Bondini Silvia, Kallman Jillian, Wheeler Angela, Prakash Shivaani, Gramlich Terry, Jondle Daniel M, Younossi Zobair M
Center for Liver Diseases at Inova Fairfax Hospital, Falls Church, VA 22003-6800, USA.
Liver Int. 2007 Jun;27(5):607-11. doi: 10.1111/j.1478-3231.2007.01482.x.
The impact of superimposed non-alcoholic fatty liver disease (NAFLD) is well established in patients with chronic hepatitis C (CH-C), but the impact in patients with chronic hepatitis B (CH-B) is less clear.
This study aims to evaluate the prevalence of NAFLD in patients with CH-B and the association with viral and host factors, particularly in patients with metabolic syndrome (MS).
Data from patients with CH-B was obtained from our databases. Patients with excessive alcohol use were excluded. Hepatitis B virus (HBV) genotyping by INNO-LIPA was available for some patients. The presence of MS was defined according to the Adult Treatment Panel III (ATP III). All biopsies were read by two hepatopathologists using Metavir, modified histologic activity index (MHAI), as well as a NAFLD pathologic protocol. Patients were classified as (1) those without NAFLD; (2) those with simple hepatic steatosis; (3) and those with superimposed non-alcoholic steatohepatitis (NASH). Factors associated with superimposed NAFLD, its subtypes, and hepatic fibrosis were also analysed.
Subjects included 153 HBV patients [66% male, age 50.5+/-27.5 years, body mass index 24.7+/-3.7 kg/m(2), waist 83.2+/-10.9 cm; 8.5% Caucasian, 67% Asian, aspartate aminotransferase (AST) 63.2+/-88.2 IU/l, alanine aminotransferase (ALT) 98.6+/-164.6 IU/l, glucose 111.6+/-50.5 mg/dl, HBV-DNA 1.8 x 10(8)+/-1.9 x 10(6) copies/ml, 7% with MS, 13% with diabetes, 20% with arterial hypertension and 8.5% with dyslipidaemia]. Liver biopsy was available for 64 subjects [19% had superimposed NAFLD, 13% had superimposed NASH, 86% had some degree of fibrosis, and 39% had advanced fibrosis (Ishak >3)]. Patients with HBV and superimposed NASH were significantly older (55 vs. 42 years, P=0.008), more likely to have hypertension (63% vs. 15%, P=0.006) and dyslipidaemia (50% vs. 8%, P=0.006), and had a larger waist circumference (92 vs. 83 cm, P=0.03). The presence of fibrosis was associated with higher waist circumference (84 vs. 80 cm, P=0.03), higher HBV-DNA (1.9 x 10(8) vs. 5 x 10(6) copies/ml, P=0.005), and elevated ALT >40 IU/l (73.6% vs. 33.3%, P=0.02).
The components of MS (obesity, hypertension, and dyslipidaemia) are associated with the presence of NASH in patients with CH-B. The presence of hepatic fibrosis seems to be associated with known host and viral factors as well as the presence of abdominal obesity.
非酒精性脂肪性肝病（NAFLD）叠加在慢性丙型肝炎（CH-C）患者中的影响已得到充分证实，但在慢性乙型肝炎（CH-B）患者中的影响尚不清楚。
本研究旨在评估CH-B患者中NAFLD的患病率及其与病毒和宿主因素的关联，特别是在代谢综合征（MS）患者中。
从我们的数据库中获取CH-B患者的数据。排除有过量饮酒的患者。部分患者可通过INNO-LIPA进行乙型肝炎病毒（HBV）基因分型。根据成人治疗小组III（ATP III）定义MS的存在。所有活检标本由两名肝病病理学家使用梅塔维（Metavir）、改良组织学活动指数（MHAI）以及NAFLD病理方案进行解读。患者被分为：（1）无NAFLD者；（2）单纯性肝脂肪变性者；（3）叠加非酒精性脂肪性肝炎（NASH）者。还分析了与叠加NAFLD及其亚型和肝纤维化相关的因素。
研究对象包括153例HBV患者[男性占66%，年龄50.5±27.5岁，体重指数24.7±3.7kg/m²，腰围83.2±10.9cm；8.5%为白种人，67%为亚洲人，天冬氨酸转氨酶（AST）63.2±88.2IU/L，丙氨酸转氨酶（ALT）98.6±164.6IU/L，血糖111.6±50.5mg/dl，HBV-DNA1.8×10⁸±1.9×10⁶拷贝/ml，7%患有MS，13%患有糖尿病，20%患有动脉高血压，8.5%患有血脂异常]。64例患者进行了肝活检[19%叠加有NAFLD，13%叠加有NASH，86%有一定程度的纤维化，39%有进展性纤维化（伊沙克评分>3）]。患有HBV且叠加有NASH的患者年龄显著更大（55岁对42岁，P = 0.008），更易患高血压（63%对15%，P = 0.006）和血脂异常（50%对8%，P = 0.006），腰围更大（92cm对83cm，P = 0.03）。纤维化的存在与更大的腰围（84cm对80cm，P = 0.03）、更高的HBV-DNA（1.9×10⁸对5×10⁶拷贝/ml，P = 0.005）以及ALT升高>40IU/L（73.6%对33.3%，P = 0.02）相关。
MS的组成成分（肥胖、高血压和血脂异常）与CH-B患者中NASH的存在相关。肝纤维化的存在似乎与已知的宿主和病毒因素以及腹部肥胖的存在相关。
