SummaryThe histological assessment of a liver biopsy specimens remains the ’’gold standard” for quantifying fibrosis with increasing interest in the use of non-invasive markers to avoid the risks of percutaneous biopsy. Understanding the mechanisms underlying hepatic fibrosis makes effective antifibrotic therapy an emerging. Therapies will have to be well tolerated over decades, with a good targeting to liver and few adverse effects on other tissues.The usefulness of non invasive markers to predict the degree of liver fibrosis or liver cirrhosis, and using colchicine as an antifibrotic treatment in liver fibrosis or cirrhosis requires further investigation.The present study has aimed at studying the role of colchicine in liver fibrosis and cirrhosis, and the role of image analysis technique in the precise quantification of fibrous tissue in liver biopsy. Also to asses the predictive values of serum aminotransferase values and platelet count on the histological finding in patients with chronic liver disease, whether they are related to severity of liver injury in chronic liver disease.This study comprised 56 subjects suffering from chronic viral hepatitis B or C with different degrees of hepatic fibrosis and cirrhosis. Their ages ranged from 19-55 years (mean age 33.46±8.5). They were selected from those patients attending the outpatients clinic and inpatients ward of Tropical Medicine department, Zagazig University Hospital.The studied cases were classified into three groups:1. Group 1 chronic HCV with colchicine therapy: included 30 cases (53.6%), they were 19 males (63.3%) and 11 females (36.7%), their ages ranged from 19-49 years with mean age (32.90±8.06).2. Group 11 chronic HBV with colchicine therapy : included 12 cases (21.4%), they were 5 male (41.7%) and 7 females (58.3%), their ages ranged from 28-55years with mean age of (37.50±8.83).3. Group 111 (control group) chronic hepatitis B or C with placebo therapy : included 14 cases (25.0%), they were 10 males (71.4%) and 4 females (28.6%) , their ages ranged from 22-44 years with mean age of (31.21±8.56).All cases were subjected to the following :- Careful history taking and general examination.- The following investigation were performed to all cases.1) Complete blood picture.2) Prothrombin time and activity determined by using thermboreels.3) Liver function tests:- Serum bilirubin (Billing et al; 1971).- Serum albumin using kits provided by BioMérieux Co. France(Doumas, 1971).- Serum ALT and AST (Reitman and Frankel, 1957).4) Abdominal Ultrasound which was performed to study the size and pattern of liver, spleen, portal system and presence or absence of ascites.5) Liver biopsy to detect the degree of fibrosis by- METAVIR system- Image analysisColchicine was given to all cases in group 1 and group 11 0.5 g twice daily for 6 months, and placebo was given to all cases of group 111 (control group) then reevaluation was done by the following investigations.- Complete blood picture.- Prothrombin time and activity- Liver function tests: - serum bilirubin - serum albumin - serum ALT and AST - Liver biopsy to calculate the degree of fibrosis by- METAVIR system- Image analysisThe following results were obtained:1. No significant improvement of colchicine on fibrosis score(staging), HAI(grading), and image analysis % after 6 month of therapy.2. No significant improvement after treatment in colchicine therapy groups in the following blood variables; serum albumin, AST,ALT levels , prothrombin time, and WBCs count.3. No significant difference between colchicine groups and placebo group after 6 month of treatment as regard fibrosis score, HAI, and image analysis %.4. Extremely significant positive correlation between image analysis % and METAVIR system in all studied groups.5. Extremely significant positive correlation between METAVIR system and image analysis % and serum AST levels in chronic hepatitis C group, chronic hepatitis C or B group, and total studied cases and high significant positive correlation between METAVIR system and image analysis % and serum ALT levels in (chronic hepatitis C or B group, and total studied cases but no significant positive correlation in chronic hepatitis B group..6. High significant positive correlation between METAVIR system and image analysis % and AST/ALT ratio in chronic hepatitis C group, chronic hepatitis C or B group, and total studied cases but no significant positive correlation in chronic hepatitis B group.7. Significant negative correlation between METAVIR system and image analysis % and platelet count in chronic hepatitis C group, chronic hepatitis C or B group, and total studied cases.8. The mean AST/ALT ratio was >1 in patients with fibrosis stage 3 or 4 and <1 in patients with stage (0-2), and AST/ALT ratio was of significant difference among stages in different studied groups.9. The mean platelet count significantly decreased with fibrosis stage in the different studied groups.10. Extremely significant positive linear regression between AST/ALT ratio and METAVIR system and image analysis % in chronic hepatitis C group, chronic hepatitis C or B group, and total studied cases. This result indicated that AST/ALT ratio has a good positive predictive value as regard METAVIR system and image analysis % in chronic hepatitis C group, chronic hepatitis C or B group, and total studied cases.11. Extremely significant negative linear regression between platelet count and METAVIR system and image analysis % in (chronic hepatitis C group, chronic hepatitis C or B group, and total studied cases. This finding indicated that platelet count has a good negative predictive value as regard METAVIR system and image analysis % in chronic hepatitis C group, chronic hepatitis C or B group, and total studied cases.12. Patients with fibrosis stages 3 and 4 had AST/ALT ratio ≥1 and platelet count < 150,000/mm3, and patients with fibrosis stages 0 - 2 has AST/ALT ratio<1 and platelet count > 150,000/mm3.Conclusion• Colchicine has no statistically significant effect on improvement of histological fibrosis staging in chronic viral hepatitis C or B infection, these findings suggest that colchicine alone might not be used for viral liver fibrosis or cirrhosis outside randomized clinical trials.• The computerized image analysis is a sensitive method of liver fibrosis. This method is reproducible, can detect early as well as advanced fibrosis or cirrhosis, may prove to be best assessment of mild fibrosis, and may be more precise than semi-quantitative estimation of changes for monitoring fibrosis progression or regression during clinical therapeutic trials.• The AST/ALT ratio increase with liver histological progression. An AST/ALT ratio of ≥ 1 in combination with a platelet count of < 150,000 can predict advanced stage of fibrosis and cirrhosis in patients with chronic hepatitis C infection, in these patients, liver biopsy may not be necessary.Recommendations• Colchicine though has no significant role, it still should be tried combined with other modalities of treatment of liver fibrosis, because it is well known that Colchicine has antiinflamatory and antifibrotic effect in several diseases as Gout, Familial Mediterranean Fever, Schistosomal liver fibrosis and Primary Biliary Cirrhosis.• We recommend the use of image analysis technique in the interpretation of liver biopsy instead of the semiquantitative scoring systems, as it is a computerized technique and dos not depend on visual interpretation of the observer.PPT. On the other hand,