Homocysteine and endothelial markers are increased in patients with chronic liver diseases

Background: Hyperhomocysteinaemia is a disorder of methionine metabolism, in which a liver plays a role. It may be frequently due to nutritional deficiencies, particularly low folate status. The aim of the study was to evaluate the serum concentration of homocysteine (Hcy) in patients with chronic liver diseases (CLD), and to assess the relation between Hcy, folate levels, and endothelial markers. Methods: Seventy-one patients with CLD and 51 healthy subjects of similar sex and age were investigated. There were 19 patients with steatosis and 52 patients with fibrosis/cirrhosis, classified by the Child-Pugh score as groups A, B and C. Fasting serum Hcy and folate levels were measured by the IMx diagnostic system (ABBOTT, USA). Plasma thrombomodulin (TM) and von Willebrand factor (vWF) as markers of endothelial dysfunction/damage were determined by ELISA methods. Results: A significant increase of Hcy in all groups of patients with CLD was found: steatosis (P=0.0036), fibrosis/cirrhosis - groups A, B and C (P=0.0067, P<0.0001, P=0.0005, respectively). No significant changes of serum folate in CLD patients were observed, but there was an inverse correlation between Hcy and folate concentrations (r(2)=0.1076, P=0.0003). A significant increase of endothelial markers in CLD patients was found: TM in steatosis (P=0.029), fibrosis/cirrhosis - group A (P=0.0010), groups B and C (P<0.0001, respectively), vWF in fibrosis/cirrhosis - group A (P=0.0003), groups B and C (P<0.0001, respectively). No significant correlation between serum Hcy and endothelial markers was observed. Conclusion: Hyperhomocysteinaemia and abnormalities of endothelial function are demonstrated in CLD patients. The impairment of liver metabolism and local changes in vessel integrity are supposed to play a main role. (C) 2009 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.