الفهرس 
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Abstract
HCV infection is slowly progressing disease which may lead to chronic
infection with subsequent liver fibrosis and cirrhosis with a lot of complications
related to liver cell failure and hepatocellular carcinoma and since chronic HCV
infection run prolonged course and its complications take long time to occur, a lot
of studies were held aiming at studying the comorbid factors which may
contribute the course and outcome of HCV infection including this study.
This study was conducted aiming at studying the comorbid factors which
may accelerate the rate of progression of chronic HCV infection into cirrhosis in
young Egyptian patients as we tried to detect some of these factors which can be
modified or treated aiming at protecting those patients from progressing to
cirrhosis and its related complications at early age.
We conducted this study on 100 young Egyptian patients with chronic HCV
infection and signs of liver cirrhosis as we looked for different comorbid factors
that may cause rabid progression of the disease including other hepatitis viruses
and we chose hepatitis B virus, bilharziasis, autoimmune liver diseases, metabolic
liver disorders and we chose diabetes mellitus and non alcoholic fatty liver
disease, hereditary liver disorders and we chose Wilson’s disease.
In our analysis for the data we found that older age is more common in the
patients with cirrhosis than younger age as we found patients above 30 years
were more than patients below 30 years with ratio 70:30, and this show the effect
of the older age on progression of the disease and developing cirrhosis.
For gender male sex was more common than female sex with ratio 64:36
and this mainly was found to be related to the protective effect of estrogen on
females especially all our patients were young patients below 40 years and
though they were below age of menopause which was found in literature to be
turning point in the progression of fibrosis in females.
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For other comorbid factors looked for we found that, in our Egyptian
patients shistosomiasis is one of the most common causes of developing of early
cirrhosis with 36% of patients got associated bilharzial infection which was found
in most of the studies to promote fibrosis through stimulation of type 2 T helper
cells, and in most of Egyptian studies and literature bilharziasis was found to be
the most important cause for spreading of HCV infection through Egyptians and
leading to failure of treatment although it is one of the factors which can be
treated protecting patients from early development of cirrhosis and improving
their response to HCV treatment.
HBV coinfection was found to be one of the important causes which may
accelerate the progression of fibrosis and in our study it was found in 22% of
patients and by reviewing literature HBV was found to have direct effect on
progression of fibrosis with development of cirrhosis and HCC.
Metabolic syndrome and specifically elevated triglycerides was found in
40% of our patients and this show the role of elevated triglycerides as isolated
factor and as part of metabolic syndrome in accelerating the progression of
cirrhosis through development of NAFLD.
Type 2 diabetes mellitus is one of the factors which may develop NAFLD
which may accelerate the development of cirrhosis in setting of associated HCV
infection as in our study in which showed 34% of patients got diabetes mellitus
type 2 and this show the importance of controlling patients’ blood sugar
especially those with HCV infection in order to protect patients from rapid
progression of disease.
In our community the prevalence of autoimmune disorders of liver is
underestimated due to lack of screening and lack of awareness, although the
prevalence of autoimmune markers in our study were not that high but they got
apparent effect progression of fibrosis and development of cirrhosis and this
show the importance of assessment of the autoimmune markers in all patients
with HCV especially those with signs of early fibrosis or early cirrhotic changes.
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Wilson’s disease and HCV relation still need special studies as the relation
between both is not well studied due to rarity of Wilson’s disease and rarity of
coinfection with HCV and Wilson’s disease as in our study no cases were found to
got Wilson’s disease and though the relation between both HCV and Wilson’s
disease couldn’t be detected.
In summary chronic HCV infection is slowly progressing disease and early
progression of fibrosis or development of cirrhosis in young age, especially below
age of 40 years which is considered the threshold for more rapid progression of
fibrosis , should be considered for screening and looking for other factors that
may accelerate the disease progression especially the modifiable factors that can
be treated or corrected in order to improve the outcome of the disease and
protect the patients from development of complications.
The factors which must be looked for in all our young Egyptian patients
confirmed to have HCV infection are Shistosomiasis, HBV coinfection,
dyslipidemia and diabetes mellitus.
Finally the drawbacks of this work were mainly not including some other
factors which may play important role in rapid progression of the disease like iron
studies.
By the end of this work our recommendations were to screen well for the
other associated causes of liver cirrhosis in all patients with HCV infection and to
conduct more studies aiming at studying the effect of correction of the comorbid
factors on the progression of disease.