2024年7月28日是第十四个“世界肝炎日”，今年中国的宣传主题是“消除肝炎，积极行动”。肝脏是人体重要的代谢和解毒器官，担负着多种重要功能。肝脏疾病已经成为了危及人们健康的最普遍疾病。肝炎是引起肝硬化、肝癌和病毒性肝炎相关死亡的常见疾病，严重威胁社会公共健康安全。
在肝炎病中，分为病毒性肝炎和非病毒性肝炎两种：
1、病毒性肝炎
病毒感染引起的肝炎，在所有病例中占绝大多数；包括甲型、乙型、丙型、丁型、戊型肝炎，对肝细胞造成损伤。
2、非病毒性肝炎
自身免疫功能异常，引发的自身免疫性肝炎；酒精性肝炎、非酒精性脂肪肝性肝炎、代谢性肝炎、药物性肝炎。
本期推文为大家准备了发表在iLIVER的7篇与肝炎相关文章，供大家阅读交流。
推荐文章1
Chronic hepatitis C in hemodialysis patients: Prevalence and liver fibrosis impact in the National Center for Renal Health in Peru
● 作者：
P. Martin Padilla-Machaca, Eduardo Luna-Victoria, Ada Cabrera, Juan-Carlos Gomez-De la Torre, Rocio Galloso, Pedro Montes
● 摘要：
Background:
Hepatitis C (HCV) remains a serious public health problem in high-risk persons such as patients on chronic hemodialysis. We aimed to estimate the serological prevalence of HCV, the HCV viral load and genotype, and liver fibrosis stage among patients on chronic hemodialysis at the National Renal Health Center in Lima, Peru.
Methods:
From June 2019 to March 2021, all patients who received chronic hemodialysis were invited to participate. Subjects who provided written informed consent were enrolled. Patients with HCV-positive serology underwent determination of HCV viral load. Samples from subjects with detectable viral load, underwent determination of HCV genotype. Then, HCV infected subjects underwent determination of liver fibrosis using transitional elastography (Fibroscan 402): Metavir score: F0–F1: 2.5–7.5 kPa, F2: 7.6–9.5 Kpa, F3: 9.6–12 Kpa, F4 (Cirrhosis): 12.1–75 Kpa.
Results:
Of the 303 subjects invited to participate, 174 (57.4%) subjects gave their written consent. Mean age was 52 years (range 22–91) and 116 (66.6%) were male. HCV serology was positive in 35.1% of patients (61/174); however, the prevalence of positive serology with detectable viral load was 20.11% (35/174). Genotype 1a was the most prevalent (85%). The majority (83.6%) of subjects with detectable viral load had values lower than 800.000 IU/mL. Twenty-nine of those 35 subjects underwent elastography evaluation, and 13 (44.8%) of them were found to have stage F2–F4 fibrosis.
Conclusions:
The prevalence of HCV at the largest reference center for hemodialysis in Lima remains high, with GT1a predominance, viral load usually below 800,000 IU/mL and significant liver fibrosis.
（扫码阅读原文）
● 如何引用：
P. Martin Padilla-Machaca, Eduardo Luna-Victoria, Ada Cabrera, et al .Chronic hepatitis C in hemodialysis patients: Prevalence and liver fibrosis impact in the National Center for Renal Health in Peru.iLIVER,2022;1(3):141-144.https://doi.org/10.1016/j.iliver.2022.08.001.
推荐文章2
Efficiency and safety of sofosbuvir in Bangladeshi children with chronic hepatitis C virus infection
● 作者：
Salahuddin Mahmud, Jahida Gulshan, Md. Belayet Hossain, Madhabi Baidya, Rafia Rashid, Farhana Tasneem, Ahmed Rashidul Hasan, Tanzila Farhana, Mohammed Reaz Mobarak, Md. Jahangir Alam, Syed Shafi Ahmed
● 摘要：
Background and aims：
Currently, treatment with oral direct-acting antivirals is recommended for all hepatitis C virus (HCV)-infected pediatric patients. The aim of this study was to evaluate the efficacy and safety of sofosbuvir and ribavirin combination therapy for children and adolescents in Bangladesh who are living with chronic HCV infection.
Methods：
An experimental study was performed from January 2021 to December 2022. HCV polymerase chain reaction (PCR)-positive thalassemic children, who were 6–18 years of age, were enrolled by consecutive nonprobability sampling. Clinical features were recorded, and investigations were performed. All patients were initially treated with sofosbuvir (200 mg for 6- to 11-year-olds and 400 mg for 12- to 18-year-olds) and ribavirin (10–15 mg/kg/day) and were assessed clinically on a four-weekly basis, along with liver-function testing. The total duration of therapy was 24 weeks. HCV PCR was done at the end of treatment and 12 weeks after the completion of treatment to see the sustained virological response.
