合并代谢功能障碍的慢性HBV感染者的临床管理

羊璐萍; 施军平

doi:10.12449/JCH240304

合并代谢功能障碍的慢性HBV感染者的临床管理

DOI: 10.12449/JCH240304

羊璐萍¹,
施军平^2, , ,

1.
浙江中医药大学第四临床医学院，杭州 310053
2.
杭州师范大学附属医院感染与肝病科，杭州 310015

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：羊璐萍负责查阅及分析文献，撰写论文；施军平负责论文修改及指导撰写，并最终定稿。

详细信息

通信作者:
施军平， 20131004@hznu.edu.cn （ORCID： 0000-0001-9434-897X）

计量
- 文章访问数: 365
- HTML全文浏览量: 159
- PDF下载量: 108
- 被引次数: 0
出版历程
- 收稿日期: 2024-01-10
- 录用日期: 2024-02-01
- 出版日期: 2024-03-20

Clinical management of chronic hepatitis B virus infection comorbid with metabolic dysfunction

Luping YANG¹,
Junping SHI^{2
, ,
,}

1.
The Fourth Clinical Medical College of Zhejiang Chinese Medical University，Hangzhou 310053，China
2.
Department of Infectious Diseases & Hepatology，The Affiliated Hospital of Hangzhou Normal University，Hangzhou 310015，China

More Information

Corresponding author: SHI Junping， 20131004@hznu.edu.cn （ORCID： 0000-0001-9434-897X）

摘要

摘要: 随着代谢功能障碍相关疾病在全球范围内快速增长，慢性HBV感染合并代谢功能障碍的患者也逐年增加。高血糖、高血压和血脂异常等代谢功能障碍的合并存在可能会使慢性HBV感染者发生不良肝脏结局和心血管事件的风险增加，并影响抗HBV治疗的应答反应。合并代谢功能障碍的慢性HBV感染者的规范管理成为当前面临的一个挑战。进一步研究代谢功能障碍与HBV之间的相互作用以及针对性的管理策略，将有助于优化慢性HBV感染者的临床管理。
- 乙型肝炎病毒 /
- 代谢障碍 /
- 治疗学
Abstract: With the rapid growth of metabolic dysfunction （MD） worldwide， there is also a gradual increase in the number of patients with chronic hepatitis B virus （HBV） infection and MD. Comorbidity with metabolic disorders such as hyperglycemia， hypertension， and dyslipidemia may increase the risk of adverse liver outcomes and cardiovascular events in patients with chronic HBV infection and affect the response to anti-HBV therapy. The standardized management of patients with chronic HBV infection and MD has become a challenge at present， and further in-depth research on the interaction between MD and HBV and targeted management strategies will help to optimize the clinical management of patients with chronic HBV infection.
- Hepatitis B Virus /
- Metabolic Dysfunction /
- Therapeutics

HTML全文

参考文献(26)

