Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Objective: To evaluate serum YKL-40 thalassemia and its relation to viral hepatitis, liver stiffness as assessed by transient elastography (FibroScan, FS) and Hepatic Iron concentration. Methods: A cross sectional study included 100 patients-TM (43 males and 57 females) with mean age 13.8±2.7 years (range: 5-18 years). Serum ferritin level, Liver enzymes (ALT and AST), HBs Ag, Anti HCV Ab and Serum YKL-40 using ELISA kit were evaluated. All patients were subjected to Liver MRI T2* to detect liver iron content by the sequence and Transient elastography (FibroScan, FS) to assess degree of liver stiffness. Results: Mean fibroscan value was (10.9±11.5) kPa with a median 6.7 (range 1.3 to 47) kPa. 64 (64%) patients were categorized as F0-1 and 17 (17%) were stage F2-3, 19 (19%) patients had severe fibrosis. Their median serum ferritin was 3100 ng\ml, with 61 (61%) patients had values exceeding 2500æg/L. Median cardiac T2* was 24.2 with 30 patients had values below 20 ms, and the median LIC was 16.21 mg/g DW with 68 patients showed readings above 7 mg/g dw. YKL-40 was evaluated as a marker of inflammation and liver fibrosis and showed mean value 1505.1 (±960.9) pg/ml, and range from 500 to 3529 pg/ml. Mean YKL-40 was significantly higher among males (p=0.03), abnormal liver enzymes, splenectomised patients, patients with HBV sero-positivity, those with moderate elevation of T2* and patients with high grades of liver fibrosis (p<0.05). YKL-40 showed positive correlation with the rate of transfusion, LIC, ferritin, ALT and AST but negative correlation with weight, height and T2*

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