慢性HBV感染重叠非酒精性脂肪性肝病临床与基础研究的现状及展望

Current status and perspectives of the clinical and basic research on concomitant chronic hepatitis B virus infection and nonalcoholic fatty liver disease

慢性乙型肝炎病毒感染(CBI)与非酒精性脂肪性肝病(NAFLD)是世界范围内慢性肝病常见的两大病因,CBI重叠或合并NAFLD(Co-CBI&NAFLD)的情况较普遍。Co-CBI&NAFLD两者的相互影响作用,尤其是NAFLD对慢性乙型肝炎(CHB)疾病进展、抗病毒疗效及结局的影响作用尚存在争议。现有的Co-CBI&NAFLD临床与基础研究结果显示,NAFLD能够一定程度上抑制HBV DNA复制,表现为血清HBV DNA载量相对较低,并可能增加慢性CHB患者血清HBsAg转阴率;基于临床前瞻性或回顾性队列研究显示,Co-CBI&NAFLD较单纯CHB肝纤维化进展呈加快趋势,乃至肝硬化及HCC发生率亦呈增加态势;Co-CBI/NAFLD组织学上两者病变并存,各自特征性病变鉴别困难。目前Co-CBI&NAFLD的自然史、发病机制尚不清楚,其病理学特征尚待确认,NAFLD对CHB疾病进程的影响作用,尤其是对抗病毒疗效的影响及疾病结局尚缺乏高等级的循证医学证据,国内外尚无Co-CBI&NAFLD诊疗或管理指南。对上述问题的解决,无疑将有助于加深对Co-CBI&NAFLD的理解与认识,规范并提高临床诊疗或管理效果,降低相关终末期肝病的发生率和病死率。

Chronic hepatitis B virus infection(CBI)and nonalcoholic fatty liver disease(NAFLD)are the two main etiologies of chronic liver diseases worldwide,and therefore,concomitant CBI and NAFLD(Co-CBI&NAFLD)is relatively common.There are still controversies over the influence of the interaction between CBI and NAFLD,especially NAFLD,on the progression,antiviral response,and outcome of chronic hepatitis B(CHB).Current clinical and basic research on Co-CBI&NAFLD have shown that NAFLD could inhibit HBV DNA replication to a certain degree,manifesting as a relatively low HBV DNA load,and it might increase HBsAg clearance rate in patients with CHB.Prospective or retrospective cohort studies have shown that patients with Co-CBI&NAFLD tend to have more rapid progression of liver fibrosis than those with CHB alone,as well as increased incidence rates of liver cirrhosis and hepatocellular carcinoma.Histologically,Co-CBI&NAFLD has the pathological changes of both CHB and NAFLD,and therefore,it is difficult to identify their own characteristic lesions.At present,the natural history and pathogenesis of Co-CBI&NAFLD remain unclear,and its pathological characteristics have not been fully identified.There is still a lack of high-level evidence-based supporting information on the influence of NAFLD on the course of CHB,especially its impact on antiviral response and disease outcome,and there are also no guidelines for the diagnosis/treatment or management of Co-CBI&NAFLD in China and globally.Solutions to the above issues will definitely deepen the understanding of Co-CBI&NAFLD,standardize and improve clinical diagnosis/treatment or management,and thus reduce the incidence and mortality rates of related end-stage liver diseases.