Yang Bingqing, Yang Tianyuan, Hou Chenxue, Li Yue, Wang Qi
Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China.
Laboratory Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Virol J. 2025 May 27;22(1):164. doi: 10.1186/s12985-025-02703-z.
This study aims to explore the effects of various hepatic steatosis conditions on histological outcomes in patients with significant inflammation and fibrosis in chronic hepatitis B (CHB) and analyze their impact on HBV virological suppression outcomes and biochemical improvement.
This retrospective study included 219 chronic hepatitis B (CHB) patients receiving nucleos(t)ide analogues therapy. Each of these patients underwent two liver biopsies. Patients were categorized into four groups based on hepatic steatosis status: sustained non-hepatic steatosis (n = 118), new-onset hepatic steatosis (n = 33), sustained hepatic steatosis (n = 37), and disappeared hepatic steatosis (n = 31). We compared the liver biochemical parameters and histological changes before and after treatment. Logistic regression analysis was performed to evaluate characteristics associated with the improvement of significant liver inflammation (G ≥ 2), significant fibrosis (S ≥ 2), and the persistence of hepatic steatosis.
After treatment, the sustained non-steatosis group exhibited the highest rate of improvement in baseline significant inflammation (75.31%), while the sustained steatosis group had the lowest (42.31%, p = 0.008). The sustained steatosis group also had the highest rate of inflammation progression (15.38%, p = 0.020) and was identified as a risk factor for inadequate baseline inflammation improvement (p = 0.006, OR = 0.244, 95% CI 0.090-0.665). In terms of baseline significant liver fibrosis improvement, the sustained non-hepatic steatosis group showed the highest improvement rate (67.14%), while the sustained hepatic steatosis group had the lowest (28.00%, p = 0.006). The new-onset steatosis group had the highest rate of liver fibrosis progression (15.00%, p = 0.027), and sustained hepatic steatosis was a risk factor for poor baseline fibrosis improvement (p = 0.001, OR = 0.180, 95% CI 0.064-0.507). Furthermore, the sustained hepatic steatosis group showed the smallest decrease in liver enzyme markers ALT, GGT, and ALP post-treatment, with reductions of 22.11% (p = 0.023), 13.86% (p = 0.003), and 1.98% (p = 0.025), respectively. Logistic regression analysis revealed that high baseline BMI and LDL-C levels were significantly associated with persistent fatty liver, with high BMI (p = 0.042, OR = 1.109, 95% CI 1.004-1.226) and high LDL-C (p < 0.001, OR = 2.570, 95% CI 1.524-4.332).
In CHB patients with significant inflammation and fibrosis, the persistence of hepatic steatosis during antiviral treatment may impede the improvement of inflammation and fibrosis, leading to disease progression and biochemical abnormalities.
本研究旨在探讨各种肝脂肪变性情况对慢性乙型肝炎（CHB）中存在显著炎症和纤维化患者组织学结果的影响，并分析其对乙肝病毒学抑制结果和生化改善的影响。
这项回顾性研究纳入了219例接受核苷（酸）类似物治疗的慢性乙型肝炎（CHB）患者。这些患者均接受了两次肝活检。根据肝脂肪变性状态将患者分为四组：持续非肝脂肪变性组（n = 118）、新发肝脂肪变性组（n = 33）、持续肝脂肪变性组（n = 37）和消失的肝脂肪变性组（n = 31）。我们比较了治疗前后的肝脏生化参数和组织学变化。进行逻辑回归分析以评估与显著肝脏炎症（G≥2）改善、显著纤维化（S≥2）改善及肝脂肪变性持续存在相关的特征。
治疗后，持续非脂肪变性组基线显著炎症改善率最高（75.31%），而持续脂肪变性组最低（42.31%，p = 0.008）。持续脂肪变性组炎症进展率也最高（15.38%，p = 0.020），并被确定为基线炎症改善不足的危险因素（p = 0.006，OR = 0.244，95%CI 0.090 - 0.665）。就基线显著肝纤维化改善而言，持续非肝脂肪变性组改善率最高（67.14%），而持续肝脂肪变性组最低（28.00%，p = 0.006）。新发脂肪变性组肝纤维化进展率最高（15.00%，p = 0.027），持续肝脂肪变性是基线纤维化改善不佳的危险因素（p = 0.001，OR = 0.180，95%CI 0.064 - 0.507）。此外，持续肝脂肪变性组治疗后肝酶标志物ALT、GGT和ALP下降幅度最小，分别下降22.11%（p = 0.023）、13.86%（p = 0.003）和1.98%（p = 0.025）。逻辑回归分析显示，高基线BMI和LDL - C水平与持续性脂肪肝显著相关，高BMI（p = 0.042，OR = 1.109，95%CI 1.004 - 1.226）和高LDL - C（p < 0.001，OR = 2.570，95%CI 1.524 - 4.332）。
在有显著炎症和纤维化的CHB患者中，抗病毒治疗期间肝脂肪变性的持续存在可能会阻碍炎症和纤维化的改善，导致疾病进展和生化异常。
