Value of hematological parameters as biomarkers of disease manifestations and severity in systemic sclerosis

Aim of the workTo investigate the value of neutrophil- lymphocyte ratio (NLR), platelet- lymphocyte ratio (PLR), red blood cell distribution width (RDW), mean platelet volume (MPV) as biomarkers of disease severity and clinical manifestations in systemic sclerosis (SSc).Patients and methodsThis study included 35 SSc patients, together with 45 controls. Disease severity was assessed by Medsger severity score (MSS). NLR, PLR, MPV, RDW were measured by COULTER LH 750 assay analyzer.ResultsThe mean age of SSc patients and controls was 42.8 ± 12.6 and 40.8 ± 9.7 years respectively. MPV, RDW, NLR, PLR were significantly higher in patients compared to controls (p = 0.03, < 0.001, <0.001, 0.02). NLR, PLR were significantly higher in patients presenting with myositis (p = 0.002, 0.004), and proximal muscle weakness on MSS (p = 0.009, 0.02). NLR was significantly higher in patients with severe peripheral vascular ischemia (p = 0.02). RDW was significantly higher in patients with higher general MSS (p = 0.03) NLR, PLR were significantly positively correlated with severity of muscle weakness (p = 0.001, 0.004), RDW was significantly associated with general MSS (p = 0.002). NLR and PLR were the valuable predictors of muscle involvement (p = 0.003, 0.005) and severity of muscle weakness (p = 0.001, 0.003).ConclusionMPV, RDW, NLR, PLR were significantly higher in SSc patients suggesting their role as biomarkers reflecting the enduring inflammatory process in SSc. Increased NLR and PLR were related to muscular involvement, and severity of muscular weakness. Increased NLR predicted severity of peripheral vascular ischemia and elevated RDW predicted general severity, MPV did not predict severity or disease manifestations of SSc.     

Post-operative albumin-bilirubin grade predicts long-term outcomes among Child–Pugh grade A patients with hepatocellular carcinoma after curative resection

Background: Although Child–Pugh grade A patients with hepatocellular carcinoma(HCC) are candidates for curative resection, some may have a poor prognosis. The albumin-bilirubin(ALBI) grade, a measure of liver function based on albumin and bilirubin, has the potential to detect Child–Pugh grade A HCC patients with poor prognosis. Because components of the ALBI grade can be measured easily even after surgery, we explored the predictive values of ALBI in patient prognosis after HCC resection. Methods: In this retrospective case-control study, we included 136 HCC patients who underwent curative resection between January 2004 and December 2013 at our hospital. ALBI grade was calculated from laboratory data recorded the day before surgery and at post-operative day 5. Results: Pre-and post-operative ALBI grade predicted patients' long-term outcomes( P = 0.020 and P 0.001, respectively, for overall survival, and P = 0.012 and P = 0.015, respectively, for recurrence-free survival). Post-operative ALBI grade was associated with patients' surgical factors of repeated hepatic resection( P = 0.012), intra-operative bleeding( P = 0.006), and surgery duration( P = 0.033). Furthermore, post-operative ALBI grade, rather than pre-operative ALBI grade, was an independent predictive factor of long-term outcome of Child–Pugh grade A patients with HCC. Conclusions: Post-operative ALBI grade is useful to predict the prognosis in patients after HCC resection.     

大量放腹水后输注人体白蛋白疗效的 Meta 分析

目的：评估肝硬化合并腹水患者经腹腔大量穿刺放液后（LVP）输注人体白蛋白的疗效。方法检索Cochrane 图书馆、PubMed、Embase、High Wire Press、web of Science、中国生物医学文献数据库、中国知网、维普数据库和万方数据库,收集用人体白蛋白治疗肝硬化腹水的随机对照试验的论文。根据纳入标准对文献进行筛选和评估,采用RevMan 5．2软件进行统计分析,计算相对危险度（RR）和95％置信区间（CI ）,试验组静脉输注人体白蛋白,对照组静脉滴注人工胶体或者血管加压素,比较试验组与对照组 LVP 后 PCD、低钠血症、肾损伤、住院病死率的情况。结果最终纳入文献13篇,均为英文文献。Meta 分析结果显示,试验组穿刺后循环障碍（PCD）发生率为14．76％,低于对照组的31．98％,差异有统计学意义（RR ＝0．48,95％ CI ：0．364～0．63,P ＜0．01）。试验组低钠血症发生率（8．12％）低于对照组（15．28％）,差异有统计学意义（RR＝0．57,95％CI ：0．37～0．87,P ＝0．009）。试验组肾损伤发生率（5．62％）低于对照组（7．03％）,差异无统计学意义（RR ＝0．88,95％CI ：0．53～1．44,P ＝0．61）。试验组住院病死率（9．56％）低于对照组（12．55％）,差异有统计学意义（RR＝0．58,95％CI ：0．364～0．93,P ＝0．02）。结论输注人体白蛋白在预防肝硬化腹水患者 LVP 后 PCD、低钠血症方面有优势,且住院病死率降低。     

