Objective To evaluate the variation of serum activin A level in liver cirrhotic patients.Methods 83 liver cirrhotic patients (32 Child-Pugh A, 30 Child-Pugh B and 21 Child-Push C) and 32 normal subjects entered the st...Objective To evaluate the variation of serum activin A level in liver cirrhotic patients.Methods 83 liver cirrhotic patients (32 Child-Pugh A, 30 Child-Pugh B and 21 Child-Push C) and 32 normal subjects entered the study. The serum levels of activin A, procollagen Ⅲ peptide and collagen Ⅳ were measured by ELISA. Results Compared with those of normal subjects (0. 76±0. 31ng/ml) ,the serum activin A levels were significantly increased in liver cirrhotic patients(1. 33±0. 83ng/ml, P <0. 01). The levels were higher in Child-Pugh C (1. 45±0. 39ng/ml, P <0. 01) and B( 1. 47±0. 81ng/ml, P <0. 01) than in Child-Pugh A (1.00±0. 35 ng/ml) and normal control group(0. 76±0. 31ng/ml). There was no significant difference between Child-Pugh B and C patients or between Child-Pugh A patients and normal control. In corresponding Child-Pugh grades, the serum activin A levels of those suffering from hepatic encephalopathy, digestive tract hemorrhage, infection or ascites were not different from those without such complications. The Serum activin A level was positively correlated with those of procollagen Ⅲ peptides, collagen Ⅳ and alanine aminotransferase. Conclusion Serum activin A was increased in cirrhotic patients and activin A may be involved in the pathogenesis of hepatic flbrosis.展开更多
AIM： To prospectively long term clinical impact evaluate the short and of selective transarterial chemoembolization （TACE） on fiver function in patients with hepatocellular carcinoma （HCC）. To assess side effects...AIM： To prospectively long term clinical impact evaluate the short and of selective transarterial chemoembolization （TACE） on fiver function in patients with hepatocellular carcinoma （HCC）. To assess side effects in relation to treatments. To analyze the overall survival and HCC progression free survival probability. METHODS： One hundred and seventeen cirrhotic patients with HCC were enrolled. Baseline liver function included Child-Pugh score and serum levels of alanine- aminotransferase （ALT）, prothrombin time （PT） and bilirubin. According to Cancer Liver Italian Program （CLIP） and Barcelona Clinic Liver Cancer （BCLC） staging systems, 71 patients were eligible for TACE; 32 had previously received treatment for HCC. No significant differences in liver function were observed between previously treated and not treated patients. TACE was performed by selective catheterization of the arteries nourishing the lesions. While hospitalized, patients underwent clinical, hematologic and ultrasonographic assessments. One month after TACE a CT scan was performed to assess tumor response. A second TACE was performed ＂on demand＂ Liver function tests were checked in all patients every four months. RESULTS： After first TACE, the mean Child-Pugh score increased from a mean baseline 5.62 ±1.12 to 6.11 ±1.57 at discharge time （P 〈 0.0001）, decreasing after four months to 5.81 ± 0.73 （not significant）. ALT, PT and bilirubin significantly （P 〈 0.0001） increased 24 h after TACE and progressively decreased until discharge. After the second TACE, variations in Child-Pugh score, ALT, PT and bilirubin were comparable to that described after the first TACE. No major complications were observed. The mean follow-up was 14.7 ＋ 6.3 mo （median： 16 mo）. Only one patient died. No other patient experienced important long term worsening of clinical status. The overall survival probability at twenty-four months was 98.18% with a correspondent HCC progression free survival probability of 69%. CONCLUSION： Selective TACE may produce significant, but transitory increases in ALT values, with no major impact on liver function and Child-Pugh score. Preservation of liver function is achievable also in patients previously treated with other therapeutic modalities and in patients undergoing multiple TACE cycles. Liver function can remain stable in the long-term, with optimal medium term survival. This result can be achieved through rigorous patient selection on the basis of tumour characteristics and clinical conditions.展开更多
