الفهرس 
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Abstract
This study include 90 subjects, 70 of them were hepatitis c positive serology divided into two groups; (group I) of 20 cirrhotic patients include 9 females and 11 males their ages ranged from (45 –62years) with mean of 53.2±4.09 ,(group II)of 50 HCC patients include 12 females and 38 males their ages ranged from (45–68years) with mean of 54.7±5.2 and third group of 20 volunteers as normal control included 10 females and 10 males their ages ranged from (46 –66years) with mean of 53.8±5.5.
The patients and controls subjected to complete history taking and clinical examination and lab tests; CBC, kidney function tests(urea&creatinine),liver function test (ALT ,AST ,TP ,Albumin ,T.bil ,ALP), PT,PC, INR,RBS, serological tests (Anti HCV antibody, HBV surface antigen, Anti HIV antibody, Anti-bilharzial antibodies), AFP and CLU.
Haematological data;
Platelets: show no significant difference in comparing diseased groups with each other but show high statistically significant decrease in comparing diseased groups with controls.
Liver function tests;
ALT and AST: was significant higher in group I LC patients and in group II HCC patients as compared to group III control group.
Serum total protein and serum albumin : show significant decreased in group I LC patients and group II HCC patients as compared to group III control group.
Serum total bilirubin and ALP: showed significant elevation in LC group and HCC group as compared to control group.
Prothrombin time, Prothrombin concentration and INR showed significant elevation in group I LC patients, group II HCC patients as regard controls.
AFP showed significant elevation in group I LC patients, group II HCC patients as regard controls and significant elevation in group II HCC as regard group I LC. No significant difference was found between early HCC (IIa) and late HCC (IIb) groups.
CLU showed significant elevation in group II Hcc as regard group I Lc and significant elevation in comparing group I Lc and group II Hcc with control group. Significant elevation was found in early HCC (IIa) as compared to late HCC (IIb) groups.There was positive correlation between AFP and CLU with (r=0.31 and P=0.003) .The area under the ROC curve of AFP (0.9,p< 0.001) was slightly bigger than that of CLU (0.8,p< 0.001). The combined parallel approach improved the diagnostic sensitivity to 96.5% and negative pre-dictive value to 96.7% over the single use of serum AFP in HCC cases, but decreased the specificity to reach 89% and positive predictive value to 88.5%.
Conclusion
CLU is elevated in the serum of patients with established HCC.
Serum AFP did better than serum CLU in all aspects of diagnostic performance for diagnosing HCC, but still the combined parallel approach improved the sensitivity which is required in screening high risk populations such as CHC patients.