Results：
There were 26 cases in total, with a mean age of 9.26 ± 2.82 years; 14 were males (53.8%), and 12 females (46.2%). Twenty-five (96.15%) patients achieved a sustained virological response, and the end-of-treatment PCR was negative. One patient (3.85%) was a nonresponder even after 24 weeks of treatment. The medication was well received, with only four patients (15.3%) reporting headaches that were reported untreated.
Conclusion：
The combination of sofosbuvir and ribavirin is effective in treating chronic HCV infection and is not accompanied by any major negative side effects.
（扫码阅读原文）
● 如何引用：
Salahuddin Mahmud, Jahida Gulshan, Md. Belayet Hossain, et al. Efficiency and safety of sofosbuvir in Bangladeshi children with chronic hepatitis C virus infection.iLIVER,2023;2(3):146-150.https://doi.org/10.1016/j.iliver.2023.06.002.
推荐文章3
Tenofovir disoproxil fumarate therapy in patients with chronic hepatitis B and advanced fibrosis or compensated cirrhosis
● 作者：
Huiying Rao, Jia Shang, Qing Xie, Jianqi Lian, Pujun Gao, Junping Shi, Xinyue Chen, Jiefei Wang, Min Xu, Liaoyun Zhang, Yingren Zhao, Qing Mao, Maorong Wang , Wei Zhao, Zong Zhang, Jidong Jia, Hong Tang, Jiming Zhang, Xin Zheng, Chang Liu，Lai Wei
● 摘要：
Background and aims：
Tenofovir disoproxil fumarate (TDF) is the first-line therapy for chronic hepatitis B. This interim analysis presents the efficacy and safety data for TDF at Week 144 in patients with chronic hepatitis B and advanced fibrosis or compensated cirrhosis from China.
Methods：
Patients were assessed for incidence of newly diagnosed hepatocellular carcinoma (HCC) and disease progression, liver stiffness measurement (LSM), virological suppression (serum hepatitis B virus DNA <20 IU/mL), alanine aminotransferase normalization, hepatitis B e antigen (HBeAg) loss and seroconversion, histological liver fibrosis score, and safety at Week 144.
Results：
Overall, 197 patients were enrolled. At Week 144, the incidence of newly diagnosed HCC was observed in 2.1% patients, and the incidence of disease progression was observed in 3.6% patients. The mean (standard deviation) change in LSM from baseline was −5.1 (5.85) kPa. Serum hepatitis B virus DNA <20 IU/mL was observed in 94.1% patients, alanine aminotransferase normalization in 33.5% patients, HBeAg loss in 35.6% patients, and HBeAg seroconversion in 14.4% patients. Among patients with stage F3 or F4 fibrosis at baseline by LSM, 38.3% patients regressed to stage F0/1, and 22.0% of patients regressed to stage F2 at Week 144. Overall, 67.7% patients experienced ≥1 adverse events, 13.8% patients experienced TDF-related adverse events, and 16.4% patients experienced serious (none were TDF-related).
Conclusions：
At Week 144 of TDF treatment, low incidence of HCC and disease progression were reported. Virological suppression was observed in 94.1% patients, which was associated with fibrosis regression. No new safety events were identified.
（扫码阅读原文）
● 如何引用：
Huiying Rao, Jia Shang, Qing Xie, et al. Tenofovir disoproxil fumarate therapy in patients with chronic hepatitis B and advanced fibrosis or compensated cirrhosis.iLIVER,2022;1(3):145-153.https://doi.org/10.1016/j.iliver.2022.08.006.
推荐文章4
Clinical analysis of the characteristics of patients diagnosed with hemolytic anemia induced by hepatitis E viral infection
● 作者：
Haohui Deng, Min Xu, Huiyuan Liu, Hongbo Gao
● 摘要：
Background：
The extrahepatic manifestations of hepatitis E virus (HEV) infection include hemolytic anemia. However, the clinical characteristics of HEV-induced hemolytic anemia have been only sporadically reported in case reports, and there is a scarcity of relevant systematic reviews. The aim of the current study was to analyze and summarize the clinical characteristics of patients diagnosed with HEV-induced hemolytic anemia.
