الفهرس 
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Abstract
Schistosomiasis and HCV co-infection is common in Egypt, and shows a specific clinical, virological and histological pattern characterized by virus persistence with high HCV RNA titres and higher necroinflammatory and fibrosis scores in liver biopsies. In addition, these patients exhibit a poor interferon therapy response and accelerated hepatic fibrosis.
Co-infections with schistosomiasis caused more severe liver disease than infection with HCV alone. Schistosomiasis was reported to cause an imbalance in HCV-specific T-cell responses leading to increased viral load, a higher probability of HCV chronicity, and more rapid progression of complications in co-infected persons. Clinical studies showed 70% to 90% of patients with chronic hepatitis, cirrhosis, or hepatocellular carcinoma had HCV infections
Fibrosis is the hallmark of chronic liver diseases, and is one of the major causes of mortality and morbidity related to both schistosomiasis and HCV, although the pattern of fibrosis and underlying immunological mechanisms are different. It results from chronic damage to the liver in conjunction with the accumulation of extracellular matrix (ECM) proteins, which is a characteristic of most types of chronic liver diseases.
The best method to diagnose hepatic fibrosis in schistosomiasis and HCV patients is histological examination. Histological examination is limited because it is difficult to obtain a regular liver biopsy due to the risk of bleeding, sampling error and finally liver biopsy reflects a static picture of hepatic fibrosis. But, with the availability of effective treatments, such as interferon and the potential for progression to hepatocellular carcinoma (HCC) in some cases, an accurate measurement of the stage of disease is important. Assessment of hepatic fibrogenesis would give more important information about the ongoing process in the liver, especially at the early stage of the disease, during follow-up and under potential anti-fibrogenic therapy.
Hepatic fibrogenesis results from an imbalance between enhanced connective tissue synthesis and diminished or altered matrix breakdown, it is characterized by an excessive accumulation of ECM components. The ECM composition in septa and cirrhotic nodules consists mainly of collagen types I and III and other non-collagenous proteins such as fibronectin.
Staging of fibrosis relies on evaluation of several histological features including assessment of extent of the extracellular matrix deposit, the localization of the deposits within the liver lobule and changes in lobular architecture. Use of non-invasive biological markers to predict fibrosis severity is important for monitoring the transition to the severe forms of the disease and prognosis of these patients. The noninvasive markers are the most widely used alternative to liver biopsy.
Fibronectin plays crucial roles in various cellular functions, including cell adhesion, migration, proliferation and differentiation, it is considered a “master organizer” for the biogenesis of the extracellular matrix. It is mainly produced by hepatocytes and cellular fibronectin in liver is produced, at least in part, by endothelial cells, fat-storing cells and to a lesser extent, by hepatocytes. It has also been mentioned that fibronectin plays an important role in hepatic fibrogenesis.
Thus, this study’s objective was to evaluate the ability of serum biomarkers of extra cellular matrix (fibronectin) and routine laboratory tests (Total bilirubin, ALT, AST, PT, PTT, Platelet count and APRI) to predict hepatic fibrosis in Egyptian patients with schistosomiasis mansoni and HCV, not only as isolated diseases, but also as co-infections which can assist the clinician in making prognostic decision.
The study was conducted on 80 individuals:
Patients group (Schistosoma mansoni infected group): 60 patients of both sexes (45 males and 15 females) and their ages ranged from 16-62 years.
- Group I: 20 patients with active Schistosoma mansoni infection selected from Kafr Elsheikh, who are passing eggs in their stools, HCV antibody negative and free of other parasitic infections.
- Group II: 20 patients with chronic Schistosoma mansoni infection selected from Kafr Elsheikh, who are not passing eggs in their stools, have Indirect Haemagglutination test positive, HCV antibody negative and free of other parasitic infection
- Group III: Including 20 patients with chronic schistosomiasis mansoni infection associated with HCV infection selected from Ain Shams University Hospitals, who are not passing eggs in their stools, have Indirect Haemagglutination test positive, HCV antibody positive, free of parasitic infections and liver biopsy was done.