Chronic liver disease(CLD)imposes a heavy burden on millions of people worldwide.Despite substantial research on the pathogenesis of CLD disorders,no optimal treatment is currently available for some diseases,such as ...Chronic liver disease(CLD)imposes a heavy burden on millions of people worldwide.Despite substantial research on the pathogenesis of CLD disorders,no optimal treatment is currently available for some diseases,such as liver cancer.Exosomes,which are extracellular vesicles,are composed of various cellular components.Exosomes have unique functions in maintaining cellular homeostasis and regulating cell communication,which are associated with the occurrence of disease.Furthermore,they have application potential in diagnosis and treatment by carrying diverse curative payloads.Hepatic macrophages,which are key innate immune cells,show extraordinary heterogeneity and polarization.Hence,macrophage-derived exosomes may play a pivotal role in the initiation and progression of various liver diseases.This review focuses on the effects of macrophage-derived exosomes on liver disease etiology and their therapeutic potential,which will provide new insights into alleviating the global pressure of CLD.展开更多
BACKGROUND Nonalcoholic fatty liver disease(NAFLD)encompasses a variety of liver conditions impacting individuals who consume minimal or no alcohol.Recently,traditional Chinese medicine has been gradually used to trea...BACKGROUND Nonalcoholic fatty liver disease(NAFLD)encompasses a variety of liver conditions impacting individuals who consume minimal or no alcohol.Recently,traditional Chinese medicine has been gradually used to treat mild to moderate fatty liver,among which Dendrobium nobile Lindl.powder has been affirmed by many doctors and patients to be effective.However,there is limited research on combining this treatment with standard therapies for mild to moderate NAFLD.AIM To survey the effect of combining Dendrobium nobile Lindl.powder with standard treatment on liver function and lipid metabolism disorder in patients with mild to moderate NAFLD.METHODS Eighty patients with mild to moderate NAFLD participated in this retrospective study,classified into two groups:The observation group(n=40)and the control group(n=40).In November 2020 and November 2022,the study was conducted at People’s Hospital of Chongqing Liang Jiang New Area.The control group received standard treatment,while the observation group received Dendrobium nobile Lindl.powder based on the control group.The study compared differences in traditional Chinese medicine clinical syndrome scores,liver fibrosis treatment,liver function indicators,lipid levels,and serum inflammatory factor levels before and after treatment,and we calculated the incidence of adverse reactions for both groups.RESULTS The total effective rate was 97.50%in the observation group and 72.5%in the control group.After 8 weeks of treatment,the main and secondary symptom scores remarkably decreased,especially in the observation group(P<0.05),and there was a significant reduction in the serum levels of hyaluronic acid(HA),laminin(LN),human rocollagen III(PC III),and collagen type IV(CIV).The levels of HA,LN,PC III,and CIV were significantly lower in the observation group(P<0.05).After 8 weeks,both groups indicated remarkable improvements in liver function and blood lipid levels,with the observation group having even lower levels(P<0.05).Serum levels of interleukin-1β,tumor necrosis factor-α,and interleukin-8 also dropped significantly.The observation group had a lower rate of adverse reactions(5.00%)compared to the control group(22.50%).CONCLUSION Adding Dendrobium nobile Lindl.powder to standard treatment has been found to remarkably improve symptoms and reduce inflammation in patients with mild to moderate fatty liver disease.It also enhances hepatic function and lipid profile,ameliorates liver fibrosis indices,and lowers the risk of side effects.Consequently,this therapeutic protocol shows promise for clinical implementation and dissemination.展开更多
More than five years ago,the treatment of hepatitis C virus infection was revolutionized with the introduction of all-oral direct-acting antiviral(DAA)drugs.They proved highly efficient in curing patients with chronic...More than five years ago,the treatment of hepatitis C virus infection was revolutionized with the introduction of all-oral direct-acting antiviral(DAA)drugs.They proved highly efficient in curing patients with chronic hepatitis C(CHC),including patients with cirrhosis.The new DAA treatments were alleged to induce significant improvements in clinical outcome and prognosis,but the exact cause of the expected benefit was unclear.Further,little was known about how the underlying liver disease would be affected during and after viral clearance.In this review,we describe and discuss the liver-related effects of the new treatments in regards to both pathophysiological aspects,such as macrophage activation,and the time-dependent effects of therapy,with specific emphasis on inflammation,structural liver changes,and liver function,as these factors are all related to morbidity and mortality in CHC patients.It seems clear that antiviral therapy,especially the achievement of a sustained virologic response has several beneficial effects on liver-related parameters in CHC patients with advanced liver fibrosis or cirrhosis.There seems to be a timedependent effect of DAA therapy with viral clearance and the resolution of liver inflammation followed by more discrete changes in structural liver lesions.These improvements lead to favorable effects on liver function,followed by an improvement in cognitive dysfunction and portal hypertension.Overall,the data provide knowledge on the several beneficial effects of DAA therapy on liverrelated parameters in CHC patients suggesting short-and long-term improvements in the underlying disease with the promise of an improved longterm prognosis.展开更多
