Sirinawasatien A, Techasirioangkun T
Division of Gastroenterology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
Gastroenterol Res Pract. 2020 Nov 2;2020:8814135. doi: 10.1155/2020/8814135. eCollection 2020.
To describe the prevalence of hepatic steatosis using a controlled attenuation parameter (CAP) and to identify the determinants associated with steatosis in Thai chronic hepatitis C patients. . An observational study was conducted among consecutive chronic hepatitis C patients who underwent vibration-controlled transient elastography (VCTE, FibroScan®) with CAP and followed up at Rajavithi Hospital, Bangkok, Thailand, between June 2018 and May 2019. Hepatic steatosis (i.e., steatosis grades S1-3) was defined by the CAP cutoff value of ≥248 (dB/m). VCTE with CAP assessments and medical records were retrospectively reviewed, and the prevalence and determinants of hepatic steatosis were analyzed.
A total of 197 eligible patients, of whom 127 (64.5%) were male, were included. The mean age was 54.52 years (SD 9.49 years), and 41.1% of subjects had a body mass index ≥ 25. The prevalence of hepatic steatosis was 26.9%. The mean liver stiffness measurement (LSM) was 21.50 kPa (SD 15.58 kPa), and 61.9% of the study population had cirrhosis, which was defined as LSM ≥ 12.5 kPa. Genotype (GT) 3 was predominant at 40.1%, followed by GT1 at 38.1% and GT6 at 21.8%. The median serum hepatitis C virus viral load was 1,100,000 IU/mL (range 5,824-20,436,840). The significant determinants of hepatic steatosis were obesity (aOR 8.58 (95% CI: 3.41-21.54)) and diabetes mellitus (aOR 3.30 (95% CI: 1.24-8.78)).
A large proportion of these Thai chronic hepatitis C patients (26.9%) had hepatic steatosis, which was strongly associated with host metabolic factors, e.g., obesity (BMI ≥ 25) and diabetes mellitus. These cofactors contributed to the progression of liver disease to cirrhosis and required concurrent management with antiviral therapy.
使用受控衰减参数（CAP）描述肝脂肪变性的患病率，并确定泰国慢性丙型肝炎患者中与脂肪变性相关的决定因素。在2018年6月至2019年5月期间，对泰国曼谷拉贾维蒂医院连续接受带有CAP的振动控制瞬时弹性成像（VCTE，FibroScan®）并进行随访的慢性丙型肝炎患者进行了一项观察性研究。肝脂肪变性（即脂肪变性分级为S1 - 3）由CAP临界值≥248（dB/m）定义。对带有CAP评估的VCTE和病历进行回顾性审查，并分析肝脂肪变性的患病率和决定因素。
共纳入197例符合条件的患者，其中127例（64.5%）为男性。平均年龄为54.52岁（标准差9.49岁），41.1%的受试者体重指数≥25。肝脂肪变性的患病率为26.9%。平均肝脏硬度测量值（LSM）为21.50 kPa（标准差15.58 kPa），61.9%的研究人群患有肝硬化，肝硬化定义为LSM≥12.5 kPa。基因型（GT）3占主导地位，为40.1%，其次是GT1，为38.1%，GT6为21.8%。丙型肝炎病毒血清病毒载量中位数为1,100,000 IU/mL（范围5,824 - 20,436,840）。肝脂肪变性的显著决定因素是肥胖（调整后比值比8.58（95%置信区间：3.41 - 21.54））和糖尿病（调整后比值比3.30（95%置信区间：1.24 - 8.78））。
这些泰国慢性丙型肝炎患者中有很大一部分（26.9%）患有肝脂肪变性，这与宿主代谢因素密切相关，如肥胖（体重指数≥25）和糖尿病。这些辅助因素导致肝病进展为肝硬化，需要在抗病毒治疗的同时进行管理。
