الفهرس 
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Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and is responsible for considerable morbidity and mortality. Early detection of patients with HCC is attractive because it gives better prognosis.
The liver is a major organ in the vitamin D endocrine system and parathyroid hormone. One of vitamin D function is regulation of calcium and phosphate homeostasis. Therefore, HCC affect level of vitamin D, PTH, calcium and phosphorus. The aim of this study was to evaluate serum levels of vitamin D, PTH, calcium, zinc and phosphorus in HCC patients in a trial to propose a possible predictive role for them in early diagnosis of HCC.
Patients and method
The study was conducted on 50 patients with hepatocellular carcinoma; 34 males (68%) and 16 females (32%), 40 patients with liver cirrhosis; 18 males (45%) and 22 females (55%) and 30 patients with chronic hepatitis 16 males (53.3%) and 14 females (46.7%).
All patients were subjected to full clinical assessment including careful history taking, measurement of liver function tests including, serum bilirubin, AST, ALT, albumin, prothrombin time and concentration and INR anti-HCV antibodies and HbsAg, abdominal ultrasonography. HCC was diagnosed by abdominal ultrasound as screening and confirmed by triphasic abdominal C.T. Measurement of serum levels of vitamin D, PTH by ELISA, calcium, zinc & phosphorus. Corrected calcium was calculated as [0.8 x (4- serum albumin)] + serum calcium.
Results
There was significant increase in the mean age of HCC group (61.5±7.3) and cirrhotic group (60.8±6) than chronic hepatitis group (51.3±3.9).
The serum levels of AST in HCC group (112.6±113.4 U/ml) and cirrhotic group (53.8±24 U/ml) were significantly higher than those of chronic hepatitis group (41.3±8.1U/ml) with p< 0.001and p=0.033. The serum levels of AST in HCC patients were significantly higher than those of cirrhotic patients p=0.003.
The serum levels of albumin in HCC group (3±0.7 gm/dl) and those of cirrhotic group (2.6±0.5 gm/dl) were significantly lower than those of chronic hepatitis group (3.7±0.3 gm/dl) with p< 0.001and p< 0.001. The serum levels of albumin in HCC patients were significantly higher than those of cirrhotic patients p=0.005.
The serum levels of corrected calcium in HCC group (10.8±1.2 mg/dl) and cirrhotic group (8.8±1.1mg/dl) were significantly higher than those of chronic hepatitis group (9.8±1.3mg/dl)with p<0.001 and p=0.004. The serum levels of corrected calcium in HCC patients were significantly higher than those of cirrhotic patients p<0.001.
The serum levels of PTH in HCC group (168.1±125 ng/L) and cirrhotic group (125±92ng/L) were significantly higher than those of chronic hepatitis group (50.5±12.7ng/L) with p< 0.001and p< 0.001. The serum levels of PTH in HCC patients were significantly higher than those of cirrhotic patients p<0.013.
The serum levels of vitamin D in HCC group (14.7±8.4ng/ml) were significantly lower than those of cirrhotic group (28.5±11.3ng/ml) and chronic hepatitis group (29.3±6.2ng/ml) with p<0.001 and p<0.001.
The serum levels of zinc in HCC group (36±17.4mcg/ml) and cirrhotic group (49.5±27.6mcg/ml) were significantly lower than those of chronic hepatitis group (82.4±24.9mcg/dl) with p<0.001 and p<0.001. The serum levels of zinc in HCC patients were significantly lower than those of cirrhotic patients p=0.023.
There was no statistical significant difference between the three groups as regard to serum phosphorus levels.
Statistically significant variables in predicting HCC in relation to chronic liver disease rather than to cirrhosis were: Age, AST, PTH and corrected calcium.