الفهرس 
Hepatitis C virus (HCV)Only 14 pages are availabe for public view
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Abstract
Chronic hepatitis C viral infection represents a worldwide viral epidemic. The natural course of HCV is less understood in the pediatric population, although fewer children progress to cirrhosis and end-stage liver disease than adults infected.
Epidemiological data indicate a strong risk for development of IR and, ultimately, overt DM in patients with chronic HCV infection.
Pathogenic mechanisms for HCV-associated IR differ from those for lifestyle-associated IR. Although the precise mechanisms of HCV-associated IR are unclear, several possibilities have been suggested and the mechanisms may be multi-factorial, including both virus and host factors.
HCV-associated IR causes: (1) hepatic steatosis, (2) resistance to antiviral treatment, (3) hepatic fibrosis and esophageal varices, (4) hepatocarcinogenesis and proliferation of HCC, and (5) extrahepatic manifestations.
The current study included sixty six chronic HCV children attending the hepatology clinic in Al Shatby Hospital, their ages ranged from 2 to 15 years old, in addition to sixty six apparently healthy children age and sex matched proven to be HCV seronegative presenting to other clinics such as general surgery and ENT clinics.
All candidates were subjected to complete history taking with special emphasis on age, sex, medical history, drug history and family history of DM. BMI, HCV viral load and liver biopsy findings (if available) were obtained from the medical sheets.
Five ml of venous blood was collected aseptically from each child, blood was centrifuged, and serum was collected and stored at -20c until used for determination of anti-HCV immunoglobulin by ELISA technique (for controls), Estimation of serum glucose level, serum insulin assay and calculation of HOMA-IR (for cases and controls).
The main results of the study included:
1. There was significant relation between the HOMA- IR of cases and the healthy controls. Also there was a significant relation regarding both fasting serum glucose and fasting serum insulin.
2. Among children who had chronic HCV there was no statistically significant relation between HOMA- IR and age.
3. It was found that the duration of the disease is not correlated to HOMA- IR.
4. BMI was not a significant factor affecting the HOMA-IR.
5. There was a significant correlation between viral load and HOMA- IR.
6. Among cases there were 47 males with mean HOMA-IR (2.99±0.74) and 19 females with mean HOMA (3.08±0.76), there was no significant relation between HOMA- IR and gender.
7. Among cases there were 54 from rural areas with mean HOMA-IR (2.97±0.74) and 12 from urban areas with mean HOMA-IR (3.22±0.76), there was no significant relation between HOMA- IR and residence.
8. There was no significant relation between HOMA- IR and co-morbidities existence.
9. Only 35 of cases had liver biopsy, 21 of them had normal liver biopsy and 14 had minimal scarring & scarring extended out from liver blood vessels. Meanwhile there was no significant association between HOMA IR and stage of fibrosis.
10. There was no significant relation between HOMA- IR and grade of inflammation.
from the results of this study it could be concluded that:
1. Children with chronic HCV infection are at high risk for IR and the subsequent development of DM as we found that among chronic HCV cases, levels of fasting serum insulin, glucose and HOMA-IR are high compared to levels among normal controls.
2. Among chronic HCV cases, HCV viral load was the only significant factor affecting the presence of IR.