OBJECTIVES: Previous exposure to hepatitis B virus (HBV) may increase the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C. We aim to study the impact of previous HBV infection on the severity and outcomes of patients with nonalcoholic fatty liver disease (NAFLD). METHODS: This was a multicenter study of 489 patients with biopsy-proven NAFLD and 69 patients with NAFLD-related or cryptogenic HCC. Antihepatitis B core antibody (anti-HBc) was used to detect the previous HBV infection. RESULTS: In the biopsy cohort, positive anti-HBc was associated with lower steatosis grade but higher fibrosis stage. 18.8% and 7.5% of patients with positive and negative anti-HBc had cirrhosis, respectively (P < 0.001). The association between anti-HBc and cirrhosis remained significant after adjusting for age and metabolic factors (adjusted odds ratio 2.232; 95% confidence interval, 1.202–4.147). At a mean follow-up of 6.2 years, patients with positive anti-HBc had a higher incidence of HCC or cirrhotic complications (6.5% vs 2.2%; P = 0.039). Among patients with NAFLD-related or cryptogenic HCC, 73.9% had positive anti-HBc. None of the patients had positive serum HBV DNA. By contrast, antihepatitis B surface antibody did not correlate with histological severity. DISCUSSION: Positive anti-HBc is associated with cirrhosis and possibly HCC and cirrhotic complications in patients with NAFLD. Because a significant proportion of NAFLD-related HCC may develop in noncirrhotic patients, future studies should define the role of anti-HBc in selecting noncirrhotic patients with NAFLD for HCC surveillance. Correspondence: Vincent Wai-Sun Wong, MD. E-mail: wongv@cuhk.edu.hk. SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/B462 Received October 20, 2019 Accepted February 13, 2020 © The American College of Gastroenterology 2020. All Rights Reserved.

中文翻译：

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乙型肝炎核心抗体阳性与非酒精性脂肪肝疾病中的肝硬化和肝细胞癌有关。

目的：先前接触过乙型肝炎病毒（HBV）可能会增加慢性丙型肝炎患者发生肝细胞癌（HCC）的风险。我们旨在研究先前的乙肝病毒感染对非酒精性脂肪肝患者的严重程度和预后的影响（NAFLD）。方法：这是一项多中心研究，对489例经活检证实的NAFLD患者和69例NAFLD相关或隐源性HCC患者进行了研究。抗乙型肝炎核心抗体（抗HBc）用于检测以前的HBV感染。结果：在活检队列中，抗-HBc阳性与脂肪变性较低但纤维化阶段较高有关。抗-HBc阳性和阴性的肝硬化患者分别为18.8％和7.5％（P <0.001）。调整年龄和代谢因子后，抗-HBc与肝硬化之间的关联仍然很显着（校正比值比为2.232； 95％置信区间为1.202-4.147）。平均随访6.2年，抗HBc阳性的患者HCC或肝硬化并发症的发生率更高（6.5％比2.2％； P = 0.039）。在患有NAFLD相关或隐源性HCC的患者中，有73.9％的抗HBc阳性。没有患者的血清HBV DNA阳性。相反，抗乙型肝炎表面抗体与组织学严重程度无关。讨论：抗-HBc阳性与NAFLD患者的肝硬化，肝癌和肝硬化并发症有关。由于非肝硬化患者中可能会出现很大比例的与NAFLD相关的HCC，未来的研究应确定抗HBc在选择非肝硬化性NAFLD患者进行HCC监测中的作用。通讯：黄文新，医学博士。电子邮件：wongv@cuhk.edu.hk。这篇论文随附了补充材料，网址为http://links.lww.com/AJG/B462。2019年10月20日接收。2020年2月13日接收。©2020年美国胃肠病学学会。保留所有权利。