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2012至2021年北京佑安医院肝衰竭住院患者流行病学特征

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中华肝脏病杂志 2024年第1期32卷 49-57页

作者：徐曼曼李珊珊杨颜榕武羽杨雪段钟平陈煜首都医科大学附属北京佑安医院肝病中心四科肝衰竭与人工肝治疗研究北京市重点实验室北京100069

目的阐述肝衰竭流行病学特征及其变化趋势,以期为肝衰竭防治策略提供循证依据。方法回顾性收集北京佑安医院2012年至2021年收治的肝衰竭住院患者流行病学信息,应用趋势检验分析其年龄、性别,以及急性肝衰竭(ALF)、亚急性肝衰竭(SALF)的... 详细信息

目的阐述肝衰竭流行病学特征及其变化趋势,以期为肝衰竭防治策略提供循证依据。方法回顾性收集北京佑安医院2012年至2021年收治的肝衰竭住院患者流行病学信息,应用趋势检验分析其年龄、性别,以及急性肝衰竭(ALF)、亚急性肝衰竭(SALF)的急性病因和慢加急性肝衰竭(ACLF)、慢性肝衰竭(CLF)的慢性肝病基础病因的逐年变化。结果在研究期间,共收集8512例肝衰竭住院患者信息,年龄为(51.3±13.5)岁,男性患者为主(71.9%),肝衰竭类型的比例从高到低依次为ACLF 4023例(47.3%)、CLF 3571例(42.0%)、SALF 670例(7.9%)、ALF 248例(2.9%)。肝衰竭整体人群中前5位的病因依次是乙型肝炎3199例(37.6%)、酒精性肝病2237例(26.3%)、隐源性肝病906例(10.6%)、乙型肝炎+酒精性肝病603例(7.1%)、药物488例(5.7%),共占比87.6%。不同类型肝衰竭患者的前3位病因分别是:ALF的急性病因,依次为药物107例(43.1%)、乙型肝炎47例(19.0%)、不明原因36例(14.5%),SALF的急性病因依次为药物381例(56.9%)、不明原因106例(15.8%)、脓毒症56例(8.4%);ACLF的慢性病因依次为乙型肝炎2092例(52.0%)、酒精性肝病813例(20.2%)、隐源性肝病398例(9.9%);而CLF的慢性病因依次是酒精性肝病1410例(39.5%)、乙型肝炎1028例(28.8%)、隐源性肝病364例(10.2%)。纵向分析显示肝衰竭患者的平均年龄逐年增加,性别比例未见显著变化趋势,始终以男性患者为主;在ALF、SALF患者中药物性肝衰竭比例逐年升高,趋势检验差异有统计学意义(P<0.05)。在ACLF、CLF患者的慢性病因中,乙型肝炎比例逐年下降,而酒精性肝病、自身免疫性肝病、隐源性肝病的比例逐年增加(P<0.05)。结论我国肝衰竭病因谱正在发生改变,尽管乙型肝炎仍然是肝衰竭的主要病因,但其占比呈现逐年减少趋势,除ACLF外,已不再是其他类型肝衰竭的首要病因,而药物性肝病、酒精性肝病、自身免疫性肝病、隐源性肝病呈逐年增加,将成为未来肝病防治的重点。

关键词：急性肝衰竭亚急性肝衰竭慢加急性肝衰竭慢性肝衰竭病因流行病学

New perspective on the natural course of chronic HBV infection

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Frontiers of Medicine 2014年第2期8卷 129-134页

作者： Yong-Yuan Zhang Ke-Qin Hu zhongping duan HB Vtech LLC 13901 Lullaby RD Germantown MD 20874 USA Division of Gastroenterology and Hepatology University of California Irvine School of Medicine Orange CA 92868 USA You An Hospital Capital Medical University Beijing 100069 China

