病毒性靜止的慢性乙型肝炎對肝脂肪變性的纖維化進程和功

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

Highlights

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    Hepatic steatosis was associated with a 3-fold increase in likelihood of HBsAg seroclearance in quiescent CHB infection.
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    Cumulative probability of HBsAg seroclearance at 3 years was 18.4% in those with steatosis and low serum HBV DNA (<200 IU/ml).
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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 a 2-fold increased risk of fibrosis progression at 36 months.
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    Routine CAP measurement in patients with apparently low-risk CHB has prognostic value.

Background & Aims
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 the risk of fibrosis progression and the likelihood of HBsAg seroclearance.
Methods
Treatment-naïve patients with CHB, normal alanine aminotransferase and low viraemia (serum HBV DNA <2,000 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 and ≥280 dB/m, respectively.
Results
A total of 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 a 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% of patients had steatosis and severe steatosis, respectively, while 4.2% had F3/F4 fibrosis at baseline, increasing to 8.7% at 3 years. The rate of liver fibrosis progression in patients with persistent severe steatosis was higher than in 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 value in patients with virologically quiescent CHB. The presence of hepatic steatosis was associated with a higher risk of fibrosis progression but, paradoxically, a 3-fold increase in HBsAg seroclearance rate.
Lay summary
Co-existing fatty liver disease in patients with chronic viral hepatitis B infection leads to worsening liver fibrosis, but also increases the chance of cure from hepatitis B virus. Routine bedside assessment of liver fat content is important for risk assessment in treatment-naïve patients with chronic hepatitis B.

StephenW

病毒性靜止的慢性乙型肝炎對肝脂肪變性的纖維化進程和功能治癒的影響

    麥龍義
    許婉軒
    馮國榮
    張家誠
    袁文峰
    懷基瀨戶
    顯示所有作者

發佈時間：2020年6月2日DOI：https：//doi.org/10.1016/j.jhep.2020.05.040

強調

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    靜態CHB感染中，肝脂肪變性與HBsAg血清清除的可能性增加3倍有關。
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    患有脂肪變性和血清HBV DNA低（<200 IU / ml）的患者3年內HBsAg血清清除的累積概率為18.4％。
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    儘管有病毒學上的靜止，在25.2％的患者中仍觀察到纖維化進展。
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    持續性嚴重肝脂肪變性與36個月時纖維化進展的風險增加2倍相關。
    •
    CHB明顯低危患者的常規CAP測量具有預後價值。

背景與目標
儘管慢性乙型肝炎（CHB）感染對肝臟相關結局的影響尚存爭議，但非酒精性脂肪性肝病仍很常見。我們旨在研究肝脂肪變性對纖維化進展風險和HBsAg血清清除的可能性的影響。
方法
前瞻性招募未接受過CHB，丙氨酸轉氨酶正常和低病毒血症（血清HBV DNA <2,000 IU / ml）的患者進行基線和3年瞬態彈性成像評估。纖維化分期是根據EASL-ALEH指南定義的，纖維化進展定義為≥1級的纖維化增量。肝脂肪變性和嚴重肝脂肪變性分別定義為受控衰減參數（CAP）≥248dB / m和≥280dB / m。
結果
總共招募了330名患者（中位年齡為50.5歲，男性為41.2％，HBV DNA中位數為189 IU / ml）。隨訪期間有22例患者（6.7％）達到了HBsAg血清清除，並且存在肝脂肪變性與HBsAg血清清除的機會明顯更高（危險比3.246； 95％CI 1.278-8.243； p = 0.013）。在基線時，分別有48.8％和28.8％的患者患有脂肪變性和嚴重脂肪變性，而在基線時有4.2％的患者患有F3 / F4纖維化，在3年時增加到8.7％。持續性嚴重脂肪變性患者的肝纖維化進展速度高於無脂肪變性患者（41.3％vs. 23％； p = 0.05）。持續性嚴重肝脂肪變性與纖維化進展獨立相關（優勢比2.379； 95％CI 1.231–4.597； p = 0.01）。
結論
CAP測量對CHB病毒學靜止的患者俱有預測價值。肝脂肪變性的存在與纖維化進展的較高風險相關，但矛盾的是，HBsAg血清清除率增加了3倍。
放置摘要
慢性乙型肝炎病毒感染患者並存的脂肪肝會導致肝纖維化惡化，但也會增加乙型肝炎病毒治癒的機會。在未接受過治療的慢性乙型肝炎患者中，常規的床旁肝脂肪含量評估對風險評估很重要。