PNPLA3 rs738409 associates with alcoholic liver cirrhosis but not with serum levels of IL6, IL10, IL8 or CCL2 in the Russian population.

INTRODUCTION AND AIM: Polymorphic variant rs738409 within the PNPLA3 gene associates with alcoholic liver cirrhosis (ALC) in heavy drinkers of various ancestry but has not yet been established in the Russian population characterized by high incidence of ALC. PNPLA3 rs738409 involvement in the inflammatory process has been proposed as one of the mechanisms of liver dysfunction. Relationship between the PNPLA3 polymorphism and the biochemical markers of inflammation in patients with ALC remains unclear. The current study revealed the association between the rs738409 polymorphism, liver cirrhosis and serum cytokines in heavy drinkers in the Russian population. MATERIALS AND METHODS: The serum levels of IL6, IL10, IL8, and CCL2 along with PNPLA3 rs738409 polymorphism were determined in heavy drinkers (AA, n=71) and heavy drinkers with diagnosed liver cirrhosis (ALC, n=110). All of the recruited individuals were Caucasians and belonged to the Russian population. RESULTS: Heavy drinkers carrying PNPLA3 rs738409 CG or CG+GG genotypes as compared with CC genotype carriers or G allele as compared with C allele carriers had significant risk of ALC. In ALC levels of interleukins and CCL2 increased as compared with AA. PNPLA3 rs738409 CC carriers had lower cirrhosis stage as compared with CG+GG carriers, however there were no differences of IL6, IL10, IL8 or CCL2 levels between G allele carriers and non-carriers in heavy drinkers. CONCLUSION: Thus, in the Russian population heavy drinkers carrying PNPLA3 rs738409 G allele are at higher risk of ALC, however the presence of rs738409 allele does not influence the serum cytokine levels.

Validation of original, expanded Baveno VI, and stepwise & platelet-MELD criteria to rule out varices needing treatment in compensated cirrhosis from various etiologies.

INTRODUCTION AND OBJECTIVES: The Baveno VI criteria to rule out varices needing treatment (VNT) was introduced in 2015. Soon after, the expanded Baveno VI and stepwise platelet-MELD criteria were proposed to be equal/more accurate in ruling out VNT; however, neither has been widely validated. We aimed to validate all 3 criteria in compensated cirrhosis from assorted causes. MATERIALS AND METHODS: We conducted a cross-sectional study including all adult compensated cirrhotic patients who underwent endoscopic surveillance at our center from 2014 to 2018 and had transient elastography (TE), and laboratory data for criteria calculation within 6 months of endoscopies. Exclusion criteria were previous decompensation, unreliable/invalid TE results, and liver cancer. The diagnostic performances of all criteria were evaluated. RESULTS: A total of 128 patients were included. The major cirrhosis etiologies were hepatitis C and B (37.5% and 32.8%, respectively). VNT was observed in 7.8%. All criteria yielded high negative predictive values (NPVs)>95%, missed VNT was observed in 2%, 2.7%, and 2.8% in the original, expanded Baveno VI, and platelet-MELD criteria, respectively. The expanded Baveno VI and the platelet-MELD criteria yielded significantly better specificities and could spare more endoscopies than the original Baveno VI criteria. CONCLUSIONS: All 3 criteria showed satisfactorily high NPVs in ruling out VNT in compensated cirrhosis from various causes. The expanded Baveno VI and the platelet-MELD criteria could spare more endoscopies than the original Baveno VI criteria. From a public health standpoint, the platelet-MELD criteria might be useful in a resource-limited setting where TE is not widely available.

Clinical Significance of Serum Adiponectin and Resistin Levels in Liver Cirrhosis.

