Liver hydatidosis is the most common clinical presentation of cystic echinococcosis(CE).Ultrasonographic mass surveys have demonstrated the true prevalence,including the asymptomatic characteristic of the majority of ...Liver hydatidosis is the most common clinical presentation of cystic echinococcosis(CE).Ultrasonographic mass surveys have demonstrated the true prevalence,including the asymptomatic characteristic of the majority of cases,providing new insight into the natural history of the disease.This raises the question of whether to treat or not to treat these patients,due to the high and unsuspected prevalence of CE.The high rate of liver/lung frequencies of cyst localization,the autopsy findings,and the involution of cysts demonstrated in long time follow-up of asymptomatic carriers contribute to this discussion.The decision to treat an asymptomatic patient by surgery,albendazole,or puncture aspiration injection and reaspiration or to wait and watch,is based on conflicting reports in the literature,the lack of complications in untreated patients over time,and the spontaneous disappearance and involution of cysts.All these points contribute to difficulties of individual clinical decisions.The patients should be informed of the reasons and the risks of watchful/waiting without treatment,the possibility of complications,and the risks of the other options.As more information on the natural history of liver hydatidosis is acquired,selection of the best treatment will be come easier.Without this knowledge it would be very difficult to establish definitive rules of treatment.At present,it is possible to manage these patients over time and to wait for the best moment for treatment.Followup studies must be conducted to achieve this objective.展开更多
AIM:To investigate if non-alcoholic fatty liver disease (NAFLD) is an early mediator for prediction of metabolic syndrome,and if liver B-ultrasound can be used for its diagnosis.METHODS:We classified 861 obese childre...AIM:To investigate if non-alcoholic fatty liver disease (NAFLD) is an early mediator for prediction of metabolic syndrome,and if liver B-ultrasound can be used for its diagnosis.METHODS:We classified 861 obese children (6-16 years old) into three subgroups:group 0 (normal liver in ultrasound and normal transaminases);group 1 (fatty liver in ultrasound and normal transaminases);and group 2 (fatty liver in ultrasound and elevated transaminases).We measured the body mass index,waist and hip circumference,blood pressure,fasting blood glucose,insulin,homeostasis model assessment of insulin resistance (HOMA-IR),whole-body insulin sensitivity index (WBISI),lipid profile and transaminases in all the participants.The risk of developing metabolic syndrome (MS) was assessed according to the degree of liver fatty infiltration based on the B-ultrasound examination.RESULTS:Among the 861 obese children,587 (68.18%) were classified as having NAFLD,and 221 (25.67%) as having MS.The prevalence of MS in NAFLD children (groups 1 and 2) was 37.64% (221/587),which was much higher than that in non-NAFLD group (group 0,12.04%) (P < 0.01).There were significantly higher incidences concerning every component of MS in group 2 compared with group 0 (P < 0.05).The incidence of NAFLD in MS patients was 84.61% (187/221),which was significantly higher than that of hypertension (57.46%,127/221) and glucose metabolic anomalies (22.62%,50/221),and almost equal to the prevalence of dyslipidemia (89.14%,197/221).Based on the B-ultrasound scales,the presence of moderate and severe liver fatty infiltration carried a high risk of hypertension [odds ratio (OR):2.18,95% confidence interval (95% CI):1.27-3.75],dyslipidemia (OR:7.99,95% CI:4.34-14.73),impaired fasting glucose (OR:3.65,95% CI:1.04-12.85),and whole MS (OR:3.77;95% CI:1.90-7.47,P < 0.01).The state of insulin resistance (calculated by HOMA-IR and WBISI) deteriorated as the degree of fatty infiltration increased.CONCLUSION:NAFLD is not only a liver disease,but also an early mediator that reflects metabolic disorder,and liver B-ultrasound can be a useful tool for MS screening.展开更多
文摘Liver hydatidosis is the most common clinical presentation of cystic echinococcosis(CE).Ultrasonographic mass surveys have demonstrated the true prevalence,including the asymptomatic characteristic of the majority of cases,providing new insight into the natural history of the disease.This raises the question of whether to treat or not to treat these patients,due to the high and unsuspected prevalence of CE.The high rate of liver/lung frequencies of cyst localization,the autopsy findings,and the involution of cysts demonstrated in long time follow-up of asymptomatic carriers contribute to this discussion.The decision to treat an asymptomatic patient by surgery,albendazole,or puncture aspiration injection and reaspiration or to wait and watch,is based on conflicting reports in the literature,the lack of complications in untreated patients over time,and the spontaneous disappearance and involution of cysts.All these points contribute to difficulties of individual clinical decisions.The patients should be informed of the reasons and the risks of watchful/waiting without treatment,the possibility of complications,and the risks of the other options.As more information on the natural history of liver hydatidosis is acquired,selection of the best treatment will be come easier.Without this knowledge it would be very difficult to establish definitive rules of treatment.At present,it is possible to manage these patients over time and to wait for the best moment for treatment.Followup studies must be conducted to achieve this objective.
基金Supported by Zhejiang Provincial Natural Science Foundation,No.Y2080047funds for Zhejiang Major Medical and Health Science and Technology Program+2 种基金 funds from Ministry of Health,No.WKJ2008-2-026Major Special Zhejiang Provincial Science and Technology Fund,No.2008c03002-1the National Key Technology R&D Program of China,No.2009BAI80B01
文摘AIM:To investigate if non-alcoholic fatty liver disease (NAFLD) is an early mediator for prediction of metabolic syndrome,and if liver B-ultrasound can be used for its diagnosis.METHODS:We classified 861 obese children (6-16 years old) into three subgroups:group 0 (normal liver in ultrasound and normal transaminases);group 1 (fatty liver in ultrasound and normal transaminases);and group 2 (fatty liver in ultrasound and elevated transaminases).We measured the body mass index,waist and hip circumference,blood pressure,fasting blood glucose,insulin,homeostasis model assessment of insulin resistance (HOMA-IR),whole-body insulin sensitivity index (WBISI),lipid profile and transaminases in all the participants.The risk of developing metabolic syndrome (MS) was assessed according to the degree of liver fatty infiltration based on the B-ultrasound examination.RESULTS:Among the 861 obese children,587 (68.18%) were classified as having NAFLD,and 221 (25.67%) as having MS.The prevalence of MS in NAFLD children (groups 1 and 2) was 37.64% (221/587),which was much higher than that in non-NAFLD group (group 0,12.04%) (P < 0.01).There were significantly higher incidences concerning every component of MS in group 2 compared with group 0 (P < 0.05).The incidence of NAFLD in MS patients was 84.61% (187/221),which was significantly higher than that of hypertension (57.46%,127/221) and glucose metabolic anomalies (22.62%,50/221),and almost equal to the prevalence of dyslipidemia (89.14%,197/221).Based on the B-ultrasound scales,the presence of moderate and severe liver fatty infiltration carried a high risk of hypertension [odds ratio (OR):2.18,95% confidence interval (95% CI):1.27-3.75],dyslipidemia (OR:7.99,95% CI:4.34-14.73),impaired fasting glucose (OR:3.65,95% CI:1.04-12.85),and whole MS (OR:3.77;95% CI:1.90-7.47,P < 0.01).The state of insulin resistance (calculated by HOMA-IR and WBISI) deteriorated as the degree of fatty infiltration increased.CONCLUSION:NAFLD is not only a liver disease,but also an early mediator that reflects metabolic disorder,and liver B-ultrasound can be a useful tool for MS screening.