الفهرس 
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Abstract
Chronic hepatitis C is a liver disease caused by the hepatitis C virus.
The virus can cause both acute and chronic hepatitis infections, ranging in
severity from a mild illness lasting a few weeks to a serious, lifelong
illness that may lead to cirrhosis, liver cell failure and hepatocellular
carcinoma as well as the most common indication for liver transplantation
in many countries.
Liver biopsy remains the cornerstone method in the diagnosis and
staging of liver fibrosis. Although liver biopsy in general a safe
procedure, it is costly and does carry a small risk for complications.
The aim of the present work was to study the relationship between
the glycated albumin (GA) to glycated hemoglobin (HbA1c) ratio alone
or in combination with APRI and the histological grading of liver
fibrosis.
This study was conducted on 90 patients (47 males, 43 females) ;
their ages ranged between 18-60years with a mean age is 43.27±11.6 with
chronic hepatitis C (Positive HCV-Ab and HCV RNA) attended to
outpatient clinic in Menofia National liver institute or outpatient clinic at
Tropical Medicine Department in Menofia university hospitals with no
statistically significant difference between the groups as regards sex.
All patients were subjected to thorough history, clinical
examination, complete blood tests, liver function tests, kidney function
tests, viral hepatitis markers, abdominal Ultrasonography, and exclusion
of other possible causes of chronic hepatitis e.g. (HBV, schistosomaisis,
autoimmune). Measurement of Glycated albumin (GA) in serum by
(ELISA) and glycated hemoglobin (HbA1c) in serum by (Microcolumn
chromatography) in the same sample and on the same period as the liver
biopsies were performed. Then, the ratio of GA/HbA1c was calculated.
The AST-to-platelet ratio index (APRI) was also calculated for all
patients. Percutaneaous liver biopsy was done with histopathological
examination and grading according to the METAVIR scoring system.
In the current study, there was a positive correlation between age
and fibrosis stage; with no statistically significant difference between the
groups as regards age and sex.
As regards Laboratory parameters, This study showed statistically
significant difference between the groups regarding platelets, albumin,
prothrombin time, AST, ALP and GGT. Serum albumin, prothrombin
time and platelets significantly decreased as fibrosis stage increased while
AST, ALP and GGT levels significantly increased with progression of
fibrosis.
This study showed statistically significant difference between the
groups regarding liver size and echopattern; with an increase in the size
and brightness of liver with progressive fibrosis in Ultrasound
examination. But our study shows no statistically significant difference
between the groups regarding Spleen size.
This study showed the GA/HbA1c ratios have an inverse correlation
with the some indicators of hepatic function, thus suggesting that the
increase of GA/HbA1c ratio indicates a reduction in the liver function
caused by the progression of liver cirrhosis.
Also, there was a positive correlation between the values of
GA/HbA1c ratio and histological grading of liver fibrosis. With
increasing the degree of Liver fibrosis according to METAVIR score,
there is an increased level of GA/HBA1c. Also, with progression of Liver
fibrosis, there is an increased level of APRI.
At The cutoff point (GA/HbA1c > 3.0), the sensitivity and
specificity were 46.7% and 76.7% respectively and for using APRI>1.5
alone were 41.7% and 80% respectively. However, when we combined the GA/HbA1c ratio with the APRI, the sensitivity and specificity to
distinguish patients with significant fibrosis (F2-F4) from those without
significant fibrosis was improved significantly. When we used
GA/HBA1c>3 and APRI>1.5; the sensitivity and specificity were 65%
and 76.7% respectively, and for GA/HBA1c>3.2 and APRI>1.5 were
56.7%and 86.7% respectively. Therefore, compared with the detection of
significant liver fibrosis by using the GA/HBA1c alone, the combination
of APRI >1.5 and GA/HbA1c ratio > 3.2 improved the sensitivity of
46.7% to 56.7% with a major increase in the specificity from 76.7% to
86.7% was observed.
The current study showed that, the positive and negative predictive
values for using the combination of GA/HBA1c>3 or APRI>1.5 and
GA/HBA1c>3.2 or APRI>1.5 are better than using either of them alone.
These findings suggest that, the GA/HbA1c ratio can be used as a
supportive index for the evaluation of liver fibrosis alone or in
combination with other non-invasive markers as APRI. Since only a
small number of patients were investigated in the present study, we will
therefore need to rigorously investigate the ratios in both larger and
different populations.