慢性乙型肝炎合并非酒精性脂肪性肝病临床研究进展
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摘要
随着人们生活水平的改善,慢性乙型肝炎(CHB)合并非酒精性脂肪性肝病(NAFLD)的发病率持续升高。本文分析比较了CHB、NAFLD与CHB合并NAFLD患者在血清学指标、影像学和病理学检查方面存在的差异。由于病毒-宿主与代谢综合征等的关系仍备受争议,进而引发临床医生不同的治疗思路,这些都需要深入研究。
The incidence rate of non-alcoholic fatty liver disease(NAFLD) with concurrent chronic hepatitis B(CHB)is increasing gradually. We will compare serum indexes, image and pathology characteristics among patients with NAFLD,CHB and NAFLD concurrent with CHB. The virus and host are both involved in the pathogenesis of steatosis. We will discuss all the above questions.
The incidence rate of non-alcoholic fatty liver disease(NAFLD) with concurrent chronic hepatitis B(CHB)is increasing gradually. We will compare serum indexes, image and pathology characteristics among patients with NAFLD,CHB and NAFLD concurrent with CHB. The virus and host are both involved in the pathogenesis of steatosis. We will discuss all the above questions.
引文
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[3]Wang MM,Wang GS,Shen F,et al.Hepatic steatosis is highly prevalent in hepatitis B patients and negatively associated with virological factors.Dig Dis Sci,2014,59(10):2571-2579.
[4]Liang J,Cai W,Han T,et al.The expression of thymosinβ4in chronic hepatitis B combined nonalcoholic fatty liver disease.Medicine,2016,95(52):e5763.
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[6]Liu X,Shen Z,Zhang H,et al.Interleukin-21 is associated with early antiviral response in patients with hepatitis B e antigen-positive chronic hepatitis B and nonalcoholic fatty liver disease.J Interferon Cytokine Res,2016,36(6):367.
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[12]Nau AL,Soares JC,Shiozawa MB,et al.Clinical and laboratory characteristics associated with dyslipidemia and liver steatosis in chronic HBV carriers.Rev Soc Bras De Med Trop,2014,47(2):158.
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[14]Zhu L Y,Wang Y G,Wei L Q,et al.The effects of the insulin resistance index on the virologic response to entecavir in patients with HBe Ag-positive chronic hepatitis B and nonalcoholic fatty liver disease.Drug De Devel Ther,2016,10:2739-2744.
[15]Chen J D.Sonographic fatty liver and hepatitis B virus carrier status:Synergistic effect on liver damage in Taiwanese adults.World J Gastroenterol,2007,13(12):1805.
[16]中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪肝专家委员会.非酒精性脂肪性肝病诊疗指南(2018年版).实用肝脏病杂志.2018,21(2):177-186.
[17]Weinstein A A,Kallman P J,Stepanova M,et al.Depression in patients with nonalcoholic fatty liver disease and chronic viral hepatitis B and C.Psychosomatics,2011,52(2):127-132.
[18]中华医学会传染病与,寄生虫病学分会,肝病学分会.病毒性肝炎防治方案.中华内科杂志,2001,40(1):324-329.
[19]Yeom S K,Chang H L,Sang H C,et al.Prediction of liver cirrhosis,using diagnostic imaging tools.World J Hepatol,2015,7(17):2069.
[20]贺文,马大庆,冯捷,等.CT定量诊断脂肪肝的临床研究.中华放射学杂志,2001,35(11):829-831.
[21]Bedossa P.Pathology of non-alcoholic fatty liver disease.Liver Int,2017,37 Suppl 1:85.
[22]Ballestri S,Nascimbeni F,Baldelli E,et al.Ultrasonographic fatty liver indicator detects mild steatosis and correlates with metabolic/histological parameters in various liver diseases.Metabolism,2017,72:57-65.
[23]Hytiroglou P.17-Hepatitis B.Prac Hepatic Pathol,2011,33(6):215-224.
[24]Lefkowitch J H.Advances in hepatobiliary pathology:update for 2010.Clin Liver Dis,2010,14(4):747.
[25]Seto W K,Yuen M F.Nonalcoholic fatty liver disease in Asia:emerging perspectives.J Gastroenterol,2017,52(2):164.
[26]Wang CC,Kao JH.Hepatitis B virus infection and decreased risk of nonalcoholic fatty liver disease:a cohort study.Hepatology,2016,65(3):828.
[27]Nascimento A C,Maia D R,Neto S M,et al.Nonalcoholic fatty liver disease in chronic hepatitis B and C patients from western Amazon.Int J Hepatol,2012(4):695950.
[28]Negro F.Hepatitis C virus-induced steatosis:an overview.Dig Dis,2010,28(1):294.
