Mindikoglu A L, Regev A, Casanova-Romero P Y, Bejarano P A, Martinez E J, Tzakis A G, Schiff E R
Center for Liver Diseases, Division of Hepatology, Department of Pathology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida 33136, USA.
Transplant Proc. 2006 Jun;38(5):1440-4. doi: 10.1016/j.transproceed.2006.02.060.
Nonalcoholic fatty liver disease (NAFLD) and the metabolic syndrome (MS) have been shown to play a role in disease progression and response to therapy in patients with chronic hepatitis C virus (HCV) infection. The primary objective of this study was to evaluate the impact of coexisting NAFLD and MS on the progression of fibrosis in patients with recurrent HCV treated with interferon (IFN)/ribavirin after orthotopic liver transplantation (OLT). From 1998 to 2004, a total of 418 patients underwent OLT in our center for HCV-related cirrhosis. Thirty-five patients with recurrent HCV on IFN/ribavirin treatment, who had at least 2 posttransplant liver biopsies at least 6 months apart, were included in the study. Patients who had MS at the time of their first posttransplant biopsy were identified. The first and last posttransplant biopsies were assessed for the presence and severity of NAFLD, grade of inflammation, and stage of fibrosis. The fibrosis progression rate (FPR) was calculated and expressed in fibrosis units per month (FU/mo). Among 35 patients, 34% were diagnosed with NAFLD in the first posttransplant biopsy. The mean FPR was 0.05+/-0.16 FU/mo in the presence of NAFLD compared to 0.07+/-0.10 FU/mo in its absence (P=.68) and 0.03+/-0.06 FU/mo in the presence of MS versus 0.10+/-0.15 FU/mo in its absence (P=.06). When FPR values were divided into two categories of <0.16 FU/mo or >or=0.16 FU/mo (below/above the 25% upper quartile) or <0.08 FU/mo or >or=0.08 FU/mo (below/above the 50% upper quartile), there was no correlation between FPR categories and the presence of NAFLD with or without MS, only MS, or the absence of both in the first liver transplant biopsy (P=.13). Coexisting NAFLD or MS had no significant effect on the progression of fibrosis after OLT in patients with treated hepatitis C after OLT.
非酒精性脂肪性肝病（NAFLD）和代谢综合征（MS）已被证明在慢性丙型肝炎病毒（HCV）感染患者的疾病进展和治疗反应中发挥作用。本研究的主要目的是评估原位肝移植（OLT）后接受干扰素（IFN）/利巴韦林治疗的复发性HCV患者中，并存的NAFLD和MS对纤维化进展的影响。1998年至2004年，共有418例患者在本中心接受OLT治疗HCV相关肝硬化。35例接受IFN/利巴韦林治疗的复发性HCV患者被纳入研究，这些患者在移植后至少有2次肝活检，间隔至少6个月。确定首次移植后活检时患有MS的患者。对首次和末次移植后活检进行评估，以确定是否存在NAFLD及其严重程度、炎症分级和纤维化分期。计算纤维化进展率（FPR），并以每月纤维化单位（FU/mo）表示。在35例患者中，34%在首次移植后活检时被诊断为NAFLD。存在NAFLD时的平均FPR为0.05±0.16 FU/mo，不存在时为0.07±0.10 FU/mo（P = 0.68）；存在MS时为0.03±0.06 FU/mo，不存在时为0.10±0.15 FU/mo（P = 0.06）。当FPR值分为<0.16 FU/mo或≥0.16 FU/mo（低于/高于上四分位数的25%）或<0.08 FU/mo或≥0.08 FU/mo（低于/高于上四分位数的50%）两类时，FPR类别与首次肝移植活检时是否存在NAFLD伴或不伴MS、仅MS或两者均不存在之间无相关性（P = 0.13）。并存的NAFLD或MS对OLT后接受治疗的丙型肝炎患者OLT后纤维化进展无显著影响。
