الفهرس 
Chapter I: Introduction and aim of workOnly 14 pages are availabe for public view
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Abstract
Around 170 million people worldwide have chronic hepatitis C (CHC) infection, causing a substantial burden of chronic liver disease globally.The impact
CHC on health is profound, as it has been shown to be a major risk factor for cirrhosis and liver cancers. Vitamin D has taken too much interest in research work in the past decade because of the wide spread distribution of its receptors in many tissues and diversity of actions that included many newly discovered non classic actions. Recently, the role of vitamin D in CLD has received much attention, given its inherent activation process by the liver.Evidence is also beginning to unravel possible correlation between vitamin D deficiency and chronic liver disease. direct therapeutic benefits of vitamin D therapy.To date it remains unknown whether vitamin D deficiency confers an enhanced risk to liver disease or whether liver disease causes vitamin D deficiency. The aim of the present study was to assess vitamin D status in patients with liver malignancy and in chronic liver disease with stress on the probable correlation between serum levels of vitamin D and extrahepatic manifestations of chronic hepatitis C. The study involved 90 persons, patients were recruited from outpatient clinics and inpatient of hepatology department, national liver institute,Menoufiya university while the healthy control were recruited from Menoufiya university employees and others, they were classified as follows: Group I,included 18 HCV non cirrhotic patients.Group II, included 18 HCV cirrhotic patients.Group III, included 18 HCC patients , HCV infected.
Group IV,included 18 HCV patients with cutaneous extrahepatic manifestations.Group V (control group) included 18 healthy persons. All patients were subjected to thorough history taking,detailed clinical examination with emphasis on cutaneous extrahepatic manifestations including lichen planus & porphyria cutanea tarda. Abdominal ultrasound ,liver function tests, serum creatnine, complete blood count and serum level of vitamin D were done for all patients. The present results revealed the following: 1-Vitamin serum level was significantly low in chronic liver disease. 2-Vitamin D serum level was significantly low in HCV non cirrhotic,HCV cirrhotic,HCC patients and patients with extrahepatic manifestations compared to healthy control. 3-Vitamin D serum level was significantly low in HCV cirrhotic patients compared to HCV non cirrhotic patients. 4- Vitamin D serum level correlated with the severity of liver disease. 5- Vitamin D serum level negatively correlated to bilirubin in all patients. 6- Vitamin D serum level positively correlated to albumen in all patients. 7- Vitamin D serum level negatively correlated to INR in all patients. 8-Vitamin D serum level positively correlated to albumen in cirrhotic and non cirrhotic patients.
9-Vitamin D serum level positively correlated to prothrombin concentration in non cirrhotic patients. 10-Vitamin D serum level negatively correlated to INR in cirrhotic patients. 11-Vitamin D was lower in non cirrhotic patients with extrahepatic manifestations than non cirrhotic patients without extrahepatic manifestations but the difference was statistically non significant. In conclusion vitamin D deficiency is an important finding in chronic liver disease specially CHC, moreover vitamin D serum level correlated clearly with the severity of liver disease.Vitamin D serum level correlated positively to albumen and negatively to bilirubin and INR.Besides its correlation to the severity of liver disease vitamin D serum level was found to be lower in non cirrhotic HCV patients with extrahepatic manifestations than in non cirrhotic HCV patients without extrahepatic manifestations.