【摘要】

背景与目的：在动物研究中，乙型肝炎病毒(HBV)蛋白的表达可引起肝脏脂肪变性，我们的目的是研究在一般人群中有或无HBV感染个体的脂肪肝发生率。 方法：我们在中国香港实施了一项横断面的人群研究，通过质子磁共振波谱检测肝内甘油三酯含量(IHTG)。 结果：  收集了1013例个体（91例HBV患者与922例对照人群）。HBV患者的中位IHTG为1.3%（0.2-33.2），对照组为2.1%（0-44.2）(P<0.001)。除外有明显酒精摄入的个体，HBV患者中非酒精性脂肪性肝病发生率为13.5%(95% CI 6.4%, 20.6%)，而对照组为28.3% (95% CI 25.3%, 31.2%)(p=0.003)，在40-59岁年龄段，HBV患者与对照组脂肪肝发生率不同，而在那些≥60岁的则发生率相似。在调准人口和代谢因素之后，HBV感染仍然是与脂肪肝低危相关的独立因素(adjusted odds ratio 0.42; 95% CI 0.20, 0.88; p=0.022)。HBV患者的代谢综合征发生率也低(11.0% vs. 20.2%; p=0.034),，但这一差异主要归因于甘油三酯水平低。在HBV患者中，病毒基因型，HBV DNA水平和HBeAg状态与脂肪肝无关。 结论：HBV感染与脂肪肝，甘油三酯，代谢综合征发生率低有关，病毒复制可影响脂质代谢，这值得进一步研究。

江西省景德镇市第三人民医院消化内科  杨力 摘译

本文首次发表于[J Hepatol, 2012 ,56(3):533-540]

Hepatitis B virus infection and fatty liver in the general population

Abstract

BACKGROUND &AIMS:

In animal studies, expression of hepatitis B virus (HBV) proteins causes hepatic steatosis. We aimed to study the prevalence of fatty liver in people with and without HBV infection in the general population.

METHODS:

We performed a cross-sectional population study in Hong Kong Chinese. Intrahepatic triglyceride content (IHTG) was measured by proton-magnetic resonance spectroscopy.

RESULTS:

One thousand and thirteen subjects (91 HBV patients and 922 controls) were recruited. The median IHTG was 1.3% (0.2-33.3) in HBV patients and 2.1% (0-44.2) in controls (p <0.001). Excluding subjects with significant alcohol consumption, the prevalence of nonalcoholic fatty liver disease was 13.5% (95% confidence interval [CI] 6.4%, 20.6%) in HBV patients and 28.3% (95% CI 25.3%, 31.2%) in controls (p=0.003). The fatty liver prevalence differed in HBV patients and controls aged 40-59years but was similar in those aged 60years or above. After adjusting for demographic and metabolic factors, HBV infection remained an independent factor associated with lower risk of fatty liver (adjusted odds ratio 0.42; 95% CI 0.20, 0.88; p=0.022). HBV patients also had a lower prevalence of metabolic syndrome (11.0% vs. 20.2%; p=0.034), but the difference was mainly attributed to lower triglyceride levels. Among HBV patients, viral genotypes, HBV DNA level and hepatitis B e antigen status were not associated with fatty liver.

CONCLUSIONS:

HBV infection is associated with a lower prevalence of fatty liver, hypertriglyceridemia and metabolic syndrome. Viral replication may affect lipid metabolism and this warrants further studies.