| Background:Chronic hepatitis B(CHB)is a common chronic liver disease,usually closely related to the occurrence of liver cirrhosis and hepatocellular carcinoma(HCC).Non-alcoholic fatty liver disease(NAFLD)not only increases liver-related damage,but also increases the risk of HCC.In recent years,the coexistence of CHB and NAFLD has become more common.There is a complex correlation between the two.The interaction between CHB and NAFLD has not been fully elucidated.Aim:We systematically reviewed the literature and performed a meta-analysis method to explore:(1)the influence of CHB on the prevalence of NAFLD;(2)the influence of NAFLD on the virological parameters of HBV(HBe Ag and HBV DNA);(3)the effect of NAFLD on the antiviral efficacy of CHB,including the effect on ALT normalization,HBe Ag clearance and HBV DNA levels;(4)The impact of NAFLD on the prognosis of CHB patients.Method:Studies related to CHB and NAFLD were searched from Pub Med,Embase,CNKI and WANFANG databases.The time period was from the establishment of the database to August 28,2020.The inclusion and exclusion criteria were formulated according to the research purpose,and the literature was screened according to the established criteria.The Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of the included case-control studies and cohort studies,and the 11 items recommended by the Agency for Healthcare Research and Quality(AHRQ)were used to evaluate the quality of the included cross-sectional studies.Two researchers independently screened the literature,collected research data and extracted relevant data,and assessed the quality of the included literature that met the criteria.Stata 13.0 software was used for meta-analysis.In the analysis of binary variables,OR/HR and its 95%CI were used as the effect indicators.In the analysis of continuous variables,different measurement units used the standardized mean difference(SMD)as the effect indicator,and the same measurement unit used the weighted mean difference(WMD)as the effect indicator.The evaluation of heterogeneity was analyzed using Q test and I~2test.If P<0.1,I~2≥50%was considered to have significant heterogeneity.In this study,random effects model was used for data analysis regardless of the heterogeneity.Sensitivity analysis,subgroup analysis,and meta regression analysis were carried out to explore potential sources of heterogeneity and verify the robustness of meta-analysis results.Results:A total of 39 studies that met the criteria were included in this study.(1)The impact of CHB on the prevalence of NAFLD:Eleven studies(670,794participants)were included to explore the incidence of NAFLD in the general population and CHB patients.Compared with HBs Ag(-)participants,the risk of NAFLD in HBs Ag(+)patients was significantly reduced(OR=0.83,95%CI=0.73-0.94,P=0.004).(2)The influence of NAFLD on the virological parameters of HBV:Fourteen studies were included to explore the correlation between NAFLD and HBV virological parameters.Compared with CHB patients without NAFLD,the positive rate of HBe Ag in CHB patients with NAFLD was significantly lower(OR=0.71,95%CI=0.56-0.90,P=0.005);the HBV DNA load in CHB patients with NAFLD was also significantly lower(WMD=-0.20,95%CI=-0.37--0.03,P=0.018).(3)The impact of NAFLD on the effect of antiviral therapy of CHB:Eight studies were included to explore the correlation between NAFLD and the antiviral efficacy in CHB patients.After received antiviral therapy for 48 weeks,the coexistence of NAFLD had no effect on the HBe Ag clearance rate in CHB patients(OR=0.79,95%CI=0.55-1.13,P=0.203).Compared with CHB patients without NAFLD,NAFLD significantly reduced the ALT normalization rate(OR=0.67,95%CI=0.52-0.86,P=0.002)and the HBV DNA negative rate(OR=0.67,95%CI=0.46-0.96,P=0.030)in CHB patients.(4)The impact of NAFLD on the prognosis of CHB patients:Nine studies were included to explore the correlation between NAFLD and the prognosis of CHB patients.The comorbidity of NAFLD significantly increased the risk of HCC in CHB patients(HR=3.21,95%CI=2.07-4.98,P<0.001).NAFLD was also associated with increased all-cause mortality in CHB patients(HR=2.04,95%CI=1.02-4.08,P=0.044).Conclusion:(1)CHB is associated with a reduced prevalence of NAFLD.(2)NAFLD is associated with a reduced HBe Ag positive rate and lower HBV DNA levels in CHB patients.(3)The comorbidity of NAFLD could affect the effect of antiviral treatment in CHB patients.(4)The comorbidity of NAFLD in CHB patients is associated with increased risk of HCC development and all-cause mortality. |
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