Zhu Yong-Fen, Wang Jin, Fang Jia-Zhui, Yang Qiao, Lv Fang-Fang
Department of Hepatology and Infection, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou 310016, China.
Gastroenterol Res Pract. 2020 Apr 20;2020:3584568. doi: 10.1155/2020/3584568. eCollection 2020.
Patients with chronic hepatitis B (CHB) concomitant with nonalcoholic fatty liver disease (NAFLD) are increasing.
To identify pathological features that can be used to differentiate between chronic inflammation caused by CHB and that caused by NAFLD.
Patients with CHB ( = 31) needing antiviral treatment, NAFLD ( = 50), or CHB-NAFLD ( = 51) who underwent biopsy were retrospectively enrolled. Pathological characteristics of chronic inflammation were evaluated using the METAVIR scoring system. The rates of three pathological characteristics were first compared in patients with NAFLD and those with CHB, then compared after fibrosis matching, and were finally compared in CHB-NAFLD patients with different viral loads.
The rates of interface hepatitis over grade 2 and fibrosis over grade 2 were significantly higher in the CHB group than in the NAFLD group (100% . 4% and 80.6% . 22%; both < 0.0001), while no significant difference was observed in the rate of lobular inflammation over grade 2 between the two groups. After fibrosis matching, in patients with F0-2 fibrosis, the rate of interface hepatitis over grade 2 in CHB was significantly higher than that in NAFLD (100% 0%; < 0.0001). In CHB-NAFLD patients with F0-2 fibrosis, the rate of interface hepatitis over grade 2 in cases with a high viral load was significantly higher than cases with a low viral load (66.6% 0%; < 0.0001). The rate of lobular inflammation showed no difference between groups.
Interface hepatitis over grade 2 can be used for the differential diagnosis of chronic inflammation associated with CHB or NAFLD in the early stage.
慢性乙型肝炎（CHB）合并非酒精性脂肪性肝病（NAFLD）的患者正在增多。
确定可用于区分由CHB引起的慢性炎症和由NAFLD引起的慢性炎症的病理特征。
回顾性纳入接受活检的需要抗病毒治疗的CHB患者（n = 31）、NAFLD患者（n = 50）或CHB-NAFLD患者（n = 51）。使用METAVIR评分系统评估慢性炎症的病理特征。首先比较NAFLD患者和CHB患者的三种病理特征发生率，然后在纤维化匹配后进行比较，最后在不同病毒载量的CHB-NAFLD患者中进行比较。
CHB组2级以上界面性肝炎和2级以上纤维化的发生率显著高于NAFLD组（100%对4%和80.6%对22%；均P < 0.0001），而两组间2级以上小叶性炎症的发生率无显著差异。纤维化匹配后，在F0-2纤维化患者中，CHB患者2级以上界面性肝炎的发生率显著高于NAFLD患者（100%对0%；P < 0.0001）。在F0-2纤维化的CHB-NAFLD患者中，高病毒载量病例2级以上界面性肝炎的发生率显著高于低病毒载量病例（66.6%对0%；P < 0.0001）。小叶性炎症的发生率在各组间无差异。
2级以上界面性肝炎可用于早期鉴别与CHB或NAFLD相关的慢性炎症。
