ABSTRACT
Although liver biopsy is acknowledged as the gold standard for evaluating fibrosis, it is occasionally prone to sampling error and complications. Is to correlate an index of biochemical markers with histological features of fibrosis in patients with chronic hepatitis C virus [HCV] and/or non alcoholic steatohepatitis [NASH] with or without schistosomiasis in order to reduce the use of liver biopsy. Fifty-six patients [n-56] attending tropical medicine clinics in Kasr El-Aini and Beni Suef Faculty of Medicine were enrolled and classified into 3 groups according to the histopathological findings of their liver biopsy. Stool and urine analysis were done to exclude passage of Schistosoma ova, in addition to liver biopsy, abdominal ultrasonography, and testing of their sera for fibrosis biomarkers [Apolipoprotein Al, Haptoglobin, Alpha-2-Macroglobulin, and Ganima-glutamyl transpeptidase [GGT]]. Patients with history of contact with canal water [35 patients] were screened for Schistosoma mansoni infection by detecting anti-Schistosoma IgG antibodies and circulating Schistosoma soluble egg antigen using indirect ELISA and sandwich ELISA techniques, respectively. Forty-three [43%] of group I [HCV] and 40% of group II [HCV and NASH] had advanced fibrosis [F3 and F4]. Out of the 35 patients with positive history of canal water contact 25 [71.4%] were antibody positive; Schistosoma antigen was detected in only 5 patients [14.3%], with no statistically significant differences in the level of fibrosis seromarkers from other patients. Alpha-2-macroglobulin was found to be a reliable predictor of fibrosis. Haptoglobin was negatively related to the degree of hepatic fibrosis in groups I and II and significantly directly correlated in group III [NASH]. By regression analysis, haptoglobin can be a good predictor for fibrosis in group Ill. Apolipoprotein Al had insignificant negative correlation to the stage of fibrosis in groups I and II. GGT was positively correlated to the degree of hepatic fibrosis in groups I, II and III. AST/platelet ratio index [APRI] proved significantly directly correlated with fibrosis stage and grade of inflammation of the studied patients. Co-infection with schistosomiasis in patients with HCV and/or NASH gave no statistically significant differenceinfibrosis staging in all groups.Alpha-2-macroglobulin, haptoglobin and apolipoprotein Al, besides APRI index and modified APRI index proved to be significant predictors of hepatic fibrosis