الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Liver cirrhosis which is now a major concern in the Middle East in general and specifically in Egypt is the end result of many chronic liver diseases, such as viral hepatitis, alcoholic liver disease, autoimmune hepatitis, and hemochromatosis. Knowing the major effects of such a condition, new markers, easier way to predict prognosis, effective management of the sequelae of cirrhosis, however, can decrease overall costs, reduce mortality, and maintain quality of life. Liver disease is progressive in response to chronic liver injury. This progression results in irreversible scarring and nodularity of the liver. This change in liver parenchyma interferes with blood flow through the liver, disrupting its biochemical function. This study aims to point at the relation between post-hepatitic cirrhosis and neutrophil dysfunction from the point of phagocytic index, also it‟s relation with the rise of leukocyte alkaline phosphatase score, which is an enzyme suggested to have role in the bactericidal activity of neutrophils and is known to be elevated in some hematological conditions such as polycythemia rubra vera, and decreases in CML, and either the rise of ammonia level in blood due to liver cirrhosis is related to these outcomes.
The present study was conducted on 80 patients, 60 patients are known hepatic caused by viral hepatitis divided according to Child Pugh classification into: Group (A): 20 patients in Child A stage, Group (B): 20 patients in Child B stage, Group (C): 20
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patients in Child C stage and Group (D): 20 control cases. Blood samples are withdrawn from all cases to assess the three tests of the study which are: Ammonia level, NAP score and neutrophil phagocytic index. As the liver is the organ responsible for ammonia metabolism and detoxification therefore with the decompensation of liver as it progress in course ammonia level was found to be remarkably elevated in cirrhotic patients plasma even in the earliest stages of liver cirrhosis with it‟s highest levels in Child (C) cases with the latest stage of cirrhosis, and increased ammonia level in blood is considered one of the important incriminated factors causing hepatic encephalopathy which is known as one of the most important complications of liver cirrhosis. Neutrophil alkaline phosphatase is an enzyme that is known to be affected by several hematological conditions that was found to be affected by liver cirrhosis and it‟s progress among different stages of the disease with the highest levels in Child (C) cases.which exposure With those two tests found to increase in level with the progress of the disease a correlation was found to be strongly positive showing directly proportional relationship between both tests which may point towards a new concept wether ammonia level elevation consequently elevates the neutrophil alkaline phosphatase and affects the NAP score and whether those two tests are dependable on eachother or it was just a coincidence that both increase in level with liver cirrhosis but they are independent.
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Also results showed that phagocytic index is not affected by the progress of the disease, and there was no positive correlation between ammonia level and phagocytic index, and these two results are still debatable as many studies stated the opposite that phagocytic index is affected by liver cirrhosis progress leading to hepatic patients‟ immunosuppression (as one of the causes of neutrophil dysfunction), and also other studies proved the opposite, whether the case was the technique of phagocytic index assay starting from sample withdrawal area, method, analysis and type of test. This study is considered as a step in many steps required tocomplete the started researches about this area concerning the effect of liver cirrhosis and it‟s progression on patients‟ immune system either directly or by inability to detoxify produced toxins during body metabolism that the diseased liver cannot handle anymore. Conclusion:
Liver cirrhosis as a condition represents a high burden condition, which affects a high percentage of the population worldwide. Liver cirrhosis has several etiologies and several effects on the human health. This study handled a part of the biochemical effects of liver cirrhosis that may help in future prediction of disease prognosis or makes the condition diagnosis much easier or even faster. By estimating levels of serum ammonia and NAP score that was found significantly increasing with the progress of the disease, an area that needs further workup on wider range and bigger sample size. Also concerning phagocytic index that was found unremarkably affected by liver
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cirrhosis in any of it‟s stages, also needs further workup on bigger sample size with different techniques. Meanwhile NAP score was found to be a test with high sensitivity, specificity and accuracy that can be used in the future as a predictive test for the disease status, a follow up marker or even a prognostic test. Recommendations:
Perform further studies and researches on the relationship between NAP score and liver cirrhosis, as it maybe a promising new marker points towards the progress of the disease or even a predictor for the disease prognosis.
Performing further investigations on the effect of ammonia level and NAP score and whether there is a direct relation between both tests, and whether it would be helpful in the management of the condition.
Assess whether by decreasing the ammonia level by medications in the patient‟s blood would affect the NAP score, and if that would play any role in the patient‟s immunity.
Make further researches on the neutrophil phagocytic index affection in cirrhotic patients with uniting the sample withdrawal site and method and the assay technique using a larger scale of patients to obtain a stable final conclusion or relationship between liver condition and neutrophil phagocytosis.
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Performing further studies on other neutrophil functions that are affected in posthepatitic cirrhosis patients such as intracellular killing, locomotion and chemotaxis to obtain a wider coverage of the immune condition of theses cases and howa to handle them.
Confirming whether there is a direct relation between ammonia level and neutrophil phagocytic index or not, by further studies and researches.
Assessing these factors more specifically on larger sample size to obtain more accurate results, also using different techniques to avoid opposing results.
Implementing the NAP score as a new marker, diagnostic, prognostic factor for the liver disease condition.