BACKGROUND Hepatic cirrhosis is associated with greater adverse event rates following surgical procedures and is thought to have a higher risk of complications with interventional procedures in general.However,these s...BACKGROUND Hepatic cirrhosis is associated with greater adverse event rates following surgical procedures and is thought to have a higher risk of complications with interventional procedures in general.However,these same patients often require interventional gastrointestinal procedures such as endoscopic retrograde cholangiopancreatography(ERCP)and endoscopic ultrasound(EUS).While studies examining this scenario exist,the overall body of evidence for adverse event rates associated with ERCP/EUS procedures is more limited.We sought add to the literature by examining the incidence of adverse events after ERCP/EUS procedures in our safety-net hospital population with the hypothesis that severity of cirrhosis correlates with higher adverse event rates.AIM To examine whether increasing severity of cirrhosis is associated with greater incidence of adverse events after interventional ERCP/EUS procedures.METHODS We performed a retrospective study of patients diagnosed with hepatic cirrhosis who underwent ERCP and/or EUS-guided fine needle aspirations/fine needle biopsies from January 1,2016 to March 14,2019 at our safety net hospital.We recorded Child-Pugh and Model for End-stage Liver Disease(MELD-Na)scores at time of procedure,interventions completed,and 30-day post-procedural adverse events.Statistical analyses were done to assess whether Child-Pugh class and MELD-Na score were associated with greater adverse event rates and whether advanced techniques(single-operator cholangioscopy,electrohydraulic lithotripsy/laser lithotripsy,or needle-knife techniques)were associated with higher complication rates.RESULTS 77 procedures performed on 36 patients were included.The study population consisted primarily of middle-aged Hispanic males.30-d procedure-related adverse events included gastrointestinal bleeding(7.8%),infection(6.5%),and bile leak(2%).The effect of Child-Pugh class C vs class A and B significantly predicted adverse events(β=0.55,P<0.01).MELD-Na scores also significantly predicted adverse events(β=0.037,P<0.01).Presence of advanced techniques was not associated with higher adverse events(P>0.05).When MELD-Na scores were added as predictors with the effect of Child-Pugh class C,logistic regression showed MELD-Na scores were a significant predictor of adverse events(P<0.01).The findings held after controlling for age,gender,ethnicity and repeat cases.CONCLUSION Increasing cirrhosis severity predicted adverse events while the presence of advanced techniques did not.MELD-Na score may be more useful in predicting adverse events than Child-Pugh class.展开更多
基金Supported by the National Nature Science Foundation of China( 30170411).
文摘Objective To evaluate the variation of serum activin A level in liver cirrhotic patients.Methods 83 liver cirrhotic patients (32 Child-Pugh A, 30 Child-Pugh B and 21 Child-Push C) and 32 normal subjects entered the study. The serum levels of activin A, procollagen Ⅲ peptide and collagen Ⅳ were measured by ELISA. Results Compared with those of normal subjects (0. 76±0. 31ng/ml) ,the serum activin A levels were significantly increased in liver cirrhotic patients(1. 33±0. 83ng/ml, P <0. 01). The levels were higher in Child-Pugh C (1. 45±0. 39ng/ml, P <0. 01) and B( 1. 47±0. 81ng/ml, P <0. 01) than in Child-Pugh A (1.00±0. 35 ng/ml) and normal control group(0. 76±0. 31ng/ml). There was no significant difference between Child-Pugh B and C patients or between Child-Pugh A patients and normal control. In corresponding Child-Pugh grades, the serum activin A levels of those suffering from hepatic encephalopathy, digestive tract hemorrhage, infection or ascites were not different from those without such complications. The Serum activin A level was positively correlated with those of procollagen Ⅲ peptides, collagen Ⅳ and alanine aminotransferase. Conclusion Serum activin A was increased in cirrhotic patients and activin A may be involved in the pathogenesis of hepatic flbrosis.
