Annals of hepatology最新文献_第9页

PRESENTATION AND FOLLOW-UP OF POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDER THROUGH 2005-2022 AT A LIVER TRANSPLANT UNIT IN BOGOTA, COLOMBIA 2005-2022年在哥伦比亚波哥大的一个肝移植单位移植后淋巴增生性疾病的表现和随访

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102022

Lina Dorado Delgado , Daniel Valery Rojas Kozhakin , Aura Blanco , Geovanny Hernandez , Carolina Salinas , Cristina Torres , Oscar Beltran , Martin Garzón , Adriana Varon

Introduction and Objectives

Post- transplant lymphoproliferative disorders (PTLD) are a group of neoplasms developed after transplantation, associated with increased mortality. The incidence of PTLD in liver transplant is 1-5.5%. Risk factors include immunosuppression, Epstein Barr Virus (EBV) mismatch and acute rejection. Clinical presentation is diverse. Treatment options include reduction of immunosuppression (RIS), rituximab and chemotherapy. The objective is to evaluate the incidence and clinical-pathological characteristics of patients with PTLD in our center.

Materials and Methods

Retrospective analysis of orthotopic liver transplant (OLT) patients over 18 years old in La Cardio from January 2005 to December 2022 was collected to identify PTLD patients. After identifying PTLD patients, demographic details, indication for liver transplant, induction and maintenance immunosuppressive regimen, EBV status, acute rejection episodes, histopathological classification of PTLD, chemotherapy used, and outcome were analysed in each case.

Results

Of a total of 617 OLT patients 4 developed PTLD representing a prevalence of 0.6% during a 17-year period of follow-up. Of the patients, 3 (75%) were female. Chronic hepatitis C, chronic hepatitis B, alcoholic hepatitis and autoimmune hepatitis was the etiology of cirrhosis in each of the patients. Median age of the cohort was 44 years. Median time of presentation for PTLD was 52,7 months since liver transplant. More detailed information is in table 1.

Conclusions

This study showed a low prevalence of PTLD among OLT recipients. Most of the patients responded well to RIS and chemotherapy. Further and multi-center studies are needed to provide a better understanding of PTLD in our population.

移植后淋巴细胞增生性疾病（PTLD）是一组移植后发生的肿瘤，与死亡率增加有关。肝移植中PTLD的发生率为1-5.5%。危险因素包括免疫抑制、eb病毒（EBV）错配和急性排斥。临床表现多样。治疗方案包括减少免疫抑制（RIS）、利妥昔单抗和化疗。目的是评估本中心PTLD患者的发病率和临床病理特征。材料与方法回顾性分析2005年1月至2022年12月La Cardio地区18岁以上的原位肝移植（OLT）患者，确定PTLD患者。在确定PTLD患者后，分析每个病例的人口统计学细节、肝移植指征、诱导和维持免疫抑制方案、EBV状态、急性排斥发作、PTLD的组织病理学分类、使用的化疗方案和结果。结果在总共617例OLT患者中，4例发生PTLD，在17年的随访期间患病率为0.6%。其中女性3例（75%）。慢性丙型肝炎、慢性乙型肝炎、酒精性肝炎和自身免疫性肝炎是每位患者肝硬化的病因。该队列的中位年龄为44岁。肝移植后PTLD的中位表现时间为52.7个月。更详细的信息见表1。结论：本研究显示OLT受者PTLD患病率较低。大多数患者对RIS和化疗反应良好。需要进一步的多中心研究来更好地了解我们人群中的PTLD。

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引用次数: 0

HIGH WAITING LIST MORTALITY AMONG LIVER TRANSPLANT CANDIDATES WITH ALCOHOL-RELATED LIVER DISEASE: A 10-YEAR COHORT FROM A BRAZILIAN TERTIARY CENTER 酒精相关性肝病肝移植候选者的高等待名单死亡率：来自巴西三级中心的10年队列研究

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102025

Guilherme Fontanini Massote , Roberta Araújo Chaves , Verena da Silva Ayub , Fernanda Souza Fernandes , Ajith Sankarankutty Kumar

Introduction and Objectives

Alcohol-related liver disease (ALD) is a leading cause of cirrhosis-related mortality and a common indication for liver transplantation. This study aimed to assess the impact and characteristics of ALD in liver transplant candidates at a tertiary center in Brazil.

Patients and Methods

This retrospective study included the medical records of patients listed for liver transplantation between 2009 and 2019 at a tertiary hospital. We evaluated the proportion of ALD as an indication, clinical and epidemiological profiles, waiting list mortality, and patterns of alcohol consumption and abstinence in patients with ALD.

Results

Among the 583 patients, 243 (41.7%) had ALD. This etiology was the most frequent among both non-transplanted (45.5%) and transplanted (38.4%) patients. In the transplanted group, ALD patients were predominantly male and smokers (p<0.001). The overall waiting list mortality rate was 70.2%, with ALD accounting for 43% of the deaths. Among the 118 transplanted patients with an alcohol-related component, data on alcohol consumption were available for 92. The mean daily alcohol intake was 133.1 g, with a mean abstinence duration of 4.9 years before transplantation.

Conclusions

ALD was the most frequent indication for liver transplantation in this cohort and was associated with high mortality on the waiting list. These findings highlight the need for the early identification and management of patients with harmful alcohol use.

