中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 42 Issue 6
Jun.  2026
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2026  >  42(6): 1279-1286

Impact of hepatic steatosis on viral load and hepatic fibrosis progression in chronic hepatitis B

DOI: 10.12449/JCH260608

  • Department of Infectious Disease （Liver Disease Center of Integrated Traditional Chinese and Western Medicine），The First Affiliated Hospital of Dalian Medical University，Dalian，Liaoning 116021，China

Research funding:

National Natural Science Foundation of China (82274260);

Liaoning Provincial Natural Science Foundation (2015020305)

More Information
  • Corresponding author: ZHU Ying， zhuyingsh52@126.com （ORCID： 0000-0002-9979-5063）
  • Received Date: 2025-12-11
  • Accepted Date: 2026-02-25
  • Published Date: 2026-06-25
    Abstract
  •   Objective  To investigate the association of hepatic steatosis with the level of viral replication and the progression of hepatic fibrosis in patients with chronic hepatitis B （CHB） through a real-world study， and to determine the independent influencing factors for hepatic fibrosis.  Methods  A total of 887 CHB patients who attended the outpatient service and inpatient ward of Hepatology in The First Affiliated Hospital of Dalian Medical University from July 2021 to March 2025 were enrolled as subjects， and according to the presence or absence of metabolic dysfunction-associated steatotic liver disease （MASLD）， they were divided into CHB group with 560 patients and CHB+MASLD group with 327 patients. The association between hepatic steatosis and HBV load in CHB patients was analyzed， as well as the impact of varying degrees of hepatic steatosis on hepatic fibrosis. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups； a Spearman correlation analysis was performed； a Logistic regression analysis was used to investigate influencing factors.  Results  The patients enrolled received antiviral therapy according to viral load； of all patients， 275 （31%） received nucleos（t）ide analogue combined with pegylated interferon-α， 532 （60%） received nucleos（t）ide analogue monotherapy， and 80 （9%） did not receive antiviral therapy. A total of 44 patients （5.0%） who were receiving PEG-IFN-α therapy and had marked thrombocytopenia were excluded， and finally 843 patients were included for comparison of aspartate aminotransferase-to-platelet ratio index （APRI） and fibrosis-4 index （FIB-4）. Compared with the CHB group， the CHB+MASLD group had a significantly higher proportion of male patients （χ2=5.917， P<0.05） and a significant increase in CAP value （t=21.646， P<0.05）. The median values of liver function parameters for the population enrolled were within the normal range， and no significant inflammatory activity was observed. The virological analysis showed that compared with the CHB group， the CHB+MASLD group had significantly lower serum level of pregenomic RNA （Z=-2.894， P<0.05） and HBeAg positivity rate （χ2=8.725， P<0.05）， and CAP was significantly negatively correlated with pgRNA （r=-0.117， P<0.05）. In the HBeAg-negative subgroup， compared with the CHB group， the CHB+MASLD group had a significantly lower level of hepatitis B surface antigen （Z=-0.765， P<0.05）； in the HBeAg-positive subgroup， the CHB+MASLD group had a significantly higher level of HBV DNA than the CHB group （Z=-2.509， P<0.05）. The analysis of hepatic fibrosis showed that the CHB+MASLD group had significantly lower values of APRI （Z=-3.418， P<0.05） and FIB-4 （Z=-6.237， P<0.05）. Compared with the CHB group， the CHB+MASLD S1 group had a significantly higher proportion of patients without fibrosis and a significantly lower proportion patients with liver cirrhosis （χ2=7.935， P<0.05）； in the CHB+MASLD S2 group， there was no significant difference in the proportion of patients with different fibrosis stages； the CHB+MASLD S3 group had a significantly lower proportion of patients without fibrosis and a significantly higher proportion of patients with early-stage fibrosis （χ2=9.101， P<0.05）. The Logistic regression analysis showed that an increase in CAP （odds ratio ［OR］=1.08， 95% confidence interval ［CI］： 1.03 — 1.13， P<0.05）， an increase in age （OR=1.02， 95%CI： 1.01 — 1.04， P<0.05）， male sex （OR=1.77， 95%CI： 1.19 — 2.64， P<0.05）， an increase in HBV DNA （OR=1.35， 95%CI： 1.15 — 1.57， P<0.001）， an increase in aspartate aminotransferase （OR=1.02， 95%CI： 1.01 — 1.03， P<0.001）， and an increase in gamma-glutamyl transpeptidase （OR=1.00， 95%CI： 1.00 — 1.01， P=0.028） were independent influencing factors for hepatic fibrosis. The risk of hepatic fibrosis in S3 patients was higher than that in patients without steatosis （OR=5.05， 95%CI： 2.48 — 10.29， P<0.001）.  Conclusion  There is a lower level of HBV replication in CHB patients comorbid with MASLD. Hepatic steatosis is associated with HBV-related virological markers and the progression of hepatic fibrosis， and severe fatty liver disease may promote the progression of hepatic fibrosis in CHB patients.