Chronic hepatitis B virus （HBV） infection is a significant threat to public health and an enormous burden on society. Mechanisms responsible for chronic HBV infection remain poorly understood. A better understanding of the natural course of chronic HBV infection may shed new light on the mechanisms underlying this disease and help in designing new antiviral strategies. Natural course of chronic HBV infection is conventionally viewed as an uninterrupted process that is usually marked by HBV e antigen （HBeAg） seroconversion or characterized by different phases associated with assumed host responses to HBV infection. However, none of these descriptions captures or highlights the core events that determine the natural course of chronic HBV infection. In this review, we briefly present the current knowledge on this subject and explain the significance and implication of events that occur during infection. A pre-core mutant becomes predominant in the viral population following elimination of the wild-type virus in duck hepatitis B virus-chronically infected animals. The coupled events in which first there is viral clearance that clears wild-type virus and then there is the reinfection of wild-type virus cleared livers with mutant virus are highly relevant to understanding of the natural course of chronic HBV infection under both treated and untreated conditions. In our new perspective, a general natural course of chronic HBV infection comprises cycles of viral clearance and reinfection, and such cycles prolong the chronic HBV infection course. Reviewing published data on the natural course of chronic HBV infection can reduce the possibility of missing important points in the initial data interpretation.

关键词： hepatitis B virus chronic HBV infection natural course hepatitis B seroconversion

Overview on acute-on-chronic liver failure

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Frontiers of Medicine 2016年第1期10卷 1-17页

作者： Jing Zhang Shan Gao zhongping duan Ke-Qin Hu Department of Hepatitis C and Drug Induced Liver Injury Beijing YouAn Hospital Capital Medical University Beij'ing 100069 China Beijing Artificial Liver Treatment & Training Center Beijing YouAn Hospital Capital Medical University~ Be~'ng 100069 Chinai' Collaborative Innovation Center of lnfectious Diseases Beijing 100069 China Division of Gastroenterology and Hepatology University of California Irvine Medical Center Orange CA 92868 USA

Liver failure （LF） is defined as severe dysfunction in hepatic synthesis, detoxification, and metabolism induced by various etiologies. CHnical presentation of LF typically includes severe jaundice, coagulation disorder, hepatic encephalopathy, and ascites. LF can be classified into acute LF, acute-on-chronic LF （ACLF）, and chronic LF. ACLF has been demonstrated as a distinct syndrome with unique clinical presentation and outcomes. The severity, curability, and reversibility of ACLF have attracted considerable attention. Remarkable developments in ACLF-related conception, diagnostic criteria, pathogenesis, and therapy have been achieved. However, this disease, especially its diagnostic criteria, remains controversial. In this paper, we systemically reviewed the current understanding of ACLF from its definition, etiology, pathophysiology, pathology, and clinical presentation to management by thoroughly comparing important findings between east and west countries, as well as those from other regions. We also discussed the controversies, challenges, and needs for future studies to promote the standardization and optimization of the diagnosis and treatment for ACLF.

关键词： liver failure chronic liver failure acute-on-chronic liver failure diagnosis prognosis treatment

Comparison of clinical features and liver histology in liver failure caused by autoimmune hepatitis with different prognosis

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Chinese Medical Journal 2022年第6期135卷 735-737页

作者： Huili Wu Hongbo Shi Hui Liu Yanmin Liu zhongping duan Complicated Liver Diseases and Artificial Liver Center Beijing YouAn HospitalCapital Medical UniversityBeijing 100069China Institute of Liver Diseases Beijing YouAn HospitalCapital Medical UniversityBeijing 100069China Department of Pathology Beijing YouAn HospitalCapital Medical UniversityBeijing 100069China Department of Hepatology Immunology Beijing YouAn HospitalCapital Medical UniversityBeijing 100069China Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research Beijing YouAn HospitalCapital Medical UniversityBeijing 100069China

To the Editor:Autoimmune hepatitis(AIH)is a type of liver parenchymal inflammation mediated by the autoimmune response of liver *** was previously considered to be a chronic liver disease,but recent observers have confirmed that AIH patients can have acute onset or even liver failure(AIH-LF).[1]The incidence of AIH-LF has also *** LF occurs,the mortality rate within 90 days could reach>40%.[2]Therefore,the occurrence of LF has a major impact on the prognosis of *** AIH-LF has a low incidence and a high mortality rate,some cases can still be cured by *** clinical characteristics that may affect the prognosis of patients with AIH-LF are still *** clarify the factors affecting the prognosis of AIH-LF,we compared the clinical characteristics of two groups of AIH-LF patients with different prognosis.

