Objectives: To investigate the prevalence and risk factors of hepatic steatosis in patients with biopsy-proven chronic hepatitis B (CHB).
Methods: One thousand nine hundred and fifteen patients with CHB who had liver biopsies seen between January 2005 and June 2007 in our department were reviewed. Patients co-infected with hepatitis C virus or HIV or suffering from liver diseases of other causes were not included. The prevalence of hepatic steatosis and its trend during the study period were determined, and the relationships among their hepatic steatosis with clinical data, serum biochemistry, HBV viral load, and the degree of liver inflammation and fibrosis stage were studied.
Results: The mean age of the patients was 30.7+/-9.5 years; 1,497 men and 418 women. Histological hepatic steatosis was present in 260 patients (13.6%), and the annual prevalence of steatosis increased with time (11.2% in 2005, 14.3% in 2006, and 17.9% in 2007). The prevalence of steatosis in male patients was significantly higher than that in female patients (15.2% vs. 7.7%, chi2 = 15.98, P less than 0.01). Body mass index (BMI), age, fasting plasma glucose (FPG) were all significantly higher in CHB patients with hepatic steatosis than in patients without steatosis (t values were 6.01, 3.60, 4.72 and 9.55, respectively, all P less than 0.01). The prevalence of overweight, obesity, diabetes, dyslipidemia and hyperuricemia were also significantly higher in patients with steatosis than those without it (chi2 values 17.00, 169.45, 6.12, 116.67 and 76.34, all P less than 0.05). Prevalence of hepatic steatosis was higher in patients with mild CHB (17.8%) than in chronic inactive HBsAg carriers (8.6%), patients with moderate CHB (9.4%) and with severe CHB (7.7%). Similarly, prevalence of steatosis was higher in patients with inflammation grade 1 (19.8%) and fibrosis stage 1 (19.1%) than in patients with inflammation grade 0 (10.3%), grade 2 (11.5%), grade 3 (9.3%) and grade 4 (7.3%), and in patients with fibrosis stage 0 (10.8%), stage 2 (13.3%), stage 3 (7.1%) and stage 4 (7.4%), respectively. No close relationship was found between hepatic steatosis and serum HBeAg status or HBV DNA titer in patients with CHB. Logistic regression analysis demonstrated that the presence of steatosis was positively correlated to BMI, serum triglyceride, apolipoprotein B, uric acid and FPG.
Conclusion: Hepatic steatosis is not uncommon in patients with CHB. It is associated with metabolic factors of the hosts and not related to the virus itself. It is also not related to the degrees of liver inflammation and fibrosis.