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The correlation between fatty liver disease and serum and histological viral parameters in patients with chronic hepatitis B

Objective 
To investigate the correlation between non-alcoholic fatty liver disease and serum and histological viral parameters in patients with chronic hepatitis B (CHB). 
 
 
Methods 
Clinical and laboratory data from patients with CHB who received liver biopsy from 2009 to 2015 were collected. Patients were divided into steatosis and non-steatosis groups based on the presence of steatosis in liver biopsies. Propensity score matching (PSM) was conducted to adjust the confounding bias including age, sex, body mass index (BMI), total cholesterol (TC) and triglyceride (TG). Correlation of liver fatty and viral parameters was compared between steatosis and non-steatosis groups. Student t test, χ2 test, rank sum test and Pearson correlation test were employed to analyze the data. 
 
 
Results 
A total of 874 patients with a mean age of (37.0±10.1) years were enrolled in the study, with 690 males and 184 females, and 270 (30.9%) patients were diagnosed with steatosis by liver biopsy. Age, gender, BMI, TC and TG were significantly different between the two groups before PSM (all P 0.05). Serum hepatitis B virus (HBV) DNA, hepatitis B surface antigen (HBsAg) level, proportion of hepatitis B e antigen (HBeAg) positivity, HBsAg and hepatitis B core antigen (HBcAg) immunohistological staining in liver tissue were not significantly different between steatosis and non-steatosis groups after PSM (all P>0.05). Patients in steatosis group were stratified into two groups according to the degree of steatosis confirmed by liver biopsies: mild steatosis group (F1) and medium to severe steatosis group (F2-F4). The serum alanine aminotransferase (ALT), HBV DNA, HBsAg level, proportion of HBeAg positivity, immunohistological HBsAg and HBcAg staining in liver tissue between those two groups showed no differences (all P>0.05). The mean rank of liver inflammation and fibrosis in F1 group were 129.9 and 128.2, respectively, which were both significantly higher than those in F2-F4 group (105.9 and 108.5, respectively; both P<0.05). Steatosis was negatively correlated with either inflammatory grade (r=-0.183, P=0.005) or fibrosis stage (r=-0.150, P =0.020). 
 
 
Conclusions 
There is no correlation between serum viral factors and hepatic steatosis. Hepatic steatosis is not associated with the expressions of HBsAg and HBcAg in liver tissue. The severity of steatosis is negatively correlated with both liver inflammation and fibrosis. 
 
 
Key words: 
Hepatitis B, chronic; Fatty liver; Liver biopsy; Propensity score matching