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1.
J Assoc Physicians India ; 69(8): 11-12, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34472804

RESUMO

INTRODUCTION: Hepatic encephalopathy (HE) is a significant complication of severe chronic liver insufficiency characterized by altered sensorium, motor, and cognitive dysfunction. This was a cross-sectional multicenter, epidemiological study to understand the prescribing pattern for primary prophylaxis of overt HE (OHE) in patients with cirrhosis in India. METHODS: The study was conducted at eight centers across different geographical regions of India. A total of 200 patients (100%) were screened, of which 197 (98.50%) met all the inclusion criteria. The prescribing pattern of the physicians was studied by calculating the percentage (subject to availability of sufficient data) of OHE-naïve patients with cirrhosis who were prescribed with different classes of drugs as primary prophylaxis of HE (such as lactulose, rifaximin, neomycin, sodium benzoate, and L-ornithine L- aspartate). The risk factors responsible for initiation of primary prophylaxis of HE was also determined. RESULTS: All the 197 patients (100%) were prescribed with prophylactic treatment. The factors that were considered by treating physicians to pose a risk for precipitating OHE for which prophylaxis was initiated were constipation in 111 (56.35%), infections in 51 (25.89%) and gastrointestinal bleeding in 35 (17.77%). Of the total 197 patients, 122 (61.93%) patients were prescribed a monotherapy, and 75 (38.07%) were prescribed a combination therapy. Of the patients on combination therapy, 68 (34.52%) patients were prescribed with two primary prophylaxis agents (dual therapy), and seven (3.55%) patients were prescribed with three primary prophylaxis agents (triple therapy). Lactulose was the most commonly prescribed agent for primary prophylaxis, followed by rifaximin. CONCLUSION: These findings may guide recommendations on primary prophylaxis for OHE in patients with liver cirrhosis that may help reduce the occurrence of first episode of overt HE, and thereby prevent subsequent cognitive impairment in these patients.


Assuntos
Encefalopatia Hepática , Estudos Transversais , Fármacos Gastrointestinais/uso terapêutico , Encefalopatia Hepática/epidemiologia , Encefalopatia Hepática/etiologia , Encefalopatia Hepática/prevenção & controle , Humanos , Lactulose/uso terapêutico , Cirrose Hepática/complicações , Cirrose Hepática/tratamento farmacológico
2.
BMC Gastroenterol ; 21(1): 343, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488642

RESUMO

BACKGROUND: Hereditary hemorrhagic telangiectasia is an autosomal dominant hereditary hemorrhagic disease. Its main feature is an abnormal structure of the blood vessel wall. Cirrhosis of the liver is a common chronic progressive disease with one or more causes in which diffuse liver damage occurs after long-term or repeated injury. Liver cirrhosis can cause dilation of gastrointestinal capillaries. Many patients with hereditary hemorrhagic telangiectasia accompanied by gastrointestinal vascular malformations and liver cirrhosis may be diagnosed only with liver cirrhosis if the clinician does not pay attention to physical examination findings and family history. Moreover, general treatment measures, such as blood transfusion, iron supplementation, and application of hemostatic drugs, are less effective for bleeding in patients with hereditary hemorrhagic telangiectasia than in those with liver cirrhosis alone. CASE PRESENTATION: Here, we report the rare case of a 75-year-old Chinese man who was admitted to the hospital with repeated melena and epistaxis. He was diagnosed with unexplained liver cirrhosis, which was later confirmed as hereditary hemorrhagic telangiectasia. Subsequently, we implemented the treatment intervention of oral thalidomide combined with gastrointestinal argon plasma coagulation. A follow-up of more than 8 months showed that the treatment effect was excellent. CONCLUSIONS: If patients with liver cirrhosis and gastrointestinal vascular malformations also have a family history of epistaxis, special attention should be paid to targeted physical examination results, and the possibility of hereditary hemorrhagic telangiectasia should be considered. Moreover, for patients with hereditary hemorrhagic telangiectasia and both gastrointestinal bleeding caused by gastrointestinal capillaries and repeated epistaxis, when other general treatment measures are ineffective, thalidomide combined with gastrointestinal argon plasma coagulation may be an effective intervention.


