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Chronic Liver Disease Patients (chronic + liver_disease_patient)
Selected AbstractsAnalysis of ,-globulin mobility on routine clinical CE equipment: Exploring its molecular basis and potential clinical utilityELECTROPHORESIS, Issue 15 2009Dieter Vanderschaeghe Abstract A study was conducted on the variability of ,-globulin mobility in serum protein electrophoresis and its molecular basis. We found that the migration time of ,-globulins can be reproducibly determined (CV=1.1%) on clinical CE equipment. Moreover, we found a significant difference (p<0.001) in the migration of ,-globulins between chronic liver disease patients (n=98) and a healthy reference group (n=47). Serum immunoglobulins were purified from these patients' sera using protein L -agarose and their glycosylation was studied using CE on a DNA sequencer. This glycomics approach revealed that several non-sialylated N-glycans show a moderate Pearson correlation coefficient (r=0.2,0.4) with the migration time of ,-globulins. Their sialylated structures correlate negatively (r=,0.2 to ,0.3). Immunoglobulins are significantly more sialylated in the healthy reference group compared with the patients (p<0.001). We estimated that sialylation heterogeneity contributes about 36% to the molecular variance (carbohydrates and amino acid composition) that affects the electrophoretic mobility of immunoglobulins. This is the first report on the migration time of ,-globulins on a clinical CE instrument and its potential clinical value to the routinely analyzed serum protein CE profiles. [source] Effect of symptomatic gastroesophageal reflux disease on quality of life of patients with chronic liver diseaseHEPATOLOGY RESEARCH, Issue 4 2008Kazutomo Suzuki Aim:, Reflux esophagitis is becoming increasingly more prevalent in Japan. It has been noted that symptomatic gastroesophageal reflux disease (GERD) and chronic liver disease may adversely affect patients' quality of life. Methods:, In the present study, 238 chronic liver disease patients (151 patients with chronic hepatitis and 87 patients with liver cirrhosis) were enrolled. The diagnosis of GERD was made based on the Quality-of-Life and Utility Evaluation Survey Technology questionnaire. Health-related quality of life was evaluated using the Short Forum 36 questionnaire. Results:, Symptomatic GERD was present in 31.8% (48/151) of patients with chronic hepatitis and 36.8% (32/87) of patients with liver cirrhosis. Among the chronic hepatitis group, compared to the GERD-negative group, the GERD-positive group had significantly lower scores in six domains, including "rolelimitation due to physical problem", "bodily pain", "general health perception", "vitality", "role limitation due to emotional problem", and "mental health". Among the cirrhotic group, compared to the GERD-negative group, the GERD-positive group had significantly lower scores in the "role limitation due to emotional problem" domain. Significant improvement in the "physical functioning", "bodily pain", and "general health perception" domain scores was noted in chronic hepatitis patients treated with rabeprazole. Conclusion:, The QOL of chronic liver disease patients with symptomatic GERD was impaired. [source] Development and evaluation of the quality of life instrument in chronic liver disease patients with minimal hepatic encephalopathyJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 3 2009Ying-qun Zhou Abstract Objectives:, The objective was to develop a valid and reliable health-related quality of life (HRQOL) assessment tool to measure the functional and health status of patients with minimal hepatic encephalopathy (mHE). Methods:, Items potentially affecting the HRQOL of these patients were identified, based on the responses from 53 patients with minimal hepatic encephalopathy, from seven liver experts, four epidemiologists and from a PubMed search of the literature. Results were explored using factor analysis and redundant questions were eliminated. The final stated questionnaire was used in 178 patients with mHE to evaluate its reliability and validity. Results:, Thirty-five items proved to be important for 32 respondents in the item reduction sample. The final instrument included five domains (30 items) which were shown as follows: physical functioning (8 items), psychological well-being (7 items), symptoms/side effects (7 items), social functioning (4 items) and general-health (4 items). An inter-item correlation for each of the five domains ranged from 0.220 to 0.776, with a mean of 0.280. Cronbach's alpha for above five domains was 0.8775, 0.8446, 0.8360, 0.7087 and 0.7016 respectively. The test-retest coefficients for the five domains were 0.94, 0.93, 0.96, 0.82 and 0.83 respectively. Factor analysis showed preservation of five components structure. Cumulative variance of principal components was 63.12%. Patients with more advanced disease seemed to have more impairment of their well-being, especially in the symptoms/side effects domain. Conclusions:, The instrument is short, easy to administer and is of good validity and reliability in patients with mHE. [source] Efficacy of granulocyte-macrophage colony-stimulating factor or lamivudine combination with recombinant interferon in non-responders to interferon in hepatitis B virus-related chronic liver disease patientsJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7 2002RAJKUMAR C GUPTAN AbstractBackground and Aims : Non-response to interferon (IFN) monotherapy is a major therapeutic