Use of Serum Vitamin B12 Level as a Marker to Differentiate Idiopathic Noncirrhotic Intrahepatic Portal Hypertension from Cryptogenic Cirrhosis

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• 作者：Ashish Goel (1)
  Banumathi Ramakrishna (2)
  Jayaprakash Muliyil (3)
  Kadiyala Madhu (1)
  K. G. Sajith (1)
  Uday Zachariah (1)
  Jeyamani Ramachandran (1)
  Shyamkumar N. Keshava (4)
  R. Selvakumar (5)
  George M. Chandy (1)
  Elwyn Elias (1) (6)
  C. E. Eapen (1)
  
• 关键词：Portal hypertension ; Nodular regenerative hyperplasia ; Cobalamin ; Hypocobalaminaemia
• 刊名：Digestive Diseases and Sciences
• 出版年：2013
• 出版时间：January 2013
• 年：2013
• 卷：58
• 期：1
• 页码：179-187
• 全文大小：443KB
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• 作者单位：Ashish Goel (1)
  Banumathi Ramakrishna (2)
  Jayaprakash Muliyil (3)
  Kadiyala Madhu (1)
  K. G. Sajith (1)
  Uday Zachariah (1)
  Jeyamani Ramachandran (1)
  Shyamkumar N. Keshava (4)
  R. Selvakumar (5)
  George M. Chandy (1)
  Elwyn Elias (1) (6)
  C. E. Eapen (1)
  
  1. Hepatology Department, Christian Medical College, Vellore, Tamil Nadu, 632004, India
  2. Pathology Department, Christian Medical College, Vellore, Tamil Nadu, 632004, India
  3. Department of Community Medicine, Christian Medical College, Vellore, Tamil Nadu, 632004, India
  4. Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
  5. Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, 632004, India
  6. Emeritus Professor, Liver Unit, University Hospital Birmingham, Birmingham, UK
  
• ISSN：1573-2568

文摘

Background and Aims Idiopathic non-cirrhotic intrahepatic portal hypertension (NCIPH) is often mis-diagnosed as cryptogenic cirrhosis. Serum vitamin B12 levels can be raised in cirrhosis, probably because of excess release or reduced clearance. Because NCIPH is characterised by long periods of preserved liver function, we examined whether serum B12 level could be used as a marker to differentiate NCIPH from cryptogenic cirrhosis. Methods We analysed serum B12 levels in 45 NCIPH and 43 cryptogenic cirrhosis patients from January 2009 to September 2011. Results Serum B12 levels were significantly lower in NCIPH patients than in cryptogenic cirrhosis patients (p?<?0.001) and were useful in differentiating the two disorders (area under ROC: 0.84; 95?% C.I: 0.76-.93). Low serum B12 level (?50?pg/ml) was noted in 25/72 (35?%) healthy controls, 14/42 (33?%) NCIPH patients, and 1/38 (3?%) cryptogenic cirrhosis patients. In patients with intrahepatic portal hypertension of unknown cause, serum B12 level?≤?50?pg/ml was useful for diagnosing NCIPH (positive predictive value: 93?%, positive likelihood ratio 12.7), and serum B12 level >1,000?pg/ml was useful in ruling out NCIPH (negative predictive value: 86?%, negative likelihood ratio: 6.67). Low serum B12 levels (?50?pg/ml) correlated with diagnosis of NCIPH after adjusting for possible confounders (O.R: 13.6; 95?% C.I:1.5-26.2). Among patients in Child’s class A, serum B12 level was ?50?pg/ml in 14/35 NCIPH patients compared with 1/21 cryptogenic cirrhosis patients (O.R: 13.3; 95?% C.I: 1.6-11). Conclusion Serum vitamin B12 level seems to be a useful non-invasive marker for differentiation of NCIPH from cryptogenic cirrhosis.