丙型肝炎病毒和人类免疫缺陷病毒合并感染患者肝脂肪变性的患病率及相关因素：法国国家艾滋病和病毒性肝炎研究机构阿基坦CO3队列研究

Prevalence of and factors associated with hepatic steatosis in patients coinfected with hepatitis C virus and HIV: Agence Nationale pour la Recherche contre le SIDA et les hépatites virales CO3 Aquitaine Cohort.

作者信息

Neau Didier, Winnock Maria, Castéra Laurent, Bail Brigitte Le, Loko Marc-Arthur, Géraut Laurent, Dupon Michel, Ragnaud Jean-Marie, Lacoste Denis, Lafon Marie-Edith, Bioulac-Sage Paulette, Dabis François

机构信息

Fédération des Maladies Infectieuses et Tropicales, Centre Hospitalo-Universitaire, Hôpital Pellegrin, Bordeaux, France.

出版信息

J Acquir Immune Defic Syndr. 2007 Jun 1;45(2):168-73. doi: 10.1097/QAI.0b013e318042e1db.

DOI:10.1097/QAI.0b013e318042e1db

PMID:17527092

Abstract

BACKGROUND

Hepatic steatosis is a common feature in liver biopsies from patients with chronic hepatitis C and is associated with fibrosis progression. Patients with HIV infection and hepatitis C virus (HCV) coinfection have more rapid progression of liver fibrosis than patients with HCV infection alone. The prevalence and factors associated with hepatic steatosis are not well defined in HCV-HIV-coinfected patients.

METHODS

Steatosis was assessed among 148 HCV-HIV-coinfected patients of the Aquitaine Cohort. Steatosis was graded as follows: none, mild (1%-10% of hepatocytes), moderate (11%-30%), severe (31%-60%), and massive (more than 60%). Epidemiologic, clinical, biologic, and therapeutic data were retrieved from the cohort database to investigate the risk factors.

RESULTS

Steatosis was present in 67% of patients (95% confidence interval [CI]: 59% to 74%) and was at least moderate in 30% (95% CI: 23% to 38%). Steatosis was macrovesicular or mixed (macro- and microvesicular) in 40.5% and 52.8% of patients, respectively. Necroinflammatory activity was the only factor independent of steatosis (adjusted odds ratio = 5.3, 95% CI: 1.6 to 17.9). When necroinflammatory activity was removed from the model, HCV genotype 3 and body mass index (BMI) were significantly associated with steatosis.

CONCLUSIONS

Liver inflammation, HCV genotype 3, and BMI are associated with steatosis, a common finding in HCV-HIV-coinfected patients.

摘要

背景

肝脂肪变性是慢性丙型肝炎患者肝活检的常见特征，且与纤维化进展相关。与单纯丙型肝炎病毒（HCV）感染患者相比，人类免疫缺陷病毒（HIV）感染合并HCV感染的患者肝纤维化进展更快。在HCV-HIV合并感染患者中，肝脂肪变性的患病率及相关因素尚未明确。

方法

对阿基坦队列中的148例HCV-HIV合并感染患者进行脂肪变性评估。脂肪变性分级如下：无、轻度（1% - 10%的肝细胞）、中度（11% - 30%）、重度（31% - 60%）和大量（超过60%）。从队列数据库中检索流行病学、临床、生物学和治疗数据以调查危险因素。

结果

67%的患者存在脂肪变性（95%置信区间[CI]：59%至74%），30%的患者至少为中度脂肪变性（95% CI：23%至38%）。分别有40.5%和52.8%的患者脂肪变性为大泡性或混合性（大泡和小泡性）。坏死性炎症活动是唯一与脂肪变性无关的因素（调整优势比 = 5.3，95% CI：1.6至17.9）。当从模型中去除坏死性炎症活动后，HCV基因3型和体重指数（BMI）与脂肪变性显著相关。