Department of Emergency and Organ Transplantation, University of Bari, Hospital Policlinico, Bari, Italy.
Am J Gastroenterol. 2013 Jul;108(7):1108-11. doi: 10.1038/ajg.2013.90. Epub 2013 Apr 9.
The relationship between hepatitis C virus (HCV) infection and type 2 diabetes mellitus (DM 2) is still uncertain. The objective of this study was to evaluate the association between HCV infection, measured as positivity to anti-HCV antibodies, and the incidence of DM 2 in a cohort of subjects sampled from the general population and followed up for 20 years.
At baseline, the cohort consisted of a random sample of 2,472 subjects (72% response rate, age range 30-69 years) from the electoral register of a town in Southern Italy. The cohort subjects were examined three times: in 1985 (M1), in 1992 (M2), and in 2005 (M3). At M1, M2, and M3, each participant filled in a questionnaire and had a blood sample taken to measure blood glucose and other serum variables including glutamic pyruvic alanine aminotransferase (ALT). Anti-HCV antibodies were analyzed with standard techniques at M1 and M2. Diabetes type 2 diagnosis was a history of diabetes and/or serum glucose ≥126 mg/dl and/or treatment with insulin or hypoglycemic drugs. Logistic regression was used for multivariable data analysis.
Diabetes prevalence was higher in subjects with positive anti-HCV antibodies at M1 and M2, and diabetes incidence was higher in subjects with baseline positive anti-HCV antibodies at M1-M2 and lower at M2-M3. In multivariable models, controlling for gender, age, and body mass index (BMI), there was no association between incident cases of diabetes and positive anti-HCV antibodies at baseline, either at M1-M2 (odds ratio (OR) 0.73, 95% confidence interval (CI) 0.43-1.22) or at M2-M3 (0.65, 0.41-1.04). HCV was associated with DM 2 only in subjects with elevated ALT (OR 0.58, 95% CI 0.31-1.08, if ALT normal; OR 1.47, 95% CI 1-2.16, if ALT elevated, controlling for age, gender, and BMI).
Our findings, in a cohort study at population level, support an association between the presence of anti-HCV antibodies at baseline and a higher incidence of type 2 diabetes in the following 20 years only in subjects with elevated ALT.
丙型肝炎病毒（HCV）感染与 2 型糖尿病（DM 2）之间的关系仍不确定。本研究的目的是评估在一项来自意大利南部一个城镇的随机人群样本中，以抗 HCV 抗体阳性来衡量 HCV 感染与 DM 2 发生率之间的关系，并对该队列进行了 20 年的随访。
在基线时，该队列由意大利南部一个城镇的选民登记册中的 2472 名受试者（72%的应答率，年龄在 30-69 岁之间）组成。对队列受试者进行了三次检查：1985 年（M1）、1992 年（M2）和 2005 年（M3）。在 M1、M2 和 M3 时，每位参与者填写一份问卷并采集血样以测量血糖和其他血清变量，包括谷氨酸丙酮酸丙氨酸氨基转移酶（ALT）。在 M1 和 M2 时，采用标准技术分析抗 HCV 抗体。2 型糖尿病的诊断是糖尿病病史和/或血清葡萄糖≥126mg/dl 和/或胰岛素或降血糖药物治疗。多变量数据分析采用 logistic 回归。
在 M1 和 M2 时抗 HCV 抗体阳性的受试者中，糖尿病的患病率较高，而在 M1-M2 时有基线抗 HCV 抗体阳性的受试者中，糖尿病的发病率较高，而在 M2-M3 时则较低。在多变量模型中，控制性别、年龄和体重指数（BMI）后，基线时抗 HCV 抗体阳性与新发糖尿病病例之间无关联，无论是在 M1-M2 时（比值比（OR）0.73，95%置信区间（CI）0.43-1.22）还是在 M2-M3 时（0.65，0.41-1.04）。只有在丙氨酸氨基转移酶（ALT）升高的受试者中，HCV 才与 DM 2 相关（ALT 正常时，OR 0.58，95%CI 0.31-1.08；ALT 升高时，OR 1.47，95%CI 1-2.16，控制年龄、性别和 BMI）。
在人群水平的队列研究中，我们的发现支持在接下来的 20 年中，基线时存在抗 HCV 抗体与 2 型糖尿病的发生率较高之间存在关联，但仅在 ALT 升高的受试者中存在这种关联。
