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World Journal of Gastroenterology 2013年第39期19卷 6515-6522页

作者： Grace Lai-Hung wong vincent wai-sun wong Institute of Digestive Disease and Department of Medicine and Therapeutics The Chinese University of Hong Kong

Chronic hepatitis B(CHB)-related hepatocellular carcinoma(HCC)is a major health problem in AsianPacific *** therapy reduces,but does not eliminate the risk of *** would be a heavy financial burden in most low and middle economic countries if all CHB patients received antiviral therapy and HCC ***,there is a need for accurate risk prediction to assist prognostication,decisions on the need for antiviral therapy and HCC surveillance.A few wellestablished risk factors for HCC,namely advanced age,male gender,high viral load,cirrhosis etc.,are the core components of three HCC risk scores:CU-HCC,GAGHCC and REACH-B *** 3 scores were confirmed to be accurate in predicting HCC up to 10 years in treatment-na ve *** validity and applicability have recently been demonstrated in a large cohort of entecavir treatment patients.A decrease in risk scores after antiviral therapy translates to a lower risk of *** findings support the application of HCC risk scores in all CHB *** levels of care and different intensities of HCC surveillance should be offered according to the risk profile of *** at risk of HCC should undergo regular HCC surveillance,even when they are receiving antiviral treatment.

关键词： Antiviral therapy Cirrhosis Hepatitis B virus DNA Hepatocellular carcinoma Risk prediction score Transient elastography

Epidemiology and Clinical Outcomes of Metabolic(Dysfunction)-associated Fatty Liver Disease

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Journal of Clinical and Translational Hepatology 2021年第6期9卷 972-982页

作者： Huapeng Lin Xinrong Zhang Guanlin Li Grace Lai-Hung wong vincent wai-sun wong Department of Medicine and Therapeutics State Key Laboratory of Digestive diseaseand Medical Data Analytics CentreThe Chinese University of Hong KongHong KongChina

Metabolic(dysfunction)-associated fatty liver disease(MAFLD)is currently the most common chronic liver disease and affects at least a quarter of the global adult *** has rapidly become one of the leading causes of hepatocellular carcinoma and cirrhosis in Western *** this review,we discuss the nomenclature and definition of MAFLD as well as its prevalence and incidence in different geographical *** cardiovascular disease remains the leading cause of death in MAFLD patients,the proportion of patients dying from hepatic complications increases sharply as the disease progresses to advanced liver fibrosis and *** addition,patients with MAFLD are at increased risk of various extrahepatic *** a causal relationship between MAFLD and extrahepatic cancers has not been established,clinicians should recognize the association and consider cancer screening(e.g.,for colorectal cancer)as appropriate.

关键词： Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Obesity Prevalence Incidence Hepatocellular carcinoma Cirrhosis

Consensus scoring systems for nonalcoholic fatty liver disease: an unmet clinical need

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Hepatobiliary Surgery and Nutrition 2021年第3期10卷 388-390页

作者： Yu-Jie Zhou vincent wai-sun wong Ming-Hua Zheng NAFLD Research Center Department of Hepatologythe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina Division of Gastroenterology and Hepatology Key Laboratory of Gastroenterology and HepatologyMinistry of HealthShanghai Institute of Digestive DiseaseRenji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina Department of Medicine and Therapeutics The Chinese University of Hong KongHong KongChina State Key Laboratory of Digestive Disease The Chinese University of Hong KongHong KongChina Institute of Hepatology Wenzhou Medical UniversityWenzhouChina Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province WenzhouChin

Noninvasive diagnosis of nonalcoholic fatty liver disease(NAFLD)has received increasing attention(1,2).Nowadays,when we search the item‘scoring system and fatty liver’in PubMed,we can see a sharp increase in the number of related papers in the past few *** fact,an era of‘information explosion’of noninvasive tests(NITs)for NAFLD is coming.

