Metabolic dysfunction-associated fatty liver disease(MAFLD)is the most prevalent chronic liver condition worldwide.Current liver enzyme-based screening methods have limitations that may missed diagnoses and treatment ...Metabolic dysfunction-associated fatty liver disease(MAFLD)is the most prevalent chronic liver condition worldwide.Current liver enzyme-based screening methods have limitations that may missed diagnoses and treatment delays.Regarding Chen et al,the risk of developing MAFLD remains elevated even when alanine aminotransferase levels fall within the normal range.Therefore,there is an urgent need for advanced diagnostic techniques and updated algorithms to enhance the accuracy of MAFLD diagnosis and enable early intervention.This paper proposes two potential screening methods for identifying individuals who may be at risk of developing MAFLD:Lowering these thresholds and promoting the use of noninvasive liver fibrosis scores.展开更多
Liver biochemical tests are some of the most commonly ordered routine tests in the inpatient and outpatient setting,especially with the automatization of testing in this technological era.These tests include aminotran...Liver biochemical tests are some of the most commonly ordered routine tests in the inpatient and outpatient setting,especially with the automatization of testing in this technological era.These tests include aminotransferases,alkaline phosphatase,gamma-glutamyl transferase,bilirubin,albumin,prothrombin time and international normalized ratio(INR).Abnormal liver biochemical tests can be categorized based on the pattern and the magnitude of aminotransferases elevation.Generally,abnormalities in aminotransferases can be classified into a hepatocellular pattern or cholestatic pattern and can be further sub-classified based on the magnitude of aminotransferase elevation to mild[<5×upper limit of normal(ULN)],moderate(>5-<15×ULN)and severe(>15×ULN).Hepatocellular pattern causes include but are not limited to;non-alcoholic fatty liver disease/non-alcoholic steatohepatitis,alcohol use,chronic viral hepatitis,liver cirrhosis(variable),autoimmune hepatitis,hemochromatosis,Wilson’s disease,alpha-1 antitrypsin deficiency,celiac disease,medication-induced and ischemic hepatitis.Cholestatic pattern causes include but is not limited to;biliary pathology(obstruction,autoimmune),other conditions with hyperbilirubinemia(conjugated and unconjugated).It is crucial to interpret these commonly ordered tests accurately as appropriate further workup,treatment and referral can greatly benefit the patient due to prompt treatment which can improve the natural history of several of the diseases mentioned and possibly reduce the risk of progression to the liver cirrhosis.展开更多
BACKGROUND Indices such as the neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),mean platelet volume(MPV),platelet distribution width(PDW),and red cell distribution width(RDW)are considered new ma...BACKGROUND Indices such as the neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),mean platelet volume(MPV),platelet distribution width(PDW),and red cell distribution width(RDW)are considered new markers of the systemic inflammatory response(SIR),and have been widely implemented for the diagnosis of patients with inflammatory diseases.These new indicators have also been widely investigated in preeclampsia(PE)but less analyzed in hemolysis,elevated liver enzymes,and low platelet(HELLP)syndrome.AIM To compare SIR markers among HELLP patients,PE only patients,and healthy gravidae.METHODS This retrospective case-control study enrolled 630 cases,including 210 patients with HELLP syndrome(HELLP group),210 patients with only PE(PE group)and 210 healthy gravidae(control group).The three groups were matched by age,parity,status of assisted reproduction,and multiple pregnancies.Birthweight,gestational age at complete blood count collection,gestational age at delivery,mode of delivery,etc.were recorded.The main indices as NLR,PLR,MPV,PDW,and RDW among the groups were compared,as well as some secondary outcomes including neutrophil,platelets,and hemoglobin.RESULTS The NLR(6.4 vs 4.3 vs 3.5),MPV(11.9 vs 11.2 vs 10.7),PDW(16.4 vs 13.3 vs 14.2),leukocyte(12.4×10^(9)/L vs 9.7×10^(9)/L vs 8.7×10^(9)/L)and neutrophil count(9.9×10^(9)/L vs 7.3×10^(9)/L vs 6.1×10^(9)/L)were highest in the HELLP group,lower in the PE group,and lowest in the control group.Both the overall comparisons between the three groups(all bP<0.01)and pairwise comparisons between every two groups elicited statistically significant differences(all dP<0.01,except control vs PE:cP<0.05 in PDW).The average lymphocyte counts were 1.4(1.1,2.0)×10^(9)/L in the HELLP group,1.6(1.3,2.0)×10^(9)/L in the PE group and 1.7(1.4,2.0)×10^(9)/L in the control group.The overall comparison of lymphocyte count within the three groups had statistically significant differences(P=0.000).The pairwise comparisons between every two groups demonstrated that the HELLP group had a lower lymphocyte count than both the PE(P=0.019)and control groups(P=0.000),but the difference between the PE and control groups was not statistically significant(P=0.432).The overall comparisons on platelet counts and the PLR among these three groups also showed statistically significant differences(both P=0.000),from low to high being those in the HELLP group(43.4×10^(9)/L,64.0),control group(180.5×10^(9)/L,103.6)and PE group(181.5×10^(9)/L,112.8).Pairwise comparisons of neither index displayed statistically significant differences between the PE and control groups(both P>0.05),while the differences in the two indices between the HELLP group and the two other groups were still statistically significant(all P=0.000).RDW values were highest in the HELLP group(14.5%[13.6,15.3]),lower in the control group(14.1%[13.5,14.8])and lowest in the PE group(13.9%[13.4,14.9]).The difference between the PE and control group did not show statistical significance(P=1.000),while RDW values in the HELLP group were higher than those in the other two groups(cP<0.05 vs control,dP<0.01 vs PE).CONCLUSION SIR markers such as NLR,RDW,MPV,and PDW were increased and PLR was decreased in HELLP.These SIR markers may become new indicators in the evaluation of HELLP syndrome.展开更多
ObjectiveTo investigate the hepatoprotective efficacy of cranberry extract (CBE) against carbon tetrachloride (CCl<sub>4</sub>)-induced hepatic injury using in-vivo animal model.MethodsThe hepatoprotective...ObjectiveTo investigate the hepatoprotective efficacy of cranberry extract (CBE) against carbon tetrachloride (CCl<sub>4</sub>)-induced hepatic injury using in-vivo animal model.MethodsThe hepatoprotective efficacy of CBE (200 and 400 mg/kg) was investigated against CCl<sub>4</sub> (4 mL/kg)-induced hepatotoxicity, elevated liver enzymes [ALT (alanine aminotransferase), AST (aspartate aminotransferase), and alkaline phosphatase (ALP)], and total protein (TP) contents in the serum. Moreover, CBE-aided antioxidant defense against hepatotoxic insult of CCl<sub>4</sub> was measured by evaluating a number of anti-oxidative biomarkers including reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA) in the serum by using spectrophotometric analyses.ResultsResults showed that the exposure of experimental animals to CCl<sub>4</sub> did induce significant hepatotoxicity compared to the non-induced (untreated) group. The oral administration of CBE demonstrated a significant dose-dependent alleviation in the liver enzymes (AST, ALT, and ALP), increased antioxidant defense (GSH, SOD, and CAT), and reduced MDA levels in the serum of treated animals compared to the animals without treatment. The resulting data showed that the administration of CBE decreased the serum levels of ALT, AST, and ALP compared to the CCl<sub>4</sub>-induced group.ConclusionsThe resulting data evidenced that CBE exhibits promising hepatoprotective potential against the chemical induced hepatotoxicity, maintains homeostasis in liver enzymes, and can provide significant antioxidant defense against free radicals-induced oxidative stress.展开更多
