알콜성 간질한에 동반된 알콜성 만성 체장염

박의련(Eui Ryun Park),이동기(Dong Ki Lee),이상철(Sang Cheol Lee),김영경(Young Kyung Kim),김준명(Jun Myeung Kim),박성진(Sung Jin Park),홍사준(Sa Joon Hong),권상옥(Sang Ok Kwon) 대한내과학회 1996 대한내과학회지 Vol.50 No.5

Objectives: The aim of this study was to investigate the prevalence of alcoholic chronic pancreatitis in alcoholic liver disease and the relationship between the degree of pancreatitis and the pathologic type of alcoholic liver disease. Methods: We reviewed ERCP in 68 patients with alcoholic liver disease who were clinically suscepted as alcoholic chronic pancreatitis. Alcoholic liver disease was diagnosed by liver biopsy and alcohol history. Alcoholic chronic pancreatitis was diagnosed by ERCP and grouped by severity according to Anacker and Loffler`s classification, Results: Pancreatic duct changes suggesting alcoholic chronic pancreatitis were present at ERCP in 31.5% of the biopsy-confirmed alcoholic liver disease. There was no correlation between the histopathologic classification of alcoholic liver disease and the severity of alcoholic chronic pancreatitis. Conclusion: In alcoholic liver disease, the possibility of alcoholic chronic pancreatitis should always be considered.

Diagnostic Value of Transaminases and Deritis Ratio for Predicting Alcoholic Liver Disease

( Mukunda Raj Kalouni ),( O. P. Talwar ),( Saroj Pokhrel ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Alcoholic liver disease is a major public health concern in Nepal. Excess alcohol consumption leads to alcoholic liver diseases. The use of test combinations significantly improves the information received with single serum enzyme determinations. Aspartate aminotransferase to alanine aminotransferase ratio (deritis ratio) is a diagnostic marker in alcoholic liver disease. The aim of the study is to rule out significance of transaminases and deritis ratio in alcoholic liver disease subjects. Methods: The study was carried out in the department of biochemistry at Manipal Teaching Hospital, and kaski Sewa Hospital and Research Center Pokhara, Nepal between 5^th October 2017 to 15^th March 2018. Clinically 50 known cases of alcoholic liver disease patients and 50 healthy individuals were enrolled in this study. The correlations of the variables were evaluated by pearson correlation coefficient. Descriptive statistics were used for analysis of the results. Data was analyzed by using SPSS version 17. P values of < 0.05 were considered statistically significant. Results: We found a significant difference between Transaminases between alcoholic liver disease patients and healthy control subjects. The mean value of AST (111.98 ± 124.05) was found to be highly increased incomparision to ALT (61.26 ± 43.86) leading to significantly higher AST/ALT ratio (1.95 ± 1.42). The mean values of deritis ratio was 1.95 in ALD patients which was markedly increased as compared to the ratio of controls (1.13). There were significant differences in the AST/ ALT ratio between two groups (P=0.000). Patients with alcoholic liver disease had an AST:ALT ratio > 1.0. Conclusions: This study suggests that high deritis ratio is the marker for alcoholic liver disease. An elevated serum AST in relation to serum ALT has been proposed as an indicator that alcohol has induced organ damage

알콜성 간질환의 HLA 및 면역학적 반응

한금주(Kum Joo Han),안병철(Byeong Cheol Ahn),권중구(Joong Goo Kweon),김영탁(Young Tak Kim),금민수(Min Soo Kum),권영오(Young Oh Kweon),김성국(Seong Kook Kim),최용환(Yong Whan Choi),정준모(Joon Mo Chung) 대한내과학회 1995 대한내과학회지 Vol.48 No.5

