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Influence of weight management on the prognosis of steatohepatitis in chronic hepatitis B patients during antiviral treatment
Hepatobiliary & Pancreatic Diseases International ( IF 3.3 ) Pub Date : 2021-07-07 , DOI: 10.1016/j.hbpd.2021.06.009
Xiu-Juan Chang 1 , Yi-Wen Shi 2 , Jing Wang 3 , Hua-Bao Liu 4 , Yan Chen 1 , Xiao-Ning Zhu 3 , Yong-Ping Chen 5 , Zu-Jiang Yu 6 , Qing-Hua Shang 7 , Lin Tan 8 , Qin Li 9 , Li Jiang 10 , Guang-Ming Xiao 11 , Liang Chen 12 , Wei Lu 13 , Xiao-Yu Hu 14 , Qing-Hua Long 15 , Lin-Jing An 1 , Zi-Yuan Zou 2 , Vincent Wai-Sun Wong 16 , Yong-Ping Yang 1 , Jian-Gao Fan 2
Affiliation  

Background

Although concomitant nonalcoholic steatohepatitis (NASH) is common in chronic hepatitis B (CHB), the impact of viral factors on NASH and the outcome of CHB patients concomitant with NASH remain unclear. We aimed to investigate the outcomes of NASH in CHB patients receiving antiviral treatment.

Methods

In the post-hoc analysis of a multicenter trial, naïve CHB patients receiving 72-week entecavir treatment were enrolled. We evaluated the biochemical, viral and histopathological responses of these patients. The histopathological features of NASH were also evaluated, using paired liver biopsies at baseline and week 72.

Results

A total of 1000 CHB patients were finally enrolled for analysis, with 18.2% of whom fulfilling the criteria of NASH. A total of 727 patients completed entecavir antiviral treatment and received the second biopsy. Serum HBeAg loss, HBeAg seroconversion and HBV-DNA undetectable rates were similar between patients with or without NASH (P > 0.05). Among patients with NASH, the hepatic steatosis, ballooning, lobular inflammation scores and fibrosis stages all improved during follow-up (all P < 0.001), 46% (63/136) achieved NASH resolution. Patients with baseline body mass index (BMI) ≥ 23 kg/m2 (Asian criteria) [odds ratio (OR): 0.414; 95% confidence interval (95% CI): 0.190-0.899; P = 0.012] and weight gain (OR: 0.187; 95% CI: 0.050-0.693; P = 0.026) were less likely to have NASH resolution. Among patients without NASH at baseline, 22 (3.7%) developed NASH. Baseline BMI ≥ 23 kg/m2 (OR: 12.506; 95% CI: 2.813-55.606; P = 0.001) and weight gain (OR: 5.126; 95% CI: 1.674-15.694; P = 0.005) were predictors of incident NASH.

Conclusions

Lower BMI and weight reduction but not virologic factors determine NASH resolution in CHB. The value of weight management in CHB patients during antiviral treatment deserves further evaluation.



中文翻译:

体重管理对慢性乙型肝炎患者抗病毒治疗期间脂肪性肝炎预后的影响

背景

虽然伴随的非酒精性脂肪性肝炎 (NASH) 在慢性乙型肝炎 (CHB) 中很常见,但病毒因素对 NASH 的影响以及伴随 NASH 的 CHB 患者的结局仍不清楚。我们旨在调查接受抗病毒治疗的慢性乙型肝炎患者 NASH 的结果。

方法

在一项多中心试验的事后分析中,招募了接受 72 周恩替卡韦治疗的初治慢性乙型肝炎患者。我们评估了这些患者的生化、病毒和组织病理学反应。还使用基线和第 72 周的配对肝活检评估了 NASH 的组织病理学特征。

结果

最终共有1000名CHB患者入组分析,其中18.2%符合NASH标准。共有727名患者完成了恩替卡韦抗病毒治疗并接受了第二次活检。有或无 NASH 患者的血清 HBeAg 消失、HBeAg 血清转换和 HBV-DNA 检出率相似(P > 0.05)。在 NASH 患者中,肝脏脂肪变性、气球样变、小叶炎症评分和纤维化分期在随访期间均有所改善(均P < 0.001),46%(63/136)的患者实现 NASH 消退。基线体重指数 (BMI) ≥ 23 kg/m 2(亚洲标准)的患者 [优势比 (OR):0.414;95% 置信区间(95% CI):0.190-0.899; = 0.012] 和体重增加 (OR: 0.187; 95% CI: 0.050-0.693; P  = 0.026) 不太可能有 NASH 分辨率。在基线时没有 NASH 的患者中,22 名(3.7%)发生 NASH。基线 BMI ≥ 23 kg/m 2 (OR: 12.506; 95% CI: 2.813-55.606; P  = 0.001) 和体重增加 (OR: 5.126; 95% CI: 1.674-15.694; P  = 0.005) 是 NASH 事件的预测因子.

结论

较低的 BMI 和体重减轻而非病毒学因素决定了慢性乙型肝炎患者 NASH 的消退。CHB 患者抗病毒治疗期间体重管理的价值值得进一步评估。

更新日期:2021-07-07
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