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1.
Int J Med Sci ; 18(1): 176-186, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33390786

RESUMO

Objective: The aim of this study was to observe the liver function recovery of COVID-19 patients after discharge. Patients and Methods: A total of 253 discharged COVID-19 patients in Shenzhen city, China were selected. The clinical characteristics of these patients were assessed. A 2-month follow-up and laboratory hematology test were performed to examine the status of patients' liver function. Results: Patients combined with liver diseases, especially fatty liver, are more likely to progress to severe condition (P<0.05). Patients in severe condition and those with liver diseases have higher rates of liver injuries during hospitalization, characterized by a significant increase in alanine aminotransferase (ALT) and aspartate aminotransferase (AST, P<0.01). The ALT, AST/ALT, gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total protein (TP), albumin (ALB), and A/G levels showed significant differences in comparison with the control group (P<0.05, and P<0.001); and the outlier ratio of A/G, ALT, GGT and ALP of patients remained abnormal higher within 14 days after discharge (P<0.001). Liver injuries of COVID-19 patients may be related to the epidemiological characteristics, clinical indexes, basic diseases, symptoms, drug treatment during hospitalization and the complications. Indicators of liver function were correlated with cardiac function, renal function, thyroid function, lipid metabolism, glucose metabolism, immune index, leukocyte, erythrocyte, hemoglobin and platelet related indexes. The outlier ratio of TP, ALB and GLB remained extremely low throughout the follow-up period; the outlier ratio of ALT, AST and GGT decreased below 10% from a high level at 40 days after discharged. However, the outlier ratio of A/G, AST/ALT and ALP remained high during the follow-up period. Conclusions: Abnormal liver function might indicate worse recovery of COVID-19 patients. Changes in liver function should be emphasized during long-term follow-up of COVID-19 patients after hospital discharge; the necessity of employing appropriate interventions for liver function repair should be emphasized.


Assuntos
/complicações , Insuficiência Hepática/virologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Lactente , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Adulto Jovem
2.
Hepatol Int ; 14(5): 723-732, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33026573

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) has rapidly become a major international public health concern. This study was designed to evaluate the clinical characteristics and risk factors of COVID-19-associated liver injury. METHODS: A fraction of 657 COVID-19 patients were retrospectively analyzed. Clinical and laboratory data were derived from electronic medical records and compared between patients with or without liver injury. Multivariate logistic regression method was used to analyze the risk factors for liver injury. RESULTS: Among 657 patients, 303 (46.1%) patients had liver injury with higher rate in severe/critically ill patients [148/257 (57.6%)] than those in moderate cases [155/400 (38.8%)]. The incidence of liver injury was much higher in male [192/303 (63.4%)] than female [111/303 (36.6%)], and in severe/critical patients [148/303 (48.8%)] with percutaneous oxygen saturation ≤ 93% [89/279 (31.9%)] or peak body temperature ≥ 38.5 °C [185/301 (61.5%)] on admission. Liver injury-related inflammations included increased white blood cells, neutrophils and decreased lymphocytes. More patients with liver injury than without had increased serum IL-2R, TNFα, ferritin, hsCRP, PCT, ESR, γ-GT, and LDH. Multivariate regression analysis revealed that increasing odds of liver injury were related to male, higher serum hsCRP (≥ 10 mg/L), and neutrophil-to-lymphocyte ratio (NLR) (≥ 5). Moreover, more deceased patients (14/82 (17%)) had significantly elevated serum TBIL than discharged patients [25/532 (4.7%)]. CONCLUSION: Liver injury is a common complication in COVID-19 patients. The potential risk factors of liver injury include male, hsCRP and NLR score. A close monitor of liver function should be warned in COVID-19 patients, especially in severe/critical individuals.


