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العنوان
ADAMTS13 and von Willebrand Factor Levels in Patients with chronic Hepatitis C:
المؤلف
Attoa, Hend Gamal El Din Ebrahim.
هيئة الاعداد
باحث / هند جمال الدين إبراهيم عطوه
مشرف / منى احمد وهبة
مشرف / نورا البسيوني إبراهيم البسيوني
مشرف / ياسمين نبيل السخاوي
تاريخ النشر
2021.
عدد الصفحات
129 p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
الطب (متفرقات)
تاريخ الإجازة
1/1/2021
مكان الإجازة
جامعة عين شمس - كلية الطب - الباثولوجيا الإكلينيكية والكيميائية
الفهرس
Only 14 pages are availabe for public view

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from 129

Abstract

Cirrhosis is an increasing cause of morbidity and mortality, being the 14th most common cause of death worldwide. Normal plasma VWF levels and normal platelet number and function are all irreplaceable factors for a physiologic primary hemostasis. Patients with liver cirrhosis have a more complex coagulation state than previously believed. They display a global hemostatic alteration, involving both pro- and anticoagulant factors.
Liver cirrhosis is in close association with bacterial translocation as a result of alteration of intestinal barrier and furthermore endotoxemia. Several mechanisms contribute to systemic inflammation in cirrhosis. Infection increases mortality in cirrhosis four times and has a poor prognosis, with 30% of patients dying within a month of infection and another 30% within a year. SBP is one of the most frequent bacterial infections in patients with cirrhosis and ascites, occurring in 10% to 25% of these patients.
ADAMTS13 is a metalloprotease of that is synthesized primarily in HSCs, and VWF is its only known substrate. ADAMTS13 is an indicator of liver function capacity. Inflammatory processes may directly modulate ADAMTS13 expression and activity. Decreased ADAMTS13 activity is associated with the abundance of unprocessed, ultra-large VWF in plasma facilitating a prothrombotic state.
VWF is predominantly produced by endothelial cells and released after stimulation with pathogen-associated molecular patterns like endotoxin or proinflammatory cytokines. VWF levels are commonly elevated in patients with cirrhosis and considered as a marker of endothelial dysfunction.
Patients with chronic liver disease have a combination of both defective coagulation and accelerated fibrinolysis. Elevated plasma values of D-dimer are frequently found in patients with liver cirrhosis with higher incidence in decompensated disease and match the severity of the disease.
The aim of the study was to assess the levels of ADAMTS13 and their impact on the prothrombotic function of VWF in patients with chronic hepatitis C with or without spontaneous bacterial peritonitis.
Seventy-five individuals were the subject of this study, 60 patients suffering from chronic hepatitis C virus (HCV) and healthy control group (n=15). Child A (n=15), Child B (n=15) and Child C (n=30) which is further classified according to the presence or absence of symptoms and signs of SBP into patients with Child C (n=15) and patients with SBP (n=15). Determination CRP by fixed time nephelometry and LBP, VWF, ADAMTS13 and D-dimer were determined by magnetic multiplexed flowcytometry based immunoassay Luminex®.
ANC and CRP levels were significantly increased in both groups of patients with Child C compared to controls and patients with Child A and Child B. Moreover, a significant increase was also found among patients with SBP compared to non-infected Child C patients. LBP levels were significantly increased in different groups of patients with chronic liver disease compared to controls. Furthermore, a significant increase was also found among patients with SBP compared to non-infected Child C patients. VWF levels were significantly increased in different groups of patients with chronic liver disease compared to controls. A similar significant increase was also noticed in Child C patients with SBP compared to those with Child A, B and non-infected Child C. In contrast, ADAMTS13 antigen levels were significantly decreased in different groups of patients with chronic liver disease compared to controls. Although a decrease in ADAMTS13 antigen levels was noticed in patients with SBP compared to those without infection, values were comparable. In the present study, D-dimer levels were found to be significantly increased in different groups of patients with chronic liver disease compared to controls. Although an increase in D-dimer levels was also noticed in Child C patients with SBP compared to non-infected patients, values were comparable.