Prevalence of metabolic syndrome, obesity and diabetes type 2 in cryptogenic cirrhosis

AIM： To evaluate the prevalence of metabolic syndrome （MS）, obesity and type 2 diabetes mellitus （T2DM） in a group of Mexican Mestizo patients with cryptogenic cirrhosis （CC） and to compare this group with patients with cirrhosis secondary to other causes （disease controls）. METHODS： Patients with CC, diagnosed between January, 1990 and April, 2005, were included in a retrospective study. Patients with cirrhosis caused by chronic hepatitis C, alcohol abuse or autoimmune hepatitis （AIH） served as disease controls. RESULTS： A total of 134 patients with CC were analyzed. Disease controls consisted of 81 patients with chronic hepatitis C, 33 with alcohol abuse and 20 with AIH. The median age of patients with CC was 57 years （range, 16-87）; 83 （61.9%） patients were female; 53 （39.6%） were Child A, 65 （48.5%） Child B, and 16 （11.9%） were Child C cirrhosis. The prevalence of MS （29.1% vs 6%; P 〈 0.001）, obesity （16.4% vs 8.2%; P = 0.04） and T2DM （40% vs 22.4%; P = 0.013） was higher in CC patients than in disease controls. There were no differences in sex, age or liver function tests between the two groups. CONCLUSION： The prevalence of MS, obesity and T2DM were higher in patients with CC than in patients with cirrhosis secondary to others causes. Our findings support the hypothesis that non-alcoholic steatohepatitis （NASH） plays an under-recognized role in CC.     

代谢综合征患者过氧化物酶体增殖物激活受体δ+294T/C基因多态性与血脂、肥胖和左室肥厚的关系

目的探讨代谢综合征(MS)患者过氧化物酶体增殖物激活受体δ(PPARδ)+294T/C基因多态性与血脂、肥胖和左室肥厚的关系。方法检测300例MS、174例高血压病(EH)和143例2型糖尿病(DM)患者的体重指数(BMI)、腰围、血压、血脂、空腹血糖(FBG)和空腹血浆胰岛素(FINS)。MS诊断根据1999年WHO亚太诊断标准,其中389例患者行超声心动图检测心脏结构改变,应用聚合酶链反应-限制性片段长度多态性方法测定PPARδ+294T/C基因多态性。结果PPARδ+294T/C基因多态性各基因型频率分布组间比较差异无统计学意义。MS组血浆总胆固醇、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平和BMI明显高于DM组。MS组和EH组的左室重量(LVM)、左室重量指数(LVMI)和左室肥厚罹患率均明显高于DM组。MS组CC型血浆总胆固醇和LDL-C水平明显高于TT型和TC型[总胆固醇:CC型(6.13±1.86)mmol/L比TC型(5.14±1.10)mmol/L或TT型(4.99±1.42mmol/L),P<0.05或P<0.01;LDL-C:CC型(3.82±1.52)mmol/L比TC型(3.14±0.88)mmol/L或TT型(2.90±0.87)mmol/L,P<0.05或P<0.01]。分析PPARδ各基因型与LVMI和BMI的关系,发现MS组C等位基因携带者(CC+TC)LVMI和BMI明显高于TT型[LVMI:CC+TC(46±10)g/m2.7比TT(44±10)g/m2.7;BMI:CC+TC(26±3)kg/m2比TT(25±3)kg/m2,P<0·05]。结论MS患者PPARδ+294T/C基因多态性与肥胖和脂质紊乱关系密切,C等位基因携带者较TT基因型患者左室重构明显。     

Hyperhomocysteinaemia in chronic liver diseases: role of disease stage, vitamin status and methylenetetrahydrofolate reductase genetics.

