High hepatitis C viral load is associated with insulin resistance in patients with chronic hepatitis C
High hepatitis C viral load is associated with insulin resistance in patients with chronic hepatitis C
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DOI：
10.1111/j.1478-3231.2007.01626.x
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发表时间：
2008-02-01
影响因子：
6.7
通讯作者：
Chen, Ding-Shinn
中科院分区：
文献类型：
--
作者：
Hsu, Ching-Sheng;Liu, Chun-Jen;Chen, Ding-Shinn
尽管胰岛素抵抗影响慢性丙型肝炎（CHC）的肝纤维化进展和治疗反应，但慢性丙型肝炎病毒（HCV）感染与胰岛素抵抗（IR）之间的关系仍有待确定。因此，我们研究了宿主、代谢和病毒因素对CHC患者IR的影响。方法：收集162例临床资料完整的CHC患者。其中94例接受了组织学检查。通过实时聚合酶链反应（PCR）测定定量HCV RNA。用型特异性引物通过逆转录PCR进行基因分型。采用稳态模型评估（HOMA）确定治疗前IR指数，并将大于2.4的指数值指定为IR。进一步分析未经调整和调整的HCV RNA水平与IR的相关性。结果如下：多元线性回归分析显示，HCVRNA水平与IR存在呈剂量-反应关系，IR与体重指数、甘油三酯、HCVRNA和丙氨酸转氨酶水平呈正相关，与脂联素水平呈负相关。按HCV基因型分层的亚组分析显示，基因型1患者有HOMR-IR指数值升高和脂联素水平降低的趋势。组织学分析显示，IR与肝脂肪变性的严重程度呈正相关。结论：我们的数据表明，较高的HCVRNA水平与CHC患者IR的存在有关。需要进一步研究以阐明HCV感染、IR和脂联素之间的相互作用，以尝试开发新的CHC辅助治疗。
Although insulin resistance affects liver fibrosis progression and treatment response in chronic hepatitis C (CHC), the relationship between chronic hepatitis C virus (HCV) infection and insulin resistance (IR) remains to be firmly established. We thus studied the impact of host, metabolic and viral factors on IR in CHC patients. Methods: A total of 162 CHC patients with complete clinical data were enrolled. Among them, 94 received histological examinations. Quantitative HCV RNA was assayed by a real-time polymerase chain reaction (PCR) assay. Genotyping was performed by reverse transcription PCR with type-specific primers. The pretreatment IR index was determined using homeostasis model assessment (HOMA), and an index value of more than 2.4 was designated IR. Unadjusted and adjusted association of the HCV RNA level and IR was further analysed. Results: In multivariate linear regression analysis, a dose-response relationship was observed between the log(10) HCV RNA level and the presence of IR. IR was positively correlated with body mass index, triglyceride, HCV RNA and alanine aminotransferase levels, but negatively correlated with adiponectin level. Subgroup analysis stratified by HCV genotype showed that there was a trend towards a higher HOMR-IR index value and lower adiponectin levels in genotype 1 patients. Histological analysis showed that IR was positively associated with the severity of hepatic steatosis. Conclusions: Our data indicate that higher HCV RNA levels are associated with the presence of IR in CHC patients. Further studies are needed to clarify the interplays between HCV infection, IR and adiponectin in an attempt to develop new adjuvant therapy for CHC.