Clinical study on the treatment of spleen deficiency and phlegm stasis syndrome in alcoholic cirrhosis with Qinggan Huashi Huoxue Decoction and conventional western medicine / 国际中医中药杂志

Objective:To evaluate the efficacy of Qinggan Huashi Huoxue Decoction combined with conventional Western medicine in the treatment of alcoholic cirrhosis with spleen deficiency and phlegm stasis syndrome.Methods:Randomized controlled trial. A total of 110 patients from Tangshan Fengrun District Hospital of Traditional Chinese Medicine from March 2020 to March 2022 were selected as observation objects and divided into 2 groups with 55 patients in each group by computer random drawing method. The control group was treated with conventional Western medicine, while the observation group was treated with Qinggan Huashi Huoxue Decoction on the basis of the control group treatment. Both groups were treated for 3 months. The traditional Chinese medicine syndrome score was performed before and after treatment, and the levels of proline peptidase (PLD), type Ⅳ collagen (Ⅳ-C) and type Ⅰ procollagen aminopeptidase (PINP) were detected by phthalaldehyde contrast colorimetry, and the levels of pentamylin 3 (PTX3), protein kinase B (Akt) and B cell activating factor receptor (BAFF-R) were determined by ELISA. Adverse events were recorded and clinical efficacy was evaluated.Results:The total effective rate in the observation group was 92.73% (51/55), while that in the control group was 76.36% (42/55), the difference between the two groups was statistically significant ( χ2=5.64, P=0.018). After treatment, the score and total score of costal pain and fullness, swelling and firmness, anorexia, white and greasy tongue coating in the observation group were significantly lower than those in the control group ( t values were 11.02, 7.36, 7.47, 6.38, 9.37, respectively, P<0.01). After treatment, the levels of serum PLD[(143.28±16.38)U/L vs. (160.69±18.35)U/L, t=5.25], Ⅳ-C[(71.93±8.33)μg/L vs. (83.12±9.91)μg/L, t=6.41], and PINP[(32.36±5.32)ng/L vs. (39.02±5.61)ng/L, t=6.39] in the observation group were significantly lower than those in the control group ( P<0.01); The levels of PTX3[(36.82±4.96)ng/L vs. (42.14±5.83)ng/L, t=5.15], Akt[(69.22±7.94)ng/L vs. (77.24±8.63)ng/L, t=5.07], and BAFF-R[(15.29±3.64)ng/L vs. (19.92±4.15)ng/L, t=6.22] in the observation group were significantly lower than those in the control group ( P<0.01). During the treatment period, the incidence of adverse reactions was 12.73% (7/55) in the observation group and 9.09% (5/55) in the control group, with no statistically significant difference between the two groups ( χ2=0.37, P=0.541). Conclusion:Qinggan Huashi Huoxue Decoction combined with conventional Western medicine therapy can improve the Traditional Chinese Medicine syndrome and the degree of liver fibrosis damage in patients with alcoholic cirrhosis with spleen deficiency and phlegm stasis syndrome, inhibit the expression of serum inflammatory factors, and improve clinical efficacy.

