Influence of metabolic syndrome on significant hepatic fibrosis in patients with chronic hepatitis B

Objective To investigate the influence of metabolic syndrome components on significant hepatic fibrosis in patients with chronic hepatitis B (CHB) and related risk factors. Methods The patients with CHB who attended Department of Hepatology in The Fourth Affiliated Hospital of Xinjiang Medical University from January 2016 to May 2017 were enrolled and divided into three groups according to the presence or absence of nonalcoholic fatty liver disease (NAFLD) or abnormal glycolipid. The patients' general information was collected, and transient elastography was performed for all patients. Body height and body weight were measured to calculate body mass index (BMI) . Liver function assessment, routine blood test, and HBsAg quantification were performed, and blood lipids and HBV DNA were measured. Fibrosis-4 (FIB-4) and aspartate aminotransferase-to-platelet ratio index (APRI) were calculated according to equations. A one-way analysis of variance was used for comparison of continuous data between groups, and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H rank sum test was used for comparison of non-normally distributed continuous data between groups, and the Wilcoxon rank-sum test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. Univariate and multivariate logistic regression analyses were used to identify the influencing factors for significant hepatic fibrosis. Results The CHB-NAFLD group had significantly higher controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) than the CHB group and the CHB-abnormal glycolipid group [CAP: 283. 16 ± 38. 43 d B/m vs 230. 61 ± 29. 97 db/m/237. 82 ± 35. 98 dB/m, P < 0. 05; LSM: 9. 40 (7. 50-12. 07) k Pa vs 8. 60 (6. 37-11. 92) k Pa/8. 20 (6. 00-11. 15) kPa, P < 0. 05], and LSM increased with the increase in the severity of NAFLD (H = 7. 76, P = 0. 02) . The CHB patients with abnormal glucose and lipids had a significantly higher LSM than those with abnormal blood lipid levels alone [9. 6 (8. 22-12. 07) vs7. 5 (5. 7-9. 67) , P < 0. 05]. The multivariate logistic regression analysis showed that increasing age (odds ratio [OR]= 1. 134, 95%confidence interval [CI]: 1. 010-1. 273, P < 0. 05) , an increase in body mass index (OR = 1. 297, 95% CI: 1. 084-1. 553, P <0. 05) , a high gamma-glutamyl transpeptidase (GGT) level (OR = 1. 025, 95% CI: 1. 006-1. 045, P < 0. 05) , a low triglyceride (TG) level (OR = 0. 399, 95% CI: 0. 180-0. 882, P < 0. 05) , and a high HBsAg level (OR = 2. 205, 95% CI: 1. 159-4. 194, P < 0. 05) were independent risk factors for significant hepatic fibrosis in CHB patients. Conclusion Besides age and high HBsAg level, overweight, a high GGT level, and a relatively low TG level also increase the risk of significant hepatic fibrosis in CHB patients.