慢性乙型肝炎患者肝脏脂肪变性与肝细胞癌发生的关系

StephenW

Clin Mol Hepatol. 2018 Oct 23. doi: 10.3350/cmh.2018.0040. [Epub ahead of print]
Association between hepatic steatosis and the development of hepatocellular carcinoma in patients with chronic hepatitis B.
Lee YB1,2, Ha Y1, Chon YE1, Kim MN1, Lee JH1, Park H1, Kim KI3, Kim SH4,5, Rim KS1, Hwang SG1.
Author information

1
    Division of Hepatology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
2
    Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
3
    Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
4
    Bio-Age, Medical Research Institute, Seoul, Korea.
5
    Department of Statistics, LSK Global Pharma Services Co., Ltd., Seoul, Korea.

Abstract
Background/Aims:

Nonalcoholic fatty liver disease (NAFLD) is becoming a worldwide epidemic, and is frequently found in patients with chronic hepatitis B (CHB). We investigated the impact of histologically proven hepatic steatosis on the risk for hepatocellular carcinoma (HCC) in CHB patients without excessive alcohol intake.
Methods:

Consecutive CHB patients who underwent liver biopsy from January 2007 to December 2015 were included. The association between hepatic steatosis (≥ 5%) and subsequent HCC risk was analyzed. Inverse probability weighting (IPW) using the propensity score was applied to adjust for differences in patient characteristics, including metabolic factors.
Results:

Fatty liver was histologically proven in 70 patients (21.8%) among a total of 321 patients. During the median (interquartile range) follow-up of 5.3 (2.9-8.3) years, 17 of 321 patients (5.3%) developed HCC: 8 of 70 patients (11.4%) with fatty liver and 9 of 251 patients (3.6%) without fatty liver. The five-year cumulative incidences of HCC among patients without and with fatty liver were 1.9% and 8.2%, respectively (P=0.004). Coexisting fatty liver was associated with a higher risk for HCC (adjusted hazards ratio [HR], 3.005; 95% confidence interval [CI], 1.122-8.051; P=0.03). After balancing with IPW, HCC incidences were not significantly different between the groups (P=0.19), and the association between fatty liver and HCC was not significant (adjusted HR, 1.709; 95% CI, 0.404-7.228; P=0.47).
Conclusions:

Superimposed NAFLD was associated with a higher HCC risk in CHB patients. However, the association between steatosis per se and HCC risk was not evident after adjustment for metabolic factors.
KEYWORDS:

Fatty liver; Liver cancer; Metabolic syndrome; Nonalcoholic fatty liver disease (NAFLD); Hepatitis B virus

PMID:
    30360031
DOI:
    10.3350/cmh.2018.0040

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StephenW

Clin Mol Hepatol。 2018年10月23日doi：10.3350 / cmh.2018.0040。 [提前打印]
慢性乙型肝炎患者肝脏脂肪变性与肝细胞癌发生的关系
Lee YB1,2，Ha Y1，Chon YE1，Kim MN1，Lee JH1，Park H1，Kim KI3，Kim SH4,5，Rim KS1，Hwang SG1。
作者信息

1
    韩国城南大学CHA盆唐医学中心内科，肝病科
2
    首尔国立大学医学院内科和肝脏研究所，韩国首尔。
3
    韩国城南大学CHA盆唐医学中心病理科。
4
    生物时代，医学研究所，韩国首尔。
五
    韩国首尔LSK全球制药服务有限公司统计局。

抽象
背景/目的：

非酒精性脂肪性肝病（NAFLD）正在成为世界范围的流行病，并且经常在慢性乙型肝炎（CHB）患者中发现。我们研究了组织学证实的肝脂肪变性对CHB患者肝细胞癌（HCC）风险的影响，而没有过量饮酒。
方法：

包括2007年1月至2015年12月接受肝活检的连续CHB患者。分析肝脏脂肪变性（≥5％）与随后的HCC风险之间的关系。使用倾向得分的反向概率加权（IPW）用于调整患者特征的差异，包括代谢因素。
结果：

在总共321名患者中，70名患者（21.8％）组织学证实了脂肪肝。在5.3（2.9-8.3）年的中位数（四分位数间）随访期间，321名患者中有17名（5.3％）患有HCC：70名患者中有8名（11.4％）患有脂肪肝，11名患者中有9名患者（3.6％）没有脂肪肝。没有和有脂肪肝的患者中HCC的五年累积发生率分别为1.9％和8.2％（P = 0.004）。共存的脂肪肝与HCC的高风险相关（调整后的危险比[HR]，3.005; 95％置信区间[CI]，1.122-8.051; P = 0.03）。在与IPW平衡后，HCC发生率在各组之间没有显着差异（P = 0.19），并且脂肪肝和HCC之间的关联不显着（调整的HR，1.709; 95％CI，0.404-7.228; P = 0.47）。
结论：

叠加的NAFLD与CHB患者的较高HCC风险相关。然而，在调整代谢因素后，脂肪变性本身与HCC风险之间的关联并不明显。
关键词：

脂肪肝;肝癌;代谢综合征;非酒精性脂肪性肝病（NAFLD）;乙型肝炎病毒

结论：
    30360031
DOI：
    10.3350 / cmh.2018.0040

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StephenW

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