Assuntos
Infecções por Coronavirus , Citocinas/sangue , Insuficiência Hepática , Contagem de Leucócitos/métodos , Testes de Função Hepática , Pandemias , Pneumonia Viral , Betacoronavirus/isolamento & purificação , China/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Estado Terminal/epidemiologia , Estado Terminal/terapia , Feminino , Insuficiência Hepática/sangue , Insuficiência Hepática/epidemiologia , Insuficiência Hepática/virologia , Humanos , Incidência , Testes de Função Hepática/métodos , Testes de Função Hepática/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
3.
Hepatol Int ; 14(5): 621-637, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32710250

RESUMO

BACKGROUND AND AIMS: Coronavirus disease 2019 (COVID-19) pandemic is ongoing. Except for lung injury, it is possible that COVID-19 patients develop liver injury. Thus, we conducted a systematic review and meta-analysis to explore the incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients. METHODS: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases were searched. The incidence of abnormal liver biochemical tests, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total bilirubin (TBIL), and albumin (ALB), was pooled. Risk ratio (RR) was calculated to explore the association of abnormal liver biochemical tests with severity and prognosis of COVID-19 patients. RESULTS: Forty-five studies were included. The pooled incidence of any abnormal liver biochemical indicator at admission and during hospitalization was 27.2% and 36%, respectively. Among the abnormal liver biochemical indicators observed at admission, abnormal ALB was the most common, followed by GGT, AST, ALT, TBIL, and ALP (39.8%, 35.8%, 21.8%, 20.4%, 8.8%, and 4.7%). Among the abnormal liver biochemical indicators observed during hospitalization, abnormal ALT was more common than AST and TBIL (38.4%, 28.1%, and 23.2%). Severe and/or critical patients had a significantly higher pooled incidence of abnormal liver biochemical indicators at admission than mild and/or moderate patients. Non-survivors had a significantly higher incidence of abnormal liver biochemical indicators than survivors (RR = 1.34, p = 0.04). CONCLUSIONS: Abnormal liver biochemical tests are common in COVID-19 patients. Liver biochemical indicators are closely related to the severity and prognosis of COVID-19 patients.


Assuntos
Infecções por Coronavirus , Cuidados Críticos , Insuficiência Hepática , Testes de Função Hepática/métodos , Pandemias , Pneumonia Viral , Infecções por Coronavirus/sangue , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Cuidados Críticos/estatística & dados numéricos , Insuficiência Hepática/diagnóstico , Insuficiência Hepática/epidemiologia , Insuficiência Hepática/virologia , Humanos , Incidência , Pneumonia Viral/sangue , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Prognóstico , Medição de Risco/métodos
4.
J Gastrointestin Liver Dis ; 29(2): 219-226, 2020 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-32530989

RESUMO

AIMS: Comparing the risk of abnormal liver function tests between severe and non-severe patients with coronavirus disease 2019 (COVID-19) by meta-analysis. METHODS: A literature search was conducted using the databases PubMed, Embase, and Cochrane Library. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using fixed- or random-effects models. Publication bias was detected by the Harbord test. RESULTS: We included 8 articles comprising 7,467 COVID-19 patients. When compared between severe and non-severe COVID-19 patients, the pooled ORs of elevated alanine aminotransferase, aspartate aminotransferase, total bilirubin, and lactate dehydrogenase levels were 2.35 (95% CI 1.38-3.98), 3.21 (95% CI 2.59-3.98), 1.87 (95% CI 1.32-2.65), and 4.83 (95% CI 2.90-8.05), respectively. CONCLUSIONS: The severity of COVID-19 is associated with liver damage, and can be a risk factor for abnormal liver function tests.


Assuntos
Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Insuficiência Hepática/virologia , Pneumonia Viral/fisiopatologia , Índice de Gravidade de Doença , China , Infecções por Coronavirus/diagnóstico , Insuficiência Hepática/diagnóstico , Humanos , Testes de Função Hepática , Pandemias , Pneumonia Viral/diagnóstico
5.
Infect Dis (Lond) ; 49(4): 241-250, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28092214

