Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 660
Filtrar
1.
Am J Case Rep ; 21: e927452, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32973125

RESUMO

BACKGROUND COVID-19 is an infectious disease caused by SARS-CoV-2. It has spread rapidly through the world, endangering human life. The main target of COVID-19 is the lungs; however, it can involve other organs, including the liver. Patients with severe COVID-19 have an increased incidence of abnormal liver function, and patients with liver disorders are considered to be at a higher risk of severe COVID-19 infection. The mechanism of liver injury reported in 14% to 53% of COVID-19 patients is poorly recognized and several possibilities need to be considered (cytokine storm, direct viral action, hypoxia). The incidence of underlying liver comorbidities in patients with a COVID-19 infection ranges from 1% to 11%. CASE REPORT This is a report of 2 nosocomial COVID-19 infections and severe COVID-19 pneumonia in 2 patients who were hospitalized during treatment for alcoholic liver disease (ALD). Case 1 and case 2 were a 31-year-old woman and a 40-year-old woman, respectively, with decompensated ALD and symptoms of the COVID-19 infection. Both patients were transferred from another hospital to our hospital after confirmation of COVID-19 during their hospitalization. The course of the infection progressed rapidly in both patients with the development of multiple-organ failure and death over a short period. CONCLUSIONS There are no clear recommendations on the management of ALD in the COVID-19 pandemic. Alcoholic hepatitis may be a risk factor for severe COVID-19 and a poor outcome. A high percentage of nosocomial COVID-19 infections are observed; therefore, special precautions should be taken to minimize the risk of COVID-19 exposure.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecção Hospitalar/diagnóstico , Hepatopatias Alcoólicas/terapia , Pneumonia Viral/diagnóstico , Síndrome Respiratória Aguda Grave/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Terapia Combinada , Infecções por Coronavirus/complicações , Infecção Hospitalar/terapia , Progressão da Doença , Evolução Fatal , Feminino , Hospitalização , Humanos , Hepatopatias Alcoólicas/diagnóstico , Insuficiência de Múltiplos Órgãos , Pandemias , Pneumonia Viral/complicações , Radiografia Torácica/métodos , Respiração Artificial , Medição de Risco
2.
Lancet Gastroenterol Hepatol ; 5(5): 485-493, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32277901

RESUMO

Alcohol-related liver disease has become the leading indication for liver transplantation in the USA, partly due to an increase in the prevalence of high-risk drinking behaviour and alcohol use disorder, particularly among young women. Achieving sustained alcohol abstinence might not only prevent the development and progression of alcohol-related liver disease, but could also lead to clinically significant improvements, even in the advanced stages of disease. In this Series paper, we discuss the diagnosis and outpatient management of alcohol-related liver disease, with an emphasis on treatment options for alcohol use disorder and the assessment of nutritional status.


Assuntos
Assistência Ambulatorial/métodos , Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/terapia , Abstinência de Álcool , Comorbidade , Diagnóstico Diferencial , Humanos , Hepatopatias Alcoólicas/complicações , Hepatopatias Alcoólicas/patologia , Desnutrição/etiologia , Desnutrição/terapia , Programas de Rastreamento , Avaliação Nutricional , Estado Nutricional , Apoio Nutricional
4.
Gut ; 69(4): 764-780, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31879281

RESUMO

Alcohol-related liver disease (ALD), which includes a range of disorders of different severity and is one of the most prevalent types of liver disease worldwide, has recently regained increased attention. Among other reasons, the realisation that any alcohol intake, regardless of type of beverage represents a health risk, and the new therapeutic strategies tested in recently published or undergoing clinical trials spur scientific interest in this area.In April 2019, Gut convened a round table panel of experts during the European Association for the Study of the Liver International Liver Congress in Vienna to discuss critical and up-to-date issues and clinical trial data regarding ALD, its epidemiology, diagnosis, management, pathomechanisms, possible future treatments and prevention. This paper summarises the discussion and its conclusions.


