慢性丙型肝炎合并2型糖尿病患者临床特征及胰岛素抵抗对抗病毒疗效影响的Meta分析

Clinical features of patients with chronic hepatitis C with concomitant diabetes type 2 and impact of insulin resistance on efficacy of antiviral therapy: a Meta analysis

目的分析慢性丙型肝炎(CHC)合并2型糖尿病患者的临床特征及胰岛素抵抗(IR)对干扰素治疗CHC患者临床疗效的影响。方法应用计算机检索Pub Med、Ovid、Science Direct、Embase、万方、维普数据库1970年至2015年1月发表的关于CHC合并2型糖尿病的临床特征及IR与CHC抗病毒治疗效果关系的文献。应用Rev Man 5.2软件进行Meta分析。结果本研究纳入22篇合格文献,全部为英文文献。关于CHC合并2型糖尿病临床特征文献11篇,IR对干扰素治疗CHC病毒学应答产生影响文献11篇;CHC合并2型糖尿病患者的年龄、体质指数(BMI)显著高于单纯CHC或单纯糖尿病患者[P=0.0001,SMD=0.30,95%CI(0.15,0.45),P=0.04,SMD=0.17,95%CI(0.01,0.34)],CHC合并2型糖尿病患者糖尿病家族史显著多于单纯CHC或单纯糖尿病患者[P=0.01,RR=1.07,95%CI(1.02,1.13)];CHC合并2型糖尿病患者感染HCV基因1型的比例显著低于单纯CHC患者[P=0.01,RR=0.82,95%CI(0.71,0.95)],但两组感染2型或3型比例无显著性差异[P=0.25,RR=1.16,95%CI(0.90,1.50),P=0.92,RR=1.06,95%CI(0.30,3.78)]);干扰素治疗CHC患者获得非持续病毒学应答(NSVR)组HOMA-IR水平和IR发生率显著高于获得持续病毒学应答(SVR)组[P<0.0001,SMD=0.80,95%CI(0.63,0.97),P<0.0001,OR=2.0,95%CI(1.59,2.52)]。结论 CHC合并2型糖尿病患者临床特征为高龄、高BMI水平和多伴有糖尿病家族史。感染基因1型CHC患者合并2型糖尿病机会小,而合并IR会降低干扰素抗病毒治疗后SVR发生率,是影响干扰素治疗CHC疗效的重要不利因素之一。

Objective To investigate the clinical characteristics of patients with chronic hepatitis C（CHC） with concomitant type 2 diabetes and to assess the impact of insulin resistance （IR） on sustained virological response （SVR） in patients with hepatitis C to treatment of intefferon-ct（IFN-α）. Methods A systematic search of electronic databases for randomized clinical trials in Pubmed,Ovid,Science Direet,Embase,Wanfang database and VIP database from 1970 to January,2015 was done as respect to clinical features of CHC with type 2 diabetes,and the correlation between IR and SVR. The Meta analysis was performed by using the RevMan 5.2 software. Result Twenty-two papers published in English were retrieved in this study,with eleven on CHC with type two diabetes,and eleven on IR impacting response to IFN-α therapy. Patients with CHC and type 2 diabetes had older age and higher BMI than in patients with CHC or diabetes alone [P=0.0001,SMD=0.30,95%CI （0.15,0.45）,P=0.04,SMD=0.17,95%CI （0.01,0.34）];More patients with CHC and type 2 diabetes had family history of diabetis than in patients with CHC or diabetes alone [P=0.01,RR=1.07,95%CI （1.02,1.13）];The incidence of genotype 1 infection in CHC patients with type 2 diabetes was significantly lower than in that of CHC alone[P=0.01,RR=O.82,95%CI（0.71,0.95）],while there was no significant differences as respect of genotypes 2/3 infection in the two groups [P =0.25,RR = 1.16,95% CI （0.90, 1.50）,P =0.92,RR =1.06,95% CI （0.30,3.78）];The incidence of IR was higher in CHC patients with non-sustained virological response （NSVR） to interferon-α therapy than in those who got SVR [P〈0.0001,SMD=0.80,95%CI（0.63,0.97）,P〈0.0001,OR=2.0,95%CI （1.59,2.52）]. Conclusions Patients with CHC and type 2 diabetes tends to be elderly with higher BMI levels and much more family history of diabetes. IR is associated with a lower SVR in CHC patients receiving IFN-α therapy.