Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea.
Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea.
Hepatology. 2017 Mar;65(3):828-835. doi: 10.1002/hep.28917. Epub 2016 Dec 30.
The presence of an association between chronic hepatitis B virus (HBV) infection and fatty liver is controversial. We examined the association between HBV infection and the development of nonalcoholic fatty liver disease (NAFLD). We conducted a cohort study of 83,339 participants without NAFLD at baseline who underwent serologic testing for hepatitis B surface antigen (HBsAg) between 2002 and 2006 and were followed annually or biennially until December 2014. NAFLD was defined as the presence of ultrasonographic fatty liver in the absence of excessive alcohol use or other identifiable causes. We used a parametric Cox model to estimate adjusted hazard ratios with 95% confidence intervals of incident NAFLD. During 484,736.1 person-years of follow-up, 20,200 incident NAFLD cases were identified. In models adjusted for age, sex, year of visit, smoking status, alcohol intake, regular exercise, education level, and body mass index, the adjusted hazard ratio (95% confidence interval) for incident NAFLD comparing HBsAg-positive to HBsAg-negative participants was 0.83 (0.73-0.94). After introducing HBV infection and confounders (including homeostasis model assessment of insulin resistance and metabolic factors) as time-dependent exposures, the association between HBV infection and decreased risk of incident NAFLD was attenuated but persisted. These associations were consistently observed across clinically relevant, prespecified subgroups.
In this large cohort of apparently healthy Korean adults, HBsAg seropositivity was associated with lower risk of developing NAFLD, indicating a possible effect of HBV infection on the pathogenesis of NAFLD development. (Hepatology 2017;65:828-835).
探讨乙型肝炎病毒（HBV）感染与非酒精性脂肪性肝病（NAFLD）的相关性。
我们进行了一项队列研究，纳入了 83339 例基线时无 NAFLD 且于 2002 年至 2006 年间接受乙型肝炎表面抗原（HBsAg）血清学检测的参与者，并在之后每年或每 2 年随访一次，直至 2014 年 12 月。NAFLD 的定义为超声检查提示存在脂肪肝而无过量饮酒或其他可识别病因。我们采用参数 Cox 模型估算了无事件发生 NAFLD 的校正风险比（HR）及其 95%置信区间。
在 484736.1 人年的随访期间，共发生 20200 例新发 NAFLD。在校正年龄、性别、随访年份、吸烟状况、饮酒量、规律运动、教育程度和体质指数后，与 HBsAg 阴性者相比，HBsAg 阳性者发生 NAFLD 的校正 HR（95%CI）为 0.83（0.73-0.94）。在引入 HBV 感染和混杂因素（包括稳态模型评估的胰岛素抵抗和代谢因素）作为时变暴露因素后，HBV 感染与新发 NAFLD 风险降低之间的关联减弱，但仍存在关联。这些关联在临床上有意义的、预先指定的亚组中一致存在。
在这项来自韩国的大型队列研究中，HBsAg 阳性与发生 NAFLD 的风险较低相关，提示 HBV 感染可能对 NAFLD 发生的发病机制有影响。
