Clinical and Molecular Hepatology

"Hana Park"

Original Article

Steatotic liver disease

Association of Visceral Fat Obesity, Sarcopenia, and Myosteatosis with Non-Alcoholic Fatty Liver Disease without Obesity: Hong-Kyu Kim, Sung-Jin Bae, Min Jung Lee, Eun Hee Kim, Hana Park, Hwi Seung Kim, Yun Kyung Cho, Chang Hee Jung, Woo Je Lee, Jaewon Choe; Clin Mol Hepatol 2023;29(4):987-1001.
Published online July 5, 2023; DOI: https://doi.org/10.3350/cmh.2023.0035

Background/Aims
To investigate whether non-alcoholic fatty liver disease (NAFLD) in individuals without generalized obesity is associated with visceral fat obesity (VFO), sarcopenia, and/or myosteatosis.
Methods
This cross-sectional analysis included 14,400 individuals (7,470 men) who underwent abdominal computed tomography scans during routine health examinations. The total abdominal muscle area (TAMA) and skeletal muscle area (SMA) at the 3^rd lumbar vertebral level were measured. The SMA was divided into the normal attenuation muscle area (NAMA) and low attenuation muscle area, and the NAMA/TAMA index was calculated. VFO was defined by visceral to subcutaneous fat ratio, sarcopenia by body mass index-adjusted SMA, and myosteatosis by the NAMA/TAMA index. NAFLD was diagnosed with ultrasonography.
Results
Of the 14,400 individuals, 4,748 (33.0%) had NAFLD, and the prevalence of NAFLD among non-obese individuals was 21.4%. In regression analysis, both sarcopenia (men: odds ratio [OR] 1.41, 95% confidence interval [CI] 1.19–1.67, P<0.001; women: OR=1.59, 95% CI 1.40–1.90, P<0.001) and myosteatosis (men: OR=1.24, 95% CI 1.02–1.50, P=0,028; women: OR=1.23, 95% CI 1.04–1.46, P=0.017) were significantly associated with non-obese NAFLD after considering for VFO and other various risk factors, whereas VFO (men: OR=3.97, 95% CI 3.43–4.59 [adjusted for sarcopenia], OR 3.98, 95% CI 3.44–4.60 [adjusted for myosteatosis]; women: OR=5.42, 95% CI 4.53–6.42 [adjusted for sarcopenia], OR=5.33, 95% CI 4.51–6.31 [adjusted for myosteatosis]; all P<0.001) was strongly associated with non-obese NAFLD after adjustment with various known risk factors.
Conclusions
In addition to VFO, sarcopenia and/or myosteatosis were significantly associated with non-obese NAFLD.

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Review

Viral hepatitis

Comparison of clinical practice guidelines for the management of chronic hepatitis B: When to start, when to change, and when to stop: Hyung Joon Yim, Ji Hoon Kim, Jun Yong Park, Eileen L. Yoon, Hana Park, Jung Hyun Kwon, Dong Hyun Sinn, Sae Hwan Lee, Jeong-Hoon Lee, Hyun Woong Lee; Clin Mol Hepatol 2020;26(4):411-429.
Published online August 28, 2020; DOI: https://doi.org/10.3350/cmh.2020.0049

Abstract
PDF

Clinical practice guidelines are important for guiding the management of specific diseases by medical practitioners, trainees, and nurses. In some cases, the guidelines are utilized as a reference for health policymakers in controlling diseases with a large public impact. With this in mind, practice guidelines for the management of chronic hepatitis B (CHB) have been developed in the United States, Europe, and Asian-Pacific regions to suggest the best-fit recommendations for each social and medical circumstance. Recently, the Korean Association for the Study of the Liver published a revised version of its clinical practice guidelines for the management of CHB. The guidelines included updated information based on newly available antiviral agents, the most recent opinion on the initiation and cessation of treatment, and updates for the management of drug resistance, partial virological response, and side effects. Additionally, CHB management in specific situations was comprehensively revised. This review compares the similarities and differences among the various practice guidelines to identify unmet needs and improve future recommendations.

