Effect Of Metabolism-associated Fatty Liver Disease On Viral Serology In Patients With Chronic Hepatitis B

Objective:CHB is a major cause of cirrhosis and hepatocellular carcinoma.With the improvement of life,the prevalence of NAFLD has increased year by year in recent years.In the beginning of 2020,after NAFLD was renamed MAFLD,the prevalence of MFFLD increased year by year with the adjustment of diagnostic criteria and changes in living conditions,and the subsequent prevalence of CHB combined with MAFLD also increased.Therefore,the importance of CHB combined with MAFLD increased significantly.The purpose of this study was to investigate the effect of MAFLD on viral serology in patients with CHB in the real world,which has certain guiding significance for the prevention and improvement of the prognosis of this disease.Methods:A total of 600 newly treated patients who were diagnosed as CHB in the Department of Infectious Diseases of Shanxi Bethune Hospital from May 2020 to June2022 were selected as the research objects.The patients were divided into CHB group（285 cases）and CHB group（315 cases）according to whether they had MAFLD or not.（1）The patient’s gender,age,height,weight and whether suffering from hypertension,diabetes and other complications,calculated body mass index（BMI）=weight（kg）/height（m²）.⑵Laboratory examination results:Liver function:Glutamate aminotransferase（ALT）,aspartate aminotransferase（AST）,alkaline phosphatase（ALP）,γ-glutamyltransferase（GGT）,Total protein（TP）,ALB（albumin）,globulin（GLB）,prealbumin（PA）,adenosine deaminase（ADA）,Total bile acid（TBA）,total bilirubin（TBIL）,direct bilirubin（DBIL）,indirect bilirubin（IBIL）,Cholinesterase（CHE）,creatine kinase（CK）.Metabolic indexes:fasting blood glucose（FBG）,total cholesterol（TC）,triglyceride（TG）,high density lipoprotein（HDL）,low density lipoprotein（LDL）,uric acid（UA）.Hepatitis B five:hepatitis B surface antigen（HBs Ag）,hepatitis B surface antibody（HBs Ab）,hepatitis B e antigen（HBe Ag）,hepatitis Be antibody（HBe Ab）,hepatitis B core antibody（HBc Ab）,Hepatitis B virus nucleic acid（HBV DNA）.⑶Transient elastic hardness test of liver:liver hardness value（LSM）,controlled attenuation parameter（CAP）.Non-parametric rank sum test,χ²test and binary Logistics regression were used to analyze the influencing factors of CHB patients with MAFLD,and multiple linear regression was used to analyze the influence of MAFLD components on the virological serological indexes of CHB patients.Results:1.General data of patients in the CHB group and the CHB combined with MAFLD group showed that:There were 231 males and 54 females aged 40（30,50）years with BMI 23.44（21.10,25.36）kg/m²,LSM 6.00（4.50,9.30）k Pa,CAP 237.00（200.50,277.50）d B/m and waist circumference 85（80,87）cm,with a course 5（2,15）years.278patients had no history of diabetes,7 had history of diabetes,247 had no history of hypertension,38 had history of hypertension,223 had no history of genetic disease,62had history of genetic disease,139 had HBe Ag negative patients,146 had HBe Ag positive patients.There were 172 males and 143 females in the CHB group with MAFLD,aged 46（38,55）years,BMI 25.30（23.44,27.68）kg/m²,LSM 6.00（4.50,9.30）k Pa,CAP of 265.00（231.00,302.00）d B/m,waist circumference was 86（82,90）cm,course disease was 7（3,20）years.312 patients had no history of diabetes,3 had history of diabetes,179had no history of hypertension,136 had history of hypertension,223 cases of non-vertical transmission,62 cases of vertical transmission,167 had negative HBe Ag.148 patients were HBe Ag positive.There were statistically significant differences in gender,age,BMI,CAP value,waist circumference,course of disease and history of hypertension between the two groups（all P<0.05）,while there were no statistically significant differences in LSM value,history of diabetes,mode of infection and HBe Ag status between the two groups（all