中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

Clinical features of liver injury induced by anti-tuberculosis drugs and related risk factors

DOI: 10.3969/j.issn.1001-5256.2021.10.022
Research funding:

The Construction of Key Medical Disciplines in Shenzhen and the Sanming Project of Medicine in Shenzhen (SZSM201612014)

  • Received Date: 2021-03-01
  • Accepted Date: 2021-04-06
  • Published Date: 2021-10-20
  •   Objective  To investigate the clinical features of liver injury induced by anti-tuberculosis drugs and related risk factors.  Methods  A total of 129 patients who were diagnosed with liver injury induced by anti-tuberculosis drugs in Shenzhen Third People's Hospital from January 2017 to December 2018 were enrolled and divided into abnormal liver function group with 51 patients (39.53%) and drug-induced liver injury (DILI) group with 78 patients (60.47%), and among these 129 patients, 13 (10.08%) had liver failure. A retrospective analysis was performed for their laboratory markers as well as treatment and prognosis data. The chi-square test was used for comparison of categorical data between two groups; the independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The multivariable logistic regression model was used to investigate the risk factors for DILI and liver failure.  Results  There were significant differences between the DILI group and the abnormal liver function group in chronic HBV co-infection (χ2=5.616, P=0.018), asymptomatic liver injury (χ2=9.451, P=0.002), liver failure (χ2=9.453, P=0.002), need to adjust anti-tuberculosis regimen (χ2=16.787, P < 0.001), time to identification of liver injury (Z=-4.001, P < 0.001), time to liver function recovery (Z=-1.735, P < 0.001), and hepatic encephalopathy (χ2=4.114, P=0.043). The multivariate logistic regression analysis showed that time to identification of liver injury > 8 weeks (odds ratio [OR]=3.94, 95% confidence interval [CI]: 1.02-15.25, P=0.047) and asymptomatic liver injury (OR=7.64, 95% CI: 1.63-35.86, P=0.010) were independent risk factors for DILI; chronic HBV co-infection (OR=14.42, 95% CI: 2.66-78.09, P=0.002) and time to identification of liver injury > 8 weeks (OR=11.97, 95% CI: 2.03-70.50, P=0.006) were independent risk factors for liver failure, while albumin ≥35 g/L (OR=0.07, 95% CI: 0.01-0.51, P=0.010) was a protective factor.  Conclusion  Anti-tuberculosis drugs may induce severe liver injury, and HBV co-infection, asymptomatic liver injury, long time to identification of liver injury, and low albumin level may increase the risk of severe liver injury. Regular follow-up, liver function monitoring, appropriate nutritional support, and HBV screening are important for reducing the risk of liver injury during anti-tuberculosis therapy.

     

  • 非酒精性脂肪性肝病(NAFLD)是临床上常见的医疗卫生难题,发病机制尚不明确,目前考虑是一类多系统疾病,影响肝脏以及肝外器官的调节功能,因此2020年由数十位国际顶尖专家组成的专家组提出,将疾病的首字母缩写从NAFLD更改为与代谢相关脂肪性肝病(metabolic associated fatty liver disease, MAFLD)[1]。目前普遍认为NAFLD与肥胖密切相关,尤其是腹型肥胖[2],控制肥胖对预防或减缓NAFLD的进展有着极其重要的意义。人体肥胖测量指标是研究者提出旨在反映身体肥胖程度的一类指标,包括腰围(WC)、腰臀围(waist-to-hip ratio, WHR)、体质量指数(BMI)等指标,通过人体肥胖测量指数可以了解自身肥胖程度以及发生NAFLD的风险,对NAFLD的预防及减轻个人和社会负担起到重大作用。

    NAFLD已经成为全球重大的卫生问题之一,据此前研究[3]报道,NAFLD的全球患病率为25.2%,预计未来十年内,非酒精性脂肪性肝炎的发病率将达56%。由于亚洲人口不断增长及城市化、经济发展的加速,NAFLD的增长速度已快于西方发达国家。过去的20年内,我国NAFLD的患病率为13%~43%[4]。北京、上海等地区的流行病学调查示NAFLD的患病率10年增长了15%以上,现可达31%。可见NAFLD的患病率已成为一个值得重点关注的问题,同时必须采取相应的措施应对这个难题。

