Gynura root has been used extensively in Chinese folk medicine and plays a role in promoting microcirculation and relieving pain.However,its hepatic toxicity should not be neglected.Recently,we admitted a 62-year old ...Gynura root has been used extensively in Chinese folk medicine and plays a role in promoting microcirculation and relieving pain.However,its hepatic toxicity should not be neglected.Recently,we admitted a 62-year old female who developed hepatic veno-occlusive disease(HVOD)after ingestion of Gynura root.Only a few articles on HVOD induced by Gynura root have been reported in the literature.It is suspected that pyrrolizidine alkaloids in Gynura root might be responsible for HVOD.In this paper,we report a case of HVOD and review the literature.展开更多
Objective: Hepatic veno-occlusive disease(HVOD) has attracted increasing attention in recent years due to its relationship with ingestion of Gynura segetum. The mortality of severe HVOD remains high due to the lack of...Objective: Hepatic veno-occlusive disease(HVOD) has attracted increasing attention in recent years due to its relationship with ingestion of Gynura segetum. The mortality of severe HVOD remains high due to the lack of specific therapies. The aim of the study was to delineate the clinical characteristics and outcomes and explore the potential prognostic factors of HVOD.Methods: This was a single-center retrospective study. Eighty-nine HVOD patients were screened from the First Affiliated Hospital of Zhejiang University with an ingestion history of G. segetum before developing symptoms from January 2009 to May 2018. The enrolled patients were divided into the survivor and death groups according to the clinical follow-up that ended on September 1, 2019. The demographic variables and clinical data of the patients were recorded. A binary logistic regression analysis and receiver operating characteristic curve were conducted to identify the prognostic factors and assess the prognostic value for predicting death, and a survival analysis was performed to evaluate the clinical outcomes.Results: Sixty-four patients were eligible for further analysis. Most patients showed abdominal distension and were positive for migrating dullness in the abdomen(P = 0.740 and P = 0.732, respectively). The patients who died had higher levels of model for end-stage liver disease score, and higher prothrombin time than those who survived(both P < 0.001). All HVOD patients in both the survival and death groups showed ascites with abnormal imaging presentations of the liver parenchyma and hepatic blood vessels.Unexpectedly, we found that hydrothorax was detected in 21(65.63%) patients in the death group and 19(59.38%) patients in the survivor group during hospitalization, which was rarely mentioned in previous studies. Furthermore, international normalized ratio(INR) and creatinine are found to be potential independent prognostic factors for predicting death. Six severe patients achieved clinical improvements and survived after liver transplantation.Conclusion: HVOD can be induced by the ingestion of G. segetum, and INR combined with creatinine has prognostic value for predicting death. Liver transplantation may be an effective treatment option for severe HVOD patients.展开更多
Hepatic veno-occlusive disease (HVOD) is rarely encountered and easily misjudged as Budd-Chiari syndrome. It is often related to stem cell transplantation in recent years. We report a case of HVOD that is related to i...Hepatic veno-occlusive disease (HVOD) is rarely encountered and easily misjudged as Budd-Chiari syndrome. It is often related to stem cell transplantation in recent years. We report a case of HVOD that is related to ingestion of some palatable local dishes. The diagnosis was confirmed by liver biopsy pathology with specific observation of inflammatory changes and fibrosis of venules intima, dilated sinusoids and central veins. Chronic diarrhea is unique for this case as a result of ingesting harmful stuffs. This case demonstrated that supervision and instruction of food recipe and traditional medicine are crucial, and prompt diagnosis, supportive care and specific treatment are essential to decreasing the morbidity and mortality of HVOD.展开更多
BACKGROUND:Hepatic veno-occlusive disease(VOD)or sinusoidal obstruction syndrome is associated with a high mortality because of its severity.Gymura segetum,a Chinese herbal medicine,is always used to cure injury and b...BACKGROUND:Hepatic veno-occlusive disease(VOD)or sinusoidal obstruction syndrome is associated with a high mortality because of its severity.Gymura segetum,a Chinese herbal medicine,is always used to cure injury and bleeding in rural areas in China.This study was undertaken to better understand VOD and its relations to the effect of Gymura segetum.METHODS:Between 2000 and 2002,two patients were admitted to our department because of VOD.Before admission,both of them had been injured and taken oral decoction of patent drug Gymura segetum.We analyzed the clinical manifestations,diagnosis and therapy of the two patients.RESULTS:Pyrrolizidine in Panax notginseng was proved to induce VOD.The diagnosis of VOD depended on hepatic biopsy.CONCLUSION:Gymura segetum can induce VOD.More attention should be paid to its unsuscepted side effects.展开更多
Nowadays hepatic veno-occlusive disease is mainly caused by Sedum aizoon in China,and its prognosis dependents on the dosage and courses of the Sedum aizoon treatment but lacks other objective indicators.There are a l...Nowadays hepatic veno-occlusive disease is mainly caused by Sedum aizoon in China,and its prognosis dependents on the dosage and courses of the Sedum aizoon treatment but lacks other objective indicators.There are a lot relationships between CA125 level and liver cirrhosis,this case had a obvious increased CA125 level in the serum,hydrothorax and ascites,following by the liver cirrhosis in a short time,and then died of upper gastrointestinal bleeding.By now we guess that CA125 level could forecast the liver cirrhosis following by hepatic veno-occlusive,which will become the prognosis of the hepatic veno-occlusive.展开更多
BACKGROUND:Hepatic veno-occlusive disease(HVOD)is a severe complication of chemotherapy before hematopoietic stem cell transplantation and dietary ingestion of pyrrolizidine alkaloids.Many experimental models were est...BACKGROUND:Hepatic veno-occlusive disease(HVOD)is a severe complication of chemotherapy before hematopoietic stem cell transplantation and dietary ingestion of pyrrolizidine alkaloids.Many experimental models were established to study its mechanisms or therapy,but few are ideal.This work aimed at evaluating a rat model of HVOD induced by monocrotaline to help advance research into this disease. METHODS:Thirty-two male rats were randomly classified into 5 groups,and PBS or monocrotaline was administered (100 mg/kg or 160 mg/kg).They were sacrificed on day 7(groups A,B and D)or day 10(groups C and E).Blood samples were collected to determine liver enzyme concentrations.The weight of the liver and body and the amount of ascites were measured.Histopathological changes of liver tissue on light microscopy were assessed by a modified Deleve scoring system.The positivity of proliferating cell nuclear antigen(PCNA)was estimated. RESULTS:The rats that were treated with 160 mg/kg monocrotaline presented with severe clinical symptoms (including two deaths)and the histopathological picture of HVOD.On the other hand,the rats that were fed with 100 mg/kg monocrotaline had milder and reversible manifestations.Comparison of the rats sacrificed on day 10 with those sacrificed on day 7 showed that the positivity of PCNA increased,especially that of hepatocytes.CONCLUSIONS:Monocrotaline induces acute,dose- dependent HVOD in rats.The model is potentially reversible with a low dose,but reliable and irreversible with a higher dose.The modified scoring system seems to be more accurate than the traditional one in reflecting the histopathology of HVOD.The enhancement of PCNA positivity may be associated with hepatic tissue undergoing recovery.展开更多
