脂肪性肝病临床特点及危险因素分析  

Analysis on clinical features of fatty liver disease and its risk factors

作　　者：赵彩彦[1] 王亚东[1] 张苹苹[1] 

机构地区：[1]河北医科大学第三医院感染科,河北石家庄050051

出　　处：《临床荟萃》2008年第4期247-251,共5页Clinical Focus

摘　　要：目的探讨脂肪性肝病(FLD)的临床特点及主要发病危险因素,为临床防治提供依据。方法本院门诊及住院患者超声检查证实为FLD人群768例(FLD组),并根据饮酒量进一步区分为非酒精性脂肪肝(NAFLD)组(334例)和酒精性脂肪肝(ALD)组(286例),另外同期检查的非FLD人群684例为对照组,收集年龄、体质量、血压、空腹血糖、空腹胰岛素、乙型和丙型肝炎病毒标志物、总胆固醇(TC)、甘油三酯(TG)、丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)以及血清总胆红素等临床资料,计算体质量指数(BMI)及胰岛素抵抗指数(HOMA-IR)。结果FLD组患病率随年龄增长而增加,60岁后逐渐降低,各年龄组男性患者比例均明显多于女性。NAFLD组和ALD组的BMI、舒张压(DBP)、HOMA-IR、TC、TG及ALT、AST均显著高于对照组(均P<0.05),但两组间乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)感染率比较差异无统计学意义(P>0.05)。Logistic回归分析显示与FLD关系最密切的前3位指标是BMI、HOMA-IR和甘油三酯(OR=8.47,4.34,3.80,P<0.05),尽管HCV感染(OR=1.95,P<0.05)是肝脏脂肪变的重要危险因素之一,但HBV感染与脂肪变之间并无相关性。结论肥胖、糖尿病、高血压、高血脂及HCV感染等均是脂肪性肝病发生的危险因素,病情严重者可表现为血清转氨酶、胆红素升高。控制体质量,维持上述各项指标正常,是防治FLD的重要措施。Objective To provide the preventive and treatment evidence for fatty liver disease （FLD） by investigating its clinical features and main risk factors. Methods Ultrasonography was used in diagnosis of 768 subjects with FLD of the hospital, and 684 non-FLD subjects as control group. According to intaking capacity of alcohol,the FLD subjects were further divided into non-alcoholic FLD（NAFLD） subgroup and alcoholic liver disease （ALD） subgroup,containing 334 and 286 subjects in each subgroup respectively. The main clinical data included age, body mass,blood pressure （BP）, fasting blood glucose （FBG）, fasting insulin （FINS）, markers of hepatitis B virus （HBV）, markers of hepatitis C virus （ HCV）, total cholesterol （TC）, triglycerides （TG）, alanine aminotransferase （ALT）, aspartate aminotransferase（AST）, total bilirubin and so on. Furthermore, the body mass index（BMI） and homeostasis model assessment-insulin resistance（HOMA-IR） were evaluated. Results The prevalence of FLD was increased with age before 60 years,later declined,and was obviously higher in male than in female. BMI,diastolic blood pressure（DBP）, HOMA-IR,TC,TG,ALT and AST in NAFLD and ALD were higher than those in control group（all P 〈 0.05）, but the ratio of HBV or HCV infected persons showed no significant difference （P 〉0.05）. Logistic regression analysis showed that the first three significant indexes,in turn, were BMI, HOMA-IR and TG （OR= 8.47, 4.34,3.80, P G0.05）. Although HCV infection （OR= 1.95, P G0.05） was one of important risk factors in hepatic adipose degeneration, HBV infection was not related to FLD. Conclusion Obesity,diabetes,hypertension,hyperlipemia and HCV infection,etc are important risk factors of FLD. The increased hepatic serum transaminase and bilirubin could be found in severe patients with FLD. To control the body mass and maintain normal of each index above-mentioned are important measures to prevent FLD.

关 键 词：脂肪肝 危险因素 体重 超声心动描记术 实验室技术和方法 

分 类 号：R575[医药卫生—消化系统]