Features of anemia in patients with alcoholic liver cirrhosis / 临床肝胆病杂志

Objective To investigate the laboratory and clinical features of anemia in patients with alcoholic liver cirrhosis. Methods A retrospective analysis was performed for the patients who were hospitalized in Beijing YouAn Hospital, Capital Medical University, from December 2020 to May 2021 and were found to have anemia based on reticulocyte hemoglobin (Hb) content (Ret-He) and whole blood cell analysis, and 106 patients with the discharge diagnosis of alcoholic liver cirrhosis who had no history of upper gastrointestinal bleeding or blood transfusion were screened out as subjects. Clinical features and related influencing factors were retrospectively analyzed based on the severity of anemia, the cytomorphological classification of anemia, and Ret-He. The independent samples t -test was used for comparison of normally distributed continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the SNK- q test and the least significant difference t -test were used for further comparison between two groups. The Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. The chi-square test was used for comparison of categorical data between groups. A Spearman correlation analysis was performed to investigate the correlation of different classification criteria for anemia with laboratory markers and clinical features. Results Among the 106 patients, there were 103 male patients (97.2%), with a mean age of 55.07±10.18 years and a mean Hb level of 87.16±18.55 g/L; there were 49 patients (46.2%) with mild anemia, 49 (46.2%) with moderate anemia, and 8(7.5%) with severe anemia; mean Ret-He was 33.65(13.3-46.4) pg, and there were 33 patients (31.1%) with ≤29 pg and 73 patients (68.9%) with Ret-He > 29 pg; among these patients, 46(43.4%) had macrocytic anemia, 34(32.1%) had normocytic anemia, 2(1.9%) had simple microcytic anemia, and 24 (22.6%) had microcytic hypochromic anemia; among these patients, 87(82.1%) had ascites and/or intra-abdominal infection, 82(77.4%) had splenomegaly and/or hypersplenism, 65(61.3%) had esophageal and gastric varices, and 31(29.2%) had hepatic encephalopathy. Compared with the control group (moderate/severe anemia), the mild anemia group had significantly higher Ret-He, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular-hemoglobin concentration (MCHC), serum iron (SI), and transferrin saturation (TS) (all P 29 pg (83.7% vs 56.1%, P =0.002) or normocytic anemia (44.9% vs 21.1%, P =0.009), a significantly lower unsaturated iron-binding capacity (UIBC) ( P 29 pg group, the Ret-He ≤29 pg group had significantly lower Hb, MCV, MCH, MCHC, SI, TS, and proportion of patients with mild anemia or ascites and/or intra-abdominal infection (all P < 0.05), a significantly higher UIBC ( P < 0.05), and a significantly higher proportion of patients with microcytic hypochromic anemia or esophageal and gastric varices ( P < 0.05). Hb, Ret-He, MCV, MCH, MCHC, UIBC, SI, and TS were correlated with the severity of anemia, the cytomorphological classification of anemia, and iron deficiency (all P < 0.05), and esophageal and gastric varices and ascites and/or abdominal infection were correlated with the cytomorphological classification of anemia and iron deficiency (all P < 0.05). Conclusion The degree of anemia is mostly mild and moderate in the decompensated stage of alcoholic liver cirrhosis, and macrocytic anemia and normocytic anemia are more common. The incidence rate of iron deficiency increases with the severity of anemia, and esophageal and gastric varices and ascites and/or intra-abdominal infection are correlated with the cytomorphological classification of anemia and iron deficiency; therefore, it is necessary to enhance the monitoring of iron deficiency anemia in such patients in clinical practice.

Expression and significance of Golgi protein 73 in alcoholic cirrhosis / 中国基层医药

Objective@#To investigate the expression and significance of Golgi protein 73 (GP73) in alcoholic cirrhosis.@*Methods@#From March 2015 to August 2017, 163 patients with alcoholic liver disease in the No.541 General Hospital were selected, including 51 patients with alcoholic fatty liver, 62 patients with alcoholic hepatitis, 50 patients with alcoholic liver cirrhosis, and 70 healthy volunteers were selected as control group.The liver function and the level of GP73 were detected.@*Results@#The GP73 level in the alcoholic liver cirrhosis group was (210.16±40.11)ng/mL, which was higher than that of the control group[(46.24±12.24)ng/mL], alcoholic fatty liver group [(85.10±20.43)ng/mL] and alcoholic hepatitis group[(160.18±32.05)ng/mL] (t=15.822, 30.022, 23.212, all P<0.05). GP73 was positively correlated with Gamma glutamyl transferase (GGT) (r=0.563, P<0.05), negatively correlated with albumin (Alb) (r=-0.488, P<0.05), and had no correlation with alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and total bilirubin (TBIL) (P>0.05). After treatment, the GP73 levels of effective patients in the alcoholic fatty liver group, alcoholic hepatitis group and alcoholic liver cirrhosis group were (54.16±11.18)ng/mL, (104.11±28.46)ng/mL, (122.03±30.54)ng/mL, respectively, which were lower than that of the ineffective patients (t=-4.600, -5.081 and -4.100, all P<0.05).@*Conclusion@#The GP73 level is significantly elevated in alcoholic liver disease.In alcoholic cirrhosis, GP73 level is the highest, has a certain relationship with the liver function index GGT, Alb and the therapeutic effect.

