慢性乙型肝炎合并代谢相关脂肪性肝病患者病毒学特征的分层分析  

Virological features of chronic hepatitis B patients with metabolic associated fatty liver disease:A stratified analysis

作　　者：吕翎娜 李琦 马文霞 丁惠国 刘晖[3] LYU Lingna;LI Qi;MA Wenxia;DING Huiguo;LIU Hui(Department of Hepatology and Gastroenterology,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China;Laboratory for Clinical Medicine,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China;Department of Pathology,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院肝病消化中心,北京100069 [2]首都医科大学附属北京佑安医院首医基础临床联合实验室,北京100069 [3]首都医科大学附属北京佑安医院病理科,北京100069

出　　处：《临床肝胆病杂志》2024年第7期1343-1348,共6页Journal of Clinical Hepatology

基　　金：国家自然科学基金(82372260);北京市自然科学基金海淀原始创新联合项目(L202023);北京佑安医院人才库项目(YARCKB2023003)。

摘　　要：目的分析不同分层的慢性乙型肝炎(CHB)合并代谢相关脂肪性肝病(MAFLD)患者的病毒学特征。方法回顾性选取2013年1月1日—2019年12月31日于首都医科大学附属北京佑安医院行经皮肝穿刺活检、未接受抗病毒治疗或接受治疗后停药6个月以上的CHB合并MAFLD患者131例和单纯CHB患者168例,比较两组患者的一般资料、血生化指标、病毒学指标;根据肝脏病理的炎症活动度(G)及肝纤维化分期(S)对两组患者进行分层,并依据肝脂肪变性程度及非酒精性脂肪性肝炎炎症活动度评分(NAS)对CHB合并MAFLD患者进一步分析,比较各组病毒学(血清HBV DNA和HBsAg水平)特征差异。计量资料两组间比较采用Wilcoxon检验;多组间比较及进一步两两比较均采用Kruskal-Wallis H检验。计数资料两组间比较采用χ^(2)检验。结果CHB合并MAFLD患者中男性、高血压及2型糖尿病的比例,血生化指标甘油三酯、低密度脂蛋白胆固醇、载脂蛋白B、ALT、GGT、尿酸和空腹血糖均明显高于单纯CHB患者(P值均<0.05),而高密度脂蛋白胆固醇、载脂蛋白A1和HBV DNA水平均显著低于单纯CHB患者(P值均<0.05)。肝纤维化分期分层分析结果显示,单纯CHB组和CHB合并MAFLD组显著肝纤维化患者(S2~4)的HBV DNA水平均低于非显著肝纤维化患者(S0~1)(P值均<0.05);单纯CHB组显著肝纤维化患者(S2~4)的HBsAg水平明显低于非显著肝纤维化患者(S0~1)(P<0.05)。炎症活动度分层分析结果显示,CHB合并MAFLD组高炎症活动度患者(G3)的HBV DNA水平高于低炎症活动度患者(G1~2)(P<0.05);CHB合并MAFLD组低炎症活动度患者(G1~2)的HBsAg水平明显低于单纯CHB组低炎症活动度患者(P<0.05)。肝脂肪变性程度分层分析结果显示,HBV DNA水平随脂肪变性程度增加而逐渐降低,其中脂肪变性重度组HBV DNA水平明显低于轻度组(P<0.05),而HBsAg水平在不同肝脂肪变性程度组间无明显变化(P>0.05)。NAS分层分析结果显示Objective To investigate the virological features of patients with chronic hepatitis B(CHB)and metabolic associated fatty liver disease(MAFLD)through a stratified analysis.Methods A retrospective analysis was performed for 131 patients with CHB and MAFLD and 168 patients with CHB alone who underwent percutaneous liver biopsy and did not receive antiviral therapy or withdrew from drugs for more than 6 months in Beijing YouAn Hospital,Capital Medical University,from January 1,2013 to December 31,2019.The two groups were compared in terms of general data,biochemical parameters,and virological parameters.The patients in the two groups were stratified according to liver inflammation grade(G)and liver fibrosis stage(S),and the patients with CHB and MAFLD were further analyzed based on the degree of hepatic steatosis and NAFLD activity score(NAS).Virological features(the serum levels of HBV DNA and HBV HBsAg)were compared between groups.The Wilcoxon test was used for comparison of continuous data between two groups,and the Kruskal-Wallis H test was used for comparison between multiple groups and further comparison between two groups;the chi-square test was used for comparison of categorical data between two groups.Results Compared with the CHB group,the CHB+MAFLD group had a significantly higher proportion of male patients,a significantly higher proportion of patients with hypertension or type 2 diabetes mellitus,and significantly higher levels of the blood biochemical parameters of triglyceride,low-density lipoprotein cholesterol,apolipoprotein B,alanine aminotransferase,gamma-glutamyl transpeptidase,uric acid,and fasting blood glucose(all P<0.05),as well as significantly lower levels of high-density lipoprotein cholesterol,apolipoprotein A1,and HBV DNA(all P<0.05).The stratified analysis based on liver fibrosis stage showed that for both the patients with CHB alone and those with CHB and MAFLD,the significant fibrosis(S2—4)group had a significantly lower level of HBV DNA than the non-significant fibrosis(S0—1)grou

关 键 词：乙型肝炎 慢性 代谢相关脂肪性肝病 病毒学 

分 类 号：R512.62[医药卫生—内科学] R575.5[医药卫生—临床医学]