title: Evidence of oxidative stress as a cofactor in the development of insulin resistance in patients with chronic hepatitis C.
abstract: OBJECTIVE
  The mechanisms by which metabolic disorders develop in patients with chronic hepatitis C are unknown. Our study aimed to test whether oxidative stress contributes to these mechanisms.
  
  
  METHODS
  The index of homeostasis model assessment-insulin resistance (HOMA-IR) and serum and hepatic levels of thioredoxin (Trx), which are markers of oxidative stress, were evaluated in 203 biopsy-proven chronic hepatitis C patients with hepatitis C virus (HCV) genotype 1 or 2 infection. HOMA-IR and Trx levels were compared with baseline values after phlebotomy in 23 patients.
  
  
  RESULTS
  HOMA-IR and serum Trx levels were significantly correlated with disease stage (HOMA-IR, P < 0.00001; Trx, P < 0.0001) and independently predicted fibrosis scores (HOMA-IR, P < 0.05; Trx, P < 0.005). Steatosis (%) was significantly correlated with HOMA-IR (P < 0.00005) and Trx (P < 0.001) stage (P < 0.00001). Serum Trx levels were significantly correlated with HOMA-IR (P < 0.05), even after adjustment for body mass index (P < 0.05). Furthermore, the mRNA levels of hepatic Trx were significantly correlated with HOMA-IR (P < 0.05) and independently-predicted HOMA-IR (P < 0.05). The alanine aminotransferase (P < 0.00001), Trx (P < 0.05), and HOMA-IR (P < 0.05) serum levels decreased significantly after phlebotomy; these effects were similar even in non-responders to interferon.
  
  
  CONCLUSIONS
  Oxidative stress contributed to the development of IR irrespective of obesity in patients with HCV genotype 1 or 2 infection. This study could contribute to our understanding of how metabolic disorders develop and how they should be treated in chronic hepatitis C patients.
authors.affiliation: Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Mitsuyoshi
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Itoh
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Sumida
authors.forename: Masahito
authors.initials: M
authors.lastname: Minami
authors.forename: Kouichirou
authors.initials: K
authors.lastname: Yasui
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Nakashima
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okanoue