    NAFLD是一类肝细胞脂质异常沉积的代谢异常综合征。肥胖、高血脂、糖尿病等是NAFLD的主要危险因素,影响着NAFLD的发生及发展。目前多种人体肥胖测量指标已用于评估人体代谢性疾病的发生发展[5],对NAFLD的防治有着重大的意义。以往学者多研究WC、WHR、腰高比(waist-to-height ratio, WHtR)及BMI与NAFLD的相关性。近年来,新型人体肥胖测量指标如身体形态指标(a body shape index, ABSI)、脂质蓄积指数(lipid accumulation product, LAP)等被一些研究者使用,但目前研究相对较少,因此有关人体测量指标的预测效果需更多的研究进行评价。

    WC是经典的人体测量指标,测量方法是经脐绕身体水平一周。因为其简单易得,已被广泛应用于评估中心性肥胖的人体测量中[6]。目前的研究[7]表明,中心性肥胖与高血压、糖尿病、冠心病等多种代谢性疾病的发生发展密切相关,WC的测量为社区人群的健康管理提供了重要的帮助,减少WC是降低男性和女性不良健康风险的重要治疗目标。

    目前有大量的WC与NAFLD相关性研究,刘亚等[8]对中国1021例女性医务人员的调查研究发现,NAFLD组的WC明显大于非NAFLD组,差异有统计学意义(P<0.05)。有学者对中国长江三角洲地区7229名中小学生NAFLD患病率展开了一项横断面调查,该地区学生的WC预测NAFLD的受试者工作曲线下面积(AUC)为0.94[9],具有较高的预测价值。Ju等[10]对9159例韩国人进行了NAFLD流行病学调查,结果显示女性WC的AUC为0.821,男性为0.759,女性的WC对NAFLD有更高的预测价值。WC是反映腹部肥胖的一个重要的指标,对NAFLD有良好的预测效果,但是WC忽略了身高的因素,将WC联合身高与NAFLD的相关性有待进一步的研究。

    WHR是衡量脂肪分布的重要指标,计算方式为WHR=WC(cm)/臀围(cm),WHR相较于WC更好的反映了腹部脂肪百分比[11]。WHR与高血压、高血糖及高脂血症等有着较高的相关性,尤其在评估高脂血症及2型糖尿病方面,WHR的精确度明显高于BMI[12],俞婷等[13]在1440名社区人群中的研究表明WHR对2型糖尿病有着重要的预测价值。李俊晴等[11]的研究表明WHR是预测心血管疾病的危险因素。由于WHR是WC和臀围的比值,肥胖者与非肥胖者理论上有着相同的WHR,当WC和臀围同时减小时,WHR的预测疾病风险能力就会减弱[14]

    在Zheng等[15]的研究中,与BMI、WC及WHtR相比,WHR是NAFLD预测能力最高的指标(AUC=0.91),截断值为0.89。Motamed等[16]在一项针对伊朗成年人的横断面研究中报道,两性WHR的AUC均高于0.70,可预测NAFLD,但未提出切点。国内也有学者在比较WC、WHR、WHtR与BMI对NAFLD的预测作用得出,WHR为NAFLD最有效的预测指标[17]。WHR对NAFLD中慢性肾脏病(CKD)的发展也有一定的相关性,Chon等[18]在一项为期12年的研究中发现,WHR降低超过5%可以显著减少NAFLD患者CKD的发生风险。尽管WHR较于WC繁杂,且如上所述,WHR是WC及臀围的比值,但目前的研究[5]显示WHR可视为NAFLD良好的预测指标,对与NAFLD的诊疗有着重要的作用。

    WHtR的计算方式为WHtR=WC(cm)/身高(cm)。WHtR避免了WHR的不足,保留了WC的特异性,已经成为评价中心型肥胖的WC及WHR的替代指标[11]。目前的研究[19]表明,WHtR可以有效的预测心血管疾病风险,且比BMI及WC更好的筛查代谢性疾病,如高血压、糖尿病等疾病[20]

