Frontiers in cellular and infection microbiology · 2026
Metabolic dysfunction-associated steatotic liver disease in chronic hepatitis B patients: risks of severe liver disease and cardiovascular disease.
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Zhang Ningxin, Xu Zhongwei, Lin Fei, Fan Haozhi, Zhou Dehong, Zheng Shiqiu, Jin Peng, Gu Huiquan, Yu Chengxiao, Jiang Longfeng
Аннотация
OBJECTIVE: To assess the association between comorbid Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and the risk of developing severe liver disease and cardiovascular disease (CVD) in patients with Chronic Hepatitis B (CHB).
METHODS: CHB Patients were continuously recruited from 2012 to 2022 using the electronic medical record system, and divided into CHB-no MASLD and CHB-MASLD groups. Follow-up continued until January 2024, aiming to compare differences of cumulative incidence between the two groups and to analyze associated risk factors.
RESULTS: 8,052 patients were included with a median follow-up of 3.9 years. Compared with CHB-no MASLD group, MASLD was independently associated with a 39% lower risk of severe liver disease (adjusted hazard ratio [aHR]=0.61, 95% confidence interval [CI] 0.49-0.76, p < 0.001), with similar effects in cirrhosis (aHR=0.61, 95% CI 0.45-0.82, p=0.001) and hepatocellular carcinoma (HCC) (aHR=0.57, 95% CI 0.41-0.80, p = 0.001). Stratified analyses indicated the protection effect was more significant in the HBsAg-positive group. Conversely, MASLD was associated with higher CVD risk (aHR=1.16, 95% CI 0.96-1.41, p=0.130), driven by coronary artery disease (aHR=1.91, 95% CI 1.34-2.74, p < 0.001) and arrhythmia (aHR=1.44, 95% CI 1.00-2.08, p=0.053). These findings remained consistent after propensity score matching (PSM).
CONCLUSION: MASLD may reduce the risk of severe liver disease through certain mechanisms, yet it also constitutes a risk factor for CVD, particularly among HBsAg-positive patients.
METHODS: CHB Patients were continuously recruited from 2012 to 2022 using the electronic medical record system, and divided into CHB-no MASLD and CHB-MASLD groups. Follow-up continued until January 2024, aiming to compare differences of cumulative incidence between the two groups and to analyze associated risk factors.
RESULTS: 8,052 patients were included with a median follow-up of 3.9 years. Compared with CHB-no MASLD group, MASLD was independently associated with a 39% lower risk of severe liver disease (adjusted hazard ratio [aHR]=0.61, 95% confidence interval [CI] 0.49-0.76, p < 0.001), with similar effects in cirrhosis (aHR=0.61, 95% CI 0.45-0.82, p=0.001) and hepatocellular carcinoma (HCC) (aHR=0.57, 95% CI 0.41-0.80, p = 0.001). Stratified analyses indicated the protection effect was more significant in the HBsAg-positive group. Conversely, MASLD was associated with higher CVD risk (aHR=1.16, 95% CI 0.96-1.41, p=0.130), driven by coronary artery disease (aHR=1.91, 95% CI 1.34-2.74, p < 0.001) and arrhythmia (aHR=1.44, 95% CI 1.00-2.08, p=0.053). These findings remained consistent after propensity score matching (PSM).
CONCLUSION: MASLD may reduce the risk of severe liver disease through certain mechanisms, yet it also constitutes a risk factor for CVD, particularly among HBsAg-positive patients.