The Influence of Alcoholic Liver Disease on Serum PIVKA-II Levels in Patients without Hepatocellular Carcinoma

BACKGROUND/AIMS: Prothrombin induced by vitamin K deficiency or antagonist II (PIVKA-II) is a widely used diagnostic marker for hepatocellular carcinoma (HCC). We evaluated the correlation between alcoholic liver disease (ALD) and serum PIVKA-II levels in chronic liver disease (CLD) patients. METHODS: We retrospectively reviewed the medical records of 2,528 CLD patients without HCC. Among these patients, 76 exhibited serum high PIVKA-II levels of >125 mAU/mL (group 1). We categorized 76 control patients matched by age, sex, and the presence of liver cirrhosis from the remaining patients who were negative for serum PIVKA-II (group 2). RESULTS: Group 1 revealed increased antibiotic usage (23.7% vs 2.6%, p<0.001) and incidence of ALD (60.5% vs 14.5%, p<0.001) as well as elevated aspartate aminotransferase (52.5 IU/L vs 30.5 IU/L, p=0.025) and gamma glutamyl transpeptidase (67.5 IU/L vs 36.5 IU/L, p=0.005) levels compared with group 2. Further, group 1 was significantly associated with a worse Child-Pugh class than group 2. In the multivariate analysis, ALD (odds ratio [OR], 7.151; p<0.001) and antibiotic usage (OR, 5.846; p<0.001) were significantly associated with positive PIVKA-II levels. CONCLUSIONS: Our study suggests that ALD and antibiotics usage may be confounding factors when interpreting high serum PIVKA-II levels in patients without HCC. Therefore, serum PIVKA-II levels in patients with ALD or in patients administered antibiotics should be interpreted with caution.

The Influence of Alcoholic Liver Disease on Serum PIVKA-II Levels in Patients without Hepatocellular Carcinoma

BACKGROUND/AIMS: Prothrombin induced by vitamin K deficiency or antagonist II (PIVKA-II) is a widely used diagnostic marker for hepatocellular carcinoma (HCC). We evaluated the correlation between alcoholic liver disease (ALD) and serum PIVKA-II levels in chronic liver disease (CLD) patients. METHODS: We retrospectively reviewed the medical records of 2,528 CLD patients without HCC. Among these patients, 76 exhibited serum high PIVKA-II levels of >125 mAU/mL (group 1). We categorized 76 control patients matched by age, sex, and the presence of liver cirrhosis from the remaining patients who were negative for serum PIVKA-II (group 2). RESULTS: Group 1 revealed increased antibiotic usage (23.7% vs 2.6%, p<0.001) and incidence of ALD (60.5% vs 14.5%, p<0.001) as well as elevated aspartate aminotransferase (52.5 IU/L vs 30.5 IU/L, p=0.025) and gamma glutamyl transpeptidase (67.5 IU/L vs 36.5 IU/L, p=0.005) levels compared with group 2. Further, group 1 was significantly associated with a worse Child-Pugh class than group 2. In the multivariate analysis, ALD (odds ratio [OR], 7.151; p<0.001) and antibiotic usage (OR, 5.846; p<0.001) were significantly associated with positive PIVKA-II levels. CONCLUSIONS: Our study suggests that ALD and antibiotics usage may be confounding factors when interpreting high serum PIVKA-II levels in patients without HCC. Therefore, serum PIVKA-II levels in patients with ALD or in patients administered antibiotics should be interpreted with caution.

Serum prohepcidin levels in chronic hepatitis C, alcoholic liver disease, and nonalcoholic fatty liver disease / 대한간학회지

