الفهرس 
Introduction. Only 14 pages are availabe for public view
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Abstract
Millions of people all over the world are chronically infected with HCV which is more prevalent in Egypt (WHO, 2014). chronic hepatitis C infection is a leading cause of liver fibrosis in which the normal liver architecture is replaced with fibrous tissue (Calvaruso and Craxì, 2011).Chronic hepatitis B virus (HBV) infection remains an important global burden with an estimated 240 million HBV carriers worldwide and more than half a million people dying annually from the consequences of the HBV infection (Erik, 2015).
Recently many noninvasive markers (NIMs) for assessing liver fibrosis have been developed, and they are frequently used in clinical practice. They have been validated in different studies, and some were found to be highly accurate in the assessment of liver fibrosis compared with liver biopsies (H. H. Chi et al., 2012), which have always been used as the standard reference method for evaluating the accuracy of noninvasive methods (Castera and Laurent 2012).
Non-invasive methods rely on two different approaches: a ‘‘biological’’ approach based on the quantification of biomarkers in serum samples or a ‘‘physical’’ approach based on the measurement of liver stiffness (LS). Although these approaches are complementary, they are based on different rationales (Mueller et al., 2014).
Transient elastography (Fibroscan) is an ultrasound technique that uses a vibration of mild amplitude and low frequency transmitted to the tissue, which induces an elastic shear wave that propagates within the liver. Pulse-echo ultrasonic acquisitions follow the shear wave and measure its speed. The velocity of wave propagation relates directly to tissue stiffness (the harder the tissue, the faster the shear propagates), which is measured in kilopascals (kPa). Liver stiffness values range from 2.5 to 75 kPa (Foucher et al., 2006).
Transient elastography is probably the most widely used noninvasive method in Europe for assessing the degree of liver fibrosis.
The advantages of this method are:
(1) It is rapid (less than 5 min), painless, noninvasive and reproducible.
(2) It acquires information from a much larger portion of the tissue compared with liver biopsy, and therefore, the risk of sampling error is significantly lower.
(3) It can be used in different liver diseases. However, increased liver stiffness is not always a surrogate of fibrosis (the presence of significant necro-inflammation or extrahepatic cholestasis may increase liver stiffness values in the absence of fibrosis) (Abdel Sameea et al., 2014).
This study included 100 patients who were selected from both outpatient clinic of hepatology department, National Liver Institut, Menoufiya University from February 2014 to September 2015.
We studied effect of food intake on liver stiffness measurement by fibroscan in Egyptian patients with chronic viral hepatitis. In all cases, after a thorough physical examination, liver ultrasonorphy and fibroscan fasting and post ninety minutes eating 500 kcal were done for all patients.
**Exclusion criteria:
1. Obese patients (BMI >30).
2. Underbuilding patients (BMI <18).
3. Other causes of cirrhosis.
5. Patients child (C).
6. Patients with hepatocellular carcinoma (HCC).
Patients with liver diseases were subjected to the following:
1- History taking and complete clinical examination.
2- Routine liver tests:
- Bilirubin (total and direct).
- Albumin.
- Prothrombin time and concentration, INR.
- ALT, AST.
3- Other laboratory investigations:
- Viral markers (HCV Ab, HBs Ag and HAV IgM)
- Quantitative PCR was done for acute HCV, HBV patients.
- Autoimmune markers.
- Complete blood count.
4- Radiological investigations: abdominal ultrasonography.
5- Body mass Index (BMI) was calculated for all patients.
6- APRI calculated from laboratory data.
7- FIB4 calculated from laboratory data.
8- Transient elastography (Fibroscan): Liver stiffness measurement was performed with a fibroscan fasting and ninety minutes post meal.
CONCLUSION
• There was significant increase in liver stiffness (LS) ninety minutes post meal (Mean ± SD= 13.65 ± 10.15) more than fasting liver stiffness (LS) (Mean ± SD= 11.57 ± 8.62) as P- value= 0.000.
• There was positive correlation between Liver stiffness (LS) fasting and APRI as R=0.67 P- value=0.00.
• There was positive correlation between Liver stiffness (LS) fasting and FIB4 as R=0.67 P- value=0.00.
• There was significant relation between fasting liver stiffness and ultrasound results where:
1. 82.5% of F0 patients were normal ultrasound.
2. 96.9 % of F4 patients were cirrhotic ultrasound.
3. 53.6 % of F2 to F3 patients were echogenic ultrasound, P-value =0.000.
• APRI score there was positive correlation between Liver stiffness (LS) fasting and APRI as R=0.67 P- value=0.00 as when increase of LS increase APRI score and APRI score accurate in normal and cirrhotic patients APRI there was significant relation between fasting liver stiffness and APRI score especially F0 and F4 (92.5%, 93.75%) respectively and reached 57.1 % in F2 to F3 as p- value= 0.00.
• FIB4 score there was positive correlation between Liver stiffness (LS) fasting and FIB4 as R=0.67 P- value=0.00 and when increase of LS increase FIB4 score and FIB4 was significant relation between fasting liver stiffness and FIB4 score especially F0 and F4 (85.5%, 90.6%) respectively and reached 50% in F2 to F3 as p- value= 0.00.