文摘AIM： To prospectively long term clinical impact evaluate the short and of selective transarterial chemoembolization （TACE） on fiver function in patients with hepatocellular carcinoma （HCC）. To assess side effects in relation to treatments. To analyze the overall survival and HCC progression free survival probability. METHODS： One hundred and seventeen cirrhotic patients with HCC were enrolled. Baseline liver function included Child-Pugh score and serum levels of alanine- aminotransferase （ALT）, prothrombin time （PT） and bilirubin. According to Cancer Liver Italian Program （CLIP） and Barcelona Clinic Liver Cancer （BCLC） staging systems, 71 patients were eligible for TACE; 32 had previously received treatment for HCC. No significant differences in liver function were observed between previously treated and not treated patients. TACE was performed by selective catheterization of the arteries nourishing the lesions. While hospitalized, patients underwent clinical, hematologic and ultrasonographic assessments. One month after TACE a CT scan was performed to assess tumor response. A second TACE was performed ＂on demand＂ Liver function tests were checked in all patients every four months. RESULTS： After first TACE, the mean Child-Pugh score increased from a mean baseline 5.62 ±1.12 to 6.11 ±1.57 at discharge time （P 〈 0.0001）, decreasing after four months to 5.81 ± 0.73 （not significant）. ALT, PT and bilirubin significantly （P 〈 0.0001） increased 24 h after TACE and progressively decreased until discharge. After the second TACE, variations in Child-Pugh score, ALT, PT and bilirubin were comparable to that described after the first TACE. No major complications were observed. The mean follow-up was 14.7 ＋ 6.3 mo （median： 16 mo）. Only one patient died. No other patient experienced important long term worsening of clinical status. The overall survival probability at twenty-four months was 98.18% with a correspondent HCC progression free survival probability of 69%. CONCLUSION： Selective TACE may produce significant, but transitory increases in ALT values, with no major impact on liver function and Child-Pugh score. Preservation of liver function is achievable also in patients previously treated with other therapeutic modalities and in patients undergoing multiple TACE cycles. Liver function can remain stable in the long-term, with optimal medium term survival. This result can be achieved through rigorous patient selection on the basis of tumour characteristics and clinical conditions.
文摘BACKGROUND Hepatic cirrhosis is associated with greater adverse event rates following surgical procedures and is thought to have a higher risk of complications with interventional procedures in general.However,these same patients often require interventional gastrointestinal procedures such as endoscopic retrograde cholangiopancreatography(ERCP)and endoscopic ultrasound(EUS).While studies examining this scenario exist,the overall body of evidence for adverse event rates associated with ERCP/EUS procedures is more limited.We sought add to the literature by examining the incidence of adverse events after ERCP/EUS procedures in our safety-net hospital population with the hypothesis that severity of cirrhosis correlates with higher adverse event rates.AIM To examine whether increasing severity of cirrhosis is associated with greater incidence of adverse events after interventional ERCP/EUS procedures.METHODS We performed a retrospective study of patients diagnosed with hepatic cirrhosis who underwent ERCP and/or EUS-guided fine needle aspirations/fine needle biopsies from January 1,2016 to March 14,2019 at our safety net hospital.We recorded Child-Pugh and Model for End-stage Liver Disease(MELD-Na)scores at time of procedure,interventions completed,and 30-day post-procedural adverse events.Statistical analyses were done to assess whether Child-Pugh class and MELD-Na score were associated with greater adverse event rates and whether advanced techniques(single-operator cholangioscopy,electrohydraulic lithotripsy/laser lithotripsy,or needle-knife techniques)were associated with higher complication rates.RESULTS 77 procedures performed on 36 patients were included.The study population consisted primarily of middle-aged Hispanic males.30-d procedure-related adverse events included gastrointestinal bleeding(7.8%),infection(6.5%),and bile leak(2%).The effect of Child-Pugh class C vs class A and B significantly predicted adverse events(β=0.55,P<0.01).MELD-Na scores also significantly predicted adverse events(β=0.037,P<0.01).Presence of advanced techniques was not associated with higher adverse events(P>0.05).When MELD-Na scores were added as predictors with the effect of Child-Pugh class C,logistic regression showed MELD-Na scores were a significant predictor of adverse events(P<0.01).The findings held after controlling for age,gender,ethnicity and repeat cases.CONCLUSION Increasing cirrhosis severity predicted adverse events while the presence of advanced techniques did not.MELD-Na score may be more useful in predicting adverse events than Child-Pugh class.
