Study on serum homocysteine level as a prognostic marker for alcoholic liver cirrhosis and viral cirrhosis patients.

Subramanian, P (2011) Study on serum homocysteine level as a prognostic marker for alcoholic liver cirrhosis and viral cirrhosis patients. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION : Liver plays a central role in the synthesis and metabolism of homocysteine, given the fact that dietary methionine is predominantly metabolized in the liver. It is well known that serum homocysteine level increases in non alcoholic fatty liver disease (NAFLD) and non alcoholic steatohepatitis (NASH) patients. Recent studies have shown that serum homocysteine levels are elevated in chronic alcoholism and liver cirrhosis patients also. Homocysteine is a well known nerve and vascular endothelial toxin, promoting mortality, coronary atherosclerosis, myocardial infarction, stroke, and dementia. Recently it is found that homocysteine can induce liver diseases also, by promoting hepatic fibrogenesis. Homocysteine metabolism requires cofactors of vitamins folate, B12 and pyridoxine, but the metabolism of these vitamins is impaired in cirrhotic patients. Homocysteine regulators called methyl donors are required to reduce serum homocysteine level. Methylation is a vital part of many biochemical processes in the body involving DNA, proteins and lipids. As improper methylation affects the brain and nervous system, correcting hyperhomocysteinemia will improve mental and emotional health as well. Though several studies have proved hyperhomocysteinemia in alcoholic liver disease and stressed the importance of reducing the serum homocysteine level, there are only very few studies which compared the serum level of homocysteine with the severity of liver disease. This study is undertaken to compare the degree of elevation of serum homocysteine level with severity of liver disease in alcoholic and viral cirrhotics and to know whether serum homocysteine level can be used as a prognostic marker to assess the severity of liver disease. STUDY OBJECTIVE : To study fasting serum Homocysteine level as a prognostic marker in patients with alcoholic liver cirrhosis and viral cirrhosis, comparing the homocysteine level with MELD score and Child-Turcotte-Pugh scores. DESIGN AND SETTING : Prospective study, Govt. Peripheral Hospital, Anna nagar, Chennai. PATIENTS: Fifty alcoholic cirrhosis and 15 viral cirrhosis patients. STUDY PERIOD : Between December 2009 and April 2011. RESULTS : Serum homocysteine levels are seen elevated in 41 out of 50 (82%) alcoholic cirrhosis patients compared to 1 out of 15 (6.67%) viral cirrhosis patients. The serum homocysteine level in alcoholic group is 23.4 + 7.91 μmol/L compared to 10.05 + 2.75 μmol/L in viral cirrhosis group. The ‘p’ value for variation in serum homocysteine level corresponding to both CTP and MELD scores is < 0.0001, in both alcoholic and viral cirrhosis patients. CONCLUSION : Serum homocysteine levels are elevated in alcoholic cirrhosis than in viral cirrhosis and correlate well with CTP and MELD scores in alcoholic cirrhosis patients.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Homocysteine ; Cirrhosis ; MELD and Child-Turcotte-Pugh score.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 14 Jul 2017 03:07
Last Modified: 14 Jul 2017 03:07

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