代谢相关脂肪性肝病合并慢性乙型肝炎患者进展期纤维化分析  

Analysis of advanced fibrosis in metabolic dysfunction-associated fatty liver disease patients with chronic hepatitis B

作　　者：吴雪 李萍[1] 宓余强[1] Wu Xue;Li Ping;Mi Yuqiang(Department of Gastroenterology,Department Two of Traditional Chinese and Western Medical Liver Disease,Tianjin Hepatopathy Research Institute,Tianjin Second People′s Hospital,Tianjin 300192,China)

机构地区：[1]天津市第二人民医院中西医结合肝病二科,天津市肝病医学研究所,天津300192 [2]华中科技大学协和深圳医院感染科

出　　处：《中华内科杂志》2024年第1期53-58,共6页Chinese Journal of Internal Medicine

基　　金：中国肝炎防治基金会王宝恩肝纤维化研究基金(2021038)。

摘　　要：目的探究代谢相关脂肪性肝病(MAFLD)合并慢性乙型肝炎(CHB)患者肝脏病理特点,以及与进展期纤维化之间的关系。方法病例对照研究。收集2016年6月至2019年9月在天津市第二人民医院进行肝组织活检的CHB患者数据。根据是否合并MAFLD将患者分为MAFLD-CHB组和CHB组,采用t检验和卡方检验比较两组间病理特点及一般基本特征,采用logistic回归分析进展期纤维化相关因素。结果本研究共纳入272例MAFLD-CHB患者和110例单独CHB患者,两组在吸烟、饮酒、高血压发生率、身体代谢指标(BMI)、丙氨酸转氨酶(ALT)、γ-谷氨酰转肽酶(GGT)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、空腹血糖水平(FPG)、血小板计数(PLT)方面差异均有统计学意义(均P<0.05)。MAFLD-CHB组进展期纤维化发生率高于CHB组(P<0.05)。logistic回归分析显示,合并MAFLD(OR=2.204,95%CI 1.018~4.774,P=0.045)、GGT(OR=1.008,95%CI 1.002~1.013,P=0.005)、PLT(OR=0.995,95%CI 0.991~0.999,P=0.019)与进展期纤维化发生相关。在MAFLD-CHB组中,合并2型糖尿病(OR=3.281,95%CI 1.375~7.832,P=0.007)、GGT(OR=1.011,95%CI 1.003~1.018,P=0.005)、PLT(OR=0.993,95%CI 0.988~0.998,P=0.004)与进展期纤维化发生相关。结论MAFLD-CHB患者进展期纤维化发生率高于单独CHB患者。在MAFLD-CHB组中,合并2型糖尿病与进展期肝纤维化发生相关。对于MAFLD-CHB患者,应更加严格控制相关危险因素,尤其对于合并2型糖尿病的患者。Objective To investigate the clinical and pathological characteristics of chronic hepatitis B(CHB)with metabolic dysfunction-associated fatty liver disease(MAFLD),as well as associations with advanced fibrosis.Methods CHB patients who underwent liver biopsy at Tianjin Second People′s Hospital from June 2016 to September 2019 were included in the study.The patients were divided into two groups based on whether they had concomitant MAFLD;a CHB group and a MAFLD-CHB group.t-tests and Chi-square tests were used to compare pathological characteristics and basic features in the two groups.Logistic regression analysis was used to analyze factors associated with advanced fibrosis.Results The CHB group included 110 patients,and the MAFLD-CHB group included 272 patients.There were significant differences in smoking,alcohol consumption,hypertension incidence,body metabolic index,alanine aminotransferase,gamma-glutamyl transferase(GGT),high-density lipoprotein,low-density lipoprotein,fasting plasma glucose,and platelets(PLT)between the two groups(all P<0.05).The MAFLD-CHB group had a higher incidence of advanced fibrosis than the CHB group(P<0.05).In logistic regression analysis MAFLD[odds ratio(OR)=2.204,95%confidence interval(CI)1.018-4.774,P=0.045],GGT(OR=1.008,95%CI 1.002-1.013,P=0.005),and PLT(OR=0.995,95%CI 0.991-0.999,P=0.019)were associated with advanced fibrosis(all P<0.05).In the MAFLD-CHB group type 2 diabetes(OR=3.281,95%CI 1.375-7.832,P=0.007),GGT(OR=1.011,95%CI 1.003-1.018,P=0.005),and PLT(OR=0.993,95%CI 0.988-0.998,P=0.004)were associated with advanced fibrosis(P<0.05).Conclusion Patients with MAFLD-CHB are more likely to develop advanced fibrosis than patients with CHB alone.In the MAFLD-CHB group type 2 diabetes mellitus was associated with advanced fibrosis.It is important to strictly control relevant risk factors in MAFLD-CHB patients,especially in patients with type 2 diabetes.

关 键 词：脂肪肝 肝炎 乙型 慢性 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]