Background and aims:There is currently no single model for predicting Wilson's disease(WD).We aimed to create a nomogram using daily clinical parameters to improve the accuracy of WD diagnosis in patients with abn...Background and aims:There is currently no single model for predicting Wilson's disease(WD).We aimed to create a nomogram using daily clinical parameters to improve the accuracy of WD diagnosis in patients with abnormal liver function.Methods:Between July 2016 and December 2020,we identified 90 WD patients with abnormal liver function who had homozygous or compound heterozygous mutations in the ATP7B gene.The control group included 128 patients with similar liver function but no WD during the same time period.To create a nomogram,we screened potential predictive variables using the least absolute shrinkage and selection operator model and multivariate logistic regression.Results:We developed a nomogram for screening for WD based on six predictive factors:serum copper,direct bilirubin,uric acid,cholinesterase,prealbumin,and reticulocyte percentage.In the training cohort,the area under curve(AUC)of the nomogram reached 0.967(95%confidence interval(CI)0.946e0.988),while the area under the precision-recall curve was 0.961.Based on the optimal cutpoint of 213.55,our nomogram performed well,with a sensitivity of 96%and a specificity of 87%.In the validation cohort,the AUC of the nomogram was as high as 0.991(95%CI 0.970e1.000).Conclusions:We developed a nomogram that can predict the risk of WD prior to the detection of serum ceruloplasmin or urinary copper,greatly increasing screening efficiency for patients with abnormal liver function.展开更多
Background The prevalence of zinc deficiency is high in patients with chronic liver disease,but few studies have hitherto explored the relationship between the serum zinc level and hepatitis B virus(HBV)-related acute...Background The prevalence of zinc deficiency is high in patients with chronic liver disease,but few studies have hitherto explored the relationship between the serum zinc level and hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF).This study aimed to assess the association between zinc deficiency and infectious complications,and model for end-stage liver disease(MELD)score in patients with HBV-related ACLF.Methods Patients with HBV-related ACLF from the Department of Infectious Diseases of the Third Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between January 2019 and December 2019 were retrospectively analysed in this study.Their demographic,clinical,and laboratory data were retrieved from the hospital information system and analysed.The Student’s t-test was used for normally distributed continuous variables between two groups and the Chi-square test was used for categorical data.Univariate and multivariate logistic regression analyses were applied to identify independent parameters.Results A total of 284 patients were included in this study,including 205 liver cirrhosis and 79 non-cirrhosis patients.The proportion of patients with zinc deficiency was the highest(84.5%),followed by subclinical zinc deficiency(14.1%)and normal zinc level(1.4%).Patients in the zinc deficiency group had a higher MELD score than the subclinical zinc deficiency or normal zinc group(P=0.021).Age,total bilirubin,and serum zinc level were independent factors for infection(P_(s)<0.05).The serum zinc level in patients without complications at admission was significantly higher than that in patients with complications(P=0.004).Moreover,the serum zinc level in patients with prothrombin time activity(PTA)of<20%was significantly lower than that in patients with 20%≤PTA<30%(P=0.007)and that in patients with 30%≤PTA<40%(P<0.001).Conclusions Zinc deficiency is common in patients with HBV-related ACLF.Zinc deficiency is closely associated with infectious complications and MELD score in patients with HBV-related ACLF.展开更多
Background and aims:To investigate the safety and efficacy of direct-acting antiviral(DAA)regimens in a cohort of Chinese patients with chronic hepatitis C virus(HCV)infection.Methods:A total of 222 adult Chinese pati...Background and aims:To investigate the safety and efficacy of direct-acting antiviral(DAA)regimens in a cohort of Chinese patients with chronic hepatitis C virus(HCV)infection.Methods:A total of 222 adult Chinese patients were enrolled and treated via DAA regimens in accor-dance with HCV management guidelines.Treatment responses were evaluated 4 weeks after treatment,at the end of treatment(EOT)and 12 weeks post-treatment.Virological responses,biochemical re-sponses,model for end-stage liver disease(MELD)and Child-Pugh(CP)scores were recorded.Results:A total of 218 patients(98.2%)achieved sustained virological response 12 weeks post-treatment and 4 patients relapsed.The combined number of rapid virological responses for all six regimens was 170/222(76.6%),and 221/222(99.6%)had achieved virological responses by the end of treatment.In decompensated cirrhosis patients the baseline mean CP score was 6.8±1.3 and the mean MELD score was 10.1±3.3.Compared with the mean CP score at baseline,the mean score is significantly lower at the end of treatment(5.7±1.3)and 12 weeks post-treatment(5.6±1.0).Estimated glomerular filtration rates did not differ significantly from baseline during the treatment or 12 weeks post-treatment.The incidence of adverse events in patients with chronic hepatitis C and compensated cirrhosis was 42/172(24.4%),and in patients with decompensated cirrhosis it was 8/22(36.4%).The most frequently reported adverse events were elevated indirect bilirubin,fatigue and rash.There were no cases of serious adverse events,death or treatment discontinuation because of adverse events.Conclusion:DAA regimens were highly effective and well tolerated irrespective of HCV genotype,cirrhosis,liver or kidney transplantation,hepatocellular carcinoma,HCV/hepatitis B virus co-infection,or renal failure.展开更多
基金supported by the Science and Technology Planning Project of Guangdong Province,China(2019B020228001)National Key R&D Program of China(2018YFC1315400)5010 Project of Sun Yat-sen University(No.2018024).