    杜程钢等[21]在分析不同腹型肥胖指标对NAFLD严重程度的预测能力中发现,相比于BMI、WC和WHR等人体肥胖测量指标,WHtR是预测NAFLD严重程度等最佳指标。Lin等[22]对台湾地区1210例儿童NAFLD患病情况进行了评估,WHtR在儿童中仍有较高的预测价值(AUC=0.80)。Özhan等[23]的研究同样支持WHtR是预测肥胖儿童NAFLD的简便方法,可用于公共卫生中的大规模筛查。WHtR更准确的反映了上腹部及矢状面的脂肪分布,而臀围受肌肉及骨量的影响对WHR的预测价值产生不利影响,导致WHtR比WHR对NAFLD有更高的预测价值[22]

    BMI作为传统肥胖测量指标被广泛应用于评价人体肥胖程度,应用范围广,BMI是定义超重和肥胖最有用衡量标准。然而,由于亚洲人口众多,世界卫生组织已按风险对不同的BMI阶层进行了分类:BMI为18.5~23 kg/m2的人群被认为与肥胖相关疾病的风险轻度增加;BMI为23~27.5 kg/m2的人群与肥胖相关的疾病风险增加;BMI为27.5 kg/m2或更高的人群,患有肥胖相关疾病的风险明显升高[24]。BMI目前已被研究者广泛的用于NAFLD流行病调查中,BMI作为应用最广泛的人体测量学指标,与之相关的研究也最多。在目前的研究中BMI更像是一个基本指标,但BMI反映的是全身肥胖,在评价腹型肥胖时便失去了准确性[11]。张莉等[25]发现男性的BMI相较于WC有更好的预测NAFLD的作用,其中切点值男性为26.07 kg/m2, 女性为25.68 kg/m2。Zhang等[26]研究显示BMI对NAFLD仍具有高于WHtR的预测价值,虽然BMI对腹型肥胖的评价欠缺准确性,BMI对NAFLD仍具有出色的预测价值,在体检或社区健康管理中具有一定的优越性。

    ABSI是一种新型肥胖测量指标,由Krakauer等[27]于2012年提出,根据WC、BMI和身高的值进行计算,计算方式为ABSI= WC(m)/[BMI2/3×身高(m)1/2]。他们的分析表明,ABSI可以评估高WC带来的额外风险。现学者们也将ABSI用于多种代谢性疾病的相关性分析,Dhana等[28]比较了ABSI与WC、BMI等人体测量学指标发现,ABSI与总死亡率、心血管疾病和癌症死亡率之间的关联性更强。邓桂娟[29]在研究中发现,ABSI是中老年女性骨质疏松的危险因素,且相较于其他人体测量指标关联最强。

    ABSI作为一个新型人体测量指标,目前仅有少部分学者用于与NAFLD的相关性分析中,Motamed等[16]评估了ABSI与NAFLD的关联性发现,ABSI与NAFLD的关联性较WHR及BRI弱,而叶菁菁等[30]的研究发现,ABSI是2型糖尿病患者发生NAFLD的独立危险因素,有着重要的预测价值。据此前报道[31],与BMI或WC相比,ABSI不能更好地预测糖尿病、高血压和高脂血症发病风险。同样地,ABSI在预测老年NAFLD的价值低于传统指标[26]。ABSI起初被用于预测死亡风险,目前的研究显示ABSI用于某些代谢性疾病的预测价值并不高,ABSI的适用范围还需要深入研究。

    LAP也是一种新型肥胖测量指标,根据WC和TG计算出的指数,计算方式为LAP(男性)=[WC(cm)-65]×TG;LAP(女性)=[WC(cm)-58]×TG。由于LAP将TG纳入计算,能够相对精确的体现人体脂质蓄积程度[5]。有研究[32]指出,LAP在预测心血管和代谢性疾病方面较传统指标有优越性。Ahn等[33]的研究表明,LAP是筛查糖尿病的可靠参数。一项10年前瞻性研究[34]显示,LAP与10年心血管疾病等发生率呈正相关,并且LAP预测心血管疾病要好于常见的人体肥胖测量指数,包括BMI、WC、WHtR。

