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Prevalence and risk factors for minimal hepatic encephalopathy in cirrhotic patients with different etiologies

portal Hypertension & Cirrhosis 2023年第4期2卷 171-180页

作者： Xiaoyan Li Shanghao Liu Huiling Xiang Qingge Zhang Ying Guo Hongmei Zu Jing Wang Jiaojian Lv Xiaoning Zhang Fanping Meng Jiahuan Li Jie Li Yangzhen Bianba Jia Shang Guo Zhang Fei Liu Zhaowei Tong Chuang Lei Wei Ye Qiaohua Yang Ningning Wang Ying Song Wei Fu Ziyue Li Yanjing Gao Yongping Zhang Jiafang Chen Caiyun Wu Qi Zheng Fang Wang Jiali Yu Lianjie Lin Chuanlong Yang Xiaoting Yang Xiaomin Ye Xiangmei Wang Xuelan Zhao Xiaolong Qi Fusheng Wang Junliang Fu Medical School of Chinese PLA BeijingChina National Clinical Research Center for Infectious Diseases The Fifth Medical Center of Chinese PLA General HospitalBeijingChina The First School of Clinical Medicine of Lanzhou University LanzhouGansuChina Tianjin Key laboratory of Extracorporeal Life Support for Critical Diseases Department of Gastroenterology and HepatologyTianjin Third Central HospitalInstitute of Hepatobiliary DiseaseTianjinChina Hepatology Department of Integrated Traditional Chinese and Western Medicine Xingtai People's HospitalXingtaiHebeiChina Department of Hepatology The Third people's Hospital of TaiyuanTaiyuanShanxiChina Department of Gastroenterology The Fourth People's Hospital of Qinghai ProvinceXiningQinghaiChina Department of Gastroenterology The Second Affiliated Hospital of Baotou Medical CollegeBaotouInner MongoniaChina Department of Infectious Disease Lishui City People's HospitalLishuiZhejiangChina Department of Infectious Diseases Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina Department of Infectious Diseases Nanjing Drum Tower HospitalThe Affiliated Hospital of Medical SchoolNanjing UniversityNanjingJiangsuChina Department of Hepatology The Third People's Hospital of Tibet Autonomous RegionLhasaXizangChina Department of Infectious Diseases Henan Provincial People's HospitalZhengzhouHenanChina Department of Gastroenterology The People's Hospital of Guangxi Zhuang Autonomous RegionNanningGuangxiChina Hunan Key laboratory of Viral Hepatitis Department of Infectious DiseasesXiangya HospitalCentral South UniversityChangshaHunanChina Department of Infectious Diseases Huzhou Central HospitalHuzhouZhejiangChina Department of Infectious Diseases The First People's Hospital of Changde CityChangdeHunanChina Liver Cirrhosis Treatment Center Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese MedicineNanjingJiangsuChina Hepatology Department of Infectious Diseases Cent

Aims:Minimal hepatic encephalopathy(MHE)significantly affects the prognosis of patients with *** study was performed to determine whether there is a difference in the prevalence of MHE among patients with cirrhosis of different etiologies and whether the etiology directly influences the occurrence of ***:This multicenter,cross-sectional study enrolled 1879 patients with confirmed cirrhosis at 40 hospitals from October 25,2021,to January 10,2023(Trial registration:https://***/[NCT05140837]).The patients'demographics,etiologies of cirrhosis,and laboratory test results were *** psychometric hepatic encephalopathy score(PHES)was determined in all patients to screen for *** logistic analyses were performed to identify the risk factors for ***:In total,736 patients with cirrhosis were *** prevalence of MHE was 42.0%(n=309).The primary etiology among all patients was hepatitis B virus(HBV)-related cirrhosis(71.9%[529/736]).The prevalence of MHE was significantly higher in patients with alcoholic cirrhosis(57.1%[40/70])than in those with HBV-related cirrhosis(40.6%[215/529],p=0.009)or hepatitis C virus(HCV)-related cirrhosis(38.2%[26/68],p=0.026).Age(odds ratio[OR],1.042;95%confidence interval[CI],1.024-1.059;p<0.001),duration of education(OR,0.935;95%CI,0.899-0.971;p=0.001),etiology(OR,1.740;95%CI,1.028-2.945;p=0.039),and high MELD-Na scores(OR,1.038;95%CI,1.009-1.067;p=0.009)were independent risk factors for *** patients with cirrhosis of different etiologies were analyzed separately,the results showed that age(OR,1.035;95%CI,1.014-1.057;p=0.001)and duration of education(OR,0.924;95%CI,0.883-0.966;p=0.001)were risk factors for MHE among patients with HBV-related cirrhosis,whereas age(OR,1.138;95%CI,1.033-1.254;p=0.009)and creatinine concentration(OR,16.487;95%CI,1.113-244.160;p=0.042)were risk factors for MHE in patients with HCV-related *** risk factors for MHE were found in patients

