Annals of hepatology最新文献_第9页

IMPLEMENTATION OF A TEST AND TREAT MODEL FOR HCV CARE UTILIZING POINT OF CARE HCV RNA TESTING IN LA BODEGA 在la bodega利用护理点HCV RNA检测实现HCV护理的测试和治疗模型

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101998

Anthony Martinez , Scott Springer , Sean Owen

Introduction and Objectives

The World Health Organization (WHO) aims to eliminate hepatitis C virus (HCV) by 2030; however, the United States (US) is unlikely to meet this target. Screening, linkage, and treatment initiation remain suboptimal.

To evaluate Point-of-care (POC) HCV RNA test (Xpert® HCV) in a test and treat model of care among People Who Use Drugs (PWUD).

Materials and Methods

La Bodega, a co-localized hepatology and addiction medicine program in Buffalo, New York (NY), specializes in HCV management among active PWUD. POC HCV RNA testing is utilized on-site. Patients with a positive HCV RNA initiate HCV therapy at the time of the initial visit. POC HCV RNA testing is also used in conjunction with lab-based RNA testing on serum to evaluate SVR4 when indicated.

Results

65 people were screened with POC HCV RNA of whom 40 had a previous HCV antibody. 11 individuals were found to be HCV RNA positive. Eleven individuals were assessed for SVR, all of whom had both undetectable serum HCV RNA and negative POC HCV RNA results. Among RNA-positive individuals, one was linked to their primary care clinic based on the patient’s preference and 10 individuals initiated therapy, receiving the full 8 or 12 weeks of therapy, depending on the chosen regimen. Two individuals remain on treatment; 6 are pending SVR assessment, and 2 achieved SVR, one of whom was pregnant and treated with sofosbuvir/velpatasvir.

Conclusions

POC HCV RNA testing is advantageous in shortening the HCV care cascade, enabling a true test-and-treat model of care for HCV.

世界卫生组织（WHO）的目标是到2030年消除丙型肝炎病毒（HCV）；然而，美国不太可能实现这一目标。筛查、联系性和开始治疗仍不理想。评估即时护理（POC） HCV RNA检测（Xpert®HCV）在药物使用人群（PWUD）的检测和治疗模式中的应用。材料和方法sla Bodega是位于纽约州布法罗市的肝病学和成瘾医学联合项目，专门研究活动性PWUD患者的HCV管理。现场使用POC HCV RNA检测。HCV RNA阳性的患者在初次就诊时开始HCV治疗。如有需要，POC HCV RNA检测也可与基于实验室的血清RNA检测结合使用，以评估SVR4。结果65人筛查出POC HCV RNA，其中40人既往有HCV抗体。11例HCV RNA阳性。对11名患者进行SVR评估，所有患者血清HCV RNA均检测不到，POC HCV RNA结果均为阴性。在rna阳性的个体中，根据患者的偏好，1人与他们的初级保健诊所联系，10人开始治疗，接受完整的8或12周的治疗，取决于所选择的方案。两人仍在接受治疗；6人正在等待SVR评估，2人达到SVR，其中1人怀孕并接受sofosbuvir/velpatasvir治疗。结论spoc HCV RNA检测有利于缩短HCV护理级联，实现真正的HCV检测和治疗模式。

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引用次数: 0

PREVALENCE OF COVERT HEPATIC ENCEPHALOPATHY IN PATIENTS WITH COMPENSATED LIVER CIRRHOSIS 代偿性肝硬化患者隐匿性肝性脑病的患病率

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102027

Oscar Suazo , Aissatou Sow , Susana Borges , Marlén Castellanos , Sila M. Gonzales , Danay Guerrero , Mirtha Infante Velasquez , Yusimik Román

Introduction and Objectives

Covert hepatic encephalopathy (CHE) is a complication that affects the quality of life and prognosis of cirrhotic patients. It is identified through appropriate neuropsychological tests. Objectives: To determine the prevalence of CHE in patients with compensated liver cirrhosis using the Psychometric Hepatic Encephalopathy Score (PHES) and its association with selected clinical factors.

Materials and Methods

A descriptive, cross-sectional study was conducted at the Institute of Gastroenterology in Havana, Cuba, between March 2023 and December 2024. Sixty-five patients with defined selection criteria were included. The prevalence of CHE was calculated according to the total PHES, using normality tables for the Cuban population. PHES scores and laboratory parameters were compared, and the association with sex, age, education, and etiology was explored between the groups with and without EHE.

Results

The prevalence of EHE was 32.3% (n=21). Differences were found between groups with and without EHE in the total PHES (p<0.001) and in each of its components. No association was demonstrated between age, sex, educational level, and etiology of cirrhosis with EHE, nor was there statistical significance between ALAT (p=0.68), ASAT (p=0.90), albumin (p=0.65), and platelet count (p=0.63). Age >60 years, male sex, viral etiology, low educational level, and liver function did not influence the diagnosis of EHE.

