Diagnosis of liver cirrhosis relies on hepatic biopsy. So far, attempts have failed to achieve a serologic test that differentiates cirrhosis from other hepatic conditions. The aim of this work was to assess the diagnostic value of the ratio of serum angiotensin converting enzyme activity (SACE) and the levels of protein C4 of serum complement (SACE/C4) in differentiating cirrhotic from noncirrhotic alcoholic liver diseases. In this study, 68 active alcoholic patients (17 with fatty liver or minimal changes, 11 with acute alcoholic hepatitis and 40 with cirrhosis) were included. Twenty healthy subjects were studied as a control group. Liver biopsy was performed in all patients. SACE levels were significantly higher in the group with cirrhosis when compared with the group of patients without cirrhosis and the control. On the other hand, serum C4 level decreased as liver damage progressed. SACE values above 25 IU/l had a sensitivity of 92.5 percent (95 percent confidence interval, 87.5 to 97.5) and a specificity of 79 percent (95% percent confidence interval, 70.5 to 87.5), in detecting those patients with liver cirrhosis. The sensitivity further increased to 95 percent (95 percent confidence interval, 90.5 to 99.5) and the specificity to 100 percent when the SACE/C4 ratio was used and a cutoff point of 145 was chosen. To conclude, in alcoholics SACE is specifically elevated in patients with cirrhosis, and the SACEIC4 ratio is a excellent biochemical index for the diagnosis of cirrhosis in alcoholic I patients. Cupyright 0 Munksgaard 1996 LNER ISSN 0106.9543
BackgroundAnti-centromere pattern (ACA) is infrequently seen among antinuclear antibodies (ANA) detected by indirect immunofluorescence (IFI). ACA is associated with systemic autoimmune diseases (SAD), especially systemic sclerosis (SSc). Some studies had recently related ACA with cancer, mostly with breast and lung cancer [1]. However, most published series of patients with ACA lack information about cancer occurrence. A prevalence of cancer of 11.1% was the only reported data, on a series of 45 unselected patients with ACA [2]ObjectivesOur aim was to study the prevalence of cancer in the largest series of patients with ACA, with a long follow-up. Our second objective was to make a cohort to calculate the incidence of cancer and to try to identify risk markers of cancer in these patientsMethodsWe included consecutive patients with at least 2 positive determinations of ANA with ACA by IFI on Hep2 cells between January 1st of 2011 and June 30th of 2015 in 6 Galician hospitals. The authors reviewed each patient's chart to determine the presence of cancer and its type among numerous variables. Then, patients with cancer at the moment of the first positive determination of ANA with ACA were excluded. We checked the presence of any tumour in patients of this cohort at the end of follow-up to calculate the incidence of cancer. Finally, we compared patients with and without cancer by multivariate analysis, with the SPSS 20.0. The ethics committees of each hospital approved the study and patients gave their consentResults369 patients with ACA were studied, of which 333 were women (90.2%), with a mean age of 64.7 years (range: 22–92). The mean follow-up from the first positive ACA determination was 67.6 months. 283 patients (76.7%) had a SAD: 46.3% SSc (79% of whom were lc-SSc), 8.13% primary biliary cholangitis, 7.05% Sjögren's syndrome, 4.6% autoimmune hepatitis and 11 other SAD (polyarthritis, SLE, Raynaud phenomenon, sarcoidosis, mixed connective tissue disease, etc). 45 of these patients (15.9%) had any overlap syndrome. 39 patients had cancer at some time (10.6%), 3 of them with 2 types of cancer. The most frequent were: breast in 9 (23.1%), lung in 5 (11%), NHL in 5 (11%) and colorectal in 4 (10.3%). Cancer preceded the diagnosis of ACA in 19 patients (48.7%), with a mean time to diagnosis of 9.1 years (range 1–18). In the cohort of 350 patients with ACA the incidence was 1.14 per 100 patients per year (n 20). The mean time to diagnosis of cancer was 7.3years (range 1–27). The oldest age was the only risk marker of cancer identified (70.8±13.29 years vs. 63.9±14.32, p 0.005). There were no differences in the other variables analysed including sex, tobacco, diagnosis of SAD, capillaroscopy pattern, ANA titrations and mortalityConclusionsCancer was frequent in patients with ACA, with a prevalence of 10.6% and incidence of 1.14 per 100 patients per year. The only risk marker of cancer identified in this population was the oldest ageReferences Briasoulis E, Kamposioras K, Tzovaras V et al. CENP-B specific anti-centromer...
BackgroundPrimary biliary cholangitis (PBC) is associated to other autoimmune diseases with an unknown prevalence. Their treatment can prevent progression to liver cirrhosis and other systemic complicationsObjectivesTo describe the clinical and analytical autoimmune characteristics in a cohort of patients with PBC diagnosed and followed in a specific unit of Hepatic Diseases. All patients were also studied in the Autoimmune and Sistemics Diseases Unit of our hospital to check for the presence of extrahepatic autoimmune diseases.MethodsWe have studied patients with PBC diagnosed in our Service since 1994 who are currently under follow-up. The diagnosis of PBC was made taking into account: the presence of colostasis enzymes with positive anti-mitochondrial antibodies (AMA) and/or compatible liver biopsyResultsWe studied 89 patients with PBC. 81 of them were women (female/male ratio 10/1) with a mean age at diagnosis of 56 years (range 23–84 years). The mean follow-up was 106 months (range 9–286). IgM was elevated in 70% of the patients in whom it was found (56/80). The ANA were positive in 71% (61/86) and the AMA in 75% (67/89). 43% of patients AMA-negative PBC had other suggestive antibodies: 7 anti-centromere, 2 AMA-2 and 1 anti-sp-100. A liver biopsy was performed on 75 patients (87%), resulting in a diagnosis of 58% and useful to exclude other pathologies in the rest. In 18 patients (20%) an overlapping condition was diagnosed: PBC +Autoimmune hepatitis. In 11 patients (12%) a Reynolds syndrome was diagnosed: PBC +Scleroderma, in all of them Raynaud phenomenon was present. On another 11 of 41 (27%) Raynaud phenomenon was also present. In 17 patients (19%) there was a history or new diagnosis of autoimmune thyroiditis and in 13 patients (15%) of Sjögren syndrome. None of them was diagnosed of IgG4-related disease. Serum IgG4 was measured in 56 patients (63%) with a mean value of 36.6 mg/dL.2,8 – 125 The patients with pure PBC were treated only with urodeoxycholic acid, with a complete response of 41%, a partial response of 51% and an absence of response of only 6 (7%). There was no difference regarding liver response to treatment among patients with pure PBC and patients with overlapping autoimmune hepatitis, Reynolds syndrome, Raynaud phenomenon, Sjögren syndrome nor autoimmune thyroiditis. Only 3% of patients with complete response and 12% of those who responded partially evolved to liver cirrhosis, with a similar follow-up time in both groups (105 vs 113 months). 5 of the 6 patients who did not have a biochemical response developed liver cirrhosis. 7 of the 13 patients with cirrhosis (54%) already presented clinical or histological data of cirrhosis in the initial evaluationConclusionsPBC patients have frequently other autoimmune diseases such as Autoimmune Hepatitis, Sjögren syndrome or Scleroderma so we must actively seek the presence of these pathologies. The treatment with ursodeoxycholic seems to be useful in all patients but it is important to make an early diagnosisDisclosure of InterestNone declared
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