丙型肝炎病毒感染对维持性血液透析患者炎症因子及糖代谢的影响

目的探讨丙型肝炎病毒(hepatitis C virus,HCV)感染对慢性肾衰竭维持性血液透析患者的微炎症状态及糖代谢的影响。方法单中心、有对照、横断面研究,比较21例HCV抗体阳性维持性血液透析患者(阳性组)与51例HCV抗体阴性患者(阴性组)的空腹血糖、空腹胰岛素和C肽水平及胰岛素抵抗指数(稳态模式评估法,homeostasis model assessment of insulin resistance index,HOMA-IR)等糖代谢指标以及C反应蛋白(C-reactive protein,CRP)和肿瘤坏死因子á(tumor necrosis factor-á,TNF-á)等炎症指标,所有患者均维持性血液透析6个月以上,透析开始前均无糖尿病史和器官移植史,6个月内无使用糖皮质激素和免疫抑制剂史,2周内无发热和感染史。两组患者年龄、性别比例及体质量指数差异均无统计学意义(P0.05)。结果阳性组平均透析治疗时间较阴性组长,分别为(53±21)月和(32±18)月。阳性组丙氨酸氨基转移酶较阴性组高,分别为(33±19)U/L和(14±14)U/L,差异有统计学意义(t=1.85,P=0.034)。两组患者的血浆白蛋白、空腹血糖和C肽水平差异均无统计学意义(P0.05),但阳性组空腹胰岛素水平高于阴性组,分别为(12.18±3.05)pmol/L和(10.52±2.98)pmol/L,差异有统计学意义(t=2.12,P=0.037);阳性组HOMA-IR也显著高于阴性组,分别为2.67±0.87和2.21±0.75,差异有统计学意义t=2.36,P=0.027);阳性组和阴性组CRP分别为(0.34±0.11)mg/dl和(0.12±0.04)mg/dl,差异有统计学意义(t=2.65,P=0.009);TNF-á分别为(22.09±7.16)pg/ml和(10.31±4.87)pg/ml,差异有统计学意义(t=2.07,P=0.045)。而且空腹胰岛素水平和HOMA-IR均与TNF-á、CRP水平呈显著的正相关。结论合并HCV感染会进一步加重慢性血液透析患者的炎症状态,并进一步导致胰岛素抵抗。

Influence of hepatitis virus C infection on proinflammatory cytokines and insulin resistance in maintain hemodialysis patients

Objective Inflammation status and proinflammatory cytokines can led to insulin resistance. Hepatitis C virus infection is often associated with the increase of proinflammatory cytokine levels. Similar changes are seen in maintain hemodialysis patients. Does hepatitis C virus infection in maintain hemodialysis patients aggravate these changes？ The purpose of this study was to investigate the influence of hepatitis C virus infection on proinflammatory cytokines and insulin resistance in maintain hemodialysis patients. Method We recruited 72 patients on regular hemodialysis 2-3 times a week for at least 6 months. Twenty-one of them （13 males and 8 females, with average dialysis duration of 53.39 ± 20.88 months） were anti-HCV antibody （＋）, and defined as the HCV（＋） group. The remaining 51 patients （29 males and 22 females, with average dialysis duration of 31.95 ± 18.15 months） were nega- tive for HCV and other hepatitis virus, and were defined as the HCV（-） group. None of the patients had a history of drug use or any other diseases that were related to insulin resistance except uremia. Fasting glucose, fasting insulin, fasting C peptide, TNF-á and CRP were assayed, and the serum samples for the assays were taken after 12 hours of fasting. Insulin resistance was calculated according to the HOMA formula. Patient was defined as HOMA-IR （＋） if the score was higher than 2.5. Results There were no significant difference in fasting glucose and C-peptide between the two groups. Fasting insulin and HOMA-IR score were higher in HCV（＋） group than in HCV（-） group （insulin 12.18 ±3.05pmol/L vs. 10.52 ±2.98pmol/L, P=0.037; HOMA-IR 2.67 ±0.87 vs. 2.21 ±0.75, P =0.027）. HOMA-IR score higher than 2.5 was found in 11 of 21 （52.38%） HCV（＋） patients and 18 of 51 （35.29%） HCV（-） patients. The serum levels of TNF-á and CRP were significantly higher in HCV（＋） group （0.34 ± 0.11mg/dl and 22.09 ± 7.16pg/ ml, respectively） than in HCV（-） group （0.12 ± 0.04mg/dl and 10.31 ± 4.87pg/ml, respectively）. HOMA-IR score was positively correlated with the levels of TNF-á （r=0.537, P=0.003） and CRP （r=0.439, P =0.004）. Conclusion In maintain hemodialysis patients, HCV infection can aggravate the microinflammatory status and lead to insulin resistance.