    Dai等[32]在40 459例中国成年人的横断面研究中发现,LAP与NAFLD的患病率高度相关,男性和女性的AUC分别为0.843和0.887,LAP在识别普通人群中的NAFLD方面具有很高的准确性,并且LAP在年轻人中准确性更高。Özcabi等[35]在一项评估LAP对儿童肥胖研究中发现,LAP是一项预测儿童NAFLD的简单准确的工具,当LAP≥42.7,则应怀疑是NAFLD。游文一等[36]在研究发现,LAP是筛选NAFLD合并代谢综合征简单有效的指标(AUC=0.806),适合大规模调查。LAP不仅与NAFLD的发生密切相关,有研究[37]报道,LAP还与ALT水平高度相关,在男性中LAP与ALT独立相关。同样地,LAP将TG纳入计算中,应用性低于BMI、WC等简单易得的指标,在临床实践中存在局限性。

    综上所述,越来越多的人体肥胖测量指标被用于NAFLD的预测中,对NAFLD的防治有着重要意义。随着研究的深入,各指标的局限性也逐渐突出,目前还需要继续研究。在日后的研究中,BMI不再是评价肥胖的唯一标准,多种人体肥胖测量指标的应用,对NAFLD的早期筛查有着重要意义,各地应开展多种人体肥胖测量指标与当地NAFLD相关性调查,了解各指标的适用性,从而对NAFLD的防治取得更大的突破。

  • [1]
    WHO. Global tuberculosis report 2020[R/OL]. https://www.who.int/tb/publications/global_report/en/(2020-10-14).
    [2]
    Tuberculosis Society of Chinese Medical Association. Guidelines for anti-tuberculosis drug-induced liver injury[J]. Chin J Tuberc Respir Dis, 2019, 42(5): 343-356. DOI: 10.3760/cma.j.issn.1001-0939.2019.05.007.

    中华医学会结核病学分会. 抗结核药物性肝损伤诊治指南(2019年版)[J]. 中华结核和呼吸杂志, 2019, 42(5): 343-356. DOI: 10.3760/cma.j.issn.1001-0939.2019.05.007.
    [3]
    SHEN T, LIU Y, SHANG J, et al. Incidence and etiology of drug induced liver injury in mainland China[J]. Gastroenterology, 2019, 156: 2230-2241. DOI: 10.1053/j.gastro.2019.02.002.
    [4]
    SHARMA SK, BALAMURUGAN A, SAHA PK, et al. Evaluation of clinical and immunogenetic risk factors for the development of hepatotoxicity during antituberculosis treatment[J]. Am J Respir Crit Care Med, 2002, 166(7): 916-919. DOI: 10.1164/rccm.2108091.
    [5]
    van HEST R, BAARS H, KIK S, et al. Hepatotoxicity of rifampin-pyrazinamide and isoniazid preventive therapy and tuberculosis treatment[J]. Clin Infect Dis, 2004, 39(4): 488-496. DOI: 10.1086/422645.
    [6]
    SHARIFZADEH M, RASOULINEJAD M, VALIPOUR F, et al. Evaluation of patient-related factors associated with causality, preventability, predictability and severity of hepatotoxicity during antituberculosis[correction of antituberclosis] treatment[J]. Pharmacol Res, 2005, 51(4): 353-358. DOI: 10.1016/j.phrs.2004.10.009.
    [7]
    SAUKKONEN JJ, COHN DL, JASMER RM, et al. An official ATS statement: Hepatotoxicity of antituberculosis therapy[J]. Am J Respir Crit Care Med, 2006, 174(8): 935-952. DOI: 10.1164/rccm.200510-1666ST.
    [8]
    WU YH, WU QH. Literature analysis of 1 949 cases liver injury induced by anti-TB drugs[J]. Northwest Pharm J, 2015, 30(6): 750-753. DOI: 10.3969/j.issn.1004-2407.2015.06.028.

    吴玉华, 武谦虎. 抗结核药致肝损害1949例文献分析[J]. 西北药学杂志, 2015, 30(6): 750-753. DOI: 10.3969/j.issn.1004-2407.2015.06.028.
    [9]
    ZHANG T, DU J, YIN X, et al. Adverse events in treating smear-positive tuberculosis patients in China[J]. Int J Environ Res Public Health, 2015, 13(1): 86. DOI: 10.3390/ijerph13010086.
    [10]
    GE QP, WANG QF, DUAN HF. Clinical analysis of protionamide and para-aminosalicylic acid induced hepatotoxicity in 129 cases[J]. Chin J Tuberc Respir Dis, 2013, 36(10): 737-740. DOI: 10.3760/cma.j.issn.1001-0939.2013.10.008.

