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Zhonghua Gan Zang Bing Za Zhi =... Jun 2024This study aims to compare the antiviral treatment similarities and differences in the population covered by the 2024 version of the World Health Organization's (WHO)... (Comparative Study)
Comparative Study
This study aims to compare the antiviral treatment similarities and differences in the population covered by the 2024 version of the World Health Organization's (WHO) hepatitis B prevention and treatment guidelines and the current Chinese hepatitis B prevention and treatment guidelines, so as to explore their impact on the indications for antiviral therapy in Chinese patients with chronic hepatitis B (CHB). The information of patients with chronic hepatitis B virus infection who did not receive antiviral treatment was collected through the registration database of the China Clinical Research Platform for Hepatitis B Elimination. Descriptive statistics were conducted on the demographic, blood, biochemical, and virological levels of patients according to the treatment recommendations of the two versions of the guidelines. The Mann-Whitney U test and χ2 test were used to compare the differences and proportional distribution of the treatment populations covered by the two guidelines. The χ2 test was used to analyze the coverage rate of different antiviral treatment indications. A total of 21,134 CHB patients without antiviral treatment were enrolled. 69.4% of patients met the 2024 versions of the WHO guidelines' recommendations. 85.0% of patients met the current Chinese hepatitis B prevention and treatment guidelines. The WHO guidelines for antiviral therapy indications were met in younger patients with higher levels of ALT, AST, and APRI scores, as well as greater proportion of patients with higher viral loads (P<0.001). The WHO guidelines recommended a cut-off value of APRI>0.5, which raised the proportion of patients on antiviral therapy from 6.6% to 30.9%. 45.7% of patients met the antiviral indications for HBV DNA >2000 IU/ml with abnormal transaminase (ALT>30 U/L for males and ALT>19 U/L for females). The reduced APRI diagnostic cut-off value and ALT treatment threshold had further increased the treatment coverage rate by 91.6% in patients with chronic HBV infection in line with the 2024 versions of WHO guidelines. The reduction of the APRI diagnostic cut-off value and the ALT treatment threshold, based on the current hepatitis B guidelines of China, will further improve the treatment coverage of CHB patients.
Topics: Humans; Antiviral Agents; World Health Organization; Hepatitis B, Chronic; Adult; Female; Male; China; Middle Aged; Practice Guidelines as Topic; Young Adult; Adolescent; Aged; East Asian People
PubMed: 38964895
DOI: 10.3760/cma.j.cn501113-20240421-00218 -
Zhonghua Gan Zang Bing Za Zhi =... Jun 2024To measure the overall and lobulated volume of the liver with different degrees of liver fibrosis and to further observe pathological changes such as liver...
To measure the overall and lobulated volume of the liver with different degrees of liver fibrosis and to further observe pathological changes such as liver microvasculature, hepatocyte apoptosis, and regeneration in order to understand the macroscopic volume changes of the liver during liver fibrosis and its relationship with liver tissue microscopic pathology in patients with chronic liver disease. 53 patients with chronic hepatitis B, alcoholic fatty liver disease, autoimmune liver disease, nonalcoholic fatty liver disease, and drug-induced chronic liver disease who underwent both liver biopsy tissue and abdominal magnetic resonance imaging were collected. Patients were divided into early (F1-2), middle (F3-4), and late (F5-6) in accordance with the Ishak fibrosis stage and Masson stain. The liver and spleen volumes were measured using ITK-SNAP software. CD31 immunohistochemical staining was used to reflect intrahepatic angiogenesis. Ki67 and HNF-4α multiplex immunohistochemical staining were used to reflect hepatocyte regeneration. GS staining was used to determine parenchymal extinction lesions. TUNEL staining was used to observe hepatocyte apoptosis. Spearman correlation analysis was used to analyze the relationship between liver volume changes and liver histopathological changes. As liver fibrosis progressed, the total liver volume and right lobe liver volume gradually decreased (<0.05), while the spleen volume gradually increased (<0.05). The expression of CD31 and GS gradually increased (<0.05), and the expression of Ki67 first increased and then decreased (<0.05). The positivity rate of CD31 was negatively correlated with the right lobe liver volume (=-0.609, <0.001) and the total liver volume (=-0.363, =0.017). The positivity rate of Ki67 was positively correlated with the right lobe liver volume (=0.423, =0.018), while the positivity rate of apoptotic cells was significantly negatively correlated with the total liver volume (=-0.860, <0.001). The positivity rate of GS was negatively correlated with the right lobe liver volume (=-0.440, =0.002), and the number of PELs was negatively correlated with RV (=-0.476, =0.013). The CD31 positive staining area was negatively correlated with the Ki67 positive staining area(=-0.511, =0.009). As liver fibrosis progresses, patients with chronic liver disease have a depletion in total liver volume and right lobe liver volume, and this is mainly in correlation with fewer liver cells and liver tissue microvasculature disorders.