BACKGROUND/AIMS: The liver plays a key role in sulphur aminoacid metabolism hence, homocysteine metabolism may be impaired in chronic liver diseases. The aim of this study was to investigate, in patients affected by chronic liver diseases, (1) the prevalence of hyperhomocysteinaemia and (2) the role of its determinants such as the stage and the aetiology of disease, vitamin status, genetic documented alterations (methylenetetrahydrofolate reductase deficiency) and presence/absence of documented malignant evolution (hepatocellular carcinoma). MATERIAL AND METHODS: One hundred and thirty patients with chronic liver disease (34 with chronic active hepatitis, 12 with fatty liver and 88 with liver cirrhosis) and 50 healthy age-matched control subjects were included into the study. RESULTS: Hyperhomocysteinaemia was defined as homocysteine plasma levels greater than 12.6 micromol/l. Hyperhomocysteinaemia prevalence in liver cirrhosis group was 40.9%, significantly higher (all P<0.01) with respect to controls (12%), chronic active hepatitis (14.7%) and fatty liver (25%) groups and increased with Child-Pugh stage [Child A: 22.2%, Child B (50%); Child C (58.3%)]. In chronic-active hepatitis and liver cirrhosis, the prevalence of subjects with methylenetetrahydrofolate reductase C677-->T mutation (both as CT and as TT) and hyperhomocysteinaemia results in significantly higher levels with respect to controls. Methylenetetrahydrofolate reductase C677-->T mutation and disease stage showed to be the most important predictive factors of hyperhomocysteinaemia in liver cirrhosis whereas the influence of homocysteine-related vitamin status seems to have a secondary role. CONCLUSIONS: In conclusion hyperhomocysteinaemia is highly prevalent in liver cirrhosis but not in other chronic liver diseases; it may contribute to fibrogenesis and vascular complication of liver cirrhosis.     

Ethnic differences in the prevalence of cryptogenic cirrhosis

OBJECTIVES: Nonalcoholic steatohepatitis (NASH) associated with obesity and type 2 diabetes mellitus (DM) is postulated to be the cause of most cases of cryptogenic cirrhosis (CC). While ethnic differences in the prevalence of obesity and DM in the United States are well documented, there is little information regarding prevalence of CC or NASH among different U.S. ethnic groups. This study was performed to assess the demographic characteristics of patients with CC at a U.S. county hospital with a racially and ethnically diverse patient population. METHODS: Medical records and pathology databases were reviewed to identify patients at Parkland Memorial Hospital, Dallas County, Texas from 1990 to 2001 with CC or cirrhosis attributed to NASH. RESULTS: Forty-one patients (12 men, 29 women) were found to meet these criteria. Of these, 68% were obese (BMI > or = 30) and/or had type 2 DM and 74% of liver biopsies revealed one or more features of NASH. Of patients with CC 68% were Hispanic while only 7% were African American, despite the fact that Hispanics comprised < 26% and African Americans > 40% of adult medicine patients. Prevalence of CC among Hispanic and African American patients was 3.1-fold higher and 3.9-fold lower, respectively, than among European American patients despite similar prevalence of DM among Hispanics and African Americans. CONCLUSION: These findings support the hypothesis that NASH associated with obesity and DM is responsible for the majority of cases of CC among Hispanics and European Americans. However, the current findings also indicate that this form of cirrhosis is unexpectedly rare among African Americans.     

Prevalence of diabetes in liver cirrhosis: A systematic review and meta‐analysis

An association between diabetes mellitus (DM) and liver cirrhosis is well‐known, but estimates of the prevalence of DM in patients with liver cirrhosis vary widely. A systematic review was undertaken to determine the prevalence of DM in adult patients with liver cirrhosis. The Medline, EMBASE, and Cochrane Library databases were searched for peer‐reviewed studies published in English (1979‐2017) that investigated the prevalence of diabetes in adult patients with cirrhosis. Pooled estimates of prevalence of DM were determined for all eligible patients and according to aetiology and severity of liver disease. Fifty‐eight studies satisfied criteria for inclusion, with 9705 patients included in the pooled prevalence analysis. The overall prevalence of DM was 31%. The prevalence of DM was highest in patients with nonalcoholic fatty liver disease (56%), cryptogenic (51%), hepatitis C (32%), or alcoholic (27%) cirrhosis. For assessing prevalence of DM as a function of severity of liver disease, evaluable data were available only for hepatitis C and hepatitis B cirrhosis. DM may be more prevalent in cirrhosis than previously thought. This has implications for prognosis and treatment in these patients.     

