Hepatocyte growth factor and chronic hepatitis C.

OBJECTIVE: The hepatocyte growth factor (HGF) is a pleiotropic cytokine produced by hepatic stellate cells and implicated in liver regeneration and fibrosis. Serum levels of HGF vary in liver diseases, reflecting hepatic damage and hepatocellular dysfunction. In this study, serum levels of HGF and the relationship between HGF and biochemical, histological and virological data, have been analysed in patients suffering from chronic hepatitis C (CHC). PATIENTS AND METHODS: Serum HGF concentration was measured by ELISA in sandwich in 45 patients with CHC. Correlation between HGF levels and histological (necroinflammatory activity and fibrosis score) and biochemical (transaminases, prothrombin activity, albumin, bilirubin), or virological (hepatitis C virus load) parameters was analyzed. Serum HGF concentration was also studied in a subgroup of the original sample treated with interferon and ribavirin. RESULTS: Sserum HGF concentrations of patients with CHC were significantly higher than those detected in healthy controls. Patients with significant fibrosis (F > or = 2) had a significantly older age, lower count of platelets and higher values of AST, GGT and HGF, than those patients with a fibrosis score F < 2. HGF concentration was identified by multivariate analysis as the only independent factor associated with significant fibrosis. Moreover, area under receiver operating curve, using HCG levels, showed similar values to those of previously validated non-invasive indexes of fibrosis. However, levels of HGF did not show a significant decrease in patients with a sustained response to anti-virus C therapy. CONCLUSION: Serum HGF concentration correlates with fibrosis score in patients with CHC, but is insensitive to monitor changes induced by anti-virus C therapy.

Factor de crecimiento hepatocitario y hepatitis crónica C / No disponible

Objetivo: el factor de crecimiento hepatocitario (HGF) es una citocinapleiotrópica producida por las células estrelladas hepáticas,que está implicada en la regeneración y la fibrosis hepática. La concentraciónsérica del HGF en las enfermedades hepáticas es variable,reflejando daño hepático y disfunción hepatocelular. En este estudiose ha analizado la concentración sérica del HGF en pacientes conhepatitis crónica por virus de la hepatitis C (VHC) y su relación conlos datos bioquímicos, histológicos y virológicos.Pacientes y métodos: se determinó la concentración séricade HGF mediante ELISA en sándwich y se analizó la correlaciónentre los niveles del HGF y los datos histológicos (actividad necroinflamatoria,estadio de fibrosis), bioquímicos (transaminasas,actividad de protrombina, albúmina, bilirrubina) y virológicos (cargaviral VHC) en 45 pacientes con hepatitis crónica C (HCC).También fueron evaluadas las cifras del HGF en el suero de unsubgrupo de pacientes de la muestra original sometidos a tratamientoantiviral con interferón y ribavirina.Resultados: la concentración sérica del HGF en pacientescon HCC fue significativamente mayor que la medida en controlessanos. Los pacientes con fibrosis hepática significativa (F ≥ 2) teníanuna edad significativamente mayor, unas cifras plaquetariassignificativamente inferiores y concentraciones séricas significativamentesuperiores de AST, GGT y HGF, en comparación conaquellos pacientes con un índice de fibrosis F < 2. En el análisismultivariante la concentración de HGF fue la única variable independienteasociada a la fibrosis significativa. El área bajo la curvaROC (receiver operating curve), usando las concentraciones séricasde HGF, mostró valores similares a los obtenidos con otros índices,previamente validados, que estiman fibrosis significativa enpacientes con HCC...(AU)

