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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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