Vinotha, T (2015) Association of High Serum Uric Acid Levels in Chronic Liver Disease. Masters thesis, Tirunelveli Medical College, Tirunelveli.
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Abstract
INTRODUCTION: In higher animals and humans the serum uric acid is an end product of purine metabolism, excreted mainly through kidneys. Increased serum uric acid levels was thought to be the main reason for arthritis due to crystal deposition in joints, renal stones and other vascular events. More recently, increased levels of serum uric acid levels also involved in the future development of hypertension, cardiovascular disease, kidney disease and metabolic syndrome. Although increased serum uric acid levels are involved in the development of many diseases the following mechanisms included as a cause, they are dysfunction of endothelium, resistance to insulin, systemic inflammation and oxidative stress. Several biological studies shown that increased serum uric acid level have been found to correlate directly with the level of tissue injury. Compared to the serum levels of uric acid, tissue levels of uric acid has better prediction of tissue injury. So serum uric acid may be considered as an indicator of tissue injury Recent studies on serum uric acid have shown an increased serum uric acid levels associated with the development of steatosis of liver in the patients who had Non-Alcoholic fatty Liver Disease (NAFLD) after adjustment for various features of metabolic syndrome. It is proposed that the role of increased uric acid levels in the pathogenesis of liver disease thought to be due to its pro-inflammatory effects, for example, increased levels of uric acid is considered as an important marker in the pathogenesis of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steato hepatitis (NASH). AIM OF THE STUDY: 1. To assess the prevalence of hyperuricemia in nonalcoholic patients with cirrhosis liver and fatty liver. 2. To study the association of uric acid and various risk factors. 3. To study the usefulness of serum uric acid as an prognostic marker in chronic liver disease. MATERIALS AND METHODS: This is a prospective study conducted on a sample south Indian population admitted in department of medicine and department of gastroenterology during the period of 2013 and 2014. The study includes a standardized questionnaire and examination based on this patients were included in this study. A total number of 100 patients who are all diagnosed to have fatty liver and cirrhosis are included in this study. Patients with prior history of alcoholic liver disease, chronic kidney disease, arthritis, cardiovascular disease and diabetes mellitus, hypothyroidism are excluded. The total number of patients included in this study was 100 out of which 75 are males and 25 are females. INCLUSION CRITERIA: Age of the patients between 30 years to 60 years without the prior history of alcoholism, diabetes mellitus, kidney disease, hypothyroidism, drug intake and cardiac disease. EXCLUSION CRITERIA: 1. Age less than 30 years and more than 60 years, 2. Gout, 3. Chronic alcoholics, 4. Known case of alcoholic liver disease, 5. Chronic kidney disease, 6. Hypothyroidism, 7. Drug intake, 8. Diabetes mellitus, 9. Cardiac disease, 10. Obesity. METHODS: A detailed history was elicited from the patient regarding their present complaints, associated symptoms, alcohol intake, smoking, previous history of hypertension, diabetes mellitus, arthritis, hypothyroidism, any cardiac illnesses and chronic drug intake. On admission routine blood investigations like blood sugar, urea, serum creatinine, liver function test, thyroid profile, lipid profile, ultra sonogram and serum uric acid levels were estimated. Waist circumference in males and females measured. Diabetes was defined as fasting blood sugar >126 mg % and post prandial blood sugar >200 mgs%. Body mass index was calculated as weight in kg/ height in m2. Serum uric acid levels also sent for analysis on the day of admission. The reagent for serum uric acid is uricase and for blood glucose trider method is used. STATISTICAL ANALYSIS: Data analysis was done and the subjects were divided in to two groups. One group with ultrasonagram findings of fatty liver and another group with the findings of cirrhosis of liver. Serum uric acid levels in both the groups are analysed with age and sex. Using the SPSS 20 and sigma stat 3.5 version software, means, standard deviations, range, frequencies, percentages, chi-square and ‘p’ values were calculated. One way ANONA and student’s t test for data and chi square test for consolidation of tables used. A ‘p’ value of < 0.05 was taken as significant relationship. CONCLUSION: Uric acid is an old molecule with many new applications and it has also been studied in various metabolic diseases, cardiovascular diseases and chronic kidney disease. In this study it has been found that uric acid has a significant correlation with BMI, waist circumference and hypercholesterolemia. Hyperuricemia is also associated with both alcoholic and nonalcoholic liver diseases due to increased oxidative stress and inflammatory actions. This study also concluded that hyperuricemia is associated with increased number of cases both with cirrhosis and fatty liver. This clearly indicates that hyperuricemia in fatty liver patients, who are nonalcoholic have considerable risk for future progression to cirrhosis of liver. Because of its association with BMI, waist circumference and hypercholesterolemia, hyperuricemia may be considered as one the risk factor for metabolic syndrome.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Association ; High Serum Uric Acid Levels ; Chronic Liver Disease. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Punitha K |
| Date Deposited: | 18 May 2018 18:57 |
| Last Modified: | 18 May 2018 18:57 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7954 |
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