Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt.
Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo 11566, Egypt.
World J Gastroenterol. 2022 Jun 14;28(22):2429-2436. doi: 10.3748/wjg.v28.i22.2429.
Many metabolic factors are associated with chronic hepatitis C virus (HCV) infection and can influence the course of the illness and impact the progression of liver and non-liver-related diseases through complex interactions. Several of these factors impact the course of chronic HCV (CHC) and result in the conceptual translation of CHC from a localized to systemic disease. Besides the traditional liver manifestations associated with CHC infection, such as cirrhosis and hepatocellular carcinoma, various extrahepatic disorders are associated with HCV infection, including atherosclerosis, glucose and lipid metabolic disturbances, alterations in the iron metabolic pathways, and lymphoproliferative diseases. The coexistence of metabolic disorders and CHC is known to influence the chronicity and virulence of HCV and accelerates the progression to liver fibrosis and hepatocellular carcinoma. Insulin resistance is one of the key factors that have a tremendous metabolic impact on CHC. Therefore, there is a great need to properly evaluate patients with CHC infection and correct the modifiable metabolic risk factors. Furthermore, patients with HCV who achieved a sustained virological response showed an overall improvement in glucose metabolism, but the exact evidence still requires further studies with long-term follow-up. This review delineates the most recent evidence on the main metabolic factors associated with CHC and the possible influence of chronic HCV infection on metabolic features.
许多代谢因素与慢性丙型肝炎病毒（HCV）感染有关，通过复杂的相互作用，这些因素会影响疾病的进程，并影响肝脏和非肝脏相关疾病的进展。其中一些因素会影响慢性丙型肝炎（CHC）的病程，并导致 CHC 从局部疾病向全身性疾病的概念转变。除了与 CHC 感染相关的传统肝脏表现，如肝硬化和肝细胞癌外，各种肝外疾病也与 HCV 感染相关，包括动脉粥样硬化、糖和脂质代谢紊乱、铁代谢途径的改变以及淋巴增生性疾病。已知代谢紊乱和 CHC 的共存会影响 HCV 的慢性和毒力，并加速向肝纤维化和肝细胞癌的进展。胰岛素抵抗是对 CHC 具有巨大代谢影响的关键因素之一。因此，非常有必要对 CHC 感染患者进行适当评估并纠正可改变的代谢危险因素。此外，获得持续病毒学应答的 HCV 患者的葡萄糖代谢整体得到改善，但确切证据仍需要进一步的长期随访研究。这篇综述阐述了与 CHC 相关的主要代谢因素的最新证据，以及慢性 HCV 感染对代谢特征的可能影响。