RESUMO

Hepatitis delta virus (HDV) is a defective satellite virus and propagates in the presence of Hepatitis B virus (HBV) surface antigen (HBsAg). Approximately 5% of the people who infected with HBV are also infected with HDV. Chronic hepatitis caused by delta is the most severe form of chronic viral hepatitis including accelerated fibrosis, liver decompensation and development of hepatocellular carcinoma. Interferon-based therapies still remain the only treatment option of the hepatitis delta. The beneficiary effects of the interferon-based therapies, however, stop frequently with termination of the given therapy and relapse rate is very high. Accordingly, the efficiency rate of this treatment does not exceed 30%. On the other hand, serious side effects of interferons are another troublesome leading to withdrawal of the therapy. The main goal of the current treatments is clearance of HBsAg. There is no available drug acting directly against the HDV. New therapies interacting with HDV life cycle are under investigation. While prenylation inhibitors act on merely HDV, viral entry inhibitors and HBsAg release inhibitors would be used in the treatment of both HBV and HDV. We hope that in the future, the use of novel therapies and HBV vaccination provide to clinicians to cope with this troublesome agent.


Assuntos
Antivirais/uso terapêutico , Hepatite D/tratamento farmacológico , Vírus Delta da Hepatite/fisiologia , Interferons/uso terapêutico , Antivirais/efeitos adversos , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/virologia , Doença Crônica , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Insuficiência Hepática/patologia , Insuficiência Hepática/virologia , Antígenos de Superfície da Hepatite B/metabolismo , Hepatite D/complicações , Hepatite D/patologia , Humanos , Interferons/efeitos adversos , Cirrose Hepática/complicações , Cirrose Hepática/patologia , Cirrose Hepática/virologia , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/patologia , Resultado do Tratamento
6.
Pediatr Int ; 59(5): 551-556, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28135025

RESUMO

BACKGROUND: The aim of the present study was to clarify the roles of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesvirus 6 (HHV-6) in immunocompetent children with acute liver dysfunction not resulting from hepatitis virus. METHODS: Sixty-eight children (median age, 3 years) hospitalized as a result of acute liver dysfunction were enrolled in this study. Hepatitis A, B, and C were excluded. The prevalence of CMV, EBV, and HHV-6 and viral DNA load in whole blood was prospectively evaluated on multiplex real-time polymerase chain reaction (PCR). RESULTS: Of the 68 children with acute liver dysfunction, multiplex real-time PCR was positive in 30 (44%). CMV, EBV, and HHV-6 DNA were detected in 13 (19%), 14 (21%), and seven (10%), respectively. Serum CMV immunoglobulin (Ig)G/IgM and EBV viral capsid antigen IgG/IgM were measured in 40 (CMV DNA positive, n = 10; negative, n = 30) and 45 (EBV DNA positive, n = 14; negative, n = 31) of the 68 children, respectively. Eighteen percent (CMV, 7/40) and 9% (EBV, 4/45) were positive for both PCR and viral-specific IgM. There was no significant difference in CMV and EBV viral load between IgM-positive and -negative children with viremia. CONCLUSIONS: CMV, EBV, and HHV-6 DNA were frequently detected in immunocompetent children with acute liver dysfunction, but primary CMV and EBV infection were confirmed in 10-20% of the children with acute liver dysfunction. The combination of PCR assay and serology is necessary to make a diagnosis of acute liver dysfunction due to primary CMV, EBV and/or HHV-6 infection in immunocompetent children.


Assuntos
Infecções por Citomegalovirus/complicações , Infecções por Vírus Epstein-Barr/complicações , Insuficiência Hepática/virologia , Herpesvirus Humano 6/isolamento & purificação , Imunocompetência , Infecções por Roseolovirus/complicações , Doença Aguda , Adolescente , Criança , Pré-Escolar , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/imunologia , Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por Vírus Epstein-Barr/epidemiologia , Infecções por Vírus Epstein-Barr/imunologia , Feminino , Insuficiência Hepática/imunologia , Humanos , Lactente , Recém-Nascido , Masculino , Reação em Cadeia da Polimerase Multiplex , Prevalência , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Infecções por Roseolovirus/diagnóstico , Infecções por Roseolovirus/epidemiologia , Infecções por Roseolovirus/imunologia , Carga Viral
7.
J Diabetes Complications ; 31(1): 186-194, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27742550