    戈启萍, 王庆枫, 段鸿飞. 含丙硫异烟胺和对氨基水杨酸治疗方案发生药物性肝损伤129例临床分析[J]. 中华结核和呼吸杂志, 2013, 36(10): 737-740. DOI: 10.3760/cma.j.issn.1001-0939.2013.10.008.
    [11]
    ZHANG MY, LEI JP, YAN SM, et al. Liver injury induced by anti-tuberculosis drugs and anti-tuberculosis therapy for patients with liver disease: Introduction of the experience of diagnosis and treatment in Chinese mainland and "Taiwan Guidelines for TB Diagnosis & Treatment"[J]. J Clin Hepatol, 2015, 31(11): 1776-1781. DOI: 10.3969/j.issn.1001-5256.2015.11.004.

    张明媛, 雷建平, 闫世明, 等. 抗结核药物所致肝损伤及肝病患者抗结核药物治疗——大陆地区诊治建议与台湾《结核病诊治指引》相关介绍[J]. 临床肝胆病志, 2015, 31(11): 1776-1781. DOI: 10.3969/j.issn.1001-5256.2015.11.004.
    [12]
    YU YC, MAO YM, CHEN CW. Guidelines for the management of drug-induced liver injury[J]. J Pract Hepatol, 2017, 20(2): 257-274. DOI: 10.3969/j.issn.1672-5069.2017.02.039.

    于乐成, 茅益民, 陈成伟. 药物性肝损伤诊治指南[J]. 实用肝脏病杂志, 2017, 20(2): 257-274. DOI: 10.3969/j.issn.1672-5069.2017.02.039.
    [13]
    AITHAL GP, WATKINS PB, ANDRADE RJ, et al. Case definition and phenotype standardization in drug-induced liver injury[J]. Clin Pharmacol Ther, 2011, 89(6): 806-815. DOI: 10.1038/clpt.2011.58.
    [14]
    JIN XL, YANG ZB, ZHAN SH, et al. Influencing factor of liver dysfunction of inpatients of tuberculosis with initial treatment[J/CD]. Chin J Exp Clin Infect Dis(Electronic Edition), 2020, 14(5): 394-400.

    金小琳, 杨智彬, 詹淑华, 等. 1501例初治住院结核病患者肝功能异常的影响因素[J/CD]. 中华实验和临床感染病杂志(电子版), 2020, 14(5): 394-400.
    [15]
    LI HL, WEN DD, BEI CL, et al. Analysis of anti-tuberculosis drug induced liver injury and its drug use cost in the hospital before and after the special rectification[J]. Chin J Clin Pharmacol Ther, 2019, 24(9): 1030-1036. DOI: 10.12092/j.issn.1009-2501.2019.09.011.