Hepatic veno-occlusive disease(VOD), also known as sinusoidal obstruction syndrome, is a major complication of hematopoietic stem cell transplantation and it carries a high mortality. Prophylaxis for hepatic VOD is co...Hepatic veno-occlusive disease(VOD), also known as sinusoidal obstruction syndrome, is a major complication of hematopoietic stem cell transplantation and it carries a high mortality. Prophylaxis for hepatic VOD is commonly given to transplant recipients from the start of conditioning through the early weeks of transplant. However, high quality evidence from randomized controlled trials is scarce with small sample sizes and the trials yielded conflicting results. Although various treatment options for hepatic VOD are available, most have not undergone stringent evaluation with randomized controlled trial and therefore it remains uncertain which treatment offers real benefit. It remains controversial whether VOD prophylaxis should be given, which prophylactic therapy should be given, who should receive prophylaxis, and what treatment should be offered once VOD is established.展开更多
BACKGROUND Hepatic steatosis,characterized by fat accumulation in hepatocytes,can result from metabolic dysfunction-associated steatotic liver disease(MASLD),infections,alcoholism,chemotherapy,and toxins.MASLD is diag...BACKGROUND Hepatic steatosis,characterized by fat accumulation in hepatocytes,can result from metabolic dysfunction-associated steatotic liver disease(MASLD),infections,alcoholism,chemotherapy,and toxins.MASLD is diagnosed via imaging or biopsy with metabolic criteria and may progress to metabolic dysfunction–asso-ciated steatohepatitis,potentially leading to fibrosis,cirrhosis,or cancer.The coexistence of hepatic steatosis with chronic hepatitis B(CHB)is mainly related to metabolic factors and increases mortality and cancer risks.As a noninvasive method,attenuation imaging(ATI)shows promise in quantifying liver fat,demonstrating strong correlation with liver biopsy.AIM To investigate the disparity of ATI for assessing biopsy-based hepatic steatosis in CHB patients and MASLD patients.METHODS The study enrolled 249 patients who underwent both ATI and liver biopsy,including 78 with CHB and 171 with MASLD.Hepatic steatosis was classified into grades S0 to S3 according to the proportion of fat cells present.Liver fibrosis was staged from 0 to 4 according to the meta-analysis of histological data in viral hepatitis scoring system.The diagnostic performance of attenuation coefficient(AC)values across different groups was compared for each grade of steatosis.Factors associated with the AC values were determined through linear regression analysis.A multivariate logistic regression model was established to predict≥S2 within the MASLD group.RESULTS In both the CHB and the MASLD groups,AC values increased significantly with higher steatosis grade(P<0.001).In the CHB group,the areas under the curve(AUCs)of AC for predicting steatosis grades≥S1,≥S2 and S3 were 0.918,0.960 and 0.987,respectively.In contrast,the MASLD group showed AUCs of 0.836,0.774,and 0.688 for the same steatosis grades.The diagnostic performance of AC for detecting≥S2 and S3 indicated significant differences between the two groups(both P<0.001).Multivariate linear regression analysis identified body mass index,trigly-cerides,and steatosis grade as significant factors for AC.When the steatosis grade is≥S2,it can progress to more serious liver conditions.A clinical model integrating blood biochemical parameters and AC was developed in the MASLD group to enhance the prediction of≥S2,achieving an AUC of 0.848.CONCLUSION The AC could effectively discriminate the degree of steatosis in both the CHB and MASLD groups.In the MASLD group,when combined with blood biochemical parameters,AC exhibited better predictive ability for moderate to severe steatosis.展开更多
Hepatic osteodystrophy(HO)is a common and frequently untreated complica-tion,manifested as osteoporosis or osteopenia,encountered in the evolution of chronic liver diseases(CLD).In addition to patients with chronic ch...Hepatic osteodystrophy(HO)is a common and frequently untreated complica-tion,manifested as osteoporosis or osteopenia,encountered in the evolution of chronic liver diseases(CLD).In addition to patients with chronic cholestasis and cirrhosis,patients with CLD from other etiologies may be affected.Several studies have reported an increased prevalence of osteoporosis/osteopenia in patients with CLD.The pathogenesis varies according to etiology and is multifactorial,involving genetic factors,vitamin deficiencies,proinflammatory cytokines,hypo-gonadism,hyperbilirubinemia,antiviral therapy,corticosteroids,and lifestyle fa-ctors.The approach to management should include individualized assessment for fracture risk factors and bone mineral density.Prevention of osteoporosis in CLD relies on the mitigation of risk factors,treatment of underlying hypogonadism,and encouraging a healthy diet and weight-bearing exercise.Treatment trials specific to HO are small,and the primary medical intervention for the treatment of osteoporosis in CLD remains bisphosphonates although the benefit in fracture reduction has not consistently been shown.Further research is necessary to better define the management and specific treatment of HO for the prevention of fragility fractures and to improve the quality of life.This article provides an updated review of HO covering all these aspects.展开更多
In this editorial,author specifically focuses upon metabolic dysfunctionassociated steatotic liver disease(MASLD)and alcohol-associated liver diseases(ALD)in the current era.This editorial article is inspired by the o...In this editorial,author specifically focuses upon metabolic dysfunctionassociated steatotic liver disease(MASLD)and alcohol-associated liver diseases(ALD)in the current era.This editorial article is inspired by the observational study by Harris et al in the recent issue.Alcohol and metabolic dysfunction cause steatotic changes in the hepatic parenchyma.The ALD and MASLD are major cause of chronic liver disease.Liver cirrhosis(LC)is a result of chronic liver inflammation with many causes(e.g.,viral hepatitis,drug,alcohol and metabolic disorder).Metabolic dysfunction-associated steatohepatitis and alcohol-associated hepatitis can lead to liver fibrosis and LC.LC leads to hepatic dysfunction and can progress to eventual liver failure and death.Though chronic viral hepatitis is considered a main cause of LC for a long time,other etiologies(i.e.,ALD,MASLD)has significantly increased in the current era.From the viewpoint of carcinogenesis,LC frequently causes hepatocellular carcinoma(HCC),and HCC is the most common type of primary liver cancer worldwide.As regards major causes of HCC,chronic viral hepatitis is gradually outweighed by ALD and MASLD.Note that patients coexisting with ALD and metabolic dysfunction-associated steatohepatitis show higher occurrence of HCC.Impact of ALD and MASLD upon the development of chronic liver disease,liver fibrosis,LC,and HCC is drastically increased in the current era.Establishments of diagnostic and therapeutic strategies to overcome these hepatic disorders are still required.展开更多