BACKGROUND：Early recurrence of hepatocellular carcinoma（HCC）is associated with worse prognosis after liver resection This study aimed to investigate the prognostic value of com mon liver enzyme markers in HCC early...BACKGROUND：Early recurrence of hepatocellular carcinoma（HCC）is associated with worse prognosis after liver resection This study aimed to investigate the prognostic value of com mon liver enzyme markers in HCC early recurrence after cu rative hepatectomy and to establish a simple predictive model for HCC early recurrence.METHODS： A total of 200 patients who had undergone curative resection for HCC were retrospectively analyzed. The patients were divided into early recurrence （within 2 years） and non-early recurrence groups. Demographical characteristics, preopera- tive liver function parameters, surgical factors and tumor related factors of the patients were assessed by univariate analysis to identify potential significant predictors for early recurrence after resection of HCC. Parameters with statisti- cal significance were entered into a Cox proportional hazard model to find independent risk factors. Receiver operating characteristic analysis was done to determine optimal cut-off values and the number of combined factors in multi-factor predictive model. RESULTS： Of 13 potential risk factors for early recurrence identified by univariate analysis, high lactate dehydrogenase （LDH〉206 U/L, HR=1.711, P=0.006）, high aspartate aminotransferase （AST）/alanine aminotransferase （ALT） ratio （AST/ ALT〉0.96, HR=1.769, P=0.006）, elevated alpha-fetoprotein （AFP〉8.6 ng/mL, HR=2.079, P=0.007）, small resection margin （〈1 cm, HR=2.354, P〈0.001） and advanced TNM stage （TNM III-IV, HR=2.164, P〈0.001） were independent risk factors for early recurrence of HCC shown by multivariate analysis. Patients with three or more concurrent independent risk factors had significantly higher risk for early recurrence than those with low risk factors. The sensitivity and specificity of this predictive model are 53.6% and 80.7%, respectively （area under curve=0.741, 95% CI 0.674-0.800, P〈0.0001）. CONCLUSIONS： Preoperative common fiver enzyme markers, LDH and AST/ALT ratio, were independently associated with early recurrence of HCC. The combination of serum liver enzyme markers with AFP, resection margin and TNM stage bet- ter predicted early recurrence of HCC after curative resection in a simple multi-factor model.展开更多
We present a case of symptomatic perihepatic adhesions,which developed after a pregnancy complicated by hemolysis,elevated liver enzymes and low platelet(HELLP)syndrome,in which a subcapsular liver hematoma occurred.O...We present a case of symptomatic perihepatic adhesions,which developed after a pregnancy complicated by hemolysis,elevated liver enzymes and low platelet(HELLP)syndrome,in which a subcapsular liver hematoma occurred.Our patient presented with complaints of persistent,severe right-sided upper abdominal pain.The complaints developed gradually,one year after a pregnancy that had been complicated by HELLP syndrome with a subcapsular liver hematoma.The hematoma had resolved spontaneously.An upperabdominal magnetic resonance imaging revealed a density between liver and diaphragm at the site of the former subcapsular hematoma,suspect of perihepatic adhesions.The presence of perihepatic adhesions was confirmed during a laparoscopy and treated by adhesiolysis in the same session.The adhesions may have developed in response to the degradation process of the subcapsular liver hematoma during conservative treatment.This case of perihepatic adhesions may therefor be the first presentation of a long term sequel of subcapsular liver hematoma in HELLP syndrome.展开更多
The prevalence of alcoholic liver disease and non-alcoholic liver disease patients has nearly doubled over the past decades worldwide. Alcoholic liver disease among patients with chronic liver disease has increased wi...The prevalence of alcoholic liver disease and non-alcoholic liver disease patients has nearly doubled over the past decades worldwide. Alcoholic liver disease among patients with chronic liver disease has increased with arisen due to alcohol consumption and obesity. The diagnosis plays a crucial role in treating such conditions based on the stages of liver functioning. The elevated liver enzymes are the key characterizing of identifying the alcoholic liver disease (ALD) and NAFLD. Later on, there is a progression of the disease conditions by developing fibrosis and cirrhosis, leading to liver carcinoma. The other state, steatohepatitis, is associated with an increase in liver-related and can lead to mortality. Risk factors for both diseases are growing, leading to various complications in health. There is no specific treatment up to date for these conditions, but statins play a crucial role in managing several liver disease conditions. The commonly used drug is hydroxymethylglutaryl coenzyme A (HMG Co-A) reductase inhibitors. It is also known as statins, which help normalize liver enzymes in patients with elevated plasma aminotransferases. As a result, external liver damage is considered safe for the liver as the Statin medication at low to moderate dose usage. OBJECTIVES: The main scope of this review is to study the various factors like pharmacological actions, adverse events, and biochemical and liver cell imaging results in patients with ALD and NAFLD. The different types of statins used in alcoholic and non-alcoholic patients’ clinical data for the safety of the statin therapy were concluded in this review. Fatty liver changes of both liver disease conditions were studied using different drugs. The other liver enzymes like Alanine transaminase (ALT), Aspartate transaminase (AST), Gamma-glutamyl Transferase (GGT), and the effectiveness of Statin therapy are considered vital concepts in this review.展开更多
The correlation between liver enzymes and lipid profile in T2D patients in the Yemeni population has been evaluated. This is a case-control study comprising 142 T2D patients and 142 healthy control subjects were carri...The correlation between liver enzymes and lipid profile in T2D patients in the Yemeni population has been evaluated. This is a case-control study comprising 142 T2D patients and 142 healthy control subjects were carried out at the outpatient clinics of Ibn-Sina hospital, Mukalla, during the period from January to May 2020. Serum fasting blood glucose (FBG), total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) were analyzed using the Cobas Integra Plus 400 autoanalyzer. Also, anthropometric and blood pressure measurements were taken from each participant. Independent sample T-test and Pearson correlation coefficient were used. T2D patients had significantly higher FBG (P ≤ 0.0001), total cholesterol (P ≤ 0.0001), LDL-C (P ≤ 0.0001), and GGT (P ≤ 0.0001) while HDL-C was significantly lower in T2D patients (P = 0.021). In correlation analysis, serum GGT was positively associated with FBG (r = 0.216;P ≤ 0.0001), total cholesterol (r = 0.196;P = 0.0001), triglyceride (r = 0.123;P = 0.038), and LDL-C (r = 0.209;P ≤ 0.0001). Also, serum ALT was positively associated with FBG (r = 0.145, P = 0.014) and triglyceride (r = 0.172, P = 0.004). In conclusion, higher levels of ALT and GGT are used as the predictive biomarkers for NAFLD in T2D patients with hyperlipidemia. Thus, routine screening of liver enzymes and lipid profile in T2D patients is recommended for the early detection of liver abnormalities and diminish diabetes complications.展开更多
BACKGROUND Previous research has highlighted correlations between blood cell counts and chronic liver disease.Nonetheless,the causal relationships remain unknown.AIM To evaluate the causal effect of blood cell traits ...BACKGROUND Previous research has highlighted correlations between blood cell counts and chronic liver disease.Nonetheless,the causal relationships remain unknown.AIM To evaluate the causal effect of blood cell traits on liver enzymes and nonalcoholic fatty liver disease(NAFLD)risk.METHODS Independent genetic variants strongly associated with blood cell traits were extracted from a genome-wide association study(GWAS)conducted by the Blood Cell Consortium.Summary-level data for liver enzymes were obtained from the United Kingdom Biobank.NAFLD data were obtained from a GWAS meta-analysis(8434 cases and 770180 controls,discovery dataset)and the Fingen GWAS(2275 cases and 372727 controls,replication dataset).This analysis was conducted using the inverse-variance weighted method,followed by various sensitivity analyses.RESULTS One SD increase in the genetically predicted haemoglobin concentration(HGB)was associated with aβof 0.0078(95%CI:0.0059-0.0096),0.0108(95%CI:0.0080-0.0136),0.0361(95%CI:0.0156-0.0567),and 0.0083(95%CI:00046-0.0121)for alkaline phosphatase(ALP),alanine aminotransferase(ALT),aspartate aminotransferase,and gammaglutamyl transferase,respectively.Genetically predicted haematocrit was associated with ALP(β=0.0078,95%CI:0.0052-0.0104)and ALT(β=0.0057,95%CI:0.0039-0.0075).Genetically determined HGB and the reticulocyte fraction of red blood cells increased the risk of NAFLD[odds ratio(OR)=1.199,95%CI:1.087-1.322]and(OR=1.157,95%CI:1.071-1.250).The results of the sensitivity analyses remained significant.CONCLUSION Novel causal blood cell traits related to liver enzymes and NAFLD development were revealed through Mendelian randomization analysis,which may facilitate the diagnosis and prevention of NAFLD.展开更多
