Hepato-gastroenterology · 2008
Association of insulin resistance with hepatic steatosis and progression of fibrosis in Chinese patients with chronic hepatitis C.
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Chu Chi-Jen, Hung Tsung-Hsing, Hwang Shinn-Jang, Wang Yuan-Jen, Yang Ching-Fen, Lin Han-Chieh, Lee Fa-Yauh, Lu Rei-Hwa, Chang Chiao-Yu, Chang Full-Young, Lee Shou-Dong
Аннотация
BACKGROUND/AIMS: To investigate the relationships between insulin resistance, hepatic steatosis, and fibrosis in consecutive non-diabetic Chinese CHC patients with biopsy results.
METHODOLOGY: A total of 192 patients were enrolled. Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR). Steatosis was assessed as the percentage of hepatocytes containing macrovesicular fat droplets and degree of hepatic fibrosis was graded by the METAVIR scoring system.
RESULTS: As compared with no steatosis group, patients with hepatic steatosis had significantly higher BMI (24.5+/-0.4 vs. 22.3+/-0.3 kg/m2, p<0.001) and HOMA-IR value (3.04+/-0.15 vs. 2.41+/-0.13, p=0.002). Patients with F3-F4 fibrosis had significantly lower ALT/AST ratio (1.38+/-0.06 vs. 1.76+/-0.05, p=0.022), lower platelet count (155+/-6 vs. 207+/-5 x 1000/cumm, p<0.001), and higher HOMA-IR value (3.29+/-0.17 vs. 2.50+/-0.12, p<0.001) as compared with F1-F2 fibrosis group. In addition, mean HOMA-IR progressively elevated along with the severity of hepatic fibrosis (F1: 2.04+/-0.15, F2: 2.77+/-0.17, F3: 3.11+/-0.25, F4: 3.46+/-0.23). Multivariate analyses showed platelet count <150,000/cumm (odds ratio: 3.88, 95% C.I.=2.87-12.05, p<0.001) and HOMA-IR >2.5 (odds ratio: 2.46, 95% C.I.=1.24-4.90, p=0.010) as independent factors associated with F3-F4 fibrosis.
CONCLUSIONS: In Chinese CHC patients, insulin resistance can occur in earlier stage of infection and closely related with hepatic steatosis and fibrosis.
METHODOLOGY: A total of 192 patients were enrolled. Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR). Steatosis was assessed as the percentage of hepatocytes containing macrovesicular fat droplets and degree of hepatic fibrosis was graded by the METAVIR scoring system.
RESULTS: As compared with no steatosis group, patients with hepatic steatosis had significantly higher BMI (24.5+/-0.4 vs. 22.3+/-0.3 kg/m2, p<0.001) and HOMA-IR value (3.04+/-0.15 vs. 2.41+/-0.13, p=0.002). Patients with F3-F4 fibrosis had significantly lower ALT/AST ratio (1.38+/-0.06 vs. 1.76+/-0.05, p=0.022), lower platelet count (155+/-6 vs. 207+/-5 x 1000/cumm, p<0.001), and higher HOMA-IR value (3.29+/-0.17 vs. 2.50+/-0.12, p<0.001) as compared with F1-F2 fibrosis group. In addition, mean HOMA-IR progressively elevated along with the severity of hepatic fibrosis (F1: 2.04+/-0.15, F2: 2.77+/-0.17, F3: 3.11+/-0.25, F4: 3.46+/-0.23). Multivariate analyses showed platelet count <150,000/cumm (odds ratio: 3.88, 95% C.I.=2.87-12.05, p<0.001) and HOMA-IR >2.5 (odds ratio: 2.46, 95% C.I.=1.24-4.90, p=0.010) as independent factors associated with F3-F4 fibrosis.
CONCLUSIONS: In Chinese CHC patients, insulin resistance can occur in earlier stage of infection and closely related with hepatic steatosis and fibrosis.