[29]江萃英,曾维琼,陈压西,等.乙型肝炎病毒对肝脂肪变患者肝细胞固醇调节元件结合蛋白表达的影响.中华肝脏病杂志,2011,19(8):608-613.
[30]Kyeongjin K,Hwan K K,Jaehun C.Hepatitis B virus Xprotein impairs hepatic insulin signaling through degradation of IRS1 and induction of SOCS3.Plos One,2010,5(3):e8649.
[31]陈娟,沈薇,程文会.乙型肝炎病毒X蛋白对HepG2细胞脂代谢相关基因表达的影响.中华肝脏病杂志,2011,19(10):768-773.
[32]Cheng Y L,Wang Y J,Kao W Y,et al.Inverse association between hepatitis B virus infection and fatty liver disease:a large-scale study in populations seeking for check-up.Plos One,2013,8(8):e72049.
[33]施军平,范建高,武瑞,等.慢性乙型肝炎患者肝细胞脂肪变的发生率及其危险因素分析.中华肝脏病杂志,2008,16(7):519-523.
[34]Zheng R D,Chen J N,Zhuang Q Y,et al.Clinical and virological characteristics of chronic hepatitis B patients with hepatic steatosis.Int J Med Sci,2013,10(5):641-646.
[35]Zhang R N,Qin P,Zheng Z,et al.Saturated fatty acid inhibits viral replication in chronic hepatitis B virus infection with nonalcoholic fatty liver disease by Toll-Like receptor4-Mediated innate immune response.Hepat Mon,2015,15(5):e27909.
[36]Pan Q,Zhang R N,Wang Y Q,et al.Linked PNPLA3 polymorphisms confer susceptibility tononalcoholic steatohepatitis and decreased viral load in chronic hepatitis B.World J Gastroenterol,2015,21(28):8605-8614.
[37]陆璐,柳银兰,杨文君,等.慢性乙型肝炎病毒携带合并非酒精性脂肪性肝病小鼠模型建立与观察.中华实验和临床病毒学杂志,2013,27(5):332-335.
[38]Chen Y,Fan C,Chen Y,et al.Effect of hepatic steatosis on the progression of chronic hepatitis B:A prospective cohort and in vitro study.Oncotarget,2017,8(35):58601-58610.
[2]Abd ElKader SM,El Den Ashmawy EM.Non-alcoholic fatty liver disease:The diagnosis and management.World J Hepatol,2015,7(6):846.
[3]Wang MM,Wang GS,Shen F,et al.Hepatic steatosis is highly prevalent in hepatitis B patients and negatively associated with virological factors.Dig Dis Sci,2014,59(10):2571-2579.
[4]Liang J,Cai W,Han T,et al.The expression of thymosinβ4in chronic hepatitis B combined nonalcoholic fatty liver disease.Medicine,2016,95(52):e5763.
[5]Machado M V,Oliveira A G,Cortez-Pinto H.Hepatic steatosis in hepatitis B virus infected patients:meta-analysis of risk factors and comparison with hepatitis C infected patients.JGastroenterol Hepatol,2011,26(9):1361-1367.
[6]Liu X,Shen Z,Zhang H,et al.Interleukin-21 is associated with early antiviral response in patients with hepatitis B e antigen-positive chronic hepatitis B and nonalcoholic fatty liver disease.J Interferon Cytokine Res,2016,36(6):367.
[7]Yuki H,Haga YJ,Tatsuo S,et al.Nonalcoholic fatty liver disease and hepatic cirrhosis:comparison with viral hepatitis-associated steatosis.World J Gastroenterol,2015,21(46):12989.
[8]Chan A W,Wong G L,Chan H Y,et al.Concurrent fatty liver increases risk of hepatocellular carcinoma among patients with chronic hepatitis B.J Gastroenterol Hepatol,2017,32(3):667.
[9]Cheng Y L,Wang Y J,Kao W Y,et al.Inverse association between hepatitis B virus infection and fatty liver disease:a large-scale study in populations seeking for check-up.Plos One,2013,8(8):e72049.
[10]施军平,范建高,武瑞,等.慢性乙型肝炎患者肝细胞脂肪变的发生率及其危险因素分析.中华肝脏病杂志,2008,16(7):519-523.
[11]宓余强,刘勇钢,徐亮,等.慢性乙型肝炎合并肝脂肪变的临床与病理学特征分析.中华肝脏病杂志,2014,17(6):817-820.
[12]Nau AL,Soares JC,Shiozawa MB,et al.Clinical and laboratory characteristics associated with dyslipidemia and liver steatosis in chronic HBV carriers.Rev Soc Bras De Med Trop,2014,47(2):158.
[13]Ceylan B,Arslan F,Batirel A,et al.Impact of fatty liver on hepatitis B virus replication and virologic response to tenofovir and entecavir.Turk J Gastroenterol,2015,27(1):42.
