To investigate the clinical and pathological features of HBeAg-positive patients with chronic hepatitis B (CHB) complicated with nonalcoholic fatty liver disease (NAFLD).

Total of 360 patients were collected from February 2013 to December 2017 in Beijing Youan Hospital, Capital Medical University, including 108 patients with chronic HBV infection, 120 patients with NAFLD and 132 patients with NAFLD and HBeAg-positive chronic hepatitis B. Liver biopsy was performed for all the patients, and the samples were detected for HBsAg and HBcAg, stained with HE. Lipid degeneration and fibrosis of liver tissue were observed under optical microscope. The serological indicators and pathological features of each group were compared.

Compared with CHI patients, the levels of ALT in patients with NAFLD and HBeAg (+) CHB and NAFLD increased significantly, with significant differences (all P < 0.05). Compared with CHI patients and the patients with NAFLD, the levels of AST and uric acid in patients with HBeAg (+) CHB and NAFLD were significantly elevated, with significant differences (all P < 0.05). Compared with patients with NAFLD, the level of triglyceride (TG) in patients with HBeAg (+) CHB and NAFLD was significantly decreased, the degree of liver fibrosis was significantly increased. Creatinine levels gradually increased in patients with CHI, patients with NAFLD and patients with HBeAg (+) CHB and NAFLD, with significant difference (P < 0.05). There was significant differences in the proportion of hyperuricemia between patients of every two groups (P < 0.05). Compared with CHI patients and patients with NAFLD, the proportion of male patients with high uric acid hematic disease in HBeAg (+) CHB and NAFLD group was significantly high (P < 0.05).

The incidence of inflammation and fibrosis is elevated in patients with HBeAg (+) CHB and NAFLD, which suggested that the presence of NAFLD may have a synergistic effect with the progression of CHB.