Assuntos
Telangiectasia Hemorrágica Hereditária , Idoso , Epistaxe/etiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Cirrose Hepática , Masculino , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia Hemorrágica Hereditária/terapia
4.
Zhonghua Gan Zang Bing Za Zhi ; 29(8): 743-747, 2021 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-34517454

RESUMO

Objective: To determine the diagnostic value of plasma heme oxygenase 1 (HO-1) in the occurrence, development, and pathological stages of chronic hepatitis B-related liver fibrosis. Methods: 211 outpatients and inpatients with chronic hepatitis B (CHB) and 57 healthy controls who visited the Third Hospital of Hebei Medical University were selected. Simultaneously, clinical data, peripheral blood routine and serum biochemical test results of the research subjects were collected. Plasma HO-1 levels were detected by enzyme-linked immunosorbent assay (ELISA). Liver fibrosis (S1 ~ 4) was staged according to liver biopsy and liver stiffness measurement (LSM). Statistical analysis: binary logistic regression was used to analyze the independent risk factors of hepatitis B-related liver fibrosis to establish a diagnostic model, and the receiver operating characteristic curve (ROC) was used to compare and analyze the staging efficiency of HO-1, new model, FIB-4 and APRI for the diagnosis of liver fibrosis. Results: Plasma HO-1 levels were significantly higher in CHB patients than healthy controls [10.11 (7.08 ~ 13.12) ng/ml and 6.71 (5.56 ~ 8.45) ng/ml, (P < 0.001)]. There were 37, 38, 38, and 98 cases with liver fibrosis stages S1, S2, S3, and S4, respectively and plasma HO-1 level was (6.91 ± 2.80) ng/ml, (8.24 ± 2.44) ng/ml, (9.96 ± 3.46) ng/ml, (12.65 ± 3.70) ng/ml, P < 0.001. HO-1, albumin, and platelets (PLT) were independent risk factors for liver fibrosis. A HAP model was established. HAP, FIB-4 and APRI sensitivity and specificity for the diagnosis of liver fibrosis staging were as follows: ≥S2 were 84.62%, 72.35 %, 81.18% and 83.78%, 81.08%, 67.57%; ≥S3 were 80.15%, 82.09%, 85.82% and 88.64%, 76.19%, 60.32%; S4 were 90.82%, 82.29%, 86.46% and 74.37%, 65.77%, 48.65%, respectively. Conclusion: Plasma HO-1 level can reflect the severity of liver fibrosis. HAP diagnostic model can more accurately mirror the process of liver fibrosis than FIB-4 and APRI, and point clinical diagnosis and prognosis assessment.


Assuntos
Heme Oxigenase-1 , Hepatite B Crônica , Aspartato Aminotransferases , Biomarcadores , Biópsia , Hepatite B Crônica/complicações , Hepatite B Crônica/patologia , Humanos , Fígado/patologia , Cirrose Hepática/diagnóstico , Cirrose Hepática/patologia , Curva ROC , Estudos Retrospectivos
5.
Zhonghua Gan Zang Bing Za Zhi ; 29(8): 748-753, 2021 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-34517455

RESUMO

Objective: To study and explore the prevalence, characteristics, preliminary risk factors, as well as their relationship with nutritional scores in liver cirrhotic patient with chronic periodontitis. Methods: 163 patients with liver cirrhosis who were hospitalized in the Hepatology Division, Department of Internal Medicine at Tianjin Third Central Hospital from June to September 2018 were enrolled as the case group, while the control group consisted 140 healthy individuals enrolled during the same period. Periodontal examination, biochemical examination and oral hygiene habits were investigated. The prevalence of periodontitis in the two groups was compared, and the risk factors of severe periodontitis were conducted by multivariate regression analysis. Results: The prevalence of chronic periodontitis was significantly higher in patients with liver cirrhosis than healthy control population, and the differences were statistically significant (P < 0.05). The prevalence of severe periodontitis and full edentulous jaws was significantly higher in patients with liver cirrhosis than healthy control group, and the differences were statistically significant (P < 0.05 and P < 0.001). Compared with the healthy control group, the depth of periodontal pocket and the degree of attachment loss were significantly increased in the liver cirrhosis group (P < 0.001). Multivariate regression analysis showed that liver cirrhosis was the independent risk factors for both groups of patients with severe periodontitis (χ (2) = 11.046, P < 0.001). Univariate and multivariate regression analysis showed that toothbrushing frequency, nutritional risk score, prealbumin level and Child-Pugh grade were independent risk factors for occurrence of severe periodontitis in liver cirrhotic patient (χ (2) = 5.252, P = 0.022; χ (2) = 24.162, P < 0.001; χ (2) = 4.159, P = 0.041; χ (2) = 9.249, P = 0.002). Conclusion: The prevalence of periodontitis is significantly higher in patients with liver cirrhosis than healthy individuals, and liver cirrhosis is an independent risk factor for the occurrence of severe periodontitis. Toothbrushing frequency, nutritional risk score, prealbumin level and Child-Pugh grade are risk factors for severe periodontitis in patients with liver cirrhosis.


