背景:肥胖慢性乙型肝炎(CHB)与非酒精性脂肪性肝病(NAFLD)患者的临床特征已得到很好的描述。然而,关于瘦肉CHB-NAFLD患者的临床特征知之甚少。
方法:该研究回顾性包括2015年至2021年接受超声检查的未治疗CHB患者。通过天冬氨酸转氨酶(AST)与血小板比值指数(APRI)评估肝纤维化,纤维化-4评分(FIB-4),NAFLD纤维化评分(NFS),和瞬时弹性成像。
结果:在1226例CHB-NAFLD患者中,25.0%患者为瘦。年龄,性别,和血小板,丙氨酸氨基转移酶,AST,和白蛋白水平是相当的精益CHB-NAFLD和非精益患者。血浆葡萄糖水平,甘油三酯,总胆固醇,和尿酸,以及并发高血压和糖尿病的比例,在瘦患者中更低。精益患者呈现较高的乙型肝炎表面抗原(HBsAg)水平(3.4log10IU/ml与3.2log10IU/ml,p=0.006),乙型肝炎病毒(HBV)DNA水平(4.1log10IU/ml与3.2log10IU/ml,p<0.001),和乙型肝炎e抗原(HBeAg)阳性比例(40.4%vs.30.2%,p=0.002)比非瘦患者。APRI的值,FIB-4和肝脏硬度在两组之间具有可比性。然而,瘦患者的NFS值较低(-3.0vs.-2.6,p<0.001)和较低的比例(12.6%与21.1%,p=0.003)比非瘦患者的晚期纤维化(NFS≥-1.5)。在HBeAg阳性和HBeAg阴性亚组中观察到类似的结果。
结论:近四分之一的CHB-NAFLD患者是瘦的。与非瘦患者相比,瘦患者的代谢异常和晚期肝纤维化比例较低。然而,精益CHB-NAFLD患者有较高的HBsAg水平,HBVDNA水平,和HBeAg阳性比例。登记处和登记号.研究/试验:Clinicaltrials.gov,标识符:NCT03097952。
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.