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Effect of alcohol consumption on liver stiffness measured by transient elastography 被引量:20
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作者 Edouard Bardou-Jacquet ludivine legros +6 位作者 Draman Soro Marianne Latournerie Anne Guillygomarc'h Caroline Le Lan Pierre Brissot Dominique Guyader Romain Moirand 《World Journal of Gastroenterology》 SCIE CAS 2013年第4期516-522,共7页
AIM:To determine the evolution of transient elastography(TE) in patients with alcoholic liver disease according to alcohol cessation or continuation.METHODS:We retrospectively selected in our local database all patien... AIM:To determine the evolution of transient elastography(TE) in patients with alcoholic liver disease according to alcohol cessation or continuation.METHODS:We retrospectively selected in our local database all patients who had two TE between June 2005 and November 2010 with chronic alcohol excessive consumption and excluded those with associated cause of liver disease.TE was performed at least one week apart by senior operator.TE examinations with less than ten successful measures or with an interquartile range above 30% were excluded.We retrospectively reviewed file of all patients to include only patient followed up by trained addictologist and for which definite information on alcohol consumption was available.Concomitant biological parameters [aspartate amino transferase(AST),alanine amino transferase and gamma-glutamyl transpeptidase(GGT)] within 4 wk of initial and final TE were recorded.Putative fibrosis score according to initial and final TE were determined with available cut-off for alcoholic liver disease and hepatitis C.Initial and final putative fibrosis score were compared according to alcohol consumption during follow-up.RESULTS:During the study period 572 patients had TE examination for alcoholic liver disease and 79 of them had at least two examinations.Thirty-seven patients met our criteria with a median follow-up of 32.5 wk.At the end of the study,13(35%) were abstinent,and 24(65%) relapsers.Eight patients had liver biopsy during follow-up.TE decreased significantly during follow-up in 85% of abstinent patients [median(range):-4.9(-6.1,-1.9)],leading to a modification of the putative fibrosis stage in 28%-71% of patient according to different cut-off value.In relapsers TE increased in 45% and decreased in 54% of patient.There was no statistical difference between initial and final TE in relapsers.In the overall population,using 22.6 kPa as cut-off for cirrhosis,4 patients had cirrhosis at initial TE and 3 patients had cirrhosis at final TE.Using 19.5 kPa as cut-off for cirrhosis,7 patients had cirrhosis at initial TE and 5 patients had cirrhosis at final TE.Using 12.5 kPa as cut-off for cirrhosis,16 patients had cirrhosis at initial TE and 15 patients had cirrhosis at final TE.Evolution of biological data was in accordance with the relapse or abstinent status:abstinence ratio(duration of abstinence/duration follow-up) was correlated with AST ratio(r =-0.465,P = 0.007) and GGT ratio(r =-0.662,P<0.0001).GGT was correlated with initial(r = 0.488,P = 0.002) and final TE(r = 0.49,P<0.005).Final TE was correlated with AST(r = 0.362,P<0.05).Correlation between TE ratio and AST ratio(r = 0.44,P = 0.01) revealed that TE varied proportionally to AST for all patients irrespective of their alcohol status.The same relationship was observed between TE ratio and GGT ratio(r = 0.65,P<0.0001).Evolution of TE was significantly correlated with the ratio of time of abstinence to observation time(r =-0.387,P = 0.016) and the evolution of liver enzymes.CONCLUSION:TE significantly decreased with abstinence.Results of TE in alcoholic liver disease cannot be interpreted without taking into account alcohol consumption and liver enzymes. 展开更多
关键词 ALCOHOL Transient ELASTOGRAPHY CIRRHOSIS FIBROSIS LIVER BIOPSY LIVER stiffness
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Acoustic radiation force impulse imaging for assessing liver fibrosis in alcoholic liver disease 被引量:7
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作者 Anita Kiani Vanessa Brun +8 位作者 Fabrice Lainé Bruno Turlin Jeff Morcet Sophie Michalak Antonia Le Gruyer ludivine legros Edouard Bardou-Jacquet Yves Gandon Romain Moirand 《World Journal of Gastroenterology》 SCIE CAS 2016年第20期4926-4935,共10页