Assuntos
Periodontite Crônica , Periodontite Crônica/complicações , Periodontite Crônica/epidemiologia , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/epidemiologia , Estado Nutricional , Perda da Inserção Periodontal , Fatores de Risco
6.
Zhonghua Gan Zang Bing Za Zhi ; 29(8): 759-765, 2021 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-34517457

RESUMO

Objective: To study the predictive value for esophageal variceal bleeding (EVB) after esophageal variceal ligation (EVL) based on clinical data and endoscopic ultrasound examination among patients with liver cirrhosis. Methods: Routine endoscopy and endoscopic ultrasound were performed on 400 preventive EVL cases who met the enrollment criteria, and their clinical indicators, microscopic manifestations, diameter and number of peripheral collateral veins, para-esophageal veins, perforating veins, and so on were monitored. Multivariate Cox proportional hazard regression analysis was performed to determine the relevant factors. Nomogram predictive model was established based on the independent prognostic factors. Nomogram internal validation was carried out with C-index to check the prediction accuracy, calibration curve evaluation consistency, and clinical benefit evaluation for decision-making. Results: Age, gender, etiology, peri-ECV number, para-ECV diameter, portal vein diameter, and azygous vein diameter were the risk factors for disease progression (P < 0.05), and they were all included in the establishment of nomogram. The C-index obtained by internal validation was 0.864, and the area under the receiver operating characteristic curve (AUC) of the predicting bleeding progression model was 0.994 (P < 0.001), suggesting that the disease had high predictive value and the calibration curve validity had consistency. Conclusion: Nomogram predictive model established based on the clinical data and endoscopic ultrasound examination is a preventive and therapeutic intervention for liver cirrhotic patients with esophageal varices, which can effectively improve the therapeutic effects of this population, reduce the EVs occurrence, and improve their quality of life. In addition, it also has an outstanding favorable performance. Therefore, it has certain guiding significance for the judgment of clinical treatment.


Assuntos
Varizes Esofágicas e Gástricas , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Ligadura , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico por imagem , Nomogramas , Qualidade de Vida
7.
Zhonghua Gan Zang Bing Za Zhi ; 29(8): 776-780, 2021 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-34517460

RESUMO

Objective: To investigate the long-term characteristic changes of virus, immune status, and liver fibrosis markers in human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infected patients after receiving direct-antiviral agents (DAAs). Methods: HIV/HCV co-infected patients who visited the Guangzhou Eighth People's Hospital, Guangzhou Medical University from May 2014 to December 2019 were selected as the research subjects. The changes of virological response rate, peripheral blood CD4(+)T lymphocyte level and serological markers of liver fibrosis (APRI score and FIB-4 index) were observed during 144 weeks of follow-up course after the end of DAAs treatment. Kruskal-Wallis test was used for statistical approach. Results: A total of 103 cases were included in the study. There were 87 males (87.5%), with a median age of 44 years. Sustained virological response rate at 12 weeks (SVR12) after DAAs treatment was 97.6%, and the SVR during the entire follow-up period was at least 95.9%. Compared with baseline, CD4(+)T lymphocyte count were significantly increased equally at 12 weeks (Z = -2.283, P = 0.022), 24 weeks (Z = -3.538, P < 0.001), 48 weeks (Z = -3.297, P = 0.001), 96 weeks (Z = -3.562, P < 0.001), and 144 weeks (Z = -2.842, P = 0.004). APRI score (Z = -6.394, P < 0.001) and FIB-4 index (Z = -2.528, P = 0.011) were significantly lower than baseline at week 4 of DAAs treatment, and thereafter remained at a low level, without further declination. Conclusion: HIV/HCV co-infected patients can maintain high SVR for a long time, acquire good immune reconstitution, and significantly improve liver fibrosis after DAAs treatment.


Assuntos
Coinfecção , Infecções por HIV , Hepatite C Crônica , Hepatite C , Adulto , Antivirais/uso terapêutico , Coinfecção/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Hepacivirus , Hepatite C/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Humanos , Cirrose Hepática/tratamento farmacológico , Masculino , Resultado do Tratamento
8.
Zhonghua Gan Zang Bing Za Zhi ; 29(8): 812-816, 2021 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-34517467

RESUMO

In recent years, with the changes in living standards and dietary structure, the incidence of non-alcoholic fatty liver disease has been increasing year by year in China, and the incidence rate in the general population is as high as 29.81%. An increasingly epidemiological evidence suggests that non-alcoholic fatty liver disease has become one of the causes of increasing liver cirrhosis and liver cancer. However, its etiology and pathogenesis are complex and have not yet been fully elucidated. Therefore, establishing an appropriate non-alcoholic fatty liver disease animal models for pre-clinical research is essential to elucidate its pathogenesis. This article summarizes the latest research progress of non-alcoholic fatty liver disease animal models, which are common at home and abroad in recent years.


