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Immune Alterations in Liver Cirrhosis: Its Relationship with Etiology,Child Pugh Stage and Malnutrition
Dr. Marlen I. Castellanos, Osvaldo R. Seijas, Dayamí González, Mercedes Ronquillo, Maria del Rosario Abreu, Sergio Ojeda
Background: Immune alterations in liver cirrhosis are variable and only a few have been correlated with the severity of the disease, malnutrition or its etiology.
Methods: A descriptive transversal study was carried out in 76 patients with liver cirrhosis predominantly of viral cause. According to the Child Pugh stage they were classified in A: 52, B:17 and C: 7. The anthropometric evaluation included mid-arm circumference, triceps and subscapular skinfold thickness. The humoral immune alterations were evaluated by assessing serum immunoglobulin (A, M, G and E) and the complement components’ C3 and C4. Cellular immunity integrated a total lymphocyte count and the delayed intradermal hypersensitivity test. The statistical analysis included Pearson’s Chi squared and non-parametric tests using the U Mann Whitney or Kruskal Wallis test.
Results: In the study group, the immunoglobulins were in normal range; however the complement components C3 and C4 showed a certain tendency to the inferior normal limit. Immunodeficiency was diagnosed in 28 patients (36.8%). Statistical comparisons showed that C4 complement component was the principal factor affected with the lower values in alcoholic and viral group, whereas for the alcohol group, IgE was found at higher titles. The major immunological dysfunction was in Child C stage, found it in 71.4%. Malnutrition was present in 63.2%, but the analysis of the humoral immunity indicators according to the nutritional state only reported significant differences in the C4 average values . A higher percentage of immunodepressed in the undernourished was reflected, in comparison to the non-malnourished.
Conclusion: In liver cirrhosis, the major contribution to the distorted immune response is the Child Pugh stage while the malnutrition maybe has a possible influence.