2022 ILC hotspot courier -Human leukin is used for hepatic cirrhosis hypodiamore treatment

For medical professionals for reading reference

The medical community cooperated with the Ministry of Medicine of Takeda, and was fortunate to invite Professor Hu Peng of the Second Affiliated Hospital of Chongqing Medical University to further interpret the treatment of human hemurin for hepatopathy at the EASL ILC 2022 conference.

Low sodium hemiamond disease

Common complications of patients with hardening liver cirrhosis

Limor sodium is a common complication of patients with severe liver cirrhosis. It is generally defined as serum sodium concentration ≤135 mmol/L. Nearly half (49%) patients with cirrhosis and ascites can be combined with hyponemia. The serum sodium concentration is below 130 mmol/L, and patients with hypertrophy with hyponemia, the risk of hepatic encephalopathy, liver and kidney syndrome, spontaneous bacterial peritonitis, risk of hospitalization and risk of death during liver transplantation during liver transplantation Both patients with cirrhosis who are not combined with low sodium disease [1]. Based on the adverse effects of hyponatremia on the prognosis of the patient, the MELD (end-end liver disease model scoring system) -NA score incorporates blood sodium index into the calculation formula of the scoring score, which increases the prognosis of patients with the prognosis of liver cirrhosis in the prediction of predicts than the MELD score. Accuracy [2].

The physiological mechanism of hyponatremia patients with liver cirrhosis

Limor sodium disease in patients with cirrhosis is mostly diluted hyponatremia. The pathogenic mechanism of its pathophysiology is: the hypertension of the hepatic cliffal vein causes the intestinal mucosa mechanical barrier damage. After the bacterial displacement occurs, the free free nitric oxide generated by the body increases, so as to relax the blood vessels of the whole body. , Leading to renin-vascular tension-aldehyde solid ketone system, sympathetic nervous system activation, and increased antidic urinary hormone, eventually causing water sodium retention and hyponatremia [3].

Figure 1: The pathological mechanism of hyponatroscopia in patients with liver cirrhosis [3]

The treatment of liver cirrhosis combined with hyponemodiamal disease

The treatment of liver cirrhosis combined with hyponatroxia varies depending on the specific cause, the severity of hyponatremia, the speed of the onset and the length of the disease. Low blood capacity hyponatremia needs to be resulted in liquid, and at the same time, it is closely monitored and gradually adjusted blood sodium to reduce the risk of permeability dehydration syndrome (ODS) [1]. Most patients with cirrhosis patients are hypertrophic diluted hyperthyroidism. The treatment includes restrictions on liquid intake, reduced or discontinued diuretics and laxatives. ) Human leakin et al. [2].

This article combines clinical studies applied by human leukin in patients with hemoglobin in patients with hyperthyroidism in liver cirrhosis. From the perspective of clinical research and international guide recommendation, human hemoglobin has the role of hemoglobin in patients with liver cirrhosis hypertrophy.

Human leukin therapy

Low sodium ledmia in patients with liver cirrhosis hospitalization

A retrospective study published in 2018 [4] Integrated into NACSELD (North American Final Liver Disease Research Alliance) database database 1,126 liver sclerosis combined with blood sodium <130 mmol/L inpatient patients, divided into intravenous injection albumin groups and non -intravenous veins Injecting white protein group. Studies adopt the decisive factor and patient's 30 -day survival rate of regression and ANCOVA (analysis) model analysis to alleviate hyponathematic (blood sodium ≥135 mmol/L). Research results: 777 patients received albumin treatment, with per capita dosage of 225 grams (IQR 100,400); 349 patients did not receive albumin treatment plan. Compared with patients who have not received human hemoglobin treatment, patients who receive human hemoglobin are significantly higher (69% vs 61%, P = 0.0085), and the blood sodium level is significantly higher and higher (137.13 mmol/l vs 135.00 mmol/L, P <0.0001) (Figure 2).

figure 2

The above results show that human hemoglobin can improve hyponatremia of patients with cirrhosis, providing evidence of evidence -based evidence for human albumin therapy for patients with cirrhosis and hyponatrosis.

Patients with liver cirrhosis hypodia

Long -term treatment of human hemoglobin

At the European Liver Research Association (EASL) conference in 2022, Professor Giacomo Zaccherini from Italy introduced the latest data on patients with hemoglobin for a long time to patients with cirrhosis combined with hyponatremia. [5] This is a post -analysis of 431 patients incorporated by ANSWER study. According to the level of blood sodium levels, the relief rate of hyponatremia, the incidence of moderate or severe hyponiasis during the 18 -month follow -up period (IRS ) The incidence ratio (IRRS) to evaluate the treatment and prevention of patients with hemoglobin for a long time to patients with cirrhosis and hyponatremia.

149 (35%) Patients with patients with hyponiasis (blood sodium <135 mmol/L) at the baseline, of which 74 were standard treatment groups and 75 of the white protein therapy group. 116 cases (22%) were combined with mild hyponemia (blood sodium 130-134 mmol/L), and 33 cases (22%) merged moderate or severe hyponiasis (blood sodium <130 mmol/L). Compared with patients with normal blood sodium, the Child-PUGH score and MELD score of patients with hyponiasis are higher. Patients with hyponatremia during baseline are randomly divided into standard treatment groups or albumin groups, and there are no significant differences in the number of people receiving different treatment [5].

