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慢性HBV/HCV感染合并轻度肝脂肪变的临床特点分析
Clinical features of chronic HBV/HCV infection complicated by mild hepatic steatosis
文章发布日期:2016年08月08日  来源:  作者:何 佳, 李 威, 李 宽, 等  点击次数:1549次  下载次数:267次

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【摘要】:目的比较初治慢性HBV/HCV感染合并轻度肝脂肪变患者的临床特点。方法收集2014年12月-2016年1月在郑州大学人民医院住院的初治慢性HBV/HCV感染者111例,全部患者经肝穿刺明确合并有轻度肝脂肪变,其中HBV感染者65例(HBV感染组),HCV感染者46例(HCV感染组)。比较两组患者的肝功能、血脂、血糖、肝脏硬度值(LSM)等临床指标变化。计量资料组间比较采用独立样本t检验或Wilcoxon秩和检验,计数资料组间比较采用χ2检验。结果两组患者LSM、AST、GGT、血浆Alb、TC、HDL-C、LDL-C、PLT比较,差异均有统计学意义(P值均<005)。将两组患者按照肝脏炎症分级和纤维化分期分为 G或S<2组(0、0~1、1、1~2),G或S≥2组(2、2~3、3~4、4)。 LSM在HBV感染组和HCV感染组不同肝脏炎症分级以及不同纤维化分期的组间比较,差异均有统计学意义[HBV感染组:640(530~770)vs 830(590~1130),Z=-2463,P=0014;670(530~780)vs 830(570~1130),Z=-2049,P=0040。HCV感染组:760(630~1150)vs 1750(1200~2670),Z=-3961,P<0001;760(590~1020)vs 1550(750~2150),Z=-3325,P=0001]。慢性HCV感染组患者中,TC在不同肝纤维化分期组间比较,差异有统计学意义(428±085 vs 382±068,t=2.045,P=0.047)。结论与初治慢性HBV合并轻度肝脂肪变比较,HCV感染合并轻度肝脂肪变的LSM、GGT、TC及LDL-C较高,Alb、PLT、AST及HDL-C较低。此外,肝脂肪变相关指标(BMI、GLU、脂肪衰减参数、血脂)与疾病的进展无正相关。
【Abstract】:ObjectiveTo investigate the clinical features of previously untreated patients with chronic HBV/HCV infection complicated by mild hepatic steatosis. MethodsA total of 111 previously untreated patients with chronic HBV/HCV infection who were hospitalized in Zhengzhou University People's Hospital from December 2014 to January 2016. Liver biopsy confirmed that all the patients had mild hepatic steatosis. Among these patients, 65 had HBV infection and 46 had HCV infection. The changes in clinical indices such as liver function, blood lipid, blood glucose, and liver stiffness measurement (LSM) were compared between the two groups. The independent samples t-test or Wilcoxon two-sample test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsThere were significant differences in LSM, aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), plasma albumin (Alb), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and platelet count (PLT) between the two groups (all P<0.05). According to liver inflammation grade and fibrosis stage, the patients were divided into G<2/S<2 group (0, 0-1, 1, 1-2) and G≥2/S≥2 group (2, 2-3, 3-4, 4). LSM showed significant differences across the groups with different liver inflammation grades and fibrosis stages (HBV infection:640(530~770)vs 830(590~1130),Z=-2463,P=0014;670(530~780)vs 830(570~1130),Z=-2049,P=0040。HCV infection:760(630~1150)vs 1750(1200~2670),Z=-3961,P<0001;760(590~1020)vs 1550(750~2150),Z=-3325,P=0001). In the patients with chronic HCV infection, TC showed a significant difference between the groups with different fibrosis stages (428±085 vs 382±068,t=2.045, P=0.047). ConclusionCompared with the previously untreated patients with chronic HBV infection complicated by mild hepatic steatosis, those with HCV infection complicated by mild hepatic steatosis have higher LSM, GGT, TC, and LDL-C, as well as lower Alb, PLT, AST, and HDL-C. In addition, the parameters associated with hepatic steatosis (BMI, GLU, fat attenuation parameter, blood lipid) are not positively correlated with disease progression.
【关键字】:肝炎病毒, 乙型; 肝炎病毒属; 脂肪肝
【Key words】:hepatitis B virus; hepacivirus; fatty liver
【引证本文】:何佳, 李威, 李宽, 等. 慢性HBV/HCV感染合并轻度肝脂肪变的临床特点分析[J]. 临床肝胆病杂志, 2016, 32(9): 1717-1720.

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