脂肪肝是乙型肝炎患者和负相关非常普遍与病毒学因素

StephenW

Digestive Diseases and Sciences
October 2014, Volume 59, Issue 10, pp 2571-2579
Date: 18 May 2014
Hepatic Steatosis Is Highly Prevalent in Hepatitis B Patients and Negatively Associated with Virological Factors

    Man-Man Wang,
    Gong-Sui Wang,
    Feng Shen,
    Guang-Yu Chen,
    Qin Pan,
    Jian-Gao Fan

Author Affiliations

        1. Department of Gastroenterology, Xinhua Hospital, Shanghai Key Laboratory of Children’s Digestion and Nutrition, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
        2. Department of Endocrinology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
        3. Department of Infectious Disease, Shunde First People’s Hospital Affiliated to Southern Medical University, Shunde, Guangdong Province, China


Abstract
Background and Aims

The interaction between hepatitis B virus (HBV) infection and hepatic steatosis remains unclear. We aimed to explore the trend of prevalence of hepatic steatosis and its relationship with virological factors in HBV infected patients.
Methods

Consecutive untreated patients with chronic HBV infection at Shunde Hospital between 2002 and 2011 were included. Quantification of HBV replication markers was performed by enzyme immunoassay, real-time polymerase chain reaction assay and immunohistochemical staining. Hepatic steatosis was defined as at least 5 % hepatocytes affected.
Results

A total of 3,212 patients (2,574 men) with a mean age of 32 ± 9.3 years were analyzed. Serological testing showed detectable HBsAg in all, HBeAg in 63.8 % and HBV DNA in 78.4 % of patients. Liver biopsies demonstrated HBsAg- and HBcAg-positive immunostaining in 96.6 and 71 % patients, respectively. Hepatic steatosis was present in 554 (17.3 %) patients, with annual prevalence increased over time from 8.2 to 31.8 % (trend analysis, x 2 = 51.657, P < 0.001). Compared to patients without steatosis, the percentages of serum HBeAg-positive and detectable HBV DNA, and intrahepatic HBsAg- and HBcAg-positive staining were decreased in steatosis patients (all P < 0.001). Adjusted for age and gender, intrahepatic HBsAg-positive staining remained as an independent factor associated with lower risk of steatosis (adjusted odds ratio 0.90, 95 % confidence interval 0.835, 0.971) in multivariate analysis.
Conclusions

Hepatic steatosis in HBV infected patients has been raging over the past decade, and it is negatively associated with intrahepatic expression of HBsAg. Lifestyle intervention may be needed to halt the onset of steatosis in chronic HBV infection.

StephenW

消化疾病与科学
2014年10月，第59卷，第10期，第2571至2579年
日期：2014年5月18日
脂肪肝是乙型肝炎患者和负相关非常普遍与病毒学因素

    曼曼王，
    公隋王，
    封神
    广玉臣，
    秦般，
    范建高

作者所属机构

        消化内科，新华医院，儿童的上海重点实验室的消化和营养，上海交通大学医学院，上海，200092，中国1部
        内分泌科，孙中山大学第三附属医院，广州，广东省，中国2部
        传染病，佛山市顺德区第一人民医院附属南方医科大学，佛山市顺德区，广东省，中国的三部


摘要
背景和目的

乙型肝炎病毒（HBV）感染，肝细胞脂肪变性之间的相互作用仍然不清楚。我们的目的是探讨脂肪肝的患病率及其与病毒学因素在乙肝病毒感染者的关系的趋势。
方法

连续的未经治疗的慢性HBV感染者在顺德医院2002年至2011年间都包括在内。用酶免疫，实时聚合酶链反应法和免疫组化染色进行乙肝病毒复制指标量化。肝脂肪变性的定义为受影响的至少5％的肝细胞。
结果

总共有3,212名患者（2574人）为32±9.3岁，平均年龄进行了分析。血清学检测结果显示乙肝表面抗原检测所有，大三阳的63.8％和HBV DNA的患者78.4％。肝活检证实HBsAg-和核心抗原阳性染色在96.6和71％的患者分别。脂肪肝是目前在554（17.3％）的患者，年患病率随着时间增加，从8.2到31.8％（趋势分析，X 2=51.657，P <0.001）。相较于患者无脂肪变性，血清HBeAg阳性和检测HBV DNA，并肝内HBsAg-和核心抗原阳性染色的百分比是在脂肪肝患者（均P <0.001）下降。调整了年龄，性别，肝内HBsAg阳性染色保持与脂肪变性的多因素分析风险较低（校正比值比0.90，95％可信区间0.835，0.971）相关联的独立因素。
结论

在乙肝病毒感染患者肝细胞脂肪变性一直肆虐在过去十年中，它是负相关的乙肝表面抗原肝内表达有关。生活方式干预可能需要停止发作脂肪变性的慢性HBV感染。