Association between hepatitis C,diabetes mellitus,and race. a case-control study

OBJECTIVE: A higher prevalence of type II diabetes mellitus (DM) has been reported in patients with hepatitis C virus (HCV) infection. However, in most of these studies, the control population was not matched for body mass index, race, and severity of liver disease, known risk factors for the development of type II DM. The aim of this study was to determine the prevalence of type II DM in patients with HCV cirrhosis compared with a control population matched for age, sex, body mass index, and severity of liver disease. METHODS: We conducted a case-control study in a University Hospital setting. We compared 97 cirrhotic patients with HCV (cases) with 194 HCV-negative patients with cirrhosis from other causes (controls). We sought to determine the prevalence of pre- and post-transplant type II DM in cases and controls. RESULTS: The age, sex, and severity of liver disease were similar in both groups, but there were more blacks in the HCV group (24 of 97, 25%) compared with controls (16 of 194, 8%). The prevalence of pretransplant DM was higher in the HCV group (19.6%) compared with controls (11.5%) (p = 0.06, OR = 1.9, 95% CI = 0.9-3.8). Blacks with HCV had a significantly higher prevalence of pretransplant DM (33.3%) compared with whites with HCV (13.2%) (p = 0.03) and black controls (6.3%) (p = 0.05). Among whites, the prevalence of DM was similar in the HCV group (13.2%) and controls (11.9%). Logistic regression showed that age was the only independent predictor for pretransplant DM (odds ratio = 1.06, 95% CI = 1.01-1.11, p = 0.01). New onset DM was similar in the HCV group (16.7%) and controls (10.1%, p = ns). The new onset of DM was similar in blacks with HCV (31.3%) and black controls (20.0%). However, by logistic regression, black race was an independent predictor for the development of new onset DM (odds ratio = 3.4, 95% CI = 1.2-9.8, p = 0.02). CONCLUSIONS: Our study shows that the prevalence of type II DM is higher in patients with HCV cirrhosis compared with a control group of patients with cirrhosis from other causes, and this was because of a higher prevalence of DM in blacks with HCV infection.     

Hepatitis C is more severe in drug users with human immunodeficiency virus infection

Drug users with chronic hepatitis C virus (HCV) infection are frequently co-infected with human immunodeficiency virus-1 (HIV-1), but it is still not clear whether HIV-1 worsens the natural history of hepatitis C. To investigate this, we conducted a multicentre observational study in 163 drug addicts with histologically documented hepatitis C, 92 of whom were also infected with HIV-1: 25 (27%) were CDC stage II, 53 (58%) were CDC stage III and 14 (15%) were CDC stage IV. Eighty-eight (54%) patients had chronic hepatitis (CH) with minimal activity, 28 (17%) had CH with moderate activity, 40 (25%) had CH with severe activity and seven (4%) had active cirrhosis. Twenty-one HIV-negative patients and 15 HIV-positive patients admitted to alcohol abuse (29% vs 16%, P =0.0665). Liver disease was more severe in HIV-positive patients than in HIV-negative ones ( P =0.0198): 34 HIV-positive patients and 13 HIV negatives had severe CH and cirrhosis. These two severe liver diseases were seen more often in HIV-positive patients with a history of alcohol abuse than in HIV-negative patients (10 out of 16 vs seven out of 21). Age, alcohol abuse and distribution of the histological categories of liver disease were statistically different in HIV-infected and HIV-uninfected patients. Multivariate analysis showed that age, alcohol abuse and serum antibodies to HIV were independently associated with severe CH or cirrhosis. Thus, HIV may enhance the risk of severe liver disease in drug users with hepatitis C, independently of the degree of immune dysfunction. Alcohol abuse may contribute independently, aggravating the cause of HCV-dependent liver disease.     

Hypertension is the Most Important Component of Metabolic Syndrome in the Association With Ischemic Heart Disease in Taiwanese Type 2 Diabetic Patients

Background To evaluate the association between components of metabolic syndrome (MS) and ischemic heart disease (IHD) in Taiwanese patients with type 2 diabetes mellitus (T2DM). Methods and Results A total of 1,296 (604 men and 692 women) subjects with T2DM aged 62.5+/-11.7 (14-87) years were studied. MS was defined using the World Health Organization modified criteria and included more than 2 of hypertension, obesity, dyslipidemia and microalbuminuria. IHD was diagnosed through history or ischemic electrocardiogram according to the Minnesota codes. Results showed that MS was present in 76.2% and IHD in 36.3% of the patients, respectively. MS increased with age for both sexes, but there was no difference between men and women in the age groups of <45, 45-54 and 55-64 years. However, the prevalence of MS was significantly higher in women (87.7% vs 78.0%) in the age group >/=65 years. IHD prevalence was significantly higher in patients with MS, hypertension, dyslipidemia and obesity (p<0.01), and was higher with borderline significance for microalbuminuria (0.05相似文献   