RESUMO

AIM: To identify the prevalence and effect of hepatopathies of different etiologies among pediatric patients with type 1 diabetes mellitus (T1DM) using transient elastography (TE) and its relation to glycemic control. METHODS: One hundred T1DM patients were studied focusing on liver functions, fasting lipid profile, hemoglobin A1c (HbA1c), hepatitis C virus (HCV), serum immunoglobulins, autoimmune antibodies; anti-nuclear antibody (ANA), anti-smooth muscle antibody (ASMA), and anti-liver kidney microsomal antibody (anti-LKM). Abdominal ultrasound was performed and TE was done for patients with HCV, positive autoimmune antibody and/or abnormal ultrasound findings. RESULTS: Thirty-one patients were found to have one or more hepatic abnormalities; clinical hepatomegaly in 8%, elevated alanine aminotransferase (ALT) in 10%, HCV in 6%, autoimmune hepatitis (AIH) in 11% (10 were positive for ASMA and 2 were positive for ANA while anti-LKM antibodies were negative) and abnormal hepatic ultrasound in 20% (12 non-alcoholic fatty liver disease, 5 AIH, 2 HCV, 1 Mauriac syndrome). Mean liver stiffness in those 31 patients was 7.0±2.1kPa (range, 3.1-11.8kPa); 24 were Metavir F0-F1, 7 were F2-F3 while none was F4. Type 1 diabetic patients with abnormal hepatic ultrasound had higher fasting blood glucose, HbA1c and total cholesterol than those with normal findings. Liver stiffness was significantly higher in patients with abnormal liver ultrasound compared with normal sonography. Liver stiffness was positively correlated to HbA1c and ALT. CONCLUSIONS: Hepatic abnormalities are prevalent in T1DM and related to poor metabolic control. TE provides a non-invasive method for detection of hepatopathy-induced fibrosis.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Insuficiência Hepática/diagnóstico por imagem , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Fígado/diagnóstico por imagem , Adolescente , Biomarcadores/sangue , Biópsia , Estudos Transversais , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/terapia , Egito/epidemiologia , Técnicas de Imagem por Elasticidade , Feminino , Hemoglobina A Glicada/análise , Hepacivirus/isolamento & purificação , Insuficiência Hepática/complicações , Insuficiência Hepática/patologia , Insuficiência Hepática/virologia , Hepatite C/complicações , Hepatite C/epidemiologia , Hepatite C/patologia , Hepatite C/virologia , Hepatite Autoimune/complicações , Hepatite Autoimune/epidemiologia , Hepatite Autoimune/patologia , Hepatite Autoimune/virologia , Hepatomegalia/complicações , Hepatomegalia/diagnóstico por imagem , Hepatomegalia/epidemiologia , Hepatomegalia/patologia , Humanos , Incidência , Fígado/patologia , Fígado/virologia , Masculino , Prevalência , Ultrassonografia
8.
Intervirology ; 60(5): 207-216, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29587272

RESUMO

AIMS: This study describes an immunoassay to detect anti-torque teno virus (TTV) antibodies using a peptide obtained from expression of the N22 region of TTV genotype 2. METHODS: The N22 region (∼500 bp) of TTV genotype 2 was cloned in a pET-28a(+) vector and expressed in ZYM-5052 autoinduction medium. Following metal affinity chromatography, a purified polypeptide was used as an antigen for the development of an immunoassay to detect anti-TTV antibodies in human sera. RESULTS: Recombinant protein (∼25-kDa) was obtained after 24 h of incubation at 25°C in ZYM-5052 autoinduction medium. A blot assay developed using this polypeptide as an antigen and TTV-positive sera as the primary antibody produced a distinct spot on the nitrocellulose membrane. Serum samples from 36 of 42 patients with renal disease and 29 of 48 patients with liver diseases produced a positive signal using this immunoassay. Simultaneously, 18 of 48 healthy controls were also detected to be positive for anti-TTV antibodies. These results were found to be comparable with TTV detection using PCR, and the assay showed a high sensitivity and specificity (i.e., 97.44 and 91.67%, respectively). Moreover, this assay could detect TTV infection irrespectively of the genotype, including cases of mixed infection. CONCLUSION: The present immunoassay using the N22 expression product may be used as an alternative to PCR to detect TTV infection in large populations.


