Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Liver Int. 2012 Jul;32(6):962-9. doi: 10.1111/j.1478-3231.2012.02771.x. Epub 2012 Feb 22.
BACKGROUND/AIMS: Pre-diabetes is a risk factor for type 2 diabetes mellitus (DM) development. This study aimed to elucidate the impact of treatment response on sequential changes in glucose abnormalities in pre-diabetic chronic hepatitis C (CHC) patients.
Chronic Hepatitis C patients with a baseline haemoglobin A1C (A1C) range 5.7-6.4% who achieved 80/80/80 adherence were prospectively recruited. All patients received current peginterferon-based recommendations. The primary outcome measurement was their A1C level at the end of follow-up (EOF). The interaction between variants of the IL28B gene and outcomes of glucose metabolism was also measured.
A total of 181 consecutive CHC patients were enrolled. The mean A1C at EOF was 5.82 ± 0.41%, which was significantly lower than the baseline level (5.93 ± 0.21%, P < 0.001). At EOF, 63 (34.8%) patients became normoglycaemic, whereas 10 (5.5%) patients developed DM. The sustained virological response (SVR) rates of 63 normoglycaemics, 108 pre-diabetics and 10 diabetic patients at the EOF were 92.1%, 84.3% and 50% respectively (normoglycaemics vs. diabetics P = 0.003; pre-diabetics vs. diabetics P = 0.02). Achievement of an SVR was the only predictive factor associated with normoglycaemia development at EOF by multivariate logistic regression analysis (Odds ratio = 2.6, P = 0.04). The prevalence of the interleukin 28B rs8099917 TT variant in patients who developed DM (70.0%) at EOF tended to be lower than that in patients with pre-diabetics (87.0%) or normoglycaemics (92.1%).
Successful eradication of HCV improves glucose abnormalities in pre-diabetic CHC patients.
背景/目的：糖尿病前期是 2 型糖尿病（DM）发展的危险因素。本研究旨在阐明治疗反应对糖尿病前期慢性丙型肝炎（CHC）患者葡萄糖异常连续变化的影响。
前瞻性招募基线糖化血红蛋白（A1C）范围为 5.7-6.4%且达到 80/80/80 依从性的慢性丙型肝炎患者。所有患者均接受现行聚乙二醇干扰素治疗建议。主要结局测量指标为随访结束时（EOF）的 A1C 水平。还测量了白细胞介素 28B 基因变异与葡萄糖代谢结果之间的相互作用。
共纳入 181 例连续 CHC 患者。EOF 时的平均 A1C 为 5.82±0.41%，明显低于基线水平（5.93±0.21%，P<0.001）。EOF 时，63（34.8%）例患者血糖正常，10（5.5%）例患者发生 DM。EOF 时 63 例血糖正常者、108 例糖尿病前期者和 10 例糖尿病患者的持续病毒学应答（SVR）率分别为 92.1%、84.3%和 50%（血糖正常者与糖尿病者比较，P=0.003；糖尿病前期者与糖尿病者比较，P=0.02）。多变量 logistic 回归分析显示，获得 SVR 是 EOF 时血糖正常发展的唯一预测因素（优势比=2.6，P=0.04）。EOF 时发生 DM（70.0%）的患者白细胞介素 28B rs8099917 TT 变异的患病率倾向于低于糖尿病前期（87.0%）或血糖正常（92.1%）患者。
成功清除 HCV 可改善糖尿病前期 CHC 患者的葡萄糖异常。
