慢性丙型肝炎合并肝脂肪变相关因素探讨

Risk factors of the chronic hepatitis C with fiver steatosis

目的了解血清视黄醇结合蛋白4（RBP4）是否为慢性丙型肝炎（CHC）合并肝脂肪变的重要因素。方法42例慢性丙型肝炎患者HCVRNA定量和HCV基因分型分别通过荧光定量聚合酶链反应（FQ—PCR）和套式反转录聚合酶链反应（RT—PCR）完成；肝功能、甘油三酯、胆固醇及胰岛素抵抗指数（HO—MA．IR）通过全自动生化分析仪检测。RBP4检测利用酶联免疫吸附试验（ELISA）方法完成。42例健康检查人群作为对照组。结果根据组织学发现，在42例CHC患者中有22例（52％）存在轻度组织学损伤，20例（48％）存在中度或重度组织学损伤。轻度组织学损伤与中度或重度组织学损伤的CHC患者的基线特征问存在差异有统计学意义。61．9％的CHC患者合并肝脂肪变，CHC合并有中度和重度肝脂肪变的患者为28．6％。CHC合并肝脂肪变组相对于健康对照组BMI、ALT、AST及胰岛素抵抗指数（HOMA—IR）均高（P〈0．01），RBP4差异则没有统计学意义[（17．1±0．8）mg／L比（17．3±0．5）mg／L，P〉0．05]。CHC合并肝脂肪变组RBP4和HOMA．IR之间呈负相关，另外RBP4和BMI之间没有相关性。结论肝脂肪变是CHC的一个重要病理学特征。CHC合并肝脂肪变性和胰岛素抵抗、BMI等有密切的关系，伴有肝脂肪变性的CHC患者更易进展为严重肝脏疾病。RBP4在CHC合并肝脂肪变的发生和发展过程中并不是一个重要的因素。

Objective To investigate if retinol binding protein 4 （RBP4） is an important factor in chronic hepatitis C with liver steatosis. Methods . Quantitative detection of HCV RNA and genotyping analysis was completed by Fluorescence Quantification- -Polymerase Chain Reaction （FQ-PCR） and Reverse Transcription-Polymerase Chain Reaction（RT-PCR）, liver function, triglyceride, cholesterin and insulin resistance index. RBP4 test was completed by Enzyme-Linked Immunosorbnent Assay （ ELISA ）. Data were analyzed by SPSS 11.5. The control group included 42 healthy human. Results Slight histopathologic damage included 22 patients. 20 patients had moderate and severe histopathologic damage. Baseline characteristics were significantly different among slight and moderate or severe histopathologic damages. 61.9% of CHC had liver steatosis, 28.6% of CHC with liver steatosis had moderate or severe histopathologic damages. The Body Mass Index（ BMI）, alanine amiotransferase（ ALT）, aspartate aminotransferase（AST） and Homeostatic Model Assessment Of Insulin Resistance （HOMA-IR） were higher in steatosis group than in control group（ P 〈 0. 01 ）. There were no statistic differences in RBP4. RBP4 and HOMAIR were negatively correlated in CHC with steatosis. There was no relation between RBP4 and BMI. Conclusions Live steatosis has important pathological characteristics in CHC with liver steatosis. CHC with liver steatosis is related to IR and BMI. The possibility of serious liver disease in patients with CHC and liver steatosis is higher than that of other patients with CHC. RBP4 is not an important factor in patients with CHC and steatosis.