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Branched-chain amino acids supplementation has beneficial effects on the progression of liver cirrhosis:A meta-analysis

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World Journal of Clinical Cases 2022年第30期10卷 10984-10996页

作者： Jia-Yu Du Liu Shu Yu-Tian Zhou Li Zhang School of Clinical Medicine Chengdu Medical CollegeChengdu 610000Sichuan ProvinceChina Department of Neuroscience College of Veterinary Medicine and Life SciencesCity University of Hong KongHong KongChina Department of Geriatrics Sichuan Provincial People’s HospitalUniversity of Electronic Science and Technology of ChinaChengdu 610000Sichuan ProvinceChina Department of Geriatrics Sichuan Academy of Medical Sciences&Sichuan Provincial People’s HospitalChengdu 610072Sichuan ProvinceChina

BACKGROUND liver cirrhosis(LC)is currently the 11^(th) most common cause of death and 15^(th) cause of morbidity globally.The treatment of LC is mainly aimed at etiological intervention,lifestyle intervention,prevention and treatment of complications and nutritional treatment.Nutritional treatment of LC mainly includes increasing dietary intake,food intake time and branched-chain amino acids(BCAAs).Despite the recommendation of BCAAs in some guidelines,adverse effects have been reported in studies so the efficacy and safety of BCAAs remain controversial.Currently,BCAAs have been widely used in chronic liver disease,while the summary of the effect of BCAAs on long-term prognosis is rare.AIM To determine the effects of BCAAs in patients with LC.METHODS The PubMed,Cochrane Library,Embase and Web of Science databases were searched.The retrieval deadline was 1 October 2021 and there were no language restrictions set in the retrieval.The study was performed in strict accordance with the inclusion and exclusion criteria.Nine studies were finally included.The primary outcome was complications of LC.The secondary outcomes were nutritional status and liver function.This meta-analysis used the Review Manager,version 5 statistical package(Cochrane Collaboration,Oxford,England)for analysis.RESULTS The analysis included nine studies that consisted of 1080 patients(554 in the BCAA groups and526 in the control groups).The nine studies were randomized control trials(RCTs).The quality of the studies was assessed using the risk of bias method recommended by the Cochrane Collaboration.BCAAs reduced the rate of complications in LC patients[Risk ratio:0.70,95%confidence interval(CI):0.56-0.88,P=0.002]and improved patients’albumin levels[std mean difference SMD:0.26,95%CI:0.12-0.40,P=0.0002].Meanwhile,BCAAs significantly ameliorated the levels of alanine transaminase(SMD:-2.03,95%CI:-2.52 to-1.53,P<0.00001)and aspartate aminotransferase(SMD:-1.8,95%CI:-2.14 to-1.46,P<0.00001).Meanwhile,glucose in the LC was significantly increased in B

关键词： liver cirrhosis Branched-chain amino acids Complications Nutrition liver function Glucose

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Modified albumin-bilirubin predicted survival of unresectable hepatocellular carcinoma patients treated with immunotherapy

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World Journal of Gastrointestinal Oncology 2023年第10期15卷 1771-1783页

作者： Huttakan Navadurong Thaninee Prasoppokakorn Nanicha Siriwong Chonlada Phathong Nattaya Teeyapun Suebpong Tanasanvimon Kessarin Thanapirom Piyawat Komolmit Pisit Tangkijvanich Sombat Treeprasertsuk Roongruedee Chaiteerakij Department of Medicine Division of GastroenterologyFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand The Thai Red Cross Society Bangkok 10330Thailand Department of Medicine Division of OncologyFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Center of Excellence in Hepatitis and liver Cancer Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology Division of GastroenterologyFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand

BACKGROUND Modified albumin-bilirubin(mALBI)grade has been established as a survival determinant in hepatocellular carcinoma(HCC)patients who receive locoregional and targeted therapies.AIM To investigate whether mALBI could predict survival in unresectable HCC(uHCC)patients who were treated with atezolizumab plus bevacizumab(AB).METHODS A single-center,retrospective cohort study enrolled uHCC patients who received AB treatment between September 2020 and April 2023 and were followed up until June 2023.An association between mALBI and patient survival was determined using Cox proportional hazards analysis.RESULTS Of the 83 patients,67 patients(80.7%)were male with the mean age of 60.6 years.Among them,22 patients(26.5%)were classified as Barcelona Clinic liver Cancer B,and 61 patients(73.5%)were classified as Barcelona Clinic liver Cancer C.Cirrhosis was present in 76 patients(91.6%),with 58 patients classified as Child-Turcotte-Pugh(CTP)A and 18 as CTP B.The median overall survival(OS)and progression-free survival were 13.0 mo[95%confidence interval(CI):5.2-20.8]and 9.0 mo(95%CI:5.0-13.0),respectively.The patients were divided into two groups based on mALBI grades:42 patients(50.6%)in the mALBI 1+2a group;and 41 patients(49.4%)in the mALBI 2b+3 group.During the median follow-up period of 7.0 mo,the mALBI 1+2a group exhibited significantly better survival compared to the mALBI 2b+3 group,with a median OS that was not reached vs 3.0 mo(95%CI:0.1-6.0,Pliver function.This highlig