Autonomic Dysfunction and Cholelithiasis in Patients with Cirrhosis

Gallstones are seen in 33–46% of patients with cirrhosis, and their prevalence is known to increase with the duration and severity of liver disease. We hypothesized that autonomic neuropathy may contribute to the formation of gallstones or gallbladder disease, as in diabetics with autonomic neuropathy, due to impaired gallbladder emptying. The objective of our study was to determine the prevalence of gallstones or gallbladder disease in cirrhotic patients with and without autonomic neuropathy. We determined autonomic function tests, gallstones, and other gallbladder disease in 123 (male 71) with varying severity of liver disease (Child classes: A, 40; B, 45; C, 35). In all, 54 patients had gallstones and an additional 22 patients had other gallbladder disease (cholecystitis, common bile duct stones, or debris). Autonomic neuropathy was seen in 97 patients (one abnormal test in 48 and two or more in 49). The prevalence of gallstones was similar in Child A (57%), Child B (64%), and Child C (63%) cirrhosis. The gallstones or gallbladder disease was not increased in women, blacks, diabetics, or alcoholic cirrhotics. The prevalence of gallbladder disease was increased in patients with autonomic neuropathy (51% vs 35%, P = 0.08); in patients with Child C cirrhosis, gallstones (P = 0.018) and gallbladder disease (P = 0.03) were seen more commonly in patients with autonomic neuropathy. Our findings suggest that autonomic neuropathy may contribute to the formation of gallstones in patients with advanced cirrhosis, perhaps by impairing gallbladder and sphincter of Oddi dysmotility.     

功能磁共振成像在乙型肝炎相关慢性肝病检测中的应用

目的 探讨功能磁共振成像指标与慢性乙型肝炎、肝硬化程度动态变化的关系，并与血清肝纤维化标志物作对照分析。方法 对47例慢性肝病患者[慢性乙型肝炎6例，肝硬化41例（其中ChildA级14例，ChildB级12例；ChildC级15例）]及10名正常人（对照组）进行扩散加权成像（DWI），用不同的b值及b值差计算肝脏表观扩散系数（ADC）。灌注加权成像（PWI）测量肝脏强化参数：到达灌注峰值时间（TP）、血容量分布及肝脏强化曲线最大上升斜率（MSI）。相位对比法（PC）测门静脉血流速度、每分钟流量。所有入选者同时检测血清肝纤维化标志物：透明质酸（HA），Ⅲ型前胶原（PCⅢ）、层黏连蛋白（LN）和Ⅳ型胶原（CⅣ）。结果 （1）DWI：Child C级肝硬化组与对照组比，ADC3差异有统计学意义（P〈0．01），Child A、B级肝硬化组与对照组之间ADC3差异也有统计学意义（P值均〈0．05）。慢性乙型肝炎组和Child C级肝硬化组间ADC3差异有统计学意义（P〈0．01）。（2）PWI：Child A、B、C级肝硬化较对照组TP明显延长（P值均〈0．01）。肝脏MSI比较，对照组明显大于Child A、B、C级肝硬化组，差异有统计学意义，P值均〈0．01。（3）Child A、B、C级肝硬化组门静脉血流速度较慢性乙型肝炎组和对照组显著下降，差异有统计学意义，P值均〈0．01。（4）Child A、B、C级肝硬化组HA较慢性乙型肝炎组和对照组显著升高，差异有统计学意义，P值均〈0．01）；Child A、B．C级肝硬化组LN也明显高于慢性乙型肝炎组和对照组，P值均〈0．01；Child A，B、C级肝硬化组PCⅢ指标较对照组显著升高，P值均〈0．01。结论 功能磁共振成像指标能反映出慢性乙型肝炎、肝硬化的动态变化，对肝硬化的诊断及临床治疗有重要的参考价值。     

Ⅱ类反式激活因子启动子Ⅳ区C-1350T和G-944C多态性与乙型肝炎肝硬化易感性的关系

目的探讨Ⅱ类反式激活因子（CIITA）启动子Ⅳ区1350和-944位点单核苷酸多态性（SNP）与乙型肝炎肝硬化易感性的关系。方法在191例慢性乙型肝炎、353例乙型肝炎肝硬化与125名无HBV感染的健康献血员人群中，应用序列特异性引物PCR技术对CIITA基因启动子Ⅳ区C1350T和G-944C位点进行基因分型研究。结果慢性乙型肝炎患者CC：37．2％、TG：42．2％、CG：18．9％，肝硬化患者CC：35．3％、TG：34．0％，CG：29．3％，肝硬化患者CC、TG单倍型频率较低，而CG单倍型频率显著升高，差异有统计学意义（CG比CC：x^2=8．274，df=1，P〈0．01；CG比TG：x2=15．027，df=1，P〈0．01）；两组患者间CC与TG单倍型频率比较，x^2=1．231，df=1，P〉0．05，差异无统计学意义。与慢性乙型肝炎患者（CC／CC：12．6％；TG／TG：18．3％；含CG的基因型：33．5％；不含CG的基因型：35．6％）相比，肝硬化人群中CC／CC（1组，19．6％）和含CG的基因型（3组，53．5％）频率显著升高，而TG／TG（2组，11．9％）和不含CG的基因型（4组，15．0％）频率显著降低（1组比2组，X2=7．176，df=1，P〈0．01；1组比4组，x^2=19．818，df=1，P〈0．01；3组比2组，x2=11．423，df=1，P〈0．01；3组比4组，x2=34．226，df=1，P〈0．01；1组比3组，x2=0．009，df=1，P〉0．05；2组比4组，x2=2．176，df=1，P〉0．05）。结论CIITA基因启动子Ⅳ区中1350和-944位点多态性与慢性HBV感染者肝硬化的易感性密切相关，携带含CG单倍型的基因型人群更容易发展为肝硬化。     

