Lisa M van Velsen, Lesley A Patmore, Jordan J Feld, Henry L Y Chan, Teerha Piratvisuth, Rong-Nan Chien, Edo J Dongelmans, Vedran Pavlovic, Leland J Yee, Willem Pieter Brouwer, Audrey Lau, Bettina E Hansen, Maria Buti, Qing Xie, Keyur Patel, Scott K Fung, Harry L A Janssen, Milan J Sonneveld
{"title":"慢性乙型肝炎患者代谢合并症与纤维化严重程度和纤维化消退的关系","authors":"Lisa M van Velsen, Lesley A Patmore, Jordan J Feld, Henry L Y Chan, Teerha Piratvisuth, Rong-Nan Chien, Edo J Dongelmans, Vedran Pavlovic, Leland J Yee, Willem Pieter Brouwer, Audrey Lau, Bettina E Hansen, Maria Buti, Qing Xie, Keyur Patel, Scott K Fung, Harry L A Janssen, Milan J Sonneveld","doi":"10.1016/j.cgh.2025.04.024","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>The presence of metabolic comorbidities is associated with a higher risk of liver-related events in chronic hepatitis B (CHB) patients. However, the association between presence of metabolic comorbidities and the severity of biopsy-proven liver fibrosis is yet unknown.</p><p><strong>Methods: </strong>Data from CHB patients from 2 tertiary clinics and 8 clinical trials was analyzed. We studied the association between presence of metabolic comorbidities with severity of liver fibrosis in untreated patients, and with fibrosis regression or progression in biopsies taken after initiation of antiviral therapy.</p><p><strong>Results: </strong>We analyzed biopsies from 3179 untreated CHB patients. Median age was 37 years, 57.6% were hepatitis B e antigen positive, with median hepatitis B virus DNA of 7.30 logIU/mL. Overweight (29.4% vs 19.0%; P < .001), hypertension (40.7% vs 23.2%; P < .001), diabetes (42.2% vs 23.6%; P < .001), and dyslipidemia (42.9 vs 23.6%; P < .001) were associated with a higher risk of advanced fibrosis, with the highest risk observed in patients with multiple comorbidities. Findings were consistent in multivariable analysis (1 comorbidity: adjusted odds ratio [aOR], 1.115; ≥2 comorbidities: aOR, 1.627; P = .006). Regression to nonadvanced fibrosis, after treatment initiation, was more often observed in patients without metabolic comorbidities (43.1%), compared with patients with 1 (31.6%) or ≥2 comorbidities (17.0%) (P = .005). Findings were consistent in multivariable analysis (1 comorbidity: aOR, 0.792; ≥2 comorbidities: aOR, 0.260; P = .025). The risk of progression to advanced fibrosis was highest in patients with ≥2 comorbidities (14.3% vs 4.6%; P = .001).</p><p><strong>Conclusions: </strong>Presence of metabolic comorbidities in untreated CHB patients is associated with more severe liver fibrosis and, after initiation of antiviral therapy, with less fibrosis regression and a higher risk of fibrosis progression.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6000,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association of Metabolic Comorbidities With Fibrosis Severity and Fibrosis Regression in Patients With Chronic Hepatitis B.\",\"authors\":\"Lisa M van Velsen, Lesley A Patmore, Jordan J Feld, Henry L Y Chan, Teerha Piratvisuth, Rong-Nan Chien, Edo J Dongelmans, Vedran Pavlovic, Leland J Yee, Willem Pieter Brouwer, Audrey Lau, Bettina E Hansen, Maria Buti, Qing Xie, Keyur Patel, Scott K Fung, Harry L A Janssen, Milan J Sonneveld\",\"doi\":\"10.1016/j.cgh.2025.04.024\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>The presence of metabolic comorbidities is associated with a higher risk of liver-related events in chronic hepatitis B (CHB) patients. However, the association between presence of metabolic comorbidities and the severity of biopsy-proven liver fibrosis is yet unknown.</p><p><strong>Methods: </strong>Data from CHB patients from 2 tertiary clinics and 8 clinical trials was analyzed. We studied the association between presence of metabolic comorbidities with severity of liver fibrosis in untreated patients, and with fibrosis regression or progression in biopsies taken after initiation of antiviral therapy.