文摘Background and aims:There is currently no single model for predicting Wilson's disease(WD).We aimed to create a nomogram using daily clinical parameters to improve the accuracy of WD diagnosis in patients with abnormal liver function.Methods:Between July 2016 and December 2020,we identified 90 WD patients with abnormal liver function who had homozygous or compound heterozygous mutations in the ATP7B gene.The control group included 128 patients with similar liver function but no WD during the same time period.To create a nomogram,we screened potential predictive variables using the least absolute shrinkage and selection operator model and multivariate logistic regression.Results:We developed a nomogram for screening for WD based on six predictive factors:serum copper,direct bilirubin,uric acid,cholinesterase,prealbumin,and reticulocyte percentage.In the training cohort,the area under curve(AUC)of the nomogram reached 0.967(95%confidence interval(CI)0.946e0.988),while the area under the precision-recall curve was 0.961.Based on the optimal cutpoint of 213.55,our nomogram performed well,with a sensitivity of 96%and a specificity of 87%.In the validation cohort,the AUC of the nomogram was as high as 0.991(95%CI 0.970e1.000).Conclusions:We developed a nomogram that can predict the risk of WD prior to the detection of serum ceruloplasmin or urinary copper,greatly increasing screening efficiency for patients with abnormal liver function.
基金supported by grants from the National Major Science and Technology Project for the Prevention and Treatment of AIDS and Viral Hepatitis[no.2018ZX10302204-002–002 to L.P.]the Five-Year Plan of the Third Affiliated Hospital of Sun Yat-sen University[no.K00006 to L.P.]+1 种基金the Clinical Research Program of the Third Affiliated Hospital of Sun Yat-Sen University[no.QHJH201808 to W.X.]the Guangzhou Science and Technology Project[no.202102080064 to W.X.].
文摘Background The prevalence of zinc deficiency is high in patients with chronic liver disease,but few studies have hitherto explored the relationship between the serum zinc level and hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF).This study aimed to assess the association between zinc deficiency and infectious complications,and model for end-stage liver disease(MELD)score in patients with HBV-related ACLF.Methods Patients with HBV-related ACLF from the Department of Infectious Diseases of the Third Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between January 2019 and December 2019 were retrospectively analysed in this study.Their demographic,clinical,and laboratory data were retrieved from the hospital information system and analysed.The Student’s t-test was used for normally distributed continuous variables between two groups and the Chi-square test was used for categorical data.Univariate and multivariate logistic regression analyses were applied to identify independent parameters.Results A total of 284 patients were included in this study,including 205 liver cirrhosis and 79 non-cirrhosis patients.The proportion of patients with zinc deficiency was the highest(84.5%),followed by subclinical zinc deficiency(14.1%)and normal zinc level(1.4%).Patients in the zinc deficiency group had a higher MELD score than the subclinical zinc deficiency or normal zinc group(P=0.021).Age,total bilirubin,and serum zinc level were independent factors for infection(P_(s)<0.05).The serum zinc level in patients without complications at admission was significantly higher than that in patients with complications(P=0.004).Moreover,the serum zinc level in patients with prothrombin time activity(PTA)of<20%was significantly lower than that in patients with 20%≤PTA<30%(P=0.007)and that in patients with 30%≤PTA<40%(P<0.001).Conclusions Zinc deficiency is common in patients with HBV-related ACLF.Zinc deficiency is closely associated with infectious complications and MELD score in patients with HBV-related ACLF.
基金This work was supported by the Science and Technology Plan-ning Project of Guangdong Province Grant(2014B020212025).
文摘Background and aims:To investigate the safety and efficacy of direct-acting antiviral(DAA)regimens in a cohort of Chinese patients with chronic hepatitis C virus(HCV)infection.Methods:A total of 222 adult Chinese patients were enrolled and treated via DAA regimens in accor-dance with HCV management guidelines.Treatment responses were evaluated 4 weeks after treatment,at the end of treatment(EOT)and 12 weeks post-treatment.Virological responses,biochemical re-sponses,model for end-stage liver disease(MELD)and Child-Pugh(CP)scores were recorded.Results:A total of 218 patients(98.2%)achieved sustained virological response 12 weeks post-treatment and 4 patients relapsed.The combined number of rapid virological responses for all six regimens was 170/222(76.6%),and 221/222(99.6%)had achieved virological responses by the end of treatment.In decompensated cirrhosis patients the baseline mean CP score was 6.8±1.3 and the mean MELD score was 10.1±3.3.Compared with the mean CP score at baseline,the mean score is significantly lower at the end of treatment(5.7±1.3)and 12 weeks post-treatment(5.6±1.0).Estimated glomerular filtration rates did not differ significantly from baseline during the treatment or 12 weeks post-treatment.The incidence of adverse events in patients with chronic hepatitis C and compensated cirrhosis was 42/172(24.4%),and in patients with decompensated cirrhosis it was 8/22(36.4%).The most frequently reported adverse events were elevated indirect bilirubin,fatigue and rash.There were no cases of serious adverse events,death or treatment discontinuation because of adverse events.Conclusion:DAA regimens were highly effective and well tolerated irrespective of HCV genotype,cirrhosis,liver or kidney transplantation,hepatocellular carcinoma,HCV/hepatitis B virus co-infection,or renal failure.
