MAFLD is Associated with the Risk of Liver Fibrosis and Inflammatory Activity in HBeAg-Negative CHB Patients

Abstract

Purpose

Chronic hepatitis B (CHB) and metabolic associated fatty liver disease (MAFLD) are both important public health problems. The effect of concomitant MAFLD on patients with CHB is still unclear. This study aimed to explore the influence of MAFLD on liver fibrosis and inflammation in CHB patients with different hepatitis B e antigen (HBeAg) status.

Patients and Methods

We retrospectively collected the clinical data of 399 treatment-naïve CHB patients who underwent liver biopsy. All patients were divided into two groups (HBeAg± group). Logistic regression analysis was used to identify factors associated with liver inflammatory activity and significant fibrosis in patients with CHB. Multivariable logistic regressions were repeated in subgroups stratified by HBeAg status.

Results

In patients with CHB, MAFLD was independently associated with a risk of moderate-to-severe liver activity and significant fibrosis (P <0.05). In the HBeAg-negative group, patients with MAFLD had significantly higher levels of alanine aminotransferase (ALT) (P <0.05) and more severe liver inflammatory activity and fibrosis (P <0.05) compared to those without MAFLD. MAFLD was independently associated with a risk of moderate-to-severe liver activity (A ≥3: OR 3.97, 95% CI 1.71–9.22, P =0.001) and significant fibrosis (F ≥2: OR 2.02, 95% CI 1.09–3.73, P =0.026). In the HBeAg-positive group, MAFLD was found to be independently associated with moderate-to-severe liver activity (OR 2.44, 95% CI 1.03–5.79, P =0.044) but not fibrosis (P =0.618).

Conclusion

MAFLD is associated with the risk of liver fibrosis and inflammatory activity in HBeAg-negative CHB patients. Sufficient attention should be paid to the prevention and treatment of MAFLD in patients with CHB, especially in HBeAg-negative patients.

Keywords:

• chronic hepatitis B
• metabolic associated fatty liver disease
• nonalcoholic fatty liver disease
• hepatitis B e antigen

Abbreviations

CHB, chronic hepatitis B; MAFLD, metabolic associated fatty liver disease; HBeAg, hepatitis B e antigen; HBV, chronic hepatitis B virus; WHO, the World Health Organization; NAFLD, nonalcoholic fatty liver disease; HCC, human hepatocellular carcinoma; BMI, Body mass index; AST, serum aspartate aminotransferase; ALT, alanine aminotransferase; ALP, alkaline phosphatase; GGT, gamma-glutamyl transpeptidase; TBA, total bile acid; CHE, cholinesterase, FBG, fasting blood glucose; TRIG, triacylglycerol; HDL-c, high-density lipoprotein cholesterol; LDL, low-density lipoprotein cholesterol; Cr, creatinine; UA, uric acid; NASH CRN, the Nonalcoholic Steatohepatitis Clinical Research Network; T2DM, type 2 diabetes mellitus; HBP, high blood pressure; HBsAg, HBV surface antigen; VIF, variance inflation factor; NASH, Nonalcoholic steatohepatitis; OR, odds ratio.

Data Sharing Statement

The data used to support the findings of this study have not been made available because no patient approval has been obtained.

Ethics Approval and Informed Consent

Studies were conducted in accordance with the Declaration of Helsinki. Ethical approval was given by the medical ethics committee of the Third Affiliated Hospital of Sun Yat-Sen University, and informed consent was waived because we used de-identified retrospective data (Approval number: zssy[2020]02-191-01).

Consent for Publication

All authors gave final approval of the version to be published and agreed to be listed as authors.

Acknowledgments

We acknowledge Yunting Zhang for her help in statistics. We also gratefully acknowledge our study group members for their work.

Author Contributions

Xiaoman Chen, study design, acquisition of data, analysis, drafted and written; Jing Zhou, study design, pathologic evaluation, analysis, drafted; Lili Wu, acquisition of data, analysis, drafted; Xiang Zhu, study design, analysis, reviewed and revised the draft; Hong Deng, study design, analysis, reviewed and revised the draft. All authors contributed to data analysis, drafting, or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

Dr Xiaoman Chen reports grants from the National Natural Science Foundation of China, during the conduct of the study. The authors declare that there are no conflicts of interest regarding the publication of this article.

Additional information

Funding

This work was supported by grants from the National Natural Science Foundation of China [grant number 81870597].