关键词： NAFLD diagnosis liver

Validation model of fibrosis-8 index score to predict significant fibrosis among patients with nonalcoholic fatty liver disease

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World Journal of Gastroenterology 2022年第15期28卷 1563-1573页

作者： Thaninee Prasoppokakorn Wah-Kheong Chan vincent wai-sun wong Panyavee Pitisuttithum Sanjiv Mahadeva Nik Raihan Nik Mustapha Grace Lai-Hung wong Howard Ho-wai Leung Pimsiri Sripongpun Sombat Treeprasertsuk Department of Medicine Division of GastroenterologyFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkok 10330Thailand Department of Medicine Division of GastroenterologyDivision of Gastroenterology and Hepatology UnitFaculty of MedicineUniversity of MalayaKuala Lumpur 50603Malaysia Department of Medicine and Therapeutics The Chinese University of Hong KongHong KongChina Department of Medicine Division of General Internal MedicineFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkok 10330Thailand Department of Pathology Hospital Sultanah BahiyahAlor SetarKedah 05460Malaysia Department of Anatomical and Cellular Pathology The Chinese University of Hong KongHong KongChina Department of Internal Medicine Prince of Songkla UniversityHat Yai 90110Thailand Department of Medicine Division of Gastroenterology and HepatologyStanford University School of MedicinePalo AltoCA 94305United States

BACKGROUND Identifying hepatic fibrosis is crucial for nonalcoholic fatty liver disease(NAFLD)*** fibrosis-8(FIB-8)score,recently developed by incorporating four additional variables into the fibrosis-4(FIB-4)score,showed better performance in predicting significant fibrosis in *** To validate the FIB-8 score in a biopsy-proven NAFLD cohort and compare the diagnostic performance of the FIB-8 and FIB-4 scores and NAFLD fibrosis score(NFS)for predicting significant *** We collected the data of biopsy-proven NAFLD patients from three Asian centers in three *** the patients with available variables for the FIB-4 score(age,platelet count,and aspartate and alanine aminotransferase levels)and FIB-8 score(the FIB-4 variables plus 4 additional parameters:The body mass index(BMI),albumin to globulin ratio,gamma-glutamyl transferase level,and presence of diabetes mellitus)were *** fibrosis stage was scored using nonalcoholic steatohepatitis CRN criteria,and significant fibrosis was defined as at least fibrosis stage *** A total of 511 patients with biopsy-proven NAFLD and complete data were included for *** these 511 patients,271(53.0%)were female,with a median age of 51(interquartile range:41,58)*** median BMI was 29(26.3,32.6)kg/m2,and 268(52.4%)had *** the 511 NAFLD patients,157(30.7%)had significant fibrosis(≥F2).The areas under the receiver operating characteristic curves of the FIB-8 and FIB-4 scores and NFS for predicting significant fibrosis were 0.774,0.743,and 0.680,*** FIB-8 score demonstrated significantly better performance for predicting significant fibrosis than the NFS(P=0.001)and was also clinically superior to FIB-4,although statistical significance was not reached(P=0.073).The low cutoff point of the FIB-8 score for predicting significant fibrosis of 0.88 showed 92.36%sensitivity,and the high cutoff point of the FIB-8 score for predicting significant fibrosis of 1.

关键词： Nonalcoholic fatty liver disease Fibrosis-8 score Fibrosis-4 score Nonalcoholic fatty liver disease fibrosis score

Overview of methodologies and statistical strategies in observational studies and meta-analyses on the risk of hepatocellular carcinoma in patients with chronic hepatitis B on entecavir or tenofovir therapy

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Hepatoma Research 2022年第1期8卷 143-156页

作者： Terry Cheuk-Fung Yip vincent wai-sun wong Mandy Sze-Man Lai Vicki Wing-Ki Hui Yee-KitTse Grace Lai-Hung wong Medical Data Analytics Centre Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong KongChina Department of Medicine and Therapeutics 9/F Lui Che Woo Clinical Sciences BuildingPrince of Wales Hospital30-32 Ngan Shing StreetShatinHong KongChina Institute of Digestive Disease The Chinese University of Hong KongHong KongChina