Expression and significance of Golgi protein 73 in alcoholic cirrhosis / 中国基层医药

Objective To investigate the expression and significance of Golgi protein 73 (GP73) in alcoholic cirrhosis.Methods From March 2015 to August 2017,163 patients with alcoholic liver disease in the No.541 General Hospital were selected,including 51 patients with alcoholic fatty liver,62 patients with alcoholic hepatitis,50 patients with alcoholic liver cirrhosis,and 70 healthy volunteers were selected as control group.The liver function and the level of GP73 were detected.Results The GP73 level in the alcoholic liver cirrhosis group was (210.16 ± 40.11)ng/mL,which was higher than that of the control group [(46.24 ± 12.24) ng/mL],alcoholic fatty liver group [(85.10 ± 20.43) ng/mL] and alcoholic hepatitis group[(160.18 ± 32.05) ng/mL] (t =15.822,30.022,23.212,all P ＜ 0.05).GP73 was positively correlated with Gamma glutamyl transferase (GGT) (r =0.563,P ＜ 0.05),negatively correlated with albumin (Alb) (r =-0.488,P ＜ 0.05),and had no correlation with alanine aminotransferase (ALT),aspartate aminotransferase (AST),alkaline phosphatase (ALP) and total bilirubin (TBIL)(P ＞ 0.05).After treatment,the GP73 levels of effective patients in the alcoholic fatty liver group,alcoholic hepatitis group and alcoholic liver cirrhosis group were (54.16 ± 11.18)ng/mL,(104.11 ± 28.46)ng/mL,(122.03 ±30.54)ng/mL,respectively,which were lower than that of the ineffective patients (t =-4.600,-5.081 and -4.100,all P ＜ 0.05).Conclusion The GP73 level is significantly elevated in alcoholic liver disease.In alcoholic cirrhosis,GP73 level is the highest,has a certain relationship with the liver function index GGT,Alb and the therapeutic effect.

Influence of alcohol consumption on liver function and rebleeding in alcoholic cirrhotic patients with esophageal and gastric varices / 临床肝胆病杂志

@#ObjectiveTo investigate the influence of alcohol consumption on liver function and prognosis in alcoholic cirrhotic patients. MethodsA total of 211 alcoholic cirrhotic patients with gastroesophageal variceal bleeding who underwent endoscopic treatment in Beijing Ditan Hospital, Capital Medical University, from September to December, 2018 were enrolled, and among these patients, there were 208 male and 3 female patients, with a mean follow-up time of 45 months (range 2-110 months). The association of alcohol consumption with liver parameters was analyzed. According to the presence or absence of gastroesophageal variceal rebleeding, the patients were divided into early rebleeding group, delayed rebleeding group, and non-rebleeding group, and the three groups were compared in terms of liver parameters and alcohol consumption. The t-test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Spearman rank correlation test was used for correlation analysis. ResultsDuration of drinking was correlated with creatinine (r=0.142, P=0.039) and direct bilirubin (DBil) (r=-0.137, P=0.047), and daily alcohol consumption was correlated with DBil (r=0.144, P=0.037) and prealbumin (r=-0.190, P=0.009), while there was no correlation between total alcohol consumption and indicators for liver injury. There were significant differences between the early rebleeding group and the delayed rebleeding group in white blood cell count (WBC) (t=-2.355, P=0.020), neutrophils (t′=-2.602, P=0.010), hemoglobin (t=2.247, P=0.026), mean corpuscular volume (t=-2.073, P=0.040), alanine aminotransferase (Z=-1.985, P=0047), international normalized ratio (Z=-2.397, P=0.017), spleen thickness (Z=-2.542, P=0.011), Child-Pugh score (t′=-2.364, P=0.020), and Child-Pugh grade (Z=-2.485, P=0.013). The non-rebleeding group had significantly lower WBC (Z=-2.276, P=0.017) and neutrophils (Z=-2.375, P=0.018) than the rebleeding group, and the early and delayed rebleeding groups had a significantly shorter duration of drinking than the non-rebleeding group (Z=-2.522, P=0.012). The logistic regression analysis showed that neutrophils was a risk factor for variceal rebleeding (odds ratio=1.152, 95% confidence interval: 1.017-1.300, P=0026). ConclusionNo dose-response relationship is found between alcohol consumption and liver injury in this study, and alcohol consumption may not have a marked effect on variceal rebleeding.

