Abstract: Objective To explore the relationship between non-alcoholic fatty liver disease (NAFLD) and the development of hepatocellular carcinoma (HCC) in patients with previous chronic hepatitis B virus (HBV) infection.Methods A retrospective study was conducted on 104 patients with HBV-related HCC who were admitted from February 2023 to February 2024 as the observation group. Among them, 23 were previously infected with HBV (HBsAg negative, anti HBc positive), and 81 were currently infected (HBsAg positive, anti HBc positive). Another 100 non-HCC chronic hepatitis B patients who received treatment during the same period of time were selected as the control group. The general information about the research subjects were collected by flipping through medical records. The clinical characteristics of the observation group and the control group, as well as the past and current HBV infections were compared. The influencing factors of HCC in HBV infected individuals through univariate and multivariate analysis were analyzed, and the relationship between NAFLD and HCC by adjusting for confounding factors were further analyzed.Results Compared with the control group, the proportion of males in the observation group (78.43% vs 63.00%), family history of liver cirrhosis (14.71% vs 6.00%), family history of liver cancer (12.75% vs 3.00%), NAFLD (20.59% vs 9.00%), liver cirrhosis (32.35% vs 15.00%), and AFP>400 ng/mL (40.20% vs 18.00%) were higher, and the average age was older [(57.96±10.43) years vs (52.14±9.86) years, all P<0.05]. Multivariate analysis showed that gender, age, family history of liver cancer, NAFLD, cirrhosis, and AFP>400 ng/mL were all influencing factors for the occurrence of HBV-related HCC (OR=2.250, 1.047, 2.586, 1.064, 2.016, 1.730, all P<0.05). Among HCC patients, compared with the current infection group, the average age of the former infection group was higher [(59.20± 9.44) years vs (53.70±10.60) years], the family history of liver cancer (38.10% vs 6.17%), diabetes (33.33% vs 12.35%), hypertension (42.86% vs 24.69%), and NAFLD (38.10% vs 16.05%) were higher (P<0.05). The patients in the HBV infection group were taken as the reference objects, and the multifactor analysis after adjusting for age, diabetes and hypertension factors showed that NAFLD was an independent imaging factor for HCC in patients with previous HBV infection (OR=1.643,95%CI: 1.301-2.818, P<0.05).Conclusion The occurrence of HBV -related HCC is associated with multiple factors such as gender, age, family history of liver cancer, NAFLD, etc. Compared to current HBV infections, patients with HBV infection related HCC have a higher incidence of NAFLD, and NAFLD may be an important risk factor for the occurrence of HCC in HBV infected individuals.

Key words: Non alcoholic fatty liver disease, Hepatitis B virus, Hepatocellular carcinoma, Hepatitis B surface antigen