乙型肝炎病毒感染和非酒精性脂肪性肝病的风险：基于人群

StephenW

Hepatitis B virus infection and risk of non‐alcoholic fatty liver disease: A population‐based cohort study
Liguo Zhu
Jie Jiang
Xiangjun Zhai
Aileen Baecker
Hong Peng
Jiao Qian
MingHao Zhou
Ci Song
Yan Zhou
Jianfang Xu
Hongjian Liu
Dong Hang
Zhibin Hu
Hongbin Shen
… See all authors
First published: 19 July 2018
https://doi.org/10.1111/liv.13933

Funding informationThis work was supported by National Natural Science Foundation of China [81502861, 81673244]; National Major S&T Projects [2009ZX10004‐904, 2011ZX10004‐902, 2013ZX10004‐905]; Foundation for the National Institutes of Health [T32CA009142]; Chinese Foundation for Hepatitis Prevention and Control—TianQing Liver Disease Research Fund Subject [TQGB20140221]; Jiangsu Health International Exchange Program; Jiangsu Province Science & Technology Demonstration Project for Emerging Infectious Diseases Control and Prevention (BE2015714); Jiangsu Province Health Development Project with Science and Education (QNRC2016546).

Liguo Zhu and Jie Jiang contributed equally to this work.

Handling Editor: Helena Cortez‐Pinto

Trial registration number: None.

Abstract
Background & aims

Although non‐alcoholic fatty liver disease (NAFLD) has been studied extensively, the potential risk factors for NAFLD among chronic hepatitis B (CHB) patients have not been fully known.
Methods

A population‐based cohort of adult CHB patients without a history of alcohol drinking or NAFLD were recruited and followed up from October 2012 to January 2015 in Jiangsu province, China. Using Cox proportional hazards regression model, potential risk factors including viral and metabolic factors for NAFLD were evaluated.
Results

Two thousand three hundred and ninety‐three adult CHB patients (mean age 50.7 ± 13.2 years) were included in the cohort. With 4429 person‐years of follow‐up, 283 individuals progressed to NAFLD with an incidence rate of 63.89/1000 person‐years. Overweight and obese CHB patients had an increased risk of NAFLD (overweight adjusted hazard ratio [HR], 3.10; 95% CI, 2.29‐4.18; obese HR, 8.52; 95%CI, 5.93‐12.25) compared to normal weight carriers. The incidence of NAFLD was associated with concurrent type 2 diabetes mellitus (DM) (HR, 1.88; 95%CI, 1.15‐3.08). However, no associations between viral factors with NAFLD incidence rate were identified. In a subgroup of participants with concurrent type 2 DM, detectable HBV DNA levels were negatively associated with the development of NAFLD (HR, 0.37; 95%CI, 0.14‐0.98). There was super‐multiplicative interaction between BMI and gender with respect to incidence of NAFLD, with an ROR of 2.08 (95%CI, 1.02‐4.23).
Conclusion

Metabolic factors play an important role in the presence of NAFLD among Chinese CHB patients. However, viral replication factors are not related to NAFLD except among those with concurrent type 2 DM.

StephenW

乙型肝炎病毒感染和非酒精性脂肪性肝病的风险：基于人群的队列研究
朱立国
江杰
襄樊翟
Aileen Baecker
洪鹏
焦倩
周明浩
慈歌
阎周
徐建芳
刘洪建
董航
志斌胡
沉红斌
......见所有作者
首次发表：2018年7月19日
https://doi.org/10.1111/liv.13933

资助信息这项工作得到了国家自然科学基金[81502861,81673244]的支持;国家重大科技项目[2009ZX10004-904,2011ZX10004-902,2013ZX10004-905];美国国立卫生研究院基金会[T32CA009142];中国肝炎防治基金会 - 天晴肝病研究基金科[TQGB20140221];江苏卫生国际交流计划;江苏省新发传染病防治科技示范项目（BE2015714）;江苏省科教发展项目（QNRC2016546）。

朱立国和江杰对这项工作做出了同样的贡献。

处理编辑：Helena Cortez-Pinto

试用注册号：无。

抽象
背景和目标

虽然非酒精性脂肪性肝病（NAFLD）已被广泛研究，但慢性乙型肝炎（CHB）患者中NAFLD的潜在危险因素尚不完全清楚。
方法

从2012年10月至2015年1月，在中国江苏省招募了一组基于人群的成人CHB患者，这些患者没有饮酒或NAFLD病史。使用Cox比例风险回归模型，评估潜在的风险因素，包括NAFLD的病毒和代谢因素。
结果

成群中包括2.333名成人CHB患者（平均年龄50.7±13.2岁）。随着4429人年的随访，283人进展到NAFLD，发病率为63.89 / 1000人年。与正常体重携带者相比，超重和肥胖的CHB患者NAFLD风险增加（超重校正风险比[HR]，3.10; 95％CI，2.29-4.18;肥胖HR，8.52; 95％CI，5.93-12.25）。 NAFLD的发病率与并发的2型糖尿病（DM）相关（HR，1.88; 95％CI，1.15-3.08）。然而，未发现病毒因子与NAFLD发病率之间的关联。在具有并发2型DM的参与者亚组中，可检测的HBV DNA水平与NAFLD的发展呈负相关（HR，0.37; 95％CI，0.14-0.98）。在NAFLD发病率方面，BMI与性别之间存在超乘法相互作用，ROR为2.08（95％CI，1.02-4.23）。
结论

代谢因子在中国CHB患者中存在NAFLD中起重要作用。然而，病毒复制因子与NAFLD无关，除了那些并发2型糖尿病的人。