糖皮质激素在胆汁淤积型药物性肝病中的作用

糖皮质激素在药物性肝病(DILD)治疗中的作用一直存在争论，临床实践中激素的使用也非常混乱。本试验采用回顾性方法，分析、评估了激素在胆汁淤积型药物性肝病中的作用，总结了我院治疗此类疾病的一些经验，供临床医师借鉴。     

腺苷蛋氨酸联合糖皮质激素治疗药物性胆汁淤积性肝病疗效

目的观察腺苷蛋氨酸联合糖皮质激素治疗药物性胆汁淤积性肝病的疗效。方法将67例药物性胆汁淤积性肝病随机分为治疗组和对照组,均予综合保肝治疗,治疗组加用腺苷蛋氨酸和糖皮质激素治疗。结果 治疗组与对照组总有效率比较无显著性差异（P〉0.05）,但显效率与对照组比较有显著性差异（P〈0.01）。治疗组治疗后TBIL、γ-GT、ALP、TBA均低于对照组（P〈0.05或P〈0.01）。结论早期联合应用腺苷蛋氨酸、糖皮质激素,可快速、安全、有效地治疗药物性胆汁淤积性肝病。     

双环醇对脂肪性肝病保护作用的研究进展

脂肪性肝病是多种原因引起的病变主体在肝小叶、以肝细胞脂肪变性和脂肪蓄积过多为主的临床病理综合征。临床上分为酒精性肝病（ALD）和非酒精性脂肪性肝病（NAFLD）两大类。双环醇是抗肝炎新药,具有抗氧化和抗炎的特性。本文就双环醇在脂肪性肝病的基础研究与临床应用的进展加以综述。     

中草药致肝病加重70例临床处理分析

近年来，因其他疾病服用中草药导致药物性肝病的报道逐渐增多，但因原有急、慢性肝病应用中草药治疗致原肝病加重的报道并不多见。本研究通过对我科近10年来收住的应用中草药后使原肝病加重的70例患者的临床处理作回顾性分析，旨在引起中西医肝病界的高度关注。     

中医临床肝病大数据知识工程研究

为高效利用中医临床肝病海量的数据资源，秉持守正创新的精神，在中医基础理论指导下，遵循中医临床肝病发生、发展及演变规律，应用大数据知识工程理论和方法，进行真实世界中医临床肝病研究，设计了中医临床肝病大数据知识工程的标准操作流程，并对其5个主要环节做了说明，用以指导和推进该工程研究，服务于中医临床肝病现代化发展需求，提高中医临床肝病大数据治理能力现代化。     

肝功能评估模型的演变

肝病是威胁人类健康最危险的疾病之一,真实、客观地判断终末期肝病病情能为临床医生选择个体化治疗方案提供有力的依据.从CTP到目前的MELD及新近出现的Lille Model,都对肝病的严重程度进行了划分.此文就各种肝功能模型的产生、特点、临床应用及目前存在的问题作一综述.     

脂肪性肝病动物模型研究进展

脂肪性肝病是较为常见的慢性肝病,早期可仅表现为肝脂肪变性,随病情进展可渐次发展为炎性反应、肝纤维化甚至肝硬化、肝细胞癌。根据患者是否有过量饮酒史,脂肪性肝病可分为酒精性脂肪性肝病(AFLD)和非酒精性脂肪性肝病(NAFLD)。构建脂肪性肝病动物模型对于研究脂肪性肝病的发病机制及诊治方法至关重要。近年来脂肪性肝病的研究蓬勃发展,现有动物模型均能部分模拟脂肪性肝病的发病,但不能完全复制其临床特点及病理生理学变化。该文对目前脂肪性肝病动物模型构建方案作一综述,为脂肪性肝病研究提供参考。     

糖尿病性肝病诊治进展

糖尿病性肝病是指由糖尿病所致的肝脏疾病,主要包括非酒精性脂肪性肝病和糖源性肝病两种。在糖尿病患者中糖尿病性肝病患病率高,危害大。目前,对于该病的认识相对匮乏。本文重点介绍糖尿病性肝病的临床和病理学特点、发病机制和治疗进展。     

磁共振弹性成像技术在慢性肝病的临床应用研究进展

磁共振弹性成像(MRE)是一种利用机械波定量测定组织弹性的新型无创性成像技术,近年来在肝纤维化、门静脉压力以及慢性肝病患者预后的预测等临床应用上取得了一定进展,本文就MRE近年在慢性肝病的临床应用研究进展进行综述。     

