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INSULIN RESISTANCE REDUCTION AFTER SUSTAINED VIROLOGICAL RESPONSE WITH DIRECT ACTING ANTIVIRAL:NOT EVERY POPULATION IMPROVES

机译:胰岛素抗性在直接代理抗病里持续的病毒学反应后降低:不是每一个人口都会改善

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摘要

ABSTRACT BACKGROUND: Hepatitis C virus (HCV) infection is a serious public health problem, that affects approximately 170 million people worldwide. Chronic HCV infection is associated with hepatic insulin resistance and an increased risk of diabetes HCV-infected patients has been well documented. OBJECTIVE: To assess the homeostasis model assessment of insulin resistance (HOMA-IR) index in patients treated with direct acting antiviral (DAAs) medication in the sustained virological response (SVR), categorized by the presence or absence of cirrhosis. METHODS: A prospective study was conducted. Data were collected at the beginning of treatment (t-base) and in the twelfth week after the completion of treatment (t-SVR12). The inclusion criteria were presence of: HCV infection (RNA-HCV positive), age ≥18 years, completion of DAAs’ therapy, and presence of diabetes with use of oral hypoglycemic agents. All samples were collected during the study period. The exclusion criteria were: presence of HBV/HIV co-infection, hepatocellular carcinoma at baseline, diabetic patients taking insulin and transplanted patients (liver/kidney). Fibrosis was assessed by hepatic elastography or biopsy (METAVIR). Cirrhosis was determined by clinical results or imaging. HOMA-IR was calculated as fasting insulin (μU/mL) × fasting glucose (mmol/L)/22.5) The patients were divided into two groups: the general study population (all patients, including the diabetic patients) and the special population (patients with normal values of HOMA-IR, which is >2.5, and without diabetes). The delta HOMA-IR value was calculated as: HOMA-IR at t-base - HOMA-IR at t-SVR12. For the descriptive statistical analysis, the paired t-test and generalized linear model assuming the log binding function were performed. A P value of < 0.05 was considered significant. RESULTS: We included 150 patients, and 75 were cirrhotic. The mean age was 55.3±9.97 and body mass index was 27.4±5.18. Twenty-two (14.67%) were diabetic patients using oral hypoglycemic agents, and 17 (11%) were cirrhotic. In the general study population, the mean glucose and HOMA-IR values increased at t-SVR12, but insulin decreased. Delta HOMA-IR was negative at t-SVR12, but there was no significant difference. Excluding diabetic patients and those with normal HOMA-IR values (<2.5), mean glucose, insulin and HOMA-IR decreased at t-SVR12. Delta HOMA-IR decreased significantly at t-SVR12 (P: 0.02). CONCLUSION: In the general population, glucose and HOMA-IR values increased at t-SVR12, but insulin decreased. In the special population, glucose, insulin, HOMA-IR and Delta HOMA-IR decreased at t-SVR12.
机译:摘要背景:丙型肝炎病毒(HCV)感染是一个严重的公共卫生问题,这影响全世界约有1.7亿人。慢性HCV感染与肝胰岛素抵抗有关,并且糖尿病HCV感染患者的风险增加已得到充分的记录。目的:评估胰岛素抵抗(HOMA-IR)指数在持续的病毒学响应(SVR)中治疗患者胰岛素抵抗(HOMA-IR)指数的稳态模型评估,由肝硬化的存在或不存在分类。方法:进行了预期研究。在治疗开始时和治疗完成后的第十二周(T-SVR12)开始,收集数据。纳入标准是存在的:HCV感染(RNA-HCV阳性),年龄≥18岁,完成DAAS的治疗,以及使用口服降糖剂的糖尿病。在研究期间收集所有样品。排除标准是:HBV / HIV的存在,基线肝细胞癌,糖尿病患者服用胰岛素和移植患者(肝脏/肾)。通过肝弹性造影或活组织检查评估纤维化(Metavir)。肝硬化是通过临床结果或成像确定的。 HOMA-IR计算为空腹胰岛素(μU/ mL)×空腹葡萄糖(MMOL / L)/22.5)患者分为两组:一般研究人群(所有患者,包括糖尿病患者)和特殊人口( HOMA-IR正常值的患者,即> 2.5,没有糖尿病)。 Delta HOMA-IR值计算为:在T-Base的HOMA-IR - T-SVR12处的HOMA-IR。对于描述性统计分析,执行假设日志绑定功能的配对T检验和广义线性模型。 p值<0.05被认为是显着的。结果:我们包括150名患者,75名是Cirrhotic。平均年龄为55.3±9.97,体重指数为27.4±5.18。二十二(14.67%)是使用口服降糖剂的糖尿病患者,17例(11%)是肝硬化的。在一般性研究人群中,平均葡萄糖和HOMA-IR值在T-SVR12增加,但胰岛素降低。 Delta HOMA-IR在T-SVR12阴性阴性,但没有显着差异。不包括糖尿病患者和具有正常HOMA-IR值(<2.5)的那些,平均葡萄糖,胰岛素和HOMA-IR在T-SVR12下降。 Delta HOMA-IR在T-SVR12下显着减少(P:0.02)。结论:在一般人群中,葡萄糖和HOMA-IR值在T-SVR12增加,但胰岛素降低。在特殊人群中,葡萄糖,胰岛素,HOMA-IR和DELTA HOMA-IR在T-SVR12下降。

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