Objective Rheumatoid arthritis(RA)is a systemic autoimmune disease that affects the small joints of the whole body and degrades the patients’quality of life.Zhengqing Fengtongning(ZF)is a traditional Chinese medicine...Objective Rheumatoid arthritis(RA)is a systemic autoimmune disease that affects the small joints of the whole body and degrades the patients’quality of life.Zhengqing Fengtongning(ZF)is a traditional Chinese medicine preparation used to treat RA.ZF may cause liver injury.In this study,we aimed to develop a prediction model for abnormal liver function caused by ZF.Methods This retrospective study collected data from multiple centers from January 2018 to April 2023.Abnormal liver function was set as the target variable according to the alanine transaminase(ALT)level.Features were screened through univariate analysis and sequential forward selection for modeling.Ten machine learning and deep learning models were compared to find the model that most effectively predicted liver function from the available data.Results This study included 1,913 eligible patients.The LightGBM model exhibited the best performance(accuracy=0.96)out of the 10 learning models.The predictive metrics of the LightGBM model were as follows:precision=0.99,recall rate=0.97,F1_score=0.98,area under the curve(AUC)=0.98,sensitivity=0.97 and specificity=0.85 for predicting ALT<40 U/L;precision=0.60,recall rate=0.83,F1_score=0.70,AUC=0.98,sensitivity=0.83 and specificity=0.97 for predicting 40≤ALT<80 U/L;and precision=0.83,recall rate=0.63,F1_score=0.71,AUC=0.97,sensitivity=0.63 and specificity=1.00 for predicting ALT≥80 U/L.ZF-induced abnormal liver function was found to be associated with high total cholesterol and triglyceride levels,the combination of TNF-αinhibitors,JAK inhibitors,methotrexate+nonsteroidal anti-inflammatory drugs,leflunomide,smoking,older age,and females in middle-age(45-65 years old).Conclusion This study developed a model for predicting ZF-induced abnormal liver function,which may help improve the safety of integrated administration of ZF and Western medicine.展开更多
Potential causes of abnormal liver function tests include viral hepatitis,alcohol intake,nonalcoholic fatty liver disease,autoimmune liver diseases,hereditary diseases,hepatobiliary malignancies or infection,gallstone...Potential causes of abnormal liver function tests include viral hepatitis,alcohol intake,nonalcoholic fatty liver disease,autoimmune liver diseases,hereditary diseases,hepatobiliary malignancies or infection,gallstones and drug-induced liver injury.Moreover,the liver may be involved in systemic diseases that mainly affect other organs.Therefore,in patients without etiology of liver injury by screening serology and diagnostic imaging,but who have systemic diseases,the abnormal liver function test results might be caused by the systemic disease.In most of these patients,the systemic disease should be treated primarily.However,some patients with systemic disease and severe liver injury or fulminant hepatic failure require intensive treatments of the liver.展开更多
Background and Aims:Anti-tuberculosis(anti-TB)druginduced liver injury(AT-DILI)is the most common side effect in patients who received anti-TB therapy.AT-DILI management includes monitoring liver function until sympto...Background and Aims:Anti-tuberculosis(anti-TB)druginduced liver injury(AT-DILI)is the most common side effect in patients who received anti-TB therapy.AT-DILI management includes monitoring liver function until symptoms arise in patients without high-risk factors for liver damage.The present study aimed to investigate the effect of liver function test(LFT)abnormal identification on the risk of DILI,including liver failure and anti-TB drug resistance in patients without high-risk factors.Methods:A total of 399 patients without high-risk factors for liver damage at baseline and who experienced LFT abnormal during the 6 months of first-line anti-TB treatment were enrolled.The Roussel Uclaf Causal Relationship Assessment Method(RUCAM,2016)was applied in suspected DILI.The correlations between the time of LFT abnormal identification and DILI,liver failure,and anti-TB drug resistance were analyzed by smooth curve fitting and multivariable logistic regression models.Results:Among all study patients,131 met the criteria for DILI with a mean RUCAM causality score of 