الفهرس 
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Abstract
.he liver is considered one of the most important vital organs in the human body and it is the largest organ inside the body and it has the greatest role in the process of demolition and construction of the various nutrients that a person consumes throughout his day. It is responsible for purifying and filtering the blood from harmful substances that have a negative impact on human health. Since the liver is considered the main filter that rids the body of those harmful substances that a person may be exposed to in his daily life, and with the accumulation of these harmful substances in the liver cells, even if they are in small proportions, over the course of a person’s life they have a very dangerous impact on his health. Since infection with hepatitis viruses is one of the most common and dangerous diseases in the world that threatens human health and has become one of the most important and dangerous causes that lead to cirrhosis and fibrosis of the liver, which in turn leads to cancer and then to liver failure that leads to death or forces the patient to undergo a liver transplant to save his life. Since liver transplant operations are risky and expensive surgeries that many patients cannot afford, we see many patients refraining from undergoing liver transplant operations. Since traditional biochemical and serological tests have become of little importance in diagnosing liver fibrosis and its degree, as well as the activity leading to the formation of fibers and the presence or absence of liver cancer, it was necessary to think and search for new methods that would be more accurate in diagnosing such diseases. Therefore, the trend towards taking a sample from the liver and analyzing it pathologically was necessary in determining the extent of fibrosis or cirrhosis of the liver and in diagnosing liver cancer. However, taking a sample from the liver is sometimes very harmful and painful for the patient and may result in bleeding due to the high fluidity time in most liver patients. It may also be suspicious due to the heterogeneous distribution of pathological changes in the liver, which leads to the lack of efficiency of the pathological sample in accurately determining the disease. Accordingly, it was necessary to search for other non-penetrating serum biochemical markers to assess the degree of fibrosis and liver cirrhosis in chronic hepatitis, as well as to predict the possibility of developing liver cancer before it occurs, and thus help in better evaluation and follow-up of the disease. Since metalloproteinase groups are the main enzymes in regulating the components of the intercellular tissue, as well as in regulating the metabolic processes of collagen and the pathological nature of fibrosis, due to their ability to cleave and replace the components of the intercellular tissue in addition to other proteins between cells, and this ability is regulated by interaction with enzymes that inhibit metalloproteinase. The metalloproteinase family contains many enzymes, the most important of which is gelatinase, which is important in the occurrence of organ fibrosis, as it has the ability to replace type IV collagen, and thus is important in the first steps responsible for the changes that occur in the construction of tissues that are characteristic of chronic viral hepatitis, as well as in the invasion and spread of cancerous tumors, due to its ability to destroy the intercellular tissue. There are two main types of gelatinase enzymes (metalloproteinase-2 and metalloproteinase-9). Studies have shown that the level of metalloproteinase-9 in the blood increases in cases of chronic liver diseases. Therefore, this study aims to evaluate the clinical significance of metalloproteinase-9 as a diagnostic indicator in cases of chronic hepatitis C and liver diseases such as fibrosis or cirrhosis and liver cancer. This study also aims to determine the extent of the relationship between the level of metalloproteinase-9 in the blood and the extent of the impact on liver cell functions, especially liver enzymes and the percentage of bile and albumin in the blood, as well as a comparison between the amount of change in the level of metalloproteinase-9 in cases of liver cancer with Change in the level of tumor markers alpha-fetoprotein
This study was conducted on seventy patients whose ages ranged between twenty
and eighty years old. They were all selected from the Digestive Surgery Center - Mansoura University and were divided into five groups in addition to twenty-five healthy
whose ages were similar to the patients under study in order to compare them with the group of patients under study.
The groups were divided as follows:
The first group: included twenty-five healthy people with an average age of
25.3±) years as a control group (4.63)
The second group: included twenty-four patients with liver tumors paired with
56.37) years. ± With hepatitis C virus and their average age (4.6
group III: It included eleven patients with liver tumors not associated with hepatitis
53.84) years. ± With hepatitis C virus and their average age (6.79
group IV: It included fourteen patients with cirrhosis associated with
53) years. . ± 43 With hepatitis C virus and their average age (9.46
group V: It included eleven patients with cirrhosis not associated with
52.64) years. ± With hepatitis C virus and their average age (9.14
group VI: It included ten patients with hepatitis C virus
48) years. . 9 ± chronic and their average age (12.4
All patients and healthy subjects underwent the following:
-1 Full knowledge of the disease history.
-2 Complete clinical examination.
-3 Routine laboratory tests
Full liver functions (albumin and bile ratio - alanine transaminase
aspartate transaminase and gamma glutamyl transaminase - thyroglobulin factor - lactate
dehydrogenase - carcinoembryonic antigen - alpha fetoprotein
and PCR -4 Serological tests for hepatitis C virus markers using
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