慢性HBV感染与代谢功能障碍的流行病学与临床转归

黄娇凤; 郑琦

doi:10.12449/JCH240303

慢性HBV感染与代谢功能障碍的流行病学与临床转归

DOI: 10.12449/JCH240303

黄娇凤,
郑琦^, ,

福建医科大学附属第一医院肝内科，福州 350004

基金项目:

国家自然基金青年科学基金项目 (82300652);

福建省自然科学基金 (2022J01700);

福建省肝病与肠道疾病临床医学研究中心 (2021Y2006)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：黄娇凤负责撰写论文；郑琦负责指导、修改及审阅论文。

详细信息

通信作者:
郑琦， bei0825@163.com （ORCID： 0000-0001-8006-7069）

计量
- 文章访问数: 516
- HTML全文浏览量: 152
- PDF下载量: 105
- 被引次数: 0
出版历程
- 收稿日期: 2024-01-09
- 录用日期: 2024-01-28
- 出版日期: 2024-03-20

Epidemiology and clinical outcome of chronic hepatitis B virus infection and metabolic dysfunction

Jiaofeng HUANG,
Qi ZHENG^{,
,}

Department of Hepatology，The First Affiliated Hospital of Fujian Medical University，Fuzhou 350004，China

Research funding:

National Natural Science Foundation of China Young Scientist Fund (82300652);

Natural Science Foundation of Fujian Province (2022J01700);

Clinical Research Center for Liver and Intestinal Diseases of Fujian Province (2021Y2006)

More Information

Corresponding author: ZHENG Qi， bei0825@163.com （ORCID： 0000-0001-8006-7069 ）

摘要

摘要: 慢性HBV感染是一种全球性公共卫生问题，是我国肝纤维化、肝硬化、肝衰竭及原发性肝癌的主要原因。随着人们生活水平的提高及饮食结构的改变，非酒精性脂肪性肝病（NAFLD）发病率也逐渐升高。基于人群的研究发现HBV感染可影响NAFLD的发生，其中机制仍不明确。肝脂肪变性也会影响HBV血清病原学标志物的表达，合并NAFLD或其他代谢功能障碍会增加HBV感染者肝纤维化、肝硬化及肝癌的风险。慢性HBV感染与代谢障碍密切相关，未来需要更多研究进一步阐明相关机制，为临床诊疗提供理论依据。
- 乙型肝炎病毒 /
- 非酒精性脂肪性肝病 /
- 代谢障碍
Abstract: Chronic hepatitis B virus （HBV） infection is a worldwide public health issue and a leading cause of liver fibrosis， liver cirrhosis， liver failure， and primary liver cancer in China. The incidence rate of nonalcoholic fatty liver disease （NAFLD） is gradually increasing with the improvement in the living standards of people and the changes in dietary structure. Population-based studies have found that HBV infection can influence the development of NAFLD， but the mechanism remains unknown. Hepatic steatosis can also influence the expression of HBV serum pathogenic indicators， and its combination with NAFLD and other metabolic dysfunction diseases can increase the risk of liver fibrosis， liver cirrhosis， and liver cancer. Chronic HBV infection is closely associated with metabolic dysfunction， and more studies are needed in the future to better understand related mechanisms， so as to provide a theoretical foundation for clinical diagnosis and treatment.
- Hepatitis B Virus /
- Non-alcoholic Fatty Liver Disease /
- Metabolic Dysfunction||

HTML全文

百舸争流，奋楫者先。2023年，《临床肝胆病杂志》12期重点号专刊权威引领，树立学科发展风向标，奏响学术前沿最强音；创办“柳荫医学峰会”“柳芽医学论坛”“柳荫访谈”系列活动，打造我国医学学术活动品牌新IP；获准加入国际管理与技术编辑学会（ISMTE）和国际医学期刊编辑委员会（ICMJE），接轨国际学术出版规范之路取得新突破；数字出版矩阵建设从“相融”迈向“深融”，实现全媒体、全形态、全流程传播体系高速发展，官方网站年度访问量超236万次，21个新媒体平台年度受众超3 000万人次，79场学术直播参会观众超100万人。