By summarizing the pharmacological effects of pomegranate extract and its active components,such as punicalagin,punicalin,gallic acid,ellagic acid,caffeic acid,and chlorogenic acid,it is found that the extract exhibit...By summarizing the pharmacological effects of pomegranate extract and its active components,such as punicalagin,punicalin,gallic acid,ellagic acid,caffeic acid,and chlorogenic acid,it is found that the extract exhibits therapeutic effects on liver injury,viral hepatitis,metabolic dysfunction-associated fatty liver disease,liver fibrosis,and liver cancer.Emerging evidence suggests that these natural products may alleviate liver diseases through multi-targeted therapeutic mechanisms,including anti-inflammation,anti-oxidative stress,immunoregulation,and anti-steatosis.The underlying mechanisms by which pomegranate exerts hepatoprotective activities may be attributed to the regulation of multiple signaling pathways,including P62/Nrf2,TGF-β1/Smad7,Wnt/β-catenin,MAPK/Nrf2,Nrf2/Keap1,Akt/FOXO3a,MAPK/NF-κB,etc.Consequently,pomegranate can serve as a functional food,nutritional supplement,or adjuvant in the modern treatment of liver diseases.展开更多
Glycogen storage diseases(GSDs)are a group of inherited disorders caused by genetic defects in various enzymes involved in glycogen production or breakdown.Hepatic GSDs often have overlapping clinical features,making ...Glycogen storage diseases(GSDs)are a group of inherited disorders caused by genetic defects in various enzymes involved in glycogen production or breakdown.Hepatic GSDs often have overlapping clinical features,making subtyping or prognostication difficult.With the availability and advancement of next-generation sequencing,definitive molecular diagnosis is now available for most patients,with newer variants being increasingly identified.Molecular diagnosis could help in systematic follow-up,anticipating complications and prognostications.However,the mutations reported in the published literature display wide variations across racial and geographical groups.Hence,natural history,long-term outcome,and genotype-phenotypic correlation studies in patients with various hepatic GSDs are needed for a deeper understanding.Considering the emerging evidence of genetic profiling of patients with hepatic GSDs,including the recent study by Vanduangden et al,this editorial aims to review the various clinical subtypes,the spectrum of genetic mutations,and genotype-phenotype correlations for various hepatic GSDs.展开更多
Hepatic hydatid disease(also known as Hepatic hydatid disease),a prevalent parasitic infection,poses a significant threat to liver function,Biliary fistula,one of its most severe complications,may lead to serious clin...Hepatic hydatid disease(also known as Hepatic hydatid disease),a prevalent parasitic infection,poses a significant threat to liver function,Biliary fistula,one of its most severe complications,may lead to serious clinical outcomes if not promptly identified,Accurate early prediction of biliary fistula is crucial for optimizing treatment strategies and improving patient outcomes,This study aimed to develop a machine learning-based predictive model for biliary fistula in hepatic hydatid disease.By collecting clinical,imaging,and laboratory data,the model identified predictive factors through feature engineering,compared multiple machine learning algorithms,and evaluated the optimal model,The results demonstrated that the constructed model exhibited excellent predictive performance,providing a reliable tool for clinical decision-making and highlighting the potential of machine learning in the diagnosis,treatment,and management of hepatic hydatid disease complications.展开更多
Non-alcoholic fatty liver disease(NAFLD),a critical global health concern,continues to challenge medical researchers with limited treatment options.This letter examines on the study by Luo et al,demonstrating that vit...Non-alcoholic fatty liver disease(NAFLD),a critical global health concern,continues to challenge medical researchers with limited treatment options.This letter examines on the study by Luo et al,demonstrating that vitamin D 1,25-dihydroxyvitamin D3[1,25(OH)2D3]improves hepatic steatosis in NAFLD by inhibiting M1 macrophage polarization via the vitamin D receptor-peroxisome proliferator-activated receptor gamma signaling pathway.This letter critically appraises these findings,comparing them to similar studies,and discusses their potential implications for treating NAFLD.Furthermore,we highlight future directions,including dose optimization and mechanistic studies.展开更多
BACKGROUND Advanced chronic liver disease is a progressive condition associated with high mor-bidity and mortality,leading to complications such as decompensation and hepatocellular carcinoma.Although prognostic score...BACKGROUND Advanced chronic liver disease is a progressive condition associated with high mor-bidity and mortality,leading to complications such as decompensation and hepatocellular carcinoma.Although prognostic scores such as the Child-Pugh score(which combines clinical assessment and laboratory parameters)and laboratory-based models,including Model for End-Stage Liver Disease(MELD)3.0,albumin-bilirubin(ALBI)grade,and fibrosis-4(FIB-4),are often used,their accuracy is limited by subjective assessments and variability in laboratory results.The Functional Liver Imaging Score(FLIS),a semi-quantitative magnetic resonance imaging(MRI)measure of liver function,may also be influenced by observer variability.This emphasizes the need for objective,reproducible tools to improve risk stratification and support treatment decision-making.AIM To evaluate the prognostic value of hepatic enhancement(HE)and signal intensity measured by gadoxetate disodium-enhanced MRI.METHODS In this retrospective cohort study,100 patients with advanced chronic liver disease underwent gadoxetateenhanced MRI.HE and signal intensity were measured quantitatively in liver segments III,VI,VIII,and the caudate lobe,and global values were calculated by averaging segmental measurements.Correlations were assessed with FLIS,Child-Pugh,MELD 3.0,ALBI,FIB-4,liver stiffness(FibroScan),and hepatic venous pressure gradient.Cox regression and receiver operating characteristic analysis were used to evaluate associations with hepatic decompensation,mortality,and hepatocellular carcinoma(HCC)occurrence during follow-up.RESULTS Global