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目的研究脂肪肝等相关因素对慢性丙型肝炎联合抗病毒治疗效果的影响。方法应用聚乙二醇干扰素α-2a联合利巴韦林治疗98例慢性丙型肝炎患者,酶免疫法检测HCV基因型,B型超声诊断脂肪肝,计算患者体质指数、腰臀比、胰岛素抵抗稳态评估模型指数(HOMA-IR),PCR法检测HCV RNA水平.化学发光仪检测血清胰岛素水平。多元逻辑回归等方法分析脂肪肝及其相关因素对抗病毒疗效的影响。结果98例患者中,HCV基因型1型35例、2型41例、3型13例、未分型9例,分别占35.7%、41.8%、13.3%和9.1%。脂肪肝在HCV基因型1型、2型、3型、未分型的比例分别为11.4%、9.8%、38.5%和11.1%(X~2=7.83,P<0.05)。在多因素分析中,抗病毒疗效与体质指数(P=0.011)、腰臀比(P=0.024)、脂肪肝(P=0.028)、基因型(P=0.037)、胰岛素水平(P=0.001)和HOMA-IR(P=0.002)呈显著相关。多元逻辑回归分析显示,胰岛素水平(OR= 7.933,P=0.001)和HOMA-IR(OR=5.995,P=0.015)是预测抗病毒疗效的独立因素。结论脂肪肝在基因3型患病率明显高于其他基因型。体质指数、腰臀比、脂肪肝、基因型、胰岛素水平和HOMA-IR可影响慢性丙型肝炎抗病毒疗效。胰岛素水平和HOMA-IR是预测抗病毒疗效的独立因素。
Objective To study the effect of fatty liver and other related factors on the treatment of chronic hepatitis C combined with antiviral therapy. Methods 98 patients with chronic hepatitis C were treated with peginterferon alfa-2a and ribavirin, HCV genotypes were detected by enzyme-linked immunosorbent assay, fatty liver was diagnosed by B-mode ultrasound, body mass index, waist-hip ratio, insulin (HOMA-IR), HCV RNA level by PCR, and serum insulin level by chemiluminescence analyzer. Multiple logistic regression analysis of fatty liver and its related factors on the anti-virus effect. Results Of the 98 patients, 35 were HCV genotype 1, 41 were type 2, 13 were type 3, and 9 were non-typed, accounting for 35.7%, 41.8%, 13.3% and 9.1% respectively. The proportions of fatty liver in HCV genotypes 1, 2 and 3 were 11.4%, 9.8%, 38.5% and 11.1%, respectively (X 2 = 7.83, P <0.05). In the multivariate analysis, the antiviral efficacy was positively correlated with the body mass index (P = 0.011), WHR (P = 0.024), fatty liver (P = 0.028), genotype (P = 0.037) And HOMA-IR (P = 0.002) were significantly correlated. Multivariate logistic regression analysis showed that insulin level (OR = 7.933, P = 0.001) and HOMA-IR (OR = 5.995, P = 0.015) were independent predictors of anti-viral efficacy. Conclusion The prevalence of fatty liver in genotype 3 is significantly higher than other genotypes. Body mass index, waist-hip ratio, fatty liver, genotype, insulin levels and HOMA-IR can affect the antiviral efficacy of chronic hepatitis C. Insulin levels and HOMA-IR are independent predictors of anti-viral efficacy.