ABSTRACT
Cirrhotic liver claims many lives in Egypt. Some factors may play a role in the pathogenesis of cirrhosis and its complications such as nitric oxide [NO] and soluble Fas [sFas]. However, others may be a consequence of liver damage as total sialic acid [TSA]. The aim of this study was to evaluate serum level of NO, sFas and TSA in patients with compensated and decompensated cirrhosis, with and without hepatitis C virus [HCV], and their correlation with the stage of the disease. The study included 34 patients with biopsy-proven cirrhosis [group I], categorized according to Child Pugh classification into three subgroups: group IA [11 patients with class A], group IB [13 patients with class B], and group IC [10 patients with class C], in addition to 15 age and sex matched healthy individuals as a control group [group II]. The mean age was 56.35 +/- 9.28 and 53 +/- 5.52 years, for group I and II, respectively. All studied individuals were subjected to full history taking, clinical examination, abdominal ultrasound, laboratory tests including liver function tests, hepatitis B surface antigen [HBsAg], hepatitis C virus antibodies [HCVAb], serum levels of NO, sFas and TSA. The study showed that, there was a significant increase in serum level of NO, TSA and sFas in cirrhotic patients group, when compared to the control group [P<0.001]. Serum NO and TSA levels were significantly increased with disease progression from grade A to grade B to grade C subgroups [P<0.001]. There was a significant increase of serum NO and TSA in cirrhotic patients with positive HCVAb, history of bleeding esophageal varices [O.V.], those with ascites, and those with spontaneous bacterial peritonitis [SBP], when compared with those with negative HCVAb, without bleeding O.V., without ascites, and without SBP, respectively. There was a positive correlation between serum NO and TSA with ALT [P<0.001] in cirrhotic patients subgroups, while there was no significant correlation as regards to sFas [P>0.05]. Serum NO is increased in patients with cirrhosis, particularly for those with positive HCVAb, and this increase is proportionate to the grade of cirrhosis. Understanding the role of NO in the pathophysiology of cirrhosis may help in initiating new lines of management. The increase of serum sFas in cirrhotic patients suggests the role of apoptosis in liver damage. Increased serum TSA in advanced cirrhosis, compared with early [Child's A] cirrhosis and controls, suggests that serum total sialic acid become a useful, non-invasive test, in the diagnosis and ftdlow up of cirrhosis