Clinicopathologic characteristics of liver inflammation and fibrosis in 310 patients with chronic hepatitis B / 中南大学学报(医学版)

OBJECTIVES@#Long-term hepatitis B virus (HBV) infection can cause recurrent inflammation in the liver, and then develop into liver fibrosis, cirrhosis, and liver cancer. The hepatic pathological change is one of the important criteria for guiding antiviral therapy in patients with chronic hepatitis B (CHB). Due to the limitations of liver biopsy, it is necessary to find valuable non-invasive indicators to evaluate the hepatic pathological changes in CHB patients and guide the antiviral therapy. This study aims to analyze the clinical characteristics of different pathological changes in CHB patients, and to explore the factors influnencing the degree of liver inflammation and fibrosis in CHB patients with normal alanine aminotransferase (ALT).@*METHODS@#This retrospective study was conducted on 310 CHB patients. Liver biopsy was performed in all these patients. The clinical data of the patients were collected. The liver biopsy pathological results were used as the gold standard to analyze the relationship between clinical indicators and liver pathological changes. Then CHB patients with normal ALT were screened, and the independent factors influencing the degree of liver inflammation and fibrosis were explored.@*RESULTS@#Among the 310 patients with CHB, there were 249 (80.3%) patients with significant liver inflammation [liver inflammation grade (G) ≥2] and 119 (38.4%) patients with significant liver fibrosis [liver fibrosis stage (S) ≥2]. The results of univariate analysis of total samples showed that the ALT, γ-glutamyl transferase, alkaline phosphatase, and HBV DNA were related to the significant liver pathological changes. Among the 132 CHB patients with normal ALT, the patients with liver pathology G/S≥2, G≥2, and S≥2 were 80.3% (106/132), 68.2% (90/132), and 43.2% (57/132), respectively. The results showed that the independent influencing factor of significant liver inflammation was HBV DNA>2 000 U/mL (OR=3.592, 95% CI 1.534 to 8.409), and the independent influencing factors of significant liver fibrosis were elevated alkaline phosphatase level (OR=1.022, 95% CI 1.002 to 1.043), decreased platelet count (OR=0.990, 95% CI 0.982 to 0.998), and positive in hepatitis B e antigen (HBeAg) (OR=14.845, 95% CI 4.898 to 44.995). According to the multivariate analysis, a diagnostic model for significant liver fibrosis in CHB patients with normal ALT was established, and the area under the receiver operating characteristic curve was 0.844 (95% CI 0.779 to 0.910).@*CONCLUSIONS@#The liver pathological changes should be evaluated in combination with different clinical indicators. A considerable number of CHB patients with normal ALT still have significant liver pathological changes, which need to be identified and treated with antiviral therapy in time. Among them, HBV DNA>2 000 U/mL suggests the significant liver inflammation, and the diagnostic model for significant liver fibrosis based on alkaline phosphatase, platelet count, and HBeAg can help to evaluate the degree of liver fibrosis.

Hepatitis D: advances and challenges / 中华医学杂志(英文版)

Hepatitis D virus (HDV) infection causes the most severe form of viral hepatitis with rapid progression to cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Although discovered > 40 years ago, little attention has been paid to this pathogen from both scientific and public communities. However, effectively combating hepatitis D requires advanced scientific knowledge and joint efforts from multi-stakeholders. In this review, we emphasized the recent advances in HDV virology, epidemiology, clinical feature, treatment, and prevention. We not only highlighted the remaining challenges but also the opportunities that can move the field forward.

Estudio descriptivo de pacientes con cirrosis hepática de etiología viral, en la provincia de Matanzas / Descriptive study of patients with viral-etiology liver cirrhosis in the province of Matanzas

RESUMEN Introducción: la cirrosis hepática de etiología viral representa un impactante problema de salud a nivel mundial, no solo por su elevada tasa de prevalencia, sino por los costos generados en la atención médica. Objetivos: determinar el comportamiento de los pacientes cirróticos, de etiología viral, en la provincia de Matanzas. Materiales y métodos: se realizó un estudio descriptivo-retrospectivo en 47 pacientes con cirrosis hepática de etiología viral, atendidos en el Servicio de Gastroenterología del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, de enero de 2016 a enero de 2018. Los resultados de las variables analizadas se expusieron en tablas de doble entrada. Resultados: el 68,1 % de los pacientes correspondió a cirrosis por virus C. Predominaron los mayores de 50 años, con carga viral entre 4-6,9 log10, y atendidos en régimen ambulatorio. En el 57,4 % se detectaron signos endoscópicos de hipertensión portal, que se corroboraron en el doppler hepático. La ascitis asociada a diferentes sepsis fueron las complicaciones más registradas. El 55,4 % fue clasificado como Child-Pugh A, y el 76,6 % en etapa clínica compensada. Conclusiones: el diagnóstico y seguimiento de la cirrosis hepática viral sigue siendo un verdadero reto para la comunidad médica. De ahí los esfuerzos que han de realizarse para su control desde las fases compensadas, para retardar la aparición de complicaciones (AU).

ABSTRACT Introduction: viral etiology liver cirrhosis is an impacting health problem around the world, not only because of its high prevalence rate but also because of the costs generated by its medical care. Objective: to determine the behavior of the patients with viral etiology liver cirrhosis in the province of Matanzas. Materials and methods: a descriptive-retrospective study was carried out in 47 patients with viral etiology liver cirrhosis treated in the service of Gastroenterology of the Hospital "Comandante Faustino Perez" of Matanzas, from January 2016 to January 2018. The results of the analyzed variables were shown in double-entry tables. Results: 68.1% of the patients presented cirrhosis caused by C virus, Patients elder 50 years old predominated, with 4-6.9 log10, treated in ambulatory regimen. Endoscopic signs of portal hypertension were found in 57.4%. It was corroborated with liver Doppler. Ascites associated to different sepsis were the most frequently registered complications. 55.4% were classified as Child-Pugh A, and 76.6% were in compensated clinical stage. Conclusions: viral liver cirrhosis diagnosis and follow-up is still a true challenge for the medical community, and hence the efforts that should be made to control it from the compensated stages to delay the appearance of complications (AU).

Strongyloides stercoralis como causa infrecuente de infección de líquido ascítico en cirrosis / Strongyloides stercoralis as uncommon cause of ascitic fluid infection in cirrhosis

Resumen Se comunica el caso clínico de un varón, con antecedentes de una cirrosis hepática alcohólica y gota, usuario crónico de antiinflamatorios, incluyendo corticoesteroides. Consultó por una melena secundaria a una úlcera bulbar. Durante su internación presentó fiebre, tratándose con ceftriaxona por un probable foco urinario. Por persistir febril, se realizó una paracentesis diagnóstica. En la muestra de líquido ascítico se observaron larvas de Strongyloides stercoralis. Recibió tratamiento antiparasitario con ivermectina, con buena respuesta clínica. Aunque la infección por S. stercoralis es relativamente frecuente en pacientes con cirrosis hepática alcohólica, la ascitis infectada por Strongyloides corresponde a una forma de presentación infrecuente. Este caso muestra la importancia de la paracentesis diagnóstica en todo paciente con ascitis secundaria a una cirrosis. Es importante considerar la presentación atípica de la infestación por Strongyloides en el contexto del paciente inmunocomprometido, ya que sin tratamiento puede tener una alta mortalidad.

