Nonalcoholic fatty liver disease among HIV-infected persons.
Nonalcoholic fatty liver disease among HIV-infected persons.
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DOI：
10.1097/qai.0b013e318198a88a
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发表时间：
2009-04-15
期刊：
影响因子：
--
通讯作者：
Hames C
中科院分区：
文献类型：
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作者：
Crum-Cianflone N;Dilay A;Collins G;Asher D;Campin R;Medina S;Goodman Z;Parker R;Lifson A;Capozza T;Bavaro M;Hale B;Hames C
描述未感染丙型肝炎病毒 (HCV) 的 HIV 感染者中非酒精性脂肪肝 (NAFLD) 的患病率和相关因素。对大型艾滋病毒诊所的艾滋病毒感染者进行的一项横断面研究。 NAFLD 被定义为没有病毒性肝炎（乙型或丙型）合并感染或过量饮酒的患者中的脂肪变性。 NAFLD 的患病率是通过超声检查确定的，由两名不了解临床信息的放射科医生进行评估；对研究人群的一个子集进行了肝活检。通过比例优势逻辑回归模型评估与 NAFLD 相关的因素。根据超声评估，216 名患者中有 67 名 (31%) 患有 NAFLD。在 NAFLD 患者中，60% 的人脂肪变性为轻度，28% 的人为中度，12% 的人为重度/显着。多变量模型中与超声检查脂肪变性程度相关的因素包括腰围增加（比值比 [OR] 2.1 每 10 cm，p<0.001）、甘油三酯升高（OR= 1.2 每 100 mg/dl，p=0.03）和较低的 HDL 水平（OR 0.7，p=0.03）。与白种人相比，非洲裔美国人患 NAFLD 的可能性较小（14% vs. 35%），尽管这没有达到统计学显着性（OR= 0.4，p=0.08）。通过肝活检诊断的患者子集也发现了类似的关联。在调整血脂异常或腰围后，CD4 细胞计数、HIV 病毒载量、HIV 感染持续时间和抗逆转录病毒药物不是与 NAFLD 相关的独立危险因素。 NAFLD 在这组 HIV 感染、HCV 血清阴性患者中很常见。 NAFLD 与较大的腰围、低 HDL 和高甘油三酯水平相关。抗逆转录病毒药物与 NAFLD 无关；需要前瞻性研究来证实这一发现。
To describe the prevalence and factors associated with nonalcoholic fatty liver disease (NAFLD) among HIV-infected persons not infected with hepatitis C virus (HCV). A cross-sectional study among HIV-infected patients in a large HIV clinic. NAFLD was defined as steatosis among patients without viral hepatitis (B or C) co-infection or excessive alcohol use. The prevalence of NAFLD was identified by ultrasound examination evaluated by two radiologists blinded to the clinic information; liver biopsies were performed on a subset of the study population. Factors associated with NAFLD evaluated by proportional odds logistic regression models. Sixty-seven (31%) of 216 patients had NAFLD based on ultrasound evaluation. Among those with NAFLD, steatosis was graded as mild in 60%, moderate in 28%, and severe/ marked in 12%. Factors associated with the degree of steatosis on ultrasound examination in the multivariate model included increased waist circumference (odds ratio [OR] 2.1 per 10 cm, p<0.001), elevated triglycerides (OR= 1.2 per 100 mg/dl, p=0.03), and lower HDL levels (OR 0.7, p=0.03). African Americans were less likely to have NAFLD compared to Caucasians (14% vs. 35%), although this did not reach statistical significance (OR= 0.4, p=0.08). Similar associations were noted for the subset of patients diagnosed by liver biopsy. CD4 cell count, HIV viral load, duration of HIV infection, and antiretroviral medications were not independent risk factors associated with NAFLD after adjustment for dyslipidemia or waist circumference. NAFLD was common among this cohort of HIV-infected, HCV-seronegative patients. NAFLD was associated with a greater waist circumference, low HDL and high triglyceride levels. Antiretroviral medications were not associated with NAFLD; prospective studies are needed to confirm this finding.