{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T22:37:17Z","timestamp":1792103837320,"version":"4.4.0"},"reference-count":44,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["No. 82305067"],"award-info":[{"award-number":["No. 82305067"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Guiding Project of the Science and Technology Department of Fujian Province","award":["2023D018"],"award-info":[{"award-number":["2023D018"]}]},{"name":"Seventh Batch of National Academic Experience Inheritance Projects for Senior Traditional Chinese Medicine Experts"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The disease burden of metabolic dysfunction\u2013associated fatty liver disease (MAFLD, non-alcoholic) combined with hepatitis B virus (HBV) infection is rising. Hepatic inflammation is a common pathway in liver disease progression, and evaluating its risk factors has clinical significance. In the context of concomitant MAFLD and HBV infection, hepatic inflammation may represent a key pathological pathway driving disease progression, making the assessment of liver inflammation crucial for controlling disease advancement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify independent risk factors for significant hepatic inflammation (grade \u2265 2) in patients with MAFLD (non-alcoholic) combined with HBV infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study included 447 treatment-na\u00efve patients with metabolic dysfunction\u2013associated fatty liver disease (non-alcoholic) and chronic hepatitis B who were diagnosed at Xiamen Hospital of Traditional Chinese Medicine between 2018 and 2024. Patients were stratified by body mass index (BMI) as normal weight (BMI\u00a0&lt;\u00a025\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ;\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0= 168), overweight (25 \u2264 BMI \u2264 30 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ;\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0= 234), and obese (BMI\u00a0&gt;\u00a030 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ;\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0= 45) to compare inflammatory differences across BMI categories. Liver biopsy was used as the histological reference standard, and multivariable logistic regression was performed to further identify the independent risk factors for significant hepatic inflammation (grade \u2265 2).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline characteristics revealed statistically significant differences among BMI groups in controlled attenuation parameter (CAP), liver stiffness measurement (LSM), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), uric acid (UA), glucose (GLU), hepatitis B surface antigen (HBsAg), hepatitis B e-antigen (HBeAg) positivity rate, and non-invasive indices APRI, GPR, and AAGP (all\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.05). A correlation was observed between BMI groups and hepatic inflammation grading (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.05), persisting even after dichotomizing inflammation grades into G1 versus G2\u20134 (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.05). Multivariate logistic regression analysis demonstrated that BMI (OR = 1.12, 95% CI [1.01\u20131.26]), LSM (OR = 1.34, 95% CI [1.17\u20131.53]), ALT (OR = 1.01, 95% CI [1.01\u20131.02]), and HBV DNA (OR = 1.32, 95% CI [1.16\u20131.51]) were independent risk factors for significant hepatic inflammation (G \u2265 2) (all\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This clinical study was conducted based on histopathological findings and demonstrated that BMI, LSM, and HBV DNA are independent risk factors for the progression of hepatic inflammation in patients with MAFLD and HBV infection, whereas ALT served as an independent non-invasive predictor of this outcome. These findings provide a novel non-invasive approach for clinicians to assess the degree of hepatic inflammation when liver biopsy results are unavailable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.21186","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T08:33:55Z","timestamp":1778056435000},"page":"e21186","source":"Crossref","is-referenced-by-count":1,"title":["Retrospective analysis of predictors for significant hepatic inflammation in metabolic-associated fatty liver disease with chronic hepatitis B"],"prefix":"10.7717","volume":"14","author":[{"given":"Long Hao","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Hepatology, Xiamen TCM Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Xiamen, Fujian Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Run Yan","family":"He","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Xiamen TCM Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Xiamen, Fujian Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan Neng","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Xiamen Humanity Hospital, Xiamen, Fujian Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heng Hong","family":"Lin","sequence":"additional","affiliation":[{"name":"Heshan District Health Service Center, Xiamen, Fujian Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia En","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Xiamen TCM Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Xiamen, Fujian Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua Xiao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Xiamen TCM Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Xiamen, Fujian Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue Ting","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Xiamen TCM Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Xiamen, Fujian Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao Lu","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Xiamen TCM Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Xiamen, Fujian Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bao Hui","family":"Pei","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Xiamen TCM Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Xiamen, Fujian Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Liver Disease, 5th Medical Center of Chinese PLA General Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Xiamen TCM Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Xiamen, Fujian Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4443","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"10.7717\/peerj.21186\/ref-1","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1016\/S2468-1253(22)00050-4","article-title":"Worldwide prevalence of hepatitis B virus and hepatitis C virus among patients with cirrhosis at country, region, and global levels: a systematic review","volume":"7","author":"Alberts","year":"2022","journal-title":"The Lancet. 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