    李红丽, 文丹丹, 贝承丽, 等. 专项整治前后结核患者肝损伤及药物使用费用对比分析[J]. 中国临床药理学与治疗学, 2019, 24(9): 1030-1036. DOI: 10.12092/j.issn.1009-2501.2019.09.011.
    [16]
    LEE AM, MENNONE JZ, JONES RC, et al. Risk factors for hepatotoxicity associated with rifampin and pyrazinamide for the treatment of latent tuberculosis infection: Experience from three public health tuberculosis clinics[J]. Int J Tuberc Lung Dis, 2002, 6(11): 995-1000.
    [17]
    NOOREDINVAND HA, CONNELL DW, ASGHEDDI M, et al. Viral hepatitis prevalence in patients with active and latent tuberculosis[J]. World J Gastroenterol, 2015, 21(29): 8920-8926. DOI: 10.3748/wjg.v21.i29.8920.
    [18]
    KIM WS, LEE SS, LEE CM, et al. Hepatitis C and not hepatitis B virus is a risk factor for anti-tuberculosis drug induced liver injury[J]. BMC Infect Dis, 2016, 16: 50. DOI: 10.1186/s12879-016-1344-2.
    [19]
    LIU YM, CHENG YJ, LI YL, et al. Antituberculosis treatment and hepatotoxicity in patients with chronic viral hepatitis[J]. Lung, 2014, 192(1): 205-210. DOI: 10.1007/s00408-013-9535-8.
    [20]
    KANEKO Y, NAGAYAMA N, KAWABE Y, et al. Drug-induced hepatotoxicity caused by anti-tuberculosis drugs in tuberculosis patients complicated with chronic hepatitis[J]. Kekkaku, 2008, 83(1): 13-19. http://europepmc.org/abstract/MED/18283910
    [21]
    WANG NT, HUANG YS, LIN MH, et al. Chronic hepatitis B infection and risk of antituberculosis drug-induced liver injury: Systematic review and meta-analysis[J]. J Chin Med Assoc, 2016, 79(7): 368-374. DOI: 10.1016/j.jcma.2015.12.006.
    [22]
    CHEN L, BAO D, GU L, et al. Co-infection with hepatitis B virus among tuberculosis patients is associated with poor outcomes during anti-tuberculosis treatment[J]. BMC Infect Dis, 2018, 18(1): 295. DOI: 10.1186/s12879-018-3192-8.
    [23]
    ZHENG J, GUO MH, PENG HW, et al. The role of hepatitis B infection in anti-tuberculosis drug-induced liver injury: A meta-analysis of cohort studies[J]. Epidemiol Infect, 2020, 148: e290. DOI: 10.1017/S0950268820002861.
    [24]
    ZHU CH, ZHAO MZ, CHEN G, et al. Baseline HBV load increases the risk of anti-tuberculous drug-induced hepatitis flares in patients with tuberculosis[J]. J Huazhong Univ Sci Technolog Med Sci, 2017, 37(1): 105-109. DOI: 10.1007/s11596-017-1702-3.
    [25]
    CHENG SQ. Diagnosis and treatment of coinfection of pulmonary tuberculosis and chronic hepatitis B[J]. World Chin J Dig, 2016, 24(18): 2785-2798. DOI: 10.11569/wcjd.v24.i18.2785.

    程书权. 应重视乙型肝炎合并肺结核的临床诊断与治疗[J]. 世界华人消化杂志, 2016, 24(18): 2785-2798. DOI: 10.11569/wcjd.v24.i18.2785.
    [26]
    TWEED CD, WILLS GH, CROOK AM, et al. Liver toxicity associated with tuberculosis chemotherapy in the REMoxTB study[J]. BMC Med, 2018, 16(1): 46. DOI: 10.1186/s12916-018-1033-7.
    [27]
    MASINI EO, MANSOUR O, SPEER CE, et al. Using survival analysis to identify risk factors for treatment interruption among new and retreatment tuberculosis patients in Kenya[J]. PLoS One, 2016, 11(10): e0164172. DOI: 10.1371/journal.pone.0164172.
    [28]
    TELEMAN MD, CHEE CB, EARNEST A, et al. Hepatotoxicity of tuberculosis chemotherapy under general programme conditions in Singapore[J]. Int J Tuberc Lung Dis, 2002, 6(8): 699-705. http://old.med.wanfangdata.com.cn/viewHTMLEn/PeriodicalPaper_JJ029828197.aspx
    [29]
    SUN HY, CHEN IL, GAU CS, et al. A prospective study of hepatitis during antituberculous treatment in taiwanese patients and a review of the literature[J]. J Formos Med Assoc, 2009, 108(2): 102-111. DOI: 10.1016/s0929-6646(09)60040-1.
    [30]
    LEE CM, LEE SS, LEE JM, et al. Early monitoring for detection of antituberculous drug-induced hepatotoxicity[J]. Korean J Intern Med, 2016, 31(1): 65-72. DOI: 10.3904/kjim.2016.31.1.65.
    [31]
    PATTERSON B, ABBARA A, COLLIN S, et al. Predicting drug-induced liver injury from anti-tuberculous medications by early monitoring of liver tests[J]. J Infect, 2021, 82(2): 240-244. DOI: 10.1016/j.jinf.2020.09.038.
  • Relative Articles

