الفهرس 
epatitis C InfectionOnly 14 pages are availabe for public view
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Abstract
The identification of individuals with severe liver fibrosis among patients with chronic liver disease is of major importance when evaluating prognosis, potential risk for complications, and when deciding treatment strategies. Although percutaneous liver biopsy is still considered a ”gold standard” for staging of liver fibrosis, attempts to find reliable noninvasive markers of liver fibrosis are frequent to avoid the complications of liver biopsy. The urokinase plasminogen activator and its receptor have been associated with hepatic inflammation and fibrosis in mice. High serum concentrations of soluble urokinase plasminogen activator receptor (suPAR) are suggested to be involved in inflammation, tissue remodeling, and cancer metastasis. So, the aim of the work is to evaluated serum suPAR as a noninvasive biomarker to detect severity of liver fibrosis and grade of activity in patient with chronic C hepatitis.
Patients and Methods:
40 naive patients with chronic hepatitis (C) viral infection prior to treatment with antiviral combination therapy (Pegylated Interferon, Ribavirin and Sofosbuvir) were selected from Hepatology and Internal Medicine outpatient clinics of Ain Shams University Hospitals and Mostafa Kamel Military Hospital, from December 2014 to May 2015.
All patients were subjected to U/S guided liver biopsy with assessment of staging of fibrosis and grade of activity according to Metavir score system. Serum soluble urokinase plasminogen activator receptor (suPAR) level was assessed.
Result:
There was significant rise in suPAR level in F4 (15.3±0.3 ng/ml) compared to F3 (6.2±1.1ng/ml), F2 (4.0±1 ng/ml) and F1 (1.1±0.2 ng/ml) with high statistical significant difference (t test value=378.87, p<0.001). Also There was significant rise in suPAR level in A2 (6.3±4.5 ng/ml) compared to A1 (1.1±0.2 ng/ml) with high statistical significant difference (t test value=2.8, p<0.001).
There was a significant positive correlation between suPAR level with the stages of liver fibrosis (r=0.921, p<0.001) and AFP (r=0.383, p<0.018).
On constructing receiver operating characteristics curve (ROC) for prediction of grade of activity, the cut-off value was ≥3.0 ng/mL can differentiate between moderate activity (A≥2) and mild activity (A˂2). For prediction of different stages of liver fibrosis, it was found that cut-off value of suPAR for prediction of significant fibrosis F≥2 was ≥2.0ng/ml with sensitivity 100% and specificity (100%) while that for prediction of advanced fibrosis F≥3 was ≥5.0ng/ml with sensitivity (100%) and specificity 85.20%. On the other hand, cut-off value for prediction of cirrhosis was ≥12 ng/ml with sensitivity (100%) and specificity (100%).
Conclusion:
suPAR level was significantly correlated and increased with advanced stages of liver fibrosis and grades of activity. Stage of liver fibrosis was the only independent factor associated with rise in suPAR level. So, Serum soluble urokinase plasminogen activator receptor can be used as a good non invasive biomarker in predicting severity of liver fibrosis and grade of activity in patients with chronic hepatitis C viral infection.