</p><p><strong>Results: </strong>We analyzed biopsies from 3179 untreated CHB patients. Median age was 37 years, 57.6% were hepatitis B e antigen positive, with median hepatitis B virus DNA of 7.30 logIU/mL. Overweight (29.4% vs 19.0%; P < .001), hypertension (40.7% vs 23.2%; P < .001), diabetes (42.2% vs 23.6%; P < .001), and dyslipidemia (42.9 vs 23.6%; P < .001) were associated with a higher risk of advanced fibrosis, with the highest risk observed in patients with multiple comorbidities. Findings were consistent in multivariable analysis (1 comorbidity: adjusted odds ratio [aOR], 1.115; ≥2 comorbidities: aOR, 1.627; P = .006). Regression to nonadvanced fibrosis, after treatment initiation, was more often observed in patients without metabolic comorbidities (43.1%), compared with patients with 1 (31.6%) or ≥2 comorbidities (17.0%) (P = .005). Findings were consistent in multivariable analysis (1 comorbidity: aOR, 0.792; ≥2 comorbidities: aOR, 0.260; P = .025). The risk of progression to advanced fibrosis was highest in patients with ≥2 comorbidities (14.3% vs 4.6%; P = .001).</p><p><strong>Conclusions: </strong>Presence of metabolic comorbidities in untreated CHB patients is associated with more severe liver fibrosis and, after initiation of antiviral therapy, with less fibrosis regression and a higher risk of fibrosis progression.</p>\",\"PeriodicalId\":10347,\"journal\":{\"name\":\"Clinical Gastroenterology and Hepatology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":11.6000,\"publicationDate\":\"2025-05-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Gastroenterology and Hepatology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.cgh.2025.04.024\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Gastroenterology and Hepatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cgh.2025.04.024","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Association of Metabolic Comorbidities With Fibrosis Severity and Fibrosis Regression in Patients With Chronic Hepatitis B.
Background and aims: The presence of metabolic comorbidities is associated with a higher risk of liver-related events in chronic hepatitis B (CHB) patients. However, the association between presence of metabolic comorbidities and the severity of biopsy-proven liver fibrosis is yet unknown.
Methods: Data from CHB patients from 2 tertiary clinics and 8 clinical trials was analyzed. We studied the association between presence of metabolic comorbidities with severity of liver fibrosis in untreated patients, and with fibrosis regression or progression in biopsies taken after initiation of antiviral therapy.
Results: We analyzed biopsies from 3179 untreated CHB patients. Median age was 37 years, 57.6% were hepatitis B e antigen positive, with median hepatitis B virus DNA of 7.30 logIU/mL. Overweight (29.4% vs 19.0%; P < .001), hypertension (40.7% vs 23.2%; P < .001), diabetes (42.2% vs 23.6%; P < .001), and dyslipidemia (42.9 vs 23.6%; P < .001) were associated with a higher risk of advanced fibrosis, with the highest risk observed in patients with multiple comorbidities. Findings were consistent in multivariable analysis (1 comorbidity: adjusted odds ratio [aOR], 1.115; ≥2 comorbidities: aOR, 1.627; P = .006). Regression to nonadvanced fibrosis, after treatment initiation, was more often observed in patients without metabolic comorbidities (43.1%), compared with patients with 1 (31.6%) or ≥2 comorbidities (17.0%) (P = .005). Findings were consistent in multivariable analysis (1 comorbidity: aOR, 0.792; ≥2 comorbidities: aOR, 0.260; P = .025). The risk of progression to advanced fibrosis was highest in patients with ≥2 comorbidities (14.3% vs 4.6%; P = .001).
Conclusions: Presence of metabolic comorbidities in untreated CHB patients is associated with more severe liver fibrosis and, after initiation of antiviral therapy, with less fibrosis regression and a higher risk of fibrosis progression.
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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