肝硬化腹水患者长期应用白蛋白治疗的现状与前景

目前,白蛋白在肝硬化腹水患者中的应用主要是预防腹腔穿刺术后循环功能障碍、预防自发性腹膜炎患者肾功能障碍和治疗肝肾综合征。近期研究发现,长期白蛋白治疗能够降低肝硬化腹水患者并发症的发生率并改善整体预后,由此带来对白蛋白临床应用指征新的思考。结合目前已开展的肝硬化腹水患者中长期应用白蛋白的临床研究进行阐述,旨在为国内开展长期白蛋白应用临床研究提供循证依据。     

Concise review: Interferon-free treatment of hepatitis C virus-associated cirrhosis and liver graft infection

Chronic hepatitis C is a major reason for development of cirrhosis and hepatocellular carcinoma and a leading cause for liver transplantation. The development of direct-acting antiviral agents lead to (pegylated) interferon-alfa free antiviral therapy regimens with a remarkable increase in sustained virologic response (SVR) rates and opened therapeutic options for patients with advanced cirrhosis and liver graft recipients. This concise review gives an overview about most current prospective trials and cohort analyses for treatment of patients with liver cirrhosis and liver graft recipients. In patients with compensated cirrhosis Child-Pugh-Turcotte (CTP) class A, all approved agents are safe and SVR rates do not significantly differ from patients without cirrhosis in general. In patients with decompensated cirrhosis CTP class B or C, daclastasvir, ledipasvir, velpatasvir, and sofosbuvir are approved, and SVR rates higher than 90% can be achieved. Especially for patients with a model of end stage liver disease score higher than 15 and therefore eligible for liver transplantation, data is scarce. Reported SVR rates in patients with cirrhosis CTP class C are lower compared to patients with a less severe liver disease. In liver transplant recipients with a maximum of CTP class A, SVR rates are comparable to patients without LT. Patients with decompensated graft cirrhosis should be treated on an individual basis.     

Use of albumin in the management of patients with decompensated cirrhosis: An independent verdict

The use of intravenous albumin in cirrhosis has been reactivated during the last two decades. During this period several investigations have shown that albumin (1) prevents circulatory dysfunction in patients with massive ascites treated by paracentesis, (2) prevents circulatory dysfunction and type-1 HRS and increases survival in patients with SBP, and (3) in association with vasoconstrictors normalizes circulatory function and serum creatinine and increases survival in patients with type-1 HRS. Indications 2 and 3 are clear. There is discussion, however, regarding indication number 1. Although no significant differences in survival have been observed in trials comparing patients treated by paracentesis with and without albumin, in none of these studies was survival an end-point of the trial. In contrast, there is evidence that paracentesis-induced circulatory dysfunction is associated with a bad outcome. In consequence, although further studies on this indication are clearly required, with the current data it is advisable to use albumin as a plasma expander in patients with massive ascites treated by paracentesis.     

UDP-glucuronosyltransferase1A1 directly binds to albumin.

UDP-glucuronosyltransferase1A1 (UGT1A1) catalyses glucuronidation of bilirubin (the final break down product of heme which is produced mainly in the spleen and liver) and is located on the lumen of the endoplasmic reticulum (ER). To identify partner UGTs that form hetero-oligomers with UGT1A1, or other proteins that bind directly to UGT1A1, yeast two-hybrid screening was performed using UGT1A1 as bait. From these studies, cDNA clones specific for human serum albumin (HSA) were unexpectedly isolated. The direct interaction between UGT1A1 and albumin was confirmed in vitro by a pull-down assay. FITC-albumin uptake into HepG2 and Huh7 cells was observed only when bilirubin are present in the culture medium. Furthermore, the endocytosis inhibitor phenylarsine oxide (PAO) prevented albumin uptake into the cells, suggesting that the albumin/bilirubin complex is internalized through receptor-mediated endocytosis. From these studies, it would appear that production of large amounts of toxic bilirubin might use different uptake pathways for entry into hepatocytes.     

Midodrine and albumin for prevention of complications in patients with cirrhosis awaiting liver transplantation. A randomized placebo-controlled trial

1. Download high-res image (185KB)
2. Download full-size image

     

Is the use of albumin of value in the treatment of ascites in cirrhosis? The case in favour

In patients with cirrhosis, ascites accumulates because of sodium retention, triggered by a reduction of the effective arterial blood volume, and imbalanced Starling forces in the splanchnic area due to portal hypertension and hypoalbuminemia. Albumin is the ideal plasma expander in this setting, since it ameliorates systemic and reneal haemodynamics, so reducing sodium retention, and increases oncotic pressure in the splanchnic compartment. In particular, albumin proved useful in patients treated with diuretics, as demonstrated by a randomised study performed at our Instituition in which 126 ascitic inpatients were treated according to a stepped-care diuretic regimen. In fact, patients receiving diuretics plus albumin (n = 63) had a higher cummulative rate of response (p < 0.05) and a shorter hospital stay (20 +/- 1 versus 24 +/- 2 days, p < 0.05) than those given diuretics alone. Treatment with albumin on an outpatient basis (25 g/week) resulted in a lower probability of developing ascites (p < 0.02 vs. patients not given albumin) and a lower probability of readmission (p < 0.02). Patients given albumin also had a better quality of life. As discussed in another article, evidence also supports the use of albumin in patients treated for paracentesis, as well as in patients with spontaneous peritonitis or hepatorenal syndrome.     