Abstract Male patient, with a history of alcoholic cirrhosis frequent user of anti-inflammatory drugs including corticosteroids. He consulted for digestive bleeding secondary to a bulbar ulcer. During the admission, he had fever and antibiotic treatment with ceftriaxone is started, for a urinary infection. Fever persisted for 48 hours, so a diagnostic paracentesis was made: Strongyloides stercoralis larvae were seen in the direct microscopic exam. The patient started antiparasitic treatment with ivermectin. He was discharged and did not returned for follow up. Although infection with S. stercoralis is relatively common in patients with alcoholic liver cirrhosis, ascites infected with Strongyloides corresponds to an infrequent form of presentation. This case shows the importance of diagnostic paracentesis in every cirrhotic patient. It is important to consider atypical presentation of Strongyloides infection in the immunocompromised host, considering it could be fatal without treatment.

Acercamiento al tratamiento del paciente cirrótico / An approach to the treatment of the cirrhotic patient

RESUMEN La cirrosis es un estado reversible de fibrosis hepática, que se ha convertido en la 8a causa de muerte en los Estados Unidos y la 9 a causa de muerte en Cuba. Este artículo repasa el tratamiento práctico de la cirrosis basado en la revisión de ensayos clínicos obtenidos de buscadores como MEDLINE, HINARI y Scielo, durante los últimos años. Las principales causas de cirrosis hepática incluyen las hepatitis crónicas por virus B, C, alcoholismo, y la esteatohepatitis no alcohólica. La desnutrición ocurre en 20 a 60 % de los pacientes con cirrosis, por lo cual las dietas hipo proteicas están bajo revisión, se recomienda el control estricto de la sal, el uso de medicamentos debe ser valorado estrictamente, y hacer un uso juicioso de los hipotensores cuando la tensión arterial media sea inferior a 82 mm de Hg, los beta bloqueadores no selectivos tienen su indicación en varices esofágicas desarrolladas, por otro lado se recomienda la cautela en analgésicos y los inhibidores de la bomba de protones, no restringiéndose el uso de estatinas. Con respecto a los procederes invasivos, el uso de métodos quirúrgicos deben ser evaluados en situaciones extremas, donde el índice MELD puede ayudar en cuanto al pronóstico y mortalidad esperada. La paracentesis en las ascitis refractaria debe ser masiva apoyada con el uso de albúmina, y se debe realizar lo más rápido posible en la sospecha de peritonitis bacteriana espontanea. Por lo que se puede concluir que el uso adecuado de la nutrición, el control de las complicaciones y los factores de riesgo puede llevar a la reversibilidad de la cirrosis hepática (AU).

SUMMARY Cirrhosis is a reversible status of the liver fibrosis, being the 8th cause of death in the United States and the 9th cause of death in Cuba. This article reviews the practical treatment of cirrhosis based on the review of clinical research published in MEDLINE, HINARI and Scielo, during the last years. The main causes of hepatic cirrhosis include the chronic hepatitis caused by B and C viruses, alcoholism, and the non-alcoholic steato-hepatitis. Malnutrition occurs in 20-60 % of the patients with cirrhosis, therefore low protein diets are under revision; it is recommended a strict use of salt; the use of drugs should be strictly evaluated. Hypotensive drugs should be cautiously used when the average arterial tension is lower than 82 Hg mm. Non-selective beta-blockers are indicated in developed esophageal varices. It is also recommended to be cautious with analgesics and proton pump inhibitors while the statins use is not restricted. Regarding the invasive procedures, surgery should be evaluated very carefully, and the MELD index can help with respect to prognosis and expected mortality. In refractory ascites, paracentesis should be massive relayed on albumin use, and should be carried out as soon as possible in the suspicion of spontaneous bacterial peritonitis. In conclusion, the adequate nutrition use, the control of complications and risk factors, could lead to reversibility of hepatic cirrhosis (AU).

Síndrome de Alagille / Alagille syndrome

Resumen Introducción: El síndrome de Alagille es una enfermedad con múltiples afectaciones, es autosómica dominante, con expresividad variable. Se identifica por manifestaciones hepáticas, vertebrales, cardiacas, oculares y dismorfia facial. Objetivo: Reportar un caso de S. de Alagille con afectación hepática, que debuta con hemorragia de vías digestivas altas. Materiales y métodos: Reporte de caso clínico confrontando con artículos de revisiones de temas en búsqueda electrónica en bases de datos de RIMA, MEDLINE, PUBMED, MEDSCAPE, de 1993-2018. Resultado: Paciente de 2 años, con diagnóstico tardío de enfermedad hepática, con progresión a cirrosis y hallazgos al examen físico que confirman Síndrome de Alagille. Se confirma el diagnóstico molecular coincidiendo con el principal hallazgo genético con anomalías asociadas al gen Jagged 1 (JAG1) localizado en el cromosoma 20 y el NOTCH2 del cromosoma 1. Conclusiones: Es de gran importancia resaltar esta patología infrecuente la cual representa un reto diagnóstico, debe tenerse en cuenta la múltiple afectación orgánica por lo cual es fundamental un manejo interdisciplinario

Abstract Introduction: Alagille syndrome is a disease with multiple impairments, is autosomal dominant with variable expressivity. It is identified by manifestations of vertebral, liver, heart, eye and facial dysmorphia. Objective: Report a case of Alagille S. with hepatic involvement, debuting with hemorrhage of upper digestive tract. Materials and methods: Clinical case report confronting articles reviewing subjects in electronic search in RIMA databases, MEDLINE, PUBMED, MEDSCAPE, from 1993-2018. Result: 2 year old patient, with late diagnosis of liver disease, with progression to cirrhosis and physical exam findings that confirm Alagille Syndrome. Confirmed the diagnostic molecular coinciding with the main genetic finding which are anomalies associated with the gene Jagged 1 (JAG1) located on chromosome 20 and the NOTCH2 of chromosome 1. Conclusions: It is important to highlight this uncommon disease which poses a diagnostic challenge, multiple organic involvement must be taken into account by which an interdisciplinary management is essential.

El trasplante de hígado es un procedimiento plausible, efectivo y seguro en pacientes con hemofilia: caso clínico / Liver transplantation in hemophilia A: report of one case

Due to blood derivative requirements, many patients with hemophilia were exposed to Hepatitis C virus infection (HCV) before the availability of HCV testing. We report a 46-year-old male with Hemophilia A with a hepatitis virus C infection since 2004 causing a cirrhosis. Due to a hepatopulmonary syndrome, he received a liver allograph using a factor VIII replacement protocol, after eradicating the virus C. He had a good postoperative evolution, and no more factor VIII was required after transplantation until his last assessment.

