Study of Liver Function and Lipid Profile Changes in Iraqi Cirrhotic patients
Jinan Hussein Murtadha, Iman Hashim, Abdul Razzaq
Department of Chemistry, College of Science for Women, University of Baghdad, Iraq.
*Corresponding Author E-mail: jinanalmosawi@gmail.com
ABSTRACT:
Cirrhosis is a
complication of many liver disease characterized by abnormal structure and
function of the liver. The aim of this study is to investigate the liver
function levels by measuring Glutamate Oxaloacetate Transaminase (GOT),
Glutamate Pyruvate Transaminase (GPT), Alkaline Phosphatase (ALP) and total
protein (T.P) and lipid profile levels by measuring total cholesterol (TC),
triglyceride (TG), low density lipoproteins (LDL) and high density lipoproteins
(HDL). Seventy five individuals of Iraqi adults (25 female and 50 male) were
divided into two groups: 25 normal individuals (10 female and 15 male) as
control group (group1), their age range (28-60) year and 50 cirrhotic patients
(20 female and 30 male), their age range (18-68) year and (35-72) year
respectively (group 2). In the present study, the mean value of GOT, GPT and
ALP activity were significantly higher in patients with cirrhosis disease than
healthy group (p 
0.01),
while the mean value of T.P. level was 6.21g/dl in cirrhotic patients compared
with healthy group 7.54g/dl. The findings indicate that serum (TC, TG, HDL and
LDL) levels were significantly decreased (P 0.01)
in cirrhotic Patients compared with healthy group. The results also indicate a
positive correlation between GOT and GPT, and between ALP and both (GOT, GPT).
Also, there was a positive correlation between TC and (TG, HDL and LDL) and
between TG and both (HDL, LDL). This study has shown that a significant
difference (P 0.05)
between male and female in the mean value of T.P and TC levels and also the
effect of duration of disease on Parameters was studied.
KEYWORDS: Cirrhosis, Dyslipidemia, Liver Function tests.
INTRODUCTION:
The aminotransferase levels observed in cirrhosis with the level of GOT activity are higher than GPT activity, elevations of both enzymes occur in patients with primary or metastatic carcinoma of the liver [4].
Blood tests used for initial assessment of liver disease include measuring of serum pyruvate and oxaloacetate transaminase (GPT and GOT) levels, alkaline phosphatase and others. The pattern of abnormalities generally points to hepatocellular versus cholestatic liver disease and helps to decide whether disease in acute or chronic and whether hepatic failure are present [5]. Cirrhosis is an advanced stage of liver fibrosis that is accompanied by distortion of the hepatic vasculature [6]. The affected regions of liver Parenchyma undergo unregulated deposition of the extracellular matrix resulting in the development of fibrosis [7], [8]. Patients with advanced liver disease and cirrhosis have subtle changes in laboratory values, typically falling within the normal range [9]. The liver plays an important role in the synthesis, secretion, catabolism and storage of lipid and lipoproteins. Therefore, the serum lipids and lipoproteins concentrations in liver disease could be changed [10].
Dyslipidemia seen in chronic liver disease differs from that found in most of the other causes of secondary dyslipidemia because circulating lipoproteins are not only present in abnormal amount but they also frequently have abnormal composition, electrophortic mobility and appearance [11]. Chronic liver disease due to various causes are often associated with dramatic reductions in plasma triglyceride and cholesterol level due to reduced lipoprotein biosynthetic capacity. Cholestasis is associated with hyper cholesterolemia as the major excretory pathway of cholesterol is blocked in this disorder [12]. Present study was conducted to fined the comparative levels of liver related enzymes and lipid profile levels among cirrhosis of liver.
MATERIALS AND METHODS:
This study was carried out in the Gastrointestinal and Liver Hospital- Medical City/Baghdad. Seventy five individuals (25 female and 50 male) were divided into two groups: Group (1) : 25 individuals (10 female and 15 male) as control group (healthy group) their age range (28-60) year and cirrhotic patients (group 2), 20 female their age range (18-68) year and 30 male their age range (35-72) year. All of the individuals were having blood to measure serum liver enzyme tests such as alkaline phosphatase (ALP), glutamate oxaloacetate transaminase (GOT),glutamate pyruvate transaminase (GPT) and total protein (T.P) and lipid profile tests such as total cholesterol (TC), triglyceride (T.G), high density lipoprotein (HDL) and Low density lipoprotein (LDL).
3ml venous blood were obtained by using a disposable plastic syringe. The samples were Centrifuge at 3000 rpm for l0 min to obtain serum samples. The separated serum samples were analyzed for liver function tests. Serum ALP, GOT, GPT were determined by enzymatic assay and total protein test were determined by Biuret method, lipid profile tests were analyzed by using different reagent kits depending on the manufactured procedure. Serum TC was determined by using enzymatic (cholesterol esterase), triglyceride was done by using (lipoprotein Lipase) kinetic method, LDL was determined using the Fried Wald method [13] and HDL was don using enzymatic method [14].
