Efficacy of antiviral therapy for chronic hepatitis B with nonalcoholic fatty liver disease

Ling QING; Weiqiang HUANG; Xiaohe LI; Feng CHEN; Yingxia LIU

doi:10.3969/j.issn.1001-5256.2021.09.015

Volume 37 Issue 9

Sep. 2021

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Article Navigation > Journal of Clinical Hepatology > 2021 > 37(9): 2075-2080

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Efficacy of antiviral therapy for chronic hepatitis B with nonalcoholic fatty liver disease

DOI: 10.3969/j.issn.1001-5256.2021.09.015

Ling QING¹,
Weiqiang HUANG^{2, 3},
Xiaohe LI²,
Feng CHEN^{2, 4
,
,},
Yingxia LIU^{2
,
,}

1.
Clinical Medicine, University of South China, Hengyang, Hunan 421000, China
2.
Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, Guangdong 518112, China
3.
Department of Ultrasound, Pingxiang Second People's Hospital, Pingxiang, Jiangxi 337000, China
4.
Digestive Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China

Research funding:

National Natural Science Foundation of China (81873573);

National Natural Science Foundation of China (81800525)

Received Date: 2021-07-30
Accepted Date: 2021-08-31
Published Date: 2021-09-20

Abstract

Abstract

Objective To investigate the influence of nonalcoholic fatty liver disease (NAFLD) on the antiviral response of patients with chronic hepatitis B (CHB), and to provide a reference for clinical treatment of such patients. Methods A total of 187 patients who attended Shenzhen Third People's Hospital from January 2011 to December 2017 were enrolled and divided into CHB group with 43 patients, NAFLD group with 41 patients, and CHB+NAFLD group with 103 patients. Related indices were measured at enrollment different time points of follow-up, including body height, body weight, alanine aminotransferase (ALT), aspartate aminotransferase, four blood lipid parameters, four indicators of liver fibrosis, aspartate aminotransferase-to-platelet ratio index, HBsAg, HBeAg, anti-HBe, and HBV DNA quantification, and the CHB patients and the CHB+NAFLD patients receiving antiviral therapy were compared in terms of treatment outcome at weeks 12, 24, 48, 72, and 96 of antiviral therapy. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Wilcoxon rank-sum test was used for comparison between two groups; the chi-square test was used for comparison of categorical data between groups. Results Compared with the NAFLD group at baseline, the CHB group and the CHB+NAFLD group had significantly lower platelet count, ALT, gamma-glutamyl transpeptidase (GGT), alkaline phosphatase, and right lobe of liver oblique diameter (all P < 0.05), and compared with the CHB group, the CHB+NAFLD group had significantly higher body mass index, total cholesterol, and triglyceride and a significantly lower spleen thickness (all P < 0.05), while there were no significant differences in the other indicators between the two groups at baseline (all P > 0.05). At week 12 of antiviral therapy, there were no significant differences in liver fibrosis markers and inflammatory indices between the CHB group and the CHB+NAFLD group (all P > 0.05); compared with the CHB+NAFLD group at weeks 24 and 48, the CHB group had significantly greater reductions in ALT (Z=-2.128 and -3.055, both P < 0.05) and GGT (Z=-2.025 and -1.631, both P < 0.05); at week 48, the CHB group and the CHB+NAFLD group had a significant reduction in HBV DNA (Z=-6.445 and -4.415, both P < 0.001), and the CHB group had a significantly greater reduction. The CHB+NAFLD group had a significantly lower HBV DNA clearance rate than the CHB group at different time points of antiviral therapy (χ²=14.237, 13.961, 15.226, 10.462, and 13.030, all P < 0.05). At week 48 of antiviral therapy, the CHB+NAFLD group had a significantly lower HBeAg clearance rate than the CHB group (χ²=5.309, P=0.021), while there was no significant difference between the two groups at week 96 (χ²=0.117, P=0.732). At weeks 24, 48, 72, and 96 of antiviral therapy, the CHB+NAFLD group had a significantly lower ALT normalization rate than the CHB group (χ²=12.049, 5.287, 11.407, and 11.375, all P < 0.05). Conclusion NAFLD reduces the antiviral response of CHB patients and prolongs the duration of antiviral therapy.
- Hepatitis B, Chronic,
- Non-alcoholic Fatty Liver Disease,
- Antiviral Agents,
- Treatment Outcome

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References(18)

