Masarone M, La Mura V, Bruno S, Gaeta G B, Vecchione R, Carrino F, Moschella F, Torella R, Persico M
Department of Internal Medicine, Gastroenterology, Hepatology and Endocrinology, Second University of Naples, Naples, Italy.
J Viral Hepat. 2007 Oct;14(10):714-20. doi: 10.1111/j.1365-2893.2007.00861.x.
Liver steatosis, diabetes mellitus and hepatitis C virus (HCV) genotype have been implicated in liver fibrosis in HCV-related chronic active hepatitis (CAH). The aim of this study was to evaluate whether steatosis and diabetes were associated with more severe liver fibrosis in patients with genotype 1b HCV-related CAH. One-hundred and eighty patients (98 men, 82 women; age range 17-68 years; median 51) infected with genotype 1b HCV underwent ultrasound examination and liver biopsy because of elevated levels of serum alanine transaminase. Based on liver histology, patients were divided into three steatosis classes: 1 (involving <33% of hepatocytes), 2 (34-66%) and 3 (>66%). Fibrosis was graded with the Ishak score (range: 0-6). Virological and epidemiologic characteristics, biochemical data, body mass index, and apparent duration of disease were recorded. Diabetes was identified according to American Diabetes Association criteria. The median fibrosis grade was 2 (23 patients had liver cirrhosis) in the three steatosis classes, with no significant differences between classes. At multivariate analysis, fibrosis was significantly related to age, alanine transaminase, diabetes, hepatitis B core antibody, steatohepatitis and grading. At binary logistic regression analysis, only diabetes and fibrosis stage were significantly associated with steatohepatitis. Steatosis was not an independent risk factor for liver disease severity in our CAH/genotype 1b HCV-infected patients. Steatohepatitis was associated as well as diabetes and affected the severity of liver fibrosis.
肝脂肪变性、糖尿病和丙型肝炎病毒（HCV）基因型与丙型肝炎病毒相关慢性活动性肝炎（CAH）中的肝纤维化有关。本研究的目的是评估脂肪变性和糖尿病是否与1b型HCV相关CAH患者更严重的肝纤维化有关。180例感染1b型HCV的患者（98例男性，82例女性；年龄范围17 - 68岁；中位数51岁）因血清丙氨酸转氨酶水平升高接受了超声检查和肝活检。根据肝脏组织学，患者被分为三个脂肪变性等级：1级（累及<33%的肝细胞）、2级（34 - 66%）和3级（>66%）。纤维化采用Ishak评分进行分级（范围：0 - 6）。记录病毒学和流行病学特征、生化数据、体重指数和疾病的表观持续时间。根据美国糖尿病协会标准确定糖尿病。三个脂肪变性等级中的纤维化中位数等级为2级（23例患者有肝硬化），各等级之间无显著差异。在多变量分析中，纤维化与年龄、丙氨酸转氨酶、糖尿病、乙肝核心抗体、脂肪性肝炎和分级显著相关。在二元逻辑回归分析中，只有糖尿病和纤维化阶段与脂肪性肝炎显著相关。在我们感染CAH/1b型HCV的患者中，脂肪变性不是肝病严重程度的独立危险因素。脂肪性肝炎与糖尿病一样相关，并影响肝纤维化的严重程度。
