title: Elevated serum α-fetoprotein levels in patients with chronic hepatitis C virus genotype 4: not the end of the story.
abstract: OBJECTIVE
  Elevated serum α-fetoprotein (AFP) is not uncommonly seen among patients with chronic hepatitis C. This study aimed to identify clinical characteristics, histological characteristics, and biochemical markers associated with increased serum AFP levels in hepatitis C virus genotype 4-infected patients with no evidence of hepatocellular carcinoma and to determine the effect of lifestyle modification on these parameters.
  
  
  METHODS
  The study included 447 chronic hepatitis C patients with no evidence of hepatocellular carcinoma and 100 healthy controls. They underwent liver biopsies, homeostasis model assessment-insulin resistance (HOMA-IR), measurement of serum insulin, leptin, adiponectin, tumor necrosis factor-α, and interleukin-6 levels by an enzyme-linked immunosorbent assay, and assessment of AFP levels. Eighty patients with HOMA-IR greater than 3 received prospective longitudinal lifestyle intervention.
  
  
  RESULTS
  In a multivariate analysis, platelet count less than 140×10/cm, a mean platelet volume of at least 9.5 fl, a neutrophil-lymphocyte ratio (NLR) of at least 2, an aspartate transaminase level of at least 55 IU/l, a γ-glutamyl transpeptidase level of at least 40 IU/l, an albumin level of up to 3.8 g/dl, HOMA-IR greater than 3, a leptin level of at least 10 pg/ml, an iron level of at least 165 μg/dl, a ferritin level of at level 175 ng/ml, and hepatic fibrosis F3-F4 were found to be independently associated with elevated AFP levels. The lifestyle intervention significantly improved BMI, platelet indices, NLR, γ-glutamyl transpeptidase, leptin, leptin/adiponectin ratio, tumor necrosis factor-α, interleukin-6, HOMA-IR, and AFP levels.
  
  
  CONCLUSIONS
  Elevated insulin resistance, leptin, serum iron, ferritin, mean platelet volume, NLR, and advanced fibrosis, as well as decreased platelet count and serum albumin, are independently associated with an elevated AFP level. Lifestyle modification can improve (reduce) insulin resistance, leptin, leptin/adiponectin ratio, platelet count and their indices, NLR, and AFP level.
authors.affiliation: Departments of aTropical Medicine, Faculty of Medicine bClinical Pathology cPathology dInternal Medicine eMedical Microbiology and Immunology, Mansoura University, Mansoura fDepartment of Internal Medicine, Aswan University, Aswan, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdel-Razik
authors.forename: Nasser
authors.initials: N
authors.lastname: Mousa
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abdel-Aziz
authors.forename: Rania
authors.initials: R
authors.lastname: Elhelaly
authors.forename: Rasha
authors.initials: R
authors.lastname: Elzehery
authors.forename: Khaled
authors.initials: K
authors.lastname: Zalata
authors.forename: Wagdi
authors.initials: W
authors.lastname: Elkashef
authors.forename: Ossama
authors.initials: O
authors.lastname: Fouda
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Awad
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hafez
authors.forename: Waleed
authors.initials: W
authors.lastname: Eldars
mesh_terms: D054392:Adipokines / Q000097:blood; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000175:diagnosis / Q000628:therapy / Q000821:virology; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007333:Insulin Resistance; D008103:Liver Cirrhosis / Q000097:blood* / Q000175:diagnosis / Q000628:therapy / Q000821:virology; D016015:Logistic Models; D008137:Longitudinal Studies; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D040242:Risk Reduction Behavior; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: C097353:AFP protein, human; D054392:Adipokines; D015415:Biomarkers; D018836:Inflammation Mediators; D000509:alpha-Fetoproteins