الفهرس 
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Abstract
Budd chiari syndrome (BCS) is a hepatic disease caused by
occlusion of the hepatic venous outflow inducing chronic liver congestion and liver
fibrosis.
The renin–angiotensin–aldosterone (RAS) axis is a system which involves many essential regulations
in the human body for blood pressure and fluid.
Angiotensin-converting enzyme (ACE), a vital part of the RAS system, was also worker as a
governing molecule in systemic and portal circulation in some liver disorders.
The aim of our work was to study the clinical utility of ACE serum level as a predictor of liver
fibrosis in patients with Budd Chiari syndrome (BCS).
Our study was conducted on 80 patients with BCS who were further subclassified according to the
stage of liver fibrosis into 50 patients with stage III fibrosis and 30 patients with stage IV
fibrosis;40 patients serving as patients control group with HCV they were subclassified according
to the stage of liver disease into 25 HCV patients with stage III fibrosis and 15 HCV patients with
stage IV fibrosis. A third group of 30 apparently healthy control subjects were also included.
The patients will be recruited from the Tropical Medicine Department at Ain Shams University
Hospitals, during the period of March 2013 till February 2014.
The results of the present study revealed significantly high serum
ACE levels in whole BCS patients group when compared with healthy controls. Moreover, when ACE
levels in BCS patients subgroups were compared with healthy controls, statistically
significant high ACE levels were observed in BCS patients .Furthermore statistically significant
high ACE serum levels were observed in whole HCV patients group and its subgroup when compared
with healthy control group.
In the present study, statistically significant lower ACE was observed in the whole BCS patient
group when compared with the whole HCV patient group. Moreover, when ACE level in BCS patients
with stage III or IV fibrosis were compared with HCV patients with the corresponding degree of
liver fibrosis, statistically significant lower levels were obtained in BCS patients.
In comparing ACE level in BCS patients stage III liver fibrosis versus stage IV liver fibrosis, a
statistically significant higher levels were obtained in the latter group. Likewise, higher
levels of ACE levels were observed in HCV stage IV fibrosis when compared with stage III fibrosis.
Moreover, ACE level showed statistically significant positive correlation with other markers of
liver fibrosis (APRI and FIB4 tests).
Studying the diagnostic performance of ACE levels using ROC curve analysis, in discriminating
patients with whole BCS patients group from healthy control group revealed that, the best
diagnostic
performance of ACE level was at a cut-off value130 ng/mL, This level
has a diagnostic sensitivity 80%, specificity of 78. 8% and efficacy
77% with AUC 0.894. While for discriminating BCS patient stage III
fibrosis from healthy controls, the cut-off value 120 ng/mL was chosen
, with sensitivity of 82%,specificity of 73. 3%, and efficacy of 75% with AUC 0.928.The
discrimination of patients with stage III fibrosis from those with stage IV fibrosis in BCS group
revealed that, the best diagnostic performance of ACE level was at a cut-off value of 420 ng/mL.
This level has a diagnostic sensitivity of 100 %, specificity of
82 % and efficacy of 85% with AUC 0.917.