Abstract: Objective To investigate of the clinical characteristics and prognosis of patients with chronic hepatitis C (CHC) complicated with metabolic associated fatty liver disease (MAFLD).Methods A total of 354 patients (173 males and 181 females) with CHC from January 2014 to February 2022 in our hospital were selected, with an age of 44 (35, 53) years. Patients with CHC were divided into simple CHC group and MAFLD group according to whether they were combined with MAFLD. Univariate and multivariate analyses were performed to identify independent predictors associated with the degree of liver fibrosis in CHC combined with MAFLD.Results There were 225 cases in CHC group and 129 cases in MAFLD group respectively, and the incidence of MAFLD was 36.4%. Comparing the clinical data of the 2 groups, the number of men in the simple CHC group was 122 (54.2%), which was significantly higher than that in the MAFLD group [51 cases (39.5%), P<0.05]; The body mass index (BMI), aspartate aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglyceride (TG), HbA1c and HOMA-IR ofn simple CHC group were significantly lower than those of MAFLD group [25 (22, 29) kg/m², 78 (44, 151) U/L, 54 (37, 152) U/L, 4.3 (3.7, 5.0) mmol, 0.9 (0.7, 1.3) mmol/L, 5.0 (4.8, 5.7) % and 1.7 (1.1, 3.1)] vs [27.5 (23, 32) kg/m², 91 (54, 168) U/L, 70 (44, 114) U/L, 4.5 (3.8, 5.4) mmol/L, 1.1 (0.8, 1.7) mmol/L, 5.5 (5.0, 6.3) % and 3.4 (1.8, 5.5), P<0.05]. Compared with simple CHC group [1.3 (1.1, 1.8) mmol/L], high density lipoprotein (HDL) in MAFLD group was significantly lower [1.1 (0.9, 1.5) mmol/L, P<0.05]. The rates of diabetes mellitus and progressive liver fibrosis in simple CHC group were 3 cases (1.3%) and 30 cases (13.3%), which were significantly lower than those in MAFLD group [11 cases (8.5%) and 43 cases (33.3%), P<0.05]. The logistic univariate regression analysis showed that age, gender, BMI, diabetes mellitus and MAFLD may influence the degree of hepatic fibrosis in CHC (all P values<0.05). The Forward LR method was used to include age, gender, BMI, diabetes mellitus and MAFLD in logistic multi-factor regression analysis, and the results showed that age and MAFLD were independent risk factors for the development of progressive liver fibrosis in CHC patients [OR=1.05 (95% CI: 1.03~1.07), 2.45 (95% CI: 1.64~3.77), respectively, P<0.001], men were the protective factors [OR=0.52 (95% CI: 0.26 ~ 0.78), P=0.007].Conclusion CHC patients with combined MAFLD have a more severe state of liver fibrosis, and age and MAFLD are independent risk factors for the development of progressive liver fibrosis in CHC patients, while men is a protective factors.

Key words: Chronic hepatitis C, Metabolic associated fatty liver disease, Hepatic fibrosis