脂肪肝与慢性乙型肝炎患者对口服抗病毒治疗的完全缓解率

StephenW

Liver Int. 2020 Feb 22. doi: 10.1111/liv.14415. [Epub ahead of print]
Fatty liver is not independently associated with rates of complete response to oral antiviral therapy in chronic hepatitis B patients.
Li J1,2, Le AK2, Chaung KT2, Henry L2, Hoang JK2, Cheung R2,3, Nguyen MH2.
Author information

1
    Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan, Shandong, China.
2
    Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA.
3
    Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.

Abstract
BACKGROUND & AIMS:

Nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis B (CHB) are common liver diseases. Concurrent NAFLD may affect antiviral treatment outcomes in CHB patients. The aim of this study is to investigate the impact of NAFLD on complete viral suppression [(CVS), HBV DNA < 20-100 IU/mL] and/or biochemical response [(BR), ALT of ≤ 25 U/L for females; 35 U/L for males] in CHB patients who received oral antiviral therapy.
METHODS:

A retrospective study of 555 treated CHB patients (187 NAFLD; 368 non-NAFLD) from 2000 to 2016 at a USA medical center. NAFLD was diagnosed by imaging and/or histology after ruling out secondary causes of hepatic steatosis.
RESULTS:

The majority of patients were male (60.7%), Asian (87.56%), and HBeAg-negative (66.7%). NAFLD patients compared to non-NAFLD were more likely HBeAg negative (74.3% vs. 62.8%, P=0.02), hypertensive (33.2% vs. 22.8%, P=0.009), male (67.4% vs. 57.3%, P=0.02) with a higher mean BMI (25.4±4.3 vs. 23.8±4.0 kg/m2 , P<0.001). Both cohorts achieved similar rates of CVS (86% vs. 88%) and BR (38% vs. 41%) during follow-up of up to 60 months (P>0.05), but NAFLD had higher cumulative rates of CVS+BR, compared with non-NAFLD patients (32.5% vs. 22.8%, P=0.03). In multivariate analyses, NAFLD was not independently associated with CVS and/or BR outcomes. Receipt of entecavir or tenofovir (versus older therapies) and lower baseline HBV DNA or higher ALT were positively associated with achieving CVS or BR.
CONCLUSION:

Concomitant NAFLD had no impact on the long-term rates of CVS and/or BR in treated CHB patients.

This article is protected by copyright. All rights reserved.
KEYWORDS:

HBV; NAFLD; antiviral therapy; biochemical responses; virological responses

PMID:
    32086988
DOI:
    10.1111/liv.14415

StephenW

肝内科。 2020年2月22日。doi：10.1111 / liv.14415。 [Epub提前发行]
脂肪肝与慢性乙型肝炎患者对口服抗病毒治疗的完全缓解率无关。
Li J1,2，Le AK2，Chaung KT2，Henry L2，Hoang JK2，Cheung R2,3，Nguyen MH2。
作者信息

1个
    山东大学附属山东省立医院传染病科，山东济南
2
    美国加利福尼亚州斯坦福市斯坦福大学医学中心胃肠病学和肝病科。
3
    美国加利福尼亚州帕洛阿尔托市退伍军人事务部帕洛阿尔托卫生保健系统胃肠病学和肝病科。

抽象
背景与目的：

非酒精性脂肪肝疾病（NAFLD）和慢性乙型肝炎（CHB）是常见的肝病。并发NAFLD可能会影响CHB患者的抗病毒治疗结果。这项研究的目的是调查NAFLD对女性完全病毒抑制[（CVS），HBV DNA <20-100 IU / mL]和/或生化反应[（BR），ALT≤25 U / L的影响;在接受口服抗病毒治疗的CHB患者中，男性为35 U / L）。
方法：

2000年至2016年在美国医疗中心对555名接受治疗的CHB患者（187名NAFLD； 368名非NAFLD）进行了回顾性研究。在排除肝脂肪变性的继发原因后，通过影像学和/或组织学诊断为NAFLD。
结果：

大多数患者为男性（60.7％），亚洲人（87.56％）和HBeAg阴性（66.7％）。与非NAFLD相比，NAFLD患者更可能出现HBeAg阴性（74.3％vs.62.8％，P = 0.02），高血压（33.2％vs. 22.8％，P = 0.009），男性（67.4％vs.57.3％，P = 0.02）和更高的平均BMI（25.4±4.3对23.8±4.0 kg / m2，P <0.001）。在长达60个月的随访中，这两个队列的CVS率（86％比88％）和BR（38％比41％）相似（P> 0.05），但是NAFLD的CVS + BR累积率更高，与非NAFLD患者相比（32.5％vs. 22.8％，P = 0.03）。在多变量分析中，NAFLD与CVS和/或BR结果并非独立相关。接受恩替卡韦或替诺福韦（相对于较旧的治疗方法）和较低的基线HBV DNA或较高的ALT与实现CVS或BR正相关。
结论：

伴随的NAFLD对治疗的CHB患者的长期CVS和/或BR发生率没有影响。

本文受版权保护。版权所有。
关键字：

乙肝病毒NAFLD；抗病毒治疗；生化反应；病毒学反应

PMID：
    32086988
DOI：
    10.1111 / liv.14415