慢性乙型肝炎肝组织损伤的相关因素研究

目的 研究慢性乙型肝炎（CHB）合并非酒精性脂肪肝（NAFLD）患者的肝损伤与肝脏脂联素及a-平滑肌肌动蛋白（a—SMA）表达的相关性，并探讨CHB患者发生NAFLD的机制。方法对94例CHB合并NAFLD患者（病例组）进行肝活检，与119例单纯CHB患者（对照组）进行比较，包括血清肝脏生化学及病毒学指标；对肝活检样本进行组织学及脂联素、a-SMA免疫组织化学染色并测量积分吸光度值。结果病例组血清ALT、总胆固醇、甘油三酯、低密度脂蛋白水平均高于对照组（Z=3．425、4．488、4．858、2．265，P〈0．05）；HBVDNA定量及HBeAg状态在两组间差异无统计学意义（Z=0．825，X^2=0．323，P〉0．05）。脂联素表达在病例组与脂变、炎症及纤维化程度均无明显相关性（r=0．032、-0．107、-0．133，P〉0．05）；而在对照组与炎症及纤维化程度呈负相关（r=-0．223、-0．259，P〈0．05）。a-SMA表达在病例组与炎症及纤维化程度呈明显正相关（r=0．323、0．355，P〈0．05）；在对照组无相关性（r=0．172、0．155，P〉0．05）。结论NAFLD的发生主要与代谢因素有关，而与病毒因素无关；脂联素与CHB合并NAFLD）的肝损伤无直接关系；a-SMA可能是判断CHB合并NAFLD患者肝脏炎症及纤维化程度的重要指标；NAFLD可能促进了CHB患者肝损伤的进展。

Objective To study the expression of adiponectin and α-smooth muscle actin (α-SMA) in liver from the patients of chronic hepatitis B(CHB) overlapped non-alcoholic fatty liver disease( NAFLD), and to explore the mechanism of CHB patients with NAFLD. Methods 94 patients of CHB overlapped NAFLD (case group)underwent liver biopsy, 119 cases of patients with CHB alone (control group) as control, the fasting venous blood sample was taken for liver biochemical and virological indicators. Liver biopsy specimens were immunohistochemically stained for histology, adiponectin and α-SMA, and integral absorbance. Results The serum ALT, total cholesterol, triglyceride, low density lipoprotein cholesterol and fasting glucose levels in case group were significantly higher than that in control group (Z = 3.425,4.488,4.858、2.265, P < 0.05) .There was no significant difference in HBV DNA viral load and HBeAg between the two groups( Z = 0.825, χ2 = 0.323, P > 0.05). In case group, adiponectin expression was no significant correlation with steatosis, inflammation and fibrosis(r = 0.032, -0.107, -0.133, P>0.05); however, in control group adiponectin was negatively related to inflammation and fibrosis(r= -0.223, -0.259,P<0.05). In case group,α-SMA expression was significant correlation with inflammation and fibrosis( r = 0.323,0.355, P < 0.05). In control group, its expression was no correlation with inflammation and fibrosis( r = 0.172,0.155, P > 0.05). Conclusions The occurrence of NAFLD is mainly related to metabolic factors and no relation with viral factors. Adiponectin is not directly related to liver injury of patients of CHB overlapped NAFLD. α-SMA may be important indicator of liver injury,and NAFLD may promote the progress of liver injury in patients with CHB.