| Objective:Analyze the clinical characteristics of chronic hepatitis B(CHB)with non-alcoholic fatty liver disease(NAFLD),and explore the risk factors of CHB with NAFLD,in order to improve the diagnosis and treatment of patients with CHB complicated with NAFLD and early find high-risk population of CHB with NAFLD to provide scientific evidence.Methods:768 CHB patients who underwent liver biopsies from October 2013 to August 2018 in department of infectious diseases of our hospital were collected.Exclude high alcohol intake,other diseases that lead to hepatic steatosis,other end-stage diseases or malignant tumors,and loss of key data.Finally 570 cases were included as the object of study.According to the clinical diagnostic criteria of CHB and NAFLD,the two groups include:CHB complicated with NAFLD group(n=172)and simple CHB group(n=398).According to the level of sex,age,BMI,ALT,HBeAg,HBV DNA,liver inflammation grade and liver fibrosis stage,CHB with NAFLD patients were divided into two or three groups respectively.This study is divided into two parts,in the first part,the demography,biochemistry,virology,imaging,liver histopathology and other clinical indexes of simple CHB and CHB with NAFLD were compared,then the clinical indexes of CHB with NAFLD patients were compared according to the divided groups above.the first part is comparing the clinical parameters,such as demography,biochemistry,virology,imaging and liver histopathology of CHB patients with NAFLD in different BMI groups.In the second part,analyze the odds ratio of CHB with NAFLD patients by univariate analysis,then the possible risk factors obtained by univariate analysis were included in multivariate analysis,then the independent risk factors of CHB with NAFLD patients were screened out.Results:1.The comparison of clinical data of simple CHB with NAFLD group and CHB group showed that there were more male patients in CHB combined with NAFLD group,the incidence of diabetes mellitus was higher.There were significant differences between the two groups,including BMI,systolic blood pressure,diastolic blood pressure,SUA,FPG,TG,TC,LDL-C,ALT and GGT were higher(P<0.05).The level of HBsAg and HDL-C were lower(P<0.05).More CHB with NAFLD patients were complicated with hyperuricemia and dyslipidemia(P<0.05).However,there was no significant difference in AST and HBV DNA levels between the two groups,as well as the marked liver inflammation(grade A?2)and significant liver fibrosis(stage F?2)between the two groups(p>0.05).2.2.The comparison of clinical data of CHB with NAFLD patients in different sex groups showed that there were significant differences between the two groups in age,family aggregation hepatitis B,smoking,BMI,systolic blood pressure,SUA,HDL-C,TG,HDL-C,ALT,AST,GGT,TBil,LSM and dyslipidemia as well as liver function abnormality and suspected NASH(P<0.05).However,there was no significant difference in HBV DNA and HBsAg levels,as well as liver fibrosis and hyperuricemia between the two groups(P>0.05).3.The comparison of clinical data of CHB with NAFLD patients in different age groups showed that there were significant differences among the three groups in sex and systolic blood pressure,comparing 18-30-year-old patients with over 40-year-old patients,the former had more males while the latter had higher systolic blood pressure(P<0.016).There was a general difference in ALT among the three groups(P<0.05),and the age of 18-30-year-old patients had significantly different from that of 30-40-year-old and over 40-year-old patients(P<0.016).There were differences in SUA,HBsAg among the three groups,and the age of 30-40-year-old patients were significantly higher than those of 18-30-year-old and over 40-year-old patients respectively.There were differences between the three groups in HBcAb(P<0.05),and the age of 30-40-year-old and over 40-year-old patients were different by pairwise comparison(P<0.016).Diastolic blood pressure and HDL-C,LSM were significantly different among the three groups(P<0.05),but there was no difference between the two groups(P>0.016).However,there was no significant difference in AST,GGT,HBV DNA level,liver inflammation and fibrosis,as well as hyperuricemia,dyslipidemia and suspected NASH(P>0.05).4.The comparison of clinical data of CHB with NAFLD patients in different BMI groups showed that the proportion of male patients with obesity was higher and the relative age was lower(P<0.05).There was a general difference in HDL-C among the three groups(P<0.05).Systolic blood pressure,diastolic blood pressure and SUA were significantly different in the three groups(P<0.05)and obesity group was higher than normal weight~2 group(P<0.016).There was a general difference in LSM among the three groups(P<0.05),obesity group was different from normal weight~2 group and over weight group(P<0.016).There was a general difference in ALT,GGT and the occurrence of suspicious NASH among the three groups,but there was no difference in each group(P>0.016).However,there was no significant difference in the levels of AST,HBV DNA,HBsAg,inflammation and fibrosis of liver tissue,as well as hyperuricemia,dyslipidemia and liver function among the three groups(P>0.05).5.The comparison of clinical data of CHB with NAFLD patients in different ALT groups showed that there were significant differences in HBV DNA,AST and GGT among the three groups(P<0.05)and each group was different(P<0.016).There were differences in sex(P<0.05)and SUA among the three groups,ALT40-80U/L group differed with ALT<40U/L group and ALT?80U/L group(P<0.016).There was a general difference in LSM,liver function abnormality among the three groups(P<0.05)and ALT<40U/L group differed with 40-80U/L group and ALT?80U/L group respectively(P<0.016).There was significant difference in age,BMI,TBil