慢性乙型肝炎患者合并极轻肝脏脂肪变性的临床特征及危险因素分析  

Clinical features and related risk factors of chronic hepatitis B patients with concomitant minimal hepatic steatosis

作　　者：马晓艳 陈云[2] 刘嘉城 李婕 吴超[3] MA Xiaoyan;CHEN Yun;LIU Jiacheng;LI Jie;WU Chao(Nanjing University Medical School,Nanjing 210008,China;Drum Tower Clinical Medical College of Nanjing Medical University,Nanjing 210008,China;Department of Infectious Diseases,Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院,南京210008 [2]南京医科大学鼓楼临床学院,南京210008 [3]南京大学医学院附属鼓楼医院感染疾病科,南京210008

出　　处：《临床肝胆病杂志》2023年第1期63-69,共7页Journal of Clinical Hepatology

基　　金：国家自然科学基金面上项目(81970545,82170609)。

摘　　要：目的观察慢性乙型肝炎(CHB)患者合并极轻肝脏脂肪变性的临床指标的变化,并分析极轻脂肪变性发生的相关影响因素。方法纳入2018年7月—2022年3月在南京大学医学院附属鼓楼医院感染疾病科行肝穿刺活检的CHB患者共179例。依据脂肪变性程度分为无脂肪变性组(n=98)、极轻脂肪变性组(n=81)。收集人口学信息、临床资料及肝组织病理学资料,比较各观察指标在两组中的差异。符合正态分布的计量资料两组间比较采用独立样本t检验,不符合正态分布的两组间比较采用Mann-Whitney U检验,计数资料两组间比较采用χ^(2)检验。相关性分析采用Spearman检验。Logistic回归分析极轻脂肪变性发生的危险因素。结果极轻脂肪变性组中男性比例(69.1%vs 52.0%)及显著纤维化比例(43.2%vs 25.5%)较无脂肪变性组高(χ^(2)值分别为5.390、6.234,P值均<0.05)。极轻脂肪变性组BMI[(23.61±2.95)kg/m^(2)vs(22.13±2.67)kg/m^(2)]、尿酸(UA)[333.0(291.0~375.5)μmol/L vs 287.5(244.8~345.3)μmol/L]、TG[0.92(0.66~1.14)μmol/L vs 0.77(0.62~1.02)μmol/L]、肝脏脂肪受控衰减参数(CAP)[234(214~258)dB/m vs 218(201~237)dB/m]水平均高于无脂肪变性组(t=-4.150,Z=-3.620,Z=-2.224,Z=-2.867,P值均<0.05)。正常体质量组,极轻脂肪变性患者UA[(333.0±63.9)μmol/L vs(291.0±72.8)μmol/L]、HBV DNA[4.44(3.51~6.79)log10IU/mL vs 3.42(3.00~5.03)log10IU/mL]高于无脂肪变性患者(t=-2.395,Z=-2.474,P值均<0.05)。BMI(OR=1.223,95%CI:1.086~1.378,P=0.001)、UA(OR=1.006,95%CI:1.002~1.010,P=0.008)为CHB合并极轻脂肪变性的危险因素。UA(OR=1.007,95%CI:1.001~1.013,P=0.022)为正常体质量CHB患者合并极轻脂肪变性的危险因素。结论合并极轻脂肪变性的CHB患者显著纤维化比例、CAP高于无脂肪变性者。BMI、UA是CHB患者发生极轻脂肪变性的独立危险因素。尤其在正常体质量CHB患者,UA升高与极轻脂肪变性的发生关系密切。Objective To investigate the changes of clinical indices in chronic hepatitis B(CHB)patients with concomitant minimal hepatic steatosis and related factors for minimal hepatic steatosis.Methods A total of 179 CHB patients who underwent liver biopsy in Department of Infectious Diseases,Affiliated Drum Tower Hospital of Nanjing University Medical School,from July 2018 to March 2022 were enrolled,and according to the degree of steatosis,they were divided into non-steatosis group with 98 patients and minimal hepatic steatosis group with 81 patients.Demographic information,clinical data,and liver histopathology data were collected,and related observation indices were compared between the two groups.The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between groups.A Spearman correlation analysis was performed,and a Logistic regression analysis was used to investigate the risk factors for minimal hepatic steatosis.Results Compared with the non-steatosis group,the minimal hepatic steatosis group had a significantly higher proportion of male patients(69.1%vs 52.0%,χ^(2)=5.390,P<0.05)and a significantly higher proportion of patients with significant liver fibrosis(43.2%vs 25.5%,χ^(2)=6.234,P<0.05).Compared with the non-steatosis group,the minimal hepatic steatosis group had significantly higher levels of body mass index(BMI)(23.61±2.95 kg/m^(2) vs 22.13±2.67 kg/m^(2),t=-4.150,P<0.05),uric acid(UA)[333.0(291.0-375.5)μmol/L vs 287.5(244.8-345.3)μmol/L,Z=-3.620,P<0.05],triglyceride[0.92(0.66-1.14)μmol/L vs 0.77(0.62-1.02)μmol/L,Z=-2.224,P<0.05],and controlled attenuation parameter(CAP)[234(214-258)dB/m vs 218(201-237)dB/m,Z=-2.867,P<0.05].In the group with normal body weight,the patients with minimal hepatic steatosis had significantly higher levels of UA(333.0±63.9μmol/L vs 291

关 键 词：乙型肝炎 慢性 非酒精性脂肪性肝病 危险因素 

分 类 号：R512.62[医药卫生—内科学]