Clinical features of chronic hepatitis B patients with lean nonalcoholic fatty liver disease

Jian Wang; Jiacheng Liu; Yilin Liu; Ruifei Xue; Jie Zhan; Suling Jiang; Li Wang; Xiaomin Yan; Yali Xiong; Juan Xia; Shengxia Yin; Xin Tong; Yuxin Chen; Jie Li; Rui Huang; Chao Wu

doi:10.1111/hepr.13854

Clinical features of chronic hepatitis B patients with lean nonalcoholic fatty liver disease

Hepatol Res. 2023 Mar;53(3):184-195. doi: 10.1111/hepr.13854. Epub 2022 Nov 21.

Authors

Jian Wang^{1

2}, Jiacheng Liu^{1

3}, Yilin Liu³, Ruifei Xue⁴, Jie Zhan⁴, Suling Jiang⁴, Li Wang¹, Xiaomin Yan^{1

2}, Yali Xiong^{1

2}, Juan Xia^{1

2}, Shengxia Yin^{1

2}, Xin Tong^{1

2}, Yuxin Chen^{2

5}, Jie Li^{1

2

3}, Rui Huang^{1

2

3}, Chao Wu^{1

2

3}

Affiliations

¹ Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
² Institute of Viruses and Infectious Diseases, Nanjing University, Nanjing, China.
³ Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.
⁴ Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
⁵ Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.

PMID: 36317959
DOI: 10.1111/hepr.13854

Abstract

Background: The clinical features have been well described in obese chronic hepatitis B (CHB) patients with nonalcoholic fatty liver disease (NAFLD). However, little is known about the clinical features of lean CHB-NAFLD patients.

Methods: The study retrospectively included treatment-naïve CHB patients who underwent ultrasound between 2015 and 2021. Liver fibrosis was assessed by aspartate aminotransferase (AST) to platelet ratio index (APRI), Fibrosis-4 score (FIB-4), NAFLD fibrosis score (NFS), and transient elastography.

Results: Among 1226 CHB-NAFLD patients, 25.0% patients were lean. The age, gender, and platelet, alanine aminotransferase, AST, and albumin levels were comparable between lean CHB-NAFLD and nonlean patients. The levels of plasma glucose, triglycerides, total cholesterol, and uric acid, as well as proportions of concurrent hypertension and diabetes, were lower in lean patients. Lean patients presented higher hepatitis B surface antigen (HBsAg) levels (3.4 log₁₀ IU/ml vs. 3.2 log₁₀ IU/ml, p = 0.006), hepatitis B virus (HBV) DNA levels (4.1 log₁₀ IU/ml vs. 3.2 log₁₀ IU/ml, p < 0.001), and hepatitis B e antigen (HBeAg) positive proportions (40.4% vs. 30.2%, p = 0.002) than nonlean patients. The values of APRI, FIB-4, and liver stiffness were comparable between two groups. However, lean patients had lower NFS values (-3.0 vs. -2.6, p < 0.001) and lower proportions (12.6% vs. 21.1%, p = 0.003) of advanced fibrosis (NFS ≥ -1.5) than nonlean patients. Similar results were observed in HBeAg-positive and HBeAg-negative subgroups.

Conclusions: Nearly a quarter of CHB-NAFLD patients were lean. Lean patients had lower proportions of metabolic abnormalities and advanced liver fibrosis than nonlean patients. However, lean CHB-NAFLD patients had higher HBsAg levels, HBV DNA levels, and HBeAg-positive proportions. Registry and registration no. of the study/trial: Clinicaltrials.gov, Identifier: NCT03097952.

Keywords: chronic hepatitis B; lean; liver fibrosis; nonalcoholic fatty liver disease.

Associated data

ClinicalTrials.gov/NCT03097952

Abstract

Associated data

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