Objective: the hepatocyte growth factor (HGF) is a pleiotropiccytokine produced by hepatic stellate cells and implicated in liverregeneration and fibrosis. Serum levels of HGF vary in liver diseases,reflecting hepatic damage and hepatocellular dysfunction.In this study, serum levels of HGF and the relationship betweenHGF and biochemical, histological and virological data, have beenanalysed in patients suffering from chronic hepatitis C (CHC).Patients and methods: serum HGF concentration was measuredby ELISA in sandwich in 45 patients with CHC. Correlationbetween HGF levels and histological (necroinflammatory activityand fibrosis score) and biochemical (transaminases, prothrombinactivity, albumin, bilirubin), or virological (hepatitis C virus load)parameters was analyzed. Serum HGF concentration was alsostudied in a subgroup of the original sample treated with interferonand ribavirin.Results: sserum HGF concentrations of patients with CHCwere significantly higher than those detected in healthy controls. Patientswith significant fibrosis (F ≥ 2) had a significantly older age,lower count of platelets and higher values of AST, GGT and HGF,than those patients with a fibrosis score F < 2. HGF concentrationwas identified by multivariate analysis as the only independent factorassociated with significant fibrosis. Moreover, area under receiveroperating curve, using HCG levels, showed similar values to thoseof previously validated non-invasive indexes of fibrosis. However,levels of HGF did not show a significant decrease in patients with asustained response to anti-virus C therapy.Conclusion: serum HGF concentration correlates with fibrosisscore in patients with CHC, but is insensitive to monitorchanges induced by anti-virus C therapy(AU)

[A high-resolution gastroenterology clinic in Andalusia: what is it, and how should it work]. / Consulta de alta resolución de digestivo en Andalucía: qué es y cómo debe funcionar?

INTRODUCTION: The present concept in our healthcare system is that medical care should be given on an outpatient basis with hospitalization occurring only when essential. We therefore put forth the development of the "all in one" outpatient office or "high resolution" outpatient clinic. For such purpose we administered a questionnaire to various Andalusian hospitals to define and determine those aspects necessary in the development of the aforementioned outpatient office. MATERIALS AND METHODS: The questionnaire was filled out by 10 Andalusian hospitals. This is a prospective-descriptive study of responses from all 10 participating hospitals. The 27 questions inquired on the existence of such an outpatient office and the infrastructure needed to develop this service: How many patients are seen, where is it physically located, where do patients come from, criteria for assigning patients to this medical office, condition of incoming patients, whether ultrasound scans are performed, whether an integrated hospital computer system exists, nursing staff, how many visits are required before coming to a diagnosis, and finally whether this type of outpatient office is needed, and if so, why. RESULTS: Of all 10 hospitals, 5 of them had this type of clinic. All of them considered this type of outpatient service essential. The number of patients treated should be "10", in the hospital itself. There are differences as to whether patients should come from the emergency room or a primary care physician. It seems logical to assume that only patients who can be diagnosed via ultrasounds or endoscopy should be chosen. To allow an ultrasonogram the patient should visit the outpatient office in a state of "fasting" and with standard blood counts from the primary care physician. The outpatient clinic should have a computer system and its own nurse. According to participating hospitals this type of outpatient visits is very useful in our present healthcare system, as it allows higher levels of collaboration between Primary Care and the specialist; it also provides a rapid orientation regarding patient pathology, and acts as a "filter" for the rest of the healthcare system. CONCLUSIONS: The outpatient office should be tended to by an attending specialist in the field (FEA) with knowledge and experience in ultrasounds and gastrointestinal endoscopy, as well as user competency with the required computer programs. In our present-day system this can be considered a modality of high-resolution outpatient services and a model of efficiency.

Consulta de alta resolución de digestivo en Andalucía: ¿qué es y cómo debe funcionar? / No disponible

