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대한간학회> Clinical and Molecular Hepatology(대한간학회지)

Clinical and Molecular Hepatology(대한간학회지) update

Clinical and Molecular Hepatology (CMH)

  • : 대한간학회
  • : 의약학분야  >  내과학
  • : KCI등재
  • : SCOPUS
  • : 연속간행물
  • : 계간
  • : 2287-2728
  • : 2287-285x
  • : 대한간학회지()→Korean Journal of Hepatology(2004~)→대한간학회지(2012~)

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수록범위 : 1권1호(1995)~28권1호(2022) |수록논문 수 : 4,752
Clinical and Molecular Hepatology(대한간학회지)
28권1호(2022년 01월) 수록논문
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KCI등재 SCOPUS

1The management of post-transplantation recurrence of hepatocellular carcinoma

저자 : Luckshi Rajendran , Tommy Ivanics , Marco Paw Claasen , Hala Muaddi , Gonzalo Sapisochin

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 28권 1호 발행 연도 : 2022 페이지 : pp. 1-16 (16 pages)

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The annual incidence of hepatocellular carcinoma (HCC) continues to rise. Over the last two decades, liver transplantation (LT) has become the preferable treatment of HCC, when feasible and strict selection criteria are met. With the rise in HCC-related LT, compounded by downstaging techniques and expansion of transplant selection criteria, a parallel increase in number of post-transplantation HCC recurrence is expected. Additionally, in the context of an immunosuppressed transplant host, recurrences may behave aggressively and more challenging to manage, resulting in poor prognosis. Despite this, no consensus or best practice guidelines for post-transplantation cancer surveillance and recurrence management for HCC currently exist. Studies with adequate population sizes and high-level evidence are lacking, and the role of systemic and locoregional therapies for graft and extrahepatic recurrences remains under debate. This review seeks to summarize the existing literature on post-transplant HCC surveillance and recurrence management. It highlights the value of early tumour detection, re-evaluating the immunosuppression regimen, and staging to differentiate disseminated recurrence from intrahepatic or extrahepatic oligo-recurrence. This ultimately guides decision-making and maximizes treatment effect. Treatment recommendations specific to recurrence type are provided based on currently available locoregional and systemic therapies. (Clin Mol Hepatol 2022;28:1-16)

KCI등재 SCOPUS

2Toward a complete cure for chronic hepatitis B: Novel therapeutic targets for hepatitis B virus

저자 : Sun Woong Kim , Jun Sik Yoon , Minjong Lee , Yuri Cho

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 28권 1호 발행 연도 : 2022 페이지 : pp. 17-30 (14 pages)

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Hepatitis B virus (HBV) affects approximately 250 million patients worldwide, resulting in the progression to cirrhosis and hepatocellular carcinoma, which are serious public health problems. Although universal vaccination programs exist, they are only prophylactic and not curative. In the HBV life cycle, HBV forms covalently closed circular DNA (cccDNA), which is the viral minichromosome, in the nuclei of human hepatocytes and makes it difficult to achieve a complete cure with the current nucleos(t)ide analogs and interferon therapies. Current antiviral therapies rarely eliminate cccDNA; therefore, lifelong antiviral treatment is necessary. Recent trials for antiviral treatment of chronic hepatitis B have been focused on establishing a functional cure, defined by either the loss of hepatitis B surface antigen, undetectable serum HBV DNA levels, and/or seroconversion to hepatitis B surface antibody. Novel therapeutic targets and molecules are in the pipeline for early clinical trials aiming to cure HBV infection. The ideal strategy for achieving a long-lasting functional or complete cure might be using combination therapies targeting different steps of the HBV life cycle and immunomodulators. This review summarizes the current knowledge about novel treatments and combination treatments for a complete HBV cure. (Clin Mol Hepatol 2022;28:17-30)

KCI등재 SCOPUS

3Current knowledge about biomarkers of acute kidney injury in liver cirrhosis

저자 : Han Ah Lee , Yeon Seok Seo

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 28권 1호 발행 연도 : 2022 페이지 : pp. 31-46 (16 pages)