In recent years,due to the increasingly accelerated pace of life,the incidence of hyperthyroidism is increasing year by year,which has a serious impact on the quality of life of patients.Traditional Chinese Medicine h...In recent years,due to the increasingly accelerated pace of life,the incidence of hyperthyroidism is increasing year by year,which has a serious impact on the quality of life of patients.Traditional Chinese Medicine has a unique effect on hyperthyroidism,Professor Zhang Ning,my tutor,who has been devoting to the clinical study of traditional Chinese medicine in the prevention and treatment of thyroid diseases for a long time,has rich theoretical knowledge as well as clinical practice experience.She's also good at using classical prescriptions for syndrome differentiation treatment,and has achieved excellent clinical efficacy.Professor Zhang Ning summarized the diagnosis and treatment idea of"treating from the liver"and ran it throughout the whole treatment process.For the patients prone to abnormal liver function,it is advocated to focus on protecting the liver in terms of medication,increase the effect of anti-hyperthyroidism,and also obtain satisfactory efficacy.展开更多
Alcoholic hepatitis(AH)is an acute hepatic inflammation associated with significant morbidity and mortality.Current evidence suggests that the pathogenesis is the end result of the complex interplay between ethanol me...Alcoholic hepatitis(AH)is an acute hepatic inflammation associated with significant morbidity and mortality.Current evidence suggests that the pathogenesis is the end result of the complex interplay between ethanol metabolism,inflammation and innate immunity.Several clinical scoring systems have been derived to predict the clinical outcomes of patients with AH;such as Child-Turcotte-Pugh score,the Maddrey discriminant function,the Lille Model,the model for end stage liver disease scores,and the Glasgow alcoholic hepatitis score.At present,Corticosteroids or pentoxifylline are the current pharmacologic treatment options;though the outcomes from the therapies are poor.Liver trans-plantation as the treatment of alcoholic hepatitis remains controversial,and in an era of organ shortage current guidelines do not recommend transplantation as the treatment option.Because of the limitations in the therapeutic options,it is no doubt that there is a critical need for the newer and more effective pharmacological agents to treat AH.展开更多
Background/Aims: Antituberculosis drug-induced liver injury (TB DILI) is a frequent medical problem in Pakistan. Critical understanding of various aspects of TB DILI is not only important to manage liver injury but ma...Background/Aims: Antituberculosis drug-induced liver injury (TB DILI) is a frequent medical problem in Pakistan. Critical understanding of various aspects of TB DILI is not only important to manage liver injury but may also prevent unnecessary discontinuation of antituberculosis treatment. The study is aimed to determine the frequency, types, severity and patterns of TB DILI. Study further evaluates various risk factors of TB DILI. Materials and Methods: This is a prospective cohort study of two seventy-eight patients with the diagnosis of tuberculosis, where patients were followed during tuberculosis treatment. TB DILI was defined in accordance to international DILI expert working group. Results: Out of two seventy eight-patients, ninety-five (34.14%) had TB DILI. The most common pattern of TB DILI was hepatocellular (63.15%) followed by mixed (23.15%) and Cholestatic (13.68%). Most of the patients had mild DILI (43.15%) followed by moderate (30.52%), severe (20.01%) and very severe (5.26%). Age > 35 years, concomitant hepatotoxic drugs, extrapulmonary TB and malnutrition are important risk factors for TB DILI. Conclusion: All patterns of TB DILI with varying severity were present. Age > 35 years, malnutrition, extrapulmonary TB and concomitant use of hepatotoxic drugs were risk factors for TB DILI.展开更多