Background： Obstructive sleep apnea-hypopnea syndrome （OSAS） is associated with elevated liver enzymes and fatty liver. The purpose of this study was to measure serum liver enzyme levels in patients evaluated by po...Background： Obstructive sleep apnea-hypopnea syndrome （OSAS） is associated with elevated liver enzymes and fatty liver. The purpose of this study was to measure serum liver enzyme levels in patients evaluated by polysomnography （PSG） and the f：actors associated with liver injury in OSAS patients. Methods： All patients referred to PSG for evaluation of sleep apnea symptoms between June 2011 and November 2014 were included in this study. Demographic data and PSG parameters were recorded. Serum alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase levels were systematically measured. OSAS patients were divided into mild, moderate, and severe groups according to the apnea-hypopnea index （AHI） values of 5-14 events/h, 15-29 events/h, and ≥30 events/h. Results： A total of 540 patients were enrolled in this study; among these patients, 386 were male. Elevated liver enzymes were present in 42.3% of OSAS patients （32.4% in mild/moderate group; 51.0% in severe group） and 28.1% patients without OSAS. Patients with OSAS had higher body mass index （BMI） （P 〈 0.01）. In the bivariate correlation, the liver enzymes level was negatively correlated with age and the lowest arterial oxygen saturation （SaO2）, and was positively correlated with BMI, oxygen desaturation index, percent of total time with oxygen saturation level 〈90% （TS90%）, AHI, total cholesterol （TC）, and triglyceride （TG）. In logistic regression analysis, Age, BMI, TS90%, TC, and TG were included in the regression equation. Conclusions： Our data suggest that OSAS is a risk factor for elevated liver enzymes. The severity of OSAS is correlated with liver enzyme levels; we hypothesize that hypoxia is one of main causes of liver damage in patients with OSAS.展开更多
With the rapid development of research on coronavirus disease 2019(COVID-19),more and more attention has been drawn to its damage to extrapulmonary organs.There are increasing lines of evidence showing that liver inju...With the rapid development of research on coronavirus disease 2019(COVID-19),more and more attention has been drawn to its damage to extrapulmonary organs.There are increasing lines of evidence showing that liver injury is closely related to the severity of COVID-19,which may have an adverse impact on the progression and prognosis of the patients.What is more,severe acute respiratory syndrome coronavirus-2 infection,cytokine storm,ischemia/hypoxia reperfusion injury,aggravation of the primary liver disease and drug-induced liver injury may all contribute to the hepatic damage in COVID-19 patients;although,the drug-induced liver injury,especially idiosyncratic drug-induced liver injury,requires further causality confirmation by the updated Roussel Uclaf Causality Assessment Method published in 2016.Up to now,there is no specific regimen for COVID-19,and COVID-19-related liver injury is mainly controlled by symptomatic and supportive treatment.Here,we review the clinical features of abnormal liver enzymes in COVID-19 and pathogenesis of COVID-19-related liver injury based on the current evidence,which may provide help for clinicians and researchers in exploring the pathogenesis and developing treatment strategies.展开更多
Background and aim Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the virus responsible for the current pandemic,can have multi-organ impact.Recent studies show that liver injury could be a manifestation ...Background and aim Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the virus responsible for the current pandemic,can have multi-organ impact.Recent studies show that liver injury could be a manifestation of the disease,and that liver disease could also be related to a worse prognosis.Our aim was to compare the characteristics of patients with severe coronavirus disease 2019(COVID-19)due to SARS-CoV-2 who required intubation versus stable hospitalized patients to identify the early biochemical predictive factors of a severe course of COVID-19 and subsequent requirement for intubation,specifically in Mexican.Methods This was an observational case-control study nested in a cohort study.Complete medical records of patients admitted for confirmed COVID-19 at a tertiary level center in Mexico City were reviewed.Clinical and biochemical data were collected,and the characteristics of patients who required invasive mechanical ventilation(IMV)(cases)were compared with stable hospitalized patients without ventilation(controls).Results We evaluated 166 patients with COVID-19 due to SARS-CoV-2 infection;114(68.7%)were men,the mean age was 50.6±13.3 years,and 27(16.3%)required IMV.The comparative analysis between cases and controls showed(respectively)significantly lower blood oxygen saturation(SpO_(2))(73.5±12.0%vs.83.0±6.8%,P<0.0001)and elevated alanine aminotransferase(ALT)(128(14–1123)IU/L vs.33(8–453)IU/L,P=0.003),aspartate aminotransferase(AST)(214(17–1247)vs.44(12–498)IU/L,P=0.001),lactic dehydrogenase(LDH)(764.6±401.9 IU/L vs.461.0±185.6 IU/L,P=0.001),and D-dimer(3463(524–34,227)ng/mL vs.829(152–41,923)ng/mL,P=0.003)concentrations.Patients in the cases group were older(58.6±12.7 years vs.49.1±12.8 years,P=0.001).Multivariate analysis showed that important factors at admission predicting the requirement for IMV during hospitalization for COVID-19 were AST≥250 IU/L(odds ratio(OR)=64.8,95%confidence interval(CI)7.5–560.3,P<0.0001)and D-dimer≥3500 ng/mL(OR=4.1,95%CI 1.2–13.7,P=0.02).Conclusions Our study confirms the importance of monitoring liver enzymes in hospitalized patients with COVID-19;seriously ill patients have significantly elevated AST and D-dimer concentrations,which have prognostic implications in the SARS-CoV-2 disease course.展开更多
Background and Aims:Liver enzyme abnormalities in coronavirus 2019(COVID-19)are being addressed in the literature.The predictive risk of elevated liver enzymes has not been established for COVID-19 mortality.In this s...Background and Aims:Liver enzyme abnormalities in coronavirus 2019(COVID-19)are being addressed in the literature.The predictive risk of elevated liver enzymes has not been established for COVID-19 mortality.In this study,we hypothesized that elevated liver enzymes at ad-mission can predict the outcome of COVID-19 disease with other known indicators,such as comorbidities.Methods:This retrospective study included all the consecutive hos-pitalized patients with confirmed COVID-19 disease from March 4th to May 31st,2020.The study was conducted in Rajiv Gandhi Government General Hospital,Chennai,Ta-mil Nadu,India.We assessed demography,clinical vari-ables,COVID-19 severity,laboratory parameters,and out-come.Results:We included 1,512 patients,and median age was 47 years(interquartile range:34-60)with 36.9%being female.Liver enzyme level(aspartate aminotrans-ferase and/or alanine aminotransferase)was elevated in 450/1,512(29.76%)patients.Comorbidity was present in 713/1,512(47.16%)patients.Patients with liver enzymes’elevation and presence of comorbidity were older,more frequently hospitalized in ICU and had more severe symp-toms of COVID-19 at the time of admission.Presence of liver enzymes’elevation with comorbidity was a high risk factor for death(OR:5.314,95%CI:2.278-12.393),as compared to patients with presence of comorbidity(OR:4.096,95%CI:1.833-9.157).Conclusions:Comorbid-ity combined with liver enzymes’elevation at presentation independently increased the risk of death in COVID-19 by at least 5-fold.展开更多
Objective:To investigate the effect of wild black mustard seed meal on thyroid hormones(thyroxine and thyroid-stimulating hormone)in Japanese quails and also study the ability of FeSO4 to alleviate the possible negati...Objective:To investigate the effect of wild black mustard seed meal on thyroid hormones(thyroxine and thyroid-stimulating hormone)in Japanese quails and also study the ability of FeSO4 to alleviate the possible negative effect of mustard meal on thyroid hormones in these birds for the first time.Methods:The experimental procedure was undertaken on 28 quails which were randomly assigned to a control and 6 test groups with 4 quails in each group for 28 days,during which the control group received basic diet with no mustard meal whereas the test groups(No.2,3 and 4)received mustard meal(5%,10%and 15%,respectively)and test groups(No.5,6 and 7)received FeSO_(4)(1%)-treated mustard meal(5%,10%and 15%,respectively)on the basic of basic diet.Results:The group fed on 15%non-treated mustard seed meal had the least thyroxine level and its level backed to normal in group fed on 15%FeSO4-treated mustard seed meal although this group had the highest alanine transaminase and aspartate transaminase levels.Conclusions:We concluded that up to 10%FeSO4 mustard seed meal could be incorporated in the quail diet successfully with the least damage to thyroids and livers,but further investigations on these birds are still needed to confirm this hypothesis.展开更多
Serum liver enzymes(alanine aminotransferase[ALT],aspartate aminotransferase[AST],λ-glutamyl transferase[GGT]and alkaline phosphatase[ALP])are the leading biomarkers to measure liver injury,and they have been reporte...Serum liver enzymes(alanine aminotransferase[ALT],aspartate aminotransferase[AST],λ-glutamyl transferase[GGT]and alkaline phosphatase[ALP])are the leading biomarkers to measure liver injury,and they have been reported to be associated with several intrahepatic and extrahepatic diseases in observational studies.We conducted a phenome-wide association study(PheWAS)to identify disease phenotypes associated with genetically predicted liver enzymes based on the UK Biobank cohort.Univariable and multivariable Mendelian randomization(MR)analyses were performed to obtain the causal esti-mates of associations that detected in PheWAS.Our PheWAS identified 40 out of 1,376 pairs(16,17,three and four pairs for ALT,AST,GGT and ALP,respectively)of genotype-phenotype associations reaching statistical significance at the 5%false discovery rate threshold.A total of 34 links were further validated in Mendelian randomization analyses.Most of the disease phenotypes that associated with genetically determined ALT level were liver-related,including primary liver cancer and alcoholic liver damage.The disease outcomes associated with genetically determined AST involved a wide range of phenotypic categories including endocrine/metabolic diseases,digestive diseases,and neurological disorder.Genetically predicted GGT level was associated with the risk of other chronic non-alcoholic liver disease,abnormal results of function study of liver,and cholelithiasis.Genetically determined ALP level was associated with pulmonary heart disease,phlebitis and thrombophlebitis of lower extremities,and hypercholesterolemia.Our findings reveal novel links between liver enzymes and disease phenotypes providing insights into the full understanding of the biological roles of liver enzymes.展开更多
