慢性乙型肝炎患者的高级纤维化与坏死性炎症程度相关，但与肝脂肪变性无关。
Advanced Liver Fibrosis Is Associated with Necroinflammatory Grade but Not Hepatic Steatosis in Chronic Hepatitis B Patients.
机构信息
Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and University, Linkou, No. 5, Fu Hsing Street, Guishan Dist., Taoyuan City, 33302, Taiwan, ROC.
College of Medicine, Guishan Dist, Chang Gung University, No. 259, Wen Hua 1st Rd, Taoyuan City, 33302, Taiwan, Republic of China.
出版信息
Dig Dis Sci. 2021 Dec;66(12):4492-4500. doi: 10.1007/s10620-020-06761-x. Epub 2021 Feb 10.
BACKGROUND AND AIMS
Patients with chronic hepatitis B (CHB) are at an increased risk of disease progression. The influence of hepatic steatosis (HS) to liver fibrosis was controversial. We aim to investigate the association between HS and liver fibrosis and explore the predicting factors for advanced fibrosis.
METHODS
CHB patients undergoing liver biopsy with complete assessments of HS, necroinflammation grade [histological activity index (HAI) score], and fibrosis stage were retrospectively recruited. Logistic regression analysis was performed to determine the factors associated with advanced liver fibrosis.
RESULTS
In this cohort of 672 patients, 342 (50.9%) had HS and 267 (39.4%) were of advanced liver fibrosis. Age [odds ratio (OR) 1.026, 95% confidence interval (CI) 1.007-1.046, p = 0.008], body mass index (BMI, OR 1.091, 95% CI 1.026-1.159, p = 0.005), genotype (C vs. B) (OR 2.790, 95% CI 1.847-4.214, p < 0.001), platelet (OR 0.986, 95% CI 0.982-0.991, p < 0.001), and HAI score (OR 1.197, 95% CI 1.114-1.285, p < 0.001) were independent factors for advanced liver fibrosis in multivariate logistic regression analysis. HAI score was also a significantly associated factor for significant liver fibrosis in non-cirrhotic subpopulation (OR 1.578, 95% CI 1.375-1.810, p < 0.001). HS was not related to advanced/significant liver fibrosis in overall/non-cirrhotic population (p > 0.05).
CONCLUSIONS
Significant or advanced liver fibrosis is associated with grade of necroinflammation but not with HS in CHB patients.
背景与目的
慢性乙型肝炎（CHB）患者疾病进展的风险增加。肝脂肪变性（HS）对肝纤维化的影响存在争议。我们旨在探讨 HS 与肝纤维化之间的关系，并探讨预测晚期纤维化的因素。
方法
回顾性招募了接受肝活检并有完整 HS、坏死性炎症分级[组织学活动指数（HAI）评分]和纤维化分期评估的 CHB 患者。采用 logistic 回归分析确定与晚期纤维化相关的因素。
结果
在这一 672 例患者队列中，342 例（50.9%）存在 HS，267 例（39.4%）为晚期纤维化。年龄[比值比（OR）1.026，95%置信区间（CI）1.007-1.046，p=0.008]、体重指数（BMI，OR 1.091，95%CI 1.026-1.159，p=0.005）、基因型（C 型比 B 型）（OR 2.790，95%CI 1.847-4.214，p<0.001）、血小板（OR 0.986，95%CI 0.982-0.991，p<0.001）和 HAI 评分（OR 1.197，95%CI 1.114-1.285，p<0.001）是多变量 logistic 回归分析中晚期纤维化的独立因素。HAI 评分也是非肝硬化亚群中显著肝纤维化的显著相关因素（OR 1.578，95%CI 1.375-1.810，p<0.001）。在总体/非肝硬化人群中，HS 与晚期/显著肝纤维化无关（p>0.05）。
结论
在 CHB 患者中，显著或晚期肝纤维化与坏死性炎症程度相关，而与 HS 无关。
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