Acute-on-chronic liver failure(ACLF)is one of the leading causes of mortality among patients with chronic liver disease.Potentially reversible,ACLF requires precise clinical classification to facilitate accurate diagnosis,targeted treatment,and comprehensive management.Based on the latest research findings and clinical evidence,the Severe Liver Disease and Artificial Liver Group and the Nutrition and Regeneration in End-Stage Liver Disease Group,Chinese Society of Hepatology,Chinese Medical Association,together with multidisciplinary experts,have jointly compiled China's first guideline for the diagnosis and treatment of ACLF.The guideline aims to provide guidance for the diagnosis,treatment,and individualized management of patients with ACLF in clinical practice.
The Chinese Society of Hepatology of the Chinese Medical Association invited relevant experts to revise and update the Guideline of Prevention and Treatment of Nonalcoholic Fatty Liver Disease (2018Version) and renamed it as (Version 2024) Guideline for the Prevention and Treatment of Metabolic Dysfunction-associated (non-alcoholic) Fatty Liver Disease. Herein, the guiding recommendations on clinical issues such as screening and monitoring, diagnosis and evaluation, treatment and follow-up of metabolic dysfunction-associated fatty liver disease are put forward.
目的 探讨采用药物洗脱微球肝动脉化疗栓塞(DEB-TACE)序贯射频消融(RFA)治疗原发性肝癌(PLC)患者的疗效.方法 2017 年11 月～2020 年11 月我院诊治的PLC患者72 例,其中接受DEB-TACE治疗38 例作为对照组,接受DEB-TACE序贯 RFA 治疗 34 例为观察组.采用电化学发光法检测血清甲胎蛋白(AFP)、热休克蛋白 90α(HSP90α)、糖类抗原125(CA125)和CA199 水平.术后行影像学检查,评估疗效.结果 治疗后近期随访,观察组和对照组客观缓解率分别为79.4%和55.3%,差异有统计学意义(P<0.05);观察组血清AFP、HSP90α和CA125 水平分别为(123.6±32.5)μg/L、(97.6±21.6)ng/mL和(30.2±13.2)U/mL,均显著低于对照组[分别为(264.5±34.6)μg/L、(129.1±22.3)ng/mL和(71.6±14.3)U/mL,P<0.05];观察组患者中位总体生存(OS)为 28 个月,其 1a和 2a生存率分别为88.2%和67.6%,而对照组患者中位OS为20 个月,其1a和2a生存率分别为71.1%和42.1%,两组差异显著(Log Rank x2 =4.258,P=0.039).结论 采用DEB-TACE序贯RFA治疗PLC患者临床疗效确切,可显著延长患者生存时间.
目的 探讨乙型肝炎肝硬化并发自发性细菌性腹膜炎(SBP)患者外周血单个核细胞(PBMCs)核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)和半胱氨酸蛋白酶 1(caspase-1)水平变化及其预测预后的价值.方法 2018 年 1月～2020 年5 月我院诊治的乙型肝炎肝硬化并发SBP患者65 例,采用PCR法检测PBMCs NLRP3 和Caspase-1 mRNA水平,采用ELISA法检测血清血白介素-1β(IL-1β)和IL-18 水平.应用受试者工作特征曲线并计算曲线下面积(AUC)分析各指标对患者预后的预测价值.结果 21 例重症组PBMCs NLRP3 和Caspase-1 mRNA水平及血清IL-1β和IL-18 水平分别为(1.5±0.3)和(2.0±0.4)、(11.7±2.1)pg/mL和(17.4±1.6)pg/mL,显著高于44 例轻症组[分别为(1.1±0.2)和(1.6±0.3)、(8.6±1.3)pg/mL和(12.1±1.3)pg/mL,P<0.05];应用PBMCs NLRP3 联合Caspase-1 水平评估SBP患者病情严重程度的AUC为0.899,SE(95%CI)= 0.036(0.828～0.971);15 例死亡组PBMCs NLRP3 和Caspase-1 mRNA水平及血清IL-1β和IL-18 水平分别为(1.7±0.3)和(2.3±0.5)、(12.5±2.2)pg/mL和(18.2±3.1)pg/mL,显著高于 50 例生存组[分别为(1.1±0.2)和(1.6±0.3)、(8.9±1.8)pg/mL 和(12.7±2.5)pg/mL,P<0.05];应用 PBMCs NLRP3 联合Caspase-1 水平预测患者预后的AUC为0.916,SE(95%CI)= 0.043(0.831～0.999).结论 乙型肝炎肝硬化并发SBP患者PBMCs NLRP3 和Caspase-1 水平升高,可能与病情严重程度相关,其机制仍需要研究.
