Evidence for a role of nonalcoholic steatohepatitis in hepatitis C: A prospective study
Evidence for a role of nonalcoholic steatohepatitis in hepatitis C: A prospective study
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DOI：
10.1002/hep.21711
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发表时间：
2007-08-01
期刊：
影响因子：
13.5
通讯作者：
Marcellin, Patrick
中科院分区：
文献类型：
--
作者：
Bedossa, Pierre;Moucari, Rami;Marcellin, Patrick
虽然脂肪变性是慢性丙型肝炎（CHC）的常见组织学特征，但非酒精性脂肪性肝炎（NASH）在此背景下尚未明确特征。这项前瞻性研究的目的是调查NASH和CHC患者的特征。活检分为单独CHC（178例患者[57%]）、CHC+脂肪变性（94例患者[34%]）或CHC+NASH（24例患者[9%]）。与CHC+脂肪变性患者相比，CHC+NASH患者的AST和甘油三酯水平显著较高，高密度脂蛋白（HDL）胆固醇或总胆固醇较低。与CHC+脂肪变性患者相比，他们还显示出更多的脂肪变性和更高的METAVIR纤维化分期。基因型3在CHC+NASH患者中比在CHC+脂肪变性或单独CHC患者中更常见。根据甘油三酯或用于评估胰岛素抵抗的稳态模型（HOMA-IR），基因型3和CHC+NASH患者与CHC+脂肪变性或单独CHC患者相似，而在基因型1患者中，HOMA-IR和甘油三酯从单独CHC到CHC+脂肪变性再到CHC+NASH逐渐增加。在多变量分析中，甘油三酯和高密度脂蛋白胆固醇是基因1型患者NASH的预测因子，而在基因3型患者中，AST是唯一的预测因子。结论：CHC+NASH患者在生物学和代谢参数以及更晚期的组织病理学病变方面与CHC+脂肪变性和单独CHC患者显著不同。NASH在基因型3中更常见，并且在该亚组中与代谢功能障碍无关，这表明NASH可能使CHC中的脂肪变性复杂化，而与脂肪变性的病因无关。
Although steatosis is a common histological feature in chronic hepatitis C (CHC), nonalcoholic steatohepatitis (NASH) has not yet been clearly characterized in this context. The aim of this prospective study was to investigate the characteristics of patients with NASH and CHC. Biopsies were categorized as CHC alone (178 patients [57%]), CHC+steatosis (94 patients [34%]), or CHC+NASH (24 patients [9%]). Patients with CHC+NASH had significantly higher AST and triglyceride levels and lower high-density lipoprotein (HDL) cholesterol or total cholesterol than patients with CHC+steatosis. They also showed more steatosis and higher METAVIR fibrosis stage than patients with CHC+steatosis. Genotype 3 was more frequent in patients with CHC+NASH than in patients with CHC+steatosis or CHC alone. Patients with genotype 3 and CHC+NASH were similar to those with CHC+steatosis or with CHC alone according to triglyceride or the homeostasis model for assessment of insulin resistance (HOMA-IR), whereas in patients with genotype 1, HOMA-IR and triglyceride increased progressively from CHC alone to CHC+steatosis to CHC+NASH. In multivariate analysis, triglyceride and HDL cholesterol were predictors of NASH in patients with genotype 1, whereas in patients with genotype 3, AST was the only predictor. Conclusion: Patients with CHC+NASH differ significantly from those with CHC+steatosis and CHC alone in terms of biological and metabolic parameters and more advanced histopathological lesions. NASH is more common in genotype 3 and is not associated with metabolic dysfunctions in this subgroup, suggesting that NASH may complicate steatosis in CHC irrespective of etiology of steatosis.