酒精相关性肝病（ALD）是肝硬化相关死亡的主要原因，也是肝移植的常见适应症。本研究旨在评估ALD对巴西三级中心肝移植候选人的影响和特征。患者与方法本回顾性研究纳入了2009 - 2019年某三级医院肝移植患者的病历。我们评估了ALD作为指征的比例、临床和流行病学概况、等候名单死亡率以及ALD患者的饮酒和戒酒模式。结果583例患者中有243例（41.7%）为ALD。这种病因在未移植（45.5%）和移植（38.4%）患者中最为常见。在移植组中，ALD患者主要是男性和吸烟者（p<0.001）。整体轮候死亡率为70.2%，ALD占死亡人数的43%。在118例有酒精相关成分的移植患者中，有92例可获得饮酒数据。移植前平均每日酒精摄入量为133.1 g，平均戒酒时间为4.9年。结论sald是该队列中最常见的肝移植指征，且与等待名单上的高死亡率相关。这些发现强调了早期识别和管理有害酒精使用患者的必要性。

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引用次数: 0

ASSESSMENT OF FIBROSIS AND STEATOSIS IN PATIENTS WITH METABOLIC ASSOCIATED STEATOTIC LIVER DISEASE USING TWO TRANSIENT ELASTOGRAPHY TECHNIQUES 使用两种瞬时弹性成像技术评估代谢性脂肪变性肝病患者的纤维化和脂肪变性

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102009

Marlyn Zamora Posada , David Castellanos Alfonso , Martin Garzon Olarte , Mario Rey Tovar

Introduction and Objectives

Metabolic associated steatotic liver disease (MASLD) is one of the leading causes of chronic liver disease worldwide. Accurate non-invasive assessment of hepatic fibrosis and steatosis is critical for cirrhosis progression risk stratification and clinical decision-making. While FibroScan® is a well-validated transient elastography technique, Hepatus® has emerged as a comparable technological alternative. There are few studies directly comparing the two modalities. This study aimed to compare the performance of FibroScan® and Hepatus® in evaluating hepatic fibrosis and fat deposition degree in patients with hepatic steatosis.

Materials and Methods

A prospective, blinded validation study was conducted in 122 adult patients with hepatic steatosis diagnosis. Liver stiffness (kPa) and steatosis (dB/m) were assessed on the same day using both devices by independent expert operators, ensuring optimal examination quality (IQR/M <0.3). Correlation, agreement and differences were analyzed using appropriate statistical tests and post-hoc analysis.

Results

For liver fibrosis, both devices showed strong correlation (r=0.85, p<0.05) and substantial agreement (Kappa=0.77), with greater concordance in advanced stages and no significant differences in mean values. Regarding hepatic steatosis, although Hepatus® reported higher absolute values (p<0.05), it showed an almost perfect positive linear correlation with FibroScan® (r≈1). Agreement for steatosis staging was moderate (Kappa=0.39), with discrepancies mainly observed in extreme categories (S0 vs S3).

Conclusions

FibroScan® and Hepatus® show high concordance and strong correlation in assessing liver fibrosis and steatosis quantification. Hepatus® may serve as a viable clinical alternative for non-invasive evaluation of MASLD in diverse healthcare settings.

代谢相关脂肪变性肝病（MASLD）是世界范围内慢性肝病的主要病因之一。准确的无创评估肝纤维化和脂肪变性对肝硬化进展风险分层和临床决策至关重要。虽然FibroScan®是一种经过验证的瞬变弹性成像技术，但Hepatus®已经成为一种类似的技术替代品。很少有研究直接比较这两种模式。本研究旨在比较FibroScan®和Hepatus®在评估肝脂肪变性患者肝纤维化和脂肪沉积程度方面的性能。材料与方法对122例确诊为肝脂肪变性的成人患者进行了前瞻性、盲法验证研究。肝脏硬度（kPa）和脂肪变性（dB/m）由独立的专家操作人员在同一天使用这两种设备进行评估，以确保最佳的检查质量（IQR/ m <0.3）。使用适当的统计检验和事后分析分析相关性、一致性和差异性。结果对于肝纤维化，两种器械具有强相关性（r=0.85, p<0.05）和一致性（Kappa=0.77），晚期一致性更强，平均值无显著差异。对于肝脂肪变性，虽然Hepatus®报告的绝对值更高（p<0.05），但它与FibroScan®显示出几乎完全的线性正相关（r≈1）。脂肪变性分期的一致性为中等（Kappa=0.39），差异主要见于极端类别（S0 vs S3）。结论fibroscan®和Hepatus®在肝纤维化和脂肪变性定量评估中具有高度一致性和强相关性。在不同的医疗环境中，Hepatus®可作为一种可行的非侵入性评估MASLD的临床替代方法。

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引用次数: 0

ATORVASTATIN AND GENE EXPRESSION SIGNATURES IN HEPATOCARCINOGENESIS 阿托伐他汀与肝癌发生中的基因表达特征

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102005

Ezequiel Ridruejo , Lucia Coli , Jimmy Daza , Giselle Romero Caimi , Timo Itzel , Andreas Teufel , Laura Alvarez

Introduction and Objectives

Hepatocellular carcinoma (HCC) represents a significant global health burden as the fourth leading cause of cancer-related deaths. While statins have shown promise in HCC prevention, their molecular mechanisms remain poorly understood.

We investigated the effect of atorvastatin (AT) on gene expression profiles and hepatocarcinogenesis in a hexachlorobenzene (HCB)-induced HCC model.

Materials and Methods

Male Wistar rats were divided into four groups: control, AT (5 mg/kg), HCB (100 mg/kg), and AT+HCB. After 30 days of treatment, we analyzed hepatosomatic index, liver histology, and performed RNA sequencing to evaluate transcriptomic changes. Gene Set Enrichment Analysis and KEGG pathway analysis were used to identify key molecular pathways. Protein expression of selected targets was confirmed by immunohistochemistry.

Results

HCB treatment significantly increased hepatosomatic index (28%, p<0.01) and induced preneoplastic lesions, which were prevented by AT co-administration. RNA sequencing revealed HCB activated multiple oncogenic pathways, including RHO GTPase cycle, TGF-β, and receptor tyrosine kinase signaling, with 84.8% concordance with established cancer pathway genes. AT treatment upregulated protective PPAR signaling, autophagy, and cellular stress response pathways while downregulating oncogenic pathways activated by HCB. AT significantly reduced the expression of key oncogenic proteins including TGF-β1, p53, and c-Myc in HCB-treated liver tissue.

Conclusions

Atorvastatin effectively prevents HCB-induced hepatocarcinogenesis through multiple mechanisms, including modulation of key oncogenic pathways and promotion of protective cellular responses. These findings provide new insights into the molecular mechanisms of statin-mediated HCC prevention and identify potential therapeutic targets for future interventions.

