Ye Junzhao, Hu Xuan, Wu Tingfeng, Wu Yanqin, Shao Congxiang, Li Fuxi, Lin Yansong, Feng Shiting, Wang Wei, Zhong Bihui
1Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou, 510080 China.
2Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou, 510080 China.
Diabetol Metab Syndr. 2019 Jun 15;11:45. doi: 10.1186/s13098-019-0440-z. eCollection 2019.
Insulin resistance (IR) related metabolic disorders are associated with a worse prognosis of chronic hepatitis B virus (CHB) infection or nonalcoholic fatty liver disease (NAFLD). However, the relationships among CHB, steatosis, IR and metabolic factors remain controversial. The study aims to evaluate the impact of insulin resistance severity on metabolic profiles in patients with CHB, NAFLD and the coincidence of the two.
We conducted a cross-sectional study between January 2011 and December 2018 that included 2768 consecutive Chinese subjects (healthy controls: 667, CHB: 970, NAFLD: 878, CHB with NAFLD: 253). IR was determined with the homeostasis model assessment for insulin resistance (HOMA-IR). Metabolic measures included fasting serum insulin, glucose, lipid profiles and uric acid.
The prevalence of IR was increased in CHB with NAFLD subjects compared with that in control subjects or subjects with CHB or NAFLD alone (41.5% vs 2.9%/11.9%/36.9%, respectively; < 0.001). Within NAFLD and CHB with NAFLD group, the frequency of metabolic syndrome, hypertension and hyperuricemia increased as the HOMA-IR category increased ( for trend < 0.05). A higher risk for total cholesterol, low-density lipoprotein cholesterol and elevated alanine transaminase was observed with IR in the CHB with NAFLD group compared with that in the other groups, while no stepwise increase in hypertriglyceridemia was found in HOMA-IR in the CHB with NAFLD group.
Insulin resistance is highly prevalent in patients with CHB combined with NAFLD, and the increased metabolic risk, rather than hypertriglyceridemia, is driven by IR in CHB combined with NAFLD.
胰岛素抵抗（IR）相关的代谢紊乱与慢性乙型肝炎病毒（CHB）感染或非酒精性脂肪性肝病（NAFLD）的预后较差有关。然而，CHB、脂肪变性、IR和代谢因素之间的关系仍存在争议。本研究旨在评估胰岛素抵抗严重程度对CHB、NAFLD患者以及二者并存患者代谢谱的影响。
我们在2011年1月至2018年12月期间进行了一项横断面研究，纳入了2768名连续的中国受试者（健康对照：667名，CHB：970名，NAFLD：878名，CHB合并NAFLD：253名）。采用胰岛素抵抗稳态模型评估（HOMA-IR）来确定IR。代谢指标包括空腹血清胰岛素、血糖、血脂谱和尿酸。
与对照组或单独患有CHB或NAFLD的受试者相比，CHB合并NAFLD受试者的IR患病率更高（分别为41.5% vs 2.9%/11.9%/36.9%；<0.001）。在NAFLD组和CHB合并NAFLD组中，随着HOMA-IR类别增加，代谢综合征、高血压和高尿酸血症的发生率升高（趋势检验<0.05）。与其他组相比，CHB合并NAFLD组中IR患者的总胆固醇、低密度脂蛋白胆固醇和丙氨酸转氨酶升高的风险更高，而CHB合并NAFLD组中HOMA-IR的高甘油三酯血症没有逐步增加。
胰岛素抵抗在CHB合并NAFLD患者中高度普遍，CHB合并NAFLD患者的代谢风险增加是由IR驱动的，而非高甘油三酯血症。