AIM: To evaluate the performance of elastography by ultrasound with acoustic radiation force impulse(ARFI) in determining fibrosis stage in patients with alcoholic liver disease(ALD) undergoing alcoholic detoxificatio... AIM: To evaluate the performance of elastography by ultrasound with acoustic radiation force impulse(ARFI) in determining fibrosis stage in patients with alcoholic liver disease(ALD) undergoing alcoholic detoxification in relation to biopsy.METHODS: Eighty-three patients with ALD undergoing detoxification were prospectively enrolled. Each patient underwent ARFI imaging and a liver biopsy onthe same day. Fibrosis was staged according to the METAVIR scoring system. The median of 10 valid ARFI measurements was calculated for each patient.RESULTS: Sixty-nine males and thirteen females(one patient excluded due to insufficient biopsy size) were assessed with a mean alcohol consumption of 132.4 ± 128.8 standard drinks per week and mean cumulative year duration of 17.6 ± 9.5 years. Sensitivity and specificity were respectively 82.4%(0.70-0.95) and 83.3%(0.73-0.94)(AUROC = 0.87) for F ≥ 2 with a cut-off value of 1.63m/s; 82.4%(0.64-1.00) and 78.5%(0.69-0.89)(AUROC = 0.86) for F ≥ 3 with a cut-off value of 1.84m/s; and 92.3%(0.78-1.00] and 81.6%(0.72-0.90)(AUROC = 0.89) for F = 4 with a cut-off value of 1.94 m/s.CONCLUSION: ARFI is an accurate, non-invasive and easy method for assessing liver fibrosis in patients with ALD undergoing alcoholic detoxification. 展开更多
关键词 ALCOHOLIC liver disease ELASTOGRAPHY NONINVASIVE Acoustic radiation force IMPULSE FIBROSIS
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Iron metabolism imbalance at the time of listing increases overall and infectious mortality after liver transplantation 被引量:2
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作者 Elodie Fallet Michel Rayar +9 位作者 Amandine Landrieux Christophe Camus Pauline Houssel-Debry Caroline Jezequel ludivine legros Thomas Uguen Martine Ropert-Bouchet Karim Boudjema Dominique Guyader Edouard Bardou-Jacquet 《World Journal of Gastroenterology》 SCIE CAS 2020年第16期1938-1949,共12页
BACKGROUND Liver transplantation(LT)is the best treatment for patients with liver cancer or end stage cirrhosis,but it is still associated with a significant mortality.Therefore identifying factors associated with mor... BACKGROUND Liver transplantation(LT)is the best treatment for patients with liver cancer or end stage cirrhosis,but it is still associated with a significant mortality.Therefore identifying factors associated with mortality could help improve patient management.The impact of iron metabolism,which could be a relevant therapeutic target,yield discrepant results in this setting.Previous studies suggest that increased serum ferritin is associated with higher mortality.Surprisingly iron deficiency which is a well described risk factor in critically ill patients has not been considered.AIM To assess the impact of pre-transplant iron metabolism parameters on posttransplant survival.METHODS From 2001 to 2011,553 patients who underwent LT with iron metabolism parameters available at LT evaluation were included.Data were prospectively recorded at the time of evaluation and at the time of LT regarding donor and recipient.Serum ferritin(SF)and transferrin saturation(TS)were studied as continuous and categorical variable.Cox regression analysis was used to determine mortality risks factors.Follow-up data were obtained from the local and national database regarding causes of death.RESULTS At the end of a 95-mo median follow-up,196 patients were dead,38 of them because of infections.In multivariate analysis,overall mortality was significantly associated with TS>75%[HR:1.73(1.14;2.63)],SF<100μg/L[HR:1.62(1.12;2.35)],hepatocellular carcinoma[HR:1.58(1.15;2.26)],estimated glomerular filtration rate(CKD EPI Cystatin C)[HR:0.99(0.98;0.99)],and packed red blood cell transfusion[HR:1.05(1.03;1.08)].Kaplan Meier curves show that patients with low SF(<100μg/L)or high SF(>400μg/L)have lower survival rates at 36 mo than patients with normal SF(P=0.008 and P=0.016 respectively).Patients with TS higher than 75%had higher mortality at 12 mo(91.4%±1.4%vs 84.6%±3.1%,P=0.039).TS>75%was significantly associated with infection related death[HR:3.06(1.13;8.23)].CONCLUSION Our results show that iron metabolism imbalance(either deficiency or overload)is associated with post-transplant overall and infectious mortality.Impact of iron supplementation or depletion should be assessed in prospective study. 展开更多
关键词 Iron deficiency OVERLOAD Cirrhosis Infection Death FERRITIN TRANSFERRIN saturation
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