    [1]Mingqiang ZHU, Dashuai YANG, Xiangyun XIONG, Junpeng PEI, Yang PENG, Youming DING. Establishment and validation of a nomogram risk prediction model for infection complications in patients after hepatectomy for liver cancer[J]. Journal of Clinical Hepatology, 2023, 39(1): 110-117. doi: 10.3969/j.issn.1001-5256.2023.01.017
    [2]Haoyou TANG, Sheng LIU, Xin ZENG, Xiaobin HUANG, Yang YANG, Dawei DENG, Jianshui LI. Establishment of a nomogram for survival rate after liver resection for primary small hepatocellular carcinoma based on SEER data and external validation[J]. Journal of Clinical Hepatology, 2022, 38(1): 110-116. doi: 10.3969/j.issn.1001-5256.2022.01.017
    [3]Jun LING, Wenwu WAN, Zheng ZENG, Huihua YAO, Ou JIANG, Bing DING. Clinical effect of transcatheter arterial chemoembolization combined with microwave ablation versus repeat resection in treatment of recurrent hepatocellular carcinoma[J]. Journal of Clinical Hepatology, 2022, 38(9): 2053-2060. doi: 10.3969/j.issn.1001-5256.2022.09.020
    [4]Mingwei LI, Jian GAO, Xiangwei ZHAI, Xiangjun QIAN, Xiajie WEN, Mingjie YAO, Zhaojun DUAN, Erjiang ZHAO, Ling ZHANG, Fengmin LU. Construction and analysis of a predictive model for posthepatectomy recurrence in patients with hepatocellular carcinoma based on preoperative CXCL13 measurement[J]. Journal of Clinical Hepatology, 2021, 37(4): 823-828. doi: 10.3969/j.issn.1001-5256.2021.04.020
    [5]Bohui LIN, Yimeng OU. Application of associating liver partition and portal vein ligation for staged hepatectomy in unresectable hepatocellular carcinoma[J]. Journal of Clinical Hepatology, 2021, 37(1): 180-183. doi: 10.3969/j.issn.1001-5256.2021.01.039
    [6]Lei WANG, Kangwei LIU, Yuling DUAN, Xinyao LI, Cijun PENG. Current status of the application of robot-assisted laparoscopic hepatectomy[J]. Journal of Clinical Hepatology, 2021, 37(11): 2732-2736. doi: 10.3969/j.issn.1001-5256.2021.11.054
    [7]Chunxia PING, Jing ZHANG, Wei ZHAO, Liang MA, Da FANG, Shichang CUI. Three-year follow-up outcomes of hepatocellular carcinoma patients undergoing liver resection versus liver transplantation[J]. Journal of Clinical Hepatology, 2021, 37(2): 343-347. doi: 10.3969/j.issn.1001-5256.2021.02.019
    [8]Zeng Qi, Shadike Apaer, Wu Jing, Nuerzhatijiang Anweier, Li Tao, Tuerhongjiang Tuxun. Left hemihepatectomy for Schnelldorfer type C polycystic liver disease: A case report[J]. Journal of Clinical Hepatology, 2020, 36(8): 1829-1831. doi: 10.3969/j.issn.1001-5256.2020.08.032
    [9]Wang XueWen, Li Han, Wu YanBin, Niu HongKai, Kong LingQun, Cheng Yu. Hepatectomy as the preferred approach for radical resection of Bismuth Ⅳ hilar cholangiocarcinoma[J]. Journal of Clinical Hepatology, 2020, 36(9): 2059-2062. doi: 10.3969/j.issn.1001-5256.2020.09.030
    [10]Li Le, Chen JinMing, Liu ZhongHua, Li Qiang, Shi Ying. Application of enhanced recovery after surgery versus traditional rehabilitation program in hepatectomy: a Meta-analysis[J]. Journal of Clinical Hepatology, 2018, 34(2): 303-308. doi: 10.3969/j.issn.1001-5256.2018.02.017
    [11]Tian Zhou, Zhang JianHuai, Sun XiTai, Liu Bin, Qi FuZhen, Wang YeBo, Wu JinSheng, Gu DianHua. Experience in laparoscopic hepatectomy in treatment of hepatocellular carcinoma[J]. Journal of Clinical Hepatology, 2018, 34(8): 1712-1716. doi: 10.3969/j.issn.1001-5256.2018.08.024
    [12]Wang DianBei, Zhao LiJin, Tu Kui, Yu Qin. Clinical effect of anatomical hepatectomy in treatment of intrahepatic bile duct stones[J]. Journal of Clinical Hepatology, 2017, 33(1): 102-105. doi: 10.3969/j.issn.1001-5256.2017.01.022
    [13]Chen Kai, Li XiangNong, Liu Kun, Nan YunGuang, Yang Jun. Clinical effect of hepatectomy versus extracapsular peeling in treatment of hepatic hemangioma[J]. Journal of Clinical Hepatology, 2017, 33(4): 699-704. doi: 10.3969/j.issn.1001-5256.2017.04.020
    [14]Liu Bin, Li WenGang, Chen FuZhen. Laparoscopic hepatectomy: the choice in the era of minimally invasive surgery[J]. Journal of Clinical Hepatology, 2017, 33(4): 643-646. doi: 10.3969/j.issn.1001-5256.2017.04.008
    [15]Li Xin. Short-and long-term efficacy of transarterial chemoembolization versus liver resection in treatment of patients with Barcelona stage B multiple hepatocellular carcinoma[J]. Journal of Clinical Hepatology, 2017, 33(7): 1296-1300. doi: 10.3969/j.issn.1001-5256.2017.07.018
    [16]Wang JinWei, Zhang YaMin. Research advances in methods for determination of tumor boundary in hepatectomy[J]. Journal of Clinical Hepatology, 2016, 32(2): 374-377. doi: 10.3969/j.issn.1001-5256.2016.02.039
    [17]Wu Xiao, Xia Hao, Wu Jian, Zhang Ming. Clinical experience in treatment of complex intrahepatic bile duct stones by regular hepatectomy[J]. Journal of Clinical Hepatology, 2016, 32(9): 1756-1759. doi: 10.3969/j.issn.1001-5256.2016.09.025
    [18]Zhang ShengJun, Liu MinLi, Chang Qi, Liu YongFeng. Efficacy comparison of precise and traditional liver resection in treatment of intrahepatic bile duct stones[J]. Journal of Clinical Hepatology, 2015, 31(10): 1648-1651. doi: 10.3969/j.issn.1001-5256.2015.10.022
    [19]Xu JunHui, Ding YouMing, Wang Bin, Fang HanGang. Clinical value of laparoscopic hepatectomy in liver cancer patients with cirrhosis[J]. Journal of Clinical Hepatology, 2014, 30(6): 552-555. doi: 10.3969/j.issn.1001-5256.2014.06.019
    [20]Zhu Yu, Zhang Wei. Clinical application of absorbable clips in hepatectomy[J]. Journal of Clinical Hepatology, 2013, 29(12): 932-935. doi: 10.3969/j.issn.1001-5256.2013.12.015
  • Cited by

