Background

Concomitant chronic hepatitis B infection (CHB) and non-alcoholic fatty liver disease (NAFLD) is common, but the implications of NAFLD on clinical outcomes of CHB, including hepatocellular carcinoma (HCC), are not well-investigated.

Methods

CHB patients were recruited for transient elastography assessment for liver stiffness (LS), and controlled attenuation parameter (CAP), a non-invasive quantification of hepatic steatosis, and were prospectively followed up for development of HCC. Steatosis and severe steatosis were diagnosed by CAP ≥ 248 dB/m and ≥ 280 dB/m respectively, and advanced fibrosis/cirrhosis was diagnosed by LS ≥ 9 kPa. The independent effect of hepatic steatosis on HCC was examined via propensity score matching (PSM) of LS and other significant clinical variables.

Results

Forty-eight patients developed HCC among 2403 CHB patients (55.6% male, median age 55.6 years, 57.1% antiviral-treated, median ALT 26 U/L) during a median follow-up of 46.4 months. Multivariate Cox regression analysis showed age (HR 1.063), male (HR 2.032), Albumin-Bilirubin score (HR 2.393) and CAP (HR 0.993) were associated with HCC development. The cumulative probability of HCC was 2.88%, 1.56% and 0.71%, respectively for patients with no steatosis, mild-to-moderate steatosis, and severe steatosis, respectively (p = 0.01). The risk of HCC increased from 1.56 to 8.89% in patients without severe steatosis if advanced fibrosis/cirrhosis was present (p < 0.001). PSM yielded 957 pairs of CHB patients and hepatic steatosis was independently associated with HCC (HR 0.41).

Conclusion

Reduced hepatic steatosis was significantly associated with a higher risk of incident HCC in CHB infection. Routine CAP and LS measurements are important for risk stratification.

中文翻译：

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肝脂肪变性减少与慢性乙型肝炎感染中肝细胞癌的风险增加有关

背景

伴随的慢性乙型肝炎感染 (CHB) 和非酒精性脂肪性肝病 (NAFLD) 很常见，但 NAFLD 对 CHB 临床结果的影响，包括肝细胞癌 (HCC)，尚未得到充分研究。

方法

招募 CHB 患者进行肝脏硬度 (LS) 和受控衰减参数 (CAP) 的瞬时弹性成像评估，这是一种肝脂肪变性的非侵入性量化，并前瞻性地随访 HCC 的发展。CAP≥248dB/m和≥280dB/m分别诊断为脂肪变性和重度脂肪变性，LS≥9kPa诊断为晚期纤维化/肝硬化。通过 LS 和其他重要临床变量的倾向评分匹配 (PSM) 检查肝脂肪变性对 HCC 的独立影响。

结果

在 46.4 个月的中位随访期间，2403 名 CHB 患者（55.6% 男性，中位年龄 55.6 岁，57.1% 接受抗病毒治疗，中位 ALT 26 U/L）中有 48 名患者发展为 HCC。多变量 Cox 回归分析显示年龄 (HR 1.063)、男性 (HR 2.032)、白蛋白-胆红素评分 (HR 2.393) 和 CAP (HR 0.993) 与 HCC 发展相关。对于无脂肪变性、轻度至中度脂肪变性和重度脂肪变性的患者，HCC 的累积概率分别为 2.88%、1.56% 和 0.71%（p  = 0.01）。如果存在晚期纤维化/肝硬化，没有严重脂肪变性的患者发生 HCC 的风险从 1.56% 增加到 8.89% ( p  < 0.001)。PSM 产生了 957 对 CHB 患者，肝脂肪变性与 HCC 独立相关（HR 0.41）。

结论

肝脂肪变性减少与 CHB 感染中发生 HCC 的风险较高显着相关。常规 CAP 和 LS 测量对于风险分层很重要。