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目的:乙型肝炎表面抗原（HBsAg）清除并不能消除乙型肝炎病毒（HBV）感染患者的肝细胞癌（HCC）风险，本研究旨在探讨非酒精性脂肪性肝病（NAFLD）在HBV既往感染者（HBsAg阴性、抗-HBc阳性）HCC发生中的作用。方法:本研究是回顾性调查研究，纳入2015年至2017年在南方医院住院并首次诊断为HCC的患者共1 605例。将HBV现症感染（HBsAg阳性、抗-HBc阳性）基础上发生HCC的患者作为参照，采用多因素Logistic回归模型分析NAFLD与HBV既往感染者发生HCC之间的关系。结果:在HBsAg和抗-HCV均阴性的HCC患者中，HBV既往感染者占比达86.7%。与HBV现症感染基础上发生HCC的患者相比，HBV既往感染基础上发生HCC的患者NAFLD患病率更高（19.7%比8.5%，n P < 0.001）。校正性别、年龄、高血压、丙氨酸转氨酶、肝硬化后，HBV既往感染基础上发生HCC的患者更可能患有NAFLD（ n OR = 2.29，95% n CI：1.40~3.74）。且这种现象只在非肝硬化（n OR = 5.26，95% n CI：2.53~10.96）、年龄≥50岁（n OR = 2.36，95% n CI：1.33~4.20）的患者中存在。n 结论:NAFLD可能是HBV既往感染者发生HCC的危险因素，尤其是在非肝硬化、年龄≥50岁人群中。“,”Objective:To explore the role of nonalcoholic fatty liver disease (NAFLD) in the development of hepatocellular carcinoma (HCC) in patients with prior hepatitis B virus infection (HBsAg-negative and anti-HBC-positive).Methods:1605 hospitalized patients who were first diagnosed with HCC at Nanfang Hospital between 2015 to 2017 were retrospectively studied. Patients who developed HCC on the basis of active HBV infection (HBsAg-positive, anti-HBc positive) were used as control. Multivariate logistic regression model was used to analyze the relationship between NAFLD and HCC in patients with prior hepatitis B virus infection.Results:Among HCC patients with both HBsAg and anti-HCV negative, the proportion of prior HBV infection accounted for 86.7%. NAFLD prevalence was higher in patients with HCC based on prior HBV infection than active HBV infection (19.7% vs. 8.5%, n P < 0.001). After adjusting for gender, age, hypertension, alanine aminotransferase, and liver cirrhosis, patients with HCC based on prior HBV infection were more likely to develop NAFLD ( n OR: 2.29, 95% n CI: 1.40-3.74), and this phenomenon was observed only in patients with non-cirrhosis (n OR: 5.26, 95% n CI: 2.53-10.96) and aged≥50 years (OR: 2.36, 95% n CI: 1.33-4.20).n Conclusion:NAFLD may be a risk factor for HCC in a previously infected patients with HBV, especially in non-cirrhotic and population aged≥50 years.