INTRODUCTION: Adiponectin and resistin levels are increased in patients with cirrhosis, but it prognostic significance is unknown. We sought to investigate the factors associated with adiponectin and resistin levels and its clinical significance in patients with cirrhosis. MATERIALS AND METHODS: This was a prospective cohort study that included 122 subjects with cirrhosis who attended an outpatient clinic and were initially evaluated in 2012. Serum adiponectin and resistin levels were measured in samples collected in 2012 (adiponectin and resistin) and 2014 (adiponectin). Thirty healthy subjects served as a control group. RESULTS: Higher adiponectin (21.59 µ g/mL vs. 12.52 µg/mL, P < 0.001) and resistin levels (3.83 ng/mL vs. 2.66 ng/mL, P < 0.001) were observed among patients with cirrhosis compared to controls. Patients classified as Child-Pugh B/C had higher adiponectin levels in relation to Child-Pugh A patients. At second measurement, adiponectin levels increased significantly in non-transplant patients and decreased in liver transplant recipients. Univariate Cox analysis showed that among patients with alcoholic liver disease, adiponectin levels were associated with lower transplant-free survival (HR = 1.034, 95% CI 1.006 - 1.062, P = 0.016). The transplant-free survival was significantly lower among patients with alcoholic liver disease and adiponectin ≥ 17 µg/mL (26.55 months, 95% CI 21.40-31.70) as compared to those with levels < 17 µg/mL (33.76 months, 95% CI 30.70-36.82) (P = 0.045). No relationship was found between the levels of resistin and survival. CONCLUSION: Adiponectin but not resistin levels were associated with intensity of liver dysfunction and worse prognosis in patients with alcoholic liver disease, suggesting a potential as a prognostic biomarker.

Usefulness of a new prognostic index for alcoholic hepatitis.

BACKGROUND: Alcoholic liver disease is a major cause of end-stage liver disease worldwide and severe forms of alcoholic hepatitis are associated with a high short-term mortality. Objectives To analyze the importance of age-bilirubin-INR-creatinine (ABIC) score as an index of mortality and predictor for complications in patients with alcoholic hepatitis. To evaluate its correlation with those complications, with risk of death, as well as the scores model for end stage liver disease (MELD) and Maddrey's discriminat function. METHODS: A total of 46 medical records of patients who had been hospitalized with alcoholic hepatitis were assessed retrospectively with lab tests on admission and after seven days. Score calculations were carried out and analyzed as well. RESULTS: The scores showed positive reciprocal correlation and were associated with both hepatic encephalopathy and ascites. ABIC index, which was classified as high risk, presented as a risk factor for these complications and for death. In univariate logistic regression analysis of mortality, the ABIC index at hospital admission odds ratio was 19.27, whereas after 7 days, it was 41.29. The average survival of patients with ABIC of low and intermediate risk was 61.1 days, and for those with high risk, 26.2 days. CONCLUSIONS: ABIC index is a predictor factor for complications such as ascites and hepatic encephalopathy, as well as for risk of death. Thus, it is a useful tool for clinical practice.

Usefulness of annew prognostic index for alcoholic hepatitis / Utilidade de um novo índice prognóstico na hepatite alcoólica

Background Alcoholic liver disease is a major cause of end-stage liver disease worldwide and severe forms of alcoholic hepatitis are associated with a high short-term mortality. Objectives To analyze the importance of age-bilirubin-INR-creatinine (ABIC) score as an index of mortality and predictor for complications in patients with alcoholic hepatitis. To evaluate its correlation with those complications, with risk of death, as well as the scores model for end stage liver disease (MELD) and Maddrey’s discriminat function. Methods A total of 46 medical records of patients who had been hospitalized with alcoholic hepatitis were assessed retrospectively with lab tests on admission and after seven days. Score calculations were carried out and analyzed as well. Results The scores showed positive reciprocal correlation and were associated with both hepatic encephalopathy and ascites. ABIC index, which was classified as high risk, presented as a risk factor for these complications and for death. In univariate logistic regression analysis of mortality, the ABIC index at hospital admission odds ratio was 19.27, whereas after 7 days, it was 41.29. The average survival of patients with ABIC of low and intermediate risk was 61.1 days, and for those with high risk, 26.2 days. Conclusions ABIC index is a predictor factor for complications such as ascites and hepatic encephalopathy, as well as for risk of death. Thus, it is a useful tool for clinical practice. .

