血液透析患者的丙型肝炎病毒感染与胰岛素抵抗、炎症及动脉粥样硬化无关。

Hepatitis C virus infection in hemodialysis patients is not associated with insulin resistance, inflammation and atherosclerosis.

作者信息

Caliskan Y, Oflaz H, Pusuroglu H, Boz H, Yazici H, Tamer S, Karsidag K, Yildiz A

机构信息

Department of Internal Medicine, Division of Nephrology, School of Medicine, Istanbul University, Istanbul, Turkey.

出版信息

Clin Nephrol. 2009 Feb;71(2):147-57. doi: 10.5414/cnp71147.

DOI:10.5414/cnp71147

PMID:19203507

Abstract

BACKGROUND

Hepatitis C virus (HCV) infection is associated with increased levels of inflammatory markers and is also a significant risk factor for the development of Type 2 diabetes mellitus (DM) in the general population. In attempt to address this issue in chronic hemodialysis (HD) patients, we evaluated the relation of HCV infection with inflammatory markers, endothelial dysfunction, insulin resistance and atherosclerosis.

METHODS

In a cohort of 72 HD patients (36 (50%) had a positive HCV EIA test and 36 (50%) had a negative anti-HCV test), we examined HCV antibody status, insulin resistance (HOMA-IR) and beta-cell function (HOMA-beta), serum inflammatory parameters (high sensitive C-reactive protein (CRP), fibrinogen and procalcitonin), and performed echocardiography, high-resolution brachial artery ultrasound and B-mode carotid Doppler examination to assess the vascular functions and atherosclerosis.

RESULTS

There were no differences in age, gender, body mass index (BMI), primary disease, duration of dialysis, smoking status, laboratory parameters except glucose, total cholesterol and LDL cholesterol between anti-HCV-positive and anti-HCV-negative groups. The serum concentrations of glucose, total cholesterol and LDL cholesterol were significantly lower in the anti-HCV-positive patients than anti-HCV-negative patients (p = 0.04, p = 0.02, p = 0.01, respectively). There were no significant differences in inflammatory parameters, total insulin secretion (HOMA-beta, p = 0.76) and insulin resistance (HOMA-R, p = 0.91) between anti-HCV-positive and negative patients. The intima media thickness, carotid plaque score and brachial artery endothelium-dependent dilatation did not differ significantly between the two groups (p = 0.44, 0.45, and 0.17, respectively).

CONCLUSION

HCV infection was not related to atherosclerosis and insulin resistance in hemodialysis patients. Since hemodialysis patients had a large number of uremia-related cardiovascular risk factors, the effect of HCV infection could disappear in this group of patients.

摘要

背景

丙型肝炎病毒（HCV）感染与炎症标志物水平升高相关，并且在普通人群中也是2型糖尿病（DM）发生的一个重要危险因素。为了探讨慢性血液透析（HD）患者中的这一问题，我们评估了HCV感染与炎症标志物、内皮功能障碍、胰岛素抵抗及动脉粥样硬化之间的关系。

方法

在一组72例HD患者中（36例（50%）HCV酶免疫分析检测呈阳性，36例（50%）抗HCV检测呈阴性），我们检查了HCV抗体状态、胰岛素抵抗（HOMA-IR）和β细胞功能（HOMA-β）、血清炎症参数（高敏C反应蛋白（CRP）、纤维蛋白原和降钙素原），并进行了超声心动图、高分辨率肱动脉超声和B型颈动脉多普勒检查以评估血管功能和动脉粥样硬化。

结果

抗HCV阳性组和抗HCV阴性组在年龄、性别、体重指数（BMI）、原发疾病、透析时间、吸烟状况、除血糖、总胆固醇和低密度脂蛋白胆固醇外的实验室参数方面无差异。抗HCV阳性患者的血糖、总胆固醇和低密度脂蛋白胆固醇血清浓度显著低于抗HCV阴性患者（分别为p = 0.04、p = 0.02、p = 0.01）。抗HCV阳性和阴性患者在炎症参数、总胰岛素分泌（HOMA-β，p = 0.76）和胰岛素抵抗（HOMA-R，p = 0.91）方面无显著差异。两组之间的内膜中层厚度、颈动脉斑块评分和肱动脉内皮依赖性扩张无显著差异（分别为p = 0.44、0.45和0.17）。