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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 10
Oct.  2022
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Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(10): 2230-2235

Clinical characteristics and prognosis of patients with chronic hepatitis B combined with metabolic associated fatty liver disease

DOI: 10.3969/j.issn.1001-5256.2022.10.007

  • Center of Hepatic and Digestive Diseases, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China

Research funding:

Digestive Medical Coordinated Development Center of Beijing Municipal Administration of Hospitals (XXZ0303)

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  • Corresponding author: LI Lei, m13699119545@163.com(ORCID: 0000-0002-0295-9480)
  • Received Date: 2022-03-17
  • Accepted Date: 2022-04-20
  • Published Date: 2022-10-20
    Abstract
  •   Objective  To analyze the clinical characteristics and prognostic factors of chronic hepatitis B (CHB) patients complicated with metabolic associated fatty liver disease (MAFLD).  Methods  A total of 114 CHB patients and 101 CHB patients complicated with MAFLD who underwent liver biopsy between 2005 and 2018 were included. A long-term cohort was established with the time of liver puncture as the baseline, and decompensated cirrhosis, liver cancer, liver transplantation and death related to liver disease as the clinical endpoints. The patient's NAS score, hepatitis inflammation activity (G) and fibrosis stage (S) were scored for the liver biopsy. According to fibrosis stage, patients were divided into no significant fibrosis (S0-1) and significant fibrosis (S2-4) groups. The clinical characteristics and prognosis of the CHB patients with or without MAFLD at the same fibrosis stage were compared. CHB patients with MAFLD were divided into NAS < 4 and NAS≥4 groups according to NAS score, and the influence of NAS score on clinical outcomes of patients was analyzed. The independent samples t-test / Wilcoxin test was performed for comparison of continuous data and the chi-square test was used for comparison of categorical data between groups. Survival analysis was performed using Kaplan-Meier survival cure and compared using log-rank test. Cox multivariate regression analysis was used to identify prognostic factors.  Results  The BMI, blood glucose and TC in CHB patients with MAFLD group were significantly higher than those in CHB alone in each fibrosis stage (P < 0.05). In patients without significant fibrosis, the levels of ALT (Z=-2.249, P=0.025), AST (Z=-2.512, P=0.012) and GGT (Z=-5.261, P < 0.001) in the complicated group were higher than those in the CHB group. With a median follow-up time of 8.0 years, the Kaplan-Meier survival analysis revealed that the complicated MAFLD significantly reduced the liver event-free survival rate of CHB patients (χ2=7.607, P=0.006). Cox multivariable analysis revealed MAFLD (HR=5.76, 95% CI: 1.54 - 21.48, P=0.009) was an independent risk factor for liver-related outcomes. In CHB patients with MAFLD, the ALT (Z=-3.139, P=0.002), AST (Z=-2.898, P=0.004), and GGT (Z=-2.260, P=0.024) of patients with NAS≥4 were higher than those of patients with NAS < 4. We found that significant fibrosis (HR=4.83, 95% CI: 1.23 - 18.91, P=0.024) was associated with the poor prognosis of CHB patients with MAFLD.  Conclusions  CHB patients with MAFLD are more likely to have impaired liver function in the early stage and the disease progresses more rapidly. Complicated MAFLD will increase the risk of liver-related events in patients with CHB, and significant fibrosis is an independent risk factor for adverse outcomes in CHB patients with MAFLD.

     

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    • References(24)
  • [1]
    ESLAM M, NEWSOME PN, SARIN SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement[J]. J Hepatol, 2020, 73(1): 202-209. DOI: 10.1016/j.jhep.2020.03.039.
    [2]
    WANG TL, LIU X, ZHOU YP, et al. Scoring scheme for the inflammatory activity and fibrosis degree in chronic hepatitis[J]. Chin J Hepatol, 1998, 6(4): 195. DOI: 10.3760/j.issn:1007-3418.1998.04.002.

