慢性乙型肝炎患者脂肪性肝炎的流行及其对疾病严重程度和

StephenW

The prevalence of steatohepatitis in chronic hepatitis B patients and its impact on disease severity and treatment response
Authors

    First published: 31 October 2016Full publication history
    DOI: 10.1111/liv.13271  View/save citation
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    Funding Information

    Funding information

    Faculty of Medicine Siriraj Hospital, Mahidol University.
    Handling Editor: Helena Cortez-Pinto

Abstract
Background & Aims

The clinical significance of steatohepatitis in chronic hepatitis B remains unclear. This study aimed to determine the prevalence and risk factors for steatohepatitis in chronic hepatitis B, and to determine its correlation with liver fibrosis and response to antiviral therapy.
Methods

Liver histopathology of 256 consecutive chronic hepatitis B patients with serum hepatitis B virus DNA >2000 IU/mL were analysed with clinical and laboratory characteristics. Virological and biochemical responses were prospectively assessed in the 112 patients treated with antiviral monotherapy.
Results

Hepatic steatosis was observed in 38% of the entire cohort, and steatohepatitis was diagnosed in 18% of patients with hepatic steatosis according to Brunt's classification. The presence of steatohepatitis was associated with overweight/obese (odds ratio, 5.99; 95% CI, 1.32-27.2) and hypertriglyceridaemia (odds ratio, 2.95; 95% CI, 1.07-8.15). None of the viral characteristics including HBeAg status, genotypes and viraemia levels was associated with the presence of steatohepatitis. Steatohepatitis was an independent predictor of significant fibrosis (odds ratio, 10.0; 95% CI, 2.08-48.5) and advanced fibrosis (odds ratio, 3.45; 95% CI, 1.11-10.7) after adjusting for viraemia levels and features of the metabolic syndrome. The rates of suppression of serum hepatitis B virus DNA <20 IU/mL combined with aminotransferase normalization at week 48 of antiviral therapy were not different between the steatohepatitis and non-steatohepatitis groups (43% vs 53%; P=.475).
Conclusions

Steatohepatitis is not uncommon in chronic hepatitis B patients. It is associated with metabolic syndrome but not viral factor. This study demonstrates that steatohepatitis is related to the severity of liver fibrosis but it does not affect response to antiviral therapy.

StephenW

慢性乙型肝炎患者脂肪性肝炎的流行及其对疾病严重程度和治疗反应的影响
作者

    首次发布：2016年10月31日全面的出版历史
    DOI：10.1111 / liv.13271查看/保存引用
    引用（CrossRef）：0篇文章检查更新

    文章的高分为1分
    资金信息

    资金信息

    马里多尔大学医学院Siriraj医院。
    处理编辑：Helena Cortez-Pinto

抽象
背景与目标

慢性乙型肝炎脂肪性肝炎的临床意义尚不清楚。本研究旨在确定慢性乙型肝炎患者脂肪性肝炎的发病率和危险因素，并确定其与肝纤维化的相关性和抗病毒治疗的反应。
方法

用临床和实验室特征分析256例连续慢性乙型肝炎患者血清乙型肝炎病毒DNA> 2000 IU / mL的肝组织病理学。在112例接受抗病毒治疗的患者中，对病毒学和生物化学反应进行了前瞻性评估。
结果

在38％的整个队列中观察到肝脂肪变性，根据Brunt的分类，在18％的肝脂肪变性患者中诊断出脂肪性肝炎。脂肪性肝炎的存在与超重/肥胖（优势比，5.99; 95％CI，1.32-27.2）和高甘油三酯血症（优势比，2.95; 95％CI，1.07-8.15）有关。不包括HBeAg状态，基因型和病毒血症水平的病毒特征与脂肪性肝炎的存在相关。在调整病毒血症水平和代谢综合征特征后，脂肪性肝炎是独立的预测指标，其显着纤维化（优势比，10.0; 95％CI，2.08-48.5）和晚期纤维化（优势比，3.45; 95％CI，1.11-10.7） 。抗病毒治疗第48周血清乙肝病毒DNA抑制率<20 IU / mL与氨基转移酶正常化的比例在脂肪性肝炎和非脂肪性肝炎组之间没有差异（43％vs 53％; P = 4.75）。
结论

慢性乙型肝炎患者的脂肪性肝炎并不罕见。它与代谢综合征相关，而不是病毒因子。本研究表明，脂肪性肝炎与肝纤维化的严重程度有关，但不影响抗病毒治疗的反应。