Contexto A doença hepática alcoólica é uma das maiores causas de doença hepática avançada no mundo, sendo que as formas graves de hepatite alcoólica estão associadas a alta mortalidade a curto prazo. Objetivos Avaliar a importância do índice age-bilirrubin-INR-creatinine (ABIC) como fator prognóstico na hepatite alcoólica e sua correlação com as complicações dessa doença, com o risco de óbito e com os escores Model for End stage Liver Disease (MELD) e Função Discriminante de Maddrey. Métodos Um total de 46 prontuários de pacientes internados por hepatite alcoólica foram avaliados de forma retrospectiva. Foi realizado levantamento de exames laboratoriais do primeiro dia de internação e 7 dias após, além de cálculo dos escores estudados. Resultados Os índices ABIC, Maddrey e MELD apresentaram correlação positiva entre si e associaram-se a encefalopatia hepática e a ascite (P<0,05). O índice ABIC, classificado de alto risco, foi fator de risco para essas complicações e para óbito. Em análise de regressão logística univariada para óbito, a razão de risco do ABIC de entrada no hospital foi de 19,27 (P=0,012) e após 7 dias de 41,29 (P=0,002). A sobrevida acumulada daqueles com ABIC de alto risco foi de 93,3% em 7 dias e de apenas 26,9% em 60 dias. Conclusões O índice prognóstico ABIC é fator de predição para complicações como ascite e encefalopatia hepática, assim como para risco de óbito, sendo ferramenta útil na prática clínica. .

Involvement of serum apolipoprotein AI and B100 and lecithin cholesterol acyl transferase in alcoholic cirrhotics.

Lipoproteins are synthesized by the liver and secreted to plasma. Chronic alcoholic intoxication produces frequently cirrhosis and concomitantly alterations in liver metabolism. Thirty patients with alcoholic cirrhosis and 83 healthy controls were selected for this study. Apolipoprotein A1, B100, lecithin cholesterol acyltransferase, responsible for cholesterol esterification and seudocholinesterase enzyme activity not related to lipid metabolism, as a referent of proteins synthesized by the liver were analyzed. In 7 patients serum tiobarbituric acids, catalase, glutathione peroxidase were measured, as exponent of the presence of oxidative stress. Our results showed a significant decrease in lipoproteins, lecithin cholesterol acyltransferase and seudocholinesterase activities. An increase in serum tiobarbituric acids and a decrease in both antioxidant enzymes were found as well. In conclusion, alcohol cirrhotic liver decreases the production of liver proteins including those related to lipid metabolism, allowing the formation of steatosis and/or necrosis. Moreover oxidative stress participate possible as a major mechanism in liver damage.

[Prognostic value of plasmatic fibronectin and Child-Pugh classification in alcoholic cirrhotic patients. A comparative study]. / Valor prognóstico da fibronectina plasmática e da classifição de Child-Pugh na cirrose hepática alcoólica. Estudo comparativo.

BACKGROUND: To assess the prognostic value of plasmatic fibronectin (FN), compared to numeric Child-Pugh classification and its biochemical parameters in patients with alcoholic cirrhosis followed prospectively during a 18 months-period. METHODS: Fifty patients with the diagnosis of cirrhosis by hepatic biopsy or clinical and biochemical criteria, were included in the study after the exclusion of hepatocarcinoma and GI bleeding, infection or continous alcohol ingestion in the last 30 days. The mean age was 51.3+/-12.6 years, being 72% males and 17 of them were classified as Child-Pugh A, 18 as B and 15 as C. Serum bilirubin concentration was measured in autoanalyzer, protein electrophoresis was performed on cellulose acetate and prothrombin time by the Quick test. Plasmatic FN was assessed by radial immunodiffusion with anti-human FN in 1% agarose gel slabs. RESULTS: One patient was excluded because no natural death and 12 died owing to hepatic disease. The numeric Child-Pugh [score > 10, Relative Risk (RR)=11.33] and total bilirubins (> 2.5 mg/dL, RR=9.47) were the best predictors of death. Mean plasmatic FN concentration was significantly higher among those who survived when compared with those who died (185+/-66 mg/L x 131+/-38 mg/L, p<0.01), with a RR=6.59, for FN < 165 mg/L. Higher levels of FN, on the other hand, were the best variable to predict survival, since 96% of these 29 patients were alive at the end of follow-up. CONCLUSION: Although having less accuracy in predicting the risk of death of these patients, plasmatic FN > 165 mg/L was better predictor of survival than Child-Pugh score or any one of its biochemical parameters.