HE showed a significant correlation with FLIS(r=0.797),Child-Pugh(r=-0.589),MELD 3.0(r=-0.658),ALBI(r=-0.599),FIB-4(r=-0.308),liver stiffness(r=-0.470),and hepatic venous pressure gradient(r=-0.340).Lower HE was significantly associated with a higher risk of decompensation and mortality in univariate Cox regression.After adjustment for MELD 3.0,etiology,and prior HCC,segment VI HE remained independently predictive of mortality.At 12 months,HE improved risk stratification for mortality and reduced unnecessary interventions by 11 per 100 patients at a 10%threshold in the decision curve analysis.HE had an area under the receiver operating characteristic curve of 0.74 for predicting decompensation and 0.74 for predicting mortality.HE was higher in patients who developed or experienced recurrence of HCC during follow-up,but this was not statistically significant(P=0.1).CONCLUSION Lower HE in segment VI improved prognostic classification of high-risk patients.These patients align with Baveno VII criteria for intensified management,supporting the potential role of HE in risk-adapted surveillance.展开更多
Metabolic dysfunction-associated steatotic liver disease(MASLD),formerly known as nonalcoholic fatty liver disease,is a chronic liver disease characterized by hepatic lipid deposition and hepatocellular steatosis,resu...Metabolic dysfunction-associated steatotic liver disease(MASLD),formerly known as nonalcoholic fatty liver disease,is a chronic liver disease characterized by hepatic lipid deposition and hepatocellular steatosis,resulting from nonalcoholic causes and closely linked to metabolic dysfunction[1].It is strongly associated with metabolic abnormalities,including type 2 diabetes,overweight,and obesity.The global prevalence of MASLD is estimated to be approximately 25%−33%,and its incidence is rising rapidly,particularly among younger populations,due to increasingly prevalent unhealthy lifestyle behaviors such as sleep deprivation,sedentary habits,and diets rich in calories.展开更多
BACKGROUND Cirrhosis is a chronic late stage liver disease associated with hepatitis viruses,alcoholism, and metabolic disorders, such as Wilson disease(WD). There are no clear markers or clinical features that define...BACKGROUND Cirrhosis is a chronic late stage liver disease associated with hepatitis viruses,alcoholism, and metabolic disorders, such as Wilson disease(WD). There are no clear markers or clinical features that define cirrhosis originating from these disparate origins. We hypothesized that cirrhosis is not one disease and cirrhosis of different etiology may have differential clinical hepatic features.AIM To delineate the liver features between WD-associated cirrhosis and hepatitis Bassociated cirrhosis in the Chinese population.METHODS In this observational study, we reviewed the medical data of consecutive inpatients who had WD-associated cirrhosis or hepatitis B-associated cirrhosis from January 2010 to August 2018, and excluded patients who had carcinoma,severe heart or pulmonary diseases, or other liver diseases. According to the etiology of cirrhosis, patients were divided into two groups: WD-associated cirrhosis group(60 patients) and hepatitis B-associated cirrhosis group(56 patients). The liver fibrosis degree, liver function indices, and portal hypertension features of these patients were compared between the two groups.RESULTS No inter-group differences were observed in the diagnostic liver fibrosis markers,however, clinical features clearly defined the origin of cirrhosis. WD-associated cirrhosis patients(16-29 years) had lower levels of alanine transaminase,aspartate transaminase, and bilirubin, lower prothrombin time, lower incidence of hepatic encephalopathy, and lower portal vein diameter(P < 0.05), compared to cirrhosis resulting from hepatitis B in older patients(45-62 years). Importantly,they had decreased risks of progression from Child-Pugh grade A to B(odds ratio = 0.046, 95% confidence interval: 0.006-0.387, P = 0.005) and of ascites(odds ratio = 0.08, 95% confidence interval: 0.01-0.48, P = 0.005). Conversely, WDassociated cirrhosis patients had a higher risk of splenomegaly(odds ratio = 4.15,95% confidence interval: 1.38-12.45, P = 0.011).CONCLUSION WD-associated cirrhosis presents a higher risk of splenomegaly associated with leukopenia and thrombocytopenia, although revealing milder liver dysfunction and portal hypertension symptoms, which recommends WD patients to be monitored for associated complications.展开更多
Wilson disease is an autosomal recessive disorder of copper metabolism that can cause fatal neurological and hepatic disease if not diagnosed and treated. The youngest child with normal liver function reported so far ...Wilson disease is an autosomal recessive disorder of copper metabolism that can cause fatal neurological and hepatic disease if not diagnosed and treated. The youngest child with normal liver function reported so far is an 8-mo-old Japanese boy with low ceruloplasmin levels, and the youngest child with elevated aminotransferase ever reported so far is a 9-mo-old Korean boy with confirmed by genetic testing. Here we report an 8-mo-old Chinese boy presented with elevated liver enzymes, and low serum ceruloplasmin level. Genetic analysis of ATP7 B gene detected two heterozygous disease causing mutations(c.2621C>T/p.A874 V and c.3809A>G/p.N1270S), and parental origins were determined. Persistent elevation of serum aminotransferase in this infant was normalized after zinc therapy. To our best knowledge, this is the youngest patient with elevated liver enzymes ever reported worldwide. We hope that this will raise awareness among pediatricians, leading to earlier diagnosis, timely treatment, and better clinical outcome.展开更多
Hepatitis C virus(HCV)infection has been increasingly associated with cardio-vascular complications,particularly atherosclerosis and cardiomyopathy,in addition to its primary hepatic effects.Studies indicate a higher ...Hepatitis C virus(HCV)infection has been increasingly associated with cardio-vascular complications,particularly atherosclerosis and cardiomyopathy,in addition to its primary hepatic effects.Studies indicate a higher prevalence of carotid atherosclerosis in patients with chronic hepatitis C infection,with viral load and steatosis emerging as independent risk factors.HCV-related athero-sclerosis appears to develop through complex processes involving endothelial dysfunction,inflammation,oxidative stress,and immune dysregulation.Key cytokines,including tumor necrosis factor-alpha and interleukin-6,increase inflammatory responses,while oxidative stress markers,such as malondial-dehyde,are associated with an increased risk of atherogenesis.In addition,HCV infection has been linked to cardiomyopathy.Direct viral effects,including HCV replication within cardiomyocytes and cytotoxicity induced by viral proteins,lead to myocardial injury and functional decline.Indirectly,HCV triggers immune-mediated damage,with heightened pro-inflammatory cytokines exacerbating cardiomyocyte apoptosis and fibrosis.Furthermore,HCV infection promotes a procoagulant imbalance,as evidenced by elevated factor VIII levels and thrombin potential,contributing to the increased cardiovascular risk.While substantial evidence indicates a relationship between HCV and cardiovascular disease,further research is needed to establish causality and guide therapeutic interventions.展开更多
