الفهرس 
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Abstract
In Egypt, it is believed now that HCC is one of the common malignancies and a leading cause of death due to high prevalence of cirrhosis related to chronic HCV. In previous years there is an increase in its incidence and it is expected that the number of cases continues to grow. HCC is a major health problem worldwide and its diagnosis is still challenging. Thioredoxin is a class of small redox proteins known to be present in all organisms. It plays a role in many important biological processes, including redox signaling. The main aim of this study was to study the serum thioredoxin level for assessment of response after ablation therapy for hepatocellular carcinoma in Egyptian patients. This prospective case study was carried out in Department of Tropical Medicine and Infectious Diseases, Tanta University Hospital. The duration of study was from April 2019 till April 2020. Eighty (80) patients were included in this study. Patients were classified into the followings: 1. group A: Included 20 cirrhotic patients without HCC. 2. group B: Included 20 HCC patients without treatment. 3. group C: Included 20 HCC patients treated with ablation therapy (radiofrequency- microwave) and follow up after 3 and 6 months. 4. group D: control group included 20 cases. Our study showed that: Significant differences were found between the four groups regarding TRX (p=0.001) as group B and C showed significant elevation in TRX level compared to group A & D (p=0.006). TRX was significantly decreased after 6 months compared to 3 months and preoperative (p=0.001). Our results showed that TRX at cutoff 100 ng/ml can differentiate between early HCC and liver cirrhosis with the sensitivity, specificity, PPV and NPV was 95%, 85%, 86% and 94% respectively. While AFP can detect patients at cutoff 30 ng/ml with the sensitivity, specificity, PPV and NPV was 75%, 70%, 71% and 74% respectively. Furthermore, in this work, TRX at cutoff 103 ng/ml can differentiate between advanced HCC and cirrhotic patients with 95% sensitivity, 100% specificity, 100% PPV, 95% NPV. While AFP can detect patients at cutoff 70 ng/ml with the 85% sensitivity, 50% specificity, 63% PPV and 77%NPV. The present study showed that there was positive significant correlations between TRX and FL size (r = 0.509, P=0.001). There were also positive significant correlations between TRX and AST (r=0.279, p=0.031), Total bilirubin (r=0.031, p=0.001), Direct bilirubin (r=0.372, p=0.003) and INR (r=0.003, p=0.001). There were insignificant correlations between TRX and each of AFP, platelet, Hb, RBCs, TLC, prothrombin activity, serum creatinine, serum albumin, Serum Urea and ESR (P > 0.05). In group C after therapeutic intervention, there was a significant decrease in TRX level among patients showing complete response compared to those with partial response or progressive course (P=0.001). So, its post interventional decrease could be a good predictive marker for good therapeutic response in HCC. After therapeutic intervention, decreased serum level of TRX can be an indicator of good response to treatment. While increased serum TRX level can be an indicator of poor response.