Association of adipokines with hepatic steatosis and fibrosis in chronic hepatitis B patients on long‐term nucleoside analogue

Abstract

Background & Aims: It is unknown how concomitant hepatic steatosis affects disease progression in chronic hepatitis B (CHB). Adipokines such as fibroblast growth factor 21 (FGF21) and adipocyte fatty acid‐binding protein (AFABP) have been associated with non‐alcoholic fatty liver disease. We determined the significance of these metabolic markers in CHB‐related liver injury.

Methods: We recruited CHB patients on antiviral treatment for transient elastography assessment to determine liver stiffness (advanced fibrosis/cirrhosis, F3/F4, defined by EASL‐ALEH criteria) and controlled attenuation parameter (hepatic steatosis, defined as ≥ 248 dB/m). Plasma FGF‐21, AFABP and adiponectin levels were measured.

Results: A total of 415 patients [mean age 59.6 years, 71.6% male, median treatment duration 6.2 years] were recruited. Patients with F3/F4 (N = 151) had lower FGF‐21 (11.7 vs 13.6 pg/mL, P = 0.055), higher AFABP (126.8 vs 84.1 pg/mL, P < 0.001) and HOMA‐IR (7.1 vs 5.1, P = 0.004) levels compared to those without F3/F4 (N = 264). Multivariate analysis showed that FGF‐21 level was associated with hepatic steatosis (OR 1.005, 95% CI 1.001‐1.009) and F3/F4 (OR 0.993, 95% CI 0.989‐0.998), while AFABP level (OR 1.001, 95% CI 1‐1.002), body mass index (BMI) (OR 1.107, 95% CI 1.037‐1.182) and presence of diabetes mellitus (OR 2.059, 95% CI 1.206‐3.516) were associated with F3/F4. With the combined presence of BMI ≥ 25 kg/m2, diabetes and AFABP > 105.9 pg/mL, the odds ratio for F3/F4 was 3.712 (95% CI 1.364‐10.105, P = 0.010).

Conclusions: Low FGF‐21 and high AFABP levels were associated with advanced fibrosis/cirrhosis in CHB patients on antiviral treatment. Plasma AFABP, together with other metabolic risk factors, may aid identification of patients lacking fibrosis improvement during antiviral treatment.