الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
A total of 70 cirrhotic patients were selected from 97 patients attending the outpatient clinic and/or inpatient of Hepatology and Gastroenterology unit at Shebin Elkom Teaching Hospital in the period between April to October 2013. They were 23females and 47 males and their ages ranged from 27 to 62 years with a mean of 48.7 ± 7.1 years. A 10 healthy persons of matched age and sex were also selected as a control group. Patients were diagnosed as having liver cirrhosis based on clinical examination, ultrasonographic findings and laboratory investigations.Patients and control subjects were divided into the following groups: Group I : Included the 70 patients with liver cirrhosis. They were subdivided into 3 subgroups according to Child – Pugh scoring system: Group Ia: comprised 15 patients with liver cirrhosis of Child – Pugh class A. Group Ib: comprised 15 patients with liver cirrhosis of Child – Pugh class B. Group Ic: comprised 40 patients with liver cirrhosis of Child – Pugh class C. Group II: Included the 10 healthy control subjects.The aim of this work was to study the serum level of TNF- in patients with liver cirrhosis and to determine the possible relation between TNF- and various complications that may occur in these patients.For this purpose, all patients and control subjects were subjected to thorough history taking, clinical examination, laboratory investigations including liver function tests, kidney function tests, serum electrolytes, hepatitis markers (HBsAg & HCV Ab) and measurement of serum level of TNF- in addition to abdominal ultrasonography.Statistical analysis revealed that: There was no statistically significant difference between studied groups regarding age and gender. The clinical evidences of cirrhosis were present in various proportions in cirrhotic subgroups. HCV infection was the most common cause of liver diseases in cirrhotic subgroups patients. There was a highly significant increase in the mean values of serum bilirubin and INR and highly significant decrease in the mean value of serum albumin in Child -Pugh class C group in comparison to other groups and significant increase in the mean values of ALT and AST levels in Child -Pugh class B and C groups in comparison to other groups. There was a highly significant decrease in the mean value of platelet count and significant decrease in the mean value of hemoglobin in Child-Pugh class C group. Ultrasound evidence of liver cirrhosis were present in different cirrhotic subgroups. There was a highly significant increase in the mean value of serum TNF-α in liver cirrhosis group in comparison to control group. There was a highly significant positive correlation between serum level of TNF- and Child - Pugh score in cirrhotic subgroups. There was a highly significant increase in the mean value of serum TNF-α in encephalopathic patients in comparison to non encephalopathic patients in cirrhotic subgroups. There was significant positive correlation between clinical grades of HE (according to West Haven criteria) & TNF-α in cirrhotic subgroups patients. There was a significant increase in the number of patients who developed HE due to infectious complications (SBP and other infections) There was no statistically significant difference in the mean value of serum TNF-α in patients with HE due to infectious and non-infectious precipitating factors. Serum TNF-α was the only independent predictor for development of hepatic encephalopathy, whereas SBP and other infections were dependent risk factors. A cutoff point of TNF-α ≥ 38.1 pg/ml had a sensitivity of 88%, specificity of 75%, positive predictive value of 71% and negative predictive value of 86% in prediction of development of HE.