Valor prognóstico da fibronectina plasmática e da classificação de Child-Pugh na cirrose hepática alcoólica: estudo comparativo / Prognostic value of plasmatic fibronectin and Child-Pugh classification in alcoholic cirrhotic patients: a comparative study

OBJETIVOS: Avaliar o valor prognóstico da fibronectina plasmática (FN), comparativamente à classificação numérica de Child-Pugh e os parâmetros bioquímicos que a compõem, no acompanhamento prospectivo de portadores de cirrose alcoólica durante 18 meses. MÉTODOS: Incluídos 50 pacientes com cirrose alcoólica, diagnosticada por biópsia ou critérios clínico-bioquímicos, excluídos aqueles com hepatocarcinoma ou hemorragia digestiva, infecção ou ingestão alcoólica continuada nos últimos 30 dias. A idade média do grupo foi 51,3±12,6 anos, 72 por cento deles do sexo masculino e classificados 17 como Child-Pugh A, 18 como B e 15 como C. Os valores das bilirrubinas foram dosados pelo método automatizado, eletroforese de proteínas em acetato de celulose e o tempo de protrombina pelo método de Quick. A FN plasmática foi dosada por imunodifusão radial, com anticorpos contra FN humana em géis de agarose a 1 por cento. RESULTADOS: Um paciente foi excluído por óbito de causa não natural e 12 foram a óbito por doença hepática. Os melhores preditores de óbito foram a pontuação de Child-Pugh [escore>10, risco relativo (RR) de 11,33) e os valores de bilirrubina (>2,5mg/dL, RR=9,47). A concentração de FN foi significantemente maior nos sobreviventes que naqueles que foram a óbito (185±66 mg/L x 131±38mg/L, p<0,01), com RR = 6,59 para FN<165mg/L. Valores de FN acima desse valor de corte, entretanto, foram os melhores indicadores de sobrevida desde que 96,5 por cento desses 29 pacientes estavam vivos ao final de 18 meses de seguimento. CONCLUSAO: Embora apresente menor acurácia em predizer o risco de óbito desses pacientes, valores de FN plasmática> 165mg/L foram melhores indicadores de sobrevida que a classificação de Child-Pugh e seus parâmetros bioquímicos isolados.

Leukocyte arylsulfatase A activity in patients with alcohol-related cirrhosis.

Arylsulfatase (ASA) enzyme deficiency is associated with metachromatic leukodystrophy (MLD), which is a hereditary myelin metabolic disease. It has been proposed that in alcoholic subjects with abnormal ASA, the accumulation of sulfatides may lead to demyelinization and generalized cerebral atrophy. ASA may be diminished in subjects with alcoholic cirrhosis having encephalopathic manifestations. This idea has not been previously proposed. Leukocyte arylsulfatase A (ASA) activity was measured in 30 healthy male volunteers and 28 patients with alcohol-related cirrhosis. The patients were divided into two groups: patients with alcohol-related cirrhosis with hepatic encephalopathy history and patients with alcoholic cirrhosis without history of hepatic encephalopathy. Alcoholic cirrhotic patients with history of encephalopathy showed 58.21% (40.95 nmol/mg protein/h) less enzymatic activity than a control group (98.00 nmol/mg protein/h), whereas the group without history of encephalopathy showed an ASA value which was 38.2% (60.55 nmol/mg protein/h) less than the control group. The results suggest that the low ASA activity is a factor associated to the appearance of encephalopathy in patients with alcohol-related cirrhosis.

Plasma hydroxy-metronidazole/metronidazole ratio can detect early changes in hepatic function in ethanol-induced liver injury.

AIMS: To evaluate the usefulness of plasma hydroxy-metronidazole/metronidazole (OH-MET/MET) ratios as a dynamic liver function test in ethanol abusers with or without liver cirrhosis. METHODS: Metronidazole was administered intravenously for 20 min to healthy volunteers, and to patients with alcohol-induced, non-cirrhotic hepatopathy and liver cirrhosis. Plasma concentrations of metronidazole and hydroxy-metronidazole were measured by high performance liquid chromatography in samples collected 5, 10, 20 and 30 min after the metronidazole infusion. RESULTS: Patients with non-cirrhotic alcoholic hepatopathy had significantly elevated aminotransferase levels compared to healthy volunteers and Child A patients. Child-Pugh C patients had significantly prolonged prothrombin times when compared to healthy volunteers and patients with non-cirrhotic hepatopathy. Metronidazole metabolism, as measured by the OH-MET/MET ratio following the intravenous administration of 500 mg of the drug, was significantly impaired in all ethanol-abusing individuals, including patients with non-cirrhotic alcoholic hepatopathy. CONCLUSIONS: Metronidazole metabolism was impaired in ethanol abusers, even in the absence of liver cirrhosis, indicating that ethanol was capable of affecting liver function in the early stages of alcohol-induced liver disease.

