RESUMO
BACKGROUND: To assess the prognostic value of plasmatic fibronectin (FN), compared to numeric Child-Pugh classification and its biochemical parameters in patients with alcoholic cirrhosis followed prospectively during a 18 months-period. METHODS: Fifty patients with the diagnosis of cirrhosis by hepatic biopsy or clinical and biochemical criteria, were included in the study after the exclusion of hepatocarcinoma and GI bleeding, infection or continous alcohol ingestion in the last 30 days. The mean age was 51.3+/-12.6 years, being 72% males and 17 of them were classified as Child-Pugh A, 18 as B and 15 as C. Serum bilirubin concentration was measured in autoanalyzer, protein electrophoresis was performed on cellulose acetate and prothrombin time by the Quick test. Plasmatic FN was assessed by radial immunodiffusion with anti-human FN in 1% agarose gel slabs. RESULTS: One patient was excluded because no natural death and 12 died owing to hepatic disease. The numeric Child-Pugh [score > 10, Relative Risk (RR)=11.33] and total bilirubins (> 2.5 mg/dL, RR=9.47) were the best predictors of death. Mean plasmatic FN concentration was significantly higher among those who survived when compared with those who died (185+/-66 mg/L x 131+/-38 mg/L, p<0.01), with a RR=6.59, for FN < 165 mg/L. Higher levels of FN, on the other hand, were the best variable to predict survival, since 96% of these 29 patients were alive at the end of follow-up. CONCLUSION: Although having less accuracy in predicting the risk of death of these patients, plasmatic FN > 165 mg/L was better predictor of survival than Child-Pugh score or any one of its biochemical parameters.
Assuntos
Fibronectinas/sangue , Cirrose Hepática Alcoólica/classificação , Biomarcadores , Brasil/epidemiologia , Eletroforese em Acetato de Celulose , Feminino , Seguimentos , Humanos , Cirrose Hepática Alcoólica/sangue , Cirrose Hepática Alcoólica/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Sensibilidade e Especificidade , Análise de SobrevidaRESUMO
OBJETIVOS: Avaliar o valor prognóstico da fibronectina plasmática (FN), comparativamente à classificação numérica de Child-Pugh e os parâmetros bioquímicos que a compõem, no acompanhamento prospectivo de portadores de cirrose alcoólica durante 18 meses. MÉTODOS: Incluídos 50 pacientes com cirrose alcoólica, diagnosticada por biópsia ou critérios clínico-bioquímicos, excluídos aqueles com hepatocarcinoma ou hemorragia digestiva, infecção ou ingestão alcoólica continuada nos últimos 30 dias. A idade média do grupo foi 51,3±12,6 anos, 72 por cento deles do sexo masculino e classificados 17 como Child-Pugh A, 18 como B e 15 como C. Os valores das bilirrubinas foram dosados pelo método automatizado, eletroforese de proteínas em acetato de celulose e o tempo de protrombina pelo método de Quick. A FN plasmática foi dosada por imunodifusão radial, com anticorpos contra FN humana em géis de agarose a 1 por cento. RESULTADOS: Um paciente foi excluído por óbito de causa não natural e 12 foram a óbito por doença hepática. Os melhores preditores de óbito foram a pontuação de Child-Pugh [escore>10, risco relativo (RR) de 11,33) e os valores de bilirrubina (>2,5mg/dL, RR=9,47). A concentração de FN foi significantemente maior nos sobreviventes que naqueles que foram a óbito (185±66 mg/L x 131±38mg/L, p<0,01), com RR = 6,59 para FN<165mg/L. Valores de FN acima desse valor de corte, entretanto, foram os melhores indicadores de sobrevida desde que 96,5 por cento desses 29 pacientes estavam vivos ao final de 18 meses de seguimento. CONCLUSAO: Embora apresente menor acurácia em predizer o risco de óbito desses pacientes, valores de FN plasmática> 165mg/L foram melhores indicadores de sobrevida que a classificação de Child-Pugh e seus parâmetros bioquímicos isolados.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Fibronectinas/sangue , Cirrose Hepática Alcoólica/classificação , Biomarcadores , Brasil/epidemiologia , Eletroforese em Acetato de Celulose , Seguimentos , Cirrose Hepática Alcoólica/sangue , Cirrose Hepática Alcoólica/mortalidade , Valor Preditivo dos Testes , Prognóstico , Sensibilidade e Especificidade , Análise de SobrevidaRESUMO
Se presenta un estudio clínico prospectivo, descriptivo de 5 años de duración, llevado cabo en la unidad de Gastroenterología del Hospital Universitario de La Samaritana (HUS), realizado 121 pacientes con Enfermedad hepática alcohólica. Fueron notorios el predominio del sexo masculino, la procedencia rural, prolongado tiempo de consumo, los altos volúmenes ingeridos, el predominio de bebidas fermentadas; el avanzado estado de deterioro clínico de los pacientes al momento de la evaluación; lo cual se corroboró mediante la clasificación de CHILD-PUGH
Assuntos
Humanos , Alcoolismo , Cirrose Hepática Alcoólica , Cirrose Hepática Alcoólica/classificaçãoRESUMO
Bleeding from esophageal varices is the major cause of death in patients with portal hypertension. The ideal surgical procedure should effectively control bleeding, with as little impairment of liver function as possible and with low rates of encephalopathy. Based on this objective, we propose the azygoportal disconnection (APD) with splenic artery ligation, and suturing of the gastric and esophageal varies without opening the esophagus, by video laparoscopy. With the patient placed in a semigynecologic position, we use five trocars, and the intervention begins by dissection of the diaphragmatic hiatus and isolation of the esophagus. Then devascularization of the gastric fundus is accomplished. After that, dissection and ligature between clips of the splenic artery are performed. The surgery proceeds with dissection and ligation of the vessels of the lesser curvature. After orally introducing a 12-mm Fouchet probe, we suture the varices of the distal esophagus transmurally, with interrupted sutures. The procedure is accomplished with a floppy Nissen valve. Between March 1994 and May 1995, four patients were treated with this method, two men and two women with a mean age of 54 years. All of them had hepatic cirrhosis. Three patients were classified Child B and the other Child C. Surgical indication in all subjects was persistent bleeding of the esophageal varices, after failure of such clinical attempts as endoscopic sclerosis and tamponade with the Sangstaken-Blakemore balloon. The operation mean time was 177 min. Neither bleeding nor hemodynamic changes occurred during the surgery. The patients were sent to the intensive care unit (ICU) postoperatively for a mean time of 3 days, and they were discharged from the hospital between days 8 and 10. The evolution demonstrated stabilization of the hepatic function and regression of the varices from grades III and IV to grade I. No bleeding recurred. Although this study had a small number of patients, we believe that this operation made by mini-invasive technique permits a quick recovery, reducing the global morbidity of this procedure.