Assuntos
Neoplasias Hepáticas , Hepatopatia Gordurosa não Alcoólica , Animais , Dieta , Modelos Animais de Doenças , Humanos , Fígado , Cirrose Hepática , Modelos Animais , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/etiologia
9.
Rev Med Suisse ; 17(749): 1495-1498, 2021 Sep 08.
Artigo em Francês | MEDLINE | ID: mdl-34495584

RESUMO

Coagulation disorders related to abnormalities in hepatic synthesis are well known as prognostic factors in hepatic cirrhosis. The risk of bleeding, mainly linked to portal hypertension, must be weighed against the risk of thrombosis, the most frequent manifestation of which is portal venous thrombosis. Conventional laboratory tests are not a reliable reflection of this delicate balance. The use of prophylactic anticoagulation in hospitalized patients with decompensated hepatic cirrhosis or therapeutic anticoagulation in venous thrombosis is recommended in most cases, in the absence of contraindications.


Assuntos
Transtornos da Coagulação Sanguínea , Trombose , Trombose Venosa , Anticoagulantes/uso terapêutico , Coagulação Sanguínea , Humanos , Cirrose Hepática/complicações
10.
World J Gastroenterol ; 27(30): 5088-5099, 2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34497437

RESUMO

BACKGROUND: As a country with a high burden of hepatitis B, China has about 86 million cases of hepatitis B virus infection, ranking the first in the world. Currently, there are about 390000 deaths due to hepatitis B-related complications such as liver cirrhosis and liver cancer every year. Consequently, how to control portal hypertension, improve liver functional reserve, and reduce the incidence of hepatic failure and liver cancer in such patients is the focus of current clinical attention. Previous clinical study in our center suggested that at 24 mo after transjugular intrahepatic portosystemic shunt (TIPS), the liver functional reserve of patients with hepatitis B cirrhosis was better than that of patients with alcohol-induced and immune cirrhosis, which may be related to the effective etiological treatment. AIM: To investigate the clinical efficacy of three first-line antiviral drugs recommended by the guidelines of prevention and treatment for chronic hepatitis B in China (2019) in the treatment of patients with hepatitis B-related cirrhosis who had received a TIPS. METHODS: The clinical data of 137 patients with hepatitis B-related cirrhosis with portal hypertension after receiving TIPS at our centre between March 2016 and December 2020 were analysed retrospectively. According to different anti-viral drugs, the patients were divided into entecavir (ETV) (n = 70), tenofovir alafenamide fumarate (TAF) (n = 32), and tenofovir disoproxil fumarate (TDF) (n = 35) groups. The cumulative incidence of hepatic encephalopathy and hepatocellular carcinoma, survival, and changes in hepatic reserve function and glomerular filtration rate in patients treated with different antiviral drugs within 24 mo after surgery were investigated. RESULTS: At 24 mo after surgery, the Child-Pugh score in the TAF group (6.97 ± 0.86) was lower than that in the TDF (7.49 ± 0.82; t = -2.52, P = 0.014) and ETV groups (7.64 ± 1.17; t = -2.92, P = 0.004). The model for end-stage liver disease score in the TAF group at 24 mo after surgery was 9.72 ± 1.5, which was lower than that in the TDF (10.74 ± 2.33; t = -2.09, P = 0.040) and ETV groups (10.97 ± 2.17; t = -2.93, P = 0.004). At 24 mo after surgery, the estimated glomerular filtration rate (eGFR) in the TAF group (104.41 ± 12.54) was higher than that in the TDF (93.54 ± 8.97) and ETV groups (89.96 ± 9.86) (F = 21.57, P < 0.001). CONCLUSION: At 24 mo after surgery, compared with TDF and ETV, TAF has significant advantages in the improvement of liver functional reserve and eGFR.


Assuntos
Doença Hepática Terminal , Hepatite B , Derivação Portossistêmica Transjugular Intra-Hepática , Antivirais/efeitos adversos , Doença Hepática Terminal/tratamento farmacológico , Hepatite B/complicações , Hepatite B/tratamento farmacológico , Hepatite B/epidemiologia , Humanos , Cirrose Hepática/tratamento farmacológico , Cirrose Hepática/epidemiologia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
11.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 33(4): 353-358, 2021 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-34505441

