慢性HBV感染与代谢相关脂肪性肝病： 已知与未知

耿楠; 倪文婧; 芮法娟; 李婕

doi:10.12449/JCH240301

慢性HBV感染与代谢相关脂肪性肝病：已知与未知

DOI: 10.12449/JCH240301

耿楠¹,
倪文婧²,
芮法娟²,
李婕^{1, 2, , ,}

1.
南京大学医学院附属鼓楼医院感染性疾病科，南京 210008
2.
南京中医药大学鼓楼临床医学院感染性疾病科，南京 210008

基金项目:

国家自然科学基金面上项目 (819705457);

国家自然科学基金面上项目 (82170609);

江苏省自然科学基金面上项目 (BK20231118)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：耿楠、倪文婧和芮法娟负责撰写文章；李婕负责审校。

详细信息

通信作者:
李婕， lijier@nju.edu.cn （ORCID： 0000-0003-0973-8645）

计量
- 文章访问数: 569
- HTML全文浏览量: 136
- PDF下载量: 215
- 被引次数: 0
出版历程
- 收稿日期: 2023-12-30
- 录用日期: 2024-01-28
- 出版日期: 2024-03-20

Chronic hepatitis B virus infection and metabolic associated fatty liver disease： The known and unknown aspects

Nan GENG¹,
Wenjing NI²,
Fajuan RUI²,
Jie LI^{1, 2
, ,
,}

1.
Department of Infectious Diseases，Affiliated Drum Tower Hospital of Nanjing University Medical School，Nanjing 210008，China
2.
Department of Infectious Diseases，Nanjing Drum Towel Hospital Clinical College of Nanjing University of Chinese Medicine，Nanjing 210008，China

Research funding:

General Project of National Natural Science Foundation of China (819705457);

General Project of National Natural Science Foundation of China (82170609);

General Project of National Science Foundation of Jiangsu Province (BK20231118)

More Information

Corresponding author: LI Jie， lijier@nju.edu.cn （ORCID： 0000-0003-0973-8645）

摘要

摘要: 慢性HBV感染是全球病毒性肝炎疾病负担的主要原因。由于生活方式和饮食习惯的改变，代谢相关脂肪性肝病（MAFLD）的发病率不断上升，已成为全球第一大慢性肝病。慢性HBV感染合并MAFLD在临床上越来越常见，代谢因素而非病毒因素是慢性HBV感染合并MAFLD的主要原因。在疾病发展进程中，炎症、纤维化而非脂肪变性是合并患者发展为肝硬化、肝细胞癌的主要影响因素。对于慢性HBV感染和MAFLD同时存在的患者，抗病毒和代谢因素的联合管理至关重要。本文就慢性HBV感染合并MAFLD的相互作用、预后转归和临床管理等热点话题进行讨论。
- 乙型肝炎病毒 /
- 乙型肝炎，慢性 /
- 代谢相关脂肪性肝病 /
- 预后 /
- 临床管理
Abstract: Chronic hepatitis B virus （HBV） infection is the main cause of the disease burden of viral hepatitis worldwide， and meanwhile， due to changes in lifestyle and dietary habits， the incidence rate of metabolic associated fatty liver disease （MAFLD） is constantly increasing， making MAFLD the leading chronic liver disease around the world. Chronic HBV infection comorbid with MAFLD is becoming more and more common in clinical practice. Metabolic factors， rather than viral factors， are the main cause of chronic HBV infection comorbid with MAFLD. During disease progression， steatohepatitis and fibrosis， rather than steatosis， are the main influencing factors for the progression to liver cirrhosis and hepatocellular carcinoma. For patients with chronic HBV infection and MAFLD， integrated management of virus and metabolic factors is of great importance. This article reviews the tissues regarding the interaction， prognosis， and clinical management of chronic HBV infection and MAFLD.
- Hepatitis B Virus /
- Hepatitis B， Chronic /
- Metabolic Dysfunction Associated Fatty Liver Disease /
- Prognosis /
- Clinical Management

