Hu Danqing, Wang Peng, Wang Xiaojing, Hu Xue, Huang Da, Yan Weiming, Xi Dong, Han Meifang, Ning Qin, Wang Hongwu
Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
National Medical Center for Major Public Health Events, Wuhan, China.
Heliyon. 2024 Mar 23;10(7):e28653. doi: 10.1016/j.heliyon.2024.e28653. eCollection 2024 Apr 15.
BACKGROUND & AIMS: With a drastic increase in the number of chronic hepatitis B (CHB) patients with coexisting nonalcoholic fatty liver disease (NAFLD), there is an urgent need to evaluate antiviral treatment effects in this special population.
CHB patients with hepatic steatosis (CHB + HS) were prospectively recruited with followed-up of 3 years. HS and liver fibrosis were assessed by transient elastography. HS was defined as controlled attenuation parameter (CAP) ≥248 dB/m, and fibrosis progression was defined with ≥1-stage fibrosis increment. Multivariate and propensity score matching (PSM) analysis were used to evaluate antiviral therapy effects on fibrosis progression.
In total 212 recruited CHB + HS patients (median age 36 years, median ALT 59 U/L), 49.1% (104/212) received antiviral therapy and 50.9% (108/212) did not. Among patients with antiviral therapy, rates of serum HBV DNA undetectable, HBeAg and HBsAg loss, and ALT normalization at year 3 were 88.5%, 31.0%, 8.7% and 70.2%, respectively. Patients with mild-moderate HS didn't differ patients with severe HS regarding biochemical and virological responses. Antiviral therapy was independently associated with a lower risk of fibrosis progression among the entire cohort (odds ratio 0.473, 95% CI 0.245-0.911, = 0.025). This finding was further verified by PSM analysis. When stratified by the severity of HS, the antiviral therapy benefits in reducing fibrosis progression were mainly seen in patients with mild-moderate HS.
Among CHB + HS patients, long-term antiviral treatment effectively inhibits HBV replication and reduces fibrosis progression. Our findings have implications for the optimal management of this population.
随着慢性乙型肝炎（CHB）合并非酒精性脂肪性肝病（NAFLD）患者数量的急剧增加，迫切需要评估这一特殊人群的抗病毒治疗效果。
前瞻性招募患有肝脂肪变性的CHB患者（CHB + HS），并进行3年随访。通过瞬时弹性成像评估肝脂肪变性和肝纤维化。肝脂肪变性定义为受控衰减参数（CAP）≥248 dB/m，纤维化进展定义为纤维化增加≥1期。采用多变量和倾向评分匹配（PSM）分析评估抗病毒治疗对纤维化进展的影响。
共招募了212例CHB + HS患者（中位年龄36岁，中位ALT 59 U/L），49.1%（104/212）接受了抗病毒治疗，50.9%（108/212）未接受。在接受抗病毒治疗的患者中，第3年血清HBV DNA检测不到、HBeAg和HBsAg消失以及ALT正常化的发生率分别为88.5%、31.0%、8.7%和70.2%。轻度至中度肝脂肪变性患者与重度肝脂肪变性患者在生化和病毒学反应方面无差异。在整个队列中，抗病毒治疗与较低的纤维化进展风险独立相关（比值比0.473，95%可信区间0.245 - 0.911，P = 0.025）。PSM分析进一步验证了这一发现。按肝脂肪变性严重程度分层时，抗病毒治疗在减少纤维化进展方面的益处主要见于轻度至中度肝脂肪变性患者。
在CHB + HS患者中，长期抗病毒治疗可有效抑制HBV复制并减少纤维化进展。我们的研究结果对这一人群的最佳管理具有启示意义。
