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Abstract In an attempt to investigate the diagnostic value of sPIIIP assay in schistosomiasis and other chronic liver diseases, sixty two CLD patients as well as 20 healthy controls were stUdied. Patients were subjected to urine and stool analysis, egg count in stools by the Kato thick smear technique (for patients excreting ova), sigmoidoscopy and rectal snip, abdominal ultrasound scanning, upper gastro-duodenal endoscopy. complete blood count, biochemical liver function profile (bilirubin, albumin. ALT. AST and AP) and testing for HBsAg by ELISA . Final histopathological diagnosis was established after examination of haematoxylin/eosin and orcein stained specimens obtained by needle biopsy of the liver for all patients. Controls were subjected to all non-invasive investigations necessary to confirm that they are not suffering from any disease condition known to affect serum levels of procoliagen-IIIpeptide. These included urine and stool analysis. abdominal sonographic scanning, complete blood count, biochemical liver functions and testing for HBsAg by ELISA. Serum samples were collected from patients and controls for determination of the level of serum procoliagen-III-peptide (sPIIIP) by radioimmunoassay. Patients and controls were age-matched and none was below the age of 16 years. Fifty nine patients were previously exposed to schistosome infection. but ova were recovered from stools in 49 (83%) at rectal snip in 58 (98%) and at liver biopsy in 33 (56%). According to final histopathological diagnosis. patients were classified into 54 cases with proven CLD and 8 patients with simple intestinal schistosomiasis (not complicated by hepatic involvement). Chronic liver disease patients included: 26 patients with pure hepatic -168- schistosomiasis; 6 cases with chronic persistent hepatitis; 6 with chronic active hepatitis; 7 with combined schistosomiasis plus chronic active hepatitis; 7 with active cirrhosis and 2 patients with miscellaneous conditions (one with hepatic venous outflow obstruction and the other with hepatocellular carcinoma). from the clinical point of view, the studied 54 CLD patients included 34 cases with clinically ”compensated” disease (no evidence of jaundice or ascites) and 20 cases with ”decompensated” illness (jaundice and/or ascites). Fifteen patients had oesophageal varices. Serum procollagen-III-peptide levels sensitively discriminated between patients with chronic liver disease in general (22.52 ± 8.89 ng/ml) and controls (7.68±2.44 ng/ml). Even when clinically compensated, CLD patients had sPIIIP values (19.19 ± 7.8 ng/ml) that are significantly higher than those of controls. Moreover, significantly higher sPIIIP levels were found in patients with decompensated illness (28.21± 7.9 ng/ml) than those with compensated disease. Also, patients with oesophageal varices had sPIIIP values (29.14±9.6 ng/ml) which are significantly higher than those without (19.97 ± 7.2 ng/ml). However, a cut-off point of sPIIIP could not be established in order to predict the presence of varices with adequate sensitivity and specificity. Serum procollagen-IlI-peptide level in healthy controls was 7.66 ± 2.44 ng/ml which is not significantly different from that in patients with simple intestinal schistosomiasis (6.89 ± 1.01 ng/ml) or that of patients with chronic persistent hepatitis (8.57 ± 1.65 ng/ml ). To the contrary, patients with pure hepatic schistosomiasis, chronic active hepatitis, combined hepatic schistosomiasis plus chronic active hepatitis. and active cirrhosis had sPIIIP values -169- (21. 12±6.5 ; 26.58±5.4 ; 31.86 ± 6.43 and 28.09 ± 7.72 ng/ml respectively) which are significantly higher than that of controls. When levels of sPIIIP in the different studied groups were compared with each other. significantly higher values were found in cases with pure hepatic schistosomiasis than those with simple intestinal schistosomiasis. Patients with chronic active hepatitis. combined schistosomiasis plus chronic active hepatitis and those with cirrhosis still had sPIIIP values that are significantly higher than patients with pure hepatic schistosomiasis. Although sPIIIP values sensitivelY discriminated between chronic active and chronic persistent hepatitis. no statistically significant difference was found between chronic active hepatitis and cirrhosis. In this study. sPIIIP in patients with positive without.However. this was underlying pathology in the carrier state. values were significantly higher HBsAg antigenaemia than patients largely dependent upon the liver that associated the HBsAg Weak. albeit statistically significant. correlation coefficients were found between sPIIIP on one hand and each of bilirubin. ALT. AST • AP and albumin. on the other hand. within the pooled group of patients with CLD (54 patients) . Also. in patients with pure hepatic schistosomiasis. sPIIIP levels correlated weakly. but still significantly. with the faecal egg count. -170- Statistical analysis of data showed that: (1) Serum procollagen-IlI-peptide assay is a sensitive predictor of chronic liver disease even when clinically compensated. (2) Patients with schistosomiasis confined to the intestinal tract without hepatic involvement have normal levels of sPIIIP. Those with hepatic involvement always have significantly elevated sPIIIP values. Thus. sPIIIP assay is superior to clinical examination. standard biochemical liver functions and even to liver biopsy (which is subject to sample variabi 1ity) in distinguishing subtle schistosomal hepatic involvement. (3) The rate of collagen synthesis in patients with pure hepatic schistosomiasis is largely dependent upon the intensity of the infection as determined by the faecal egg count. (4) Serum procollagen-IlI-peptide assay sensitively discriminates between chronic persistent hepatitis and other potentially progressive chronic liver lesions. Thus, it constitutes a useful asset to needle biopsy diagnosis particularly in disease conditions where sampling variability makes the interpretation of liver biopsy difficult (such as chronic active hepatitis and cirrhosis) . (5) Serum procollagen-IlI-peptide assay reflects the activity of the underlying liver pathology. Thus, high levels are found in pure hepatic schistosomiasis. but ”higher” levels are seen in chronic active hepatitis and ”still higher” levels are encountered in combined schistosomiasis plus chronic active hepatitis. -171- (6) It is likely that sPIIIP is affected by parenchymal necro-inflammation and does not reflect the activity of mesenchymal elements. hepatosolely (7) Although higher levels of sPIIIP are associated with portal hypertension and oesophageal varices. the assay is not sensitive or specific enough to be of clinical value in this particular aspect. (8) The major potential of sPIIIP assay lies in follow-up of patients with active chronic liver diseases obviating the need for a repeat biopsy. When anti-fibrotic drugs become available for wide clinical application, serial assays of sPIIIP would be indispensable for therapy monitoring. |