الفهرس 
HEPATITIS C VIRUSOnly 14 pages are availabe for public view
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Abstract
Chronic hepatitis C virus (HCV) infection is a major cause of progressive live r damage and is associated with a wide spectrum of liver histological lesions , ranging from mild chronic hepatitis to cirrhosis and hepatocellular carcinoma .
Insulin resistance plays a primary role in the development of type 2 diabetes . This is supported by prospective longitudinal studies showing that insulin resistance is the best predictor for the development of diabetes , preceding the onset of diabetes by 10 to 20 years , and by cross – sectional studies showing that insulin resistance is consistent finding in patients with type 2 diabetes .
A high serum ferritin concentration has been reported in patients with chronic HCV infection In the present study, In addition, we have observed higher serum ferritin levels in type 2 diabetic patients than in the control subjects. Furthermore, diabetes but not HCV infection was independently related to ferritin in multiple regression analyses. Taken together, our results suggest that the increase of serum ferritin reported in HCV infection could be related to the high prevalence of diabetes observed in these patients rather than to HCV infection itself.
The specific mechanisms that could lead to ferritin enhancement in type 2 diabetic patients remain to be elucidated. It is well known that chronic inflammatory diseases are associated with an increase in ferritin levels
In recent years, there has been a mounting body of evidence that suggests a major role of inflammation in the etiopathogenesis of type 2 diabetes
In fact, inflammatory cytokines such as tumor necrosis factor-α and interleukin- 6 have been detected in significant amounts in patients with either insulin resistance syndrome or diabetes
The particularly high ferritin serum levels observed in our patients with both HCV infection and diabetes can probably be explained by the simultaneous occurrence of two inflammatory processes. Inflammatory mediators such as tumor necrosis factor-α and interleukin-6 have been detected in significant amounts, not only in subjects with insulin resistance or type 2 diabetes, but also in HCV-infected patients
In HCV-infected patients, the serum ferritin level is a predictive factor for the respond to the treatment . An increased serum ferritin level has also been reported to predict nonresponse to treatment (interferon and ribavirin) in patients with chronic hepatitis C infection
In light of the findings in our study that an increased ferritin level in HCV infection is closely associated with diabetes, the interactions of diabetes with hepatic fibrosis, progression of iron deposition, and response to treatment in HCV infection deserve to be evaluated in future studies.
In conclusion, we provide evidence that anti–HCV-positive patients without diabetes did not show higher ferritin concentrations than control subjects. Therefore, the increase in ferritin levels detected in HCV patients is closely related to the presence of diabetes. In addition, diabetes
should be taken into consideration when evaluating iron metabolism in HCVinfected patients.