RESUMEN
We assessed the effect of different hepatic conditions such as fibrosis, steatosis and necroinflammatory activity on liver stiffness as measured by transient elastography in HIV/HCV-coinfected patients. We studied all consecutive HIV/HCV-coinfected patients who underwent liver biopsy and elastography between January 2007 and December 2008. Liver fibrosis was staged following METAVIR Cooperative Study Group criteria. Steatosis was categorized according to the percentage of affected hepatocytes as low (≤10%), moderate (<25%) and severe (≥25%). A total of 110 patients were included. Fibrosis was distributed by stage as follows: F0, n = 13; F1, n = 47; F2, n = 29; F3, n = 18; and F4, n = 3. Liver biopsy revealed the presence of hepatic steatosis in 68 patients (low to moderate, n = 53; and severe n = 15). By univariate regression analysis, fibrosis, necroinflammatory activity, and the degree of steatosis were correlated with liver stiffness. However, in a multiple regression analysis, steatosis and fibrosis were the only independent variables significantly associated with liver stiffness. With a cut-off of 9.5 kPa to distinguish patients with F ≤ 2 from F ≥ 3, elastography led to a significantly higher number of misclassification errors (25%vs 5%; P = 0.014), most of which were false positives for F ≥ 3. Our study suggests that the correlation between liver stiffness and fibrosis as estimated by transient elastography may be affected by the presence of hepatic steatosis in HIV/HCV-coinfected patients.
Asunto(s)
Coinfección , Hígado Graso/patología , Infecciones por VIH/complicaciones , Hepatitis C/complicaciones , Cirrosis Hepática/patología , Adulto , Elasticidad , Diagnóstico por Imagen de Elasticidad , Hígado Graso/complicaciones , Femenino , Humanos , Cirrosis Hepática/complicaciones , Masculino , Persona de Mediana EdadRESUMEN
La hiperuricemia puede dar lugar o no a patología clínica, esencialmente articular y renal. En función de que La hiperuricemia es un trastorno metabólico que obliga a determinar su causa. La decisión de administrar un tratamiento hipouricemiante depende de la enfermedad de base y de su repercusión sistémica en cada individuo. El estudio de todo enfermo con una concentración sérica de uratos elevada debe ocuparse de los siguientes aspectos: a) diagnóstico fisiopatológico: sobreproducción y/o infraexcreción renal de ácido úrico; b) daño tisular; c) patologías asociadas, y d) tratamiento (AU)