Conclusions

The PHES is an objective tool that allowed the identification of EHE in the context studied, which is relevant for the early management of compensated cirrhosis.

隐蔽性肝性脑病（CHE）是一种影响肝硬化患者生活质量和预后的并发症。它是通过适当的神经心理学测试来确定的。目的：利用肝性脑病心理测量评分（PHES）确定代偿性肝硬化患者中CHE的患病率及其与选定临床因素的关系。材料与方法一项描述性横断面研究于2023年3月至2024年12月在古巴哈瓦那胃肠病学研究所进行。纳入了65例具有明确选择标准的患者。利用古巴人口的正态表，根据公共卫生指数的总数计算了古巴疾病的患病率。比较EHE组和非EHE组的PHES评分和实验室参数，并探讨其与性别、年龄、教育程度和病因的关系。结果EHE患病率为32.3% （n=21）。在有EHE和没有EHE的组之间，总PHES （p<0.001）及其每个组成部分存在差异。年龄、性别、受教育程度、肝硬化病因与EHE无相关性，ALAT （p=0.68）、ASAT （p=0.90）、白蛋白（p=0.65）、血小板计数（p=0.63）之间无统计学意义。年龄60岁、男性、病毒病因、低文化程度、肝功能对EHE的诊断无影响。结论PHES是一种客观的工具，可以在研究的背景下识别EHE，这与代偿性肝硬化的早期治疗有关。

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引用次数: 0

HEALTH LITERACY AS A DETERMINANT OF FRAILTY IN PATIENTS WITH LIVER CIRRHOSIS 健康素养是肝硬化患者虚弱的决定因素

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101980

Ismael de Jesús Yepes Barreto , Nicole Chamorro , Guillermo Donado

Introduction and Objectives

Health literacy (HL) is a key social determinant of health, especially in chronic conditions like cirrhosis, where disease management depends heavily on patient comprehension and engagement. HL refers to the ability to access, understand, and use health information to make informed decisions. Frailty, a state of decreased physiological reserve and increased vulnerability, is a strong predictor of adverse outcomes in cirrhosis. Although the Liver Frailty Index (LFI) is commonly used to assess physical frailty, the role of HL in this context remains poorly explored. This study aimed to determine the association between HL and frailty in patients with cirrhosis.

Patients and Methods

We conducted a cross-sectional study among adults with confirmed cirrhosis attending outpatient hepatology clinics in Cartagena, Colombia, between September and December 2024. HL was measured using the Short Assessment of Health Literacy for Spanish Adults (SAHL-S), and frailty was assessed with the LFI, which includes grip strength, chair stands, and balance tests. Trained clinicians performed all tests using calibrated equipment. Demographic and clinical variables were obtained from records and structured interviews. Patients with encephalopathy or severe mobility limitations were excluded. Frailty was defined as LFI ≥ 4.5.

Results

Among 89 participants (57.3% women, mean age 64.8), 85.4% were Child-Pugh A. History of decompensation and variceal bleeding were present in 24.7% and 13.5%, respectively. LFI categorized 15.7% as robust, 65.2% as prefrail, and 19.1% as frail. In multivariable analysis, low HL (OR 2.8; 95% CI 1.3–6.0) and variceal bleeding (OR 3.2; 95% CI 1.4–7.1) independently predicted frailty.

Conclusions

Low HL independently predicts frailty and should be addressed to improve outcomes in cirrhosis care.

健康素养（HL）是健康的关键社会决定因素，特别是在肝硬化等慢性疾病中，疾病管理在很大程度上取决于患者的理解和参与。HL是指获取、理解和使用卫生信息以做出明智决策的能力。虚弱，一种生理储备减少和脆弱性增加的状态，是肝硬化不良结局的一个强有力的预测因子。尽管肝脆弱指数（LFI）通常用于评估身体虚弱，但HL在这方面的作用仍未得到充分探讨。本研究旨在确定HL与肝硬化患者虚弱之间的关系。患者和方法我们对2024年9月至12月在哥伦比亚卡塔赫纳肝病门诊就诊的确诊肝硬化成人进行了一项横断面研究。使用西班牙成人健康素养短期评估（SAHL-S）测量HL，使用LFI评估虚弱程度，其中包括握力、椅架和平衡测试。训练有素的临床医生使用校准的设备进行所有测试。从记录和结构化访谈中获得人口统计学和临床变量。排除有脑病或严重活动受限的患者。虚弱定义为LFI≥4.5。结果89名参与者中（57.3%为女性，平均年龄64.8岁），85.4%为Child-Pugh a。有失代偿史和静脉曲张出血分别占24.7%和13.5%。LFI将15.7%归类为健壮，65.2%为虚弱，19.1%为虚弱。在多变量分析中，低HL （OR 2.8; 95% CI 1.3-6.0）和静脉曲张出血（OR 3.2; 95% CI 1.4-7.1）独立预测虚弱。结论：slow HL独立预测衰弱，应加以解决，以改善肝硬化护理的结果。

