HEPATITIS C INFECTION & DIABETES IN INJECTION DRUG USERS

建议进行一项分两个阶段的研究，以检查丙型肝炎病毒(丙型肝炎病毒)感染和随后发生的2型糖尿病之间的关系。来自第三次全国健康和营养检查调查和其他研究的最新证据表明，这种联系。鉴于注射吸毒者中丙型肝炎病毒感染的高流行率(约90%)，这项研究对注射吸毒者具有巨大的健康影响。第一阶段涉及一项病例队列研究，以确定在一大群社区男性和女性中，丙型肝炎病毒感染和2型糖尿病之间是否存在独立的因果关系。我们将从社区动脉粥样硬化风险(ARIC)研究中招募436例糖尿病患者和872名年龄匹配的对照组，并将评估在糖尿病发病前采集的冷冻血清样本中丙型肝炎病毒抗体的存在。在第二阶段，我们将测试马里兰州巴尔的摩大量静脉注射吸毒者(艾滋病与静脉注射经历有关)中的抗-丙型肝炎病毒阳性者的子集(n=210)是否患有糖尿病。我们将比较2型糖尿病患者和年龄匹配的对照组在丙型肝炎病毒特征方面的差异，如丙型肝炎病毒核糖核酸、肝酶和丙型肝炎病毒基因，以试图阐明这种被提出的联系的机制。这项研究的结果将推动未来对肝病在糖尿病发病机制中的作用的流行病学和生理学研究，以及在注射吸毒者等承受丙型肝炎病毒疫情大部分负担的人群中潜在的糖尿病预防计划。

Proposed is a two-phase study to examine the association between hepatitis C virus (HCV) infection and subsequent development of type 2 diabetes mellitus. Recent evidence from the third National Health and Nutrition Examination Survey and other studies suggest such an association. Given the high prevalence of HCV infection (approximately 90 percent) in injection drug users (IDUs), this study has tremendous health implications for IDUs. Phase I involves a case-cohort study to determine whether there is an independent causal association between HCV infection and type 2 diabetes in a large cohort of community-based men and women. We will enroll 436 incident diabetes cases and 872 age- matched controls from the Atherosclerosis Risk in Communities (ARIC) study and will assess the presence of HCV antibody from frozen serum samples taken prior to the onset of diabetes. In Phase II, we will test a subset (n=210) of anti-HCV positive individuals from a large cohort of IDUs (AIDS Link to Intravenous Experiences) in Baltimore, Maryland for diabetes. Cases of type 2 diabetes will be compared to age-matched controls for differences in HCV viral characteristics such as HCV RNA, liver enzymes and HCV genotype in an attempt to elucidate the mechanism of this proposed association. The results of this study will drive future epidemiological and physiological research into the role of liver disease in the pathogenesis of diabetes as well as potential diabetes prevention programs in populations such as IDUS who bear most of the burden of the hepatitis C virus epidemic.