High prevalence of undiagnosed liver cirrhosis and advanced fibrosis in type 2 diabetic patients

Background. Patients with type 2 diabetes mellitus (T2DM) are at risk for developing end-stage liver disease due to nonalcoholic steatohepatitis (NASH), the aggressive form of non-alcoholic fatty liver disease (NAFLD). Data on prevalence of advanced fibrosis among T2DM patients is scarce. Aim. To evaluate prevalence of steatosis, advanced fibrosis and cirrhosis using non-invasive methods in T2DM patients.Material and methods. 145 consecutive T2DM patients (> 55 years-old) were prospectively recruited. Presence of cirrhosis and advanced fibrosis was evaluated by magnetic resonance imaging (MRI) and NAFLD fibrosis score (NFS) respectively. Exclusion criteria included significant alcohol consumption, markers of viral hepatitis infection or other liver diseases. Results are expressed in percentage or median (interquartile range).Results. 52.6% of patients were women, the median age was 60 years old (57-64), mean BMI was 29.6 ± 4.7 kg/m² and diabetes duration was 7.6 ± 6.9 years. A high prevalence of liver steatosis (63.9%), advanced fibrosis assessed by NFS (12.8%) and evidence of liver cirrhosis in MRI (6.0%) was observed. In a multivariate analysis GGT > 82 IU/L (P = 0.004) and no alcohol intake (P = 0.032) were independently associated to advanced fibrosis.Conclusion. A high frequency of undiagnosed advanced fibrosis and cirrhosis was observed in non-selected T2DM patients. Screening of these conditions may be warranted in this patient population.     

Cryptogenic cirrhosis in the region where obesity is not prevalent

AIM: Recent studies have demonstrated that obesity is the common feature of cryptogenic cirrhosis (CC) and non-alcoholic steatohepatitis. However, there is little information on CC in the region where obesity is not prevalent, METHODS: The clinical features, and the liver-related morbidity and mortality of CC were analyzed in Japan where the prevalence of obesity is low. Among 652 cir-rhotic patients, we identified 29 patients (4.4%) with CC. Of these, 24 CC patients who were followed up for more than 6 months were compared in a case-control study with age-, sex-, and Child-Pugh score-matched controls having cirrhosis of viral etiology. RESULTS: Obesity (BMI≥25 kg/m2), diabetes mellitus, and hypertriglyceridemia were more frequent, and the visceral fat area was larger in the CC patients than in the controls. The indices of insulin resistance were higher and the serum aminotransferase levels were lower in the CC patients than in the controls. Logistic regression analysis identified the elevated hemoglobin A1c, BMI≥25 kg/m2, and normal aminotransferase levels as independent predictors of CC. Kaplan-Meier analysis demonstrated lower occurrence of hepatocellular carcinoma and higher survival rate in the CC than in the controls in contrast to the similar cumulative probability of liverrelated morbidity between those groups. CONCLUSION:CC more frequently presents with the clinical features suggestive of non-alcoholic steatohepatitis compared with controls even in the region where obesity is not prevalent. The lower occurrence of hepatocellular carcinoma and higher survival rate may indicate an indolent clinical course in CC as compared with viral cirrhosis.     

