الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
chronic Hepatitis B (CHB) is defined as chronic necro inflammatory disease. It is the 10th leading cause of death in the world. Hepatitis B virus (HBV) infection is considered as the major cause of liver fibrosis (LF). Liver fibrosis is leading eventually to cirrhosis and is triggered by chronic liver damage, and a prolonged inflammation produced by hepatitis virus infection. Accurate evaluation of the severity of liver fibrosis in patients with CHB is necessary for not only prediction of the long-term treatment, but also determination of the time to begin an antiviral therapy. The prognosis and management of patients with CHB depend on the amount and progression of liver fibrosis. Cytokines have been identified as potential markers of fibrosis because they are involved fibrogenesis and they are found to be fundamental mediators in the host adaptive immune response to HBV. Angiopoietin-like protein 2 (Angptl2) is not only a chronic inflammatory mediator but also tissue remodeling factor. This study aimed to explore the predictive value of Angptl2 in different fibrosis stages in patients chronically infected with hepatitis B virus. This study was performed in National Hepatology and Tropical Medicine Research Institute (NHTMRI) on eighty patients with chronic HBV infection with different fibrosis stages and ten control volunteers. All patients enrolled in this study were subjected to the following: 1. Full clinical data and the history of all patients were recorded. 2. Indirect fibrosis markers, including (AAR, APRI, and FIB-4) were calculated in the patient groups only. 3. Non-invasive imaging technique of fibrosis (Liver stiffness measurement) was measured to all patients. b 4. Measurement of serum Angptl2 concentrations to patients /controls. The results of this study assured that: 1. Control group included ten volunteers with 8 females and 2 males, their ages ranged from 15 to 20 years old. HBV patients were divided into three groups: group 1 (F0-F1) ”no/mild hepatic fibrosis”: included 33 patients (41.25%), 25 of them are males and 8 females with mean age 39.364. group 2 (F2) ”significant hepatic fibrosis”: included 9 patients (11.25%), 8 males and 1 female with mean age 37.444. group 3 (F3- F4) ”severe hepatic fibrosis and cirrhosis” included 38 patients (47.5%), 28 of them are males and 10 females with mean age 49.421. The mean age of all patients was 43.925 years. In this study population, 61 (76.25%) are males and 19 (23.75%) are females. 2. In the control group, serum Angptl2 concentration was (0.930± 0.472 ng/ml), which was different from that in patients with no/moderate fibrosis, so the early fibrosis stages can be distinguished. 3. With progression in the fibrosis stages, the Angptl2 concentrations were significantly increasing, (p= 0.002*). 4. Serum Angptl2 concentrations weren’t just positively associated but they were significantly correlated with liver stiffness measurements by Fibroscan (r=0.249), (p= 0.026*). 5. Angptl2 concentrations were compared with the commonly known noninvasive fibrosis markers (APRI, FIB-4, and AAR). Overall, there is a positive association between Angptl2 and APRI, FIB-4 and AAR in the three patient groups of fibrosis. 6. A significant correlations were found between Angptl2 levels and (Age, AAR, and Fibroscan), (r=0.359, p=0.001*), (r=0.242, p=0.031*), (r=0.249, p=0.026*), respectively. c 7. Angptl2 showed areas under the receiver operating characteristics curve of 0.702 for distinguishing patients with significant fibrosis (F2- F4) with a sensitivity of 87.23% and NPV of 71.4 % by using a cutoff value of >1.1. 8. AUROCs of the three biomarkers at different cut-offs for the diagnosis of F2–4 fibrosis were calculated. Angptl2 is superior to AAR with AUC of 70.2% and 67.8%, for predicting significant fibrosis (F ≥ 2), respectively. 9. When Angptl2 was combined with APRI, FIB-4, and AAR for assessment of significant fibrosis, AUROCs enhanced significantly, P value 1year) with a value of 2.81 ng/ml than those with recent infection.