笃行不怠，勇毅者胜。2023年，《临床肝胆病杂志》继续入编《中文核心期刊要目总览》；被荷兰《医学文摘（网络版）》（Embase）、ISSN国际中心开放学术资源库（ROAD）收录，稳居我国中文科技期刊进入国际知名数据库数量榜首；荣获“第四届吉林省高校科技期刊奖·卓越奖”；13篇论文入选中国科协“2023年度科技期刊双语传播工程”；2篇论文获评中华医学会“2023年度中华医学科技论文TOP100”；1篇论文荣膺中国科协“第八届优秀科技论文”，连续2届蝉联该奖项；在《科技期刊世界影响力指数（WJCI）报告》“消化病及腹部疾病”目录仅入选的8种中文期刊中排名四连冠；连续3届入选“中国精品科技期刊”，F5000论文入选总数（64篇）连续6年高居消化病学类精品科技期刊榜首；综合评价总分在我国消化病学类核心期刊中排名五连冠；近5年来第4次问鼎“百种中国杰出学术期刊”！

2023次列车已到站，2024号巨轮正启航。《临床肝胆病杂志》将继续凝专业之力，聚奋进之魂，夯学术之基，在新兴智能化信息革命中勇立潮头，以精品意识、精良内容、精准服务，助力我国肝胆病学科再创佳绩，更展新风！

岁且更始，时乃日新。恭祝大家新春嘉平！葳蕤繁祉！长乐未央！

《临床肝胆病杂志》主编

2024年元月

参考文献(46)