关键词： Unresectable hepatocellular carcinoma Atezolizumab plus bevacizumab Modified albumin-bilirubin grade Immunotherapy liver function

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liver dysfunction during COVID-19 pandemic:Contributing role of associated factors in disease progression and severity

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World Journal of Hepatology 2022年第6期14卷 1099-1110页

作者： Tarun Sahu Babita Pande Manasa PL Henu Kumar Verma Department of Physiology All India Institute of Medical SciencesRaipur 492001ChhattisgarhIndia Center for Basic Sciences Pt.Ravishankar Shukla UniversityRaipur 492001ChhattisgarhIndia Department of Immunopathology Institute of Lungs Health and ImmunityMunich 85764BavariaGermany

In December 2019,a new strain of coronavirus was discovered in China,and the World Health Organization declared it a pandemic in March 2020.The majority of people with coronavirus disease 19(COVID-19)exhibit no or only mild symptoms such as fever,cough,anosmia,and headache.Meanwhile,approximately 15%develop a severe lung infection over the course of 10 d,resulting in respiratory failure,which can lead to multi-organ failure,coagulopathy,and death.Since the beginning of the pandemic,it appears that there has been consideration that preexisting chronic liver disease may predispose to deprived consequences in conjunction with COVID-19.Furthermore,extensive liver damage has been linked to immune dysfunction and coagulopathy,which leads to a more severe COVID-19 outcome.Besides that,people with COVID-19 frequently have abnormal liver function,with more significant elevations in alanine aminotransferase and aspartate aminotransferase in patients with severe COVID-19 compared to those with mild/moderate disease.This review focuses on the pathogenesis of severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection in the liver,as well as the use of liver chemistry as a prognostic tool during COVID-19.We also evaluate the findings for viral infection of hepatocytes,and look into the potential mechanisms behind SARS-CoV-2-related liver damage.

关键词： SARS-CoV-2 COVID-19 liver function Hepatic injury Viral infection

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Current management of liver diseases and the role of multidisciplinary approach

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World Journal of Hepatology 2022年第11期14卷 1920-1930页

作者： Nouhoum Bouare Department of Assurance Quality and Biosafety/Biosecurity National Institute of Public HealthBamako 1771Mali

liver is an organ having extremely diversified functions,ranging from metabolic and synthetic to detoxification of harmful chemicals.The multifunctionality of the liver in principle requires the multidisciplinary and pluralistic interventions for its management.Several studies have investigated liver function,dysfunction and clinic.This editorial work discusses new ideas,challenges and perspectives of current research regarding multidisciplinary and pluralistic management of liver diseases.In one hand the discussions have carried out on the involvement of extracellular vesicles,Na^(+)/H^(+) exchangers,severe acute respiratory syndrome coronavirus 2 and Epstein–Barr virus infections,Drug-induced liver injury,sepsis,pregnancy,and food supplements in hepatic disorders.In the other hand this study has discussed hepatocellular carcinoma algorithms and new bio-chemical and imaging experiments pertaining to liver diseases.Relevant articles with an impact index value">0"from reference citation analysis,which is an open multidisciplinary citation analysis database based on artificial intelligence technology,have served for the study’s argumentation.This work may be a useful tool for the clinical practice and research in managing and investigating liver disorders.