Measuring Intrahepatic Vascular Changes Using Contrast-Enhanced Ultrasonography to Predict the Prognosis of Alcoholic Hepatitis Combined with Cirrhosis: A Prospective Pilot Study

BACKGROUND/AIMS: Acute hepatic dysfunction combined with alcoholic hepatitis (AH) in alcoholic cirrhosis is related to hepatic hypo-perfusion secondary to intrahepatic necroinflammation, neoangiogenesis, and shunt. The hepatic vein arrival time (HVAT) assessed by microbubble contrast-enhanced ultrasonography (CEUS) is closely correlated with the severity of intrahepatic changes. We investigated the usefulness of HVAT to predict short-term mortality of AH in cirrhosis. METHODS: Thirty-nine patients with alcoholic cirrhosis (27 males) and AH were prospectively enrolled. HVAT study was performed within 3 days after admission using ultrasonic contrast (SonoVue®). The primary outcome was 12-week mortality. RESULTS: Twelve-week mortality developed in nine patients. HVAT was significantly different between the mortality and survival groups (9.3±2.0 seconds vs 12.6±3.5 seconds, p=0.002). The odds ratio of a shortened HVAT for 12-week mortality was 1.481 (95% confidence interval, 1.050–2.090; p=0.025). The area under the receiver operating characteristic curve of HVAT for 12-week mortality was 0.787 (p=0.010). The combination of MDF and HVAT ≥11.0 seconds resulted in an 87.5% survival rate even if the MDF score ≥32; however, HVAT < 11.0 seconds was related with mortality despite a MDF score < 32. CONCLUSIONS: HVAT using microbubble CEUS could be a useful additional index to predict short-term mortality in patients with AH and cirrhosis.

The Effects of Autophagy Inhibitor on Activation of Alcohol induced Hepatic Stellate Cells / 天津医药

Objective To observe the effect of autophagy inhibitor on the activation of alcohol induced hepatic stel-late cells, and the mechanisms thereof. Methods HSC-T6 cells were cultured in vitro and divided into four groups, includ-ing blank control group, alcohol group, 5 mmol/L 3-MA+alcohol group (low alcohol group) and 10 mmol/L 3-MA+alcohol group (high alcohol group). RT-PCR was used to detect the expression levels ofα-smooth muscle actin (α-SMA) and typeⅠcollagen. The levels of LC3Ⅱ,α-SMA and typeⅠcollagen were detected by Western blot assay. The cell viability of HSC-T6 was detected by MTT assay. Results The mRNA expressions ofα-SMA, typeⅠcollagen and the protein of expressionsα-SMA, typeⅠcollagen and LC3Ⅱwere significantly up-regulated in alcohol group compared with those of control group (P<0.05), while the expressions of those parameters were significantly down-regulated in 10 mmol/L 3-MA+alcohol group (P<0.01). The mRNA and protein levels ofα-SMA and typeⅠcollagen were significantly decreased in two 3-MA-treated groups compared with those in alcohol group (P<0.05). Meanwhile, compared with the 5 mmol/L 3-MA+alcohol group,the protein expressions ofα-SMA, typeⅠcollagen and LC3Ⅱwere significantly decreased in10 mmol/L 3-MA+alcohol group (P < 0.05 ). Compared with the alcohol group,there was significantly lower proliferation activity in all two 3-MA-treated groups (P<0.05). Conclusion 3-MA can inhibit the protein expression of LC3Ⅱ,α-SMA and typeⅠcollagen induced by alcohol in HSC-T6 cells, and inhibit the proliferation of HSC cells.

