Advanced Stages Of Liver Cirrhosis Research Articles

Serum hepatocyte growth factor levels in primary biliary cirrhosis

Recent studies have shown that serum levels of hepatocyte growth factor, a potent mitogen for hepatocytes, are increased in patients with fulminant liver failure and with advanced stages of liver cirrhosis. Retrospective study. Serum levels of hepatocyte growth factor (HGF) were determined in 26 patients with advanced stages of liver cirrhosis by means of an enzyme-linked immunosorbent assay. In 23 of these patients, liver biopsies were obtained before treatment with ursodeoxycholic acid and investigated for hepatocyte expression of the proliferating cell nuclear antigen (PCNA) and the Ki-67 antigen by immunocytochemical methods. In 25 of the 26 patients, serum HGF levels did not differ from those of patients with histologically normal livers. Levels did not vary between the different stages of primary biliary cirrhosis but increased moderately when re-evaluated after a period of 24 +/- 4.9 months or 54 +/- 10.7 months. An abnormally increased serum HGF level was observed in only one patient, who had end-stage liver cirrhosis before liver transplantation. Both PCNA and Ki-67 antigen labelling indices were significantly higher at all stages of primary biliary cirrhosis than in normal liver, indicating increased hepatocyte proliferation, but the labelling indices did not correlate with the HGF concentrations in serum. Serum HGF levels in almost all patients with primary biliary cirrhosis were within normal limits despite increased hepatocyte proliferation. The results support the hypothesis that HGF serum levels may reflect liver dysfunction rather than active hepatocyte proliferation.

Serum, fecal and urinary bile acids in patients with mild and advanced liver cirrhosis.

The levels and compositions of bile acids in the serum, feces and urine were determined by gas chromatography in male patients with mild and advanced stages of liver cirrhosis, defined by usual clinical and laboratory criteria. Increased concentrations of serum bile acids, a decreased ratio of serum cholic acid plus deoxycholic acid/chenodeoxycholic acid plus lithocholic acid, a reduction of fecal bile acids, especially deoxycholic acid, and a reduction in total daily excretion of bile acids were found in patients with advanced cirrhosis. Furthermore, 3 beta-hydroxy-5-cholenoic acid, a presumed intermediate in the alternate pathway of chenodeoxycholic acid synthesis, was found in the urine of patients with very advanced cirrhosis. Such changes were absent in patients with mild cirrhosis except for increased concentration of serum bile acids and decreased excretion of total bile acids. The present study suggests that marked changes in bile acid metabolism occur only in advanced cirrhosis.

Intralipid clearance and lipoprotein pattern in men with advanced alcoholic liver cirrhosis

Twelve male patients with advanced alcoholic cirrhosis of the liver were found to have markedly low serum lipid and lipoprotein concentrations. Serum triglyceride and cholesterol concentrations were about 50% of matched control values. The very low density lipoproteintriglyceride concentration was only one-third of control values and the cholesterol concentrations in very low density and low density lipoproteins were far below control values. The mean high density lipoprotein cholesterol concentration was not significantly decreased, but in three of 12 patients extremely low values were found. These findings may reflect a failure of lipoprotein synthesis secondary to a bad nutritional state and metabolic disturbances in this advanced stage of liver cirrhosis. By means of the intravenous fat tolerance test with Intralipid it could be shown that substantial amounts of triglycerides could be cleared from the plasma in these patients. However, studies on the long-term Intralipid clearance capacity have to be performed before any general recommendations about the inclusion of fat emulsions in parenteral nutrition of these patients can be made.