代谢综合征对丙型肝炎病毒感染者肝纤维化进程的研究  

Effect of metabolic syndrome on progression of liver fibrosis in patients with chronic hepatitis C virus infection

作　　者：刘志威 陈友鹏[2,3] 何京[2] 李桃源 赵利婷[2] 梁旭竞 Liu Zhiwei;Chen Youpeng;He Jing;Li Taoyuan;Zhao Liting;Liang Xujing(Department of Internal Medicine,the Sixth People’s Hospital of Huizhou,Huizhou 516200,China)

机构地区：[1]惠州市第六人民医院内三科,惠州516200 [2]暨南大学附属第一医院感染科,广州510630 [3]中山大学附属第七医院感染内科,深圳518107

出　　处：《新医学》2019年第9期691-695,共5页Journal of New Medicine

摘　　要：目的探讨丙型肝炎病毒(HCV)感染伴代谢综合征与否对肝脏病变进展的影响.方法收集住院诊断为HCV感染患者186例,男109例、女77例.将纳入病例按BMI值、血糖、血脂水平正常与否分为2组:BMI≥24kg/m2组与BMI<24kg/m2组,空腹血糖受损(IFG)或临床诊断为2型糖尿病(T2DM)组与空腹血糖正常组,高脂血症组与非高脂血症组.比较组间肝功能指标如ALT、AST、AST/ALT比值、谷氨酰转肽酶、碱性磷酸酶、腺苷脱氨酶(ADA)、胆碱酯酶、总胆红素、白蛋白、肝纤维化4指数(FIB-4)、急性时相反应指数(APRI)、HCVRNA定量、甲胎蛋白的差异.代谢性指标与临床指标关系采用多重线性回归分析.结果IFG或T2DM组的AST/ALT比值、胆碱酯酶、血清白蛋白水平均低于空腹血糖正常组,ADA水平高于空腹血糖正常组(P均<0.05).BMI≥24kg/m^2组与BMI<24kg/m^2组、高脂血症组与非高脂血症组的各项肝功能指标比较差异均无统计学意义(P均>0.05).多重线性回归分析显示,HCV感染者甘油三酯水平与FIB-4评分(标准化偏回归系数=0.233,P=0.002)及APRI(标准化偏回归系数=0.409,P<0.001)有关.结论慢性HCV感染者出现糖耐量异常、2型糖尿病时,有可能影响肝脏合成功能;如果罹患代谢综合征,有可能加速肝脏纤维化进程.Objective To evaluate the effect of metabolic syndrome on the progression of liver fibrosis in patients diagnosed with chronic hepatitis C virus(HCV)infection.Methods A total of 186 patients infected with HCV,109 males and 77 females,were recruited in this investigation.According to the body mass index(BMI),blood glucose level and blood lipid level,all patients were respectively divided into two groups:BMI≥24 kg/m2 and BMI<24 kg/m2 groups,impaired fasting glucose(IFG)/clinically diagnosed type 2 diabetes mellitus(T2DM)and normal fasting glucose groups,hyperlipidemia and non-hyperlipidemia groups.The liver function-related parameters including alanine transaminase(ALT),aspartate transaminase(AST),AST/ALT ratio,γ-glutamyl transpeptidase(γ-GT),alkaline phosphatase(ALP),adenosine deaminase(ADA),cholinesterase,total bilirubin,albumin,fibrosis index based on the four factors(FIB-4),acute phase reaction index(APRI),HCV RNA quantification and alpha-fetoprotein were statistically compared between different groups.The relationship between metabolic parameters and clinical parameters was analyzed by multiple linear regression.The AST/ALT ratio,cholinesterase and serum albumin levels in the IFG and T2DM groups were significantly lower,whereas the ADA levels were remarkably higher compared with those in normal fasting glucose group(all P<0.05).The liver function indexes did not significantly differ between the BMI≥24 kg/m^2 and BMI<24 kg/m^2 groups,hyperlipidemia and non-hyperlipidemia groups(all P>0.05).Multiple linear regression analysis demonstrated that the triglyceride level in HCV infected patients was significantly correlated with the FIB-4 score(β=0.233,P=0.002)and APRI(β=0.409,P<0.001).Conclusions Chronic HCV infection complicated with impaired glucose tolerance and T2DM may affect the function of liver synthesis.If complicated with metabolic syndrome,it probably accelerates the progression of liver fibrosis.

关 键 词：丙型肝炎病毒 代谢综合征 肝纤维化 

分 类 号：R589[医药卫生—内分泌] R512.63[医药卫生—内科学] R575.2[医药卫生—临床医学]