الفهرس 
HEPATOCELLULAR CARCINOMA IN chrONIC HEPATITIS C VIRUS PATIENTSOnly 14 pages are availabe for public view
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Abstract
Persistent Hepatitis C virus (HCV) infection is widespread; it affects millions of people worldwide and induces a range of chronic liver diseases. Chronic HCV infection causes progressive hepatic fibrosis and cirrhosis in up to 20% of patients and approximately 10%-20% of cirrhotic patients may go on to develop hepatocellular carcinoma (HCC) within five years.
Chronic HCV infection is associated with the development of hepatic steatosis and unique, virus-specific alterations in host metabolism leading to the development of IR, which is one of the gravest metabolic disturbances of human body, growing rapidly all over the world. It is an important marker of metabolic syndrome in general, and is an independent risk factor for its cardiovascular complications.
It has been reported that IR can increase the risk of developing HCC in patients with chronic HCV infection. A multiplicity of viral and host factors may play a crucial role in facilitating the onset of IR in patients with chronic hepatitis C (CHC) that may ultimately end with HCC development.
HCV-associated insulin resistance is involved in the development of various complications including Hepatic steatosis, Resistance to anti-viral treatment, Hepatic fibrosis and esophageal varices, Hepatocarcinogenesis and proliferation of HCC, as well as extrahepatic manifestations.
The focus of the study was to elucidate the potential role of IR in the development of HCC in CHC patients.
In the present study, two hundred fifty subjects were included and classified into three groups; group I included one hundred HCV +ve hepatocellular. Group II included one hundred patients with HCV related chronic liver disease. Group III included fifty healthy persons.
The results in the current study revealed that fasting blood sugar, fasting serum insulin level and HOMA-IR were significantly higher among HCC group than HCV group and controls. There were also positive correlation between HOMA-IR and Alpha-fetoprotein, BMI, LDL and Child-Pugh score.
When HOMA-IR was studied by logistic regression model to find its role as risk factors for development of HCC, it was found that HOMA-IR above 4 is considered independent predictors for development of hepatocellular carcinoma.
In conclusion: we demonstrated the independent association between IR and HCC development in chronic HCV infection. These findings 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 may be warranted in these patients.