BACKGROUND/AIMS: Patients with various chronic liver diseases frequently have increased body iron stores. Prohepcidin is an easily measurable precursor of hepcidin, which is a key regulator of iron homeostasis. This study investigated the serum prohepcidin levels in patients with various chronic liver diseases with various etiologies. METHODS: Serum prohepcidin levels were measured in patients with chronic hepatitis C (CH-C) (n=28), nonalcoholic fatty liver disease (NAFLD) (n=24), and alcoholic liver disease (ALD) (n=22), and in healthy controls (n=25) using commercial ELISA. Serum interleukin 6 (IL-6) levels and blood iron indices were also measured. RESULTS: The serum levels of both prohepcidin and IL-6 were significantly higher in CH-C patients than in healthy controls, and there was a positive correlation between the IL-6 and prohepcidin levels (r=0.505, p=0.020). The prohepcidin levels in ALD patients did not differ from those in controls, despite their significantly elevated IL-6 levels. There was a tendency for a negative correlation between serum prohepcidin levels and transferrin saturation in ALD patients (r=-0.420, p=0.051). Neither prohepcidin nor IL-6 was significantly elevated in the NAFLD group, despite the presence of elevated serum iron and ferritin levels. CONCLUSIONS: The role of prohepcidin may differ in different human liver diseases. In the setting of CH-C, both the serum prohepcidin and IL-6 levels were significantly elevated and were positively correlated with each other.

Índices plaquetários em indivíduos com doença hepática alcoólica crônica / Platelet indices in chronic alcoholic liver disease patients with thrombocytopenia

OBJETIVO: Detectar alterações nos índices plaquetários em indivíduos com doença hepática alcoólica crónica e trombocitopenia e determinar o seu grau de correlação com outros parâmetros hematológicos. MÉTODOS: Foram estudados um total de 65 indivíduos, divididos em dois grupos: controlos (n = 35) e com doença hepática alcoólica crónica e trombocitopenia (n = 30). O grupo controlo foi emparelhado por idade e sexo com o grupo de doentes. A todos eles, foi efectuado hemograma completo, incluindo índices plaquetários. RESULTADOS: Os doentes com doença hepática alcoólica crónica apresentaram contagem de eritrócitos, leucócitos e plaquetas significativamente inferiores aos encontrados na população controlo. O mesmo se verificou com os valores de hemoglobina, hematócrito e valores absolutos de linfócitos e neutrófilos. O volume globular médio, a hemoglobina globular média e o RDW ("red cell distribution width") revelaram-se significativamente superiores no grupo de doentes. Relativamente aos índices plaquetários, foi encontrado aumento estatisticamente significativo do PDW ("platelet distribution width") e uma diminuição estatisticamente significativa no plaquetrócrito no grupo de doentes quando comparado com o grupo controlo. Em relação ao volume plaquetário médio não se encontraram diferenças estatisticamente significativas entre os dois grupos. Foi encontrada correlação estatisticamente significativa entre a contagem de plaquetas e os outros parâmetros hematológicos analisados. O plaquetrócito revelou-se o índice plaquetário que mais se relaciona com os restantes parâmetros hematológicos. CONCLUSÃO: Os doentes com doença hepática alcoólica crónica apresentam diminuição nas três linhas hematopoiéticas, possivelmente associada com o hiperesplenismo que estes doentes apresentam. Adicionalmente às alterações numéricas, encontraram-se alterações morfológicas a nível dos eritrócitos e plaquetas, demonstráveis pelos índices eritrocitários e plaquetários.

AIM: To detect alterations in platelet indices in patients with chronic alcoholic liver disease and thrombocytopenia, and its correlation with other haematological parameters. METHODS: We studied 65 individuals separated in two groups: controls (n = 35) and chronic alcoholic liver disease patients with thrombocytopenia (n = 30). The control group was age and gender matched with patients group. In all, controls and patients, a haematological evaluation was done, including platelets indices. RESULTS: In the patients group we found a low number of erythrocytes, leucocytes and platelet when we compare with controls. The same is true when we compare haemoglobin, hematocrit and absolute count of lymphocyte and neutrophil. The mean globular volume, mean globular haemoglobin and red cell distribution width where significantly higher in patients group. Platelet indices showed a statistical significant increased in platelet distribution width and decreased in platelet crit in the patient group. No differences where found on mean platelet volume between the two groups. Correlation between platelet number and other haematological parameters was found. CONCLUSION: Chronic alcoholic liver disease patients showed a decrease in all haematopoietic cell lines, probably associated with hypersplenism found in those patients. Additionally to the numeric alterations the erythrocyte and platelets showed morphologic alteration revelled by respective indices.