[1]	Chinese Society of Hepatology, Chinese Medical Association, Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B(2022 version)[J]. Chin J Infect Dis, 2023, 41( 1): 3- 28. DOI: 10.3760/cma.j.cn311365-20230220-00050. 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 中华传染病杂志, 2023, 41( 1): 3- 28. DOI: 10.3760/cma.j.cn311365-20230220-00050.
[2]	World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021: accountability for the global health sector strategies 2016- 2021: actions for impact[EB/OL].( 2021-05-20). https://iris.who.int/handle/10665/341412. https://iris.who.int/handle/10665/341412
[3]	JENG WJ, LIAW YF. Finite antiviral therapy in chronic hepatitis B patients with cirrhosis[J]. Semin Liver Dis, 2021, 41( 3): 349- 357. DOI: 10.1055/s-0041-1729973.
[4]	RIAZI K, AZHARI H, CHARETTE JH, et al. The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2022, 7( 9): 851- 861. DOI: 10.1016/S2468-1253(22)00165-0.
[5]	WONG VW, EKSTEDT M, WONG GL, et al. Changing epidemiology, global trends and implications for outcomes of NAFLD[J]. J Hepatol, 2023, 79( 3): 842- 852. DOI: 10.1016/j.jhep.2023.04.036.
[6]	YOUNOSSI ZM, GOLABI P, PAIK JM, et al. The global epidemiology of nonalcoholic fatty liver disease(NAFLD) and nonalcoholic steatohepatitis(NASH): a systematic review[J]. Hepatology, 2023, 77( 4): 1335- 1347. DOI: 10.1097/HEP.0000000000000004.
[7]	LUUKKONEN PK, QADRI S, AHLHOLM N, et al. Distinct contributions of metabolic dysfunction and genetic risk factors in the pathogenesis of non-alcoholic fatty liver disease[J]. J Hepatol, 2022, 76( 3): 526- 535. DOI: 10.1016/j.jhep.2021.10.013.
[8]	YOUNOSSI ZM, KOENIG AB, ABDELATIF D, et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes[J]. Hepatology, 2016, 64( 1): 73- 84. DOI: 10.1002/hep.28431.
[9]	HUANG DQ, EL-SERAG HB, LOOMBA R. Global epidemiology of NAFLD-related HCC: trends, predictions, risk factors and prevention[J]. Nat Rev Gastroenterol Hepatol, 2021, 18( 4): 223- 238. DOI: 10.1038/s41575-020-00381-6.
[10]	ESLAM M, NEWSOME PN, SARIN SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement[J]. J Hepatol, 2020, 73( 1): 202- 209. DOI: 10.1016/j.jhep.2020.03.039.
[11]	SHI YW, YANG RX, FAN JG. Chronic hepatitis B infection with concomitant hepatic steatosis: Current evidence and opinion[J]. World J Gastroenterol, 2021, 27( 26): 3971- 3983. DOI: 10.3748/wjg.v27.i26.3971.
[12]	THOMOPOULOS KC, ARVANITI V, TSAMANTAS AC, et al. Prevalence of liver steatosis in patients with chronic hepatitis B: a study of associated factors and of relationship with fibrosis[J]. Eur J Gastroenterol Hepatol, 2006, 18( 3): 233- 237. DOI: 10.1097/00042737-200603000-00002.
[13]	MACHADO MV, OLIVEIRA AG, CORTEZ-PINTO H. Hepatic steatosis in hepatitis B virus infected patients: meta-analysis of risk factors and comparison with hepatitis C infected patients[J]. J Gastroenterol Hepatol, 2011, 26( 9): 1361- 1367. DOI: 10.1111/j.1440-1746.2011.06801.x.
[14]	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.
[15]	JIANG D, CHEN C, LIU X, et al. Concurrence and impact of hepatic steatosis on chronic hepatitis B patients: a systematic review and meta-analysis[J]. Ann Transl Med, 2021, 9( 23): 1718. DOI: 10.21037/atm-21-3052.
[16]	YANG M, WEI L. Impact of NAFLD on the outcome of patients with chronic hepatitis B in Asia[J]. Liver Int, 2022, 42( 9): 1981- 1990. DOI: 10.1111/liv.15252.
[17]	XIONG J, ZHANG H, WANG Y, et al. Hepatitis B virus infection and the risk of nonalcoholic fatty liver disease: a meta-analysis[J]. Oncotarget, 2017, 8( 63): 107295- 107302. DOI: 10.18632/oncotarget.22364.
[18]	WANG CC, KAO JH. Hepatitis B virus infection and decreased risk of nonalcoholic fatty liver disease: A cohort study[J]. Hepatology, 2017, 66( 2): 681. DOI: 10.1002/hep.29252.
[19]	WONG VW, WONG GL, CHU WC, et al. Hepatitis B virus infection and fatty liver in the general population[J]. J Hepatol, 2012, 56( 3): 533- 540. DOI: 10.1016/j.jhep.2011.09.013.
[20]	CHENG YL, WANG YJ, KAO WY, et al. Inverse association between hepatitis B virus infection and fatty liver disease: a large-scale study in populations seeking for check-up[J]. PLoS One, 2013, 8( 8): e72049. DOI: 10.1371/journal.pone.0072049.
[21]	HUANG J, JING M, WANG C, et al. The impact of hepatitis B virus infection status on the prevalence of nonalcoholic fatty liver disease: A population-based study[J]. J Med Virol, 2020, 92( 8): 1191- 1197. DOI: 10.1002/jmv.25621.
[22]	YU MW, LIN CL, LIU CJ, et al. Hepatic steatosis and development of type 2 diabetes: Impact of chronic hepatitis B and viral specific factors[J]. J Formos Med Assoc, 2022, 121( 8): 1478- 1487. DOI: 10.1016/j.jfma.2021.10.014.
[23]	CHEN YY, FANG WH, WANG CC, et al. Increased body fat percentage in patients with hepatitis B and C virus infection[J]. PLoS One, 2018, 13( 7): e0200164. DOI: 10.1371/journal.pone.0200164.
