病毒性静止的慢性乙型肝炎对肝脂肪变性的纤维化进程和功

StephenW

Diverse effects of hepatic steatosis on fibrosis progression and functional cure in virologically quiescent chronic hepatitis B

    Lung-Yi Mak
    Rex Wan-Hin Hui
    James Fung
    Ka-Shing Cheung
    Man-Fung Yuen
    Wai-Kay Seto
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Published:June 02, 2020DOI:https://doi.org/10.1016/j.jhep.2020.05.040
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Highlights

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    Presence of hepatic steatosis on transient elastography, reflected by controlled attenuation parameter (CAP), was associated with 3-fold increase in likelihood of subsequent hepatitis B surface antigen (HBsAg) seroclearance in virologically quiescent CHB infection.
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    The cumulative probability of HBsAg seroclearance at 36 months was 18.4% for those with hepatic steatosis and low serum HBV DNA (<200 IU/mL) compared to 3.3% for those with either one of the favourable factors, and 1.1% for those without hepatic steatosis and with higher serum HBV DNA.
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    Fibrosis progression was still observed in 25.2% patients despite virological quiescence.
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    Persistent severe hepatic steatosis was associated with more than 2-fold increase risk in fibrosis progression at 36 months.
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    Routine CAP measurement in apparently low-risk CHB patients carries prognostic value for subsequent HBsAg seroclearance and fibrosis progression.

Abstract
Background
Concomitant non-alcoholic fatty liver disease is common in patients with chronic hepatitis B (CHB) infection, although its impact on liver-related outcomes remains controversial. We aimed to study the effect of hepatic steatosis on risk of fibrosis progression and hepatitis B surface antigen (HBsAg) seroclearance.
Methods
Treatment-naive CHB patients with normal alanine aminotransferase and low viremia (serum HBV DNA <2000 IU/mL) were prospectively recruited for baseline and 3-year transient elastography assessment. Fibrosis staging was defined according to the EASL-ALEH guidelines, with fibrosis progression defined as ≥1 stage increment of fibrosis. Hepatic steatosis and severe hepatic steatosis were defined as controlled attenuation parameter (CAP) ≥248 dB/m & ≥280 dB/m respectively.
Results
330 patients (median age 50.5 years, 41.2% male, median HBV DNA 189 IU/mL) were recruited. Twenty-two patients (6.7%) achieved HBsAg seroclearance during follow-up, and the presence of hepatic steatosis was associated with significantly higher chance of HBsAg seroclearance (hazard ratio: 3.246, 95%CI 1.278–8.243, p=0.013). At baseline, 48.8% and 28.8% had steatosis and severe steatosis, respectively. 4.2% had F3/F4 at baseline, which increased to 8.7% at 3 years. The rate of liver fibrosis progression in patients with persistent severe steatosis was higher than those without steatosis (41.3% vs. 23%, p=0.05). Persistent severe hepatic steatosis was independently associated with fibrosis progression (odds ratio: 2.379, 95%CI 1.231–4.597, p=0.01).
Conclusions
CAP measurements have predictive values in virologically quiescent CHB patients. Presence of hepatic steatosis was associated with a higher risk of fibrosis progression but paradoxically a 3-fold increase in HBsAg seroclearance rate.

StephenW

病毒性静止的慢性乙型肝炎对肝脂肪变性的纤维化进程和功能治愈的影响

    麦龙义
    许婉轩
    冯国荣
    张家诚
    袁文峰
    怀基濑户
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发布时间：2020年6月2日DOI：https：//doi.org/10.1016/j.jhep.2020.05.040
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强调

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    在受控的衰减参数（CAP）反映的瞬时弹性成像上，肝脂肪变性的存在与病毒学稳定的CHB感染中随后的乙型肝炎表面抗原（HBsAg）血清清除的可能性增加了3倍相关。
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    肝脂肪变性和血清HBV DNA低（<200 IU / mL）的患者在36个月时HBsAg血清清除的累积概率为18.4％，而具有任一有利因素的患者为3.3％，无肝炎的患者为1.1％脂肪变性和血清HBV DNA较高。
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    尽管有病毒学上的静止，在25.2％的患者中仍观察到纤维化进展。
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    持续性严重肝脂肪变性与36个月纤维化进展的风险增加2倍以上有关。
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    在明显低危的CHB患者中进行常规CAP测量对随后的HBsAg血清清除和纤维化进展具有预后价值。

抽象
背景
尽管慢性乙型肝炎（CHB）对肝脏相关结局的影响尚存争议，但伴随的非酒精性脂肪性肝病仍很常见。我们旨在研究肝脂肪变性对纤维化进展风险和乙型肝炎表面抗原（HBsAg）血清清除的影响。
方法
前瞻性招募未接受过治疗的丙氨酸转氨酶正常且病毒血症低（血清HBV DNA <2000 IU / mL）的CHB患者进行基线和3年瞬态弹性成像评估。纤维化分期是根据EASL-ALEH指南定义的，纤维化进展定义为≥1级纤维化增量。肝脂肪变性和严重肝脂肪变性分别定义为受控衰减参数（CAP）≥248dB / m和≥280dB / m。
结果
招募了330名患者（中位年龄50.5岁，男性41.2％，中位HBV DNA 189 IU / mL）。随访期间有22例患者（6.7％）达到了HBsAg血清清除，并且肝脂肪变性的存在与HBsAg血清清除的机会明显更高有关（危险比：3.246，95％CI 1.278-8.243，p = 0.013）。基线时，脂肪变性和严重脂肪变性分别为48.8％和28.8％。基线时F3 / F4占4.2％，三年后增加到8.7％。持续性严重脂肪变性患者的肝纤维化进展速度高于非脂肪变性患者（41.3％vs. 23％，p = 0.05）。持续性严重肝脂肪变性与纤维化进展独立相关（赔率：2.379，95％CI 1.231-4.597，p = 0.01）。
结论
CAP测量在病毒学上静止的CHB患者中具有预测价值。肝脂肪变性的存在与纤维化进展的较高风险相关，但矛盾的是HBsAg血清清除率增加了3倍。