Hepatic osteodystrophy (HO) is the generic term defining the group of alterations in bone mineral metabolism found in patients with chronic liver disease. This paper is a global review of HO and its main pathophysiolo...Hepatic osteodystrophy (HO) is the generic term defining the group of alterations in bone mineral metabolism found in patients with chronic liver disease. This paper is a global review of HO and its main pathophysiological, epidemiological and therapeutic aspects. Studies examining the most relevant information concerning the prevalence, etiological factors, diagnostic and therapeutic aspects involved in HO were identified by a systematic literature search of the PubMed database. HO generically defines overall alterations in bone mineral density (BMD) (osteoporosis or osteopenia) which appear as a possible complication of chronic liver disease. The origin of HO is multifactorial and its etiology and severity vary in accordance with the underlying liver disease. Its exact prevalence is unknown, but different studies estimate that it could affect from 20% to 50% of patients. The reported mean prevalence of osteoporosis ranges from 13%-60% in chronic cholestasis to 20% in chronic viral hepatitis and 55% in viral cirrhosis. Alcoholic liver disease is not always related to osteo-penia. HO has been commonly studied in chronic cholestatic disease (primary biliary cirrhosis and primary sclerosing cholangitis). Several risk factors and pathogenic mechanisms have been associated with the loss of BMD in patients with chronic liver disease. However, little information has been discovered in relationship to most of these mechanisms. Screening for osteopenia and osteoporosis is recommended in advanced chronic liver disease. There is a lack of randomized studies assessing specific management for HO.展开更多
文摘Gynura root has been used extensively in Chinese folk medicine and plays a role in promoting microcirculation and relieving pain.However,its hepatic toxicity should not be neglected.Recently,we admitted a 62-year old female who developed hepatic veno-occlusive disease(HVOD)after ingestion of Gynura root.Only a few articles on HVOD induced by Gynura root have been reported in the literature.It is suspected that pyrrolizidine alkaloids in Gynura root might be responsible for HVOD.In this paper,we report a case of HVOD and review the literature.
基金supported by the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine(Grant No. 2017-XK-A36)the Foundation of Key Research Project of Zhejiang Province for Traditional Chinese Medicine (Grant No. 2019ZZ014)。
文摘Objective: Hepatic veno-occlusive disease(HVOD) has attracted increasing attention in recent years due to its relationship with ingestion of Gynura segetum. The mortality of severe HVOD remains high due to the lack of specific therapies. The aim of the study was to delineate the clinical characteristics and outcomes and explore the potential prognostic factors of HVOD.Methods: This was a single-center retrospective study. Eighty-nine HVOD patients were screened from the First Affiliated Hospital of Zhejiang University with an ingestion history of G. segetum before developing symptoms from January 2009 to May 2018. The enrolled patients were divided into the survivor and death groups according to the clinical follow-up that ended on September 1, 2019. The demographic variables and clinical data of the patients were recorded. A binary logistic regression analysis and receiver operating characteristic curve were conducted to identify the prognostic factors and assess the prognostic value for predicting death, and a survival analysis was performed to evaluate the clinical outcomes.Results: Sixty-four patients were eligible for further analysis. Most patients showed abdominal distension and were positive for migrating dullness in the abdomen(P = 0.740 and P = 0.732, respectively). The patients who died had higher levels of model for end-stage liver disease score, and higher prothrombin time than those who survived(both P < 0.001). All HVOD patients in both the survival and death groups showed ascites with abnormal imaging presentations of the liver parenchyma and hepatic blood vessels.Unexpectedly, we found that hydrothorax was detected in 21(65.63%) patients in the death group and 19(59.38%) patients in the survivor group during hospitalization, which was rarely mentioned in previous studies. Furthermore, international normalized ratio(INR) and creatinine are found to be potential independent prognostic factors for predicting death. Six severe patients achieved clinical improvements and survived after liver transplantation.Conclusion: HVOD can be induced by the ingestion of G. segetum, and INR combined with creatinine has prognostic value for predicting death. Liver transplantation may be an effective treatment option for severe HVOD patients.
文摘Hepatic veno-occlusive disease (HVOD) is rarely encountered and easily misjudged as Budd-Chiari syndrome. It is often related to stem cell transplantation in recent years. We report a case of HVOD that is related to ingestion of some palatable local dishes. The diagnosis was confirmed by liver biopsy pathology with specific observation of inflammatory changes and fibrosis of venules intima, dilated sinusoids and central veins. Chronic diarrhea is unique for this case as a result of ingesting harmful stuffs. This case demonstrated that supervision and instruction of food recipe and traditional medicine are crucial, and prompt diagnosis, supportive care and specific treatment are essential to decreasing the morbidity and mortality of HVOD.
文摘BACKGROUND:Hepatic veno-occlusive disease(VOD)or sinusoidal obstruction syndrome is associated with a high mortality because of its severity.Gymura segetum,a Chinese herbal medicine,is always used to cure injury and bleeding in rural areas in China.This study was undertaken to better understand VOD and its relations to the effect of Gymura segetum.METHODS:Between 2000 and 2002,two patients were admitted to our department because of VOD.Before admission,both of them had been injured and taken oral decoction of patent drug Gymura segetum.We analyzed the clinical manifestations,diagnosis and therapy of the two patients.RESULTS:Pyrrolizidine in Panax notginseng was proved to induce VOD.The diagnosis of VOD depended on hepatic biopsy.CONCLUSION:Gymura segetum can induce VOD.More attention should be paid to its unsuscepted side effects.
文摘Nowadays hepatic veno-occlusive disease is mainly caused by Sedum aizoon in China,and its prognosis dependents on the dosage and courses of the Sedum aizoon treatment but lacks other objective indicators.There are a lot relationships between CA125 level and liver cirrhosis,this case had a obvious increased CA125 level in the serum,hydrothorax and ascites,following by the liver cirrhosis in a short time,and then died of upper gastrointestinal bleeding.By now we guess that CA125 level could forecast the liver cirrhosis following by hepatic veno-occlusive,which will become the prognosis of the hepatic veno-occlusive.