Assuntos
Anticorpos Antivirais/química , Infecções por Vírus de DNA/diagnóstico , Immunoblotting/métodos , Torque teno virus/imunologia , Proteínas Virais/imunologia , Adulto , Estudos de Casos e Controles , Clonagem Molecular , Infecções por Vírus de DNA/virologia , Escherichia coli/genética , Escherichia coli/metabolismo , Feminino , Expressão Gênica , Vetores Genéticos/química , Vetores Genéticos/metabolismo , Genótipo , Insuficiência Hepática/diagnóstico , Insuficiência Hepática/virologia , Humanos , Masculino , Proteínas Recombinantes/genética , Proteínas Recombinantes/imunologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/virologia , Sensibilidade e Especificidade , Torque teno virus/genética , Torque teno virus/isolamento & purificação , Proteínas Virais/genética
9.
Hepatology ; 61(1): 46-55, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25125218

RESUMO

UNLABELLED: Human immunodeficiency virus (HIV) and hepatitis virus coinfection amplify and accelerate hepatic injury. MicroRNAs (miRNAs) are small regulatory RNAs suggested as biomarkers for liver injury. We analyzed the circulating levels of miRNAs in HIV patients with regard to the extent and etiology of liver injury. Total RNA was extracted from 335 serum samples of HIV patients and 22 healthy control participants using Qiazol. Comprehensive polymerase chain reaction (PCR) array analyses (768 miRNA) were performed in serum samples of eight HIV, eight HIV/HCV (hepatitis C virus), six HCV patients, and three healthy controls. Reverse transcription (RT)-PCR measured levels of miRNA-122, miRNA-22, and miRNA-34a in serum samples of 335 patients and 19 healthy control participants. Liver injury and fibrosis in these patients were defined using aspartate aminotransferase (AST) levels, fibrosis-4 (FIB-4) index and AST-to-platelet ratio index (APRI) score. The miRNA pattern of HIV/HCV samples showed altered expression of 57 and 33 miRNA compared to HCV and HIV infection, respectively. miRNA-122, miRNA-22, and miRNA-34a were highly up-regulated in HIV/HCV patients. Analyzing the entire cohort, these miRNAs were correlated with liver function tests and were independent predictors of liver injury (AST >2 × ULN). miRNA-122 and miRNA-22 were associated with relevant fibrosis (FIB-4 >1.45; APRI >1). Circulating levels of miRNA-122 were independent predictors for relevant fibrosis in HIV patients. Interestingly, miRNA-122 and miRNA-34a levels were higher in HIV/HCV patients, miRNA-22 levels were highest in HIV/HBV patients, and circulating levels of miRNA-34a correlated positively with illicit drug use and ethanol consumption. CONCLUSION: Circulating miRNA-122, miRNA-22, and miRNA-34a correlates with the etiology of liver injury in HIV patients. These biomarkers not only mirror different mechanisms of hepatic injury, but also are independent predictors of liver injury in HIV patients.


Assuntos
Infecções por HIV/complicações , Insuficiência Hepática/sangue , Hepatite Viral Humana/complicações , Cirrose Hepática/sangue , MicroRNAs/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Coinfecção/sangue , Feminino , Infecções por HIV/sangue , Voluntários Saudáveis , Insuficiência Hepática/diagnóstico , Insuficiência Hepática/virologia , Hepatite Viral Humana/sangue , Hepatite Viral Humana/virologia , Humanos , Cirrose Hepática/diagnóstico , Cirrose Hepática/virologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Adulto Jovem
10.
JAMA Intern Med ; 175(2): 178-85, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25485735