Serum Th1/Th2 cytokine levels and their clinical significance in patients with alcoholic liver cirrhosis / 临床肝胆病杂志

Objective To investigate the relationship of serum Th1/Th2 cytokine levels with liver function and their clinical significance in patients with alcoholic liver cirrhosis (ALC).Methods Thirty-four ALC patients,13 patients with viral liver cirrhosis (VLC),and 17 healthy controls were included in the study.Serum levels of Th1 cytokines (tumor necrosis factor (TNF)α,interferon (IFN)γ,and inter-leukin (IL)-12)and Th2 cytokines (IL-10,IL-4,IL-6,and IL-13)were measured by cytometric bead array,and their correlations with Child-Pugh classification,model of end-stage liver disease (MELD)score,and biochemical parameters of liver function were ana-lyzed.Comparison between multiple groups was made by Kruskal-Wallis H test,and comparison between two groups was made by Mann-Whitney U test.Correlation analysis was performed by Spearman rank test.Results The Th1 (TNFαand IFNγ)/Th2 (IL-10,IL-4, and IL-13)cytokine levels in ALC group were significantly lower than those in healthy control group (P<0.05),and these indices de-creased nonsignificantly as the Child-Pugh class increased.Compared with VLC patients,ALC patients had significantly increased Th1/Th2 cytokine levels except IL-4 level (P<0.05).In ALC patients,TNFα,IL-10,and IL-13 levels were positively correlated with pro-thrombin time activity (P<0.05)but negatively correlated with total bilirubin and MELD score (P<0.05);especially,the levels of IL-10,IL-13,IL-4,TNFα,and IFNγwere negatively correlated with daily alcohol consumption (P<0.05).Conclusion The expression of Th1/Th2 cytokines is significantly reduced in ALC patients and is correlated with alcohol intake and liver function damage.Monitoring se-rum Th1/Th2 cytokine levels in ALC patients is helpful for clinical treatment and prognostic evaluation.

Spontaneous Arterial Bleeding in Patients with Alcoholic Liver Cirrhosis: a Series of Three Cases / 대한내과학회지

Spontaneous arterial bleeding has been reported rarely. In a patient consuming heavy amounts of alcohol with alcoholic liver cirrhosis, spontaneous bleeding can be evoked by thrombocytopenia, altered platelet function, and shear stress on fully dilated arteries by portal hypertension. Alcohol consumption itself can also predispose a patient to bleeding by influencing the aggregation and activation of platelets, and altering the coagulation and fibrinolysis pathway. All of these mechanisms could cause patients with alcoholic liver cirrhosis to bleed spontaneously; however, conditions inducing peripheral arterial bleeding are very rare. Here, we report three cases of spontaneous arterial bleeding in patients with liver cirrhosis consuming heavy amounts of alcohol. All of the patients bled without any physical trauma, and the involved arteries were the intercostal arteries in two cases and a gastroduodenal artery in the other case. The patients were treated by angiographic embolization. One expired due to recurrence of arterial bleeding despite repeated angiographic embolization and massive transfusion.

Relevant research of occurrence and severity of alcoholic liver diseases / 中国医师杂志

Objective To investigate the disease occurrence-related factors and severity of alcoholic hepatitis (AH) and alcoholic liver cirrhosis (ALC).Methods According to the clinical diagnostic criteria that were passed by the 2010 Chinese Society of Fatty Liver Hepatology and alcoholic liver disease study group,the clinical data of 241 AH and ALC patients were analyzed.Results The amount of liquor taken daily,the time limit of drinking,and total amount of liquor taken in ALC patients were significantly different from those in AH patients (P ＜0.01),respectively.In ALC patients,the proportion (48.39％)of workers,peasants,and unemployed low-income alcoholics was significantly higher than that (25.58％)in AH patients (P ＜0.01).Laboratory tests showed the AST/ALT ratio in the ALC group (2.63 ±4.74)was significantly higher than that in the AH group (1.01 ±0.52) (P ＜0.01); TG [(1.33±1.24)mmol/L] and cholesterol (CHOL) [(3.14 ± 1.25) mmol/L] in ALC group were significantly lower than TG [(2.29 ± 1.60)mmol/L] and CHOL [(4.27 ±0.79)mmol/L] in the AH group (P ＜0.01).Conclusions Alcoholic liver disease occurrence and severity were related to the amount of liquor taken,the time limit of drinking,and the work ; AST/ALT ratio,TG and CHOL values were consistent with the severity of alcoholic liver disease.

