间促进了丙型肝炎级联护理。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-12-24 DOI: 10.1016/j.aohep.2025.102178

Sabrina Fan, Haris Imsirovic, Curtis Cooper

Introduction and objectives: To assess the utility of telemedicine on provision of hepatitis C care, we compared characteristics and outcomes of HCV-infected patients engaging in standard in-clinic care, telemedicine only (TM), and hybrid (HB) models of care across pre-, peri‑ and post-COVID-19 pandemic periods.

Patients and methods: HCV RNA positive patients assessed between October 2017 and March 2025 at The Ottawa Hospital Viral Hepatitis Program (Ottawa, Canada) were retrospectively analyzed.

Results: Of 1118 patients, 626 (56.0 %) engaged in standard care, 139 (12.4 %) in TM care, and 353 (31.6 %) in HB care. TM group patients were less likely to have immigrated, experienced substance abuse, housing instability, incarceration, or psychiatric conditions, or be based in Ottawa. Utilization of HB and TM care were highest during the pandemic. Across all time periods, HB care demonstrated higher DAA treatment initiation and completion compared to standard or TM care (standard: 81.5 %; TM: 79.1 %; HB: 92.1 %, p < 0.01), (standard: 91.3 %; TM: 93.6 %; HB: 96.3 %, p = 0.02), respectively, with no difference in SVR. During the pandemic, a greater proportion of patients experiencing barriers to cure engaged in HB or TM care and achieved DAA completion (pre: 91.1 %; pandemic: 98.1 %; post: 95.8 %, p < 0.01). HB care was associated with increased odds of DAA initiation (OR = 2.87; 95 % CI 1.82 to 4.53), including patient populations experiencing barriers to cure (OR = 2.35; 95 % CI 1.35 to 4.07).

Conclusions: HB models demonstrate potential in addressing public health challenges and engaging marginalized populations, supporting increased integration into HCV care programs.

简介和目标：为了评估远程医疗在提供丙型肝炎护理方面的作用，我们比较了在covid -19大流行之前、期间和之后接受标准临床护理、仅远程医疗（TM）和混合（HB）治疗模式的丙型肝炎感染患者的特征和结果。患者和方法：回顾性分析2017年10月至2025年3月在渥太华医院病毒性肝炎项目（加拿大渥太华）评估的HCV RNA阳性患者。结果：1118例患者中，626例（56.0%）接受标准治疗，139例（12.4%）接受TM治疗，353例（31.6%）接受HB治疗。TM组患者移民、药物滥用、住房不稳定、监禁或精神疾病或居住在渥太华的可能性较小。乙肝和TM护理的使用率在大流行期间最高。在所有时间段内，与标准或TM护理相比，HB护理显示出更高的DAA治疗开始和完成（标准：81.5%;TM: 79.1%; HB: 92.1%, p < 0.01），（标准：91.3%;TM: 93.6%; HB: 96.3%, p = 0.02），SVR无差异。在大流行期间，有更大比例的患者接受了HB或TM治疗并完成了DAA（大流行前：91.1%；大流行前：98.1%；大流行后：95.8%,p < 0.01）。HB护理与DAA启动的几率增加相关（OR = 2.87;95% CI 1.82至4.53），包括经历治愈障碍的患者群体（OR = 2.35;95% CI 1.35至4.07）。结论：HB模型在应对公共卫生挑战和吸引边缘化人群方面显示出潜力，支持将丙型肝炎病毒纳入治疗方案。

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引用次数: 0

Is FIB-4 the right tool for screening for liver fibrosis? FIB-4是筛查肝纤维化的正确工具吗？

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-12-24 DOI: 10.1016/j.aohep.2025.102176

Leen J M Heyens, Demi P A van Malde, Gediz Dogay Us, Francesco Innocenti, Mathieu Struyve, Christophe Van Steenkiste, Sven Francque, Geert Robaeys, Ger H Koek

Introduction and objectives: The screening accuracy of non-invasive fibrosis tests like FIB-4 in metabolic dysfunction-associated steatotic liver disease (MASLD) remains unclear. Using standard cut-offs, this study evaluated FIB-4's agreement with vibration-controlled transient elastography (VCTE) and identified and validated new thresholds.

Patients and methods: A prospective cohort study (2019-2024) in Belgian and Dutch primary care used VCTE by FibroScan® (Echosens, France) as a proxy for the fibrosis stage. The FIB-4 index was derived from electronic patient data and study blood samples. Agreement between VCTE and FIB-4 was analysed using Weighted Cohen's kappa. New fibrosis cut-offs (≥F2; ≥8 kPa) for ≤65 and >65 years were determined via Youden's Index and validated in a Turkish primary care cohort and a Belgian secondary care T2DM cohort.

