Serum Fetuin-A Evaluation in Chronic Hepatitis C-Virus Patients with Concomitant Type 2 Diabetes Mellitus

Abstract

Background and study aim: Hepatitis C virus infection represents a potential public health problem worldwide. Many studies have shown markedly higher prevalence of insulin resistance (IR) and type 2 diabetes mellitus (T2DM) among patients with hepatitis C virus (HCV) infection compared to healthy subjects. Fetuin-A is one of the principal hepatokines regulating the human metabolism. This study aimed to estimate the level of Fetuin-A in HCV patients with concomitant T2DM, and its relation to insulin resistance. Patients and Methods: The study was conducted on 115 subjects, 87 patients had chronic HCV infection with and without T2DM, diabetic patients without HCV infection and 28 healthy control, they were subjected to full history taking thorough clinical examination, abdominal ultrasonography, routine laboratory investigation including fasting and post prandial blood glucose level and assessment of HOMA- IR, viral markers and serum Fetuin-A level by ELISA. Results Conclusion : There was high statistically significant increase of serum Fetuin-A level among HCV with DM patient group followed by HCV group when compared to DM and control groups. Serum Fetuin-A level was higher in HCV patients than non HCV subjects with statistically significant difference.Also,it was higher among diabetic patients than non diabetic subjects with statistically significant difference.Serum Fetuin-A level was positively correlated with glucose homeostasis parameters in both HCV and HCV&D.M patients with high statistically significant difference. At Cut-off value of serum Fetuin-A >5.2 mg/mL, Sensitivity was 54.84, Specificity was 96.30, positive PV 94.4 and negative PV was 65.0 for prediction of IR in HCV patients. While, at Cut-off value of serum Fetuin-A >4.9 mg/mL, sensitivity was 72.41, specificity was 79.31, positive PV was 77.8 and negative PV was 74.2 for prediction of DM in HCV patients. Conclusion: Fetuin-A may have role as a mediator in IR of either HCV or diabetes. However, Fetuin-A is more specific for evaluation of IR than DM in HCV patients as other factors may be incriminated in the pathogenesis of DM in HCV patients other than serum Fetuin-A level alone.