The indices determing the severity of the liver disease and evaluating the total functioning hepatic cell mass

Abstract

It has been well known that levels of blood coagulation factors decrease in various liver diseases and this decrease relates to the development of disseminate intravascular coagualtion (DIC). In the present study, serial dilution protamin sulfate (SDPS) test and hepaplastin (Hp) test were performed to evaluate the clinical role of the changes in blood coagulation factors in various liver diseases.Out of 65 cases of various liver disease, 5 cases including 3 of subacute hepatitis, 1 of hepatic cirrhosis and hepatic cancer, were positive for SDPS test. These five cases died shortly after the development of positive SDPS test, suggesting that development of DIC is the terminal event of severe liver diseases. PIVKA index, which is an index of circulating anticoagulant level, was not rel ated to the development of DIC in this study.Hp test, which represnts the total activity of factor II, VII and X, were decreased markedly in subacute hepatitis, moderately in liver cirrhosis, and slightly in classical acute hepatitis and chronic hepatitis, respectively. In intrahepatic cholestasis, values of Hp test were normal, despite of marked jaundice and elevation of serum transaminase activity. In acute hepatitis, values of Hp test were clossely related to the extent of hepatic cell necrosis. The levels of serum prealbumin, which is mainly produced in the liver and has rapidly turnover rate, showed similar change to that of Hp test and correlation between Hp test and serum prealbumin levels was significant statistically. In the hepatectomized rats, values of Hp test and the residual liver weigt were significantly correlated. These results suggested that Hp test or serum prealbumin level is an excellent index to evaluate the total functioning hepatic cell mass.At present time, there is no specific test to evaluate the total functioning hepatic cell mass, which is one of the most important factors to decide prognosis of liver disease. Determination of Hp test values and serum prealbumin level are essential for the treatment various liver diseases.