Topics: Humans; Liver Cirrhosis; Liver; Male; Female; Middle Aged; Adult; Aged; Liver Regeneration; Chronic Disease; Hepatocytes; Organ Size; Apoptosis; Hepatitis B, Chronic
PubMed: 38964894
DOI: 10.3760/cma.j.cn501113-20231219-00286 -
Zhonghua Gan Zang Bing Za Zhi =... Jun 2024To explore the related factors of thrombocytopenia (TCP) occurrence in patients with cirrhosis. A cross-sectional study was conducted. Inpatients with an initial...
To explore the related factors of thrombocytopenia (TCP) occurrence in patients with cirrhosis. A cross-sectional study was conducted. Inpatients with an initial diagnosis of cirrhosis at Peking University First Hospital from January 1, 2010 to December 31, 2020 were included. Clinical data such as demographic characteristics, etiology of cirrhosis, complications of cirrhosis, laboratory indicators, Child-Pugh grade, invasive procedures, and mortality during hospitalization were collected. A logistic regression model was used to explore the related factors of TCP occurrence in patients with cirrhosis. Categorical variables were compared by the (2) test. The inter-group comparison was performed using continuous variables, a -test, one-way analysis of variance (ANOVA), or a nonparametric test. There were a total of 2 592 cases of cirrhosis. 75 cases with incomplete clinical data were excluded. 2 517 cases were included for analysis. The median age was 58 (50, 67) years. Males accounted for 64%. 1 435 cases (57.0%) developed TCP, and 434 cases (17.2%) had grade 3-4 TCP. Gender, primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and concomitant esophagogastric varices (EGV) were the major factors associated with TCP. Females were more prone to combine with TCP (=1.32, 95%: 1.12-1.56, =0.001). Patients combined with EGV (=3.09, 95%: 2.63-3.65, <0.001) were more prone to develop TCP, which was associated with the increased incidence of hypersplenism (<0.001). Patients with PBC (=0.64, 95%: 0.50-0.82, <0.001) and PSC (=0.23, 95%: 0.06-0.65, =0.010) were less prone to develop TCP, which was due to the shorter prothrombin time and better coagulation function of PBC patients (<0.001), and the lower proportion of hypersplenism in combined PSC patients (=0.004). Patients with TCP and grade 3-4 TCP had a higher rate of hemostatic procedures (<0.05), but a lower rate of liver biopsy (<0.05). Patients with grade 3-4 TCP had a higher nosocomial mortality rate compared to those without (=0.004). TCP is common in patients with cirrhosis. However, TCP occurrence is higher in female patients with EGV and lower in patients combined with PBC and PSC. TCP affects invasive procedures and is associated with adverse outcomes.
Topics: Humans; Cross-Sectional Studies; Thrombocytopenia; Male; Middle Aged; Female; Liver Cirrhosis; Aged; Risk Factors; Logistic Models; Liver Cirrhosis, Biliary; Adult
PubMed: 38964893
DOI: 10.3760/cma.j.cn501113-20240408-00183 -
Zhonghua Gan Zang Bing Za Zhi =... Jun 2024Non-alcoholic fatty liver disease (NAFLD) is a common concomitant disease in adults with type 2 diabetes mellitus (T2DM) and prediabetes. Therefore, T2DM/NAFLD patient...
