Association of insulin resistance with hepatic steatosis and progression of fibrosis in Chinese patients with chronic hepatitis C.
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.
Chu
Chi-Jen
CJ
Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China. cjchu@vghtpe.gov.tw
Hung
Tsung-Hsing
TH
Hwang
Shinn-Jang
SJ
Wang
Yuan-Jen
YJ
Yang
Ching-Fen
CF
Lin
Han-Chieh
HC
Lee
Fa-Yauh
FY
Lu
Rei-Hwa
RH
Chang
Chiao-Yu
CY
Chang
Full-Young
FY
Lee
Shou-Dong
SD
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