慢性HBV感染合并肝脂肪变性患者临床特征及危险因素分析  

The clinical features and risks of patients with chronic HBV infection complicated with hepatic steatosis

作　　者：刘永萍 孟樱 吴晓瑛 郑燕 黄伟 余楷 张仙土 刘雁 Liu Yongping

机构地区：[1]浙江中医药大学附属杭州西溪医院,310023

出　　处：《浙江临床医学》2024年第12期1761-1763,1767,共4页Zhejiang Clinical Medical Journal

基　　金：浙江省医药卫生科技计划项目(2024KY212);杭州市医药卫生科技项目(A20220228);杭州市生物医药和健康产业发展扶持科技专项(2022WJC288)。

摘　　要：目的探讨慢性HBV感染(CBI)合并肝脂肪变性(HS)患者的临床特征及临床结局,并分析CBI患者发生HS的危险因素。方法选择2017年6月至2021年12月本院收治的CBI患者468例,根据肝组织病理结果分为CBI组和CBI+HS组(ST1、ST2、ST3~4)。比较各组患者临床指标及肝组织病理结局,并采用Logistic回归分析法分析CBI患者发生HS的危险因素。结果两组患者BMI、ALT、ALP、GGT、TG、LDL-C、FBS、UA、APOB、PIIINP、APOA1和TE比较,差异有统计学意义(P<0.05);不同HS程度分组BMI、AST、糖尿病患病比例、ALT、GGT及纤维化分布比较,差异有统计学意义(P<0.05)。Logistic回归分析显示ALT、AST、ALP、TG、TE、PIIINP是CBI患者发生HS的危险因素。结论CBI患者发生HS主要受代谢因素影响,合并HS患者纤维化程度较高;按代谢和纤维化的独立危险因素分层有助于疾病的管理。Objective To investigate the clinical characteristics and outcomes of patients with chronic hepatitis B virus(HBV)infection(CBI)complicated with hepatic steatosis(HS),and to analyze the risk factors for HS in CBI patients.Methods 468 patients with CBI admitted to our hospital from June 2017 to December 2021 were selected and divided into the CBI group and the CBI+HS group(ST1,ST2,ST3-4)according to the pathological results of liver tissue.The clinical indicators and liver histopathological outcomes of patients in each group were compared,and the risk factors of HS in CBI patients were analyzed by Logistic regression analysis.Results There were significant differences in body mass index(BMI),ALT,ALP,GGT,TG,LDL-C,FBS,UA,APOB,PIIINP,APOA1 and TE between the two groups(P<0.05).There were significant differences in BMI,AST,proportion of diabetes mellitus,ALT,GGT,and fibrosis distribution between groups with different HS severity(P<0.05).Logistic regression analysis showed that ALT,AST,ALP,TG,TE and PIIINP were risk factors for HS in CBI patients.Conclusion The occurrence of HS in CBI patients is mainly affected by metabolic factors,and the degree of fibrosis is higher in patients with HS.Stratification by independent risk factors for metabolism and fibrosis facilitates disease management.

关 键 词：慢性乙肝病毒感染 肝脂肪变性 肝组织病理 临床特征 危险因素 

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