Li Jie, Le An K, Chaung Kevin T, Henry Linda, Hoang Joseph K, Cheung Ramsey, Nguyen Mindie H
Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan, Shandong, China.
Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA.
Liver Int. 2020 May;40(5):1052-1061. doi: 10.1111/liv.14415. Epub 2020 Mar 15.
BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis B (CHB) are common liver diseases. Concurrent NAFLD may affect antiviral treatment outcomes in CHB patients. The aim of this study is to investigate the impact of NAFLD on complete viral suppression ([CVS], HBV DNA <20-100 IU/mL) and/or biochemical response ([BR], ALT of ≤25 U/L for females; 35 U/L for males) in CHB patients who received oral antiviral therapy.
A retrospective study of 555 treated CHB patients (187 NAFLD; 368 non-NAFLD) from 2000 to 2016 at a USA medical centre. NAFLD was diagnosed by imaging and/or histology after ruling out secondary causes of hepatic steatosis.
The majority of patients were male (60.7%), Asian (87.56%) and HBeAg-negative (66.7%). NAFLD patients compared to non-NAFLD were more likely HBeAg negative (74.3% vs 62.8%, P = .02), hypertensive (33.2% vs 22.8%, P = .009) and male (67.4% vs 57.3%, P = .02) with a higher mean BMI (25.4 ± 4.3 vs 23.8 ± 4.0 kg/m , P < .001). Both cohorts achieved similar rates of CVS (86% vs 88%) and BR (38% vs 41%) during the follow-up of up to 60 months (P > .05), but NAFLD had higher cumulative rates of CVS + BR, compared with non-NAFLD patients (32.5% vs 22.8%, P = .03). In multivariate analyses, NAFLD was not independently associated with CVS and/or BR outcomes. Receipt of entecavir or tenofovir (vs older therapies) and lower baseline HBV DNA or higher ALT were positively associated with achieving CVS or BR.
Concomitant NAFLD had no impact on the long-term rates of CVS and/or BR in treated CHB patients.
非酒精性脂肪性肝病（NAFLD）和慢性乙型肝炎（CHB）是常见的肝脏疾病。合并NAFLD可能会影响CHB患者的抗病毒治疗效果。本研究旨在调查NAFLD对接受口服抗病毒治疗的CHB患者实现完全病毒抑制（[CVS]，HBV DNA<20 - 100 IU/mL）和/或生化应答（[BR]，女性ALT≤25 U/L；男性ALT≤35 U/L）的影响。
对2000年至2016年在美国一家医疗中心接受治疗的555例CHB患者（187例NAFLD；368例非NAFLD）进行回顾性研究。在排除肝脂肪变性的继发原因后，通过影像学和/或组织学诊断NAFLD。
大多数患者为男性（60.7%）、亚洲人（87.56%）且HBeAg阴性（66.7%）。与非NAFLD患者相比，NAFLD患者更可能为HBeAg阴性（74.3%对62.8%，P = 0.02）、高血压患者（33.2%对22.8%，P = 0.009）且为男性（67.4%对57.3%，P = 0.02），平均BMI更高（25.4±4.3对23.8±4.0 kg/m²，P < 0.001）。在长达60个月的随访期间，两个队列实现CVS（86%对88%）和BR（38%对41%）的比例相似（P > 0.05），但与非NAFLD患者相比，NAFLD患者CVS + BR的累积发生率更高（32.5%对22.8%，P = 0.03）。在多变量分析中，NAFLD与CVS和/或BR结局无独立相关性。接受恩替卡韦或替诺福韦（相对于旧疗法）以及较低的基线HBV DNA或较高的ALT与实现CVS或BR呈正相关。
合并NAFLD对接受治疗的CHB患者的长期CVS和/或BR发生率无影响。
