{"id":28,"date":"2025-09-01T09:20:21","date_gmt":"2025-09-01T09:20:21","guid":{"rendered":"https:\/\/biogeo.ubbcluj.ro\/sdsms\/?page_id=28"},"modified":"2025-09-01T14:52:33","modified_gmt":"2025-09-01T14:52:33","slug":"medicina-interna","status":"publish","type":"page","link":"https:\/\/biogeo.ubbcluj.ro\/sdsms\/?page_id=28","title":{"rendered":"Medicin\u0103 intern\u0103"},"content":{"rendered":"\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p><strong>(a) Evaluarea riscului comorbidit\u0103\u021bilor multi-sistemice la pacien\u021bii obezi si non-obezi cu boala hepatic\u0103 steatozic\u0103 asociat\u0103 disfunc\u021biei metabolice (MASLD) \u00een vederea unor noi strategii de preven\u021bie cardio-vascular\u0103 \u0219i oncologic\u0103. <\/strong>\u2013 coordonator: CS I dr. Florea Mira Lia<\/p>\n\n\n\n<p>Boala hepatic\u0103 steatozic\u0103 asociat\u0103 cu disfunc\u021bia metabolic\u0103 (MASLD), cunoscut\u0103 anterior sub numele de ficat gras non-alcoolic (<em>non-alcoholic fatty liver disease -NAFLD<\/em>) este manifestarea hepatic\u0103 a disfunc\u021biei metabolice sistemice. Eviden\u021bele \u0219tiin\u021bifice definesc MASLD nu doar ca o boal\u0103 hepatic\u0103, ci ca o boal\u0103 sistemic\u0103, care se constituie \u00een factor de risc independent pentru multiple boli extrahepatice: cardiovasculare, oncologice, boal\u0103 cronic\u0103 renal\u0103, apnnee \u00een somn, psoriazis. Prevalen\u021ba global\u0103 general\u0103 a steatozei hepatice asociate cu disfunc\u021bia metabolic\u0103 (MASLD) a crescut constant \u00een ultimele decenii \u0219i este estimat\u0103 acum la 38% \u00een popula\u021bia general\u0103 adult\u0103 \u0219i este \u00een cre\u0219tere \u0219i la adolescen\u021bii supraponderali \u0219i obezi. Ea evolueaz\u0103 spre steatohepatit\u0103 asociat\u0103 cu disfunc\u021bia metabolic\u0103 (MASH), cu progresie c\u0103tre fibroz\u0103 avansat\u0103, ciroz\u0103 \u0219i carcinom hepatocelular. De asemenea, pacien\u021bii cu MASLD, \u0219i \u00een special cei cu MASH \u0219i fibroz\u0103 hepatic\u0103, prezint\u0103 un risc crescut de a dezvolta diabet zaharat de tip 2, boli cardiovasculare, \u0219i cancere extrahepatice.<\/p>\n\n\n\n<p>De\u0219i obezitatea este un factor de risc bine cunoscut, un num\u0103r substan\u021bial de pacien\u021bi cu MASLD nu sunt obezi. MASLD este o provocare pentru medicin\u0103 modern\u0103 \u0219i datorit\u0103 prevalen\u021bei progresive a ei \u0219i \u00een popula\u021bia normoponderal\u0103, definit\u0103 ca \u0219i Lean MAFLD (MAFLD non-obeza). \u00cen r\u00e2ndul pacien\u021bilor MASLD 56,6% nu sunt obezi \u00een SUA \u0219i 51,3% este prevalen\u021ba Lean MASLD \u00een Europa \u0219i este \u00een cre\u0219tere \u0219i \u00een Asia (41% \u00een Asia de sud \u0219i 38% \u00een Asia de est (Japonia).<\/p>\n\n\n\n<p>Fenotipul MASLD non-obez (Lean MASLD) pare s\u0103 aib\u0103 profiluri metabolice \u0219i fiziopatologice distincte, \u00eens\u0103 este insuficient diagnosticat\u0103 \u00een practica clinic\u0103. Algoritmii de diagnostic existen\u021bi nu diferen\u021biaz\u0103 \u00een mod adecvat \u00eentre MASLD non-obez\u0103 \u0219i cea obez\u0103, ceea ce conduce la subdiagnosticare \u0219i management defectuos. Exist\u0103 un interes emergent pentru MASLD non-obez\u0103 (Lean MASLD), datorit\u0103 morbidit\u0103\u021bii \u0219i mortalit\u0103\u021bii crescute de orice cauz\u0103 a pacien\u021bilor MASLD non-obezi, de\u0219i afectarea hepatic\u0103 ini\u021bial\u0103 este mai pu\u021bin sever\u0103.<\/p>\n\n\n\n<p>Asocierea MASLD cu boli cardiovasculare si oncologice, face din studiul patogenezei ei multifactoriale <em>o prioritate pentru reducerea progresiunii complica\u021biilor metabolice \u0219i oncologice. <\/em>Dimensiunea consecin\u021belor hepatice \u0219i extrahepatice <em>\u0219<\/em>iabsen\u021ba identific\u0103rii unei terapii eficiente<em>, e<\/em>xplic\u0103 interesul cercet\u0103torilor \u0219i motiveaz\u0103 \u0219i propunerea acestei teme de cercetare.