Abstract
Lysosomal acid lipase is an enzyme that intervenes in the last steps of lipid metabolism to hydrolyze cholesteryl esters. Patients with cryptogenic cirrhosis present a clear deficiency of lysosomal acid lipase with an unknown mechanism. Design: The present study has an analytical and retrospective design, of a sample of 55 patients with cryptogenic cirrhosis. The degree of association of lysosomal acid lipase was determined with the results of the enzymes alanine aminotransferase and alkaline phosphatase, as well as with the clinical manifestations of portal hypertension and splenic volume. The sensitivity and specificity of the test were determined for the diagnosis of the manifestations of portal hypertension. Results: The most frequent complication of portal hypertension was variceal hemorrhage with 40%, followed by ascites with 32.7%, and last, by hepatic encephalopathy, with 18.2%. Association by the x² test was without statistical significance with values of 0.177, 0.299, and 0.184 for encephalopathy, variceal hemorrhage, and ascites, respectively. The association of lysosomal acid lipase and splenic volume utilizing the Student t-test had a low degree of association and p >0.05. Through ROC curves, we obtained AUROC results close to 0.5. Conclusion: It is established that there is no correlation of the levels of activity of lysosomal acid lipase with the values of alanine aminotransferase and alkaline phosphatase, as well as with the presence or absence of clinical manifestations and by ultrasound of portal hypertension. Lysosomal acid lipase is not a good test for the diagnosis of the clinical manifestations of portal hypertension.
Highlights
Liver cirrhosis is considered a global public health problem with an increasing prevalence at a worldwide level, due to greater recognition of the diagnosis and the associated risk factors
The importance of the latter lies in that variceal hemorrhage is the complication associated with greater mortality; our patients have been documented with esophageal varices, classifying enlarged varices according to the classification of Baveno
According to the study published by Bernstein, et al patients with lysosomal acid lipase deficiency (LALD) are associated with a rise in ALT and AST [18], while in our results, mean ALT and alkaline phosphatase (ALP) were found increased: the diminution of the Lysosomal acid lipase (LAL) enzyme in patients with Cryptogenic cirrhosis (CC) had no correlation with the increase of ALT and ALP, concluding that the diminution of LAL does not entail the measurement of hepatic enzymes
Summary
Liver cirrhosis is considered a global public health problem with an increasing prevalence at a worldwide level, due to greater recognition of the diagnosis and the associated risk factors. Liver cirrhosis has an estimated prevalence in the North-American population of 0.27% [1] and a prevalence in the Latin population of chronic liver disease (CLD) of 61.1% [2]. CLD-associated mortality increased by 46% at the global level during the period comprising 1980-2010 and it is between the first 11 causes of death in American Journal of Internal Medicine 2021; 9(3): 142-147 some countries [3,4]. The main cause of liver cirrhosis in Mexico is alcoholic liver disease (ALD) and hepatitis C virus (HCV) infection [6, 7]. Cryptogenic cirrhosis (CC) was the third most frequent cause in 2004 in Mexico [7], at present with non-alcoholic steatohepatitis (NASH) the third most frequent cause with 23.3% [8]
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