中华肝脏病杂志最新文献

{"title":"[Guidelines for the diagnosis and treatment of acute-on-chronic liver failure (2025 version)].","authors":"","doi":"10.3760/cma.j.cn501113-20250312-00089","DOIUrl":"10.3760/cma.j.cn501113-20250312-00089","url":null,"abstract":"<p><p>Acute-on-chronic liver failure (ACLF) is one of the leading causes of mortality among patients with chronic liver disease. Potentially reversible, ACLF requires precise clinical classification to facilitate accurate diagnosis, targeted treatment, and comprehensive management. Based on the latest research findings and clinical evidence, the Severe Liver Disease and Artificial Liver Group and the Nutrition and Regeneration in End-Stage Liver Disease Group, Chinese Society of Hepatology, Chinese Medical Association, together with multidisciplinary experts, have jointly compiled China's first guideline for the diagnosis and treatment of ACLF. The guideline aims to provide guidance for the diagnosis, treatment, and individualized management of patients with ACLF in clinical practice.</p>","PeriodicalId":24006,"journal":{"name":"中华肝脏病杂志","volume":"33 4","pages":"329-339"},"PeriodicalIF":0.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Bile acid metabolism and the occurrence and development of primary liver cancer].","authors":"J Han, Y Y Lu","doi":"10.3760/cma.j.cn501113-20250318-00098","DOIUrl":"https://doi.org/10.3760/cma.j.cn501113-20250318-00098","url":null,"abstract":"<p><p>Primary liver cancer is a common malignant tumor with a high mortality rate. Therefore, early-stage diagnosis and screening are of enormous significance. In recent years, studies have found that bile acids play a key role in the occurrence and development of liver cancer and are expected to become novel diagnostic markers and intervention targets. This article reviews the abnormal changes in bile acid metabolism during the occurrence and development of liver cancer, including the changes in bile acid composition and levels in liver tissue, plasma, feces, and urine, as well as the changes in enzymes related to bile acid metabolism. Furthermore, it expounds the mechanism by which bile acids affect the occurrence of liver cancer, such as participating in multiple signaling pathways to initiate the occurrence and affecting the immune microenvironment, and discusses the potential of bile acids as diagnostic markers for prevention and treatment strategies targeting bile acid metabolism. Bile acids have potential value in the diagnosis and prevention of liver cancer; yet, there are still challenges. In the future, it is necessary to build a large-scale follow-up cohort and biobank, innovate technology for detecting bile acids, and integrate it with multi-omics so as to improve the accuracy of early-stage diagnosis and prevention and treatment of liver cancer.</p>","PeriodicalId":24006,"journal":{"name":"中华肝脏病杂志","volume":"33 4","pages":"317-322"},"PeriodicalIF":0.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Study on the value of abnormal prothrombin in the diagnosis of HBV-related hepatocellular carcinoma].","authors":"J M Zhang, S X Zhao, L D Liu, F Han, W G Ren, X Q Wu, M J Sun, J J Song, Y M Nan","doi":"10.3760/cma.j.cn501113-20250314-00095","DOIUrl":"https://doi.org/10.3760/cma.j.cn501113-20250314-00095","url":null,"abstract":"<p><p><b>Objective:</b> To establish and explore a novel model and its clinical application value based on abnormal des-gamma-carboxy prothrombin (DCP) for the early-stage diagnosis of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). <b>Methods:</b> A total of 420 cases with chronic HBV infection with nodular liver lesions examined by imaging at the Third Hospital of Hebei Medical University from January 2021 to June 2024 were retrospectively selected. They were divided into the HBV-HCC group (182 cases) and the control group (238 cases) according to the current HCC diagnostic criteria. The basic information of patients, liver-related biochemical indicators, serum DCP, alpha-fetoprotein (AFP) levels, and the efficacy of combined detection in diagnosing early-stage HCC were collected and analyzed. A DSGAA model based on DCP (D) combined with gender (S), γ-glutamyl transferase (GGT, G), AFP (A) and age (A) as independent variables was constructed. The diagnostic performance of the novel model was compared with that of the traditional model through nomogram visualization output and calibration curve. <b>Results:</b> The age, sex, hemoglobin, albumin, alanine aminotransferase, alkaline phosphatase, and GGT levels were significantly higher in patients with HCC than those of the control group (<i>P</i><0.05). The positivity detection rate in patients with HBV-HCC was significantly higher in DCP than that of AFP (85.71% <i>vs</i>. 