脂肪细胞因子与胰岛素抵抗：埃及慢性丙型肝炎病毒基因 4 型患者对治疗反应的预测因子。
Adipokines and insulin resistance, predictors of response to therapy in Egyptian patients with chronic hepatitis C virus genotype 4.
机构信息
Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt.
出版信息
Eur J Gastroenterol Hepatol. 2013 Aug;25(8):920-5. doi: 10.1097/MEG.0b013e32835f2726.
BACKGROUND
Hepatitis C virus (HCV) infection has major health impact worldwide and is a significant cause of chronic liver disease. In Egypt, HCV is highly endemic (up to 15% of the population); 91% of the patients are infected with genotype 4. Searching for new predictors of response to therapy is mandatory to decrease the cost and the adverse effects of current therapy.
AIM
The aim of this study was to clarify the usefulness of serum leptin, adiponectin, and insulin resistance (IR) as predictors of response to treatment in hepatitis C virus genotype 4 (HCVG4).
METHODS
One hundred patients with chronic HCVG4 who were candidates for treatment with pegylated interferon α and ribavirin were included in the study. Age, sex, and BMI were determined, and quantitative HCV PCR, assessment of serum leptin, adiponectin, IR, and pretreatment liver profile, and liver biopsy were performed.
RESULTS
The male to female ratio was 68/32; the mean age of the patients was 40.9 ± 7.8 years and BMI was 28.3 ± 10 kg/m. Sustained virological response (SVR) was achieved by 56% of the patients. On performing logistic regression, BMI [odds ratio (OR) 6.5; P=0.004], serum leptin (OR 27.8; P ≤ 0.001), aspartate aminotransferase (OR 1.06; P ≤ 0.001), IR (OR 1.15; P ≤ 0.001), histological activity index (OR 1.77; P=0.006), and fibrosis (OR 2.93; P=0.001) were found to be independent negative predictors of SVR, whereas serum adiponectin (OR 0.74; P ≤ 0.001) was found to be an independent positive predictor of SVR. Pretreatment adiponectin (cutoff 13.75; sensitivity 92.86%; specificity 86.86%) shows area under the curve of 0.879 (95% confidence interval 0.802-0.956; P<0.001) and insignificant area under the curve for leptin or IR.
CONCLUSION
BMI, pretreatment high leptin levels, and IR are negative predictors for SVR and pretreatment low adiponectin levels are an independent positive predictor for SVR in HCVG4.
背景
丙型肝炎病毒（HCV）感染在全球范围内对健康有重大影响，是慢性肝病的重要原因。在埃及，HCV 高度流行（高达 15%的人口）；91%的患者感染基因型 4。寻找新的治疗反应预测因子对于降低现有治疗的成本和不良反应至关重要。
目的
本研究旨在阐明血清瘦素、脂联素和胰岛素抵抗（IR）作为丙型肝炎病毒基因型 4（HCV G4）治疗反应预测因子的有用性。
方法
纳入 100 例慢性 HCV G4 患者，他们是聚乙二醇干扰素α和利巴韦林治疗的候选者。确定年龄、性别和 BMI，并进行定量 HCV PCR、血清瘦素、脂联素、IR 以及治疗前肝脏谱和肝活检评估。
结果
男性与女性的比例为 68/32；患者的平均年龄为 40.9 ± 7.8 岁，BMI 为 28.3 ± 10 kg/m。56%的患者获得持续病毒学应答（SVR）。进行逻辑回归后，BMI[比值比（OR）6.5；P=0.004]、血清瘦素（OR 27.8；P ≤ 0.001）、天冬氨酸氨基转移酶（OR 1.06；P ≤ 0.001）、IR（OR 1.15；P ≤ 0.001）、组织学活动指数（OR 1.77；P=0.006）和纤维化（OR 2.93；P=0.001）是 SVR 的独立负预测因子，而血清脂联素（OR 0.74；P ≤ 0.001）是 SVR 的独立正预测因子。治疗前脂联素（截断值 13.75；灵敏度 92.86%；特异性 86.86%）的曲线下面积为 0.879（95%置信区间 0.802-0.956；P<0.001），而瘦素或 IR 的曲线下面积不显著。
结论
BMI、治疗前高瘦素水平和 IR 是 SVR 的负预测因子，而治疗前低脂联素水平是 SVR 的独立正预测因子，在 HCV G4 中。
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