Methotrexate is the first line drug treatment for anumber of rheumatic and non-rheumatic diseases. It is effective in controlling disease activity and preventing disease-related damage, and significantly cheaper than ...Methotrexate is the first line drug treatment for anumber of rheumatic and non-rheumatic diseases. It is effective in controlling disease activity and preventing disease-related damage, and significantly cheaper than many alternatives. Use in rheumatoid arthritis infers a significant morbidity and mortality benefit. Methotrexate is generally well tolerated but can cause symptomatic adverse events. Multiple serious adverse events have been attributed to methotrexate, based largely on older reports using high or daily doses, and subsequent case reports and circumstantial evidence. The risk with modern dosing regimens: Lower doses, weekly schedules, and concomitant folic acid is less clear. Clarification and dissemination of the actual risk is crucial so appropriate judgements can be made for patients who may benefit from this treatment. Methotrexate has been associated with a range of liver related adverse events ranging from asymptomatic transaminase elevations to fibrosis and fatal hepatic necrosis. Concern over potential liver toxicity has resulted in treatment avoidance, cessation, or recommendations for investigations which may be costly, invasive and unwarranted. Modern laboratory monitoring of liver blood tests may also influence the risk of more serious complications. The majority of present day studies report an approximate doubling of the relative risk of elevated transaminases in methotrexate treated patients but no increased risk of symptomatic or severe liver related adverse events. In this article we will review the evidence around methotrexate and liver related adverse events.展开更多
目的探究肝功能指标总胆红素水平及转氨酶水平与认知功能的相关性。方法选择NHANES数据库2011~2012年的数据,最后纳入1260例年龄≥60岁的美国人,对总胆红素水平以及天门冬氨酸氨基转移酶(Aspartate aminotransferase,AST)/谷氨酸-丙酮...目的探究肝功能指标总胆红素水平及转氨酶水平与认知功能的相关性。方法选择NHANES数据库2011~2012年的数据,最后纳入1260例年龄≥60岁的美国人,对总胆红素水平以及天门冬氨酸氨基转移酶(Aspartate aminotransferase,AST)/谷氨酸-丙酮酸转氨酶(Alanine aminotransferase,ALT)比值进行四分位数分组,并用多因素回归的方法探究其与认知功能[(3次建立阿尔茨海默病登记处联盟(Consortium to establish a registry for Alzheimer's disease,CERAD)总分、CERAD延迟测试、动物流畅性测试(Animal fluency test,AFT)以及数字符号替换测试(Digit symbol substitution test,DSST)]的关系。结果与较低的胆红素水平(Q1=0.2~0.6 mg/dL)比较,Q2(0.7 mg/dL)、Q3(0.8 mg/dL)和Q4(0.9~2.3 mg/dL)胆红素水平与3次CERAD总分之间的β分别为0.78(95%CI=0.11~1.4,P=0.028)、1.6(95%CI=0.7~2.4,P=0.003)和0.52(95%CI=-0.19~1.2,P=0.13),没有观察到转氨酶水平与认知功能的相关性。结论中等水平的胆红素与认知功能中的短暂记忆得分呈正相关,可能具有神经保护作用。展开更多
The coronavirus disease 2019(COVID-19)hit the entire world as a global pandemic and soon became the most important concern for all patients with chronic diseases.An early trend in higher mortality in patients with acu...The coronavirus disease 2019(COVID-19)hit the entire world as a global pandemic and soon became the most important concern for all patients with chronic diseases.An early trend in higher mortality in patients with acute respiratory distress attracted all researchers to closely monitor patients for the involvement of other systems.It soon became apparent that patients with chronic liver diseases are at increased risk of mortality given their cirrhosis-associated immune dysfunction.Additionally,liver function abnormalities were noted in patients with severe COVID-19.Profound cytokine storm,direct viral infection,drugs and reactivation of viral infections were causes of deranged liver functions.Here,we discuss the relation between COVID-19 and chronic liver disease,specifically cirrhosis,hepatitis B,hepatitis C,and non-alcoholic fatty liver disease(NAFLD),as well as the liver manifestations of COVID-19.The metabolic syndrome,obesity,diabetes mellitus and NAFLD were found to worsen outcome in different studies reported worldwide.Decompensated cirrhosis should be considered a risk factor for death and severe COVID-19.Recently,COVID-19 related cholangiopathy has also been reported with changes of secondary sclerosing cholangitis.The long-term persistence of viral antigens in gut epithelia raises concern regarding the future risk of autoimmune liver diseases.展开更多