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引用次数: 0

PLANT-DERIVED MONOTERPENE SYNERGIZES WITH SORAFENIB TO SUPPRESS DRUG-TRIGGERED HEPATOCELLULAR CARCINOMA IN ANIMALS 植物源单萜与索拉非尼协同抑制动物药物引发的肝细胞癌

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101986

Amr Amin

Introduction and Objectives

Sorafenib (SB), while established as a first-line multikinase inhibitor for advanced hepatocellular carcinoma (HCC), demonstrates constrained clinical utility due to significant adverse effects and the emergence of drug resistance. To potentially enhance its therapeutic profile, we explored combination therapy with natural compounds. Previous investigations from our group identified safranal (SF), a major bioactive monoterpene constituent of saffron, as exhibiting notable anti-HCC properties.

This study aimed to investigate potential synergistic interactions between SB and SF that might improve HCC treatment outcomes.

Materials and Methods

We employed a chemically-induced cirrhotic HCC rat model to evaluate both SF monotherapy and SB-SF combination therapy. Comprehensive molecular characterization included RNA sequencing with subsequent differential gene expression analysis, pathway enrichment studies, and protein interaction network mapping. Mechanistic findings were confirmed through immunohistochemical and immunoblotting techniques.

Results

The SB-SF combination demonstrated enhanced anticancer efficacy compared to SB alone. Transcriptomic profiling identified 45 differentially expressed genes associated with HCC suppression, particularly those involved in proliferation control, oxidative stress response, and apoptotic regulation. The combination therapy significantly downregulated key oncogenic markers including NF-κB-p65, COX-2, and β-catenin, suggesting its potential as a cost-effective therapeutic approach that warrants further clinical investigation.

Conclusions

The study reveals a multifaceted mechanism by which SF augments SB's anticancer activity in HCC. The combined treatment modulates critical oncogenic pathways including NF-κB and Wnt/β-catenin signaling while rebalancing apoptotic regulators through decreased Bcl-2 and increased Bax/caspase expression. Additionally, it suppresses proliferative markers such as Ki-67 and PCNA while attenuating inflammatory mediators including TNF-α and MMP-9. These coordinated effects demonstrate potent anti-tumorigenic, anti-angiogenic, and pro-apoptotic activity, highlighting the therapeutic promise of this combination approach for HCC treatment.

orafenib （SB）作为治疗晚期肝细胞癌（HCC）的一线多激酶抑制剂，由于明显的不良反应和耐药的出现，其临床应用受到限制。为了潜在地提高其治疗效果，我们探索了与天然化合物的联合治疗。本小组先前的研究发现，藏红花中一种主要的生物活性单萜成分——藏红花醛（SF），具有显著的抗hcc特性。本研究旨在探讨SB和SF之间可能改善HCC治疗结果的潜在协同相互作用。材料与方法采用化学诱导的肝硬化肝细胞癌大鼠模型，对SF单药治疗和SF -SF联合治疗进行评价。全面的分子表征包括RNA测序和随后的差异基因表达分析、途径富集研究和蛋白质相互作用网络制图。机制发现通过免疫组织化学和免疫印迹技术证实。结果与单用SB相比，SB- sf联合用药的抗癌效果明显增强。转录组学分析鉴定了45个与HCC抑制相关的差异表达基因，特别是那些涉及增殖控制、氧化应激反应和凋亡调节的基因。联合治疗显著下调关键的致癌标志物，包括NF-κB-p65、COX-2和β-catenin，表明其作为一种具有成本效益的治疗方法的潜力，值得进一步的临床研究。结论本研究揭示了SF增强SB在HCC中抗肿瘤活性的多方面机制。联合治疗可调节关键的致癌途径，包括NF-κB和Wnt/β-catenin信号通路，同时通过降低Bcl-2和增加Bax/caspase表达来重新平衡凋亡调节因子。此外，它抑制增殖标志物如Ki-67和PCNA，同时减弱炎症介质包括TNF-α和MMP-9。这些协同作用显示出强大的抗肿瘤、抗血管生成和促凋亡活性，突出了这种联合治疗方法在HCC治疗中的治疗前景。