BACKGROUND Primary hepatocellular carcinoma(HCC)is a common malignant tumour,and its early symptoms are often not obvious,resulting in many patients experiencing middle-to late-stage disease at the time of diagnosis.T...BACKGROUND Primary hepatocellular carcinoma(HCC)is a common malignant tumour,and its early symptoms are often not obvious,resulting in many patients experiencing middle-to late-stage disease at the time of diagnosis.The optimal time for surgery is often missed for these patients,and those who do undergo surgery have unsatisfactory long-term outcomes and a high recurrence rate within five years.Therefore,postoperative follow-up treatments,such as transhepatic arterial chemoembolization(TACE),have become critical to improving survival and reducing recurrence rates.AIM To validate the prophylactic role of TACE after hepatic resection and to assess its impact on patient prognosis.METHODS This study investigated the efficacy of TACE in patients with intermediate-stage HCC after hepatectomy.When the post-treatment results of the observation group and the control group were compared,it was found that the inclusion of TACE significantly improved the clinical efficacy,reduced the levels of tumour markers and did not aggravate the damage to liver function.Thus,this may be an effective and comprehensive treatment strategy for patients with intermediate-stage HCC that helps to improve their quality of life and survival time.RESULTS When the baseline data were analysed,no statistical differences were found between the two groups in terms of gender,age,hepatitis B virus,cirrhosis,Child-Pugh grading,number of tumours,maximum tumour diameter and degree of tumour differentiation.The assessment of clinical efficacy showed that the post-treatment overall remission rate of the observation group was significantly higher than that of the control group.In terms of changes in tumour markers,the alpha-fetoprotein and carcinoembryonic antigen levels in the patients in the observation group decreased more significantly after treatment compared with those in the control group.When post-treatment changes in liver function indicators were analysed,no statistical differences were found in the total bilirubin,alanine aminotransferase and aspartate aminotransferase levels between the two groups.CONCLUSION In patients with intermediate-stage HCC,post-hepatectomy TACE significantly improved clinical outcomes,reduced tumour-marker levels and may have improved the prognosis by removing residual lesions.Thus,this may be an effective and comprehensive treatment strategy for patients with intermediate-stage HCC.展开更多
Coronavirus disease 2019(COVID-19)disease affects multiple organs,including anomalies in liver function.In this review we summarize the knowledge about liver injury found during severe acute respiratory syndrome coron...Coronavirus disease 2019(COVID-19)disease affects multiple organs,including anomalies in liver function.In this review we summarize the knowledge about liver injury found during severe acute respiratory syndrome coronavirus 2(SARSCoV-2)infection with special attention paid to possible mechanisms of liver damage and abnormalities in liver function tests allowing for the evaluation of the severity of liver disease.Abnormalities in liver function observed in COVID-19 disease are associated with the age and sex of patients,severity of liver injury,presence of comorbidity and pre-treatment.The method of antiviral treatment can also impact on liver function,which manifests as increasing values in liver function tests.Therefore,analysis of variations in liver function tests is necessary in evaluating the progression of liver injury to severe disease.展开更多
Background andAims:Hepatitis C Virus(HCV)is uniformly recurrent after liver transplant(LT)and recurrence is associated with an increased risk of mortality.Immunosuppressive medications increase the risk of chronic kid...Background andAims:Hepatitis C Virus(HCV)is uniformly recurrent after liver transplant(LT)and recurrence is associated with an increased risk of mortality.Immunosuppressive medications increase the risk of chronic kidney disease,and the presence of chronic kidney disease presents a challenge for HCV treatment in LT recipients.The aim of this study was to assess changes in glomerular filtration rates(GFRs)of LT recipients receiving HCV treatment.Methods:This is a retrospective study of LT patients who received HCV treatment between 2015 and 2016(n=60).The outcomes of interest were differences in serum creatinine levels and in GFR,measured at treatment initiation and at 24 weeks after treatment.The average age of the patients was 59 years-old,and 17%were cirrhotic and 67%were treatment-experienced.All patients received sofosbuvir/ledipasvir without ribavirin.Results:All patients achieved sustained virologic response at 12 weeks after treatment(SVR12).At baseline,55%of patients had GFR<60 mL/min per 1.73 m2.Among those patients,GFR did not change in 18%,33%had improved GFR,and 48%had worsened GFR.Up to 45%of the patients had a GFR>60 mL/min per 1.73 m2.Among those patients,GFR did not change in 81%,and 19%had worsened GFR.In the entire cohort,65%of patients had improved or stable GFR and 35%had worsened GFR.The average change in serum creatinine between baseline and 24 weeks was 0.10(p=0.18).Conclusions:This study showed improved or unchanged GFR in 65%and worsened GFR in 35%of LT recipients who achieved SVR12.Worsening of GFR was more frequently encountered in those with impaired renal function at baseline.Caution should be used when treating HCV in LT recipients,especially those with baseline status of renal impairment.展开更多
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 eval...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.展开更多
基金Ningbo Natural Science Foundation,No.2022J229and the Project of Ningbo Leading Medical&Health Discipline,No.2022-S04.