<\/p>\n\n\n\n<p><em>Obiectivele studiul vizeaz\u0103 analiza comparativ\u0103 la pacien\u021bii cu Lean MASLD (MASLD non obezi) \u0219i MASLD obezi a urm\u0103torilor parametrii:<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>analiza pattern-urilor alimentare, \u0219i adic\u021biei alimentare la indivizii cu MASLD obez\u0103 \u0219i nonobez\u0103 utiliz\u00e2nd: Yale Food Addiction Scale 2.0 (YFAS 2.0), instrument validat pentru diagnosticul \u0219i cuantificarea adic\u021biei alimentare \u0219i Three-Factor Eating Questionnaire (TFEQ) pentru evaluarea comportamentului alimentar (alimenta\u021bie emo\u021bional\u0103, reactiv\u0103 la stimuli externi \u0219i component\u0103 auto-controlat\u0103);<\/li>\n\n\n\n<li>analiza biomarkerilor non-invazivi <em>biochimici <\/em>(teste hepatice, profil lipidic, glicemic,HgbA1c, rezisten\u021ba la insulin-HOMA-IR; evaluarea \u021besutului adipos disfunc\u021bional: rezistenta la leptin\u0103 \u0219i inflama\u021bia cronic\u0103 subclinic\u0103 prin markeri standard: hsCRP, ferritina \u0219i emergen\u021bi: adiponectin\u0103, leptin\u0103, fibroblast growth factor 21 (FGF-21).<\/li>\n\n\n\n<li>analiza <em>modific\u0103rilor epigenetice <\/em>induse de <em>stresul celular metabolic cronic <\/em>prin identificarea alter\u0103rilor de metilare a ADN-ului, a modific\u0103rilor histonelor \u0219i a expresiei ARN-ului necodant (miRNA), care influen\u021beaz\u0103 pattern-urile de expresie ale genelor legate de metabolismul lipidic, inflama\u021bie cronic\u0103 \u0219i fibroz\u0103 hepatic\u0103;<\/li>\n\n\n\n<li>analiza markerilor <em>imagistici <\/em>non-invazivi emergen\u021bi:<\/li>\n\n\n\n<li>evaluare cardiovascular\u0103: clinic\u0103, electrocardiografic\u0103, Holter Ecg, ecocardiografie \u00een grupul MASLD cu risc \u00eenalt.<\/li>\n<\/ul>\n\n\n\n<p><em>Rezultatele studiului <\/em>ar putea conduce la identificarea precoce a subsetului de pacien\u021bi tineri cu MASLD, cu risc \u00eenalt de progresie multisistemic\u0103 a bolii \u0219i la oportunit\u0103\u021bi de posibile noi \u021binte terapeutice. Ele ar facilita dezvoltarea de noi strategii de reducere a morbidit\u0103\u021bii \u0219i mortalit\u0103\u021bii prin boli cardiovasculare \u0219i oncologice, care fac din Rom\u00e2nia \u021bara care, conform datelor Eurostat, ocup\u0103 locul I privind decesele evitabile \u00een UE.<\/p>\n\n\n\n<p><strong>(b) Studiul prevalentei \u0219i particularit\u0103\u021bilor cancerului hepatic, pancreatic \u0219i colo-rectal \u00een boala hepatic\u0103 steatozic\u0103 asociat\u0103 disfunc\u021biei metabolice (MASLD). <\/strong>\u2013 coordonator: CS I dr. Florea Mira Lia<\/p>\n\n\n\n<p>Boala hepatic\u0103 steatozic\u0103 asociat\u0103 disfunc\u021biei metabolice (MASLD) a devenit principala cauz\u0103 a bolilor hepatice cronice la nivel mondial \u0219i are patogenez\u0103 complex\u0103, heterogen\u0103 cu implica\u021bii multisistemice extrahepatice: cardiovasculare, renale \u0219i oncologice. Ea este asociat\u0103 cu un risc crescut de dezvoltare a cancerului, studiile relev\u00e2nd o inciden\u021b\u0103 crescut\u0103 a cancerului hepatocelular \u0219i a cancerelor extrahepatice (cancer pancreatic, colorectal). Cre\u0219terea prevalen\u021bei obezit\u0103\u021bii, sindromului metabolic, diabetului zaharat tip 2 \u0219i \u00een consecin\u021b\u0103 a MASLD, face ca aceasta sa fie \u00een prezent a 2-a cauza de transplant hepatic cu poten\u021bial de a deveni prima \u00een urm\u0103toarele decade.