γ-干扰素诱导蛋白-10 与慢性丙型肝炎：与胰岛素抵抗、组织学特征和持续病毒学应答的相关性。
Interferon-γ-inducible protein-10 in chronic hepatitis C: Correlations with insulin resistance, histological features & sustained virological response.
机构信息
Department of Hepatology, Regional Institute of Gastroenterology & Hepatology "Prof. Dr. Octavian Fodor"; Department of Internal Medicine, 3rd Medical Clinic, Iuliu Hatieganu University of Medicine & Pharmacy, Cluj-Napoca, Romania.
Department of Hepatology, Regional Institute of Gastroenterology & Hepatology "Prof. Dr. Octavian Fodor", Cluj-Napoca, Romania.
出版信息
Indian J Med Res. 2017 Apr;145(4):543-550. doi: 10.4103/ijmr.IJMR_1410_14.
BACKGROUND & OBJECTIVES: One of the multiple factors contributing to virological response in chronic hepatitis C (CHC) is interferon-gamma-inducible protein-10 (IP-10). Its level reflects the status of interferon-stimulated genes, which in turn is associated with virological response to antiviral therapy. The aim of this study was to evaluate the role of serum IP-10 levels on sustained virological response (SVR) and the association of this parameter with insulin resistance (IR) and liver histology.
METHODS
Two hundred and three consecutive biopsy proven CHC patients were included in the study. Serum levels of IP-10 were determined using ELISA method. IR was evaluated by homeostasis model assessment-IR (HOMA-IR). Histological features were assessed invasively by liver biopsy and noninvasively using FibroTest, ActiTest and SteatoTest. Predictive factors for SVR and their interrelations were assessed.
RESULTS
A cut-off value for IP-10 of 392 pg/ml was obtained to discriminate between responders and non-responders. SVR was obtained in 107 patients (52.70%). Area under the receiver operating characteristic curve for SVR was 0.875 with a sensitivity of 91.6 per cent, specificity 74.7 per cent, positive predictive value 80.3 per cent and negative predictive value 88.7 per cent. Higher values of IP-10 were associated with increasing stages of fibrosis (P<0.01) and higher grades of inflammation (P=0.02, P=0.07) assessed morphologically and noninvasively through FibroTest and ActiTest. Significant steatosis and IR were also associated with increased levels of IP-10 (P=0.01 and P=0.02). In multivariate analysis, IP-10 levels and fibrosis stages were independently associated with SVR.
INTERPRETATION & CONCLUSIONS: Our findings showed that the assessment of serum IP-10 level could be a predictive factor for SVR and it was associated with fibrosis, necroinflammatory activity, significant steatosis and IR in patients with chronic HCV infection.
背景与目的
导致慢性丙型肝炎（CHC）病毒学应答的多种因素之一是干扰素-γ诱导蛋白-10（IP-10）。其水平反映了干扰素刺激基因的状态，而这又与抗病毒治疗的病毒学应答相关。本研究旨在评估血清 IP-10 水平对持续病毒学应答（SVR）的作用，并探讨该参数与胰岛素抵抗（IR）和肝组织学之间的关系。
方法
本研究纳入了 203 例经肝活检证实的 CHC 连续患者。采用酶联免疫吸附法（ELISA）测定血清 IP-10 水平。通过稳态模型评估-IR（HOMA-IR）评估 IR。通过肝活检进行侵袭性评估，并使用 FibroTest、ActiTest 和 SteatoTest 进行非侵袭性评估。评估 SVR 的预测因素及其相互关系。
结果
获得了区分应答者和无应答者的 IP-10 截断值为 392pg/ml。107 例患者（52.70%）获得 SVR。SVR 的受试者工作特征曲线下面积为 0.875，敏感性为 91.6%，特异性为 74.7%，阳性预测值为 80.3%，阴性预测值为 88.7%。IP-10 水平越高，纤维化分期越高（P<0.01），形态学和非侵袭性评估的炎症程度越高（P=0.02，P=0.07，通过 FibroTest 和 ActiTest）。显著的脂肪变性和 IR 也与 IP-10 水平升高相关（P=0.01 和 P=0.02）。多变量分析显示，IP-10 水平和纤维化分期与 SVR 独立相关。
解释与结论
我们的研究结果表明，血清 IP-10 水平的评估可能是 SVR 的预测因素，与慢性 HCV 感染患者的纤维化、坏死性炎症活动、显著的脂肪变性和 IR 相关。
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