     

    • FullText(HTML)
  • loading
    • References(23)
  • [1]
    BURKI T. WHO’s 2024 global hepatitis report[J]. Lancet Infect Dis, 2024, 24( 6): e362- e363. DOI: 10.1016/S1473-3099(24)00307-4.
    [2]
    Author Group of Expert Consensus. Chinese expert consensus on clinical practice of chronic hepatitis B functional(clinical) cure[J]. Chin J Hepatol, 2025, 33( 10): 977- 987. DOI: 10.3760/cma.j.cn501113-20250723-00286.

    专家共识编写组. 中国慢性乙型肝炎功能性(临床)治愈临床实践专家共识[J]. 中华肝脏病杂志, 2025, 33( 10): 977- 987. DOI: 10.3760/cma.j.cn501113-20250723-00286.
    [3]
    CHEN H, HUANG FM, LIN J, et al. Expression of serum pgRNA in patients with chronic HBV infection and its significance[J]. Chin J Nosocomiol, 2022, 32( 6): 880- 884. DOI: 10.11816/cn.ni.2022-216351.

    陈红, 黄富敏, 琳杰, 等. 慢性HBV感染患者血清pgRNA的表达及意义[J]. 中华医院感染学杂志, 2022, 32( 6): 880- 884. DOI: 10.11816/cn.ni.2022-216351.
    [4]
    ZHENG Q, ZOU BY, WU YK, et al. Systematic review with meta-analysis: Prevalence of hepatic steatosis, fibrosis and associated factors in chronic hepatitis B[J]. Aliment Pharmacol Ther, 2021, 54( 9): 1100- 1109. DOI: 10.1111/apt.16595.
    [5]
    HUANG SC, KAO JH. Metabolic dysfunction-associated fatty liver disease and chronic hepatitis B[J]. J Formos Med Assoc, 2022, 121( 11): 2148- 2151. DOI: 10.1016/j.jfma.2022.07.013.
    [6]
    WANG J, LIU JC, LIU YL, et al. Clinical features of chronic hepatitis B patients with lean nonalcoholic fatty liver disease[J]. Hepatol Res, 2023, 53( 3): 184- 195. DOI: 10.1111/hepr.13854.
    [7]
    YOU H, WANG FS, LI TS, et al. Guidelines for the prevention and treatment of chronic hepatitis B(version 2022)[J]. J Clin Transl Hepatol, 2023, 11( 6): 1425- 1442. DOI: 10.14218/JCTH.2023.00320.
    [8]
    YOUNOSSI ZM, ZELBER-SAGI S, LAZARUS JV, et al. Global consensus recommendations for metabolic dysfunction-associated steatotic liver disease and steatohepatitis[J]. Gastroenterology, 2025, 169( 5): 1017- 1032.e2. DOI: 10.1053/j.gastro.2025.02.044.
    [9]
    Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the prevention and treatment of metabolic dysfunction-associated(non-alcoholic) fatty liver disease(version 2024)[J]. J Prac Hepatol, 2024, 27( 4): 494- 510. DOI: 10.3760/cma.j.cn501113-20240327-00163.

    中华医学会肝病学分会. 代谢相关(非酒精性)脂肪性肝病防治指南(2024年版)[J]. 实用肝脏病杂志, 2024, 27( 4): 494- 510. DOI: 10.3760/cma.j.cn501113-20240327-00163.
    [10]
    Chinese Society of Ultrasound in Medicine, Chinese Portal Hypertension Alliance(CHESS). Chinese expert consensus on the diagnosis of cirrhotic portal hypertension by ultrasound elastography(2023 version)[J]. Natl Med J China, 2023, 103( 32): 2480- 2494. DOI: 10.3760/cma.j.cn112137-20230513-00782.

