肝病学和胰腺科学

Non-Alcoholic Fatty Liver Disease (NAFLD) has emerged as a global health concern, affecting approximately 25% of the world's population. Initially recognized as a hepatic manifestation of metabolic syndrome, NAFLD's implications extend far beyond the liver, significantly impacting cardiovascular health. This comprehensive review delves into the intricate relationship between NAFLD and Cardiovascular Disease (CVD), shedding light on their shared pathophysiological mechanisms, diagnostic challenges, and therapeutic implications. Public health initiatives aimed at promoting healthy lifestyle behaviours, including balanced nutrition, regular physical activity, and smoking cessation, are pivotal in reducing the prevalence and severity of both NAFLD and CVD. Community-based screening programs leveraging non-invasive diagnostic modalities hold promise in identifying high-risk individuals at an early stage, facilitating timely intervention and risk factor modification. Shared risk factors such as obesity, insulin resistance, dyslipidemic, and hypertension form the cornerstone of the NAFLD-CVD nexus.

Hepatocellular carcinoma is one of the most prevalent types of liver cancer, with a high mortality rate worldwide. Early detection of HCC is crucial for effective treatment and improved patient outcomes. While conventional diagnostic methods like imaging and biopsy remain primary tools, emerging biomarkers offer promising avenues for early detection, enabling timely intervention. This article explores recent advancements in biomarkers for the early detection of HCC. Alpha-Fetoprotein (AFP) has long been utilized as a biomarker for HCC screening. However, its sensitivity and specificity are suboptimal, leading to the exploration of novel biomarkers to complement AFP in early detection efforts. Recent studies have investigated AFP-L3 and des-gamma-carboxy prothrombin isoforms of AFP, which have shown improved performance in detecting early-stage HCC. MicroRNAs are small non-coding RNA molecules involved in the regulation of gene expression. Dysregulation of miRNAs has been implicated in various cancers, including HCC. Several studies have identified specific miRNAs with diagnostic potential for early-stage HCC. For instance, miR-21, miR-122, and miR-223 have shown promise as HCC biomarkers due to their aberrant expression patterns in tumor tissues and circulation. CTCs are cancer cells that detach from primary tumours and circulate in the bloodstream.

Hepatitis C Virus (HCV) infection is a major global health concern, with significant morbidity and mortality associated with chronic liver disease. While the advent of Direct-Acting Antiviral agents (DAAs) has revolutionized HCV treatment, challenges such as viral resistance and access to therapy persist. In this article, we review recent advancements in hepatitis C treatment, focusing on novel antiviral therapies that offer promise for further improving patient outcomes. We explore host-targeted therapies, combination regimens, therapeutic vaccines, and immune modulators as innovative approaches to enhance viral clearance and reduce liver-related complications. Additionally, we discuss challenges such as access to treatment, management of comorbidities, and global elimination efforts. By embracing these novel antiviral strategies and addressing existing barriers, we can advance towards the goal of hepatitis C elimination and improve the lives of individuals affected by this chronic viral infection.

Hepatic fibrosis represents a significant challenge in the management of chronic liver diseases, with its progression often leading to cirrhosis and liver failure. Traditional methods for assessing hepatic fibrosis, such as liver biopsy, are invasive and carry risks. Consequently, there has been considerable interest in developing non-invasive techniques for evaluating hepatic fibrosis. In recent years, significant advancements have been made in this field, offering clinicians a range of non-invasive tools for accurately assessing fibrosis progression and guiding treatment decisions. This review highlights the latest advancements in non-invasive techniques for hepatic fibrosis assessment and their clinical implications. We discuss the utility of various imaging modalities, including transient electrography, magnetic resonance elastography, and ultrasound-based techniques, in accurately quantifying liver stiffness and detecting fibrosis. Additionally, we examine the role of serum biomarkers, such as Fibrosis-4 index (FIB-4), Aspartate Aminotransferase to Platelet Ratio Index (APRI) and Enhanced Liver Fibrosis (ELF) panel, in predicting fibrosis severity and monitoring disease progression.