To characterize natural history of cryptogenic cirrhosis (CC) and compare its clinical features and outcomes to those of hepatitis C virus (HCV)-related cirrhosis.METHODSA prospective cohort of 102 consecutive patient...To characterize natural history of cryptogenic cirrhosis (CC) and compare its clinical features and outcomes to those of hepatitis C virus (HCV)-related cirrhosis.METHODSA prospective cohort of 102 consecutive patients at their first diagnosis of CC were enrolled in this study. The clinical data and outcomes were compared to an age- and Child-Pugh class-matched cohort of 110 patients with HCV-related cirrhosis. Diagnosis of cirrhosis was based on compatible clinical and laboratory parameters, ultrasound/endoscopic parameters and, whenever possible, on histological grounds and transient elastography. All cases of cirrhosis without a definite etiology were enrolled in the CC group. The parameters assessed were: (1) severity of liver disease at the time of first diagnosis; (2) liver decompensation during follow-up; (3) hepatocellular carcinoma (HCC); (4) orthotopic liver transplantation; and (5) death. The independent associated factors were evaluated by multiple logistic regression analysis, and survival and its determinants by the Kaplan-Meier model, log-rank test and Cox regression.RESULTSAt the first observation, median age was 66 and 65 years and male gender was 36% and 58% for CC and HCV cirrhosis, respectively. CC showed Child-Pugh class A/B/C of 47%/31%/22%, respectively. Compared to HCV cirrhosis, CC exhibited a significantly higher prevalence of metabolic syndrome (12% vs 54%, respectively), overweight/obesity, high BMI, impaired glucose tolerance, high blood pressure, dyslipidemia, hyperuricemia, cardiovascular diseases, extrahepatic cancer, and gallstones. Over a median period of 42 mo of follow-up, liver decompensation, HCC development and death for CC and HCV-related cirrhosis were 60.8%, and 54.4%, 16.7% and 17.2%, 39.2% and 30%, respectively. The median survival was 60 mo for CC. Independent predictors of death were age and Child-Pugh class at diagnosis. CC showed an approximately twofold higher incidence of HCC in Child-Pugh class A.CONCLUSIONUndiagnosed nonalcoholic fatty liver disease has an etiologic role in CC that is associated with a poor prognosis, early HCC development, high risk of cardiovascular disease and extrahepatic cancer.展开更多
Heidan disease(black jaundice)is a kind of jaundice,which is caused by lingering and chronic jaundice,often with blood stasis and damp-heat,etc.The clinical symptoms of Heidan disease(black jaundice)are similar to tho...Heidan disease(black jaundice)is a kind of jaundice,which is caused by lingering and chronic jaundice,often with blood stasis and damp-heat,etc.The clinical symptoms of Heidan disease(black jaundice)are similar to those of cirrhosis caused by multiple chronic liver diseases in Western medicine.Heidan disease(black jaundice)generally belongs to yin jaundice type,and the pathogenesis is mostly related to blood stasis and dampness stagnation,often with damp-heat residue.According to Zhongjing Zhang,the prescription Xiaoshi Fanshi powder for the treatment of Heidan disease(black jaundice)is based on the understanding that the nature of Heidan disease(black jaundice)is inseparable from the two key pathological factors of dampness and blood stasis.The treatment of jaundice should be based on removing blood stasis and dampness,supplemented by soothing the liver and promoting the transportation function of spleen,removing blood stasis and harmonizing the collaterals,and promoting diuresis and reducing jaundice.In the treatment of jaundice,removing blood stasis and purging turbidity should be stressed,and powerful tonification should be used with caution.Since blood stasis and turbidity are always intermingling and often complicated with damp heat,the method of warm drying should be used with caution.For promoting blood circulation,removing blood stasis,and dredging the liver-biliarycollaterals,drasticmedicine shouldbeused withcaution.展开更多
AMP-activated protein kinase (AMPK) is a sensor of cellular energy status that plays a key role in energetic metabolism regulation.Metabolic changes in immune cells, such as dendritic cell (DC), macrophages, neutrophi...AMP-activated protein kinase (AMPK) is a sensor of cellular energy status that plays a key role in energetic metabolism regulation.Metabolic changes in immune cells, such as dendritic cell (DC), macrophages, neutrophils and lymphocytes that participate in the signal directed programs that promote or inhibit immune mediated diseases, including cancer, atherosclerosis and inflammatory diseases. Multiple pathogenic mechanisms are involved in the initiation and progression of disease, and many pathways have been uncovered. The mechanistic overlap in the metabolic changes and inflammation could indicate that some of the targets they have are in common, whereas AMPK could be useful in treatment of both disorders. The insight into identification of AMPK responsible for specific immune regulation, anti-inflammatory actions and understanding of the underlying molecular mechanism will promote the generation of novel AMPK activators, and provide novel therapy strategy.展开更多
