Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Clin Gastroenterol Hepatol. 2018 Apr;16(4):575-583.e2. doi: 10.1016/j.cgh.2017.09.044. Epub 2017 Sep 29.
BACKGROUND & AIMS: The interaction between chronic hepatitis B (CHB) and hepatic steatosis is poorly understood. We investigated whether measurement of controlled attenuation parameter (CAP), a non-invasive method to quantify steatosis, can assist in monitoring patients with CHB.
We performed transient elastography, to measure liver stiffness, and made CAP measurements in 1606 patients with CHB (898 treated with nucleoside analogues, for a median 75.4 months) in Hong Kong, from January 2015 through September 2016. We also collected information on patients' medical history, current treatment, and smoking and alcohol habits, anthropometric measurements. We obtained and analyzed fasting blood samples. Severe liver fibrosis was defined, according to guidelines, as a liver stiffness measurement greater than 9.0 kPa in patients with normal level of alanine aminotransferase (ALT) or greater than 12.0 kPa in patients with a level of ALT 1-5-fold the upper limit of normal. Steatosis was defined as a CAP measurement of 248 dB/m or more, and severe steatosis as a CAP measurement or 280 dB/m more. We performed multivariate analysis to identify factors associated with severe fibrosis.
The prevalence of steatosis, severe steatosis, and severe fibrosis in our cohort were 40.8%, 22.6%, and 14.1%, respectively. A higher proportion of patients with severe steatosis had severe fibrosis (21.4% vs 11.9% in the overall cohort; P < .001). In multivariate analysis, severe steatosis was associated with severe fibrosis in treatment-naïve patients (odds ratio, 3.60, 95% CI, 1.21-10.75) and in patients receiving treatment (odds ratios: 1.95 [1.06-3.61] for 3 or more years of treatment, 2.28 [1.13-4.61] for 5 or more years of treatment, and 2.79 [1.17-6.62] for 7 or more years of treatment). With every increase in CAP value of 10 dB/m, the risk of severe fibrosis increased by 15% in treatment-naïve patients and by 7%-8% in patients receiving treatment.
Severe steatosis, determined by CAP measurement, is associated with severe fibrosis in treatment-naïve patients with CHB and in patients receiving treatment. Longitudinal studies are required to investigate if steatosis control, in addition to antiviral treatment, can reduce the burden fibrosis in patients with CHB.
慢性乙型肝炎（CHB）与肝脂肪变性之间的相互作用尚不清楚。我们研究了一种非侵入性方法来定量肝脂肪变性的受控衰减参数（CAP）的测量是否可以帮助监测 CHB 患者。
我们对 2015 年 1 月至 2016 年 9 月期间在香港的 1606 例 CHB 患者（898 例接受核苷类似物治疗，中位治疗时间为 75.4 个月）进行了瞬时弹性成像，以测量肝硬度，并进行了 CAP 测量。我们还收集了患者的病史、当前治疗情况、吸烟和饮酒习惯以及人体测量学数据。我们采集并分析了空腹血样。根据指南，将严重肝纤维化定义为 ALT 正常水平的患者中肝硬度测量值大于 9.0 kPa，或 ALT 水平为正常值上限 1-5 倍的患者中肝硬度测量值大于 12.0 kPa。将脂肪变性定义为 CAP 测量值为 248 dB/m 或更高，严重脂肪变性定义为 CAP 测量值为 280 dB/m 或更高。我们进行了多变量分析以确定与严重纤维化相关的因素。
在我们的队列中，脂肪变性、严重脂肪变性和严重纤维化的患病率分别为 40.8%、22.6%和 14.1%。患有严重脂肪变性的患者中严重纤维化的比例更高（21.4%比总体队列中的 11.9%；P<.001）。多变量分析显示，严重脂肪变性与未接受治疗的患者的严重纤维化相关（比值比，3.60，95%置信区间，1.21-10.75）和接受治疗的患者（治疗 3 年以上的比值比：1.95 [1.06-3.61]，治疗 5 年以上的比值比：2.28 [1.13-4.61]，治疗 7 年以上的比值比：2.79 [1.17-6.62]）。未接受治疗的患者中，CAP 值每增加 10 dB/m，严重纤维化的风险增加 15%，而接受治疗的患者中，严重纤维化的风险增加 7%-8%。
CAP 测量确定的严重脂肪变性与未接受治疗的 CHB 患者和接受治疗的患者的严重纤维化相关。需要进行纵向研究，以探讨除抗病毒治疗外，控制脂肪变性是否可以降低 CHB 患者的纤维化负担。
