Service d'Hépato-Gastroentérologie, Hôpital Huriez, CHRU Lille, Lille, France.
J Hepatol. 2011 Dec;55(6):1187-94. doi: 10.1016/j.jhep.2011.03.010. Epub 2011 Apr 13.
BACKGROUND & AIMS: Recent studies suggested that SVR rates might be lower in HCV patients with insulin resistance (IR) than in patients without IR, but the extent of the impact of IR on treatment response has not been established. We aimed to confirm the role of IR assessed by the homoeostasis model assessment (HOMA-IR) on SVR and to determine its magnitude.
We performed meta-analysis of studies evaluating the impact of IR in HCV patients treated with pegylated interferon and ribavirin.
Fourteen studies involving 2732 patients were included. SVR was less frequent in patients with IR than in patients without IR (mean difference: -19.6%, 95% CI: -29.9% to -9.4%, p<0.001). In sensitivity analyses according to HCV-1 patients, patients with IR also less frequently attained a SVR than patients without IR (mean difference: -13.0%, 95% CI: -22.6% to -3.4%, p=0.008). In addition, the baseline HOMA-IR index was lower in responders than in non-responders (mean difference: -0.92, 95% CI: -1.53 to -0.32, p<0.001). In sensitivity analyses restricted to HCV-1 patients, the baseline HOMA-IR index remained lower in responders than in non-responders (mean difference: -0.63, 95% CI: -1.13 to -0.14, p<0.001).
HCV patients with IR have a 20% lower SVR than patients without IR. The baseline HOMA-IR index is a major determinant of SVR.
最近的研究表明，与无胰岛素抵抗（IR）的 HCV 患者相比，IR 患者的 SVR 率可能较低，但 IR 对治疗反应的影响程度尚未确定。我们旨在通过评估稳态模型评估（HOMA-IR）来确认 IR 在 SVR 中的作用，并确定其程度。
我们对评估 IR 对聚乙二醇干扰素和利巴韦林治疗的 HCV 患者影响的研究进行了荟萃分析。
纳入了 14 项涉及 2732 名患者的研究。IR 患者的 SVR 频率低于无 IR 患者（平均差异：-19.6%，95%CI：-29.9%至-9.4%，p<0.001）。根据 HCV-1 患者进行敏感性分析时，IR 患者的 SVR 频率也低于无 IR 患者（平均差异：-13.0%，95%CI：-22.6%至-3.4%，p=0.008）。此外，应答者的基线 HOMA-IR 指数低于无应答者（平均差异：-0.92，95%CI：-1.53 至-0.32，p<0.001）。在仅限于 HCV-1 患者的敏感性分析中，应答者的基线 HOMA-IR 指数仍低于无应答者（平均差异：-0.63，95%CI：-1.13 至-0.14，p<0.001）。
IR 的 HCV 患者的 SVR 比无 IR 的患者低 20%。基线 HOMA-IR 指数是 SVR 的主要决定因素。
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