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引用次数: 0

DATA OMISSION IN COMPULSORY NOTIFICATION FORMS RELATED TO HEPATITIS A, B AND C AND HIV CO-INFECTION 在与甲型、乙型和丙型肝炎以及艾滋病毒合并感染有关的强制通知表格中遗漏数据

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102042

Isabelle Cristine de Jesus Macedo , João Vitor da Mota Silva , Ana Paula Maciel Gurski , Mário Peribanez Gonzalez , Elton Carlos de Almeida , Aline Alves da Silva , Ana Monica de Mello , Carla Francisca dos Santos Cruz , Nathália da Silva Cruz , Jose Nilton Neris Gomes , Leonardo Carrara Matsuura

Introduction and Objectives

Co-infection with Human Immunodeficiency Virus (HIV) and hepatitis C virus (HCV) represents a significant public health challenge in Brazil, as it is associated with worsening clinical outcomes, such as accelerated progression of liver disease and increased morbidity and mortality.

To describe the rate of incomplete reporting related to HCV and HIV co-infection among individuals notified between 2013 and 2023 in the North region of Brazil.

Materials and Methods

This is a descriptive, cross-sectional study conducted using data from the Notifiable Diseases Information System (Sinan) database for the period from 2013 to 2023. The variables used were viral hepatitis classification and co-infection with HIV. Subsequently, a descriptive analysis was performed to identify omissions in the HIV co-infection variable in viral hepatitis notifications.

Results

A high number (18.6%) of data omissions was observed regarding HIV and viral hepatitis co-infection. Among the types, the highest omission rate was observed in hepatitis A notifications (21.7%), followed by hepatitis C (20.3%) and hepatitis B (17%). Among the states, Roraima showed the highest percentage of omission of information on HIV diagnosis (23.2%).

Conclusions

The data reveal a significant percentage of omissions regarding the investigation of HIV co-infection in viral hepatitis notifications, especially for hepatitis A (21.7%), C (20.3%), and B (17%). This weakness in the completeness of information compromises epidemiological surveillance and health action planning.

在巴西，人类免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）的合并感染是一项重大的公共卫生挑战，因为它与临床结果恶化有关，例如肝病进展加快、发病率和死亡率增加。描述巴西北部地区2013年至2023年通报的个人中与丙型肝炎病毒和艾滋病毒合并感染相关的不完整报告率。材料和方法这是一项描述性横断面研究，使用2013年至2023年期间来自法定疾病信息系统（思南）数据库的数据。使用的变量是病毒性肝炎分类和合并感染HIV。随后，进行了描述性分析，以确定病毒性肝炎报告中HIV合并感染变量的遗漏。结果HIV与病毒性肝炎合并感染的数据漏报率高达18.6%。其中，漏报率最高的是甲型肝炎（21.7%），其次是丙型肝炎（20.3%）和乙型肝炎（17%）。在各州中，罗赖马州遗漏艾滋病毒诊断信息的比例最高（23.2%）。结论数据显示，病毒性肝炎报告中HIV合并感染调查的遗漏率很高，特别是甲型肝炎（21.7%）、丙型肝炎（20.3%）和乙型肝炎（17%）。这种信息不完整的弱点影响了流行病学监测和卫生行动规划。

{"title":"DATA OMISSION IN COMPULSORY NOTIFICATION FORMS RELATED TO HEPATITIS A, B AND C AND HIV CO-INFECTION","authors":"Isabelle Cristine de Jesus Macedo , João Vitor da Mota Silva , Ana Paula Maciel Gurski , Mário Peribanez Gonzalez , Elton Carlos de Almeida , Aline Alves da Silva , Ana Monica de Mello , Carla Francisca dos Santos Cruz , Nathália da Silva Cruz , Jose Nilton Neris Gomes , Leonardo Carrara Matsuura","doi":"10.1016/j.aohep.2025.102042","DOIUrl":"10.1016/j.aohep.2025.102042","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Co-infection with Human Immunodeficiency Virus (HIV) and hepatitis C virus (HCV) represents a significant public health challenge in Brazil, as it is associated with worsening clinical outcomes, such as accelerated progression of liver disease and increased morbidity and mortality.</div><div>To describe the rate of incomplete reporting related to HCV and HIV co-infection among individuals notified between 2013 and 2023 in the North region of Brazil.</div></div><div><h3>Materials and Methods</h3><div>This is a descriptive, cross-sectional study conducted using data from the Notifiable Diseases Information System (Sinan) database for the period from 2013 to 2023. The variables used were viral hepatitis classification and co-infection with HIV. Subsequently, a descriptive analysis was performed to identify omissions in the HIV co-infection variable in viral hepatitis notifications.</div></div><div><h3>Results</h3><div>A high number (18.6%) of data omissions was observed regarding HIV and viral hepatitis co-infection. Among the types, the highest omission rate was observed in hepatitis A notifications (21.7%), followed by hepatitis C (20.3%) and hepatitis B (17%). Among the states, Roraima showed the highest percentage of omission of information on HIV diagnosis (23.2%).</div></div><div><h3>Conclusions</h3><div>The data reveal a significant percentage of omissions regarding the investigation of HIV co-infection in viral hepatitis notifications, especially for hepatitis A (21.7%), C (20.3%), and B (17%). This weakness in the completeness of information compromises epidemiological surveillance and health action planning.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102042"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

