病毒性肝炎合并脂肪肝的治疗策略教材教学课件.pptx

病毒性肝炎合并脂肪肝的治疗策略目 录病毒性肝炎合并脂肪肝的流行病学慢性乙型肝炎合并脂肪肝的危害和治疗策略慢性丙型肝炎合并脂肪肝的危害和治疗策略全球和中国肝病的病因分布HBV感染和脂肪肝是我国最主要的肝病病因。Wang FS, et al. Hepatology. 2014 ;60(6):2099-10814%-71%的慢乙肝患者合并脂肪肝欧洲和中东地区亚太地区Raluca Pais, et al. Clin Liver Dis 18 (2014) 165–17840-86%的慢性丙型肝炎患者合并脂肪肝T Asselah, et al. Gut 2006;55:123–130中国慢性乙型肝炎和慢性丙型肝炎患者脂肪肝的流行情况Raluca Pais, et al. Clin Liver Dis 18 (2014) 165–178合并脂肪肝对慢性病毒性肝炎患者临床预后的影响肝细胞癌风险肝硬化风险范建高. 中华肝脏病杂志; 2009;17(11):801-805问 题如何正确理解病毒肝与脂肪肝之间的关系？如何治疗病毒肝合并脂肪肝的患者？病毒性肝炎（乙型、丙型）→ 脂肪肝 ？病毒性肝炎（乙型、丙型） + 脂肪肝 ？以治疗脂肪肝为主？以治疗病毒肝为主？双管齐下？HBV感染与代谢综合征的相互关系：临床研究汇总研究设计样本量结果Jarcuska PCross-section855A higher viral load in patient of chronic HBV infection with metabolic syndrome than those without.Chung THCross-section9474HBV infection was negatively associatedwith metabolic syndrome in men.Jinjuvadia RLarge population databaseChronicHBV: pastexposure toHBV=593594:7280620Chronic HBV infection was inversely associatedwith metabolic syndromeLi WC2013Case series26305The prevalence of metabolic syndromewas not different between HBV and non-HBV patientsLi X2012Case series138Metabolic syndrome in HBV patientscorrelated with insulin resistance and less effect of virusWong VW2012Case series1013HBV infection is associated with lower prevalence of metabolic syndrome than controls (11% vs. 20.2%; p=0.034)Jan CF 2006Population basedCross-sectional study53528There was an inverse association betweenmetabolic syndrome and HBV infection.Chia-Chi Wang, et al. J Gastroenterol Hepatol. 2014 Aug 5. doi: 10.1111/jgh.12700. [Epub ahead of print]慢性HBV感染与代谢综合征相关性的荟萃分析OR= 0.82Chia-Chi Wang, et al. J Gastroenterol Hepatol. 2014 Aug 5. doi: 10.1111/jgh.12700. [Epub ahead of print]合并代谢综合征(包括脂肪肝)对HBV肝病进展的影响研究者主要结论来源Mena á, et al. 慢性非活动性HBV携带者，代谢综合征与纤维化发展有关J Gastroenterol Hepatol. 2014 Jan;29(1):173-8.Wong GL, et al. 慢性乙肝患者合并代谢综合征增加肝纤维化进展风险Aliment Pharmacol Ther. 2014 Apr;39(8):883-93.Wong GL, et al. 慢性乙肝患者，代谢综合征增加肝硬化风险Gut. 2009;58(1):111-7.Huang YW, et al. 慢性乙肝合并新发糖尿病的患者，肝硬化和失代偿风险增加Clin Infect Dis. 2013. [E