慢性乙型肝炎合并肝脂肪变的影响因素

The influencing factors of hepatic steatosis in patients with chronic hepatitis B

目的探讨慢性乙型肝炎（CHB）合并肝脂肪变的影响因素，为CHB患者肝脂肪变的防治提供理论依据。方法研究对象为厦门大学附属东南医院肝病中心住院的CHB患者291例，其中132例CHB合并肝脂肪变（肝脂肪变组），159例CHB患者不合并肝脂肪变（无肝脂肪变组），采用病例对照研究的方法，对两组人群体质指数（BMI）、腰臀比（WHR）、空腹血糖（FBG）、三酰甘油（TG）、总胆固醇（Tc）、AST、7-GT、HBeAg、HBVDNA等指标进行比较，分析各项指标与CHB合并肝脂肪变的关系以及两组的肝组织学特征。统计学处理采用秩和检验和t检验。结果CHB合并肝脂肪变患者和无肝脂肪变患者FBG、TG、TC、7-GT、AST分别为（5．11±0．62）mmol／L、（1．81土0．89）mmol／L、（5．29±1．05）mmol／L、（65．04±53．89）U／L、（65．60±71．52）U／L和（4．94±1．89）mmol／L、（1．21±0．79）mmol／L、（4．25±1．58）mmol／L、（146．48±200．39）U／L、（65．35±180．57）U／L，肝脂肪变组患者FBG、TG、TC高于无肝脂肪变组（Z值分别-3．607、4．039和4．197，均P〈0．01），无肝脂肪变组患者7-GT、AST高于肝脂肪变组（Z值分别：2．627和3．020，均P〈0．01）。CHB合并肝脂肪变患者和无肝脂肪变患者BMl分别为（26．89±2．78）、（21．17±2．96）kg／H12，肝脂肪变组BMI高于无肝脂肪变组（t--9．711，P〈0．01）；CHB合并肝脂肪变的男性患者和无肝脂肪变的男性患者的WHR分别为0．93±0．05、0．87±0．06，肝脂肪变组男性患者WHR高于无肝脂肪变组（t=4．469，P〈0．01）。CHB合并肝脂肪变患者与无肝脂肪变患者HBeAg、HBVDNA阳性率的差异无统计学意义（x2=0．334、2．960，均P〉0．05）。CHB合并肝脂肪变患者的肝细胞脂肪变性程度较无肝脂肪变患者重（Z=-16．145，P〈0．01），无肝脂肪变组肝细胞炎症活动度分级和纤维化分期均较肝脂肪变组重（Z值分别=-12．639和-11．242，均P〈0．01）。结论BMI、WHR、FBG、TG、TC是CHB合并肝脂肪变的影响因素，CHB患者肝脂肪变缘于人体学指标及代谢因素的改变，而非HBV作用的结果。针对上述影响因素采取相应措施，可有效防治CHB患者肝脂肪变。

Objective To explore the influencing factors of hepatic steatosis in patients with chronic hepatitis B （CHB）, and to provide a theoretical basis of hepatic steatosis prevention and control. Methods A total of 291 hospitalized CHB patients in affiliated Southeast Hospital of Xiamen University were enrolled and divided into two groups： 132 CHB patients with hepatic steatosis as the case group and 159 CHB patients without hepa＇tic steatosis as the control group. Conducted a case control study and compared the two groups in terms of body mass index （BMI）, waist-to-hip ratio （WHR）, fasting blood glucose （FBG）, triglyceride （TG）, total cholesterol （TC）, aspartate aminotransferase （AST）, gamma-glutamyl transpeptidase （;^-GT）, hepatitis B e antigen （HBeAg）, hepatitis B virus DNA （HBV DNA） by descriptive analysis and inferential statistics to analyze the association of these factors with hepatic steatosis in CHB patients. The histological characteristics of the liver were observed. The date analysis used rank sum test and t test. Results FBG, TG, TC, y-GT, AST of the case group and the control group were （5.11-t-0.62） mmol/L, （1. 814-0.89） mmol/L, （5. 294- 1.05） mmol/L, （65. 044-53.89） U/L, （65. 604-71.52） U/L and （4.94_＋1.89） mmol/L, （1. 214- 0.79） mmol/L, （4. 254-1. 58） mmol/L, （146. 484-200. 39） U/L, （165. 35~180. 57） U/L, respectively. The case group had significantly higher FBG, TG and TC than the control group （Z= 3. 607, 4. 039 and 4. 197, respectively, all P^0.01）, while the control group had significantly higher 7-GT and AST （Z=2. 672 and 3. 020, respectively, both P%0.01）. BMI of the two groups were （26. 894-2.78） kg/m2 and （21.17~2.96） kg/m2 , respectively, higher in the case group （t=9. 711, P%0.01）. WHR in male patients of two groups were 0.93~0.05 and 0. 874-0.06, respectively, higher in male patients of the case group （t=4. 469, P%0.01）. Positive rate of HBeAg, HBV DNA between the case group and the control group hadn＇t significantly difference （X2 =0. 334, 2. 960 both P0.05）. The case group had more severe degree of hepatic steatosis than the control group （Z= --16. 145, P%0.01）, while the inflammatory activity and fibrosis were more advanced in the control group （Z=--12. 639, P〈0.01 Z=--11. 242, P%0.01, respectively）. Conclusions BMI, WHR, FBG, TG and TC appear to be the influencing factors of CHB with hepatic steatosis. The hepatic steatosis in CHB patients is mainly caused by the changes of anthropometric indexes and metabolic factors rather than the effect of HBV. If effective measures are taken, hepatic steatosis in CHB patients can be effectively prevented.