Department of Family Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
J Gastroenterol Hepatol. 2011 Jan;26 Suppl 1:96-101. doi: 10.1111/j.1440-1746.2010.06542.x.
Hepatic steatosis is commonly seen in patients with chronic hepatitis C virus (HCV) infection, and the prevalence is much higher prevalence than in the general population or in patients with chronic hepatitis B. Hepatic steatosis in patients with chronic hepatitis C can be due to alcohol consumption and host metabolic factors such as high body mass index (BMI), obesity, hyperlipidemia, metabolic syndrome and diabetes mellitus in which insulin resistance plays an important role. However, in genotype 3 HCV infection, hepatic steatosis can result from direct viral cytopathic effect. Demographic and clinical characteristics associated with hepatic steatosis in patients with chronic hepatitis C including older age, higher BMI, more genotype 3 infection, and higher mean serum levels of triglyceride, alanine aminotransferase and γ-glutamyl transpeptidase. The clinical relevance of hepatic steatosis in patients with chronic hepatitis C includes a close correlation with hepatic fibrosis, and a poor response to combination peginterferon and ribavirin treatment. In addition, hepatic steatosis has been reported to associate with increased frequency of hepatocellular carcinoma in patients with chronic HCV infection. Whether life style modification such as weight reduction or adding an insulin resistance reducing agent such as metformin or thiazolidinediones combined with current standard peginterferon plus ribavirin treatment will benefit to the chronic hepatitis C patients with hepatic steatosis deserves further evaluation.
慢性丙型肝炎病毒（HCV）感染患者常合并肝脂肪变性，其发生率显著高于普通人群或慢性乙型肝炎患者。HCV 相关肝脂肪变性的发生可能与饮酒及宿主代谢因素相关，如高体重指数（BMI）、肥胖、高脂血症、代谢综合征和糖尿病，其中胰岛素抵抗起重要作用。然而，在基因 3 型 HCV 感染中，肝脂肪变性可能由直接的病毒细胞病变作用所致。与慢性丙型肝炎患者肝脂肪变性相关的临床特征包括年龄较大、BMI 较高、更多的基因 3 型感染及较高的血清甘油三酯、丙氨酸氨基转移酶和γ-谷氨酰转肽酶平均水平。慢性丙型肝炎患者肝脂肪变性的临床意义包括与肝纤维化密切相关，以及对聚乙二醇干扰素联合利巴韦林治疗的应答不佳。此外，已有研究报道肝脂肪变性与慢性 HCV 感染患者肝细胞癌的发生频率增加相关。减轻体重等生活方式的改变或联合目前标准的聚乙二醇干扰素加利巴韦林治疗加用胰岛素抵抗减轻剂（如二甲双胍或噻唑烷二酮类）是否会使合并肝脂肪变性的慢性丙型肝炎患者获益，尚需进一步评估。
