الفهرس 
Liver CirrhosisOnly 14 pages are availabe for public view
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Abstract
C
hronic liver disease (CLD) is defined as the continuity of clinical and biochemical evidence of hepatic dysfunction for longer than six months
Cirrhosis results from different mechanisms of liver injury that lead to necroinflammation and fibrogenesis; histologically it is characterized by diffuse nodular regeneration surrounded by dense fibrotic septa with subsequent parenchymal extinction and collapse of liver structures, together causing pronounced distortion of hepatic vascular architecture
Although Cirrhosis results from different mechanisms of liver injury such as (viral hepatitis, autoimmune, Wilson disease, hemochromatosis, non-alcoholic cirrhosis, drug induced….etc.), chronic viral hepatitis (HBV,HCV) is considered the most important cause of liver disease in Egypt because of high prevalence rate of hepatitis C virus (HCV) in the general Egyptian population, HCV is considered the major risk factor for cirrhosis
Androgens are important anabolic hormones produced predominantly in the testes, with effects on muscle, haematopoiesis, metabolism and sexual function. Low circulating testosterone levels in men are associated with anaemia, osteoporosis, insulin resistance and increased all-cause mortality.The extent of androgen deficiency increases in parallel with worsening severity of liver failure, as classified by the Child Pugh score.
Low serum testosterone has been reported in up to 90% of men with cirrhosis and is thought to contribute to many of the clinical features of advanced liver disease in men, including altered body hair distribution, gynecomastia, testicular atrophy, muscle wasting, impaired sexual function, anemia, and fatigue.
Sarcopenia is defined as a muscle mass two standard deviations below the healthy young adult mean. Although sarcopenia is associated with aging, it can also be present as a result of chronic diseases and malignancy, and it ultimately leads to decreased functional capacity and higher risk of mortality, including among patients with cirrhosis.
It was shown that sarcopenia appearance was increased in liver cirrhosis male patients more than male elder patients without liver cirrhosis
from this point we designed our study to detect the correlation between serum testosterone level and sarcopenia in Egyptian male patients with liver cirrhosis.
This study will be conducted on 20 patients with liver cirrhosis and 20 healthy subjects without evidence of any liver disease as controls. Patients and controls will be selected from inpatient and outpatient clinic of GIT Department, Ain Shams University hospital and the Hepatology Department, Al Haram Specialized Hospital.
Patients and controls will be classified into the following groups:
group I: will include 20 healthy Subjects as control Group.
group II: will include 20 patients with CLD (liver cirrhosis) which are then divided according to the severity using Child-Pugh score to child A,B and C
All patients underwent medical history taking, clinical examination (general and local), and Laboratory investigations were done including (CBC,AST, ALT, bilirubin(total and direct), PT, albumin, serum Urea and creatinine, Na&K, serum free testestrone and AFP), Radiological examination including (abdominal ultrasound. CT scan), body weight and BMI were measured for both patients and controls. Child pugh score was applied on patients with liver disease.
Data were collected, tabulated and statistical analysis was done and revealed that, the group of cirrhotic patient reported decrease in the serum free &total testestrone than healthy controls, also this group of cirrhotic patients reported presence of sarcopenia
In the current study we found that no significant differences between study groups regarding age and etilology. MELD score was significantly different among all study groups; was highest child-C, followed by child-B and lowest in child-A.
Free and total testosterone were significantly different among all study groups; was highest in control, followed by child-A, then child-B and lowest in child-C.
SMI was significantly different among all study groups; was highest in control, followed by child-A, then child-B and lowest in child-C.
Sarcopenia was significantly different among all study groups; was lowest in control, followed by child-A, then child-B and highest in child-C.
We reported that there was significant negative correlation between free &total testesterone and age in control group, positive correlations between free testesterone and SMI in all study groups and negative correlations between free &total testesterone and child& meld scores in CLD groups.
We also reported that there was significant negative correlation between SMI and age in control group, negative correlations between SMI and meld scores in CLD groups
To summarize our study found that Free &total testesterone and SMI had significantly high Diagnostic performance in differentiation between child grades as the following:
Free testosterone ≤4.80 (ng/dL), total testosterone ≤14.90 (ng/dL) and SMI ≤56.3 (cm2/m2) had perfect diagnostic characteristics in differentiating CLD from control.
Free testosterone ≤2.80 (ng/dL), total testosterone ≤14.90 (ng/dL) and SMI ≤56.3 (cm2/m2) had perfect diagnostic characteristics in differentiating child-A from control.
Free testosterone ≤1.68 (ng/dL), total testosterone ≤11.30 (ng/dL) and SMI ≤50.0 (cm2/m2) had high diagnostic characteristics in differentiating child-B from child-A.
Free testosterone ≤0.75 (ng/dL), total testosterone ≤8.40 (ng/dL) and SMI ≤46.6 (cm2/m2) had perfect diagnostic characteristics in differentiating child-C from child-B.