RESUMO
This study was conducted on 40 Egyptian children (21 males and 19 females) with various chronic liver diseases, selected from the out-patient Pediatric Hepatology Clinic of Ain Shams University Hospital. Their ages ranged from 1.5 to 13 years with a mean of 5.98 +/- 3.72 years. Twenty healthy children of comparable age and sex to the patients were chosen as controls. All children were subjected to detailed history taking, thorough clinical examination and laboratory investigations including full blood picture, urine and stool examination, liver function tests, prothrombin time and hepatitis B surface antigen in addition to sigmoidoscopy with rectal snip examination, abdominal ultrasonography and liver biopsy. Moreover, immunological investigations were done, that included estimation of the serum complement levels of C3 and C4 by using single radial immunodiffusion method, assessment of the phagocytic and intracellular killing activity of polymorphonuclear leucocytes by living Candida albicans uptake and detection of non organ specific autoantibodies in the serum by indirect immunofluorescence technique. This study showed that the serum level of C3 was increased and C4 was decreased significantly in patients with chronic liver disease, especially in chronic active hepatitis. Regarding phagocytosis, there was significant impairment of the neutrophil phagocytic function but not the intracellular lytic activity of candida albicans. This reduced phagocytic function was more pronounced in patients having chronic hepatitis and cirrhosis than in bilharzial and other cases. Serum autoantibodies; antinuclear and antimitochondrial antibodies were absent in the sera of both patients and controls, while antismooth muscle antibodies were found in the sera of 47.5% of patients with chronic liver diseases and non of the control sera. The highest incidence of these antibodies was present in HBs Ag negative patients with chronic active hepatitis (80%). We concluded that patients with chronic liver diseases have disturbed functions of both complement and phagocytic systems that may lead to increased susceptibility to recurrent infections. So, routine assessment of immunological status with early diagnosis and treatment of infections are important in the proper management of these patients. In addition, detection of serum auto-antibodies in these patients is helpful in the early diagnosis of auto-immune liver diseases.