الفهرس 
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Abstract
Parasitic diseases caused by helminths and protozoa are major causes of human disease and misery in most countries of the tropics. They plague billions of people and kill millions annually.
Many parasites affect the liver through primary or multi-system involvement. S. mansoni is the most common parasite in Egypt affecting the liver. It can lead to periportal fibrosis (PPF) with severe sequelae and complications. Fascioliasis is another important parasitic infection affecting the liver giving different clinical presentations such as hepatomegaly and obstructive jaundice. Entamoeba histolytica, an endemic protozoal infection is capable of invading tissues, causing amoebic hepatitis and abscess formation. Moreover, many space occupying lesions were caused by hydatid cyst of the liver.
Acquisition of infection, clinical severity and outcome of a parasitic disease often depends on innate and acquired host immunity.
Interleukin-6 is a pleiotropic cytokine that has important roles in the regulation of the immune response, inflammation and hematopoiesis.
6 is produced by a variety of cells including T cells, B cells, fibroblasts endothelial cells, monocytes and some tumor cells. It is rapidly produced in response to bacterial and viral infection, inflammation or trauma.
Serum IL-6 levels are low in physiological conditions, but increase considerably in pathological conditions such as trauma, inflammation liver cirrhosis and hepatocellular carcinoma.
The aim of the present work was to study the prevalence of parasitic infections in hepatic patients, in addition to study the relationship between parasitic infections and serum level of IL-6 in hepatic patients.
This study was carried out on 96 individuals selected from those attending Liver Institute, Menoufiya University Hospital and Shebin ELKom Education Hospital. They represented both sexes 52 males and 44 females of different age groups ranging from 16 to 70 years old. They were divided into four groups, group I consisted of 20 apparently healthy individuals without hepatic affection or parasitic infections as a control group (normal hepatic non parasitic), group II consisted of 20 non hepatic patients with parasitic infections (normal hepatic parasitic), group III consisted of 20 hepatic patients free from any parasitic infections(hepatic non parasitic) and group IV consisted of 36 hepatic patients with parasitic infections (hepatic parasitic).
In the present study, comparison was made between studied groups regarding age. The mean age was 44.85+9.48 in group I, 37.65+12.9 in group II, 42.75+13.4 in group III and 42.06+13.03 in group IV. The difference between studied groups regarding age was statistically non significant (p >0.05).
Regarding sex distribution among studied groups, the number of males was 12 (60%) and females 8 (40%) in group I, the number of males was 9(45%) and female 11 (55%) in group II, Number of males and females were 11, 9 in group III with percentages of 55% & 45%. Lastly,
percentage of males (20) was 55.6% and females (16) was 44.4% in group IV. These results were statistically non significant (p>0.05).
In the current study, regarding to laboratory data (SGOT, SGPT prothrombin concentration and bilirubin) among different studied groups the mean value of SGOT was 39.6+51.86 in group I, 29.1+6.97 in group II, 89.05+25.24 in group III and 105.17+44.74 in group IV. These results were statistically highly significant among group III & IV (P<0.001).
While, the mean value of SGPT was 27.05+5.69 in group I, 28.1+5.47 in group II, 96.55+40.15 in group III and 111.33+72.71 in group IV. These results were statistically highly significant among group III & IV(P<0.001). The mean value of prothrombin concentration was 12.5+0.0 in group I, 12.5+0.0 in group II, 16.6+2.19 in group III and 16.23 +2.19 in group IV. This results were statistically highly significant among group III & IV (P<0.001). While the mean value of bilirubin was 0.59+0.32 in group I, 0.63+0.36 in group II, 4.98+2.01 in group III and 4.7+2.06 in group IV, and these results were statistically highly significant among group III & IV (P<0.001).
Regarding condition and size of the liver, the most prevalent pathological conditions were viral hepatitis, cirrhosis and hepatocellular carcinoma and atrophic liver which were prominent in group I & IV. This may be attributed to the type of studied individuals who where selected as being hepatic and hepatic parasitic. Regarding to atrophic liver, the number of patients were 6 (30%) and 10 (27.8 %) in group III & IV respectively.
