Volume : VI, Issue : I, January - 2016

The Relationship Between Trace Elements And Hepatic Encephalopathy In Egyptian Patients With Liver Cirrhosis

Ahmed Samir Abo Halima, Ossama Ashraf Ahmed, Hanan Mahmoud Badawy, Amal Shawky Bekir

Abstract :

Introduction : Hepatic encephalopathy is a complex and potentially reversible neuropsychiatric syndrome complicating acute or chronic liver disease. Clinical manifestations are multiple and varied, ranging from minimal neurological changes to coma. Ammonia is the main toxic substance involved in the pathogenesis of hepatic encephalopathy, although other mechanisms, such as modifications of the blood–ain barrier, disruptions in neurotransmission and abnormalities in GABAergic and benzodiazepine pathways may also play a role. The identification and treatment of precipitating factors is crucial in the management of patients with hepatic encephalopathy (Bismuth M et al., 2011). Apart from increased blood ammonia, alterations in various other substances have been implicated in the pathogenesis of hepatic encephalopathy (HE). The role of trace elements like zinc and manganese has been described recently (Chetri K and Choudhuri G, 2003). Aim of the Study : The purpose of this case control study is to investigate the possible relationship between hepatic encephalopathy and serum levels of manganese (Mn), zinc (Zn), and copper (Cu) in egyptian cirrhotic patients compared with age– and sex–matched control subjects and correlate them with various clinical and laboratory parameters. Patients and methods : This case control study was carried out in Sohag General Hospital from January to March 2012. It included 30 cirrhotic patients and 10 healthy subjects as controls that were matched for age and gender. Cirrhotic patients were classified into 2 groups, Group I: which included 15 cirrhotic patients with hepatic encephalopathy. Group II: which included 15 cirrhotic patients without hepatic encephalopathy. All participants were subjected to full history taking, thorough clinical examination, abdominal ultrasonography and routine laboratory investigations. Serum levels of manganese (Mn), zinc (Zn), and copper (Cu) and also blood ammonia levels were estimated in all subjects. All patients were classified according to modified Child–Pugh‘s classification to asses the severity of liver cirrhosis. Severity of hepatic encephalopathy was assessed according to West Haven (W–H) criteria. Results : In this study, serum manganese levels were highly significant increased in cirrhotic patients with or without HE compared to controls (median 2.5 µg/dl in cirrhosis with HE and 2.2 µg/dl in cirrhosis without HE vs. 0.75 µg/dl in controls, p<0.001 for both) Whereas, serum manganese levels were not significantly different between cirrhotic patients with HE and cirrhotic patients without HE (median 2.5 µg/dl in cirrhosis with HE vs. 2.2 µg/dl in cirrhosis without HE, p>0.05) In this study, serum zinc levels showed highly significant decrease in child C patients in comparison to child B patients in both cirrhosis with HE group (median 47.5 µg/dl in child B vs. 26.5 µg/dl in child C, p>0.01) and in all cirrhotic patients (both with and without HE) (median 45.0 µg/dl in child B vs. 28.5 µg/dl in child C, p>0.001) In this study, serum copper levels showed significant increase in child C patients in comparison to child B patients in cirrhosis with HE group (median 92.25 µg/dl in child B vs. 165.5 µg/dl in child C, p>0.05) Conclusion; serum levels of studied trace elements differ significantly in patients with liver cirrhosis compared to healthy subjects as there was significant increase in serum levels of manganese and copper, whereas, there was significant decrease in serum zinc levels in cirrhotic patients (regardless presence or absence of HE) compared to control subjects. However, there were no significant differences in serum levels of studied trace elements in cirrhotic patients with HE compared to those without HE

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Article: Download PDF   DOI : 10.36106/ijar  

Cite This Article:

Ahmed Samir Abo Halima, Ossama Ashraf Ahmed, Hanan Mahmoud Badawy, Amal Shawky Bekir The Relationship Between Trace Elements and Hepatic Encephalopathy in Egyptian Patients With Liver Cirrhosis Indian Journal of Applied Research, Vol.6, Issue : 1 January 2016

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