Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Clin Mol Hepatol. 2023 Apr;29(2):320-331. doi: 10.3350/cmh.2022.0422. Epub 2023 Feb 1.
The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) has increased among the general population and chronic hepatitis B (CHB) patients worldwide. Although fatty liver disease is a well-known risk factor for adverse liver outcomes like cirrhosis and hepatocellular carcinoma, its interactions with the hepatitis B virus (HBV) and clinical impacts seem complex. The presence of hepatic steatosis may suppress HBV viral activity, potentially leading to attenuated liver injury. In contrast, the associated co-morbidities like diabetes mellitus or obesity may increase the risk of developing adverse liver outcomes. These findings implicate that components of MAFLD may have diverse effects on the clinical manifestations of CHB. To this end, a clinical strategy is proposed for managing patients with concurrent CHB and MAFLD. This review article discusses the updated evidence regarding disease prevalence, interactions between steatosis and HBV, clinical impacts, and management strategies, aiming at optimizing holistic health care in the CHB population.
代谢相关脂肪性肝病（MAFLD）在普通人群和全球慢性乙型肝炎（CHB）患者中的患病率均有所增加。尽管脂肪肝是肝硬化和肝细胞癌等不良肝脏结局的已知危险因素，但它与乙型肝炎病毒（HBV）的相互作用及其临床影响似乎较为复杂。肝脂肪变性的存在可能会抑制 HBV 病毒的活性，从而导致肝损伤减轻。相反，糖尿病或肥胖等相关合并症可能会增加发生不良肝脏结局的风险。这些发现表明，MAFLD 的成分可能对 CHB 的临床表现产生不同的影响。为此，提出了一种用于管理同时患有 CHB 和 MAFLD 的患者的临床策略。本文讨论了关于疾病流行、脂肪变性与 HBV 之间相互作用、临床影响和管理策略的最新证据，旨在优化 CHB 人群的整体保健。
