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insulin sensitizers in treatment of nonalcoholic fatty liver disease:Systematic review

World Journal of Gastroenterology 2006年第48期12卷 7826-7831页

作者： Norberto C Chavez-Tapia Tonatiuh Barrientos-Gutierrez felix i tellez-ávila Francisco Sánchez-ávila Maria Antonieta Montao-Reyes Misael Uribe Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Zalvador Zubirán Mexico City Mexico The University of Texas School of Public Health Houston United States instituto de Educación Media Superior Mexico City Mexico

AiM: To summarize the evidence available for the clinical effectiveness of insulin sensitizers in the treatment of nonalcoholic fatty liver disease (NAFLD) systematically. METHODS: Relevant articles were located using computer-assisted searches of Medline (1966-March 2006), EMBASE (1988-March 2006), CiNAHL (1982-March 2003), Educational Resource information Center (1966-March 2006), Library, information Science & Technology Abstracts (1967-March 2006), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (1994-2006), dissertations in ProQuest and FirstSearch databases. Manual searches were made in the abstracts from meetings of the American Gastroenterological Association (1999-2006), and the American Association for the Study of Liver Diseases (2003-2005). Studies were retrieved using the following selection criteria: (1) clinical trials using insulin sensitizers in subjects with NAFLD, (2) adult patients, (3) published as full manuscripts or abstracts, and (4) English, Spanish, German, and French languages only. Data were abstracted independently by two reviewers following standardized procedures. A face-to- face comparison of data was conducted to ensure the completeness and reliability of the abstraction process. RESULTS: Nine studies were included, six using metformin and three using thiazolidinediones. Only two studies were placebo-controlled trials. The mediansample size for all studies was 18 subjects. in the placebo-controlled trials, metformin improved insulin resistance markers and liver function tests, but not histological scores. in the single-arm trials, metformin and thiazolidinediones improved insulin resistance markers and liver function tests, and beneficial histological changes were reported. There is limited high-quality information available from which to draw categorical conclusions about the clinical use of insulin sensitizers in ***: Current information indicates that the use of insulin sensitizers

关键词：敏化剂治疗非酒精性脂肪肝病理

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PPis are not associated with a lower incidence of portal-hypertension-related bleeding in cirrhosis

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World Journal of Gastroenterology 2010年第46期16卷 5869-5873页

作者： Mauricio Garcia-Saenz-de-Sicilia Francisco Sanchez-Avila Norberto C Chavez-Tapia Gustavo Lopez-Arce Sandra Garcia-Osogobio Roberto Ruiz-Cordero felix i tellez-Avila Department of Gastroenterology Instituto Nacional de Ciencias Medicas y Nutrición Salvador ZubiranMexico CityMexico Medica Sur Clinic and Fundation Endoscopy Department Instituto Nacional de Ciencias Medicas y Nutricion Salvador ZubiranMexico City14000Mexico

AiM:To determine if proton pump inhibitor use in cirrhotic patients with endoscopic findings of portal hypertension is associated with a lower frequency of gastrointestinal ***:Patients with cirrhosis and endoscopic findings related to portal hypertension,receiving or not receiving proton pump inhibitor (PPi) therapy,were included *** assigned patients to two groups:group 1 patients underwent PPi therapy and group 2 patients did not undergo PPi ***:One hundred and five patients with a median age of 58 (26-87) years were included,57 (54.3%) of which were *** varices were found in 82 (78%) patients,portal hypertensive gastropathy in 72 (68.6%) patients,and gastric varices in 15 (14.3%) *** therapy was used in 45.5% of patients (n=48).Seventeen (16.1%) patients presented with upper gastrointestinal bleeding;in 14/17 (82.3%) patients,bleeding was secondary to esophageal varices,and in 3/17 patients bleeding was attributed to portal hypertensive *** related to portal hypertension according to PPi therapy occurred in 18.7% (n=9) of group 1 and in 14% (n=8) of group 2 (odds ratio:0.83,95% confidence interval:0.5-1.3,P=0.51).CONCLUSiON:Portal hypertension bleeding is not associated with PPi *** findings do not support the prescription of PPis in patients with chronic liver disease with no currently accepted indication.

关键词： Drug prescription Liver cirrhosis Portal hypertension Proton pump inhibitors Upper gastrointestinal bleeding

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Clinical heterogeneity in autoimmune acute liver failure

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World Journal of Gastroenterology 2007年第12期13卷 1824-1827页

作者： Norberto C Chavez-Tapia Julio Martinez-Salgado Julio Granados Misael Uribe felix i tellez-Avila Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City MexicoJulio Granados Department of Immunology and Rheumatology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico Department of immunology and Rheumatology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico

AiM: To describe the outcome and prognosis in a cohort of patients with acute liver failure due to autoimmune hepatitis without liver transplantation. METHODS: A retrospective trial was conducted in 11 patients with acute liver failure due to autoimmune hepatitis who attended the instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran. Demographic, biochemical and severity indexes, and treatment and outcome were assessed. RESULTS: Among the 11 patients, with a median age of 31 years, 72% had inflammatory response syndrome, and six patients received corticosteroids. The mortality rate within four weeks was 56%, and the one-year survival was 27%. in the survivors, severity indexes were lower and 83% received corticosteroids. CONCLUSiON: We observed a relatively high survival rate in patients with acute liver failure due to autoimmune hepatitis. This survival rate could be influenced by severity of the disease and/or use of corticosteroids.

关键词：自体免疫性肝炎急性肝衰竭临床异质性皮质类固醇

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

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World Journal of Gastroenterology 2008年第30期14卷 4771-4775页

作者： felix i tellez-Avila Francisco Sanchez-Avila Mauricio García-Saenz-de-Sicilia Norberto C Chavez-Tapia Ada M Franco-Guzman Gustavo Lopez-Arce Eduardo Cerda-Contreras Misael Uribe Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

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 ity (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, obesityand 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.

关键词：隐原性肝硬化慢性肝炎代谢综合症肥胖糖尿病

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