Abstract
ObjectiveTo investigate the effects of non-alcoholic fatty liver disease on aminotransferase (ALT) levels and transient elastography in patients with chronic hepatitis B (CHB).MethodsA cross-sectional study of 230 patients with CHB and ALT levels up to two times the upper limits of normal, of one-year duration, from June 2018 to May 2019. The demographic, clinical, and laboratory characteristics of each patient were collected. Transient elastography was performed to evaluate controlled attenuation parameter (CAP or steatosis) and liver stiffness (fibrosis).ResultsA total of 161 (70%) patients were overweight, with over two-thirds (166; 72.2%) having elevated ALT >35 U/L. Three-fourths of the patients (178; 77.4%) had a hepatitis B virus (HBV) deoxyribonucleic (DNA) level of less than 2000 IU/ml. Steatosis was detected in 166 (72.2%) patients while fibrosis of F2 or more in 88 (38.3%). Multivariate regression analysis showed that weight, homeostatic model assessment of insulin resistance (HOMA-IR), and elevated ALT levels of more than 35 were independently associated with higher CAP values (p= 0.019, 0.001, and 0.004, respectively). Age, insulin levels, and platelet counts were independently associated with liver elasticity (p=0.00, 0.002, and 0.028, respectively). HBV DNA levels did not show any significant association with CAP score, liver stiffness, and HOMA-IR or ALT level. Among those with an elevated ALT of 35 or above (n=166), 124 patients had HBV DNA levels less than 2000 IU/ml. Out of these, 97 (78.2%) patients had steatosis and 51 (41.1%) had F2 or more fibrosis.ConclusionA significant number of patients with CHB with mildly elevated ALT levels are overweight, have significant steatosis and fibrosis, but low HBV DNA levels. This aspect is important while making decisions regarding hepatitis B treatment.
Highlights
Chronic hepatitis B (CHB) and nonalcoholic fatty liver disease (NAFLD) are two of the most prevalent liver diseases worldwide
Multivariate regression analysis showed that weight, homeostatic model assessment of insulin resistance (HOMA-IR), and elevated alanine transaminase (ALT) levels of more than 35 were independently associated with higher CAP values (p= 0.019, 0.001, and 0.004, respectively)
hepatitis B virus (HBV) DNA levels did not show any significant association with CAP score, liver stiffness, and HOMA-IR or ALT level
Summary
Chronic hepatitis B (CHB) and nonalcoholic fatty liver disease (NAFLD) are two of the most prevalent liver diseases worldwide. It is estimated that 25%-30% of CHB patients have a coexisting NAFLD [2,3]. Liver biopsy remains the gold standard to diagnose NAFLD, but it is invasive and should be considered in patients with NAFLD who are at increased risk of having steatohepatitis and/or advanced fibrosis [4]. More attention is being given to non-invasive imaging studies and markers for the assessment of NAFLD, including ultrasound, transient elastography, and so on. Vibration-controlled transient elastography is a noninvasive technique to assess hepatic fibrosis and steatosis, and it has been evaluated in patients with chronic hepatitis B and C and NAFLD [5]. Transient elastography utilizes proprietary algorithms based on the ultrasonic attenuation coefficient of vibrationcontrolled transient elastography, and the liver stiffness measurement (LSM) and CAP are calculated from the returning shear wave velocities, which correlate with hepatic fibrosis and steatosis, respectively [6]
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