Methods：
This study included 1 patient diagnosed with HEV-induced hemolytic anemia who was admitted to our hospital and 19 additional patients identified through the available literature.
Results：
Of the 20 patients included in this study, the majorities were from China and India (12 and 6 cases, respectively); furthermore, 13 of them were men and 7 were women, with an average age of 35 (16–56) years. The highest total bilirubin level was 646 (452–913) μmol/L, highest alanine aminotransferase level was 1335 (708–2798) IU/L, and lowest hemoglobin level was 6.0 ± 2.0 g/dL. Additionally, 10 patients (50.0%, 10/20) underwent the glucose-6-phosphate dehydrogenase (G6PD) activity test, and all of them were diagnosed with G6PD deficiency (100.0%, 10/10). Finally, 18 patients (90.0%) recovered and 2 died (10.0%) after treatment.
Conclusions：
Most of the patients with HEV-induced hemolytic anemia recovered with treatment. Acute HEV infection that causes hemolytic anemia is strongly associated with the G6PD status of the patients.
（扫码阅读原文）
● 如何引用：
Haohui Deng, Min Xu, Huiyuan Liu, et al. Clinical analysis of the characteristics of patients diagnosed with hemolytic anemia induced by hepatitis E viral infection.iLIVER,2022;1(2):117-121.
https://doi.org/10.1016/j.iliver.2022.05.001.
推荐文章5
Viral diseases in Africa: Preventing the outbreak of acute hepatitis of unknown etiology
● 作者：
Okereke Promise Udohchukwu, Innocent Kitandu Paul, Margareth Richard Mallya, Matilda K. Basinda, Sospeter Berling Sospeter, Juvenali Ruaichi
● 摘要：
Hepatitis is an inflammation of the liver. There had been an outbreak of hepatitis of unknown origin among children, where nine pediatric patients in Alabama, United States of America, tested negative for hepatitis viruses (A, B, C, D, and E) and autoimmune conditions. So far, no case has been recorded in Africa. This article seeks to give guidelines on how to prevent its occurrence in Africa. Various literatures were reviewed on the background of hepatitis of unknown origin while focusing on World Health Organization publication as regards the outbreaks in other European countries. Therefore, it is worthy to state that Africa needs to keep its healthcare systems ready to take care of the mechanism by which the outbreak may occur and protect the vulnerable pediatric population from such an outbreak.
（扫码阅读原文）
● 如何引用：
Okereke Promise Udohchukwu, Innocent Kitandu Paul, Margareth Richard Mallya,et al. Viral diseases in Africa: Preventing the outbreak of acute hepatitis of unknown etiology.iLIVER,2022;1(4):235-236.https://doi.org/10.1016/j.iliver.2022.10.002.
推荐文章6
Risk factors related to significant hepatic inflammation in patients with acute drug-induced liver injury
● 作者：
Yu-Ting Xiong, Jian-Fei Wang, Le Li, Zhi-Fang Bai, Yan Liu, Ang Huang, Ke-Xin Wang, Yiming Fu , Wucai Yang, Chang Guo, Mengwen He, Wen-Chang Wang, Chun-Yan Wang, Dong Ji
● 摘要：
ackground and aims：
Currently, research on biopsy-proven acute drug-induced liver injury (DILI) remains limited. This study aimed to identify clinical characteristics and risk factors for significant hepatic inflammation in patients with acute DILI.
Methods：
An ambispective cohort study was conducted on biopsy-proven acute DILI patients admitted to our hospital from 2012 to 2018. Using the Scheuer scoring system, patients were categorized into G0-2 or G3-4 groups and followed up for 12 months after first admission. Clinical characteristics and outcomes were retrieved from medical records.
Results：
The median age of the 157 enrolled patients (65.6% female) was 40.4 (interquartile range (IQR), 31.9–49.1) years. The median latency and length of hospitalization were 30.0 (IQR, 5.0–60.0) and 18.0 (IQR, 12.0–26.0) days. The proportions of patients in the G0-2 and G3-4 groups were 54.8% and 45.2%, respectively. Logistic regression analysis revealed that females (odds ratio (OR): 2.623, 95% confidence interval (CI): 1.169–5.887, p = 0.019), higher body mass index (OR: 1.168, 95% CI: 1.029–1.325, p = 0.016), higher total bilirubin (OR: 1.004, 95% CI: 1.000–1.007, p = 0.047), and lower prothrombin activity (OR: 0.976, 95% CI: 0,957–0.995, p = 0.013) were associated with significant hepatic inflammation. The predominance of the hepatocellular injury pattern (60.5%) at admission transformed into a predominance of the cholestatic pattern (60.5%) at discharge. During follow-up, 23 patients (14.6%) developed chronic DILI, with nine patients (5.7%) progressing to cirrhosis. Moreover, 15 female patients (9.6%) developed autoimmunity (3cases in the G0-2 group vs 12 cases in the G3-4 group, p < 0.05).