Experiencia peruana en el tratamiento de hepatitis crónica C con las nuevas drogas antivirales de acción directa / Peruvian experience in the treatment of chronic hepatites C with the new direct acting antiviral drugs

Objetivos: La terapia ideal para la hepatitis crónica C consiste en el uso de drogas antivirales de acción directa (DAA). En el Perú la experiencia en vida real con DAA no se conoce, por lo que el objetivo del presente estudio es reportar la alta eficacia terapéutica con estos esquemas. Material y métodos: Mediante correo electrónico se invitó a participar a través de una encuesta a médicos hepatólogos a nivel nacional. Se incluyeron los datos de 4 médicos. Los resultados fueron analizados con estadística descriptiva. Resultados: Se incluyeron 63 pacientes, la edad promedio fue 59 años, varones fueron 49,21%, cirrosis estuvo presente en el 49,21% (31/63), 34,92% había sido no respondedor a terapia con PEGIFN/RBV. El Genotipo 1 estuvo presente en 93,65% de casos, siendo el 1a el predominante (58,73%). Solo hubo dos casos de genotipo 2 y uno de genotipo 3. Se utilizaron 10 esquemas de combinación con DAA, siendo los más eficaces, Sofosbuvir/Ledipasvir, Sofosbuvir/Ledipasvir/ Ribavirina y Sofosbuvir/Simeprevir, en todos ellos se logró Respuesta Viral Sostenida (RVS) de 100%. Con los otros 7 esquemas la RVS fue menor a 90% o solo se había incluido uno o dos pacientes. La tolerancia a la terapia fue adecuada y todos los pacientes culminaron la terapia. Conclusiones: En vida real los esquemas de terapia antiviral para hepatitis C con DAA tienen alta eficacia y seguridad. Las mejores respuestas se obtuvieron con Sofosbuvir/Ledipasvir, Sofosbuvir/Ledipasvir/Ribavirina y Sofosbuvir/Simeprevir. Esta data puede ser útil para considerar estrategias de tratamiento con el enfoque de salud pública.

Objective: The ideal therapy for chronic hepatitis C is the use of direct acting antivirals (DAA). In Peru there is no data in this aspect, in that sense it is necessary to report real life experience with these drugs. Material and methods: A digital survey was sent through e-mail to hepatologists, and the data of four is considered in this study. Statistical analysis was descriptive. Results: We included 63 patients, mean age was 59 years, 49.21% were male, cirrhosis was present in 49.21%, and 34.92% was non-responder to PEGIFN and Ribavirin. Genotype 1 was present in 93.65%, and subtype 1a was 58.73%, there were only 2 cases with Gt 2 and one with Gt 3. There were 10 different DAA combinations used, and the most effective were Sofosbuvir/ Ledipasvir, Sofosbuvir/Ledipasvir/Ribavirina and Sofosbuvir/Simeprevir, in all these cases the Sustained Viral Response (SVR) was 100%. The other combinations had SVR < 90% or only 1-2 patients included. All patients tolerated treatments and no serious adverse events occurred. Conclusions: In real life antiviral treatment for hepatitis C with AAD is effective and well tolerated. The best SVR was obtained with Sofosbuvir/Ledipasvir, Sofosbuvir/Ledipasvir/Ribavirina and Sofosbuvir/Simeprevir. This report may be useful to consider treatment strategies with focus in public health.

Predictores de infección y mortalidad en pacientes con cirrosis hepática en el hospital de alta complejidad Virgen de la Puerta de Trujillo, Perú / Predictors of infection and mortality in patients with liver cirrhosis in the high complexity hospital Virgen de la Puerta from Trujillo, Peru

Introducción: La cirrosis hepática descompensada por infecciones bacterianas es uno de los principales diagnósticos de admisión a hospitalización, teniendo en cuenta que el riesgo per se en ello es más alto que en pacientes no cirróticos, conllevando a cifras altas de mortalidad. Objetivo: El presente estudio buscó determinar los predictores de infección y mortalidad en pacientes con cirrosis hepática, así como las características epidemiológicas-clínicas de los pacientes con cirrosis. Materiales y métodos: De manera prospectiva se recolectaron los datos de los pacientes cirróticos hospitalizados en el servicio de Gastroenterología y Medicina interna del hospital de alta complejidad Virgen de la Puerta desde el 2015 a Junio del 2018. Resultados: El estudio incluyó 66 pacientes. La frecuencia de infección fue de 37,88%, siendo más frecuente la peritonitis bacteriana espontánea (21,2%) y la mortalidad total fue de 12,12%. Al realizar regresión logística binaria y curva ROC se obtuvieron como predictores de mortalidad, el valor de MELD >13,5 (p=0,003), TP >18,26 (p=0,003) y el estadio Child Pugh C (p=0,02, IC 95% EXP(B) 0,13-0,365). Las variables que predicen ausencia de mortalidad fueron un valor de plaquetas ≥ 74 500 /mm3 (p=0,01) y Sodio ≥133 mEq/l (p=0,019). Los predictores de infección, valor de MELD ≤14,5 (p=0,0004) y el nivel de sodio ≥134,5 mEq/l (AUC 0,696, p=0,028), para predecir ausencia de infección. Conclusiones: El MELD alto es un factor predictor tanto de mortalidad como de infección. El Child Pugh C y los valores de tiempo de Protrombina altos son predictores de mortalidad. El nivel de sodio normal es un predictor de ausencia de mortalidad e infección, así como el valor de plaquetas discretamente disminuido es predictor de ausencia de mortalidad.

Introduction: Liver cirrhosis decompensated due to bacterial infections is one of the main diagnoses of admission to hospitalization, taking into account that the risk per se in it is higher than in non-cirrhotic patients, leading to high mortality rates. Objective: The present study sought to determine the predictors of infection and mortality in patients with liver cirrhosis, as well as the epidemiological-clinical characteristics of patients with cirrhosis. Material and methods: Prospective data were collected from hospitalized cirrhotic patients in the Gastroenterology and Internal Medicine Service of the Hospital High Complexity "Virgen de la Puerta", from 2015 to June 2018. Results: The study included 66 patients. The infection frequency was of 37.88%, being more frequent the spontaneous bacterial peritonitis (21.2%) and the total mortality was of 12.12%. When performing binary logistic regression and ROC curve, the MELD value> 13.5 (p=0.003), TP >18.26 (p=0.003) and the Child Pugh C stage were obtained as predictors of mortality (p=0.02, IC 95% EXP(B) 0.13-0.365). The variables that predict absence of mortality were a platelet value ≥74 500 /mm3 (p=0.01) and sodium ≥133 (p=0.019). The predictors of infection, MELD value ≤14.5 (p=0.0004) and sodium level ≥134.5 (AUC 0.696, p=0.028), to predict absence of infection. Conclusions: High MELD is a predictor of both mortality and infection. Child Pugh C and high values of Prothrombin time are predictors of mortality. The normal sodium level is a predictor of absence of mortality and infection, as well as platelet values discreetly low are predictors of absence of mortality.

