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首页> 外文期刊>Gut: Journal of the British Society of Gastroenterology >Insulin resistance and geographical origin: major predictors of liver fibrosis and response to peginterferon and ribavirin in HCV-4.
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Insulin resistance and geographical origin: major predictors of liver fibrosis and response to peginterferon and ribavirin in HCV-4.

机译：胰岛素抵抗和地理起源：HCV-4中肝纤维化以及对聚乙二醇干扰素和利巴韦林反应的主要预测因子。

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BACKGROUND AND AIMS: Hepatitis C virus (HCV) genotype 4 (HCV-4) is increasing in prevalence in Western countries. However, little is known about the severity of the disease and response to treatment. The aim of this study was to assess the predictors (logistic regression) of severe fibrosis (METAVIR score F3-F4), and sustained virological response (SVR) to peginterferon and ribavirin in 226 consecutive HCV-4 patients (Egyptians 40%, Europeans 35% and Africans 24%). PATIENTS AND METHODS: Insulin resistance was assessed using the homeostasis model (HOMA-IR). Serum HCV-RNA level (bDNA) and subtypes of HCV (LiPA) were determined for all patients. RESULTS: Insulin resistance (HOMA-IR >3) was present in 105 patients (46%), and was associated with: age >45 years (OR, 2.614; 95% CI, 1.316 to 5.194), body mass index (BMI) >25 kg/m(2) (OR, 2.105; 95% CI, 1.048 to 4.229), serum HCV-RNA >800 000 IU/ml (OR, 3.143; 95% CI, 1.503 to 6.574), severe fibrosis (OR, 2.657; 95% CI, 1.214 to 5.818), and steatosis >30% (OR, 2.488; 95% CI, 1.105 to 5.602). Severe fibrosis was present in 67 patients (29%) and was associated with Egyptian origin (OR, 5.872; 95% CI, 2.747 to 12.553), excessive alcohol intake (OR, 5.311; 95% CI, 1.287 to 21.924), and HOMA-IR >3 (OR, 3.864; 95% CI, 1.859 to 8.034). 108 patients received a 48 week course of peginterferon plus ribavirin. SVR (undetectable serum HCV-RNA (TMA) 24 weeks after treatment stopping) was achieved in 59 patients (55%) and was associated with Egyptian origin (OR, 13.119; 95% CI, 3.089 to 55.706), HOMA-IR <2 (OR, 5.314; 95% CI, 1.953 to 14.459), and non-severe fibrosis (OR, 8.059; 95% CI, 2.512 to 25.855). CONCLUSION: Insulin resistance and geographical origin are major predictors of liver fibrosis and response to peginterferon and ribavirin in HCV-4 patients. Insulin resistance is frequently encountered in these patients, and correlated independently with serum HCV-RNA.
机译：背景与目的：在西方国家，丙型肝炎病毒（HCV）基因型4（HCV-4）的发病率正在增加。但是，关于疾病的严重程度和对治疗的反应知之甚少。这项研究的目的是评估226例连续HCV-4患者中严重纤维化（METAVIR评分F3-F4）和对聚乙二醇干扰素和利巴韦林的持续病毒学应答（SVR）的预测因子（逻辑回归）（埃及40％，欧洲人35 ％和非洲人24％）。患者和方法：使用稳态模型（HOMA-IR）评估胰岛素抵抗。确定所有患者的血清HCV-RNA水平（bDNA）和HCV亚型（LiPA）。结果：105例患者（46％）存在胰岛素抵抗（HOMA-IR> 3），并与年龄> 45岁（OR，2.614; 95％CI，1.316至5.194），体重指数（BMI）相关> 25 kg / m（2）（OR，2.105; 95％CI，1.048至4.229），血清HCV-RNA> 800000 IU / ml（OR，3.143; 95％CI，1.503至6.574），严重纤维化（OR ，2.657; 95％CI，1.214至5.818）和脂肪变性> 30％（OR，2.488; 95％CI，1.105至5.602）。严重纤维化存在于67位患者中（29％），并与埃及血统（OR，5.872; 95％CI，2.747至12.553），过量饮酒（OR，5.311; 95％CI，1.287至21.924）和HOMA相关-IR> 3（OR，3.864; 95％CI，1.859至8.034）。 108名患者接受了聚乙二醇干扰素加利巴韦林治疗48周的疗程。 SVR（停止治疗后24周未检测到血清HCV-RNA（TMA））达到59例患者（55％），并且与埃及血统相关（OR为13.119; 95％CI为3.089至55.706），HOMA-IR <2 （OR，5.314; 95％CI，1.953至14.459）和非严重纤维化（OR，8.059; 95％CI，2.512至25.855）。结论：胰岛素抵抗和地理起源是HCV-4患者肝纤维化以及对聚乙二醇干扰素和利巴韦林反应的主要预测指标。这些患者经常遇到胰岛素抵抗，并且与血清HCV-RNA独立相关。

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