Statistical analysis:
The Statistical Analysis System ــSAS (2012) program was used to study the effect of difference factors on parameters studied. Least significant differences LSD test was used to compare between mean values of the parameters. Also, in this study was estimate of correlation coefficient between variables. [15].
RESULTS AND DISCUSSION:
In table (1) shows
the effect of cirrhosis disease on liver function tests, there is a significant
difference (p0.01)
in the mean value of serum alkaline phosphatase (ALP), glutamate pyruvate
transaminase (GPT) and glutamate oxaloacetate transaminase (GOT). The mean
value of ALP activity reached to (197.83 ± 24.92) U/L compared with Control
(66.94± 3.14) U/L. Serum GOT and
GPT activity were (80.93 ± 8.51, 62.80 ± 6.89) U/L respectively in cirrhotic
patients compared with control (26.42 ± 1.26, 24.89 ± 1.10) U/L respectively.
In the same table, the mean value of total protein was decreased in cirrhotic
patients compared with control (healthy group) (p ≤ 0.01).
|
Parameters |
Mean ± Standard Error (Mean ± SE) |
|||
|
Groups |
ALP (U/L) |
GOT (U/L) |
GPT (U/L) |
T.P(g/dl) |
|
Patients (No. =50) |
197.83± 24.92 |
80.93 ±8.51 |
62.80± 6.89 |
6.21± 0.18 |
|
Control (No. =25) |
66.94± 3.14 |
26.42± 1.26 |
24.89± 1.10 |
7.54± 0.20 |
|
LSD value |
63.43 ** |
21.74** |
17.57** |
0.56** |
(P ≤ 0.01) **
The results presented in table (2) show, the effect of cirrhosis Table (1): Effect of cirrhosis on liver function levels. on lipid profile tests such as TC, TG, HDL and LDL (p ≤ 0.01). The data indicate that elevation in the mean value of all parameters in the patients compared with control. The mean value of TC, TG, HDL and LDL were reached to (98.67 ± 5.21, 65.50± 5.24, 36.33±3.71 and 46.67 ±3.64) mg /dl respectively.
Table (2): comparison of lipid profile levels between cirrhotic patients and healthy group (control).
|
Parameters |
Mean ± Standard Error (Mean ± SE) |
|||
|
Groups |
TC (mg/dl) |
TG (mg/dl) |
HDL (mg/dl) |
LDL (mg/dl) |
|
Patients (No. 50) |
98.67± 5.21 |
65.50± 5.24 |
36.33± 3.71 |
46.67± 3.64 |
|
Control (No. 20) |
160.94± 4.51 |
122.63± 4.64 |
86.00± 6.38 |
106.21± 5.17 |
|
LSD value |
15.04 ** |
15.22** |
13.84** |
12.39** |
(p ≤ 0.01)**
The results in table (3) indicate that, there is a strong correlation between ALP and GOT (r=0.66**, P≤ 0.01) and with GPT (r=0.57**, P≤ 0.01). Also, there is a positive correlation between GOT and GPT (r=0.84**, P≤0.01). As shown in the same table, a positive correlation between TC and (TG, HDL and LDL) (P≤ 0.01) and there is a positive correlation between TG and HDL (r=0.58** P≤ 0.05) and with LDL (r =0.67**, P≤ 0.05), while there is a negative correlation between T.P and (GOT, ALP) levels.
Table (3): The correlation coefficient between parameters studied in cirrhotic patients
|
Parameters |
Correlation coefficients |
Significant level |
|
ALP and GOT |
0.66 |
** |
|
ALP and GPT |
0.57 |
** |
|
ALP and T.P |
-0.34 |
* |
|
GOT and GPT |
0.84 |
** |
|
GOT and T.P |
-0.39 |
** |
|
TC and TG |
0.44 |
** |
|
TC and HDL |
0.54 |
** |
|
TC and LDL |
0.66 |
** |
|
TG and HDL |
0.58 |
** |
|
TG and LDL |
0.67 |
** |
(p ≤ 0.05)*, (p ≤ 0.01)**
The statistical results in table (4) show, there is a significant difference (p ≤ 0.05) between male and female in the mean value of T.P and TC levels. Also, the results indicate that, there is no effect of sex on (ALP, GOT, GPT, TG, HDL and LDL) levels in cirrhotic patients
Table (4): Effect of sex on ALP, GPT, GOT, T.P, TC, TG, HDL and LDL in cirrhotic patients
|
parameters |
Mean ± Standard error (Mean ±SE) |
||
|
Male |
Female |
LSD value |
|
|
ALP (U/L) |
175.78 ±17.18 |
230.91 ± 56.94 |
106.44 NS |
|
GOT (U/L) |
81.94 ±9.54 |
79.41 ± 16.36 |
34.67 NS |
|
GPT (U/L) |
60.00 ± 9.30 |
67.00 ±10.47 |
30.01 NS |
|
T.P (g/dl) |
6.69 ± 0.21 |
5.50 ± 0.23 |
0.670* |
|
TC (mg/dl) |
110.61 ± 6.34 |
80.75 ± 6.07 |
16.95* |
|
TG (mg/dl) |
61.89 ± 5.82 |
70.91 ± 9.90 |
22.56 NS |
|
HDL (mg/dl) |
39.44 ± 4.18 |
31.67 ± 6.84 |
16.01 NS |
|
LDL (mg/dl) |
47.27 ± 3.51 |
45.75 ± 7.67 |
14.51 NS |
(P≤ 0.05)*, NS: Non – significant
Table (5) shows, the effect of duration of cirrhosis on liver function levels and lipid profile levels. The results found that, there is a significant difference (p £0.05) in the mean value of GOT and TC in the cirrhotic patients. The mean value of GOT reached to (105 ±21.32) U/L in duration of disease less than l year compared with (68.90 ± 6.07) U/L in duration of disease more than l year and the mean value of TC reached to (79.20 ± 8.53) mg/dl in duration of disease less than l year compared with (108.40 ± 5.47) mg/dl in duration of disease more than l year . The results show, there is no significant difference between two duration of disease in (ALP, GPT, T.P, TG, HDL and LDL) levels.
