الفهرس 
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Abstract
The aim of the present work was to assess the relation between endothelial Nitric Oxide Synthase G894T gene variants and occurrence of type II hepatorenal syndrome.
This study was conducted on 120 participants including 80 patients with liver cirrhosis and 40 healthy persons of matched age and sex without evidence of any liver, kidney or any other systemic diseases as controls. Participants were selected from patients attending the outpatient and \ or inpatient departments of Tropical Medicine department-Menoufia University and internal medicine department-Kafrelsheikh Liver Research Center Hospital in the period between November 2017 to March 2018.
Patients were 53 males and 27 females (66.25% and 33.75 respectively). Their ages ranged from 39-67 years. 40 healthy persons of matched ages and sex were selected as a control group.
Patients and controls were classified into the following groups:
: 40 cirrhotic patients without hepatorenal syndrome.
: 40 cirrhotic patients with hepatorenal syndrome type II.
: 40 healthy persons as controls.
All patients and controls were subjected to the following:
Proper and detailed history taking, complete physical examinations including general examination and local abdominal examination and full investigations including: complete blood count, liver function tests, kidney function tests, serological tests for hepatitis markers (HCV & HBV), serum electrolytes (Na & K), abdominal ultrasonography, Genotyping of eNOS G894T polymorphism by Real Time PCR, and plasma nitrite level.
Statistical analysis of the data revealed:
There was no statistical significant difference between the 3 studied groups regarding sex and age.
There was no statistical difference between both patient groups regarding history of hematemesis, melena, hepatic encephalopathy. In addition, no significant difference between them regarding jaundice, hepatomegaly, splenomegaly and grade of ascites.
Statistical analysis revealed that chronic hepatitis C virus (HCV) was the commonest etiology of cirrhosis in GI (80%) and GII (75%).
There was high statistically significant difference between the 3 studied groups regarding hemoglobin concentration, white blood cells and platelets. The lowest values were observed in GI and GII with no significant difference between them.
There was high statistically significant difference between the 3 studied groups regarding ALT, serum albumin, INR, total and direct bilirubin. ALT, INR, total and direct bilirubin were significantly higher in addition, serum albumin was significantly lower in GI and GII than in GIII.
Summary
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Statistical analysis revealed that, there was high significant difference between 3 groups regarding blood urea and serum creatinine. They were significantly higher in GII compared with GI and GIII.
Regarding serum Na, it was significantly lower in GI than in GIII with much lower levels observed in GII compared to GI and GIII.
Regarding serum K, it was significantly higher in GII than in GI and GIII, with no significant difference between them.
Child-pough score was statistically not significant different between GI and GII. However, MELD score was significantly higher in GII than in GI patients.
Statistical analysis revealed that, plasma nitrite was markedly higher in HRS patients (GII) than cirrhotic patients and controls (p=0.027 and < 0.001 respectively). In addition, higher levels were found in cirrhotic patients than in controls.
There was high significant difference between the 3 studied groups regarding eNOS G894T genotypes and allele frequencies.
TT homozygous mutant was markedly higher versus GG and GT in both cirrhotic (22.5%) and HRS (30%) patients than in healthy controls (10%). However, genotypes were not significantly different between cirrhotic and HRS patients.
Regarding allele frequency; T allele was significantly higher in cirrhotic patients (47.5%) and HRS patients (52.5%) than in controls (25%) with no significant difference between cirrhotic and HRS patients.
GT and TT genotypes increase the risk of decompensated cirrhosis. Moreover, both GT and TT genotypes increase risk and can predict HRS.
In accordance with genotype results T allele increase the risk of decompensated cirrhosis and HRS.
There was significant association between TT genotype and higher K level and also plasma nitrite level in GI (decompensated cirrhosis)
There was significant association between eNOS G894T genotypes and plasma nitrite level, with distinct relation between TT genotype and lower plasma nitrite level. However, there was no significant relation between genotypes and Child-Pough, platelet count, serum Na, serum K or MELD score.