Risk Factors of Metabolic Dysfunction-associated Steatotic Liver Disease in a Cohort of Patients With Chronic Hepatitis B.

IF 12 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Maria Kalafateli, Roberta Forlano, Eleanor Barnes, Laura Martinez-Gili, Madeleine Lacey, Giordano Sigon, Benjamin H Mullish, Vincent Mallet, Lucia Parlati, Paul Richardson, Niamh Forde, Gaetano Serviddio, Rosanna Villani, Sabela Lens, Maria Buti, Elena Vargas, Mauro Viganò, Alessandro Loglio, Pietro Lampertico, Roberta D'ambrosio, Sara Monico, Gabriele Maffi, Rosa Lombardi, Anna Ludovica Fracanzani, Chiara De Luca, Patrick Ingiliz, Alessandra Mangia, Federica Leserre, Antonio Manuel Napolitano, Valeria Piazzolla, Francesco Paolo Russo, Giovanni Raimondo, Irene Cacciola, Carlo Saitta, Maud Lemoine, George Papatheodoridis, Margarita Papatheodoridi, Dimitrios N Samonakis, Denise O'Donnell, Jennifer O'Donoghue, Robin Daniel Abeles, Nicola Pugliese, Alessio Aghemo, Marina Berenguer, Ashley Brown, Mark R Thursz, Pinelopi Manousou
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引用次数: 0

Abstract

Background & aims: Chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) commonly co-exist, with conflicting data in prevalence and disease severity. We aimed to investigate these discrepancies.

Methods: This multicenter study included consecutive patients with CHB from 19 European centers. A survey on standard of care for MASLD screening in CHB was circulated.

Results: A total of 1709 patients with CHB were included; median age, 53 years (interquartile range [IQR], 42-64); males, 60.7%; body mass index (BMI), 25.6 kg/m2 (IQR, 14-63 kg/m2); and 57.3% White. MASLD prevalence (1510 consecutive patients) was 42.3%. BMI (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.19-1.36), ferritin (OR, 1.00; 95% CI, 1.00-1.00) and type 2 diabetes (OR, 2.60; 95% CI, 1.12-6.02) were independently associated with MASLD. The prevalence of advanced fibrosis was 18% (255/1420) in the whole cohort, 25.4% (162/639) among patients with CHB with MASLD, and 13.7% in those without MASLD. Independent predictors of advanced fibrosis were MASLD (OR, 2.76; 95% CI, 1.50-5.05), BMI (OR, 1.08; 95% CI, 1.02-1.15), alanine transaminase (OR, 1.01; 95% CI, 1.00-1.03), lower platelets (OR, 0.99; 95% CI, 0.98-0.99), insulin treatment (OR, 13.88; 95% CI, 2.95-65.28), and long-term antivirals (OR, 4.86; 95% CI, 2.40-9.85). During follow-up (48 months), only patients without MASLD showed significant liver stiffness measurement improvement over time (P < .001). Among patients with MASLD, Fibrosis-4 and liver stiffness measurement performed moderately at predicting advanced fibrosis (area under the receiver operating characteristic curve = 0.71 vs 0.70; P = .38) against histology. As standard of care, 68.4% of centers screened all patients with CHB for MASLD; 52.6% followed the same treatment indication in those with CHB and MASLD vs CHB only.

Conclusion: In this large European cohort, MASLD and fibrosis were highly prevalent among patients with CHB, whereas MASLD aggravated liver fibrosis. Though screening strategies remain inconsistent, ferritin levels, increased BMI, and type 2 diabetes may inform on the presence of MASLD. Biomarkers showed modest performance in predicting fibrosis.

慢性乙型肝炎患者代谢功能障碍相关脂肪变性肝病的危险因素
背景和目的:慢性乙型肝炎(CHB)和代谢功能障碍相关的脂肪变性肝病(MASLD)通常共存,在患病率和疾病严重程度方面的数据相互矛盾。我们的目的是调查这些差异。方法:这项多中心研究包括来自19个欧洲中心的连续慢性乙型肝炎患者。一份关于慢性乙型肝炎患者MASLD筛查护理标准的调查报告传阅。结果:纳入CHB患者1709例;中位年龄:53岁(42-64岁),男性60.7%,BMI 25.6(14-63),白人57.3%。MASLD患病率(1510例连续患者)为42.3%。BMI (OR=1.27, 95% CI:1.19-1.36)、铁蛋白(OR=1.00, 95% CI:1.00-1.00)和2型糖尿病(T2DM) (OR=2.60, 95% CI:1.12-6.02)与MASLD独立相关。在整个队列中,晚期纤维化的患病率为18% (255/1420),CHB合并MASLD的患病率为25.4%(162/639),无MASLD的患病率为13.7%。晚期纤维化的独立预测因子为MASLD (OR:2.76, 95%CI:1.50-5.05)、BMI (OR:1.08, 95%CI:1.02-1.15)、ALT (OR:1.01, 95%CI:1.00-1.03)、PLTs (OR:0.99, 95%CI:0.98-0.99)、胰岛素治疗(OR:13.88, 95%CI:2.95-65.28)和长期抗病毒药物(OR:4.86, 95%CI:2.40-9.85)。在随访期间(48个月),只有没有MASLD的患者随着时间的推移显示出显著的LSM改善(结论:在这个大型欧洲队列中,CHB患者中MASLD和纤维化非常普遍,而MASLD加重了肝纤维化。尽管筛查策略仍不一致,但铁蛋白水平、BMI和T2DM升高可能提示MASLD的存在。生物标志物在预测纤维化方面表现平平。
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来源期刊
CiteScore
16.90
自引率
4.80%
发文量
903
审稿时长
22 days
期刊介绍: Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.
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