Introducción: la idea actual de nuestro sistema sanitario esque la asistencia sea ambulatoria y que se utilice la hospitalizacióncuando sea precisa. En este sentido es de destacar el desarrollo dela consulta única o de alta resolución. Por ello, se ha realizado unaencuesta entre varios hospitales andaluces con la idea de definir ydeterminar qué aspectos son necesarios para poder desarrollaresta consulta.Material y métodos: la encuesta ha sido contestada por 10hospitales andaluces. Se trata de un estudio prospectivo descriptivode las respuestas contestadas por los distintos hospitales. Laspreguntas son 27 en las que se reflexiona sobre la existencia de laconsulta y la infraestructura para desarrollarla: cuántos pacientesse ven, dónde se pasa esta consulta, de dónde provienen los pacientes,los criterios para derivar los pacientes a esta consulta, lascondiciones en las que acude el enfermo, si se realiza ecografía deabdomen, si se dispone de sistema informático integrado hospitalario,enfermera, en cuántas visitas se emite un diagnóstico del pacientey, por último, se pregunta si se cree que es necesaria estaconsulta y por qué.Resultados: de los 10 hospitales 5 tienen consulta de alta resolución,aunque todos consideran que la deberían tener. El númerode pacientes atendidos debe ser 10 y en el propio hospital.Existen diferencias en considerar si los pacientes deben provenirdesde Urgencias o desde el médico de cabecera. Parece lógicopensar que sólo se deben derivar pacientes cuya patología puedaser diagnosticada mediante ecografía y/o endoscopia. El pacientedebería acudir a la consulta en ayunas y con analítica del médicode cabecera, para así poder realizarles la ecografía. La consultadebe constar de sistema informático y de una enfermera propia.Según los encuestados este tipo de consultas es muy útil en nuestroactual sistema, porque permite mayor colaboración entreAtención Primaria y el especialista, y consigue una orientación rápidade la patología del paciente actuando de filtro adecuado parael resto de las consultas

Introduction: the present concept in our healthcare system isthat medical care should be given on an outpatient basis with hospitalizationoccurring only when essential. We therefore put forththe development of the “all in one” outpatient office or “high resolution”outpatient clinic. For such purpose we administered aquestionnaire to various Andalusian hospitals to define and determinethose aspects necessary in the development of the aforementionedoutpatient office.Materials and methods: the questionnaire was filled out by10 Andalusian hospitals. This is a prospective-descriptive study ofresponses from all 10 participating hospitals. The 27 questionsinquired on the existence of such an outpatient office and the infrastructureneeded to develop this service: How many patientsare seen, where is it physically located, where do patients comefrom, criteria for assigning patients to this medical office, conditionof incoming patients, whether ultrasound scans are performed,whether an integrated hospital computer system exists,nursing staff, how many visits are required before coming to a diagnosis,and finally whether this type of outpatient office is needed,and if so, why.Results: of all 10 hospitals, 5 of them had this type of clinic.All of them considered this type of outpatient service essential.The number of patients treated should be “10”, in the hospital itself.There are differences as to whether patients should comefrom the emergency room or a primary care physician. It seemslogical to assume that only patients who can be diagnosed via ultrasoundsor endoscopy should be chosen. To allow an ultrasonogramthe patient should visit the outpatient office in a state of“fasting” and with standard blood counts from the primary carephysician.The outpatient clinic should have a computer system and itsown nurse. According to participating hospitals this type of outpatientvisits is very useful in our present healthcare system, as it allowshigher levels of collaboration between Primary Care and thespecialist; it also provides a rapid orientation regarding patientpathology, and acts as a “filter” for the rest of the healthcare system (AU)

Modulation of the anti-inflammatory interleukin 10 and of proapoptotic IL-18 in patients with chronic hepatitis C treated with interferon alpha and ribavirin.

The aim of this work was to analyse apoptosis rate, measured by the serum levels of proapoptotic interleukin (IL)-18 and of soluble Fas (sFas), as well as of anti-inflammatory IL-10, in patients with chronic hepatitis C, at baseline and after treatment with interferon alpha and ribavirin. Twenty-seven patients with biopsy-proven chronic hepatitis C were studied, at baseline and after treatment with interferon alpha (21 cases) or pegylated interferon (6 cases) plus ribavirin. A group of 15 healthy sex- and age-matched individuals was selected as control. Serum concentrations of sFas, IL-10 and IL-18 were determined by ELISA in sandwich. The relationship of these molecules to necro-inflammatory and fibrotic activity was evaluated. Evolution of the serum concentrations of these molecules was analysed after treatment. Significantly increased serum concentrations of sFas were detected in patients with chronic hepatitis, compared with controls. Levels of this molecule were significantly correlated with necroinflammatory activity. Likewise, concentrations of IL-10 were significantly increased in the group of patients, compared with controls. Treatment with interferon and ribavirin induced a significant decrease of IL-18 concentration independently of the viral response. In contrast, levels of sFas decreased only in those patients with sustained response to therapy. Finally, baseline levels of IL-10 were significantly increased in patients without response to treatment, compared with those with sustained response, but the concentration did not change with the treatment. Increased serum levels of IL-10 are a negative prognostic marker of response to hepatitis C treatment. A significant decrease of apoptotic rate, as determined by sFas, can be expected in patients with a response to therapy.

