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Abstract
Hepatitis C virus infection was considered a major health problem worldwide. The HCV infections are most commonly diagnosed by chance during clinical investigation and or biochemical testing of the liver functions or blood screening in blood banks. This is because the disease in many patients is asymptomatic and progressive silently. The preliminary diagnosis of the infection is by anti-HCV testing. However, HCV seropositivity does not usually mean a present or chronic infection because some patients cure without treatment and the presence of anti-HCV only reflects the immune reaction of those patients against the infection. The infection with HCV can be confirmed by HCV-RNA testing using the polymerase-chain-reaction (PCR) technique. This technique not only confirms persistent infection (qualitative measurement), but also quantify the viral load of HCV (quantitative measurement) The effect of HCV infection on the liver tissue can be assessed by taking a liver sample (biopsy) using a needle and examining the histopathological lesions caused by the virus. This method was considered as the ideal means for evaluating the necroinflammatory grades and fibrotic stages of the disease. Many authors recommended the routine performance of liver biopsy before initiation of antiviral therapy for chronic hepatitis C. The purpose of a pretreatment liver biopsy is to distinguish patients most likely to benefit from therapy (i.e., those with advanced stages of fibrosis) from patients who may be less likely to benefit (i.e., those with minimal or no portal fibrosis). In other words, only patients with significant fibrosis (METAVIR stages F2, F3 and F4) should be considered for antiviral therapy. But the technique of taking liver biopsy is hampered by several risks including pain, hemorrhage and death. Furthermore, the high coast and technical experiences beside the different contraindications limited the routine use of liver biopsy. Hence, there is an urgent need for non-histological tests that can reflect the severity of liver diseases in HCV infected patients. The present study tried to estimate the relationship between some selected serum markers [ alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST/ALT ratio, matrix metalloproteinase 9 (MMP9) and alphafetoprotein (AFP)] and the stage of fibrosis and/or liver cancer in 72 cases referred to the Early Cancer Detection Unit for liver biopsy assessment. The level of serum ALT and AST concentrations was estimated using an automated system according to the manufacturer’s instructions. The concentration of serum MMP-9 was determined by the application of an enzyme immunoassay, while that of AFP was estimated by using the light immunoassay technique following the manufacturer’s instructions. In addition, the effect of host characteristics (age at liver biopsy and sex) and the viral characteristics (viral load and type of the virus) on the severity of liver disease were studied. The viral load was assayed using the real-time PCR technique, while the viral serotypes were determined by using the commercial HCV serotyping 1-6 assay (Murex diagnostics corporation, UK), and the tests were performed according to the manufacture’s instructions. The usefulness of the selected markers was estimated by calculating the sensitivity and specificity of the test in differentiating between significant and non-significant fibrosis and between cancerous and non-cancerous lesions.