RESUMO

OBJECTIVE: To detect the expression of transforming growth factor-ß1 (TGF-ß1), p38MAPK and bone morphogenetic protein-7 (BMP-7) protein in the liver specimens of patients with hepatic alveolar echinococcosis, and to investigate the potential role of TGF-ß1, p38MAPK and BMP-7 protein in hepatic fibrosis caused by hepatic alveolar echinococcosis. METHODS: A total of 20 patients with hepatic alveolar echinococcosis were enrolled as study subjects, and hepatic specimens were sampled from the sites within 0.5 cm (Group A) and 0.5 to 1.5 cm from hepatic alveolar echinococcosis lesions (Group B), while normal liver specimens sampled from the sites 2 cm and greater from hepatic alveolar echinococcosis lesions served as controls (Group C). The fibrosis of liver specimens was pathological examined using HE and Masson staining, and the expression of TGF-ß1, p38MAPK and BMP-7 protein was quantified in liver tissues using Western blotting. The associations of TGF-ß1, p38MAPK and BMP-7 protein expression with hepatic fibrosis were assessed. RESULTS: HE staining showed the malaligned structure of hepatocytes and destruction of the structure of hepatic lobules at various degrees in liver specimens in groups A and B, with hepatocyte degeneration, atrophy and necrosis, hyperplasia of fibrous tissues and eosinophilic granulocyte infiltration seen, while no abnormal pathological alterations of liver tissues, normal hepatocyte structure and morphology and uniform size, no malaligned structure of hepatocytes, clear structure of hepatic lobules, no or mild hepatocyte degeneration or necrosis, and no eosinophilic granulocyte infiltration were seen in Group C. Masson staining showed that there was hyperplasia of multiple fibrous connective tissues in the liver portal areas in groups A and B, with fibrosis seen in hepatic lobules, while no obvious pathological changes were seen in Group C. There were significant differences seen in TGF-ß1 (P < 0.001), p38MAPK (P < 0.01) and BMP-7 protein (P < 0.05) expression in liver tissues in groups A, B and C, and higher TGF-ß1, p38MAPK and BMP-7 protein expression was quantified in groups A and B than in Group C (all P values < 0.05), while greater TGF-ß1, p38MAPK and BMP-7 protein expression was detected in Group B than in Group C (all P values < 0.05). The expression of TGF-ß1, p38MAPK and BMP-7 protein correlated positively with the severity of hepatic fibrosis (r = 0.866, 0.702 and 0.801, all P values < 0.05), and there were significant differences in TGF-ß1 (F = 72.580, P < 0.01), p38MAPK (χ2 = 31.705, P < 0.01) and BMP-7 protein expression (χ2 = 48.388, P < 0.01) among liver tissues with different degrees of fibrosis. The TGF-ß1 protein expression correlated positively with p38MAPK and BMP-7 protein expression (r = 0.607 and 0.702, both P values < 0.001), and the BMP-7 protein expression also correlated positively with p38MAPK protein expression (r = 0.456, P < 0.001). CONCLUSIONS: The interaction among TGF-ß1, p38MAPK and BMP-7 jointly participates in the development of hepatic fibrosis induced hepatic alveolar echinococcosis.


Assuntos
Equinococose Hepática , Fator de Crescimento Transformador beta1 , Proteína Morfogenética Óssea 7/genética , Equinococose Hepática/patologia , Humanos , Fígado/patologia , Cirrose Hepática/patologia , Proteínas Quinases p38 Ativadas por Mitógeno
12.
Ann Palliat Med ; 10(8): 8692-8700, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488358

RESUMO

BACKGROUND: Few studies comprehensively compared the performance of magnetic resonance elastography (MRE) and transient elastography (TE) in the diagnosis of liver fibrosis. Therefore, we conducted a meta-analysis to evaluate and compare the diagnostic efficacy of these 2 techniques in patients with hepatic fibrosis in order to gain a better understanding of their overall diagnostic performance and aid in maximizing their clinical utility. METHODS: Systematic literature searches of the PubMed, EmBase, Cocharane Library, and China National Knowledge Infrastructure databases were carried out to identify studies that applied MRE and TE in the diagnosis of liver fibrosis. The combined sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (ORs) were estimated using a bivariate random effects model. Review Manager 5.2 was used to analyze the selected articles, and forest plot, sensitivity, and bias analyses were performed for the included literature. To determine the diagnostic efficacy of MRE and TE for liver fibrosis, pooled sensitivity and specificity analyses were conducted. RESULTS: Eight studies met the inclusion criteria. In the diagnosis of stage F0-F1 liver fibrosis, MRE showed higher sensitivity than TE (OR =0.62, 95% CI: 0.41-0.95, P=0.03). MRE also showed higher specificity than TE for diagnosing stage F2-F4 liver fibrosis (OR =0.41, 95% CI: 0.27-0.62, P<0.0001). There was no difference in the sensitivity of MRE and Te to F2-F4 hepatic fibrosis and the specificity of MRE and Te to F0-F1 hepatic fibrosis. CONCLUSIONS: In terms of sensitivity and specificity, MRE is superior to TE in diagnosing different stages of liver fibrosis to a certain extent. MRE may be a useful, noninvasive method for the assessment of liver fibrosis in patients with chronic liver disease.


