الفهرس 
Introduction
Hepatitis C VirusOnly 14 pages are availabe for public view
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Abstract
This work was designed to elucidate the value of platelets count, MPV, platelet aggregation with ADP and CRP in diagnosis and probable predicting HCC in liver cirrhosis patients, and to clarify their relation to ALT, AST and AFP.
This study included 50 patients, 30 patients hepatitis C –relared liver cirrhosis , 20 patients hepatocellular carcinoma on top hepatitis C -related cirrhosis, their age ranged from 40 to 65 years with a mean + SD (54.83 5.07) , beside 20 apparently healthy individuals age and sex matched to the patients were chosen as a control group , attending the Out- Patients Clinic and the in patients who were admitted to Gastrohepatology Unit of Internal Medicine Department of Assiut University Hospitals.
Inclusion criteria
1 Patients with hepatitis C-related liver cirrhosis.
2-Patients with HCC on top of hepatitis C-related liver cirrhosis, the diagnosis of HCC based on consistent findings obtained by imaging techniques: ultrasonography (US), computed tomography (CT) and alfa feto protein .
Exclusion criteria
1-Patients with HCC under chemotherapy or any interventional management as radiofreqency (R.F.A) &transarterialchemoembolisation (TACE) and non steroid anti-inflammatory drugs.
2-Patients with diabetes , hypertension, renal failure, cigarette smoking, estrogen replacement therapy.
All patients were subjected to:
Full history taking and thorough clinical examination.
To all patients the following investigations were performed:
1-Complete blood count including MPV.
2-Liver function tests (serum ALT, albumin level).
3-Anti HCV and HBsAg .
4-Blood urea and serum creatinine.
5-Abdominal sonography.
6- Prothrombin time and concentration ( PT & PC )
7- C - reactive protein.
8-Alpha-fetoprotein (AFP).
9-Platelet aggregation with ADP.
The results of this study showed that:
Platelets count was significantly lower in both (HCV-LC) and (HCV-HCC) patients than controls (P<0.001 for each), and was significantly lower in (HCV-LC) than (HCV-HCC) patients (P<0.001).
Our results revealed that, MPV was significantly higher in (HCV-LC) compared to controls (P= 0.003), MPV values were significantly higher among (HCV-HCC) patients compared to those with (HCV-LC) and controls (p < 0.001 for each).
There were significant increased levels of ALT in both (HCV-LC) and (HCV-HCC) patients compared to controls (p < 0.001). Whereas ALT levels between (HCV-LC) and (HCV-HCC) patients (P > 0.05) showed no significant difference.
There were significant increased levels of AST in both (HCV-LC) and (HCV-HCC) patients than in controls (p=0.007, p < 0.001) respectively, and in (HCV-LC) than (HCV-HCC) patients ( p=0.004).
This study revealed a statistically significant positive correlation between MPV and: AST (r= 0.364, p<0.05), ALT (r= 0.723, p<0.001) in (HCV-LC) patients.
There was a significant positive correlation between MPV and AFP levels in (HCV-LC) patients (r= 0.452, p=0.01), also there was a positive correlation between MPV and AFP levels in (HCV-HCC) patients (r= 0.147, p> 0.05) but not statistically significant.
This study revealed a statistically significant positive correlation between AFP and ALT levels, where increased levels of AFP was highly associated with increased ALT levels (r= 0.852, p <0.001), while no significant difference could be detected between AFP levels, AST (r= 0.178, p> 0.05) or platelets count (r= 0.153, p > 0.05).
Our results revealed that (HCV- HCC) patients had higher CRP levels than control and (HCV-LC) patients (p<0.001 for each).
As regard AFP, the current study showed that, AFP levels were significantly higher in (HCV-HCC) patients than in control and (HCV-LC) patients (p<0.001 for each). While (HCV-LC) patients had higher AFP levels than control (P>0.05), but this difference was statistically insignificant.
There were significant increased platelet aggregation with ADP in (HCV-HCC) patients than in control and (HCV-LC) patients (p=0.01 , p<0.001) respectively, While there was reduced platelet aggregation with ADP in (HCV-LC) patients than in controls without significant statistical difference (P > 0.05).
In the present study we found a significant positive correlation between AFP and Platelet aggregation with ADP (r= 0.487, p<0.05) in HCC patients.
Conclusions
Based on the results of this study, we can conclude that:
1- In hepatitis C-related liver cirrhosis patients, lower platelet count, higher levels of MPV , CRP and AFP and reduced platelet aggregation with ADP can serve as a useful adjuvant markers in follow up the patients along with impaired liver functions for early detection of HCC.
2- increased platelet aggregation with ADP is easy, available method could be used in follow up of HCC patients
3- MPV is increased in cirrhotic patients , MPV is an indictor of platelet activation. MPV was positively correlated with AST, ALT level.
4- Elevated AFP levels correlated positively with ALT and AST elevation.