Assuntos
Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/epidemiologia , Humanos , Hepatopatias Alcoólicas/terapia
5.
Gastroenterol Hepatol ; 42(10): 657-676, 2019 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31771785

RESUMO

Alcohol-related liver disease (ARLD) is the most prevalent cause of advanced liver disease and liver cirrhosis in Europe, including Spain. According to the World Health Organization the fraction of liver cirrhosis attributable to alcohol use in Spain is 73.8% among men and 56.3% among women. ARLD includes various stages such as steatohepatitis, cirrhosis and hepatocellular cancer. In addition, patients with underlying ARLD and heavy alcohol intake may develop alcoholic hepatitis, which is associated with high mortality. To date, the only effective treatment to treat ARLD is prolonged withdrawal. There are no specific treatments, and the only treatment that increases life expectancy in alcoholic hepatitis is prednisolone. For patients with alcoholic hepatitis who do not respond to treatment, some centres offer the possibility of an early transplant. These clinical practice guidelines aim to propose recommendations on ARLD taking into account their relevance as a cause of advanced chronic liver disease and liver cirrhosis in our setting. This paper aims to answer the key questions for the clinical practice of Gastroenterology, Hepatology, as well as Internal Medicine and Primary Health Centres, making the most up-to-date information regarding the management and treatment of ARLD available to health professionals. These guidelines provide evidence-based recommendations for the clinical management of this disease.


Assuntos
Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/terapia , Algoritmos , Humanos , Hepatopatias Alcoólicas/etiologia
6.
Korean J Gastroenterol ; 74(4): 205-211, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31650796

RESUMO

Background/Aims: The serum aminotransferase level is usually elevated in rhabdomyolysis, and these enzymes originate from the skeletal muscle. On the other hand, there is limited data showing whether the degree of elevation of these enzymes differs according to the concurrent liver disease. Methods: Patients with rhabdomyolysis were selected when their serum creatinine kinase level was >1,000 U/L. They were categorized as the group with and without concurrent liver disease. The AST and ALT levels in both groups were compared. In addition, the aminotransferase level was compared between those with rhabdomyolysis and those with alcoholic liver disease. Results: Among the 165 patients with rhabdomyolysis, 19 had concurrent liver disease. The median peak AST was higher in the group with concurrent liver disease (332 U/L [interquartile range (IQR), 127-1,604] vs. 219 U/L [IQR, 115-504]). In addition, the median peak ALT was higher in the group with concurrent liver disease (107 U/L [IQR, 74-418] vs. 101 U/L [IQR, 56-218]). On the other hand, there was no significant difference in both enzymes between the two groups. The median peak AST level was significantly higher in those with rhabdomyolysis than in those with alcoholic liver disease (221 U/L [IQR, 118-553] vs. 103 U/L [IQR, 59-206]), but the median peak ALT was not significantly different (102 U/L [IQR, 58-222] vs. 51 U/L [IQR, 26-117]). Conclusions: Rhabdomyolysis showed an elevated AST-dominant aminotransferase level, which is not different according to concurrent liver disease. Therefore, it is recommended that rhabdomyolysis be considered first in cases of elevated aminotransferase levels in patients with a suspicious skeletal muscle injury.


Assuntos
Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Hepatopatias/diagnóstico , Rabdomiólise/diagnóstico , Adulto , Creatinina/sangue , Feminino , Humanos , Hepatopatias/sangue , Hepatopatias/complicações , Hepatopatias Alcoólicas/sangue , Hepatopatias Alcoólicas/complicações , Hepatopatias Alcoólicas/diagnóstico , Masculino , Pessoa de Meia-Idade , Rabdomiólise/sangue , Rabdomiólise/complicações
9.
Sci Rep ; 9(1): 11580, 2019 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399619

RESUMO

A mass spectrometric analysis platform has been developed to determine whether glycosylation patterns of alpha-1 acid glycoprotein (AGP) could be used as a marker for early detection of hepatocellular carcinoma (HCC) in different etiologies, i.e. non-alcoholic steatohepatitis (NASH), alcoholic liver disease (ALC), and hepatitis C virus (HCV). MALDI-MS profiling of N-glycans of AGP purified from 20 µL of patient serum in HCC (n = 72) and liver cirrhosis (n = 58) showed that a unique trifucosylated tetra-antennary glycan (m/z 3490.76) was predominantly identified in HCCs but was absent in healthy subjects and the majority of cirrhosis patients. Receiver operation characteristic (ROC) curve analysis showed that the trifucosylated N-glycan of AGP (triFc_AGP) could differentiate HCC from cirrhosis with an area under the curve (AUC) of 0.707, 0.726 and 0.751 for NASH, ALC and HCV, respectively. When combining triFc_AGP with INR and AFP, the panel had the greatest benefit in detection of NASH-related HCCs, with a significantly improved AUC of 0.882 for all NASH HCCs and 0.818 for early NASH HCCs compared to AFP alone (0.761 and 0.641, respectively). Moreover, triFc_AGP could serve as a potential marker for monitoring AFP-negative HCC patients.


