Serum Bile Acid Levels,lipid profile and alkaline phosphatase as a Predictor of Severity of Liver Fibrosis in Patients with chronic hepatitis C

Abstract

Liver fibrosis occurs in response to chronic liver injury or disease, such as hepatitis C. Eighty percent (80%) of acutely infected hepatitis C patients will become chronically infected and approximately 16% will further progress to cirrhosis over 20 years, though studies have reported large variances (Chopra, 2014). Advanced fibrosis has been found to lead to a 10% annual chance of progressing to cirrhosis, though it may not progress in all patients, and studies have found the mean time to progress to cirrhosis to be 30 years.5 Short-term liver related morbidity is not generally expected in patients with F0 and F1 (Thein et al., 2008). Metabolic profiles correlate with hepatitis C virus (HCV) infection and are known to be predictors of virologic responses in chronic hepatitis C patients on interferon-based treatment. However, little is known about the differential association of lipid profiles with hepatitis C viral load between genotype 1 and 2 infections (Miyanari et al., 2007). Serum bile acids (SBAs) are commonly elevated in cholestatic liver diseases, but it is unclear if SBA levels are also elevated in non-cholestatic chronic liver diseases and whether levels correlate with disease severity (Miyanari et al., 2007). Summary and Conclusion - 102 - Elevation of ALP is observed in patients who have some form of extra hepatic and intra hepatic bile duct obstruction. Any mechanism that impaired excretion of ALP in bile will result in regurgitation of enzyme into circulation via the hepatic sinusoid. The increased ALP present in the patients with disease closely resembles the ALP that can be extracted from liver (Nyblom. et al., 2004). The increased cholestatis stimulates the synthesis of ALP by the bile ductules cell providing more ALP which ultimately enters the bloods, the amphillic nature of bile salts facilitates the release of ALP from its membranes bound site and entry into blood (Nyblom. et al., 2004). A proportional relationship is found between serum lipid profiles and hepatitis C viral load in patients with genotype 2 infection; however, whether manipulation of lipid profi les would improve the response to current anti-HCV therapy is to be determined in further studies (Hsu et al., 2009). This study was carried out in hepatitis treatment unit, Al-Ahrar hospital, Zagazig from May 2015 to May 2016. We aimed to assess the role of level of bile acid, lipid profile and alkaline phosphatase as a non-invassive method in relation to liver fibrosis in patient with hepatitis HCV. Summary and Conclusion - 103 - The study results showed that there was statistically significant increase (p<0.05) of ALP level in smoker patients compared to nonsmoker patients. Statistical results revealed that there was high statistically significant increase (p<0.001) of bile acid level in patients aged 45 years old and in patients with hepatic or splenic enlargement compared to other patients. There was high st