Factors associated with significant liver fibrosis in chronic hepatitis B patients with non-alcoholic fatty liver disease / 中华传染病杂志

ABSTRACT

Objective:To investigate the influencing factors of significant liver fibrosis in patients with chronic hepatitis B (CHB) concurrent with non-alcoholic fatty liver disease (NAFLD).Methods:Those who underwent liver pathological examination and confirmed diagnosis of CHB and NAFLD in Tianjin Second People′s Hospital from August 2014 to September 2017 were enrolled. Data regarding their demographic information, laboratory tests results, and liver pathology results were analyzed. The latter results were used to categorize the patients either in non-significant liver fibrosis group (Metavir stage<F2) or in significant liver fibrosis group (Metavir stage≥F2). The measurement data were compared using t test or Mann-Whitney U test, and the count data using chi-square test.The factors influencing the onset of significant liver fibrosis were subsequently explored with binary logistic regressions. Results:Out of 273 patients screened, 160 and 113 patients respectively belonged to the non-significant fibrosis group and the significant fibrosis group. Age, histologic activity, NAFLD type, liver stiffness measurement, hepatitis B e antigen (HBeAg) status (positive/negative), hepatitis B virus (HBV) DNA, aspartate aminotransferase, γ-glutamyl transpeptidase, total bilirubin, high blood glucose (with/without) and platelet count between the two groups were statistically significant( t=2.232, χ2=44.276, χ2=4.808, t=2.096, χ2=5.299, t=3.191, U=7 041.500, U=6 873.500, t=2.989, χ2=5.588, t=3.429, all P<0.05). Logistic regression showed that non-alcoholic steatohepatitis (NASH), histologicactivity, HBV DNA and platelet count were the independent influencing factors for significant liver fibrosis (odds ratio ( OR)=2.809, 6.730, 0.843, 0.995, respectively, all P<0.05). Patients were divided into two subgroups according to their HBeAg status, the results showed that for patients with negative HBeAg, NASH, histologic activity, HBV DNA and platelet count were the independent influencing factors for significant liver fibrosis ( OR=8.629, 3.626, 0.740, 0.992, respectively, all P<0.05). For patients with positive HBeAg, histologic activity and high blood glucose were the independent risk factors for significant liver fibrosis ( OR=12.738, 4.223, respectively, both P<0.01). Conclusion:Liver inflammation, NASH and high blood glucose are the serious risk factors during the onset and progression of significant liver fibrosis in patients with CHB and NAFLD, while HBV DNA and platelet count levels are negatively correlated with significant liver fibrosis.