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대한간학회> Clinical and Molecular Hepatology(대한간학회지)> Risk of hepatocellular carcinoma in untreated patients with chronic hepatitis B: Independent of HBeAg status?

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Risk of hepatocellular carcinoma in untreated patients with chronic hepatitis B: Independent of HBeAg status?

Ho Soo Chun , Minjong Lee
  • : 대한간학회
  • : Clinical and Molecular Hepatology(대한간학회지) 27권3호
  • : 연속간행물
  • : 2021년 07월
  • : 448-450(3pages)
Clinical and Molecular Hepatology(대한간학회지)

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  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCI,SCOPUS
  • : 계간
  • : 2287-2728
  • : 2287-285x
  • : 학술지
  • : 연속간행물
  • : 1995-2021
  • : 4729


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KCI등재 SCI SCOPUS

1KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease

저자 : Seong Hee Kang , Hye Won Lee , Jeong-ju Yoo , Yuri Cho , Seung Up Kim , Tae Hee Lee , Byoung Kuk Jang , Sang Gyune Kim , Sang Bong Ahn , Haeryoung Kim , Dae Won Jun , Joon-il Choi , Do Seon Song , Won K

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 363-401 (39 pages)

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KCI등재 SCI SCOPUS

2Entecavir versus tenofovir in patients with chronic hepatitis B: Enemies or partners in the prevention of hepatocellular carcinoma

저자 : Sung Won Lee , Jonggi Choi , Seung Up Kim , Young-suk Lim

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 402-412 (11 pages)

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Over the past several decades, entecavir (ETV) and tenofovir disoproxil fumarate (TDF) have remained the first-line antiviral agents in several international guidelines. These two antiviral agents have shown similar short to intermediateterm efficacy, including virologic, biochemical, serologic, and histologic responses. However, huge controversies regarding the antiviral efficacy of ETV and TDF in preventing the development of hepatocellular carcinoma (HCC) still exist. In this review, we summarized recent studies that compared the treatment efficacy of ETV and TDF in terms of HCC development. (Clin Mol Hepatol 2021;27:402-412)

KCI등재 SCI SCOPUS

3Anti-fibrotic treatments for chronic liver diseases: The present and the future

저자 : Naoshi Odagiri , Tsutomu Matsubara , Misako Sato-matsubara , Hideki Fujii , Masaru Enomoto , Norifumi Kawada

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 413-424 (12 pages)

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Liver fibrosis reflects tissue scarring in the liver due to the accumulation of excessive extracellular matrix in response to chronically persistent liver injury. Hepatocyte cell death can trigger capillarization of liver sinusoidal endothelial cells, stimulation of immune cells including macrophages and Kupffer cells, and activation of hepatic stellate cells (HSCs), resulting in progression of liver fibrosis. Liver cirrhosis is the terminal state of liver fibrosis and is associated with severe complications, such as liver failure, portal hypertension, and liver cancer. Nevertheless, effective therapy for cirrhosis has not yet been established, and liver transplantation is the only radical treatment for severe cases. Studies investigating HSC activation and regulation of collagen production in the liver have made breakthroughs in recent decades that have advanced the knowledge regarding liver fibrosis pathophysiology. In this review, we summarize molecular mechanisms of liver fibrosis and discuss the development of novel anti-fibrotic therapies. (Clin Mol Hepatol 2021;27:413-424)

KCI등재 SCI SCOPUS

4β-blockers in advanced cirrhosis: More friend than enemy

저자 : Ki Tae Yoon , Hongqun Liu , Samuel S. Lee

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 425-436 (12 pages)