    中华医学会超声医学分会, 中国门静脉高压联盟(CHESS). 中国超声弹性成像技术诊断肝硬化门静脉高压专家共识(2023版)[J]. 中华医学杂志, 2023, 103( 32): 2480- 2494. DOI: 10.3760/cma.j.cn112137-20230513-00782.
    [11]
    ZHANG N, LI CH, ZHAO RJ, et al. Research progress on CD8+T cell dysfunction in chronic hepatitis B virus infection[J]. Chin J Cell Mol Immunol, 2025, 41( 5): 456- 460. DOI: 10.13423/j.cnki.cjcmi.009977.

    张楠, 李传海, 赵荣洁, 等. 慢性HBV感染中CD8+T细胞功能障碍研究进展[J]. 细胞与分子免疫学杂志, 2025, 41( 5): 456- 460. DOI: 10.13423/j.cnki.cjcmi.009977.
    [12]
    ZHANG SS, MAK LY, YUEN MF, et al. Mechanisms of hepatocellular carcinoma and cirrhosis development in concurrent steatotic liver disease and chronic hepatitis B[J]. Clin Mol Hepatol, 2025, 31( Suppl): S182- S195. DOI: 10.3350/cmh.2024.0837.
    [13]
    ZHANG RN, PAN Q, ZHANG Z, et al. Saturated fatty acid inhibits viral replication in chronic hepatitis B virus infection with nonalcoholic fatty liver disease by Toll-like receptor 4-mediated innate immune response[J]. Hepat Mon, 2015, 15( 5): e27909. DOI: 10.5812/hepatmon.15(5)2015.27909.
    [14]
    HUANG SC, SU TH, TSENG TC, et al. Metabolic dysfunction-associated steatotic liver disease facilitates hepatitis B surface antigen seroclearance and seroconversion[J]. Clin Gastroenterol Hepatol, 2024, 22( 3): 581- 590.e6. DOI: 10.1016/j.cgh.2023.09.040.
    [15]
    MAK LY, HUI RW, FUNG J, et al. Diverse effects of hepatic steatosis on fibrosis progression and functional cure in virologically quiescent chronic hepatitis B[J]. J Hepatol, 2020, 73( 4): 800- 806. DOI: 10.1016/j.jhep.2020.05.040.
    [16]
    MAJEED AA, BUTT AS. Hepatitis B virus infection and metabolic dysfunction associated steatotic liver disease: Rising pandemic with complex interaction[J]. World J Hepatol, 2025, 17( 1): 100968. DOI: 10.4254/wjh.v17.i1.100968.
    [17]
    ZHANG JB, LIN SZ, JIANG DX, et al. Chronic hepatitis B and non-alcoholic fatty liver disease: Conspirators or competitors?[J]. Liver Int, 2020, 40( 3): 496- 508. DOI: 10.1111/liv.14369.
    [18]
    ZHANG JX, LING N, LEI Y, et al. Multifaceted interaction between hepatitis B virus infection and lipid metabolism in hepatocytes: A potential target of antiviral therapy for chronic hepatitis B[J]. Front Microbiol, 2021, 12: 636897. DOI: 10.3389/fmicb.2021.636897.
    [19]
    KO HH, PATEL NH, HAYLOCK-JACOBS S, et al. Severe hepatic steatosis is associated with low-level viremia and advanced fibrosis in patients with chronic hepatitis B in North America[J]. Gastro Hep Adv, 2022, 1( 1): 106- 116. DOI: 10.1016/j.gastha.2021.09.005.
    [20]
    LIU J, MA Y, HAN P, et al. Hepatic steatosis leads to overestimation of liver stiffness measurement in both chronic hepatitis B and metabolic-associated fatty liver disease patients[J]. Clin Res Hepatol Gastroenterol, 2022, 46( 8): 101957. DOI: 10.1016/j.clinre.2022.101957.
    [21]
    European Association for the Study of the Liver. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis-2021 update[J]. J Hepatol, 2021, 75( 3): 659- 689. DOI: 10.1016/j.jhep.2021.05.025.
    [22]
    LIGUORI A, ZONCAPÈ M, CASAZZA G, et al. Staging liver fibrosis and cirrhosis using non-invasive tests in people with chronic hepatitis B to inform WHO 2024 guidelines: A systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2025, 10( 4): 332- 349. DOI: 10.1016/S2468-1253(24)00437-0.
    [23]
    HUANG SC, LIU CJ. Chronic hepatitis B with concurrent metabolic dysfunction-associated fatty liver disease: Challenges and perspectives[J]. Clin Mol Hepatol, 2023, 29( 2): 320- 331. DOI: 10.3350/cmh.2022.0422.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Tables(5)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (48) PDF downloads(20) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return