Impacto da lista de espera para AADs em pacientes cirróticos por VHC / Waiting daas list mortality impact in hcv cirrhotic patients

ABSTRACT BACKGROUND: The infection for the hepatitis C virus (HCV) is a leading cause of liver-related morbidity and mortality through its evolution to liver cirrhosis, end-stage liver complications and hepatocellular carcinoma. Currently, the new drugs for the HCV infection, based on direct antiviral agents, have changed the outcomes in this setting. OBJECTIVE: To assess death incidence, during the wait for the treatment with the new drugs, and to analyze which independent variable (age, sex, ascite, HDA, albumin, α-fetoprotein, platelets and Meld score) had relation with death. METHODS: Prospective study with cirrhotic patients by HCV. Inclusion: cirrhotic patients by hepatic biopsy (METAVIR), clinic or image, detectable RNA (HCV). Exclusion: Other stages of hepatic fibrosis and hepatocellular carcinoma. Descriptive statistic in continue variables. Fisher Exact and Kaplan Meier and Cox Regression Analysis to assess the association of variables studied with death. P<0.05. RESULTS: A total of 129 patients were included. Of this, 73% were men. Mean age was 57.8±12.1, albumin of 3.5±0.6 mg/dL, platelets of 123.4±59.6 and Meld score of 10.59±3.56. The time of observation was 11.2±3.26 months, and the number of death 9/129 (6,9%). The Kaplan-Meier showed association between death with albumin lower than 2.9 (0.0006), MELD score higher than 15 (0.007) and α-fetoprotein higher than 40 ng/mL (<0.0001). Adjusted Cox Regression Analysis showed that α-fetoprotein higher than 40 ng/ml could be considered an independent risk for death. CONCLUSION: We conclude that, patients with advanced cirrhosis should be prioritized for treatment with direct antiviral agents.

RESUMO CONTEXTO: A infecção pelo vírus da hepatite C (VHC) é uma das principais causas de morbidade e mortalidade relacionada ao fígado, através de sua evolução para cirrose hepática, complicações hepáticas em estágio terminal e carcinoma hepatocelular. Atualmente, os novos fármacos para a infecção pelo VHC, baseados nos novos antivirais de ação direta (AADs), modificaram os resultados nesse cenário. OBJETIVO: Avaliar a incidência de morte, durante a espera pelo tratamento com as novas drogas, e analisar quais variáveis independentes (idade, sexo, ascite, HDA, albumina, α-fetoproteína, plaquetas e escore de MELD) tiveram relação com o óbito. MÉTODOS: Estudo prospectivo com pacientes cirróticos pelo VHC. Inclusão: pacientes cirróticos por biópsia hepática (METAVIR), clínica ou imagem, RNA detectável (VHC). Exclusão: Outras fases de fibrose hepática e carcinoma hepatocelular. Estatística descritiva em variáveis contínuas. Exato de Fisher e Kaplan Meier e Análise de Regressão de Cox para avaliar a associação das variáveis estudadas com o óbito. P<0,05. RESULTADOS: Um total de 129 pacientes foram incluídos. Destes, 73% eram homens. A idade média foi de 57,8±12,1, a albumina de 3,5±0,6 mg/dL, as plaquetas de 123,4±59,6 e o escore de MELD de 10,59±3,56. O tempo de observação foi de 11,2±3,26 meses e o número de mortes 9/129 (6,9%). O Kaplan-Meier mostrou associação entre o óbito com albumina menor que 2,9 (0,0006), escore MELD maior que 15 (0,007) e α-fetoproteína maior que 40 ng/mL (<0,0001). A análise de regressão de Cox ajustada mostrou que α-fetoproteína maior que 40 ng/mL poderia ser considerada um risco independente para morte. CONCLUSÃO: Concluímos que pacientes com cirrose avançada devem ser priorizados para tratamento com AADs.

Polimorfismos en los genes de la enzima alcohol deshidrogenasa (ADH1) y la citocromo P450 2E1 (CYP2E1) en pacientes con cirrosis y carcinoma hepatocelular / Polymorphisms in alcohol dehydrogenase (ADH1) and cytochrome p450 2E1 (CYP2E1) genes in patients with cirrhosis and/or hepatocellular carcinoma

Introducción. Uno de los principales factores de riesgo del carcinoma hepatocelular es el consumo crónico de alcohol. En estudios en diferentes poblaciones, se sugiere que las variantes genéticas de las enzimas que participan en el metabolismo del alcohol, como la alcohol deshidrogenasa (ADH) y la citocromo P450 (CYP2E1), estarían asociadas con riesgo de enfermedades hepáticas terminales. Objetivo. Identificar y caracterizar las variantes alélicas de los genes ADH1B, ADH1C y CYP2E1 en pacientes colombianos con diagnóstico de cirrosis y carcinoma hepatocelular. Materiales y métodos. Se incluyeron muestras de pacientes atendidos entre el 2005 y el 2007, y entre el 2014 y el 2016, en la unidad de hepatología de un hospital de Medellín. La genotipificación de las muestras se hizo mediante reacción en cadena de la polimerasa (Polymerase Chain Reaction, PCR) con análisis de los polimorfismos en la longitud de los fragmentos de restricción (Restriction Fragment Length Polymorphism, RFLP). Los resultados se compararon con los de dos grupos de control y con lo reportado en la base de datos del 1000 Genomes Project. Resultados. Se recolectaron 97 muestras de pacientes con diagnóstico de cirrosis y carcinoma hepatocelular. Los dos factores de riesgo más frecuentes fueron el consumo crónico de alcohol (18,6 %) y las colangiopatías (17,5 %). Los genotipos más frecuentes en la población de estudio fueron el ADH1B*1/1 (82 %), el ADH1C*1/1 (59 %) y el CYP2E1*C/C (84 %). Conclusiones. En este primer estudio de los polimorfismos en pacientes colombianos con diagnóstico de cirrosis y carcinoma hepatocelular, los genotipos más frecuentes fueron el ADH1B*1/1, el ADH1C*1/1 y el CYP2E1*C/C. No se observaron diferencias estadísticamente significativas en la frecuencia de los genotipos entre los casos y los controles. Se requieren estudios adicionales en población colombiana para evaluar el riesgo de la enfermedad hepática terminal por consumo crónico de alcohol y la asociación con los polimorfismos.

