Hepatitis B Virus Infection and Decreased Risk of Nonalcoholic Fatty Liver Disease: A Cohort Study
Hepatitis B Virus Infection and Decreased Risk of Nonalcoholic Fatty Liver Disease: A Cohort Study
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DOI：
10.1002/hep.28917
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发表时间：
2017-03-01
期刊：
影响因子：
13.5
通讯作者：
Ryu, Seungho
中科院分区：
文献类型：
--
作者：
Joo, Eun-Jeong;Chang, Yoosoo;Ryu, Seungho
慢性乙肝病毒感染与脂肪肝之间是否存在关联存在争议。我们研究了乙肝病毒感染与非酒精性脂肪性肝病(NAFLD)的发展之间的关系。我们对83,339名基线没有NAFLD的参与者进行了一项队列研究，这些参与者在2002年至2006年期间接受了乙肝表面抗原(HBs)的血清学测试，并每年或每两年进行一次跟踪，直到2014年12月。NAFLD被定义为在没有过度饮酒或其他可识别的原因的情况下出现超声脂肪肝。我们使用参数COX模型来估计调整后的危险比，其可信区间为95%。在484,736.1人年的随访中，确认了20,200例非酒精性脂肪肝病例。在调整了年龄、性别、就诊年份、吸烟状况、饮酒、定期锻炼、教育水平和体重指数的模型中，与乙肝表面抗原阳性和阴性参与者相比，发生非酒精性脂肪肝的调整危险比(95%可信区间)为0.83(0.73-0.94)。在引入了乙肝病毒感染和混杂因素(包括胰岛素抵抗和代谢因素的稳态模型评估)作为时间依赖的暴露后，乙肝病毒感染和NAFLD发生风险降低之间的联系减弱了，但仍然存在。在临床相关的预先指定的亚组中，这些相关性一直被观察到。结论：在这一庞大的看似健康的朝鲜族成年人队列中，HBs Ag阳性与NAFLD的发病风险较低相关，提示乙肝病毒感染可能在NAFLD的发病机制中起作用。
The presence of an association between chronic hepatitis B virus (HBV) infection and fatty liver is controversial. We examined the association between HBV infection and the development of nonalcoholic fatty liver disease (NAFLD). We conducted a cohort study of 83,339 participants without NAFLD at baseline who underwent serologic testing for hepatitis B surface antigen (HBsAg) between 2002 and 2006 and were followed annually or biennially until December 2014. NAFLD was defined as the presence of ultrasonographic fatty liver in the absence of excessive alcohol use or other identifiable causes. We used a parametric Cox model to estimate adjusted hazard ratios with 95% confidence intervals of incident NAFLD. During 484,736.1 person-years of follow-up, 20,200 incident NAFLD cases were identified. In models adjusted for age, sex, year of visit, smoking status, alcohol intake, regular exercise, education level, and body mass index, the adjusted hazard ratio (95% confidence interval) for incident NAFLD comparing HBsAg-positive to HBsAg-negative participants was 0.83 (0.73-0.94). After introducing HBV infection and confounders (including homeostasis model assessment of insulin resistance and metabolic factors) as time-dependent exposures, the association between HBV infection and decreased risk of incident NAFLD was attenuated but persisted. These associations were consistently observed across clinically relevant, prespecified subgroups. Conclusion: In this large cohort of apparently healthy Korean adults, HBsAg seropositivity was associated with lower risk of developing NAFLD, indicating a possible effect of HBV infection on the pathogenesis of NAFLD development.