文摘BACKGROUND:Hepatic veno-occlusive disease(HVOD)is a severe complication of chemotherapy before hematopoietic stem cell transplantation and dietary ingestion of pyrrolizidine alkaloids.Many experimental models were established to study its mechanisms or therapy,but few are ideal.This work aimed at evaluating a rat model of HVOD induced by monocrotaline to help advance research into this disease. METHODS:Thirty-two male rats were randomly classified into 5 groups,and PBS or monocrotaline was administered (100 mg/kg or 160 mg/kg).They were sacrificed on day 7(groups A,B and D)or day 10(groups C and E).Blood samples were collected to determine liver enzyme concentrations.The weight of the liver and body and the amount of ascites were measured.Histopathological changes of liver tissue on light microscopy were assessed by a modified Deleve scoring system.The positivity of proliferating cell nuclear antigen(PCNA)was estimated. RESULTS:The rats that were treated with 160 mg/kg monocrotaline presented with severe clinical symptoms (including two deaths)and the histopathological picture of HVOD.On the other hand,the rats that were fed with 100 mg/kg monocrotaline had milder and reversible manifestations.Comparison of the rats sacrificed on day 10 with those sacrificed on day 7 showed that the positivity of PCNA increased,especially that of hepatocytes.CONCLUSIONS:Monocrotaline induces acute,dose- dependent HVOD in rats.The model is potentially reversible with a low dose,but reliable and irreversible with a higher dose.The modified scoring system seems to be more accurate than the traditional one in reflecting the histopathology of HVOD.The enhancement of PCNA positivity may be associated with hepatic tissue undergoing recovery.
文摘Hepatic veno-occlusive disease(VOD), also known as sinusoidal obstruction syndrome, is a major complication of hematopoietic stem cell transplantation and it carries a high mortality. Prophylaxis for hepatic VOD is commonly given to transplant recipients from the start of conditioning through the early weeks of transplant. However, high quality evidence from randomized controlled trials is scarce with small sample sizes and the trials yielded conflicting results. Although various treatment options for hepatic VOD are available, most have not undergone stringent evaluation with randomized controlled trial and therefore it remains uncertain which treatment offers real benefit. It remains controversial whether VOD prophylaxis should be given, which prophylactic therapy should be given, who should receive prophylaxis, and what treatment should be offered once VOD is established.
基金Supported by the National Natural Science Foundation of China,No.82202185and Shanghai Science and Technology Development Foundation,No.22Y11911500.
文摘BACKGROUND Hepatic steatosis,characterized by fat accumulation in hepatocytes,can result from metabolic dysfunction-associated steatotic liver disease(MASLD),infections,alcoholism,chemotherapy,and toxins.MASLD is diagnosed via imaging or biopsy with metabolic criteria and may progress to metabolic dysfunction–asso-ciated steatohepatitis,potentially leading to fibrosis,cirrhosis,or cancer.The coexistence of hepatic steatosis with chronic hepatitis B(CHB)is mainly related to metabolic factors and increases mortality and cancer risks.As a noninvasive method,attenuation imaging(ATI)shows promise in quantifying liver fat,demonstrating strong correlation with liver biopsy.AIM To investigate the disparity of ATI for assessing biopsy-based hepatic steatosis in CHB patients and MASLD patients.METHODS The study enrolled 249 patients who underwent both ATI and liver biopsy,including 78 with CHB and 171 with MASLD.Hepatic steatosis was classified into grades S0 to S3 according to the proportion of fat cells present.Liver fibrosis was staged from 0 to 4 according to the meta-analysis of histological data in viral hepatitis scoring system.The diagnostic performance of attenuation coefficient(AC)values across different groups was compared for each grade of steatosis.Factors associated with the AC values were determined through linear regression analysis.A multivariate logistic regression model was established to predict≥S2 within the MASLD group.RESULTS In both the CHB and the MASLD groups,AC values increased significantly with higher steatosis grade(P<0.001).In the CHB group,the areas under the curve(AUCs)of AC for predicting steatosis grades≥S1,≥S2 and S3 were 0.918,0.960 and 0.987,respectively.In contrast,the MASLD group showed AUCs of 0.836,0.774,and 0.688 for the same steatosis grades.The diagnostic performance of AC for detecting≥S2 and S3 indicated significant differences between the two groups(both P<0.001).Multivariate linear regression analysis identified body mass index,trigly-cerides,and steatosis grade as significant factors for AC.When the steatosis grade is≥S2,it can progress to more serious liver conditions.A clinical model integrating blood biochemical parameters and AC was developed in the MASLD group to enhance the prediction of≥S2,achieving an AUC of 0.848.CONCLUSION The AC could effectively discriminate the degree of steatosis in both the CHB and MASLD groups.In the MASLD group,when combined with blood biochemical parameters,AC exhibited better predictive ability for moderate to severe steatosis.
文摘Hepatic osteodystrophy(HO)is a common and frequently untreated complica-tion,manifested as osteoporosis or osteopenia,encountered in the evolution of chronic liver diseases(CLD).In addition to patients with chronic cholestasis and cirrhosis,patients with CLD from other etiologies may be affected.Several studies have reported an increased prevalence of osteoporosis/osteopenia in patients with CLD.The pathogenesis varies according to etiology and is multifactorial,involving genetic factors,vitamin deficiencies,proinflammatory cytokines,hypo-gonadism,hyperbilirubinemia,antiviral therapy,corticosteroids,and lifestyle fa-ctors.The approach to management should include individualized assessment for fracture risk factors and bone mineral density.Prevention of osteoporosis in CLD relies on the mitigation of risk factors,treatment of underlying hypogonadism,and encouraging a healthy diet and weight-bearing exercise.Treatment trials specific to HO are small,and the primary medical intervention for the treatment of osteoporosis in CLD remains bisphosphonates although the benefit in fracture reduction has not consistently been shown.Further research is necessary to better define the management and specific treatment of HO for the prevention of fragility fractures and to improve the quality of life.This article provides an updated review of HO covering all these aspects.
文摘In this editorial,author specifically focuses upon metabolic dysfunctionassociated steatotic liver disease(MASLD)and alcohol-associated liver diseases(ALD)in the current era.This editorial article is inspired by the observational study by Harris et al in the recent issue.Alcohol and metabolic dysfunction cause steatotic changes in the hepatic parenchyma.The ALD and MASLD are major cause of chronic liver disease.Liver cirrhosis(LC)is a result of chronic liver inflammation with many causes(e.g.,viral hepatitis,drug,alcohol and metabolic disorder).Metabolic dysfunction-associated steatohepatitis and alcohol-associated hepatitis can lead to liver fibrosis and LC.LC leads to hepatic dysfunction and can progress to eventual liver failure and death.Though chronic viral hepatitis is considered a main cause of LC for a long time,other etiologies(i.e.,ALD,MASLD)has significantly increased in the current era.From the viewpoint of carcinogenesis,LC frequently causes hepatocellular carcinoma(HCC),and HCC is the most common type of primary liver cancer worldwide.As regards major causes of HCC,chronic viral hepatitis is gradually outweighed by ALD and MASLD.Note that patients coexisting with ALD and metabolic dysfunction-associated steatohepatitis show higher occurrence of HCC.Impact of ALD and MASLD upon the development of chronic liver disease,liver fibrosis,LC,and HCC is drastically increased in the current era.Establishments of diagnostic and therapeutic strategies to overcome these hepatic disorders are still required.
