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慢性乙型肝炎合并非酒精性脂肪性肝病的临床特征分析
Prevalence and clinical features of hepatic steatosis in patients with chronic hepatitis B
文章发布日期:2015年06月09日  来源:  作者:张志侨,王功遂,康凯夫,等  点击次数:1579次  下载次数:309次

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【摘要】:目的探讨慢性乙型肝炎(CHB)患者肝脏脂肪变性的流行现状和临床特征。方法回顾性分析2006年1月-2014年12月在广东省佛山市顺德区第一人民医院感染性疾病科住院治疗的1580例乙型肝炎患者的临床资料,对其临床及病理学指标进行比较分析。根据是否合并肝脏脂肪变性分为脂肪肝组(n=216)和非脂肪肝组(n=1364)。计量资料组间比较采用t检验,非正态分布时组间比较采用两独立样本非参数秩和检验(Mann-Whitney U)。计数资料采用χ2检验。两变量间相关性分析采用Spearman相关分析。结果肝脏脂肪变性发病率均随年龄增长而增加(P值均<0.001),发病高峰期均位于年龄≥45岁。在年龄<30岁和30~44岁的患者中,男性发病率高于女性,差异有统计学意义(P<0.05)。脂肪肝组和非脂肪肝组相比,脂肪肝组糖尿病、胆固醇异常、甘油三酯异常、低密度脂蛋白异常、尿酸异常和有饮酒史的患者数量明显升高,组间差异均有统计学意义(P值均<0.05)。两组在身体质量指数、GGT、白蛋白、尿素氮、肌酐、尿酸、血糖、总胆固醇、甘油三酯、低密度脂蛋白、载脂蛋白A、载脂蛋白B水平升高,而AST水平降低,两组间差异均有统计学意义(P值均<0.05)。两组间HBeAg差异无统计学意义(P>005);两组间HBV DNA差异有统计学意义(P<005)。脂肪肝组的炎症程度和纤维化程度较非脂肪肝组轻,两组间差异均有统计学意义(P值均<0.05)。非脂肪肝组患者更容易合并肝组织炎症≥3级和肝纤维化≥3期,两组间差异均有统计学意义(P值分别为0.001、0015)。结论脂肪肝组患者更容易合并糖脂代谢紊乱,其肝脏脂肪变性和HBeAg之间无明显相关关系,但可能和HBV DNA、炎症分级和纤维化分期之间存在一定程度的关联,有必要进一步研究以明确其内在联系。
【Abstract】:ObjectiveTo analyze the prevalence and clinical features of hepatic steatosis in patients with chronic hepatitis B. MethodsThe clinical data of patients with chronic hepatitis B who were hospitalized at the Department of Infectious Diseases, the First People′s Hospital of Shunde, Guangdong, China, from January 2006 to December 2014, were retrospectively collected for analysis and comparison of clinical and pathological indicators. The patients were divided into fatty liver group and non-fatty liver group depending on the presence or absence of fatty liver. Continuous data of the two groups were compared using the t test and categorical data were compared using the χ2 test. If data were not normally distributed, comparisons were made using the Mann-Whitney U test. ResultsThe incidence of fatty liver increased with age (P<0.05) and peaked at an age of ≥45 years in both groups. Fatty liver was more likely to occur in men than in women below 30 years and between 30 and 44 years (P<0.05). Diabetes, abnormal levels of cholesterol, triglycerides, low-density lipoprotein, and uric acid, and a history of alcohol consumption were significantly more frequent in the fatty liver group than in the non-fatty liver group (P<0.05). Levels of body mass index, gamma-glutamyl transpeptidase, albumin, blood urea nitrogen, creatinine, uric acid, glucose, total cholesterol, triglycerides, low-density lipoprotein, apolipoprotein A, apolipoprotein B, aspartate aminotransferase were significantly different between the two groups (P<0.05). Inflammation and fibrosis were significantly milder in the fatty liver group compared with the non-fatty liver group (P<0.05). Patients in the non-fatty liver group were more likely to be complicated by grade 3 liver inflammation and stage 3 fibrosis (P=0.001 and P=0.015). ConclusionFatty liver patients are more likely to present with glucose and lipid metabolism disorder. Hepatic steatosis is not significantly correlated with HBeAg, but may be somewhat associated with HBV DNA, inflammation grade and fibrosis stage. Further studies are needed to establish their connections.
【关键字】:肝炎,乙型,慢性;脂肪肝;炎症;纤维化;危险因素
【Key words】:hepatitis B, chronic; fatty liver; inflammation;fibrosis; risk factors
【引证本文】:

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