[Markers of hepatic fibrogenesis in alcoholic patients]. / Marcadores de fibrogénesis hepática en pacientes alcohólicos.

BACKGROUND: An elevation of serologic markers of hepatic fibrogenesis has been reported in liver diseases of different etiologies. Among these, the N-terminal type III procollagen (P-III-P) and the P1 proteolytic fragment of laminin (P1 laminin) increase in alcoholic liver damage, in proportion to the progression of this condition. AIM: To study serum levels of P-III-P and P1 laminin in asymptomatic alcoholics with and without liver damage and decompensated alcoholic cirrhotics, compared to normal controls. METHODS: Serum P-III-P and laminin levels were measured in asymptomatic alcoholics during detoxification treatment. Liver biopsies were obtained, in order to detect liver damage, which was graded with a numeric score, considering values over 6 as severe damage. Serum fibrogenesis markers were also measured in a group of decompensated alcoholic cirrhotics. RESULTS: P-III-P levels were significantly higher in cirrhotic patients compared to alcoholics with or without liver damage and to normal controls. Laminin was not different between groups. P-III-P did not correlate with histologic score in asymptomatic patients. CONCLUSIONS: In this study P-III-P and P1 laminin were not usefull discriminators of severe liver damage among asymptomatic alcoholics; their levels were found to rise significantly only when liver disease has become clinically evident.

Protein-energy status and 15N-glycine kinetic study of child a cirrhotic patients fed low- to high-protein energy diets.

In five male cirrhotic patients (Child A) and in four age- and sex-matched healthy control subjects, whole-body protein turnover was measured using a single oral dose of 15N-glycine as a tracer and urinary ammonia as end product. Subjects were studied in the fasting and feeding state, with different levels of protein and energy intake. The patients were underweight and presented lower plasma transthyretin and retinol-binding protein levels. When compared with controls, the kinetic studies showed patients to be hypometabolic in the fasting (D0) state and with the control diet [D1 = (0.85 g of protein/ 154 kJ) x kg-1.day-1]. However, when corrected by body weight, the kinetic differences between groups disappeared, whereas the N-retention in the feeding state showed better results for the patients due mainly to their efficient breakdown decrease. When fed high-level protein or energy diets [D1 = (0.9 g protein/195 kJ) and D3 = (1.56 g protein/158 kJ) x kg-1.day-1], the patients showed D0 = D1 = D2 < D3 for N-flux and (D0 = D1) < D3 (D2 is intermediary) for protein synthesis. Thus, the present data suggest that the remaining mass of the undernourished mild cirrhotic patients has fairly good protein synthesis activity and also that protein, rather than energy intake, would be the limiting factor for increasing their whole-body protein synthesis.

[Determination of 25-hydroxyvitamin D serum levels and its seasonal variations in healthy young people]. / Determinación de los niveles séricos de 25-hidroxivitamina D y sus variaciones estacionales en una población normal joven.

BACKGROUND: 25-hydroxyvitamin D has a longer half life and its serum levels have less daily variations than calcitriol. Thus, its measurement is a better indicator of vitamin D status. AIM: To measure 25-hydroxyvitamin D levels in normal subjects during summer and winter. PATIENTS AND METHODS: Vitamin D was measured using a competitive protein binding radioassay in 61 subjects (27 male) aged 21 to 57 years old, during July and August (winter) and February and March of the next year (summer). RESULTS: 25-hydroxyvitamin levels were 28.8 +/- 1.5 and 30.9 +/- 2.3 ng/ml during winter and summer respectively. No differences were found between men and women. Ninety five percent confidence levels were between 13 and 50 ng/ml. Levels in one patient with malabsorption were 9.3 ng/ml, in 2 patients with hypophosphatemic osteomalacia were 2.1 and 9.3 ng/ml, in 12 patients with alcoholic cirrhosis were 16.4 +/- 1.3 ng/ml, in 4 patients with primary osteoporosis were 23.3 +/- 0.7 and in three patients receiving vitamin D were 334 +/- 33.2 ng/ml. CONCLUSIONS: Normal levels of 25-hydroxyvitamin D range from 13 to 50 ng/ml in normal adults, there are no differences between men and women and seasonal variations are minimal.

