Comparison of the Child-Turcotte-Pugh Classification and the Model for End-stage Liver Disease Score as Predictors of the Severity of the Systemic Inflammatory Response in Patients Undergoing Living-donor Liver Transplantation

홍상현,김정은,조미라,허유정,최종호,최정현,이재민 대한의학회 2011 Journal of Korean medical science Vol.26 No.10

The aim of this study was to evaluate and compare the Child-Turcotte-Pugh (CTP)classification system and the model for end-stage liver disease (MELD) score in predicting the severity of the systemic inflammatory response in living-donor liver transplantation patients. Recipients of liver graft were allocated to a recipient group (n = 39) and healthy donors to a donor group (n = 42). The association between the CTP classification, the MELD scores and perioperative cytokine concentrations in the recipient group was evaluated. The pro-inflammatory cytokines measured included interleukin (IL)-1β, IL-6,and tumor necrosis factor (TNF)-α; the anti-inflammatory cytokines measured included IL-10 and IL-4. Cytokine concentrations were quantified using sandwich enzyme-linked immunoassays. The IL-6, TNF-α, and IL-10 concentrations in the recipient group were significantly higher than those in healthy donor group patients. All preoperative cytokine levels, except IL-6, increased in relation to the severity of liver disease, as measured by the CTP classification. Additionally, all cytokine levels, except IL-6, were significantly correlated preoperatively with MELD scores. However, the correlations diminished during the intraoperative period. The CTP classification and the MELD score are equally reliable in predicting the severity of the systemic inflammatory response, but only during the preoperative period.

Comparison of the Child-Turcotte-Pugh Classification and the Model for End-stage Liver Disease Score as Predictors of the Severity of the Systemic Inflammatory Response in Patients Undergoing Living-donor Liver Transplantation

Hong, Sang-Hyun,Kim, Jeong-Eun,Cho, Mi-La,Heo, Yu-Jung,Choi, Jong-Ho,Choi, Jung-Hyun,Lee, Jaemin The Korean Academy of Medical Sciences 2011 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.26 No.10

<P>The aim of this study was to evaluate and compare the Child-Turcotte-Pugh (CTP) classification system and the model for end-stage liver disease (MELD) score in predicting the severity of the systemic inflammatory response in living-donor liver transplantation patients. Recipients of liver graft were allocated to a recipient group (n = 39) and healthy donors to a donor group (n = 42). The association between the CTP classification, the MELD scores and perioperative cytokine concentrations in the recipient group was evaluated. The pro-inflammatory cytokines measured included interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α; the anti-inflammatory cytokines measured included IL-10 and IL-4. Cytokine concentrations were quantified using sandwich enzyme-linked immunoassays. The IL-6, TNF-α, and IL-10 concentrations in the recipient group were significantly higher than those in healthy donor group patients. All preoperative cytokine levels, except IL-6, increased in relation to the severity of liver disease, as measured by the CTP classification. Additionally, all cytokine levels, except IL-6, were significantly correlated preoperatively with MELD scores. However, the correlations diminished during the intraoperative period. The CTP classification and the MELD score are equally reliable in predicting the severity of the systemic inflammatory response, but only during the preoperative period.</P>