文摘Chronic liver disease(CLD)imposes a heavy burden on millions of people worldwide.Despite substantial research on the pathogenesis of CLD disorders,no optimal treatment is currently available for some diseases,such as liver cancer.Exosomes,which are extracellular vesicles,are composed of various cellular components.Exosomes have unique functions in maintaining cellular homeostasis and regulating cell communication,which are associated with the occurrence of disease.Furthermore,they have application potential in diagnosis and treatment by carrying diverse curative payloads.Hepatic macrophages,which are key innate immune cells,show extraordinary heterogeneity and polarization.Hence,macrophage-derived exosomes may play a pivotal role in the initiation and progression of various liver diseases.This review focuses on the effects of macrophage-derived exosomes on liver disease etiology and their therapeutic potential,which will provide new insights into alleviating the global pressure of CLD.
基金Supported by the Chongqing Science and Health Joint Medical Research Project,No.2022MSXM133the First Batch of Key Disciplines on Public Health in Chongqing,Natural Science Foundation of Chongqing,No.CSTB2022NSCQ-MSX1522.
文摘BACKGROUND Nonalcoholic fatty liver disease(NAFLD)encompasses a variety of liver conditions impacting individuals who consume minimal or no alcohol.Recently,traditional Chinese medicine has been gradually used to treat mild to moderate fatty liver,among which Dendrobium nobile Lindl.powder has been affirmed by many doctors and patients to be effective.However,there is limited research on combining this treatment with standard therapies for mild to moderate NAFLD.AIM To survey the effect of combining Dendrobium nobile Lindl.powder with standard treatment on liver function and lipid metabolism disorder in patients with mild to moderate NAFLD.METHODS Eighty patients with mild to moderate NAFLD participated in this retrospective study,classified into two groups:The observation group(n=40)and the control group(n=40).In November 2020 and November 2022,the study was conducted at People’s Hospital of Chongqing Liang Jiang New Area.The control group received standard treatment,while the observation group received Dendrobium nobile Lindl.powder based on the control group.The study compared differences in traditional Chinese medicine clinical syndrome scores,liver fibrosis treatment,liver function indicators,lipid levels,and serum inflammatory factor levels before and after treatment,and we calculated the incidence of adverse reactions for both groups.RESULTS The total effective rate was 97.50%in the observation group and 72.5%in the control group.After 8 weeks of treatment,the main and secondary symptom scores remarkably decreased,especially in the observation group(P<0.05),and there was a significant reduction in the serum levels of hyaluronic acid(HA),laminin(LN),human rocollagen III(PC III),and collagen type IV(CIV).The levels of HA,LN,PC III,and CIV were significantly lower in the observation group(P<0.05).After 8 weeks,both groups indicated remarkable improvements in liver function and blood lipid levels,with the observation group having even lower levels(P<0.05).Serum levels of interleukin-1β,tumor necrosis factor-α,and interleukin-8 also dropped significantly.The observation group had a lower rate of adverse reactions(5.00%)compared to the control group(22.50%).CONCLUSION Adding Dendrobium nobile Lindl.powder to standard treatment has been found to remarkably improve symptoms and reduce inflammation in patients with mild to moderate fatty liver disease.It also enhances hepatic function and lipid profile,ameliorates liver fibrosis indices,and lowers the risk of side effects.Consequently,this therapeutic protocol shows promise for clinical implementation and dissemination.
