慢性乙型肝炎患者合并代谢综合征的临床特征

Clinical characteristics of chronic hepatitis B patients with metabolic syndrome

目的 探讨CHB合并代谢综合征（MS）患者的临床特征.方法 纳入未接受过抗病毒治疗的CHB患者127例,其中合并MS 45例,未合并MS 82例.比较两组患者的年龄、性别、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、ALT、HBeAg、HBVDNA等指标,分析各项指标与CHB合并MS的关系.对94例患者进行肝脏活组织穿刺检查,其中合并MS组31例,未合并MS组63例.比较两组患者的肝组织学特征.采用t检验和x^2检验进行分析.结果 CHB合并MS组和未合并MS组患者BMI、WHR、TG、TC、FBG分别为（28.88±3.00） kg/m^2、0.93±0.03、（2.77±0.17） mmol/L、（6.51±0.95） mmol/L、（6.67±0.45） mmol/L和（24.64±2.21） kg/m^2、0.91±0.04、（1.50±0.65） mmol/L、（4.38±0.71） mmol/L、（4.91±0.92） mmol/L,合并MS组患者BMI、WHR、TG、TC、FBG均高于未合并MS组（t值分别为9.109、3.245、2.642、3.762和2.586,均P＜0.05）.两组患者年龄、ALT、AST差异均无统计学意义（t值分别为2.224、0.703、0.141,均P＞0.05）;性别、HBeAg及HBV DNA阳性率差异均无统计学意义（x^2值分别为1.662、0.037、0.944,均P＞0.05）.合并MS组炎症活动度分级（G）为G0～G1、G2～G4者分别占48.39％（15/31）和51.61％（16/31）,未合并MS组G0～G1、G2～G4分别占49.21％（31/63）和50.79％（32/63）,两组比较差异无统计学意义（x^2=0.006,P＞0.05）;而合并MS组纤维化分期（S）为S0～S1、S2～S4者分别占32.26％（10/31）和67.74％（21/31）,未合并MS组S0～S1、S2～S4分别占60.32％（38/63）和39.68％（25/63）,两组比较差异有统计学意义（x^2=6.546,P＜0.05）.结论 CHB合并MS患者的BMI、WHR、TG、TC、FBG水平高于未合并MS患者,MS的出现可能会促进CHB患者肝脏纤维化的进展.

Objective To explore the clinical characteristics of chronic hepatitis B patients with metabolic syndrome （MS）.Methods A total of 127 patients with untreated chronic hepatitis B infection were recruited.The patients were divided into two groups according to the diagnosis of MS,with 45 in MS group and 82 in non-MS group.Age,gender,body mass index （BMI）,waist-to-hip ratio （WHR）,fasting blood glucose （FBG）,triglyceride （TG）,total cholesterol （TC）,aspartate aminotransferase （AST）,alanine aminotransferase （ALT）,hepatitis B e antigen （HBeAg）,hepatitis B virus deoxyribonucleic acid （HBV DNA） were compared between groups.Liver biopsy was performed in 94 patients,including 31 in MS group and 63 in non-MS group,to compare the histological characteristics of liver between two groups.A chi-square test and t test were used for the data analysis.Results BMI,WHR,TG,TC,and FBG results of patients in MS group and nonMS group were （28.88±3.00） kg/m^2,0.93±0.03,（2.77±0.17） mmol/L,（6.51±0.95） mmol/L,（6.67±0.45） mmol/L,and （24.64± 2.21） kg/m^2,0.91±0.04,（1.50±0.65） mmol/L,（4.38±0.71） mmol/L,（4.91±0.92） mmol/L,respectively.Patients in MS group had higher BMI,WHR,FBG,TG and TC compared with those in non-MS group （t=9.109,3.245,2.642,3.762 and 2.586,respectively; all P〈0.05）.No statistical significant differences were found in age,ALT or AST between two groups （t=2.224,0.703 and 0.141,respectively; all P〉0.05）.Neither any statistical difference was found in gender,the positive rate of HBeAg and HBV DNA between two groups （x^2 =1.662,0.037 and 0.944,respectively; all P〉0.05）.In inflammation activity comparison,the result of liver biopsy showed that 48.39 % （15/31） were classified as G0-G1 and 51.61%（16/31） as G2-G4 in MS group,and those in non MS group were 49.21%（31/63） and 50.79%（32/63）,respectively.No statistical significance was reached （x^2 =0.006,P〉0.05）.In fibrosis stage comparison,patients in MS group classifies as S0-S1 and S2-S4 were 32.26% （10/31） and 67.74%（21/31）,respectively,and those in non-MS group were 60.32% （38/63）and 39.68% （25/63）,respectively.The liver fibrosis in MS group was significantly more severe than that in non-MS group （x^2 =6.546,P〈0.05）.Conclusions The CHB patients with MS have higher BMI,WHR,FBG,TG and TC.The presence of MS may promote the progress of liver fibrosis in CHB patients.