Objectives: In order to examine for one of the genetic predisposition to alcohol related liver disease, and for evaluation of their immunologic status, we studied HLA and delayed skin test in patients with alcoholic liver disease. Methods: A study of HLA in 50 patients with alcoholic liver disease(including 38 patients with liver cirrhosis) was conducted and delayed skin hyper-sensitivity to ubiquitous antigens was also tested in 46 patients with alcoholic liver disease. Results: 1) The comparison of the frequency of HLA-A2, A26, A34, B8, B48, B51, B60, B62 and DR3 between the patient group with alcoholic liver disease(N=50) and control group(N=196) showed higher values for the patients group, 78% vs 49%(p<0.0001), 18% vs 7.7% (p<0.05), 10% vs 0% (p<0.0001), 4% vs 0.5%(p,0.05), 10% vs 2%(p<0.01), 40% vs 7.7%(p<0.0001), 28% vs 9.7%(p<0.001), 34% vs 16.3%(p<0.01) and 24% vs 2.9%(p<0.0001) respectively. 2) The comparison of the frequency of HLA-A2, A26, A34, B8, B51, B60, B62 and DR3 between the patient group with aloholic liver cirrhosis(N=38) and control group(N=196) showed higher values in the patients group, 76.3% vs 43%(p<0.001), 21.1% vs 7,7%(p<0.01), 10.5% vs 0%(p<0.0001), 5.3% vs 0.5%(p<0.001), 36.8% vs 7.7%(p<0.0001), 28.9% vs 9.7%(p<0.001), 34.2% vs 16.3%(p<0.01) and 21.1% vs 2.9%(p<0.0001). 3) The data of delayed skin test with ubiquitous antigens did not show significant difference between the group of alcoholic liver disease(N=46) and that of normal control(N=20). Conclusion: Theses results suggest that genetic factor would be involved in the progression of the alcoholic liver disease but further studies are needed to evaluate the immunologic status in alcohnlic liver disease.

Prospective Validation of LSM Using ARFI Elastography to Predict Advanced Fibrosis and Cirrhosis Based on Metavir and Laennec Staging in Patients with Alcoholic Liver Disease

( Youn-i Choi ),( Won Kim ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Accurate assessment of advanced fibrosis and cirrhosis is important to predict long-term clinical outcomes in patients with alcoholic liver disease. Acoustic radiation force impulse (ARFI) elastography is one of the liver stiffness measurement (LSM) methods to assess liver fibrosis in patients with chronic liver disease. However, little is known about the correlation between LSM by means of ARFI and the severity of fibrosis in patients with alcoholic liver disease. Methods: We conducted a prospective cohort study including 170 alcoholic liver disease patients with ongoing or prior alcohol abuse history (male > 80g/day, female > 40g/day ) without any other cause of chronic liver disease. We used ARFI elastography for measuring liver stiffness and performed liver biopsy for staging fibrosis based on the Metavir stage and the Laennec sub-classification of cirrhosis. Diagnostic measurement of serum fibrosis indices and ARFI imaging were compared with predicted significant (≥F2)or advanced (≥F3) fibrosis or cirrhosis (F4) by analyzing the area under the receiver operating characteristic (AUROC) curve. Results: Aspartate aminotransferase to alanine aminotransferase ratio (AAR) (rs=0.35, p=0.00) aspartate aminotransferase to platelet ratio index (APRI)( rs=0.17, p=0.018), and Fib-4(rs=0.35, p=0.00) showed weak positive correlations with METAVIR stages. ROC curve analysis identified shear wave velocity (Vs) of liver ≥ 1.34m/s (AUROC of 0.917; SE, 0.0226; 95% CI, 0.865-0.954) as the optimal cut-off for predicting significant fibrosis (≥F2). For predicting advanced fibrosis (≥F3), the optimal cut-off of Vs of liver was ≥ 1.67m/s (AUROC of 0.929; SE, 0.0210; 95% CI, 0.879-0.962). For cirrhosis (F4), the optimal cut-off value was ≥ 2.09m/s of Vs of liver (AUROC of 0.929; SE, 0.0204; 95% CI, 0.877-0.961). A tendency toward increasing liver stiffness existed in a graded manner across METAVIR stages (P<0.001). Conclusions: In this prospective evaluation of patients with alcoholic liver disease, we suggest that ARFI elastography might be an excellent, non-invasive, diagnostic tool for predicting advanced fibrosis and cirrhosis in comparison with other noninvasive serum fibrosis indices.

