肝脂肪变性与慢性乙型肝炎之间的关系及对肝纤维化的影响  

The relationship between hepatic steatosis and chronic hepatitis B and the effects on liver fibrosis

作　　者：曾扠明 卢世云[2] 郭太林[1] 苏友福 陈文惠[1] 何晓红[1] Zeng Chaiming;Lu Shiyun;Guo Tailin;Su Youfu;Chen Wenhui;He Xiaohong(Department of Geriatric Medicine,Fujian Provincial Hospital,Fuzhou 350001,China;Department of Gastroenterology,Jinshan Branch of Fujian Provincial Hospital,Fuzhou 350001,China;Department of Infectious Disease,Wuyishan Municipal Hospital,Wuyishan 354300,China)

机构地区：[1]福建省立医院干部特诊科,福州350001 [2]福建省立医院金山分院消化内科,福州350001 [3]武夷山市立医院感染科,354300

出　　处：《国际病毒学杂志》2019年第6期408-412,共5页International Journal of Virology

基　　金：福建省科技厅引导性项目资助(2018Y0013)。

摘　　要：目的探讨慢性乙型肝炎(chronic hepatitis B,CHB)合并非酒精性脂肪肝(nonalcoholic fatty liver disease,NAFLD)患者中肝脂肪变性与乙肝病毒复制状态之间的关系及对肝纤维化的影响.方法选取福建省立医院2016年12月至2019年2月期间就诊的CHB患者126例,其中59例合并NAFLD.分析单纯CHB组和伴脂肪变性CHB组之间的乙肝病毒复制状况,通过无创肝纤维化诊断模型GPR、FIB-4、APRI和Forns预测肝纤维化的情况,并通过Pearson分析检测模型与乙肝病毒载量、生化、血常规的相关性.结果CHB合并NAFLD组HBeAg(hepatitis B virus e antigen)阳性率明显低于单纯CHB组(x2=5.301,P=0.021),两组间在HBV DNA载量方面无明显差异(U=1918.500,P=0.903).抗病毒治疗的比例在合并NAFLD的CHB组是明显高于单纯CHB组(x2=4.131,P=0.042).肝纤维化无创诊断模型GPR、APRI评分在两组间没有差异,FIB-4、Forns指数在合并NAFLD的CHB组较单纯CHB组降低(U=1426.500,P=0.007;U=1323.000,P=0.001).这4个无创肝纤维化诊断模型均与TBIL,DBIL,AST,GGT呈正相关,与ALB,PLT呈负相关,组间差异均有统计学意义(P<0.05).结论在CHB合并NAFLD组,HBeAg阳性率更低,抗病毒治疗比例更高,提示HBeAg阴性及接受抗病毒治疗的CHB患者更需警惕NALFD发生.使用无创肝纤维化诊断模型GPR、APRI、FIB-4及Forns评分提示肝脂肪变性并没有加重CHB引起的肝纤维化的程度.Objective To investigate the relationship between hepatic steatosis and hepatitis B virus(HBV)replication in patients with chronic hepatitis B(CHB)and non-alcoholic fatty liver disease(NAFLD)and the effect of hepatic steatosis on hepatic fibrosis.Methods A total of 126 CHB patients were selected from Fujian Provincial Hospital from December 2016 to February 2019,including 59 patients complicated with NAFLD.Hepatitis B virus replication was analyzed between CHB group and CHB group with steatosis.Hepatic fibrosis was predicted by noninvasive diagnostic models,including GPR,FIB-4,APRI and Forns models.The correlations of noninvasive diagnostic models with HBV viral load,biochemistry tests and blood routine tests were analyzed by Pearson correlation analysis.Results The positive rate of Hepatitis B virus e antigen(HBeAg)in CHB combined with NAFLD group was significantly lower than that in CHB group(x2=5.301,P=0.021).There was no statistically significant difference in HBV DNA quantification between the two groups(U=1918.500,P=0.903).Antiviral therapy in CHB combined with NAFLD group was significantly higher than that in CHB alone group(x2=4.131,P=0.042).GPR and APRI scores of non-invasive diagnostic model of liver fibrosis showed no statistically significant difference between the two groups.FIB-4 and Forns index in CHB combined with NAFLD group were significantly lower than those in CHB alone group(U=1426.500,P=0.007;U=1323.000,P=0.001),The results of the four models were positively correlated with TBIL,DBIL,AST and GGT,but were negatively correlated with ALB and PLT.There was significant difference between groups(P<0.05).Conclusions In CHB combined with NAFLD group,the positive rate of HBeAg was lower and the proportion of antiviral treatment was higher,suggesting that the prevalence of NALFD among CHB patients with HBeAg negative and antiviral treatment should be paid more attention.The scores of non-invasive diagnostic models,including GPR,APRI,FIB-4 and Forns,for the diagnosis of liver fibrosis indicated that he

关 键 词：福建省立医院 乙肝病毒复制 肝纤维化诊断 HBEAG阴性 肝脂肪变性 慢性乙型肝炎 NAFLD 非酒精性脂肪肝 

分 类 号：R51[医药卫生—内科学]