The role of diabetes in hepatocellular carcinoma: a case-control study among United States Veterans

OBJECTIVE: Diabetes mellitus (DM) has been reported to increase the risk of hepatocellular carcinoma (HCC). We carried out a case-control study to examine the role of DM while controlling for several known risk factors of HCC. METHODS: All hospitalized patients with primary liver cancer (PLC) during 1997-1999 were identified in the computerized database of the Department of Veterans Affairs, the Patient Treatment File. Controls without cancer were randomly assigned from the Patient Treatment File during the same time period. The inpatient and outpatient files were searched for several conditions including DM, hepatitis C virus (HCV), hepatitis B virus (HBV), alcoholic cirrhosis, autoimmune hepatitis, hemochromatosis, and nonspecific cirrhosis. Adjusted odds ratios (OR) were calculated in a multivariable logistic regression model. RESULTS: We identified 823 patients with PLC and 3459 controls. The case group was older (62 yr [+/-10] vs 60 [+/-11], p < 0.0001), had more men (99% vs 97%, 0.0004), and a greater frequency of nonwhites (66% vs 71%, 0.0009) compared with controls. However, HCV- and HBV-infected patients were younger among cases than controls. Risk factors that were significantly more frequent among PLC cases included HCV (34% vs 5%, p < 0.0001), HBV (11% vs 2%, p < 0.0001), alcoholic cirrhosis (47% vs 6%, p < 0.0001), hemochromatosis (2% vs 0.3%, p < 0.0001), autoimmune hepatitis (5% vs 0.5%, p < 0.0001), and diabetes (33% vs 30%, p = 0.059). In the multivariable logistic regression, diabetes was associated with a significant increase in the adjusted OR of PLC (1.57, 1.08-2.28, p = 0.02) in the presence of HCV, HBV, or alcoholic cirrhosis. Without markers of chronic liver disease, the adjusted OR for diabetes and PLC was not significantly increased (1.08, 0.86-1.18, p = 0.4). There was an increase in the HCV adjusted OR (17.27, 95% Cl = 11.98-24.89) and HBV (9.22, 95% CI = 4.52-18.80) after adjusting for the younger age of HCV- and HBV-infected cases. The combined presence of HCV and alcoholic cirrhosis further increases the risk with an adjusted OR of 79.21 (60.29-103.41). The population attributable fraction for HCV among hospitalized veterans was 44.8%, whereas that of alcoholic cirrhosis was 51%. CONCLUSION: DM increased the risk of PLC only in the presence of other risk factors such as hepatitis C or B or alcoholic cirrhosis. Hepatitis C infection and alcoholic cirrhosis account for most of PLC among veterans.     

Reappraisal of the characteristics of glucose abnormalities in patients with chronic hepatitis C infection

OBJECTIVES: There is growing evidence suggesting the mutual link between type 2 diabetes mellitus (T2DM) and hepatitis C virus (HCV) infection. However, the impact of HCV infection on the suite of glucose abnormalities has rarely been investigated. The study aimed to determine the difference regarding the prevalence and the characteristics of glucose abnormalities between chronic hepatitis C (CHC) patients and community-based controls. It also aimed to investigate the related clinical, virological, and histological features of glucose abnormalities in HCV infection.
METHODS: Six hundred eighty-three CHC patients and 515 sex-/age-matched controls were included. Oral glucose tolerance test (OGTT) was performed in 522 CHC patients and 447 controls without known T2DM. Clinical data were assessed upon the different stages of glucose abnormalities based on OGTT results.
RESULTS: The prevalence of normoglycemia, IGT, and T2DM in 683 CHC patients was 27.7%, 34.6%, and 37.8%, respectively. There was a significant linear trend from normoglycemia to T2DM in terms of age, family history of T2DM, and advanced liver fibrosis in CHC patients. For those CHC patients without fibrosis, the prevalence of glucose abnormalities reached 67.9% high. All CHC patients carried a significantly higher prevalence than controls regarding those aged <65 yr. For those without known DM, there was a 3.5-fold increase in the prevalence of glucose abnormalities in CHC (65.8%) patients in comparison with controls (35.3%) (OR 3.51, 95% CI 2.70–4.56, P < 0.001).
CONCLUSIONS: CHC patients carried a high prevalence of glucose abnormalities. Determination of glucose abnormalities by OGTT may be suggested.     