Results: Among 563 participants (median age 62 years, 47.1 % male, 14.2 % with T2DM, median BMI 28.2 kg/m²), FIB-4 showed poor agreement with VCTE (κ = 0.138, 95 % CI: 0.069-0.207). Suggested new cut-offs of 1.29 (≤65 years) and 1.72 (>65 years) were proposed. The 1.29 cut-off performed similarly to the existing 1.3 in validation cohorts. In the Türkiye and T2DM cohorts, the 1.72 cut-off improved sensitivity over 2.0 but had lower specificity.

Conclusions: The FIB-4 index showed poor agreement with VCTE and low sensitivity, making it an unreliable standalone diagnostic tool for liver fibrosis in people with MASLD in both primary and secondary care. Alternative non-invasive tests or improved cut-off values are needed for accurate fibrosis detection in clinical practice.

简介和目的：非侵入性纤维化试验如FIB-4在代谢功能障碍相关脂肪变性肝病（MASLD）中的筛查准确性尚不清楚。使用标准截止值，本研究评估了FIB-4与振动控制瞬态弹性成像（VCTE）的一致性，并确定并验证了新的阈值。患者和方法：比利时和荷兰初级保健的一项前瞻性队列研究（2019-2024）使用FibroScan®（Echosens，法国）的VCTE作为纤维化分期的替代指标。FIB-4指数来源于电子患者数据和研究血液样本。使用加权科恩kappa分析VCTE与FIB-4之间的一致性。通过约登指数确定≤65岁和≥65岁的新纤维化临界值（≥F2;≥8 kPa），并在土耳其初级保健队列和比利时二级保健T2DM队列中进行验证。结果：在563名参与者中（中位年龄62岁，47.1%为男性，14.2%为T2DM，中位BMI 28.2 kg/m²），FIB-4与VCTE的一致性较差（κ = 0.138,95% CI: 0.069-0.207）。建议新的临界值分别为1.29（≤65岁）和1.72（≤65岁）。1.29的临界值与验证队列中现有的1.3相似。在t rkiye和T2DM队列中，1.72的临界值比2.0提高了敏感性，但特异性较低。结论：FIB-4指数与VCTE的一致性较差，敏感性较低，使其成为MASLD患者初级和二级护理中肝纤维化的不可靠的独立诊断工具。在临床实践中，需要替代的非侵入性测试或改进的临界值来准确检测纤维化。

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引用次数: 0

A three-gene resistome signature as a prognostic tool in hepatocellular carcinoma. 三基因抵抗组标记作为肝细胞癌的预后工具。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-12-24 DOI: 10.1016/j.aohep.2025.102179

Anabel Sanchez-Martin, Rocio I R Macias, Luis Muñoz-Bellvís, Luis M Gonzalez, Alejandro Forner, Maria Reig, Jose J G Marin, Oscar Briz

Introduction and objectives: Outcomes for patients with hepatocellular carcinoma (HCC) are generally poor, partly due to significant multidrug resistance. HCC heterogeneity decreases the accuracy of traditional prediction models. This study aimed to evaluate the prognostic significance of the HCC resistome.

Materials and methods: Clinical and transcriptomic data from 371 HCC cases available at TCGA were analyzed. An external dataset (604 patients from 4 cohorts) and 40 HCC samples, in which gene expression was determined by RT-qPCR, were used to validate the prognostic model.

Results: The in silico analysis revealed two distinct clusters of patients based on the expression of resistome genes. Kaplan-Meier analysis indicated that Cluster 1 (C1) exhibited a better prognosis. Furthermore, the response to sorafenib treatment was better in patients included in C1 than in C2. Cox regression analysis identified the resistome profile as an independent prognostic factor alongside clinicopathological features such as tumor stage and ECOG status. Fifty-eight out of 81 genes examined displayed differential expression between clusters. Thirteen genes demonstrated a correlation between their expression levels and patient survival. In Cox multivariate analysis, SLC22A1, BIRC5, and ABCC1 genes emerged as independent prognostic factors, forming the basis for a risk model. BIRC5 and ABCC1 upregulation and SLC22A1 downregulation were associated with worse outcomes. Experimental results confirmed that patients with higher risk scores had a worse prognosis.

Conclusions: A prognostic signature based on the expression levels of three resistome-associated genes has been defined and can serve as a helpful complementary tool in clinical settings to categorize HCC patients.