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Nonselective beta-adrenergic blocker (NSBB) therapy for the prevention of initial and recurrent gastrointestinal bleeding in cirrhotic patients with gastroesophageal varices has been used for the past four decades. NSBB therapy is considered the cornerstone of treatment for varices, and has become the standard of care. However, a 2010 study from the group that pioneered β-blocker therapy suggested a detrimental effect of NSBBs in decompensated cirrhosis, especially in patients with refractory ascites. Since then, numerous additional studies have incompletely resolved whether NSBBs are deleterious, although more recent evidence weighs against a harmful effect. The possibility of a “therapeutic window” has also been raised. We aimed to review the literature to analyze the pros and cons of using NSBBs in patients with cirrhosis, not only with respect to bleeding or mortality but also to other potential benefits and risks. β-blockers are highly effective in preventing first bleeding and recurrent bleeding. Furthermore, NSBBs improve congestion/ischemia of the gut mucosa, decrease intestinal permeability, and therefore indirectly alleviate systemic inflammation. β-blockers shorten the electrocardiographic prolonged QTc interval and may also decrease the incidence of hepatocellular carcinoma. On the other hand, the possibility of deleterious effects in cirrhosis has not been completely eliminated. NSBBs may be associated with an increased risk of portal vein thrombosis, although this could be correlational artifact. Overall, we conclude that β-blockers in cirrhosis are much more of a friend than enemy. (Clin Mol Hepatol 2021;27:425-436)

KCI등재 SCI SCOPUS

5Changes in the epidemiology and management of bacterial infections in cirrhosis

저자 : Salvatore Piano , Marta Tonon , Paolo Angeli

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 437-445 (9 pages)

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Patients with cirrhosis are susceptible to develop infections because of immune dysfunction, changes in microbiome and increase in bacterial translocation from the gut to systemic circulation. Bacterial infections can worse the clinical course of the disease, triggering the development of complications such as acute kidney injury, hepatic encephalopathy, organ failures and acute on chronic liver failure. In recent years, the spread of multi drug resistant bacteria made more challenging the management of infections in patients with cirrhosis. Hence, the mortality rate associated to sepsis is increasing in these patients. Therefore, the optimization of the management of infections has a high priority in cirrhosis. Herein we reviewed the recent changes in the epidemiology and the management of bacterial infections in patients with liver cirrhosis. (Clin Mol Hepatol 2021;27:437-445)

KCI등재 SCI SCOPUS

6An analysis of polygenic risk scores for non-alcoholic fatty liver disease

저자 : Dae Won Jun

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 446-447 (2 pages)

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KCI등재 SCI SCOPUS

7Risk of hepatocellular carcinoma in untreated patients with chronic hepatitis B: Independent of HBeAg status?

저자 : Ho Soo Chun , Minjong Lee

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 448-450 (3 pages)

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KCI등재 SCI SCOPUS

8Outcomes after liver transplantation in Korea: Incidence and risk factors from Korean transplantation registry

저자 : Jong Man Kim , Deok Gie Kim , Jihyun Kim , Keunsung Lee , Kwang-woong Lee , Je Ho Ryu , Bong-wan Kim , Dong Lak Choi , Young Kyoung You , Dong-sik Kim , Yang Won Nah , Koo Jeong Kang , Jai Young Cho , G

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 451-462 (12 pages)

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Background/Aims: To analyze the incidence and risk factors of outcomes after liver transplantation (LT) in the Korean population.
Methods: This study analyzed data from the liver cohort of Korean Organ Transplantation Registry (KOTRY) who had LT between May 2014 and December 2017. Study measures included the incidence of post-LT outcomes in recipients of living donor LT (LDLT) and deceased donor LT (DDLT). Cox multivariate proportional hazards model was used to determine the potential risk factors predicting the outcomes.
Results: A total of 2,563 adult recipients with LT (LDLT, n=1,956; DDLT, n=607) were included, with mean±standard deviation age of 53.9±8.9 years, and 72.2% were male. The post-LT outcomes observed in each LDLT and DDLT recipients were death (4.0% and 14.7%), graft loss (5.0% and 16.1%), rejection (7.0% and 12.0%), renal failure (2.7% and 13.8%), new onset of diabetes (12.5% and 15.4%), and hepatocellular carcinoma (HCC) recurrence (both 6.7%). In both LDLT and DDLT recipients, the most common post-LT complications were renal dysfunction (33.6% and 51.4%), infection (26.7% and 48.4%), and surgical complication (22.5% and 23.9%). Incidence of these outcomes were generally higher among recipients of DDLT than LDLT. Multivariate analysis indicated recipient age and DDLT as significant risk factors associated with death and graft loss. DDLT and ABO incompatible transplant were prognostic factors for rejection, and HCC beyond Milan criteria at pre-transplant was a strong predictor of HCC recurrence.
Conclusions: This study is a good indicator of the post-LT prognosis in the Korean population and suggests a significant burden of post-LT complications. (Clin Mol Hepatol 2021;27:451-462)

