慢性乙型肝炎伴发代谢综合征影响因素分析  

Viral and host factors of metabolic syndrome in chronic hepatitis B

作　　者：柴艳云[1,2] 张锦前[1] 凌伟[1] 李贲[1] 王琦[1] 张维燕[1] 范小玲[1] 成军[1] 

机构地区：[1]首都医科大学北京地坛医院传染病研究所,北京市100015 [2]山西医科大学

出　　处：《中华实验和临床感染病杂志（电子版）》2009年第1期29-32,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：国家自然科学基金项目(30600524)

摘　　要：目的探讨慢性乙型肝炎(chronic hepatitis B,CHB)患者伴发代谢综合征(metabolic syndrome,MS)的影响因素。方法选取我院2005年1月至2007年12月住院的未接受过抗病毒治疗的CHB患者89例,根据患者是否伴有MS分为两组:MS组(30例)和非MS组(59例)。比较两组间的年龄、性别、BMI等一般情况;肝脏酶学指标(ALT、AST、ALP、LDH、GGT);FPG、FINS、HOMA-IR、HOMA-β等糖代谢相关指标;TG、CHO、Apo A1、Apo B、FFA等脂代谢相关指标;HBV基因型、病毒载量等病毒相关指标;存在肝脏脂肪变性比例及严重程度。结果MS组LDH、GGT、FPG、FINS、HOMA-IR、HOMA-β,TG、Apo B水平,以及肝脏存在脂变的比例及严重程度明显高于非MS组(P<0.05)。75名男性患者中有28名伴有MS,14名女性患者中有2名伴有MS(P>0.05)。两组人群ALT、AST、ALP、CHE、CHO、ApoA1、FFA、病毒载量、HBV基因型无统计学差异(P>0.05)。MS组肝脏脂变程度较非MS组更为严重(P<0.001)。结论CHB患者伴发的MS与胰岛素抵抗及糖、脂代谢因素密切相关(尤与糖代谢相关性更为显著),与病毒本身无明确相关性,CHB患者所存在的肝脏脂肪变及MS之间密切相关,很可能是CHB患者伴发MS的一个重要组分。Objective To investigate the viral and host factors of metabolic syndrome in chronic hepatitis B. Methods Eighty-nine patients from Beijing Ditan Hospital in 2005 to 2007 and with untreated chronic hepatitis B were studied. The patients were divided into two groups depending on the diagnose of metabolic syndrome, group with MS （30 patients） and group without MS （59 patients）. The groups were compared in terms of age, gender, BMI, hver enzymes （ALT, AST, ALP, LDH, GGT）, FPG, FINS, HOMA-IR, HOMA-[3, triglyceride, cholesterol, Apo Al, ApoB, FFA, HBV genotype, viral load and hepatosteatosis. Results Between the group with MS and without MS, the mean age, BMI and gender were not statistically significant difference（P 〉0.05）. In the group of chronic hepatitis B with MS, the LDH, GGT, FPG, FINS, HOMA-IR, HOMA-β, TG, ApoB level, the degree of hepatosteatosis, the positity of HBeAg were significantly higher than those in the group without MS （ P 〈 0.05 ） . No significant differentce was found in the positity of ALT, AST, ALP, CHE, CHO, apoAl, FFA, viral load, genotype between the two groups. （P 〉 0. 05 ）. More over, the degree of hepatosteatosis was statistically different between the two groups（P 〈0. 001 ）. The degree of hepatosteasis in the group with MS is significandy more severe than that in the group without MS （P 〈 0.001 ）. Conclusions Metabolic syndrome in chronic hepatitis B patients is correlative to insulin resistance, glycometabolism and lipid metabolism （the correlation of glycometabolism is more predominant） rather than the effect of viruses.

关 键 词：慢性乙型肝炎 代谢综合征 因素 

分 类 号：R512.6[医药卫生—内科学] R589[医药卫生—临床医学]