VISCERAL FAT AS A KEY DRIVER OF LIVER FIBROSIS IN MASLD: A DXA-BASED ANALYSIS 内脏脂肪是masld肝纤维化的关键驱动因素：一项基于dxa的分析

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102017

Jenaine Rosa Emiliano Godinho , Raul Donizetti Moraes Silva , Lívia Manéa Petri , Ana Cecilia Sartori Ferruzzi , Jordanna de Paula Torres , Henrique Pezzin Sario , João Marcello de Araújo-Neto , Maria Auxiliadora Nogueira Saad , Priscila Pollo-Flores , Débora Vieira Soares

Introduction and Objectives

Adiposity is associated with an increased risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD).

Verify the association between liver fibrosis and visceral adiposity in MASLD by Dual-energy X-ray absorptiometry (DXA) method.

Materials and Methods

In a cross-sectional study, assessment of MASLD and significant fibrosis (F≥2) were performed by ultrassonography and transient elastography, respectively. Dual-energy X-ray absorptiometry (DXA) were performed to assess fat mass index (FMI), visceral adipose tissue (VAT)and android-to-gynoid (A/G) ratio. Data are reported as median (IQR) or n (%); p < 0.05 was considered significant

Results

141 participants were enrolled, 32(22.7%) had hepatic fibrosis. Age was 62.0(55.0–68.0) years, and 118(83.7%) were women. Adiposity parameters were waist-to-height ratio (WHtR) 0.66 (0.59–0.71); abdominal circumference (AC) 105.0(94.4–114.1) cm; fat mass index (FMI) 13.94 (10.50–17.20) kg/m²; VAT 1784 (1203–2430) cm³; and A/G 1.13 (1.04–1.23). The prevalence of obesity (BMI ≥ 30 kg/m²), high FMI (> 14 kg/m²), and A/G > 1 was 45(31.9%), 52(36.9%), and 130(92.2%) respectively. The groups with and without fibrosis were compared. Age and sex were similar between groups. Those with fibrosis had significantly higher WHtR, AC, VAT, trunk fat mass, android fat mass, and total fat mass. (Table 1).

Conclusions

This study shows that central and visceral adiposity are significantly linked to liver fibrosis. These findings are measured by DXA, an accurate method, and are supported by simple and cost-effective clinical measures such as WHtR and AC.

简介和目的肥胖与发生代谢功能障碍相关的脂肪变性肝病（MASLD）的风险增加相关。通过双能x线吸收仪（DXA）方法验证MASLD肝纤维化与内脏脂肪之间的关系。材料和方法在横断面研究中，分别通过超声和瞬时弹性成像评估MASLD和显著纤维化（F≥2）。采用双能x线吸收仪（DXA）评估脂肪质量指数（FMI）、内脏脂肪组织（VAT）和雌雄比（A/G）。数据以中位数（IQR）或n（%）报告；p <； 0.05认为显著。结果141名参与者入组，32名（22.7%）发生肝纤维化。年龄62.0（55.0 ~ 68.0）岁，女性118例（83.7%）。肥胖参数为腰高比（WHtR） 0.66 (0.59 ~ 0.71)；腹围（AC） 105.0(94.4-114.1) cm；脂肪质量指数（FMI） 13.94 (10.50 ~ 17.20) kg/m2；增值税1784 (1203-2430)cm3；A/G 1.13（1.04-1.23）。肥胖（BMI≥30 kg/m2）、高FMI （> 14 kg/m2）和A/G >； 1患病率分别为45（31.9%）、52（36.9%）和130（92.2%）。比较有纤维化组和无纤维化组。两组之间的年龄和性别相似。纤维化患者的WHtR、AC、VAT、躯干脂肪质量、android脂肪质量和总脂肪质量显著升高。(表1)。结论本研究表明，中枢性和内脏性肥胖与肝纤维化有显著关系。这些发现是通过DXA（一种准确的方法）测量的，并得到简单和具有成本效益的临床测量（如WHtR和AC）的支持。

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引用次数: 0

INR-PLATELET RATIO AS A PREDICTOR OF ESOPHAGEAL VARICES IN MEXICAN CIRRHOTIC PATIENTS 血小板内比值作为墨西哥肝硬化患者食管静脉曲张的预测因子

