Rafi Hanane, Kabbaj Nawal, Salihoun Mouna, Amrani Laila, Acharki Mohamed, Guedira Mouad, Nya Mhamed, Amrani Naima
EFD-Hepatogastroenterology Unit, Ibn Sina Hospital, UM5S, Rabat, Morocco.
Arab J Gastroenterol. 2011 Sep;12(3):136-8. doi: 10.1016/j.ajg.2011.07.003. Epub 2011 Sep 15.
Hepatic steatosis seems to be frequently found histopathologically in chronic hepatitis C virus (HCV)-infected patients. The aim of this study is to determine the influence of steatosis on HCV disease severity (fibrosis) and to evaluate its impact on sustained virological response (SVR) to antiviral therapy.
From April 2008 to April 2010, 148 consecutive adults (87 females (59%) and 61 males (41%); mean age: 55.2 years) with HCV admitted for liver biopsy were included in this retrospective study. At least one element of metabolic syndrome was identified in all cases: Obesity (n=44), hyperlipidaemia (n=40), hypertension (n=29) and diabetes (n=21). Liver fibrosis was classified according to the Metavir score and hepatic steatosis described as following: S0: absent; S1: minimal (<30%); S2: moderate (30-60%); and S3: severe (>60%). Patients were divided into two groups: S0S1 group (absent or minimal steatosis) and S2S3 group (moderate to severe steatosis). Of the 148 patients, 53 were treated with pegylated interferon and ribavirin combination therapy.
Steatosis was found in 40 patients (27%): S1 in 72.5%, S2 in 17.5% and S3 in 10% of cases. The distribution of patients according to the degree of fibrosis was as follows: in the S0S1 group, F1=12.4%, F2=36.5%, F3=21.1% and F4=21.1% and in the S2S3 group, F1=9%, F2=45.5%, F3=18.2% and F4=27.3%. There was no difference between the two groups regarding the degree of fibrosis (p≥0.80). The rate of SVR was 64%: 63% in the S0S1 group and 75% in the S2S3 group. The difference was not statistically significant (p=1).
Steatosis was found in 25% of cases. Liver steatosis in chronic hepatitis C is not a negative prognostic factor of response to combined antiviral therapy. These results must be confirmed by a large series of patients.
在慢性丙型肝炎病毒（HCV）感染患者中，肝脂肪变性似乎在组织病理学上经常被发现。本研究的目的是确定脂肪变性对HCV疾病严重程度（纤维化）的影响，并评估其对抗病毒治疗持续病毒学应答（SVR）的影响。
2008年4月至2010年4月，148例因HCV接受肝活检的连续成年患者（87例女性（59%）和61例男性（41%）；平均年龄：55.2岁）纳入本回顾性研究。所有病例均至少确定有一项代谢综合征要素：肥胖（n = 44）、高脂血症（n = 40）、高血压（n = 29）和糖尿病（n = 21）。肝纤维化根据梅塔维（Metavir）评分分类，肝脂肪变性描述如下：S0：无；S1：轻度（<30%）；S2：中度（30 - 60%）；S3：重度（>60%）。患者分为两组：S0S1组（无或轻度脂肪变性）和S2S3组（中度至重度脂肪变性）。148例患者中，53例接受聚乙二醇干扰素和利巴韦林联合治疗。
40例患者（27%）发现有脂肪变性：72.5%为S1，17.5%为S2，10%为S3。根据纤维化程度的患者分布如下：在S0S1组中，F1 = 12.4%，F2 = 36.5%，F3 = 21.1%，F4 = 21.1%；在S2S3组中，F1 = 9%，F2 = 45.5%，F3 = 18.2%，F4 = 27.3%。两组在纤维化程度方面无差异（p≥0.80）。SVR率为64%：S0S1组为63%，S2S3组为75%。差异无统计学意义（p = 1）。
25%的病例发现有脂肪变性。慢性丙型肝炎中的肝脂肪变性不是联合抗病毒治疗应答的不良预后因素。这些结果必须通过大量患者的研究来证实。
