الفهرس 
LIVER CIRRHOSISOnly 14 pages are availabe for public view
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Abstract
H
epatitis C virus can cause both acute and chronic hepatitis. The acute process is self-limited, rarely causes hepatic failure and usually leads to chronic infection. chronic HCV infection often follows a progressive course over many years and can ultimately result in cirrhosis, HCC and the need for liver transplantation.
Liver cirrhosis is one of the major leading causes of morbidity and mortality worldwide including Egypt. Cirrhotic patients evaluated for the presence of complications by using Child-Pugh score. However; the cirrhotic patients particularly those with Child grades B and C with ascites or hemorrhagic tendency are usually treated with albumin or blood transfusion which may affect the numerical value for calculating the Child- Pugh score.
Cholinesterase is a family of enzymes that catalyze the hydrolysis of the neurotransmitter acetylcholine into choline and acetic acid (Mohamed et al., 2017). There are 2 types; Acetyl cholinesterase also known as erythrocyte cholinesterase found in RBCs cell membrane and pseudo-cholinesterase known as plasma cholinesterase which is synthesized mainly in hepatocyte and is released into blood and its activity is reduced in liver dysfunction due to reduced synthesis (Yanai and Hoshino, 2010).
The aim of this study is to evaluate serum cholinesterase level as a biomarker for detecting liver injury in patients with CHC. For this propose 40 patients with liver cirrhosis due to HCV infection and 10 healthy adults were selected and divided into 3 groups:
• group 1: 20 Patients having compensated liver cirrhosis due to HCV infection.
• group 2: 20 Patients having decompensated liver cirrhosis due to HCV infection
• group 3: 10 Healthy subjects matched for age and sex as a control.
All the participitants were subjected to clinical evaluation; laboratory investigations including CBC, liver and kidney function tests, AFP, APRI sore, serum cholinesterase level evaluation, abdominal ultrasonography and liver Fibroscan.
The obtained results showed that:
• Sensitivity of cholinesterase is 100%, its specificity is 100% and its accuracy is 100%, in predicting liver injury in patients with chronic hepatitis C.
• Cholinesterase is positively correlated with Hb, platelets and albumin.
• Cholinesterase is negatively correlated with ALT, AST and ALP, total, direct bilirubin, PT, INR, urea, creatinine and AFP.
• There is significant increase of cholinesterase among compensated compared with decompensated cirrhotic patients.
• There is significant decrease of cholinesterase among compensated cirrhotic patients compared with controls.
• There is significant decrease of cholinesterase among decompensated cirrhotic patients compared with controls.
• There is significant difference between the studied cirrhotic patients as regards APRI, in predicting liver injury in patients with chronic hepatitis C.
• APRI < 0.5 correctly identified healthy controls from compensated cirrhosis with sensitivity of APRI is 97.5% and its specificity is 100%.
• APRI ≤ 1.2 can identify compensated from decopensated cirrhotics with sensitivity of 90% and specificity is 65%.
• There is significant decrease of APRI among compensated compared with decompensated cirrhotic patients.
• There is significant increase of APRI among compensated cirrhptic patients compared with controls.
• There is significant increase of APRI among decompensated cirrhotic patients compared with controls.
CONCLUSION AND RECOMMENDATIONS
Conclusion
• There is association between cholinesterase and liver disorders, viral hepatitis and liver cirrhosis.
• Cholinesterase can be used as a routine diagnostic test besides other liver function tests for investigation of liver disorders.
• Cholinesterase is an excellent biomarker of cirrhosis with good sensitivity and specificity.
• Cholinesterase shows good correlation with albumin, PT, INR and Child-Puch score.
• Cholinesterase distinguishes decompensated cirrhosis from compensated cirrhosis well.
• Low levels of cholinesterase in cirrhosis may serve as a useful prognostic marker of advanced liver disease.
• The level of cholinesterase is closely correlated with the severity of liver damage and correlated also with the Child- Pugh score.
• Combination of cholinesterase with Child-Pugh score may be more objective and accurate in evaluating the liver reserve function of cirrhotic patients.
• Cholinesterase level reflects liver cell conditions; where low levels indicate hepatocellular damage.
Recommendation
• Long-term follow-up studies are warranted to define cholinesterase exact role in clinical practice.