Abu El Makarem, et al. Etiology of cirrhosis influences the incidence of diabetes mellitus (DM). Non-alcoholic fatty liver disease, alcohol liver disease, hemochromatosis and hepatitis C virus are frequently associated with DM. Patients with chronic hepatitis C have higher prevalence of insulin resistance and type 2 diabetes mellitus (T2DM). Some studies have evaluated the effect of T2DM on the outcome of cirrhosis, and it was found that diabetic patients present greater mortality rate. Nowadays, it is unclear the physiopathological pathways of damage of T2DM over liver function. Abu El Makarem, et al. provide the first study about the significance of monocytic tissue factor (MTF) expression in T2DM and hepatitis C cirrhotic patients. They compared the expression MTF in four groups; cirrhotics with T2DM (n = 139), cirrhotics without T2DM (n = 130), diabetics without liver disease (n = 100) and a healthy group (n = 100). MTF expression was significantly higher in T2DMgroups, but T2DM with cirrhotics presented the highest expression of MTF and it increased in relation of stage of the Child-Pugh score. A secondary finding was that the use of exogenous insulin is associated with significantly higher MTF expression when compared with sulphonylurea and insulin sensitizers. Authors propose that endothelial dysfunction in patients with T2DM and cirrhosis increased flow of inflammatory cytokines, and activation of TF on monocytes, which can intensify immunological and inflammatory environment. Participation of inflammatory cells has been explored in patients with non-alcoholic steatohepatitis; in this setting, inflammatory monocytes appears significantly expanded in relation to controls. In patients with different stages of cirrhosis, it was found increased accumulation of monocyte in the liver tissue and has been proposed that monocytes cause intrahepatic perpetuation of inflammation and direct activation of stellate cells. Role of monocytes in the progression of liver disease must be extensively researched, especially when in presence of a condition of impaired glucose metabolism.
2014-03-01 | 373 visitas | Evalua este artículo 0 valoraciones
Vol. 13 Núm.1. Enero-Febrero 2014 Pags. 4-6 Ann Hepatol 2014; 13(1)