<\/p>\n\n\n\n<p><em>Obiectivele studiului vizeaz\u0103:<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><em>aprofundarea mecanismelor implicate \u00een carcinogeneza din MASLD: <\/em>inflama\u021bie cronic\u0103 sistemic\u0103, stres oxidativ, stres al reticulului endoplasmatic, disfunc\u021bia mitocondrial\u0103, alterarea adipokinelor \u0219i dereglarea axei intestin-ficat;<\/li>\n\n\n\n<li><em>analiza biomarkerilor emergen\u021bi proteici: <\/em>osteopontina-proteina multifunc\u021bional\u0103 implicat\u0103 \u00een fibrogenez\u0103 \u0219i carcinogenez\u0103 \u0219i frac\u021bia AFP-L3 form\u0103 glicozilat\u0103 a Alfa-fetoproteinei, asociat\u0103 specific cu progresia MASLD spre hepatocarcinom (HCC);<\/li>\n\n\n\n<li><em>studiul unor biomarkeri metabolomici \u0219i lipidomici:<\/em><\/li>\n\n\n\n<li>analiza profilurilor metabolice ale lipidelor \u0219i metaboli\u021bilor (acizi biliari, ceramide \u0219i acil-carnitine) cu poten\u021bial de identificare <em>a <\/em>HCC \u00een MASLD;<\/li>\n\n\n\n<li>analiza ARN-urilor non-codante: <em>alter\u0103rile nivelurilor serice <\/em>ale microARN, (miRNA) \u0219i ARN-urile lungi non-codante (lncRNA) par a fi biomarkeri promi\u021b\u0103tori; microARNurile (miARN): miR-122, miR-21 \u0219i miR-221 sunt implicate \u00een dezvoltarea precoce a HCC. Dereglarea ARN-urilor lungi non-codante (lncRNAs): (ex, HULC, MALAT1) serice sau tisulare par a fi biomarkeri de progresie a HCC.<\/li>\n\n\n\n<li><em>studiul unor biomarkeri epigenetici:<\/em><\/li>\n\n\n\n<li>analiza profilurilor de metilare ADN: metilarea aberanta a genelor specifice &#8211; RASSF1A, GSTP1 \u00een ADN-ul liber circulant (cfDNA) are poten\u021bialul de detectare precoce HCC;<\/li>\n\n\n\n<li>analiza ADN-ul tumoral circulant (ctDNA) &#8211; metoda non-invaziv\u0103 de identificare amodifica rilor genetice s i epigenetice specifice HCC, a profilului molecular al tumorii, care este suportul tratamentului personalizat.<\/li>\n\n\n\n<li><em>studiul biomarkerilor imagistici:<\/em><\/li>\n\n\n\n<li>analiza datelor de Ultrasonografie abdominal\u0103, CEUS-US \u0219i a Elastografiei ultrasonografice pentru monitorizarea grupurilor MASLD cu risc \u00eenalt \u0219i diagnostic precoce a HCC);<\/li>\n\n\n\n<li>CT, RMN, PET\/CT) la cazurile cu suspiciune de cancer hepatic, pancreatic;<\/li>\n\n\n\n<li>endoscopia, endoscopia cu videocapsul\u0103 sau ecoendoscopia colorectal\u0103 pentru detec\u021bia cancerului colorectal \u00een grupul MASLD cu risc oncologic \u00eenalt.<\/li>\n<\/ul>\n\n\n\n<p><em>Rezultatele studiului <\/em>vor contribui la rafinarea stratific\u0103rii riscului \u0219i a strategiilor de preven\u021bie a cancerului la aceasta popula\u021bie cu risc ridicat. identificarea unor caracteristici distincte ale cancerelor asociate cu MASLD care vor facilita elaborarea unor protocoale de screening oncologic \u0219i de tratament precoce.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>(a) Evaluarea riscului comorbidit\u0103\u021bilor multi-sistemice la pacien\u021bii obezi si non-obezi cu boala hepatic\u0103 steatozic\u0103 asociat\u0103 disfunc\u021biei metabolice (MASLD) \u00een vederea unor noi strategii de preven\u021bie cardio-vascular\u0103 \u0219i oncologic\u0103. \u2013 coordonator: CS I dr. Florea Mira Lia Boala hepatic\u0103 steatozic\u0103 asociat\u0103 cu disfunc\u021bia metabolic\u0103 (MASLD), cunoscut\u0103 anterior sub numele de ficat&hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"fullwidth-template.php","meta":{"footnotes":""},"class_list":["post-28","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/biogeo.ubbcluj.ro\/sdsms\/index.php?rest_route=\/wp\/v2\/pages\/28","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biogeo.ubbcluj.ro\/sdsms\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/biogeo.ubbcluj.ro\/sdsms\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/biogeo.ubbcluj.ro\/sdsms\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/biogeo.ubbcluj.ro\/sdsms\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=28"}],"version-history":[{"count":2,"href":"https:\/\/biogeo.ubbcluj.ro\/sdsms\/index.php?rest_route=\/wp\/v2\/pages\/28\/revisions"}],"predecessor-version":[{"id":103,"href":"https:\/\/biogeo.ubbcluj.ro\/sdsms\/index.php?rest_route=\/wp\/v2\/pages\/28\/revisions\/103"}],"wp:attachment":[{"href":"https:\/\/biogeo.ubbcluj.ro\/sdsms\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=28"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}