Insulin Resistance in Patients with Chronic Hepatitis C Infection

Abstract: Chronic HCV infection has emerged as a complex multifaceted disease with manifestations extending beyond the liver. Hepatic steatosis, insulin resistance (IR) and type II diabetes have been observed to occur more frequently in association with HCV infection than other chronic inflammatory liver disease. Insulin resistance is more often seen in hepatitis C than in other liver disease, including non-alcoholic steatohepatitis. Insulin resistance (IR) promotes liver fibrosis as hyperinsulinemia per se stimulates the proliferation of stellate cells enhancing the secretion of extracellular matrix. Moreover, hyperinsulinemia stimulate the expression of connective tissue growth factor. On the other hand, HCV is directly associated with IR in a dose-dependent manner as viral eradication after antiviral treatment may lead to an improvement of insulin resistance. The aim of this work is to study the relation between patients with CHC infection and insulin resistance. The study was conducted on 50 non diabetic patients with CHC and 10 age, sex, BMI matched group as a control. Complete history taking and clinical examination specially to examination of blood pressure, jaundice vascular spiders, liver flaps BMI, acanthosis nigricans, clinically detectable organomegaly or ascites, laboratory investigations including fasting serum glucose, fasting insulin, AST, AIT, Tbil and PT. Results showed that the means of fasting serum insulin, fasting serum glucose, serum AIT and AST were statistically higher in patients with HCV compared to the control. HOMA IR was found to be higher in patients with HCV than control with value of 4.9+1.6 and 0.99+0.28 respectively. HOMA is founded to be statistically related to BMI and serum. glucose and nearly significant to HCV (correlation coefficient 0.23 p-value 0.09). HCV was found to be significantly related to serum glucose, and HOMA. Linear regression analysis revealed that BMI and HCV infection were significant predictors for high HOMA level P 0.001, R seg : 0.617 which means that the regression model is significant and could explain 61.7% of change in HOMA level. In conclusion insulin resistance is common in patients with HCV. Recommendation monitoring and follow-up of serum glucose is important in euglycemic CHC patients. Study of vascular risk in CHC patients with metabolic IR is important and needed to be clarified