Splenic hypofunction in cirrhosis is not associated with increased risk for infections.

BACKGROUND/AIM: Pitted cell count has been described as a sensitive marker of splenic function. Recently, pitted cell count was shown to be increased in patients with alcoholic liver disease, and also to be associated with an increased susceptibility to infection. Therefore, our aim in the present study was to assess splenic function in a group of patients with cirrhosis and to determine its possible role in the development of infections. METHODS: Splenic function was assessed during hospitalization in 44 patients diagnosed as having cirrhosis, and was compared to 18 healthy subjects. Function was evaluated by counting the number of pitted cells in peripheral blood films. Results were the mean value of two independent counts and were expressed as number of pitted cells/100 erythrocytes. RESULTS: The mean percentage of pitted cells in peripheral blood of cirrhotic patients was significantly greater than that assessed in controls (3.5 +/- 3.7% vs. 1.6 +/- 0.9%, P < 0.01, Mann-Whitney U test). Eighteen patients with cirrhosis (36%) had counts greater than 3.4% (mean + 2 SD of the control group). There were no significant differences between patients with counts above or below 3.4% in terms of liver tests, platelet and reticulocyte counts, the presence of complications, Child-Pugh score and the prevalence of infections. There was no difference in pitted cell count between alcoholic and non-alcoholic cirrhotic patients (3.8 +/- 3.4% vs. 3.1 +/- 2.8% respectively, P, NS). Moreover, the mortality rate and the occurrence of infections were similar in patients with normal and increased pitted cell counts during 1-year follow-up. CONCLUSION: The increased number of pitted cells in patients with cirrhosis is not related to heptic function and does not represent a risk factor for infections.

The predictive value of serum laminin for the risk of variceal bleeding related to portal pressure levels.

BACKGROUND/AIMS: This paper presents the results of the radioimmunologic determination of laminin in serum of patients with alcoholic liver cirrhosis with a preserved hepatic function, trying to evaluate its predictive value for the risk of variceal bleeding, assessed by a portal pressure level equal to or higher than 12 mmHg. PATIENTS AND METHODS: Twenty alcoholic cirrhotic patients with a preserved hepatic function as assessed by the Child-Pugh classification, had their peripheral blood taken for radioimmunological determination of serum laminin and were submitted to hepatic vein catheterization for portal pressure measurement. RESULTS: A positive and significant correlation (r = 0.70, p < 0.001) was found between serum laminin levels (mean value + SD = 2.70 + 1.13 U/ml) and hepatic vein pressure gradient (mean HVPG + SD = 16.30 + 6.06 mmHg). Such correlation prompted us to find a value for the level of laminin that more closely represented a HVPG of 12 mmHg, a well known threshold pressure for esophageal varices bleeding. At a cut-off concentration for laminin of 2.19 U/ml, sensitivity was 73%, specificity 60%, the positive predictive value was 85% and the negative predictive value 43%. In this study population, with a prevalence of 75% of a HVPG > or = 12 mmHg, the diagnostic accuracy for such levels of serum laminin was 70%. CONCLUSIONS: Although a valid attempt in having a non invasive parameter for the investigation of portal hypertension, peripheral serum laminin alone doesn't seem to be a reliable marker for predicting portal hypertension and to assess the risk of variceal bleeding in patients with alcoholic cirrhosis.