    王泰龄, 刘霞, 周元平, 等. 慢性肝炎炎症活动度及纤维化程度计分方案[J]. 中华肝脏病杂志, 1998, 6(4): 195. DOI: 10.3760/j.issn:1007-3418.1998.04.002.
    [3]
    KLEINER DE, BRUNT EM, VAN NATTA M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease[J]. Hepatology, 2005, 41(6): 1313-1321. DOI: 10.1002/hep.20701.
    [4]
    Chinese Society of Infectious Diseases, Chinese Medical Association, Chinese Society of Hepatology, Chinese Medical Association. The guidelines of prevention and treatment for chronic hepatitis B (2019 version)[J]. J Clin Hepatol, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.

    中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.
    [5]
    HANIF H, KHAN MM, ALI MJ, et al. A new endemic of concomitant nonalcoholic fatty liver disease and chronic hepatitis B[J]. Microorganisms, 2020, 8(10): 1526. DOI: 10.3390/microorganisms8101526.
    [6]
    HUI R, SETO WK, CHEUNG KS, et al. Inverse relationship between hepatic steatosis and hepatitis B viremia: Results of a large case-control study[J]. J Viral Hepat, 2018, 25(1): 97-104. DOI: 10.1111/jvh.12766.
    [7]
    SHI YW, YANG RX, FAN JG. Chronic hepatitis B infection with concomitant hepatic steatosis: Current evidence and opinion[J]. World J Gastroenterol, 2021, 27(26): 3971-3983. DOI: 10.3748/wjg.v27.i26.3971.
    [8]
    ZHANG Z, WANG G, KANG K, et al. Diagnostic accuracy and clinical utility of a new noninvasive index for hepatic steatosis in patients with hepatitis B virus infection[J]. Sci Rep, 2016, 6: 32875. DOI: 10.1038/srep32875.
    [9]
    HUANG J, JING M, WANG C, et al. The impact of hepatitis B virus infection status on the prevalence of nonalcoholic fatty liver disease: A population-based study[J]. J Med Virol, 2020, 92(8): 1191-1197. DOI: 10.1002/jmv.25621.
    [10]
    WANG B, LI W, FANG H, et al. Hepatitis B virus infection is not associated with fatty liver disease: Evidence from a cohort study and functional analysis[J]. Mol Med Rep, 2019, 19(1): 320-326. DOI: 10.3892/mmr.2018.9619.
    [11]
    LV DD, WANG YJ, WANG ML, et al. Effect of silibinin capsules combined with lifestyle modification on hepatic steatosis in patients with chronic hepatitis B[J]. Sci Rep, 2021, 11(1): 655. DOI: 10.1038/s41598-020-80709-z.
    [12]
    ZHANG GS, LI SN, MENG DM, et al. Analysis of influencing factors of chronic hepatitis B complicated with nonalcoholic fatty liver disease[J]. J Hanan Med Coll, 2019, 25(15): 1130-1134. DOI: 10.13210/j.cnki.jhmu.20190507.004.

    张国顺, 李盛楠, 孟冬梅, 等. 慢性乙型肝炎合并非酒精性脂肪性肝病的影响因素分析[J]. 海南医学院学报, 2019, 25(15): 1130-1134. DOI: 10.13210/j.cnki.jhmu.20190507.004.
    [13]
    ZHU L, JIANG J, ZHAI X, et al. Hepatitis B virus infection and risk of non-alcoholic fatty liver disease: A population-based cohort study[J]. Liver Int, 2019, 39(1): 70-80. DOI: 10.1111/liv.13933.
    [14]
    CAO D, CHEN WJ, LI YP, et al. Research advances in chronic hepatitis B complicated by nonalcoholic fatty liver disease. [J]. J Clin Hepatol, 2018, 34(9): 1986-1989. DOI: 10.3969/j.issn.1001-5256.2018.09.033.

