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Detection of pre-S2 and its antibody in serum from patients with fulminant type B hepatitis (FH-B)
INTRAVASCULAROESOPHAGEALVARICEALPRESSURE(IOVP) AND VARICEALBLEEDINGRISK
D.Taranto,N.Caporaso,R.Suozzo,M.Coltorti Istituto di Medicina Generale e Metodo1ogia Clinica - I Facolta di Medicina e Chirurgia- Universitd di Napoli
The endoscopic score of oesophageal hemorrhagic risk is the most common predictive index of rupture of oesophageal varices. However, this predictivity is not always accurate. The aim of this study was to evaluate whether IOVP can serve as an adjunctive parameter predictive of variceal bleeding. Methods:39 patients with liver cirrhosis (22 M; 17 F; median age 55 years) were studied. IOVP was evaluated according to Staritz et al. Results:l) IOVPwas 19+9 mmHg(mean + SD).2)IOVP significantly correlated with percentage of oesophageal lumen occupancy (r=O.57;P 0.01) and with the endoscopic score of the variceal hemorrhagic risk evaluated according to Beppu et al. (r=O.49;P 0.01). 3)Mean values of IOVP were s i g n i f i c a n t l y higher (P 0.01) in Child B and C patients than in Child A patients (23.4 and 23.6 vs 17.1 mmHg respectively).4)lOVP values were s i g n i f i c a n t l y higher in pat:ents with gastric varices (P O.01).5)Preliminary data show that a low endoscopic score ( -1.5) together with a high IOVP( 20 mmHg) has a high c o r r e l a t i o n with oesophageal variceal bleeding than each parameter alone. In c o n c l u s i o n : l ) IOVP is p o s i t i v e l y correlated w:th a)size of oesophageal varices b)endoscopic score of risk of variceal bleeding c ) e n t i t y of l i v e r damage evaluated according to Child-Pugh c r i t e r i a . 2) IOVP may add to the p r e d i c t i v e value of the endoscopic score of r i s k of variceal bleeding.
DETECTION OF PRE-S2 AND ITS ANTIBODY IN SERUM FROM PATIENTS WITH FULMINANT TYPE B HEPATITIS (FH-B). N.Tassopoulos 1, A.Budkowska2~ S.Hadzixannis3. Western A t t i c a General H o s p i t a l , Athens, Greece:zINSERM U 131, Clamart, France and 3Academic Dept. of Medicine, Hippokration General H o s p i t a l , Athens, Greece. Detection of pre-S 2 in serum from p a t i e n t s with benign acute hepat i t i s B is c o r r e l a t e d w e l l with the presence of a c t i v e r e p l i c a t i o n of HBV, whereas the appearance of a n t i - p r e - S 2 i s u s u a l l y followed by e l i m i n a t i o n of c i r c u l a t i n g HBsAg. We have tested by monoclonal antibody enzyme immunoassay f o r the presence of pre-S 2 and a n t i - p r e - S 2 16 serum samples c o l l e cted from 7 a d u l t p a t i e n t s with FH-B; a l l of them were IgM anti-BBc posit i v e . Of these 7 p a t i e n t s , four died of l i v e r f a i l u r e and the remaining 3 survived. On admission, 4 p a t i e n t s w e r e p o s i t i v e f o r both HBsAg and anti-HBs, 2 were p o s i t i v e only f o r anti-HBs and one was p o s i t i v e only f o r HBsAg. Three p a t i e n t s were p o s i t i v e f o r pre-S 2, 3 f o r a n t i - p r e - S 2 and one was negative f o r both of them. Pre-S 2 was detectable only in the presence of c i r c u l a t i n g HBsAg regardless of the coexistence of anti-HBs. In c o n t r a s t , a n t i - p r e - S 2 was demonstrated only in the presence of anti-HBs even in the absence of HBsAg. The outcome of FH-B appeared to be unrelated to the p r e - S 2 / a n t i - p r e - S 2 s t a t u s . These data i n d i c a t e t h a t : (a) immune reactions to pre-S 2 epitope seem to be unrelated to the pathogenesis of FH-B and (b) the presence of c i r c u l a t i n g pre-S 2 peptide and i t s antibody lacks of prognostic s i g n i f i cance.
