脂肪肝與乙型肝炎患者纖維化進展有關

StephenW

Fatty Liver Linked to Fibrosis Progression in People With Hepatitis B

Unexpectedly, liver steatosis was also associated with a greater chance of achieving HBsAg seroclearance.

February 25, 2021 • By Sukanya Charuchandra

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Fat accumulation in the liver was not only linked to a higher likelihood of fibrosis progression but also to a threefold bump in the odds of hepatitis B surface antigen (HBsAg) seroclearance in people with inactive chronic hepatitis B, according to study results published in the Journal of Hepatology.

Non-alcoholic fatty liver disease (NAFLD) frequently accompanies chronic hepatitis B, but its effect on liver-related outcomes is not well understood. Fatty liver disease and hep B both independently increase the risk of cirrhosis and liver cancer. Chronic hepatitis B can be treated with antivirals, but it is seldom cured.

Lung-Yi Mak, MBBS, of the University of Hong Kong, and colleagues explored the impact of fat accumulation in the liver on the risk of developing fibrosis and HBsAg seroclearance. The loss of HBsAg and related antibodies in people with chronic hepatitis B is considered a functional cure.

The team recruited individuals with chronic hepatitis B virus (HBV) infection who had normal ALT liver enzyme levels and low hepatitis B viral load in their blood. They had not yet received antiviral therapy, which is generally not recommended for people with inactive hepatitis B. The 330 participants had a median age of 51 years, and 59% were women.

These participants underwent transient elastography (FibroScan) twice—at the time of recruitment and after three years—to assess the extent of liver fibrosis. In addition to liver stiffness measurements, the researchers also determined the controlled attenuation parameter (CAP) score, which measures the intensity of sound waves as they travel through fatty tissue compared with normal liver tissue.

At the beginning of the study, 49% of participants had fat accumulation in the liver, including 29% with severe steatosis. At study initiation, 4.2% had advanced liver fibrosis or cirrhosis; this increased to 8.7% after three years. Overall, fibrosis progression was seen in 25% of the participants even with inactive HBV.

Liver fibrosis was more common in people with persistent severe liver fat accumulation (41%) compared with those who had a recent onset (35%) or those without fat buildup (23%). Further, continual severe fat accumulation in the liver was independently linked to the advancement of fibrosis.

Twenty-two participants (6.7%) attained HBsAg seroclearance over the course of the study. Fat buildup in the liver was linked to a threefold higher likelihood of seroclearance.

Individuals with liver fat accumulation and a low HBV viral load had a 18% chance of achieving HBsAg seroclearance. For those with just one of these factors, the likelihood of seroclearance was 3.3%. People without fat buildup and a higher viral load had only a 1.1% chance of attaining seroclearance.

“Routine CAP measurement in apparently low-risk [chronic hepatitis B] patients carries prognostic value for subsequent HBsAg seroclearance and fibrosis progression,” wrote the researchers.

“Coexisting 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,” they added. “Routine bedside assessment of liver fat content is important for risk assessment in treatment-naive patients with chronic hepatitis B.”

Click here to read the study abstract in the Journal of Hepatology.

StephenW

脂肪肝與乙型肝炎患者纖維化進展有關

出乎意料的是，肝脂肪變性也與獲得HBsAg血清清除的機會更大有關。

2021年2月25日•Sukanya Charuchandra發表

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根據發表在《華爾街日報》上的研究結果，肝臟中的脂肪積累不僅與纖維化進展的可能性更高有關，而且與非活動性慢性乙型肝炎患者中乙型肝炎表面抗原（HBsAg）血清清除機率的三倍增加有關。肝病學。

非酒精性脂肪性肝病（NAFLD）經常伴隨慢性乙型肝炎，但其對肝臟相關結局的影響尚不清楚。脂肪肝和乙肝均獨立增加肝硬化和肝癌的風險。慢性乙型肝炎可以用抗病毒藥治療，但很少治愈。

香港大學的MBBS的麥龍儀及其同事探討了肝臟中脂肪堆積對發生纖維化和HBsAg血清清除的風險的影響。慢性乙型肝炎患者體內HBsAg和相關抗體的丟失被認為是一種功能性治愈方法。

該小組招募了患有慢性乙型肝炎病毒（HBV）感染的人，這些人的血液中的ALT肝酶水平正常且乙肝病毒載量低。他們尚未接受抗病毒治療，通常不建議非活動性乙型肝炎患者使用。330名參與者的中位年齡為51歲，其中59％為女性。

這些參與者在募集時和三年後進行了兩次瞬時彈性成像（FibroScan），以評估肝纖維化程度。除了測量肝臟硬度外，研究人員還確定了受控衰減參數（CAP）分數，該分數可測量聲波穿過脂肪組織時與正常肝組織相比的強度。

在研究開始時，有49％的參與者肝臟中脂肪堆積，其中29％患有嚴重脂肪變性。在研究開始時，有4.2％的患者患有晚期肝纖維化或肝硬化。三年後增加到8.7％。總體而言，即使不活動的HBV，也有25％的參與者看到了纖維化進展。

與持續發作的肝臟脂肪堆積（35％）或沒有脂肪堆積的人群（23％）相比，持續存在嚴重肝脂肪堆積的人群（41％）肝纖維化更為常見。此外，肝臟中持續的大量脂肪積累與纖維化的進展獨立相關。

在研究過程中，有22名參與者（6.7％）達到了HBsAg血清清除。肝臟中脂肪堆積與血清清除的可能性增加了三倍。

肝脂肪積聚且HBV病毒載量低的個體有18％的機會實現HBsAg血清清除。對於那些僅具有這些因素之一的人，血清清除的可能性為3.3％。沒有脂肪堆積和較高的病毒載量的人只有1.1％的機會獲得血清清除。

研究人員寫道：“在低危[慢性乙型肝炎]患者中常規的CAP測定對隨後的HBsAg血清清除和纖維化進展具有預後價值。”

他們補充說：“慢性乙型肝炎病毒感染患者並存的脂肪肝疾病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。” “常規的床邊肝脂肪含量評估對於未接受過治療的慢性乙型肝炎患者的風險評估至關重要。”

單擊此處閱讀《肝病學雜誌》上的研究摘要。