脂肪肝及其相关因素对联合抗病毒治疗慢性丙型肝炎效果的影响

The impact of fatty liver and its related factors on the efficacy of antiviral therapy in patients with chronic hepatitis C

目的研究脂肪肝等相关因素对慢性丙型肝炎联合抗病毒治疗效果的影响。方法应用聚乙二醇干扰素α-2a联合利巴韦林治疗98例慢性丙型肝炎患者,酶免疫法检测HCV基因型,B型超声诊断脂肪肝,计算患者体质指数、腰臀比、胰岛素抵抗稳态评估模型指数(HOMA-IR),PCR法检测HCV RNA水平.化学发光仪检测血清胰岛素水平。多元逻辑回归等方法分析脂肪肝及其相关因素对抗病毒疗效的影响。结果98例患者中,HCV基因型1型35例、2型41例、3型13例、未分型9例,分别占35.7%、41.8%、13.3%和9.1%。脂肪肝在HCV基因型1型、2型、3型、未分型的比例分别为11.4%、9.8%、38.5%和11.1%(X^2=7.83,P<0.05)。在多因素分析中,抗病毒疗效与体质指数(P=0.011)、腰臀比(P=0.024)、脂肪肝(P=0.028)、基因型(P=0.037)、胰岛素水平(P=0.001)和HOMA-IR(P=0.002)呈显著相关。多元逻辑回归分析显示,胰岛素水平(OR= 7.933,P=0.001)和HOMA-IR(OR=5.995,P=0.015)是预测抗病毒疗效的独立因素。结论脂肪肝在基因3型患病率明显高于其他基因型。体质指数、腰臀比、脂肪肝、基因型、胰岛素水平和HOMA-IR可影响慢性丙型肝炎抗病毒疗效。胰岛素水平和HOMA-IR是预测抗病毒疗效的独立因素。

Objective To investigate the impact of fatty liver and its related factors on the efficacy of antiviral therapy in patients with chronic hepatitis C. Methods ninety-eight patients with chronic hepatitis C were treated with 180 μg peginterferon α-2a plus ribavirin. Hepatitis C virus （HCV） genotypes were measured by enzyme-linked immunosorbent assay （ELISA） and fatty liver were detected by ultra sonography. The body mass index （BMI）, waist to hip ratio （WHR） and homeostasis model assessment of insulin resistance （HOMA-IR） were calculated. The serum HCV RNA level was determined by polymerase chain reaction （PCR） and serum insulin level was detected by chemiluminescence analysis. The impact of fatty liver and its related factors on the efficacy of antiviral therapy were analyzed by multivariate Logistic regression analysis. Results Of 98 patients with chronic hepatitis C, 35 （35.7%） were genotype 1, 41 （41.8%） were genotype 2, 13 （13.3%） were genotype 3, 9 （9. 1%） were undetermined genotype. genotype 1, 2, 3 and undetermined genotype was The incidence of fatty liver in HCV infection of 11.4%, 9.8%, 38.5% and 11.1%, respectively （X^2 = 7.83, P = 0.05）. With multivariate analysis, the efficacy of antiviral therapy was significantly associated with BMI （P = 0. 011）, WHR （P = 0. 024）, the level of serum insulin （P = 0. 001）, genotype （P = 0. 037）, the fatty liver （P = 0. 028） and HOMA-IR （P= 0. 002）. The multivariate regression analysis showed that the serum insulin levels （OR = 7. 933, P = 0. 001）and HOMA-IR （OR= 5. 995, P= 0. 015） were independent predictor to the efficacy of antiviral therapy. Conclusions The incidence of fatty liver in HCV genotype 3 infection is significantly higher than that in other genotypes. The BMI, WHR, the level of serum insulin, genotype, fatty liver and HOMA-IR are associated with the efficacy of antiviral therapy. The level of serum insulin and HOMA-1R are independent factors for predicting the effect of antiviral therapy.