摘要
目的探讨肝脏脂肪衰减参数(CAP)对慢性乙型肝炎(CHB)患者抗病毒疗效及肝纤维化的影响。方法回顾性分析2019年1月至2021年1月柳州市人民医院肝病科收治e抗原阳性的180例CHB患者临床资料,根据瞬时弹性成像技术检测结果,按照CAP分为A组(CAP<260 db/m)60例、B组(CAP介于260~292 db/m)60例、C组(CAP>292 db/m)60例。分析抗病毒治疗12、24、48和96周时的生化学、病毒学、血清学应答情况,各组随机入组20例进行肝病理检查评估肝纤维化情况。结果3组在年龄、性别、基线ALT、AST、HBV DNA水平无差异,与A组相比,C组患者体质指数、三酰甘油(TG)、总胆固醇(TC)和GGT水平较高(P<0.05),B组的TC、TG水平高于A组,差异有统计学意义(P<0.05)。对三组各随机入组20例患者进行肝活检,根据病理结果分为肝硬化组和非肝硬化组,logistics回归分析发现两组CAP值、BMI、TG差异有统计学意义(P<0.05)。行ROC分析,CAP、TG评分曲线下面积(AUC)最大,分别为0.780、0.746。恩替卡韦抗病毒治疗后第12周、24周、48周,患者ALT水平复常A组为35例(58.33%)、60例(100%)、60例(100%);B组为22例(36.67%)、55例(91.67%)、59例(98.33%);C组为14例(23.33%)、21例(35%)、48例(80%),A组和C组差异有统计学意义(P<0.01)。HBV DNA转阴率随着恩替卡韦治疗时间的延长逐渐增加。24周时三组HBV DNA转阴率分别为96.67%(58例),75%(45例),63.33%(38例),其中A组和B组,A组和C组均差异有统计学意义(P<0.01)。在抗病毒治疗第48周和第96周,HBeAg血清转换率逐渐升高,A组为8.33%(5例),11.67%(7例);B组为1.67%(1例),5%(3例);C组为0,1.67%(1例),其中A组和C组HBeAg转阴率差异有统计意义(P<0.05)。结论CAP值、TG、BMI是CHB患者发生肝硬化的影响因素。
Objective To retrospectively analyze the clinical data of E antigen positive chronic hepatitis B(CHB)patients admitted from January 2019 to January 2021,and to explore the influence of Controlled Attenuation Parameter(CAP)of fatty liver on the efficacy of antiviral therapy and liver fibrosis progression in CHB.Methods According to the results of CAP determined by transient elastography,the patients were divided into group A(CA P<260 db/m,N=60 cases),group B(CAP between 260~292 db/m,N=60 cases)and group C(CA P>292 db/m,N=60 cases).The biochemical,virological and serological responses at 12 weeks,24 weeks,48 weeks and 96 weeks after antiviral treatment were retrospectively analyzed.Twenty patients in each group were randomly assigned for hepatological examination to evaluate liver fibrosis.Results There were no differences in age,sex,baseline alanine transaminase(ALT),aspartate transaminase(AST)and HBV-DNA among the three groups.The levels of body mass index(BMI),Triglyceride(TG),total cholesterol(TC)andγ-glutamyl transpeptadase(GGT)in Group C were higher than Group A(P<0.05)and the levels of cholesterol(TC)and triglyceride(TG)in group B were higher than those in group A(P<0.05).Twenty patients in each of the three groups were randomly divided into cirrhotic group and non-cirrhotic group according to the pathological results.Logistics regression analysis showed that there were significant differences in CAP value(P<0.01),BMI and TG between the cirrhotic and noncirrhotic groups(P<0.05).Receiver operator characteristic curve(ROC)analysis showed that the areas under the curve(AUC)of CAP and TG were the largest,which were 0.780 and 0.746.At 12th,24th,and 48th weeks after entecavir(ETV)antiviral treatment,there were significant differences in the normalization rate of ALT levels,which were 35 cases(58.33%),60 cases(100%),and 60 cases(100%)in Group A,22 cases(36.67%),55 cases(91.67%)and 59 cases(98.33%)in group B,14 cases(23.33%),21 cases(35%)and 48 cases(80%)in Group C,respectively,especially in Group A and Group C(P<0.01).The negative conversion rate of HBV DNA gradually increased with time after ETV treatment.At 24 weeks,the negative rates of HBV DNA in these three groups were 96.67%(58 cases),75%(45 cases)and 63.33%(38 cases),respectively,with significant differences between group A and group B,or group A and group C(P<0.01).At the 48th and 96th week of antiviral treatment,the HBeAg seroconversion rate gradually increased,the HBeAg negative rate were 8.33%(5 cases)and 11.67%(7 cases)in Group A;1.67%(1 case)and 5%(3 cases)in group B.and 0%,1.67%(1 case)in Group C,respectively,with a significant difference between group A and group C.Conclusion Low CAP value,TG and BMI are independent indexes related to liver fibrosis progression in patients with CHB complicated with NAFLD.Liver steatosis affects biochemical response,delays early response of antiviral treatment,and affects serological response of HBeAg.Therefore,prevention and treatment of NAFLD in CHB patients complicated with NAFLD is of positive significance to improve antiviral efficacy.
作者
杨秀珍
袁淑芳
佘东明
柯柳
李俩
何唐艳
张月圆
李夏蓉
丹扬萍
YANG Xiu-zheng;YUAN Shu-fang;SE Dong-ming;KE Liu;LI Liang;HE Tang-yan;ZHANG Yue-yuan;LI Xia-rong;DAN Yang-ping(Infection Disease,Development of Liuzhou People’s Hospital,Guangxi 545000,China)
出处
《肝脏》
2022年第7期768-772,共5页
Chinese Hepatology
基金
柳州市科技计划(2021CBC105)
柳州市人民医院课题(Iry202103)。
