WCIM 2014 SEOUL KOREA 107
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0231 Gastroenterology
Tenofovir-Associated Nephrotoxicity in a Patient with Chronic Hepatitis B: A Case Report
Hyeki CHO1, Yuri CHO1, Jeong-Hoon LEE1, Su Jong YU1, Kook-Hwan OH2, Kyoungbun LEE3, Jung-Hwan YOON1, Hyo-Suk LEE1, Yoon Jun KIM1
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Med- icine, Korea1, Nephrology Division, Department of Internal Medicine, Seoul National University College of Medicine, Korea2, Department of Pathology, Seoul National University College of Medicine, Korea3
Tenofovir disoproxil fumarate (TDF) is an effective agent for chronic hepatitis B (CHB) infection as well as human immunodeficiency virus (HIV) infection, and its use is rapidly increasing worldwide. It is now established that TDF is associated with renal toxicity in HIV-infected patients, while severe or symptomatic TDF-associated nephro- toxicity has been rarely reported in patients with CHB. Here, we present a patient with TDF-associated nephrotoxicity who was being treated for CHB infection. Five months after starting TDF treatment, the patient was found to have clinical manifestations of proximal renal tubular dysfunction and histopathologic evidence of acute tubular necrosis. The patient’s renal function improved markedly after TDF was discontinued.
Finally, we discuss the risk factors of TDF-associated renal toxicity and present recom- mendations for monitoring renal function during TDF therapy.
PS 0232 Gastroenterology
Effect of Metformin in the Treatment of Nonalcoholic Fatty Liver Disease-A Meta Analysis on Chinese Clinical Trials
Xi JIN1, You-Ming LI1
The First Affiliated Hospital, School of Medicine, Zhejiang University, China1
Background: Nonalcoholic fatty liver disease (NAFLD) is currently the most common liver disease worldwide, with increasing prevalence in China as well. Nevertheless, the pathogenesis of NAFLD is still unclear, where the participation of insulin resistance is well acknowledge. As one type of insulin-sensitizing agent, metformin is theoretically useful in NAFLD therapy but the clinical data from china is lacking. In this study, we systematically analyzed the effect of Metformin in treating NAFLD.
Methods: Randomized controlled trials conducted in China and published between January 2000 to December 2013 were screened from Chinese biomedicine web data- base and Chinese scientifi c journals database using proper MESH headings, followed by assessment from two independent investigators according to established inclusion criteria. The characteristics of chosen articles were displayed for further analysis while the primary and secondary end point were set as alleviation of metabolic parameters and hepatocyte lipid accumulation, respectively. The summary odds ratio was calculat- ed to determine the overall effect of metformin in NAFLD therapy. All the data were entered and analyzed using REVIEW MANAGER 4.1, and p<0.05 was defi ned as statis- tically signifi cant in all analysis.
Results: Eight qualifi ed trials were enrolled and the summary odds ratio for effective therapy on NAFLD was 3.34 (95% CI: 2.57, 4.56, p<0.01). The difference in the fol- low-up period did not infl uence the fi nal outcomes.
Conclusions: Metformin therapy is effective in treating NAFLD patients in China.
PS 0233 Gastroenterology
Alcoholic Liver Disease in Nepal: Identifying Home- Made Alcohol as Culprit
Bickram PRADHAN1, Antoine HADENGUE2, Shatdal CHAUDHARY1, François CHAPPUIS3, Dharanidhar BARAL4, Pascal GACHE5, Prahlad KARKI1, Suman RIJAL1 Internal Medicine, BP Koirala Institute of Health Sciences, Nepal1, Gastroenterology and Hepatology, Ge- neva University Hospital, Switzerland2, Tropical and Humanitarian Medicine, Geneva University Hospital, Switzerland3, Community Medicine and School of Public Health, BP Koirala Institute of Health Sciences, Nepal4, Alcohologu Unit, Community Medicine, Geneva University Hospital, Switzerland5
Background: Though the type of alcohol consumed is not thought to be associated with Alcoholic Liver Disease (ALD), some studies have shown a beverage specifi c ef- fect. The prevalence of alcohol use disorders (AUD) is very high in Nepal due to easy availability of cheap locally brewed alcoholic beverages. In the present study we aim to detect the prevalence of ALD in patients with AUD and to study the effects of the different types of alcoholic beverages on the liver.
Methods: This cross-sectional study was conducted in the internal Medicine depart- ment of a tertiary care center in Nepal. All patients classifi ed as having either alcohol abuse or alcohol dependence by DSM IV were evaluated for presence of ALD.
Results: A total 1332 patients were screened of which 447 patients (292 males and 155 females) had AUD. Chronic liver disease (CLD) was detected in 144 patients (10.8%).
Most of the patients consumed home made locally brewed alcohol like chhang (62%), rakshi (77%) and tongba(16.3%). On multivariate analysis the following variables were found to be signifi cantly associated with CLD: Male sex (OR 1.81, 95% CI [1.12-2.94] p value 0.02): rakshi consumption = 30 units (OR 2.53, 95% CI [1.07-6.01] p value 0.04);
togba consumption (OR 3.02, 95% CI [1.22-7.50] p value 0.02
Conclusions: There was a signifi cant increase in the risk of developing ALD with the consumption of rakshi and tongba after adjusting for total unit consumed. The ab- sence of striking differences between our patients with CLD and non-CLD patients as regards the amount of alcohol consumed demonstrates that, although alcohol consumption is a pre-requisite for the development of ALD, other factors like type of alcoholic beverage consumed may be involved
PS 0234 Gastroenterology
Effect of Mir-34a in Regulating Steatosis by Targeting PPARa Expression in NAFLD
Jiexia DING1, Meng LI1, Xi JIN1, Shaohua CHEN1, Chaohui YU1, Youming LI1 The First Affiliated Hospital, Zhejiang University School of Medicine, China1
Background: The association between altered expression of miR-34a and pathophys- iological features of nonalcoholic fatty liver disease (NAFLD) and whether there is a connection between susceptibility to NAFLD has not been completely clarifi ed.
Methods: The vitro model was established by culturing L02 cells with a high concen- tration of free fatty acid (FFA) and the vivo model was established by feeding C57BL/6 mice with HFD. To determine the effects of miR-34a, cultured L02 cells transfected with miR-34a inhibitor and C57BL/6 mice injected with miR-34a inhibitor through vein tail were analysed for the level of PPARaand the metabolic sensor AMPK. In func- tional experiments, TG content and steatosis degree were measured by TG assay kit, HE and Oil Red O staining.
Results: miR-34a expression is signifi cantly upregulated in steatosis-induced hepato- cytes and in liver tissues of HFD fed mice. The upregulation of miR-34a resulted in the downregulation of hepatic peroxisome proliferator-activated receptor-a(PPARa), the direct target of miR-34a. Moreover, the action of miRNA-34a on PPAR-a depends on the presence of a single miRNA-34a binding site. Silencing miR-34a led to an initial increase the level of PPARaand the targets of PPARa, including CPT1, CPT2, SLC27A4, SLC27A1 and ACBD3. Activation of the central metabolic sensor AMPK was also in- creased. In functional experiments, miR-34a inihibitor suppressed cell and mice liver TG content and improve steatosis degree. Furthermore, inhibition of PPARa expression aggravated hepatocellular steatosis in vitro models.
Conclusions: NAFLD is associated with altered hepatic miR-34a expression. Decreased expression of miR-34a potentially contributes to altered lipid metabolism implicated in the pathogenesis of NAFLD. These results suggest that regulating it’s target PPARa by down-regulation of miR-34a levels may be a therapeutic strategy against NAFLD.
