Association of Insulin Resistance with Hepatic Steatosis and Progression of Fibrosis in Chinese Patients with Chronic Hepatitis C

Background/Aims: To investigate the relationships between insulin resistance, hepatic steatosis, and Fibrosis in consecutive non-diabetic Chinese CHC patients with biopsy results. Methodology: 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/m(2), 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.