Assuntos
Técnicas de Imagem por Elasticidade , Bases de Dados Factuais , Humanos , Cirrose Hepática/diagnóstico por imagem , Projetos de Pesquisa , Sensibilidade e Especificidade
13.
Z Gastroenterol ; 59(9): 954-960, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34507374

RESUMO

BACKGROUND: The COVID-19 pandemic has caused a significant impact on the medical care of many diseases and has led to reduced presentations to the emergency department. Reduced presentations may be due to overwhelmed capacities of hospitals or collateral damage from fear of infection, lockdown regulations, or other reasons. The effect on patients with liver cirrhosis is not established. OBJECTIVE: We aim to assess the impact on the care of patients with liver cirrhosis in a tertiary center in Northern Germany. METHODS: All patients presenting to the emergency department with a diagnosis of cirrhosis between March 1 and May 31 from 2015-2020 were included. Reasons for presentation, duration of symptoms, the severity of liver disease, and 30-day mortality were assessed and compared between patients presenting during the COVID-19 pandemic and pre-COVID-19. RESULTS: Overall, 235 patients were included. Despite an overall decline in presentations to the emergency department by 11.7%, the frequency of patients presenting with liver cirrhosis has remained stable (non-significant increase by 19.5%). No significant difference could be detected for the MELD score, the CLIF-organ failure subscores, and the 30-day mortality before and during the COVID-19 pandemic. Up to 75% of patients with liver cirrhosis had symptoms >24 h before presenting to the emergency department. CONCLUSION: Despite the overall trend of reduced emergency presentations during the COVID-19 pandemic, the frequency of presentations of patients with liver cirrhosis did not decline. Morbidity and mortality were not affected in a setting of disposable healthcare resources. The late presentation to the emergency department in many cirrhotic patients may open opportunities for interventions (i.e., with early telemedicine intervention).


Assuntos
COVID-19 , Pandemias , Controle de Doenças Transmissíveis , Serviço Hospitalar de Emergência , Alemanha/epidemiologia , Humanos , Cirrose Hepática/diagnóstico , Cirrose Hepática/epidemiologia , SARS-CoV-2
14.
Rev Med Suisse ; 17(748): 1453-1456, 2021 Sep 01.
Artigo em Francês | MEDLINE | ID: mdl-34468096

RESUMO

Treatment of hepatitis C has known major progress thanks to direct-acting antivirals resulting in the healing, defined by a viral clearance (sustained virological response [SVR]), in the vast majority of patients. However, there is a residual risk of progressive liver damage in a minority of patients, potentially leading to complications such as liver decompensation, hepatocellular carcinoma and/or death. This article discusses the current knowledge of residual liver disease after treatment, the impact of comorbidities and the factors potentially predicting patients at risk of complications and warranting surveillance.


Assuntos
Carcinoma Hepatocelular , Hepatite C Crônica , Hepatite C , Neoplasias Hepáticas , Antivirais/uso terapêutico , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/etiologia , Hepacivirus , Hepatite C/complicações , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/epidemiologia , Humanos , Cirrose Hepática/tratamento farmacológico , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/etiologia
15.
Nihon Yakurigaku Zasshi ; 156(5): 275-281, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34470931

RESUMO

Nonalcoholic steatohepatitis (NASH) is one of the most common causes of chronic liver disease, with the increased prevalence of obesity, type 2 diabetes, and metabolic disorders in recent years. As the disease progresses, it leads to hepatic fibrosis, which may progress to hepatocellular carcinoma, but there is still no cure for severe hepatic fibrosis. Currently, in order to develop drugs for the treatment of NASH, the effects of candidate drugs are evaluated by a long-term administration to mice and rats that are fed a high-fat or methionine-deficient diet to reproduce the pathology of fatty liver and liver fibrosis. Since drug development using these experimental animals is time-consuming and costly, in vitro models that reproduce the pathology of NASH have recently been developing. In this review, we will outline the current issues in the diagnosis and treatment of NASH, and introduce our research for the discovery of early diagnostic markers and the development of new therapeutic agents using liver organoid cultures derived from mouse models of NASH.


Assuntos
Diabetes Mellitus Tipo 2 , Hepatopatia Gordurosa não Alcoólica , Animais , Dieta Hiperlipídica , Modelos Animais de Doenças , Descoberta de Drogas , Fígado , Cirrose Hepática , Camundongos , Camundongos Endogâmicos C57BL , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Hepatopatia Gordurosa não Alcoólica/patologia , Organoides , Ratos
16.
BMC Pediatr ; 21(1): 385, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479517

