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Clinical assessment and management of liver fibrosis in nonalcoholic fatty liver disease

World Journal of Gastroenterology 2020年第39期26卷 5919-5943页

作者： Alejandro Campos-Murguía astrid ruiz-margáin JoséA González-Regueiro Ricardo U Macías-Rodríguez Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico

Non-alcoholic fatty liver disease(NAFLD)is among the most frequent etiologies of cirrhosis worldwide,and it is associated with features of metabolic syndrome;the key factor influencing its prognosis is the progression of liver *** review aimed to propose a practical and stepwise approach to the evaluation and management of liver fibrosis in patients with NAFLD,analyzing the currently available *** the assessment of NAFLD patients,it is important to identify clinical,genetic,and environmental determinants of fibrosis development and its *** properly detect fibrosis,it is important to take into account the available methods and their supporting scientific evidence to guide the approach and the sequential selection of the best available biochemical scores,followed by a complementary imaging study(transient elastography,magnetic resonance elastography or acoustic radiation force impulse)and finally a liver biopsy,when *** help with the selection of the most appropriate method a Fagan′s nomogram analysis is provided in this review,describing the diagnostic yield of each method and their post-test probability of detecting liver ***,treatment should always include diet and exercise,as well as controlling the components of the metabolic syndrome,+/-vitamin E,considering the presence of sleep apnea,and when available,allocate those patients with advanced fibrosis or high risk of progression into clinical *** final end of this approach should be to establish an opportune diagnosis and treatment of liver fibrosis in patients with NAFLD,aiming to decrease/stop its progression and improve their prognosis.

关键词： Non-alcoholic fatty liver disease Liver fibrosis Clinical assessment Diagnosis Treatment Test accuracy

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Clinical scenarios for the use of S100β as a marker of hepatic encephalopathy

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World Journal of Gastroenterology 2016年第17期22卷 4397-4402页

作者： Andrés Duarte-Rojo astrid ruiz-margáin Ricardo U Macias-Rodriguez Francisco Javier Cubero José Estradas-Trujillo Rosa Ma Munoz-Fuentes Aldo Torre University of Arkansas for Medical Sciences Little Rock AR 72205 United States Department of Gastroenterology Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran Mexico City 14000 Mexico Department of Internal Medicine III University Hospital RWTH Aachen 52074 Aachen Germany Department of Immunology Complutense University School of Medicine 28040 Madrid Spain

AIM: To evaluate the association between serum concentrations of S100β in patients with cirrhosis and the presence of low grade hepatic encephalopathy (HE).METHODS: This was a cross-sectional study. The population was categorized into four groups healthy subjects, cirrhosis without HE, cirrhosis with covert hepatic encephalopathy (CHE) and cirrhosis with overt HE. Kruskal-Wallis, Mann Whitney’s U with Bonferroni adjustment Spearman correlations and area under the ROC were used as ***: A total of 61 subjects were included, 46 cirrhotic patients and 15 healthy volunteers. S100β values were different among all groups, and differences remained significant between groups 1 and 2 (P 0.13 ng/mL as the best cutoff value of S100β for the diagnosis of HE (sensitivity 83.3%, specificity 63.6%).CONCLUSION: Serum concentrations of S100β are higher in patients with cirrhosis than in healthy volunteers, and are further increased in the presence of hepatic encephalopathy. The results suggest that serum biomarkers such as S100β could help in the correct characterization of incipient stages of HE.

关键词： Hepatic encephalopathy S100β protein Astrocyte Psychometric hepatic encephalopathy score Critical flicker frequency

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Nutritional therapy for hepatocellular carcinoma

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World Journal of Gastrointestinal Oncology 2021年第10期13卷 1440-1452页

作者： astrid ruiz-margáin Berenice M Román-Calleja Paulina Moreno-Guillén JoséA González-Regueiro DeyaniraKúsulas-Delint Alejandro Campos-Murguía Nayelli C Flores-García Ricardo Ulises Macías-Rodríguez Liver Nutrition Clinic Department of GastroenterologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Liver Fibrosis and Nutrition Lab MICTLÁN-Network(Mechanisms of Liver InjuryCell Death and Translational Nutrition in Liver Diseases-Research Network)Mexico City 14080Mexico Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico

