北美大型慢性乙型肝炎成人队列中肝脂肪变性和脂肪性肝炎。
Hepatic Steatosis and Steatohepatitis in a Large North American Cohort of Adults With Chronic Hepatitis B.
机构信息
University of California San Francisco, San Francisco, California, USA.
National Institutes of Health Bethesda, Maryland, USA.
出版信息
Am J Gastroenterol. 2021 Aug 1;116(8):1686-1697. doi: 10.14309/ajg.0000000000001257.
INTRODUCTION
Fatty liver disease (FLD) influences liver disease progression and liver cancer risk. We investigated the impact of FLD on liver disease severity in a large North American cohort with chronic hepatitis B virus (HBV).
METHODS
Liver biopsies from 420 hepatitis B surface antigen-positive adults enrolled in the Hepatitis B Research Network and who were not on HBV therapy in the previous month were evaluated for inflammation and fibrosis. Steatohepatitis was based on steatosis, hepatocyte ballooning ± Mallory-Denk bodies, and perisinusoidal fibrosis. Models evaluated factors associated with steatohepatitis, and the associations of steatohepatitis with fibrosis, and longitudinal alanine aminotransferase, aspartate aminotransferase, and Fibrosis-4.
RESULTS
The median age was 42 years, 62.5% were male, and 79.5% were Asian. One hundred thirty-two (31.4%) patients had FLD (77 [18.3%] steatosis only, 55 [13.1%] steatohepatitis). Older age, overweight/obesity, and diabetes were associated with steatohepatitis. Steatohepatitis (vs no FLD) was associated with 1.68 times higher risk of advanced fibrosis at baseline (95% confidence interval, 1.12-2.51), and there was an indication of higher incident cirrhosis rate during follow-up. Steatohepatitis vs no FLD was also independently associated with, on average, 1.39 times higher alanine aminotransferase (P < 0.01) and 1.25 times higher Fibrosis-4 (P = 0.04) across 4 years.
DISCUSSION
Coexisting steatosis occurred in nearly a third of adults (13% had steatohepatitis) with chronic HBV in this North American cohort who underwent liver biopsies. Steatohepatitis was associated with advanced fibrosis and higher biochemical measures of hepatic inflammation over time. Therefore, in addition to viral suppression, screening for and managing metabolic abnormalities is important to prevent disease progression in HBV.
简介
脂肪肝疾病（FLD）影响肝脏疾病的进展和肝癌风险。我们研究了在一个有大量慢性乙型肝炎病毒（HBV）的北美队列中，FLD 对肝脏疾病严重程度的影响。
方法
从 420 名乙型肝炎表面抗原阳性的成年人中抽取肝脏活检样本，这些成年人在前一个月内没有接受 HBV 治疗，并在乙型肝炎研究网络中接受评估。炎症和纤维化是基于脂肪变性、肝细胞气球样变和 Mallory-Denk 小体、窦周纤维化来评估的。模型评估了与脂肪变性相关的因素，以及脂肪变性与纤维化的相关性，以及纵向丙氨酸氨基转移酶、天冬氨酸氨基转移酶和 Fibrosis-4。
结果
中位年龄为 42 岁，62.5%为男性，79.5%为亚洲人。132 名（31.4%）患者有 FLD（77 名[18.3%]单纯脂肪变性，55 名[13.1%]脂肪性肝炎）。年龄较大、超重/肥胖和糖尿病与脂肪变性相关。与无 FLD 相比，脂肪变性（vs 无 FLD）发生晚期纤维化的风险增加 1.68 倍（95%置信区间，1.12-2.51），并且在随访期间肝硬化发生率有升高的趋势。脂肪变性（vs 无 FLD）也与平均高出 1.39 倍的丙氨酸氨基转移酶（P < 0.01）和高出 1.25 倍的 Fibrosis-4（P = 0.04）相关，这些数据持续了 4 年。
讨论
在这个接受了肝脏活检的北美队列中，近三分之一（13%）的慢性 HBV 成年人（13%患有脂肪性肝炎）同时存在脂肪变性。脂肪变性与晚期纤维化和随时间推移肝脏炎症的生化指标升高有关。因此，除了病毒抑制之外，筛查和管理代谢异常对于预防 HBV 疾病进展非常重要。
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