Laboratoire Alphabio, Marseille, France.
Aliment Pharmacol Ther. 2009 Jul;30(1):61-70. doi: 10.1111/j.1365-2036.2009.03995.x. Epub 2009 Mar 9.
Insulin resistance (IR), the major feature of the metabolic syndrome, is also common in patients with chronic HCV infection. Liver fibrosis and steatosis are known potential outcome of chronic hepatitis B or C infection. Studies have shown that HIV positive individuals co-infected with HCV have more rapid live disease progression than those with HIV alone. Few data have reported the influence of IR on steatosis and fibrosis in the context of HIV-HCV coinfection.
To test the association among insulin resistance (IR), liver fibrosis and liver steatosis in HIV-HCV and HCV-infected patients.
A total of 170 HIV-HCV-infected patients matched by age, gender and genotype with 170 HCV mono-infected patients were included. Patients were considered to be IR when the homeostasis model assessment of IR >2. Significant fibrosis was considered if METAVIR >or=F2 and significant steatosis if >or=10%.
Insulin resistance was independently associated in HCV patients with fibrosis [odds ratio (OR) = 2.04 (95% CI 1.02-4)], a body mass index (BMI) >25 kg/m(2) [OR = 3.33 (1.47-7.69)] and steatosis [OR = 3.33 (1.67-6.67)]. Fibrosis >or=F2 was associated in HCV patients with high liver activity grade (>or=A2) [OR = 8.33 (3.85-16.67)], male gender [OR = 3.03 (1.33-7.14)] and IR [OR = 2.44 (1.15-5)]. In HIV-HCV patients, >or=A2 [OR = 5.56 (1.64-20)] was associated with fibrosis. Steatosis >or=10% was associated in HCV patients with IR [OR = 3.13 (1.59-6.25) and >or=F2 (OR = 2.22 (1.15-4.17)]. In HIV-HCV, a BMI >25 kg/m(2) [OR = 3.85 (1.64-9.10)], >or=A2 [OR = 2.16 (1.02-4.55); P = 0.044] and nucleoside reverse transcriptase inhibitor [OR = 3.61 (1.19-10.96); P = 0.023] were independently associated with significant liver steatosis.
Insulin resistance is associated with liver fibrosis and steatosis in HCV mono-infected, but not in HIV-HCV co-infected patients. Significant liver fibrosis is associated with IR independent of liver steatosis only in HCV mono-infected patients.
胰岛素抵抗（IR）是代谢综合征的主要特征，在慢性 HCV 感染患者中也很常见。肝纤维化和脂肪变性是慢性乙型或丙型肝炎感染的已知潜在后果。研究表明，HIV 阳性合并 HCV 感染的个体比单独感染 HIV 的个体肝脏疾病进展更快。关于 HIV-HCV 合并感染中 IR 对脂肪变性和纤维化的影响，鲜有数据报道。
检测 HIV-HCV 和 HCV 感染患者中胰岛素抵抗（IR）与肝纤维化和肝脂肪变性之间的关联。
共纳入 170 例 HIV-HCV 感染患者，按年龄、性别和基因型与 170 例 HCV 单感染患者匹配。当稳态模型评估的 IR＞2 时，认为存在胰岛素抵抗。如果 METAVIR＞或＝F2 则认为存在显著纤维化，如果＞或＝10％则认为存在显著脂肪变性。
在 HCV 患者中，IR 与纤维化独立相关[比值比（OR）＝2.04（95％CI 1.02-4）]，体质指数（BMI）＞25 kg/m2[OR＝3.33（1.47-7.69）]和脂肪变性[OR＝3.33（1.67-6.67）]。在 HCV 患者中，纤维化＞或＝F2 与肝高活动度分级（＞或＝A2）[OR＝8.33（3.85-16.67）]、男性[OR＝3.03（1.33-7.14）]和 IR[OR＝2.44（1.15-5.18）]相关。在 HIV-HCV 患者中，＞或＝A2[OR＝5.56（1.64-20）]与纤维化相关。在 HCV 患者中，脂肪变性＞或＝10％与 IR[OR＝3.13（1.59-6.25）和＞或＝F2（OR＝2.22（1.15-4.17）]相关。在 HIV-HCV 中，BMI＞25 kg/m2[OR＝3.85（1.64-9.10）]、＞或＝A2[OR＝2.16（1.02-4.55）；P＝0.044]和核苷逆转录酶抑制剂[OR＝3.61（1.19-10.96）；P＝0.023]与显著肝脂肪变性独立相关。
IR 与 HCV 单感染患者的肝纤维化和脂肪变性相关，但与 HIV-HCV 合并感染患者无关。在 HCV 单感染患者中，IR 与肝纤维化相关，而与肝脂肪变性无关。
