饮酒对慢性乙型病毒性肝炎进展为肝硬化的影响  

Effect of drinking on progress of chronic viral hepatitis B to liver cirrhosis

作　　者：周恩豪 杨春[1] ZHOU Enhao;YANG Chun(Department of Infectious Diseases,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400036,China)

机构地区：[1]重庆医科大学附属第一医院感染科,400036

出　　处：《重庆医学》2021年第16期2787-2793,共7页Chongqing medicine

摘　　要：目的探索饮酒量对慢性乙型病毒性肝炎(以下简称慢性乙肝)进展为肝硬化的影响,以及酒精与乙型肝炎病毒(HBV)对肝硬化进展的相互作用。方法回顾性分析该院就诊的90例乙型肝炎肝硬化患者的临床资料,根据既往饮酒史分为不饮酒组、适量饮酒组和过量饮酒组。记录患者开始治疗时、治疗第3、6个月的肝纤谱[Ⅲ型胶原蛋白(PⅢNP)、Ⅳ型胶原蛋白(CⅣ)、层粘连蛋白(LN)、透明质酸(HA)],HBV DNA载量,转氨酶[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)],乙型肝炎表面抗原(HBsAg)定量,Child评分分级情况及并发症发生情况。结果3组各时间点肝纤谱指标、HBV DNA载量、转氨酶水平比较,差异均有统计学意义(P<0.05),且过量饮酒组水平最高;而适量饮酒组和不饮酒组上述指标水平在部分时间点无明显差异(P>0.05)。3组各时间点Child评分分级构成比较,差异均有统计学意义(P<0.001),其中过量饮酒组中Child C级患者比例高于其余两组,不饮酒组中Child A级患者比例高于其余两组。治疗第3、6个月时,过量饮酒组Child C级患者比例较入组时无明显差异(P>0.05)。3组各时间点HBsAg水平无明显差异(P>0.05)。结论患有慢性乙肝并过量饮酒的患者可能通过激活HBV DNA增加肝脏炎症,加速肝硬化的进展,适量饮酒对慢性乙肝进展为肝硬化的影响可能不大。Objective To explore the influence of alcohol consumption on the progression of chronic viral hepatitis B to liver cirrhosis,and how alcohol interacted with hepatitis B virus(HBV)to affect the progression of liver cirrhosis.MethodsThe clinical data of 90 cases of patients with hepatitis B liver cirrhosis treated in this hospital were retrospectively analyzed.The patients were divided into the non-drinking group,moderate drinking group and excessive drinking group acording to the past drinking history.The levels of liver fiber spectrum(PⅢNP,CⅣ,LN and HA),HBV DNA load,transaminase(ALT,AST),HBsAg quantity,the number of patients in Child-Pugh scoring system rating and complication occurrence in each group were recorded at the treatment begining and 3,6 months after treatment.Results The levels of liver fiber spectrum indicators,HBV DNA loads,and levels of transaminase had statistically significant differences among the three groups at any time point(P<0.05),moreover the levels in the excessive drinking group were the highest;but the levels of above indicators at the partial time points had no statistically significant difference between the modereate drinking group and non-drinking group(P>0.05).The comparison of Child-Pugh score grade constituent showed statistically significant differences among the three groups at any time point(P<0.001),in which the proportion of patients with Child grade C in the excessive drinking group was higher than that in the other two groups,and the proportion of patients with the Child grade A in the non-drinking group was higher than that in the other two groups.At the 3,6 months after treatment,the proportion of patients with the Child grade C in the excessive dringking group showed no statistically significant difference compared with that at the treatment begining(P>0.05).The HBsAg level at each time point had no statistically significant difference among the three groups(P>0.05).Conclusion Chronic viral hepatitis B and excessive drinking may increase liver inflammation by activa

关 键 词：乙型病毒性肝炎 饮酒 过度饮酒 肝硬化 

分 类 号：R512.62[医药卫生—内科学]