慢性乙型肝炎合并代谢相关脂肪性肝病的临床及病理特点分析  

Analysis of clinical and pathological features of chronic hepatitis B combined with metabolic-associated fatty liver disease

作　　者：尚梦月 陈永忠[1] 保洁 仝亚林[1] Shang Mengyue;Chen Yongzhong;Bao Jie;Tong Yalin(Department of Gastroenterology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院消化内科,郑州450052

出　　处：《中华肝脏病杂志》2023年第2期126-132,共7页Chinese Journal of Hepatology

基　　金：青年科学基金(82002552)。

摘　　要：目的分析慢性乙型肝炎(CHB)合并代谢相关脂肪性肝病(MAFLD)患者的临床及病理组织学特征。方法收集2015年1月至2021年10月郑州大学第一附属医院有肝穿刺活组织检查的529例患者的临床资料,其中CHB患者290例,CHB合并MAFLD患者155例,MAFLD患者84例。对3组患者的临床资料包括一般资料、生物化学指标、FibroScan指标、病毒载量及病理组织学进行分析。采用二元logistic回归分析探讨CHB患者发生MAFLD的影响因素。结果(1)CHB合并MAFLD组年龄、男性、高血压及糖尿病的比例、人体质量指数、空腹血糖、γ-谷氨酰转移酶、低密度脂蛋白、胆固醇、甘油三酯、尿酸、肌酐、肝脏脂肪变受控衰减指数均高于CHB患者,而高密度脂蛋白、HBeAg阳性率、病毒载量水平、肝脏纤维化等级(S分期)均低于CHB患者,差异均有统计学意义(P<0.05)。(2)CHB合并MAFLD组的丙氨酸转氨酶、天冬氨酸转氨酶、γ-谷氨酰转移酶、甘油三酯、尿酸、肌酐、肝脏脂肪变受控衰减指数均低于MAFLD患者,而高密度脂蛋白高于MAFLD患者,差异具有统计学意义(P<0.05);两组的肝脏炎症和纤维化等级(GS分期)差异无统计学意义(P>0.05)。二元多因素logistic回归分析结果显示,超重/肥胖、甘油三酯、低密度脂蛋白、肝脏脂肪变受控衰减指数、HBeAg阳性是CHB患者发生MAFLD的独立影响因素。结论CHB患者合并代谢紊乱易发生MAFLD,HBV病毒因素、肝脏纤维化程度与肝脏组织脂肪变性之间有一定相关性。Objective To analyze the clinical and histopathological features of patients with chronic hepatitis B(CHB)combined with metabolic-associated fatty liver disease(MAFLD).Methods Clinical data of 529 cases who had liver biopsies at the First Affiliated Hospital of Zhengzhou University between January 2015 and October 2021 were collected.Among them were 290 cases with CHB,155 cases with CHB combined with MAFLD,and 84 cases with MAFLD.Three groups of patients clinical data,including general information,biochemical indicators,FibroScan indicators,viral load,and histopathology,were analyzed.A binary logistic regression analysis was used to explore the factors influencing MAFLD in patients with CHB.Results(1)Age,male status,proportion of hypertension and diabetes,body mass index,fasting blood glucose,γ-glutamyl transpeptidase,low-density lipoprotein,cholesterol,triglycerides,uric acid,creatinine,and the controlled attenuation parameter for hepatic steatosis were higher in CHB combined with MAFLD than in CHB patient groups.In contrast,the high-density lipoprotein,HBeAg positivity rate,viral load level,and liver fibrosis grade(S stage)were lower in CHB patients,and the differences were statistically significant(P<0.05).(2)Alanine aminotransferase,aspartate aminotransferase,γ-glutamyl transpeptidase,triglycerides,uric acid,creatinine,and the controlled attenuation parameter for hepatic steatosis in CHB combined with the MAFLD were lower than those in MAFLD patient groups,while high-density lipoprotein was higher than that of MAFLD patients,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the grade of liver inflammation and fibrosis(GS stage)between the two groups(P>0.05).Binary multivariate logistic regression analysis showed that overweight/obesity,triglycerides,low-density lipoprotein,the controlled attenuation parameter for hepatic steatosis,and HBeAg positivity were independent influencing factors for MAFLD in CHB patients.Conclusion Patients with CHB combin

关 键 词：慢性乙型肝炎 代谢相关脂肪性肝病 危险因素 炎症及纤维化 

分 类 号：R575.5[医药卫生—消化系统] R512.62[医药卫生—内科学]