RESUMO

IMPORTANCE: Knowing the rate of liver fibrosis progression in hepatitis C virus (HCV)-infected persons can help inform patients and providers (clinicians, medical institutions or organizations, and third-party payers) in making treatment decisions. OBJECTIVE: To determine the rate and factors associated with liver fibrosis progression and hepatic decompensation in persons after acquiring HCV infection. DESIGN, SETTING, AND PARTICIPANTS: Secondary data analysis of persons in the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES), a national Veterans Affairs (VA) database, between 2002 and 2012. Among 610 514 persons in ERCHIVES (half were HCV positive), we identified those with an initial negative and subsequent positive test result for HCV antibody and positive HCV RNA test result (HCV+). Controls had 2 negative HCV antibody test results (HCV-) in a comparable time frame and were matched 1:1 on age (in 5-year blocks), race, and sex. We excluded persons with human immunodeficiency virus, hepatitis B, less than 24 months of follow-up, hepatocellular carcinoma, and cirrhosis at baseline. MAIN OUTCOMES AND MEASURES: Progression of liver fibrosis as estimated by the Fibrosis-4 (FIB-4) index; development of cirrhosis, defined by a FIB-4 score greater than 3.5; and development of hepatic decompensation. RESULTS: The evaluable data set consisted of 1840 persons who were HCV+ and 1840 HCV- controls. The HCV+ persons were younger and had a lower mean (SD) body mass index (27.39 [5.51] vs 29.49 [6.16]; P < .001), a higher prevalence of alcohol and drug abuse and dependence diagnoses, and higher serum aminotransferase levels, but had a lower prevalence of diabetes and hypertension. Fibrosis progression started early after infection among HCV+ persons and tapered off after 5 years. A total of 452 cirrhosis and 85 hepatic decompensation events were recorded. After 10 years of follow-up, HCV+ persons were more likely to have a diagnosis of cirrhosis compared with HCV- controls (18.4% vs 6.1%). Nine years after diagnosis of cirrhosis, hepatic decompensation events were uncommon but had a higher rate in the HCV+ group (1.79% vs 0.33%). CONCLUSIONS AND RELEVANCE: Persons who seroconverted for HCV have a more rapid progression of liver fibrosis and accelerated time to development of cirrhosis after seroconversion compared with HCV- controls. Fibrosis progression occurs early after infection; however, hepatic decompensation is uncommon after diagnosis of cirrhosis.


Assuntos
Hepatite C Crônica/complicações , Cirrose Hepática/virologia , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Progressão da Doença , Feminino , Insuficiência Hepática/virologia , Hepatite C Crônica/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
11.
Arab J Gastroenterol ; 12(1): 29-33, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21429452

RESUMO

BACKGROUND AND STUDY AIMS: Early diagnosis of hepatocellular carcinoma (HCC) is the only hope for cure. Although the role of alpha foetoprotein (AFP) in the diagnosis of advanced HCC is well recognised, at least one-third of cases will be missed unless another diagnostic tool is used. Increased levels of circulating interleukin-18 (IL-18) have been observed in patients with several cancer types and were described in patients with chronic hepatitis. The aim of this study is to assess the role of serum IL-18 level in the diagnosis of hepatitis C virus (HCV)-related HCC. PATIENTS AND METHODS: A total of 75 subjects categorised into four groups, including 25 patients with HCV-related HCC and AFP above 200ng/ml, 25 patients with HCV-related HCC and AFP below 200ng/ml, 15 patients with HCV-related chronic liver disease and 10 healthy controls, were enrolled. HCC was diagnosed according to guidelines of the American Association for the Study of Liver Diseases. AFP and IL-18 were assessed in all subjects. RESULTS: AFP and IL-18 levels are significantly higher in patients with HCC than in disease control and healthy control subjects. IL-18 level is not correlating with the size or the number of hepatic focal lesions neither with the presence of lymphovascular invasion or abdominal lymphadenopathy. The best cut-off value of IL-18 for the diagnosis of HCC is 500pg/ml with 84% sensitivity and 86.7% specificity and the area under receiver operating characteristic curve is 0.675. CONCLUSION: Serum IL-18 level is a suitable marker for the diagnosis of HCV-related HCC complementary to AFP, especially in cases with AFP level less than the diagnostic value.