Hipomagnesemia em cirróticos alcoólicos näo relacionada ao uso de diuréticos de alça / Hypomagnesemia in alcoholic cirrhotics not related to loop diuretic use

Os valores séricos de magnésio obtidos por método colorimétrico automatizado foram avaliados em 31 pacientes portadores de cirrose de etiologia alcoólica com hipertensäo portal e que näo faziam uso de diuréticos de alça e correlacionados com a avaliaçäo clínica, bioquímica e nutricional e os valores séricos de cálcio, fósforo, potássio e zinco. A avaliaçäo antropométrica foi feita pela medida da prega cutânea tricipal (PCT), circunferência do braço (CB) e circunferência muscular do braço (CMB). Dos pacientes avaliados, 16 apresentavam valores de magnésio estavam reduzidos em 20 por cento ou mais. Hipocalcemia e hipopotassemia foram observadas em apenas um paciente, cada uma. Hipofosfatemia e reduçäo do zinco sérico foram observadas em dois pacientes. Foram detectadas significantes associaçöes entre a hipomagnesemia e menor tempo de abstinência alcoólica, medidas antropométricas da CB e da CMB, o nível de albuminemia e o grau de disfunçäo hepática medido pela classificaçäo de Child-Pugh. Isoladamente, os valores de CMB se correlacionaram significativamente com os níveis de magnésio (r=0,51p<0,01). Estes resultados sugerem que, mesmo em cirróticos alcoólicos que näo estejam utilizando diuréticos de alça, a hipomagnesemia leve e moderada seja frequente e que a desnutriçäo, a disfunçäo hepática avançada e o alcoolismo estejam associados aos baixos valores séricos deste íon

Serum zinc concentrations in two cohorts of 153 healthy subjects and 100 cirrhotic patients from Mexico City.

The aim of this study was to assess serum zinc levels in a cohort of healthy subjects and cirrhotic patients from Mexico City. A total of 153 healthy subjects and 100 cirrhotic patients, males and females aged 18-65, were studied. Inclusion criteria for healthy subjects were (1) Mexican-born with first and second generation relatives born in Mexico, and (2) somatometric (body mass index under 30) and clinical evaluation establishing that they had no underlying disease. Entry criteria for cirrhotic patients were (1) clinical and histological proven cirrhosis, (2) compensated liver disease (absence of coma, bleeding hemorrhage or refractory ascitis), and (3) cirrhosis of any cause. Zinc serum levels were measured with atomic absorption spectrophotometry. In healthy subjects, mean serum levels were 77.4 +/- 4.2 micrograms/dl (range 42.9-105.2 micrograms/dl). In cirrhotic patients zinc serum levels (58.9 +/- 16.1 micrograms/dl, range 22-88 micrograms/dl) were significantly lower than in healthy subjects (p < 0.05). A stepwise decline in serum zinc with worsening Child class (A, 73.4 +/- 13; B, 64.4 +/- 12; C, 55.8 +/- 15.6; p < 0.05 by ANOVA test) was found. In conclusion, this study confirms that zinc serum levels are significantly lower in cirrhotic patients and shows that zinc serum levels in a cohort of 153 healthy subjects from Mexico City were unexpectedly lower compared to those found in other countries. This last finding might be explained by different dietetic patterns and deserves further investigation.

O vírus da hepatite B na doença hepática alcoólica: avaliaçäo clínica e bioquímica / The hepatitis B virus in alcoholic liver disease: its clinical and biochemical assessment

Foram estudados prospectiva e sequencialmente 107 pacientes com doença hepática alcoólica (DHA) crônica, sendo 83 casos de cirrose e 24 de hepatite alcoólica. Além do etilismo, ingestäo mínima de 70 gramas de etanol puro ao dia por período superior a sete anos, todos apresentaram disfunçäo hepatocelular. De acordo com o perfil sorológico para o VHB os pacientes foram alocados em quatro grupos a saber: grupo I infectados: AgHBs e anti-HBc positivos; grupo II imunes: anti-HBs e anti-HBc positivos; grupo III sem marcadores do VHB: AgHBs, anti-HBc e anti-HBs negativos; grupo IV IV anti-HBc positivo isoladamente. A prevalência de infecçäo pelo VHB na DHA foi alta: 42,06 por cento apesar dos índices elevados de imunidade: 26,17 por cento sugerindo que na DHA ocorre maior exposiçäo ao VHB com resposta imunológica deficiente. A análise dos parâmetros clínico-bioquímico, quando considerados isoladamente, näo mostrou diferenças estatisticamente significantes entre os grupos I, II, e III, entretanto a clasificaçäo de Child/Campbell, discriminou o grupo infectado, onde houve predomínio da classe C, de pior prognóstico