الفهرس 
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Abstract
It has become apparent that hepatitis C virus (HCV) infection is a major health problem worldwide particularly in developing countries like Egypt. The diagnosis of liver diseases caused by the infection is by taking a tissue (biopsy) sample from the liver using a needle, and examining it histopathologically, but this technique was hampered by many limitations and contraindications. One trial to replace liver biopsy with a simple blood test(s) (whose levels can reflect the severity of liver disease) is the present study.
The present study was done on 72 cases (62 fibrotics and 10 hepatocellular carcinomas; HCCs) who referred to the Early Cancer Detection Unit for liver biopsy assessment. Their sera were tested for liver enzymes (alanine aminotrasferase [ALT], aspartate aminotransferase [AST] and AST/ALT ratio), HCV viraemia and type, matrix metalloproteinase-9 (MMP-9) and alpha fetoprotein (AFP). The relationships between the values of these serum tests and the stages of liver fibrosis or the presence of HCC were studied in this work.
The results of this study showed the following;
The serum ALT level at 60 U/L is indicative of significant fibrosis in 81%. Serum AST level at 130 U/L is indicative of significant fibrosis in 88%. However, the transaminases levels can’t differentiate, at any level between cancerous and non-cancerous lesions. The transaminases ratio (AST/ALT) at a cut off value 1.0 reflects significant fibrosis in 93% of patients but can’t differentiate between cancerous and non-cancerous lesions. Similarly, the serum level of MMP-9 is diagnostic at a level of 160 mg/dl or less for severe fibrosis in 87% of patients but not for HCC. On the other hand the level of AFP at 1000 ng/ml or more is diagnostic for cancerous lesions in 90% of patients but cannot differentiate at any level between mild and significant fibrosis.
Unfortunately, the HCV level of viraemia and type did not affect the severity of liver disease.
Finally, the age of the patient at biopsy was found to correlate positively with liver disease. The significant fibrosis was found in 81% of patients aged 45 years or more. While, at a cut off value of 55 years, age at biopsy is diagnostic for HCCs in 88% of patients with a specificity of 71%. On the other hand, the sex of the patient has no effect on severity of liver disease.
In conclusion, there is no single blood test whose value can predict the severity of liver diseases in HCV infection with 100% accuracy but the use of the above significant serum parameters together with age of the patient can help exclude the need for liver biopsy in many patients, at least those with contraindications for liver biopsy or those refuting this investigation.