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Acute kidney injury (AKI) is common in advanced cirrhosis. Prerenal azotemia, hepatorenal syndrome, and acute tubular necrosis are the main causes of AKI in patients with cirrhosis. Evaluation of renal function and differentiation between functional and structural kidney injury are important issues in the management of cirrhosis. However, AKI in cirrhosis exists as a complex clinical spectrum rather than concrete clinical entity. Based on current evidence, changes in serum creatinine (Cr) levels remain the most appropriate standard for defining AKI in cirrhosis. However, serum Cr has a limited role in assessing renal function in this population. This review examines previous studies that investigated the ability of recent biomarkers for AKI in cirrhosis from the perspective of earlier and accurate diagnosis, classification of AKI phenotype, and prediction of clinical outcomes. Serum cystatin C and urine neutrophil gelatinase-associated lipocalin have been extensively studied in cirrhosis, and have facilitated improved diagnosis and prognosis prediction in patients with AKI. In addition, urine N-acetyl-β-D-glucosaminidase, interleukin 18, and kidney injury molecule 1 are other promising biomarkers for advanced cirrhosis. However, the clinical significance of these markers remains unclear because there are no cut-off values defining the normal range and differentiating phenotypes of AKI. In addition, AKI has been defined in terms of serum Cr, and renal biopsy―the gold standard―has not been carried out in most studies. Further discovery of innovate biomarkers and incorporation of various markers could improve the diagnosis and prognosis prediction of AKI, and will translate into meaningful improvements in patient outcomes. (Clin Mol Hepatol 2022;28:31-46)

KCI등재 SCOPUS

4Nonalcoholic fatty liver disease-based risk prediction of adverse pregnancy outcomes: Ready for prime time?

저자 : Seung Mi Lee , Won Kim

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 28권 1호 발행 연도 : 2022 페이지 : pp. 47-49 (3 pages)

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KCI등재 SCOPUS

5Non-alcoholic fatty liver disease in pregnancy, paving the way for adverse pregnancy outcome risk assessment

저자 : Ja-young Kwon

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 28권 1호 발행 연도 : 2022 페이지 : pp. 50-51 (2 pages)

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KCI등재 SCOPUS

6Systematic review with meta-analysis: Non-alcoholic fatty liver disease and the association with pregnancy outcomes

저자 : Hydar El Jamaly , Guy D Eslick , Martin Weltman

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 28권 1호 발행 연도 : 2022 페이지 : pp. 52-66 (15 pages)

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Background/Aims: Maternal and fetal outcomes in pregnant patients with Non-alcoholic fatty liver disease (NAFLD) have been largely unexplored. To determine the level of evidence associated with maternal and fetal outcomes in pregnant women with NAFLD.
Methods: We conducted a comprehensive literature search. The studies included pregnant patients with a previous, current or subsequent diagnosis of NAFLD. We used a random-effects model using odds ratios (OR) with 95% confidence intervals (CI).
Results: Twenty-two studies, with 13,641 female NAFLD patients were reviewed. The results highlight that NAFLD patients had a statistically significant increased likelihood of baseline diabetes mellitus (OR, 6.00; 95% CI, 2.21-16.31; P<0.001; n=7), baseline Hypertension (OR, 3.75; 95% CI, 2.13-6.59; P<0.001; n=4), gestational hypertension (OR, 1.83; 95% CI, 1.03-3.26; P=0.041; n=2), and pre-eclampsia (OR, 2.43; 95% CI, 1.46-4.04; P=0.001; n=3). The odds for a past and current history of gestational diabetes mellitus were OR, 3.78; 95% CI, 2.21-6.44; P<0.001; n=5 and OR, 3.23; 95% CI, 1.97- 5.31; P<0.001; n=6, respectively. As for fetal outcomes, pregnant NAFLD patients were significantly more likely to have a premature birth (OR, 2.02; 95% CI, 1.44-2.85; P<0.001; n=4), large for gestational age birth (OR, 2.01; 95% CI, 1.72-2.37; P< 0.001; n=2) or a history of prior miscarriage or abortion (OR, 1.15; 95% CI, 1.02-1.30; P=0.02; n=2). Egger's regression revealed no evidence of publication bias (P >0.05).
Conclusions: This meta-analysis provides pooled evidence that NAFLD is associated with a substantial increase in maternal diabetic and hypertensive complications and multiple adverse fetal outcomes. This data is important for clinicians managing these patients before, during and after pregnancy. (Clin Mol Hepatol 2022;28:52-66)