$184
D.Taranto,N.Caporaso,R.Suozzo,M.Coltorti Istituto di Medicina Generale e Metodo1ogia Clinica - I Facolta di Medicina e Chirurgia- Universitd di Napoli
The endoscopic score of oesophageal hemorrhagic risk is the most common predictive index of rupture of oesophageal varices. However, this predictivity is not always accurate. The aim of this study was to evaluate whether IOVP can serve as an adjunctive parameter predictive of variceal bleeding. Methods:39 patients with liver cirrhosis (22 M; 17 F; median age 55 years) were studied. IOVP was evaluated according to Staritz et al. Results:l) IOVPwas 19+9 mmHg(mean + SD).2)IOVP significantly correlated with percentage of oesophageal lumen occupancy (r=O.57;P 0.01) and with the endoscopic score of the variceal hemorrhagic risk evaluated according to Beppu et al. (r=O.49;P 0.01). 3)Mean values of IOVP were s i g n i f i c a n t l y higher (P 0.01) in Child B and C patients than in Child A patients (23.4 and 23.6 vs 17.1 mmHg respectively).4)lOVP values were s i g n i f i c a n t l y higher in pat:ents with gastric varices (P O.01).5)Preliminary data show that a low endoscopic score ( -1.5) together with a high IOVP( 20 mmHg) has a high c o r r e l a t i o n with oesophageal variceal bleeding than each parameter alone. In c o n c l u s i o n : l ) IOVP is p o s i t i v e l y correlated w:th a)size of oesophageal varices b)endoscopic score of risk of variceal bleeding c ) e n t i t y of l i v e r damage evaluated according to Child-Pugh c r i t e r i a . 2) IOVP may add to the p r e d i c t i v e value of the endoscopic score of r i s k of variceal bleeding.
DETECTION OF PRE-S2 AND ITS ANTIBODY IN SERUM FROM PATIENTS WITH FULMINANT TYPE B HEPATITIS (FH-B). N.Tassopoulos 1, A.Budkowska2~ S.Hadzixannis3. Western A t t i c a General H o s p i t a l , Athens, Greece:zINSERM U 131, Clamart, France and 3Academic Dept. of Medicine, Hippokration General H o s p i t a l , Athens, Greece. Detection of pre-S 2 in serum from p a t i e n t s with benign acute hepat i t i s B is c o r r e l a t e d w e l l with the presence of a c t i v e r e p l i c a t i o n of HBV, whereas the appearance of a n t i - p r e - S 2 i s u s u a l l y followed by e l i m i n a t i o n of c i r c u l a t i n g HBsAg. We have tested by monoclonal antibody enzyme immunoassay f o r the presence of pre-S 2 and a n t i - p r e - S 2 16 serum samples c o l l e cted from 7 a d u l t p a t i e n t s with FH-B; a l l of them were IgM anti-BBc posit i v e . Of these 7 p a t i e n t s , four died of l i v e r f a i l u r e and the remaining 3 survived. On admission, 4 p a t i e n t s w e r e p o s i t i v e f o r both HBsAg and anti-HBs, 2 were p o s i t i v e only f o r anti-HBs and one was p o s i t i v e only f o r HBsAg. Three p a t i e n t s were p o s i t i v e f o r pre-S 2, 3 f o r a n t i - p r e - S 2 and one was negative f o r both of them. Pre-S 2 was detectable only in the presence of c i r c u l a t i n g HBsAg regardless of the coexistence of anti-HBs. In c o n t r a s t , a n t i - p r e - S 2 was demonstrated only in the presence of anti-HBs even in the absence of HBsAg. The outcome of FH-B appeared to be unrelated to the p r e - S 2 / a n t i - p r e - S 2 s t a t u s . These data i n d i c a t e t h a t : (a) immune reactions to pre-S 2 epitope seem to be unrelated to the pathogenesis of FH-B and (b) the presence of c i r c u l a t i n g pre-S 2 peptide and i t s antibody lacks of prognostic s i g n i f i cance.
$184