Poynard Thierry, Ratziu Vlad, McHutchison John, Manns Michael, Goodman Zachary, Zeuzem Stefan, Younossi Zobair, Albrecht Janice
Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, Université Paris VI, Paris, France.
Hepatology. 2003 Jul;38(1):75-85. doi: 10.1053/jhep.2003.50267.
It has been suggested that hepatitis C virus (HCV) and especially genotype 3 is associated with steatosis. We assess the effect of treatment with peginterferon or interferon alfa-2b and ribavirin on steatosis. We analyzed 1,428 naïve patients included in a randomized trial. A single pathologist scored steatosis at baseline and 24 weeks after the treatment. At baseline, steatosis was present in 935 of 1,428 patients (65%), including 175 (83%) of 210 patients with genotype 3 versus 760 (62%) of 1,218 with other genotypes (P <.001). The variables associated with steatosis in logistic regression were genotype 3 (P <.001), triglycerides greater than 1.7 mmol/L (P <.001), body mass index greater than 27 (P <.04), age greater than 40 years (P <.001), and septal fibrosis (P =.007). In genotype 3-infected patients, steatosis was associated with high viral load and with lower serum cholesterol. Steatosis was associated with lower sustained response rate, even after taking into account other factors (P <.001). Among virologic responders, steatosis was much improved in genotype 3, improvement of at least 1 grade in 77%, and disappearance in 46% compared with other genotypes, 46% and 29%, respectively (P <.001 both comparisons). In genotype 3 responders, the baseline low serum cholesterol was corrected by treatment (P <.001). Steatosis was associated with HCV genotype 3, triglycerides, high body mass index, age, fibrosis stage, and lower virologic response to treatment. In conclusion, sustained disappearance of the virus is associated with reduction of steatosis in genotype 3 as well as a correction of baseline low serum cholesterol.
有人提出丙型肝炎病毒（HCV）尤其是3型基因型与脂肪变性有关。我们评估聚乙二醇干扰素或干扰素α-2b联合利巴韦林治疗对脂肪变性的影响。我们分析了纳入一项随机试验的1428例初治患者。由一名病理学家在基线和治疗24周后对脂肪变性进行评分。在基线时，1428例患者中有935例（65%）存在脂肪变性，其中210例3型基因型患者中有175例（83%），而1218例其他基因型患者中有760例（62%）（P<.001）。逻辑回归中与脂肪变性相关的变量有3型基因型（P<.001）、甘油三酯大于1.7 mmol/L（P<.001）、体重指数大于27（P<.04）、年龄大于40岁（P<.001）和间隔纤维化（P=.007）。在3型基因型感染患者中，脂肪变性与高病毒载量及较低的血清胆固醇有关。脂肪变性与较低的持续应答率相关，即使在考虑其他因素后也是如此（P<.001）。在病毒学应答者中，3型基因型患者的脂肪变性有明显改善，77%至少改善1级，46%消失；而其他基因型患者分别为46%和29%（两项比较P均<.001）。在3型基因型应答者中，治疗可纠正基线时的低血清胆固醇（P<.001）。脂肪变性与HCV 3型基因型、甘油三酯、高体重指数、年龄、纤维化阶段以及较低的治疗病毒学应答有关。总之，病毒的持续清除与3型基因型患者脂肪变性的减轻以及基线低血清胆固醇的纠正有关。