KCI등재 SCI SCOPUS

9Serum milk fat globule-EGF factor 8 protein as a potential biomarker for metabolic syndrome

저자 : Han Ah Lee , Jihwan Lim , Hyung Joon Joo , Young-sun Lee , Young Kul Jung , Ji Hoon Kim , Hyunggin An , Hyung Joon Yim , Yoon Tae Jeen , Jong Eun Yeon , Do-sun Lim , Kwan Soo Byun , Yeon Seok Seo

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 463-473 (11 pages)

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Background/Aims: Useful biomarkers for metabolic syndrome have been insufficient. We investigated the performance of serum milk fat globule-EGF factor-8 (MFG-E8), the key mediator of inflammatory pathway, in diagnosis of metabolic syndrome.
Methods: Subjects aged between 30 and 64 years were prospectively enrolled in the Seoul Metabolic Syndrome cohort. Serum MFG-E8 levels were measured at baseline.
Results: A total of 556 subjects were included, comprising 279 women (50.2%) and 277 men (49.8%). Metabolic syndrome was diagnosed in 236 subjects (42.4%), and the mean MFG-E8 level of subjects with metabolic syndrome was significantly higher than that of subjects without metabolic syndrome (P<0.001). MFG-E8 level was significantly correlated with all metabolic syndrome components and pulse wave velocity (all P<0.05). Subjects were categorized into two groups according to the best MFG-E8 cut-off value as follows: group 1, MFG-E8 level <4,745.1 pg/mL (n=401, 72.1%); and group 2, MFG-E8 level ≥4,745.1 (n=155, 27.9%). At baseline, metabolic syndrome in group 2 was significantly more prevalent than in group 1 (63.9% vs. 34.2%, P<0.001). During median follow-up of 17 months, metabolic syndrome developed in 122 (38.1%) subjects among 320 subjects without it at baseline. The incidence of metabolic syndrome in group 2 was significantly higher than that in group 1 (55.4% vs. 34.5%, P=0.003). On multivariate analysis, MFG-E8 level ≥4,745.1 pg/mL was an independent predictor for diagnosis and development of metabolic syndrome after adjusting other factors (all P<0.05).
Conclusions: Serum MFG-E8 level is a potent biomarker for the screening and prediction of metabolic syndrome. (Clin Mol Hepatol 2021;27:463-473)

KCI등재 SCI SCOPUS

10The impact of unrestricted access to direct-acting antiviral among incarcerated hepatitis C virus-infected patients

저자 : Yu Jun Wong , Prem Harichander Thurairajah , Rahul Kumar , Kwong Ming Fock , Ngai Moh Law , Sin-yoong Chong , Fria Gloriba Manejero , Tiing-leong Ang , Eng Kiong Teo , Jessica Tan

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 474-485 (12 pages)

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Background/Aims: Despite the disproportionally high prevalence rates of hepatitis C virus (HCV) amongst the incarcerated population, eradication remains challenging due to logistic and financial barriers. Although treatment prioritization based on disease severity is commonly practiced, the efficacy of such approach remained uncertain. We aimed to compare the impact of unrestricted access to direct-acting antiviral (DAA) among incarcerated HCV-infected patients in Singapore.
Methods: In this retrospective study, we reviewed all incarcerated HCV-infected patients treated in our hospital during the restricted DAA era (2013-2018) and unrestricted DAA access era (2019). Study outcomes included the rate of sustained virological response (SVR), treatment completion and treatment default. Subgroup analysis was performed based on the presence of liver cirrhosis, HCV genotype and HCV treatment types.
Results: A total of 1,001 HCV patients was followed-up for 1,489 person-year. They were predominantly male (93%) with genotype-3 HCV infection (71%), and 38% were cirrhotic. The overall SVR during the restricted DAA access era and unrestricted DAA access era were 92.1% and 99.1%, respectively. Unrestricted access to DAA exponentially improved the treatment access among HCV-infected patients by 460%, resulting in a higher SVR rate (99% vs. 92%, P=0.003), higher treatment completion rate (99% vs. 93%, P<0.001) and lower treatment default rate (1% vs. 9%, P<0.001).
Conclusion: In this large cohort of incarcerated HCV-infected patients, we demonstrated that unrestricted access to DAA is an impactful strategy to allow rapid treatment up-scale in HCV micro-elimination. (Clin Mol Hepatol 2021;27:474-485)