Utility of gamma-glutamyl transpeptidase and mean corpuscular volume in alcoholic liver disease.

The present study was designed to establish the role of Gamma-glutamyl transpeptidase (gamma-GT) and mean corpuscular volume (MCV) in alcoholic liver disease (ALD). Serum gamma-GT, total and direct bilirubin, albumin, total protein, AST, ALT and ALP were assayed by standard methods in a clinical chemistry autoanalyser. MCV, Hb, PCV and RBC were measured by an automated cell counter. Activity of gamma-GT and MCV levels were significantly higher in the patients with ALD compared to controls. A gamma-GT level of > or = 25 U/l was found to be significantly associated with ALD. MCV level > or = 100 fl/l showed a significant association with ALD. An AST to ALT ratio > 1 was found in 92% of the patients. None of the patients showed an ALT level > or = 300 IU/l. The degree of AST elevation in the patients with ALD was higher (3.7 times) then ALT (3.2 times). A gamma-GT level > or = 25 IU/L and an MCV level > or = 100 fl/l stand as markers of heavy alcohol consumption in this study. An AST to ALT ratio > 1 was present in most of the patients with ALD. The degree of elevation of AST was higher than ALT in the patients with ALD.

Metabolic effects of alcoholism and its relationship with alcoholic liver disease

Chronic and excessive ethanol consumption is associated with cellular proliferation, fibrosis, cirrhosis and cancer of liver. It was planned to study the effect of alcohol on different biochemical parameters as distribution of these parameters may lead to several complications in gastrointestinal tract, liver, kidney, brain etc. 50 alcoholic males and 20 normal subjects [with no history of alcohol] with an age ranges 30-45 years were included in the study. Biochemical parameters related to liver were estimated by standard kit. Besides, ions and electrolytes were also determined by standard kit and flame photometery. It was observed that level of alkaline phosphatase, alanine transferase, protein and globulin were significantly increased as compared to normal subjects. Besides, ions like calcium and phosphate were significantly decreased. On the other hand the level of potassium and magnesium was significantly decreased as compared to normal subjects. Electrophoresis shows a protein of 100Kda is present in the patients sample as compared to control subjects. It is therefore concluded that abnormal biochemical function of liver in alcoholism can lead to several complications, hence further research is needed to reach a definite conclusion

Reliability of some biochemical parameters as prognostic factors for hepatitis in schistosomiasis patients

The early diagnosis of hepatitis in patients is sometimes difficult and despite adequate studies may remain undetected. To carry out this point, 4 selected groups of patients were investigated. Group 1 included patients with chronic liver cirrhosis due to schistosomiasis with a positive ELISA and PCR tests for HCV and showed a very high level of iron and ferritin as compared with the control group. Group 2 consisted of patients with chronic liver cirrhosis due to schistosomiasis with negative ELISA for either HBV or HCV antibodies and revealed a significant increase in copper and decrease in zinc as compared with the control group. Group 3 composed of patients with HCV infection, confirmed by antibody detection through third generation ELISA, RIBA III. Patients in this group showed a significant increase in the iron and ferritin level compared with the control group. Moreover, group 4 encompassed patients with HBV infection showed a positive ELISA for antibody detection [HBsAb] and immunochromatographic reaction for detection of surface antigen [HBsAg]. The results suggested that reduced level of Zn ++ and increased level Cu ++ might be a reflection of the incidence of HBV more than HCV infection, while a high level of iron and ferritin are potential biomarkers for schistosomiasis patients with early HCV infection

Colchicina na doença hepática crônica de etiologia alcoólica. Estudo duplo-cego, randomizado, de seus efeitos sobre os níveis séricos das proteínas plasmáticas e evoluçäo clínica dos pacientes / Colchicine in chronic liver disease of alcoholic etiology. Double-blind, randomized study of its effects on the serum levels of plasma proteins and clinical evolution of the patients