关键词： liver management liver function liver dysfunction liver clinic liver diagnosis Multidisciplinary approach

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Fuzheng Huayu preparation(扶正化瘀胶囊/片)combined with tenofovir disoproxil fumarate on hepatitis B:a systematic review and Meta-analysis

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Journal of Traditional Chinese Medicine 2023年第2期43卷 221-230页

作者： ZHANG Junli HE Ying ZHANG Xia FU Hongfang HU Xiaoyu Department of Infectious Diseases Hospital of Chengdu University of Traditional Chinese MedicineChengdu 610072China

OBJECTIVE:To systematically evaluate the effectiveness of Fuzheng Huayu preparation(扶正化瘀胶囊/片,FZHY)plus tenofovir disoproxil fumarate(TDF)on hepatitis B.METHODS:Numerous databases—PubM ed,Embase,Cochrane Library,China National Knowledge Infrastructure Database,WanFang Database,China Science and Technology Journal Database,and China Biological Medicine Database—were searched to identify the randomized controlled trials published from the inception of the database to November 2021.Two researchers independently conducted literature screening,data extraction,and bias risk assessment.Rev Man 5.4 software was used for Meta-analysis.RESULTS:Eight studies involving 990 patients met the inclusion criteria in the current Meta-analysis.Levels of alanine transaminase,aspartate aminotransferase,total bilirubin,hyaluronic acid,typeⅢprocollagen,laminin,and type IV collagen after combination therapy were significantly lower than those after TDF therapy alone.However,albumin levels did not differ significantly between the two regimens.Subgroup analysis based on disease progression suggested that the combination therapy improved albumin levels in patients with chronic hepatitis B but not in patients with hepatitis B-related cirrhosis.Moreover,subgroup analysis based on treatment duration suggested that the albumin levels were increased and the typeⅢprocollagen levels were decreased with the>24-week combination therapy but not with the≤24-week combination therapy.CONCLUSIONS:A combination regimen of TDF and FZHY is more effective in treating hepatitis B than TDF alone.The combination therapy can effectively alleviate hepatic fibrosis and improve liver function.However,more standardized,highquality studies with larger sample sizes are warranted to validate the study results.

关键词： Fuzheng Huayu preparation Tenofovir liver cirrhosis liver function systematic review Meta-analysis

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Pattern of liver injury in adult patients with COVID-19: a retrospective analysis of 105 patients

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Military Medical Research 2021年第1期8卷 9-16页

作者： Qi Wang Hong Zhao Li-Gai Liu Yan-Bin Wang Ting Zhang Ming-Hui Li Yan-Li Xu Gui-Ju Gao Hao-Feng Xiong Ying Fan Ying Cao Rui Ding Jing-Jing Wang Cheng Cheng Wen Xie Center of liver Diseases Beijing Ditan HospitalCapital Medical UniversityBeijing 100015China Beijing Key Laboratory of Emerging Infectious Diseases Beijing 100015China Clinical and Research Center of Infectious Diseases Beijing Ditan HospitalCapital Medical UniversityBeijing 100015China Department of Critical Care Medicine Beijing Ditan HospitalCapital Medical UniversityBeijing 100015China

Background: Recent studies reported that patients with coronavirus disease-2019(COVID-19) might have liver injury. However, few data on the combined analysis and change patterns of alanine aminotransferase(ALT), aspartate aminotransferase(AST) and total bilirubin(TBil) have been shown.Methods: This is a single-center retrospective study. A total of 105 adult patients hospitalized for confirmed COVID-19 in Beijing Ditan Hospital between January 12, and March 17, 2020 were included, and divided into mild group(n=79) and severe group(n=26). We compared liver functional test results between the two groups. Category of ALT change during the disease course was also examined.Results: 56.2%(59/105) of the patients had unnormal ALT, AST, or total TBil throughout the course of the disease, but in 91.4%(96/105) cases the level of ALT, AST or TBil ≤3 fold of the upper limit of normal reference range(ULN). The overall distribution of ALT, AST, and TBil were all significantly difference between mild and severe group(Pliver function index is very common in patients with COVID-19 infection, and the level were less than 3×ULN, but most are reversible. The abnormality of 2 or more indexes is low in the patients with COVID-19, but it is more likely to occur in the severe group.

关键词： Coronavirus disease-2019 liver function Dynamic change

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Relationship between serum HBV DNA level and HBV-specific, nonspecific cytotoxic T lymphocytes and natural killer cells in patients with chronic hepatitis B

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Chinese Medical Journal 2009年第18期122卷 2129-2132页

作者： GU Xi-bing YANG Xiao-juan WANG Dong HUA Zhong XU Yue-qin LU Zhong-hua Department of liver Diseases Wuxi Hospital for Infectious Diseases Wuxi Jiangsu 214005 China