简介和目的肝细胞癌（HCC）是全球重大的健康负担，是癌症相关死亡的第四大原因。虽然他汀类药物在预防HCC方面显示出前景，但其分子机制仍知之甚少。我们研究了阿托伐他汀（AT）对六氯苯（HCB）诱导的肝癌模型中基因表达谱和肝癌发生的影响。材料与方法Wistar小鼠随机分为4组：对照组、AT （5 mg/kg）组、HCB （100 mg/kg）组和AT+HCB组。治疗30天后，我们分析了肝体指数、肝脏组织学，并进行了RNA测序来评估转录组的变化。基因集富集分析和KEGG通路分析用于鉴定关键分子通路。选择的靶点通过免疫组化证实蛋白表达。结果shcb治疗可显著提高肝体指数（28%,p<0.01），并可诱发肿瘤前病变。RNA测序显示，HCB激活了多种致癌途径，包括RHO GTPase周期、TGF-β和受体酪氨酸激酶信号传导，与已建立的癌症途径基因的一致性为84.8%。AT治疗上调PPAR保护性信号、自噬和细胞应激反应途径，同时下调HCB激活的致癌途径。AT显著降低了hcb处理的肝组织中TGF-β1、p53和c-Myc等关键致癌蛋白的表达。结论托伐他汀通过多种机制有效预防hcb诱导的肝癌发生，包括调节关键的致癌途径和促进保护性细胞反应。这些发现为他汀类药物介导的HCC预防的分子机制提供了新的见解，并确定了未来干预的潜在治疗靶点。

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引用次数: 0

ARTIFICIAL INTELLIGENCE IN PREDICTING THE RISK OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH METABOLICALLY ASSOCIATED STEATOTIC LIVER DISEASE: DEVELOPMENT AND VALIDATION OF A PREDICTIVE MODEL IN 306 PATIENTS 人工智能预测代谢相关脂肪变性肝病患者发生肝细胞癌的风险：306例患者预测模型的开发和验证

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101995

Giovane Carvalho Viola , Rodolfo Carvalho Viola , Regiane Alencar , Renato Altikes , Claudia Tani , Lisa Saud , Mario Pessoa , Aline Chagas , Claudia Oliveira

Introduction and Objectives

To evaluate the accuracy of an artificial intelligence (AI) model, based on routine clinical and laboratory data, in predicting the risk of developing hepatocellular carcinoma (HCC) in patients with Metabolically Associated Steatotic Liver Disease (MASLD). Our aim was to create and validate a tool to support risk stratification and facilitate early surveillance of high-risk individuals.

Materials and Methods

This was a retrospective case-control study including 306 MASLD patients divided into an HCC group (129 patients), with diagnosis confirmed by histopathological criteria or LI-RADS classification, and a control group (177 patients). Collected variables included age, body mass index, comorbidities (diabetes mellitus, dyslipidemia, presence of portal hypertension), and serum laboratory parameters: aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, creatinine, platelets, cholesterol (HDL, LDL, and triglycerides), and non-invasive indices: neutrophil-to-lymphocyte ratio (NLR), FIB-4, and AST/ALT ratio. The XGBoost (Extreme Gradient Boosting) AI algorithm was implemented, and the dataset was randomly split into a training cohort (80%) and an internal validation cohort (20%) to develop and assess the model’s performance.

Results

The AI model demonstrated high discriminative ability for HCC, achieving an area under the ROC curve (AUC-ROC) of 0.9, with a sensitivity of 90.9% and specificity of 84.3%. The strongest predictors of HCC were serum creatinine, followed by the presence of portal hypertension, elevated NLR, and LDL levels.

Conclusions

The AI-driven model, developed using widely available clinical and laboratory parameters, demonstrated excellent performance in identifying MASLD patients at high risk of developing hepatocellular carcinoma. By enabling early and cost-effective risk stratification, this tool may support targeted surveillance strategies and improve clinical decision-making in real-world hepatology practice.

目的评估基于常规临床和实验室数据的人工智能（AI）模型在预测代谢相关脂肪变性肝病（MASLD）患者发生肝细胞癌（HCC）风险方面的准确性。我们的目标是创建并验证一种工具，以支持风险分层，并促进对高危个体的早期监测。材料和方法本研究是一项回顾性病例对照研究，包括306例MASLD患者，分为肝癌组（129例），经组织病理学标准或LI-RADS分类确诊，对照组（177例）。收集的变量包括年龄、体重指数、合并症（糖尿病、血脂异常、是否存在门脉高压）、血清实验室参数：天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、白蛋白、肌酐、血小板、胆固醇（HDL、LDL和甘油三酯），以及无创指标：中性粒细胞与淋巴细胞比值（NLR）、FIB-4和AST/ALT比值。采用XGBoost （Extreme Gradient Boosting）人工智能算法，将数据集随机分为训练队列（80%）和内部验证队列（20%），以开发和评估模型的性能。结果AI模型对HCC具有较高的鉴别能力，ROC曲线下面积（AUC-ROC）为0.9，灵敏度为90.9%，特异性为84.3%。HCC的最强预测因子是血清肌酐，其次是门脉高压、NLR升高和LDL水平。结论人工智能驱动的模型使用广泛可用的临床和实验室参数开发，在识别高风险的MASLD患者发展为肝细胞癌方面表现出色。通过实现早期和具有成本效益的风险分层，该工具可以支持有针对性的监测策略，并改善现实世界肝病学实践中的临床决策。

