RESUMEN
Background: Chronic hepatitis C virus infection are often associated with extra hepatic imrnunological manifestations including various autoimmune disorders . The aim of this study was to evaluate the significance of immune thrombocytopenia and platelet associated IgG in patients with chronic hepatitis C and patients with liver cirrhosis .Forty patients with chronic hepatitis C virus infection were chosen for this study . They were divided according to platelet cotmt into thrombocytopenic group and non thrombocytopenic group matched for age and sex .all patients were subjected to liver function tests , renal function tests , complete blood picture, bone marrow biopsy ,abdominal ultrasonography , liver biopsy with histopathological examination and platelet Ig G assay[PA Ig G]
Results: PA IgG was significantly high in thrombocytopenic group [15 out of 20 ; 75%] compared with non thrombocytopenic group [3 out of 20 ,15%][p< 0.01] . Moreover , in the thrombocytopenic group,when we compared PAIgG and child's grades we found that PAIgG was significantly high in patients with child's C grade [6 out- of 6 100%], when compared to child's B'[4 out of 7 ; 57%], and those with child's A [0 out of 7Also PAIgG was significantly high in patients with child's B when compared with those with child's A grade[p<0.05]. As regards histopathology index , we found that in the thrombocytopenic group , PAIgG was significantly high in patients with liver cirrhosis [8. out of 10;.80%] compared with chronic active hepatitis[2 out of 10 ;20%][p< 0.01]. Moreover , we found that histopathological activity index was significantly high in the thrombocytopenic group [9.1+ 2.5] comparing with non-thrombocytopenic group [7.35 +2.5][p,0.05] . Also fibrosis stage was significantly high in the thrombocytopenic group [2.5+0.96] , comparing to non thrombocytopenic group [2.05+0.876][p< 0.05]. the study
Concluded: that It is vitally important not to immediately conclude that the thrombocytopenia encountered in patients with chronic hepatitis C indicates cirrhosis with portal hypertension andhypersplenism, but autoimmune mechanisms may be the cause. PAIgG and immune thrombocytopenia can be used as prognostic marker from the clinical and pathological point of view in patients with chronic hepatitis C virus infection and in patients with liver cirrhosis passing from one stage to another
RESUMEN
To our knowledge no previous data worldwide investigated the effects of interferon therapy in the treatment of hepatitis C virus [HCV] for longer than two years. So, this study was conducted to address the longer-term [3.5 years] Group II: 59 patients, chronic HCV with no cirrhosis, [interferon group-I] received interferon 3MIU every other day for 6 months. 57 patients completed the interferon therapy as 2 patients excluded during interferon therapy.outcomes of clinical, virological, biochemical and clinical responses to interferon therapy and the change in incidence of hepatocellular carcinoma [HCC] and other HCV-related complications in-patients with chronic hepatitis C with and without liver cirrhosis. 139 patients in our study were classified into 4 groups: Group I: 20 patients, chronic HCV with no cirrhosis, [control group-1] received silymarin 70 mg thrice daily for 3.5 years. Group III: 20 patients, chronic HCV with cirrhosis, [control group-2] received silymarin 70mg thrice daily for 3.5 years. Group IV: 40 patients, chronic HCV with cirrhosis, [interferon group-2] received interferon 3MIU every other day. for 6 months. Evaluation of our patients during the study period was based on the followings: 1] Response at the end of interferon therapy and 3 years after interferon withdrawal. 2] Incidence of liver decompensation. 3] Incidence of portal hypertension 4] Incidence of gastrointestinal bleeding. 5] Incidence of hepatocellular carcinoma. 1- Interferon alpha is effective in chronic hepatitis C and 49% of patients obtain a sustained benefit [long-term responders]. 2-The sustained response to interferon therapy in patients with chronic hepatitis C with cirrhosis is 0% after 3 years of stop interferon. 3-Interferon therapy significantly reduces the risk of developing portal hypertension, ascites and hepato-cellular carcinoma in patients with HCV cirrhosis irrespective of the virological response to interferon. - Early treatment of patients with chronic hepatitis C before reaching the stage of cirrhosis.- Proper selection of patient who is candidate for interferon therapy to increase the response rate. Cirrhosis should not be considered a reason for excluding patients with HCV- related liver disease from interferon therapy