ABSTRACT
Introducción: en el hígado, el factor de crecimiento hepático (FCH) es conocido por ser un potente agente mitogénico tanto in vivo como in vitro. Sin embargo, el papel del FCH en la cirrosis no está completamente claro y algunos estudios lo señalan como un marcador de severidad en la cirrosis, en la insuficiencia hepática aguda y en la hepatitis crónica. Objetivos: determinar la relación entre el FCH y el estadio de la cirrosis hepática e identificar los factores asociados con los niveles de FCH en esta población. Metodología: se evaluaron todos los pacientes con cirrosis hepática atendidos desde enero a marzo de 2014. La elastografía transitoria (ET), la recopilación de la información clínica y la extracción de la muestra para la determinación del FCH se realizó de forma simultánea en el momento de la inclusión. Resultados: no se encontró relación entre los niveles de FCH y la clasificación de Child-Pugh; sin embargo, se observaron niveles más elevados en pacientes con enfermedad descompensada. Se determinó una asociación lineal positiva entre el FCH y la dureza hepática estimada por elastografía (b = 0,53; r2 = 0,26; p = 0,002) y una asociación lineal negativa con la albúmina (b = -0,62; r2 = 0,39; p <0,001). Únicamente la albúmina conservó esta asociación en el análisis multivariante. Conclusión: el FCH es un marcador de severidad en la cirrosis hepática. La albúmina y el grado de fibrosis determinada por ET se asociaron con niveles de FCH
Introduction: Hepatocyte growth factor (HGF) is known to be a potent mitogenic agent both in vivo and in vitro. The role of HGF in cirrhosis is not completely clear, but some studies point to it as a marker of severity in cirrhosis, acute liver failure and chronic hepatitis. Objective: The objective of this study was to determine the relationship between HGF and the stage of hepatic cirrhosis and to identify factors associated with HGF levels in this population. Methodology: All patients with hepatic cirrhosis treated from January to March 2014 were evaluated. At the time patients were enrolled in the study their clinical histories were taken and they underwent transient elastography and extraction of samples for measurement of HGF. Results: No relationships were found between HGF levels and Child-Pugh classifications, however, higher levels of HGF were observed in patients with decompensated disease. A positive linear relations was found between HGF and hepatic hardness estimated by elastography (b = 0.53, r2 = 0.26, p = 0.002) and a negative linear relation was found between HGF and albumin (b = -0.62, r2 = 0.39, p <0.001). Only albumin retained this association in the multivariate analysis. Conclusion: HGF is a marker of severity in liver cirrhosis. Albumin and the degree of fibrosis determined by transient elastography were associated with HGF levels.
Subject(s)
Elasticity Imaging Techniques , Liver Cirrhosis , Hepatocyte Growth FactorABSTRACT
Objective To evaluate the preoperative liver function and prognosis of laparoscopic cholecystectomy (LC) in patients with cirrhosis,using the Child-Turcotte-Pugh classification and the model for end-stage liver disease(MELD) score.Methods From January 2009 to June 2013,973 patients who were admitted to the Department of General Surgery of our hospital and the HuiZhou Municipal Central Hosptial were studied.Of the 373 patients with cirrhosis,38 patients were excluded because of Child C,MELD ＞ 30,or laparotomy.The remaining 335 patients who received laparoscopic cholecystectomy were randomly divided into two groups The Child grade and MELD score were retrospectively analyzed.Results There was no significant difference in intraoperative hemorrhage between the Child A group [(106 ± 11) ml] and the Child B group [(109 ± 11) ml] (P ＞ 0.05).The R ＜ 14 scores in the MELD group [(58 ± 15) ml] was significantly lower than that in the R≥ 14 group [(120 ± 28) ml] (P ＜ 0.01).There was no significant difference in postoperative complications between the Child group A (10 cases,12％) and the Child group B (17 cases,21％) (P ＞0.05).There was a significantly lower incidence in the R ＜ 14 scores in the MELD group (10 cases,12％) than the R ≥ 14 group (27 cases,33％) (P ＜ 0.05).There was also no significant difference in the hospital stay between the Child A group (9 ± 1) and the Child B group (10 ± 2)(P ＞0.05) ; the R ＜ 14 score of the MELD group (7 ± 1) was significantly less than that of the R≥ 14 group (11 ±2) (P ＜0.01).There was no significant difference in the cost of hospitalization between the Child A group (1.337 ± 0.063) and the Child B group (1.359 ± 0.089) (P ＞ 0.05) ; the R ＜ 14 group (MELD score 1.108 ± 0.123) was significantly less than that of the R ≥ 14 group (1.568-± 0.117)(P ＜ 0.01).Conclusion Compared with the Child-Turcotte-Pugh classification,the MELD score was more scientific,objective and accurate in judging the preoperative liver function.It helped to predict the amount of intraoperative hemorrhage and postoperative morbidity,reduced hospital stay and hospitalization expenses.Therefore,the MELD scoring system more objectively guided the treatment of patients with cholecystitis with cirrhosis.
ABSTRACT
The aim of this study was to evaluate and compare the Child-Turcotte-Pugh (CTP) classification system and the model for end-stage liver disease (MELD) score in predicting the severity of the systemic inflammatory response in living-donor liver transplantation patients. Recipients of liver graft were allocated to a recipient group (n = 39) and healthy donors to a donor group (n = 42). The association between the CTP classification, the MELD scores and perioperative cytokine concentrations in the recipient group was evaluated. The pro-inflammatory cytokines measured included interleukin (IL)-1beta, IL-6, and tumor necrosis factor (TNF)-alpha; the anti-inflammatory cytokines measured included IL-10 and IL-4. Cytokine concentrations were quantified using sandwich enzyme-linked immunoassays. The IL-6, TNF-alpha, and IL-10 concentrations in the recipient group were significantly higher than those in healthy donor group patients. All preoperative cytokine levels, except IL-6, increased in relation to the severity of liver disease, as measured by the CTP classification. Additionally, all cytokine levels, except IL-6, were significantly correlated preoperatively with MELD scores. However, the correlations diminished during the intraoperative period. The CTP classification and the MELD score are equally reliable in predicting the severity of the systemic inflammatory response, but only during the preoperative period.