Abstract
Objective To investigate the risk factors for hepatic steatosis in chronic hepatitis B (CHB), to determine its correlation with liver necroinflammation and fibrosis and response to peginterferon alpha-2a (PEG-IFNα-2a) antiviral therapy, and to explore the mechanisms underlying the poor antiviral effect of PEG-IFNα-2a in CHB patients with hepatic steatosis. Methods We analysed the impact of hepatic steatosis on the antiviral effect of PEG-IFNα-2a on CHB patients in a cohort of 226 patients who underwent pretherapeutic liver biopsy. To assess the complete response (CR), virological response (VR), and biochemical response (BR), the 226 patients were treated with PEG-IFNα-2a for 48 weeks and were followed-up for 24 weeks. The expressions of hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) in the liver tissue were detected in all patients to explore the possible mechanism of hepatic steatosis with regard to antiviral effects. Results The patients were divided into four groups based on the severity of hepatic steatosis: 119 with no steatosis, 76 with mild steatosis, 22 with moderate steatosis, and 9 with severe steatosis. In the hepatic steatosis groups, the proportions of male patients, patients aged >40 years, patients with hyperuricaemia, patients with a BMI > 23 kg/m2, and total cholesterol (TC), triglyceride (TG), glucose (GLU), and uric acid (UA) levels were significantly higher than those in the group without steatosis, whereas the alanine aminotransferase (ALT) and aspartate transaminase (AST) levels were significantly lower than those in the group without steatosis. The multivariate analysis results indicated that a BMI > 23 kg/m2 was independently associated with CHB patients with hepatic steatosis; the levels of baseline AST and UA were independently associated with CHB patients with significant hepatic steatosis, and the baseline AST level was independently associated with significant liver fibrosis. After 48 weeks of treatment and 24 weeks of follow-up, the rates of CR, VR, and BR had gradually decreased, whereas the severity of hepatic steatosis had increased. Conclusion Hepatic steatosis can reduce the efficacy of PEG-IFNα-2a in the treatment of CHB patients, and its mechanism may be related to the different HBcAg expression patterns in liver tissue.
Highlights
Chronic hepatitis B (CHB) and nonalcoholic fatty liver disease (NAFLD) are two major chronic liver diseases in China
All patients were defined as hepatitis B surface antigen (HBsAg)- and hepatitis B core antigen (HBcAg)-positive for at least 6 months, with baseline HBV DNA levels greater than 20,000 IU/mL, ALT levels elevated between 2 and 10 times the upper limit of normal (ULN), and hepatic histopathology results demonstrating steatosis
The patients were divided into four groups according to their degrees of hepatic steatosis
Summary
Chronic hepatitis B (CHB) and nonalcoholic fatty liver disease (NAFLD) are two major chronic liver diseases in China. As lifestyle and dietary structure have changed, the number of CHB patients with hepatic steatosis has increased. The incidence varies widely around the world, fluctuating between 27 and 51% [1, 2], with a median prevalence of 28%. A report of 1915 liver biopsy cases in China revealed that the incidence of hepatic steatosis in CHB patients was 14% [3]. Whether CHB with hepatic steatosis has an aggravating effect on the progression of liver disease is unknown
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