慢性乙型肝炎肝脂肪变的相关因素分析

目的了解慢性乙型肝炎(CHB)患者肝脂肪变的相关因素。方法收集临床及病理确诊的CHB患者1039例进行回顾性研究,了解肝脂肪变与其生物化学指标、肝组织学改变之间的关系。结果在1039例CHB患者中,男843例,女196例,平均年龄(37±11)岁,肝脂肪变发生率36.1%(375/1039),其中F_1占66.4%,男性脂肪变(38.8%,327/843)明显高于女性(24.5%,48/196),差异有统计学意义(P<0.05)。CHB患者合并肝脂肪变组的年龄、UA、BMI、TC、TG、ApoA、ApoB、AFP及代谢综合征相关疾病的发病率高于无脂肪变组(P<0.05),2组HBeAg状态、HBV-DNA水平比较差异无统计学意义(P>0.05)。肝脂肪变分级与肝脏炎性反应、肝纤维化程度呈负相关(P<0.05),多因素回归分析显示:CHB肝脂肪变与BMI、TG呈正相关(β=0.323,β=2.255,P均<0.01),与AFP呈负相关(β=-0.008,P<0.05),结论CHB肝脂肪变并不少见,主要与宿主代谢因素有关,与HBeAg状态、HBV-DNA无关,不会加重肝脏的炎性反应活动度及纤维化程度。

The relationship between chronic hepatitis B and hepatic fatty degeneration

Objective To investigate the relationship between chronic hepatitis B(CHB) and hepatic fatty degeneration. Methods 1039 patients with biopsy proven CHB were reviewed in the study.Biological chemical index,liver histology and body mass index(BMI) were examined in these patients.Results A total of 1039 CHB patients(843 men) with a mean age of(37±11) years were analyzed.Hepatic fatty degeneration was present in 375(36.1%) patients.The prevalence of hepatic fatty degeneration in male patients was significantly higher than that in female patients(38.8%vs.24.5%,P < 0.01).Age,BMI,uric acid(UA),cholesterol(TC),triglyceride(TG),apolipoprotein A(ApoA),apolipoprotein B (ApoB) and the occurrence of metabolic syndrome were significantly higher in CHB patients with hepatic fatty degeneration than those without hepatic fatty degeneration(P < 0.05 ).No significant difference was found in serum HBeAg status or HBV-DNA titer(P >0.05).The multivariate correlation displayed that the severity of hepatic fatty degeneration was positive related to the BMI and TG(β=0.323,β=2.255,P <0.01),and was negative related to the level of AFP(β= -0.008, P <0.05).Conclusion Hepatic fatty degeneration is common found in CHB.It is associated with metabolic factors than virus factors.The existence of hepatic fatty degeneration dose not exacerbate liver inflammation or fibrosis.