Autoantibodies in Chinese patients with chronic hepatitis B:Prevalence and clinical associations

AIM: To investigate the prevalence of autoantibodies and their associations with clinical features in Chinesepatients with chronic hepatitis B(CHB).METHODS: A total of 325 Chinese patients with CHB were enrolled in this retrospective,hospitalbased study.Patients with chronic hepatitis C(CHC),autoimmune hepatitis(AIH),or primary biliary cirrhosis(PBC) were included,with healthy donors acting as controls.A panel of autoantibodies that serologically define AIH and PBC was tested by indirect immunofluorescence assay and line immunoassay.The AIH-related autoantibody profile included homogeneous anti-nuclear antibodies(ANA-H),smooth-muscle antibodies,anti-liver kidney microsome type 1,antiliver cytosolic antigen type 1,and anti-soluble liver antigen/liver pancreas; the PBC-related antibodies were characterized by ANA-nuclear dots/membranous rimlike,anti-mitochondrial antibodies-M2(AMA-M2),antiBPO(recombinant antigen targeted by AMA-M2),antiSp100,anti-promyelocytic leukemia protein(anti-PML),and anti-gp210.The dichotomization of clustering was used to unequivocally designate the AIH or PBC profiles for each case.Anti-Ro52 antibodies were also tested.RESULTS: The prevalence of any autoantibody in CHB amounted to 58.2%,which was similar to the 66.2% prevalence in CHC,significantly higher than the 6.7% in the healthy controls(P < 0.001),and lower than the 100% found in AIH and PBC(P = 0.004 and P < 0.001,respectively).There were more anti-PML and anti-gp210 antibodies among the CHB patients than the CHC patients(11.1% vs 0%,P = 0.003; 12.6% vs 0%,P < 0.001,respectively).The prevalence and titer of AMA,anti-BPO,anti-PML,and anti-gp210 were higher in PBC than in those with CHB.Among the CHB patients,the prevalence of ANA,especially ANA-H,was significantly lower in patients with compensated and decompensated cirrhosis compared with patients without cirrhosis.Thirty-eight cases of hepatocellular carcinoma(HCC) in CHB showed a significant differencecompared with non-HCC patients in the prevalence of anti-PML(0% vs 12.5%,P = 0.013).Dichotomization of the autoantibodies revealed that the PBC profile was more prevalent in patients with CHB than in those with CHC,and that it was strongly correlated with both compensated and decompensated cirrhosis.In contrast,the prevalence of the AIH profile was significantly higher in non-cirrhosis patients with CHB than in those with compensated cirrhosis(18.5% vs 8.2%,P = 0.039).Moreover,the AIH profile was also closely associated with hepatitis B e-antigen positivity.CONCLUSION: ANA-H could be an indicator of earlystage CHB.Dichotomizing the autoantibody profiles revealed that the PBC profile is strongly associated with cirrhosis in CHB.     

Prevalence of type 2 diabetes mellitus and chronic liver disease: A retrospective study of the association of two increasingly common diseases in Mexico

Background.Recent studies have demonstrated a relationship between insulin resistance (IR) and type 2 diabetes mellitus (T2DM). The aim of this study was to determine the prevalence of T2DM among patients with liver disease.Methods. A retrospective study was performed by examining the charts of patients who presented with a diagnosis of liver disease at a university hospital between January 2006 and April 2010.Results. Liver disease was found in 129 patients. The most prevalent liver disease was cirrhosis, with 61 patients (47.2%), 44 patients had hepatitis C virus (34.1%) and 28 patients had hepatocellular carcinoma (21.7%). T2DM was diagnosed in 30 patients, 18 of whom were male (18/60; 30%) and 12 of whom were female (12/69; 17.4%). Only liver cirrhosis was significantly related to T2DM (21 of 61 patients; 34.4%, p < 0.004).Conclusions. The prevalence of T2DM among patients with liver disease (23.2%) is well established and similar to that reported in Western and some Eastern countries.     

Liver cirrhosis in HIV-infected patients: prevalence, aetiology and clinical outcome

Liver disease is frequently seen in HIV+ patients as a result of coinfection with hepatitis B (HBV) or C (HCV) viruses, alcohol abuse and/or exposure to hepatotoxic drugs. The aim of this study was to assess the prevalence of liver cirrhosis, its main causes and clinical presentation in HIV+ patients. Observational, cross-sectional, retrospective study of all HIV+ individuals followed at one reference HIV outpatient clinic in Madrid. Liver fibrosis was measured in all cases using transient elastometry (FibroScan). All 2168 HIV+ patients on regular follow-up (76% males, 46% injecting drug users) were successfully examined by FibroScan) between October 2004 and August 2006. Liver cirrhosis was recognized in 181 (overall prevalence, 8.3%), and the main aetiologies were HCV, 82.3%; HBV, 1.6%; dual HBV/HCV, 2.8%; and triple HBV/HCV/ hepatitis delta virus (HDV) infection, 6.6%. The prevalence of cirrhosis differed among patients with distinct chronic viral hepatitis: HCV, 19.2%; HBV, 6.1%; HBV/HCV, 41.7%; and HBV/HCV/HDV, 66.7%. In 12 patients with cirrhosis (6.7%), no definite aetiology was recognized. Overall, cirrhotics had lower mean CD4 counts than noncirrhotics (408 vs 528 cells/microL respectively; P = 0.02), despite similar proportion of subjects with undetectable viraemia on highly active antiretroviral therapy. Clinical manifestations of liver cirrhosis were: splenomegaly, 61.5%; oesophageal varices, 59.8%; ascites, 22.6%; encephalopathy, 12.1%; and variceal bleeding, 6.1%. Liver cirrhosis and hepatic decompensation events are relatively frequent in HIV+ individuals. Chronic HCV and alcohol abuse, but not chronic HBV, play a major role. Transient elastometry may allow the identification of a significant number of HIV+ individuals with asymptomatic liver cirrhosis.     

