High body mass index is an independent risk factor for nonresponse to antiviral treatment in chronic hepatitis C
High body mass index is an independent risk factor for nonresponse to antiviral treatment in chronic hepatitis C
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DOI：
10.1053/jhep.2003.50350
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发表时间：
2003-09-01
期刊：
影响因子：
13.5
通讯作者：
Heathcote, J
中科院分区：
文献类型：
--
作者：
Bressler, BL;Guindi, M;Heathcote, J
本研究的目的是确定体重指数（BMI）是否是慢性丙型肝炎患者抗病毒治疗反应的独立预测因子。对1989年至2000年在一个中心接受抗病毒药物治疗的所有慢性丙型肝炎患者进行回顾性分析。持续应答定义为治疗完成后6个月聚合酶链反应检测丙型肝炎病毒（HCV）RNA阴性和/或丙氨酸氨基转移酶（ALT）水平正常（仅适用于HCV RNA检测可用性之前接受治疗的患者）。根据BMI（正常，30 kg/m2）将所有患者分为3组。共253例患者接受干扰素（IFN）单药治疗或IFN与利巴韦林联合治疗。如果无法获得预定的临床特征，则排除患者。使用logistic回归，并调整检查变量（年龄，性别，饮酒史>50 g/d，治疗前活检时肝硬化，BMI）后，似然比检验显示，BMI组（P = .01），基因型（P < .01）和肝硬化（P < .01）对治疗的反应存在显著差异。与基因型1相比，基因型2或3的患者成功的优势比（OR）为11.7，肥胖患者与非肥胖患者相比的OR为0.15，肥胖患者与正常和超重患者相比的OR为0.23。肝脂肪变性不是抗病毒治疗反应的独立危险因素。总之，只有当BMI大于30 kg/m2时，肥胖才是丙型肝炎治疗反应的独立（基因型和肝硬化）阴性预测因子。
The aim of this study was to determine if body mass index (BMI) was an independent predictor of response to antiviral treatment in patients with chronic hepatitis C. A retrospective review was performed of all patients at a single center with chronic hepatitis C treated with antiviral medication from 1989 to 2000. A sustained response was defined as either negative hepatitis C virus (HCV) RNA by polymerase chain reaction and/or normal alanine aminotransferase (ALT) level (only in those treated before availability of HCV RNA testing) 6 months following completion of therapy. All patients were classified into one of 3 groups according to BMI (normal, 30 kg/m(2)). A total of 253 patients were treated with either interferon (IFN) monotherapy or IFN in combination with ribavirin. Patients were excluded if predetermined clinical characteristics were unavailable. Using logistic regression, and after adjusting for the examined variables (age, sex, history of alcohol consumption >50 g/d, cirrhosis on pretreatment biopsy, and BMI), likelihood ratio tests showed significant differences in response to treatment according to BMI group (P = .01), genotype (P < .01), and cirrhosis (P < .01). Those with genotypes 2 or 3 had an odds ratio (OR) for success of 11.7 compared with those with genotype 1, cirrhotic patients had an OR of 0.15 compared with noncirrhotic patients, and obese patients had an OR of 0.23 compared with normal and overweight patients. Hepatic steatosis was not an independent risk factor for response to antiviral treatment. In conclusion, obesity, only when defined as a BMI greater than 30 kg/m(2), is an independent (of genotype and cirrhosis) negative predictor of response to hepatitis C treatment.