脂肪变性、HBV 相关肝细胞癌、肝硬化和 HBsAg 血清学清除：系

StephenW

脂肪变性、HBV 相关肝细胞癌、肝硬化和 HBsAg 血清学清除：系统评价和荟萃分析
毛宪华 1 , 张嘉诚 1 2 , 彭成志 3 , 麦龙宜 1 4 , 何明诚 1 , 冯志强 1 4 , 诺姆佩莱格 5 6 , Howard H-W Leung 7 , Rajneesh Kumar 8 9 , Jeong-Hoon Lee 10 , Amir Shlomai 11 , Man-Fung Yuen 1 4 , Wai-Kay Seto 1 2 4
隶属关系
隶属关系

    1
    香港大学临床医学院医学系。
    2
    香港大学深圳医院内科。
    3
    香港大学李嘉诚医学院。
    4
    香港大学肝脏研究国家重点实验室。
    5
    以色列佩塔提克瓦拉宾医疗中心肠胃科。
    6
    以色列特拉维夫特拉维夫大学萨克勒医学院。
    7
    香港中文大学解剖及细胞病理学系。
    8
    新加坡中央医院肠胃和肝病科。
    9
    新加坡杜克-新加坡国立大学研究生医学院。
    10
    首尔国立大学医学院内科和肝脏研究所，韩国首尔。
    11
    医学 D 部和肝脏研究所，拉宾医学中心，贝林森医院，佩塔提克瓦和特拉维夫大学萨克勒医学院，特拉维夫，以色列。

    PMID：36111362 DOI：10.1002/hep.32792

抽象的

背景与目的：非酒精性脂肪性肝病 (NAFLD) 和慢性乙型肝炎 (CHB) 感染是肝细胞癌 (HCC) 的常见病因。肝脂肪变性对 CHB 中 HCC 的影响，以及其与肝硬化、纤维化和乙型肝炎表面抗原 (HBsAg) 血清学清除的关系仍存在争议。

方法和结果：通过 PubMed、EMBASE 和 Cochrane 图书馆收集了从成立到 2022 年 2 月 1 日的观察性研究数据。感兴趣的结果包括肝脂肪变性与 HCC、肝硬化、晚期纤维化和 HBsAg 血清学清除的关联，以汇总的形式表示优势比（OR）。进行了额外的亚组和敏感性分析以验证结果的稳健性。共纳入 34 项研究，涉及 68,268 名慢性乙型肝炎患者。肝脂肪变性与较高的 HCC 几率相关（OR 1.59；95%CI 1.12-2.26；I2 =72.5%），在亚洲这种关联保持一致（OR 1.56；95%CI 1.08-2.25），中位随访研究持续时间≥5 年（OR 2.82；95%CI 1.57-5.08），排除饮酒（OR 1.71；95%CI 1.01-2.91）和活检证实的脂肪变性（OR 2.86；95%CI 1.61-5.06） ，尽管在接受核苷（酸）类似物治疗的患者中未发现显着相关性（OR 1.05；95%CI 0.62-1.77）。脂肪变性与肝硬化（OR 1.52；95%CI 1.07-2.16；I2 =0%）和 HBsAg 血清清除（OR 2.22；95%CI 1.58-3.10；I2 =49.0%）的发展相关。

结论：肝脂肪变性与慢性乙型肝炎患者发生 HCC 和肝硬化的风险增加相关，但实现功能性治愈的机会更高，突出了识别慢性乙型肝炎伴随脂肪变性的重要性。

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StephenW

Steatosis, HBV-related hepatocellular carcinoma, cirrhosis & HBsAg seroclearance: a systematic review and meta-analysis
Xianhua Mao  1 , Ka Shing Cheung  1   2 , Chengzhi Peng  3 , Lung-Yi Mak  1   4 , Ho Ming Cheng  1 , James Fung  1   4 , Noam Peleg  5   6 , Howard H-W Leung  7 , Rajneesh Kumar  8   9 , Jeong-Hoon Lee  10 , Amir Shlomai  11 , Man-Fung Yuen  1   4 , Wai-Kay Seto  1   2   4
Affiliations
Affiliations

    1
    Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong.
    2
    Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen.
    3
    Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
    4
    State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong.
    5
    The Division of Gastroenterology, Rabin Medical Center, Petach Tikva, Israel.
    6
    Sackler school of Medicine, Tel Aviv University, Tel Aviv, Israel.
    7
    Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong.
    8
    Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
    9
    Duke-NUS Graduate Medical School, Singapore.
    10
    Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
    11
    Department of Medicine D and The Liver Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

    PMID: 36111362 DOI: 10.1002/hep.32792

Abstract

Background & aim: Non-alcoholic fatty liver disease (NAFLD) and chronic hepatitis B (CHB) infection are common aetiologies of hepatocellular carcinoma (HCC). The impact of hepatic steatosis on HCC in CHB, as well as its relationship with the development of cirrhosis, fibrosis and hepatitis B surface antigen (HBsAg) seroclearance, remains controversial.

Approach & results: Data of observational studies were collected via PubMed, EMBASE and Cochrane Library from inception to February 1, 2022. Outcomes of interest included the association of hepatic steatosis with HCC, cirrhosis, advanced fibrosis and HBsAg seroclearance, expressed in terms of pooled odds ratios (ORs). Additional sub-group and sensitivity analyses were performed to validate robustness of findings. A total of 34 studies with 68,268 CHB patients were included. Hepatic steatosis was associated with higher odds of HCC (OR 1.59; 95%CI 1.12-2.26; I2 =72.5%), with the association remaining consistent in Asia (OR 1.56; 95%CI 1.08-2.25), studies with a median follow-up duration of ≥5 years (OR 2.82; 95%CI 1.57-5.08), exclusion of alcohol use (OR 1.71; 95%CI 1.01-2.91) and biopsy-proven steatosis (OR 2.86; 95%CI 1.61-5.06), although no significant association was noted among nucleos(t)ide analogue-treated patients (OR 1.05; 95%CI 0.62-1.77). Steatosis was associated with the development of cirrhosis (OR 1.52; 95%CI 1.07-2.16; I2 =0%) and HBsAg seroclearance (OR 2.22; 95%CI 1.58-3.10; I2 =49.0%).

Conclusions: Hepatic steatosis was associated with an increased risk of HCC and cirrhosis among CHB patients, but with a higher chance of achieving a functional cure, highlighting the importance of identifying concomitant steatosis in CHB.

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