肝硬化患者血脂异常分析*

目的 分析不同病因和不同Child-Pugh分级的肝硬化患者血脂水平和血脂异常类型。方法 2013年1月～2017年12月我科住院的448例肝硬化患者,其中乙型肝炎194例,丙型肝炎20例,酒精性46例,病毒与酒精性41例,隐源性85例,自身免疫性肝炎33例,NAFLD相关10例和血吸虫病19例。回顾性分析血脂指标,包括总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白A(APOA)、载脂蛋白B(APOB)。结果 在448例肝硬化患者中,221例(49.3%)存在血脂异常,其中低HDL血症207例(93.7%),混合型高脂血症1例(0.5%);186例Child A级患者血TC水平为(3.8±0.9)mmol/L,显著高于183例B级【(3.4±1.3)mmol/L,P<0.01】,或79例C级【(3.1±1.3)mmol/L,P<0.01】;A级TG为(1.1±0.6)mmol/L,显著高于B级【(0.9±0.5)mmol/L,P<0.01】,或C级【(0.9±0.5)mmol/L,P <0.01】;A组HDL为(1.3±0.4)mmol/L,显著高于B级【(1.1±0.4)mmol/L,P <0.01】,或C级【(0.8±0.4)mmol/L,P <0.01】;A级LDL为(2.1±0.6)mmol/L,显著高于B级【(1.8±0.9)mmol/L,P <0.01】,或C级【(1.7±0.8)mmol/L,P <0.01】;A级APOA为(1.1±0.3)mmol/L,显著高于B级【(0.9±0.3)mmol/L,P <0.01】,或C级【(0.8±1.3)mmol/L,P <0.01】;A级APOB为(0.7±0.2)mmol/L,显著高于B级【(0.6±0.3)mmol/L,P <0.01】;随着Child-Pugh分级变差,血脂异常率显著升高,三组分别为32.3%、52.5%和82.3%(P <0.01); NAFLD和丙型肝炎肝硬化患者血脂异常率最高,均为60%,而乙型肝炎肝硬化患者血脂异常率相对较低,为43.8%。结论 肝硬化患者血脂异常以低HDL血症最常见,且随着Child-Pugh分级变差而显著升高。NAFLD和丙型肝炎肝硬化患者最容易出现血脂异常,值得关注。

Dyslipidemia in patients with liver cirrhosis

Objective The aim of this study was to analyze the dyslipidemia in patients with liver cirrhosis (LC). Methods A total of 448 patients with LC were admitted to our hospital between January 2013 and December 2017, and included hepatitis B in 194, hepatitis C in 20, alcohol-induced in 46, hepatitis B or C with alcohol in 41, cryptogenic in 85, autoimmune hepatitis in 33, NAFLD in 10 and schistosomiasis in 19 cases. The blood lipid were analyzed, including total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low density lipoprotein (LDL), apolipoprotein A (APOA) and apolipoprotein B (APOB). Results Out of the 448 patients with LC, 221 cases (49.3%) had dyslipidemia, and the majority of dyslipidemia was low HDL (n=207, 93.7%); the mixed hyperlipidemia was the least (n=1, 0.5%);the blood TC in 186 patients with Child class A was (3.8±0.9) mmol/L, significantly higher than [(3.4±1.3) mmol/L,P<0.01] in 183 patients with class B, or [(3.1±1.3) mmol/L, P <0.01] in 79 patients with class C; the blood TG in class A was (1.1±0.6) mmol/L, significantly higher than [(0.9±0.5) mmol/L, P <0.05] in class B, or [(0.9±0.5) mmol/L, P <0.01] in class C; the HDL level was (1.3±0.4) mmol/L, significantly higher than [(1.1±0.4) mmol/L, P <0.01] in class B, or [(0.8±0.4) mmol/L, P <0.01] in class C; the LDL was (2.1±0.6) mmol/L, significantly higher than [(1.8±0.9) mmol/L, P <0.01] in class B, or [(1.7±0.8) mmol/L, P <0.01] in class C; the APOA was (1.1±0.3) mmol/L, significantly higher than [(0.9±0.3) mmol/L, P <0.01] in class B, or [(0.8±1.3) mmol/L, P <0.01] in class C; the APOB was (0.7±0.2) mmol/L, significantly higher than [(0.6±0.3) mmol/L, P <0.01] in class B; the proportion of dyslipidemia increased significantly with the Child-Pugh classification deteriorated, e.g., the percentages of dyslipidemia was 32.3% in class A, 52.5% in class B, and 82.3% in class C (P <0.01); the dyslipidemia was most common in patients with NAFLD associated (60.0%) and hepatitis C-induced LC (60.0%), and relatively less common in hepatitis B-induced (43.8%). Conclusion Low HDL level is the most common type of dyslipidemia in patients with LC, and as the liver function deteriorates, it becomes common.