文摘More than five years ago,the treatment of hepatitis C virus infection was revolutionized with the introduction of all-oral direct-acting antiviral(DAA)drugs.They proved highly efficient in curing patients with chronic hepatitis C(CHC),including patients with cirrhosis.The new DAA treatments were alleged to induce significant improvements in clinical outcome and prognosis,but the exact cause of the expected benefit was unclear.Further,little was known about how the underlying liver disease would be affected during and after viral clearance.In this review,we describe and discuss the liver-related effects of the new treatments in regards to both pathophysiological aspects,such as macrophage activation,and the time-dependent effects of therapy,with specific emphasis on inflammation,structural liver changes,and liver function,as these factors are all related to morbidity and mortality in CHC patients.It seems clear that antiviral therapy,especially the achievement of a sustained virologic response has several beneficial effects on liver-related parameters in CHC patients with advanced liver fibrosis or cirrhosis.There seems to be a timedependent effect of DAA therapy with viral clearance and the resolution of liver inflammation followed by more discrete changes in structural liver lesions.These improvements lead to favorable effects on liver function,followed by an improvement in cognitive dysfunction and portal hypertension.Overall,the data provide knowledge on the several beneficial effects of DAA therapy on liverrelated parameters in CHC patients suggesting short-and long-term improvements in the underlying disease with the promise of an improved longterm prognosis.
基金Capital health development scientific research project(No.First Issue 2020-2-4162)Capital building project for sustainable utilization of valuable Chinese medicine resources(No.2060302)
文摘In recent years,due to the increasingly accelerated pace of life,the incidence of hyperthyroidism is increasing year by year,which has a serious impact on the quality of life of patients.Traditional Chinese Medicine has a unique effect on hyperthyroidism,Professor Zhang Ning,my tutor,who has been devoting to the clinical study of traditional Chinese medicine in the prevention and treatment of thyroid diseases for a long time,has rich theoretical knowledge as well as clinical practice experience.She's also good at using classical prescriptions for syndrome differentiation treatment,and has achieved excellent clinical efficacy.Professor Zhang Ning summarized the diagnosis and treatment idea of"treating from the liver"and ran it throughout the whole treatment process.For the patients prone to abnormal liver function,it is advocated to focus on protecting the liver in terms of medication,increase the effect of anti-hyperthyroidism,and also obtain satisfactory efficacy.
基金Supported by K08 AA016570 from the NIH/NIAAA,1I01-CX000361-01 from the Veterans Affairs Research and Admin-istration,Indiana University Research Support Fund GrantW81XWH-12-1-0497 from United States Department of Defense(all to Liangpunsakul S)
文摘Alcoholic hepatitis(AH)is an acute hepatic inflammation associated with significant morbidity and mortality.Current evidence suggests that the pathogenesis is the end result of the complex interplay between ethanol metabolism,inflammation and innate immunity.Several clinical scoring systems have been derived to predict the clinical outcomes of patients with AH;such as Child-Turcotte-Pugh score,the Maddrey discriminant function,the Lille Model,the model for end stage liver disease scores,and the Glasgow alcoholic hepatitis score.At present,Corticosteroids or pentoxifylline are the current pharmacologic treatment options;though the outcomes from the therapies are poor.Liver trans-plantation as the treatment of alcoholic hepatitis remains controversial,and in an era of organ shortage current guidelines do not recommend transplantation as the treatment option.Because of the limitations in the therapeutic options,it is no doubt that there is a critical need for the newer and more effective pharmacological agents to treat AH.
文摘Background/Aims: Antituberculosis drug-induced liver injury (TB DILI) is a frequent medical problem in Pakistan. Critical understanding of various aspects of TB DILI is not only important to manage liver injury but may also prevent unnecessary discontinuation of antituberculosis treatment. The study is aimed to determine the frequency, types, severity and patterns of TB DILI. Study further evaluates various risk factors of TB DILI. Materials and Methods: This is a prospective cohort study of two seventy-eight patients with the diagnosis of tuberculosis, where patients were followed during tuberculosis treatment. TB DILI was defined in accordance to international DILI expert working group. Results: Out of two seventy eight-patients, ninety-five (34.14%) had TB DILI. The most common pattern of TB DILI was hepatocellular (63.15%) followed by mixed (23.15%) and Cholestatic (13.68%). Most of the patients had mild DILI (43.15%) followed by moderate (30.52%), severe (20.01%) and very severe (5.26%). Age > 35 years, concomitant hepatotoxic drugs, extrapulmonary TB and malnutrition are important risk factors for TB DILI. Conclusion: All patterns of TB DILI with varying severity were present. Age > 35 years, malnutrition, extrapulmonary TB and concomitant use of hepatotoxic drugs were risk factors for TB DILI.
