Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Internal Medicine

Background: Insulin resistance (IR) is exceedingly common in patients with hepatitis C virus (HCV) related chronic liver disease. IR has been systematically associated with advanced fibrosis and fibrosis progression. The quantitative measurement of IR might be a potential predictor of portal hypertension in early cirrhosis. AIM OF THE WORK: In this study, we tried to identify the significance of two non-invasive tests; namely platelet count/Splenic diameter ratio and insulin resistance (HOMA-IR) for assessment of esophageal varices in child A and/or B post-hepatitis C virus liver cirrhotic patients. Subjects and Methods: Patients were divided into three groups: group )1( 25 child A or B post-HCV liver cirrhosis patients with homa-IR <3.5, group (2) 25 child A or B post-HCV liver cirrhosis patients with homa-IR >3.5, group (3) 20 healthy age and sex matched controls. All patients enrolled in the study were subjected to full history taking, thorough examination, laboratory investigations (HOMA-IR, CBC, AST, ALT, total bilirubin, INR, serum albumin, anti-HCV Ab, HBsAg). Radiological investigation was in the form of abdominal ultrasonography and fibroscan. Interventional investigation was in the form of upper endoscopy. Results: This study found a strong association between insulin resistance (IR) and hepatitis C virus, liver cirrhosis, degree of fibrosis, esophageal varices development, grades and risk of bleeding. This association was independent from age, sex, diabetes, insulin or liver functions. There was inverse correlation between Platelet count splenic diameter ratio (PC/SD) and esophageal varices development, grades and risk of bleeding

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