Clinical Characteristic Analysis Of Chronic Hepatitis B Complicated With Fatty Liver Disease

Background: It is estimated that over 350 million people are suffering from chronic hepatitis B(CHB)worldwide,which is one of the leading causes of cirrhosis and hepatocellular carcinoma.Non-alcoholic fatty liver disease(NAFLD)is another common chronic liver disease,with an incidence of 20-40% in the population and may progress to cirrhosis and hepatocellular carcinoma(HCC).Identifying and improving the risk factors of NAFLD may help to reduce these complications.Previous researches have reported some NAFLD risk factors which including age,gender,and some metabolic factors,such as centrality obesity,higher body mass index(BMI),fasting blood glucose,cholesterol,elevated triglyceride and HDL levels.Many patients suffered from chronic hepatitis B and NAFLD at the same time because both chronic hepatitis B and NAFLD are very common.However,the effect of HBV on hepatic steatosis is still unclear.Now there are three theories about the relationship of HBV and hepatic steatosis: 1.Hepatitis B virus(HBV)and host metabolic factors co-affect the occurrence of liver steatosis;2.HBV is a protective factor,which could prevent the liver ectopic fat accumulation.3.There is no association between HBV and liver steatosis.Objective: To study the effect of HBV on liver steatosis.We hypothesized that the degree of fatty degeneration in CHB infection may be more influenced by the metabolic factors of the host than the direct effect of HBV.Methods: Fibro Scan is a newly developed non-invasive quantitative detection method for the determination of liver hardness and steatosis,and the degree of steatosis in liver tissue is evaluated by controlled attenuation parameter(CAP).A larger CAP value represents a more severe steatosis.In this study,the CAP values of patients with NAFLD,CHB,NAFLD and CHB were measured by the Fibro Scan-502 model.The HBV DNA low viral load were determined in the patients with NAFLD and CHB and the HBVDNA<500 copy/ml.Results: 150 patients with CHB and NAFLD,200 patients with NAFLD and 103 patients with CHB were included in this study,and the CAP values of these patients were measured.The mean CAP value of NAFLD patients(284 ± 30.3 d B/m)was significant greater than the CHB group(185 ± 44.7 d B/m)and the CHB combined NAFLD group(272 ± 33.7 d B/m)(P <0.01).There was no significant difference in age among CHB and NAFLD group(46.5 ± 12.8 years),NAFLD group(49.0 ± 11.7 years)and CHB group(46.0 ± 11.8 years)(P = 0.059).No significant difference was found between the CAP values in NAFLD group and CHB combined NAFLD group(P = 0.401).The percent of male in CHB combined NAFLD,NAFLD group and CHB group was 56.2%(90/150),51%(102/200),59.2%(61/103)(P = 0.348),respectively.In the patients with CHB combined NAFLD,there was no significant association between HBV DNA and the CAP value(r =-0.125,P = 0.129)when the HBV DNA>500 copy/ml.When HBV DNA < 500 copy/ml,exclude 14 negative results,there was no significant difference of the high sensitivity HBV DNA and the CAP value(r =-0.001,P =0.996).No significant correlation were observed between HBs Ag or HBe Ag values and CAP values(r = 0.107,P = 0.193;r =-0.013,P = 0.872 respectively).The levels of ALT,AST,GGT had not correlated with the CAP values(r =-0.155,P = 0.058;r =-0.133,P = 0.105;r = 0.089,P = 0.280,respectively),but the levels total cholesterol,triglyceride,low-density lipoprotein(LDL)had significant positive correlation with the CAP value(r = 0.358,P < 0.01;r = 0.280,P = 0.001;r = 0.173 P = 0.034,respectively),and the highdensity lipoprotein(HDL)had a negative correlation with the CAP value(r =-0.174,P = 0.033).Conclusion: Liver CAP value is not affected by HBV infection.The progression of fatty degeneration in CHB patients may mainly due to host metabolic status rather than the viral infection.