文摘BACKGROUND Primary hepatocellular carcinoma(HCC)is a common malignant tumour,and its early symptoms are often not obvious,resulting in many patients experiencing middle-to late-stage disease at the time of diagnosis.The optimal time for surgery is often missed for these patients,and those who do undergo surgery have unsatisfactory long-term outcomes and a high recurrence rate within five years.Therefore,postoperative follow-up treatments,such as transhepatic arterial chemoembolization(TACE),have become critical to improving survival and reducing recurrence rates.AIM To validate the prophylactic role of TACE after hepatic resection and to assess its impact on patient prognosis.METHODS This study investigated the efficacy of TACE in patients with intermediate-stage HCC after hepatectomy.When the post-treatment results of the observation group and the control group were compared,it was found that the inclusion of TACE significantly improved the clinical efficacy,reduced the levels of tumour markers and did not aggravate the damage to liver function.Thus,this may be an effective and comprehensive treatment strategy for patients with intermediate-stage HCC that helps to improve their quality of life and survival time.RESULTS When the baseline data were analysed,no statistical differences were found between the two groups in terms of gender,age,hepatitis B virus,cirrhosis,Child-Pugh grading,number of tumours,maximum tumour diameter and degree of tumour differentiation.The assessment of clinical efficacy showed that the post-treatment overall remission rate of the observation group was significantly higher than that of the control group.In terms of changes in tumour markers,the alpha-fetoprotein and carcinoembryonic antigen levels in the patients in the observation group decreased more significantly after treatment compared with those in the control group.When post-treatment changes in liver function indicators were analysed,no statistical differences were found in the total bilirubin,alanine aminotransferase and aspartate aminotransferase levels between the two groups.CONCLUSION In patients with intermediate-stage HCC,post-hepatectomy TACE significantly improved clinical outcomes,reduced tumour-marker levels and may have improved the prognosis by removing residual lesions.Thus,this may be an effective and comprehensive treatment strategy for patients with intermediate-stage HCC.
文摘Coronavirus disease 2019(COVID-19)disease affects multiple organs,including anomalies in liver function.In this review we summarize the knowledge about liver injury found during severe acute respiratory syndrome coronavirus 2(SARSCoV-2)infection with special attention paid to possible mechanisms of liver damage and abnormalities in liver function tests allowing for the evaluation of the severity of liver disease.Abnormalities in liver function observed in COVID-19 disease are associated with the age and sex of patients,severity of liver injury,presence of comorbidity and pre-treatment.The method of antiviral treatment can also impact on liver function,which manifests as increasing values in liver function tests.Therefore,analysis of variations in liver function tests is necessary in evaluating the progression of liver injury to severe disease.
文摘Background andAims:Hepatitis C Virus(HCV)is uniformly recurrent after liver transplant(LT)and recurrence is associated with an increased risk of mortality.Immunosuppressive medications increase the risk of chronic kidney disease,and the presence of chronic kidney disease presents a challenge for HCV treatment in LT recipients.The aim of this study was to assess changes in glomerular filtration rates(GFRs)of LT recipients receiving HCV treatment.Methods:This is a retrospective study of LT patients who received HCV treatment between 2015 and 2016(n=60).The outcomes of interest were differences in serum creatinine levels and in GFR,measured at treatment initiation and at 24 weeks after treatment.The average age of the patients was 59 years-old,and 17%were cirrhotic and 67%were treatment-experienced.All patients received sofosbuvir/ledipasvir without ribavirin.Results:All patients achieved sustained virologic response at 12 weeks after treatment(SVR12).At baseline,55%of patients had GFR<60 mL/min per 1.73 m2.Among those patients,GFR did not change in 18%,33%had improved GFR,and 48%had worsened GFR.Up to 45%of the patients had a GFR>60 mL/min per 1.73 m2.Among those patients,GFR did not change in 81%,and 19%had worsened GFR.In the entire cohort,65%of patients had improved or stable GFR and 35%had worsened GFR.The average change in serum creatinine between baseline and 24 weeks was 0.10(p=0.18).Conclusions:This study showed improved or unchanged GFR in 65%and worsened GFR in 35%of LT recipients who achieved SVR12.Worsening of GFR was more frequently encountered in those with impaired renal function at baseline.Caution should be used when treating HCV in LT recipients,especially those with baseline status of renal impairment.
基金Novel Coronavirus Pneumonia Emergency Project of University of South China,No.2020-15 and No.2020-25Fund Project of Hengyang City for Prevention and Control of COVID-19,No.202010031577and Key Research and Development Program of Hunan Province,No.2020SK3039 and No.2020SK3040.
文摘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.