12
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1KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease

저자 : Seong Hee Kang , Hye Won Lee , Jeong-ju Yoo , Yuri Cho , Seung Up Kim , Tae Hee Lee , Byoung Kuk Jang , Sang Gyune Kim , Sang Bong Ahn , Haeryoung Kim , Dae Won Jun , Joon-il Choi , Do Seon Song , Won K

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 363-401 (39 pages)

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2Entecavir versus tenofovir in patients with chronic hepatitis B: Enemies or partners in the prevention of hepatocellular carcinoma

저자 : Sung Won Lee , Jonggi Choi , Seung Up Kim , Young-suk Lim

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 402-412 (11 pages)

다운로드

(기관인증 필요)

초록보기

Over the past several decades, entecavir (ETV) and tenofovir disoproxil fumarate (TDF) have remained the first-line antiviral agents in several international guidelines. These two antiviral agents have shown similar short to intermediateterm efficacy, including virologic, biochemical, serologic, and histologic responses. However, huge controversies regarding the antiviral efficacy of ETV and TDF in preventing the development of hepatocellular carcinoma (HCC) still exist. In this review, we summarized recent studies that compared the treatment efficacy of ETV and TDF in terms of HCC development. (Clin Mol Hepatol 2021;27:402-412)

KCI등재SCISCOUPUS

3Anti-fibrotic treatments for chronic liver diseases: The present and the future

저자 : Naoshi Odagiri , Tsutomu Matsubara , Misako Sato-matsubara , Hideki Fujii , Masaru Enomoto , Norifumi Kawada

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 413-424 (12 pages)

다운로드

(기관인증 필요)

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Liver fibrosis reflects tissue scarring in the liver due to the accumulation of excessive extracellular matrix in response to chronically persistent liver injury. Hepatocyte cell death can trigger capillarization of liver sinusoidal endothelial cells, stimulation of immune cells including macrophages and Kupffer cells, and activation of hepatic stellate cells (HSCs), resulting in progression of liver fibrosis. Liver cirrhosis is the terminal state of liver fibrosis and is associated with severe complications, such as liver failure, portal hypertension, and liver cancer. Nevertheless, effective therapy for cirrhosis has not yet been established, and liver transplantation is the only radical treatment for severe cases. Studies investigating HSC activation and regulation of collagen production in the liver have made breakthroughs in recent decades that have advanced the knowledge regarding liver fibrosis pathophysiology. In this review, we summarize molecular mechanisms of liver fibrosis and discuss the development of novel anti-fibrotic therapies. (Clin Mol Hepatol 2021;27:413-424)

KCI등재SCISCOUPUS

4β-blockers in advanced cirrhosis: More friend than enemy

저자 : Ki Tae Yoon , Hongqun Liu , Samuel S. Lee

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 425-436 (12 pages)

다운로드

(기관인증 필요)

초록보기

Nonselective beta-adrenergic blocker (NSBB) therapy for the prevention of initial and recurrent gastrointestinal bleeding in cirrhotic patients with gastroesophageal varices has been used for the past four decades. NSBB therapy is considered the cornerstone of treatment for varices, and has become the standard of care. However, a 2010 study from the group that pioneered β-blocker therapy suggested a detrimental effect of NSBBs in decompensated cirrhosis, especially in patients with refractory ascites. Since then, numerous additional studies have incompletely resolved whether NSBBs are deleterious, although more recent evidence weighs against a harmful effect. The possibility of a “therapeutic window” has also been raised. We aimed to review the literature to analyze the pros and cons of using NSBBs in patients with cirrhosis, not only with respect to bleeding or mortality but also to other potential benefits and risks. β-blockers are highly effective in preventing first bleeding and recurrent bleeding. Furthermore, NSBBs improve congestion/ischemia of the gut mucosa, decrease intestinal permeability, and therefore indirectly alleviate systemic inflammation. β-blockers shorten the electrocardiographic prolonged QTc interval and may also decrease the incidence of hepatocellular carcinoma. On the other hand, the possibility of deleterious effects in cirrhosis has not been completely eliminated. NSBBs may be associated with an increased risk of portal vein thrombosis, although this could be correlational artifact. Overall, we conclude that β-blockers in cirrhosis are much more of a friend than enemy. (Clin Mol Hepatol 2021;27:425-436)