Tumor mucinoso papilar intraductal pancreático / Pancreatic intraductal papillary mucinous tumor

No disponible

Adhesion molecules as a prognostic marker of liver cirrhosis.

OBJECTIVE: Endothelial activation plays an active role in modifications of the circulatory status of cirrhotic patients. Soluble endothelial adhesion molecules, induced by pro-inflammatory cytokines, could be considered markers of endothelial activation. Their role in the natural history of cirrhosis and portal hypertension has not been reported. Our objective was to analyze the prognostic value of soluble adhesion molecules in cirrhotic patients. MATERIAL AND METHODS: Serum concentrations of soluble CD14, soluble receptors of tumor necrosis factor alpha and adhesion molecules ICAM-1 (intercellular adhesion molecule-1) and VCAM-1 (vascular cell adhesion molecule 1) as well as mean blood pressure, plasma renin activity, aldosterone, vasopressin and norepinephrine concentrations were determined in 64 cirrhotic patients (Child-Pugh class: A 48.4%, B 34.4%, C 17.2%), without any evidence of infection, and in 25 healthy controls. Patients were followed-up for a mean of 36.4 (range 6-60) months. RESULTS: Increased concentrations of soluble CD14, tumor necrosis factor receptors and ICAM-1 and VCAM-1 were detected in cirrhotic patients when compared with healthy controls. Tumor necrosis factor receptors and adhesion molecule concentrations were both significantly higher in advanced phases of cirrhosis (Child Pugh class C and B versus A). Fifteen patients died as a related consequence of liver cirrhosis. Multivariate analysis demonstrated that Child-Pugh score and serum levels of tumor necrosis factor receptor I and ICAM-1 were associated with mortality. CONCLUSIONS: In addition to the classic factor implicated in mortality (Child-Pugh class), alterations in inflammation-related components and soluble adhesion molecules, as representatives of hemodynamic alterations, are of prognostic significance in cirrhotic patients.

85 Aniversario de la Revista Española de Enfermedades Digestivas (Nº Extraordinario)

No disponible

Septic arthritis due to Streptococcus bovis in a patient with cirrhosis of enolic etiology.

We present a case of bacteremia and septic arthritis due to Streptococcus bovis biotype I after shock, in a patient with liver cirrhosis of enolic etiology. Diagnosis was made based on a clinical setting of fever and a painful shoulder. The presence of colonic neoplasia was ruled out in this patient and the bacteremia developed without endocarditis.

Artritis séptica por Streptococcus bovis en cirrótico de etiología enólica / Septic arthritis due to streptococcus bovis in a patients with cirrhosis of enolic etiology

Aportamos un caso de bacteriemia y artritis séptica por Streptococcus bovis biotipo I tras traumatismo, en un paciente afecto de una cirrosis hepática de etiología enólica. El diagnóstico se realizó en el contexto de un cuadro febril con hombro doloroso. En este paciente se descartó la presencia de neoplasia colónica y la bacteriemia cursó sin endocarditis (AU)

Ultrasonography in patients with chronic liver disease: its usefulness in the diagnosis of cirrhosis.

OBJECTIVE: To prospectively assess the usefulness of ultrasonography in predicting the presence of cirrhosis in patients with asymptomatic chronic liver disease in unknown stage. EXPERIMENTAL DESIGN: Eighteen doppler and ultrasonographic features were prospectively assessed immediately before performing laparoscopy and/or liver biopsy. Usefulness of predictive variables selected by multiple regression analysis and included in a scoring scale was determined by ROC curves. PATIENTS: One hundred and thirteen consecutive patients with neither clinical nor biochemical signs of advanced liver disease submitted for study. RESULTS: Liver enlargement, liver surface nodularity, liver parenchyma distortion, flattening of flow wave in hepatic veins, portal and splenic veins dilatation, decreased variability in splenic vein caliber with breathing. Collateral vessels, and splenomegaly were associated to cirrhosis. Multivariate analysis showed the joint assessment of hepatic echostructure, portal vein caliber and spleen area to be the best approach to ultrasonographic staging, with sensitivity of 80%, specificity of 92% and accuracy of 89% in the diagnosis of cirrhosis. CONCLUSIONS: Ultrasonography enabled the presence or absence of cirrhosis to be correctly determined even in patients with asymptomatic disease. Combined assessment of hepatic echostructure, portal vein diameter and spleen size provides the highest accuracy.

