Introduction and Objectives

Chronic hepatitis B (CHB) may progress to more serious liver diseases and it is often accompanied by non-alcoholic fatty liver disease (NAFLD). NAFLD and CHB share risk factors for liver fibrosis and cirrhosis, but the influence of NAFLD on fibrosis progression is controversial. This retrospective study evaluated the prevalence of NAFLD in patients with CHB and investigated associations between NAFLD and liver fibrosis in a large multi-center cohort of hepatitis B patients submitted to liver biopsy.

Patients and Methods

Treatment-naïve patients with CHB who underwent liver biopsy were analyzed. Propensity score matching (PSM) was performed to adjust the confounders between patients with and without NAFLD.

Results

A total of 1496 CHB patients were included. Two hundred and ninety (19.4%) patients were diagnosed with NAFLD by liver biopsy. The proportions of significant liver fibrosis (52.8% vs. 63.9%, P<0.001), advanced liver fibrosis (27.2% vs. 36.5%, P=0.003), and cirrhosis (13.4% vs. 19.7%, P=0.013) was considerably lower in CHB patients with NAFLD compared to those without NAFLD. 273 patients were included in each group after PSM adjusted for age, sex, hepatitis B envelope antigen status, and hepatitis B virus DNA. Liver fibrosis remained less severe in CHB patients with NAFLD than those without NAFLD (P<0.05) after PSM. The presence of NAFLD was considered an independent negative factor of significant liver fibrosis (odds ratio (OR) 0.692, P=0.013) and advanced liver fibrosis (OR 0.533, P = 0.002) in CHB patients.

Conclusions

NAFLD is not uncommon in CHB patients with the prevalence of 19.4%. The presence of NAFLD is associated with less severe liver fibrosis in CHB patients.

Registration No. of the study/trial

NCT03097952.

中文翻译：

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NAFLD 与慢性乙型肝炎中较轻的肝纤维化相关：一项多中心回顾性研究

简介和目标

慢性乙型肝炎（CHB）可能会发展为更严重的肝脏疾病，并且通常伴有非酒精性脂肪肝病（NAFLD）。NAFLD 和 CHB 具有肝纤维化和肝硬化的共同危险因素，但 NAFLD 对纤维化进展的影响存在争议。这项回顾性研究评估了慢性乙型肝炎患者中 NAFLD 的患病率，并在接受肝活检的大型多中心乙型肝炎患者队列中调查了 NAFLD 与肝纤维化之间的关联。

患者和方法

对接受肝活检的初治慢性乙型肝炎患者进行了分析。进行倾向评分匹配（PSM）来调整患有和不患有 NAFLD 的患者之间的混杂因素。

结果

总共包括 1496 名慢性乙型肝炎患者。290 名 (19.4%) 患者通过肝活检诊断为 NAFLD。显着肝纤维化（52.8% vs. 63.9%，P<0.001）、晚期肝纤维化（27.2% vs. 36.5%，P=0.003）和肝硬化（13.4% vs. 19.7%，P=0.013）的比例分别为：与非 NAFLD 患者相比，患有 NAFLD 的 CHB 患者的发病率要低得多。PSM 调整年龄、性别、乙型肝炎包膜抗原状态和乙型肝炎病毒 DNA 后，每组纳入 273 名患者。PSM 后，合并 NAFLD 的 CHB 患者的肝纤维化程度仍较未合并 NAFLD 的患者轻（P<0.05）。NAFLD的存在被认为是CHB患者发生显着肝纤维化（优势比（OR）0.692，P=0.013）和晚期肝纤维化（OR 0.533，P=0.002）的独立负面因素。

结论

NAFLD 在 CHB 患者中并不罕见，患病率为 19.4%。NAFLD 的存在与 CHB 患者较轻的肝纤维化有关。

研究/试验注册号

NCT03097952。