RESUMEN
Background: Several studies have investigated certain fibrosis markers that incorporate liver function tests, fragments of liver-matrix components and/or degraded products generated by hepatic stellate cells for determining the degree of hepatic fibrosis. However, the role of these molecules in the development of hepatic fibrosis is unclear. This work aimed (a) to determine whether platelet-derived growth factor (PDGF) is linked to different stages of hepatic fibrosis and (b) investigate its diagnostic performance alongside other laboratory and demographic factors in assessing liver fibrosis in chronic hepatitis C infection. Methods: Liver-fibrosis was staged according to Fibroscan, PDGF quantified using ELISA, and liver function tests and other analytes determined by standard techniques in 239 patients with chronic hepatitis C virus infection. Results: Patients with significant (F2-F4), advanced fibrosis (F3-F4) and cirrhotic liver disease (F4) showed significantly (P<0.0001) higher PDGF levels increase respectively compared to stage F0/1. We used this to construct the PARA-Index (PDGF/albumin ratio, age), which performed well in assessing hepatic-fibrosis stages with AUCs of 0.91, 0.87 and 0.86 for identifying F2-F4, F3-F4 and F4, respectively. Additionally, the PARA-Index correlated strongly (r=0.65, P<0.0001) with the severity of the fibrosis. An elevated PARA-index provided odds ratios of 21.0, 20.7 and 10.3 for developing F2-F4, F3-F4 and F4, respectively. Conclusion: A panel of mitogenic (PDGF), biochemical (albumin) and demographical (age) parameters may improve liver-fibrosis staging with a high degree of accuracy in those with a hepatitis C virus infection.
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Albúminas/metabolismo , Biomarcadores/metabolismo , Hepatitis C Crónica/metabolismo , Cirrosis Hepática/metabolismo , Factor de Crecimiento Derivado de Plaquetas/metabolismo , Adulto , Femenino , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/virología , Humanos , Hígado/metabolismo , Hígado/fisiopatología , Hígado/virología , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/virología , Masculino , Persona de Mediana Edad , Mitógenos/metabolismo , Curva ROC , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Fibrosis markers are useful for the prediction of cirrhosis but clinical scores such as King's score, AST-Platelet ratio index (APRI), Biotechnology research center (BRC), Fibrosis routine test (FRT), Fibro-α score and Fibro-quotient (FibroQ) have limited accuracy for diagnosing significant fibrosis. We hypothesised that new markers (reflecting the balance between hepatic fibrogenesis and fibrolysis) together with other indirect fibrosis markers would together construct a more sensitive and specific score capable of identifying fibrosis than existing scores. METHODS: Collagen IV, hyaluronic acid, platelet-derived growth factor (PDGF) and tissue inhibitor of metalloproteinase-1 (TIMP-1) were measured by ELISA, and AST, ALT, platelet count, albumin, total bilirubin, INR and AFP by routine methods in 148 patients with hepatitis C induced liver disease. Stepwise linear discriminant analysis and area under receiver-operating characteristic curves (AUCs) were used to create a predictive score and compare it to others. RESULTS: Patients with significant fibrosis (n = 100, F2-F4) showed 2.08, 2.14, 1.80 and 1.90-fold increase in collagen IV, hyaluronic acid, PDGF and TIMP-1, respectively, over patients with no or mild fibrosis (n = 48, F0/F1)(all p < 0.01). Significant independent predictors of F2-F4 were AFP (AUC 0.79), age (0.76), PDGF (0.74), collagen IV (0.78) and TIMP (0.75), which together formed a five-marker score 'Fibro-Mark' for predicting F2-F4. In comparison with other scores, AUC for Fibro-Mark was 0.89, BRC was 0.83, followed by FRT and King's score (both 0.82), APRI (0.80), Fibro-α (0.70) and finally Fibro Q (0.63). CONCLUSIONS: The Fibro-Mark score provides better discrimination in hepatic-fibrosis staging in chronic hepatitis C patients than existing scores.