and liver tissue significant inflammation among the three groups(P<0.05),and they were also different in ALT<40U/L group and ALT?80U/L group by pairwise comparison(P<0.016).Combined with diabetes mellitus was different among the three groups(P<0.05),ALT<40U/L group differed with ALT in 40-80U/L group in the pairwise comparison(P<0.016).The levels of HBeAg and the incidence of hyperuricemia were significantly different among the three groups(P<0.05),but there was no difference in each group(P>0.016).However,there was no significant difference in HBsAg levels,liver fibrosis,dyslipidemia and suspicious NASH among the three groups(P>0.05).6.The comparison of clinical data of CHB with NAFLD patients in different HBeAg groups showed that there were differences in age,FPG,HBV DNA,HBsAg,HBcAb,ALT,AST and abnormal liver function(P<0.05).However,there was no significant difference in GGT,liver tissue inflammation and fibrosis,as well as hyperuricemia,dyslipidemia and suspicious NASH between the two groups(P>0.05).7.The comparison of clinical data of CHB with NAFLD patients in different HBV DNA groups showed that there was a general difference in ALT and AST among the three groups,HBV DNA2000~20000IU/ml group differed in HBV DNA?20000IU/ml group and HBV DNA<2000IU/ml group by pairwise comparison(P<0.016).There was a general difference in age and GGT among the three groups(P<0.05),HBV DNA?20000IU/ml group was different from HBV DNA<2000IU/ml group by pairwise comparison(P<0.016).There were differences in SUA and the levels of HBsAg,HBeAg and HBcAb among the three groups(P<0.05)and HBV DNA<2000IU/ml group differed with HBV DNA2000-20000IU/ml group and HBV DNA?20000IU/m group,respectively(P<0.016).BMI,TBil,LSM and abnormal liver function were significantly different among the three groups(P<0.05),but each group had no difference(P>0.016).However,there was no significant difference in liver inflammation and fibrosis,as well as hyperuricemia,dyslipidemia and suspicious NASH among the three groups(P>0.05).8.The comparison of clinical data of CHB with NAFLD patients in different liver inflammation grades showed that FPG,HDL-C,HBeAg,ALT,AST and GGT levels,as well as LSM,the significant liver fibrosis,liver function abnormality and suspicious NASH were different between the two groups(P<0.05).There was no significant difference in HBV DNA,HBsAg level,hyperuricemia and dyslipidemia between the two groups(P>0.05).9.The comparison of clinical data of CHB with NAFLD patients in different liver fibrosis stages showed that systolic blood pressure,TG,HBsAg,AST,liver significant inflammation,LSM and abnormal liver function were significantly different between the two groups(P<0.05).However,there was no significant difference in ALT,GGT and HBV DNA levels,as well as hyperuricemia,dyslipidemia and suspicious NASH between the two groups(P>0.05).10.Univariate analysis showed that the risk of male CHB patients had 1.621 times appearing NAFLD compared with females(P<0.05).Patients with diabetes mellitus had9.912 times appearing NAFLD compared with those without diabetes mellitus(P<0.05).Patients with overweight and obesity respectively had 4.789 times and 21.399 times appearing NAFLD compared with those with BMI under 18.5-23.9kg/m2(P<0.05).Patients with systolic blood pressure within 130-140mmHg had 2.394 times appearing NAFLD compared with patients with those whose systolic blood pressure under130mmHg(P<0.05).Patients with FPG within 5.6-6.9mmol/L and FPG?7.0mmol/L respectively had 2.076 times and 13.285 times appearing NAFLD compared with those with FPG<5.6mmol/L(P<0.05).patients with ALT?40U/L had 1.839 times appearing NAFLD compared with those with ALT<40U/L(P<0.05).Patients with GGT?45U/L had1.773 times appearing NAFLD compared with those with GGT<45U/L(P<0.05).Patients with HDL-C?1.04mmol/L had 2.745 times appearing NAFLD compared with those with TG<1.7mmol/L(P<0.05).Patients with HDL-C?1.04mmol/L had 2.745 times appearing NAFLD compared with those with HDL-C<1.04mmol/L(P<0.05).Patients with LDL-C?3.37mmol/L had 3.462 times appearing NAFLD compared with those with LDL-C<3.37mmol/L.Patients with SUA 360-420mmol/L and SUA?420mmol/L respectively had 4.708 times and 5.493 times appearing NAFLD compared with those with SUA<360mmol/L(P<0.05).There was no significant difference in the relative risk of NAFLD among CHB patients in other clinical indicators(P>0.05).11.Multivariateanalysisshowedthatoverweight,SUA?360mmol/L,TG?1.7mmol/L and complicated with diabetes mellitus were independent risk factors for NAFLD in patients with CHB.And those who were with overweight and obesity had4.925 times and 27.799 times appearing NAFLD compared with normal weight respectively.SUA 360?mmol/L had 2.564 times appearing NAFLD compared with SUA<360mmol/L.TG?1.7mmol/L had 1.703 times appearing NAFLD compared with TG<1.7mmol/L.and the occurrence of NAFLD in the combined diabetes mellitus had7.529 times appearing NAFLD compared with patients without diabetes mellitus.Conclusion:1.Comparing simple CHB patients,CHB with NAFLD were more likely to have abnormal liver function,disorder of glucose and lipid metabolism,and the level of HBsAg expression was lower,but the degree of inflammation and fibrosis in liver tissue had no significant difference.2.CHB with NAFLD patients of male,over 40 years old,overweight were more likely to have abnormal liver function and lipid metabolism disorder.HBsAg expression level was lower in CHB with NAFLD patients who were over 40 years old and had significant fibrosis of liver tissue.3.The independent risk factors of CHB with NAFLD patients were overweight,combined with diabetes mellitus,SUA?360mmol/L and TG?1.7mmol/L.The risk of NAFLD in obese CHB patients was higher. |
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