الفهرس 
HEPATIC FIBROSISOnly 14 pages are availabe for public view
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Abstract
The aim of our study was to evaluate recent non invasive fibrosis biomarker test (APRI test) in the diagnosis of the stage of hepatic fibrosis as compared to liver biopsy as a golden standerd.
The study included 50 patients (20 patients with HCV related chronic liver disease and 20 patients with HCV related chronic liver disease mixed with schistosomiasis as well as 10 individuala as a control group).
All patients were subjected to the following:
1. Careful medical history taking.
2. Complete clinical examination.
3. Laboratory evaluation including:
- Liver profile including AST, ALT, GT, Alkaline phosphatase, S.bilirubin, S.albumin and PT.
- Complete blood picture including platelet count.
- Serology for shistosomiasis when possible.
- HCV antibodies by Enzyme linked immuno-sorbent assay (ELISA technique).
- PCR for HCV RNA.
- Abdominal ultrasonography.
- Ultrasound guided liver biopsy and histopathological examination.
- AST-to-Platelet Ratio Index (APRI) was calculated for every patient.
In the studied groups:
- There was no statistical significant difference between group 1 and group 2 as regards history of blood transfusion, history of previous operation, history of dental procedures and history of tattooing (P>0.05).
- There was no statistical significant difference between group 1 and group 2 as regards the liver size, echogenicity, spleen size and stage of fibrosis (P>0.05).
- Patients of group 2 showed significantly higher percentages of periportal fibrosis (P<0.0001).
- Patients of group 1 showed significantly higher mean age than control group P<0.05, higher ALT, AST, T bilirubin, D bilirubin, prothrombin time(PT) and portal vein(PV) diameter, lower platelets than group 3 (P<0.05).
- Patients of group 2 showed significantly higher ALT, AST, T bilirubin, PT , INR and PV diameter, lower platelets when compared to group 3 (P<0.05).
- There was no statistical significant difference between patients of group 1 and group 2 as regards ALT, AST, T bilirubin, D bilirubin, PT , PV diameter and platelets the (P>0.05).
- Group 1 and group 2 showed significantly higher APRI when compared to control P<0.0001, but no difference between the patients groups (P>0.05).
- There was no statistical significant difference between group 1 and group 2 as regards the APRI and PCR (P>0.05).
- There was no statistical significant difference between group 1 and group 2 as regards the biopsy stages and grades (P>0.05).
- There was a positive correlation between APRI and stages in all cases and in individual groups (P<0.05).
- Mild fibrosis showed significantly lower APRI than moderate fibrosis (P=0.001) but no difference between mild and severe and between moderate and severe fibrosis (P>0.05).
- APRI was reliable to predict fibrosis (P<0.0001) and AUC (area under the curve) was 94%.
- The best cut off value for APRI was 0.2 with a sensitivity of 90%, specificity 80%, PPV 95% and NPV 67% with a diagnostic accuracy of 88%.
- Cases with APRI >0.2 were 36 times more likely to be involved in fibrosis than those with level <0.2 (odd ratio = 36, 95%CI: 6 to 232).
- APRI was reliable to predict moderate fibrosis P=0.001 and AUC (area under the curve) was 81%.
- The best cut off value for APRI was .0.31 with a sensitivity of 94%, specificity 65%, PPV 68% and NPV 94% with a diagnostic accuracy of 78%.
- Cases with APRI >0.31 were 32 more likely to be involved in moderate fibrosis as those with level <0.31 (odd ratio = 32, 95%CI: 4 to 285).