Since the first reports of coronavirus disease 2019(COVID-19)cases in December 2019 in China,numerous papers have been published describing a high frequency of liver injury associated with severe acute respiratory syn...Since the first reports of coronavirus disease 2019(COVID-19)cases in December 2019 in China,numerous papers have been published describing a high frequency of liver injury associated with severe acute respiratory syndrome coronavirus 2 infection,many of them proposing a link between these findings and patient outcomes.Increases in serum aminotransferase levels(ranging from 16%to 62%)and bilirubin levels(ranging from 5%to 21%)have been reported and seem to be more often observed in patients with severe forms of COVID-19.Although absolute changes in these parameters are frequently seen,other variables,such as the ratio above the upper limit of normal,the onset of liver injury as a complication in severe cases and histopathological findings,reinforce that liver changes are of dubious clinical relevance in the course of this disease.Other factors must also be considered in these analyses,such as the repercussions of hemodynamic changes,the presence of thrombotic events,and,mainly,the possible drug-induced liver injury with the current,yet off-label,treatment.This paper aimed to analyze the currently available data on liver injury in patients with COVID-19.展开更多
AIM: To determine the clinical effectiveness of intense psychological support to physical activity (PA) in nonalcoholic fatty liver disease (NAFLD), compared with cognitive-behavioral treatment (CBT).
AIM To study liver stiffness(LS) during pregnancy and its association with complications during pregnancy.METHODS In this observational, diagnostic study, 537 pregnant women were prospectively enrolled at the Departme...AIM To study liver stiffness(LS) during pregnancy and its association with complications during pregnancy.METHODS In this observational, diagnostic study, 537 pregnant women were prospectively enrolled at the Department of Obstetrics and Gynecology, University hospital Heidelberg and Salem Medical Center. LS was measured using the Fibroscan device(Echosens, Paris) in all women and in 41 cases 24 h after delivery. Clinical and morphological data were recorded and abdominal ultrasound and standard laboratory tests were performed. No complications were observed in 475 women(controls) while preeclampsia and intrahepatic cholestasis of pregnancy(ICP) developed in 22 and 40 women, respectively.RESULTS In controls, LS increased significantly from initially 4.5 ± 1.2 kPa in the second trimester to 6.0 ± 2.3 kPa(P < 0.001) in the third trimester. In the third trimester, 41% of women had a LS higher than 6 kPa. Elevated LS in controls was significantly correlated with alkaline phosphatase, leukocytes, gestational age and an increase in body weight and body mass index(BMI). In women with pregnancy complications, LS was significantly higher as compared to controls(P < 0.0001). Moreover, in multivariate analysis, LS was an independent predictor for preeclampsia with an odds ratio of 2.05(1.27-3.31) and a cut-off value of 7.6 kPa. In contrast, ICP could not be predicted by LS. Finally, LS rapidly decreased in all women within 24 h after delivery from 7.2 ± 3.3 kPa down to 4.9 ± 2.2 kPa(P < 0.001).CONCLUSION During pregnancy, LS significantly and reversibly increases in the final trimester of pregnant women without complications. In women with preeclampsia, LS is significantly elevated and an independent noninvasive predictor.展开更多
Hepatic artery pseudoaneurysms(HAP)are rare events,particularly after liver biopsy,but can be associated with serious complications.Therefore a high suspicion is necessary for timely diagnosis and appropriate treatmen...Hepatic artery pseudoaneurysms(HAP)are rare events,particularly after liver biopsy,but can be associated with serious complications.Therefore a high suspicion is necessary for timely diagnosis and appropriate treatment.We report on a case of HAP that potentially formed after a liver biopsy in a patient with sarcoidosis.The HAP in our case was virtually undetectable initially by angiography but resulted in several complications including recurrent gastrointestinal bleeding,hemorrhagic cholecystitis and finally hepatic infarction with abscess formation until it became detectable at a size of 5-mm.The patient remains asymptomatic over a year after endovascular embolization of the HAP.In this report,we demonstrate that a small HAP can avoid detection by angiography at an early stage while being symptomatic for a prolonged course.A high clinical suspicion with a close clinical/radiological follow-up is needed in symptomatic patients with history of liver biopsy despite initial negative work up.Once diagnosed,HAP can be safely and effectively treated by endovascular embolization.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)was perhaps the most severe global health crisis in living memory.Alongside respiratory symptoms,elevated liver enzymes,abnormal liver function,and even acute liver fai...BACKGROUND The coronavirus disease 2019(COVID-19)was perhaps the most severe global health crisis in living memory.Alongside respiratory symptoms,elevated liver enzymes,abnormal liver function,and even acute liver failure were reported in patients suffering from severe acute respiratory disease coronavirus 2 pneumonia.However,the precise triggers of these forms of liver damage and how they affect the course and outcomes of COVID-19 itself remain unclear.AIM To analyze the impact of liver enzyme abnormalities on the severity and outcomes of COVID-19 in hospitalized patients.METHODS In this study,684 depersonalized medical records from patients hospitalized with COVID-19 during the 2020-2021 period were analyzed.COVID-19 was diagnosed according to the guidelines of the National Institutes of Health(2021).Patients were assigned to two groups:those with elevated liver enzymes(Group 1:603 patients),where at least one out of four liver enzymes were elevated(following the norm of hospital laboratory tests:alanine aminotransferase(ALT)≥40,aspartate aminotransferase(AST)≥40,gamma-glutamyl transferase≥36,or alkaline phosphatase≥150)at any point of hospitalization,from admission to discharge;and the control group(Group 2:81 patients),with normal liver enzymes during hospitalization.COVID-19 severity was assessed according to the interim World Health Organization guidance(2022).Data on viral pneumonia complications,laboratory tests,and underlying diseases were also collected and analyzed.RESULTS In total,603(88.2%)patients produced abnormal liver test results.ALT and AST levels were elevated by a factor of less than 3 in 54.9%and 74.8%of cases with increased enzyme levels,respectively.Patients in Group 1 had almost double the chance of bacterial viral pneumonia complications[odds ratio(OR)=1.73,P=0.0217],required oxygen supply more often,and displayed higher biochemical inflammation indices than those in Group 2.No differences in other COVID-19 complications or underlying diseases were observed between groups.Preexisting hepatitis of a different etiology was rarely documented(in only 3.5%of patients),and had no impact on the severity of COVID-19.Only 5(0.73%)patients experienced acute liver failure,4 of whom died.Overall,the majority of the deceased patients(17 out of 20)had elevated liver enzymes,and most were male.All deceased patients had at least one underlying disease or combination thereof,and the deceased suffered significantly more often from heart diseases,hypertension,and urinary tract infections than those who made recoveries.Alongside male gender(OR=1.72,P=0.0161)and older age(OR=1.02,P=0.0234),diabetes(OR=3.22,P=0.0016)and hyperlipidemia(OR=2.67,P=0.0238),but not obesity,were confirmed as independent factors associated with more a severe COVID-19 infection in our cohort.CONCLUSION In our study,the presence of liver impairment allows us to predict a more severe inflammation with a higher risk of bacterial complication and worse outcomes of COVID-19.Therefore,patients with severe disease forms should have their liver tests monitored regularly and their results should be considered when selecting treatment to avoid further liver damage or even insufficiency.展开更多
基金the National Natural Science Foundation of China,No.82070588 and No.82370577.
