الفهرس 
Liver fibrosis and HCVOnly 14 pages are availabe for public view
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Abstract
Background: New direct-acting antivirals (DAA) has dramatically increased the cure rate in patients with chronic hepatitis C and result in improvement in liver stiffness measured by transient elastography (TE) in patients with sustained virologic response (SVR). Multiple non-invasive methods have been used successfully in the assessment of liver fibrosis. Mac-2 Binding Protein Glycosylation isomer (M2BPGi) is a novel serological glyco-biomarker for staging liver fibrosis. Aim of the work: We aimed to evaluate the impact of sustained virologic response (SVR) to direct antivirals on liver stiffness using the serum level of Mac-2 binding protein in patients with compensated chronic HCV who received direct acting antivirals (DAAs) according to National Committee for Combating Viral Hepatitis before (baseline) and after (sustained virologic response week 12) treatment, and to assess how this biomarker was correlated with another standard non-invasive methods of fibrosis assessment, FIB-4, PAPAS index and Fibro scan. Patients and Methods: Our cohort study consisted of 80 Egyptian patients with compensated chronic HCV who received direct acting antivirals (DAAs) (65 patients received sofosbuvir/ daclatasvir and 15 patients received sofosbuvir/ daclatasvir/ ribavirin) according to National Committee for Combating Viral Hepatitis. All patients were subjected to clinical evaluation, laboratory investigations, abdominal ultrasonography, transient elastography (Fibroscan) in addition to non-invasive indices (Mac-2bp, PAPAS index, and FIB-4). Fibroscan, Mac-2bp, FIB-4 and PAPAS index were measured in all patients at base line before treatment and 12 weeks after end of treatment (EOT) and achievement of SVR. Results: The current study showed that the mean value of LSM, FIB-4, PAPAS index and Mac-2bp at baseline were 11.4±9.5, 1.8±1.3, 2.2±0.5, and 9.0±8.8 and after achieving SVR 9.5±6.3, 1.3±0.7, 2.1±0.3 and 6.7±7.3 respectively with significant improvement in all parameters (P=0.002, <0.001, 0.010 and <0.001 respectivily). ALT, AST and ALP significantly decreased after achieving SVR 12 while Albumin and Platelets significantly increased after achieving SVR 12. Mac-2 bp levels increased with the progression of liver fibrosis. The areas under the curve (AUROC) of Mac-2bp at baseline in F≥2, F≥3 and F4 were 0.710, 0.569, and 0.801 respectively and after achieving SVR were 0.583, 0.893, and 0.844 respectively. (AUROC) of Mac-2bp for differentiating advanced fibrosis (F3-4) from non-advanced fibrosis (F0-2) at baseline and after achieving SVR were 0.730 and 0.891 respectively. Mac-2bp after achieving SVR12 had more favorable diagnostic accuracy for distinguishing advanced liver fibrosis (F3-4) from non-advanced fibrosis (F0–2) with an AUC 0.891. Conclusion: Mac-2 binding protein (Mac-2bp) is a simple and reliable noninvasive marker for liver fibrosis assessment in patients with chronic hepatitis C. Liver stiffness measurements (LSM) evaluated using transient elastography (TE) significantly decreased overall in patients with chronic HCV infection who received direct-acting antivirals (DAAs) therapy and achieved sustained virologic response 12 weeks after end of treatment (SVR12