HBsAg阳性B超诊断的脂肪肝(男性人群)丙氨酸氨基转移酶的分布特征  

Distribution of alanine transarninase in male subjects with ultrasonography diagnostic fatty liver and positive serum HBsAg

作　　者：陈金军[1] 杨洁[1] 耿书英[1] 王燕军[1] 侯金林[1] 温淑娟[2] 

机构地区：[1]南方医科大学南方医院感染内科,广州市510515 [2]南方医科大学南方医院医学检验中心,广州市510515

出　　处：《实用医学杂志》2009年第9期1387-1391,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金资助项目(编号:30671873)

摘　　要：目的:了解HBsAg阳性的、B超诊断的脂肪肝(SFL)人群的临床特点。方法:采集2006年6-9月参与健康检查的成人(年龄18～70岁,无既往病史,性别不限)人群的资料,包括性别、年龄、身高、体重、血压、空腹生化指标、血清HBV标志物及腹部B超等数据。结果:HBsAg阳性SFL(HBsAg+/SFL+)的总体流行率为2.24%(100/4 469);HBsAg阳性发生SFL的几率低于HBsAg阴性人群[18.3%(100/547)vs 24.0%(943/3 922),P=0.003]。在男性3 224例中,HBsAg阳性SFL(HBsAg+/SFL+,n=94)与HBsAg阴性SFL(HBsAg-/SFL+,n=837)在年龄>35岁、体重指数>25、血糖异常、总胆固醇异常以及ALT异常[正常值上限(ULN),40 U/L]的比例接近,而明显高于HBsAg阳性或阴性未诊断SFL(HBsAg+/SFL-,n=318和HBsAg-/SFL-,n=1 975)组。与HBsAg+/SFL-组(OR=4.453,95%CI=2.921～6.787,P<0.001)及HBsAg-/SFL+组(OR=4.395,95%CI=3.127～6.178,P<0.001)比较,ALT>1.5 ULN的风险在HBsAg+/SFL+组中最高(OR=6.381,95%CI=3.619-11.250,P<0.001)。在ALT≤1.0 ULN的男性人群中(n=2 512),ALT>0.5 ULN的比例HBsAg+/SFL+组(44/51)高于HBsAg-/SFL+组(356/487,P=0.043)和HBsAg+/SFL-组(157/223,P=0.022)以及HBsAg-/SFL-组(844/1 751,P<0.001)。结论:男性HBsAg阳性B超诊断的SFL人群在临床特征上与一般的HBV感染者明显不同而与HBsAg阴性SFL人群接近,但导致肝脏疾病进展的可能性更大。Objective To investigate the clinical characteristics of serum HBsAg positive subjects with uhrasonography diagnostic fatty liver （SFL）. Methods Gender, age, height, body weight, blood pressure, fasting biochemical criterions, serum HBV markers, and abdominal sonographic evaluation data in all subjects （aged 18-70, without severe diseases） from June to September 2006 were collected and analyzed. Results Prevalence of HBsAg positive SFL （HBsAg＋/SFL＋） was 2.24% （ 100/4 469）, and the occurrence rate of SFL was lower in HBsAg carriers （n = 547） than that in subjects without HBsAg （n = 3 922） （ 18.3% vs 24.0%, P = 0.003）. Proportions of subjects with age 〉 35, body mass index 〉 25, elevated plasma glucose, elevated cholesterol and elevated alanine transarninase （ALT） （〉 40 IU/L） in HBsAg positive SFL group （HBsAg＋/SFL＋ group, n = 94） were similar to those in HBsAg negative SFL group （HBsAg-/ SFL＋ group, n = 837）, but those in the both groups were significantly higher than those in no SFL groups （HBsAg＋/SFL- group, n = 318 and HBsAg-/SFL- group, n = 1 975）. Subjects in HBsAg＋/SFL＋ group had a higher risk having ALT 〉 60 IU/L （OR = 6.381, 95% CI = 3.619-11.250, P 〈 0.001） as compared to HBsAg-/SFL＋ group （OR = 4.395, 95% CI = 3.127-6.178, P 〈 0.001） or HBsAg＋/SFL- group （OR = 4.453, 95% CI = 2.921-6.787, P 〈 0.001）. In subjects with normal ALT （≤〈 40 IU/L） levels, proportion of subjects with actual ALT 〉 20 IU/L was significantly higher in HBsAg＋/SFL＋ group （44/51） than those in HBsAg-/SFL＋ group （356/487, P=0.043）, HBsAg＋/SFL- group （157/223, P = 0.022） and HBsAg-/SFL- group （844/1 751, P 〈 0.001 ）. Conclusions The clinical characteristics of male HBsAg carriers with SFL were different from those with ordinary HBV infection, but were similar to SFL patients without HBsAg. The probability of exacerbation is increased in HBsAg carriers with SFL than that in SFL patients without HBsAg.

关 键 词：脂肪肝 B超 乙型肝炎表面抗原 谷丙转氨酶 

分 类 号：R575.5[医药卫生—消化系统] R512.62[医药卫生—内科学]