Sustained virological response prevents the development of insulin resistance in patients with chronic hepatitis C

被引:87
作者
Aghemo, Alessio [1 ]
Prati, Gian Maria [1 ]
Rumi, Maria Grazia [2 ]
Soffredini, Roberta [1 ]
D'Ambrosio, Roberta [1 ]
Orsi, Emanuela [3 ]
De Nicola, Stella [1 ]
Degasperi, Elisabetta [1 ]
Grancini, Valeria [3 ]
Colombo, Massimo [1 ]
机构
[1] Univ Milan, AM Migliavacca Ctr Liver Dis, Div Gastroenterol 1, Fdn IRCCS Ca Granda,Osped Maggiore Policlin, I-20122 Milan, Italy
[2] Univ Milan, Liver Unit, San Giuseppe Hosp, I-20122 Milan, Italy
[3] Univ Milan, Endocrinol & Diabetol Unit, Osped Maggiore Policlin, Fdn IRCCS Ca Granda, I-20122 Milan, Italy
关键词
HOMEOSTASIS MODEL ASSESSMENT; VIRUS-INFECTION; PLUS RIBAVIRIN; HCV INFECTION; IMPACT; DETERMINANTS; ASSOCIATION; SENSITIVITY; GENOTYPE-1; STEATOSIS;
D O I
10.1002/hep.25867
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Hepatitis C virus (HCV) infection is associated with insulin resistance (IR), which is a condition known to influence the progression of liver fibrosis and the response to pegylated interferon (PEG-IFN)/ribavirin (RBV) therapy. We aimed to assess whether a sustained virological response (SVR) after antiviral therapy prevents the development of IR in the long term. Members of the Milan Safety Tolerability study cohort, who received PEG-IFNa2a/RBV or PEG-IFNa2b/RBV, underwent a homeostasis model assessment (HOMA) at the baseline and 24 months after treatment completion. For all patients (n = 431), a liver biopsy sample was scored for grading, staging (Ishak), and steatosis. At the baseline, IR (HOMA value > 2) was detected in 48 patients (12%), and it was associated with body weight (P = 0.03), an HCV load < 0.6 x 10(6) IU/L (P = 0.006), fibrosis staging >= 4 (P = 0.01), and moderate to severe steatosis (P = 0.03). IR did not influence the rates of end-of-treatment response (75% versus 69%, P = 0.4), SVR (63% versus 60%, P = 0.8), or relapse (19% versus 24%, P = 0.5). After treatment, IR developed in 49 of the 384 nondiabetic patients (14%). Although the mean baseline and posttreatment HOMA values were similar in SVR patients (1.11 +/- 0.8 versus 1.18 +/- 1.1, P = 0.25), patients experiencing treatment failure showed a significant increase in the mean HOMA value at the follow-up visit (1.20 +/- 0.85 versus 1.49 +/- 1.3, P = 0.007), and there was an increased rate of de novo IR in non-SVR patients versus SVR patients (17% versus 7%, P = 0.007). According to a logistic regression analysis, treatment failure (odds ratio = 2.81, 95% confidence interval = 1.39-5.67, P = 0.004) and a 10% body mass index increase (odds ratio = 6.42, 95% confidence interval = 1.69-24.3, P = 0.006) were significantly associated with the development of de novo IR. Conclusion: In nondiabetic patients with chronic HCV, the achievement of SVR with PEG-IFN and RBV prevents the development of de novo IR. (HEPATOLOGY 2012;56:16811687)
引用
收藏
页码:1681 / 1687
页数:7
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