Background The response of patients with chronic hepatitis B （CHB） to antiviral therapy against hepatitis B virus （HBV） is related to the base line level of HBV DNA, but the mechanism is not clear. The present study aimed to understand the possible relationship between the level of HBV DNA and HBV-specific, nonspecific cytotoxic T lymphocytes （CTL） and natural killer （NK） cells of CHB patients and the mechanism how the HBV DNA level influences the antiviral therapeutic effect. Methods Totally 100 adult patients with CHB who were positive for HBV DNA, HBeAg and （HLA）-A2 were enrolled into this study. HBV DNA was tested by real time fluorescence quantitative polymerase chain reaction （PCR）. HBV specific and nonspecific CTL and NK cells were tested by flowcytometry. Serum alanine aminotransferase （ALT） and total bilirubin （TBil） were determined for each patient using routine biochemical tests. The 100 cases were assigned to two groups based on their HBV DNA level： group A had 48 cases, their HBV DNA level was 104-105 copies/ml, group B had 52 cases their HBV DNA level was 106-107 copies/ml. HBV specific CTL, nonspecific CTL, NK cells, ALT and TBil of the two groups were compared. Results HBV DNA level of groups A and B was （4.81±0.39） log10 copies/ml and （6.81±0.40） log10 copies/ml, respectively （t=25.32, P 〈0.001）. HBV specific CTL and NK cells of group A were significantly higher than those of group B （P 〈0.001 for both）. Nonspecific CTL of group A was significantly lower than that of group B （P 〈0.01）. ALT and TBil of group A were significantly lower than those of group B （P 〈0.01 and P 〈0.05, respectively）. Conclusions Serum HBV DNA level of patients with CHB is related to HBV specific CTL, nonspecific CTL and NK cells, which might result in inflammatory reaction of liver and cause more damage to liver function. Mechanism of HBV DNA level affecting the efficacy of anti-viral treatment may be related to the levels of HBV specific CTL and NK cells.

关键词： chronic hepatitis B HBV DNA cytotoxic T lymphocyte liver function NK cells

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Serum Bilirubin and 6-min Walk Distance as Prognostic Predictors for Inoperable Chronic Thromboembolic Pulmonary Hypertension： A Prospective Cohort Study

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Chinese Medical Journal 2015年第23期128卷 3125-3131页

作者： Juan-Ni Gong Zhen-Guo Zhai Yuan-Hua Yang Yan Liu Song Gu Tu-Guang Kuang Wan-Mu Xie Ran Miao Chen Wang Department of Pulmonary and Critical Care Medicine Beijing Institute of Respiratory Medicine Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China Department of Respiratory Medicine and Critical Care Medicine China-Japan Friendship Hospital Beijing 100029 China Department of Respiratory Medicine Capital Medical University Beijing 100069 China Department of Cardiovascular Surgery Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China Department of Clinical Laboratory Beijing Instituteof Respiratory Medicine Beijing Chao-Yang Hospital Capital Medical University Key Laboratory of Respiratory and Pulmonary Circulation Disorders Beijing 100020 China China-Japan Friendship Hospital National Clinical Research Center of Respiratory Medicine Beijing 100029 China

Background： Inoperable chronic thromboembolic pulmonary hypertension （CTEPH） is a severe clinical syndrome characterized by right cardiac failure and possibly subsequent liver dysfunction. However, whether serum markers of liver dysfunction can predict prognosis in inoperable CTEPH patients has not been determined. Our study aimed to evaluate the potential role of liver function markers （such as serum levels of transaminase, bilirubin, and gamma-glutamyl transpeptidase [GGT]） combined with 6-min walk test in the prediction of prognosis in patients with inoperable CTEPH. Methods： From June 2005 to May 2013, 77 consecutive patients with inoperable CTEPH without confounding co-morbidities were recruited for this prospective cohort study. Baseline clinical characteristics and 6-min walk distance （6MWD） results were collected. Serum biomarkers of liver function, including levels of aspartate aminotransferase, alanine aminotransferase, GGT, uric acid, and serum bilirubin, were also determined at enrollment. All-cause mortality was recorded during the follow-up period. Results： During the follow-up, 22 patients （29%） died. Cox regression analyses demonstrated that increased serum concentration of total bilirubin （hazard ratio [HR] = 7.755, P 〈 0.001）, elevated N-terminal of the prohormone brain natriuretic peptide （HR = 1.001, P = 0.001）, decreased 6MWD （HR = 0.990, P 〈 0.001）, increased central venous pressure （HR = 1.074, P = 0.040）, and higher pulmonary vascular resistance （HR = 1.001, P = 0.018） were associated with an increased risk of mortality. Serum concentrations of total bilirubin （HR = 4.755, P = 0.007） and 6MWD （HR = 0.994, P = 0.017） were independent prognostic predictors for CTEPH patients. Patients with hyperbilirubinemia （≥23.7 μmol/L） had markedly worse survival than those with normobilirubinemia. Conclusion： Elevated serum bilirubin and decreased 6MWD are potential predictors for poor prognosis in inoperable CTEPH.