肝纤维化的诊断和治疗进展

肝纤维化的诊断手段主要包括病理组织学检查、血清学指标检测及影像学检查,其中肝活检组织病理学检查是诊断肝纤维化和肝硬化的“金标准”,但也有其局限性,肝纤维化的血清学指标包括血清Ⅲ型前胶原氨基端肽、血清层连蛋白P1、血清透明质酸、血清Ⅳ胶原、血清Ⅵ型胶原、基质金属蛋白酶等,这些指标和肝组织病理学纤维化程度有较好的相关性。抗纤维化的治疗包括针对原发病的病因治疗和针对抗肝纤维化本身的治疗。本文对此作一综述。     

Low gradient ascites： A seven-year course review

AIM: To study the patients with low gradient ascites in hospitals of Guilan Province (northern Iran). METHODS: Patients admitted in hospitals of Guilan Province with low gradient ascites from 1993 to 2000 were enrolled in the study. Serum and ascitic fluid albumin levels were determined by biochemical reactions. The serum-ascitic albumin gradient (SAAG) less than 1.1 g/dL was considered low. Statistical analysis was performed with SPSS 9.0 software and P<0.05 was considered statistically significant. RESULTS: Of the 148 patients enrolled in the study, 72 (48.6%) were males and 76 (51.4%) were females with a mean age of 59.03±13.54 years. Tuberculous peritonitis was the most frequent cause of low gradient ascites in 68 (45.9%). Other most frequent causes were cancer in 62 (41.9%), nephrotic syndrome in 9 (6%), pancreatitis in 6 (4%). Peritoneal cancer was found in 22 (35%), ovarian and gastric cancers were found in 14 (22.5%) and 12 (19.3%), respectively. All of which were the causes of ascites. The mean SAAG was 0.68±0.19 g/dL. The mean serum and ascitic fluid albumin concentrations were higher in tuberculous patients (P<0.006), but lactate dehydrogenase (LDH) level was higher in cancer patients (P<0.0001). In peritoneal tuberculosis, mean ascitic glucose concentration was significantly lower than other patients (P<0.0001). CONCLUSION: Tuberculosis should be considered in all patients with low gradient ascites especially in developing countries (like Iran), as the first cause of ascites. In the approach to patients with low gradient ascites, ascitic fluid glucose, and LDH level are useful indicators for decision making.     

宫颈癌患者血液炎性标志物水平变化及其临床意义

［摘要］　目的　探讨宫颈癌患者血液炎性标志物水平变化及其临床意义。方法　回顾性分析2017年1月至2020年12月广西壮族自治区妇幼保健院收治的94名宫颈癌患者（宫颈癌组）的临床资料,另选择同期来该院接受检查的94名健康体检者作为对照组。根据宫颈癌患者的临床特征进一步分为不同亚组：鳞癌组（74例）和腺癌组（20例）;肿瘤直径<4 cm组（70例）和≥4 cm组（24例）;术后病理分期ⅠA～ⅠB₂期组（63例）和ⅠB₃～ⅢC₂期组（31例）。比较各组C-反应蛋白（CRP）、白蛋白（ALB）、中性粒细胞（NEUT）、淋巴细胞（LY）、血小板（PLT）、白细胞（WBC）、C-反应蛋白与白蛋白比值（CAR）、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值（PLR）以及预后营养指数(PNI)。结果　与对照组相比,宫颈癌组的ALB、PNI水平更低,CAR、NLR和PLR水平更高,差异有统计学意义（P<0.05）。Pearson相关分析结果显示,PLR与NLR呈正相关（r=0.654,P=0.000）,PNI与PLR和NLR呈负相关（r=-0.352,P=0.000;r=-0.250,P=0.000）。腺癌组PLR水平显著高于鳞癌组（P<0.05）。与肿瘤直径<4 cm组相比,≥4 cm组PLT水平更高,差异有统计学意义（P<0.05）。与ⅠA～ⅠB₂期组相比,ⅠB₃～ⅢC₂期组的PLR、PLT更高,差异有统计学意义（P<0.05）。结论　宫颈癌患者CAR、NLR和PLR水平上升,这可能有助于宫颈癌的鉴别诊断。PLR对评估宫颈癌病理分期有一定的指导意义。