直接抗病毒药物对慢性丙型肝炎合并2型糖尿病老年患者糖代谢的影响

Impact of direct-acting antiviral agents on glycometabolism in elderly patients with chronic hepatitis C and type 2 diabetes mellitus

目的 观察慢性丙型肝炎合并2型糖尿病(type 2 diabetes mellitus, T2DM)老年患者(年龄≥60岁)应用直接抗病毒药物治疗后糖化血红蛋白(glycosylated hemoglobin Ac, HbAc)、空腹血糖(fasting plasma glucose, FPG)水平变化,探讨其糖代谢改善的影响因素。方法 慢性丙型肝炎合并T2DM老年患者154例,均采用直接抗病毒药物治疗12周取得持续病毒学应答,于治疗前及治疗后12周检测HbAc、FPG水平。根据治疗后12周HbAc水平,将154例患者分为糖代谢改善组106例(HbAc水平较治疗前下降≥0.5%)和糖代谢未改善组48例(HbAc水平较治疗前下降<0.5%)。比较2组性别,年龄,体质量指数,T2DM家族史,T2DM病程,治疗前HbAc、谷丙转氨酶水平及Child-Pugh肝功能分级等临床资料;多因素logistic回归分析慢性丙型肝炎合并T2DM老年患者应用直接抗病毒药物治疗后糖代谢未改善的影响因素。结果 154例患者治疗后12周HbAc[(7.03±0.58)%]、FPG[(6.70±0.78)mmol/L]水平均低于治疗前[(7.63±0.79)%、(7.89±0.69)mmol/L](t=-17.309,P<0.001;t=-18.197,P<0.001)。糖代谢改善组体质量指数[(23.41±3.17)kg/m^(2)]、有T2DM家族史比率(46.23%)均低于糖代谢未改善组[(24.83±3.66)kg/m^(2)、64.58%](P<0.05),T2DM病程[(4.42±2.34)年]短于糖代谢未改善组[(6.15±2.38)年](P<0.05),治疗前HbAc水平[(7.80±0.84)%]、Child-Pugh分级A级比率(75.47%)均高于糖代谢未改善组[(7.26±0.48)%、52.08%](P<0.05);2组性别、年龄、治疗前谷丙转氨酶水平比较差异均无统计学意义(P>0.05)。T2DM病程(OR=1.522,95%CI:1.251~1.852,P<0.001),治疗前HbAc水平(OR=0.134,95%CI:0.056~0.321,P<0.001)、Child-Pugh分级(OR=3.468,95%CI:1.374~8.754,P=0.008)是慢性丙型肝炎合并T2DM老年患者应用直接抗病毒药物治疗后糖代谢未改善的影响因素。结论 慢性丙型肝炎合并T2DM老年患者应用直接抗病毒药物治疗取得持续病毒学应答者HbAc、FPG水平下降,T2DM病程、HbAc水平及Child-Pugh分级是其治疗后糖代谢未改善的影响因素。

Objective To observe the changes of glycosylated hemoglobin Ac (HbAc)and fasting plasma glucose(FPG)levels in elderly patients(age≥60years)with chronic hepatitis C (CHC)and type 2diabetes mellitus(T2DM)after direct-acting antiviral agents (DAAs)treatment,and to investigate the influencing factors of glycometabolism improvement.Methods Totally 154elderly patients with CHC and T2DM were treated with DAAs for 12weeks and achieved sustained virological response.The levels of HbAc and FPG were detected before treatment and 12weeks after treatment.According to the HbAc level 12weeks after treatment 154patients were divided into 106patients with HbAc levels decreased by ≥0.5% compared with before treatment(improved glycometabolism group),and 48patients with HbAc level decreased by<0.5% (non-improved glycometabolism group).The clinical data as gender,age,body mass index,T2DM family history,course of T2DM,and the levels of HbAc and glutamic-puruvic transaminase as well as Child-Pugh grade before treatment were compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of glycometabolism improvement in elderly patients with CHC and T2DM after DAAs treatment.Results The levels of HbAc and FPG were lower 24weeks after treatment[(7.03±0.58)%,(6.70±0.78)mmol/L]than those before treatment [(7.63±0.79)%,(7.89±0.69)mmol/L](t= -17.309,P<0.001;t=-18.197,P<0.001). The BMI and percentages of patients with T2DM family history were lower[(23.41±3.17)kg/m^(2),46.23%],the course of T2DM was shorter[(4.42±2.34)years],and the HbAc level and percentage of patients with Child-Pugh A before treatment were higher [(7.80±0.84)%,75.47%]in improved glycometabolism group than those in non-improved glycometabolism group [(24.83±3.66)kg/m^(2),64.58%,(6.15±2.38)years,(7.26±0.48)%,52.08%](P<0.05).There were no significant differences in the gender,age and glutamic-pyruvic transaminase level before treatment between two groups (P>0.05).The course of T2DM(OR=1.522,95%CI:1.251-1.852,P<0.001),HbAc level before treatment(OR=0.134,95%CI:0.056-0.321,P<0.001),and Child-Pugh grade (OR=3.468,95%CI:1.374-8.754,P=0.008)were the influencing factors of glycometabolism improvement in elderly patients with CHC and T2DM after DAAs treatment.Conclusions The levels of HbAc and FPG decrease in elderly patients with CHC and T2DM who achieve sustained virological response after DAAs treatment.The course of T2DM before treatment,HbAc level and Child-Pugh grade are the influencing factors of glycometabolism improvement after DAAs treatment.