الفهرس 
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Abstract
Summary
World Health Organization (WHO) estimated that about 170 million people are infected with hepatitis C virus worldwide. chronic hepatitis C (CHC) virus infection is the leading cause of chronic liver disease worldwide. (Al-Saeed, 2011). Egypt has the highest prevalence of antibodies to hepatitis C virus (HCV) in the world; Egypt has been widely regarded as having an epidemic, estimated nationally at 14.7%. An estimated 9.8% are chronically infected. (Miller and Abu-Raddad, 2010). The relationship between chronic liver diseases and type two diabetes mellitus is strong enough to be called “hepatogenous diabetes”, which is now recognized by the World Health Organization as an independent entity involving the development of T2DM caused by cirrhosis. (Ylse et al., 2011). It has been suggested that 17–30% of cirrhotic patients are clinically diabetic. (Compean et al., 2009). In 1994, association between HCV and diabetes was first described by Allison et al, who noted that people with cirrhosis and HCV had T2DM more commonly than those with cirrhosis from other causes. ( Douglas and George, 2009). Tumor necrosis factor-α has been shown by several studies to link obesity, a known major risk factor for type 2 DM, and insulin resistance in HCV patients . (Greenberg and McDaniel, 2002).
The study was conducted in the Communicable Disease Research and Training Center (CDRTC) in Suez city ,Included 88patients divided into 3 groups of patients: First group included HCV patients alone , second group included HCV patients with diabetic and third group included patients have DM alone . The study included adult patients (>18 years) of both sexes, seroreactive to anti HCV antibody and positive for HCV RNA by PCR and elevated ALT and attending the CDRTC for more than 6 months . The study excluded patients with other etiology of liver disease, patients with decompensated cirrhosis, hepatocellular carcinoma or type I diabetes mellitus were excluded, patients previously treated with pegylated interferon/ribavirin and patients on steroid therapy or cytotoxic drugs.
Study showed that the age of most study population is more than 50 years (67%) , females form 59.1 % of study population and significantly was infrequent in first group (53.3%) compared to second (75.9 %) and third groups (82.8 %) P= 0.03* , most of study population married (73.9 % ) , 85.2 % live in urban area , the majority of study population is Illiterate or Read and write ( 83%), 87.5 were non workers or have non skilled work. Common symptoms among study population were dyspepsia (33%), Fatigue (30.7 %), Anorexia (25.3%). Mean of BMI was significantly higher in DM alone compared to HCV alone or HCV with DM, (p= 0.04*). In laboratory investigations of three groups of level of serum fasting insulin was significantly lower in patients with DM alone compared to patients with HCV alone and patients with HCV and DM (P =0.03*). Insulin resistance (HOMA-IR) was significantly higher in patients with HCV and DM compared to patients with DM alone and patients HCV alone, (P =0.00*). Level of serum tumor necrosis factor-alpha among three groups shows that its level is higher in patients with HCV alone compared to patients with HCV and DM and patients with diabetes mellitus alone , and this was statistically not significant. ( P= 0.17). Fasting blood sugar and 2hour postprandial were significantly lower in patients with HCV alone compared to patients with HCV and DM and patients with diabetes mellitus only, (P =0.00*). Insulin resistance was more frequent in patients with HCV and DM followed by patients with DM alone followed by patients with HCV alone, and this was statistically significant (P=0.01*). Insulin resistance HOMA-IR >3 was found in 28 patients of study population. Patients with IR have statistically significant higher level of fasting insulin .FBS , 2HPP compared to patients without IR . but no significant variation in level of TNF in two groups. Among HCV patients 18 patients with IR also have statistically significant high level of fasting insulin .FBS , 2HPP, elevated SGOT and SGPT compared to patients without IR. But no significant variation in level of TNF in two groups. In this study positive correlation was found between HOMA and age, BMI and Duration of CLD but none of these correlation were significant. There were significant positive correlation between HOMA-IR and Fasting insulin and fasting blood sugar,(P=0.00*).negative correlation between HOMA-IR and TNF but was statistically not significant ,(P=0.50).