الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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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
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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
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(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.
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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.
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(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.