problem in the management of chronic hepatitis B infection. The efficacy of combination therapy to enhance the immunomodulatory effect of IFN by combining granulocyte-macrophage colony-stimulating factor (GMCSF) or decreasing viral load by adding an antiviral agent such as lamivudine was evaluated prospectively. Methods : Twenty-four patients with chronic hepatitis B who were non-responders to previous IFN therapy were randomized to receive an IFN and GMCSF (group A, n = 10) or IFN and lamivudine (group B, n = 14) combination for 6 months. The end-of-treatment response was assessed by hepatitis B virus (HBV)-DNA and hepatitis B e antigen (HBeAg) determination. Results : All patients successfully completed both the treatment schedules. The mean age, alanine aminotransferase (ALT) levels, liver histology, HBV-DNA levels and distribution of HBV genotypes were comparable between the two groups. At the end of treatment there was a significant decrease in mean ALT levels. The HBV-DNA and HBeAg loss was seen in six of 10 (60%) patients in group A and in seven of 14 (50%) patients in group B. During a mean follow-up of 15 ± 3 months, two of six (33%) patients in group A and three of seven (43%) patients in group B relapsed with HBV-DNA and HBeAg positivity, which meant an overall sustained response of 40% and 28%, respectively. None of the factors such as HBV viral load, ALT levels or liver histology could predict the non-response to combination therapy or occurrence of relapse. There was a trend in patients with genotype A compared with genotype D towards non-response to therapy, although the difference was not significant. Conclusions : The combination of IFN plus GMCSF or lamivudine was effective in non-responders to IFN monotherapy. Larger studies using such combination therapies would be helpful in improving treatment strategies for chronic hepatitis B. © 2002 Blackwell Publishing Asia Pty Ltd [source] Hepatitis B virus BCP, precore/core, X gene mutations/genotypes and the risk of hepatocellular carcinoma in IndiaJOURNAL OF MEDICAL VIROLOGY, Issue 7 2010Mohammad Asim Abstract The study aims to characterize mutations of the HBV genome involving BCP, Precore/core and X regions and also defines HBV genotypes in patients of hepatocellular carcinoma (HCC). The study involved 150 HBV-related HCC cases and 136 HBV-related chronic liver disease patients without HCC as controls. HBV DNA was subjected to mutational analysis using SSCP technique, genotyping by RFLP, and direct nucleotide sequencing. HBV DNA was found in 58.7% (88/150) of the HCC cases and 74.3% (101/136) of controls. HBV mutants were observed in 44.3% of HCC cases and 43.2% of controls. HBV/D was prevalent amongst the patients and controls, followed by HBV/A. The prevalence of the TT1504 mutation in the X gene, the V1753 and T1762/A1764 mutations in the BCP region, and G1914 mutation in the core gene were significantly higher in the HCC group than in the non-HCC group. Multivariate analyses showed that the TT1504, V1753, A1762T/G1764A, and the G1914 mutations and the patient's age, sex, and HBeAg status increased the risk of HCC development significantly. Also, patients with HCC had lower levels of serum albumin, viral load, and platelet counts but higher values of alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, bilirubin, and Alpha feto-protein than those of controls (P,<,0.001 for all comparisons). HBV/D was the predominant genotype associated with HCC cases seen in India. The presence of different types of HBV mutations, age, sex, HBeAg status, and viral load was found to increase significantly the risk of HCC development in India. J. Med. Virol. 82: 1115,1125, 2010. © 2010 Wiley-Liss, Inc. [source] Clinical predictors of fibrosis in patients with chronic liver diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2010M. STEPANOVA Aliment Pharmacol Ther,31, 1085,1094 Summary Background, Patients with chronic liver disease and components of metabolic syndrome may be at higher risk for fibrosis. Aim, To assess the impact of clinicodemographic factors on hepatic fibrosis in CLD. Methods, Of 1028 chronic liver disease patients, 964 were included in the analysis. Extensive clinico-demographic and histological data were available. Significant baseline fibrosis (METAVIR stage ,2) and fibrosis progression (increase of ,1 stage in subsequent biopsy) were compared between groups using univariate and multivariate analyses. Results, Compared with HCV and HBV, NAFLD patients were more obese (higher BMI and waist circumference), diabetic, hypertensive and hyperlipidaemic. Significant fibrosis occurred in 55%, 43% and 20% of HCV, HBV and NAFLD, respectively. Factors independently associated with fibrosis in NAFLD included DM, elevated AST and ALT. For viral hepatitis, independent predictors of fibrosis were low platelet count (HBV and HCV), age (HBV) and elevated AST and ALT (HCV). A second biopsy was available for 96 patients with follow-up of about 4 years. Factors independently associated with progression of fibrosis were HCV infection, higher ALT and lower platelet count. Conclusions, Diabetes mellitus is an independent risk factor for fibrosis only in NAFLD. Elevated aminotransferases and/or low platelet counts are independently associated with significant baseline fibrosis or progression of fibrosis, in patients with chronic liver disease. [source] Hepatocyte senescence in end-stage chronic liver disease: a study of cyclin-dependent kinase inhibitor p21 in liver biopsies as a marker for progression to hepatocellular