Elsammak M, Refai W, Elsawaf A, Abdel-Fattah I, Abd Elatti E, Ghazal A
Department of Chemical Pathology, Medical Research Institute, Alexandria University, Egypt.
Curr Med Res Opin. 2005 Apr;21(4):527-34. doi: 10.1185/030079905X38141.
There is evidence of an increased incidence of insulin resistance and diabetes mellitus (DM) in patients with hepatitis C virus (HCV) infection. Several mechanisms have been proposed, including inadequate insulin secretion or interference with signaling within the insulin receptor. We assessed serum tumor necrosis factor alpha (TNFalpha) and ferritin levels as potential mediators of insulin resistance in HCV positive Egyptian patients.
Patients (n = 27) with HCV infection, patients (n = 23) with hepatitis C and DM (HCV + DM), patients (n = 22) with DM, and sex- and age-matched controls (n = 18) were included in this study. The degree of insulin resistance (HOMA index) was significantly higher in the HCV, HCV + DM and DM groups compared to the controls. The mean +/- SD of the HOMA index was 4.53 +/- 2.84, 6.1 +/- 2.36, 3.69 +/- 2.2 and 1.32 +/- 0.49, in HCV, HCV + DM, DM and controls, respectively. Serum TNFalpha levels were significantly higher in the HCV, HCV + DM groups compared with the healthy controls and DM patients (p < 0.001). The median (range) values of TNFalpha in HCV, HCV + DM, DM patients and controls subjects were 25.5 (0.43-124.0), 19.8 (0.51-139), 0.85 (0-10.5) and 0.32 (0-5.8) pg/mL, respectively. There was a significant positive correlation between the HCV load and both HOMA index and TNF alpha level. HCV and HCV + DM patients also had significantly higher serum ferritin levels compared with healthy controls and patients with DM. The mean +/- SD of serum ferritin in HCV, HCV + DM, DM patients and controls subjects was 258.1 +/- 116.2, 285.8 +/- 124.3, 86.9 +/- 41.8 and 159.9 +/- 76.9 ng/mL, respectively.
Patients with HCV infection had a significantly higher level of TNFalpha and ferritin which may explain their insulin resistance. HOMA index and serum TNFalpha levels correlated positively with the HCV load.
有证据表明丙型肝炎病毒（HCV）感染患者中胰岛素抵抗和糖尿病（DM）的发病率有所增加。已经提出了几种机制，包括胰岛素分泌不足或对胰岛素受体内信号传导的干扰。我们评估了血清肿瘤坏死因子α（TNFα）和铁蛋白水平，作为HCV阳性埃及患者胰岛素抵抗的潜在介质。
本研究纳入了HCV感染患者（n = 27）、丙型肝炎合并糖尿病患者（HCV + DM，n = 23）、糖尿病患者（n = 22）以及性别和年龄匹配的对照组（n = 18）。与对照组相比，HCV组、HCV + DM组和DM组的胰岛素抵抗程度（HOMA指数）显著更高。HCV组、HCV + DM组、DM组和对照组的HOMA指数平均值±标准差分别为4.53±2.84、6.1±2.36、3.69±2.2和1.32±0.49。与健康对照组和DM患者相比，HCV组和HCV + DM组的血清TNFα水平显著更高（p < 0.001）。HCV组、HCV + DM组、DM患者和对照组的TNFα中位数（范围）值分别为25.5（0.43 - 124.0）、19.8（0.51 - 139）、0.85（0 - 10.5）和0.32（0 - 5.8）pg/mL。HCV载量与HOMA指数和TNFα水平均呈显著正相关。与健康对照组和DM患者相比，HCV组和HCV + DM患者的血清铁蛋白水平也显著更高。HCV组、HCV + DM组、DM患者和对照组的血清铁蛋白平均值±标准差分别为258.1±116.2、285.8±124.3、86.9±41.8和159.9±76.9 ng/mL。
HCV感染患者的TNFα和铁蛋白水平显著更高，这可能解释了他们的胰岛素抵抗。HOMA指数和血清TNFα水平与HCV载量呈正相关。
