الفهرس 
INTRODUCTION
REVIEW OF THE LITERATUREOnly 14 pages are availabe for public view
 |  | from | 75 |  |  |
| | | from | 75 | | |
Abstract
The estimated global prevalence of HCV infection is 2.2%, corresponding to about 130 000 000 HCV-positive persons worldwide. An estimated 27% of cirrhosis and 25% of HCC worldwide occur in HCV-infected people. The highest HCV prevalence in the world occurs in Egypt, where the prevalence of infection increases steadily with age and attributed to contaminated glass syringes used in nationwide schistosomiasis treatment campaigns from 1960 to 1987.Transmission occurs mainly through injection drug use (IDU), blood transfusions, organ transplantations, accidental needle sticks.75%-85% of HCV-infected persons will progress to chronic HCV infection, and are at risk for the development of extra hepatic manifestations, compensated and decompensated cirrhosis, and Hepatocellular carcinoma (HCC).Cirrhosis is the final and irreversible stage of chronic hepatitis. It is defined anatomically as a diffuse process of fibrosis in addition to parenchymal nodule formation, with complete loss of normal hepatic architecture and functional alteration of blood flow, resulting in increased portal pressure. Cirrhosis is usually, asymptomatic until complications of liver disease occur such as hematemesis, ascites, hepatic encephalopathy and HCC.
Apelin is a peptide recently added to the family of adipokines. Its expression has been detected in many organs including brain, lungs, placenta, breasts in pregnant and lactating women, kidneys, prostate, testes, uterus, gastrointestinal tract, heart, and vascular tissue. It has many physiological roles in human body including positive inotropic effect, lowers blood pressure, regulation of body temperature, and thirst sensation, in addition to recent studies which related it to liver disease particularly in inflammation, fibrosis, angiogenesis, and hemodynamic disturbances in cirrhosis.
The aim of this work was to study the endogenous apelin in post hepatitis C chronic liver diseases.
To achieve this goal, 80 subjects were included in the study subdivided into two groups:
Group I: 60 patients with post hepatitis C chronic liver disease were classified according to the child Pugh score into:
• 12 patients with child Pugh score A.
• 20 patients with child Pugh score B.
• 28 patients with child Pugh score C.
Group II: 20 normal healthy volunteers of comparable age and sex as control.
All patients were evaluated clinically and the severity of liver disease was graded according to child-Pugh scoring system. blood samples were collected from all patients and healthy subjects to assess CBC ,liver profile ,urea and creatinine ,serum alpha fetoprotein ,serum apelin-13 and viral markers(HCV-Ab and HCV-RNA For hepatitis C -HBs-Ag and HBC-Ab For hepatitis B).abdominal ultrasound was performed in all patients for the diagnosis of liver cirrhosis, portal hypertension and detection of ascites.upper GIT endoscopy was performed in all patients for the detection of esophageal ,gastric varices and portal hypertensive gastropathy.
Statistical analysis of data obtained from the present study show the following results:
There was no significant difference between the two groups as regards sex and age.
As regard clinical examination, significant difference between the three child classes of group I was present in: Jaundice (p<0.001*), Hepatic encephalopathy (MCP=<0.001*), and ascites (MCP=<0.001*), while no significant difference in GIT bleeding between the three groups and a positive significant relation was found between the mean serum apelin-13 level and the presence of encephalopathy.
In the present study, the mean hemoglobin concentration (9.89 ± 1.80 g/dl in group I vs 13.96 ± 1.26 g/dl in group II), RBCs count (3.70 ± 1.08x106/cmm in group I vs 4.53 ± 0.65x106/cmm in group II) and platelet count (139.97 ± 61.09x103/ cmm in group I vs 321.41±104.52x103/cmm in group II) were significantly lower in group I compared to group II (p <0.001*, p=0.002, p <0.001* respectively). But no significant difference was found between the two groups as regards WBCs count.
Concerning the liver function tests, there was no significant difference between the two groups as regards ALT. But the mean serum level of AST was significantly higher in group I (53.16 ± 43.04 IU/L) compared to group II (24.75 ± 5.92 IU/L), MWp <0.001*. The mean prothrombin time(15.95 ± 2.41 vs 12.70 ± 0.73sec), INR (1.53 ± 0.29 vs 1.06 ± 0.09) and total serum bilirubin(2.15 ±1.78 vs 0.73 ± 0.17mg/dl) were significantly higher in group I compared to group II, ,MWp <0.001*, p = 0.032*, p = 0.040.while, the mean serum albumin was significantly lower in group I (2.80 ± 0.73 g/dl) compared group II(4.44 ± 0.42 g/dl), MWp <0.001*.
The mean serum urea (38.55 ± 15.26 in group I vs 30.30 ± 8.03 mg/dl in group II) and creatinine (0.96 ± 0.27 in group I vs 0.79 ± 0.20 mg/dl in group II) were significantly higher in group I compared to group II, p = 0.024*, p = 0.010*.
In the current study, the mean serum alpha fetoprotein was significantly higher in group I (9.74 ± 9.69ng/ml) compared to group II (2.95 ± 1.65ng/ml), p <0.001*.
The mean serum apelin-13 was statistically significantly higher in group I (681.41 ± 209.83pg/ml) compared to group II (278.78 ± 58.12pg/ml), p<0.0001*. Also, in group I the mean serum apelin was significantly higher in child C patients(707.34 ± 177.19 pg/ml) compared to child A(570.20 ± 169.10 pg/ml), p= 0.039*.As regards ultrasonic data, the percentage of shrunken liver was significantly higher in child class C (60.7%) compared to (0%) in child A and (15%) in child B, MCP=<0.001*.The mean spleen size and Portal vein diameter were significantly lower in child A compared to child B and C, p = 0.052, P=0.017*. Positive significant correlation was found between the mean serum apelin-13 level and spleen size. Only six patients of the total sixty had non hepatopetal flow, all of them were patients of child C, P < 050*. The portal vein flow velocity was statistically significantly lower in patients of child C compared to patients of child A and child B, p <0.001*.
Finally, as regards endoscopic data, a significant difference was present between the three child classes of group I for the presence of esophageal varices i.e. The percentage of patients with esophageal varices was significantly higher in patients of child class C (100%) compared to patients of child class B (90%) and patients of child class A (50%); MCp= 0.013*. gastric varices was significantly lower in patients of child class C compared to patients of child class B but no significant difference was found between the three child classes of group I as regards the presence of portal hypertensive gastropathy and a Positive significant relation was found between the mean serum apelin-13 level and esophageal varices and portal hypertensive gastropathy.