Homocysteine plasma levels in primary biliary cirrhosis (PBC)

Abstract number: P0429

Fedi S., Marcucci R., Paniccia R., Antonucci E., Manta R., Poli D., Coppo M., Biagini M. R., Surrenti C., Abbate R., Gensini G. F.

University of Florence, Italy

PBC patients are known to tolerate variceal bleeding fairly well. Recent evidence has shown thrombosis in the portal vein radicles of PBC patients and it was demonstrated that PBC patients were hypercoagulable on thrombelastography. Aims of this study were: (1) to evaluate the presence of a hypercoagulable state in PBC patients; (2) to investigate homocysteine plasma levels and its genetic and environmental determinants in this group of patients. We studied 51 consecutive patients (median age: 63 years, range: 20–76) with PBC, selected from the Gastroenterology Unit of Florence. 102 healthy subjects, age and sex-matched, recruited from the blood donors of our hospital, were used as controls. The hemostatic process in whole blood has been measured by the Sonoclot™ analysis. d-dimer (D-D), thrombin-anti-thrombin complex (TAT), Tissue Factor (TF) and Thrombomodulin (TM) plasma levels were evaluated using ELISA method. Homocysteine levels were detected by FPIA method. Sonoclot RATE values of PBC patients were significantly (P < 0.001) higher than in controls. In 26/51 (51%) patients the Sonoclot RATE value was higher than 95th percentile of controls (P < 0.001). Sonoclot TP values were significantly (P < 0.001) higher in PBC patients with respect to controls. Sonoclot TP was higher than 95th percentile of controls (P < 0.001) in 21/51 (41.2%) patients. In 9/51 (17.6%) and 11/51 (21.6%) PBC patients, TAT and D-D plasma levels were higher than 95th percentile of controls and the difference did not reach the statistical significance. TM and TF levels were significantly higher in patients than in controls (TM 23.7 (2.6–153.5) ng mL^-1 vs. 13.8 (7.6–23.1) ng mL^-1; TF 255.6 (81.4–1259.6) pg mL^-1 vs. 121.9 (24.8–466.1) pg mL^-1; P < 0.001). Hcy plasma levels, both in the fasting state and postmethionine loading, were significantly higher in patients than in controls (Fasting: 12.1 (1.5–58.8) mmol L^-1 vs. 9.9 (6.4–18.0) mmol L^-1; Post-methionine 30.1 (9.2–99.6) mmol L^-1 vs. 28.0 (16.4–38.9) mmol L^-1, P < 0.001). As a whole, hyperhomocysteinemia was diagnosed in 23/51 patients (45.1%). Vitamin deficiencies were detected in 45/51 patients (88.2%). The prevalence of the homozygous TT677 genotype was significantly higher in patients (31.4%) in comparison to controls (17.5%) (P < 0.05). In conclusion, we demonstrated the presence of high Hcy levels in PBC associated with a high prevalence of vitamin deficiencies, which may account for the hypercoagulable state found in these patients.