Rodríguez-Torres Maribel, Govindarajan Sugantha, Solá Ricard, Clumeck Nathan, Lissen Eduardo, Pessôa Mário, Buggisch Peter, Main Janice, Depamphilis Jean, Dieterich Douglas T
Fundacion de Investigacion de Diego, Avenida De Diego #359, Santurce, PR 09909, USA.
J Hepatol. 2008 May;48(5):756-64. doi: 10.1016/j.jhep.2008.01.015. Epub 2008 Feb 7.
BACKGROUND/AIMS: Hepatic steatosis is caused by the complex interaction of host and viral factors, such as metabolic syndrome (MS), alcoholism and HCV genotype, and in HIV-HCV co-infected patients, antiretroviral therapy may also play a role. A large population of patients from the AIDS Pegasys Ribavirin International Co-infection Trial (APRICOT) had paired liver biopsies interpreted and graded for steatosis along with lipid measurements and anthropometric data.
We analyzed these patients to determine the prevalence of steatosis, baseline factors associated with steatosis, effect of steatosis in HCV therapy efficacy and the impact of anti-HCV treatment on steatosis.
A total of 65/283 (23%) patients with paired biopsies were positive for steatosis. Patients with steatosis were significantly more likely to have HCV genotype 3, bridging fibrosis/cirrhosis, higher HCV RNA levels, increased triglycerides and lower cholesterol levels. The only different body measurement was neck circumference which was greater in patients with steatosis and significantly decreased from baseline during the study. Hip circumference was predictive of steatosis at baseline.
Factors associated to the metabolic syndrome are important in co-infected patients. Treatment outcome affected steatosis in that viral eradication reduced steatosis in genotype 3 patients, but altogether steatosis did not affect efficacy of treatment in any genotype.
背景/目的：肝脂肪变性是由宿主和病毒因素的复杂相互作用引起的，如代谢综合征（MS）、酗酒和丙型肝炎病毒（HCV）基因型，在人类免疫缺陷病毒（HIV）-HCV合并感染患者中，抗逆转录病毒疗法也可能起作用。来自艾滋病派罗欣利巴韦林国际合并感染试验（APRICOT）的大量患者进行了配对肝脏活检，对肝脂肪变性进行了解读和分级，并进行了血脂测量和人体测量数据收集。
我们分析了这些患者，以确定肝脂肪变性的患病率、与肝脂肪变性相关的基线因素、肝脂肪变性对HCV治疗疗效的影响以及抗HCV治疗对肝脂肪变性的影响。
共有65/283（23%）例进行配对活检的患者肝脂肪变性呈阳性。肝脂肪变性患者更有可能感染HCV 3型、存在桥接纤维化/肝硬化、HCV RNA水平较高、甘油三酯升高和胆固醇水平较低。唯一不同的身体测量指标是颈围，肝脂肪变性患者的颈围更大，且在研究期间从基线水平显著下降。臀围是基线时肝脂肪变性的预测指标。
与代谢综合征相关的因素在合并感染患者中很重要。治疗结果影响肝脂肪变性，因为病毒根除可减轻3型基因型患者的肝脂肪变性，但总体而言，肝脂肪变性并不影响任何基因型的治疗效果。
