比较 HIV 感染者和未感染者中肝脂肪变性的患病率、严重程度和危险因素。
Comparison of the prevalence, severity, and risk factors for hepatic steatosis in HIV-infected and uninfected people.
机构信息
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3910 Powelton Ave 4nd Floor, Ste. 411F, Philadelphia, PA, 19104, USA.
Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
出版信息
BMC Gastroenterol. 2019 Apr 15;19(1):52. doi: 10.1186/s12876-019-0969-1.
BACKGROUND
Hepatic steatosis is prevalent in Western countries, but few studies have evaluated whether the frequency and severity of steatosis are greater in the setting of HIV infection. We compared the prevalence and severity of hepatic steatosis between HIV-infected (HIV+) and uninfected persons and identified factors associated with greater steatosis severity within both groups.
METHODS
We performed a cross-sectional study among participants without cardiovascular disease who participated in a substudy of the Veterans Aging Cohort Study. Hepatic steatosis was defined by noncontrast computed tomography (CT) liver-to-spleen (L/S) attenuation ratio < 1.0. Multivariable linear regression was used to: 1) evaluate the association between HIV infection and severity of hepatic steatosis, as measured by absolute liver attenuation, and 2) identify factors associated with greater severity of steatosis, by HIV status.
RESULTS
Among 268 participants (median age, 55 years; 99% male; 79% black; 23% obese; 64% HIV+ [91% on antiretroviral therapy]), the overall prevalence of steatosis was 7.8% and was similar between HIV+ and uninfected individuals (13 [7.6%] versus 8 [8.2%], respectively; p = 0.85). Participants with HIV, the majority of whom received antiretroviral therapy, had a higher mean absolute liver attenuation (mean difference, 5.68 Hounsfield units; p < 0.001), correlating with lesser hepatic steatosis severity, compared to uninfected participants. After adjusting for covariates, only advanced hepatic fibrosis was associated with greater severity of steatosis in HIV+ persons (p = 0.03) and uninfected individuals (p < 0.001).
CONCLUSIONS
In this sample of participants without cardiovascular disease, the prevalence of hepatic steatosis by noncontrast abdominal CT was not different by HIV status. Increasing severity of steatosis was independently associated with advanced hepatic fibrosis in both groups.
背景
肝脂肪变性在西方国家很常见，但很少有研究评估 HIV 感染患者中脂肪变性的频率和严重程度。我们比较了 HIV 感染（HIV+）和未感染患者的肝脂肪变性的患病率和严重程度，并确定了两组中与脂肪变性严重程度相关的因素。
方法
我们对参加退伍军人衰老队列研究亚研究的无心血管疾病患者进行了横断面研究。肝脂肪变性通过非对比 CT 肝脾衰减比值（L/S）<1.0 定义。多变量线性回归用于：1）评估 HIV 感染与肝脂肪变性严重程度（以肝衰减绝对值衡量）之间的关系，以及 2）按 HIV 状态确定与脂肪变性严重程度相关的因素。
结果
在 268 名参与者中（中位数年龄 55 岁；99%为男性；79%为黑人；23%为肥胖；64%为 HIV+[91%接受抗逆转录病毒治疗]），脂肪变性的总体患病率为 7.8%，HIV+和未感染个体之间相似（分别为 13 [7.6%]和 8 [8.2%]；p=0.85）。接受抗逆转录病毒治疗的 HIV 患者中，大多数患者的肝衰减绝对值较高（平均差异 5.68 亨氏单位；p<0.001），与脂肪变性严重程度较轻相关，与未感染患者相比。调整协变量后，只有晚期肝纤维化与 HIV+患者（p=0.03）和未感染患者（p<0.001）脂肪变性严重程度增加相关。
结论
在这个没有心血管疾病的参与者样本中，非对比腹部 CT 肝脂肪变性的患病率与 HIV 状态无关。两组中，脂肪变性严重程度的增加与晚期肝纤维化独立相关。
Zotero 插件