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102003

Cinthya Yatzel Mulato Briones , Raúl Ramírez Marcial , Maria del Rosario Herrero Maceda , Scherezada María Isabel Mejía Loza , Rodrigo Vázquez Pérez , María Isabel Astudillo Delgado , Alejandra Díaz García

Introduction and Objectives

High mortality from esophageal variceal bleeding necessitates primary prophylaxis in cirrhosis. Mexico's endoscopy-limited settings require biochemical predictors like the INR-Platelet Ratio (INPR) for variceal detection.The present work proposes that the INPR retains predictive validity for esophageal varices in Mexican cirrhotic patients.Consequently, validation of this hypothesis constitutes the primary objective of this investigation.

Patients and Methods

An observational, single-center study was conducted in the Gastroenterology Department of Hospital Juárez de México between 2023 and 2024.Inclusion criteria:Patients aged over 18 years with a diagnosis of cirrhosis confirmed by FIB-4 or hepatic ultrasound,and no prior endoscopic screening.A total of 139 patients were included: 71 women (51.1%) and 68 men (48.9%). Statistical analyses were performed using IBM SPSS Statistics software. Descriptive population analyses utilized frequencies and medians.Group comparisons were conducted using the chi-square test and Student’s t-test,with a p-value <0.05 considered statistically significant.ROC curves and the Youden index were employed to identify optimal cutoff values for sensitivity and specificity.

Results

Using an INPR cut-off of ≥0.9463 for detecting esophageal varices (irrespective of size), the following performance metrics were achieved: sensitivity 83%, specificity 71%, PPV 85%, NPV 66%. +LR 2.87, -LR 0.24.

Conclusions

The INR-Platelet Ratio is an efficient tool for healthcare providers to initiate screening and prioritize early endoscopy, particularly in patients with other risk markers such as thrombocytopenia or Child-Pugh B/C cirrhosis.Future studies should evaluate its cutoff points to reduce unnecessary endoscopies and improve timely complication detection.

肝硬化患者食管静脉曲张出血死亡率高，需要进行初级预防。墨西哥内窥镜受限的环境需要像inr -血小板比率（INPR）这样的生化预测指标来检测静脉曲张。目前的研究表明，INPR对墨西哥肝硬化患者的食管静脉曲张保持预测有效性。因此，验证这一假设构成了本研究的主要目标。患者和方法：于2023年至2024年在Juárez de membroxico医院消化内科进行了一项观察性单中心研究。纳入标准：年龄在18岁以上，经FIB-4或肝脏超声确诊为肝硬化，既往无内镜筛查的患者。共纳入139例患者：女性71例（51.1%），男性68例（48.9%）。采用IBM SPSS统计软件进行统计分析。描述性总体分析使用频率和中位数。组间比较采用卡方检验和学生t检验，p值<；0.05认为差异有统计学意义。采用ROC曲线和约登指数确定敏感性和特异性的最佳截止值。结果采用≥0.9463的INPR截止值检测食管静脉曲张（无论大小），实现了以下性能指标：敏感性83%，特异性71%，PPV 85%, NPV 66%。+ lr 2.87, -lr 0.24。结论inr -血小板比率是医疗保健提供者启动筛查和优先考虑早期内窥镜检查的有效工具，特别是对于具有其他风险标志物（如血小板减少症或Child-Pugh B/C肝硬化）的患者。未来的研究应评估其截止点，以减少不必要的内窥镜检查，提高并发症的及时发现。

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引用次数: 0

LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA: IMPLICATIONS OF EXPANDING AGE LIMITS IN LOW-DONATION SETTINGS IN LATIN AMERICA 肝细胞癌肝移植：在拉丁美洲低捐献环境中扩大年龄限制的意义

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102028

Maria Fernanda Lynch-Mejía , Francisco Vargas-Navarro , Wagner Ramírez-Quesada , Maria José Soto-Echeverri , Andrés Solera-Vega , Alejandra Ochoa-Palominos , Pablo Coste

Introduction and Objectives

In Costa Rica, liver transplantation (LT) for hepatocellular carcinoma (HCC) is legally restricted to patients under 65 years. This limits curative options and may favor patients receiving exception MELD points. The country’s average liver donation rate remains low, at 5.4 donors per million population per year, further limiting access.

Materials and Methods

We assessed transplant eligibility, bridging therapies, and outcomes in HCC patients at a tertiary center. Eligibility was defined as age <65, meeting UCSF criteria, and having no contraindications. We modeled the impact of raising the age limit to <70 years.

