维持性血液透析患者丙型肝炎病毒感染对胰岛素抵抗、动脉粥样硬化的影响

The influence of hepatitis C virus infection on insulin resistance and atherosclerosis in maintenance hemodialysis patients

目的探讨丙型肝炎病毒(HCV)感染对维持性血液透析(MHD)患者胰岛素抵抗、微炎症及动脉粥样硬化的影响。方法 HCV(+)组和HCV(-)组患者各24例,比较两组患者血压、体重指数、胰岛素抵抗指数(HOMA-IR)、超敏C反应蛋白(hsCRP)、颈动脉内膜中层厚度(IMT)、心脏彩超及生化指标。结果两组患者在年龄、性别、透析龄、原发病、BMI、血压、血红蛋白、白蛋白、高密度脂蛋白、Ca^(2+)、P^(3-)、iPTH、胰岛素、HOMA-IR、IMT、颈动脉斑块比例、左室射血分数、左室重量指数差异无显著性;HCV(+)组血清总胆固醇、甘油三酯、低密度脂蛋白较HCV(-)组显著下降;ALT、AST、hsCRP、hsCRP>4mg/dl的比例显著升高。结论本研究表明MHD患者合并HCV感染导致血TG、LDL、Tch显著下降;ALT、AST、hsCRP、hsCRP>4mg/dl的比例显著升高,但对胰岛素抵抗、动脉粥样硬化影响差异无显著性。

Objective To study the influence of hepatitis C virus infection on insulin resistance, inflammation and atherosclerosis in maintenance hemodialysis patients. Methods In a cohort of 48 MHD patients, positive anti-HCV antibody was found in 24 patients and negative anti-HCV antibody was found in the remaining 24 patients. Insulin resistance was assessed by HOMA-IR. The intima thickness of carotid artery （ IMT）, left ventricular ejection fraction （ LVEF）, left ventricular mass index （LVMI） were measured by ultrasonography. Serum hemoglobin, albumin, blood lipid,AST,ALT,iPTH and high sensitive C-reactive protein（hsCRP） were examined by routine methods. Results there were no differences found in age, gender, body mass index（BMI） , primary disease, duration of dialysis, smoking status, blood pressure, hemoglobin, albumin, HDL cholesterol, Ca^2＋ , P^3- , iPTH between anti-HCV-positive and anti-HCV-negative groups. Tch,TG,LDL were significantly lower in anti-HCV-positive patients than in anti-HCV- negative patients. ALT, AST, hsCRP and percent of hsCRP 〉 4mg/dl were significantly higher in anti-HCV antibody patients than in negative patients. Conclusion In MHD patients, HCV infection could make serum Tch,TG, LDL decrease significantly and serum ALT, AST, hsCRP, percent of hsCRP 〉 4mg/dl increase significantly. But we could not found the association between HCV infection and insulin resistance and atherosclerosis in this study.