文摘Metabolic dysfunction-associated fatty liver disease(MAFLD)is the most prevalent chronic liver condition worldwide.Current liver enzyme-based screening methods have limitations that may missed diagnoses and treatment delays.Regarding Chen et al,the risk of developing MAFLD remains elevated even when alanine aminotransferase levels fall within the normal range.Therefore,there is an urgent need for advanced diagnostic techniques and updated algorithms to enhance the accuracy of MAFLD diagnosis and enable early intervention.This paper proposes two potential screening methods for identifying individuals who may be at risk of developing MAFLD:Lowering these thresholds and promoting the use of noninvasive liver fibrosis scores.
文摘Liver biochemical tests are some of the most commonly ordered routine tests in the inpatient and outpatient setting,especially with the automatization of testing in this technological era.These tests include aminotransferases,alkaline phosphatase,gamma-glutamyl transferase,bilirubin,albumin,prothrombin time and international normalized ratio(INR).Abnormal liver biochemical tests can be categorized based on the pattern and the magnitude of aminotransferases elevation.Generally,abnormalities in aminotransferases can be classified into a hepatocellular pattern or cholestatic pattern and can be further sub-classified based on the magnitude of aminotransferase elevation to mild[<5×upper limit of normal(ULN)],moderate(>5-<15×ULN)and severe(>15×ULN).Hepatocellular pattern causes include but are not limited to;non-alcoholic fatty liver disease/non-alcoholic steatohepatitis,alcohol use,chronic viral hepatitis,liver cirrhosis(variable),autoimmune hepatitis,hemochromatosis,Wilson’s disease,alpha-1 antitrypsin deficiency,celiac disease,medication-induced and ischemic hepatitis.Cholestatic pattern causes include but is not limited to;biliary pathology(obstruction,autoimmune),other conditions with hyperbilirubinemia(conjugated and unconjugated).It is crucial to interpret these commonly ordered tests accurately as appropriate further workup,treatment and referral can greatly benefit the patient due to prompt treatment which can improve the natural history of several of the diseases mentioned and possibly reduce the risk of progression to the liver cirrhosis.
基金Supported by the People’s Wellbeing Project of Suzhou City,No.SS201710the Clinical Expert Team Introduction Project of Suzhou City,No.SZYJTD201709and the Research Project on Maternal and Child Health of Jiangsu Province,No.F202045.
文摘BACKGROUND Indices such as the neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),mean platelet volume(MPV),platelet distribution width(PDW),and red cell distribution width(RDW)are considered new markers of the systemic inflammatory response(SIR),and have been widely implemented for the diagnosis of patients with inflammatory diseases.These new indicators have also been widely investigated in preeclampsia(PE)but less analyzed in hemolysis,elevated liver enzymes,and low platelet(HELLP)syndrome.AIM To compare SIR markers among HELLP patients,PE only patients,and healthy gravidae.METHODS This retrospective case-control study enrolled 630 cases,including 210 patients with HELLP syndrome(HELLP group),210 patients with only PE(PE group)and 210 healthy gravidae(control group).The three groups were matched by age,parity,status of assisted reproduction,and multiple pregnancies.Birthweight,gestational age at complete blood count collection,gestational age at delivery,mode of delivery,etc.were recorded.The main indices as NLR,PLR,MPV,PDW,and RDW among the groups were compared,as well as some secondary outcomes including neutrophil,platelets,and hemoglobin.RESULTS The NLR(6.4 vs 4.3 vs 3.5),MPV(11.9 vs 11.2 vs 10.7),PDW(16.4 vs 13.3 vs 14.2),leukocyte(12.4×10^(9)/L vs 9.7×10^(9)/L vs 8.7×10^(9)/L)and neutrophil count(9.9×10^(9)/L vs 7.3×10^(9)/L vs 6.1×10^(9)/L)were highest in the HELLP group,lower in the PE group,and lowest in the control group.Both the overall comparisons between the three groups(all bP<0.01)and pairwise comparisons between every two groups elicited statistically significant differences(all dP<0.01,except control vs PE:cP<0.05 in PDW).The average lymphocyte counts were 1.4(1.1,2.0)×10^(9)/L in the HELLP group,1.6(1.3,2.0)×10^(9)/L in the PE group and 1.7(1.4,2.0)×10^(9)/L in the control group.The overall comparison of lymphocyte count within the three groups had statistically significant differences(P=0.000).The pairwise comparisons between every two groups demonstrated that the HELLP group had a lower lymphocyte count than both the PE(P=0.019)and control groups(P=0.000),but the difference between the PE and control groups was not statistically significant(P=0.432).The overall comparisons on platelet counts and the PLR among these three groups also showed statistically significant differences(both P=0.000),from low to high being those in the HELLP group(43.4×10^(9)/L,64.0),control group(180.5×10^(9)/L,103.6)and PE group(181.5×10^(9)/L,112.8).Pairwise comparisons of neither index displayed statistically significant differences between the PE and control groups(both P>0.05),while the differences in the two indices between the HELLP group and the two other groups were still statistically significant(all P=0.000).RDW values were highest in the HELLP group(14.5%[13.6,15.3]),lower in the control group(14.1%[13.5,14.8])and lowest in the PE group(13.9%[13.4,14.9]).The difference between the PE and control group did not show statistical significance(P=1.000),while RDW values in the HELLP group were higher than those in the other two groups(cP<0.05 vs control,dP<0.01 vs PE).CONCLUSION SIR markers such as NLR,RDW,MPV,and PDW were increased and PLR was decreased in HELLP.These SIR markers may become new indicators in the evaluation of HELLP syndrome.
基金the Institute of Molecular Biology and Biotechnology (IMBB), University of Lahore for providing resources and financial support
文摘ObjectiveTo investigate the hepatoprotective efficacy of cranberry extract (CBE) against carbon tetrachloride (CCl<sub>4</sub>)-induced hepatic injury using in-vivo animal model.MethodsThe hepatoprotective efficacy of CBE (200 and 400 mg/kg) was investigated against CCl<sub>4</sub> (4 mL/kg)-induced hepatotoxicity, elevated liver enzymes [ALT (alanine aminotransferase), AST (aspartate aminotransferase), and alkaline phosphatase (ALP)], and total protein (TP) contents in the serum. Moreover, CBE-aided antioxidant defense against hepatotoxic insult of CCl<sub>4</sub> was measured by evaluating a number of anti-oxidative biomarkers including reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA) in the serum by using spectrophotometric analyses.ResultsResults showed that the exposure of experimental animals to CCl<sub>4</sub> did induce significant hepatotoxicity compared to the non-induced (untreated) group. The oral administration of CBE demonstrated a significant dose-dependent alleviation in the liver enzymes (AST, ALT, and ALP), increased antioxidant defense (GSH, SOD, and CAT), and reduced MDA levels in the serum of treated animals compared to the animals without treatment. The resulting data showed that the administration of CBE decreased the serum levels of ALT, AST, and ALP compared to the CCl<sub>4</sub>-induced group.ConclusionsThe resulting data evidenced that CBE exhibits promising hepatoprotective potential against the chemical induced hepatotoxicity, maintains homeostasis in liver enzymes, and can provide significant antioxidant defense against free radicals-induced oxidative stress.