Results

Of 260 patients, 52 (20%) met transplant criteria; 86.5% received bridging therapy (TACE 27, ablation 18, resection 2). One additional patient was downstaged to eligibility. Among 53 total candidates, 30.2% progressed or died before listing, 11.3% remained stable on alternative treatments, 45% were transplanted, and 9.4% died or dropped out while on the waitlist. Mean wait time was 148.1 days (SD 93.5). Expanding the age limit to <70 years would increase eligibility by 49%, adding 27 candidates. However, this may disadvantage other patients with high functional MELD scores, as those with HCC receive exception points after three months of evaluation.

Conclusions

Raising the age threshold for LT would expand access for older HCC patients but may exacerbate inequities in organ allocation due to low donation rates and MELD exception prioritization. Policy reform must be accompanied by increased organ procurement efforts and ethical safeguards to ensure equitable access in low-donation settings such as Costa Rica.

在哥斯达黎加，肝细胞癌（HCC）的肝移植（LT）在法律上仅限于65岁以下的患者。这限制了治疗选择，可能有利于接受例外MELD点的患者。该国的平均肝脏捐献率仍然很低，每年每百万人中只有5.4人捐献肝脏，这进一步限制了获取肝脏的机会。材料和方法我们评估了三级中心HCC患者的移植资格、桥接治疗和预后。资格定义为年龄65岁，符合UCSF标准，无禁忌症。我们模拟了将年龄限制提高到70岁的影响。结果260例患者中，52例（20%）符合移植标准；86.5%接受了桥接治疗（TACE 27，消融18，切除2）。另外一名患者被降级为合格。在53名候选人中，30.2%的人在上市前进展或死亡，11.3%的人在替代治疗中保持稳定，45%的人移植，9.4%的人在等待名单中死亡或退出。平均等待时间为148.1天（SD 93.5）。将年龄限制扩大到70岁将使资格增加49%，增加27名候选人。然而，这可能会使其他具有高功能MELD评分的患者处于不利地位，因为HCC患者在三个月评估后获得例外分。提高肝移植的年龄门槛将扩大老年HCC患者获得肝移植的机会，但由于低捐献率和MELD例外优先级，可能加剧器官分配的不公平。政策改革必须伴随着加强器官采购工作和道德保障，以确保在哥斯达黎加等低捐赠环境中公平获得器官。

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引用次数: 0

ENCEPHALAPP STROOP TO DETECT COVERT HEPATIC ENCEPHALOPATHY IN PATIENTS WITH COMPENSATED CIRRHOSIS 脑电图检测代偿性肝硬化患者隐匿性肝性脑病

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102026

Oscar Suazo , Kemo Sayon , Yusimik Román , Sila M. Gonzales , Mirtha Infante Velasquez , Marlén Castellanos , Danay Guerrero , Susana Borges

Introduction and Objectives

Covert hepatic encephalopathy (CHE) is a common complication in patients with compensated cirrhosis, associated with subtle cognitive impairment and a worse prognosis. The EncephalApp Stroop is a digital tool that facilitates its identification.

To evaluate the diagnostic capacity of the EncephalApp Stroop to identify CHE in patients with compensated cirrhosis

Materials and Methods

A diagnostic evaluation study was conducted in patients with compensated cirrhosis treated at the Institute of Gastroenterology in Havana, Cuba, between March 2023 and December 2024. All participants completed the EncephalApp Stroop and the Psychometric Hepatic Encephalopathy Score (PHES). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. The discriminatory capacity of the test was assessed using ROC curve analysis, considering a cutoff point of >190 seconds in the “on” time metric plus “off” time, and the PHES result as the gold standard.

Results

Seventy patients of both sexes were included, with a predominance of viral etiology (74.3%). The prevalence of EHE was 38.6%. The EncephalApp Stroop showed a sensitivity of 95.2% (95% CI: 77.3% to 99.2%) and specificity of 85.7% (95% CI: 73.3% to 92.9%), PPV of 74.1% (95% CI: 55.3% to 86.8%) and NPV of 97.7% (95% CI: 87.9% to 99.6%) for the detection of HSE, with an area under the ROC curve of 0.905 (95% CI: 0.826-0.984).

Conclusions

The EncephalApp Stroop is a valid, accessible, and efficient diagnostic test for identifying EHE in compensated cirrhosis, with high performance compared to PHES as the gold standard. Its implementation can optimize early detection and clinical management.

