中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2012年
7期
517-521
,共5页
肝炎病毒,乙型%胰岛素抗药性%丙氨酸转氨酶%人体质量指数
肝炎病毒,乙型%胰島素抗藥性%丙氨痠轉氨酶%人體質量指數
간염병독,을형%이도소항약성%병안산전안매%인체질량지수
Hepatitis B virus%Insulin resistance%Alanine aminotransferase%Body mass index
目的 探讨慢性HBV感染与胰岛素抵抗(IR)的关系.方法 纳入68例慢性乙型肝炎轻度(MCHB)患者为病例组,选择同期无肝炎病毒感染且肝功正常者67例为对照组.采用稳态模型评估的胰岛素抵抗指数(HOMA-IR)判定IR,根据HOMA-IR将MCHB组分为伴IR组(HOMAIR＞ 2.7)和未伴IR组(HOMA-IR≤ 2.7).检测患者肝功能生物化学指标、糖代谢与脂代谢指标、人体质量指数(BMI)、HBV标志物、HBV DNA载量、肿瘤坏死因子α等,并在两组间进行比较.两组间计量资料比较采用独立样本t检验或Mann -Whitney秩和检验;对率的比较采用x2检验;采用Spearman秩相关或点双序列相关分析MCHB患者IR的相关因素;采用二元logistic回归法分析MCHB患者IR的危险因素.结果 MCHB组患者存在高血清胰岛素血症、高ALT和高HOMA-IR值,分别为11.10 (2.90 ～ 53.24) μU/ml、46(9～126) U/L和2.44 (0.55 ～ 11.93),分别高于对照组的7.10(1.20 ～ 16.60)μU/ml、13(5～ 36) U/L和1.61 (0.23 ～ 3.43),Z值分别为-5.451、-8.211和-5.631,P值均＜0.01.MCHB患者有30例(44.12％)存在IR,伴IR组的ALT和BMI值分别为(66.40±32.85)U/L和(22.16±1.03) kg/m2,高于未伴IR组的(47.47±32.87) U/L和(21.58±1.24) kg/m2,t值分别为-2.358和-3.566,P值均＜0.05.在MCHB组中,BMI和ALT与IR呈正相关,相关系数r分别为0.374和0.282,P值均＜0.05.HBV DNA载量与IR无相关性(r=0.015,P＞0.05).二元logistic回归分析提示BMI和ALT是MCHB患者IR的独立危险因素,[Exp (B):1.85,P＜0.01; Exp (B):1.022,P＜0.05].结论 在慢性HBV感染诱导的轻度肝脏炎症者中IR发生率高,可能与肝功能损害和BMI相关,但与HBV DNA载量无关.
目的 探討慢性HBV感染與胰島素牴抗(IR)的關繫.方法 納入68例慢性乙型肝炎輕度(MCHB)患者為病例組,選擇同期無肝炎病毒感染且肝功正常者67例為對照組.採用穩態模型評估的胰島素牴抗指數(HOMA-IR)判定IR,根據HOMA-IR將MCHB組分為伴IR組(HOMAIR＞ 2.7)和未伴IR組(HOMA-IR≤ 2.7).檢測患者肝功能生物化學指標、糖代謝與脂代謝指標、人體質量指數(BMI)、HBV標誌物、HBV DNA載量、腫瘤壞死因子α等,併在兩組間進行比較.兩組間計量資料比較採用獨立樣本t檢驗或Mann -Whitney秩和檢驗;對率的比較採用x2檢驗;採用Spearman秩相關或點雙序列相關分析MCHB患者IR的相關因素;採用二元logistic迴歸法分析MCHB患者IR的危險因素.結果 MCHB組患者存在高血清胰島素血癥、高ALT和高HOMA-IR值,分彆為11.10 (2.90 ～ 53.24) μU/ml、46(9～126) U/L和2.44 (0.55 ～ 11.93),分彆高于對照組的7.10(1.20 ～ 16.60)μU/ml、13(5～ 36) U/L和1.61 (0.23 ～ 3.43),Z值分彆為-5.451、-8.211和-5.631,P值均＜0.01.MCHB患者有30例(44.12％)存在IR,伴IR組的ALT和BMI值分彆為(66.40±32.85)U/L和(22.16±1.03) kg/m2,高于未伴IR組的(47.47±32.87) U/L和(21.58±1.24) kg/m2,t值分彆為-2.358和-3.566,P值均＜0.05.在MCHB組中,BMI和ALT與IR呈正相關,相關繫數r分彆為0.374和0.282,P值均＜0.05.HBV DNA載量與IR無相關性(r=0.015,P＞0.05).二元logistic迴歸分析提示BMI和ALT是MCHB患者IR的獨立危險因素,[Exp (B):1.85,P＜0.01; Exp (B):1.022,P＜0.05].結論 在慢性HBV感染誘導的輕度肝髒炎癥者中IR髮生率高,可能與肝功能損害和BMI相關,但與HBV DNA載量無關.
