Tumor Suppressor Protein [p53] And Multidrug Transport Protein [p170] In Hodgkins Disease:

Naeem Goda Ouf

The present s dy was performed on 50 children categorized asfollows:• Fifteen children with hronic liver disease 11 males and 4 females with theirage ranging from 6 months to 13 years. According to histopathologicalfindings in the liv biopsy this group included patients with glycogenstorage disease, conic persistent hepatitis, bilharzial portal fibrosis,posthepatitic cirrho is, mixed type (chronic active.hepatitis plus bilharzialportal fibrosis) an a case of intrahepatic biliary cirrhosis and congenitalhepatic fibrosis.• Fifteen children wi hepatitis E virus infection, 9 males and 6 females withtheir age ranging fr m 6 to 13 years.• Twenty apparently ealthy children as reference group, 10 males and 10females with their a e ranging from 5 to 13 years.A few childre were from Benha city, but most were residents ofnearby rural communi .es.Two serum s pies were obtained from every patient with a 6 monthsinterval between the st and the second samples.In addition to I history and clinical examination, all children weresubjected to the fo wing investigations: liver function tests, hepatitis Bsurface antigen, hist pathological examination of liver biop SII¥¥AI?Y M’J) ct1;VCZII.570;Vliver disease group), and quantitative measurement of serum TNF-a byenzyme linked immun sorbent assay.As regards the liver function tests, most of them showed a significantdifference between e reference group and the chronic liver disease andHEV +ve groups. ey are markedly affected in the chronic liver diseasegroup than in HEV + e group.r disease group, also showed a higher rate of increasein serum ALT level 53.2%) than the HEV+ve group (23.5%) at P< 0.03.However, the alkalin phosphatase level showed no significant rate of changebetween the two grou s.Serum AST le el showed a higher rate of increase (43.6%) in thechronic liver disease oup than the HEV + ve group (21.5%) at P< 0.03.Total serum bi irubin and serum direct bilirubin showed no significantdifference between e reference group and the two pathological groups.They also showed no ignificantrate of change between the two groups.Considering s rum albumin level, the chronic liver disease groupshowed a significantl larger rate of decrease in the serum albumin (-7.3%)than the HEV+ ve gr up (-4.2%) at P< 0.01.The chronic li er disease group aslo showed a larger rate of decreasein A/G ratio (-12.5%) than the HEV+ve group (- 5.7%) at P< 0.0002.At p<0.02 the conic liver disease group showed a significant higherrate of increase (4.3% in the prothrombin time than the HEY +ve group(2.8%). whereas at 0.04, the chronic liver disease group showed asignificant larger rate f decrease in the prothrombin time (-8.8%) than theHEY +ve group (-6.1% .SlIJlJlARY Mlf) aJA’tzll.57OA’Considering the serum TNF-a level, there was a significant negativecorrelation between ag and serumTNF- a. in the reference group at P< 0.05and correlation coeffic ent (r) = - 0.489. However, there was no correlationbetween serum TNF-a evel and sex in the reference group.There was a si ificant difference in serum TNF-a level between thereference group and th first samples of chronic liver disease and hepatitis Evirus + ve (HEY + ve) groups at P< 0.001, but with no significant differencein TNF-a level betwe the first samples of chronic liver disease and HEY+ ve groups.Serum TNF-a I vel in the second samples also showed no significantdifference between the chronic liver disease and HEY + ve groups.There was a si ificant differenc in serum TNF-a level between thefirst and second sampl sat P< 0.0001 in the chronic liver disease group andat P< 0.02 in HEY + v group.There was a hi er incidence of elvated TNF-a levels in the chronicliver disease group ( 3.4 % in the first samples and 100% in the seconddamples) than inthe second sampleHEV + ve group (80% in the first samples and 86.7% inAs regardsdisease group sholevel (35.5%) thane rate of increase of serum TNF-a, the chronic livera significantly higher rate of increase in serum TNF-ae HEV+Ve group at P<0.004.There was n significant correlation between serum TNF-a level andthe histopathologic findings in liver biopsy, however, patients withbilharzial portal fib osis followed by patients with liver cirrhosis showedremarkably elevated erum TNF-a levels.It was noted serum TNF-a levels were higher in patients withchronic active hepati is than in patients with chronic persistent hepatitis, andthis denoted that in eased TNF-a production is related to the activity ofhepatitis.Also, it was n ted that, increased TNF-a production is a commonphenomenon in patie with HBs Ag +Ve serum as well as in patients withHBs Ag - Ve serum. is finding indicates that TNF-a production does notdepend on the etiolo of hepatitis but reflects the activity of hepatitis.-a levels were also recorded in patients with HEVinfection, with tenden y of much more elevation by time, and this mightsuggest hat hepatitis E infection might progress to chronic liver disease.When considering the hronic liver disease group as a whole no significantcorrelation could be p ved between serum TNF-a level and liver functionStlJ/,VARY AA’IJ CZlA’CZtlSJOA’tests, but within e subgroups of chronic liver disease specially bilharzialportal fibrosis gro p and mixed group (bilharzia! POrtal fibrosis and chronicactive hepatitis) a sitive correlation was found between serum TNF-a.leveland liver function sts specially transaminases, serum albumin and NG ratio,prothrombin time d prothrombin concentration.When trying to determine the cut off value of serum TNF-a. for thediagnosis of chroni liver disease, we considered that serum TNF-a. rangebetween 188.8-200 g/m1is the cut off value of serum TNF-a.. The optimumsensitivity (75%) an specificity (78.6%) of this serum test were achieved atthis range.The introducti n of each new laboratory parameter for disease shouldbe coupled with qu stions about the efficiency, reliability, specificity andsensitivity of the me urement. In addition, it remains to be seen whetherthere is a real need f r this new index in view of the quality of the availablealternative indices.Serum TNF-a. laims this special field of application because of thesimplicity of the meas ement, its reliability and prognostic value, in additionto its considerable sen ’tivity (75%) and specificity (78.6%).Our present study owed increased serum TNF-a. levels, in chronic liverdisease, but it is n certain that the production of TNF-a. in localinflammatory areas is so increased. Studies on the production of TNF-a. inthe liver may provide further insight on the pathogenesis of chronic liverdisease.