Liver Fibrosis is Associated with NAFLD Activity Score in Chronic Hepatitis B Patients with Liver Steatosis

Background: Chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD) are two leading hepatic diseases that cause severe public health problems. The relationship between the severity of NAFLD and liver fibrosis in CHB patients remains controversial. Objectives: This study aimed at further clarifying the association between them. Methods: A total of 272 CHB patients and 31 NAFLD patients without CHB, who underwent liver biopsies and routine blood tests were included. The NAFLD activity scores (NAS) for NAFLD patients and the METAVIR scoring system for all the patients were used to evaluate the liver pathology. The associations between steatosis or NAS score and liver fibrosis were statistically analyzed. Results: METAVIR F0-4 was identified in 10.0%, 30.5%, 36.0%, 13.2%, and 10.3% of all the CHB patients, respectively. The prevalence of hepatic steatosis in CHB patients was 39.7% (n = 108). Among them, 26.9% (n = 29) of patients had NAS 5. The severity of fibrosis was not related to the degree of steatosis nor NAS score (P > 0.05) in NAFLD patients without CHB. Similarly, the results suggested that there was no significant difference in the severity of liver fibrosis in CHB patients with varying degrees of steatosis (P > 0.05). However, the severity of liver fibrosis increased with NAS score (P = 0.004) in CHB patients with NAFLD. Conclusions: The severity of liver fibrosis in CHB patients was associated with NAS score, yet not with fat content.