[24]	LEI S, CHEN S, ZHAO X, et al. Hepatitis B virus infection and diabetes mellitus: the Kailuan prospective cohort study in China[J]. Hepatol Int, 2020, 14( 5): 743- 753. DOI: 10.1007/s12072-020-10086-2.
[25]	JOO EJ, CHANG Y, YEOM JS, et al. Chronic hepatitis B virus infection and risk of dyslipidaemia: A cohort study[J]. J Viral Hepat, 2019, 26( 1): 162- 169. DOI: 10.1111/jvh.13014.
[26]	BAKER F ABU, DAVIDOV Y, ISRAEL A, et al. Chronic hepatitis B infection and diabetes mellitus: a double liver trouble?[J]. Minerva Med, 2023, 114( 5): 658- 666. DOI: 10.23736/S0026-4806.23.08428-8.
[27]	KIM K, CHOI S, PARK SM. Association of fasting serum glucose level and type 2 diabetes with hepatocellular carcinoma in men with chronic hepatitis B infection: A large cohort study[J]. Eur J Cancer, 2018, 102: 103- 113. DOI: 10.1016/j.ejca.2018.07.008.
[28]	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.
[29]	CHU CM, LIN DY, LIAW YF. Clinical and virological characteristics post HBsAg seroclearance in hepatitis B virus carriers with hepatic steatosis versus those without[J]. Dig Dis Sci, 2013, 58( 1): 275- 281. DOI: 10.1007/s10620-012-2343-9.
[30]	CHU CM, LIN DY, LIAW YF. Does increased body mass index with hepatic steatosis contribute to seroclearance of hepatitis B virus(HBV) surface antigen in chronic HBV infection?[J]. Int J Obes(Lond), 2007, 31( 5): 871- 875. DOI: 10.1038/sj.ijo.0803479.
[31]	FUNG J, YUEN MF, LAI CL. The role of steatosis in HBsAg seroclearance for patients with chronic hepatitis B infection: fact or fiction?[J]. Dig Dis Sci, 2013, 58( 1): 20- 22. DOI: 10.1007/s10620-012-2441-8.
[32]	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.
[33]	CHAN AW, WONG GL, CHAN HY, et al. Concurrent fatty liver increases risk of hepatocellular carcinoma among patients with chronic hepatitis B[J]. J Gastroenterol Hepatol, 2017, 32( 3): 667- 676. DOI: 10.1111/jgh.13536.
[34]	LEE YB, HA Y, CHON YE, et al. Association between hepatic steatosis and the development of hepatocellular carcinoma in patients with chronic hepatitis B[J]. Clin Mol Hepatol, 2019, 25( 1): 52- 64. DOI: 10.3350/cmh.2018.0040.
[35]	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.
[36]	VAN KLEEF LA, CHOI H, BROUWER WP, et al. Metabolic dysfunction-associated fatty liver disease increases risk of adverse outcomes in patients with chronic hepatitis B[J]. JHEP Rep, 2021, 3( 5): 100350. DOI: 10.1016/j.jhepr.2021.100350.
[37]	LIN S, HUANG J, WANG M, et al. Comparison of MAFLD and NAFLD diagnostic criteria in real world[J]. Liver Int, 2020, 40( 9): 2082- 2089. DOI: 10.1111/liv.14548.
[38]	ZHAO J, ZHAO Y, WANG H, et al. Association between metabolic abnormalities and HBV related hepatocelluar carcinoma in Chinese: a cross-sectional study[J]. Nutr J, 2011, 10: 49. DOI: 10.1186/1475-2891-10-49.
[39]	MARENGO A, ROSSO C, BUGIANESI E. Liver cancer: connections with obesity, fatty liver, and cirrhosis[J]. Annu Rev Med, 2016, 67: 103- 117. DOI: 10.1146/annurev-med-090514-013832.
[40]	LIU F, GUO Z, DONG C. Influences of obesity on the immunogenicity of Hepatitis B vaccine[J]. Hum Vaccin Immunother, 2017, 13( 5): 1014- 1017. DOI: 10.1080/21645515.2016.1274475.
[41]	KHALILI M, SHUHART MC, LOMBARDERO M, et al. Relationship between metabolic syndrome, alanine aminotransferase levels, and liver disease severity in a multiethnic North American cohort with chronic hepatitis B[J]. Diabetes Care, 2018, 41( 6): 1251- 1259. DOI: 10.2337/dc18-0040.
[42]	WONG GL, WONG VW, CHOI PC, et al. Metabolic syndrome increases the risk of liver cirrhosis in chronic hepatitis B[J]. Gut, 2009, 58( 1): 111- 117. DOI: 10.1136/gut.2008.157735.
[43]	WONG GL, CHAN HL, YU Z, et al. Coincidental metabolic syndrome increases the risk of liver fibrosis progression in patients with chronic hepatitis B--a prospective cohort study with paired transient elastography examinations[J]. Aliment Pharmacol Ther, 2014, 39( 8): 883- 893. DOI: 10.1111/apt.12658.
[44]	CHAO LT, WU CF, SUNG FY, et al. Insulin, glucose and hepatocellular carcinoma risk in male hepatitis B carriers: results from 17-year follow-up of a population-based cohort[J]. Carcinogenesis, 2011, 32( 6): 876- 881. DOI: 10.1093/carcin/bgr058.
[45]	CAMPBELL C, WANG T, MCNAUGHTON AL, et al. Risk factors for the development of hepatocellular carcinoma(HCC) in chronic hepatitis B virus(HBV) infection: a systematic review and meta-analysis[J]. J Viral Hepat, 2021, 28( 3): 493- 507. DOI: 10.1111/jvh.13452.
[46]	YU MW, LIN CL, LIU CJ, et al. Influence of metabolic risk factors on risk of hepatocellular carcinoma and liver-related death in men with chronic hepatitis B: a large cohort study[J]. Gastroenterology, 2017, 153( 4): 1006- 1017. e 5. DOI: 10.1053/j.gastro.2017.07.001.