ABSTRACT
This study was conducted to investigate the serum levels of soluble Fas [sFas] antigen, soluble intracellular adhesion molecules-1 [sICAM-1] and interleukin-18 [IL-18] in patients with chronic hepatitis C and to correlate their levels with the severity of pathological findings judged by liver biopsy interpreted as Scheuer score. The study included 30 patients with chronic hepatitis C [Study group] infection persisting for longer than 6 months with HCV antibody positive and increased serum alanine aminotransferase [ALT] values and 10 volunteers to donate blood samples as control group. After complete history taking and full clinical examination, all patients and controls gave a fasting blood sample for colorimetric estimation of serum aspartate transaminase [AST], ALT and total [TB] and direct [DB] bilirubin and for ELISA assays of serum sICAM-1, sFas and IL- 18 levels. Blind liver biopsies were done and histopathological inflammatory activity [grading, 0-4 scale] and fibrosis stage [0-4 scale] were assessed according to Scheuer classification. Pathological examination of Liver biopsy detected 21 chronic hepatitis specimens and 9 cirrhosis specimens with a significant [p<0.05] increase of Scheuer scores in patients with cirrhosis compared to patients with chronic hepatitis. Serum levels of AST and ALT were significantly [p<0.05] elevated in study compared to control group, with a non-significant [p>0.05] increase of AST/ALT ratio; however, serum AST levels and AST/ALT ratio were significantly [p<0.05] higher and serum ALT levels were non-significantly [p>0.05] higher in cirrhotic patients compared to those with chronic hepatitis. Serum sFas, sICAM-1 and IL-18 levels in study group were significantly [p<0.05] higher compared to controls levels with a significant [p<0.05] increase of sICAM-1 levels and non-significant [p>0.05] increase of sFas and IL-18 levels in cirrhotic patients compared to patients with chronic hepatitis. There was a positive significant correlation between the mean Scheuer necroinflammatory score and serum levels of ALT, sICAM-1 and AST/ALT ratio and between the mean Scheuer fibrosis score and serum levels of ALT, sFas, sICAM-1 and IL-18 and AST/ALT ratio. Logistic regression analysis showed that AST/ALT ratio [beta=0.679, p<0.001] and serum levels of sICAM-1, [beta=0.327, p=0.005] are the most significant predictors of disease severity. It could be concluded that serum levels of sICAM-1, sFas and IL- 18 and AST/ ALT ratio are closely correlated with histopathological results of liver biopsy and thus their elevated levels could be considered pathognomonic markers suggesting the severity of chronic hepatitis C
ABSTRACT
This work was conducted on 40 patients with chronic virus hepatitis [21 patients with chronic hepatitis C with bilharzial periportal fibrosis, 2 patients with combined chronic hepatitis B and C and 17 patients with chronic hepatitis C alone] in addition to 10 healthy age and sex matched control subjects. The objective of this work was to study the status of TGF- beta-1 among patients with chronic virus hepatitis and its relation to age and sex and to evaluate the effect of colchicine and oral enzyme therapy on the level of TGF- beta-1. Patients were divided into 2 groups, group I who received oral enzyme therapy and group II who received colchicine, plasma level of TGF- beta-1 was estimated by ELISA with [MEDGENIX TGF- beta-1, ELISA kit] before and after receiving the treatment. It was found that plasma TGF- beta-1 level was significantly higher in patients with chronic virus hepatitis than control group and this level is not related to age or sex. The plasma TGF- beta-1 level was significantly higher in patients with chronic hepatitis C infection with bilharzial periportal fibrosis of liver than in patient with chronic hepatitis C alone, also it was significantly higher in patient with ultrasonographic findings of cirrhosis than those without cirrhosis. The plasma TGF- beta-1 level had no correlation with liver function tests but had positive correlation with serum procollagen III. Before treatment there was no significant difference in clinical picture, laboratory investigations, serum procollagen III and plasma TGF- beta-1 level between group I and group H but after treatment, there was improvement in clinical picture, liver function tests and significant reduction of serum procollagen III and plasma TGF- beta-1 level in group I but not in group II. So it can be concluded that plasma TGF- beta-1 level is a good marker of liver fibrogenesis and oral enzyme therapy is anti-TGF- beta-1 and can reduce the hepatic fibrosis in patients with chronic viral hepatitis