减重对CHB和(或)NAFLD患者肝纤维化及脂肪肝程度的影响  

The impact of weight loss on the severity of liver fibrosis and fatty liver in patients with chronic hepatitis B and/or non-alcoholic fatty liver disease

作　　者：厉绾 韩艳霞 谢寿珍 马颖才[1] 杨永耿[1] 李萍英[1] LI Wan;HAN Yan-xia;XIE Shou-zhen;MA Ying-cai;YANG Yong-geng;LI Ping-ying(Department of Gastroenterology,Qinghai Provincial People’s Hospital,Xining 810007,China;Qinghai University,Xining 810016,China;Department of Hepatology,The fourth People’s Hospital of Qinghai Province,Xining 810007,China)

机构地区：[1]青海省人民医院消化科,西宁810007 [2]青海大学,810016 [3]青海省第四人民医院肝一科,810012

出　　处：《肝脏》2023年第2期203-206,共4页Chinese Hepatology

基　　金：青海省卫生与健康委员会指导性研究项目(2019-wjzdx-34)。

摘　　要：目的 通过Fibro-Touch无创诊断CHB和(或)NAFLD患者肝纤维化和脂肪肝程度,评价减重干预对CHB和(或)NAFLD肝纤维化及肝脏脂肪变影响。方法 收集A组(CHB)病例52例、B组(NAFLD)病例58例,C组(CHB合并NAFLD)病例50例。记录干预前患者的Fibro-Touch检测指标:肝脏硬度值(LSM)、肝脏脂肪变受控衰减参数(CAP)、肝功能及血脂指标等一般资料,开展6个月的减重干预指导,分为干预有效组(BMI下降≥2 kg/m^(2))、干预无效组(BMI下降<2 kg/m^(2)),结束后复测上述指标,并对上述指标进行减重干预前后比较。结果 B组干预有效组患者的LSM、ALT值有所下降,B组干预有效组减重前LSM、ALT值分别为(9.8±1.9)kPa,、(31.8±10.6)U/L,B组干预有效组减重6个月后LSM、ALT值分别为(8.0±1.5)kPa、(31.8±10.6)U/L,差异有统计学意义(P值分别为0.002和0.001);三组病例中干预有效组的CAP值均下降明显,A组减重前CAP(230.2±10.3)db/m,六个月后CAP(212.7±10.1)db/m,P=0.003、B组减重前CAP(303.9±26.2)db/m,六个月后CAP(261.8±18.6)db/m,P=0.008、C组减重前CAP(289.7±31.6)db/m,六个月后CAP(250.1±21.6)db/m,P=0.016(P<0.05);三组病例中干预有效组,A组减重前TG、LDL-c为(1.3±0.4)、(2.2±0.7)mmol/L,A组六个月后TG、LDL-c为(0.9±0.2)、(1.7±0.5)mmol/L,B组减重前TG、LDL-c为(2.3±1.2)、(2.8±1.1)mmol/L,B组六个月后TG、LDL-c为(1.7±0.7)、(2.3±0.7)mmol/L,C组减重前TG、LDL-c为(1.9±1.0)、(2.1±0.6)mmol/L,C组六个月后TG、LDL-c为(1.2±0.6)、(1.6±0.5)mmol/L,干预有效组前后血脂(TG、LDL-c)均下降明显(P<0.05)。结论 通过Fibro-Touch无创检测CHB和(或)NAFLD患者肝纤维化和脂肪肝程度,发现有效的减重干预能明显缓解NAFLD患者肝脏脂肪变程度,改善肝纤维化,还能改善肝功能及血脂指标,进一步延缓此类疾病的进展。通过有效的减重干预后,单纯CHB患者CAP有所下降,CHB合并NAFLD患者脂肪肝程度有所好转,同时还能改善血脂指标,其中TG、LDL-c改善Objective To evaluate the impact of weight loss to mitigate the progression of liver fibrosis and the accumulation of liver fat in chronic hepatitis B(CHB) and/or non-alcoholic fatty liver disease(NAFLD) patients. Methods The participants were divided into three groups: group A with CHB(52 cases), group B with NAFLD(58 cases), and group C with CHB concurrent with NAFLD(50 cases). Fibro-Touch was used to non-invasively detect the degree of liver fibrosis and fatty liver disease by measurement of liver stiffness(LSM) and controlled attenuation coefficient(CAP), The general liver function indicators and blood levels of lipids of these participants were tested before and after intervention. According to the guidance, the interventions on weight loss were conducted in three groups of cases for 6 months. The effectiveness of intervention was defined as a decrease in BMI for ≥2 kg/m^(2). Results The values of LSM and ALT in the effective group B decreased, and the values of LSM and ALT before weight loss in the effective group B were(9.8±1.9) kPa and(31.8±10.6) U/L, respectively. After six months of weight loss, the values of LSM and ALT in group B were(8.0±1.5) kPa and(31.8±10.6) U/L, respectively, and the differences were statistically significant(P values 0.002 and 0.001, respectively). The CAP value of the effective intervention group decreased significantly in the three groups. The CAP value of the group A before weight loss was(230.2±10.3) db/m, and the CAP after six months was(212.7±10.1) db/m, P=0.003. The CAP value of the group B before weight loss was(303.9±26.2) db/m. After six months, the CAP was(261.8±18.6) db/m, P=0.008. Before the weight loss in group C, the CAP was(289.7±31.6) db/m and after six months, the CAP was(250.1±21.6) db/m, P=0.016(P<0.05). In the effective intervention group, before weight loss, TG and LDL-c in group A were(1.3±0.4) and(2.2±0.7) mmol/L, and after six months, TG and LDL-c in group A were(0.9±0.2) and(1.7±0.5) mmol/L. Before weight loss, TG and LDL-c of group B we

关 键 词：慢性乙型病毒性肝炎 非酒精性脂肪性肝病 Fibro-Touch 减重 肝纤维化 脂肪肝程度 

分 类 号：R575[医药卫生—消化系统]