慢性乙型肝炎合并非酒精性脂肪性肝病：当前的认识与争议

阳韬; 李军

doi:10.3969/j.issn.1001-5256.2023.08.005

慢性乙型肝炎合并非酒精性脂肪性肝病：当前的认识与争议

DOI: 10.3969/j.issn.1001-5256.2023.08.005

阳韬,
李军^, ,

南京医科大学附属第一医院感染内科，南京 210029

基金项目:

国家自然科学基金 (81871242)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：阳韬负责检索文献，撰写文章；李军负责设计文章框架，修改和审核文章。

详细信息

通信作者:
李军，dr-lijun@vip.sina.com (ORCID: 0000-0002-1961-7188)

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出版历程
- 收稿日期: 2023-05-08
- 录用日期: 2023-06-21
- 出版日期: 2023-08-20

Chronic hepatitis B comorbid with nonalcoholic fatty liver disease: Contemporary insights and controversies

Tao YANG,
Jun LI^{,
,}

Department of Infectious Diseases, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China

Research funding:

National Natural Science Foundation of China (81871242)

More Information

Corresponding author: LI Jun, dr-lijun@vip.sina.com (ORCID: 0000-0002-1961-7188)

摘要

摘要: 我国有众多慢性乙型肝炎(CHB)患者，近些年非酒精性脂肪性肝病(NAFLD)发病率也不断上升，CHB合并NAFLD的患病率也呈现上升趋势。由于CHB和NAFLD的最终结局是导致肝硬化和肝细胞癌的发生，因此两种疾病并存已经引起了广泛的关注和研究。目前CHB合并NAFLD导致肝细胞癌风险、全因死亡率和抗病毒治疗效果仍有争议，且相互作用机制仍不清楚。因此本文就CHB合并NAFLD进行简要综述，并对目前其相互关系进行探讨，为临床治疗提供参考。
- 乙型肝炎, 慢性 /
- 非酒精性脂肪性肝病 /
- 治疗学
Abstract: In China, a substantial number of patients suffer from chronic hepatitis B (CHB), and the incidence rate of nonalcoholic fatty liver disease (NAFLD) has been increasing in recent years, with a tendency of increase in the prevalence rate of CHB and NAFLD. Since the outcome of CHB or NAFLD is liver cirrhosis and hepatocellular carcinoma (HCC), the comorbidity of these two diseases has attracted wide attention and extensive research. Currently, there are still controversies over the risk of HCC due to CHB comorbid with NAFLD, all-cause mortality rate, and the efficacy of antiviral therapy, and the mechanism of interaction remains unknown. Therefore, this article briefly reviews CHB comorbid with NAFLD and discusses the association between the two diseases, in order to provide a reference for clinical management.
- Hepatitis B, Chronic /
- Non-alcoholic Fatty Liver Disease /
- Therapeutics

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表 1 CHB合并NAFLD治疗文献总结

Table 1. Reviewing the literature on the treatment of CHB with NAFLD

发表年份	地区	纳入例数(例)	纳入时间(年)	使用药物	抗病毒治疗反应
2020^[14]	美国	NAFLD: 187 非NAFLD: 368	2000—2016	LAM、ADV、ETV、TDF	两组的CVS和BR相似
2015^[33]	土耳其	HS: 63(21 ETV vs 42 tenofovir)	2011—2013	ETV或tenofovir	ETV和tenofovir对患有HS的CHB患者有类似的效果
2019^[34]	韩国	HS: 146 非HS: 188	2007—2016	ETV或tenofovir	两组CVS相似
2016^[35]	中国	NAFLD: 61 非NAFLD: 64	2018—2013	ETV	在第24~96周SVR相似。在第48和96周，两组之间的HBeAg血清转换率无影响。在第48和96周，NAFLD的BR低于非NAFLD组
2020^[36]	中国台湾	HS: 94 非HS: 102	2003—2016	LAM、ADV、ETV、LdT、TDF	两组HBeAg血清清除率无影响
2020^[37]	中国	HS: 127 非HS: 119	2010—2016	PEG-IFNα-2a	HS可降低PEG-IFNα-2a治疗CHB患者的效果
2011^[38]	土耳其	HS: 19 非HS: 65	2006—2009	PEG-IFNα-2a或PEG-IFNα-2b	HS对PEG-IFN治疗的SVR率呈下降趋势，但无统计学差异
2016^[39]	土耳其	HS: 76 非HS: 69	2001—2012	tenofovir或ETV	两组SVR相似
2007^[40]	土耳其	HS: 48 非HS: 92	2002—2006	PEG-IFNα或PEG-IFNα联合LAM	两组患者的治疗结果无影响
2012^[41]	中国	HS: 34 非HS: 62	2007—2008	PEG-IFNα-2a或PEG-IFNα-2b	不影响PEG-IFN治疗48周时SVR，但可能会影响其BR
2015^[42]	中国	HS: 22 非HS: 28	2005—2009	PEG-IFNα-2a	轻度HS对PEG-IFN α-2a抗病毒治疗48周时的疗效无影响
2012^[43]	中国	HS: 65 非HS: 148	2007—2009	ETV	HS降低ETV治疗病毒学反应
2014^[44]	中国	NAFLD: 106 非NAFLD: 210	2007—2009	LAM +ADV或ETV	NAFLD组的SVR明显低于非NAFLD组
2015^[45]	中国	NAFLD: 89 非NAFLD: 52	2006—2012	ETV	中度NAFLD组SVR和BR均明显低于非NAFLD组
2015^[46]	中国	HS: 31 非HS: 58	2010—2013	PEG-IFN	96周时，HS组SVR低于非HS组
注：LAM，拉米夫定；LdT，替比夫定；ADV，阿德福韦酯；ETV，恩替卡韦; TDF，富马酸替诺福韦酯；tenofovir，替诺福韦；PEG-IFN，聚乙二醇干扰素。

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