Utilidad de la ecografía en el diagnóstico de cirrosis en pacientes con hepatopatía crónica / Ultrasonography in patients with chronic liver disease: its usefulness in the diagnosis of cirrhosis

Objetivo: establecer la utilidad de la ecografía en la predicción de la existencia de una cirrosis hepática en pacientes con enfermedad hepática crónica clínicamente silente. Diseño experimental: estudio prospectivo y ciego. Inmediatamente antes de la realización de laparoscopia y/o biopsia hepática se practicó una ecografía abdominal, con estudio Doppler. Mediante regresión logística múltiple se determinó el valor predictivo para la presencia de cirrosis de 18 variables analizadas. Mediante curvas ROC se estableció la precisión de las variables predictoras para determinar la presencia o ausencia de cirrosis. Pacientes: ciento trece pacientes consecutivos sin indicios clínicos ni bioquímicos de enfermedad hepática avanzada ingresados para filiación de una hepatopatía crónica. Resultados: el tamaño hepático, la irregularidad de la superficie hepática, la alteración en su ecoestructura, el aplanamiento de la onda de flujo de la vena suprahepática, la dilatación de las venas porta y esplénica, la disminución de las modificiaciones del calibre de la vena esplénica con la respiración, la presencia de circulación colateral y la evidencia de esplenomegalia se asociaron a la presencia de cirrosis. La valoración conjunta de la ecoestructura hepática, el calibre de la vena porta y el tamaño del bazo permitió establecer el diagnóstico de cirrosis con una sensibilidad del 80 por ciento, especificidad del 92 por ciento y precisión del 89 por ciento. Conclusiones: la ecografía permite analizar correctamente la presencia o ausencia de cirrosis aún en pacientes sin indicios clínicos de insuficiencia hepatocelular ni hipertensión portal. La mayor precisión diagnóstica se obtiene mediante la valoración conjunta de la alteración en la ecoestructura hepática, el calibre de la vena porta y el tamaño del bazo (AU)

Expression of proinflammatory cytokines and their inhibitors during the course of spontaneous bacterial peritonitis.

The aim of this work was the evaluation, in cirrhotic patients with noninfected ascites and with spontaneous bacterial peritonitis (SBP), of serum and ascitic fluid levels of proinflammatory cytokines [interleukin (IL) 1-beta, tumor necrosis factor alpha (TNF-alpha), and IL6] and antiinflammatory compounds [IL10, soluble IL-1 receptor antagonist (sIL-1Ra), soluble receptors of TNF p55 and p75 (sTNFR55 and sTNFR75), and soluble receptor of IL6 (sIL6R)], as well as their relationship with the outcome of the infection in those with SBP. These molecules were assayed by ELISA in noninfected cirrhotic controls (n = 15), patients with SBP (n = 32), and healthy controls (n = 20). Serum levels of IL6 and of the majority of antiinflammatory mediators, sIL1Ra, sTNFR75, and sIL6R, were higher in control cirrhotic patients compared to healthy subjects. SBP was associated with significantly elevated ascitic fluid levels of every one of the proinflammatory cytokines compared to those in cirrhotic controls. Also, serum levels of IL10 and both TNF receptors and ascitic fluid levels of sIL1Ra and sTNFR55 were higher in patients with SBP compared to cirrhotic controls. Ascitic fluid levels of proinflammatory cytokines decreased rapidly after resolution of the infection; however, nonsignificant changes were detected in ascitic fluid concentrations of antiinflammatory molecules. Thus, elevated levels of antiinflammatory compounds both in noninfected cirrhotic patients and in patients with SBP suggest a regulatory control of the inflammatory process by these molecules in liver cirrhosis patients.