59.89%,<i>P</i><0.05). The abnormal detection rate of DCP in patients with AFP-negative was 76.7%. The sensitivity for diagnosing HCC was significantly higher in DCP than AFP (73.63% <i>vs</i>. 64.29%,<i>P</i><0.05), with specificity of 83.6% in all. The specificity for diagnosing early-stage HCC was 89.09%, surpassing that of AFP at 68.06% (<i>P</i><0.05). The area under the receiver operating characteristic curve (AUC) for the constructed DSGAA diagnostic model was 0.8841, with an optimal cutoff value of 0.377, a sensitivity of 80.22%, and a specificity of 86.13%. The AUC for diagnosing early-stage HCC was 0.8122, with a sensitivity of 66.18%, and a specificity of 86.13%, and the diagnostic efficacy was higher than other models (<i>P</i><0.05). <b>Conclusion:</b> DCP has superior diagnostic efficacy for HBV-related HCC, and the DSGAA model is expected to be used as a new method for screening and diagnosing early-stage HBV-related HCC.</p>","PeriodicalId":24006,"journal":{"name":"中华肝脏病杂志","volume":"33 4","pages":"340-347"},"PeriodicalIF":0.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Occurrence risk of extrahepatic liver tumor with hepatitis B virus infection].","authors":"D L Zhao, L Wei","doi":"10.3760/cma.j.cn501113-20240710-00318","DOIUrl":"10.3760/cma.j.cn501113-20240710-00318","url":null,"abstract":"<p><p>Hepatitis B virus (HBV) infection is a global public health problem, which mainly causes a series of liver diseases such as hepatitis, liver cirrhosis, and hepatocellular carcinoma. However, recent years' studies have shown that the occurrence of multiple extrahepatic malignancies may also be associated with HBV infection. For example, studies have found that patients with HBV infection have a significantly higher risk of developing digestive system tumors such as gastric cancer, colorectal cancer, and pancreatic cancer, as well as an increased risk of other systemic malignancies such as lymphoma, leukemia, and oral cancer. Although the liver is the primary target organ of HBV, the presence of the virus in non-hepatic tissues suggests that it may play an impact in the development of other extrahepatic tumors. The findings of these associations have important implications for public health policies and cancer prevention strategies, emphasizing the need for multisystem tumor screening in patients with HBV infection.</p>","PeriodicalId":24006,"journal":{"name":"中华肝脏病杂志","volume":"33 4","pages":"395-401"},"PeriodicalIF":0.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Research progress and clinical application in the early diagnosis and treatment technology of hepatocellular carcinoma].","authors":"Y M Nan, S X Zhao, L D Liu","doi":"10.3760/cma.j.cn501113-20250314-00093","DOIUrl":"10.3760/cma.j.cn501113-20250314-00093","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) is a malignant tumor that endangers human health globally. Diagnosis and treatment at an early stage are the keys to receiving radical treatment and improving survival rates. A clinical solution for HCC diagnosis at an early stage is the combination of serum markers and imaging technology. A basic strategy for screening and diagnosis at an early stage with a favorable cost-effectiveness ratio is the alpha-fetoprotein combined with abdominal ultrasound. The HCC diagnostic rate at an early stage can be improved with AFP combined with des-gamma carboxy prothrombin, aldehyde-keto reductase 1B10, liquid biopsy, and imaging tests. The radical treatment for early-stage HCC has entered a new era of diversification. The effectiveness of radical treatment can assist in improving the combined use of small molecule targeted medications and immune checkpoint inhibitors. The prevention and control of liver cancer will move toward a new stage of greater precision and efficiency with the advancement of biotechnology and policy promotion.</p>","PeriodicalId":24006,"journal":{"name":"中华肝脏病杂志","volume":"33 4","pages":"307-309"},"PeriodicalIF":0.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comparison of the efficacy of anatomical resection versus hepatic parenchymal preservation preference in patients with solitary small hepatocellular carcinoma and cirrhosis: a multicenter retrospective study].","authors":"L M Huang, Y Yang, Y T Li, X M Wang, S M Zheng, Q Lu, Z S Lai, Y P Lai, Z R Ding, J H Lyu, J C Zhang, X F Qiu, W P Zhou, K Y Lin, Y Y Zeng","doi":"10.3760/cma.j.cn501113-20250315-00097","DOIUrl":"10.3760/cma.j.cn501113-20250315-00097","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the efficacy of anatomical resection (AR) in the early stages of treating solitary hepatocellular carcinoma (HCC) combined with liver cirrhosis with a diameter of ≤5 cm in comparison to different surgical methods of preferential hepatic parenchymal preservation (non-anatomical liver resection, NAR). &lt;b&gt;Methods:&lt;/b&gt; The clinical data of 1 390 cases with solitary HCC combined with liver cirrhosis at an early stage who underwent liver resection at Mengchao Hepatobiliary Hospital of Fujian Medical University and six other medical centers from September 2013 to May 2019 were retrospectively analyzed. Patients were divided into the AR group (486 cases) and the NAR group (904 cases) and the wide surgical margin (WSM) group (745 cases) and the narrow surgical margin (NSM) group (645 cases) according to whether they received AR and the width of the surgical margin (1 cm). The basic information of the patients, preoperative evaluation index data, and postoperative follow-up (follow-up every 3 months) were collected. The Kaplan-Meier method was used to plot the survival curve.The log-rank test was used to compare the difference in survival between the two groups. The Cox proportional hazards regression model was used to analyze the factors affecting the prognosis. Propensity score matching (PSM) was applied to reduce intergroup bias. &lt;b&gt;Results:&lt;/b&gt; The overall survival (OS) rates for all patients at 1, 3, and 5 years were 95.5%, 79.9%, and 63.5%, respectively. The recurrence-free survival (RFS) rates were 81.5%, 59.0%, and 43.7%, respectively. There was a statistically significant difference in RFS rate between the AR group and the NAR group prior to PSM, but no statistically significant difference in OS rate (RFS rate: 47.0% &lt;i&gt;vs&lt;/i&gt;. 41.9%,&lt;i&gt;P&lt;/i&gt;&lt;0.05; OS rate: 64.4% &lt;i&gt;vs&lt;/i&gt;. 62.9%, &lt;i&gt;P&lt;/i&gt;&gt;0.05). The postoperative RFS rate and OS rate were significantly superior in the WSM group than those of the NSM group (RFS rate: 47.8% &lt;i&gt;vs&lt;/i&gt;. 37.2%,&lt;i&gt;P&lt;/i&gt;&lt;0.001; OS rate: 69.0% &lt;i&gt;vs&lt;/i&gt;. 57.3%, &lt;i&gt;P&lt;/i&gt;&lt;0.001). There was no statistically significant difference in OS rate and RFS rate between the AR group and the NAR group following PSM (RFS: 46.3% &lt;i&gt;vs&lt;/i&gt;. 45.1%,&lt;i&gt;P&lt;/i&gt;&gt;0.05; OS rate: 64.0% &lt;i&gt;vs&lt;/i&gt;. 64.3%, &lt;i&gt;P&lt;/i&gt;&gt;0.05).The 5-year OS and RFS rates in the WSM group were 66.8% and 60.2%, respectively. The 5-year OS and RFS rates for the NSM group were 48.7% and 41.4%, respectively, with a statistically significant difference (&lt;i&gt;P&lt;/i&gt;&lt;0.05). Cox multivariate analysis indicated that serum albumin, tumor diameter, microvascular invasion, and surgical margin were independent prognostic factors affecting OS and RFS. The Child-Pugh grade and satellite lesions were independent prognostic factors affecting OS. &lt;b&gt;Conclusion:&lt;/b&gt; Anatomical liver resection is not an independent risk factor for prognosis, but the state of the resection margin determines the prognosis of patients with solitary HCC combined with cirrhosis.","PeriodicalId":24006,"journal":{"name":"中华肝脏病杂志","volume":"33 4","pages":"348-358"},"PeriodicalIF":0.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Application value of an aMAP score in predicting the occurrence of hepatocellular carcinoma in patients with chronic hepatitis B receiving antiviral therapy].","authors":"Y F Gao, Z Z Liu, L Y Ma, Y X Liu, C Y Zhao","doi":"10.3760/cma.j.cn501113-20240226-00093","DOIUrl":"https://doi.org/10.3760/cma.j.cn501113-20240226-00093","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the predictive value of an aMAP score for the occurrence risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) receiving antiviral therapy. <b>Methods:</b> The medical records of 508 CHB patients who started receiving antiviral treatment in the Third Hospital of Hebei Medical University and the Fifth Hospital of Shijiazhuang from January 2001 to November 2021 were retrospectively analyzed. They were divided into low-, intermediate-, and high-risk groups according to the aMAP, AASL-HCC, PAGE-B, mPAGE-B, and CAMD scoring criteria. At the end of follow-up, they were divided into HCC (33 cases) and non-HCC group (475 cases) according to whether HCC occurred. The occurrence risk factors for HCC were analyzed by univariate and multivariate Cox regression analysis. The cumulative incidence of HCC at different time points was estimated by the Kaplan-Meier method and compared by the log-rank method. The HCC prediction performance of the aMAP score was evaluated by the receiver operating characteristic (ROC) curve and compared with other scores. The Mann-Whitney <i>U</i> test, or Fisher test, was used to compare the non-normally distributed quantitative data between groups. The <i>χ</i>² test was used to compare the count data between groups. <b>Results:</b> A total of 33 cases (6.5%) developed HCC during the median follow-up period of 8.7 (6.8-8.9) years. Multivariate analysis showed that age＞50 years (<i>HR</i>=2.804, 95%<i>CI</i> 1.332-5.902; <i>P</i>=0.007) and liver cirrhosis (<i>HR</i>=11.808, 95%<i>CI</i> 4.360-31.976; <i>P</i><0.001) were independent risk factors for HCC occurrence. The cumulative incidence of HCC defined by the aMAP score at 3 and 5 years was significantly lower in the low-risk group (0, 0) than that in the intermediate-risk group (4.4%, 5.4%) and the high-risk group (10.8%, 18.5%), <i>P</i><0.001. The aMAP score performed similarly to the AASL-HCC score, mPAGE-B score, and CAMD score [area under the ROC curve (AUC) was 0.863, 0.900, 0.851, and 0.886, respectively], with <i>P</i>＞0.05 in terms of the 3-year HCC prediction performance; and was equally superior with the PAGE-B score (AUC was 0.732), with <i>P</i><0.05. The aMAP score was not worse than the AASL-HCC score and CAMD score (AUC was 0.890, 0.894, and 0.882, respectively), with <i>P</i>＞0.05 in terms of the 5-year HCC prediction performance; however, it was significantly superior to the PAGE-B score and mPAGE-B score (AUC was 0.795 and 0.875, respectively), with <i>P</i><0.05. In addition, the AUC of the aMAP score for predicting HCC occurrence at baseline, 1 year, 2 years, and 3 years of antiviral treatment was＞0.9. <b>Conclusions:</b> The aMAP score can accurately assess the risk of HCC in CHB patients receiving antiviral therapy.</p>","PeriodicalId":24006,"journal":{"name":"中华肝脏病杂志","volume":"33 4","pages":"359-365"},"PeriodicalIF":0.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Assessment and management of malnutrition in patients with cirrhosis combined with hepatic encephalopathy].","authors":"Y Xu, J Kang, X H Wang, L Zhang, D C Cai","doi":"10.3760/cma.j.cn501113-20241214-00622","DOIUrl":"https://doi.org/10.3760/cma.j.cn501113-20241214-00622","url":null,"abstract":"<p><p>Hepatic encephalopathy and malnutrition due to hyperammonemia often interact with each other, forming a vicious circle in patients with cirrhosis. In addition, hepatic encephalopathy and malnutrition have a high incidence in patients with cirrhosis, which seriously affects the quality of life and prognosis. Therefore, identifying whether malnutrition is present in patients with cirrhosis combined with hepatic encephalopathy is crucial for providing appropriate interventions.This article reviews the pathogenesis, nutritional assessment methods, and nutritional management of malnutrition in patients with liver cirrhosis combined with hepatic encephalopathy.</p>","PeriodicalId":24006,"journal":{"name":"中华肝脏病杂志","volume":"33 4","pages":"402-408"},"PeriodicalIF":0.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Research and application progress for liver xenotransplantation].","authors":"Y Xie, D Wang, W T Jiang","doi":"10.3760/cma.j.cn501113-20240528-00270","DOIUrl":"https://doi.org/10.3760/cma.j.cn501113-20240528-00270","url":null,"abstract":"<p><p>Liver transplantation is an effective treatment method for many end-stage liver diseases; however, the shortage of donor livers is one of the main obstacles affecting its development. Thus, xenotransplantation is expected to be a potential way to solve the shortage of organs. Gene editing technology has been used to improve animal genes so they can enhance their physiological compatibility with humans, and new immunosuppressive drugs are combined to reduce the occurrence of rejection so as to prolong the survival time of grafts. Liver xenotransplantation is more prominent than that of the heart or kidney transplants, and the related molecular mechanisms, such as xenogeneic rejection and coagulation disorders after surgery, need to be further studied due to the more complex structure and physiological functions of the liver. This paper reviews the historical development, current main problems, and clinical applications based on the latest research progress at home and abroad, with aim to improve clinicians' understanding of liver xenotransplantation.</p>","PeriodicalId":24006,"journal":{"name":"中华肝脏病杂志","volume":"33 4","pages":"388-394"},"PeriodicalIF":0.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A case of hereditary hemorrhagic telangiectasia treated with bevacizumab].","authors":"W T Chao, H Ma, X H Li, B Feng, H Wang, C C Wu, H Y Rao, R Huang","doi":"10.3760/cma.j.cn501113-20240129-00064","DOIUrl":"10.3760/cma.j.cn501113-20240129-00064","url":null,"abstract":"","PeriodicalId":24006,"journal":{"name":"中华肝脏病杂志","volume":"33 ","pages":"375-378"},"PeriodicalIF":0.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}