{"title":"ARTIFICIAL INTELLIGENCE IN PREDICTING THE RISK OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH METABOLICALLY ASSOCIATED STEATOTIC LIVER DISEASE: DEVELOPMENT AND VALIDATION OF A PREDICTIVE MODEL IN 306 PATIENTS","authors":"Giovane Carvalho Viola , Rodolfo Carvalho Viola , Regiane Alencar , Renato Altikes , Claudia Tani , Lisa Saud , Mario Pessoa , Aline Chagas , Claudia Oliveira","doi":"10.1016/j.aohep.2025.101995","DOIUrl":"10.1016/j.aohep.2025.101995","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>To evaluate the accuracy of an artificial intelligence (AI) model, based on routine clinical and laboratory data, in predicting the risk of developing hepatocellular carcinoma (HCC) in patients with Metabolically Associated Steatotic Liver Disease (MASLD). Our aim was to create and validate a tool to support risk stratification and facilitate early surveillance of high-risk individuals.</div></div><div><h3>Materials and Methods</h3><div>This was a retrospective case-control study including 306 MASLD patients divided into an HCC group (129 patients), with diagnosis confirmed by histopathological criteria or LI-RADS classification, and a control group (177 patients). Collected variables included age, body mass index, comorbidities (diabetes mellitus, dyslipidemia, presence of portal hypertension), and serum laboratory parameters: aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, creatinine, platelets, cholesterol (HDL, LDL, and triglycerides), and non-invasive indices: neutrophil-to-lymphocyte ratio (NLR), FIB-4, and AST/ALT ratio. The XGBoost (Extreme Gradient Boosting) AI algorithm was implemented, and the dataset was randomly split into a training cohort (80%) and an internal validation cohort (20%) to develop and assess the model’s performance.</div></div><div><h3>Results</h3><div>The AI model demonstrated high discriminative ability for HCC, achieving an area under the ROC curve (AUC-ROC) of 0.9, with a sensitivity of 90.9% and specificity of 84.3%. The strongest predictors of HCC were serum creatinine, followed by the presence of portal hypertension, elevated NLR, and LDL levels.</div></div><div><h3>Conclusions</h3><div>The AI-driven model, developed using widely available clinical and laboratory parameters, demonstrated excellent performance in identifying MASLD patients at high risk of developing hepatocellular carcinoma. By enabling early and cost-effective risk stratification, this tool may support targeted surveillance strategies and improve clinical decision-making in real-world hepatology practice.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101995"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154652","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

PRIMARY MALIGNANT LIVER TUMORS: A 20-YEAR RETROSPECTIVE POSTMORTEM REVIEW 原发性恶性肝脏肿瘤：20年回顾性尸检回顾

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102007

Jessica Mejía Ramírez , Fatima Higuerade la Tijera , Gerardo Aristi Urista , A. Paola Escobedo Zuñiga , Paola Daniela Guerrero Ramírez , Félix Alberto Pérez Cardenas , Jose Luis Pérez Hernández

Introduction and Objectives

Primary malignant liver tumors represent one of the leading causes of cancer-related mortality worldwide. Their incidence has increased over recent decades, paralleling the rise in chronic liver diseases.

To determine the prevalence of different non-metastatic primary malignant liver tumors found in autopsies performed between 2003 and 2023 at a tertiary care center.

Materials and Methods

A retrospective, descriptive, observational study of autopsies performed in the pathology department of a tertiary care center between 2003 and 2023. Descriptive statistics were used, including measures of central tendency and dispersion.

Results

Autopsy was performed on 10,139 patients, 126 (1.24%) were classified as malignant primary liver tumors with 63±12 years, 52 females (41.3%) and 74 males (58.7%) and were distributed as follows: Hepatocarcinoma 99 (78.5%) with 63±12 years, 39 women (38.6%) and 60 men (59.4%); 38 (37.6%) had metastases mainly in lung followed by lymph nodes, only 9% were not related to cirrhosis; Intrahepatic cholangiocarcinoma 24 (19%) with 65 ±14 years, 12 males (50%), 12 females (50%), 70.8% had pulmonary metastases and 47.8% were not related to cirrhosis.Hepatic primitive neuroectodermal tumor 2 (1.59%) with 54 ±5.6 years with pleural and pulmonary metastases. Fibrolamellar carcinoma 1 (0.79%) with 24 years and metastasis in lymph nodes.

Conclusions

The prevalence of liver tumors in autopsy is low, the most prevalent being hepatocarcinoma followed by cholangiocarcinoma.

简介和目的原发性恶性肝肿瘤是全球癌症相关死亡的主要原因之一。近几十年来，这些疾病的发病率一直在上升，与慢性肝病的发病率上升相当。确定2003年至2023年在三级医疗中心进行的尸检中发现的不同非转移性原发性恶性肝肿瘤的患病率。材料和方法回顾性、描述性、观察性研究2003年至2023年在三级医疗中心病理部门进行的尸检。使用描述性统计，包括集中趋势和离散度的测量。结果共解剖10139例患者，其中原发性恶性肝肿瘤126例（1.24%），年龄63±12岁，女性52例（41.3%），男性74例（58.7%），分布如下：肝癌99例（78.5%），年龄63±12岁，女性39例（38.6%），男性60例（59.4%）；38例（37.6%）以肺转移为主，其次为淋巴结转移，与肝硬化无关的仅有9%；肝内胆管癌24例（19%），年龄65±14岁，男性12例（50%），女性12例（50%），70.8%发生肺转移，47.8%与肝硬化无关。肝原始神经外胚层肿瘤2例（1.59%），54±5.6年伴胸膜和肺转移。纤维板层癌1(0.79%)，24年，淋巴结转移。结论肝脏肿瘤在尸检中的检出率较低，以肝癌居首，其次为胆管癌。