[Renal Doppler ultrasonography and its relationship with the renal function in patients with liver cirrhosis]. / Ecografía Doppler renal y su relación con la función renal en pacientes con cirrosis hepática.

BACKGROUND: To relate the renal hemodynamic changes, as assessed by Doppler ultrasonography,with the development of ascites, renal function, and endogenous vasoactive systems in patients with liver cirrhosis. PATIENTS AND METHODS: 60 cirrhotic patients were studied prospectively, 31 of these compensated and 29 with ascites. The renal resistive index, renal function and plasmatic levels of renin, aldosterone, noradrenaline and ADH activity were determined. RESULTS: The renal resistive index was significantly higher in the cirrhotic patients with ascites (0.68) than in the compensated cirrhotics (0.63) and was significantly correlated with the serum levels of creatinine,urinary excretion of sodium, plasmatic renin activity and plasmatic concentration of aldosterone. CONCLUSIONS: The renal resistive index, study by means of Doppler ultrasonography, shows progressively increased levels with the evolution of the disease, with the deterioration of the renal function and with the activation of the endogenous vasoactive systems.

Serial analysis of serum and ascitic fluid levels of soluble adhesion molecules and chemokines in patients with spontaneous bacterial peritonitis.

The aim of this work was the evaluation of serum and ascitic fluid levels of chemokines (IL-8, growth-regulated oncogene (Gro-alpha), and monocyte chemotactic protein-1 (MCP-1)), and of soluble adhesion molecules (P-selectin, E-selectin, L-selectin, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1)) in patients with spontaneous bacterial peritonitis (SBP). These compounds were serially analysed in serum and ascitic fluid by ELISA in patients with SBP (n = 20), non-infected cirrhotic controls (n = 12), and healthy controls (n = 15). Infected and non-infected cirrhotic patients showed significantly higher serum levels of adhesion molecules. SBP was associated with significantly higher serum and ascitic fluid levels of IL-8, Gro-alpha and ICAM-1 and with ascitic fluid concentrations of MCP-1. Significantly elevated serum levels of both ICAM-1 and VCAM-1 were detected in patient non-survivors after SBP. Thus, higher ascitic fluid levels of chemokines could be implicated in the peritoneal infiltrate in patients with SBP. Prognostic significance can be attributed to serum levels of ICAM-1 and VCAM-1 in these patients.

Ecografía Doppler en la valoración de la hemodinámica renal en pacientes con hepatopatía crónica / Doppler ultrasonography in the assessment of renal hemodynamics in patients with choric liver disease

OBJETIVO: valorar los cambios hemodinámicos renales mediante determinación con ecografía Doppler del índice de resistencia (IR) renal en pacientes con hepatopatía crónica en diferentes estadios evolutivos. En pacientes con cirrosis, analizar el IR renal en función de la presencia o no de ascitis y la respuesta al tratamiento diurético. PACIENTES Y MÉTODOS: se estudió de forma prospectiva 24 sujetos con hepatitis crónica, 39 pacientes cirróticos compensados y 34 con ascitis. Los cirróticos con ascitis se dividieron en grupo 1: con respuesta a medidas dietéticas y bajas dosis de diuréticos, y grupo 2: ascitis refractaria o que precisan dosis superiores de diuréticos. RESULTADOS: El IR renal fue significativamente superior en los pacientes cirróticos con ascitis (0,68 ñ 0,06) que en los cirróticos compensados (0,63 ñ 0,03; p < 0,01), y en éstos que en los sujetos con hepatitis crónica (0,61 ñ 0,04; p < 0,05). Los cirróticos con ascitis del grupo 1 presentaron un IR renal inferior a los del grupo 2 (0,65 ñ 0,05 vs 0,72 ñ 0,06; p < 0,01). CONCLUSIONES: el IR renal se incrementa conforme avanza la hepatopatía crónica. Los pacientes cirróticos con elevación del IR renal son no respondedores o requieren mayor dosis de diuréticos. Se requieren estudios para valorar la utilidad del IR renal en la predicción de la respuesta al tratamiento diurético en pacientes con ascitis (AU)

Risk factors for hepatocellular carcinoma in patients with liver cirrhosis.