RESUMO

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) can range from simple steatosis to steatohepatitis with or without fibrosis. The predictors for liver fibrosis and the effect of nutritional intervention on hepatic fibrosis in pediatric population are not well established. We aimed to investigate the predictors for liver fibrosis and the effects of short-term nutritional intervention on steatosis and fibrosis among obese adolescents with NAFLD. METHODS: Cross-sectional study among obese adolescents. Sociodemographic and clinical data were collected. Liver fibrosis was estimated by Shearwave elastography. All participants were recommended to consume a low carbohydrate diet and were followed biweekly. Blood tests and elastography were performed upon admission and repeated after 3 months. RESULTS: Fifty-seven pediatric patients were recruited (35 males, mean age 13.5±2.9 years, mean body mass index [BMI] 38.8±9.7). Liver fibrosis was diagnosed in 34 (60%) subjects, which was moderate/severe (F≥2) in 24 (70%). A higher BMI Z score and moderate/severe steatosis correlated with moderate/severe fibrosis (P < 0.05). Seventeen patients completed 3 months of follow-up and displayed a decrease in BMI Z score (from BMI Z score 2.6±0.5 before intervention to 2.4±0.5 after intervention), with a significant decrease in liver fibrosis (P = 0.001). CONCLUSION: Pediatric patients with high BMIs and severe liver steatosis are at risk for severe liver fibrosis. Nutritional intervention with minimal weight loss may improves hepatic fibrosis among the pediatric population. TRIAL REGISTRATION: TRN NCT04561804 (9/17/2020).


Assuntos
Hepatopatia Gordurosa não Alcoólica , Obesidade Pediátrica , Adolescente , Índice de Massa Corporal , Criança , Estudos Transversais , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Cirrose Hepática/etiologia , Cirrose Hepática/patologia , Masculino , Hepatopatia Gordurosa não Alcoólica/complicações , Obesidade Pediátrica/complicações , Projetos Piloto
17.
Anticancer Res ; 41(9): 4411-4416, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34475062

RESUMO

BACKGROUND/AIM: Detection of hepatocellular carcinoma using intraoperative ultrasonography (IOUS) is indispensable for successful laparoscopic hepatectomy (LH). This study was performed to evaluate patients with intraoperatively unidentified tumours undergoing LH. PATIENTS AND METHODS: Seven patients who underwent LH for hepatocellular carcinoma and whose tumours were not detected using IOUS were included in this study. Clinical features, preoperative imaging, intraoperative imaging, surgical procedures, and pathological findings were evaluated. RESULTS: Using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging, all the tumours were enhanced in the arterial phase and rapidly washed out, becoming hypointense to the remainder of the liver. All tumours except one were <2 cm in size. Severe liver fibrosis was observed in all cases. Tumours that were invisible on preoperative ultrasonography also could not be detected using IOUS or indocyanine green fluorescence imaging. Five patients underwent hepatectomy based on anatomical landmarks and achieved curative resection, whereas curative resection failed in two patients. CONCLUSION: When tumours cannot be identified by IOUS, LH based on anatomical landmarks should be preferred. Importantly, invisible tumours on preoperative ultrasonography may not be identified intraoperatively during LH.


Assuntos
Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Cirrose Hepática/patologia , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Feminino , Gadolínio DTPA/administração & dosagem , Hepatectomia , Humanos , Verde de Indocianina/administração & dosagem , Laparoscopia , Cirrose Hepática/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Imagem por Ressonância Magnética Intervencionista , Masculino , Pessoa de Meia-Idade , Carga Tumoral , Ultrassonografia de Intervenção
18.
BMC Gastroenterol ; 21(1): 306, 2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34332532

RESUMO

BACKGROUND: We previously reported on the trends in the etiologies of hepatocellular carcinoma (HCC) diagnosed in patients between 1995 and 2009. The aims of our updated study were to evaluate the incidence, nonhepatitis B and nonhepatitis C viral (NBNC) etiologies, and clinical characteristics of HCCs occurring in patients between 1992 and 2018. METHODS: The study enrolled 2171 consecutive patients with HCC between 1992 and 2018. Their medical records were reviewed. The patients were divided into two groups, patients with early diagnoses from 1992 to 2009 and those with late diagnoses from 2010 to 2018. RESULTS: NBNC-HCC occurred in 514 patients (23.6%). The percentage of patients with HCC who had NBNC-HCC increased from 26.5% in 2009 to 46.3% in 2018. Patients with NBNC-HCC were older (median ages from 67 to 73 years). Type 2 diabetes mellitus (48.5-60.3%: P = 0.008), hypertension (48.5-57.4%: P = 0.047), and hyperlipidemia (39.2-53.8%: P = 0.001) increased significantly in recent years. The median FIB-4 index decreased (4.37-3.61: P = 0.026) and the median platelet count increased (15.1-17.9 × 104/µL: P = 0.013). Among the 514 patients with NBNC-HCC, 194 underwent hepatic resection for nonalcoholic steatohepatitis (NASH) (15%), alcoholic liver disease (ALD) (29%), and cryptogenic hepatitis (56%). Cirrhosis was detected in 72%, 39%, and 16% of patients with NASH, ALD, and cryptogenic hepatitis, respectively. The prevalence of cirrhosis in patients with NASH was significantly higher than the prevalence of cirrhosis in the other groups (P < 0.001). Overall, 70% of the non-malignant liver tissue of patients with NBNC-HCC was not involved with cirrhosis. On the other hand, the median FIB-4 index in patients with cryptogenic HCC was 2.56, which was a significantly lower value than those values in the other groups of patients. The FIB-4 index considered as one of useful screening of HCC. CONCLUSIONS: The prevalence of NBNC-HCC has increased rapidly even in a regional university hospital. Metabolic syndrome may be an important risk factor for HCC. HCC was also found in patients with non-cirrhotic livers. The FIB-4 index may be a useful screening method for HCC in patients with NBNC.