回顾性分析临床药物性肝病109例

目的:分析总结近年来药物性肝病的情况,提高本病的诊断治疗水平.方法:回顾调查1999-2004年各种药物致药物性肝病109例,分析统计每年药物性肝病发病例数的变迁及临床情况.结果:抗生素、非甾体抗炎药、治疗甲亢药、中草药、抗结核药是主要的损肝药物.急性药物性肝损伤是逐年增加的,肝损伤发生时间因所用药物不同而差异很大,无临床症状者占22.94%,有症状者占77.06%.慢性药物性肝病7例,急性药物性肝损伤102例(肝细胞损伤型67例,胆汁淤积型23例,混合型12例);治愈17例,好转81例,未愈10例,死亡1例.结论:药物性肝病多数表现为急性药物性肝损伤,少数为慢性肝损伤,取决于药物的种类、剂量和给药途径.药物性肝病的早期诊断与重视程度和认识有关,加强规范合理用药及用药监测可以预防本病.     

Characterization of patients with both alcoholic and nonalcoholic fatty liver disease in a large United States cohort

BACKGROUND Nonalcoholic fatty liver disease(NAFLD) is the hepatic manifestation of the metabolic syndrome(Met S) and is characterized by steatosis in the absence of significant alcohol consumption. However, Met S and significant alcohol intake coexist in certain individuals which may lead to the development of BAFLD.AIM To assess the clinical characteristics of patients with both alcoholic and NAFLD(BAFLD) in a large cohort in the United States.METHODS Adults from the National Health and Nutrition Examination Survey between2003-2014 were included. NAFLD was diagnosed based on elevated alanine aminotransferase(ALT) and being overweight or obese in the absence of other liver diseases. BAFLD patients met the criteria for NAFLD but also had either Met S or type 2 diabetes and consumed excessive amounts of alcohol. Univariable and multivariable analysis were performed to assess differences between NAFLD and BAFLD and to compare severity based on a validated fibrosis score(FIB4 index).RESULTS The prevalence of NAFLD was at 25.9%(95%CI; 25.1-26.8) and that of BAFLD was 0.84%(0.67, 1.02) which corresponds to an estimated 1.24 million Americans affected by BAFLD. Compared to NAFLD, patients with BAFLD were more likely to be male, smokers, have higher ALT, aspartate aminotransferase,triglycerides, and lower platelets; P 0.01 for all. More importantly, after adjusting for Met S components, BAFLD patients were significantly more likely to have advanced fibrosis [adjusted OR(95%CI) based on FIB4 index 2.67 was 3.2(1.4, 7.0), P = 0.004].CONCLUSION A significant percentage of the American general population is afflicted by BAFLD and these patients tend to have more advanced liver fibrosis.     

Variation in Hepatic Estrogen Receptor Concentrations in Patients with Liver Disease a Multivariate Analysis

Hepatic estrogen receptor concentrations were measured in liver biopsy specimens from 102 patients (58 women and 44 men) with liver disease and correlated to several clinical, biochemical, and histologic background variables by means of multiple regression analysis. Half of the tissue was processed for histologic evaluation with a semiquantitative registration of histologic characteristics, whereas the other part was used for receptor analysis by enzyme immunoassay. Fifteen patients with no or minimal histologic changes served as controls. The analysis shows that the reduced estrogen receptor concentrations observed in patients with chronic liver diseases reflect the degree of liver dysfunction and not the specific type of liver disease. Serum albumin, log serum bilirubin, log serum alkaline phosphatases, and the degree of parenchymal fibrosis were significantly related to hepatic estrogen receptor level in the final regression model, but only part of the variation can be explained by these variables, and other factors must be of importance.     

