慢性乙型肝炎患者糖耐量减低的相关性分析及危险因素的筛选

Screening of risk factors and correlation analysis of impaired glucose tolerance in patients with chronic hepatitis B

目的了解慢性乙型肝炎患者糖耐量减低(impaired glucose tolerance,IGT)发生情况及相关因素,IGT与遗传代谢因素、病原学、生化及肝脏组织学损害程度的关系,筛选IGT的危险因素。方法收集199例慢性乙型肝炎患者的临床资料,包括人口学资料、糖尿病家族史、体重指数(body mass index,BMI)、血常规、生化、凝血系列、病理诊断(炎症分级G、纤维化分期S)及口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)。比较正常糖耐量(normal glucose tolerance,NGT)组和IGT组之间的差异;IGT和患者的临床指标、HBV DNA阳性患者HBV DNA载量与临床指标的相关性分析采用Spearman’s法;应用Logistic回归分析筛选发生IGT的危险因素。结果 199例慢乙肝患者行OGTT试验,发生IGT患者29例,占14.6%;NGT组与IGT组之间有统计学意义的指标有:年龄(岁)(29.59±8.50 vs 38.45±10.78,P=0.000)、糖尿病家族史(6.5%vs44.8%,P=0.000)、BMI(kg/m2)(21.14±1.58 vs 22.76±1.60,P=0.000)、TG(mmol/L)(1.50±0.46 vs 2.31±0.77,P=0.000)、ALB(g/L)(42.42±5.54 vs 40.32±4.60,P=0.033)、HBV DNA阳性(81.2%vs 62.1%,P=0.028);与IGT相关有统计学意义的临床指标是:年龄(r=0.350,P=0.000)、糖尿病家族史(r=0.510,P=0.000)、BMI(r=0.417,P=0.000)、TG(r=0.286,P=0.000)、ALB(r=-0.158,P=0.032)和HBV DNA(r=-0.170,P=0.022);在156例HBV DNA阳性的患者中,与HBV DNA相关有统计学意义的临床指标是:年龄(r=-0.232,P=0.002)、HBeAg阳性(r=0.479,P=0.000)、ALT(r=0.210,P=0.005)、Dbil(r=-0.216,P=0.004)和IGT(r=-0.155,P=0.038);Logistic回归分析筛选出发生IGT的独立危险因素是:年龄、糖尿病家族史、BMI和TG。结论慢性乙型肝炎患者发生IGT主要取决于患者的遗传背景、自身因素和代谢特点,HBVDNA、ALB对预测IGT也有一定价值。

[ Objective ] To study the occurrence and related factors of impaired glucose tolerance （IGT）, the rela- tionship between IGT and genetic metabolic factors, etiology, biochemical and histopathology,and screenthe risk fac- tors of IGT in patients with chronic hepatitis B. [Methods] A total of 199 patients with chronic hepatitis B （176 men and 23 women; mean age 32.12 years） were enrolled in the study. Clinical data, including family history of dia- betes, the oral glucose tolerance test （OGT]？）, demographic, anthropometric, family history of diabetes, body mass index （BMI）, histopathology, clinical and laboratory data were obtained from each patient. The prevalence of IGT in patients with chronic hepatitis B received OGTI＇. Clinical data differences were analyzed by the use of the t test or X2 test between the patients with normal glucose tolerance （NGT） and IGT. The correlations were analyzed between IGT and clinical data. HBV DNA and clinical data in patients with HBV DNA positive by the use of the Spearman＇s test. Predictive factors for IGT were evaluated by the use of the multivariate logistic regression analysis. [Results] Out of 199 patients, 29 （14.6%） were diagnosed as aving IGT. The significant differences in the parameters between the patients with NGT and IGT were age （years） （29.59 ± 8.50 vs 38.45 ± 10.78, P =0.000）, family history of diabetes （6.5% vs 44.8%, P =0.000）, BMI （kg/m2） （21 14 ± 1.58 vs 22.76 ±1.60, P =0.000）, TG （mmol/L） （1.50± 0.46 vs 2.31 ± 0.77, P =0.000）, ALB （g/L） （42.42 ± 5.54 vs 40.32 ± 4.60, P =0.033）, HBV DNA positive （81.2% vs62.1%, P =0.028）. The significant differences in the parameters associated with IGT were age （r =0.350, P = 0.000）, family history of diabetes （r =0.510, P =0.（300）, BMI （r =0.417, P =0.000）, TG （r =0.286, P =0.000）, ALB （r =-0.158, P =0.032）, HBVDNA positive （r =-0.170, P =0.022） in 199 patients and associated with HBV DNA were age （r =-0.232, P =0.002）, HBeAg positive （r =0.479, P =0.000）, ALT （r =0.210, P =0.005）, Dbil （r =-0.216, P = 0.004）, IGT （r =-0.155, P =0.038） in 156 HBV DNA positive patients. Multivariate logistic regression analysis showed that independent risk factors for IGT were age, family history of diabetes, BMI and TG. [ Conclusions ] IGT in patients with chronic hepatitis B mostly were contributed by the genetic background, demographic,metabolic characteristics, and partly by HBVDNA and ALB.