    Periodical cited type(6)

    1. 陈小燕,袁乙富,杜晟楠,曹勤,蒋元烨. 超重人群中健康者与非酒精性脂肪性肝病患者的临床特征及血清脂质组学分析. 临床肝胆病杂志. 2024(02): 284-291 . 本站查看
    2. 杨波,胡钢伟,王征,田雅军. 简易胰岛素抵抗替代指标与空勤人员非酒精性脂肪性肝病相关性研究. 空军航空医学. 2024(01): 86-90 .
    3. 王芳,王妍,喻筱维,杨金凤,戴俊明,傅力. 民航飞行员12项人体测量学指标的聚类分析及验证. 空军航空医学. 2024(02): 102-107 .
    4. 王洪岩,刘宇鹏,付红梅,徐睿玲,闫朝岐. 内脏脂肪指数和脂质蓄积指数对非超重/肥胖者代谢相关脂肪性肝病的预测价值. 中华健康管理学杂志. 2023(11): 848-853 .
    5. 李丽文. 体检人群中2型糖尿病患者非酒精性脂肪肝的患病率和危险因素分析. 医学食疗与健康. 2022(03): 117-120 .
    6. 李燕,何韵彬. 减重手术治疗肥胖合并非酒精性脂肪性肝病的效果分析. 中外医疗. 2022(17): 52-56 .

    Other cited types(4)

  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Tables(4)

    Article Metrics

    Article views (643) PDF downloads(69) Cited by(10)
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return