ABSTRACT
BACKGROUND: Chronic liver disease and cirrhosis are of the major health concern worldwide. Assessment of liver fibrosis is necessary to determine disease severity and prognosis at the time of presentation to determine suitable treatment. Liver biopsy is considered as standard golden method in diagnosis of liver fibrosis. However, this procedure is invasive; thus, multiple laboratory and radiologic tests are used to help determination of the degree of fibrosis. Growth differentiation factor 15 (GDF-15) is a pleiotropic cytokine involved in regulating inflammatory and apoptotic pathways. It is suggested that GDF-15 plays an important role in pathogenesis of liver fibrosis. In this study, we aimed to evaluate efficiency of growth differentiation factor 15 in diagnosing liver fibrosis. The study was a case-control study conducted on 55 chronic HCV patients recruited from hepatitis C virus clinic at Faculty of Medicine Ain Shams Research Institute (MASRI), and 30 healthy subjects age- and sex-matched. The patients were classified into three subgroups according to the degree of liver fibrosis assessed by fibro-scan. Serum concentration of GDF-15 was determined by enzyme-linked immunosorbent assay. RESULTS: Our results revealed a highly significant statistical rise in GDF-15 levels among studied chronic HCV patients with liver fibrosis when compared to the control group (p < 0.01). Furthermore, there was a significant positive correlation between the degree of fibrosis assessed by fibro-scan and GDF-15 serum levels. Levels of GDF-15 were significantly higher in patients with mild degree of fibrosis (patients' subgroup Ð) when compared with the controls' group (p < 0.01) suggesting the role of this marker in early detection of liver fibrosis. A statistically significant increase in serum GDF-15 levels was noticed among patients with advanced fibrosis "subgroup ÐÐÐ" compared to those with mild fibrosis "subgroup Ð" (p < 0.05). The diagnostic sensitivity and specificity of GDF-15 were 96.7%, 98.2%, respectively at a cut-off value of 150 ng/L for discrimination between patients' and controls' groups. CONCLUSION: Growth differentiation factor 15 could be a potential marker of liver fibrosis especially in early detection as its levels were significantly higher in patients' group with liver fibrosis than controls' group and there was a significant positive correlation between the degree of liver fibrosis and GDF-15 serum levels.
ABSTRACT
OBJECTIVE: To evaluate adiponectin levels in children and adolescents with type I diabetes, and their relationship to long term complications. DESIGN: Cross sectional. SETTING: Tertiary referral hospital, Cairo, Egypt. PARTICIPANTS: Thirty children and adolescents with type I diabetes mellitus, classified into complicated and non-complicated and compared to 10 healthy age and sex matched subjects as a control group. METHODS: All children underwent anthropometric measurements, neurological assessment, fundus examination, echocardiography and assays of HbA1c, creatinine, 24-hr urinary protein, and serum adiponectin. MAIN OUTCOME MEASURE: Relationship of serum adiponectin to complications of type I diabetes mellitus, and glucose control. RESULTS: Serum adiponectin was significantly elevated in complicated diabetes (10.3 ± 5.9 pg/dL) as compared to the controls (6.5 ± 3.7 pg/dL) (P<0.01), and correlated directly with HbA1c (P<0.05) and creatinine (P<0.001). Patients with nephropathy showed high values of adiponectin (15.7 ± 3.7 pg/dL). CONCLUSION: Elevated adiponectin level in children and adolescents with type I diabetes indicates poor glycemic control and development of complications, especially nephropathy.
