الفهرس 
LIVER CIRRHOSIS
Clinical ManifestationsOnly 14 pages are availabe for public view
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Abstract
Mitric oxide is a potent vasodilator and it is elevated in patient with cirrhosis, the imbalance between it and vasoconstrictors in the renal microcirculation has been proposed to be responsible for deterioration of kidney function in these patients. Moreover, a progressive rise in levels of NOx had been proposed during progressive renal dysfunction in cirrhosis.
The aim of this study was to determine whether serum levels of nitrate correlate with renal dysfunction in patients with liver cirrhosis.
Among patients admitted to Tropical Medicine Department -Ain Shams University hospital, a total of 60 patients with liver cirrhosis were included in this study. Patients were diagnosed with stigmata of chronic liver disease based on clinical, laboratory and radiological data.
The present study included sixty patients with liver cirrhosis. They were 29 (49%) males and 31 (51%) females. Their ages ranged from 33 to 76 years with mean age 50.5 ± 9.35 years. The patients were divided into 3 groups according to degree of hepatic decompensation.
All the patients were subjected to full history taking, clinical examination, laboratory investigations including liver function tests, renal function tests and serum nitric oxide metabolites (nitrate).
Patient with HRS had a higher mean nitrate levels followed by DLC then CLC and controls. There was a significant statistical difference between groups I&II and I&III (P<0.05), no statistical significant difference between (I & IV) and (II & III) (P>0.05), and hight significant statistical difference between groups (II & IV) and (III & IV) (P<0.001).
The present study showed that sensitivity and specificity of NO metabolites (Nitrate) were 100% and 93.3% respectively, accuracy 95% at cutoff point of 387 μmol/L in diagnosis patients with HRS.
All patients (100%) with HRS (group III) were positive for nitrate whereas only four patients with DLC (20%) (group II) were positive for nitrate. All patients with CLC (group I) or controls (group IV) were negative for nitrate . There was no significant statistical difference between patients with CLC (group I) & DLC (group II) and controls as regard the distribution of Nitrate (P>0.05), as non of patients with CLC (group I) or controls (group IV) were positive for nitrate and only four patients with DLC (20%) (group II) were positive for nitrate.Whereas there was a highly significant statistical difference between patients with HRS (group III) and controls as regard the distribution of nitrate (P<0.001).The prevalence of nitrate positive patients increased to 100% in patients with HRS (20 of 20), in comparison to 20% in patients with DLC (4 of 20). (P<0.001).group III showed significantly higher rate of positive nitrate when compared to other groups, the difference was highly significant (P<0.001).
Also there was correlation between nitrate levels and Child Pugh classification in liver cirrhosis.Cirrhotic patients with Child C had higher mean levels of nitrate than did patients with Child A.