Endothelium Derived Microparticles: A Reliable Biomarker for Detection of Portal Hypertension in Chronic Hepatitis C Patients

摘要

Vascular endothelium plays a pivotal role in the pathogenesis of numerous chronic disorders. Cirrhosis is associated with enhancedendothelial dysfunction and increased intrahepatic vascular tone due to imbalance in equilibrium between endothelium derived relaxing andcontracting factors. We aimed to clarify the contribution of endothelial dysfunction in the mechanism of portal hypertension in chronic liverdisease [CLD] patients and to evaluate the clinical utility of endothelial dysfunction markers for detection of portal hypertension. Forty fivepatients were the subject of this study classified according to Child-Pugh classification into 3 groups (15 each).Patients were furtherclassified into 2 groups according to the presence or absence of portal hypertension (30 and 15 patients respectively) in addition to 15healthy subjects serving as a control group. Endothelial dysfunction was assessed by measurement of soluble thrombomodulin (sTM), vonWillebrand factor (vWF), soluble E-selectin (sE-selectin) and quantitative assay of CD31+/CD42- endothelial microparticles (EMPs).Results revealed evidence of endothelial dysfunction reflected by increased levels of sTM, vWF, sE-selectin and EMP which were moreevident with progression of the disease, particularly in Child C group. Moreover, statistically significant higher levels of sTM, vWF andEMP were identified in patients with portal hypertension compared to those without portal hypertension. Statistical analysis proved thatEMPs assay is the most sensitive (96.67%) and specific (93.33%) biomarker for prediction of portal hypertension. In conclusion endothelialdysfunction is a major determinant of portal hypertension in CLD patients. EMPs have been identified as a reliable non invasive laboratorymarker for the detection of portal hypertension in those patients.