Pacientes portadores de hepatopatia crônica de etiologia alcoólica, quando tratados com colchicina durante período de 12 meses, apresentaram índices de recuperaçäo dos níveis plasmáticos de albumina e protrombina significantemente superiores aos de pacientes fazendo uso de placebo. Entretanto, nenhuma diferença estatística pôde ser observada entre os dois grupos quanto à taxa de mortalidade e de admissäo hospitalar dos pacientes, no período estudado. OBJETIVO. Analisar a evoluçäo clínica e os níveis plasmáticos de albumina, pré-albumina, transferrina e protrombina em portadores de hepatopatia crônica alcoólicaem uso de colchicina ou placebo, durante período de 12 meses. MÉTODOS. em um estudo duplo-cego, 41 pacientes portadores de hepatopatia crônica de etiologia alcoólica foram randomizados para receber placebo (20 pacientes) ou colchicina (21 pacientes), avaliando sua evoluçäo clínica e dos níveis das proteínas plasmáticasalbumina, pré-albumina e transferrina por imunodifusäo radial e do tempo e atividade de protrombina pelo método de Quick modificado. RESULTADOS. Apenas 7,3 por cento dos pacientes näo completaram os 12 meses de seguimento do estudo. Näo se observaram diferenças significantes entre os grupos, no que se refere à taxa de mortalidade ou ao número de internaçöes hospitalares. Quanto aos níveis séricos protéicos, observaram-se valores significantemente superiores no grupo da colchicina do que no grupo placebo, para as médias das variaçöes percentuais dos níveis de albumina (17,9 por cento colchicina x 3,6 por cento placebo, p<0,05) e da atividade de protrombina (19,2 por cento colchicina x 2,1 por cento placebo, p<0,05). As variaçöes dos valores da pré-albumina, apesar de apresentarem o mesmo comportamento observado para os níveis de albumina e protrombina, näo atingiram significância estatística. Já os níveis de transferrina sérica näo diferiram entreos dois grupos. CONCLUSÄO. Estes resultados sugerem que a administraçäo de colchicina tenha um efeito benéfico sobre os níveis de proteínas plasmáticas nos pacientes com hepatopatia crônica de etiologia alcoólica.

Glutatión sanguíneo en el paciente alcohólico con hepatopatía / Blood glutathione in the alcoholic patient with hepatopathy

Dada la gran importancia del glutatión como indicador de la reserva antioxidante tisular y en vista de la existencia de datos contradictorios en la literatura internacional, se decidió cuantificar la concentración del glutatión oxidado y del reducido en muestra de sangre de 18 individuos no bebedores y de 52 enfermos alcohólicos. El diagnóstico de los enfermos se hizo por medio de la clínica y estudios de laboratorio, lo que permitió agruparlos en tres grados crecientes de severidad de acuerdo al índice de Orrego. Se observó que existe un abatimiento de los niveles de glutatión total en sangre que es mayor conforme más severo es el daño hepático. El glutatión reducido en sangre, que es la fracción útil como antioxidante, muestra una disminución paralela al glutatión total; mientras que se observa un aumento en la fracción oxidada del glutatión sanguíneo, que guarda relación con la severidad del daño hepático. Se concluye que la determinación del glutatión total, así como sus fracciones reducida y oxidada, puede servir para conocer la reserva antioxidante en la sangre y probablemente en el organismo y con ello contribuye a evaluar las posibilidades de recuperación de los pacientes alcohólicos

Reservas hepáticas de hierro y nivels de perritina en suero de pacientes alcohólicos y no alcohólicos con hepatopatias crónicas / Hepatic iron stores and serum ferritin levels in alcoholic and non-alcoholic patients with chronic liver diseases

