Clinical implications,diagnosis,and management of diabetes in patients with chronic liver diseases

Diabetes mellitus(DM)negatively affects the development and progression of chronic liver diseases(CLD)of various etiologies.Concurrent DM and CLD are also associated with worse clinical outcomes with respect to mortality,the occurrence of hepatic decompensation,and the development of hepatocellular carcinoma(HCC).Unfortunately,early diagnosis and optimal treatment of DM can be challenging,due to the lack of established clinical guidelines as well as the medical complexity of this patient population.We conducted an exploratory review of relevant literature to provide an up-to-date review for internists and hepatologists caring for this patient population.We reviewed the epidemiological and pathophysiological associations between DM and CLD,the impact of insulin resistance on the progression and manifestations of CLD,the pathogenesis of hepatogenic diabetes,as well as the practical challenges in diagnosis and monitoring of DM in this patient population.We also reviewed the latest clinical evidence on various pharmacological antihyperglycemic therapies with an emphasis on liver disease-related clinical outcomes.Finally,we proposed an algorithm for managing DM in patients with CLD and discussed the clinical and research questions that remain to be addressed.

腹膜后脂肪肉瘤中天冬氨酸-天冬酰胺β轻化酶蛋白的表达及其临床意义

目的探讨腹膜后脂肪肉瘤中天冬氨酸-天冬酰胺β轻化酶(aspartate-β-hydroxylase,ASPH)的表达,分析其与患者的临床病理学特征及预后的关系。方法收集2017年2月至2018年2月北京大学国际医院腹膜后肿瘤外科收治并经过手术治疗的69例腹膜后脂肪肉瘤患者的临床资料,通过免疫组化方法检测肿瘤组织中ASPH的表达,采用SYFPEITHI和NetMHCpan软件预测方法对ASPH蛋白HLA-A2限制性CTL表位进行预测。结果本组69例腹膜后脂肪肉瘤患者的ASPH阳性率为81%,其中高分化脂肪肉瘤ASPH阳性率为73%,去分化脂肪肉瘤ASPH阳性率为87%,两者相比差异具有统计学意义(P<0.05)。ASPH表达水平高与低的患者术后无复发生存率差异有统计学意义(P<0.05)。用基序预测法筛选出5个HLA-A2限制性CTL表位(9肽)与HLA-A2分子具有较高的结合力。结论腹膜后脂肪肉瘤中ASPH表达水平与肿瘤恶性程度呈正相关.ASPH表达水平是腹膜后脂肪肉瘤术后无复发生存率的独立危险因素。ASPH存在HLA-A2限制性CTL表位,有望用于腹膜后脂肪肉瘤的免疫治疗。