References

[1]	Chinese Society of Hepatology and Chinese Society of Infectious Disease, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B: A 2015 update[J]. J Clin Hepatol, 2015, 31(12): 1941-1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002. 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015年更新版)[J]. 临床肝胆病杂志, 2015, 31(12): 1941-1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002.
[2]	YOUNOSSI Z, ANSTEE QM, MARIETTI M, et al. Global burden of NAFLD and NASH: Trends, predictions, risk factors and prevention[J]. Nat Rev Gastroenterol Hepatol, 2018, 15(1): 11-20. DOI: 10.1038/nrgastro.2017.109.
[3]	WONG SW, CHAN WK. Epidemiology of non-alcoholic fatty liver disease in Asia[J]. Indian J Gastroenterol, 2020, 39(1): 1-8. DOI: 10.1007/s12664-020-01018-x.
[4]	LI J, ZOU B, 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.
[5]	LIU Q, YANG Y, MAO J, et al. Analysis of prevalence status and influencing factors of fatty liver in crowd in Wuhan city[J]. Chin Nurs Res, 2016, 30(31): 3927-3929. DOI: 10.3969/j.issn.1009-6493.2016.31.025. 刘倩, 杨莹, 毛靖, 等. 武汉市人群脂肪肝患病情况及其影响因素分析[J]. 护理研究, 2016, 30(31): 3927-3929. DOI: 10.3969/j.issn.1009-6493.2016.31.025.
[6]	ZHANG J, LIN S, JIANG D, et al. Chronic hepatitis B and non-alcoholic fatty liver disease: Conspirators or competitors?[J]. Liver Int, 2020, 40(3): 496-508. DOI: 10.1111/liv.14369.
[7]	SETO WK, YUEN MF. Nonalcoholic fatty liver disease in Asia: emerging perspectives[J]. J Gastroenterol, 2017, 52(2): 164-174. DOI: 10.1007/s00535-016-1264-3.
[8]	Group of Fatty Liver and Alcoholic Liver Diseases, Society of Hepatology, Chinese Medical Association. Guidelines for Management of non-alcoholic fatty liver disease[J]. J Clin Hepatol, 2010, 26(2): 120-124. http://lcgdbzz.org/cn/article/doi/1001-5256%20(2010)%2002-0120-05 中华医学会肝脏病学分会脂肪肝和酒精性肝病学组. 非酒精性脂肪性肝病诊疗指南[J]. 临床肝胆病杂志, 2010, 26(2): 120-124. http://lcgdbzz.org/cn/article/doi/1001-5256%20(2010)%2002-0120-05
[9]	CHOI H, BROUWER WP, ZANJIR W, et al. Nonalcoholic steatohepatitis is associated with liver-related outcomes and all-cause mortality in chronic hepatitis B[J]. Hepatology, 2020, 71(2): 539-548. DOI: 10.1002/hep.30857.
[10]	SCHUPPAN D, SURABATTULA R, WANG XY. Determinants of fibrosis progression and regression in NASH[J]. J Hepatol, 2018, 68(2): 238-250. DOI: 10.1016/j.jhep.2017.11.012.
[11]	KOYAMA Y, BRENNER DA. Liver inflammation and fibrosis[J]. J Clin Invest, 2017, 127(1): 55-64. DOI: 10.1172/JCI88881.
[12]	MORALES MR, SENDRA C, ROMERO-GOMEZ M. Hepatitis B and NAFLD: Lives crossed[J]. Ann Hepatol, 2017, 16(2): 185-187. DOI: 10.5604/16652681.1231556.
[13]	XIAO CH, LI XH, ZHANG CL, et al. Efficacy of adefovir dipivoxil in treatment of chronic hepatitis B patients with non-alcoholic fatty liver disease[J]. J Clin Hepatol, 2015, 31(2): 266-268. DOI: 10.3969/j.issn.1001-5256.2015.02.029. 肖春花, 利旭辉, 张春兰, 等. 阿德福韦酯治疗慢性乙型肝炎合并非酒精性脂肪性肝病的疗效观察[J]. 临床肝胆病杂志, 2015, 31(2): 266-268. DOI: 10.3969/j.issn.1001-5256.2015.02.029.
[14]	JIN X, CHEN YP, YANG YD, et al. Association between hepatic steatosis and entecavir treatment failure in Chinese patients with chronic hepatitis B[J]. PLoS One, 2012, 7(3): e34198. DOI: 10.1371/journal.pone.0034198.
[15]	CHEN MQ, WU JM, CHEN J, et al. The effect of non-alcoholic fatty liver disease on virologic response in patients with hepatitis B e antigen-positive chronic hepatitis B treated with nucleoside analogues[J]. Clin J Infect Dis, 2014, 32(3): 158-161. DOI: 10.3760/cma.j.issn.1000-6680.2014.03.007. 陈梅琴, 吴金明, 陈娟, 等. 合并非酒精性脂肪性肝病对e抗原阳性慢性乙型肝炎患者核苷类似物抗病毒疗效的影响[J]. 中华传染病杂志, 2014, 32(3): 158-161. DOI: 10.3760/cma.j.issn.1000-6680.2014.03.007.
[16]	WU L, PAREKH VV, GABRIEL CL, et al. Activation of invariant natural killer T cells by lipid excess promotes tissue inflammation, insulin resistance, and hepatic steatosis in obese mice[J]. Proc Natl Acad Sci U S A, 2012, 109(19): e1143-e1152. DOI: 10.1073/pnas.1200498109.
[17]	LU HH, CHEN QQ, SUN FF, et al. Progress on chronic hepatitis B complicated with non-alcoholic fatty liver disease[J/CD]. Chin J Liver Dis (Electronic Edition), 2020, 12(3): 12-16. DOI: 10.3969/j.issn.1674-7380.2020.03.003. 陆慧慧, 陈琦琪, 孙芳芳, 等. 慢性乙型肝炎合并非酒精性脂肪性肝病研究进展[J/CD]. 中国肝脏病杂志(电子版), 2020, 12(3): 12-16. DOI: 10.3969/j.issn.1674-7380.2020.03.003.
[18]	ZHANG RN, PAN Q, ZHANG Z, et al. Saturated fatty acid inhibits viral replication in chronic hepatitis B virus infection with nonalcoholic Fatty liver disease by toll-like receptor 4-mediated innate immune response[J]. Hepat Mon, 2015, 15(5): e27909. DOI: 10.5812/hepatmon.15(5)2015.27909.

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Efficacy of antiviral therapy for chronic hepatitis B with nonalcoholic fatty liver disease

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