الفهرس 
Hepatitis COnly 14 pages are availabe for public view
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Abstract
60 patients with chronic hepatitis C were included, these patients classified into 30 patients with HCV did not receive medical treatment and 30 patients of HCV who received course therapy with peg interferon plus ribavirin for 24 weeks, and they were compared to 15 patients of non diabetic patients without chronic hepatitis C as a control group.
All subjects were evaluated at the beginning of the study and 6 months later by:
Insulin resistance was calculated through the HOMA method as follows:
HOMA = fasting serum insulin (µu/ml) X serum glucose (mmol/dL) / 22.5.
Patients were categorized as insulin resistant if HOMA was greater than 2 and diabetes if greater than 4.
Liver biopsy was done to evaluate degree of inflammation, steatosis and fibrosis index.
PCR for all patients with chronic hepatitis C and other liver function tests were done.
The prevalence of insulin resistance is significantly different in the three groups. In control group IR was 4 cases (26.7%) and after 6monthes become 6 cases (40%). While in chronic hepatitis C without receiving treatment from 8 cases (26.7%) become 19 cases (63.3 %), 5 cases of them (16.7%) developed DM, but in patients of chronic hepatitis C who received course therapy with peg interferon plus ribavirin for 24 weeks, 14 cases of insulin resistance pretreatment and after 6 months were as follows:
4 cases who became HCV –ve became insulin sensitive and
1 case who became HCV –ve still insulin resistant and
3 cases of HCV +ve developed DM and
6 cases had no changes (still insulin resistant).
Other 16 cases who were insulin sensitive pretreatment and after 6 months were as follows:
7 cases who became HCV –ve still insulin sensitive and
7 cases developed insulin resistance (HCV +ve) and
2 cases had no changes (HCV +ve and insulin sensitive).
The three patients who developed DM after 6 months of therapy were insulin resistant before treatment. So development of DM and increase of insulin resistance was significantly higher with failure to respond to treatment reflecting most propably direct effect of HCV and no effect of pegylated interferon therapy.
In correlation between HOMA-IR and studied parameters we found highly significant relation between HOMA IR and liver enzymes, lipid and steatosis and inflammation by liver biopsy and significant relation between HOMA IR and BMI, waist circumference and fibrosis index.
The prevalence of insulin resistance is significantly higher in HCV patients and it is improved with successful antiviral therapy.
In HCV patients’ insulin resistance was correlated with inflammation, steatosis and fibrosis on liver biopsy as well as with BMI and waist circumference.
This study has established an etiological link between insulin resistance & DM in chronic hepatitis C patients, whether received treatment or not.
It is concluded that prevalence of insulin resistance and diabetes mellitus in patients with chronic hepatitis C was due to multiple causes and clearance of HCV infection improves insulin sensitivity, and treatment with pegulated interferon and ribavirin for 24 weeks had no effect on insulin sensitivity.
from these findings, we recommend that all patients presenting with chronic hepatitis C should be investigated for insulin resistance and DM during or shortly after treatment with Pegylated Interferon.