RESUMO
To evaluate circulating blood ammonia [NH3], S 100B and neuron-specific enolase [NSE] levels in patients with liver cirrhosis with or without hepatic encephalopathy [HE] and to choose which of these parameters could be used as a useful marker for early diagnosis of HE. Subjects and The study included 20 patients with liver cirrhosis without HE, 20 patients with sub clinical HE [SHE], 24 patients with HE grades I-IV and 20 matched for age and sex healthy control subjects. Blood levels of NH3, S100B and NSE were determined by calorimetric method for the former and by enzyme immunometric assay [EIA] for the 2 latter. Blood levels of NH3 and S 100B were significantly elevated in patients with cirrhosis, SHE and HE with various grades compared to normal subjects. Serum NSE levels were significantly increased in patients with SHE and HE with various grades compared to normal subjects. These parameters were significantly greater in patients with SHE and HE grades I-IV in comparison to cirrhotic patients. Serum S100B and NSE levels were significantly higher in patients with HE grades I-IV in comparison to SHE cases. Plasma NH3 levels showed no significant difference among patients with different Child-Pugh classes or between patients with different HE grades and SHE. Meanwhile, serum S 100B and NSE showed significant increase in Child class C in comparison to Child class A and B and in patients with different HE grades compared to those in SHE cases. Plasma NH3 level was significantly correlated with serum S100B and NSE levels and significant correlation was found also between S 100B and NSE levels. The 3 parameters exhibited similar sensitivity of 79.50%, but plasma NH3 and serum S 100B showed 100% specificity meanwhile, serum NSE showed 80% specificity for predicting HE in comparison to cirrhotic patients. Serum S100B levels appeared to be a better marker predicting HE than plasma NH3 and serum NSE