Relationship between steatosis, inflammation, and fibrosis in chronic hepatitis C: A meta-analysis of individual patient data
Relationship between steatosis, inflammation, and fibrosis in chronic hepatitis C: A meta-analysis of individual patient data
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DOI：
10.1053/j.gastro.2006.03.014
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发表时间：
2006-05-01
期刊：
影响因子：
29.4
通讯作者：
Negro, Francesco
中科院分区：
文献类型：
--
作者：
Leandro, Gioacchino;Mangia, Alessandra;Negro, Francesco
背景和目标：脂肪变性是慢性丙型肝炎（CHC）的常见组织学表现，但脂肪变性是否是肝纤维化的独立预测因子尚不清楚。我们评估了脂肪变性和纤维化之间的关联，以及CHC患者和根据丙型肝炎病毒（HCV）基因型和体重指数进行亚组分析的常见相关因素。方法：我们对来自意大利、瑞士、法国、澳大利亚和美国10个临床中心的3068例经组织学证实的CHC患者的个体数据进行了荟萃分析。结果：1561例患者（50.9%）存在脂肪变性，2688例患者（87.6%）存在纤维化。HCV基因型1型1694例（55.2%），2型563例（18.4%），3型669例（21.8%），4型142例（4.6%）。通过逐步logistic回归分析，脂肪变性与基因型3、纤维化、糖尿病、肝脏炎症、持续性酗酒、较高的体重指数和老年独立相关。纤维化与炎症活动、脂肪变性、男性和老年独立相关，而HCV基因型2与纤维化减少相关。在亚组分析中，脂肪变性和纤维化之间的关联总是取决于脂肪变性和肝脏炎症之间的同时关联。结论：在这个庞大且地理位置不同的CHC患者群体中，脂肪变性被证实与CHC中的纤维化显着且独立相关。肝脏炎症可能介导肝脂肪变性患者的纤维化。控制代谢因素（如超重，通过生活方式调整）在CHC的管理中显得很重要。
Background & Aims: Steatosis is a frequent histologic finding in chronic hepatitis C (CHC), but it is unclear whether steatosis is an independent predictor for liver fibrosis. We evaluated the association between steatosis and fibrosis and their common correlates in persons with CHC and in subgroup analyses according to hepatitis C virus (HCV) genotype and body mass index.Methods: We conducted a meta-analysis on individual data from 3068 patients with histologically confirmed CHC recruited from 10 clinical centers in Italy, Switzerland, France, Australia, and the United States.Results: Steatosis was present in 1561 patients (50.9%) and fibrosis in 2688 (87.6%). HCV genotype was 1 in :1694 cases (55.2%), 2 in 563 (18.4%), 3 in 669 (21.8%), and 4 in :142 (4.6%). By stepwise logistic regression, steatosis was associated independently with genotype 3, the presence of fibrosis, diabetes, hepatic inflammation, ongoing alcohol abuse, higher body mass index, and older age. Fibrosis was associated independently with inflammatory activity, steatosis, male sex, and older age, whereas HCV genotype 2 was associated with reduced fibrosis. In the subgroup analyses, the association between steatosis and fibrosis invariably was dependent on a simultaneous association between steatosis and hepatic inflammation.Conclusions: In this large and geographically different group of CHC patients, steatosis is confirmed as significantly and independently associated with fibrosis in CHC. Hepatic inflammation may mediate fibrogenesis in patients with liver steatosis. Control of metabolic factors (such as overweight, via lifestyle adjustments) appears important in the management of CHC.