Diao Yuting, Hu Danqing, Hu Xue, Wang Peng, Wang Xiaojing, Luo Xiaoping, Wang Hongwu, Ning Qin
Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, Hubei Province, China.
National Medical Center for Major Public Health Events, 1095, Jiefang Avenue, Wuhan, 430030, Hubei Province, China.
Infect Dis Ther. 2022 Jun;11(3):1133-1148. doi: 10.1007/s40121-022-00629-5. Epub 2022 Apr 10.
We aimed to elucidate the impact of metabolic syndrome (MS) and nonalcoholic fatty liver disease (NAFLD) on treatment-naïve patients with chronic hepatitis B (CHB) and normal alanine aminotransferase (ALT).
We analyzed the clinical characteristics of a cross-sectional cohort of treatment-naïve patients with CHB and ALT in the upper limit of normal (ULN) from October 2018 to July 2021. ALT ≤ 0.5 ULN was stratified as low-normal ALT (LNALT) and 0.5 ULN < ALT ≤ ULN as high-normal ALT (HNALT). Transient elastography (TE) was used to evaluate liver steatosis and fibrosis.
Among 733 patients with CHB enrolled, 23.1% of them had MS, 37.2% of them had NAFLD, and 5.9% of them had significant fibrosis. The proportions of patients with MS, steatosis, and significant fibrosis in the HNALT group were higher than those in the LNALT group (31.4% vs. 14.1%, p < 0.001; 48.7% vs. 25.2%, p < 0.001; and 8.0% vs. 3.6%, p = 0.013, respectively). Multiple linear regression showed that steatosis (beta = 0.098, p = 0.001) and MS (beta = 0.092, p = 0.002) were independently related to ALT levels in the normal range. Multivariate logistic regression showed that age (OR 1.049, 95% CI 1.012-1.087, p = 0.010), aspartate aminotransferase (AST) (OR 1.059, 95% CI 1.005-1.115, p = 0.030), and severe steatosis (OR 2.559, 95% CI 1.212-5.403, p = 0.014) were independently associated with significant fibrosis. When analyzed in the subgroup of CHB with NAFLD, age (OR 1.060, 95% CI 1.006-1.117, p = 0.029) and severe steatosis (OR 2.962, 95% CI 1.126-7.792, p = 0.028) were still statistically significant.
The accumulation of MS components exacerbated hepatic steatosis. Severe NAFLD was independently associated with significant fibrosis. This emphasizes the importance of screening for MS and NAFLD in patients with CHB and normal ALT, where a more active intervention may apply.
我们旨在阐明代谢综合征（MS）和非酒精性脂肪性肝病（NAFLD）对初治慢性乙型肝炎（CHB）且丙氨酸氨基转移酶（ALT）正常患者的影响。
我们分析了2018年10月至2021年7月初治CHB且ALT处于正常上限（ULN）的横断面队列患者的临床特征。ALT≤0.5 ULN被分层为低正常ALT（LNALT），0.5 ULN＜ALT≤ULN为高正常ALT（HNALT）。采用瞬时弹性成像（TE）评估肝脏脂肪变性和纤维化。
在纳入的733例CHB患者中，23.1%患有MS，37.2%患有NAFLD，5.9%有显著纤维化。HNALT组中MS、脂肪变性和显著纤维化患者的比例高于LNALT组（分别为31.4%对14.1%，p＜0.001；48.7%对25.2%，p＜0.001；8.0%对3.6%，p = 0.013）。多元线性回归显示，脂肪变性（β = 0.098，p = 0.001）和MS（β = 0.092，p = 0.002）与正常范围内的ALT水平独立相关。多因素逻辑回归显示，年龄（OR 1.049，95%CI 1.012 - 1.087，p = 0.010）、天冬氨酸氨基转移酶（AST）（OR 1.059，95%CI 1.005 - 1.115，p = 0.030）和重度脂肪变性（OR 2.559，95%CI 1.212 - 5.403，p = 0.014）与显著纤维化独立相关。在合并NAFLD的CHB亚组中分析时，年龄（OR 1.060，95%CI 1.006 - 1.117，p = 0.029）和重度脂肪变性（OR 2.962，95%CI 1.126 - 7.792，p = 0.028）仍具有统计学意义。
MS组分的积累加剧了肝脏脂肪变性。重度NAFLD与显著纤维化独立相关。这强调了在CHB且ALT正常的患者中筛查MS和NAFLD的重要性，对此可能需要更积极的干预。