关键词： etiology liver cirrhosis minimal hepatic encephalopathy psychometric hepatic encephalopathy score risk factors

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Segmental intrahepatic cholestasis as a technical complication of the transjugular intrahepatic porto-systemic shunt

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World Journal of Gastroenterology 2019年第43期25卷 6430-6439页

作者： Julian Nikolaus Bucher Marcus Hollenbach Steffen Strocka Gereon Gaebelein Michael Moche Thorsten Kaiser Michael Bartels Albrecht Hoffmeister Department of Surgery Munich University Hospital at GroβhadernBavariaMunich 81377Germany Medical Department Ⅱ-Gastroenterology HepatologyInfectious DiseasesPulmonologyUniversity of Leipzig Medical CenterSaxonyLeipzig 04103Germany Department of Diagnostic and Interventional Radiology University of Leipzig Medical CenterSaxonyLeipzig 04103Germany Department of General VisceralVascular and Pediatric SurgeryUniversity of SaarlandSaarlandHomburg 66421Germany Department of Diagnostic and Interventional Radiology BavariaNuernberg 90411Germany Institute of laboratory Medicine Clinical Chemistry and Molecular DiagnosticsUniversity of Leipzig Medical CenterSaxonyLeipzig 04310Germany Department for General and Visceral Surgery Helios Park-Klinikum LeipzigSaxonyLeipzig 04289Germany Medical Department Ⅱ-Gastroenterology HepatologyInfectious DiseasesPulmonologyUniversity of Leipzig Medical CenterLeipzig 04103SaxonyGermany

BACKGROUND Segmental intrahepatic cholestasis caused by transjugular intrahepatic portosystemic shunt(TIPS)(SIC-T),is a rare complication of this technique and only referred by case ***,we conducted a systematic,retrospective analysis to provide evidence regarding prevalence and consequences of this TIPS-induced bile duct *** To assess prevalence and outcome of SIC-T in a large *** In this retrospective cohort study,we screened the institutional databases for all consecutive patients that were treated by TIPS-placement or TIPS-revision between January 2005 and August *** analyzed radiologic images for signs of biliary *** that were indicative of SIC-T were reviewed by two independent radiologists and additional patient data was *** statistics of patient demographics,indications for TIPS and procedural details were *** regression analysis was performed to identify predictors for the development of *** We analyzed 135 cirrhotic patients who underwent TIPS(mean age 55 years,79%male gender).Etiology of cirrhosis was alcohol in most cases and indications for TIPS were mainly refractory ascites and recurrent variceal *** revision was necessary in 31 *** identified 4 cases(2.9%)of SIC-T in direct proximity of the *** was confirmed by CT-scan,MRI or endoscopic retrograde cholangio pancreaticography(ERCP).In two patients TIPS was implanted via the right and in one through the medial hepatic *** patient received TIPS-prolongation by multiple *** patients were asymptomatic but one cholangitic abscess necessitated a transhepatic *** regression analysis identified TIPS-placement other than from medial hepatic vein to right portal vein as risk factor(OR 21.0)for *** SIC-T ads to(mostly late)complications in the interventional treatment of cirrhotic portal hypertensions and can lead to cholangitic ***

关键词： Transjugular intrahepatic portosystemic shunt Cirrhosis Ascites Bleeding Cholestasis Biliary congestion

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Traditional Chinese medicine targets on hepatic stellate cells for the treatment of hepatic fibrosis: A mechanistic review

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portal Hypertension & Cirrhosis 2023年第1期2卷 16-31页

