46, P = 0.0001) and tyrosine (r = 0.55, P < 0.0001). However, BCAA Nutlin-3 were not significantly correlated with HOMA-IR (r = −0.21, P = 0.082). In multivariate analysis, only two factors were identified as independent parameters contributing to a HOMA-IR of 2.5 or more: total cholesterol (odds ratio [OR], 6.511; 95% confidence interval [95% CI], 1.554–27.284; P = 0.010) and tyrosine (OR, 4.839; 95% CI, 1.087–21.549; P = 0.039). Serum tyrosine levels may be associated with IR in patients with HCV-related chronic liver disease. INSULIN RESISTANCE (IR) increases during the early stages of hepatitis

C virus (HCV)-related chronic liver disease.[1, 2] HCV induces both hepatic and peripheral IR.[3, 4] IR increases with the progression of fibrosis;[1, 2, 5] in addition, IR is a risk factor for fibrosis progression and development of hepatocellular carcinoma (HCC), and is a sign of poor long-term prognosis.[1, 6, 7] Therefore, it is important to diagnose the early stages of IR in patients with chronic liver disease. The Homeostasis Model of Assessment – Insulin Resistance (HOMA-IR) is the most commonly used model for assessing IR in hepatitis C.[8] HOMA-IR is significantly correlated with body

mass index (BMI) and clinical parameters such as prothrombin activity, serum bilirubin and leptin in patients with HCV-related cirrhosis.[7] Compared to persons without liver disease, patients 上海皓元 with liver cirrhosis (LC) show lower levels of branched-chain amino

acids (BCAA) such Sotrastaurin order as valine, leucine and isoleucine, and higher levels of aromatic amino acids (AAA) such as tyrosine and phenylalanine.[9, 10] The ratio of BCAA to AAA, known as Fisher’s ratio, decreases in LC patients.[11, 12] Recent studies have assayed the ratio of BCAA to tyrosine level (BTR) instead of Fisher’s ratio, and BTR has been found to decrease in LC patients.[13, 14] In addition, Michitaka et al. reported that serum tyrosine levels were increased in the early stages of chronic liver disease, whereas serum BCAA levels were decreased mainly in LC.[14] Recently, a relationship has been reported between amino acid levels and the risk of diabetes mellitus, and serum tyrosine levels have been found to predict occurrence of diabetes mellitus.[15-17] However, no clinical studies have examined the relationship between serum tyrosine levels and HOMA-IR. Therefore, we investigated the relationship between HOMA-IR and BTR and the serum levels of BCAA and tyrosine in HCV-related chronic liver disease. SEVENTY-ONE CONSECUTIVE PATIENTS hospitalized at Yamaguchi University Hospital were included in this retrospective cohort study between January 2009 and December 2012. The eligibility criteria were presence of HCV-related chronic liver disease, alcohol consumption of 20 g/day or less, and no use of medications containing BCAA or antidiabetic agents.