HBeAg阳性与阴性慢性乙型肝炎合并脂肪肝患者临床和病理学特征分析

Clinical and pathological features of HBeAg negative/positive chronic hepatitis B patients complicated with fatty liver disease

目的研究HBeAg阳性与HBeAg阴性慢性乙型肝炎合并脂肪肝患者临床和肝组织病理学特征。方法回顾性分析行肝穿刺活检术的慢性乙型肝炎(CHB)患者120例的临床资料,分析比较HBeAg阳性与HBeAg阴性CHB合并脂肪肝患者血清生化指标、病毒载量和肝组织病理学表现等的差异。结果在120例CHB患者中,HBeAg阳性68例(56.7%),阴性52例(43.3%)。在HBeAg阳性组中检出合并脂肪肝者11例(16.2%),明显低于HBeAg阴性组18例(34.6%,P<0.05);HBeAg阳性合并脂肪肝患者血清TG和GGT水平高于无脂肪肝的HBeAg阳性患者(P<0.05);在伴脂肪肝患者,HBeAg阳性者平均年龄(28.2±11.3岁)和纤维化评分(2.0±0.7)较HBeAg阴性者低(分别为36.2±14.6岁和2.6±0.8,P<0.05),而体重指数(BMI,27.3±4.0)、TG(3.7±0.4mmol/L)和HBV DNA定量水平(6.8±1.3 lgcopies/mL)高于阴性患者(分别为20.1±5.1,1.5±0.4 mmol/L,4.4±2.6 lgcopies/mL),差异有统计学意义(P<0.05)。结论 HBeAg阴性慢性乙型肝炎合并脂肪肝患者比例较高,应尽早行肝穿刺活检,以便指导治疗。

Objective To investigate the clinical and pathological features of HBeAg negative and positive chronic hepatitis B patients complicated with fatty liver.Methods In 120 patients with chronic hepatitis B（CHB）,the liver biopsy was conducted,and blood biochemical parameters and serum HBV DNA were tested respectively.Results Among 120 patients with CHB,68 were HBeAg positive（56.7%）,and 52 HBeAg negative（43.3%）.In patients with HBeAg positive,we found fatty liver disease in 11（16.2%）,much lower than 18（34.6%,P0.05）in HBeAg negative patients;Serum triglyceride and γ-glutamyltranspeptidase levels in HBeAg positive patients with fatty liver disease were higher than in HBeAg positive patients without（P0.05）;In patients with fatty liver disease,the average ages（36.2±14.6y-o）and hepatic fibrosis scores（2.6±0.8）in HBeAg negative were significantly higher than in HBeAg positive group（28.2±11.3y-o and 2.0±0.7,respectively,P0.05）,while body mass index（20.1±5.1）,triglyceride（1.5±0.4mmol/L）and HBV DNA load（4.4±2.6 lgcopies/mL）were lower than in HBeAg positive（27.3±4.0,3.7±0.4 mmol/L,6.8±1.3 lgcopies/mL,respectively（P0.05）.Conclusion The prevalence of fatty liver disease in HBeAg negative CHB patients is relatively higher,so they should be checked-up as early as possible.