바이러스성 및 알코올성 간질환에서의 장투과성의 변화

김정욱 ( Kim Jeong Ug ),전우규 ( Jeon U Gyu ),윤중원 ( Yun Jung Won ),박동일 ( Park Dong Il ),조용균 ( Jo Yong Gyun ),성인경 ( Seong In Gyeong ),박창영 ( Park Chang Yeong ),손정일 ( Son Jeong Il ),김병익 ( Kim Byeong Ig ),김은정 ( 대한소화기학회 2004 대한소화기학회지 Vol.43 No.2

Background/Aims: Increased intestinal permeability has been possible contributing factors to the pathogenesis of alcoholic liver disease. Moreover, it can contribute to the development of bacterial infection and intestinal endotoxemia in patients with liver cirrhosis. This study aimed to examine the difference of intestinal barrier dysfunction between alcoholic and viral liver disease patients through the comparison of the intestinal permeabilities of patients with clinical characteristics. Methods: Intestinal permeabilities were measured in 18 healthy controls, 41 patients with alcoholic liver disease (17 cases of alcoholic liver disease without cirrhosis and 24 cases of alcoholic liver cirrhosis) and 46 patients with viral liver disease (14 cases of chronic viral hepatitis and 32 cases of viral liver cirrhosis) by measuring 24 hour urine excretion of 51Cr-EDTA. Results: The intestinal permeability was significantly increased in the patients with alcoholic liver disease without cirrhosis (5.62±80%), alcoholic liver cirrhosis (5.29±48%) and viral liver cirrhosis (3.15±39%) compared with that in control subjects (1.99±53%). On the contrary, it was not increased in the patients with chronic viral hepatitis (2.05±57%) versus controls. The significant correlation was not found between intestinal permeability and clinical and laboratory findings. Conclusions: The intestinal permeability was elevated in patients with alcoholic liver disease compared to those with viral liver cirrhosis. The pathophysiology of liver injury secondary to intestinal epithelial damage may be different between alcoholic and viral liver diseases. (Korean J Gastroenterol 2004; 43:104-111)

비알콜성 지방간 초음파 영상에 GLCM과 인공신경망을 적용한 비알콜성 지방간 질환 분류

김지율,예수영 한국방사선학회 2023 한국방사선학회 논문지 Vol.17 No.5

Non-alcoholic fatty liver disease is an independent risk factor for the development of cardiovascular disease, diabetes, hypertension, and kidney disease, and the clinical importance of non-alcoholic fatty liver disease has recently been increasing. In this study, we aim to extract feature values ​​by applying GLCM, a texture analysis method, to ultrasound images of patients with non-alcoholic fatty liver disease. By applying an artificial neural network model using extracted feature values, we would like to classify the degree of fat deposition in non-alcoholic fatty liver into normal liver, mild fatty liver, moderate fatty liver, and severe fatty liver. As a result of applying the GLCM algorithm, the parameters Autocorrelation, Sum of squares, Sum average, and sum variance showed a tendency for the average value of the feature values ​​to increase as it progressed from mild fatty liver to moderate fatty liver to severe fatty liver. The four parameters of Autocorrelation, Sum of squares, Sum average, and sum variance extracted by applying the GLCM algorithm to ultrasound images of non-alcoholic fatty liver disease were applied as inputs to the artificial neural network model. The classification accuracy was evaluated by applying the GLCM algorithm to the ultrasound images of non-alcoholic fatty liver disease and applying the extracted images to an artificial neural network, showing a high accuracy of 92.5%. Through these results, we would like to present the results of this study as basic data when conducting a texture analysis GLCM study on ultrasound images of patients with non-alcoholic fatty liver disease.