基金supported by grants from the Key Project of Medical Science and Technology Development FoundationNanjing Municipality Health Bureau(ZKX12011)+1 种基金Jiangsu Provincial Innovation Program for Ph D Candidates(KYLX_0058)Scientific Research Foundation of Graduate School of Nanjing University(2013CL14)
文摘BACKGROUND：Early recurrence of hepatocellular carcinoma（HCC）is associated with worse prognosis after liver resection This study aimed to investigate the prognostic value of com mon liver enzyme markers in HCC early recurrence after cu rative hepatectomy and to establish a simple predictive model for HCC early recurrence.METHODS： A total of 200 patients who had undergone curative resection for HCC were retrospectively analyzed. The patients were divided into early recurrence （within 2 years） and non-early recurrence groups. Demographical characteristics, preopera- tive liver function parameters, surgical factors and tumor related factors of the patients were assessed by univariate analysis to identify potential significant predictors for early recurrence after resection of HCC. Parameters with statisti- cal significance were entered into a Cox proportional hazard model to find independent risk factors. Receiver operating characteristic analysis was done to determine optimal cut-off values and the number of combined factors in multi-factor predictive model. RESULTS： Of 13 potential risk factors for early recurrence identified by univariate analysis, high lactate dehydrogenase （LDH〉206 U/L, HR=1.711, P=0.006）, high aspartate aminotransferase （AST）/alanine aminotransferase （ALT） ratio （AST/ ALT〉0.96, HR=1.769, P=0.006）, elevated alpha-fetoprotein （AFP〉8.6 ng/mL, HR=2.079, P=0.007）, small resection margin （〈1 cm, HR=2.354, P〈0.001） and advanced TNM stage （TNM III-IV, HR=2.164, P〈0.001） were independent risk factors for early recurrence of HCC shown by multivariate analysis. Patients with three or more concurrent independent risk factors had significantly higher risk for early recurrence than those with low risk factors. The sensitivity and specificity of this predictive model are 53.6% and 80.7%, respectively （area under curve=0.741, 95% CI 0.674-0.800, P〈0.0001）. CONCLUSIONS： Preoperative common fiver enzyme markers, LDH and AST/ALT ratio, were independently associated with early recurrence of HCC. The combination of serum liver enzyme markers with AFP, resection margin and TNM stage bet- ter predicted early recurrence of HCC after curative resection in a simple multi-factor model.
文摘We present a case of symptomatic perihepatic adhesions,which developed after a pregnancy complicated by hemolysis,elevated liver enzymes and low platelet(HELLP)syndrome,in which a subcapsular liver hematoma occurred.Our patient presented with complaints of persistent,severe right-sided upper abdominal pain.The complaints developed gradually,one year after a pregnancy that had been complicated by HELLP syndrome with a subcapsular liver hematoma.The hematoma had resolved spontaneously.An upperabdominal magnetic resonance imaging revealed a density between liver and diaphragm at the site of the former subcapsular hematoma,suspect of perihepatic adhesions.The presence of perihepatic adhesions was confirmed during a laparoscopy and treated by adhesiolysis in the same session.The adhesions may have developed in response to the degradation process of the subcapsular liver hematoma during conservative treatment.This case of perihepatic adhesions may therefor be the first presentation of a long term sequel of subcapsular liver hematoma in HELLP syndrome.
文摘The prevalence of alcoholic liver disease and non-alcoholic liver disease patients has nearly doubled over the past decades worldwide. Alcoholic liver disease among patients with chronic liver disease has increased with arisen due to alcohol consumption and obesity. The diagnosis plays a crucial role in treating such conditions based on the stages of liver functioning. The elevated liver enzymes are the key characterizing of identifying the alcoholic liver disease (ALD) and NAFLD. Later on, there is a progression of the disease conditions by developing fibrosis and cirrhosis, leading to liver carcinoma. The other state, steatohepatitis, is associated with an increase in liver-related and can lead to mortality. Risk factors for both diseases are growing, leading to various complications in health. There is no specific treatment up to date for these conditions, but statins play a crucial role in managing several liver disease conditions. The commonly used drug is hydroxymethylglutaryl coenzyme A (HMG Co-A) reductase inhibitors. It is also known as statins, which help normalize liver enzymes in patients with elevated plasma aminotransferases. As a result, external liver damage is considered safe for the liver as the Statin medication at low to moderate dose usage. OBJECTIVES: The main scope of this review is to study the various factors like pharmacological actions, adverse events, and biochemical and liver cell imaging results in patients with ALD and NAFLD. The different types of statins used in alcoholic and non-alcoholic patients’ clinical data for the safety of the statin therapy were concluded in this review. Fatty liver changes of both liver disease conditions were studied using different drugs. The other liver enzymes like Alanine transaminase (ALT), Aspartate transaminase (AST), Gamma-glutamyl Transferase (GGT), and the effectiveness of Statin therapy are considered vital concepts in this review.
文摘The correlation between liver enzymes and lipid profile in T2D patients in the Yemeni population has been evaluated. This is a case-control study comprising 142 T2D patients and 142 healthy control subjects were carried out at the outpatient clinics of Ibn-Sina hospital, Mukalla, during the period from January to May 2020. Serum fasting blood glucose (FBG), total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) were analyzed using the Cobas Integra Plus 400 autoanalyzer. Also, anthropometric and blood pressure measurements were taken from each participant. Independent sample T-test and Pearson correlation coefficient were used. T2D patients had significantly higher FBG (P ≤ 0.0001), total cholesterol (P ≤ 0.0001), LDL-C (P ≤ 0.0001), and GGT (P ≤ 0.0001) while HDL-C was significantly lower in T2D patients (P = 0.021). In correlation analysis, serum GGT was positively associated with FBG (r = 0.216;P ≤ 0.0001), total cholesterol (r = 0.196;P = 0.0001), triglyceride (r = 0.123;P = 0.038), and LDL-C (r = 0.209;P ≤ 0.0001). Also, serum ALT was positively associated with FBG (r = 0.145, P = 0.014) and triglyceride (r = 0.172, P = 0.004). In conclusion, higher levels of ALT and GGT are used as the predictive biomarkers for NAFLD in T2D patients with hyperlipidemia. Thus, routine screening of liver enzymes and lipid profile in T2D patients is recommended for the early detection of liver abnormalities and diminish diabetes complications.
基金the Shanghai Natural Science Foundation of China,No.23ZR1447800and the Fengxian District Science and Technology Commission Project,China,No.20211838.
文摘BACKGROUND Previous research has highlighted correlations between blood cell counts and chronic liver disease.Nonetheless,the causal relationships remain unknown.AIM To evaluate the causal effect of blood cell traits on liver enzymes and nonalcoholic fatty liver disease(NAFLD)risk.METHODS Independent genetic variants strongly associated with blood cell traits were extracted from a genome-wide association study(GWAS)conducted by the Blood Cell Consortium.Summary-level data for liver enzymes were obtained from the United Kingdom Biobank.NAFLD data were obtained from a GWAS meta-analysis(8434 cases and 770180 controls,discovery dataset)and the Fingen GWAS(2275 cases and 372727 controls,replication dataset).This analysis was conducted using the inverse-variance weighted method,followed by various sensitivity analyses.RESULTS One SD increase in the genetically predicted haemoglobin concentration(HGB)was associated with aβof 0.0078(95%CI:0.0059-0.0096),0.0108(95%CI:0.0080-0.0136),0.0361(95%CI:0.0156-0.0567),and 0.0083(95%CI:00046-0.0121)for alkaline phosphatase(ALP),alanine aminotransferase(ALT),aspartate aminotransferase,and gammaglutamyl transferase,respectively.Genetically predicted haematocrit was associated with ALP(β=0.0078,95%CI:0.0052-0.0104)and ALT(β=0.0057,95%CI:0.0039-0.0075).Genetically determined HGB and the reticulocyte fraction of red blood cells increased the risk of NAFLD[odds ratio(OR)=1.199,95%CI:1.087-1.322]and(OR=1.157,95%CI:1.071-1.250).The results of the sensitivity analyses remained significant.CONCLUSION Novel causal blood cell traits related to liver enzymes and NAFLD development were revealed through Mendelian randomization analysis,which may facilitate the diagnosis and prevention of NAFLD.