{"title":"PRIMARY MALIGNANT LIVER TUMORS: A 20-YEAR RETROSPECTIVE POSTMORTEM REVIEW","authors":"Jessica Mejía Ramírez , Fatima Higuerade la Tijera , Gerardo Aristi Urista , A. Paola Escobedo Zuñiga , Paola Daniela Guerrero Ramírez , Félix Alberto Pérez Cardenas , Jose Luis Pérez Hernández","doi":"10.1016/j.aohep.2025.102007","DOIUrl":"10.1016/j.aohep.2025.102007","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Primary malignant liver tumors represent one of the leading causes of cancer-related mortality worldwide. Their incidence has increased over recent decades, paralleling the rise in chronic liver diseases.</div><div>To determine the prevalence of different non-metastatic primary malignant liver tumors found in autopsies performed between 2003 and 2023 at a tertiary care center.</div></div><div><h3>Materials and Methods</h3><div>A retrospective, descriptive, observational study of autopsies performed in the pathology department of a tertiary care center between 2003 and 2023. Descriptive statistics were used, including measures of central tendency and dispersion.</div></div><div><h3>Results</h3><div>Autopsy was performed on 10,139 patients, 126 (1.24%) were classified as malignant primary liver tumors with 63±12 years, 52 females (41.3%) and 74 males (58.7%) and were distributed as follows: Hepatocarcinoma 99 (78.5%) with 63±12 years, 39 women (38.6%) and 60 men (59.4%); 38 (37.6%) had metastases mainly in lung followed by lymph nodes, only 9% were not related to cirrhosis; Intrahepatic cholangiocarcinoma 24 (19%) with 65 ±14 years, 12 males (50%), 12 females (50%), 70.8% had pulmonary metastases and 47.8% were not related to cirrhosis.Hepatic primitive neuroectodermal tumor 2 (1.59%) with 54 ±5.6 years with pleural and pulmonary metastases. Fibrolamellar carcinoma 1 (0.79%) with 24 years and metastasis in lymph nodes.</div></div><div><h3>Conclusions</h3><div>The prevalence of liver tumors in autopsy is low, the most prevalent being hepatocarcinoma followed by cholangiocarcinoma.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102007"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154649","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

EVALUATION OF RESPONSE TO SECOND LINE THERAPY IN PATIENTS WITH PRIMARY BILIARY CHOLANGITIS AND INADEQUATE RESPONSE TO UDCA: A PILOT STUDY OF LIVER BIOPSIES FOLLOW UP 评价原发性胆管炎患者对二线治疗的反应和对udca反应不足：肝活检随访的初步研究

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101989

Alejandra Villamil , Daniela de la Viña , Eduardo Mullen , Ignacio Lucero , Juan Carlos Bandi

Introduction and Objectives

Response to second line therapy is improvement of cholestatic parameters and prevention of fibrosis or liver events. AIM: to evaluate response at Month 12 and identify epidemiological, clinical and histological findings related to response.

Patients and Methods

50 patients initiating OCA (n=12), PPAR agonists (n=29) or combination of both (n=9) completed 12 months treatment and had baseline and M12 biopsy. Duct loss was evaluated with cytokeratin 7 and 19 and Scheuer staging applied. Biliary interface activity and bile duct damage recorded. Elastography was done at baseline and at 12 months. Statistical analysis using parametric t tests and 1-way ANOVA was performed.

Results

Mean age 53.6±10.6y and 84 % female. Mean ALP 388.8±166.6, ALT 71.3±40.6 and BT 0.9±0.4. 10 patients were cirrhotic. Response to second line therapy was 30 % with POISE criteria (n=15) and 14 % for ALP normalization (n=7). Male sex (p.04), moderate/severe ductopenia (p.01), elevated ALT (82 vs 46, p.003), bilirubin (1.07 vs 0.7, p.02) and cirrhosis (p.02) correlated with no response. Moderate/severe portal inflammation with interface hepatitis and lobular spilling was observed in 28 samples, irrespective of age and correlated with fibrosis. No patient with severe inflammation achieved response (n=5), and only 21% with moderate inflammation (n=5). On FU biopsies, response related with improvement of inflammation in 11 patients. Mild ductopenia did not affect response. No LFT predicted cirrhosis or portal inflammation. Cirrhosis at month 12 correlated with liver events in 5 patients resulting in 1 liver related death and 3 transplants. Elastography correlated with cirrhosis and liver events (10.4 vs 22.9, p<0.001) but not with inflammation or ductopenia.

Conclusions

Non response (70 %) related to male sex, cirrhosis, transaminases, moderate/severe inflammation and ductopenia. Cirrhosis and elastography correlated with liver events. Adverse histological findings suggest early second line intervention.

对二线治疗的反应是改善胆汁淤积参数和预防纤维化或肝脏事件。目的：评估第12个月的反应，并确定与反应相关的流行病学、临床和组织学结果。患者和方法50例开始OCA (n=12)， PPAR激动剂（n=29）或两者联合（n=9）的患者完成了12个月的治疗，并进行了基线和M12活检。用细胞角蛋白7和19和Scheuer分期评估导管损失。记录胆道界面活动及胆管损伤情况。在基线和12个月时进行弹性成像。采用参数t检验和单因素方差分析进行统计分析。结果平均年龄53.6±10.6岁，女性占84%。平均ALP 388.8±166.6,ALT 71.3±40.6,BT 0.9±0.4。肝硬化10例。二线治疗对POISE标准的应答率为30% (n=15)，对ALP正常化的应答率为14% （n=7）。男性（p.04）、中度/重度ductopia （p.01）、ALT升高（82 vs 46, p.003）、胆红素（1.07 vs 0.7, p.02）和肝硬化（p.02）与无应答相关。在28个样本中观察到中度/重度门静脉炎症伴界面肝炎和小叶溢出，与年龄无关，并与纤维化相关。严重炎症患者无应答（n=5），中度炎症患者仅有21%应答（n=5）。在FU活检中，11例患者的反应与炎症改善有关。轻度ductopia不影响反应。LFT不能预测肝硬化或门静脉炎症。12个月肝硬化与5例肝脏事件相关，导致1例肝脏相关死亡和3例肝脏移植。弹性成像与肝硬化和肝脏事件相关（10.4 vs 22.9, p<0.001），但与炎症或ductoloia无关。结论snon应答（70%）与男性、肝硬化、转氨酶、中重度炎症和ductopia有关。肝硬化和弹性成像与肝脏事件相关。不良组织学结果提示早期二线干预。

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引用次数: 0

VALIDATION OF AGILE-3+ AND AGILE-4 SCORES FOR NONINVASIVE DETECTION OF FIBROSIS AND CIRRHOSIS IN METABOLIC DYSFUNCTION–ASSOCIATED STEATOTIC LIVER DISEASE IN LATIN AMERICA 验证agile-3 +和agile-4评分在拉丁美洲无创检测代谢功能障碍相关脂肪变性肝病的纤维化和肝硬化

