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- 现金
- 62111 元
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- 注册时间
- 2009-10-5
- 最后登录
- 2022-12-28
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2086
The Impact of Nonalcoholic Fatty Liver Disease
(NAFLD) on the Development of Hepatocellular
Carcinoma (HCC) in Chronic Hepatitis B
Infection Patients
Jie Li1,2, Kevin T. Chaung1, Pauline Nguyen1, An K. Le1,
Joseph K Hoang1, Hwai-I Yang3 and Mindie H. Nguyen1,
(1)Division of Gastroenterology and Hepatology, Stanford
University Medical Center, (2)Department of Infectious
Disease, Shandong Provincial Hospital Affiliated to Shandong
University, (3)Genomics Research Center, Academia Sinica
Background: Nonalcoholic fatty liver disease (NAFLD) is
the most common cause of chronic liver disease worldwide.
However, data on the natural history of patients with NAFLD
associated with chronic hepatitis B (NAFLD-CHB) is limited.
Our goal was to evaluate the effect of NAFLD on the
incidence of cirrhosis and hepatocellular carcinoma (HCC)
in CHB patients and NAFLD. Methods: We conducted
a retrospective cohort study of adult CHB patients from
Stanford University Medical Center and Taiwan REVEALHBV
study cohort. NAFLD was defined as hepatic steatosis
(> than 5%) on imaging. HCC diagnosis was confirmed by
liver histology or by a combination of clinical history and
radiographic imaging as outlined in the AASLD HCC practice
guidelines. Cirrhosis was diagnosed via histology or clinical
criteria. A sub-analysis was conducted for treated or untreated
CHB patients with and without NAFLD. Results: Among
the 4,267 CHB study patients, 1,576 patients (36.9%) had
concurrent NAFLD and most NAFLD-CHB patients (75.6%)
were male with a mean age of 45.5 ± 10.0. NAFLD-CHB
patients had higher BMI, glucose, triglyceride, ALT, AST,
lower HBV DNA, HDL levels, and were more likely to have
diabetes, hyperlipidemia hypertension, compared with non-
NAFLD patients (P < 0.05 for all). At a median follow-up of
43 months 191 patients developed cirrhosis (n=135, 3.16%)
or HCC (n=56, 1.31%) - 38 (28.1%) cirrhotic patients had
NAFLD and 14 (25.0%) HCC patients had NAFLD. We found
no significant difference in cirrhosis and HCC development
between NAFLD and No-NAFLD patients both in Stanford
cohort and Taiwan cohort. Furthermore, in untreated patients
group, compared to patients without NAFLD, CHB patients
with concurrent NAFLD had lower risk for cirrhosis (cumulative
5-year incidence: 3.06% vs.5.49%, P = 0.001) and HCC
(cumulative 5-year incidence: 0.06% vs. 3.09%, P = 0.01).
Similarly, in treated HBV infection patients groups, compared
to patients without NAFLD, CHB patients with NAFLD also
had a lower risk for HCC (cumulative 5-year incidence: 2.16%
vs. 7.02%, P = 0.03), compared with non-NAFLD patients. But
there was no statistically significant difference in the risk for
cirrhosis development between NAFLD and non-NAFLD CHB
patients. On multivariate analysis among the untreated and
treated CHB patients, only age was significant predictor for
liver cirrhosis or HCC in untreated CHB patients. For treated
CHB patients, age and diabetes were significant predictors
for liver cirrhosis and BMI was predictive for HCC while fatty
liver was protective of HCC. Conclusion: Concurrent NAFLD
was found to be associated with a decrease in the incidence
of cirrhosis and HCC development in CHB patients. |
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发表于 2018-10-29 16:24