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Colágeno Tipo IV/sangre , Hepatitis C Crónica/diagnóstico , Ácido Hialurónico/sangre , Cirrosis Hepática/diagnóstico , Factor de Crecimiento Derivado de Plaquetas/metabolismo , Inhibidor Tisular de Metaloproteinasa-1/sangre , Adulto , Alanina Transaminasa/sangre , Área Bajo la Curva , Aspartato Aminotransferasas/sangre , Bilirrubina/sangre , Biomarcadores/sangre , Análisis Discriminante , Femenino , Hepacivirus/patogenicidad , Hepacivirus/fisiología , Hepatitis C Crónica/sangre , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/virología , Humanos , Relación Normalizada Internacional , Hígado/metabolismo , Hígado/patología , Hígado/virología , Cirrosis Hepática/sangre , Cirrosis Hepática/complicaciones , Cirrosis Hepática/virología , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Valor Predictivo de las Pruebas , Pronóstico , Albúmina Sérica/metabolismo , Índice de Severidad de la Enfermedad , alfa-Fetoproteínas/metabolismoRESUMEN
UNLABELLED: Although hypovitaminosis D has been reported in the neonatal period and infancy, there is currently little information on the longitudinal changes in vitamin D status throughout early infancy. AIM: To estimate, in Al Ain, UAE, the prevalence of vitamin D deficiency and longitudinal changes and risk factors in infants between birth and 6 months of age. METHODS: Serum 25-OH-vitamin-D levels were measured after birth and 6 months later in 27 infants of mothers of Middle Eastern or Asian origin who were pregnant between the months of September and November 2007. RESULTS: At delivery, mean (SD) maternal serum 25-OH-vitamin-D level was 35.5 nmol/L (24.7); five mothers (22%, 95% CI 0.7-43) had adequate serum levels (>50 mmol/L), 11 (48%, 95% CI 27-70) insufficient levels (25-50 nmol/L) and seven (30%, 95% CI 13-53) deficient (<25 nmol/L) levels. Serum 25-OH-vitamin-D levels were adequate in eight infants (30%, CI 14-50%), insufficient in 13 (48%, CI 28-60%) and deficient in six (22%, CI 8.5-42%). Despite recommendations, none had received any vitamin D supplementation since birth. Despite the high prevalence of hypovitaminosis D at birth and the lack of pharmacological supplementation, the number of infants with adequate levels at 6 months of age rose to 20 (87%, CI 66-97%). No infant had deficiency (CI 0-21%) and three (13%, CI 27-33%) had insufficiency. Adequate levels were detected in four infants who were partially breastfed [mean (SD) 108.5 (20.7) nmol/L] and in only 84% of the 19 exclusively breastfed infants [mean (SD) 96.2 (44.5) nmol/L] but the difference was not statistically significant. Although serum levels improved at 6 months, it occurred more slowly in exclusively breastfed infants. CONCLUSION: In the absence of vitamin D supplementation, guidelines for vitamin D supplementation in infancy still need to be followed because the mechanisms for normalisation are not clearly understood.
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Deficiencia de Vitamina D/diagnóstico , Deficiencia de Vitamina D/epidemiología , Vitamina D/sangre , Femenino , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Prevalencia , Factores de RiesgoRESUMEN
Prospective longitudinal study of vitamin D status and its risk factors in 75 pregnant women from early pregnancy until 6 months postpartum, by serial measurement of serum 25 (OH) vitamin D levels. The serum levels at booking were not significantly different between nationalities (p = 0.06), parity (p = 0.2), education levels (p = 0.4), dress code (p > 0.5), consumption of vitamin D fortified milk (p = 0.2) or, fatty fish (p = 0.5), sun-exposed body surface area (p = 0.3), weekly time exposed to the sun (p = 0.08) or the sun exposure index (p = 0.2). Vitamin D status progressively worsened as the proportion with adequate serum levels fell from 31% at the antenatal visit, to 23% after birth and 17%, 6 months later (p = 0.02). While 80% of mothers who were exclusively breast-feeding had low vitamin D levels 6 months after delivery, this occurred in only 67% of those partially breast-feeding (p = 0.6).
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Complicaciones del Embarazo/etnología , Deficiencia de Vitamina D/etnología , Adolescente , Adulto , Femenino , Humanos , Estudios Longitudinales , Periodo Posparto , Embarazo , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Emiratos Árabes Unidos/epidemiología , Adulto JovenRESUMEN
AIM: To determine and compare the usefulness of cord blood screening for free thyroxine (FT4) and thyroid stimulating hormone (TSH). BACKGROUND: There is a vast amount of literature on capillary heel prick screening tests, but relatively little on cord blood testing particularly FT4. For a decade all infants born at Tawam Hospital had cord blood FT4 and at Oasis Hospital cord TSH measured through the hospital-based screening programme. On January 1st 1998, the national screening programme (NSP) for congenital hypothyroidism (CH) in the United Arab Emirates (UAE) started using capillary TSH measurement (Delfia method). Since then newborns in both hospitals have been screened both ways, i.e. cord blood and capillary blood screening. METHODS: We reviewed retrospectively all infants born from January 1998 until the end of June 2004 with CH who had double screening: cord FT4 or TSH and 4th-5th day TSH screening. RESULTS: Thirteen infants (one in 1,778) had CH in Tawam Hospital. In six of these the cord blood FT4 was low (<9.1 pm/l) (0.73 ng/dl) and in seven the cord blood FT4 was normal, i.e., over half were missed. Eight infants (one in 1,198) had CH in the Oasis Hospital. Cord blood TSH was high in six of them (>13 IU/l) and two were normal. Cord FT4 detected the most severe cases, but missed most others. Cord TSH detected six out of eight cases, but there was a recall rate of one in 23. CONCLUSIONS AND RECOMMENDATIONS: Cord FT4 identifies only infants with severe CH. Cord TSH is more sensitive than cord FT4 screening. Capillary TSH dried blood spot testing on the 3rd-5th day is the most sensitive method.