8.86±0.63.26/131 and 105/131 were in the probable grading and highly probable grading,respectively.The time of abnormal LFT identification was an independent predictor of DILI,liver failure,and anti-TB drug resistance in the crude model and after adjusting for other risk patient factors.The time of abnormal LFT identification was positively correlated with DILI,liver failure,and anti-TB drug resistance.The late identification group(>8 weeks)had the highest risk of DILI,followed by liver failure compared with the other two groups.Conclusions:The time to identification of LFT was positively correlated with DILI,liver failure,and anti-TB drug resistance.The risk of DILI and liver failure was significantly increased in the late identification group with abnormal LFT identified after 8 weeks compared with 4 and 8 weeks.Early monitoring of LFT is recommended for patients without the high-risk factor of DILI after anti-TB treatment is initiated.展开更多
To date,it remains unclear if severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)co-infection exacerbates liver injury in patients with chronic hepatitis B virus(HBV)infection.In this study,we present a retros...To date,it remains unclear if severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)co-infection exacerbates liver injury in patients with chronic hepatitis B virus(HBV)infection.In this study,we present a retrospective study of 133 hospitalized confirmed mild coronavirus disease 2019(COVID-19)cases,including 116 patients with COVID-19 with negative serum hepatitis B antigen and 17 HBV inactive carriers with COVID-19.We found that there were no significant differences for the discharge rate or duration of hospitalization be-tween the two groups.However,inactive HBV carriers with SARS-CoV-2 co-infection are at a higher risk of abnormal liver function tests.The enhanced liver injury induced by SARS-CoV-2 and HBV co-infection was identified as the hepatocyte type rather than the cholangiocyte type.Moreover,the inflammatory response,including abnormal lactate dehydrogenase,D-dimer and interleukin-6 production,may contribute to this injury following SARS-CoV-2 co-infection.Collectively,SARS-CoV-2 and HBV co-infection exacerbates liver function of the pa-tients with COVID-19.展开更多
基金supported by the Budgeted Fund of Shanghai University of Traditional Chinese Medicine(Natural Science)(No.2021LK037)the Open Project of Qinghai Province Key Laboratory of Tibetan Medicine Pharmacology and Safety Evaluation(No.2021-ZY-03).
文摘Objective Rheumatoid arthritis(RA)is a systemic autoimmune disease that affects the small joints of the whole body and degrades the patients’quality of life.Zhengqing Fengtongning(ZF)is a traditional Chinese medicine preparation used to treat RA.ZF may cause liver injury.In this study,we aimed to develop a prediction model for abnormal liver function caused by ZF.Methods This retrospective study collected data from multiple centers from January 2018 to April 2023.Abnormal liver function was set as the target variable according to the alanine transaminase(ALT)level.Features were screened through univariate analysis and sequential forward selection for modeling.Ten machine learning and deep learning models were compared to find the model that most effectively predicted liver function from the available data.Results This study included 1,913 eligible patients.The LightGBM model exhibited the best performance(accuracy=0.96)out of the 10 learning models.The predictive metrics of the LightGBM model were as follows:precision=0.99,recall rate=0.97,F1_score=0.98,area under the curve(AUC)=0.98,sensitivity=0.97 and specificity=0.85 for predicting ALT<40 U/L;precision=0.60,recall rate=0.83,F1_score=0.70,AUC=0.98,sensitivity=0.83 and specificity=0.97 for predicting 40≤ALT<80 U/L;and precision=0.83,recall rate=0.63,F1_score=0.71,AUC=0.97,sensitivity=0.63 and specificity=1.00 for predicting ALT≥80 U/L.ZF-induced abnormal liver function was found to be associated with high total cholesterol and triglyceride levels,the combination of TNF-αinhibitors,JAK inhibitors,methotrexate+nonsteroidal anti-inflammatory drugs,leflunomide,smoking,older age,and females in middle-age(45-65 years old).Conclusion This study developed a model for predicting ZF-induced abnormal liver function,which may help improve the safety of integrated administration of ZF and Western medicine.