关键词： AIH clinical prognosis

Guidelines for Prevention and Treatment of Chronic Hepatitis B

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Journal of Clinical and Translational Hepatology 2021年第5期9卷 769-791页

作者： Guiqiang Wang zhongping duan Chinese Society of Infectious Diseases,Chinese Medical Association Chinese Society of Hepatology,Chinese Medical Association Center for Liver Diseases Department of Infectious DiseasesPeking University First Hospital Department of Infectious and Liver Diseases Peking University International HospitalBeijingChina

To achieve the goal of the World Health Organization to eliminate viral hepatitis as a major public health threat by 2030,the Chinese Society of Infectious Diseases and the Chinese Society of Hepatology convened an expert panel in 2019 to update the guidelines for the prevention and treatment of chronic hepatitis B(CHB).The current guidelines cover recent advances in basic,clinical,and preventive studies of CHB infection and consider the actual situation in *** guidelines are intended to provide support for the prevention,diagnosis,and treatment of CHB.

关键词： Hepatitis B Chronic Guidelines Prevention Treatment

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Journal of Clinical and Translational Hepatology 2021年第2期9卷 180-186页

作者： Jie Bai Lu Li Hui Liu Shuang Liu Li Bai Wenyan Song Yu Chen Sujun Zheng zhongping duan Fourth Department of Liver Disease(Difficult&Complicated Liver Diseases and Artificial Liver Center) Beijing You’an Hospital Affiliated to Capital Medical UniversityBeijingChina Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research BeijingChina Department of Pathology Beijing You’an HospitalCapital Medical UniversityBeijingChina Department of Radiology Beijing You’an HospitalCapital Medical UniversityBeijingChina

Background and Aims:Bilirubin encephalopathy/kernicterus is very rare in *** study is aimed to investigate the clinical manifestations and genetic features of two patients with UGT1A1-related ***:Sanger sequencing analysis was performed to identify UGT1A1 gene mutations in the patients and their *** analysis was used to predict the potential functional effects of novel missense *** manifestations and biochemical parameters were collected and ***:Two patients with Crigler-Najjar syndrome type II(CNS2)developed kernicterus in *** sequencing identified a compound heterozygous mutation in the UGT1A1 gene in patient 1,which was inherited from his mother(G71R)and his father(c.-3279T>G;S191F).Patient 2 carried three heterozygous mutations,namely G71R,R209W and M391K;among which,the M391K mutation has not been reported *** prediction software showed that the M391K mutation was *** were relieved in the two patients after phenobarbital and artificial liver support *** 1 also underwent liver ***:Adults with CNS2 are at risk for *** treatment is beneficial for maintaining bilirubin levels and preventing kernicterus.

关键词： Kernicterus UGT1A1 Crigler-Najjar syndrome type II Phenobar-bital

Direct-acting Antiviral-induced Transient Recovery of NK Cells in Early-stage Treatment of Chronic Hepatitis C Patients

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Journal of Clinical and Translational Hepatology 2022年第6期10卷 1117-1124页

作者： Xiaohui Zhang Yingying Jiang Shaobin Li Dandan Bian Mei Liu Ming Kong Yu Chen zhongping duan Sujun Zheng The Fourth Department of Hepatology Beijing YouAn HospitalCapital Medical UniversityBeijingChina Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment&Research Beijing YouAn HospitalCapital Medical Univer-sityBeijingChina Department of Gastroenterology and Hepatology Beijing YouAn HospitalCapital Medical UniversityBeijingChina School of Energy and Power Engineering Beihang UniversityBeijingChina Department of Infectious Diseases Electric Power Teaching HospitalCapital Medical UniversityBeijingChina Oncology Department Beijing YouAn HospitalCapital Medical UniversityBeijingChina The First Department of Hepatology Beijing YouAn HospitalCapital Medical UniversityBeijingChina