Hepatocellular carcinoma(HCC)is the most frequent primary liver cancer and presents together with cirrhosis in most *** addition to commonly recognized risk factors for HCC development,such as hepatitis B virus/hepatitis C virus infection,age and alcohol/tobacco consumption,there are nutritional risk factors also related to HCC development including high intake of saturated fats derived from red meat,type of cooking(generation of heterocyclic amines)and contamination of foods with *** the contrary,protective nutritional factors include diets rich in fiber,fruits and vegetables,n-3 polyunsaturated fatty acids and *** the patient is being evaluated for staging and treatment of HCC,special attention should be paid to nutritional support,including proper nutritional assessment and therapy by a multidisciplinary *** must be considered that these patients usually develop HCC on top of long-lasting cirrhosis,and therefore they could present with severe *** complications should be properly addressed and considered for nutritional *** addition to traditional methods,functional testing,phase angle and computed tomography scan derived skeletal muscle index-L3 are among the most useful tools for nutritional *** therapy should be centered on providing enough energy and protein to manage the increased requirements of both cirrhosis and *** with branched-chain amino acids is also recommended as it improves response to treatment,nutritional status and survival,and finally physical exercise must be encouraged and adapted to individual needs.

关键词： Sarcopenia Liver Cancer Diet Branched-chain amino acids Nutrition

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Hematological abnormalities in liver cirrhosis

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World Journal of Hepatology 2024年第9期16卷 1229-1244页

作者： Oscar Manuel Fierro-Angulo JoséAlberto González-Regueiro Ariana Pereira-García astrid ruiz-margáin Fernando Solis-Huerta Ricardo Ulises Macías-Rodríguez Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico 14080Mexico Department of Hematology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico 14080Mexico

Hematological abnormalities are common in cirrhosis and are associated with various pathophysiological *** have documented a prevalence of thrombocytopenia,leukopenia,and anemia in patients with compensated cirrhosis of 77.9%,23.5%,and 21.1%,*** abnormalities carry significant clinical implications,including considerations for invasive procedures,infection risk,bleeding risk,and ***,cirrhosis was believed to predispose patients to bleeding due to alterations observed in classical coagula-tion tests such as prothrombin time,partial thromboplastin time,international normalized ratio,and ***,this understanding has evol-ved,and cirrhosis patients are now also acknowledged as being at a high risk for thrombotic *** in cirrhosis patients presents a complex pheno-type,with procoagulant and anticoagulant abnormalities offsetting each *** multifactorial phenomenon is inadequately reflected by routine laboratory *** complications are more prevalent in decompensated cirrhosis and may correlate with disease *** is primarily associated with portal hypertension,endothelial dysfunction,mechanical vessel injury,dissem-inated intravascular coagulation,endotoxemia,and renal *** review comprehensively outlines hematologic index abnormalities,mechanisms of hemostasis,coagulation,and fibrinolysis abnormalities,limitations of laboratory testing,and clinical manifestations of bleeding and thrombosis in patients with liver cirrhosis.

关键词： Cirrhosis Anemia Leukopenia Thrombocytopenia Coagulopathy Bleeding Thrombosis

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Low phase angle is associated with the development of hepatic encephalopathy in patients with cirrhosis

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World Journal of Gastroenterology 2016年第45期22卷 10064-10070页

作者： astrid ruiz-margáin Ricardo Ulises Macías-Rodríguez Javier Ampuero Francisco Javier Cubero Luis Chi-Cervera Silvia L Ríos-Torres Andrés Duarte-Rojo Ángeles Espinosa-Cuevas Manuel Romero-Gómez Aldo Torre Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán14080 México City México Department of Internal Medicine Ⅲ University Hospital RWTH Aachen52074 Aachen Germany Unit for the Clinical Management of Digestive Diseases Virgen del Rocio-Virgen Macarena University Hospital41009 Sevilla Spain Department of Immunology Complutense University School of Medicine28040 Madrid Spain University of Arkansas for Medical Sciences Little Rock AR 72205 United States Department of Nephrology and Mineral Merabolism Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán México City 14080 México

