Sumida Yoshio, Kanemasa Kazuyuki, Imai Shunsuke, Mori Kojiro, Tanaka Saiyu, Shimokobe Hideto, Kitamura Yoko, Fukumoto Kohei, Kakutani Akira, Ohno Tomoyuki, Taketani Hiroyoshi, Seko Yuya, Ishiba Hiroshi, Hara Tasuku, Okajima Akira, Yamaguchi Kanji, Moriguchi Michihisa, Mitsuyoshi Hironori, Yasui Kohichiroh, Minami Masahito, Itoh Yoshito
Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan,
J Gastroenterol. 2015 Sep;50(9):996-1004. doi: 10.1007/s00535-015-1039-2. Epub 2015 Jan 28.
Clinical data regarding Helicobacter pylori (H. pylori) infection in nonalcoholic fatty liver disease (NAFLD) are limited. The aim was to evaluate H. pylori infection in patients with NAFLD and its association with disease severity.
One hundred and thirty patients with biopsy-proven NAFLD [43 with nonalcoholic fatty liver (NAFL) and 87 with nonalcoholic steatohepatitis (NASH)] were recruited for blood samples for anti-H. pylori immunoglobulin G (IgG) and standard biochemical tests were obtained after overnight fasting. Glucose tolerance was evaluated by 75-g oral glucose tolerance test. Liver biopsies were scored for NAFLD activity score (NAS), fibrosis and iron deposits.
H. pylori IgG seropositivity was found in 40 % of patients overall. The prevalence of NASH was significantly higher in the patients with H. pylori IgG seropositivity (81 %) than in those without (58 %, p = 0.008). Glucose intolerance was similar between the two groups. The total NAS and the grade of hepatocyte ballooning were higher in the patients with H. pylori IgG seropositivity than in those without, while the hepatic iron grade was lower in the patients with H. pylori IgG seropositivity than in those without. H. pylori infection (p = 0.030), female gender (p = 0.029), and NAFIC score ≥ 2 points (p < 0.001) could independently predict NASH in logistic regression analysis, independent of age, obesity and glucose tolerance.
The association of H. pylori seropositivity with hepatocyte ballooning suggests that H. pylori infection may represent another contributing factor in the progression from NAFL to NASH. Eradicating H. pylori infection may have therapeutic prospects in NASH treatment.
关于非酒精性脂肪性肝病（NAFLD）中幽门螺杆菌（H. pylori）感染的临床数据有限。目的是评估NAFLD患者中的H. pylori感染及其与疾病严重程度的关联。
招募了130例经活检证实为NAFLD的患者[43例非酒精性脂肪肝（NAFL）患者和87例非酒精性脂肪性肝炎（NASH）患者]，采集血液样本检测抗H. pylori免疫球蛋白G（IgG），并在过夜禁食后进行标准生化检测。通过75克口服葡萄糖耐量试验评估葡萄糖耐量。对肝活检组织进行非酒精性脂肪性肝病活动评分（NAS）、纤维化和铁沉积评分。
总体上40%的患者H. pylori IgG血清学呈阳性。H. pylori IgG血清学呈阳性的患者中NASH的患病率（81%）显著高于血清学呈阴性的患者（58%，p = 0.008）。两组之间的葡萄糖不耐受情况相似。H. pylori IgG血清学呈阳性的患者的总NAS和肝细胞气球样变分级高于血清学呈阴性的患者，而H. pylori IgG血清学呈阳性的患者的肝铁分级低于血清学呈阴性的患者。在逻辑回归分析中，独立于年龄、肥胖和葡萄糖耐量，H. pylori感染（p = 0.030）、女性（p = 0.029）和NAFIC评分≥2分（p < 0.001）可独立预测NASH。
H. pylori血清学阳性与肝细胞气球样变的关联表明，H. pylori感染可能是NAFL进展为NASH的另一个促成因素。根除H. pylori感染在NASH治疗中可能具有治疗前景。