Introduction: One of the most important risk factors for hepatocellular carcinoma (HCC) is alcohol consumption: Studies in different populations suggest that the risk of liver disease could be associated with genetic variants of the enzymes involved in alcohol metabolism, such as alcohol dehydrogenase (ADH) and cytochrome P450 CYP2E1. Objective: To identify and characterize the allelic variants of ADH1B, ADH1C and CYP2E1 genes in Colombian patients with cirrhosis and/or HCC. Materials and methods: We included samples from patients attending the hepatology unit between 2005-2007 and 2014-2016 of a hospital in Medellin. Samples were genotyped using PCR-RFLP. We compared the results with two control groups and the 1000 Genomes Project database. Results: We collected 97 samples from patients with a diagnosis of cirrhosis and/or HCC. The two main risk factors were chronic alcohol consumption (18.6%) and cholangiopathies (17.5%). The most frequent genotypes in the study population were ADH1B*1/1 (82%), ADH1C*1/1 (59%), and CYP2E1*C/C (84%). Conclusions: This first study of polymorphisms in Colombian patients diagnosed with cirrhosis and/or HCC showed genotypes ADH1B*1/1, ADH1C*1/1 and CYP2E1*C/C as the most frequent. We found no significant differences in the genotype frequency between cases and controls. Further studies are necessary to explore the association between polymorphisms and the risk of end-stage liver disease from alcohol consumption.

Bioimpedância: nova abordagem para detecção não invasiva da fibrose hepática - estudo piloto / Bioimpedance: new approach to non-invasive detection of liver fibrosis - a pilot study

ABSTRACT BACKGROUND: Fibrosis are common structural hepatic change in patients with chronic hepatitis. Liver biopsy is the gold standard for determining the extent of liver fibrosis. Considering the technical difficulties and cost, improvements in non-invasive screening tools are greatly needed. Bioimpedance have been shown to be safe to evaluate tissue fibrosis. OBJECTIVE: To assess the utility of using monofrequential bipolar bioimpedance for the detection of severity of liver fibrosis consistent with chronic viral hepatitis C infections. METHODS: One hundred and ten patients were studied prospectively and formed two groups according to the lab tests results for the detection of HCV, ALT and AST: Group 1 Control (n=50 healthy patients with HCV negative and with ALT and AST values within the normal clinical range) and Group 2 Positive (n=60 patients positive for anti-HCV positive) which were biopsied. All patients underwent an examination with an Electro Sensor Complex, bioimpedance technology. To compare the groups 1 and 2, the ROC curves was used to determine the specificity and sensitivity of the bioimpedance to detect liver fibrosis. To identify liver fibrosis severity the Group 2 Positive was subdivided according to the liver biopsy results (Metavir fibrosis score) into: Sub Group 2A (F0-F1 n=25) - patients without or with minimal portal fibrosis and Sub Group 2B (F3-F4 n=20) patients with numerous septa/cirrhosis. A statistical analysis was conducted to analyze the bioimpedance data differences in delta of the conductance. RESULTS: From the comparison between Groups 1 and 2: 1) The delta value for conductance in the pathway representing the right foot-left hand minus left hand-right foot demonstrated a sensitivity of 85% and a specificity of 78% with a cutoff value ≤5 and P=0.0001. 2) For the comparison between Sub Group 2A (Metavir F0+F1) and Sub Group 2B (Metavir F3+F4), the neural network for the Electro Sensor Complex data demonstrated a sensitivity of 85% and a specificity of 72% with a cutoff probability >50% and P=0.001. AUCROC=0.81. CONCLUSION: Bioimpedance technology had good level sensitivity and acceptable specificity for detecting liver fibrosis using delta of the conductance. There is a potential for the use of bioimpedance technology as non-invasive approaches for screening of liver fibrosis.

RESUMO CONTEXTO: A fibrose é uma alteração hepática estrutural comum em pacientes com hepatite crônica. A biópsia hepática é o padrão ouro para determinar a extensão da fibrose hepática. Considerando as dificuldades técnicas e os custos, melhorias em ferramentas de rastreio não-invasivas são bastante necessárias. A tecnologia bioimpedância tem se mostrado ser segura para avaliar fibrose tecidual. OBJETIVO: Avaliar a utilidade do uso da bioimpedância bipolar para detectar a severidade da fibrose hepática compatível com a hepatite viral B e C. MÉTODOS: Cento e dez pacientes foram estudados, prospectivamente e dois grupos foram formados de acordo com os resultados dos testes laboratoriais para a detecção de HCV, ALT e AST: Grupo 1 Controle (n=50 pacientes saudáveis com HCV negativos e com valores de ALT e AST dentro do padrão de normalidade) e Grupo 2 Positivo (n=60 pacientes positivos para a infecção viral anti-VHC ou HBsAg positiva) que foram biopsiados. Todos os pacientes foram submetidos a um exame com o Electro Sensor Complex, que utiliza a bioimpedância bipolar. Para comparar os Grupos 1 e 2, a curva ROC foi utilizada para determinar a especificidade e sensibilidade da bioimpedância em detectar a fibrose hepática. Para identificar a severidade da fibrose hepática, o Grupo 2 Positivo foi subdividido de acordo com os resultados da biópsia (escore Metavir) em: Sub Grupo 2A (F0-F1 n=25 ) - pacientes sem ou com fibrose portal mínima e Sub Grupo 2B (F3-F4 n=20) pacientes com numerosos septos/cirrose. A análise estatística foi realizada para analisar as diferenças dos valores delta de condutância da bioimpedância. RESULTADOS: A comparação entre os Grupos 1 e 2 mostrou: 1) O valor delta de condutância na via do pé direito à mão esquerda menos o valor do delta da mão esquerda ao pé direito demonstrou uma sensibilidade de 85% e uma especificidade de 78%, com um valor de corte ≤5 e P=0,0001. 2). Na comparação entre o Sub Grupo 2A (Metavir F0+F1) e o Sub Grupo 2B (Metavir F3 + F4), a rede neural para os dados aferidos pelo Electro Sensor Complex demonstrou uma sensibilidade de 85% e uma especificidade de 72%, com um corte de probabilidade >50% P=0,001 e AUCROC=0,81. CONCLUSÃO: Bioimpedância apresentou boa sensibilidade e aceitável especificidade para a detecção da fibrose hepática utilizando o delta da condutância da bioimpedância. Existe um potencial para o uso da bioimpedância como abordagens não-invasivas para o rastreamento da fibrose hepática.

IL-6, TNF-α, IL-10, and nutritional status in pediatric patients with biliary atresia / IL-6, TNF-α, IL-10 e estado nutricional em pacientes pediátricos com atresia biliar

Abstract Objectives: The objective of the present study is to evaluate whether IL-6, TNF-α, IL-10 are associated with nutritional status in patients with cirrhosis secondary to biliary atresia and compare to healthy controls. Methods: The parameters used for nutritional assessment were the standard deviation scores of height-for-age and of triceps skinfold thickness-for-age. The severity of cirrhosis was evaluated using the Child-Pugh score and PELD/MELD. Serum cytokines were measured using Cytometric Bead Array flow cytometry. Results: IL-6, TNF-α, and IL-10 were significantly higher in the cirrhosis group when compared with the control group (2.4 vs. 0.24 (p < 0.001), 0.21 vs. 0.14 (p = 0.007), and 0.65 vs. 0.36 (p = 0.004), respectively. IL-6 and IL-10 were positively correlated with disease severity (0.450 [p = 0.001] and 0.410; [p = 0.002], respectively). TNF-α did not show a significant correlation with disease severity (0.100; p = 0.478). Regarding nutritional evaluation, IL-6 was negatively correlated with the standard deviation score of height-for-age (−0.493; p < 0.001) and of triceps skinfold thickness-for-age (−0.503; p < 0.001), respectively. IL-10 exhibited a negative correlation with the standard deviation score of height-for-age (−0.476; p < 0.001) and the standard deviation score of triceps skinfold thickness-for-age (−0.388; p = 0.004). TNF-α did not show any significance in both anthropometric parameters (−0.083 (p = 0.555) and −0.161 (p = 0.253). Conclusion: The authors suggest that, in patients with cirrhosis secondary to biliary atresia, IL-6 could be used as a possible supporting biomarker of deficient nutritional status and elevated IL-10 levels could be used as a possible early-stage supporting biomarker of deteriorating nutritional status.