OBJECTIVE: Although cirrhosis is known to predispose toward hepatocellular carcinoma (HCC), there is no agreement on the factors that can influence the risk for HCC in patients with cirrhosis. This study was designed to identify differences in cirrhosis-related risk factors for developing HCC in relation to epidemiological characteristics, stage of the disease and etiology. METHODS: 512 patients from southwestern Spain with Child-Pugh stage A or B cirrhosis were examined periodically by ultrasonography, and alpha-fetoprotein (AFP) concentration was measured. RESULTS: The average length of follow-up was 37 months. A total of 52 cases of HCC were detected, which represented a risk of 17% after 5 years of follow-up. The Cox model showed that the risk of HCC increased by 8% per year of increasing age. Male sex (relative risk: 3.4), hepatitis C virus infection (relative risk: 4.6), hepatitis B virus infection (relative risk: 2.9) and AFP levels higher than 15 ng/ml (relative risk: 2.5) were also shown to be risk factors. Among alcoholic patients, only age (risk increased by 15% per year), and hepatitis C virus infection (relative risk: 5.4) were risk factors for HCC. However, in patients infected by hepatitis C virus, the main risk factors were age (relative risk increased by 8% per year), male sex (relative risk: 3.9), co-infection with hepatitis B virus (relative risk: 4.9), and increased AFP (relative risk: 2.8). Of the patients with HCC, 71% were infected with hepatitis C virus. Alcoholism, Child-Pugh stage and duration of cirrhosis did not increase the risk of the appearance of HCC. CONCLUSIONS: The risk of HCC increased to 17% after 5 years of follow-up in patients with Child-Pugh stage A or B cirrhosis. Hepatitis C virus infection was the main risk factor in patients with cirrhosis. Other risk factors were age, male sex, hepatitis B virus infection and altered AFP level.

Factores de riesgo de aparición del carcinoma hepatocelular en pacientes con cirrosis hepática / Risk Factors for hepatocellular carcinoma in patients with liver cirrhosis

OBJETIVO: determinar la existencia de diferencias en el riesgo de presentar un carinoma hepatocelular (CHC) en pacientes con cirrosis en función de sus características epidemiológicas, evolución de la hepatopatía y su etiología. PACIENTES Y MÉTODOS: 512 pacientes cirróticos en grado A/13 de Child-Pugh menores de 70 años fueron valorados periódicamente mediante ecografía y determinaciones de alfa-fetoproteína (AFP). RESULTADOS: tras un seguimiento medio de 37 meses se detectaron 52 CHC (riesgo acumulado del 17 por ciento a los 5 años). El modelo de Cox demostró que por cada año de edad el riesgo de CHC se incrementó un 8 por ciento. El sexo varón (RR: 3,4), la infección por virus C (RR: 4,6), la infección por el virus B (RR: 2,9) y la alteración de la AFP (RR: 2,5) también se mostraron como factores de riesgo. Entre los pacientes etílicos, sólo la edad (incremento del 15 por ciento por cada año transcurrido) y la infección por el virus C (RR: 5,4) fueron factores de riesgo. En los pacientes infectados por el virus C supusieron un mayor riesgo: la edad (S por ciento por cada año), el sexo varón (RR: 3,9), la coinfección por el virus B (RR: 4,9) y la elevación de la AFP (RR: 2,8). El 71 por ciento de los pacientes con CHC tenían infección por el virus C. El etilismo y la duración de la cirrosis no incrementaron el riesgo de aparición del tumor, CONCLUSIONES: el riesgo de aparición del CHC asciende al 17 por ciento tras 5 años de seguimiento en pacientes con cirrosis en grado A/B de Child-Pugh. El virus C es el principal factor de riesgo en nuestro medio. Otros factores demostrados son la edad, el sexo varón, la infección por el virus B y la alteración de la AFP. El etilismo y la duración de la hepatopatía no influye en el riesgo de aparición del tumor (AU)