간경변증의 상태와 식도정맥류의 정도가 식도정맥류 결찰요법에 미치는 영향

황재석 啓明大學校 醫科大學 1998 계명의대학술지 Vol.17 No.2

식도 정맥류 출혈로 내원한 환자 중 결찰요법을 시행하여 정맥류가 근절된 57명을 대상으로 하여 식도 정맥류의 정도와 간경변증의 상태가 정맥류의 근절 (또는 grade 1 이하)에 미치는 영향을 알기 위해 근절 때까지 시생한 결찰요법의 횟수, 사용한 고무 밴드수를 비교하여 다음과 같은 결과를 얻었다. 1) 간경변증의 원인은 알콜성 33명 (58\%), 괴사성 24명 (42%)이었으며, Child-Pugh 분류에 의한 간경변증은 A는 16명 (28%), B는 32명 (56%), C는 9명 (16%)이었다. 2) 식도 정맥류의 크기는 (grade, G)는 정맥류의 직경이 4-6 mm (G2)는 5명, 7-10 mm (G3)는 28명, 10 mm 이상은 (G4) 24명이었다. 정맥류의 위치 (location, L)는 하부에만 있는 경우가 (L1) 5명, 하ㆍ중부에 있는 경우가 (L2) 34명, 전식도에 정맥류가 관찰되는 경우가 (L3) 18명이다. 3) 식도 정맥류의 크기와 결찰요법의 횟수를 비교하면 G2,일 때 2.2±0.8, G3일 때 2.2±0.5, G4일 때 2.8±0.7회로서 정맥류의 크기가 10 mm이상일 때 결찰요법의 횟수는 유의하게 증가하였다. (p=0.006) 식도 정맥류의 크기와 사용된 고무 밴드수를 비교하면 G2일 때 5.6±2.5, G3일 때 5.6±2.0, G4일 때 9.0±3.2개로서 정맥류의 크기가 10 mm이상일 때 사용된 고무 밴드수는 유의하게 증가하였다.(p〈0.001). 4) 식도 정맥류의 위치와 결찰요법의 횟수를 비교하면 L1일 때 1.6±0.5, L2일 때 2.3±0.6, L3일대 3.0±0.5회로서 정맥류의 위치가 전 식도에 존재할수록 결찰요법의 횟수는 유의하게 증가하였다.(p〈0.001). 식도 정맥류의 위치와 사용된 고무 밴드수를 비교하면 L1일 때 3.2±1.3, L2일 때 6.3±2.5, L3일 때 9.4±2.8개로서 정맥류의 위치가 전 식도에 존재할수록 사용된 고무 밴드수는 유의하게 증가하였다(p〈0.001). 5) Child-Pugh 분류에 의한 결찰요법의 횟수를 비교하면 A, B, C일 때 각각 2.4±0.7, 2.6±0.6, 2.2±0.8회로 유의한 차이가 없었다. Child-Pugh 분류에 의한 사용된 고무 밴드수를 비교하면 A, B, C일 때 각각 7.1±3.3, 7.1±2.7, 6.6±4.3개로서 역시 유의한 차이가 없었다. 이상의 결과를 볼 때 식도 정맥류의 결찰요법에서 식도 정맥류의 위치가 전 식도에 존재할수록, 또한 정맥류의 크기가 클수록 정맥류 근치에 필요한 내시경 시술횟수는 증가하고 사용된 고무 밴드수도 증가하는 것으로 나타났다. 그러나 간경변증의 심한 정도는 영향을 미치지 못하는 것으로 사료된다. EVL is a newly developed alternative technique to sclerotherapy. This technique consists of mechanical ligation and thrombosis of varices using elastic "O" rings. Fifty-seven bleeding patients were selected for evaluation. These patients had varices that were eradicated by EVL. They were analysed based on the severity of varices and liver cirrhosis that affected eradication of varices. We compared the ligation time and the number of bands used for eradication of varices. 1. Among 57 liver cirrhosis patients, 33 (58%) patients were due to alcoholics, while 24 (42%) patients were due to postviral infection. According to Child- Pugh classification, 16 (28%) patients were A, 32 (56%) patients B, and 9 (16%) patients C. 2. The severity of varices is classified by grade (G) and location (L) as follows: Five patients with G2 (varix diameter between 4-6 mm), 28 with G3(7-10mm), and 24 with G4 (over 10mm) ; 5 patients with L1 (inferior), 34 with L2 (inferior and middle), and 18 with L3 (entire portion). 3. The ligation time and the number of bands used for eradication of varices by grade were 2.2 and 5.6 for G2 and G3, and 2.8 and 9.0 for G4 respectively. 4. The ligation time and the number of bands used for eradication of varices by location were 1.6 and 3.2 for L1, 2.3 and 6.3 for L2, 3.0 and 9.4 for L3 respectively. 5. According to Child-Pugh classification, the ligation time and the number of bands used for eradication were not significantly different. In conclusion, the ligation time and the number of bands used for eradication of varices were increased as the size of varix and location of the lesion became more involved. However, the severity of cirrhosis did not affect procedures.

간이식 대기 중인 간경변 환자에서 의미 있는 폐내 단락의 빈도와 이와 연관된 인자에 관한 연구

이지민,최문석,이상철,박승우,배문희,이준혁,고광철,백승운,이풍렬,김재준,이종철 대한간학회 2002 Clinical and Molecular Hepatology(대한간학회지) Vol.8 No.3

