Department of Medicine, University of Verona, Verona, Italy.
Liver Int. 2011 Jan;31(1):66-74. doi: 10.1111/j.1478-3231.2010.02343.x. Epub 2010 Sep 14.
To investigate the independent association between the homeostasis model assessment of the insulin resistance (HOMA-IR) score and rapid virological response (RVR) and sustained virological response (SVR) in chronic hepatitis C (CHC).
Observational prospective cohort study of 412 CHC patients [59% males; mean age 45 years; genotype 1 (44%), 2 (32%), 3 (19%) and 4 (5%)] treated with pegylated interferon α plus ribavirin.
A HOMA-IR ≥2.0 was present in 49% and a metabolic syndrome in 4% of patients. By multivariate analysis, independent predictors of SVR were the lack of advanced fibrosis (≥F3) in genotype 1 and a lower body mass index in genotype 3 patients. In the subgroup of patients in whom HCV-RNA was evaluated at week 4 (n = 281), independent predictors of RVR were HCV-RNA <700,000 IU/ml, age <40 years and lower aspartate aminotransferase:alanine aminotransferase ratio in genotype 1 and baseline HOMA-IR ≤2 in genotype 3 patients. No predictive factor of RVR was identified among genotype 2 patients. RVR was the strongest predictor of SVR among genotype 1 or 3 patients.
In this series of treatment-naïve, Caucasian CHC patients at a low risk for the metabolic syndrome, HOMA-IR is not a predictor of SVR, irrespective of the HCV genotype, although it may predict RVR in genotype 3 infection.
探讨稳态模型评估的胰岛素抵抗（HOMA-IR）评分与慢性丙型肝炎（CHC）患者快速病毒学应答（RVR）和持续病毒学应答（SVR）之间的独立相关性。
这是一项观察性前瞻性队列研究，共纳入 412 例 CHC 患者[59%为男性；平均年龄 45 岁；基因型 1（44%）、2（32%）、3（19%）和 4（5%）]，均接受聚乙二醇干扰素α联合利巴韦林治疗。
49%的患者存在 HOMA-IR≥2.0，4%的患者存在代谢综合征。多因素分析显示，基因型 1 患者无晚期纤维化（≥F3）和基因型 3 患者较低的体重指数是 SVR 的独立预测因素。在 HCV-RNA 于第 4 周（n=281）评估的患者亚组中，RVR 的独立预测因素为 HCV-RNA<700,000 IU/ml、年龄<40 岁和基因型 1 患者较低的天冬氨酸氨基转移酶/丙氨酸氨基转移酶比值以及基因型 3 患者基线 HOMA-IR≤2。基因型 2 患者中未发现 RVR 的预测因素。RVR 是基因型 1 或 3 患者 SVR 的最强预测因素。
在这一系列治疗初治、白种人、代谢综合征风险较低的 CHC 患者中，HOMA-IR 不是 SVR 的预测因素，与 HCV 基因型无关，但可能预测基因型 3 感染的 RVR。
