ABSTRACT
Chronic hepatitis C [CHC] was found to be closely related to insulin resistance [IR] and may increase risk of liver steatosis and fibrosis. Several mechanisms have been proposed to explain HCV-induced IR; including obesity, steatosis, leptin hormone and serum amyloid -A [SAA]. The aim of the present work was to assess serum amyloid -A and leptin levels and insulin resistance in normal weight and obese patients with chronic hepatitis C, and their relation to the steatotic changes and grade of inflammation and fibrosis according to Metavir scoring system. The present study was earned out on thirty patients with chronic hepatitis C [Group II], and thirty male-control subjects of matched age and body built [Group I]. Both groups were further divided according to body mass index [BMI] into normal-weight [Ia and IIa] and over-weight and obese [Ib and IIb] subgroups. All studied subjects were subjected to full history taking, thorough clinical examination and ultrasound of the abdomen. Percutaneous ultrasound assisted tru cut needle liver biopsy was done to HCV patients and assessed for tile grade of the necro-inflammatory changes and fibrosis, according to Metavir scoring system, and steatosis. Laboratory investigations included the evaluation of fasting serum amyloid-A, leptin, glucose and insulin levels and insulin resistance index [assessed by HOMA equation]. In addition; HBs-Ag, HCV-antibodies, and HCV-RNA by PCR and serum anti-sehistosomal antibodies were also evaluated. All patients and controls were negative for HBs-Ag and schistosomal antibodies. It was found that SAA was significantly higher in the patients group [subgroups Ia, IIb] than controls. Fasting serum amyhoid-A, leptin, glucose and insulin levels and HOMA, were significantly higher in the obese subjects [subgroups Ib and IIb] than in normal weight subjects [subgroups Ia and IIa]. There was a significant positive correlation between HOMA and both serum amyloid-A and leptin levels in obese subjects. Moreover, serum amyloid-A, leptin and insulin were positively correlated with increased BMI and waist/hip ratio in obese subjects [subgroups Ib and IIb]. Steatotic changes were significantly higher in obese patients [group IIb] than in normal weight patients [groups IIa]. Steatosis and necroinflammatory grades in CHC patients showed a positive significant correlation with serum amyloid-A, leptin and HOMA. Moreover steatosis was significantly correlated with fasting serum glucose, while necroinflammatory grade was significantly correlated with fasting serum insulin level. From the present work, it could be concluded that - Serum amyloid A, leptin hormone and insulin resistance were significantly correlated with both steatosis and the severity of Metavir necroinflammatory grade in CHC patients. - SAA is a feature of obesity in both HCV patients and controls as an inflammatory marker. Also, it seems to be altered by viral factors as it was significantly increased in CHC patients than controls. Thus, SAA might be a missing link between enhanced adipose tissue mass, low grade inflammatory state and insulin resistance in CHC patients. Therefore it is recommended for CHC patients to undergo weight reduction programs and follow up investigations including SAA and leptin levels