Особливості вуглеводного обміну у хворих на цукровий діабет 2 типу поєднаний з хронічним гепатитом С

Abstract

У роботі представлені результати обстеження 400 хворих на цукровий діабет (ЦД) 2 типу, серед яких 125 хворих на ЦД 2 типу поєднаний з хронічним гепатитом С (ХГС) склали першу досліджувану групу і 275 хворих на ЦД 2 типу без ХГС — другу. Відмічено, що 49,6% хворих на ЦД 2 типу з ХГС мали тяжку форму діабету, на противагу хворим без ХГС, де тяжкі форми зареєстровані у 26,5% хворих. Встановлено, що знижена секреція С-пептиду частіше, реєструвалася у хворих на ЦД 2 типу з ХГС, аніж без вірусу (70,4% пацієнтів проти 6,2%; p<0,001). У хворих з високим вірусним HCV навантаженням С-пептид нижче норми зареєстровано у 83,6% випадків, а з низьким — у 61,8%. Встановлено, що висока реплікативна активність HCV веде до зниження секреції інсуліну з розвитком інсулінової недостатності, погіршенням компенсації та клінічного перебігу ЦД 2 типу; В работе представлены результаты обследования 400 больных сахарным диабетом (СД) 2 типа, среди которых 125 больных СД 2 типа сочетанным с хроническим гепатитом С (ХГС) составили первую группу и 275 больных СД 2 типа без ХГС – вторую. Отмечено, что 49,6% больных СД 2 типа с ХГС имели тяжелую форму диабета, в отличие от больных без ХГС, где тяжелые формы имели 26,5% человек. Установлено, что сниженная секреция С-пептида чаще регистрировалась у больных СД 2 типа с ХГС, чем без вируса (70,4% пациентов против 6,2%; p<0,001). У больных с высокой вирусной HCV нагрузкой С-пептид ниже нормы зарегистрирован в 83,6% случаев, а с низкой — в 61,8%. Установлено, что высокая репликативная активность HCV ведет к снижению секреции инсулина с развитием инсулиновой недостаточности, ухудшением компенсации и клинического течения СД 2 типа; Studies in recent decades show that HCV-infection is not the only cause of liver disease, but it is a systemic pathological process, generalized infection, the consequences of which are damage many organs and systems. The purpose of the work — to examine the state of C-peptide secretion in patients with type 2 diabetes mellitus combined with chronic hepatitis C, depending on the viral load HCV. Object and methods. The study involved 400 patients aged 31 to 70 years (in average — 54,1 ± 1,1 years): 247 (61,7%) men and 153 (38,3%) women, who were treated in endocrinology and gastroenterology departments of Transcarpathian Regional clinical hospital named after A. Novak. Two groups of patients were formed, including first studied group consisted of 125 patients with type 2 diabetes mellitus combined with chronic hepatitis C (CHC) and a second comparison group consisted of 275 patients with type 2 diabetes mellitus without CHC. The first group was divided into: 1a subgroup (n = 49) — patients with a high viral load HCV RNA 6х105 IU/ml and 1b subgroup (n = 76) — patients with a low viral load HCV RNA ≤ 6х105 IU/ml. Since the determination of insulin has meaning only in patients not receiving insulin, for evaluation of the functional state of ß-cell apparatus of the pancreas in the surveyed patients, was used determination of C-peptide in serum by ELISA using the kits of reagents DRG (USA) according to the methodology producer. Results. It was noted that 49.6% patients with type 2 diabetes mellitus with chronic hepatitis C had a severe form of diabetes, in contrast to patients without chronic hepatitis C, where severe forms were in 26.5% of patients. The majority of severe type 2 diabetes mellitus were in patients with chronic hepatitis C, namely 75.8% (47 of 62) are persons of working age. Studying the level of C-peptide secretion was found that it’s reduced secretion significantly more often recorded in patients with type 2 diabetes with chronic hepatitis C, than without the virus, namely 70.4% of patients versus 6,2% (p <0,001) respectively. In the subgroup of patients with high viral load HCV C-peptide below normal was registered in 83.6% of cases and in the subgroup with low viral load at 61.8%. Also among patients with high viral load decompensated carbohydrate metabolism had 89.8% (44 of 49), and there was no patient with full compensation. In patients with low viral activity 64.5% (49 of 76) of patients had decompensated carbohydrate metabolism and 9.2% (7 of 76) — full compensation (p <0,01). It was established that severe grade of type 2 diabetes mellitus more often had chronic hepatitis C patients (49.6%) than without chronic hepatitis C (26,5%) (p <0,001). In the group with high viral activity severe degree of type 2 diabetes mellitus had 65.3% patients, against 39.5% in the group with low viral activity (p <0,01). Conclusions 1. Reduced secretion of C-peptide was significantly more often recorded in patients with type 2 diabetes with chronic hepatitis C, than in uninfected, namely 70.4% of patients versus 6,2% (p <0,001). Significant effect on basal secretion of C-peptide has replicating activity of HCV. 2. The obtained results suggest a possible role of hepatitis C virus in carbohydrate metabolism, followed by the development of insulin deficiency, impairment of compensation and the clinical course of type 2 diabetes mellitus.