Resumo Objetivos: Avaliar se há associações entre a IL-6, o TNF-α, a IL-10 e a estado nutricional em pacientes com cirrose secundária a atresia biliar e comparar com controles saudáveis. Métodos: Os parâmetros usados na avaliação nutricional foram desvio padrão de estatura para a idade e espessura da prega cutânea do tríceps para a idade. A gravidade da cirrose foi avaliada por meio da classificação de Child-Pugh e do PELD/MELD. As citocinas no soro foram medidas por citometria de fluxo - técnica de Cytometric Bead Array. Resultados: A IL-6, o TNF-α e a IL-10 foram significativamente maiores no grupo de cirrose em comparação com o grupo de controle [2,4 em comparação com 0,24 (p < 0,001)], [0,21 em comparação com 0,14 (p = 0,007)] e [0,65 em comparação com 0,36 (p = 0,004)], respectivamente. A IL-6 e a IL-10 demonstraram correlação positiva com a gravidade da doença (0,450; p = 0,001) e (0,410; p = 0,002), respectivamente. O TNF-α não mostrou relevância na gravidade da doença (0,100; p = 0,478). Com relação à avaliação nutricional, a IL-6 demonstrou correlação negativa com o desvio padrão de estatura para a idade (−0,493; p < 0,001) e o desvio padrão de espessura da prega cutânea do tríceps para a idade (−0,503; p < 0,001), respectivamente. A IL-10 demonstrou correlação negativa com o desvio padrão de estatura para a idade (−0,476; p < 0,001) e o desvio padrão de espessura da prega cutânea do tríceps para a idade (−0,388; p = 0,004), respectivamente. O TNF-α não mostrou relevância em ambos os parâmetros antropométricos [(−0,083; p = 0,555); (−0,161; p = 0,253)]. Conclusão: Assim, sugerimos que, em pacientes com cirrose secundária a atresia biliar, IL-6 pode ser usado como um possível biomarcador de suporte do estado nutricional deficiente e níveis aumentados de IL-10 podem ser usados como um possível biomarcador de suporte, em fase inicial, de deterioração do estado nutricional.

Management Strategies for Liver Fibrosis

Abstract: Liver fibrosis resulting from chronic liver injury are major causes of morbidity and mortality worldwide. Among causes of hepatic fibrosis, viral infection is most common (hepatitis B and C). In addition, obesity rates worldwide have accelerated the risk of liver injury due to nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). Also liver fibrosis is associated with the consumption of alcohol, or autoimmune hepatitis and chronic cholangiophaties. The response of hepatocytes to inflammation plays a decisive role in the physiopathology of hepatic fibrosis, which involves the recruitment of both pro- and anti-inflammatory cells such as monocytes and macrophages. As well as the production of other cytokines and chemokines, which increase the stimulus of hepatic stellate cells by activating proinflammatory cells. The aim of this review is to identify the therapeutic options available for the treatment of the liver fibrosis, enabling the prevention of progression when is detected in time.

Evaluación comparativa entre MELD y Child-Pugh como escalas pronósticas de sobrevida en pacientes con cirrosis hepática en Chile / Comparative evaluation of survival prognosis using MELD or Child-Pugh scores in patients with liver cirrhosis in Chile

Background: Currently, most liver units use the Child-Pugh (CP) or the Model for End-Stage Liver Disease (MELD) scores to establish survival prognosis among patients with liver cirrhosis. Which classification is superior, is not well defined. Aim: To compare CP and MELD classification scores to predict survival among adult patients with liver cirrhosis in Chile. Material and Methods: Follow-up of 137 consecutive adult patients with liver cirrhosis aged 59 ± 12 years (55% women). The diagnosis was reached by clinical, laboratory and image studies at three different centers of Santiago. Patients were staged with CP and MELD classification scores at baseline and followed over a period of 12 months. The predictive capacity of the scores for survival was analyzed using a multivariate statistical analysis (Kaplan-Meier curves). Results: The most common etiology was alcohol (37.9%). The actuarial survival rate was 79.6% at 12 months of follow-up. When comparing groups with areas under curve of receiver operating characteristic curves (AUROC), there was no statistically significant difference in survival between less severe and advanced disease, assessed with both survival scales. The AUROC for MELD and CP were 0.80 and 0.81, respectively. Conclusions: This clinical study did not find a statistically significant difference between the two classifications for the prediction of 12 months survival in patients with cirrhosis.

Survival benefits of interferon-based therapy in patients with recurrent hepatitis C after orthotopic liver transplantation

Recurrent hepatitis C after orthotopic liver transplantation (OLT) is universal and can lead to graft failure and, consequently, reduced survival. Hepatitis C treatment can be used to prevent these detrimental outcomes. The aim of this study was to describe rates of hepatitis C recurrence and sustained virological response (SVR) to interferon-based treatment after OLT and its relationship to survival and progression of liver disease through retrospective analysis of medical records of 127 patients who underwent OLT due to cirrhosis or hepatocellular carcinoma secondary to chronic hepatitis C between January 2002 and December 2013. Fifty-six patients were diagnosed with recurrent disease, 42 started interferon-based therapy and 37 completed treatment. Demographic, treatment- and outcome-related variables were compared between SVR and non-responders (non-SVR). There was an overall 54.1% SVR rate with interferon-based therapies. SVR was associated with longer follow-up after treatment (median 66.5 vs 37 months for non-SVR, P=0.03) and after OLT (median 105 vs 72 months, P=0.074), and lower rates of disease progression (15 vs 64.7%, P=0.0028) and death (5 vs 35.3%, P=0.033). Regardless of the result of therapy (SVR or non-SVR), there was a significant difference between treated and untreated patients regarding the occurrence of death (P<0.001) and months of survival (P<0.001). Even with suboptimal interferon-based therapies (compared to the new direct-acting antivirals) there is a 54.1% SVR rate to treatment. SVR is associated with improved survival and reduced risks of clinical decompensation, loss of the liver graft and death.

