الفهرس 
Introduction
Hepatic stellate cells (HSC)Only 14 pages are availabe for public view
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Abstract
Background: Transient elastography (fibroscan) is a rapid, non invasive and reproducible method allowing liver stiffness measurements (LSM) to evaluate liver fibrosis. The aim of this study: to evaluate the accuracy of fibroscan in assessment of liver fibrosis in patients with chronic hepatitis C in comparison with liver biopsy (LB). Also, to assess the impact of treatment with pegylated interferon and ribavirin on the liver histology.
Aim of work: Our work aimed to evaluate the accuracy of fibroscan in assessment of liver fibrosis in patients with chronic hepatitis C in comparison with liver biopsy. Also to assess the impact of treatment with pegylated interferon and ribavirin on the liver histology.
Patients and methods: This prospective study enrolled 134 patients with chronic hepatitis C (genotype 4). Nine patients were excluded because biopsy specimens length < 1.5 cm or contain < 10 portal tracts. All patients underwent LB, LSM (Fibrsocan, Echosens, Paris, France) and routine laboratory investigations. Liver fibrosis was assessed by Metavir scoring system with scale range from 0 to 4 by 2 experienced pathologists. Also steatosis and necroinflammatory activity were reported. The accuracy of fibroscan was assessed by measurement of the areas under the receiver operating characteristics (ROC) curve, sensitivity and specificity. After treatment with combination therapy of pegylated interferon alpha 2a and ribavirin for 48 weeks, sixteen patients were reassessed by post-treatment liver biopsy after 1 year of discontinuation of treatment.
Results: Fibroscan values ranged from 2.4 to 75.4 kilopascals. For F 2, the cut off was 7.8 kpa with AUROC of 0.82, sensitivity of 67% and specificity of 91%. For F 3, the cutoff was 11.9 kpa with AUROC of 0.91, sensitivity of 86% and specificity of 85%. For F = 4, the cut off was 19.3 kpa with AUROC of 0.96 sensitivity of 95% and specificity of 92%. Liver stiffness measurement by fibroscan was correlated significantly with Metavir fiborsis stages (P = 0.000) but not with the degree of necro-inflammatory activity or steatosis (P = 0.311, P = 0.384 respectively). There was significant positive correlation between APRI and both fibroscan values and different fibrosis stages in liver biopsy according to Metavir scoring system (P = 0.004, P = 0.002 respectively). This study concluded that APRI has a high negative predictive value to Rule out cirrhosis. Sixteen patients (13 responders and 3 relapsers) reassessed after interferon therapy and there was regression in fibrosis stages in some patients after interferon therapy, but this didn’t reach statistical significance (P = 0.069) while significant decrease in the degree of necroinflammatory activity was reported (P = 0.002). Non invasive methods such as transient elastography (Fibroscan) and APRI are easy and quick clinical non invasive methods for assessment of fibrosis. Results are available immediately and they are accurate methods for prediction of significant fibrosis, detection of cirrhosis and in the follow up of patients during and after receiving antiviral treatment. Also non invasive methods can be helpful in patients refuse biopsy and in patients with relative contraindication to liver biopsy (such as hemophilia or anticoagulation therapy in patients who are at high risk of developing thrombotic events if treatment is interrupted).
Conclusions: Combination of pegylated interferon and ribavirin could improve histological activity grade after one year of the end of treatment in chronic hepatitis C patients.