Elevated serum tumor necrosis factor alpha and ferritin may contribute to the insulin resistance found in HCV positive Egyptian patients

Authors: Elsammak, M.; Refai, W.; Elsawaf, A.; Abdel-Fattah, I.; Abd Elatti, E.; Ghazal, A.

Source: Current Medical Research and Opinion, Volume 21, Number 4, April 2005 , pp. 527-534(8)

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Abstract:

Objective: There is evidence of an increased incidence of insulin resistance and diabetes mellitus (DM) in patients with hepatitis C virus (HCV) infection. Several mechanisms have been proposed, including inadequate insulin secretion or interference with signaling within the insulin receptor. We assessed serum tumor necrosis factor alpha (TNFα) and ferritin levels as potential mediators of insulin resistance in HCV positive Egyptian patients.

Patients and results: Patients (n = 27) with HCV infection, patients (n = 23) with hepatitis C and DM (HCV + DM), patients (n = 22) with DM, and sex- and age-matched controls (n = 18) were included in this study. The degree of insulin resistance (HOMA index) was significantly higher in the HCV, HCV + DM and DM groups compared to the controls. The mean ± SD of the HOMA index was 4.53 ± 2.84, 6.1 ± 2.36, 3.69 ± 2.2 and 1.32 ± 0.49, in HCV, HCV + DM, DM and controls, respectively. Serum TNFα levels were significantly higher in the HCV, HCV + DM groups compared with the healthy controls and DM patients (p < 0.001). The median (range) values of TNFα in HCV, HCV + DM, DM patients and controls subjects were 25.5 (0.43–124.0), 19.8 (0.51–139), 0.85 (0–10.5) and 0.32 (0–5.8) pg/mL, respectively. There was a significant positive correlation between the HCV load and both HOMA index and TNF α level. HCV and HCV + DM patients also had significantly higher serum ferritin levels compared with healthy controls and patients with DM. The mean ± SD of serum ferritin in HCV, HCV + DM, DM patients and controls subjects was 258.1 ± 116.2, 285.8 ± 124.3, 86.9 ± 41.8 and 159.9 ± 76.9 ng/mL, respectively.

Conclusion: Patients with HCV infection had a significantly higher level of TNFα and ferritin which may explain their insulin resistance. HOMA index and serum TNFα levels correlated positively with the HCV load.

Keywords: FERRITIN; HEPATITIS C VIRUS; INSULIN RESISTANCE; TUMOR NECROSIS FACTOR ALPHA

Document Type: Research article

DOI: http://dx.doi.org/10.1185/030079905X38141

Affiliations: 1: Department of Chemical Pathology, Medical Research Institute, Alexandria University, Egypt

Publication date: 2005-04-01

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