The risk of liver injury in patients with coronavirus disease 2019(COVID-19)infection is quite evident.Furthermore,liver function test abnormalities are still detected in COVID-19 patients despite the development of a...The risk of liver injury in patients with coronavirus disease 2019(COVID-19)infection is quite evident.Furthermore,liver function test abnormalities are still detected in COVID-19 patients despite the development of antivirals and the availability of several types of vaccines.This editorial describes liver involvement during COVID-19 infection in patients with or without preexisting liver injury,such as chronic liver disease,to elucidate COVID-19-induced liver function abnormalities and their severity,pathophysiology,clinical manifestations,and clinical and laboratory outcomes.We also discuss the effect of vaccination against COVID-19 to better understand host factors,such as age,gender,and race,on the incidence and severity of liver dysfunction at initial presentation and during the illness.Finally,we summarize the results of relevant meta-analyses published to date and highlight the importance of adequate liver function monitoring in the current climate of the overwhelming COVID-19 pandemic.展开更多
BACKGROUND Nonalcoholic fatty liver disease(NAFLD)and type-2 diabetes mellitus(T2DM)have an intricate bidirectional relationship.Individuals with T2DM,not only have a higher prevalence of non-alcoholic steatosis,but a...BACKGROUND Nonalcoholic fatty liver disease(NAFLD)and type-2 diabetes mellitus(T2DM)have an intricate bidirectional relationship.Individuals with T2DM,not only have a higher prevalence of non-alcoholic steatosis,but also carry a higher risk of progression to nonalcoholic steatohepatitis.Experts still differ in their recommendations of screening for NAFLD among patients with T2DM.AIM To study the prevalence of NAFLD and advanced fibrosis among our patient population with T2DM.METHODS During the study period(November 2018 to January 2020),59 adult patients with T2DM and 26 non-diabetic control group individuals were recruited prospectively.Patients with known significant liver disease and alcohol use were excluded.Demographic data and lab parameters were recorded.Liver elastography was performed in all patients.RESULTS In the study group comprised of patients with T2DM and normal alanine aminotransferase levels(mean 17.8±7 U/L),81%had hepatic steatosis as diagnosed by elastography.Advanced hepatic fibrosis(stage F3 or F4)was present in 12%of patients with T2DM as compared to none in the control group.Patients with T2DM also had higher number of individuals with grade 3 steatosis[45.8%vs 11.5%,(P<0.00001)and metabolic syndrome(84.7%vs 11.5%,P<0.00001)].CONCLUSION A significant number of patients with T2DM,despite having normal transaminase levels,have NAFLD,grade 3 steatosis and advanced hepatic fibrosis as measured by liver elastography.展开更多
Since the coronavirus disease 2019(COVID-19)has hit the world as a pandemic,researchers all over the world have worked on its diagnostics,prognosticating factors,etc.The present study showed liver enzymes,especially a...Since the coronavirus disease 2019(COVID-19)has hit the world as a pandemic,researchers all over the world have worked on its diagnostics,prognosticating factors,etc.The present study showed liver enzymes,especially aspartate aminotransferase(AST)levels,to be high in non-survivors with raised AST/alanine aminotransferase ratio.Considering the non-specific nature of AST with its presence in organs other than liver such as muscle,heart,kidney and brain makes it difficult to interpret.Even pre-existing metabolic syndrome and non-alcoholic fatty liver disease are confounding factors for deranged liver functions detected during COVID-19 disease.Therefore,the results of the study should be taken with caution.展开更多
