الفهرس 
Hepatitis C VirusOnly 14 pages are availabe for public view
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Abstract
HCV is a major cause of liver diseases all over the world. An estimated 3% of the world’s populations are chronically infected with HCV. HCV genotype 4 (HCV-g4) is the most frequent cause of chronic hepatitis C in Egypt with the highest worldwide incidence and prevalence of HCV-4 infections.
EHM are an integral part of the natural history of HCV infection. Arthralgia is one of the most common EHM in patients with hepatitis C virus (HCV) infection or HCV-related cryoglobulinemia. The worldwide prevalence of arthritis presumed to be due to HCV infection has been reported between 2.4 million and 45.9 million people.
Hepatitis C arthritis can mirror rheumatoid arthritis symptoms. Consequently, HCV infection should be considered in the differential diagnosis of patients with atypical arthritis. The clinical picture of HCV-related arthropathy varies widely, ranging from polyarthralgia to monoarticular or oligoarticular arthritis and symmetric chronic polyarthritis.
Many autoantibodies, including RF, are common in HCV-infected patients. In the light of these features, the distinction between liver disease-associated arthropathy and the occurrence of rheumatoid arthritis may be difficult. Therefore, the detection of classical RF is of little utility as a diagnostic tool because a high percentage of patients with HCV infection or associations of RA in autoimmune liver diseases have been shown to display serum RF reactivity.
Protein citrullation is involved in the pathogenesis of certain human diseases, the best example is RA. The most specific family of RA antibodies is the antibodies directed against citrullinated proteins (Anti CCP and Anti MCV), which are a very useful diagnostic tool for rheumatologists.
Anti- MCV antibodies are member of ACPA family that results due to antibody production against antigens produced from the citrullination of vimentin. The anti-citrullinated protein antibodies are produced locally in the inflamed synovium and since hepatic Stella cell, which plays a pivotal role in hepatic fibrosis, contains the filament vimentin. Oxidative stress due to liver injury can modify this vimentin and become immunogenic stimulating the production of anti-MCV antibody.
The aim of this study was to to find out if anti-modified citrullinated vimentin (anti-MCV) antibodies are produced in patients with chronic hepatitis C and if such production is associated with HCV related arthropathy.
This study enrolled sixty (60) chronic HCV-infected patients (group І) with positive anti-HCV antibodies and HCV RNA who were admitted to Ain Shams University Hospitals as patient group and thirty (30) individual were enrolled as healthy control group (group ІІ). The laboratory work was done in the Clinical Pathology Department, Ain Shams University Hospitals. We used Quantitative analysis of anti-MCV by using sandwich Enzyme-Linked ImmunoSorbant Assay (ELISA).
The assessment of level of anti-MCV antibody among chronic HCV-infected patient was higher than the levels among the controls group (p < 0.001). While, there was no statistically significant difference in the anti-MCV values between HCV patients with arthropathy and HCV patients without arthropathy.
The present study suggested cut-off value of anti-MCV to be 57.5 ug/L, it achieved 80% sensitivity and specificity for diagnosis of liver fibrosis. Post Hoc test showed no significant differences in anti-MCV values between HCV patients with no fibrosis versus mild degree of liver fibrosis, while there was a highly significant statistical difference between HCV patients with no fibrosis or mild liver fibrosis versus patients with moderate degree of liver fibrosis.
In conclusion, the present study has identified that anti-MCV antibody can be a very useful new biomarker for the diagnosis of liver fibrosis. It is readily available and also sensitive noninvasive marker to distinguish between stages of liver fibrosis in patients with chronic hepatitis.
The usefulness of anti-MCV antibody for diagnosis and staging of liver fibrosis was due to that the assay can be performed using blood as a step before doing liver biopsy. Or it can be used on a point-of-care testing basis, thus allowing the physician to get anti-MCV values in a short time from serum samples.
This study also suggested that this biomarker could be used to perform early and reliable risk stratification and to identify high-risk patients who could benefit from a more aggressive approach.
Also from our finding we can conclude that the value of anti MCV antibody in diagnosing arthritis in patients infected with HCV is questionable and the estimated value of anti MCV antibody should be interpreted with cautious because HCV infection alone can elevated anti MCV antibody titer even in absence of arthritis.