알코올성 간 질환 환자의 Carbohydrate Deficient Transferrin의 임상적 유용성 연구

손계성 ( Gye Sung Son ) 대한임상검사과학회 2005 대한임상검사과학회지(KJCLS) Vol.37 No.1

It is well known that intaking alcohol chronically and heavily causes many formsof physical systemic distress including serious chronic alcoholic liver disease such as alcoholic hepatitis, fatty liver, liver cirrhosis and hepatoma. Carbohydrate-deficient transferrin (CDT) is known as a specific marker in detecting and monitoring alcohol associated disease. Weanalyzed various alcohol-associated parameters to evaluate the clinical usefulness of CDT. The first patient group consisted of fifty patients, who had been diagnosed with alcoholic liver disease from January 2003 to June 2004 at Chungnam National University Hospital. The second group consisted of 12 patients with non-alcoholic liver disease. The third group consisted of 19 teetotalerswho had visited the hospital for the purpose of routine healthcare checks. Various hepatic parameters such as CDT, г-GT (gamma-glutamyl transferase), AST (aspartate aminotransferase) and ALT (alanine aminotransferase) were compared in the three groups. CDT and AST increased in direct proportion to the amount and duration of alcohol consumption with high significance, but г-GT and ALT showed arbitrary patterns with no statistical significance. The sensitivities of CDT, г-GT, AST and ALT were 74 %, 96 %, 68 % and 58 %, respectively and the specificities were 95 %, 74 %, 68 % and 79 % in order respectively. The correlation study of CDT with г-GT, AST and ALT showed a very low value of correlation coefficients, implying that CDT could be taken as an independent parameter in evaluating alcohol liver disease compared to г-GT, AST and ALT. This present study suggested that CDT coud be one of the most useful parameters in reflecting the amount and duration of alcohol consumption as well as being another independent parameter in assessing and following up patients with alcoholic liver disease. Moreover we recommend it is the best method of measuring both CDT and г-GT in patients with alcoholic liver disease.

Cardiovascular risk in alcoholic liver disease and non-alcoholic fatty liver disease: How to assess and manage?

장병국 ( Byoung Kuk Jang ) 대한간학회 2019 간학회 싱글토픽 심포지움 Vol.2019 No.1

Non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) are one of the most common liver diseases worldwide and its prevalence is increasing. NAFLD and ALD increase cardiovascular mortality as well as liver related mortality. According to long-term follow-up studies, cardiovascular mortality is most important cause of death in NAFLD and ALD patients. It is already known that NAFLD and ALD are independently associated with various risk factors of cardiovascular disease (CVD). However, it is unclear how NAFLD and ALD affect CVD each other. This review will focus on the relevance of NAFLD and ALD on CVD and its application in clinical practice.

Endoplasmic reticulum stress and autophagy dysregulation in alcoholic and non-alcoholic liver diseases

김윤석,Sang Geon Kim 대한간학회 2020 Clinical and Molecular Hepatology(대한간학회지) Vol.26 No.4

Alcoholic and non-alcoholic liver diseases begin from an imbalance in lipid metabolism in hepatocytes as the earliest response. Both liver diseases share common disease features and stages (i.e., steatosis, hepatitis, cirrhosis, and hepatocellular carcinoma). However, the two diseases have differential pathogenesis and clinical symptoms. Studies have elucidated the molecular basis underlying similarities and differences in the pathogenesis of the diseases; the factors contributing to the progression of liver diseases include depletion of sulfhydryl pools, enhanced levels of reactive oxygen and nitrogen intermediates, increased sensitivity of hepatocytes to toxic cytokines, mitochondrial dysfunction, and insulin resistance. Endoplasmic reticulum (ER) stress, which is caused by the accumulation of misfolded proteins and calcium depletion, contributes to the pathogenesis, often causing catastrophic cell death. Several studies have demonstrated a mechanism by which ER stress triggers liver disease progression. Autophagy is an evolutionarily conserved process that regulates organelle turnover and cellular energy balance through decomposing damaged organelles including mitochondria, misfolded proteins, and lipid droplets. Autophagy dysregulation also exacerbates liver diseases. Thus, autophagy-related molecules can be potential therapeutic targets for liver diseases. Since ER stress and autophagy are closely linked to each other, an understanding of the molecules, gene clusters, and networks engaged in these processes would be of help to find new remedies for alcoholic and non-alcoholic liver diseases. In this review, we summarize the recent findings and perspectives in the context of the molecular pathogenesis of the liver diseases.

알코올간질환 : 알코올간염의 임상상과 치료

이병석 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.4(S)

Alcoholic liver disease includes fatty liver, alcoholic hepatitis, and alcoholic cirrhosis. Alcoholic hepatitis is an acute and severe form of alcoholic liver disease. Its mortality has been reported high rate. Abstinence and life style modification is very impotant for patients with alcoholic liver disease. There are many drugs for treatment of alcoholic liver disease, especially alcoholic hepatitis. Among those, corticosteroid therapy appears to be beneficial to severe alcoholic hepatitis (DF>32). The benefits of other therapeutic drugs remain controversial. We review the clinical features and treatment modalities of alcoholic liver disease.