慢性乙型肝炎中脂肪肝與肝硬化，肝細胞癌和HBsAg血清清除之

StephenW

Association between fatty liver and cirrhosis, hepatocellular carcinoma, and HBsAg seroclearance in chronic hepatitis B
Jie Li  1   2 , Hwai-I Yang  3 , Ming-Lun Yeh  4 , Michael H Le  5 , An K Le  5 , Yee Hui Yeo  5 , Chia-Yen Dai  4 , Scott Barnett  5 , Jian Q Zhang  6 , Jee-Fu Huang  4 , Huy N Trinh  7 , Christopher Wong  8 , Clifford Wong  8 , Joseph K Hoang  5 , Ramsey Cheung  9 , Ming-Lung Yu  4 , Mindie H Nguyen  5
Affiliations
Affiliations

    1
    Department of Infectious Disease, Shandong Provincial Hospital affiliated to Shandong University, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, China.
    2
    Department of Infectious Disease, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China.
    3
    Genomics Research Center, Academia Sinica, Taiwan.
    4
    Hepatobiliary Section, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Cancer Research and Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
    5
    Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA.
    6
    Chinese Hospital, San Francisco, CA, United States.
    7
    San Jose Gastroenterology, San Jose, CA, United States.
    8
    Wong Clinics, San Francisco, CA, United States.
    9
    Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States.

    PMID: 33249474 DOI: 10.1093/infdis/jiaa739

Abstract

Background: Chronic hepatitis B (CHB) and fatty liver (FL) are common, natural history data on concurrent FL and CHB (FL-CHB) are limited. This study aimed to evaluate the effect of FL on cirrhosis, hepatocellular carcinoma (HCC), and HBsAg seroclearance incidence in CHB patients.

Methods: In a retrospective cohort study of 6,786 adult CHB patients, we used propensity score matching (PSM) to balance the FL-CHB and non-FL CHB groups. Kaplan-Meier methods were used to compare cumulative cirrhosis, HCC, and HBsAg seroclearance rates between subgroups.

Results: Before PSM, compared to non-FL CHB, FL-CHB patients had lower 10-year cumulative rates of cirrhosis, HCC, and a higher HBsAg seroclearance rate. Similar results were found in the matched FL-CHB and non-FL CHB patients, as well as in antiviral treated PSM cohort. Cox proportional hazards model indicated FL to remain significantly and strongly associated with lower risk of cirrhosis and HCC (HR: 0.19, 95% CI: 0.12-0.33, P<0.001, 0.21, 95% CI: 0.09-0.51, P=0.001, respectively) in antiviral treated patients, but not in untreated patients.

Conclusions: FL was significantly associated with lower cirrhosis and HCC risk and higher HBsAg seroclearance. Further studies are needed to confirm our funding and investigate the mechanisms underlying the impact of FL on CHB.

Keywords: HBsAg seroclearance; cirrhosis; fatty liver; hepatitis B virus; hepatocellular carcinoma.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

StephenW

慢性乙型肝炎中脂肪肝與肝硬化，肝細胞癌和HBsAg血清清除之間的關聯
李傑1 2，楊懷一3，葉明倫4，邁克爾·赫勒5，安克勒5，余慧妍5，戴家仁4，斯科特·巴內特5，張建Q 6，吉富Huang 4，Huy N Trinh 7，Christopher Wong 8，Clifford Wong 8，Joseph K Hoang 5，Ramsey Cheung 9，余明龍4，Mindie H Nguyen 5
隸屬關係
隸屬關係

    1個
    山東大學附屬山東省立醫院傳染病科，山東大學齊魯醫學院，山東濟南
    2
    山東第一醫科大學附屬山東省立醫院傳染病科，山東濟南。
    3
    台灣中央研究院基因組研究中心。
    4
    高雄醫科大學附屬醫院內科肝膽科；高雄醫科大學醫學院肝炎研究中心，癌症研究中心和隊列研究中心，台灣高雄。
    5
    美國加利福尼亞州斯坦福市斯坦福大學醫學中心胃腸病學和肝病科。
    6
    美國加利福尼亞州舊金山中國醫院。
    7
    美國加利福尼亞州聖何塞，聖何塞胃腸病學。
    8
    Wong診所，美國加利福尼亞州舊金山。
    9
    美國加利福尼亞州帕洛阿爾托市退伍軍人事務部帕洛阿爾托衛生保健系統胃腸病學和肝病科。

    PMID：33249474 DOI：10.1093 / infdis / jiaa739

抽象

背景：慢性乙型肝炎（CHB）和脂肪肝（FL）常見，同時存在FL和CHB（FL-CHB）的自然史數據有限。本研究旨在評估FL對CHB患者肝硬化，肝細胞癌（HCC）和HBsAg血清清除率的影響。

方法：在一項回顧性隊列研究中，對6,786名成年CHB患者進行研究，我們使用傾向評分匹配（PSM）來平衡FL-CHB和非FL CHB組。使用Kaplan-Meier方法比較亞組之間的累積肝硬化，HCC和HBsAg血清清除率。

結果：PSM前，與非FL CHB相比，FL-CHB患者的10年肝硬化，HCC累積率較低，HBsAg血清清除率較高。在匹配的FL-CHB和非FL CHB患者以及抗病毒治療的PSM隊列中發現了相似的結果。 Cox比例風險模型表明FL仍與肝硬化和HCC的較低風險顯著相關，且高度相關（HR：0.19，95％CI：0.12-0.33，P <0.001，0.21，95％CI：0.09-0.51，P = 0.001，分別在抗病毒治療的患者中進行，但未在未治療的患者中進行。

結論：FL與較低的肝硬化和HCC風險以及較高的HBsAg血清清除率顯著相關。需要進一步的研究來確認我們的資金，並調查FL對CHB影響的潛在機制。

關鍵詞：HBsAg血清清除；肝硬化脂肪肝;乙型肝炎病毒;肝細胞癌。

©2020作者。牛津大學出版社，美國傳染病學會出版。版權所有。有關權限，請發送電子郵件至：[email protected]。

lancas

。。。。肝硬化竟然有高得HBSAG血清清楚。。。。

StephenW

回复 lancas 的帖子

不是.
脂肪肝(FL, fatty liver)乙肝患者, 與非脂肪肝乙肝患者相比,  肝硬化, 肝細胞癌率似乎較低, HBsAg血清清除率較高.

這些結果似乎不是直覺的, 需要更多研究以找出原因.