Department of Medicine and Medical Specialties, Metabolic Clinic, Infectious and Tropical Disease Unit, University of Modena and Reggio Emilia, Modena, Italy.
Arch Med Res. 2011 Nov;42(8):690-7. doi: 10.1016/j.arcmed.2011.12.009. Epub 2012 Jan 4.
To promote our understanding of the relative contribution of metabolic and viral factors, the independent predictors of fatty liver and insulin resistance (IR) were assessed by comparing patients with nonalcoholic fatty liver disease (NAFLD) to individuals with virus-associated fatty liver disease (VAFLD): human immunodeficiency virus (HIV)-VAFLD, hepatitis C virus (HCV)-VAFLD and HIV-HCV-VAFLD.
One hundred eighty eight consecutive patients with viral infections (103 HIV, 85 patients with HCV genotype 1 infection: 45 mono-infected and 40 HIV/HCV co-infected) with or without steatosis and 126 NAFLD patients were analyzed. Steatosis was diagnosed by ultrasonography. To assess the odds ratio (OR) of steatosis and IR, HCV and NAFLD, respectively, were used as the reference values. IR was evaluated through homeostasis model (HOMA) and the metabolic syndrome (MetS) using standard criteria.
The prevalence of VAFLD was 47%. Multivariate logistic regression analysis was carried out using HCV as the reference. VAFLD was predicted by HIV, HIV/HCV, female gender, waist circumference (WC) and HOMA (OR = 3.99, 3.76, 2.80, 1.08 and 1.18). According to multiple linear regression using NAFLD as the reference, IR was predicted by HCV, HIV and HIV/HCV, WC, triglycerides (coefficient beta = 2.25, 0.99, 1.86, 0.08, 0.05, respectively). In linear models, for any given number of components of MetS, HCV and HCV/HIV-associated fatty liver disease had greater HOMA compared to NAFLD (p <0.001).
Whereas HIV confers a higher risk of steatosis, VAFLD is associated with higher IR than NAFLD and such an effect is specifically linked to HCV rather than to HIV infection.
为了增进我们对代谢和病毒因素相对贡献的理解，通过比较非酒精性脂肪性肝病（NAFLD）患者和病毒相关脂肪性肝病（VAFLD）患者，评估了独立预测脂肪肝和胰岛素抵抗（IR）的因素：人类免疫缺陷病毒（HIV）-VAFLD、丙型肝炎病毒（HCV）-VAFLD 和 HIV-HCV-VAFLD。
分析了 188 例连续的病毒感染患者（103 例 HIV、85 例 HCV 基因型 1 感染者：45 例单纯感染和 40 例 HIV/HCV 混合感染），这些患者均有或无脂肪变性，以及 126 例 NAFLD 患者。脂肪变性通过超声检查诊断。为了评估发生脂肪变性和 IR 的比值比（OR），分别以 HCV 和 NAFLD 为参考值。IR 通过稳态模型（HOMA）和代谢综合征（MetS）用标准标准进行评估。
VAFLD 的患病率为 47%。使用 HCV 作为参考进行多变量逻辑回归分析。VAFLD 由 HIV、HIV/HCV、女性、腰围（WC）和 HOMA 预测（OR=3.99、3.76、2.80、1.08 和 1.18）。根据以 NAFLD 为参考的多元线性回归，IR 由 HCV、HIV 和 HIV/HCV、WC、甘油三酯预测（系数β=2.25、0.99、1.86、0.08、0.05）。在线性模型中，对于 MetS 的任何给定数量的组成部分，HCV 和 HCV/HIV 相关的脂肪性肝病的 HOMA 均高于 NAFLD（p<0.001）。
虽然 HIV 会增加发生脂肪变性的风险，但与 NAFLD 相比，VAFLD 与更高的 IR 相关，这种影响与 HCV 相关，而不是与 HIV 感染相关。