文摘Potential causes of abnormal liver function tests include viral hepatitis,alcohol intake,nonalcoholic fatty liver disease,autoimmune liver diseases,hereditary diseases,hepatobiliary malignancies or infection,gallstones and drug-induced liver injury.Moreover,the liver may be involved in systemic diseases that mainly affect other organs.Therefore,in patients without etiology of liver injury by screening serology and diagnostic imaging,but who have systemic diseases,the abnormal liver function test results might be caused by the systemic disease.In most of these patients,the systemic disease should be treated primarily.However,some patients with systemic disease and severe liver injury or fulminant hepatic failure require intensive treatments of the liver.
基金supported by the funds for the construction of key medical disciplines in Shenzhen.
文摘Background and Aims:Anti-tuberculosis(anti-TB)druginduced liver injury(AT-DILI)is the most common side effect in patients who received anti-TB therapy.AT-DILI management includes monitoring liver function until symptoms arise in patients without high-risk factors for liver damage.The present study aimed to investigate the effect of liver function test(LFT)abnormal identification on the risk of DILI,including liver failure and anti-TB drug resistance in patients without high-risk factors.Methods:A total of 399 patients without high-risk factors for liver damage at baseline and who experienced LFT abnormal during the 6 months of first-line anti-TB treatment were enrolled.The Roussel Uclaf Causal Relationship Assessment Method(RUCAM,2016)was applied in suspected DILI.The correlations between the time of LFT abnormal identification and DILI,liver failure,and anti-TB drug resistance were analyzed by smooth curve fitting and multivariable logistic regression models.Results:Among all study patients,131 met the criteria for DILI with a mean RUCAM causality score of 8.86±0.63.26/131 and 105/131 were in the probable grading and highly probable grading,respectively.The time of abnormal LFT identification was an independent predictor of DILI,liver failure,and anti-TB drug resistance in the crude model and after adjusting for other risk patient factors.The time of abnormal LFT identification was positively correlated with DILI,liver failure,and anti-TB drug resistance.The late identification group(>8 weeks)had the highest risk of DILI,followed by liver failure compared with the other two groups.Conclusions:The time to identification of LFT was positively correlated with DILI,liver failure,and anti-TB drug resistance.The risk of DILI and liver failure was significantly increased in the late identification group with abnormal LFT identified after 8 weeks compared with 4 and 8 weeks.Early monitoring of LFT is recommended for patients without the high-risk factor of DILI after anti-TB treatment is initiated.
基金This work was supported by the Major National S&T Program(grant numbers 2017ZX10202203 and 2017ZX10302201)from Sdience&Technology Commission of China,the Emergency Project(grant number cstc2020jscx-fyzx0053)from the Sci-ence&Technology Commission of Chongqing,the Natural Science Foundation Project of CQ CSTC(grant number cstc2020jcyj-msxmX0081)the Venture and Innovation Sup-port Program for Chongqing Overseas Returnees(grant number cx2019114)+1 种基金the COVID-19 Emergengy Project(grant number CQMUNCP0207)the Scientfic Research Staring Foundation of Chongqing Medical University(grant number X9729)from Chongqing Medical University.
文摘To date,it remains unclear if severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)co-infection exacerbates liver injury in patients with chronic hepatitis B virus(HBV)infection.In this study,we present a retrospective study of 133 hospitalized confirmed mild coronavirus disease 2019(COVID-19)cases,including 116 patients with COVID-19 with negative serum hepatitis B antigen and 17 HBV inactive carriers with COVID-19.We found that there were no significant differences for the discharge rate or duration of hospitalization be-tween the two groups.However,inactive HBV carriers with SARS-CoV-2 co-infection are at a higher risk of abnormal liver function tests.The enhanced liver injury induced by SARS-CoV-2 and HBV co-infection was identified as the hepatocyte type rather than the cholangiocyte type.Moreover,the inflammatory response,including abnormal lactate dehydrogenase,D-dimer and interleukin-6 production,may contribute to this injury following SARS-CoV-2 co-infection.Collectively,SARS-CoV-2 and HBV co-infection exacerbates liver function of the pa-tients with COVID-19.
