48例非酒精性脂肪肝合并慢性乙型肝炎患者临床分析

Clinical analysis on 48 patients of chronic hepatitis B combined with nonalcoholic fatty liver disease

目的探讨非酒精性脂肪肝合并慢性乙型肝炎患者的临床病理特征。方法对非酒精性脂肪肝合并慢性乙型肝炎患者和慢性乙肝患者的丙氨酸氨基转移酶、门冬氨酸氨基转移酶、碱性磷酸酶、γ-谷氨酸转移酶、空腹血糖、空腹胰岛素、总胆固醇、三酰甘油、HBV-DNA等进行比较,计算体重指数、胰岛素抵抗指数,通过肝脏组织病理学结果观察非酒精性脂肪肝合并慢性乙型肝炎患者病理特征。结果非酒精性脂肪肝合并慢性乙型肝炎患者的空腹血糖、空腹胰岛素、总胆固醇、三酰甘油、体重指数、胰岛素抵抗指数等高于慢性乙肝患者,病毒载量较低,炎症活度多为G1和G2,纤维化程度在S2以下,脂肪变程度多在F2、F3之间,肝脾CT比值低于慢性乙肝患者。结论非酒精性脂肪肝合并慢性乙型肝炎患者的临床病理特征不同于单纯慢性乙肝患者,应积极行肝组织学检查早期诊断,合理抗病毒治疗。

Objective To discuss the clinical and pathological features of patients of chronic hepatitis B（CHB）combined with nonalcoholic fatty liver disease（NAFLD）.Methods Alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,alkaline phosphatase（ALP）,plasmay-glutamyltransferase（GGT）,fasting bloodglucose（FBG）,fasting insulin（RI）,the total cholesterol（TC）,triglyceride（TG）,HBV-DNA were compared between the patients with NAFLD combined with CHB and the patients with CHB,the body mass index（BMI）and insulin resistance index（IR）were calculated,the pathological features of patients with NAFLD combined with CHB were observed through the liver histopathologic findings.Results FBG,RI,TC,TG,BMI,IR of patients with CHB combined with NAFLD were higher than those of CHB patients,and HBV-DNA was significantly lower,inflammation activity were G1 and G2,the degree of fibrosis was in the S2 stage,the degree of fatty degeneration was between F2 and F3,and the liver spleen CT ratio was lower than CHB patients.Conclusion The feature of clinic and pathology on patients with CHB combined with NAFLD are different from those of CHB patients,early diagnosis of positive liver biopsy should be made to give the proper antiviral treatment.