Sterling Richard K, Contos Melissa J, Smith Paula G, Stravitz R Todd, Luketic Velimir A, Fuchs Michael, Shiffman Mitchell L, Sanyal Arun J
Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia 23298-0341, USA.
Hepatology. 2008 Apr;47(4):1118-27. doi: 10.1002/hep.22134.
Hepatic steatosis has been reported in human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection. However, the features of steatohepatitis, including cytologic ballooning and pericellular fibrosis, its risk factors, and the impact on disease severity in such patients are unknown. To assess this, we prospectively reviewed liver histology in consecutive coinfected patients to define the prevalence and severity of the features of steatohepatitis, its risk factors, and its impact on the severity of liver disease. A total of 222 subjects (74% male, mean age 45, 78% African American, 90% genotype 1) were studied. The mean body mass index (BMI) was 26, and 18% had a BMI >30. The prevalence of risk factors for steatosis were: diabetes (31%), hypertension (15%), dyslipidemia (8%), metabolic syndrome (9%), and alcohol abuse (21%). Steatosis was present in 23% and steatohepatitis was present in 17%. The steatosis was mild (5%-33%) in 19%, and moderate to severe (>33%) in 4%. Cytologic ballooning and pericellular fibrosis were present in 30% and 13%, respectively. The mean Ishak score was 6.9, and 33% had bridging fibrosis or cirrhosis. Both steatosis and cytologic ballooning were associated with BMI, metabolic syndrome, and insulin resistance, and presence of either was strongly associated with advanced fibrosis (P < 0.0001). By multiple logistic regressions, the following associations were identified: increased BMI, diabetes, and genotype 3 with steatosis; diabetes with cytologic ballooning; and longer duration of infection with steatohepatitis.
Steatosis and steatohepatitis are present in 23% and 30%, respectively, of patients with HIV/HCV coinfection, and both are associated with an increased risk of having advanced fibrosis. Although we did identify genotype 3, increased BMI, and diabetes as risk factors, we found no independent association with antiretroviral therapy.
据报道，人类免疫缺陷病毒（HIV）/丙型肝炎病毒（HCV）合并感染患者中存在肝脂肪变性。然而，脂肪性肝炎的特征，包括细胞气球样变和细胞周围纤维化、其危险因素以及对这类患者疾病严重程度的影响尚不清楚。为了评估这一点，我们对连续的合并感染患者的肝脏组织学进行了前瞻性回顾，以确定脂肪性肝炎特征的患病率和严重程度、其危险因素以及对肝脏疾病严重程度的影响。共研究了222名受试者（74%为男性，平均年龄45岁，78%为非裔美国人，90%为基因1型）。平均体重指数（BMI）为26，18%的人体重指数>30。脂肪变性危险因素的患病率分别为：糖尿病（31%）、高血压（15%）、血脂异常（8%）、代谢综合征（9%）和酒精滥用（21%）。23%的患者存在脂肪变性，17%的患者存在脂肪性肝炎。19%的患者脂肪变性为轻度（5%-33%），4%的患者为中度至重度（>33%）。细胞气球样变和细胞周围纤维化分别存在于30%和13%的患者中。平均伊沙克评分6.9，33%的患者有桥接纤维化或肝硬化。脂肪变性和细胞气球样变均与BMI、代谢综合征和胰岛素抵抗相关，二者中的任何一项均与晚期纤维化密切相关（P<0.0001）。通过多元逻辑回归分析，确定了以下关联：BMI增加、糖尿病和基因3型与脂肪变性相关；糖尿病与细胞气球样变相关；感染持续时间较长与脂肪性肝炎相关。
HIV/HCV合并感染患者中分别有23%和30%存在脂肪变性和脂肪性肝炎，二者均与晚期纤维化风险增加相关。虽然我们确实确定基因3型、BMI增加和糖尿病为危险因素，但未发现与抗逆转录病毒治疗存在独立关联。
