Antiviral Treatment for Hepatitis C Virus Infection Is Associated With Improved Renal and Cardiovascular Outcomes in Diabetic Patients
Antiviral Treatment for Hepatitis C Virus Infection Is Associated With Improved Renal and Cardiovascular Outcomes in Diabetic Patients
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DOI：
10.1002/hep.26892
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发表时间：
2014-04-01
期刊：
影响因子：
13.5
通讯作者：
Wu, Chun-Ying
中科院分区：
文献类型：
--
作者：
Hsu, Yao-Chun;Lin, Jaw-Town;Wu, Chun-Ying
丙型肝炎病毒感染与胰岛素抵抗和糖尿病密切相关。这项以人群为基础的队列研究旨在调查丙型肝炎病毒感染的抗病毒治疗是否与改善糖尿病相关的临床结果有关。从台湾国民健康保险研究数据库中，2,267,270名被诊断患有糖尿病的台湾居民被筛选出符合资格。丙型肝炎病毒感染通过特定的诊断代码和血清抗体的测定来确定。在排除严重共病的患者后，我们招募了总共1411名接受聚乙二醇化干扰素和利巴韦林治疗的合格患者(治疗队列)，并根据倾向评分(未治疗队列)将他们与1411名未治疗的对照组1：1进行匹配。我们还将1：4的治疗队列与5644名未感染丙型肝炎病毒的糖尿病患者(未感染队列)进行匹配。参与者在接受抗病毒治疗或相应的日历日期后，被跟踪观察终末期肾病(ESRD)、缺血性中风和急性冠状动脉综合征(ACS)的发生情况。从2003年到2011年，治疗、未治疗和未感染队列中终末期肾病的8年累计发病率分别为1.1%(95%可信区间，0.3-2.0%)、9.3%(95%可信区间，5.9-12.7%)和3.3%(95%可信区间，2.3-4.3%)(P<；0.001)；卒中组分别为3.1%(95%CI，1.1~5.0%)、5.3%(95%CI，3.0~7.5%)、6.1%(95%CI，4.8~7.4%)(P=0.01)；急性冠脉综合征分别为4.1%(95%可信区间，2.1~6.1%)、6.6%(95%可信区间，3.7~9.5%)和7.4%(95%可信区间，5.9~9.0%)(P=0.05)。与未经治疗的队列相比，抗病毒治疗与终末期肾病的多变量调整风险比为0.16(95%CI，0.07-0.33%)、缺血性卒中的风险比为0.53(95%CI，0.30-0.93)和ACS的多变量调整风险比为0.64(95%CI，0.39-1.06)相关。结论：丙型肝炎病毒感染的抗病毒治疗与改善糖尿病患者的肾脏和心血管结局有关。(《肝病》2014；59：1293-1302)
Hepatitis C virus (HCV) infection is causally associated with insulin resistance and diabetes mellitus. This population-based cohort study aimed to investigate whether antiviral therapy for HCV infection was associated with improved clinical outcomes related to diabetes. From the Taiwan National Health Insurance Research Database, 2,267,270 Taiwanese residents diagnosed with diabetes mellitus were screened for eligibility. HCV infection was defined by a specific diagnosis code and measurement of serum antibody. After excluding patients with serious comorbidity, we enrolled a total of 1,411 eligible patients who received pegylated interferon plus ribavirin (treated cohort), and matched them 1:1 with 1,411 untreated controls by propensity scores (untreated cohort). We also matched the treated cohort 1:4 with 5,644 diabetic patients without HCV infection (uninfected cohort). Participants were followed up for the occurrence of endstage renal disease (ESRD), ischemic stroke, and acute coronary syndrome (ACS) after receiving antiviral treatment or the corresponding calendar date. From 2003 to 2011, the 8-year cumulative incidences of ESRD in the treated, untreated, and uninfected cohorts were 1.1% (95% confidence interval [CI], 0.3-2.0%), 9.3% (95% CI, 5.9-12.7%), and 3.3% (95% CI, 2.3-4.3%), respectively (P < 0.001); those of stroke were 3.1% (95% CI, 1.1-5.0%), 5.3% (95% CI, 3.0-7.5%), and 6.1% (95% CI, 4.8-7.4%), respectively (P = 0.01); and those for ACS were 4.1% (95% CI, 2.1-6.1%), 6.6% (95% CI, 3.7-9.5%), and 7.4% (95% CI, 5.9-9.0%), respectively (P = 0.05). As compared with the untreated cohort, antiviral treatment was associated with multivariate-adjusted hazard ratios of 0.16 (95% CI, 0.07-0.33%) for ESRD, 0.53 (95% CI, 0.30-0.93) for ischemic stroke, and 0.64 (95% CI, 0.39-1.06) for ACS. Conclusion: Antiviral treatment for HCV infection is associated with improved renal and cardiovascular outcomes in diabetic patients. (HEPATOLOGY 2014;59:1293-1302)