肝脂肪变性对慢性乙型肝炎患者PEG-IFNα-2a抗病毒作用的影响

StephenW

Impact of Hepatic Steatosis on the Antiviral Effects of PEG-IFN α-2a in Patients with Chronic Hepatitis B and the Associated Mechanism
Huiqing Liang  1   2 , Yaoyu Liu  3 , Xiaoqian Jiang  3 , Xiaoting Zheng  3 , Jinmo Tang  1 , Jiaen Yang  1 , Hongli Zhuang  4 , Penghua Lai  2 , Li Peng  2 , Zhenying Guo  2 , Shanshan Cai  3 , Dan Luo  3 , Lingxia Xu  2 , Qianguo Mao  1 , Shaodong Chen  2
Affiliations
Affiliations

    1
    Hepatology Unit, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian, China.
    2
    Department of Traditional Chinese Medicine, Medical College of Xiamen University, Xiamen, Fujian, China.
    3
    Fujian University of Traditional Chinese Medicine, Fujian, China.
    4
    Department of Traditional Chinese Medicine, No.1 Hospital Affiliated to Xiamen University, Xiamen, Fujian, China.

    PMID: 32676103 PMCID: PMC7335408 DOI: 10.1155/2020/1794769

Abstract

Objective: To investigate the risk factors for hepatic steatosis in chronic hepatitis B (CHB), to determine its correlation with liver necroinflammation and fibrosis and response to peginterferon alpha-2a (PEG-IFNα-2a) antiviral therapy, and to explore the mechanisms underlying the poor antiviral effect of PEG-IFNα-2a in CHB patients with hepatic steatosis.

Methods: We analysed the impact of hepatic steatosis on the antiviral effect of PEG-IFNα-2a on CHB patients in a cohort of 226 patients who underwent pretherapeutic liver biopsy. To assess the complete response (CR), virological response (VR), and biochemical response (BR), the 226 patients were treated with PEG-IFNα-2a for 48 weeks and were followed-up for 24 weeks. The expressions of hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) in the liver tissue were detected in all patients to explore the possible mechanism of hepatic steatosis with regard to antiviral effects.

Results: The patients were divided into four groups based on the severity of hepatic steatosis: 119 with no steatosis, 76 with mild steatosis, 22 with moderate steatosis, and 9 with severe steatosis. In the hepatic steatosis groups, the proportions of male patients, patients aged >40 years, patients with hyperuricaemia, patients with a BMI > 23 kg/m2, and total cholesterol (TC), triglyceride (TG), glucose (GLU), and uric acid (UA) levels were significantly higher than those in the group without steatosis, whereas the alanine aminotransferase (ALT) and aspartate transaminase (AST) levels were significantly lower than those in the group without steatosis. The multivariate analysis results indicated that a BMI > 23 kg/m2 was independently associated with CHB patients with hepatic steatosis; the levels of baseline AST and UA were independently associated with CHB patients with significant hepatic steatosis, and the baseline AST level was independently associated with significant liver fibrosis. After 48 weeks of treatment and 24 weeks of follow-up, the rates of CR, VR, and BR had gradually decreased, whereas the severity of hepatic steatosis had increased.

Conclusion: Hepatic steatosis can reduce the efficacy of PEG-IFNα-2a in the treatment of CHB patients, and its mechanism may be related to the different HBcAg expression patterns in liver tissue.

Copyright © 2020 Huiqing Liang et al.
Conflict of interest statement

The authors declare that they have no conflicts of interest.

StephenW

肝脂肪变性对慢性乙型肝炎患者PEG-IFNα-2a抗病毒作用的影响及其相关机制
梁慧清1 2，刘瑶瑜3，江小倩3，郑小婷3，唐金模1，杨嘉恩1，洪利庄4，彭华来2，李鹏2，郭振英2，杉杉菜3，罗丹3，灵霞徐2，钱国茂1，陈少东2
隶属关系
隶属关系

    1个
    厦门市中医院肝病科，福建厦门
    2
    厦门大学医学院中医系，福建厦门
    3
    福建中医药大学，福建。
    4
    厦门大学附属第一医院中医科，福建厦门

    PMID：32676103 PMCID：PMC7335408 DOI：10.1155 / 2020/1794769

抽象

目的：探讨慢性乙型肝炎（CHB）肝脂肪变性的危险因素，确定其与肝坏死性炎症和纤维化的关系以及对聚乙二醇干扰素α-2a（PEG-IFNα-2a）抗病毒治疗的反应，并探讨其潜在机制PEG-IFNα-2a在CHB肝脂肪变性患者中抗病毒作用较差。

方法：我们分析了226例接受治疗前肝活检的患者中肝脂肪变性对PEG-IFNα-2a对CHB患者抗病毒作用的影响。为了评估完全缓解（CR），病毒学缓解（VR）和生化反应（BR），对226例患者进行PEG-IFNα-2a治疗48周，并随访24周。检测所有患者肝组织中乙型肝炎表面抗原（HBsAg）和乙型肝炎核心抗原（HBcAg）的表达，以探讨肝脂肪变性抗病毒作用的可能机制。

结果：根据肝脂肪变性的严重程度将患者分为四组：无脂肪变性119例，轻度脂肪变性76例，中度脂肪变性22例和重度脂肪变性9例。在肝脂肪变性组中，男性患者，年龄大于40岁的患者，高尿酸血症患者，BMI> 23 kg / m2以及总胆固醇（TC），甘油三酸酯（TG），葡萄糖（GLU）和尿酸（UA）水平显着高于无脂肪变性组，而丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）水平显着低于无脂肪变性组。多元分析结果表明，BMI> 23 kg / m2与CHB肝脂肪变性患者独立相关；基线AST和UA的水平与严重肝脂肪变性的CHB患者独立相关，基线AST的水平与肝纤维化严重相关。经过48周的治疗和24周的随访，CR，VR和BR的发生率逐渐降低，而肝脂肪变性的严重程度有所增加。

结论：肝脂肪变性可降低PEG-IFNα-2a治疗CHB患者的疗效，其机制可能与肝组织中HBcAg表达方式的不同有关。

版权所有©2020 Huiqing Liang等。
利益冲突声明

作者宣称他们没有利益冲突。

StephenW

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