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Refractory hepatic encephalopathy in a patient with hypothyroidism: Another element in ammonia metabolism

World Journal of Gastroenterology 2017年第28期23卷 5246-5252页

作者： Fernando Díaz-Fontenla Marta Castillo-Pradillo Arantxa Díaz-Gómez Luis Ibanez-Samaniego Pilar Gancedo Juan Adan Guzmán-de-Villoria Pilar Fernández-García rafael banares-canizares Rita García-Martínez Unidad de Hepatología Servicio de Aparato DigestivoHospital General Universitario Gregorio Maranón Instituto de Investigación Sanitaria Hospital Gregorio Maranón Servicio de Aparato Digestivo Hospital Santa Bárbara Servicio de Radiodiagnóstico Hospital General Universitario Gregorio Maranón Centro de Investigación Biomédica en Red de Salud Mental Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Facultad de Medicina Universidad San Pablo CEU

Hepatic encephalopathy(HE) remains a diagnosis of exclusion due to the lack of specific signs and symptoms. Refractory HE is an uncommon but serious condition that requires the search of hidden precipitating events(i.e.,portosystemic shunt) and alternative diagnosis. Hypothyroidism shares clinical manifestations with HE and is usually considered within the differential diagnosis of HE. Here,we describe a patient with refractory HE who presented a large portosystemic shunt and post-ablative hypothyroidism. Her cognitive impairment,hyperammonaemia,electroencephalograph alterations,impaired neuropsychological performance,and magnetic resonance imaging and spectroscopy disturbances were highly suggestive of HE,paralleled the course of hypothyroidism and normalized after thyroid hormone replacement. There was no need for intervention over the portosystemic shunt. The case findings support that hypothyroidism may precipitate HE in cirrhotic patients by inducing hyperammonaemia and/or enhancing ammonia brain toxicity. This case led us to consider hypothyroidism not only in the differential diagnosis but also as a precipitating factor of HE.

关键词： Hepatic encephalopathy Hypothyroidism Cognitive impairment Cirrhosis Portosystemic shunt Magnetic resonance spectroscopy

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Everolimus immunosuppression reduces the serum expression of fibrosis markers in liver transplant recipients

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World Journal of Transplantation 2014年第2期4卷 133-140页

作者： Ainhoa Fernández-Yunquera Cristina Ripoll rafael banares Marta Puerto Diego Rincón Ismael Yepes Vega Catalina Magdalena Salcedo Department of Liver Transplantation Hospital General Gregorio Mara?ón28028 MadridSpain On-Line Bio-medical Investigation Center for Hepatic and Gastrointestinal Diseases 28028 MadridSpain

AIM: To evaluate the expression of serum fibrosis markers in liver transplantation(LT) recipients on everolimus monotherapy compared to patients on an anti-calcineurin ***: This cross-sectional case-control study included LT patients on everolimus monotherapy(cases)(E)(n = 30) and matched controls on an anticalcineurin regimen(calcineurin inhibitors, CNI), paired by etiology of liver disease and time since LT(n = 30). Clinical characteristics, blood tests and elastography were collected. Serum levels of transforming growth factor-β(TGF-β), angiopoietin-1, tumor necrosis factor(TNF), platelet derived growth factor, amino-terminal propeptide of type Ⅲ procollagen(PⅢNP), hyaluronicacid(HA), VCM-1(ng/m L), interleukin(IL)-10, interferoninducible protein 10(IP-10), vascular endothelial growth factor and hepatocyte growth factor(HGF)(pg/m L) were determined by enzyme-linked immunosorbent assay. Expression of these markers between E and CNI was compared. Stratified analysis was done according to factors that may influence liver fibrosis. Variables are described with medians(interquartillic range) or ***: A total of 60 patients [age: 59(49-64), hepatitis C virus(HCV): n = 21(35%), time from LT: 73 mo(16-105)] were included. Patients had been on everolimus for a median of 15 mo. No differences in inflammatory activity, APRI test or liver elastography were found between the groups. No significant differences were observed between the groups in serum levels of PⅢ NP, metalloproteinase type = 1, angiopoietin, HGF, IP-10, TNF-α, IL-10 and vascular cell adhesion molecule. Patients on E had a lower expression of TGF-β [E: 12.7(3.7-133.6), CNI: 152.5(14.4-333.2), P = 0.009] and HA [E: 702.89(329.4-838.2), CNI: 1513.6(691.9-1951.4), P = 0.001] than those on CNI. This difference was maintained in the stratified analysis when recipient age is more than 50 years(TFG-β1: P = 0.06; HA: P = 0.005), in patients without active neoplasia(TFG-β1, P = 0.009; HA: P =

关键词： Everolimus Rapamycin Liver fibrosis Mammalian target of rapamycin Transplantation

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