الفهرس 
? Liver FibrosisOnly 14 pages are availabe for public view
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Abstract
Liver fibrosis and cirrhosis resulting from long-standing liver damage represent a major health care burden worldwide. In Egypt, HCV is the main cause of liver fibrosis.
The assessment of the stage of liver disease is important for the diagnosis, treatment, as well as for follow-up. The assessment of liver fibrosis can be classified into invasive and non-invasive approaches. Although liver biopsy is considered gold standard in assessment of liver fibrosis its invasiveness and complications limit its use. Hence, the non-invasive methods are now increasingly used in patients with chronic liver diseases like serum biomarkers of fibrosis as well as imaging techniques.
While accurate in excluding or confirming significant fibrosis, most ¬of serum biomarker of fibrosis can’t completely ¬¬fulfill¬ the¬ requirements ¬of ¬an ¬ideal biomarker. Most of them lack the sensitivity to discriminate between different stages of fibrosis, are of no prognostic value and often not specific to the liver.
Growth differentiation factor 15 (GDF-15) is a transforming growth factor β (TGF-β) protein widely distributed in all tissues particularly in liver and involved in inflammation, infection, fibrosis, and apoptosis pathways. serum GDF15 levels were found to be increased in patients with liver fibrosis, cirrhosis and hepatocellular carcinoma associated with different etiologies. GDF15 induces fibrosis by increasing phosphorylation of SMAD2 and SMAD3, which play a crucial role in hepatic stellate cells activation and fibrogenesis. GDF-15 leads to increase expression of fibrosis markers, such as Alpha-smooth muscle actin and collagen I.
In this regard, the present study aimed to investigate the clinical utility of GDF-15 serum level as a predictor of the degree of liver fibrosis in patients with chronic HCV infection and its correlation with the fibro-scan results.
This study was conducted at hepatitis C virus Clinic at Ain Shams University hospital on 55 chronic HCV patients, who were further classified according to the stage of liver fibrosis assessed by fibro-scan into three subgroups. Subgroup І has fibrosis degree of F0-1 and F1, Subgroup II has fibrosis degree of F1-2 and F2, and Subgroup III whom has fibrosis degree of F3, F3-4 and F4 by fibro-scan. In addition to 30 healthy controls. Patients with hepatocellular carcinoma or diagnosed with other cancers, Patients on anti-inflammatory drugs, Patients with autoimmune diseases and patients with BMI >35 kg/m2 were excluded from our study.
Results of our study revealed a highly significant statistical rise in GDF-15 levels among studied chronic HCV patients when compared to the control group (P value zero). Furthermore, there was a significant positive correlation between the degree of fibrosis assessed by transient elastography and GDF-15 serum levels. A statistically significant increase in serum GDF-15 levels was noticed among patients with advanced fibrosis “subgroup ІІІ” compared to those with mild fibrosis “subgroup І”. While, there was no significant difference in the GDF-15 level among patient subgroup І and Ц and between patient subgroup Ц and ІІІ.
In conclusion, GFD-15 is a potential marker for early detection of liver fibrosis as its levels were significantly higher in patients with mild degree of liver fibrosis than controls. This can help physicians initiating treatment earlier hence achieving higher survival rate. Also, there was a significant positive correlation between the degree of liver fibrosis and GDF-15 serum levels.