Weight loss during cirrhosis is related to the etiology of liver disease / Perda de peso durante a cirrose está relacionada à causa da doença hepática

CONTEXT: Malnutrition is widely described in patients waiting for liver transplantation (LTx). However, risk factors associated with weight loss during liver disease have not yet been well studied. OBJECTIVES: The aim of this study was to assess weight loss and its risk factors during liver disease and up to the first appointment after transplantation. Patients who underwent LTx were retrospectively assessed for weight loss during liver disease while on the waiting list for LTx. The usual weight of the patients before disease and their weight on the first outpatient appointment after transplant were considered. Demographic, socioeconomic, lifestyle and clinical variables were collected to assess risk factors using a linear regression analysis. We retrospectively evaluated 163 patients undergoing LTx between 1997 and 2008. RESULTS: Patients lost in average 7.7 ± 12.4 kg while ill. Variables independently associated with weight loss by multiple linear regression analyses were as follows: former smoker (P = 0.03), greater body mass index (P<0.01), overweight before liver disease (P = 0.02) and indication for LTx (P = 0.01). Among these indications, patients with alcoholic cirrhosis had lost significantly more weight (P<0.01), and those with hepatitis C virus (P = 0.01) and autoimmune hepatitis (P = 0.02) had lost significantly less weight. CONCLUSIONS: Patients experienced weight loss during liver disease independent of age, sex, schooling and income; however, the etiology of liver disease was related to weight loss.

CONTEXTO: A desnutrição é amplamente descrita em pacientes à espera de transplante hepático (LTx). No entanto, fatores de risco associados à perda de peso durante a doença do fígado ainda não foram bem estudados. OBJETIVOS: Avaliar a perda de peso e seus fatores de risco durante a doença do fígado e até a primeira consulta após o transplante. Pacientes submetidos ao LTx foram retrospectivamente avaliados para perda de peso durante a doença do fígado, enquanto na lista de espera para LTx. O peso usual dos pacientes antes da doença e seu primeiro peso ambulatorial após o transplante foram considerados para as análises. Variáveis demográficas, de estilo de vida, socioeconômicas e variáveis clínicas foram coletadas para avaliar fatores de risco, usando análise de regressão linear múltipla. RESULTADOS: Foram avaliados retrospectivamente 163 pacientes submetidos a LTx entre 1997 e 2008. Os pacientes perderam em média 7,7 ± 12,4 kg, quando doentes. Variáveis independentemente associadas à perda de peso foram as seguintes: ex-fumante (P = 0,03), maior índice de massa corporal (P<0,01), excesso de peso antes de doença hepática (P = 0,02), indicação ao transplante (P = 0,01). Das indicações ao transplante, os indivíduos que foram diagnosticados com cirrose etanólica perderam significantemente mais peso (P<0,01) e os diagnosticados com hepatite viral C (P = 0,01) e hepatite autoimune (P = 0,02), significantemente menos. CONCLUSÕES: Os pacientes estudados apresentaram perda de peso durante a doença do fígado independentemente da idade, sexo, escolaridade e renda, no entanto, a causa da doença hepática esteve relacionada à perda de peso.

A case of hypervascular hyperplastic nodules mimicking hepatocellular carcinoma in alcoholic liver cirrhosis / 대한간학회지

Benign hypervascular hyperplastic nodules (HHN) in liver cirrhosis are very rare. It is important to distinguish between regenerative nodules (hyperplastic nodules) and tumorous nodules (dysplastic or neoplastic nodules) in hepatocellular nodular lesions. The differential diagnosis between HHN and hepatocellular carcinoma on the basis of radiologic imaging is often difficult, and is clinically important when determining the therapeutic plan. Therefore, histological confirmation by needle biopsy sampling of the liver is necessary for a correct diagnosis of HHN. We report herein a case of benign HHN mimicking hepatocellular carcinoma in a 32-year-old male alcoholic liver cirrhosis patient without viral hepatitis infection.