简介和目的：肝细胞癌（HCC）患者的预后通常很差，部分原因是多药耐药。HCC异质性降低了传统预测模型的准确性。本研究旨在评价肝细胞癌抵抗组的预后意义。材料和方法：对TCGA 371例HCC患者的临床和转录组学数据进行分析。使用外部数据集（来自4个队列的604例患者）和40个HCC样本，通过RT-qPCR检测基因表达，来验证预后模型。结果：基于抵抗组基因的表达，计算机分析显示了两种不同的患者群。Kaplan-Meier分析显示1组（C1）预后较好。此外，C1组患者对索拉非尼治疗的反应优于C2组。Cox回归分析发现，抵抗组谱与临床病理特征（如肿瘤分期和ECOG状态）一样，是一个独立的预后因素。81个基因中有58个在集群之间表现出差异表达。有13个基因的表达水平与患者的生存存在相关性。在Cox多变量分析中，SLC22A1、BIRC5和ABCC1基因成为独立的预后因素，形成了风险模型的基础。BIRC5和ABCC1上调和SLC22A1下调与较差的预后相关。实验结果证实，风险评分越高的患者预后越差。结论：基于三种抵抗体相关基因表达水平的预后特征已经被定义，并且可以作为临床环境中对HCC患者进行分类的有用补充工具。

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引用次数: 0

Natural history and outcomes of MASLD and MetALD following non-alcoholic fatty liver disease reclassification in a Canadian cohort 加拿大非酒精性脂肪性肝病重分类后MASLD和MetALD的自然历史和结局

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-11-27 DOI: 10.1016/j.aohep.2025.102166

Yousef Almahanna , Francisco Idalsoaga , Luis Antonio Díaz , Ahmed Almohsen , Yi Nong Song , Amani Bajunayd , Rokhsana Mortuza , Jeemin Kim , Adrienne Abaya , Mohammad Qasim Khan , Juan Pablo Arab

Introduction and Objectives

Steatotic liver disease (SLD) affects 40 % of North Americans, with some progressing to advanced fibrosis. A recent nomenclature update redefined subtypes, distinguishing Metabolic dysfunction-associated steatotic liver disease (MASLD), Metabolic and alcohol-associated liver disease (MetALD), and alcohol-associated liver disease (ALD). This study aimed to assess the prevalence of MetALD and ALD in a previously Non-alcoholic fatty liver disease (NAFLD) -labeled cohort, evaluate cardiometabolic risk factors, and analyze short-term outcomes.

Materials and Methods

This retrospective observational cohort study included patients referred to a specialized NAFLD clinic in Ontario, Canada (October 2021–September 2023). Adults (age ≥18 years) with radiographic hepatic steatosis were categorized into MASLD, MetALD, or ALD based on gender-specific alcohol consumption thresholds documented in electronic medical records. Baseline characteristics and short-term outcomes were compared across groups.

Results

Among 445 patients, MASLD was most prevalent (88.3 %), followed by MetALD (8.9 %) and ALD (2.7 %). Males predominated in MetALD (67.5 %) and ALD (83.4 %) (p = 0.002). Smoking was strongly linked to ALD (p = 0.001). Diabetes was more common in MASLD (32.5 %, p = 0.012), while hypertension and dyslipidemia showed no significant differences across SLD subtypes. Advanced fibrosis (F3-F4) was present in 16.1 %. In a two-year follow-up, higher mortality incidences were observed in ALD (16.6 %). Additionally, regression of fibrosis was observed across all groups.

Conclusions

11.7 % of patients historically labeled as NAFLD met criteria for MetALD or ALD, underscoring the importance of updated nomenclature. High fibrosis prevalence and ALD-related mortality highlight the need for early screening, precise alcohol assessment, and multidisciplinary care to improve outcomes.

简介和目的：脂肪变性肝病（SLD）影响40%的北美人，其中一些进展为晚期纤维化。最近的命名更新重新定义了亚型，区分了代谢功能障碍相关脂肪变性肝病（MASLD），代谢和酒精相关肝病（MetALD）和酒精相关肝病（ALD）。本研究旨在评估先前非酒精性脂肪性肝病（NAFLD）标记队列中MetALD和ALD的患病率，评估心脏代谢危险因素，并分析短期结果。材料和方法：这项回顾性观察性队列研究纳入了在加拿大安大略省一家NAFLD专科诊所就诊的患者（2021年10月- 2023年9月）。根据电子病历中记录的性别特异性酒精消费阈值，影像学诊断为肝脂肪变性的成人（年龄≥18岁）被分为MASLD、MetALD或ALD。各组间比较基线特征和短期结果。结果：445例患者中，MASLD发生率最高（88.3%），其次为MetALD（8.9%）和ALD（2.7%）。男性以MetALD（67.5%）和ALD（83.4%）为主（p=0.002）。吸烟与ALD密切相关（p=0.001）。糖尿病在MASLD中更为常见（32.5%,p=0.012），而高血压和血脂异常在SLD各亚型间无显著差异。晚期纤维化（F3-F4）占16.1%。在两年的随访中，ALD患者的死亡率较高（16.6%）。此外，在所有组中都观察到纤维化的消退。结论：11.7%既往标记为NAFLD的患者符合MetALD或ALD的标准，强调了更新命名法的重要性。高纤维化患病率和ald相关死亡率强调需要早期筛查、精确的酒精评估和多学科护理来改善预后。

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引用次数: 0