e抗原阴性慢性乙型肝炎合并肝脂肪变的预测指标及炎性反应和纤维化诊断  

Predictors for HBeAg negative chronic hepatitis patients with steatosis and its value in diagnosis of hepatic inflammation and fibrosis

作　　者：郑瑞丹[1] 徐成润[1] 孟家榕[1] 张闽峰[1] 窦爱霞[2] 周琨[2] 陆伦根[2] 

机构地区：[1]解放军第一七五医院肝病治疗中心,漳州363000 [2]上海交通大学附属第一人民医院消化科

出　　处：《中华消化杂志》2009年第9期533-536,共4页Chinese Journal of Digestion

基　　金：上海市科学技术委员会资助项目（054119618）;漳州市科技局基金资助项目（Z04094）

摘　　要：目的研究HBeAg阴性慢性乙型肝炎（CHB）合并肝脂肪变患者的临床和病理关系，探讨预测此类患者肝组织炎性反应和纤维化的指标。方法分别收集经临床与病理检查确诊的HBeAg阴性CHB合并和不合并肝脂肪变患者56例和60例，分别研究并比较其空腹血糖（FBG）、空腹血胰岛素（FINS）、三酰甘油（TG）、胆固醇（TC）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、谷氨酰转肽酶（GGT）、碱性磷酸酶（ALP）、白蛋白（Alb）、球蛋白（Glb）、胰岛素抵抗指数（HOMA—IR）、HBVDNA水平、体重指数（BMI），并就上述指标与肝组织脂肪变、炎性反应和纤维化的关系进行统计学分析。结果与HBeAg阴性CHB不合并肝脂肪变者相比，合并肝脂肪变患者BMI、FBG、FINS、TG、TC、GGT、ALP、Glb和HOMA-IR明显增高（P值均〈0．05），HBVDNA、AST、ALT、Alb明显降低（P值均〈0．05），此外炎性反应程度和纤维化程度亦明显增强。可预测HBeAg阴性CHB者是否存在肝脂肪变的参数有BMI、FBG、FINS、TG、TC、GGT和HOMAIR（P值均〈0．05）。可预测HBeAg阴性CHB合并肝脂肪变者肝组织是否存在炎性反应的参数有ALT、AST、Glb和HBVDNA（P值均〈0．05），可预测其是否存在肝组织纤维化的参数有ALT、AST、Alb、Glb和HBVDNA（P值均〈0．05）。结论肝脂肪变在HBeAg阴性CHB患者中较常见，其肝组织脂肪变与BMI、FBG、FINS、TG、TC、GGT和HOMA—IR有关。此类患者除肝脂肪变明显增加外，肝组织炎性反应和纤维化程度亦明显加重。Objective To investigate the relationship between clinical presentation and pathological characteristics in HBeAg negative chronic hepatitis B（CHB） patients with steatosis, and to find out the predictors of hepatic inflammation and fibrosis. Methods HBeAg negative CHB patients with （n = 56） or without （n=60） steatosis confirmed clinically and pathologically were enrolled in the study. All patients were examined for fasting blood glucose （FBG）, fasting insulin （FINS）, triglyceride （TG）, cholesterol （TC）, alanine aminotransferase （ALT）, aspartate aminotransferase （ AST）, gamma-glutamyhransferase （GGT）, alkaline phosphatase （ALP） albumin （Alb）, globulin（Glb）, homeostatic model assessment of insulin resistance （HOMA IR）, HBV DNA and body mass index（BMI）. The association of above parameters with hepatic inflammation, fibrosis and fatty deposition were analyzed statistically. Results It was demonstrated that BMI, FBG, FINS, TG, TC, GGT, ALP , Glb and HOMA IR were significantly higher in HBeAg negative CHB patients with steatosis than those without steatosis （P〈0.05）. Whereas the levels of HBV DNA, AIb, ALT and AST were significantly lower in HBeAg negative CHB patients with steatosis compared with those without steatosis （P〈0. 05）. The hepatic inflammation and fibrosis were aggravated in patients with steatosis. It was implicated that BMI,FBG, FINS, TG, TC, GGT and HOMA-IR（all P values 〈 0.05） were significant predictors for hepatic steatosis, while ALT, AST, Glb and HBV-DNA（all P values d0.05） were significant predictors for hepatic inflammation. And the predictors for hepatic fibrosis were ALT, AST, Alb, Glb and HBV-DNA（all P values 〈0. 05）. Conclusions Hepatic steatosis is common in HBeAg negative CHB patients which is positively associated with parameters including BMI, FBG, FINS, TG, TC, GGT, ALP and HOMA-IR. Besides steatosis, the hepatic inflammation and fibrosis are also aggravated in these patients.

关 键 词：乙型肝炎 慢性 脂肪肝 诊断 

分 类 号：R686[医药卫生—骨科学]