Accompanying Fatty Liver Disease May Lead To Overestimation Of Liver Fibrosis By Liver Stiffness Measurement In Hepatitis B

Objective:The impact of hepatic steatosis on the diagnostic capability of LSM have not been completely investigated.Therefore,In this study we aimed to explore the association between existence of fatty liver disease(FLD)and the diagnostic performa-nce of LSM among hepatitis B patients in a single center in Tianjin,China.Methods:The study population consisted of outpatients and inpatients who infected with hepatitis B virus and underwent a TE examination at Tianjin Third Center Hospital,between Mar 2014 and Dec 2017.The medical records of patients,laborator-y data,ultrasound imaging were reviewed.The diagnosis of liver cirrhosis was based on comprehensive analysis of clinical diagnosis,laboratory data(blood routine,liver function),ultrasound and LSM score.All patients were divided into two groups depended on the existence of cirrhosis.The diagnosis of liver cirrhosis was based on comprehensive analysis of clinical diagnosis,laboratory data(blood routine,liver function),ultrasound and LSM score.Patients without cirrhosis were further grouping according to the combination of FLD exist,which detected by ultrasound.Mann-Whit-ney U test and X2 test were used to compare continuous or categorical variables.To assess the independent association of clinical parameters with LSM,we used univari-ate and multivariate linear regression analyses,collinearity diagnosis was made on liner regression model.Results:Overall,21%of subjects(200of 952)were categorized as cirrhosis group,79%(752 of 952)were categorized as non-cirrhosis group.Among the non-cirrhosis subjects,33%(246 of 752)were categorized as FLD group,67%(506 of 752)were categorized as non-FLD group.There were marked differences in BMI values,CAP score and LSM values between the FLD group and non-FLD group.BMI values(kg/m~2)was 27.34(25.22,28.68),23.74(20.59,25.76)in FLD group and non-FL D group,respectively(P<0.001).CAP score(dB/m)was 255.47(238.93,277.83),224.66(208.54,234.81)in FLD group and non-FLD group,respectively(P<0.001).The LSM values(kPa)were 7.54(6.56,8.54),6.39(5.32,7.00)in FLD group and non-FLD group,respectively(P<0.001).The subjects with FLD also had significantly higher serum hemoglobin,platelet,glutamic-pyruvic transaminase,mitochondrial aspartate aminotransferase,Glutamyl transpeptidase,alkaline phosphatase,albumin,glucose,total cholesterol,total triglyceride,blood urea nitrogen,creatinine,levels than those without.More male subjects were in FLD group than non-FLD group(71.6%vs 54%P<0.001).In Univariate linear regression analysis,sex(B=0.085,SE=0.492),CAP(B=0.215,SE=0.006),BMI(B=0.088,SE=0.062),Age(B=0.233,SE=0.019),ALB(B=-0.455,SE=0.054),TB(B=0.367,SE=0.023),GGT(B=0.346,SE=0.004),ALP(B=0.292,SE=0.007),ALT(B=0.217,SE=0.003),m-AST(B=0.280,SE=0.026),PW(B=0.242,SE=1.714),SPT(B=0.408,SE=0.284)were significantly associated with LSM.Multivariate linear regression analysis showed that higher CAP(B=0.098,P=0.006),age(B=0.120,P<0.001),lower albumin(B=-0.265,P<0.001),total bilirubin(B=0.112,P<0.001),Glutamyl transpeptidase(B=0.128,P<0.001),alkaline phosphatase(B=0.090,P=0.001),glutamic-pyruvic transaminase,(B=0.124,P=0.004),mitochondr-ial aspartate aminotransferase(B=0.275,P<0.001),width of portal(B=0.083,P=0.002),thickness of spleen(B=0.208,P<0.001)were positively related to LSM,sex and BMI were no significantly association with LSM.Conclusions:In conclusion,LSM in hepatitis B patients with fatty liver disease have higher LSM values which may lead to overestimation of fibrosis in patients.Interpre-ting LSM values is supposed to give a consideration to the simultaneous determinati-on of CAP,which could help to more accurately predict the hepatic fibrosis degree in hepatitis B patients with fatty liver disease.