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Original Article

Viral hepatitis

Association between hepatic steatosis and the development of hepatocellular carcinoma in patients with chronic hepatitis B: Yun Bin Lee, Yeonjung Ha, Young Eun Chon, Mi Na Kim, Joo Ho Lee, Hana Park, Kwang-il Kim, Soo-Hwan Kim, Kyu Sung Rim, Seong Gyu Hwang; Clin Mol Hepatol 2019;25(1):52-64.
Published online October 23, 2018; DOI: https://doi.org/10.3350/cmh.2018.0040

Abstract
PDF

Background/Aims
Nonalcoholic fatty liver disease (NAFLD) is becoming a worldwide epidemic, and is frequently found in patients with chronic hepatitis B (CHB). We investigated the impact of histologically proven hepatic steatosis on the risk for hepatocellular carcinoma (HCC) in CHB patients without excessive alcohol intake.
Methods
Consecutive CHB patients who underwent liver biopsy from January 2007 to December 2015 were included. The association between hepatic steatosis (≥ 5%) and subsequent HCC risk was analyzed. Inverse probability weighting (IPW) using the propensity score was applied to adjust for differences in patient characteristics, including metabolic factors.
Results
Fatty liver was histologically proven in 70 patients (21.8%) among a total of 321 patients. During the median (interquartile range) follow-up of 5.3 (2.9–8.3) years, 17 of 321 patients (5.3%) developed HCC: 8 of 70 patients (11.4%) with fatty liver and 9 of 251 patients (3.6%) without fatty liver. The five-year cumulative incidences of HCC among patients without and with fatty liver were 1.9% and 8.2%, respectively (P=0.004). Coexisting fatty liver was associated with a higher risk for HCC (adjusted hazards ratio [HR], 3.005; 95% confidence interval [CI], 1.122–8.051; P=0.03). After balancing with IPW, HCC incidences were not significantly different between the groups (P=0.19), and the association between fatty liver and HCC was not significant (adjusted HR, 1.709; 95% CI, 0.404–7.228; P=0.47).
Conclusions
Superimposed NAFLD was associated with a higher HCC risk in CHB patients. However, the association between steatosis per se and HCC risk was not evident after adjustment for metabolic factors.

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Case Reports

Viral hepatitis

Two cases of telbivudine-induced myopathy in siblings with chronic hepatitis B: Eun Hye Kim, Hana Park, Kun Ho Lee, Sang Hoon Ahn, Seung-Min Kim, Kwang-Hyub Han; Korean J Hepatol 2013;19(1):82-86.
Published online March 25, 2013; DOI: https://doi.org/10.3350/cmh.2013.19.1.82

Abstract
PDF

Telbivudine is an L-nucleoside analogue with potent antiviral activity against hepatitis B virus (HBV). Clinical trials have shown that telbivudine has a more potent and sustained antiviral activity with a lower frequency of viral resistance than lamivudine. Although there are several reports concerning the safety profile of telbivudine, most adverse events are described as mild and transient in nature. Here we report two cases of telbivudine-induced myopathy in patients with chronic hepatitis B who were siblings.