[14]Zhu L Y,Wang Y G,Wei L Q,et al.The effects of the insulin resistance index on the virologic response to entecavir in patients with HBe Ag-positive chronic hepatitis B and nonalcoholic fatty liver disease.Drug De Devel Ther,2016,10:2739-2744.
[15]Chen J D.Sonographic fatty liver and hepatitis B virus carrier status:Synergistic effect on liver damage in Taiwanese adults.World J Gastroenterol,2007,13(12):1805.
[16]中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪肝专家委员会.非酒精性脂肪性肝病诊疗指南(2018年版).实用肝脏病杂志.2018,21(2):177-186.
[17]Weinstein A A,Kallman P J,Stepanova M,et al.Depression in patients with nonalcoholic fatty liver disease and chronic viral hepatitis B and C.Psychosomatics,2011,52(2):127-132.
[18]中华医学会传染病与,寄生虫病学分会,肝病学分会.病毒性肝炎防治方案.中华内科杂志,2001,40(1):324-329.
[19]Yeom S K,Chang H L,Sang H C,et al.Prediction of liver cirrhosis,using diagnostic imaging tools.World J Hepatol,2015,7(17):2069.
[20]贺文,马大庆,冯捷,等.CT定量诊断脂肪肝的临床研究.中华放射学杂志,2001,35(11):829-831.
[21]Bedossa P.Pathology of non-alcoholic fatty liver disease.Liver Int,2017,37 Suppl 1:85.
[22]Ballestri S,Nascimbeni F,Baldelli E,et al.Ultrasonographic fatty liver indicator detects mild steatosis and correlates with metabolic/histological parameters in various liver diseases.Metabolism,2017,72:57-65.
[23]Hytiroglou P.17-Hepatitis B.Prac Hepatic Pathol,2011,33(6):215-224.
[24]Lefkowitch J H.Advances in hepatobiliary pathology:update for 2010.Clin Liver Dis,2010,14(4):747.
[25]Seto W K,Yuen M F.Nonalcoholic fatty liver disease in Asia:emerging perspectives.J Gastroenterol,2017,52(2):164.
[26]Wang CC,Kao JH.Hepatitis B virus infection and decreased risk of nonalcoholic fatty liver disease:a cohort study.Hepatology,2016,65(3):828.
[27]Nascimento A C,Maia D R,Neto S M,et al.Nonalcoholic fatty liver disease in chronic hepatitis B and C patients from western Amazon.Int J Hepatol,2012(4):695950.
[28]Negro F.Hepatitis C virus-induced steatosis:an overview.Dig Dis,2010,28(1):294.
[29]江萃英,曾维琼,陈压西,等.乙型肝炎病毒对肝脂肪变患者肝细胞固醇调节元件结合蛋白表达的影响.中华肝脏病杂志,2011,19(8):608-613.
[30]Kyeongjin K,Hwan K K,Jaehun C.Hepatitis B virus Xprotein impairs hepatic insulin signaling through degradation of IRS1 and induction of SOCS3.Plos One,2010,5(3):e8649.
[31]陈娟,沈薇,程文会.乙型肝炎病毒X蛋白对HepG2细胞脂代谢相关基因表达的影响.中华肝脏病杂志,2011,19(10):768-773.
[32]Cheng Y L,Wang Y J,Kao W Y,et al.Inverse association between hepatitis B virus infection and fatty liver disease:a large-scale study in populations seeking for check-up.Plos One,2013,8(8):e72049.
[33]施军平,范建高,武瑞,等.慢性乙型肝炎患者肝细胞脂肪变的发生率及其危险因素分析.中华肝脏病杂志,2008,16(7):519-523.
[34]Zheng R D,Chen J N,Zhuang Q Y,et al.Clinical and virological characteristics of chronic hepatitis B patients with hepatic steatosis.Int J Med Sci,2013,10(5):641-646.
[35]Zhang R N,Qin P,Zheng Z,et al.Saturated fatty acid inhibits viral replication in chronic hepatitis B virus infection with nonalcoholic fatty liver disease by Toll-Like receptor4-Mediated innate immune response.Hepat Mon,2015,15(5):e27909.
[36]Pan Q,Zhang R N,Wang Y Q,et al.Linked PNPLA3 polymorphisms confer susceptibility tononalcoholic steatohepatitis and decreased viral load in chronic hepatitis B.World J Gastroenterol,2015,21(28):8605-8614.
[37]陆璐,柳银兰,杨文君,等.慢性乙型肝炎病毒携带合并非酒精性脂肪性肝病小鼠模型建立与观察.中华实验和临床病毒学杂志,2013,27(5):332-335.
[38]Chen Y,Fan C,Chen Y,et al.Effect of hepatic steatosis on the progression of chronic hepatitis B:A prospective cohort and in vitro study.Oncotarget,2017,8(35):58601-58610.