Can serum fibrosis markers predict medium/large oesophageal varices in patients with liver cirrhosis?

Non-invasive predictors of medium/large oesophageal varices [LOVs] could reduce the number of screening endoscopies. As portal hypertension is a consequence of liver fibrosis, serum fibrosis markers were evaluated together with other variables as possible non-invasive predictors of medium OV/LOV. A total of 154 cirrhotic patients with splenomegaly and 30 healthy control subjects were recruited in a prospective study in two gastroenterology centres in Upper Egypt. Clinical parameters assessed included Child-Pugh class, liver size and ascites. Laboratory parameters included complete blood count, liver function tests, and aspartate aminotransferase [AST]/platelet ratio. Transforming growth factor-p! [TGF-beta [1]], alpha2 macro globulin [A[2]M] and hyaluronic acid [HA] were assayed. Ultraso-nographic examination was done for assessment of liver span, portal vein diameter and detection of minimal ascites. Oesophageal varices were diagnosed and graded by oesophagogastroduodenoscopy. Fifty-four patients [35%] had no or small varices and 100 [65%] patients had medium OV/LOV by endoscopy. On multivariate analysis, the independent predictors of medium OV/LOV were the presence of ascites [beta = 0.258, p = 0.047] and serum HA [beta = 0.449, p = 0.009]. The receiver operating characteristic curve for HA showed the area under the curve to be 0.916. The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of HA at a cut-off value of 207 micro g T[1] were 94%, 77.8%, 88.7%, 87.5% and 88.3%, respectively. The presence of ascites and serum HA level higher than 207 micro g T[1] can predict the presence of medium OV/LOV in cirrhotic patients. This would help physicians to identify patients who would most likely benefit from screening endoscopy and thus, reduce costs and discomfort from unnecessary endoscopic procedures

Serum prohepcidin, iron and hepatic iron status in chronic hepatitis C in Egyptian patients

Patients with chronic hepatitis C [CHC] often have increased liver iron. Hepcidin has recently emerged as a key regulator for iron homeostasis. Therefore, we aimed to study the relationship between serum prohepcidin, serum iron indices, hepatic necro-inflammation, fibrosis and hepatic iron density and to determine the predictors of advanced fibrosis in these patients. Fifty CHC treatment naive patients and 20 healthy controls were enrolled in this study. Complete blood count, liver function tests, serum iron indices and serum prohepcidin were assayed. Liver biopsy was performed for all patients for assessment of necro-inflammatory activity, fibrosis and liver iron density. Thirty-four patients [68%] had mild fibrosis [stage 0, 1,2] and sixteen [32%] had advanced fibrosis [stage 3, 4]. All cases were positive for liver iron stain [68% mild, 32% advanced]. Mean serum prohepcidin level was significantly lower in CHC patients than healthy controls. In univariate analysis, prohepcidin was significantly associated with necro-inflammatory activity [P<0.05] and advanced fibrosis [P<0.05]. Multivariate analysis revealed that necro-inflammatory activity and liver iron density arc independently associated with stage of fibrosis. No significant correlations were found between prohepcidin and serum iron indices or liver iron score. Scrum prohcpcidin is reduced in CHC which may be one -not the only- factor leading to iron overload in these patients. Histological grading and hepatic iron density are independent predictors of advanced fibrosis. Further studies are needed to clarify the role of viral and host genetic factors in hepatic iron deposition

Alterations in thyroid gland size and functions in cirrhotic patients: relationships with splanchnic haemodynamics

Thyroid dysfunction has long been reported in liver diseases. But limited informations are available on thyroid size and the involvement of thyroid hormones in the haemodynamic alterations of cirrhosis. To 1] study changes in thyroid gland volume and functions in different grades of liver cirrhosis. 2] Investigate the relationship of thyroid hormone levels to changes in the hepatic and splenic haemodynamics in cirrhotic patients. Thirty-six cirrhotic patients with different disease severity were chosen according to Child- Pugh classification [12 Child class A, 12 Child Band 12 Child C]. Twelve healthy controls were included in the study. For all subjects, serum levels of FT3, FT4 and TSH levels were measured. An ultrasound scan of the thyroid was done for measuring thyroid volume. A colour Doppler ultrasound scan of the abdomen was performed for measuring portal vein diameter [PVD], cross sectional area, maximal velocity [PV V max], mean velocity [PV V mean], blood flow rate [PV BFR] and congestion index [CI]. Hepatic and splenic arteries resistive indices [HA RI, SA RI] were also studied. Total thyroid volume was increased in patients compared to healthy controls and it significantly increased with progression of the disease from Child A to C. Mean serum levels of free T3 [FT3], free FT4 [FT4] and TSH were significantly decreased in patients compared to healthy controls. However, they were not correlated to thyroid volume. FT4 had a significant negative correlation with PVD, PV BFR and CI, while FT3 had a significant positive correlation with PV V max. Total thyroid volume showed a significant negative correlation with PV V max and positive correlations with both CI and HA RI. Thyroid volume is increased in cirrhotic patients independently from thyroid hormones status. Low FT4 values of cirrhotic patients may participate in arterial vasoconstriction present in hepatic and splenic arteries. FT4 levels are directly correlated with Doppler parameters of portal hypertension

Endothelial cell dysfunction and inflammatory process in type 1 diabetic patients with-and without micro vascular disease

Endothelial cell dysfunction results in altered production of cell adhesion molecules [CAMs] that may be involved in the pathogenesis of diabetic microvascular disease. Increased circulating cytokines may also be involved in this process. The aim of the present study was to evaluate levels of some CAMs and cytokines in children and adolescents with type 1 diabetes. It was also aimed to assess these parameters in relation to microvascular complications and certain risk factors. The study included 45 cases with type 1 diabetes aged 8-22 years of whom, 30 cases had evidence of microangiopathy [retinopathy or nephropathy] and 15 cases had not. Fifteen apparently healthy matchable subjects were included as controls. Cases were subjected to full history taking and physical examination. Direct ophthalmoscopy and fluorescein angiography were used to diagnose retinopathy, while nephropathy was diagnosed by detection of microalbuminuria. Level of glycated hemoglobin [HbA[1c]] and serum levels of sVCAM-1 and sE-selectin as well as IL-6 and TNF alpha were assessed for all patients and controls. The results showed that diabetic patients as a whole had significantly higher serum levels of sVCAM-lt sE-selectin, IL-6 and TNF alpha than controls. Post pubertal age, long duration of illness, obesity and high HbA[1c] level were significant risk factors for higher levels of CAMs. Significant positive correlations were found between levels of HbA[1c] and each of serum levels of sE-selectin and IL-6. Also significant positive correlations were found between each of serum levels of sVCAM-1 and sE-selectin, and IL-6 and TNF alpha. Patients with evidence of microangiopathy had significantly higher level of sVCAM-1 than cases without, and the latter group had significantly higher level of sE-selectin than controls. It is concluded that young patients with type 1 diabetes had significant markers of endothelial cell dysfunction particularly in those with microvascular disease. Screening of diabetic patients with E-selectin may help early diagnosis of endothelial dysfunction. Strict glycemic control and new therapeutic targets are mandatory to improve diabetic outcome in such cases