KCI등재 SCOPUS

7Cervicocerebral atherosclerosis and its hepatic and coronary risk factors in patients with liver cirrhosis

저자 : Jihyun An , Hyung-don Kim , Seon-ok Kim , Ha Il Kim , Gi-won Song , Han Chu Lee , Ju Hyun Shim

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 28권 1호 발행 연도 : 2022 페이지 : pp. 67-76 (10 pages)

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Background/Aims: We aimed to investigate the silent atherosclerotic burden of cervicocephalic vessels in cirrhotic patients compared with the general population, as well as the relevant risk factors including coronary parameters.
Methods: This study included 993 stroke-free patients with liver cirrhosis (LC) who underwent magnetic resonance angiography (MRA) of the head and neck as a pre-liver transplant assessment and 6,099 health checkup participants who underwent MRA examination. The two cohorts were matched for cerebrovascular risk factors, and the prevalence of atherosclerosis in major intracranial and extracranial arteries was compared in 755 matched pairs. Moreover, traditional, hepatic, and coronary variables related to cerebral atherosclerosis were assessed in cirrhotic patients.
Results: Overall, intracranial atherosclerosis was significantly less prevalent in the LC group than in the matched control group (2.3% vs. 5.4%, P=0.002), whereas the prevalence of extracranial atherosclerosis was similar (4.4% vs. 5.8%, P=0.242). These results were maintained in multivariate analyses of the pooled samples, with corresponding adjusted odds ratios [ORs] of LC of 0.56 and 0.77 (95% confidence intervals [CIs], 0.36-0.88 and 0.55-1.09). In the LC group, lower platelet count was inversely correlated with intracranial atherosclerosis (adjusted OR, 0.31; 95% CI, 0.13-0.76). Coronary artery calcium (CAC) score ≥100 was the only predictive factor for both intracranial and extracranial atherosclerosis (adjusted ORs, 4.06 and 5.43, respectively).
Conclusions: LC confers protection against intracranial atherosclerosis, and thrombocytopenia may be involved in this protective effect. High CAC score could serve as a potential surrogate for cervicocerebral vascular screening in asymptomatic cirrhotic patients. (Clin Mol Hepatol 2022;28:67-76)

KCI등재 SCOPUS

8U-shaped relationship between urea level and hepatic decompensation in chronic liver diseases

저자 : Huapeng Lin , Grace Lai-hung Wong , Xinrong Zhang , Terry Cheuk-fung Yip , Ken Liu , Yee Kit Tse , Vicki Wing-ki Hui , Jimmy Che-to Lai , Henry Lik-yuen Chan , Vincent Wai-sun Wong

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 28권 1호 발행 연도 : 2022 페이지 : pp. 77-90 (14 pages)

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Background/Aims: We aimed to determine the association between blood urea level and incident cirrhosis, hepatic decompensation, and hepatocellular carcinoma in chronic liver disease (CLD) patients.
Methods: The association between blood urea level and liver fibrosis/liver-related events were evaluated on continuous scale with restricted cubic spline curves based on generalized additive model or Cox proportional hazards models. Then, the above associations were evaluated by urea level within intervals.
Results: Among 4,282 patients who had undergone liver stiffness measurement (LSM) by transient elastography, baseline urea level had a U-shaped association with LSM and hepatic decompensation development after a median follow-up of 5.5 years. Compared to patients with urea of 3.6-9.9 mmol/L, those with urea ≤3.5 mmol/L (adjusted hazard ratio [aHR], 4.15; 95% confidence interval [CI], 1.68-10.24) and ≥10 mmol/L (aHR, 5.22; 95% CI, 1.86-14.67) had higher risk of hepatic decompensation. Patients with urea ≤3.5 mmol/L also had higher risk of incident cirrhosis (aHR, 3.24; 95% CI, 1.50-6.98). The association between low urea level and incident cirrhosis and hepatic decompensation was consistently observed in subgroups by age, gender, albumin level, and comorbidities. The U-shaped relationship between urea level and LSM was validated in another population screening study (n=917). Likewise, urea ≤3.5 mmol/L was associated with a higher risk of incident cirrhosis in a territory-wide cohort of 12,476 patients with nonalcoholic fatty liver disease at a median follow-up of 9.9 years (aHR, 1.27; 95% CI, 1.03-1.57).
Conclusions: We identified a U-shaped relationship between the urea level and liver fibrosis/incident cirrhosis/hepatic decompensation in patients with CLD. (Clin Mol Hepatol 2022;28:77-90)