Entecavir(ETV)and tenofovir disoproxil fumarate(TDF)are first-line antiviral therapies for patients with chronic hepatitis B(CHB)and reduce the risk of disease progression and liver-related complications,as well as improve survival by effectively suppressing viral ***,since the first publication in 2019 on a lower risk of hepatocellular carcinoma(HCC)in Korean patients receiving TDF than those receiving ETV,the topic has remained a hot and unsettled *** studies and meta-analyses have yielded conflicting *** HCC takes time to develop,studies are mainly observational to benefit from a larger sample size and longer follow-up that provides a higher statistical power to compare the two ***,TDF was available to CHB patients a few years later than ETV in most countries,thus leading to a difference in follow-up ***,despite studying the same topic,the difference in data sources and available parameters,inclusion and exclusion criteria,and use of statistical methods complicated the interpretation and comparison of the findings and contributed to between-study heterogeneity in *** review describes some caveats in interpreting and comparing the results from these observational studies and *** studies should explore better designed observational studies with high-quality data sources,and aggregation of patient data in metaanalysis to tackle between-study heterogeneity.

关键词： Bias confounding hepatitis B virus hepatocellular carcinoma liver cancer nucleos(t)ide analogues propensity score

Non-invasive tests of non-alcoholic fatty liver disease

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Chinese Medical Journal 2022年第5期135卷 532-546页

作者： Guanlin Li Xinrong Zhang Huapeng Lin Lilian Yan Liang Grace Lai-Hung wong vincent wai-sun wong Department of Medicine and Therapeutics The Chinese University of Hong KongHong KongChina State Key Laboratory of Digestive Disease The Chinese University of Hong KongHong KongChina Medical Data Analytics Centre The Chinese University of Hong KongHong KongChina

For the detection of steatosis,quantitative ultrasound imaging techniques have achieved great progress in past *** resonance imaging proton density fat fraction is currently the most accurate test to detect hepatic *** blood biomarkers correlate with non-alcoholic steatohepatitis,but the accuracy is *** liver fibrosis,liver stiffness measurement by transient elastography(TE)has high accuracy and is widely used across the *** resonance elastography is marginally better than TE but is limited by its cost and *** blood biomarkers of fibrosis have been used in clinical trials and hold promise for selecting patients for treatment and monitoring treatment *** article reviews new developments in the non-invasive assessment of non-alcoholic fatty liver disease(NAFLD).Accumulating evidence suggests that various non-invasive tests can be used to diagnose NAFLD,assess its severity,and predict the *** studies are needed to determine the role of the tests as monitoring *** cannot overemphasize the importance of context in selecting appropriate tests.

关键词： Fatty liver Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Liver fibrosis Cirrhosis Transient elastography FibroScan Magnetic resonance imaging

Prevalence and risk factors for impaired renal function among Asian patients with nonalcoholic fatty liver disease

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Hepatobiliary & Pancreatic Diseases International 2024年第3期23卷 241-248页

作者： Chao sun George Boon-Bee Goh Wan-Cheng Chow Wah-Kheong Chan Grace Lai-Hung wong wai-Kay Seto Yi-Hsiang Huang Han-Chieh Lin I-Cheng Lee Hye Won Lee Seung Up Kim vincent wai-sun wong Jian-Gao Fan Center for Fatty Liver Disease Department of GastroenterologyXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai Key Lab of Pediatric Gastroenterology and NutritionShanghai 200092China Department of Gastroenterology&Hepatology Singapore General HospitalSingaporeSingapore Gastroenterology and Hepatology Unit Department of MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia Department of Medicine and Therapeutics and State Key Laboratory of Digestive Disease The Chinese University of Hong KongHong KongChina Department of Medicine The University of Hong KongHong KongChina Institute of Clinical Medicine National Yang Ming Chiao Tung University School of MedicineTaipeiTaiwanChina Division of Gastroenterology and Hepatology Taipei Veterans General HospitalTaipeiTaiwanChina Faculty of Medicine National Yang Ming Chiao Tung University School of MedicineTaipeiTaiwanChina Department of Internal Medicine Yonsei University College of MedicineSeoulKorea