[Interpretation of the 2024 American Diabetes Association guidelines for the comprehensive management of non-alcoholic fatty liver disease combined with diabetes mellitus].
Non-alcoholic fatty liver disease (NAFLD) is a common concomitant disease in adults with type 2 diabetes mellitus (T2DM) and prediabetes. Therefore, T2DM/NAFLD patient populations are at high risk for cardiovascular disease. The occurrence and progression of non-alcoholic fatty liver disease-related liver fibrosis and cardiovascular disease have a severe impact on the patient's prognosis and mortality rate. The American Diabetes Association's 2024 "Guidelines for the Standardized Management of Diabetes" put forward recommendations relevant to the screening, evaluation, treatment, and management of NAFLD in T2DM and prediabetic populations, as well as liver fibrosis. The important measures for decelerating liver inflammation and fibrosis progression and the risk of cardiovascular disease are based on improvements in lifestyle methods, weight loss, and blood sugar control.
Topics: Non-alcoholic Fatty Liver Disease; Humans; Diabetes Mellitus, Type 2; United States; Prediabetic State; Cardiovascular Diseases; Liver Cirrhosis
PubMed: 38964892
DOI: 10.3760/cma.j.cn501113-20240119-00045 -
Zhonghua Gan Zang Bing Za Zhi =... Jun 2024In order to achieve the early goal of "eliminating viral hepatitis as a public health threat by 2030" as proposed by the World Health Organization, the relevant issues...
In order to achieve the early goal of "eliminating viral hepatitis as a public health threat by 2030" as proposed by the World Health Organization, the relevant issues that have not yet reached consensus on the aspects of hepatitis B prevention and treatment, including population-wide screening, adult hepatitis B vaccination, the evaluation of quantitative values of hepatitis B virus DNA, the alanine aminotransferase threshold for initiating antiviral therapy, the treatment of patients in the "indeterminate phase," the treatment of patients with co-infections and comorbidities, and others. Thus, experts have formulated recommendations to further expand hepatitis B prevention and treatment, with the aim of accelerating the elimination of hepatitis B virus infection.
Topics: Humans; Hepatitis B; Hepatitis B virus; Hepatitis B Vaccines; Antiviral Agents; World Health Organization
PubMed: 38964891
DOI: 10.3760/cma.j.cn501113-20240407-00175 -
Zhonghua Gan Zang Bing Za Zhi =... Jun 2024Hypoalbuminemia is one of the important clinical features of decompensated cirrhosis. As the disease progresses, not only does the total albumin concentration decrease,... (Review)
Review
Hypoalbuminemia is one of the important clinical features of decompensated cirrhosis. As the disease progresses, not only does the total albumin concentration decrease, but so does the proportion of albumin that remains structurally and functionally intact. The structural and functional integrity of albumin is essential for its normal physiological role in the body. This led to the concept of "effective albumin concentration," which may be much lower than the total albumin concentration routinely measured clinically in patients with advanced cirrhosis. Liquid chromatography-tandem mass spectrometry, and electron paramagnetic resonance (EMR) are emerging technologies for effective albumin concentration detection, showing promising clinical application prospects, but research in patients with cirrhosis is still in the preliminary stage. Therefore, this article will comprehensively summarize the latest research on the aspects of effective albumin detection methods, liquid chromatography-tandem mass spectrometry, and electron paramagnetic resonance, as well as their applications.
Topics: Humans; Electron Spin Resonance Spectroscopy; Tandem Mass Spectrometry; Chromatography, Liquid; Serum Albumin; Liver Cirrhosis; Hypoalbuminemia
PubMed: 38964890
DOI: 10.3760/cma.j.cn501113-20240308-00122 -
Zhonghua Gan Zang Bing Za Zhi =... Jun 2024Thrombocytopenia is one of the common complications of cirrhotic patients, which can induce an increasing bleeding risk and closely correlate with bleeding following... (Review)
Review
Thrombocytopenia is one of the common complications of cirrhotic patients, which can induce an increasing bleeding risk and closely correlate with bleeding following invasive procedures. Consequently, how to respond to thrombocytopenia is crucial for improving the prognosis of patients with cirrhosis. This article reviews the main mechanisms of cirrhosis concurrent with thrombocytopenia, as well as the corresponding clinical management strategies.
