الفهرس 
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Abstract
This study was conducted on 60 patient with chronic HCV recruited from the Hepatology Clinic and Internal Medicine Department, Ain Shams University Hospital during the period from May 2011 to January 2012. Patient were divided into 2 groups:
Group (I) consists of 60 pts complaining of chronic hepatitis Cinfection which were divided into 3 subgroups, group (IA) consists of hepatitis C infected pts with liver cirrhosis, group (IB) consists of hepatitis c infected pt with hepatic steatosis, and group (IC) consists of chronic hepatitis C infected pt without hepatic steatosis nor cirrhosis.
Group (IІ): 20 healthy individuals.
All were subjected to thorough medical history taking, full clinical examination, investigations for liver functions, renal function, measurement of serum RBP4 levels and HOMA insulin resistance assesment.
In this study patient were 38 males (63.4%) and 22 (36.6%) females. Their ages ranged from 40-55 with mean (44.900±6.9) 20 adults served as the control group. The age and sex distribution of the control group were matched to those of the case group.
In this study patient were 38 males (66.2/) and 21(37/) females. Their ages ranged from 40-55 with mean value (44.9±6.9). Group (1A): mean age (49±3), group (1B): with mean age (48±4.3), group (1C) mean age (37±5.6) with no significance difference between groups as regard age. With control mean age (49.2±3.412), also there is no significant difference between patient and control as regard age with p value (p=0.01).
Classification of cirrhotic patients according to Modified Child classification9 patient (22.5%)of cirrhotic patient child A,18(40%) of the patient child B, 13(32.5%) of the patient child C.
In this study showed no significant diffrence in body mass index (BMI) between cases compared to controls
(P = 0.070).
This study showed a highly significant difference between cases and controls regarding serum transaminases (ALT = 74.6 ± 30.7 and 32.4 ± 9.45 U/l in cases and controls respectively, P = 0) and (AST = 64.9 ± 20.6 and 28.4 ± 5.45 U/l in cases and controls respectively, P = 0).
This study showed a highly significant difference between cases and controls regarding serum albumin (3.023 ± 0.54and 3.69 ± 0.178 g/dl in cases and controls respectively, P = 0.0004).
This study showed a highly significant difference between cases and controls regarding INR (1.50 ± 0.2 and 1.1 ± 0.23 in cases and controls respectively, P = 0).
This study showed a highly significant difference between cases and controls regarding total billirubin (2.1and ± 1.096 mg/dl in cases and controls respectively, P = 0.000). And direct bilirubin (0.836±0807 with p value 0).
This study showed a highly significant difference between case and control regarding HOMA –IR (2.378±1.360, 1.245±0.45 in cases and controls respectively with p value=0.00).
As regard comparison between three subgroups as regard liver function:
Group (1A): Alt (91.950±41.218), AST (98±45), albumin (2.815±0.477), prothrombin time 16.730±2.999, INR (1.5±0.2), total billrubin (2.580±1.305) and direct billrubin (1.183±0.954).
Group (1B): Alt (65±48), AST (98±45), albumin (2.7±0.4), prothrombin time (16.6±1.8), INR (1.5±0.2), total billrubin (1.5±0.2) and direct billrubin (0.7±0.4).
Group (1C): Alt (52±8), AST (65±8), albumin (3.4±0.17), prothrombin time (12.8±1.8), INR (1.1±0.2), total billrubin (1.5±0.2) and direct billrubin (0.7±0.4).
In this study showed a highly significant difference between cases and controls regarding RBP4 as RBP4 was significantly lower in patients compared with controls (24.29±5.48 and 40.43±1.928 µg/ml in cases and controls respectively, P ≤ 0.000).
In this study there were highly significant difference between 3 subgroups in group (I) with (p value 0.000) as regard serum level of RBP4, in group (IA) it was (18.77µg/dl), group it was (26.620µg/dl), and group (IC) it was (27.5µg/dl).
This study showed a highly significant positive correlation in our patients between serum RBP4 and albumin (p vaue≤0.00), prothrombine time (p value 0.01), INR (p value≤0.000), while negative correlation between RBP4 and total bilirubin with p value (p value =0.004), ALT with p (p≤0.000).
In this study there is no significant correlation between level of RBP4and patients BMI.
In this study there is correlation between level of RBP4and patients age.
In this study there was significant positive correlation between level of RBP4and patients insulin resistance by HOMA-IR in HCV infected patient with p value (p=0.036).
In this study there is no correlation between level of RBP4 and degree of hepatic steatosis in patients of subgroup (IB) with p value (0.136).
In this study there is no correlation between level of RBP4and HCV PCR RNA level in patients with HCV infected patient .
In this study there is highly significant difference between cirrhotic pts in group (1) according to child pugh classification as regard mean RBP level with (p value 0.000).and also mean RBP4 decreased significantly with worsening of clinical stage of cirrhotic patient (Child A A27.6µg/dl±4.118, Child B 21.8±4.878 µg/dl, Child C 21.4±5.1 µg/dl) with (p value ≤0.000).
When we studied level of insulin resistance by (HOMA –IR )method in HCV patient in comparison to control group, IR was higher in HCV (mean 2.3± SD1.3) patient in comparison to control group (mean1.2± SD.45).
By linear regression analysis RBP4was independently linked to HOMA-IR score (P value ≤0.000) in HCV infected patient.
Roc curves was done showed that the RBP have a sensitivity of 98.3% and specificity of 100.0% in hepatitis C virus infected patient with NPV of 95.2% and PPV of 100% and accuracy of 99.7% at the cut off point of < 32.