[1]	ALBERTI KG, ECKEL RH, GRUNDY SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity[J]. Circulation, 2009, 120( 16): 1640- 1645. DOI: 10.1161/CIRCULATIONAHA.109.192644.
[2]	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.
[3]	RINELLA ME, LAZARUS JV, RATZIU V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature[J]. Hepatology, 2023, 78( 6): 1966- 1986. DOI: 10.1097/HEP.0000000000000520.
[4]	Committee of Hepatology, Chinese Research Hospital Association; Fatty Liver Expert Committee, Chinese Medical Doctor Association; National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, et al. Expert recommendations on standardized diagnosis and treatment for fatty liver disease(2019 revised edition)[J]. J Clin Hepatol, 2019, 35( 11): 2426- 2430. DOI: 10.3969/j.issn.1001-5256.2019.11.007. 中国研究型医院学会肝病专业委员会, 中国医师协会脂肪性肝病专家委员会, 中华医学会肝病学分会脂肪肝与酒精性肝病学组, 等. 脂肪性肝病诊疗规范化的专家建议(2019年修订版)[J]. 临床肝胆病杂志, 2019, 35( 11): 2426- 2430. DOI: 10.3969/j.issn.1001-5256.2019.11.007.
[5]	FAN JG, LI XY. NAFLD renaming to MAFLD, MASLD: background, similarities, differences, and countermeasures][J] Chin J Hepatol, 2023, 31( 8): 789- 792. DOI: 10.3760/cma.j.cn501113-20230809-00042. 范建高, 李小英. NAFLD更名MAFLD、MASLD: 背景、异同、对策[J]. 中华肝脏病杂志, 2023, 31( 8): 789- 792. DOI: 10.3760/cma.j.cn501113-20230809-00042.
[6]	XIE J, WANG X, PAN D, et al. Ageing and non-liver comorbidities in population with chronic hepatitis B infection in the western pacific region from 1990 to 2019[J]. Front Physiol, 2023, 14: 1176113. DOI: 10.3389/fphys.2023.1176113.
[7]	WONG GL, WONG VW, YUEN BW, et al. An aging population of chronic hepatitis B with increasing comorbidities: A territory-wide study from 2000 to 2017[J]. Hepatology, 2020, 71( 2): 444- 455. DOI: 10.1002/hep.30833.
[8]	PAN XF, WANG L, PAN A. Epidemiology and determinants of obesity in China[J]. Lancet Diabetes Endocrinol, 2021, 9( 6): 373- 392. DOI: 0.1016/S2213-8587(21)00045-0.
[9]	BUSCEMI S, CHIARELLO P, BUSCEMI C, et al. Characterization of metabolically healthy obese people and metabolically unhealthy normal-weight people in a general population cohort of the ABCD study[J]. J Diabetes Res, 2017, 2017: 9294038. DOI: 10.1155/2017/9294038.
[10]	OH H, JUN DW, LEE IH, et al. Increasing comorbidities in a South Korea insured population-based cohort of patients with chronic hepatitis B[J]. Aliment Pharmacol Ther, 2020, 52( 2): 371- 381. DOI: 10.1111/apt.15867.
[11]	MAK LY, HUI RW, LEE CH, et al. Glycemic burden and the risk of adverse hepatic outcomes in patients with chronic hepatitis B with type 2 diabetes[J]. Hepatology, 2023, 77( 2): 606- 618. DOI: 10.1002/hep.32716.
[12]	TAO J, ZHANG W, YUE H, et al. Prevalence of hepatitis B virus infection in Shenzhen, China, 2015-2018[J]. Sci Rep, 2019, 9( 1): 13948. DOI: 10.1038/s41598-019-50173-5.
[13]	LEE HW, KIM SU, PARK JY, et al. External validation of the modified PAGE-B score in Asian chronic hepatitis B patients receiving antiviral therapy[J]. Liver Int, 2019, 39( 9): 1624- 1630. DOI: 10.1111/liv.14129.
[14]	MENA Á, PEDREIRA JD, CASTRO Á, et al. Metabolic syndrome association with fibrosis development in chronic hepatitis B virus inactive carriers[J]. J Gastroenterol Hepatol, 2014, 29( 1): 173- 178. DOI: 10.1111/jgh.12432.
[15]	BOCKMANN JH, KOHSAR M, MURRAY JM, et al. High rates of liver cirrhosis and hepatocellular carcinoma in chronic hepatitis B patients with metabolic and cardiovascular comorbidities[J]. Microorganisms, 2021, 9( 5): 968. DOI: 10.3390/microorganisms9050968.
[16]	HUANG SC, SU TH, TSENG TC, et al. Distinct effects of hepatic steatosis and metabolic dysfunction on the risk of hepatocellular carcinoma in chronic hepatitis B[J]. Hepatol Int, 2023, 17( 5): 1139- 1149. DOI: 10.1007/s12072-023-10545-6.
[17]	AMIRZADEGAN A, DAVOODI G, BOROUMAND MA, et al. Association between hepatitis B surface antibody seropositivity and coronary artery disease[J]. Indian J Med Sci, 2007, 61( 12): 648- 655.
[18]	KIM JT, PARK MS, NAM TS, et al. Multiple cerebral arterial stenosis associated with hepatitis B virus infection[J]. J Clin Neurol, 2011, 7( 1): 40- 42. DOI: 10.3988/jcn.2011.7.1.40.
[19]	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.
[20]	WANG CC, CHENG PN, KAO JH. Systematic review: chronic viral hepatitis and metabolic derangement[J]. Aliment Pharmacol Ther, 2020, 51( 2): 216- 230. DOI: 10.1111/apt.15575.
[21]	VILAR-GOMEZ E, MARTINEZ-PEREZ Y, CALZADILLA-BERTOT L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis[J]. Gastroenterology, 2015, 149( 2): 367- 378. e5; quiz e14-15. DOI: 10.1053/j.gastro.2015.04.005.
[22]	YOUNOSSI ZM, COREY KE, LIM JK. AGA clinical practice update on lifestyle modification using diet and exercise to achieve weight loss in the management of nonalcoholic fatty liver disease: expert review[J]. Gastroenterology, 2021, 160( 3): 912- 918. DOI: 10.1053/j.gastro.2020.11.051.
[23]	CHANG FM, WANG YP, LANG HC, et al. Statins decrease the risk of decompensation in hepatitis B virus- and hepatitis C virus-related cirrhosis: A population-based study[J]. Hepatology, 2017, 66( 3): 896- 907. DOI: 10.1002/hep.29172.
[24]	SIMON TG, DUBERG AS, ALEMAN S, et al. Lipophilic statins and risk for hepatocellular carcinoma and death in patients with chronic viral hepatitis: results from a nationwide swedish population[J]. Ann Intern Med, 2019, 171( 5): 318- 327. DOI: 10.7326/M18-2753.
[25]	BHATTACHARJEE J, KIRBY M, SOFTIC S, et al. Hepatic natural killer T-cell and CD8+ T-cell signatures in mice with nonalcoholic steatohepatitis[J]. Hepatol Commun, 2017, 1( 4): 299- 310. DOI: 10.1002/hep4.1041.
[26]	Professional Committee of Prevention and Treatment of Pharmaceutical Liver Injury of China Medical Biotechnology Association, Pharmaceutical Hepatology Group of Liver Disease Branch of Chinese Medical Association. Chinese guideline for diagnosis and management of drug-induced liver injury(2023 version)[J]. Chin J Gastroenterol, 2022, 27( 6): 341- 375. DOI: 10.3760/cma.j.cn501113-20230419-00176. 中国医药生物技术协会药物性肝损伤防治技术专业委员会, 中华医学会肝病学分会药物性肝病学组. 中国药物性肝损伤诊治指南(2023年版)[J]. 胃肠病学, 2022, 27( 6): 341- 375. DOI: 10.3760/cma.j.cn501113-20230419-00176.