Assuntos
Carcinoma Hepatocelular/metabolismo , Fucose/metabolismo , Neoplasias Hepáticas/metabolismo , Orosomucoide/metabolismo , Idoso , Biomarcadores Tumorais/metabolismo , Carcinoma Hepatocelular/diagnóstico , Feminino , Glicosilação , Humanos , Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/metabolismo , Neoplasias Hepáticas/diagnóstico , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/metabolismo
10.
Gastroenterology ; 157(4): 1055-1066.e11, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31251928

RESUMO

BACKGROUND & AIMS: Trends of mortality associated with extrahepatic complications of chronic liver disease might be changing. We studied trends in mortality from extrahepatic complications of viral hepatitis, alcoholic liver disease (ALD), and nonalcoholic fatty liver disease in the United States. METHODS: We performed a population-based study using US Census and the National Center for Health Statistics mortality records from 2007 through 2017. We identified trends in age-standardized mortality using Joinpoint trend analysis with estimates of annual percent change. RESULTS: The liver-related mortality among patients with hepatitis C virus (HCV) infection increased from 2007 through 2013 and then decreased once patients began receiving treatment with direct-acting antiviral (DAA) agents, from 2014 through 2017. Among patients with HCV infection, the age-standardized mortality for extrahepatic cancers was 2.6%, for cardiovascular disease was 1.9%, and for diabetes was 3.3%. Among individuals with hepatitis B virus infection, liver-related mortality decreased steadily from 2007 through 2017. During the study, age-standardized mortality from hepatitis B virus-related extrahepatic complications increased by an average of 2.0% each year. Although liver-related mortality from ALD continued to increase, mortality from extrahepatic complications of ALD did not change significantly during the 11-year study. Among patients with nonalcoholic fatty liver disease, the cause of death was most frequently cardiovascular disease, which increased gradually over the study period, whereas liver-related mortality increased rapidly. CONCLUSIONS: In an analysis of US Census and the National Center for Health Statistics mortality records, we found that after widespread use of DAA agents for treatment of viral hepatitis, cause-specific mortality from extrahepatic cancers increased, whereas mortality from cardiovascular disease or diabetes increased only among patients with HCV infection. These findings indicate the need to reassess risk and risk factors for extrahepatic cancer, cardiovascular disease, and diabetes in individuals successfully treated for HCV infection with DAA agents.


Assuntos
Causas de Morte/tendências , Hepatite B Crônica/mortalidade , Hepatite C Crônica/mortalidade , Hepatopatias Alcoólicas/mortalidade , Hepatopatia Gordurosa não Alcoólica/mortalidade , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Censos , Bases de Dados Factuais , Atestado de Óbito , Feminino , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/tratamento farmacológico , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/tratamento farmacológico , Humanos , Hepatopatias Alcoólicas/diagnóstico , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Prevalência , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
11.
Int J Mol Sci ; 20(11)2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31159489

RESUMO

Alcoholic liver disease (ALD) refers to the damages to the liver and its functions due to alcohol overconsumption. It consists of fatty liver/steatosis, alcoholic hepatitis, steatohepatitis, chronic hepatitis with liver fibrosis or cirrhosis, and hepatocellular carcinoma. However, the mechanisms behind the pathogenesis of alcoholic liver disease are extremely complicated due to the involvement of immune cells, adipose tissues, and genetic diversity. Clinically, the diagnosis of ALD is not yet well developed. Therefore, the number of patients in advanced stages has increased due to the failure of proper early detection and treatment. At present, abstinence and nutritional therapy remain the conventional therapeutic interventions for ALD. Moreover, the therapies which target the TNF receptor superfamily, hormones, antioxidant signals, and MicroRNAs are used as treatments for ALD. In particular, mesenchymal stem cells (MSCs) are gaining attention as a potential therapeutic target of ALD. Therefore, in this review, we have summarized the current understandings of the pathogenesis and diagnosis of ALD. Moreover, we also discuss the various existing treatment strategies while focusing on promising therapeutic approaches for ALD.