AIM Evaluate the association between phase angle and the development of hepatic encephalopathy in the longterm follow-up of cirrhotic *** This was a prospective cohort study. Clinical, nutritional and biochemical evaluations were performed. MannWhitney's U and χ2 tests were used as appropriate. Kaplan-Meier curves and Cox proportional Hazards analysis were used to evaluate the prediction and incidence of hepatic *** Two hundred and twenty were included; the most frequent etiology of cirrhosis was hepatitis C infection, 52% of the patients developed hepatic encephalopathy(18.6% covert and 33.3% overt); the main precipitating factors were infections and variceal bleeding. KaplanMeier curves showed a higher proportion of HE in the group with low phase angle(39%) compared to the normal phase angle group(13%)(P = 0.012). Furthermore, creatinine and phase angle remained independently associated to hepatic encephalopathy in the Cox regression multivariate analysis [hazard ratio = 1.80(1.07-3.03)]. CONCLUSION In our cohort of patients low phase angle was associated with an increased incidence of hepatic encephalopathy. Phase angle is a useful nutritional marker that evaluates cachexia and could be used as a part of the integral assessment in patients with cirrhosis.

关键词： Malnutrition Hepatic encephalopathy Phase angle Cachexia Prognosis

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Clinical characteristics and treatment outcomes in patients with liver cirrhosis and lymphoma

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World Journal of Hepatology 2020年第2期12卷 34-45页

作者： JoséA González-Regueiro astrid ruiz-margáin Mariana Cruz-Contreras Ana M Montaña-Duclaud Andrea Cavazos-Gómez Roberta Demichelis-Gómez Ricardo U Macías-Rodríguez Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición SalvadorGastroenterologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránVasco de Quiroga 15Belisario Domínguez Sección XVITlalpanMexico City 14080Mexico Department of Hematology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránVasco de Quiroga 15Belisario Domínguez Sección XVITlalpanMexico City 14080Mexico

BACKGROUND A significant number of patients with liver cirrhosis concomitantly develop some type of solid or hematological cancer,including *** of patients with lymphoma and cirrhosis is challenging for physicians due to the clinical characteristics related to cirrhosis,including biochemical and functional abnormalities,as well as portal hypertension and lack of scientific evidence,limiting the use of ***,experts recommend only offering oncological treatment to patients with compensated *** To evaluate the clinical characteristics and treatment outcomes in patients with cirrhosis and lymphoma treated with *** This was a case-control study conducted at a tertiary care center in *** was recorded from medical files and from 8658 possible candidates with cirrhosis and/or lymphoma(2000 to 2018).Only 23 cases had both diseases concomitantly;10 patients with cirrhosis and lymphoma(cases)met the selection criteria and were included,and 20 patients with lymphoma(controls)were included and matched according to age,sex,and date of diagnosis,type and clinical stage of *** patients received treatment with *** statistical analysis,descriptive statistics,Shapiro-Wilk test,Mann-Whitney U test,chisquare test and Fisher's exact test were *** was evaluated using Kaplan-Meier curves and Log-rank *** There were differences in biochemical variables inherent to liver disease and portal hypertension in patients with *** most frequent etiology of cirrhosis was hepatitis C virus(50%);80%were decompensated,the median Child-Turcotte-Pugh score was 7.5(6.75-9.25),and mean Model for End-stage Liver Disease was 11.5±*** lymphomas,non-Hodgkin's were the most common(90%),and diffuse large B cell subtype was the most frequent,with a higher International Prognostic Index in the cases(3 vs 2,P=0.049).The chemotherapy regimens had to be adjusted more frequently in the case

关键词： Cirrhosis Cancer Lymphoma Chemotherapy Treatment Survival Toxicity Adverse events

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Secondary sclerosing cholangitis after critical COVID-19:Three case reports

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World Journal of Hepatology 2022年第8期14卷 1678-1686页

作者： Juan M Mayorquín-Aguilar Aldo Lara-Reyes Luis Alberto Revuelta-Rodríguez Nayelli C Flores-García astrid ruiz-margáin Marco Antonio Jiménez-Ferreira Ricardo Ulises Macías-Rodríguez Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Department of Pathology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico