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101969

Carlos Esteban Coronel Castillo , Luis Antonio Diaz Piga , Natalia Baeza , Francisco Idalsoaga , Daniel Cabrera Garcia , Fernando Javier Barreyro , Sebastian Marciano , Jorge Martinez Morales , Cristiane Villela Nogueira , Nathalie Leite , Gil Salles , Claudia Regina Cardoso , Claudia Alves Couto , Rafael Theodoro , Mísia Joyner de Sousa Dias Monteiro , Mario Guimaraes Pessoa , Mario Reis Alvares-da Silva , Bruno Basso , Gabriella Jonko , Fatima Higuera de la Tijera , Juan Pablo Arab

Introduction and Objectives

Early detection of liver fibrosis in Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) is crucial for preventing progression to cirrhosis. The Agile-3+ and Agile-4 scores are designed to identify advanced fibrosis and cirrhosis, respectively, but their performance in Latin American populations is unknown. This study aimed to validate Agile-3+ and Agile-4 scores in predicting advanced fibrosis and cirrhosis in a well-characterized cohort of Latin American patients.

Materials and Methods

Multicenter cross-sectional study with 770 patients from 10 centers across Brazil, Argentina, Chile, and Mexico, all diagnosed with MASLD per 2023 criteria. Liver fibrosis was assessed by vibration-controlled transient elastography (VCTE). Scores (FIB-4, Agile-3+, Agile-4) were calculated from biochemical and clinical data. Diagnostic accuracy for detecting advanced fibrosis (≥F3) and cirrhosis (F4) was evaluated using ROC curves and Youden index.

Results

Median age was 59 years; 60% were men. Median BMI was 33.3 kg/m²; 69.6% had type 2 diabetes. Median liver stiffness was 9.1 kPa; 29.9% had advanced fibrosis, and 10.5% cirrhosis. Agile-4 outperformed VCTE stiffness in predicting advanced fibrosis (AUROC 0.765, p=0.037) and demonstrated superior accuracy for cirrhosis (AUROC 0.875, p=0.003) (Figure 1). The optimal cut-offs for Agile-4 were ≥0.159 (rule out cirrhosis with 90% sensitivity) and ≥0.366 (rule in cirrhosis with 90% specificity).

Conclusions

In this Latin American MASLD cohort, Agile-4 score demonstrated superior noninvasive rule-out performance for advanced fibrosis and cirrhosis. Incorporating these thresholds into VCTE algorithms could reduce unnecessary biopsies and improve streamline MASLD care pathways.

简介和目的代谢功能障碍相关脂肪变性肝病（MASLD）患者肝纤维化的早期检测对于预防进展为肝硬化至关重要。Agile-3+和Agile-4评分分别用于识别晚期纤维化和肝硬化，但它们在拉丁美洲人群中的表现尚不清楚。本研究旨在验证Agile-3+和Agile-4评分在拉丁美洲患者中预测晚期纤维化和肝硬化的疗效。材料和方法对770例患者进行多中心横断面研究，这些患者来自巴西、阿根廷、智利和墨西哥的10个中心，均根据2023标准诊断为MASLD。通过振动控制瞬时弹性成像（VCTE）评估肝纤维化。根据生化和临床资料计算得分（FIB-4、Agile-3+、Agile-4）。采用ROC曲线和约登指数评估晚期纤维化（≥F3）和肝硬化（F4）的诊断准确性。结果中位年龄59岁；60%是男性。中位BMI为33.3 kg/m2；69.6%患有2型糖尿病。肝脏硬度中位数为9.1 kPa；29.9%为晚期纤维化，10.5%为肝硬化。Agile-4在预测晚期纤维化方面优于VCTE刚度（AUROC 0.765, p=0.037），并且在预测肝硬化方面具有更高的准确性（AUROC 0.875, p=0.003）（图1）。敏捷-4的最佳截止值为≥0.159（排除肝硬化，敏感性90%）和≥0.366（排除肝硬化，特异性90%）。结论：在这个拉丁美洲MASLD队列中，Agile-4评分显示了晚期纤维化和肝硬化的无创排除性能。将这些阈值纳入VCTE算法可以减少不必要的活检，并改善简化MASLD的护理途径。

{"title":"VALIDATION OF AGILE-3+ AND AGILE-4 SCORES FOR NONINVASIVE DETECTION OF FIBROSIS AND CIRRHOSIS IN METABOLIC DYSFUNCTION–ASSOCIATED STEATOTIC LIVER DISEASE IN LATIN AMERICA","authors":"Carlos Esteban Coronel Castillo , Luis Antonio Diaz Piga , Natalia Baeza , Francisco Idalsoaga , Daniel Cabrera Garcia , Fernando Javier Barreyro , Sebastian Marciano , Jorge Martinez Morales , Cristiane Villela Nogueira , Nathalie Leite , Gil Salles , Claudia Regina Cardoso , Claudia Alves Couto , Rafael Theodoro , Mísia Joyner de Sousa Dias Monteiro , Mario Guimaraes Pessoa , Mario Reis Alvares-da Silva , Bruno Basso , Gabriella Jonko , Fatima Higuera de la Tijera , Juan Pablo Arab","doi":"10.1016/j.aohep.2025.101969","DOIUrl":"10.1016/j.aohep.2025.101969","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Early detection of liver fibrosis in Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) is crucial for preventing progression to cirrhosis. The Agile-3+ and Agile-4 scores are designed to identify advanced fibrosis and cirrhosis, respectively, but their performance in Latin American populations is unknown. This study aimed to validate Agile-3+ and Agile-4 scores in predicting advanced fibrosis and cirrhosis in a well-characterized cohort of Latin American patients.</div></div><div><h3>Materials and Methods</h3><div>Multicenter cross-sectional study with 770 patients from 10 centers across Brazil, Argentina, Chile, and Mexico, all diagnosed with MASLD per 2023 criteria. Liver fibrosis was assessed by vibration-controlled transient elastography (VCTE). Scores (FIB-4, Agile-3+, Agile-4) were calculated from biochemical and clinical data. Diagnostic accuracy for detecting advanced fibrosis (≥F3) and cirrhosis (F4) was evaluated using ROC curves and Youden index.</div></div><div><h3>Results</h3><div>Median age was 59 years; 60% were men. Median BMI was 33.3 kg/m<sup>2</sup>; 69.6% had type 2 diabetes. Median liver stiffness was 9.1 kPa; 29.9% had advanced fibrosis, and 10.5% cirrhosis. Agile-4 outperformed VCTE stiffness in predicting advanced fibrosis (AUROC 0.765, p=0.037) and demonstrated superior accuracy for cirrhosis (AUROC 0.875, p=0.003) (Figure 1). The optimal cut-offs for Agile-4 were ≥0.159 (rule out cirrhosis with 90% sensitivity) and ≥0.366 (rule in cirrhosis with 90% specificity).</div></div><div><h3>Conclusions</h3><div>In this Latin American MASLD cohort, Agile-4 score demonstrated superior noninvasive rule-out performance for advanced fibrosis and cirrhosis. Incorporating these thresholds into VCTE algorithms could reduce unnecessary biopsies and improve streamline MASLD care pathways.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101969"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154310","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