The prevalence of atrophic liver was highly significant among Group III than other groups (P<0.001)Cirrhosis of the liver was detected in group III, all patients showed positive cirrhosis (100%). In group IV, the number of individuals with negative cirrhosis was 26 (72.2%) and the number of patients with positive cirrhosis was 10 (27.8%). All these results were statistically significant (P<0.001). The prevalence of viral hepatitis was high among group III, the number of positive cases were 6 (30%) and negative cases were 14 (70%) but no cases were detected among group I, II and IV. All these results were statistically significant (P<0.001). Regarding hepatocellular carcinoma, all patients in group IV showed positive results while no cases were detected in group I & II. In group III, the number of negative cases was 14 (70%) and the number of positive cases was 6(30%). These results were statistically significant (P<0.001).The higher detection rate of hepatocellular carcinoma in group IV may be attributed to the presence of parasitic infection (schistosomiasis) which was prevalent in this group or as a complication of chronic viral hepatitis.
The results of the current study showed the distribution of parasitic infection among studied groups. The prevalence rate of Entamoeba histolytica was 30% and Giardia, 50% which was significantly higher among normal hepatic parasitic group than hepatic parasitic ones(P<0.001), while the prevalence rate of Schistosoma was 44.4% and Toxoplasma, 25% which was significantly higher among hepatic parasitic group than normal hepatic parasitic group (P<0.05).
In the current study, a comparison between studied groups was performed regarding to IL-6. The mean value of IL-6 was 13.79+3.31 in group I 26.96+6.84 in group II, 80.95+18.57 in group III and 122.53+28.88 in group IV. The mean value of IL-6 for group IV was highly significant than other groups (p<0.001).
In the current work, the relation between sex & IL-6 was performed. The mean value of IL-6 among males was 16.16+1.76 and 10.24+0.86 among females in group I, it was 29.43+6.59 among males and 20.14+6.31
among females in group II. The mean value of IL-6 among males was 180.46+69.98 and 89.84+30.33 among females in group III. While in group IV, The mean value of IL-6 among males was 100.79+23.39 and (70.56+18.85) among females. These results revealed that higher levels of IL-6 were detected among males than females in all groups and these results were statistically highly significant (p<0.001).
The result of the current study showed Pearson correlation between IL-6 & age among G III & G IV. There was +ve correlation between IL-6 & age reaching a significant level for G III (p<0.05).
In the present work, Pearson correlation between IL-6 & laboratory data of SGOT, SGPT, prothrombin concentration and bilirubin among group III & group IV. There was non significant +ve correlation between IL-6
& (SGOT, SGPT and bilirubin) among G III & G IV. But there was non significant -ve correlation between IL-6 & prothrombin concentration among G III & G IV.
In the current study, the relation between IL-6 & size of the liver among G III & IV showed that, in group III, the mean value of IL-6 in patients with normal liver was 101.16+21.67 and 144.13+42.74 in patients with atrophic liver. In group IV, the mean value of IL-6 in patients with normal liver was 80.35+10.36 and 93.83+19.55 in patients with atrophic liver and these results were statistically significant (p<.001).
In this work, the relation between IL-6 & liver cirrhosis among G IV showed that, the mean value of IL-6 in patients with -ve cirrhosis was 81.35+10.26 and 91.31+18.23 in patients with +ve cirrhosis. There was a significant difference between -ve cirrhosis & +ve cirrhosis regarding IL-
6 (p<0.05).
In this study, the relation between IL-6, hepatitis and hepatocellular carcinoma among G III showed that, the mean value of IL-6 in patients without hepatitis was 112.16+26.67 and 148.13+38.74 in patients with hepatitis. The value of IL-6 was markedly increased. This result was statistically significant (p<0.05).
The mean value of IL-6 in patients without hepatic carcinoma was 96.03+35.99 and 215.39+78.86 in patients with carcinoma. The value of IL-6 among those with hepatocellular carcinoma was highly significant than those without hepatocellular carcinoma (p<0.001).
In the present work, the mean value of IL-6 among GII & GIV (normal hepatic parasitic& hepatic parasitic) and its relation to types of parasitic infections detected. The mean value of IL-6 in group II, among patients infected with Entamoeba histolytica was 29.09+5.57, 26.97+8.24 in patients infected with Giardia lambia, 23.73+4.19 in patients infected with Enterobius vermicularis in group II, and 75.5+12.83 in group IV. In group IV, the mean value of IL-6 in patients infected with Schistosoma mansoni was 133.13+13.15, Fasciola gigantica, 120.15+10.8, Hydatid disease, 74.81+16.71 and Toxoplama, 78.69+16.47. There was asignificant relationship between mean the value of IL-6 among group II and IV regarding to Enterobius vermicularis infection.
from this study it is concluded that, some parasitic infections are associated with alteration in the level of the serum cytokines which may play a role in the pathogenesis as well as in the immunity against them.
Interleukin-6 was found to increase in parasitic infections especially those affecting the liver.