Helicobacter pylori Infection and Peptic Ulcer Disease in Cirrhosis

An increased frequency of peptic ulcer diseaseis noted in patients with cirrhosis, but the role of H.pylori in this disorder remains to be determined. Thediagnosis of cirrhosis was confirmed by a combination of clinical, biochemical, radiological, andhistological methods. The severity of cirrhosis wasassessed by Pugh's modification of Child's criteria.Upper gastrointestinal endoscopy was performedconsecutively to evaluate the presence of varices andgastroduodenal mucosa. H. pylori status was assessed byhistology, urease test, and serology. In all, 130patients with cirrhosis were recruited into the study;there were 86 males and 44 females with a mean (SD)age of 54.4 (12.7) years. The H. pylori prevalence was76.2% . There was no difference in age between the H.pylori-positive and -negative cirrhotics (P = 0.29). The H. pylori prevalence revealed no differenceamong cirrhotics with Child A (77.8%), Child B (72.9%),and Child C (78.6%) (P = 0.8), and neither was there adifference in H. pylori prevalence in cirrhotics with and without congestive gastropathy (77% vs73.7% , P = 0.84). The prevalence of H. pylori incirrhotics with and without varices did not show astatistical difference (75% vs 81.8%, P = 0.68). There also was no difference in the H. pyloriprevalence between cirrhotic patients with and withoutpeptic ulcers (84.4% vs 69.7% , P = 0.09). Inconclusion, the prevalence of H. pylori or peptic ulceris independent of the severity of cirrhotic liver disease. Theassociation between H. pylori infection and peptic ulcerdisease is weak in cirrhosis.     

肝病伴糖代谢异常患者的临床分析

目的探讨肝病伴糖代谢异常的临床特点及其可能机制.方法分别对29例慢性乙型肝炎伴糖代谢异常患者及62例乙型肝炎后肝硬化伴糖代谢异常患者进行相关分析.结果 （1）乙型肝炎后肝硬化患者中肝源性糖耐量减低（IGT）及肝源性糖尿病（DM）发生率高于慢性乙型肝炎患者（20.53%对3.82%,P＜0.05;24.11%对1.64%,P＜0.01）.（2）慢性乙型肝炎及乙型肝炎后肝硬化伴肝源性IGT或DM患者均无糖尿病症状,而19例慢性乙型肝炎伴原发性DM者中12例有症状,12例乙型肝炎后肝硬化伴原发性DM者中6例有症状.（3）慢性乙型肝炎伴肝源性IGT或DM者,空腹血糖（FPG）、餐后血糖（PPG）水平均低于伴原发性DM者（P＜0.05）;但前者葡萄糖负荷后胰岛素（PINS）及C肽（PCP）分泌水平高于后者（P＜0.05）.（4）乙型肝炎后肝硬化伴肝源性DM与伴原发性DM患者的FPG、PPG水平差异均无统计学意义,伴肝源性DM患者空腹胰岛素（FINS）、PINS、空腹C肽（FCP）及PCP水平高于伴原发性DM患者（P＜0.05）,但两者的PINS/FINS、PCP/FCP值差异无统计学意义,且小于5;伴肝源性DM患者其FPG、PPG水平均显著高于伴肝源性IGT者（P＜0.05）,FINS、PINS及FCP、PCP水平均低于肝源性IGT患者（P＜0.05,P＜0.01）.结论肝病继发糖代谢异常者多发生于肝硬化患者,且以肝功能损害较重者为主,多无症状;慢性乙型肝炎伴肝源性DM患者胰岛β细胞分泌胰岛素的功能增强,而乙型肝炎后肝硬化伴肝源性DM患者则减弱.