The grade of histological severity is a determining factor to evaluate the prognosis and survival rate in primary biliary cholangitis (PBC). However, liver biopsy is limited by sampling error, invasiveness, high cost, and poor compliance. Therefore, in order to overcome the limitations of liver biopsy, some non-invasive evaluation methods have been studied and applied to evaluate the progression of liver fibrosis in PBC. The prognostic score can be calculated using routine laboratory test results obtained at the time of diagnosis, which are characterized by their simplicity, affordability, ease of acquisition, and superior reproducibility. Recent studies have reported that the prognostic score can be employed as a non-invasive liver fibrosis model to diagnose the liver fibrosis stage in PBC and predict the transplant-free survival rate, in addition to being used to evaluate the patient prognosis and transplant-free survival (TFS). This paper reviews, summarizes, and explores the research progress of different prognostic scores as non-invasive liver fibrosis models via their diagnostic performance and predictive accuracy for PBC.

Lipoprotein X(LpX)is an atypical lipoprotein that abnormally accumulates in the plasma of patients with cholestatic liver disease,and it is also a major pathogenic factor for hypercholesterolemia.The formation of LpX is closely associated with the abnormal metabolism of free cholesterol,phospholipids,and other lipid components in bile.LpX cannot be cleared via the low-density lipoprotein receptor pathway and is mainly metabolized by the reticuloendothelial system.The abnormal accumulation of LpX is closely associated with various complications of cholestatic liver disease,including xanthoma and neuropathy.Although there is no significant correlation between the high level of LpX and the risk of atherosclerosis,the role of LpX in cholesterol metabolism disorders cannot be neglected.Due to the similarities in density and characteristics between LpX and low-density lipoprotein cholesterol,clinical testing may result in misdiagnosis and related treatment risks.Current studies mainly focus on the mechanisms of LpX formation,the clinical significance of LpX,related detection methods,and potential therapeutic strategies.Plasma exchange is considered the preferred treatment in the state of high LpX,while traditional lipid-lowering drugs have a limited effect on LpX.This article explores the formation and clearance mechanisms of LpX in cholestatic liver disease,along with its impact of cholestatic liver disease and related detection methods,in order to improve the understanding of the pathophysiology and clinical significance of LpX,provide new strategies for the management of cholestatic liver disease and its complications,and finally improve the prognosis of patients.

Lipoprotein X(LpX)is an atypical lipoprotein that abnormally accumulates in the plasma of patients with cholestatic liver disease,and it is also a major pathogenic factor for hypercholesterolemia.The formation of LpX is closely associated with the abnormal metabolism of free cholesterol,phospholipids,and other lipid components in bile.LpX cannot be cleared via the low-density lipoprotein receptor pathway and is mainly metabolized by the reticuloendothelial system.The abnormal accumulation of LpX is closely associated with various complications of cholestatic liver disease,including xanthoma and neuropathy.Although there is no significant correlation between the high level of LpX and the risk of atherosclerosis,the role of LpX in cholesterol metabolism disorders cannot be neglected.Due to the similarities in density and characteristics between LpX and low-density lipoprotein cholesterol,clinical testing may result in misdiagnosis and related treatment risks.Current studies mainly focus on the mechanisms of LpX formation,the clinical significance of LpX,related detection methods,and potential therapeutic strategies.Plasma exchange is considered the preferred treatment in the state of high LpX,while traditional lipid-lowering drugs have a limited effect on LpX.This article explores the formation and clearance mechanisms of LpX in cholestatic liver disease,along with its impact of cholestatic liver disease and related detection methods,in order to improve the understanding of the pathophysiology and clinical significance of LpX,provide new strategies for the management of cholestatic liver disease and its complications,and finally improve the prognosis of patients.

The grade of histological severity is a determining factor to evaluate the prognosis and survival rate in primary biliary cholangitis (PBC). However, liver biopsy is limited by sampling error, invasiveness, high cost, and poor compliance. Therefore, in order to overcome the limitations of liver biopsy, some non-invasive evaluation methods have been studied and applied to evaluate the progression of liver fibrosis in PBC. The prognostic score can be calculated using routine laboratory test results obtained at the time of diagnosis, which are characterized by their simplicity, affordability, ease of acquisition, and superior reproducibility. Recent studies have reported that the prognostic score can be employed as a non-invasive liver fibrosis model to diagnose the liver fibrosis stage in PBC and predict the transplant-free survival rate, in addition to being used to evaluate the patient prognosis and transplant-free survival (TFS). This paper reviews, summarizes, and explores the research progress of different prognostic scores as non-invasive liver fibrosis models via their diagnostic performance and predictive accuracy for PBC.

Objective:To describe the prevalence and clinical characteristics of macroprolactinemia in hyperprolactinemia patients.Methods:Consecutive 111 outpatients diagnosed with hyperprolactinemia were included in this study. Macroprolactin was routinely screened using the polyethylene glycol(PEG) precipitation method. Recovery of monomeric prolactin less than 40% was defined as macroprolactinemia. Clinical characteristics were analyzed in this study.Results:Among the 111 cases included, 99 were female and 12 were male, with an average age of(32.2±7.9) years. There were 32 cases(28.8%) of macroprolactinemia and 28 of them with normal monomeric prolactin levels(simple macroprolactinemia). prolactin levels before precipitation in simple macroprolactinemia were significantly lower than those with true hyperprolactinemia[(49.81±23.58 vs 83.56±65.82) ng/mL, P<0.05]. No amenorrhea and infertility were observed in patients with simple macroprolactinemia. The clinical manifestations of prolonged menstruation, oligomenorrhea and galactorrhea in female patients accounted for 25.9%, 37.0%, and 7.4%, respectively. Imaging data were obtained in 92 cases. The prevalence of pituitary adenomas in simple macroprolactinemia and true hyperprolactinemia was 42.9% and 66.0%, respectively. Fifteen(46.8%) of the macroprolactinemia cases were receiving or had received bromocriptine treatment, and 66.7% of them failed to achieve normal prolactin levels during therapy. Conclusion:Macroprolactinemia might be common in clinical practice. Macroprolactin should be screened in hyperprolactinemia patients lack of amenorrhea and infertility, and with poor response to dopamine agonist therapy.