慢性丙型肝炎合并脂肪肝的临床特征及危险因素分析

Clinical characteristics and risk factors of chronic hepatitis C complicated by fatty liver

目的分析慢性丙型肝炎(CHC)合并脂肪肝的临床特征及危险因素。方法收集2017年3月至2021年3月于湖州市第一人民医院就诊的符合纳入标准的CHC患者258例的临床资料,按是否合并脂肪肝将患者分为单纯CHC组和合并脂肪肝组,分析并比较两组患者的一般资料、肝功能、凝血功能及血脂指标等。结果258例CHC患者中有81例合并脂肪肝,占31.40%;177例未合并脂肪肝,占69.14%。两组患者年龄、性别以及烟酒史等差异均无统计学意义(均P>0.05);两组体质量指数(BMI)差异有统计学意义(χ^(2)=29.81,P<0.001),与单纯CHC组患者比较,合并脂肪肝患者BMI明显偏高。两组患者在高血压、冠心病病史方面差异均无统计学意义(均P>0.05)。两组患者在是否合并高甘油三酯血症和低密度脂蛋白升高方面差异均有统计学意义(χ^(2)=8.53、6.99,P=0.004、0.008);在是否存在高胆固醇血症以及高密度脂蛋白降低等方面差异均无统计学意义(均P>0.05);两组患者丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)等肝功能指标差异均无统计学意义(均P>0.05);两组患者γ-谷氨酰转移酶(γ-GGT)差异有统计学意义(t=-8.71,P<0.001)。两组患者活化部分促凝血酶原激酶时间(APTT)差异无统计学意义(P>0.05);凝血酶原时间(PT)、国际标准化比值(INR)等凝血功能指标差异均有统计学意义[(10.10±0.67)s比(11.99±1.33)s,0.91±0.07比0.98±0.11;t=9.74、4.46,均P<0.001]。两组患者空腹血糖(FBG)、血尿酸(sUA)水平差异均无统计学意义(均P>0.05);空腹血胰岛素(FINS)差异有统计学意义[(16.82±1.15)mlU/L比(12.52±1.06)mlU/L,t=-24.33,P<0.001]。将两组患者的基本资料和临床资料进行比较,筛选出差异有统计学意义的因子(BMI、高甘油三酯血症、低密度脂蛋白升高、γ-GGT、PT、INR以及FINS)并进行多因素logistic回归分析结果显示,BMI≥24 kg/m2、高甘油三酯血症、γ-GGT、PT、INR以及FINS为CHC合并脂肪肝的独立危险因素(P=0.017、0.003、0.021、0.034、0.004、0.001)。治疗6个月时,单纯CHC组丙型肝炎病毒(HCV)RNA转阴率明显高于合并脂肪肝组,差异有统计学意义(χ^(2)=7.32,P=0.010)。结论CHC合并脂肪肝患者的相关危险因素包括BMI、高甘油三酯血症、低密度脂蛋白升高、γ-GGT、PT、INR以及FINS,其中BMI、高甘油三酯血症、γ-GGT、PT、INR以及FINS是其独立危险因素。此外,CHC合并脂肪肝患者可能影响抗病毒治疗效果。

Objective To analyze the clinical characteristics and risk factors of chronic hepatitis C(CHC)complicated by fatty liver.Methods The clinical data of 258 patients with chronic hepatitis C who received treatment in The First People's Hospital of Huzhou from March 2017 to March 2021 were included in this study.They were divided into simple CHC group and CHC complicated by fatty liver group according to whether they had fatty liver.General data,liver function,coagulation function and blood lipid indexes were compared between the two groups.Results Among 258 patients with CHC infection,81 cases had fatty liver,accounting for 31.40%;177 cases did not have fatty liver,accounting for 69.14%.There were no significant differences in age,sex,and history of smoking and alcohol use between the two groups(both P>0.05).Body mass index(BMI)differed significantly between the two groups(χ^(2)=29.81,P<0.001).BMI in the CHC complicated by fatty liver group was slightly higher than that in the simple CHC group.There were no significant differences in history of hypertension and coronary heart disease between the two groups(both P>0.05).There were significant differences in the presence of hypertriglyceridemia and the increase of low-density lipoprotein between the two groups(χ^(2)=8.53,6.99,P=0.004,0.008).There were no significant differences in the presence of hypercholesterolemia and the reduction of high-density lipoprotein(both P>0.05).There were no significant differences in liver function indexes such as alanine aminotransferase and aspartate aminotransferase between the two groups(both P>0.05).The level ofγ-glutamyltransferase(γ-GGT)was significantly different between the two groups(t=-8.71,P<0.001).There was no significant difference in activated partial thromboplastin time between the two groups(P>0.05).There were significant differences in prothrombin time(PT)and international normalized ratio(INR)between the two groups[PT:(10.10±0.67)seconds vs.(11.99±1.33)seconds;INR:0.91±0.07 vs.0.98±0.11;t=9.74,4.46,both P<0.001].There were no significant differences in fasting blood glucose and blood uric acid levels between the two groups(both P>0.05).Fasting insulin(FINS)differed significantly between CHC complicated by fatty liver and simple CHC groups[(16.82±1.15)mlU/L vs.(12.52±1.06)mlU/L,t=-24.33,P<0.001].The general data and clinical data were compared between the two groups.BMI,hypertriglyceridemia,high-and low-density lipoprotein,γ-GGT,PT,INR and FINS differed significantly between the two groups.Multivariate logistic regression results showed that BMI≥24 kg/m2,hypertriglyceridemia,γ-GGT,PT,INR and FINS were independent risk factors for CHC complicated by fatty liver(P=0.017,0.003,0.021,0.034,0.004,0.001).After 6 months of treatment,CHC RNA negative conversion rate in the simple CHC group was significantly higher than that in the CHC complicated by fatty liver group(χ^(2)=7.32,P=0.010).Conclusion The related risk factors of CHC complicated by fatty liver include BMI,hypertriglyceridemia,elevated low-density lipoprotein,γ-GGT,PT,INR and FINS,among which,BMI,hypertriglyceridemia,γ-GGT,PT,INR and FINS are independent risk factors.In addition,CHC complicated by fatty liver may affect the efficacy of antiviral therapy.