title: Association of insulin resistance with hepatic steatosis and progression of fibrosis in Chinese patients with chronic hepatitis C.
abstract: OBJECTIVE
  To investigate the relationships between insulin resistance, hepatic steatosis, and fibrosis in consecutive non-diabetic Chinese CHC patients with biopsy results.
  
  
  METHODS
  A total of 192 patients were enrolled. Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR). Steatosis was assessed as the percentage of hepatocytes containing macrovesicular fat droplets and degree of hepatic fibrosis was graded by the METAVIR scoring system.
  
  
  RESULTS
  As compared with no steatosis group, patients with hepatic steatosis had significantly higher BMI (24.5+/-0.4 vs. 22.3+/-0.3 kg/m2, p<0.001) and HOMA-IR value (3.04+/-0.15 vs. 2.41+/-0.13, p=0.002). Patients with F3-F4 fibrosis had significantly lower ALT/AST ratio (1.38+/-0.06 vs. 1.76+/-0.05, p=0.022), lower platelet count (155+/-6 vs. 207+/-5 x 1000/cumm, p<0.001), and higher HOMA-IR value (3.29+/-0.17 vs. 2.50+/-0.12, p<0.001) as compared with F1-F2 fibrosis group. In addition, mean HOMA-IR progressively elevated along with the severity of hepatic fibrosis (F1: 2.04+/-0.15, F2: 2.77+/-0.17, F3: 3.11+/-0.25, F4: 3.46+/-0.23). Multivariate analyses showed platelet count <150,000/cumm (odds ratio: 3.88, 95% C.I.=2.87-12.05, p<0.001) and HOMA-IR >2.5 (odds ratio: 2.46, 95% C.I.=1.24-4.90, p=0.010) as independent factors associated with F3-F4 fibrosis.
  
  
  CONCLUSIONS
  In Chinese CHC patients, insulin resistance can occur in earlier stage of infection and closely related with hepatic steatosis and fibrosis.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China. cjchu@vghtpe.gov.tw
authors.forename: Chi-Jen
authors.initials: CJ
authors.lastname: Chu
authors.forename: Tsung-Hsing
authors.initials: TH
authors.lastname: Hung
authors.forename: Shinn-Jang
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Yuan-Jen
authors.initials: YJ
authors.lastname: Wang
authors.forename: Ching-Fen
authors.initials: CF
authors.lastname: Yang
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Fa-Yauh
authors.initials: FY
authors.lastname: Lee
authors.forename: Rei-Hwa
authors.initials: RH
authors.lastname: Lu
authors.forename: Chiao-Yu
authors.initials: CY
authors.lastname: Chang
authors.forename: Full-Young
authors.initials: FY
authors.lastname: Chang
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D002681:China; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000503:physiopathology*; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055815:Young Adult