Department of Medicine I, University of Bonn, Bonn, Germany.
Department of Medicine I, University of Frankfurt, Frankfurt, Germany.
Liver Int. 2019 Aug;39(8):1514-1520. doi: 10.1111/liv.14107. Epub 2019 Apr 5.
Severe hepatic steatosis shows a high prevalence and contributes to morbidity and mortality in human immunodeficiency virus (HIV) infected patients. Known risk factors include obesity, dyslipidaemia and features of metabolic syndrome. Fibroblast growth factor 21 (FGF-21) is involved with hepatic glucose and lipid metabolism. This study aimed to evaluate FGF-21 as a biomarker for severe hepatic steatosis in non-obese HIV-infected patients.
This is a prospective, cross-sectional, monocentric study including HIV-infected out-patients. Hepatic steatosis was measured via controlled attenuation parameter (CAP) using FibroScan 502 touch (ECHOSENS, France). Severe hepatic steatosis was defined at CAP ≥ 253 dB/m. Peripheral blood samples were collected and plasma was analysed for FGF-21. Demographic and clinical characteristics were collected from patient's health records.
In total, 73 non-obese HIV-monoinfected patients were included in this study. Prevalence of severe hepatic steatosis was 41%. Patients with severe hepatic steatosis showed significantly higher levels of FGF-21. Univariate analysis revealed FGF-21, BMI, hyperlipidaemia, ALT levels and arterial hypertension as significant, while multivariate analysis showed only FGF-21, arterial hypertension and ALT levels as significant independent risk factors for severe hepatic steatosis.
This study presents FGF-21 as an independent and stronger predictor of severe hepatic steatosis than blood lipids in HIV-infected patients. Moreover, arterial hypertension and ALT levels predict severe steatosis even in non-obese HIV-monoinfected patients. Furthermore, this study supports existing metabolic risk factors and expands them to non-obese HIV-infected patients.
严重肝脂肪变性在人类免疫缺陷病毒（HIV）感染患者中发病率高，与发病率和死亡率有关。已知的危险因素包括肥胖、血脂异常和代谢综合征的特征。成纤维细胞生长因子 21（FGF-21）参与肝脏的糖和脂质代谢。本研究旨在评估 FGF-21 作为非肥胖 HIV 感染患者严重肝脂肪变性的生物标志物。
这是一项前瞻性、横断面、单中心研究，纳入了 HIV 感染门诊患者。使用 FibroScan 502 touch（ECHOSENS，法国）通过受控衰减参数（CAP）测量肝脂肪变性。CAP≥253dB/m 定义为严重肝脂肪变性。采集外周血样并分析血浆中的 FGF-21。从患者的健康记录中收集人口统计学和临床特征。
本研究共纳入 73 例非肥胖 HIV 单一感染者。严重肝脂肪变性的患病率为 41%。患有严重肝脂肪变性的患者 FGF-21 水平明显更高。单因素分析显示 FGF-21、BMI、高脂血症、ALT 水平和动脉高血压为显著相关因素，而多因素分析显示仅 FGF-21、动脉高血压和 ALT 水平为严重肝脂肪变性的独立危险因素。
本研究表明 FGF-21 是 HIV 感染患者严重肝脂肪变性的独立且更强的预测因子，比血脂更有意义。此外，动脉高血压和 ALT 水平甚至可以预测非肥胖 HIV 单一感染者的严重脂肪变性。此外，本研究支持现有的代谢危险因素，并将其扩展到非肥胖 HIV 感染患者。