KCI등재SCISCOUPUS

5Changes in the epidemiology and management of bacterial infections in cirrhosis

저자 : Salvatore Piano , Marta Tonon , Paolo Angeli

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 437-445 (9 pages)

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(기관인증 필요)

초록보기

Patients with cirrhosis are susceptible to develop infections because of immune dysfunction, changes in microbiome and increase in bacterial translocation from the gut to systemic circulation. Bacterial infections can worse the clinical course of the disease, triggering the development of complications such as acute kidney injury, hepatic encephalopathy, organ failures and acute on chronic liver failure. In recent years, the spread of multi drug resistant bacteria made more challenging the management of infections in patients with cirrhosis. Hence, the mortality rate associated to sepsis is increasing in these patients. Therefore, the optimization of the management of infections has a high priority in cirrhosis. Herein we reviewed the recent changes in the epidemiology and the management of bacterial infections in patients with liver cirrhosis. (Clin Mol Hepatol 2021;27:437-445)

KCI등재SCISCOUPUS

6An analysis of polygenic risk scores for non-alcoholic fatty liver disease

저자 : Dae Won Jun

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 446-447 (2 pages)

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KCI등재SCISCOUPUS

7Risk of hepatocellular carcinoma in untreated patients with chronic hepatitis B: Independent of HBeAg status?

저자 : Ho Soo Chun , Minjong Lee

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 448-450 (3 pages)

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KCI등재SCISCOUPUS

8Outcomes after liver transplantation in Korea: Incidence and risk factors from Korean transplantation registry

저자 : Jong Man Kim , Deok Gie Kim , Jihyun Kim , Keunsung Lee , Kwang-woong Lee , Je Ho Ryu , Bong-wan Kim , Dong Lak Choi , Young Kyoung You , Dong-sik Kim , Yang Won Nah , Koo Jeong Kang , Jai Young Cho , G

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 451-462 (12 pages)

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Background/Aims: To analyze the incidence and risk factors of outcomes after liver transplantation (LT) in the Korean population.
Methods: This study analyzed data from the liver cohort of Korean Organ Transplantation Registry (KOTRY) who had LT between May 2014 and December 2017. Study measures included the incidence of post-LT outcomes in recipients of living donor LT (LDLT) and deceased donor LT (DDLT). Cox multivariate proportional hazards model was used to determine the potential risk factors predicting the outcomes.
Results: A total of 2,563 adult recipients with LT (LDLT, n=1,956; DDLT, n=607) were included, with mean±standard deviation age of 53.9±8.9 years, and 72.2% were male. The post-LT outcomes observed in each LDLT and DDLT recipients were death (4.0% and 14.7%), graft loss (5.0% and 16.1%), rejection (7.0% and 12.0%), renal failure (2.7% and 13.8%), new onset of diabetes (12.5% and 15.4%), and hepatocellular carcinoma (HCC) recurrence (both 6.7%). In both LDLT and DDLT recipients, the most common post-LT complications were renal dysfunction (33.6% and 51.4%), infection (26.7% and 48.4%), and surgical complication (22.5% and 23.9%). Incidence of these outcomes were generally higher among recipients of DDLT than LDLT. Multivariate analysis indicated recipient age and DDLT as significant risk factors associated with death and graft loss. DDLT and ABO incompatible transplant were prognostic factors for rejection, and HCC beyond Milan criteria at pre-transplant was a strong predictor of HCC recurrence.
Conclusions: This study is a good indicator of the post-LT prognosis in the Korean population and suggests a significant burden of post-LT complications. (Clin Mol Hepatol 2021;27:451-462)

KCI등재SCISCOUPUS

9Serum milk fat globule-EGF factor 8 protein as a potential biomarker for metabolic syndrome

