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 HCVrelated 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 anticitrullinated 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 antimodified 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 antiMCV 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.