الفهرس 
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Abstract
HCV affects not only the liver but also non-hepatic tissues. A
number of extrahepatic clinical disorders have been recognized/some of
these ’disorders have an established association with HCV while others
have probable or weak association. The association ofHCV with both
DM and hyperamylasemia is controversial.
The aim of this work was to study serum insulin, C-peptide and
amylase concentrations in patients with CHCV infection in a trial to
search for any pathogenic impact ofHCV on some of the endocrine and
exocrine functions of the pancreatic gland.
Our study included one hundred male subjects divided equally into
4 groups:
Group 1: Control group.
Group 2: Type-2 diabetes mellitus (DM) group.
Group 3: Chronic hepatitis C virus (CHCV) group.
Group 4: Chronic hepatitis C virus with type-2 diabetes mellitus (CHCV
with DM) group.
Diagnosis of CHCV was based on the presence of positive HCV
antibody by RIBA I I and confirmed by positive HCV antigen by PCR
and liver biopsy. Diagnosis ofDM was dependent on past history ofDM
or oral hypoglycemic drugs, fasting blood glucose> 126 mgldL and/or 2-
hours postprandial glucose> 200 iri more than one occasion. -
SUMMARY, CONCLUSION AND RECOMMENDATIONS
All patients and controls were subjected to the following:
1- Full history taking and thorough clinical examination.
2- Routine investigations including:
a- Hepatitis markers: HCV antibody and HBsAg.
b- Liver function tests: ALT, AST, albumin and bilirubin.
c- Fasting blood glucose, 2-hours postprandial blood glucose and
serum creatinine.
3- Specific investigations including HCV-RNA, serum insulin, C-peptide
and amylase concentrations.
4- Abdominal ultrasonography.
5- Liver biopsy for all patients positive for HCV antibody and antigen.
from our study the following results were obtained:
1- Only 8% of patients with CHCV and OM had positive family history
of OM while 88% of patients in diabetic group had positive family
history of OM.
2- The mean duration ofHCV contamination was statistically longer in
patients with CHCV and OM compared to patients with CHCV only.
3- 60% of patients with CHCV and OM had their liver disease diagnosed
before OM. On the other hand 32% of these patients had OM prior to
liver disease.
4- The mean value of serum ALT and AST were significantly higher in
patients with CHCV infection (group 3) and in patients with CHCV
and OM (group 4) when compared to the control group.
5- The mean value of AL T was statistically higher in patients with
CHCV and OM (group 4) compared to patients with CHCV (group 3).
6- The mean value of both FG and 2-HPG were statistically higher in
patients with CHCV and OM (group 4) compared to diabetic patients
(group 2).
SUMMARY, CONCLUSION AND RECOMMENDATIONS
7- Serum insulin and C-peptide concentrations were:
a- Statistically elevated in OM group (group 2) when compared to the
co!!trol group.
b- Non-significantly changed in CHCV group (group 3) when
compared to the control group.
c- Statistically decreased in CHCV with OM group (group 4) when
compared to the control, the diabetic and HCV groups.
8- No significant correlation was found between serum insulin or Cpeptide
values and age of the patient, duration ofHCV contamination,
serum ALT, AST and FG in both CHCV with OM and CHCV groups.
In addition no correlation was found between serum insulin and Cpeptide
and duration of OM in CHCV with OM (group 4) and OM
(group 2) groups.
9- Serum amylase concentrations were:
a- Non-significantly changed in OM group (group 2) when compared
to the control group.
b- Statistically elevated in patients with CHCV (group 3) and CHCV
with OM (group 4) when compared to the control group and the
diabetic groups.
c- Non-significantly changed in CHCV group with DM (group 4)
when compared to CHCV group (group 3).
10- No significant correlation was found between serum amylase
values and age of the patient, duration ofHCV contamination, serum
ALT, AST and FG in both CHCV and CHCV with OM, groups.
from our work we could conclude that:
1-Hyperglycemia associated with CHCV infection can not contribute
neither to type-I nor to type-2 OM and this may suggest asignificant
role ofHCV in the development of OM in these patients.
2- The occurrence of hyperamylasemia in both CHCV and CHCV with
DM groups and hypoinsulinemia in the latter group only may point to
the importance of some viral factors as length of contamination
period, genotype and/or infection titre in the development ofDM in
that group. Moreover, the absence of frank pancreatic disease despite
of this hyperamylasemia may suggest a state of subclinical pancreatic
infection in patients with CHCVinfection
3- Pancreatic gland; both the endocrine and exocrine parts, might be
included as one of the extrahepatic target ofHCV.
In continuation to Our work, we recommend further studies on:
1- Investigation of HCV antigen by PCR in pancreatic l3-cells in HCVinfected
experimental animals to clarify the exact pathogenic role of
HCV infection in the development ofDM.
2- Detection of HCV antigen in the pancreatic juice may throw lights on
the effect ofHCV on the exocrine pancreatic gland.
3- The role of HCV factors namely; HCV genotype and viremia titre in
development ofDM and hyperamylasemia in CHCV patients.
4- The HLA haplotypes and some autoantibodies specifically Iiverpancreas
antibodies and their relation to the pancreatic affection in
CHCV patients.
5- The convenience of survey of hyperglycemia in patients with CHCV
infection for early detection and management of DM and its
complications.