P>0.05）.2.The results of liver function indexes in the two groups showed that:In CHB group,ALT 30.00（20.00,46.85）IU/L,AST 26.00（21.00,34.00）IU/L,ALP 78.00（66.10,95.00）IU/L,GGT 25.80（17.00,42.00）IU/L,TP 73.60（69.40,76.50）g/L,ALB 45.70（41.95,47.85）g/L,GLB 27.60（24.75,31.30）g/L,PA 245.00（185.00,288.00）mg/L,ADA 13.20（10.00,17.00）IU/L,TBA 4.40（2.30,8.70）umol/L,TBIL 15.60（12.00,22.40）umol/L,DBIL 5.60（3.25,8.20）umol/L,IBIL 10.00（7.65,14.40）umol/L,CHE6767.00（780.95,8903.00）KU/L,CK 88.00（61.00,123.00）IU/L.In CHB combined with MAFLD group ALT 29.90（21.00,44.00）IU/L,AST 26.00（20.00,35.00）IU/L,TP73.90（69.40,76.50）g/L,ALB 45.80（42.50,47.90）g/L,GLB 27.50（24.70,30.80）g/L,ALP 79.00（67.00,98.00）IU/L,GGT 26.00（19.00,40.00）IU/L,PA 254.00（211.00,301.00）mg/L,ADA 13.00（10.20,17.00）IU/L,TBA 3.90（2.10,7.10）umol/L,TBIL14.30（10.70,20.40）umol/L,DBIL 5.00（3.20,7.80）umol/L,IBIL 9.20（6.90,12.20）umol/L,CHE 7205.00（3164.00,9483.00）KU/L,CK 86.00（66.00,129.00）IU/L.There were statistically significant differences in PA,TBIL and IBIL between the two groups（all P<0.05）.Comparison of liver function between the two groups:There was no significant difference among ALT,AST,ALP,GGT,TP,ALB,GLB,ADA,TBA,IBIL,CHE,CK（all P>0.05）.3.The results of metabolic indexes of patients in CHB group and CHB combined with MAFLD group showed as follows:In CHB group FBG 5.21（4.76,5.53）mmol/L,TC 4.21（3.66,4.88）mmol/L,TG 1.17（0.86,1.46）mmol/L,HDL 1.25（1.07,1.45）mmol/L,LDL 2.25（1.93,2.74）mmol/L,UA 316.50（254.00,365.80）mmol/L.In CHB combined with MAFLD group,FBG 5.68（5.19,6.10）mmol/L,TC 4.32（3.46,5.06）mmol/L,TG 1.53（1.04,2.20）mmol/L,HDL 1.17（0.98,1.38）mmol/L,LDL 2.34（1.74,2.94）mmol/L,UA 326.00（256.70,369.00）mmol/L.The FBG,TG,HDL had statistical significance between the two groups（all P<0.05）,while TC,LDL,UA had no statistical significance（all P>0.05）.4.The results of virological indexes of patients in CHB group and CHB combined with MAFLD group showed:In CHB group HBs Ag 2.94（2.26,3.39）log₁₀IU/m L,HBs Ab 0.30（0.10,0.63）m IU/m L,HBe Ag 1.38（0.00,29.00）S/CO,HBe Ab 75.20（44.35,99.90）S/CO,HBc Ab 359.30（45.40,555.00）S/CO,HBV DNA 2.44（1.70,4.00）log₁₀IU/L.In CHB combined with MAFLD group HBs Ag 2.77（2.01,3.37）log₁₀IU/m L,HBs Ab 0.30（0.10,0.60）m IU/m L,HBe Ag 0.65（0.00,23.45）S/CO,HBe Ab 81.90（50.55,99.90）S/CO,HBc Ab 343.35（118.80,527.75）S/CO,HBV DNA 1.70（1.69,3.13）log₁₀IU/L.The difference of HBs Ag pair and HBV DNA pair was statistically significant between the two groups（all P<0.05）,but HBs Ab HBe Ag,HBe Ab and HBc Ab were not significantly different（all P>0.05）.5.The results of binary logistics multivariate analysis of CHB patients with MAFLD showed that gender,age,history of hypertension,waist circumference and triglyceride were all influencing factors of CHB patients with MAFLD（P<0.05,OR values were 1.028,0.098,0.357,1.123,2.350,respectively;95%CI was 1.010～1.048,0.057～0.169,0.215～0.593,1.067～1.182,1.741～3.172）,respectively.6.Through multiple linear regression analysis,the effects of MAFLD components on the levels of viral serological indicators in CHB patients showed that systolic blood pressure,diastolic blood pressure and waist circumference had statistically significant effects on serum HBs Ag levels in CHB patients（B=-0.007,t=-2.450,P=0.015,B=-0.025,t=-3.667,P<0.001,B=-0.021,t=-2.516,P=0.012）.The effects of BMI,FBG,TG and HDL on serum HBs Ag level in CHB patients were not statistically significant（B=0.024,t=1.719,P=0.086,B=-0.009,t=-0.892,P=0.373,B=0.006,t=0.752,P=0.453,B=0.024,t=1.719,P=0.086,B=-0.009,t=-0.892,P=0.373,B=0.006,t=0.752,P=0.453,B=0.004,t=0.533,P=0.594）.Conclusions:1.The combination of MAFLD can affect the levels of FBG,TG and TBIL in CHB patients.2.Age,sex,history of hypertension,waist circumference and triglyceride were all factors influencing CHB and MAFLD.3.MAFLD can reduce serum HBs Ag and HBV DNA levels in patients with chronic hepatitis B to a certain extent.