Background and Aims:The rapid clearance of hepatitis C virus induced by direct-acting antivirals(DAAs)affects natural killer(NK)cells,but the reported results are not consistent,and the relative mechanism was *** study focused on the dynamic changes of NK cells during and after DAA treatment and analyzed the ***-ods:Peripheral blood from 35 chronic hepatitis C patients who were treated with DAAs were collected at baseline and weeks 1,2,4,12,and post-treatment *** fre-quency,subset,and phenotype of NK cells were assayed by flow *** dehydrogenase assays were used to evaluate the cytotoxicity of NK *** concentra-tions were measured with Luminex ***:All pa-tients achieved a sustained viral response(SVR),and the NK cell frequencies were not changed significantly during DAA ***,the cytotoxicity of NK cells recov-ered significantly early in week 1,and then continuously decreased below normal *** changes of genotypes including NKp30+,NKp46+,and NKG2A+NK cells were par-allel to NK *** subset of CD56dim NK cells con-tinuously increased and did not return to normal even at 12 weeks after ***(IL)-2,IL10,IL15,interferon-gamma,and tumor necrosis factor-alpha all in-creased after week 4,peaked at the end of therapy,and then exhibited varying degrees of reduction with ***-clusions:DAA treatment led to transient functional recov-ery of NK cells in the early stage of treatment,and then continuously decreased to below normal *** of NK subsets,phenotypes,and the microenvironment may be involved in the changes.

关键词： Hepatitis C Natural killer cell Cytokines Phenotype

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防微杜渐,关注肝衰竭前期诊疗

中华肝脏病杂志 2020年第4期28卷 289-291页

作者：段钟平首都医科大学附属北京佑安医院疑难肝病及人工肝中心肝衰竭与人工肝治疗研究北京市重点实验室100069

肝衰竭病情重、进展快、病死率甚高,在肝衰竭发生前期进行早期预警,早期干预,对改善患者预后至关重要。目前关于肝衰竭前期的诊断标准尚不统一,关于肝衰竭前期的研究主要集中在乙型肝炎相关肝衰竭人群中进行,现就目前肝衰竭前期早期诊... 详细信息

肝衰竭病情重、进展快、病死率甚高,在肝衰竭发生前期进行早期预警,早期干预,对改善患者预后至关重要。目前关于肝衰竭前期的诊断标准尚不统一,关于肝衰竭前期的研究主要集中在乙型肝炎相关肝衰竭人群中进行,现就目前肝衰竭前期早期诊断、预警及治疗展开讨论。

关键词：肝衰竭早期诊断早期预警

A HRG novel mutation associated with idiopathic portal hypertension: Case report and literature review

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iLIVER 2022年第2期1卷 90-95页

作者： Shan Tang Li Bai Wei Zhang Wenyan Song Hui Liu Lei Li Chen Liang zhongping duan Sujun Zheng The First Unit Department of HepatologyBeijing YouAn HospitalCapital Medical UniversityBeijingChina The Fourth Unit Department of HepatologyBeijing YouAn HospitalCapital Medical UniversityBeijingChina Beijing Key Laboratory of Liver Failure and Artificial Liver Treatment Research BeijingChina Department of Radiology Beijing YouAn HospitalCapital Medical UniversityBeijingChina Department of Pathology Beijing YouAn HospitalCapital Medical UniversityBeijingChina Department of Digestive Center Beijing YouAn HospitalCapital Medical UniversityBeijingChina

Idiopathic portal hypertension(IPH)is defined as the presence of portal hypertension in the absence of a common *** can have several etiologies,one of which is a genetic *** genetic mutations,such as KCNN3 and DGUOK,were shown to be related to IPH *** is the first case report of a 22-year-old man who was diagnosed with IPH with a novel heterozygous mutation in the histidine-rich glycoprotein gene(c.545G>C,p.R182T).Using bioinformatics analysis and the protein quantification method,we showed that this novel mutation has a pathogenetic role in *** study broadens the mutation spectrum of the histidine-rich glycoprotein gene and provides new ideas for IPH etiology.

关键词： Case report HRG gene Heterozygous mutation IPH