摘要
目的:了解单纯慢性乙型肝炎患者与慢性乙型肝炎合并脂肪变性者的肝脏病变特点及临床改变的差异,并寻找与肝纤维化程度改变相关的危险因素.方法:分析275例初治HBsAg阳性患者的肝组织病理情况,依据肝脏病理检查结果将病例分为单纯乙型肝炎组和乙型肝炎合并脂肪变性组,用t检验比较两组患者在年龄、腰围、尿酸、血脂方面的差异,利用多元线性回归法分析各危险因素对肝脏纤维化的影响.统计学处理采用SPSS Statistics17.0统计软件,P<0.05有统计学意义.结果:275例乙型肝炎患者中有脂肪变性者104例.慢性乙型肝炎合并脂肪肝组相比单纯慢性乙型肝炎组在腰围(84.2cm±9.9cm vs 80.1cm±7.8cm,P=0.03),尿酸(325.05μmol/L±98.32μmol/L vs 275.57μmol/L±74.00μmol/L,P=0.001),甘油三酯(1.68mmol/L±1.03mmol/L vs 1.13mmol/L±0.65mmol/L,P=0.001),低密度脂蛋白(2.70mmol/L±0.77mmol/L vs 2.29mmol/L±0.60mmol/L,P=0.001),胆固醇(4.30mmol/L±0.83mmol/L vs 3.97mmol/L±0.79mmol/L,P=0.02)水平上存在统计学意义,合并脂肪变性组相对于单纯慢性乙型肝炎组有着更大的体质量指数.而且单纯慢性乙型肝炎组与脂肪变性组在纤维化水平上存在差异(χ2=5.364,P=0.021).通过多元回归分析发现:年龄,炎症水平分级,饮酒以及HBeAg阴性状态是慢性乙型肝炎患者纤维化进展加重的独立危险因素(均P<0.05);脂肪沉积对肝脏纤维化的影响为负相关,即肝脏纤维化程度较重,脂肪沉积越轻(t=-2.689,P=0.008).结论:肝组织病理及临床资料显示:血脂紊乱,肥胖等代谢综合征是肝细胞脂肪变性的主要原因,而与酒精因素无关.年龄、炎症水平、e抗原阴性状态、饮酒是慢性乙型病毒性肝炎(hepatitis B virus infection,CHB)患者肝组织纤维化进展相关的独立危险因素,但随着纤维化程度的加重,肝细胞脂肪变程度反而减轻.
AIM： To compare the difference in clinical char- acteristics and hepatic pathological changes between patients with CHB and those with CHB and fatty degeneration, and to identify risk fac- tors associated with the degree of hepatic fibrosis. METHODS： The liver with newly diagnosed biopsy of 275 patients CHB was analyzed. On the basis of pathological results, the patients were divided into two groups： those with simple CHB and those with CHB and fatty degenera- tion. The age, waistline, uric acid, and blood fat were compared between the two groups. Mul- tiple linear regression was used to analyze each risk factor for hepatic fibrosis.RESULTS： Of 275 CHB patients, 104 had steato- sis. Significant differences were noted in waistline （84.2 cm ＋ 9.9 cm vs 80.1 cm ＋ 7.8 cm, P = 0.03）, uric acid （325.05 ~tmol/L _＋ 98.32 ~mol/L vs 275.57 ~tmol/L _＋ 74 ~mol/L, P = 0.001）, TG （1.68 mmol/ L ＋ 1.03 mmol/L vs 1.13 mmol/L ＋ 0.65 mmol/L, P = 0.001）, LDL （2.7 mmol/L ＋ 0.77 mmol/L vs 2.29 mmol/L ＋ 0.60 mmol/L, P =0.001）, TC （4.30 mmol/L ＋ 0.83 mmol/L vs 3.97 mmol/L ＋_ 0.79 mmol/L, P = 0.02） between patients with simple CHB and those with CHB and fatty degeneration. Patients with CHB and fatty degeneration had a greater body mass index. A significant difference in the degree of fibrosis was also noted between the two groups （;2 = 5.364, P = 0.021）. Multiple regression analysis revealed that age, level of in- flammation, drinking and HBeAg negativity were independent risk factors for fibrosis progression in patients with CHB （all P 〈 0.05）. Fat deposition was negatively correlated with hepatic fibrosis in patients with CHB （t = -2.689, P = 0.008）. CONCLUSION： Dyslipidemia, obesity and met- abolic syndrome are primary causes of hepatic steatosis, which has no significant association with alcohol factors. Age, level of inflammation, e antigen negativity, and drinking are inde- pendent risk factors for the progression of liver fibrosis in CHB patients. The increase in the de- gree of fibrosis is associated with a decrease in the degree of hepatic steatosis.
出处
《世界华人消化杂志》
CAS
北大核心
2013年第8期694-699,共6页
World Chinese Journal of Digestology
基金
新疆维吾尔自治区科技计划基金资助项目
No.2011141137
国家自然科学基金资助项目
No.30760220~~
