慢性乙型肝炎患者肝细胞脂肪变的发生率及其危险因素分析  

Prevalence and risk factors of hepatic steatosis in patients with chronic hepatitis B

作　　者：施军平[1,2] 范建高 武瑞[1] 高晓倩[1] 张莉[1] 王浩[1] 

机构地区：[1]浙江中医药大学附属杭州市第六人民医院感染科,310014 [2]上海交通大学附属第一人民医院

出　　处：《中华肝脏病杂志》2008年第7期519-523,共5页Chinese Journal of Hepatology

摘　　要：目的了解肝细胞脂肪变在慢性乙型肝炎（CHB）患者中的发生率及危险因素。方法对2005年1月2007年6月经肝活组织检查证实的CHB患者进行回顾性研究，剔除合并HCV和HIV等病毒感染及其他慢性肝病。调查肝细胞脂肪变在CHB患者中的发生率及其变化趋势，分析肝脂肪变与相关的人口学特征、病毒学指标和生物化学指标、以及肝组织学改变之间的关系。结果在1915例CHB患者中，男1497例，女418例，平均年龄（30．7±9．5）岁。肝组织病理显示肝细胞脂肪变发生率为13．6％（260／1915），并呈逐年增高趋势（2005-2007年分别为11．2%、14．3％、17．9％）。肝细胞脂肪变程度〈30％（F1）的患者占90．4％；男性肝脂肪变（15．2％，228／1497）明显高于女性（7．7％，32／418）。有肝脂肪变的CHB患者，其体重指数、年龄、空腹血糖和尿酸明显高于无肝脂肪变患者，t值分别为6．01，3．60，4．72，9．55，P值均〈0．01。超重、肥胖、糖尿病、血脂异常和高尿酸血症患病率也明显高于无肝脂肪变患者，x^2值分别为17．00，169．45，6．12，116．67，76．34，P值均〈0．05。轻度CHB患者肝脂肪变发生率（17．8％）显著高于慢性HBsAg携带者（8．6％）以及CHB中度（9．4％）和重度（7．7％）患者；同样，炎症活动度G1患者肝脂肪变发生率（19．8％）和纤维化程度S1患者肝脂肪变发生率（19．1％）分别显著高于G0、G2、G3和G4（分别为10．3％、11．5％、9．3％和7．3％）和S0、S2、S3和S4（分别为10．8％、13．3％、7．1％、7．4％）患者；肝脂肪变发生率与HBeAg状态及HBV DNA水平无相关关系。多元回归分析显示：体重指数、甘油三酯、载脂蛋白B、尿酸和空腹血糖与CHB患者肝脂肪变的发生密切相关。结论肝细胞脂肪变在CHB患者中并不少见，其发生主要由患者的代谢因素所致，而与HBV本身无关；�Objective To investigate the prevalence and risk factors of hepatic steatosis in patients with biopsy-proven chronic hepatitis B （CHB）. Methods One thousand nine hundred and fifteen patients with CHB who had liver biopsies seen between January 2005 and June 2007 in our department were reviewed. Patients co-infected with hepatitis C virus or HIV or suffering from liver diseases of other causes were not included. The prevalence of hepatic steatosis and its trend during the study period were determined, and the relationships among their hepatic steatosis with clinical data, serum biochemistry, HBV viral load, and the degree of liver inflammation and fibrosis stage were studied. Results The mean age of the patients was 30.7 ± 9.5 years; 1,497 men and 418 women. Histological hepatic steatosis was present in 260 patients （13.6%）, and the annual prevalence of steatosis increased with time （11.2% in 2005, 14.3% in 2006, and 17.9% in 2007）. The prevalence of steatosis in male patients was significantly higher than that in female patients （15.2% vs. 7.7%, x^2 = 15.98, P 〈 0.01）. Body mass index （BMI）, age, fasting plasma glucose （FPG） were all significantly higher in CHB patients with hepatic steatosis than in patients without steatosis （t values were 6.01, 3.60, 4.72 and 9.55, respectively, all P 〈 0.01）. The prevalence of overweight, obesity, diabetes, dyslipidemia and hyperuricemia were also significantly higher in patients with steatosis than those without it （ x^2 values 17.00, 169.45, 6.12, 116.67 and 76.34, all P 〈 0.05）. Prevalence of hepatic steatosis was higher in patients with mild CHB （17.8%） than in chronic inactive HBsAg carriers （8.6%）, patients with moderate CHB （9.4%） and with severe CHB （7.7%）. Similarly, prevalence of steatosis was higher in patients with inflammation grade 1 （19.8%） and fibrosis stage 1 （19.1%） than in patients with inflammation grade 0 （10.3%）, grade 2 （11.5%）, grade 3 （9.3%） and grade 4 （7.3%）, and in patie

关 键 词：肝炎 乙型 慢性 患病率 肝脂肪变 

分 类 号：R686[医药卫生—骨科学]