정상인과 anti-HCV 양성자에서 인슐린 저항성의 유병률 비교
Comparison of the prevalence of insulin resistance between the HCV Antibody positive and non-infected examinee
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Background/Aims: Considerable evidence indicates that patients with chronic hepatitis C virus (HCV) infection have a greater risk of developing insulin resistance (IR) compared with non-infected individuals or patients with hepatitis B virus (HBV) infection. Few reports have examined the prevalence of IR and hepatic steatosis in patients with chronic HCV infection in Korea. Methods: Ninety subjects positive for HCV antibody who had normal fasting blood glucose levels and no history of diabetes mellitus were compared with 271 HCV non-infected, age- and sex-matched, healthy examinees between January 2005 and December 2006. Results: No significant differences in the body mass index (BMI) and fasting blood glucose level were found between the anti- HCV-antibody-positive and non-infected groups. The serum fasting insulin level was significantly higher in the HCV-antibody-positive group than in the non-infected group (9.11±2.94 vs. 8.43±2.70 µU/mL (mean±SD), p=0.04). Although the homeostasis model assessment of insulin resistance (HOMA-IR) was not significantly different between the two groups (2.035±0.69 vs. 1.899±0.64, p=0.088), the prevalence of insulin resistance (HOMA-IR≥2.7) was significantly higher in the anti-HCV positive group (18.9% vs. 10.3%, p=0.042). Hepatic steatosis identified by transabdominal ultrasonography was significantly more frequent in the non-infected group (20.3% vs. 11.1%, p=0.028). Conclusions: The anti-HCV positive subjects had significant hyperinsulinemia and a higher prevalence of insulin resistance than the non-infected group, whereas hepatic steatosis was more frequent in the non-infected group.
Abstract
목적: 만성 C형 간염 항체 보유자들은 정상인들이나 만성 B형 간염에 비해 인슐린 저항성이 생길 가능성이 더 높다는 보고들이 많다. 만성 C형 간염에서 지방간이 50% 이상 발생하는데 이는 인슐린 저항성과 관계되어 있다. 그러나 한국에서 만성 C형 간염 보유자에서 인슐린 저항성과 지방간의 유병률에 대한 역학조사가 없었다. 방법: 2005년 1월부터 2006년 12월까지 본원에서 건강검진을 시행받은 수진자를 대상으로 하였으며, 정상 공복 혈당을 보이고 당뇨의 과거력이 없는 anti-HCV 양성자 90명과 나이, 성별을 맞춘 정상대조군 271명을 서로 비교하였다. 결과: Anti-HCV 양성자와 정상대조군 사이에 체질량 지수와 공복 혈당은 유의한 차이가 없었으나 공복 인슐린 농도가 anti-HCV 양성자에서 유의하게 높았다(9.11±2.94 vs. 8.43±2.70, p=0.04). 비록 HOMA-IR 값은 anti-HCV 양성자와 음성자군 사이에 의미있는 차이는 없었지만(2.035±0.69 vs. 1.899±0.64, p=0.088), HOMA-IR 값이 2.7 이상으로 인슐린 저항성이 있다고 판단되는 환자의 비율은 anti-HCV 양성자 군에서 음성자군에 비해 유의하게 높았다(18.9% vs. 10.3%, p=0.042). 지방간은 복부초음파로 진단하였으며 anti-HCV 양성자보다 정상대조군에서 그 유병률이 의미있게 높았다(20.3% vs. 11.1%, p=0.028). Anti-HCV 양성자에서 다른 변수의 보정 후 지방간 발생에 대한 위험도는 0.294 (95% 신뢰구간 0.099- 0.875, p=0.011)이다. 결론: Anti-HCV 양성자군에서 공복 고인슐린혈증을 보였으며 HOMA-IR의 값도 증가하는 경향을 보였으나 지방간 발생은 정상대조군에서 더 많았다.
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