摘要
目的探讨CHB合并NAFLD患者发生明显肝损伤的影响因素。方法回顾性分析2020年1月1日至2020年12月30日期间就诊于昆明市第三人民医院的225例CHB合并NAFLD患者的临床资料,根据肝损伤程度分为A组(120例,无肝损伤或轻度肝损伤)和B组(105例,中度或重度肝损伤)。对2组患者的基本资料、代谢相关指标、血细胞分析、肾功能、乙肝相关病原学等实验室资料进行单因素分析,然后将单因素分析中筛查得到的指标全部纳入二元Logistic回归分析,探索CHB合并NAFLD患者发生中度或重度肝损伤的影响因素。结果(1)A组vs B组:男性占比(76.67%vs 87.62%)、HBeAg阳性占比(49.17%vs 53.91%)、CHOL[(4.89±0.95)mmol/L vs(4.23±1.17)mmol/L]、HDL-C[1.10(0.94~1.28)mmol/L vs 0.90(0.53~1.18)mmol/L]、LDLC[3.03(2.52~3.60)mmol/L vs 2.70(2.05~3.19)mmol/L]、PLT[(202.47±60.79)×10^(9)/L vs(173.37±60.89)×10^(9)/L]、BUN[4.51(3.83~5.41)mmol/L vs 3.92(3.37~5.02)mmol/L]、UA[369.00(314.00~421.00)μmol/L vs 338.50(292.00~397.25)μmol/L]、Ln(HBV-DNA)[12.79(7.82~17.31)IU/mL vs 15.44(12.64~17.76)IU/mL]在2组间比较差异有统计学意义,均P<0.05。(2)二元Logisitic回归分析显示,PLT[OR(95%CI)=0.993(0.987~0.999)]、BUN[OR(95%CI)=0.726(0.565~0.932)]、UA[OR(95%CI)=0.994(0.990~0.998)]、HDLC[OR(95%CI)=0.175(0.060~0.510)]每下降1个单位,发生中重度肝损伤的可能性分别增加0.7%、27.4%、0.6%、82.5%;Ln(HBV-DNA)[OR(95%CI)=1.138(1.045~1.239)]每升高1个单位,发生中重度肝损伤的可能性增加13.8%,均P<0.05。结论HBV-DNA、HDL-C、BUN、UA、PLT是CHB合并NAFLD患者发生中度或重度肝损伤的影响因素,临床需高度重视。
Objective To investigate the influencing factors of liver injury in patients with chronic hepatitis B(CHB)and non-alcoholic fatty liver disease(NAFLD).Methods The clinical data of 225 patients with CHB complicated with NAFLD admitted to the Third People’s Hospital of Kunming from January 1^(st),2020 to December 30^(th,)2020 were retrospectively analyzed.According to the liver function,they were divided into group A(120 cases,no liver injury or mild liver injury)and group B(105 cases,moderate or severe liver injury).The basic information,metabolism biomarkers,routine blood,renal functions and etiology markers of hepatitis B were used to perform an unifactor analysis.To explore the influencing factors of moderate or severe liver injury,binary logistic regression analysis were further performed.Results 1.There were significant differences in gender[group A vs.group B(the same as following):proportion of males=76.67%vs.87.62%],HBeAg(+/-)[(HBeAg positive)=49.17%vs.53.91%],CHOL[(4.89±0.95)mmol/L vs.(4.23±1.17)mmol/L],HDL-C[1.10(0.94~1.28)mmol/L vs.0.90(0.53~1.18)mmol/L],LDL-C[3.03(2.52~3.60)mmol/L vs.2.70(2.05~3.19)mmol/L],PLT[(202.47±60.79)*10^(9)/L vs.(173.37±60.89)*10^(9)/L],BUN[4.51(3.83~5.41)mmol/L vs.3.92(3.37~5.02)mmol/L],UA[369.00(314.00~421.00)μmol/L vs.338.50(292.00~397.25)μmol/L],Ln(HBV-DNA)[12.79(7.82~17.31)IU/mL vs.15.44(12.64~17.76)IU/mL]between two groups(P<0.05).2.Binary Logisitic regression analysis showed that PLT[OR(95%CI)=0.993(0.987~0.999)],BUN[OR(95%CI)=0.726(0.565~0.932)],UA[OR(95%CI)=0.994(0.990~0.998)],HDL-C[OR(95%CI)=0.175(0.060~0.510)]were protective factors,with 1 unit decrease of which,the probability of moderate and severe liver injury increased by 0.7%,27.4%,0.6%and 82.5%,respectively;and HBV-DNA[OR(95%CI)=1.138(1.045~1.239)]was a risk factor,the probability of moderate to severe liver damage increased by 13.8%with 1 unit increase of Ln(HBVDNA).Conclusion HBV-DNA,HDL-C,BUN,UA and PLT are influencing factors for moderate or severe liver injury in CHB patients with NAFLD and a higher attention should to be paid.
作者
李生浩
丁洁
王晴晴
刘思奇
华丽娟
段劲宇
柏保利
杜安瑞
常国楫
李俊义
LI Sheng-hao;DING Jie;WANG Qing-qing;LIU Si-qi;HUA Li-juan;DUAN Jin-yu;BO Bao-li;DU An-rui;CHANG Guo-ji;LI Jun-yi(Dept.of Infectious Disease,The Third People’s Hospital of Kunming,Kunming Yunnan 650041,Kunming Yunnan 650041,China;Dept.of Information,The Third People’s Hospital of Kunming,Kunming Yunnan 650041,Kunming Yunnan 650041,China)
出处
《昆明医科大学学报》
CAS
2021年第7期77-82,共6页
Journal of Kunming Medical University
基金
云南省地方本科高校基础研究联合专项基金资助项目(2018FH001-087)
云南省基础研究专项基金资助项目(202101AT070054)
昆明市科技保障民生发展计划基金项目(昆科计字2019-1-S-25318000000808)
昆明市卫健委卫生科研课题(2020-03-08-113,2021-03-08-005)。