TRANSPLANT-FREE SURVIVAL AMONG PATIENTS WITH HEPATOCELLULAR CARCINOMA MANAGED AT A TERTIARY REFERRAL HOSPITAL IN PERU 秘鲁三级转诊医院肝细胞癌患者的无移植生存率

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102038

Mariella Rosalina Huaman Rivera , Diego Francisco Pinto Ruiz , Estefania Liza Baca , Zuly Placido Damian , Javier Diaz Ferrer

Introduction and Objectives

Peru has one of the highest liver cancer rates in South America, yet limited access to transplantation makes evaluating prognosis through alternative treatments essential. We aimed to determine transplant-free survival in patients with hepatocellular carcinoma (HCC) treated at “Hospital Nacional Edgardo Rebagliati Martins” (HNERM), Lima, Peru.

Materials and Methods

Retrospective cohort study using data from patients hospitalized in the hepatology unit of HNERM (2012-2014). We included adults diagnosed with HCC by CT, MRI, or biopsy; those with prior liver transplants or lost to follow-up were excluded. We reviewed clinical records and the national death registry over 120 months. Transplant-free survival was estimated using Kaplan–Meier, and survival differences by cirrhosis, BCLC-stage, and treatment were assessed using the Mantel–Haenszel method (α=0.05).

Results

A total of 112 patients with HCC were included (median age 68 [IQR:60-75years]; 51.8% female). The leading etiology of HCC was viral (HBV 31.3%, HCV 15.2%, co-infection 4.5%), followed by NAFLD. 87.5% had cirrhosis, Child-Pugh B. Participants without cirrhosis were significantly younger (p<0.01). Overall, 57.1% received palliative care, followed by TACE (28.6%), chemotherapy (6.3%), surgery (5.4%), and ethanol injection (2.7%). Transplant-free survival rates were 59.8% at 6 months and 1.8% at 120 months. Median survival was 8.0 months with cirrhosis and 11.3 without, with no significant difference. Surgical treatment showed better survival outcomes (p<0.01) (figure1). Among patients with cirrhosis, 60-month survival significantly varied by BCLC stage, favoring earlier stages (p<0.01)

Conclusions

Early diagnosis regardless of cirrhosis status and broader treatment availability are crucial to improve HCC survival in Peru.

秘鲁是南美洲肝癌发病率最高的国家之一，但由于移植手术的机会有限，因此通过替代治疗来评估预后至关重要。我们的目的是确定在秘鲁利马“国家埃德加多·雷巴利亚蒂·马丁斯医院”（HNERM）治疗的肝细胞癌（HCC）患者的无移植生存率。材料与方法回顾性队列研究，数据来自2012-2014年在我院肝病科住院的患者。我们纳入了通过CT、MRI或活检诊断为HCC的成年人；既往肝移植或随访失败者排除在外。我们回顾了超过120个月的临床记录和全国死亡登记。采用Kaplan-Meier法估计无移植生存期，采用Mantel-Haenszel法评估肝硬化、bclc分期和治疗的生存差异（α=0.05）。结果共纳入112例HCC患者，中位年龄68岁[IQR:60-75岁]，女性占51.8%。HCC的主要病因是病毒性肝炎（HBV 31.3%, HCV 15.2%，合并感染4.5%），其次是NAFLD。87.5%的人有肝硬化，Child-Pugh B.无肝硬化的参与者明显更年轻（p<0.01）。总体而言，57.1%的患者接受了姑息治疗，其次是TACE（28.6%）、化疗（6.3%）、手术（5.4%）和乙醇注射（2.7%）。6个月时无移植存活率为59.8%，120个月时为1.8%。有肝硬化的中位生存期为8.0个月，无肝硬化的中位生存期为11.3个月，无显著差异。手术治疗显示更好的生存结果（p<0.01）（图1）。肝硬化患者的60个月生存率随BCLC分期的不同而有显著差异，更倾向于早期阶段（p<0.01）。结论早期诊断而不考虑肝硬化状况和更广泛的治疗对提高秘鲁HCC患者的生存率至关重要。

