الفهرس 
Hepatitis C Virus InfectionOnly 14 pages are availabe for public view
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Abstract
The World Health Organization (WHO) estimates that
>185 million people worldwide or 2.8% of the human
population have been infected with HCV; of these 130–170
million are chronically infected and 350,000 deaths occur each
year as a result of HCV-related cirrhosis and liver cancer. The
prevalence of HCV varies from 1.2% to 3.8% in different
regions of the world (Cornberg et al., 2011).
Alpha-fetoprotein (AFP) is a foetal glycoprotein which has
been widely used as a serum marker for diagnosing
hepatocellular carcinoma (HCC); however, elevated serum AFP
levels have also been documented in non-HCC patients with
chronic liver disease (Chen et al., 2007).
To fulfill the aim of the work, this study was
designed to evaluate the clinical significance of Alpha-
Fetoprotein (AFP) levels in chronic hepatitis C patients without
hepatocellular carcinoma (HCC) in Egypt.
This study was conducted through collaboration
between Tropical Medicine Department, Ain Shams
University and Sohag Cardiology and Hepato-
Gastroenterology Center, Ministry of Health, in the
period from January 2010 to January 2013. The patients
enrolled in our study were selected from Tropical
Medicine Clinic of Ain-Shams University Hospital ”ELDemerdash”
and from the Interferon Unit - before
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treatment - of Sohag Cardiology and Hepato-
Gastroenterology Center, Ministry of Health. We
operated our study on selected 70 patients of chronic
liver disease with proven chronic hepatitis C virus
infection by history taking, clinical manifestations and
positive laboratory investigations for chronic HCV
infection to fulfill the predesigned inclusion criteria.
All patients were subjected to the following; careful
history, thorough clinical examination and laboratory
investigations [liver enzymes (AST and ALT), serum albumin,
INR, total and direct bilirubin, complete blood picture and viral
markers (HCV-Ab, HBs-Ag and quantitative PCR for HCVRNA).
Abdominal ultrasound and histopathological
examination of ultrasound guided liver biopsy were done for all
cases.
Our study included 90 subjects, divided into two groups:
Control Group: includes (20) healthy individuals, and study
Group: includes (70) patients with chronic hepatitis C (CHC)
without evidence of hepatocellular carcinoma (HCC). The two
groups were well-matched regarding age, gender and BMI.
The gender distribution of the studied group; males
were 58 patients (82.9 %) while females were 12 patients
(17.1%).
The current study reveals that AFP levels were
very much higher in HCV cases compared to controls.
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The current study assessed the correlation between
AFP and different variables in the control group and in different
fibrosis stages of the cases group, we found that all correlations
were non significant, with the exception of total bilirubin level,
which showed significant positive correlation with AFP levels
among stages F3 and F4; and platelet level, which showed
negative significant correlation with AFP level among F4 stage
patients.
Concerning the correlation between mean
AFP levels and different stages of liver fibrosis,
there was a positive highly significant correlation. It was found
that higher serum AFP levels were associated with more
advanced stage of fibrosis especially F3 & F4.
Regarding the mean AFP levels in different
grades of liver pathology, there was no statistical
significant relation. Also, there was no statistical significant
relation between the mean AFP levels and the
presence of Steatosis.
The present work designed a ROC curve which
revealed that the level of AFP can be used as a screening for
chronic HCV infection (sensitivity=75.4%, specificity=85.7%),
as well as for advanced fibrosis in chronic HCV infection
(sensitivity=69.7%, specificity=83.8%).
The current study proved that determination of
serum AFP levels may be useful as a non invasive indicator of
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severity of liver staging, as it is associated with increased levels
of matavir staging. So serum AFP levels should be routinely
screened in parallel with image studies in HCV positive
patients.