Hsieh Meng-Hsuan, Lee Li-Po, Hsieh Ming-Yen, Tsai Kun-Bow, Huang Jee-Fu, Hou Nai-Jen, Chen Shinn-Chern, Lin Zu-Yau, Hsieh Ming-Yuh, Wang Liang-Yen, Dai Chia-Yen, Chuang Wan-Long, Yu Ming-Lung
Department of Occupational and Environmental Medicine, Kaohsiung Municipal HsiaoKang Hospital, Kaohsiung, Taiwan.
Jpn J Infect Dis. 2007 Nov;60(6):377-81.
Hepatitis C virus (HCV) infection has been associated with hepatic steatosis. However, the role of hepatic steatosis in the pathogenesis of HCV infection remains controversial. In our study, 425 consecutive HCV-viremic patients with biopsy-proven chronic hepatitis C (male, 264; mean age, 49.0 years) were enrolled. Scoring of hepatic steatosis was based on the method described by Kleiner and on histopathology performed using the Knodell and Scheuer systems. HCV RNA level and genotypes were determined at the time of biopsy. Hepatic steatosis was observed in 30.8% of patients, including 113 mild, 16 moderate, and 3 with severe hepatic steatosis. Patients with a body mass index (BMI) <23 kg/m(2) had a significantly lower rate (18.9%) of hepatic steatosis (P<0.001). Hepatic steatosis did not correlate with the hepatic necroinflammatory activity, but was related to hepatic fibrosis (P=0.035). Hepatic steatosis was also not associated with HCV RNA level, and the distribution was similar between patients with HCV genotype 1 and genotype 2 infection. According to multivariate analysis, BMI is the strongest risk factor associated with hepatic steatosis, followed by hepatic fibrosis and triglyceride level with odds ratios (95% confidence intervals) of 2.51 (1.49-4.23), 2.06 (1.14-3.70), and 1.02 (1.01-1.03), respectively. Hepatic steatosis was associated with being overweight, hepatic fibrosis, and triglyceride level in chronic hepatitis C.
丙型肝炎病毒（HCV）感染与肝脂肪变性有关。然而，肝脂肪变性在HCV感染发病机制中的作用仍存在争议。在我们的研究中，纳入了425例经活检证实为慢性丙型肝炎的HCV病毒血症患者（男性264例，平均年龄49.0岁）。肝脂肪变性的评分基于Kleiner描述的方法，并使用Knodell和Scheuer系统进行组织病理学检查。在活检时测定HCV RNA水平和基因型。30.8%的患者观察到肝脂肪变性，其中轻度肝脂肪变性113例，中度16例，重度3例。体重指数（BMI）<23 kg/m²的患者肝脂肪变性发生率显著较低（18.9%）（P<0.001）。肝脂肪变性与肝脏坏死性炎症活动无关，但与肝纤维化有关（P=0.035）。肝脂肪变性也与HCV RNA水平无关，HCV基因型1和基因型2感染患者之间的分布相似。根据多变量分析，BMI是与肝脂肪变性相关的最强危险因素，其次是肝纤维化和甘油三酯水平，优势比（95%置信区间）分别为2.51（1.49 - 4.23）、2.06（1.14 - 3.70）和1.02（1.01 - 1.03）。在慢性丙型肝炎中，肝脂肪变性与超重、肝纤维化和甘油三酯水平有关。
