Rugivarodom Manus, Pongpaibul Ananya, Chainuvati Siwaporn, Nimanong Supot, Chotiyaputta Watcharasak, Tanwandee Tawesak, Charatcharoenwitthaya Phunchai
Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Clin Transl Hepatol. 2023 Feb 28;11(1):76-87. doi: 10.14218/JCTH.2022.00055. Epub 2022 May 23.
Metabolic dysfunction-associated fatty liver disease (MAFLD) is prevalent in patients with chronic hepatitis B (CHB). The effect of the histologic MAFLD phenotype on long-term CHB outcomes is unknown. We performed a longitudinal study to determine the prognostic relevance of biopsy-proven hepatic steatosis and steatohepatitis for CHB patients.
Clinical and laboratory data were obtained from CHB patients who underwent liver biopsy during 2002-2008 and were treated with antiviral drugs. A hepatopathologist reviewed the biopsy specimens. Cox proportional hazards regression was used to estimate the adjusted hazard ratio (aHR) of outcomes, including all-cause mortality, liver transplantation, and liver-related events.
In accordance with Brunt's classification, 408 patients had steatohepatitis (=34), "steatosis but not steatohepatitis" (=118), or "non-steatosis" (=256). All steatohepatitis patients had features of metabolic dysfunction. Over a mean follow-up of 13.8±3.1 years, 18 patients died or underwent liver transplantation. In multivariate-adjusted analysis, steatohepatitis (aHR, 6.37; 95% confidence interval [CI]: 1.59-25.5) compared with non-steatosis and advanced fibrosis (aHR, 11.3; 95% CI: 1.32-96.3) compared with no fibrosis were associated with overall mortality/liver transplantation. Thirty-five patients developed 43 liver-related events, among which 32 were hepatocellular carcinoma. These events were associated with steatohepatitis (aHR, 5.55; 95% CI: 2.01-15.3) compared with non-steatosis and advanced fibrosis (aHR, 6.23; 95% CI: 1.75-22.2) compared with no fibrosis. The steatosis but not steatohepatitis group had a non-significantly higher risk of overall mortality and liver-related events.
Metabolic dysfunction-associated steatohepatitis increased the risk of long-term mortality/transplantation and liver-related events in CHB patients.
代谢功能障碍相关脂肪性肝病（MAFLD）在慢性乙型肝炎（CHB）患者中普遍存在。组织学MAFLD表型对CHB患者长期预后的影响尚不清楚。我们进行了一项纵向研究，以确定经活检证实的肝脂肪变性和脂肪性肝炎对CHB患者的预后相关性。
收集2002年至2008年期间接受肝活检并接受抗病毒药物治疗的CHB患者的临床和实验室数据。一名肝脏病理学家对活检标本进行了评估。采用Cox比例风险回归来估计包括全因死亡率、肝移植和肝脏相关事件在内的预后调整风险比（aHR）。
根据布伦特分类，408例患者患有脂肪性肝炎（=34）、“脂肪变性但无脂肪性肝炎”（=118）或“无脂肪变性”（=256）。所有脂肪性肝炎患者均有代谢功能障碍的特征。在平均13.8±3.1年的随访中，18例患者死亡或接受了肝移植。在多变量调整分析中，与无脂肪变性相比，脂肪性肝炎（aHR，6.37；95%置信区间[CI]：1.59 - 25.5）以及与无纤维化相比，晚期纤维化（aHR，11.3；95%CI：1.32 - 96.3）与总体死亡率/肝移植相关。35例患者发生了43次肝脏相关事件，其中32次为肝细胞癌。与无脂肪变性相比，这些事件与脂肪性肝炎（aHR，5.55；95%CI：2.01 - 15.3）以及与无纤维化相比，晚期纤维化（aHR，6.23；95%CI：1.75 - 22.2）相关。脂肪变性但无脂肪性肝炎组的总体死亡率和肝脏相关事件风险略高，但无统计学意义。
代谢功能障碍相关脂肪性肝炎增加了CHB患者长期死亡/移植风险和肝脏相关事件风险。