목적: 간폐증후군은 간질환이 있는 환자에서 저산소증이 유발되는 상태로서, 폐내 단락이 그 주된 기전으로 알려져있다. 간이식은 간폐증후군의 유일한 치료 방법으로 알려져 있고, 이식 후에 폐내 단락의 정상화가 일어날 수 있다. 그러나 간이식을 시행할 경우 가역성을 미리 예측할 수 없는 것이 문제이다. 국내에서는 이식 대기중인 간경변증 환자에서의 폐내 단락의 유병률에 관한 연구가 아직 없는 실정이다. 저자 등은 간이식 대기중인 간경변증 환자에서 의미 있는 폐내 단락의 유병률과 폐내 단락과 연관된 위험 인자를 알아보고자 하였다. 대상과 방법: 1999년 11월부터 2001년 2월까지 삼성서울병원 에서 간경변증이나 이에 동반된 간암으로 간이식 대기 중인 환자 57명 (남 : 여 = 38 : 19, 연령 18∼71 세, 중앙값 49세)을 대상으로 하였다. 간경변증의 원인은 B형 간염이 47명, C형 간염이 4명, 그 외 알코올과 윌슨병, 원발성 담도성 간경변증 등이 6명이었고, 전체 환자 중에 간암이 동반된 환자는 13명이었다. 이들에게 조영 증강 심초음파를 시행하여 폐내 단락의 유무 및 정도를 평가하였으며, Ⅱ등급 이상의 단락을 의미 있는 단락으로 보았다. 대상 환자를 의미 있는 단락을 가진 군과 그렇지 않은 군으로 나누어, 양 군 간의 간기능, 식도 정맥류 유무, 위 정맥류 유무, 복수, 간성 뇌증 유무를 비교하였다. 결과: 총 57명의 환자 중 의미 있는 폐내 단락을 가진 군 은 30명(52.6%)이었다. 의미 있는 폐내 단락은 Child- Pugh분류 C군에서 38명 중 24명(63.2%), A, B군에서 19명 중 6명(31.6%)으로 관찰되었다(p< 0.05). 의미 있는 폐내 단락이 있는 군과 없는 군 간의 성별, 나이, 간경변증 원인, 식도 정맥류 유무, 위 정맥류 유무, 복수, 간성 뇌증 유무 등에는 유의한 차이가 없었다. 결론: 이상의 결과로 폐내 단락은 간이식 대기중인 간경변증 환자에서 흔히 관찰되는 소견이며, Child-Pugh 분류 C군은 의미 있는 폐내 단락의 위험 인자임을 알 수 있었다. Backgrounds/Aims: Hepatopulmonary syndrome is a condition of severe hypoxia with intrapulmonary shunt (IPS) in the setting of hepatic dysfunction. Liver transplantation has been suggested as a definite treatment for hepatopulmonary syndrome with reversal of IPS in some patients. Inconsistency of response and inability to predict reversibility, however, are significant problems. We performed this study to evaluate the prevalence of significant IPS in pretransplantation cirrhotic patients and to find any risk factors of IPS. Methods: Fifty-seven patients (M:F = 38:19, median age 49 years (range 18 - 71)) with liver cirrhosis awaiting liver transplantation were serially included. Their IPS status was evaluated using contrastenhanced echocardiography. Significant shunt was defined as a shunt of grade ≥2. Results: Significant IPS was detected in 30 (52.6%) among 57 patients. Significant shunt was found in 24 (63.2%) of 38 Child-Pugh class C patients and in 6 (31.6%) of 19 Child-Pugh class A or B patients (p<0.05). No significant difference in prevalence of significant shunt was seen according to age, sex, presence or absence of hepatocellular carcinoma, ascites, hepatic encephalopathy, and gastroesophageal varix. Conclusion: Significant intrapulmonary shunt is a common finding in cirrhotic patients awaiting liver transplantation. Child-Pugh class C is the risk factor associated with high prevalence of significant shunt. (Korean J Hepatol 2002;8:271-276)

상복부 초음파 영상에서 간경변증 환자군과 대조군의 담석증 유병률 연구

조청현(Cheong-Hyeon Jo),김용권(Yong-Gwon Kim),유세종(Se-Jong Yoo),배석환(Seok-Hwan Bae) 대한방사선과학회(구 대한방사선기술학회) 2023 방사선기술과학 Vol.46 No.6

This study aimed to understand the correlations of prevalence and relevant variables of cholelithiasis with a group of cirrhosis patients and a control group targeting the subjects who received the abdomen ultrasonography from K university hospital in Daejeon Metropolitan City from January 1st 2019 to December 31st. And the results are as follows. First, the group of cirrhosis patients showed relatively higher prevalence of cholelithiasis than the control group as ordinary people, which showed statistically significant differences. Second, in the control group, there were statistically significant differences in the occurrence of cholelithiasis with respect to age. Conversely, in the cirrhosis patient, there was no statistically significant association observed with age; nonetheless, age itself exhibited statistical significance. Third, according to sex, the prevalence was not statistically significant in both group of cirrhosis patients and control group. Fourth, in each degree and cause of subdivided cirrhosis, the correlation was only shown in each degree. In the results of this study, the cirrhosis patients showed high correlation with the incidence of cholelithiasis, and the control group showed the high correlation with the incidence of cholelithiasis according to age.

Effectiveness of Lenvatinib versus Sorafenib for Unresectable Hepatocellular Carcinoma in Patients with Hepatic Decompensation

( Min Kyung Park ),( Yun Bin Lee ),( Hyemi Moon ),( Na Ryung Choi ),( Minseok Albert Kim ),( Heejoon Jang ),( Joon Yeul Nam ),( Eun Ju Cho ),( Jeong-hoon Lee ),( Su Jong Yu ),( Yoon Jun Kim ),( Jung-h 대한간학회 2021 춘·추계 학술대회 (KASL) Vol.2021 No.1

Gene Regulations in HBV-Related Liver Cirrhosis Closely Correlate with Disease Severity

( Se Ram Lee ),( So Youn Kim ) 생화학분자생물학회 2007 BMB Reports Vol.40 No.5