基金Supported by the National Natural Science Foundation of China(81573563)Scientific and Technological Innovation Team for Qinghai-Tibetan Plateau Research in Southwest Minzu University(2024CXTD16)the Sichuan Provincial Administration of Traditional Chinese Medicine Innovation Team Project(2023ZD05).
文摘By summarizing the pharmacological effects of pomegranate extract and its active components,such as punicalagin,punicalin,gallic acid,ellagic acid,caffeic acid,and chlorogenic acid,it is found that the extract exhibits therapeutic effects on liver injury,viral hepatitis,metabolic dysfunction-associated fatty liver disease,liver fibrosis,and liver cancer.Emerging evidence suggests that these natural products may alleviate liver diseases through multi-targeted therapeutic mechanisms,including anti-inflammation,anti-oxidative stress,immunoregulation,and anti-steatosis.The underlying mechanisms by which pomegranate exerts hepatoprotective activities may be attributed to the regulation of multiple signaling pathways,including P62/Nrf2,TGF-β1/Smad7,Wnt/β-catenin,MAPK/Nrf2,Nrf2/Keap1,Akt/FOXO3a,MAPK/NF-κB,etc.Consequently,pomegranate can serve as a functional food,nutritional supplement,or adjuvant in the modern treatment of liver diseases.
文摘Glycogen storage diseases(GSDs)are a group of inherited disorders caused by genetic defects in various enzymes involved in glycogen production or breakdown.Hepatic GSDs often have overlapping clinical features,making subtyping or prognostication difficult.With the availability and advancement of next-generation sequencing,definitive molecular diagnosis is now available for most patients,with newer variants being increasingly identified.Molecular diagnosis could help in systematic follow-up,anticipating complications and prognostications.However,the mutations reported in the published literature display wide variations across racial and geographical groups.Hence,natural history,long-term outcome,and genotype-phenotypic correlation studies in patients with various hepatic GSDs are needed for a deeper understanding.Considering the emerging evidence of genetic profiling of patients with hepatic GSDs,including the recent study by Vanduangden et al,this editorial aims to review the various clinical subtypes,the spectrum of genetic mutations,and genotype-phenotype correlations for various hepatic GSDs.
文摘Hepatic hydatid disease(also known as Hepatic hydatid disease),a prevalent parasitic infection,poses a significant threat to liver function,Biliary fistula,one of its most severe complications,may lead to serious clinical outcomes if not promptly identified,Accurate early prediction of biliary fistula is crucial for optimizing treatment strategies and improving patient outcomes,This study aimed to develop a machine learning-based predictive model for biliary fistula in hepatic hydatid disease.By collecting clinical,imaging,and laboratory data,the model identified predictive factors through feature engineering,compared multiple machine learning algorithms,and evaluated the optimal model,The results demonstrated that the constructed model exhibited excellent predictive performance,providing a reliable tool for clinical decision-making and highlighting the potential of machine learning in the diagnosis,treatment,and management of hepatic hydatid disease complications.
基金National Natural Science Foundation of China,No.82170406 and No.81970238.
文摘Non-alcoholic fatty liver disease(NAFLD),a critical global health concern,continues to challenge medical researchers with limited treatment options.This letter examines on the study by Luo et al,demonstrating that vitamin D 1,25-dihydroxyvitamin D3[1,25(OH)2D3]improves hepatic steatosis in NAFLD by inhibiting M1 macrophage polarization via the vitamin D receptor-peroxisome proliferator-activated receptor gamma signaling pathway.This letter critically appraises these findings,comparing them to similar studies,and discusses their potential implications for treating NAFLD.Furthermore,we highlight future directions,including dose optimization and mechanistic studies.
文摘BACKGROUND Advanced chronic liver disease is a progressive condition associated with high mor-bidity and mortality,leading to complications such as decompensation and hepatocellular carcinoma.Although prognostic scores such as the Child-Pugh score(which combines clinical assessment and laboratory parameters)and laboratory-based models,including Model for End-Stage Liver Disease(MELD)3.0,albumin-bilirubin(ALBI)grade,and fibrosis-4(FIB-4),are often used,their accuracy is limited by subjective assessments and variability in laboratory results.The Functional Liver Imaging Score(FLIS),a semi-quantitative magnetic resonance imaging(MRI)measure of liver function,may also be influenced by observer variability.This emphasizes the need for objective,reproducible tools to improve risk stratification and support treatment decision-making.AIM To evaluate the prognostic value of hepatic enhancement(HE)and signal intensity measured by gadoxetate disodium-enhanced MRI.METHODS In this retrospective cohort study,100 patients with advanced chronic liver disease underwent gadoxetateenhanced MRI.HE and signal intensity were measured quantitatively in liver segments III,VI,VIII,and the caudate lobe,and global values were calculated by averaging segmental measurements.Correlations were assessed with FLIS,Child-Pugh,MELD 3.0,ALBI,FIB-4,liver stiffness(FibroScan),and hepatic venous pressure gradient.Cox regression and receiver operating characteristic analysis were used to evaluate associations with hepatic decompensation,mortality,and hepatocellular carcinoma(HCC)occurrence during follow-up.RESULTS Global HE showed a significant correlation with FLIS(r=0.797),Child-Pugh(r=-0.589),MELD 3.0(r=-0.658),ALBI(r=-0.599),FIB-4(r=-0.308),liver stiffness(r=-0.470),and hepatic venous pressure gradient(r=-0.340).Lower HE was significantly associated with a higher risk of decompensation and mortality in univariate Cox regression.After adjustment for MELD 3.0,etiology,and prior HCC,segment VI HE remained independently predictive of mortality.At 12 months,HE improved risk stratification for mortality and reduced unnecessary interventions by 11 per 100 patients at a 10%threshold in the decision curve analysis.HE had an area under the receiver operating characteristic curve of 0.74 for predicting decompensation and 0.74 for predicting mortality.HE was higher in patients who developed or experienced recurrence of HCC during follow-up,but this was not statistically significant(P=0.1).CONCLUSION Lower HE in segment VI improved prognostic classification of high-risk patients.These patients align with Baveno VII criteria for intensified management,supporting the potential role of HE in risk-adapted surveillance.
