الفهرس 
Causes of liver fibrosisOnly 14 pages are availabe for public view
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Abstract
Progressive hepatic fibrosis with the development of cirrhosis is a feature of almost all chronic liver diseases. Approximately 10–20% of patients with chronic viral hepatitis will have cirrhosis at first clinical presentation, and as many 20–30% of those who do not have cirrhosis will eventually develop this condition and its complications within one or more decades. These complications are liver failure, ascites, variceal bleeding, portal-systemic encephalopathy, and hepatocellular carcinoma. That is why a precise estimation of the degree of liver fibrosis is important for estimation of prognosis, surveillance, and treatment decisions in patients with chronic viral hepatitis.
Liver biopsy is currently considered the gold standard for assessing hepatic fibrosis. However, it is an invasive and painful procedure, with rare but potential life threatening complications, limiting its acceptance and repetition in usually asymptomatic patients. In addition, the accuracy of liver biopsy in assessing fibrosis may be questioned because of sampling error and interobserver variability, which may lead to understaging of cirrhosis. Thus there is a need to develop and validate non-invasive biochemical markers that can accurately reflect the full spectrum of hepatic fibrosis, cirrhosis, and its severity in liver diseases.
In this work we studied 40 patients with chronic viral hepatitis proved by liver biopsy and we evaluated the diagnostic efficacy of some non-invasive biochemical markers; APRI score, Forn’s index, Goteborg University Cirrhosis Index (GUCI) and serum matrix metalloproteinase-1 (MMP-1) in determining the stage of liver fibrosis in patients with chronic viral hepatitis. Also we compared those markers with the diagnostic efficacy of FibroScan as a new non invasive technique for detection of degree of liver fibrosis depending on liver stiffness.
The patients were classified according to the stage of liver fibrosis measured by Knodell’s score into; mild fibrosis (0,1,2), moderate fibrosis (3,4) and severe fibrosis (5,6). Then patients were classified into non severe fibrosis (0,1,2,3,4) and severe fibrosis (5,6) to calculate the sensitivity of individual marker in prediction of severe fibrosis or cirrhosis.
This study showed that some parameters did not show any statistically significant difference among patients with mild, moderate and severe fibrosis. These parameters include patient’s sex, duration of the disease, size of liver as measured by ultrasound, white blood cell count, hemoglobin concentration, serum ALT, ALP, total proteins, PTT, cholesterol, renal function tests and serum matrix metalloproteinase -1 (MMP-1).
Other parameters showed statistically significant difference among patients with mild, moderate and severe fibrosis. These parameters include age of the patients, platelet count, serum AST, albumin, bilirubin, GGT, PT, INR, APRI, Forn’s index, GUCI and FibroScan. So they can be used to differentiate between patients with mild, moderate and severe fibrosis.
Moreover, some non invasive markers could significantly differentiate between non severe and severe fibrosis. So they can be used for prediction of severe fibrosis or cirrhosis in patients with chronic viral hepatitis. These markers include APRI, Forn’s index, GUCI and FibroScan.
When we calculated the sensitivity and specificity of non invasive markers in prediction of severe fibrosis or cirrhosis at a certain cut off value for each marker the results were as follows; serum matrix metalloproteinase -1 (MMP-1) recorded sensitivity (60%) and specificity (50%) at 2850 as a cut off value. AST platelet ratio index (APRI) recorded sensitivity (70%) and specificity (40%) at -0.15 as a cut off value. Forn’s index recorded sensitivity (75%) and specificity (40%) at -566 as a cut off value. Goteborg University Cirrhosis Index (GUCI) recorded higher sensitivity (80%) and higher specificity (60%) at 428 as a cut off value. FibroScan recorded the highest sensitivity (90%) and highest specificity (70%) at 9.65 as a cut off value.
It is clear that the sensitivity and specificity of FibroScan as a new non invasive technique for detection of degree of liver fibrosis exceeds that of serum matrix metalloproteinase -1 (MMP-1), AST platelet ratio index (APRI), Forn’s index and Goteborg University Cirrhosis Index (GUCI).