BACKGROUND The global coronavirus disease 2019(COVID-19)pandemic has caused more than 5 million *** involvement is well described,including liver *** patients with critical COVID-19,a new entity called"post-COVID-19 cholangiopathy"has been *** SUMMARY Here,we present three patients with severe COVID-19 that subsequently developed persistent cholestasis and chronic liver *** three patients required intensive care unit admission,mechanical ventilation,vasopressor support,and broad spectrum antibiotics due to secondary *** transplant protocol was started for two of the three *** Severe COVID-19 infection should be considered a potential risk factor for chronic liver disease and liver transplantation.

关键词： SARS-CoV-2 Persistent cholestasis Liver chemistry Hypoxic cholangiopathy Case report

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Clinical perspectives,assessment,and mechanisms of metabolicassociated fatty liver disease in patients with COVID-19

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World Journal of Gastroenterology 2021年第33期27卷 5502-5519页

作者： Alejandro Campos-Murguía Berenice M Román-Calleja JoséA González-Regueiro Ivonne Hurtado-Díaz-de-León Alberto Adrián Solís-Ortega Nayelli C Flores-García Ignacio García-Juárez astrid ruiz-margáin Ricardo Ulises Macías-Rodríguez Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Liver Fibrosis and Nutrition Lab(LFNLab) MICTLÁN-Network(Mechanisms of Liver InjuryCell Death and Translational Nutrition in Liver Diseases-Research Network)Mexico City 14080Mexico

Metabolic diseases are highly prevalent worldwide and have been associated with adverse clinical outcomes,including mortality,in patients developing coronavirus disease(COVID-19).Because of the close relationship between metabolic diseases such as type 2 diabetes mellitus and obesity and the presence of metabolicassociated fatty liver disease(MAFLD),a high number of cases of patients affected by both MAFLD and COVID-19 would be expected,especially in highrisk *** studies have shown an increased risk of adverse clinical outcomes,viral shedding,and deep vein thrombosis,especially in patients with MAFLD-related liver *** predisposition to poor outcomes and severe acute respiratory syndrome coronavirus 2 infection in patients with MAFLD could be secondary to mechanisms common to both,including preexisting systemic chronic inflammation,endothelial dysfunction,and involvement of the renin-angiotensin *** of the increased risk of adverse outcomes,MAFLD should be screened in all patients admitted for *** computed tomography scans could be of help,assessment of liver fibrosis is also recommended,favoring noninvasive methods to limit the exposure of healthcare *** involvement in this population ranges from abnormalities in liver chemistry to hepatic steatosis in postmortem ***,preventive measures should be strongly advocated in patients already known to have MAFLD,including the use of telemedicine and vaccination in addition to general measures.

关键词： Metabolic-associated fatty liver disease COVID-19 Mortality Fibrosis Histology Epidemiology

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Prognostic performance of an index based on lactic dehydrogenase and transaminases for patients with liver steatosis and COVID-19

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World Journal of Gastroenterology 2022年第37期28卷 5444-5456页

作者： Ricardo Ulises Macías-Rodríguez Alberto Adrián Solís-Ortega Victoria J Ornelas-Arroyo astrid ruiz-margáin Maria Sarai González-Huezo Nestor A Urdiales-Morán Berenice M Román-Calleja Juan M Mayorquín-Aguilar JoséA González-Regueiro Alejandro Campos-Murguía Israel Vicente Toledo-Coronado Mónica Chapa-Ibargüengoitia Bernardo Valencia-Peña Carlos Fernando Martínez-Cabrera Nayelli C Flores-García Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Department of Gastroenterology Centro Médico ISSEMYMToluca 52140Mexico Department of Radiology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico

