الفهرس 
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Abstract
Chronic hepatitis C (CHC) has a number of features that suggest that it should be recognized not only as a viral disease but also as a metabolic liver disease that encompasses insulin resistance (IR), liver steatosis, impaired glucose tolerance or type 2 diabetes mellitus (T2DM) and disturbances in lipid metabolism.
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease all over the world, and is commonly associated with obesity, dyslipidemia and insulin resistance. It usually has no symptoms, in most cases, and it diagnosed accidentally when investigations were performed for other reasons. On the bases of disease severity, NAFLD is divided into simple steatosis and a more severe form called nonalcoholic steatohepatitis (NASH), which progresses to liver fibrosis and cirrhosis.
Adipose tissue has been identified as an important endocrine organ which not only stores energy but also regulates energy homeostasis and metabolism. It communicates with the liver and skeletal muscles via secreted proteins called adipocytokines (adipokines), that regulate the long term energy balance or insulin sensitivity of insulin -responsive tissues that can be important participants in the inflammatory process.
Chemerin is a new adipokine, which expression has been found in a number of tissues including those of the liver, pancreas and lungs, as well as in adipose tissue. The liver is one of the main chemerin-secreting organs, although adipose tissue produces more. It has been shown to be associated with body mass index (BMI), plasma triglycerides (TG), blood pressure and insulin resistance. Chemerin is a chemoattractant protein and it has a role in adipogenesis, angiogenesis and glucose homeostasis. Chemerin receptors are expressed in the liver suggesting that chemerin may be relevant in liver physiology and pathophysiology. It reveals chimeric nature; being both
pro-inflammatory and anti-inflammatory. These observations point to aprobable role of chemerin in the pathogenesis of the inflammatory process in chronic liver disease.
The aim of this work is to evaluate the role of serum Chemerin as a biomarker in patients with chronic hepatitis C virus with and without Non Alcoholic Fatty Liver Disease and its correlation to disease progress and activity and to evaluate its relationship with various laboratory parameters of the disease.
• All cases were subjected to :
1) Full history taking,
2) Complete clinical examination,
3) Laboratory investigations including : complete blood count, liver function tests, Coagulation Profile, Virology (HCV Ab, HBs Ag), HCV RNA PCR for +ve HCV Ab, Serum AFP, Fasting blood sugar, HbA1c, Kidney function Tests, Lipid profile, Serum level of Chemerin.
4) Abdominal ultrasound, Echocardiography.
• The main findings can be summarized as follows :
- There was statstically highly significant difference in serum chemerin between patient group and control, with higher levels with group of chronic hepatitis c virus with NAFLD patients.
- There was significant positive correlation between seum chemerin with, ALT, AST, BMI, INR and triglycerides.
- There was significant positive correlation between serum chemerin with FIB4 index and NAFLD fibrosis score.
- There was significant negative correlation between serum chemerin with serum albumin.
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