Assuntos
Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/terapia , Animais , Gerenciamento Clínico , Diagnóstico Precoce , Humanos , Fígado/patologia , Hepatopatias Alcoólicas/patologia , Transplante de Fígado , Terapia de Alvo Molecular
13.
Liver Transpl ; 25(9): 1310-1320, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31063642

RESUMO

Alcohol-associated liver disease (ALD) is the most common indication for liver transplantation (LT) in the United States and Europe. A 6-month alcohol abstinence period has been required by many transplant programs prior to listing, which may influence wait-list (WL) outcomes. Therefore, we examined WL events in patients with ALD versus non-ALD with a special interest in whether these outcomes differed by sex. All US adults listed for LT from January 2002 to December 2016 were eligible except status 1 patients, Model for End-Stage Liver Disease exceptions, retransplants and those with acute alcoholic hepatitis. The outcomes of interest were cumulative WL death or being too sick and WL removal for improvement within 2 years of listing. Competing risk regression models were used to evaluate recipient factors associated with the outcomes. Among the 83,348 eligible WL patients, 23% had ALD. Unadjusted cumulative WL removal within 2 years was 19.0% for ALD versus 21.1% for non-ALD (P < 0.001). In fully adjusted models, ALD was associated with a significantly lower risk of WL removal for death or being too sick (subhazard ratio [SHR], 0.84; 95% confidence interval [CI], 0.81-0.87; P < 0.001) and a higher risk of removal for improvement (SHR, 2.91; 95% CI, 2.35-3.61; P < 0.001) versus non-ALD patients. After adjusting for potential confounders, women with ALD had a higher risk of removal for death or being too sick (SHR, 1.09; 95% CI, 1.00-1.08; P < 0.001) and a higher chance for improvement (SHR, 2.91; 95% CI, 2.35-3.61; P < 0.001) than men with ALD. In conclusion, WL candidates with ALD have more favorable WL outcomes than non-ALD patients with a 16% lower risk of removal for deterioration and 191% higher risk of removal for improvement. This result likely reflects the benefits of alcohol abstinence, but it suggests that listing criteria for ALD may be too restrictive, with patients who might derive benefit from LT not being listed.


Assuntos
Abstinência de Álcool , Doença Hepática Terminal/mortalidade , Hepatopatias Alcoólicas/mortalidade , Transplante de Fígado/normas , Listas de Espera/mortalidade , Adolescente , Adulto , Idoso , Progressão da Doença , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/patologia , Doença Hepática Terminal/cirurgia , Feminino , Humanos , Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/patologia , Hepatopatias Alcoólicas/cirurgia , Transplante de Fígado/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
14.
World J Gastroenterol ; 25(12): 1445-1456, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30948908

RESUMO

Explosive economic growth and increasing social openness in China over the last 30 years have significantly boosted alcohol consumption, and consequently, the incidence of alcoholic liver disease (ALD) in China has increased. Because the epidemiologic and clinical features of ALD in the Chinese population may differ from those of the Caucasian population, this review describes the epidemiology, pathogenesis, genetic polymorphisms, diagnosis, and treatment of ALD in the Chinese population. This updated knowledge of ALD in China provides information needed for a global understanding of ALD and may help in the development of useful strategies for reducing the global ALD burden.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Efeitos Psicossociais da Doença , Hepatopatias Alcoólicas/epidemiologia , Fatores Socioeconômicos , Consumo de Bebidas Alcoólicas/efeitos adversos , Grupo com Ancestrais do Continente Asiático/genética , China/epidemiologia , Predisposição Genética para Doença , Humanos , Incidência , Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/genética , Hepatopatias Alcoólicas/terapia , Polimorfismo Genético , Fatores de Risco
15.
Biomed Res Int ; 2019: 7604939, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30834274

RESUMO

Background: In inflammatory bowel disease (IBD) patients there are reports of the occurrence of hepatobiliary manifestations, so the aim of this study was to evaluate the hepatobiliary manifestations in patients with Crohn's disease (CD) and ulcerative colitis (UC) from an IBD reference center. Methods: Cross-sectional study in an IBD reference center, with interviews and review of medical charts, between July 2015 and August 2016. A questionnaire addressing epidemiological and clinical characteristics was used. Results: We interviewed 306 patients, and the majority had UC (53.9%) and were female (61.8%). Hepatobiliary manifestations were observed in 60 (19.6%) patients with IBD. In the greater part of the patients (56.7%) hepatobiliary disorders were detected after the diagnosis of IBD. In UC (18.2%) patients, the hepatobiliary disorders identified were 11 (6.7%) non-alcoholic fatty liver disease, 9 (5.5%) cholelithiasis, 6 (3.6%) primary sclerosing cholangitis (PSC), 3 (1.8%) hepatotoxicity associated with azathioprine, 1 (0.6%) hepatitis B, and 1 (0.6%) hepatic fibrosis. In CD (21.3%) patients, 11 (7.8%) had cholelithiasis, 11 (7.8%) non-alcoholic fatty liver disease, 4 (2.8%) PSC, 3 (2.1%) hepatotoxicity, 1 (0.7%) hepatitis B, (0.7%) hepatitis C, 1 (0.7%) alcoholic liver disease, and 1 (0.7%) autoimmune hepatitis (AIH). There was one case of PSC/AIH overlap syndrome. Conclusion: The frequency of hepatobiliary disorders was similar in both forms of IBD in patients evaluated. The most common nonspecific hepatobiliary manifestations in IBD patients were non-alcoholic liver disease and cholelithiasis. The most common specific hepatobiliary disorder was PSC in patients with extensive UC or ileocolonic CD involvement; this was seen more frequently in male patients.


