Internal Medicine Department, Al-Azhar Faculty of Medicine, Nasr City, Cairo, Egypt.
Hepatol Int. 2008 Sep;2(3):341-5. doi: 10.1007/s12072-008-9077-y. Epub 2008 Apr 22.
Introduction Patients with chronic liver disease ultimately progress to develop cirrhosis and portal hypertension. Recently it seems well established that nitric oxide disturbances play a key role in the pathogenesis of chronic liver disease and portal hypertension. The aim of this work was to clarify the correlation between chronic liver disease stages, liver function status, esophageal varices presence and nitric oxide disturbances. Subjects and methods All subjects (n = 120) in the present study were classified into; group I which included 15 age and sex matched healthy volunteers (taken as control), group II which included 20 patients with chronic active hepatitis, and group III which included 85 patients with hepatic cirrhosis. All subjects included were subjected to full clinical assessment, routine laboratory investigations, serum nitrate level determination using colorimetric method, abdominal ultrasonography and upper endoscopy. Results Increased serum nitrate level could not be detected in patients with chronic active hepatitis as well as those with early cirrhosis (Child's class A). Progressive and significant increase of serum nitrate levels were detected in more advanced stages of cirrhosis (Child's class B & C). The best non-invasive predictor for the presence of oesophageal varices was a combination of platelet count <150.000/mm(3), splenomegaly >18 cm, Child's class B or C and serum nitrate >/=38 mumol/l, with 93.3% sensitivity and 100% specificity. Conclusion Serum nitrate level can be used as a non-invasive predictor for progression of chronic liver disease as well as for the presence of oesophageal varices.
简介 患有慢性肝病的患者最终会发展为肝硬化和门静脉高压。最近，一氧化氮紊乱似乎在慢性肝病和门静脉高压的发病机制中起着关键作用，这一点已得到充分证实。本研究的目的是阐明慢性肝病的分期、肝功能状态、食管静脉曲张的存在与一氧化氮紊乱之间的相关性。 对象和方法 本研究共纳入 120 例受试者，分为三组：I 组包括 15 例年龄和性别匹配的健康志愿者（作为对照组），II 组包括 20 例慢性活动性肝炎患者，III 组包括 85 例肝硬化患者。所有受试者均进行了全面的临床评估、常规实验室检查、比色法测定血清硝酸盐水平、腹部超声检查和上消化道内镜检查。 结果 慢性活动性肝炎和早期肝硬化（Child 分级 A）患者的血清硝酸盐水平并未升高。在更晚期的肝硬化（Child 分级 B 和 C）中，血清硝酸盐水平逐渐显著升高。预测食管静脉曲张存在的最佳非侵入性指标是血小板计数<150,000/mm³、脾肿大>18cm、Child 分级 B 或 C 以及血清硝酸盐水平≥38μmol/L，其敏感性为 93.3%，特异性为 100%。 结论 血清硝酸盐水平可作为预测慢性肝病进展和食管静脉曲张存在的非侵入性指标。