Topics: Humans; Thrombocytopenia; Liver Cirrhosis
PubMed: 38964889
DOI: 10.3760/cma.j.cn501113-20240326-00158 -
Zhonghua Gan Zang Bing Za Zhi =... Jun 2024Portal vein thrombosis (PVT) is divided into cirrhotic and non-cirrhotic PVTs. The incidence rate of PVT varies greatly among different clinical stages of cirrhosis,... (Review)
Review
Portal vein thrombosis (PVT) is divided into cirrhotic and non-cirrhotic PVTs. The incidence rate of PVT varies greatly among different clinical stages of cirrhosis, with an overall incidence rate of about 13.92%, and the prevalence of cirrhotic PVT following splenectomy is as high as 60%. The pathogenesis of cirrhotic PVT is still unclear. However, the activation of Janus kinase/signal transduction and activator transcription signaling pathways, the rise in the expression of von Willebrand factor, and the gut microbiota along with its metabolite trimethylamine-N-oxide play an important role in the injury of vascular endothelial cells and the formation of PVT in cirrhosis. Therefore, these could be a new target for cirrhotic PVT prevention and treatment.
Topics: Humans; Portal Vein; Venous Thrombosis; Liver Cirrhosis; Signal Transduction; Methylamines; Gastrointestinal Microbiome; von Willebrand Factor; Janus Kinases
PubMed: 38964888
DOI: 10.3760/cma.j.cn501113-20240229-00100 -
Zhonghua Gan Zang Bing Za Zhi =... Jun 2024Managing cirrhosis complications is an important measure for improving patients' clinical outcomes. Therefore, in order to provide a complete disease assessment and...
Managing cirrhosis complications is an important measure for improving patients' clinical outcomes. Therefore, in order to provide a complete disease assessment and comprehensive treatment, improve quality of life, and improve the prognosis for patients with cirrhosis, it is necessary to pay attention to complications such as thrombocytopenia and portal vein thrombosis in addition to common or severe complications such as ascites, esophagogastric variceal bleeding, hepatic encephalopathy, and hepatorenal syndrome. The relevant concept that an effective albumin concentration is more helpful in predicting the cirrhosis outcome is gradually being accepted; however, the detection method still needs further standardization and commercialization.
Topics: Humans; Liver Cirrhosis; Hepatic Encephalopathy; Hepatorenal Syndrome; Ascites; Thrombocytopenia; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage
PubMed: 38964887
DOI: 10.3760/cma.j.cn501113-20240409-00184 -
BMJ Case Reports Jul 2024Multisystem inflammatory syndrome in children (MIS-C) is a known complication of COVID-19. There is still limited knowledge about this condition. Here, we report the...
Multisystem inflammatory syndrome in children (MIS-C) is a known complication of COVID-19. There is still limited knowledge about this condition. Here, we report the case of a previously healthy toddler boy, who presented with acute liver failure and duodenal lesions resulting in severe haematemesis and haemorrhagic shock, requiring intensive care unit care. The patient had persistent transaminitis, a deranged coagulation profile, inflammatory markers were elevated, and laboratory tests were negative for common infectious hepatitis aetiologies as well as COVID-19 Reverse transcription polymerase chain reaction. His COVID-19 antibody was reactive. Upper gastrointestinal endoscopy revealed a Forrest grade III duodenal ulcer. Looking into the constellation of symptoms and laboratory findings a confirmed diagnosis of acute viral hepatitis caused by MIS-C was made. Hence, he was given intravenous methylprednisolone along with intravenous immunoglobulins, after which he improved clinically and transaminitis resolved. The patient was discharged on clinical improvement and was doing fine on follow-up up to 6 months.
Topics: Humans; Male; Systemic Inflammatory Response Syndrome; COVID-19; Liver Failure, Acute; Gastrointestinal Hemorrhage; Methylprednisolone; Immunoglobulins, Intravenous; Hematemesis; Duodenal Ulcer; SARS-CoV-2; Child, Preschool
PubMed: 38964873
DOI: 10.1136/bcr-2023-256643