The Clinical Analysis In The Chronic Hepatitis B Viral Hepatitis Patients With Hepatic Steatosis

Objective:To explore the related risk factors causing hepatic steatosis in chronic hepatitis B viral(CHB)patients,impacts of the hepatic steatosis acted on the liver inflammation and fibrosis,and the reliability of ultrasonic inspection,CT,MRI,FibroScan in diagnosing the hepatic steatosis.Methods:A total of 411 patiens with chronic hepatitis B who underwent liver biopsies but not accepted Antiviral therapy were admitted in this retrospective study form the The First Affiliated Hospital of Guangxi Medical University during August 2007 to May 2017.According to the result of pathology,they were divided into two groups:the hepatic steatosis group(steatosis>5%),and simple CHB group(steatosis<5%).We collected their gender,age,height,weight,history of drinking,ultrasound,CT,MRI,FibroScan and inflammation of the liver tissue(G)and fibrosis stage(S)and other materials.Fasting venous blood was taken to detect HBVDNA,serum enzymology index[aspartic acid transaminase(AST),alanine aminotransferase(ALT),gamma-glutamyl transpeptidase(GGT)],lipid metabolism index[total triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low density cholesterol(TC),lipoprotein cholesterol(LDL-C)].And the body mass indexes were calculated[BMI = weight(kg)/height(m2)].To analyze the related risk factors causing hepatic steatosis for CHB patients,the measurement data conforming to normal distribution used independent sample t-test and qualitative data used multiple logistic regression analysis;chi-square analysis was used to analyze the impacts of the hepatic steatosis on the liver inflammation and fibrosis,and the reliability of ultrasonic inspection,CT,MRI,FibroScan in diagnosing the hepatic steatosis.Results:(1)The incidence of CHB patients combined with hepatic steatosis was 22.1%.(2)The subgroup analysis showed that male(P=0.009),alcohol consumption(P=0.035),high body mass index(P=0.000)and the increase of total cholesterol(P=0.000)could increase the risk of CHB patients combined with hepatic steatosis.But age,HBVDNA,TC,HDL-C,LDL-C,ALT,AST,GGT had no impact on hepatic steatosis.(3)The multivariable analysis showed that BMI ?24.6 kg/m2(OR = 3.225,P = 0.001),TG ?1.70 mmo/L(OR = 2.971,P = 0.006)and alcohol consumption(OR = 4.002,P =0.010)were independent risk factors.(4)Hepatic steatosis had no obvious effect on increasing the degree of liver inflammation and fibrosis(P>0.05).(5)The reliability of ultrasonic inspection,CT,MRI,FibroScan in diagnosing the hepatic steatosis:AUC:FibroScan>ultrasonic inspection>CT>MRI;SN:FibroScan>ultrasonic inspection>CT>MRI;SP:CT,MRI>ultrasonic inspection>FibroScan;PPV:CT>ultrasonic inspection>FibroScan>MRI;NPV:FibroScan>ultrasonic inspection>CT>MRI;Youden index:FibroScan>ultrasonic inspection>CT>MRI;diagnostic coincidence rate:ultrasonic inspection>CT>FibroScan>MRI.Conclusions:(1)The incidence of CHB patients combined with hepatic steatosis was 22.1%.(2)High body mass index,drinking,elevated triglycerides were independent risk factors of CHB combined with hepatic steatosis.(3)FibroScan had a simple and high diagnostic efficiency to diagnose the hepatic steatosis with easy to popularize in clinic.