Department of Family Medicine, Pusan National University School of Medicine, Beomeo-ri Mulgeum-eup, Yangsan 626-770, South Korea.
World J Gastroenterol. 2012 Nov 14;18(42):6120-6. doi: 10.3748/wjg.v18.i42.6120.
To investigate the relationship between chronic viral hepatitis B (CVHB) and insulin resistance (IR) in Korean adults.
A total of 7880 adults (3851 men, 4029 women) who underwent a comprehensive medical examination were enrolled in this study. Subjects diagnosed with either diabetes mellitus, or any other disorder that could influence their insulin sensitivity, were rejected. Anthropometry, metabolic risk factors, hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B core antibody, fasting plasma glucose and insulin were measured for all subjects. Homeostasis model assessment (HOMA), quantitative insulin check index (QUICKI), and Mf(fm) index were used for determining insulin sensitivity. Each participant was categorized into a negative, recovery, or CVHB group. To compare variables between groups, a t-test and/or one-way analysis of variance were used. Partial correlation coefficients were computed to present the association between insulin resistance and other variables. Multiple logistic regression analysis was used to assess the independent association between CVHB and IR.
The mean age of men and women were 48.9 and 48.6 years, respectively. Subjects in the CVHB group had significantly higher waist circumference [(86.0 ± 7.7 cm vs 87.3 ± 7.8 cm, P = 0.004 in men), (78.3 ± 8.6 cm vs 80.5 ± 8.5 cm, P < 0.001 in women)], cystatin C [(0.96 ± 0.15 mg/dL vs 1.02 ± 0.22 mg/dL, P < 0.001 in men), (0.84 ± 0.15 mg/dL vs 0.90 ± 0.16 mg/dL, P < 0.001 in women)], fasting insulin [(5.47 ± 3.38 μU/mL vs 6.12 ± 4.62 μU/mL, P < 0.001 in men), (4.57 ± 2.82 μU/mL vs 5.06 ± 3.10 μU/mL, P < 0.001 in women)] and HOMA index [(1.24 ± 0.86 vs 1.43 ± 1.24, P < 0.001 in men), (1.02 ± 0.76 vs 1.13 ± 0.87, P = 0.033 in women)] compared to control group. The HOMA index revealed a positive correlation with body mass index (BMI) (r = 0.378, P < 0.001), waist circumference (r =0.356, P < 0.001), percent body fat (r = 0.296, P < 0.001), systolic blood pressure (r = 0.202, P < 0.001), total cholesterol (r = 0.134, P < 0.001), triglycerides (r = 0.292, P < 0.001), cystatin C (r = 0.069, P < 0.001) and uric acid (r = 0.142, P < 0.001). The QUICKI index revealed a negative correlation with BMI (r = -0.254, P < 0.001), waist circumference (r = 0-0.243, P < 0.001), percent body fat (r = -0.217, P < 0.001), systolic blood pressure (r = -0.132, P < 0.001), total cholesterol (r = -0.106, P < 0.001), triglycerides (r = -0.205, P < 0.001), cystatin C (r = -0.044, P < 0.001) and uric acid (r = -0.096, P < 0.001). For subjects identified with IR, the odds ratio of an accompanying diagnosis of chronic hepatitis B was 1.534 (95% CI: 1.158-2.031, HOMA index criteria) or 1.566 (95% CI: 1.124-2.182, QUICKI criteria) after adjustment for age, gender, BMI, and amount of alcohol consumption.
Our study demonstrates that CVHB is associated with IR. CVHB may need to be monitored for occurrence of IR and diabetes mellitus.
探讨韩国成年人慢性乙型肝炎病毒（CVHB）与胰岛素抵抗（IR）之间的关系。
共纳入 7880 名接受全面体检的成年人（男性 3851 名，女性 4029 名）。排除患有糖尿病或任何其他可能影响其胰岛素敏感性的疾病的患者。对所有受试者进行人体测量、代谢风险因素、乙肝表面抗原、乙肝表面抗体、乙肝核心抗体、空腹血糖和胰岛素的检测。使用稳态模型评估（HOMA）、定量胰岛素检查指数（QUICKI）和 Mf（fm）指数来确定胰岛素敏感性。将每个参与者分为阴性、恢复或 CVHB 组。为了比较组间的变量，使用 t 检验和/或单因素方差分析。计算偏相关系数以显示胰岛素抵抗与其他变量之间的关联。使用多因素逻辑回归分析评估 CVHB 与 IR 之间的独立关联。
男性和女性的平均年龄分别为 48.9 岁和 48.6 岁。CVHB 组的腰围明显更高[（86.0±7.7cm 与 87.3±7.8cm，P=0.004，男性）；（78.3±8.6cm 与 80.5±8.5cm，P<0.001，女性）]、胱抑素 C[（0.96±0.15mg/dL 与 1.02±0.22mg/dL，P<0.001，男性）；（0.84±0.15mg/dL 与 0.90±0.16mg/dL，P<0.001，女性）]、空腹胰岛素[（5.47±3.38μU/mL 与 6.12±4.62μU/mL，P<0.001，男性）；（4.57±2.82μU/mL 与 5.06±3.10μU/mL，P<0.001，女性）]和 HOMA 指数[（1.24±0.86 与 1.43±1.24，P<0.001，男性）；（1.02±0.76 与 1.13±0.87，P=0.033，女性）]与对照组相比。HOMA 指数与体重指数（BMI）（r=0.378，P<0.001）、腰围（r=0.356，P<0.001）、体脂百分比（r=0.296，P<0.001）、收缩压（r=0.202，P<0.001）、总胆固醇（r=0.134，P<0.001）、甘油三酯（r=0.292，P<0.001）、胱抑素 C（r=0.069，P<0.001）和尿酸（r=0.142，P<0.001）呈正相关。QUICKI 指数与 BMI（r=-0.254，P<0.001）、腰围（r=0-0.243，P<0.001）、体脂百分比（r=-0.217，P<0.001）、收缩压（r=-0.132，P<0.001）、总胆固醇（r=-0.106，P<0.001）、甘油三酯（r=-0.205，P<0.001）、胱抑素 C（r=-0.044，P<0.001）和尿酸（r=-0.096，P<0.001）呈负相关。对于被诊断为 IR 的受试者，在调整年龄、性别、BMI 和饮酒量后，慢性乙型肝炎的诊断比值比为 1.534（95%CI：1.158-2.031，HOMA 指数标准）或 1.566（95%CI：1.124-2.182，QUICKI 标准）。
本研究表明，CVHB 与 IR 相关。CVHB 可能需要监测发生 IR 和糖尿病的情况。