Cardiovascular risk assessment of the liver transplant candidate

Liver transplantation (LT) candidates today are increasingly older, have greater medical acuity, and have more cardiovascular comorbidities than ever before. Steadily rising model for end-stage liver disease (MELD) scores at the time of transplant, resulting from high organ demand, reflect the escalating risk profiles of LT candidates. In addition to advanced age and the presence of comorbidities, there are specific cardiovascular responses in cirrhosis that can be detrimental to the LT candidate. Patients with cirrhosis requiring LT usually demonstrate increased cardiac output and a compromised ventricular response to stress, a condition termed cirrhotic cardiomyopathy. These cardiac disturbances are likely mediated by decreased beta-agonist transduction, increased circulating inflammatory mediators with cardiodepressant properties, and repolarization changes. Low systemic vascular resistance and bradycardia are also commonly seen in cirrhosis and can be aggravated by beta-blocker use. These physiologic changes all contribute to the potential for cardiovascular complications, particularly with the altered hemodynamic stresses that LT patients face in the immediate post-operative period. Post-transplant reperfusion may result in cardiac death due to a multitude of causes, including arrhythmia, acute heart failure, and myocardial infarction. Recognizing the hemodynamic challenges encountered by LT patients in the perioperative period and how these responses can be exacerbated by underlying cardiac pathology is critical in developing recommendations for the pre-operative risk assessment and management of these patients. The following provides a review of the cardiovascular challenges in LT candidates, as well as evidence-based recommendations for their evaluation and management.     

Effect of Silymarin on Chemical,Functional, and Morphological Alterations of the Liver

One hundred and six consecutive patients with liver disease were selected on the basis of elevated serum transaminase levels. The patients were randomly allocated into a group treated with Silymarin (treated) and a group receiving placebo (controls). Ninety-seven patients completed the 4-week trial—47 treated and 50 controls. In general, the series represented a relatively slight acute and subacute liver disease, mostly induced by alcohol abuse. There was a statistically highly significantly greater decrease of S-SGPT (S-ALAT) and S-SGOT (S-ASAT) in the treated group than in controls. Serum total and conjugated bilirubin decreased more in the treated than in controls, but the differences were not statistically significant. BSP retention returned to normal significantly more often in the treated group. The mean percentage decrease of BSP was also markedly higher in the treated. Normalization of histological changes occurred significantly more often in the treated than in controls.     

Liver transplantation: the Italian experience

BACKGROUND: Liver transplantation is the standard treatment for patients with end-stage liver disease no longer responsive to conventional medical treatment AIMS: To report the long-term experience of liver transplantation in Italy. PATIENTS AND METHODS: Data were obtained retrospectively by means of a multiple-item form collected from 15 Italian liver transplant centres. The filing centre was centralized. RESULTS: A total of 3323 liver transplants were performed on 3026 patients, with a cumulative proportional survival of 72.4%. Three, 5 and 10 years' patient survival rates were 72.3%, 68.8% and 61.3%, respectively. The most common indication for liver transplantation were hepatitis B virus (+/- hepatitis D virus)- and hepatitis C virus-related cirrhosis (59.4%). Excellent survival rates were observed particularly in controversial indications, such as alcoholic cirrhosis, hepatitis B virus-related cirrhosis and hepatocellular carcinoma. Retransplantation was required in 8.9% of the cases. The overall prevalence of acute cellular rejection episodes was 43.5%. In our study population, primary non-function and disease recurrence were the most common causes of graft failure (28.7% and 25.4%, respectively). Infections and/or sepsis were the most common causes of death after transplantation (42%). CONCLUSION: This study confirms that patients with controversial indications to liver transplantation such as alcoholic cirrhosis, HBV-related cirrhosis and hepatocellular carcinoma can achieve excellent survival when properly selected.     

Transition of an acronym from nonalcoholic fatty liver disease to metabolic dysfunction-associated fatty liver disease

Nonalcoholic fatty liver disease(NAFLD) is a global public health concern owing to its substantial contribution to chronic liver diseases. The disease is closely linked to metabolic syndrome(MS), suggesting a common biological pathway and shared disease mechanism for both ailments. Previous studies revealed a close relationship of NAFLD with the components of MS including abdominal obesity,dyslipidemia, hypertension, and hyperglycemia. Hence, a group of experts recently renamed NAFLD as metabolic dysfunction-associated fatty liver disease(MAFLD) in order to encompass a more appropriate pathogenesis of the disease.NAFLD was first named to describe a condition similar to alcoholic hepatitis in absence of significant alcohol consumption. However, knowledge pertaining to the etiopathogenesis of the disease has evolved over the past four decades. Recent evidence endorses NAFLD as a terminology of exclusion and suggests that it may often leads to misdiagnosis or inappropriate management of patients, particularly in clinical practice. On the other hand, the new definition is useful in addressing hepatic steatosis with metabolic dysfunction, which ultimately covers most of the patients with such illness. Therefore, it seems to be helpful in improving clinical diagnosis and managing high-risk patients with fatty liver disease. However, it is imperative to validate the new terminology at the population level to ensure a holistic approach to reduce the global burden of this heterogeneous disease condition.