Acoustic radiation force impulse (ARFI) elastography compared with biopsy for evaluating hepatic fibrosis after liver transplantation: a cross-sectional diagnostic study / Elastografia ARFI (acoustic radiation force impulse ) comparada com biópsia na avaliação de fibrose hepática após transplante: estudo transversal diagnóstico

ABSTRACT CONTEXT AND OBJECTIVE: Biopsies are used after liver transplantation to evaluate fibrosis. This study aimed to evaluate the elasticity of transplanted livers by means of a non-invasive examination, acoustic radiation force imaging (ARFI) elastography, correlating the results with the histological analysis. DESIGN AND SETTING: Cross-sectional study in a public university hospital. METHODS: All patients consecutively operated between 2002 and 2010 with an indication for biopsy were evaluated by means of elastography. The radiologist evaluating ARFI and the pathologist doing anatomopathological examinations were blinded to each other's evaluations. RESULTS: During the study period, 33 patients were included. The indication for transplantation was cirrhosis due to hepatitis C in 21 cases (63%). Liver biopsies showed absence of fibrosis (F0) in 10 patients, F1 in 11, F2 in 8 and F3 in 4. There were no cases of F4 (cirrhosis). The difference in ARFI values (degree of fibrosis) was 0.26 (95% confidence interval, CI: 0.07-0.52) between the groups F0-F1 and F2-F4 (P = 0.04). An area under the curve of 0.74 (CI: 0.55-0.94) and a cutoff of 1.29 m/s between the groups resulted in the best relationship between sensitivity and specificity. Sensitivity (0.66; CI: 0.50-0.83) was lower than specificity (0.85; CI: 0.72-0.97). There was no significant difference in ARFI between patients with hepatitis C and those with other diseases. CONCLUSIONS: The values obtained from elastography were not affected by inflammatory reaction or anatomical alterations. A cutoff point of 1.29 m/s separating patients with or without significant fibrosis was identified.

RESUMO CONTEXTO E OBJETIVO: Biópsias são utilizadas para avaliar fibrose após transplante de fígado. O estudo objetivou avaliar a elasticidade hepática após transplante por meio de um exame não invasivo, a elastografia ARFI (acoustic radiation force imaging ), correlacionando-a com a análise histológica. TIPO DE ESTUDO E LOCAL: Estudo transversal em hospital público universitário. MÉTODOS: Todos os pacientes consecutivamente operados entre 2002 e 2010, com indicação para biópsia, foram avaliados por elastografia. O radiologista avaliando ARFI e o patologista fazendo exames anatomopatológicos estavam cegos para as avaliações um do outro. RESULTADOS: No período do estudo, 33 pacientes foram incluídos. A indicação para o transplante foi cirrose por hepatite C em 21 (63%). As biópsias mostraram ausência de fibrose (F0) em 10 pacientes, F1 em 11, F2 em 8, F3 em 4 e nenhum caso de F4 (cirrose). A diferença nos valores de ARFI (grau de fibrose) foi de 0,26 (intervalo de confiança, IC, de 95%: 0,07-0,52) entre os grupos F0-F1 e F2-F4 (P = 0,04). A área sob a curva de 0,74 (IC: 0,55-0,94) e o valor de corte de 1,29 m/s entre os grupos resultaram na melhor relação entre sensibilidade e especificidade, de 0,57. A sensibilidade (0,66; IC: 0,50-0,83) foi menor que a especificidade (0,85; IC: 0,72-0,97). Não houve diferença significativa em ARFI entre pacientes com hepatite C e aqueles com outras doenças. CONCLUSÕES: Os valores obtidos com a elastografia não foram afetados por reação inflamatória ou alterações anatômicas. Foi identificado ponto de corte de 1,29 m/s que separa pacientes com ou sem fibrose significativa.

Caracterización clínica de pacientes cirróticos con gastropatía portal hipertensiva / Clinical Characterization of Cirrhotic Patients with Hypertensive Portal Gastropathy

Introducción: la gastropatía portal hipertensiva (GPH) constituye una complicación de la hipertensión portal de relevancia clínica, que aparece en pacientes con cirrosis hepática. Objetivo: caracterizar los diferentes tipos de gastropatía portal hipertensiva (GPH) según la presencia de manifestaciones de hipertensión portal, el estado de la función hepática y la ocurrencia de eventos de sangrado digestivo. Método: estudio descriptivo, de corte transversal que incluyó 46 pacientes con diagnóstico de cirrosis y evidencia endoscópica de gastropatía portal hipertensiva (GPH), atendidos entre 2011-2013 en el servicio de Gastroenterología del Hospital Militar Central Dr. Luis Díaz Soto. Se clasificaron según su forma leve o grave y se hicieron comparaciones entre ambos grupos. Resultados: el 78,2 por ciento de los pacientes presentó una gastropatía leve y la localización más frecuente resultó ser el fondo gástrico (78,2 por ciento). Todos los casos con la forma grave fueron hombres (p=0,008). Entre los que tuvieron una gastropatía grave, predominaron los que tuvieron un mayor diámetro de la porta (18,3 mm vs 13,5 mm, p=0,001) y del bazo (137,4mm vs130,03 mm, (p=0,0002), así como los que también tenían várices esofágicas (100 por ciento, p=0,007), por lo que el sangrado agudo también fue más frecuente entre ellos (60 por ciento, p=0,01). No se manifestaron diferencias con los parámetros hematológicos de hipertensión portal ni con los grados de función hepática, aun cuando el 63 por ciento de los pacientes se encontró en los grupos B y C de la clasificación de Child-Pughs-Turcotte. Conclusiones: la forma grave de la gastropatía portal hipertensiva (GPH) es la menos frecuente, pero se acompaña de alteraciones clínicas, humorales e imaginológicas relevantes, que requieren una atención personalizada para este tipo de enfermos(AU)

Introduction: Hypertensive portal gastropathy (HPG) is a complication of portal hypertension of clinical relevance, which appears in patients with liver cirrhosis. Objective: Characterize the different types of hypertensive portal gastropathy (HPG) according to the presence of manifestations of portal hypertension, the state of liver function and the occurrence of digestive bleeding events. Method: A descriptive, cross-sectional study was conducted in 46 patients diagnosed with cirrhosis and endoscopic evidence of portal hypertensive gastropathy (HPG), treated from 2011 to 2013 in the Gastroenterology Department of Dr. Luis Díaz Soto Central Military Hospital. They were classified according to mild or severe form and comparisons were made between both groups. Results: 78.2 percent of the patients presented mild gastropathy and the most frequent location was the gastric fundus (78.2 percent). All cases with the severe form were men (p = 0.008). Among those who had severe gastropathy, those with larger diameter of the portal (18.3 mm vs 13.5 mm, p = 0.001) and spleen (137.4 mm vs 130.03 mm, p = 0, 0002), as well as those who also had esophageal varices (100 percent, p = 0.007), so that acute bleeding was also more frequent among them (60 percent, p = 0.01). Hematologic factors of portal hypertension or with degrees of liver function, although 63 percent of patients were found in groups B and C of the Child-Pughs-Turcotte classification. Conclusions: The severe form of hypertensive portal gastropathy (GPH) is the least frequent, but it is accompanied by relevant clinical, humoral and imaging alterations, which require a personalized attention for this type of patients(AU)