Citations

Citations to this article as recorded by

Telbivudine-Induced Myopathy: Clinical Features, Histopathological Characteristics, and Risk Factors
Min-Yu Lan, Hui-Chen Lin, Tsung-Hui Hu, Shu-Fang Chen, Chien-Hung Chen, Yung-Yee Chang, King-Wah Chiu, Tsu-Kung Lin, Shun-Sheng Chen
Journal of Clinical Neurology.2023; 19(1): 52. CrossRef
Telbivudine for renal transplant recipients with chronic hepatitis B infection: a randomized controlled trial with early termination
Ya-Wen Yang, Meng-Kun Tsai, Ching-Yao Yang, Chih-Yuan Lee, Bor-Luen Chiang, Hong-Shiee Lai
Clinical and Experimental Nephrology.2020; 24(5): 474. CrossRef
Comparison of clinical practice guidelines for the management of chronic hepatitis B: When to start, when to change, and when to stop
Hyung Joon Yim, Ji Hoon Kim, Jun Yong Park, Eileen L. Yoon, Hana Park, Jung Hyun Kwon, Dong Hyun Sinn, Sae Hwan Lee, Jeong-Hoon Lee, Hyun Woong Lee
Clinical and Molecular Hepatology.2020; 26(4): 411. CrossRef
Telbivudine-Induced Myopathy Incidentally Detected by FDG PET/CT Imaging in a Patient With History of Hepatocellular Carcinoma
Sijuan Zou, Zhaoting Cheng, Shuang Song, Dongling Zhu, Xiaohua Zhu
Clinical Nuclear Medicine.2019; 44(2): 171. CrossRef
Mitochondrial myopathies caused by prolonged use of telbivudine
Jong-Mok Lee, Jin-Hong Shin, Young-Eun Park, Dae-Seong Kim
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Chronic Hepatitis B: A Critical Discussion
Jianfei Long, Min Wang, Bicui Chen, Jiming Zhang, Bin Wang
Future Virology.2017; 12(3): 111. CrossRef
The Ca 2+ /CaMKK2 axis mediates the telbivudine induced upregulation of creatine kinase: Implications for mechanism of antiviral nucleoside analogs’ side effect
Long Jianfei, Wang Min, Ma Chunlai, Chen Bicui, Zhang Jiming, Wang Bin
Biochemical Pharmacology.2017; 146: 224. CrossRef
Rhabdomyolysis, lactic acidosis, and multiple organ failure during telbivudine treatment for hepatitis B: a case report and review of the literature
Jinxin Zheng, Minggui Deng, Xiaoliang Qiu, Zhong Chen, Duoyun Li, Xiangbin Deng, Qiwen Deng, Zhijian Yu
Journal of Medical Case Reports.2017;[Epub] CrossRef
Cumulative incidence and risk factors of creatine kinase elevation associated with telbivudine
Li Chen, Cai Cheng, Bicui Chen, Yue Zhao, Jiming Zhang, Bin Wang
European Journal of Clinical Pharmacology.2016; 72(2): 235. CrossRef
Clinicopathological Features of Telbivudine-Associated Myopathy
Tomica Ambang, Joo-San Tan, Sheila Ong, Kum-Thong Wong, Khean-Jin Goh, Jose Ignacio Herrero
PLOS ONE.2016; 11(9): e0162760. CrossRef

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Hepatogastric fistula caused by direct invasion of hepatocellular carcinoma after transarterial chemoembolization and radiotherapy: Hana Park, Seung Up Kim, Junjeong Choi, Jun Yong Park, Sang Hoon Ahn, Kwang-Hyub Han, Chae Yoon Chon, Young Nyun Park, Do Young Kim; Korean J Hepatol 2010;16(4):401-404.
Published online December 31, 2010; DOI: https://doi.org/10.3350/kjhep.2010.16.4.401

Abstract
PDF

A 63-year-old man with a history of hepatitis-B-related hepatocellular carcinoma (HCC) in the left lateral portion of the liver received repeated transcatheter arterial chemoembolization (TACE) and salvage radiotherapy. Two months after completing radiotherapy, he presented with dysphagia, epigastric pain, and a protruding abdominal mass. Computed tomography showed that the bulging mass was directly invading the adjacent stomach. Endoscopy revealed a fistula from the HCC invading the stomach. Although the size of the mass had decreased with the drainage through the fistula, and his symptoms had gradually improved, he died of cancer-related bleeding and hepatic failure. This represents a case in which an HCC invaded the stomach and caused a hepatogastric fistula after repeated TACE and salvage radiotherapy.

Citations

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