Hospital Nossa Senhora das Graças, Departamento de Gastroenterologia e Hepatologia, Curitiba, PR, Brasil.
Arq Gastroenterol. 2020 Jul-Sep;57(3):267-271. doi: 10.1590/S0004-2803.202000000-50.
Chronic hepatitis C still figures as an important cause of morbidity among the Brazilian population, and is closely associated with metabolic disturbances, including insulin resistance (IR), which can be evaluated by the Homeostatic Model Assessment (HOMA-IR). IR may entail lower sustained virologic response (SVR) on certain therapeutic regimens and faster progression to advanced hepatic fibrosis. With the arrival of the direct acting agents (DAA) in hepatitis C treatment, there is an increased need in observing the impact in patients' IR profile while using such therapies.
We included patients older than 18 from two tertiary care in Curitiba - PR, of both sexes, with chronic hepatitis C, treated with DAA, from July 2015 to September 2017. We also evaluated the patients' levels of fasting insulin, fasting glucose and glycated hemoglobin before starting treatment and 12 months after finishing it. We also used epidemiologic data, such as age, sex, hepatic fibrosis degree, body mass index, abdominal circumference, viral genotype and the presence of diabetes mellitus before and after treatment. IR was assessed before and after treatment and calculated by the HOMA-IR score. Insulin resistance was defined by a HOMA-IR greater than 2.5. We excluded patients who lost follow-up, those who did not achieve SRV and those who did not have a laboratory profile. The results of quantitative variables were described by means, medians, and standard deviations. P values <0.05 indicated statistical significance.
We included 75 patients in this study, with a mean age of 55.2 years and 60% of males. Forty-three patients had advanced fibrosis. Twenty one (28%) had a previous diabetes mellitus diagnosis. We identified 31 (41.3%) patients with IR before antiviral treatment, and this number increased to 39 (52%) after 12 months of finishing treatment, according to HOMA-IR. There was no statistic difference between insulin, glucose and HOMA-IR measurements before and after curing hepatitis C. We observed a weight gain in patients shortly after curing hepatitis C, but this did not persist at the end of the study. We also had no significant difference in IR prevalence when viral genotype was concerned.
In this study, there was no statistically significant difference between HOMA-IR results in patients before and 12 months after treatment for hepatitis C. Even though patients gained weight after the cure, this was not statistically significant after a year (P=0.131).
慢性丙型肝炎仍然是巴西人口发病的重要原因之一，并且与代谢紊乱密切相关，包括胰岛素抵抗（IR），可以通过稳态模型评估（HOMA-IR）进行评估。IR 可能会导致某些治疗方案的持续病毒学应答（SVR）降低，并且更快地进展为晚期肝纤维化。随着直接作用抗病毒药物（DAA）在丙型肝炎治疗中的应用，在使用此类治疗方法时，观察患者 IR 谱的影响的需求增加了。
-1）比较丙型肝炎慢性患者在接受 DAA 治疗前后 HOMA-IR 的结果，并在完成治疗后 12 个月达到 SVR。2）评估丙型肝炎治愈后体重的变化。
我们纳入了来自巴西库里蒂巴的两家三级保健机构的年龄大于 18 岁的慢性丙型肝炎患者，男女不限，接受 DAA 治疗，时间为 2015 年 7 月至 2017 年 9 月。我们还评估了患者治疗前和治疗后 12 个月的空腹胰岛素、空腹血糖和糖化血红蛋白水平。我们还使用了流行病学数据，例如治疗前后的年龄、性别、肝纤维化程度、体重指数、腰围、病毒基因型和糖尿病存在情况。治疗前后通过 HOMA-IR 评分评估 IR。HOMA-IR 大于 2.5 定义为胰岛素抵抗。我们排除了失去随访的患者、未达到 SVR 的患者和未进行实验室检查的患者。定量变量的结果用平均值、中位数和标准差描述。P 值<0.05 表示具有统计学意义。
本研究共纳入 75 例患者，平均年龄为 55.2 岁，男性占 60%。43 例患者有晚期纤维化。21 例（28%）有糖尿病既往诊断。我们发现 31 例（41.3%）患者在抗病毒治疗前存在 IR，根据 HOMA-IR，这一数字在治疗 12 个月后增加到 39 例（52%）。丙型肝炎治愈前后胰岛素、葡萄糖和 HOMA-IR 测量值之间无统计学差异。我们观察到丙型肝炎治愈后患者体重增加，但在研究结束时没有持续。当涉及病毒基因型时，我们也没有发现 IR 患病率的显著差异。
在这项研究中，丙型肝炎患者治疗前后的 HOMA-IR 结果之间没有统计学差异。尽管患者在治愈后体重增加，但一年后这并没有统计学意义（P=0.131）。