Assuntos
Carcinoma Hepatocelular , Diabetes Mellitus Tipo 2 , Neoplasias Hepáticas , Idoso , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/etiologia , Humanos , Incidência , Cirrose Hepática/complicações , Cirrose Hepática/epidemiologia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/etiologia
19.
Zhonghua Gan Zang Bing Za Zhi ; 29(7): 685-689, 2021 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-34371540

RESUMO

Objective: To investigate the effect of anti-liver fibrosis treatment on the occurrence of liver cancer in patients with hepatitis B-related liver cirrhosis within three years. Methods: 1,049 cases with hepatitis B-related liver cirrhosis who were hospitalized in Beijing Ditan Hospital affiliated to Capital Medical University from October 2008 to August 2016 were enrolled. Clinical data were collected, and COX regression analysis was used to find the independent influencing factors for the occurrence of liver cancer in patients with hepatitis B-related liver cirrhosis within three years. According to whether the patients had received anti-liver fibrosis treatment for ≥ 6 months, they were divided into combination and antiviral group. There were 388 cases in combination group and 661 cases in antiviral group. In addition, the combination group received anti-liver fibrosis therapy with Chinese patent medicine on the basis of antivirus, and the antiviral group received antiviral treatment. The incidence of liver cancer within three years were compared between the two groups, and the incidence of liver cancer in patients with different Child-Pugh grades and mPAGE-B risks was further analyzed. The independent samples t-test, Mann Whitney U test, χ2 test or Fisher's exact probability method were used for data comparison. Results: Anti-liver fibrosis treatment was an independent protective factor to prevent liver cancer in patients with hepatitis B-related liver cirrhosis within 3 years (P < 0.05). The incidence of liver cancer in the combination group was lower than antiviral group within 3 years (10.3% vs. 15.4%, χ (2) = 5.480, P < 0.05). Child-Pugh stratified analysis showed that the risk of liver cancer was significantly reduced in Child-Pugh grade A patients (6.7% vs. 12.6%, χ (2) = 2.857, P = 0.040). Among high-risk patients with mPAGE-B, the incidence of liver cancer was significantly lower in combination group than control group (13.7% vs. 19.9%, χ (2) = 6.671, P = 0.031). Conclusion: Compared to antiviral therapy alone, combined anti-liver fibrosis and antiviral therapy can reduce the liver cancer occurrence risk in patients with hepatitis B-related liver cirrhosis for 3 years. Patients with Child-Pugh grade A and high-risk group by mPAGE-B scores are the dominant population to receive treatment.


Assuntos
Carcinoma Hepatocelular , Hepatite B Crônica , Hepatite B , Neoplasias Hepáticas , Antivirais/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/etiologia , Hepatite B/complicações , Hepatite B/tratamento farmacológico , Hepatite B Crônica/tratamento farmacológico , Humanos , Cirrose Hepática/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/etiologia , Estudos Retrospectivos
20.
Zhonghua Gan Zang Bing Za Zhi ; 29(7): 716-720, 2021 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-34371546

RESUMO

Spontaneous bacterial peritonitis (SBP) is a common complication in patients with liver cirrhosis, and it is also an important inducement for patients with liver cirrhosis to develop into an acute decompensated stage, and thereby has become the concern and difficulties of clinical treatment. SBP pathogenic bacteria varies with time and region, and the confirmed detection rate of Gram-positive bacteria and multidrug-resistant bacteria has been increasing year by year. Therefore, whether the antimicrobial treatment plan based on the previous guidelines is still applicable remains to be further explored. This paper focuses on introducing the pathogenic bacteria characteristics for cirrhosis combined with SBP in different study populations, different regions, different time, and different infection modes, and further summarizes empirical antimicrobial treatment plan according to the changes of SBP pathogenic bacteria, in order to provide theoretical basis for clinical treatment.


Assuntos
Infecções Bacterianas , Peritonite , Antibacterianos/uso terapêutico , Bactérias , Infecções Bacterianas/tratamento farmacológico , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/tratamento farmacológico , Peritonite/tratamento farmacológico
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