关键词： Chronic Thromboembolic Pulmonary Hypertension Heart Failure liver function Prognosis

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COVID-19 combined with liver injury:Current challenges and management

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World Journal of Clinical Cases 2021年第15期9卷 3487-3497页

作者： Man-Ling Deng Yong-Jun Chen Mei-Ling Yang Yi-Wen Liu Hui Chen Xiao-Qing Tang Xue-Feng Yang Department of Gastroenterology The Affiliated Nanhua HospitalHengyang Medical CollegeUniversity of South ChinaHengyang 421002Hunan ProvinceChina Department of Neurology The Affiliated Nanhua HospitalHengyang Medical CollegeUniversity of South ChinaHengyang 421002Hunan ProvinceChina Department of Oncology The Affiliated Nanhua HospitalHengyang Medical CollegeUniversity of South ChinaHengyang 421002Hunan ProvinceChina Institute of Clinical Medicine The First Affiliated HospitalHengyang Medical CollegeUniversity of South ChinaHengyang 421001Hunan ProvinceChina

Coronavirus disease 2019(COVID-19)combined with liver injury has become a very prominent clinical problem.Due to the lack of a clear definition of liver injury in patients with COVID-19,the different selection of evaluation parameters and statistical time points,there are the conflicting conclusions about the incidence rate in different studies.The mechanism of COVID-19 combined with liver injury is complicated,including the direct injury of liver cells caused by severe acute respiratory syndrome coronavirus 2 replication and liver injury caused by cytokines,ischemia and hypoxia,and drugs.In addition,underlying diseases,especially chronic liver disease,can aggravate COVID-19 liver injury.In the treatment of COVID-19 combined with liver injury,the primary and basic treatment is to treat the etiology and pathogenesis,followed by support,liver protection,and symptomatic treatment according to the clinical classification and severity of liver injury.This article evaluates the incidence,pathogenesis and prevention and treatment of COVID-19 combined with liver injury,and aims to provide countermeasures for the prevention and treatment of COVID-19 combined with liver injury.

关键词： SARS-CoV-2 COVID-19 liver function liver injury Pathogenesis Treatment

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Right hepatectomy in living donors with previous abdominal surgery

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Hepatobiliary & Pancreatic Diseases International 2017年第1期16卷 33-38页

作者： Seong Hoon Kim Seung Duk Lee Young Kyu Kim Sang-Jae Park Center for liver Cancer National Cancer Center 111 Jungbalsan-ro Ilsandong-gu Goyang-si Gyeonggi-do 410-769 Korea

BACKGROUND： Few studies have evaluated the impact of previous abdominal surgery （PAS） on living donor right hepatectomy （LDRH）. The aim of this study was to investigate the outcomes of liver transplantation using right lobe grafts of living donors with PAS. METHODS： Data were reviewed from LDRH patients at the authors＇ institution between March 2008 and November 2014. LDRH patients with PAS were divided into two groups according to upper PAS （group 1） or lower PAS （group 2）, and they were compared to those without PAS （group 3） who were matched 1：1 based on age, gender, and body mass index. Periop- erative data, complications by the Clavien classification, and the outcomes with more than 14 months follow-up were compared. RESULTS： Twenty-three （4.9%） of a total of 471 LDRH donors had PAS. Eleven donors were assigned to group 1, 12 to group 2, and 23 to group 3. Intraperitoneal adhesions were found in 20 （87.0%） of 23 donors with PAS, of whom 5 （21.7%） had adhesiolysis-related injuries that happened more commonly in group 1 than in group 2 （P=0.025）. LDRH was successfully completed under upper midline laparotomy in all donors. No donors received perioperative blood transfusion. The peak postoperative AST, ALT, INR, and total bilirubin levels made no difference between the three groups. Compared with group 3, groups 1 and 2 had a longer operative time （P=0.012） and a higher grade I complication rate （P=0.047）. All donors recovered fully to their routine activities. The 23 recipients of grafts from donors with PAS showed good liver function with 1-year graft and patient survivals of 100%. CONCLUSION： A history of PAS is not a contraindication to LDRH in the current era of advanced surgical techniques.

关键词： living donor liver transplantation liver surgery liver function

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