Asselah T, Rubbia-Brandt L, Marcellin P, Negro F
Service d'Hépatologie and INSERM CRB3, Hôpital Beaujon, Clichy 92110, France.
Gut. 2006 Jan;55(1):123-30. doi: 10.1136/gut.2005.069757.
Hepatic steatosis is a common histological feature of chronic hepatitis C. Various factors are associated with hepatic steatosis, including obesity, high alcohol consumption, diabetes type II, and hyperlipidaemia. These factors may contribute to steatosis in patients with chronic hepatitis C. In humans, hepatitis C virus (HCV) genotype 3 is more commonly associated with steatosis. In vitro studies and the transgenic mouse model have suggested that the HCV core protein (genotype 1) can induce lipid accumulation within hepatocytes. However, what is the relevance of steatosis in chronic hepatitis C? It seems that in certain populations, steatosis may be associated with fibrosis progression and this may be genotype specific. The mechanisms underlying this association are unknown; neither is it clear whether this holds true for all patients or only a subgroup. Indeed, after antiviral treatment, virus related steatosis disappears whereas the host associated steatosis remains unaffected. This review describes and discusses the basic and clinical aspects of the relationship between steatosis and progression of fibrosis, and response to treatment in patients with chronic hepatitis C.
肝脂肪变性是慢性丙型肝炎常见的组织学特征。多种因素与肝脂肪变性相关,包括肥胖、大量饮酒、II型糖尿病和高脂血症。这些因素可能促使慢性丙型肝炎患者发生脂肪变性。在人类中,丙型肝炎病毒(HCV)3型更常与脂肪变性相关。体外研究和转基因小鼠模型表明,HCV核心蛋白(1型)可诱导肝细胞内脂质蓄积。然而,慢性丙型肝炎中脂肪变性的相关性如何?在某些人群中,脂肪变性似乎可能与纤维化进展相关,且这可能具有基因型特异性。这种关联的潜在机制尚不清楚;也不清楚这是否适用于所有患者或仅适用于一个亚组。实际上,抗病毒治疗后,病毒相关的脂肪变性消失,而宿主相关的脂肪变性仍未受影响。本文综述并讨论了脂肪变性与慢性丙型肝炎患者纤维化进展及治疗反应之间关系的基础和临床方面。