BACKGROUND Metabolic associated fatty liver disease(MAFLD)is associated with complications and mortality in patients with coronavirus disease 2019(COVID-19).However,there are no prognostic scores aimed to evaluate the risk of severe disease specifically in patients with MAFLD,despite its high *** dehydrogenase,aspartate aminotransferase and alanine aminotransferase have been used as markers of liver ***,we propose an index based on lactate dehydrogenase,aspartate aminotransferase and alanine aminotransferase for the prediction of complications and mortality in patients with MAFLD and *** To evaluate the prognostic performance of an index based on lactate dehydrogenase and transaminases(aspartate aminotransferase/alanine aminotransferase)in patients with COVID-19 and MAFLD[liver fibrosis and nutrition(LNF)-COVID-19 index].METHODS In this retrospective cohort study,two cohorts from two different tertiary centers were *** first was the derivation cohort to obtain the score cutoffs,and the second was the validation *** included hospitalized patients with severe COVID-19 and *** steatosis was evaluated by computed tomography *** under the receiver operating characteristic(ROC)curve analysis and survival analysis were *** In the derivation cohort,44.6%had MAFLD;ROC curve analysis yielded a LFN-COVID-19 index>1.67 as the best cutoff,with a sensitivity of 78%,specificity of 63%,negative predictive value of 91%and an area under the ROC curve of *** the multivariate analysis,the LFN-COVID-19 index>1.67 was independently associated with the development of acute kidney injury(odds ratio:1.8,95%confidence interval:1.3-2.5,P<0.001),orotracheal intubation(odds ratio:1.9,95%confidence interval:1.4-2.4,P<0.001),and death(odds ratio:2.86,95%confidence interval:1.6-4.5,P<0.001)in both *** LFN-COVID-19 index has a good performance to predict prognosis in patients with MAFLD and COVID-19,which

关键词： COVID-19 Metabolic associated fatty liver disease Lactate dehydrogenase Transaminases Prognosis Nonalcoholic fatty liver disease

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Effect of non-alcoholic beer,diet and exercise on endothelial function,nutrition and quality of life in patients with cirrhosis

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World Journal of Hepatology 2020年第12期12卷 1299-1313页

作者： Ricardo U Macias-Rodriguez astrid ruiz-margain Berenice M Roman-Calleja May E Espin-Nasser Nayelli CFlores-Garcia Aldo Torre Gretel Galicia-Hernandez Silvia L Rios-Torres Gabriela Fernandez-del-Rivero Arturo Orea-Tejeda Oscar A Lozano-Cruz Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiranMexico City 14080Mexico Liver Fibrosis and Nutrition Lab(LFN-Lab) MICTLÁN Network:Mechanisms of Liver InjuryCell Death and Translational Nutrition in Liver Diseases-Research NetworkMexico City 14080Mexico Department of Cardiology Instituto Nacional de Enfermedades RespiratoriasMexico City 14080Mexico Department of Internal Medicine Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiranMexico City 14080Mexico

BACKGROUND The implementation of nutritional strategies targeting several variables at once could benefit patients with ***-alcoholic beer has different compounds that exert antioxidant,anti-inflammatory and nutritional *** To evaluate the effect of diet+exercise and non-alcoholic beer on nutritional status,endothelial function and quality of life in patients with *** In this randomized open clinical trial,patients with cirrhosis were randomized into two groups:The intervention(non-alcoholic beer+diet+exercise)and control(water+diet+exercise)*** consisted of 330 mL nonalcoholic beer/day or the same amount of water,plus an individualized dietary plan and an exercise program with a pedometer-based bracelet to reach at least 5000 steps/d and>2500 above the baseline during 8 *** function(flow-mediated dilation,plethysmography),biochemical and nutritional variables and quality of life(CLDQ)were *** Forty-three patients were included in the study,21 in the control group and 22 in the intervention *** mean age was 53.5±7.8 years,60%were women,the median MELD score was 8(7-10)and most patients were Child-Pugh A(88%).Adherence to the interventions was>90%in both groups,there were no adverse events and all biochemical parameters remained stable in both *** function improved in both *** measured nutritional parameters improved in the intervention group,compared to only 2 in the control group and quality of life improved in both groups;however,more domains improved in the intervention *** The intervention consisting of non-alcoholic beer,diet and exercise seems to be safe and well tolerated in patients with cirrhosis,and shows improvement in nutritional status,endothelial function,and quality of *** results need to be further confirmed.

关键词： Hops Portal hypertension Sarcopenia Diet Cirrhosis Antioxidants

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