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RISS 인기검색어
- 검색키워드
- 저자 : Suthat Liangpunsakul (검색결과 2 건)
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Non-Invasive Diagnosis and Biomarkers in Alcohol-Related Liver Disease
( Suthat Liangpunsakul ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Alcohol-related liver disease (ALD) represents a spectrum of clinical illness and pathological change in individuals with acute and chronic alcohol consumption. Patients may have minimal abnormalities from steatosis or may develop more severe signs and symptoms of liver disease associated with inflammation seen in alcoholic hepatitis or cirrhosis. The risk of ALD is closely related with the per capita alcohol consumption; however, careful study of the relationship between development/natural history of ALD and the quantity of alcohol consumed is almost impossible, because data collection always involves numerous broad assumptions and rough estimates. Drinking becomes excessive when it causes or elevates the risk for alcohol-related problems or complicates the management of other health problems. According to the National Institute on Alcohol Abuse and Alcoholism (NIH/NIAAA), excessive drinking is defined as men who drink more than 4 standard drinks in a day (or more than 14 per week) and women who drink more than 3 drinks in a day (or more than 7 per week). Early studies in France suggested that a long-term consumption of 80 grams per day or more was associated with increased risk of cirrhosis but subsequent estimates of the threshold for harm have been below this level, especially for women. Screening for excessive alcohol use is important in the diagnosis of ALD. Besides questionnaires, several laboratory tests have been used to screen for excessive alcohol use (EAU) in clinical practice. Determination of the breath and blood alcohol concentration (BAC) or by the highly specific direct markers ethyl glucuronide (EtG) and ethyl sulphate (EtS) in blood and/or urine has been used, but they are only specific to very recent alcohol ingestion; its use may not be useful in clinical situation. Other lab tests to screening for chronic alcohol use are gamma glutaryl transferase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and mean corpuscular volume (MCV). Despite their common use, these tests revealed low sensitivities and specificities. Transferrin molecules in the blood usually contain several carbohydrate components, which is reduced, resulting in an increase in %CDT, among excessive alcohol users. Phosphatidylethanol (PEth) represents a group of phospholipids present in cell membranes, which are formed directly after alcohol intake via the enzyme phospholipase D from phosphatidylcholine in the presence of alcohol. ALD is rarely detected at the early stage. In a study of 3,500 patients worldwide with chronic liver disease, only 3.8% of patients with ALD were seen at early stages defined as those without any signs of chronic liver disease or complications from portal HTN. Whereas the majority of patients were seen at advanced stages were those with ALD compared with viral hepatitis such as HCV and HBV. These results indicate that ALD is normally detected at later stages when patients require hospitalization owing to liver-related complications. Early detection or screening for ALD is therefore important. The diagnostic tool depends on the disease stage in the spectrum of ALD. For hepatic steatosis, liver ultrasound is accepted as an initial screen for fatty liver because it is non-invasive, inexpensive and widely available. Controlled attenuation parameter is a simple and promising new bedside technique for diagnosing steatosis in patients with ALD, but it requires further validation. For evaluation of fibrosis, several blood tests are available; however, the sensitivity and specificity are varied (depending on the cut off values). The use of transient elastography to determine the degree of fibrosis is promising. There are 2 important components for the diagnosis of alcoholic hepatitis, history of alcohol consumption and clinical presentation/laboratory tests. Excessive alcohol use should have occurred for >6 months, with < 60 days of abstinence before the onset of jaundice. Jaundice should be accompanied by malaise, tender hepatomegaly, or with hepatic decompensation. Serum bilirubin cutoff is >3 mg/dL with the AST (>50 IU/mL), and AST to alanine aminotransferase (ALT) ratio of >1.5. Liver biopsy is not always required unless the clinical diagnosis is unclear. To date, no specific non-invasive diagnosis and biomarkers in ALD are reliable and validated. Systematic studies in a large and well characterized patients with ALD are needed to address these shortcomings.
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Sen Han,Ting Zhang,Praveen Kusumanchi,Nazmul Huda,Yanchao Jiang,Zhihong Yang,Suthat Liangpunsakul 대한간학회 2020 Clinical and Molecular Hepatology(대한간학회지) Vol.26 No.4
Long non-coding RNAs (lncRNAs), a class of transcribed RNA molecules with the lengths exceeding 200 nucleotides, are not translated into protein. They can modulate protein-coding genes by controlling transcriptional and posttranscriptional processes. The dysregulation of lncRNAs has been related to various pathological disorders. In this review, we summarized the current knowledge of lncRNAs and their implications in the pathogenesis of three common liver diseases: nonalcoholic fatty liver disease, alcohol-related liver disease, and cholestatic liver disease. Future studies to further define the role of lncRNAs and their mechanisms in various types of liver diseases should be explored. An improved understanding from these studies will provide us a useful perspective leading to mechanism-based intervention by targeting specific lncRNAs for the treatment of liver diseases.
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