KCI등재 SCOPUS

9A cost-effectiveness study of universal screening for hepatitis C virus infection in South Korea: A societal perspective

저자 : Hye-lin Kim , Kyung-ah Kim , Gwang Hyun Choi , Eun Sun Jang , Moran Ki , Hwa Young Choi , Sook-hyang Jeong

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 28권 1호 발행 연도 : 2022 페이지 : pp. 91-104 (14 pages)

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Background/Aims: This study aimed to evaluate the cost-effectiveness of hepatitis C virus (HCV) screening compared to no screening in the Korean population from societal and healthcare system perspectives.
Methods: A published decision-tree plus Markov model was used to compare the expected costs and quality-adjusted life years (QALY) between one-time universal HCV screening and no screening in the population aged 40-65 years using the National Health Examination (NHE) program. Input parameters were obtained from analyses of the National Health Insurance claims data, Korean HCV cohort data, or from the literature review. The population aged 40-65 years was simulated in a model spanning a lifetime from both the healthcare system and societal perspectives, which included the cost of productivity loss due to HCV-related deaths. The incremental cost-effectiveness ratio (ICER) between universal screening and no screening was estimated.
Results: The HCV screening strategy had an ICER of $2,666/QALY and $431/QALY from the healthcare system and societal perspectives, respectively. Both ICERs were far less than the willingness-to-pay threshold of $25,000/QALY, showing that universal screening was highly cost-effective compared to no screening. In various sensitivity analyses, the most influential parameters on cost-effectiveness were the antibodies to HCV (anti-HCV) prevalence, screening costs, and treatment acceptance; however, all ICERs were consistently less than the threshold. If the anti-HCV prevalence was over 0.18%, screening could be cost-effective.
Conclusions: One-time universal HCV screening in the Korean population aged 40-65 years using NHE program would be highly cost-effective from both healthcare system and societal perspectives. (Clin Mol Hepatol 2022;28:91-104)

KCI등재 SCOPUS

10Nonalcoholic fatty liver disease and early prediction of gestational diabetes mellitus using machine learning methods

저자 : Seung Mi Lee , Suhyun Hwangbo , Errol R. Norwitz , Ja Nam Koo , Ig Hwan Oh , Eun Saem Choi , Young Mi Jung , Sun Min Kim , Byoung Jae Kim , Sang Youn Kim , Gyoung Min Kim , Won Kim , Sae Kyung Joo , Sue

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 28권 1호 발행 연도 : 2022 페이지 : pp. 105-116 (12 pages)

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Background/Aims: To develop an early prediction model for gestational diabetes mellitus (GDM) using machine learning and to evaluate whether the inclusion of nonalcoholic fatty liver disease (NAFLD)-associated variables increases the performance of model.
Methods: This prospective cohort study evaluated pregnant women for NAFLD using ultrasound at 10-14 weeks and screened them for GDM at 24-28 weeks of gestation. The clinical variables before 14 weeks were used to develop prediction models for GDM (setting 1, conventional risk factors; setting 2, addition of new risk factors in recent guidelines; setting 3, addition of routine clinical variables; setting 4, addition of NALFD-associated variables, including the presence of NAFLD and laboratory results; and setting 5, top 11 variables identified from a stepwise variable selection method). The predictive models were constructed using machine learning methods, including logistic regression, random forest, support vector machine, and deep neural networks.
Results: Among 1,443 women, 86 (6.0%) were diagnosed with GDM. The highest performing prediction model among settings 1-4 was setting 4, which included both clinical and NAFLD-associated variables (area under the receiver operating characteristic curve [AUC] 0.563-0.697 in settings 1-3 vs. 0.740-0.781 in setting 4). Setting 5, with top 11 variables (which included NAFLD and hepatic steatosis index), showed similar predictive power to setting 4 (AUC 0.719- 0.819 in setting 5, P=not significant between settings 4 and 5).
Conclusions: We developed an early prediction model for GDM using machine learning. The inclusion of NAFLDassociated variables significantly improved the performance of GDM prediction. (ClinicalTrials.gov Identifier: NCT02276144) (Clin Mol Hepatol 2022;28:105-116)

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