Liver cirrhosis (LC) represents a very special and important
problem in Egypt because of endemicity of bilhareziasis and
its complications. Patients with liver cirrhosis have high
bleeding tendency and they may develop petechies, ecchymosis,
gastrointestinal bleeding, bleeding gum, epistaxis etc.
Many factors are proposed to explain this bleeding tendency
in liver cirrhosis of which platelets abnormalities and alterations
of both coagulation and fibrinolytic systems are the most
appreciable. Epistaxis is one of the presentation of patients
with liver cirrhosis. Nasal mucosal changes were found to be
extensive in liver cirrhosis and these changes could not be
explained upon the mentioned bleeding abnormalities only.
A further pathogenic factor controlling angiogenesis may be
added. Vascular Endothelial Growth Factor (VEGF) was
claimed to take a part in this situation as it is one of the most
important angiogenetic factors in the body. Our study focused
to clear up the clinical significant of serum level of VEGF
and possible nasal mucosal changes (NMC) as an example
for bleeding tendency in such patients. The study included
45 patients with LC and 20 healthy controls. Patients are
classified according to Child classification into three groups.
Bleeding tendency in the form of epistaxis was the main
complaint in a good ratio of patients and it was found to be
correlated with vascular nasal changes even in patients with
normal bleeding profile in those patients. Serum level of
VEGF was directly proportional to the staging of L.C. Our
results suggest that VEGF may have a significant new possible
role for bleeding tendency in patients with L.C. as shown
from its more expression and significant effect on nasal
mucoas and submucosa in the form of organization, vascularization
and other changes of nasal granulation tissues of those
patients. These changes were found to be more and more with
progression of the disease. |
