Hong Shan, Hao Yiwei, Sun Lei, Li Ping, Yang Junru, Zhang Fuyang, He Lingling, Zhang Jing, Wei Hongshan
Department of Gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, PR China.
Department of Medical Records and Statistics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, PR China.
Ann Hepatol. 2024 Sep 19;30(2):101589. doi: 10.1016/j.aohep.2024.101589.
Significant fibrosis is an indicator of clinical intervention for both chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD). There remains a paucity of data regarding the clinical impact of biopsy-defined MASLD on significant fibrosis in CHB patients. The current study aims to elucidate whether patients with concomitant MASLD are at higher risk of significant fibrosis in patients with CHB.
This retrospective research of two tertiary hospitals comprised 1818 patients between 2009 and 2021 with CHB and hepatic steatosis who had not received antiviral therapy. Pathologic findings by liver biopsy were contrasted between CHB group (n = 844) and CHB + MASLD (n = 974) group. METAVIR values of F≥2 were used to categorize significant fibrosis.
Patients with CHB + MASLD had more significant fibrosis (35.5 % vs. 23.5 %, p < 0.001) than CHB group. The presence of MASLD [adjusted odds ratio (aOR) 2.055, 95 % confidence interval (CI) 1.635-2.584; p < 0.001] was strongly associated with significant fibrosis in all CHB patients. There was a trend for patients with more cardiometabolic risk factors (CMRFs) to have a higher prevalence of significant fibrosis: (25.7 % in CMRF1 subgroup v.s. 34.9 % in CMRF2 subgroup v.s. 53.7 % in CMRF≥ 3 subgroup, p < 0.001). Patients with CMRF≥3 had a three-fold higher significant fibrosis than those with just one CMRF.
MASLD was associated with higher fibrosis stage in patients with CHB. Early detection and intervention are crucial to patients with three or more cardiometabolic risk factors.
显著纤维化是慢性乙型肝炎（CHB）和代谢功能障碍相关脂肪性肝病（MASLD）临床干预的指标。关于活检确诊的MASLD对CHB患者显著纤维化的临床影响，目前的数据仍然匮乏。本研究旨在阐明合并MASLD的患者在CHB患者中发生显著纤维化的风险是否更高。
这项对两家三级医院的回顾性研究纳入了2009年至2021年间1818例未接受抗病毒治疗的CHB合并肝脂肪变性患者。对比了CHB组（n = 844）和CHB + MASLD组（n = 974）肝活检的病理结果。采用METAVIR F≥2值对显著纤维化进行分类。
CHB + MASLD患者的显著纤维化发生率高于CHB组（35.5%对23.5%，p < 0.001）。MASLD的存在[调整优势比（aOR）2.055，95%置信区间（CI）1.635 - 2.584；p < 0.001]与所有CHB患者的显著纤维化密切相关。合并更多心脏代谢危险因素（CMRFs）的患者有显著纤维化患病率更高的趋势：（CMRF1亚组为25.7%，CMRF2亚组为34.9%，CMRF≥3亚组为53.7%，p < 0.001）。CMRF≥3的患者发生显著纤维化的几率是仅有一个CMRF患者的三倍。
MASLD与CHB患者更高的纤维化分期相关。对有三个或更多心脏代谢危险因素的患者进行早期检测和干预至关重要。