HTML全文

参考文献(26)

[1]	LIU Z, LIN C, MAO X, et al. Changing prevalence of chronic hepatitis B virus infection in China between 1973 and 2021: a systematic literature review and meta-analysis of 3 740 studies and 231 million people[J]. Gut, 2023, 72( 12): 2354- 2363. DOI: 10.1136/gutjnl-2023-330691.
[2]	LI J, ZOU B, YEO YH, et al. Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999-2019: a systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2019, 4( 5): 389- 398. DOI: 10.1016/S2468-1253(19)30039-1.
[3]	HUI R, SETO WK, CHEUNG KS, et al. Inverse relationship between hepatic steatosis and hepatitis B viremia: Results of a large case-control study[J]. J Viral Hepat, 2018, 25( 1): 97- 104. DOI: 10.1111/jvh.12766.
[4]	WANG MM, WANG GS, SHEN F, et al. Hepatic steatosis is highly prevalent in hepatitis B patients and negatively associated with virological factors[J]. Dig Dis Sci, 2014, 59( 10): 2571- 2579. DOI: 10.1007/s10620-014-3180-9.
[5]	HUANG SC, SU TH, TSENG TC, et al. Metabolic dysfunction-associated steatotic liver disease facilitates hepatitis B surface antigen seroclearance and seroconversion[J]. Clin Gastroenterol Hepatol, 2023. DOI: 10.1016/j.cgh.2023.09.040.[ Online ahead of print]
[6]	MAK LY, HUI RW, FUNG J, et al. Diverse effects of hepatic steatosis on fibrosis progression and functional cure in virologically quiescent chronic hepatitis B[J]. J Hepatol, 2020, 73( 4): 800- 806. DOI: 10.1016/j.jhep.2020.05.040.
[7]	LI J, YANG HI, YEH ML, et al. Association between fatty liver and cirrhosis, hepatocellular carcinoma, and hepatitis B surface antigen seroclearance in chronic hepatitis B[J]. J Infect Dis, 2021, 224( 2): 294- 302. DOI: 10.1093/infdis/jiaa739.
[8]	MAO X, CHEUNG KS, PENG C, et al. Steatosis, HBV-related HCC, cirrhosis, and HBsAg seroclearance: A systematic review and meta-analysis[J]. Hepatology, 2023, 77( 5): 1735- 1745. DOI: 10.1002/hep.32792.
[9]	TONG X, SONG Y, YIN S, et al. Clinical impact and mechanisms of hepatitis B virus infection concurrent with non-alcoholic fatty liver disease[J]. Chin Med J(Engl), 2022, 135( 14): 1653- 1663. DOI: 10.1097/CM9.0000000000002310.
[10]	JOO EJ, CHANG Y, YEOM JS, et al. Hepatitis B virus infection and decreased risk of nonalcoholic fatty liver disease: A cohort study[J]. Hepatology, 2017, 65( 3): 828- 835. DOI: 10.1002/hep.28917.
[11]	ZHENG Q, ZOU B, WU Y, et al. Systematic review with meta-analysis: prevalence of hepatic steatosis, fibrosis and associated factors in chronic hepatitis B[J]. Aliment Pharmacol Ther, 2021, 54( 9): 1100- 1109. DOI: 10.1111/apt.16595.
[12]	ZHU L, JIANG J, ZHAI X, et al. Hepatitis B virus infection and risk of non-alcoholic fatty liver disease: A population-based cohort study[J]. Liver Int, 2019, 39( 1): 70- 80. DOI: 10.1111/liv.13933.
[13]	ZHOU R, YANG L, ZHANG B, et al. Clinical impact of hepatic steatosis on chronic hepatitis B patients in Asia: A systematic review and meta-analysis[J]. J Viral Hepat, 2023, 30( 10): 793- 802. DOI: 10.1111/jvh.13872.