Non-alcoholic fatty liver disease (NAFLD) in different populations: A clinical and epidemiological study - sample of São José do Rio Preto / Doença hepática gordurosa não alcoólica em diferentes populações: um estudo clínico e epidemiológico - Amostra de São José do Rio Preto

SUMMARY Introduction: NAFLD is an heterogeneous condition that includes steatosis and non-alcoholic steatohepatitis (NASH), in the absence of significant alcohol consumption, reaching 30% of the population. The most common risk factors are: age, gender, ethnicity, diabetes mellitus (DM), obesity, predisposition, metabolic syndrome (MS), insulin resistance (IR), drugs, and polycystic ovary syndrome. Objective: To describe the profile of patients with NAFLD seen at Hospital de Base of Rio Preto, in the state of São Paulo. Method: Patients with NAFLD were assessed, with medical and epidemiological data collected after informed consent. Results: Of the 62 patients evaluated, 76% were women, 73% Caucasians, and 71% were aged between 50 and 69 years and had no symptoms. Ultrasonography results showed steatosis in 84%. NASH was diagnosed in 61% of the sample. 21 patients underwent liver biopsy, of which 36% had cirrhosis, 1 had liver cancer, and 1 pure steatosis (5% each). Risk factors were found in 70% of patients with metabolic syndrome, 87% with increased waist circumference, 63% with dyslipidemia, 61% (n=38) with high blood pressure (HBP), 28% with DM, 52% physically inactive, and 44% with insulin resistance (IR) (HOMA> 3.5). There was an association between IR and NASH (p=0.013), IR and obesity (p=0.027), IR and MS (p=0.006), and MS and steatosis on medical ultrasound (USG) (p=0.014). Conclusion: The most frequent risk factors were MS and its variables: increased waist circumference, dyslipidemia and HBP. This underscores the importance of metabolic control in NAFLD and confirms its role as the hepatic component of metabolic syndrome.

RESUMO Introdução: a doença hepática gordurosa não alcoólica (DHGNA) é uma condição heterogênea que inclui esteatose e esteato-hepatite não alcoólica (NASH), na ausência de consumo significante de álcool, podendo atingir 30% da população. Fatores de risco mais comuns são idade, gênero, etnia, diabetes mellitus (DM), obesidade, predisposição, síndrome matabólica (SM), resistência à insulina (RI), drogas e síndrome do ovário policístico. Objetivo: descrever o perfil de portadores de DHGNA assistidos no Hospital de Base de São José do Rio Preto, SP. Método: foram avaliados pacientes com DHGNA e coletados dados clínico-epidemiológicos, após consentimento informado. Resultados: dos 62 pacientes estudados, houve predomínio de mulheres (76%), caucasoides (73%), idade entre a quinta e sexta décadas e assintomáticos (71%). Exame de ultrassonografia (US) mostrou esteatose em 84%. NASH foi diagnosticada em 61% da casuística. Em 21 pacientes, biópsia hepática mostrou cirrose em 36% e câncer de fígado e esteatose pura em um paciente (5%) cada. Dos fatores de risco, 70% dos pacientes apresentavam SM; 87%, cintura abdominal alterada; 63%, dislipidemia; 61% (n=38), hipertensão arterial sistêmica (HAS); 28%, DM; 52%, sedentarismo, e em 44% encontrou-se RI (HOMA>3,5). Houve associação entre RI e NASH (p=0,013), RI e obesidade (p=0,027), RI e SM (p=0,006), SM e esteatose à US (p=0,014). Conclusão: os fatores de risco mais frequentes foram SM e suas variáveis (cintura abdominal aumentada, dislipidemia e HAS), o que ressalta a importância do controle metabólico na DHGNA e corrobora o seu papel como componente hepático da SM.

Perfil epidemiológico dos pacientes portadores de cirrose hepática atendidos no Ambulatório de Hepatologia do Centro de Especialidades Médicas do CESUPA (CEMEC), em Belém - PA / Epidemiological profile of cirrhosis of liver patients treated at the Outpatient of Hepatology of Medical Specialities CESUPA Center (CEMEC) in Belem - PA

Introdução: a cirrose hepática é considerada a principal doença crônica do fígado, e é caracterizada pela substituição difusa da estrutura hepática por nódulos de estrutura anormal circundados por fibrose. Objetivos: este trabalho tem como objetivo descrever o perfil epidemiológico dos pacientes portadores de cirrose hepática atendidos no CEMEC. Metodologia: a pesquisa foi realizada pela coleta de dados no período de dezembro de 2013 a fevereiro de 2014 pela coleta de dados feita em prontuários de pacientes cadastrados (de agosto de 2012 a dezembro de 2013) no CEMEC, em Belém, PA. Tratou-se de um estudo transversal, analítico e descritivo. Resultados: obtivemos uma amostra total de 21 pacientes (16,27% dos pacientes cadastrados), em que foram observadas as características sexo (masculino 61,9% e feminino 38,1%) com predominância da faixa etária entre 50 e 59 anos (38,1%). A principal origem etiológica foi a alcoólica com um total de 11 pacientes. Ocorreu uma predominância da classe Child-Pugh A (52,4%), em que a alteração laboratorial mais prevalente foi a hiperbilirrubinemia e a complicação mais observada, a presença de varizes esofágicas. Conclusão: o tratamento da doença hepática subjacente, bem antes do desenvolvimento da cirrose, é uma estratégia primária de prevenção. Como as causas principais da cirrose estão relacionadas com escolhas do estilo de vida ? como uso de injetáveis, consumo de álcool e sexo sem proteção - os programas de prevenção enfocam justamente na mudança do estilo de vida.

Introduction: cirrhosis is considered the main chronic liver disease and is characterized by diffuse liver replacement by abnormal structure nodules surrounded by fibrosis. Objectives: this study aims to describe the epidemiological profile of patients with liver cirrhosis treated at CEMEC. Methodology: the survey was conducted for data collection made in medical records of patients registered from August 2012 to December 2013 in CEMEC the period December 2013 to February 2014 in Belém, PA. This was a cross-sectional, analytical and descriptive study. Results: we obtained a total sample of 21 patients (16.27% of registered patients) were observed where the characteristics: sex (male 61.9% and female 38.1%) predominated where the age group 50-59 years (38. 1%). The main etiological origin was alcoholic with a total of 11 patients. There was a predominance of Child-Pugh class A (52.4%) where the most prevalent laboratory parameters were hyperbilirubinemia and the most frequently observed complication was the presence of esophageal varices. Conclusion: treatment of underlying liver disease, long before the development of cirrhosis it is a primary prevention strategy. As the main causes of cirrhosis are related to lifestyle choices - such as injecting, alcohol consumption and unprotected sex - prevention programs just focus on lifestyle change.