慢性乙型肝炎患者肝脂肪变性与血清、肝组织病毒因素的关系  

The correlation between fatty liver disease and serum and histological viral parameters in patients with chronic ;hepatitis B

作　　者：王明芳[1] 林苏[1] 吴银莲[1] 朱月永[1] 江家骥[1] 

机构地区：[1]福建医科大学附属第一医院肝病中心,福州350005

出　　处：《中华传染病杂志》2016年第3期141-145,共5页Chinese Journal of Infectious Diseases

基　　金：福建省财政厅卫生专项（脂肪性肝病研究平台建设）;福建省教育厅科技项目（JA15207）

摘　　要：目的：探讨 CHB 患者血清、肝组织的病毒因素与肝脂肪变性的相关性。方法收集2009年至2015年确诊为 CHB 并行肝活组织检查患者的临床及实验室检查资料，根据肝脏病理中是否存在脂肪变性，分为脂肪变性组和非脂肪变性组，采用倾向值匹配法校正两组的年龄、性别、体质指数（BMI）、总胆固醇（TC）、三酰甘油（TG）后，比较肝脂肪变性与病毒因素的关系。数据采用 t 检验和卡方检验、秩和检验及 Pearson 相关分析。结果874例患者纳入研究，男690例，女184例，平均年龄（37．0±10．1）岁，病理学确诊的肝脂肪变性发生率为30．9％（270／874）。通过倾向值匹配法对脂肪变性组和非脂肪变性组进行匹配，共240对患者匹配成功。匹配前两组年龄、性别、BMI、TC、TG 差异均有统计学意义（均 P ＜0．05），匹配后两组差异均无统计学意义（均 P ＞0．05）。匹配后脂肪变性组及非脂肪变性组在血清 HBsAg 效价、HBV DNA、HBeAg 阳性及肝组织 HBsAg、HBcAg 染色方面的差异均无统计学意义（均 P ＞0．05）。轻度脂肪变性组（F1）与中、重度脂肪变性组（F2～F4）的血清 ALT、HBV DNA、HBsAg 效价、HBeAg 阳性及肝组织 HBsAg、HBcAg 染色强阳性率均差异无统计学意义（均 P ＞0．05）。F1组肝脏炎症活动度分级及纤维化分期的平均秩分别为129．9和128．2，高于 F2～F4组的105．9和108．5，差异均有统计学意义（均 P ＜0．05）。脂肪变性程度与炎症活动度分级呈负相关（r ＝－0．183，P ＝0．005），与纤维化分期也呈负相关（r＝－0．150，P ＝0．020）。结论 CHB 患者血清病毒相关指标与肝脏是否脂肪变性及脂肪变性的严重程度无关，肝脂肪变性不影响肝组织 HBsAg、HBcAg 的表达，随着脂肪变性程度的加重，肝脏的炎症活动度分级及纤维化分期反而减轻。Objective To investigate the correlation between non-alcoholic fatty liver disease and serum and histological viral parameters in patients with chronic hepatitis B （CHB）.Methods Clinical and laboratory data from patients with CHB who received liver biopsy from 2009 to 2015 were collected. Patients were divided into steatosis and non-steatosis groups based on the presence of steatosis in liver biopsies.Propensity score matching （PSM）was conducted to adjust the confounding bias including age, sex,body mass index （BMI）,total cholesterol （TC）and triglyceride （TG）.Correlation of liver fatty and viral parameters was compared between steatosis and non-steatosis groups.Student t test,χ^2 test,rank sum test and Pearson correlation test were employed to analyze the data.Results A total of 874 patients with a mean age of （37.0±10.1）years were enrolled in the study,with 690 males and 184 females,and 270 （30.9%）patients were diagnosed with steatosis by liver biopsy.Age,gender,BMI,TC and TG were significantly different between the two groups before PSM （all P 〈0.05）,but those were comparable after PSM （all P 〉0.05 ）.Serum hepatitis B virus （HBV）DNA,hepatitis B surface antigen （HBsAg） level,proportion of hepatitis B e antigen （HBeAg ）positivity,HBsAg and hepatitis B core antigen＆amp;nbsp;（HBcAg）immunohistological staining in liver tissue were not significantly different between steatosis and non-steatosis groups after PSM （all P 〉0.05）.Patients in steatosis group were stratified into two groups according to the degree of steatosis confirmed by liver biopsies：mild steatosis group （F1 ）and medium to severe steatosis group （F2-F4）.The serum alanine aminotransferase （ALT）,HBV DNA,HBsAg level, proportion of HBeAg positivity,immunohistological HBsAg and HBcAg staining in liver tissue between those two groups showed no differences （all P 〉0.05）.The mean rank of liver inflammation and fibrosis in F1 group were 129.9 and 128.2,respectively,which were b

关 键 词：肝炎 乙型 慢性 脂肪肝 肝脏活检 倾向值匹配法 

分 类 号：R512.62[医药卫生—内科学]