本文選題：胰島素抵抗 + 慢性丙型肝炎��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的研究在合并2型糖尿病的慢性丙型肝炎患者中,胰島素抵抗(IR)對其抗病毒治療應(yīng)答的影響,以及抗病毒治療后IR改善情況,并探討其二者之間可能存在的互相影響機制。方法研究對象為2013年7月~2015年8月江蘇省淮安市第四人民醫(yī)院收治的慢性丙型肝炎成人患者共120例,分為A組:60例,為合并2型糖尿病的慢性丙型肝炎患者;B組:60例,為不合并2型糖尿病的慢性丙型肝炎患者;兩組患者統(tǒng)一使用普通干擾素聯(lián)合利巴韋林抗病毒治療,基因1型者治療48周,非基因1型者治療24周,均隨訪24周;分析比較兩組患者生化學(xué)、病毒學(xué)應(yīng)答情況,以及A組患者抗病毒治療前后胰島素抵抗改善情況。同期設(shè)立單純2型糖尿病組(C組)和健康人群組(D組)作為對照,每組各60例。結(jié)果(1)A組、C組IR水平明顯高于其他兩組,同時B組高于D組(P0.05);而在A組與C組間比較,此種差異沒有統(tǒng)計學(xué)意義(P0.05)。(2)治療后A、B兩組患者生化指標(biāo)均逐步明顯改善,且各觀測點(治療4周、12周,治療結(jié)束時及隨訪24周)ALT復(fù)常比率無明顯差異(P0.05)。(3)A、B兩組患者快速病毒學(xué)應(yīng)答率(RVR)分別為3.33%和4.88%,完全早期病毒學(xué)應(yīng)答率(c EVR)分別為23.33%和36.59%,差異均無統(tǒng)計學(xué)意義(P0.05);而兩組患者治療結(jié)束時病毒學(xué)應(yīng)答率(ETVR)分別為50.00%和73.17%,持續(xù)病毒學(xué)應(yīng)答率(SVR)分別為43.33%和68.29%,差異均具有統(tǒng)計學(xué)意義(P0.05)。(4)A組患者中,獲得SVR組IR改善率明顯高于未獲得SVR組,差異具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論丙型肝炎患者存在明顯胰島素抵抗,尤其在合并2型糖尿病患者中表現(xiàn)明顯。胰島素抵抗存在可影響合并2型糖尿病的慢性丙型肝炎患者的抗病毒應(yīng)答療效,明顯降低其SVR;同時有效的抗病毒治療可明顯改善合并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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R512.63;R587.1

【參考文獻】

相關(guān)期刊論文 前8條

1 劉瑩;林潮雙;蔡慶賢;彭亮;趙志新;;慢性丙型肝炎合并2型糖尿病患者基因型特征分析[J];中華實驗和臨床感染病雜志(電子版);2013年04期

2 陳園生;李黎;崔富強;邢文革;王璐;賈志遠;周脈耕;龔曉紅;王富珍;鄭徽;羅會明;畢勝利;汪寧;楊維中;梁曉峰;;中國丙型肝炎血清流行病學(xué)研究[J];中華流行病學(xué)雜志;2011年09期

3 Chao-Hung Hung;Jing-Houng Wang;Tsung-Hui Hu;Chien-Hung Chen;Kuo-Chin Chang;Yi-Hao Yen;YuanHung Kuo;Ming-Chao Tsai;Chuan-Mo Lee;;Insulin resistance is associated with hepatocellular carcinoma in chronic hepatitis C infection[J];World Journal of Gastroenterology;2010年18期

4 Mark W Douglas;Jacob George;;Molecular mechanisms of insulin resistance in chronic hepatitis C[J];World Journal of Gastroenterology;2009年35期

5 李曉娟;顏偉;周平;王純巍;司慧遠;張宏偉;;丙肝病毒感染并發(fā)2型糖尿病的臨床研究[J];西南國防醫(yī)藥;2009年08期

6 Diego Garcia-Compean;Joel Omar Jaquez-Quintana;Jose Alberto Gonzalez-Gonzalez;Hector Maldonado-Garza;;Liver cirrhosis and diabetes:Risk factors,pathophysiology,clinical implications and management[J];World Journal of Gastroenterology;2009年03期

7 趙平;王江濱;焦健;;慢性丙型肝炎患者2型糖尿病并發(fā)率調(diào)查及其基因型特征分析[J];中華肝臟病雜志;2006年02期

8 張愛秋;李新華;王國強;曹春蕊;;慢性丙型肝炎干擾素治療后復(fù)發(fā)患者胰島素抵抗的臨床分析[J];臨床內(nèi)科雜志;2013年07期

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