文摘To characterize natural history of cryptogenic cirrhosis (CC) and compare its clinical features and outcomes to those of hepatitis C virus (HCV)-related cirrhosis.METHODSA prospective cohort of 102 consecutive patients at their first diagnosis of CC were enrolled in this study. The clinical data and outcomes were compared to an age- and Child-Pugh class-matched cohort of 110 patients with HCV-related cirrhosis. Diagnosis of cirrhosis was based on compatible clinical and laboratory parameters, ultrasound/endoscopic parameters and, whenever possible, on histological grounds and transient elastography. All cases of cirrhosis without a definite etiology were enrolled in the CC group. The parameters assessed were: (1) severity of liver disease at the time of first diagnosis; (2) liver decompensation during follow-up; (3) hepatocellular carcinoma (HCC); (4) orthotopic liver transplantation; and (5) death. The independent associated factors were evaluated by multiple logistic regression analysis, and survival and its determinants by the Kaplan-Meier model, log-rank test and Cox regression.RESULTSAt the first observation, median age was 66 and 65 years and male gender was 36% and 58% for CC and HCV cirrhosis, respectively. CC showed Child-Pugh class A/B/C of 47%/31%/22%, respectively. Compared to HCV cirrhosis, CC exhibited a significantly higher prevalence of metabolic syndrome (12% vs 54%, respectively), overweight/obesity, high BMI, impaired glucose tolerance, high blood pressure, dyslipidemia, hyperuricemia, cardiovascular diseases, extrahepatic cancer, and gallstones. Over a median period of 42 mo of follow-up, liver decompensation, HCC development and death for CC and HCV-related cirrhosis were 60.8%, and 54.4%, 16.7% and 17.2%, 39.2% and 30%, respectively. The median survival was 60 mo for CC. Independent predictors of death were age and Child-Pugh class at diagnosis. CC showed an approximately twofold higher incidence of HCC in Child-Pugh class A.CONCLUSIONUndiagnosed nonalcoholic fatty liver disease has an etiologic role in CC that is associated with a poor prognosis, early HCC development, high risk of cardiovascular disease and extrahepatic cancer.
基金supported by the National Natural Science Foundation of China(81403407)Special Program of the International Cooperation in Chinese Medicine of the State Administration of Traditional Chinese Medicine(China-Australia Chinese Medicine Center[Melbourne]GZYYGJ2021024)。
文摘Heidan disease(black jaundice)is a kind of jaundice,which is caused by lingering and chronic jaundice,often with blood stasis and damp-heat,etc.The clinical symptoms of Heidan disease(black jaundice)are similar to those of cirrhosis caused by multiple chronic liver diseases in Western medicine.Heidan disease(black jaundice)generally belongs to yin jaundice type,and the pathogenesis is mostly related to blood stasis and dampness stagnation,often with damp-heat residue.According to Zhongjing Zhang,the prescription Xiaoshi Fanshi powder for the treatment of Heidan disease(black jaundice)is based on the understanding that the nature of Heidan disease(black jaundice)is inseparable from the two key pathological factors of dampness and blood stasis.The treatment of jaundice should be based on removing blood stasis and dampness,supplemented by soothing the liver and promoting the transportation function of spleen,removing blood stasis and harmonizing the collaterals,and promoting diuresis and reducing jaundice.In the treatment of jaundice,removing blood stasis and purging turbidity should be stressed,and powerful tonification should be used with caution.Since blood stasis and turbidity are always intermingling and often complicated with damp heat,the method of warm drying should be used with caution.For promoting blood circulation,removing blood stasis,and dredging the liver-biliarycollaterals,drasticmedicine shouldbeused withcaution.
基金supported by the Science and Technology Innovation Team of Shanxi Province (201605D131045-18)Key Laboratory of Effective Substances Research and Utilization in Traditional Chinese Medicine of Shanxi Province (201605D111004).
文摘AMP-activated protein kinase (AMPK) is a sensor of cellular energy status that plays a key role in energetic metabolism regulation.Metabolic changes in immune cells, such as dendritic cell (DC), macrophages, neutrophils and lymphocytes that participate in the signal directed programs that promote or inhibit immune mediated diseases, including cancer, atherosclerosis and inflammatory diseases. Multiple pathogenic mechanisms are involved in the initiation and progression of disease, and many pathways have been uncovered. The mechanistic overlap in the metabolic changes and inflammation could indicate that some of the targets they have are in common, whereas AMPK could be useful in treatment of both disorders. The insight into identification of AMPK responsible for specific immune regulation, anti-inflammatory actions and understanding of the underlying molecular mechanism will promote the generation of novel AMPK activators, and provide novel therapy strategy.
