| Abstract: |
All subjects involved in the study were subjected to the following :-Full history taking and clinical examination .- Complete blood picture and liver & renal function tests .-Serological study of HCV-Ab and HbsAg.-Abdominal ultrasonography.-Liver biopsy and histopathological study.-Measurements of serum hyaluronic acid , neopterin and procollagen III peptide.The study showed that :There was highly significant elevated serum HA, neopterin and PIIIP in patients with active cirrhosis compared to precirrhotic patients.Serum HA as a serum marker of fibrosis was superior than serum neopterin and PIIIP in differentiating active cirrhosis from chronic hepatitis.There was non significant difference between serum HA& neopterin& PIIIP and Child-pugh’s score .There was significant elevated serum levels of HA and neopterin in patients with +ve HCV-Ab and non significant difference in serum levels of PIIIP in both groups .There was non significant elevation in serum levels of HA ,neopterin and PIIIP in patients with mixed infection of HCV or HBV with schistosomiasis than patients with VHC or VHB.There was highly significant elevated serum levels of HA, neopterin and PIIIP in patients with HCC than controls, this could be as most of the patients with HCC had various stages of histopathological activity.There was significant correlation between serum HA, and liver function tests in patients with chronic hepatitis and active cirrhosis. There was significant correlation between serum neopterin and PIIIP and some parameters of liver function tests in most of patients with chronic liver disease. There was non significant correlation between serum HA, neopterin and PIIIP and liver function tests in patients with HCC.Sensitivity, specificity of HA ,neopterin ,PIIIP and abdominal ultrasonography to differentiate active cirrhosis from other histopathological grades were detected .At cut-off value of 83 ug/L,serum HA could differentiate between patients with active cirrhosis and chronic hepatitis with sensitivity of 84.6%, specificity of 62.1% and accuracy of 69% . This was superior to neopterin , PIIIP ,and ultrasonography. Ultrasonography had sensitivity of 53.8 %, specificity of 72.4 % and accuracy of 66.6%.From this work we can conclude that :1-Serum markers of fibrosis as HA , neopterin and PIIIP could be indicators of fibrosis in chronic liver disease .They can be helpful in differentiating liver cirrhosis from chronic hepatitis.2-HA is the best marker for diagnosing liver cirrhosis than neopterin and PIIIP.3-Co-infection with schistosomiasis in patients with chronic viral liver disease could be a risk factor in the development of chronic hepatitis and cirrhosis.4-Serum HA is superior than ultrsonography to diagnose liver cirrhosis , and when serum HA used in addition to ultrsound, it could increase the value of ultrsound to diagnose liver cirrhosis.RECOMMINDATIONS1-In the clinical setting , determination of serum HA levels to be used for following fibrosis process and differentiating chronic hepatitis from cirrhosis and to be used in the management in patients having contraindication or refuse liver biopsy and to limiting the number of liver biopsies during follow up.2-Application of serum markers of fibrosis especially HA in combination to ultrasound as a non invasive tools for diagnosing hepatic cirrhosis, and to discriminate precirrhotic grades of chronic liver disease.
|
|
|