AASLD2018[396]脂肪变性对大鼠纤维化进程的影响 慢性乙型肝炎

StephenW

396
Impact of Steatosis on Fibrosis Progression in
Chronic Hepatitis B Patients: Results from 239
Paired Liver Biopsies before and after Anti-Viral
Therapy
Yameng Sun, Xiaoning Wu, Xinyan Zhao, Jialing Zhou,
Shanshan Wu, Yuanyuan Kong, Bingqiong Wang, Shuyan
Chen, Yiwen Shi, Xiaojuan Ou, Jidong Jia and Hong You,
Liver Research Center, Beijing Friendship Hospital, Capital
Medical University, Beijing Key Laboratory of Translational
Medicine in Liver Cirrhosis, National Clinical Research Center
of Digestive Diseases, Beijing, China;
Background: HBV-related liver fibrosis can be reversed in
most of the patients after antiviral therapy. However, a subset
of about 10% progress even after effective suppressing
HBV-DNA. One of the hypothesis within this subset was
considered a possible contribution by steatosis. However,
here has been no large-scale histologically dynamic analysis
undertaken addressing this. Methods: Chronic hepatitis B
(CHB) patients with paired liver biopsies before and after
78 weeks of entacavir-based treatment were enrolled in this
study. Liver fibrosis and steatosis were assessed by Ishak
fibrosis score and NAFLD activity score (NAS), respectively.
Fibrosis or steatosis progression was defined as those
scores increasing ≥1 unit after treatment. Results: A total
of 239 CHB patients with paired liver biopsies were included
in the final analysis. Among them, 53 (22.2%) patients had
the concomitant steatosis, with a prevalence of 17.6%, 4.2%
and 0.4% in steatosis Grade 1, 2 and 3, respectively. After
anti-HBV therapy, 25 (10.5%) patients developed histological
fibrosis progression. However, in the patients with CHB
and steatosis before treatment, fibrosis progression only
occurred in 4 (7.5%) patients, which is comparable with that
in patients with CHB alone (11.3%, P=0.467). After adjusting
for BMI, gender and Ishak fibrosis stage, baseline steatosis
was not associated with fibrosis progression (HR=0.679;
95%CI: 0.218-2.118). Interestingly, in those 32 patients with
increasing steatosis, 6 (18.8%) had fibrosis progression.
In those 183 patients with stable steatosis, 18 (9.8%) had
fibrosis progression. In those 24 patients with decreasing
steatosis, only 1 patient (4.2%) had fibrosis progression.
Although P value was 0.094, it suggested an ordered trend
of association of steatosis changes and fibrosis progression.
Conclusion: Pre-treatment steatosis was not associated with
fibrosis progression in CHB patients after anti-viral therapy.
However, deteriorating steatosis may increase the risk of
fibrosis progression.

StephenW

396
脂肪变性对大鼠纤维化进程的影响
慢性乙型肝炎患者：239例结果
抗病毒之前和之后的配对肝活检
治疗
孙亚蒙，吴晓宁，赵新艳，周嘉陵，
吴珊珊，袁元元，王炳琼，舒妍
陈义文，欧小娟，贾继东，洪友，
首都北京友谊医院肝病研究中心
医科大学，北京市转化重点实验室
肝硬化医学，国家临床研究中心
中国北京消化疾病杂志;
背景：HBV相关的肝纤维化可逆转
大多数患者在抗病毒治疗后。但是，一个子集
即使在有效抑制之后，也有大约10％的进展
HBV-DNA。该子集中的一个假设是
被认为是脂肪变性的可能贡献。然而，
这里一直没有大规模的组织学动态分析
承担了这个问题。方法：慢性乙型肝炎
（CHB）患者之前和之后进行配对肝活组织检查
以此为基础，参加了为期78周的依他康维治疗
研究。 Ishak评估了肝纤维化和脂肪变性
纤维化评分和NAFLD活动评分（NAS）。
纤维化或脂肪变性进展被定义为那些
治疗后评分增加≥1个单位。结果：总计
包括配对肝活组织检查的239名CHB患者
归根结底。其中，53例（22.2％）患者有
伴发脂肪变性，患病率为17.6％，4.2％
1级，2级和3级脂肪变性分别为0.4％和0.4％。后
抗HBV治疗，25例（10.5％）患者发生组织学研究
纤维化进展。但是，在CHB患者中
和治疗前的脂肪变性，仅纤维化进展
发生在4例（7.5％）患者中，与此相当
单独CHB患者（11.3％，P = 0.467）。调整后
对于BMI，性别和Ishak纤维化分期，基线脂肪变性
与纤维化进展无关（HR = 0.679;
95％CI：0.218-2.118）。有趣的是，在那些32名患者中
增加脂肪变性，6（18.8％）有纤维化进展。
在183例稳定性脂肪变性患者中，18例（9.8％）患有脂肪变性
纤维化进展。在那些24名患者中有所下降
脂肪变性，只有1名患者（4.2％）有纤维化进展。
尽管P值为0.094，但它表明有序趋势
脂肪变性与纤维化进展的关联
结论：治疗前脂肪变性与治疗无关
抗病毒治疗后CHB患者的纤维化进展。
然而，恶化的脂肪变性可能会增加患病的风险
纤维化进展。