Assessment of factors associated with pre-diabetes in HCV infection including direct and dynamic measurements of insulin action.
Assessment of factors associated with pre-diabetes in HCV infection including direct and dynamic measurements of insulin action.
复制标题
评估与 HCV 感染中糖尿病前期相关的因素，包括直接和动态测量胰岛素作用。
DOI：
10.1111/j.1365-2893.2011.01568.x
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发表时间：
2012
影响因子：
2.5
通讯作者：
Khalili,M
中科院分区：
文献类型：
--
作者：
Mukhtar,NA;Ayala,C;Maher,JJ;Khalili,M
虽然丙型肝炎（HCV）与糖尿病有关，但很少有研究在这一人群中检查糖尿病前期。我们的目的是评估HCV感染患者中与糖尿病前期相关的因素，包括直接测量胰岛素作用。97名非糖尿病、非糖尿病和HCV感染患者接受了临床评价和口服葡萄糖耐量试验（OGTT）。在胰岛素抑制试验期间，通过稳态血糖（SSPG）浓度直接测量胰岛素敏感性。采用OGTT测定早期胰岛素分泌和总胰岛素分泌。糖尿病前期的发生率如下：21%空腹血糖受损（IFG），7%糖耐量受损（IGT）和9% IFG/IGT合并。12%的白种人、50%的非洲裔美国人和70%的拉丁美洲人患有糖尿病前期（P= 0.002）。 不同糖代谢类别的患者特征相似，但IFG/IGT合并患者的体重指数（BMI）高于正常糖耐量（NGT）（30 vs 26 kg/m2，P= 0.007），LDL低于NGT和IGT（分别为74、104和112 mg/dL，P≤ 0.01）。 在多变量分析中，非白种人（OR 23.1，P = 0.003）、BMI（OR 3.4，P = 0.02）和肝脏炎症（OR 7.9，P = 0.03）可预测IFG，而非白种人（OR 14.8，P = 0.01）和SSPG（OR 1.1/10单位，P= 0.01）可预测IGT。 与NGT相比，糖尿病前期患者经胰岛素抵抗程度调整后的早期和总胰岛素分泌减少（分别为P= 0.01和P = 0.02）。 糖尿病前期在HCV感染患者中非常普遍，在某些情况下，与宿主对病毒的反应一致。然而，在大多数情况下，HCV感染患者中与糖尿病前期相关的因素与非HCV人群中观察到的因素相似。
Although hepatitis C (HCV) is associated with diabetes, few studies have examined pre‐diabetes in this population. We aimed to evaluate factors associated with pre‐diabetes in HCV‐infected patients, including direct measurement of insulin action. Ninety‐seven non‐cirrhotic, non‐diabetic and HCV‐infected patients underwent clinical evaluation and oral glucose tolerance testing (OGTT). Insulin sensitivity was measured directly by steady‐state plasma glucose (SSPG) concentration during insulin suppression test. Early phase and total insulin secretion were determined using OGTT. Rates of pre‐diabetes were as follows: 21% impaired fasting glucose (IFG), 7% impaired glucose tolerance (IGT) and 9% combined IFG/IGT. Twelve percent of Caucasians, 50% of African Americans and 70% of Latinos had pre‐diabetes (P= 0.002). Patient characteristics among the glucose metabolism categories were similar except those with combined IFG/IGT had a higher body mass index (BMI)vsnormal glucose tolerance (NGT) (30vs26 kg/m2,P= 0.007) and lower LDLvsNGT and IGT (74, 104 and 112 mg/dL, respectively,P≤ 0.01). On multivariable analysis, non‐Caucasian race (OR 23.1,P= 0.003), BMI (OR 3.4,P= 0.02) and greater liver inflammation (OR 7.9,P= 0.03) predicted IFG, whereas non‐Caucasian race (OR 14.8,P= 0.01) and SSPG (OR 1.1 per 10 units,P= 0.01) predicted IGT. Early and total insulin secretion adjusted for the degree of insulin resistance was decreased in pre‐diabetes compared with NGT (P= 0.01 andP= 0.02, respectively). Pre‐diabetes is highly prevalent among HCV‐infected patients, and in some instances, coincides with host responses to the virus. In most cases, however, factors that are associated with pre‐diabetes in HCV‐infected patients are similar to those observed in the non‐HCV population.