الفهرس 
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Abstract
Chronic liver disease is frequently associated with insulin resistance. This
work aimed to investigate this point in Egyptian chronic liver disease
patients admitted to the Internal Medicine Department, Menoufia
University Hospitals.
Five age, sex and BMI matched groups were included. These were HCC,
LC, HCV, chronic HBV patients and healthy controls. The ethics
certificate of Menoufia University Hospitals was considered. Clinical and
laboratory data were collected. These included fasting blood glucose,
HbA1c, fasting insulin, ALT, AST, AFP, HCV Ab, HBsAg, HBsAb,
HBeAg, HBcAb and quantitative RT-PCR for HCV RNA.
Fasting blood glucose, HbA1c and fasting insulin levels were higher in
HCC patients, LC patients and chronic HCV patients than chronic HBV
patients and healthy control.
Insulin resistance was measured by Homeostasis model assessment
method for assessment of insulin resistance (HOMA-IR) and quantitative
insulin sensitivity check index QUICKI. These parameters showed that
IR was higher in HCC patients, LC patients and chronic HCV patients
than chronic HBV patients and healthy control.
HCV infection was associated with higher IR. HCV Ab seropositive
patients, regardless the hepatic lesion (HCC, LC or chronic infection),
had higher insulin resistance than seronegative patients, regardless the
hepatic lesion, and healthy control.
Positive correlation was noted between HCV load as measured by
quantitative RT-PCR and IR. Chronic HCV patients with higher HCV
loads had higher IR.
There was an independent association between IR and HCC development
in chronic HCV infection. HCV Patients with HCC had higher IR. IR is
accused with progression of HCV infection to HCC development. This
finding may have important prognostic and therapeutic implications in
the management of chronic HCV-infected patients. Since IR is a
potentially modifiable factor, therapeutic intervention aimed at decreasing
IR by insulin sensitizers, diet and weight reduction may be warranted in
these patients to prevent liver disease progression.
On the other hand, no difference was noted between various causes of
liver cirrhosis and IR and no difference existed between different classes
of Child-Pugh classification and IR.