概述慢性C型肝炎與脂肪肝及胰島素抗性之關連

The Relationship between Chronic Hepatitis C and Hepatic Steatosis and Insulin Resistance

張育霖(Yu-Lin Chang)

《內科學誌》 23卷4期 (2012/08) Pp. 267-273

https://doi.org/10.6314/JIMT.2012.23(4).05

摘要

慢性Ｃ型肝炎（Chronic hepatitis C）患者可能出現相關肝外疾病（extrahepatic manifestations）。隨醫療日益普及進步，越來越多疾病被發現與C型肝炎相關連。本文回顧文獻，探討C型肝炎與脂肪肝（hepatic steatosis, fatty liver）的關連性，進一步提及與胰島素抗性（insulin resistance）、第二型糖尿病（type 2 diabetes mellitus，以下本文糖尿病皆指第二型）的關係。慢性C型肝炎與脂肪肝建立關係的機轉有多篇文獻提出，主要是C型肝炎病毒核心蛋白影響肝細胞的脂肪代謝，使脂肪囤積於肝細胞，導致脂肪肝。而經機轉解釋或實際觀察結果都可發現，治療慢性C型肝炎可使脂肪肝獲得改善。慢性C型肝炎患者易發生胰島素抗性，相關機轉牽涉多項病毒與宿主因素，控制不佳容易發展糖尿病及脂肪代謝問題。慢性C型肝炎患者伴隨胰島素抗性者會加速其肝硬化。胰島素抗性使C型肝炎治療成效不彰。於治療C型肝炎前或同步控制胰島素抗性（生活調整或藥物介入）有些患者可獲較佳的效果。在為慢性C型肝炎患者追蹤治療時，應注意有否發生相關疾病，若發現須一併控制。

關鍵字

慢性C型肝炎 ； 脂肪肝 ； 胰島素抗性

並列摘要

Patients with chronic hepatitis C may have extrahepatic manifestations. As medicine science improves and medical service is more available, more diseases are found having relationship to hepatitis C. I reviewed journals and discussed the relationship and possible mechanisms between hepatitis C and hepatic steatosis, insulin resistance and type 2 diabetes mellitus. Hepatitis C core protein influences lipid metabolism in liver cell, so lipid accumulates in liver cell, then causes hepatic steatosis. Treating hepatitis C makes hepatic steatosis recovery. Patients with chronic hepatitis C often have insulin intolerance and often develop type 2 diabetes mellitus. Chronic hepatitis C combines with insulin resistance make hepatic cirrhosis worse. Insulin resistance impairs response of interferon treatment for hepatitis C. To control insulin resistance before or during treatment for hepatitis C with life modification or using some medicines enhance sustained virological response. Beware the relate diseases when we care patients with chronic hepatitis C, control them if they develop.

並列關鍵字

Chronic hepatitis C ； Hepatic steatosis ； fatty liver ； Insulin resistance