Con el objeto de evaluar la utilidad de la ferritina en suero (Ft) como indicador de reservas de hierro de pacientes alcohólicos y no alcohólicos con hepatopatías clínicas se estudiaron 35 pacientes: 18 con cirrosis o fibrosis alcohólica y 17 con padecimientos hepáticos de etiología diversa, no alcohólicos. Los pacientes alcohólicos tenían 3 a 32 meses de abstinencia alcohólica. Las reservas de hierro se establecieron mediante la cuantificación de hierro no hemínico (HNH) en biopsia hepática. En 8 casos del grupo de alcohólicos (44%) y en 4 de los no alcohólicos (23%) el HNH estuvo por arriba de muestras cifras de referencia (> 48 mg/100 g en varones y > 20 mg/100 g en mujeres). En los pacientes alcohólicos se obtuvieron correlaciones directas significativas entre Ft y ALAT y Ft vs, bilirrubina total, mientras que estas correlaciones inversas y no significativas en los no alcohólicos. La correlación entre HNH y Ft fue estadísticamente significativa en los no alcohólicos (r = 0.667), pero fu más baja en los alcohólicos (r = 0.478). Concluimos que: a) la siderosis hepática, descrita en una proporción considerable de los bebedores activos, permanece en los alcohólicos que tienen 3 o más meses de abstinencia alcohólica, b) en individuos con hepatopatías crónicas no alcohólicos la Ft aparentemente sí refleja reservas de hierro, c) en los alcohólicos la inflamación o necrosis hepática modifica los niveles de Ft, por lo tanto este parámetro no es útil para establecer las reservas de hierro en estos pacientes

Concentración sérica de alfa-1-antitripsina en diversas enfermedades hepáticas / Serum concentration of alpha-1-antitrypsin in different hepatic diseases

Se investigó la concentración sérica de alfa-1-antitripsina (A1AT) en 195 pacientes con diversas hepatopatías y en 43 adultos sanos. En todas las enfermedades hepáticas estudiadas se encontró un incremento significativo de la A1AT sérica respecto al grupo control (p < 0,001; hepatitis fulminante p < 0,05) confirmando que esta glicoproteína es un reactante de fase aguda. En las hepatitis fulminantes la concentración sérica de A1AT fue similar a la encontrada en los pacientes con hepatitis viral aguda sin insuficiencia hepática. La mayor elevación de la A1AT correspondió a los pacientes con obstrucción biliar y tumores hepáticos (primitivos y metastásicos) registrándose diferencias significativas respecto a las hepatopatías agudas y crónicas necrótico-inflamatorias (hepatitis, cirrosis, alcoholismo) (p < 0,001); a su vez en los pacientes con hígado metastásico la A1AT sérica fue mayor que en el resto de la población estudiada (p < 0,004 vs obstrucción biliar; p < 0,05 vs hepatoma). El 96% de las metástasis hepáticas presentaron valores de A1AT mayores de 400mg% registrándose diferencias significativas con el resto del grupo. La determinación de la A1AT sérica puede ser de utilidad para el diagnóstico de los tumores hepáticos malignos; de acuerdo a nuestros hallazgos el dosaje de esta glicoproteína carece de valor en el diagnóstico del hepatocarcinoma y en la insuficiencia hepática aguda

Lipoproteínas plasmáticas en las hepatopatías alcohólicas / Plasma lipoproteins in alcoholic liver diseases

Con el propósito de valorar las modificaciones que ocurren en las liproteínas plasmáticas en el alcoholismo crónico y su relación con las alteraciones observadas en la histología hepática fueron estudiadas un grupo de 62 alcoholistas crónicos y uno de 36 sujetos normales de similar sexo y edad que fueron empleados como controles. En base a los hallazgos en la punción biopsia hepática los etilistas fueron clasificados como sin lesión a la histología óptica (6 pacientes) hepatitis e hígado graso (18 pacientes) y cirrosis hepáticca (38 pacientes). El grupo de alcoholistas en conjunto mostró aumentos significativos con respecto al grupo control en la gamaglutamiltranspeptidasa, triglicéridos y apoproteína B y una disminución significativa en los valores de C-HDL y de apoproteínas AI. Los etilistas presentaron un descenso gradual y significativo tanto del C-HDL como de la Apo AI a medida que el daño histológico hepático evolucionaba desde "sin lesión histológica" a "cirrosis hepática". Se concluye que los resultados hallados podrían ser debidos a ambos, el efecto metabólico directo del alcohol y el daño estructural hepático irreversible provocado por el mismo