[14]	KHALILI M, KLEINER DE, KING WC, et al. Hepatic steatosis and steatohepatitis in a large north american cohort of adults with chronic hepatitis B[J]. Am J Gastroenterol, 2021, 116( 8): 1686- 1697. DOI: 10.14309/ajg.0000000000001257.
[15]	HUANG Y, GAN Q, LAI R, et al. Application of fatty liver inhibition of progression algorithm and steatosis, activity, and fibrosis score to assess the impact of non-alcoholic fatty liver on untreated chronic hepatitis B patients[J]. Front Cell Infect Microbiol, 2021, 11: 733348. DOI: 10.3389/fcimb.2021.733348.
[16]	CHOI H, BROUWER WP, ZANJIR W, et al. Nonalcoholic steatohepatitis is associated with liver-related outcomes and all-cause mortality in chronic hepatitis B[J]. Hepatology, 2020, 71( 2): 539- 548. DOI: 10.1002/hep.30857.
[17]	PELEG N, ISSACHAR A, SNEH ARBIB O, et al. Liver steatosis is a strong predictor of mortality and cancer in chronic hepatitis B regardless of viral load[J]. JHEP Rep, 2019, 1( 1): 9- 16. DOI: 10.1016/j.jhepr.2019.02.002.
[18]	MAK LY, HUI RW, FUNG J, et al. Reduced hepatic steatosis is associated with higher risk of hepatocellular carcinoma in chronic hepatitis B infection[J]. Hepatol Int, 2021, 15( 4): 901- 911. DOI: 10.1007/s12072-021-10218-2.
[19]	WONG YJ, NGUYEN VH, YANG HI, et al. Impact of fatty liver on long-term outcomes in chronic hepatitis B: a systematic review and matched analysis of individual patient data meta-analysis[J]. Clin Mol Hepatol, 2023, 29( 3): 705- 720. DOI: 10.3350/cmh.2023.0004.
[20]	JIN X, CHEN YP, YANG YD, et al. Association between hepatic steatosis and entecavir treatment failure in Chinese patients with chronic hepatitis B[J]. PLoS One, 2012, 7( 3): e34198. DOI: 10.1371/journal.pone.0034198.
[21]	CHEN J, WANG ML, LONG Q, et al. High value of controlled attenuation parameter predicts a poor antiviral response in patients with chronic hepatits B[J]. Hepatobiliary Pancreat Dis Int, 2017, 16( 4): 370- 374. DOI: 10.1016/S1499-3872(16)60144-3.
[22]	CHARATCHAROENWITTHAYA P, PONGPAIBUL A, KAOSOMBATWATTANA U, et al. The prevalence of steatohepatitis in chronic hepatitis B patients and its impact on disease severity and treatment response[J]. Liver Int, 2017, 37( 4): 542- 551. DOI: 10.1111/liv.13271.
[23]	CHEN YC, JENG WJ, HSU CW, et al. Impact of hepatic steatosis on treatment response in nuclesos(t)ide analogue-treated HBeAg-positive chronic hepatitis B: a retrospective study[J]. BMC Gastroenterol, 2020, 20( 1): 146. DOI: 10.1186/s12876-020-01289-w.
[24]	LI J, LE AK, CHAUNG KT, et al. Fatty liver is not independently associated with the rates of complete response to oral antiviral therapy in chronic hepatitis B patients[J]. Liver Int, 2020, 40( 5): 1052- 1061. DOI: 10.1111/liv.14415.
[25]	PLAUTH M, BERNAL W, DASARATHY S, et al. ESPEN guideline on clinical nutrition in liver disease[J]. Clin Nutr, 2019, 38( 2): 485- 521. DOI: 10.1016/j.clnu.2018.12.022.
[26]	HUANG SC, LIU CJ. Chronic hepatitis B with concurrent metabolic dysfunction-associated fatty liver disease: Challenges and perspectives[J]. Clin Mol Hepatol, 2023, 29( 2): 320- 331. DOI: 10.3350/cmh.2022.0422.