The Application Value Of ROS,Adiponectin And TNF-α In Patients With CHB Complicated With NAFLD

ObjectiveIn patients with NAFLD,CHB and CHB complicated with NAFLD,compare the differences of ROS,adiponectin and TNF-αlevel in different liver pathological groups,and explore the indicators or formulas that can distinguish the etiology of hepatitis in patients with chronic HBV infection complicated with NAFLD.MethodsWe collected the information of all inpatients with NAFLD,CHB,and CHB complicated with NAFLD diagnosed by histopathology in our hospital from June2016 to December 2018.According to the inclusion criteria and exclusion criteria,a total of 159 patients(21cases,57cases,81cases)were enrolled.Patients were divided into 2 groups according to inflammatory activity G and NAS(G≥2 was active HBV infection,G<2 was inactive HBV infection;NAS≥4 was NASH,NAS<4 was NAFL):NASH group included simple NASH,inactive HBV infection complicated with NASH and active HBV infection complicated with NASH,a total of 35cases;non-NASH group included active HBV infection complicated with NAFL and inactive HBV infection complicated with NAFL,a total of 66 cases.Serum ROS,adiponectin and TNF-αlevels were tested by ELISA.Compared the differences in clinical indicators between NASH group and non-NASH group,and a logistic regression formula related to NASH was obtained,and compared the differences of ROS,adiponectin and TNF-αlevel in different degrees of steatosis and fibrosis groups.Results1.Serum ROS level in patients with NAFLD was higher than that in patients with a history of hepatitis b infection(P<0.05).Adiponectin levels in men were lower than in women,and those with a history of diabetes were lower than those without diabetes(all P<0.05).2.Serum ROS level in patients with NASH was significantly higher than that in inactive HBV infection patients and active HBV infection complicated with NAFL patients(all P<0.05).People with NASH has a lower adiponectin level than HBV active patients(P<0.05);adiponectin level in NASH with active HBV infection patients was lower than that in inactive HBV infection patients and active HBV infection patients;adiponectin in patients with active HBV infection was higher than that in patients with active HBV infection complicated with NAFL(all P<0.05).3.The proportion of females in NASH group was higher than that in non-NASH group,and the proportion of hepatitis b infection history in NASH group was lower than that in non-NASH group(all P<0.05).NASH group presented higher ROS、CAP、E、UA、CHO、TG、WBC、NEUT、LYMPH and PLT level as compared with the non-NASH group(all P<0.05),while MPV、AFP and CA199 in NASH group were significantly lower than those in non-NASH group(all P<0.05).4.NASH inflammation related regression equation was Y=0.02*CAP+0.584* WBC+0.587*ROS-10.982,and the overall prediction accuracy was 81.2%,cut-off value was-1.313,the AUC was 0.896,sensitivity and specificity were 97.1%and71.2%respectively,positive and negative predictive value were 64.2%and 97.9%,respectively.5.Serum ROS level in patients with NAFLD was higher than that in patients with CHB and CHB complicated with NAFLD patients(all P<0.05).Serum adiponectin and TNF-αlevel in CHB complicated with NAFLD patients was lower than that in CHB patients(all P<0.05).6.In patients with CHB complicated with NAFLD,serum ROS level in mild steatosis group was lower than that in moderate and severe steatosis group,but adiponectin level was higher than that in moderate and severe steatosis group(all P<0.05).There was a positive correlation between ROS and the degree of steatosis(r_s=0.318,P<0.05),adiponectin was negatively correlated with the degree of steatosis(r_s=-0.342,P<0.05).Adiponectin was negatively correlated with hepatocyte ballooning in patients with NALFD(r_s=-0.437,P<0.05).7.In patients with CHB complicated with NAFLD,TNF-αlevel in significant fibrosis group was higher than that in non-significant fibrosis group(P<0.05).and TNF-αwas positively correlated with the degree of fibrosis(r_s=0.240,P<0.05).Conclusions1.ROS is an indicator of inflammation in patients with NASH.Adiponectin was associated with gender and history of diabetes.2.The formula Y=0.02*CAP+0.584*WBC+0.587*ROS-10.982 can be used for screening of NASH.When Y>-1.313,it should suggest that liver inflammation in patients with chronic HBV infection complicated with NAFLD was mainly caused by NASH.3.The increase of ROS and decrease of adiponectin are of great significance in predicting the occurrence of NAFLD and the degree of steatosis in CHB complicated with NAFLD patients.ROS and adiponectin can not be used to assess liver fibrosis.4.TNF-αcan be used to assess the degree of fibrosis in patients with CHB complicated with NAFLD,but it can not be used to assess the degree of liver inflammation and steatosis.