목적 탐토만성HBV감염여이도소저항(IR)적관계.방법 납입68례만성을형간염경도(MCHB)환자위병례조,선택동기무간염병독감염차간공정상자67례위대조조.채용은태모형평고적이도소저항지수(HOMA-IR)판정IR,근거HOMA-IR장MCHB조분위반IR조(HOMAIR＞ 2.7)화미반IR조(HOMA-IR≤ 2.7).검측환자간공능생물화학지표、당대사여지대사지표、인체질량지수(BMI)、HBV표지물、HBV DNA재량、종류배사인자α등,병재량조간진행비교.량조간계량자료비교채용독립양본t검험혹Mann -Whitney질화검험;대솔적비교채용x2검험;채용Spearman질상관혹점쌍서렬상관분석MCHB환자IR적상관인소;채용이원logistic회귀법분석MCHB환자IR적위험인소.결과 MCHB조환자존재고혈청이도소혈증、고ALT화고HOMA-IR치,분별위11.10 (2.90 ～ 53.24) μU/ml、46(9～126) U/L화2.44 (0.55 ～ 11.93),분별고우대조조적7.10(1.20 ～ 16.60)μU/ml、13(5～ 36) U/L화1.61 (0.23 ～ 3.43),Z치분별위-5.451、-8.211화-5.631,P치균＜0.01.MCHB환자유30례(44.12％)존재IR,반IR조적ALT화BMI치분별위(66.40±32.85)U/L화(22.16±1.03) kg/m2,고우미반IR조적(47.47±32.87) U/L화(21.58±1.24) kg/m2,t치분별위-2.358화-3.566,P치균＜0.05.재MCHB조중,BMI화ALT여IR정정상관,상관계수r분별위0.374화0.282,P치균＜0.05.HBV DNA재량여IR무상관성(r=0.015,P＞0.05).이원logistic회귀분석제시BMI화ALT시MCHB환자IR적독립위험인소,[Exp (B):1.85,P＜0.01; Exp (B):1.022,P＜0.05].결론 재만성HBV감염유도적경도간장염증자중IR발생솔고,가능여간공능손해화BMI상관,단여HBV DNA재량무관.
Objective To investigate the factors associated with insulin resistance (IR) in patients with chronic hepatitis B virus (HBV) infection.Methods Sixty-eight patients with mild chronic hepatitis B (MCHB) caused by HBV were recruited for study.Sixty-seven healthy individuals with no hepatitis virus infections and normal liver function were enrolled as controls.Demographic,anthropometric,clinical,and blood biochemical parameters were compared between the two groups.IR was determined by the homeostasis model assessment (HOMA-IR).The MCHB group was further divided into patients with IR (HOMA-IR:＞2.7) and patients without IR (HOMA-IR:＜2.7).Demographic,anthropometric,clinical,and blood biochemical parameters were compared between the two sub-groups.Finally,the potential factors associated with IR were evaluated.Results Compared to the healthy controls,the MCHB patients had significantly higher serum insulin (Z=-5.451,P＜0.01),alanine aminotransferase (ALT) (Z=-8.21 1,P＜0.01) and HOMAIR (Z=-5.631,P＜0.01).IR was detected in 44.12％ (30/68) of the MCHB patients.The levels of ALT and body mass index (BMI) were significantly different between the MCHB patients with IR and without IR (t=-2.358,and t=-3.566,P＜0.05).There was a significant correlation between BMI,ALT,and HOMA-IR in the MCHB patients (r=0.374,r=0.282,P＜0.05),but not with the HBV DNA loads (r=0.015,P=0.904).Binary logistic regression analysis indicated that BMI [Exp(B):1.859,P＜0.01] and ALT [Exp(B):1.022,P＜0.05]were independent risk factors of IR in MCHB.Conclusion There is a high prevalence of insulin resistance in patients with mild hepatitis caused by chronic HBV infection.in these patients,IR is correlated with abnormal liver function and BMI,and not HBV load.