carcinomaLIVER INTERNATIONAL, Issue 5 2007Elizabeth M. Brunt Abstract Background: Histologic markers to predict hepatocellular carcinoma (HCC) include small cell change and dysplastic nodules. Hepatocyte senescence is noted in chronic liver disease and may or may not be important in progression to HCC. Aim: The study was undertaken to compare standard histologic features of chronic liver disease as well as markers of senescence and proliferation in two groups of biopsies from patients followed for at least a year. Methods: Standard histologic evaluation of necroinflammatory activity, fibrosis, steatosis, and iron, internationally accepted criteria of dysplasia, and immunohistochemical markers for proliferation and hepatocyte senescence were compared in 47 liver biopsies from noncholestatic chronic liver disease patients who subsequently either underwent transplant (the Control group, n=19) or had biopsy-proven (HCC group, n=28) over a similar time period of 34.9 months (mean) and 42.5 months (mean) respectively. Results: Both groups were predominantly men; the MELD score was higher, and mean age was less in the Control group (46.9 vs 53.8 years, P=0.01). Small cell change was not significantly different in the biopsies between the two groups; neither were grade, stage (Ishak scores), nor presence or location of iron. Steatosis was more common in the group that subsequently developed HCC (P=0.04). The MIB-1 proliferation index was greater in the biopsies from the Control group. The senescence marker p21, and the ratio of p21:MIB-1 were not statistically different between the two groups. However, a Spearman's rank correlation showed a linear correlation of p21/MIB-1 with a greater amount of dyplasia in the explant livers of Controls. Conclusions: These findings suggested the Control groups' livers maintained effective removal of cells from the cell cycle by overexpression of p21 and, while not ,protected' from significant involvement by dysplasia, may have been precluded from development of HCC. [source] Delayed neuropsychologic dysfunction after liver transplantation for acute liver failure: A matched, case-controlled studyLIVER TRANSPLANTATION, Issue 10 2002Elizabeth W. Jackson Although several studies have identified posttransplant neurologic sequelae in patients with acute liver failure (ALF), the effects of these sequelae on neuropsychologic functioning after transplant is unknown. This study compared neuropsychologic functioning of ALF patients with chronic liver disease patients after liver transplantation. After liver transplantation, seven ALF patients were compared with a matched control group of patients who had been transplanted for chronic liver disease. The patients were matched by gender, age (within 5 years), and time since transplantation (within 2 years). Patients completed a 2-hour battery of tests, which included measures of attention, memory, motor performance, abstract conceptualization, and visuospatial perception. There were no significant differences between the groups on measures of socioeconomic status or education. Significant differences were found on three separate tests: WAIS-III Vocabulary, WAIS-III Similarities, and WMS-III Paired Associate Learning II. Although these tests measure distinct functions (vocabulary knowledge, abstract conceptualization, and delayed verbal recall), they may be influenced by broader verbal functions, such as verbal fluency, conceptualization, and the ability to articulate ideas. When patients were asked what functions had noticeably deteriorated since transplantation, nearly all complained of memory difficulties, and there was no difference between groups. However, more ALF than chronic liver disease (CLD) patients complained of concentration difficulties. The results of this study suggest that ALF patients may experience more neuropsychologic dysfunction after transplant. Further studies are required to expand on these initial observations with the potential to improve patient care and referral to appropriate rehabilitative services. [source] Improved Survival After Liver Transplantation in Patients with Hepatopulmonary SyndromeAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2010S. Gupta Hepatopulmonary syndrome (HPS) is present in 10,32% of chronic liver disease patients, carries a poor prognosis and is treatable by liver transplantation (LT). Previous reports have shown high LT mortality in HPS and severe HPS (arterial oxygen (PaO2) ,50 mmHg). We reviewed outcomes in HPS patients who received LT between 2002 and 2008 at two transplant centers supported by a dedicated HPS clinic. We assessed mortality, complications and gas exchange in 21 HPS patients (mean age 51 years, MELD score 14), including 11/21 (52%) with severe HPS and 5/21 (24%) with living donor LT (median follow-up 20.2 months after LT). Overall mortality was 1/21 (5%); mortality in severe HPS was 1/11 (9%). Peritransplant hypoxemic respiratory failure occurred in 5/21 (24%), biliary complications in 8/21 (38%) and bleeding or vascular complications in 6/21 (29%). Oxygenation improved in all 19 patients in whom PaO2 or SaO2 were recorded. PaO2 increased from 52.2 ± 13.2 to 90.3 ± 11.5 mmHg (room air) (p < 0.0001) (12 patients); a higher baseline macroaggregated albumin shunt fraction predicted a lower rate of postoperative improvement (p = 0.045) (7 patients). Liver transplant survival in HPS and severe HPS was higher than previously demonstrated. Severity of HPS should not be the basis for transplant refusal. [source] | |||||||||||||||||||||||||