在长期随访中，肝脂肪变性的存在不会增加慢性乙型肝炎患

StephenW

Presence of Hepatic Steatosis Does Not Increase the Risk of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B Over Long Follow-Up
Chong Teik Lim  1 , George Boon Bee Goh  1   2 , Huihua Li  3   4 , Tony Kiat-Hon Lim  2   5 , Wei Qiang Leow  2   5 , Wei Keat Wan  2   5 , Rafay Azhar  2   5 , Wan Cheng Chow  1   2 , Rajneesh Kumar  1   2
Affiliations
Affiliations

    1
    Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
    2
    Duke-NUS Graduate Medical School, Singapore.
    3
    Department of Health Services Research Unit, Singapore General Hospital, Singapore.
    4
    Centre of Quantitative Medicine, Duke-NUS Medical School, Singapore.
    5
    Department of Pathology, Singapore General Hospital, Singapore.

    PMID: 32435130 PMCID: PMC7223198 DOI: 10.1177/1178636120918878

Abstract

Background: Chronic hepatitis B (CHB) infection and nonalcoholic fatty liver disease (NAFLD) are liver diseases which may lead to hepatocellular carcinoma (HCC) formation. Both disease entities have been attributed independently to increase risk of HCC development. While concomitant hepatic steatosis in patients with CHB are becoming more frequent in view of increasing NAFLD prevalence, there is no conclusive evidence linking presence of hepatic steatosis and increased HCC risk in patients with CHB infection. This study explores the association of hepatic steatosis among CHB-infected individuals in HCC development.

Methods: This is a retrospective study on a cohort of patients with CHB who underwent liver biopsy between January 2000 and December 2014. They were stratified according to presence and severity of histologically proven hepatic steatosis and subsequently followed up to evaluate the association between hepatic steatosis and HCC development.

Results: Among 289 patients with a median follow-up of 111.1 months, hepatic steatosis was present in 185 patients (64.0%). In all, 27 patients developed HCC on follow-up and 21 of them had hepatic steatosis. Univariate Cox analysis showed that age (hazard ratio [HR] = 1.08, 95% CI = 1.042-1.12), type 2 diabetes mellitus (T2DM) (HR = 4.00, 95% CI = 1.622-9.863), and Ishak score (HR = 1.221, 95% CI = 1.014-1.472) were associated with HCC development, whereas multivariate Cox analysis demonstrated that age and T2DM (HR = 2.69, 95% CI = 1.072-6.759) were significant risk factors for development of HCC.

Conclusions: Concurrent hepatic steatosis in patients with CHB infection is not a risk factor for hepatocellular carcinoma formation.

Keywords: Hepatitis B; hepatic steatosis; hepatocellular carcinoma; liver biopsy.

StephenW

在长期随访中，肝脂肪变性的存在不会增加慢性乙型肝炎患者肝细胞癌的风险
Chong Teik Lim 1，George Boon Bee Goh 1 2，Huihua Li 3 4，Tony Kiat-Hon Lim 2 5，Wei Qiang Leow 2 5，Wei Keat Wan 2 5，Rafay Azhar 2 5，Wan Cheng Chow 1 2，Rajneesh Kumar 1 2
隶属关系
隶属关系

    1个
    新加坡新加坡总医院消化内科和肝病科。
    2
    新加坡国立杜克大学医学院。
    3
    新加坡新加坡总医院卫生服务研究室。
    4
    新加坡国立杜克大学医学院定量医学中心。
    5
    新加坡新加坡总医院病理科。

    PMID：32435130 PMCID：PMC7223198 DOI：10.1177 / 1178636120918878

抽象

背景：慢性乙型肝炎（CHB）感染和非酒精性脂肪肝疾病（NAFLD）是可能导致肝细胞癌（HCC）形成的肝脏疾病。这两个疾病实体都被独立地归因于增加了HCC发生的风险。尽管鉴于NAFLD患病率增加，CHB患者并发肝脂肪变性变得更加频繁，但尚无确凿的证据将CHB感染患者存在肝脂肪变性和HCC风险增加联系起来。这项研究探讨了肝癌发展过程中CHB感染个体之间肝脂肪变性的关联。

方法：这是一项回顾性研究，研究对象是2000年1月至2014年12月间进行肝活检的CHB患者。根据组织学证实的肝脂肪变性的存在和严重程度对患者进行分层，随后进行随访以评估肝脂肪变性与肝脂肪变性之间的关系。 HCC开发。

结果：在289位患者中位随访111.1个月中，有185例患者发生肝脂肪变性（64.0％）。共有27例患者在随访中发展为HCC，其中21例患有肝脂肪变性。单因素Cox分析显示年龄（危险比[HR] = 1.08，95％CI = 1.042-1.12），2型糖尿病（T2DM）（HR = 4.00，95％CI = 1.622-9.863）和Ishak评分（HR = 1.221，95％CI = 1.014-1.472）与HCC的发生有关，而多元Cox分析表明年龄和T2DM（HR = 2.69，95％CI = 1.072-6.759）是发展HCC的重要危险因素。

结论：CHB感染患者并发肝脂肪变性不是肝细胞癌形成的危险因素。

关键字：乙型肝炎；肝脂肪变性肝细胞癌；肝活检。

StephenW

https://journals.sagepub.com/doi/pdf/10.1177/1178636120918878