Table (5): Effect of two duration of disease on liver function and lipid profile level
|
Parameters |
Meant± Standard Error (Mean ±SE) |
||
|
Less than l year |
More than l year (2 -12) year |
LSD value |
|
|
ALP (U/L) |
253.50±55.78 |
179.00 ± 250.07 |
110.62 NS |
|
GOT (U/L) |
105.00±21.23 |
68.90 ± 6.07 |
36.03* |
|
GPT (U/L) |
70.40±51.78 |
59.00 ±6.88 |
31.18 NS |
|
T.P (g/dl) |
5.90 ± 0.23 |
6.37 ± 0.25 |
0.697 NS |
|
TC (mg/dl) |
79.20±8.53 |
108.40 ± 5.47 |
17.61* |
|
TG (mg/dl) |
60.70±9.18 |
67.90 ± 6.48 |
23.45 NS |
|
HDL (mg/dl) |
32.70±6.55 |
38.51 ± 4.55 |
16.63 NS |
|
LDL (mg/dl) |
43.20 ± 8.22 |
48.40 ± 3.73 |
15.07 NS |
(P≤ 0.05)*, NS: Non – significant
According to our results, the serum liver enzymes activity are raised in cirrhotic patients comparison with healthy group. These results agree with Essam et al [16]. Cirrhosis can cause increased pressure in the portal vein that carries blood from the gut and the spleen to the liver, this is called portal hypertension. When this develops, the spleen becomes engorged with blood and consumes platelets and may be the first indicator of chronic liver disease [17]. Deranged liver function tests are common problem and their interpretation is complicated by the production of liver enzymes from multiple organs and lack of specify for marker of liver function, raised ALP reflects biliary tree injury and cholestasis, whereas raised GOT and GPT Levels reflect hepatocyte injury [18]. An increased GOT/OPT ratio in patients with increased serum aminotransferase has also been associated with the development of cirrhosis in nonalcoholic steatohepatitis [19]. Elevated transaminase activities are considered as an index marker of hepatotoxicity, linked to oxidant stress [20]. Also, this study shows a significant decrease in the mean values of serum TC, TG, HDL and LDL levels in cirrhotic patients compared with control group, these results agree with Nangliya et at [21]. Serum lipid profile levels in patients with cirrhosis are inversely related to severity of disease [22]. Mandal et al [23], were showed that a significant decrease in lipid profile levels. Jitendra et al [24] ,were found that serum lipid profile changes in liver cirrhosis patients in comparison to age and sex matched apparently healthy control. The liver plays a central role in regulating the synthesis, degradation and storage of cholesterol and lipoproteins. TC and lipoproteins have been showed to decrease with the progression of fibrosis and farther with the onset of cirrhosis, this change in lipid levels can be used to estimate prognosis of cirrhotic patients [25]. A reduction in TC levels is believed to be a consequence of decreased synthesis or partial blockage of the same esterification processes, likely due to decline in the production of the enzyme ACAT (Acyl coA: Cholesterol acyl transferees)[26]. The formation of LDL is directly related to the production of VLDL and when the metabolism of this lipoproteins is impaired, the other downstream lipid functions also undergo changes [27].
CONCLUSION:
The routine use of serum biochemical tests allows for the detection of acute and chronic liver injury before the onset of symptoms. These tests consist of markers hepatocellular injury (amino- transferase and Alkaline phosphatase) and tests of Liver synthetic function (serum total protein). Also, dyslipidemia is a common finding in Liver cirrhosis, Lipid profile should be advised in all cases with liver cirrhosis.
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Received on 03.07.2019 Modified on 03.10.2019
Accepted on 10.11.2019 © RJPT All right reserved
Research J. Pharm. and Tech. 2020; 13(4):1837-1840.
DOI: 10.5958/0974-360X.2020.00331.5