Studies have found that compared with the standard therapy group, hyponatremal leukemia patients with hypolisy leukoprotein group relief rate and faster relief rate (Figure 3): After the first month, 45%of the albumin group is low The blood and sodium levels of sodium sepsis resumed normal, and 28%of patients with hyponatremia patients in the standard therapy group resumed normal (P = 0.042). After the third month, 71%and 44%(P = 0.006) were reached. image 3

The study also further discussed the prevention of human hemoglobin long -term treatment on hyponatremia: the incidence of moderate or severe hyponestreneliamal disease in the albumin group was significantly lower than that of the standard treatment group. Regardless of whether the patient's baseline is combined with hyponiasis, the incidence ratio of moderate or severe hyponatrosion is 0.245 (P <0.001) and 0.539 (P = 0.008). The above results show that long -term use of human lenin may prevent the occurrence of hyponatremia.

Recommended recommendations at home and abroad

Based on evidence -based medical evidence, relevant guidelines at home and abroad have also given recommendations on the management of human lenin in patients with cirrhosis and hyponatremia.

In 2018, the European Liver Research Association published "EASL Clinical Practice Guide: Management of Patients with Patients with Hepatitis During the Evil" [6] It is recommended that patients with high -volume hyponatremia can use human leukin, but related support data is limited (related support data, but related support data is limited (related support data, but related support data is limited. II-3; 2).

In the same year, the Pharmacy Commission of the Chinese Pharmaceutical Hospital and the Chinese Medical Association liver Disease Branch jointly published the "Guidelines for the Fast Suggestion of Human Bloodyls for Hepatotherapy Treatment" [7]. It can prevent liver cirrhosis and hyponatremia.

In 2021, the "Diagnosis, Evaluation and Management Guidelines for Hittimonia, spontaneous bacterial peritonitis and liver and kidney syndrome released by the American Society of liver Diseases (AASLD) [1] recommended that for severe hyponemodiamal (blood sodium <120 mmol <120 mmol /L) Patients should be more stringent restrictions on water intake and infusion of human hemoglobin.

Summarize:

Serum sodium levels are independent risk factor for prognosis of patients with cirrhosis, and should pay attention to the management of hyponiasis. Human lean protein has a variety of physiological functions, which plays an important role in the treatment of complications such as hardrimized liver cirrhosis, spontaneous bacterial peritonitis, liver and kidney syndrome and other complications. At the EASL conference in 2022, an analysis of ANSWER study provided important clinical evidence for patients with hemoglobin for long -term use of human hemoglobin to treat liver sclerosis and hyponatroscopymia. For patients with cirrhosis combined with hyponatremia, human albumin can be used as one of the effective drug options.

Expert Introduction

Hu Peng

Professor, chief physician, doctoral supervisor

Deputy Dean of the Second Affiliated Hospital of Chongqing Medical University

Deputy Director of Key Laboratory of Molecular Biology Education Department of Infectious Diseases

Deputy Director of the Institute of Viral hepatitis of Chongqing Medical University

Standing Committee Member of the Chinese Medical Association Liver Disease Branch

Member of the Chinese Medical Association Infectious Disease Branch

Chairman of the Professional Committee of the Chongqing Medical Association Liver Diseases

Member of the China Prevention Medicine Infectious Disease Prevention and Control Branch

Member of the Chinese Medical Association Internal Medicine Branch

The 5th "Chinese Physician Award" winner

Deputy Editor -in -Chief of "Chinese Liver Destroyer Magazine"

Chongqing Yingcai Innovation Leading Talents, Chongqing Academic and Technical Leader, Chongqing Municipal Medical Leadership Talents

The Chinese government goes to Palestine's anti -epidemic medical expert group head

references:

[1]Biggins SW,Angeli P,Garcia-Tsao G,et al.Diagnosis,Evaluation,and Management of Ascites,Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome:2021 Practice Guidance by the American Association for the Study of Liver Diseases.Hepatology.2021 ; 74 (2): 1014-1048.

[2] CHINESE SOCIETY of Hepatology, Chinese Medical Association.guideline for Diagnosis and Treatment of Liver Cirrhosis.j clin hepatol.2019,35 (11): 2408-2425.

[3] Praharaj dl, Anand AC.Clinical Implications, Evaluation, and Management of Hyponatremia in Cirrhosis.j Clin Exp Hepatol.2022; 12 (2): 575-594.

[4]Bajaj JS,Tandon P,OʼLeary JG,et al.The Impact of Albumin Use on Resolution of Hyponatremia in Hospitalized Patients With Cirrhosis.Am J Gastroenterol.2018;113(9):1339.[5]Giacomo Zaccherini,et Al.CorrecTion and Prevention of Hyponatremia in Patients with

Cirrhosis and Ascites-Post Hoc Analysis of the Answer Study DataBase.Journal of hepatology.2022; 77 (S1): s665–s939.

[6] EUROPEAN Association for the Study of the Liver.easl Clinical Practice Guidelines for the Management of Patients with Decompensated Cirrrhosis.j hePatol.2018; 69 (2) 406-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-46-4

[7]Li Hui-bo,et al.Expert consensus on rapid advice guidelines for the pharmacological management of human albumin in patients with liver cirrhosis.Clinical Medicaion Journal.2018;16(12):10-16.

Approval coding: VV-MEDMAT-71865

Approval time: July 2022

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