الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Hepatitis C is major cause of liver related morbidity and mortality worldwide and represents a major public health problem . Therapy of hepatitis C virus has improved in recent years and eradication of HCV by treatment is a reality in many chronically infected patients , but the issue of a substantial number of non responders is still unsolved . The highest response rates to antiviral therapy for the treatment of chronic hepatitis C have been achieved using the combination of pegylated – interferon and ribavirin
Many host and viral factors influence the virological response rate to combined interferon and ribavirin therapy . Viral factors include viral load and genotype , whereas host factors include age , gender , host immune status and body mass index .
Insulin resistance, glucose intolerance and diabetes mellitus are commonly associated with cirrhosis . The exact pathogenic mechanism responsible are still unknown ; however , they may be related to both HCV itself and to liver injury . It was found that HCV infection contributes to the pathogenesis of insulin resistance and diabetes mellitus, also it was suggested that the inverse relation is there as well , namely, that a pre-existing insulin resistance syndrome influences the course of HCV infection by decreasing the rate of response to current standard HCV therapy. Whether insulin resistance is a marker for patients who are very difficult to treat or whether it play a role interferon plus ribavirin resistance remains unclear.
The main aim of this work was to study the effect of insulin resistance on the response to pegylated interferon and ribavirin therapy in patients with chronic hepatitis C and to what extent this variable can be used to predict early virological response
This study was conducted on 60 patients with chronic active hepatitis C fulfilling the criteria for treatment with interferon and ribavirin . They were recruited from the hepatology clinic and internal medicine out- patients clinic of El Obour Hospital (Kafr El Sheikh Governorate )& Benha university hospital.
All patients were subjected to;
1- Full history taking.
2- Clinical examination including body mass index and Fundus examination.
3- Laboratory investigations including complete liver functions, renal functions, complete blood picture, fating blood sugar and two hours post prandial, TSH, alpha fetoprotein, pregnancy test and HBsAg
4- Hepatitis C virus antibody and HCV-RNA by quantitative PCR .
5- Abdominal ultrasonography.
6- Liver biopsy with histopathological scoring (grading and staging).
7- All the patients were given pegylated interferon α 2b at a dose of 1.5 mg/kg body weigh every week plus ribavirin at a dose of 10.6 mg/kg/day. Follow up with quantitative HCV-RNA was done after 12weeks for EVR.
8- Insulin resistance index using HOMA-IR was measured before starting therapy .
During therapy
CBC and aminotransferase levels were measured at weeks1,2, 4, 8 and 12 weeks thereafter.
from the 60 patients, 13 patients were non-responders and 47 patients showed EVR.
In this study, EVR was 78.3% . There was a significant statistical difference between responders and non responders regarding age. Non-responders had a higher age than responders. While, there was no significant statistical difference between males and females, regarding response .
In the present study, there was statistically significant relation between BMI and EVR. While, there was significant statistical difference between responders and non responders regarding HAI grading and staging.
There was a higher percentage of non response at 12 week among cases with resistant HOMA compared to sensitive cases and the difference was significant statistically.
HOMA-IR was less in responder than non responders and was
A positive correlation was found between BMI and HOMA-IR.