Plasma level of tissue factor pathway inhibitor in children with chronic liver disease

ABSTRACT

Tissue factor pathway inhibitor [TFPI] is one of physiological coagulation inhibitors, which when decreased may facilitate coagulation especially in advanced liver disease. The aim of this study is to measure the Plasma level of [TFPI] in patients with chronic liver disease [CLD] of various etiologies and correlate this with other parameters routinely used to assess these patients. We measured Plasma level of [TFPI] in 50patients with [CLD] using a specific ELIZA test along with 10 matched healthy controls. The children were classified into 6 groups, group [I] control groupn=10, group [II] those with chronic HBV and HCV viral infection ; n=17, group [III] a metabolic one ; n=9, group [IV] those with autoimmune hepatitis ; n=10, group [V] patients with biliary disorders ; n = 9 and group [VI] hepatovascular group ; n = 5. All children were also subjected to clinical exam,. Liver function tests, PT and conc, PTT, Plasma level of protein C and factor V, serum fibrinogen, HBSAg, anti HBc total and IgM, anti HCV, HCV-RNA for anti HCV +/- ve patients, ultrasound and liver biopsy was done for 36 patients. The result showed that TFPI was decreased in different types of CLD irrespective to the etiology compared to control group group [I] 83.2 +/- 18.50ng/mL, group[II]30.9 +/- 20.2 ng/mL, group[III] 57.5 +/- 21.5 ng/mL, group [IV] 58 +/- 24.5 ng/mL, group [V] 35.9 +/- 16.9 ng/mL and group[VI] 71.2 +/- 47.1 ng/mL. The results gave a statistically sig. value in all groups except group [VI]. There was no sig. difference between cirrhotics and non cirrhotics regarding TFPI Plasma level, [non cirrhotics 41.2 +/- 23.1 ng/mL ; n=18, cirrohtics 54.5 +/- 33.2 ng/mL; n =32 The study also showed a sig. decrease of TFPI with disease progression child A cirrohtics 73.8 +/- 36.46 ng/mL ; n = 7, child B 52.7 +/- 14.6 ng/mL; n = 4, child C 36.2 +/- 29.33 ng/mL; n = 7. There was no sig, correlation between TFPI plasma level and AST, ALT . ALP, GGT, protein C and factor V but a sig. one was found with serum fibrinogen and PTT