Recidiva da ingesta alcoólica em pacientes candidatos a transplante hepático: análise de fatores de risco / Relapse of alcohol consumption in liver transplant candidates: risk factor analysis

RACIONAL: A recidiva do consumo do álcool após transplante representa grande preocupação nos centros transplantadores e é objeto de debate e controvérsia. OBJETIVO: Avaliar a recidiva da ingesta alcoólica e eventuais fatores a ela relacionados, em pacientes cirróticos, referidos para transplante hepático. MÉTODOS: Estudo retrospectivo de julho de 1995 a setembro de 2005 incluindo 90 pacientes adultos com cirrose hepática, listados para transplante. Os critérios de exclusão eram: ausência de 6 meses de abstinência, não liberação da equipe de psicologia. O diagnóstico da recidiva (ingesta de qualquer quantidade de bebida alcoólica) era feito com base nas informações contidas nos prontuários e fornecidas por contato telefônico. RESULTADOS: A recidiva encontrada foi de 18,9 por cento, que correspondeu a 14,6 por cento do número total de homens e 62,5 por cento do número total das mulheres. A raça, média das idades, classificação de disfunção hepática, tempo de etilismo, quantidade da ingesta alcoólica e realização ou não de transplante, não mostraram correlação significativa com a recidiva da ingesta alcoólica. A comparação tempo de abstinência e recidiva guardou relação inversamente proporcional. CONCLUSÃO: A recidiva da ingesta alcoólica é baixa. Sexo feminino e tempo de abstinência inferior a 1 ano têm influência sobre a recidiva da ingesta alcoólica.

BACKGROUND: Alcohol relapse after transplantation is a serious concern in transplant centers and is a subject of controversy and debate. AIM: To evaluate the relapse of alcohol ingestion and the eventual associated factors in cirrhotic patients referred for liver transplantation. METHODS: A retrospective study comprised of 90 adult patients with liver cirrhosis, listed for transplant. The exclusion criteria were: not having at least 6 months of abstinence and release not approved by the psychology team. The diagnosis of relapse (ingestion of any quantity of alcohol) was done based on the information in the patients’ histories and those provided by telephone contact. RESULTS: The rate of relapse was of 18.9 percent. This corresponded to 14.6 percent of the total number of men and 62.5 percent of the total number of women. Race, mean age, classification of hepatic dysfunction, time of alcoholism, quantity of alcohol ingested and the execution of transplant did not show significant correlation to alcohol relapse. The comparison between time of abstinence and relapse had an inversely proportional correlation. CONCLUSION: Relapse of alcohol consumption was low. Being of the female gender and having less than 1 year of abstinence has an influence upon alcohol relapse.

The Prognosis of Liver Cirrhosis in Recent Years in Korea

The survival of a recent series of 823 cirrhosis patients who were followed up for a mean of 48 months was analyzed. Cirrhosis was ascribed to alcohol (26%), hepatitis virus B (58%), hepatitis virus C (11%) or both (2%), or was cryptogenic (3%). Features of decompensation were observed in 51% of the patients at entry, and newly developed in 44% of compensated patients within 5 yr. The 5-yr survival after decompensation was 25%. The leading causes of death were liver failure (53%), hepatocellular carcinoma (HCC, 23%), and variceal bleeding (10%). Early detection of HCC significantly improved the survival of cirrhosis patients. Biannual ultrasonography increased the detection rate of small HCC. Mortality of variceal hemorrhage was much lower in patients with Child-Pugh scores from 5 to 8 than in those with scores above 8 (5% vs. 52%). Endoscopic prophylaxis significantly decreased the incidence of first variceal hemorrhage, but the effect was insufficient to improve the rate of survival. Mortality of first spontaneous bacterial peritonitis was 18%. These data suggest that the mortality of major complications of liver cirrhosis has considerably decreased during the last two decades, while there was no remarkable improvement in long-term survival. More efficient management of etiologic factors would be required.

