Clinical Analysis Of The Relationship Between Chronic Hepatitis B And Nonalcoholic Fatty Liver Disease

Objects:Nonalcoholic fatty liver disease(NAFLD) refer to the liver disease characterized by the pathological features of diffuse hepatocellular macrovesicular steatosis in addition to the causes of alcohol and other specific factor. The incidence of NAFLD is increasing along with the improvement of people’s living standard. At present, NAFLD has become a common liver disease after viral hepatitis. Obesity and abnormal glucose metabolism are generally considered as the main factors that influence the occurrence and development of NAFLD. Chronic HBV infection occupies a greater proportion than other viral hepatitis infection in our country. The overlapping incidence of chronic HBV infection and NAFLD can not be ignored. Researches have shown that liver damages in patients with chronic HBV infection can also include hepatocellular fatty degeneration and lipid metabolism disorder. Due to the fatty degeneration of liver cells has certain influence on CHB patients with antiviral treatment, and the effect of antiviral treatment is closely related to the prognosis of CHB patients, therefore paying more attention to the study of HBV chronic infection complicated with fatty liver has important clinical application value and practical significance. The most controversial issue in clinical practice is:(1) whether HBV chronic infection is more prone to combine with fatty liver?(2) What’s impact on the clinical outcomes when HBV chronic infection combined with NAFLD ?(3) whether the fatty liver influences the replication and removal of HBV-DNA? This clinical experiment aimed to explore the relationship between the occurrence of NAFLD in the patients with obesity, high cholesterol or high blood glucose who have CHB or not. And the occurrence and development of NAFLD also the clinical feature and significance of the CHB were discussed in our study by analyzing the liver function index(ALT, AST, ALP, R–GGT, ALB, TBA), HBV-DNA load, HBs Ag levels and HBe Ag levels in CHB and CHB with NAFLD patients. Methods:CHB inpatients or outpatients with obesity or high cholesterol or high blood glucose were selected from 2013 October to 2014 October in infectious department or endocrine department of Heping Hospital(as experience group), and the populations with HBV-negative in medical examination department were absorbed as concurrent control group. Height and weight data were collected, and body mass index was calculated(BMI = body weight(kg) / height 2(M2)). The 653 cases which in accordance with the inclusion criteria were divided into the control group non CHB and BMI≥28(128 cases),group non CHB and BMI<28(232 cases),CHB and BMI≥28(98cases), group CHB and BMI<28(195 cases). Venous blood were collected to detect serum enzyme indexes(ALT, AST, ALP, R –GGT、ALB、TBA), lipid metabolism parameters(TC, TG), fasting blood glucose, HBV immunological markers and HBV-DNA load. B ultrasound examination for upper abdomen was executed in each case. Finally, the rates, biochemical indicators, HBV-DNA load, HBs Ag levels, HBe Ag levels and clinical data were statistically analyzed. Results:1. Overall analysis showed that there was no statistically significant difference(P>0.05) between CHB group(26.9%) and non CHB group(26.6%) in terms of the incidence of NAFLD. And stratified analysis demonstrated that, NAFLD incidences in pure CHB group, pure BMI ≥ 28 with CHB group, pure high blood sugar with CHB group, pure high cholesterol with CHB group were lower than the non CHB group, correspondingly(23.1%VS.31.6%,21.4%VS.31.9%,18%VS.27.8%,19.7%VS.28.1%,respe-ctively), while no statistically significant differences were observed(all P>0.05);NAFLD incidence in the CHB group with concurrence of BMI ≥28 and high blood sugar, BMI ≥28 and high cholesterol, high blood sugar and high cholesterol, the three factors, was higher than the non CHB group, correspondingly(38.9%VS.31.1%, 34.8%VS.25.8%, 46.7%VS.17.3%, 33.3% VS.19.1%, respectively), while no statistically significant differences were detected(all P <0.05).2.Multiple regression analysis showed that: BMI ≥28 with high blood sugar, BMI ≥28 with high cholesterol, the concurrence of high blood sugar and high cholesterol, the concurrence of the three factors, and CHB are the risk factors of NAFLD, in addition, the first four? factors and the fifth factor have interactive effects.3. Serum ALT, AST, ALP, gamma-GGT, TBA, ALB in CHB group associated with NAFLD were significantly higher than those in pure CHB group(all P<0.05).4. HBV-DNA load, HBs Ag levels, HBe Ag levels in CHB patients associated with NAFLD group(4.76 ± 1.48 log copies, 610.45±20.12 IU/ml、10.50±1.22 S/CO) was significantly lower((P<0.05)) than those of patients with pure CHB group(7.12 ± 2.01 log copies, 1015.76±19.06 IU/ml、18.93±1.73 S/CO, respectively). Conclusions:1. The incidence of NAFLD is increasing in the CHB patients along with the two factors(Obesity, high blood sugar, high cholesterol). The CHB is one of the risk factors of NAFLD, and the pathogenic factors have the interaction in the two disease;2. The liver damages were more serious in CHB with NAFLD patients than pure CHB patients;3. The HBV-DNA load, HBs Ag and HBe Ag levels in CHB with NAFLD patients were lower than that in pure CHB patients, while the possible mechanisms of this phenomenon need to be further explored.