Prevalence And Risk Factors Of Non-alcoholic Fatty Iver Disease In Chronic Hepatitis B Patients With Anti-viral Treatment

Objective Chronic hepatitis B(CHB)and non-alcoholic fatty liver disease(NAFLD)are two of the most common liver diseases in China.More and more CHB patients are concurrent with NAFLD.Previous study showed that concurrent NAFLD in CHB patients were associated with higher HCC risk.The prevalence of NAFLD in hepatitis B virus infected patients without anti-viral treatment has been studied in a few studies.However,little is known about NAFLD in CHB patients with anti-viral therapy.We aimed to investigate the prevalence and risk factors of NAFLD in patients with anti-viral treatment.Methods This was a cross-sectional study.During May 2014 and December 2017,3477 CHB patients on anti-viral therapy were recruited in this study.After excluding significant alcohol consumption and other secondary causes of fatty liver,NAFLD was defined by abdominal ultrasonography.Our study aimed to investigate the prevalence of NAFLD.Logistic regression model analysis was conducted to explore risk factors of NAFLD.Besides age and sex,diabetes mellitus,hypertension,central obesity,triglycerides,high-density lipoprotein cholesterol,uric acid,anti-viral duration,cirrhosis,heptatitis B surface antigen(HBsAg),and HBV DNA were put into logistic regression model.Results Among 3477 CHB patients on anti-viral therapy,the prevalence of NAFLD was 24.1%.Compared to non-NAFLD patients,patients with NAFLD had higher body mass index(BMI),waist circumstance,hip circumstance,systolic and diastolic blood pressure,fasting plasma glucose,triglycerides,total cholesterol,low-density lipoprotein cholesterol,and uric acid.The difference between the two groups are significant(P<0.001).Besides,the prevalence of hypertension,diabetes mellitus,metabolic syndrome and proportions of its components were also significant higher in NAFLD patients(P<0.001).High-density lipoprotein cholesterol level and the proportion of cirrhosis were lower in patients with NAFLD than those without(P<0.001).The median duration of anti-viral therapy in NAFLD group was longer than that in non-NAFLD group(P<0.001).In Logistic multivariate analysis,after adjusting for age and sex,central obesity,hypertension,and triglyceride were risk factors of NAFLD.The odds ratios(ORs)and 95%confidential intervals(CI)were 6.676(5.400～8.253),1.468(1.133～1.902),1.513(1.314～1.742).Central obesity increasesd the risk of NAFLD by 5.676 times.While high-density lipoprotein cholesterol(OR:0.390,95%CI:0.277～0.547)and imaging cirrhosis(OR:0.427,95%CI:0.340～0.538)were associated with lower risk of NAFLD.Anti-viral duration(OR:1.045,95%CI:1.007-1.084)was another factor associated with higher risk of NAFLD.Dividing patients into three subgroups,non-cirrhotic subgroup,Model for End-Stage Disease(MELD)score lower than 10 points subgroup and MELD score higher than 10 points subgroup,we found that triglyceride,total cholesterol,low-density lipoprotein cholesterol,and high-density lipoprotein cholesterol were significantly different in the three subgroups.With the progression of liver disease,triglyceride,total cholesterol,and low-density lipoprotein cholesterol decreased gradually,while high-density lipoprotein cholesterol increased.Conclusions It’s not uncommon CHB patients on anti-viral therapy suffered from NAFLD.Central obesity,hypertension,and hypertriglyceridemia were risk factors of NAFLD.While high-density lipoprotein cholesterol and cirrhosis were associated with lower risk of NAFLD.It’s indicated that anti-viral duration was independently associated with NAFLD.