Effects of FFBJRGP on collagen deposition in hepatic Disse space in alcohol induced liver fibrosis in rat / 解放军医学杂志

Objective To study the effect of Fufangbiejiaruanganpian (FFBJRGP) on deposition of collagens around hepatic Disse space in experimental alcohol liver fibrosis (ALF). Methods The ALF rat model was induced by feeding a mixture of alcoholic liquid which included alcohol, vegetable oil and pyrazole, combined with a high fatty food. Then, all of the ALF rats were treated with FFBJRGP in high, moderate, and low dose. At the time of termination of the treatment, HYP level in liver tissue, collagen Ⅳ and LN levels in the serum and pathological changes were studied by Mallory stain and sirius red stain. Results The levels of HYP in hepatic tissues, collagen Ⅳ and LN in sera are increased remarkably in ALF rats, while all these indexes were reduced after moderate or low-dose FFBJRGP treatment (P

Association Between Polymorphisms of Ethanol-Metabolizing Enzymes and Susceptibility to Alcoholic Cirrhosis in a Korean Male Population

Alcohol is oxidized to acetaldehyde by alcohol dehydrogenase (ADH) and cytochrome P-4502E1 (CYP2E1), and then to acetate by aldehyde dehydrogenase (ALDH). Polymorphisms of these ethanol-metabolizing enzymes may be associated with inter-individual difference in alcohol metabolism and susceptibility to alcoholic liver disease. We determined genotype and allele frequencies of ALDH2, CYP2E1, ADH2, and ADH3 in male Korean patients with alcoholic cirrhosis (n=56), alcoholics without evidence of liver disease (n=52), and nondrinkers (n=64) by using PCR or PCR-directed mutagenesis followed by restriction enzyme digestion. The prevalences of heterozygous ALDH2*1/*2 plus homozygous ALDH2*2/*2 in patients with alcoholic cirrhosis (7.1%) and alcoholics without evidence of liver disease (3.8%) were significantly lower than that in nondrinkers (45.3%). The c2 allele frequencies of the CYP2E1 in alcoholic cirrhosis, alcoholics without evidence of liver disease, and nondrinkers were 0.21, 0.20, and 0.20, respectively. Allele frequencies of ADH2*2 in the three groups were 0.78, 0.74, and 0.77 and those of ADH3*1 were 0.94, 0.98, and 0.95. Therefore, we confirmed the observation that the ALDH2*2 gene protects against the development of alcoholism. However, the development of cirrhosis in Korean alcoholic patients was not associated with polymorphisms of ethanol-metabolizing enzymes.

THE PATHOLOGICAL MECHANISM OF MATRIX DEGRADATION IN ALCOHOLIC HEPATIC FIBROSIS / 解放军医学杂志

To study the mechanism of matrix degradation in alcoholic liver disease (ALD), the liver tissues from 28 patients with ALD were divided into three groups according to their fibrosis degree. The mRNA expression of matrix metalloproteinase 1 (MMP 1), matrix metalloproteinase 2 (MMP 2), membrane type metalloproteinase (MT1 MMP), and tissue inhibitors of metalloproteinase (TIMP) was detected using in situ hybridization method. The results showed that the cells with positive MMP 1, MMP 2, MT1 MMP, and TIMP mRNA staining were mainly located around the fibrotic central veins, walls of sinusoids, and portal triads. These positive cells were the cells of hepatic sinusoidal walls and a few hepatocytes, meanwhile, some cells expressed both the MMP 2 and the MT 1MMP mRNA. The positive cells of the MMP 2, MT1 MMP, and TIMP mRNA increased in parallel with the severity of fibrosis, whereas the expression of MMP 1 mRNA decreased. These changes were observed predominantly in moderate fibrosis group. There findings demonstrated that down regulation of MMP 1 expression and up regulation of TIMP expression might be involved in excessive accumulation of extracellular matrix (ECM) in ALD. MMP 2 might collaborate with MT1 MMP in degradation of ECM. thereby contributing to fibrosis of central veins.Hepatic stellate cells might be the main cellular source of MMP 1, MMP 2, MT1 MMP and TIMP in ALD.