الفهرس 
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Abstract
HCV is a significant health problem and a leading cause of HCC and liver transplantation. Egypt was considered the highest country having chronic HCV in the world, estimated nationally about 10 % and over 90% of the infections have been reported to be HCV GT-4.
HCC represents 85–90% of all liver malignancy; it is the second leading cause of cancer-related deaths, estimated to be responsible for nearly 9.1% of total death in 2012.
AFP, as a commonly used marker for diagnosis of hepatocellular carcinoma (HCC), is not specific. It can be elevated in chronic hepatitis B or C in the absence of cancer. It can also be increased in patients with cholangiocarcinoma, as well as in non-liver cancer such as gastric cancer.
Also, AFP has low sensitivity as it may be normal in up to 40% of HCC cases especially early stages. So,AFP is a marker with poor sensitivity and specificity for diagnosis of patients with HCC.
Vitronectin (VTN) is a glycoprotein which is synthesized in the liver and is abundantly found in serum, the extracellular matrix and bone. VTN might be involved in the progression of hepatocellular carcinoma (HCC) and have been shown to be a potential tumour marker for HCC.
This study aimed to study the level of serum Vitronectin (VTN) compared to AFP in diagnosis and prognosis of hepatocellular carcinoma on top of HCV-related liver diseases.
This study was conducted in AL Mahalla Hepatology Teaching Hospital.
All patients were subjected to the following:
1- Full history taking.
2- Complete physical examination.
3- Routine laboratory investigations:
- CBC
- Liver function tests
- Kidney function tests
- Coagulation profile
- Viral markers for hepatitis B and C including HCV abs & HBsAg.
- HCV-RNA PCR
- Serum AFP
-Serum Vitronectin
4- Imaging studies:
- Abdominal ultrasonography for All patients
- Triphasic CT scan with contrast only in HCC patients.
60 person were divided into four groups:
1- group 1: included 10 normal persons.
2- group 2:included 10 patients who were positive (+ve) hepatitis C Virus infection.
3- group 3: included 20 cirrhotic patients on top of HCV infection.
4- group 4: included 20 patients with HCC (on top of hepatitis C virus related cirrhosis) which didn’t have any intervention before, in which we will test them for vitronectin and AFP before their first intervention and after intervention within 3 months.
- HCC patients diagnosed by abdominal ultrasound and Triphasic Computerized Tomography.
- Cirrhotic patients diagnosed by clinical, biochemical, and abdominal ultrasonographic findings.
The following results were obtained Regarding:
Age:
• The mean age of the cases showed high statistically significant difference between the study groups (P < 0.001).
Sex:
• There were a total number of 29 males and 31 females with significant difference in the sex distribution between the study groups.
• 80% of the cases in HCC group were males.
• This sex distribution can be attributed to high prevalence of risk factors like:
- Smoking
- Diabetes Mellitus
- HCV in males
- possible role of sex hormones.
Liver function tests and Creatinine:
• On analyzing laboratory characters of the studied groups, we found: statistically significant difference between cirrhosis group and non-cirrhotic groups which shows:
- Low platelets count
- High serum creatinine,
- High INR,
- Lower serum albumin
- High bilirubin
- Higher AST.
AFP:
• The median level of AFP in group 4 (HCC patients) was 110 IU/ml which was higher than its median value in the other study groups with high level of significance between the study groups.
Vitronectin
• The median level of vitronectin levels in the different study groups didn’t reveal a statistically significant difference between the different study groups.
• The serum level of vitronectin in group 3 (cirrhotic patients) has no statistically significant difference between the three subgroups
AFP and Vitronectin level in group IV(HCC patients):
• By The analysis of serum level of AFP and vitronectin level in group IV before and after treatment, The median level of AFP was significantly lower than its level before treatment,while the change in vitronectin level was statistically insignificant.