隐蔽性肝性脑病（CHE）是代偿性肝硬化患者的常见并发症，伴有细微的认知障碍和较差的预后。EncephalApp Stroop是一种便于识别的数字工具。为了评估EncephalApp Stroop在代偿性肝硬化患者中识别CHE的诊断能力材料和方法，研究人员于2023年3月至2024年12月在古巴哈瓦那胃肠病学研究所对代偿性肝硬化患者进行了一项诊断评估研究。所有参与者都完成了EncephalApp Stroop和肝性脑病心理测量评分（PHES）。测定敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。采用ROC曲线分析，考虑“开”时间指标加“关”时间的截断点为190秒，以PHES结果为金标准，评估试验的鉴别能力。结果共纳入70例患者，男女均有，以病毒性病因为主（74.3%）。EHE患病率为38.6%。EncephalApp Stroop检测HSE的灵敏度为95.2% (95% CI: 77.3% ~ 99.2%)，特异性为85.7% (95% CI: 73.3% ~ 92.9%)， PPV为74.1% (95% CI: 55.3% ~ 86.8%)， NPV为97.7% (95% CI: 87.9% ~ 99.6%)， ROC曲线下面积为0.905 （95% CI: 0.826 ~ 0.984）。结论EncephalApp Stroop是代偿性肝硬化EHE诊断的一种有效、便捷、高效的检测方法，与PHES相比具有较高的性能。它的实施可以优化早期发现和临床管理。

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引用次数: 0

GUT MYCOBIOME IN THE SPECTRUM OF METABOLIC-DYSFUNCTION ASSOCIATED STEATOTIC LIVER DISEASE (MASLD): FROM MASH TO HEPATOCELLULAR CARCINOMA 代谢功能障碍相关脂肪变性肝病（masld）谱中的肠道菌群：从土豆泥到肝细胞癌

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102044

Cassio Marques Perlin , Melina Keingeski Belén , Bruno de Souza Basso , Beatriz Mendes Borba , Julliane Dutra Medeiros , Francis Moreira Borges , Bernd Schnabl , Mario Reis Alvares-da-Silva

Introduction and Objectives

Gut microbiome (GM) dysbiosis is associated with the development and progression of metabolic-dysfunction associated steatotic liver disease (MASLD) and steatohepatitis (MASH). There is still very limited data on the gut mycobiome (GMyco). This study aims to evaluate the composition of the GMyco at different stages of MASLD.

Patients and Methods

28 patients were included: controls (CON), n=6; MASH, n=6; cirrhosis (CIR), n=7; and hepatocellular carcinoma (HCC), n=5. Stool samples were collected and stored in a -80°C freezer for DNA extraction and sequencing (18S region). The single sequence variants (ASVs) obtained were compared to the SILVA database.

Results

77.93% women, average BMI of 31.4 kg/m2, use of antibiotics in the last 6 months (30.4%), and concurrent lipid-lowering drugs in 26.1%. MASH patients had a greater alpha-diversity (p<0,05) than CON. CON had a higher abundance of Ascomycota phylum, and MASH higher Basidiomycota. CON had higher Aspergillaceae family, while there was a higher abundance of Malasseziaceae and Sporidiobolaceae in CIR and Saccharomycetacea in HCC. Only one ASV (genus Naganishia, previously reported as Cryptococcus) was homogeneously distributed in MASLD and absent in CON.

Conclusions

This study shows in an unprecedented way GMyco profile in the different strata of MASLD. Basidiomycetes, higher in MASH, were previously described in obese patients. For the first time, the genus Naganishia was described in this population. Our findings suggest that fungi could be a potential biological marker in the MASLD spectrum in the future.

肠道微生物群（GM）失调与代谢功能障碍相关的脂肪性肝病（MASLD）和脂肪性肝炎（MASH）的发生和进展有关。关于肠道菌群（GMyco）的数据仍然非常有限。本研究旨在评价MASLD不同阶段GMyco的组成。患者与方法28例患者：对照组（CON）， n=6；土豆泥,n = 6;肝硬化（CIR）， n=7；肝细胞癌（HCC）， n=5。收集粪便样本，保存在-80°C冷冻箱内，用于DNA提取和测序（18S区）。结果77.93%的女性，平均BMI为31.4 kg/m2，最近6个月内使用抗生素（30.4%），同时使用降脂药物（26.1%）。MASH患者的α -多样性高于CON患者（p < 0.05）， CON患者的子囊菌门丰度更高，而MASH患者的担子菌门丰度更高。CON中曲霉科含量较高，CIR中Malasseziaceae和Sporidiobolaceae含量较高，HCC中Saccharomycetacea含量较高。只有一种ASV （Naganishia属，以前报道为隐球菌）在MASLD中均匀分布，而在con中未发现。结论本研究以前所未有的方式显示了GMyco在MASLD不同地层中的分布。担子菌，在MASH中较高，以前在肥胖患者中被描述过。在该居群中首次发现长岛属。我们的研究结果表明，真菌可能是未来MASLD谱中潜在的生物标记物。

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引用次数: 0