作者： Dengcheng Hui Lu Liu Yanqin Bian Nisma L.B.Azami Jingru Song Yanping Huang Mingyu Sun Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine ShanghaiChina Shanghai University of Traditional Chinese Medicine ShanghaiChina Key laboratory of Liver and Kidney Diseases Institute of Liver DiseasesShuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina Arthritis Institute of Integrated Chinese and Western Medicine Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina Department of Gastroenterology Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical UniversityHangzhouZhejiangChina Department of Good Clinical Practice Office Tongren HospitalShanghai Jiao Tong ShanghaiJiaotong University School of MedicineShanghaiChina

Liver cirrhosis is a leading cause of death from liver‐related diseases accompanied by a variety of complications;however,hepatic fibrosis,an inevitable stage of cirrhosis,is possible to be reversed and *** stellate cells(HSCs)are the primary cells that secrete extracellular matrix in the liver and play a dominant role in the pathogenesis of hepatic *** therapeutic approaches for reversing hepatic fibrosis aim at inhibiting the activation of HSCs and inducing their inactivation or *** review highlights the mechanism by which traditional Chinese medicine(TCM)regulates the activity of HSCs and exerts antifibrotic effects,providing insights and prospects for the treatment of hepatic fibrosis with TCM.

关键词： extracellular matrix hepatic fibrosis hepatic stellate cells Traditional Chinese medicine

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Management of hepatocellular carcinoma with portal vein tumor thrombosis: Review and update at 2016

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World Journal of Gastroenterology 2016年第32期22卷 7289-7300页

作者： Stephen L Chan Charing CN Chong Anthony WH Chan Darren MC Poon Kenneth SH Chok State Key laboratory in Oncology of South China Institute of Digestive Disease The Chinese University of Hong Kong Department of Clinical Oncology Sir YK Pao Center for Cancer Hong Kong Cancer Institute The Chinese University of Hong Kong Prince of Wales Hospital Department of Surgery Prince of Wales Hospital The Chinese University of Hong Kong State Key Laborator in Oncology of South China Department of Anatomical and Cellular Pathology The Chinese University of Hong Kong Department of Surgery Queen Mary Hospital The University of Hong Kong

portal vein tumor thrombosis(PVTT) is a common phenomenon in hepatocellular carcinoma(HCC). Compared to HCC without PVTT, HCC with PVTT is characterized by an aggressive disease course, worse hepatic function, a higher chance of complications related to portal hypertension and poorer tolerance to treatment. Conventionally, HCC with PVTT is grouped together with metastatic HCC during the planning of its management, and most patients are offered palliative treatment with sorafenib or other systemic agents. As a result, most data on the management of HCC with PVTT comes from subgroup analyses or retrospective series. In the past few years, there have been several updates on management of HCC with PVTT. First, it is evident that HCC with PVTT consists of heterogeneous subgroups with different prognoses. Different classifications have been proposed to stage the degree of portal vein invasion/thrombosis, suggesting that different treatment modalities may be individualized to patients with different risks. Second, more studies indicate that more aggressive treatment, including surgical resection or locoregional treatment, may benefit select HCC patients with PVTT. In this review, we aim to discussthe recent conceptual changes and summarize the data on the management of HCC with PVTT.

关键词： Liver cancer Vascular invasion Targeted agent Surgery Radiotherapy

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Non‐hemodynamic effects:Repurposing of nonselective beta‐blockers in cirrhosis?

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portal Hypertension & Cirrhosis 2022年第2期1卷 153-156页

作者： Yi Yang Mingkai Li Jinni Luo Hongsheng Yu Hong Tian Xing Wang Department of Gastroenterology The Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina School of Medicine Xizang Minzu UniversityXianyangChina Guangdong Provincial Key laboratory of Liver Disease Research GuangzhouChina

To the Editor:Liver cirrhosis(LC),the end‐stage condition of chronic liver disease,results in>1,300,000 annual deaths ***,the global incidence of decompensated cirrhosis is rising yearly.1 Following clinically significant portal hypertension(CSPH)in the late compensated stage of LC,as the disease progresses to the decompensated stage,ascites,gastroesophageal variceal bleeding,hepatic encephalopathy(HE),and other severe complications *** beta‐blockers(NSBBs)have currently served as the first‐line therapy for primary and secondary prophylaxis of portal‐hypertensive gastrointestinal bleeding,as recommended by practice guidelines.2 Moreover,recent recommendations have extended the use of NSBBs to compensate LC patients with CSPH.

关键词： cirrhosis bleeding hypertensive

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