文摘Background： Obstructive sleep apnea-hypopnea syndrome （OSAS） is associated with elevated liver enzymes and fatty liver. The purpose of this study was to measure serum liver enzyme levels in patients evaluated by polysomnography （PSG） and the f：actors associated with liver injury in OSAS patients. Methods： All patients referred to PSG for evaluation of sleep apnea symptoms between June 2011 and November 2014 were included in this study. Demographic data and PSG parameters were recorded. Serum alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase levels were systematically measured. OSAS patients were divided into mild, moderate, and severe groups according to the apnea-hypopnea index （AHI） values of 5-14 events/h, 15-29 events/h, and ≥30 events/h. Results： A total of 540 patients were enrolled in this study; among these patients, 386 were male. Elevated liver enzymes were present in 42.3% of OSAS patients （32.4% in mild/moderate group; 51.0% in severe group） and 28.1% patients without OSAS. Patients with OSAS had higher body mass index （BMI） （P 〈 0.01）. In the bivariate correlation, the liver enzymes level was negatively correlated with age and the lowest arterial oxygen saturation （SaO2）, and was positively correlated with BMI, oxygen desaturation index, percent of total time with oxygen saturation level 〈90% （TS90%）, AHI, total cholesterol （TC）, and triglyceride （TG）. In logistic regression analysis, Age, BMI, TS90%, TC, and TG were included in the regression equation. Conclusions： Our data suggest that OSAS is a risk factor for elevated liver enzymes. The severity of OSAS is correlated with liver enzyme levels; we hypothesize that hypoxia is one of main causes of liver damage in patients with OSAS.
基金This work was supported by the Hubei Province Key Research and Development Project(No.2020BCB007).
文摘With the rapid development of research on coronavirus disease 2019(COVID-19),more and more attention has been drawn to its damage to extrapulmonary organs.There are increasing lines of evidence showing that liver injury is closely related to the severity of COVID-19,which may have an adverse impact on the progression and prognosis of the patients.What is more,severe acute respiratory syndrome coronavirus-2 infection,cytokine storm,ischemia/hypoxia reperfusion injury,aggravation of the primary liver disease and drug-induced liver injury may all contribute to the hepatic damage in COVID-19 patients;although,the drug-induced liver injury,especially idiosyncratic drug-induced liver injury,requires further causality confirmation by the updated Roussel Uclaf Causality Assessment Method published in 2016.Up to now,there is no specific regimen for COVID-19,and COVID-19-related liver injury is mainly controlled by symptomatic and supportive treatment.Here,we review the clinical features of abnormal liver enzymes in COVID-19 and pathogenesis of COVID-19-related liver injury based on the current evidence,which may provide help for clinicians and researchers in exploring the pathogenesis and developing treatment strategies.
文摘Background and aim Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the virus responsible for the current pandemic,can have multi-organ impact.Recent studies show that liver injury could be a manifestation of the disease,and that liver disease could also be related to a worse prognosis.Our aim was to compare the characteristics of patients with severe coronavirus disease 2019(COVID-19)due to SARS-CoV-2 who required intubation versus stable hospitalized patients to identify the early biochemical predictive factors of a severe course of COVID-19 and subsequent requirement for intubation,specifically in Mexican.Methods This was an observational case-control study nested in a cohort study.Complete medical records of patients admitted for confirmed COVID-19 at a tertiary level center in Mexico City were reviewed.Clinical and biochemical data were collected,and the characteristics of patients who required invasive mechanical ventilation(IMV)(cases)were compared with stable hospitalized patients without ventilation(controls).Results We evaluated 166 patients with COVID-19 due to SARS-CoV-2 infection;114(68.7%)were men,the mean age was 50.6±13.3 years,and 27(16.3%)required IMV.The comparative analysis between cases and controls showed(respectively)significantly lower blood oxygen saturation(SpO_(2))(73.5±12.0%vs.83.0±6.8%,P<0.0001)and elevated alanine aminotransferase(ALT)(128(14–1123)IU/L vs.33(8–453)IU/L,P=0.003),aspartate aminotransferase(AST)(214(17–1247)vs.44(12–498)IU/L,P=0.001),lactic dehydrogenase(LDH)(764.6±401.9 IU/L vs.461.0±185.6 IU/L,P=0.001),and D-dimer(3463(524–34,227)ng/mL vs.829(152–41,923)ng/mL,P=0.003)concentrations.Patients in the cases group were older(58.6±12.7 years vs.49.1±12.8 years,P=0.001).Multivariate analysis showed that important factors at admission predicting the requirement for IMV during hospitalization for COVID-19 were AST≥250 IU/L(odds ratio(OR)=64.8,95%confidence interval(CI)7.5–560.3,P<0.0001)and D-dimer≥3500 ng/mL(OR=4.1,95%CI 1.2–13.7,P=0.02).Conclusions Our study confirms the importance of monitoring liver enzymes in hospitalized patients with COVID-19;seriously ill patients have significantly elevated AST and D-dimer concentrations,which have prognostic implications in the SARS-CoV-2 disease course.
文摘Background and Aims:Liver enzyme abnormalities in coronavirus 2019(COVID-19)are being addressed in the literature.The predictive risk of elevated liver enzymes has not been established for COVID-19 mortality.In this study,we hypothesized that elevated liver enzymes at ad-mission can predict the outcome of COVID-19 disease with other known indicators,such as comorbidities.Methods:This retrospective study included all the consecutive hos-pitalized patients with confirmed COVID-19 disease from March 4th to May 31st,2020.The study was conducted in Rajiv Gandhi Government General Hospital,Chennai,Ta-mil Nadu,India.We assessed demography,clinical vari-ables,COVID-19 severity,laboratory parameters,and out-come.Results:We included 1,512 patients,and median age was 47 years(interquartile range:34-60)with 36.9%being female.Liver enzyme level(aspartate aminotrans-ferase and/or alanine aminotransferase)was elevated in 450/1,512(29.76%)patients.Comorbidity was present in 713/1,512(47.16%)patients.Patients with liver enzymes’elevation and presence of comorbidity were older,more frequently hospitalized in ICU and had more severe symp-toms of COVID-19 at the time of admission.Presence of liver enzymes’elevation with comorbidity was a high risk factor for death(OR:5.314,95%CI:2.278-12.393),as compared to patients with presence of comorbidity(OR:4.096,95%CI:1.833-9.157).Conclusions:Comorbid-ity combined with liver enzymes’elevation at presentation independently increased the risk of death in COVID-19 by at least 5-fold.
基金Supported by Shahid Bahonar University of Kerman Research Council(Grant No.92-GR-VT-11).
文摘Objective:To investigate the effect of wild black mustard seed meal on thyroid hormones(thyroxine and thyroid-stimulating hormone)in Japanese quails and also study the ability of FeSO4 to alleviate the possible negative effect of mustard meal on thyroid hormones in these birds for the first time.Methods:The experimental procedure was undertaken on 28 quails which were randomly assigned to a control and 6 test groups with 4 quails in each group for 28 days,during which the control group received basic diet with no mustard meal whereas the test groups(No.2,3 and 4)received mustard meal(5%,10%and 15%,respectively)and test groups(No.5,6 and 7)received FeSO_(4)(1%)-treated mustard meal(5%,10%and 15%,respectively)on the basic of basic diet.Results:The group fed on 15%non-treated mustard seed meal had the least thyroxine level and its level backed to normal in group fed on 15%FeSO4-treated mustard seed meal although this group had the highest alanine transaminase and aspartate transaminase levels.Conclusions:We concluded that up to 10%FeSO4 mustard seed meal could be incorporated in the quail diet successfully with the least damage to thyroids and livers,but further investigations on these birds are still needed to confirm this hypothesis.
基金This work was supported by the National Postdoctoral Program for Innovative Talents(grant number:BX2021077)National Natural Science Foundation of China(grant numbers:91846302,82073637)+4 种基金the National Key Research and Development Program of China(grant numbers:2017YFC0907000,2017YFC0907500,2019YFC1315804,2019FY101103)key basic research grants from the Science and Technology Commission of Shanghai Municipality(grant number:16JC1400500)the Shanghai Municipal Science and Technology Major Project(grant number:2017SHZDZX01)Three-Year Action Plan for Strengthening Public Health System in Shanghai(grant number:GWV-10.2-YQ32)Innovation Grant from Science and Technology Commission of Shanghai Municipality,China(grant number:20ZR1405600).
