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胰岛素抵抗对慢性丙型肝炎合并2型糖尿病患者抗病毒应答疗效影响的研究

发布时间:2018-06-28 06:24

  本文选题:胰岛素抵抗 + 慢性丙型肝炎 ; 参考:《青岛大学》2017年硕士论文


【摘要】:目的研究在合并2型糖尿病的慢性丙型肝炎患者中,胰岛素抵抗(IR)对其抗病毒治疗应答的影响,以及抗病毒治疗后IR改善情况,并探讨其二者之间可能存在的互相影响机制。方法研究对象为2013年7月~2015年8月江苏省淮安市第四人民医院收治的慢性丙型肝炎成人患者共120例,分为A组:60例,为合并2型糖尿病的慢性丙型肝炎患者;B组:60例,为不合并2型糖尿病的慢性丙型肝炎患者;两组患者统一使用普通干扰素联合利巴韦林抗病毒治疗,基因1型者治疗48周,非基因1型者治疗24周,均随访24周;分析比较两组患者生化学、病毒学应答情况,以及A组患者抗病毒治疗前后胰岛素抵抗改善情况。同期设立单纯2型糖尿病组(C组)和健康人群组(D组)作为对照,每组各60例。结果(1)A组、C组IR水平明显高于其他两组,同时B组高于D组(P0.05);而在A组与C组间比较,此种差异没有统计学意义(P0.05)。(2)治疗后A、B两组患者生化指标均逐步明显改善,且各观测点(治疗4周、12周,治疗结束时及随访24周)ALT复常比率无明显差异(P0.05)。(3)A、B两组患者快速病毒学应答率(RVR)分别为3.33%和4.88%,完全早期病毒学应答率(c EVR)分别为23.33%和36.59%,差异均无统计学意义(P0.05);而两组患者治疗结束时病毒学应答率(ETVR)分别为50.00%和73.17%,持续病毒学应答率(SVR)分别为43.33%和68.29%,差异均具有统计学意义(P0.05)。(4)A组患者中,获得SVR组IR改善率明显高于未获得SVR组,差异具有统计学意义(P0.05)。结论丙型肝炎患者存在明显胰岛素抵抗,尤其在合并2型糖尿病患者中表现明显。胰岛素抵抗存在可影响合并2型糖尿病的慢性丙型肝炎患者的抗病毒应答疗效,明显降低其SVR;同时有效的抗病毒治疗可明显改善合并2型糖尿病的慢性丙型肝炎患者的IR水平。
[Abstract]:Objective to study the effect of insulin resistance (IR) on the antiviral response and the improvement of IR after antiviral therapy in patients with chronic hepatitis C complicated with type 2 diabetes mellitus, and to explore the possible mechanism of interaction between them. Methods from July 2013 to August 2015, 120 adult patients with chronic hepatitis C were treated in Huaian fourth people's Hospital of Jiangsu Province. They were divided into two groups: group A: 60 cases, group B: 60 cases with type 2 diabetes mellitus. Patients with chronic hepatitis C without type 2 diabetes mellitus were treated with common interferon combined with ribavirin for 48 weeks and non-gene type 1 patients for 24 weeks, and all patients were followed up for 24 weeks. The biochemical and virological responses of the two groups and the improvement of insulin resistance before and after antiviral therapy in group A were analyzed and compared. Type 2 diabetes mellitus (group C) and healthy persons (group D) were divided into two groups: 60 cases in each group. Results (1) the level of IR in group A was significantly higher than that in group A and group C, and that in group B was higher than that in group D (P0.05), but there was no significant difference between group A and group C (P0.05). (2). And the observation points (4 weeks and 12 weeks of treatment), At the end of the treatment and 24 weeks follow-up, there was no significant difference in alt normalization ratio between the two groups (P0.05). The rapid virological response rate (RVR) was 3.33% and 4.88%, and the complete early virological response rate (c EVR) was 23.33% and 36.59%, respectively. There was no significant difference between the two groups (P0.05). At the end of treatment, the virological response rate (ETVR) was 50.00% and 73.17%, and the persistent virological response rate (SVR) was 43.33% and 68.29%, respectively. The difference was statistically significant (P0.05) in group A (P0.05). The IR improvement rate of SVR group was significantly higher than that of no SVR group (P0.05). Conclusion there is significant insulin resistance in patients with hepatitis C, especially in patients with type 2 diabetes. Insulin resistance can affect the antiviral response of chronic hepatitis C patients with type 2 diabetes and decrease the SVR.The effective antiviral therapy can obviously improve the IR level of chronic hepatitis C patients with type 2 diabetes.
【学位授予单位】:青岛大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R512.63;R587.1

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