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Influence of weight management on the prognosis of steatohepatitis in chronic hepatitis B patients during antiviral treatment |
Xiu-Juan Chang a , # , Yi-Wen Shi b , # , Jing Wang c , Hua-Bao Liu d , Yan Chen a , Xiao-Ning Zhu c , Yong-Ping Chen e , Zu-Jiang Yu f , Qing-Hua Shang g , Lin Tan h , Qin Li i , Li Jiang j , Guang-Ming Xiao k , Liang Chen l , Wei Lu m , Xiao-Yu Hu n , Qing-Hua Long o , Lin-Jing An a , Zi-Yuan Zou b , Vincent Wai-Sun Wong p , ∗, Yong-Ping Yang a , ∗, Jian-Gao Fan b , ∗ |
a Department of Liver Disease, Chinese PLA General Hospital, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
b Center for Fatty Liver, Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai 200092, China
c Department of Liver Disease, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 610072, China
d Department of Liver Diseases, Traditional Chinese Medicine Hospital of Chongqing, Chongqing 400038, China
e Department of Infectious and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
f Department of Infectious Disease, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
g Center of Therapeutic Liver Disease, the 960th Hospital of Chinese PLA, Taian 271000, China
h Liver Disease Department, Fuyang 2nd People’s Hospital, Fuyang 236015, China
i Department of Liver Diseases, Fuzhou Infectious Diseases Hospital, Fuzhou 350025, China
j Department of Infectious Diseases, Southwest Hospital, Army Military Medical University, Chongqing 400038, China
k Department of Infectious Diseases, Guangzhou 8th People’s Hospital, Guangzhou 510060, China
l Department of Hepatic Diseases, Shanghai Public Health Clinical Center, Shanghai 201508, China
m Department of Liver Diseases, Tianjin Second People’s Hospital, Tianjin Institute of Hepatology, Tianjin 300192, China
n National Integrative Medicine Clinical Base for Infectious Diseases and Department of Infectious Diseases, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610000, China,
o Department of Infection and Liver Disease, Yichun People’s Hospital, Yichun 336028, China
p Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
∗ Corresponding authors.
E-mail addresses: wongv@cuhk.edu.hk (V.W.-S. Wong), yongpingyang@hotmail.com (Y.-P. Yang), fanjiangao@xinhuamed.com.cn (J.-G. Fan).
# Contributed equally. |
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Abstract Background: Although concomitant nonalcoholic steatohepatitis (NASH) is common in chronic hepatitis B (CHB), the impact of viral factors on NASH and the outcome of CHB patients concomitant with NASH remain unclear. We aimed to investigate the outcomes of NASH in CHB patients receiving antiviral treat- ment.
Methods: In the post-hoc analysis of a multicenter trial, naïve CHB patients receiving 72-week entecavir treatment were enrolled. We evaluated the biochemical, viral and histopathological responses of these patients. The histopathological features of NASH were also evaluated, using paired liver biopsies at base- line and week 72.
Results: A total of 10 0 0 CHB patients were finally enrolled for analysis, with 18.2% of whom fulfilling the criteria of NASH. A total of 727 patients completed entecavir antiviral treatment and received the second biopsy. Serum HBeAg loss, HBeAg seroconversion and HBV-DNA undetectable rates were similar between patients with or without NASH ( P > 0.05). Among patients with NASH, the hepatic steatosis, ballooning, lobular inflammation scores and fibrosis stages all improved during follow-up (all P < 0.001), 46% (63/136) achieved NASH resolution. Patients with baseline body mass index (BMI) ≥23 kg/m 2 (Asian criteria) [odds ratio (OR): 0.414; 95% confidence interval (95% CI): 0.190-0.899; P = 0.012] and weight gain (OR: 0.187; 95% CI: 0.050-0.693; P = 0.026) were less likely to have NASH resolution. Among patients without NASH at baseline, 22 (3.7%) developed NASH. Baseline BMI ≥23 kg/m 2 (OR: 12.506; 95% CI: 2.813-55.606; P = 0.001) and weight gain (OR: 5.126; 95% CI: 1.674-15.694; P = 0.005) were predictors of incident NASH.
Conclusions: Lower BMI and weight reduction but not virologic factors determine NASH resolution in CHB. The value of weight management in CHB patients during antiviral treatment deserves further evaluation.
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