Association of liver fibrosis with the clinical features in chronic hepatitis C

• Main Author: Batbold Batsaikhan
• Other Authors: Chia-Yen Dai
• Format: Others
• Language: en_US
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/8g45t5

博士 === 高雄醫學大學 === 醫學研究所博士班 === 106 === Globally over 170 millions of people infected with Hepatitis C virus (HCV) as a prevalence of 2.8-3% of World population and it is serious burden of global health, Taiwan and Mongolia is an endemic areas for HCV infection. Therefore HCV infection is one of the major cause of advanced fibrosis, cirrhosis and hepatocellular carcinoma. Thus, HCV infection and its complications remain the leading threat for public in recent decades. However it is possible to treat HCV patients by powerful direct acting antivirals, interferon based treatment will still remain in standard care especially in economically non developed countries. There is an urgent need to investigate that HCV related liver disease progression and related factors for advanced liver fibrosis is necessary to prevent the complications for clinicians. My colleagues and I have developed new non-invasive, simple biomarker to predict advanced fibrosis in chronic hepatitis C (CHC) patients and this new score contains serum Interleukin-4 (IL4) cytokine level. We studied that high serum IL4 level is strongly associated with advanced liver fibrosis and the combination of serum IL4, ferritin, glutamyl oxaloacetic transaminase levels and patient’s age had strong value to predict advanced fibrosis in CHC. Our study developed new score to predict advanced liver fibrosis for possibility to replace liver biopsy which this procedure have several complications to individuals. We also identified that an elevated serum ferritin level was associated with liver steatosis as well as advanced fibrosis. Sex specific 1.5 fold increase of serum ferritin level may be useful for predicting liver steatosis also fibrosis. Therefore we investigated the significant association between advanced liver fibrosis and cryoglobulinemia in CHC patients who undergo liver biopsy. Interestingly this result was the same in CHC patient without liver biopsy (assessed by FIB4 (>3.25) index). It is the first study used FIB4 score to predict fibrosis in CHC patients with cryoglobulinemia. We also investigated the persistent cryoglobulinemia after interferon based, standard antiviral treatment is associated with advanced fibrosis. Patients with sustained virologic response (SVR) and persistent cryoglobulinemia are more likely to have advanced fibrosis. We confirmed that significant increase of serum lipid profiles after interferon based antiviral treatment. HCV infection is associated with low lipids and it is significantly increased in SVR patients after the treatment. However patients with advanced fibrosis did not increased. All our study results provides the insight of carefully follow up strategy, monitoring and treatment options in advanced fibrosis.