Assuntos
Eliminação Hepatobiliar , Doenças Inflamatórias Intestinais/diagnóstico , Fígado/fisiopatologia , Adulto , Azatioprina/efeitos adversos , Colelitíase/diagnóstico , Colelitíase/fisiopatologia , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/fisiopatologia , Doença de Crohn/diagnóstico , Doença de Crohn/fisiopatologia , Estudos Transversais , Feminino , Hepatite B/diagnóstico , Hepatite B/fisiopatologia , Hepatite C/diagnóstico , Hepatite C/fisiopatologia , Hepatite Autoimune/diagnóstico , Hepatite Autoimune/fisiopatologia , Humanos , Doenças Inflamatórias Intestinais/classificação , Doenças Inflamatórias Intestinais/fisiopatologia , Hepatopatias/classificação , Hepatopatias/patologia , Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Adulto Jovem
16.
Dig Dis Sci ; 64(7): 2014-2023, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30761471

RESUMO

BACKGROUND: Excess consumption of alcohol can lead to cirrhosis, but it is unclear whether the type of alcohol and pattern of consumption affects this risk. AIMS: We aimed to investigate whether type and pattern of alcohol consumption early in life could predict development of severe liver disease. METHODS: We examined 43,242 adolescent men conscribed to military service in Sweden in 1970. Self-reported data on total amount and type of alcohol (wine, beer, and spirits) and risk behaviors associated with heavy drinking were registered. Population-based registers were used to ascertain incident cases of severe liver disease (defined as cirrhosis, decompensated liver disease, liver failure, hepatocellular carcinoma, or liver-related mortality). Cox regression models were used to estimate hazard ratios for development of severe liver disease. RESULTS: During follow-up, 392 men developed severe liver disease. In multivariable analysis, after adjustment for BMI, smoking, use of narcotics, cardiovascular fitness, cognitive ability, and total amount of alcohol, an increased risk for severe liver disease was found in men who reported drinking alcohol to alleviate a hangover ("eye-opener"; aHR 1.47, 95% CI 1.02-2.11) and men who reported having been apprehended for being drunk (aHR 2.17, 95% CI 1.63-2.90), but not for any other risk behaviors. Wine consumption was not associated with a reduced risk for severe liver disease compared to beer and spirits. CONCLUSIONS: Certain risk behaviors can identify young men with a high risk of developing severe liver disease. Wine consumption was not associated with a reduced risk for severe liver disease compared to beer and spirits.


Assuntos
Bebidas Alcoólicas/efeitos adversos , Hepatopatias Alcoólicas/epidemiologia , Assunção de Riscos , Consumo de Álcool por Menores , Adolescente , Adulto , Fatores Etários , Idoso , Cerveja , Seguimentos , Humanos , Hepatopatias Alcoólicas/diagnóstico , Masculino , Pessoa de Meia-Idade , Militares , Prognóstico , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Suécia/epidemiologia , Fatores de Tempo , Vinho , Adulto Jovem
17.
Hepatology ; 69(5): 2271-2283, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30645002

RESUMO

A joint meeting of the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) was held in London on September 30 and October 1, 2017. The goals of the meeting were to identify areas of broad agreement and disagreement, develop consensus, and determine future directions to ultimately reduce the burden, morbidity, and mortality of alcohol-related liver disease (previously termed alcoholic liver disease). The specific aims of the meeting were to identify unmet needs and areas for future investigation, in order to reduce alcohol consumption, develop markers for diagnosis and prognosis of disease, and create a framework to test novel pharmacological agents with pre-specified treatment endpoints. A table summary of these goals and aims is provided in the context of epidemiology, current management strategies, next steps for future trials and translational science.