Coronavirus disease 2019(COVID-19)pneumonia outbreak started in December 2019.On March 12,2020,the World Health Organization(WHO)declared that the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)constitutes...Coronavirus disease 2019(COVID-19)pneumonia outbreak started in December 2019.On March 12,2020,the World Health Organization(WHO)declared that the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)constitutes a pandemic,and as of May 2021,SARS-CoV-2 has infected over 167.3 million patients,including 3.4 million deaths,reported to WHO.In this review,we will focus on the relationship between SARS-CoV-2 infection and the liver.We will discuss how chronic liver diseases affect the COVID-19 disease course and outcomes.We will also discuss the SARS-CoV-2 effects on the liver,mechanisms of acute liver injury,and potential management plans.展开更多
文摘Methotrexate is the first line drug treatment for anumber of rheumatic and non-rheumatic diseases. It is effective in controlling disease activity and preventing disease-related damage, and significantly cheaper than many alternatives. Use in rheumatoid arthritis infers a significant morbidity and mortality benefit. Methotrexate is generally well tolerated but can cause symptomatic adverse events. Multiple serious adverse events have been attributed to methotrexate, based largely on older reports using high or daily doses, and subsequent case reports and circumstantial evidence. The risk with modern dosing regimens: Lower doses, weekly schedules, and concomitant folic acid is less clear. Clarification and dissemination of the actual risk is crucial so appropriate judgements can be made for patients who may benefit from this treatment. Methotrexate has been associated with a range of liver related adverse events ranging from asymptomatic transaminase elevations to fibrosis and fatal hepatic necrosis. Concern over potential liver toxicity has resulted in treatment avoidance, cessation, or recommendations for investigations which may be costly, invasive and unwarranted. Modern laboratory monitoring of liver blood tests may also influence the risk of more serious complications. The majority of present day studies report an approximate doubling of the relative risk of elevated transaminases in methotrexate treated patients but no increased risk of symptomatic or severe liver related adverse events. In this article we will review the evidence around methotrexate and liver related adverse events.
文摘目的探究肝功能指标总胆红素水平及转氨酶水平与认知功能的相关性。方法选择NHANES数据库2011~2012年的数据,最后纳入1260例年龄≥60岁的美国人,对总胆红素水平以及天门冬氨酸氨基转移酶(Aspartate aminotransferase,AST)/谷氨酸-丙酮酸转氨酶(Alanine aminotransferase,ALT)比值进行四分位数分组,并用多因素回归的方法探究其与认知功能[(3次建立阿尔茨海默病登记处联盟(Consortium to establish a registry for Alzheimer's disease,CERAD)总分、CERAD延迟测试、动物流畅性测试(Animal fluency test,AFT)以及数字符号替换测试(Digit symbol substitution test,DSST)]的关系。结果与较低的胆红素水平(Q1=0.2~0.6 mg/dL)比较,Q2(0.7 mg/dL)、Q3(0.8 mg/dL)和Q4(0.9~2.3 mg/dL)胆红素水平与3次CERAD总分之间的β分别为0.78(95%CI=0.11~1.4,P=0.028)、1.6(95%CI=0.7~2.4,P=0.003)和0.52(95%CI=-0.19~1.2,P=0.13),没有观察到转氨酶水平与认知功能的相关性。结论中等水平的胆红素与认知功能中的短暂记忆得分呈正相关,可能具有神经保护作用。
文摘The coronavirus disease 2019(COVID-19)hit the entire world as a global pandemic and soon became the most important concern for all patients with chronic diseases.An early trend in higher mortality in patients with acute respiratory distress attracted all researchers to closely monitor patients for the involvement of other systems.It soon became apparent that patients with chronic liver diseases are at increased risk of mortality given their cirrhosis-associated immune dysfunction.Additionally,liver function abnormalities were noted in patients with severe COVID-19.Profound cytokine storm,direct viral infection,drugs and reactivation of viral infections were causes of deranged liver functions.Here,we discuss the relation between COVID-19 and chronic liver disease,specifically cirrhosis,hepatitis B,hepatitis C,and non-alcoholic fatty liver disease(NAFLD),as well as the liver manifestations of COVID-19.The metabolic syndrome,obesity,diabetes mellitus and NAFLD were found to worsen outcome in different studies reported worldwide.Decompensated cirrhosis should be considered a risk factor for death and severe COVID-19.Recently,COVID-19 related cholangiopathy has also been reported with changes of secondary sclerosing cholangitis.The long-term persistence of viral antigens in gut epithelia raises concern regarding the future risk of autoimmune liver diseases.
文摘The risk of liver injury in patients with coronavirus disease 2019(COVID-19)infection is quite evident.Furthermore,liver function test abnormalities are still detected in COVID-19 patients despite the development of antivirals and the availability of several types of vaccines.This editorial describes liver involvement during COVID-19 infection in patients with or without preexisting liver injury,such as chronic liver disease,to elucidate COVID-19-induced liver function abnormalities and their severity,pathophysiology,clinical manifestations,and clinical and laboratory outcomes.We also discuss the effect of vaccination against COVID-19 to better understand host factors,such as age,gender,and race,on the incidence and severity of liver dysfunction at initial presentation and during the illness.Finally,we summarize the results of relevant meta-analyses published to date and highlight the importance of adequate liver function monitoring in the current climate of the overwhelming COVID-19 pandemic.
文摘BACKGROUND Nonalcoholic fatty liver disease(NAFLD)and type-2 diabetes mellitus(T2DM)have an intricate bidirectional relationship.Individuals with T2DM,not only have a higher prevalence of non-alcoholic steatosis,but also carry a higher risk of progression to nonalcoholic steatohepatitis.Experts still differ in their recommendations of screening for NAFLD among patients with T2DM.AIM To study the prevalence of NAFLD and advanced fibrosis among our patient population with T2DM.METHODS During the study period(November 2018 to January 2020),59 adult patients with T2DM and 26 non-diabetic control group individuals were recruited prospectively.Patients with known significant liver disease and alcohol use were excluded.Demographic data and lab parameters were recorded.Liver elastography was performed in all patients.RESULTS In the study group comprised of patients with T2DM and normal alanine aminotransferase levels(mean 17.8±7 U/L),81%had hepatic steatosis as diagnosed by elastography.Advanced hepatic fibrosis(stage F3 or F4)was present in 12%of patients with T2DM as compared to none in the control group.Patients with T2DM also had higher number of individuals with grade 3 steatosis[45.8%vs 11.5%,(P<0.00001)and metabolic syndrome(84.7%vs 11.5%,P<0.00001)].CONCLUSION A significant number of patients with T2DM,despite having normal transaminase levels,have NAFLD,grade 3 steatosis and advanced hepatic fibrosis as measured by liver elastography.
文摘Since the coronavirus disease 2019(COVID-19)has hit the world as a pandemic,researchers all over the world have worked on its diagnostics,prognosticating factors,etc.The present study showed liver enzymes,especially aspartate aminotransferase(AST)levels,to be high in non-survivors with raised AST/alanine aminotransferase ratio.Considering the non-specific nature of AST with its presence in organs other than liver such as muscle,heart,kidney and brain makes it difficult to interpret.Even pre-existing metabolic syndrome and non-alcoholic fatty liver disease are confounding factors for deranged liver functions detected during COVID-19 disease.Therefore,the results of the study should be taken with caution.
文摘Coronavirus disease 2019(COVID-19)pneumonia outbreak started in December 2019.On March 12,2020,the World Health Organization(WHO)declared that the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)constitutes a pandemic,and as of May 2021,SARS-CoV-2 has infected over 167.3 million patients,including 3.4 million deaths,reported to WHO.In this review,we will focus on the relationship between SARS-CoV-2 infection and the liver.We will discuss how chronic liver diseases affect the COVID-19 disease course and outcomes.We will also discuss the SARS-CoV-2 effects on the liver,mechanisms of acute liver injury,and potential management plans.
