B型肝炎病人的脂肪肝-元分析方法
HEPATIC STEATOSIS IN HEPATITIS B VIRUS INFECTED PATIENTS – META-ANALYSIS
OF RISK FACTORS AND COMPARISON WITH HEPATITIS C INFECTED PATIENTS
Mariana V. Machado1, António G. Oliveira2, Helena Cortez-Pinto1,*
Journal of Gastroenterology and Hepatology
Accepted Article (Accepted, unedited articles published online for future
issues)
ABSTRACT
Although hepatic steatosis (HS) has an association with hepatitis C virus
(HCV) infection, an association with hepatitis B virus (HBV) is
controversial. We performed a meta-analysis to evaluate HS prevalence and
risk factors, in HBV infection. Standard guidelines for performance of
meta-analyses were followed. Studies with HS assessed by histology were
included. Pooled odd ratios (OR) and standardized mean differences (SMD)
were obtained with the random-effects model and DerSimonian-Laid method.
Seventeen out of 21 studies were included, comprising 4100 HBV infected
patients. Overall HS prevalence was 29.6%. Eight studies also included 945
HCV infected patients, showing decreased risk of HS in HBV versus HCV
patients (OR 0.55, 95%CI [0.45-0.67], p < 0.001). In HBV, HS positively
associated with male gender (OR 1.74, 95%CI [1.28-2.38], p < 0.001), body
mass index (SMD 2.17, 95%CI [1.23, 3.11], p < 0.001), obesity (OR 6.59,
95%CI [3.51-12.257], p = 0.003), diabetes (OR 2.62, 95%CI [1.37-4.00], p =
0.004), glycemia (SMD 0.84, 95%CI [0.00, 1.67], p = 0.049), triglycerides
(SMD 1.18, 95%CI [0.48, 1.89], p = 0.001), cholesterol (SMD 0.88, 95%CI
[0.31, 1.45], p = 0.003), moderate alcohol consumption (OR 1.54, 95%CI
[1.10-2.15], p = 0.011) and negatively with HBV DNA (SMD -74.12, 95%CI
[-82.93, -65.31], p < 0.001). HS had no association with aminotransferases,
HBeAg, genotype or hepatic histology, necroinflammation or fibrosis.
Conclusions: HS in HBV seems to be as frequent as in the general
population, and lower than in HCV infected patients, relating to metabolic
factors but not with hepatic histology severity. A puzzling strong negative
association between viral load and HS, may even suggest a protective effect
of the virus on HS.