Background:Nonalcoholic fatty liver disease(NAFLD)is associated with impaired renal function,and both diseases often occur alongside other metabolic ***,the prevalence and risk factors for impaired renal function in patients with NAFLD remain *** objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD ***:All adults aged 18-70 years with ultrasound-diagnosed NAFLD and transient elastography examination from eight Asian centers were enrolled in this prospective *** fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase(FAST),Agile 3+and Agile 4 *** renal function and chronic kidney disease(CKD)were defined by an estimated glomerular filtration rate(eGFR)with value of<90 mL/min/1.73 m^(2) and<60 mL/min/1.73 m^(2),respectively,as estimated by the CKD-Epidemiology Collaboration(CKD-EPI)***:Among 529 included NAFLD patients,the prevalence rates of impaired renal function and CKD were 37.4%and 4.9%,*** multivariate analysis,a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+and Agile 4 scores were independent risk factors for CKD(P<0.05).Furthermore,increased fasting plasma glucose(FPG)and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome(P<0.05).Compared with patients with normoglycemia,those with prediabetes[FPG≥5.6 mmol/L or hemoglobin A1c(HbA1c)≥5.7%]were more likely to have impaired renal function(P<0.05).Conclusions:Agile 3+and Agile 4 are reliable for identifying NAFLD patients with high risk of *** glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.

关键词： Nonalcoholic fatty liver disease Impaired renal function Agile 3+ Agile 4 Metabolic syndrome

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非酒精性脂肪性肝病患者最佳诊疗的风险分层

中华消化杂志 2023年第4期43卷 217-223页

作者：黄炜燊香港中文大学内科及药物治疗学系医学数据分析中心中国香港999077 香港中文大学消化疾病研究所消化疾病国家重点实验室中国香港999077

非酒精性脂肪性肝病(NAFLD)影响了全球约30%的成年人口,是肝硬化和肝细胞癌的重要病因。与其他慢性肝病不同,NAFLD大部分由初级保健医师和非肝病专科医师诊治。尽管NAFLD的绝对患病人群数量庞大,但是仅有一小部分患者最终会发生肝病相... 详细信息

非酒精性脂肪性肝病(NAFLD)影响了全球约30%的成年人口,是肝硬化和肝细胞癌的重要病因。与其他慢性肝病不同,NAFLD大部分由初级保健医师和非肝病专科医师诊治。尽管NAFLD的绝对患病人群数量庞大,但是仅有一小部分患者最终会发生肝病相关并发症。因此,正确选用无创性检查手段、为肝病专科医师及诊治NAFLD患者的其他医师建立一套诊疗路径至关重要。在此背景下,美国胃肠病学会成立了多学科诊疗小组,为识别伴有进展期肝纤维化的NAFLD患者提供临床诊疗路径指导。这条路径包括以下4个关键步骤:①初级保健医师和非肝病专科医师识别高危患者;②根据病史和体格检查进行初步评估;③利用无创性纤维化评分筛选伴进展期纤维化的NAFLD患者;④对无创性纤维化评分后风险不确定的患者进行特异性纤维化测试,如振动控制瞬时弹性成像。本文将阐述这些推荐意见的理论基础,并指出进一步的研究方向和需要改进的领域。

关键词：脂肪肝非酒精性脂肪性肝病肝纤维化肝硬化

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From NAFLD to MAFLD:a“redefining”moment for fatty liver disease

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Chinese Medical Journal 2020年第19期133卷 2271-2273页

作者： Kenneth IZheng Jian-Gao Fan Jun-Ping Shi vincent wai-sun wong Mohammed Eslam Jacob George Ming-Hua Zheng Department of Hepatology MAFLD Research CenterThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiang 25000China Department of Gastroenterology Center for Fatty LiverXin Hua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai Key Laboratory of Pediatric Gastroenterology and NutritionShanghai 200065China Department of Liver Diseases Hangzhou Normal University Affiliated HospitalHangzhouZhejiang 311121China Department of Medicine and Therapeutics The Chinese University of Hong KongHong Kong 999077China Storr Liver Centre Westmead Institute for Medical ResearchWestmead Hospital and University of SydneySydney 2145Australia Institute of Hepatology Wenzhou Medical UniversityWenzhouZhejiang 325000China Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province WenzhouZhejiang 325000China.