Conclusion：
Acute DILI patients with high-risk factors were more likely to develop significant hepatic inflammation, and females with significant inflammation were at a higher risk of developing autoimmunity during follow-up.
（扫码阅读原文）
● 如何引用：
Yu-Ting Xiong, Jian-Fei Wang, Le Li, et al. Risk factors related to significant hepatic inflammation in patients with acute drug-induced liver injury.iLIVER,
2024;3(2):100095.https://doi.org/10.1016/j.iliver.2024.100095.
推荐文章7
Metabolic syndrome is associated with significant hepatic fibrosis and steatosis in patients with nonalcoholic steatohepatitis
● 作者：
Qian-Qian Li, Yu-Ting Xiong, Danni Wang, Ke-Xin Wang, Chang Guo, Yi-Ming Fu, Xiao-Xia Niu, Chun-Yan Wang, Jian-Jun Wang, Dong Ji, Zhi-Fang Bai
● 摘要：
Background and aims：
Nonalcoholic steatohepatitis (NASH), an inflammatory form of non-alcoholic fatty liver disease, can progress to advanced liver fibrosis, cirrhosis, and liver cancer. Metabolic syndrome (MetS) parallels the prevalence of non-alcoholic fatty liver disease/NASH and increases patients’ risk of advanced liver disease. This study aimed to determine whether MetS was associated with the histological progression of NASH.
Methods：
Patients with liver biopsy-proven NASH were retrospectively screened and categorized into two groups for each histological feature: with (<2 points) or without (≥2 points) significant hepatic steatosis/inflammation/fibrosis. Multivariable logistic regression was used to explore the association between MetS and histological features.
Results：
In total, 386 patients with a median age of 33.0 years were enrolled; among them, 35.2% were female, and 41.2% had MetS. The proportion of significant hepatic fibrosis and steatosis in those with MetS was significantly higher than in those without MetS (p < 0.05). Multivariable logistic regression analyses showed that MetS remained significantly associated with significant hepatic fibrosis (adjusted odds ratio: 1.852, 95% confidence interval: 1.042–3.292, p = 0.036), and severe hepatic steatosis (adjusted odds ratio: 2.008, 95% confidence interval: 1.030–3.914, p = 0.041).
Conclusion：
MetS was associated with significant hepatic fibrosis and steatosis in patients with NASH. Our results suggest that NASH patients with MetS should be closely monitored and given targeted intervention and treatment, which may help to prevent disease progression and mitigate the growing burden of NASH.
（扫码阅读原文）
● 如何引用：
Qian-Qian Li, Yu-Ting Xiong, Danni Wang,et al. Metabolic syndrome is associated with significant hepatic fibrosis and steatosis in patients with nonalcoholic steatohepatitis. iLIVER. 2024;3(2):100094.
doi: 10.1016/j.iliver.2024.100094.
相关图书推荐
《精准肝脏外科学》
《肝脏外科术中超声基础》
《经皮肝穿刺胆管取石术手术学》
期刊介绍
iLIVER是由中华人民共和国教育部主管，清华大学主办，清华大学出版社出版，爱思唯尔全球发行的肝病领域开放式英文期刊。本刊旨在传播肝病领域的创新和实践成果，并为从事肝胆系统研究的多学科专家和学者提供核心学术资源。本刊可发表肝胆系统领域中临床医学、转化医学、基础医学和公共卫生的原创研究、荟萃分析、综述、共识和实践指南等研究。主题涵盖范围包括：
● 肝的结构、功能及调节机制的研究；
● 肝胆疾病的基础研究，包括病因、发病机制、病理生理学和预防策略；
● 肝胆疾病的预防、诊断、治疗、康复和慢性病管理；
● 与肝胆疾病流行病学、预防、监测和卫生政策相关的公共卫生研究；
● 肝脏健康相关的转化科学；
● 数据和智能技术在肝病领域的应用；
● 与肝胆疾病相关的临床药物试验和医疗器械临床试验；
● 以肝病为重点的跨学科研究。
为鼓励肝胆领域创新性研究，iLIVER在创刊初期（2022-2024）免收版面费并为接收文章提供免费的英文润色服务！
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