RESUMO
INTRODUCTION: Type 1 hepatorenal syndrome (HRS) is a functional renal failure that complicates end-stage cirrhosis. The vasopressin analogue terlipressin has been associated with improved renal function in patients with type 1 HRS. AIM: To evaluate the effectiveness of an infusion of terlipressin plus albumin in reversing type 1 HRS, its tolerability, and its adverse effects. METHODS: Thirteen consecutive patients with cirrhosis and type 1 HRS were included in the study. All patients received terlipressin plus albumin as treatment for HRS. The patients were divided in two groups. Group 1 contained eight patients in whom HRS was reversed with treatment, who were classified as responders. Group 2 contained five patients who were nonresponders. RESULTS: Sixty-one percent of the patients who received terlipressin plus albumin responded to therapy and underwent HRS reversal. In two patients, treatment with terlipressin was stopped because of adverse events. No relapse of HRS after terlipressin withdrawal was observed in this study. CONCLUSION: The rate of successful treatment with terlipressin plus albumin was 61%, similar to that in previously reported controlled trials. However, this is the first experience reported in Mexico. A cardiovascular evaluation is required before the start of treatment with terlipressin. This treatment appears to be an effective therapy for improving renal function in patients with type 1 HRS.
Assuntos
Albuminas/uso terapêutico , Síndrome Hepatorrenal/tratamento farmacológico , Síndrome Hepatorrenal/etiologia , Cirrose Hepática/complicações , Lipressina/análogos & derivados , Creatinina/sangue , Quimioterapia Combinada , Feminino , Síndrome Hepatorrenal/epidemiologia , Humanos , Lipressina/uso terapêutico , Masculino , México , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Terlipressina , Resultado do Tratamento , Vasoconstritores/uso terapêuticoRESUMO
INTRODUCTION: Leptin has been implicated in the pathogenesis of nonalcoholic steatohepatitis. It has also been suggested that adiponectin plays an important role in the transition from fatty liver disease to nonalcoholic steatohepatitis. OBJECTIVE: To evaluate whether leptin and adiponectin levels are related to the degree of necroinflammatory activity and fibrosis in patients with nonalcoholic steatohepatitis. METHODS: Leptin and adiponectin levels were determined in 52 patients with nonalcoholic steatohepatitis and in 49 controls by enzyme-linked immunosorbent analysis. RESULTS: Median (interquartile range) leptin levels were higher in patients with nonalcoholic steatohepatitis than in the controls (5.75 (12.3) ng mL-1 and 2.80 (2.40) ng mL-1, respectively; P = 0.0035). Adiponectin levels were lower in patients with nonalcoholic steatohepatitis than in the controls (6.55 (5.05) mg mL-1 and 9.30 (6.70) mg mL-1, respectively; P = 0.0218). Leptin levels were lower in overweight patients than in obese patients (2.25 (6.73) and 8.0 (16.0) ng mL-1, respectively; P = 0.0025). The amount of necroinflammatory activity observed in liver biopsies correlated positively with the amount of fibrosis (P < 0.0001). Increased lactate dehydrogenase correlated with increased fibrosis in patients with nonalcoholic steatohepatitis (P = 0.0012). Necroinflammatory activity correlated with adiponectin, g-glutamyltranspeptidase, the quantitative insulin-sensitivity check index, and ferritin (P < 0.05). Risk factors for nonalcoholic steatohepatitis in the logistic regression analysis were leptin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and g-glutamyltranspeptidase (P < 0.0001). Only lactate dehydrogenase (P = 0.0012) was significantly associated with advanced fibrosis on logistic regression analysis. CONCLUSIONS: Lactate dehydrogenase was associated with fibrosis and advanced fibrosis. Leptin was associated with nonalcoholic steatohepatitis but not with fibrosis or necroinflammatory activity. Adiponectin was related to necroinflammatory activity. Risk factors for nonalcoholic steatohepatitis were leptin and liver enzymes (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gama-glutamyltranspeptidase).
Assuntos
Fígado Gorduroso/sangue , Leptina/sangue , Adiponectina/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Fígado Gorduroso/etiologia , Fígado Gorduroso/patologia , Feminino , Humanos , L-Lactato Desidrogenase/sangue , Cirrose Hepática/sangue , Cirrose Hepática/etiologia , Modelos Logísticos , Masculino , México , Pessoa de Meia-Idade , Necrose , Obesidade/sangue , Obesidade/complicações , Sobrepeso/sangue , Sobrepeso/complicações , Medição de Risco , Fatores de Risco , Adulto Jovem , gama-Glutamiltransferase/sangueRESUMO
Objetivo. Estudiar el curso clínico y la supervivencia de 4 pacientes con trasplante hepático ortotópico (THO) realizados en Monterrey, N.L. Antecedentes. El programa de THO en humanos se inicio en 1991 en el Hospital Universitario de la UANL en Monterrey. Resultados. Tres pacientes pediátricos con diagnóstico de cirrosis hepáticos por atresia de vías biliares y un paciente adulto con cirrosis hepática alcohólica, todos con clasificación C Child-Pugh. El trasplante realizado fue completo en dos pacientes. Uno pediátrico y un adulto, reducido en dos pacientes pediátricos, uno de éstos con injerto de donador vivo relacionado. El esquema de inmunosupresión fue a base de ciclosporina, esteroides y azatriopina. Complicaciones: hemorragia abdominal; hipertensión arterial; colangitis y colestasis; insuficiencia renal aguda; neumonía, datos de rechazo, sepsis y fuga biliar en dos casos, respectivamente y pancreatitis aguda en un caso. Sobrevida: límites de 16 horas a 3 años con 5 meses. Conclusiones. El THO en pacientes con enfermedades terminales del hígado es una terapéutica quirúrgica moderna capaz de rehabilitar y prolongar la sobrevida de estos pacientes. La factibilidad de THO reducido con donadores vivos constituye una opción ante la escasez de órganos