The term non-alcoholic fatty liver disease(NAFLD)was coined in 1980 to characterize a disease similar to alcoholic fatty liver disease that developed in patients without a history of excessive alcohol intake.[1]Morphologically,NAFLD is characterized by excess fatty infiltration of the liver in the absence of known causes of liver disease(eg,alcohol,autoimmune liver disease,viral hepatitis,etc).The clinical manifestations of NAFLD(both hepatic and extrahepatic)depend on the outcome of complex interactions between its primary drivers including poor lifestyle habits and diet,a dysfunctional microbiota,genetic predisposition,and environmental cues that result in metabolic dysfunction and liver ***,bringing all patients with their markedly different clinical courses under the NAFLD umbrella belies its complexity and implies a homogeneous disease state that then negatively impacts clinical management and a deeper understanding of *** advances in current knowledge on the spectrum of fatty liver diseases,it is apparent that the fourdecade-old outdated term NAFLD can no longer serve to usefully describe a highly heterogeneous *** disease as we understand it today not only impacts patients who consume alcohol and those who do not,but also potentially impacts all patients with any form of liver disease,by acting as a disease modifier.[2]

关键词： NAFLD Morphological markedly

Gamma-glutamyl transferase and cardiovascular risk in nonalcoholic fatty liver disease:The Gut and Obesity Asia initiative

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World Journal of Gastroenterology 2020年第19期26卷 2416-2426页

作者： Panyavee Pitisuttithum Wah-Kheong Chan George Boon-Bee Goh Jian-Gao Fan Myeong Jun Song Phunchai Charatcharoenwitthaya Ajay Duseja Yock-Young Dan Kento Imajo Atsushi Nakajima Khek-Yu Ho Khean-Lee Goh vincent wai-sun wong Sombat Treeprasertsuk Department of Medicine Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Department of Medicine University of MalayaKuala Lumpur 50603Malaysia Department of Gastroenterology&Hepatology Singapore General HospitalSingapore 169608Singapore Department of Gastroenterology Shanghai Jiao Tong University School of MedicineShanghai 200092China Department of Internal Medicine The Catholic University of KoreaDaejeon 301-723South Korea Division of Gastroenterology Faculty of Medicine Siriraj HospitalMahidol UniversityBangkok 10700Thailand Department of Hepatology Post Graduate Institute of Medical Education and ResearchChandigarh 160012India Department of Medicine National University of Singapore 119228Singapore Department of Gastroenterology and Hepatology Yokohama City University Graduate School of MedicineYokohama 236-0004Japan Department of Medicine and Therapeutics The Chinese University of Hong KongHong Kong 999077China

BACKGROUND Gamma-glutamyl transferase(GGT)is associated with the risk of cardiovascular disease(CVD)in the general *** To identify the association of baseline GGT level and QRISK2 score among patients with biopsy-proven nonalcoholic fatty liver disease(NAFLD).METHODS This was a retrospective study involving 1535 biopsy-proven NAFLD patients from 10 Asian centers in 8 countries using data collected by the Gut and Obesity in Asia(referred to as“GO ASIA”)*** patients with available baseline GGT levels and all 16 variables for the QRISK2 calculation(QRISK2-2017;developed by researchers at the United Kingdom National Health Service;https://***/2017/;10-year cardiovascular risk estimation)were included and compared to healthy controls with the same age,sex,and *** risk was ***2 score>10%was defined as the high-CVD-risk *** stages 3 and 4(F3 and F4)were considered advanced *** A total of 1122 patients(73%)had complete data and were included in the final analysis;314(28%)had advanced *** median age(interquartile range[IQR])of the study population was 53(44-60)years,532(47.4%)were females,and 492(43.9%)were of Chinese *** median 10-year CVD risk(IQR)was 5.9%(2.6-10.9),and the median relative risk of CVD over 10 years(IQR)was 1.65(1.13-2.2)compared to healthy individuals with the same age,sex,and *** high-CVD-risk group was significantly older than the low-risk group(median[IQR]:63[59-67]vs 49[41-55]years;P<0.001).Higher fibrosis stages in biopsy-proven NAFLD patients brought a significantly higher CVD risk(P<0.001).Median GGT level was not different between the two groups(GGT[U/L]:Median[IQR],high risk 60[37-113]vs low risk 66[38-103],P=0.56).There was no correlation between baseline GGT level and 10-year CVD risk based on the QRISK2 score(r=0.02).CONCLUSION The CVD risk of NAFLD patients is higher than that of healthy *** GGT level cannot predict CVD ri

关键词： Nonalcoholic fatty liver disease Gamma glutamyl transferase QRISK Cardiovascular risk Gut and Obesity in Asia