Bockmann Jan-Hendrik, Kohsar Matin, Murray John M, Hamed Vanessa, Dandri Maura, Lüth Stefan, Lohse Ansgar W, Schulze-Zur-Wiesch Julian
Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel Site, Martinistr. 52, 20246 Hamburg, Germany.
Microorganisms. 2021 Apr 30;9(5):968. doi: 10.3390/microorganisms9050968.
The prevalence of metabolic and cardiovascular diseases is rising worldwide. However, little is known about the impact of such disorders on hepatic disease progression in chronic hepatitis B (CHB) during the era of potent nucleo(s)tide analogues (NAs).
We retrospectively analyzed a single-center cohort of 602 CHB patients, comparing the frequency of liver cirrhosis at baseline and incidences of liver-related events during follow-up (hepatocellular carcinoma, liver transplantation and liver-related death) between CHB patients with a history of diabetes, obesity, hypertension or coronary heart disease (CHD).
Rates of cirrhosis at baseline and liver-related events during follow-up (median follow-up time: 2.51 years; NA-treated: 37%) were substantially higher in CHB patients with diabetes (11/23; 3/23), obesity (6/13; 2/13), CHD (7/11; 2/11) or hypertension (15/43; 4/43) compared to CHB patients without the indicated comorbidities (26/509; 6/509). Multivariate analysis identified diabetes as the most significant predictor for cirrhosis ( = 0.0105), while comorbidities did not correlate with liver-related events in pre-existing cirrhosis.
The combination of metabolic diseases and CHB is associated with substantially increased rates of liver cirrhosis and secondary liver-related events compared to CHB alone, indicating that hepatitis B patients with metabolic comorbidities warrant particular attention in disease surveillance and evaluation of treatment indication.
代谢性疾病和心血管疾病在全球范围内的患病率正在上升。然而，在强效核苷类似物（NA）时代，对于这些疾病对慢性乙型肝炎（CHB）患者肝病进展的影响知之甚少。
我们回顾性分析了一个单中心队列中的602例CHB患者，比较了有糖尿病、肥胖、高血压或冠心病（CHD）病史的CHB患者与无上述合并症的CHB患者在基线时肝硬化的发生率以及随访期间肝脏相关事件（肝细胞癌、肝移植和肝脏相关死亡）的发生率。
与无上述合并症的CHB患者（26/509；6/509）相比，患有糖尿病（11/23；3/23）、肥胖（6/13；2/13）、CHD（7/11；2/11）或高血压（15/43；4/43）的CHB患者在基线时的肝硬化发生率以及随访期间肝脏相关事件的发生率（中位随访时间：2.51年；接受NA治疗：37%）显著更高。多变量分析确定糖尿病是肝硬化的最显著预测因素（ = 0.0105），而合并症与已存在肝硬化患者的肝脏相关事件无关。
与单纯CHB相比，代谢性疾病与CHB并存与肝硬化发生率和继发性肝脏相关事件的大幅增加相关，这表明患有代谢合并症的乙型肝炎患者在疾病监测和治疗指征评估中值得特别关注。
