الفهرس 
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Abstract
Chronic hepatitis C is the most common blood-borne pathogen, representing a global public health challenge affecting approximately 3% of the world‘s population .Egypt has the largest national-level HCV prevalence in the world. The estimated percentage of the Egyptian population in the 15–59 years age group who are positive for HCV antibody is 14.7%. Over 80% of HCV infections in the Egyptian population are among individuals aged 30 years and above . Liver fibrosis is a consequence of almost all chronic liver diseases predominantly arising from viral, alcohol-induced, autoimmune and metabolic aetiologies. It describes the result of a dysregulated wound healing response driven by hepatocyte injury and resulting in the dysregulation of the balance of extracellular matrix turnover favouring net deposition. The progressive accumulation of matrix ultimately leads to the development of cirrhosis in a proportion of patients with associated important clinical sequelae.
von Willebrand factor (vWF) is a large important adhesive protein for both platelet adhesion and aggregation.
von Willebrand factor antigen is released by activated endothelial cells and therefore represents an indicator of endothelial cell activation.The endothelium plays a crucial role in many vascular diseases ,and endothelial dysfunction is a fundamental component of the increased hepatic vascular tone of cirrhotic livers. As vWF-Ag is elevated in liver disease it might be a key player in establishing liver fibrosis,and it can be detected by an enzyme-linked immunosorbent assay (ELISA).
The aim of the work was to evaluate vWF-Ag as a marker for prediction of liver fibrosis and cirrhosis in patients with chronic
hepatitis C . A comparative study was done between vWF-Ag and four liver fibrosis indices (APRI , Fibro Q, FIB4 and vitro score) in the pateint group.
This study included 88 subject,58 with chronic hepatitis C selected from the outpateint clinics of the National Liver Institute, Menoufia University and 30 healthy volenteers as a control group.
The subjects of this study were classified into 2 groups:
•group (I): Included 58 patients with chronic HCV infection with liver fibrosis classified according to METAVIR classification.
•group (II): Included 30 apparently healthy individuals serve as a control group with no history of liver diseases.
All subjects in the study were subjected to the followings:
A-Full history taking.
B-Full general clinical examinations.
C-Routine laboratory investigations:
1-Liver function tests.
2-HCV antibody .
D-Liver biopsy
E-vWF –Ag serum level by ELISA.
The results of these study revealed that:
•There was no statistical difference between the pateints and the controls as regard to age , gendre and smoking.
•There is statistical difference between pateints and controls regarding laboratory investigations including ALT, AST, total bilirubin, direct bilirubin, albumin, PT, prothrombin concentration, INR and platelet count.
•Comparing between the pateint and the control group as regard noninvasive fibrosis markers including; FIB4 , APRI, Fibro Q and VITRO score ,showed high statistical difference among pateint and control groups with median levels higher in pateint group than control group.
•Comparing between studied groups according to the vWF-Ag; highest levels were reported among patients with F4 It is highly significant among patients with F2 , F3 and F4 against control group and significant among patients with F0 and F1 against control group.
•There is a significant correlation between vWF-Ag and both VITRO score and FIB4 while no significant correlation found between vWF-Ag and APRI and FIBRO Q.
•Shows regarding APRI, at cut off >0.28 the AUC was 0.841,the sensitivity was 62.1%, specificity was 93.3%, PPV was94.7%and NPV was 56%, regarding FIB4, at cut off >0.79 the AUC was0.941, the sensitivity was 89.7%, specificity was 93.3%, PPV was96.3%and NPV was 82.4%, regarding VITRO score, at cut off >3.4 the AUC was 0.935,the sensitivity was 84.5%, specificity was 93.3%, PPV was96.1%and NPV was 75.7%, regarding FIBRO-Q, at cut off >1.8 the AUC was0.877,the sensitivity was 72.4%, specificity was 93.3%, PPV was95.5%and NPV was 63.6% and regarding vWF-Ag, at cut off >384.4 the AUC was 0.918 ,the sensitivity was 91.4%, specificity was 66.7%, PPV was84.1%and NPV was 80%.
•The ROC curve shows agreement (sensitivity, specificity and accuracy) for APRI,FIB4,vitro score,FIBRO-Q and vWF-Ag to diagnose F4 vs. F0+F1+F2+F3, it shows regarding APRI,
at cut off >0.58 the AUC was 0.689, the sensitivity was 60.7%, specificity was 80%, PPV was73.9%and NPV was 68.6%, regarding FIB4, at cut off >2.2 the AUC was 0.675, the sensitivity was 46.4%, specificity was 86.7%, PPV was76.5%and NPV was 63.4%, regarding VITRO score, at cut off >13.2 the AUC was 0.576, the sensitivity was 72.1%, specificity was 73.3%, PPV was65.2%and NPV was 62.9%, regarding FIBRO-Q, at cut off >2.1 the AUC was0.658, the sensitivity was 78.6%, specificity was 53.3%, PPV was61.1%and NPV was 72.7% and regarding vWF-Ag, at cut off >3066 the AUC was0.558, the sensitivity was 70.2%, specificity was 76.7%, PPV was63.2%and NPV was 59%.
•The ROC curve shows agreement (sensitivity, specificity and accuracy) for APRI,FIB4,vitro score,FIBRO-Q and vWF-Ag to diagnose F4+F3 vs. F0+F1+F2, regarding APRI,at cut off >0.58 the AUC was0.731, the sensitivity was 57.9%, specificity was 95% PPV was95.7%and NPV was 54.3%, regarding FIB4, at cut off >1.3 the AUC was0.729, the sensitivity was 63.2%, specificity was 85%, PPV was88.9%and NPV was 54.8%, regarding VITRO score, at cut off >14.32 the AUC was 0.638,the sensitivity was 47.4%, specificity was 95%, PPV was94.7%and NPV was 48.7%, regarding FIBRO-Q, at cut off >2.76 the AUC was0.66, the sensitivity was 44.7%, specificity was 75%, PPV was77.3%and NPV was 41.7% and regarding vWF-Ag, at cut off >3463 the AUC was0.598,the sensitivity was42.1% specificity was 95%, PPV was94.1%and NPV was 46.3%.