الفهرس 
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Abstract
Chronic hepatitis C virus infection is recognized as a global health problem, with 170 to 200 million people estimated to be infected worldwide. Egypt has the highest prevalence of HCV in the world; about 12 to 15%of the total population is infected. In the United States, chronic HCV is the most common cause of end stage liver disease, hepatocellular cancer, and the most frequent indication for liver transplantation. HCC is the commonest primary cancer in the liver. It is the 5th commonest malignancy worldwide and the third leading cause of cancer related death.
Cirrhosis is a gradually developing, chronic disease of the liver which always involves the organ as a whole. It is the irreversible consequence and final stage of various chronic liver diseases of different etiology or the result of long-term exposure to various noxae. The extent of the morphological changes depends on the cause and stage of cirrhosis.
This process distorts the normal liver architecture, interferes with blood flow through the liver and disrupts the functions of the liver.
Cirrhosis was historically classified morphologically as micronodular, macronodular, or mixed. Micronodular cirrhosis, characterized by nodules less than 3 mm in diameter, was believed to be caused by alcohol, hemochromatosis, cholestatic causes of cirrhosis, and hepatic venous outflow obstruction. Macronodular cirrhosis, characterized by various sized nodules larger than 3 mm, was believed to be secondary to chronic viral hepatitis.
Classification of cirrhosis according to its etiology would be desirable, as this approach may help to determine prophylactic and therapeutic measures as well as prognosis. If all diagnostic options are employed and the patient cooperates optimally, an etiological identification of cirrhosis is possible in almost all cases today. Due to improved detailed diagnostics, the group of so-called cryptogenic cirrhoses has been consistently reduced (<10% of cases). Causes of cirrhosis can be identified by the history combined with investigation.
The importance of zinc was 1st reported for Aspergillus niger. It took over 75 y to realize that zinc is also an essential trace element for rats, and an additional 30 y went by before it was recognized that this was also true for humans. The adult body contains about 2 to 3 g of zinc. Zinc is found in organs, tissues, bones, fluids, and cells. It is essential for many physiological functions and plays a significant role in a number of enzyme actions in the living systems. Bioinformatics estimates report that 10% of the human proteome contains zinc-binding sites. Based on its role in such a plethora of cellular components, zinc has diverse biological functions from enzymatic catalysis to playing a crucial role in cellular neuronal systems. Thus, based on the various published studies and reports, it is pertinent to state that zinc is one of the most important essential trace metals in human nutrition and lifestyle. Its deficiency may severely affect the homeostasis of a biological system.
This study aimed to evaluate zinc status in cirrhotic patients that may indicate the pathophysiological as well as therapeutic role of zinc in liver cirrhosis. This study was carried on 53 patients with liver cirrhosis and 10 normal volunteers as control. They include 33males and 20 females, their age ranged from 33 to 70 years. patients were
selected from inpatients and outpatient hepatology clinic of Menoufia University Hospital from August 2015 till February 2016.Each was subjected to history taking ,Laboratory investigations like , Complete liver function tests (ALT, AST, GGT, Alk Phosphatase ,Total bilirubin) , Complete blood count, Estimation of serum zinc levels &Serum Albumin level also was subjected to radiological study like, ultrasound.
Results:
There were no significant differences between case and control as regard age and gender. There were statistically significant difference between cirrhotic subgroup patients as regard ascites, lower limb edema and Jaundices also there no statically significant difference between cirrhotic subgroup patients as regard pallor and presence of splenomegally. There were statistically significant difference between cirrhotic subgroup patients as regard AST, ALT, Bilirubin, Albumin and PT.
This study shows that serum zinc level is significantly lower in child C than A but no significant differences between A and B and between B and C.
RBCs are significantly higher in control than patient, HB is significantly lower in patient than control, Platelets are significantly lower in patient than control and there were no significant difference between patient and control as WBC. GGT is significantly lower in patient than control. PT is significantly higher in patient than control. INR is significantly higher in patient than control. Albumin is significantly lower in patient than control. Bilirubin is significantly higher in patient than control. Zinc level is significant lower in patient than in control.
There is positive correlation between zinc level and HB, RBCs and platelet in both groups. No significant correlation between zinc level and liver function tests in patient groups (A), (B) and (C) according to Child Pugh Score except there positive correlation between zinc level and ALP in cirrhotic patient in group C.