{"title":"TRANSPLANT-FREE SURVIVAL AMONG PATIENTS WITH HEPATOCELLULAR CARCINOMA MANAGED AT A TERTIARY REFERRAL HOSPITAL IN PERU","authors":"Mariella Rosalina Huaman Rivera , Diego Francisco Pinto Ruiz , Estefania Liza Baca , Zuly Placido Damian , Javier Diaz Ferrer","doi":"10.1016/j.aohep.2025.102038","DOIUrl":"10.1016/j.aohep.2025.102038","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Peru has one of the highest liver cancer rates in South America, yet limited access to transplantation makes evaluating prognosis through alternative treatments essential. We aimed to determine transplant-free survival in patients with hepatocellular carcinoma (HCC) treated at “Hospital Nacional Edgardo Rebagliati Martins” (HNERM), Lima, Peru.</div></div><div><h3>Materials and Methods</h3><div>Retrospective cohort study using data from patients hospitalized in the hepatology unit of HNERM (2012-2014). We included adults diagnosed with HCC by CT, MRI, or biopsy; those with prior liver transplants or lost to follow-up were excluded. We reviewed clinical records and the national death registry over 120 months. Transplant-free survival was estimated using Kaplan–Meier, and survival differences by cirrhosis, BCLC-stage, and treatment were assessed using the Mantel–Haenszel method (α=0.05).</div></div><div><h3>Results</h3><div>A total of 112 patients with HCC were included (median age 68 [IQR:60-75years]; 51.8% female). The leading etiology of HCC was viral (HBV 31.3%, HCV 15.2%, co-infection 4.5%), followed by NAFLD. 87.5% had cirrhosis, Child-Pugh B. Participants without cirrhosis were significantly younger (p<0.01). Overall, 57.1% received palliative care, followed by TACE (28.6%), chemotherapy (6.3%), surgery (5.4%), and ethanol injection (2.7%). Transplant-free survival rates were 59.8% at 6 months and 1.8% at 120 months. Median survival was 8.0 months with cirrhosis and 11.3 without, with no significant difference. Surgical treatment showed better survival outcomes (p<0.01) (figure1). Among patients with cirrhosis, 60-month survival significantly varied by BCLC stage, favoring earlier stages (p<0.01)</div></div><div><h3>Conclusions</h3><div>Early diagnosis regardless of cirrhosis status and broader treatment availability are crucial to improve HCC survival in Peru.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102038"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154330","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

EVIDENCE-BASED DIGITAL SUPPORT IN HEPATOLOGY: RETRIEVAL-AUGMENTED GENERATION'S ROLE IN AUTOIMMUNE LIVER DISEASES MANAGEMENT 肝病学中的循证数字支持：检索增强代在自身免疫性肝病管理中的作用

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101957

Ezequiel Ridruejo , Ernesto Saenz , Jimmy Daza , Heike Bantel , Marcos Girala , Matthias Ebert , Florian Van Bommel , Andreas Geier , Andres Gomez Aldana , Mario Reis Alvares-da-Silvai , Markus Peck-Radosavljevicj , Frank Tacke , Arndt Weinmann , Juan Turnes , Javier Pazo , Andreas Teufel

Introduction and Objectives

Autoimmune liver diseases (AILDs) present significant diagnostic and management challenges. Following our initial evaluation of Large Language Models (LLMs), we developed and assessed three specialized Retrieval-Augmented Generation (RAG) systems. These systems incorporated comprehensive clinical guidelines and medication safety information to enhance decision support accuracy. Our aim was to evaluate the effectiveness of Retrieval-augmented AI systems in providing evidence-based recommendations for AILD management.

Materials and Methods

We engineered three distinct RAG systems: HepaChat, RAG-ChatGPT, and RAG-Claude. Each system integrated 13 international clinical guidelines spanning AIH, PBC, and PSC management. Additionally, we incorporated a comprehensive database containing 12,465 FDA medication warnings to ensure safety protocol adherence. Ten liver specialists (six European, four American) evaluated system responses to 56 standardized clinical questions using a 1-10 Likert scale. Questions addressed disease comprehension, therapeutic approaches, and clinical decision-making across all three major AILDs.

Results

Quantitative analysis revealed HepaChat's superior performance (mean score 7.58±1.48) with 33 best-rated responses, compared to RAG-Claude (7.22±1.58, 12 best-rated) and RAG-ChatGPT (7.21±1.67, 9 best-rated). Geographic stratification unveiled variations in evaluation patterns (Americas: 7.97 vs Europe: 6.40). Disease-specific analysis demonstrated HepaChat's excellence in AIH (Europe: 7.12, Americas: 8.17) and PSC management in Europe (6.89), while achieving optimal performance in AIH and PBC in the Americas (8.17 and 8.37, respectively). All three systems showed marked improvement over conventional LLMs (2023 benchmark: 6.72±1.67).

Conclusions

This evaluation demonstrates that specialized RAG systems incorporating clinical guidelines and safety protocols can significantly enhance AILD management support. Geographic variations in assessment highlight the importance of considering regional clinical perspectives in AI system development.

自身免疫性肝病（AILDs）的诊断和治疗面临重大挑战。在我们对大型语言模型（llm）的初步评估之后，我们开发并评估了三个专门的检索增强生成（RAG）系统。这些系统纳入了全面的临床指南和药物安全信息，以提高决策支持的准确性。我们的目的是评估检索增强人工智能系统在为AILD管理提供循证建议方面的有效性。材料和方法我们设计了三种不同的RAG系统：HepaChat， RAG- chatgpt和RAG- claude。每个系统集成了13个国际临床指南，涵盖AIH， PBC和PSC管理。此外，我们纳入了一个包含12,465个FDA药物警告的综合数据库，以确保安全协议的遵守。10名肝脏专家（6名欧洲人，4名美国人）使用1-10李克特量表评估了系统对56个标准化临床问题的反应。问题涉及所有三种主要aild的疾病理解、治疗方法和临床决策。结果HepaChat的平均评分为7.58±1.48，评分最高的有33个，而RAG-Claude评分为7.22±1.58，评分最高的有12个；RAG-ChatGPT评分为7.21±1.67，评分最高的有9个。地理分层揭示了评估模式的差异（美洲：7.97 vs欧洲：6.40）。疾病特异性分析显示，HepaChat在AIH（欧洲：7.12，美洲：8.17）和PSC管理方面表现优异（欧洲：6.89），而在美洲的AIH和PBC方面表现最佳（分别为8.17和8.37）。与传统LLMs相比，这三种系统都有显著改善（2023年基准：6.72±1.67）。结论：本评价表明，结合临床指南和安全方案的专门RAG系统可以显著提高对AILD管理的支持。评估中的地理差异突出了在人工智能系统开发中考虑区域临床观点的重要性。

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引用次数: 0