저자 : Han Ah Lee , Jihwan Lim , Hyung Joon Joo , Young-sun Lee , Young Kul Jung , Ji Hoon Kim , Hyunggin An , Hyung Joon Yim , Yoon Tae Jeen , Jong Eun Yeon , Do-sun Lim , Kwan Soo Byun , Yeon Seok Seo

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 463-473 (11 pages)

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Background/Aims: Useful biomarkers for metabolic syndrome have been insufficient. We investigated the performance of serum milk fat globule-EGF factor-8 (MFG-E8), the key mediator of inflammatory pathway, in diagnosis of metabolic syndrome.
Methods: Subjects aged between 30 and 64 years were prospectively enrolled in the Seoul Metabolic Syndrome cohort. Serum MFG-E8 levels were measured at baseline.
Results: A total of 556 subjects were included, comprising 279 women (50.2%) and 277 men (49.8%). Metabolic syndrome was diagnosed in 236 subjects (42.4%), and the mean MFG-E8 level of subjects with metabolic syndrome was significantly higher than that of subjects without metabolic syndrome (P<0.001). MFG-E8 level was significantly correlated with all metabolic syndrome components and pulse wave velocity (all P<0.05). Subjects were categorized into two groups according to the best MFG-E8 cut-off value as follows: group 1, MFG-E8 level <4,745.1 pg/mL (n=401, 72.1%); and group 2, MFG-E8 level ≥4,745.1 (n=155, 27.9%). At baseline, metabolic syndrome in group 2 was significantly more prevalent than in group 1 (63.9% vs. 34.2%, P<0.001). During median follow-up of 17 months, metabolic syndrome developed in 122 (38.1%) subjects among 320 subjects without it at baseline. The incidence of metabolic syndrome in group 2 was significantly higher than that in group 1 (55.4% vs. 34.5%, P=0.003). On multivariate analysis, MFG-E8 level ≥4,745.1 pg/mL was an independent predictor for diagnosis and development of metabolic syndrome after adjusting other factors (all P<0.05).
Conclusions: Serum MFG-E8 level is a potent biomarker for the screening and prediction of metabolic syndrome. (Clin Mol Hepatol 2021;27:463-473)

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10The impact of unrestricted access to direct-acting antiviral among incarcerated hepatitis C virus-infected patients

저자 : Yu Jun Wong , Prem Harichander Thurairajah , Rahul Kumar , Kwong Ming Fock , Ngai Moh Law , Sin-yoong Chong , Fria Gloriba Manejero , Tiing-leong Ang , Eng Kiong Teo , Jessica Tan

발행기관 : 대한간학회 간행물 : Clinical and Molecular Hepatology(대한간학회지) 27권 3호 발행 연도 : 2021 페이지 : pp. 474-485 (12 pages)

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Background/Aims: Despite the disproportionally high prevalence rates of hepatitis C virus (HCV) amongst the incarcerated population, eradication remains challenging due to logistic and financial barriers. Although treatment prioritization based on disease severity is commonly practiced, the efficacy of such approach remained uncertain. We aimed to compare the impact of unrestricted access to direct-acting antiviral (DAA) among incarcerated HCV-infected patients in Singapore.
Methods: In this retrospective study, we reviewed all incarcerated HCV-infected patients treated in our hospital during the restricted DAA era (2013-2018) and unrestricted DAA access era (2019). Study outcomes included the rate of sustained virological response (SVR), treatment completion and treatment default. Subgroup analysis was performed based on the presence of liver cirrhosis, HCV genotype and HCV treatment types.
Results: A total of 1,001 HCV patients was followed-up for 1,489 person-year. They were predominantly male (93%) with genotype-3 HCV infection (71%), and 38% were cirrhotic. The overall SVR during the restricted DAA access era and unrestricted DAA access era were 92.1% and 99.1%, respectively. Unrestricted access to DAA exponentially improved the treatment access among HCV-infected patients by 460%, resulting in a higher SVR rate (99% vs. 92%, P=0.003), higher treatment completion rate (99% vs. 93%, P<0.001) and lower treatment default rate (1% vs. 9%, P<0.001).
Conclusion: In this large cohort of incarcerated HCV-infected patients, we demonstrated that unrestricted access to DAA is an impactful strategy to allow rapid treatment up-scale in HCV micro-elimination. (Clin Mol Hepatol 2021;27:474-485)

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