Addition of statins to the standard treatment in patients with cirrhosis:Safety and efficacy

This review summarizes the safety and efficacy of statins in patients with cirrhosis.Due to concerns about the safety of statins in patients with impaired liver function,they have recently been investigated as a potential treatment option in cirrhosis.The most clinically significant adverse event is statin-related myopathy,and this may be related to the high serum statin concentrations in the setting of severely impaired liver function.Rhabdomyolysis is the most serious and potentially life-threatening manifestation.It has recently been demonstrated that the recommended dose of simvastatin in patients with decompensated cirrhosis would be 20 mg/d because higher values,such as 40 mg/d,are associated with many adverse events,especially muscle injury.Likewise,simvastatin should not be administered to patients with Model for End-stage Liver Disease score>12 and/or Child-Pugh class C because of the high risk of severe muscle injury.Due to the pleiotropic effects,the focus on statins has shifted from being considered harmful to something useful.Through these effects,statins could prevent liver-related morbidity and mortality in cirrhotic patients.Observational studies in large populations of patients with cirrhosis have shown that treatment with statins to decrease high cholesterol levels was associated with a reduced risk of hepatic decompensation,hepatocellular carcinoma development and death.The few randomized controlled trials in patients with cirrhosis and portal hypertension showed that statins lower portal pressure,quite likely through a reduction in hepatic resistance.Another large randomized controlled trial in patients with variceal bleeding showed that simvastatin in addition to standard of care did not prevent rebleeding but improved survival rate.Despite these encouraging outcomes,the quality of the evidence regarding the use of statins is low or very low due to the observational characteristics of most of the studies involved.Therefore,it is advisable to perform further randomized controlled trials on a large series of patients with hard clinical endpoints,using different statin types and varying doses.The objectives would be to prevent liver-related morbidity and mortality rather than treating cirrhosis complications to take additional information that makes it possible to add statins to the standard of care of these patients.

CCL2-2518 A/G and CCR2 190 A/G do not influence the outcome of hepatitis C virus infection in the Spanish population

瞄准：估计在这 chemokine 和它的受体(CCR2 ) 之间的 CCL2 或相互作用是否与长期的丙肝的结果并且与对抗病毒的治疗的回答被联系。方法：有长期的丙肝和 193 非感染的匹配的控制的 284 个病人在这研究被包括。病人们作为 F0-F2 根据他们肝的纤维变性的 Scheuer 分数被分类( n = 202 )或 F3-F4 ( n = 82 )并且根据他们对反肝炎 C 的反应支撑了反应的病毒( HCV )治疗( SR ， n = 101 )或非支撑的反应( NSR ， n = 98 )。-2518 (A/G ) 的 Genotyping CCL2 用 PCR-RFLP 被执行， genotyping 190 (A/G ) 用 PCR 手臂的 CCR2 rs3138042 (G/A ) 的系统，和 genotyping CCR2 使用 Taqman 探针。结果： Univariate 分析识别了趋于影响纤维变性的 4 个参数(感染持续时间时间，病毒的遗传型，性和著名计算机生产厂商层次)和 7 个参数( CCL2G ， CCL2ACCR2A ，病毒血层次，纤维变性舞台，病毒的遗传型，感染持续时间时间和著名计算机生产厂商层次)显著地影响了或趋于影响反应到治疗。Multivariate 分析作为独立地影响了纤维变性舞台和病毒的遗传型的参数识别了性和著名计算机生产厂商层次，感染持续时间时间是独立地影响了反应到处理的二个参数。结论：我们变化在基因对 CCL2/CCR2 学习了的结果 indicate 不在西班牙的人口为 HCV 感染在到处理的结果和反应起一个主要作用。