Assuntos
Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/virologia , Hepatite C Crônica/fisiopatologia , Interleucina-18/sangue , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/virologia , Adulto , Idoso , Biomarcadores/sangue , Carcinoma Hepatocelular/sangue , Feminino , Insuficiência Hepática/sangue , Insuficiência Hepática/diagnóstico , Insuficiência Hepática/virologia , Hepatite C Crônica/sangue , Humanos , Neoplasias Hepáticas/sangue , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade , alfa-Fetoproteínas/análise
12.
Clin Gastroenterol Hepatol ; 8(6): 541-5, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20298811

RESUMO

BACKGROUND & AIMS: Acute exacerbations of chronic hepatitis B virus (HBV) infection can lead to hepatic decompensation. It is important to identify factors that predict the development of hepatic decompensation during exacerbation so that antiviral therapy can be initiated immediately. METHODS: Acute exacerbation, defined by an abrupt increase in alanine aminotransferase (ALT) levels to >5-fold the upper limit of normal, occurred in 110 hepatitis B e antigen (HBeAg)-seropositive non-cirrhotic patients (138 episodes). The patients were monitored every 1 to 2 weeks for serum levels of ALT, bilirubin, albumin, and prothrombin. Sex, age, HBV genotype, ALT level, HBV viral load, and the causes (spontaneous or relapse from antiviral treatment) of exacerbation were included in multivariate logistic regression analyses. The receiver operating characteristic curve was used to identify the optimal cut-off value of serum HBV DNA level to identify patients at risk for decompensation. RESULTS: Seven of the 138 episodes of acute exacerbation (5.1%) resulted in hepatic decompensation; serum HBV DNA level was the only significant risk factor (P = .003). The area under the receiver operating characteristic curve was 88.6% (P < .001). A serum HBV DNA cut-off value of 1.55 x 10(9) copies/mL predicted decompensation with a sensitivity of 85.7%, a specificity of 85.5%, a negative prediction value of 99.1%, and positive prediction value of 24.0%. CONCLUSIONS: During acute exacerbation of HBeAg-positive chronic hepatitis B, a serum HBV DNA cut-off value of 1.55 x 10(9) copies/mL can be used to identify patients in need of immediate antiviral therapy.


Assuntos
DNA Viral/sangue , Insuficiência Hepática/diagnóstico , Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/patologia , Hepatite B Crônica/virologia , Carga Viral , Adolescente , Adulto , Alanina Transaminase/sangue , Antivirais/uso terapêutico , Bilirrubina/sangue , Feminino , Insuficiência Hepática/virologia , Antígenos E da Hepatite B/sangue , Hepatite B Crônica/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Protrombina/análise , Curva ROC , Albumina Sérica/análise , Adulto Jovem
13.
Rev. chil. pediatr ; 76(4): 393-396, ago. 2005.
Artigo em Espanhol | LILACS | ID: lil-433007

RESUMO

Introducción: La infección por parvovirus humano B19 (PHB 19) produce un amplio rango de enfermedades que van desde eritema infeccioso en niños hasta artritis aguda en adultos. Algunos estudios sugieren un rol patogénico del PHB 19 en el desarrollo de la hepatitis aguda (HA) y falla hepática fulminante (FHF) en niños y adultos. La Anemia aplástica (AA) es una complicación reconocida de la HA y FHF por PHB 19. Objetivo: Reportar un caso de FHF por infección por PHB 19 y revisar la literatura. Caso clínico: Niña de 7 años de edad con HA que en una semana desarrolló FHF con serología IgM anti-PHB 19 positiva. Otras causas virales, autoinmunes, metabólicas o toxicas fueron descartadas. Fue sometida a trasplante hepático ortotópico (THO) y un año después no ha presentado complicaciones. Conclusiones: El PHB 19 puede causar HA y FHF, su oportuno diagnóstico y tratamiento, que en el caso de la FHF incluye el THO puede resultar en un pronóstico favorable.


Assuntos
Masculino , Humanos , Criança , Hepatite/complicações , Infecções por Parvoviridae/complicações , Infecções por Parvoviridae/terapia , Insuficiência Hepática/virologia , Transplante de Fígado , DNA Viral/sangue , Imunossupressores/uso terapêutico , Anemia Aplástica/etiologia , Infecções por Parvoviridae/diagnóstico , Infecções por Parvoviridae/imunologia , Imunoglobulina M/sangue , Resultado do Tratamento
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