文摘Serum liver enzymes(alanine aminotransferase[ALT],aspartate aminotransferase[AST],λ-glutamyl transferase[GGT]and alkaline phosphatase[ALP])are the leading biomarkers to measure liver injury,and they have been reported to be associated with several intrahepatic and extrahepatic diseases in observational studies.We conducted a phenome-wide association study(PheWAS)to identify disease phenotypes associated with genetically predicted liver enzymes based on the UK Biobank cohort.Univariable and multivariable Mendelian randomization(MR)analyses were performed to obtain the causal esti-mates of associations that detected in PheWAS.Our PheWAS identified 40 out of 1,376 pairs(16,17,three and four pairs for ALT,AST,GGT and ALP,respectively)of genotype-phenotype associations reaching statistical significance at the 5%false discovery rate threshold.A total of 34 links were further validated in Mendelian randomization analyses.Most of the disease phenotypes that associated with genetically determined ALT level were liver-related,including primary liver cancer and alcoholic liver damage.The disease outcomes associated with genetically determined AST involved a wide range of phenotypic categories including endocrine/metabolic diseases,digestive diseases,and neurological disorder.Genetically predicted GGT level was associated with the risk of other chronic non-alcoholic liver disease,abnormal results of function study of liver,and cholelithiasis.Genetically determined ALP level was associated with pulmonary heart disease,phlebitis and thrombophlebitis of lower extremities,and hypercholesterolemia.Our findings reveal novel links between liver enzymes and disease phenotypes providing insights into the full understanding of the biological roles of liver enzymes.
文摘Since the first reports of coronavirus disease 2019(COVID-19)cases in December 2019 in China,numerous papers have been published describing a high frequency of liver injury associated with severe acute respiratory syndrome coronavirus 2 infection,many of them proposing a link between these findings and patient outcomes.Increases in serum aminotransferase levels(ranging from 16%to 62%)and bilirubin levels(ranging from 5%to 21%)have been reported and seem to be more often observed in patients with severe forms of COVID-19.Although absolute changes in these parameters are frequently seen,other variables,such as the ratio above the upper limit of normal,the onset of liver injury as a complication in severe cases and histopathological findings,reinforce that liver changes are of dubious clinical relevance in the course of this disease.Other factors must also be considered in these analyses,such as the repercussions of hemodynamic changes,the presence of thrombotic events,and,mainly,the possible drug-induced liver injury with the current,yet off-label,treatment.This paper aimed to analyze the currently available data on liver injury in patients with COVID-19.
基金Supported by European Community’s Seventh Framework Program(FP7/2007-2013)under grant agreement,No.HEALTH-F2-2009-241762 for the project FLIP(in part)Centis E,Nuccitelli C and Moscatiello S supported by specific research contracts within the same program
文摘AIM: To determine the clinical effectiveness of intense psychological support to physical activity (PA) in nonalcoholic fatty liver disease (NAFLD), compared with cognitive-behavioral treatment (CBT).
基金Supported by the Dietmar Hopp Foundation(in part,DFG),No.MU 1373/9-1
文摘AIM To study liver stiffness(LS) during pregnancy and its association with complications during pregnancy.METHODS In this observational, diagnostic study, 537 pregnant women were prospectively enrolled at the Department of Obstetrics and Gynecology, University hospital Heidelberg and Salem Medical Center. LS was measured using the Fibroscan device(Echosens, Paris) in all women and in 41 cases 24 h after delivery. Clinical and morphological data were recorded and abdominal ultrasound and standard laboratory tests were performed. No complications were observed in 475 women(controls) while preeclampsia and intrahepatic cholestasis of pregnancy(ICP) developed in 22 and 40 women, respectively.RESULTS In controls, LS increased significantly from initially 4.5 ± 1.2 kPa in the second trimester to 6.0 ± 2.3 kPa(P < 0.001) in the third trimester. In the third trimester, 41% of women had a LS higher than 6 kPa. Elevated LS in controls was significantly correlated with alkaline phosphatase, leukocytes, gestational age and an increase in body weight and body mass index(BMI). In women with pregnancy complications, LS was significantly higher as compared to controls(P < 0.0001). Moreover, in multivariate analysis, LS was an independent predictor for preeclampsia with an odds ratio of 2.05(1.27-3.31) and a cut-off value of 7.6 kPa. In contrast, ICP could not be predicted by LS. Finally, LS rapidly decreased in all women within 24 h after delivery from 7.2 ± 3.3 kPa down to 4.9 ± 2.2 kPa(P < 0.001).CONCLUSION During pregnancy, LS significantly and reversibly increases in the final trimester of pregnant women without complications. In women with preeclampsia, LS is significantly elevated and an independent noninvasive predictor.
文摘Hepatic artery pseudoaneurysms(HAP)are rare events,particularly after liver biopsy,but can be associated with serious complications.Therefore a high suspicion is necessary for timely diagnosis and appropriate treatment.We report on a case of HAP that potentially formed after a liver biopsy in a patient with sarcoidosis.The HAP in our case was virtually undetectable initially by angiography but resulted in several complications including recurrent gastrointestinal bleeding,hemorrhagic cholecystitis and finally hepatic infarction with abscess formation until it became detectable at a size of 5-mm.The patient remains asymptomatic over a year after endovascular embolization of the HAP.In this report,we demonstrate that a small HAP can avoid detection by angiography at an early stage while being symptomatic for a prolonged course.A high clinical suspicion with a close clinical/radiological follow-up is needed in symptomatic patients with history of liver biopsy despite initial negative work up.Once diagnosed,HAP can be safely and effectively treated by endovascular embolization.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)was perhaps the most severe global health crisis in living memory.Alongside respiratory symptoms,elevated liver enzymes,abnormal liver function,and even acute liver failure were reported in patients suffering from severe acute respiratory disease coronavirus 2 pneumonia.However,the precise triggers of these forms of liver damage and how they affect the course and outcomes of COVID-19 itself remain unclear.AIM To analyze the impact of liver enzyme abnormalities on the severity and outcomes of COVID-19 in hospitalized patients.METHODS In this study,684 depersonalized medical records from patients hospitalized with COVID-19 during the 2020-2021 period were analyzed.COVID-19 was diagnosed according to the guidelines of the National Institutes of Health(2021).Patients were assigned to two groups:those with elevated liver enzymes(Group 1:603 patients),where at least one out of four liver enzymes were elevated(following the norm of hospital laboratory tests:alanine aminotransferase(ALT)≥40,aspartate aminotransferase(AST)≥40,gamma-glutamyl transferase≥36,or alkaline phosphatase≥150)at any point of hospitalization,from admission to discharge;and the control group(Group 2:81 patients),with normal liver enzymes during hospitalization.COVID-19 severity was assessed according to the interim World Health Organization guidance(2022).Data on viral pneumonia complications,laboratory tests,and underlying diseases were also collected and analyzed.RESULTS In total,603(88.2%)patients produced abnormal liver test results.ALT and AST levels were elevated by a factor of less than 3 in 54.9%and 74.8%of cases with increased enzyme levels,respectively.Patients in Group 1 had almost double the chance of bacterial viral pneumonia complications[odds ratio(OR)=1.73,P=0.0217],required oxygen supply more often,and displayed higher biochemical inflammation indices than those in Group 2.No differences in other COVID-19 complications or underlying diseases were observed between groups.Preexisting hepatitis of a different etiology was rarely documented(in only 3.5%of patients),and had no impact on the severity of COVID-19.Only 5(0.73%)patients experienced acute liver failure,4 of whom died.Overall,the majority of the deceased patients(17 out of 20)had elevated liver enzymes,and most were male.All deceased patients had at least one underlying disease or combination thereof,and the deceased suffered significantly more often from heart diseases,hypertension,and urinary tract infections than those who made recoveries.Alongside male gender(OR=1.72,P=0.0161)and older age(OR=1.02,P=0.0234),diabetes(OR=3.22,P=0.0016)and hyperlipidemia(OR=2.67,P=0.0238),but not obesity,were confirmed as independent factors associated with more a severe COVID-19 infection in our cohort.CONCLUSION In our study,the presence of liver impairment allows us to predict a more severe inflammation with a higher risk of bacterial complication and worse outcomes of COVID-19.Therefore,patients with severe disease forms should have their liver tests monitored regularly and their results should be considered when selecting treatment to avoid further liver damage or even insufficiency.