Assuntos
Alcoolismo/complicações , Hepatopatias Alcoólicas/etiologia , Biomarcadores , Gerenciamento Clínico , Progressão da Doença , Humanos , Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/epidemiologia , Hepatopatias Alcoólicas/terapia , Pesquisa Médica Translacional
19.
J Cell Mol Med ; 23(2): 887-897, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30478965

RESUMO

Alcoholic liver disease (ALD) is a complication that is a burden on global health and economy. Interleukin-33 (IL-33) is a newly identified member of the IL-1 cytokine family and is released as an "alarmin" during inflammation. Soluble suppression of tumourigenicity 2 (sST2), an IL-33 decoy receptor, has been reported as a new biomarker for the severity of systemic and highly inflammatory diseases. Here, we found the levels of plasma sST2, increased with the disease severity from mild to severe ALD. Importantly, the plasma sST2 levels in ALD patients not only correlated with scores for prognostic models (Maddrey's discriminant function, model for end-stage liver disease and Child-Pugh scores) and indexes for liver function (total bilirubin, international normalized ratio, albumin, and cholinesterase) but also correlated with neutrophil-associated factors as well as some proinflammatory cytokines. In vitro, lipopolysaccharide-activated monocytes down-regulated transmembrane ST2 receptor but up-regulated sST2 mRNA and protein expression and produced higher levels of tumour necrosis factor-α (TNF-α). By contrast, monocytes pretreated with recombinant sST2 showed decreased TNF-α production. In addition, although plasma IL-33 levels were comparable between healthy controls and ALD patients, we found the IL-33 expression in liver tissues from ALD patients was down-regulated at both RNA and protein levels. Immunohistochemical staining further showed that the decreased of IL-33-positive cells were mainly located in liver lobule area. These results suggested that sST2, but not IL-33, is closely related to the severity of ALD. Consequently, sST2 could be used as a potential biomarker for predicting the prognosis of ALD.


Assuntos
Doença Hepática Terminal/diagnóstico , Proteína 1 Semelhante a Receptor de Interleucina-1/genética , Interleucina-33/genética , Hepatopatias Alcoólicas/diagnóstico , Fígado/metabolismo , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Progressão da Doença , Doença Hepática Terminal/sangue , Doença Hepática Terminal/complicações , Doença Hepática Terminal/genética , Humanos , Proteína 1 Semelhante a Receptor de Interleucina-1/sangue , Interleucina-33/sangue , Lipopolissacarídeos/farmacologia , Fígado/patologia , Hepatopatias Alcoólicas/sangue , Hepatopatias Alcoólicas/complicações , Hepatopatias Alcoólicas/genética , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Monócitos/citologia , Monócitos/efeitos dos fármacos , Monócitos/metabolismo , Prognóstico , Índice de Gravidade de Doença , Solubilidade , Fator de Necrose Tumoral alfa/sangue , Fator de Necrose Tumoral alfa/genética
20.
Transplantation ; 103(1): 131-139, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30300285

RESUMO

BACKGROUND: In the United States, alcoholic liver disease (ALD) has recently become the leading indication for liver transplantation. METHODS: Using the United Network for Organ Sharing registry, we examined temporal trends in adult liver transplant waitlist (WL) registrants and recipients with chronic liver disease (CLD) due to ALD from 2007 to 2016. RESULTS: From 2007 to 2016, ALD accounted for 20.4% (18 399) of all CLD WL additions. The age-standardized ALD WL addition rate was 0.459 per 100 000 US population in 2007; nearly doubled to 0.872 per 100 000 US population in 2016 and increased with an average annual percent change of 47.56% (95% confidence interval, 30.33% to 64.72%).The ALD WL addition rate increased over twofold among young (18-39 years) and middle-aged (40-59 years) adults during the study period. Young adult ALD WL additions presented with a higher severity of liver disease including Model for End-Stage Liver Disease score compared to middle aged and older adults (≥60 years). The number of annual ALD WL deaths readily rose from 2014 to 2016, despite an overall annual decline in all CLD WL deaths. Severe hepatic encephalopathy, low body mass index (<18.5) and diabetes mellitus were significant predictors for 1-year WL mortality. CONCLUSIONS: Alcoholic liver disease-related WL registrations and liver transplantation have increased over the past decade with a disproportionate increase in young and middle-aged adults. These subpopulations within the ALD cohort need to be evaluated in future studies to improve our understanding of factors associated with these alarming trends.


Assuntos
Hepatopatias Alcoólicas/cirurgia , Transplante de Fígado/tendências , Adolescente , Adulto , Distribuição por Idade , Feminino , Humanos , Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Listas de Espera , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA