基于216对配对病例研究慢性乙型肝炎患者肝脂肪变性的临床和病理特征  

The clinical and pathological features of hepatic steatosis in patients with chronic hepatitis B based on a ;matched case-control study

作　　者：张志侨 王功遂 康凯夫[2] 吴国标[2] 王鹏 

机构地区：[1]广东省佛山市顺德区第一人民医院感染性疾病科,528300 [2]广东省佛山市顺德区第一人民医院病理科,528300

出　　处：《中华传染病杂志》2016年第3期146-150,共5页Chinese Journal of Infectious Diseases

基　　金：广东省卫生厅立项资助课题（A2013695）

摘　　要：目的：基于配对病例对照研究方法分析合并肝脂肪变性的 CHB 患者的临床和病理特征。方法采用横断面研究的方法收集2006年1月至2014年12月在广东省佛山市顺德区第一人民医院感染性疾病科行肝穿刺术的 CHB 患者的临床资料，按照性别一致、年龄接近的原则进行配对，共获得216对配对患者。对两组人群的临床、病理指标进行比较和分析。计量资料近似正态分布时采用 t检验，非正态分布时采用两独立样本或多独立样本非参数秩和检验，计数资料采用χ^2检验。结果配对后脂肪肝组和非脂肪肝组患者的超重／肥胖分别占84．2％和18．5％（χ^2＝189．30，P ＝0．001）、高胆固醇分别占30．6％和13．4％（χ^2＝18．47，P ＝0．001）、高三酰甘油分别占27．3％和9．7％（χ^2＝22．15，P ＝0．001）、高低密度脂蛋白分别占16．7％和5．6％（χ^2＝13．50，P ＝0．001）、高尿酸分别占31．0％和15．3％（χ^2＝15．04，P ＝0．001）、饮酒史分别占38．9％和25．9％（χ^2＝8．08，P ＝0．001）。两组间 HBV DNA 和HBeAg 差异均无统计学意义（均 P ＞0．05）。非脂肪肝组和脂肪肝组患者肝组织炎症活动度分级≥3级（54．6％比37．5％，χ^2＝12．75，P ＜0．01）和纤维化分期≥3期（53．2％比41．7％，χ^2＝5．80，P ＝0．016），差异有统计学意义。结论伴有超重／肥胖、高胆固醇、高三酰甘油、高低密度脂蛋白、高尿酸和饮酒史的 CHB 患者更易出现肝脂肪变性。非脂肪肝组炎症活动度分级和纤维化分期均重于脂肪肝组。Objective To study the clinical and pathological features of hepatic steatosis in patients with chronic hepatitis B （CHB）based on a matched case-control study.Methods Cross-sectional study was carried out on CHB patients who received liver biopsy in the Department of Infectious Diseases, Shunde First People′s Hospital from January 2006 to December 2014.Clinical data of the patients were collected.A total of 216 matched pairs were created according to gender and age.The clinical and pathological feathers of both groups were compared and analyzed. Quantitative data with normal distribution were compared by t test and those with abnormal distribution were compared by nonparametric rank sum test of two- or multi-independent samples. Categorical data were compared by χ^2 test. Results In matched pairs,rates of overweight/obesity were 84.2% in fatty liver group and 18.5 % in non-fatty liver group （χ^2 =189.30,P =0.001 ）,patients with high cholesterol in the two groups were 30.6% and 13.4%,respectively （χ^2 =18.47,P =0.001 ）,high triglycerides were 27.3% and 9.7%, respectively （χ^2 =22.15 ,P =0.001）,high low-density lipoprotein were 16.7% and 5 .6%,respectively （χ^2 =13.50,P =0.001）,high uric acid were 31 .0% and 15 .3%,respectively （χ^2 =15 .04,P =0.001 ） and rates of alcohol history were 38.9% and 25 .9%,respectively （χ^2 =8.08,P =0.001）.The differences of hepatitis B virus （HBV）DNA and status of hepatitis B e antigen between the two groups were not statistically significant （both P 〉0.05 ）.Compared to fatty liver group,rates of hepatic inflammation activity degree ≥ 3 （54.6% vs 37.5 %,χ^2 = 12.75 ,P 〈0.01 ）and fibrosis staging ≥ 3 （53.2% vs 41 .7%,χ^2 =5 .80,P =0.016）in non-fatty liver group were both significantly higher.Conclusions CHB patients with overweight/obesity,high cholesterol,high triglycerides,high low-density lipoprotein,high uric acid and drinking history are more likely to develop hepatic steatosis.The inflammatory grade and fibrosis stage

关 键 词：肝炎 乙型 脂肪肝 炎症 纤维化 病例对照研究 影响因素 

分 类 号：R512.62[医药卫生—内科学]