文摘Metabolic dysfunction-associated steatotic liver disease(MASLD),formerly known as nonalcoholic fatty liver disease,is a chronic liver disease characterized by hepatic lipid deposition and hepatocellular steatosis,resulting from nonalcoholic causes and closely linked to metabolic dysfunction[1].It is strongly associated with metabolic abnormalities,including type 2 diabetes,overweight,and obesity.The global prevalence of MASLD is estimated to be approximately 25%−33%,and its incidence is rising rapidly,particularly among younger populations,due to increasingly prevalent unhealthy lifestyle behaviors such as sleep deprivation,sedentary habits,and diets rich in calories.
基金Supported by the Science and Technology Planning Project of Guangdong Province,No.2015A030302085 and No.2016A020212022
文摘BACKGROUND Cirrhosis is a chronic late stage liver disease associated with hepatitis viruses,alcoholism, and metabolic disorders, such as Wilson disease(WD). There are no clear markers or clinical features that define cirrhosis originating from these disparate origins. We hypothesized that cirrhosis is not one disease and cirrhosis of different etiology may have differential clinical hepatic features.AIM To delineate the liver features between WD-associated cirrhosis and hepatitis Bassociated cirrhosis in the Chinese population.METHODS In this observational study, we reviewed the medical data of consecutive inpatients who had WD-associated cirrhosis or hepatitis B-associated cirrhosis from January 2010 to August 2018, and excluded patients who had carcinoma,severe heart or pulmonary diseases, or other liver diseases. According to the etiology of cirrhosis, patients were divided into two groups: WD-associated cirrhosis group(60 patients) and hepatitis B-associated cirrhosis group(56 patients). The liver fibrosis degree, liver function indices, and portal hypertension features of these patients were compared between the two groups.RESULTS No inter-group differences were observed in the diagnostic liver fibrosis markers,however, clinical features clearly defined the origin of cirrhosis. WD-associated cirrhosis patients(16-29 years) had lower levels of alanine transaminase,aspartate transaminase, and bilirubin, lower prothrombin time, lower incidence of hepatic encephalopathy, and lower portal vein diameter(P < 0.05), compared to cirrhosis resulting from hepatitis B in older patients(45-62 years). Importantly,they had decreased risks of progression from Child-Pugh grade A to B(odds ratio = 0.046, 95% confidence interval: 0.006-0.387, P = 0.005) and of ascites(odds ratio = 0.08, 95% confidence interval: 0.01-0.48, P = 0.005). Conversely, WDassociated cirrhosis patients had a higher risk of splenomegaly(odds ratio = 4.15,95% confidence interval: 1.38-12.45, P = 0.011).CONCLUSION WD-associated cirrhosis presents a higher risk of splenomegaly associated with leukopenia and thrombocytopenia, although revealing milder liver dysfunction and portal hypertension symptoms, which recommends WD patients to be monitored for associated complications.
基金Supported by National Natural Science Foundation of China,No.81070281
文摘Wilson disease is an autosomal recessive disorder of copper metabolism that can cause fatal neurological and hepatic disease if not diagnosed and treated. The youngest child with normal liver function reported so far is an 8-mo-old Japanese boy with low ceruloplasmin levels, and the youngest child with elevated aminotransferase ever reported so far is a 9-mo-old Korean boy with confirmed by genetic testing. Here we report an 8-mo-old Chinese boy presented with elevated liver enzymes, and low serum ceruloplasmin level. Genetic analysis of ATP7 B gene detected two heterozygous disease causing mutations(c.2621C>T/p.A874 V and c.3809A>G/p.N1270S), and parental origins were determined. Persistent elevation of serum aminotransferase in this infant was normalized after zinc therapy. To our best knowledge, this is the youngest patient with elevated liver enzymes ever reported worldwide. We hope that this will raise awareness among pediatricians, leading to earlier diagnosis, timely treatment, and better clinical outcome.
文摘Hepatitis C virus(HCV)infection has been increasingly associated with cardio-vascular complications,particularly atherosclerosis and cardiomyopathy,in addition to its primary hepatic effects.Studies indicate a higher prevalence of carotid atherosclerosis in patients with chronic hepatitis C infection,with viral load and steatosis emerging as independent risk factors.HCV-related athero-sclerosis appears to develop through complex processes involving endothelial dysfunction,inflammation,oxidative stress,and immune dysregulation.Key cytokines,including tumor necrosis factor-alpha and interleukin-6,increase inflammatory responses,while oxidative stress markers,such as malondial-dehyde,are associated with an increased risk of atherogenesis.In addition,HCV infection has been linked to cardiomyopathy.Direct viral effects,including HCV replication within cardiomyocytes and cytotoxicity induced by viral proteins,lead to myocardial injury and functional decline.Indirectly,HCV triggers immune-mediated damage,with heightened pro-inflammatory cytokines exacerbating cardiomyocyte apoptosis and fibrosis.Furthermore,HCV infection promotes a procoagulant imbalance,as evidenced by elevated factor VIII levels and thrombin potential,contributing to the increased cardiovascular risk.While substantial evidence indicates a relationship between HCV and cardiovascular disease,further research is needed to establish causality and guide therapeutic interventions.
文摘Hepatic osteodystrophy (HO) is the generic term defining the group of alterations in bone mineral metabolism found in patients with chronic liver disease. This paper is a global review of HO and its main pathophysiological, epidemiological and therapeutic aspects. Studies examining the most relevant information concerning the prevalence, etiological factors, diagnostic and therapeutic aspects involved in HO were identified by a systematic literature search of the PubMed database. HO generically defines overall alterations in bone mineral density (BMD) (osteoporosis or osteopenia) which appear as a possible complication of chronic liver disease. The origin of HO is multifactorial and its etiology and severity vary in accordance with the underlying liver disease. Its exact prevalence is unknown, but different studies estimate that it could affect from 20% to 50% of patients. The reported mean prevalence of osteoporosis ranges from 13%-60% in chronic cholestasis to 20% in chronic viral hepatitis and 55% in viral cirrhosis. Alcoholic liver disease is not always related to osteo-penia. HO has been commonly studied in chronic cholestatic disease (primary biliary cirrhosis and primary sclerosing cholangitis). Several risk factors and pathogenic mechanisms have been associated with the loss of BMD in patients with chronic liver disease. However, little information has been discovered in relationship to most of these mechanisms. Screening for osteopenia and osteoporosis is recommended in advanced chronic liver disease. There is a lack of randomized studies assessing specific management for HO.
