Non-insulin-dependent diabetes mellitus (NIDDM) may be associated with chronic hepatitis C virus (HCV) infection. This was studied further in two parts. First, 1,151 patients with HCV-related cirrhosis and 181 patients with hepatitis B virus (HBV)-related cirrhosis, well matched for age, sex, and severity of cirrhosis, were reviewed retrospectively. The prevalence of diabetes mellitus was higher in HCV-related cirrhosis (23.6%) than in HBV-related cirrhosis (9.4%; odds ratio [OR], 2.78; 95% confidence interval [CI], 1.6-4.79; P ؍ .0002). The prevalence of diabetes mellitus was associated closely with the Child-Pugh score (OR, 3.83; 95% CI, 2.38-6.17; P F .0001) and increasing age (OR, 1.02; 95% CI, 1.00-1.03; P ؍ .0117). Second, 235 patients with biopsy confirmed chronic HBV or HCV underwent an oral glucose tolerance test. Only 1 of 70 patients with chronic viral hepatitis without cirrhosis was diabetic. However, 31 of 127 patients with HCV-related cirrhosis (24.4%) were diabetic compared with 3 of 38 patients with HBVrelated cirrhosis (7.9%, P ؍ .0477). The major variables associated with NIDDM were cirrhosis (OR, 14.39; 95% CI, 1.91-108; P ؍ .0096) and male sex (OR, 4.64; 95% CI, 1.32-16.18; P ؍ .0161). Fasting insulin levels in 30 patients with HCV-related cirrhosis and diabetes mellitus were elevated significantly, which was consistent with insulin resistance. However, acute insulin responsiveness was reduced in all patients with HCV infection and diabetes suggesting concomitant B-cell dysfunction. This study confirms an association between HCV and NIDDM. (HEPATOL-OGY 1999;30:1059-1063.)An association between cirrhosis and abnormalities of glucose metabolism has been recognized for over 20 years. 1
End-stage liver disease caused by hepatitis C virus (HCV) units 3 times weekly) and oral ribavirin (1,200 mg/d) for a infection has become the most common indication for orduration of 6 months, followed by maintenance with ribavirin thotopic liver transplantation (OLT). The resurgence of HCV alone for an additional 6 months. Twenty-one liver transplant following transplantation is characterized early on by the recipients with recurrent hepatitis C infection (HCV-RNA-detection of HCV-RNA in serum and liver. The natural hispositive; active hepatitis without rejection on biopsy) were tory and long-term outcome of HCV recurrence following enrolled in this study. Pretreatment serum alanine transami-OLT remain uncertain. The histological consequences of nase (ALT) levels were at least two times the upper limit of HCV infection are more severe in patients after OLT than in normal. Before treatment, all patients were HCV-RNA-posi-nonimmunosuppressed subjects.1 Indeed, over 50% of liver tive and mean HCV-RNA titers were 125 million genome-transplant patients develop chronic active hepatitis after two equivalents/mL. Mean pretreatment histological score was 6.3 years; 2 subsequent progression to cirrhosis threatens graft { 2. After 6 months of combination therapy, all 21 patients function and patient survival.3 Currently, no effective prehad normal ALTs. Ten patients (48%) cleared HCV-RNA from ventive or therapeutic interventions are available to halt this their serum, as assessed by polymerase chain reaction (PCR), progressive deterioration of the graft. and HCV-RNA levels decreased significantly in the others (P The mechanisms of HCV-induced liver damage after trans-Å .0001). Improvement in histological score was seen in all plantation are poorly understood. Immunosuppression is patients after combination therapy (P Å .0013). During main-likely a major factor, because it is associated with a dramatic tenance ribavirin monotherapy, ALT remained normal in all increase of viral replication resulting in high-circulating but 1 of the 18 patients who tolerated therapy. HCV-RNA HCV-RNA levels, 16-fold higher than pretransplant values. 4 reappeared in 5 patients, but HCV-RNA levels did not return It also has been suggested that infection by genotype 1b (the to pretreament levels (P Å .0004). Comparison of pretreat-most common in this setting) has a more aggressive course ment and postribavirin monotherapy liver biopsies revealed following transplantation and that this occurs independently improvement in all but 1 of the 18 patients who tolerated of the viral burden. 5 ribavirin (P Å .0002). Side effects were restricted to anemia, Because high HCV-RNA titers and HCV 1b genotype are which necessitated cessation of ribavirin therapy in 3 patients. two of the unfavorable predictors for the lack of response to No patient experienced graft rejection during the study pe-interferon alfa (IFN-a) therapy, 6-7 it is not surprising that riod. These results are significantly better than those reported IFN-a has not been found to be effectiv...
A prospective controlled study of the diagnostic accuracy of blind percutaneous liver biopsy in comparison to laparoscopy plus guided biopsy for the recognition or exclusion of cirrhosis has been performed. One hundred twenty-six patients with a clinical diagnosis of chronic, diffuse, well-compensated liver disease were randomized into two groups and submitted either to percutaneous blind liver biopsy (PB: 64 patients) or to laparoscopy with guided biopsy (LB: 62 patients), in order to assess the accuracy of either procedure in diagnosing cirrhosis. PB correctly recognized or ruled out cirrhosis in 52 patients (82%). Inconclusive results were mostly false negative, as demonstrated by the presence on endoscopy of esophageal varices or by subsequent LB. LB demonstrated presence or absence of cirrhosis in all patients. The difference between the rate of accurate results of the two procedures is statistically significant. It is concluded that in patients without esophageal varices, LB should be the investigation of choice for the assessment of liver structure since the presence of cirrhosis can be missed in up to 20% of cases by PB.
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