HBeAg阳性慢性乙型肝炎合并非酒精性脂肪肝患者的临床与病理学特征

目的探讨HBeAg阳性慢性乙型肝炎患者合并非酒精性脂肪肝病（NAFLD）的临床与病理学特征。 方法选取2013年6月至2017年12月首都医科大学附属北京佑安医院病理确诊的慢性HBV感染（CHI）患者（108例）、NAFLD患者（120例）及HBeAg阳性慢性乙型肝炎合并NAFLD患者（132例）共360例。入组病例均行肝组织活检术，标本分别行HBsAg和HBcAg检测和HE染色。光学显微镜下观察肝组织脂肪变性和纤维化程度。比较各组患者血清学指标以及病理学特征。 结果较CHI患者，NAFLD患者和HBeAg（+）CHB合并NAFLD患者ALT水平显著升高，差异具有统计学意义（P均< 0.05）。较CHI和NAFLD患者，HBeAg（+）CHB合并NAFLD患者的AST与尿酸水平均显著升高，差异具有统计学意义（P均< 0.05）。较NAFLD患者，HBeAg（+）CHB合并NAFLD患者的甘油三酯（TG）水平显著降低，肝纤维化程度显著升高。CHI患者、NAFLD患者和HBeAg（+）CHB合并NAFLD患者三组患者的肌酐水平逐渐升高，差异具有统计学意义（P < 0.05）。各组患者两两比较高尿酸血症所占比例差异均有统计学意义（P均< 0.05）。与CHI患者和NAFLD患者相比，HBeAg（+）CHB合并NAFLD患者中男性高尿酸血症患者比例显著升高，差异具有统计学意义（P均< 0.05）。 结论炎症和纤维化发生率在HBeAg（+）CHB合并NAFLD患者中升高，提示NAFLD的存在可能与CHB病情进展有协同作用。

Clinical and pathological on HBeAg-positive patients with chronic hepatitis B complicated with nonalcoholic fatty liver disease

ObjectiveTo investigate the clinical and pathological features of HBeAg-positive patients with chronic hepatitis B (CHB) complicated with nonalcoholic fatty liver disease (NAFLD). MethodsTotal of 360 patients were collected from February 2013 to December 2017 in Beijing Youan Hospital, Capital Medical University, including 108 patients with chronic HBV infection, 120 patients with NAFLD and 132 patients with NAFLD and HBeAg-positive chronic hepatitis B. Liver biopsy was performed for all the patients, and the samples were detected for HBsAg and HBcAg, stained with HE. Lipid degeneration and fibrosis of liver tissue were observed under optical microscope. The serological indicators and pathological features of each group were compared. ResultsCompared with CHI patients, the levels of ALT in patients with NAFLD and HBeAg (+) CHB and NAFLD increased significantly, with significant differences (all P < 0.05). Compared with CHI patients and the patients with NAFLD, the levels of AST and uric acid in patients with HBeAg (+) CHB and NAFLD were significantly elevated, with significant differences (all P < 0.05). Compared with patients with NAFLD, the level of triglyceride (TG) in patients with HBeAg (+) CHB and NAFLD was significantly decreased, the degree of liver fibrosis was significantly increased. Creatinine levels gradually increased in patients with CHI, patients with NAFLD and patients with HBeAg (+) CHB and NAFLD, with significant difference (P < 0.05). There was significant differences in the proportion of hyperuricemia between patients of every two groups (P < 0.05). Compared with CHI patients and patients with NAFLD, the proportion of male patients with high uric acid hematic disease in HBeAg (+) CHB and NAFLD group was significantly high (P < 0.05). ConclusionsThe incidence of inflammation and fibrosis is elevated in patients with HBeAg (+) CHB and NAFLD, which suggested that the presence of NAFLD may have a synergistic effect with the progression of CHB.