    曹丹, 陈文静, 李艳平, 等. 慢性乙型肝炎合并非酒精性脂肪性肝病的临床研究进展[J]. 临床肝胆病杂志, 2018, 34(9): 1986-1989. DOI: 10.3969/j.issn.1001-5256.2018.09.033.
    [15]
    XIE F, MENG QH, HOU W, et al. Clinical and pathological on HBeAg-positive patients with chronic hepatients B complicated with nonalcoholic fatty liver disease[J]. Chin J Exp Clin Infect Dis (Electronic Edition), 2018, 12(3): 256-261. DOI: 10.3877/cma.j.issn.1674-1358.2018.03.011.

    谢放, 孟庆华, 侯维, 等. HBeAg阳性慢性乙型肝炎合并非酒精性脂肪肝患者的临床与病理学特征[J]. 中华实验和临床感染病杂志(电子版), 2018, 12(3): 256-261. DOI: 10.3877/cma.j.issn.1674-1358.2018.03.011.
    [16]
    CHEN Y, FAN C, CHEN Y, et al. Effect of hepatic steatosis on the progression of chronic hepatitis B: A prospective cohort and in vitro study[J]. Oncotarget, 2017, 8(35): 58601-58610. DOI: 10.18632/oncotarget.17380.
    [17]
    YANG XZ, GENG AW, XIAO L, et al. Pathological and clinical features of patients with chronic hepatitis B and nonalcoholic fatty liver disease[J]. J Pract Hepatol, 2017, 20(1): 101-102. DOI: 10.3969/j.issn.1672-5069.2017.01.026.

    杨秀珍, 耿爱文, 肖丽, 等. 慢性乙型肝炎合并脂肪肝临床与肝组织病理学分析[J]. 实用肝脏病杂志, 2017, 20(1): 101-102. DOI: 10.3969/j.issn.1672-5069.2017.01.026.
    [18]
    LI J, ZOU BY, YEO YH, et al. Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999-2019: a systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2019, 4(5): 389-398. DOI: 10.1016/S2468-1253(19)30039-1.
    [19]
    MAK LY, CRUZ-RAMÓN V, CHINCHILLA-LÓPEZ P, et al. Global epidemiology, prevention, and management of hepatocellular carcinoma[J]. Am Soc Clin Oncol Educ Book, 2018, 38: 262-279. DOI: 10.1200/EDBK_200939.
    [20]
    FAN JG, CHEN GF, JI D, et al. Long-term disease progression in chronic hepatitis B Chinese patients with comorbid nonalcoholic fatty liver disease[J]. J Hepatol, 2017, 66(1): S416-S417. DOI: 10.1016/S0168-8278(17)31194-7.
    [21]
    CHAN AW, WONG GL, CHAN HY, et al. Concurrent fatty liver increases risk of hepatocellular carcinoma among patients with chronic hepatitis B[J]. J Gastroenterol Hepatol, 2017, 32(3): 667-676. DOI: 10.1111/jgh.13536.
    [22]
    SONG C, ZHU J, GE Z, et al. Spontaneous seroclearance of hepatitis B surface antigen and risk of hepatocellular carcinoma[J]. Clin Gastroenterol Hepatol, 2019, 17(6): 1204-1206. DOI: 10.1016/j.cgh.2018.08.019.
    [23]
    van KLEEF LA, CHOI H, BROUWER WP, et al. Metabolic dysfunction-associated fatty liver disease increases risk of adverse outcomes in patients with chronic hepatitis B[J]. JHEP Rep, 2021, 3(5): 100350. DOI: 10.1016/j.jhepr.2021.100350.
    [24]
    SHI YW, YANG RX, FAN JG. Chronic hepatitis B infection with concomitant hepatic steatosis: Current evidence and opinion[J]. World J Gastroenterol, 2021, 27(26): 3971-3983. DOI: 10.3748/wjg.v27.i26.3971.
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